APHA Midyear Meeting on Implementing Health Reform:  A Public Health Approach, Chicago, June 23-25, 2011

If you’re interested in more information than is contained in this very brief report (including breakout sessions), I encourage you to read the full report at ?? and/or and view videos and slides available at http://apha.confex.com/apha/mid2011/webprogram/start.html

I attended the first APHA midyear meeting as the Epidemiology Section representative and attended all plenary sessions as well as several breakout sessions.  The meeting opened with a rousing session on The Public Health Context of Health Care Reform with speakers on health care reform and how it will relate to prevention.  Celinda Lake (Lake Research Partners) gave a fascinating overview of opinions on health care reform and public health. The public is strongly supportive of prevention and thinks it should be a higher priority. However, the public is divided about personal responsibility for health vs. community responsibility. They like incentives for healthy living but not punishment and had little idea of what constitutes community prevention

Former Michigan Gov. Jennifer Granholm was, in my opinion, the most exciting speaker of the conference. She led us through her education in health care. Her take is that vested interests are part of the problem but it’s also that we’re so afraid of government.  This is a uniquely American problem as other countries don’t have this weird aversion to government helping people. We go overseas to fight to install democracy in other countries, but we seem to hate the product of democracy, which is government. We need a heavy dose of citizen activism to prevent damaging cuts to the ACA and to keep Medicare intact. She ended by stating that public health is a form of political, social and economic justice

Seeking Common Ground:  Various Approaches to Improving Population Health consisted of talks with varying viewpoints. Some of the comments were that public health is not the principle target of opposition to ACA but it is in the middle of the bullseye regarding the role of government.  The fate of ACA will be decided on Nov 6, 2012. All agreed that public health and population health is critical and the role of communities is important.  Common ground is not news worthy and while individuals could work out differences, the parties are playing to their respective bases. The public doesn't know the facts and thinks the U.S. health care system is great.

The Friday general session was entitled Putting It All in Perspective:  Public Health, Health Care, and Quality.  Public health is now part of CMS daily conversations, and ACA means they can now hold insurance companies accountable.  CMS wants feedback on what they propose to do which is a three pronged approach - better care for individuals, better health for the population, and reducing costs through improvements, not through withholding care. 

The final plenary, “Where do we go from here?” featured Lawrence Wallack, from Portland State University with an inspiring talk on our challenges. There are more people in poverty than any time since data has been collected. It’s easier to raise strong children than repair broken men. The country is divided into Yoyos (You are on your own) who feel your health is a consequence of your choices and government is just in the way. Then there are the WITTS (We are in this together). WITTS, who have been losing ground since the '70s, think that government provides the basic glue for society and controls market excesses. However, the unintended consequence may be unanticipated dependence on government.  How will we balance individual responsibility with that of state – this is the basic struggle of public health. We believe facts will save the day, but now finding facts matter less than we think, and like an underpowered antibiotic, facts can make situation worse.  We need to make the argument about who we are as a people and why it matters. Our profession is being tested, but we can make a difference!

We ended with a joint luncheon session between the section reps and the state affiliates. There was consensus among the attendees that smaller, regional meetings would be ideal and to keep the same theme of health care reform. There will be a Joint ICS/Affiliates meeting on Oct. 30 at the APHA Annual Meeting to continue the dialogue.

Final thoughts:  It is important that we as epidemiologists follow what’s happening with ACA as initiatives such as meaningful use, comparative effectiveness research, and health outcomes will need our expertise. We can have a major role in designing and evaluating studies, collecting data, interpreting results and in general making sure that the science of public health is included in any decisions made. Thank you for the opportunity to represent the Epidemiology Section.