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:

Public health departments and schools of public health across the country are showing the love this Valentine’s Day. Many have loaded great ideas for healthy hearts and happy lives on their home pages, Twitter feeds and  Facebook pages:

• The Massachusetts Department of Health offers (somewhat) healthy  Valentine’s Day chocolate ideas.  
• The Lexington-Fayette County (Kentucky) Health Department wants to salute American Heart Month (February) by having people wear red for Valentine’s Day and share photos through the department’s  Twitter feed or Facebook page.
• A community health clinic in Yolo County, Calif., is holding its annual Valentine’s Day diaper drive.
• Our Favorite: A Valentine’s Day infographic from the Ohio State University College of Public Health gives healthy AND romantic tips for the day. Best idea—take romantic walks! [See full infographic below.]
  

>>Bonus Link: Whether you mailed a card or not, the Centers for Disease Control and Prevention has a virtual rack full of Valentine’s Day health-e (get it?) cards, with all the gush, and plenty of heart-healthy ideas.

San Diego County in California has set out to become the nation’s first “heart attack and stroke-free zone.” In a collaborative effort, local hospitals and health care providers are using innovative health information technology and focusing heavily on prevention to achieve this important goal, while the public health community continues to work toward making the county a healthier place to live.

The community was inspired to set this unprecedented public health benchmark when the California Department of Managed Health Care (DMHC) launched the Right Care Initiative in 2008, setting a statewide goal of reaching the 90th percentile nationally for controlling many of the factors which lead to heart attacks and strokes. Prior to 2008, 16 million Californians – about 44 percent of the population – were affected by chronic disease, half of whom suffered from more than one chronic condition. 

DMHC has formed key partnerships with California health plans and medical groups, the California Chronic Care Coalition, University of California, American Diabetes Association, American Heart/Stroke Association and community organizations throughout the state. As a result, doctors, patients, and community organizations are saturated with traditional and social media that stress the importance of being proactive.

Communities strive to meet the Right Care Initiative goals through the enhanced practice of patient-centered, evidence-based medicine focusing on the following efforts:

• engaging patients more actively to improve their health with diet and exercise;
• involving pharmacists as part of the patient’s care team; and
• learning proper medication protocol.

Since the Initiative started almost five years ago, eight of the nine largest health plans in California have made overall improvements on heart and diabetes quality measures, 11 groups in California have reached the 90th percentile of clinical control measures, and DMHC has assisted more than one million Californians to resolve their health plan problems.

San Diego is just one community among many waging a battle against chronic disease and the enormous toll it exacts on quality and years of life. Stroke alone takes more than 140,000 lives each year.  According to the American Stroke Association, only two-thirds of Americans know at least one of the seven warning signs of stroke. The American Heart Association (AHA) and American Stroke Association (ASA) partnered with the Ad Council to launch their first national multimedia public service campaign to raise awareness in recognizing and responding to the warning signs of stroke by using the acronym: F.A.S.T.

A study released this fall in the American Journal of Public Health looks at a critical evidence-based teen pregnancy prevention program led by the United Way of Greater Milwaukee. The United Way catalyzed critical partnerships between schools, community organizations and the Milwaukee Health Department to focus on the goal of reducing teen pregnancies.

In 2008, United Way of Greater Milwaukee, together with its partners, made a public commitment to reduce teen births among 15- to 17-year-olds by 46 percent by 2015. In October 2011, the City of Milwaukee and United Way announced the fourth consecutive yearly drop in the teen birth rate, by 13.5 percent, to its lowest level in decades. The current trend indicates that the partners are on track to reach their goal of 30 births per 1,000 (a 46 percent drop) by 2015.

Initiatives to support these goals include:

• Significant investments in programs through the Healthy Girls project that helps young people understand the consequences of teen pregnancy while also teaching them the skills needed to cope with social pressure to engage in sexual activity.
• A collaboration with the Medical College of Wisconsin and Children's Hospital of Wisconsin residents to develop content for a youth-focused, website, Baby Can Wait, with medically accurate and age-appropriate content on preventing pregnancy and promoting healthy relationships.
• United Way worked with Milwaukee Public Schools and other community leaders to revise human growth and development curriculum. Community members were given an opportunity to review the materials and make suggestions about content, and teachers received training in the new curriculum.

