The Future of Public Health: Public Health 3.0 and Accountable Population Health

Public health spending has remained a small fraction of total health expenditures in the United States for the past several decades despite increasing complexity in health challenges facing our country in the 21st century. COVID-19 put our health and public health systems to the ultimate test, and while successful in some respects, it also became apparent that traditional approaches to public health and health care were not adequate to deal with crisis. Critical gaps in public health funding, paired with other recent health care trends support a re-envisioning of how public health, health care, and social service systems can work together to address population health challenges. In this discussion paper, to advance this re-envisioning, we describe a path toward Accountable Population Health with better, more intentional partnerships between health care and public health to achieve population health goals – including building community level resources and accountability to track and improve population health outcomes.

The paper outlines three major elements of how the Accountable Population Health approach could be initially applied:

• Providing foundational data for situational awareness of urgent community health risks and for determining actionable, feasible steps to make measurable progress across health care, public health, and social services.
• The use of accountable health care reforms to advance population test to treat initiatives related to public health goals.
• Addressing other public health threats that are not well supported in most FFS-based health care systems today (e.g., opioid use disorder).

The health challenges facing the United States in the 21st century require a reinvigorated, feasible approach to public health. Our proposed Accountable Population Health approach will leverage digital data systems, biomedical innovations, and trends in health policy reforms to enhance community capabilities through engagement with private sector and social service organizations. While not a silver bullet, if applied, this approach can help to better understand and address public health challenges, build public trust and confidence, and build better, more resilient, and more sustainable health care and public health capabilities.