Good Advice

Physicians Help Shape Public Health Policy

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 Tex Med. 2013;109(10):43-47.

By Crystal Zuzek
Associate Editor   

Texas physicians are making a difference, not only in their clinics and hospitals, but on state and local committees that help shape health care policy. Reducing death and disability from cardiovascular disease and stroke and improving childhood nutrition are just two of the areas where physicians' expertise is vital.

Physicians bring knowledge and experience to public health groups, says William "Chip" Riggins, MD, a member of the Public Health Funding and Policy Committee (PHFPC) created by the legislature in 2011. Dr. Riggins also is a member of the Texas Medical Association Council on Science and Public Health and executive director and local health authority of Williamson County and Cities Health District. "Physicians are on the front line of health care and should have a prominent role in public health as the health care landscape transforms."

TMA helps physicians gain membership on state public health committees. For instance, the association nominated Dr. Riggins and Harlan "Mark" Guidry, MD, health authority and chief executive officer of Galveston County Health District, to fill local health authority positions on the PHFPC when it was established. Dr. Riggins is the committee vice chair.

State officials look to TMA for recommendations on physicians to fill committee positions. When established state committees and councils have vacancies, the Texas Department of State Health Services (DSHS) or other agency typically notifies TMA and invites the association to submit a nomination. TMA then sends a letter of reference to support a physician member who is qualified and interested in membership. And when new TMA-supported legislation creates a committee or council, the association works with the appropriate agency to appoint a TMA member. A TMA member may contact the association for support in becoming a member of a state committee or council.

Fighting Chronic Disease

J. Neal Rutledge, MD, an Austin neurointerventional surgeon, is acting chair of the Texas Council on Cardiovascular Disease and Stroke. He's been a member since 2005. He also chairs the Governor's EMS and Trauma Advisory Council Stroke Committee. Dr. Rutledge says his goal is to "decrease state expenditures by promoting prevention, effective acute treatment, and remediation of cardiovascular disease and stroke."

"The council is focusing on chronic disease and rehabilitation and research with better metrics and targeted reporting for the legislature," he said.

Created by the legislature in 1999, the council combats cardiovascular disease (CVD) and stroke, which DSHS says are the No. 1 and No. 3 causes of death in Texas. It does so through health education, public awareness, and community outreach. It also coordinates activities among agencies to improve access to treatment; develops treatment recommendations; and collects and analyzes information related to CVD and stroke.

The council collaborates with business, health care, education, and community organizations to develop a list of indicators that can help communities promote a healthy environment to reduce the impact of CVD and stroke. Dr. Rutledge says indicators adopted by cities who participate in the Heart and Stroke Healthy City Program include placing lifesaving devices such as automated external defibrillators in public places, preserving park space for physical activity, and encouraging employers to offer health insurance coverage for preventive services.

The Heart and Stroke Healthy City Program recognizes cities that have implemented health-conscious policies that can influence positive environmental change and improve health.

Dr. Rutledge says the program's "interventions have made a difference in increasing physical activity, improving eating habits, reducing tobacco use, and decreasing emergency response time to heart attacks and strokes."

Assessing School Nutrition 

Texas Agriculture Commissioner Todd Staples established the Healthy Students = Healthy Families committee in 2007 to advise the Texas Department of Agriculture (TDA) on the state's public school nutrition policy and on program administration matters.

The advisory committee's 11 members include nutritionists, health care professionals, food service professionals, and educators. Texas Pediatric Society (TPS) President Kimberly Avila Edwards, MD, of Austin, has chaired the committee since its inception and represents TPS and TMA.

"Government's ability to be accountable to its people depends on the public's involvement in the process," Commissioner Staples said. "Without this leadership, unintended consequences are inevitable. Dr. Kim Avila Edwards' leadership as chair of the Healthy Students = Healthy Families advisory committee has been extremely valuable as we have continued to focus our child nutrition assistance programs to place those who are truly in need on a path of self-sufficiency."

The committee works with the Texas Hunger Initiative in the Baylor University School of Social Work to assess the barriers Texas school districts face in offering summer food programs. The committee plans to give TDA input on methods to increase participation among eligible children.

"One in four Texas children is at risk for hunger. Some children who qualify for free or reduced-price school meals don't take part in a summer food program. The committee plans to examine the issue and provide recommendations to TDA to help eliminate the obstacles that prevent some children from participating," Dr. Avila Edwards said.

The Center for Public Policy Priorities has identified factors that limit access to summer food programs, including lack of transportation, inadequate meal reimbursements and number of food sites, and lack of program awareness.

Healthy Students = Healthy Families also works to identify potential changes to the Texas public school nutrition policy that could improve service delivery and student wellness.

