Jo Ivey Boufford: Q&A at the National Network of Public Health Institutes Annual Conference

May 24, 2012, 4:41 PM, Posted by

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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?

Dr. Boufford: I think advocacy for helping the public understand the importance of public health in general and the fact that while the U.S. spends a huge amount of money in its health system, most of it is not generating terrific health results. Our investments in our health system are off kilter because most of it’s in the personal care side and very little is in the broader public health side. So as a consequence, health outcomes aren’t what they should be, and I think the public health institutes can help the public and policymakers and politicians understand that that imbalance is causing a problem in terms of a lot of money spent is not generating the kind of health outcomes we’d like to see.

I think the second opportunity is really working in partnership with state and local health departments to help fill gaps in their ability to deliver the central health functions to communities. Those gaps very often are related to the amount of funding available, but sometimes busy health departments don’t have a research capacity that a public health institute might have.

NPH: Public health accreditation was a key topic on the agenda at the NNPHI meeting. How do you foresee the initiative making a difference to improve the public’s health?

Dr. Boufford: I think it’s an important step for assuring a basic level of quality and capability in state and local health departments who choose to go for accreditation. I think it raises the bar. It will certainly help identify state and local health departments that aren’t able, because of resource constraints or other lack of support, to reach that bar. The hope is that all health departments will eventually want to achieve that level of functionality because it stipulates certain skills and capabilities that stakeholders will be able to invest in—such as workforce or in other systems that are specifically identified as weak in the accreditation process. And, most other major players in the health systems space are accredited. Hospitals are accredited; community health centers are accredited, so I think that having public health agencies accredited adds to credibility.

NPH: How important is it for communities to take ownership of becoming healthier, even if health departments and public health institutes stand ready to help them?

Dr. Boufford: Most of the literature is very clear, that if the community itself doesn’t own the agenda of improving the health situation in a community, there is no sustainability in terms of really reaching the kind of health goals that might be set by a health department or by a public health institute. So the engagement of community is really a fundamental component of making a health system work towards health, and I think the challenge of effective partnership with public health institutes, and with state and local health departments of communities is really fundamental.

There needs to be community engagement in helping define what they see as the problems in their communities and then in helping to develop solutions that are relevant at the community level. If we can say there’s an obesity problem in a community, the community may help us identify problems impacting that, such as no place to buy fresh fruits and vegetables or no safe spaces for their kids to play; or the schools in their community don’t offer recess or don’t offer healthy food. So, those become local solutions that will be relevant in some communities, but not in others. And the community needs to work with you to judge whether your intervention made a difference.

I think that’s more and more the philosophy that is taking over in terms of public health action, and the ability to activate communities by giving them more information and helping them understand the role that they play is going to be fundamental to long-term change.

NPH: What is the importance of cross-sector partnerships in improving the health of communities?

Dr. Boufford: It’s fundamental because in the first place, government by itself can’t deliver the kinds of changes we’re talking about. So you’ve got to have government working in public-private partnerships with community groups, with business, with media, with academics to join together around changing communities in the ways that we’ve talked about. I think the other multi-sectorial piece is that health departments alone can’t make these changes. To change streets, you have issues of transportation policy; to improve security in a community, you need to work with the police department; to make parks available, you need to work with the parks department. All of those involve government agencies beyond the health departments at state or local level, and so the multi-sectorial approach is dynamic.

NPH: What are some exciting efforts underway in New York to improve population health?

Dr. Boufford: The aging improvement district idea involves the commitment of the mayor and the city council to helping make New York City friendlier to older persons so that they can age in a healthier and more active way and give back to their community. It starts fundamentally with the voices of seniors defining what makes it hard or easy for them to live in their communities, and that then becomes a discussion with people in a position to help deliver interventions to address their concerns. I think New York City, under Mayor Bloomberg, has really provided a gold standard for how cities can work to make environmental change through the regulatory process, including the smoking bans, calorie postings, eliminating trans fats from chain restaurants, bike lanes, parks, accessibility, and pedestrian malls, as just some examples. All of these are efforts that the city has put in place to change the environment to make it healthier so that the healthy choice is the easy choice for the people who live in New York City.

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