The Health Systems Learning Group (HSLG) is made up of 43 organizations, including 36 non-profit health systems that have met for the last eighteen months to share innovative practices aimed at improving health and economic viability of communities.

The idea for the learning collaborative came from a series of meetings at the White House Office and U.S. Department of Health & Human Services Center for Faith-Based & Neighborhood Partnerships. The HSLG’s administrative team is based at Methodist Le Bonheur Healthcare Center for Excellence in Faith and Health in Memphis, Tenn., and at Wake Forest Baptist Health System in Winston-Salem, N.C. The Robert Wood Johnson Foundation provided a grant to share the group’s findings and lessons learned.

In addition to its other work, earlier this year the HSLG released a monograph that aims to help identify and activate proven community health practices and partnerships. Once identified, they can be combined with other evidence-based initiatives to reveal new pathways to transform unmanaged charity care into strategic, sustainable community health improvement.

Recently, NewPublicHealth spoke with the Reverend Doctor Gary Gunderson, vice president of the Division of Faith and Health Ministries at Wake Forest Baptist Health and co-principal investigator of the Health Services Learning Group, about their vision for the future of healthy communities and the role that hospitals and health systems will play.

NewPublicHealth: What are the goals of the Health Systems Learning Group?

Gary Gunderson: The essence of the task was to help each other learn how we can fulfill our most basic mission. All of the Health Systems Learning Group members are not-profit. The vast majority are faith-based, and so in every case our essential mission boils down to improving the health of the community that created us.

All of the HSLG members are financially stable and we all provide a lot of charity care, but that does not add up to necessarily fulfilling our real aspirational mission and that’s what we came together: to see whether it’s possible to do that in the current environment. And our fundamental answer is that it is possible to do that, but we have to have some new competencies and expanded commitments in order to do it.

Last week the Public Health Accreditation Board (PHAB) awarded five-year national accreditation status to five public health departments, bringing the number of health departments now accredited to 19 since the credential was launched two years ago. Hundreds more health departments are currently preparing to apply for accreditation, which includes a peer-reviewed assessment process to ensure it meets or exceeds a set of public health quality standards and measures. Among the newly accredited is the Chicago Department of Public Health.

"This is an important achievement and recognition that highlights the city of Chicago’s ongoing commitment to health and wellness on the part of all of our residents,” said Chicago Mayor Rahm Emanuel in a statement issued by PHAB.  "We are focused on policies that will help all Chicagoans and their families enjoy the highest quality of life, [and w]e will continue to strive to make Chicago one of the healthiest cities in the world."

NewPublicHealth recently spoke with Bechara Choucair, MD, MS, Commissioner of the Chicago Department of Public Health, about the value of accreditation for improving the health of the community—and about how this effort supports Healthy Chicago, the city’s public health agenda.

>>Read more about Healthy Chicago in a previous NewPublicHealth Q&A with Choucair.

NewPublicHealth: You’re one of the first public health departments to be accredited. How did that happen so quickly?

Bechara Choucair: When we released Healthy Chicago in 2011, one of the strategies we identified was to obtain accreditation. We wanted to be the first big city to earn the credential. It took us 18 months and we are excited that we are the first big city to be accredited and the first in Illinois. And one of the added bonuses of accreditation is a sense of pride. It says a lot to our staff, residents and our mayor.

NPH: A community health assessment is required as part of the accreditation application. What did Chicago’s community health assessments entail?

Jane Brody is the Personal Health columnist for The New York Times. She joined the newspaper in 1965 as a specialist in medicine and biology after receiving degrees in biochemistry and writing for multiple college newspapers, as well as for the Minneapolis Tribune. With her column she has seen and reported on almost 50 years in the evolution of personal and community health.

NewPublicHealth recently spoke with Brody about her take on the state of community health—and what we can all do to improve it.

NewPublicHealth: Over the years, what efforts have you seen that you think have been most effective at improving community health?

Jane Brody: Well, I think one of the most exciting things that’s happened in New York City, and possibly in other cities as well, is getting better food to people who live in food deserts. For example, collecting food that would otherwise be wasted and bringing it to communities where people get free food that is healthy, fresh, and they even have demonstrations of recipes. In fact, I got one of my favorite recipes—it’s a green bean frittata—from one of their demonstrations that I attended just to see how it all worked out.

We’ve also, as you’ve no doubt heard, been putting in all of these bike lanes and we now have introduced the Bike Share Program, which is not inexpensive, but it does at least give more people an opportunity to get off their butts and get out of their cars and maybe even not even use public transportation in some cases, but to get some exercise to and from work, which is wonderful. I remember during one of the transit strikes that we had in New York City, I rode my bicycle from Brooklyn to Times Square where I work, over the bridges and stuff, and it was just wonderful because I got my exercise in at the same time as I got to work and I didn’t have to spend an extra hour exercising. There have been improvements. We have, of course, public pools that are only open in the summer, but in summer is better than no public pools and nobody has to pay anything for a public pool, which is really great.

