Transcript of the Healthy People 2010 Regional Meeting
Sacramento, California
December 9-10, 1998

U. S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion

Framework and Goals

DR. BANKS: Good morning, and welcome back. I am glad so many of you decided to return. I think we had a very productive day yesterday. For those who were not here yesterday, I am Ron Banks. I am the Regional Health Administrator for the Department of Health and Human Services, US Public Health Service for Region IX which is based in the Regional Office in San Francisco.

 

Before we get started I would like to introduce and acknowledge a couple of members of the Region IX staff. First I want to acknowledge the Senior Public Health Adviser and the Deputy Regional Health Administrator, Al Granados.  Al?

 

I want to publicly thank Al for filling in for me yesterday when I had to leave to accompany the Surgeon General to the state capitol for a meeting in a public reception that was held in his honor.

 

Also, Jean Kajikawa, and, Jean, are you here? Jean is from Hawaii. Maybe she is sleeping in late. It might be a little too cold here for her. Christina Perez and not a member of my staff but an important member, indeed, Dr. Linda Meyers who currently is the Acting Director of the Office of Disease Prevention and Health Promotion. All of these people will be involved in today's session. This is Dr. Meyers to my right.

 

During the fall of 1998, the US Department of Health and Human Services has convened five regional meetings to discuss progress toward achieving the national goals in the year 2000 which we referred to as Healthy People 2000, and to hear comments from the public about the draft goals for the year 2010.

This meeting in Sacramento is the final regional meeting. The purpose of today's session is to hear your comments on the draft of Healthy People 2010, which was made public on September 15, 1998.

 

Your input is vital and will be used to help finalize the health objectives for the nation for the year 2010.

 

I encourage all of you to provide oral statements about the draft document. In addition to your oral statement, I encourage you to submit any written comments you would like to make about this draft via the Internet or by mail.

 

Written comments will, also, be accepted at this regional meeting today. As a matter of fact you can submit those at the Registration Desk. An electronic copy of your written comments on disk will greatly facilitate placement of your comments on the Internet. Also, a transcript of today's session will be made public and posted on the Healthy People Web site.

 

In addition, all written comments received between September 15, and December 15, you still have until December 15, to make your comments, and all of these comments will be posted on the Web site, and the address for the Web site should be in your materials.

 

Now, this morning to help assure a fair opportunity for everyone to participate in today's hearing we will be using the following procedures. First, each oral statement will be limited to 3 minutes, and it is obvious why we have to do that. The main reason is so we can hear from the greatest number of participants.

 

Second, each individual and organization will be limited to one oral statement for the opening session and for each focus area.

 

Third, if time permits at the end of a concurrent session, the floor will be open for general comments. From eight-thirty until nine this morning, I will be hearing your comments on the framework, goals and leading health indicators for Healthy People 2010.   Then at nine, we will break. At that time we will have a 15-minute break before we assemble in the concurrent sessions. Both of those sessions will be held in this room, but we have to leave for about 15 minutes so they can ready the room. I understand they are going to put a partition in.

 

Now, you may have in your briefing materials that some of you would be going, I believe, to the Sierra Room and the other half of you would be in this room. Everyone, as I understand it now, will be in this room, but they will need us to be out of here for about 15 minutes during our scheduled break so they can partition the room.  These sessions will adjourn at 1 p.m., today. During the plenary session I invite you to give your comments on the framework, goals and leading health indicators that are proposed for Healthy People 2010.  This material, as you probably know is found in Sections 8 and B of a draft public comment. I think you all have this.  I would like to now turn the podium over to Dr. Linda Meyers.

 

DR. MEYERS: Thank you, good morning. Before I review the topic for this first session, I wanted to take just a moment for some acknowledgement. This is the fifth, as you know, the fifth of five regional meetings that have taken place since October, and ODPHP is really honored to coordinate, and I emphasize coordinate the development of Healthy People 2010, and in that capacity we provide a number of services. We provide support for a Secretary's Council that Secretary Shalala chairs and that provides overall guidance, and we convene a Healthy People Steering Committee that provides more day-to-day oversight and guidance on the process.  This is made up of HHS senior staff. Many of them are either here today or have been at the other regional meetings. I wanted to thank all of you for all of your extra effort. These are all jobs on top of normal day-to-day routines.

