Building a culture of health: challenges for the public health workforce.

Health and health care have reached a pivotal point in the U.S. For generations, Americans’ health has been unequally influenced by income, education, ethnicity, and where people live. Healthcare systems have operated largely apart from each other and from community life. The definition of health has been “not needing to seek health care,” rather than the broader public health view that all aspects of our lives—in our work, families, and communities—should support active and healthy living. Today, however, the world is changing and the education, training, and practice strategies of the public health workforce must adapt to these changes. This requires new skills and perspectives, some of which are presented in papers in this special issue. A growing number of communities, regions, and states are working to redefine what it means to get and stay healthy by addressing social and physical spaces and conditions in which people live, learn, work, and play—the social, environmental, and economic determinants of health. Demographics are shifting, especially in terms of the U.S. population’s age, ethnic diversity, and education levels. Workforce constraints and financial pressures, along with the requirements of federal healthcare reform, are changing who has access to care, how care is paid for and delivered, and how patients and providers interact. Coordinated efforts to promote wellness and prevent disease are proliferating among a diverse set of stakeholders, including organizations that are traditionally “non-health” focused. Providers of personal health services are connecting with their public health colleagues and multiple levels, and “big data”—large, varied data sets that are available in real or almost-real time—make it possible to analyze health patterns in unprecedented ways to gain a clearer picture of the actionable determinants, trends, and outcomes of societal health and well-being. These developments in health and society present a window of opportunity for real societal transformation and an imperative for public health professionals to