1. Building an Integrated Health Team and a Vision of Health Care Reform Marguerite Pappaioanou, DVM, MPVM, PhD Executive Director Association of American Veterinary Medical Colleges National Public Health Week University of Tennessee

2. The Spectrum of Health Care Prevention Public Health Treatment/Cure Medical Care/ Service Delivery

3. Health Care Costs - US Health spending nationally exceeded $2 trillion in 2006, representing 16% of the GDP. About half of spending growth due to medical price inflation -- the rising cost of providing existing services to patients. A far smaller portion is due to aging. Nearly one in five out-of-pocket dollars is spent on prescription drugs. CA Health Care Fndn

4. $3.6 trillion total for FY10

5. Global Map of Life Expectancy Source: Wikipedia

6. Health Outcomes Infant mortality rate for African-Americans is 2.5 times higher than for Whites Overall mortality is 30% higher for Black Americans compared to white Americans Life expectancy is 5 years shorter for African- Americans compared to white Americans African-American women > 2X as likely to die from cervical cancer as white women

7. Why Health Care Reform? Access to care varies by  Income  Insurance  Race/ethinicity  Location– urban vs rural Quality of care varies by race/ethnicity Costs of health care rising greater than the rate of inflation Emphasis continues to be on cure rather than prevention

8. Health Issues for our Nation Obesity – Nutrition, Physical Exercise  Heart and cardiovascular disease  Diabetes  Cancer Injuries Food safety – foodborne outbreaks Mental health Occupational safety Influenza, vaccine preventable diseases Disabilities Emerging zoonotic diseases Antibiotic resistance

9. HHS in the 21 st Century The Nation’s Top Health Challenges The rising prevalence of costly chronic diseases Developing prevention and treatment methods for diseases that currently lack them Persistent poverty (affecting > 37 million Americans,2007) Global threats to health (including pandemics, emerging infections, bioterrorism, natural disasters, and climate change Workforce shortages The crumbling public health infrastructure Social, environment, and behavioral factors affecting health Health disparities and the needs of vulnerable populations

10. PREVENTION BETTER THAN CURE

11. Public Health “ is what we, as a society, do collectively to assure the conditions in which people can be healthy.” Institute of Medicine, The Future of Public Health, 1988

12. Prevention Individual actions (diet, exercise, vaccinations, smoking cessation, screening, regular checkups, etc.) Population – based actions to maximize individual actions collectively!

13. Guide to Community Preventive Services Synthesis of evidence on the effectiveness of population based interventions  Mass media campaigns, laws, fluoride in drinking water, reminder notices for immunizations  Different exposures, outcomes, study designs Recommendations to state health departments on most effective interventions

14. Links Between Human and Animal Health and the Environment The Human-Animal Bond

15. Wildlife Domestic Animal Human Translocation Human encroachment Ex situ contact Ecological manipulation Human behaviors Global travel Urbanization Biomedical manipulation Food processing/distribution Technology and Industry Agricultural Extensive Production Encroachment Introduction “Spill over” & “Spill back” One Health One Medicine After Daszak P. et.al. Science 2000 287:443

16. Infectious Organisms Pathogenic to Humans and Percent Zoonotic 21753830765 2871415 Source, Taylor LH et al. 2001; Phil. Trans. R. Soc. Lond. B.Vol. 356:983-989 132

17. Links Between Human and Animal Health Improved Human Health & Well Being Foodborne Disease Emerging Diseases Bio- Agro- Terrorism Injuries Occupational Health Mental Health Environmental Health Antibiotic Resistance Emergency Response Disability

18. Our Food What people want  Quantity  Quality  Safety  Cost/Affordability Issues  Globalization  Intensification  Animal welfare  Animal husbandry, food system, feed  Use of antibiotics, antibiotic resistance

19. Human Diseases and Injuries with Serious Health Consequences Acquired from Dogs and Cats Dog bite injuries Cat scratch disease Toxocaral Larva Migrans Congenital toxoplasmosis

20. X X Focus of veterinarian’s attention

21. Veterinarians-- Opportunities for Prevention to Improve Human Health Food safety Vaccination programs (Rabies, Avian Influenza) Screening, counseling Counseling, health education by veterinarians  Obesity, diabetes, zoonotic diseases, injuries – dog bite injuries, falls Occupational safety Keeping companion animals healthy (mental health) Evacuation

