Are Local Public Health Department Services Related to Racial Disparities in Mortality?

Betty Bekemeier,David Grembowski,Youngran Yang,Jerald R Herting

doi:10.1177/2158244014527989

Betty Bekemeier, David Grembowski + Show 2 more

Open Access

https://doi.org/10.1177/2158244014527989

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Abstract

Our study aim was to determine whether local health department (LHD) services were associated with U.S. racial disparities in 1993-to-2005 mortality rates. In a national sample of LHDs, we examined 10 LHD service domains and gaps in Black–White all-cause mortality rates, drawing data from the National Association of County and City Health Officials’ National Profile of Local Health Departments surveys, as well as mortality and other public data files. Two service domains, maternal/child health and other activities, were significantly associated with decreases in the Black–White mortality gap for 15- to 44-year-olds. The health services domain approached significance in decreasing this gap. Screening was associated unexpectedly with a significant increase in the Black–White mortality gap for 15- to 44-year-olds. Selected LHD services that are provided directly to individuals and are allocated by need may have particular benefit for reducing Black–White mortality disparities for U.S. adults aged 15 to 44.

Highlights

An emerging national Public Health Services and Systems Research (PHSSR) agenda in the United States recognizes the crucial role that local public health departments (LHDs) have in reducing disparities in morbidity and mortality in populations (Henry, Scutchfield, & Perez, 2008)
We found that 1993-to-2005 changes in the breadth of services in 10 LHD service domains were not associated with 1993-to2005 changes in Black–White disparities in mortality for all ages
Increases in the breadth of Maternal/Child Health services and Other Activities were each associated with decreases in the Black– White mortality gap for ages 15 to 44

Summary

Introduction

An emerging national Public Health Services and Systems Research (PHSSR) agenda in the United States recognizes the crucial role that local public health departments (LHDs) have in reducing disparities in morbidity and mortality in populations (Henry, Scutchfield, & Perez, 2008). LHDs are the governmental entities expected to conduct populationlevel activities that monitor differential rates of death, disease, and disability, and LHDs address disparities by assuring the availability of appropriate, effective, and accessible resources and services to vulnerable populations by creating healthy living conditions (National Association of County and City Health Officials [NACCHO], 2005b). These resources and services “vary tremendously” among LHDs (Erwin, 2008), have been changing dramatically in recent decades, and involve activities focused on prevention and delivered at a population level, as well as intensive direct services targeting groups at risk In the wake of great change among U.S public health systems and in light of the critical role LHDs are expected to play in reducing health disparities, we know little about the relationship between LHD services and Black–White disparities in mortality (Bombard et al, 2012; Grembowski, Bekemeier, Conrad, & Kreuter, 2010)

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