Transcript of the Healthy People 2010 Regional Meeting
Seattle, Washington
December 2-3, 1998
U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion
Framework and Goals
DR. SLOAN: I am the Regional Health Administrator for Region VIII, one of the two regions that is represented here today. Our offices our housed out of Denver.
We welcome all of you to a very important session this morning that I think will produce additional comments, we hope, and we hope you have had some time to reflect on the excellent panel discussions and dialogue that went on in the breakout groups yesterday so that we can further refine this document.
I think it is clear that it is a very, very intensive, complex set of objectives, and the 26 chapters represent the best thinking over nearly 20 years of trying to put together an approach to healthy people in the United States.
It is clear to all of us that without people like you who are investing the time and taking time out of busy schedules to be here with your colleagues this document won't represent any of the reality that basically each of you face in your communities.
I would like to acknowledge with me today my colleagues from the other region, as well as from the Office of Disease Prevention and Health Promotion.
On my left over here you met yesterday Dr. Richard Lyons, the RHA in Seattle, Region X, his deputy, Karen Matsuda, also, here in Region X, over here the person who is going to be sort of our traffic woman. Monitoring the time is Jane Wilson, the Deputy RHA in Region VIII and right next to me is the Acting Director of the Office of Disease Prevention and Health Promotion, Linda Meyers, Dr. Linda Meyers.
I want to say just by way of background, and it will be a little repetitive of some things that you heard yesterday but just for those who maybe could only come today it is important to remember that this process is something that is a work in progress, and that has been going on since the fall of 1998, when we started a series of regional meetings, and this is the fourth of five meetings. There is one more next week in Sacramento, essentially meetings brought together to discuss progress towards achieving the national health goals for the year 2000 and to hear comments from the public about the draft goals for the year 2010.
The purpose of today's session is to hear your comments on the draft of Healthy People 2010. I think most of you have seen this document and if you haven't read it don't feel alone. Some of you have more interest in certain parts of it. You will get more opportunity, I think, to dig into the 500 or so objectives in there.
Your input is vital and will be used to finalize the health objectives of the nation for the year 2010. I encourage all of you to provide oral statements about the draft document. In addition to the oral statement, I encourage you to submit written comments via the Internet or mail.
Written comments will, also, be accepted at this regional meeting, and you can submit those to the Registration Desk across the foyer or to any member of the regional staff here or the Office of Disease Prevention.
An electronic copy of your written comments on disk will greatly facilitate the placement of your comments on the Internet if you would like to do so.
A transcript of today's session will be made public and be posted on the Healthy People Web site.
In addition, all written comments received between September 15 and December 15, 1998, will be posted on the Web site. The address for this Web site is in the materials that you have in your registration packets.
To help assure a fair opportunity for everyone to participate in today's hearing we will be using the following procedures. First, each oral statement will be limited to 3 minutes so that we can hear from the greatest number of participants.
Second, each individual and organization will be limited to one oral statement for the opening session and for each focus area.
Third, if time permits at the end of the concurrent sessions, the time between now and 9 a.m., the floor will be open for general comments. From eight-twenty to nine, as I have said, I will be hearing your comments on the framework, goals and leading health indicators for Healthy People 2010.
Then at 9 o'clock, we will break into two concurrent sessions. Session One will cover the focus areas 1 through 13. This session will be convened by Dr. Lyons and Karen Matsuda in this room, and so you will remain here.
Session Two will cover focus areas 14 through 26. I will convene the session with Jane Wilson, my Deputy in Cascade Ballroom 1 which is down two levels.
The session will adjourn at 1 p.m., today. So, everybody who I know has made airline and other reservations can be assured that we will be finished by then.
During the Plenary Session this morning, I would like you to give your comments on the framework, goals and leading health indicators that are proposed for Healthy People 2010.
This material is found in Section A and B of the draft for public comments, again, in the yellow book. Dr. Linda Meyers, Acting Director of the Office of Disease Prevention and Health Promotion is here to listen to these comments.
I would like to invite her now to make a brief opening statement before we hear the comments.
