7.3: Public Health Initiatives, Delivery Mechanisms, and Implications
By the end of this section, you should be able to:
- Describe Healthy People 2030, a public health initiative that seeks to improve health outcomes.
- Categorize public health policies by mechanisms of delivery (fiscal policy, regulation, education, preventative treatment, and screening).
- Examine the implications of the Institute for Healthcare Improvement (IHI) Triple Aim to improve population health, reduce costs, and improve client satisfaction.
This chapter has discussed health policy and the balance between the right to human health and individual rights. This section will look at one U.S. public health initiative, the mechanisms of public health delivery, and a framework that has been developed to improve population health, reduce costs, and improve client satisfaction.
Healthy People 2030
The Health of the Population described Healthy People , a public health initiative that seeks to improve health outcomes in the United States. Put forth by the HHS, the 10-year plan establishes public health priorities and data-driven objectives to improve public health and well-being over a decade. The most recent iteration of the plan, Healthy People 2030, includes 23 high-priority leading health indicators (LHIs) to improve health and well-being over the lifespan. Most LHIs address factors that affect major causes of death and disease, such as the proportion of people with access to health insurance and the number of people exposed to unhealthy air (ODPHP, n.d.-c).
Public health policies and programs are what drive and establish the mechanisms by which such health outcomes are achieved. Table 7.5 provides examples of LHI objectives as established by Healthy People 2030 and examples of policies and programs necessary to achieve them.
| Leading Health Indicator Objective | Public Health Policy or Program to Achieve the Objective |
|---|---|
| Increase the proportion of people with health insurance | The passage of the ACA improved access to health insurance through the expansion of Medicaid and the health care marketplace. The HHS (2022) reports that the total enrollment for Medicaid expansion , Marketplace coverage, and the Basic Health Program reached a high of over 35 million people as of early 2022. |
| Increase the proportion of persons who know their HIV status | According to the CDC, increasing the number of people who are aware of their HIV status is critical to preventing HIV infections. To increase Americans’ awareness of their HIV status, the CDC has established the Expanded Testing Initiative , through which three programs have been launched (see Expanded Testing Initiative) (CDC, 2020b). |
| Reduce household food insecurity and, in doing so, reduce hunger |
The
Special Supplemental Nutrition Program for Women, Infants, and Children
(WIC) provides federal grants to states for “supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age 5 who are found to be at nutritional risk” (USDA Food and Nutrition Service, n.d.)
In a 2015 policy statement, the American Academy of Pediatrics (AAP) recommended that “pediatricians engage in efforts to mitigate food insecurity at the practice level and beyond,” including connecting families to and advocating for federal nutrition programs (AAP, 2015). |
| Increase the proportion of persons who are vaccinated annually against seasonal influenza | State laws establish requirements regarding the vaccination of schoolchildren (CDC, 2016). In addition, the CDC works with public health agencies and private organizations to “improve and sustain immunization coverage and to monitor the safety of vaccines” (CDC, 2022c). |
| Reduce drug overdose deaths |
The
Overdose Response Strategy
(ORS) is a
collaboration
between the CDC and the High Intensity Drug Trafficking Areas (HIDTA) program designed to help communities reduce drug overdoses through evidence-based intervention strategies at the local, regional, and state levels (CDC, 2023b).
The Bureau of Justice Assistance’s Comprehensive Opioid, Stimulant, and Substance Abuse Program (BJA COSSAP) supports state, local, and tribal responses to substance use to decrease overdose deaths, improve public safety, and improve access to treatment services in the criminal justice system (CDC, 2023b). |
| Reduce the number of days people are exposed to unhealthy air | The U.S. Environmental Protection Agency (EPA) Clean Air Act programs have lowered the levels of six common pollutants by 78 percent and have led to an improvement in air quality in the United States (EPA, 2023). |
Public Health Policy Delivery Mechanisms
Health policy interventions are how health policies are carried out (Hadler et al., 2018). Public health officials responsible for making decisions must consider certain factors, including selecting the appropriate intervention, facilitating the implementation of the intervention, and assessing the effectiveness of the intervention. Mechanisms for delivering public health policy interventions include fiscal policy, regulation, education, preventative treatment, and screening. Table 7.6 defines public health policy delivery mechanisms and provides examples of each.
