APHA-CHPPD Collaborative Projects - Recently Updated Pages

Healthy People 2020 Registrants' Questions

Pritii — Tue, 02 Jun 2009 08:51:02 CDT

Practice/Translational Research/Incentives/Tools/Best Practice/Evaluation/Advocacy

What is the role of Translational Research in these tight times?
What advice do you have for regions that are struggling with a poor economic outlook, as well as poor health lifestyles, as in Western New York, as far as innovative resolutions to economic renewal/healthy living?
How can the achievement of Healthy People 2020 goals be incentivized at the community level?
The importance of nutrition for a healthy lifestyle. Accurate labeling of what's in our food. School programs regarding a holistic approach being healthy in regard to nutrition, exercise to give our children a "head start".
What specifically would be recommended for creating the most direct economic benefit in healthcare savings by providing which of the preventive treatment(s) or assistive technologies?
How can we insure that with a turning tide and influx of energy related businesses hopefully booming, that we promote and mandate a clean and unpolluted environment necessary to live a healthy life in our states? (North Dakota and Coal Fire power plants=increase of asthma and other chronic respiratory diseases)
What steps, activities do we need to be taking to encourage insurance companies to begin reimbursing for prevention and wellness behaviors? For example, for gym memberships, classes for weight managment, stress management?
How will the public health infrastructure be improved? How will these funds be used to insure that research is translated into practice? How much funding will be allocated for evaluating program efficacy? Effectiveness?
How do you see the role of Employers in supporting and promoting the HP 2020 initiatives? Will you be providing free promotional tools and resources?
What incentives will be provided to employers and unions to initiate or maintain wellness in the workplace
Examples of successful community partnerships highlighting critical elements.
How can Healthy People be promoted as a tool to help engage public health departments and define their role in improving the nation's health and shaping local, state and national reform efforts.
How to identify the most effective and efficient interventions to risk factors that can improve people's health the most with limited funding available?
How has public health practice changed in the speakers perspectives when considering not just elimination or reduction in services, but including consolidation of services as well.
How to do health marketing to gain leadership/policy maker support, funds, resources for community-based prevention which we know can have an ROI of 5.6:1
What strategies for addressing health equity -- an overarching goal of HP 2020 -- are being considered given this economic climate?
How to begin addressing the SDOH, such as poverty, in our country.
Identifying co-occurring disorders best practices in relationship with co-morbid conditions.
Future impact on the State of Public Health
What are the opportunities, if any, within Healthy People 2020, to address problem gambling as a public health issue, especially in this age of economic downturn when vulnerable individuals who are facing mounting financial difficulties are increasingly, and errantly, turning to gambling endeavors "to make some money to pay bills"?
What impact in the economic reform going to have on the healthcare workforce and which occupations will be impacted most?
Just So I Know, WHAT Steps are in place to make 2020 mostly a time to celebrate how much improvement was made Years 2009 - 2010 to provide the REAL Help Needed by REAL People? Research to Implementation, workforce etc.
Since health reform is currently focused on healthcare, how does the debate get expanded to what the public health field shows that place and environment rather than healthcare are at least as important if not more important to creating healthier people. How does Healthy People 2020 specifically get tied in? Also since public sees health reform needs differently than policymakers/research, what is their view or knowledge of Healthy People?
With all the discussion revolving healthcare reform, we cannot forget that healthcare is only a part of what makes our health. How can we make the current reform discussion to also include the social determinants of health (education, housing, employment, segregation, etc.)?
What are some of the successful programs being funded that have brought together interprofessional groups to carry out health promotion in urban communities?
How to use HP2020 at the community level
1.What are the future challenges in public health? 2.How is public health dealing with the U.S economic down-turn and how does it effect the health of the nation? 3.What are the opportunities of young professionals in public health? Is it the same as in the past or are then new emerging fields in public health? 4.How is technology influencing public health opportunities?
opportunities for HP 2020
What is the potential impact of health care reform on local public health programs?
community health programs, classes, clinics
Opportunities to promote physical activities
What is the scope of Electronic Health Record (EHR) in HP2020? Do you think the EHR may reduce healthcare disparities?

Workforce

Is there a use for nurse practitioners to help reduce access to health care of minorities, uninsured and underinsured?
How can MPH programs better prepare graduates for professional success in this challenging time of economic renewal and reform?

Healthy People Objectives/Involvement ·

Is Healthy People (2010, 2020) still relevant? Have heard nothing from administration
Goal 9 of Healthy People 2010 was to improve pregnancy planning and reduce unintended pregnancy, but there was a great level of controversy when there were discussions to expand eligibility for family planning services in Medicaid to align with eligibility with pregnancy-related care. (It should be noted that such legislative action would save the federal government an estimated $700 million over 10 years.) Despite that controversy, there was almost universal support for a focus on prevention and wellness. At our organization, we focus on prevention and wellness as broader than a focus on prevention of chronic disease. In fact, family planning has been considered one of the top ten public health achievements of the last century and has been classified in statute as both a primary health service and a health promotion service. To what extent should we be mobilizing as a health advocacy community to support the use of (American Recovery and Reinvestment Act of 2009) ARRA prevention and wellness funds to cover pregnancy planning/prevention services and education along with other Healthy People objectives that aren't specifically focused on chronic disease prevention?
Adolescent Immunization Issues
How can worksite wellness programs get involved as part of Healthy People 2020?
How can we focus the Health Care Reform as a strategy to meet our national goals of Healthy People 202
1. Nutrition - Americans lack basic understanding of nutrition. What will be done to educate consumers about fundamental nutrition principles? 2. CAM - It actually works! What will be done to stimulate health care coverage for complimentary and alternative medicine (CAM), including "health & nutritional coaching"? 3. The bottom line is that we need to do something radically different than the current "mainstream" health care model. We really need a true "reform." What fundamental changes will be made to the current health care model?
hEALTHCARE rEFORM FOR wORKERS' cOMPENSATION
As a health educator and grants consultant, I am more interested in listening to issues raised and discussed. I do not have a specific question at this moment. My firm is involved as a "Participating Organization" in development of HP2020 Objectives and I monitor federal initiatives for my health agency clients
1) How are preventive services with proven health outcome- and cost-efficacy (e.g. Nutritional Counseling, Exercise programs, Stress Reduction classes) going to be incorporated in a new Healthcare system? 2) How are Healthy Places (e.g. Walkable/Bikeable Cities, Urban Green spaces, Community Parks and Gardens) that provide a range of health benefits being considered for inclusion in HP2020? 3) What role do holistic/integrative/CAM practices of health (e.g. Naturopathic, Traditional Chinese Medicine, Homeopathy) have in keeping people healthy?
National Breastfeeding Goals for the United States How the Healthy People 2020 will be marketed I continue to meet healthcare professionals that are not aware of the Healthy People 2000,2010, or upcoming 2020.
How will the HP 2020 objectives be similar and how will they be different from the HP 2010 objectives? MAny states are considering eliminating existing oral health programs (and many other significant and beneficial preventive-oriented health programs from their budgets. Can/will stimulus money be used to to save these established and proven programs that are now in serious jeopardy
What objectives concerning consumer food safety education are being considered as part of the Health People 2020 initiative and who do you see as being the delivery agent(s) of that education and outreach?
Access to equal opportunities for Health and wellness for those with Chronic Illness including Mentall Health and Addiction

Special populations
Seniors ·

Interested in elders with chronic disease/how they can stay healthy and prevent disability/functional limitations
funding opportunities - geriatrics
How will seniors benefit from the new opportunities?

State Roles ·

When will the Healthy People documents come to the states?
Relationship of HW2020 to state health plans.

Funding ·

What are the top priorities for funding for health promotion and disease prevention?
rural areas never get much funding or help - what are ways to assure equality of opportunity in funding?
what anticipated funding will be available to truly implement and effectively evaluate criteria stated Healthy People 2020?
I am an environmental health educator. People often ask me what efforts are being made to prevent illness and injury instead of curing or treating illness and injury after the fact. Some folks think it's a way for people in the healthcare industry to make money. How much of the funding is going into wellness programs and efforts to keep people healthy?
Can you provide more information about how the $1 billion that the ARRA designates for "Prevention and Wellness" will be used? Specifically, will any of that funding be directed towards women's health? How can the Healthy People measures in focus areas related to reproductive health - such as family planning and sexually transmitted diseases - be used to advocate for comprehensive health reform
Funds that may be available

In an Era of Economic Downturn and Renewal, Opportunities for Healthy People 2020

Pritii — Mon, 01 Jun 2009 15:02:50 CDT

Scroll to the bottom of this page after "Attachments" to access a copy of the presentations.

In this age of economic downturn, there are opportunities for Healthy People. The health stimulus package includes a significant allocation for health reform. What share of the allocation will eventually go towards keeping people healthy? What factors will facilitate the investment in healthy people? What checks and balances are in place to ensure that those who need the resources the most have access to them? These are some of the questions that will be discussed by the presenters at this webinar and audio conference. In addition, we has asked registrants for their questions, and a few of these will be discussed.

Learning Objectives

List critical opportunities for health investments
Describe the potential for using Healthy People measures to explain for need for national health financing and delivery reform
Use Healthy People as a tool to define the role of public health departments and community partners in ensuring nation’s health and reducing potential costs for national reform efforts

Moderated by: Helda Pinzon-Perez, PhD, RN, MPH; Associate Professor, Department of Public Health, California State University, Fresno

Speakers:
Eva M. Moya, LMSW, PhD Candidate, Project Concern International; Advocacy, Communication and Social Mobilization Coordinator, member of the Secretary's Advisory Community on National Health Promotion and Disease Prevention Objectives for 2020

Brian Smedley, PhD, Vice President and Director of the Health Policy Institute of the Joint Center for Political and Economic Studies, Washington, DC.

John Capitman, PhD, Executive Director, Central Valley Health Policy Institute, California State University , Fresno

Speaker Bios:

Helda Pinzon-Perez, Ph.D., RN, MPH, CHES is a native of Colombia. She has a Ph.D. on Health Education, a Masters degree in Public Health with emphasis on Health Policy and Management, a Masters degree on Health Science, and a Bachelors of Science in Nursing. She is an Associate Professor in the Department of Public Health at California State University, Fresno. Her major research interests are Hispanic/Latino health issues, International Health, and Alternative/Holistic Health. She is currently the director of the Community Health Option in the Department of Public Health at CSUF. She teaches courses in the area of health promotion.

Ms. Eva Moya is a native of the El Paso/Ciudad Juarez Border region. She is a borderlander. Presently she is a Doctoral Candidate at UTEP Interdisciplinary Health Sciences PhD Program and serves as the Director Tuberculosis Division, U.S.-Mexico Border Health Association and as Senior Project Coordinator for Advocacy, Communication and Social Mobilization, Project Concern International in El Paso, Texas. Eva serves on Secretary’s’ Promotion and Disease Prevention Healthy People 2010 Advisory Committee, Texas Health Disparities Task Force and various advisory councils. Her expertise includes border, binational and cross-border health; health diplomacy; and migrant community health education, Community Health Workers/Promotores(as) de Salud Program implementation and evaluation; non-governmental organizations, health centers and academic institutions.

