Reasons for Optimism in Population Health – Part II

In the current climate of political and global tumult, it is easy to feel pessimistic about current and future population health. For example, in my own area of research, teenage pregnancy prevention, the U.S. Department of Health and Human Services has recently announced early termination of the primary sources of funding for developing evidence-based teenage pregnancy prevention programs. In order to stay energized in our pursuits to improve population health, it is important to remember things that are going right–places where progress is being made. I queried a half-dozen leading population health researchers to ask them what reasons they find for maintaining optimism about population health in the United States. This two-part post summarizes their thoughts and my own. (You can read Part I here.)

Part II

Local efforts (city and state governments)

While all interviewees worried about the effects of recent federal policies on population health, respondents found considerable reason for optimism in the actions of state and local governments to promote population health. The state of California was highlighted for its leadership role in areas such as maternal health research, boycotting government-sponsored travel to states who discriminate against LGBTQ populations, and convening an alternate coalition of governments willing to adhere to the Paris Agreement on climate change.

Cities were also noted as reasons for optimism. For example, in their new book Climate of Hope, Michael Bloomberg and Carl Pope note that cities are responsible for 70% of US emissions, and city policies can help to drastically reduce emissions even in absence of federal commitments, such as with the Paris Climate Agreement. Cities are taking many other actions aimed at reducing inequality and improving population health, such as providing protections for immigrants from intrusive federal policing by designating themselves sanctuary cities, removing all confederate statues in response to recent White Supremacist demonstrations in Charlottesville, and passing $15 per hour minimum wage ordinances. Cities’ and states’ actions serve as reminders that meaningful policy can be implemented at all levels of government and population health improvement can be implemented even despite federal policies that often work against it.

Other sectors: nonprofit, academic, private, and partnerships among them

Finally, respondents saw non-governmental sectors as having a positive and increasingly large role in population health promotion, reminding population health scientists and practitioners that while elections and elected officials matter, they do not control everything.

Nonprofit sector: Nonprofit organizations make a difference in their community in ways that have a positive impact on social determinants of health–despite the challenges facing them at the federal (and in some cases, the state level). By not depending entirely on government funding, nonprofits have some immunization from the current political turbulence. For example, Make the Road New York is a fully-staffed organization with over 20,000 members working on the front lines to protect immigrant rights in multiple domains, including health care and the legal system.

Academic sector: Academia continues to produce research reporting on the results of public policies for population health. For example, research from the University of Texas’ Texas Policy Evaluation Project showed the negative health impacts of abortion restrictions on women’s health across the state. This research was cited as highly influential in the U.S. Supreme Court’s recent ruling in Whole Women’s Health v. Hellerstedt, in which the Court overturned a Texas state law requiring hospital admitting privileges and surgical center facilities for all abortion providers. This ruling has resulted in decreased enthusiasm for passing such laws in other states.

Private sector: Respondents highlighted developments in the private sector, particularly in technology, with potential to improve population health. Innovation in databases and computing have enabled more data, of all forms, to be rapidly generated, stored, and analyzed cheaply. This has positive implications for issues such as healthcare cost control, identifying excellent or underwhelming provider performance, and predicting risks, such as those in vulnerable populations. A host of health-oriented startups now exist: for example, ESO solutions creates software to enable data sharing between emergency medical services and hospitals, helping to boost continuity of care and quality monitoring.

Multisector partnerships: A final area of optimism was the increasing popularity of population-health oriented multisector partnerships, which aim to make change through synergy of complementary sectors. The Building Healthy Places network, for example, is a partnership between the community development and health sectors. Their mission is to “catalyze and support collaboration across the health and community development sectors, together working to improve low-income communities and the lives of people living in them.” Policy Link, a national research and action institute, works to advance economic and social equity across multiple public sectors. Policy Link’s products include evidence-based tool kits to help cities enact evidence-based economic and social policies that promote equity.

In summary, leading population health scientists have many reasons to maintain optimism about the future of population health in the United States. One respondent said it best: “History has shown us that our darkest hours can give rise to our greatest aspirations and triumphs. That is what helps me remain optimistic, whether we are talking about population health or the broader zeitgeist. We do a disservice to the many people before us who gave up their energy, talent, and in some cases, their lives by wallowing only in how bad things are in the present moment.” With that and some of the above examples in mind, let’s maintain optimism and get to work!

Thank you to the following individuals for their contributions to this post:

Christine Bachrach, PhD, Research Professor, Department of Sociology, University of Maryland and Managing Director, International Association for Population Health Science Executive Director

Merlin Chowkwanyun, PhD, MPH, Assistant Professor, Department of Sociomedical Sciences, Columbia University

Dorothy Daley, PhD, Professor, School of Public Affairs and Administration, University of Kansas

Lindsay Till Hoyt, PhD, Assistant Professor, Department of Psychology, Fordham University

John Mullahy, PhD, Professor, Department of Population Health Sciences, University of Wisconsin

Stephanie Robert, PhD, Professor, School of Social Work, University of Wisconsin