ASTHO Profile Report Supports Population Health

February 07, 2018|12:28 p.m.| ASTHO Staff

José Montero, MD, MHCDSJosé Montero, MD, MHCDS, is deputy director of CDC, as well as director of the Office for State, Tribal, Local, and Territorial Support. In this position, Montero oversees support to the U.S. health departments, tribal nations, and insular areas, as well as activities designed to improve the public health system’s capacity and performance. Prior to CDC, Montero served as director of the Division of Public Health Services at the New Hampshire Department of Health and Human Services and as ASTHO President. Montero has extensive experience in public health leadership and in the prevention and control of infectious diseases. With this in mind, ASTHO spoke with Montero to discuss the ASTHO Profile report and its impact on public and population health.

In your opinion, how does the work of state and territorial health agencies support population health?

Public health agencies are at the forefront of population health. Their responsibility, through their collective action, is to improve the health outcomes of a population defined by geography. However, public health agencies work in diverse ways to improve these outcomes. Some agencies are regulatory in nature only; some are engaged in regulation, policy development, and implementation; some even provide direct clinical services. All of them track outcomes. Every agency does it differently, and every jurisdiction does it differently. But, at the end of the day, we all, as individuals, look to our government to create and facilitate the conditions that will make and keep us healthy. That is what will improve population health outcomes, and that is the role of public health agencies.

The ASTHO Profile collects information about state/territorial health agency leaders, structure, finances, activities, and workforce. How does this information assist public health agencies in achieving their missions?

The ASTHO Profile, by bringing together this information, allows many different groups to better design, target, and measure population health interventions. When planning activities and programs, we always need to look at which populations we are serving – not only from the risk factor or disease perspective, but also from the perspective of institutional capacity. What resources are available to better serve a particular population, and what is not available? What types of public health agencies serve them? Having this information consolidated in one document facilitates the work not only for the public health agencies themselves, but also for many other players. For example, we know that many for-profit, non-profit and academic organizations play an important role in public health, so it is quite valuable for them to have access to this information. Because the reach of many of these organizations goes beyond geographic or political boundaries, the ability to aggregate the data or see specific differences becomes very valuable.

The ASTHO Profile found that the number of states sharing resources with other states on a continuous, recurring (nonemergency) basis has risen substantially, from 9 percent in 2012 to 27 percent in 2016. Why do you think this is occurring? How do you think this will affect the work of state health agencies now and in the future?

Population health is not about individual clinical care, but is about the overarching set of policies, activities, and services that affect our physical and social environment and how we relate to them, how we interact. It’s well known that addressing the non-medical and structural determinants of health is essential to improving population health outcomes. Public health agencies cannot and should not attempt to do this work alone. We need to work with others who share roles and responsibilities with and for the communities. Some of those key players might be other public agencies, such as the department of environment, the department of education, or the agency that works on housing. Other key players may be in the financial or academic sectors.

In addition, we know that key infrastructure is needed. For example, to prevent chronic diseases, we are talking about initiatives such as the Complete Streets project, which makes it easier for people of all ages and abilities to walk, ride bikes, and use public transit. At the same time, these initiatives focus on factors that facilitate healthy engagement with our environment, and can revitalize a whole area with clear social and economic benefits.

We also need to look at how food distribution systems work to ensure access to healthy food and prevent the creation of food deserts. Public health plays a role in this, but, we need partners to help us. So, it’s very important to identify the common interests that can help increase partnerships and build coalitions. The Profile suggests a key trend that we need to applaud: the braiding of funds. The more that we as agencies, systems, and communities learn to see the combined impact of our economic footprint, the better off we are. The Profile report shows the trend going in the right direction, and this is incredibly important. Hopefully, in the next report, we’ll see an even bigger jump.