Transcript of the Healthy People 2010 Regional
Meeting
Chicago, Illinois
November 5-6, 1998
Department of Health and Human Services
Office of Disease Prevention and Health Promotion
Session III: Preventing Diseases and Disorders
DR. ELLIS: Good morning. Let's not act like we are in church. Come to the front row, and I am not going to preach a sermon. Come forward. We want to feel a part of.
Thank you very much. Keep coming forward. We love that. Good morning. If you have to do like some do, and find out who I am, I am Frank Ellis, and I am from region VII, Kansas City, Missouri, and the regional health administrator for region VII.
I will say good morning again. What we will be doing is hearing comments on the various chapters. To help really assure a fair opportunity for everyone to participate in today's hearing, we will be using the same procedure that was used at the opening session that you saw and listened to, for those that were here.
First, each oral statement will be limited to three minutes, so that we will hopefully afford the greatest number of participants.
There is a light process here, and the light will turn green as you start. It will turn yellow when there is only one minute that remains, and then it will turn red when your time is ended.
Second, each individual or organization will be limited to one oral statement for each focus area.
Third, we will allow hopefully 20 minutes of comments for each of the various focus areas. That means that we will hopefully hear anywhere between five and seven individuals on each topic.
At the end of the session, the floor will be open for comments on the focus area and other general comments.
I will ask each of you to introduce yourself by name, state of residence, also organization and also we would be pleased, if you would, if the comment period on behalf of the organization would not duplicate itself, at this point in time.
One of the other things that I would like to also do is to talk about the focus areas, and focus area 16 relates to arthritis, osteoporosis, and chronic back conditions.
Paul Scherr of CDC will be representing, and is currently a coordinator of that work focus group.
Focus number 17 is cancer. Robert Fulwood from the National Institutes of Health -- no, actually, it is Chuck Gollmar.
For focus area 18, diabetes, again, Paul Scherr.
Focus area number 19, disabilities and secondary conditions, Don Lollar, CDC. Thank you, sir. Don also is a working group coordinator for this particular focus group.
Focus area number 20, Charles Gollmar, who you met yesterday, will cover cancer, respiratory disease and heart disease.
For number 21, HIV, Carmen Villar from CDC. Carmen is also on the work group as a coordinator for this focus area.
Focus area number 22, immunization and infectious diseases, Chris Benjamin. Thank you.
MS. SMITH: And Nicole Smith from CDC.
DR. ELLIS: Focus area number 23, mental health and mental disorders --.
Focus area number 24, we have already made mention of, respiratory disease.
Focus area number 25, sexually transmitted disease, that is Carmen also. Thank you.
Focus area number 26, substance abuse, Ann Mahony. She will be here shortly. Thank you.
That takes care of all of those. Having said that, we are about ready, shall we? Thank you. We will start with microphone number one, microphone number two, and microphone number three.
MS. DAVIS: I am Margaret Davis from the state of Illinois and I am representing the African American AIDS Network and the Chicago Chapter, National Black Nurses Association.
I would like to address the health indicators in HIV/AIDS. About 64 percent of all the newly diagnosed cases are people of color, coming from the people of color communities.
Congressman Stokes has launched an initiative to increase spending targeted to these communities to the tune of about $134 million.
When this initiative launches, I think it would do a lot to eliminate a disparity around the excess death from HIV/AIDS.
One of the things that I would like to see in terms of implementation of strategy is that the monies come into the communities of color and go into organizations that represent the communities of color.
I am despaired by the monies coming into the state department, the Chicago Department of Health and other entities that really are not impacting these numbers.
I think the communities would do a better job of addressing their own needs.
One of the things that the African American AIDS Network is working on is the inclusion of faith-based organizations in the fight against HIV/AIDS.
As we can all attest, those individuals who have a strong spirituality and a strong sense of correctness in their lifestyles have not had the strong incidence of HIV/AIDS as other populations.
I would think that many of these skills that are taught in these congregations can be taught to other communities, one about hope and resiliency, one about lifestyle, one about marriage, monogamous marriages.
All of those types of things could do a lot to help reduce HIV/AIDS.
I know that CDC is involved in participatory research. Those are other skills that would help community-based organizations partner with universities in order to do the type of evaluations necessary for continuous grant funding.
Lastly, I would like to see there be a way of dispersing the information, best practice methods, that can be replicated all over the city in a very, very simplistic fashion, as opposed to big, Healthy People 2010 documents, just something very simple that can go to communities and be sent. Thank you.
DR. ELLIS: Thank you. That was a presentation for item 21 on HIV. Perhaps my instructions did not convey the proper procedural process.
I wonder if, after that comment, would you go back to the room and sign, so we will know exactly who that was.
The concern that we have at this point is item number 16, which relates specifically to arthritis, two, osteoporosis and, three, chronic back pain. Would you relate your concerns and bits of information to that item? Is that what this is for, at number two microphone? Okay. What we are having is only those who present themselves for that particular item.
Sixteen? There is no one else for number 16. That lets us go to the next one, which is number 17, which is cancer. Is there anyone who has any concern about cancer? Any comments? Go right ahead.
DR. MEYER: Yes, thank you. I am Dianne Meyer from Chicago, Illinois. I am representing the American Speech-Language Hearing Association, or ASHA, in my comments today.
ASHA is the scientific and credentialing organization for over 93,000 audiologists, speech-language pathologists and speech and hearing scientists.
ASHA urges the inclusion of laryngeal cancer to the cancers of the oral cavity and pharynx, because the risk factors are closely related. Thank you.
DR. ELLIS: Thank you. Anyone else? Go back to the back, if you would, and sign. Thank you very much.
MS. DAVIS: Margaret Davis with the Chicago Chapter, National Black Nurses Association.
One of the things that I am interested in terms of cancer prevention and early detection is the notion of community-based strategies.
There are a lot of programs now that are implementing strategies in beauty parlors and barber shops, that have become very effective.
Here in Illinois, we are doing a problem called stay beautiful, stay alive, with the nursing sorority at the University of Illinois.
We would like to see the continued funding of the national black leadership initiative on cancer. These were regional funded programs started by HHS director Louis Sullivan.
Now they are approaching the time that they may no longer get funded. I think these regional programs had a lot of emphasis of allowing cancer awareness in communities.
In addition, I would like to urge the NIH to continue funding demonstration projects that help educate professionals, both nursing and medicine, on having their curriculum tailored to address cancer risk in the curricula.
Lastly, I think that clinical trials should again be mandated to include people of color in their programming.
DR. ELLIS: Thank you very much. One of the things, to add to what it is you said, is that the faith community has been very active along that line.
Another component part along the cancer initiative that addresses itself to African Americans is support groups. Support groups have also been assisted in that structure using the faith community, again.
As we alluded to yesterday, there are eight denominations, 65,000 churches, and 20 million individuals who are part and parcel of that effort. That is another item that might come under the aegis of cancer.
Is there anyone else? Microphone number three. Cancer? No. The next item, then, is diabetes. Anyone commenting on that? Microphone number two.
MS. GARCIA: Thank you. I am Elsa Garcia. I am with Total Access, the president of Total Access, a home health agency, working with the Hispanic Physician Network, and a past president of the Illinois Hispanic Nurses.
