Preventing Chronic Disease Dialogue

The Preventing Chronic Disease journal welcomes comments from readers on selected published articles to encourage dialogue between chronic disease prevention, researchers, practitioners and advocates.

Health Departments in a Brave New World

March 29th, 2013 8:38 am ET -

ESSAY

Christopher Maylahn, MPH; David Fleming, MD; Guthrie Birkhead, MD, MPH

Suggested citation for this article: Maylahn C, Fleming D, Birkhead G. Health Departments in a Brave New World. Prev Chronic Dis 2013;10:130003. DOI: http://dx.doi.org/10.5888/pcd10.130003

The number of people at risk for chronic diseases is increasing, and methods for reducing risk and promoting health are becoming more complex. Demands of changing political and social environments, as well as economic and demographic trends, are forcing state and local health departments to reassess what is most important and make judicious choices that will yield the greatest gains. Health departments cannot afford to squander time and resources on ineffective programs and policies; to maintain their relevance, they must adopt a public health agenda that is both ambitious and grounded in science.
The mission of health departments is the same today as it was in the 1800s: to ensure conditions in which people can be healthy. As essential players in the nation’s public health system, health departments are operating in the best of times and the worst of times. On the one hand, prevention is getting more attention, and new cross-sector collaborations to embed health in all policies can affect upstream health determinants and push the clinical care system toward more effective, efficient, and equitable care. On the other hand, resources are tight, additional budget cuts loom, and public health is caught up in the larger issues of increasing political polarization and distrust of government. Aligning health with community and economic development can help mitigate these problems. Working with partners from different sectors is essential in reshaping commercial and government policies and practices that drive poor population health (1).
State and local health departments must capitalize on opportunities that now exist to transform the way they do business. Improving the health of Americans requires improvement of population health at multiple levels. The momentum of health care reform and the increased support for prevention must be harnessed. A coordinated approach to prevent chronic diseases and promote health is now supported by new funding provided by the Centers for Disease Control and Prevention (CDC). State public health chronic disease prevention and control programs, especially those that focus on common risk factors such as poor nutrition, low levels of physical activity, and tobacco use, have demonstrated the potential benefits of an integrated model and are a key link to improving our nation’s health (2). State chronic disease directors must expand the effects of local and community-based health programs through coordination and dissemination of evidence-based interventions. Strong leadership from state health directors can reinvent the way health departments operate and stimulate the public health system to be more effective.
We offer 3 priority areas where action can lead to real change in health department programs and practices. Concerted efforts in these areas could substantially improve the health of Americans.