DR. MEYERS: Thank you. I would, also, like to use this opportunity while I have the microphone to thank our regions for allowing us to be a part of this and to come here and listen. ODPHP is honored to be able to coordinate the Healthy People 2010 development process and to be a part of these regional meetings.
I would, also, like to thank the terrific ODPHP staff and especially Linda Bailey who has been coordinating this activity on behalf of the office and Paul Kim, both of them at the back who was working on the public health infrastructure meeting yesterday morning along with Kristine Gebbie.
We are pleased to listen to your comments about the framework, goals and leading health indicators. Dr. Satcher, yesterday, described these. I would like to just go over briefly what it is that we are focusing on this morning.
The draft framework, and it is in the book but the framework was, also, in your folder as a single sheet, includes two goals, four major sections and the focus area.
As shown in the figure the proposed goals for Healthy People are to increase the quality and years of healthy life and to eliminate health disparities.
The goals are encircled by four major sections, promote healthy behaviors, prevent diseases and disorders, promote healthy and safe communities and surrounding it all improve systems of personal and public health.
Are these appropriate? Can they be better stated? Do they communicate? The 26 focus areas are arrayed within the four major sections, and these are on the agenda for the breakout sessions as well as in the table of contents in the yellow book.
Do these make sense; are they arrayed appropriately; do they communicate what Healthy People is about?
Last, the leading health indicators are intended to be a small set of objectives that could be presented to the general public and to non-health professionals as an introduction to Healthy People.
Page 7 of the yellow book describes the leading health indicator components and the process for developing those. We welcome your comments on those as well, and we are ready to listen.
Thank you.
DR. SLOAN: Thank you. I would invite each of you now for your comments, and if you would like to make a comment we would ask you to come to the forward mike here and queue up behind the microphone. The microphone has some lights on there to give you advance notice of about when your 3 minutes will be up.
For anyone with special needs, please raise your hand if you would prefer to use a hand-held microphone. We will get a microphone over to you.
I will ask each of you to introduce yourselves by name and your state. Also, please let us know if you are commenting on behalf of an organization as opposed to you as an individual.
After your comments, please sign your name at the table in the back of the room. I think you can see the table directly down the aisle there.
Each person will have 3 minutes for comments. When the light turns yellow you have 1 minute remaining. When the light turns red, your time will be ended, and you will be taken out physically.
(Laughter.)
DR. SLOAN: We haven't arranged for that yet, but we will begin with the first person now. Would you please state your name and as you come up please state which state you are from. There are too many states in there, but let us begin now with the first comment?
The first person always gets 6 minutes. No, you are still on 3 minutes. Thank you, sir.
DR. FOX: I am Fred Fox, a physician and public policy director of the Gay and Lesbian Medical Association, a national organization representing over 2000 physicians in all 50 states. I am based in San Francisco.
Our goal is to promote the quality of health care for the lesbian, gay, bisexual and transgendered community and the HIV-positive community. In addition to racial and ethnic minorities, I want to speak for the often silent and unrepresented minority group of LGBT peoples estimated to be between 3 and 10 percent of our population here in America.
Regarding the goal of eliminating health disparities, if health equity and eliminating disparities is the 2010 goal then I ask for Healthy People 2010 to include for the first time a substantial minority in its data collection and targets the minority of LGBT people, not only in the health arena of HIV but in health care overall.
We of the LGBT community are your brothers and sisters in the communities of ethnic, racial and the disabled minorities. As Dr. Doong said yesterday in the Eliminating Health Disparities Breakout Session if no health data is accumulated then there is no problem. If there is no problem, then there is no action, and if there is no action, then there are persistent and increased gaps in health care.
As a postscript, I want to ask that the completed CDC, NIH and now embargoed Lesbian Health Report of the Institute of Medicine be released prior to December 15, to allow for its many objectives and calls for data accumulation and study to be included in the Healthy People 2010.
Thank you.
DR. SLOAN: Thank you for your comments, sir. Would you sign at the desk in the back, please?
Next?
