Friedell Committee hears focus should be on prevention programs, community strategies and community partnerships

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Seventy percent of the influence on our health comes from our own behaviors and the environment. So, plans to improve Kentucky’s low health status should focus on quality prevention programs, recognizing the importance of community determinants of health, and creating successful community partnerships.

Those were the main arguments from speakers Oct. 25 in Frankfort at the annual meeting of the Friedell Committee for Health, which focused on population health — defined as “the health outcomes of a group of individuals including the distribution of such outcomes within the group.”

Larry Cohen

Larry Cohen, founder and executive director of the Prevention Institute, said we must start demanding quality preventive care, just like we ask for quality health care.

“When people talk about health care, the expectation is for the highest quality, but with prevention we don’t always emphasize quality,” he said. “We have a lot of tools at our disposal, but they require a different set of strategies, they require a different kind of political will and then they require elements like funding.”

Cohen gave several examples of the social and community determinants of health. In Cincinnati, he said, the health department and local hospital tracked asthma rates by location and were able to determine the housing areas that were most affected and the bus routes and truck routes that were causing the most asthma-causing pollutants.

“If we don’t change the environment, don’t change the norms, we can’t change the behavior and the medical conditions are going to be predictable outcomes,” Cohen said.

Cohen said genetics influences 20 percent of our health, and health care influences it by 10 percent. Though the environment and our behaviors have a 70 percent influence, but only 3 percent of health resources are spent on prevention.

“In terms of our investment patterns and our prevention strategies, we have a systemic failure in investing in health,” he said.

Cohen discussed several new ways to fund preventive health, including collaborative strategies that bring the money saved through prevention programs back to the programs; improved community benefit spending, which is a requirement or non-profit hospitals; and “wellness trusts,” which work under the premise that savings from prevention initiatives, like a cigarette tax, is captured and re-invested back into “evidence-informed prevention strategies.”

“What we are talking about is a paradigm shift with leadership from Kentucky . . . a different way of working, a different way of thinking, he said.

Community partnerships

Dr. Douglas Scutchfield

Dr. Douglas Scutchfield , the Peter Bosomworth Professor of Health Services Research and Policy at the University of Kentucky, told the group, “There is a paradigm shift. There is a growing realization that controlling the increase in health-care expenditure and improving the health of our nation’s population requires major changes in the way we’ve been doing business.”

Scutchfield discussed findings from a study that looked at characteristics of successful relationships between hospitals and health departments.

He said successful partnerships have common threads, including: being built on a basis of trust, with clear, agreed-upon missions and goals that are defined and measurable; having a designated body with a clearly defined charge; and having broad and diversified funding sources.

He said Kentucky has many organizations that have formed successful partnerships with the communities they serve, including Humana and several accredited health departments and their local hospitals.

Patty Dale Tye, a Humana vice-president, said the health-insurance company is working with seven communities, including Louisville, to improve community health by bringing like-minded people together to work on health initiatives specific to their communities, like behavioral health issues, obesity and diabetes and access to healthy foods.

“We can’t expect people to be healthy simply by visiting their doctors or using a hospital,” she said. “We have to meet them outside of those places, we have to meet them in their communities where they live.”

Carrie Conia, accreditation coordinator for the Owensboro-based Green River Health Department, talked about the Green River Regional Health Council, which works to improve access to care, fight obesity and promote healthy lifestyles, offers education about tobacco and substance abuse, and an initiative to help young people make healthy choices.

Lynne Saddler, director of the Northern Kentucky Independent District Health Department, ticked off a long list of its successful community partnerships and said they have worked toward creating an action plan with measurable objectives, like a complete streets project, smoke-free policies, public-housing initiatives and their heroin impact response initiatives.

“Health departments need to change their thinking from controlling and owning the whole process of community health improvement and really think about facilitating and collaborating that,” she said.

Judy Mattingly, director of the Franklin County Health Department, pointed out that one of the 10 essential public-health services is mobilizing community partnership. She said partnerships are even more necessary these days because of budget cuts in every aspect of health care, including health departments: “No one agency can do it alone.”

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