Members and leaders from the American Public Health Association meet this week in Charlotte, as they wait for word on the Supreme Court’s decision about the federal health reform law.
By Kelsey Tsipis
In an event overshadowed by the pending Supreme Court decision on the federal health reform bill, state and national public health leaders are meeting in Charlotte this week for the American Public Health Association’s midyear meeting.
Hundreds of public health officials and workers came for Tuesday’s opening address by Dr. Donald Berwick, former administrator for the Centers for Medicare and Medicaid Services. Berwick’s keynote address focused on how public health workers need to work in a changing health care system, and to do more with less money.
“We’re going to have to think this through, it’s not going to be obvious,” said Berwick, who stressed a redesign of the health care world to eliminate waste and improve quality while reducing cost, something Berwick called the “triple aim.”
Berwick offered examples, such as the Nuka system, based in Anchorage, Alaska, where system leaders use multidisciplinary teams to provide patient care. In eight years, Berwick said, the system has cut emergency room use by half, had a third fewer hospitalizations, and cut costs while having “the best quality scores you can find, and highest satisfaction for patients and providers.”
Berwick also encouraged those present to be guided by a moral code that prioritizes care to the poor, people with disabilities and the elderly.
“The biggest risk for American health care today is that it will fail the moral test,” Berwick said, citing a quote by late Senator Hubert Humphrey that’s on the wall of the entrance to the building housing the Department of Heath and Human Services in Washington, D.C. “The wealthy will get through, the middle class will be injured but survive, but people at the dawn, and at the shadow, and the twilight of life are really at risk.”
N.C. speakers stress quality improvements
Dr. Laura Gerald, the North Carolina’s State Health Director from the Division of Public Health also spoke about obstacles faced by her department in improving health outcomes with dwindling resources.
“Our work is getting much more challenging,” Gerald said. “We’re increasingly having to do more with less. What’s challenging is we’re also at times asked to do more with nothing, so that is a little bit tougher.”
Gerald noted that, for example, in this year’s state legislative session, funding for tobacco cessation programs was cut from about $18 million last year to $2.7 million for the upcoming fiscal year.
“I’m not sure exactly how we’re supposed to keep our youth tobacco use rates at the overall low that we experienced in the last youth tobacco survey” said Gerald. “It makes no sense to cut prevention efforts and funds at a time when we need to be pulling dollars out of the system, and we need to address our most common clinical killer, rather than just ignoring it.”
Mecklenburg County Health Director E. Winters Mabry deescribed the success of Charlotte’s school nurse program, the largest program in Mabry’s department.
The county’s school district has about 130,000 students, with 117 nurses based at schools around the Charlotte-Mecklenburg School District.
“One of the challenges… is that over ten percent of our students come to school with chronic illnesses,” Mabry said, listing asthma, diabetes and obesity as problems.
Mabry said his county’s school nurses do case management of high-risk students, with goals around school attendance, behavior, grades, quality of participation and health outcomes.
“I’m pleased to report last year we managed more than 2100 students who are at high risk and had positive outcomes in 95 percent,” Mabry said.
After the opening session, attendees scattered into sessions on topics, such as creating a workforce for the future, and achieving health equity.
National and local leaders presented strategies used around the country to address health inequalities in places where there are racial and socioeconomic disparities.
“I’m from Eastern North Carolina – Robeson County – which has a huge health equity problem, unfortunately,” said Gerald.
“What we find in eastern North Carolina is a high proportion of rural parts of the state so we have some of the socioeconomic challenges. And that’s also where we have pockets of racial and ethnic minorities,” she said, “so when you combine both the rural status and high minority populations, what you see are even worse health outcomes and even unhealthier communities.”
Gearing up for the Supreme Court decision
Conference attendees continued into the evening to discuss the public health implications of the Supreme Court’s upcoming decision on the federal health reform law, expected Thursday.
Justices are expected to rule on the constitutionality of the landmark Affordable Care Act, often called Obamacare, which if upheld in its entirety would create mechanisms for covering an estimated 30 million more Americans with health insurance.
Sarah Somers, from the Triangle-based National Health Law Program, gave a overview of the key provisions of the Affordable Care Act, as well as the most of the possible outcomes of Thursday’s ruling.
Dr. Georges Benjamin, the executive director of the APHA discussed the importance of health care reform despite the Supreme Court ruling.
“These are uncertain times for public health, which is why it’s crucial to bring the public health community together to set new priorities,” said Benjamin. “When we marshal our collective strength, the public health community can make an enormous difference in the health of all Americans and save lives.”