NewPublicHealth caught up with Nicole Angresano, Vice President at United Way of Greater Milwaukee, to get her take on the program’s successes and what other communities can learn from them.

NewPublicHealth: What is different about this effort to focus on teen pregnancy for your community?

The state of Maryland recently passes legislation to address health disparity issues through “health enterprise zones.” The legislation allows local non-profits, health agencies, and local health providers to work together to address this critical issue through innovative public health strategies including tax incentives, financial awards and capital improvement funding for physicians and health care organizations.

Lt. Governor Anthony Brown of Maryland played a key role in establishing the zones, and spoke about them in session at yesterday’s GOVERNING Summit on Healthy Living. Lt. Governor Brown gave some important background on his personal push to establish the health enterprise zones, explaining that his father was a doctor who “taught a lesson of service.” For decades, he said his father saw and cared for patients in some of the poorest neighborhoods in New York. “I saw the file cabinets of unpaid invoices. My father taught me we have a responsibility to serve and care for our neighbors.”

Brown told the audience that, “as we look at health reform, there are real opportunities to address disparities in health. As we expand access, we need to increase quality and equity. I believe we can eliminate health disparities.” NewPublicHealth had the opportunity to speak with Lt. Governor Brown about health enterprise zones.

NewPublicHealth: Is this the first time that a health enterprise zone has been implemented?

"Black men today are more likely to receive a GED in prison than graduate from college. One in three black men, and one in six Latino men, are projected to go to prison in their lifetimes.

There is new hope--Sacramento is now responding to this crisis. This time last year, California Assemblymember Sandré Swanson created a special committee of legislators whose sole charge is to improve the life chances of these young men. The Select Committee on Boys and Men of Color spent the past year traveling the state hearing from black and brown men--adolescents, men who have "made it" and others who've turned their lives around. The Committee is in the process of presenting their findings and practical solutions.

For me, this is personal. In the 1960s, as a young boy growing up in a South Bronx housing project, I saw graffiti, shattered glass, broken elevators, zip guns and welfare. I didn't need a medical degree then to know that the place was unhealthy. And I didn't need a doctorate to understand that black and brown people were at the short end of the fairness and opportunity stick. My family was living it.

I understand now that successful, thriving young people aren't born. They're nurtured. The checklist to grow up includes caring adults, safe places to play, good schools and real job opportunities." – Robert K. Ross, President and CEO of The California Endowment

Robert K. Ross, MD, President and CEO of The California Endowment, recently returned from a three-month study leave to better understand the challenges and opportunities facing boys and young men of color across California and the country.

Dr. Ross is at the American Public Health Association gathering this week to discuss The Endowment’s Building Healthy Communities initiative and the foundation’s work to advance the health and well being of our young people.

NewPublicHealth: What are the goals of The California Endowment’s work with boys and young men of color?

Dr. Robert Ross: Many young people in California live in communities with concentrated poverty, under-resourced schools and unsafe streets. They are more likely to experience poor health, suffer from unemployment and lead shorter lives. This is especially true of young men of color—African Americans, Latinos, Asians and Native Americans.

As thousands of people who are striving to improve health and health care convene in San Francisco, Calif., for the American Public Health Association Annual Meeting, RWJF is hosting brief interviews with thought leaders from across sectors. Brian Gallagher, President and CEO of United Way Worldwide, provided his thoughts on partnerships.

NewPublicHealth also spoke with Stacey Stewart, who was recently named to the new position of president of United Way USA. She was previously the executive Vice President, Community Impact Leadership and Learning at United Way Worldwide. Stewart shared her goals for UnitedWay USA, as well as what she's learned about the integral connections between education, income and health.