Improving Population Health

La Crosse Medical Health Science Consortium Moves Toward “Super-Integration”

By David A. Kindig, MD, PhD

Last week, I addressed the issue of population health resource allocation. I asked, “Where would you put the money?” and mentioned (among other possible approaches) the concept of a multi-sector “super-integrator” to take the lead in identifying and harnessing resources for population health improvement. I was delighted to hear from reader Catherine Kolkmeier, who directs the La Crosse Medical Health Science Consortium here in Wisconsin. Catherine was intrigued by the super-integrator concept and curious as to my opinion of whether the consortium fits this model.

"Where Would You Put the Money?"

By David A. Kindig, MD, PhD

As regular readers know, I’ve been arguing consistently for the need for a regular, sustainable revenue stream to support population health improvement. However, I’ve not directly addressed the question of how these dollars should be allocated. As one of the authors of the important Evans-Stoddart population field model said in their 2003 AJPH article (Consuming Research, Producing Policy?), “redirecting resources means redirecting someone’s income…most students of population health cannot confidently answer the question…well, where would you put the money?” 

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.

Population Health Eye on Pre-Kindergarten

By Kirstin Q. Siemering, DrPH, RD

Here on the Improving Population Health blog, we recognize the important role that education plays in health outcomes. Earlier this year, David Kindig encouraged business sector investments in early childhood education as a means for improving the health of tomorrow’s workforce. And back in September, our “Eye On Pop Health” series focused on higher education, paying special attention to the need for community college reform.

This month, we’re celebrating the end of one impressive early learning initiative and the start of another. The Pew Center on the States’ ambitious, 10-year Pre-K Now campaign will end on December 31, 2011. The campaign’s goal, which was to advance high quality, voluntary pre-kindergarten for all three- and four-year old, hit many milestones as it worked toward transforming U.S. education from a K-12 system to a Pre-K-12 system. And last Friday, Domestic Policy Council Director Melody Barnes joined Education Secretary Arne Duncan and Health and Human Services Secretary Kathleen Sebelius to announce $500 million in grants to nine state winners of the Race to the Top Early Learning Challenge to spur improvement in early childhood education programs.

Can Leadership Come from within Health Care? Comments on the Triple Aim Regional Strategy…and Mt. Sinai Academic Health Center

By David A. Kindig, MD, PhD

We don’t usually repost the formal comments we get in response to a given blog, but we had several particularly thoughtful ones in response to the Nov 16 Triple Aim: Accelerating and Sustaining Collective Regional Action by John Whittington and I that I wanted to call attention to…as well as a provocative essay from Mt. Sinai Medical Center.

From Pamela Russo: Thank you for the brief history and evolution of the Triple Aim with regards to population health - clarifies and offers great promise. It offers a good model for broader and more collaborative interpretation of how hospital community benefits activities could evolve under the new regulations.

From Mary Lou Andersaen:  At the end of the Clinton administration such a program was funded to provide $1M /year for 5 years to support the development of a small group of communities to develop such systems linking all important sectors. Lessons were learned and a continuing organization called Communities Joined in Action continue that mission struggling without the necessary support to achieve the spreading of the best results. That passion exists right now in this country. Tap into it!

From Robert Stone Newsom:  Interesting approach and glad to see they have the critical element of “funders” in the list. The question as always remains: who are these funders? Whose pocketbook (profits, wages, income) must ultimately be reduced for such population health improvement to occur? All available evidence strongly supports the supposition that neither providers nor private sector insurers have any incentive to reducing their own income and profits for such ‘public good’ funding. Consequently increased taxation is likely the only sustainable approach. However, recent history has demonstrated both the 1% and 99%’s inability and / or unwillingness to meaningfully address the moral hazard inherent in our current healthcare ‘market’ models. In healthcare markets rational self-interest may guarantee that population health continues to be the victim of the tragedy of the commons.

County Health Roadmaps

By Bridget Booske Catlin, PhD, MHSA

Hopefully, by now everyone who reads this blog has heard of the County Health Rankings but I suspect few of you have heard of the County Health Roadmaps. Ranking the health of nearly every county in the nation, the County Health Rankings illustrate what we know when it comes to what’s making people sick or healthy. The new County Health Roadmaps show what we can do to create healthier places to live, learn, work and play. The Robert Wood Johnson Foundation (RWJF) is collaborating with the University of Wisconsin Population Health Institute (UWPHI) to bring this program to cities, counties and states across the nation.