Dr. Avila Edwards says the committee is collaborating with Texas AgriLife, a research group that focuses on agriculture, natural resources, and the life sciences, to assess methods to identify and evaluate food waste in schools and recommend ways TDA can reduce it. 

Dr. Avila Edwards encourages physicians to get involved with state and local groups that have the power to shape public health policy.

"Physicians have expertise in individual health and behaviors and can lend their unique viewpoints to influence the overall health of Texas communities," she said.

Transforming Public Health

PHFPC, upon which Drs. Guidry and Riggins serve, helped DSHS change the way it funds local health departments.

The committee evaluated DSHS contracts with local departments and helped them improve operations. DSHS funds local health departments in two ways: noncompetitive contracts renewed annually and competitive grants for which local health departments and other entities, such as community health centers, apply.

According to Dr. Guidry, DSHS had many noncompetitive contracts for services with local health departments that posed administrative burdens. The committee recommended - and DSHS agreed - that noncompetitive contracts be bundled. Now, instead of 25 separate contracts for services, for example, local health departments receive one that bundles all services together. Dr. Guidry says this makes the process more manageable for local health departments.

Dr. Riggins says the committee's operational recommendations to DSHS "will result in improved flexibility and predictability of public health contracts and hopefully improved stability for local health departments to focus on the health of their communities."

The legislature directed PHFPC to define the core public health services a local entity should provide to establish a common standard for what should be funded. The committee also evaluates the state's public health system related to those services and identifies areas for improvement. PHFPC identifies all funding sources available to local health entities to perform the core public health services, and committee members establish public health policy priorities.

Each year, the committee presents a report on its activities to the legislature that includes recommendations on the use and allocation of funds, ways to improve the overall health of Texans, and the contracting process for local public health services.

The committee's 2013 annual report, available online, details the group's efforts to accomplish its goals.

Additionally, PHFPC surveyed local health authorities and found that many feel the position is underutilized and its responsibilities too vaguely defined. Drs. Riggins and Guidry say the results of the survey suggest a need for more training for local health authorities.

"I think as we redefine public health agencies, we need to look at a more modern role for local health authorities as the formal bridges to the health care community and as leaders in community preparedness, health improvement, and the provision of culturally appropriate services. I think we should ask if the current role, with its emphasis on regulatory programs, police powers in emergencies and outbreaks, and approval for transport of deceased bodies, is the best use of our time and talents as trusted leaders," Dr. Riggins said. 

TMA Takes a Stand

As a member of the TMA Council on Science and Public Health, Dr. Riggins has the opportunity to report back and seek input from the association on policy issues PHFPC is considering. This collaboration resulted in the recent revision of TMA policies on public health infrastructure. The TMA House of Delegates at TexMed 2013 adopted a policy that lists these 10 essential public health services: 

  • Monitor health status to identify community health problems.
  • Diagnose and investigate health problems and health hazards in the community.
  • Inform, educate, and empower people about health issues.
  • Mobilize community partnerships to identify and solve health problems.
  • Develop policies and plans that support individual and community health efforts.
  • Enforce laws and regulations that protect health and ensure safety.
  • Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
  • Assure a competent public health and personal health care workforce.
  • Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
  • Research new insights and innovative solutions to health problems. 

The policy also affirms TMA's stance that health departments should receive adequate funding "to provide these essential services in every Texas community deliberately and apart from indigent care."

The House of Delegates also adopted a policy on core public health functions: "The Texas Medical Association affirms the need for the practice of the core public health functions of assessment, assurance, and policy development as distinct, inherently governmental, complementary, and necessary to support population health in each Texas community."

TMA clarified its policies on local public health authorities and training. New policy states TMA "recognizes that there is an interdependence between medicine and public health and supports the preservation of the local health authority role as the bridge between both." The policy urges DSHS to encourage local public health entities "to collaborate with county medical societies to strengthen the bond between medicine and public health."

PHFPC is evaluating and recommending improvements to the definition of public health in Texas and vetting the Minimum Package of Public Health Services recommended by the Institute of Medicine (IOM) in its 2012 report titled For the Public's Health: Investing in a Healthier Future. Dr. Riggins says the concept is gaining momentum nationally and advocates consistent funding for public health agencies so they can implement population-based health improvement strategies in addition to fulfilling a safety net role. 

"Our committee's work will be vital to ensuring Texas is prepared for any changes in federal funding approaches. Ultimately, it's increasingly clear that funding and policy changes at the federal and state levels will be necessary to realize improved health outcomes from our health care expenditures," Dr. Riggins said. 

Crystal Zuzek can be reached at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email.

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