Dr. Brian D. Smedley is Vice President and Director of the Health Policy Institute of the Joint Center for Political and Economic Studies in Washington, DC. In this position, Dr. Smedley oversees all of the operations of the Institute, which was started in 2002 with funding from the W.K. Kellogg Foundation. The Institute has a dual focus: to explore disparities in health and to generate policy recommendations on longstanding health equity concerns.

Dr. John Capitman is the executive director for the Central Valley Health Policy Institute at California State University , Fresno. Capitman brings an extensive background in research and is nationally renowned for his work in health disparities, long-term care, substance abuse and racial and ethnic disparities in cancer care. Dr. Capitman was formerly a professor and director of long-term care studies in the Schneider Institute for Health Policy at the Heller School for Social Policy and Management at Brandeis University.

APHA-CHPPD Collaborative Projects

Pritii — Tue, 12 May 2009 08:23:45 CDT

Back to APHA-CHPPD Home Page

The Community Health Planning and Policy Development (CHPPD) of the American Public Health Association (APHA) is a diverse section with members working with schools, governments, health care, community-based organizations and the community on a variety of issues. We need to reach out to members within our section and APHA and outside APHA to help refine our thoughts and ideas on important public health issues. This wiki is a venue that will help us.

Projects
Webinar/audioconference: Tuesday, June 2, 3 - 4:30 p.m. Eastern Time
In an Era of Economic Renewal and Reform, Opportunities for Healthy People 2020.
Registration by Wednesday, May 27th is appreciated so we can send you the webinar/audio conference information in time.

Past Webinar/audioconference:

Wednesday, April 1, 3:00 - 4:30 p.m. Eastern Time
Measuring the Value of Community Prevention

Wednesday, February 11, 3 - 4:30 p.m. Eastern Time

Role of Community in Health System Reform

Proposed APHA Policy Paper (submitted February 17, 2009): Public Health’s Critical Role in Health Reform

Measuring the Value of Community Prevention

Pritii — Thu, 02 Apr 2009 09:20:55 CDT

In the July 2008 report released by the Trust for a Healthier America, Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, the researchers concluded that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save the country more than $16 billion annually within five years. This is a return of $5.60 for every $1. This report was developed by a partnership of the Prevention Institute, Trust for America’s Health, the Urban Institute, the New York Academy of Medicine, The California Endowment, and the Robert Wood Johnson Foundation.

Some studies have indicated that practitioners do not understand the practical application of these findings. The webinar and audio conference will focus on explaining ways that communities can apply the cost-benefit analysis findings. The presenters will do so by describing a framework for community health, linking it to determinants of health at the community level and sharing case studies from around the country that illustrate promising approaches. The session will emphasize elements for success in implementation of prevention strategies to improve health, such as cross-sectoral partnerships, an emphasis on promoting equity, and a set of actions government can take to support change efforts at the local level. This session will also explore the data needs and how communities that are implementing innovative strategies can help build the evidence base and support for these investments.

Learning Objectives:
Participants will be able to:

List at least three important findings from on costs and benefits of prevention approaches.
Discuss how communities use and/or contribute towards cost and benefits studies for investment in community health prevention.
Discuss ways to increase the capacity of government to prevent illness and injury in the first place through public policy and institutional-practice change.
Describe at least two community based prevention case studies that have shown the sort of return on investment revealed through the economic model.

Presenters
Linnea Ashley, MPH, Program Coordinator
Janani Srikantharajah, BA, Program Coordinator

Resources

Prevention for a Healthier America (pdf, 75 pages): The report examines how much the country could save in health care costs by investing more in disease prevention, specifically by funding proven community-based programs that result in increased levels of physical activity, improved nutrition (both quality and quantity of food), and a reduction in smoking and other tobacco use rates. It was developed through a partnership of the Trust for America's Health, The Urban Institute, The New York Academy of Medicine, the Robert Wood Johnson Foundation, The California Endowment, and the Prevention Institute.

Reducing Inequities in Health and Safety through Prevention (pdf, 18 pages): The Prevention Institute memo offers a suggested strategy for developing a comprehensive, prevention-oriented approach to health equity.

Healthy People, Healthy Places (pdf, 6 pages): Developed by Prevention Institute and Policy Link list recommendations for administrators on integrating the goals of individual and community health and well-being, equity, and economic growth.

Good Health Counts: A 21st Century Approach to Health and Community for California (pdf, 90 pages): This report outlines strategies and approaches to health that would be applicable to communities outside California as well.

Planning for Healthy Places with Health Impact Assessments: A ‘how to’ guide for conducting health impact assessments (HIAs), developed by the American Planning Association and the National Association of County & City Health Officials, sponsored by the Centers for Disease Control and Prevention. This online course will explain the value of conducting an HIA and the steps involved in conducting an HIA. Throughout the course, examples of health impact assessments have been highlighted and discussed. This course is available for free, thanks to a grant from the Centers for Disease Control and Prevention.

Presenters: Measuring the Value of Community Prevention

Pritii — Mon, 30 Mar 2009 08:58:11 CDT

Linnea Ashley, MPH, Program Coordinator

With previous work experience focused on marginalized populations both nationally and internationally, Linnea joined the Prevention Institute in October 2007. Linnea supports Prevention Institute's work across a number of content areas. She alsoassists in the coordination of the organization's media advocacy activities, including the Rapid Response Media Network. As a graduate intern she worked with the Louisiana Public Health Institute on a nutrition initiative. In 2006, as a Rotary Ambassadorial Scholar in New Zealand, she worked with the Centre for Health Services Research and Policy on evaluations of health projects targeting Pacific Island populations. Prior to that she served as a Peace Corps Volunteer in South Africa with projects on education and HIV/AIDS training, and was a reporter at several newspapers. She received her Masters in Public Health from Tulane University in New Orleans and her BS in Journalism from Florida A&M University.

Janani Srikantharajah, BA, Program Coordinator Janani is a Program Coordinator at Prevention Institute. She supports Prevention Institute's work with the Healthy Eating Active Living Convergence Partnership, a collaborative of six major health funders in the United States. Janani is also involved in the organization's efforts to incorporate primary prevention into national level discussions about health care reform, as well as broader efforts to eliminate health disparities and promote a community health approach to improving health. Prior to joining Prevention Institute, Janani spent two years with the Ernest Gallo Research Clinic, at UCSF, studying alcohol addiction pathways. She has also worked with the Bay Area Youth Alternatives and the Continentals of Omega Boys and Girls Club in pipeline programs to help prepare youth in low income communities for higher education; served as the Solano County youth representative to the American Red Cross Bay Area Board of Directors; and is currently a needle exchanger for the San Francisco AIDS Foundations Prevention Project. Janani graduated from UC Berkeley with a BA in Molecular and Cell Biology and a minor in Conservation Resource Studies.

Healthy People 2020: Promoting Public Health in an Era of Economic Downturn and Renewal

Pritii — Sun, 08 Mar 2009 16:35:24 CDT

There is no abstract available for this page revision.

Public Health’s Critical Role in Health Reform

tpilisuk — Thu, 19 Feb 2009 13:37:46 CST

Policy statement by primary authors:
Tammy Pilisuk, MPH
CHPPD Section
Member, Federal Activism Council
National Multiple Sclerosis Society

Ellen R. Shaffer PhD MPH
Medical Care Section
Center for Policy Analysis
San Francisco Presidio
P.O. Box 29586
San Francisco, CA 94129

This policy statement is supported by the Medical Care Section and the Community Health and Policy Development (CHPPD) Section of the American Public Health Association (APHA).

It aims to respond to the following topics identified as policy gaps by the Action Board and Joint Policy Council (JPC):

Health reform and the changing role of the public health system
Public health workforce issues
Financing options for increasing public health funding

We look forward to collaborating with other APHA members and Sections and interest groups who may wish to comment on these issues.

I. Problem Statement

Rationale for Health System Reform

“I take care of an uninsured patient population. Not only am I seeing increased numbers of patients, due to the economic crisis, but patients that have previously had stable medical problems are becoming increasingly less stable related to stress from lack of work and less ability to eat healthfully because of cost. I anticipate an increased incidence of domestic violence, andwomen feeling more "trapped"- and an associated decrease in the availability of programs for assistance... this is all part of things ‘mushrooming.’ “ - Amy Fendrich, M.D. Member, APHA Medical Care Section. Personal communication, February 17, 2009.

The U.S. remains alone among developed nations in failing to provide coverage for health care to all residents. The crisis threatens to become more painful as the economy slows. APHA members are joining with national leaders who are proposing to reform the health system.

An estimated 47 million Americans have no health care coverage (National Physicians Alliance, 2008). There is growing evidence that many of those who have some type of public or private coverage face serious barriers to care, restrictions to allowable benefits, or prohibitive costs (Families USA 2008, Brown et al. 2008). Health care expenditures are increasing at a faster rate than the economy. The New America Foundation has estimated that the US economy lost $207 billion in 2007 because of poor health and shorter lifespan of the uninsured—an amount stated to be the sum total expense of the public cost of providing health care coverage to all Americans (Axeen & Carpenter 2008). In short, the health system is broken because it is not available to everyone. While costs continue to increase, there is no concomitant increase in access to health services or improvement in health outcomes.

Private health insurance plans cover about half the people in the U.S. who are insured, and private funds account for less than half of health expenditures. Most privately insured people obtain insurance based on their employment, and contribute to the cost of coverage. There is no requirement that employers offer health benefits. Private insurance plans vary widely, and increasingly fail to cover basic needs: they may not be affordable, may not cover dependents, may exclude people with certain health conditions or coverage for certain benefits. Employees with job-based insurance can lose coverage if they change jobs, or if employers change the terms of coverage or discontinue it.

In 2008 candidates for president campaigned on proposals for national health reform. Since assuming office, President Obama continues to call for health reform, and leaders in Congress are drafting legislative proposals.

Other groups are looking to join the policy discussion to make sure the needs of their constituencies are considered. Among these, the National Multiple Sclerosis Society's 2008 principles of health care reform (NMSS 2008) addresses seven principles with a focus on individuals with chronic care needs and disabilities. A team from the Mailman School of Public Health developed a set of principles relating to women’s reproductive health (Chavkin et al. 2008)

In 2006, the Citizens' Health Care Working Group convened a series of community meetings that recommended “affordable health care for all Americans” with equitable financing defined as 1) not creating a disproportionate increase in the financial burden on the sick; 2) based on a household’s ability to pay; and 3) sharing the cost among all segments of society. They concluded that government, families, and businesses must be involved in improving health care and that “… [we]need to address the entire health care system,” as well as specific problems in cost, quality, or access…”

The Center for Policy Analysis’ Criteria to Evaluate Health Care Reform (2008) encompasses a broad view of health reform, incorporating the concerns of national public health and women’s groups and emphasizing public health and social justice. It calls for universal, affordable coverage, with fair and stable financing, that controls costs; an accountable delivery system that offers quality, appropriate, accessible and equitable care; eliminating social and economic disparities that undermine health; and a strong public health system. (Center for Policy Analysis 2008)

In December 2008, the Obama Transition Team took the issue of health care reform directly to the American people. People from all walks of life were asked to participate in health care reform house parties and report their findings back to the just-forming Obama Administration. Thousands of people participated in this fact-finding exercise. Findings from this effort have not yet been released.

