Roundtable on Population Health Improvement: 2021 Annual Report (2022)

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Roundtable on Population Health Improvement Board on Population Health and Public Health Practice HEALTH AND MEDICINE DIVISION 2021 Annual Report 

MESSAGE FROM THE CO-CHAIRS  Raymond Baxter and Kirsten Bibbins-Domingo The Roundtable on Population Health Improvement begins its 10th year against a backdrop of evolving threats to population health and the social drivers of health. The COVID-19 pandemic continued to highlight the conditions that undermine health, equity, and well-being and the solutions to some of the high- level challenges facing our society. These include income inequality, lack of opportunity and fair life chances due to structural racism, the unfolding effects of climate change, insufficient pay and protections for many workers, and toxic misinformation and disinformation. In 2021, the roundtable continued its public events (i.e., workshops) designed to frame issues of importance to leaders, practitioners, and researchers in health and other sectors; explored promising and innovative solutions for and approaches to population health improvement; and facilitated new and generative connections In 2021, the pandemic among people and organizations. Although the all-virtual format limited interaction and networking, organizers included virtual small group discussions where continued to highlight the appropriate. But the all-virtual format also may have brought new and more diverse conditions that affect health audiences to roundtable events: more than 4,200 participants from across the and equity, and the roundtable country tuned in to view the 2021 workshop webcasts, and nearly 1000 viewers continued to lift up innovative tuned in to various webinars. solutions and strategies The roundtable’s 2021 workshops and ancillary activities linked to the six conditions of influence in population health previously identified as a flexible deployed by communities, organizing principle for the roundtable’s work: resources, metrics, research, practitioners, and leaders policy, communication, and relationships. The workshops ranged from exploring from around the U.S. strategies to build community power to providing a deeper analysis of the 2 

meaning and prerequisites of spatial justice in the service of community health, equity, and well-being. The workshops generally began with historical context as an intentional strategy to illuminate the structural and systemic conditions that shaped each of the topics being discussed and their effects on health and equity. They also include a perspective on narrative and framing to highlight the importance of language, perception, media, and communication in shaping the Raymond Baxter, Ph.D. conditions for health and health equity. Trustee, Blue Shield of California Foundation; Board member, We look ahead to conversations and actions that will shape a healthier and more CDC Foundation equitable 2022. Visit us at http://www.nas.edu/PopHealthRT. Kirsten Bibbins-Domingo, M.D., Ph.D. Vice Dean for Population Health and Health Equity, and Chair, Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco 3 

Looking Back Roundtable Activities in 2021 Workshops The roundtable held five virtual workshops in 2021. These workshops continued the roundtable’s exploration of the social drivers of health (e.g., economics, place) and of past and persisting racially unjust systems and structures that shape those drivers. The COVID-19 pandemic continued to challenge the health and social sectors and threaten the health and well-being of historically marginalized communities. All workshops were webcast live; videos, slide presentations, and other resources for these events are archived at http://www.nas.edu/PopHealthRT. Community-Led Initiatives for Population Health Improvement Past roundtable workshops have explored the roles and the potential of communities and their partners to improve the conditions for health and equity. The workshop in January 2021 highlighted strategies to build the power of communities themselves and featured practitioners, scholars, and other experts. Speakers highlighted the need to value relationships as much as technical solutions; discussed power as a driver, definer, and shaper of the social determinants of health; and explored the body of knowledge, expertise, and proven practices on community power building. January workshop panelists Tony Iton (The California Endowment), LaTosha Brown (Black Voters Matter), and Ai-jen Poo (National Domestic Worker Alliance and Caring Across Generations). 4 

Looking Back: Roundtable Activities in 2021 “I think that sense of community and connection that we create is not just about power, but is about that sense of self, that sense of belonging, that sense of collective confidence that we are and can be powerful together and can actually change the conditions of our lives.” – Ai-jen Poo at the January 2021 workshop on community power U.S. Health Care Expenditures: Costs, Lessons, and Opportunities In March, the roundtable held a workshop that examined the persisting challenge of the nation’s uncontrolled health care spending. The event also highlighted in detail the opportunity costs—other worthwhile investments the U.S. foregoes when it invests one-sixth of its economy in health care. Another component of the workshop explored innovative policy and communication approaches to address these issues, in addition to public views on evidence-based investments that improve population health and health equity. “There are innovative approaches to curb cost growth while improving quality and outcomes, but their adoption and implementation will require political will, leadership, data capacity and access, and investment in value-based care and social-needs care.” – highlight from the workshop proceedings drawing on presentations of Rachel Block, Kara Odom-Walker, Benjamin Miladin, and Spencer Carrucciu 5 

