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National Rural Health Association 33rd Annual Conference, Savannah, GA

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Title: National Rural Health Association 33rd Annual Conference, Savannah, GA Last modified by: Joycelyn Elders Created Date: 5/13/2010 3:51:21 PM – PowerPoint PPT presentation

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Title: National Rural Health Association 33rd Annual Conference, Savannah, GA


1
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2
Healthcare Systems in Small Caribbean Communities
  • Health Care Conference Aruba Better Together
  • Oranjestad, Aruba
  • June 1, 2015
  • M. Joycelyn Elders, MD

3
Health Care Resources - Aruba
  • Population 103,000
  • Health care is single payer and universal
    coverage - AZV
  • Healthcare expenditures 8.4 of GDP
  • 21rst century primary, secondary, tertiary and
    emergency services available for all
  • Medical Schools 0 (2 private foreign schools)
  • Full service hospital 1 (290 beds)
  • Department of Health
  • Eldercare (SABA)

4
Health Policies
  • Informed by health guidelines and standards of
    The Netherlands as well as International Health
    Regulations and World Health Organization
  • Health System stewardship guided by the Ministry
    of Health

5
Vision for the 21rst Century
  • Healthy People in Healthy Communities
  • Healthcare system that is available, affordable,
    accessible and crisis responsive
  • Patient-centered, prevention-focused, purpose-
    driven, solution-oriented
  • Fosters individual responsibility, human dignity
    improves health status enhances quality of life
  • Healthcare system that is transparent,
    patient-centered, equitable
  • Design develop a consumer responsive healthcare
    system for diverse communities.

6
Ancient Chinese Proverb
7
We must transform our present Sickcare System
into a Healthcare System
8
Engineering a Better Health Care System A Report
From the US Presidents Council of Advisors on
Science and Technology JAMA August 27, 2014
Vol 312, No. 8, p 787
  • Transformation of healthcare delivery is
    essential to the linked goals of affordability,
    quality of care and healthy communities.
  • Leveraging scientific knowledge to transform
    healthcare delivery

9
US Presidents Council of Advisors on Science and
Technology (PCAST) Recommendations
  • Better alignment of payment systems with outcomes
  • Increase access to relevant health data and
    analytics.
  • Technical assistance in systems engineering
    approaches
  • Involve communities in improving healthcare
    delivery.
  • Shared lessons from successful efforts
  • Train healthcare professionals in new skills and
    approaches systems engineering

10
Health Goals of the USA 2020 A Society in
which all people live long healthy lives
  • Overarching Goals
  • Attain high quality, longer lives free of
    preventable disease, disability, injury, and
    premature death.
  • Achieve health equity, eliminate disparities, and
    improve the health of all groups.
  • Create social and physical environments that
    promote good health for all.
  • Promote quality of life, healthy development and
    healthy behaviors across all life stages.

11
IOM Report on Core Metrics for Health and
Healthcare
  • Core metrics for better health at lower cost.
  • Life expectancy
  • Well being (self-reported health status
  • Overweight and obesity
  • Addictive behavior
  • Unintended pregnancy
  • Healthy communities
  • Preventive services

12
IOM Report, continued
  • Access to care (Care needed in timely fashion)
  • Evidence-based care
  • Care matched with patient goals
  • Personal spending burden
  • Population spending burden
  • Individual engagement
  • Community engagement
  • Patient safety (www.iom.edu/coremetrics)

13
Major Problems of Healthcare Systems
  • Access
  • Provider, Financial, Cultural, Transportation
  • Cost
  • Costs too much, delivers too little
  • Lack of resources, low premiums, high cost of
    meds, cost of services abroad
  • Quality
  • Gross lapses in quality of care
  • Major health disparities
  • Lack of transparency

14
Reasons for Increased Cost of Health Care
  • Increasing number of elderly living longer
  • Greater burden of chronic disease
  • More medications used
  • Improved technology
  • Higher rates of hospitalizations
  • Increased use of nursing facilities
  • ADL need for 40 for gtage 85

15
Factors Affecting Our Health
  • Poverty
  • What are the effects of poverty?
  • Lack of Health Care, Education, Housing, Food
  • Crime, Stress in children adults, Poor
    environment
  • Lack of education
  • How do we reach people for education?
  • Home, TV, Books, Online, Schools and Colleges,
    Churches
  • Risky behaviors
  • How you live life more critical to longevity than
    genetics
  • Tobacco use, Alcohol drug abuse, Car crashes,
    Obesity
  • Access to health care
  • Provider, Financial, Cultural, Transportation,
    Time

