Iskandar: Hello I'm Dr. John Iskandar.
Welcome to CDC's Beyond the Data.
I'm here today with Dr. Karen DeSalvo,
acting Assistant Secretary for Health and one
of our most visionary contemporary public
health leaders.
Welcome Dr. DeSalvo.
DeSalvo: Thank you John, it's great to be here.
Iskandar: We heard during today's Grand Rounds
about your experience as Health Commissioner of New Orleans,
a city where we both did some of our training.
What were the lessons there, are particularly with regard
to this idea of health in all policies?
DeSalvo: Initially was a very strong awakening that health,
to get to health would take more than healthcare.
Adjust rebuilding our healthcare system
after flooding was going to, as the the data would say,
make a difference in 10 maybe 20% of the health
of an extremely unhealthy population
and really are determinants of health for broader.
They were about poverty and public safety
and even transportation and we learn for example
that the bus routes in the city
of New Orleans were essentially all designed to bring people
to the emergency room or clinic at Charity Hospital
and not really distributing that to an opportunity to go
to the community health centers.
So there are a lot of ways that we had a reengineer all
of our systems, not just healthcare and public health
but all the other sectors so that we can begin
to make advancements broadly in the health of our community.
Iskandar: And I think another insight there was
about public health being,
I used to think you meant metaphorically at the table
but you really meant literally at the table,
so what was that experience
like as New Orleans first ever Health Commissioner following
Hurricane Katrina?
DeSalvo: There're a lot of tables that were sat to think
about rebuilding our community and we were lucky
in many ways there as the public health community
because we were a part of a civic engagement rebirth
and there was a great deal of thinking
about what were the right voices and experiences
and who should be there and a lot of cross talking
and community conversation anyway, But public health as it,
as it can be many communities was really weakened not just
by the storm but by years of decreased funding, some brought
on frankly because we
as a nation have forgotten how valuable public health is,
how it is a part of the infrastructure of our country
and have increasingly turned to the tools of medicine
as a way to save lives.
Great success in this country on using the tools of medicine,
vaccinations, drugs, dialysis,
surgeries to improve life expectancy.
But, as some people may know we began to plateau
in life expectancy and just as we took another look
in New Orleans at what were the right players that needed
to be involved, the country's looking again and saying
that there are broader issues at play
and public health is the natural, a natural leader
in seeing that the conditions in which we live and learn
and work are play are healthy so that, that becomes
that the easy, the easy choice but also just
that the basic infrastructure is strong.
It was, so I was in the midst of rebuilding and a part
of our infrastructure in the community and as I said,
got very lucky because we had strong leadership not only
from our mayor but from other parts of civic society
who recognize that to get to health we would need that part
of our infrastructure to be strong,
our health department in particular.
Iskandar: Very interesting.
So one way I think of your work at the federal level is as sort
of an extension really of that concept of health
and all policies, so for people
who haven't heard what public health 3.0 is
or who have heard it but really aren't sure what it means can
you tell us where we stand and what that up concept means?
DeSalvo: Public health is undergoing an evolution.
It's transforming.
This began very organically not only in communities
like New Orleans where we were rethinking how we are
approaching how often, with whom we're approaching it,
but I've learned that it's happening all
across the country.
It's the next generation of public health practice.
The early days 1.0 were a time when the epidemiology told us
that it was about communicable disease that was the ways
that we needed to support the public's health.
Sanitation and vaccination in that period as examples.
But as the epidemiology changed to so did the work and focus
of public health to chronic disease,
non-communicable disease.
And though that work isn't done, we made a lot of progress
in that, in the space of non-communicable disease clearly
to really tackle more upstream that the causes
of cardiovascular disease, the leading cause of death.
Even injury, if you, if you, as you move down the list,
it's really is gonna take a broader approach.
And that means taking a health and all policies approach
to working with transportation or housing
but also really being able to lead the conversation
and measure our success
and addressing the social determinants.
