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Let’s Recreate a Sense of Let’s Recreate a Sense of Community Community

to Tackle Healthcare Challenges! to Tackle Healthcare Challenges!

FLORIDA ON THE MOVE!!FLORIDA ON THE MOVE!!September 30, 2005September 30, 2005

Marcia L. Comstock, MD MPHMarcia L. Comstock, MD MPH

Wye River Group on HealthcareWye River Group on Healthcare

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Today’s AgendaToday’s Agenda

What we’ve learned from our What we’ve learned from our community leadership initiativecommunity leadership initiative

6 ‘truths’ about tackling 6 ‘truths’ about tackling healthcare challengeshealthcare challenges

How they apply to community How they apply to community activism activism

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WRGHWRGHA NFP health policy catalyst to:A NFP health policy catalyst to: Raise public awareness of health Raise public awareness of health

system challenges and the need for system challenges and the need for engagementengagement

Raise stakeholders' awareness of Raise stakeholders' awareness of others' perspectives in order to others' perspectives in order to advance constructive changeadvance constructive change

Raise public policymakers' awareness Raise public policymakers' awareness of areas where there is a making of a of areas where there is a making of a consensus among stakeholdersconsensus among stakeholders

Promote visionary leadership in Promote visionary leadership in public and private sectorspublic and private sectors

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6 ‘Truths’ about Tackling 6 ‘Truths’ about Tackling Healthcare ChallengesHealthcare Challenges

1. We need a common vision for health & 1. We need a common vision for health & healthcarehealthcare

2. Government will not fix our healthcare 2. Government will not fix our healthcare problemsproblems

3. Communities are the logical place for 3. Communities are the logical place for initiating changeinitiating change

4. The challenges are too great for the 4. The challenges are too great for the industry aloneindustry alone

5. We need to think HEALTH--not 5. We need to think HEALTH--not healthcarehealthcare

6. Our health & healthcare are too 6. Our health & healthcare are too important to leave to othersimportant to leave to others

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“ “Communities Shaping a Communities Shaping a Vision…..”Vision…..”

Hundreds of leaders in a dozen Hundreds of leaders in a dozen communitiescommunities

Physician, hospital, insurance, public Physician, hospital, insurance, public health, business, consumer, health, business, consumer, government government

Diverse communities in size, Diverse communities in size, geography, population demographics, geography, population demographics, culture, cost and quality of healthcareculture, cost and quality of healthcare

Site visits, interviews, leadership Site visits, interviews, leadership roundtablesroundtables

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“ “Communities Shaping a Communities Shaping a Vision…..”Vision…..”

Learn about healthcare values that guide Learn about healthcare values that guide thinking of community leaders and citizensthinking of community leaders and citizens

Understand their conclusions about what Understand their conclusions about what works and what needs to be fixedworks and what needs to be fixed

Create mechanisms for this thinking to Create mechanisms for this thinking to inform the national policy debate inform the national policy debate

Support changes to enable communities to Support changes to enable communities to better meet their healthcare needsbetter meet their healthcare needs

Identify creative, collaborative, replicable Identify creative, collaborative, replicable community-based initiatives that address community-based initiatives that address healthcare problems healthcare problems

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What Did We Hear?What Did We Hear?

Community discussions less Community discussions less polarized, less partisan, more focused polarized, less partisan, more focused on finding practical solutionson finding practical solutions

We face a major crisis and we need We face a major crisis and we need definitive action NOWdefinitive action NOW

Healthcare leaders more motivated Healthcare leaders more motivated than in the past to work together on than in the past to work together on solutionssolutions

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What Did We Hear?What Did We Hear? There is no social contract for healthcare There is no social contract for healthcare

that is well-articulated and broadly that is well-articulated and broadly understoodunderstood

People do not know what they should People do not know what they should realistically expect from the health care realistically expect from the health care system, nor do they understand their system, nor do they understand their responsibility to contributeresponsibility to contribute

The healthcare system has fostered The healthcare system has fostered unrealistic expectationsunrealistic expectations

We need to restore a sense of community We need to restore a sense of community interdependence interdependence

Healthcare is both a public and a private Healthcare is both a public and a private goodgood

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What Did We Hear?What Did We Hear? Individuals need to be actively Individuals need to be actively

involved in making key choices about involved in making key choices about health-related behaviors, and health-related behaviors, and healthcare-related decisionshealthcare-related decisions

Increased personal responsibility Increased personal responsibility must be linked with efforts to educate must be linked with efforts to educate and actively reach out to patientsand actively reach out to patients

The health care system should be The health care system should be more accountable for delivering high more accountable for delivering high value carevalue care

Communities should enable people to Communities should enable people to make good choices and adopt more make good choices and adopt more positive health behaviorspositive health behaviors

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What Did We Hear?What Did We Hear? There is a serious void of leadership in There is a serious void of leadership in

the healthcare industrythe healthcare industry Health care institutions have lost Health care institutions have lost

credibility with the public and credibility with the public and skepticism about motives is prevalentskepticism about motives is prevalent

There is tremendous fragmentation in There is tremendous fragmentation in healthcarehealthcare

Some policy and financing issues must Some policy and financing issues must be addressed at the federal levelbe addressed at the federal level

BUT, there is great faith in the ability BUT, there is great faith in the ability of communities to develop creative of communities to develop creative approaches to health challenges approaches to health challenges

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THE ‘TRUTHS’THE ‘TRUTHS’

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We need a vision…..We need a vision…..

