If you’re interested in learning a bit more about Public Health 3.0, you’re not alone. While there are many health departments across the country already implementing the goals of Public Health 3.0, there are still many health departments who are unsure where to begin or may have never even heard the term. This article will allow you to brush up on the basics of Public Health 3.0 and know where to look to find more information if you want it.
1. What is “Public Health 3.0”?
The term “Public Health 3.0” was coined in 2016 by Karen B. DeSalvo, MD, MPH, MSc Acting Assistant Secretary for the US Department of Health and Human Services (HHS). That same year, the Office of the Assistant Secretary for Health (OASH) released a whitepaper entitled, Public Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure which really defines the entire thrust of Public Health 3.0.
Public Health 3.0 is a term meant to describe a progression or “modernization” of public health goals and missions. Public Health 3.0 isn’t something completely new; in fact, in that whitepaper, Dr. DeSalvo says, “Public Health 3.0 exemplifies the transformative success stories that many pioneering communities across the country have already accomplished. The challenge now is to institutionalize these efforts and replicate these triumphs across all communities for all people. Our collaborative action must ensure, for the first time in history, that every person in America has a truly equal opportunity to enjoy a long and healthy life.”
“The challenge now is to institutionalize these efforts and replicate these triumphs across all communities for all people. Our collaborative action must ensure, for the first time in history, that every person in America has a truly equal opportunity to enjoy a long and healthy life.”
–Dr. Karen B. DeSalvo
The Office of Disease Prevention and Health Promotion (ODPHP) answers this question in a 2016 article: “We often hear that your ZIP code is more important to your health than your genetic code, and public health not only has to be part of that shift in thinking, we have to be ready to lead. It is time to rethink how we can turn these indicators and social determinants around, and take the lead in making communities healthier.”
Public Health 3.0 is a more sharply defined focus on addressing ALL the factors that affect a person’s overall health — the social determinants of health or “the conditions in which people are
born, live, work, and age.” (OASH Public Health 3.0 whitepaper)
2. Where did Public Health 3.0 Come From?
The entire history of public health from the late 19th century to the present, is broken down by the CDC into three periods of public health advancement which they labeled, Public Health 1.0, Public Health 2.0, and Public Health 3.0.
Public Health 1.0: Late 19th – Late 20th Century
Defined by the CDC as, “the period from the late 19th century through much of the 20th century when modern public health became an essential governmental function with specialized federal, state, local, and tribal public health agencies.”
During this period, public health was able to:
- Develop systematized sanitation
- Improve food and water safety
- Expand understanding of diseases through advancements in science
- Develop vaccines and antibiotics to help with prevention and treatment
- Expand capability in epidemiology and laboratory science
Public Health 2.0: 1980s to Now
The IOM Committee felt that public health had become too focused on providing clinical care and was unprepared to face a new era marked by a rise in chronic diseases such as the HIV/AIDS epidemic.
In addition, as an American Journal of Public Health article explains, “… by late in the century, the capacity and effectiveness of public health agencies varied enormously across the country, with little consensus about what should be expected of public health…”
“… by late in the century, the capacity and effectiveness of public health agencies varied enormously across the country, with little consensus about what should be expected of public health…”
American Journal of Public Health “Public Health 3.0: Time for an Upgrade” (April 2016)
As a result:
- The IOM Committee defined a core set of functions for public health: assessment, policy development, and assurance.
- Public health became more focused on improving health through prevention, management, and treatment of diseases
- Performance standards were established for public health agencies, which has matured into today’s accreditation standards
- Public health agencies became increasingly professionalized
Public Health 3.0: Now – Future
Despite the changes brought by Public Health 2.0, there are still challenges facing public health:
- Public Health 2.0 did not give a lot of definition as to how public health leaders could, “work across sectors to address social, environmental, or economic determinants of health.” (Am J Public Health)
- Shifting demographics have meant a shift in the leading health challenges facing communities
- Leading causes of death are now largely attributed to behaviors vs. disease or illness (e.g. smoking, eating patterns, etc.)
- Public health departments face increasingly tight budgets with increasingly heavier demands
- The ACA improved access to healthcare which means less people need clinical care from health departments; this has led to a prioritization of prevention over clinical care
- “The ACA’s requirement that nonprofit hospitals must do community health needs assessments has increased collaboration between medicine and public health.” (Am J Public Health)
These challenges have led to a re-envisioning of public health and to the development of Public Health 3.0.