 

We, also, provide guidance to the focus area work groups which are led by representatives from agencies throughout the Department. They are here today to listen to your comments and take them back to other work group members.  These are the folks that over the next few months will be considering the comments very carefully and incorporating them into a draft for presentation to the Secretary's Council in April.

 

So, we thank you. They are the people who make the process work. We, also, provide a framework and support for these regional meetings. Our goal was to work with regional health officers in each of the collective regions and to provide a framework with the hope that the regional offices would provide the content and would really be in charge of the meeting so that each meeting would reflect particular issues and concerns in that region.   We hope we have succeeded, and we really thank you, Dr. Banks and Mr. Granados and all of your team for allowing us this opportunity to be in this region and working with you on this.

 

I especially want to thank all of you for coming out today to talk with us about Healthy People, and lastly, I wanted to thank the creative and productive team for ODPHP. Some are in Washington, and some are here today, but they are all involved and pitched in with Healthy People and have made it possible.

Linda Bailey at the back of the room by the Christmas tree deserves special thanks.

 

(Applause.)

 

DR. MEYERS: Thank you. She has kept us on target and with exemplary skills pulled off the framework for five regional meetings, and is still smiling and more to the point is still speaking with all of us.  This session this morning is to talk about the draft framework and the goals and the major sections and the focus areas and the leading health indicators.  You all have in your folders what we are calling the framework, the bull's eye which at the moment shows two major goals.  As Dr. Satcher talked about yesterday they are to increase the quality and years of healthy life and to eliminate health disparities. We look forward to your comments on those during this session.   The goals are encircled by four major sections, promoting healthy behaviors, preventing diseases and disorders, sorry, prevent and reduce diseases and disorders, promote healthy and safe communities and then surrounding all of that improve systems of pubic and personal health.

 

These four major areas have within them 26 focus areas, and those you have on your agenda, and they are, also, listed in the table of contents in the book.

We are open for comments during this session on the general structure of those focus areas; do they make sense; should there be more; should they be placed differently, and last the leading health indicators are intended to be a small set of objectives that could be presented to the general public and to non-health professionals as an introduction to Healthy People.  These are discussed briefly on Page 7 of the draft, and we, also, are looking forward to hearing your comments on those.  Thank you.

 

DR. BANKS: Thank you, Linda.

 

At this time I invite anybody who has comments to queue up behind the microphone. Those of you who have special needs, someone may need a hand-held microphone, raise your hand, if you do.  I would like for each person who is planning to make a comment to first state your name, your residence and whether or not you are commenting on behalf of yourself or whether you are commenting on behalf of an organization.  Once you have given your comments, would you go to the, is there a table in the back of the room where they can sign? Go to the back of the room and sign.

 

Remember the ground rules that we have set. Each person has 3 minutes. When you have 1 minute left I am told there is a yellow light that will come on, and when your time is up I am told a red light will come on.  We will begin with the first person. Would you please state your name and residence?

 

MS. STERN: I am Judith S. Stern. I am a professor of nutrition and internal medicine at the University of California, Davis, and I am a registered dietitian. I want to comment about leading health indicators. In fact, I think obesity should be considered a leading health indicator and have a separate chapter, and in terms of my background, I am a former president of several organizations, including the American Society for Clinical Nutrition, the North American Association for the Study of Obesity. I am a member of the National Academy of Sciences, Institute of Medicine, and I chaired their 1995 report Weighing the Options on Obesity, and I am a member of the Obesity Task Force. I have to say that I am mother of Daniel. I am concerned about my son, also, and again, I think that obesity does meet all the criteria for leading indicators.

