Academic journal article Australian Health Review

Public Health Systems Research: The State of the Field

Academic journal article Australian Health Review

Public Health Systems Research: The State of the Field

Article excerpt

Abstract

Public health infrastructure provides the building blocks required for the system to achieve public health goals. A systems approach to public health has been suggested as a means to tackle persistent and emerging problems. Systems and infrastructure are attracting increased research attention. A review of the Australian and international literature suggests an absence of empirical evidence about how the system and its component parts does, or should, work and highlights some of the difficulties associated with generating such evidence. It also indicates there is significant scope for further research.

Aust Health Rev 2008: 32(4): 721-732

IF PUBLIC HEALTH is "the organised response by society to protect and promote health, and to prevent illness, injury and disability",1 then the public health system is the structure by which this is attempted. Without a "system" there can be no "organised response". Lenihan claims that "the notion of the public health system is one of the most important concepts to emerge in public health thinking in the past 20 years".2 (p. 165) He argues that taking a systems approach will provide opportunities to tackle persistent and emerging issues in population health. This approach requires research knowledge about the system and its component parts. Many commentators date research interest in public health systems and infrastructure from the publication of the Institute of Medicine (IOM) report on the status of public health in the United States, two decades ago.3 There, public health infrastructure has been defined as "systems, competencies, relationships, and resources that enable performance of the ten Essential Services".4 (p. 46) In Australia, the National Public Health Partnership (NPHP) describes infrastructure as the "building blocks necessary to accomplish the activities of health protection, illness prevention and health promotion".5

The performance of the public health system relies on the strength of its infrastructure and the transformational power of its capacity. Attempting to make judgements about the type and level of infrastructure and capacity required to assure a high performing public health system highlights a number of gaps in our knowledge about that system. These include: what public health is and what it does; optimal ways in which public health should be organised and staffed; how the system could best be resourced; and how success in public health might be measured. These are issues addressed through public health systems research.

Wilson asks, "What capacity should the Australian public health system have to effectively respond to known and emerging public health challenges?".6 (foreword) These questions can only be answered through public health systems research. Public health systems research (PHSR) is an emerging field; a subset of health services research (HSR) which examines how public health is organised and delivered, how it is financed and what impact it has on the health of populations.7

Without research which specifies the adequacy of public health infrastructure and capacity, it is difficult to argue for, and to make, decisions about what investments and other policies are needed. There is need, therefore, to take stock of PHSR. This article outlines some of what is known from PHSR in Australia and internationally, and identifies where there are knowledge gaps.

Methods

This review began by mapping out the potential areas of interest to identify search terms and possible data sources. The literature was searched using the major computerised databases - Proquest/ABI Inform, CINAHL, and MEDLINE. It was necessary to search broadly using combinations of keywords such as "public health", "systems research" and "services research", and then more narrowly using search words such as governance, financing/funding, workforce and workforce development, planning, and leadership. Web-based information such as the E-News from the Public Health Foundation provided alerts to newly published material that might be of relevance. …

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