Presentation on theme: "Public Health 2030: A Scenario Exploration"— Presentation transcript:
1Public Health 2030: A Scenario Exploration Supported by grants from:
2IntroductionPublic Health is “what we as a society collectively do to ensure the conditions for people to be healthy.”The Who, What, and How of public health is evolving – not always in consistent directions.Scenarios all exploring the factors shaping public health, and public health’s actions to consider alternative paths into the future.
3The Public Health 2030 Project Funded by Robert Wood Johnson & Kresge Foundations following scenarios on Vulnerability 2030, Primary Care 2025 , and Health and Health Care 2032Explore key forces shaping public healthConsider the future of public health functions, financing and sustainabilityBuild expectable, challenging, and visionary scenarios that facilitate preparation, imagination, and aspirationProvide and widely distribute the scenarios as a tool for public health agencies, organizations, and schools
4Developing the Scenarios Considered key drivers shaping public healthDeveloped expectable, challenging, and aspirational forecasts for the driversInterviewed experts, Project advisersDeveloped and used state and local Public Health 2030 ScenariosDeveloped national Public Health 2030 Scenarios
5Aspirational Futures: Scenario Zones Visionary/Surprisingly SuccessfulExpectableChallenging
6Public Health 2030: State & Local Scenarios Fargo Cass Public Health (ND)Boston Public Health Commission (MA)Cuyahoga County Board of Health (OH)Virginia Department of Health
7National Public Health 2030 Scenarios Scenario 1: One Step Forward, Half a Step BackSignificant advances in big data analytics, in access to and quality of health care; yet recurring fiscal and health challenges for communities and PHAs.Scenario 2: Overwhelmed, Under-ResourcedEconomic and environmental challenges, infectious diseases increase, health care reform halted, public health constrained.Scenario 3: Sea Change for Health EquityPHAs evolve into health development agencies. Economic stability and value and policy shifts toward equity support this evolution.Scenario 4: Community-Driven Health and EquityInnovation in communities, alternative economics, transformation is accelerated through technology and recognition of economic and social injustice.
8Scenario 1: One Step Forward, Half a Step Back Public Health 2030: A Scenario ExplorationScenario 1: One Step Forward, Half a Step Back
9Scenario 1: One Step Forward, Half a Step Back Public health agencies (PHAs) advance capabilities in technology and big data analyticsPublic health is restrained byHigh costs of health careVariations in PHAs’ technological capabilities, funding, services, and effectiveness
10Scenario 1: One Step Forward, Half a Step Back Public health funding varies widely; Federal funding for health care programs reduced as access to health care improvesPHAs refocus on prevention and improving community conditionsPHAs consolidate and share services; most improve comparability and show positive returns on investment (ROI)
11Scenario 1: One Step Forward, Half a Step Back Emergence of Big DataImproved surveillance and analysisPHAs provide quality control, and some “nudge” social networks toward better health
12Scenario 1: One Step Forward, Half a Step Back When possible, PHAsAutomate inspectionsEnhance population health monitoringImprove emergency preparednessSome PHAs are confined to mandated servicesOthers are able to emphasize prevention
13Scenario 1: One Step Forward, Half a Step Back More extreme weather events (EWEs) and vector-borne infectionsE.g. Lyme disease and dengue feverPHAs use simulations and gamification to prepare communities for emergencies
14Scenario 1: One Step Forward, Half a Step Back Health care reform largely implementedExpansion of Accountable Care Organizations (ACOs), Triple Aim, and Patient-Centered Medical Homes (PCMH)Care improved by knowledge technologies – Doc Watson, digital health coachPHAs focus on prevention, have varying roles with ACOsTriple AimElectronic Health Records (EHRs)
15Scenario 1: One Step Forward, Half a Step Back Health care costs continue to rise as access improvesSocial determinants not addressedNo “game-changers”Continued disparities
17Scenario 2: Overwhelmed, Under-Resourced Public Health 2030: A Scenario ExplorationScenario 2: Overwhelmed, Under-Resourced
18Severe recessions in 2016 and 2023 Scenario 2: Overwhelmed, Under-ResourcedSevere recessions in 2016 and 2023PHA funding reduced, many programs eliminated
19PHAs blamed for lack of preparation and ineffective responses Scenario 2: Overwhelmed, Under-ResourcedPHAs blamed for lack of preparation and ineffective responsesPublic distrusts PHAs, federal government in general, and health care
20Distrust grows, people refuse to get flu shots Scenario 2: Overwhelmed, Under-ResourcedDistrust grows, people refuse to get flu shotsHighly virulent flu strain in 2020Tens of thousands of people die
21Scenario 2: Overwhelmed, Under-Resourced Citizen science and technology grow but serve affluent and reinforce disparities.PHA health care services cut while need grows.Excellent, personalized care for those who can afford it.Innovative private sector approaches to health for those who can afford them.
