July 2019: Investments in Population Health

The July/August issue of the Journal of Public Health Management and Practice focuses on investments in population health. The lead commentary by Adam Lustig of the Trust for America’s Health (TFAH) calls for a greater emphasis on the importance of multisector solutions beyond health care. He refers to a newly released TFAH report, Promoting Health and Cost Control in States, (an initiative supported by the Robert Wood Johnson Foundation and Kaiser Permanente), that pinpoints evidence-based policies to promote healthy lifestyles and reduce rising costs. Policy makers and public health officials can address the social determinants of health by fostering healthy behaviors, the connections between education and health, healthy and affordable housing, and the built environment.

A number of articles in this issue report on community benefit expenditures of United States hospitals. Begun and Trinh find that the level of community health improvement expenses is positively associated with larger hospitals, system membership, profit margin and urban location. Rozier and colleagues, also reporting on community benefits of nonprofit hospitals, outline the priorities that guide decision makers when allocating resources to community health projects. Projects were more likely to be selected when identified by a community health assessment or when supported by evidence or cross-sector collaboration.

Fos and colleagues, in their article “Community Benefit Spending among North Carolina’s Tax Exempt Hospitals After Performing Community Health Needs Assessments,” found on average that the study hospitals community benefit spending was 15% of operating expenses. Of note of the aggregate community benefit spending of $2.6 billion in the study hospitals, 85% was allocated to patient financial assistance with only 0.7% allocated to community building activities such as affordable housing, economic development, or improvement of the environment.

“State Laws and Nonprofit Hospital Community Benefit Spending” by Johnson et al determined the association of state laws on nonprofit hospital community benefit spending. A total of 2,421 nonprofit short-term acute care hospitals were examined that filed an internal revenue service Form 990 and Schedule H between 2009 and 2015. State laws were found to be associated with community benefit spending. Of importance, policy makers can use this type of legislation to increase hospital investment in public health.

McCullough, Singh and Leider, in their article “The Importance of Governmental and Nongovernmental Investments in Public Health and Social Services for Improving Community Health Outcomes,” approach the key question of whether these types of spending do improve community health. They do find that hospital provision of community health services and increases in governmental health and social services spending are associated with improved health. They recommend policy makers take advantages of the synergy of public and private community resources.

Honore, in an article on the Public Health Uniform Data System (PHUNDS), continues to advocate for a financial system for local health departments that applies uniform practices. She provides a 10-year retrospective review, building on a foundation of articles previously published in JPHMP, showing the benefits of PHUNDS to reduce financial risks, increase revenues, and improve management skills.

Two articles in this issue focus on substance abuse. A commentary by Martin and Krakov, “Visualizing the Opioid Epidemic: Lessons Learned from a Dozen Years of Engaging Communities with Data,” describes how local and state health departments are developing opioid dashboards to advance understanding of the epidemic and orient communities toward action. A case study, “Development of Safe Syringe Exchange Programs: The Role of the North Carolina Division of Public Health,” describes the role of state health director, Danny Staley, in implementing this progressive initiative in a conservative political climate.


Lloyd F. Novick, MD, MPH is Professor Emeritus of the Department of Public Health at the Brody School of Medicine, East Carolina University. Previously, he was chair of this Department. He has served as the Commissioner of Health and Secretary for Human Services of Vermont, Director of Health Services for Arizona, and Director of the Office of Public Health for New York State. Previous academic positions include Professor and Director of the Preventive Medicine Program for SUNY Upstate Medical University, Professor and Chair of Epidemiology at the University of Albany School of Public Health, and Clinical Professor and Director of the Teaching Program in Epidemiology and Public Health at the University of Vermont, College of Medicine. [Full bio]

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