Population Health Blog

Population Health Blog

Why It Matters

Why wait for a crisis? Public health funding needs attention

By Dennis Archambault

In his 2016 National Public Health Week proclamation, Gov. Rick Snyder said the observance “allows Michigan to celebrate public health accomplishments made over the past two decades and to bring a renewed focus to the work ahead.” He didn’t indicate specific accomplishments, but anyone reading the document would have to remark at its ironic timing. In the midst of one of the state’s most devastating public health crises, the governor is celebrating public health accomplishments.

He didn’t suggest that there may be no better time than the present to realize the essential value of a well-funded, skilled public health workforce in Michigan — one that is prepared to anticipate and prevent the health impact of policy actions like the ones that resulted in the poisoning of the Flint water supply.

The governor’s proclamation came as the House Fiscal Agency’s 2016-17 budget recommendations for Health and Human Services included a $500,000 cut (before there was an awareness of the $450 million deficit, resulting in further budget cuts across the board), while allowing for $15.1 million in Flint emergency funds. Arguably, there’s considerable irony in the public health funding cut and the relatively astronomical cost of the public health crisis — one that could have been mitigated — even prevented — with prudent, proactive community benefit analysis. Yes, this costs money. But so do crises that affect the health of thousands of citizens.

Emily Friedman’s article, “Before It’s Too Late: Defending Public Health,” published in the April 5 edition of Hospitals and Health Networks magazine http://www.hhnmag.com/ notes that despite the health system’s “infatuation” with the concept of population health, “we continue to underfund, disdain and sometimes even dismiss the work of public health professionals and their agencies.” Public health, she argues is population health.

Friedman’s article sites a range of infectious disease threats that are the daily “invisible” work of local, state, and national public health professionals. This invisibility (and related lack of political voice) has contributed to the chronic underfunding  and public disregard for the function that has protected the common good since the first public health department was founded in 1889.

The struggle between individual rights and the common good, largely driven by economic class and structural racism, has been integral to the American experience. We have seen the impact of disinvestment in public health and environmental quality buckle under the pressure of economic development in the industrial corridor of Southeast Michigan through approval of permits that would allow increased pollution without analysis of community health impact.

Friedman questions whether society is really serious about population health. Are elected officials really committed to investing in the public health infrastructure? Are state health and environmental quality officials committed to the common good? Are health systems committed to real community health investment, beyond investments that support marketing imperatives? If so, “we had better understand that public health is population health.”

Authority Health sponsors the Population Health Council, which creates a forum for health officials and agencies impacting the social determinants of care — including population health professionals from health systems. This council respects the leadership role of public health professionals, as well as the synergistic possibilities of a collaboration of allies to influence public policy and health behavior to create a culture of health.

Gov. Snyder’s proclamation offers food for thought: “Every day health professionals in Michigan work to ensure that all residents have the opportunity to lead a healthy life, empower communities with the tools, knowledge and resources to make a difference, and encourage individuals to take charge of their health, by promoting prevention and health equity in the community.” His challenge, and the population health community’s imperative, is to insist that the public health system is properly financed and that health resources are invested in community well-being.

Dennis Archambault is vice president of Public Affairs at Authority Health.

The rural implications of urban vacant space

By Dennis Archambault

Detroit Free Press Editor Stephen Henderson’s recent commentary, “Sprawl, isolation, and the poverty they leave behind,” warns of  Detroit becoming “an economic chasm that’s largely cut off from areas where there’s more opportunity.” This is a problem that has been worsening for some time and has considerable impact on the health of the city’s population. The gentrification under way in urban Detroit threatens to create two cities: one affluent, young, and trendy; the other large expanses of vacant land with sections of concentrated poverty – the worst formula for creating a healthy urban fabric. You might conclude that there will be one community that’s healthy and the other burdened by chronic disease, crime, and chronic stress.

Looking through a population health lens, the future for low income Detroiters is bleak if current trends continue. Not only is the low income population disconnected from health care resources necessary to prevent and manage chronic disease, it is cut off from sources of fresh food and water, good education, safe places to exercise, and employment. The proliferation of urban farms may be good seasonal sources of vegetables and community connection, they also are increasingly symbolic of rural life.

Henderson points out that while there are clear differences in urban and rural poverty, the distinction between the two in Detroit is disappearing rapidly. That could have profound implications for population health.

Dennis Archambault is vice president of Public Affairs for Authority Health.