Equally importantly, there is a need to support a broader public health system as an integral part of reforming the nation’s health. The Prevention Institute (2008) estimates that only 15% of premature deaths are directly attributed to shortfalls in medical care. PRI’s recent report, Reducing Health Care Costs Through Prevention, also concludes that preventive care keeps our population healthier and saves costs by reducing needless preventable illnesses and injuries.

At a time when there is growing recognition that the public’s health is affected by a wide range of factors, there is a unique opportunity to support the viewpoint long advanced by APHA: that population health is largely determined by social and economic policies, which can be directed to benefit the public.

APHA has long advocated for universal coverage for affordable health care as a basic human right. As the United States once again approaches the prospect of a transformative leap to achieve universal coverage for health care, it is valuable to reflect on public health’s strong body of policy articulating the importance of an affordable health care system that covers everyone, with comprehensive benefits, democratic participation to assure that the health care delivery system is responsive and provides appropriate, quality care, and the critical role of public health in all its dimensions in improving the health of the public.

II. Existing APHA Policies and Resolutions

APHA has committed to supporting health care system reforms, including reforms in the coverage and financing of health care, and reforms in the health care delivery system. APHA also calls attention to the importance and impact of the range of public health activities from preventive services to healthier communities to elimination the social and economic inequalities that undermine health.

In 1993 APHA leaders developed 14 Points on Health Reform, described below, that established public health’s essential criteria for reform. This section reviews statements by related organizations, and then illustrates the breadth of existing APHA policies that support the 14 Points.

Policies by Related Organizations

Rekindling Reform elaborated on the 14 Points in the January, 2003, edition of the American Journal of Public Health, focusing on
1. Universal and Equitable Coverage
2. Comprehensive Benefits and Quality Health Care
3. Affordable and Equitable Financing
4. Simplified Administration and Sensibly Organized Work
5. Accountability
6. A Strong Public Health System

APHA Policies: The 14 Points

APHA recognizes and affirms that access to health care is a basic human right. The APHA 14 Points on Health Reform, established in 1993 and reaffirmed in 2000 (Policy #20007), created core principles that health care financing and delivery systems that must address. The present statement does not modify those established 14 Points, but builds on them, citing related APHA policies that further define or enhance each Point.

1. Universal coverage for everyone in the United States.
APHA endorses effective health care reform that covers all residents. Prior comprehensive health care reform statements include support for a:

A National Program for Personal Health Services (#7018)
Committee for a National Health Service (#7601)
Comprehensive universal national health program that supports the goal of a single payer approach (#9502)
Campaign for universal health care (#20007)

Also significant are numerous prior APHA health care reform positions that address the importance of coverage for vulnerable and underserved populations:

National insurance program for children (#7408) and for special need children (#9418)
Health care reform for people with disabilities (#9307) and support for disabilities prevention activities (#9505)
Improving the health status of American Indians and Alaska Natives (#20015)
Support for rural health care (#9522)
Ensuring access to health services for undocumented immigrants (#9401)
Support for culturally and linguistically appropriate primary care and prevention services (#9616)
Improving Access to Vision and Eye Health Services for Long-Term Care Facility Residents (#9504)

2. Comprehensive benefits including health maintenance, preventive, diagnostic, therapeutic, rehabilitative, behavioral, palliative, long-term care, and end-of-life services for all types of illnesses and health conditions and all other necessary services to meet patients' total health needs
APHA policies establish support for comprehensive health care benefits, and point to issues of access and expansion of conventional health care benefits needed by individuals and by communities. Policies include specific mention of contraceptives and reproductive health care (#200611), mental health treatment (#9701), dental and oral health (#200117, #6611), affordable prescription drugs (#7810, 20018, 20006), vision rehabilitation (#200312), in-home and community-based long-term care (9005), hospice care (#2000-5), chiropractic care (#8331), and alternative and complementary medicine (#9714)

3. Guaranteed protection against very high health care costs

Toward a Comprehensive Universal National Health Program (#9502) supports a national tax-based single payer system with support for ERISA waivers. Other APHA policy has emphasized protecting health care accessibility and quality in a profit-oriented marketplace (#9702) and support for national standards of accountability for access and quality in managed care (#9615) by standing up for the right of individuals to access health care services through a strong regulatory oversight of public to private health care service conversions.

4. Integration of health care and public health through publicly-accountable mechanisms to assure maximum responsiveness to community needs.

APHA also has a record of support for building and maintaining healthy communities, calling on government other sectors of society to invest in programs and policies that can achieve health at the community level. These include:

The role of public health in ensuring healthy communities (#9521PP)
Support for immunization programs (#200023)
Reducing the rising rates of asthma (#200012)
Promoting public health through physical activity (#9709)
Disabilities prevention activities (#9505)
Reducing health disparities in people with disabilities through improved environmental programmatic and service access (#2004-02)

5. Clearly identified roles for federal, state, and local government health agencies.

The particular importance of Medicare, entitlement programs and public health coverage to vulnerable populations has been noted in:
The federal and state government role in advocating on behalf of children with special health care needs and their families (#9418)
By calling on the President and Congress to defend and support the Medicaid and Medicare (Maintaining the National Commitment to the Nation's Health #9601)
Promoting Accountability in the Provision of Health and Welfare Services to Persons with Mental Illness (#9604),\
4APHA policies also support the government’s obligation to address social, economic and political determinants of health:
Maintaining the National Commitment to the Nation's Health (#9601) affirms that the health of the people requires a universal national health care policy as well as social and economic policies that foster the health, stability, and general welfare of the population, including resources that are basic to health: affordable housing, a safe and nutritious food supply, a safe, peaceful environment, full employment opportunities for a meaningful role in society, and education and information throughout the life span.

As such, APHA urges the President and Congress to defend and support the Medicaid, Medicare, and federal public health, environmental protection, occupational health and safety programs, and federal housing, food, nutrition, and income maintenance entitlements and programs, as well as voter registration services in all public health agencies.

More recently, APHA supported an Urgent Call for a Nationwide Public Health Infrastructure and Action to Reverse the Obesity Epidemic (#200619) which requires multiple cross-cutting policy recommendations.

Policies also call for strengthening the public health infrastructure including: HIV Surveillance by State Public Health Agencies (#9920)

Reducing youth tobacco use (#9514)
Public health laboratory services (#9614)
Integrated vector control (#200013), which asks to strengthen state and national disease surveillance and detection systems and adequately fund public risk communication.
The Role of Public Health in Ensuring Healthy Communities (#9521) recognized public health agencies as the lynch pins for protecting the public from illness, disease, injury, unnecessary death and disability. These may take the form of research, policy and programs affecting workplace hazards, and safety of air, water, and food, and community development.

6. Incentives and safeguards to assure effective and efficient organization and integration of services and a high-quality health system.

Coordination of carefor vulnerable populations is emphasized in Linkage of Medical Services for Low-Income Populations with Mental Health, Substance Abuse (#9611)
Standards of protection, regulatory oversight and enforcement have been standard tools of safeguarding both individual and public health.

7. Fair payment to providers using mechanisms which encourage appropriate treatment by providers and appropriate utilization by consumers.

8. Ongoing evaluation and planning to improve the delivery of health services with consumer and provider participation.
APHA has endorsed public accountability, with adequate data systems for monitoring performance and comparative evaluation and organization and administration by federal, state, and local governments assisted by regional organizations for planning and evaluation (#7018)
9. Inclusion of disease prevention and health promotion programs.

10. Support of education and training programs for all health workers.

Workforce policies recognize a range of health care providers, and the importance of training, recruitment and retention policies that foster a diverse workforce, well qualified to provide high quality and responsive care (#20013, #20032, #9402, #9414, #2005-12)
Further, the call for Ethical Restrictions on International Recruitment of Health Professionals to the United States
(#200616) recognized the regrettable absence of a rational, unified national health system. Noting that this impedes our ability to adopt an “ethical recruitment policy” in the face of a health care marketplace that is growing increasingly dependent on foreign-trained health workers. As such, APHA urged:
- Voluntary adoption of a health industry-wide code of ethics that guides recruitment and employment of health professionals (including unlicensed caregivers) from abroad.
- Expansion of class size for U.S. health professional training programs
- Government subsidies to improve salary scales and working conditions
- Incentives to better distribute health professionals
- Regulations on U.S. government health care services contracts (e.g., for Medicare and research purposes) to abide by a specified code of standards.

11. Affirmative action programs in the training, employment, and promotion of health workers.

Endorsed in Addressing Hispanic Underrepresentation in the Health Professions (#9613):

12. Non-discrimination in the delivery of health services.

Principles were endorsed in support for disabilities prevention activities (#9505),
Improving the health status of American Indians and Alaska Natives (#20015)
Ensuring access to health services for undocumented immigrants (#9401), and
Support for culturally and linguistically appropriate primary care and prevention services (#9616)

13. Education of consumers about their health rights and responsibilities. In 1970, APHA took an initial step toward development of a rational health system in this country by recommending a "national health care program to include democratically constituted, consumer-majority, policy making bodies at every level of administration.” (#7018)

To update this resolution for the 21st Century, APHA requests that a specific taskforce study existing health reform proposals and make recommendations to ensure that any health system reform provides an adequate infrastructure to support democratic, community input into issues of health care access, quality, resource distribution, and priorities.

Proposed health care system reforms for children (#9418) included planning and evaluation with consumer and provider participation and mechanisms to ensure consumer participation in governance and redress of grievances. It also specified consumer education with the appeal that public agencies take the role to inform consumers and providers about individual rights, entitlements, and standards that define quality health care. Additionally, consumer organizations were given a role in assisting families with information and support.

14. Attention in the organization, staffing, delivery, and payment of care to the needs of all populations including those confronting geographic, physical, cultural, language, and other non-financial barriers to service.

In 1970, APHA called for a health care system reform financed by combination of federal social insurance and general tax revenues, to insure health care as a social right, and to achieve reasonable equity in paying for it (#7018).
Eliminating financial and other barriers to care have been affirmed in several prior APHA policies (#9616, #9418, #7018)

III. Optimizing Health Reform Policy

Efforts to establish universal coverage for the entire population in the U.S. dating back to the early 1900s have faced serious obstacles. Recent successful national health care reform efforts in the U.S. include federal legislation that created Medicare and Medicaid in 1965, publicly financed programs that cover all eligible residents. Medicare is a federally funded program that covers U.S. residents age 65 and over who have contributed to the cost of the program through payments to the Social Security system, and people with certain health conditions and disabilities. Medicaid is funded by both the federal and state governments, and administered by states. It covers some low-income residents with certain health conditions. Medicaid covers pregnancy for most low-income women, and is the major source of funding for nursing home services. Federal law also created the State Children’s Health Insurance Program, which covers about half of low-income children.

