Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle 98195, USA.
J Public Health Manag Pract. 2012 Mar-Apr;18(2):E1-E10. doi: 10.1097/PHH.0b013e318242d4fc.
The activities that local health departments (LHDs) conduct and their workforce characteristics change over time. We know little, however, about how changes among the services LHDs conduct are associated with the nature of LHD leadership and how these factors impact health. This study investigated changes in LHD services and leadership and how these changes are associated with mortality disparities.
We conducted regression analyses of secondary data using an exploratory panel time series design.
We used secondary data to investigate changes in LHD services and leadership and how these changes were associated with each other and with 1993 to 2005 changes in black-white mortality disparities. Local health department services were examined relative to change in breadth of services within each of 10 program domains between 1993 and 2005. LHD leadership was examined for discipline of the lead executive in 1993 and 2005.
Our sample included 558 county or multicounty "common local areas," representing county-level data for LHDs and their jurisdictions.
Significant beneficial relationships exist between having a clinician as lead executive in an LHD and reductions in black-white mortality disparities. Local health departments with a clinician (usually a nurse or physician) as their lead executive in 1993 and/or 2005 experienced a significant decrease in black-white mortality disparities for young adults (age 15-44 years) in their jurisdictions from 1993 to 2005 when compared with LHDs with nonclinician leaders.
The discipline of an LHD's lead executive as a clinician appears to have a significant relationship with the impact of LHD practice on reducing black-white mortality disparities. This study suggests that the discipline of an LHD's leadership may be an important factor to consider in relation to local public health capacity to impact health disparities. Further research related to the mechanisms at play in these relationships is warranted.
地方卫生部门（LHD）开展的活动及其劳动力特征随时间而变化。然而，我们对 LHD 开展的服务变化如何与 LHD 领导层的性质相关联以及这些因素如何影响健康知之甚少。本研究调查了 LHD 服务和领导层的变化，以及这些变化如何与死亡率差异相关。
我们使用探索性面板时间序列设计对二次数据进行回归分析。
我们使用二次数据来调查 LHD 服务和领导层的变化，以及这些变化如何相互关联，以及 1993 年至 2005 年期间黑人和白人死亡率差异的变化。LHD 服务的变化是相对于每个 10 个计划领域的服务范围在 1993 年至 2005 年之间的变化来检查的。LHD 领导层的变化是针对 1993 年和 2005 年领导执行人员的学科进行检查的。
我们的样本包括 558 个县或多县“常见的地方区域”，代表 LHD 及其管辖范围内的县级数据。
在 LHD 中，领导执行人员为临床医生与减少黑人和白人死亡率差异之间存在显著的有益关系。在 1993 年和/或 2005 年，具有临床医生（通常是护士或医生）作为领导执行人员的 LHD ，与具有非临床医生领导的 LHD 相比，其管辖范围内的年轻成年人（15-44 岁）的黑人和白人死亡率差异在 1993 年至 2005 年间显著下降。
LHD 领导执行人员的学科作为临床医生似乎与 LHD 实践对减少黑人和白人死亡率差异的影响有显著关系。本研究表明，LHD 领导力的纪律可能是与地方公共卫生能力影响健康差异相关的一个重要因素。需要进一步研究这些关系中发挥作用的机制。
