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Slide Set C: Painting the Picture: A Reality Check

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External Consultation on Program Collaboration and Service Integration
        
PAINTING THE PICTURE: A REALITY CHECK
August 21, 2007
Slide 1
External Consultation on Program Collaboration and Service Integration
PDF File or PPT File


A "Glimpse" Into Local Public Health Practice
        
Stephanie Bailey, MD, MS
Office of the Chief for Public Health Practice
12/06/06
Local Health Officer/Nashville, TN
May 1995 – Sept. 2006
Slide 2
A “Glimpse” Into Local Public Health Practice
PDF File or PPT File


THREE PICTURES
        
One you are most familiar with 	
  and…….
Two that you may not be.
Slide 3
THREE PICTURES
PDF File or PPT File


Health Protection: Urgent Threats
        
CDC has been operating in emergency mode 28 times in the past 5 years.  (and in some major ways this has affected you: smallpox clinics, anthrax detection, SARS protocols, etc)
Over the last five years, we all have faced unprecedented threats to health and safety. (Tsunami, Hurricanes Katrina & Rita, SARS, West Nile Virus…)
But we can combat these successfully. We can reduce disparities. And we can protect the nation’s health and economic security. But we can do this only if bold steps are taken to rebalance the current investment portfolio. 
Health protection must be prioritized—through preparedness; health promotion; and disease, injury, and disability prevention—at least as much as disease treatment is prioritized, and these actions must occur now.
Moreover, health protection research also must be prioritized to create a solid evidence-based foundation for the policies, programs, and practices necessary for success—at least as much as biomedical research is prioritized.
Slide 4
Health Protection: Urgent Threats
PDF File or PPT File


The New/Old Normal: Urgent Realities
        
Too many chronic diseases are urgent  and give us a landscape of our urgent realities – that we work to combat every day and take a great toll on our communities. 
Obesity, diabetes, ongoing tobacco use, tuberculosis, sexually transmitted disease, cardiovascular disease, enormous health disparities just in our country, let alone looking at things from the global frame.

So the problems that affect Americans' lives every day are also urgent in our minds.  And these problems also bring up the same challenges that the urgent threats bring up, complacency being chief among them.

Many of these threats are preventable, but are still increasing in communities across our country. More and more people are not able to enjoy the best possible quality of health as a result. Each of us has major role to play in combating these threats by supporting the research and programs necessary to ensure that people and our partners have access to the best possible health protection information and tools they need to make decisions about health.   
Business as usual is not enough; we must do more – and do it faster, smarter,  better and cheaper, I might add. - if we are to make an impact.  WHAT A MANDATE!  Faster, better, smarter and cheaper. 

What if we treated our urgent realities with the same zeal, commitment, concern that we combat urgent threats – Would we make a difference … I think so.  What if all the accidents that occur over a year occurred in one night?  What if all the people who are going to die from tobacco-related illnesses in a year dies in one day?
What would be your response today?  What if we targeted conditions that lead to institutionalization of the elderly?  Mike Mcgee in his book, Health Politics, he states how since 1980 there has been a nearly 15% decrease in the prevalence of chronic disability and institutionalization among people 65 and older.  A drop in disability translate directly into cost savings since it is 7x more expensive to care for a disabled senior vs. a healthy one.  Incontinence affects 13m, half of all nursing home patients, at a cost of nearly $12B per year. Major activity limitations are a common cause of nursing home admissions.  The most common cause is arthritis, affecting 50% of people >65, and as estimated 60m by 2020. Hip fractures are a second source of immobility, projected to occur 420,000 times in the year 2020, nearly all fall related. (mainly the result of poor supervision and unsafe environments)

In addition to the obvious benefits of medical treatment and the creation of safe environments, the expansion of exercise and muscle strengthening could make a real difference in the incidence of falls and fractures.  Finally, a focus on medications, their interactions, assistance in their accurate and regular administration and regular evaluation would lead to further improvement.  Dollars spent on both geriatric training and the prevention of these conditions most likely to cause disability and institutionalization are an extraordinary investment.  Adding a single month of independence acc to Dr.McGee and health to America’s senior pop’n would save $5B.  A10% decrease in hospitalization and institutionalization would accrue $50B in savings per year.
Don’t you want this to occur before we get there?!  With the prediction that >1m people will be 100 years of age or older by 20/20, prevention and health maintenance need to drive  our discussions now!
Slide 5
The New/Old Normal: Urgent Realities
PDF File or PPT File


The first 'unknown' to you
        
The Stories of our Children
Data:2004
Slide 6
The first 'unknown' to you
PDF File or PPT File


Raphael, age 10, 4th Grade
        
Mother incarcerated

“waited all day to talk to mentor, wanting only to tell her about seeing his sister being shot the night before”

