http://nwhf.org/conversation/ en info@communityhealthpriorities.org Copyright 2012 2012-02-07T18:55:11+00:00 http://nwhf.org/conversation/comments/hunger-obesity/ http://nwhf.org/conversation/comments/hunger-obesity/ “People are fed by the food industry, which pays no attention to health, and are treated by the health industry, which pays no attention to food.” - Wendell Berry This January, Laurie Trieger, executive director of the Lane Coalition for Healthy Active Youth (LCHAY) and I hosted a session at the 2012 Food Security Summit in Corvallis exploring the root causes of hunger and obesity. Obesity and hunger are very much linked and we hope to eventually be able to identify key policy priorities that could begin to address these root causes. I believe this discussion needs to start with the acknowledgement that, like hunger, obesity is a symptom of a deeply flawed economic structure that favors profits over health. The industrialized food production and food distribution system is responsive to economic goals and completely ignores the health or environmental needs of the community. This is why we have concentrated animal feeding operations where thousands of pigs and chickens can live in crammed conditions and are pumped with antibiotics to avoid mass infections.  The drive to make money is also the reason the food industry has spent billions of dollars in advertising fast foods, sugary drinks, salty and greasy snacks, and thousands of other edible products.  And by the way, advertising dollars has moved well beyond traditional media; the food industry is investing larger portions of their budgets in digital marketing to kids using Facebook, Twitter, and web-based video games that require the user to give personal information and buy their products.  These techniques are based on brain research intended to understand the causes such mental health problems as ADD/ADHD, depression and schizophrenia. They are exploiting children’s underdeveloped brains to sell their products. The food industry has made plenty of calories available because the price of food industrially processed food is economically efficient to produce.  Unfortunately, those calories lack any real nutritional value.  While there’s protein and other nutrients in a Big Mac, there’s also so much fat and sodium that, on balance, the nutritional benefit is less than the harm from eating it. Scientists like Kent Thornburg at OHSU are finding that in fact our society is experiencing “high calorie malnutrition.”  The result is a dual crisis of obesity and malnutrition. Hunger in America indeed looks very different from hunger in places like Ethiopia. Hunger in America is not necessarily about not having enough to eat (though that also takes place, particularly in these hard economic times, with many parents skipping meals to feed their children).  But hunger in America is more about quality than quantity.  So my question for policy makers and advocates is this: What is the single, most important thing we can do to tackle the dual crisis of hunger and obesity? Disparities, Economic Issues, Food & Nutrition, Public Health 2012-02-07T18:55:11+00:00 http://nwhf.org/conversation/comments/February/ http://nwhf.org/conversation/comments/February/ This February, during African American History Month, I wonder what non-African Americans (98% of Oregon and 96% of Portland) will reflect on and do as part of this recognition.  At a time when there is still much intolerance, I am now hearing from more people who want to promote better conversations about our increasingly multicultural society.  What do we value?  Where do we point when we want examples of an equitable society? What does it look like when we get to equity? When I think of the non-profit world in which I live, I see an opportunity and a responsibility to do much more to create an equitable society. But we need to do so with intention and clarity of purpose. I don’t ever recall a time in my 40-year career, when conversations about equity, inclusion and social justice in our society, jobs and schools, were as active as they are today. I take this as an opportunity; we should take advantage of this readiness. Looking into my own heart, I have come to think of equity in our society as having three major components: - Gender - Race - Generation Equity is about gender balance on our boards and among our staff.  As with the other components, groups that bring gender balance to their boards and staff are more efficient, more thoughtful, and more responsive to the communities they serve and less biased in their decision making. With regard to race and ethnic background, equity is about intentionally embracing the differences that add value to the whole. It is so important to distinguish this from the melting pot mentality of assimilation. Assimilation is a real loss to everyone if we don’t find ways to encourage and embrace the different cultural contributions to our society. Stereotypes – both negative and positive – are destructive to our larger society. We all know that any assumptions about any ethnic group as being “uneducated” or “poor” are harmful to our larger common good. But we also must not continually point to those who “broke out of poverty” as great exceptions. This too is one of the most destructive perspectives that many white people bring to the table. It is this majority viewpoint that keeps reinforcing the institutional racism that prevents achievement by many more persons of color.  