 

We are in the midst of a global epidemic of obesity in the US and in fact, excuse me, it is part of a global epidemic. The World Health Organization in June 1997 said that obesity is one of the greatest neglected public health problems of our time with an impact on health which may prove as great as smoking, and the Surgeon General has certainly reinforced that obesity or diet and inactivity is the second leading cause of preventable death and in fact, it predisposes us to 32-plus other comorbidities, not just diabetes and heart disease but things like birth defects and carpal tunnel syndrome, even urinary tract infection. It is a high cost. It costs the American public up to $200 billion.

 

It disproportionately affects women and minorities and children, and it has been estimated that about 97 million Americans are either overweight or obese, and there is great disparity with health care delivery. In fact, under many health care systems obesity isn't treated, and it is finally one of the few measures with Healthy People 2000 that is going the other way. The goal for Healthy People 2000 was no more than 20 percent. We are now up to 35 percent which is a 40 percent increase.

So, in conclusion, one, I think there is consensus that obesity is a disease in its own entity, and I am making a strong pitch for it being a leading health indicator, and it should have its own separate chapter.  Thanks.

 

DR. BANKS: Thank you. Duly noted. I just want to, also, emphasize that this session is not for any of us to answer questions. This session is merely for comments.

 

MR. FALCON: Good morning. My name is Adolph Falcon. I am Vice President for Policy and Research of the National Coalition of Hispanic Health and Human Services Organizations in Washington, D.C.  I am testifying on behalf of COSSMHO and our 1500 community-based organizations and individual health providers serving Hispanic communities.  First of all, we would like to call for a baseline in tracking data systems to identify, collect, report and analyze data for Hispanics under each objective of Healthy People 2010. This is the same comment we have given under the objectives for 1990 and the year 2000.   Right now we stand at the point of the 521 numbered objectives in the draft, 19.2 percent have collected baseline Hispanic data.  Getting to 100 percent should not be our goal for 2010. It really needs to be our goal in the next 1 to 2 years of implementing Healthy People 2010.

 

Secondly, Cosmos strongly supports the establishment of the goal of Healthy People 2010 to eliminate racial and ethnic disparities in health.  Under each objective the target should be the same for all groups, with data reported separately for each racial and ethnic group including Hispanics. This, once again, is testimony we had given for 1990 and 2000, and we are very pleased to see that in this draft of 2010 the goal of eliminating the disparity in health has been taken on.

 

Thirdly, we call for the target-setting method for Healthy People 2010 to be the better than the best method. By setting a target as better than the best group is doing it gives a place for all groups to move forward, too. It, also, moves us away from looking at non-Hispanic whites as necessarily the goal for all groups to move towards.   Certainly in some areas like birth outcomes and many nutrition and diet areas Hispanics are in fact doing better than most groups are doing, and would be the target goal.

 

Also, reflecting the nation's diversity, you will recall that under each objective concern of cultural and linguistic competency and appropriate services and outreach should be incorporated under each objective.

 

Finally, we call for target setting to be bold and ambitious. Some of the areas have accomplished this, but areas, for example, environmental health and the health professions really set very small goals in terms of progress.  In setting goals for the nation for 2010 they should be ambitious.

 

Finally, I would like to say that I am disappointed to see that this meeting wasn't held in an area like Los Angeles where more Hispanic community-based organizations would have access to provide testimony.

 

Certainly as we look at the room today it is about half the size that was in Chicago. When community-based organizations do submit testimony, also, in written form there should be a method to really look at the kind of effort that was needed to provide the testimony and assure that that testimony is not lost in the testimony that a number of better-funded constituencies are able to give.

 

DR. BANKS: Thank you.

 

MR. DE MIRANDA: Good morning. My name is John de Miranda. I am Executive Director of the National Association on Alcohol, Drugs and Disability.

The goal in the draft to improve the health conditions for people with disabilities is laudable, and part of that should include improving access to substance abuse prevention and treatment services for people with disabilities.

 

On January 13, we are holding a press conference with SAMHSA Director Chavez(?) to put a light on the inaccessibility of alcohol and drug services throughout the country funded with the public health block grant dollars that are for the most part inaccessible to people with disabilities.