Expelled at end of school year because someone said something about his mother
Slide 7
Raphael, age 10, 4th Grade
PDF File or PPT File


Renaldo, age 11, 6th grade
        
Mother killed at age 6

Father lives in East Tennessee

3 cousins in household
Slide 8
Renaldo, age 11, 6th grade
PDF File or PPT File


Amanda, age 8
        
Mother on disability

Old brother, age 17, in jail

Older sister, age 15, pregnant

All three children have separate dad
Slide 9
Amanda, age 8
PDF File or PPT File


Christopher, age 12, 5th grade
        
 of 6 children

Father on disability

Suspended 2  x week, in school, for anger

All brothers expelled from school

2 older/2 younger
Slide 10
Christopher, age 12, 5th grade
PDF File or PPT File


Kenny, age 12, 4th grade
        
1 of 6 children

Father incarcerated
Slide 11
Kenny, age 12, 4th grade
PDF File or PPT File


Thomas, Kindergarten
        
Crack baby

Kicked out of school for attacking teacher
Slide 12
Thomas, Kindergarten
PDF File or PPT File


Courtney, age 5, Kindergarten
        
Mother incarcerated

Aunt raising 7 children, none are hers
Slide 13
Courtney, age 5, Kindergarten
PDF File or PPT File


Keisha, age 6, 1st grade
        
Dad incarcerated

5 siblings, older teenage sister has a baby
Slide 14
Keisha, age 6, 1st grade
PDF File or PPT File


Jarvis
        
Age six, first grade

Two older brothers, ages 16 and 17

Lives with aunt because both parents incarcerated on drug charges

October 2005, placed back in first grade……………
Slide 15
Jarvis
PDF File or PPT File


Jackie, age 12, 4th grade
        
Family has been put out of MDHA

Was in room when uncle was shot

Has been raped

WHEN SHE GROWS UP…. ……………she wants to be a doctor
Slide 16
Jackie, age 12, 4th grade
PDF File or PPT File


Social Costs of This Disparity
        
- Incarceration
Handicaps
Violence, truancy, suspensions
Mixed families
Failure (academic)
Needing and/or wanting attention
Lack of tools
Adult indifference
Low self-esteem
Slide 17
Social Costs of This Disparity
PDF File or PPT File


The second "unknown" picture to you
        
What funding streams (and policies) look like at the local (and state) level
Slide 18
The second "unknown" picture to you
PDF File or PPT File


Resource Flow

CMS  HRSA  CDC  SAMHSA  OPHS

Mental Health Agency  MEDICAID  Department of Health  Substance Abuse Agency  State Family Planning Agency  State Funds

Substance Abuse  CHC  Department of Health  Clinics  Community Organization s Family Planning

Pregnant Wife, Drug Addicted Husband
Children
Slide 19
Resource Flow
PDF File or PPT File


Resource Flow (HCFA)

CMS -> MEDICAID
-> CHC
-> Clinics
-> Community Organizations
All to Pregnant Wife, Drug Addicted Husband, Children
Slide 20
Resource Flow (HCFA)
PDF File or PPT File


Resource Flow  (HRSA)
        
HRSA
-> CHC
-> Dept. of Health
     CHC, Department of Health, Clinics, Community Organizations, Family Planning
-> State Family Planning Agency
All to Pregnant Wife, Drug Addicted Husband, Children
Slide 21
Resource Flow (HRSA)
PDF File or PPT File


Resource Flow (CDC)
        
CDC
-> Department of Health
     -> Department of Health -> Pregnant Wife, Drug Addicted Husband, Children
     -> Clinics -> Pregnant Wife, Drug Addicted Husband, Children
-> Community Organizations -> Pregnant Wife, Drug Addicted Husband, Children
Slide 22
Resource Flow (CDC)
PDF File or PPT File


Resource Flow (SAMHSA)
        
SAMHSA
-> Mental Health Agency -> Pregnant Wife, Drug Addicted Husband, Children
-> Substance Abuse Agency -> Substance Abuse -> Pregnant Wife, Drug Addicted Husband, Children
Slide 23
Resource Flow (SAMHSA)
PDF File or PPT File


Resource Flow (OPHS)
        
OPHS
-> Department of Health
     -> Department of Health -> Pregnant Wife, Drug Addicted Husband, Children
     -> Family Planning -> Pregnant Wife, Drug Addicted Husband, Children
-> State Family Planning Agency -> Family Planning -> Pregnant Wife, Drug Addicted Husband, Children
-> Community Organizations -> Pregnant Wife, Drug Addicted Husband, Children
Slide 24
Resource Flow (OPHS)
PDF File or PPT File


Resource Flow (STATE FUNDS)
         
