d.health Exclusive Interview
Dr. Karen DeSalvo, Dell Medical School
SHARE THIS POST
Karen DeSalvo MD, MPH, MSc
At the Dell Medical School, Karen DeSalvo serves as a professor in the Division of Primary Care and Value-Based Health, with a primary appointment in the Department of Internal Medicine and secondary appointment in the Department of Population Health. She works on a range of projects that involve different parts of the medical school and that take advantage of the cutting-edge work happening on the University of Texas campus in the areas of community health, medical care and research related to the social determinants of health. She looks for ways to leverage technology and digital health in traditional public health programs and strategies — both to advance health beyond the traditional medical model and to address issues where people live, learn, work and play.
Dr. DeSalvo most recently served as Acting Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS). From 2014 to 2016 DeSalvo served as the National Coordinator for Health Information Technology, under President Obama. Dr. DeSalvo formerly served as New Orleans Health Commissioner. She was previously professor of medicine and vice dean for community affairs and health policy at the Tulane School of Medicine.
D.HEALTH: What new initiatives will you be working on at Dell Med?
DESALVO: I am thrilled to join the University of Texas at Austin Dell Medical School faculty. Austin is where I grew up and it has been a nice homecoming. The team at Dell Medical School includes an extraordinary set of visionary leaders whose aim is to transform the model of medical education and care delivery from one that is a sickness model to a wellness model. This means we need to build a business model, a data model, and a partnership model that encourages and rewards community health. It is a big shift from the current sickness model in healthcare. My work will be to support and enable the ongoing efforts with particular attention to our community-facing work and our partnerships with public health, business and technology.
D.HEALTH: What can be done to improve social determinants of health for aging adults?
DESALVO: The social determinants of health are important non-medical factors that account for 80% of our health outcomes. The evidence tells us that where we learn, work, live and play has a major impact on health; in aging adults, some areas outside of medicine become particularly important to health and health outcomes. For example, there has been a lot of attention to challenges around access to healthy food and food insecurity. Another growing problem is social isolation. Partnerships between health care, public health, and the food and nutrition sector—such as what health plans are doing with their members—show us that identifying and addressing food insecurity can not only improve self-reported healthy days, but also cost.
D.HEALTH: Writing in Health Affairs, you emphasized that “cross-sectoral collaboration is inherent to the Public Health 3.0 vision”. Can you give an example?
DESALVO: While I was at HHS, we produced a report called Public Health 3.0 that describes an innovative effort across the country to work in cross-sectoral ways to address all the determinants of health, including the social determinants. These Public Health 3.0 communities are bringing business, health care, social services and others to the table to set a vision and goal, share resources and data, and solve problems together. A great example is what Louisville has done to improve asthma control while addressing local air quality. Using “smart” inhalers to identify asthma hot spots throughout the city, public health partnered with local businesses to track location and frequency of use, informing targeted public health initiatives to prevent asthma attacks.
D.HEALTH: What would you mark as your greatest accomplishment in your former role as National Coordinator for Health IT? What do you see as the most promising innovations or technologies as they relate to solving data interoperability?
DESALVO: I’m most proud of two concepts that we launched when I was National Coordinator. One was to shift the focus of federal and national Health IT work from electronic health records and institutions to people. Doing so established the importance of having a longitudinal health record that serves as the foundation for understanding somebody’s health from birth to death. But the data is only good if it is available and actionable. The second effort was to require information systems to publish APIs or doorways to the data, so that it would not only be easy to aggregate and put to use, but also that it could be accessed with appropriate privacy and security. We are now seeing a schematic uptake in the use of these concepts and the use of APIs. Take for example that Apple has announced that it would pull all of a user’s health data onto their iPhone. This is a transformational change in control, use and availability of data that is allowing a lot of innovation in the marketplace and is going to shift the power structure to give consumers more control over their health information.
D.HEALTH: This year, the d.health Summit will be held in Boston, ranked #9 on the Milken Institute’s Best Cities for Successful Aging 2017 Report. What is needed to bring models that enable successful aging in cities like Boston to scale nationally?
DESALVO: Creating a strong foundation for health in a community translates to better health for everyone. When communities create the conditions in which everyone can be healthy, then everybody benefits. This is shown in work by researchers like Raj Chetty who help us understand that when you create stronger communities, life expectancy gaps narrow and everyone’s life expectancy improves. If we want to improve the health of aging populations we want to do things that improve the health of everybody. This will require us to address the broader context of people’s lives, like healthy food and transportation.