Category Archives: Public health system and finance
Public health has experienced major economic, environmental, and technology upheavals in recent years. A new round of research supported by the Robert Wood Johnson Foundation (RWJF) will examine how recent dramatic changes in the operation of the nation’s public health system impact its effectiveness in such critical roles as emergency preparedness and reporting of disease outbreaks.
Seven new research awards are part of an initiative on “natural experiments” in public health delivery developed by the National Coordinating Center for Public Health Services and Systems Research (PHSSR), a RWJF-funded center housed at the University of Kentucky College of Public Health. The awards of $200,000 each are being administered by the National Network of Public Health Institutes.
NewPublicHealth spoke with Lainie Rutkow, PhD, JD, MPH, assistant professor at the Johns Hopkins Bloomberg School of Public Health, about her award to assess whether state laws influence the public health workforce’s willingness to respond in emergencies. The award will include collaboration with the National Registry of Emergency Medical Technicians; Butler County Health Department in Missouri; and the Multnomah County Health Department in Oregon. Rutkow, a member of the Eastern Region of the Network for Public Health Law, will also be presenting about some of her other emergency preparedness work at the Public Health Law Conference in Atlanta this week.
>>Follow NewPublicHealth coverage of the Public Health Law Conference, with speaker interviews, session coverage and more.
NewPublicHealth: Tell us about natural experiments and the opportunity they offer to better understand how the public health system can operate more effectively.
Lainie Rutkow: Natural experiments really capitalize on variations that already exist, particularly within the public health system, and as researchers we can analyze the public health impacts of a natural experiment over time and also in different settings. I see natural experiments as an opportunity to compare populations who are exposed to a particular policy with populations that have not been exposed to that policy. It would be very difficult or impossible to do that kind of thing in a controlled research setting.
NPH: What is your particular award designed to look at?
The Transforming Public Health project supported by the Robert Wood Johnson Foundation (RWJF) and convened by RESOLVE brought together a group of local, state and national public health leaders to develop guidance for public health officials and policymakers in prioritizing critical public health functions in a changing political and funding landscape.
Recently, the Foundation hosted a webinar to discuss the Transforming Public Health project. Speakers included:
- Terry Cline, Oklahoma State Health Department
- David Fleming, Seattle-King County Health Department
- Abby Dilley, RESOLVE
- Abbey Cofsky, RWJF program officer
- Paul Kuehnert, senior program officer and director of the RWJF Public Health team
>>Read our recap of the discussion from the webinar.
But the conversation shouldn't stop there. We want to hear your thoughts on the future of public health. Below are some questions to get you started. Feel free to add your thoughts in the comments below, and help us chart the course for a new public health.
- How is your public health department adapting in the current changing landscape?
- How is your community prioritizing programs and services to take on new challenges in a time of declining resources?
- How have you engaged policy-makers and diverse partners in your community on issues critical to public health?
>>Read more: Check out these resources to get ready for the webinar and inform the discussion:
Jo Ivey Boufford, MD, president of the New York Academy of Medicine, was a keynote speaker this week at the National Network of Public Health Institutes (NNPHI) Annual Conference in New Orleans, La.
>>Watch Dr. Boufford in a video series on working together to make communities healthier places to live:
NewPublicHealth spoke with Dr. Boufford about the conference theme, “Leveraging Public Health Institutes for Systems Change.”
NPH: The theme of the conference is leveraging public health institutes for systems change. What systems do you think need changing to improve population health?
Dr. Boufford: I think there are really two major components to a public health system. One of them obviously is the governmental public health infrastructure—the public health agencies at state and local levels that are really charged to assure the health of the public, by detecting illness and promoting health information and trying to change environments so people can live in healthier communities. A lot of reports have shown that that part of the health system has historically been very under-invested in, and it needs to be shorn up. I think the national public health institutes should be strong advocates and partners of the governmental public health agencies in leveraging resources to improve population health.
The other part of the system is the personal health care system, which is and potentially will be undergoing dramatic change with the Accountable Care Act (ACA). There are a number of opportunities to get better population health impact out of the personal health care system, such as looking at the role of community health centers, of medical homes, of accountable care organization models to improve the health of a geographic community or particular population over time. So I would say those are the two big opportunities, and public health institutes in states need to work closely to take full advantage of the opportunities for populations.
NPH: What other key roles do you see public health institutes playing in improving population health?
Last week’s Keeneland Conference included a session that looked at research in the area of law and legal process. The session was moderated by Scott Burris, JD, director of Public Health Law Research, a program of the Robert Wood Johnson Foundation, based at Temple University.
Burris noted several key presentations during the conference including one by Julia Costich, JD, PhD, who is an associate professor in the Department of Health Services Management at the University Of Kentucky College Of Public Health. Costich presented on the importance of how health agencies enforce the power they have. Burris says there is a huge body of literature from regulatory and governance sources on how effective regulators regulate—and that public health is only beginning to draw on. “That’s really opening a big important door, and we’ll see a lot more about that in future years.”
