Roundtable on Population Health Improvement: 2017 Annual Report (2018)

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Members also participated in workgroups, and with outside colleagues, in two topical collaboratives that advanced the conversation and facilitated important relationships. Staff and members continued their engagement in external stakeholder convenings, which offered opportunities to disseminate roundtable products and form new collaborative relationships. In 2018, we are excited to welcome Joshua Sharfstein as a co-chair of the round­ George Isham Senior Advisor, HealthPartners, Inc., and table with one of us George Isham retiring from the roundtable. We will continue Senior Fellow, HealthPartners Institute for to focus on the three Es, including an evolving conversation about a well-being Education and Research economy—­advancing the health-in-all-policies approach in broader context and with attention to the flow of funds in society and how it supports or impedes community health, prosperity, and vibrancy. We look forward to another fruitful year for the roundtable and working together toward a culture of health and well-being. George Isham Sanne Magnan Sanne Magnan Adjunct Assistant Professor of Medicine, Visit us at http://www.nas.edu/PopHealthRT. University of Minnesota 

Looking Back Roundtable Activities in 2017 Workshops The roundtable met four times in 2017. Based on 2016 strategic planning, the roundtable held workshops on the three Es: education and economics (as two key social determinants of health), and health equity, which the roundtable resolved to “Doing something urgently about consider a permanent lens for its work. the global climate crisis, could be In 2017, the roundtable’s workshops addressed the topics of rural health equity, the largest public health opportunity early childhood care and education, tax policy, and climate change. All workshops we’ve had in a very long time.” were webcast live; video and slide presentations for these events are archived – Heard at workshop on climate change and health. at http://www.nas.edu/PopHealthRT. In addition, the roundtable convened collaborative activities. Protecting the Health and Well-Being of Communities in a Changing Climate In March 2017, the roundtable worked with the Roundtable on Environmental Health Sciences, Research, and Medicine to explore the implications of climate change for population health and the potential strategies that public health, environmental health, health care, and related stakeholders can implement to help communities and regions address and mitigate health effects. The roundtable featured presentations that ranged from interfaith and private-sector actions to strengthen the environmental features that mitigate the effects of climate change, to health-sector efforts to lower environmental impacts in ways that support improved health outcomes. 

Looking Back: Roundtable Activities in 2017 “Rural communities are close-knit. People know each other. They come to each other’s aid. They Rural Health Equity and Well-Being: Challenges and Opportunities are resilient. There are a lot of In June 2017, the roundtable held a joint workshop with the Roundtable on the really positive factors about being Promotion of Health Equity to explore a range of initiatives focused on improving in a rural community that can be community well-being. The objectives of this workshop were: (1) to explore the impacts of racial inequities, economic issues, and immigration on U.S. rural leveraged” communities; and (2) to learn about asset-based approaches to addressing these – Heard at workshop on rural health equity. challenges in initiatives that improve population health and health equity. The workshop included invited presentations on and discussions of initiatives created to tackle systematic disinvestment in rural communities and implications for improving the social determinants of health, including access to and quality of health care services. The workshop was intended to illustrate some promising and constructive actions that rural communities facing these enormous challenges are taking to equitably improve residents’ health and well-­being. 

Exploring Early Childhood Care and Education Levers to Improve Population Health In September 2017, the roundtable explored the intersection of health and early childhood care and education, two key social determinants of health. The workshop featured perspectives of experts from the health, child care, early childhood education, and other relevant sectors, and explored topics such as the state of the evidence, shared outcomes/metrics, financing, and ways that health-sector leaders and practitioners can partner with and support care- and education-sector colleagues. Participants from Colorado, Missouri, Nebraska, and other communities showcased state- and local-level approaches and organizational strategies to create incentives and partnerships for better access and quality of early childhood care and education. Speakers and audience members discussed effective interventions to improve early literacy, and began an inquiry into the possibilities for integrating measures of educational attainment in the health “…young children thrive when sector, including payment models. they have secure, positive ­relationships with adults who Exploring Tax Policy to Advance Population Health, Health Equity, and Economic Prosperity are knowledgeable about how to In December 2017, the roundtable addressed the use of tax policies to channel ­support their development and resources and shape economic incentives affecting population health. The learning and are responsive to workshop began with a “tax policy 101” overview. Other presentations and their individual progress.” discussion ranged from extant and potential excise taxes and the conditions and considerations needed to enact them, to state budgetary environments and – Heard at the workshop on early available opportunities. childhood care and education. Participants engaged in table-top tax policy design exercises for the fictional state of Ourlandia, equipped with state revenue and spending figures and thought-provoking questions about who is harmed and who benefits from a particular policy approach. 

