together Creating Health in the Social, Physical & Natural Environment: A Call to Leadership

Transcription

1 Creating Health in the Social, Physical & Natural Environment: A Call to Leadership WE BUILD A BRIGHTER FUTURE Association for Community Health Improvement March 11, 2009 Raymond J. Baxter, PhD Senior Vice President, Community Benefit, Research and Health Policy Kaiser Permanente

2 Health Is Rooted in Communities Our Mission for 60 Years: To improve the health of our members and the communities we serve 2

3 Our Work Addresses the Critical Challenges in Care, Coverage and Community Health Workstream Approach Care and Coverage for Low-Income People Fill coverage/access gaps, create high impact, inform policy Safety Net Partnerships Support a robust safety net and promote community-based systems of prevention and care for the underserved Community Health Initiatives (CHI) Engage in deep, comprehensive, sustained intervention to change a community s health Knowledge Development and Dissemination Translate KP s research and experience into practice and policy, share with the public and the field Social Responsibility platform links Community Benefit to Disparities and Environmental Stewardship to address the social, economic, and environmental determinants of health 3

4 Evolving Toward a Total Community Health Organization Do Good Things Make an Impact Be Accountable for All Our Impacts Assure access Address the conditions of health in the physical, social, natural environment Understand our ecological and economic footprint, and its impact on community health; act accordingly 4

5 Implications of Being a Total Community Health Organization Access to quality care is critical, but it is not enough Care must be safe, effective and organized around medical home Build on heritage of prevention and population health Address social, economic and environmental determinants, and disparities Unite evidence-based integrated care and research, with public health and safety net partners and civic activism Build strong community partnerships, policies and practices that improve health Concentrate investments for scale, visibility and impact Invest large-scale, long-term, in communities health Evaluate, report publicly, be accountable for our impacts 5

6 We Must Address the Crisis in Coverage Impact of a 1% Point Increase in Unemployment % = Decrease in State Revenues & Increase in National Unemployment Rate 3-4% Increase in Medicaid and CHIP Enrollment (million) Increase in Uninsured (million) Source: John Holahan and Bowen Garrett, Rising Unemployment, Medicaid, and the Uninsured, prepared for the Kaiser Commission on Medicaid and the Uninsured, January

7 Care and Coverage for Low-Income Families Is Not Just Charity Care Move traditional ER-based charity care to appropriate settings Enroll uninsured in comprehensive charitable coverage programs (100,000 members) Transform care delivery in Medicaid via Rapid Learning Initiative (Center for Health Care Strategies) Automate eligibility assistance for low income services/benefits Collaborate with City and County-based universal coverage plans Harvest lessons for health reform Strategy: fill holes, create high impact, inform policy 7

8 No Single Organization Can Assure Access Safety Net Partnerships Fund increased capacity in public health, community clinics and public hospitals (direct operating and capital) Share clinical, technical and material support, including KP clinicians Collaborate to reduce health disparities (ALL/PHASE for at-risk diabetics) Fund staff development and quality improvement (500 IHI scholarships, national quality centers for NAPH and NACHC) Support registries, EHR, medical home and panel management Collaborate on policy Strategy: support a robust safety net and promote communitybased systems of disease prevention and management 8

9 But 100% Access to Care That Is Only 55% Right Wouldn t Be Much of An Achievement Percent of recommended care received Overall Breast Hypertension Asthma Diabetes Pneumonia Hip fracture cancer Source: E. McGlynn et al., "The Quality of Health Care Delivered to Adults in the United States," The New England Journal of Medicine, June 26,