On diabetes, as we all know, prevention is a thing that we should go after. My biggest concern in all the programs that we have is that the programs be culturally sensitive and linguistically sensitive, because of the Hispanic population having different levels of acculturation.
Our problem here is that we have identified only four certified diabetic educators in the state of Illinois, and we are a population of about three million.
We would like this issue addressed, because at the same time, these diabetic educators have the ability now to bill Medicare and insurance companies, and insurance companies have been mandated to provide these services, at the very same time that certification for this is being tightened up and excluding Hispanic nurses and professionals from getting certification. I would like this to be addressed. Thank you.
DR. ELLIS: Thank you. Yes, sir.
MR. SMITH: Good morning.
DR. ELLIS: Good morning.
MR. SMITH: My name is J.P. Smith. I represent the American Society of Bariatric Physicians in Inglewood, Colorado.
We are a national medical society of doctors and allied health professionals offering treatment for obesity and associated conditions.
For those of you not familiar with the term, bariatrics is a branch of medicine specializing in the treatment of overweight and obesity.
Yesterday, Surgeon General Satcher told us that Healthy People's goals are moving in the wrong direction as far as obesity is concerned.
Perhaps that is because obesity is not being treated as the chronic condition as it is. From one third to one half of the American population is either clinically obese or overweight and moving toward obesity.
There is a frightening increase in the number of obese children and adolescents, and many of these kids are developing adult-type complications, such as type II diabetes.
Healthy People 2010's nutrition and diabetes goals -- and to a lesser extent physical activity goals -- address obesity to a limited degree.
Obesity is a multi-factorial chronic disease affecting millions of Americans. Obesity contributes to the development of diabetes, hypertension, cardiovascular disease, some types of cancer, and several other disorders.
Obesity can be debilitating and often places a social stigma on its victims.
The ASBP and other members of the obesity community believe that obesity itself, and not synonyms or only comorbidities, should be recognized as a major public health problem in the United States.
Obesity should be addressed on the same level of smoking, because of its impact on mortality, morbidity, quality of life, cost and stigma.
Prevention of obesity, especially among children and adolescents, should be a national priority.
I am addressing this section because Healthy People 2010 does not provide a forum for discussing obesity. Thank you.
DR. ELLIS: Thank you, sir. Number 19, which is disability and secondary conditions. We will go from one to two to three.
MS. MANASTER-ELDAR: Good morning.
DR. ELLIS: Good morning.
MS. MANASTER-ELDAR: My name is Faye Manaster-Eldar. My family and I live in Skokie, Illinois, just north of Chicago. I am the parent of Maya Eldar, 17, who is deaf, blind and has cerebral palsy.
Maya's disabilities were caused by extreme prematurity. She was born at 26 weeks gestation, weighing only one pound and nine ounces, and she spent 14 weeks in the neonatal intensive care unit.
Despite the dire predictions of Maya's potential made by many specialists, today she is a junior in high school, in a regional deaf education program.
She reads and writes Braille, communicates fluently via tactile sign language, and walks with a walker.
This is the result of a lot of hard work on the part of our family, many dedicated professionals, and Maya herself.
I am a volunteer state coordinator for Family Voices, a national grass roots organization of parents and care givers, advocating for children with special health care needs and their families.
Children with special health care needs have all the same health prevention issues as other children, plus their disability-related needs.
Public health systems need to recognize their mandate to include children with special health care needs, in all direct care, enabling and population-based services.
Families need ongoing support to raise children with special needs who are as healthy as possible.
Increased coordination between public health programs, Medicaid and SHIP programs, children with special health needs programs and families is needed, in order to improve the outcomes for all of our children.
The children with special health care needs who are at greatest risk of poor outcomes are children born into the demographic groups who suffer the greatest disparities related to health status and access to care.
Poverty plus disability is a double whammy that our nation cannot afford. All across our nation, we are fortunate to have a growing network of families of children with special health care needs, who are trained and experienced in collaborating with professionals in policy making, developing performance measures, evaluating programs, training health care professionals, and planning and conducting outreach activities.
This movement toward greater parent/professional collaboration gained momentum under the aegis of former Surgeon General Koop in the 1980s.
Family Voices works closely with the MCH Bureau to keep this momentum going. We are ready and willing to join you at the Healthy People table. We need to promote the concept of healthy and disabled to everyone in the field.
There are many professionals and family leaders in the special needs field who are able to work together and are willing to work with our public health colleagues to facilitate full inclusion in health care and in life.
With this in mind, I am submitting the following objectives. One, include families of children with special health care needs along with people with disabilities in developing the 2010 objectives.
Two, establish regional demonstration project initiatives for training and technical assistance to public health programs on inclusion in health care for children with special health care needs.
DR. ELLIS: Thank you. Thank you very much.
DR. THORNTON: Good morning.
DR. ELLIS: Good morning.
DR. THORNTON: I am Dr. Lisa Thornton. I am the medical director and chief of Kids Rehab, a joint program operated by Schwab Rehabilitation Hospital, Larabita(?) Children's Hospital and Research Center, and the University of Chicago Children's Hospital.
In that role, I care for children with disabilities from infancy through adolescence. It is a pleasure for me to be able to offer testimony today on behalf of all children with disabilities and on behalf of the following organization:
The Illinois chapter of the American Academy of Pediatrics, Children Memorial Hospital, El Valor Corporation, Family Voices, the Illinois Maternal and Child Health Coalition, La Rabida Children's Hospital, the National Association of Children's Hospitals, Schwab Rehabilitation hospital, Pathways Awareness foundation, United Cerebral Palsy Association of Greater Chicago, the University of Chicago Children's Hospital, and Voices for Illinois Children.
Ten percent of children under the age of 18 have chronic illnesses or disability as defined by a duration of three months and requiring multiple services.
By this definition, at least seven million children in this country have chronic illnesses and disabilities. In Illinois, as many as 30,000 children have chronic illnesses and disabilities.
These children need national health policies that embrace them and allow them every opportunity to maximize their development and quality of life.
Early detection and intervention make an enormous difference in these children. Every day, in my practice, I see children who are very young, infants, and when we get them at that age, we are able to do a lot of things to help maximize their potential.
When I see children at the age of 10 or 15, we are fighting an uphill battle to try to remediate these children and rehabilitate them from congenital disabilities that they sustained in infancy.
The problem is that many people don't know how to recognize the early signs of disability and delay. So, children lose ground.
That is why our organizations are submitting collective testimony today, on the need for greater emphasis on the child in the Healthy People 2010 draft objectives.
Our objectives are as follows. First, we must ensure that all infants and children, from infancy to grade 12, are periodically screened using observational, physical and postural assessment and medical diagnosis for early identification of developmental disabilities.
Second, we must ensure that all infants and children through grade 12 are periodically screened for language, sensory and vision processing difficulties that interfere with learning.
Third, we must ensure that every infant and child detected as having a disability be referred for, and receive, therapeutic intervention and medical care for their identified disabilities.
Finally, we must ensure that all new parents receive education about how to monitor their children's physical, social, emotional and cognitive development, and about the importance of early detection, early intervention and developmental stimulation.
