Population Health Implications of the Affordable Care Act: Workshop Summary (2013)

 

From the 16 October 2013 summary at Full Text Reports

Source: Institute of Medicine

Population Health Implications of the Affordable Care Act is the summary of a workshop convened in June 2013 by the Institute of Medicine Roundtable on Population Health Improvement to explore the likely impact on population health improvement of various provisions within the Affordable Care Act (ACA). This public workshop featured presentations and discussion of the impact of various provisions in the ACA on population health improvement.

Several provisions of the ACA offer an unprecedented opportunity to shift the focus of health experts, policy makers, and the public beyond health care delivery to the broader array of factors that play a role in shaping health outcomes. The shift includes a growing recognition that the health care delivery system is responsible for only a modest proportion of what makes and keeps Americans healthy and that health care providers and organizations could accept and embrace a richer role in communities, working in partnership with public health agencies, community-based organizations, schools, businesses, and many others to identify and solve the thorny problems that contribute to poor health.

Population Health Implications of the Affordable Care Act looks beyond narrow interpretations of population as the group of patients covered by a health plan to consider a more expansive understanding of population, one focused on the distribution of health outcomes across all individuals living within a certain set of geopolitical boundaries. In establishing the National Prevention, Health Promotion, and Public Health Council, creating a fund for prevention and public health, and requiring nonprofit hospitals to transform their concept of community benefit, the ACA has expanded the arena for interventions to improve health beyond the “doctor’s” office. Improving the health of the population – whether in a community or in the nation as a whole – requires acting to transform the places where people live, work, study, and play. This report examines the population health-oriented efforts of and interactions among public health agencies (state and local), communities, and health care delivery organizations that are beginning to facilitate such action.

Related articles

• Population Health Implications of the Affordable Care Act: Workshop Summary (nap.edu)

 

[Reblog]New IOM report focuses on funding health improvement rather than financing health system reform

Posted on April 26, 2012 by sarabeazley at American Hospital Association Resource Center Blog

” . . . it is no longer sufficient to expect that reforms in the medical care delivery system (for example, changes in payment, access and quality) alone will improve the public’s health.”

The Institute of Medicine has issued the third and final report of a series on public health that focuses on how altering the fundamental physical and social environment will lead to improved health in the general population, an essential requirement of any effective reform of the system that delivers health care services.

For the Public’s Health: Investing in a Healthier Future addresses its thesis in four chapter:

• Introduction and Context
• Reforming Public Health and Its Financing
• Informing Investment in Health
• Funding Sources and Structures to Build Public Health

The committee responsible for the report also propose ten recommendations, among which are the following:

• Greater legislative/regulatory flexibility in the allocation of funds by state and local health agencies in pursuit of public health improvement initiatives;
• Reduction in the provision of clinical care services by public health agencies so that they can focus on the delivery of population-based services, such as nurse home visits and health promotion activities;
• Development of  a model chart of accounts for use by public health agencies to improve their tracking of funds and measuring program effectiveness;
• Doubling the current federal appropriation for public health, with periodic adjustments to ensure public health agencies’ ability to deliver a minimum package of services;
• Reallocation of state and local funds from paying for services currently reimbursed through Medicaid or state health insurance exchanges to financing population-based prevention and health promotion initiatives conducted by public health departments.

Source: Institute of Medicine.  For the Public’s Health: Investing in a Healthier Future. Washington, DC: National Academies Press, 2012.  Free online edition at:http://books.nap.edu/openbook.php?record_id=13268.

The two previous reports are also available online.

For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges.  2011. http://www.nap.edu/catalog.php?record_id=13093

or the Public’s Health: The Role of Measurement in Action and Accountability. 2010. http://books.nap.edu/openbook.php?record_id=13005

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American Hospital Association Resource Center Blog

” . . . it is no longer sufficient to expect that reforms in the medical care delivery system (for example, changes in payment, access and quality) alone will improve the public’s health.”

The Institute of Medicine has issued the third and final report of a series on public health that focuses on how altering the fundamental physical and social environment will lead to improved health in the general population, an essential requirement of any effective reform of the system that delivers health care services.

For the Public’s Health: Investing in a Healthier Future addresses its thesis in four chapter:

• Introduction and Context
• Reforming Public Health and Its Financing
• Informing Investment in Health
• Funding Sources and Structures to Build Public Health

The committee responsible for the report also propose ten recommendations, among which are the following:

• Greater legislative/regulatory flexibility in the allocation of funds by state and local health agencies in pursuit of public health…

View original post 171 more words

Violence prevention, health promotion coming together: Projects creating healthier neighborhoods

From the April 2012 edition of The Nation’s Health

byTeddi Dineley Johnson
In Louisville, Ky., some liquor retailers are taking down alcohol ads that once covered their exterior walls. In Chula Vista, Calif., long-vandalized utility boxes are being painted and transformed into works of art. And in a Denver neighborhood, youths at risk for gang violence are sowing seeds of hope in a community garden.

