Public Health 3.0 or Public Health Modernization: What is it and Why Does it Matter? (Part 1 of 2) | Public Health EHR Software

We recently attended the February Wisconsin Association of Local Health Departments and Boards Operations Conference.

The conference centered around the idea of public health modernization, and featured a keynote address by Rex D. Arche r, MD, MPH, Director of Health, Kansas City, Missouri entitled, “The Future of Public Health: Strengthening Your Role as Your Community’s Chief Health Strategist.”

David W. Pluymers, Assistant Director of the Rock County Public Health Department, also presented on “Public Health Modernization” which really made us think.

So after hearing David W. Pluymers’ excellent presentation, we asked him if we could interview him and ask him more about Public Health Modernization/Public Health 3.0, and he kindly agreed.

David’s Background

For those that don’t know, David’s journey into public health began with a Master of Science in Technology and Human Affairs from Washington University in St. Louis, one of a very limited number of colleges in the country offering an Engineering and Policy program.

His degree focused heavily on industrial engineering and systems thinking topics, which were the catalyst for David’s interest in public health. David said, “It’s really a lot of systems thinking. A lot of, in my mind, industrial engineering… Similarly, when we do a lot of logic modeling work in public health, it all fits together.”

What was the core of David’s presentation?

At the core of David’s presentation was the shift in focus from illness care to health promotion and disease prevention.

“The keynote speaker, Rex Archer… spoke to this much more eloquently than I did. I talk about it in the context of the 2012 IOM report. That report stated, ‘[The US] spends extravagantly on clinical care but meagerly on other types of population-based actions that influence health more profoundly than medical services.’

“[The US] spends extravagantly on clinical care but meagerly on other types of population-based actions that influence health more profoundly than medical services.”

2012 IOM Report

The report also says that, “The health system’s failure to develop and deliver effective preventive strategies continues to take a growing toll on the economy and society.”

“The health system’s failure to develop and deliver effective preventive strategies continues to take a growing toll on the economy and society.”

2012 IOM Report

David explained, “We spend a lot of money on people once they become ill rather than working on prevention and means of having healthier communities, healthier societies, addressing social determinants of health, addressing health equity, addressing access to care. That priority shift to prevention is the crux of Public Health 3.0.”

So, What Is Public Health Modernization Or Public Health 3.0?

David shared that the term “Public Health 3.0” was initiated September 2017 by Karen B. DeSalvo, the Acting Secretary for Health at the US Department of Health and Human Services (HHS).

According to the HHS, Public Health 3.0 encompasses the enhancement and broadening of public health practice as pioneering local public health departments shift focus to:

Address social determinants of health (or upstream determinants of health)
Collaborate across non-traditional sectors
Embrace the role of the Chief Health Strategist

Both public health practice and policy are transforming to address changing population health challenges.

However, David is quick to emphasize that Public Health 3.0 isn’t a radical new approach to public health, “This has been more of a step-wise evolution and progression over a period of many years. We’re not asking anyone to do anything dramatically differently…This is a progression rather than a blunt, new way of thinking. We’ve been progressing into this mindset for the past several years.”

“This has been more of a step-wise evolution and progression over a period of many years. We’re not asking anyone to do anything dramatically differently…This is a progression rather than a blunt, new way of thinking. We’ve been progressing into this mindset for the past several years.”

David W. Pluymers

What Are The Core Functions of Public Health?

To demonstrate this, David walked through this idea’s evolution and development. “The core functions of public health arose out of the 1988 IOM report. The core functions are: Assessment, Policy Development, and Assurance.”

Assessment

“Our public health work should start with an assessment, really looking at your community and the factors within it that are either promoting health or challenging health,” David explained.

He went on, “The assessment is the important first step in determining what the community health needs are. That assessment work, demonstrating the need for programs in a community, is critical to effectively seeking funding, particularly grant funding.”

Policy Development

David continued, “In response to the assessment, we design interventions… work towards policy systems and environmental change so that we can then make lasting improvements to community and population health, as opposed to treating illnesses. We want to be looking upstream at root causes of poor health outcomes.”

He expanded, “I think a common language is an important thing. We need to be exploring and using new types of data; using data as both part of our assessments and to improve the effectiveness of our interventions through measuring outcomes. Those data pieces are critical. That’s one of the key recommendations in PH 3.0.”

Assurance

“The final stage is assurance,” David continued, “assuring that people have access to care, assuring that we have a competent workforce, and evaluating what we’re doing to make sure that we’re having an impact to improve community health outcomes.

“If we’re not having the desired impact, we need to change what we’re doing. If we are improving conditions our outcomes, we need to tell people about it and let them know that their dollars are being spent wisely on these efforts.

“We look at policy systems and environmental change in the individual, community, and system levels.”

Public Health Can and Should Transform the Data

David describes how Public Health 3.0 modernizes those core functions, “In public health we should be measuring, we should be using both quantitative and qualitative data to really assess and frame what we’re doing, to create a baseline, and then to demonstrate that we either are or are not having measurable outcomes towards improving community health.”

“I did a little work in knowledge management some years ago looking at the flows of knowledge and information though an organization.

“One of the key concepts is taking data and transforming it into information and further into intelligence. That normally means showing trends and comparing the data,” David shared.

As examples, he described how a public health worker can compare data to a:

State average
National average
Current year’s data
Previous year’s data, etc

“You’re looking for trends and further comparing those trends”. He explained that public health needs to be able to show how those data are changing or compare them to other data.

“We want to turn data into information… then we want to further transform that information into intelligence that we can use for decision making… That intelligence can be used to move decision makers to change conditions, or to create knowledge that will get individuals or populations to assume healthier behaviors.”

“We want to turn data into information… then we want to further transform that information into intelligence that we can use for decision making… That intelligence can be used to move decision makers to change conditions, or to create knowledge that will get individuals or populations to assume healthier behaviors.”

David W. Pluymers

David talked about training seminars he had attended some years ago, given by Edward Tufte, “Dr. Tufte has written several incredible books on the visual display of quantitative information… One key point from the seminars is that data become much more meaningful when compared them to something – a standard or to other data. It’s in that comparison that the data become information.”

“Data become much more meaningful when compared them to something – a standard or to other data. It’s in that comparison that the data become information”

David W. Pluymers

“You might even just have a year’s worth of data, but if you’re comparing it to a state average, a national average, or even a neighboring community’s data, then it becomes information. Further, it can become intelligence when it includes both trend and comparison.”