Looking Back: Roundtable Activities in 2017 Proceedings of a Workshop Advancing the Science to Improve Population Health was released in January 2017. It summarized the workshop presentations and discussions that explored the basic and translational research needs for population health science, and discussed specific https://www.nap. research priorities and actions to foster population health improvement. This workshop edu/catalog/23541/ was designed to provide frameworks for understanding population health research advancing-the-sci- and its role in shaping and having an effect on population health; identify individual and ence-to-improve-pop- institutional facilitators and challenges regarding the production, communication, and ulation-health-procee- dings-of-a use of research for population health improvement; and identify key areas for future research critical to the advancement of population health improvement. In January 2017, Community Violence as a Population Health Issue was released. It https://www.nap.edu/ provided an overview of the presentations and discussions that explored the influence catalog/23661/commu- of trauma and violence on communities. The publication highlighted examples of nity-violence-as-a-pop- ulation-health-is- community-based organizations using trauma-informed approaches to treat violence sue-proceedings-of-a and build safe and healthy communities. The proceedings showcased examples that can serve as models in different sectors and communities and shared lessons learned. Exploring Equity in Multisector Community Health Partnerships was released in June 2017. The publication summarized the presentations and discussions that https://www.nap. built on previous National Academies of Sciences, Engineering, and Medicine edu/catalog/24786/ workshops that explored how safe and healthy communities are a necessary exploring-equity-in-mul- tisector-communi- component of health equity and efforts to improve population health. The ty-health-partner- proceedings explored how a variety of community-based organizations worked ships-proceedings-of-a with and through multisector health partnerships to engage residents, reduce health disparities, and improve health and well-being. In October 2017, the roundtable’s 18th Proceedings of a Workshop, Protecting the https://www.nap.edu/ Health and Well-Being of Communities in a Changing Climate, was released. It catalog/24846/protect- summarized the presentations and discussions that share current approaches and ing-the-health-and-well- explore potential strategies for public health, environmental health, health care, and being-of-communities- in-a-changing-climate related stakeholders to help communities and regions to address and mitigate the health effects of climate change. All roundtable proceedings to date are available for free download at http://www. nas.edu/PopHealthRT under Publications. 

Discussion Papers and Commentaries* In 2017, a total of 10 papers authored by individuals or groups of relevant experts associated with the roundtable were posted on the National Academy of Medicine’s Perspective page at https://nam.edu/perspectives. Paper topics ranged from accountable communities for health to the value of business investment in community health. • Building Health Literacy and Family Engagement in Head Start Communities: A Case Study  https://nam.edu/building-health-literacy-and-family-engagement-in- head-start-communities-a-case-study/ •  Philanthropy and Beyond: Creating Shared Value to Promote Well-Being for Individuals in Their Communities  https://nam.edu/philanthropy-and-beyond- creating-shared-value-to-promote-well-being-for-individuals-in-their-communities/ • Case Study: Improving Population and Individual Health Through Health System Transformation in Washington State  https://nam.edu/case-study-improving- population-and-individual-health-through-health-system-transformation-in- washington-state/ • Case Study: Medicaid and Public Health Collaboration in Oregon  https://nam. edu/case-study-medicaid-and-public-health-collaboration-in-oregon/ • Case Study: Nationwide Children’s Hospital: An Accountable Care Organization Going Upstream to Address Population Health  https://nam.edu/case-study- nationwide-childrens-hospital-an-accountable-care-organization-going-upstream- to-address-population-health/ •  Standardized Screening for Health-Related Social Needs in Clinical Settings: The Accountable Health Communities Screening Tool  https://nam.edu/standardized- screening-for-health-related-social-needs-in-clinical-settings-the-accountable- health-communities-screening-tool/ • Social Determinants of Health 101 for Health Care: Five Plus Five  https://nam. edu/social-determinants-of-health-101-for-health-care-five-plus-five/ • Defining an Accountable Community for Health for Children and Families  https:// nam.edu/defining-an-accountable-community-for-health-for-children-and-families/ 