22Scenario 2: Overwhelmed, Under-Resourced “Runaway climate change” emergesClimate refugees and migrantsHealth, violence, and discrimination worsenPHAs overwhelmed, struggle to recover
23Scenario 2: Overwhelmed, Under-Resourced PHAs understaffed, overwhelmed.Many universities shut down public health programs.Private sector innovations ignore disparities and vulnerability.Worsening disparities in health, quality health care access, effective prevention, and other public health services.
25Scenario 3: Sea Change for Health Equity Public Health 2030: A Scenario ExplorationScenario 3: Sea Change for Health Equity
26Changes in values and demographics. Scenario 3: Sea Change for Health EquityChanges in values and demographics.Funding improves for public health.Public health pursues advanced analytics, gamification, and multisectoral partnerships.Improvements in housing, economic opportunity, education, and other social determinants of health.Some disparities persist.But in 2030, the vast majority of Americans have attained greater opportunity for good health.
27Support for “common sense” policy Scenario 3: Sea Change for Health EquitySupport for “common sense” policyPublic support for opportunity, equity, and fairness in policies and economicsNational minimum wage, Health in All PoliciesInnovation and use of new tech for outcomes
28Scenario 3: Sea Change for Health Equity Public health funding improvesEconomies gradually grow, reduce fiscal strains and cutsPHAs foster additional resources from business, foundations, ACOsEvaluations show positive ROICongress restores Prevention Fund restored to $2B level in 2020, add 2% tax in 2022 on medical services
29PHAs become chief health strategists, shift away from direct services Scenario 3: Sea Change for Health EquityPHAs become chief health strategists, shift away from direct servicesCollaborative networks and partnershipsSimulations, forecasts, analysesSpread best practicesIdentify most cost-effective and appropriate providers
30PHAs lead coalitions, recognized by the public has chief health Scenario 3: Sea Change for Health EquityGaming changes communities’ awareness of and commitment to achieving healthNew tech developments are made to be affordable and culturally appropriatePHAs lead coalitions, recognized by the public has chief healthstrategists
31Community Centered Health Scenario 3: Sea Change for Health EquityHealth care improvesCapitated, effective, accessedPrimary Care supports community preventionFederal $ cuts to PH programs for screening and treatmentCommunity Centered HealthHome
32Better health and health equity, less demand for health care Scenario 3: Sea Change for Health EquityBy 2030,Better health and health equity, less demand for health careImproved community conditions, esp. for low income communities
34Scenario 4: Community-Driven Health and Equity Public Health 2030: A Scenario ExplorationScenario 4: Community-Driven Health and Equity
35Scenario 4: Community-Driven Health and Equity Health improvement initiatives coalesce via technology and networks into a broad, national public health infrastructure.Value shift to equity was accelerated by another major recession and economic transformation.The nation tries to come to terms with its racial and socioeconomic histories, and tries to create a more equitable society.Public health sheds many functions and facilitates these movements to improve health.