We recognize the dearth of available data from which to gauge progress for children and we are eager to work with the Centers for Disease Control and others to develop data collection systems to track health objectives for infants and children with disabilities.
It is absolutely essential. It is also essential -- thank you very much.
DR. ELLIS: Thank you very, very much. If you would to the rear and sign the roster, if you would. Number three, please?
MS. RYAN: I am Shirley Ryan. I am chairman of Pathways Awareness Foundation and president of what was formerly called Pathways Center for Children.
I am very happy to be here. First of all, I thank you very much. This public hearing is important. We are thrilled to have a chapter on disability in the Healthy Person 2010 goals.
I would like to also address the need for greater emphasis for children and youth in this chapter.
As president of one organization and chairman of the other, let me tell you that there are seven million children.
I work with Lisa Thornton you just heard speak and 12 organizations she just cited. Chicago and the state of Illinois have been very proactive with the fine delivery system that we have, but we need more help than that.
If you are a private paying patient in this state, you have a better chance of getting early detection, early intervention -- meaning better therapy -- but you do not have a guaranteed chance.
We produce a brochure which is now used by 22 states at their piece on child find. These pieces are in both English and Spanish. Millions have been distributed throughout the country.
Let me say that it is endorsed by the American Academy of Pediatrics, Illinois chapter. It teaches you -- this brochure now goes for any child born within the city of Chicago automatically gets this with their birth certificate, to show you how we are encouraging people to do it.
We are also working proactively through the great therapist centers that we have, to educate therapists, physical therapists with at least three years of physical therapy experience in pediatric needs, and how a child born without oxygen loss doesn't -- you don't see that until they are three months old and their head is not up.
They can be taught how to hold their head up. They can be taught how to sit, before any abnormal patterns start.
This is early detection by the doctor saying, yes, mother, I hear you, or parent. Yes, this is early intervention or appropriate therapy. Yes, this is also informed parenthood.
If you are in the public sector, you have a very limited opportunity, and the child may not be picked up at least until 15 months or two years.
I encourage you to address the needs of children early, educate, early detection, early intervention, and also, at four years, re-screening them for hearing, sight.
If a child has low vision, they will pass the vision test, but they may not be able to see anything that is less than 24 pica. Thank you very much.
DR. ELLIS: Thank you very much. Number one, if you would, please.
DR. RIMMER: Jim Rimmer from the University of Illinois at Chicago, Department of Disability and Human Development.
I would first like to start with my concluding statement because I am afraid I am going to run out of time. I am sort of long-winded so I will start with the concluding statement.
I would like to reinforce Mrs. Maggie Daley's comments that persons with disabilities should be included in each chapter, as well as a special chapter, which we have called chapter 19.
The reason for that is, if you look on the front cover of this document, it says Healthy People. The mind set of most health care providers is that people with disability are not healthy.
In fact, if you look at the old World Health Organization definition, health is defined as the absence of disease.
If we don't put this on the forefront of the minds of health care providers, what will very often happen is they will be excluded.
A very small example of this, if you look before 1974, at the educational programs for children, before PL94-142, the individuals with disabilities education act, they were very often excluded from participation in educational programs as well as physical education and physical activity.
I have a feeling that if we don't put persons with disabilities throughout the context of the entire chapter, most health providers out there will look at this and say, well, you know, people with disabilities really are not part of the focus of Healthy People 2000, because they are not healthy.
In fact, many health care providers, if you read the literature, consider health and disability on opposite ends of the spectrum. If you are healthy, you are not disabled, and if you are disabled, you are not healthy.
I think it is very, very important for the panel to look at this issue very seriously. When we are talking about 54 million Americans with disabilities, we are talking about a great number of people who really need attention and improvement in health.
Today the buzz word is not primary prevention of disability, but prevention of secondary conditions and secondary disabilities. That is really what we are after.
Just because you have one primary condition or one primary disability doesn't negate the fact that you are more susceptible to heart disease, high blood pressure, osteoporosis, pressure sores, and many, many other secondary conditions that affect people who are disabled.
I would encourage you all, who are at the to of the food chain, to please consider people with disabilities as a healthy group. Health is on a continuum, and I think they should be included in every chapter as well as chapter 19. Thank you very much.
DR. ELLIS: Thank you, sir. Microphone number one?
DR. MEYER: Good morning.
DR. ELLIS: Good morning.
DR. MEYER: I am Dianne Meyer from Rush Presbyterian, St. Luke's Medical Center in Chicago, and today I am representing the American Speech-Language Hearing Association, or ASHA. ASHA is the scientific and credentialing organization for audiologists, speech-language pathologists, and speech and hearing scientists.
ASHA supports the definition of people with disabilities as inclusive of communication activities and suggests the activity of hearing as another example of potential limitation.
Hearing loss and deafness affects 28 million Americans, with an increasing prevalence due to recreational or occupational noise exposure or to toxic medication and chemicals, or life saving successes at birth.
Approximately 46 million people, one in six, in the United States are affected by a hearing loss or a communication disorder.
Functionality for children and adults with hearing, speech, language, voice, and swallowing disorders is dependent upon early identification and expedited linkages to intervention.
For this reason, ASHA urges that the chapter on disability and secondary conditions contain the following two developmental objectives, taken and modified from the Year 2000 1997 review.
First, increase the percentage of primary care providers who routinely screen infants and children for impairments of hearing, language, speech, vision and other developmental milestones, and refer for diagnostic and treatment services, as well as assistive technology, as part of well child care.
ASHA recommends that all newborns in birthing facilities be screened for hearing loss, with physiologic measures, as close to hospital discharge as possible.
Children at risk for fluctuating, delayed onset, or progressive hearing loss, should be monitored every six months until three years of age, and then at intervals thereafter, dependent on risk factors.
Infants, toddlers and preschoolers, aged seven months through age five years, should be screened as needed, requested or mandated by statute, or if risk factors indicate.
Screen school-aged children five through 18 years, on initial entry to school, and annually in kindergarten through third grade, and in seventh and 11th grades.
Second, increase the percentage of primary care providers for adults who screen hearing, speech oral/motor, language, cognition, voice and swallowing disorders, and refer for appropriate diagnostic and treatment services, and assessment of candidacy for assistive technologies.
ASHA recommends that adults be screened for hearing impairment, disability and ear disorder at least once a decade from age 18 to 50, and at three-year intervals thereafter.
The ability of adults to stay active, productive, and functionally independent depends on the ability to communicate, to hear, read, understand spoken language, and express ideas through speech and written language.
These two objectives should be linked to access to quality health services. Thank you.
DR. ELLIS: Thank you very much. Microphone number three.
MS. SCHROCK: My name is Karen Schrock and I am with Adult Well-Being Services in Detroit, Michigan.
I have a general comment on this section, and that is that there be an objective developed that addresses the needs of care givers for people with disabilities.
I raise this because I don't know where else this might fit. In our work with the elderly and our work with those with developmental disabilities, we find that this is a major concern and it is not being addressed in a systematic way.
I heard the parent who spoke, and I am familiar with Voices. One of my previous jobs was with children with special health needs in Michigan.
These parents and other caregivers have lifelong responsibilities for caretaking that are just under the radar in terms of health care costs and all the rest.
I would hope that we could find a way to address the needs of caregivers in this section, or wherever it is appropriate. Thank you.
