MCHB ALL GRANTEE MEETING

Critical MCH Issues and Recommended Strategies

October 4-7, 2004

WENDY HELLERSTEDT: We have a bit of a joke. You’re seeing these slides for the first time and so are we! So, what I want to do to begin is, first of all, say good morning. I want to give you a little bit, and I can do it in two minutes, just about how we thought about our charge, which is the Public Health Approach. We thought about the IOM Report, and how it called for transformation of National Health Policy that traditionally has been grounded in health care services and biomedical research that serve individuals. What they asked us to do was look more expansively beyond individuals into social, economic, cultural, environment. They also affirmed the importance of political will and policy in the public health approach. This moves away from thinking about providing health services for the sick to broader thinking about why people get sick in the first place. And it also challenges us to still think about why, in this country, there are such deep social disparities in health.

There are three things that were really the central ideas that our three teams thought about, and these come from the IOM report when you’re thinking about a population health approach. First, disease risk should not be thought of as a dichotomy: risk or no risk; its really part of a continuum. There are degrees of risk. It’s rare that there are just people at the extremes. The one thing we want to think about and secondly, is that there are few people in the population who are very high risk or very low-risk. The majority of people fall in the middle, and that leads us to thinking about strategies or interventions that modify risk for the entire population, that bring the entire population’s distribution of risk to lower levels. And the third thing that we thought about is that the individual’s risk for illness can’t be considered in isolation from the disease risk of the population in which he or she lives. And again, that made us think about the importance of policy. Not only formal policies regarding seat belt use or unleaded gasoline or water and food safety laws, but informal policies that may be articulated by social norms.

Two major themes emerged from our three critical issues, and I want to just emphasize those before I go into them and they are these: All three of our mini-groups said that in order for any change to take place, we have to do as Dr. Koop said, think about marketing. The people who are working against health promotion are better at it than we are. And the other thing, and I was asked to say this by several of the group members, and this came through all the groups, is we need bold leadership and we need to ask for accountability. And while we very much appreciate that the Bureau’s given us a chance to talk about this, we also really hope we can see action as a result. Well, let me go into our three critical areas in the population approach. The first team that we had was facilitated by Laura Cavanaugh and are recorded by Julie McDougal, and our issue was Universal Access to Comprehensive Care, and this included the Medical Home Model, Prevention and Health Promotion, and Direct Care. What we really want to stress in this is that this Universal Access is affordable, relative to the strategies.

Okay, the strategies: Marketing was a big thing, like I said; in every group it was. And we wanted to really think about marketing to all but also tailoring messages to specific sub-groups, and especially to expose the opposition. This was a really important thing that people talked about is, there are people who benefit from sickness, and we wanted to be good and expose that. Marketing within our own agencies: We need help in collecting and analyzing data. And framing Universal Access according to the ten essential public health functions. Another strategy, and I think, let’s see, change it please? Okay, good. Bottom-up activation, assisting clients and consumers to become effective advocates. And HRSA needs to fund with a focus on prevention, not solely disease issues. And we turned to historical models of public health that have worked. Public health nursing was given as an example. Next, please? Thank you. Yeah. You know, all three of these groups were absolutely energetic. They were wonderful. I had to float among the three, and I have to tell that when I had to leave a discussion it just pained me, so I do thank HRSA for making this available to us.

The second team was lead by Phyllis Slawyer, and recorded by Jamie Resnick. Our critical issue there was to provide an adequate number of people who are well trained in the workforce to serve the needs of children and families. And the strategies were to create a national and independent council through an RFP process that would define future MCH workforce in key competencies for the workforce to convene a national meeting of universities and others to expand best practices and strategies for new best practices. To develop a systematic way of analyzing within each state, within each region, and nationally, the training needs and improve targeting of training resources to provide block grant application guidance from the MCHB. Expand the use of technology and technology came up in all three of the groups. Develop future interdisciplinary models for MCH training; and require current university and training programs to provide culturally competent training of professionals and providers. Thank you.

The next one, please? Okay. And again, the strategies make it easy for universities and training programs to incorporate MCH into courses by innovative models. The Bureau of Health Professionals should develop strategies for incorporating MCH contents into existing courses. Coming from the school of public health, I really echo this, I have to say. Identify and develop best practices in changing licensure exams to include cultural competency. Develop programs to target young children in schools to showcase MCH careers, how important that is. That came up several times. Finalize implementation of accrediting state health departments to include workforce development. A National Healthcare Service Corp to expand health disciplines and incentives to train people to serve rural and underserved areas. Develop schools of public health in every state with a focus on MCH. And develop community advocacy boards for the purposes of recruiting and attracting trained MCH personnel. Thank you.

Okay, our mini-group number three was led by Mario Drummond and recorded by Chris DeGraw. This was the issue that actually had the most votes of all of our groups, and that was to change the focus of our society from disease-orientation. Again, this is just what the IOM asked us to do to health prevention and promotion and to adopt a wellness or a holistic model. And strategies: Yeah. Create a broad coalition for wellness, and this group was very energized about how broad that coalition should be, including people from the community, families, universities, national, regional, state policy makers. Foster leaders. Again, this idea of leadership, to embrace wellness and health promotion. Work to shift consumer preferences and priorities to advocate for wellness.

The word wellness was used a lot, and I think that was a word that this group particularly liked. Looking for slogans all the time, wellness. To change financial approaches to foster better balance between health promotion and diagnosis and treatment. Next, please? And that was it for our group. Thank you very much.