title: Macro Trends and the Future of Public Health Practice.
abstract: Public health practice in the twenty-first century is in a state of significant flux. Several macro trends are impacting the current practice of governmental public health and will likely have effects for many years to come. These macro trends are described as forces of change, which are changes that affect the context in which the community and its public health system operate. This article focuses on seven such forces of change: the Patient Protection and Affordable Care Act, public health agency accreditation, climate change, health in all policies, social media and informatics, demographic transitions, and globalized travel. Following the description of each of these, this article then turns to possible approaches to measuring, tracking, and understanding the impact of these forces of change on public health practice, including the use of evidence-based public health, practice-based research, and policy surveillance.
authors.affiliation: Department of Public Health, University of Tennessee, Knoxville, Tennessee 37996; email: perwin@utk.edu.
authors.forename: Paul Campbell
authors.initials: PC
authors.lastname: Erwin
authors.affiliation: Prevention Research Center in St. Louis, Brown School; and Division of Public Health Sciences and Alvin J. Siteman Cancer Center, School of Medicine, Washington University in St. Louis, St. Louis, Missouri 63130-4838; email: rbrownson@wustl.edu.
authors.forename: Ross C
authors.initials: RC
authors.lastname: Brownson
mesh_terms: D057231:Climate Change; D005544:Forecasting; D006801:Humans; D058991:Patient Protection and Affordable Care Act; D011634:Public Health; D015980:Public Health Practice; D014481:United States
keywords: Affordable Care Act; accreditation; climate change; demographic transitions; evidence-based public health; forces of change; globalized travel; health in all policies; policy surveillance; practice-based research; social media