We believe that the prospects for major litigation against the publicly funded alcohol and drug services for people with disabilities is in the offing, and especially because of the fact that the indicators are that substance abuse problems among people with disabilities are higher than the general population. Yet, they have less access to these services than the general population.  Thank you.

 

DR. BANKS: Thank you.

 

Good morning.

 

MR. SPOEHR: Good morning. My name is Hardy Spoehr. I am Executive Director of Popelolalokaki(?) which is the Native Hawaiian Health Initiative in Honolulu, Hawaii.

 

My comments will be brief, and we will be submitting further testimony. Our major concern is that there is a contingent link between the Asian and Pacific Island component within the draft. We would like to strongly recommend that the OMB 15 circular recommendations be adopted as the framework for Healthy People 2010. We realize that by the year 2003, I believe OMB 15 circular recommendations are targeted to be implemented in the Federal Government, but we would hope that perhaps this document because it extends through the year 2010 that it be perhaps the foremost document and adopt those guidelines at the onset.

With that we just thank you for having us here today and look forward to your continued success.

 

DR. BANKS: Thank you, and thank you for coming.  Are there any others?

 

MR. WENGER: My name is Steve Wenger. I live Saint Joseph, Missouri and work for HearHand Health System. I, also, represent several community boards. We are simply users of the information in local problem solving, and with that in mind there is a couple of suggestions around indicators to develop more fully an understanding of leading indicators versus lagging indicators, predictive indicators to be more clear so that we can get more to root causes and advance rather than always thinking about lagging indicators from a historical perspective.

 

A second is to begin developing, and I don't know that you could do it for this document but begin developing and taking serious asset mapping and capacity building indicators, and there are several that are being developed if you are not familiar with the Search(?) Institute out of Minneapolis, but building on the assets of kids rather than trying to beat down the deficits is turning out to be a pretty good strategy, and I would suggest exploring that in 2010.Thank you.

 

DR. BANKS: Thank you.

 

MS. TYLER: Good morning. I am Aubin Tyler. I am with the Arizona Department of Health Services. We have had some discussions around the idea of healthy community indicators, and it makes sense to us that if we are going to spend the next 10 years talking about healthy people in healthy communities that healthy community objectives need to be incorporated into this document.   The kinds of things I am talking about are just to give you a few examples population and housing density, parks and trees and green spaces, exposure to violence, level of graffiti, trash and dilapidation.

 

There are lots of other indicator sets like this. The Civic League has a list of such indicators. Search Institute, I believe, does as well, and I know that I think even the IOM came up with some community indicators this year in a new document that they put out.   So, that is really our plea that those be considered. Leading indicators might be just the right place to do that.

 

Thank you.

 

DR. BANKS: Thank you.

 

MR. TOLERAN: Good morning. My name is Daniel Toleran, and I am speaking on behalf of the Association of Asian Pacific Community Health Organizations. We are a national association of community health centers. Our comments are restricted to one, recognizing the laudable goals.

 

DR. BANKS: Where are you from, sir?

 

MR. TOLERAN: The Association of Asian Pacific Community Health,.

 

DR. BANKS: What city?

 

MR. TOLERAN: Oh, from Oakland. I am in this region. Again, we want to acknowledge that there is a thrust on the federal level to eliminate health disparities among ethnic and minority communities, but our comments are restricted to data specifically, and I think it is a clarification in terms of role of data if it is to provide fundamental, strategic and programmatic direction for all these activities for Healthy People 2010. We want to remind the panel that in the Healthy People 2000 many of the objectives that were identified for Asian Pacific Islanders that had been proposed were not accepted due to the lack of national baseline data.

Again, we are asking HHS to consider either local, regional or state data in establishing these baselines so that there can be objectives specific to Asian Americans and Pacific Islanders.  Thank you.

 

DR. BANKS: Thank you.