MR. FINGER: My name is Reg Finger. I am from Colorado. I am speaking on behalf of myself. These objectives are extremely aggressive. They are a challenge to us all and of course, will require commitment from not only the public health community, not only the health community but the improvements that are targeted, and I will cite infant mortality as an example, where we are shooting for five per 1000 infant deaths by the year 2010 as a goal in reduction of infant mortality, requires some major societal change, getting it down that far, and that is just one example, and throughout the 500 objectives there are examples of improvement which requires major societal change and not just public health activities to make those changes.
Given that that is the case, my concrete suggestion is for the introduction materials in the final release of Healthy People 2010 to contain a clarion call to the faith communities, to political leadership and to business leadership to get on board, and I think the leading health indicators are a good thing to market to these people as has been suggested, but I do think that the document itself needs to contain a paragraph or two of direct appeal to these sectors of society to commit themselves to these goals, and there should be some process of receiving and publishing written commitments from leaders of these communities as the final year 2010 document goes to press. That is what I would recommend be done specifically about that.
My only other statement in a general sense has to do with the fact that much of the improvement, also, will depend on federal funding, and there is a lot of money being spent by the US Department of Health and Human Services for these ends.
Unfortunately, there are some goals and objectives in the document that depend on enactment of state and local legislation, and right now the rules that Congress has given for the expenditure of federal funds that you cannot use federal money to lobby, to influence or to work for or against state or local legislation, and I see that as a major problem especially in an objective like 716 which is to increase to 50 the number of states with primary seatbelt laws. That is just one example.
So, I would suggest that all that can be done through direct line authority policy advocacy through the federal people be done to modify in some way this requirement so that federal resources could be brought to bear on these objectives that we all agree on such as primary seatbelt enforcement and several others throughout the document. If that barrier could be removed we could go a lot longer way towards achieving the objectives with the resources that we have.
Thank you very much.
DR. SLOAN: Thank you, sir, for your comments.
The next person, please?
MS. QUINN: I am Sheila Quinn. I am the Executive Director of the American Association of Naturopathic Physicians, and I have some comments on behalf of that organization. In reviewing this generally excellent document I am struck by the fact that despite its concern with health improvement and disease prevention it does not include representation from the alternative medicine community either at the leadership level or at the level of implementing goals and objectives.
When researchers analyze why alternative medicine has experienced such dramatic growth during the past decade the reasons always include the public's interest in primary prevention, responsible self-care, less harmful and more natural therapeutic options and cost effectiveness, as well as the frequent failure of conventional providers to help the patient.
It seems clear that there is a natural affinity between the philosophies and practices of many alternative health care disciplines and the goals and objectives of the country's public health infrastructure.
We can only hope that the final document will include not only an acknowledgement of these mutual interests but a strong recommendation for integrating alternative providers into the nation's health care system including all public health facilities.
The move towards managed care as the dominant model and other economic pressures have reduced the ability of many conventional providers to spend the time it takes to do good patient education, to work on improving life style behaviors, such as exercise and diet and to discuss with patients critical aspects of their health, such as emotional well-being and spiritual practices.
Instead of asking overburdened conventional providers to add even more responsibilities to their shrinking time with the patient, it would be far more productive to emphasize creating integrated service delivery sites where patients who are most interested or perhaps most at risk can consult a variety of providers who already emphasize spending time on patient education, developing the therapeutic relationship and working together under very difficult challenges of changing behaviors.
Such providers exist and are licensed in many states. Acupuncture, chiropractic, massage and naturopathic medicine combined reach many millions of people already and are continuing to experience significant growth.
We would like to see the integration of complementary and alternative medicine into mainstream medicine become an explicit goal expressed throughout the Healthy People 2010 document.
There are many specific goals and objectives where the expertise of alternative providers could be a tremendous asset, and we feel confident that the leading care professions would be happy to work on developing an integrating language that would address this need.
We recognize that the combined expertise and efforts of all trained health care personnel will be required to accomplish the objectives that have been articulated in this visionary process. We cannot afford to omit key players from any discipline. In fact, unprecedented advances can be made only if we all work together.
Thank you for the opportunity to comment.
DR. SLOAN: Thank you for your comments, ma'am.
Next person, please?
