The impact of the COVID-19 response on the provision of other public health services in the U.S.: A cross sectional study

Introduction Funding and staff formerly dedicated to routine public health tasks (e.g., responding to communicable and non-communicable diseases, investigating foodborne outbreaks, conducting routine surveillance) and services (e.g., environmental health, substance abuse, maternal-child health) may no longer be available in many public health departments due to the COVID-19 response. The objective of this study was to assess the extent to which staffing for essential public health services has been redirected to the COVID-19 response. Materials and methods This is a cross-sectional study using a survey distributed through the Qualtrics platform. Individuals (N = 298) working in public health across governmental and academic public health departments in the U.S. during the ongoing COVID-19 pandemic response were surveyed. Survey items measured multiple domains including professional experience (i.e., training, years of experience, content expertise, job functions, hours worked), mental and physical health status (i.e., generalized anxiety, depression, burnout), and career plans (i.e., pre-pandemic vs. current career plans). Results The total number of content expertise areas and programmatic functions covered by individual public health workers increased between January and September of 2020, with 26% (73 of 282) of respondents reporting an increase in both. The total number of respondents working in infectious disease and preparedness remained constant, while declines were reported in program evaluation (-36%) and health education (-27%) and increases were reported in disease investigation (+35%). Conclusions The provision of many essential public health functions and tasks have been limited or eliminated while the U.S. public health workforce responds to the COVID-19 pandemic. These findings highlight opportunities for funding and professional development of public health systems, both during and after the COVID-19 response, to help ensure the continuity of essential public health services, staffing sustainability, and preparedness for future public health emergencies in the U.S.

Quantifying Disaster Impacts on Local Public Health Agency’s Leadership, Staffing, and Provision of Essential Public Health Services

Objective: The objective of this study is to assess the impact that natural disaster response has on local health departments’ (LHD) ability to continue to provide essential public health services. Methods: A web-based survey was sent to all North Carolina Local Health Directors. The survey asked respondents to report on LHD functioning following Hurricanes Florence (2018) and Dorian (2019). Results: After Hurricane Florence, the positions who most frequently had regular duties postponed or interrupted were leadership (15 of 48; 31.3%), and professional staff (e.g., nursing and epidemiology: 11 of 48; 22.9%). Staffing shelters for all phases – from disaster response through long-term recovery – was identified as a burden by LHDs, particularly for nursing staff. Approximately 66.6% of LHD jurisdictions opened an Emergency Operations Center (EOC) or activated Incident Command System in response to both hurricanes. If an EOC was activated, the LHD was statistically, significantly more likely to report that normal duties had been interrupted across every domain assessed. Conclusions: The ability of LHDs to perform regular activities and provide essential public health services is impacted by their obligations to support disaster response. Better metrics are needed to measure the impacts to estimate indirect public health impacts of disasters.

Influence of National Essential Public Health Services Policy on Expenditure for Hypertension in China: A Difference-in-Difference Analysis

Background: The prevention and control of hypertension should be an effective way to reduce deaths and it has been a high priority in China. The Chinese government issued the National Essential Public Health Services Package (NEPHSP) in 2009; this initiative provides free public health services to meet the challenges posed by hypertension. It includes health education, regular health checkups, and regular follow-ups provided to patients with hypertension aged ≥ 35. This study explored the influence of the NEPHSP on outpatient and inpatient expenditure among patients with hypertension. Methods: Data were mined from the 2011–2015 Harmonized China Health and Retirement Longitudinal Study. The dependent variables were the outpatient and inpatient expenditure of patients with hypertension. The independent variable was defined as whether covered by the NEPHSP in 2013 or 2015. Using propensity score matching (PSM) to match the individual characteristics of hypertension in the NEPHSP-covered group and the NEPHSP-uncovered group, Tobit regression models with difference-in-differences (DID) were used to analyze the outcomes. Results: After PSM, of the 1,956 hypertensive participants, 369 had physical exams covered by the NEPHSP in 2013 and 2015. In 2013 and 2015, the outpatient and inpatient expenses of patients with hypertension increased compared with 2011. A DID estimate for the NEPHSP-covered service was associated with a marginal significant decrease of RMB 319.79 (p = 0.586) and RMB 1072.02 (p = 0.068) in hypertension inpatient expected expenditure in 2013 and 2015, respectively. The DID estimate showed no significant change among outpatient expected expenditure. Conclusions: The NEPHSP may reduce inpatient expenditure among patients with hypertension. Further strengthening of the NEPHSP may reduce their burden.

