Health Policy Primer (a.k.a. physician activism basics)

1. Health Policy Primer(a.k.a. physician activism basics) Department of Internal Medicine Morning Report 19 March 2007 Ryan Buchholz, MD

2. “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe

3. 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

4. Non-Aims • A partisan political discourse • An excuse for a nap

5. 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

6. 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? Introduction, continued

7. 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

8. Dana Carvey Michael Chang Brian McBride My journey • Childhood: Apathy + Cynicism • “Student government doesn’t matter” • Politicians are selfish • Sports are cooler anyways

9. later wrote My journey: influences • University: Apathy  Service “Social Justice” Drew Hansen

10. “Large-scale social forces…” Subject of My journey: influences • University: “Poverty, Culture, and Infectious Disease” > Paul Farmer MD = natural attorney for the poor

11. “You’re my eyes and ears in the field…” + Dan Glickman Founder of Tony Hall Author of My journey: influences • Post-University: Fighting Hunger

12. 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.

13. 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

14. Assessment / plan? DM, uncontrolled & complications Morbid obesity Poverty OHA/insulin + diet + exercise, labs Eat healthy Refer to Farm Share Case presentation, continued

15. + Jorge C Farm Share • Learned to eat healthy • Lost 150 lbs. • Glycemic control • Volunteering • New lease on life = “Farm Share saved my life.” — Jorge C.

16. Resources and Opportunities

17. Resources • People all around you! • Jane Henney, MD: VP of UC Academic Health Center and former FDA Commissioner (jane.henney@uc.edu) • Robert Graham, MD: UCFP Professor and former Ass’t Surgeon General (grahamj3@fammed.uc.edu) • Stephen Wilson, MD: UC Internist and Pediatrician, Cincinnati Board of Health (wilsse@ucmail.uc.edu) • Melissa Saladonis, CCHMC Director of Government Affairs (melissa.saladonis@cchmc.org) • Sarah Corathers, MD: Chair (ex officio), AAP Resident Section (sarah.corathers@uc.edu)

18. 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

19. 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

20. 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

21. Opportunities: 4 • Books: • White Coat, Clenched Fist (Mullan) • Pathologies of Power (Farmer) • Mountains Beyond Mountains (Kidder)

22. Porter and Teisberg. JAMA 2007;297:1103-11. Opportunities: 4 • Books: • White Coat, Clenched Fist (Mullan) • Pathologies of Power (Farmer) • Mountains Beyond Mountains (Kidder) • Articles: • This past week’s JAMA

23. 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”

24. Summary • Primer on health policy: doctors’ business • Resources and opportunities: strike a chord?

25. “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe

26. Special Thanks • Christine + Jonathan Buchholz • Caroline Mueller • Brian Volck • Tiffiny Diers • Carl Fichtenbaum • Stephen Wilson • Mia Mallory • Melissa Saladonis

27. Questions? Comments? ryan.buchholz@uc.edu or ryan.buchholz@cchmc.org Blog: healthequity.wordpress.com

28. U.S.: #43 U.S.: #29 WHO, World Health Statistics 2005. Health Indicators

29. Health Expenditures U.S.: #1 OECD Indicators 2005

30. A world distorted by AIDS… People Living with HIV, UNDP 2004 Dorling D. PLoS Medicine 2007;4(1)13-8.

31. …is distorted by social structures Physicians Working, WHO 2004 Dorling D. PLoS Medicine 2007;4(1)13-8.