Department of Health Services Management, University of Kentucky College of Public Health, Lexington, 40536-0003, USA.
Am J Public Health. 2012 Oct;102(10):1936-41. doi: 10.2105/AJPH.2012.300656. Epub 2012 Aug 16.
We explored the association between the legal infrastructure of local public health, as expressed in the exercise of local fiscal and legislative authority, and local population health outcomes. METHODS. Our unit of analysis was public health jurisdictions with at least 100,000 residents. The dependent variable was jurisdiction premature mortality rates obtained from the Mobilize Action Toward Community Health (MATCH) database. Our primary independent variables represented local public health's legal infrastructure: home rule status, board of health power, county government structure, and type of public health delivery system. Several control variables were included. We used a regression model to test the relationship between the varieties of local public health legal infrastructure identified and population health status.
The analyses suggested that public health legal infrastructure, particularly reformed county government, had a significant effect on population health status as a mediator of social determinants of health.
Because states shape the legal infrastructure of local public health through power-sharing arrangements, our findings suggested recommendations for state legislation that positions local public health systems for optimal impact. Much more research is needed to elucidate the complex relationships among law, social capital, and population health status.
我们探究了地方公共卫生法律架构（表现为地方财政和立法权的行使）与地方人口健康结果之间的关联。方法：我们的分析单位是至少有 10 万居民的公共卫生管辖区。因变量是 Mobilize Action Toward Community Health（MATCH）数据库中的管辖区域过早死亡率。我们的主要自变量代表地方公共卫生的法律架构：自治地位、公共卫生委员会权力、县政府结构和公共卫生提供系统类型。纳入了几个控制变量。我们使用回归模型来检验所确定的各种地方公共卫生法律架构与人口健康状况之间的关系。
分析表明，公共卫生法律架构，特别是经改革的县政府，作为健康决定因素的中介，对人口健康状况有显著影响。
由于州通过权力共享安排塑造地方公共卫生的法律架构，我们的研究结果提出了州立法的建议，为地方公共卫生系统的最佳影响做好准备。还需要更多的研究来阐明法律、社会资本和人口健康状况之间的复杂关系。