Rather, we need to challenge ourselves as to why we have not created the supports of our privilege to make the path to success achievable by all people.  When Arthur Ashe said “Racism is not an excuse to not do the best you can,” he was referring to his own race. But it works the other way around: But being raised with privilege is not an excuse to ignore the needs of others. When I say that equity is about generation, I’m not talking about our elders, who actually represent a less diverse and wealthier proportion of our overall population. I’m talking about our younger generation, which is a much more culturally diverse demographic than the larger American population.  We need to erase the idea that the “baby boomers” are our most capable leaders and the holders of the correct way to do things. The newer generation has heard us say “the world we give you is not your fault, but it’s your problem.”  The boomers need to get out of the way and let the next generation of leaders step up and take over. For one thing, the next generation of leaders does not want to lead in the way the boomers have.  Research conducted by Pew Research Center among others, shows that the “millennial” generation values work-life balance, volunteerism for the common good, and living within their needs, to a much larger degree than the boomers. Wealth accumulation while crushing others is not part of their game plan. So, this February, as I honor African American History Month, I do so through my universal lens of equity. In fact, many of these thoughts are influenced by the “Universal Declaration of Human Rights,” which was largely authored by Eleanor Roosevelt.  I have this small booklet right next to my computer, and I think it will be one of the most important gifts I will give to my successor when I retire in June. Disparities, Public Health, Urban Issues 2012-02-01T21:52:30+00:00 http://nwhf.org/conversation/comments/pov/ http://nwhf.org/conversation/comments/pov/ Northwest Health Foundation is pleased to launch “Points of View,” an occasional series of communications around important topics that extend across all of our work. The first edition of Points of View focuses on the efforts of the foundation and its partners to achieve health equity in the regions we serve. One of the foundation’s guiding principles is that “Deliberate strategies are required in order to effectively overcome health inequities.” Embedded in this principle is the point of view that equity will not happen on its own. A “rising tides lifts all boats” approach simply will not work. In order to overcome inequities, we need to intentionally examine systemic policies and practices that still exist and serve to marginalize some and perpetuate disparities. “Perspectives on Equity” can be seen here. It features three short videos, as well as additional context and resources around each video. In addition, because many of our partners have been asking for information about how we talk about this issue, we have included talking points on the subject. Not everyone agrees with this point of view, though. Some suggest inequities will solve themselves, or that it’s inappropriate or even “racist” to try to correct social injustices. What’s your view? Disparities, Economic Issues, Policies & Laws 2012-01-23T18:45:14+00:00 http://nwhf.org/conversation/comments/cco/ http://nwhf.org/conversation/comments/cco/ Next month (February 2012), the Oregon version of health care reform, the coordinated care organization (CCO), will be acted on by our Legislature.  They are now waiting for the report and recommendations from the Health Policy Board in response to the direction SB 3650.  I have attended the conversations about CCO’s for the past several months and here are my thoughts: First, the idea of creating a health care system is remarkable in its vision.  I say BRAVO to the forward thinking legislators. Right now we do not have an American health care system, but rather a collection of independent fiefdoms.  It’s important to understand that our first efforts will not get it right, but the efforts are critical first steps. If we acknowledge that, and do not think that the effort is a failure when we uncover the inevitable problems, we will be successful in the longer term. If we are committed to the “triple aim” of cost, access, quality, and committed to work with patients and providers, we will evolve into a system that actually can improve our world ranking of a healthy population and be cost effective. Second, the health policy board received a great deal of good information from providers and consumers about what the new CCO’s should include.  