As the nation’s local public health departments begin to consider what Public Health 3.0 (PH3.0) will mean for their missions in addressing the full range of factors that influence a person’s overall health and well-being — in short, the social determinants of health — NACCHO recommends taking a comprehensive approach to create sustainable, lasting improvements for the health of all U.S. communities.
Public Health 3.0, an initiative of the U.S. Department of Health and Human Services (HHS), emphasizes collaborative environmental, policy, and systems-level actions that directly affect the social determinants of health inequity. It represents a challenge to business leaders, community leaders, state lawmakers, and federal policymakers to incorporate health into all areas of governance to address health disparities.
The report, Public Health 3.0: A call to Action to Create a 21st Century Public Health Infrastructure, also highlights five cities and counties across the U.S. that are making innovative changes in their communities with their approaches to comprehensive public health. What these have in common is:
- Cultivating strong leadership and workforce, and building a strong workforce pipeline;
- Creating a mission-driven, collaborative infrastructure, and one that may go through the rigorous accreditation process to assess capacity;
- Leading for collective impact by developing cross-sector partnerships;
- Thinking creatively to seize opportunities for growth, and recruiting people who have skills, training, or education that are not traditional in the public health field including community advocates, community organizers, and communications professionals;
- Forging partnerships with non-traditional collaborators, including universities and business mentorship programs; and,
- Addressing data gaps, and making more raw, de-identified data available to researchers and the community.
Why Now?
When Dr. Karen DeSalvo, acting assistant secretary for health at the U.S. Department of Health and Human Services, said that, “Your ZIP code is more important to your health than your genetic code,” she added, “Public health not only has to be part of that [shift in thinking], it has to be ready to lead.”
Despite spending more on healthcare than any country in the world, the U.S. ranks 34th in life expectancy. When a zip code is more influential on your health than your genetic code, it’s time to rethink how to turn these indicators and social determinants around, and take the lead in making communities healthier. In an article in the April 2016 issue of the American Public Health Association’s (APHA’s) American Journal of Public Health, Dr. DeSalvo, along with fellow officials from HHS and the Centers for Disease Control and Prevention, argue that as the nation’s disease burden is increasingly attributable to behaviors shaped by social and environmental determinants, public health agencies must take a lead role in building the community conditions that promote good health and well-being for all.
Models of Success
It’s easy to approach Public Health 3.0 with some weariness and trepidation. After all, there have been several iterations, and regular calls over the years to Do Something. So how is this different from its predecessors? The good news is that many communities across the nation are already doing the hard work to develop ambitious plans to change their local health system to foster improvements in their community’s health. Tackling influencers of wellness that fall outside of the scope of the traditional health care delivery system is not only hard work, but it requires dedication and creativity.
In 2016, the Office of the Assistant Secretary for Health (OASH) launched an initiative to lay out the vision for PH3.0, characterize its key elements, and identify the actions that would be necessary to better support a new approach to public health. OASH visited five communities that are aligned with the PH3.0 vision, and in these regional listening sessions, local leaders shared their strategies and exchanged ideas for advancing PH3.0. Those in attendance represented a highly diverse group of people working in public health and other fields, including nonprofit organizations, philanthropy, business, social services, the medical community, state and local government, transportation, and environmental services.
The report details the five examples of communities across the U.S. that are taking innovative approaches to public health, including California’s Accountable Communities for Health, a multi-payer, multi-sector alliance of healthcare systems, providers, insurers, public health, community and social service organizations, schools, and other partners. With innovative funding, partnerships, the capacity to collect, analyze, and share data, and a portfolio of interventions that address the social determinants of health disparities, including community programs and resources, California’s goal of saving money to reinvest into upstream prevention is achievable.
Another example, Priority Spokane, focuses on housing and education to support improvements in economic vitality, education, the environment, health, and community safety. The collaborative’s partners include the Spokane Regional Health District, Spokane Public Schools, the City of Spokane, and the Spokane Housing Authority. Priority Spokane analyzed graduation rates to identify educational attainment as a priority indicator, and in its research and analysis, found three tipping points: low attendance, suspensions, and low course completion. Using these insights, Priority Spokane created essential supports to keep students on track, and advocated for new state laws that promote restorative versus exclusionary discipline; developed a mentorship program with Gonzaga University; and worked with community partners to create a community dashboard to monitor progress. In five years, Spokane’s graduation rate jumped from 60 percent to 80 percent.
The Role of the Community Health Strategist in PH3.0
You need leaders if you’re leading a charge. That’s where the Community Health Strategist piece comes into play. Broadly speaking, a Community Health Strategist (CHS) isn’t necessary one person at the top leading the effort; it can be the chief health officer, a group of local health department (LHD) representatives, or a coalition of those both in and outside the public health sphere, collaborating and working towards the same goals. Community Health Strategists are public health leaders in their community, engaging with community stakeholders to actively address the social determinants of health inequity. Ideally, the CHS will help to develop strong strategic partnerships with players in other sectors, including civic and community leaders representing both the grassroots and the grasstops —a smaller group of people in targeted areas developing close one-on-one relationships with officials. For in-depth information about the role of the CHS, read the September 2016 report from the Public Health Leadership Forum, The Department of Health and Human Services as the National Chief Health Strategist: Transforming Public Health and Health Care to Create Healthy Communities.
NACCHO’s Role in Supporting PH3.0
To best support its local public health departments, NACCHO, through its Transformation and Communications Workgroups and teams, will help to develop messaging and a common language about how we talk about our work, how we conduct our business, and how the systems connect. Mindful that many LHDs are doing innovative work, we want to amplify those efforts. For example, if an LHD is doing just one thing to address capabilities, we want to know that, so that we can be the agents for positive healthcare changes. To do this, we need to develop messaging and define action steps. We also invite all of our LHDs to share ideas about PH3.0 and whatever you’re doing in your community and health department via the NACCHO Virtual Community at Transforming Public Health.
