Category Archives: Federal Reserve
NewPublicHealth has written extensively about community development—how financial investments can in time make the places we live, learn, work and play healthier. To truly be successful, it’s a course that no one organization or institution or person can take alone. It’s about partnerships. Community developers, public health officials, foundations and bankers must all come together to determine a strategy for investing and reinvesting in communities.
On Tuesday, September 3, from noon to 5:15 p.m. EST, SOCAP Health will bring together in a live webcast an array of experts to explore this new “health impact economy” and discuss real-world examples of successful partnerships that are improving health in low-income neighborhoods. The event is being held by the Federal Reserve Bank of San Francisco, and additional sponsors include Social Capital Markets (SOCAP) and the Robert Wood Johnson Foundation.
Before Tuesday’s online event, take a look back at NewPublicHealth’s coverage of community development. Some of our biggest stories include:
Will we ever see the end of poverty in the United States? An “Investing in What Works for America’s Communities” event held December 4 in Washington, D.C., looked at the evidence and leading examples toward doing just that. The event, sponsored by the Low Income Investment Fund, the Federal Reserve Bank of San Francisco, and The Citi Foundation, convened top community and economic development experts, analysts, financiers, researchers, philanthropists, and public policymakers from across the nation to share their findings and efforts for improving communities and discussing the next steps toward reversing record high rates of poverty. Reducing poverty, said participants, also goes hand in hand with making communities more sustainable and healthy places to live, learn, work, play, and grow.
The event was a showcase for the book, Investing in What Works for America’s Communities, in which essays from more than 40 experts in a variety of fields provide innovative ideas and concepts that are transforming community involvement and providing sustainable and healthy neighborhoods across the nation. More than 500 people from all backgrounds of public health to private sectors of the government were in attendance, either in person or through the live webcast.
Risa Lavizzo-Mourey, MD, MBA, President and CEO of the Robert Wood Johnson Foundation, is among several critical thinkers who have authored essays in a new book, Investing in What Works for America’s Communities. The book, a joint project of the Federal Reserve Bank of San Francisco and the Low Income Investment Fund, includes chapters on policy, finance and education, offers a hard and experienced look at what it will take to help build strong communities that support the opportunities for people to live healthy and productive lives.
In her essay, “Why Health, Poverty, and Community Development Are Inseparable,” Lavizzo-Mourey writes about the growing need for collaboration across disciplines to revitalize low-income communities and create opportunities to make choices that enable all people to live a long and healthy life, regardless of where they live. Read an excerpt:
In order to improve health in this country, the health sector must work closely with those who plan and build communities, especially the community development and finance organizations that work in low-income neighborhoods to build child care centers, schools, grocery stores, community health clinics, and affordable housing. From the health perspective, our interest is less about the buildings and more about what happens in them. Are the schools providing healthful food and eliminating empty-calorie snacks? Is there daily physical activity during and after school? Are grocery stores providing and promoting healthful foods? Are health clinics providing “prescriptions” of healthy lifestyles and services such as the Supplemental Nutrition Assistance Program, in addition to medications? Is affordable housing situated in proximity to safe places to play and be physically active? Is the neighborhood walkable, with well-lighted sidewalks that lead to public transportation, jobs, and services?
Other key essays in the new book include:
· Fighting Poverty through Community Development—by Shaun Dovonan, U.S. Secretary of Housing and Urban Development; Arne Duncan, U.S. Secretary of Education; and Kathleen Sebelius, U.S. Secretary of Health and Human Services. In their essay, the Secretaries call for the empowerment of federal, regional, and local officials with a wide range of responsibilities to break barriers, effectively meet community needs, and spark economic development.
· America’s Tomorrow: Race, Place, and the Equity Agenda—by Angela Glover Blackwell, founder and CEO of the poverty action advocacy group PolicyLink. Blackwell argues that equity-driven policy change is essential to transforming poverty-driven communities into high-opportunity communities. She says this requires broad-based alliances across fields and an inclusive agenda that focuses on those left behind. This also means building public infrastructure, growing new businesses and jobs, and preparing workers for the jobs of tomorrow.
