(An item taken from the daily/weekly/monthly ISHN Member information service) The Transforming Public Health project, funded by the Robert Wood Johnson Foundation (RWJF) and convened by RESOLVE, tasked a small group of public health thought leaders with developing guidance for public health officials and policy-makers in prioritizing vital public health functions in a shifting political and fiscal landscape. The resulting document stresses the need for health departments to develop policy goals; use integrated data sets; communicate with the public and other audiences to disseminate and receive information; mobilize the community and forge partnerships; cultivate leadership along with organization, management, and business skills; and protect the public in the event of an emergency. These emerging concepts are intended for consideration by governmental health practitioners to help guide difficult resource allocation decisions while also trying to adapt to ever changing challenges, demands, and opportunities. There is much to agree with in this paper but I want to isolate and debate a key contradiction or competition within the report that dramatically affects how public health systems work with schools. Read More
Here are two excerpts from the report that indicate who public health should be working more closely with in the future. In its primary, opening analysis, the report appears to suggest that public health needs to get closer to the population by going to places or settings where they live, learn, work and play.
"There is growing recognition that where people live, learn, work, and play can be as important to health outcomes as medical intervention. Indeed, improving educational opportunities, assuring stable housing, improving access to healthy foods, and creating walkable communities are public health interventions, and governmental public health departments need to embrace new tools and train or retrain a workforce with new skills in order to lead a “health in all policies” approach that also addresses the social determinants of health"
But in their subsequent discussions of future directions, the authors suggest that public health integrate more closely with the health care sector:
"Building new models that integrate clinical and population health. National efforts to implement health and payment reform create a timely opportunity to connect clinical and population health in ways not previously possible. Governmental health departments may want to consider their role in the promotion, training, and certification of community health workers who may be members of clinical teams, involved in neighborhood-based activities, and/or both. The increased availability of HIT in the clinical setting may also result in enhanced surveillance of the community’s health, for example, aggregating illness reporting data and the determination of chronic disease prevalence"
In my view, such close integration runs the risk that public health will talk about "population health" and "health promotion" but will actually be funded, organized, structured and rewarded for addressing the disease of the month and will continue to send packages and programs to schools to address the latest issue rather than working with the schools to identify the health and social issues of urgent concern to those communities/schools and building an agenda of programs around those concerns. By tying itself more closely to the power structures and professionals concerned with specific diseases, public health will continue to bounce between the disease of the month as they emerge. Instead, the public health system should be structured and rewarded differently, by populations and settings that work with those populations far more closely that public health or health care can ever hope to do. Instead of monitoring specific diseases among individuals (or combinations of these diseases) to measure effectiveness, let's monitor changes in the "health" or health promoting capacity of those settings.
In other words, before public health sets off on a new course, we need to look at the boat which we have built, who is in it with us and who should be in another boat while being part of the same navy.
"There is growing recognition that where people live, learn, work, and play can be as important to health outcomes as medical intervention. Indeed, improving educational opportunities, assuring stable housing, improving access to healthy foods, and creating walkable communities are public health interventions, and governmental public health departments need to embrace new tools and train or retrain a workforce with new skills in order to lead a “health in all policies” approach that also addresses the social determinants of health"
But in their subsequent discussions of future directions, the authors suggest that public health integrate more closely with the health care sector:
"Building new models that integrate clinical and population health. National efforts to implement health and payment reform create a timely opportunity to connect clinical and population health in ways not previously possible. Governmental health departments may want to consider their role in the promotion, training, and certification of community health workers who may be members of clinical teams, involved in neighborhood-based activities, and/or both. The increased availability of HIT in the clinical setting may also result in enhanced surveillance of the community’s health, for example, aggregating illness reporting data and the determination of chronic disease prevalence"
In my view, such close integration runs the risk that public health will talk about "population health" and "health promotion" but will actually be funded, organized, structured and rewarded for addressing the disease of the month and will continue to send packages and programs to schools to address the latest issue rather than working with the schools to identify the health and social issues of urgent concern to those communities/schools and building an agenda of programs around those concerns. By tying itself more closely to the power structures and professionals concerned with specific diseases, public health will continue to bounce between the disease of the month as they emerge. Instead, the public health system should be structured and rewarded differently, by populations and settings that work with those populations far more closely that public health or health care can ever hope to do. Instead of monitoring specific diseases among individuals (or combinations of these diseases) to measure effectiveness, let's monitor changes in the "health" or health promoting capacity of those settings.
In other words, before public health sets off on a new course, we need to look at the boat which we have built, who is in it with us and who should be in another boat while being part of the same navy.
RSS Feed