16
  • Major Determinants of Health
  • Social and behavioral factors 50
  • Environment 20
  • Genetics 20
  • Access to care 10

17
The Social Determinants Framework
Health Care
Education
Housing
Physical Environment
Work Environment
Income
Transportation
Racism
Criminal Justice
Social Concerns
Depressed immune system Chronic Neuroendocrine
activation
Overall Health Well-Being
Stress
Social Policy
Genetic
Local Community
Health Outcomes
And
Individual
Poor Health
Individual Behaviors
Economic Policy
Material Deprivation
18
Criteria for Selecting Rural Health Priorities
  • Identified by rural people as high priority
  • Rural vs. Urban prevalence
  • Impact of the issue on mortality
  • Impact of the issue on morbidity
  • Risk factors on other health problems
  • Conditions causes are known
  • Solutions are available
  • Community interventions are known to work

19
Top 10 Health Concerns of People Living in Rural
Areas
  • Access to Quality Health Services
  • Physician access
  • Financial access
  • Transportation access
  • Cultural access
  • EMS, LTC
  • Cancer in rural areas
  • Diabetes in rural areas
  • Heart Disease
  • Maternal, infant child health issues
  • Mental health and mental disorders
  • Nutrition overweight
  • Oral health
  • Substance abuse
  • Tobacco use

20
Other Areas of High Priority in Rural Health
  • Education community based programs
  • Public health infrastructure
  • Immunizations infectious disease
  • Injury violence prevention
  • Family planning
  • Environmental health

21
Access to LTC in Rural Areas
  • By 2030, elderly pop. will double
  • 1/5 of US pop will be gtage 65
  • 75 of those gt65 will suffer at least 1 chronic
    disease
  • 22 of US elderly reside in rural areas
  • Rural elderly are 12.8 vs. urban pop elderly
    12.3
  • Elderly in rural areas receive fewer and narrower
    range of services
  • Less well-educated, poorer
  • Assisted living 76 urban
  • Nursing homes highest rate in rural areas
  • Majority of LTC provided by informal network

22
Major Barriers to Health Care in Small Communities
  • Lack of providers
  • Limited knowledge of resources
  • Isolation
  • Socioeconomic factors
  • Lack of coordination of services
  • Culture
  • Education

23
Ways to Improve Healthcare Delivery
  • Improve transparency
  • Better understand social determinants of health
  • Encourage better health behaviors
  • Reward primary care
  • Improve information technology, HIT, EHR
  • Implement a team approach to care
  • Empower patients Patient-centered Health Care
  • Create a unified system of care.

24
New Technologies as Aids for Rural Health Care -
Telehealth
  • EKG using smart phone apps sensors
  • Blood drops instead of test tubes of blood for
    200 or more tests
  • Blood pressure with smart phone
  • Virtual consultations. Patient travels to center
    to consult with specialist via internet
  • E-visits through video or Skype with telephone or
    computer.
  • HIT, e-charts

25
7 Characteristics of Healthy People
  • Eat breakfast
  • High fiber, low saturated fat diet
  • with 3 meals and 3 snacks daily
  • Exercise 20-30 minutes
  • 7 - 8 hours sleep
  • Dont smoke
  • Drink only in moderation
  • Responsible sexual behavior

26
8 Tests to Save Your Life
  • Height, weight BMI
  • BP
  • Mammogram
  • PAP or PSA
  • Lipid profile
  • Hgb A1C, HIV
  • ECHO, EKG
  • Colonoscopy

27
Strategies for Solutions to Common Health Problems
  • Collaboration strategies
  • Educational strategies
  • Access strategies
  • Prevention strategies
  • Intervention strategies
  • Research strategies
  • Political strategies
  • Leadership strategies
  • 5 Cs of Leadership Clarity of vision,
    Consistency, Competency, Commitment, Control

28
What Do We Know?Better Together
  • Partners
  • Program, Policies, Partnerships
  • Aware, Advocate, Action plan
  • Reach out, Responsible
  • Technology, Together, Tools of commitment
  • Network, Novel ideas
  • Educate, Empower, Elucidate
  • Research, Resources
  • Successful, Services

29
What Is Our Role? Save the Community
  • THE END
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