· Crime and Community Development—by Ingrid Gould Ellen, professor of urban planning and public policy at New York University. Ellen’s thesis is that public safety is an important element of community development both because people subjectively care about it, but also because crime objectively destroys the fabric of neighborhoods and heightens stress. She suggests three strategies: increasing collective efficacy (the willingness of residents to monitor public spaces and intervene when those spaces or their neighbors are threatened); reducing physical blight and disorder; and community courts, which often also house a variety of social service programs.
A new article in the journal Shelterforce (the publication of the National Housing Institute) by Marjorie Paloma, MPH, senior adviser and senior program officer for the Health Group at the Robert Wood Johnson Foundation (RWJF), looks at collaboration among varied sectors—such as community development and health —to help create healthier housing options for diverse populations. Improvements have ranged from reducing allergens in low-income housing to improve asthma symptoms among children, to a new model of nursing home that groups just a few people in smaller facilities, resulting in better, longer and healthier lives.
Paloma says many of these collaborations are just a few years old and bring together groups such as RWJF and Federal Reserve Banks working on parallel tracks toward improving people’s lives. “These changes to housing are far less about bricks and mortar and more about creating stability for people, especially the most vulnerable,” Paloma says.
In an interview, Paloma pointed to a 2009 article, published in the Community Development Investment Review, about the Foundation’s Commission to Build a Healthier America and on the factors outside the health sector. “At that point,” says Paloma, “all of us saw that to create healthier, more vibrant communities, these sectors need to connect and collaborate with each other.”
The health news service HealthDay has picked its top health news stories for the past year, and most have a public health connection, including the pending suit by tobacco companies against the Food and Drug Administration’s decision to require graphic cigarette warnings labels and groundbreaking research that found that early treatment of people infected with HIV can often prevent transmission of the virus to their partners.
We have a few noteworthy items to add as well:
- Continuing budget cuts to state and local health departments
- Increasing focus and new data on the value of prevention
- Growing prominence of new partners beyond traditional public health such as the Federal Reserve Bank, private business and the housing, education and transportation sectors, in the effort to improve the health and lives of all Americans
Stay tuned today for a continued look back at the year in public health, including 2011's top 10 NewPublicHealth posts and top 25 tweets from @RWJF_PubHealth.
>>Read the HealthDay 2011 wrap-up here.
Weigh In: What public health issues were key for your community in 2011; and what improvements are you hoping for in 2012?
Where you live—your zip code, your neighborhood, and even your home—may have just as much or more impact on your health as what goes on in the doctor’s office. “You can predict the life expectancy of a child by the zip code in which they grow up. This is wrong,” said U.S. Department of Housing and Urban Development (HUD) Secretary Shaun Donovan (as quoted in an opinion piece in today’s Roll Call and in a recent commentary, together with U.S. Department of Health and Human Services Secretary Kathleen Sebelius, “How Housing Matters”).
Recent research on a HUD demonstration project found that poor women who were given the opportunity to live in safer, more affluent neighborhoods had lower rates of obesity, diabetes, psychological distress, and major depression. The Roll Call opinion piece, jointly authored by Raphael Bostic, PhD, Assistant Secretary, Policy Development and Research at HUD and Risa Lavizzo-Mourey, MD, MBA, President and CEO of the Robert Wood Johnson Foundation, looks at the role of housing in health, and new collaborations across sectors that recognize that providing healthier, more affordable housing can lead to significant health outcomes.
NewPublicHealth caught up with Raphael Bostic to get his take on changes at HUD to integrate health in all policies, some of the innovative housing programs from the field and how the health field can better support this work. Bostic addressed similar topics a recent conference hosted by the Federal Reserve Bank of San Francisco, RWJF and The Pew Charitable Trusts.
NewPublicHealth: Why is HUD looking at health and how does this fit with HUD’s more central mission?
Raphael Bostic: One of the things that has really been interesting for us as we’ve looked at our programs and our activities is the intersection between housing and a whole host of other areas—health care, school performance, job attachment—they all seem to be pretty closely linked to how well people were housed. We started down this route to pay specific attention to those intersections, and have that as a central platform in our strategic plan.
