Collaborative partnerships between healthcare and non-healthcare entities are crucial for addressing health and social inequities and improving patient outcomes. This study examines the impact of community-level factors on changes in physician participation within local public health systems over time.

Methods

We conducted a retrospective cohort study using the National Survey of Public Health Systems (NALSYS) data. NALSYS collects information on 20 core population health activities aligning with the 3 core functions of public health: assessment, policy development, and assurance and evaluation. Data from 2014, 2016, and 2018 were analyzed to examine trends in physician contributions. Multivariable regression analysis assessed the impact of community-level factors on physician participation.

Principal Findings

Physician participation in public health activities remained consistent from 2014 to 2018 (16%). Assessment activities increased from 21.3% to 24.3%, while assurance and evaluation activities displayed variability, declining from 7.2% in 2014 to 6.9% in 2016, with a slight rebound to 7.0% in 2018. Participation in policy and planning activities remained stable. Rural communities had lower physician participation, with negative associations between uninsured rates and physician engagement in all activity subgroups (p<0.05). Poverty rates and physician contributions varied between rural and urban areas, with a strong positive association observed in rural areas for physician involvement in policy and planning activities (p<0.05). Urban communities showed no statistically significant differences in overall physician contributions.

Conclusion

Significant differences in physician participation exist between urban and rural communities. Strengthening physician involvement in public health activities may enhance access and quality of care.