This year’s Health Datapalooza closed out its fourth annual conference today in Washington, D.C. The confab features new and emerging uses of data by companies, startups, academics, government agencies and individuals, and was borne out of a decision by the U.S. Department of Health and Human Services to release some of the health data it collects. This year, the conference included a community health track that looked at emerging tools to improve population health, and recommendations from key public health experts on what’s still needed.

>>For more on the conference, read "Dispatches from Datapalooza" and other conference-related updates over at the Pioneering Ideas blog from the Pioneer Portfolio at the Robert Wood Johnson Foundation.

The session had a world class moderator at the helm in Edward Sondik, PhD, who recently retired as director of the National Center for Health Statistics who set the stage for the session by telling the standing room only audience that “previously most health data applications were focused on the individual, but now we’re seeing data initiatives that can do a great deal to give us more information at the community level.”

Data-sharing resources for community health presented at the session included:

The Three Rivers district health department in Owenton, Kentucky was one of three health departments in that state and eleven in the country to receive national public health accreditation from the Public Health Accreditation Board. NewPublicHealth has been speaking with directors from accredited health departments about the value of the credential; how it can change their operations and outcomes; and what they’d like to share with departments considering applying for the credential. We recently spoke with Georgia Heise, DrPH, Three Rivers’ health director and a vice president of the National Association of County and City Health Officials, about the benefits she sees from both the application process and the new status accreditation confers.

NewPublicHealth: What has the reaction been from community members and policymakers to the news that you’re now accredited?

Georgia Heise: It has been wonderful. Our health department has talked about accreditation from the day we started working on it, so people have been waiting to see what the decision was going to be. We’ve gotten flowers, cards, letters, and emails and there have been celebrations hosted by us and by others. And we did get some attention from policymakers, which was wonderful.

We have, for the past three years now, introduced into the Kentucky legislative process a bill that would require health departments in Kentucky to be accredited by 2020. We haven’t got that bill approved yet, but we continue to work on it and we think we will eventually. But that effort means that the legislators are familiar with the concept of accreditation. While maybe they haven’t paid that much attention to it before, they’re paying more attention now because Kentucky had three health departments receive accreditation in the first round and that’s gotten some attention statewide.

NPH: In terms of the process, what has been harder than you thought and what was easier

NewPublicHealth is partnering with Grassroots Change: Connecting for Better Health to share interviews, tools, and other resources on grassroots public health. The project of the Robert Wood Johnson Foundation Health Group supports grassroots leaders as they build and sustain public health movements at the local, state and national levels.

In this Q&A, conducted by Grassroots Change, Shannon Frattaroli, PhD, Associate Professor at the Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, shares her perspective on grassroots power and the future of public health. Her research helps answer two critical questions: Why are grassroots movements so important; and what is a public health movement, anyway?

>> Frattaroli’s interview has been edited for NewPublicHealth. View the full interview at GrassrootsChange.net.

Grassroots Change: What do you see as the role of grassroots movements in public health?

Shannon Frattaroli: There’s tremendous potential. Public health at its core is about the public. The public should have a voice in public health, and grassroots movements are one way for that to happen. The public has been very engaged in policy issues or problems throughout the history of public health. When people get engaged and are strategic with regard to policy change, things can happen quickly. And change can happen in a way that feels more legitimate. I think it’s where we should be moving in the future.

GC: What does “grassroots movement” mean? How are grassroots health movements different from other types of advocacy?

Several sessions at this week’s American Public Health Association meeting in San Francisco urged nonprofit hospitals and public health departments seeking national accreditation to join forces on community assessment reports that both are required to file.

Assessments can reveal critical needs in a community, such as asthma trends that could point to poor housing conditions. In a growing number of cities, such reports are providing the evidence needed to marshal resources and action such as dispatching case workers to make home visits to help prevent and reduce asthma emergencies. Such expenditures can reduce the cost burden of paying for emergency care and prevent more health crises in the first place.

In San Francisco, the health department and the city’s non-profit hospitals have been collaborating on community benefit and needs assessments reports since 1994 and have achieved much more than “just a sheaf of papers that sits on a shelf,” says Jim Soos, Assistant Director of Policy & Planning at San Francisco Department of Public Health. The collaboration has resulted in a number of critical efforts to improve health here, including San Francisco’s Community Health Improvement Plan (CHIP), which will be launched by early in 2013. 

Several sessions at this year’s American Public Health Association meeting include brass-tacks guidelines for initiating and furthering partnerships between public health and hospitals to improve community health. In a session yesterday, Michael Bilton, who co-founded and leads the Association for Community Health Improvement of the American Hospital Association, spoke about the value of partnerships between public health and hospitals, since both have requirements to complete similar community needs assessments.

