In the closing session of the workshop, Pamela Russo and Sanne Magnan called on roundtable members and participants to share their final observations. David Kindig, a professor emeritus of population health sciences and the emeritus vice chancellor for health sciences at the University of Wisconsin School of Medicine and Public Health, spoke to the importance of population health financing as a key priority area for the roundtable to focus on over the next few years. Russo emphasized the value of having speakers from other sectors inform the discussions of the roundtable. The question of whether anything presented from other sectors is transferrable to population health is very difficult to answer, she said. George Isham added that there is a lot of nuance and texture to these examples from other sectors, and there is an opportunity to take advantage of expertise from adjacent sectors to gain deeper insights. Many of the comments that followed focused on working more effectively—and reciprocally—with other sectors to solve multiple problems and achieve co-benefits.
Isham spoke of the need for population health to consider its overall aim or objective. Is there a broader framing of health in all policies that is, perhaps, “well-being” in an economic and educational sense that could be agreed upon across sectors? Are there tangible pathways to that larger objective that can be drawn to the different sectors?
José Montero, the vice president of population health and health systems integration at Cheshire Medical Center/Dartmouth Hitchcock Keene, agreed with Isham on the concept of well-being spanning sectors. He also observed that the system, in theory, is not designed for interdependence and that investments are generally made within one’s purview. While the health sector might wonder why other sectors do not recognize the health impacts of their actions, it is also true that the health sector does not recognize its own impact on other sectors. For example, it does not study the impact on educational outcomes of its interventions in children’s health.
Montero said there is a need to refine the language of population health to reach different audiences. For example, there is a common perception concerning health that it is purely medicine-related, and talking about health in all policies seems to mean “hospitals in all places” to some. If population health is not able to reach those constituents, it cannot achieve the impact needed.
Catherine Baase, the global director of health services for The Dow Chemical Company, also noted with interest the focus of the discussions on co-benefits, which she said reinforced the connectedness of the sectors from the macroeconomic perspective, as well as from the systems perspective of the creation of human flourishing.1 She referred participants to a forthcoming report from the Samueli Institute on well-being for the nation.2
In response to the takeaway messages shared by one of the small groups (see Chapter 5), a participant countered that while the restorative justice intervention is at the individual level, the result is well-being at the community and population level.
Bob Griss of the Institute for Social Medicine and Community Health suggested that the four models discussed at the workshop are exceptions in those sectors, although it might be nice to think that these sectors are all going the way of prevention models in the health sector. All of these sectors, including health, have models that look logical, but all have had to fight political battles. The political determinants of health, he said, underly the social determinants of health. In beginning to look at these successful models, it is important to recognize the political constraints
1 A term used to refer to a holistic notion of health and well-being that goes beyond typical biomedical indicators.
and to determine how to address them. Community participation and other approaches are important to translate into political strategies, he said. This is more than a communication problem, Griss said; it is a political problem, and it needs to be framed in such ways that social movements can act on it.
Several participants emphasized the need for better cooperation and engagement between health and other sectors. Marthe Gold of The New York Academy of Medicine, Kindig, and Montero mentioned the need for more outreach to other non-health organizations, getting health experts invited to other sectors’ discussions, and finding ways that the health sector can help other sectors accomplish their agendas. Gold and others mentioned moving beyond “health as the center of the universe” to health as part of a broader coalition. Discussion is needed regarding what role the range of actors in the health sector should play. One important role mentioned was that the health sector should make sure that it is ready to engage with the other sectors and talk about what creates health. Montero said that even though some of the examples discussed might be more at the individual level, they will get to the population prevention level in the future. The question is, will the health sector be ready to work with other sectors on objectives that seem so well aligned?
Gold also emphasized the need for further discussion on the role that evidence plays in making the arguments for financing. Based on the presentations, there would appear to be very rich datasets in other sectors that the health sector is not aware of or does not have access to. Is there a way for individuals in the health sector to make better use of these data resources and be more ingenious as to where they look for information?
Milstein offered the term “multi-solving,” coined by Climate Interactive, as the name for finding good solutions to solve multiple problems.3 This term reflects a movement away from the style of practice where one topic is always in the foreground while the others are the means to that end. Milstein referred also to a February 2016 roundtable workshop comment by Julie Sweetland of FrameWorks Institute, who said that Americans will strongly endorse solutions to problems that they refuse to believe even exist because pragmatism is a powerful ethic. It could be, he
3 See https://www.climateinteractive.org/programs/multisolving (accessed July 25, 2018).
suggested, that multi-solving is the discipline of population health pragmatism at its best. The examples discussed are exceptions to the norm, but they have been successful in accomplishing what people heretofore had not believed was possible. The dollars saved are real. Milstein suggested that the population health sector should focus on the problems that can be solved together. The hope, he said, is that those problems, when solved well, can be financed well.