Building Multisectoral Partnerships for Population Health and Health Equity - Preventing Chronic Disease: November 2010: 10_0079

http://www.cdc.gov/pcd/issues/2010/nov/images/cover_nov10.jpg
November 2010
Volume 7: Issue 6
ISSN: 1545-1151
SPECIAL TOPIC
Building Multisectoral Partnerships for Population Health and Health Equity
Stephen Fawcett, PhD; Jerry Schultz, PhD; Jomella Watson-Thompson, PhD; Michael Fox, PhD; Roderick Bremby, MPA


Suggested citation for this article: Fawcett S, Schultz J, Watson-Thompson J, Fox M, Bremby R. Building multisectoral partnerships for population health and health equity. Prev Chronic Dis 2010;7(6). http://www.cdc.gov/pcd/issues/2010/nov/10_0079.htm. Accessed [date].

PEER REVIEWED
Abstract

Poor performance in achieving population health goals is well-noted — approximately 10% of public health measures tracked are met. Less well-understood is how to create conditions that produce these goals. This article examines some of the factors that contribute to this poor performance, such as lack of shared responsibility for outcomes, lack of cooperation and collaboration, and limited understanding of what works. It also considers challenges to engaging stakeholders at multiple ecologic levels in building collaborative partnerships for population health. Grounded in the Institute of Medicine framework for collaborative public health action, it outlines 12 key processes for effecting change and improvement, such as analyzing information, establishing a vision and mission, using strategic and action plans, developing effective leadership, documenting progress and using feedback, and making outcomes matter. The article concludes with recommendations for strengthening collaborative partnerships for population health and health equity.


The Problem

Poor performance in achieving population health goals is all too familiar. So is the accompanying every-decade ritual in the United States: the announcement of a new round of planning to create health goals for the nation (eg, Healthy People 2020), followed by a wave of enthusiasm and then disenchantment (eg, “the problems with the data arise from . . .”), search for the guilty (eg, “but they were never at the table”), punishment of the innocent (eg, “with this reorganization, our agency looks forward to . . .”), and reward for the uninvolved (eg, “we should never forget that America offers the world’s highest-quality health care”).

Lost in this drama are the numbers: for the 281 measurable public health performance objectives tracked for Healthy People 2010, only 10% met their targets (1). Although progress was made toward meeting nearly 50% (n = 138) of the objectives, 20% (n = 57) grew worse. Disparities in health outcomes for ethnic minorities also remain a failure. One of the most glaring disparities is in the African American community, in which 48% of adults suffer from a chronic disease compared with 39% of the general population. Why do we keep falling short of the bars we have set for ourselves in population health and health equity?

Several factors contribute to these poor results. First, multiple and unconnected sectors lack shared responsibility for outcomes. Consumers, providers, insurance companies, employers, and government agencies all vie for individual advantage in our fragmented health care system, avoiding responsibility for unimpressive outcomes. Second, the health care system lacks cooperation and collaboration in achieving population-level goals. Emmanuel and Fuchs (2) characterize this as “the myth of shared responsibility.” Third, no public or private entity has overall responsibility for improving population health. This situation contributes to a willingness to proclaim victory for hard work, rather than meaningful improvement (3). Finally, moving toward improved population health and health equity requires understanding what works and what does not, and a willingness to agree on the price we pay for each. Sustained cooperation and shared responsibility among stakeholders in different sectors of a comprehensive public health system are necessary (4).

The public health response promotes community partnerships and cooperation as represented in the essential services. Public health agencies have come to recognize that community partnerships are a necessity in health improvement and that major health initiatives require community coalitions (5). Results are mixed, but the empirical evidence base for the effectiveness of partnerships to improve population health is growing (6-9).

In response to these problems, we offer a framework to guide collaborative action to improve population health. We also outline key processes for promoting community/system change and population health improvement. We conclude with 7 recommendations for strengthening collaborative partnerships for population health and health equity.

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Preventing Chronic Disease: November 2010: 10_0079