“Iron Triangle of Health Policy” - PowerPoint

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					 Hawaii Health Insurance Status
     1,101,000 covered (90%)
     123,000 uninsured over 1yr. (10%)
       (despite employer mandate)

Source: US Census, 2002
Eliminating Health Disparities
    Eliminating  disparities in health by race,
     ethnicity, gender, sexual orientation,
     geography or socioeconomic status
    Systemic changes needed
Social Determinants of Health
                       Jobs
                       Housing
                       Education
                       Equal Opportunities
                       Access to Health Care
                       The mission of government
National Public Health Week
    April 5-11, 2004
    Eliminating Health Disparities, From
     Statistics to Solutions
IOM: Community
   Support community    led needs assessments,
    service programs with support and TA
   Support community long range public
    health plans and institutionalizing change
  Disparity Solution Examples, Hawaii
   Hele Mai Ai - Diabetes Nutrition Project
   Big Bend Diabetes Education Program - Perry
   Childhood Rural Asthma Project - Waianae
   Kauai Developmental Disability Council
   Hansen’s Disease Immigrant Outreach
   Aire Fresco - tobacco cessation Maui Hispanics
   Community mapping: Tobacco in Native
   North Hawaii Outcomes Project - Kamuela

Source: APHA Database
Honolulu has highest percentage of
Asian American Health
   Health  beliefs & Physical Activity in Elderly
   Cultural acceptance of API schizophrenic adolescent
   Pacific Diabetes Today- Kauai
   Early Access Project - new immigrant intro to PH

Source: APHA Database
 For FY 2005
 What We Need vs. What We Will Get
 APHA What We Need                   HHSWhat is Proposed
 OMH - Any Increase                  OMH - Cut $8 million
   – Focus on racial/ethnic issues     – 15% cut
 Closing  the Health Care
  Gap bill (S.2091)
 Healthcare Equality and
  Accountability Act (S.1833)
Public Health Infrastructure
    The  workforce, buildings, equipment,
     laboratory, surveillance systems and
     organizational structure needed to protect
     the public and promote health
Public Health Infrastructure
Public Health Preparedness Pyramid
  State Assessment of PH Readiness

Dec 2003
 Hawaii Use of Bioterrorism Funds
 Accomplished                       Still   To Do
  – Increase State spending on PH      – Spent 90% federal $
  – Has bioterrorism plan              – Gave >50% to LHD
                                       – Can distribute strategic
  – > 3 counties with emergency
                                         pharmacy stockpile
    alert capability
                                       – Has Biosafety 3 Lab
  – State SARS plan
                                       – More BT labs for a PH
                                       – Pandemic flu plan
Public Health Workforce, 2000
  Hawaii PH Workforce, 2000

Source: The Public Health Workforce, Enumeration 2000, HRSA
IOM: Government Public Health
  Review  state public health laws in context
   of emergency health powers
  Train the public health workforce
  Communication is key - languages and
  National health information infrastructure
  Assess state health dept. funding and TA
  Assess state lab capability and funding
IOM: Government Public Health
  Federal, state, local sustainable investment in public
   health infrastructure
  Combine or cluster categorical grants
  Assess the accreditation of public health agencies
  Evidence based public and preventive health research
  Federal govt. agencies need clear lines of authority
  State health officers and DHHS Annual Meeting
IOM: Businesses and Employers
  Create plans for making insurance affordable for
   small businesses
  Corporations work with PH agencies to set health
   goals for employees and community
  Collect useful public health data
  Enhance communication/marketing of health
   promotion and disease prevention
  Give an award to business leaders who invest in
   community health
IOM: Media
  Ongoing  dialogue with journalists and public health
   agencies, including training in public health
  Television should donate more PSAs
  Media should communicate accurate facts
  Research influence of media on changing behavior
IOM: Academia
   Integrate interdisciplinary learning opportunities
    in public health
   HRSA public health training grants
   Support for leadership training institutes/programs
   Federal grants should support public health
    practice research
     – Peer reviewed
     – Longer time lines to assess prevention
     – Coordination between NIH and CDC
   Faculty   rewarded for service in public health
CDC Futures Initiative
    New  direction for CDC
    Primary “customer” is the public
    Marketing of public health
    Partnerships with business

    Health   Impact
      – Preparedness
      – Health Promotion and Disease, Injury, Disability
    Coordinating   centers
    Scientific basis-Public health research grant
CDC next steps
    New         organizational charts
      Coordinating Center for Infectious Disease – includes the National Center for Infectious
       Diseases, the National Immunization Program, and the National Center for STD, TB, and HIV
       Prevention. Dr. Mitchell Cohen will lead this coordinating center.

      Coordinating Center for Health Promotion – includes the National Center for Chronic Disease
       Prevention and Health Promotion; the National Center for Birth Defects and Developmental
       Disabilities; and Genomics. Dr. Donna Stroup will lead this coordinating center.

      Coordinating Center for Environmental Health, Injury Prevention, and Occupational Health
       – includes the National Center for Environmental Health/Agency for Toxic Substances and Disease
       Registry, the National Center for Injury Prevention and Control, and the National Institute for
       Occupational Safety and Health. Dr. Henry Falk will lead this coordinating center.

      Coordinating Center for Public Health Information and Services – includes the National Center
       for Health Statistics, a new National Center for Health Marketing, and a new center for public health
       informatics. Dr. James Marks will lead this coordinating center.

      Office of Global Health – Dr. Stephen Blount

      Office of Terrorism Preparedness and Response – Charles Schable

    Reorganization                   cannot occur without additional
CDC Office of the Director
    Office of Strategy and Innovation: Kathy Cahill
    *       Analytic function to assess external involvement and trend analysis
    *       Innovation and creativity
    *       Goals management-strategy and development

    Office of Workforce and Career Development (OWCD): Dr. Steve Thacker, Director; Barbara
     Holloway Deputy Director
    *       Recruitment
    *       Workforce development
    *       Learning
    *       Succession planning
    *       Houses CDC’s Office of the Chief Learning Officer

    Chief of Public Health Improvement: Dr. Ed Thompson
    *       Support and standards for the public health systems

    Chief of Science: Dixie Snider
    *       Public health research
    *       Scientific leadership and collaborations

    Chief Operating Officer: Bill Gimson
    *     Management and business operations for CDC
    Chief of Staff: Bob Delaney
    *     Manages day-to-day activities of the Office of the Directo
    CDC Washington: Don Shriber
For FY 2005
What We Need vs. What We Will Get
 APHA  What We Need            HHS What is Proposed
 CDC - $1 Billion More         CDC - Cut $300 Million
  – 14% increase                 – 2.8% cut
  – Futures Initiative           – State preparedness cuts
 HRSA   - $1.1 Billion More    HRSA   - Cut $610 Million
  – 16% increase                 – 8.8% cut
  – HIV, MCH, Primary Care
Examples of Cuts in HRSA
    Community   Access Program - 90%
    Health Professional training grants - 25%
      – Zero for Public Health Programs
    Rural Health - 66%
    Newborn hearing program - 100%
    Trauma/EMS - 100%
    State Planning Grant - 100%
    Public Health Improvement - 100%
    Smallpox compensation program - 100%
Public Health “Burnout”
    Dependent  on government funding
    Often prevention is first to be cut
    “Penny wise, Pound foolish?”
Fighting Back
    “Ilive in your district and this is what I am
     concerned about.”
    Visit your Senator and Representative
Reminder of What We Do?
    Futureof Public Health is in our hands
    Noble Profession
     – Health care
     – Public service
Mahalo for inviting me!