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The role of military service in preventing depression in China: evidence from a nationally representative longitudinal survey

Despite recognition in the West that military veterans experience more mental health issues than the general population, little research has focused on this subject in China. This study examined the associatio...

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Prevalence and factors associated with female sterilization in Rwanda: evidence from the demographic and health survey data (2019–2020)

Female sterilization is a safe and effective surgical procedure of achieving contraception. There is disparity in the prevalence of female sterilization globally, with high income countries having higher rates...

How co-locating public mental health interventions in community settings impacts mental health and health inequalities: a multi-site realist evaluation

Public mental health interventions are non-clinical services that aim to promote wellbeing and prevent mental ill health at the population level. In England, the health, social and community system is characte...

Finding your lane: experiences and beyond for adults learning to swim

The purpose of this study was to examine experiences and impacts from participating in an adult swim instruction program. We conducted 20 semi-structured interviews with adults aged 18 + who had participated i...

The impact of the COVID-19 pandemic on cardiovascular disease prevention and corresponding geographical inequalities in England: interrupted time series analysis

There has been disruption to the detection and management of those with hypertension and atrial fibrillation (AF) during the COVID-19 pandemic. This is likely to vary geographically and could have implications...

Working hours, social engagement, and depressive symptoms: an extended work-life balance for older adults

In recent years, researchers have been examining the impact of work-life balance (WLB) on mental health, considering it as a potential risk factor. However, it remains unclear whether the traditional understan...

Prevalence of internet addiction and anxiety, and factors associated with the high level of anxiety among adolescents in Hanoi, Vietnam during the COVID-19 pandemic

The COVID-19 pandemic and the resulting isolation measures created an increase in the usage of smart devices and internet among adolescents. This study aims to estimate the prevalence of internet addiction, th...

Analysis of factors that promote the participation of patients with chronic diseases in shared decision making on medication: a cross-sectional survey in Hubei Province, China

Shared decision making (SDM) improves the health status of patients with chronic diseases, especially in the condition of poly-medicated patients. This study aims to find the factors associated with participat...

Health-related quality of life of children from low-income families: the new patterns study

Child poverty has been gradually rising, and about 12% of all Norwegian children are living in a state of relative poverty. This study was part of the New Patterns project, which recruits low-income families r...

Migration and health study: a socio-ecological analysis of sexual health among migrants in Manitoba, Canada

To develop effective public health policies, programs, and services tailored to the unique sexual health needs of migrant populations, it is essential to understand the myriad socio-ecological factors that inf...

Prevalence of fibromyalgia among university students and its impact on their health-related quality of life: a survey-based study from Egypt

University students are more likely to experience stress, anxiety, and depression. All these factors are regarded as psychological contributors to fibromyalgia syndrome (FMS).

Thoughts, perceptions and concerns of coastal residents regarding the discharge of tritium-containing treated water from the Fukushima Daiichi Nuclear Power Plant into the Pacific Ocean

As a part of the decontamination process after the Fukushima Daiichi Nuclear Power Plant accident of 2011, 1.32 million tonnes of tritium-containing water will be discharged from the power plant into the Pacif...

The influence of meaningful work on the mental health of SME employees in the COVID-19 era: can coping strategies mediate the relationship?

Stress, depression, and anxiety are prevalent issues among SME employees during the COVID-19 pandemic. Even while having meaningful work that expressively contributes to individual growth has been related to i...

School and class closures and adolescent mental health during the second and later waves of the COVID-19 pandemic in Finland: a repeated cross-sectional study

Since the start of the COVID-19 pandemic, several studies have shown deterioration of adolescents’ mental health when comparing periods before and after the start of the pandemic when there were national schoo...

Association of fish and meat consumption with non-alcoholic fatty liver disease: Guangzhou Biobank Cohort Study

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. Unhealthy dietary habit is one of major risk factors of NAFLD. However, the associations between specific types of fish and m...

Exercise instructors are not consistently implementing the strength component of the UK chief medical officers’ physical activity guidelines in their exercise prescription for older adults

Strength training recommendations have been embedded within the UK’s Chief Medical Officers’ physical activity guidelines since 2011. There is limited evidence that these recommendations are used by exercise i...

Physical activity, sleep disorders, and type of work in the prevention of cognitive function decline in patients with hypertension

Hypertensive patients are likelier to have cognitive function decline (CFD). This study aimed to explore physical activity level, sleep disorders, and type of work that influenced intervention effects on cogni...

Nutritional needs, resources, and barriers among unhoused adults cared for by a street medicine organization in Chicago, Illinois: a cross-sectional study

Those experiencing houselessness rely on obtaining food from community organizers and donations. Simultaneously, the houseless face disproportionally high rates of medical conditions that may be affected by di...

The Cantabria Cohort, a protocol for a population-based cohort in northern Spain

Cantabria Cohort stems from a research and action initiative lead by researchers from Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital and University of Cantabria, supported by...

Modelling individual infancy growth trajectories to predict excessive gain in BMI z-score: a comparison of growth measures in the ABCD and GECKO Drenthe cohorts

Excessive weight gain during childhood is a strong predictor for adult overweight, but it remains unknown which growth measures in infancy (0–2 years of age), besides predictors known at birth, are the stronge...

Association between personality characteristics and sleep quality among Chinese middle-aged and older adults: evidence from China family panel studies

Poor sleep quality will have adverse effects on physical and mental health, quality of life and other aspects of middle-aged and older adults. Sleep quality is affected by many factors. Whether the sleep quali...

Association between composite dietary antioxidant index and coronary heart disease among US adults: a cross-sectional analysis

The Composite Dietary Antioxidant Index (CDAI) is a dietary antioxidant score that plays a protective role in many diseases, including depression, osteoporosis, papillomavirus infection, etc. However, the asso...

