Jeffrey P. Brosco, M.D., Ph.D., professor and associate director of the Mailman Center for Child Development in the Department of Pediatrics at the University of Miami Miller School of Medicine, has been appointed the department’s inaugural associate chair of population health.
The appointment reflects the vision of Miller School chair of Pediatrics Glenn Flores, M.D., FAAP, who sees population health as the future of pediatrics.
“Children’s health is determined by the well-being of their families, their neighborhoods and schools, and their access to doctors and other health professionals,” said Dr. Flores, who also is senior associate dean of child health, professor of pediatrics and public health sciences, and George E. Batchelor Endowed Chair in Child Health at the Miller School. “The associate chair of population health will bring attention to public policy and health care system changes that have the potential to improve the health of all children.”
While many universities and health care systems are moving toward a population health management approach that aims to improve outcomes by focusing on patients seen within the health care system, the Miller School is taking the concept a step further, according to Dr. Brosco.
“With the leadership of Dr. Flores, we are looking at population health at large, which pushes us to think about the impact of homes and neighborhoods, schools, communities, and more on children’s health,” Dr. Brosco said. “It is a well-known principle that what happens in life outside the hospital probably matters most for children’s and adults’ health.”
The second principle guiding the Miller School’s population health initiative is that adult health begins in childhood.
“For example, if a mom lives under a lot of stress while she is pregnant, her child is born at low birth weight, and that child is exposed to environmental stresses when young, the chances of having a heart attack, stroke, or cancer later in life go up dramatically,” said Dr. Brosco.
“If you look at the top ten causes of death for adults in the U.S., they are all clearly related to exposure to adverse childhood events. So, although this is an initiative in the Department of Pediatrics, it has wide-ranging, long-term effects for adults and everything we do in the Miller School.”
The third principle of the initiative is an embrace of the trend toward value-based care.
“Tying reimbursement for health care professionals to patient outcomes allows us to focus on prevention and health promotion and do the things that most of us went into the health professions for in the first place,” Dr. Brosco said.
These principles pave the way for creating, advocating for, and implementing changes aimed at improving children’s health in the community, state, and nation.
A specific area of need in Florida, for example, is in children’s mental health. Only half of the approximately 400,000 children in the state who have a developmental behavioral disorder such as ADHD, anxiety, depression or autism, are receiving treatment for their mental health condition, according to Dr. Brosco.
“Think about that: About 200,000 children with reported developmental/behavioral disorders are not getting treatment,” Dr. Brosco said. “And it’s not just Florida. This is true in just about every state.”
A population health approach considers the fundamental influences on a person’s health and well-being, Dr. Brosco explained. These factors range from financially helping families living in poverty to adding green space to neighborhoods and establishing college funds in high-risk neighborhoods – all evidence-based ways to improve children’s mental health.
“A population-health approach looks at everything that can improve the situation and help prevent disease, if possible,” Dr. Brosco said.
In the newly designated position, Dr. Brosco will work on legislation at the federal, state, and county levels to improve children’s health and well-being.
“Our work also encompasses the system and institutional levels,” he said. “At the Miller School, we screen for social determinants of health at each of our medical encounters. These screenings could be linked seamlessly to computer-generated information about where a local family might find housing, food and security support, job training – whatever may be needed.”
A practicing pediatrician, Dr. Brosco is associate director of the Mailman Center for Child Development, director of population health ethics in the Institute for Bioethics and Health Policy, and chair of the Pediatric Bioethics Committee at Holtz Children’s Hospital in the Jackson Health System.
He is also a historian who has gone to great lengths to advocate for and improve children’s health.
“For more than two decades, Dr. Brosco has held a series of leadership positions for the Florida Department of Health’s Children’s Medical Services, which seeks to improve the health of children with special health care needs,” Dr. Flores said. “From 2017 to 2019, he was Florida’s Deputy Secretary of Health for Children’s Medical Services and is currently the state’s Title V Director for Children and Youth with Special Health Care Needs.”
On a national level, Dr. Brosco participates in groups such as the Advisory Committee on Heritable Disorders in Newborns and Children and the National Workgroup on Standards for Systems of Care for Children and Youth with Special Health Care Needs. In 2019 he was awarded a federal Maternal and Child Health Bureau Director’s Award for noteworthy national level contributions to the health of infants, mothers, children, adolescents, and children with special health care needs.