The County Health Roadmaps project includes several efforts to build connections with local communities, national partners and leaders across all sectors to improve health. The project includes grants to coalitions across the U.S. that are working to improve the health of people in their communities; grants to national organizations to mobilize local leaders and affiliates to improve health; a prize program to recognize communities taking action and whose promising efforts will likely lead to better health; and tools and resources to help groups working to improve the health of people in their communities. 

Berwick is Gone: The Collision of Candor and Politics

By David A. Kindig, MD, PhD

We knew it was coming, but I winced when I saw the headline: Medicare and Medicaid Chief, Never Confirmed by Senate, Is Stepping Down. The headline, of course, refers to Don Berwick, who has run this critical agency in the Obama administration since July 2010. He is a highly regarded pediatrician and heath policy expert, and the founder of the Institute for HealthCare Improvement (IHI), a nationally recognized organization that leads efforts to improve health care quality and contain costs. Under his leadership, CMS has released final rules for Accountable Care Organizations’ (ACOs) Medicare Shared Savings Program, developed the Comprehensive Primary Care Initiative, and launched the Health Care Innovation Challenge.

Berwick is resigning because his appointment is an Obama “recess” appointment not requiring Senate confirmation.

Triple Aim: Accelerating and Sustaining Collective Regional Action

By David A. Kindig, MD, PhD and John Whittington, MD

I’ve been following the Institute for Healthcare Improvement’s (IHI) Triple Aim for some time. The IHI was founded in 1991 by Don Berwick and a small group of colleagues who were committed to redesigning health care into a system no longer plagued by errors, waste, delay, and unsustainable social and economic costs. In 2005, IHI created a vision to work on three simultaneous aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. A year ago they embarked on a broader regional health improvement effort at the community level.

While openly enthusiastic about their work, I’ve also offered constrictive criticism -- especially regarding their concept of the Third Aim Population Health, and how robustly the non-health care determinants fit into their model and priorities.

Is There Synergy in Community Development Financing and Population Health?

By David A. Kindig, MD, PhD

It’s been more than a year since I first blogged – with some incredulity – on the first Federal Reserve Healthy Communities Conference.

The Healthy Communities Initiative was created by the Federal Reserve System and the Robert Wood Johnson Foundation to encourage stronger linkages between community development and health. That first meeting, in July 2010, was devoted to building bridges and understanding between two fields with potential for synergy in goals and resources but very little else in common (including language).

This week I attended a follow-up meeting called Healthy Communities: Building Systems to Integrate Community Development and Health. Sponsored by the Federal Reserve Bank of San Francisco, the Robert Wood Johnson Foundation, and the Pew Charitable Trusts, the meeting brought together about 120 leaders from academia, foundations, banking and finance, and the federal government (including the White House, HUD, DOE, DHHS, and EPA).

(How) Does Where You Live Get Under Your Skin?

By David A. Kindig, MD, PhD

Last week Kirstin blogged on an innovative housing project in the South Bronx that incorporated fitness promoting design principles. She cited the Robert Wood Johnson Foundation’s Commission to Build a Healthier America's Issue Brief on Housing and Health which identified three interrelated aspects of residential housing that influence health: (1) affordability, (2) the physical conditions within homes, and (3) neighborhood environments surrounding homes.

Last week there was significant media coverage (including the October 29 Economist!) of an article by Jens Ludwig and colleagues that was featured in the Oct 20 New England Journal of Medicine. The study reported that moving from a high poverty neighborhood to a lower poverty one showed substantial improvement in obesity rates and blood sugar levels. Why was this report deemed of such interest and importance, even by the mainstream press?

Population Health Eye on Affordable and Healthy Housing for All

By Kirstin Q. Siemering, DrPH

This past summer, several news articles called attention to the County Health Rankings’ finding that people who live in urban and suburban environments tend to be healthier than those living in rural areas. The Wall Street Journal and the CBS Early Show should be applauded for calling attention to the fact that of the more than 3,000 counties assessed in the 2011 Rankings, 84% of the unhealthiest were rural while 48% of the healthiest were either urban or suburban. But we need to keep in mind that cities are also home to populations facing enormous health challenges.

