摘要：The Institute of Medicine has recommended that policy decisions about improvement of national public health systems be guided by sound scientific evidence. However, to date there is no national research agenda to help guide public health systems. The Centers for Disease Control and Prevention was called upon to lead a collaborative consensus-based process to define key research questions and establish a framework to create opportunities to better coordinate, leverage, and identify public health resources, which are increasingly scarce. The public health systems research agenda that emerged from this process has 14 overarching priority research themes. This national agenda should stimulate and guide research to meet the urgent need to improve the nation’s public health systems. Centers for Disease Control and Prevention, in collaboration with the Council on Linkages Between Academia and Public Health Practice and other public health systems partners, should develop a research agenda and estimate funding needed to build the evidence base that will guide policymaking for public health practice. —Institute of Medicine 1 (p9) In its 2002 report, the Institute of Medicine (IOM) recommended that an investment be made in developing a research agenda to guide policy decisions that shape public health practice. 1 Similarly, the US Department of Health and Human Services, in Healthy People 2010: Understanding and Improving Health, recognized the need for a strong public health infrastructure that would provide the capacity to prepare for and respond to acute and chronic threats to the nation’s health. Healthy People 2010 developed a series of benchmark indicators for public health infrastructure that calls for a systematic approach to data gathering, analysis, and research. 2 Since the publication of these 2 seminal reports, the pace of change in public health has been accelerating, owing in large measure to the environment resulting from the events of September 11, 2001; newly emerging threats (e.g., severe acute respiratory syndrome [SARS], the obesity epidemic); and dramatic shifts in funding for public health agencies. These new challenges have placed additional strains on already stressed services, programs, and staff. If we are to build the capacity needed to meet the ever-expanding list of threats to the public’s health, it is essential that we first define public health systems, how they function, and what factors contribute to high performance. Mays et al. describe public health systems research as “a field of study that examines the organization, financing, and delivery of public health services within communities, and the impact of these services on public health.” 3 (p180) To date, no public health systems research agenda exists. The relatively new field of public health systems research is related to, but distinct from, more well-established areas such as health services research. It has emerged within the last decade primarily because of the need to better understand how the level of development of national public health infrastructure and the multiplicity of organizational arrangements in public health affect health outcomes. There is still a need to fully investigate the diversity of public health agency structures and functions, how resources are used at the state and local levels, how public health performance can affect health status outcomes, and myriad other issues. Early research and practice-based efforts represent the foundation upon which future research can be conducted. Initial work in public health systems research generally focused on identifying the roles, functions, and resources of public health agencies. 4 – 11 Over time, research expanded beyond agency boundaries to explore partnerships within public health by investigating the concept of a public health system 12 , 13 and by focusing on collaborations between public health and sectors such as medicine 14 and managed care. 15 These activities were catalyzed, in great part, by a series of reports issued by the IOM. The 1988 IOM report urged a stronger focus on exploring and building the governmental public health role, as well as the role of other partners involved in public health. 16 The IOM reiterated this call to action in 1997 17 and again in 2002. 1 Other contributions to public health literature have echoed this need. 18 – 23 Concurrently with researchers, public health practitioners have begun to address these issues in the field; this is evidenced through efforts such as the National Public Health Performance Standards Program 24 and the Turning Point initiative. 25 A public health systems research agenda will be instrumental in catalyzing new research and practice-based initiatives and raising awareness about the importance of such endeavors. A consensus-based research agenda establishes a framework that not only creates opportunities to better coordinate, leverage, and identify resources and activities but also provides the scientific basis for policy decisions affecting our nation’s health. Previous experiences in setting research agenda priorities in behavioral health, 26 clinical preventive services, 27 community design and land-use choices, 28 and public health workforce issues 29 have been taken into account in the process of developing a public health systems research agenda.
