HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

Introduction and Welcome

DENNIS P. WILLIAMS: Thanks Peter. It’s a pleasure to serve with someone who’s been working in the area of Maternal and Child Health for two centuries. This is really a great honor for us, and, welcome to all of you, welcome to Washington. You’re really lucky. After what seems like weeks and weeks of rain, you’re going to have a beautiful week. I just came back from Texas where we spent a week and I’ll tell you a little bit about it later in my remarks, but we spent a week in activities related to the, border bi-national health week along the US Mexico border. And in west Texas, we were in Laredo and El Paso. El Paso is called the Sun City because it never rains. The sun is always shining. But when we went there, there was this big cloud that just sort of sat over west Texas. And we started the week in Laredo and it rained. We moved to El Paso and it poured for a day and a half. We did get to Las Cruces towards the end of the stay and it was sunny there, but it was extraordinary. And in El Paso it’s sort of like snow in Washington. Everybody panics when you get a little bit of snow in Washington, because they’re afraid they can’t get around and get to work. In El Paso if it rains, they panic because they’re afraid of flooding and other things, so.

Anyway, welcome to Washington, you’re going to have a great week and I’m very happy to spend some time with you because the Title V Directors really are so vital to so much of the work that HRSA and other federal agencies do. Your responsibilities for public health in your states go far beyond administration of the Title V program, which is a huge responsibility by itself. I know that many of you also administer WIC, school health initiatives, programs for Children with Special Healthcare Needs, Family Planning Programs, and even Health Centers in some states. You play a crucial role in your state’s public health protections and the services you oversee for women and their children truly do benefit them across their lifespan. It’s a slogan, which is the slogan of this meeting.

We know, too, that many of you played enormously important roles during the disastrous hurricanes that ravaged Louisiana and her neighbors. I had the opportunity just before I came up here this morning, to meet with Mary Craig from Louisiana and she talked to me a little bit about some of her experiences in Louisiana and the aftermath of the hurricane. And it’s pretty clear, we all experienced it from afar. It was a unique event, certainly, in my experience and probably in the experience of the country. In hearing about what happened from somebody who, whose had to endure that for the last month or so is quite, quite moving. A lot of the Maternal and Child Health offices in Louisiana are in New Orleans if I understand it correctly. And so their offices and the people who staff them have been dispersed and trying to keep that Title V program going under these circumstances is really a great, a great challenge and we give Mary, we wish you all the best and we want to give you as much support as we can. But it’s also clear from your discussion with me that this is not over. This is a very long-term recovery effort, not just to get people back to work. Housing, getting people just to come back home. Lots of people had to leave the state as a result of the devastation. Bringing people back, getting housing, getting that economy and that society back together is going to be a long-term effort and the federal government is going to be with the state and local governments, working with them to try to achieve that over the next, over the coming period of time.

But during the, during that crises, many of you sent Title V staff into shelters to help evacuees. And you and your own staffs filled the empty spots that those responders left in the clinics where they normally worked. And I thank all of you for funneling to us so quickly the information we asked for on how your states were responding to the public health emergency caused by the hurricanes. One of the things the secretary asked us to do and we met with him everyday during this period. There was a great hunger for information about what was going on, on the ground. And through are Community Health Center network, through the Title V, a grantee network, you were very good in bringing us information about what was going on in your area. What was happening? How many evacuees you were seeing and providing services to and in the early days of the crisis that provided a lot of the information that we had available and gave people a sense of what was going on and we appreciate it. Sometimes we can be a burden on you, but I can tell you that that information was well received, very useful, and provided a good input to a decision making process, which was difficult at that time, trying to grasp the dimensions of the crises and what kind of services people were getting and the, and the kind of things they needed.

