shift some traditional public and population health services into the care delivery system.

California is implementing the ACA by creating health exchanges and policies and committing to develop and enforce language and cultural competency standards. The state is conducting a massive outreach campaign, said Flores, to enroll people by 2014 and is pushing for coverage for the remaining uninsured. The state is also developing consensus indicators for population health, creating community centers of care that will act as health homes that reach into the community, and training community connectors and promotores to act as educators, facilitators, and advocates, as well as expanding the health workforce in underserved areas. All of these changes are not happening easily, he said, and budget conflicts are creating challenges in balancing short-term fiscal concerns with long-term benefits. Flores noted that discussions about ACA implementation are commonly dominated by clinical care interests, with too little focus on prevention, population health, and social aims.

Investing the savings that ACA implementation will generate in prevention will be an uphill battle as well, he predicted. He stressed the importance of learning how to build bridges and create partnerships; ascertaining the level of understanding among policy makers and the public; and making business cases for prevention, public health, and population health. “Community empowerment and giving communities the capacity to work on behalf of population health should be among the highest priorities,” said Flores, who noted that community empowerment is a priority of the many Community Transformation Grant program recipients in California. The goals of this program are to maximize health impact through prevention, advance health equity and reduce health disparities, and expand the evidence base so that local policy, environmental, and infrastructure changes have a positive impact on health.

In closing his presentation, Flores quoted remarks made by Lawrence Brilliant, President of the Skoll Global Threats Fund, at the 2013 Commencement for the Harvard School of Public Health: “Somehow, these two sides of our national health debate—one outward looking at social justice and inclusion and one looking inward at high quality patient care that is exclusionary, met then [1960s “Great Society”] and must meet now on sacred ground, sharing the profound obligation—and great joy—of improving the health of the people.”



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