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Leading the Health System through Policy Development New Roles for Public Health.

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Presentation on theme: "Leading the Health System through Policy Development New Roles for Public Health."— Presentation transcript:

1 Leading the Health System through Policy Development New Roles for Public Health

2 The Ten Essential Public Health Services 1. Monitor health status 2. Diagnose and investigate health problems 3. Inform and educate 4. Mobilize communities to address health problems 5. Develop policies and plans 6. Enforce laws and regulations 7. Link people to needed health services 8. Assure a competent health services workforce 9. Evaluate health services 10. Conduct research for new innovations

3 Essential Services: A Different View

4 Inform, Educate, and Empower People About Health Issues l Initiatives using health education and communication sciences to: Build knowledge and shape attitudes Inform decision-making choice Develop skills and behaviors for healthy living l Health education and health promotion partnerships within the community to support healthy living l Media advocacy and social marketing

5 Mobilize Community Partnerships to Identify and Solve Health Problems l Constituency development and identification of system partners and stakeholders l Coalition development l Formal and informal partnerships to promote health improvement

6 Develop Policies and Plans That Support Individual and Community Health Efforts l Policy development to protect health and guide public health practice l Community and state planning l Alignment of resources to assure successful planning


8 Health Issues Have Moved to the Forefront of Public Attention l Unrelenting health care cost pressures l Large gaps in health care quality & safety l Persistent disparities in health outcomes l Rapidly growing obesity epidemic & related chronic diseases l Newly emerging infectious diseases l Concerns about public health infrastructure & preparedness for emerging threats

9 …Creating a Unique Window of Opportunity for Policy Change l Educating & informing elected officials l Mobilizing health professionals l Engaging businesses/employers l Building coalitions with community organizations l Empowering consumers to take action

10 Tuberculosis Whooping Cough Measles Death Rates 1860 – 1970 Deaths per 100,000

11 Focusing on disease prevention has led to major achievements Rate if trend continued Peak Rate Actual Rate Age-adjusted Death Rate per 100,000 Population Year Actual and Expected Death Rates for Coronary Heart Disease, 1950–1998 Marks JS. The burden of chronic disease and the future of public health. CDC Information Sharing Meeting. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion; 2003.

12 Source: Centers for Disease Control and Prevention. Health-related quality of life: prevalence data. National Center for Chronic Disease Prevention and Health Promotion, Accessed March 21 at. But the pictures look different when we examine summary measures of health (or affliction) 14% increase

13 Leading Causes of Death, Heart disease 2. Cerebrovascular disease 3. Cancer – lung, trachea 4. Lower respiratory infections 5. Chronic Obstructive Pulmonary Disease 6. Cancer – colon, rectum 7. Cancer – stomach 8. Traffic accidents 9. Self-inflicted injuries 10. Diabetes Developed Nations 1. Lower respiratory infections 2. Heart disease 3. Cerebrovascular disease 4. Diarrheal diseases 5. Perinatal conditions 6. Tuberculosis 7. Chronic Obstructive Pulmonary Disease 8. Measles 9. Malaria 10. Traffic accidents Developing Nations

14 Some important drivers of population health Globalization Changes in the environment A social and political environment that prioritizes health Disparities in health status and access to care Advances in biotechnology and information technology Infectious disease threats Including MAN- MADE ONES!!

15 Political Theory 101 Potential Solutions Window of Opportunity Policy Change Kingdon J.W. Agendas, Alternatives, and Public Policies (1984, 2003) Perceived Problems Political Dynamics

16 Our Challenge as Public Health Leaders l Lead policy change while the window remains open Identify promising policy solutions Engage stakeholders across the health system Promote evidence-based policy development

17 The Health System The full complement of individuals and institutions whose actions influence the publics health -Institute of Medicine


19 Safer, Healthier Population Becoming Vulnerable Becoming no longer vulnerable Vulnerable Population Becoming Affected Population with Disease Developing Complications Population with Complications Targeted protection Primary prevention Secondary prevention Dying from Complications Tertiary prevention Society's Health Response General protection Adverse Living Conditions Demand for response Public Health Medical Care Demand for response Other Sectors Source: Adapted from Bobby Milstein, CDC Syndemics Prevention Network Health System Dynamics that Influence the Publics Health

20 Spectrum of Action within the Health System SHORT months-years INTERMEDIATE years-decades LONG decades-centuries Time Horizon SECONDARY & TERTIARY Physiological Change Treatment Services Focus on Disease PRIMARY & SECONDARY Behavioral Change Focus on Risk Disease Prevention INTERGENERATIONAL Social Change Focus on Conditions Health Promotion Focus on Capacity for Action Capacity Building or Empowerment Policy & Infrastructure Change Policy Development

21 Decision-making: the Interface of Policy & Leadership l Decisions that determine the current and future structure and operation of the health system and its impact on the publics health l Decision-makers: government, health professionals, employers, industry, consumers communities

22 Examples of Traditional Public Health Policies l Seat belt laws l Indoor air regulations l Helmet laws l Immunization requirements l Product labeling l Others……..

