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The healthcare delivery system is evolving. As described in Chapter 1, its historical simplification of being “a workshop for the physician” is no longer relevant; now it has “the complexity of a living organism.” To take the analogy further, the healthcare delivery system, like most living organisms, is not the only creature in the community. Its borders can abut or meld with other evolving systems, and its intended outputs will be influenced by what’s happening in the surrounding environment. Healthcare delivery systems research, therefore, cannot be conducted without an understanding of the influences outside its formal operations. Furthermore, that which is outside the formal healthcare delivery system can be a key asset to the study of healthcare delivery science itself. To tap into this added value and analytic insight most effectively, partnering with community, professional, and policy organizations becomes paramount.

This chapter will first set the stage for this discussion, describing what produces health and the context within which the healthcare delivery system itself resides. It will identify other institutions and organizations relevant to the goal of improved health and outline reasons why developing partnerships with relevant players outside of the healthcare delivery system should be of interest to healthcare delivery science through case examples. It will pay particular attention to public health departments because they are a common entity across all communities, and because they have unique standing with respect to mission, resources, and data. Finally, it will provide practical guidance for successful partnering with those outside the healthcare delivery system.


Health is the product of a lifelong interplay between individuals and their environments. Often underappreciated is that healthcare itself is a relatively small contributor to overall population health.1,2 While individual-level conditions, such as genetic mutations, cardiovascular risk factors, or diseases, are often the target of medical interventions, a host of nonclinical, social, and economic factors are influencing health concurrently. These factors include those commonly referred to as the “social determinants of health,” such as housing, education, income, discrimination, and safety.3 They shape the conditions of places where we live, learn, work, play, and worship, molding the health of individuals, communities, and populations across the life course.4 (See Figure 10-1.5)

Figure 10-1

Socioecological model, a multilevel approach to epidemiology described by Kaplan et al. (Used with permission from Kaplan GA, Everson SA, Lynch JW (2000).5)

These factors, their quality, and their distribution across populations may enhance or impede health and contribute to inequities in health outcomes commonly documented today. For example, parks that are perceived to be unsafe are less likely to be used for physical activity by those who live in the community6; poorly maintained housing affected by mold, dust mites, or cockroaches can exacerbate asthma7...

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