GUEST POST by Virgie Townsend, JD, associate editor at the Association of State and Territorial Health Officials (ASTHO)

About 40 percent of the health care dollars spent in New York State come from Medicaid. Realizing that the rate was climbing far too fast, the state brought together health care advocates, physician representatives, elected officials, management and unions to solve the growing financial issue by addressing the social determinants.

And they were effective. Last year the state saved $4 billion while adding approximately 154,000 people to its Medicaid program.

One of the key figures behind the public health improvements was New York State Health Commissioner Nirav R. Shah, MD, MPH, who last week moderated the panel discussion “Medicaid and Public Health: Improving Partnerships” at the Association of State and Territorial Health Officials’ (ASTHO) 2013 Annual Meeting.

>>Read more in a NewPublicHealth Q&A with Shah.

>>Read more on New York State’s Health Improvement Plan.

>>Follow continued ASTHO Annual Meeting coverage on NewPublicHealth.org.

In addition to Shah, the panel included Vermont Department of Health Commissioner Harry Chen, MD; Executive Director of the National Association of Medicaid Directors Matt Salo; and Chief Medical Officer for Center for Medicaid and CHIP Services Stephen Cha, MD, MHS. Shah and Chen discussed how their states are improving population health through greater integration with Medicaid, while Cha and Salo presented their views from the Medicaid perspective.

GUEST POST by Lisa Junker, CAE, Director of Communications at the Association of State and Territorial Health Officials (ASTHO).

The United States is facing a “perfect storm of vulnerability,” said U.S. Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, MPH, yesterday at the 2013 Annual Meeting of the Association of State and Territorial Health Officials (ASTHO)—and state and local public health officials are on the front line of defense.

Frieden began his remarks by encouraging his listeners to “go back to first principles” and keep in mind the first priority of government, which is to keep people safe.

“If the government can’t keep people safe, whether it’s the police or us in public health, we are failing at our number-one responsibility to the public,” Frieden said.

And to keep the U.S. population safe today, public health officials have to keep their eyes open for threats arriving from outside our borders. Infectious diseases, drug resistance, new pathogens, intentional engineering of microbes, and globalization of travel, food and medicines: “If there’s a blind spot anywhere, we’re at risk everywhere,” Frieden emphasized.

He also focused on CDC’s partnership with state and local public health, even during the current tight fiscal atmosphere.

“Overall, our approach has been to double down on support for the front lines [state and local health agencies],” he said. “We all are in this together…We have lots of problems and lots of opportunities, and the more effectively we are connected, the more effectively we can address these opportunities.”

For the last several years there’s been a bit of a tradition at the annual meeting of the Association of State and Territorial Health Officials (ASTHO), with the incoming president introducing a year-long “President's Challenge” to focus the attention of state health officers on a critical national public health issue.

José Montero, MD, outgoing president of ASTHO and director of the New Hampshire Department of Health and Human Services, chose the reintegration of public health and health care. The starting point for the challenge was a report by the Institute of Medicine, Primary Care and Public Health: Exploring Integration to Improve Population Health. In his announcement, Montero emphasized the need to take a systems approach to health care transformation in order to achieve lasting improvements in population health.

Throughout the past year, both state health departments and other public health organizations have added their integration projects to a project list maintained by ASTHO. This includes the State of New Hampshire Department of Public Health, which has collaborated with a community health center network and others to use electronic health records to link providers and tobacco quitline services, with the goal of cutting smoking rates.

>>Follow our ASTHO Annual Meeting coverage throughout the week.

Just ahead of the 2013 ASTHO annual meeting, NewPublicHealth spoke with Montero about the importance of the challenge he put forward for his fellow state health officers and next steps.

NewPublicHealth: What participation have you seen by the state health departments in your President's Challenge on reintegration of public health and health care?

José Montero: The specific metric that I used was to have states and the District of Columbia send stories that illustrate levels of partnership and integration. During the past year, the visibility of the topic has grown dramatically. In addition, ASTHO has an ongoing partnership that has brought together more than 50 different organizations for the same purpose. We meet regularly, working together on how to advance the agenda of better coordination and integration, and every day we identify new people who want to participate, and I think that has been an amazing result. I don’t want to claim that all of this is because of the ASTHO initiative. There were a lot of things that were out there already. But this was a timely call, and all of those who were working on it are joining efforts to make it happen.

The annual meeting of the Association of State and Territorial Health Officials (ASTHO) begins tomorrow in Orlando, Florida. Attendees at the ASTHO annual meeting head to the same sessions and listen to the same speakers over three days, which helps create a common fluency with critical public health issues. It also creates cohesion among state health officers, who often work with each other during public health crises and learn from each others’ successful approaches to dilemmas such as budget cuts and entrenched chronic disease.

>>Follow our ASTHO Annual Meeting coverage throughout the week.

Ahead of the meeting, NewPublicHealth spoke with ASTHO’s long-time executive director, Paul Jarris, MD, about the key issues participants will engage in during the 2013 ASTHO meeting.