The present financial crisis has renewed interest in and the opportunity to address the health care crises of the under- and uninsured, and unaffordable care. Current proposals vary in methods of financing and coverage, and the degree of change they seek to make to the existing patchwork system. Proposals also incorporate assumption about political factors that could influence the success take into account both fiscal and political projections in designing optimal plans for the American public.

Each system has important implications for meeting APHA’s criteria for reform. APHA should support proposals that can succeed in achieving universal coverage – that is, covers all residents - and is affordable, as well as other critical goals. Such programs must at a minimum strengthen and expand existing public sector, social insurance programs such as Medicare, Medicaid, SCHIP and safety net services (public hospitals, community health centers, and a network of state, county, local and nonprofit health services).

III. Key Public Health Issues in Health Reform

Social Determinants of Health

A growing recognition of the social determinants of health, such as clean and safe food, water and air; safety from violence, security in income, nutrition, shelter, and community; unfettered access to clinical preventive services, immunizations and screenings; and disease surveillance all play vital roles in the health of our communities nationwide.

The broadest view has been articulated by the Commission on the Social Determinants of Health 2008: Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. These avoidable health inequalities arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces and policies.

Health IT

Inefficiencies are inherent in a patchwork system with many layers of administration and redundancies because health care providers and service agencies cannot easily share or exchange information. As a result, calls for bringing health care information technology into the 21st Century have become more popular (MedPac 2004). The Institute of Medicine’s Quality Chasm report (2001) called for new organizational models capable of investing in health information technology (IT); managing new clinical knowledge and skills; designing care processes based on best practices; assembling and deploying multidisciplinary teams; coordinating care; and measuring and improving performance. The development of databases, registries, and tracking systems facilitate monitoring of diseases, risk factors, and other factors needed to assess, plan for, and predict interventions and outcomes. Clearly, investment in IT tools must be part of investing in our health system infrastructure.

Accountability of health care

Health planning and regulatory oversight have been essential tools in controlling market-driven inefficiencies in health care delivery (Center for Governmental Research 2008). Unlike other industries, in which competition and market forces promote price controls and efficiency, price controls in the health care industry are weak, and often misdirected. Competition in health care has resulted in overcapacity, rather than greater efficiency (i.e. capacity that matches consumer needs) and lower costs for consumers. While not all stakeholders embrace community health planning and regulation, they have been shown to improve performance by supporting planning, supplementing resources, addressing overcapacity, and promoting standards. In Rochester, New York, a long-standing history of community-based planning helped limit the expansion of hospital capacity, and control the diffusion of expensive medical technology to effectively control health care expenditures (Hall & Griner 1993).

Improving the Population’s Health

“Covering the uninsured and modernizing America’s health care system are urgent priorities, but they are not enough. This nation is facing a true epidemic of chronic disease. An increasing number of Americans are suffering and dying needlessly from diseases such as obesity, diabetes, heart disease, asthma and HIV/AIDS, all of which can be delayed in onset if not prevented entirely. One in 3 Americans—133 million—have a chronic condition, and children are increasingly being affected.

“The federal government and state and local governments play critical roles across the full range of disease prevention and health promotion activities. First, working together, governments at all levels should lead the effort to develop a national and regional strategy for public health and align funding mechanisms to support its implementation. Second, the field of public health would benefit from greater research to optimize organization of the 3,000 health departments in this nation,45 collaborative arrangements between levels of government and its private partners, performance and accountability indicators, integrated and interoperable communication networks, and disaster preparedness and response. Third, the government must invest in workforce recruitment as well as modernizing our physical
structures, particularly our public health laboratories. And finally, the government must examine its own policies, including agricultural, educational, environmental and health policies, to assess and improve their effect on public health in this nation.” (Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All)

Health Impact Assessments can call attention to neighborhood conditions, and broader social and economic policies, that directly affect health at the population level. For example, residents, city planners and health departments can call attention to the need for healthy built environments. These require adequate and good quality housing; access to public transit, schools, and parks; safe routes for pedestrians and bicyclists; meaningful and productive employment; unpolluted air, soil, and water; and, cooperation, trust, and civic participation. The Healthy Development Measurement Tool connects public health to urban development planning to achieve a higher quality social and physical environment that advances health. http://www.thehdmt.org/

In addition, APHA must play a key role in advocating for a strong public health infrastructure and a system that improves population health. While often neglected in the past, public health is now frequently referenced by policymakers, both regarding health care delivery system improvements and support for clinical preventive services such as immunizations, and also regarding broader public health functions that safeguard and improve population health, from monitoring and surveillance of health conditions to addressing social and economic inequalities.

IV. Financing Comprehensive Reform
APHA has expressed support for the single payer financing system for decades, including through the 14 Points and in a 1995 policy statement. Under this system, a single payer - the government - pays directly for all health care. This system is widely accepted by Lewin and other analysts (Congressional Budget Office, Government Accounting Office) to be capable of achieving the two important attributes of successful and sustainable health care systems: 1) Universal coverage. Eligibility is guaranteed automatically as a condition of the program, eliminating current private insurance industry practices such as exclusions for pre-existing conditions. Private plans compete by seeking to exclude people who are likely to use health benefits, and who would thus incur a “loss” to the insurance company; or by limiting services and reimbursements to patients. A single payer plan would also achieve: 2) A substantial measure of cost control. This is possible because the government has sufficient economic and political power to negotiate for affordable prices with health care providers, including the pharmaceutical industry. The system eliminates the participation of the thousands of private health insurance plans, and therefore sharply reduces administration costs, estimated at 31% of health care expenditures, many times higher than Medicare or other national systems. (Woolhandler 2003).

Most other industrialized countries employ some form of government mechanism to assure universal coverage and to control costs. All have better coverage and spend less than the U.S. They have health outcomes that are at least as good as the U.S., and in some cases better.

Industries that would lose substantial revenues under a single payer system are politically opposed to it. The private health insurance industry would be sharply curtailed, while the pharmaceutical, hospital supply, and other health-related industries would experience prices more in line with those in the rest of the world. Other opponents include interests who are ideologically or structurally in favor of free market approaches as an alternative to government administration of health care services, which often include large employer groups, and individuals who mistrust the government. Single payer proposals have been portrayed in the past as too sharp a departure from present arrangements (Lake 2007, Geyman 2005). However, single payer legislation has passed in two separate sessions of the California legislature in the last four years. The public and most physicians now express support for a government-financed system like Medicare. (Carroll, Ackerman)

A report prepared by the Institute for Health and Socio-Economic Policy (2009) asserts that implementing a single payer system would create over 2.6 million new jobs--more than the number of jobs lost during 2008--and create an economic fiscal stimulus of $317 billion. The authors concluded that cost savings would exceed the new costs of providing universal coverage for all.

HR 676 of 2009 is the most recent national legislation that builds on the Medicare program to propose a single payer financing system.

V. APHA’s Role in Reform

APHA shares values with many of the groups seeking to fix our ailing health care system. Indeed, its record of support for the inclusion of home and community-based long-term care and other options not traditionally covered by any conventional public or private health plans enables APHA to advocate for enriching many proposals for “universal health care.”

APHA must marshal its forces to articulate and advocate for its long-standing policies. Premier among these is universal coverage for all residents. This is a basic cornerstone of human rights as well as APHA policy. It is essential to the ability of any health system to contribute to improving health, at a cost that is affordable for all payers, including individuals, employers and the government.

Additionally, APHA is uniquely positioned to advocate for the inclusion of public health in the reform policy discussions. By calling for “health reform,” APHA can broaden the policy agenda to include key policy areas that impact Americans’ ability to achieve optimum health. These include:

Building a robust multi-disciplinary health planning infrastructure that guides policy and program development on behalf of our communities.
Restoring strong regulatory oversight to ensure that any health system reforms work in the best interest of health care consumers. And, as a core value, that the
Incorporating non-medical social determinants of health (e.g., economic, urban development, agricultural, environmental, housing, zoning, transportation, trade and other policy arenas) into program and policies that support each community’s ability to offer healthy living options to all its residents.

APHA has the capability and responsibility to mobilize the efforts of our members, leaders and staff, and to build partnerships with allies and policy-makers, to assure that the present historic opportunity for transformational change is realized.

Action Statements

Therefore the American Public Health Association

Urges Congress and the Administration to enact a program of universal coverage for health care that includes all residents, that is affordable for all payers, including individuals, employers and the government, and that is consistent with APHA policies and principles.

Urges Congress and the Administration to support and enact the First 100 Days Agenda for Health Reform, and to continue its approach to health reform: to strengthen and expand existing public health insurance programs, and to improve the public’s health.

Urges the US Congress and DHHS to consider and adopt the APHA’s 14 principles of health care reform, and the Center for Policy Analysis’ Criteria for Reform.

Urges the DHSS and the CDC to identify multidisciplinary best practice preventive health education practices (e.g. weight management education, diabetes education, asthma education) and recommend they be covered health benefits for all Americans.

Urges the CDC to develop a community health registry as part of the health care information technology initiatives that gathers data on chronic diseases and key determinants of health.

Urges the CDC to endorse an agenda that supports education, policy and practice in addressing the social determinants of health by funding best practices that improve the health of communities.

Urges CDC identify an office within the organization that can oversee evaluation of community health assessments, certificate of need programs and health impact assessment.

Urges Congress to allocate financial and human resources at federal, state and local levels to set up a workgroup in collaboration with professional organizations including, but not limited to, APHA, Association of State and Territorial Health Officials (ASTHO), Council of State and Territorial Epidemiologists (CSTE), and the National Association of County and City Health Officials (NACCHO) to develop a plan and recommendations for developing and evidence-base of effective community health assessment practice.

Urges DHHS to engage in a new era of health care regulatory and participatory oversight including restoration community health planning as a planning and regulatory process that empowers communities to participate in identifying their health care needs, making service providers accountable for meeting them, and evaluating their impact on community health status.

Urges the US Congress and the National Conference of State Legislatures to adopt a legislative strategy that will consider the community health impact of budget decisions and new laws (e.g., zoning, agriculture, water, urban development, economic development, education)

Pledges - and urges membership units and members to engage in the health care reform debate by building and working with coalitions and providing input to guide health care reform policy agendas and advocacy work to protect vulnerable populations and communities and to identify public health initiatives to include in existing reform agendas.

References

Axeen S & Carpenter E (2008) The cost of doing nothing, Why the cost of failing to fix our health system is greater than the cost of reform. New America Foundation November 2008.

Brookings/JTPC: Brookings-Urban Joint Tax Policy Center (2008) An updated analysis of the 2008 presidential candidates' tax plans: Revised August 15, 2008
http://www.taxpolicycenter.org/publications/urlprint.cfm?ID=411749; and
Aug. 28: http://www.taxpolicycenter.org/publications/url.cfm?ID=411750

Brown ER et al. (2008) Nearly 6.4 million California residents lacked health insurance in 2007 – Recession likely to reverse small gains in coverage. UCLA Center for Health Policy Research, Los Angeles, CA.