The ACA’s Essential Health Benefits: Start Simply, Learn over Time, Make it Better

By John R. Ball, MD, JD

On October 6, the Institute of Medicine released the report Essential Health Benefits: Balancing Coverage and Cost. The report was in response to a request from the Department of Health and Human Services to recommend “criteria and policy foundations” for the Secretary’s determination of the essential health benefits (EHB) required to be offered by qualified health plans participating in the new state health insurance exchanges established by the Patient Protection and Affordable Care Act (ACA).

Early press coverage, which is often the public’s only impression of such reports, pretty much got it right: the report called for a balancing of the comprehensiveness of coverage with the affordability of the benefit package. If cost were not taken into account in constructing benefits, the resulting package would rapidly become unaffordable, frustrating the central intent of the ACA, which was to make health insurance more available to more people. 

Ignoring Evidence and Economics at Our Peril

By David A. Kindig, MD, PhD

Two recent New York Times articles jumped off the page at me. The first, on the recommendation by the U.S. Preventive Services Task Force to forego routine screening for prostate cancer with the PSA test, received wide media coverage. The second, on an Institute of Medicine (IOM) panel recommendation that costs should explicitly be considered in deciding what benefits must be provided by insurance plans, received less attention. Both deserve attention from population health advocates and policy makers.

Do We Need Population Health Shock Therapy?

By David A. Kindig, MD, PhD

I just finished reading Thomas Friedman and Michael Mandelbaum’s new book That Used To Be Us: How America Fell Behind in the World It Invented and How We Can Come Back. It’s a sobering read as it assesses the U.S.’s position in the world and what we have to do to regain lost economic and social competitiveness.

Friedman and Mandelbaum focus on four areas we need to urgently address in order to avoid falling into second world status: globalization, the information technology revolution, deficits and debt, and energy demand and climate change. The authors express particular concern about our education performance, and argue that recent information about relative international test score performance should have prompted a response similar to the investments in science and technology spurred by Sputnik a generation ago. But that hasn’t happened.

HIA: A Practical Tool for Factoring Health into Decision Making Across Sectors

By Pamela Russo, MD, MPH

Staying healthy, whether we’re talking about individuals or populations, is influenced by people’s access to high quality health care and clinical prevention - but there is powerful evidence that staying healthy is more strongly influenced by people’s education, job opportunities, economic status, and the social and physical environmental conditions where they are born, grow, live work, and age. This understanding needs to be conveyed in a useful way to those making decisions on policies, programs and projects in non-health sectors such as transportation, energy production, labor, or education, who rarely consider the consequences of their decisions on factors that influence health. Absent the consideration of effects on human health, we have often unintentionally created conditions that are either hazardous to human health or create barriers for people to adopt and maintain healthy behaviors. How can we convert the evidence on the multiple factors that drive population health into something decision-makers can use to build health into their equations?

Will the Jobs Bill Impact Population Health?

By David A. Kindig, MD, PhD

The last week has seen much attention devoted to the issue of jobs and unemployment in our country. Presidential elections often hinge on the state of the economy and the persistence of high unemployment rates will likely play a greater role in 2012 than in previous periods. While a growing literature shows that displaced workers (defined as individuals who lose their jobs as part of plant closings, mass layoffs, and other firm-level employment reductions) tend to experience significant long-term earnings losses as well as decreased job stability, lower employment rates, earlier retirement, lower personal spending, and decreased health insurance coverage.

In addition to these primarily economic effects, there are likely to be health effects as well. Unemployment (measured as the percent of the population age 16 and over that is unemployed but seeking work) is one of seven key measures in the County Health Rankings’ Social and Economic Factors, but is only briefly mentioned in Healthy People 2020’s new section on the Social Determinants of Health.