NewPublicHealth: What are key themes at this year’s annual meeting?

Dr. Paul Jarris: There are a number of major health issues on the agenda for the conference, including an update on Healthy Babies are Worth the Wait, last year’s ASTHO presidential challenge. Together with the Health Resource Services Administration (HRSA) there’s an intention to roll out Healthy Babies learning collaboratives across the country, and we’ll be sharing successes of the initiative from the past year.

Another major area we’ll be talking about will be the reintegration of public health and health care. A lot of this work has been outgoing ASTHO president Dr. Jose Montero’s presidential challenge for the last year, and there’s been a lot of work going on, including the development of a national collaborative between public health and primary care that ASTHO is supporting. The collaborative involves more than 50 different health care and public health organizations, brought together for the purposes of improving the population’s health.

Incoming president Terry Cline will launch his Presidential Challenge, a major initiative on prescription drug abuse and misuse and overdose. There are more people who die from prescription drug overdose than from motor vehicle accidents in this country—and there’s much that can be done about it. We’ll also have the leadership from the Office of National Drug Control Policy speaking on this critical issue.

The business sector is a critical partner when it comes to promoting the health of a community. Employment, income and overall economic stability greatly impact employee and community health. Increasingly, businesses are expanding their efforts from worksite-based health promotion programs to community-wide initiatives to ensure their employees’ access to healthy choices and environments.

Next Tuesday at 3 p.m., a County Health Rankings webinar will take a look at how local health leaders and businesses can work together to advance the health improvement efforts in their communities. The webinar will feature guest speaker Cara McNulty, Senior Group Manager for Prevention and Wellness at Target Corporation, which according to webinar organizers is “known for its commitment to community giving.” McNulty will share examples and lessons learned from her experience at Target to answer key questions:

• What kinds of partnerships are businesses looking for?
• What do communities and businesses need to understand about each other in order to forge successful partnerships?

>>Join the webinar to learn how to build common ground with businesses in your community and advance community health together.

Last week the Public Health Accreditation Board (PHAB) awarded five-year national accreditation status to five public health departments, bringing the number of health departments now accredited to 19 since the credential was launched two years ago. Hundreds more health departments are currently preparing to apply for accreditation, which includes a peer-reviewed assessment process to ensure it meets or exceeds a set of public health quality standards and measures. Among the newly accredited is the Chicago Department of Public Health.

"This is an important achievement and recognition that highlights the city of Chicago’s ongoing commitment to health and wellness on the part of all of our residents,” said Chicago Mayor Rahm Emanuel in a statement issued by PHAB.  "We are focused on policies that will help all Chicagoans and their families enjoy the highest quality of life, [and w]e will continue to strive to make Chicago one of the healthiest cities in the world."

NewPublicHealth recently spoke with Bechara Choucair, MD, MS, Commissioner of the Chicago Department of Public Health, about the value of accreditation for improving the health of the community—and about how this effort supports Healthy Chicago, the city’s public health agenda.

>>Read more about Healthy Chicago in a previous NewPublicHealth Q&A with Choucair.

NewPublicHealth: You’re one of the first public health departments to be accredited. How did that happen so quickly?

Bechara Choucair: When we released Healthy Chicago in 2011, one of the strategies we identified was to obtain accreditation. We wanted to be the first big city to earn the credential. It took us 18 months and we are excited that we are the first big city to be accredited and the first in Illinois. And one of the added bonuses of accreditation is a sense of pride. It says a lot to our staff, residents and our mayor.

NPH: A community health assessment is required as part of the accreditation application. What did Chicago’s community health assessments entail?

Tackling the problem of obesity in the United States cannot be done with a single step solution. There are many factors that need to be addressed at the family, school and community levels in order for obesity rates to continue to decline across the country. Unfortunately, not everyone has equal access to the education and options that allow us to make healthier food choices. Higher prices and lack of accessibility to fresh produce serve as barriers for lower income communities in the battle against obesity and improving public health.

In urban areas across the country, groups focused on healthy living and eating are working to develop programs to create more healthy options for everyone. Programs in cities such as New York, Los Angeles and Philadelphia—to name just a few—have caught on with local food vendors, store owners, public health departments and the general public as we start to see rates of obesity drop in those targeted areas.

>>Read more about the fight against childhood obesity and the signs of progress in different areas across the country.

We have found some great examples of programs across the country that are proving successful in their attempts to increase the number of healthy options available to at-risk children and the greater community.

