Providing a critical roadmap to bridge the gap between medicine and public health
Academic medical centers across the country and around the world are rapidly creating and expanding population health departments to bridge the worlds of clinical practice and public health. However, few frameworks exist to guide these efforts. Now a new case study from a pioneering leader in the field provides an important and definitive road map.
The report—published by the Department of Population Health at NYU School of Medicine in the June 2019 issue of Academic Medicine—includes four core approaches to improving health and reducing health inequities:
- Engaging community partners to ensure that research goals and activities align with real-world priorities
- Turning information into insight through rigorous analysis of data from diverse sources
- Transforming healthcare to bridge the divide between research and clinical operations
- Shaping policy by expanding the evidence base for and evaluating policies that advance population health
"While departments of Population Health are emerging independently at multiple institutions across the country, they share a number of core goals," says Marc N. Gourevitch, MD, MPH , the Muriel G. and George W. Singer Professor and chair of the Department of Population Health at NYU School of Medicine, and co-author of the case study. "We offer an approach for academic medical centers to promote health across the domains of research, education, and practice."
Launched in 2012, the Department of Population Health at NYU School of Medicine was one of the first departments of its kind in the country—and now the largest, with nearly 100 full-time faculty and 350 staff. Its roster of interdisciplinary research encompasses numerous disciplines including community-engaged preventive health; mathematical modeling of health interventions; biomedical ethics, early childhood development; and healthcare delivery system improvements. Its faculty have published more than 2,000 peer-reviewed academic articles, and the Department has more than doubled its extramural funding, exceeding $49 million this year (of which 49 percent is from the National Institutes of Health).
A Record of Achievement
The report cites examples of successful initiatives that correspond to the four core approaches proposed as a framework for departments of population health:
- Engaging community health workers from South Asian communities burdened by high rates of diabetes and hypertension to work with residents to prevent and manage diabetes, and from barbershops and churches in the African American community to promote colorectal screening among black men —the population most likely to die from colorectal cancer in the U.S.
- Exploring the connection between the presence of specific communities of oral bacteria and the subsequent development of different cancers by applying novel computational approaches, and investigating whether or not modifiable behaviors such as smoking and consuming specific foods increase risk for developing these oral bacteria profiles
- Supporting transformation of health care delivery from a volume- to a value-based approach by developing new models for improving and linking community-based, office-based, and hospital-based care through information technology, identifying high-risk populations, and evaluating the effectiveness of value-based care interventions.
- Determining the influence of policies to alter the food environment on health outcomes such as childhood obesity, diabetes, and cancer
Gourevitch and Lorna Thorpe, Ph.D., MPH , professor of Population Health and director of the department's Division of Epidemiology—and the case study's co-author—agree that Population Health departments face a number of common challenges. These include tensions in balancing priorities of research, practice, and evaluation; sustaining an integrated, interdisciplinary approach; and perhaps the largest hurdle, the lack of financial models that reward health care delivery systems for investing meaningfully in the health of geographic populations.
Despite these challenges, "academic medical centers and health systems across the country will increasingly endorse population health, not only to achieve the improved outcomes that come from addressing patients' social needs but also to harness resources and expertise in measuring the impact of novel approaches on the health of clinical populations and the communities in which they live," Thorpe says.
Gourevitch recently co-authored another study—along with eight other population health department chairs nationwide—describing the emergence and growth of the field in U.S. academic medicine in the journal JAMA Network Open . Key findings in that study also highlighted common elements and opportunities, and challenges across these new academic entities.
"Health systems achieve their missions most successfully when they partner with the communities they serve to create programs that meet defined needs," says Robert I. Grossman, MD, the Saul J. Farber Dean of NYU School of Medicine and CEO of NYU Langone Health. "In addition to providing outstanding clinical care, we foster broad-based investigation into what most benefits communities in sustaining good health and quality of life. Our Department of Population Health leads much of this effort."