Public health systems: a social networks perspective.

OBJECTIVE To examine the relationship between public health system network density and organizational centrality in public health systems and public health governance, community size, and health status in three public health domains. DATA SOURCES/STUDY SETTING During the fall and the winter of 2007-2008, primary data were collected on the organization and composition of eight rural public health systems. STUDY DESIGN Multivariate analysis and network graphical tools are used in a case comparative design to examine public health system network density and organizational centrality in the domains of adolescent health, senior health, and preparedness. Differences associated with public health governance (centralized, decentralized), urbanization (micropolitan, noncore), health status, public health domain, and collaboration area are described. DATA COLLECTION/EXTRACTION METHODS Site visit interviews with key informants from local organizations and a web-based survey administered to local stakeholders. PRINCIPAL FINDINGS Governance, urbanization, public health domain, and health status are associated with public health system network structures. The centrality of local health departments (LHDs) varies across public health domains and urbanization. Collaboration is greater in assessment, assurance, and advocacy than in seeking funding. CONCLUSIONS If public health system organization is causally related to improved health status, studying individual system components such as LHDs will prove insufficient for studying the impact of public health systems.