By David A. Kindig, MD, PhD
We regularly scan eleven journals for new studies of particular population health relevance (the list of journals is at the end of this post). A couple of recent papers caught our eye:
Bostic, R. et. al., Health Affairs, 31(9), 2130-2137.
This article reviews the approach that one federal department, the Department of Housing and Urban Development (HUD) has taken in response to recent calls for a health in all policies approach, both by Office of Management and Budget (OMB) and notably in the cross sectoral National Prevention Strategy. The impact of housing on health has been appreciated since the tenement reforms around the turn of the last century. More recently HUD has been active in lead abatement efforts; its1992 Moving to Opportunity for Fair Housing Demonstration used vouchers to move residents out of public housing into more affluent neighborhoods. This project showed positive health impacts, including reductions in psychological distress, depression, and obesity among adults.
The passage of the Affordable Care Act (ACA) advanced health in all policies partnerships such as between HUD and the Department of Health and Human Services (HHS), with collaboration occurring on such projects as the Housing Capacity Building Initiative for Community Living project, providing housing and human services support to older adults or adults with disabilities. These types of partnerships could be very important in coordinating diverse, yet complementary agency interests into promoting improved public health. However, questions remain over the long-term efficacy of such coordination, the cost/benefit ratio of community investments to health savings, and the potential for institutionalization. Such silo busting approaches are extremely hard to achieve, were federal departments to develop and sustain the type of efforts described, the population health impact could be dramatic.
Mechanic R., Altman S., and McDonough J. Health Affairs, September 2012, published online ahead of print.
This blog has often highlighted the importance of health care cost-containment for population health, as increasing costs absorb resources needed in for other non-medical determinants of health. Massachusetts’ healthcare reform in 2006 provided the precursor to the eventual passage of the ACA in 2010, and therefore provides a frame into the long-term implications of such reform policies. Following Massachusetts’ individual mandate in 2006, costs became of upmost importance, because the mandate hinged on state subsidies for purchasing private insurance. The expansion threatened the existence of the program by overwhelming the state public insurance rolls. In response, Massachusetts moved to stiffly regulate insurance premiums and payment systems even prior to the 2012 revision (passed in August), but concern persisted as to whether these measure were sufficient to properly cut costs. The 2012 revision strengthened cost-containment measures, including working directly with providers to monitor and enforce fee limits expanding alternative payment systems, and addressing cost disparities amongst providers. The bipartisan nature of these reforms, long-term commitments, and multiple approaches to cost-containment have valuable lessons for future federal and state policies that seek to achieve similar outcomes under the ACA framework.
I want to acknowledge the assistance of Erik Bakken, BA for his assistance in scanning the literature and drafting this post.
Journals we follow:
American Journal of Preventive Medicine
American Journal of Public Health
Annual Review of Public Health
Health Affairs
Journal of the American Medical Association (JAMA)
Journal of Epidemiology and Community Health
Journal of Health and Social Behavior
Milbank Quarterly
New England Journal of Medicine
Preventing Chronic Disease
Social Science and Medicine
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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