Civic Engagement and Civic Infrastructure to Advance Health Equity The roundtable’s June workshop examined civics as a key driver of health. It began with a conversation intended to connect the dots between health and civic engagement through the framework of the political determinants of health. It featured the work of scholars and practitioners working to gather data, develop Tweet from roundtable co-chair Kirsten Bibbins-Domingo at the September 2021 and communicate measures, and protect and promote the health of American workshop on spatial justice democracy. The workshop also featured presentations and discussions about civic infrastructure, from schools to local media, and included the voices of youth leaders and leaders working to facilitate voting access. The event concluded with a practical exercise that gave participants the opportunity to engage in a mini democratic deliberation. Spatial Justice as a Driver of Health Equity in the Context of Societal Emergencies The September workshop included discussions about the meaning of spatial justice and related concepts, explored private versus public access and design, and considered policy strategies that support greater inclusion. The presenters Several September workshop planning committee members reflecting on the day’s also reflected on the evidence about how spatial justice affects health and health activities in Lourdes’ “kitchen”: Lourdes equity, and the implications for improving design, planning, and infrastructure. The Rodriguez (St. David’s Foundation), Dawn event included discussions about how using a spatial justice lens ought to shape Alley (Morgan Health), Alejandra Hernandez (The Kresge Foundation), and Monique Tsosie planning and preparedness for societal emergencies, from pandemic response to (Inter Tribal Council of Arizona, Inc.). the effects of climate change such as heat and flooding. 6 

Looking Back: Roundtable Activities in 2021 Economic Innovations to Support Health, Equity, and Well-Being: Tweet from workshop speaker Rita Hamad Exploring Policies that Further the Well-Being of Care Economy during the December workshop on the care economy Workers The December workshop was planned to center workers in the care economy, whose health and well-being are closely intertwined with the health and well-being of all American families. Child care workers as well as home care and long-term care workers provide invaluable services, caring for the youngest, the oldest, and the disabled members of families and communities. The workshop began “[L]iterally nobody in America with some historical and economic grounding—from the enslaved women who should be poor. It is a policy provided care to today’s caregivers who remain primarily women of color—and the antecedents to the persisting injustices in pay and benefits, and the affronts to choice that we have anybody dignity that those workers face. poor, and the tax code is a . . . viable way to redress poverty.” – Darrick Hamilton at the December 2021 workshop on the care economy 7 

Webinars The roundtable partnered with the American Public Health Association, Vot-ER, Healthy Democracy Healthy People, and the Network for Public Health Law to host two webinars on voting and health in August (Civic Health Month) and September (September 28 is National Voter Registration Day). In November, the roundtable partnered with the Funders Forum for Accountable Health (at The George Washington University) and the Georgia Health Policy Center to host a webinar about equitable community use of American Rescue Plan Act resources. Also in November, the roundtable co-hosted a webinar with the National Academies Response and Resilient Recovery Strategic Science Initiative on housing instability and health, showcasing findings and conclusions from the consensus study report Rental Eviction and the COVID-19 Pandemic. Proceedings of a Workshop Six publications resulting from the roundtable’s work were released in 2021: Harnessing the Value of Co-Creating and Stewarding Places for Health, Equity, and Well-Being: Proceedings of a Workshop Population Health in Challenging Times: Insights from Key Domains: Proceedings a Workshop Models for Population Health Improvement by Health Care Systems and Partners: Tensions and Promise on the Path Upstream: Proceedings of a Workshop Population Health in Rural America in 2020: Proceedings of a Workshop Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium A Population Health Perspective on Middle School Success: Activities, Programs, and Policies: Proceedings of a Workshop 8 

Looking Back: Roundtable Activities in 2021 “Although health systems have come to accept their role in helping change community conditions in support of health, their complex institutional, Other Publications1 financial, and sociopolitical In 2021, three articles associated with roundtable activities were published by considerations can prevent National Academy of Medicine (NAM) Perspectives, Health Affairs, and JAMA positive change or lead to Health Forum. more harm. We suggest that Social Determinants of Health 201 for Health Care: Plan, Do, Study, Act the concept of spatial justice The Reallocationists Versus the Direct Allocationists must be incorporated in health Spatial Justice and Implications for US Health Care system actions to improve population health.” – Baciu, Rodriguez, and Bibbins-Domingo in JAMA Health Forum article, October 21, 2021 1 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 publications of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved. 9 

