Jul 25 2012

Transforming Public Health: A NewPublicHealth Q&A

The Transforming Public Health project supported by the Robert Wood Johnson Foundation 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. The report, which emerged from the discussions, stresses the need for public health leaders to take critical steps such as to develop policy goals, mobilize the community and forge partnerships with health care, business and other sectors.

On Friday, August 10, the Foundation will host a webinar to discuss the Transforming Public Health project. Speakers will include Terry Cline, Oklahoma State Health Department; David Fleming, Seattle-King County Health Department, who were both participants in the convenings, along with Abby Dilley, RESOLVE; Abbey Cofsky, RWJF program officer, and Paul Kuehnert, senior program officer and director of the RWJF Public Health team. (Read a NewPublicHealth interview with Paul Kuehnert on the future of public health and the growing importance of partnerships in creating stronger health departments and healthier communities.)

NewPublicHealth spoke with Paul Jarris, MD, executive director of the Association of State and Territorial Health Officers and Robert Pestronk, MPH, executive director of the National Association of County and City Health Officials, who were also participants, to discuss how the findings can be implemented to help improve public health services and population health.

NewPublicHealth: What were some of the key issues raised by the project?

Paul Jarris: The world is truly changing. It’s already changed at the state and local level, where we’ve lost the 62,000 [public health] jobs, where we are cutting programs that were unthinkable to cut in the past being reduced and in some cases eliminated. And then there are the impacts of the Affordable Care Act and changes coming in funding from the federal government, which, of course, is most of the money that comes into the states for public health. A lot of our discussion during the convenings focused on how we could be proactive in anticipating these changes – determining [how] we can preserve the core or foundational aspects of public health, and make sure it’s as efficient and effective as possible. And, keeping in mind that, at the same time, public health leaders need to look for and anticipate new opportunities to best protect and serve the needs of the public.

NPH: What were some of the critical lessons learned from the discussions?

Paul Jarris: Policymakers need to assure that we have a robust public health system in place as we move through health reform. Secondly, there are important functions like infectious disease, which don’t go away. We have a hepatitis C outbreak in New Hampshire, and we have a dramatic pertussis outbreak in Washington State, so it would be a mistake to think we don’t need to maintain vigilance and maintain the very infrastructure that has made these diseases so rare.

On top of that, we need to look at public health and into the future to see the unique contributions that public health makes to overall health in the healthcare system. For example, it’s still very necessary to have surveillance going on, but that surveillance is going to change–we’ll have integration of electronic health records, a different type of surveillance. We’re moving into a new world and that needs to be supported if the American people are going to be protected.

And, as [public health leaders and elected officals] look at what to do and not do, and consider: Is public health the most appropriate party to perform a function? Can they do it most effectively? Can they do it most efficiently? Is there anyone else who can do that function? In many parts of the country, if public health wasn’t providing the safety net, there simply would be no safety net, and that will be equally true when we have many more people who are insured try to find a primary care provider and there simply isn’t one other than the public health department to, for example, investigate a person’s suspected tuberculosis or STD or hepatitis C. That’s a function of the public health department, not a function typically of the clinical sector. So, we need to maintain the core public health services and make sure they are as effective and efficient as possible. But there’s going to be new things that need to be done and supported.

Robert Pestronk: There was general agreement that the future design, capacities, activities and performance of local health departments are an important national issue, and that some of the issues that are fundamental for local health department success in the future revolve around the themes of leadership, partnership, policy, data—having it and how it can be used—and communications. And I think that some of the values that are important going forward are values of continuous quality improvement and accountability. In our conversations anticipating the future, there was a good sense that some core capacities and activities need to be present in all local health departments and as a result, some consistent and sustainable and sufficient source of funding will be necessary in addition to specific capacities and skills within the workforce that will be necessary. That allows the advocates to make the argument about why a certain level of funding is necessary at all levels.

I think a lot more work will need to be done to become much more specific about how the ideas and themes of the report can be turned into something more operational at health departments across the country. Baked into this conversation is a sense that in some states there will need to be additional cross-jurisdictional efforts, already present in a lot of places.

NPH: How do you think the project helps improve public health’s role in protecting the public?

Paul Jarris: In many cases public health can be the honest broker or the convener — not just within the health sector but across those areas that affect health such as transportation, education, and economic development – to allow us to work in a much broader sphere than we are now. Those skills to lead across sectors are ones that not all health departments have right now and that need to be developed.

Robert Pestronk: While documents like this help to stimulate thinking within the public health community, the question is whether in the larger policy community, anyone is giving attention to these issues, particularly within Congress and at the federal level. The national discussion is so focused on clinical care that the extent to which there can be growing incentives to develop the governmental public health system at the local level all across the country remains to be seen.

Tags: Partnerships, Public Health Departments, Public and Community Health, Q&A