By ADM Rachel L. Levine, Assistant Secretary for Health, U.S. Department of Health and Human Services
Last month I was honored to deliver the keynote address to the American Public Health Association 2023 Annual Meeting held in Atlanta, Georgia. I spoke about an important initiative that we are continuing to develop and the need to take the social determinants of health “to the next level.” To reach the broadest possible audience, I am sharing my remarks from that meeting. If you have thoughts that you would like to share, please send a note at Contact Us | health.gov.
Here are my remarks as prepared for delivery on Sunday, November 12, 2023…
Thank you, Dr. Benjamin. I am very pleased to be here.
I would like to invite you all to join me in sharing a commitment to thriving for all people and places in our nation. We have an historic opportunity to reposition our collective resources and expertise, and to move our focus beyond health protection and health recovery. We can collectively support all people, in every community, as they achieve and sustain well-being.
The COVID-19 pandemic disrupted health systems across the country and exacerbated long-standing inequities.
The convergence of disease with underlying vulnerabilities pushed us to develop a bold federal plan to achieve equitable long-term resilience. This plan explores how federal departments and agencies can maximize the impact of existing resources and existing authorities through unified action. It explores how we can strategically channel resources and authorities to support greater thriving for all people and places, with no exception.
The pandemic sparked what we are now advancing. We created an opportunity out of a crisis.
We must take the social determinants of health further and integrate approaches to strengthen conditions vital to improving individual and community resilience and well-being nationwide. The vital conditions for well-being and justice identify the factors that people depend on to reach their full potential.
The vital conditions framework identifies the core elements needed to create a thriving community rather than measures of productivity or descriptions of vulnerabilities or negative determinants in a community.
We are now describing what it takes to build equity and transformational resilience into federal mindsets, federal skill sets, and federal work systems.
We have not landed on a final name for this plan, but I could not wait to share this effort with A.P.H.A. So, right now, we are calling this the federal People & Places Thriving Initiative.
It will serve as a roadmap for how we care for the American people in all ways.
The methodology of this work asks us to make philosophical shifts in how we work and what we are trying to realize.
First, it is truly a whole-of-government approach. While I have served as the executive champion since stepping into my role as the Assistant Secretary for Health. This effort was co-created and is endorsed by more than 47 federal departments and agencies. The breadth of active interagency partnership is a testament that this work is clearly different from what has come before. It strikes a chord that resonates across a wide array of sectors. It is a testament to the value of building the right shared ethos, of building a structure that rewards proactivity and innovation, of building connections, and of aligning work across diverse federal agencies.
Further, and importantly for this audience, this is not only a public health and a health system initiative. This work recognizes that health is one vital condition for all communities but is not the axis around which everything revolves.
While we see many challenges within the frame of public health – from housing insecurity and lack of transportation to nutrition insecurity and environmental injustices to climate change and lack of contraception access – we actually cannot solve all needs within the existing public health framework. Instead, we must collectively understand our relationship to these needs and how our collective resources can help create enduring cross-system solutions.
Second, to address the root causes of inequities, it is critical that we expand and diversify the federal agencies and economic sectors working to realize a more equal society. The underlying framework of the People & Places Thriving Initiative is known as the Vital Conditions for Wellbeing and Justice. This framework provides a roadmap for realizing a broader and more inclusive approach. It provides an asset-focused and actionable organizing structure designed to yield complementary, synchronized cross-agency delivery of goods and services. It is built on the awareness that braided funding and other federal strategies can build resilience more intentionally.
The framework:
- Creates a big tent where many federal departments see a role for themselves;
- Supports clear action while providing a shared vision for thriving;
- Is asset-driven vs. vulnerability oriented;
- Focuses on systems investments rather than just demographics;
- Supports working as an integrated system; and
- Facilitates transparency and shared accessible language.
Third, the People & Places Thriving approach is focused on the long game. Specifically, it seeks to equitably address enhanced long-term resilience over the next decade and beyond. This deliberately differs from the more immediate focus on near-term recovery. Efforts toward near-term recovery are critical, but they are not sufficient to achieve improved, sustainable resilience for individuals and communities or meaningfully address deep inequities.
Finally, this work intentionally shifts our language to be transparent. It aligns with how communities understand their needs and prioritizes acknowledging shared assets. As leaders who are a part of our communities and who engage with our communities, we need to use community-driven language.
All of you are critical partners to help ensure the success of the work ahead. The primary focus of the Initiative is on actions that federal partners can take to better align and maximize their departmental and agency levers. However, it also provides shared concepts and language through which the federal government can better engage civil society. Through the framework of the vital conditions for well-being and justice, we can all understand the needs of communities and align the resources of the federal government to best meet those needs.
Many of you may be wondering, how is this work making a real difference across the complex and dynamic federal system?
First, we are working many federal efforts to cultivate community relationships driven by shared values, such as the U.S. Department of Transportation’s interagency effort on access and mobility.
Second, we are focusing on long-term investment approaches and positive outcomes that include thriving for people and places. We know that we cannot build a more thriving society simply by shifting to an urgent service model. We must invest in long-term resources and outcomes.
Third, there is more integrated funding and technical assistance support to communities through efforts like the HHS-led Food as Medicine Unified Federal Project and the National Endowment for the Arts-led Interagency Working Group on Arts, Health and Civic Infrastructure.
We are continuing to deepen our understanding of these complex concepts through analytic efforts, including the use of the vital conditions framework to guide the HHS Justice40 benefits effort.
There is incredible uptake and leadership across the country from state public health leaders, local unified governments and civil sector organizations. These stakeholders are focusing their resources to build long-term system capabilities that increase equitable thriving. A growing number of states, such as Delaware, are leading their state health improvement plans through the frame of the vital conditions and thriving ethos.
Many other states and communities, from West Virginia and California to Palm Beach County, Florida, and Fox Cities, Wisconsin, are investing in vital conditions solutions.
A number of organizations, such as the National Association of Community Health Centers and the Association of American Medical Colleges, are driving their vision for the future through the vital conditions ethos of the People & Places Thriving Initiative.
Several states and local communities are finding inspiration in the recommendations of the Initiative and taking action to realize the recommendations within their communities. This growing momentum is powerful. We are committed to supporting and partnering in that expansion, to align our work, and to share this ethos of thriving. This is a time to realize what it looks like to truly work as a unified system for greater well-being.
The People & Places Thriving Initiative gives me hope.
I hope that the complex and deeply rooted inequity that we see across communities can be clearly defined and addressed, so that we all can work together more effectively.
Despite the heavy toll it has exacted, COVID-19 and the challenges of the past 3 years remind us of a fundamental truth: that we need each other. That our happiness and our very survival depend on our connection to one another and our community.
That spirit of community is what we need now more than ever, and we must call upon it again. I believe we can and must build these connections and opportunities to realize health and well-being. We can do this in a manner that enables us to truly support equity in engagement, access, and outcomes and build a society in which all people and places thrive, with no exception.
We can do better, we must do better, and with your help, we will do better.
Thank you.
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