| Category | Explanation | Example(s) |
|---|---|---|
| Fiscal Policy | The U.S. government can use fiscal policy, including subsidies, free services, and taxes, to incentivize healthy behaviors and discourage unhealthy ones (Nugent & Knaul, 2006). |
|
| Regulation | Any law, ordinance, rule, and so on issued by a government agency or organization. | The FDA is the U.S. agency responsible for regulating food- and health-related products. For example, under the Federal Food, Drug, and Cosmetic Act (FFDCA), the FDA regulates the safety and effectiveness of medical devices. |
| Education | The information, tools, and resources needed to obtain and sustain positive health outcomes (also referred to as health literacy ). | The CDC’s Diabetes Self-Management Education and Support (DSMES) Toolkit program provides individuals living with diabetes the necessary education and support to make the best health care decisions, leading to more positive health outcomes (CDC, 2022b). |
| Preventative Treatment | Routine care that people receive to maintain their health or prevent disease. | Well-child visits , vaccinations, and blood tests as required by the Children’s Health Insurance Program (CHIP) are examples of preventative treatment . |
| Screening | Tests that screen people for diseases or other issues, often catching them before symptoms are noticed. | CDC guidelines on disease-specific screening s, such as mammograms, colonoscopies, and blood pressure screenings, are examples of screenings to improve public health by preventing disease progression. |
Education is a crucial social determinant of health. Access to education increases the probability that individuals will have the necessary skills to make the best decisions related to their health. Education also assists in increasing one’s health literacy, which is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
Institute for Healthcare Improvement Triple Aim
Despite its high costs, the U.S. health care system lags in factors relating to access, affordability, and quality. As discussed in What Is Population Health? the Triple Aim is a framework developed by the Institute for Healthcare Improvement (IHI) that aims to improve health care system performance on three levels (IHI, 2023):
- Improving the client experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of health care
The IHI Triple Aim recommends a change process that includes identifying target population s; defining systems, aims, and measures to target the population; developing a portfolio of project work that is strong enough to drive system changes; and performing rapid testing that is specific to the needs of the local communities and the issues the community faces (IHI, 2023). The key to the success of the IHI Triple Aim is the utilization of and adherence to five components, shown in Table 7.7.
| Component | Explanation/Examples |
|---|---|
| Focus on Individuals and Families |
|
| Redesign of Primary Care Services and Structures |
|
| Population Health Management (Prevention and Health Promotion) |
|
| Cost Control Platform |
|
| System Integration and Execution |
|
The results and benefits of the IHI Triple Aim are as follows (IHI, 2023):
- Populations are healthier.
- Clients receive more coordinated care, which lessens the burden of disease and illness.
- The per capita cost of care for populations is stabilized.
- The burden on publicly funded health care budgets (such as Medicaid and Medicare) is lessened.
- The economic well-being of populations is improved.
Organizations and programs such as primary care coalitions, regional health care systems, and others have experienced success implementing the IHI Triple Aim (IHI, 2023).
Since the inception of the Triple Aim in 2008, two more aims have been proposed, including a Quintuple Aim (Mate, 2022). Those two aims are improving workforce well-being and safety and advancing health equity.
This video describes a population health initiative in Minnesota that focuses on improving the health, well-being, and quality of life of the residents. Note this video is over 22 minutes.
Watch the video, and then respond to the following questions.
- How does the Heart of New Ulm study use electronic health records and data warehousing to meet clients’ needs?
- What are examples of health interventions at a population level?
- How does the Triple Aim relate to the Heart of New Ulm?
- Do you agree that improving health outcomes requires making it easy for clients to do the right thing? Why or why not?