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Let’s Recreate a Sense of Community to Tackle Healthcare Challenges! FLORIDA ON THE MOVE!! September 30, 2005 Marcia L. Comstock, MD MPH Wye River Group on Healthcare
Today’s Agenda • What we’ve learned from our community leadership initiative • 6 ‘truths’ about tackling healthcare challenges • How they apply to community activism
WRGH A NFP health policy catalyst to: • Raise public awareness of health system challenges and the need for engagement • Raise stakeholders' awareness of others' perspectives in order to advance constructive change • Raise public policymakers' awareness of areas where there is a making of a consensus among stakeholders • Promote visionary leadership in public and private sectors
6 ‘Truths’ about Tackling Healthcare Challenges 1. We need a common vision for health & healthcare 2. Government will not fix our healthcare problems 3. Communities are the logical place for initiating change 4. The challenges are too great for the industry alone 5. We need to think HEALTH--not healthcare 6. Our health & healthcare are too important to leave to others
“Communities Shaping a Vision…..” • Hundreds of leaders in a dozen communities • Physician, hospital, insurance, public health, business, consumer, government • Diverse communities in size, geography, population demographics, culture, cost and quality of healthcare • Site visits, interviews, leadership roundtables
“Communities Shaping a Vision…..” • Learn about healthcare values that guide thinking of community leaders and citizens • Understand their conclusions about what works and what needs to be fixed • Create mechanisms for this thinking to inform the national policy debate • Support changes to enable communities to better meet their healthcare needs • Identify creative, collaborative, replicable community-based initiatives that address healthcare problems
What Did We Hear? • Community discussions less polarized, less partisan, more focused on finding practical solutions • We face a major crisis and we need definitive action NOW • Healthcare leaders more motivated than in the past to work together on solutions
What Did We Hear? • There is no social contract for healthcare that is well-articulated and broadly understood • People do not know what they should realistically expect from the health care system, nor do they understand their responsibility to contribute • The healthcare system has fostered unrealistic expectations • We need to restore a sense of community interdependence • Healthcare is both a public and a private good
What Did We Hear? • Individuals need to be actively involved in making key choices about health-related behaviors, and healthcare-related decisions • Increased personal responsibility must be linked with efforts to educate and actively reach out to patients • The health care system should be more accountable for delivering high value care • Communities should enable people to make good choices and adopt more positive health behaviors
What Did We Hear? • There is a serious void of leadership in the healthcare industry • Health care institutions have lost credibility with the public and skepticism about motives is prevalent • There is tremendous fragmentation in healthcare • Some policy and financing issues must be addressed at the federal level • BUT, there is great faith in the ability of communities to develop creative approaches to health challenges
We need a vision….. • We need a visible and respected national spokesperson for health as well as local champions • We need to decide as a society what we really want from healthcare • Our views about health and healthcare are VERY personal • ‘Think globally, act locally’
Washington won’t solve our problems! • We need to shift our thinking • ‘Top down’ approaches used for 60 years have not worked • Reform efforts must recognize the pluralistic nature of this country and consider our culture • Start by carefully defining problems and priorities from the unique perspective of a community
Communities are the logical place for initiating change • All healthcare is local • Policies determined at the community level more likely to be based on the actual conditions in a community • Programs tailored to communities more effective • Health care leaders are more likely to work together productively within their own backyard • Community-based discussion is much more likely to pull in participation from the grassroots and reflect a community’s values and priorities
The challenges are too great for the healthcare system alone • To restore trust the public needs to see leaders working collaboratively in their best interest • Health care leaders need to stop pointing the finger of blame at each other and cooperate on a common agenda • Each organization only owns a piece so none feels responsible for the whole • Individuals and non-healthcare organizations have important roles to play in promoting health at the community level
Think health, not healthcare • The healthcare delivery system is important to health, but it is not the only factor • Our common connection is not healthcare it is the improved health of the American people • The greatest challenges to change are cultural--individual, organizational, societal • Replace blame with personal commitment and community action • Adopt an ‘ecological’ model that addresses individuals, social environments, physical environments, economics, and policies
Engage the public! • The public needs to be involved in discussions of key choices • Health and healthcare are too important for us to not get engaged in creating our healthcare future!
The Citizens’ Health Care Working Group • Charged by Congress with engaging the public in a dialogue on healthcare • What healthcare benefits and services should be provided? • How does the American public want healthcare delivered? • How should healthcare coverage be financed? • What trade-offs is the public willing to make? • Recommendations and an action plan will be presented to Congress
The ‘Public’ View • Obesity is everybody’s problem! • Healthcare providers should be central to the effort to address the problem • Significant role for community organizations—schools, employers, government • Supports multi-pronged community strategy addressing education, personal behavior, environment, policy
Thinking Out of the Box • The healthcare system: position as ‘economic engine’; broaden reach into the community--where people live and work • Public health: cannot be all things to all people; reach out to the industry and non-traditional players • Business: a ‘benign but vested stakeholder’ in employee health & productivity; catalysts for community collaboration
Critical Success Factors • Leadership • Messages • Interventions • Partners • Incentives • Resources
Leadership • We need a visible, respected national spokesperson for ‘Health’ • We need local respected ‘champions’ to serve as magnifiers • All must be giving the same message
Messages • We cannot assume people know what ‘health’ is! • Specific, actionable, consistent, broadly applicable, and culturally relevant • Simple, user friendly information to overcome all the ‘noise’ in their lives • Traditional ‘white coat’ public health messages don’t work • Messages need to be positive, fun, engaging • Make ‘health’ COOL!
Interventions • There is really no ‘high risk’ group • Personalize messages and interventions for each target group by identifying relevant incentives for positive behavior • Make benefits clear and tangible • Ensure ‘trialability’ • Pilots must be self-sustaining, measurable, replicable and ‘scaleable’ • Think broadly in terms of designing interventions
Partnering • Involve ‘grassroots’: broad coalition of public and private sector; business; non-traditional allies, e.g., faith-based groups, food & beverage industry, etc. • Leverage ALL existing assets of partners, e.g., brands and relationships • Consider ‘arts’ partners to engage people in creative ways • Build in accountability • Buy-in to shared credit
Incentives • ‘Freebies’ work, but it is more important to empower individuals to act • Data must be communicated in meaningful ways for each target group • Find out what motivates different groups • Incentives for partnerships must be complementary
Resources • Cultural changes takes 7-10 years! • Need adequate funding/resources to sustain a long-term campaign • Consider as resources all the expertise in and the relationships of partner organizations, not just financial assets
Challenges • People tend to thing ‘positively’ about themselves, their families, etc. • Some perceive ‘the health message’ to be an intrusion • Must align businesses need to make a profit with an interest in benefiting society • Our focus on the ‘science’ in public issues impedes our understanding of the ‘art’ • Our communities are weak and fractured !!
Conclusion! • There is a great opportunity to improve the health of the nation by employing the talents of a broad-based multi-stakeholder effort by organizing and aligning the short and long term interests of traditional and non traditional stakeholders • We should not re-invent the wheel; rather we should build on current programmatic activity (pilots, demonstrations, and national programs) underway