Nicole Alexander-Scott, MD, MPH
Director, Rhode Island Department of Health President, Association of State and Territorial Health Officials

Recent data reveals a troubling trend for the United States. We spend far more on healthcare than other developed countries, yet children born today enter a nation where American life expectancy is declining. Depression, trauma experienced in childhood, loneliness among elders, intergenerational poverty, and racial discrimination are factors driving people to higher rates of suicide and substance use disorders. Now is the time to accelerate our collective efforts to address population health.

We cannot achieve population-wide improvements in health outcomes without addressing the underlying causes of health inequities. Eighty percent of our health is determined by the socioeconomic and environmental factors within our communities. Government has the power of policy to influence changes that contribute to improved health. However, real change will only occur when we engage communities in defining what’s important to them, and support communities through state and local-level public health policy. During the Population Health Alliance Capitol Caucus and Innovation Summit in October 2018, for example, there was an interactive dialogue on approaches to fostering community engagement and future implications for population and public health. Empowering communities to share their experiences and participate in the decision-making processes that influence their health will help to inform high-impact, sustainable interventions.

Governmental public health and human service agencies have undertaken innovative work to develop community‐led, place‐based approaches to population health improvement. These approaches take broad, cross‐sector perspectives on creating needed changes in local communities that impact health. Many efforts across the country, like Rhode Island’s Health Equity Zones, the BUILD communities, and Live Well San Diego, show that health can improve in communities when community residents, healthcare and public health leaders, social service organizations, and businesses all work together.

As board president for the Association of State and Territorial Health Officials (ASTHO), a national association providing leadership, advocacy, and capacity building for state health officials across the country, my aim is to advance state and territorial health official leadership and policy development to fulfill the goals of the ASTHO President’s Challenge: Building Healthy and Resilient Communities. These goals include supporting health officials to mobilize community-led, place-based efforts focused on measurable outcomes, and connecting public health officials to business leaders who want to invest in these approaches and advance economic development by reaching across sectors.

In this work, as leaders in population health, we must focus on populations with the greatest known disparities by translating evidence-based practices into actionable steps that are tailored to the needs, assets, and challenges of each community.  This approach will enable the use of cost-effective strategies that have the highest impact. First, we must work with communities and advance their capacity to lead and develop skills that grow their local, population health-improving partnerships. Community action and policies to address barriers to population health must be informed by and with community residents. Secondly, we must work with policymakers and business leaders to shift more of our health investments toward community development opportunities. Working together alongside communities, we can achieve this vision, improve population health, and advance health equity.

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