36Scenario 4: Community-Driven Health and Equity Groupnets used to improve behavioral health at the micro-level, often through “peer uplift”Community activity & organizations focused on healthPHAs lead on information quality & community facilitation
37Scenario 4: Community-Driven Health and Equity Health records integrated with other personal and community data to allow advanced health analysis and targetingCommunity health learning systems enhance PHAs’ roles as facilitators and health strategistsGames and simulations improve community engagement and planning
38Scenario 4: Community-Driven Health and Equity Environmental Health evolvesPHAs work with communities, and partners to reduce environmental impact and expand renewable energy.Highly effective pre-event resilience games and simulations for Extreme Weather Events.
39Governments spend less and spend “smarter” Scenario 4: Community-Driven Health and EquityGovernments spend less and spend “smarter”Unemployment accelerates shift to alternative economics/new community economic models
40Economic and social justice movement progressed Scenario 4: Community-Driven Health and EquityEconomic and social justice movement progressed“Truth and Reconciliation” processes spreadNew legislation promotes social and economic fairness
41Scenario 4: Community-Driven Health and Equity Public health graduates are trained for community engagement and advanced analyticsPHAs serve as effective chief health strategistsDisparities are reduced and the nation is largely unified in seeking to eliminate them
43See the Public Health 2030 Scenario Matrix for a side-by-side comparison of the scenarios across multiple dimensionsScenario 1Scenario 2Scenario 3Scenario 4MACRO AND OPERATING ENVIRONMENTSEconomyFiscal HealthInternet & Social MediaEnvironmental Threats & ImpactsHealth CareHealth EquityPublic HealthPublic Health RolesFunding for Public HealthPublic Health & Health CareHealth Care’s Role in Population HealthSurveillance and EpidemiologyEmergency PreparednessEnvironmental Health/SafetyInjury and Violence PreventionEtc.
44Scenario Likelihood and Preferability Poll Public Health 2030 ScenariosLikelihoodPreferabilityScenario 1: One Step Forward, Half a Step Back0-100Scenario 2: Overwhelmed, Under-ResourcedScenario 3: Sea Change for Health EquityScenario 4: Community-Driven Health and EquityPlease use the grid below to assess the likelihood and preferability of each scenario separately.100% refers to highly likely or preferable.0% means there is nothing desirable or preferable about a particular scenario.Percentages can be from 0 to 100 in each cell. Columns or rows need not add up to 100%. For example, you may assign 60% for likelihood and 85% for preferability of a scenario.
45Implications/Questions Implications for public health in your city, county – your goals, directions, strategies?What are your expectations, fears and aspirations for public health?Other questions?
46Public Health 2030 Recommendations from theNational WorkshopMarch 6 & 7, 2014
47Rec 1:Transform Public Health Agencies into “Health Development Agencies” with Dedicated, Sustainable, and Sufficient Funding.1A: Develop Dedicated, Sustainable, and Sufficient Funding1B: Implement Policies for the Systematic Use and Development of Evidence and Best Practices1C: Build Public Health Agencies' Role in Fostering Prevention and Health Promotion StrategiesRec 2:Partner in Health Care Transformation to Facilitate the Evolution from a Health Care System to a Health SystemRec 3:Build the Capacity for Dialogue about Inclusion, Opportunity, and EquityRec 4:Dialogue with Other Sectors to Support Innovation
48Rec1:. Transform Public Health Agencies into Rec1: Transform Public Health Agencies into “Health Development Agencies” with Dedicated, Sustainable, and Sufficient Funding.Conceiving of public health agencies as “health development agencies” is new. We believe that taking steps toward the realization of this endeavor will pave the path for developing and recruiting the people and resources needed to innovate, and to make major inroads into improving population health and eliminating health disparities.
