The Seven Year Itch: Advances and Opportunities for Public Health Practice

I look forward to continuing this journey, working alongside skilled, diverse partners, colleagues, and others yet to come; committed to public health now and in the future.
— Sandra Melstad

Author: Sandra Melstad, MPH, SLM Consulting LLC

Author: Sandra Melstad, MPH, SLM Consulting LLC

In April 2019, SLM Consulting, LLC was fortunate to celebrate seven years in business, providing data driven public health solutions to impact communities where people live, work, learn, and play. Looking back over the past seven years, provides an opportunity to reflect on the how public health practice has evolved and what opportunities still exist to impact population health.

Public health is centered on promoting and protecting the health of people where they live, work, learn, and play (American Public Health Association, 2019). Public health impacts everyone, every day, from what we eat, how we live, or the environment and the human impact. As the evidence continues to highlight the reality that social, economic, and environmental factors determine health outcomes, public health approaches have fostered innovation and  implementation of policy and programs that address the root causes of health outcomes to improve population health. Advances in public health, driven by science and medicine, and our understanding of what determines health outcomes, have contributed to an increase in the average life expectancy.

Successful approaches utilized across the nation include a multi-modal thoroughfare plan developed by the City of Columbus, OH to address inequitable distribution of transportation or the Vermillion, SD Farmers Market recognized a need to accept SNAP benefits to increase access to healthy foods for low-income and underserved population in the community.  AARP has now identified the need to support livable communities and help people of all ages to live healthy in their own community, addressing issues with transportation, housing, social participation and support and access to community and health services.

Innovation has also helped to advance public health, including advances in technology, such as telehealth, that provides an opportunity to rural patients to connect with healthcare providers and reduce barriers to care. Technology has also helped drive chronic disease self-management and patient engagement, including utilization of wearables to support medication compliance (Jimenez, 2016).

Despite the numerous gains made in public health, there are opportunities that still exists to advance public health practice and build on the great work that has occurred.

  • Enhance Multi-Sector Collaborations: A body of research continues to build that recognizes the need for multi-sector collaborations to positively impact health outcomes, yet silos continue to exist, and collaboration of diverse partners is still a challenge. Engagement of diverse, community-based partners is integral for collaboration and impact.  The Practical Playbook just released a book, The Practical Playbook II, Building Multisector Partnership That Work, that provides insights into building effective multisector partnerships.

  • Integrate Evidence-Based Practice: Evidence-based practice (EBP) continues to be important to support public health practice and increase the likelihood of success to address health outcomes. Thus, it is critical to identify opportunities to require and integrate it into everyday practice and build the public health workforce capacity, including administrative support to institutionalize EBP. The Prevention Research Center in St. Louis outlines strategies to integrate EBP.

  • Engage in Data Sharing: Data sharing is wide recognized as an evidence-based practice to reduce duplication of efforts and support collective impact; however, institutional or organizational barriers prevent sharing. Engaging in data sharing provides an opportunity to engage partners in ongoing and meaningful ways (Prevention Research Center in St. Louis, 2018). For example, Data Across Sectors for Health is an initiative of the Robert Wood Johnson Foundation to foster data sharing and promote a culture of health.  

  • Address Root Cause of Health Outcomes: Despite substantial growth in the awareness  of health equity and how to achieve it, gaps still exist in understanding the need to achieve health equity. Steps to address health inequities can begin by checking assumptions and addressing the root causes (e.g. poverty, geographic isolation, racial bias, poor housing) of health outcomes. Just like evidence-based practice, addressing health equity should be standard practice, not an exception. The Health Equity Institute for Research, Practice & Policy, is a key player in the fight to address health equity.

  • Strengthen Public Health Funding: A key and critical opportunity to advance public health practice is to increase investments in public health, such as the Prevention and Public Health Fund and other key funding sources. The United States outspends other developed countries yet has some of the poorest health outcomes and a low-life expectancy in comparison. Despite the cost-savings that public health provides to preventing and addressing health outcomes, only 1% of health care spending is focused on prevention and public health, despite that reality chronic diseases are the leading cause of death and disability and account for 90% of health care costs (American Public Health Association, n.d.). Unfortunately, public health’s share of total health spending is projected to decline to 2.4% in 2023 (Himmelstein & Wolhandler, 2016). The decline in spending has left state and local governments with fiscal challenges.

The reality of public health practice is that tremendous work is occurring where in communities large and small across the world and in your backyard; guided by advocates, practitioners, clinicians and community members who are committed to ensuring a healthy community and everyone if afforded the opportunity to be healthy.  I look forward to continuing this journey, working alongside skilled, diverse partners, colleagues, and others yet to come; committed to public health now and in the future.


American Public Health Association. (2019). What is public health? Retrieved from

American Public Health Association. (n.d.). Prevention and public health fund, dedicated to improving our nation’s public health. Retrieved from

Himmelstein, D. & Wollhandler, S. (2016). Public health’s falling share of US health spending. American Journal of Public Health 106(1), 1-2. doi: 10.2105/AJPH.2015.302908

Jimenez, J. (2016). Five ways innovation is advancing public health. In Forbes (website). Retrieved from

Prevention Research Center in St. Louis. (2018). Putting evidence to work for health: how health departments can encourage evidence-based decision making. Retrieved from