DC Public Health Case Challenge On October 29, the roundtable co-hosted with the National Academy of Medicine the 8th Annual DC Public Health Case Challenge, where six DC-area multi- disciplinary university teams competed in developing and presenting solutions to the challenge—this year focused on the prevention and control of bacterial sexually transmitted infections in 18–24-year-old residents of the District of Columbia. An 18-year-old youth leader participated on the judging panel. The teams researched DC community–based organizations and some highlighted the importance of engaging with and integrating community voices in the hypothetical projects they developed. Members of the six university teams that competed in the 8th Annual DC Public Health Case Challenge held at the National Academy of Sciences. Roundtable member Dawn Alley, second from the right served on the judging panel at the DC Public Health Case Challenge, along with Rebekah Horowitz, Ed Belcher, Matthew Rose, Nixon Arauz (left to right). Darrin D’Agostino Victor Dzau, President of the NAM, welcomes DC Public Health Case Challenge participants, participated remotely. one of the first in-person events at the National Academy of Sciences Building since the start of the pandemic. 10 

Looking Back: Roundtable Activities in 2021 Action Collaboratives2 Health Care Expenditure A 2012 Institute of Medicine report recommended that the Secretary of HHS set targets for life expectancy and per capita health (care) expenditure to bring the United States in line with the average among peer nations. A decade later, the U.S. standing in life expectancy and spending has not improved. The Health Care Expenditure Collaborative is facilitating dialogue and analysis about furthering A stylized rendering of a graph updating with this recommendation. The collaborative held monthly meetings and some of 2018–2019 data Figure 1-2 from the 2012 IOM report For the Public’s Health: Investing its members contributed as planners of or speakers at the roundtable’s March in a Healthier Future. The United States is workshop on the costs, opportunities, and lessons of U.S. health care spending. an extreme outlier in per capita health care spending versus life expectancy (as a proxy Bridging Public Health, Health Care & Community for health sector performance). The collaborative, which was intended to serve as a conduit for sharing innovations at the interface of health care and public health, concluded its work in early 2021 after holding a webinar. April 2021 | Achieving Population Health Goals Through Integration The webinar featured Nemours’ 2020 Integrator Learning Lab and spotlighted achievements of participating networks to illustrate the types of gains that are possible as a result of strategic alignment. Speakers presented a framework of essential integrative activities, as well as tools used to support network achievements, and a summary of insights, lessons learned, and areas for future focus. Business Engagement in Building Healthy Communities The Action Collaborative on Business Engagement in Building Healthy Communities is an ad hoc convening mechanism under the auspices of the roundtable. The collaborative’s purpose is to facilitate private-sector partnerships and catalyze actions of business, health, community, and public sectors to work together to enhance the lives of workers and communities by improving the nation’s health and wealth. The collaborative hosted two webinars. 2 Disclaimer: Action Collaboratives are ad hoc convening mechanisms under the auspices of the Roundtable. Any products and activities associated with the collaboratives do not necessarily represent the views of any one organization, the Roundtable, or the National Academies and has not been subjected to the review procedures of, nor are they a reports or products of, the National Academies. 11 

May 2021 | Community Health and Economic Prosperity: Insights from the Surgeon General’s Report This webinar focused on the 2021 U.S. Surgeon General’s report on Community Health and Economic Prosperity, highlighting the role of business in shaping the conditions for better health and well-being. Anand Parekh from the Bipartisan Policy Center moderated a conversation with the senior editors of the report: Ursula Bauer from the Office of the Surgeon General and Greg Fairchild, professor at the University of Virginia Darden School of Business. December 2021 | From Healthy Communities to School Nutrition: A Company’s Commitment to Its Community This webinar featured Nancy Easton (Wellness in the Schools), Curt Ellis (FoodCorps), and Kim Fortunato (Campbell Soup Company) sharing lessons learned from a decade long Campbell Soup Company collective in Camden, New Jersey, which focused on improving childhood health and school nutrition. “When we think about our military, nobody says can you choose between the Army, the Navy, and the Marine Corps. And when we think about our care agenda and an agenda about building a system that includes childcare and paid family and medical leave and home and community-based services and paid sick days, I do not think we should have to choose just one.” – Julie Kashen at the December 2021 workshop on the care economy 12 

