Achieving an effective, efficient, and equitable health system has proven to be an elusive goal for health policy makers in the United States, but the field of health services research (HSR) has become increasingly central in charting the path toward this destination. HSR has evolved in tandem with the information needs of decision makers in government and the private sector, from perennial interests in coverage and cost containment to more recent concerns about quality, safety, and health disparities. Over much of this history, the producers and users of health services research have focused heavily on the production and consumption of medical care, while giving comparatively little attention to another important component of the health system—that of public health services. These services include population-wide efforts to identify and investigate health threats, promote healthy lifestyles, prevent disease and injury, prepare for emergencies and disasters, and assure the quality of water, food, air, and other resources that affect human health (Institute of Medicine, Committee for the Study of the Future of Public Health 1988). The relative paucity of studies on this aspect of health system performance reflects the relatively low priority given to public health practice during the last half of the 20th century.
In recent years, public health has undergone a notable resurgence in visibility among both policy makers and the public at large. Concerns about gaps in the availability and quality of public health services have grown rapidly in response to both new and persistent health risks, including infectious diseases like SARS and pandemic influenza, the threat of bioterrorism, natural disasters like the 2005 Gulf hurricanes, and the rapid advance of obesity and preventable chronic diseases. Since 2001, the federal government has invested >$10 billion in new funds to support public health activities, with a primary focus on helping communities prepare for and respond to large-scale public health emergencies (Trust for America's Health 2006). The increased attention and resources have generated expanded interest in using the concepts and methods of health services research to develop better ways of organizing, financing, and delivering public health services. This emerging focal point within health services research has become known as public health services and systems research (Mays, Halverson, and Scutchfield 2003; Scutchfield et al. 2007;).
Available at: http://works.bepress.com/f_douglas_scutchfield/62/