1. Health Policy Primer (a.k.a. physician activism basics) Department of Internal Medicine Morning Report 19 March 2007 Ryan Buchholz, MD

2. “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe

3. Aims Convince you that health policy is doctors’ business* *…and that health policy is particularly important for the poor Provide you with a few resources and contacts Strike a chord within you

4. Non-Aims A partisan political discourse An excuse for a nap

5. Introduction Health policy, broadly construed −Macro-level: Global health National / federal policy State / regional policy −Micro-level: Your community Your institution or practice Proximal Distal

6. Introduction, continued Have you ever… Signed a petition? Sent a letter to a politician? Visited a politician’s office? Attended a city council meeting? Participated in quality improvement efforts? Voted? Volunteered for a campaign? Read the newspaper? Are you a member of ACP, AAP, AMA, SGIM?

7. Agenda My journey from apathy to advocacy (i.e., health policy is doctors’ business) ~ 5 minutes Case discussion ~ 5 minutes Q+A/Resources: Health policy opportunities ~ 10 minutes

8. My journey Childhood: Apathy + Cynicism “Student government doesn’t matter” Politicians are selfish Sports are cooler anyways Michael Chang Brian McBride Dana Carvey

9. My journey: influences University: Apathy  Service Drew Hansen “Social Justice” later wrote

10. My journey: influences University: “Poverty, Culture, and Infectious Disease” Paul Farmer “Large-scale social forces…” Subject of > MD = natural attorney for the poor

11. My journey: influences Post-University: Fighting Hunger Tony Hall “You’re my eyes and ears in the field…” Author of + Dan Glickman Founder of

12. Case presentation Jorge C, a 45 year-old man with −uncontrolled diabetes mellitus x 20 years, −morbid obesity, and −h/o recently broken tibia presents to your office for hospital F/U after a near below-knee amputation, asking how he can lose weight and control his diabetes.

13. Case presentation, continued SOCHx: former truck driver (now blind), immigrated from Cuba at age 16, married and LW wife (IHOP waitress) and children PMHx: diabetic retinopathy  legally blind; near-BKA after fractured tibia ROS: gaining weight, can’t see, polydipsia/polyuria/polyphagia PE: consistent with history as described

14. Case presentation, continued Assessment / plan? 1.DM, uncontrolled & complications 2.Morbid obesity 3.Poverty 1.OHA/insulin + diet + exercise, labs 2.Eat healthy 3.Refer to Farm Share

15. Farm Share Jorge C + = Learned to eat healthy Lost 150 lbs. Glycemic control Volunteering New lease on life “Farm Share saved my life.” — Jorge C.

16. Resources and Opportunities

17. Resources People all around you! −Jane Henney, MD: VP of UC Academic Health Center and former FDA Commissioner (jane.henney@uc.edu) −Robert Graham, MD: UCFP Professor and former Ass’t Surgeon General (grahamj3@fammed.uc.edu) −Stephen Wilson, MD: UC Internist and Pediatrician, Cincinnati Board of Health (wilsse@ucmail.uc.edu) −Melissa Saladonis, CCHMC Director of Government Affairs (melissa.saladonis@cchmc.org) −Sarah Corathers, MD: Chair (ex officio), AAP Resident Section (sarah.corathers@uc.edu)

18. Opportunities Conferences and Seminars Health Foundation of Greater Cincinnati seminarsHealth Foundation of Greater Cincinnati −Strategic planning: Jul. 12, Nov. 15 −Working with the media: Mar. 8, Sep. 10 −How a piece of paper can catch a policymaker’s eye: Oct. 5

19. Opportunities: 2 Conferences and Seminars −Center for Closing the Health Gap: April 13 and 14, 2007 – David Satcher will keynote! −April 19-21, 2007: Internal Medicine 2007 −June 3-5, 2007: AAP Annual Legislative Conference in Washington, DC −October 11-12, 2007: Ohio ACP in Columbus

20. Opportunities: 3 Online petitions Health Care for all Children The One Campaign Vote Congressional elections Ohio legislature elections Local elections Get out Cover the Uninsured Week 2007: April 23-29Cover the Uninsured

21. Opportunities: 4 Books: −White Coat, Clenched Fist (Mullan) −Pathologies of Power (Farmer) −Mountains Beyond Mountains (Kidder)

22. Opportunities: 4 Books: −White Coat, Clenched Fist (Mullan) −Pathologies of Power (Farmer) −Mountains Beyond Mountains (Kidder) Articles: −This past week’s JAMA Porter and Teisberg. JAMA 2007;297:1103-11.

23. Opportunities: 5 Rotations −Initiative on Poverty, Justice, and Health: September, February, and April 2007-8 −Advanced Healthcare Improvement: Spring 2008 −Cambridge, the Amazon, southern Africa: do an elective abroad, or “on the rez”

24. Summary Primer on health policy: doctors’ business Resources and opportunities: strike a chord?

25. “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe

26. Special Thanks Christine + Jonathan Buchholz Caroline Mueller Brian Volck Tiffiny Diers Carl Fichtenbaum Stephen Wilson Mia Mallory Melissa Saladonis

27. Questions? Comments? ryan.buchholz@uc.edu or ryan.buchholz@cchmc.org Blog: healthequity.wordpress.com

28. Health Indicators WHO, World Health Statistics 2005. U.S.: #43U.S.: #29

29. Health Expenditures U.S.: #1 OECD Indicators 2005

30. A world distorted by AIDS… Dorling D. PLoS Medicine 2007;4(1)13-8. People Living with HIV, UNDP 2004

31. …is distorted by social structures Dorling D. PLoS Medicine 2007;4(1)13-8. Physicians Working, WHO 2004