And after seeing how, how the stunning double disasters that hit Louisiana affected the delivery of services there, many of you are now reexamining your own preparedness and rethinking actions you might need to take to evaluate newborn nurseries or neonatal intensive care units and other vulnerable populations. It’s an exercise that officials at all levels of government should undertake. Perhaps the most important lesson Katrina and then Rita taught us is that we have to more honestly contemplate unthinkable events. And then we must think more deeply than we have up to now about what planning is needed to respond to those events. It’s one thing to plan how to deliver services when hospitals and clinics are put out of service. It’s another thing entirely to develop the layers of planning needed to respond to a disaster that also wipes out transportation and communication systems. And one of the things I heard a lot is that communications as much as anything else became very difficult in the aftermath of the hurricane, just as it was an issue in immediate aftermath of September 11 th. So communications is clearly one area that state and federal governments are going to have to look at a lot as we move forward. It’s one of the lessons I think we’ve learned from, from these experiences. And now we know that we must reconsider our assumptions about how first responders and hospital and clinic staff can be expected to respond when they themselves are left homeless or evacuated to distant areas. Our imaginations were not equal to nature’s awesome fury. And September 11 th proved that we were not equal to the worst designs of our fellow man. And so we all have a great deal of work ahead of us.

Let me now turn to updates on progress and some of HRSA’s regular programs and initiatives. In this year’s National Child Health Day Proclamation, President Bush reaffirmed his commitment to help schools and communities create safe and nurturing environments for all children and promote a cultural responsibility. His commitment supports HRSA’s own efforts to prevent the harmful effects of bullying by changing the culture that allows it to persist particularly in our schools. The Journal of the American Medical Association reports that nearly 30 percent of all youth ages 11 to 15 have been a victim or a perpetrator of bullying and we’ve all seen the tragic consequences of bullying at school over the past several years. We continue to build on the momentum of last year when HRSA with the help of Surgeon General Carmona, launched the take a stand, lend a hand, stop bullying now campaign. The campaign’s website at www.stopbullyingnow.hrsa.gov recently added Spanish content for adults along with 12 new fact sheets. We are proud to say that 21 states now have anti bullying laws and HRSA is still working with, with our 72 partners from the American Academy of Pediatrics to the Departments of Justice and Education to bring bullying to a halt.

Later this week, HRSA will sponsor another important public meeting or the advisory committee on Heritable Disorders and genetic diseases in newborns and children. Earlier this year the American College of Medical Genetics delivered to the committee its report, which we commissioned on the issue of federal guidelines to help standardize screening practices among states. The report gathered information on newborn screening, reviewed the scientific evidence and presented options from model policies and procedures. This past spring we received formal public comments on the report, which gave parents and other interested parties a chance to weigh in on its conclusions. The report has since been sent to HHS secretary Mike Lovett for his review and consideration.

Many of you know that HRSA is now more than halfway through our implementation of President Bush’s Health Center expansion initiative. That initiative, of course, will create or expand 1200 Health Center sites and serve an additional six million patients annually by the end of 2006. The expansion remains a priority for the President because he knows that Health Centers work for America. According to the latest statistics in 2004, Health Centers served an estimated 13.1 million people; close to three million more patients than were served in 2001 at about 3,700 comprehensive primary care delivery sites. The growth at the Health Center Network not only expands access to care. It also helps reduce health disparities. As you know, almost two thirds of Health Center patients come from minority groups. They are the one who will benefit most from the increased access to care and the expansion of available healthcare services. And about 40 percent of all patients treated in healthcare centers have no insurance at all.

Through the years Health Centers have built the solid record of success. Evaluations from patients tell us that Health Centers offer care that rivals and sometimes surpasses healthcare found in the open market. Health Centers have improved health outcomes, increased preventive services, improved management of chronic disease, and reduced hospitalizations. This underscores our belief that HRSA supported Health Centers on the frontlines of American healthcare are providing the best primary and preventive care services to some of our neediest friends and neighbors.

