A Public Health Challenge

By Susan G. Barrera, Deborah Bohr and Gretchen Williams Torres

A new report provides recommendations, immediate actions and resources for designing a cohesive system to attend to the public’s health.


Susan G. Barrera	Deborah Bohr	Gretchen Williams Torres

It may seem an inopportune time to ask more of hospital leaders, yet that is precisely the goal of the National Steering Committee on Hospitals and the Public’s Health, a panel of hospital leaders, public health directors and academics convened by the Health Research & Educational Trust (HRET).

In a new report, the committee calls on hospitals to become collaborators and leaders in re-creating the U.S. public health infrastructure and capacity. Why should hospital leaders participate in this endeavor? Because hospitals have a vested interest in their communities’ health. They also cannot afford to maintain the status quo.

Unacceptable Returns on Health Investment

The old models of medical care and public health delivery no longer work. Our nation spends $2 trillion a year on health care, yet ranks 37th out of 191 countries on eight health outcomes tracked by the World Health Organization. Seventy-five percent of health care spending goes toward preventable diseases. U.S. residents are becoming sicker, and they are not receiving an acceptable return on their investment. We can save billions of dollars if we invest instead in illness and injury prevention.

HRET, with the support of the Centers for Disease Control and Prevention, convened the committee from July 2005 to September 2006 to examine the role of hospitals in health promotion and disease prevention. Its specific aim was to illustrate why and how hospitals and health systems can be better integrated with the public health system. In return, the committee is issuing a call to action directed at policy-makers and practitioners to incite fundamental change--to guide hospitals’ and health systems’ engagement in improving the public’s health and to eliminate the barriers that preclude this engagement.

Insufficient Funding for Public Health

The public health system is the totality of public health departments, emergency response organizations, governmental agencies, hospitals and health care providers, social service organizations, and many entities whose common goal is ensuring a healthy population. Until Sept. 11, 2001, public health departments suffered from a near-fatal lack of funding. Since then, the federal government has spent billions of dollars to resuscitate specific components of the public health infrastructure needed to fight a new threat: bioterrorism.

Public health services are best delivered locally, at the community level, but the majority of public health departments lack funding, information technology and staff to adequately provide disease surveillance and protection to their constituents. With decreasing annual budgets, many cannot perform traditional public health functions. In addition, today we recognize that determinants of disease include environmental, economic and social factors that originate outside the purview of public health agencies.

Call for a New Paradigm

We all have economic and personal interests in improving the health of our communities, as there is a strong correlation between good health and educational and economic achievement. A healthy workforce is vital to our national economy, yet we are facing a chronic disease epidemic. The public pays a high price directly and indirectly for declining population health status. Americans pay taxes to support Medicaid and Medicare. Those who are fortunate enough to have health insurance pay higher insurance rates to cover medical treatment for the uninsured and underinsured.

The committee is calling for change and innovation--for hospital leaders to help public health leaders define and develop a new public health system to improve Americans’ health. Mutual respect and cooperation must guide efforts to recreate the public health infrastructure. The ideal is a partnership in which each member does the work for which it is best-suited and supports the other in its work.

Seven Recommendations

Hospitals must look beyond their walls and the immediate sick. A new U.S. health care system requires a realignment of financial incentives--in both the public and private sectors. The report contains a detailed introduction to the American health care crisis and a discussion of the role hospitals must play in changing the system and improving U.S. health. The committee makes seven recommendations in areas where hospital leadership and involvement are urgently needed:

• Eliminate health disparities. Health care quality studies demonstrate that, in general, members of racial and ethnic minorities, those with lower incomes, and the less educated receive poorer quality care. Hospitals must ensure that managers and clinical staff members are culturally competent and deliver culturally competent care, and that they are diverse, reflecting the communities they serve.

• Coordinate care. The health care system is fragmented into many independent and uncoordinated provider sectors. Duplication, waste, delay and inefficiency must be eliminated. The system should be easy-to-navigate and user-friendly, delivering the right care at the right time in the most appropriate setting.

• Promote primary prevention. Chronic disease epidemics affect everyone, not just those with the disease. Private and public health care providers must work with community organizations to reduce risky behaviors and environmental constraints that lead to disease, disability and death. Successful prevention interventions involve community partners in their design, implementation and evaluation.

• Optimize access to care for all. Lack of access leads to a cascade of health-related problems. Health care utilization is a function of affordable health insurance and the availability of accessible services. Hospitals must reduce barriers to access in their communities.

• Advocate payment for prevention. Many insurance companies refuse to pay for diabetes daily test strips and other comparatively inexpensive disease management activities. Then, when complications arise because insurers failed to pay for interventions, insurance plans willingly make large payouts for diabetic limb amputations and other treatments. Primary preventive interventions consume fewer resources in the long run and promote better quality of life for individuals and populations immediately. Medical care payment policy needs to be restructured to support health promotion, disease prevention and primary care.

• Build the community’s capacity to stay healthy. Hospitals must enter into the communities they serve, and together with public health and other agencies, analyze and understand the multitude of biological and genetic processes; individual behaviors; and social, economic, political and physical environments that affect the health of their communities. Investing resources to address population-level factors that affect health outcomes improves the long-term health status of communities.

• Support recreating the public health infrastructure and expanding capacity. The current public health system is underfunded, undermanned and woefully inadequate to meet the challenges of protecting and promoting all Americans’ health. America’s economic future depends on improving the public’s health; we can achieve this only through major expansion of public health activities to eliminate preventable diseases. We need to start with an active dialogue between hospitals and local public health agencies.

The report provides guidance on how hospital leaders can deliver new strategies for institutional involvement in these critical areas. While the immediate result of the committee’s work is this report, it is the intent of HRET and the steering committee that the report’s recommendations will provide a substantive starting point for hospitals to engage in discussion and strategic planning for health promotion and disease prevention at every level--organizational, community, regional and national.

Susan G. Barrera, J.D., M.P.P., is research manager at HRET; Deborah Bohr, M.P.H., is senior director, special projects; and Gretchen Williams Torres, M.P.P., is director, research.

The Report of the National Steering Committee on Hospitals and the Public’s Health can be accessed at www.hret.org.

GIVE US YOUR COMMENTS!

Hospitals & Health Networks welcomes your comment on this article. E-mail your comments to hhn@healthforum.com, fax them to H&HN Editor at (312) 422-4500, or mail them to Editor, Hospitals & Health Networks, Health Forum, One North Franklin, Chicago, IL 60606.

If you would like a FREE Subscription to H&HN OnLine, please click here to register.

This article 1st appeared on April 24, 2007 in HHN Magazine online site.

To respond to this article, please click here.