Public health systems: a social networks perspective.
OBJECTIVE
To examine the relationship between public health system network density and organizational centrality in public health systems and public health governance, community size, and health status in three public health domains.


METHODS
During the fall and the winter of 2007-2008, primary data were collected on the organization and composition of eight rural public health systems.


METHODS
Multivariate analysis and network graphical tools are used in a case comparative design to examine public health system network density and organizational centrality in the domains of adolescent health, senior health, and preparedness. Differences associated with public health governance (centralized, decentralized), urbanization (micropolitan, noncore), health status, public health domain, and collaboration area are described.


METHODS
Site visit interviews with key informants from local organizations and a web-based survey administered to local stakeholders.


RESULTS
Governance, urbanization, public health domain, and health status are associated with public health system network structures. The centrality of local health departments (LHDs) varies across public health domains and urbanization. Collaboration is greater in assessment, assurance, and advocacy than in seeking funding.


CONCLUSIONS
If public health system organization is causally related to improved health status, studying individual system components such as LHDs will prove insufficient for studying the impact of public health systems.
Wholey
Douglas R
DR
Division of Health Policy & Management, University of Minnesota, School of Public Health, Minneapolis, MN 55455-0392, USA. Whole001@umn.edu
Gregg
Walter
W
Moscovice
Ira
I
D000293:Adolescent; D000368:Aged; D019058:Community Networks / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D015999:Multivariate Analysis; D011635:Public Health Administration; D015980:Public Health Practice; D012111:Residence Characteristics; D019035:Rural Health Services / Q000458:organization & administration*; D014481:United States
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