Improving Population Health

Population Health Financing: Beyond Grants

By David A. Kindig, MD, PhD

My professional coming of age took place the late 1960s, in one of the original Office of Economic Opportunity (OEO) neighborhood health centers in the South Bronx. Because the health centers were a part of the larger federal antipoverty strategy, they were founded on a broad view of health (we would call it a population health framework even though that terminology didn’t exist then). Health care innovation was the core, with community health workers, health care teams, and the understanding that the residents who didn’t use the clinic contributed to overall neighborhood heath as much as those who did.

But the OEO funding paid for much more than health care, including job training, legal advocacy, school health programs, neighborhood built environments – what we now see as the multiple determinants of health. But one of the main lessons of my entire career was the following: when the grant goes away, the programs or innovations which it supported dwindle too. Don’t get me wrong: federal and foundation grants are essential for innovation to occur, and I have served productively on both the giving and receiving ends of this equation. But initial funding almost always ends at some point (through change of political priorities or foundation leadership and priorities), and additional funds must be sought for sustainability or going to scale.

Make Way for Starbucks' Community Stores

By Kirstin Q. Siemering, DrPH, RD

Population health can be a hard sell for the business sector, where the nature of the work has historically meant a focus on profits to the exclusion of most if not all other priorities. Although we applaud the current expansion of worksite wellness programs, we recognize that these efforts represent only a fraction what is needed for broad and lasting change. For broad population health improvement, we need to get beyond individual knowledge and behavior to effect policy and environmental changes that make the healthy choice the easy choice.

As we consider tangible roles for businesses to play in population health improvement, it might be helpful to think of a continuum, with worksite wellness as a starting point. Many potential roles remain unexplored, but we should all take a vested interest in shaping how work on the other end of the spectrum might look.

Community Benefit in the Population Health Literature

By David A. Kindig, MD, PhD

We try to keep this blog accessible and policy relevant, and therefore carefully avoid being overly academic. However, we also regularly follow the literature, which is a challenge given the breadth of multidisciplinary scholarship underpinning the field. So periodically I will point to particularly recent and relevant articles that may be of interest to readers. The list of 11 journals we regularly scan is listed at the bottom of this post. I welcome your flagging for me other journals and articles you suggest we follow. I’m going to start this series by focusing on an article from the December 2011 issue of the American Journal of Public Health.

The Impact of the Individual Mandate and Internal Revenue Service Form 990 Schedule H on Community Benefits from Nonprofit Hospitals by Principe K, Adams EK, Maynard J, and Becker ER.

IPH Reader Craig Mosbaek Weighs in on 2012

We were delighted to have a few takers for our recent call for readers' ideas for what's on the population health radar in 2012. We thought many would appreciate reader Craig Mosbaek's perspective:

By Craig Mosbaek, MPH

Here are six trends I think will have big impacts on public health in the coming year.

The policy approach to public health. The understanding of how policies and environments shape health behaviors and health outcomes will continue to develop.  Elected officials are beginning to appreciate this more, as well as public health professionals and others. You can see this institutionalized in initiatives such as CDC’s Community Transformation Grants, APHA’s new policy contest, and the Public Health Accreditation standards.

Funding for public health departments.  There have already been big budget cuts at many local and state health departments.  With the poor economy, these cuts will persist and there may be major reductions in federal spending on the horizon.  With limited resources, health departments should focus their efforts on the most important public health issues.

Healthcare costs saved by public health efforts. Public health advocates are increasingly using the argument that policies to improve population health will reduce long-term healthcare costs.  More research will focus on the return on investment (ROI) of public health approaches. Effective use of this argument could help alleviate the upcoming budget cuts for health departments.

Broadening the definition of public health. When expanding the definition of public health, some people use terms such as the social determinants of health or health in all policies. We are still working on how to talk about this broadened definition in ways that engage the public and encourage collaboration with other sectors.

Health impact assessments.  A corollary to the above (broadening the definition of public health) is the growing use of health impact assessments  (HIAs).  The PEW site shows about 80 completed HIAs nationwide right now. I wouldn’t be surprised to see 80 more HIAs completed in 2012 alone.

New communications technology. New media (blogs, Facebook, Twitter, video over the Internet) will continue to transform the ways we communicate. This impacts how public health professionals collaborate with each other, as well as how we interact with the public.  

Craig Mosbaek, MPH, President of Mosbaek Consulting, focuses on improving public health policy through communications, research/evaluation, and strategic planning. In 2010, he worked for Congress as the American Public Health Association’s Public Health Fellow in Government.

Population Health Outlook for 2012

By David A. Kindig, MD, PhD

Last week I reflected on Improving Population Health in 2011; today I’m looking forward to the year ahead. So what are the opportunities and challenges that 2012 presents for us?

The fall elections. On the one hand this is a challenge, since health outcomes and health disparities rarely directly enter into the political discussion and debate. Health care costs do, from both political parties, but in a relatively confined way. Rarely do ideas extend beyond the cost savings to examine, for example, how waste could be directed towards non-health care investments. The overwhelming task of implementing the Affordable Care Act (ACA) and defending its legal challenges requires much time and energy and has led some to believe that the current situation necessitates focusing efforts. Perhaps we should work now to consolidate and strengthen health care access and cost issues and – at least for now – have other determinants take a back seat.

Given what we know produces health, such an approach may be appropriate and opportunistic. Access to affordable health care is an important determinant of health, but even with full ACA implementation will not reach everyone. Jobs and economic development are at the top of the political agenda, and many candidates appreciate the role of education in increasing opportunity and economic productivity. Many leading Republicans support such goals. In an unexpected twist the Occupy Wall Street movement has moved the issue of income inequality onto the front page. Influencing candidates of both parties to campaign on strong economic development and education agendas could be the most important thing population health advocates could do this year.

The science of early intervention. Nicholas Kristoff’s recent op-ed, A Poverty Solution that Starts with a Hug summarizes the findings from an American Academy of Pediatrics policy statement in this way: “Cues of a hostile or indifferent environment flood an infant, or even a fetus, with stress hormones like cortisol in ways that can disrupt the body’s metabolism or the architecture of the brains. The upshot is that children are sometimes permanently undermined. Even many years later, as adults, they are more likely to suffer heart disease, diabetes or other physical ailments. They are also more likely to struggle in school, have short tempers, and tangle with the law.” This science is not unknown to scholars, but it is beginning to diffuse into the policy arena (and Kristoff is hardly a science/policy columnist). We need to keep developing more robust findings and facilitate their understanding at all levels of private and public policy.

The Best of 2011 – and an Invitation to Help Shape IPH in 2012

By David A. Kindig, MD, PhD

I don’t usually make formal New Year’s resolutions, but I do think about the passing of the old year and the opportunities and responsibilities in the new one. In that spirit, I’m devoting this week’s post to some key pieces from our 2011 archives.  Next week, we’ll be looking forward to give a preview of possible topics for 2012. We welcome any and all ideas from readers – this is your chance to help shape Improving Population Health in the coming year! Please just use the comment box below or email me directly.

So whether it’s for the first time -- or for a second look -- I invite you to take a look at some of my favorite posts from 2011.