We’ve been running a demonstration project called Moving to Opportunity, and some of preliminary results of that study, which started in the early 1990s, suggested that health benefits were going to emerge as one of the biggest benefits of people getting housed well. The experimental research really did guide us in a significant way.
NPH: Did this Moving to Opportunity study represent a turning point in how HUD thought about health and housing?
Raphael Bostic: There’s always been some intuition in this building that housing played a role in health, but the experimental results made it concrete and something that we could act on. It also made it easier for us for us to talk to our partners, our stakeholders and grantees to let them know they should be thinking about health, and to think about how the programs they’re designing affect health. That’s been a good conversation to be able to have and point to real findings that say when people get housed better, they wind up healthier.
We’re starting to see some other efforts in this area as well. Asthma is a huge problem, and a costly problem, especially for young people. The quality of housing and how well the housing is built and kept plays a huge role in the incidence of asthma. There are a number of efforts to have joint interventions where health organizations use their resources to do interventions to get housing up to better quality standards, which will then save them money because they don’t have to treat uncontrolled asthma. That really falls in line with the idea that we have that housing policy is health policy.
NPH: How is HUD’s outlook different now than in the past?
Raphael Bostic: One, we’re thinking much more broadly about what success for our program looks like. It used to be success for us was that someone had a voucher and was in a house. We didn’t look much beyond that to say are other parts of their quality of life changing significantly. This has allowed us to focus much more broadly on what success means.
It has also made us be more proactive in finding partnerships with our sister agencies in the federal government. Our partnership with the Department of Health and Human Services has been significantly strengthened and deepened. Similarly, we’re working closely with Department of Education around educational outcomes—it’s really allowed us to be much more integrated, hopefully to get a holistically better set of outcomes.
NPH: What are some of the innovative programs that are working?
Raphael Bostic: Some of our most basic programs have a viewpoint on health embedded in them. There’s Choice Neighborhoods, which is a program where we take some of the worst of our public housing and we convert it into higher-quality, mixed-income, mixed-tenure (rental and ownership) developments. We take those places where we know health is as bad as it’s going to be from a housing perspective and convert them into places where there’s much healthier lifestyles—you have sidewalks, you have walkable neighborhoods, you have amenities and the like. That’s one where I think we will see significant improvements in health because of the housing policy.
Another initiative is the Sustainable Communities Planning Grant. What we’re trying to do is facilitate and incentivize regional planning and more coordinated development of housing that is more sustainable, more walkable, closer to jobs and helps to make living easier, which should translate into real health benefits.
Our basic programs, including support through the Housing Choice Voucher program, where we help people have some mobility to choose the neighborhood they live in, has allowed people to get away from the neighborhoods that were a source of stress and lack of safety—so we’re seeing significant psychological benefits.
And our Housing Opportunities for Persons With AIDS program has been extremely beneficial. One of the most sobering statistics I heard at our conference in September was that for people with HIV/AIDS, if you had 100 people and didn’t get them quality housing, only 25 were still alive five years later. If you got them housing, 95 of them were still alive three to five years later. Talk about an “aha moment.”
NPH: What challenges does HUD face in looking at health-related effects of its work?
Raphael Bostic: Health is a very specialized field. A lot of the housers aren’t aware of what good interventions look like and they don’t really know who to talk to in getting that information. You wind up with a very siloed atmosphere. I think that’s the biggest challenge, is getting the experts to talk to people beyond the usual suspects and get them to understand that we need to be a broader and more integrated community. We’re trying to start facilitating those conversations about health and housing.
NPH: What can the health sector do to help and to work together?
Raphael Bostic: Figure out what sorts of activities are going on in communities that could be informed by health considerations. There’s a movement afoot where people are trying to get health professionals on planning commissions and on code boards so that when zoning decisions come up, we think about them in terms of their health impact. I think that’s an interesting way to make sure health is thought about in all the situations where it’s relevant.
The partnerships we’ve formed with HHS and other agencies here have been extremely positive—it’s really my hope that those collaborations happening on a national level will eventually diffuse down. If we integrate health and housing policies at all levels, that will be very exciting.