23 What Policies and Policy-makers are Relevant to Public Health? l Legislative policy: local, state, and federal levels l Regulatory policy: government agencies l Professional policy: associations (AMA, APHA, NAIC) l Industry self-regulatory policy (AHA, NCQA, PhaRMA) l Institutional policy: individual orgs/coalitions Employers Community organizations Insurers Health departments Universities

24 What Are Our Policy Instruments? l Traditional instrument: regulatory authority l Exists for only a very narrow scope of activities l Must be backed by enforcement – costly & difficult l Effective only for specific purposes – not always for changing behavior of individuals/organizations Carrots vs. sticks Restricting choices vs. changing how decisions are made

25 What Policies and Policy-makers are Relevant to Public Health? l Many of the policies affecting the publics health lie outside the field of public health Education Land use Economic development Agriculture & food production Competition & trade law/regulation Labor/human resources

26 What Are Our Policy Instruments? l Non-traditional instruments increasingly important Financing: incentivize performance, reward results Data/information: inform consumers, providers, employers, insurers, communities Convening power: bring together stakeholders for voluntary policy change enforced by peer pressure Leading by example: institutional policy changes adopted by public health agencies, replicated by others

27 Policy Leadership in Arkansas Healthy Arkansas Initiative l Launched by Governor Huckabee in May 2004 l Focus on promoting healthy lifestyles Reduce tobacco use Increase physical activity Reduce obesity l Work across life stages through multiple channels Schools Workplaces Public programs (Medicaid) Community aging centers

28 Current Approaches in Arkansas Healthy Arkansas Initiative ADH must achieve the following goals by January 2007: l Increase from 64 percent to 85 percent the percentage of juveniles who are active at least three times a week for at least 20 minutes. l Increase from 15 percent to 30 percent the percentage of adults who exercise at least three times a week for at least 30 minutes. l Reduce the percentage of obese children from 11 percent to 5 percent. l Reduce the percentage of obese adults from 23 percent to 15 percent. l Reduce the percentage of adolescents who smoke from 36 percent to 16 percent. l Reduce the percentage of adults who smoke from 24 percent to 12 percent.

29 Policy Instruments in Healthy Arkansas l Financing: create financial incentives in the state employee health plan to quit smoking, improve BMI l Information: market effective worksite health promotion strategies to employers l Convene: leading employers to agree on wellness coverage l Lead by example: Adopt worksite wellness at ADH and document, disseminate results

30 Current Approaches in Arkansas Act 1220 Child Obesity Initiative l Passed by the state legislature in 2003 l Annual BMI assessments for all public school children (450,000 kids) l Annual feedback reporting to families, schools, and districts l Changes in school policy to improve nutrition, increase physical activity

31 Policy Instruments in Act 1220 l Information: Customized reports provide feedback to families on BMI risks and advice on risk reduction l Convening power: bring together schools, providers, community organizations to design and implement broad-based prevention strategies l Leading by example: Facilitate pilot projects that allow schools to test policy changes (e.g. vending machines) and disseminate results to others

32 Current Approaches in Arkansas UAMS Smoke Free Campus Initiative l First medical center in AR to go completely smoke free, including outdoor areas l Implemented in July 2004 l Counseling and cessation support for employees, students and patients

33 Policy Instruments in Smoke Free Campus Initiative l Financing: enhanced coverage for cessation counseling and aides l Leading by Example: Promotion of UAMS policies designed to encourage other hospitals and work sites to follow suit

34 Policy Instruments in National Public Health Infrastructure l Agency Accreditation linked to incentives l Agency Accreditation as a condition of participation l Certification of Public Health Officers l Licensure of Public Health Officials l Registratoin of public health units

35 The Essential Role of Policy Research l Effective policy development ultimately must be based on evidence l Critical need to expand the evidence base on effective public health policy l Take every opportunity to evaluate new policies and measure their impact!!

36 The Essential Role of Policy Research The Committee had hoped to provide specific guidance elaborating on the types and levels of workforce, infrastructure, related resources, and financial investments necessary to ensure the availability of essential public health services to all of the nations communities. However, such evidence is limited, and there is no agenda or support for this type of research, despite the critical need for such data to promote and protect the nations health. Institute of Medicine, 2003

37 The Future for Public Health Policy Development l Evidence-based policy decision-making is the goal l Policy innovation and creativity is critical, but must be coupled with policy evaluation Learn what works where Disseminate, replicate, adapt l Capitalize on the open window for policy change…while it lasts

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