1. Hawaii Health Insurance Status u 1,101,000 covered (90%) u 123,000 uninsured over 1yr. (10%) (despite employer mandate) Source: US Census, 2002

2. Eliminating Health Disparities u Eliminating disparities in health by race, ethnicity, gender, sexual orientation, geography or socioeconomic status u Systemic changes needed

3. Social Determinants of Health u Jobs u Housing u Education u Equal Opportunities u Access to Health Care u The mission of government

4. National Public Health Week u April 5-11, 2004 u Eliminating Health Disparities, From Statistics to Solutions

5. IOM: Community u Support community led needs assessments, service programs with support and TA u Support community long range public health plans and institutionalizing change

6. Disparity Solution Examples, Hawaii u Hele Mai Ai - Diabetes Nutrition Project u Big Bend Diabetes Education Program - Perry u Childhood Rural Asthma Project - Waianae u Kauai Developmental Disability Council u Hansen’s Disease Immigrant Outreach u Aire Fresco - tobacco cessation Maui Hispanics u Community mapping: Tobacco in Native Hawaiians u North Hawaii Outcomes Project - Kamuela Source: APHA Database

7. Honolulu has highest percentage of Asians

8. Asian American Health u Health beliefs & Physical Activity in Elderly Filipinos u Cultural acceptance of API schizophrenic adolescent u Pacific Diabetes Today- Kauai u Early Access Project - new immigrant intro to PH Source: APHA Database

9. For FY 2005 What We Need vs. What We Will Get u APHA What We Need u OMH - Any Increase –Focus on racial/ethnic issues u Closing the Health Care Gap bill (S.2091) u Healthcare Equality and Accountability Act (S.1833) u HHS What is Proposed u OMH - Cut $8 million –15% cut

10. Public Health Infrastructure u The workforce, buildings, equipment, laboratory, surveillance systems and organizational structure needed to protect the public and promote health

11. Public Health Infrastructure

12. Public Health Preparedness Pyramid

13. State Assessment of PH Readiness Dec 2003

15. Hawaii Use of Bioterrorism Funds u Accomplished –Increase State spending on PH –Has bioterrorism plan –> 3 counties with emergency alert capability –State SARS plan u Still To Do –Spent 90% federal $ –Gave >50% to LHD –Can distribute strategic pharmacy stockpile –Has Biosafety 3 Lab –More BT labs for a PH emergency –Pandemic flu plan

16. Public Health Workforce, 2000

17. Hawaii PH Workforce, 2000 Source: The Public Health Workforce, Enumeration 2000, HRSA

18. IOM: Government Public Health Infrastructure u Review state public health laws in context of emergency health powers u Train the public health workforce u Communication is key - languages and culture u National health information infrastructure u Assess state health dept. funding and TA u Assess state lab capability and funding

19. IOM: Government Public Health Infrastructure u Federal, state, local sustainable investment in public health infrastructure u Combine or cluster categorical grants u Assess the accreditation of public health agencies u Evidence based public and preventive health research u Federal govt. agencies need clear lines of authority u State health officers and DHHS Annual Meeting

20. IOM: Businesses and Employers u Create plans for making insurance affordable for small businesses u Corporations work with PH agencies to set health goals for employees and community u Collect useful public health data u Enhance communication/marketing of health promotion and disease prevention u Give an award to business leaders who invest in community health

21. IOM: Media u Ongoing dialogue with journalists and public health agencies, including training in public health u Television should donate more PSAs u Media should communicate accurate facts u Research influence of media on changing behavior

22. IOM: Academia u Integrate interdisciplinary learning opportunities in public health u HRSA public health training grants u Support for leadership training institutes/programs u Federal grants should support public health practice research –Peer reviewed –Longer time lines to assess prevention –Coordination between NIH and CDC u Faculty rewarded for service in public health

23. CDC Futures Initiative u New direction for CDC u Primary “customer” is the public u Marketing of public health u Partnerships with business u Health Impact –Preparedness –Health Promotion and Disease, Injury, Disability prevention u Coordinating centers u Scientific basis-Public health research grant

24. CDC next steps u New organizational charts  Coordinating Center for Infectious Disease – includes the National Center for Infectious Diseases, the National Immunization Program, and the National Center for STD, TB, and HIV Prevention. Dr. Mitchell Cohen will lead this coordinating center.  Coordinating Center for Health Promotion – includes the National Center for Chronic Disease Prevention and Health Promotion; the National Center for Birth Defects and Developmental Disabilities; and Genomics. Dr. Donna Stroup will lead this coordinating center.  Coordinating Center for Environmental Health, Injury Prevention, and Occupational Health – includes the National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, the National Center for Injury Prevention and Control, and the National Institute for Occupational Safety and Health. Dr. Henry Falk will lead this coordinating center.  Coordinating Center for Public Health Information and Services – includes the National Center for Health Statistics, a new National Center for Health Marketing, and a new center for public health informatics. Dr. James Marks will lead this coordinating center.  Office of Global Health – Dr. Stephen Blount  Office of Terrorism Preparedness and Response – Charles Schable u Reorganization cannot occur without additional funding

25. CDC Office of the Director  Office of Strategy and Innovation: Kathy Cahill  *Analytic function to assess external involvement and trend analysis  *Innovation and creativity  *Goals management-strategy and development  Office of Workforce and Career Development (OWCD): Dr. Steve Thacker, Director; Barbara Holloway Deputy Director  *Recruitment  *Workforce development  *Learning  *Succession planning  *Houses CDC’s Office of the Chief Learning Officer  Chief of Public Health Improvement: Dr. Ed Thompson  *Support and standards for the public health systems  Chief of Science: Dixie Snider  *Public health research u *Scientific leadership and collaborations  Chief Operating Officer: Bill Gimson  *Management and business operations for CDC  Chief of Staff: Bob Delaney  *Manages day-to-day activities of the Office of the Directo u CDC Washington: Don Shriber

26. For FY 2005 What We Need vs. What We Will Get u APHA What We Need u CDC - $1 Billion More –14% increase –Futures Initiative u HRSA - $1.1 Billion More –16% increase –HIV, MCH, Primary Care u HHS What is Proposed u CDC - Cut $300 Million –2.8% cut –State preparedness cuts u HRSA - Cut $610 Million –8.8% cut

27. Examples of Cuts in HRSA u Community Access Program - 90% u Health Professional training grants - 25% –Zero for Public Health Programs u Rural Health - 66% u Newborn hearing program - 100% u Trauma/EMS - 100% u State Planning Grant - 100% u Public Health Improvement - 100% u Smallpox compensation program - 100%

28. Public Health “Burnout” u Dependent on government funding u Often prevention is first to be cut u “Penny wise, Pound foolish?”

29. Fighting Back u “I live in your district and this is what I am concerned about.” u Visit your Senator and Representative

30. Reminder of What We Do? u Future of Public Health is in our hands u Noble Profession –Health care –Public service

31. Mahalo for inviting me!