NPH: What other organizations or sectors need to be involved in these collaborations to really make an impact on health?
Raphael Bostic: Community development organizations have become increasingly interested, particularly in minority and low-income areas, in the health of their communities. If there are ways to improve health, it improves employability and a whole host of things. How communities are constructed, how neighborhoods are laid out, and how we plan for new, transit-oriented developments—those are all broader community development concerns that have real positive implications, if done well, for how people are housed. A number of community development professionals get this already. There’s a lot of work to be done. Some studies have showed that how communities are zoned and constructed can have direct impacts on obesity, diabetes, hypertension and other health issues. I think there’s more research to be done to better understand those relationships.
>>Read more on the link between housing and health.
Collaboration between the community development and health sectors is critical and beginning to gain greater traction to improve lives—particularly in low-income neighborhoods—according to Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation (RWJF) and Sandra Braunstein, director of the Federal Reserve Board’s Division of Consumer and Community Affairs, writing in the November issue of Health Affairs. The journal issue, produced with support from RWJF, features several articles on emerging collaboration between these sectors to improve health. Access the articles here.
>>Recommended Reading: For an overview of the articles included in the Health Affairs issue, check out this post from the County Health Rankings blog.
Also this week, the Federal Reserve Bank of San Francisco, the Pew Charitable Trusts and RWJF hosted a day-long conference, “Building Healthy Communities,” to discuss next steps for these shared new efforts.
The conference builds on a series of regional meetings held in the last year and attended by experts in community development, finance, urban planning, housing, government, business, academic, philanthropy and health sectors to help lay the groundwork for innovative new ideas and public and private partnerships with shared goals—such as creating safe and accessible places to exercise, preventing chronic diseases, and building safe, affordable housing. View the webcast or participate in the discussion on Twitter at #FedHealth.
“Greater opportunities lie ahead,” writes David Erickson, PhD, Manager of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco, who is both a co-author in the current Health Affairs issue and a coordinator of this week’s conference. “Many of those opportunities involve better coordination. Moving beyond coordination to integration will require the health sector to see community development as its partner in addressing the 'upstream' factors that influence health.”
NewPublicHealth spoke with David Erickson about the developments this week and next steps in the intersection between community development and health.
NewPublicHealth: How did this week’s conference build on past regional conferences?
David Erickson: Previous Healthy Communities conferences have focused on "consciousness raising”—making the case that health care and community development are both necessary prescriptions for better health. This conference attempted to not only surface new ideas and partnerships, but also to drill in on three specific areas of systems change—finance, data, and policy—necessary to fully integrate population health work and community development. As the day unfolded, a consensus emerged that a new business model is needed to incentivize collaboration and capture downstream health care cost savings resulting from strategic community investments.
NPH: Can you give us a strong example of a recent community-building collaboration?
A movement to improve health at the community level has been gaining traction, including new efforts to improve not only access to health care but also access to resources that promote health, such as safe housing, farmers’ markets and recreational facilities.
A major force behind this effort is an emerging collaboration between the public health, health care, community development and economic development industries. The Federal Reserve System has been convening leaders from these industries to discuss collaboration to reduce health disparities and create healthier communities for all.
To date, the Federal Reserve Banks of Boston, New York and San Francisco have held regional meetings. On September 28, the Federal Reserve Bank of Dallas will host “Healthy Communities: the Intersection of Community Development and Health” at its Houston Branch. NewPublicHealth talked with Elizabeth Sobel Blum from the Federal Reserve Bank of Dallas to learn why the Dallas Fed is involved in this movement and to hear about her expectations for this conference.
NewPublicHealth: Why is the Federal Reserve Bank of Dallas interested in health?
Elizabeth Sobel Blum: At the Dallas Fed’s Community Development Office, our role is to support the Federal Reserve System’s economic growth objectives by promoting community and economic development and fair and impartial access to credit. Our constituents serve low- and moderate-income individuals, often by providing or facilitating affordable housing, personal financial products and services, small business development products and services and community facilities.