Dropout rate and associated factors of community-based health insurance beneficiaries in Ethiopia: a systematic review and meta-analysis

Ethiopia aims to achieve universal healthcare using health insurance. To do so, it has been implementing community-based health insurance since 2011. However, the retention of members by the scheme has not yet...

Investigation of predictors of severity of diabetes complications among hospitalized patients with diabetes in Florida, 2016–2019

Severe diabetes complications impact the quality of life of patients and may lead to premature deaths. However, these complications are preventable through proper glycemic control and management of risk factor...

The dynamic nexus: exploring the interplay of BMI before, during, and after pregnancy with Metabolic Syndrome (MetS) risk in Chinese lactating women

The health implications of BMI and MetS in lactating women are significant. This study aims to investigate the relationship between risk of Mets in lactation and BMI in four stages: pre-pregnancy, prenatal per...

Revisiting the effects of state earned income tax credits on infant health: a quasi-experimental study using contiguous border counties approach

To examine the effects of refundable state earned income tax credits (EITC) on infant health.

Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal

Diagnosis delay contributes to increased tuberculosis (TB) transmission and morbimortality. TB incidence has been decreasing in Portugal, but median patient delay (PD) has risen. Symptom valorisation may deter...

Riding high: seroprevalence of SARS-CoV-2 after 4 pandemic waves in Manitoba, Canada, April 2020–February 2022

Canada is emerging from the largest SARS-CoV-2 Omicron wave to date, with over 3.3 million confirmed cases. Unfortunately, PCR confirmed cases illuminate only a small portion of infections in the community and...

Comorbidities of diabetes and hypertension in Vietnam: current burden, trends over time, and correlated factors

Vietnam conducted the national Noncommunicable Disease Risk-Factor Surveillance (STEPs) surveys in the years 2010, 2015, and 2021. This study aims to use STEPs data to assess the burden of comorbidity between ...

Maternal stimulation and early child development in sub-saharan Africa: evidence from Kenya and Zambia

Despite major improvements in child survival over the past decade, many children in low and middle-income countries (LMICs) remain at risk of not reaching their developmental potential due to malnutrition, poo...

Understanding knowledge, attitudes and practices on Ebola Virus Disease: a multi-site mixed methods survey on preparedness in Rwanda

The overall goal of this survey was to understand the knowledge, attitudes, and practices related to the Ebola Virus Disease (EVD) in Rwanda.

Perceptions surrounding the possible interaction between physical activity, pollution and asthma in children and adolescents with and without asthma

A cornerstone of asthma management is maintaining physical activity (PA), but this may lead to increased exposure to, and deeper inhalation of, pollutants. Furthermore, children and adolescents may be more sus...

Association between Gross National Income per capita and COVID-19 vaccination coverage: a global ecological study

Coronavirus 2019 (COVID-19) pandemic has claimed over six million lives and infected more than 650 million people globally. Public health agencies have deployed several strategies, including rolling out vaccin...

Gender-specific inequalities in coverage of Publicly Funded Health Insurance Schemes in Southern States of India: evidence from National Family Health Surveys

Publicly Funded Health Insurance Schemes (PFHIS) are intended to play a role in achieving Universal Health Coverage (UHC). In countries like India, PFHISs have low penetrance and provide limited coverage of se...

Cost-utility and budget impact analyses of cervical cancer screening using self-collected samples for HPV DNA testing in Thailand

Cervical cancer ranks as the third most prevalent cancer among women in Thailand. However, the effectiveness of cervical cancer screening programs is limited by several factors that impede the screening rate. ...

Structural transition of parenthood among Chinese nulliparous couples with planned pregnancies, 2013–2019

The postponement of parenthood is a global public health issue that has received attention of many public health experts. However, few studies have investigated the postponement in marriage age, marriage and c...

Comparison of clinical characteristics and disease burden between early- and late-onset type 2 diabetes patients: a population-based cohort study

The clinical characteristics of early-onset type 2 diabetes (T2D) patients are not fully understood. To address this gap, we conducted a cohort study to evaluate clinical characteristics and disease burden in ...

Study on the correlation between lifestyle and negative conversion time in patients diagnosed with coronavirus disease (COVID-19): a retrospective cohort study

As of early December 2022, China eased the coronavirus disease (COVID-19) restriction, affecting over 80% of the country’s population and posing a severe threat to public health. Previous studies mostly focuse...

Measuring adolescent health literacy in Taiwan: validation of the health literacy assessment scale for adolescents

This study aimed to validate the Chinese version of the Health Literacy Assessment Scale for Adolescents (HAS-A) and conduct a comparative analysis of adolescent health literacy between Taiwan and other countr...

Acceptability of a hypothetical dengue vaccine and the potential impact of dengue vaccination on personal vector control behavior: a qualitative study in Fortaleza, Brazil

Dengue is the most rapidly spreading viral vector-borne disease in the world. Promising new dengue vaccines have contributed to a growing consensus that effective dengue control will require integrated strateg...

Prevalence and factors associated with inconsistent condom use among female sex workers in Ethiopia: findings from the national biobehavioral survey, 2020

The HIV prevalence among Ethiopian female sex workers (FSWs) is estimated to be around 18.5%, which implies that FSWs' sexual partners are significantly exposed to HIV infection and that may be a major factor ...

A realist interview study of a participatory public mental health project “#KindnessByPost”

#KindnessByPost (KbP) is a participatory public health initiative in which people anonymously send and receive cards containing messages of goodwill with others also taking part in the programme. Quantitative ...

Birth outcomes and early growth patterns associated with age at adiposity rebound: the Ma’anshan birth cohort (MABC) study

Early onset of adiposity rebound (AR) is considered an early indicator of obesity risk. Our objective was to investigate the association of birth outcomes and early physical growth patterns with early AR in ch...