DR. ELLIS: Thank you very much. Is there any other comment in relationship to disabilities and secondary conditions? All microphones are now open.
We go to the next, which is number 20, heart disease and stroke. Microphone number two.
MS. LANG: Good morning.
DR. ELLIS: Good morning.
MS. LANG: My name is Willa Lang and I am the executive director of the National Kidney Foundation of Illinois.
I am here today to urge you to separate kidney disease and hypertension from this category. Kidney disease costs our government millions of dollars.
There are 60 million people in the United States with hypertension, and that is just kidney disease waiting to happen.
The incidence of kidney failure increases 10 percent every year. Twenty-five percent of those individuals who are on dialysis could have prevented it by controlling their high blood pressure.
Even more cases of dialysis can be prevented by controlling diet and increasing exercises.
Kidney disease strikes minorities at an amazing and disproportionate rate. Many of our patients are not in a financial position to obtain the resources needed so that they may help themselves.
It is clear that we need to separate kidney disease and hypertension into its own category in order to address these statistics and mitigate these devastating illnesses. Thank you very much.
DR. ELLIS: Thank you. Microphone number one.
MR. HAVERKATE: My name is Rick Haverkate. I represent the Inter-tribal Council of Michigan.
Ischemic heart disease is the number one cause of death rate in the Bemidgi area office, which is roughly about the same region as region V.
However, it has been found, through a study by the Indian Health Service, that 20 to 50 percent of all Native American deaths are miscoded on death certificates, as well as the problem that seldom to the death certificates mention contributing factors to death, such as diabetes and obesity. We know that obesity is a huge problem on our reservations.
When we are studying community health assessment, we are finding, of course, that ischemic heart disease is a main cause of death.
I would like to suggest that more objectives be put into the Healthy People 2010 that discuss access to data.
I noted that in the objectives that it usually says not available, Native American data. For our communities to be able to follow these objectives, to have some sort of baseline, we need access to the data. We need people training us how to collect that data, how to develop it.
I know in a few places in the objectives it mentioned that. One of the things we see quite often is that Native Americans are neither born nor do they die, but they just exist somewhere in the middle. So, we have no way of looking at vital record data.
Just as a final statement, our communities are in dire need of access to data, specifically as it relates to heart disease.
DR. ELLIS: Thank you, sir. Microphone number three.
MS. HALL: Good morning.
DR. ELLIS: Good morning.
MS. HALL: My name is Roberta Hall. I am the executive director of the Ho-Chunk Nation Health Department. I am glad I had an opportunity to attend this Healthy People regional meeting, where you are getting the community involved and you want their comments on this draft report.
I have been looking through this draft report, and I am disturbed that we don't have the data available that we need to address chronic illness in Native Americans.
Especially in this area, where we are talking about heart disease and stroke. We can address, like the doctor said, diabetes, all of them.
I remember yesterday Dr. Satcher, who I am really very pleased that he is in the position he holds, because when he was first confirmed he made his proclamation of his observations of disease and so forth, and he talked about high risk of smoking and so forth.
He made major comments on the Native Americans high rate of smoking, which is affecting their health, which affects heart disease, which affects the strokes, high risk for that.
He mentioned the Native Americans and he mentioned the Native American youth, and I was quite pleased by that.
He emphasized yesterday that they want to get the best information involvement with the community based on scientific data. Am I right? He said that.
We have all these agencies throughout the federal, state and local collecting data. We are part of those communities.
We have treaty rights that kind of base our existence here in the good old United States of America, North American Continent.
So, by that, we have a right to various resources, and we have a right to various services. One of them has always been talked about, and that is the provision of health care services, doctors, nurses, resources.
We talk about disparities? We have a lot of illness in Ho-Chunk nation. Diabetes is 30 percent. That affects heart disease, strokes, all of this. We need to be putting our minds together, how we are going to address the unavailable data.
I cannot accept the fact that we don't have available data. We have to get that available data into this document, so that we can address these in a very collective asserted way, so that we can make good progress, eliminate all of these concerns so that we can have a healthier population for the Native Americans.
I thank you for your time. I hope that we can address these things in good faith.
DR. ELLIS: Thank you very much. Microphone number one.
DR. MEYER: I am Dianne Meyer from Chicago, Illinois, and in my comments I am representing the American Speech-Language Hearing Association or ASHA.
ASHA urges the addition of the following objective: Delay institutionalization of people with stroke-related disorders from the time of the disease onset by two years.
Seventy-five percent of all strokes occur in persons 65 years or older, and nearly 60 percent of non-comatose stroke survivors suffer speech and language impairments.
Diagnosis and treatment can improve the functionality of stroke survivors. Thank you.
DR. ELLIS: Thank you. Is there anyone else? Microphone number one is clear; microphone number two clear; microphone number three clear.
The next item is number 21, HIV. We had one response. Is there anyone else who would like to make a comment? Microphone number three.
MS. SCHROCK: My name is Karen Schrock, again, from Adult Well-Being Services in Detroit. I have two comments on the objectives here.
There has been much published recently about older people being sexually active. However, if you read this report, you would not know that.
I mention that because we are looking at a specific objective on condom use, and the ages stop at 44.
I would like to suggest that we need to address the need to educate older adults, who are still sexually active, beyond age 44, to use condoms, to prevent HIV. Thank you.
DR. ELLIS: Thank you very much. Microphone number one.
MR. SLOBODKIN: David Slobodkin, speaking as an individual. I am an emergency physician and we do treat a great deal of STDs and HIV.
I was a little surprised that I could not find any place a reference to HIV counseling and testing specifically for people being treated for STDs.
It is kind of covered in the STD section, objective 20 under the guidelines of the CDC, but I think it is sufficiently important that it needs to be mentioned specifically.
The objectives in the HIV section mention HIV counseling and testing for prisoners, HIV counseling and testing for people in drug abuse treatment. It mentions bacterial STD screening for people in HIV treatment, but it does not mention the converse, which I think is very important, particularly as these diseases are treated in many, many different settings, from the office to episodic care settings, to specialized STD settings.
The standards of care are very unhomogenous. Thank you.
DR. ELLIS: Thank you, sir. Microphone number two.
DR. MEYER: I am Dianne Meyer representing the American Speech-Language Hearing Association, or ASHA. ASHA represents over 93,000 audiologists, speech-language pathologists and speech and hearing scientists in the United States.
ASHA recommends adding a new objective to this chapter. Increase screening and referral of persons with HIV for secondary conditions, such as hearing loss, which may be ameliorated by enhanced quality of life and prolonged productivity.
As a result of drug-related ototoxicity and/or susceptibility to middle ear disease, persons with HIV may incur hearing loss of a fluctuating or a permanent nature.
Audiologic monitoring and fitting of hearing aids or assistive technologies when needed can enhance communication with significant others and in the work place. Thank you.
DR. ELLIS: Thank you very much. Microphone number two.
MS. ZWICK: I am Janet Zwick from the Iowa Department of Public Health. I would like to follow up just a moment on what Karen Schrock had said.
The behavioral risk factors surveillance, which is something that a lot of you are using for the data, does not even -- the module in regard to sexual activity is not even asked if you are over the age of 50.
