FUTURE DIRECTIONS: Case Reports: Case Report Introduction
This article serves as an introduction to case reports from 3 outstanding local health departments that have both achieved national accreditation and received recognition as winners of the Robert Wood Johnson Foundation (RWJF) Culture of Health Prize.1 Their stories illustrate the resonance between the evolving standards, measures, and guidance of national accreditation, and the RWJF vision of creating a Culture of Health in a community. The Public Health Accreditation Board (PHAB) version 1.0 of the Standards and Measures2 raised the bar for community engagement and cross-sectoral collaboration in creating and then implementing a community health improvement plan. Version 1.53 increased the emphasis on operationalizing equity and broadening the spectrum of cross-sectoral collaborators and the need to address the social determinants of health. Over the same period, RWJF developed the vision of a Culture of Health, where everyone has the opportunity to live a healthier life, and developed the Action Framework4 for improving health, well-being, and equity across the nation. Within the reports from these 3 health departments, there are multiple examples in each of the 4 areas of action of the Action Framework that were catalyzed by accreditation standards; this introduction highlights a sample of these.
The first area of the Action Framework is making health a shared value across a community, including changing mindsets and expectations, and developing a sense of community and civic engagement. An example of this work is Miami-Dade County as the lead convener for the Consortium for a Healthier Miami-Dade since 2003. The county transformed its community health improvement plan (CHIP) process in response to the PHAB standards to a collective impact approach and held a CHIP summit that developed partnerships to address the identified priorities.
The second area of the Action Framework is fostering cross-sectoral collaboration to improve well-being. All of the 3 departments have achieved this, building off the relationships developed in large part through the broader inclusion of partners in the community health assessment (CHA) and CHIP processes. All 3 health departments identified with their partners the more upstream factors influencing health, the social determinants of health, and took action to address these. For example, the Spokane Regional Health District is the cornerstone for the Priority Spokane coalition, which chose to focus on improving health by increasing high school graduation rates in the community. The health department provided leadership and tracking and analysis of real-time data for the coalition, demonstrating progress, and identifying a significant factor to be addressed in the second cycle, namely, the drastically high number of students who are homeless. Spokane identified the PHAB standards on data surveillance and performance measurement tracking as key to its ability to provide this role to the coalition.
The third area of the Action Framework is creating healthier, more equitable communities. This includes policies and interventions to improve the built environment and physical conditions and also the social and economic environments. The Kansas City, MO, Health Department (KCMOHD) had a 10-year history of partnership with community-based organizations, the Communities Creating Opportunity (CCO). The accreditation standards prompted KCMOHD to finalize a Memorandum of Understanding (MOU) as evidence of commitment to joint action. KCMOHD provides evidence concerning issues, shows inequities, and provides real-time data. CCO provides “the power through motivation and mobilization of the community.” Together, they have achieved significant policy success to improve the social and economic well-being and reduce inequities in their jurisdiction.
The fourth Action Framework emphasizes strengthening integration of health services and systems. This includes ensuring access to both public health and health care services. Among Miami-Dade's multiple CHIP projects is a collaboration between a large Miami-Dade County Hospital, a neighborhood health and wellness coalition, a corporate partner, and the health department that focuses on prediabetic patients using a collective impact approach. All of the health departments noted the inclusion of health care organizations in their community coalitions and collaboration to develop a single CHA and community health needs assessment required for nonprofit hospitals.
RWJF and PHAB accreditation share a common goal of improving health, well-being, and equity. There is great consonance between the mission and vision of public health departments and the Culture of Health, and that has been strengthened by the standards of accreditation. Together, we can see both spread across the nation.