Health4All Leadership and Training Conference George R Flores MD MPH April 12 2015 Sacramento Spending Too Much on Medical Care 2009 data Notes Amounts in US Purchasing Power Parity see ID: 656660
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Slide1
Reimagining
HealthThrough an Equity Lens
Health4All Leadership and Training Conference
George R. Flores MD, MPH
April 12, 2015SacramentoSlide2Slide3Slide4Slide5Slide6
Spending Too Much on Medical Care…
^ 2009 data
Notes: Amounts in U.S.$ Purchasing Power Parity, see
www.oecd.org/std/ppp
; includes only countries over $2,500. OECD defines Total Current Expenditures on Health as the sum of expenditures on personal health care, preventive and public health services, and health administration and health insurance; it excludes investment.
Source: Organisation for Economic Co-operation and Development.
“
OECD Health Data: Health Expenditures and Financing
”
, OECD Health Statistics Data from internet subscription database.
http://www.oecd-library.org
, data accessed on 08/23/12.
Total= $2.6 Trillion
(17.9% of GDP)
Estimated excess:
$700B - $1.2TSlide7
…and Not Enough on Prevention
Medical Care: 10%
Genetics: 20%
Behaviors & Environment: 70%
Prevention: 3%
Medical Care: 97%
Factors Influencing Health
National Health Expenditure
References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future.” June 2012
(
17% of GNP)Slide8
Our health largely depends on conditions where we live, learn, work and
play—
and not just on the medical treatment we receiveSlide9
Why Are Surroundings Different?Slide10Slide11
Historical Narrative
POLICIES: Redlining, racially restrictive covenants, land ownership rights, Medicaid, Social Security, affordable housingPRACTICES: Racial segregation- inner cities, barrios, reservations, ChinatownsPRESENT: Predatory lending, immigration , incarceration, school push out, gay marriageCommon Denominator: EXCLUSIONSlide12
California Poverty
vs. Life ExpectancySlide13Slide14
Non-White or Hispanic/Latino Population, 2010
Pollution Burden of California
Source: California Communities Environmental Health Screening Tool, Version 1.1, 2013
Pollution Burden scores for each ZIP code are derived from the average percentiles of the six Exposures indicators (ozone and PM2.5 concentrations, diesel PM emissions, pesticide use, toxic releases from facilities, and traffic density) and the five Environmental Effects indicators (cleanup sites, impaired water bodies, groundwater threats, hazardous waste facilities and generators, and solid waste sites and facilities). Indicators from the Environmental Effects component were given half the weight of the indicators from the Exposures
component.
The calculated average percentile (up to 100th percentile) was divided by 10 and rounded to one decimal place for a Pollution Burden score ranging from 0.1 -
10, where 10 is the highest burden.
Data methodology and limitation are available at:
http://
www.oehha.ca.gov/ej/ces11.html
Climate
Change Will Impact All Californians But The Most Vulnerable Will Suffer The
MostSlide15
CRH
AFFECTS MULTIPLE ORGANS & SYSTEMS
STRESSOR
CORTISOL
Hypothalamus
Pituitary Gland
Adrenal Glands
ACTH
Stress pathway from brain to body
Center on Social Disparities in Health, University of CA, San FranciscoSlide16
When the external becomes internal:
How we internalize our environment
Allostatic Load
Inadequate TransportationLong Commutes
Housing
Lack of social capital
High Demand-Low Control Jobs
Lack of access to stores, jobs, services
Crime
Stress
Stress
Stress
Stress
Stress
StressSlide17
Five percent of Americans, most with poly-
chronic disease— many of which are (or may be) preventable— account for close to 45 percent of the massive $2.6 trillion total spent in health care. Over the long term, it’s clear that the only way to flatten the health care spending curve is by investing in wellness and prevention. 1
1. T. Main and A. Slywotzky, The Volume-to-Value Revolution: Rebuilding the DNA of Health from the Patient In, Oliver Wyman Health
Innovation Center, 2012.Slide18Slide19
“Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.”