State Funds
-> Substance Abuse -> Pregnant Wife, Drug Addicted Husband, Children
-> Department of Health -> Pregnant Wife, Drug Addicted Husband, Children
-> Clinics -> Pregnant Wife, Drug Addicted Husband, Children
-> Community Organizations -> Pregnant Wife, Drug Addicted Husband, Children
-> Family Planning -> Pregnant Wife, Drug Addicted Husband, Children
Slide 25
Resource Flow (STATE FUNDS)
PDF File or PPT File


Resource Flow (All Agencies)
CMS -> MEDICAID
-> CHC -> Pregnant Wife, Drug Addicted Husband, Children
-> Clinics -> Pregnant Wife, Drug Addicted Husband, Children
-> Community Organizations -> Pregnant Wife, Drug Addicted Husband, Children

HRSA
-> CHC -> Pregnant Wife, Drug Addicted Husband, Children
-> Dept. of Health
     -> CHC, Department of Health, Clinics, Community Organizations, Family Planning -> Pregnant Wife, Drug Addicted Husband, Children
-> State Family Planning Agency -> Pregnant Wife, Drug Addicted Husband, Children

CDC
-> Department of Health
     -> Department of Health -> Pregnant Wife, Drug Addicted Husband, Children
     -> Clinics -> Pregnant Wife, Drug Addicted Husband, Children
-> Community Organizations -> Pregnant Wife, Drug Addicted Husband, Children

SAMHSA
-> Mental Health Agency -> Pregnant Wife, Drug Addicted Husband, Children
-> Substance Abuse Agency-> -> Substance Abuse -> Pregnant Wife, Drug Addicted Husband, Children

OPHS
-> Department of Health
     -> Department of Health - >Pregnant Wife, Drug Addicted Husband, Children
     -> Family Planning -> Pregnant Wife, Drug Addicted Husband, Children
-> State Family Planning Agency -> Family Planning -> Pregnant Wife, Drug Addicted Husband, Children
-> Community Organizations -> Pregnant Wife, Drug Addicted Husband, Children

State Funds
-> Substance Abuse -> Pregnant Wife, Drug Addicted Husband, Children
-> Department of Health -> Pregnant Wife, Drug Addicted Husband, Children
-> Clinics -> Pregnant Wife, Drug Addicted Husband, Children
-> Community Organizations -> Pregnant Wife, Drug Addicted Husband, Children
-> Family Planning -> Pregnant Wife, Drug Addicted Husband, Children
Slide 26
Resource Flow (All Agencies)
PDF File or PPT File


Through the Council’s process and YOUR leadership as well as partner efforts, PHSR will be seen as a critical component of “doing business” (protecting and improving health not to mention reducing injuries) and be used by all agencies and organizations, to some extent, that comprise the public health system.  

A Public Health System is Complex
This illustration has been referred to as “the eggs” or “the web” – it is a cluttered representation of the complexity of a public health system and examples of organizations and groups that make up the system network.  

As you can see, there are many partners and groups represented who contribute to health and delivery of the EPHS. These include:

- Healthcare providers like hospitals, physicians, community health centers, mental health,  labs, nursing homes and others who provide preventive, curative, and rehabilitative care.
- Public safety such as police, fire and EMS.  Their work is focused on preventing and coping with injury and other emergency health situations.
- Human Service and Charity Organizations such as food banks, public assistance agencies, transportation providers, and others that assist people to access healthcare and receive other health-enhancing services.
- Education and Youth Development Organizations like schools, faith institutions, youth centers, and others groups that assist with informing, educating, and preparing children to make informed decisions and act responsively regarding health and other life choices and to be productive contributors in the community.   
- Recreation and Arts-related Organizations who contribute to the physical and mental well-being of the community and those that live, work and play in it.
- Economic and Philanthropic Organizations such as employers, community development and zoning boards, United Way, community and business foundations that provide resources necessary for individuals and organizations to survive and thrive in the community.
Slide 27
The venue for making it happen everyday
PDF File or PPT File



Man’s Search for Meaning
An Introduction to Logotherapy
Viktor E. Frankl

“He who has a why to livecan bear with almost any how.”
Slide 28
One of my favorite books
PDF File or PPT File


“the significance of the problems we face cannot be solved at the same level of thinking we had when we created them” - Albert Einstein
Slide 29
Albert Einstein
PDF File or PPT File


50 Reasons Not To Change
        
(Collage of talk bubbles)
        
Stop.
Look inward.
Listen.
To yourself.
To others.
Slide 30
50 Reasons Not To Change
PDF File or PPT File


PUBLIC HEALTH IS LIFE BETTER
        …this is but a “glimpse”
Slide 31
PUBLIC HEALTH IS LIFE BETTER
PDF File or PPT File


A "Glimpse" Into Local PH Practice
        
Stephanie Bailey
Office of the Chief for Public Health Practice
12/06/06
Slide 32
A "Glimpse" Into Local PH Practice
PDF File or PPT File  

 
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