Carroll A & Ackerman (2003) Support for national health insurance among U.S. physicians: 5 years later. Annals of Internal Medicine, 148(7), April 1, 2008; ABC News/Washington Post, Oct. 9-13, 2003, Associated Press/Yahoo News Poll, Dec. 14-20, 2007.

Center for Policy Analysis (2008) Criteria for Reform, 2008, http://www.centerforpolicyanalysis.org/sitebuildercontent/sitebuilderfiles/compareplanscriteria8-08.pdf

Collins S et al. (2009) Analysis of leading congressional health care bills, 2007-2008:
Part I, insurance coverage. January 2009 (see pp. 29-34, 93-99) http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=777197

Corburn J & Bhatia (2007) Health Impact Assessment in San Francisco: Incorporating the Social Determinants of Health into Environmental Planning. Journal of Environmental Planning and Management, Vol. 50, No. 3, 323 – 341, May 2007

Chavkin W, Rosenbaum S, Jones J & Rosenfield A (2008) Women’s health and health care reform: The key role of comprehensive reproductive health care. Mailman School of Public Health at Columbia University.

Citizens Health Care Reform Working Group (Sept 2006). The health report to the American people. http://govinfo.library.unt.edu/chc/healthreport/healthrep.html

Cohen L et al. (2008) Reducing health care costs through prevention. The Prevention Institute, Oakland CA.

Commission on the Social Determinants of Health (2008) Closing the gap in a generation: Health equity though action on the social determinants of health. World Health Organization. Geneva, Switzerland.

Daschle T, Greenberger S & Lambrew, JM. (2008). Critical: What we can do about the health care crisis. Thomas Dunne Books, St. Martin Press.

Families USA (2008) Empty promise: Searching for health insurance in an unfair market. Washington DC

Geyman JP (2005). Myths and memes about single-payer health insurance in the united States: A rebuttal to conservative claims. International Journal of Health Services, 35(1): 63-90.

Institute for Health and Socio-Economic Policy (2009). Single Payer/Medicare for All: An economic stimulus plan for the nation (version 1.0)

Lake, C (2007). How to talk to voters about health care, December 5, 2007, presentation to the Minnesota Legislature.

The Lewin Group (2008). Cost impact analysis for health care in America proposal final report. Prepared by the Economic Policy Institute. The Lewin Group, Inc.

MedPac (2004). Report to the congress: New approaches in Medicare, Chapter 7 Information Technology in Health Care. June 2004

National Coalition on Health Care (2008) Facts on health insurance coverage. Washington, DC

National Multiple Sclerosis Society (2008) National health care reform principles. NMSS Washington DC.

National Physicians Alliance (2008) Achieving guaranteed, quality, affordable health care for all. Reston, VA

The Rekindling Reform Steering Committee (2003) Rekindling Reform: Principles and Goals January 2003, Vol 93, No. 1 | American Journal of Public Health 115-117.
Woolhandler, S et al. (2003) Costs of health care administration in the United States and Canada, New England Journal of Medicine 349: 768-775.

Feb 11 Webinar: Role of Community in Health System Reform?

Pritii — Thu, 19 Feb 2009 11:42:05 CST

Much momentum is building around national health care reform for 2009. The general public, policymakers, business representatives, and the health care workforce have all deemed the current system to be “broken.” We know that health care in the United States costs more than in other developed countries, yet yields poorer health outcomes--despite accounting for 16% of our GDP. Moreover, public health services account for a small fraction of overall health care spending.

To understand these issues, the Community Health Planning and Policy Development (CHPPD) Section of APHA offered a free webinar on Wednesday, February 11, 3 – 4 pm Eastern Time. Five speakers presented perspectives on a position paper the section worked on with the Medical Care Section. They described community health planning from the medical perspective and from the public health/community perspective with opportunities for action. The learning objectives of the webinar stated the participants would:

Understand the difference between community health planning in the medical and public health/community realms.
Be able to analyze if community health planning features in current health system discussions.
Be able to recognize how community health planning affects access, cost and quality of health systems?
Know concrete action steps to take to enable community, public health and medical systems collaboration on health system reform.

Moderator: Apryl R. Brown, MPH, MD, Instructor, Wayne County Community College District in Detroit, Michigan and Coordinator, Detroit Medical Reserve Corps

Presenters:
Tammy Pilisuk, MPH, Unit Chief, Provider Education of the Information and Education Section, Immunization Branch, California Department of Public Health
Ellen R. Shaffer, Ph.D is a Co-Director of the Center for Policy Analysis, and Assistant Clinical Professor in the Department of Clinical Pharmacy at the University of California, San Francisco
John Steen, Principal, John Steen & Associates, and Immediate Past President, American Health Planning Association
Lauren Tobias, MPP, Deputy Director, Division of Policy for the Office of Health Systems Management, New York State Department of Health
Priti Irani, MSPH, Research Scientist, Office of Public Health Practice, New York State Department of Health

Registration for the webinar is now closed.

Resources:

APHA 14 Points on Universal Health Care

Pritii — Wed, 11 Feb 2009 12:41:02 CST

APHA 14 Points on Universal Health Care Toward a National Health Program for the United States
Source: http://www.apha.org/advocacy/priorities/issues/access/legislative14points.htm

In the early 1990's, the APHA Executive Board enunciated 14 principles for use in evaluating proposals for a National Health Program. These criteria were distilled from policies adopted by the APHA Governing Council over the years. They continue to reflect our views and, we believe, the views of the majority of APHA members.

Universal coverage for everyone in the United States.
Comprehensive benefits including health maintenance, preventive, diagnostic, therapeutic, and rehabilitative services for all types of illnesses and health conditions.
Elimination of financial barriers to care.
Financing based on ability to pay.
Organization and administration of health care through publicly-accountable mechanisms to assure maximum responsiveness to public needs, with a major role for federal, state, and local government health agencies.
Incentives and safeguards to assure effective and efficient organization of services and high-quality care.
Fair payment to providers using mechanisms which encourage appropriate treatment by providers and appropriate utilization by consumers.
Ongoing evaluation and planning to improve the delivery of health services with consumer and provider participation.
Inclusion of disease prevention and health promotion programs.
Support of education and training programs for all health workers.
Affirmative action programs in the training, employment, and promotion of health workers.
Non-discrimination in the delivery of health services.
Education of consumers about their health rights and responsibilities.
Attention in the organization, staffing, delivery, and payment of care to the needs of all populations including those confronting geographic, physical, cultural, language, and other non-financial barriers to service.

APHA 14 Principles for Health Care Reform

tpilisuk — Wed, 11 Feb 2009 11:22:44 CST

APHA 14 Points on Universal Health Care Toward a National Health Program for the United States
In the early 1990's, the APHA Executive Board enunciated 14 principles for use in evaluating proposals for a National Health Program. These criteria were distilled from policies adopted by the APHA Governing Council over the years. They continue to reflect our views and, we believe, the views of the majority of APHA members.

Universal coverage for everyone in the United States.
Comprehensive benefits including health maintenance, preventive, diagnostic, therapeutic, and rehabilitative services for all types of illnesses and health conditions.
Elimination of financial barriers to care.
Financing based on ability to pay.
Organization and administration of health care through publicly-accountable mechanisms to assure maximum responsiveness to public needs, with a major role for federal, state, and local government health agencies.
Incentives and safeguards to assure effective and efficient organization of services and high-quality care.
Fair payment to providers using mechanisms which encourage appropriate treatment by providers and appropriate utilization by consumers.
Ongoing evaluation and planning to improve the delivery of health services with consumer and provider participation.
Inclusion of disease prevention and health promotion programs.
Support of education and training programs for all health workers.
Affirmative action programs in the training, employment, and promotion of health workers.
Non-discrimination in the delivery of health services.
Education of consumers about their health rights and responsibilities.
Attention in the organization, staffing, delivery, and payment of care to the needs of all populations including those confronting geographic, physical, cultural, language, and other non-financial barriers to service.

Community Health Planning

Pritii — Tue, 10 Feb 2009 10:05:58 CST

By John Steen

Community health planning is a deliberate effort to involve the members of a geographically defined community in an open public process designed to improve the availability, accessibility, and quality of healthcare services in their community as a means toward improving its health status. That public process must provide broadly representative mechanisms for identifying community needs, assessing capacity to meet those needs, allocating resources, and resolving conflicts. The challenge that community health planning addresses is that of making the healthcare system more accountable to average residents in their communities. The policy rationale for this is that of bringing private interests in healthcare delivery into better alignment with public interests.

From the beginning of national community health planning in the establishment of Comprehensive Health Planning Agencies in 1966, the federal government explicitly operationalized a commitment to providing consumers, including minorities and the poor, the opportunity to play a policymaking role in planning, delivering, and evaluating the healthcare services for which they are in greatest need.

Community Health Education

If it is to constitute a community benefit, the process conjoining consumer and provider, layperson and professional, community and provider organizations in partnership, must recognize and operationalize a set of imperatives involving the sharing of information which is personally meaningful to each participant in each of the roles played by the participant in the community. The information about community health status, health problems, and resources must be assimilated and integrated by each participant into his or her understanding of the community and its value system before the participant is asked to base decisions about resources and needs on it. The requisite decisions are judgments which are made by the participants acting on behalf of the community -- a fiduciary responsibility they may be expected to meet only if their judgment is informed.

Therefore, the sponsor of a community health needs assessment should understand the nature and extent of the obligation it assumes through its sponsorship: To support community discussion in which each participant understands the bearing and relevance of all of the major factors -- in epidemiology and sociology, in the health care system and the community which contribute to, and complicate, his or her judgments. Given the scope and complexity of those factors, it is a daunting challenge for a sponsor to meet its obligation.

It is by operationalizing respect for the community that a sponsor induces the community to become vested in the partnership in which responsibility for improving the health of the community is shared. Planners show respect by becoming aware of their community’s concerns, and officials demonstrate their willingness to be accountable to their constituents in how they use resources. Respect is shown too by recognition of the validity of community judgments even when they differ from more rigorous professional judgments.

The predominance of the instrumental approach to health promotion reflects the bias in favor of measuring the efficacy of interventions in behavioral terms rather than in normative terms that consider the intention of people to achieve well being by living a good life. If we truly wish to promote their health, we must promote their ability to think for themselves and exercise their own judgment. Our intent must be their empowerment and not their manipulation.

Community Engagement

The U.S. Institute of Medicine has described the proper use of community assets by public health:

“Communities and community organizations can be vital contributors to the resources and capacity of a public health system. A community’s right to self-determination, its knowledge of local needs and circumstances and its human, social, and cultural assets, including the linkages among individuals, businesses, congregations, civic groups, schools, and innumerable others, are all important motivations for community health action. In cases in which community health promotion and protection activities are initiated by a health department or an organization, engaging the community is a primary responsibility. Realizing the vision of healthy people in healthy communities is possible only if the community, in its full cultural, social, and economic diversity, is an authentic partner in changing the conditions for health.”[i]

The community health planning process can be used to create coalitions to identify and to address community health needs and problems.[ii] Their functions may include:

Undertaking community health needs assessments and community health improvement projects;
Receiving health education to enable spokespersons to exercise informed judgment on health policy issues;
Mobilizing community health initiatives; and,
Building capacity to address community priorities.