The Technical Efficiency of Essential Public Health Services Provision in China: Based on a Panel Data Analysis

BackgroundProviding essential public health services equally to all Chinese is one of the objectives of health system reform since 2009. Essential public health service program is to provide a package of public health services for all Chinese freely by the primary health institutions. Since the implementation of the national essential public health service program, the level of funding and the intensity of input have been continuously increasing. However, in the context of China’s economic development entering a new normal phase, the growth rate of funding for essential public health services has far exceeded the growth rate of GDP and central fiscal revenue, and the sustainability of the development of national essential public health service programs has been seriously challenged. Improving the efficiency of resource use may be an effective way to ensure the continuation of the national essential public health service program. But little evidence was available about technical efficiency in essential public health services provision. Therefore, the aim of this study was to assess the technical efficiency of essential public health services in Shandong province.Methods This study was a retrospective study based on the historical panel data of Shandong Province, East China. The data came from the Shandong Provincial Essential public health Service Program Database of the Medical Management Center of Shandong Provincial Health Commission, which covered all 137 counties and districts in 16 cities of Shandong Province from 2014 to 2019. The principal component analysis method was used to classify multiple output indicators of essential public health service programs, so as to achieve the purpose of generic index extraction. The efficiency coefficient transformation analysis method was used to transform the data of each principal component score after the principal component analysis of the input index of essential public health service programs. The CCR model and BBC model in the Data Envelopment Analysis （DEA） method were used to calculate the comprehensive technical efficiency, pure technical efficiency and scale efficiency of essential public health services.ResultsThe average comprehensive technical efficiency of essential public health services in Shandong Province showed a slight downward trend from 0.8896 in 2014 to 0.8753 in 2019. The average pure technical efficiency of essential public health services was kept at 0.99. The average scale efficiency of essential public health services showed a slight downward trend from 0.8871 in 2014 to 0.8744 in 2019. The proportion of counties and districts with the comprehensive technical efficiency of essential public health services in Shandong Province was increased from 15.3% in 2014 to 21.9% in 2019. But the proportion of counties with the pure technical efficiency decreased from 38.0% in 2014 to 35.9% in 2019. The proportion of counties with scale efficiency of essential public health services showed an upward trend, rising from 14.8% in 2014 to 22.6% in 2019, increasing by 7.8%.The ratio of effective comprehensive technical efficiency of essential public health services in Shandong Province to all counties and districts has shown a upward trend. Among them, the proportion of counties with effective pure technical efficiency was higher than the proportion of counties with efficient scale efficiency each year. At the same time, the increase in the proportion of counties with effective scale efficiency was higher than the increase in the proportion of counties with effective pure technical efficiency. The increasing proportion of effective counties in the comprehensive technical efficiency of essential public health services in Shandong Province was mainly due to the increasing proportion of effective counties in the scale efficiency and the good performance of effective counties in the pure technical efficiency. This showed that, although the investment scale of Shandong Province in the counties was gradually sufficient, there was still a phenomenon of insufficient resource investment in most counties. That would ultimately affect the sustainability of the implementation of essential public health services.Conclusion The research have demonstrated that the technical efficiency of essential public health services in Shandong Province has shown a slight downward trend, and the main reason for its downward trend was the decline in scale efficiency. The scale efficiency in essential public health services affected the technical efficiency and would ultimately threaten the sustainable development of essential public health services. It is recommended that future research directions should focus on the influencing factors and improvement measures of the scale efficiency of essential public health services.