 

MS. BEGLEY: Good morning. It is odd to speak to three and have several hundred behind you, but my name is Doreen Begley. I am here as a staff nurse from Reno, Nevada. I work in a level 2 trauma center in the emergency department and I am, also, representing the Emergency Nurses Association which is a nursing specialty volunteer group of nurses, and we are 24,500 strong.

 

I have three burning topics that affect my daily practice as an emergency nurse. One is access to care, and I think that emergency departments are the only health care providers that have a national mandate to provide services through OSHA, not OSHA, COBRA, and I think that we really need to continue that process, but we, also, need to address managed care problems that have been cropping up to prevent us from universally offering health care access to all of our clients.  The second burning issue that is in my face daily is injury prevention and the violence portion of Healthy People 2010. I think that injury prevention is key to having a healthy society. The best diseases and traumas that happen are the ones that don't. When it comes to violence I think we need to recognize that an emergency department in emergency care is front line for not only identifying issues such as domestic or family or intimate partner, whatever the term for identifying it is today, and I would, also, like to encourage your report to set RSA nurses, sexual assault nurse examiners to be the industry standard for data collection for evidence so we can not only identify these problems but hopefully come up with some solutions and then lastly Dr. Satcher mentioned end-of-life issues yesterday in his topic, and I don't see a real strong presence of this, but I think that we as a country need to recognize the graying of America and despite all of our wonderful initiatives to provide a healthy society the death rate will remain the same of one per customer.  So, we do need to identify it. Thank you very much for your time.

 

DR. BANKS: Thank you.

 

MS. SOULELES: My name is David Souleles. I am representing Dr. Deanna Bunta and the management team and staff of the city of Long Beach Department of Health and Human Services here in Southern California.

 

Generally the Department supports the overall goals of increasing quality and years of healthy life and of eliminating health disparities. We are particularly interested in the second goal of eliminating health disparities in that in order to accomplish the first goal we think the second goal has to be accomplished, and with rising numbers of uninsured in this country we feel that that goal is going to be particularly challenging and needs particular emphasis and focus in the coming years.

The Department staff after reviewing the various objectives believes that generally they are reasonable and set at least a somewhat aggressive standard for achieving some improvements in health in the coming decade.

 

In terms of some structural issues about this document to make it more user friendly, we feel it is a bit of a foreboding document and will be a bit challenging for many to get passed taking the shrink wrap off.

 

(Laughter.)

 

MR. SOULELES: We would suggest perhaps a Cliffs Notes version that might be a little bit more user friendly. We like the idea of trying to maintain a searchable, fully interactive system on the Internet and perhaps on CD-ROM, anything that will move towards making it a more accessible document that doesn't sit on the book shelf and collect dust.  Thank you very much.

 

DR. BANKS: Thank you. Could you come up the center aisle? It makes it easier to go to the back and sign in, and would each of the other participants once you have made your comments go down the center aisle and sign in the back?  Go right ahead, sir?

 

MR. BAU: Good morning. My name is Ignatius Bau. I am from the Asian and Pacific Islander, American Health Forum in San Francisco. I have a couple of comments first about data, some of which you have heard, but I want to re-emphasize and reinforce, first, a recommendation that there be a specification of what it means when data are not available, whether national data are not available, whether simply no data period are available or whether data are available but may not be scientifically valid enough to set objectives and goals around.

 

Secondly, I think we should look at both a top-down approach and a bottom-up approach when it comes to data and look at state and local and regional data in places where that can help, perhaps drive some improvements in national data collection and third, to support the comments yesterday of really needing separate objectives and goals around data similar to Chapter 22 in Healthy People 2000.

 

Second, the comments are around cultural and linguistic competence, needing to set objectives both in the health communication area, as well as in the access to quality of services area, both of which are very, very critical if we are to reduce health disparities, and finally, a comment around sexual orientation.

I am very disappointed as someone who works in HIV prevention that there is much emphasis on heterosexual transmission and reducing heterosexual transmission when the epidemic is still largely an epidemic among men including gay men of color, and I think especially again if we are to reduce health disparities we need to talk about sexual orientation issues, as well and, also, need to address those issues when we talk about suicide, especially suicide among youth.