Through the experience acquired in performing such functions, coalitions can then provide a voice for:

How health plans serving their communities are governed;

How quality of care is measured;

Making the health care system more responsive to consumer needs;

Planning and developing services to meet their needs, and evaluating results;

Providing oversight for provider initiatives;

Validating the missions of health care systems;

Improving the health status of all of their members; and,

Determining how societal resources are distributed.

The significance of such a community health planning process is captured in the realization that it is unique for examining the way in which the entire healthcare system is organized in a community, and how it interfaces with all the community’s needs. The legitimization of that process derives from its embodiment of the best principles of democracy and good government, but most of all, by the validation of the community that supports and participates in it.

Regulatory Activities

In the context of community health planning, certificate of need (CON) and licensure regulations are seen as policy tools for implementing local and state health plans. A state health plan can incorporate general policies for the state’s delivery system as well as service specific standards against which regulators may measure proposals.

Certificate of need is a public process which makes healthcare providers accountable for meeting access, quality and cost standards, and provides a context within which provider initiatives may be evaluated against alternatives for meeting state priorities for improving the health status of its citizens. New York State invented CON in 1964-65 through legislation which declared as its “policy and purpose” that “hospital and related services of the highest quality, efficiently provided and properly utilized at a reasonable cost, are of vital concern to the public health.”

The essential function of CON programs is to transform private business plans into public information. The best programs also use an open public process to draw up a state health plan, and public hearings in the review of CON applications. Although CON is not proactive, ultimately having to choose among provider proposals, it does provide the opportunity for negotiations in which plans may be improved. Within their statutory authority, CON programs can make their approvals contingent on state health plan provisions and policies, and on the concerns they hear from their communities. And by reviewing a batch of similar applications competitively, they can establish a process in which providers are motivated to best satisfy considerations reflecting the public interest.

Public Health

Healthy People

The Department of Health and Human Services’ Healthy People initiative is the most comprehensive set of goals and goal setting processes in public health, one that sets our national public health priorities. It began with the 1979 Surgeon General’s Report of the same name, and it is renewed each decade, providing a set of prevention and health status objectives used to measure the progress of federal public health programs, guide the development of state and community plans, and measure the performance of health plans serving communities. It includes a guide for communities, Healthy People in Healthy Communities.[iii]

Mobilizing for Action through Planning and Partnerships (MAPP)

Mobilizing for Action through Planning and Partnerships (MAPP)[iv] is a tool that communities can use to do strategic planning for community-wide health improvement. It outlines a process for the collaboration and participation of a broad range of community stakeholders in the development of a plan. The process builds ownership of the plan and the commitment to carry it out among those participating. Teaching residents to think collectively about their communities is one of the ways it does so.

MAPP is the product of a cooperative agreement between the CDC and NACCHO. It begins with a partnership between community groups and officials in which a health department, health plan, or hospital acts as convener. A steering group with subcommittees representing all sectors of the community guides the endeavor. The group creates a vision of better health for its community and proceeds through four assessments: A community themes and strength assessment, a local public health system assessment, a community health status assessment, and a forces of change assessment. It identifies strategic issues elicited through its assessments, formulates goals and strategies, and plans action steps to meet them.

It is in these assessments, especially of the local public health system,[v] that community health planning tools and methods are brought into public health to a greater extent than in previous practice, in order to determine the extent to which the ten essential public health services are being performed. Two of the ten bring this point home:

Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
Research for new insights and innovative solutions to health problems.

What is important in engaging the community is not the process model used but the forums for public deliberation in which the best judgment of all members can be aired. It is more important for public officials to learn how the public frames public health issues than it is for them to try to provide answers to them.

Between 1996 and 2002, the W.K. Kellogg Foundation initiated a program of community engagement known as Turning Point. Experience was acquired from 41 local Turning Point partnerships. Several of these proved sufficiently autonomous to define the public health needs of their communities and what public health meant to them, developing their own agendas. Their definitions of public health represented a wide scope of core public health functions:

Community assets/mobilization
Health services for underserved
Health services for general population
Oral health
Behavioral health
Occupational health
Environmental health
Social determinants of health
Public safety
Economic development[vi]

Public health must acknowledge communities to be the primary subjects of its practice. The three dimensions of public health – the familiar triad of agent, host, environment – represent a dynamic that exists within the fourth dimension of community. Community determines the effects, quantitatively and qualitatively, of that dynamic. And people are themselves agents in the cause of pursuing their own wellness and not to be manipulated as mere hosts.

The Benefits of a Mature Planning Process: Solidarity and Good Government

Over the course of time spent in their public deliberations, participants develop a sense of collegiality and trust. Social, economic, and political capital will likely be distributed unequally among them, but differences can often be overcome by personal and social relationships that grow in strength over time. Furthermore, the planning process fosters greater allegiance to the communitarian values that unite them as members of the community.

The members of communities participating in health planning are learning about their communities and applying good public health principles grounded in social justice. As informed citizens, they become constituencies for developing consensus on an agenda for progressive political and social change. This was one of the aims that led Congress to establish the national health planning program in 1974 when it was seen as a precursor for a national health insurance program.[vii] Ultimately, as a process of civic participation, the community and the nation can gain newly articulate spokespersons and advocates for progress.

The community’s participation in a public policy process that encourages self-government can pay dividends for democracy. Government’s involvement in planning brings it closer to the people and restores accountability for the appropriateness of such planning. Seen as appropriate, the plans can foster public support for greater funding of public health.

[i] Institute of Medicine, Committee on Assuring the Health of the Public in the 21st Century, Board on Health Promotion and Disease Prevention. The Future of the Public’s Health in the 21st Century. Washington, DC: National Academy Press, 2002, p.204. http://www.nap.edu/catalog.php?record_id=10548#toc.

[ii] The Prevention Quality Indicators developed by the federal Agency for Healthcare Research and Quality (AHRQ) identify hospital admissions that could have potentially been avoided through high-quality community-based primary care: http://www.qualityindicators.ahrq.gov/pqi_overview.htm.

[iii] http://www.healthypeople.gov/Publications/HealthyCommunities2001/toc.htm.

[iv] http://www.naccho.org/topics/infrastructure/MAPPold/documents/MAPP_Handbook_fnl.pdf.

[v] Standards for local public health system assessment can be found in the National Public Health Performance Standards Program at: www.phppo.cdc.gov/dphs/nphpsp.

[vi] Community Participation Can Improve America’s Public Health Systems, prepared by The Lewin Group, Inc. for the W.K. Kellogg Foundation, April 2002, Exhibit 2, p.14. http://www.wkkf.org/Pubs/Health/TurningPoint/Pub3713.PDF.

[vii] Health Planning in the United States: Selected Policy Issues, Report of a Study, Volume I,
Institute of Medicine, 1981, p.34. http://www.nap.edu/catalog.php?record_id=9938.

Glossary: Health System Reform

Pritii — Tue, 10 Feb 2009 08:09:09 CST

Certificate of Need (CON): A Certificate of Need (CON), in the United States, is a legal document issued by a federal or state regulatory agency with authority over an area which affirms that a proposed acquisition, expansion, or creation of a facility falling under that authority is required to fulfill the needs of a community. The concept of the Certificate of Need first arose in the field of health care. New York passed the first certificate-of-need law in 1964, the Metcalf- McCloskey Act. (Available at http://en.wikipedia.org/wiki/Certificate_of_Need as of February 9, 2009)

Community: The aggregate of persons with common characteristics such as geographic, professional, cultural, racial, religious, or socio economic similarities; communities can be defined by location, race, ethnicity, age, occupation, interest in particular problems or outcomes, or other common bonds. (Public Health: What is it and How it Works. Turnock B.J.; Gaithersburg, MD:Aspen Publishers, Inc, 1997)

Community Health Assessment: Part of a strategic plan that describes the community by collecting, analyzing and using data to educte and mobilize communities, develop priorities, garner resources, and plan actions to improve public health. (Available at http://www.nyhealth.gov/statistics/chac/usefulcha/findings.htm#definitions as of February 9, 2009)

Community Service Plan: A Community Service Plan identifies at a minimum the populations and communities served by the voluntary non-profit general hospital and the hospital's committment to meeting the health care needs of the community. (NYS Statute - 10 NYCRR, Section 2801-1).

Community Health Planning: Delibrate pursuit of improvements in the health status of a community or the efficiency of the health care system through a public process that allows all members of the community to have significant input. (Reconsidering Community Health Planning for New York City. United Hospital Fund. Cavanaugh S, Tallon J. Issue Brief. 2008)

Health System: The network of organizations and professionals that participate in public health and health care services for a defined population or community. This network includes governmental public health agencies as well as relevant health care and social service providers, community based organizations, and private institutions with an interest in population health.(Public Health Administration: Principles for population-based management.Ed. L.F.Novick and G.P.Mays; Gaithersburg, MD:Aspen Publishers, Inc, 2001.)

Public Health: The mission of public health is to fulfill society's desire tocreate conditions so that people can be healthy (Institute of Medicine, 1988).

Prevention Quality Indicators:The Prevention Quality Indicators (PQIs) are a set of measures that can be used with hospital inpatient discharge data to identify quality of care for "ambulatory care-sensitive conditions." These are conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease. (Available at http://www.qualityindicators.ahrq.gov/pqi_overview.htm as of February 10, 2009)

Single Payer Health Care: of, relating to, or being a system in which health-care providers are paid for their services by the government rather than by private insurers . (http://www.merriam-webster.com/dictionary/single%20payer%20)

Socialized Medicine: Medical and hospital services for the members of a class or population administered by an organized group (as a state agency) and paid for from funds obtained usually by assessments, philanthropy, or taxation. (http://www.merriam-webster.com/dictionary/socialized+medicine)

Universal Health Care: Offers health care for all residents of a geographic/political entity; includes everyone, regardless of medical condition; a vast pool that guarantees affordable costs. (http://www.massnurses.org/single_payer/definitions.htm)

Community Health Planning and Health Care Reform

Pritii — Mon, 02 Feb 2009 09:07:03 CST

By John Steen

The benefits that may be achieved by giving community health planning a major role in establishing and operating health care systems are made evident in a careful review of its short history.

Health planning began as regional hospital planning by citizen councils in major cities. Cleveland established a Hospital Council in 1916 and issued a landmark survey of health care resources in 1920. However, the “consumer” members of such councils were civic leaders selected less for their skills in evaluating resource needs and costs than for their connections in fundraising to facilitate the financing of hospital projects.

Community health planning in the full sense of planning by members of the affected community began in 1960-61 in Rochester, NY when Marion Folsom who had served as the first secretary of the federal Department of Health, Education and Welfare (1955) formed a citizen planning council to review the community’s need for hospital beds and hospital plans to fund their construction.[1] Folsom was an executive at Kodak where it was believed that, as the city’s largest purchaser of health care, it had the right to ask such questions, and Blue Cross saw itself as a beneficiary too.[2] In 1964-65, New York State formalized that process in law and regulation by enacting the nation’s first Certificate of Need (CON) legislation.

