Longitudinal Changes in Local Public Health Collaboration: Assessing Differences in Governance and Geography.

Abstract

<b>Objectives.</b> To identify factors associated with longitudinal change in multisector collaboration in the delivery of essential public health services in the United States. <b>Methods.</b> We measured correlates of change in the intensity of collaboration in essential public health service delivery using data from the 1998 to 2023 National Longitudinal Survey of Public Health Systems. We used paired <i>t</i> tests to examine changes in collaboration intensity across sectors. We then estimated 2-part models to identify correlates of change in collaboration probability and intensity. <b>Results.</b> Multisector collaborations did not change significantly between 1998 and 2023. Rural jurisdictions were least likely to have expanded their multisector collaborations across this time period, and they did so at a lesser magnitude. Decentralized local public health department governance was associated with an increase in multisector collaboration but only among urban jurisdictions. <b>Conclusions.</b> Urban jurisdictions showed greater multisector collaboration expansion between 1998 and 2023 than their rural counterparts. Rural jurisdictions may face unique challenges to partnership building and collaboration, and these challenges may be exacerbated under decentralized governance structures. (<i>Am J Public Health</i>. 2026;116(S3): S192-S201. https://doi.org/10.2105/AJPH.2026.308536).