Raymond Fabius, MD
Co-Founder & President, HealthNEXT
Co-Chair, Program and Membership Committee, Population Health Alliance

The final session of our recent PHA Capital Caucus dealt with the best ways to influence public and population health. The focus was on whether the push approaches are better than the pull approaches. By push we mean working to identify the disadvantaged or those with significant illness burden or those that have identified health gaps from best practice and find ways to move this cohort toward better health. By pull we mean to emphasize the importance of health and wellbeing, recognize and reward those that take good care of themselves and build cultures of health to pull the others along.

Dan Buettner – author of Blue Zones was the first speaker. His book that studied the few places on earth where people routinely live for 90-100 years in good health. He participated by video and reiterated his findings. In these Blue Zones people eat largely plant based diets, get a healthy amount of activity as part of their daily routine, don’t smoke and drink alcohol in moderation. They have a strong emphasis on family and community. He concluded that iving a long and successful life is the consequence of the environment, the people and the culture that surrounds you rather than intermittent interventions such as medical treatments or diet programs.

Mary Ann Cooney touched on the many efforts of her organization (ASTHO) and the challenges and opportunities to make impacts on a state and federal level. She mentioned the importance of data and analytics. She spoke about the importance of not leaving the disadvantaged behind. She highlighted a few programs such as STD prevention and combating the opioid epidemic that have worked to improve the illness burden of populations served. Mary Ann also discussed the importance of health equity.

I provided some concluding remarks based on my textbook – Population Health: Creating Cultures of Wellness reviewing the five pillars of population health and health care continuum with a focus on what it takes to be maximally well. I was able to place an emphasis on the social determinants of health where PHA plays an important leadership role. I featured a key PHA whitepaper on the measurement of health management efforts and the importance of tracking performance over time.

I highlighted a few efforts to improve population health on a grand scale such as the California Endowment and the UK National Wellbeing Index. And then I shared the research emanating from My company HealthNEXT which recently showed a strong correlation between a company’s culture of health and their medical trend. In fact, our research supports the notion that health care costs can be controlled by employers large and small by emulating those employers who have already achieved this. Additionally, our research shows that companies recognized for their cultures of health and safety out-perform in the stock market. So building cultures of health appear to create a competitive advantage in the marketplace.

The conclusion of this session was that a balance of pushing and pulling may be the best approach, as we recognize and reward best efforts while at the same time identify those not doing well and attempt to remediate with programs and services. Along the way it is imperative to establish metrics to track over time and demonstrate that your intentions are being met. The ultimate goal is to refine the best methods to elevate the health status of the populations we serve from the patient level to global health.