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Health is rooted in communities
The Role of Prevention in Health Care Reform
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WE BUILD A BRIGHTER FUTURE
National Health Policy Conference
February 3, 2009
Raymond J. Baxter, PhD
Senior Vice President, Community Benefit, Research and Health Policy
Kaiser Permanente
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Kaiser Permanente’s heritage of prevention
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Kaiser Permanente HEAL community interventions in 39 sites
Clark County, WA
• Origins in construction sites: workplace safety a priority
• Prevention as a central tenet: “We are a health plan, not a sick plan”
• Early work with health assessment, preventive screenings and
immunizations
• Public health roles
• Today: from clinical prevention to community health
¾Raising the bar on screenings
¾HEAL community health interventions
¾Environmental, organizational and policy change
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Portland, OR
Cleveland, OH
Santa Rosa
Richmond
Modesto
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Prince George’s
County, MD
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6 HEAC Sites
Colorado
(statewide)
Atlanta, GA
Denver, CO
 Community Health Initiative sites
“ Joint initiatives with other funders
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Commerce City, Park Hill,
Lincoln Park
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Kaiser Permanente’s approach: Creating healthy communities for our people
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Four health reform principles for community and public health
• Access to quality care is critical, but it is not enough
1. Health reform should promote wellness by addressing the social
determinants of health and by strengthening of the social, cultural, and
physical environments that influence behavior.
• Care must be safe, effective and organized around medical home
• Build on heritage of prevention and population health
• Address social, economic and environmental determinants, and disparities
2. Funding for community-based prevention and public health should reflect
the value of these strategies in reducing healthcare costs and alleviating
disease burden.
• Unite evidence-based integrated care and research, with public health and
safety net partners and civic activism
• Build strong community partnerships, policies and practices that improve
health
3. Health reform should recognize and support the role of healthcare
delivery systems in promoting community health, and facilitate integration
of public health and healthcare delivery systems.
• Concentrate investments for scale, visibility and impact
4. Solutions should be designed and prioritized to simultaneously address
equity, buttress our economy and promote environmental sustainability.
• Invest large-scale, long-term, in communities’ health
• Evaluate, report publicly, be accountable for our impacts
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Heath Reform should promote wellness by addressing the social determinants of health and by
strengthening of the social, cultural and physical environments that influence behavior
Why prevention: How and where people live affects their health
• The nation should establish a comprehensive strategy for prevention that:
¾ Prioritizes prevention opportunities based on their potential to improve population health status
and reduce healthcare costs
¾ Ensures adequate funding
¾ Promotes evidence-based practices for both clinical and community-based prevention
¾ Provides a role for organized delivery systems to deliver effective community-based and clinical
preventive services.
• Community-based prevention and public health efforts at the state and federal level should:
¾ Focus on populations of individuals
¾ Focus on social determinants of health and the conditions in the social, physical and cultural
environment that influence behavior
¾ Address social equity and health disparities as explicit goals, and
¾ Be informed by and contribute to the emerging evidence base in this area
• Community grants should be authorized and amply funded to support the work of community
residents and community-based organizations to transform the social, cultural and physical
environments in ways that promote healthier lifestyles
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Powerful forces shape health behaviors
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Heath Reform should promote wellness by addressing the social determinants of health and by
strengthening of the social, cultural and physical environments that influence behavior
• Government and non-government health organizations must have the
authority, skills and resources to bring a health perspective to decisions
made in other sectors that have important health implications (e.g.,
transportation, land use, community economic development, agriculture)
• The acute shortage of community heath workers and the growing
shortage of public health workers must be addressed as an urgent
national priority. This workforce must be trained to develop, deploy and
deliver community-based prevention strategies that have the attributes
described above.
• Community-based prevention efforts must be culturally competent and
tailored to the populations being targeted
• Public health indicators such as Healthy People 2020 that focus on social
determinants of health should be widely communicated and applied
• Health reform will require going outside traditional health policy to other
sectors.
