Public Health The Roundabout for a Healthier Future

Transcription

1 Northern Illinois Rural Public Health Institute Rock Island, IL, July 16 19, 2012 Public Health The Roundabout for a Healthier Future Public health is purchasable within natural limitations, a community can determine its own death rate. Herman M. Biggs, NYC, 1914 Outline Roundabouts Spend more, get less Trilogy of reports If only one intervention Big tent

2 Observation from travels

3 Newer Traffic Paradigm

4 Roundabout Advantages Safety benefits reduced fatalities reduced injuries pedestrian advantages Reduced traffic delays Reduced fuel consumption Improved air quality Reduced construction / maintenance costs Improved aesthetics

5 Most initially opposed or at least skeptical

6 They work great!

7 Just try them

8 Elegant solution

9 Not so Elegant Trend International Comparison of Spending on Health, * Source: OECD Health Data 2010 (Oct. 2010).

10 Expenditures as % of GDP US Social and Health Spending Compared to other wealthy countries, the US allocates far more of its social spending on health care than on other important services. Source: Bradley et al., 2011:3 (BMJ)

11 Ratio of Social to Health Service Expenditures OECD Average Source: Bradley et al., 2011:3 (BMJ)

12 What the US gets for its investment Years of longevity

13 U.S. Health Rankings Source (# of Countries) UN (n=146) OECD (n=34) CIA (n=221) Life Expectancy 28 ( ) Infant Mortality 32 ( ) (2008) 49 (2010) 47 (2011 est.) Maternal Mortality NA 25 (2007) 52 (2011 est.) Source: IOM, Apr. 2012

14 In search of better value The US lags behind its peers on health status while outspending every country in the world on health, largely in clinical care costs. Rising spending on medical care diverts funds from education, business development, and other systems that keep nations globally competitive. We need to make our health dollars buy more. Eliminating inappropriate and unnecessary care Limiting administrative costs Achieving universal access Implementing population-based health improvement strategies

15 Measurement and Accountability Institute of Medicine (NAS) Strategies to Improve Health Revitalizing Law and Policy (Dec. 2010) Investing in Public Health (Apr. 2012) Public Health Paradigm to a Healthier Future (Jun. 2011) Exploring Integration of Primary Care and Public Health (Mar 2012)

16 IOM Trilogy of Reports ( ) Essential for Public Health Progress Sponsor: The Robert Wood Johnson Foundation Project duration: November 2009 April 2012 Project deliverables: 3 reports on 3 related topics (measurement, law, and, funding) Committee: 18 members with expertise including public health practice and research, corporate wellness, medical care quality measurement, public health systems research, public health law, primary care, medical care system management, health economics and financing, public health information systems

17 Changing the conditions for health through: Measurement data and information to mobilize, act, and hold accountable Laws and public policy as the basis for governmental public health authority, population health interventions, and in the form of multi-sectoral approaches Funding to ensure the capabilities needed by public health agencies and others in the system

18 Minimum Package of Public Health Services Foundational Capabilities Information systems, surveillance and epidemiology Health planning Partnership development, mobilization Policy development, analysis, decision support Communication Public health research, evaluation and QI Source: IOM, 2012

19 Minimum Package of Public Health Services Basic Programs Maternal and child health promotion Injury control Communicable disease control Chronic disease prevention Environmental health Mental health and substance abuse

20 For the Public s Health: Investing in a Healthier Future Summary Recommendations Establish national goals for life expectancy and per capita health expenditures Minimum package of foundational and public health services Increase appropriations (double) based on cost of minimum service package Establish dedicated funding source by enacting tax on all medical transactions.

21 Exploring Integration of Primary Care and Public Health The dramatic rise in health care costs has led many stakeholders to embrace innovative ideas Health research continues to clarify the importance of social and environmental determinants of health and the impact of primary prevention An unprecedented wealth of health data is providing new opportunities to understand and address community-level health concerns The ACA presents an overarching opportunity to change the way health is approached in the United States

22 Potential for Interagency Collaboration The committee examined how HRSAsupported primary care systems and public health departments could integrate efforts in three specific areas: Maternal and child health (specifically the Maternal, Infant, and Early Childhood Home Visiting Program) Cardiovascular disease prevention Colorectal cancer screening

23 Changing the conditions for health contributions of many sectors and stakeholders: a true health system

24 Funding versus Preventable Disease Category Burden of Disease Rank (by cost, 1997) Fraction of CDC 2003 budget, % Cardiovascular, circulatory Injury Cancer Mental health Endocrine and metabolic disorders Disability 6 3 Chronic lung disease Infectious disease 8 70 Source: 1997 and 2003 budget date from Curry et al., 2006

25 Our Children's Health is our Community's Wealth Evidence to Guide Policy and Practice The early years of life set us on paths leading toward or away from good health

26 Scientific Consensus on Early Childhood Development Convergence of findings from neuroscience, genetics, developmental psychology, molecular biology, economics, and program evaluation research.

