Today, New York State Health Commissioner Nirav R. Shah, MD, MPH, released the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State. The plan is a blueprint for local community action to improve health and address health disparities, and is the result of a collaboration with 140 organizations, including hospitals, local health departments, health providers, health plans, employers and schools that identified key priorities.

Dr. Shah, the architect behind today’s prevention agenda, was confirmed as New York State’s youngest Commissioner of Health two years ago. The state’s governor, Andrew Cuomo, had three critical goals: reduce the state’s annual Medicaid growth rate of 13 percent, increase access to care and improve health care outcomes.

Shah, a former Robert Wood Johnson Foundation Physician Faculty Scholar and Clinical Scholar, has already made important inroads in all three goals and the prevention agenda builds on that. NewPublicHealth spoke with Dr. Shah about prevention efforts already underway in the state, and what it takes to partner health and health care to achieve needed changes in population health.

NewPublicHealth: How does improving the social determinants of health help you achieve your goals in New York State?

Dr. Shah: New York’s Medicaid program covers 40 percent of the health care dollars spent in the state. We were growing at an unsustainable rate, and we needed a rapid, but effective solution. So, we engaged the health care community, including advocates, physician representatives, the legislature, unions, management, and launched a process that enables continuous, incremental, but real change toward the Triple Aim—improved individual health care, improved population health and lower costs.

Collectively, these efforts resulted in a $4 billion savings last year in the State’s Medicaid program, increased the Medicaid rolls by 154,000 people, and resulted in demonstrable improvements in quality throughout the system.

NPH: What opportunities do you see for public health and health care to work together in New York State?

While this is the first year that the American Public Health Association has used “return on investment” as the theme for National Public Health Week, which runs through April 7, it’s far from the first time that public health practitioners have made the case to policymakers that the work of public health can save lives and money.

Research on the impact of public health services includes the critical fact that spending just $10 per person in programs aimed at smoking cessation, improved nutrition and better physical fitness could save the nation more than $16 billion a year, according to the Trust for America’s Health. That’s a nearly $6 return for every $1 spent.

Over the last two years, NewPublicHealth has reported frequently on the value of investing in public health. Some of our favorite ROI articles, reports and other resources include:

• >>UPDATE: Trust for America's Health released Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts today. The report examine public health funding and key health facts in states around the country, finding inadequate and cut funding and wide variation in health outcomes by state and county.
  
• Making the Case for Prevention: A Q&A with James S. Marks, Senior Vice President, Robert Wood Johnson Foundation, about the great potential for investing in prevention.
  
• National Prevention Resources Starter Guide:
  A collection of resources that showcase how different fields can work together and take action to prioritize prevention.
  
• Strategies to Move from Sick Care to Health Care: The  Trust for America's Health identifies high-impact steps that the nation can take to prioritize prevention and improve Americans' health.
• Workplace Wellness Perspectives: A Q&A with two very different businesses—one big, one small; one academic, one industrial—on creating healthier workplaces.
• Employers Join Community Health Movement: A Q&A with Trust for America’s Health and the National Business Coalition on Health about the critical role of employers in community prevention efforts.
• Stories of the value of investing in prevention from Wyandotte County, Kan., and Hernando, Miss.

>>Read more on the value of prevention from RWJF.org.

As research builds showing that where you live has a big impact on how healthy you are, organizations and businesses across the country are joining the dialogue on how to create healthier communities. Recently, The Atlantic and GlaxoSmithKline hosted “A Conversation on Community Health”—a series of events in U.S. cities across the country to explore what it takes, to create a healthy community. The series brought together leaders from across different sectors to forge a dialogue across different perspectives.

Jason Q. Purnell, PhD, MPH, Assistant Professor at the Brown School of Social Work and Public Health at Washington University in St. Louis, was a panelist at the St. Louis Conversation on Community Health, along with Jackie Joyner-Kersee and others. Recently, Dr. Purnell shared his vision for community health, and the critical role of broad collaboration across sectors, with NewPublicHealth.

NewPublicHealth: What's your vision of a healthy community? 

Jason Purnell: My vision for a healthy community includes the elimination of health disparities by race and ethnicity and socioeconomic status.  It involves everyone, regardless of zip code or net worth, having the resources to lead full, productive lives.  I follow the World Health Organization in its holistic focus on social, emotional, and physical well-being rather than a more narrow focus on disease prevention.  A healthy community allows everyone in its boundaries to express their full potential; it allows them to participate in the life of the community, in life itself, to the fullest extent possible.   

NPH: Your efforts have included collaboration across psychology, public health, oncology, and primary care. Similarly, the Conversation on Community Health series includes participants from across sectors. Why does public health require such broad collaboration?