49The health development agency of 2030 will: Identify problems and opportunities to improve community health,Catalyze and incentivize action by sectors within health and outside healthCarry out some but not all of the traditional assurance and protection functions of PHAs todayPromote health in the broader context, assure inclusiveness, and are fully incorporated into community improvement processesPerform strong fiscal management (“No margin, no mission”)
50The health development agency of 2030 will: Learn and apply innovation principles from other sectors and organizationsLeverage other stakeholders and resources from other sectors to improve health and wellbeingHave adequate funding for the necessary infrastructure.Employ staff with the interdisciplinary training and skills needed to work with other stakeholders and support the agency’s role in fostering prevention and health promotion.
51Rec1A: Develop Dedicated, Sustainable, and Sufficient Funding Health development agencies will require dedicated, sustainable, and sufficient funding streams that lie outside of traditional categorical programs.
52Rec1A: Action StepsDefine with specificity what is needed for the health dev. agency, what it will cost, and accountability measuresReview and support current efforts to define and estimate the costs of foundational capabilities and experiments in fundingDefine options for developing revenue streams to support the foundational capabilitiesEnable flexible use of grant funding. Expand federal block grant funding to dedicate a portion specifically to supporting the foundational capabilities
53Rec1A: Action StepsIntegrate standards for goodness (appropriateness and effectiveness) and fairness (equity) into grants and partnershipsDesign grant requirements to promote multi-sector participation and collaborationPromote National Public Health Accreditation
54Rec1B: Implement Policies for the Systematic Use and Development of Evidence and Best Practices Strong fiscal management and effectiveness will require continual and enhanced research, evaluation, and translation of policies, programs, and services. Moreover, evidence and best practices information on a few policies already exists but this information is not used systematically by PHAs and community organizations.
55Rec1B: Action StepsAssure adequate data collection, analysis, and utilization to support the mission of public health agenciesDevelop metrics and tools to support policy and impact assessmentsCapture value and improved outcomes through a defined evaluation processImprove the systematic collection, growth, and use of evidence of what works in public health. Identify and disseminate existing best practices.
56Rec1B: Action StepsDevelop tools and resources for health development agencies to use that are equivalent to those used in economic development, but with community health improvement indicators as the outcome measures/ROIDesign successive versions of the public health accreditation standards and measures to drive innovation
57Existing sources for evidence-based practices to identify promising practices include: The Practical Playbook (www.practicalplaybook.org)Strategies for Reducing Health Disparities — Selected CDC-Sponsored Interventions, United States, 2014 (http://www.cdc.gov/mmwr/preview/ind2014_su.html#HealthDisparities2014)Guide to Community Preventive Services (www.thecommunityguide.org/index.html)Healthy People 2020Compendium of Proven Community Based Prevention Programs (http://tfah.org/report/110)County Health RankingsTHRIVE tool (http://thrive.preventioninstitute.org/thrive/index.php)Various examples from state and local PHAs
58Rec1C: Build Public Health Agencies' Role in Fostering Prevention and Health Promotion Strategies …Public health agencies can provide this trusted leadership but will require the expansion of prevention research and subsequent publication and dissemination of findings, as well as improvements in workforce development and agency communications capabilities.
59Rec1C: Action StepsDemonstrate the value of PHA leadership in fostering prevention & health promotion strategies to other stakeholders.Promote foundational capabilities of state & local public health agencies. Engage outside stakeholders in this conversation.Incorporate the necessary skills and competencies for these capabilities into training for public health professionals.Identify best practices already in existence that demonstrate these capabilities, and promote these practices.
60Rec1C: Action StepsAssure adequate IT capabilities, data collection, analysis, and utilization to support these foundational capabilities.Enhance PHAs’ communication capabilities in the evolving Internet, social media, and broadcast era.Develop marketing skills to build support for and create coalitions in support of the "health development agency" concept.Assure that all PHA processes amplify hidden or muffled community voices.Expand prevention research, including enlarging the number of researchers focused on prevention.
