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Consideration of an Applied Model of Public Health Program Infrastructure

Lavinghouze, René MA; Snyder, Kimberly MPH; Rieker, Patricia PhD; Ottoson, Judith EdD, MPH

Journal of Public Health Management and Practice: November/December 2013 - Volume 19 - Issue 6 - p E28–E37
doi: 10.1097/PHH.0b013e31828554c8
Original Articles

Systemic infrastructure is key to public health achievements. Individual public health program infrastructure feeds into this larger system. Although program infrastructure is rarely defined, it needs to be operationalized for effective implementation and evaluation. The Ecological Model of Infrastructure (EMI) is one approach to defining program infrastructure. The EMI consists of 5 core (Leadership, Partnerships, State Plans, Engaged Data, and Managed Resources) and 2 supporting (Strategic Understanding and Tactical Action) elements that are enveloped in a program's context. We conducted a literature search across public health programs to determine support for the EMI. Four of the core elements were consistently addressed, and the other EMI elements were intermittently addressed. The EMI provides an initial and partial model for understanding program infrastructure, but additional work is needed to identify evidence-based indicators of infrastructure elements that can be used to measure success and link infrastructure to public health outcomes, capacity, and sustainability.

This article explores applicability of the Ecological Model of Infrastructure to a broader public health program context. It also discusses potential and challenges of the model to its utility.

Office on Smoking and Health, Centers for Disease Control and Prevention (Ms Lavinghouze); ICF International (Ms Snyder), Atlanta, Georgia; Boston University (Dr Rieker); Harvard Medical School (Dr Rieker), Boston, Massachusetts; and San Francisco State University, San Francisco, California (Dr Ottoson).

Correspondence: René Lavinghouze, MA, Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Hwy F-79, Atlanta, GA 30341 (

Ms Snyder was supported through the American Recovery and Reinvestment Act (ARRA) funding (Pub L 111-5)/Centers for Disease Control and Prevention, Communities Putting Prevention to Work Cooperative Agreement DP09-901 (supplement) under contract: Monitoring and Evaluation of the ARRA and ACA Communities and States with ICF International. For the remaining authors no conflicts of interest were declared.

No other authors or persons contributed significant intellectual thought or writing to this article. The findings and conclusions in this article are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.

The authors declare no conflicts of interest.

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.