2010 Forum Saturday Sessions

On Saturday, the Forum presenters offered a fascinating array of perspectives on the issues of implementing health promotion and prevention strategies and the implications for practitioners. Just look at the presenters:  

What Lessons Can We Learn from Canada?
Sylvie Stachenko, MD, MSc, FCPP
School of Public Health, University of Alberta, Canada

The first distinguished speaker was from Canada, a nation with a long term commitment to public health. Dr. Sylvie Stachenko is Dean of the Alberta School of Public Health in Canada. Dr. Stachenko has served as the Deputy Chief Public Health Officer at the Public Health Agency of Canada, as the director general in the Centre for Chronic Disease Prevention and Control at the Public Health Agency of Canada. Prior to that, she worked with the World Health Organization (WHO) Regional Office for Europe as the director of Health Policy and Services.   Insights from her presentation brought these issues to light:  

• The near-complete separation between public health and health care delivery approaches is a fundamental problem not just in the US, but in Canada as well. Policy is one thing, practice is another.

• The goal should be to integrate the public health, health services, and efforts to improve the social, environmental and cultural factors that also affect health status. As it stands today, however, neither in Canada nor the United States have achieved that goal.

• The assumption that the physician should be the central force in prevention, and that primary care should be the place where that occurs (starting with an annual physical or opportunistic tests) is not working either here or in Canada. Part of the problem is time, part is money (lack of reimbursement), and part is culture. Broader approaches involving more kinds of health care providers and workers are needed and should involve interdisciplinary teams. Partnerships among institutions and communities are also needed. 

What is Healthy People 2020?
Rear Admiral Penelope Slade-Sawyer PT, MSW
Deputy Asst. Secretary for Health

Rear Admiral Penelope Slade-Sawyer, Deputy Assistant Secretary for Health, US Department of Health and Human Services, Acting Executive Director, President's Council on Physical Fitness and Sports, directs the Office of Disease Prevention and Health Promotion (ODPHP), Office of Public Health and Science (OPHS) at HHS. RADM Slade-Sawyer is a commissioned corps officer in the United States Public Health Service. She is responsible for strengthening the disease prevention and health promotion priorities of the Department of Health and Human Services.   Rear Admiral Slade-Sawyer joined us to discuss Healthy People 2020, an initiative which provides a comprehensive set of national, ten year health objectives that serves as a framework for public health priorities and actions. The product of a collaborative process, this initiative is designed to measure progress over time. More than 350 national membership organizations and 250 State health, mental health, substance abuse, and environmental agencies participated in the process to develop Healthy People 2010.  The strengths of the process:  

• Collaboration and Consensus

• Wide Array of Diverse Users

• Public Access to Data via Internet

• Science-Based and Evidence-Based

• Data-Driven

• Measurable Objectives With Targets

Challenges with the process:  

• Balancing between encyclopedic approach and targeted effort

• Integrating target-setting across all areas

• Developing and funding of data sources

• Developing an implementation plan

• Providing technical assistance

What are the Delivery Models for Preventive Care?
Robert A. Smith, PhD
Director, Cancer Screening, American Cancer Society Professor of Epidemiology, Emory University School of Medicine   

Dr. Robert Smith is Director, Cancer Screening Cancer Control Sciences Department at the American Cancer Society. Dr. Smith has been the leader of the American Cancer Society’s screening efforts for many years, providing counsel in updating the society’s widely-regarded guidelines, organizing conferences to review the latest scientific developments in cancer screening, and secondary prevention. More recently, he has become involved in working in the general area of screening and prevention and belongs to a coalition of prevention experts from the fields of Cardiology and Diabetes studying issues in prevention delivery. General screening recommendations are sanctioned by the US Preventive Services Task Force. This group has recommended more than 20 preventive services for adults that are supported by hard evidence and should be offered to Americans according to their, age, sex and risk history.   Sadly, less than half American adults received the top 5 recommended preventions. For example, five of the highest ranking preventative services are being delivered and used by less than half of the people who need them. These top ranking preventative services include:  