Ma'am, would you sign at the table in the back, please?
MR. SLAGLE: Good morning and thank you. My name is Eric Slagle. I am Assistant Secretary for Environmental Health Programs with the Washington State Department of Health.
The Department of Health strongly supports the two overall goals of Healthy People 2010, those of increasing quality years of life and eliminating health disparities. State and local public health communities in Washington State have made a concerted effort over the past 5 years to strengthen our ability to protect and improve health. The statewide health improvement plan has been developed and state funding to local health provided.
This funding allows local health to address community needs and priorities. It, also, provides for investing in a strong public health infrastructure. The federal Department of Health and Human Services is a vital partner to the state's effort to improve health. The Healthy People 2010 objectives provide a framework to measure progress.
There are three key areas that we feel strongly where the Federal Government policy could enhance state and local efforts to meet the Healthy People 2010 objectives. First, federal funding should be flexible to allow local determination of health improvement priorities, and it should create accountability for change linked to Healthy People 2010.
The diversity of issues and conditions requires a local priority setting to address local needs. Adequate and flexible funding is especially important to environmental health programs which have generally shifted to fee and categorical funding over the past decade.
Secondly, federal funding for state and local public health infrastructure should be increased and a portion of federal grants should be identified for infrastructure development. A major challenge, again, particularly in environmental health is identifying and addressing new and emerging issues. Infrastructure is key to accomplishing this.
Third, federal funding should provide incentives for state and local public health to form partnerships with community organizations and other government agencies.
Environmental health programs and other public health programs are often complex. They require the combined efforts from those involved in public health, health care, environmental protection as well as the regulated entities. A partnership among all these groups is needed in order to effectively address the issues.
Thank you for the opportunity to comment.
DR. SLOAN: Thank you, sir for your comments.
Could you please sign at the desk in the back?
Next person, please?
MS. SHURTLEFF: I am Cynthia Shurtleff, and I am speaking as Cochair of the March of Dimes Public Affairs Committee in Washington State, and these comments are from the National March of Dimes.
March of Dimes Birth Defects Foundation with its mission to prevent birth defects and infant mortality strongly supports the aims of the Healthy People 2010 objectives. They applaud the expansion of the year 2010 objectives to focus on additional areas not previously addressed, such as those of closing the gaps between disparities of minorities, ethnic populations, people with disabilities and so forth.
The March of Dimes would like to stress several areas within maternal infant and child health. One is preconceptional health promotion. The March of Dimes considers it very important to stress preconceptional health, and they provide a monograph, a 1993 monograph entitled Towards Improving the Outcomes of Pregnancy, the 1990s and Beyond to help you.
They would like to stress expanding the list of objectives so that they would be more comprehensive, and this would serve as a good road map to link the many objectives throughout Healthy People 2010 that directly impact on maternal, infant and child health objectives.
The second area we would like to stress is preventing low birth weight, prematurity and infant mortality and would like to suggest creating objectives stratified by plurality, thereby distinguishing between singleton and multiple gestation births.
We would, also, like to stress the increased use of assisted reproductive technologies, and an effort should be made to track the perinatal outcomes associated with these. In terms of low birth weight add objectives to monitor the outcomes depending on the type of delivery.
Another area they would like to stress is promoting the appropriate use and interpretation of perinatal data and add to the background chapter calculation news; also, small numbers and small areas should be considered. The March of Dimes is willing to provide technical assistance, and they now have a perinatal data center which you can contact for help with this area.
Another area is enhancing the clinical perinatal data systems, and I won't go into all the details. I have copies of this testimony which I will leave, and lastly, I will again echo the comments of the Washington State Department of Health that it is important to ensure that the objectives in the public health infrastructure chapter include important partnerships between governmental, not-for-profit, academic and for-profit agencies with respect to training, program planning, evaluation and other data.
Currently the focus is heavily on local, state and federal governmental agencies, and in the next decade innovative partnerships will be more important.
Thank you very much for this opportunity.
DR. SLOAN: Thank you for your comments, and I want to remind you, too, that again for everyone and some who might have come in late that the specific comments around the 26 focus areas will take place between nine and one, and we are trying to get some comments here, remember, about the general infrastructure and the objectives and the health indicators.
