WELCOME TO BUILDING A HEALTHY GEORGIA

Transcription

1 1 The Role of Future Public Health Professionals and Public Health Policy-making WELCOME TO BUILDING A HEALTHY GEORGIA September 27, 2011 Georgia Center, University of Georgia

2 Georgians for a Healthy Future is a non-profit health policy and advocacy organization that provides a voice for Georgia consumers on vital and timely health care issues. Our mission is to build and mobilize a unified voice, vision and leadership to achieve a healthy future for all Georgians. We envision a day in which all Georgians will have the quality, affordable health care they need to lead healthy lives and contribute to the health of their communities. GHF approaches our goal of ensuring access to quality, affordable health care for all Georgians in 3 major ways: 1) outreach and public education, 2) building, managing, and mobilizing coalitions, and 3) public policy advocacy.

3 University of Georgia College of Public Health Dean Phillip Williams September 27, 2011

4 Why work in public health? The work is challenging and interesting There is a real need for this activity, specifically in Georgia There are employment opportunities

6 Georgia is Unhealthy Georgia ranks at the bottom nationally in most key indicators of wellness Georgia is aging, the 65-and-over population will increase by 62 percent by 2020 Georgia has the second-highest rate of childhood obesity in the country and nearly 60 percent of Georgians are considered overweight

7 Georgia is Diverse 44% minority: ~56% white, ~31% black, ~9% latino, ~3% Asian From 2000 to 2010, the white population grew by 4% while the minority population grew by 40% Significant health disparity exists between racial/ethnic groups

9 Georgia Health Rankings

10 What do these 30 counties have in common with: Dominican Republic Gaza Strip Thailand El Salvador

12 Who is in the Public Health Workforce? Individuals employed by local, State, and Federal government health agencies Individuals in academia who educate, train, or perform research in public health Private sector health care delivery and insurance organizations that provide community-based public health services Private industry, including consulting services, that provide environmental health or wellness program expertise 2008, The University of Georgia. All rights reserved.

13 Georgia is Understaffed Georgia has a shortage of properly trained public health personnel Many of Georgia s key public health personnel lack the basic training and education necessary Georgia s public health work force issues, such as: high vacancy rates; high turnover rates; aging of the work force; and high retirement eligibility.

14 The Public Health Workforce Certain fields in public health are particularly suffering from work force shortages, including: nursing; epidemiology; laboratory services; and environmental health. 2008, The University of Georgia. All rights reserved.

16 THE AFFORDABLE CARE ACT IMPLICATIONS FOR GEORGIA Phaedra Corso, PhD, MPA Professor and Head, Department of Health Policy and Management College of Public Health, UGA

17 Why Health Care Reform in the US? The status quo is unsustainable Healthcare costs are high Healthcare costs are rising Americans have insufficient access to HC services Health status and outcomes are inadequate

18 Current Financing of HC in the US Government (public) % of total (~4% of GDP): Medicare (15% of the federal budget in 2010) Medicaid/SCHIP (8% of the federal budget in 2010) Other Public healthcare provision, research/development Market-based (private) 54.5% of total Private health insurance Patient out-of-pocket Other

19 Trends in US Public/Private Financing 1960: -77% of total was private * 21% private HI * 55% OOP * 2% other -22% of total was public * 9% other federal * 13% other state/local Source: CBO, 2007

20 Approaches to Reforming the US System FOCUS ON REDUCING UNINSURED GOVT DRIVEN MARKET DRIVEN FOCUS ON REDUCING HC COSTS

21 Patient Protection and Affordable Care Act, March 2010 Expansion of Medicaid Individual Mandate State-based Health Exchanges Employer-based carrots and sticks to increase HI coverage

22 Theory Behind the Affordable Care Act Builds on current system to expand coverage The tax-preference for employer coverage remains Expands existing programs to cover lowest-income Americans Provides subsidies for small businesses & middleincome individuals without employer coverage Increases coverage for preventive care Invests in health care infrastructure Pilots projects for payment reforms

