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5 Closing Remarks1 In the final session of the joint National Academies of Sciences, Engi- neering, and Medicine and Interdisciplinary Association for Population Health Science (IAPHS) symposium, David Kindig, emeritus professor of population health sciences at the University of WisconsinâMadison, 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 popula- tion health improvement in which he said he âlaid out a very ambitious timeline for research, debate, and implementation in several phases.â A key principle of the book, Kindig said, was that âpopulation health improvement will not be achieved until appropriate financial incentives are aligned for this outcomeâ (Kindig, 1997). Reflecting on the current state of population health he acknowledged that there have been accom- plishments, 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 1 The comments in this section refer solely to remarks made by David Kindig of the Uni- versity of WisconsinâMadison 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. 43 PREPUBLICATION COPYâUncorrected Proofs
44 POPULATION HEALTH SCIENCE IN THE UNITED STATES Kindig referred to his prior work in which he said that the key population health question to be addressed is the following: In a resource-limited world, what is the optimal national and local per capita investment, and policy strength across sectors (health care, public health, health behavior, social factors, physical environment) for improv- ing overall health and reducing disparities? 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), Â indig K said that the total health budget required is unknown. The figures pro- vided by the Centers for Medicare & Medicaid Services Office of the A Â ctuary 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 acknowl- edged 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 commu- nity-based actions and dependable resources.2 To develop more depend- able 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 men- tioned 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 2 The roundtable mission, as described on the roundtable webpage at the time of the joint symposium, was: to catalyze urgently needed action toward a stronger, more healthful, and more productive society. The roundtable will therefore facilitate sustainable collaborative action by a community of science-informed leaders in public health, health care, busi- ness, education and early childhood development, housing, agriculture, transporta- tion, economic development and nonprofit and faith-based organizations. PREPUBLICATION COPYâUncorrected Proofs
CLOSING REMARKS 45 respond to.3 Results would then be summarized in a presentation on the final day of the IAPHS meeting. 3 The survey can be viewed at https://iaphs.org/population-health-survey (accessed July 27, 2020). PREPUBLICATION COPYâUncorrected Proofs
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