I think that is a data item that we need to look at very closely and we really do need to start addressing the needs of individuals over the age of 50 on HIV and sexually transmitted diseases. Thank you.
DR. ELLIS: Thank you very much. The microphones are clear. The next item is item number 22, immunization and infectious diseases. Anyone at microphone number one? Anyone at microphone number two? Microphone number three? Microphone number one.
DR. SLOBODKIN: David Slobodkin, this time speaking for the American College of Emergency Physicians.
They have recently reiterated their support for specifically influenza and pneumococcal immunization of adults in emergency departments.
In general, I think that adult immunization is somewhat slighted in this document. Without minimizing the crucial importance of childhood immunization and the huge impact of morbidity and mortality that occurs in children, the fact still remains that the overwhelming majority of vaccine preventable deaths in the country occur in adults, not in children.
Specifically, I was disappointed that on page 22-9, objective one, pneumococcus and influenza do not appear in the list of vaccine preventable diseases.
I was also disappointed that objective 32 refers only to children when it talks about an immunization registry.
I think that a voluntary immunization registry for adults would very specifically affect the ability to increase immunization rates for hepatitis B and for pneumococcus.
I am also disappointed that, although objective 24 specifies ambitious goals for influenza and pneumococcal immunizations, there are really no process objectives to support that, with the exception of objective 31, which talks about monitoring of existing practices.
I think that in general, it appears that adult immunization has almost been tacked onto a chapter primarily devoted to childhood immunization.
Even a short chapter dedicated solely to adult immunization might better address the needs of people who are dealing with adult immunization, which remains a very major problem in the country. Thank you.
DR. ELLIS: Thank you, sir. Microphone three.
MS. MAGALHAES: Rebecca Magalhaes, La Leche League International. I would just like to remind those who are responsible for the immunization part of this draft that colostrum, which is the first milk the baby receives when they breast-feed, is actually the first immunization that baby receives.
Possibly, initiation of breast-feeding by 100 percent of women could be one of the indicators for immunization.
DR. ELLIS: Thank you very much. Microphone number three is clear, number two is clear. Number one, please?
MS. CAMP: I am Susan Camp. I work for HRSA. I am speaking as a private individual.
In terms of the adult immunizations, 55 years ago I had all of my immunizations for DPT. Six months ago, I became sick after being exposed, and two weeks ago it was finally confirmed that I have adult pertussis.
I think this issue is probably overlooked. What I have been told -- you can still hear my voice; it is still very hoarse.
What I have been told is that there is increased incidence across the city of Chicago, but it is not being picked up. I went to the physicians five times and nobody picked it up.
It was finally diagnosed in a casual conversation that I had with a nurse practitioner at one of our community health centers. I think we really need to look at this. Thank you.
DR. ELLIS: Thank you very much. Is there anyone else? Microphone number one is clear, two is clear, and number three is clear.
Item number 23, mental health and mental disorders. Microphone number one?
MS. LAMBERT: Thank you. Good morning.
DR. ELLIS: Good morning.
MS. LAMBERT: My name is Kimberly Lambert and I am a graduate student in the schools of public health and social work at the University of Michigan, Ann Arbor.
Prior to entering this dual degree program, I spent two years as a secondary level world geography and cultures teacher, one year in a suburban middle school and one year at an inner city high school both near or in the city of Chicago.
My experience in these schools and the ineffectiveness of the schools in providing necessary health and mental health services for youth stimulated my interest in becoming a social worker and prevention program coordinator for school districts.
I felt that one of our nation's greatest resources -- schools -- were not being utilized effectively.
Because all children under the age of 16 are required to be enrolled in school in the United States, schools have the potential to provide access to both educational and human services resources that many of today's youth would otherwise not receive.
I am honored to be able to speak to you today on the need to utilize schools in our nation's effort to address mental health issues of children.
I am primarily going to address draft objective 2010, section 23, number four, page 23-10, lines 31 through 34, the need to reduce the prevalence of mental disorders among children and adolescents.
Although an objective pointing to the mental health problems of children and adolescents was included in the Healthy People 2000 objectives, I believe that the nature and urgency of this issue has become more prominent in the years since these objectives were written.
Much to my surprise, eating disorders I observed as a major issue in my educational experiences, and in my personal life, has been an included focus of objective number four, and thus, is being made a health priority in the years ahead.
Anorexia nervosa has one of the highest mortality rates of any mental illness today. Yet, up to this point, it has not been considered a public health issue.
According to the American Anorexia and Bulimia Association, this year alone more than 50,000 persons will die from complication of eating disorder behaviors, it is estimated that five to 10 million Americans suffer from some form of an eating disorder, with the highest prevalence of the disorder in young persons age 15 to 25.
A young woman with anorexia nervosa is 12 times as likely to die than other women her age without the disorder.
The etiology of eating disorders remains complex, but the onset of the behaviors often is found to develop as a result of a combination of biological, environmental and familial factors, all of which are highly preventable at a young age.
At the same time we are learning more about the risks associated with eating disorders, and at the same time as the incidence of the disorders in our population is rising, many insurance companies are no longer covering necessary services, and hospital programs for people with eating disorders are closing.
At the same time we are making this issue a health priority, funding of secondary and tertiary prevention programs are becoming less available.
Primary prevention may be our only chance at lowering the prevalence of these deadly disorders. I suggest that primary prevention and early intervention of eating disorders in young persons be mandated as a component of social service programs provided by our nation's schools.
With proper funding and staff, our schools could provide access to these needed medical health services for children, adolescents, and their families. Our strongest resource needs to be utilized. Thank you.
DR. ELLIS: Thank you very much. Microphone number three.
MS. MAGALHAES: Rebecca Magalhaes. I am here speaking as an individual.
A few months ago, my youngest son was diagnosed with schizophrenoform disorder. Upon discharge from the hospital, he was given a telephone number to call if he had any further feelings of persecution, paranoia and -- well, I don't -- basically, what I want to say is that I don't think, from these few months of living with this, with him, that there isn't a support structure for people like my son.
He was referred to a mental health center, which had nobody -- or at least they didn't put him in touch with anybody who knew anything about his mental illness.
He was put in touch with a counselor, who proceeded to tell him he had another mental illness in one visit and told him in a second visit told him, no, she didn't think he had that one, he had another one.
He just appeared to fall into a black hole. When I found out later the telephone number he had been given was actually the wrong number for the University of Iowa hospitals, it would have been impossible for him to get through, not the way he is.
I just think that something needs to be done, and I don't know what it is, because I am in this very newly, but there has to be a support structure for these people, and there just isn't.
DR. ELLIS: Thank you very much. Microphone number two.
MS. KROOPKIN: Hi. My name is Debbie Kroopkin, and I am representing Chicago Health Outreach, which provides health services and mental health services to homeless people and immigrants and refugees.
Outreach is not only a critical element to facilitate access to care for homeless individuals, but also for refugee, immigrant and other ethnic populations.
Outreach is essential not only to re-engage homeless individuals into the mental health system, but also to assist in retaining the individual's involvement in the system.
Positive outcome measures should be identified for homeless people with mental illness, just as they have been for multi-cultural mental health care.
Permanent and supportive housing is essential to improve and maintain health and mental health. Housing needs to be stated as an integral component of the services provided by the health system to people with mental illness.