Jennifer Ibrahim, PhD, MPH, an associate professor of public health at Temple University, looked at how law is being figured out at the local level. Burris said that researchers both at the Public Health Law Research Program and collaborators have conducted research on the relationship between state and local health officers and their lawyers.
National Public Health Accreditation launched last fall, and since then 64 local health departments, three tribal health departments and one state department have submitted applications to the National Public Health Accreditation Board (PHAB). Carol Moehrle, chair of PHAB and director of public health for the Idaho North Central District, spoke about the accreditation process and benefits during a keynote speech at the Keeneland Conference. NewPublicHealth caught up with Carol Moehrle during the meeting.
NewPublicHealth: Are you pleased with the number of applicants you’ve seen so far?
Carol Moehrle: We are pleased. We knew we’d have some early adopters. And to have 68 complete their applications with the last seven months, that’s a great start. We’ve got a long way ahead, but we also know we have many applicants in the queue waiting to apply. We’re hearing lots of good energy, and departments beginning the process now can look to the earlier applicants for best practices, so applying will be easier as time goes on.
NPH: What is the process and timetable for accreditation application review?
Richard J. Umbdenstock, American Hospital Association: Opportunities for Collaboration Between Health and Health Care
The intersection of health and health care was an important theme at this year’s Keeneland Conference—during sessions on recent IOM reports, in hallway conversations, in discussions of Public Health Services and Systems Research that explores the most efficient ways to deliver public health services, and, notably, during the keynote address by Richard Umbdenstock, president and CEO of the American Hospital Association.
In his presentation, Umbdenstock talked about hospitals and public health, "collaborating for communities," and said that as health care providers, hospitals had tended to focus on treating the individual, rather than on prevention for the population. Now, he said, the money is gone and the public cares more about health, meaning it makes less and less sense for either hospitals or public health to be concerned with protecting their turf. “We need to incent health and deglamourize consumption.” Quoting a colleague, Umbdenstock said “what we need to do is create an epidemic of health.”
Umbdenstock spoke frankly when he told the attendees, “hospitals want to improve the lives of their patients, and not just their health care. Rather than wait for an [hospital] admission that won’t be paid, they’d rather get upstream on primary care.”
“Public health departments must be funded and supported so that wellness and prevention touches all and there are enough resources to do that,” said Umbdenstock. “And this is where research can play a big part—collaborative health research. We need to know the most effective collaborative models and the most effective ways to advocate for greater personal and community responsibility.”
NewPublicHealth caught up with Richard Umbdenstock following his talk.
NewPublicHealth: What are you hearing from hospitals about the new IRS community benefit requirement?
Richard Umbdenstock: Some hospitals have had similar responsibilities at the state level and many have had to put out accountability reports to their communities, so for many it’s not a new concept. In addition, hospitals have long been under a microscope and they also understand that community benefit is a wonderful community education tool. If they can tell it in a clear and consistent fashion, there’s a real opportunity for the public to better understand what hospitals and public health departments do.
NPH: Do hospitals and public health understand the critical community roles each one plays?
Richard Umbdenstock: I don’t think there’s any question what public health departments do after you’ve see them spring into action after a disaster, just as a lot of people don’t value what hospitals do until after they’ve been a patient. On a day-to-day basis we can all get so deep in our work that we just don’t see what the other person is doing. What we’re learning is that we all serve the same person.
Frontiers in Public Health Services & Systems Research: Making Critical Research Accessible, Quickly
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Glen Mays, MPH, PhD, F. Douglas Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health, talks about the launch of a brand new online journal covering public health systems and services research, and why it is so critical right now, to inform smart investments in public health and prevention. The new journal, Frontiers in PHSSR, is designed to disseminate the most critical early findings from PHSSR research much faster—making these findings accessible far in advance of the fully-developed scientific manuscript. To be eligible for inclusion in Frontiers, findings must have the potential to guide future public health practice, health policy, and research. Mays is the editor in chief of the new journal.
Portions of the post below are adapted from the opening commentary in Frontiers, authored by Mays, F. Douglas Scutchfield, Paul K. Halverson, William Riley and Peggy Honore.
The need for a strong and effective public health system in the United States is perhaps more urgent today than at any other time in our nation’s history. Preventable diseases and injuries account for more than three-fourths of the $2.6 trillion in health care expenditures incurred annually in the U.S. The growing prevalence of obesity, diabetes and other preventable conditions constrains the nation’s economic productivity and global competitiveness. The American public health system—the diffuse constellation of governmental public health agencies and their peers and partners in community-based settings and the private sector—is tasked with developing and delivering strategies that promote health and prevent disease and injury on a population-wide basis. They share the mission of creating conditions in which people can be healthy.