 

DR. BANKS: Thank you.

 

MR. SUTOCKY: Good morning, my name is Jim Sutocky. I am here representing the Department of Health Services, Health Information and Strategic Planning Division. I will keep my comments brief because we are submitting written comments to you.

 

DR. BANKS: You are from Sacramento?

 

MR. SUTOCKY: From Sacramento, yes. Given the emphasis and the importance and value of data and surveillance systems that we have heard here over the past 2 days now, for tracking and measuring progress toward achieving the national Healthy People goals, I would like to reiterate our concerns about the omission of the Chapter 22 from Healthy People 2000 and how it had been translated into the Healthy People 2010 draft and would again encourage DHHS to consider restating many of those objectives into Healthy People 2010.  Thank you.

 

DR. BANKS: Thank you.

MR. AMEN-RA: My name is Anusha Amen-Ra. I am with the Sacred Space Healing Center in San Francisco. I am a clinical nutritionist. I am here to speak on behalf of myself as a clinical nutritionist and with our organization. We do a number of different things at our healing center, very holistic types of approaches and would like to really see more holistic approaches being put forth in your document.  We, also, would like to see more culturally oriented material as it relates to things such as nutrition. For instance, I saw one comment that said something about the drinking of milk as being more of a way to get more calcium in one's diet, but for many Asians and African Americans they remain intolerant of being able to digest milk.

 

The other thing I would like to see more is in terms of prevention, I would like to see more of a real working partnership between the doctors and people like myself and organizations like ourselves. There really can be more of a much closer working arrangement where doctors are working with us to help people to develop more of a healthy life style and healthy approach as to dealing with their illnesses.  Thank you.

 

DR. BANKS: Thank you.

 

MR. RUBIN: Good morning. My name is Jeffrey Rubin. I am the Chief of the Disaster Medical Services Division of the State of California Emergency Medical Services Authority based here in Sacramento.

 

I want to compliment HHS on this document. It is a very complete and thorough document. There is one area though that is a mission of public health that is highlighted in the document that, unfortunately, is not spelled out in detail, and that is the response to disasters and the assistance of communities in their recovery.

The United States and California particularly is disaster prone with many national and technological disasters and new hazards that face us every day such as the threat of weapons of mass destruction. All these have had and will continue to have an impact on the health of our community.  The American Public Health Association has recognized this in creating an Emergency Health Services Forum within the APHA position statements. It is a core public health function. It is carried out here in California by local health departments, emergency medical services agencies and county health care services agencies.   It must be highlighted and brought to fruition as far as level of interest and visibility within the document as a leading health indicator.  It is important that disaster medical services and emergency health services be included in an overall public health document.  We look forward to providing you written testimony and thank you for your time today.

 

DR. BANKS: Thank you, Jeff.

 

MS. DAVIS-ALDRITT: I am Linda Davis-Aldritt. I am the President-Elect of the California School Nurses Organization. I am local here in Sacramento although our organization is statewide. CSNO, our California School Nurses Organization would like to comment HHS on the document and particularly on the mention and inclusion of school nursing. We support the recommendation of a 750-to-1 ratio for school nurses. However, we would, also, like to comment that given the number of special needs children who have many medical needs, and are very medically fragile, we would like to recommend that within the document a statement be made that those nurses who have special education populations have a 100-to-1 ratio rather than 750.

 

We would, also, like some consideration made, particularly for rural areas where 750-to-1 might not be realistic. We have counties in California that have 7000 square miles and very sparse populations. So, we would like to have that looked as well.

 

Additionally because school nurses tend to operate in isolation and are the only medical or health-related person on the school campus they need the support and guidance at the state level, and we would like to encourage the inclusion and a statement in the document about having a school nurse consultant in the state education agency in each state.   Thank you.

 

DR. BANKS: Thank you.

 

MR. JIANG: Good morning. My name is Stephen Jiang, Executive Director of the Association of Asian Pacific Community Health Organizations based in Oakland, California.