Intensive case management with client support services is necessary for the majority of homeless people with mental illness.
Integrative approaches to people with mental illness and substance abuse should be specified in the document.
We recommend integrative approaches that incorporate harm reduction and stages of change. The discussion of employment supports and services for people with mental illness should emphasize the need for the development of appropriate models for this population, as well as recognizing the need to decrease the system barriers for the full participation of people with mental illness and the rehabilitation services system.
The Surgeon General stressed the importance of collaboration between systems, but this is not emphasized enough in the plan.
The homeless mentally ill population is a prime example of a group of people who have fallen through all the cracks of the service delivery systems.
They reflect the critical need for service delivery systems to work much more closely together. Specific emphasis should be placed on the health system, working actively with mental health and other systems, including housing, particularly for people with mental illness. Thank you.
DR. ELLIS: Thank you. Microphone number one.
DR. MEYER: I am Dianne Meyer from Chicago, Illinois representing the American Speech-Language Hearing Association, or ASHA. ASHA is the scientific and credentialing organization for audiologists, speech-language pathologists and speech and hearing scientists.
Firmly grounded in our professions' scopes of practice, are prevention, early identification of prevention, early identification and treatment of hearing, communication and related disorders for children and adults.
In proposed objective 23-12, ASHA recommends the addition of the words, communicative and hearing, so that it reads: Increase to at least 60 percent the proportion of primary care providers who routinely review with patients their cognitive, communicative, hearing, emotional and behavioral functioning, and the resources available to deal with any problems that are identified.
Degenerative neurologic disorders -- for example, Alzheimer's and Parkinson's diseases -- with related speech-language, swallowing and hearing impairments, may present as, or be concomitant with mental health disorders.
Appropriate screening, assessment or treatment can preclude or delay institutionalization, and enhance quality of life. Thank you.
DR. ELLIS: Thank you. Microphone number two.
DR. STIDWILL: I am Barbara Stidwill, a board member of Suicide Prevention Services in Aurora. I am looking at the objectives on page 23-9, actually objectives 23-1 and 23-2.
In line with the previous comment that I made, we do believe that suicide needs to be pulled out of this section and given its own focal point.
If, indeed, it remains under the section that it is under, there needs to be information added to the HIV section, substance abuse section, and other sections within the draft that do talk about the incidence of suicide among those people, and reiterate that point in the other sections.
The numbers we are talking about are staggering. I believe you need to check your numbers before you finalize this draft.
For instance, incidence that you have listed of youth age 15 to 19, 10.5 per 100,000 as a baseline number, is significantly less than came out from the Centers for Disease Control and Prevention in April 1996, which was talking about at least 13.8 per 100,000 among that similar age group.
So, I think if there are perhaps extra statistics that are added that indicate the number of survivors, the number of people that are impacted by suicides every year, the impact of this entire phenomenon will be seen.
The fact that there are currently at least 4.5 million people that we call survivors of a suicide in America right now -- that means a person who lost a friend or a relative through suicide -- those people take at least six times as long to recover from the death of a person by suicide than by any other kind of death, through the grief process.
This costs our taxpayers, our businesses, our entire society a tremendous amount of money. I just think the statistics need to be added in greater detail. Thank you.
DR. ELLIS: Thank you. We can take one more comment under chapter 23. Microphone number three.
MS. SCHROCK: I am Karen Schrock with Adult Well-Being Services. I want to comment briefly on three objectives.
The first is objective 21, and it talks about increasing the percent of states who have plans to address the mental health needs for the elderly. I think every state should have that. That should be a simple thing to do.
I guess the second comment I will make is that there is an objective here for co-occurring mental health and substance abuse disorders.
I think that there should be a statement there, not just to address those needs in the plan, but address them in a way that is recognized to be effective, which is with integrated treatment. You can address the needs of people without making it effective.
The last comment I will make is on the issue of item 24, which is states having offices of consumer affairs for mental health services.
Again, my comment is the same as I made with respect to 21. I think with the changes that are occurring in mental health funding across the country, every state ought to do that. Thank you.
DR. ELLIS: Thank you very much. Microphone number one is clear, microphone number two clear, microphone number three clear. Move to item number 24, respiratory diseases.
Anyone at microphone number one? Anyone at microphone number two? Anyone at microphone number three?
Move to item number 25, sexually transmitted diseases. Microphone number three.
MR. RABINS: Good morning.
DR. ELLIS: Good morning.
MR. RABINS: My name is Charlie Rabins. I am from Springfield, Illinois and I am representing the National Coalition of STD Directors.
The National Coalition of STD directors is a national partnership of state, county, city and territorial STD prevention and control directors, whose mission is to promote policies programs and strategies that reduce the prevalence of STDs.
It is our programs, coordinated by our membership, which will bear much of the responsibility for implementing the Healthy People 2010 recommendations, and achieving the objectives.
We support the elimination of health disparities in the Healthy People 2010 model. However, we believe that the bacterial objectives on chlamydia, gonorrhea, primary and secondary syphilis and congenital syphilis are unrealistic, and are unlikely to be achieved primarily because they ignore the significant differences in initial baseline status among the populations described.
In addition, they use the target setting method of better than the best which, in every case, establishes the objective below the rate for the group with the lowest prevalence, which often represents an extremely small percentage of the affected population.
For example, the Healthy People 2010 objective for gonorrhea is below 19 per 100,000, whereas the current rate for Africa Americans is over 900 per 100,000. It would take over a 48-fold decrease.
The compound effect of these decisions is to create objectives for the vast majority of the affected populations which had the highest rates to begin with, which are too low to be probably achieved, given our current resources and science base.
We suggest establishing different targets for each racial/ethnic group which are aggressive, but realistic and achievable.
The weighted average of these group-specific objectives could then be used to establish a single target for each broad objective, which would reflect challenging and achievable progress for each sub-group.
In addition, we have several comments concerning the overview. For example, contributing factors.
The asymptomatic nature of STDs. Current studies have determined that over 90 percent -- not 50 percent of men -- with chlamydia have no symptoms.
It is critical that the asymptomatic nature of the infection in men not be underestimated.
The utilization of hepatitis B vaccine is mentioned, but the hepatitis A vaccine is not mentioned. We recommend that there be an objective on hepatitis A vaccine for men who have sex with men.
One other thing in biomedical intervention. The term theoretically is used to reference partner notification.
We believe that there is enough evidence to indicate that it is more than theoretical, the basis of partner notification. Thank you.
DR. ELLIS: Thank you. Microphone number one is clear; microphone number two is clear; microphone number three, if you would, please.
MS. SCHROCK: Thank you. My name is Karen Schrock and I am with Adult Well-Being Services. I have two comments on this section.
First, we need to address the needs of older people in terms of their sexuality. Secondly, we need to put some goal in here related to STD clinics doing screening for substance abuse.
We conducted a needs assessment study at Michigan and found very high rates of substance abuse amongst STD clients.
It is alluded to here, but not specifically recommended as an objective. I think it would make a lot of good, common sense. Thank you.
DR. ELLIS: Thank you very much. Microphone number one is clear; microphone number two is clear; microphone number three is clear. Are there any additional comments on the item of 25, sexually transmitted diseases?