The individuals community developers reach are the same individuals who face major health disparities. While access to health care is one component that explains these disparities, the social determinants of health – where people work, live, learn and play – can play a strong role as well. The more opportunities individuals have to make healthy choices, the more likely they can live longer and healthier lives. These social determinants of health are the nexus of the community development and health sector’s joint interests. It is in this space that collaboration is imperative. And the health of our country and economy depend on it: in general, wealthier people are healthier and healthier people are more economically productive.
NewPublicHealth: Why are you focused on healthy communities now?
How can the billions of dollars that are spent each year on community development make the places where we live, learn, work and play healthier?
That question is among many debated today by leaders in urban planning, housing, government, business, philanthropy, public health, and health care, who are gathering at the New York Federal Reserve to share ideas about making communities healthier--together.
The meeting is supported by the Robert Wood Johnson Foundation, which is partnering with the Federal Reserve Banks of San Francisco and New York, the New York Academy of Medicine, and the Primary Care Development Corporation, to bring traditional and non-traditional partners together to find common ground on addressing the social and environmental factors that influence health. This is the fourth meeting like this that David Erickson, PhD, who manages the Center for Community Development Investments for the Federal Reserve Bank of San Francisco, has convened in the past year. He talked to NewPublicHealth.org about today’s Healthy Communities Conference and why community developers and public health advocates are natural partners.
NPH: You’ve said that health is too important to be left to the health sector alone. But how do you engage groups that don’t speak the same language to even sit at the same table and work on an issue that is relatively foreign to many of them? How do you help those in the transportation, housing, education and health sectors bridge their differences and roll up their sleeves and work together?
Erickson: It is much easier than you might think though there are challenges. We often confuse each other just in the language that we use. We say CDC and we mean community development corporation but for people in public health that acronym means something entirely different. But in terms of our work, there is a strong and immediate bond. We often start our meetings with a local health expert showing heat maps with red colors representing neighborhoods with the worst health outcomes. If you pick asthma, for example, you see which neighborhoods light up in red. We then have community development experts put up a similar map to look at things like overcrowded housing or high unemployment rates and you see maps that are practically identical. Instantly, everyone in the room realizes that we are working together to address problems for the same communities.
Those of us in community development work in the large financial world and banks are our biggest partners but we are not always understood by them. People who do community development have an immediate affinity and understanding for those in population health and vice versa. Where we do stumble is how we make it concrete. Those of us in community development know how to put grocery stores in food deserts or build, locate and finance small businesses. But we struggle with how to link more effectively to federally qualified health centers or connect housing with improving public health. We need to do better at taking approaches to community development that are geared toward attacking the root causes of bad health. That is a real challenge. What we are trying to do is find the best ideas and practices so we can create a playbook to show us how.
NPH: This is the fourth of several meetings you’ve had like this. What are your goals coming out of these meetings? How do you keep the conversation going and ultimately push it beyond just talk into action?
Erickson: We have multiple goals. Some are more achievable than others. One goal has been to just do some consciousness raising, which we have been successful with. People are more knowledgeable about these issues and more sophisticated about how to approach needs. The other goal is to just get people to meet each other. We have been successful in creating local partnerships. For example, a group of researchers from the University of California, Berkeley attended one of our meetings in Los Angeles and met a group of housing experts from Mercy Housing, a nonprofit Catholic affordable housing developer. The researchers are now teamed up with this group to do a health analysis for a 50-acre public housing site in San Francisco that wants to incorporate health into development. A community developer just doesn’t have time to pour over all the health literature. Now they have this built in advisory committee from Berkeley, who are leaders in the field of population and public health, who are helping them. Plus, they will have the data and analysis to figure out what the health effects are of remaking a community. We hope that during the process that not only will Berkeley researchers be able to feed back strategic information so developers can make adjustments in the best interest of their tenants but also realize what this means from a health perspective to radically improve a neighborhood. This is a partnership that emerged from a conversation begun at a reception we held during the meeting. We have similar stories coming out of Boston, where the Boston Community Foundation is working with the Boston Federal Reserve on a local housing project and Los Angeles, where researchers at UCLA are beginning discussions with Federal Reserve staff in Los Angeles.
