'This is about who we are as a people’

How should we craft our message?

That was the main question of the Closing Session of APHA's 2011 Midyear Meeting in Chicago, which welcomed more than 600 attendees. And what an interesting question it is. Think about it: Why — with so many facts, so much data and with other countries soaring past us in the health statuses of their populations — why is there so much controversy and pushback to efforts to fix an obviously broken health system? Why doesn't the argument that we're all in this together — that when one person is lifted, we're all lifted — resonate more widely? Why, why, why don't the facts of our current health situation trigger a massive outcry from every corner of the nation?!?!?!

Well, we've totally been asking the wrong question and talking the wrong language, according to Closing Session speaker Lawrence Wallack, dean of the College of Urban and Public Affairs at Portland State University, who said that while "we believe deep down that the facts will set us free and that data will win the day," the facts actually matter much less than we think. Wallack's speech was an inspiring and thought-provoking moment — one that made this blogger both more hopeful for public health and yet, increasingly frustrated that public health successes can't speak more plainly for themselves. (And as a traditionally trained journalist, having someone affirm that facts matter less and less just made me sad.)

Wallack told attendees that while health reform supporters use controlling costs as a way of persuading the public to support reform, opponents secretly rejoice. Confused? Wallack explains it perfectly: Reformers keep thinking that there's a cost-related answer that will satisfy the opposition. When all along, the only answer that will satisfy the opposition is one that won't even solve the problem. It's a never-ending discussion with no end point that provides a perfect distraction.

"The reformers," Wallack said, "are trapped in their own question."

On the other side, opponents of health reform are occupied with entirely different questions — ones about freedom and the roles of government. And in an argument about costs vs. freedom, freedom always wins, Wallack said. At the end of the day, it's about what words mean, not what words we say, he said. (Isn't that just the greatest way to put it?)

So where do we go from here? First we need to correct our fundamental errors and start making better arguments about what kind of country we are and what kind of values guide us, Wallack said. The real issue is how we define fairness; how do we create messages that reflect public health's social justice values, Wallack said.

"This is about who we are as a people," he said.

In sending off the attendees of this year's Midyear Meeting, APHA's Dr. Georges Benjamin said to get passionate about social justice and health care. His presentation nicely complemented sentiments of the session's first speaker, Assistant U.S. Surgeon General James Galloway, who noted that reform can "bring us to the pinnacle of public health."

"We are angry and we're not going to take it anymore," Benjamin said. "The health of Americans is too darn important."

You got that right!

Don't forget to join us in October for APHA's 139th Annual Meeting in Washington, D.C., where the theme of the meeting will be "Healthy Communities Promote Healthy Minds and Bodies." Click here for registration info. And, of course, your devoted APHA bloggers and this very blog will be in D.C. to cover all of the exciting events.

See you in the nation's capital!

Above, Lawrence Wallack, Georges Benjamin and James Galloway help close the 2011 APHA Midyear Meeting. Photo by Michele Late

The art of public health storytelling

Rise and shine! How about some speed dating to start off our final day in Chicago? In one of this morning’s APHA Midyear Meeting breakouts, Engaging Policy-makers and Other Leaders: How Public Employees Can Advocate Effectively for Public Health and Prevention, we were asked to turn to our neighbors and share stories about the work we are involved with back home. We were instructed to use words such as “children,” “health” and “local” to better connect rather than use professional jargon. In other words, use ‘people-speak’ not ‘brand-speak.’

Guided by Senior Vice President for Public Health at Burness Communications Chuck Alexander, our little get-to-know-you exercise was really a lesson in the art of storytelling.

Elizabeth Wenk, also of Burness Communications, underscored the importance in storytelling particularly when backing up your message on Capitol Hill.

“Policy-makers really care about how an issue is impacting their constituents. The more we can push stories is how we’ll make improvements in prevention and public health,” said Wenk.

“Our parents didn’t put us to bed at night reading a Census book,” she said.