So, the next person, please?
DR. BLAGG: My name is Christopher Blagg. I am a physician from Seattle, and I am here representing the Council of American Kidney Societies which is a consortium of all the professional societies dealing with kidney disease in this country, and we believe this is a very good document, and it refers to kidney disease indirectly in a number of your focus sections, but we believe that chronic kidney disease deserves a section of its own.
The reason for that is that there are one-quarter million people in this country at this time on dialysis, a large number of patients who have been transplanted, and the estimate is that by the year 2010 there will be double that number, 500,000 people on dialysis, and that excludes all the people with other conditions.
It costs currently somewhere in the region of $15 billion a year, and so, obviously if you double the cost of that you are talking about $30 billion a year in the year 2010.
We think there are things that can be done that are important. You are already stressing in here the importance of diabetes which accounts for one-third of our patients and there is some discussion of hypertension in the section on cardiovascular disease and stroke, but we think it most important that there be increased efforts to educate both the public and the profession on the management of patients before they get to the point of needing dialysis.
There are many patients who die early after the start of their treatment on dialysis because they have not been well managed beforehand. Their quality of life before they reach dialysis may be impaired by not being treated appropriately, and we believe that there is much that can be done to improve this, and I would be happy to put some comments in writing about some of the specific things that we think could be appropriate to include in a section on chronic kidney disease.
Thank you for listening to my comments.
DR. SLOAN: Thank you for your comments, sir.
Next person, please?
MS. ELLERY: Good morning. I am Nancy Ellery, and I am here representing the Department of Public Health and Human Services in Montana, and Montana is not just a rural state, but it is a mega rural state. It is one of the few truly frontier states that are out in this part of the country that have less than 6 people per square mile, but I do want to definitely applaud you, everyone who has put a lot of time and effort into this document.
I think it is an excellent document, and I certainly appreciate your use of technology so we all don't have to lug around a big yellow book all the time, but I do have some concerns.
Being from a rural state I think that one of the things that has not been adequately addressed is rural issues. If you look at all the objectives I think there may be 11 objectives that address rural issues specifically, and there are none that mention frontier states, and I think this is something that really needs to be looked at.
I am very glad you included infrastructure as a section in the report because I think that is a critical issue in rural states, but I think some of the rural health disparities can be just as important and critical as the racial disparities, and I think we need to look at that. Rural states have unique challenges. They have wide-open spaces, few people, very little providers, but a real independent spirit, and I think some rural health issues in some areas.
There are definitely some advantages of living in a rural state. You can, like we did to get our comments together for this meeting, we were able to get almost everybody that had a concern in one big room and really talk about what was needed to improve upon this document, and our creativity has allowed us to develop some really innovative service delivery models that the whole country can look at in terms of medical assistance facilities that are the precursor for the critical access hospitals and how you can really make good use of telemedicine, but rural populations do have very special health care needs that the Healthy People 2010 objectives do not address.
Many of the objectives assume that primary care is available and that there is an infrastructure there, and that is just not the case in many rural areas. Also, Montana is a very conservative state politically, and it is difficult to get some of the resources we need to make some of these objectives happen. We just passed an initiative recently that required a public vote on every new tax increase or fee increase. We get a lot of fees to support our public health structure. So, that is going to make it more difficult.
I, also, think that there are many objectives that -- there are, also, in this document too many objectives for states to really get a handle on. Five hundred is just really hard to grapple with. You have got certainly the leading health indicators, but I think in order to really make this a usable document there has to be a fewer number of objectives.
In Montana we took what we thought were the 15 priority problem areas and put them into something that we could talk to the general public about and our legislators so they could get an understanding of what we think is important because in the end you have got to make these objectives local, have them be able to be translated to the local level and have local relevance because that is really where it all happens.
All health care is local, and in our case very rural, and outside of this regional meeting you probably won't hear too many people come up and talk about some of the rural issues, and that is because many of those people cannot afford to come to meetings like this, and they are small in number, and they just don't have the resources to be able to come and talk about these issues.
