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 National Public Health Week University of Tennessee
Dec 17, 2015
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
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
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
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
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