The important test is whether the legislature has the ability to work with these recommendations to advance the interests of all people or default to rewarding the few power players.  Can the legislature support the work of the Health Policy Board and really listen to and act on their recommendations? Third, there is some question whether we should have one CCO in a region or several to promote competition.  It seems to me that the fewer CCOs the better. We know that shifting from one insurance carrier to another, by insureds or practitioners, produces redundant administration that can run up the cost of health care by as much as 30% without providing any additional direct services. Fourth, governance is the most critical factor in the success of CCOs. While some feel that only providers should be part of the governance board, these boards must be made up of providers, local public health, local elected officials and consumers. I recommended a 40-20-20-20 percent allocation. Fifth, there is a risk that CCOs will get contracts to provide coverage, but fail to provide timely access.  It should not be acceptable for patients to wait 6 weeks for appointments or to drive 60 miles to see a provider in another city.  Monitoring timely and meaningful access should be part of the legislative requirements. Sixth, culturally adequate care cannot be compromised.  CCO’s need to have the expectations laid out for equity, and systems in place for helping them achieve culturally adequate care as well as documenting equity from the patient’s perspective. Seventh, the selection process of CCOs should be spelled out.  The Oregon Health Authority should create a review group with the same make-up as the recommended governance board to select the CCOs for certification. Eighth, we need to see the allocation to CCOs as a fixed pot of money and that the providers in this system should be paid fairly for their services, but be paid by salary rather than fee for service. Within this salary structure, primary care providers should be recognized as the important role of keeping people healthy and if there is to be cost savings in this system, it will be because of their effectiveness.  It is important to reduce the competitiveness for dollars we see in the fee for service system. Finally, one issue that has been largely avoided thus far is the need for the full range of health services to include women’s health.  While the issue was raised at the CCO workgroup meetings, there was no further acknowledgment of it. Women’s health services, especially reproductive health, should not be systematically denied by providers.  It is essential that we have create an explicit understanding of the women’s health services that our CCOs are expected to provide.  We are on the brink of a remarkable opportunity to affect the health of our generation and those that follow us.  If we are willing to keep our focus on that which brings health to all Oregonians, we will have made a great achievement.  I hope the legislators will step up to do their part. ————————- Thomas Aschenbrener, NWHF President, serves on Oregon’s Governor-appointed CCO Criteria Work Group. Disparities, Economic Issues, Policies & Laws, Public Health 2012-01-23T18:32:59+00:00 http://nwhf.org/conversation/comments/kids/ http://nwhf.org/conversation/comments/kids/ Increasing concerns about chronic diseases such as diabetes and risk factors such as obesity have forced society to take a critical look at how the food industry –  specifically manufacturers of processed foods – markets its products to consumers.  Children and adolescents are specific demographics targeted by advertisers as their purchasing influence nears $1 trillion per year. As the pie continues to grow, marketers are targeting teenagers through digital media that are based on the latest cognitive science and mental illness research.  Federal regulations (e.g. Children’s Online Privacy Protection Act) and voluntary guidelines may provide some protection for children 12 and under. However, as the important report “Marketing food to Children and Adolescents” writes, those 13 and older are “treated as if they were adults online, fair game for all manner of targeting, data collection and interactive marketing applications.”  The report also highlights research on brain development which shows that the teenage brain lacks the necessary maturity to control some urges.  These factors (a growing, profitable market niche; a regulatory gap and susceptibility by teenagers) give rise to concerns about the fairness of online marketing practices.  Moreover, these practices raise questions as to their legality under the Oregon Unlawful Trade Practices Act, which prohibits “knowingly taking advantage of a customer’s physical infirmity, ignorance, illiteracy or inability to understand the language of the agreement.”  (Ore. Rev. Stat. § 646.605(9)).  