a vision for a culture of health - wichita state...
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A Vision for aCulture of Health
Paul Kuehnert, DNP, RN
Robert Wood Johnson Foundation
72nd Annual
Kansas Public Health Association Conference
Presentation Overview
• Our current public health environment
• Re-imagining public health for the 21st
century
• Promising practices
“The two most important daysin your life are the day you wereborn and the day you find out why.”
-Mark Twain
Helen Bruce, MD
1907 - 1994
• City of St. Louis Health Department
1947 – 1981
• Health Commissioner
1972 - 1981
Dr. Bruce’s 20th Century Public Health Legacy
Top three causes of death in 1900
• Pneumonia
• Tuberculosis• Diarrhea
Influenza Pandemic
Deaths from Infectious Disease
1900-2000, US
Changing leading causes of death – US
Mo
rtality
Rate
Epidemiologic Transition
1900
Pneumonia
Tuberculosis
Diarrhea
2010
Heart
Disease
Cancer
Stroke
Our 21st Century Public Health Problem
‘Shorter, sicker lives’
Spending more…Getting less
9
Low Life Expectancy at Every Age
•For both sexes,
the US never
ranks higher than
15 out of 17
countries before
age 75.
Ranking of US Mortality Rates by Age Group vs. Peer
Countries, 2006-2008
Source: IOM Report, Shorter Lives, Poorer Health. 2013
Particularly perplexing
IF
HEALTHCARE = HEALTH
11
What Determines Health?
Healthcare Genetics Social, Environmental, Behavioral Factors
20% 20% 60%
Source:Bradley & TaylorThe American Healthcare Paradox
employment
programs
supportive
housing
& rent
subsidies
nutritional
support &
family
assistance
other
social
services
that
exclude
health
benefits
Social Services
Source:Bradley &TaylorThe American Healthcare Paradox
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
Total Expenditures as a % GDP, 2009*
Social ServiceExpenditure, %GDP
*Switzerland and Turkey are missing
Pe
rcen
t o
f G
DP
Source:Bradley &TaylorThe American Healthcare Paradox
0.00
0.50
1.00
1.50
2.00
2.50
Ratio of Social to Health
Expenditures, 2009*
*Switzerland and Turkey are missing
data for 2009
Ratio o
f S
ocia
l to
Hea
lth
Sp
en
din
g
Source:Bradley &TaylorThe American Healthcare Paradox
In OECD, for $1 spent on health care,
about $2 is spent on social services.
In the US, for $1 spent on health care,
about $0.90 is spent on social services.
Source:Bradley &TaylorThe American Healthcare Paradox
2009
Average 81.8
US, 78.2 Australia
Canada
Finland
France
Hong Kong
Iceland
Israel
Italy
Japan
Macao
Norway
Spain
Sweden
Switzerland
16 years
Life expectancy, by county, compared to
the world’s 10 best countries
Murray, C JL and Ezzati, M. “Falling behind: life expectancy in
US counties from 2000 to 2007 in an international context,”
Population Health Metrics, June 2011
County Health Rankings:Health Outcomes
20
County Health Rankings:Health Factors
21
22
Impact of the 2008 Recession on Local Public Health
NACCHO 2015 Forces of Change Survey
Changing Dynamics in Health Care
• Health care value
• Transparency
• Payment reform and care coordination
23
24
Major reduction in uninsurance rate
15.4
1615.1
14.7
14.4
11.5
9.8
0
2
4
6
8
10
12
14
16
18
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Uninsurance rate
Source: National Health Interview Survey
2015 is estimated point
Health Reform & Public Health
• Expansion of insurance coverage
• Expansion of clinical preventive services covered
• National Prevention Council
• Prevention and Public Health Fund
• Community benefit requirements for non-profit
hospitals
• Workplace wellness incentives
25
Low Life Expectancy at Every Age
•For both sexes,
the US never
ranks higher than
15 out of 17
countries before
age 75.
Ranking of US Mortality Rates by Age Group vs. Peer
Countries, 2006-2008
Source: IOM Report, Shorter Lives, Poorer Health. 2013
Every System is
perfectly designed
to get the results it gets
- Don Berwick
Culture of Health
29
Vision:
We, as a nation, will strive together to
create a culture of health enabling all in
our diverse society to lead healthy lives,
now and for generations to come.
Being healthy and staying
healthy is an esteemed
social value
health of the population guides public and private decision-making
geography and demographics do not serve as barriers to good health.
individuals,
businesses and
governments
work collectively
to foster healthy
communities and
lifestyles.
we are all
supported to make
proactive choices
that will improve
our health.
How do we go
about building a
‘Culture of Health’
That’s all very nice, but……
Do more than think big.
Act together.
© 2008 Robert Wood Johnson Foundation. All rights reserved.
There’s More to Health than Health Care
Collaborative Planning
• Health care
• Social services
• Other units of government
44
Under the Affordable Care Act, all non-
profit hospitals must have:
The Affordable Care Act
changes the requirements for
federal tax-exempt status for
hospitals.
1. Written, well-publicized
financial assistance policy
2. Fair charges for patient care
3. Fair debt collection practices
4. Regularly assess the health
needs of their communities,
with input from community
and public health leaders, and
develop implementation plans
to address needs
•4
Available at:
www.ahacommunityconnections.org
Kane County, Illinois
• 515,000 residents
• Second & fifth largest cities
• 70% urban/suburban, 30% rural
• One third Hispanic
• Second youngest county in Illinois
• Fastest growing segment: 45-64 year olds
Community Assessment & PlanningWhy?
• Efficient resource use: 9 Kane
County agency partnership
• KCHD reorganization>>>capacity
• Alignment around health needs &
priorities
What?
• Comprehensive two-part report
• Assessment
• Improvement Plan
• 9 customized reports
• Health integrated in Kane 2040
Plan
• Web-based data and source
reports
Plan found at: www.kanehealth.com/chip.htm
2040 Kane County Comprehensive Plan challenges
Water
supply
Safe,
affordable
& diverse
housing
Healthy
population
Mobility &
connectivity
2040 Kane County Comprehensive Plan
www.countyhealthrankings.org
Paying for and rewarding value
Addressing Social Needs
61
Care coordination
• Multiple chronic conditions, socially
complex
• Perinatal
• Aging in place
62
“The best way to predict the future is to create it.” -Peter Drucker
66
Imagine a Culture of Health!!
Contact Info:
Paul Kuehnert, Director
Bridging Health & Health Care
Portfolio
(609)-627-6319
Twitter: @PaulKuehnert