Public health is what we do collectively as a society to assure the conditions in which we can achieve optimal health, and public health matters to everyone every day. The public health field’s accomplishments over the past century have been profound. At the turn of the millennium, the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR) published public health’s top 10 achievements of the 20th century, including vaccination, motor-vehicle safety, family planning, control of infectious diseases and recognition of tobacco use as a health hazard.
Public health’s efforts were credited with increasing life expectancy at birth among U.S. residents by 62 percent, from 47.3 years in 1900 to 76.8 years in 2000, nearly 30 years, a fantastic feat. However, there was a growing recognition that to sustain these achievements and address evolving challenges around chronic disease and growing health disparities, the scope and approach of public health needed to evolve.
A framework for considering the history of public health practice in the U.S. is to conceptualize three eras (see Figure 1):
PUBLIC HEALTH 1.0: Public Health 1.0 (the late 19th and most of the 20th centuries) focused on comprehensive public health protection—from primary prevention through treatment. The public health system developed an astounding range of tools and capacity for safe-guarding health primarily in food safety and infection control.
PUBLIC HEALTH 2.0: By the late 20th century, local public health capacity varied greatly among states and communities. In its seminal 1988 report, “The Future of Public Health,” the Institute of Medicine (IOM) reported the strain under which public health authorities worked to provide safety-net clinical services. The IOM called attention to the lack of capacity of the public health system to continue this role and the need to shift focus and resources to address new infectious disease challenges (e.g., COVID-19 and HIV/AIDS) and the growing challenge of chronic disease prevention and preparedness. The result: defined core functions of public health (assessment, policy development and assurance) and the 10 Essential Public Health Services (Figure 2). Governmental public health came of age culminating in today’s public health department accreditation movement.
PUBLIC HEALTH 3.0: We are in a time of disruption and an evolving scope of public health practice that has been labeled Public Health 3.0. In 2016, federal officials challenged the public health community to upgrade in “Public Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure.” This emerging version of public health repre-sents a significant shift with an emphasis on cross-sector collaboration and systems approaches for health strategies.
What changes in a Public Health 3.0 approach?
Health is influenced by social, physical and economic environments, and these environments often lead to health disparities – unequal health outcomes among populations. Access to health insurance does not assure access to a health care provider. Even access to a health care provider does not assure access to health. In fact, zip code is a better predictor of health than genetic code. Public Health 3.0 pushes further upstream through Policy, Systems and Environmental (PSE) change to address the root causes of health including education, housing, transportation, economic stability and discrimination. It requires that public health practitioners must expand their competencies to include strategic and systems thinking, change management, communication and policy development.
What does Public Health 3.0 look like for health care providers and administrators?
The concepts of population health are increasingly incorporated into clinical training and appear as part of U.S. health care’s Triple Aim framework. Health care is increasingly shaped by value-based care payment models driving providers and administrators to advance population health management strategies. Public Health 3.0 presents an opportunity for better integration between health care services and public health as depicted in the CDC’s Three Buckets of Prevention (Figure 3).Public Health 3.0 requires public health and health care professionals to expand their appreciation of the barriers to health in the community and be innovative in forming collaborations with non-traditional partners whose work intersects with the social determinants of health.
COVID-19 through a Public Health 3.0 lens
As our nation and the world are surging our public health capacity to address the coronavirus pandemic, a Public Health 3.0 approach offers insight and opportunities to respond differently.
How will the economic hardships experienced by Iowans disadvantage their health outcomes in the short and long term? Will children who are missing instructional time and access to meals due to the closure of schools be at greater risk for lower educational attainment, a known social determinant of health?
Public Health 3.0 guides us to look further upstream and collaborate with other sectors and non-traditional community partners to mitigate these impacts.
Jeneane Moody, M.P.H., is an instructor in DMU’s department of public health. Her pub-lic health career has included leadership and advocacy roles in the nonprofit sector and community health practice in governmental public health, including serving as executive director of the Iowa Public Health Association.