Does a technique that is “purposefully designed to tap into unconscious processes, thus bypassing the rational decision making” violate the UTPA if an adolescent does not have the physical and mental capacity to control certain inhibitions and make rational decisions? I would be very interested in hearing what you think. —————————— Alejandro Queral , MS, JD, is a program officer at Northwest Health Foundation. He works in the area of public health, including public health infrastructure, and improving population health by addressing the social determinants of health. Policies & Laws, Food & Nutrition 2012-01-23T15:59:14+00:00 http://nwhf.org/conversation/comments/about_the_conversation_the_nwhf_blog/ http://nwhf.org/conversation/comments/about_the_conversation_the_nwhf_blog/ The Conversation is the connection between Northwest Health Foundation and our community. Check in here to learn more about our work, and share your own views. You can add your comments to the entries posted, or to post a blog entry of your own. Posts prior to 2012 were written for a NWHF project called “Community Health Priorities.” 2012-01-12T01:57:51+00:00 http://nwhf.org/conversation/comments/poll_community_health_priority/ http://nwhf.org/conversation/comments/poll_community_health_priority/ This is post we created back in 2008. Since that time it received over 100 responses. Click through them to see what our grantees, partners, and colleagues said when we asked: What’s your community health priority? We know it’s hard, but if you had to choose just one issue to get additional funding, which would it be? The bottom line is that we’re trying to determine where you feel the greatest needs are right now. What is the most important public health issue in your community?  (  polls) Polls 2012-01-01T11:43:39+00:00 http://nwhf.org/conversation/comments/doctors/ http://nwhf.org/conversation/comments/doctors/ A recent survey of doctors finds that they are well-aware of the impact of social needs on their patients’ health.  The survey of 1,000 primary care physicians and pediatricians was conducted by Harris Interactive on behalf of the Robert Wood Johnson Foundation. More than 4 in 5 of the surveyed doctors agree that unmet social needs are directly leading to worse health and that patients’ social needs are as important to address as their medical conditions. However, 80% of these doctors are not confident in their capacity to address their patients’ social needs, which impedes their ability to provide quality care.  Physicians wish they could write prescriptions for health-promoting services such as fitness programs, nutritious food, and transportation assistance. Based on these data, the Robert Wood Johnson Foundation published Health Care’s Blind Side:  The Overlooked Connection Between Social Needs and Good Health.  This report concludes with three strong recommendations: Recognize that social needs are connected to Americans’ health. Equip physicians and other health care practitioners with the resources they need to make patients healthy. Rethink the health care system to address unmet social needs. More good discussion of these issues can be found in this blog post by Dr. Douglas Jutte, a professor at University of California Berkeley’s School of Public Health.  He recounts the story of a patient whose, “long-term health and well being…hinged not on the quality of my medical care but on a taxi voucher and a broken carburetor.”  He also has a number of recommendations, such as reimbursing providers for these non-medical interventions that improve health and more appropriate training of doctors in medical schools. As Dr. Jutte points out, some people are surprised by the survey results showing doctors’ awareness of the importance of social factors in health.  The survey shows that doctors are concerned about social factors, now we need the systems around them to support their efforts to improve their patients’ health.   Policies & Laws, Food & Nutrition, Polls, Public Health, Transportation 2011-12-12T23:19:07+00:00 http://nwhf.org/conversation/comments/ota/ http://nwhf.org/conversation/comments/ota/ The following is a report from Lisa Arkin, Executive Director, Oregon Toxics Alliance, about a small community engagement grant received in 2011: Oregon Toxics Alliance, based in Eugene, is educating thousands of Oregonians by way of a film & community forum series, Living Downstream–Conversations on the Science of Pollution and Health.  The topic of these conversations is about the vital link between the health of our bodies and the health of our air, land and water.  Our goal is to raise awareness, stimulate conversations, and move Oregonians to action to support toxics use reduction policies.  This project highlights the film by biologist and author Sandra Steingraber, and engages people in civic engagement around environmental health priorities.  We showed the film in many small communities – from Selma in Josephine County to Deadwood in Oregon’s West Coast Range.  Reaching over 600 people, a number of folks were inspried to share their personal narrative of an unwanted chemical exposure.  