Health departments seeking public health accreditation must complete a community needs assessment, and non-profit hospitals must complete community benefits reports every three years under the Affordable Care Act.

Bilton pointed out that for many communities, the collaboration won’t be one that starts from scratch. San Francisco has had a community benefit requirement for non-profit hospitals since 1994, “which promoted a sense of collaboration in many communities,” Bilton told the audience at the APHA session.

Bilton says the collaboration also aligns with the National Prevention Strategy, released by the Surgeon General last year, which is promoting partnerships across federal agencies to improve community health.

>>Read an interview series on the National Prevention Strategy on NewPublicHealth.

Bilton says the Strategy specifically points to community needs assessments as a way to identify and begin working on many of the priorities in the Strategy. “And those priorities have already been identified by many hospitals,” says Bilton. The joined forces of hospitals and public health departments also help achieve the “triple aim” of additional goals stressed in the Affordable Care Act including improving improving care, improving health care quality and reducing costs. These collaborations underscore the notion that helping to manage population health is the role of hospitals as well, said Bilton.

Bilton advised public health officials anxious to collaborate with hospitals on community benefit requirements to do several things including:

• Become acquainted with hospital regulations
• Approach hospitals as early as possible in your process
• Find out who is leading the assessment
• Ask hospitals about their assessment  process and goals
• Offer to help hospitals with with data, communications,  facilitation or staff expertise, as appropriate  
• Balance short term needs such as fulfilling IRS or accreditation requirements with longer term opportunities—sustained health improvement collaboration.

>>Bonus Link: Read a NewPublicHealth interview with Laurie Cammisa from Children's Hospital Boston on community benefit collaboration. 

The Community Health Initiative (CHI), a program of the Cincinnati Children’s Hospital Medical Center in Ohio, includes work with nontraditional community partners to support community organizing and address critical children’s health issues in the community. For example, using geocoding technology to identify areas of greatest need—“hotspots”—by mapping clusters of readmitted asthma patients to substandard housing units owned by the same landlord. CHI partnered with the Legal Aid Society of Greater Cincinnati, which helped tenants form an association and compel the property owner to make repairs. CHI also makes referrals to Legal Aid for patients who need help with Medicaid benefits or require other legal assistance. CHI has developed specific health metrics with which it evaluates the effectiveness of its programs and shares these data with local community organizations and CHI’s community partners.

The CHI work was featured in a new community benefit issue brief from The Hilltop Institute at UMBC, “Community Building and the Root Causes of Poor Health.”

NewPublicHealth recently spoke with Robert Kahn, MD, MPH, who is the Director of Research in the Division of General and Community Pediatrics at Cincinnati Children’s Hospital.

NewPublicHealth: What are the goals of the Community Health Initiative?

Robert Kahn: The Cincinnati Children's Hospital board established in its strategic plan for 2015 four goals that relate to the health of all 190,000 children in our county. The goals relate to:  infant mortality, unintentional injuries, asthma, and obesity rates as they relate to hospital readmissions. Our plan is to build a strategy and an infrastructure to cover the ground between a more traditional clinical approach and a truly public and social wellbeing approach to these conditions.

NPH: Why are partners so critical? 

>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.

NewPublicHealth was on the ground at the National Association of County and City Health Officials Annual 2012 conference, providing the latest conference news and in­-depth interviews with conference speakers, as well as local success stories and a glimpse into the Los Angeles public health scene. Coverage highlights included:

• A discussion with Paul Kuehnert, new senior program officer for the Robert Wood Johnson Foundation and director of the Foundation’s Public Health Team, and former executive director for health for Kane County, Ill.
• A Q&A with Jonathan Fielding, MD, MPH, MA, MBA, director of the Los Angeles County Department of Public Health.
• Violence prevention discussions around the special screening of The Interrupters, including a talk with CeaseFire violence interrupter Ricardo “Cobe” Williams and a Q&A with Baltimore Health Commissioner Oxiris Barbot
• A photo tour of the L.A. City Emergency Operations Center, a model for collaboration around preparedness
• A site visit and photo tour of a corner store participating in the Long Beach Health Department’s healthy corner store initiative through the Healthy Eating Active Living Zone program.

At the conference, we also spoke with attendees about how local health departments are forging innovative new partnerships across sectors and across communities to meet shared goals and leverage resources. We asked: What’s the most creative, outside-the-box partner you’ve engaged with from a sector beyond public health? What did they add to the conversation and your joint efforts? What successes have you achieved as a result of partnerships? Who do you see as the most critical partners for public health?

A sampling of responses we heard from attendees are recapped below. Themes that emerged included the critical nature of partnerships between health departments and hospitals, Community Health Assessments and Improvement Plans as a catalyst for partnerships and sustained community health changes, and diverse partnerships across the community that each bring something valuable to the table.