10 Research and Education Are Essential to Effective Care Developing and Disseminating Knowledge Organize electronic medical records into unique longitudinal database: diverse population of 9 million Harness research capacity: 2800 studies underway to improve care Build tools to advance care: Archimedes, Carepoint, Optimizer Create research utilities : Care data analysis, genes and health, community health, Center for Comparative Effectiveness Educate clinicians: more than 2700 residents a year; scholarships and training programs for nurses, pharmacists, therapists, techs Provide health education for consumers: engage half a million young people each year in award-winning Educational Theatre; put Amazing Food Detective game in 5,000 schools Combine these in the complete knowledge cycle: use unique longitudinal clinical database for real-time research, translate into practice, embed in EHR, evaluate, refine and educate Strategy: translate Kaiser Permanente s research and experience into practice, share with community partners, the public and the field 10

11 ALL/PHASE: Bringing It All Together Clinicians devised ALL = Aspirin, Lisinopril, Lipid-Lowering medication Archimedes model simulated impact on at-risk diabetics KP clinicians refined in practice, spread KP-wide KP s Care Management Institute evaluated ALL: prevented 1,279 MIs and strokes per year at 40% implementation Diffused through safety net partnerships in 20 settings throughout CA, (in 2009, GA, CO and NW) Year 2 results from San Diego Community Clinic Consortium More than 1400 diabetic patients placed on ALL regimen (approx. 72% Latino) 90% + medication adherence rate (based upon prescription refills) Learnings being fed back to KP to improve adherence 11

12 But Access to High Quality, Evidence-Based Care Is Still Not Enough If There Are Inequities in Health 12

13 A Total Health Organization Must Address People in Their Communities Same care doesn t yield same results Patients can t be healthy in unhealthy environments Communities hold critical resources An evidence base on community-level interventions is emerging Creating the conditions for people to be healthy should be a shared social goal The IOM Report on Public Health in 21st Century 13

14 Evolving Toward a Total Community Health Organization Do Good Things Make an Impact Be Accountable for All Our Impacts Assure access Address the conditions of health in the physical, social, natural environment Understand our ecological and economic footprint, and its impact on community health; act accordingly 14

15 Economic Conditions Shape the Chances, Choices and Health of KP Members Same care doesn t always get same results Mortality Rate per 100, Poverty Level (%) Age-Adjusted Mortality Rate Alameda County Division of Research Steve Sidney, M.D. 15

16 Poverty Matters Utility for Care Data Analysis 16

17 Education Matters Utility for Care Data Analysis 17

18 Obesity Tracks Poverty and Education Utility for Care Data Analysis 18

19 Diabetes Tracks Obesity, Poverty and Education Utility for Care Data Analysis 19

20 Diabetes Is Exacerbated by Place Utility for Care Data Analysis 20

21 Economic and Social Determinants Drive the Actual Causes of Death 21

22 Economic and Social Conditions Shape Health Unequal access to safe, walkable neighborhoods 22

23 Place and Race Shape Health An unhealthy food environment 23

24 Kaiser Permanente Now Has HEAL Community Interventions in 39 Sites Clark County, WA Portland, OR Cleveland, OH Santa Rosa Richmond Modesto Prince George s County, MD 6 HEAC Sites Colorado (statewide) Atlanta, GA Community Health Initiative sites Joint initiatives with other funders Denver, CO Commerce City, Park Hill, Lincoln Park 24

25 Healthy Eating Requires Access to Healthy Foods Many of our communities work with corner stores to bring in healthy foods, or use economic development or zoning strategies to attract full service grocery stores. 25

26 Active Living Requires Safe Routes and Safe Places Building Safe Routes to School 26

27 Healthy Eating and Active Living Are Not Always the First Priority Other community concerns are pressing: safety, jobs, community development 27

28 To Improve Physical Activity, We Need to Address Community Safety and Confidence Percent Who Don't Feel Safe in their Neighborhood Overall Modesto Richmond Santa Rosa DUG Commerce City GA OH Source: CHI Youth Survey,

29 We Must Work Across the Socio-Ecological Spectrum Kate Meyers, Racial and Health Disparities, Kaiser Permanente Institute for Health Policy,