27 Understanding the Biology of Health

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30 The brain s activity can be measured in electrical impulses here, hot colors like red or orange indicate more activity, and each column shows a different kind of brain activity. Young children institutionalized in poor conditions show much less than the expected activity.

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35 The Foundations to Lifelong Health are Built in Early Childhood What Science Tells Us Early experiences are built into our bodies Significant adversity undermine development of body s stress response system, affect developing brain, cardiovascular system, immune system, and metabolic regulatory controls These disruptions persist into adulthood and lead to lifelong impairments in both physical and mental health

36 Science Points Toward a 3-Tiered Approach to Reducing Disparities Basic health services and early care and education available to all children. Broadly targeted interventions such as income supports and early enrichment for children in poverty. TIER 3: NARROWLY TARGETED TIER 2: BROADLY TARGETED TIER 1: UNIVERSALLY AVAILABLE Narrowly targeted, specialized services for children experiencing tolerable or toxic stress.

37 Best Bets for Targeted Services for Vulnerable Infants, Toddlers, and their Families Skilled home visiting (prenatal to age 3) Combined home and very high quality center- based services (birth to age 3) Source: Center on the Developing Child, Harvard University,

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39 What These Five Numbers Tell Us PER SECOND MONTHS % 3:1 3:1 ODDS DOLLARS

40 Winnebago County Health Department Targeted Intensive Prenatal Case Management Program Exploratory Data Analysis of Program Outcomes by Service Level

41 WCHD Exploratory Data Analysis Case Control Study Design Jan 2005 Dec 2006 TIPCM/WL-FCM Combined Cases n=373 TIPCM n=267 WL-FCM n=106 Hypothesis: enhanced services provided through TIPCM are associated with improved care and birth outcomes compared to like-profile pregnant women served on FCM (WL)

42 WCHD TIPCM (n=261) LBW Outcomes vs. Program Contacts Contacts LBW Births Total Births % LBW % % %

43 Conclusion Preliminary results support the hypothesis that TIPCM services improve prenatal contacts, care and birth outcomes Results indicate that TIPCM services for high risk moms lead to increased client contacts, increased prenatal visits and reduced low birth weight outcomes, when seven (7) or more client contacts are achieved.

44 IPHA Strategic Plan Mission: Lead and advance public health practice in Illinois Vision: Wellness and health equity Focus areas: Public health system improvement; public health policy; membership and organization

45 IPHA Sections Academia for Public Health Behavioral Health Boards of Health Environmental Epidemiology/ Health Statistics Family Planning Food and Nutrition Health Administration Health Education/Promotion HIV/ AIDS Injury Control/EMS Maternal & Child Health Nursing Oral Health Professional Support Senior Health

46 IPHA Standing Committees Nominating Annual Meeting/Conference Membership Policy and Legislative Continuing Education Marketing and Communications

47 IPHA has a Creating Conditions in Which People Can Be Healthy Together we can

48 Northern Illinois Rural Public Health Institute Making Strides Towards Healthier Rural Community IOM, For the Public s Health: Investing in a Healthier Future, April 2012 IOM, For the Public s Health: Revitalizing Law and Policy to Meet New Challenges, June 2011 IOM, For the Public s Health: The Role of Measurement in Action and Accountability, Dec, 2010 IOM, Primary Care and Public Health: Exploring Integration to Improve Population Health, March Resources

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50 Targeted Intensive Prenatal Case Management (TIPCM) Goal Objective Staffing IDHS: To reduce Medicaid expenditures during first year of life through improved pregnancy outcomes and healthy early childhood development in high-risk pregnant women and their newborns Enhance FCM for high-risk pregnancies Lower caseloads More frequent contacts Linkage to medical care, mental health, dental services, substance abuse, smoking cessation Services to overcome barriers: transportation, translation and child care Must be BSN with emphasis in child health, community health or public health nursing, or MSW with emphasis on services for women and children; and experience working with young women and children

51 Findings TIPCM/WL-FCM (n=373) Strong direct association with participation in TIPCM program and client contacts (p 0.001) Moderate direct association with client contacts( 7) and prenatal visits (OR=2.19, CI= , p <0.001) Moderate direct association with participation in TIPCM program and prenatal visits (OR=1.97, CI= , p=0.006) Suggestive but not significant moderate inverse association with client contacts( 7) and low birth weight (OR=0.56, CI= , p=0.064) TIPCM Only (n=267) Moderate inverse association with TIPCM contacts ( 7) and low birth weight (OR=0.46, CI= , p=0.025)