The 1960s were the era of community action in which community health centers were developed with federal support. At that time, the Congress believed that consumers deserved to have a policymaking role in the institutions that served them, and so these centers were required to have community governing boards with consumer majorities. This marked the first federal initiative to put the community in charge of its health services as a major step toward “health reform.” However, with the ascendancy of conservative politics in subsequent years, the centers were relegated to the welfare system as a medical “safety net.”

In 1966, the federal Partnership for Health Care Act supported a network of state and local agencies to engage in comprehensive health planning, and they too were required to have boards reflective of their communities with consumer majorities. These agencies were able to go wherever their community health assessment and promotion activities led them, and they were expected to coordinate government planning to better serve their communities. They were the first agencies ever empowered to look at the organization of health care delivery in the community in its entirety.

The principal rationale for the federal role in health planning was to contain costs by controlling utilization of services funded by Medicare and Medicaid that had been enacted in 1965 without utilization controls. At the time, most businesses and Blue Cross plans throughout the nation supported health planning to reduce their costs too.

In the 1970s, the prospect of developing a national health insurance program furnished an additional reason for cost control. It also made it desirable to develop an understanding of health care delivery amongst the electorate, and with it a consensus of support for an adequate solution that would take the form of a national health care system.[3] The hearings in the Congress 35 years ago debated the same issues being debated there now, and Sen. Ted Kennedy was one of the principal authors/proponents of national health insurance and of community health planning’s role in it even then.

In 1974, the National Health Planning and Resources Development Act created a network of 205 local health systems agencies (HSAs) and corresponding state health planning and coordinating agencies, following a template of one HSA for every one million people, on average, in each state. Their legitimacy was firmly grounded in their being mirrors of their communities, but their volunteer members had much to learn about health care delivery and about their communities before they could act as fiduciaries for those communities. Orienting them to their roles was the function of health planning agency staff that over time delivered a practicum to the volunteers about all the factors involved in their deliberations.

The introduction of health systems agencies was seen to provide “the first serious opportunity for a comprehensive approach to the entire health care system.’”[4] It was an investment in the “democratization of health care” by a government that wished to make health care more accountable to the people. And for 12 years, it did just that, for the real significance of HSAs is that they were all about transforming the politics of health care through a new paradigm that gave a role to ordinary people and their community organizations. Among the unintended consequences of that political experiment was the deconstruction of the mystique, and with it the sovereignty, of modern medicine. Among the intended consequences was advancement of an ideal – the autonomy of individuals to make their own choices with regard to as fundamental a good as health and health care, i.e., consumer empowerment.

Consumer empowerment was the most progressive principle embodied in community health planning and regulation, and it was always in conflict with the ability of business to manage competitively in a “free market.” Today, the move away from reliance on market solutions once again provides an opening for government regulation.[5] The HSAs were an attempt to engage and realize “the democratic wish” by institutionalizing a communitarian process,[6] and once again we have an opportunity to design a comprehensive approach to the entire health care system that requires “broad, workable forms of popular participation.”[7]

I have traced this brief history so that it may inform our current efforts toward a national health care system that best serves all of us. I hope too, that by understanding it, we may avoid being condemned to repeat it.

I am going to address health planning and regulation as if they were integral to each other, two sides of the same coin, because they are. CON is reactive; health status (social justice) goals can only be met through a proactive population health approach. The experience of the HSAs demonstrated that it was the health systems plan that identified all community health needs and the strategies for meeting them. CON was a weak implementation strategy best for translating private business plans into public information, and engaging the public in reviewing potential service changes in terms of their likely impact on their communities. The most democratic processes staffed by HSAs were the public hearings they held in the course of acquiring community input for their plans and their major CON reviews. The greatest benefit to state health departments was in having their plans and expenditures better aligned with community circumstances and needs.

The classical process of community health planning was composed of three fundamental steps: First, survey health system resources, then determine how those resources could most efficiently meet area needs,[8] and finally plan the redirection of those resources. That redirection of resources is more effectively realized through collaboration with providers than through regulation.[9]

The current model for a community health planning agency is an “honest broker” able to convene community representatives to share data and analyze its import to the best interests of all the community’s members. It anticipates that its plans will be implemented through the community participants who formulated those plans and the coalitions that they are able to mobilize. The Finger Lakes HSA in Rochester succinctly describes its role as “collecting, analyzing and interpreting data, identifying problems and assessing service needs, convening stakeholders, advocating for and facilitating implementation of solutions, and evaluating and communicating results.”[10] This is more explicitly a population health approach of community engagement and community development. The message it conveys is that, to be addressed adequately, health issues must be owned by community leaders rather than by government agencies.

With their focus on how health issues impact their communities, health planning agencies must try to breach the barrier between medicine and public health, but the structure and funding of the medical care system is an impediment to the equitable provision of public health services. Medicine is focused on treatment as a personal health service rather than on prevention, and the most efficient prevention strategies are population health approaches. If we had a national health care system as a function of government as in European countries, both medicine and public health could be carried out by the same agencies in an integrated fashion. Over the past half-century, medicine and public health have become increasingly isolated, functioning as virtually independent disciplines. And most egregiously of all, all previous attempts to deliver a national health care system have totally ignored public health.

Logically if not politically, the only answer to this otherwise intractable problem is for reform to focus on health, rather than health care, on the end instead of the means, but to note too how much more effective public health is as a means. To reform our “system,” it must be refocused on the dignity and autonomy of those it serves who need to be educated about the true benefits of living a healthy life.

To the extent that there is public participation in community health planning, the public will come to demand that the systembe more accountable for meeting its true needs.

[1] Folsom’s Patient Care Planning Council trimmed the proposed number of hospital beds by 70%, and added nursing home beds. The result was to transform a $30 million hospital proposal into a $14 million community health care plan.

[2] And thus the community health planning and health regulation movement had its inception as a smart business initiative. See William P. Brandon, “Rochester: Flower City and Flexnerian Seedling,” in The Training of Primary Physicians, ed. Stephen J. Kunitz, University Press of America, 1986.

[3] This step was overlooked by the Clinton Administration’s ill-fated Health Security Act (1993-94) that offered us instead a “black box” process and the advice to “trust them” with one-sixth of the entire domestic economy.

[4] Anne and Herman Somers, “The Philadelphia Medical Commons: The Choices Ahead,” in Health and Health Care, ed. Somers and Somers, Aspen, 1977, p.251.

[5] New York City has felt the loss of its HSA acutely since 1996, and ever since then its progressive organizations have lobbied local government to restore community health planning/regulation. See http://www.phanyc.org/pdfs/NYCphiW2.pdf (p.8ff); http://www.uhfnyc.org/usr_doc/Jim_Tallon_testimony_on_health_planning.pdf; http://www.uhfnyc.org/usr_doc/Reconsidering_Community_Health_Planning.pdf.

[6] For an account of what it was like to be a volunteer health planner in an HSA in 1985, go to: http://www.context.org/ICLIB/IC09/Bird.htm.

[7] James A. Morone, The Democratic Wish: Popular Participation and the Limits of American Government. Basic Books, 1990, p.336. Morone explains how “American policy makers used the democratic wish to reconfigure the power relations in the health care system.”(321) It may again be the time for us to tackle the challenge to “marry democratic wishes to contemporary institutions.”(338)

[8] In the early health planning agencies, need was projected from existing service utilization; population-based need assessment came later. Mature health planning concentrated on increasing access to health care services for underserved populations.

[9] Community health planning agencies require a statutory mandate to acquire their sanction of “state action immunity” (from federal anti-trust laws) when they seek to have providers collaborate rather than compete in health care delivery. That sanction necessarily involves “active state supervision” based on "clearly articulated and affirmatively expressed" state policies.

[10] Wade Norwood, Director of Community Engagement, FLHSA, 2007.

American Public Health Association Policy Positions Related to Health Reform, 1993-2008

Pritii — Mon, 02 Feb 2009 05:05:21 CST

Policy Name and Number and Year	Date	Access to Care	Quality of Care	Financing	Public Health Infrastructure	Applied Research	Prevention
#20079: Building A Public Health Infrastructure For Physical Activity Promotion	11/6/2007	X		X	X		X
#200619: Urgent Call For A Nationwide Public Health Infrastructure And Action To Reverse The Obesity Epidemic	11/18/2006				X
#200616: Ethical Restrictions On International Recruitment Of Health Professionals To The United States	11/8/2006				X	X
#200611: Ensuring That Individuals Are Able To Obtain Contraceptives At Pharmacies	11/8/2006	X					X
#2005-12: Strengthening The Public Health Work Force To Address Current And Future Challenges	12/14/2005				X	X
#2004-02: Reducing Health Disparities In People With Disabilities Through Improved Environmental Programmatic And Service Access	11/9/2004	X			X	X
#20032: The Impact Of A Public Health Nursing Shortage On The Nation’s Public Health Infrastructure	11/18/2003			X	X	X
#20034: Protecting Essential Public Health Functions Amidst State Economic Downturns	11/18/2003			X	X
#200312: Increasing Access To Vision Rehabilitation	11/18/2003	X		X
# 200116: Recognizing The Role Of Veterinarians In The Public Health Workforce	1/1/2001				X
#20015; APHA Position Paper On The Health Status Of American Indians And Alaska Natives	1/1/2001	X			X
#20013: Increasing Access To Out-Of-Hospital Maternity Care Services Through State-Regulated And Nationally-Certified Direct-Entry Midwives	1/1/2001	X	X	X	X	X
#200117: Support the Framework for Action on Oral Health in America: A Report of the Surgeon General	1/1/2001	X		X	X
#200013: Maximizing Public Health Protection With Integrated Vector Control	1/1/2000			X	X		X
#20007: Support For A New Campaign For Universal Health Care	1/1/2000	X		X
#200012: Reducing The Rising Rates Of Asthma	1/1/2000	X	X	X	X	X	X
#200023: The Need For Continued And Strengthened Support For Immunization Programs	1/1/2000	X		X	X
# 9920: Support for HIV Surveillance by State Public Health Agencies	1/1/1999				X	X
#9702: Protecting Health Care Accessibility And Quality In A Profit-Oriented Marketplace	1/1/1997	X	X	X
#9701: For Nondiscriminatory Coverage Of All Mental Health Treatment	1/1/1997	X	X	X		X
# 9714: Support For Research On Alternative And Complementary Practices	1/1/1997					X
#9709: Promoting Public Health Through Physical Activity	1/1/1997	X		X	X	X	X
#9601: Maintaining The National Commitment To The Nation’s Health	1/1/1996	X		X	X		X
#9616: Public Health Services And Managed Care	1/1/1996	X					X
#9604: Accountability in the Provision of Health and Welfare Services to Persons with Mental Illness	1/1/1996	X	X	X	X	X
#9614: The Role of the Public Health Laboratory and the Definition of Public Health Laboratory Services	1/1/1996				X
#9613: Addressing Hispanic Underrepresentation in the Health Professions	1/1/1996				X
#9602: Maintaining Access to Care among Medicaid Recipients under State Block Grants	1/1/1996	X		X	X	X
#9611:Linkage of Medical Services for Low-Income Populations with Mental Health, Substance Abuse	1/1/1996	X	X	X			X
# 9502: Toward A Comprehensive Universal National Health Program	1/1/1995	X		X	X	X
#9504: Improving Access to Vision and Eye Health Services for Long-Term Care Facility Residents:	1/1/1995	X	X
#9505: Support for the Disabilities Prevention Activities	1/1/1995			X
#9514: Reducing Youth Tobacco Use through Increased Excise Taxes	1/1/1995			X			X
#9521: The Role Of Public Health In Ensuring Healthy Communities	1/1/1995			X	X	X	X
#9515: Protecting Confidential Data in Disease Registries	1/1/1995				X
#9522: Rural Health Goals: Guaranteeing a Future	1/1/1995	X	X	X	X	X	X
#9402: National Health Care Reform Incentives for Worksite Health Promotion Programs:	1/1/1994			X
#9401: Ensuring Access to Health Services for Undocumented Immigrants	1/1/1994	X		X
#9418: Children with Special Health Care Needs under Health Care Reform	1/1/1994	X	X	X	X		X
#9307People With Disabilities in National Health Care Reform	1/1/1993				X