The public health system is uniquely positioned—but not optimally equipped or resourced—to take on these challenges. Only about 3 percent of the nation’s $2.6 trillion in annual health expenditures is devoted to public health activities. Some of our greatest uncertainties now lie in how best to organize, finance, and deliver effective public health prevention strategies to communities across the U.S. The field of public health services and systems research (PHSSR) has emerged to fill this void.
Frontiers in PHSSR
The American public health system and the populations it serves do not have the luxury of waiting the 15 years typically required to get research-tested solutions widely adopted into practice. The costs associated with missed opportunities for disease prevention and health promotion are straining government and household budgets now.
To help develop and grow this scientific learning community, we have launched a new, open-access, peer-reviewed journal, Frontiers in Public Health Services and Systems Research. This journal provides a platform for rapidly and widely communicating emerging findings and lessons learned from studies of public health services and delivery systems. Frontiers will feature brief descriptions of preliminary findings from ongoing or recently completed empirical studies and quality improvement projects that answer important questions regarding the organization, financing, and delivery of public health services.
In 2009, the Robert Wood Johnson Foundation, requested the Institute of Medicine (IOM) to convene a committee to consider three major topics in public health: measurement, law and policy, and funding. The last of these reports, which recommends new health targets and changes in how public health is funded and organized, was released last week and has been a key topic of discussion at this week’s Keeneland Conference.
Harvey Fineberg, MD, president of the IOM, delivered a keynote address on these three reports, as well as another recent report on the potential for collaboration between public health and primary care. NewPublicHealth spoke to Dr. Fineberg about the reports and next steps.
>>We're on the ground in Kentucky all week. Follow our coverage for the latest news.
NewPublicHealth: How will the findings from the three-report series on public health be helpful to public health service delivery going forward?
Dr. Harvey Fineberg: I think of these reports as the contemporary trilogy of public health. They each stand on its own and yet are also connected in a vital way.
The first report looks at how we can know where we stand in public health. It emphasizes the importance of a standard core set of indicators. The aim is to make them a guide for policy and practice of public health, and to monitor where we are and what needs to be done.
The second report was on the legal foundation that provides the authority for health agencies to protect the public’s health. It turns out that many of the statutes have been on the books for decades and don’t necessarily have the specifics for dealing with contemporary needs such as the challenge of dealing with obesity or emerging infectious diseases or bioterrorism. The report pointed to the ten essential services of public health which set a standard of practice, and spoke to what state laws would be needed to make the ten core functions operable.
The third report dealt with essentially the resources that would be needed to carry out public health services. And the committee found that we grossly under-invest in public health. They recommended a conservative estimate of doubling the national investment and proposed a fee on dollars that flow through the medical system to be captured and reinvested in prevention, which they said would ultimately protect and improve health.
NPH: How important was the evidence base to the committee in producing the reports?
Debra Joy Pérez, MA, MPA, PhD, assistant vice president for Research and Evaluation at the Robert Wood Johnson Foundation, was a keynote speaker at the Keeneland Conference yesterday and spoke about the evolution of public health services and systems research (PHSSR). NewPublicHealth asked Debra Pérez about that evolution.
>>Follow our continuing coverage of the Keeneland Conference.
NPH: Why is the field of PHSSR a priority for the Robert Wood Johnson Foundation?
Debra Pérez: Right now, I think more than ever we need evidence to provide decision-makers with the evidence for how best to apply limited resources. We know in the last year alone over 40,000 public health jobs were eliminated, so that means that health departments are struggling with staffing and infrastructure issues, and they need evidence to help them best apply the limited resources they have now.
NewPublicHealth: What’s the scope of the conference this year compared to previous years?
The annual Keeneland Conference kicked off today, where more than 300 public health services and systems researchers (PHSSR), public health officials and policy-makers have convened to discuss the latest issues in this growing field of research. PHSSR is aimed at establishing an evidence base to allow public health officials to make smarter, more-informed decisions with regard to resource allocation, staffing, operations and service provision.
NewPublicHealth is on the ground in Kentucky to capture the critical conversations and Q&As from leaders in the field. We spoke with F. Douglas Scutchfield, MD, director of the National Coordinating Center for PHSSR and the Peter Bosomworth endowed faculty in the University of Kentucky College of Public Health, to get his take on where the PHSSR field stands and the anticipated highlights of conference.
NewPublicHealth: What are the critical areas for public health as you head into the Keeneland Conference?
Dr. Scutchfield: I think there are several agendas that will be a backdrop against which Keeneland is taking place. One is a reformed healthcare system, with the Affordable Care Act and its implications for public health and public health’s relations with a variety of other service delivery systems, such as primary care and hospitals.
We will also see the rollout of a new research agenda, published as a supplement to the American Journal of Preventive Medicine,that will give us a new direction to pursue in terms of how we’re going to begin to try improving the infrastructure in the public health system.
NPH: What has been your sense in speaking with colleagues in the field about what kind of research is most in demand for public health leaders and decision-makers right now?