Pop Health Twitter Roundup (9/22/11)

The latest and greatest from @PopHealth:

Not happy with the USDA's MyPlate guidelines, Harvard professors came up with their own

Global & Local: Designing Cities with Children in Mind

Michigan's Governor Rick Snyder: "Health is the foundation for Michigan's economic transformation"

Making it in the U.S. -- More than Just Hard Work

Employment prospects for low-qualified people are much dimmer than those for their more highly qualified counterparts

Nourishing NYC: working to eliminate the correlation between obesity and poverty

Claims data from 4 major insurers to become available to researchers through new Health Care Cost Institute

2011 MacArthur Fellow Roland Fryer examines causes and consequences of economic disparity due to race and inequality

Population Health Eye on Community Colleges

By Kirstin Q. Siemering, DrPH

We’ve often discussed the importance of education for population health. An individual’s level of educational attainment is important for ensuring both income and health. The level of education of the workforce in a community is also important for economic growth. In a 2010 Chronicle of Higher Education article, Chairman of the Salt Lake City Chamber of Commerce Mark Bouchard did a “then and now” comparison of how companies approach location decisions. Ten years ago, Bouchard said, the norm was for such efforts to be led by a firm’s real estate committee. These days, leadership is more often than not provided by human resource officials wanting to “know about the quality of the work force.” Since the article was published, this message has only become more relevant – and given the current 9% national unemployment rate, will likely remain so for some time.

While it may seem as if policymakers and advocates focus more on the importance of early childhood education and high school completion than on higher education, a recent and growing spotlight on community colleges has begun to draw attention to the challenges and opportunities of this piece of the puzzle. This past spring, the Brookings-Rockefeller Project on State and Metropolitan Innovation released Community Colleges and Regional Recovery: Strategies for State Action to promote the idea that the time is ripe for states “to maximize their return on every public investment dollar for long-term, sustainable economic growth.” While the report is not framed in population health terms, its message clearly aligns with a population health framework that recognizes social and economic factors as key drivers of health.

Pop Health Twitter Roundup (9/14/11)

The latest and greatest from @PopHealth:

• New from Health Affairs:  "A Decade Of Health Care Cost Growth Has Wiped Out Real Income Gains For An Average US Family"

• Cities versus rural for healthy living

• Massachusetts Lawmaker Introduces Bill To Minimize Disparities In Health Care Prices

• Medicare Chief Donald Berwick turns 65, signs up

• Supporting Health in All Policies: National Research Council gives guidance on use of Health Impact Assessment

• Cross-state partnership creates a win-win for maternal & child health

• Heard about RWJF's new initiative to transform health care?

• New bike share program offering $15/yr memberships for low income residents & free helmet

• U.S. Census reveals current poverty rate highest since 1993

CMS Turns an Ear to Population Health

By David A. Kindig, MD, PhD

Last month I was privileged to be part of a group invited to the federal Center for Medicare and Medicaid Innovation (“Innovation Center”) to discuss population health models and opportunities. Why would the federal agency with the overwhelming job of controlling health care costs and implementing health reform be concerned about this?

The reason is that the Centers for Medicare and Medicaid Services (CMS) is viewing its approach to health improvement through the lens of the Triple Aim, with its Innovation Center being a new engine for revitalizing and sustaining Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) and ultimately, for improving the health care system for all Americans.

Pop Health Twitter Roundup (9/7/11)

The latest and greatest from @PopHealth:

• Families feeling sharp edge of state budget cuts

• NACCHO has released its 2010 National Profile of Local Health Departments

• Colleges increasingly inhospitable to smoking

• Announcing plans for a course on telling the stories of public and population health

• Hoping for Change: Health and Social Disparities Facing Men and Boys of Color

• Coming soon from the National Research Council -- new report on the role of Health Impact Assessment

• New report from TFAH & RWJF -- Remembering 9/11 and Anthrax: Public Health's Vital Role in Nat'l Defense

• F.D.A. to review safety of popular bone drugs

• Food for thought: revive home economics classes to fight obesity?

• Great post on struggles grocery stores find in food deserts

Locally Customized Population Health Policy Packages?

By David A. Kindig, MD, PhD

In my last post I suggested that those who allocate resources must provide ample guidance to ensure that local level health improvement strategies actually align with the best available evidence. I mentioned the University of Wisconsin What Works data base as well as the approach that the previous administration allocated its State Health Improvement Plan (SHIP) resources in the state of Minnesota. But I indicated that What Works is not tailored to individual communities and that the Minnesota example is limited to health behavior interventions, not all population health determinants.

