A. Eugene Washington, chancellor for health affairs and the president and chief executive officer of the Duke University Health System, spoke at the Duke Global Health Institute (DGHI) faculty meeting on Friday, December 11. He offered a preview of a key feature that promises to be part of the health system’s forthcoming strategic plan: population health improvement.
Washington has engaged in a broad and deep conversation with Duke constituents and external stakeholders as part of the seven-month strategic planning process. Duke’s ability to serve as a convener and an instigator in improving the health of the local population was one of the more powerful ideas to emerge from the process, according to Washington.
“In partnership with others in this region, we can measurably improve health,” he said.
Effective Health Care Requires Holistic Approach
Washington describes the evolution of health care from individual patient care, to population health management within the purview of a health system, to population health improvement. Population health improvement, he said, is incorporating much more than the care an individual might receive in a clinic or hospital. Population health improvement takes into account a wide range of social and environmental determinants of health and seeks to impact health much further “upstream” from the clinic or hospital.
The need for health care, says Washington, is not what is driving the equation. “We need to work with various sectors in our community—government, non-profits and private industry—to get at factors like the physical environment as well as social and environmental factors that impact health.”
Duke Well-Positioned as Public Health Focus Evolves
The notion of population health improvement comes as the practice of public health is in transition. Once a function of preventing communicable diseases, public health now finds itself facing the challenge of non-communicable diseases such as diabetes, heart disease and cancer.
This evolution shifts what had been the traditional purview of public health to health systems like Duke. Thus, Washington says, new approaches and new leadership are needed. He believes academic health systems like Duke are well positioned to forge new ways of thinking about disease and health and bring the right community partners to the table.
“We’re talking about a fundamentally different role for Duke—one that we haven’t played before,” says Washington.
Washington’s Approach Dovetails with DGHI’s Work
Washington’s focus on population health aligns closely with the majority of research taking place among DGHI faculty and students. “The field of population health plays a prominent role at DGHI, where as much as three-quarters of our faculty’s research—whether local or global—is population-based,” said Michael Merson, DGHI director.
“I think this paradigm shift is exciting and transformative for Duke and the communities Duke serves,” said Wendy Prudhomme-O’Meara, associate professor of medicine and global health, who is based full-time in Kenya. “This approach resonates with me because it’s the way we already think about health in Kenya—we aim to prioritize health promotion, remove social and economic barriers, and empower communities to take charge of their own health.” This community-facing approach to health, she says, was born out of necessity in resource-constrained settings such as Kenya.
We’re talking about a fundamentally different role for Duke—one that we haven’t played before.A. Eugene Washington, chancellor for health affairs and the president and CEO of the Duke University Health System