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Leading the Health System through Policy Development

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Title: Leading the Health System through Policy Development


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

2
The Ten Essential Public Health Services
  • Monitor health status
  • Diagnose and investigate health problems
  • Inform and educate
  • Mobilize communities to address health problems
  • Develop policies and plans
  • Enforce laws and regulations
  • Link people to needed health services
  • Assure a competent health services workforce
  • Evaluate health services
  • Conduct research for new innovations

3
Essential Services A Different View
4
Inform, Educate, and Empower People About Health
Issues
  • Initiatives using health education and
    communication sciences to
  • Build knowledge and shape attitudes
  • Inform decision-making choice
  • Develop skills and behaviors for healthy living
  • Health education and health promotion
    partnerships within the community to support
    healthy living
  • Media advocacy and social marketing

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

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

7
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8
Health Issues Have Moved to the Forefront of
Public Attention
  • Unrelenting health care cost pressures
  • Large gaps in health care quality safety
  • Persistent disparities in health outcomes
  • Rapidly growing obesity epidemic related
    chronic diseases
  • Newly emerging infectious diseases
  • Concerns about public health infrastructure
    preparedness for emerging threats

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

10
Death Rates 1860 1970
Tuberculosis Whooping Cough Measles
Deaths per 100,000
11
Focusing on disease prevention has led to major
achievements
Actual and Expected Death Rates for Coronary
Heart Disease, 19501998
700
Rate if trend continued
600
500
Peak Rate
400
Age-adjusted Death Rate per 100,000 Population
300
200
Actual Rate
100
50
1950
1960
1970
1980
1990
1995
1955
1965
1975
1985
Year
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
But the pictures look different when we examine
summary measures of health (or affliction)
14 increase
Source Centers for Disease Control and
Prevention. Health-related quality of life
prevalence data. National Center for Chronic
Disease Prevention and Health Promotion, 2003.
Accessed March 21 at lthttp//apps.nccd.cdc.gov/HRQ
OL/gt.
13
Leading Causes of Death, 1990
Developed Nations
Developing Nations
  • Heart disease
  • Cerebrovascular disease
  • Cancer lung, trachea
  • Lower respiratory infections
  • Chronic Obstructive Pulmonary Disease
  • Cancer colon, rectum
  • Cancer stomach
  • Traffic accidents
  • Self-inflicted injuries
  • Diabetes
  • Lower respiratory infections
  • Heart disease
  • Cerebrovascular disease
  • Diarrheal diseases
  • Perinatal conditions
  • Tuberculosis
  • Chronic Obstructive Pulmonary Disease
  • Measles
  • Malaria
  • Traffic accidents

14
Some important drivers of population health
Changes in the environment
Disparities in health status and access to care
Infectious disease threats Including MAN-MADE
ONES!!
Globalization
A social and political environment that
prioritizes health
Advances in biotechnology and information
technology
15
Political Theory 101
Potential Solutions
Perceived Problems
Political Dynamics
Window of Opportunity
Policy Change
Kingdon J.W. Agendas, Alternatives, and Public
Policies (1984, 2003)
16
Our Challenge as Public Health Leaders
  • 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
18
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19
Health System Dynamics that Influence the
Publics Health
Demand for response
Demand for response
Demand for response
Public Health
Medical Care
Other Sectors
Source Adapted from Bobby Milstein, CDC
Syndemics Prevention Network
20
Spectrum of Action within the Health System
Policy Development
Time Horizon
SHORT months-years
LONG decades-centuries
INTERMEDIATE years-decades
21
Decision-making the Interface of Policy
Leadership
  • Decisions that determine the current and future
    structure and operation of the health system and
    its impact on the publics health
  • Decision-makers government, health
    professionals, employers, industry, consumers ?
    communities

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

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

24
What Are Our Policy Instruments?
  • Traditional instrument regulatory authority
  • Exists for only a very narrow scope of activities
  • Must be backed by enforcement costly
    difficult
  • 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?
  • 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?
  • 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
  • Launched by Governor Huckabee in May 2004
  • Focus on promoting healthy lifestyles
  • Reduce tobacco use
  • Increase physical activity
  • Reduce obesity
  • 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
  • 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.
  • Increase from 15 percent to 30 percent the
    percentage of adults who exercise at least three
    times a week for at least 30 minutes.
  • Reduce the percentage of obese children from 11
    percent to 5 percent.
  • Reduce the percentage of obese adults from 23
    percent to 15 percent.
  • Reduce the percentage of adolescents who smoke
    from 36 percent to 16 percent.
  • Reduce the percentage of adults who smoke from
    24 percent to 12 percent.

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

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

31
Policy Instruments in Act 1220
  • Information Customized reports provide feedback
    to families on BMI risks and advice on risk
    reduction
  • Convening power bring together schools,
    providers, community organizations to design and
    implement broad-based prevention strategies
  • 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
  • First medical center in AR to go completely smoke
    free, including outdoor areas
  • Implemented in July 2004
  • Counseling and cessation support for employees,
    students and patients

33
Policy Instruments in Smoke Free Campus Initiative
  • Financing enhanced coverage for cessation
    counseling and aides
  • 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
  • Agency Accreditation linked to incentives
  • Agency Accreditation as a condition of
    participation
  • Certification of Public Health Officers
  • Licensure of Public Health Officials
  • Registratoin of public health units

35
The Essential Role of Policy Research
  • Effective policy development ultimately must be
    based on evidence
  • Critical need to expand the evidence base on
    effective public health policy
  • 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
  • Evidence-based policy decision-making is the
    goal
  • Policy innovation and creativity is critical, but
    must be coupled with policy evaluation
  • Learn what works where
  • Disseminate, replicate, adapt
  • Capitalize on the open window for policy
    changewhile it lasts
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