“Public Health 3.0 refers to a new era of enhanced and broadened public health practice that goes beyond traditional public department functions and programs. …At the core of Public Health 3.0 is the notion that local communities will lead the charge in taking public health to the next level and ensuring its continued success.” (CDC)
3. Why do we need Public Health 3.0?
“Despite public health’s increasing focus on how environments impact health, our ZIP codes remain a more accurate determinant of health than our genetic codes. As a society, we have a collective responsibility to create conditions that allow all members of our communities to make healthy choices. And yet public health initiatives often exist in silos, resulting in missed opportunities to leverage the critical knowledge of communities to improve health at the local level.” (Healthy People.gov)
The core recommendations or goals of Public Health 3.0 (see below) outline practices that public health can implement in order to address social determinants of health and further health equity. To understand more about how inequity can affect public health, you can view this excellent video produced by The California Endowment to encourage building healthy communities in the state of California. The principles apply nationwide.
4. What are the 5 Goals of Public Health 3.0?
Public Health 3.0 focuses on 5 core recommendations (or goals) for public health departments in this new era:
- Health departments will own the role of a Chief Health Strategist, driving initiatives in their community, especially upstream interventions to address social determinants of health.
- Public Health departments should engage in cross-sector collaboration between other health departments, intra-governmental departments, and community entities (such as hospitals, clinics, and other local businesses).
- Health departments should seek accreditation from the Public Health Accreditation Board (PHAB).
- Health departments should collect and compile timely, reliable, granular-level, actionable data to guide, focus, and assess the impact of prevention initiatives, and they should make this data accessible to the community.
- Funding for public health should be enhanced and substantially modified, and innovative funding models should be explored so as to expand financial support for Public Health 3.0–style leadership and prevention initiatives.
5. What does it mean to be the Chief Health Strategist? (Goal #1)
According to the Public Health Foundation (PHF), “…a Community Chief Health Strategist is an engaged change leader (or group of leaders) who builds community coalitions that investigate and take action to make meaningful progress on a community health issue.”
A chief health strategist:
- Forms partnerships across multiple sectors
- Collects meaningful data about the health of their community
- Leverages the partnerships they’ve created to examine the data, set goals, and develop plans to improve their community’s health
- Is the catalyst for change in their community, inspiring and urging action from community leaders, local businesses, and even grass-level movements
- Assess social determinants of health and drives upstream interventions to address them
6. How can health departments address develop cross-sector collaboration? (Goal #2)
The CDC outlines what it means to develop the cross- sector collaboration recommended by Public Health 3.0: “Communities should create innovative and sustained organizational structures that include agencies or organizations across multiple sectors and with a shared vision, which allows blending and braiding of funding sources, capturing savings for reinvestment over time, and a long-term roadmap for creating health, equity, and resilience in communities.”
Clackamas County Public Health in Washington has done an excellent job of developing cross-sector partnerships in their community.
- Partnered with their local transportation department to do a transportation health impact assessment and share resources.
- Done health impact assessments in conjunction with housing policy
- Created an opioid task force in conjunction with multiple sectors from the community
- Partnered with hospitals, CCOs, and others to conduct a regional health needs assessment
7. What is the importance of PHAB Accreditation? (Goal #3)
PHAB accreditation helps create a cultural shift towards Public Health 3.0: “Public Health Accreditation Board (PHAB) criteria and processes for department accreditation should be enhanced and supported so as to best foster Public Health 3.0 principles, as we strive to ensure that every person in the United States is served by nationally accredited health departments.” (OASH Public Health 3.0 whitepaper)
Gretchen Sampson, MPH, RN, the Community Services Director for Polk County Health Department in WI shared with Champ Software the benefits her health department received as a result of PHAB accreditation.
Gretchen shared that accreditation:
- Identifies strengths and weaknesses (aka areas for improvement)
- Strengthens your internal and external partnerships
- Encourages prioritization and address of long-standing concerns
- Provides the stimulus of quality improvement
- Improves management processes
- Increases communication with governing entities
- Creates accountability to external stakeholders
- Fosters teamwork and communication within the department
- Is REWARDING!
8. How can health departments collect the kind of data Public Health 3.0 recommends? (Goal #4)
RESOLVE’s 2014 paper, The High Achieving Governmental Health Department in 2020 as the Community Health Strategist outlines the importance of data collection: “Public health has always been an information-based discipline. That’s its stock in trade. But the old ways of collecting and analyzing information are no longer sufficient. The nature of information technology, information sources, and public expectations of accessibility are changing, and public health needs to rapidly adapt and evolve in response.”
Public health departments are using a variety of means to collect meaningful data, such as:
- Hiring a specific person whose job is to collect that type of data
- Forming cross-sector partnerships and establishing coalitions to collect raw data from the community by conducting forums and telephone surveys, convening focus groups, and collecting key informant surveys
- Using Excel to compile the data
How can EHRs and EMRs help?