So these public health 3.0 communities are building
on their 1.0 and 2.0 and really expanding their purview thinking
about how they work in a multisectoral fashion
and are either at the table or leading
at the table where appropriate.
We're seeing also that they're considering themselves
responsible and accountable
to be a chief health strategist on the front lines.
This is a term that can apply really to many types of leaders
on the front lines but when the public health leaders begin
to see themselves as being strategically responsible,
not for executing on programs that are funding,
but really leaning in and thinking ahead about the ways
that they can broadly create a healthy environment,
the conditions in which everyone can be healthy.
Those are the communities where their beginning
to see a lot more success in reversing the course.
You know there's some really nice work by a Ross Chetty
that looks at more than a billion data points of people
across this country and looked at life expectancy
and what are the underlying characteristics
that that predict which communities are healthier
and the public health is not called out network specifically,
there a lot of recurring themes and it essentially points
to the entire community working together
to address broad determinates like poverty and education
in public infrastructure and that that theme is repeated
in these public health 3.0 communities and has given me,
frankly, a lot of not just hope but excitement
about public health being back and, you know,
back is the convener of stature and being able
to have these really important conversations
that I think are going to put the trajectory
of life expectancy while being back on the right track.
Iskandar: So one of CDC's always most important partners is state
and local health departments and many
of our Grand Rounds audience working those kind of settings.
What does this idea of public health 3.0.
What does or what could it mean for them
in their day-to-day work and lives?
DeSalvo: We know in that we put out reports
on public health 3.0 that's available at healthy people.gov,
healthy people 2020.gov.
So if people want to get more into the weeds about it,
we make five recommendations essentially
about what success looks like and then hanging off
of those are another 46 recommendations.
There's 51 in all but really five big ones about leadership
and funding and data and accreditation and accountability
and partnerships and then ways that federal state
and local governments but also the private sector can work
together to create the kind of environment
that allows them to be successful.
What I heard in the listening tour we did
about public health 3.0 and what we have been and learning
from other sources, particularly people working on this
on the front lines is that this is the way they want to work.
They want to be able to think broadly about systems
and environmental and policy level change.
They want to be able to convene and shape health
in all policies across government.
Sometimes when you're doing that its short-term
or it's not sustainable because the funding they receive tends
to be more categorical, because they may not have the data
or the tools to look at the health
of their community broadly,
and you got to have the right partners, so maybe businesses
at the table with them in effective ways as they want.
And, and maybe even as leaders in public health
and it doesn't have to be the Health Commissioner
or State Health Officer or Secretary.
Everybody's a leader in public health.
Our education and training experiences haven't always
brought us the vocabulary that gives us that comfort
that we can talk with the criminal justice system
or transportation or the housing sector,
so it's also incumbent upon those of us working
in public health to continuously learn and retrain.
To make certain that when we are having those conversations we
can understand the kinds of decisions
that maybe other sectors are making and help them learn
about the downstream consequences.
So I do hope people look at the report
because we took the time also to think
about what would be most impactful and would begin
to bring this new world of public health 3.0
to more communities to help those that are engaged
in it to be successful.
Oh, and there are some case studies so people can learn
about communities that are doing it in and learn from them.
Iskandar: So really, a vision of a future
in which public health has a leadership role not just
in health but really in improving society in general.
DeSalvo: And well-being!
And to paraphrase something that we say sometimes
in health information technology, "the future is here,
it's just not everywhere".
And, so, we found that there a lot of leading-edge communities
in Kansas and in Spokane, Washington and in Tennessee
and in and in the Northeast Pennsylvania.
And they just really need to be supported and to have kind
of a framework and be connected to each other
so they can keep learning and growing and advancing movement.
Iskandar: Well thank you very much
for joining us today Dr. DeSalvo.
DeSalvo: Thank you John.
Iskandar: Please join us next month for Beyond the Data.