health policy primer (a.k.a. physician activism basics)

Health Policy Primer(a.k.a. physician activism basics)

Department of Internal MedicineMorning Report19 March 2007

Ryan Buchholz, MD

“Knowing is not enough; we must apply.Willing is not enough; we must do.”

—Goethe

Aims

• Convince you that health policy is

doctors’ business**…and that health policy is particularly

important for the poor

• Provide you with a few resources

and contacts

• Strike a chord within you

Non-Aims

• A partisan political discourse

• An excuse for a nap

Introduction

• Health policy, broadly construed−Macro-level:

• Global health• National / federal policy• State / regional policy

−Micro-level:• Your community• Your institution or practice

Proximal

Distal

Introduction, continued

•Have you ever…•Signed a petition?•Sent a letter to a politician?•Visited a politician’s office?•Attended a city council meeting?

•Participated in quality improvement efforts?•Voted?•Volunteered for a campaign?•Read the newspaper?•Are you a member of ACP, AAP, AMA, SGIM?

Agenda

• My journey from apathy to advocacy (i.e., health policy is doctors’ business)

• ~ 5 minutes

• Case discussion• ~ 5 minutes

• Q+A/Resources: Health policy opportunities

• ~ 10 minutes

My journey• Childhood: Apathy + Cynicism

• “Student government doesn’t matter”• Politicians are selfish• Sports are cooler anyways

Michael Chang Brian McBride

Dana Carvey

My journey: influences

• University: Apathy Service

Drew Hansen

“Social Justice”

later wrote

My journey: influences

• University: “Poverty, Culture, and Infectious Disease”

Paul Farmer

“Large-scale social forces…”

Subject of

>

MD = natural attorney for the poor

My journey: influences

• Post-University: Fighting Hunger

Tony Hall

“You’re my eyes and ears in the field…”

Author of

+

Dan GlickmanFounder of

Case presentation

• Jorge C, a 45 year-old man with−uncontrolled diabetes mellitus x 20

years,−morbid obesity, and−h/o recently broken tibia

presents to your office for hospital F/U after a near below-knee amputation, asking how he can lose weight and control his diabetes.

Case presentation, continued• SOCHx: former truck driver (now blind),

immigrated from Cuba at age 16, married and LW wife (IHOP waitress) and children

• PMHx: diabetic retinopathy legally blind; near-BKA after fractured tibia

• ROS: gaining weight, can’t see, polydipsia/polyuria/polyphagia

• PE: consistent with history as described

Case presentation, continuedAssessment /

plan?

1. DM, uncontrolled& complications

2. Morbid obesity

3. Poverty

1. OHA/insulin + diet

+ exercise, labs

2. Eat healthy

3. Refer to Farm

Share

Farm Share

Jorge C

+ =

•Learned to eat healthy

•Lost 150 lbs.

•Glycemic control

•Volunteering

•New lease on life“Farm Share saved my

life.”

— Jorge C.

Resources and Opportunities

Resources• People all around you!

− Jane Henney, MD: VP of UC Academic Health Center and former FDA Commissioner (jane.henney@uc.edu)

−Robert Graham, MD: UCFP Professor and former Ass’t Surgeon General (grahamj3@fammed.uc.edu)

−Stephen Wilson, MD: UC Internist and Pediatrician, Cincinnati Board of Health (wilsse@ucmail.uc.edu)

−Melissa Saladonis, CCHMC Director of Government Affairs (melissa.saladonis@cchmc.org)

−Sarah Corathers, MD: Chair (ex officio), AAP Resident Section (sarah.corathers@uc.edu)

Opportunities

Conferences and Seminars

• Health Foundation of Greater Cincinnati

seminars−Strategic planning: Jul. 12, Nov. 15−Working with the media: Mar. 8, Sep.

10−How a piece of paper can catch a

policymaker’s eye: Oct. 5

Opportunities: 2

Conferences and Seminars−Center for Closing the Health Gap: April

13 and 14, 2007 – David Satcher will keynote!

−April 19-21, 2007: Internal Medicine 2007

−June 3-5, 2007: AAP Annual Legislative Conference in Washington, DC

−October 11-12, 2007: Ohio ACP in Columbus

Opportunities: 3• Online petitions

• Health Care for all Children• The One Campaign

• Vote• Congressional elections• Ohio legislature elections• Local elections

• Get out• Cover the Uninsured Week 2007: April 23-29

Opportunities: 4• Books:

−White Coat, Clenched Fist (Mullan)−Pathologies of Power (Farmer)−Mountains Beyond Mountains (Kidder)

Opportunities: 4• Books:

−White Coat, Clenched Fist (Mullan)−Pathologies of Power (Farmer)−Mountains Beyond Mountains (Kidder)

• Articles:−This past week’s JAMA

Porter and Teisberg. JAMA 2007;297:1103-11.

Opportunities: 5

Rotations−Initiative on Poverty, Justice, and

Health: September, February, and April 2007-8

−Advanced Healthcare Improvement: Spring 2008

−Cambridge, the Amazon, southern Africa: do an elective abroad, or “on the rez”

Summary

• Primer on health policy: doctors’

business

• Resources and opportunities: strike

a chord?

“Knowing is not enough; we must apply.Willing is not enough; we must do.”

—Goethe

Special Thanks

• Christine + Jonathan Buchholz

• Caroline Mueller• Brian Volck• Tiffiny Diers• Carl Fichtenbaum• Stephen Wilson• Mia Mallory• Melissa Saladonis

Questions? Comments?

ryan.buchholz@uc.edu

or

ryan.buchholz@cchmc.org

Blog: healthequity.wordpress.com

Health Indicators

WHO, World Health Statistics 2005.

U.S.: #43 U.S.: #29

Health Expenditures

U.S.: #1

OECD Indicators 2005

A world distorted by AIDS…

Dorling D. PLoS Medicine 2007;4(1)13-8.

People Living with HIV, UNDP 2004

…is distorted by social structures

Dorling D. PLoS Medicine 2007;4(1)13-8.

Physicians Working, WHO 2004