Issue 1, Number 3 - Fall/Winter 2011

The Future of Health Care: National Strategy, Local Action, Personal Responsibility

By Valerie Brown, First District Supervisor, Sonoma County

The affordable care act passed by Congress in March 2010, mandated the
creation of the National Prevention, Health Promotion, and Public Health Council (also known as the National Prevention Council) and the development of the National Prevention and Health Promotion Strategy. The Council is chaired by Regina Benjamin, MD, U.S. Surgeon General, and is comprised of Cabinet secretaries and heads of 17 federal departments to provide coordination and leadership at the federal level and among all executive agencies regarding prevention, wellness, and health promotion practices.

The National Prevention and Health Promotion Strategy is monumental in that it moves our country from a hospital/emergency room model to a prevention and wellness model. To achieve this goal, people must take more responsibility for their health and more emphasis must be placed on creating healthy communities. Creating a system where people acknowledge that “health happens between medical appointments” is crucial. Implementing such national strategies will ensure that people will live longer, healthier, more productive lives.

The National Prevention Council’s mission is to increase the number of Americans who are healthy at every stage of life. The focus is on creating healthy and safe community environments, developing clinical and community preventative services, empowering people, and eliminating health disparities.

In addition to the representatives of federal agencies and departments thatmake up the National Prevention Council and are involved in the development of the National Prevention Strategy, the Affordable Care Act required the formation of an Advisory Group to be made up of no more than 25 professionals who were appointed by President Obama to provide guidance to the Council and to advise on effective, science-based prevention and health promotion practices. By the first meeting of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health in June 2011, there were 15 appointees and a chairperson, Jeffrey Levi, PhD, Executive Director of Trust for America’s Health (TFAH), a non-profit, non-partisan organization dedicated to making disease prevention a national priority.

It was certainly an honor to be appointed by the President, especially when I realized how important it was to have local government at the policy table. Most of the services under discussion are delivered at the county or local level, especially for the most underserved and underinsured. As the only elected representative of county government serving on the Advisory Group, the opportunity to weigh in on policy development of strategic goals was, and is, significant.

In Sonoma County’s population of 482,000, we have 82,000 uninsured residents, according to 2009 California Health Interview Survey (CHIS) data. When the Affordable Care Act is fully implemented by 2014, we will be able to extend coverage to 54,000 of those people. Our County responsibilities include Health Services, a department in charge of monitoring, promoting, and protecting the physical and mental health of our population and community, providing health care, educating the community about disease and injury prevention, convening and supporting community partners on health issues, and developing population-based health policies.

In these times of limited financial resources, our focus is on evidence-based programs, such as AVANCE (the Spanish word for “advance”). This is an upstream program that trains Latino parents of children under age three to support optimal child development and school readiness while helping the parents with literacy. The County is also identifying opportunities for greater collaboration with our community partners such as the Dental Days program, which provides preventative dental care to at-risk one-year-olds and other children at Women, Infants, and Children (WIC) program sites, and the Jump Start program in partnership with the Sonoma County Office of Education, which funds transition programs that enable low-income, at-risk four-year-olds to become better prepared to enter kindergarten.

In addition to focusing on evidence-based programs, these programs exemplify our focus on supporting and empowering existing community organizations and their leaders to address health issues in their neighborhoods and communities.

Counties are also under federal and state mandates to create programs promoting the recovery and wellness of individuals with serious and persistent mental illness and substance use disorders, including those in our jail population. Each year the Sonoma County Behavioral Health Division and its contract mental health professionals provide mental health services to more than 9,000 residents, including 1,300 children, and substance use services to more than 14,000 individuals, including 1,000 children. These services include innovative partnerships with schools and public safety departments.

Sonoma County’s Environmental Health and Safety Department includes food and dairy inspections, inspections of small water systems, childhood lead prevention, and housing consultation in organized camps and detention facilities. Our focus on providing access to health care for every child has been fundamental in providing a wellness model from the start of a child’s life. Imagine the opportunity to have the national government recognize what Sonoma County is doing that works (and does not work) and to see our programs emulated across the country toward achieving goals toward healthy living in a healthy environment. These are only a few reasons why this national policy development is so important to Sonoma County residents and the country.

The National Prevention and Health Promotion Strategy has identified seven targeted priorities where opportunities exist to change unhealthy patterns and become a healthier nation: tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating, active living, injury- and violence-free living, reproductive and sexual health, and mental and emotional well-being. There is no question that each of these priorities are being addressed already within many programs across the country, but the keys to unlocking their greater effectiveness include increasing analysis and research, breaking down the silos of care, building capacity and networks, and incorporating evaluation and accountability.

Throughout the rest of the year, the Advisory Group is working on policy components to provide background and implementation steps through two working groups: 1) Co-Benefits, which is focusing on how to form partnerships with other sectors, local constituents, and other advisory groups, and 2) Prevention and Integrative Health, focusing on how community and clinical prevention and integrative health can fit into the reforming health care system. The Advisory Group continues to conference by phone and meet in person periodically, most recently in early October, to review data from the two subcommittees and add additional value to the National Strategy. Our future efforts will be focused around education and awareness of the Prevention Strategy and how communities can move toward incorporating health in all their policies. The early part of next year a forum is being planned for the San Francisco area to unveil the aspects of the strategy and to share best practices with North Bay communities.

To find Sonoma County at the national policy table developing long-term strategies for prevention, wellness, and integrated health is extraordinary. Reaching those goals under the Affordable Care Act, providing access to improved Medicare benefits to 70,000 more Sonoma County seniors, and increasing our focus on community health clinics and wellness clinics is the right approach for a healthier future. The National Prevention, Health Promotion, and Public Health Council’s achievable goal is for all providers within the health care network to incorporate all aspects of a person’s life to yield positive health outcomes and a healthier community overall.

It is my great honor and delight to work with leaders throughout the country who are equally passionate about this major shift in the delivery of healthcare services and systems for all Americans.

The National Prevention Strategy, released in June 2011, is available online at: http://www.healthcare.gov/prevention/nphpphc/strategy/index.html
Please contact Supervisor Brown at vbrown@sonoma-county.org with ideas and suggestions of best practices in your organization or community.

About the author: Valerie Brown was first appointed to Sonoma County Board of Supervisors in 2002 by then Governor Gray Davis and subsequently was elected to that position in 2004 and 2008. Supervisor Brown oversees county departments and initiatives in numerous areas including health services. She recently launched the nationally-acclaimed Network of Care for Healthy Communities Project, an innovative local delivery web portal that provides the public, healthcare providers, local government leaders, and community organizations with easy-to-find resources and understandable key data. Supervisor Brown served as president of the U.S. National Association of Counties in 2009. In 2010, she was named County Official of the Year by Public CEO and Leader of the Year by California Women Lead. Supervisor Brown has also served as a city council member and mayor for the City of Sonoma and as a California State Assembly member from 1992 to 1998.