We know from the County Health Rankings and our own experiences that communities vary widely in both their health outcomes and the factors or determinants of those outcomes. There are many examples of both high and low ranking counties which vary on their determinant profile…some have high health care quality and access but poor behaviors, others have high social factors like education and income but poor air and water quality. Given limited resources, it is critical that investments be made carefully to have the most impact.

Would it be helpful to identify a set of Population Health Policy Packages that suggest the best options for local communities to make, given their outcomes and health determinants profile? 

Gone Fishing

Please stay tuned for a new post next week!

Can Policy Models be Helpful to Local Decision Makers?

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?

A Population Health Opportunity Map

By David A. Kindig, MD, PhD

A commentary in the May 25 JAMA by Jonathan Fielding and Steve Teutsch caught my eye a couple of months ago. Both authors play influential roles in national population health policy, from their practice based experiences in the Los Angeles County Department of Public Health.

They begin by arguing that as we reform the health CARE system, complementary improvements are needed in community prevention programs and policies as well. The challenge for both national and local policy makers is to be able to “identify and implement those interventions that provide the greatest benefits and value,” including the relative effectiveness of both clinical and community prevention efforts. They suggest that a first step has to be a sound framework for “identifying and organizing” the universe of interventions which have been shown to have evidence of effectiveness.

Pop Health Twitter Roundup (8/9/11)

The latest and greatest from @PopHealth:

• New article in British Medical Journal uses Health Impact Assessment to analyze urban bicycle sharing program

• First-Ever National Healthy Eating and Physical Activity Standards Developed for Afterschool Programs

• How does education affect your community? Check out the United Way's new Common Good Forecaster to find out

• This fall, all 34,000 Cincinnati Public School students will have daily access to a school salad bar

• NYT "Well": Friendly Workplace Linked to Longer Life

• Ample Harvest is making fresh produce available to more than 4,000 food pantries across the US

• Check out the new Health Wonk Review blog carnival hosted by Joe Paduda at Managed Care Matters

• From Washington Post: Towns change programs, enlarge street signs to adapt to an older population

• Health Leads: Slashing the Price of Health with Common Sense from NYT columnist David Bornstein

• Weight, income, public food programs: A look at how the pounds add up

Population Health Eye on "Total Worker Health" in Lincoln, Nebraska

By Kirstin Q. Siemering, DrPH, RD

Lincoln Industries in Lincoln, Nebraska is the nation’s leading supplier of products requiring high performance metal finishing. The company was established in 1955 and employs over 400 people in an operation that runs 24 hours per day, seven days per week.

The company’s commitment to worker well-being has earned it widespread recognition. Lincoln Industries has been honored by the U.S. Dept. of Health and Human Services, the American Heart Association, Partners for Prevention, and others. The company has also been named one of the “25 Best Medium Companies to Work for in America” by the Great Place to Work Institute.

Pop Health Twitter Roundup (8/2/11)

 The latest and greatest from @PopHealth:

• Separate & Unequal: The Neighborhood Gap for Black, Hispanics, and Asians in Metropolitan America (via US2010 Project)

• Linking transportation policy & health -- new report from Partnership for Prevention

• New from the Commonwealth Fund: The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations

• New Canadian report sees key role for social media: "Communicating the Social Determinants of Health"

• SAMHSA announces new approach to Prevention and Promotion, incl. grants specifically for tribes & tribal communities

• NYT "Fixes" columnist David Bornstein writes about "Treating the Cause, Not the Illness" in his piece on Health Leads

• Environmentalists laud automakers for prioritzing fuel economy as carmakers back strict new rules for gas mileage

• How a park helped one town weather the recession

• UC Berkeley journalism students offer USDA ideas for revamping food labels

• Almost 50% of U.S. health care spending will come from government coffers by 2020 says new report from Health Affairs

Modeling Long Run Population Health Costs and Outcomes

By David A. Kindig, MD, PhD

The broad population health model that underpins this blog and the County Health Rankings must have long-term relevance because quick fixes are few and far between. There is an imperative to invest now in factors we know to be strong drivers of long-term health, such as early childhood interventions (see Can We Afford to Wait for Better Evidence on Improving Child Health? and Business Investment in Early Childhood: Making Future Workers Happier). There is also a need for more research which can better estimate such long-term impacts; the IOM’s recent report on Public Health Measurement and Accountability calls for advancing the use of predictive and system-based simulation models to understand the health consequences of the underlying determinants of health.