There being none, we will move to item number 26, substance abuse. Microphone number two, if you would, please.
MS. ZWICK: I am Janet Zwick from the Iowa Department of Public Health. I would like to recommend that you add two objectives to this chapter.
The first one has to do with insurance parity, and I would like to have you add one similar to objective number 17 in the mental health chapter.
The second one that I would like to have you add has to do with problem gambling. Whether it fits in the substance abuse chapter or the mental health chapter is at your discretion.
As states are increasing gambling activities, we are also seeing a high increase regarding problem gambling.
Gambling is an addiction, similar to alcohol, other drugs, tobacco, eating disorders, et cetera. There is also a very high rate of suicide associated with problem gambling, as well as a high rate of alcohol and other drug abuse. Thank you.
DR. ELLIS: Thank you very much. Microphone number three.
MS. ROBERTSON: I am Dorothy Robertson from Jackson, Mississippi. I am on the board for Mississippi Action for Program, which is a Head Start board. I am also working with the mental health center, which is Life Help, located in Greenwood, Mississippi. There I work as an outpatient substance abuse service coordinator.
What I would like to address is, in your objectives, I would like to see you look closely at prevention, prevention in the areas starting with early child development and going to your elderly.
The second, I would like for you to also address, in all your focuses that you have, indicators in your screening mechanisms that would address substance abuse.
Before your treatment can start, you should find out if there is any substance abuse, because many times people start medicating themselves before they come to a physician.
Once they get there, they continue to misuse and abuse substances. Therefore, I think that is an area.
The next area is unborn children. I think you should look at drug effects there in terms of following them through, once they are born, into the early child development.
The other area that I would also like to see is more training in the field that would lead professionals to be able to identify substance abuse problems when they see them, in all ages and in all cultures. Thank you.
DR. ELLIS: Thank you very much. Microphone number one.
MS. DAVIS: Margaret Davis, the Southside Health Consortium, Healthy Start Southeast in Illinois, as well as the Chicago Chapter, National Black Nurses Association.
One of the things that I would like to do in terms of implementation of the objective 15-B, in terms of increase to 80 percent the estimated proportion of youth receiving great risk from marijuana, one of the problems we are faced with is that many of our youth don't consider marijuana as an elicit drug.
As a result, they are continuing this behavior into pregnancy. We are seeing large numbers of young women who are pregnant testing positive, because we do routine screening of toxicology on all of our prenatal clients.
A large percentage of the younger clients, under 21, are testing positive for marijuana. I would suggest that there needs to be a greater awareness given into the community.
Lastly, as a result of the high incidence of substance abuse as it relates to pregnancy, the service delivery system is not adequate to address it, and the gender specific needs of the substance abusing woman must be advocated, such as child care for individuals who are in residential settings. Thank you.
DR. ELLIS: Thank you very much. Microphone number two, please.
MS. SCHROCK: My name is Karen Schrock. I am executive director of Adult Well-Being Services in the city of Detroit.
I have two recommendations. First, that there be a specific recommendation for states to increase the amount of substance abuse programming for older adults.
Second, that the recommendation number 19 be reworded to focus not on primary care providers, who will not in general be comfortable talking to older people about their alcohol and other drug use, but to enlist the support of community-based providers in that effort. Thank you.
DR. ELLIS: Thank you very much. Microphone number one, please.
DR. RHODES: Hi. I am Karin Rhodes. I am an emergency room physician on the south side of Chicago. I am a representative for the Society of Academic Emergency Medicine.
I also want to address objective 19, paragraph one. It is an excellent objective, referring to primary care physician screening for substance abuse in the elderly, greater than 60.
What we recommend is to increase this to include all age groups, or to separate it into two separate objectives, and to include emergency care providers in this.
There are several reasons to extend it to emergency care providers and to include all age ranges.
High risk drinking usually starts in late adolescence or young adulthood, and young people are exactly the ones who are more likely to wind up in an emergency room.
Many substance abusers do not receive regular primary care. The ideal time to intervene would be early in a person's life before dependent-significant morbidity or major trauma occurs.
The key to successful intervention is bringing it to people and not requiring them to seek it out. There are over 100 million emergency department visits per year.
About 10 percent of emergency department patients present with problems related to alcohol and drug abuse. Many others, if they are screened, would have problems in this area that could be addressed.
The emergency room visit has the potential to be a teachable moment. We know that brief interventions can be effective across a variety of health care settings, age, and cultural groups.
Including emergency providers in this Healthy People 2010 objective will help pave the way for emergency departments to advocate for substance abuse response teams, which can facilitate linking our patients to appropriate community services.
In order to facilitate data collection in that regard, the Society for Academic Emergency Medicine recommends including emergency providers in the primary care provider survey and other national surveys monitoring this objective. Thank you very much, and thanks for your work in this area.
DR. ELLIS: Thank you very much. Item number 26, substance abuse. Microphone number one is clear; microphone number two is clear; microphone number three is clear.
At this point in time, they have given me permission, and said that I could sit down now, having stood this long, and will shut off microphone number three.
At this point, it is open for any comments that anyone would like to make at this particular time. Microphone number two.
MS. ANDERSON-SMALL: Good morning, Dr. Ellis.
DR. ELLIS: Good morning.
MS. ANDERSON-SMALL: My name is Cheryl Anderson-Small and I am the director of the Office of Minority Health from the state of Michigan, and the Michigan Department of Community Health.
What I would offer to the panelists and to the review committee for 2010 is that there was a specific section on health disparities.
It appears as if it always is an isolated session where just colored people attend, or persons who are concerned about colored people attend.
What I offer to you, which is, I am sure, very, very clear to this enlightened group, is that health disparities is a thread that needs to be integrated throughout all of these important goals and priorities that have been delineated in this volume.
The other component, or the subset, of the importance of looking at the disparate status throughout all of these priorities, is to ensure that there is some specific methodology by which we can stop that circular argument that there isn't a sufficient denominator or numerator to look carefully at the populations of color.
Perhaps a regional system where we collect data for all American Indians in region V, for instance, from where I come, from Minnesota, from Illinois, et cetera, if that is one step toward getting some aggregate data so that we could get a more disaggregated look at each of those populations, perhaps that is something that needs to be entertained.
I know that through the federal office of minority health, there is work that is being done this coming year, I understand, through the appropriations. There is $1 million that has been appropriated for the federal Office of Minority Health to work in collaboration with the National Center for Health Statistics.
I hope that is one of those considerations that is being looked at. Again, it is a circular argument. We don't have the statistics.
We have the numbers, because in fact, people are there, and if you count like one, two, three, four, five, six -- you know, I am not a statistician. To me, it makes sense that whatever method would ensure that we count the persons about whom all this disparate status is continually discussed, then we would be able to have a more systematic way of analyzing the impact.
Those are the two, thread throughout all the priorities, and a data collection and analysis system that would allow for a really, true disaggregated system. Thank you.
DR. ELLIS: Thank you very much. Microphone number one.
MS. WILLIAMS: Good morning.
DR. ELLIS: Good morning.
MS. WILLIAMS: Penelope Williams, city of Milwaukee Health Department. The comment I have is in reference to page number three of the introduction, in which the comments will be accepted through December 15.