Distribution incidence, mortality of tuberculosis and human development index in Iran: estimates from the global burden of disease study 2019

Tuberculosis is one of the most serious challenges facing the global healthcare system. This study aims to investigate the incidence and mortality of tuberculosis in Iran from 2010 to 2019 as well as its relat...

Determinants of catastrophic costs among households affected by multi-drug resistant tuberculosis in Ho Chi Minh City, Viet Nam: a prospective cohort study

Globally, most people with multidrug-resistant tuberculosis (MDR-TB) and their households experience catastrophic costs of illness, diagnosis, and care. However, the factors associated with experiencing catas...

Serum lipoprotein(a) and reclassification of coronary heart disease risk; application of prediction in a cross-sectional analysis of an ongoing Iranian cohort

Recent studies have introduced elevated lipoprotein(a) (Lp(a)) as a risk factor for coronary heart disease (CHD). This study investigated whether the addition of Lp(a) as a novel biomarker to the Framingham Ri...

How is the COVID-19 pandemic impacting our life, mental health, and well-being? Design and preliminary findings of the pan-Canadian longitudinal COHESION study

With the advent of the COVID-19 pandemic, in-person social interactions and opportunities for accessing resources that sustain health and well-being have drastically reduced. We therefore designed the pan-Cana...

Model-based analysis of the incidence trends and transmission dynamics of COVID-19 associated with the Omicron variant in representative cities in China

In 2022, Omicron outbreaks occurred at multiple sites in China. It is of great importance to track the incidence trends and transmission dynamics of coronavirus disease 2019 (COVID-19) to guide further interve...

Motives for leisure-time physical activity participation: an analysis of their prevalence, consistency and associations with activity type and social background

Studies argue that knowledge about motives for physical activity participation can inform activities, initiatives and interventions to promote physical activity. However, most of these studies are based on sma...

Protocol for a randomised controlled trial of a healthy relationship tool for men who use intimate partner violence (BETTER MAN)

Intimate partner violence (IPV) is common globally, but there is a lack of research on how to intervene early with men who might be using IPV. Building on evidence supporting the benefits of online interventio...

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Public health 3.0: a call to action for public health to meet the challenges of the 21st century, karen b. desalvo.

1 New Orleans, Louisiana

Y. Claire Wang

2 Columbia University, Mailman School of Public Health, New York, New York

Andrea Harris

3 Washington, DC

John Auerbach

4 Trust for America’s Health, Washington, DC

5 Atlanta, Georgia

Patrick O’Carroll

6 The Task Force for Global Health, Decatur, Georgia

Public health is what we do together as a society to ensure the conditions in which everyone can be healthy. Although many sectors play key roles, governmental public health is an essential component. Recent stressors on public health are driving many local governments to pioneer a new Public Health 3.0 model in which leaders serve as Chief Health Strategists, partnering across multiple sectors and leveraging data and resources to address social, environmental, and economic conditions that affect health and health equity. In 2016, the US Department of Health and Human Services launched the Public Health 3.0 initiative and hosted listening sessions across the country. Local leaders and community members shared successes and provided insight on actions that would ensure a more supportive policy and resource environment to spread and scale this model. This article summarizes the key findings from those listening sessions and recommendations to achieve Public Health 3.0.

Editor’s Note: This article is a joint publication initiative between Preventing Chronic Disease and NAM Perspectives .

Introduction

The United States has made enormous progress during the past century in improving the health and longevity of its population through public health interventions and high-quality clinical care. In 2015, life expectancy at birth was 78.8 years, 10 years longer than in the 1950s ( 1 ). Smoking prevalence rates among adults and teenagers are less than half what they were 50 years ago ( 2 ). The proportion of people without health insurance is at a historic low of 8.8% ( 3 ). Health reform efforts have also improved health care quality and slowed the growth rate of health care costs.

However, this success falls short of ensuring that everyone in America can achieve an optimal and equitable level of health. The Centers for Disease Control and Prevention (CDC) recently reported that the historical gain in longevity in the United States has plateaued for 3 years in a row ( 4 ). Racial and ethnic disparities persist across many health outcomes and conditions, including life expectancy, infant mortality, and exposure to environmental pollutants ( 5 ). The gap in life expectancy between people with the highest and lowest incomes is narrow in some communities but wide in others ( 6 ). By mapping life expectancies in several cities across the United States, researchers illustrated that this metric can differ by as much as 20 years in neighborhoods just a few miles apart ( 7 ). These data suggest that investing in safe and healthy communities matters, especially for the most disadvantaged populations ( 8 ). However, many of these challenges require community-based interventions beyond health care. Indeed, today a person’s zip code may be a stronger determinant of health than is his or her genetic code ( 7 , 9 ).

To solve the fundamental challenges of population health, we must address the full range of factors that influence a person’s overall health and well-being. Education, safe environments, housing, transportation, economic development, access to healthy foods — these are the major social determinants of health, comprising the conditions in which people are born, live, work, and age ( 10 ). Fortunately, many pioneering communities across the country are already working to improve health by influencing these determinants in a positive way. From Nashville, Tennessee, to Manchester, New Hampshire, to Harris County, Texas, and the Shoalwater Bay Indian Tribe in Washington, community leaders have built coalitions to improve educational attainment, promote economic opportunity, ensure community safety, and build environments that promote mental health and community engagement.

Key Influence of the Social Determinants of Health

Driven by payment policy changes, our health care system is transforming from one focused on episodic, nonintegrated care toward one that is value-based and would benefit from collaboration with allied community efforts. CDC developed a framework to conceptualize such integration across 3 areas of prevention— traditional clinical preventive interventions, interventions that extend care outside of the care setting, and population or community-wide interventions ( 11 ) ( Figure 1 ). Although work in all of these areas is necessary to improve health, the work of Public Health 3.0 is focused on the second and third areas.