 

I wanted to talk about the other part of the data. You have heard from my colleagues that there are data sets that are missing. Where there are data, for example, I am looking at tobacco, we have to look at Asian Americans and Pacific Islander populations in a disaggregated group rather than an aggregated group. For example, with the tobacco, it is 3.4 as the overall AAPI group. However, you have numbers as low as .8 in Chinese, as high as 15.9 in the Native Hawaiian population.

 

Local studies have shown Laos(?) for example have rates of over 50 percent smoking. So, a number of 3.4 for AAPIs as a whole really discounts much of our population. I support Hardy Spoehr in his move toward pushing for an OMB 15 adjustment to the year 2000 objectives as Senator Kakka(?) had established to separate out Pacific Islanders because many of their health indicators reflect more accurately the Native American health indicators than they do Asian American health indicators. You aggregate them together, this population drops out, and there are significant needs such as diabetes overlooked as well.  Thank you.

 

DR. BANKS: Thank you.

 

DR. VALDEZ: I don't know if I can do this. Good morning. I am Dr. Elizabeth Valdez. I am the founder and present CEO of Concilio(?) Latino Resolute(?). That is a community-based organization based in Phoenix, Arizona, solely dedicated to health promotion and disease prevention.  My overall comments include that the baseline and tracking system shall be identified and data collected, analyzed and reported for Hispanics and male Hispanics or groups under each objective.  Of 521 numbered objectives only 100, that means less than 20 percent have collected baseline Hispanic data. Improving this number must be an urgent priority for Healthy People 2010.  Whenever Hispanic data are not available a plan on how the data, including Hispanic subgroup data will be collected should be outlined.  The goal of Healthy People 2010 shall be to eliminate racial and ethnic disparities in health under each objective. The target shall be the same for all group with data reported separately for each racial and ethnic group including Hispanics.   Concilio strongly supports the current draft of Healthy People 2010 that calls for eliminating racial and ethnic disparities in health.

 

In the year 2000 there will be an equal number of Hispanics, including persons who live in Puerto Rico and African Americans. This means that one in four persons in the United States will be Hispanic or African American.  By eliminating the health gap among all Americans the Healthy People 2010 objectives will truly achieve an improvement in health for the whole nation.

 

Do I still have time? Thank you. The target setting for Healthy People 2010 shall be the better than the best method. Setting the Healthy People 2010 targets, those that are population based are better than what the best group is doing, moves away from assuming that the non-Hispanic white population always represents the best health standards. Indeed, in many areas including birth outcomes and a number of areas and diet and nutrition Hispanics are doing the best of all groups including non-Hispanic whites.   The better than the best target setting methods allow for all groups in the country to have a target for improved health in all areas of Healthy People 2010.  Reflecting the nation's diversity all objectives shall incorporate the need for culturally and linguistically appropriate services and outreach.

The target setting shall be ambitious and bold. Targets need to reflect change that will have significant impact on human life. In certain areas like environmental health the objectives seem to accomplish little, if anything.  Thank you and have a happy holiday.

 

DR. BANKS: Thank you.

 

We will take the last four comments of people standing, and if there are additional comments we would like for you to submit those in writing or to give those at the end of one of the concurrent sessions.

 

MR. DANISE: Good morning. My name is Roberto Danise. I am the Executive Director for Pitt(?) River Health Services, an organization that provides health and human services to Native Americans in Northern California and Southern Oregon.

 

I would like to add to this a perspective of the people that I represent, and that is 400 years ago when the first settlers came here the Lakota brothers welcomed them like this, a pretty powerful symbol. They spoke different languages, but they were inviting them to follow the principles of quata(?) which means you are my other me. You are my other me.

 

Many problems will be solved if we embrace such a perspective. Another perspective of the Native Americans is to think in terms of what is going to be happening in the future not only 10 years from now but seven generations from now. Perhaps that will be pretty helpful given the last 400 years that we had, and the third one, Native Americans view disease sometimes in a different light For instance, greed is a disease, and imagine if we were to treat one single individual such as Bill Gates (Laughter.)

