Category Archives: Public-private partnerships
Today, New York State Health Commissioner Nirav R. Shah, MD, MPH, released the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State. The plan is a blueprint for local community action to improve health and address health disparities, and is the result of a collaboration with 140 organizations, including hospitals, local health departments, health providers, health plans, employers and schools that identified key priorities.
Dr. Shah, the architect behind today’s prevention agenda, was confirmed as New York State’s youngest Commissioner of Health two years ago. The state’s governor, Andrew Cuomo, had three critical goals: reduce the state’s annual Medicaid growth rate of 13 percent, increase access to care and improve health care outcomes.
Shah, a former Robert Wood Johnson Foundation Physician Faculty Scholar and Clinical Scholar, has already made important inroads in all three goals and the prevention agenda builds on that. NewPublicHealth spoke with Dr. Shah about prevention efforts already underway in the state, and what it takes to partner health and health care to achieve needed changes in population health.
NewPublicHealth: How does improving the social determinants of health help you achieve your goals in New York State?
Dr. Shah: New York’s Medicaid program covers 40 percent of the health care dollars spent in the state. We were growing at an unsustainable rate, and we needed a rapid, but effective solution. So, we engaged the health care community, including advocates, physician representatives, the legislature, unions, management, and launched a process that enables continuous, incremental, but real change toward the Triple Aim—improved individual health care, improved population health and lower costs.
Collectively, these efforts resulted in a $4 billion savings last year in the State’s Medicaid program, increased the Medicaid rolls by 154,000 people, and resulted in demonstrable improvements in quality throughout the system.
NPH: What opportunities do you see for public health and health care to work together in New York State?
Organization and business leaders across the country are realizing that every sector needs to join the fight—or at least the conversation—to create healthier places to live. While altruistic motivations play an important role in this movement, a growing body of research also points to the idea that better health is a major driver for a healthier economy.
Recently, GlaxoSmithKline (GSK) partnered with The Atlantic to host “A Conversation on Community Health”—a series of events in U.S. cities across the country to explore what it means, and what it takes, to create a healthy community. NewPublicHealth checked in with GSK’s Senior Vice President and Corporate Medical Director, Robert Carr, MD, MPH, FACPM, to get his take on why businesses should care about community health, and why a broad, cross-sector dialogue is a critical next step.
>>Read more on communities that were recognized for innovations that are improving the health and lives of their residents, with the 2013 RWJF Roadmaps to Health Prize.
NewPublicHealth: What prompted you and GSK to start thinking about community health?
Dr. Carr: As an HR executive and medical director of a global business, I’m acutely aware that employees are—first and foremost—members of families and communities. The places where they live and the choices made by the people around them profoundly influence the health of our employees. We regularly hear that our employees want to know not only what they can do to lead healthier lives but also what we can do as a company to improve the health of their own community. They want us to dig in and find out what’s needed. Similarly, we recently conducted some research about what Americans are looking for more broadly, and we learned that they want the same thing from GSK. They want us to do more in their communities.
We heard them loud and clear, and we are digging in, starting with understanding what it means and what it takes to be a healthy community. Last year we kicked off a program we call “Healthy Communities.” As part of this attempt to learn more, directly from those on the ground in different American cities, we partnered with The Atlantic for “A Conversation on Community Health.”
NPH: What’s the focus of the “Conversation on Community Health” series?
How healthy is your county? Answers are out today in the 2013 County Health Rankings, which examine the health and well-being of people living in nearly every county in the United States and show that how long and well people live depends on multiple factors beyond just their access to medical care. The Rankings allow counties to see what’s making residents sick or healthy and how they compare to other counties in the same state. The County Health Rankings, now in its fourth year, is a joint project of the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute.
“The County Health Rankings can be put to use right away by leaders in government, business, health care, and every citizen motivated to work together to create a culture of health in their community,” said Dr. Risa Lavizzo-Mourey, RWJF president and CEO. “The Rankings are driving innovation, unleashing creativity, and inspiring big changes to improve health in communities large and small throughout the country.”
The Rankings examine 25 factors that influence health, including rates of childhood poverty and smoking, obesity levels, teen birth rates, access to physicians and dentists, rates of high school graduation and college attendance, access to healthy foods, levels of physical inactivity, and percentages of children living in single parent households.
Although the Rankings only allow for county-to-county comparisons of ranks within a state, this year’s Rankings show significant new national trends:
Preparing for disasters like Hurricane Sandy is critical, even more so because of the massive devastation this storm has brought to Staten Island, New York, where hundreds are still without power, and thousands must rebuild their homes and businesses. Thanks to some critical partnerships that have developed among non-profits and businesses in Staten Island in the last few years, some vital relationships that help to facilitate rapid response were already in place when the super storm hit.
