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New Economic Realities Prompt Rethinking of Public Health Service Models

April 16, 2012

The broad public health community certainly finds itself living in interesting times! The combination of an economic recession with sharp decreases in public support for most state and local health departments, and the winds of change accompanying national efforts to reform the delivery of health services create a necessity to rethink the way public health services are organized and delivered. Whether, in hindsight, this will prove to have been the proverbial Chinese curse, or a wonderful opportunity (or a little bit of both) remains to be seen.

The articles in the May supplement to the American Journal of Preventive Medicine entitled, An Agenda for Public Health Systems and Services Research, concisely describe the state of the art of public health practice. They also make it clear that much remains to be known about the nature of the public health workforce, the best way to structure public health departments, the best ways to assure effective and high-quality public health services, and how to best structure new partnerships for research and service. The proposed research agenda to better define these issues is complicated by the current rapid pace of change, but that reality also brings new urgency to the topic.

It is clear that the most effective health departments will reach out to work more closely with their academic and medical communities, and vice versa. One way to think about how to foster stronger medicine/public health partnerships focused on improving community health status is for organized communities to expand the Accountable Care Organization concept championed by the Patient Protection and Affordable Care Act to that of the Accountable Care Community (ACC). An ACC develops partnerships across all sectors of society focused on improving overall population health. Key elements include policy initiatives related to the social determinants of health, providing community and clinical preventive services, universal access to medical care and research to define best practices and outcomes.

A worrisome reality is that many health departments, by virtue of size, location, level of sophistication, and common practice will be reluctant or find it difficult to join in the partnerships the “new” public health will require. As noted in a previous blog post, they may wish to consider the idea of the “Academic Health Department.” as one tool at their disposal. It is to be hoped that the growing robustness of the Public Health Services and Systems Research effort and the pressure for change will result in new models of service provision that will be reflected in positive population health outcomes.

— C. William Keck, MD, MPH

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