Social determinants take center stage in call for Public Health 3.0
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* Kim Krisberg

Despite spending more on health care than any country in the world and being home to some of the best, most cutting-edge medicine, the U.S. ranks 34th in life expectancy. In fact, for Americans living in poverty, lifespan is on the decline. The challenge of turning such indicators around have led federal health officials to call for a new era of public health, Public Health 3.0.

“Your ZIP code is more important to your health than your genetic code,” Karen DeSalvo, MD, MPH, MSc, acting assistant secretary for health at the U.S. Department of Health and Human Services, told *The Nation’s Health.* “Public health not only has to be part of that (shift in thinking), it has to be ready to lead.”

In an article in the April issue of APHA’s *American Journal of Public Health,* DeSalvo, along with fellow officials from HHS and the Centers for Disease Control and Prevention, argue that as the nation’s disease burden is increasingly attributable to behaviors shaped by social and environmental determinants, public health agencies must take a lead role in building the community conditions that promote good health and well-being for all.

The article authors refer to Public Health 1.0 as the period during the 20th century that brought about monumental advances in science and medicine, such as antibiotics and vaccines, and accelerated the fields of epidemiology and laboratory science. Public Health 2.0 began with a 1988 report from the then-Institute of Medicine report on the “Future of Public Health,” which concluded that the nation’s public health system had fallen into “disarray” and jump-started a national effort to clearly define essential public health services. Now, the authors argue, it is time to upgrade from Public Health 2.0 to Public Health 3.0, which the authors described as a “modern version that emphasizes cross-sector collaboration and environmental, policy and systems-level actions that directly affect the social determinants of health.”

The key components of Public Health 3.0 are enhanced public health leadership in the community, broad engagement with partners across multiple sectors, an accreditation process that includes Public Health 3.0 elements, more timely and locally relevant data, new metrics of community health and more flexible public health funding. The HHS Office of the Assistant Secretary for Health is leading the Public Health 3.0 initiative, which will build off ongoing Healthy People 2020 efforts that encourage collaboration across sectors and communities.

DeSalvo noted that while transitioning to Public Health 3.0 will require new resources — a challenge for a field that already struggles with underfunding — the Affordable Care Act has given public health the opportunity to move away from caring for the uninsured and “into a world where they can think more about policy and systems-level change.”

To shift public health into the new era, DeSalvo said HHS will help jump-start a national conversation on the importance of achieving good health beyond the realm of health care.

Throughout 2016, the HHS Office of the Assistant Secretary for Health will host regional listening sessions with leaders from the public and private sectors, with the ultimate goal of issuing a national framework for Public Health 3.0.

For more information, visit [www.healthypeople.gov](http://www.healthypeople.gov) and [www.ajph.org](http://www.ajph.org).

*   Copyright The Nation’s Health, American Public Health Association