We need a visible and respected We need a visible and respected national spokesperson for health as national spokesperson for health as well as local championswell as local champions

We need to decide as a society what We need to decide as a society what we really want from healthcarewe really want from healthcare

Our views about health and Our views about health and healthcare are VERY personal healthcare are VERY personal

‘‘Think globally, act locally’Think globally, act locally’

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Washington won’t solve our Washington won’t solve our problems!problems!

We need to shift our thinkingWe need to shift our thinking ‘‘Top down’ approaches used for 60 Top down’ approaches used for 60

years have not workedyears have not worked Reform efforts must recognize the Reform efforts must recognize the

pluralistic nature of this country and pluralistic nature of this country and consider our culture consider our culture

Start by carefully defining problems Start by carefully defining problems and priorities from the unique and priorities from the unique perspective of a community perspective of a community

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Communities are the logical Communities are the logical place for initiating changeplace for initiating change

All healthcare is localAll healthcare is local Policies determined at the community Policies determined at the community

level more likely to be based on the level more likely to be based on the actual conditions in a communityactual conditions in a community

Programs tailored to communities more Programs tailored to communities more effectiveeffective

Health care leaders are more likely to Health care leaders are more likely to work together productively within their work together productively within their own backyard own backyard

Community-based discussion is much Community-based discussion is much more likely to pull in participation from more likely to pull in participation from the grassroots and reflect a the grassroots and reflect a community’s values and priorities community’s values and priorities

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The challenges are too great The challenges are too great for the healthcare system for the healthcare system

alonealone To restore trust the public needs to see To restore trust the public needs to see

leaders working collaboratively in their leaders working collaboratively in their best interestbest interest

Health care leaders need to stop Health care leaders need to stop pointing the finger of blame at each pointing the finger of blame at each other and cooperate on a common other and cooperate on a common agendaagenda

Each organization only owns a piece so Each organization only owns a piece so none feels responsible for the whole none feels responsible for the whole

Individuals and non-healthcare Individuals and non-healthcare organizations have important roles to organizations have important roles to play in promoting health at the play in promoting health at the community levelcommunity level

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Think health, not Think health, not healthcarehealthcare

The healthcare delivery system is important The healthcare delivery system is important to health, but it is not the only factorto health, but it is not the only factor

Our common connection is not healthcare it Our common connection is not healthcare it is the improved health of the American is the improved health of the American peoplepeople

The greatest challenges to change are The greatest challenges to change are cultural--individual, organizational, societalcultural--individual, organizational, societal

Replace blame with personal commitment Replace blame with personal commitment and community action and community action

Adopt an ‘ecological’ model that addresses Adopt an ‘ecological’ model that addresses individuals, social environments, physical individuals, social environments, physical environments, economics, and policies environments, economics, and policies

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Engage the public!Engage the public!

The public needs to be involved in The public needs to be involved in discussions of key choicesdiscussions of key choices

Health and healthcare are too Health and healthcare are too important for us to not get engaged important for us to not get engaged in creating our healthcare future!in creating our healthcare future!

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The Citizens’ Health Care The Citizens’ Health Care Working GroupWorking Group

Charged by Congress with engaging the Charged by Congress with engaging the public in a dialogue on healthcarepublic in a dialogue on healthcare What healthcare benefits and services should What healthcare benefits and services should

be provided?be provided? How does the American public want How does the American public want

healthcare delivered?healthcare delivered? How should healthcare coverage be How should healthcare coverage be

financed?financed? What trade-offs is the public willing to make?What trade-offs is the public willing to make?

Recommendations and an action plan Recommendations and an action plan will be presented to Congresswill be presented to Congress

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How does this play out in How does this play out in community efforts to fight community efforts to fight

obesity??obesity??