1. Discussing daily aspirin use with at-risk adults

2. Screening adults age 50+ for colorectal cancer

3. Intervening with smokers to help them quit

4. Vaccinating older adults against bacterial pneumonia

5. Screening young, sexually active women for Chlamydia  

Dr. Smith explained that the shift from regular checkups to incidental encounters with healthcare professionals has been the culprit. Most adults don’t get regular checkups, and using acute care visits to identify and address health promotion and disease prevention has had limited success.   Dr. Smith’s conclusion was that each of the current preventative models being considered has features worth retaining. The Chronic Care Model is the most promising approach to the management of chronic disease, however, it is narrowly focused and consistent with improvement within the current paradigm. The Medical Home embraces the features of the Chronic Care Model, and places emphasis on prevention, but to date, the design, mechanics and goals for the “home and its residents” have not been well defined. 

What About Health Promotion in the Community?
Yvonne J. Graham, RN, BHA, MPH
Deputy Borough President for Brooklyn, Brooklyn, NY  

Ms. Graham is the Deputy Borough President of Brooklyn and oversees health care policy and all human services for the borough president. She has been a pioneer in the area of public health for more than thirty years. Ms. Graham founded and then served as executive director of the Caribbean Women’s Health Association (CWHA), which provides comprehensive, culturally-sensitive health care, immigration, and social support services to diverse communities. She was instrumental in the development of Brooklyn’s Center on Health Disparities, which is working to reduce cardiovascular disease, HIV/AIDS, tuberculosis, infant mortality, asthma, and diabetes among minority communities. The center is an innovative partnership with the Borough President’s Office, SUNY Downstate Medical Center, and the Arthur Ashe Institute for Urban Health.   Ms. Graham focused on the “Social Change Model” for introducing health care prevention into economically-stressed communities, which emphasized partnering with community-based organizations. Due to unique economic stresses and cultural influences, it is difficult to reach members of the community without “speaking their language” through a trusted representative who is active in their community. The idea is to work with these community leaders to:  

• Organize education programs

• Mobilize volunteers

• Empower the community

• Advocate for the unique needs of that community 

Panel & Audience Discussion  
NAP President-Elect Arthur I. Hazlewood, DDS, MPH, led a discussion between the panelists. Forum participants were offered the chance to submit questions to the four panelists, stimulating even more insights. 

Interdisciplinary Small Groups: Discussion of models and policy
Dr. Elizabeth A. Rider
Co-Chair, NAP Medicine Academy and Director of Programs for Communication Skills, John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital in Boston, MA 

Dr. Rider facilitated the afternoon group discussions where were offered the opportunity to present solutions based on our expertise and the information that was presented in the morning presentations. It gave participants the chance to give immediate feedback on three questions:

1. What their professions were doing that was novel
2. What could they do in the community if barriers were removed
3. What benefit could be derived from interdisciplinary approaches to prevention and health promotion

Their responses were recorded and will be used to prepare the NAP 2010 Policy Paper on this topic. Look for the release of the new policy paper soon!  

Next steps in 2010  
As interdisciplinary advisers to public policy makers, NAP has an unequaled chance to impact with this year’s Policy Paper — which is the next step. As it has in the past, a policy paper will be created based on a combination of literature review, learning at the Forum, and group discussion. This year’s topic is devoted to recommendations that will strengthen the contribution of practitioners to health prevention and promotion. With the health reform bill having finally passed, NAP will have an unequaled chance to make recommendations to the agencies charged with implementing the prevention and health promotion aspects of the bill. The Policy Paper should be done by June — look for it! In the meantime, review the other recent policy papers which NAP is using in briefings on the Hill and with the agencies. Go to www.NAPractice.org and click on “Public Policy”, then “Policy Papers.”  

Make plans to attend NAP’s 2011 Forum March 25-26, 2011
Plan to attend next year’s expanded 2-day annual meeting and Forum, held Friday and Saturday, March 25-26 at the Marriott Crystal Gateway Hotel, Arlington, VA