Looking Back: Roundtable Activities in 2017 • The ROI of Health and Well-Being: Business Investment in Healthier Communities  https://nam.edu/roi-health-well-business-investment-healthier- communities/ • Elements of Accountable Communities for Health: A Review of the Literature  https://nam.edu/elements-of-accountable-communities-for-health-a- review-of-the-literature/ Disclaimer: The views expressed in these papers are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The papers are intended to help inform and stimulate discussion. They are not reports of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved. Other Activities The roundtable and staff continued to support the work and learning of two action collaboratives: one on bridging public health and health care, and the other on the business role in building healthy communities. Collaborative activities included webinars, conference calls, and an in-person meeting. In October 2017, the roundtable and the National Academy of Medicine co-hosted the fifth annual DC Public Health Case Challenge, a problem-based learning opportunity in which teams from area universities compete in developing innovative responses to a hypothetical case/call for proposals. The 2017 case was developed around two key threats to the well-being of Washington, DC’s youngest residents: lead poisoning and adverse childhood experiences. Six teams competed and were judged by a panel with expertise in early childhood health and development, child health policy, and social work. A grand prize and three categorical prizes were awarded. A stakeholder dialogue is being planned for early 2018 to bring students together with leaders from relevant DC-area nonprofits and local government. 

Looking Forward Roundtable Activities in 2018 In 2018, roundtable members and staff will host four workshops and will continue two or more collaborative efforts to encourage broad external engagement on topics of relevance to population health, in addition to continuing to disseminate and build on past work through webinars, dialogues, and writings. Workshop topics for 2018 will likely include the following: 1. March 2018: a workshop on faith-based health assets exploring their collaboration with the public and health sectors, describing lessons about effectiveness and lack thereof (including challenges and barriers), and showcasing work that has achieved improved outcomes. 2. June 2018: a workshop on education that builds on previous dialogue about this key social determinant of health and the cross-sector engagement necessary. 3. October 2018: a workshop co-hosted with the Interdisciplinary Association for Population Health Science to explore past achievements and future frontiers. 4. December 2018: a workshop on economics, examining the ways in which economic and related policies can support the improvement of population health. 

Looking Forward: Roundtable Activities in 2018 

ROUNDTABLE MEMBERS   George J. Isham (Co-Chair) Mary Lou Goeke Jeffrey Levi HealthPartners, Inc. United Way of Santa Cruz County The George Washington University Sanne Magnan (Co-Chair) Marthe R. Gold Sharrie Mcintosh University of Minnesota The New York Academy of Medicine New York State Health Foundation Philip Alberti Marc N. Gourevitch Robert McLellan Association of American Medical Colleges NYU School of Medicine Dartmouth-Hitchcock Medical Center Terry Allan Garth Graham Phyllis D. Meadows Cuyahoga County Board of Health Aetna Foundation Kresge Foundation John Auerbach Gary Gunderson Bobby Milstein Trust for America’s Health Wake Forest University ReThink Health Catherine Baase Wayne Jonas José T. Montero Michigan Health Improvement Alliance, Inc. H&S Ventures Centers for Disease Control and Prevention Debbie I. Chang Robert M. Kaplan Mary Pittman Nemours Stanford University Public Health Institute Charles J. Fazio David A. Kindig (emeritus co-chair) Pamela Russo HealthPartners, Inc. University of Wisconsin-Madison Robert Wood Johnson Foundation George R. Flores Paula Lantz Joshua M. Sharfstein The California Endowment University of Michigan Johns Hopkins University Kathy Gerwig Michelle Larkin Mylynn Tufte Kaiser Permanente Robert Wood Johnson Foundation State of North Dakota Alan Gilbert Thomas A. LaVeist GE Healthymagination The George Washington University 

ROUNDTABLE SPONSORSHIP ROUNDTABLE VISION AND MISSION The roundtable’s vision is of a strong, healthful, and productive society that cultivates human capital and equal opportunity. This vision rests on the recognition that outcomes such as improved life expectancy, quality of life, and health for all are shaped by Aetna Foundation interdependent social, economic, environmental, AAMC (Association of American Medical Colleges) genetic, behavioral, and health care factors. The California Endowment Altering these factors will require robust national Dartmouth-Hitchcock Medical Center and community-based actions and dependable GE resources to achieve them. HealthPartners The roundtable intends to catalyze urgently Health Resources and Services Administration needed action toward a stronger, more healthful, HHS Office of the Assistant Secretary for Health and more productive society. The roundtable will HHS Program Support Center therefore facilitate sustainable collaborative action Kaiser Permanente East Bay Community Foundation by a community of science-informed leaders from Kresge Foundation public health, health care, business, education, early childhood development, housing, agriculture, Nemours transportation, economic development, and nonprofit New York State Health Foundation and faith-based organizations. NYU School of Medicine Department of Population Health ReThink Health ROUNDTABLE STAFF Robert Wood Johnson Foundation ALINA B. BACIU Samueli Institute Project Director Wake Forest Baptist Medical Center/Stakeholder Health KIMANI HAMILTON-WRAY Senior Program Assistant CARLA ALVARADO Program Officer (from October 2017) DARLA THOMPSON Program Officer (until August 2017) ROSE MARIE MARTINEZ Director, Board on Population Health and Public Health Practice 

