ASTHO Opening Session Targets the Intersection of Public Health and Health Care

Sep 13, 2012, 10:27 AM

Paul Wallace speaking at the ASTHO opening session Paul Wallace speaking at the ASTHO opening session

GUEST POST by Lisa Junker, CAE, director of communications for the Association of State and Territorial Health Officials (ASTHO)

At the opening session of the ASTHO Annual Meeting in Austin, Paul Wallace, vice president of The Lewin Group, pointed toward the need for collaboration and partnership between the health care and public health sectors to overcome key challenges and trends facing the United States at the federal, state and local level.

>>Read our earlier interview with Paul Wallace on public health and primary care integration.

“What are the opportunities to create a shared conversation around prevention?” asked Wallace, who chaired the Institute of Medicine (IOM) Committee on the Integration of Primary Care and Public Health.

He gave attendees an overview of the process his IOM committee underwent to develop the recently-released report “Primary Care and Public Health: Exploring Integration to Improve Population Health.”  The committee was charged with identifying the best examples of effective integration and the factors that promote and sustain those efforts, examining the ways federal agencies can use the provisions of the Affordable Care Act to promote integration, and discussing how Health Resources and Services Agency (HRSA) supported primary care systems and state and local public health can promote those efforts moving forward.

Wallace noted that one of the committee’s first challenges was developing a shared definition of “integration,” which they came to see as “the linkage of programs and activities to promote overall efficiency and effectiveness and achieve gains in population health.” They also realized that “integration” is not an all or nothing proposition; it instead reflects a continuum ranging from isolation to cooperation, collaboration, partnership and even merger. Any of these points along the continuum of cooperation may be appropriate in a given situation.

Wallace also noted that today is not the first time public health and health care leaders have considered the benefits of greater integration. He pointed to the Folsom Commission’s forward-thinking 1966 report, “Health is a Community Affair,” which covered much of the same ground as his committee’s efforts. But today may be a better time for these ideas to take root, Wallace said: “The challenge is taking what has been the opportunity for decades and turning it into action.”

Four key factors could promote the success of today’s integration efforts: a dramatic rise in health care costs (and those costs’ resulting impact on other sectors such as education, jobs and infrastructure); an increasing understanding of chronic health conditions, their social and environmental determinants, and the impact of primary prevention; the unprecedented wealth of data available to health care and public health practitioners and leaders; and the overarching opportunity presented by the Affordable Care Act to change the way we approach health in the United States.

Wallace described a number of key principles identified by the IOM committee in their review of successful integration efforts. First, participants must share a common goal —improving the public’s health. The community must be engaged in defining and addressing population health needs. Aligned leadership must bridge disciplines, programs and jurisdictions to reduce fragmentation and foster community. To do this successfully, though, leaders must also take care to clarify roles and ensure accountability, and provide oversight for the shift in the way the system works. The effort must be sustainable and include the establishment of shared infrastructure and efforts to build for enduring value and impact. And of course data and analysis must be shared and used collaboratively.

With those principles in mind, Wallace noted, “There is no single best solution for achieving integration,” but he also encouraged state health leaders to look at their communities as possible laboratories to develop solutions.  The natural diversity among the states and among local communities gives ASTHO members and other state and local public health leaders the opportunity to identify and learn from early adopters and innovators. “If this is going to happen, it’s going to happen in the states,” Wallace concluded.

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