One such model does exist, and was reported on in the May 2011 Health Affairs issue on Environmental Health discussed last week. The article, authored by Bobby Milstein, Jack Homer and colleagues, focuses on the HealthBound policy simulation model which has been developed by the CDC over the past decade. This work seems and is ambitious, as any such analytic and projection tool has to be, but it also simplifies the sheer complexity of the U.S. health system into a tractable form that can be understood and studied by diverse stakeholders. It is built on the methodology of systems dynamics modeling, using several hundred interacting elements and differential equations tied to ten national data bases and many key reference studies.

Pop Health Twitter Roundup (7/27/11)

 The latest and greatest from @PopHealth:

• The wealth gap between whites and minorities is at its widest in 25 years

• Academy Health announces new initiative to generate evidence & leverage findings from Beacon Communities

• McDonald's adds choice of fruit or veggies to Happy Meals and reduces french fry portion by 50% (kcals down ~20%)

• Mark Bittman proposes a solution to the Standard American Diet (also see interesting interactive timeline)

• Who are America's poor children? New report examines health disparities by race and ethnicity

• Haven't heard of Health Leads? The Atlantic has a great conversation with CEO (and MacArthur Fellow) Rebecca Onie

• Pop Health win: new Russian law categorizes beer as alcohol (not food)

• Important new study links increased public health spending to reduced mortality

Population Health and the Physical Environment: Beyond Air and Water

By David A. Kindig, MD, PhD

The population health model that underpins the County Health Rankings and this blog group the factors that drive health outcomes into four categories:

• Health Behaviors

• Clinical Care

• Social and Economic Factors

• Physical Environment

While we have discussed many aspects of the first three, we have (so far) focused little attention on the Physical Environment. This is partly justified; our model attributes only 10% of the total factor score to this area. But there is also the sense that environmental issues  – which we all intrinsically recognize as affecting health and quality of life -- often seem a bit remote or beyond our control.

Pop Health Twitter Roundup (7/20/11)

The latest and greatest from @PopHealth

• According to a Gallup poll, 59% of Americans said they support a ban on smoking in all public places

• New Online Platform, likeminded.org, for stories of community change

• The Struggle to Eat: a perspective on the SNAP (formerly Food Stamp) program

• US food companies announce self-imposed regulations that limit calories, sugar, sodium, fat in foods advertised to kids

• New Study Shows Impact of San Francisco’s Health Care Security Ordinance

• Dr. Barbot, Commissioner of Health for Baltimore City, MD, talks Healthy Baltimore 2015 with RWJF's New Public Health

• California smoking rates hit all-time low: 11.9% (it's the 2nd state, after Utah, to reach nat'l target of 12%)

• Pop Health win! WI State Admin reverses course to support applications for federal health grants

• New report from IOM says too many Americans lack access to dental care

• What Google's Cafeterias Can Teach Us About Health (smart labeling, vending machines where healthy food costs less)

• Minnesota Deems Child Care Subsidy Program "Not Critical" During Government Shutdown

Population Health Eye on Food Deserts in Small Town America

By Kirstin Q. Siemering, DrPH, RD

People have been researching food access for at least 50 years, but it has only been since the mid-1990s that this has been framed primarily as a health issue. The term “food desert,” which has gained recognition in recent years, was coined by University of London researcher Steven Cummins to describe places without adequate access to healthy, reasonably priced food.

The United States Department of Agriculture (USDA) was directed by the 2008 Farm Bill to study food deserts throughout the nation. This effort culminated in the 2009 National Academies report, The Public Health Effects of Food Deserts, which concludes with research and policy recommendations. The USDA recently unveiled its food desert locator, which is part of Michelle Obama’s Let’s Move campaign (and a complement to its Food Environment Atlas). Urban areas are taking up the charge to increase residents’ access to healthy foods. Baltimore’s Department of Planning has a Food Policy Director and Food Policy Councils are cropping up across the country (The New York Times’ Mark Bittman recently wrote about food policy organizing in Detroit).

IRS Invites Comments Regarding Community Health Needs Assessments

We recognize the importance of IRS Community Benefit policy as a potential population health improvement tool and so want  to call readers’ attention to the new call for comments on this issue.

