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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


Public Health


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

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
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

  • 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

One Health

One Medicine




“Spill over” &

“Spill back”

Human encroachment

Ex situ contact

Ecological manipulation

Human behaviors





Global travel





Extensive Production

Food processing/distribution

Technology and


After Daszak P.

Science 2000 287:443

infectious organisms pathogenic to humans and percent zoonotic
Infectious Organisms Pathogenic to Humans and Percent Zoonotic








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









Bio- Agro-


Improved Human

Health & Well Being




Mental 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
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
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.”;

Source of data- CDC

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


Academic Settings

Outreach, community service, policy



  • 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





Public health advisors


Sanitary Engineers

Industrial Hygienists

Environmental Specialists


Laboratory Scientists

Social Workers

Health Educators


Information Technology Specialists




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
    • 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
  • 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!)
  • 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