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.
Hold on to recent gains. While we need to continue to look for new sources for investment, we need to strongly resist attempts to reallocate funds away from the Prevention Funds established by ACA. Spending on prevention should not be considered health care “waste” and should be spared budget reduction. We must find ways to prevent decimation of state and local governmental public health workforce budgets. This will require strong leadership from the National Prevention Strategy as well as the Population Health group in the CMS Innovation Center.
Support local action. With more attention to local outcomes, emphasis needs to move to local action for population health improvement. There are many public and private demonstration grants in the field, such as the work of the California Endowment and the CDC Community Transformation grants, as well asour own Robert Wood Johnson Foundation funded County Health Roadmaps. We need to learn from these initiatives and bring to scale successful models. An upcoming post will feature the new Roadmaps to Health Prize, which will recognize up to six communities in 2013 that are making progress worthy of emulation – in some cases against tough odds.
With all the daunting issues both here and in the world, I sometimes wonder whether we will be able to assemble the will and resources to show improvement in our health outcomes and disparities. But we aren’t a single issue field. While the multiple determinants of health can sometimes seem to be so broad as to challenge priority setting, they invite – indeed require – working with other partners for a multisectoral solution.
I’m sure 2012 will also bring other unanticipated challenges and opportunities for population health commentary, and you can count on us to be highlighting and critiquing them.
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. Follow him on twitter: @DAKindig.
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