I would like consideration to extend that date, for persons to take this very valuable information back to their communities, to do focus groups and to get additional comment that might be helpful and very useful to this initiative.
DR. ELLIS: Thank you very much. Is there anyone who would go to microphone, which is clear? Microphone number one is also clear.
Is there any comment that anyone in the audience at all would like to make at this point in time?
MS. DAVIS: Margaret Davis, Chicago Chapter, National Black Nurses Association.
One of the things that I think that is needed as we advance this Healthy People 2010 objectives, is to advance the notion of participatory research, where academic centers and community-based organizations work together, but in an equal partnership.
I think there needs to be a look at the research that is coming out of CDC on participatory research.
I think that they are going to be having a conference, early part of 1999, to look at equity and research funding capacity building and evaluation.
I think that would be the only way that we can really achieve these goals of Healthy People 2010.
DR. ELLIS: Thank you very much. This session is now open for any comments from any of the other areas that were previously participating, that now have come into this ballroom. Microphone number one, open.
DR. SLOBODKIN: David Slobodkin, again speaking as an individual. Looking through the entire document, I think that there are many areas where it would be very useful to remember that a very significant proportion of the population lie outside the conventional health system.
Over 15 percent of the country is uninsured. Probably another 15 percent go in and out of various kinds of insurance.
I think that it is unwise to assume that all patients will have a medical home that can coordinate their care.
I think in many, many instances the patients do not have a medical home are being treated in episodic care settings, that could be included in prevention activities to a much greater degree, and could be encouraged to promote health to a much greater degree.
Just looking through this list -- tobacco use, injury and violence prevention, obesity, oral health, a major problem we see in the emergency department, access has been discussed specifically in relation to emergency care.
Ten percent of the patients in my emergency department are pregnant, 10 percent of the women. So, family planning is something that I think is not available to many young women, who may actually have a significant number of medical contacts, but are not having that need addressed.
Certainly, maternal, infant and child health, health communications, many emergency departments, or site of care patients spend hours in the waiting room. That time is available to anybody who cares to use it.
Arthritis, disability, HIV, mental health, again, the most disorganized patients, who are least able to follow a treatment regimen and show up to fixed appointments during the day, are seen in emergency departments.
Very frequently, we have very little to offer them. We have very few places we can refer to. But that is a way to reach those persons, if we wanted to reach out. Outreach doesn't necessarily have to mean going to people's homes.
Diabetes, immunizations I talked about, asthma, are very, very prevalent in emergency departments. Substance abuse, again, the patients least likely to be reachable in other settings.
Again, it is not necessary to go to street corners to find people who are addicted to drugs. You can wait in the waiting room of most emergency departments and they will come to you. Again, this is underutilized. Thank you.
DR. ELLIS: Thank you. Is there anyone else who has any comment relative to any of the areas of concern?
One of the things I noted -- and I may be in error -- and that is that as we talked about the elderly, two areas come to my mind.
One of them happens to be professional podiatric care and the second happens to be oral care in relationship to the elderly, where those who are edentulous sometimes stay in long-term care programs, don't eat properly, their nutrition goes down.
They may be starving and die because of the lack of dentures. Food becomes very distasteful, so they don't feed them properly. They do die. Microphone number one.
MS. CHRISTMAS: Good morning. My comments are of an awareness concern of our senior population on drug abuse.
They are over-medicated. There are a lot of emergency cases that come into our hospitals because of this. Some have even come into emergencies and they might be saying that they are alcohol abuse or something like that.
There should be some awareness and some education for our senior populations on medications that they take.
Medications sometimes don't mix with one another and sometimes they suffer reactions from over-drug, because a lot of them take more than four or five different medicines. It could be a condition that would be involved in abuse of this area of drugs. Thank you.
DR. ELLIS: Thank you very much. Microphone number one is open. Microphone number two is open for comments. Any comment from anyone? Microphone number two.
MS. THOMAS: Hi. I am Sandra Thomas with the Chicago Department of Health. I would just like to make a general comment. Many of the illnesses that we are dealing with are chronic illnesses.
I think that in many of our intervention programs, and also in the way that we develop objectives, we seem to focus on single points in time in the natural course of a chronic illness with a person.
One thing, I deal a lot with asthma in my work. People live with asthma for most of their lives. For some people it will go away, and we can't really get effective management of asthma unless we get people to realize it is a chronic illness.
Many of our interventions and our objectives for care, they are like one shot, that if you get someone under control at one point in time, like that takes care of them the rest of their lives.
Chronic illnesses, you know, our objectives in the way that we address our patients with chronic illness, is to reinforce that they are living with this illness, that there is not just this one single point in time cure.
There is this underlying reinforcement of the episodic nature of chronic illness, when that is, you know, sort of the opposite of what is really true.
So, I just think we should reinforce that in sort of the larger framework of how we talk among ourselves, to our clinical population about chronic illness.
DR. ELLIS: Thank you very much. Is there anyone in the audience that would like to make a comment? Comments are open as they relate to any of the other areas or sessions that have been held. Microphone number one.
MS. GONZALES: Good morning. My name is Ada Gonzales. I am a nurse at St. Mary of Nassar Hospital and past president of the Illinois Hispanic Nurses Association.
Where I work, I provide community health education programs, which sometimes the importance of these programs is not reinforced.
I see in many of the health screenings people with high cholesterol levels have never heard about the food pyramid, don't exercise, sugar is elevated, and obesity is definitely a problem.
Even the literature that I order from various national organizations about losing weight, reducing you cholesterol, and fitness, I see many times that the food pyramid is not even included.
People have no idea, many of them, what are the number of servings that are recommended. Even the food pyramid doesn't even have additional information about the importance of exercise.
I would like to see definitely that literature and information be culturally sensitive, but please, do not leave the food pyramid out, and probably add fitness along with it. It is a very key thing.
Also, another concern I have is young adults between 19 and 24. Many of them have no health insurance, parents cannot carry them on their health insurance, and many times they are working part time and going to college.
There is definitely a big need, and oral health is really a big concern. Sometimes the public health clinics here in the city of Chicago won't even taken them because they are not patients of the clinic. Yet, if they have dental problems, they are not accepted. So, we need to address those issues, too.
I think that prevention and primary care is very important. They go hand in hand, but many times when we get these results, I find that there is not really a big follow up in helping people to access health care services.
Just for example, if I have somebody with high blood sugar, are we aggressively making sure that this person accesses these services?
At the same time, what happens if they have no insurance or they are residents, then they find that they have nowhere to go?
We continue to see these disparities in our community and we have got to make sure that these people access the health care services and that they are available to them, even if they are not citizens. Thank you very much.
DR. ELLIS: Thank you very much. Is there anyone else who has a comment, general or otherwise?
I have never found an audience that was more cooperative with the speaker and staying within time, being very courteous. I really appreciate that. You made the operation of the process much smoother, so I am very appreciative.
The other thing I am very appreciative of is having this full table of experts, and I do mean experts, who have taken in all that you have said.
It will really be recorded. You will also find it, as we begin to be publishing the material that is here. So, thank you, thank you, thank you all. Godspeed; be careful.
[Whereupon, at 11:05 a.m., the session was adjourned.]