NPH: So what is the take-away message from all of these encounters or opportunities?
Erickson: I have been doing community development for 20 years and frankly it gets kind of depressing. While there are plenty of wins out there - places that seemed hopeless are now thriving thanks to community development - if you look at the overall numbers, we are not winning the war against poverty and unhealthy communities. As a community developer, I find that when we start talking to health professionals, I find new allies. These are people who have new ideas, resources and energy to put into this effort. So it is very energizing.
NPH: The measures for success for the public health and financial sectors seem to be at opposite ends of the spectrum. Banks and community developers tend to see themselves as short-term lenders and want to see short-term wins. Investments in public health often take years if not decades to show promise. How do you convince your financial partners that the ROI for investing in improved health is worth it?
Erickson: Some look to childhood reading levels as an indicator of prison population eight years out. That is something we could be looking at – intermediate measures – such as childhood reading rates or high school graduation levels or unemployment levels – to assess whether health is improving. Community developers are increasingly on the hook to try to explain the benefits that come from community development interventions. Increasingly we are going to look to health as a partner in measuring the success or failure of those interventions. That will be an important part of the community development toolbox going forward.
NPH: What can community development and finance experts teach health experts and vice-versa? Have these meetings yielded some key lessons that others can learn from that are trying to do the same thing?
Erickson: One thing that community developers are very good at is being plugged into a local community and understanding their needs and connecting them to much bigger systems and resources at a much greater scale then they can source locally. They are on the side of the community but also can go to Wall Street and tap sources of capital as well as the federal government. They can bring in this whole symphony of players to work on a project. And that would be helpful to health. The community developer can play that coordinating role and bring the right players to the table that assemble and harmonize the right subsidy and market rates for capital. I think the two working together will be a powerful combination. Health can teach us a lot about measurement and being more methodical to make sure we stay with what is working and discontinue what doesn’t seem to be helping. It also helps community developers broaden their focus to improve the health of local people.
NPH: Do you believe then that we are moving to a new way of dealing with health at the community level?
Erickson: We know from studies that only about 10 percent of premature deaths are related to access to health care and environmental and social factors are much more significant. If we are going to keep the country healthier and make some improvements in the overall health of the people here, we really have to improve those areas so people don’t get sick in the first place. People understand that you can live a healthier life but I think what people don’t often understand is the gradient for improved health. It’s not just that poor people are sick and wealthy people are not. It’s that at every income bracket as your income rate rises, people tend to be a little healthier. If you have a sense of control over your life, you tend to live better and live longer. We are increasingly understanding that people in local communities feel like they have no control over their lives. We think we can intervene in those places and give them a sense of control and translate that into significant health improvements.
NPH: Do you feel like you’re having impact? Can you share a story of how you’ve affected change or gotten a non-health sector to think differently about improving the places we live, learn, work, and play?
Erickson: We still have a way to go but we are changing the conversation and that is an important step. I think it’s definitely changing how we in community development think about how we do our work. One small example is that the lead umbrella organization for community development finance – Opportunity Finance Network – has a conference every year that is attended by anyone who does community development finance work in the United States. Now they have a health track as part of the meeting. They never had that before. We do think we will see concrete changes soon. Housing and Urban Development is pushing for sustainable communities and focusing on the effects of place on health. We see this happening with transportation projects too. Agency heads in charge of health and city leaders are starting to work together and that has been unprecedented. This is still relatively new but it is pretty remarkable that at the highest levels, there is interest in bringing different components together to build healthier communities.
We recently held an equitable transit-oriented development conference here at the San Francisco Federal Reserve Bank and there was a discussion about building affordable housing units near a train stations. A train station in a community increases land value because it provides access to transportation. The developers not only looked at what it would do for the economy but they also factored in how it would affect health, and saw from studies that it would foster physical activity and reduce obesity rates. It was unusual to think about building a train station using the lens of public health but it shows that health is becoming part of the equation for community development.
Read previous NewPublicHealth.org Q&As with newsmakers and difference makers in public health.
What's the latest in health services research and current health policy issues?