They certainly don't have access to the Internet and in many cases they don't even have a personal computer. So, I really think we just need to recognize this and give very serious consideration to the major issues we have in the rural parts of our country.
Thank you.
DR. SLOAN: Thank you for your comments.
Next person, please?
Is the light working on the microphone there? There is a little encroachment going on here, and we would appreciate it if when that light comes on you wind down within about 10 seconds.
Thank you.
MS. HALL: My name is Elinor Hall, and I am from Oregon, and I am representing the Oregon Health Division, and we do want to thank you and the Department of Health and Human Services for holding this regional meeting and giving us a chance to comment and dialogue.
We have a couple of comments, overview general comments. There has been some very interesting conversation in the meetings yesterday about what are the purposes of Healthy People 2010, and there is obviously a variety of purposes. We think that the current goals will serve the purpose very well for tracking specific objectives over time and setting long-term goals, but we do not think the current document will be terribly helpful for conducting and developing public health programs and policies in the state and local levels.
We think that a way to make this more useful would be to include information about how our public health programs affect these goals and how good public health programs will help us achieve these goals.
There are so many confounding factors unrelated to public health that affect the health of individuals that without some connection of the goals to public health programs we think they will be less useful to our public and legislators and our public health workers all around the country.
I know you struggled with how large the document is, and I am not sure whether these best practices, proven strategies, interim measures for reaching the target should be incorporated into this document or should be references from this document, but we think it would really magnify the effect of the Healthy People 2010 to see how public health programs are related to achieving the goals.
Secondly, we would like to see more discussion on the importance of measuring objectives at local and community levels. This kind of discussion would support the vision of healthy people in healthy communities.
Communities need data at the local level to assess their health. As we promote the use of data for decision making and that becomes more commonplace at local levels there is more clamoring for accurate local data. In our state we think communities would need Zip Code level data and in some areas perhaps census block data.
Counties, especially in the West are often very large entities and average a lot of different health populations and concerns.
Thirdly, we do applaud the decision of all of you to make the 2010 goals identical for all population groups. We think that setting identical targets is important if one of our major goals is to eliminate health disparities rather than just reduce health disparities. So, we, also, commend the decision to emphasize the importance of socioeconomic status as a key determinant of health disparities in the US.
We think this is something that needs to be better understood throughout the country.
To truly address the problems of health inequities among different populations the 2010 targets must be realistic. Therefore we suggest that the 2010 targets be chosen that will be reasonable for the population as a whole but are achievable even though they may not be the paramount objectives for some of the subpopulations. So, we are supportive of one objective and encourage us to make it attainable.
Thank you for the opportunity to comment, and we will submit this electronically as well. Was the light working?
DR. SLOAN: No. Could you hold your comments just for a minute to make sure that we have the light?
Okay, we will go ahead.
MS. JACKSON: My name is Emma Jackson from Colorado, and I don't know who I am representing actually. It says, "Denver Public Schools" on my tag, but some communications have the Colorado Council of Black Nurses. So, I appreciate whoever did it. I have a concern about the document including strategies to enhance communication between the public health delivery system, the local public health delivery system and grassroots growth, especially at base community.
We are concerned because we feel that to eliminate disparities, especially in the African-American community we must put emphasis and include our faith communities. It is expected that this will not happen, that is the elimination of disparities without their involvement.
Additionally I would suggest that we involve a more intense effort to recruit African-Americans for participation in clinical trials. Here, again, researchers, scientists and others must collaborate, align and cooperate with the black church and other religious institutions of persons impacted by health care disparities.
Thank you.
DR. SLOAN: Thank you, ma'am. If you could hold your comment here, we have a comment in the back, please?
Go ahead?
