Public Health 3.0 is changing how we design for well-being

Olivia, a 23-year-old resident of suburban Kansas City, visits her local public health clinic for a prenatal exam and immunization update. When her nurse observes that she is underweight, Olivia says she can’t always afford groceries and is feeling depressed and anxious. These issues are beyond the nurse’s expertise, so she walks Olivia to the mental health clinic and helps her get an intake assessment with a licensed mental health clinician. She also asks a case manager to help Olivia sign up for food assistance.

Thomas is a 72-year-old recent widower who is deeply saddened by his wife’s death. He visits the health services building to talk with a psychologist, and he mentions during their conversation that he’s having difficulties with Medicaid enrollment. The psychologist introduces him to a case manager who explains his Medicaid benefits and, when Thomas says he’s struggling to cook for himself, signs him up for free meals through the Aging and Human Services program.

James is a 56-year-old veteran who was diagnosed with PTSD following his military service in Desert Storm. News coverage of a mass shooting last weekend induced flashbacks and nightmares, and he went to a bar and relapsed after being alcohol-free for 10 years. His wife has brought him to the counseling center for help. She expresses concern that James has also started taking narcotics, so the counselor refers him to the on-site drug treatment program for a same-day consultation.

While the stories of Olivia, Thomas, and James are fictional, they accurately depict the complex needs of everyday real people who need public health and mental health services in the U.S. Their personas, based on real case studies, are helping design the Johnson County health services building in Olathe, Kansas. Once complete, it will allow staff to take a more holistic approach to patient care known as Public Health 3.0, which addresses a patient’s broader social, environmental, and economic conditions.

“My career started during what could be called Public Health 2.0,” says Charlie Hunt, director of the Johnson County Department of Health and Environment. “We dealt with health education and clinical care, not topics like housing or financial stability. Our work has broadened to focus on Public Health 3.0, which is about working collaboratively and connecting our clients to partners who can help them with lots of factors that impact physical health.”

Public health efforts in the U.S. began with smallpox quarantines and inoculations in colonial times. Following a 1988 report from the Institute of Medicine, the concept of public health expanded in the ‘90s but was still centered on physical health determinants like sanitation, nutrition, and epidemiology. The federal Department of Health and Human Services launched the Public Health 3.0 initiative in 2016 and published recommendations and key findings from extensive listening sessions the following year.

Addressing complex and interconnected health determinants like air quality, water quality, environmental toxins, crime, poverty, substance use and misuse, occupational hazards, teen pregnancy, housing insecurity, food insecurity, unemployment, domestic abuse, and truancy is a challenge. Ideally, staff could easily collaborate across disciplines to coordinate care plans and interventions, but mental health and public health are usually housed in separate facilities, sometimes on opposite sides of a city or county. That’s why Johnson County’s new building will take the bold step of co-locating public health and mental health providers, including crisis services for mental health and mental health case managers. Shared spaces promote interaction among staff and support operational policies that encourage them to seek assistance from practitioners in other fields to provide comprehensive care. Confronting the mental health crisis is particularly urgent in Kansas, which currently ranks 22nd overall in the U.S. and Puerto Rico due to its high prevalence of mental illness and low care access rates.

Centrally located resources like pharmacy and lab services, meeting rooms, and public education spaces help ensure that clients receive holistic support that addresses their physical, mental, and emotional needs. Throughout the building, designers are creating an environment that helps vulnerable clients feel safe, respected, and empowered. This patient-centered, trauma-informed approach is a crucial part of addressing the complex needs of vulnerable populations and fostering a sense of safety and trust. Specifically, trauma-informed design practices provide ample natural light, soothing colors, and a layout that ensures clear sightlines and easy navigation into and out of the building.

Johnson County’s design and operational responses to the Public Health 3.0 framework represent a groundbreaking approach to integrating mental health and public health services. The examples of Olivia, Thomas, and James show that tackling today’s complex health determinants requires staff and spaces that work together to treat the whole patient, and the approach serves as a model for other communities.