Wenk reasoned that a personal story is just a piece (albeit important) of the full pie. She says the way to really drive home a message is to weave a story through data.

“The more that we can be pushing stories into public health officials’ vernacular, that’s when we’re really going to make a difference,” said Wenk. “It’s knowing your audience. It’s figuring out what is really going to resonate with this audience.”

Hey, that reminds me of a great “storytelling” video that APHA put together. In case you need a little inspiration, give it a look.

Public health in the headlines

A new report APHA released in concert with its Midyear Meeting assessing the state of the public health workforce under health reform caught the attention of reporters yesterday. Check out some of the great coverage.

Associated Press: Many health provisions in Affordable Care Act have not received funding

The Boston Globe: Daily Check Blog

Modern Healthcare: APHA: Lack of funding jeopardizes reform-law goals

The Hill: News bites: public health workers needed

To protect and serve

Friday afternoon's session on Protecting Impacted Public Health Programs at APHA’s 2011 Midyear Meeting was both encouraging and frustrating...which is not surprising. In the field of public health, those two words probably go together just as well as peanut butter and jelly.

When it comes to vaccines, Alexandra Stewart, assistant research professor at the George Washington University School of Public Health and Health Services, said the health reform law could go far in promoting vaccination. For example, health insurance plans offered via the new state health insurance exchanges will be required to cover — with no cost sharing — all vaccines recommended by the national Advisory Committee on Immunization Practices. Also, states that decide to offer such recommended vaccines via their Medicaid programs will be eligible for a boost in federal Medicaid matching funds, Stewart said.

The health reform-related vaccine provisions could help fill woeful (and frankly, short-sighted) state funding gaps. For instance, Stewart noted, Alaska has eliminated funds for adult vaccines; California cut $18 million from its vaccine program; North Carolina withdrew all funding from its universal childhood vaccine program; and in Indiana, county health departments are prohibited from administering government-purchased vaccines to children who have insurance. But with the promise of health reform far from a sure thing, the gains and successes the U.S. has achieved in vaccination rates could be in trouble.

In the field of HIV/AIDS prevention and care, health reform presents the same kind of nervous hope. The law has the potential to reduce barriers to HIV screening, will expand access to health care and treatments, and eliminate discriminatory insurance practices against people living with HIV, said Christopher Brown, assistant commissioner of the STI/HIV Division with the Chicago Department of Public Health. However, health reform should not be viewed as a replacement for the national Ryan White program, which provides assistance to people with HIV who don't have sufficient insurance or financial resources. Ryan White offers a number of needed services that health reform will not, such as medical transportation, emergency financial assistance and housing, psychosocial support and early intervention services, Brown said. Luckily, Brown said he is "seeing support from the highest level of government" that the Ryan White program isn't going away.

Unfortunately, it's unclear what health reform will do for the "silent epidemic" of sexually transmitted diseases, said Gail Bolan, director of CDC's Division of Sexually Transmitted Disease Prevention. Bolan first gave a little background: the annual cost of STDs in the nation is $17 billion (whoa!) and rates of some STDs are actually on the rise, such as chlamydia and syphilis. The provisions of health reform could boost the work against STD infection via expansion of Medicaid eligibility, new technologies and investments in community health centers, which often serve as primary care providers for populations at particular risk for STDs, Bolan said. But having insurance doesn't always mean access and safety net services will still be needed to reach all those at risk, she noted, adding that in 2008–2009, 69 percent of state and local STD programs experienced funding cuts. Bolan called on public health folks to remain committed to assessing the quality and effectiveness of STD programs going forward, Bolan said.

"We have to be able to answer the 'so what' questions," she told session attendees, as in, if this program goes away, then so what?

What do you think, readers? Are you worried that health reform will threaten the survival of important public health programs? Let us know in the comments section!

Affordable Care Act making inroads for Americans with Medicare

Just 15 months after it was enacted, the Affordable Care Act is already improving care for people with Medicare, according to program officials, and that success is expected to continue to grow as additional provisions of the law are implemented.

