Ringside Seat

More than 25 years ago, Mary Ann Liebert and her team invited me to become the editor-in-chief of one of her scholarly journals entitled, at that time, Disease Management. At Jefferson Medical College during this same time, I was lucky enough to achieve tenure as the chairman of a new Department of Health Policy. Our world was evolving very quickly as healthcare costs continued to rise and there was a growing sense that care coordination and more attention to the health of the population would be needed to move American health care in the right direction. I gladly accepted the challenge and have never looked back! Now as I conclude my more than 25-year tenure as editor-in-chief of Population Health Management (PHM), I am honored to reflect on the remarkable evolution of our field and to share insights into its future trajectory.

Our readers are smart. I’m confident that they share my reflections about the advancements we have made in the last quarter century and the sad recognition that our public health infrastructure is so tenuous. This recognition of course came from the near collapse of this infrastructure during the COVID pandemic, especially in the 2020–2022 timeframe. We’ve also witnessed the integration of digital health technologies and emphasis on health equity and the recognition that global health security initiatives will be more critical than ever.

Similarly, we recognize that the value-based care tools used to implement improvements in the health of the population remain stalled. Unexplained clinical variation is still in my mind the root of all evil in our system and the lack of closure between physician performance and the need to improve outcomes is paramount. In addition, the economic incentives to reduce variation are too modest to seriously affect physician behavior.

As noted above, our Journal has evolved as well. Initially named Disease Management, and ultimately changed to Population Health Management. That was a good move as we remain the only scholarly peer-reviewed journal with Population Health in its title. This was the beginning of our leadership role in this field while concurrently, I became the inaugural Dean of America’s first College of Population Health. One could argue that through my deanship, this amazing journal and our annual national Population Health Colloquium (now in its 24th year), we have helped sculpt the field of Population Health.

I have some special memories as editor-in-chief. Of course, there’s the nearly daily responsibility of reviewing articles with two incredibly capable managing editors, Deborah Meiris and Virginia Hawkins. My relationship with these managing editors enabled us, as a team, to produce the journal on time with excellent content over such a long time span. Another special memory is our annual editorial board in-person dinner on the top floor of the beautiful Loews Hotel in Center City Philadelphia. As evening approached, we looked out on America’s founding city and had an opportunity to reflect collectively on our progress in the past year and the challenges as we saw that lay ahead.

I was especially proud of the role we played at the height of the pandemic, publishing our special issue in one of the quickest responses to COVID about appropriate laboratory testing, vaccination policy, and a deep recognition that structural racism was killing Americans. Our published roundtables and our special relationship with certain key companies like Quest Laboratories and others enabled us to present a balanced view, but we did “call it like we saw it” and noted that while America suffered over 1.5 million deaths, the rest of the developed world, with far fewer resources, saved many more of its citizens. This was a population health failure in America.

I also had the ringside seat to the evolution of America’s biggest business. I believe personally that value-based care is the way we implement the tenets of population health management. We have made modest progress here but I’m hoping that the Journal will continue to tackle how we might appropriately align economic incentives to drive evidence-based clinical behavior.

As we anticipate the future of population health, no doubt it will be driven in large part by advances in artificial intelligence and related technologies. I hope we’ll continue our focus on health equity and address health disparities head-on. The cultural rift between public health practitioners and more traditional clinicians sadly will continue. Medical schools, nursing schools, pharmacy schools, and certainly, our peer group Colleges of Population Health has an awful lot of work to do to build a curriculum whereby graduates of all health professional schools will have at least a rudimentary understanding of the SDOH, epidemiology, vaccination policy, and related topics. Despite incredible energy that we devoted in creating these linkages, I can declare that we have made modest success.

As editor-in-chief, I had a ringside seat in reading, studying, and evaluating the work of colleagues literally from around the world. It helped me better understand the complexity and challenges that we faced day-to-day. It was a real privilege to get insight from so many individuals, organizations, governments, and the special institutions devoted to improving health. It helped me personally to keep my own True North to focus on improving the health of populations.

I want to thank Mary Ann Leibert herself for the confidence she had in me a quarter of a century ago and her key team members, including Marianne Russell, Sophie Reisz, and Jamie Deveraux. Once again our annual in-person editorial board meetings were the highlight of my tenure. I wish the Mary Ann Liebert publishing team all the best following the sale of the eponymous publishing organization to Sage Publications in California. Special thanks also to Dr. Alexis Skoufalos, our longstanding Associate Dean at the College of Population Health for her unwavering support and, of course, to our second Dean, Dr. Billy Oglesby.

When you sit at the ringside, you see things others may not. That is the sweat, the tears, the agony of defeat, and the ecstasy of victory. I can confidently say that I have experienced all these emotions during my tenure. As I step down from this role, I’m supremely confident that our field of Population Health is very well-positioned to navigate the technological and economic trends buffeting our industry. The dedication and ingenuity of our community will undoubtedly continue to drive progress and hopefully actually improve health outcomes for our population.

It has been the privilege of a lifetime to make a sustained contribution to our field and to this Journal. I am looking forward with great interest to witnessing the continued advancement of population health and this wonderful collective intellectual exercise of peer review. I may not be seated at ringside, but I’ll be just a few rows back from the center of the action, looking with pride at those still in the ring.