 

MR. DANISE: -- we will be able to leave him still $1 billion and have $1 billion every year for health curing one single individual. I propose that we reclassify our diagnosis system and treat individuals like that in the US.  (Applause.)

 

DR. BANKS: Thank you very much.

 

MS. JONES: Good morning. My name is Erica Jones, and I represent California Medical Review. California Medical Review is California's peer review organization emphasizing quality improvement projects. Our corporate office is in San Francisco, and I would just like to offer insight toward reducing disparities in minorities and that is as I go about doing education to Medicare beneficiaries I am finding that they aren't educated on their basic rights, moreover what they are entitled to as a Medicare beneficiary and I would move to offer that we implement grassroots educational programs to Medicare beneficiaries to give them a foundation which they need to access quality health for their Medicare benefits.  That is all. Thank you.

 

DR. BANKS: Thank you.

 

MR. BOZARTH: I am Elvis Bozarth. I live in Santa Rosa. I am here representing the Association for Retarded Citizens of the State of California. I am, also, a member of our local area Agency on Aging and president of or local chapter of IARC(?) and a consultant with the National Association Regarding Aging Issues.

There is a great deal of overlap now between the developmental disabilities and aging, largely due to good public health that we have had through the years.  I want to speak about two or three issues that we need badly and that is increased ability for telemedicine, both in the achieving of the technology for training of people to use it. All over this nation including our state we have people living in isolated areas that are bereft of adequate medical care and prevention simply because of accessibility issues.   We need to, also, have a look at getting regulations that are more realistic. For instance, the tremendous underfunding of a model that we have in this state called Residential Care Facility for the Elderly, the sole income to a provider of that is usually the SSI check that the individual draws and as a result of this underfunding the care is underfunded.  In the developmental disabilities we have a model similar to that, but in addition to the SSI the state reimburses some additional matters, and we need models like that all over the country for the aging as well as for people with developmental disabilities, and I want to speak to enforcement. It is one thing to have laws and to give fines to care providers, but unless those fines are collected it doesn't do any good.  Thank you.

 

DR. BANKS: Thank you.

 

MS. SHELTON: Good morning. I am happy to be the caboose this morning. My name is Shirley Shelton, and my comments are personal. However, I do work for the State Department of Health Services here in Sacramento.

 

I have two comments. They are regarding the goals to eliminate health disparities. First of all I would like to say that I, personally, like the goals. I understand and my perspective is that to eliminate health disparities is the ultimate goal, but I am not hung up on whether or not the goal should be eliminate versus reduce.  My perspective is that what I need to do is to improve birth outcomes, and I see it as a continuum. If I improve, I reduce, and that leads to elimination. So, I think the eliminate is the ultimate.

 

Second of all, in order to eliminate health disparities what I would like to see and I implore the federal level to take a look at is modeling to states so that we can model to the local levels the partnership, creation and formation with other departments at the federal level because when we are working in the community to eliminate the disparities we find as I do in my work concerning infant mortality, infant mortality is related to a multitude of issues, such as housing, transportation, child care, incarceration, and the list goes on and on and on.

 

So, what we find is that the priorities in the community are something else, and so what I have realized in the lessons that I have learned is that to eliminate health disparities is bigger than the health issue.  It delves over into other issues. So, what I am really asking the Feds to do is to model to the state a partnership formation with those other agencies so that they can, also, adopt our goals as their goals, and then in turn perhaps we might have a chance at being successful in eliminating the health disparities.   Thank you.

 

DR. BANKS: Thank you.

 

I certainly want to thank everyone for your very thoughtful comments, and I want to assure you that these comments will be taken into consideration as we finalize the Healthy People 2010 document.

I certainly want to invite everybody to participate in one of the concurrent sessions and as I said earlier, both of those concurrent sessions will convene in here, one session on either side of the aisle. There will be a partition that will be erected while we are taking a 15-minute break. This session is adjourned.

(Thereupon, at 9:00 AM the Plenary Session was adjourned.)

Sacramento Transcripts and Summaries