5

Closing Remarks¹

In the final session of the joint National Academies of Sciences, Engineering, and Medicine and Interdisciplinary Association for Population Health Science (IAPHS) symposium, David Kindig, emeritus professor of population health sciences at the University of Wisconsin–Madison, reflected on the discussions and shared his perspective on the primary challenge for population health going forward.

More than two decades ago, Kindig published a book on population health improvement in which he said he “laid out a very ambitious timeline for research, debate, and implementation in several phases.” A key principle of the book, Kindig said, was that “population health improvement will not be achieved until appropriate financial incentives are aligned for this outcome” (Kindig, 1997). Reflecting on the current state of population health he acknowledged that there have been accomplishments, including a recognition of the importance of health equity and the role of social determinants of health, but there is much still to be done, he said.

The Roundtable on Population Health Improvement has highlighted resources, goals and metrics, science-informed interventions, policies, communication and movement building, and partnerships as key drivers of population health improvement. However, finances loom large, and

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¹ The comments in this section refer solely to remarks made by David Kindig of the University of Wisconsin–Madison and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

Kindig referred to his prior work in which he said that the key population health question to be addressed is the following:

Referring to the comments by Whelan (see Chapter 4) about the need to understand the total cost of care (beyond the cost of health care), Kindig said that the total health budget required is unknown. It is not the figures provided by the Centers for Medicare & Medicaid Services Office of the Actuary report on health care spending, he said. A complete health budget, he continued, would include adequate resources for public health, as well as a share of investments in other sectors that have a role in promoting health (e.g., education, housing, economic development). He acknowledged that there are many challenges to developing such a budget.

The roundtable mission states that population health improvement, including health equity, will require more robust national and community-based actions and dependable resources.² To develop more dependable streams of financial resources, Kindig said that it is necessary to move beyond grants and short-term appropriations. He mentioned the funding of crop subsidies, mortgage interest deductions, and Medicare medical education payments as examples of dependable funding formulas. He also called on the population health sector to use its political clout to support resource allocation for other sectors that affect health (as mentioned above, early childhood support, economic development, housing). Kindig referred participants to a publication (Kindig, 2015) in which he challenged the population health field to move from benchmarks based only on health determinants (e.g., smoking, poverty rates) to benchmarks based on investments in health (e.g., per capita investment to achieve determinant benchmarks).

In closing, Kindig drew attention to an electronic survey about future population health research priorities for IAPHS meeting attendees to

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² The roundtable mission, as described on the roundtable webpage at the time of the joint symposium, was:

respond to.³ Results would then be summarized in a presentation on the final day of the IAPHS meeting.

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³ The survey can be viewed at https://iaphs.org/population-health-survey (accessed July 27, 2020).

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