• In New York City, pediatricians at Lincoln Medical Center in the Bronx and Harlem Hospital have started prescribing fruits and vegetables for children. The prescriptions allow them to use coupons for produce at local farmers markets and city green carts. Medical professionals see this as a longer-term solution to the issues they are seeing children come in with, rather than simply prescribing them medicine.
• With Philadelphia weighing in as the most obese city in the nation, The Food Trust’s Brianna Almaguer Sandoval has enlisted the help of corner store owners to start providing healthier options on their shelves. The Healthy Corner Store Initiative provides store owners with free marketing materials such as labels and recipe cards; trainings on how to select, price and display the healthier offerings; and for some even funding for new shelves and refrigerator cases to help better stock fresh food.
• Groups in Athens, Ohio, are joining together to host an event called “Bounty on the Bricks,” to raise money to create a new grant program to enhance the capacity for local food pantries to provide more healthy options for their visitors in need. Those who bought tickets to the event will enjoy a meal celebrating local farmers and fresh produce along one of the main streets in Athens. The dinner will be held August 10 and organizers have already surpassed expected ticket sales.

Even as the global population continues to grow, technological and societal advances mean that our world is constantly getting smaller. Or at least that we are becoming more interconnected.

Understanding this—that a person in a Midwestern U.S. state is better off when a person on the other side of the world has access to quality health care—the U.S. Department of Health and Human Services’ (HHS) Global Health Strategy is working with partners across the globe to improve the health of everyone.

"Although the chief mission of [HHS] is to enhance the health and well being of Americans, it is critically important that we cooperate with other nations and international organizations to reduce the risks of disease, disability, and premature death throughout the world," said HHS Secretary Kathleen Sebelius.

One of the most powerful initiatives has been the push toward greater immunization rates. Immunizations alone saved 3 million children’s lives in 2011. Over the past decade, premature deaths from measles have been cut by 71 percent and from tetanus by more than 90 percent. And polio is closer and closer to complete eradication.

Still, vaccine-preventable diseases still account for approximately one in four global deaths of children under the age of 5. And of the 22 million children who go without the full benefits of vaccines each year, it is often the poorest that are most affected.

Among the greatest continuing obstacles are the persistent myths surrounding vaccinations, such as the false and repeatedly debunked belief that they cause autism.

“Overcoming these mistaken beliefs has become an integral part of our work towards global vaccine access. Until we reach the day when no lives are lost to vaccine-preventable diseases, we will aggressively continue to develop new and improved vaccines and ensure they are available to everyone in every country.”

>> Read the full “Beyond our borders: Why the U.S. Department of Health and Human Services invests in global efforts” at DefeatDD.org.

“Public health will always be local. But we will always need to adapt and evolve to continue to be relevant and effective,” said Thomas Frieden, MD, MPH, Director of the Centers for Disease Control and Prevention (CDC) to the packed crowd of local health department leaders at the opening session of this year’s National Association of County and City Health Officials (NACCHO) Annual Meeting. That means leveraging what’s working well, and keeping a finger on the pulse of what will work even better in the future, according to panelists at yesterday’s session, which was moderated by Dr. Swannie Jett, DrPH, MSc, Health Officer for the Florida Department of Health in Seminole County and included presentations by a number of federal-level public health officials.

>>Follow ongoing NewPublicHealth coverage of NACCHO Annual, including session recaps, interviews with speakers and more.

Jett alluded to a rapid transformation in public health that will change what it means to ensure the health of a nation or a county.

“Public health needs to be at the forefront,” said Jett. “We need to take the lead in our communities. We need to reach out to community partners, and to health officers in other counties and states. We need to bring everyone into the fold in this conversation.”

These kinds of cross-cutting partnerships, with public health playing a central role, were also the subject of a recent op-ed by Frieden on the Huffington Post, sharing success stories from the 2013 Annual Status Report of the National Prevention Strategy. The Strategy envisions a prevention-oriented society where all sectors recognize the value of health for individuals, families, and society, working together to achieve better health for all Americans. Frieden shared some examples of efforts to create healthier places to live happening across the country:

Progress in reversing childhood obesity was the focus of an event today in Washington, D.C.,  hosted by Voices for Healthy Kids, a partnership between the Robert Wood Johnson Foundation (RWJF) and the American Heart Association (AHA). Leaders from four states and five cities or counties that have seen at least small gains in reversing childhood obesity shared their programs and strategies with over 200 attendees from the public, private, and nonprofit sectors. The goal of Voices for Healthy Kids is to reverse the childhood obesity epidemic in the U.S. by 2015.

>>Read more on signs of progress in reversing the childhood obesity epidemic in 11 different locations across the country.

“These early signs of progress are extremely promising,” said Risa Lavizzo-Mourey, MD, president and CEO of RWJF. “The leaders joining us today are showing that we can reverse the childhood obesity epidemic, and that we must continue to learn from what’s happening on the ground so we can prioritize strategies that are working.”

Participating communities included the states of California, New Mexico, West Virginia and Mississippi, New York City, Philadelphia, Anchorage and Kearney, Nebraska and Granville and Vance Counties in North Carolina. The childhood obesity declines reported by these communities have been measured since the mid-2000's and range from a 1.1 percent decline among students in grades 5, 7, and 9 in California to a 13 percent decline among students in kindergarten through grade 5 in Mississippi.

“In order to see these declines replicated across the country, we have to make healthy changes in every school district, every community and every state,” said Nancy Brown, CEO of AHA.