Public Health in the 21St Century: a View from the Front Lines Laquandra S

Editorial

Public Health in the 21st Century: A View From the Front Lines LaQuandra S. Nesbitt, MD, MPH; Julie Morita, MD

ealth officials of large metropolitan/urban areas and big cities grow and evolve, so do the tasks areas, or big cities, are often asked to de- of creating effective solutions to improve population H scribe their typical day. If you have ever health. The reemergence of vaccine-preventable ill- served in this role, you know there is no real answer nesses such as the multistate measles outbreak of to this question. If you have the opportunity to be in- 2015 and the growing interest in urban agriculture, trospective, you may find that you can describe the including live poultry in backyard flocks, require broad scope of the responsibility you have to the peo- public health leaders to reassess current policies for ple you serve and the types of skills you use every day relevance.4 Recognizing that urban agriculture is often as surveillance, program and policy development, and a solution many community members and advocates visioning for the future. seek to implement as a means to address food security City and county health departments that serve and access to healthful foods, public health leaders in the nation’s largest urban areas, specifically the 30 big cities have the opportunity to implement innova- largest jurisdictions, serve nearly 1 in 5 residents of tive approaches to allow the practice while ensuring the US population.1 These local public health de- the health and well-being of their jurisdictions. partments are often providing population health ser- Large local health departments need to work with vices to residents who are less likely than their rural partners to address health inequities and emerging peers to die of heart disease, cancer, unintentional in- public health threats. The US Department of Health jury, chronic lower respiratory disease, and stroke.2 and Human Services’ “Public Health 3.0: A Call to While metropolitan areas on average experience bet- Action for Public Health to Meet the Challenges of ter population health outcomes than rural areas, the the 21st Century,”5 challenges local government lead- senior health officials who lead these health depart- ers to serve as the Chief Health Strategist to coor- ments are all too familiar with the disparities and in- dinate multisector partnerships to address the social equities that exist within their communities. Further- and structural factors (eg, housing, transportation, more, they know that the racial and ethnic minority education, economic development) that affect health residents in their urban communities are more likely and healthy equity. Local public health departments’ to experience health-related behaviors that are linked knowledge of population-level health concerns and to chronic disease than whites who reside in rural appreciation for the relationship between social and areas.3 The masking of these inequities by the over- structural factors that impact health poise them as all health and vitality in our big cities presents unique natural conveners of multisector partners to address challenges for the contemporary public health leader health within their jurisdictions. as well as the public health workforce. While there are challenges associated with playing Improving the health of the nation has always re- this role, they are not insurmountable and the po- quired strong leaders in public health and account- tential benefits are far reaching. Kansas City Health ability to the people we serve. Just as metropolitan Department’s plan that highlighted the large disparity in life expectancy between whites and African Amer- icans catalyzed governmental agencies, community Author Affiliations: District of Columbia Department of Health, Washington, groups, nonprofit organizations, and businesses to District of Columbia (Dr Nesbitt); and Chicago Department of Public Health, address the social and structural factors that affect Chicago, Illinois (Dr Morita). health. Seattle King County Health Department, The authors declare no conflicts of interest. other local government agencies, and community Correspondence: LaQuandra S. Nesbitt, MD, MPH, District of Columbia Department of Health, 825 North Capitol St NE, Washington, DC 20002 partners launched their Equity and Social Justice ([email protected]). Initiative, which focused on creating livable wages, Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. affordable housing, quality education and health 6 DOI: 10.1097/PHH.0000000000000917 care, and safe and vibrant neighborhoods. And,

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the Chicago Department of Public Health launched where members of our community have the oppor- Healthy Chicago 2.0, which has led to several mul- tunity to achieve their best health is one we believe is tisector, community-engaged, health equity–focused possible through effective partnerships, political will, collaborations, including reducing traffic fatalities, and a steadfast commitment to those we serve. increasing permanent supportive housing, and imple- menting and evaluating transit-oriented development References initiatives.7 In Washington, District of Columbia, 1. Henson RM, McGinty M, Juliano C, Purtle J. Big City Health Offi- the DC Department of Health effectuates its health cials Conceptualizations of Health Equity. In press. equity and Health in All Policies strategy through its 2. Centers for Disease Control and Prevention Morbidity and Mortal- DC Healthy People 2020 shared community agenda ity Weekly Report. Leading Cause of Death in Nonmetropolitan and Metropolitan Areas—United States, 1999-2014. Atlanta, GA: to improve population health and the DC Health Sys- US Department of Health and Human Services, CDC; 2017. tems Plan. The DC Health Systems Plan, historically 3. Centers for Disease Control and Prevention Morbidity and Mortality focused on the management of health care assets, now Weekly Report. Health-Related Behaviors by Urban-Rural County Classification—United States, 2013. Atlanta, GA: US Department articulates a plan for hospital community benefits of Health and Human Services, CDC; 2017. that is aligned with the health and social needs of 4. Centers for Disease Control and Prevention. U.S. Multi-state the community driving investments into data-driven Measles Outbreak, December 2014-January 2015.Atlanta,GA: US Department of Health and Human Services, Centers for Dis- population health strategies. These strategies are out- ease Control and Prevention; 2015. http://emergency.cdc.gov/han/ lined in DC Healthy People 2020 and create a new han00376.asp. Accessed September 9, 2018. connectivity between public health program/policy 5. DeSalvo KB, Wang YC, Harris A, Auerbach J, Koo D, O’Carroll P. Public Health 3.0: a call to action for public health to meet the chal- and health care financing. lenges of the 21st century. Prev Chronic Dis. 2017;14:170017. In addition to continuing to play traditional roles in 6. National Academies of Sciences, Engineering, and Medicine. Com- surveillance, programs, and policy, large local health munities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press; 2017. departments are embracing their roles as Chief Health 7. Dircksen JC, Prachand NG, Adams D, Bocksay K, Brown J, Cibulskis Strategist to address social and structural factors that A, et al. Healthy Chicago 2.0: Pathway to Improve Health Equity. influence health. This shared vision for big cities 2016.