Mays Glen P, Hogg Rachel A
Glen P. Mays is with the Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington. At the time of this study, Rachel A. Hogg was with the National Coordinating Center for Public Health Services and Systems Research, College of Public Health, University of Kentucky, Lexington. Glen P. Mays is also a guest editor for this supplement issue.
Am J Public Health. 2015 Apr;105 Suppl 2(Suppl 2):S280-7. doi: 10.2105/AJPH.2014.302456. Epub 2015 Feb 17.
We examined public health system responses to economic shocks using longitudinal observations of public health activities implemented in US metropolitan areas from 1998 to 2012.
The National Longitudinal Survey of Public Health Systems collected data on the implementation of 20 core public health activities in a nationally representative cohort of 280 metropolitan areas in 1998, 2006, and 2012. We used generalized estimating equations to estimate how local economic shocks relate to the scope of activities implemented in communities, the mix of organizations performing them, and perceptions of the effectiveness of activities.
Public health activities fell by nearly 5% in the average community between 2006 and 2012, with the bottom quintile of communities losing nearly 25% of their activities. Local public health delivery fell most sharply among communities experiencing the largest increases in unemployment and the largest reductions in governmental public health spending.
Federal resources and private sector contributions failed to avert reductions in local public health protections during the recession. New financing mechanisms may be necessary to ensure equitable public health protections during economic downturns.
我们利用1998年至2012年在美国大都市地区开展的公共卫生活动的纵向观察数据，研究了公共卫生系统对经济冲击的应对措施。
国家公共卫生系统纵向调查收集了1998年、2006年和2012年全国280个具有代表性的大都市地区队列中20项核心公共卫生活动的实施数据。我们使用广义估计方程来估计当地经济冲击如何与社区开展的活动范围、开展这些活动的组织组合以及对活动有效性的认知相关。
2006年至2012年期间，平均每个社区的公共卫生活动减少了近5%，最底层的五分之一社区的活动减少了近25%。在失业率上升幅度最大且政府公共卫生支出削减幅度最大的社区中，地方公共卫生服务的下降最为明显。
在经济衰退期间，联邦资源和私营部门的贡献未能避免地方公共卫生保护措施的减少。可能需要新的融资机制来确保在经济低迷时期实现公平的公共卫生保护。
