System approaches in governmental public health: Findings from an analysis of the literature

The U.S. public health enterprise is a complex system of public and private partners, loosely coupled, which work together to improve the public's health. This scoping review utilized peer-reviewed and grey literature to understand systems approaches may be used in the design or enhancement of public health governance structures and service delivery mechanisms. Titles and abstracts were screened against the research question and retained materials were reviewed in full. The final analytic sample included 34 articles from an initial pool of 1128 unique citations that collectively described 25 systems approaches. The findings indicate that few avenues may be present to guide design or enhancement of public health systems when needs arise, such as in response to the COVID-19 pandemic. Scarcity of literature on this topic presents a challenge, and further analytical studies are needed to inform evidence-based systems design strategies and applications.