An integrative model to incorporate public health in the national health reform dialogue: Margins of opportunity

U.S. health reform policy discussions have routinely focused on expanding access to health care, containing costs, financing the system and delivering quality care. Within the Public Health community, much of this conversation is perceived to be occurring without a full consideration of the value of Public Health. The objective of this research project was to identify opportunities and establish a framework for Public Health to become part of the health reform debate. Literature and document reviews, focus groups, and key informant interviews were conducted in Phase I to identify strategic health improvement priority areas and locate the priorities common to both the Public Health and non public health sectors. In Phase II, stakeholders were convened to discuss how to integrate health improvement priorities into health transformation at the local, state, and national levels. Stakeholders returned to their respective constituents to discuss specific strategies and policies, then reconvened to share and integrate what was learned. Over 500 individuals representing academic, government, business, philanthropic and broader health policy sectors participated. A model was developed to define and visualize three levels of reform efforts. In the model, health care service delivery and financing is located within more comprehensive levels of reform for community-based strategies and health in all policies. The margins between each level of reform offer the greatest opportunities for progress in advancing the dialogue. By broadening the health reform conversation to include the these additional levels, an intersectoral process emerged to engage stakeholders at every level as instruments of reform.