Forces of Change

One of the four fundamental assessments in the community-based strategic planning instrument known as MAPP (Mobilizing for Action through Planning and Partnerships) is the “Forces of Change” assessment—a process for identifying and understanding known or likely major contextual elements that could support, bolster, hinder, or even negate taking action on key strategic issues. Without laying claims as a soothsayer I have recently been deliberating about the future of public health practice by considering the current and likely forces of change on the practice setting and the public health practitioner, being joined in this effort by my friend and colleague Ross Brownson, PhD (Washington University in St. Louis, MO). Thus far, our discussions have focused on seven such forces of change for the future of public health practice. Some of these forces of change have been present and apparent already for several years, while others are just appearing on the public health practice landscape. While I am certain that AJPH readers and authors will have other ideas to add to this list, I believe it is a useful way to think about the future of public health practice, and thus is a useful springboard for launching my appointment as an Associate Editor of AJPH, with a focus on Public Health Practice.

The major forces of change we have been considering include:

• Patient Protection and Affordable Care Act (ACA)

The expansion of health insurance coverage will provide new or improved access to clinical services, and the requirement of “first dollar” coverage for primary and secondary preventive services will change the nature of what health departments provide (and the funding support for this) and how they may bill for such services. How will public health practice respond in this milieu, in a manner that creates synergy with primary care?

• Accreditation

Achieving a set of widely accepted performance standards should drive quality improvement in public health practice in ways that matter. How can accreditation create opportunities to strengthen the evidence base of public health practice?

• Climate Change

Climate change will impact public health practice because of changes in the ecology of infectious diseases, rising sea levels and the movement of populations through forcible displacement, and weather extremes and the impact on food production, security, and costs. How will public health practitioners respond with appropriate health promotion and disease prevention efforts, which will require new knowledge and skill sets?

• Health in All Policies

An increasing demand for community health assessments will provide public health practitioners unparalleled opportunities to apply the Health in All Policies approach to partnership development. How can public health practitioners translate their understanding of the social determinants of health to policy engagement across disciplines and sectors?

• Social Media

As a force of change, the expanded use of social media and informatics will compress the time between exposure to illness and source identification, placing added demands for quick resolution (especially related to acute disease outbreaks) onto public health practitioners. How will public health practice drive the best use of such information, rather than be driven by it?

• Demographic Transitions

From 4.1% of the population in 1900, those 65 years and older constituted 13% of the US population in 2010, and by 2050 are projected to be 20.9% of the total US population. The nation will also, by that date, become a majority–minority population. When will public health practice—still predominately focused on infants, children, and young women—look like the population they serve?

• Globalized Travel

One word completely describes this as an increasingly powerful force of change: Ebola. How will public health practice inform and influence the right ethical balance between the rights of individuals and the good of the population?

Across all of these forces of change, the practice of public health will continue to be challenged to respond in a manner that speaks truth to power, that reflects the social justice roots of public health, and that remains committed to eliminating health inequities. What a privilege it will be to contribute to the dialogue about what this public health practice of the future will be.