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Transportation policy is health policy
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Funding for community-based prevention and public health should reflect the
value of these strategies in alleviating disease burden and improving quality of life
7% of Americans’
urban trips are
biking/walking:
46% in Holland
• Prevention spending as a share of total federal healthcare expenditures should
be commensurate with its potential to alleviate disease burden and improve
quality of life
• Investments in prevention research as a share of total federal health research
spending should be increased similarly
• Funding streams for community-based prevention and other public health
efforts should be consistent over time, sustained and dedicated
¾Federal funding streams for public health and prevention should be focused
on the factors and conditions that contribute to health, including the social
determinates of health
¾State and local entities should be able to consolidate funding streams in
order to increase flexibility, innovation and impact on the factors and
conditions that contribute to health
Slide courtesy of Richard Jackson, MD
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If we stand for health, we have to engage actively in the society
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Prevention spending needs to reflect its value
• “Too often, too many Americans go without high-value preventive
services such as cancer screening and immunizations to protect
against flu or pneumonia. Similarly, community-based prevention
efforts, which have helped to drive down rates of smoking and lead
poisoning, for example, are underutilized despite their effectiveness.
The nation also faces epidemics of obesity and chronic diseases as
well as new threats of pandemic flu and bioterrorism. Despite all of
this, fewer than four cents of every health care dollar gets spent on
prevention and public health. This needs to change.”
Opening Statement – Health and Human Services Secretary-Designate Tom Daschle,
Senate Committee on Health, Education, Labor and Pensions, January 8, 2009
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Kate Meyers, Racial and Health Disparities, IHP
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Access to healthy foods
Health reform should recognize and support the role of healthcare delivery systems in promoting
community health, and facilitate integration of public health and healthcare delivery systems
• Public hospitals and community health centers are critical to community health and
must be sufficiently resourced
• Health reform must harness the assets of delivery organizations in order to mitigate
inequity and health disparities, and provide for rational and efficient allocation of
resources according to community need
• Health information technology incorporating personal health record portability is
essential to the coordination of services between the public health and healthcare
delivery systems, and to the safe and efficient delivery of care. Health reform should
support and facilitate the adoption of these systems
• Essential clinical preventive services should be covered in all federally supported health
plans including Medicare, Medicaid, SCHIP and any new public plans.
• The IRS should encourage non-profit hospitals to invest in evidence-based community
prevention efforts including community coalitions addressing specific health goals,
changes in the physical environment and community building activities
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Promoting access to local food through farmers markets at our facilities
Solutions should be designed and prioritized to simultaneously address equity,
buttress our economy and promote environmental sustainability
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There is clear evidence linking socioeconomic status and environmental health
to the health of individuals and communities. This requires that health reform
explicitly address these social determinants of health, and that policies
effecting education, transportation, the built environment and the food system,
among others, explicitly identify and consider the health impacts of those
policies.
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Policies and projects intended to stimulate economic growth and protect the
environment, if designed smartly, can also result in significant public health
benefit. (For instance, investments in public transit and urban green spaces
can simultaneously create jobs, reduce greenhouse grass emissions and
promote physical activity.) These public health benefits should be accurately
accounted for and considered by policymakers when choosing between
alternative economic stimulus and environmental protection strategies.
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Solar panels at the Modesto Medical Center
The evidence is clear: People cannot be healthy in toxic environments
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Improving health …need to be informed by a comprehensive understanding of the wide
range of factors that shape health status. We need to converge across sectors – health,
transportation, land use, agriculture, infrastructure, economic development – to
maximize the health and well-being of individuals and communities. Converging across
issues is challenging but necessary, and will have huge payoffs for health and for the
economy.
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Footnote: PolicyLink and Prevention Institute, 2008. Healthy People, Healthy Places: Directions for Improving Community,
Individual and Economic Health
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We have to put “health” back in health reform
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For more information
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Don’t stop at coverage and access
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Address disparities explicitly
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Look at the economics of prevention
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Take a multi-sectoral approach to health (“Health in All Policies”)
• http://convergencepartnership.org
• http://www.kp.org/communitybenefit
• http://www.policylink.org
• http://www.preventioninstitute.org
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