Centers for Disease Control and Prevention’s Three Buckets of Prevention.

To improve the health of all people in America, we must also address factors outside of health care. Doing so means we must build on past successes and work across sectors to get closer to the essential definition of public health: Public health is what we do as a society to ensure the conditions in which everyone can be healthy ( 12 ).

The Evolution of Public Health

This expanded mission of public health was underscored in the 1988 Institute of Medicine (IOM, now the National Academy of Medicine) report, The Future of Public Health ( 12 ). It is even more salient today. Pioneering communities across the country are demonstrating how this can be achieved, particularly when led by local public health departments ( 13 ).

The 2002 IOM report, The Future of the Public’s Health in the 21st Century ( 14 ), called for strengthening governmental public health capabilities and requiring accountability from and among all sectors of the public health system. However, public health has been significantly underfunded. Relative to health care spending, the United States has made paltry investments in upstream, nonmedical determinants of health, such as social services, education, transportation, environmental protection, and housing programs. This lack of investment has had detrimental effects on population health ( 15 ). In addition, the 2008 recession precipitated a large and sustained reduction in state and local spending on public health activities ( 16 ). In 2012, nearly two-thirds of the US population lived in jurisdictions in which their local health department reported budget-related cuts to at least one critical program area ( 17 ).

Unfortunately, the need to strengthen the public health system, and the peril for failing to do so, is often only revealed in the context of disasters and crises. For example, in the aftermath of Hurricane Katrina, it became apparent that restoring health care services alone was insufficient in restoring New Orleans’s health care system. The water crisis in Flint, Michigan, reminded us of the costly consequences of not placing health and environmental impacts at the center when making decisions that affect the public’s health. For a community to address fundamental drivers of health while establishing readiness and resilience to crises requires a strong public health infrastructure, effective leadership, useable data, and adequate funding.

Public Health 3.0: A Renewed Approach to Public Health

Public Health 3.0 builds on the extraordinary successes of our past ( Figure 2 ). Public Health 1.0 refers to the period from the late 19th century through much of the 20th century when modern public health became an essential governmental function with specialized federal, state, local, and tribal public health agencies. During this period, public health systematized sanitation, improved food and water safety, expanded our understanding of diseases, developed powerful prevention and treatment tools such as vaccines and antibiotics, and expanded capability in epidemiology and laboratory science. This scientific and organizational progress meant that comprehensive public health protection — from effective primary prevention through science-based medical treatment and tertiary prevention — was possible for the general population.

Evolution of public health practices. Abbreviation: IOM, Institute of Medicine.

Public Health 2.0 emerged in the second half of the 20th century and was heavily shaped by the 1988 IOM report The Future of Public Health ( 12 ). In that seminal report, the IOM posited that public health authorities were encumbered by the demands of providing safety-net clinical care and were unprepared to address the rising burden of chronic diseases and new threats such as the HIV/AIDS epidemic. The report’s authors declared, “This nation has lost sight of its public health goals and has allowed the system of public health activities to fall into disarray.”

With this call to action, the IOM defined a common set of core functions, and public health practitioners developed and implemented target capacities and performance standards for governmental public health agencies at every level. During the 2.0 era, governmental public health agencies became increasingly professionalized.

Public Health 3.0 refers to a new era of enhanced and broadened public health practice that goes beyond traditional public department functions and programs. Cross-sectoral collaboration is inherent to the Public Health 3.0 vision, and the Chief Health Strategist role requires high-achieving health organizations with the skills and capabilities to drive such collective action. Pioneering US communities are already testing this approach to public health, with support from several national efforts.

Learning From the Field

At the core of Public Health 3.0 is the notion that local communities will lead the charge in taking public health to the next level and ensuring its continued success. Over the spring and summer of 2016, we visited communities across the United States to assess the accuracy of the 5 key components of the Public Health 3.0 framework and to hear firsthand what policy and other changes would support and sustain communities’ Public Health 3.0 work.

We selected 5 geographically and demographically diverse communities and convened listening sessions with approximately 100 participants each. Each meeting showcased successful multisectoral collaboration designed to address the social determinants of health. The communities visited were Allegheny County, Pennsylvania; Santa Rosa, California; Kansas City, Missouri; Nashville, Tennessee; and Spokane, Washington. They were selected as representative of the broader Public Health 3.0 movement because of their national reputation for multisectoral collaboration, evidence of a strong local public health leader, innovative use of data and metrics, and funding. They also had experience in public health department accreditation. Allegheny County, Pennsylvania, is a prototype for the model including their work to form a structured partnership supporting health and blending and braiding funding across several governmental jurisdictions ( 18 ).

In these listening sessions, local leaders shared their knowledge, strategies, and ideas for successfully implementing Public Health 3.0–style initiatives. Meeting participants represented an array of expertise beyond public health and health care. Although participants noted unique challenges and successes in each region, many common themes emerged across the meetings.

Recommendations to Achieve Public Health 3.0

Based on insights gathered from the public health community at these listening sessions, from conversations with leaders, and from a review of prior reports that lay out a framework for strengthening public health, we propose 5 broad recommendations that define the conditions needed to support health departments and the broader public health system as it transforms into the Public Health 3.0 model. A more detailed list of specific actions can be found in the Appendix and in the full report ( 18 ).

