Our Childrens Health: Beyond the Medical Model

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Our Childrens HealthBeyond the Medical Model

• Judith A. Monroe, M.D.
• State Health Commissioner

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Asthma

• Widespread, chronic condition
• Prevalent in low-income communities where there
  are high rates of tobacco use
• Synergistic effects of tobacco smoke and mold

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Childhood Obesity

• Epidemic
• Environmental Factors

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The Future of the Publics Healthin the 21st
Century (IOM, 2003)

• Health is a primary public good because many
  aspects of human potentialare contingent on it.
  In view of the value of health to employers,
  business, communities, and society in general,
  creating the conditions for people to be healthy
  shouldbe a shared social goal

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IOM, 2003

• The special role of government must be allied
  with the contributions of other sectors of
  society.

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Collaboration

• Working together as partners
• Sharing risks and rewards
• Pooling resources
• Acting as a team
• Joining forces

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Why Collaborate ?

• Institute of Medicine (IOM) Report
• Ninety-five (95) of health care spending is
  directed toward medical care and biomedical
  research.
• However,
• Behavior and environment are responsible for 70
  of avoidable mortality.

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White Elephants -Plague of Collaborations

• Money
• Issues of race
• Knowledge
• Skills
• Education
• Community history
• Personal or professional agendas
• Community leaders are usual suspects

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Collaborative Processes

• Empower individuals
• By getting them directly and actively involved in
  addressing problems that affect their lives
• Create bridging social ties
• Bring people together across societys dividing
  lines
• Create synergy
• The breakthroughs in thinking and action produced
  when a collaborative process successfully
  combines knowledge, skills, and resources of a
  diverse group

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Synergy

• Poor social or environmental conditions
• are those which set us against each
• other by making our personal interests
• antagonistic to the group, to those of
• others. Maslow on Management
• Ruth Benedict defined synergy as the social
• institutional arrangements which fuse
• selfishness and unselfishness resolves the
• dichotomy between selfishness and altruism

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Synergy

• Synergy occurs when a group of
• people and organizations combine
• their resources rather than dyadically
• exchange them.
• Think Stew

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Potential Outcomes of Collaborative Health Care

• Reduced incidence of chronic diseases
• Appropriately immunized populations
• Increased economic stability and growth
• Reduced use of high-cost services

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Institutions Could Work Together to Reduce
Obesity
Indiana State Health Department Could
Establish A Complex Adaptive System
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Institutions that Could Work Together to Reduce
Obesity
System
Health Care Providers
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Institutions that Could Work Together to Reduce
Obesity
System
Health Care Providers
Health Departments
Schools
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Institutions that Could Work Together to Reduce
Obesity
Families
System
Health Care Providers
Health Departments
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Institutions that Could Work Together to Reduce
Obesity
Families
System
Schools
Health Care Providers
Health Departments
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Institutions that Could Work Together to Reduce
Obesity
Families
System
Schools
Health Care Purchasers Payers
Health Care Providers
Health Departments
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Institutions that Could Work Together to Reduce
Obesity
Families
System
Employers/Worksites
Schools
Health Care Purchasers Payers
Health Care Providers
Health Departments
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Institutions that Could Work Together to Reduce
Obesity
Families
Media
System
Employers/Worksites
Schools
Health Care Purchasers Payers
Health Care Providers
Health Departments
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Institutions that Could Work Together to Reduce
Obesity
Families
Media
System
Employers/Worksites
Schools
Health Care Purchasers Payers
Health Care Providers
Local, County, State Governments
Health Departments
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Institutions that Could Work Together to Reduce
Obesity
Colleges Universities
Families
Media
System
Employers/Worksites
Schools
Health Care Purchasers Payers
Health Care Providers
Local County Government
Health Departments
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Institutions that Could Work Together to Reduce
Obesity
Colleges Universities
Families
Media
System
Schools
Employers/Worksites
Health Care Purchasers Payers
Health Care Providers
Local, County, State Government
Health Departments
Food/Beverage/Physical Activity Industry
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ISDH role in Collaborative Health Care

• Support health promotion and disease prevention
  evidence-based programs
• Provide communities access to current and timely
  health data
• Enhance environmental health partnerships
• Facilitate a health care technology system
• Identify underserved populations, especially
  minority populations

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ISDH Internal Collaboration

• ICLPPP sharing resources with MCH programs to
  increase lead testing
• 6 full time staff
• funding for risk assessment, materials, supplies

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ISDH Internal Collaboration

• Piloting approaches to educate and promote
  primary prevention in 3 communities
• Bloomington
• Vincennes
• South Bend

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ISDH Internal Collaboration

• Providing resources to develop medical management
  recommendation charts and to send these to all
  physicians and health providers that work with
  children

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ISDH Internal Collaboration

• Providing staff resources
• Providing resources at the local level to conduct
  the filter paper project that does blood lead
  test for children through WIC clinics

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ISDH Internal Collaboration

• Collaboration with food protection program to
  ensure that we address issues regarding lead
  exposure through food sources and disseminate
  that information throughout the state

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ISDH Internal CollaborationCHIRP

• ICLPPP Childhood Immunization Program putting
  all lead data into CHIRP and adding prompts that
  inform doctors for the need to test children for
  lead and to follow-up

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OMPP and ISDH Collaboration

• Share data and resources to increase blood lead
  testing of children
• Chronic disease management

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Partnerships and External Collaboration

• Head Start
• Healthy Families
• Community Development
• First Steps
• Purdue Cooperative Extension Services
• Housing Programs

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FSSA Indiana Housing and Community Development
Authority

• Healthy Housing from a Holistic Perspective
• Energy Efficient, Healthy, and Cost Effective
  Homes
• Weatherization Crew air quality, carbon
  monoxide, safety, lead, mold and mildew and cost
  effectiveness

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ISDH IDEM

• Developing comprehensive risk assessment tools
• Reporting tools
• Educate first, enforcement second

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Todays Challenge

• Think about Chronic Disease Management as a
  collaboration
• Example Diabetes
• What partnering can be done?
• Incorporate resources provided by ISDH for
  patient education
• Coordinate with LHD on presentations, support
  group discussions, or patient education

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Todays Challenge

• Think about obesity prevention for children and
  youth as a collaboration
• Develop nutritional plans
• Encourage active lifestyles or exercise
• Support Youth Corps training
• Collaborate with LHD and Rural Health Clinics on
  pandemic flu planning and implementation

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Problem

• Technical Problem Expert Solution
• Adaptive Problem Person/Community With Problem
  Must Solve

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Solution

• Success of public health in the past has largely
  been technical.
• Success of public health today is largely
  adaptive work.

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Must Fix the Problem-Solving Process

• Politics of Interest Groups
• Look at problems in isolation rather than in
  relation to each other or the broader community
  context
• Eroding Sense of Community
• Confrontational politics and growing diversity of
  the population
• Limited Involvement of Community Residents
• Rarely treated as peers or resources in problem
  solving
• source Lasker RD, Weiss ES, Broadening
  Participation in Community Problem Solving a
  Multidisciplinary Model to Support Collaborative
  Practice and Research, New York Academy of
  Medicine, 2003.

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Leadership

• Adaptive work requires
• grassroots leadership.

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Beliefs

• Indiana has tremendous human
• capital.
• Hoosiers want to be healthy.
• Public health leaders will unite to
• develop grassroots leadership
• necessary for adaptive change.
• Synergy is within our immediate grasp.

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Vision

• Indiana will be one of the nations
  healthiest states in 2010.

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INShape Indiana
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