From the notice:

This notice addresses the community health needs assessment (“CHNA”) requirements described in section 501(r)(3) of the Internal Revenue Code (“Code”) and related excise tax and reporting obligations, applicable to hospital organizations that are (or seek to be) recognized as described in section 501(c)(3) of the Code…

…Although the CHNA requirements are not effective until taxable years beginning after March 23, 2012, Treasury and the IRS are publishing this notice regarding the CHNA requirements now because they understand that some hospital organizations may choose to start the process of conducting CHNAs and developing implementation strategies in advance of the effective date.

Comments are due September 23, 2011.

Pop Health Twitter Roundup (7/13/11)

The latest and greatest from @PopHealth

• Teaching a new generation of doctors to provide better coordinated, more patient-centered care

• Do businesses have a social responsibility to help make communities healthier?

• Gardeners in one PA community combine their growing power to create a bounty of fresh produce for local food pantries

• City vs. country: who is healthier?

• Better education = Better Health -- Q&A with Steven Woolf

• Health Leads shows that health is more than health care -- Great segment on work in Providence

• Mayo Clinic launches social media community for information and support

• First study of its kind shows that Medicaid benefits the poor

• New CA law requires all public schools to provide free, fresh drinking H2O to students at mealtimes

• RWJF, TFAH release F as in Fat 2011. Where does your state stand?

How Much Prevention "Stuff" Does Wisconsin Need?

By David A. Kindig, MD, PhD

Well, Wisconsin is back in the national news this week, with the refusal of our State Department of Health Services to support $28 million in federal grant applications from organizations like the Milwaukee Health Department for chronic disease prevention programs aimed at smoking and diabetes. The Department Secretary is quoted as saying “Why are we asking for taxpayer money for stuff we are already doing….this is stuff that goes on all the time.”

Perhaps he is wishing he hadn’t said that, because there is no evidence based case that can be made for not increasing our support for such public health and prevention programs. The “stuff” that we have way too much of is not prevention but the high health care costs that result from such chronic diseases. Resolution of federal and state budgets will require effectively addressing this issue; we have to spend much more on prevention to reduce the mortality and morbidity burden that has health care budgets skyrocketing and contributing substantially to the national debt.

Pop Health Twitter Roundup (7/7/11)

The latest and greatest from @PopHealth

• Johns Hopkins U studying whether public health trends can be tracked via Twitter

• New study calculates number of deaths caused by poverty

• Ironic tragedy: motorcyclist crashes, dies, during ride to protest helmet laws in New York

• Worrisome trend -- state preemption of local govts' adopting policies that would improve health in their communities

• State of WI blocks plans to apply for federal health grants

• The socio-economic significance of food deserts

• On the demise of Google Health, Matthew Holt @ Health Care Blog explains need for an independent health data utility

• What would happen to health inequalities if smoking were eliminated?

The IOM Weighs in on Multisector Health Policy

By David A. Kindig, MD, PhD

A few weeks ago I wrote about the first report in the Institute of Medicine For the Public’s Health series on The Role of Measurement in Action and Accountability. The second report, Revitalizing  Law and Policy to Meet New Challenges was released last week. Its overall purpose is to review how statutes and regulations “prevent injury and disease, save lives, and improve the health of populations.” This post will focus on the third chapter, “Intersectoral Action for Health.”

There is growing consensus around the idea that multisectoral solutions are needed to address broad population health challenges.  Various conceptual approaches have been suggested, such as Health Outcome Trusts, Accountable Health Communities (by Sanne Magnan, former Minnesota Commissioner of Health), and my own “Super Integrator” concept. The opportunity for the federal government to coordinate across all departments is also the charge and the promise of the new National Prevention Council. The IOM chapter on intersectoral action provides an excellent and concise summary of the evidence and arguments for such an approach, and includes three important recommendations (the report has nine recommendations altogether):

Pop Health Twitter Roundup (6/29/11)

The latest and greatest from @PopHealth

• NY Times: Concerns about costs rise with hospices’ use

• Geomedicine: Imagine providing physicians with info about social determinants of health

• Across Europe, stifling drivers in favor of mass transit & walking is urban policy

• Did you know the LA School District voted no on flavored milk in schools? This & much more in @RWJFCenter’s weekly update

• Is bicycle commuting an under-appreciated pop health metric?