MS. MC DEVITT: Yes, my name is Lauren McDevitt, and I am from North Carolina with the North Carolina Office of Disability. I want to represent myself and individuals with disabilities, and I wanted to comment specifically on something that addresses the framework of Healthy People 2010. It was mentioned yesterday disability is now going to be a chapter presented in the Healthy People which is a vital recognition by the public health community and the general population that disability is very important and that disability is not merely illness or sickness as traditionally viewed but I want to point out that this recommendation really can be needed within the combined disability chapter but this must be addressed within all chapters of Healthy People 2010. Disability is really a health disparity issue, and disability has traditionally been a target and there are suggestions as far as health care and issues of health promotion and wellness in many of the health objectives and I feel like the most important thing for me personally is that disability is included as a subpopulation within many, if not eventually all of the chapters that are addressed in the Healthy People 2010. All of the objectives are important to the general population. They are, also, important for people with disabilities as part of that general population and your goal is eliminating health disparities and persons with disabilities are included in that, and a disability is really seen as a health disparity.
Thank you.
DR. SLOAN: Thank you for your comments.
Next?
MR. SPECTER: Good morning. My name is David Specter. I am Director of the Health Department in Jefferson County, Washington on the Olympic Peninsula, also, a rural community. I am here today as the Chair of the Washington State Association of Local Public Health Officials.
We are an association of 34 local health jurisdictions that provide public health services in Washington State's 39 counties, and I will probably echo some of the comments you have already heard today, but that is okay because we do want to reinforce some of the points that have been made, first of all the fact that Washington State is and has a diverse population living in disparate areas throughout our state from dense urban areas to sparsely populated rural areas, all with unique needs and challenges.
We do need flexibility to respond to the challenges and appreciate the goals in Healthy People 2010 to address the disparities among these populations. This is a basic value held by local public health in Washington and is a goal that we strive towards.
We are no different than the rest of the nation in that we see disparities along racial, economic and ethnic lines.
You heard a presentation from Dr. Wang yesterday from Seattle King County that provided some pretty compelling evidence of disparities along racial lines. I guess I would add to that and emphasize the challenges we face in rural communities.
Where I come from, for instance, we don't have tremendous racial disparities, but our largest city has all of 8000 people in it, and that is considered urban, and I can tell you that what we need to do in that community is very different than in our rural communities of one or two thousand people in Brinnon and Quilcene along the Hood Canal, and we need a flexibility to be able to respond to those differences.
We cannot take a cookie cutter approach and expect to get results in those areas.
Members of the public health community in Washington have made a commitment to strengthen public health systems infrastructure. In order to adequately address public health needs in our community we must have a strong public health infrastructure.
In Washington we have begun to change the way we do business in our communities to begin to address those infrastructure needs, and we are returning to our roots in public health, prevention, protection and health promotion. We are working in partnerships with other organizations in the community to address health care and public health issues.
We work very closely with the Washington State Department of Health, and they have been integral along with local public health in developing partnerships, and the infrastructure support is absolutely critical to continue the partnerships, and again, speaking from a rural perspective the resources it takes us to join together with others in the community really do need to be supported, and I see my red blinking light. So, I will be fast.
There are really three points I want to emphasize then, providing flexible funding to allow us to respond to local health improvement priorities, increasing federal funding for state and local public health infrastructure and recognizing the importance of partnerships.
Thank you very much for the opportunity to address you.
DR. SLOAN: Thank you for your comments, sir.
The prerogative of the Chair will be that we will have two additional commenters, and then we will close this session, but I would encourage those of you who still have comments to make those comments in the specific sessions that we will have afterwards and to submit any of your comments in writing even though we may not have time, will not have time to hear you in this Plenary Session.
So, we will have these two, and then we would ask that you make any other further comments in the other sessions.
Ma'am?
MS. PETERSON: My name is Jane Peterson, and I teach public health nursing at Seattle University, and I am actually here speaking on behalf of public health nurses and the university.
I commend you on the framework for the document. I worked overseas in Third World countries, and it sounds like Health for All from the WHO. It is a very familiar-sounding document, and it speaks to prevention. It speaks to health promotion.
Some questions I have had to do with in terms of soliciting information, evaluation, not losing the average citizen, the consumer. A lot of the consumer participation in here has to do with targeted groups from industry, from communities, whatever, and there are some Joe Blows and Jane Blows on the street or in life who I think we need to target and collect information.