Speaking at a session at APHA’s 2011 Midyear Meeting in Chicago, Caya Lewis, chief of staff for the Centers for Medicare and Medicaid Services, spotlighted the inroads that the historic health reform law has made so far. Among the accomplishments is that more than 5 million Americans with Medicare — or about 16 percent of beneficiaries — have received free preventive services because of the law. The new interest in the services, which include mammograms, bone density screenings and prostate cancer screenings, has resulted because the cost barriers have been removed, Lewis said.

“We are really working toward getting people to get what they need for chronic conditions,” Lewis said.

In addition, more than 780,000 beneficiaries received an annual wellness visit — another new benefit — between January and June of this year, Lewis noted. To help reach more Medicare recipients with the message about the new benefits, CMS has launched the Share the News, Share the Health campaign with online ads and community events.

The health reform law has also allowed seniors affected by the prescription drug “donut hole” to receive refunds and rebates for payments. By 2020, that entire coverage gap will be closed, thanks to the law, Lewis said.

Other law-related changes that are expected to improve the health of Americans include measures to hold down rate increases by health insurers, state health exchanges that will allow people to have access to affordable insurance and risk assessments in wellness visits.

“We have a lot to look forward to,” Lewis said. “There’s a lot of work ahead.”

Above, Caya Lewis, left, of CMS speaks with APHA Midyear Meeting attendees following a session on improving the quality, safety and value in the health system. Photo by Michele Late

A time to retool

Can guess how many state and local public health jobs were lost in just one year?

If you wagered 43,000, you were (unfortunately) right. It’s a dramatic hit that has reverberated in states across the country. Some 89 percent of state health departments across the country have lost staff within the past year.

And the sobering reality is that the public health workforce will shoulder the brunt of federal budget cuts in years to come.

“The public health workforce is fundamentally changing. The workforce of the future is going to be dramatically different from today,” said Paul Jarris, executive director of the Association of State and Territorial Health Officials, during a session at the 2011 APHA Midyear Meeting. “We’re moving way beyond the talk of doing more with less.”

So, it begs the question: what exactly is the less we are doing? What will the limited funding allow us to do?

Jarris explained that the “future” workforce will be called upon to integrate clinical medicine more than ever before to ensure people are safer and healthier in the system (not to mention to ensure that everyone has access in the first place).

Cynthia Lamberth of the University of Kentucky College of Public Health echoed the same sentiments, saying that by virtue of the Affordable Care Act, we have a tremendous opportunity to retool our workforce and do more work at the intersection of public health and health care.

“There is increased demand for services not only on preventive care but particularly on prevention in general,” said Lamberth. “This is not a time to be waiting and see what happens with the Affordable Care Act. We all need to be involved and determine where we fit into this picture. This is a time for reinvention for what we do to serve our communities.”

Lamberth says some of that reinvention could translate into an enhanced focus on school-based health centers, community transformation grants, maternal and child health visitation programs, healthy living and aging well.

So, while there’s a lot of talk about the doom and gloom around workforce losses, why not also pepper the conversation with some of the exciting opportunities to advance our trade in a new direction that lie ahead?

Tweet of the day

We’ve been asking tweeps to include #APHAMid11 as they live tweet sessions here in Chicago. So, today’s tweet comes to us from @jessicakeralis:

"We can't 'wait and see' - we need to start planning NOW." Interesting session on developing the public health workforce at #APHAMid11

We thought it was a valuable (and timely!) session, too. Keep on chirping, folks. Maybe we’ll highlight your rock-star tweet here tomorrow.

Props to our partners!

We offer a special shout out and sincere thanks to our grantors, sponsors, donors and partners for their generous support of the APHA Midyear Meeting. As we’ve heard throughout this meeting, the success of health reform — indeed of public health — relies on such collaboration and innovation. We appreciate your support!