23 Medicaid Eligibility Changes in Georgia Selected Populations Current Eligibility New Eligibility Children (6-18 years-old) % FPL Adults with Children Peachcare for Kids with a premium Medicaid available for those at or below 29% FPL Medicaid with no premium Medicaid available for those at or below 133% FPL Adults with no children None Medicaid available for those at or below 133% FPL ~700,000 newly eligible for public insurance. Source: Georgia Health Policy Center

24 Medicaid Expansion Costs for GA New Federal Funds, $14,551 Cumulative Spending from 2014 to 2019 New state funds average $120 million for the first six years New state funds 2.7% increase above baseline without reform ($ s in millions) New State Funds, $714 Source: Kaiser Commission on Medicaid and the Uninsured

25 Individual Mandate: Unexpected HI Consequences of ACA Implementation In the individual insurance policy market, no companies are left in Georgia that will insure an individual minor. Why? There are no more caps on any policies (previously capped at a $1,000,000/ member); There are more restrictions on underwriting; and Anyone prior to their 26th birthday can still stay on their parents policy. So most all children will be insured on their employed parent's policy, or by a government payer (Medicare or Medicaid). Those left would be individuals and more than likely a very bad medical risk.

26 Employer-based HI Coverage 100% 80% 60% Uninsured, 19 Uninsured, 6 Exchange, 9 Medicaid, 15 Medicaid, 20 Nongroup, 10 Nongroup, 8 Represents undocumented population 40% 20% Employer Coverage, 56 Employer Coverage, 52 0% Non-Elderly, Nationwide Population Source: Congressional Budget Office

27 Why the Drop in Employer Coverage? Some currently covered workers would enroll in Medicaid or subsidized exchanges Some smaller employers would terminate coverage so their employees would qualify for generous subsidies through exchanges Some employers would weight lower penalties versus high costs of coverage and drop benefits Retiree benefits may get cut

28 State-Based HI Exchanges

29 44% 39% 17%

30 Do you think you and your family will be better off or worse off under the health reform law? Better off Worse off No difference Unsure/Refuse August % 33% 37% 6% Jan % 32% 44% 4% June % 28% 39% 5% Apr % 32% 30% 8% Source: Kaiser Family Foundation at

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32 32 om Facebook: Partner Up! for Public Health

33 Testimony made it clear that due to the current and worsening shortage of public health nurses, during a time of significant medical emergency, Georgia will not be able to perform as is required and expected by the public. [Federally required Emergency Support Functions] 6 & 8, [Strategic National Stockpile] distribution, telephone triage, and emergency support will not function as designed, and will lead to mass disruption, unavailability and degradation of care, perhaps leading to panic or civil unrest. In the event of pandemic, the medical system in Georgia will collapse due to unprecedented volume without improvement to existing public health infrastructure. -Study Committee on Public Health Georgia House of Representatives 2006

34 The Committee recognizes that Georgia s Public Health System is in a state of crisis due to increasing responsibilities, increasing population, emergency infectious disease, the problems of immigration, the threats of terrorism and pandemic influenza, a shrinking public health workforce, and decreasing funds. -Study Committee on Public Health Georgia House of Representatives 2006

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36 36 Connecting the Dots: Public and Economic Health University of Wisconsin 2011 Health Outcomes Rankings Premature Death Poor or Fair Health Poor Mental & Physical Health Days Low Birth Weight Georgia DCA 2011 Job Tax Credit Rankings Average Per Capita Income Unemployment Rate Poverty Rate

37 37 Top & Bottom 10 County 2011 Job Tax Credit Rankings (Reversed) Oconee 1 2 Columbia 2 8 Harris 3 14 Fayette 4 1 Forsyth 5 3 Bryan 6 23 Cherokee 7 6 Cobb 8 5 Effingham 9 27 Houston Wisconsin Health Outcomes Rankings County 2011 Job Tax Credit Rankings (Reversed) Calhoun Warren Macon Treutlen Johnson Atkinson Taliaferro 156 NR Jenkins Telfair Hancock Wisconsin Health Outcomes Rankings

