Disparities

Editor’s Note: This is part of a series of posts contributed by Andrew Wickerham, who attended the 139^th Annual Meeting of the American Public Health Association this week in Washington, DC.

Think back to high school or college when a teacher would offer comments on a test or essay, along the lines of,  “B-, could have included more background on FDR’s reason for passing Social Security.”  That's not far off from the exercise the Department of Health and Human Services (HHS) undergoes periodically as part of its HealthyPeople Leading Health Indicators (LHIs) program, only the note to the country is more alongs the lines of,  “C-, work on diet, exercise, and making sure people with high blood pressure take their medication.” 

Unfortunately, most Americans, like bored, uninterested students in history class, don't seem to care. We have yet to make improvements to our health—and by many measures are worse off than we were a decade ago. So why does the federal government bother with the regular (read: expensive) process of revising the HealthyPeople guidelines?

HealthyPeople (HP)  started with a 1979 Surgeon General’s report intended to focus America’s public health agenda, prevent disease, and promote overall wellness. Three reports—HP1990, HP2000, and HP2010—followed, offering a decennial update to the national health improvement framework. Each report listed a series of LHIs, with the intent of focusing efforts for the coming decade. HP2020 launched in December 2010, and on Monday, HHS Assistant Secretary for Health Howard Koh, MD, MPH announced the newly updated list of 26 LHIs during a press conference at the American Public Health Association annual meeting.

Now, goals and objectives are certainly good things—they can serve to guide policy and reinvigorate practice. “The Leading Health Indicators imply priorities,” former Texas Commissioner of Health Eduardo J. Sanchez, MD, MPH, said at Monday’s event. Yet, the process of setting new goals for HealthyPeople seems rather conflicted.

Early reports on the relative successes and failures of HP2010 suggest that only a few hundred out of almost 1,000 HP2010 goals were achieved, and that ground was lost in the critical area of chronic disease management, with Americans suffering higher rates of obesity and hypertension. Nevertheless, HP2020 rolls out hundreds of new goals and objectives, in addition to the new LHIs.

There was one bright spot at the meeting. For the first time HP2020 includes consideration of the social determinants of health—the non-clinical factors that affect human health—as part of the LHIs. Socioeconomic disparities are widely recognized health indicators because disparity affects ability to access health care, self advocate, and make healthier behavior choices.  High-school graduation rates will be tracked as an LHI under HP2020 as a way to study the socioeconomic factors that influence health, and to encourage policymakers and providers to take a more holistic approach to improving population health.

Tomorrow, October 20th, Justin King from the Asset Building Program is speaking at a briefing organized by the Congressional Out of Poverty Caucus. See the details below from the briefing invitation.

LOS ANGELES – Recognizing the need to assist Los Angeles residents struggling with medical debt, healthcare practitioners today joined financial services providers and community groups to discuss how best to implement the Affordable Care Act in Los Angeles and strategies for keeping Angelenos out of debt. Speakers also highlighted options for those plagued by medical debt.

Tarnish on the Golden State, a new report issued by the New America Foundation, exposes how medical debt can lead to ill health and financial insecurity for individuals and families. Tens of millions of American families struggle to pay health insurance premiums and medical bills. In 2010, 44 million working aged American adults had medical debt or medical bills they were paying off over time. In California, over two million people had medical debt prior to the recession and the problem has likely become worse since then.

Over two million Californians have medical debt. These residents find it difficult to access needed health care or affordable credit. Medical debt and its consequences illustrate the detrimental effect of inadequate health insurance coverage. The financial stress resulting from unaffordable healthcare costs makes it harder for Californians to pay other bills. For Californians with medical debt, their physical, mental and financial health are at risk, as is their long term financial security.

Over two million Californians have medical debt. These residents find it difficult to access needed health care or affordable credit. Even after the passage of the Affordable Care Act, an estimated 80% of farm workers, who are undocumented, will continue to struggle with being uninsured and accessing healthcare. This can lead to medical debt that makes it harder for them to pay other bills and leads to financial and mental stress. For residents with medical debt, both their physical and financial health are at risk.

Over two million Californians have medical debt. These residents find it difficult to access needed health care or affordable credit. Even with the passage of the Affordable Care Act, many Los Angeles residents will continue to struggle with medical debt that makes it harder for them to pay other bills and leads to financial and mental stress.

Like many American patients, the American health care delivery system suffers not only from acute crises, but also from a chronic, poorly managed and debilitating disease. Primary care is in trouble. Not only are primary care physicians (PCPs) fleeing the profession in droves, but fewer and fewer medical students express an interest in pursuing a primary care career. Those entering the profession don't last long - 1 in 5 general internists become specialists by their tenth year in practice. The workforce pyramid needed to support effective health care reform – with a broad base of primary care providers – is being steadily eroded.

The coming crisis was the topic of a recent conference hosted by the American Board of Family Medicine and the Robert Graham Center. Dr. Robert Phillips, director of the Graham Center, emphasized that while the average ratio of individuals in the U.S. to PCPs is 1500:1, that ratio ranges from 500:1 to 5000:1 depending upon the region you’re talking about. While we don’t know the “right” ratio, we do know that rural communities are particularly barren of PCPs.

Don't forget to join us today for the event Moving Beyond Death Panels, where a distinguished panel of experts will discuss the implications of the most recent Dartmouth Atlas, Quality of End-of-Life Cancer Care for Medicare Beneficiaries Regional and Hospital-Specific Analyses. This study reinforces previous findings that the end-of-life care patients receive often falls short of their desires and wishes, and those of their families. All health care, including -- if not especially -- that which comes at the end of life, must be responsive to patients' needs and respectful to their personal values and choices.

To RSVP or see a full list of speakers, click here. If you can't make it in person, be sure to check out our live webcast or follow along on our Twitter feed, the NewHealthDialog. We'll be live-tweeting under the hashtag #nafevents. We hope to see you there!

The Health Policy Program invites you to join us at an event tomorrow from 12 to 2pm to discuss the controversial issue of end-of-life care, and the implications it holds for patients, families, providers and yes -- even those who pay for the care. While last year's contentious health reform debate painted the issue in harsh and often equivocal terms, the choices around end-of-life care are complex and deeply personal and are not a simple contrast between cure vs. care.

At the event, Moving Beyond Death Panels, a distinguished panel of experts will discuss the implications of the most recent Dartmouth Atlas, "Quality of End-of-Life Cancer Care for Medicare Beneficiaries Regional and Hospital-Specific Analyses." This study reinforces previous findings that the end-of-life care patients receive often falls short of their desires and wishes, and those of their families. All health care, including -- if not especially -- that which comes at the end of life, must be responsive to patients' needs and respectful to their personal values.

Lunch will be available at noon. To RSVP or see a full list of speakers, click here. If you can't make it in person, be sure to follow along on our Twitter account, NewHealthDialog. We'll be live-tweeting under the hashtag #nafevents. We hope to see you there!