Many of you also know that HRSA administers the National Bioterrorism Hospital Preparedness Program, which has awarded close to two billion dollars in grants to states since the program was established following the September 11 terrorist attacks in 2001. States used these funds to develop and implement regional plans to improve the ability of hospitals, emergency departments, EMS systems, and other healthcare organizations to respond to possible bioterror attacks and other public health emergencies. Hurricane Katrina gave us a valuable glimpse into how state’s have invested these funds to improve their response capabilities.

In North Carolina, for example, state officials used beds, medical equipment, and training paid for by the HRSA Hospital Preparedness grants to setup a 120 bed mobile hospital in the parking lot of a K-Mart in Waveland, Mississippi soon after hurricane Katrina ravaged the area. As of early October, the 450 medical personnel who staffed the unit on a rotating basis had treated 7,000 local residents. The mobile unit was the only hospital operating in hard hit Hancock County, considered the EPI-Center of Katrina’s fury, after the local hospital was flooded to its second floor during the storm.

The North Carolina Health Department put CDC and Department of Homeland Security funds together with those from HRSA, to staff and outfit the State Medical Assistance Team that operated the mobile hospital. The State Medical Assistance team operates something like a Medical State National Guard. The 900 healthcare professionals and trauma experts, who made up the ranks of the State Medical Assistance Team, are committed to report to duty when their team is called to service. The North Carolina team also got substantial private sector support for its mission in Mississippi Hendrick Motorsports finance car racing company based in North Carolina, provided weekly flights between North Carolina and the Mississippi coast that allowed the team to rotate staff in and out of the area.

North Carolina responded to Mississippi ’s request under guidelines established by the Emergency Management Assistance Compact, which the US Congress ratified in 1996. The Compact allows states asking for and asking for aid during disasters or emergencies to honor licenses, certificates and other permits awarded by responding states. The mobile hospital is scheduled to demobilize and return to North Carolina at the end of October by which time local hospital facilities hope to reopen.

It’s a very good example of what we can do to help each other in these kinds of situations. It also, I think, points out that the extent of the devastation of these hurricanes is very much, has many of the same affects as one might expect from a, a large bioterrorism or other kind of events. What were learning from this hurricane can be applied across a range of disasters and I think it reinforced the notion that as we prepare hospitals for a bioterrorism mode of events, we really need to prepare them for all, excuse me, all hazards kind of approach to, to preparedness. Not just bioterrorism, but to all hazards natural and manmade. And I think this is a good example of what we can do there.

Let me now talk a little about an effort we started at the beginning of this year inside HRSA to take a look at how we interact with state governments and how we can improve these relationships. And in so doing, of course, improve the delivery of services to the needy populations HRSA and states serve. Cassie Lauver heads up the effort, which we call the HRSA State Partnership Committee. Cassie and her colleagues started with an internal review of how each of HRSA’s bureaus and offices work with state officials. They examine mechanisms for collaboration, points of contact, what worked in the past, and barriers to working well together. They also sought comments from outside groups and they looked at earlier studies that recommended ways to improve collaboration inside HRSA and with our state partners.

We’ve learned several things. We need to communicate and collaborative internally within HRSA before we can honestly expect to communicate and collaborate better with our state and local partners. We do some things very well at HRSA and the lessons from those successes could be adapted to other programs. Our relationships with states contain both gaps and overlaps. In both cases we miss out on opportunities to collaborate more successfully. Recommendations from the committee have been shared with HRSA’s leadership and we are currently examining them and considering their merits. And we’re going to focus on, we’re going to take what we’ve learned from Cassie’s work and we’re going to do some work with some individual states as sort of pilots to see how we can actually collaborate better than we have in the past. And we’re going to use Texas as one place to start. We’ve already gathered a lot of statistics about what all of HRSA's programs, not just Maternal and Child but what all of HRSA’s programs are doing in Texas, where those resources are located, what their mission is and how we can get our own programs in that state to work more closely together to meet common objectives.

