Accelerating a learning public health system: Opportunities, obstacles, and a call to action

Abstract

Introduction: Public health systems worldwide face increasing challenges in addressing complex health issues and improving population health outcomes. This experience report introduces the concept of a Learning Public Health System (LPHS) as a potential solution to transform public health practice. Building upon the framework of a Learning Health System (LHS) in healthcare, the LPHS aims to create a dynamic, data-driven ecosystem that continuously improves public health interventions and policies. This report explores the definition, benefits, challenges, and implementation strategies of an LPHS, highlighting its potential to revolutionize public health practice.

Methods: This report employs a comparative analysis approach, examining the similarities and differences between an LPHS and an LHS. It also identifies and elaborates on the potential benefits, challenges, and barriers to implementing an LPHS. Additionally, the study investigates promising national initiatives that exemplify elements of an LPHS in action.

Results: An LPHS integrates data from diverse sources to inform knowledge generation, policy development, and operational improvements. Key benefits of implementing an LPHS include improved disease prevention, evidence-informed policy-making, and enhanced health outcomes. However, several challenges were identified, such as interoperability issues, governance concerns, funding limitations, and cultural factors that may impede the widespread adoption of an LPHS.

Conclusions: Implementation of an LPHS has the potential to significantly transform public health practice. To realize this potential, a call to action is issued for stakeholders across the public health ecosystem. Recommendations include investing in informatics infrastructure, prioritizing workforce development, establishing robust data governance frameworks, and creating incentives to support the development and implementation of a LPHS. By addressing these key areas, public health systems can evolve to become more responsive, efficient, and effective in improving population health outcomes.

Keywords: learning health system; learning public health system; public health.

FIGURE 1

A simplified version of the LHS cycle of data from patient encounters generating medical knowledge and improved care. Adapted from Reference [2] and an unpublished figure shared by Dr. Chris Chute.

FIGURE 2

An overview of an LPHS of today. (A). Public health encounters take place in many different locations and contexts. (B). Data are stored in siloed databases without a common identifier for each person. (C). Laws and regulations, or in some cases the cautious interpretation of unclear regulations, make it challenging to aggregate and use data. (D). The outer loop represents generalizable knowledge that may be broadly applied. (E). The inner loop depicts a local, operational learning cycle. (F). In addition to evidence and knowledge, politics plays a part in the development of public health policies and guidelines. (G). Today's LPHS generally lacks the decision support component that exists in clinical care.

FIGURE 3

Consolidated vision for a future LPHS. Instead of only public health encounters, encounter types are aggregated for a given individual and stored in a health data utility (HDU) under proper governance. In addition to traditional clinical or public health guidelines, this enables more complex analysis and resulting policies that account for many different facets of a person's experience. Both operational knowledge and generalizable knowledge are used to inform practice.