Public Health 3.0
Changing the Boundaries of Public Health
On a train ride from New York to Baltimore more than 20 years ago, then-Dean Al Sommer said something remarkable that I never forgot. The problem with public health, he said, is that it has no boundaries. He argued that public health has been its own worst enemy by taking responsibility for everything that impacts health, even if the major social and economic determinants of health such as income and education are beyond our control.
Although Al, more than anyone, recognized the overwhelming importance of addressing problems deeply rooted in social determinants (like violence and substance use disorders), he questioned whether the public health community had the understanding, tools or political support to do much about them.
A lot has changed since that train ride, and I am cautiously optimistic that we are primed to do more.
Enter the era of Public Health 3.0, which was launched in 2016 by the U.S. Department of Health and Human Services and embodied in the Robert Wood Johnson Foundation’s Culture of Health initiative. In a 2016 American Journal of Public Health article, the architects of this new paradigm encourage us to “boldly expand the scope and reach of public health to address all factors that promote health and well-being, including those related to economic development, education, transportation, food, environment and housing.” Fundamental to success, they argue, is our ability to embrace new partnerships that cross sectors of society outside traditional public health circles.
The principal public health tools of assessment, policy development, implementation and evaluation (defined by Public Health 2.0) remain at the core of what we do. Public Health 3.0 prescribes that we apply them in new settings and in new ways, working closely with professionals who are primarily defined by their own area of expertise (like public safety or housing) but who recognize the power of public health to engage communities and use data to drive evidence-based policies and programs.
With this new approach, public health leaders are called upon to serve as “chief health strategists” for communities. They build strategic partnerships across sectors and ensure that goals are aligned in ways that benefit health. They also apply a systems perspective to solve problems by analyzing data drawn from many sources.
This role for public health professionals is not totally novel. They have long coordinated emergency responses to natural and manmade disasters. We need to extend this role to the health challenges we face day in and day out.
Fortunately, political will is also changing, albeit slowly. Elected officials and civic leaders increasingly recognize that the health of their communities depends on safe streets, sound housing, accessible transportation and healthy food. Health impact assessments are gaining traction with decision-makers who use them to evaluate policies for their potential consequences on health.
Our School is uniquely positioned to deliver on the premise and promise of Public Health 3.0. We already work closely with organizations outside of traditional public health—from our groundbreaking collaboration with the Baltimore Police Department to reduce violence to our work with public schools on the Good Behavior Game. And a recent gift from Bloomberg Philanthropies is a game-changer. To address five urgent health issues (addiction and overdose, violence, environmental challenges, obesity and the food system, and risks to adolescent health), the Bloomberg American Health Initiative is training students from community organizations around the country. Some of our initial partners include Outside In, which serves people in Portland who are homeless or have low incomes; Centro SOL, which promotes equity in health and opportunities for Baltimore’s Latino community; and Cherokee Nation Behavioral Health, which provides counseling services for addiction-related disorders. The Initiative will eventually provide 50 master’s scholarships and 10 doctoral scholarships every year to students committed to returning to their home organization for at least a year after graduation. Each graduate will acquire critical public health skills and infuse his or her organization with new knowledge and energy. Over time, the Initiative will increasingly engage with agencies outside the health sector to offer the lens of public health—including equity, evidence and policy—to make progress on shared goals.
One sign that the times are truly changing is that Al Sommer is now deeply involved with and committed to the Bloomberg American Health Initiative. But we must remember his warning that designing and implementing interventions that address deeply rooted social determinants are challenging at best and must withstand critical impact evaluation. And although we do have success stories, all too often political commitment or resources aren’t sufficient to scale up these successes and sustain them for the long term. So, we must become more creative in marshaling resources and political commitment.
One pathway is through the changes underway in the health care system. The emerging interest in holding health care systems accountable for their population’s health opens an opportunity for new strategies and investments. A key question to address, however, is how to redistribute savings realized by the health care system that result from investments made in other sectors.
We must continue to push the boundaries of public health and work with partners in and outside the health field to find solutions. I can think of no better place to drive this agenda than Johns Hopkins. Our schools of public health, nursing and medicine have always prided themselves on working together toward a shared goal of reducing death and disability and improving quality of life. Three disciplines for the 3.0 vision—that’s a path to realizing our common vision for a safer and healthier world.