We’re then going to talk, sit down with the state. State has many of the similar programs with similar objectives and it’s our view if we sit down with the state and look at what they’re goals are, what our goals are, that if we work together, we can make limited resources go a lot further and be more effective if we collaborate and work together than if we continue to operate separately. So we’re going to test out this theory in Texas. What we learn there we’re going to move on to other states and work, looking to work with all of you eventually to see whether we can work together more effectively than we have in the past.

I can tell you that improving the way HRSA shares useful information with you will be one of the areas that we will focus on. And in that vein I can tell you that our staff and the office of information of technology is working hard right now to improve the user friendliness of the HRSA geo special data warehouse. For those who may not know about it, the data warehouse gives the public, gives the public access to an incredible range of HRSA information on grants and grantees, and health and demographic statistics. And the software allows you to pilot these investments, to plot these investments on a map you can build on your computer.

Earlier this month the data warehouse was honored with one of the ten awards for innovative technology by the magazine, Government Computer News. It’s amazing technology and we’re proud of it. But many of you have said you want to see us improve the data we offer and make it easier for you to access to use. My information technology people tell me that in response, they updated the warehouse to give you easier access to reports of HRSA grants in your states. They also say that new and improved state and county profiles were included in the update with plenty of charts and graphs. And we’re not done yet. The information technology staff will continue working to make the data warehouse easier to use and the right data, at the right time, in the right format so that you can use the information you find there to improve the programs that you operate.

Now, let me spend just a couple of minutes to tell you about Border Bi-National Health Week. About two years ago, the US/Mexico Border Health Commission met in Washington and agreed to work together to collaborate on a Border Bi-National Health Week every year. And this is the idea; it builds on something that Mexico has done for many years. They mobilize their whole population across the whole country, focus them on a childhood immunizations and other health screenings in order to get people into care and to diagnose various diseases. Mexico, of course, has a very centralized, government run, and health delivery system, so it’s different than ours. But the notion of mobilizing the population, focusing them periodically on health care needs seem to us a good idea. And so it was decided to, at the same time that Mexico was having one of its health weeks, we on the US side of the border, along that 2000 mile border from California through Arizona and New Mexico and Texas, stretching maybe a 100 miles inland, we would try to have activities along the US side of the border, Health Fairs and other health activities at the same time that the Mexican government was holding a healthcare week on its side of the border. And we would work together, collaborate together, to see whether we can get a deal with some of the health issues along that border, which if you look at the health statistics in that area of the country, you would find that they are, that that stretch of land, that 2000 mile stretch of land a 100 miles inland has probably the worst health status statistics of any part of the United States. So it’s an area that we need to focus on and we need to work hard to try to improve the healthcare and the health status of the people who live in those communities.

Last year that initial planning decision led to the first Border Bi-National Health Week a year ago in October. We had about; let’s see if I can remember these statistics from my discussions there. There were about 17 US border counties last year that participated in events along the border during that week. Five Mexican states, and there were 126 individual events by, organized by local communities along that border, during that week. More than 535,000 people benefited from those events including 63,000 health screenings and on the Mexican side of the border, more than 500,000 immunizations were accomplished during that period of time.

This year we just completed last week the second Border Bi-National Health Week and we really hope to continue this process going into the future. Dr. Duke spent three days along the border in El Paso and in Las Cruces, New Mexico. I was also with her at that time. I went there and at the beginning of the week starting on Tuesday, spent some time in Laredo, Texas. And other people from HRSA, John Nelson, who is here, the Deputy Administrator of Maternal and Child Health, was in California along the border and participated in events both on the US and on the Mexican side of the border. And Marcia Brand who heads our office of Rural Health Policy was in Nogales, Arizona along with Lou Valdez from our office of Global Policy, and she also, she and her staff participated in events there on both sides of the border.