38 38 Economics & Public Health 2011 Tax Credit Rankings Unemployment Rate Per Capita Income Poverty Rate 2011 Health Outcomes Rankings Life Expectancy % Poor or Fair Health Poor Physical & Mental Health Days Low Birthweight Georgia Dept. of Community Affairs 2011 Job Tax Credit Rankings University of Wisconsin 2011 County Health Rankings for Mortality & Morbidity

39 Partner Up! Power Ratings & Rankings Economic Ranking x Health Ranking = Partner Up! Power Rating Best Possible Rating: 1 x 1 = 1 Worst Possible Rating: 159 x 159 = 25,281

40 Partner Up! Power Rankings: Top 10 County Economic Ranking Health Ranking Partner Up Power Rating Oconee Fayette Forsyth Columbia Cobb Cherokee Harris Gwinnett Bryan Houston

41 Partner Up! Power Rankings: Bottom 10 County Economic Ranking Health Ranking Partner Up Power Ratings Calhoun ,400 Telfair ,900 Warren ,046 Quitman ,022 Turner ,312 Macon ,280 Jenkins ,038 Burke ,016 Crisp ,711 Jefferson ,845

42 Average Medicaid Spending Per Capita By Power Ranking Tier $800 $700 $ $ $600 $500 $ $400 $300 $200 $100 $0 Green Counties Yellow Counties Red Counties

43 Average Medicaid Rate By Partner Up! Rating Tier 25.0% 20.0% 19.4% 22.7% 15.0% 12.0% 10.0% 5.0% 0.0% Green Yellow Red

44 Average Medicaid Spending Per Enrollee By Power Ranking Tier $3,600 $3,500 $3,400 $3, $3, $3,300 $3,200 $3, $3,100 $3,000 $2,900 Green Counties Yellow Counties Red Counties

45 Rural Counties by Power Rankings

46 Tier Profiles: Size Matters Tier No. Urban Counties No. Rural Counties Combined Population Top Tier ,775,499 Middle Tier ,912,922 Bottom Tier ,773,866 Top Tier rural counties tend to be attached to urban areas Most Bottom Tier urban counties aren t much above the 35,000 person threshold 30 counties have populations under 10,000; none are in the Top Tier, 11 are in the Middle Tier, 18 are in the Bottom Tier, and 3 are unrated.

47 A Few Modest Suggestions Call the Question: What should be the state s commitment to, and strategy for, rural Georgia? Create a burning platform approach to dealing with rural health, education and economic disasters Ask Gov. Deal to create an inter-departmental Task Force (DEcD, DPH, DCH, DOE, DCA, University System + GRHA, ACCG, GMA) Develop/organize multi-county pilot program

48 Facebook: Partner Up! for Public Health

49 GEORGIA PUBLIC HEALTH TRAINING CENTER Center Coordinator: Ashley Wells

50 Public Health Training Center Funding Health Resources and Services Administration (HRSA) National Public Health Training Center (PHTC) Program Length of funding 5 years Purpose Strengthen national PH system/infrastructure Improve competence in technical, scientific, managerial, and leadership skills of the current and future public health workforce

51 National PHTC Program

52 PHTC Program Goals Training: Centers must train the public health workforce. Collaborative Projects: Centers must involve faculty members and students in collaborative projects to enhance public health services to medically underserved areas/communities (MUA). Field Placements: Centers must establish or strengthen field placements for students in public or nonprofit private health agencies or organizations, particularly those serving underserved areas and populations.

53 Georgia Public Health Training Center Key Members UGA Center Administration Center Director: Dr. Marsha Davis, Assistant Dean Center Coordinator: Ashley Wells, MPH, CHES Sub-Contract: Georgia State University Principal Investigator: Dr. Michael Eriksen Co-Investigator: Dr. Sheri Strasser Co-Investigator: Dr. Frances McCarty Inst. Dsgn/LMS Manager: Sarah Boos Beddington, MPH

54 Additional Partner Institutions Armstrong Atlantic University Fort Valley State University Georgia Southern University Georgia Health Sciences University

55 Georgia Public Health Training Center Mission The mission of the Georgia Public Health Training Center (GPHTC) is to build the capacity of the current and future generation of public health workers in governmental public health, health care organizations, and non-profit organizations for the purpose of advancing and improving the health of Georgia citizens.