52 Context High investment, poor return The U.S. is first in the world in medical care expenditures (17% of GDP), but The U.S. ranks 49th in life expectancy Health care reform through the Affordable Care Act is only part of the solution Improving medical care (quality, access, financing) is a worthy goal, but it will not, on its own, have a major effect on outcomes The other part of the solution: changing the conditions for health

53 Winnebago County Health Rankings 2012 Local Health Factors Below Statewide Mean of all Illinois Counties Premature death (-0.05 z-score) Adult obesity (-0.18 z-score) High school graduation (-0.64 z-score) Poor mental health days (-0.75 z-score) Adult smoking (-0.97 z-score) Teen birth rate (-0.98 z-score) Low birth weight (-1.12 z-score) Children in poverty (-1.21 z-score) Single-parent households (-1.22 z-score) Violent crime rate (-1.29 z-score) Unemployment (-2.97 z-score)

54 Winnebago County Maternal/Prenatal /Early Childhood Poor birth outcomes reflect health of the community, borne disproportionately by vulnerable populations, under and uninsured public sector largest cost burden. Infant mortality, ; = 8.9; 20% higher than IL, 11% higher than prior 5-year average of 8 ( ) Infant mortality is 8 times higher for LBW vs NBW and 150 times higher for VLBW births vs NBW African American 2-3 times risk of IM, LBW and teen births First trimester prenatal care declined from high of 81% in 2002 to low of 75% in 2008 (7.5% lower)

55 Strong Foundations Partnership Maternal, Infant and Early Childhood Home Visiting City of Rockford, Winnebago County Presentation The early years of life set us on paths leading toward or away from good health

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61 Maximizing Return on Investment The basic principles of neuroscience and human capital formation indicate that later remediation will produce less favorable outcomes than preventive intervention. Low cost services that have little impact are a waste of money. Responsible investments focus on effective programs that are implemented well, and improved continuously. Source: Center on the Developing Child, Harvard University,

62 Key Elements of a Successful Early Childhood Policy Agenda Investing in the development and retention of a skilled early childhood workforce. Planning broadly from pregnancy to kindergarten, and looking beyond education and health care. Source: Center on the Developing Child, Harvard University, Leveraging the power and sustainability of bipartisanship and public-private sector partnerships.

63 The Foundations of Life-Long Health

64 This is the explanation for the slide below from see if Mike wants to use these words instead of the 1,2,3,4,5 there is there now 700 New Neural Connections Per Second 18 Months: Age At Which Disparities in Vocabulary Begin to Appear % Chance of Developmental Delays When Children Experience 6-7 Risk Factors 3:1 Odds of Adult Heart Disease After 7-8 Adverse Childhood Experiences $4 - $9 in Returns For Every Dollar Invested in Early Childhood Programs What These Five Numbers Tell Us

65 2010 County Health Rankings Winnebago Co, IL Local Health Factors Distribution Around Statewide Mean WORSE Hospice Use (0.02) Physical health days (0.03) College degrees (0.21) Fair health (0.42) Ozone days (0.44) Income inequality (0.50) Children in poverty (0.60) Adult Smoking (0.62) Mental health days (0.68) Particulate days (0.72) Social support (0.75) Teen birth (0.94) Vehicle crash deaths (0.95) Binge drinking (0.03) Uninsured adults (0.07) Diabetic screening (0.11) Liquor store density (0.52) Prevent. Hospital stays (0.72) BETTER Violent crime (1.18) Low Birth Weight (1.27) Single-parent households (1.32) Unemployment (1.57) Chlamydia (1.72) Adult obesity (1.07) Access to healthy foods (1.22) Primary care provider (1.55) HS graduation (2.08) Standard Deviation from the Mean

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67 Context: High investment, poor return

68 Changing the conditions for health contributions of many sectors and stakeholders: a true health system

69 What Do We Mean By Integration? Variables Used by the Committee: Level Partners Action Degree Degrees of Integration:

70 Why Integrate? A wide array of public and private actors across the nation contribute to the health of populations Achieving substantial and lasting improvements in population health will require a concerted effort aligned under a common goal Integration of primary care and public health could enhance the capacity of both sectors to carry out their missions and link with other stakeholders to catalyze a collaborative, intersectoral movement toward improved population health

71 Changing the conditions for health (1) Begins with data and indicators, because: What is not measured is not done What is measured may not always be done, but is harder to ignore What is measured can facilitate mutual accountability (2) Although measuring health outcomes and their determinants is not sufficient for galvanizing action, facilitating change, and informing accountability, it is an essential first step.

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