Transcript 0412ACADEMYHARRIS (No Slide Title)

Creating and Sustaining
Policy Change
December 1, 2004
Virginia Bales Harris, M.P.H., B.A.
Director, Division of Adult and Community Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Health and Human Services
Policy Interventions
• What are policy, system, and
environmental interventions?
• What leads the public health
community to use these tools?
• Why should we apply these tools to
prevent chronic disease?
• What does it take to create and sustain
policy change?
Policy Change …
• Impacts the population, not just
individuals
• Involves a variety of organizations and
diverse populations
Policy Change …
• Public policy can be federal, state, and
local
• Organizational policy includes formal
rules or regulations in specific settings
• System and environmental
interventions change economic, social
and physical environment
Policy Change
Laws, regulations, formal and informal
rules that are adopted on a collective
basis to guide individual and collective
behavior.
Examples…
• Gas tax to build interstate highways
• Interest deduction to increase home
ownership
• School lunch programs
System and Environmental Change
The physical, biologic, and social
factors that act upon an individual or
community and determine its form and
survival.
Examples…
• Increased driver safety by improved
road design
• Increased pedestrian safety by using
traffic slowing measures
• Increased cancer screening by adding
mammography coverage to state
employees insurance
What leads the public health
community to use these tools?
… Infectious Diseases
• Water potability
• Vaccination requirements for school
• Food safety inspections
… Supplements
• Rickets: vitamin D fortification of milk
• Pellagra: niacin fortification of flour
• Neural tube defects: folic acid
fortification of flour
• Dental caries: water fluoridation
• Goiter: iodine in salt
… Injuries
• Federal requirements to provide padded
dashboards and steering columns;
shatter-proof windshields; and
seatbelts
• Motorcycle and bicycle helmets
• Occupational safety laws
…Tobacco
• Eliminating tobacco in soldiers’ rations
• Removing the subsidies for tobacco
products from the commissary and the
PX
• Workplace smoking changes
• Community smoking ordinances
Chronic Disease Prevention
Why should we apply Policy, System
and Environmental Interventions to
prevent Chronic Diseases?
Number of People with Multiple Chronic
Conditions will Increase by 1/3 in 20 Years
90
80
70
60
81
million
50
40
30
20
60
million
10
0
2000
Source: Partnership for Solutions, 2003
2020
75% of all Health Care Spending Involved
People with Chronic Conditions in 1998
58%
Uninsured
Privately
Insured
68%
Medicaid
77%
96%
Medicare
0
10
20
30
40
50
60
70
80
90
100
Percentage of Spending on People with Chronic Conditions
Source: Medical Expenditure Panel Survey, 1998 and Partnership for Solutions
What Works?
Chronic Disease Prevention
We know from long experience that
personal behavior change is best
achieved if reinforced, stimulated,
rewarded, and supported.
– Individual
– Interpersonal (family, friends, and networks)
– Organizational policies and procedures
– Community environment and systems
– Public Policy and legislation
Public Health Successes in Behavior Change
(Examples)
• Tobacco Use Reductions Through Public
Education and Policy Change
• Physical Activity Through School Health
• VERB (CDC Youth Media Campaign)
Governors Can
• Be a role model
• Host awareness campaigns
• Provide recognition
• Review your state’s public health code
Policymakers Can Be …
• Champions and supporters
• Movers and shakers
• Curve-setters
• Proactive in establishing laws and policies
Executive, Legislative and Business
Partnerships Can …
• Work with major insurers
• Promote reimbursement for
preventive services
• Recognize businesses and
workplaces for successes
Health Care Settings Can…
• Implement clinician reminder systems
• Adhere to the Chronic Care Model
• Provide non-physician counseling on risk
and lifestyle behavior change
• Implement ongoing innovation to respond
to emergencies like strokes
Businesses Can…
• Create spaces and time for physical activity
• Provide nutrition and weight control classes
• Negotiate a health benefits plans that
reimburses for preventive services & drug
coverage for chronic disease
• Assure detection and follow-up services with
employees
Schools Can…
• Adopt daily physical education classes
• Provide healthy foods in school cafeterias
• Prohibit smoking on school property
• Provide training and support to employees
and surrounding community
Communities Can…
• Organize screening services
• Become an advocate for a health lifestyle
• Promote healthy lifestyles through walking
clubs, support groups, and educational
classes
Are you the group to do this?
Next Steps…