Miller’s Rule: Improving Public Health Requires Understanding Institutions and Delivery Systems

This week we lost one of the great public health services researchers of the 20th Century in Dr. C. Arden Miller, who died on Sunday after more than a half-century of scientific inquiry to improve population health. His research spanned a wide continuum: vaccine development, reproductive health services, infant mortality, and—for much of the last three decades of his career—public health delivery systems. Miller believed that a key to improving America’s sub-optimal and inequitable health status lies in discovering ways of improving the fragmented and diffuse delivery systems for prevention and public health initiatives. And so early in the 1970s he began using the theories and methods of health services research to study public health institutions and delivery systems, while most of the HSR field focused narrowly on medical care delivery and financing.

Miller’s work provided the foundation for much of the contemporary research on public health delivery and financing, including our national surveys of public health delivery systems and our methods for measuring public health system performance. Indeed, his enthusiasm for this area of inquiry is what attracted me to the PHSSR field as a graduate student from more “mainstream” research interests in health care financing and care management. Methodologically, Miller taught us that one can learn only so much about delivery systems from afar through surveys and administrative data. At some point, one must go down to the factory floor, observe the operations and talk to the people who do the work of producing population health. His comparative case studies of U.S. local health departments (books pictured) and cross-national comparisons of maternal and child health systems (featured in a 1994 New York Times article) are powerful examples of the merits of a mixed-methods approach.

Miller’s long legacy of action-oriented public health research lives on in the work of the many, many researchers and health professionals whom he taught and mentored. Farewell and God Speed Dr. Miller.

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