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Public Health Systems and Services Research
Public health systems and services research (PHSSR) has been defined as: "'a field of study that examines the organization, financing and delivery of public health services in communities, and the impact of these services on public health.'" Traditionally, a great amount of research on issues related to public health practice has focused on the various governmental agencies charged with guarding and promoting the health of communities. PHSSR takes a different approach, and examines issues related to public health through a systems perspective. Thus, it includes not only state, local, and federal governmental public health agencies, but also private and nonprofit agencies that contribute to public health services.

It is thought that adopting a systems perspective may yield a clearer and deeper view of the true impacts of variations in characteristics of public health. The traditional approach of limiting public health research solely to governmental entities does not permit researchers to recognize and analyze the important contributions of private and non-governmental agencies to public health endeavors. For example, some public health agencies may not provide communities with important services such as family planning, due to the politically volatile nature of these services. However, a nonprofit agency such as Planned Parenthood may step in and provide these services to communities. Thus, researchers that examine these communities solely through the perspective of governmental public health agencies will miss the contributions of nonprofits and other organizations to these services, and may develop faulty research as a result.

PHSSR is an offspring of the cross pollination of public health research and health services research (HSR). Beginning as a special interest group at the AcademyHealth the field has emerged over the past decade as scholars and practitioners have used the methods and tools of health services research to answer important questions regarding the organization, financing, delivery and impact of public health activities. Researchers with experience in both fields realize that many of the techniques and models used in, and lessons learned from, HSR can be applied to the public health system. In fact, the naming of PHSSR sprung largely from the desire to relate it to HSR.

The publication of several key documents by the federal government laid the cornerstone for the development of PHSSR. In 1988 the Institute of Medicine report, The Future of Public Health, was published. This laid out a bold agenda that helped shape the growth of the field of public health, and called on agencies and academia to gather data and conduct research that could be used to improve the health of the public. In 1994 the list of 10 Essential Public Health Services was created, and stimulated an ongoing dialogue about the best ways to provide key public health services. Chapter 23 of Healthy People 2010, which lists objectives for the achievement and development of public health infrastructure, stimulated researchers to examine these topics. These documents collectively exposed the need for high quality evidence with which to make decisions about how best to deliver public health services to communities.

Changes and challenges at the state and local level have also helped shape the field of PHSSR. Professional organizations including the Association of State and Territory Health Officials, the National Association of County and City Officials, and the National Association of Local Boards of Health also support PHSSR. These professional organizations provide a forum from which public health practitioners can collect data related to the public health system, collect data relevant to PHSSR, and communicate relevant research questions regarding issues faced by their constituents to the research community.

In 2001, the terrorist attacks on September 11, followed by the anthrax episode brought renewed focus to the importance of public health resources. Questions from the research and professional community following these events exposed many gaps in the existing body of knowledge about public health. For example, research did not yet exist that explored the effect of funding on system performance, even for conditions unrelated to preparedness. The renewed interest in the public health infrastructure brought about by these events, combined with the bold agenda set forth in documents such as Healthy People 2010, and the availability of data from practice organizations, led to the development of public health systems and services research (PHSSR). The continued development of this area is imperative to the success of rebuilding and modernizing public health infrastructure and improving our nation’s health.

Prominent federal agencies such as the US Department for Health and Human Services, (HHS) and the Centers for Disease Control and Prevention (CDC) actively promote, support and utilize PHSSR. For example, the National Public Health Performance Standards Program assessment instruments utilized by the CDC are designed to measure the performance of various aspects of the public health system. CDC also funds research using data collected by these instruments, including research promoted through the National Network of Public Health Institutes and research done by the University of Kentucky Center for Public Health Systems and Services Research (UKCPHSSR) and University of Arkansas for Medical Sciences (UAMS). In addition, the National Libraries of Medicine house a PHSSR subset on the HSRR database  (http://wwwcf.nlm.nih.gov/hsrr_search/index.cfm), which contains information about various research resources with utility for PHSSR.

Nonprofit agencies and private foundations, such as the Robert Wood Johnson Foundation (RWJF) also promote, support and utilize PHSSR. RWJF has been a driving force in the development of the field, by launching a series of activities designed to expand the volume and quality of research on public health systems and services. For example, RWJF offers funding opportunities for PHSSR researchers through avenues such as special topics solicitations in the Changes in Health Care Financing and Organization initiative and young investigator grants administered by the University of Kentucky. In addition, RWJF provides funding for numerous initiatives housed in the UKCPHSSR, as well as joint initiatives between the UKCPHSSR, RWJF, and UAMS such as the Keeneland PHSSR Conference.

PHSSR is a trans-disciplinary field that studies topics related to the following areas, as put forth by The Council on Linkages between Academia and Public Health Practice: organization & structure, finance, workforce, technology, data, and methods. PHSSR draws researchers from a number of areas of inquiry outside of traditional public health, including business and law, and these researchers apply the unique perspectives of their disciplines to examining the public health system. The ultimate purpose of PHSSR is to apply these varying perspectives to the examination of the public health system, and, as a result, to improve the health of the communities and citizens served by the system.

Research Agenda
The National Coordinating Center for Public Health Services and Systems Research (PHSSR) worked with the Robert Wood Johnson Foundation (RWJF), Altarum Institute, and the Centers for Disease Control and Prevention (CDC) to develop the new PHSSR research agenda to guide the future of the field.

The Public Health Workforce

Enumeration Demand, Supply, and Shortages Diversity and Disparities Recruitment and Retention Workforce Competencies Educational Methods and Curricula Public Health System Structure and Performance

System Boundaries and Size Public Health Agency Organization and Governance Interorganizational Relationships and Partnerships Performance Measurement, Quality Improvement, and Accreditation Social Determinants of Health and Health Disparities Public Health Financing and Economics

Fiscal Analysis Financing Mechanisms Costs, Performance, and Outcomes

Public Health Information and Technology

Capabilities to Assess and Monitor Health Outcomes Translation and Dissemination of Research-Tested Public Health Strategies Information and Communication Technologies