a vision for a culture of health - wichita state...

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

pkuehnert@rwjf.org

Twitter: @PaulKuehnert