On the surface, the three scenarios might appear to lack a common thread, but joining them is an emerging public health movement that brings practitioners in the fields of violence prevention, healthy eating and active living together to transform their communities in ways that will foster health and safety.

At its core, the work aims to get to the root cause of why some people are not going outside to exercise and not eating healthy foods, said Mighty Fine, MPH, CHES, a public health practice manager in APHA’s Center for Professional Development.

“Promoting healthy eating and physical activity are front and center on the nation’s public health agenda, but people who feel unsafe in their communities are less likely to go outside for walks, take their children to parks or use community centers or services such as public transportation,” Fine said. “And to make matters worse, grocery stores are reluctant to locate in communities in which people feel unsafe, which limits residents’ access to healthy foods.”

Until recently, the connection between violence and health outcomes has not been intuitively apparent to the public health community, and the lack of attention has prevented some people from living a healthy lifestyle, Fine said….

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We Can’t App Our Way Into Better Health or Healthcare – Health Is Social

We Can’t App Our Way Into Better Health or Healthcare

From the 9 March 2012 post at Health is Social

It’s cool and all that we can track our every step, our every weight, our every heartbeat, our every glucose reading.

Cooler still is to receive relevant feedback based on all the tracks.

Cooler yet is to gain proper interpretation of what the feedback means.

Even cooler is for us to get healthier and to deliver better care with all this tracking.

That last sentence – it’s not *just* cooler: it’s crux.

We can build all kinds of mobile applications. We can track all sorts of things.

But if we track the wrong things, we’ll simply railroad ourselves – or at least hop on the wrong train.

It’s not enough to track all those pushups and all those marathons.

In fact, how do you know that all those sweaty visits to the gym aren’t slowly making invisible tears in your muscles – how do you know that all those tears aren’t inducing a chronic state of tiny inflammatory processes that one day will lead to a myocardial infarction?

You see, the problems in front of you aren’t the problems in front of you: for an app that tracks your gym activity *might* be blinding you to some other problems.

Building and using more and more apps won’t convey us into better health or healthcare. Yes, they can help nudge and guide us – and that’s important as long as the contexts and processes into which those nudges and guides are the right ones.

An app is a module.

Health is a whole.

 

Healthy People? Not Quite Yet —From “The Public’s Health” Blog

Healthy People? Not Quite Yet [ The Public’s Health]

Excerpt from Dr. Rubin’s blog

In 1979, the publication of Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention represented the first report emphasizing the importance of decreasing early mortality through health promotion and disease prevention programs. This led to the Centers for Disease Control and Prevention’s development of specific, national 10-year health objectives, contained within a collaborative initiative known as Healthy People. The 2010 objectives fell within 28 public health focus areas including cancer, diabetes, immunizations and infectious diseases, injury and violence prevention, nutrition and overweight, and many others (the full list can be found here).

So as a country, how well did we meet the Healthy People 2010 objectives? I guess that depends on your definition of success. A final review of the 2010 results showed that of the 733 objectives for which data were available:

 23% met the 2010 targets
 48% made progress toward the 2010 targets
 5% showed no change from baseline
 24% moved away from the 2010 targets

 Read the entire blog item here

Related Resource

• Structured Evidence Queries (SEQs) for the Healthy People 2020 Leading Health Indicators

  Healthy People 2020 (HP2020) is a ten-year health promotion program for improving the health of all Americans. Led by the U.S. Department of Health and Human Services, HP2020 is organized into 42 subject areas with 600 public health objectives. These objectives, developed and selected through consultation with a broad range of organizations, groups, and individuals, provide a framework for monitoring and measuring improvements in health status of the American population over the ten-year period from 2010 to 2020.

  The Leading Health Indicators (LHI) are a set of objectives carefully selected to represent high-priority health issues and actions that can be taken to address them.

  The Healthy People 2020 Structured Evidence Queries (SEQs) are pre-formulated PubMed search strategies intended to support both public health practitioners and researchers in their efforts to achieve specific HP2020 public health objectives. The HP2020 SEQs provide citations to the most up-to-date peer-reviewed literature from the PubMed database of the National Library of Medicine.

  For persons interested in using the SEQs or other NLM resources to create products for the LHI App Challenge, e.g., for mobile devices, please contact the PHPartners Team. More general information about PubMed linking and E-utilities is available from Entrez Programming Utilities Help

  ---

  The Structured Evidence Queries link each Leading Health Indicator objective to PubMed citations related to that objective. For two LHI objectives, in Clinical Preventive Services (vaccination rate for toddlers) and Injury and Violence (fatal injuries), a set of SEQs is provided to further assist users. Your feedback will help us refine the SEQs over time.