I like the fact that you have not available information against certain groups. I think that is very helpful to point out what is missing. I think that needs to stay. I think that if information becomes available or can be gotten from other sources it needs to be indicated so that when we pick this up to do research or to work with it we know where to go for information.
My stomach is queasy over better than the best, and my red flag goes up in terms of our notion of social justice in what we are trying to do when we do the better than the best, what happens, and I will leave that as just a comment to be worked out.
Thank you for the opportunity.
DR. SLOAN: Thank you for your comments.
Sir, you have the last word.
MR. MACDONALD: I am Steve Macdonald at the Washington State Department of Health, and today I am representing the Office of Epidemiology.
I would like to briefly outline four major proposals which we have and we will submit more fully in writing.
The first is to alter the data source for each objective to show the state level data source. Our proposal is to change the format and content for each national health objective such that the data source section includes two subsections, the national level and state level. The identified data systems should have reasonable comparability.
Our second proposal is that federal agencies work together to assure this comparability. Currently incompatibility between nationally representative data systems such as NCHS's National Health Interview Survey and state-based data systems such as the Behavioral Risk Factor Surveillance System make it difficult to use many national health objectives at the state level.
Our third proposal is to make objectives developmental unless state data is available. So, we want to consider each national health objective to be developmental unless it includes data sources at both the national and state level.
Objectives which cannot be tracked to the state level cannot be easily used by states and local communities in the health improvement plans and then fourth, include national health objectives on data system development in every chapter.
Our proposal is to establish national health objectives focused on data system development in each and every chapter to assure that infrastructure for surveillance and information systems are adequate to track progress in each focus area.
Those are our four modest proposals.
(Laughter.)
MR. MACDONALD: Thank you for this opportunity.
DR. SLOAN: Thank you, sir, for your comments. Because of the brevity of the last two speakers I will recognize a final speaker who was up and ready to speak if you would like to make your comments, please?
MS. AZCAPOTZALCO: Good morning. My name is Cherylle Azcapotzalco. I am an African-American Indian. My experience is as a registered nurse community health nurse and a former cultural diversity chairperson with the American Red Cross in a Central California Chapter, and this is part of the issues I had brought up yesterday in one of the sessions, and when I look at the grand scheme of things and the little short and sweet graph here on the healthy people and healthy communities, improving systems I look at two primarily that say, "Prevent and reduce diseases and disorders," and I look at the other one that says, "Promote healthy and safe communities." I see the best way of doing this, and I don't really see it as mandated or brought up as part of the objectives that we can facilitate all the communities' access to health care by having the communities have a cultural familiar as you may have it in their community or someone who has a mandated training culturally competent health care practitioner.
I know that as both a community health nurse and as the American Red Cross when I go into various communities, one such example is where I had privilege access to 64 different cultures, I go through the gatekeepers and they are more often comfortable if I do have someone with me who represents their group, and I think it is very important. That way they do have access to quality care. It is easier for me to coordinate health care services for these clients to get them to the TB clinic, to get them to the physician or physical therapy so they can quit falling at home and ending up in emergency rooms.
So, I believe it is very important that we include that as part of the objective, that if you really do want to access the communities and prevent disease and disorders and promote the health and safe community you access them in a culturally familiar way, and that is the gist of my comments.
Thank you.
DR. SLOAN: Thank you very much for your comments, ma'am.
I think as all of you have heard this has been a very productive and useful session, and I want to thank all of you for your thoughtful comments. It will be very helpful to us as we finalize the Healthy People 2010 document.
As I said earlier, I would invite those of you who did not have an opportunity to comment here to make comments in the concurrent sessions to follow this or to submit written comments.
I invite all of you to participate in one of the concurrent sessions or to move back and forth as you would like.
As I said earlier, Session One focus areas 1 through 13 will stay convened here in the Grand Ballroom and will be convened by Dr. Lyons and Karen Matsuda.
Session two focus areas 14 through 26 will be convened by me and Jane Wilson in the Cascade Ballroom two floors down.
Thank you for your participation. This session is adjourned. Please move quickly to the other room if you are going to be in those other sessions.
Thank you.
(Thereupon, at 9 a.m., the Plenary Session was adjourned.)