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The Economic, Institutional, and Political Determinants of Public Health Delivery System Structures
Public Health Reports
  • Richard C. Ingram, University of Kentucky
  • F. Douglas Scutchfield, University of Kentucky
  • Glen P. Mays, University of Arkansas
  • Michelyn W. Bhandari, Eastern Kentucky University
Abstract
OBJECTIVES: A typology of local public health systems was recently introduced, and a large degree of structural transformation over time was discovered in the systems analyzed. We present a qualitative exploration of the factors that determine variation and change in the seven structural configurations that comprise the local public health delivery system typology. METHODS: We applied a 10-item semistructured telephone interview protocol to representatives from the local health agency in two randomly selected systems from each configuration--one that had maintained configuration over time and one that had changed configuration over time. We assessed the interviews for patterns of variation between the configurations. RESULTS: Four key determinants of structural change emerged: availability of financial resources, interorganizational relationships, public health agency organization, and political relationships. Systems that had changed were more likely to experience strengthened partnerships between public health agencies and other community organizations and enjoy support from policy makers, while stable systems were more likely to be characterized by strong partnerships between public health agencies and other governmental bodies and less supportive relationships with policy makers. CONCLUSIONS: This research provides information regarding the determinants of system change, and may help public health leaders to better prepare for the impacts of change in the areas discussed. It may also help those who are seeking to implement change to determine the contextual factors that need to be in place before change can happen, or how best to implement change in the face of contextual factors that are beyond their control.
Document Type
Article
Publication Date
3-1-2012
Notes/Citation Information

Published in Public Health Reports, v. 127, no. 2, p. 208-215.

© Copyright 2012 by the Association of Schools of Public Health.

Copyright holder has granted permission to post the article here.

Citation Information
Richard C. Ingram, F. Douglas Scutchfield, Glen P. Mays and Michelyn W. Bhandari. "The Economic, Institutional, and Political Determinants of Public Health Delivery System Structures" Public Health Reports Vol. 127 Iss. 2 (2012) p. 208 - 215
Available at: http://works.bepress.com/f_douglas_scutchfield/44/