Defining public health systems: A critical interpretive synthesis of how public health systems are defined and classified.

Abstract

Background: With recent emphasis on creating a stronger, more patient-centred, health system in Ontario, there remains no clear definition of a “public health” system, hindering the ability to integrate preventive public health and health care practices. This study aims to describe public health systems and initiate a research agenda for this field.

Methods: A critical interpretive synthesis of the literature was conducted using six electronic databases. In addition, data extraction, coding and analysis followed a best-fit framework analysis method. Initial codes were based on two current leading health systems and policy classification schemes: health systems arrangements (based on governance, financial and delivery arrangements) and the 3I+E framework for health policy formulation (institutions, interests, ideas and external factors). New codes were developed as guided by the data. A constant comparative method was used to develop concepts and to further link these into themes. Additional documents were identified to fill conceptual gaps.

Results: 5,933 unique documents were identified and 338 documents met the inclusion criteria. 81 documents were purposively sampled for full-text review and 58 of these were included in this study. Nine documents were found to help fill conceptual gaps. Generally, public health systems can be defined using traditional healthcare systems and policy frameworks. There was also a strong emphasis on identifying and standardizing the roles and functions of public health. Partnerships (community and multi-sectoral) are common features within and between components of public health systems. A public health system framework and a model of a population health system were conceptualized.

Discussion: Understanding public health systems can help strengthen these systems and further integrate preventive public health and primary care services. Systems are influenced by organizational and contextual factors that need to be explored to improve population health. A research agenda is proposed to move this field forward.