• Great interview with Austin Frakt on the contribution of blogs to research translation

• MA's new system for cutting healthcare costs not working -- cost disparities not related to quality persist

• Engaging youth in urban planning through a competition on "dream streets"

David Brooks: Pop Health Columnist?

David A. Kindig, MD, PhD

For me, reading David Brooks’ twice weekly New York Times column is a must. Dubbed “the liberals favorite conservative,” Brooks writes from a moderate and evidence based perspective that is almost always illuminating and refreshing.

In his June 13 column titled Pundit Under Protest, he complained about having to cover the upcoming Presidential campaign because “the two parties contesting this election are unusually pathetic. Their programs are unusually unimaginative. Their policies are unusually incommensurate to the problem at hand.”

Brooks said that what the country needs is a political party that “would be offering a multifaceted reinvigoration agenda. It would grab growth ideas from all spots on the political spectrum and blend them together. Its program would be based on the essential political logic: If you want to get anything passed, you have to offer an intertwined package that smashes the Big Government vs. Small Government orthodoxies and gives everybody something they want.”

National Prevention Strategy Released

Last week the Surgeon General and the National Prevention Council released the first National Prevention Strategy report. They are to be congratulated for this since it is a major milestone in the effort to improve population health, and should be required reading for all who share this goal. As this effort unfolds over the coming years, enhancements such as those suggested in this blog will still be required. But for now, let’s read and appreciate the effort to date.

Pop Health Twitter Roundup (6/22/11)

The latest and greatest from @PopHealth:

Jack in the Box will no longer offer toys in kids' meals. Great move -- will others follow suit?

Do personal health technologies contribute to health inequities? Peter Orszag weighs in

A London neighborhood creates a "Fairness Commission" to address public sector income differentials

U.S. Releases Graphic Images to Deter Smokers

A new tool for epidemiologists? Social Media.

New research on Social Security & Health: preventing poverty among seniors linked to declines in mortality

"It’s everyone’s responsibility and everyone’s opportunity" Surgeon General on the National Prevention Strategy

KaBOOM! -- Sparking leadership and unleashing energy within to help communities create places for kids to play

Hospital Community Benefit: An Update on Opportunities and Challenges

By David A. Kindig, MD, PhD

Last summer, I called attention to the IRS request for comments on reporting requirements for non-profit hospitals, which must justify their tax exempt status by providing “community benefit” to the communities they serve. This is a big deal, since having this status amounts to a collective tax savings for these nonprofit hospitals of about $13 billion annually (a 2007 IRS estimate). Stories such as this one in Modern HealthCare highlight the controversial nature of this issue. Last week I attended a conference sponsored by St. Louis University and the Hilltop Institute to review current policy and research perspectives with regard to community benefit.

Pop Health Twitter Roundup (6/14/11)

The latest and greatest from @PopHealth:

New health policy in Ireland to focus on prevention

NY Times coverage on the costs of urban diets and anti-obesity campaigns (with a focus on Louisville, KY)

Hawaii: teacher hooks kids on running – they become “Mighty Milers” and test scores rise

Healthy Food Financing Initiative (HFFI) brings nutritious food to 400,000 through small-scale, local establishments

Study of preschool children shows benefits lasting into adulthood

CDC provides updated FAQs on Community Transformation Grants

Who is HHS Chief Technology Officer Todd Park? Check out this great feature in the Atlantic

Webcasts from the 6/9/11 Health Data Initiative Forum

The Health Care Blog hosts the 6/9/11 edition of the Health Wonk Review

Minnesota Idea Open launches new crowdsourcing competition: CHALLENGE II to address water issues

Population Health Eye on Utah's Wasatch Front

By Kirstin Q. Siemering, DrPH, RD 

When it comes to transportation policy, Utah’s Wasatch Front region is a frontrunner. The Wasatch Front is an urban area in north-central Utah that consists of a chain of cities and towns stretched along the Wasatch Range. Roughly 80% of Utah's population resides in this narrow region, which contains Salt Lake City, Provo and Ogden. With strong leadership, collaboration, and advocacy, the area has become a model for transportation policy to address rapid population growth and development occurring over the last half century.

So what does this have to do with population health?