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The ‘Public’ ViewThe ‘Public’ View

Obesity is everybody’s problem!Obesity is everybody’s problem! Healthcare providers should be central Healthcare providers should be central

to the effort to address the problemto the effort to address the problem Significant role for community Significant role for community

organizations—schools, employers, organizations—schools, employers, government government

Supports multi-pronged community Supports multi-pronged community strategy addressing education, personal strategy addressing education, personal behavior, environment, policy behavior, environment, policy

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Thinking Out of the BoxThinking Out of the Box

The healthcare system: position as The healthcare system: position as ‘economic engine’; broaden reach into ‘economic engine’; broaden reach into the community--where people live and the community--where people live and workwork

Public health: cannot be all things to all Public health: cannot be all things to all people; reach out to the industry and people; reach out to the industry and non-traditional playersnon-traditional players

Business: a ‘benign but vested Business: a ‘benign but vested stakeholder’ in employee health & stakeholder’ in employee health & productivity; catalysts for community productivity; catalysts for community collaborationcollaboration

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Critical Success FactorsCritical Success Factors

LeadershipLeadership MessagesMessages

InterventionsInterventions PartnersPartners

IncentivesIncentives ResourcesResources

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LeadershipLeadership

We need a visible, respected We need a visible, respected national spokesperson for national spokesperson for ‘Health’‘Health’

We need local respected We need local respected ‘champions’ to serve as ‘champions’ to serve as magnifiersmagnifiers

All must be giving the same All must be giving the same messagemessage

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MessagesMessages

We cannot assume people know what We cannot assume people know what ‘health’ is!‘health’ is!

Specific, actionable, consistent, broadly Specific, actionable, consistent, broadly applicable, and culturally relevantapplicable, and culturally relevant

Simple, user friendly information to Simple, user friendly information to overcome all the ‘noise’ in their livesovercome all the ‘noise’ in their lives

Traditional ‘white coat’ public health Traditional ‘white coat’ public health messages don’t workmessages don’t work

Messages need to be positive, fun, Messages need to be positive, fun, engagingengaging

Make ‘health’ COOL!Make ‘health’ COOL!

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InterventionsInterventions

There is really no ‘high risk’ groupThere is really no ‘high risk’ group Personalize messages and Personalize messages and

interventions for each target group by interventions for each target group by identifying relevant incentives for identifying relevant incentives for positive behaviorpositive behavior

Make benefits clear and tangibleMake benefits clear and tangible Ensure ‘trialability’Ensure ‘trialability’ Pilots must be self-sustaining, Pilots must be self-sustaining,

measurable, replicable and ‘scaleable’measurable, replicable and ‘scaleable’ Think broadly in terms of designing Think broadly in terms of designing

interventions interventions

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PartneringPartnering Involve ‘grassroots’: broad coalition of Involve ‘grassroots’: broad coalition of

public and private sector; business; public and private sector; business; non-traditional allies, e.g., faith-based non-traditional allies, e.g., faith-based groups, food & beverage industry, etc.groups, food & beverage industry, etc.

Leverage ALL existing assets of Leverage ALL existing assets of partners, e.g., brands and relationshipspartners, e.g., brands and relationships

Consider ‘arts’ partners to engage Consider ‘arts’ partners to engage people in creative wayspeople in creative ways

Build in accountabilityBuild in accountability Buy-in to shared creditBuy-in to shared credit

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IncentivesIncentives

‘‘Freebies’ work, but it is more Freebies’ work, but it is more important to empower individuals to important to empower individuals to actact

Data must be communicated in Data must be communicated in meaningful ways for each target groupmeaningful ways for each target group

Find out what motivates different Find out what motivates different groupsgroups

Incentives for partnerships must be Incentives for partnerships must be complementarycomplementary

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ResourcesResources

Cultural changes takes 7-10 years!Cultural changes takes 7-10 years! Need adequate funding/resources to Need adequate funding/resources to

sustain a long-term campaignsustain a long-term campaign Consider as resources all the Consider as resources all the

expertise in and the relationships of expertise in and the relationships of partner organizations, not just partner organizations, not just financial assetsfinancial assets

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ChallengesChallenges

People tend to thing ‘positively’ about People tend to thing ‘positively’ about themselves, their families, etc.themselves, their families, etc.

Some perceive ‘the health message’ to be Some perceive ‘the health message’ to be an intrusionan intrusion

Must align businesses need to make a Must align businesses need to make a profit with an interest in benefiting profit with an interest in benefiting societysociety

Our focus on the ‘science’ in public issues Our focus on the ‘science’ in public issues impedes our understanding of the ‘art’impedes our understanding of the ‘art’

Our communities are weak and Our communities are weak and fractured !!fractured !!

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Conclusion!Conclusion!

There is a great opportunity to improve There is a great opportunity to improve the health of the nation by employing the the health of the nation by employing the talents of a broad-based multi-talents of a broad-based multi-stakeholder effort by organizing and stakeholder effort by organizing and aligning the short and long term interests aligning the short and long term interests of traditional and non traditional of traditional and non traditional stakeholdersstakeholders

We should not re-invent the wheel; rather We should not re-invent the wheel; rather we should build on current programmatic we should build on current programmatic activity (pilots, demonstrations, and activity (pilots, demonstrations, and national programs) underwaynational programs) underway