NewPublicHealth spoke with David Sorkin, executive director of the Jewish Community Center of Staten Island, who is a also a founding board member and past president of the Staten Island Not-For-Profit Association and former chairman of the Staten Island Economic Development Corporation Business Council.
NewPublicHealth: How did prior relationships help you serve the community when the hurricane hit?
David Sorkin: The Staten Island Not-For-Profit Association is a collective of about 150 not-for-profits on Staten Island who have been networking, training, and learning together over the past four or five years. We already had relationships and interconnections, which allowed us all to react very, very quickly to issues and concerns as well as emergencies because we have emergencies almost every day, though different from a super storm.
A “normal” emergency not related to a storm is when we have a family or an individual who’s in crisis and needs a variety of support such as economic, legal, financial, counseling or a combination of all of them. So, we work together on a regular basis. The other avenue we work through is the Staten Island Economic Development Corporation, which is a coalition of businesses on Staten Island. Because we’re a part of that, I was able to access quality services from businesses and corporations on Staten Island with good relationships already built in. So, I don’t have to worry about vetting these companies and organizations during an emergency and I know that they can come to our assistance very, very quickly.
Several sessions at this week’s American Public Health Association meeting in San Francisco urged nonprofit hospitals and public health departments seeking national accreditation to join forces on community assessment reports that both are required to file.
Assessments can reveal critical needs in a community, such as asthma trends that could point to poor housing conditions. In a growing number of cities, such reports are providing the evidence needed to marshal resources and action such as dispatching case workers to make home visits to help prevent and reduce asthma emergencies. Such expenditures can reduce the cost burden of paying for emergency care and prevent more health crises in the first place.
In San Francisco, the health department and the city’s non-profit hospitals have been collaborating on community benefit and needs assessments reports since 1994 and have achieved much more than “just a sheaf of papers that sits on a shelf,” says Jim Soos, Assistant Director of Policy & Planning at San Francisco Department of Public Health. The collaboration has resulted in a number of critical efforts to improve health here, including San Francisco’s Community Health Improvement Plan (CHIP), which will be launched by early in 2013.
In a new interview with Ramona Trovato, Deputy Assistant Administrator of the Environmental Protection Agency (EPA), NewPublicHealth continues its conversation series about the National Prevention Strategy. The strategy was released last year by Surgeon General Regina Benjamin, MD, MBA, to help create a healthier and more fit nation.
Earlier this year the Surgeon General’s office released the Strategy’s National Action Plan, designed to show how the 17 Federal Agencies charged with advancing the National Prevention Strategy are implementing its vital components. The EPA has several partner initiatives critical to the health of the nation, which include:
- Partnership for Sustainable Communities: The EPA is a partner, together with the Department of Transportation and the Department of Housing and Urban Development, in this partnership to help communities improve access to affordable housing and transportation while protecting the environment, all critical aspects of healthy living.
- Green Ribbon Schools: EPA is a partner with the Department of Education and other agencies for this recognition award that encourages state education agencies and schools to recognize the links between education, health, and the environment, and to make all three of these areas a priority.
- Safe routes to school: Agencies including HHS, EPA and the Department of Transportation support efforts to improve the ability of students to walk and bicycle to school safely.
- Task Force on Environmental Health Risks and Safety Risks to Children: This multi-agency task force, which includes the EPA, recommends strategies for protecting children's health and safety, including specific priorities around asthma, unintentional injuries, lead poisoning, cancer, and environmental health in schools.
- Aging Initiative: This EPA initiative aims to prioritize environmental health hazards that affect older persons, focus on “smart growth” principals to support active aging, and examine the environmental impact of an aging population, and encourage civic involvement among older persons in their communities to reduce hazards.
Ramona Trovato shared with us EPA’s long history of health promotion and its current efforts to help improve population health as a member agency of the National Prevention Council.
NewPublicHealh: How does the Environmental Protection Agency (EPA) align itself with the National Prevention Strategy?
Ramona Trovato: The EPA is really pleased to be part of the National Prevention Council and the National Prevention Strategy. We firmly believe in preventing ill health and in promoting wellness, and it’s something that matters to us in all the work that we do. We have very successfully partnered with Department of Health and Human Services in the past and with a number of other federal agencies including the Consumer Product Safety Commission, the Department of Transportation and the Department of Housing and Urban Development to benefit the public’s health.
NPH: What are the key roles of the Environmental Protection Agency in protecting the nation’s health?