• 1. Public health leaders should embrace the role of Chief Health Strategist for their communities — working with all relevant partners so that they can drive initiatives including those that explicitly address “upstream” social determinants of health. Specialized Public Health 3.0 training should be available for the public health workforce and public health students.
• Although the local health officer often may serve in the role of Chief Health Strategist, there are circumstances in which such leadership comes from those in other sectors. Regardless, the public health workforce must acquire and strengthen its knowledge base, skills, and tools to meet the evolving challenges to population health, to be skilled at building strategic partnerships to bring about collective impact, to harness the power of new types of data, and to think and act in a systems perspective. This will require a strong pipeline into the public health workforce, as well as access to ongoing training and midcareer professional development resources.
• 2. Public health departments should engage with community stakeholders — from both the public and private sectors — to form vibrant, structured, cross-sector partnerships designed to develop and guide Public Health 3.0–style initiatives and to foster shared funding, services, governance, and collective action.
• Communities should create innovative and sustained organizational structures that include agencies or organizations across multiple sectors and with a shared vision, which allows blending and braiding of funding sources, capturing savings for reinvestment over time, and a long-term roadmap for creating health, equity, and resilience in communities.
• 3. Public Health Accreditation Board (PHAB) criteria and processes for department accreditation should be enhanced and supported to best foster Public Health 3.0 principles, as we strive to ensure that every person in the United States is served by nationally accredited health departments.
• As of August 2016, approximately 80% of the US population lived in the jurisdiction of one of the 324 local, state, and tribal health departments that has been accredited or is in the process of becoming accredited by the PHAB ( 19 ). The vision of ensuring that every community is protected by an accredited local or a state health department (or both) requires major investment and political will to enhance existing infrastructure. Although research found accreditation supports health departments in quality improvement and enhancing capacity ( 20 ), the health impact and return on investment of accreditation should be evaluated on an ongoing basis.
• 4. Timely, reliable, granular-level (ie, subcounty), and actionable data should be made accessible to communities throughout the country, and clear metrics to document success in public health practice should be developed to guide, focus, and assess the impact of prevention initiatives, including those targeting the social determinants of health and enhancing equity.
• The public and private sectors should work together to enable more real-time and geographically granular data to be shared, linked, and synthesized to inform action while protecting data security and individual privacy. This includes developing a core set of metrics that encompass health care and public health, particularly the social determinants of health, environmental outcomes, and health disparities.
• 5. Funding for public health should be enhanced and substantially modified , and innovative funding models should be explored to expand financial support for Public Health 3.0–style leadership and prevention initiatives. Blending and braiding of funds from multiple sources should be encouraged and allowed, including the recapturing and reinvesting of generated revenue. Funding should be identified to support core infrastructure as well as community-level work to address the social determinants of health.
• To secure sufficient and flexible funding in a constrained and increasingly tightening funding environment, local public health needs a concrete definition of the minimum capabilities, the costs of delivering these services, and a structured review of funding streams to prioritize mandatory services and infrastructure building.

Early Action on the Recommendations

Upon the release of the report, several public and private organizations committed to advancing its recommendations. It was embraced by the American Public Health Association as the blueprint for the future of public health ( 21 ); others committed to developing training for Chief Health Strategists ( 22 ) or to building bridges between public health and the clinical care system, including payers ( 23 ). The US Department of Health and Human Services (HHS) implemented 3 priority recommendations, including extending reporting on accreditation status to federal public health entities, establishing a social determinants of health workgroup to support alignment of HHS policies, and launching a conversation about state-based opportunities to leverage health and human services resources to improve the public’s health ( 23 ). Additionally, CDC’s Health Impact in 5 Years (HI-5) initiative ( 24 ) provides nonclinical, community-wide toolkits to address social determinants of health that have demonstrated not only health improvement but also cost-effectiveness within 5 years. Community-level uptake and action through these resources could accelerate the impact of Public Health 3.0 collaborations.

Key Barriers

For many communities, transforming to a Public Health 3.0 model will prove challenging. Although funding has stabilized, local health departments continue to face resource challenges from local financing streams, and proposals to reduce federal public health spending are likely to have a major impact at the local level ( 25 ). Despite promising advances such as the Big Cities Project, the absence of nonproprietary tools for data, analytics, metrics, and other uses leaves actionable information out of reach for most localities ( 25 ). Additionally, the daily challenges of meeting statutory public health responsibilities and a lack of experience and skill prevents most local health leaders from acting as Chief Health Strategists to bring people together across sectors. Finally, the basic foundational structure of local governmental public health may itself be a barrier to efficient and cost-effective coordination at the local level.

The era of Public Health 3.0 is an exciting time of innovation and transformation. With the Public Health 3.0 framework, we envision a strong local public health infrastructure in all communities and its leaders serving as Chief Health Strategists that partner with stakeholders across a multitude of sectors on the ground to address the social determinants of health. With equity and social determinants of health as guiding principles, every person and every organization can take shared accountability to ensure the conditions in which everyone can be healthy regardless of race, ethnicity, gender identity, sexual orientation, geography, or income level. If successful, such transformation can form the foundation from which we build an equitable health-promoting system — in which stable, safe, and thriving community is a norm rather than an aberration. The Public Health 3.0 initiative seeks to inspire transformative success stories such as those already witnessed in many pioneering communities across the country. The challenge now is to institutionalize this expanded approach to community-based public health practice and replicate these triumphs across all communities, for the health of all people.

Acknowledgments

We acknowledge the many communities and leaders who helped inform this work. The views expressed in this article 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 article is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies.

Appendix. Full List of Recommendations to Achieve Public Health 3.0.

Leadership & Workforce

• Public health associations such as Association of State and Territorial Health Officials (ASTHO) and National Association of County and City Health Officials (NACCHO) should develop best practice models and training for current public health leaders looking to work as Chief Health Strategists.
• The Health Resources and Services Administration (HRSA) should incorporate principles of Public Health 3.0 and social determinants of health in their workforce training programs, including the National Health Service Corps orientation, public health training center, and National Coordinating Center for Medicare and Medicaid Services Accountable Health Communities Model.
• Local public health agencies should partner with public health training centers and academic schools and programs of public health to inform training that meets the local public health workforce needs.
• The business and public health communities should jointly explore leadership development and workforce enrichment opportunities such as short-term fellowships or exchange programs, with a particular focus on the financial and operational capacity of local health departments.
• Academic institutions should encourage their faculty and administrations to develop meaningful partnerships with local public health departments and support service learning and internships for students from all disciplines in state and local health departments.
• Local health departments should train their leaders and staff in the concept and application of the collective impact model of social change.
• Public health should work with leadership institutes and business schools to establish professional development resources and opportunities.