Looking Forward Roundtable Activities in 2022 In 2022, roundtable members and staff will host four workshops and will further action 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, convenings, and written products, including National Academy of Medicine Perspectives. Workshop topics for 2022 will include the following: 1. February 28, 2022 – a workshop on the workforce for population health. 2. June 22, 2022 – a workshop on financing for population health and accountability to community. 3. September 19, 2022 – a workshop on the role of business/employers in population health. 4. December 13, 2022 – a workshop on the role of youth in leading and informing population health improvement efforts. 13 

Looking Forward: Roundtable Activities in 2022 14 

ROUNDTABLE MEMBERS   Ray Baxter (Co-Chair) Dora Hughes Kara Odom Walker Blue Shield of California Foundation Centers for Medicare and Medicaid Services Nemours Children’s Health System Kirsten Bibbins-Domingo (Co-Chair) Hilary Heishman (from May 2021) Willie (Billy) Oglesby University of California, San Francisco Robert Wood Johnson Foundation Jefferson University Philip Alberti Sheri Johnson Jason Purnell Association of American Medical Colleges University of Wisconsin–Madison BJC Health Care Dawn Alley Wayne Jonas Washington University in Saint Louis Morgan Health H&S Ventures Lourdes J. Rodríguez John Auerbach (until July 2021) Robert M. Kaplan St. David’s Foundation Trust for America’s Health Stanford University Pamela Russo (through April 2021) Debbie I. Chang Michelle Larkin (through May 2021) Robert Wood Johnson Foundation Blue Shield of California Foundation Robert Wood Johnson Foundation Kosali Simon Marc N. Gourevitch Milton Little Indiana University NYU Langone Health United Way of Greater Atlanta Terry Williams (from October 2021) Meg Guerin-Calvert Phyllis D. Meadows Atrium Health FTI Consulting The Kresge Foundation Oktawia Wojcik (from June 2021) Gary R. Gunderson (through Bobby Milstein Robert Wood Johnson Foundation September 2021) ReThink Health Hanh Cao Yu Atrium Health Wake Forest Baptist José T. Montero The California Endowment Stakeholder Health Centers for Disease Control and Prevention Wake Forest University 15 

ROUNDTABLE SPONSORS ROUNDTABLE VISION AND MISSION Vision | A thriving, healthful, and equitable society Mission | In recognition that health and quality of life for all are shaped by interdependent historical and contemporary social, political, economic, environmental, genetic, behavioral, and health Association of American Medical Colleges care factors, the Roundtable on Population Health Blue Cross and Blue Shield of North Carolina Improvement exists to provoke and catalyze Blue Shield of California Foundation urgently needed multi-sector, community-engaged The California Endowment collaborative action. The Kresge Foundation Nemours The Rippel Foundation Robert Wood Johnson Foundation Saint David Foundation Samueli Foundation The Snowy Owl Foundation ROUNDTABLE STAFF Thomas Jefferson University ALINA B. BACIU Wake Forest Baptist Medical Center Roundable Director CARLA ALVARADO (through January 2021) Program Officer ALEXANDRA ANDRADA (from February 2021) Program Officer AYSHIA COLETRANE Senior Program Assistant HARIKA DYER (through July 2021) Research Assistant MAGDALINE ANDERSON (from September 2021) Research Assistant ROSE MARIE MARTINEZ Senior Director, Board on Population Health and Public Health Practice This list includes all organizations that were sponsors of the roundtable for any part of 2021. MISRAK DABI Financial Business Partner 16 