You'll be able to find out at the AcademyHealth Annual Research Meeting, which takes place June 12-14 in Seattle. The annual meeting has been the premiere forum for health services research for close to thirty years. Key topics this year include health reform and using social media to disseminate research.
At the conclusion of the meeting, the Public Health Services Research Interest Group, funded by the Robert Wood Johnson Foundation, will be celebrating its tenth anniversary. Speakers include Debra Pérez, M.A., M.P.A., Ph.D., Interim Assistant Vice President for Research and Evaluation at the Foundation. You’ll be able to follow coverage of the conference here on NewPublicHealth.org.
In advanceof the Annual Research Meeting, NewPublicHealth spoke with Lisa Simpson, M.B., B.Ch., M.P.H., president and CEO of AcademyHealth, and David Colby, Ph.D., vice president of Research and Evaluation at the Robert Wood Johnson Foundation.
NPH: What are the key topics that will be discussed at the Annual Research Meeting?
Dr. Simpson: There is a rich set of presentations this year, as in other years. We’re lucky to receive terrific abstracts and presentations. One area where I’m particularly interested to hear and learn more is around what’s happening at the community level and the efforts on the ground to transform the delivery system. Some of those efforts are working very collaboratively with local public health and reaching beyond the traditional boundaries of medical care. For example, understanding how health information technology and different payment approaches are facilitating these newer organizational financing and collaborative models.
NewPublicHealth: From both your perspectives, can you talk about the intersection of health services research and public health services research?
Dr. Simpson: This is the tenth anniversary of the annual meeting of our Public Health Services Research Interest Group and we are reflecting on the progress we’re making in this field, how much public health services research is part of the family of health services research and how integral it is to advancing health. We have to have evidence to improve the delivery of care and the prevention agenda for population health. That’s where I think the future is going. I would also comment that increasingly we’re seeing alignments and recognition within the more traditional medical care delivery system of the need to focus on population health and the need for partnership and even more collaboration between the health system and the public health system.
Dr. Colby: Health services research is a young field and it’s a field that is interdisciplinary. So the boundaries around health services research are more like a fuzzy set than a brick wall. We have a strong tradition of looking at delivery, quality, and access in the medical care system. Yet the goal of many members of AcademyHealth, as expressed by David Kindig, M.D., the former chair, is to study how to maximize the health of individuals and the health of populations. The AcademyHealth board adopted a definition of health services research which included the impacts of social effects and personal behaviors on health and well-being. This means that research needs to focus on all the inputs into health from the health care system, personal behavior and characteristics, and the environment. There is a recognition that you have to take into account all of these things to influence people’s health.
Dr. Simpson: I agree with David. As a pediatrician we especially focus on factors outside of medical care and the health of children in particular is so dependent on that multidisciplinary approach to understand what works to maximize and optimize health outcomes for children and their families and their communities. There really are those fuzzy boundaries.
NPH: What is the conversation that needs to take place between health services delivery and public health?
Dr. Colby: Articles written in the early 1990s showed the most important inputs into the health of the public are not from the medical care system. If we want to improve the health of Americans, we have to be working on those areas that will produce the most leverage, and that is improving where people live, learn, work and play.
Dr. Simpson: As we think about public health, increasingly I think that we understand that what contributes to the health of the public goes well beyond public health departments or what is traditionally thought of as the institutions of public health. We’re seeing employers having a dramatic stake in public health, promoting employee wellness and health promotion and disease prevention. We’re seeing the health care delivery system moving more and more toward health as part of the triple aim which focuses on improving population health, the patient experience of care and cost. It is about how communities exist and structure their community institutions well beyond public health and health delivery--from transportation to food, the environment and the built environment--all of these contribute to achieving the health of the public--and so health services research is expanding its methods, approaches and data sets to bring in information that captures the dynamics and influences on the child, the family, the community. In that way, we are better able to tease out and understand the policy levers and the interventions that can optimize health outcomes.
Dr. Colby: One example is that the Federal Reserve became very interested in the impact of community development on the health of Americans. They have held several conferences around the country about the interface between what they do in housing and other policies and the health of Americans.