Strategic Partnerships

• Local public health agencies should form cross-sector organizational structures aimed at achieving a collective vision of community health that are capable of receiving and sharing resources and governance.
• The US Department of Health and Human Services (HHS) should work with others to develop a report defining the key characteristics of successful local public health models that address social determinants of health through cross-sector partnerships and recommending pathways to wide adoption.
• The Assistant Secretary for Preparedness and Response (ASPR) and the Centers for Disease Control and Prevention (CDC) should work with state and local health entities to ensure synchronization between health care practices, coalitions, and public health entities. Pre-crisis collaboration is essential to improve sharing of limited resources, improve timely and accurate communication, and improve sharing of data relevant to preparedness planning and response.
• Local public health leaders should create cross-jurisdictional organizational structures or partnerships for community development efforts.
• Public health entities should partner with environmental health agencies to address the environmental determinants of health.
• HHS should continue to develop tools and resources (such as the HI-5 [Health Impact in 5 Years]) that identify system-level drivers of health disparities, connecting health and human services, and work with communities to translate evidence to action.
• HRSA should recommend that health centers document collaboration with their state and/or local health department.
• Health care providers should identify clear mechanisms to engage with local public health as part of their effort to achieve the three-part aim of better care, smarter spending, and healthier people.
• The Centers for Medicare and Medicaid Services (CMS) and ASPR should work together to ensure state and local public health entities engage health care providers during times of crisis or disaster. Preparedness measures are essential to healthier and more resilient people.
• The Substance Abuse and Mental Health Services Administration should encourage state mental health and substance use disorder agencies and other grantees to collaborate with state, local, and tribal public health entities in achieving PH3.0 goals.
• The Agency for Healthcare Research & Quality should ensure linkages between primary care and public health via the Primary Care Extension Program and evaluate outcomes.
• The National Institutes of Health should continue its community participatory research and engagement efforts, such as the Clinical and Translational Science Awards and the Partnerships for Environmental Public Health, to accelerate translation of evidence to community action, as well as to generate new knowledge in the evaluation and implementation of public health interventions.
• Public health leaders should pursue local partnerships to ensure population health is central in all community development efforts.

Infrastructure and Accreditation

• HHS should assess opportunities to incentivize Public Health Accreditation Board (PHAB) accreditation through federal programs and policies.
• HHS should require state and local health departments receiving federal grants to indicate their PHAB accreditation status, including applications in progress or plans to apply in the future.
• The federal government should partner with the private sector to create a learning community for local health departments seeking to engage in PH3.0 work with a particular focus on collective impact models to address the social determinants of health.
• Resources to support the accreditation process and maintenance should be more readily available from public and private funding sources.
• PHAB should continue to evolve accreditation expectations by incorporating Public Health 3.0 concepts.
• Philanthropic organizations supporting local public health activities and social interventions should require grant applicants to collaborate with local health departments.
• ASTHO and NACCHO should accelerate their support of state and local health departments moving to accreditation.
• PHAB and its strategic partners should continue to enable pathways to accreditation for small and rural health departments.
• States should assess the efficiency and effectiveness of their local health departments, including addressing jurisdictional overlaps and exploring opportunities for shared services mechanisms.

Data, Metrics, and Analytics

• HHS should utilize opportunities such as Healthy People 2030, NCVHS’s population health subcommittee, the Evidence-Based Policymaking Commission, and the census to elevate metrics related to social determinants to be leading health indicators, to define community-level indicators that address the social determinants of health and to explore models to leverage administrative data.
• NCVHS should advise the secretary of HHS to incentivize the integration of public health and clinical information.
• CDC should continue its work with the private sector to make subcounty-level data including health, health care, human services, environmental exposure, and social determinants of health available, accessible, and useable.
• HHS should work with public health leadership and the private sector to develop a nonproprietary tool to support geographic information systems and other analytic methods for front-line public health providers.
• Health systems and other electronic health data repositories should prioritize data sharing at the federal, state, and local level with the goal of achieving a learning health system inclusive of public health by 2024 as described in the Office of the National Coordinator for Health Information Technology (ONC) Nationwide Interoperability Roadmap.
• The HHS Office for Civil Rights should continue to develop guidance for the public health system to provide clarity on private and secure data use, as well as guidance to promote civil rights compliance to address those social determinants which are the product of discriminatory practices.
• ONC and the Administration for Children and Families should continue to establish clear data and interoperability standards for data linkage between health and human services sectors.
• HHS should continue to identify gaps in the collection of data relating to race/ethnicity, language, gender identity or sexual orientation in existing surveys. When feasible, governmental and nongovernmental stakeholders at all levels — federal, state, local, and tribal — should collect standardized, reliable data concerning disparities.
• HHS should facilitate linking environmental and human services data to health.

