2023 Chronic Disease

How Health Departments Can Offer More Programs That Work

Ross Brownson. Washington University in St. Louis Brown School faculty photographed on Thursday, Nov. 11, 2021. (Photo © Whitney Curtis)

As public health departments across the U.S. face increased scrutiny, the Brown School’s Prevention Research Center has partnered with the Brookings Institution in a groundbreaking investigation to identify ways to improve decision making and more effectively use health department resources. The study’s latest findings, published in the American Journal of Preventive Medicine, used information from public health practice and computer modeling to test how various factors influence health department decisions about their programs.

At issue is “misimplementation” – the premature ending of effective activities or the continuation of ineffective programs, which waste resources and result in worse health outcomes.

“It is an extremely important study because up to one-third of public health programs are ended when they should continue or continue when they should have ended,” said Ross Brownson, the Steven H. and Susan U. Lipstein Distinguished Professor and the director of the PRC who was principal investigator for the study. “The agent-based model we created provides actionable ideas to address these issues, which could result in more effective and efficient public health practice.”

The lead author of the agent-based modeling methods and findings paper was Matt Kasman, assistant research director of the Center on Social Dynamics and Policy at the Brookings Institution, which created an animation to explain the model and what was learned. “Our research is the first application of a sophisticated, flexible, methodological approach to this important topic,” he said. The creation of computer simulations was led by Ross Hammond, the Betty Bofinger Brown Distinguished Professor of Public Health at the Brown School. “I think this study is a great example of the potential a partnership between systems science and implementation science can have,” he said. “This is an important growth area for both fields.”

The simulations, based on information the team gathered from a national survey, interviews, and expert public health practitioners, showed that increasing either evidence-based decision-making or information sharing could reduce misimplementation. Shifting leadership priorities to emphasize effectiveness resulted in the largest reduction, while organizational restructuring had little impact. The key takeaway: Focusing decision-making on effectiveness and evaluation information, not how long a program has been in place, can greatly improve program continuation decision-making.

Kasman said the team’s findings are of immediate value. “Empirical evidence from the last decade shows significant room for improvement in effective allocation of resources through continuation decisions made by leadership in state public health departments,” he said. “Our findings point to some concrete, feasible actions that can be taken to do so. Now is an apt time to implement these changes to policy and practice, as state public health departments have recently faced increasing challenges both in terms of the magnitude of the problems that they confront as well as the politicization of their work. We hope that our work will help our public health system prepare for future crises that it will be called upon to confront.” During the team’s interviews, health department managers and staff provided ways health departments can help ensure optimal decision-making based on evidence, and how leaders can help. An evaluation process in place when programs begin helped staff identify and document what wasn’t working and what needed to be adapted or discarded. Participants emphasized the importance of maintaining positive relationships with partners through close communication throughout the process.