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


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External Consultation on Program Collaboration and Service Integration
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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


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A “Glimpse” Into Local Public Health Practice
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THREE PICTURES One you are most familiar with and Two that you may not be.

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THREE PICTURES
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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.

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Health Protection: Urgent Threats
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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!
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The New/Old Normal: Urgent Realities
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The first unknown to you The Stories of our Children Data:2004

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The first ‘unknown’ to you
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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

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Raphael, age 10, 4th Grade
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Renaldo, age 11, 6th grade Mother killed at age 6 Father lives in East Tennessee 3 cousins in household

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Renaldo, age 11, 6th grade
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Amanda, age 8 Mother on disability Old brother, age 17, in jail Older sister, age 15, pregnant All three children have separate dad

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Amanda, age 8
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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

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Christopher, age 12, 5th grade
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Kenny, age 12, 4th grade 1 of 6 children Father incarcerated

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Kenny, age 12, 4th grade
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Thomas, Kindergarten Crack baby Kicked out of school for attacking teacher

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Thomas, Kindergarten
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Courtney, age 5, Kindergarten Mother incarcerated Aunt raising 7 children, none are hers

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Courtney, age 5, Kindergarten
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Keisha, age 6, 1st grade Dad incarcerated 5 siblings, older teenage sister has a baby

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Keisha, age 6, 1st grade
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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

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Jarvis
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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

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Jackie, age 12, 4th grade
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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

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Social Costs of This Disparity
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The second unknown picture to you What funding streams (and policies) look like at the local (and state) level

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The second “unknown” picture to you
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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 Organizations Family Planning Pregnant Wife, Drug Addicted Husband Children

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Resource Flow
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Resource Flow (HCFA)

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Resource Flow (HCFA)
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Resource Flow (HRSA)

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Resource Flow (HRSA)
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Resource Flow (CDC)

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Resource Flow (CDC)
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Resource Flow (SAMHSA)

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Resource Flow (SAMHSA)
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Resource Flow (OPHS)

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Resource Flow (OPHS)
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Resource Flow (STATE FUNDS)

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Resource Flow (STATE FUNDS)
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Resource Flow (All Agencies)

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Resource Flow (All Agencies)
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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.

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The venue for making it happen everyday
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 Man’s Search for Meaning An Introduction to Logotherapy Viktor E. Frankl “He who has a why to livecan bear with almost any how.”

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One of my favorite books
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“the significance of the problems we face cannot be solved at the same level of thinking we had when we created them” - Albert Einstein

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Albert Einstein
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50 Reasons Not To Change (Collage of talk bubbles) Stop. Look inward. Listen. To yourself. To others.

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50 Reasons Not To Change
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PUBLIC HEALTH IS LIFE BETTER …this is but a “glimpse”

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PUBLIC HEALTH IS LIFE BETTER
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A Glimpse Into Local PH Practice Stephanie Bailey Office of the Chief for Public Health Practice 12/06/06

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A “Glimpse” Into Local PH Practice
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