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The public institutions we’ve long relied on are outmoded and ill equipped to solve today’s financial, demographic and structural challenges. At least, that’s how Americans of all ages have begun to feel. Some harken back to times when families and neighbors supported each other in times of need, and when service providers, policy makers and employers were more connected and responsive to local communities.

Yet, with nods to social progress and new tools to address modern challenges, many of us sense a transformation underway. Behind it all is a growing recognition that health, prosperity and social justice are not only connected, but are also built in communities.

In health care circles, conversation is heating up about the social determinants of health, community prevention and clinical-community connections.

A growing number of providers and payers recognize that only 20% of health outcomes are attributed to clinical care, and that prevention produces better and more equitable health outcomes at lower human and financial cost. They are shifting their focus from individual medicine and disease management to community prevention and population health.

I was recently involved in a powerful convening, hosted by the Blue Cross Blue Shield of North Carolina Foundation(BCBSNCF), to build the capacity of health clinics and other partners serving low-income people to improve health equity by supporting healthier community environments. Using the Prevention Institute’s Community Centered Health Home(CCHH) model as a focus, the event engaged 12 county-based partnerships in an intensive learning process.

We discussed prevention and healthy community change; clinical leadership and capacity; community assessment and prioritization; meaningful community engagement; and the role of community health workers. Clinics and their partners also assessed their readiness and identified gaps in capacity for becoming a CCHH.

I came away inspired, ready to work and asking a few questions about this potentially transformative period in the life of our health system:

• Should we expect our (mostly private) health care system and clinical providers to fund and support work that our (chronically underfunded) local health departments are better trained for? Are ideological beliefs about government driving this trend versus capacity, performance and accountability? Are social determinants of health like quality education, access to jobs, and a safe living environment no longer a public responsibility?

• How can we grow more active clinical champions for prevention given their time pressures? What kind of supports and systems do clinical organizations need to contribute their assets to healthy community change even as they are trying to address growing medical needs?

• Since social capital and direct engagement are so fundamental to health equity, behavior change and the effectiveness of community-based partnerships, how must structures and processes evolve to improve all the relationships needed to succeed in communities, partnerships and clinics? How can community health workers play a pivotal, expanded role?

• Given the time-consuming, collaborative nature of health equity work, who will fund the “backbone” functions needed to support healthy community-clinical partnerships? This includes the leadership and facilitation of partnerships, data collection and analysis, communication and outreach. Is philanthropy up to this task and capable of scaling it? What evidence will government and the private sector each need to fill financing gaps over time?

These are some of the questions we will be seeking to answer in the next several years as we innovate to improve the performance of our health system.  Hopefully, you’ll help us answer them so that all people can benefit from the quality communities, public institutions and health they deserve.