We launched a new website, http://www.SafePublicPlaces, to create a central place to learn and get involved in environmental health projects that focus on pesticide reduction. Take a look; you can read some selected narratives. Sparking conversations on science, we published our report Assessing Environmental Impact Quotients for Pesticide Use on State Highways in Lane County. This quantitative analysis of the ubiquitous use of pesticides on state highways was inspired by the frequent complaints we receive about ODOT’s policy.  A growing number of rural communities are taking action to manage their local highways pesticide free!  There are wonderful examples in Lane, Lincoln and Josephine counties. Neighborhoods are also taking action by working with OTA to issue photographic essays and put pressure on municipalities to eschew pesticide use in public places – for example, three neighborhood organizations joined together to complain about overuses of pesticides on public golf courses that in Eugene.  Our research is being used to support a safer local and state chemical policy, one that is truly based on environmental justice and health. Next steps in the project will bring us back before the Oregon Transportation Commission in early 2012 to discuss the recommendations in our aforementioned report.  ODOT Director Garrett is suggesting that the OTC hold a Pesticide Workshop to explore the issue and the alternatives, and evaluate ODOT’s progress to reduce pesticide loading in the environment. We are also working with state legislators to bring the issue before the appropriate committees in order to schedule work sessions.  Our grassroots organizing continues apace, including the broadening our coalition of organic growers and distributors and strengthening the highly effective Oregon Pesticide Action Workgroup (OPAWG).  OPAWG meets monthly to discuss the science of pesticide reduction and take action on the most pressing issues.  You can attend meetings in our office or by teleconference – for more information, get in touch with me.  OPAWG promotes many projects including local efforts like Williams Mow Day and the Triangle Lake No Spray Work Party.  Our next big event is planned for 2013, when we will host the Oregon Hearings on Pesticide Exposure (O-HOPE), the first event of its kind in North America. The objective of O-HOPE is to provide a forum for sharing pesticide exposure narratives, report on the enormity of the problem, and to provide solutions and alternatives to decision-makers with the goal of enacting lasting policy change. Please contact us if you would like to partner to bring your community together through film showings and community forums in your town. Environmental Health, Disparities, Grantee Reports, Public Health 2011-11-01T19:10:39+00:00 http://nwhf.org/conversation/comments/Medicare/ http://nwhf.org/conversation/comments/Medicare/ Oregon’s U.S. Senator Ron Wyden and Wisconsin Representative Paul Ryan have released a new plan to reform Medicare.  Starting in ten years, seniors would have the option of staying in traditional Medicare or entering a privately-run healthcare plan.  These private Medicare plans would be required to offer benefits that are at least as comprehensive as those covered by traditional Medicare.  In addition, all seniors would have a new “catastrophic cap” on out-of-pocket health expenses.  Currently, there is no such cap for Medicare participants. Starting in 2023, government funding for Medicare would be capped.  Congress would be required to address any budget shortfalls and could institute means-tested premiums and lower fees for providers and drug companies.  The reform plan has many similarities to the plan Rep. Ryan released earlier this year, including the use of “vouchers” or “premium supports” to allow seniors to access privately-run plans.  One of the biggest differences in the new Wyden-Ryan plan is the option for seniors to remain in traditional Medicare. “I will never do anything to shred that or weaken it or harm [Medicare] in any way,” Senator Wyden said in an interview with Politico.  “I simply believe that there is now an opportunity for progressives and conservatives to come together and to strengthen the program for the long term and particularly, deal with the costs and demographic challenges.” Both Sen. Wyden and Rep. Ryan understand the political nature of any reform plan.  Their op-ed in the Wall Street Journal today begins:  “Few issues draw more heated partisan rhetoric than the future of Medicare. Seniors are a reliable and powerful voting bloc, and both Republicans and Democrats are guilty of exploiting Medicare to frighten and entice voters.” Politico’s daily update on health issues indicated the significance of Wyden’s and Ryan’s partnership with, “We’re pretty sure the health policy world will be buzzing about this one today. As one congressional aide put it to us in an email today: ‘Whoa.’”  Major newspapers across the country are reporting on these developments, including the New York Times, Washington Post, and Bloomberg news service. Policies & Laws, Public Health 2011-11-01T16:17:00+00:00