Building an Integrated Health Team and

a Vision of Health Care Reform

Marguerite Pappaioanou, DVM, MPVM, PhDExecutive Director

Association of American Veterinary Medical Colleges

National Public Health WeekUniversity of Tennessee

The Spectrum of Health Care

PreventionPublic Health

Treatment/CureMedical Care/ Service Delivery

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

$3.6 trillion total for FY10

Global Map of Life Expectancy

Source: Wikipedia

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? 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

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 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

PREVENTIONBETTER THAN CURE

Public HealthPublic Health

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

Institute of Medicine, Institute of Medicine, The Future of Public HealthThe Future of Public Health, , 19881988

Prevention

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

Population – based actions to maximize individual actions collectively!

Guide toCommunity Preventive Services

Synthesis of evidence on the effectiveness of population based interventionsMass 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

The Human-Animal Bond

Wildlife

DomesticAnimal Human

Translocation

Human encroachmentEx situ contactEcological manipulationHuman behaviors

Global travelUrbanizationBiomedicalmanipulation

Food processing/distributionTechnology andIndustry

AgriculturalExtensive Production

EncroachmentIntroduction“Spill over” &“Spill back”

One HealthOne Medicine

After Daszak P. et.al.Science 2000 287:443

Infectious Organisms Pathogenic to Humans and Percent Zoonotic

0%10%20%30%40%50%60%70%80%90%

100%

Non- zoonoticZoonotic

217 538 307 65 287 1415

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

132

Links Between Human and Animal Health

Improved HumanHealth & Well Being

Foodborne Disease

Emerging Diseases

Bio- Agro-Terrorism

Injuries OccupationalHealth

Mental Health

EnvironmentalHealth

Antibiotic Resistance

EmergencyResponse

Disability

Our Food What people want

QuantityQualitySafetyCost/Affordability

Issues Globalization IntensificationAnimal welfareAnimal husbandry, food system, feedUse of antibiotics, antibiotic resistance

Human Diseases and Injuries with Serious Health Consequences

Acquired fromDogs and Cats

Dog bite injuries Cat scratch disease Toxocaral Larva Migrans Congenital toxoplasmosis

X

XFocus of veterinarian’s attention

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

Dog Bite Injuries

Estimated 4.7 million bites per year 800,000 require medical care

446,000 non-emergency care visits321,000 emergency room visits13,000 hospitalizations20 fatalities

> $250 million per year

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

Watch Out! Pet Falls Hurt 86K Per YearGovernment 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 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

General

Multidisciplinary practice, programs on the groundEducating, training students, practitioners of multiple disciplines, policymakersDeveloping one health policiesMulti-disciplinary integrated research (e.g., NIH Clinical Translational Research Centers)

Academic Settings

Outreach, community service, policy

Teaching Research

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

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

U.S. Veterinarians in Public Health

Private practitioners Local/County Health Departments State Health Departments Federal Government

DHHS: CDC, FDA, NIH USDA: APHIS and FSISEPADoD

Colleges of Veterinary Medicine, Medicine, Schools of Public Health

Industry/Drug Companies (Human/Animal) NGOs

The Veterinary OathThe Veterinary Oath

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

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

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-- 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

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 ofWhat each profession brings to the tableHow to work together

Household and community needs, dynamics, rural living, culture

Develop and evaluate models (try this out!)

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 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