Organization and business leaders across the country are realizing that every sector needs to join the fight—or at least the conversation—to create healthier places to live. While altruistic motivations play an important role in this movement, a growing body of research also points to the idea that better health is a major driver for a healthier economy.

Recently, GlaxoSmithKline (GSK) partnered with The Atlantic to host “A Conversation on Community Health”—a series of events in U.S. cities across the country to explore what it means, and what it takes, to create a healthy community. NewPublicHealth checked in with GSK’s Senior Vice President and Corporate Medical Director, Robert Carr, MD, MPH, FACPM, to get his take on why businesses should care about community health, and why a broad, cross-sector dialogue is a critical next step.

>>Read more on communities that were recognized for innovations that are improving the health and lives of their residents, with the 2013 RWJF Roadmaps to Health Prize.

NewPublicHealth: What prompted you and GSK to start thinking about community health?

Dr. Carr: As an HR executive and medical director of a global business, I’m acutely aware that employees are—first and foremost—members of families and communities. The places where they live and the choices made by the people around them profoundly influence the health of our employees. We regularly hear that our employees want to know not only what they can do to lead healthier lives but also what we can do as a company to improve the health of their own community. They want us to dig in and find out what’s needed. Similarly, we recently conducted some research about what Americans are looking for more broadly, and we learned that they want the same thing from GSK.  They want us to do more in their communities.

We heard them loud and clear, and we are digging in, starting with understanding what it means and what it takes to be a healthy community.  Last year we kicked off a program we call “Healthy Communities.”  As part of this attempt to learn more, directly from those on the ground in different American cities, we partnered with The Atlantic for “A Conversation on Community Health.”

NPH: What’s the focus of the “Conversation on Community Health” series?

How healthy is your county? Answers are out today in the 2013 County Health Rankings, which examine the health and well-being of people living in nearly every county in the United States and show that how long and well people live depends on multiple factors beyond just their access to medical care. The Rankings allow counties to see what’s making residents sick or healthy and how they compare to other counties in the same state. The County Health Rankings, now in its fourth year, is a joint project of the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute.

“The County Health Rankings can be put to use right away by leaders in government, business, health care, and every citizen motivated to work together to create a culture of health in their community,” said Dr. Risa Lavizzo-Mourey, RWJF president and CEO. “The Rankings are driving innovation, unleashing creativity, and inspiring big changes to improve health in communities large and small throughout the country.”

The Rankings examine 25 factors that influence health, including rates of childhood poverty and smoking, obesity levels, teen birth rates, access to physicians and dentists, rates of high school graduation and college attendance, access to healthy foods, levels of physical inactivity, and percentages of children living in single parent households. 

Although the Rankings only allow for county-to-county comparisons of ranks within a state, this year’s Rankings show significant new national trends:

Washington State Secretary of Health Mary Selecky has announced her retirement from state service.  Selecky has served under three governors since her initial appointment as acting secretary in October 1998. She also served two terms as president of the Association of State and Territorial Health Officials, served on the board of the National Association of County and City Health Officials and is a past president of the Washington State Association of Local Public Health Officials. In 2010, Selecky received the American Medical Association's Nathan Davis Award for Outstanding Government Service.

NewPublicHealth Health spoke with Mary Selecky about her public health career and accomplishments.

NewPublicHealth: Your tenure has spanned many public health game changers. What stands out to you as the greatest triumphs and greatest threats in Washington State?

Mary Selecky: In terms of greatest triumphs, a key one is that we took on the issue of tobacco use in Washington State. Tobacco would be at the top of my list because of the health impact it has had and because it really is something that can be prevented by getting the right information out to people. It has taken us decades for the public to get it that smoking kills.

We had an announcement about tobacco yesterday, in fact. Among our 10th-graders, 9.5 percent used a cigarette in the last 30 days, and our rate has dropped from two years ago, even though across the nation the rate has flattened. So we’re doing something right. We’re a smoke-free state—not just tobacco-free but smoke free. And that really has the most profound influence on people’s health.

On the other hand, tobacco is also our greatest threat, because the tobacco companies continue to spend more than $140 million in this state to get you to use their product or to switch products, and we know they’ve moved to point-of-sale marketing. If you go into the smaller stores particularly, you’re greeted by all these tobaccos posters on the windows, inside the shop and on the counter. Those kinds of things are going on every single day—and every year there’s a new crop of 10th-graders. So it disturbs me that so many of our states have reduced tobacco prevention programs and that, as a result, nationally we’re not making much headway.

To mark the launch of the 2013 County Health Rankings, Risa Lavizzo-Mourey, MD, MBA, President and CEO of the Robert Wood Johnson Foundation will be taking questions and leading a group discussion via Twitter on March 20, from 2:00 p.m. to 3:00 p.m.

