Building an integrated health team and a vision of health care reform
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National Public Health Week University of Tennessee. Building an Integrated Health Team and a Vision of Health Care Reform. Marguerite Pappaioanou, DVM, MPVM, PhD Executive Director Association of American Veterinary Medical Colleges. The Spectrum of Health Care. Prevention Public Health.

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Building an integrated health team and a vision of health care reform

National Public Health Week

University of Tennessee

Building an Integrated Health Team and a Vision of Health Care Reform

Marguerite Pappaioanou, DVM, MPVM, PhD

Executive Director

Association of American Veterinary Medical Colleges


The spectrum of health care

The Spectrum of Health Care

Prevention

Public Health

Treatment/Cure

Medical Care/ Service Delivery


Health care costs us

Health Care Costs - US

  • Health spending nationally exceeded $2 trillion in 2006, representing 16% of the GDP.

  • About half of spending growth due to medical price inflation -- the rising cost of providing existing services to patients. A far smaller portion is due to aging.

  • Nearly one in five out-of-pocket dollars is spent on prescription drugs.

CA Health Care Fndn


Building an integrated health team and a vision of health care reform

$3.6 trillion total for FY10


Global map of life expectancy

Global Map of Life Expectancy

Source: Wikipedia


Health outcomes

Health Outcomes

  • Infant mortality rate for African-Americans is 2.5 times higher than for Whites

  • Overall mortality is 30% higher for Black Americans compared to white Americans

  • Life expectancy is 5 years shorter for African-Americans compared to white Americans

  • African-American women > 2X as likely to die from cervical cancer as white women


Why health care reform

Why Health Care Reform?

  • Access to care varies by

    • Income

    • Insurance

    • Race/ethinicity

    • Location– urban vs rural

  • Quality of care varies by race/ethnicity

  • Costs of health care rising greater than the rate of inflation

  • Emphasis continues to be on cure rather than prevention


  • Health issues for our nation

    Health Issues for our Nation

    • Obesity – Nutrition, Physical Exercise

      • Heart and cardiovascular disease

      • Diabetes

      • Cancer

    • Injuries

    • Food safety – foodborne outbreaks

    • Mental health

    • Occupational safety

    • Influenza, vaccine preventable diseases

    • Disabilities

    • Emerging zoonotic diseases

    • Antibiotic resistance


    Hhs in the 21 st century the nation s top health challenges

    HHS in the 21st CenturyThe Nation’s Top Health Challenges

    • The rising prevalence of costly chronic diseases

    • Developing prevention and treatment methods for diseases that currently lack them

    • Persistent poverty (affecting > 37 million Americans,2007)

    • Global threats to health (including pandemics, emerging infections, bioterrorism, natural disasters, and climate change

    • Workforce shortages

    • The crumbling public health infrastructure

    • Social, environment, and behavioral factors affecting health

    • Health disparities and the needs of vulnerable populations


    Prevention better than cure

    PreventionBetter than cure


    Public health

    Public Health

    “ is what we, as a society, do collectively to assure the conditions in which people can be healthy.”

    Institute of Medicine, The Future of Public Health, 1988


    Prevention

    Prevention

    • Individual actions (diet, exercise, vaccinations, smoking cessation, screening, regular checkups, etc.)

    • Population – based actions to maximize individual actions collectively!


    Guide to community preventive services

    Guide toCommunity Preventive Services

    • Synthesis of evidence on the effectiveness of population based interventions

      • Mass media campaigns, laws, fluoride in drinking water, reminder notices for immunizations

      • Different exposures, outcomes, study designs

    • Recommendations to state health departments on most effective interventions


    Links between human and animal health and the environment

    Links Between Human and Animal Health and the Environment

    The Human-Animal Bond


    Building an integrated health team and a vision of health care reform

    One Health

    One Medicine

    Translocation

    Encroachment

    Introduction

    “Spill over” &

    “Spill back”

    Human encroachment

    Ex situ contact

    Ecological manipulation

    Human behaviors

    Wildlife

    Domestic

    Animal

    Human

    Global travel

    Urbanization

    Biomedical

    manipulation

    Agricultural

    Extensive Production

    Food processing/distribution

    Technology and

    Industry

    After Daszak P. et.al.

    Science 2000 287:443


    Infectious organisms pathogenic to humans and percent zoonotic

    Infectious Organisms Pathogenic to Humans and Percent Zoonotic

    217

    538

    307

    65

    287

    1415

    132

    Source, Taylor LH et al. 2001; Phil. Trans. R. Soc. Lond. B.Vol. 356:983-989


    Links between human and animal health

    Links Between Human and Animal Health

    Emergency

    Response

    Emerging

    Diseases

    Antibiotic

    Resistance

    Foodborne

    Disease

    Bio- Agro-

    Terrorism

    Improved Human

    Health & Well Being

    Disability

    Environmental

    Health

    Mental Health

    Injuries

    Occupational

    Health


    Our food

    Our Food

    • What people want

      • Quantity

      • Quality

      • Safety

      • Cost/Affordability

    • Issues

      • Globalization

      • Intensification

      • Animal welfare

      • Animal husbandry, food system, feed

      • Use of antibiotics, antibiotic resistance


    Human diseases and injuries with serious health consequences acquired from dogs and cats

    Human Diseases and Injuries with Serious Health Consequences Acquired fromDogs and Cats

    • Dog bite injuries

    • Cat scratch disease

    • Toxocaral Larva Migrans

    • Congenital toxoplasmosis


    Building an integrated health team and a vision of health care reform

    Focus of veterinarian’s attention

    X

    X


    Veterinarians opportunities for prevention to improve human health

    Veterinarians-- Opportunities for Prevention to Improve Human Health

    • Food safety

    • Vaccination programs (Rabies, Avian Influenza)