61Rec2: Partner in Health Care Transformation to Facilitate the Evolution from a Health Care System to a Health SystemSpecific trends in health care supporting this shift to emphasizing community health and prevention include:Health care systems, particularly those pursuing the Triple Aim…and…improving population healthThe move away from fee-for-service payment toward pay for value and global budgeting approaches adopted by both public agencies and private not-for-profit clinical entities
62Rec2: Partner in Health Care Transformation to Facilitate the Evolution from a Health Care System to a Health SystemIn its role as chief health strategist, public health needs to seize the opportunity and be at the table to offer strategic direction, facilitation, vision for prevention, advanced analytics, best practice knowledge on community health interventions, and (where relevant) services. Public health needs to share its experiences to ensure that new initiatives can build on learnings and successes. Public health also needs to share in the savings realized when prevention and health promotion bend the health cost curve downward.
63Rec2: Action StepsAt the national and state levelsIdentify specific models and best practices of effective public health collaborations with health care systemsDevelop tools and venues for educating health care professionals and the broader health leadership community on the importance of taking a community-oriented approach and on the models and best practicesState and local governmental public health agencies should build both the evidence- and practice-base for public health in collaboration with community partners
64Rec2: Action StepsAt the local levelState and local public health agencies should determine how they can best contribute to enhanced health provider efforts to improve population healthLocal health departments should facilitate discussions with and learning by health care providers about innovations and new models for joint public health/health care service delivery that represent opportunities for enhanced community healthIdentify health care leaders who are interested in and/or have a track record of addressing community needs
65Rec2: Action Steps At the local level …PHAs should work with clinical partners to encourage that Community Health Needs Assessment processes:Collaborate with PHAs on comprehensive CHNAs.Include robust analysis of community conditions and root causes of health inequities.Deploy big data analytics that uses public health and health care data.Work with communities to identify the community’s concerns and priorities and build on these concerns to develop and implement plans to address community needs.Align with the voluntary Public Health Accreditation Board (PHAB) standards.
66Rec3: Build the Capacity for Dialogue about Inclusion, Opportunity, and Equity There are important value changes that public health agencies need to reinforce. The ability to frame a dialogue, both internal to the agency and external in the community, about the historical legacy and present day practices of racism and other "isms" is fundamental to understanding and addressing the root causes of health inequity and advancing community vitality.
67Rec3: Action StepsUse dialogues to identify and promote fundamental aspirations of communities and residents, and use them to inform the work of public health agencies, including community health improvement plans and internal agency strategic plans. Integrate opportunities for dialogue on legacy and future-focused narratives into routine public health practice.Identify opportunities to dialogue with executive and legislative policymakers.Identify existing good examples of dialogues, disseminate them, and replicate them.
68Rec4: Dialogue with Other Sectors to Support Innovation Public health should facilitate mutual understanding of needs and perspectives, and tailor messages accordingly […] Public health also needs to seek lessons in innovation through these dialogues with other stakeholders and sectors.
69Rec4: Action StepsDefine and acquire the skills needed for effective dialogue with other stakeholders and sectors.Institutionalize measures for effective dialogue.Adjust public health messages to reflect what community stakeholders can hear and absorb.Conduct dialogues with stakeholders and sectors outside of public health ("Talk to somebody different").Conduct one-on-one meetings with strategic stakeholders.
70Rec4: Action StepsIdentify and pursue opportunities for dialogue with executive and legislative policymakers, as well as with the media.Identify innovative options that meet the needs and perspectives of multiple, diverse stakeholders and sectors.Catalyze Health Collaboratives comprised of influential champions who work to educate decision makers and the public about the critical importance of health development agencies’ work in ensuring the economic future of our country.
71Rec4: Action StepsMarket health development agencies by providing a clear and compelling case for and image of them. This should encourage stakeholders to come to health development agencies for consultation regarding prevention, health promotion, and disease management strategies, and to trust their evaluation processes related to the measurement of national, state, and local health outcomes.
72Public Health 2030: A Scenario Exploration Supported by grants from: