Karen DeSalvo lays out vision for 'Public Health 3.0,' focuses on social determinants of health

The former national coordinator says addressing social determinants is critical to the success of value-based care and that big infrastructure investment will enable localized approaches to public health.
By Mike Miliard
02:11 PM
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Karen DeSalvo Public Health 3.0

Karen DeSalvo, MD, is the former National Coordinator for Health IT.

Improving social determinants of health is a must-do for value-based care models that seek to improve and maintain health instead of treating illness, said former National Coordinator for Health IT Karen DeSalvo, MD.

Writing in Health Affairs, along with Jeffrey Levi, professor of health management & policy at the Milken Institute School of Public Health at The George Washington University, DeSalvo raised the alarm that "for the first time in generations, life expectancy has plateaued and is declining."

That's largely due to socioeconomic, racial, geographic and behavioral factors that aren't being adequately addressed by the U.S. healthcare system.

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Doing so requires connecting the care delivery system with services and organizations in the community that can address social factors and create healthy conditions in the community.

That's a hugely complex challenge, and one that will require a broad effort from many different stakeholders, said DeSalvo and Levi. "But the sad truth is, the public health infrastructure is struggling to step up to serve as that bridge. Like other parts of our nation’s infrastructure, it has been chronically underfunded."

The article calls for a "Public Health 3.0 Environment," marked by "shared responsibility from all levels of government and civil society" and big investments from federal, state and local agencies, as well as private organizations, in public health efforts beyond the healthcare delivery system.

"Cross-sectoral collaboration is inherent to the Public Health 3.0 vision, with health departments serving as the Chief Health Strategist for their communities. Health departments in this role must be high-achieving health organizations with the skills and capabilities to drive such collective action."

DeSalvo and Levi said cities such as Baltimore are embracing initiatives along these lines, but that "a more strategic approach is needed to bring this model to scale nationally."

Such a system depends on meeting several factors, they said. It should ensure that foundational public health services are made available everyone in America, regardless of where they live. It should be flexible, enabling communities to address their own particular health challenges. It should encourage outcomes-based approaches.

In addition, Public Health 3.0 should be "predictable rather than crisis oriented, so communities can plan and invest strategically," and its efforts should support customizable regional approaches that help maximize the efficiency of those investments.

Finally, the system, would encourage and incentivize public-private partnerships and, "perhaps most importantly, be data- and evidence-driven in both identifying priorities and investing in solutions."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com