Jose T. Montero, MD, director of the Division of Public Health Services at the New Hampshire Department of Health and Human Services, was elected president of the Association of State and Territorial Health Officials (ASTHO) during the association’s recent annual meeting in Austin, Texas.
Dr. Montero began his medical career in Putumayo, Colombia, where he served as a local, county and state health official. He then went to teach family and preventive medicine and later became Colombia’s public health director. Dr. Montero began his service in New Hampshire in 1999 as chief of the New Hampshire Communicable Disease Section in the Division of Public Health. Before becoming director of the New Hampshire Division of Public Health Services, Dr. Montero was the state epidemiologist. He is an adjunct professor of family medicine and a member of the preventive medicine residency advisory committee at Dartmouth Geisel School of Medicine.
NewPublicHealth spoke with Dr. Montero about the new ASTHO President's Challenge, which will focus this year on the integration of public health and health care.
NewPublicHealth: Why is so critical now to work toward the improved integration of public health and health care?
Dr. Montero: We keep talking about the health system but there is not much that is health-focused—it’s currently mostly about providing care after people becomes ill. From a public health perspective we’re trying to improve outcomes and quality, without spending the amount of money on health that we’re currently spending because we can’t sustain that. The system needs to continue changing and evolving, but we don’t yet know what exactly how it will look or how it should look. We need to create a new system. Based on the experiences of some states, such as Massachusetts and Oregon, we know gaining access to health insurance has expanded use, but we don’t know if they’ve achieved improved health outcomes yet. We’re working toward that. But we need to work on the right indicators that allow us to consistently measure total population health.
When you look across the country, you see that public health entities provide the continuum of care throughout the life cycle. We are already integrating health care and the public health system at several different places and levels, but it’s not consistent. To prepare ourselves for the future, we need to be able to look at public health and health delivery systems and integrate them philosophically. We need to capture examples, decode them, and see what works and what doesn’t and how to use which in different parts of the country. We have different cultures, different investment levels, and different expectations. We can’t just copy and paste.
NPH: What are the critical issues you’re looking at?
GUEST POST by Lisa Junker, CAE, director of communications for the Association of State and Territorial Health Officials (ASTHO)
At the opening session of the ASTHO Annual Meeting in Austin, Paul Wallace, vice president of The Lewin Group, pointed toward the need for collaboration and partnership between the health care and public health sectors to overcome key challenges and trends facing the United States at the federal, state and local level.
>>Read our earlier interview with Paul Wallace on public health and primary care integration.
“What are the opportunities to create a shared conversation around prevention?” asked Wallace, who chaired the Institute of Medicine (IOM) Committee on the Integration of Primary Care and Public Health.
He gave attendees an overview of the process his IOM committee underwent to develop the recently-released report “Primary Care and Public Health: Exploring Integration to Improve Population Health.” The committee was charged with identifying the best examples of effective integration and the factors that promote and sustain those efforts, examining the ways federal agencies can use the provisions of the Affordable Care Act to promote integration, and discussing how Health Resources and Services Agency (HRSA) supported primary care systems and state and local public health can promote those efforts moving forward.
James S. Marks, MD, Senior Vice President of the Robert Wood Johnson Foundation, recently spoke on a keynote panel at the annual ASTHO meeting in Austin, Texas, on making the case for prevention. NewPublicHealth spoke with Dr. Marks about the great potential for investing in prevention.
NewPublicHealth: What do you think are the big issues facing state health officers across the country?
James Marks: The thing that I am most struck by is that we all know that public health, like so many of our sectors, is struggling in these tough economic times. But I’m seeing state health officers look increasingly at how they and medical care can connect and integrate and support each other as something we need increasingly in this country. They have to ask where they are going to get the best value in health. Sometimes it will be in medical care, many times it will be in prevention and public health, and they should be working to create common purpose.
NPH: What is the training of health officers for that?
United Way of North Central Florida is focused on the building blocks that lead to a good quality of life – education, income and health – recognizing that communities are stronger when children are successful in school, families are financially stable and people are healthy. One of their primary roles is as a convener, to bring hundreds of organizations together across diverse sectors to set priorities and create change.
As part of our series looking at the work of United Ways across the nation in creating healthier communities, we spoke with Debbie Mason, President and CEO of the United Way of North Central Florida, and Mona Gil de Gibaja, Vice President of Community Impact, about their community planning process, strategies for effective partnerships, and the role of critical partners such as businesses and the local health department.
NewPublicHealth: What is the planning process you’re engaging in to set priorities around education, income and health?
Debbie Mason: Our major focus is education, but this is so inextricably linked to income and health. No matter where you start, you still wrap into the other two.