By Karen Hacker, MD, MPH; Director, Allegheny County Health Department; Pittsburgh, Pennsylvania
Today, public health has the potential to be at the forefront of redefining standards for population health. Today, we are not the only ones in the population health sphere. As health care moves from volume to value, we are hearing new standards for population health such as membership in a health insurer, a patient with a specific condition, or a group of patients served by the same physician (a physician’s panel). These are not the standards that public health has historically used to measure population health.
Public Health 3.0 should make us all think about population health. What can public health uniquely do to improve population health? What is our role in creating a community culture of health? In social determinants of health? How can we create and influence change? We cannot do it ourselves. We must reach across sectors to address the needs of the population we serve. Public Health 3.0 recognizes that local public health departments sit at the nexus of population health. As a local health department director, I often say that if I could identify all the chess pieces and move them to where they are needed, I could really make a difference in the health of our population. But there are many challenges inherent in this new role for local public health departments. Does the health department have the right leadership to muster support and garner respect? Does the health department have the infrastructure needed to mobilize the public? Is data available and accessible to measure the health department’s progress in addressing population health? Does the health department’s workforce have the skills to transform from historically siloed programming to a systems approach?
Here in Allegheny County, we are mobilizing our stakeholders in our Plan for a Healthier Allegheny. We have workgroups meeting to address priorities and we can see alignment happening. We have the benefit of innovative and thoughtful leadership at many levels — elected officials, health department leadership, universities, foundations, and health care. But, we still encounter hurdles. One particular challenge relates to data and data access. This capability underpins our ability to be true stewards of population health. While the public demands that we are data driven, our systems are lacking. The IT needs of public health are great while the amount of data that is potentially available is enormous. We must develop the capacity and relationships to access and utilize data effectively both internally and externally if we are to meet the Public Health 3.0 challenge. Currently, we are working closely with our managed care organizations to retrieve claims data on chronic disease. We are fortunate to have insurers who are willing to work with us. But there is no imperative, and, we have yet to crack the electronic health record. Some health departments, such as Denver, are having success. The Denver CHORDS project is a unique strategy to use electronic health data for public health purposes, but initiatives like this one are few and far between.
As a public health community, we must develop procedures and protocols for sharing healthcare data and for updating our own antiquated systems that can be spread nationally. This is a critical component of achieving Public Health 3.0.