Transformation Paper

Public Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure

Introduction

It is unacceptable that in the 21st century, people continue to experience differences in health status as a consequence of their ethnicity, skin color, where they reside, or level of income. As an employee in the state health department (reporting to the State Director of Public Health), I am convinced that we should all play a more active role in efforts to promote the health equity agenda and transform public health practice. It is on this basis that I review a report that purports to explore ways of transforming public health practice and reducing health inequities. The report is titled, Public Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure.

A Review and Critique of the Report

There is need to ensure that every citizen of this great country has what is, in essence, a just and fair opportunity to achieve what could be deemed their full potential in as far as their health and wellbeing is concerned. Despite having made significant progress on multiple fronts, i.e. with regard to advances in technology and advancement of democracy, the United States is yet to achieve health equity. This has been an elusive goal for a long time. Indeed, as Williams and Sternthal (2010) point out, racial differences in health can be tracked back to the countrys earliest medical records. This is to say that the country still grapples with disparities in as far as health outcomes are concerned. Thus, there exists significant differences in not only health resources distribution, but also health status across different population groups. In addition to identifying the need to ensure that all citizens have a fair chance of achieving the highest level of health, this particular report illustrates the progress that has been made in the past to make this ideal a reality. Strategies that have been deployed have been identified and ideas for further progress floated.

From the onset, the report recognizes that health equity cannot be achieved in a vacuum. This is to say that the achievement of health equity is a collaborative effort in which case all persons should play a meaningful role and share experiences. For this reason, the initiation of what could be deemed a national dialogue i.e. by organizing regional meetings and engaging stakeholders across multiple sectors is a welcome move. It is also laudable that insights have been sought from communities that are both demographically and geographically diverse. A number of direct benefits were derived from these engagements. For instance, they provided a platform for all those involved in efforts to transform the public health to share their experiences, knowledge, as well as insights. Further, thanks to the said engagements, it was possible to gain better perspective of the challenges that could get in the way of the successful implementation of the health equity agenda. It is also through the insights of participants in regional engagements that we can be able to gain better perspective of how collaboration could be used as a tool for success going forward.

In as far as the consultative agenda is concerned, the report also appears to be appreciative of the fact that officials in the public health realm are not the only custodians of resources, knowledge and insights regarding the promotion and protection of the peoples health. It is for this reason that the regional meetings that were instituted in this case roped in participants from various domains. The regional dialogues gave rise to a number of key findings which ultimately informed the development of a number of recommendations. The five findings have been indicated as; strong leadership and workforce; strategic partnerships; flexible and sustainable funding; timely and locally relevant data, metrics, and analytics; and foundational infrastructure (U.S. Department of Health and Human Services, 2020). One of the findings that I find rather intriguing, and relevant in our case, relates to funding. This is especially the case given that because of competing priorities, securing adequate funding for some initiatives could be a tall order especially when it comes to initiatives at the local level. Various ideas and suggestions were floated by participants in regional meetings. One such idea relates to widening the net in the search for funders and partners. For instance, there may be need to reach out to non-traditional funding sources such as venture capital formations that are passionate about certain social causes. Also, we need to recognize that support is not only financial. Non-financial resources could be thought of in terms of access to information, etc. Participants also floated the need for more flexible funding. This kind of funding would not be overly dependent upon traditional funding sources which happens to be rather rigid. This does not, however, mean that traditional funding streams should be disregarded.

The other equally intriguing finding sourced from participants relates to the establishment of strategic partnerships. As the report points out, participants were able to not only highlight the relevance of strategic partnerships, but also suggest ways of ensuring that engagements of this nature are fruitful. As has been indicated elsewhere in this write-up, collaboration remains key to the achievement of health equity in this country. It is, thus, encouraging for those on the ground to underline the need for such collaboration and offer suggestions on the way forward. The relevance of collaboration is further reinforced by Marmot, Friel, Bell, Houweling, and Taylor (2008) who point out that action on the social determinants of health must involve the whole of government, civil society, local communities, business, and international agencies (1661).

It should, however, be noted that collaboration cannot be pursued in a haphazard manner. Indeed, as has been indicated in this report, participants in the regional meetings were categorical that unstructured collaborative efforts are likely to fail. This is to say that there may be need for deeper assessment of collaborative relationships to ensure that they are meaningful and effective. This could be followed by the establishment of a structure that outlines formats of engagement. Another factor that could be taken into consideration in this case is partnership attributes. This is key to the formation of relationships and associations that are strong and authentic. In any case, we should also be aware of the fact that strong and authentic relationships are not formed or established in a day. Indeed, as participants in the regional engagements indicate, it could take time to ensure smooth communication and develop trust. It is on the strength of this reality that the said participants recommend that certain steps not be overlooked regardless of how irrelevant they may seem. Thus, some of the details that must not be overlooked are inclusive of, but they are not limited to; meeting face to face, clearly explaining each partners value, setting expectations for how each partner will contribute, and setting deadlines for meeting the groups goals (U.S. Department of Health and Human Services, 2020).

