Management Academy On The Road

Here's a quick update on our Management Academy On The Road program. We completed a pilot in Florida with five counties; we launched a new group in Maryland this spring; two more groups launch this summer. The program is two on-site days, supported by webinars and technical assistance before and after (details on the MAPH website).

Here's a short list of business plan ideas in development across these groups.

• An ER Diversion project with hospitals, public health and the Federally Qualified Health Center
• An "Academic Health Department" plan to allow the county to participate in clinical trials, bringing in revenue and expanding treatment options
• A dental clinic add-on to an existing Ryan White organization
• A free clinic to create a bridge for the uninsured until 2014
• A health coaching project
• A project to combine substance abuse/behavioral health in an integrated organization

What ideas are sitting in your community's health improvement plan? What ideas are bubbling up from your community health assessment or your MAPP process? Can we help you push them to implementation?

--Steve Orton

Health, Obesity and Business

A few weeks ago we got the following comment from David, who quoted Dr. Jim Johnson, a faculty member at the Kenan-Flagler Business School and teacher in the Management Academy for Public Health:

"... In the companies he had consulted with, Dr. Johnson stated that the number
one factor a business looks at is the health status of the community. Why?
Because of the potential cost to the company. Yet, our commissioners continue to
focus on tax rates and education levels, both very important, but with barely a
nod towards the community's health. Wonder what it will take to make us truly
realize what our "good health" is worth to us?"

A recent article in the Charlotte Observer, reprinted in our local Raleigh News & Observer which also quoted Dr. Johnson, looked at the issue of businesses assessing health status before committing to communities from a slightly different angle:

… Among other considerations, companies could be eyeing obesity rates before
deciding where to put new plants and offices. The idea is that by examining
obesity rates and avoiding opening where more obese people live, companies can
cut their future health care costs. For the Carolinas, that could spell trouble,
given that the majority of residents are tipping the scales.

This makes me think of a few things, in no particular order:

- recent data are calling into question the assumption that overweight equals unhealthy. For example, a recent New York Times article cited data from the Archives of Internal Medicine that showed that in a study of cardiovascular risk factors in 5,400 adults, half of those deemed overweight and one-third of those deemed obese were "metabolically healthy" -- that is, they had healthy levels of "good" cholesterol, blood pressure, blood glucose, etc. And, about a quarter of slim, "healthy-weight" individuals had at least two cardiovascular risk factors. So any company thinking of using obesity rates as proxy for health should consult with someone who knows the latest research (i.e., a health care or public health researcher or professional -- someone who understands the big picture about health and all it entails) before using that to determine whether to set up shop.

- As David suggests, a good strategy for communities trying to attract business would be to improve the health of its community. Community health insurance? Community design to encourage safe activity in neighborhoods and public spaces? Community resources toward public swimming pools, parks, playgrounds, tennis courts, basketball courts? Community health clinics? There are a lot of things to think about. They cost money, but so do unhealthy citizens and empty worksites.

- A good business strategy for businesses who are already established would be to improve the health status of their employees. How could they do this? One commenter to the N & O story said she tries to apply to companies that offer a gym or fitness discount, and suggested that companies have subsidized cafeteria and gym on the premises to make it easier for employees to fit healthy living into their schedule. Here at the NC Institute for Public Health we don’t have such facilities, but we do have in our written policy manual the support for staff members’ taking breaks to exercise, the commitment to having healthy food at company events, the support for on-site exercise clubs, etc.

- Several Management Academy teams have been built around partnerships with businesses that want to help their employees be healthier. We wrote a few weeks ago in this space about a team in Oklahoma building a partnership around health insurance and business interests. We write about others in the book – in Chapter 6 we mention a plan in Virginia that aimed to provide health screenings and education at worksites (pg. 55). In their exploration of need that team had found that businesses are desperate for public health help in implementing such programs. Visit the “Business Plan” section of the MAPH website (www.maph.unc.edu) for many more ideas. Note that in general, the plans do not solely address obesity; rather they look at the big picture of overall healthy living.

That's all for today.

-- Anne Menkens

What if Health Care Costs were treated like Gas Costs?

Last night we had our “book launch” for Public Health Business Planning here in Chapel Hill. It was a wonderful event, attended by the current cohort of Management Academy, some former students, the Dean of the UNC School of Public Health, faculty, friends, family, and colleagues from across the country. Thank you all for coming!

One conversation out of many sticks with me this morning. I was talking with one of my colleagues here at the NC Institute for Public Health who runs our Leadership Novant program, and we got talking about rising health care costs. It seems that so much attention has been paid to gas costs recently, but rising health care costs are affecting families, businesses, and communities at least as much as rising gas prices. According to a recent info sheet from the National Coalition on Health Care, national health expenditures on health care costs were $2.3 trillion in 2007. If that number is too vast to mean anything, think of this: the annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $12,100 in 2007. Workers contributed nearly $3,300 toward that premium, or 10 percent more than they did in 2006. You can see that would be devastaing to a full-time minimum wage worker making $10,712, but even people making an average income are feeling the hit, for insurance that often covers less and less. An article in the Washington Post pointed out that even when costs are not directly passed on to employees, the increased prices are effectively lowering pay because employers cannot afford to give regular raises under these conditions.

It's not that the media are ignoring this problem, but it is not front and center the way gas prices are this summer. We mused, one of the reasons we think about gas prices so much is that we look at them all the time: at every corner gas station, there’s a huge sign showing today’s price per gallon. Every nightly news segment starts with a story about the price of gas and its effect on a family’s budget, tourism, the trucking industry, food prices… you name it. What if every corner had a sign saying what today’s price for a colonoscopy was, with flip-numbers ready to go up that next dime per procedure? “Get your colonoscopy today because tomorrow it might be doubled in price!” What if every news day started with a run down of the many things families are giving up because they have to pay such high health insurance premiums? Or, worse yet, how many more families are going without health insurance because they need to eat, pay rent and, yes, buy gas? What if the cost of not preventing flu, tooth decay, heart attacks, cancer were broken down into a per-person or per-illness figure and flashed before our eyes every time we went to the drug store? If every time we had to fill a prescription it was like filling a gas tank, putting one pill in at a time and watching a meter go up, we'd pay more attention!

Food for thought.

Anne Menkens