Arguably one of the most important tools you’ll need is an electronic health record or electronic medical record (EHR/EMR) that allows you to collect, compile, exchange or share, and leverage your data in a meaningful and actionable way.
You want your EHR/EMR be able to:
- Collect your data
- Report on it in a meaningful way (every piece of data you enter should be able to be pulled out in a meaningful report)
- Measure outcomes and program progress towards goals
- Provide you with visual tools
- Enable you to export your data
- Connect you with an HIE so that you can exchange your data with partners
One example is Champ Software’s Nightingale Notes.
For examples of how an EHR/EMR can help you collect and compile timely and actionable data, see:
- Blog article, “Empowering Local Health Departments to Address Health Inequity”
- Blog article, “Are you satisfied with the data you’re getting from your documentation system?”
- This article describes why your EHR should not just collect your data, but should offer you the ability to leverage your data and pull it back out in a meaningful way.
- Kitsap County Public Health Department’s Success Story
- They describe their success in measuring outcomes using data collected from their EHR, Nightingale Notes.
9. What sort of innovative funding can public health seek out? (Goal #5)
Public health can focus on generating new and innovative funding sources as well as maximizing the efficiency of resources they already have.
Generating new funding sources:
RESOLVE‘s 2014 paper, The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist addresses this topic. The paper suggests a need for public health to shift away from providing the same or similar direct clinical services as primary care providers and instead focus on providing more complementary services: “… Such services can be new generators of revenue, offered to insurers and clinicians in exchange for reimbursement.”
Incentive payments offered to primary care providers will likely continue to trend even more towards population-based outcomes as a quality measure. This offers a lot of opportunities for savvy health departments to take initiative in partnering with those providers to provide upstream community health interventions and possibly share in the revenue stream from those incentive payments.
Some examples of this type of partnership mentioned in RESOLVE’s paper are:
- Bundled packages of home visits by educators and risk reduction specialists to women with high-risk pregnancies or to families with a child who has moderate to severe asthma
- Community health workers who could help patients address social determinants of health by linking them with opportunities for improved housing, employment training, or family unification
- Collaboration with providers on linking treatment with community-level upstream intervention programs (for example, linking smoking cessation treatment with community-level cessation groups)
Maximizing the efficiency of current funds:
In addition to these innovative ideas, local public health departments can capitalize on the funding they already receive. This can be done by ensuring programs are running efficiently and that funds are being attributed to the programs which are most effective.
Local health departments should measure this efficiency and effectiveness by employing an EHR or EMR (such as Nightingale Notes) that allows them to:
- Measure outcomes
- See meaningful data on dashboards
- Run reports
- Access new and timely data
- Analyze program progress in meeting goals
- Prove resources are being wisely used
- See all of this data at multiple levels (e.g. community, program, population, individual)
10. How does Healthy People 2020 fit in?
“Healthy People is a program of a nationwide health-promotion and disease-prevention goals set by the United States Department of Health and Human Services.” — Wikipedia
“Healthy People provides science-based, national goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the United States. For four decades, Healthy People has established benchmarks and monitored progress over time…” — CDC
Released in 2010, Healthy People 2020 is the set of goals public health is meant to achieve by the year 2020. According to Healthy People.gov, those goals are:
- Identify nationwide health improvement priorities.
- Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress.
- Provide measurable objectives and goals that are applicable at the national, State, and local levels.
- Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge.
- Identify critical research, evaluation, and data collection needs.
If those goals sound familiar, it’s because Public Health 3.0 encompasses these objectives and provides recommendations on how public health can achieve them.
According to the National Center on Health, Physical Activity and Disability (NCHPAD), “Public Health 3.0 is a recognition that for a community to be healthy, improvements in transportation, access to healthy food, the natural environment, housing, safety, and other areas must be made. In addition, Public Health 3.0 recognizes the significant need for public health data all the way down to the neighborhood level, and that increased financial investment is necessary to support communities in creating optimal health. Public Health 3.0 will be integral in the formation of the objectives for Healthy People 2030, which begins just a few short years from now.”
“Public Health 3.0 will be integral in the formation of the objectives for Healthy People 2030, which begins just a few short years from now.”
If you’d like to read more about Public Health 3.0 and the movement towards public health modernization, here are some excellent additional resources:
- Healthy People’s Recommendations to Achieve Public Health 3.0
- RESOLVE’s 2014 paper, The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
- HHS’s Public Health 3.0 Whitepaper, Public Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure