By David A. Kindig, MD, PhD
Two recent posts have featured population health policy models (see Modeling Long Run Population Health Costs and Outcomes and A Population Health Opportunity Map). Such models will be increasingly important as we strive to effectively allocate resources appropriately across sectors to improve overall health outcomes and improve health equity. But to those in the local trenches, particularly in a time of resource reductions, models may seem abstract and irrelevant. What do we know NOW that can help communities make the best decisions possible in these challenging times? Can top down models or tools be helpful to communities looking for bottom up solutions?
Passion and commitment are absolutely vital to this work, but too often we ignore the evidence, mistake process for product, and wind up squandering resources and our chances of making a real impact. Despite our still incomplete understanding of the evidence, what we do know can play a valuable role in shaping local level action. But giving greater attention to the evidence will require going beyond models; we need practical tools and guidance on which strategies are likely to result in the greatest health gains.
One such tool is the University of Wisconsin Population Health Institute based tool, What Works: Policies and Programs to Improve Wisconsin’s Health. This tool presents evidence of effectiveness for nearly 400 specific programs and policies across all four factors of the County Health Rankings model. While initially intended for use in our state, the underlying evidence is national and global in scope.
But having user-friendly access to the evidence is only one piece of the puzzle – knowledge is necessary but often not sufficient to drive needed action. Extracting the greatest value from our limited resources will take a concerted top down and bottom up effort; we need to foster a better division of responsibility that allows the treetops and grassroots to play to their strengths. Those who allocate resources must provide ample guidance and establish a system of accountability to ensure that local level health improvement strategies actually align with the best available evidence. Rather than being oppressive, such top down structures can assist communities by streamlining decision-making processes and helping them move more quickly to action.
The Minnesota Health Department used such an approach with its $47 million Statewide Health Improvement Program (SHIP). The program awarded 41 grants covering all 87 counties and 9 tribal communities. Proposals required applicants to select from a “Menu of Interventions” that addressed policy, systems, and environmental approaches for three key risk factors (unhealthy eating, physical inactivity, and tobacco use and exposure) in four different settings (schools, communities, worksites, and health care systems). The broadly prescriptive menu served as a guide for what to do, but not how to do it; communities determined how best to implement the strategies they selected. The results are quite promising, as explained in this March 2011 Progress Brief on the program’s first year.
Such an approach makes eminent sense to me. We need top down thinking and guidance combined with bottom up energy and leadership. Do you have other examples of this type of coordination? If so, please let us know as we’d like to draw attention to them on the blog.
David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health.
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