56 Current PH Workforce Future PH Workforce

57 Future Public Health Workforce Field placements should provide public health students with: City, county, district and state health departments and nonprofit private health agencies or organizations Underserved areas and populations

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59 Public Health Districts in GA

60 GPHTC Internships Goal Prepare the future public health workforce for careers in local, district and state public health offices and community organizations Activities Seven (7) MPH students have been placed in public health internships across the state in summer 2011 Students represent the following institutions: 3- UGA 2- Armstrong Atlantic University 2 - Georgia Health Sciences University Stipends and housing arrangements were facilitated by GPHTC

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62 GPHTC Internships Healthy Colquitt Coalition (via YMCA)- Moultrie, GA Ellenton Clinic Farmworker Health Services- Moultrie, GA Southwest GA Public Health District- Albany, GA Center for Black Women s Wellness- Atlanta, GA Northwest GA Public Health District- Rome, GA Coastal GA Public Health District- Savannah, GA

63 Future Public Health Workforce and GPHTC Summary Train students in public health settings Involve students in collaborative projects Retain students in public health jobs in the state of Georgia Impact rural and medically underserved areas Questions? Ashley Wells,

64 64 The Role of Future Public Health Professionals and Public Health Policy-making Student Involvement through Advocacy Michelle Putnam, MPH September 27, 2011

65 The Role of Future Public Health Professionals and Public Health Policymaking 65 Mission Health Students Taking Action Together (HealthSTAT) is a student-run, non-profit organization that unites students throughout the state and across disciplines in service, education, and advocacy to promote a healthy Georgia. Advocacy agenda: safety net system funding; collaborative care and chronic disease management; childhood obesity prevention

66 The Role of Future Public Health Professionals and Public Health Policymaking 66 How does health policy influence your job?

67 67 The Role of Future Public Health Professionals and Public Health Policymaking How health policy is made: 8 th grade government version

68 68 Reality: compromise, compromise, compromise BIG problems stakeholders $$$$ {policy}

69 69 The Role of Future Public Health Professionals and Public Health Policymaking Advocacy What it is Who it helps

70 70 The Role of Future Public Health Professionals and Public Health Policymaking Access to Care and Safety Net Trauma Tobacco Safety Net Immigrant Health

71 71 The Role of Future Public Health Professionals and Public Health Policymaking Advocating Pick your topic Research Your topic Where your topic fits on a state level Your target legislators Find ties to the legislator s district: constituent Educate yourself on the details Engage

72 72 The Role of Future Public Health Professionals and Public Health Policymaking Lessons Learned research educate numbers focus funding committees relevancy engage off-session

73 73 The Role of Future Public Health Professionals and Public Health Policymaking Success! Now what? Implementation (the magic word) Affordable Care Act Department of Public Health Medicaid Always room for improvement, input, and evaluation

74 The Role of Future Public Health Professionals and Public Health Policymaking 74

75 75 The Role of Future Public Health Professionals and Public Health Policymaking Get involved Project Coordinator Help lead a project or an event in any of our care. learn. act. areas Board of Directors Learn more about the inner workings of nonprofits and leadership Become a Member show up at events, get access to special networking activities and professional seminars sign up at

76 76 The Role of Future Public Health Professionals and Public Health Policymaking Thank You! HealthSTAT 1561 McLendon Avenue Atlanta, GA

77 The Role of Future Public Health Professionals and Public Health Policy-making THANK YOU TO OUR SPONSORS: GEORGIA HEALTH FOUNDATION SOUTHERN PARTNERS FUND A SPECIAL THANKS TO THE FOLLOWING ORGANIZATIONS FOR THEIR SUPPORT: HEALTHCARE GEORGIA FOUNDATION SMALL BUSINESS MAJORITY