Transforming public health in the United States.

Abstract

For decades, governmental public health in the united States has been relegated to operating at the margins of the country's massive healthcare system that drives nearly 20% of the uS economy.1 Further buffeted in recent years by a variety of external forces (including the 2008 economic recession, shifting demographics, a high and complex population burden of chronic disease, and a rapidly changing health care delivery system), public health leaders and policymakers increasingly recognize that the existing practice models are no longer adequate for the task of protecting and promoting the public's health.2 put simply, uS public health risks moving from being marginalized to becoming irrelevant if public health practice is not transformed.the challenges embedded in changing public health practice are multiple, and are made more complex by the decentralized structure of public health in the united States. public health here is a federated enterprise that includes national entities such as the Center for Disease Control and prevention, the Food and Drug Administration, and others; state and local governmental health departments; non-governmental organizations at the national, state, and community levels that are organized around single or multiple health-related issues; and public and private colleges and universities that provide education and training to the multiple disciplines making up the public health workforce. National study committees convened by the National Academy of Science's institute of Medicine over the past 30 years3-5 have consistently found the uS public health system to be in a state of disarray: misunderstood by elected policymakers and the general public; under-resourced in financial, technological, and workforce spheres; and highly variable in practice and services provided by over 2500 state and local governmental public health departments.For more than 20 years, the robert Wood Johnson Foundation (rWJF) has made significant investments in advancing public health in the united States. this includes multi-million dollar, flagship investments in public health accreditation and in public health systems and services research, with both efforts broadly directed toward improving the quality and impact of public health practice. it also includes more recent, and more narrowly concentrated, investments in engaging public health leaders in focused dialogues on critical operational issues as well as on more aspirational strategic thinking about how to catalyze and support transformational change in public health practice. three current examples of these strategic investments include:1. Building consensus around a set of core and foundational public health capabilities and services;2. developing an aspirational vision for uS public health in 2030; and3. identifying leadership and educational preparation needed to prepare the public health workforce of the future.Foundational Capabilitiesrecognition of the significant variability in the type, amount and financing of public health services led the institute of Medicine in 2012 to call for a '... minimum package of public health services, which includes the foundational capabilities and an array of basic programs no health department can be without...'.5 through funding a public Health Leadership Forum (pHLF), rWJF convened a diverse group of federal, state, and local public health leaders and stakeholders in April 2013 to review this recommendation and operationalize it. over the course of the next nine months, the group developed consensus around a foundational capabilities and services framework6 (see Figure 1) and operationalized them with enough specificity that a costing model is now being developed. the framework is being systematically vetted with the broader uS public health community by way of presentations at multiple conferences, webinars, and social media. once vetted, it is hoped that the foundational capabilities and services framework will be utilized by state, local, and federal policymakers and result in increased resources for public health while decreasing variability in practice and, ultimately, improve population health outcomes. …