What I found very encouraging was that in places like Laredo, this Border Bi-National Health Week provides an opportunity for the community to come together and to form partnerships, form relationships that hopefully will endure and lead to a collaboration throughout the year. In Laredo I found the, Dr. Hector Gonzalez whose the head of the City Health Department there, he has a Health Department that does a lot of the traditional public health functions, but he’s also very much focused on primary care. Not just traditional public health but also delivering primary care services to people who need it in his community. And he’s reaching out to some of our community health centers like Gateway Community Health Center in Laredo and forming a partnership that allows them to extend their reach into the population for delivery of primary care services. Laredo, like a lot of the other towns, El Paso and other towns along the border are rapidly growing, have rapidly growing populations. Their populations are probably going to double over the next 10 years and there’s a lot of people coming back and forth across that border. There are a lot of issues there and forming partnerships across the community to try to deal with these issues is something we’re try to foster in these Border Bi-National Health Weeks, help to foster.

In Las Cruces where we visited, we visited a community health center there, La Clinica de Familia. They also have a Healthy Start Grant and they do a great job combining primary care services to the Latino population there with a Healthy Start Grantee with great outreach. They use Promotoras and other community workers to reach out into the community and they have many messages, not just pregnancy but nutrition and, and it’s a mechanism that they can reach out into the community to bring people into care and, and have a better outcome with respect to pregnancies. So it’s pretty, they’ve also partnered with their city and county health department and one of the things that we were happy to learn about when we were there, the county health department pulling together a coalition, an alliance of all of the major health care providers in Las Cruces, including the hospitals, apply to HRSA for a community, healthy community access grant and they won. They tried. It took them three years. Over the course of that three-year period they built a coalition of local people and they applied to and on the third try they got a new grant.

They’re going to get about a million dollars a year for the next three years and they’re focused on trying to develop as a way of melding together this coalition, which they have formed. They’re going to construct a computer system that allows them to track the patients that the hospitals, the primary care providers, the health department come into contact with, they’ll have like an electronic health record computer system that allows everybody who touches those patients to have access to their records, so that they can track these people and provide better care over time. It’s something that is a good thing in and of itself but it also has the by product, you see we think over the long-term is the best thing, of building relationships so that scarce resources in all these communities can be brought to bear, to deliver primary care to those who most need it.

We also, in El Paso, found similar circumstances there and we had the opportunity to cross the border to Juarez where we visited a Promotora Conference. There were Promotoras working in Mexico, Promotoras working on the US side of the border. They had a week, long conference where they compared their own experiences and learned from each other about how to reach out into their communities in an effective way and bring healthcare to them. We also had the opportunity to see a major Mexican hospital in Juarez. It’s one of the best hospitals that, on either side of the border, very great neonatal intensive care unit there, because, you know, the government’s funds are supplemented by the local community, they created a foundation and they bring, it gets all the resources on their side of the border to bear on this hospital. They have also good relationships on the US side of the border. So this, that’s an example of what, can be accomplished with events like Border Bi-National Health Week. I wanted to let you know what we were doing there. And that we hope to continue our, HRSA’s involvement in these activities as we attempt over the long term to improve healthcare along the border.

Finally, I guess you all know that the fiscal year 2006 budget remains in discussion in the Congress and that the government is operating under a continuing resolution. Reauthorization of the Ryan White CARE Act, whose current authorization ended with the September 30 th. Fiscal year 2005 also remains in debate in the Congress. Last year President Bush stated his commitment to reauthorize the CARE Act based on these principles, focusing federal resources on life extending care, insuring flexibility to charter resources to address areas of greatest need and insuring results. The President’s FY2006 budget asks for two point one billion dollars in CARE Act activities, a slight increase over FY2005 with the extra funds going to provide additional funding for the State AIDS Drug Assistance Program. The FY2006 request is more than 275 million dollars more than the appropriation in 2001 when President Bush came into office. Finally, let me tell you that the grantee performance review schedule for calendar year 2006 is now available on the web at www.hrsa.gov/performancereview. That site also contains a copy of the Performance Review Protocol, the protocol guide and other relevant documents you might find useful. Thank you for listening. It’s been a pleasure to be with you today. Thank you.