  To use an HP2020 SEQ to search PubMed, please expand the Leading Health Indicator topic area (“+”) and click the  button by the LHI objective.

  [Go to http://phpartners.org/hp2020_lhi.html to use the structured  evidence queries below]

  

  1. Access to Health Services 

  2. Clinical Preventive Services 

  3. Environmental Quality 

  4. Injury and Violence 

  5. Maternal, Infant and Child Health 

  6. Mental Health 

  7. Nutrition, Physical Activity and Obesity 

  8. Oral Health 

  9. Reproductive and Sexual Health 

  10. Social Determinants 

  11. Substance Abuse 

  12. Tobacco 

Related articles

• Healthy People? Not Quite Yet. (drrubinblog.com)
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• Syphilis Rises 36% In USA In Four Years (jflahiff.wordpress.com)
• Thank you Public Health! (healthygenerations.wordpress.com)
• Public Health Investments Pay Off (jflahiff.wordpress.com)
• Public health experts condemn plans (mirror.co.uk)

Improving health will take a village

From the 8 December 2011 Eureka News Alert

Collaboration of public and private health partners is essential for health improvement

WASHINGTON, DC – Improving health is too multifaceted to be left solely in the hands of those working in the health sector alone, according to the latest Healthy People 2020 Objectives for the Nation. A recent shift in national health priorities has led Healthy People, a program that sets the national agenda for health promotion and disease prevention, to add ‘social determinants’ into its 2020 goals.

Two papers published in the December issue of the journal Health Education & Behavior (HE&B), published by the Society for Public Health Education (SOPHE), examine the history of the Healthy People Objectives and the new integration of social determinants in Healthy People 2020.

In both papers, the authors examine the effects of poverty, education and social structure on health and conclude that the country’s compass for health improvement must point beyond the diseases to address their root causes and forge new public and private health partnerships.

In their article, “Healthy People: A 2020 Vision for the Social Determinants Approach,” U.S. Assistant Secretary for Health Howard K. Koh, MD, MPH, and colleagues outline the need for collective effort and an expanded way of thinking to make true impacts on public health. “Health starts where people live, labor, learn, play and pray. The social determinants approach makes the healthier choice the easier choice for all people throughout the life span.”…

…

Read more about the history of Healthy People and the inclusion of social determinants in health education in both articles. They are available free in Health Education & Behavior for the next 45 days at:

“Healthy People: A 2020 Vision for the Social Determinants Approach” by Dr. Howard K. Koh, Julie J. Piotrowski, Dr. Shiriki Kumanyika, and Dr. Jonathan E. Fielding:http://heb.sagepub.com/content/38/6/551.full.pdf+html

“Healthy People 1980-2020: Raising the Ante Decennially or Just the Name From Public Health Education to Health Promotion to Social Determinants?” by Dr. Lawrence W. Green and Dr. John P. Allegrante: http://heb.sagepub.com/content/38/6/558.full.pdf+html

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Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths

Full Text Online Article from the 11 July 2011 issue of Health Affairs – At the Intersection of Health, Healthcare, and Policy

[Abstract]Public health encompasses a broad array of programs designed to prevent the occurrence of disease and injury within communities. But policy makers have little evidence to draw on when determining the value of investments in these program activities, which currently account for less than 5 percent of US health spending. We examine whether changes in spending by local public health agencies over a thirteen-year period contributed to changes in rates of community mortality from preventable causes of death, including infant mortality and deaths due to cardiovascular disease, diabetes, and cancer.

We found that mortality rates fell between 1.1 percent and 6.9 percent for each 10 percent increase in local public health spending. These results suggest that increased public health investments can produce measurable improvements in health, especially in low-resource communities. [Flahiff’s emphasis].However, more money by itself is unlikely to generate significant and sustainable health gains; improvements in public health practices are needed as well.

Click here to read the rest of the article

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Database of Promoting Health Effectiveness Reviews (DoPHER)

 

Database of Promoting Health Effectiveness Reviews (DoPHER)
http://eppi.ioe.ac.uk/webdatabases/Intro.aspx?ID=2

Focused coverage of systematic and non-systematic reviews of effectiveness
in health promotion and public health worldwide. This register currently
contains details of over 2,500 reviews of health promotion and public
health effectiveness.

There are many ways to search the reports through the Searchtab.
One may browse reports by clicking on the Reporttab, then Explore, and finally Generic Keywords ( focus of the report option)

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