title: Local public health system performance and community health outcomes.
abstract: BACKGROUND
  Public health systems are charged with protecting the health and well-being of the communities they serve. Higher-performing public health systems should be associated with improved community health status. Currently, little research examines the impact of variations in public health system performance on community health outcomes.
  
  
  OBJECTIVE
  The current study seeks to provide local public health system partners with evidence regarding the impact of their efforts. It does so through examining the relationship between variations in local public health system performance in providing the core functions of public health (assessment, assurance, and policy development) and community health outcomes.
  
  
  METHODS
  Measures of community health status (dependent variables) and community demographic characteristics, collected from 1994 to 2003, were merged with measures of public health system performance collected from 2002 to 2007 (independent variables). For each dependent variable, Pearson correlations were calculated with all of the independent variables. Multivariate linear regression models were developed for each health outcome. Analysis was completed in 2010.
  
  
  RESULTS
  Bivariate analysis found nine associations between local public health system performance and health outcomes. Linear regression models found associations between performance and three of the six outcomes measured. The outcomes associated with performance are those that would seem to be most sensitive to variations in practice. Poverty is significantly associated with all the health outcomes measured.
  
  
  CONCLUSIONS
  These associations between performance and health outcomes suggest that improving performance of the core functions of public health may improve health.
authors.affiliation: Department of Health Services Management, University of Kentucky College of Public Health, Lexington, Kentucky, USA. rcingr2@uky.edu
authors.forename: Richard C
authors.initials: RC
authors.lastname: Ingram
authors.forename: F Douglas
authors.initials: FD
authors.lastname: Scutchfield
authors.forename: Richard
authors.initials: R
authors.lastname: Charnigo
authors.forename: Martha C
authors.initials: MC
authors.lastname: Riddell
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D006291:Health Policy; D006304:Health Status; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011203:Poverty / Q000706:statistics & numerical data; D015980:Public Health Practice / Q000592:standards*