- President ObamaSlide20Slide21
Equity Improves the Bottom Line
Despite our wealth, the U.S. is unhealthier across the board than our peers.There is evidence that flattening the social gradient improves the health of all. Transferring some of the medical care overspend to equitable social and infrastructure investments can both stabilize the nation’s fiscal health, and improve well-being.Focused upstream interventions (policy, system, and environmental changes) offer promise.Slide22Slide23
Family & CultureSlide24Slide25
How Do We Get There
?Slide26
It Takes More Than Health Care…
MedicinePublic HealthCommunity HealthFocusIndividualPopulation
PlaceEthic
Personal ServicePublic ServiceCivic Responsibility
EmphasisDiagnosis and Treatment
Prevention and Health Promotion
People
Power
Paradigm
Medical Care
Prevention
Health-supportive and Equitable Environments & Policies
Identity
ProfessionMultiple professionsCommunity residentsRootsBiologyEpidemiologySocietySectorPrivatePublicPublic-Private CollaborationSlide27Slide28
.orgSlide29
Unprecedented Resources to Prevent Illness & Keep People Healthy
Expanded Insurance CoveragePrevention ServicesInnovation ModelsHealth Equity ProvisionsHealth Workforce IncentivesHealth HomesBetter Care
Lower Cost
Better Health
EquitySlide30
Consider options for waivers, mandates, market solutions, and cost controls through an Equity Lens
100% coverage -- no uninsuredCommunity-wide primary preventionConsumers and communities informed and incentivized to improve health outcomesLanguage and cultural competenceHealth career opportunities for underservedGood jobs for low-income peopleSlide31
Improve Equity Beyond ACA Implementation
Clinical care + public health + community health partnershipsStrengthen the safety net, public education, youth servicesIncrease capacity and fix mal-distribution of workforce, including public healthFollow enrollment with strengthening health literacy, system navigation, resilience, stewardship Saturate at-risk places with CHWs/promotorasAdvance health-supportive policies & community conditions
Health, race, and class impact analysis in all environmental planning, policy and resource decision-makingSlide32
Advancing Health Equity
Must explicitly address and understand how we got here. (What is the history?)Must give voice to those most impacted by the inequitable conditions. Slide33
Central Questions
For UsHow committed are WE to the principles of social justice?How does that commitment translate to our practice?Slide34
Key Ingredients for Change
Power matters (political, social, economic)Participation matters (undocumented, ex-felons, LGBTQ, BMOC)Narrative matters (personal responsibility & access to healthcare not the whole story….)Resources matter(leveraging various forms of capital)Slide35
Increasing Capacity for Change
Build strategic and integrative partnerships between public and private sectors, communities and resources.Deepen understanding of equity, community conditions and engagement, power & politics.Share training, lessons, expertise and resources across partners. Collaborate to catalyze leadership and advocacy across sectors.Slide36
Collaboration
Matters
Health Equity PriorityBridge Care and Community
Health Impact Assessment
Health in All Policies
100% Coverage & Access
Health Homes
Community Outreach
Empowered Patients
Build Capacity
Advocate
Partnerships
Stewardship
Youth Involvement
Individual Medical Care
Public Health
Community HealthSlide37
POWER
POLICY
COMMUNICATIONSSlide38Slide39Slide40
Big Wins at the Half-way Point
Cutting the number of uninsured Californians in halfIgniting a statewide policy debate about health coverage for undocumented CaliforniansReducing epidemic numbers of school suspensions by nearly a thirdCatalyzing nationwide and statewide strategies on improving wellness in young men of color; andInfluencing regional planning with health and prevention approaches. Slide41
Resources to Support Change
Payment reform that covers cost of community outreach and preventionFunding for public health and prevention programsFunding for education, nutrition, physical activity, social services, and youth programsFunding by transportation, housing, business, and development to improve conditions in at-risk placesSlide42
Community is the Cure. Health equity is the aim.
We all have a role. We all stand to gain.Slide43
gflores@calendow.org