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Is Public Health Missing a Bountiful Feast? Taking on the Social Determinants of Health

Date: 11/1/2017 10:53 AM

Related Categories: Performance Management, Quality Improvement

Topic: Performance Management and Quality Improvement, PHF News, Strategic Planning

Tag: Population Health, Essential Public Health Services, Community Health Improvement Plan

Author: Margie Beaudry

In October 2017, a colleague and I attended an outstanding meeting convened by the Root Cause Coalition in Louisville, KY. The group’s second annual Summit on the Social Determinants of Health drew some 450 attendees from hospitals and health systems, health plans, social service agencies, and community-based organizations from all over the country. The event was remarkable from several perspectives:

  • It focused on strategies and analytics to address the upstream causes of chronic health challenges, especially health disparities.
  • It featured dialogue among leaders from diverse settings about how to innovate to improve community and individual health.
  • It highlighted successful partnerships involving healthcare and community service organizations.

Opening Our Eyes
One of the most remarkable things about this meeting was that -- apart from two of us from PHF and Director of the Louisville Metro Department of Public Health -- the public health community did not appear to be there. The presenters and attendees did not include people from governmental public health, schools of public health, public health institutes, or the other national organizations providing guidance and advocacy for them. For this bountiful feast of upstream innovation, mutual respect, and forthright problem solving, public health was not at the table.


The planners had not targeted public health organizations as likely attendees, and the meeting was not promoted in any of the usual newsletters, listservs, or social media platforms that reach this audience. We spoke with regional hospital associations, health systems, and payers in attendance about the role that health departments play in their initiatives. We ascertained that health departments are valued partners in health assessments – in helping to identify the challenges at hand. However, when it comes to planning and implementing an improvement strategy that requires out-of-the-box thinking and action, public health is often not a part of the dialogue or process. We heard that governmental public health can be bureaucratic and slow, risk averse, and not inclined to innovate.


Perhaps this should not surprise us. Limited resources force public health organizations to be smart and strategic about investing in initiatives. They often cannot afford to be experimental or go down a road that may not be successful.


Is This a Problem?
Suppose public health’s involvement does constrain ingenuity or slow the pace of change when it comes to addressing social determinants of health. Suppose those leading innovative solutions do not see public health as relevant. Is this problematic? The Ten Essential Public Health Services include “#4: Mobilize community partnerships and action to identify and solve health problems.” If health departments are not part of the development, installation, and monitoring of groundbreaking solutions (such as those featured at the Root Cause Coalition meeting), then how will health departments fulfill this role? The Public Health Accreditation Board (PHAB) recognizes that innovation is essential. It established the Public Health National Center for Innovation (PHNCI) to test and share models of innovation to help health departments adapt to meet the changing needs in their communities. In addition, innovation is only one piece of the puzzle. According to Christopher F. Koller, President of The Milbank Memorial Fund, a series of new reports suggest, “leadership and persistence are at least as important as innovation.”1 If these health improvement activities are going on in your backyard, but your health department is not involved, then you are missing an opportunity to be a true public health leader or Community Chief Health Strategist.


Stimulate a Culture of Innovative, Audacious Solutions
While this may seem like a daunting problem, we have seen it before. PHF has the expertise to help you to address this challenge by fostering productive partnerships. For the public health community to join the conversation and contribute to lasting solutions addressing the social determinants of health, individuals and organizations must take deliberate steps to counteract its perceived inertia and reluctance. A great place to start is with the health improvement planning and implementation.

  1. Think Outside the Box. Get innovative ideas going within your organization to help change this image of public health. Seriously consider bold, ambitious ways to effect change at the root cause. Challenge assumptions. Then paddle upstream and test the water.
  2. Act First, Apologize Later. People respect results. If your agency’s structure and culture reward the status quo, then do not ask permission to get better results by breaking the mold.
  3. Share Ownership. Come to the table, and then contribute what you know in order to achieve through partnership what you cannot do on your own.
  4. Bring QI to the Table with You. When it gets challenging, be persistent. Like any change process, innovation requires critical thinking about problems and informed experimentation with solutions.
Need to Develop a CHIP/SHIP/THIP?
Building and implementing a health improvement plan is the ideal chance to innovate and lead strategies to address the social determinants of health.

Already Have a CHIP/SHIP/THIP?
Use these PHF resources and services to support an innovative, collaborative strategy for its implementation: 

1Milbank Memorial Fund Newsletter, October 2017


Join the Conversation
What is the reputation of public health in your community? How did this come to be? Leave a comment below so others can learn from your experience.



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