It should be noted that various communities across the nation have been keen to address the various determinants of health via the application of a wide range of innovative solutions and approaches. However, the role of the entire public health system in the achievement of public health and reduction of health disparities remains critical. Indeed, in the words of Marmot, Friel, Bell, Houweling, and Taylor (2008), ministries of health and their ministers are crucial to the realization of change (1662). This is a fact that has been correctly recognized in the report. Indeed, as has been indicated in the report, without support from across the broader public health system, however, public health entities will not be able to achieve or sustain their transformation (U.S. Department of Health and Human Services, 2020).

As has been indicated elsewhere in this write-up, a number of findings were made following the regional dialogues with the said findings informing the development of a number of recommendations. Thus, these recommendations are themed around the findings. A total of five recommendations were floated. It is important to note that the said recommendations are essentially meant to ensure that the various communities across the U.S. benefit from efforts to strengthen public health. Thus, to an even greater extent, these recommendations would help us understand what is needed for health departments to thrive and play a meaningful role in the promotion of the health and wellbeing across the entire population. The first recommendation relates to the acceptance of a broader role that of the community Chief Health Strategist by public health leaders as they seek to engage and rope in all the relevant players involved with undertakings meant to address those social determinants of health classified as upstream. Those serving in this role ought to be provided or equipped with skills that enable them to perform optimally. This is a crucial point given that efforts to promote health equity ought to be directed in a deliberate and engaging manner, and the person directing the said efforts ought to have the skills and capabilities needed to address evolving challenges in this realm. The report does capture the need to extend the said training to the entire public health workforce.

The second recommendation has got to do with the establishment of meaningful partnerships between public health departments and other stakeholders particularly the community. This happens to be one of the most recurrent themes across the entire report. More specifically, the need for such collaboration has been established so as to ease sharing of a wide range of resources and knowledge in the development of the various initiatives meant to promote and/or advance the public health 3.0 agenda. In the light of calls for closer collaboration, the relevance of ensuring that all...

…possible solutions that have been proposed to rein in this particular issue is accelerated data sharing and the exploration of new data types. In as far as the latter solution is concerned, it would be prudent to note that data traditionally collected by local public health officials at times paint an incomplete picture of a communitys challenges and successes (U.S. Department of Health and Human Services, 2020). For this reason, there may be need to explore other sources that are able to better capture the key trends and circumstances unique to a community.

The report also fails to fully capture or take into consideration the role of various emerging and contemporary challenges on the achievement of health equity and transformation of the public health system. For instance, the nation is emerging from a pandemic that has ravaged communities and families. This could be considered a shifting population health challenge. Further, we may be headed towards a major downturn in economic activity. The World Health Organization WHO (2020) points out that inequities in informal employment between and within countries are exacerbated by COVID 19, and will have long- term negative impacts on the health of informal workers and on health equity. This effectively worsens an already bad situation. There is also no doubt whatsoever that an economic crisis will impact efforts to rein in health inequity. This is especially the case as state and local governments and agencies, as well as key partners work in a resource constrained environment and, hence, scale down their spending on public health engagements. As has been indicated in the report, public health and social services have been immensely underfunded (U.S. Department of Health and Human Services, 2020). A sustained downturn in economic activity is likely to precipitate further spending reductions. We must be aware of, and factor in, these events if we are to make meaningful progress in our efforts to bring about transformation in our public health system and, thus, rein in health inequity. Although emerging trends are largely difficult to predict, we can prepare and ready ourselves to address issues that have the potential to derail our efforts. For instance, capacity for readiness can be built by ensuring that we are not overly dependent on traditional funding streams. This is to say that we must broaden our search for funding beyond local, state, and federal funding. It should also be noted that collaboration which is a crucial theme throughout the report could be instrumental in ensuring efficiency in as far as the prudent utilization of available resources is concerned. In our case, we could, for instance, advance the collaborative agenda as a way to eliminate task duplication. As has been indicated in the report, collective efforts can also be pursued by mixing funds.

Lastly, it should also be noted that this particular report fails to adequately appreciate the need to protect data security in the course of storage or exchange of the said data. This is despite the fact that the need to ensure that communities across the U.S. have access to data that is not only actionable but also reliable and timely happens to be one of the key recommendations highlighted in the report. The relevance of data security cannot be overstated in the current day and age where third party access to the personal records of people remains a major concern. Thus, the storage and transmission of data and the need for data security measures such as encryption should have been explored in greater detail.

Conclusion

In the final analysis, it should be noted that although this particular report emphasizes the important role that public health entities play in efforts to reduce health inequity, it also restates the relevance of collaboration, particularly multi-sector collaboration. For this reason, we must commit to take part in the various collaborative efforts. There exists many opportunities for such cooperation. These have been explored in the report. It is only through our collective actions and efforts that we can accomplish anything meaningful and, thus, ensure the health and wellbeing of all. However, it should also be noted that for the said collaborative efforts to bear fruit, there will be need to ensure that we are aware of what has been accomplished in the past and how this could be leveraged to ensure even greater success going forward. This, as has been indicated elsewhere in thus write-up, is what could be conceptualized as building on past successes. It is hoped that this review and/or critique of the report will bring us closer to the achievement of health equity within our jurisdiction and across the nation. Griffith, Mason, Yonas, Eng, Jeffries, Plihcik and Parks (2007) offer us a timely reminder of that fact that the more overt ethnic as well as racial barriers in the countrys healthcare system were eradicated during the Civil Rights Era more than five decades…