ABSTRACT
Prior to passage of the Affordable Care Act (ACA), responsibility for the health of populations was viewed as almost exclusively the purview of governmental public health. Underfunded and largely unreimbursed by third parties, the public health perspective was encompassed within the rubric of the three core functions (assessment, assurance, and policy development) and the Ten Essential Public Health Services (EPHS) (see Figure 2.1 ).[1, 2] For the broader public health
practice, community population health meant serving the entire population of the jurisdiction along with any visitors or temporary residents-in short, everyone. Distinctions between the current view of some health plans and public health remain, yet the central tenet for both is the improvement of health outcomes for groups of people which the entity (public or private, governmental or otherwise) has responsibility.[3, 4]
Largely an historical byproduct of divergent funding sources and conceptual models, public health and health care have endured an uneasy co-existence.[5] One need look no further than our nation’s current infl ated health expenditures and unimpressive health outcomes to determine that our present bifurcated approach poorly serves our long-term interests. Population health conceptually embraces the potential for shared accountability across both health sectors. Although direct lines of accountability may become blurred in shared accountability models (some may term it an oxymoron by defi nition), the shared emphasis and combined resources feature better health and prevention far more prominently on the national health agenda. This is the direction underscored by the ACA, and also as put into practice by the Centers for Medicare and Medicaid through the Accountable Care Organizations (ACOs) and various innovation grant models. It is also supported by recent reports recommending professional health sector marital counseling-enabling public health and primary care to collaborate far more closely.[6]
Contemplating a future, one in which public health and health care are collaborators rather than competitors, was envisioned in the late 1990s and framed in the context of the public health system and national public health performance standards (see Figure 2.2 ).[7] The National Public Health Performance Standards (NPHPS) program is a CDC-led partnership of national public health organizations to improve public health systems through the development and application of local and state-based performance standards. The NPHPS consists of three performance self-assessment instruments, one for state public health systems, one for local public health systems, and one for local governing bodies. The NPHPS are framed as optimal standards using the Ten EPHS framework, and as such constitute a unique resource to examine public health system expectations. In a related fashion, Public Health Accreditation Board standards and measures (see Chapter 8 ) establish a framework for governmental public health. The two models complement one another. Key to understanding the NPHPS is the embedded notion of the system , and the critical role that system partners play in building capacity and ultimately improving health outcomes. In many ways, the NPHPS set the stage for the collaboration and partnerships we have today, by establishing and building a science base around the effectiveness of shared system efforts.
