Public Health Systems Working Group

 The Public Health Systems Working Group (Systems Working Group) was established in 2007 as a structured venue to facilitate connectivity and interaction among system stakeholders. The Systems Working Group is housed in the Public Health System, Finance, and Quality Program. Emerging from the Systems Working Group should be a synergy to produce, disseminate, and transfer knowledge to strengthen the public health system. The focus of the Systems Working Group is on improving coordination and discussion of system-wide issues that could assist individual participants in their respective offices regarding their areas of responsibility. Given that many HHS offices do not have a research mission or authority, the Systems Working Group will facilitate elevating and communicating the Public Health Systems Research (PHSR) needs of these offices. Also, since state and local issues do impact national interests and risks, activities of the Systems Working Group will periodically incorporate other public and private partners to connect all levels of the system in this effort. Input from participants in the HHS-OMH/RWJF Public Health Systems Research Expert Panel was instrumental with the establishment of the Systems Working Group. The diagram below (Figure 1) represents a series of events that lead to mainstreaming HHS-wide dialogue on the public health system through the Public Health System, Finance, and Quality Program. 

An overarching goal of the Systems Working Group is to improve coordination of HHS-wide public health systems issues. The main outcomes are to promote synergy between system stakeholders that should lead to improved quality and strengthening of the public health system. A method for achieving this is to identify and examine critical system issues of mutual interest across HHS agencies and offices. This will be accomplished through value-adding activities under the following framework:

• Production of Knowledge
• Dissemination and Integration of Knowledge

The practice of public health in the nation is delivered through an intricate system of federal, state, and local governmental agencies and other public and private organizations working to ensure conditions in which the population can be safe and healthy. This enormous operational structure makes understanding the connected dynamic relationships in the system a complex and daunting challenge. The Center for Studying Health System Change noted over a decade ago that the public health sector, unlike the medical care system, had very little measures and research that could be used to examine the system. More recently, discussions under the Public Health Systems Research Expert Panel, lead jointly by the Office of Minority Health (OMH) and the Robert Wood Johnson Foundation (RWJF) have continued to raise awareness about these challenges.

However, a synergistic network structure across HHS where the leadership efforts of multiple offices and agencies could add greater value to ensuring a robust public health system remains uncoordinated.  The Institute of Medicine in 1988 noted governmental public health as the organizational center of public health activities and further recognized the public health knowledge base as the nucleus of what the federal government should promote to ensure an effective system. The Public Health Systems Working Group is accordingly established in HHS as a means of systematically aligning knowledge generation, dissemination, and application efforts to strengthen and add value to all sectors of the public health system.  

Figure 1. Series of national events that lead to the establishment of the Public Health Systems Working Group and Public Health Quality Forum

2006 1^st National Public Health Systems Research Conference

The first national conference on Public Health Systems Research (PHSR) was held in February 2006 as an adjunct meeting to the Academy Health National Health Policy Conference. A national advisory committee that included HHS representation provided advice in designing the conference content. An estimated 125 conference participants were surveyed to compile a list of recommendations on how to advance the developing field of public health systems research.  Many participants recommended that HHS engagement in Public Health Systems Research was essential to advancing the field. Conference organizers were invited to testify before the Senate Subcommittee on Bioterrorism and Public Health Preparedness and that testimony subsequently lead to the inclusion of mandates for Public Health Systems Research in the 2006 Pandemic and All-Hazards Preparedness Act. 

HHS-Office of Minority Health & Robert Wood Johnson Foundation Public Health Systems Research Expert Panel

Garth Graham, MD, MPH, HHS Deputy Assistant Secretary for Minority Health, served as a member of the Public Health Systems Research advisory committee that provided advice on organizing the 1^st national conference. As a result of this engagement, a Public Health Systems Research Expert Panel was established in collaboration with the Robert Wood Johnson Foundation.

The initial Expert Panel meeting was held in February 2007.  Panel members encouraged greater integration across HHS on PHSR in addition to the broader topic of Systems Issues since many HHS offices and programs do not have a research mission or authority.

The follow-up Expert Panel meeting was held in February 2008. Many Panel members expressed a need to focus on improving quality in the public health system.

Public Health Systems Working Group

As a means of facilitating greater connectivity across HHS on system-level public health issues, a Public Health Systems Working Group was established in the Office of Public Health and Science. A major topic of discussion by the group was to examine the Centers for Medicare and Medicaid Services (CMS) National Health Expenditure Accounts (NHEAs).

Public Health Quality Forum

In April 2008, a Public Health Quality Forum was established in response to numerous suggestions for public health quality improvements made in the 2008 Expert Panel meeting.