30 Evolving Toward a Total Community Health Organization Requires Accountability Do Good Things Make an Impact Be Accountable for All Our Impacts Assure access Address the conditions of health in the physical, social, natural environment Understand our ecological and economic footprint, and its impact on community health; act accordingly 30

31 First, Do No Harm Then Now 31

32 We Have to Address the Impact of Healthcare on the Environment Healthcare uses 341 trillion BTU/yr Hospitals are the second most energy-intensive commercial buildings in the U.S. A single x-ray machine uses 900,000 gallons of commercial buildings potable water/year Medical waste incinerators are a major source of dioxin emissions 32

33 Healthcare Plays a Central Role in Local Economies 42% of all new jobs created were in healthcare Today, healthcare is one of the few sectors that is growing Hospitals are the biggest employer in many communities KP s new hospital in Modesto yields: 2,600 new jobs $98.9 million in local sales $147.7 million in local wages 33

34 We Can Choose to Build Responsibly Transportation-oriented development Bike parking w/ shower facilities Healing gardens, trails Green building standards Welcoming stairwells Natural light, noise mitigation Placement of nursing stations Tobacco, PVC and mercury-free facilities Research-based, standardized exam rooms Space for fresh food prep > 150 planning and design standards in excess of code minimums and/or common practice support the 3 safeties 34

35 We Can Choose to Use Energy Responsibly Solar panels at the Modesto Medical Center 35

36 We Can Choose to Purchase Responsibly KP s Local Sourcing Project Northern CA Inpatient Food Buy: 250 tons of fresh produce/year 6,000 meals/day 10% of total food buy fresh produce Environmental Impact: Excess carbon emissions: 6.34 tons Carbon footprint: 260 acres Estimated emissions reduction from modest seasonal menu shift: 20% Progress to Date: More than 60 tons of food locally sourced Vital support for local farmers A supply chain serving more than a dozen other hospitals, schools and universities 36

37 We Can Choose to Improve Access to Healthy Local Food Promoting access to local food through farmers markets at our facilities 37

38 We Must Be Accountable for Our Impact on the Environment Kaiser Permanente's Environmental Stewardship Agenda Overarching Principles: Prevention focus Protection of the biosphere Sustainable use of natural resources Reduction and disposal of wastes Energy conservation Risk reduction Commitment to equity Safe products and services Environmental restoration Engage the public Management commitment Audits and reports 38

39 Food Policy, Chemicals and Climate Change ALL Affect Health Direct Impacts of the Environment on Health Industrial agriculture 14.1 million Americans drink ground water contaminated with pesticides, higher exposure levels to farmworker families Concentrated Animal Feeding Operations (CAFOs) contaminate groundwater, harm air quality 70% of all antibiotics consumed in the U.S. are used in livestock and poultry for nontherapeutic purposes Toxic chemicals Human biosamples (cord blood, breast milk, tissue) include a variety of toxic substances including VOCs, pesticides, dioxins, PBDEs, heavy metals In 2000, more than 200,000 Californians were diagnosed with a preventable chronic disease attributable to chemical exposure in the workplace. Climate Change Excessive heat exposure (Europe 2003; Chicago 2005): heat-related mortality expected to double in many U.S. cities by 2020 and triple of Rising air temperatures worsen air quality: asthma, respiratory illness, hypertension Vector-borne infectious disease including dengue and malaria Contaminated water supplies associated with flooding, excessive rainwater runoff Conflict 39

40 Health is at the Center of a New Vision of Sustainability Healthy People Healthy Places Healthy Local Economies 40

41 Good Environmental Policy Is Good Health Policy 7% of Americans urban trips are biking/walking: 46% in Holland Slide courtesy of Richard Jackson, MD 41

42 Evolving Toward a Total Community Health Organization Do Good Things Make an Impact Be Accountable for All Our Impacts Assure access Address the conditions of health in the physical, social, natural environment Understand our ecological and economic footprint, and its impact on community health; act accordingly 42

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44 WE BUILD A BRIGHTER FUTURE