"Public Health is Evolving Right Before Our Eyes": Discussion on Transforming Public Health

Aug 15, 2012, 11:33 AM

Late last week hundreds of local, state and national public health practitioners gathered electronically for a webinar on a new report, Transforming Public Health, supported by the Robert Wood Johnson Foundation (RWJF). The goal of the webinar was to help public health officials and policymakers prioritize critical public health functions as budgets and governmental changes transform public health and responsibilities.

Key presenters included Terry Cline, PhD, commissioner of health of the Oklahoma State Department of Health; David W. Fleming, MD, director and health officer for public health in Seattle & King County in Washington State; and Paul Kuehnert, senior program officer and director of the RWJF Public Health team. Abbey Cofsky, RWJF program officer welcomed webinar attendees and Abby Dilley of RESOLVE moderated the discussion.

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The webinar led with panelists discussing the report and how public health transformations are happening in communities across the country, but also included ample time for attendees to ask their public health questions of the panelists. The discussion portion began with a question on what successful transformation of public health might look like in four years, and how that can be measured. “This is a critical time for public health,” said David Fleming. “Whether we are still here having this discussion [in four years] will be an indication of successful transformation.” Fleming added that public health will need to look at several factors: whether we have successfully preserved core functions, expanded to protect key features such as injury prevention and health equity, brought in new skill sets needed to survive and secured long term financing. To ensure success, said Terry Cline, metrics will have to involve population-based outcomes in communities and engagement of the health care system to join us.

Asked about what leadership of public health will look like going forward, Terry Cline said, “We have opportunities at multiple levels to exercise our leadership, including [access to other] leaders and policy-makers.” A disadvantage, though, points out Cline is that public health officials sometimes take on public health in its entirety “and then it doesn’t become a shared responsibility.” Cline says in Oklahoma, the governor and mayors have stepped up, because of the close relationships “and it warms your heart to hear the mayor talking about the number of bike trails and senior centers.” Adds Cline: “It’s a measure of success when other people champion the cause, not just us in public health.”


“Increasingly, said David Fleming, “our job in public health is influencing without authority and working within communities to get organizations and agencies that we don’t control and don’t give financing to, to align what they do with the health of the public. In my mind, that’s the most important area to focus on.”

Another webinar participant asked about the 1988 Institute of Medicine report on The Future of Public Health, and how the Transforming Public Health report differed from the earlier document. Terry Cline called it a “difference in magnitude of change.” Before, Cline said, public health adapted. “Now,” said Cline, “we have the chance to influence that change.”

David Fleming added, “the environment has changed dramatically. Health costs have spiraled out of control; we’ve had a recession, and there is increased distrust of government and public health. The strategy we embark on needs to acknowledge that. We’ve tried to define public health as doing all things for all people, and now we really have to define ourselves. From a policy and financing standpoint, we need to really determine what we will need to get our jobs done.”

And Paul Kuehnert made the critical point that three recent Institute of Medicine reports on public health drill down to public health financing, policy and law, and “if you look at the recommendations, it gives us a much better sense of policy recommendations that put the pieces out there of what the transformed system needs to address.”

In response to a question about public health partnerships with key stakeholders, which Terry Cline called “critical to our success,” David Fleming said “there is too little money in governmental public health [to pretend] we can do this without the private sector.”

The webinar ended on a question about information systems transformation. Terry Cline said that was “one of the clearest examples of concrete [opportunities]  to change the way we do business in public health and health,” and David Fleming said that it needs to be a core competency. “On the cultural side,” said Fleming, “we need to increase the willingness of clinical colleagues to provide relevant information to public health agencies. That’s a current challenge we’ll need to confront.”

In response to the discussion on leadership, Paul Kuehnert of RWJF made a critical point: “Often times as leaders in public health agencies, there are political and reputational risks…when you start opening up and asking the difficult questions. But I think we’re obligated in these changing times, not to shy away from those issues and to take those risks.”

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This commentary originally appeared on the RWJF New Public Health blog.