Big city health departments lead the way in improving population health

The health departments of the nation's largest cities play a central role in developing innovative population health strategies for improving public health across the United States, according to a special January issue of the Journal of Public Health Management and Practice.

"Indeed, cities are at the forefront in extending public health and social policy to realize changes in our environment abetting population health," according to a commentary by Lloyd F. Novick, MD, MPH, Editor-in-Chief of Journal of Public Health Management and Practice. The de Beaumont Foundation, in partnership with the Robert Wood Johnson Foundation, provides support for the Big Cities Health Coalition (BCHC), a forum for the leaders of America's largest metropolitan health departments.

Big Challenges, Big Ideas for Improving Public Health

Titled "Big City Health Departments: Leadership Perspectives," the special issue presents updates and ideas from the member health departments of the BCHC. The 15 articles in the special issue highlight the efforts of urban public health departments in designing new approaches designed to make cities healthier places to live. Dr Novick cites examples including:

• The Chicago Department of Health's comprehensive "Healthy Chicago" strategy using informatics to guide service delivery and policy, with efforts coordinated across city departments.
• The San Francisco Health Department's broadened role in health promotion and injury prevention, focusing on "community wellness...and development of healthy and sustainable environments."
• The City of Los Angeles General Plan, which seeks to promote healthy environments through a "multi-sectoral" approach, encompassing areas such as city public health, parks, and law enforcement.
• Numerous cities introducing "health in all policies" approaches, including Seattle/King County, Boston, and Washington, DC.

A recurring theme is the impact of the Affordable Care Act on public health, in big cities and around the country. While its effects on expanding insurance coverage and increasing access to health services have received the most attention, the Act includes many provisions targeting public health provisions—for example, programs to improve population health by improving nutrition and physical activity and reducing smoking.

Dr Novick discusses these emerging strategies in context of the history of public health leadership in US cities, with progress depending on "political support, public health infrastructure, and systems for collecting and analyzing health data." He concludes, "We are now witnessing an even broader expanded agenda for urban public health, illustrated in this issue: health in all policies; collaboration with a network of community players; and engagement with reform of health care services."

An introductory article by James B. Sprague, MD, CEO of the de Beaumont Foundation, highlights the role of big city health departments in advancing public health at every level. He notes that the 20 members of the BCHC serve approximately 46 million Americans, or 15 percent of the population. "Working together, these cities have used their combined resources and experience to formulate new strategies and solutions to address common challenges."

Creative thinking and leadership are critical to meeting the "triple aims" of the population health approach: access, quality, and cost savings—added to the classic public health challenges of infectious disease, sanitation, and food and water safety, as well as emergency preparedness. Dr Sprague concludes, "Supporting innovation where it is most likely to occur and encouraging subsequent diffusion for uptake among a broader audience can be an effective strategy for systems change."