T I M E LI NE 2013 | February: The Roundtable on Population Health 2015 | February Workshop: Public Health and Health Care: Improvement is launched | April Workshop: Perspectives on Collaboration and Innovation at the Interface | April Workshop: Improving Population Health | June Workshop: Population Health How Modeling Can Inform Strategies to Improve Population and the Affordable Care Act | September Workshop: Applying Health: A Workshop | June workshop: Applying a Health Lens II: a Health Lens to Decision Making in Non-Health Sectors | The Role and Potential of the Private Sector to Improve Economic December Workshop: Accelerating a Movement to Improve Well-Being and Community Outcomes | July Workshop: Metrics Health and Promote Health Equity that Matter for Population Health Action | September Workshop: Advancing the Science to Improve Population Health 2014 | February Workshop: Resources for Population Health Improvement | April Workshop: The Role and Potential of 2016 | February Workshop: Framing the Dialogue on Race and Communities in Population Health Improvement | June Workshop: Ethnicity to Advance Health Equity | June Workshop: Community Opportunities for Progress at the Interface of Health and Violence as a Population Health Issue | October Workshop: Education | July Workshop: Business Engagement in Achieving Building Sustainable Financing Structures for Population Health | Population Health | September Workshop: Communicating to December Workshop: Exploring the Infrastructure of Multisector Advance the Public’s Health | December Workshop: Achieving Community Health Partnerships Meaningful Population Health Outcomes: A Workshop on Spread and Scale 2017 | March Workshop: Protecting the Health and Well- Being of Communities in a Changing Climate | June Workshop: Achieving Rural Health Equity and Well-Being: Challenges and Opportunities | September Workshop: Exploring Early Childhood Care and Education Levers To Improve Population Health | December Workshop: Exploring Tax Policy to Advance Population Health, Health Equity, and Economic Prosperity 

About the Roundtable on About the National Academies of Population Health Improvement Sciences, Engineering, and Medicine The Roundtable on Population Health Improvement was The National Academy of Sciences, National Academy of established in February 2013 to bring together philanthropy, Engineering, and National Academy of Medicine work together community-based organizations, health care delivery, as the National Academies of Sciences, Engineering, and governmental public health, academia, and business in a wide- Medicine (“the Academies”)  to provide independent, objective ranging dialogue about what is needed to improve health in the analysis and advice to the nation and conduct other activities to United States and across diverse populations. Multiple National solve complex problems and inform public policy decisions. The Academies reports have added to a growing chorus of concern Academies also encourage education and research, recognize that while U.S. spending on health care services has no peer, the outstanding contributions to knowledge, and increase public nation’s performance as measured by key health metrics leaves understanding in matters of science, engineering, and medicine. much to be desired. Finding solutions calls for acknowledging The Health and Medicine Division (HMD), formerly known as that health is created by many different factors, and that child the program unit of the Institute of Medicine, is a division of the poverty, the high school dropout rate, and a lack of affordable Academies. HMD’s aim is to help those in government and the housing, to name a few such factors, have far-reaching private sector make informed health decisions by providing consequences for the health of individuals, communities, evidence upon which they can rely. Each year, more than 3,000 and the nation. Finding solutions will also require unusual individuals volunteer their time, knowledge, and expertise to partnerships and creative interactions across disciplines and advance the nation’s health through the work of HMD. sectors, involving a combination of individual resolve, community action, and societal commitment. To inform the dialogue among Many of the studies that HMD undertakes are requested by those seeking and implementing such solutions, the roundtable federal agencies and independent organizations; others begin as organizes four workshops per year to explore topics of interest specific mandates from Congress. While our expert, consensus and showcase promising examples and lessons learned. committees are vital to our advisory role, HMD also convenes a series of forums, roundtables, and standing committees, as well Information about past and upcoming events is available at the as other activities, to facilitate discussion; discovery; and critical, roundtable’s website at http://www.nas.edu/pophealthRT. cross-disciplinary thinking.