Sustainable and Flexible Funding

• The CMS and private payers should continue to explore efforts to support population-level health improvements that address the social determinants of health.
• HHS should explore transformation grants for state and local health departments to evolve toward PH3.0 structure, analogous to the State Innovation Model (SIM) grants to support health care system transformation.
• State governments receiving funds through SIM or Medicaid Waiver processes should be required to document their health department accreditation status and their strategies for addressing the social determinants in partnership with their local public health departments.
• States should maximize their use of the funding through the Health Services Initiative option under the Children’s Health Insurance Program to advance their public health priorities for low-income children.
• HHS should enhance its coordination both within the department and with other agencies, developing and executing cross-agency efforts to strategically align policies and programs that address the social determinants of health.
• Public and private funders should explore options to provide more flexibility for accredited health departments to allocate funds toward cross-sector efforts including partnership development and collective impact models in addressing the social determinants.
• Communities should examine how to best use the Affordable Care Act’s community benefits requirement for nonprofit hospitals by coordinating the alignment of the data collection process and pooling resources and how these can be used to advance and provide funding for public health.
• Public health agencies and academic institutions should periodically calculate the funding gap — the difference between the costs of providing foundational capabilities by each local health department and its current funding level — and communicate these figures in the context of forging partnerships and expanding funding sources.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.

Suggested citation for this article: 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 Challenges of the 21st Century. Prev Chronic Dis 2017;14:170017. DOI: https://doi.org/10.5888/pcd14.170017 .

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The Open Public Health Journal is an Open Access journal which publishes original research articles, reviews/mini-reviews, short articles and guest edited single topic issues in the field of public health. Topics covered in this interdisciplinary journal include: public health policy and practice; theory and methods; occupational health and education; epidemiology; social medicine; health services research; ethics; environmental health; adolescent health; AIDS care; and mental health care.

The Open Public Health Journal , a peer reviewed journal, is an important and reliable source of current information on developments in the field. Emphasis is placed on publishing quality papers, making them freely available to researchers worldwide.

Recent Articles

Research article, editor's choice, compliance with lockdown regulations during the covid-19 pandemic in south africa: findings from an online survey.

Background:

Background: SARS-CoV-2 has resulted in the COVID-19 pandemic. Based on a nationally representative online survey conducted several weeks on the pandemic, this paper explores how South Africans responded to the compliance regulations laid down by the national government and factors associated with individuals’ confidence in their community adhering to lockdown regulations.

The study was conducted using a closed-ended questionnaire on a data-free online platform. Additionally, a telephonic survey was included to accommodate individuals who do not have access to smart-phones. The study population consisted of respondents who were 18 years and older and living in South Africa (n=19 933). Data were benchmarked to the 2019 midyear population estimates. Descriptive statistics and bivariate logistic regression are presented.

Over a quarter (26.1%) of respondents reported that they had not left home, indicating compliance with the COVID-19 control regulations, and 55.3% who did leave their homes did so to purchase essential items. A small proportion (1.2%) reported that they had visited friends. People, classified as coloured, those who were more literate (those with secondary, matric and tertiary education status), those residing in disadvantaged areas (informal settlements, townships, rural areas and farms), and those who perceived their risk of contracting COVID-19 as moderate and high, reported not being confident of their community adhering to lockdown.

Conclusion:

Communication strategies must be employed to ensure that important information regarding the pandemic be conveyed in the most important languages and be dispatched via various communication channels to reach as many people as possible.

COVID-19 Pandemic: The Vaccine of a Society is its Education

Sanitary and Hygienic Aspects of the COVID-19 Self-isolation

Social Support and Breast Cancer Recurrence: Is there any Association?

Exploring Mortality Rates for Major Causes of Death in Korea

Listen to the Midwives in Limpopo Province South Africa: An Exploratory Study on Maternal Care

Comparative Study on the Clinicopathological Profiles of Breast Cancer Among Iraqi and British Patients

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Track your manuscript, published contents, about the editor, about the journal, journal metrics, readership statistics:, total views/downloads: 1,082,275, unique views/downloads: 228,479, press release, the nursing journal directory indexes bentham journal, the open public health journal.

The Open Public Health Journal has been Indexed in the Nursing Journal Directory . The Nursing Journal Directory , a joint service of the International Academy of Nursing Editors (INANE) and Nurse Author & Editor , aims to maintain the directory to help authors, related to nursing, to find relevant, reputable journals for publishing their work. Its vetting process for indexing journals draws on the COPE Principles of Transparency and Best Practice in Scholarly Publishing .

The Open Public Health Journal is a peer-reviewed, open access journal which publishes original research articles, reviews/mini-reviews, short articles and guest edited single topic issues in the field of public health. Topics covered in this interdisciplinary journal include: public health policy and practice; theory and methods; occupational health and education; epidemiology; social medicine; health services research; ethics; environmental health; adolescent health; AIDS care; and mental health care.

Dr. Matthias Beck Ph.D. (MIT) serves as the Editor-in-Chief of The Open Public Health Journal . Dr. Beck is a Professor of Management at the Cork University Business School, University College Cork, Ireland. He has published more than 100 academic papers and several widely read books in the areas of risk, health and health management. His work on occupational cancers won the 2013 American Public Health Association (APHA) Occupational Health Section’s Scientific Research Award.

Learn more about the journal here: https://openpublichealthjournal.com/index.php

Professor Mauro Giovanni Carta Receives Honorary Membership of the National Academy of Medicine of Brazil

Bentham Open congratulates Professor Mauro Giovanni Carta , the Editor-in-Chief of the journal, Clinical Practice & Epidemiology in Mental Health , for receiving the Honorary Membership of the National Academy of Medicine of Brazil .

Professor Mauro Giovanni Carta is a prominent researcher and author in the field of psychiatry , having published more than 200 publications in various international journals. Prof. Carta holds various key positions in the University of Cagliari, Italy, and other renowned organizations. He serves as a Full Professor of Translational Medicine at the University of Cagliari; the Head of Liaison Psychiatric Unit at University Hospital of Cagliari; Co-chairman at WHO-Geneva and University of Cagliari agreement for implementing the Quality Rights Project in the Mediterranean Area; the Head of a Collaborating Unit, Chafea – European Union, Joint Action on Mental Health, University of Cagliari; and the President of the Mediterranean Society on Mental Health.