    • Screening, counseling

    • Counseling, health education by veterinarians

      • Obesity, diabetes, zoonotic diseases, injuries – dog bite injuries, falls

    • Occupational safety

    • Keeping companion animals healthy (mental health)

    • Evacuation


    Veterinarian s on the front line can prevent this from happening

    Veterinarian’s on the Front Line Can Prevent This from Happening


    Dog bite injuries

    Dog Bite Injuries

    • Estimated 4.7 million bites per year

    • 800,000 require medical care

      • 446,000 non-emergency care visits

      • 321,000 emergency room visits

      • 13,000 hospitalizations

      • 20 fatalities

    • > $250 million per year


    86 000 falls each year associate with pets and pet toys

    86,000 falls each year associate with pets and pet toys

    Watch Out! Pet Falls Hurt 86K Per Year

    Government Advises Better Lighting, Throwing Pet Toys Away

    “Watch out for Fluffy and Fido! Cats and dogs are a factor in more than 86,000 serious falls each year, according to the first government study of pet-related tumbles.”

    KHOU.com;

    Source of data- CDC


    One health

    One-Health

    “One Health is the collaborative effort of multiple disciplines – working locally, nationally, and globally – to attain optimal health for people, animals, and our environment.”


    Putting one health into action

    Putting One Health Into Action

    General

    Academic Settings

    Outreach, community service, policy

    Teaching

    Research

    • Multidisciplinary practice, programs on the ground

    • Educating, training students, practitioners of multiple disciplines, policymakers

    • Developing one health policies

    • Multi-disciplinary integrated research (e.g., NIH Clinical Translational Research Centers)


    Rural communities

    Rural Communities

    • Health care providers scarce to non-existent

    • People in close contact with livestock, poultry, companion animals

    • Intersection of environmental, human, animal health


    The integrated health team protecting and promoting health

    The Integrated Health Team Protecting and Promoting Health

    • Physicians

    • Physician assistants

    • Nurses

    • Dentists

    • Optometrists

    • Veterinarians

    • Veterinary technicians

    • Other


    Public health workforce

    Nurses

    Physicians

    Veterinarians

    Dentists

    PhDs

    Public health advisors

    MPHs

    Sanitary Engineers

    Industrial Hygienists

    Environmental Specialists

    Epidemiologists

    Laboratory Scientists

    Social Workers

    Health Educators

    Statisticians

    Information Technology Specialists

    Entomologists

    Lawyers

    Other

    Public Health Workforce


    U s veterinarians in public health

    U.S. Veterinarians in Public Health

    • Private practitioners

    • Local/County Health Departments

    • State Health Departments

    • Federal Government

      • DHHS: CDC, FDA, NIH

      • USDA: APHIS and FSIS

      • EPA

      • DoD

    • Colleges of Veterinary Medicine, Medicine, Schools of Public Health

    • Industry/Drug Companies (Human/Animal)

    • NGOs


    The veterinary oath

    The Veterinary Oath

    “…. I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of livestock resources,the promotion of public healthand the advancement of medical knowledge.”


    Federation of associations of schools of the health professions

    Federation of Associations of Schools of the Health Professions

    • Addresses education’s role in organizational matters of health care

    • Encourages effective collaboration among the health professions in education and practice and

    • Prepares health professionals for the future


    Fashp organizations

    FASHP Organizations

    • Seek to support efforts that ensure coverage of and access to safe, high-quality, cost-effective preventive services and care for patients

    • Congress must pay close attention to the professional health care workforce and role of education in providing the workforce

    • Shortage of qualified health care professionals


    Fashp team based patient centered care principles for health care reform

    FASHP Team-based, patient centered care, principles for health care reform--

    • Suggest reforms that will create a health care system that increases access to high-quality, cost-effective, patient centered care that is available to all

    • A high quality health care system should emphasize wellness and preventive care

    • Must have a well-educated and trained health professions workforce of all FASHP represented providers

    • Investment must be made to expand faculty rosters to train health professionals of tomorrow

    • Composition of the health care workforce should reflect the country’s population


    Challenges to achieving an integrated health team

    Challenges to Achieving an Integrated Health Team

    • Different numbers (2-3 M nurses, 800 K physicians, 80 k veterinarians)

    • Different cultures, vocabulary, missions

    • Understanding of educational pathways

    • Respect and appreciation, attitudes

    • Inequitable pay, benefits

    • Protocols for communication, mechanisms


    Training education

    Training/Education

    • Train health professionals together to aid in their understanding of

      • What each profession brings to the table

      • How to work together

    • Household and community needs, dynamics, rural living, culture

    • Develop and evaluate models (try this out!)


    Summary

    Summary

    • There is a huge need for US health reform

    • Prevention must be included in health reform and assigned a high priority

    • The public will benefit from a one-health approach and a truly integrated health team with a full spectrum of health professionals

    • Veterinary medicine is an important member of the health team

    • Workforce shortages in numbers and in geographic location exist for most if not all health professions


    A strong future for one health

    A Strong Future for One Health

    • Changing climates and ecosystems, with increasing vector populations

    • Encroachment on animal habitat

    • Changing human lifestyles with animals

      • Human behaviors

    • Globalization of the food supply; threat of agro-terrorism

    • More and faster global travel

    • Civil unrest/war – displaced people and animals

    • Microbial adaptation and change (Influenza!)

    • >80% of bio-threat agents of concern are zoonotic

    • Growing awareness of value and benefit to One Health by different health professions


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