Cezar Brian C Mamaril

Hospital Contributions to the Delivery of Public Health Activities in US Metropolitan Areas: National and Longitudinal Trends

OBJECTIVES We investigated changes in hospital participation in local public health systems and the delivery of public health activities over time and assessed the relationship between hospital participation and the scope of activities available in local public health systems. METHODS We used longitudinal observations from the National Longitudinal Survey of Public Health Systems to examine how hospital contributions to the delivery of core public health activities varied in 1998, 2006, and 2012. We then used multivariate regression to assess the relationship between the level of hospital contributions and the overall availability of public health activities in the system. RESULTS Hospital participation in public health activities increased from 37% in 1998 to 41% in 2006 and down to 39% in 2012. Regression results indicated a positive association between hospital participation in public health activities and the total availability of public health services in the systems. CONCLUSIONS Hospital collaboration does play an important role in the overall availability of public health services in local public health systems. Efforts to increase hospital participation in public health may have a positive impact on the scope of services provided and population health in US communities.

Accounting for Natural Disasters: The Impact of Earthquake Risk on California Municipal Bond Pricing

While Katrina has raised awareness of the potential impact of hurricanes on municipalities along the Gulf Coast, it remains unclear if the municipal bond market considers other types of natural disaster risk in other areas. We attempt to fill this gap by conducting an analysis to determine if underlying geologic earthquake risk affects interest costs for municipal bond issuers in California. We find that earthquake risk does matter in determining the interest costs for municipalities issuing debt, but not universally - only for municipal bonds issued after Hurricane Katrina and only in relation to underlying geologic earthquake risk.

Estimating the Cost of Providing Foundational Public Health Services

OBJECTIVE To estimate the cost of resources required to implement a set of Foundational Public Health Services (FPHS) as recommended by the Institute of Medicine. STUDY DESIGN A stochastic simulation model was used to generate probability distributions of input and output costs across 11 FPHS domains. We used an implementation attainment scale to estimate costs of fully implementing FPHS. DATA COLLECTION/EXTRACTION METHODS We use data collected from a diverse cohort of 19 public health agencies located in three states that implemented the FPHS cost estimation methodology in their agencies during 2014-2015. PRINCIPAL FINDINGS The average agency incurred costs of

Evaluating Local Health Department Disease Surveillance and Epidemiologic Investigation

48 per capita implementing FPHS at their current attainment levels with a coefficient of variation (CV) of 16 percent. Achieving full FPHS implementation would require

Preventable Death Rates Fell Where Communities Expanded Population Health Activities Through Multisector Networks

82 per capita (CV=19 percent), indicating an estimated resource gap of

Estimating the Costs of Foundational Public Health Capabilities: A Recommended Methodology

34 per capita. CONCLUSIONS Substantial variation in costs exists across communities in resources currently devoted to implementing FPHS, with even larger variation in resources needed for full attainment. Reducing geographic inequities in FPHS may require novel financing mechanisms and delivery models that allow health agencies to have robust roles within the health system and realize a minimum package of public health services for the nation.

Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities

A general theme is identified from the papers featured in this Frontiers of PHSSR issue by relating it to the evaluation of local health department (LHD) disease surveillance and investigation activities. The discussion focuses on how the studies in this issue contribute to the extant empirical PHSSR literature on disease surveillance and investigation by (1) highlighting the challenges and constraints to LHD preparedness capacity and response; (2) determining the level and variability among LHDs of implementing disease surveillance systems to help address the surveillance input constraints; and (3) considering the various evaluation methods for assessing LHD surveillance and investigation processes and infrastructure.