22. Veterinarian’s on the Front Line Can Prevent This from Happening

23. Dog Bite Injuries Estimated 4.7 million bites per year 800,000 require medical care  446,000 non-emergency care visits  321,000 emergency room visits  13,000 hospitalizations  20 fatalities > $250 million per year

24. 86,000 falls each year associate with pets and pet toys Watch Out! Pet Falls Hurt 86K Per Year Government Advises Better Lighting, Throwing Pet Toys Away “Watch out for Fluffy and Fido! Cats and dogs are a factor in more than 86,000 serious falls each year, according to the first government study of pet-related tumbles.” KHOU.com; Source of data- CDC

25. One-Health “One Health is the collaborative effort of multiple disciplines – working locally, nationally, and globally – to attain optimal health for people, animals, and our environment.”

26. Putting One Health Into Action General Multidisciplinary practice, programs on the ground Educating, training students, practitioners of multiple disciplines, policymakers Developing one health policies Multi-disciplinary integrated research (e.g., NIH Clinical Translational Research Centers) Academic Settings Outreach, community service, policy Teaching Research

27. Rural Communities Health care providers scarce to non- existent People in close contact with livestock, poultry, companion animals Intersection of environmental, human, animal health

28. The Integrated Health Team Protecting and Promoting Health Physicians Physician assistants Nurses Dentists Optometrists Veterinarians Veterinary technicians Other

29. Public Health Workforce Nurses Physicians Veterinarians Dentists PhDs Public health advisors MPHs Sanitary Engineers Industrial Hygienists Environmental Specialists Epidemiologists Laboratory Scientists Social Workers Health Educators Statisticians Information Technology Specialists Entomologists Lawyers Other

30. U.S. Veterinarians in Public Health Private practitioners Local/County Health Departments State Health Departments Federal Government  DHHS: CDC, FDA, NIH  USDA: APHIS and FSIS  EPA  DoD Colleges of Veterinary Medicine, Medicine, Schools of Public Health Industry/Drug Companies (Human/Animal) NGOs

31. The Veterinary Oath “…. I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of livestock resources, the promotion of public health and the advancement of medical knowledge.”

32. Federation of Associations of Schools of the Health Professions Addresses education’s role in organizational matters of health care Encourages effective collaboration among the health professions in education and practice and Prepares health professionals for the future

33. FASHP Organizations Seek to support efforts that ensure coverage of and access to safe, high- quality, cost-effective preventive services and care for patients Congress must pay close attention to the professional health care workforce and role of education in providing the workforce Shortage of qualified health care professionals

34. FASHP Team-based, patient centered care, principles for health care reform-- Suggest reforms that will create a health care system that increases access to high-quality, cost-effective, patient centered care that is available to all A high quality health care system should emphasize wellness and preventive care Must have a well-educated and trained health professions workforce of all FASHP represented providers Investment must be made to expand faculty rosters to train health professionals of tomorrow Composition of the health care workforce should reflect the country’s population

35. Challenges to Achieving an Integrated Health Team Different numbers (2-3 M nurses, 800 K physicians, 80 k veterinarians) Different cultures, vocabulary, missions Understanding of educational pathways Respect and appreciation, attitudes Inequitable pay, benefits Protocols for communication, mechanisms

36. Training/Education Train health professionals together to aid in their understanding of  What each profession brings to the table  How to work together Household and community needs, dynamics, rural living, culture Develop and evaluate models (try this out!)

37. Summary There is a huge need for US health reform Prevention must be included in health reform and assigned a high priority The public will benefit from a one-health approach and a truly integrated health team with a full spectrum of health professionals Veterinary medicine is an important member of the health team Workforce shortages in numbers and in geographic location exist for most if not all health professions

38. A Strong Future for One Health Changing climates and ecosystems, with increasing vector populations Encroachment on animal habitat Changing human lifestyles with animals  Human behaviors Globalization of the food supply; threat of agro-terrorism More and faster global travel Civil unrest/war – displaced people and animals Microbial adaptation and change (Influenza!) >80% of bio-threat agents of concern are zoonotic Growing awareness of value and benefit to One Health by different health professions