T I M E LI NE 2013 | February: The Roundtable on Population Health Childhood Care and Education Levers to Improve Population Improvement is launched | April Workshop: Perspectives on Health | December Workshop: Exploring Tax Policy to Advance Improving Population Health | June Workshop: Population Health Population Health, Health Equity, and Economic Prosperity and the Affordable Care Act | September Workshop: Applying 2018 | March Workshop: Faith–Health Collaboration to a Health Lens to Decision Making in Non-Health Sectors | Improve Population Health | June Workshop: School Success: December Workshop: Accelerating a Movement to Improve An Opportunity for Population Health Action | October Health and Promote Health Equity Workshop: Population Health Science in the United States: 2014 | February Workshop: Resources for Population Health Trends, Evidence, and Effective Policy | December Workshop: Improvement | April Workshop: The Role and Potential of Reorienting Health Care and Business Investment Priorities Communities in Population Health Improvement | June Workshop: Toward Health and Well-Being Opportunities for Progress at the Interface of Health and Education 2019 | March Workshop: Dialogue About the Workforce for | July Workshop: Business Engagement in Achieving Population Population Health Improvement | June Workshop (joint event Health | September Workshop: Communicating to Advance the with three other groups in the National Academies): Implications Public’s Health | December Workshop: Achieving Meaningful of the California Wildfires for Health, Communities, and Population Health Outcomes: A Workshop on Spread and Scale Preparedness | September Workshop: Models for Population 2015 | February Workshop: Public Health and Health Care: Health Improvement by Health Care Systems and Partners: Collaboration and Innovation at the Interface | April Workshop: Tensions and Promise on the Path Upstream | December How Modeling Can Inform Strategies to Improve Population Workshop: A Population Health Perspective on Middle School Health: A Workshop | June Workshop: Applying a Health Lens II: Success: Activities, Programs, and Policies The Role and Potential of the Private Sector to Improve Economic 2020 | February Workshop: Harnessing the Value in Co-creating Well-Being and Community Outcomes | July Workshop: Metrics and Keeping Inclusive Healthy Places | June Workshop: Population That Matter for Population Health Action | September Workshop: Health in Rural America 2020 | September Workshop: Population Advancing the Science to Improve Population Health Health in Challenging Times: Insights from Key Domains 2016 | February Workshop: Framing the Dialogue on Race and 2021 | January Workshop: Community Power/Community- Ethnicity to Advance Health Equity | June Workshop: Community Led Initiatives to Improve Health | March Workshop: US Health Violence as a Population Health Issue | October Workshop: Care Expenditures: Costs, Opportunities, and Lessons | June Building Sustainable Financing Structures for Population Health | Workshop: Civic Engagement and Civic Infrastructure to December Workshop: Exploring the Infrastructure of Multisector Advance Health Equity | September Workshop: Spatial Justice Community Health Partnerships as a Driver of Health in the Context of Societal Emergencies | 2017 | March Workshop: Protecting the Health and Well- December Workshop: Economic Innovations to Support Health, Being of Communities in a Changing Climate | June Workshop: Equity, and Well-Being: Exploring Policies that Further the Well- Achieving Rural Health Equity and Well-Being: Challenges Being of Care Economy Workers. and Opportunities | September Workshop: Exploring Early 17 

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, the National Academy established in February 2013 to bring together philanthropy, of Engineering, and the National Academy of Medicine work community-based organizations, health care delivery, together as the National Academies of Sciences, Engineering, governmental public health, academia, and business in a wide- and Medicine (the National Academies) to provide independent, ranging dialogue about what is needed to improve health in the objective analysis and advice to the nation and conduct other United States and across diverse populations. Multiple National activities to solve complex problems and inform public policy Academies publications have added to a growing chorus of decisions. The National Academies also encourage education concern that while U.S. spending on health care services has and research, recognize outstanding contributions to knowledge, no peer, the nation’s performance as measured by key health and increase public understanding in matters of science, metrics leaves much to be desired. Finding solutions calls for engineering, and medicine. acknowledging that health is created by many different factors, The Health and Medicine Division (HMD), formerly known as and that child poverty, the high school dropout rate, and a lack of the program unit of the Institute of Medicine, is a division of the affordable housing, to name a few such factors, have far-reaching National Academies. HMD’s aim is to help those in government consequences for the health of individuals, communities, and the and the private sector make informed health decisions by nation. Finding solutions also requires unusual partnerships and providing evidence upon which they can rely. Each year, more creative interactions across disciplines and sectors, involving a than 3,000 individuals volunteer their time, knowledge, and combination of individual resolve, community action, and societal expertise to advance the nation’s health through the work of HMD. commitment. To inform the dialogue among those seeking and implementing such solutions, the roundtable hosts four workshops Many of the studies that HMD undertakes are requested by per year that bring together a range of experts to explore topics of federal agencies and independent organizations; others begin interest and showcase promising examples and lessons learned. as specific mandates from Congress. While its expert, consensus committees are vital to its advisory role, HMD also convenes a Information about the roundtable is available at series of forums, roundtables, and standing committees, as well http://www.nas.edu/pophealthRT. as other activities, to facilitate discussion, discovery, and critical cross-disciplinary thinking. 18