The Gulf Region Health Outreach Program (GRHOP) and a Public Health Mantra
by Maureen Lichtveld, MD, MPH, and Bernard Goldstein, MD
In public health we repeat over and over again, in suitably hushed tones, the phrase “There is no major public health problem that can be solved by one discipline working alone.” Our literature contains reverent references to the need for the hyphen disciplinaries (multi-; trans- and cross-); to systems approaches, and, coming soon, to convergent science. For accreditation, our schools and programs must teach a range of disciplines that is only surpassed by the School of Arts and Sciences. Yet, the health literature abounds with failures to bring us together to solve problems.
The supplement to the November issue of the JPHMP contains fifteen publications reflecting both intended and unintended benefits associated with GRHOP: First, the program was deliberately designed to strengthen the existing fragile health infrastructure in communities affected by the Gulf oil spill by integrating disciplines and resources horizontally and vertically. Horizontal integration was uniquely enabled by supporting major components of the public health infrastructure considered the “floor” of the public health home designed to support all public health services: workforce development, organizational capacity, and knowledge management. Specifically, through investment by the Primary Care Capacity Project, GRHOP strengthened the health workforce, invested in transdisciplinary workplace integration, and in either synchronizing or establishing electronic health record management systems. Vertically, investments in environmental health and mental and behavioral health resulted in breaking down the traditional silo approach of disease-specific funding and program implementation. Furthermore, health literacy was bolstered by community health worker training and placement in Federally Qualified Health Centers and community organizations. Indeed, through this discipline-blind approach we achieved the desired outcome of not only strengthening the infrastructure undergirding all public health programs but also advanced the integration of these programs. Secondly, GHROP was designed to transcend geographic boundaries by investing in affected communities living in 17 parishes and counties located in four affected states. This approach deliberately counters the public sector policy of jurisdictional funding and resulted in geographic synergy and effective use of resources. Moreover, by doing so, GRHOP enhanced the network within and among state health programs anticipated to mount effective responses to future oil spills or other disasters.
In addition to the intended benefits, the program resulted in two promising unintended outcomes: the vertical integrated design allowed for examining output, outcome, and ultimately impact across programs, culminating in an enterprise-wide evaluation strategy. Furthermore, the horizontal health services integration facilitated the creation of a peer-learning network through a Regional Care Collaborative (RCC). The RCC’s webinar series and annual meeting fostered collaborative learning among all GRHOP partners in general and those engaged in advancing sustainable clinical health services specifically. Not since the September 2011 events was there such a massive investment in public health preparedness. In contrast to those funds restricting spending to bioterrorism agents, GRHOP investments allowed for broad flexibility resulting in exemplary transdisciplinary results maximally benefitting health disparate communities by promoting health and wellbeing while fostering self-reliance and sustainability.
About the Authors
Dr. Maureen Lichtveld, member of the National Academy of Medicine, is Professor and Chair, Department of Global Environmental Health Sciences, Tulane University, School of Public Health and Tropical Medicine and holds an endowed chair in environmental policy. She is the Principal Investigator of GRHOP’s Environmental Health Capacity and Literacy Project. [Full bio]
Dr. Bernard Goldstein is Emeritus Dean of the University of Pittsburgh Graduate School of Public Health. He was an Advisory Board member of the NAS Gulf Research Program and was the original chair and now an external member of the Gulf Region Health Outreach Program Coordinating Committee. [Full bio]