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Public Health

Benefits and Challenges of PHSSR

Public health services and systems research (PHSSR) is, according to Mays, Halverson, and Riley in Holsinger’s Contemporary Public Health chapter 6, “the field of inquiry that examines the organization, financing, and delivery of public health at local, state, and national levels, and the impact of these services in population health.” Based on the IOM’s public health functions framework and the 10 essential services of public health, PHSSR might be called “the science of public health delivery”, playing on the phrase championed by World Bank Group’s Jim Yong Kim, in its attempt to identify and define the best evidence-based practices in public health delivery while developing theoretical and analytical frameworks to understand how the variables of public health organization, finance, delivery, and management interact with the peculiarities of the populations being served. PHSSR gets at the difference between efficacy and effectiveness. Intervention research identifies efficacious practices in controlled settings, while PHSSR identifies effective means for implementing the best intervention at the right place, time, population, and degree. It asks, “how do we reduce harm, waste, and inequity, in both practices and outcomes, in public health.”

Currently, evidence identifying what’s most effective or efficient in public health is limited or lacking. There is very little in the way of research-tested guidelines available to practitioners; there are too few decision support tools to inform funding or staffing for public health managers. Most public health-relevant policy (which actually includes most public policies) is based on little more than good intentions, anecdote, or precedent, and often, the input of influential special interests. By identifying what works best, for whom, and why, PHSSR has the potential to magnify, perhaps multiply, the potency of public health practice and to minimize, perhaps dramatically, currently growing social and health disparities.

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