The National Academy of Medicine is an integral and active part of the evolution of the practice of medicine in Brazil. The National Academy, founded on June 30, 1829, maintains the objective of contributing to the study, discussion and development of the practices of medicine, surgery, public health and related sciences. It also serves as a consultative body for the Brazilian Government on the matters of health and medical education.

Clinical Practice & Epidemiology in Mental Health is an open access, peer-reviewed journal, which publishes research articles, reviews / mini-reviews, letters in all areas of clinical practice and epidemiology in mental health.

The journal covers topics including clinical and epidemiological research in psychiatry and mental health; diagnosis, prognosis and treatment of mental health conditions; frequencies and determinants of mental health conditions in the community and the populations at risk; research and economic aspects of psychiatry, with special attention given to manuscripts presenting new results and methods in the area; and clinical epidemiologic investigation of pharmaceutical agents.

For more information about the journal, please visit: https://clinical-practice-and-epidemiology-in-mental-health.com/

Bentham Open Welcomes Sultan Idris University of Education (UPSI) as Institutional Member

Bentham OPEN is pleased to welcome Sultan Idris University of Education (UPSI), Malaysia as Institutional Member. The partnership allows the researchers from the university to publish their research under an Open Access license with specified fee discounts. Bentham OPEN welcomes institutions and organizations from world over to join as Institutional Member and avail a host of benefits for their researchers.

Sultan Idris University of Education (UPSI) was established in 1922 and was known as the first Teacher Training College of Malaya. It is known as one of the oldest universities in Malaysia. UPSI was later upgraded to a full university institution on 1 May, 1997, an upgrade from their previous college status. Their aim to provide exceptional leadership in the field of education continues until today and has produced quality graduates to act as future educators to students in the primary and secondary level.

Bentham OPEN publishes a number of peer-reviewed, Open Access journals. These free-to-view online journals cover all major disciplines of science, medicine, technology and social sciences. Bentham OPEN provides researchers a platform to rapidly publish their research in a good-quality peer-reviewed journal. All peer-reviewed accepted submissions meeting high research and ethical standards are published with free access to all.

Ministry Of Health, Jordan joins Bentham Open as Institutional Member

Bentham OPEN is pleased to announce an Institutional Member partnership with the Ministry of Health, Jordan . The partnership provides the opportunity to the researchers, from the university, to publish their research under an Open Access license with specified fee concessions. Bentham OPEN welcomes institutions and organizations from the world over to join as Institutional Member and avail a host of benefits for their researchers.

The first Ministry of Health in Jordan was established in 1950. The Ministry began its duties in 1951, the beginning of the health development boom in Jordan. The first accomplishment was the establishment of six departments in the districts headed by a physician and under the central administration of the Ministry. The Ministry of Health undertakes all health affairs in the Kingdom and its accredited hospitals include AL-Basheer Hospital, Zarqa Governmental Hospital, University of Jordan Hospital, Prince Hashem Military Hospital and Karak Governmental Hospital.

Bentham OPEN publishes a number of peer-reviewed, Open Access journals. These free-to-view online journals cover all major disciplines of science, medicine, technology and social sciences. Bentham OPEN provides researchers a platform to rapidly publish their research in a good-quality peer-reviewed journal. All peer-reviewed, accepted submissions meeting high research and ethical standards are published with free access to all.

Porto University joins Bentham Open as Institutional Member

Bentham OPEN is pleased to announce an Institutional Member partnership with the Porto University, Faculty of Dental Medicine (FMDUP) . The partnership provides the opportunity to the researchers, from the university, to publish their research under an Open Access license with specified fee concessions. Bentham OPEN welcomes institutions and organizations from world over to join as Institutional Member and avail a host of benefits for their researchers.

The Porto University was founded in 1911. Porto University create scientific, cultural and artistic knowledge, higher education training strongly anchored in research, the social and economic valorization of knowledge and active participation in the progress of the communities in which it operates.

There's need to intensify diabetes screening amongst older patients living with HIV

This article by Dr. Olufunso O. Sogbanmu et al. is published in The Open Public Health Journal, Volume 12, 2019

HIV patients can suffer from a range of ailments. However, the prevalence of specific diseases may be depended on geographical or demographic factors. A team of researchers from the University of Fort Hare in South Africa, led by Olufunso O. Sogbanmu have studied the incidence of diabetes mellitus in HIV patients Buffalo City, East London. The team's research has shown the need to screen older individuals diagnosed with HIV as crucial in offering a timely point of care and interventions to enable prompt diagnosis of diabetes mellitus in this cohort of patient and prevent possible comorbidities that may result from delayed diagnosis.

The study examined the prevalence of diabetes mellitus in newly diagnosed HIV-positive patients in Buffalo City Municipality, East London, South Africa. The majority of the participants were female (75%) and the prevalence of diabetes mellitus was 6% amongst newly diagnosed HIV positive patient using the definition based on the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) 2017 guideline of HbA1c of above 6.5%. The multivariate analysis indicates only age (p=0.031) and race (0.019) significantly shows a correlation to increase the risk of development of diabetes mellitus in newly diagnosed HIV positive patients. The binary logistic regression analysis shows that age (above 46 years) (p=0.001; AOR (6.60); CI (2.08-20.9) was directly related to the development of diabetes mellitus.

Another highlight of the study is the possibility that glycated haemoglobin may underestimate diabetes mellitus diagnosis amongst HIV positive population, hence, there may be a need to consider different screening tests to aid the diagnosis of diabetes mellitus amongst HIV positive patients. The research has been published in The Open Public Health Journal (Volume 12, 2019).

To access the full text of the article, please visit:  https://benthamopen.com/ABSTRACT/TOPHJ-12-263

Dr O. O. SOGANMU  PHD (Microbiology), MMed (Family Medicine), MBcHB

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