The Q&A will focusing on what's new in the 2013 County Health Rankings and how individuals and organizations can make use of the Rankings to create change for better health in their communities. Submit your questions to: @RWJF_PubHealth or @CHRankings and make sure to use the hashtag #healthrankings.

You can follow the County Health Rankings & Roadmaps on Facebook and Twitter to learn about the new data, find stories about how the project has improved health in communities like yours and get ideas for taking action where you live. The Facebook page will be posting useful new infographics, videos, quotes and images all week. On Twitter, join the Q&A, share your #healthrankings to fill in the “Race to 50” map, and ask an expert for help by tweeting your county to #myrankings.

Time to vote! The U.S. Department of Health and Human Services (HHS) has announced the start of public voting for the People’s Choice Award in the HHSinnovates Program, which rewards outstanding projects led by HHS employees to solve critical health issues.

The public is invited to cast their votes for finalists who submitted ideas that have proven to be scalable, replicable and uniquely innovative. The finalist with the highest number of votes will win the “People’s Choice” award, which will be announced March 19 in Washington, D.C.

Vote for your favorite finalist here. The top contenders include:

• Connecting to Combat Alzheimer’s
• FDA-iRISK
• The Body Weight Simulator
• Portal System: Linking Health Care Clinics
• Counterfeit Detector Device
• The Weight of the Nation Campaign

Read the full post for a detailed description of each.

Expect a workout if you’re headed out to the park in a growing number of cities around the country. Not just from trails and bike paths, but from elliptical machines, chinning bars, stationary bikes and resistance equipment now installed in close to 100 parks. No gym membership card, or fees of any kind, required.

The burgeoning project, called Fitness Zones, is a program of the Trust for Public Land, a national nonprofit land conservation organization. The “Zones” are installed at parks and recreation centers, using specially designed outdoor exercise equipment aimed at users of all ages. NewPublicHealth recently spoke with Adrian Benepe, Senior Vice President and Director of City Park Development at the Trust for Public Land, about the fast-paced growth and impact of the Fitness Zones.

NewPublicHealth: When are the chief goals of the Fitness Zone program?

Adrian Benepe: The Fitness Zone program is part of the Trust for Public Land’s Parks for People project and is aimed at urban parks. We have, just in the last three years, either created or are in the process of creating 81 Fitness Zones across the country. To establish a Fitness Zone, we work with public agencies, cities, county governments and parks departments to put together packages of public and private funding. In many cases we will do the design and installation ourselves.

The Fitness Zones function as free gyms. We aim to put them into areas where there is a high incidence of obesity and less opportunity to find or afford gym memberships. There are a lot of people who can’t afford to go to a gym and if they see their neighbors out there exercising, that can increase their motivation.

NPH: What differences do you need in design and installation for different geographic locations and climates?

Expansion of Health Insurance Coverage Could Lead to Physician Shortage
A new study in Health Affairs finds that expansion of insurance coverage under the Affordable Care Act could increase demand, on average, for primary care physicians more than 5 percent above the current number of available doctors. It also found that seven million people live in areas where the demand will exceed the supply of primary care providers by more than 10 percent. The researchers say the study emphasizes the need to promote policies that encourage more primary care providers to practice in areas where shortages will be very high. Read more on health disparities.

Institute of Medicine Launches ‘Roundtable on Population Health Improvement
The Institute of Medicine has launched a Roundtable on Population Health Improvement to provide opportunities for experts on education, urban planning, medicine, public health, social sciences and other fields to make recommendations on improving the nation’s health. "The evidence is now clear that broader social and environmental factors play major roles in a person's likelihood to have a low birth weight baby—a risk for many serious health problems— or die of a heart attack or complications from diabetes," said roundtable co-chair David Kindig, Emeritus Professor of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison. "That's why it's essential to engage all these sectors—education, housing, transportation, community organizations, and business among others— in efforts to improve health outcomes." The issues the roundtable will address include expanding reimbursement to include more nonclinical, population-based interventions; reorienting the relationship between clinical medicine and public health in ways that will benefit population health outcomes; and engaging professionals from nonhealth fields in health improvement efforts. Read more on community health.

CDC: 11% of Daily Calories for Adults Comes from Fast Food
From 2007 to 2010 approximately 11 percent of the calories in American adults' daily diets came from fast food, according to a report from the U.S. Centers for Disease Control and Prevention. While high, the rate was down from 2003 to 2006, when about 13 percent of daily calories came from restaurants such as McDonald's, Burger King, Wendy's and Pizza Hut. "The good news from this study is that as we get older, perhaps we do get wiser and eat less fast food," said Samantha Heller, a clinical nutritionist at the NYU Center for Musculoskeletal Care in New York City. "However, a take-home message is that the study suggests that the more fast food you eat, the fatter you get." Read more on nutrition.