HISTORICAL APHA POLICIES RELATED TO HEALTH REFORM
Policy Name and Number and Year	Date	Access to Care	Quality of Care	Financing	Public Health Infrastructure	Applied Research	Prevention
#7601; 1/1/1976: Committee for a National Health Service	1/1/1976				X	X
#7408: Health Insurance for Infants, Children, and Youth:	1/1/1974	X	X				X
#7018: A National Program for Personal Health Services	1/1/1970	X	X	X	X
#5013: Policy on Medical Care in a National Health Program	1/1/1950	X	X	X

Role of Community in Health System Reform? Presenters

JWSteen — Sat, 31 Jan 2009 20:24:06 CST

Apryl R. Brown, MD is an APHA Governing Councilor and Policy Co-Chair of the Community Health Planning and Policy Development Section. She is a member of the APHA Education Board. In her community, she oversees the operation of the Detroit Medical Reserve Corps (MRC), which is a local unit of the national community based organization Civilian Volunteer Medical Reserve Corps. The mission of the Detroit MRC is to address public health issues such as improving health literacy among the general public, increasing disease prevention, eliminating health disparities, and strengthening public health preparedness to be utilized during natural and/or man induced disasters and emergencies. At the University of Michigan Center for Public Health and Community Genomics, Dr. Brown works as a community outreach associate recruiting community-based organizations to attend activities pertaining to the field of genetics. As an adjunct faculty member at Wayne County Community College District, she teaches introductory biology and human anatomy and physiology to students pursuing various careers in the health care profession. In addition to belonging to APHA, Dr. Brown is a member of various public health, honorary, and civic organizations. She looks forward to continue participating in the APHA and working in the public health profession.

Priti Irani, MS is a Research Scientist in the Office of Public Health Practice at the New York State Department of Health. She assists local health departments, hospitals and community partners with planning initiatives. Before joining the NYSDOH in 1999, Priti worked for nine years as Public Health Educator at Schenectady County Public Health Services, and coordinated a Parent AIDS Education Program for Cornell Cooperative Extension, Schenectady County. Priti has a Masters in Science in Public Health from the University of Massachusetts in Amherst. She also has a Masters in Biochemistry from Baroda, India and worked as a journalist for two years in Mumbai (India).

Tammy Pilisuk, MPH is Unit Chief, Provider Education of the Information and Education Section of the California Department of Public Health's Immunization Branch, where she has worked for the past eight years. Before that, she worked for many years with the Family Caregiver Alliance to advance policy reform for long-term care. Tammy also has a long-standing volunteer relationship with the National Multiple Sclerosis Society, serving as chair of the northern California Government Relations Committee, winning a national leadership ward in 2001. In 2008, she was nominated to the Society's Federal Activism Council which advises the Society's public policy leadership. Her proposal for developing health care reform principles won acceptance of the full NMSS Board and the Society's "principles" document has now become the centerpiece of their advocacy efforts across the 50 states. Tammy is a graduate of the UC Berkeley School of Public Health and lives in Berkeley CA.

Ellen R. Shaffer, Ph.D is a Co-Director of the Center for Policy Analysis, an independent organization dedicated to protecting human health and expanding access to health care, water, and other vital human services, in an era of economic globalization. She is also an Assistant Clinical Professor in the Department of Clinical Pharmacy at the University of California, San Francisco. She served as senior health policy advisor to U.S. Senator Paul Wellstone from 1992 to 1995, guiding staff work on national health care reform and managed care patients' rights. Her proposal for a state-based universal health service, under a grant from the California Health Care Options Project, extended her work with U.S. Representative Barbara Lee on H.R. 3000, the U.S. Universal Health Service Act. She co-authored the chapter on politics in the latest edition of Our Bodies Ourselves. She serves on the Executive Board of the American Public Health Association. She has a Masters in Public Health from the University of California at Berkeley, a Ph.D. from the School of Hygiene and Public Health at Johns Hopkins University, and is a Certified Employee Benefits Specialist.

John Steen is a consultant with over 35 years of experience in community health planning, state health regulation, management consulting, public health and health policy. He was Assistant Director of the Health Systems Agency of NYC, 1978-1986. Subsequently, he was Executive Director of a New Jersey health planning agency, a consultant in Westchester County, NY, and Director of Georgia’s Regulatory Compliance/ Certificate of Need program. He has been a professor and lecturer in health policy. In recent years, Mr. Steen’s consulting engagements have been principally in certificate of need and community health promotion initiatives. For the American Health Planning Association (AHPA), he has concentrated on researching health policy issues in health planning, health regulation and public health.

Lauren Tobias, MPA is Deputy Director for the Division of Policy for the Office of Health Systems Management, New York State Department of Health. Prior to joining the New York State Department of Health, Ms. Tobias worked for Family Planning Advocates of New York State as a private consultant and prior that as Director of Public Policy. Ms. Tobias served as a Senior Legislative Associate for the Majority Leaders’ Research Office of the New York State Assembly. Ms. Tobias earned her Master of Arts in Public Affairs and Policy from the Rockefeller College of the State University at Albany.

"Role of Community Health System Reform?" Presenters

JWSteen — Sat, 31 Jan 2009 13:26:54 CST

Apryl R. Brown, MD is an APHA Governing Councilor and Policy Co-Chair of the Community Health Planning and Policy Development Section. She is a member of the APHA Education Board. In her community, she oversees the operation of the Detroit Medical Reserve Corps (MRC), which is a local unit of the national community based organization Civilian Volunteer Medical Reserve Corps. The mission of the Detroit MRC is to address public health issues such as improving health literacy among the general public, increasing disease prevention, eliminating health disparities, and strengthening public health preparedness to be utilized during natural and/or man induced disasters and emergencies. At the University of Michigan Center for Public Health and Community Genomics, Dr. Brown works as a community outreach associate recruiting community-based organizations to attend activities pertaining to the field of genetics. As an adjunct faculty member at Wayne County Community College District, she teaches introductory biology and human anatomy and physiology to students pursuing various careers in the health care profession. In addition to belonging to APHA, Dr. Brown is a member of various public health, honorary, and civic organizations. She looks forward to continue participating in the APHA and working in the public health profession.

Priti Irani, MS is a Research Scientist in the Office of Public Health Practice at the New York State Department of Health. She assists with offering technical assistance to local health departments, hospitals and community partners on planning and policy development initiatives. Before joining the NYSDOH in 1999, Priti worked for nine years as Public Health Educator at Schenectady County Public Health Services, and coordinated a Parent AIDS Education Program for Cornell Cooperative Extension, Schenectady County. Priti has a Masters in Science in Public Health from the University of Massachusetts in Amherst. She also has a Masters in Biochemistry from Baroda, India and worked as a journalist for two years in Mumbai (India).

Tammy Pilisuk, MPH is Unit Chief, Provider Education of the Information and Education Section of the California Department of Public Health's Immunization Branch, where she has worked for the past eight years. Before that, she worked for many years with the Family Caregiver Alliance to advance policy reform for long-term care. Tammy also has a long-standing volunteer relationship with the National Multiple Sclerosis Society, serving as chair of the northern California Government Relations Committee, winning a national leadership ward in 2001. In 2008, she was nominated to the Society's Federal Activism Council which advises the Society's public policy leadership. Her proposal for developing health care reform principles won acceptance of the full NMSS Board and the Society's "principles" document has now become the centerpiece of their advocacy efforts across the 50 states. Tammy is a graduate of the UC Berkeley School of Public Health and lives in Berkeley CA.

Ellen R. Shaffer, Ph.D is a Co-Director of the Center for Policy Analysis, an independent organization dedicated to protecting human health and expanding access to health care, water, and other vital human services, in an era of economic globalization. She is also an Assistant Clinical Professor in the Department of Clinical Pharmacy at the University of California, San Francisco. She served as senior health policy advisor to U.S. Senator Paul Wellstone from 1992 to 1995, guiding staff work on national health care reform and managed care patients' rights. Her proposal for a state-based universal health service, under a grant from the California Health Care Options Project, extended her work with U.S. Representative Barbara Lee on H.R. 3000, the U.S. Universal Health Service Act. She co-authored the chapter on politics in the latest edition of Our Bodies Ourselves. She serves on the Executive Board of the American Public Health Association. She has a Masters in Public Health from the University of California at Berkeley, a Ph.D. from the School of Hygiene and Public Health at Johns Hopkins University, and is a Certified Employee Benefits Specialist.

John Steen is a consultant with over 35 years of experience in community health planning, state health regulation, management consulting, public health and health policy. He was Assistant Director of the Health Systems Agency of NYC, 1978-1986. Subsequently, he was Executive Director of a New Jersey health planning agency, a consultant in Westchester County, NY, and Director of Georgia’s Regulatory Compliance/ Certificate of Need program. He has been a professor and lecturer in health policy. In recent years, Mr. Steen’s consulting engagements have been principally in certificate of need and community health promotion initiatives. For the American Health Planning Association (AHPA), he has concentrated on researching health policy issues in health planning, health regulation and public health.

Lauren Tobias, MPP is Deputy Director for the Division of Policy for the Office of Health Systems Management, New York State Department of Health. Prior to joining the New York State Department of Health, Ms. Tobias worked for Family Planning Advocates of New York State as a private consultant and prior that as Director of Public Policy. Ms. Tobias served as a Senior Legislative Associate for the Majority Leaders’ Research Office of the New York State Assembly. Ms. Tobias earned her Master of Arts in Public Affairs and Policy from the Rockefeller College of the State University at Albany.

What are key issues you would like to see included in Healthy People 2020?

Pritii — Sun, 25 Jan 2009 17:54:33 CST

In 2020 there should be an opportunity for meaningful participation in planning and evaluation for non-professional, organized, statewide citizen groups.