Late last month, Lilian Shirley, director of Oregon's public health division, urged her colleagues in other states to get involved with healthcare reform efforts.
“As health transformation washes over you and your communities, it would be good to get involved at a very high level,” Shirley said during a webcast meeting hosted by the Northwest Center for Public Health Practice and the University of Washington’s School of Public Health Department of Health Services.
Shirley's presentation discussed the preventive focus of Oregon's state health transformation efforts, which keyed in on providing screening and chronic care services for conditions that contribute to the leading causes of preventable death in the state.
“We knew that we spent about 16 percent, and that was going up every year, just on healthcare spending,” Shirley said. “We also knew that we were spending a lot of money, and Oregon is one of the states that has a high obesity rate.”
At the same time, she said, many in the healthcare field weren't aware what their colleagues were doing to prevent illness upstream – and, in general, different silos tend to speak different languages when it comes to addressing health problems.
“Very few providers were even aware that public health was doing work that could benefit these (low-income) children,” Shirley said, including nutrition programs, health literacy programs, and health screenings.
Shirley said 323,312 adults in Multnomah County are considered at risk, with 35,079 having received the diagnosis. The majority of those diagnosed were receiving treatment, but Shirley said officials have turned their focus to preventing people from developing diabetes in the first place.
Officials have turned the same preventive lens to other major health problems: the behaviors most commonly associated with premature death in Oregon include smoking, unhealthy diet, lack of physical activity, risky alcohol and drug use.
“While we think of liver disease as end stage, but there are so many things we can do upstream to prevent it,” Shirley said, adding that it is the ninth leading cause of death in Oregon.
Other areas of focus have included identifying and working with medically high-risk children, and preventing liver disease in the state.
“We are making sure the funding follows the epidemiology,” Shirley said.
Routine screenings for alcohol and drug abuse are now part of the state's plan for curbing health spending – alone with improved health literacy programs, a healthy retail initiative to improve access to fresh produce, school-based healthy eating programs, and considering health outcomes during city planning efforts.
Shirley urged public health officials to look for opportunities to collect and provide data at the community level and rally resources and partnerships to make a measurable impact on health. She urged audience members to let policy officials involved in reform efforts know what they are already doing to help prevent illness and cut costs, but also to look to community partners to address the social determinants of health and deal with health problems from an upstream perspective – because social inequities created by policy decisions are a major driver of health problems in many populations.
Just providing care, education or screenings isn't the only solution to cutting health costs, she said.
“It's about the people in our communities with us, who live in our communities, who work in our communities,” Shirley said, urging meeting participants to consider the big picture when making health plans.
Christen can be reached at [email protected].
TO LEARN MORE:
To view the Northwest Center for Public Health Practice's webinar including Shirley's talk, click here.