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Health Policy Primer (a.k.a. physician activism basics). Department of Internal Medicine Morning Report 19 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* - PowerPoint PPT Presentation
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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 ([email protected])
−Robert Graham, MD: UCFP Professor and former Ass’t Surgeon General ([email protected])
−Stephen Wilson, MD: UC Internist and Pediatrician, Cincinnati Board of Health ([email protected])
−Melissa Saladonis, CCHMC Director of Government Affairs ([email protected])
−Sarah Corathers, MD: Chair (ex officio), AAP Resident Section ([email protected])
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
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