NPH: What do you think the Federal Reserve’s contribution can be that another entity might not be able to contribute?
Dr. Colby: When the Federal Reserve starts talking about health issues, it’s a ‘wow.’ The Fed controls significant amount of money that can be used to improve the health of Americans. Where and how you build houses, parks, sidewalks, and grocery stores will have an impact on health of Americans.
NPH: There are two sessions at the annual meeting that are devoted to helping researchers disseminate their findings. Are researchers finding it more or less difficult to get their information out to the stake-holders that need it and then make its way to the field?
Dr. Simpson: I think the answer is, like so many things in health policy, it depends. Our field is growing and vibrant. Our membership is at the highest point ever, almost 4,500, and we represent a very diverse field.
I think that there are many journal opportunities, and depending on which journal you’re working with, the competition and the difficulty in getting your work published in an academic journal varies tremendously--as might the delay in publication between when you have your findings and when it actually appears online. But I think that increasingly, researchers are recognizing that there need to be, and there are, many other venues for getting their findings into the hands of the decision makers who need evidence.At the same time, journals are moving toward more timely reviews and expedited online publishing.
There are also many other ways that researchers have been working increasingly to get their evidence into action--and we support a number of those methods. For example, learning networks where we identify a policy need and researchers and experts who have been publishing and working in that area and we bring them together. These networks create an opportunity for a researcher to very directly inform policymakers about their area of expertise and passion. Another example is the HCFO--Health Care Financing and Organization--a program of The Robert Wood Johnson Foundation managed by AcademyHealth. As the national program office for HCFO, we bring researchers together with their targeted users and audiences in small, focused discussions where you can really delve deeply into what is known and what is not. These sessions not only get information to the user more quickly, they actually help the researchers better understand what evidence is most needed. So, together with our members, we are really looking in very different ways to achieve our goal of moving knowledge into action.
NPH: Canyou talk about the impact of social media on evidence dissemination?
Dr. Colby: Health services researchers have to get used to social media for three separate purposes. One purpose is getting information out to people. Reporters follow tweets and that’s where they pick up some emerging stories. Obviously, the reporters will call up and get more in-depth information beyond 140 characters but Twitter provides the lead.
Another purpose is that social media tools are going to provide data for health systems researchers. For example, a project that we funded published an article on following tweets to figure out the impact of certain diseases, and an earlier article we funded used Google searches to show the spread of a disease. These studies represent a new epidemiology, which lets you know what’s going on before you get the official records.
Finally, I think that these social media tools are going to be very important in helping people improve their health. You could have an app on your phone that reminds you that you have to do specific things on a daily basis to improve your health.
Dr. Simpson: To build on what David has said, we see social media as the newest tool in our tool kit to support our mission of moving knowledge into action. I think there is enormous potential for the field to embrace these technologies and push them even further. In fact, one of the things that we’re announcing next week at an Institute of Medicine meeting around newly available data, and also at the Annual Research Meeting, is the REACH--Relevant Evidence to Advance Care and Health--Challenge. The REACH Challenge, which we are sponsoring in partnership with Health 2.0, offers a prize of $5,000 to a team of researchers, developers and other specialists who takes evidence-based research and data and translates them into an application that advances health and care.
This is really the future. Apps and social media are clearly an exciting new strategy for evidence dissemination and a new way to reach the audiences we need to target.
AcademyHealth has focused a lot more on social media in the last couple of years. You can follow us on Twitter, at @academyhealth or with the hashtag #ARM11 for the annual research meeting. We also have a blog at blog.academyhealth.org. And also new this year at the Annual Research Meeting is what I call "American Idol meets AcademyHealth," where we’re asking people at the meeting to choose their favorite poster presentation for inclusion in a first-ever “virtual poster session” by texting their vote to us. So we’re really trying to expand our approach and the various methods we use to engage our various audiences. At its core, it’s about matching up the content and the evidence with the medium and the messenger and the audience, and aligning all of these points so you’re delivering the right information in the right way to the right customer at the right time.
NPH: Will you both be tweeting at the meeting?
Dr. Simpson: David will be tweeting and I’m going to start learning how to tweet at the meeting!
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