Building a resilient public health system for international migrant workers: a case study and policy brief for COVID-19 and beyond

PurposeThis article analyzes deficiencies in public health services for international migrant workers (IMWs) during the COVID-19 pandemic and provides a policy brief for improvement of the public health system.Design/methodology/approachA COVID-19 outbreak that initially clustered in IMWs and further contributed to the resurgence of the disease across Thailand in December 2020 was analyzed to address the deficiencies in public health services based on the framework of the 10 Essential Public Health Services (EPHS). The EPHS framework was also applied to develop policy options and recommendations in the subsequent policy brief.FindingsThis outbreak unveiled unique challenges that make IMWs more vulnerable to COVID-19. The public health system, challenged by the COVID-19 outbreak among IMWs, manifested deficiencies in the planning and implementation of all essential services. Delayed detection of the outbreak along with the lack of policy accommodating undocumented IMWs and the lack of equitable access to testing and treatment for COVID-19 resulted in the transmission of the disease that harmed the public at large.Originality/valueThe comprehensive analysis of the deficiencies in public health services for IMWs enabled a clear description of problems that could be further prioritized by relevant stakeholders. The policy brief provides policymakers with evidence-based recommendations for improving public health services for IMWs during the COVID-19 pandemic and beyond.

Does economic development widen or narrow the gap of public health service utilization among different subgroups of internal migrants? Evidence from the China Migrant Dynamic Survey in 2017

Background: China is promoting the equalization of National Essential Public Health Services (NEPHS) for the internal migrants (IMs). Studies have analyzed the impact of migration range (MR) and regional economic development level (REDL) on the IMs' NEPHS utilization (NEPHSU), but no studies have explored the interaction of MR and REDL on it.Methods: Data from the China Migrant Dynamic Survey of 2017, involving 122656 IMs. Per capita GDP was set as the indicator for REDL, and 28 provinces were divided into three groups according to REDL: affluent, medium and poor. The MR was divided into inter-province and intra-province, and social capital (SC) was distinguished into cognitive (CSC) and structural social capital (SSC). Awareness of NEPHS (ANEPHS) and establishment of health record (EHR) were selected as indexes of NEPHSU. Multiple line charts and hierarchical logistic regression were used to investigate the interaction of MR, REDL and SC on NEPHSU.Results: (1) The socioeconomic status (SES) and social capital (SC) of inter-provincial IMs were significantly lower than those of intra-provincial IMs, and the gap was most prominent in affluent areas. (2) From low to high, the NEPHSU of inter-provincial IMs was ranked as affluent, medium and poor, while the corresponding order of intra-provincial IMs was medium, poor and affluent areas, and the gap of NEPHSU between inter-provincial and intra-provincial IMs was the largest in affluent areas. (3) SC could significantly promote the IMs' NEPHSU, but there was a gap between inter-provincial and intra-provincial IMs, and the gap was the largest in affluent areas.Conclution: REDL can significantly affect the gaps of SES and SC among subgroups of IMs with different MR. Inter-provincial migrants in affluent areas have relatively lower SES and SC, which may be a major barrier to their access to NEPHS, and the government should pay special attention to this vulnerable group when promoting equalization of NEPHS for IMs.

U.S. COVID-19 State Government Public Dashboards: An Expert Review

Background In the United States, all 50 state governments deployed publicly viewable dashboards regarding the novel coronavirus disease 2019 (COVID-19) to track and respond to the pandemic. States dashboards, however, reflect idiosyncratic design practices based on their content, function, and visual design and platform. There has been little guidance for what state dashboards should look like or contain, leading to significant variation. Objectives The primary objective of our study was to catalog how information, system function, and user interface were deployed across the COVID-19 state dashboards. Our secondary objective was to group and characterize the dashboards based on the information we collected using clustering analysis. Methods For preliminary data collection, we developed a framework to first analyze two dashboards as a group and reach agreement on coding. We subsequently doubled coded the remaining 48 dashboards using the framework and reviewed the coding to reach total consensus. Results All state dashboards included maps and graphs, most frequently line charts, bar charts, and histograms. The most represented metrics were total deaths, total cases, new cases, laboratory tests, and hospitalization. Decisions on how metrics were aggregated and stratified greatly varied across dashboards. Overall, the dashboards were very interactive with 96% having at least some functionality including tooltips, zooming, or exporting capabilities. For visual design and platform, we noted that the software was dominated by a few major organizations. Our cluster analysis yielded a six-cluster solution, and each cluster provided additional insights about how groups of states engaged in specific practices in dashboard design. Conclusion Our study indicates that states engaged in dashboard practices that generally aligned with many of the goals set forth by the Centers for Disease Control and Prevention, Essential Public Health Services. We highlight areas where states fall short of these expectations and provide specific design recommendations to address these gaps.