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Advisory Group on Prevention, Health Promotion, and Integrative and Public Health Conference Call

February 26, 2014

Attendees

Advisory Group Members:

Jeffrey Levi (Chair), JudyAnn Bigby, Richard Binder, Valerie Brown, Ned Helms, Patrik Johansson, Janet Kahn, Charlotte Kerr, Elizabeth Mayer-Davis, Dean Ornish, Barbara Otto, Linda Rosenstock, John Seffrin, Ellen Semonoff, Susan Swider, Sharon Van Horn, Kimberlydawn Wisdom

Let the record state who is absent: Jonathan Fielding, Jerry Johnson, Jacob Lozada, Vivek

Murthy, Herminia Palacio

Welcome, Roll Call, and Introductions

Dr. Jeffrey Levi, chair of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (hereinafter called the Advisory Group), welcomed participants. Ms. Brigette Ulin, Acting Designated Federal Official, conducted the roll call and confirmed a quorum was present.

Dr. Levi reviewed the agenda and asked if anyone had additional announcements or topics for discussion. He then introduced Dr. Boris Lushniak, Acting Surgeon General, who provided an update from the Surgeon General’s Office.

Update from the Office of the Surgeon General

Dr. Lushniak’s remarks included the following:

  • A vote of the Senate Health, Education, Labor and Pensions (HELP) Committee had been scheduled that morning on Dr. Vivek Murthy’s becoming the 19th Surgeon General. The previous hearing on February 4, 2014, had some poignant questions but went relatively smoothly. The full Committee voted and put it to the full Senate. There was no indication of when the full Senate vote will occur. Office of the Surgeon General staff are preparing information for the incoming Surgeon General when confirmed.
  • Dr. Mary Beth Bigley moved to the Health Resources and Services Administration. Dr. Bigley played a key role in the National Prevention Council (Council), as well as leading the Surgeon General’s Calls to Action and serving as acting editor of Public Health Reports journal.

Additional highlights from the Office of the Surgeon General include the following:

  • Working closely with the Centers for Disease Control and Prevention (CDC) and all Council departments to prepare the Annual Status Report. All 20 Council member departments are highlighted in the report, sharing their successes under the flag of prevention. This year’s report will be more user-friendly for stakeholders and improve how it highlights Council member departments’ work. The new infographic, Prevention Matters, which shows the four strategic directions, has received tremendous response.
  • On January 11, 2014, in honor of the 50th anniversary of the first Surgeon General’s Report on Smoking and Health, a memorial service was held at the grave of Rear Admiral Luther Terry, who issued the first report. The event was attended by 80 people who have been active in smoking and tobacco control efforts, as well as by Dr. Terry’s sons, and several former Surgeons General. The 50th anniversary report was released January 17, 2014, at a White House event that included Secretary of the Department of Health and Human Services Kathleen Sebelius, Assistant Secretary for Health Dr. Howard Koh, and CDC Director Dr. Thomas Frieden.
  • The Centers for Medicare and Medicaid Services (CMS) recently included the National Prevention Strategy as part of their scope of work for Quality Improvement Organizations (QIOs), which operate in all 50 states and 3 territories to improve healthcare quality for Medicare beneficiaries.
  • The Surgeon General’s office continues to work with Council departments to advance their commitments to the Action Plan—so that prevention is embedded in all aspects of the work and policies of member organizations.

Dr. Levi thanked Dr. Lushniak. He noted that in Dr. Murthy’s hearing, several questions referenced the National Prevention Strategy, and Senator Barbara Mikulski, who chairs the Senate Appropriation Committee, had encouraged Dr. Murthy to increase use of the National Prevention Council.

Discussion of Draft Report to Surgeon General

Dr. Levi thanked the members of the drafting committee and led the group in reviewing the draft. Advisory Group comments/suggestions included:

  • Adding explicit language about having a collective impact framework—in which agencies identify a common agenda and common metric, so they can evaluate the effectiveness and impact of collaboration efforts—and using a well-supported methodology.
  • Recommendations use “must” or “should” in some places and “could” in others; “should” would be more appropriate.
  • Referencing line 46, which indicates lifestyle approaches can be used as both treatment and prevention, and health savings can accrue, language was suggested to indicate that some conventional treatments have been shown not to work and to give examples.
    • There was disagreement about adding these comments to the recommendations. This report should not have a high level of detail, and getting into specifics might muddy things.
    • The drafting committee considered this point, and the current draft reflected the consensus of the group regarding the level of specificity and purpose of this report.
    • The purpose and goal of the report to the Surgeon General was to keep the document high level to a) get consensus from Advisory Group, and b) to generate a robust discussion with the Surgeon General moving forward. The group generally agreed with keeping the report high level. Where and when to provide more specific detail would be the future work of the Council.
    • Dr. Dean Ornish respected the Advisory Group’s decision to not add more detail, but he noted that the decision did not reflect his recommendation.
  • A proposed edit to line 83 of the draft: “…National Prevention Council agencies should use a collective impact framework to assess the initiative including use of common data collection, outcome measures, and grant reporting requirements related to health that can promote multisector collaboration” was made to the document.
  • Regarding lines 154–159, it is not possible to get common data collection unless money is available for the effort. This issue could be addressed in the recommendations regarding process rather than policy.

On Recommendation 2, encourage the integration of the National Prevention Strategy into existing programs. For instance, new community prevention grants created by Congress, and grantees could receive guidance on how to apply the Strategy in that context.

On Recommendation 3, note that health impact assessments pertain to policies and projects. In line 113, the text will be edited as follows: “The Surgeon General should encourage, coordinate, or conduct health impact assessments of key federal policies and projects as a way of promoting the National Prevention Council’s commitment to ‘identify opportunities to consider prevention and health’ within their departments.”

Recommendation 4 pertains to leveraging private sector investments.

Advisory Group comments on the process-related recommendations:

Process Recommendation 1, the Advisory Group could think more about roundtables between the Advisory Group and members of the Council, rather than the more formal method of having select members come before the Advisory Group to “testify.” The roundtables would be a means to flesh out the ideas put forth in the recommendations.

Process Recommendation 2 reflects the desire of Advisory Group members to be emissaries for the National Prevention Strategy without creating a cumbersome structure that would be focused around major events. It would take advantage of the Surgeon General’s visits to various communities, and Advisory Group members would carry on the discussion with their communities. A revision will be made beginning in line 148 so it is clear that the recommendation pertains to communities in which an Advisory Group member works: “…the Surgeon General should establish an ongoing communication process in each community that has an Advisory Group member regarding the NPS.”

Process Recommendation 3 notes that the Annual Status Report is not an ongoing requirement. It is important for the Advisory Group to affirm the value of the annual report and recommend that it continue. The group agreed with this recommendation as written.

Process Recommendation 4 notes that to fulfill the Advisory Group’s mission fully, additional resources would be needed. Beginning in line 161, the following change will be made: “Resources provided to coordinate the National Prevention Council’s work should be sufficient to carry out our recommended initiatives."

Dr. Levi took a formal vote on the report to the Surgeon General. All members present were in favor; there were zero “no” votes or abstentions. Let the record show who were absent for voting: Dr. Jonathan Fielding, Dr. John Seffrin, Dr. Vivek Murthy, Mr. Jerry Johnson, Dr. Herminia Palacio, and Dr. Jacob Lozada.

Discussion of Draft Resolution on Prevention Programming Changes

A draft resolution regarding the Omnibus appropriation, which puts forth some changes on prevention programming, was discussed. In the past, the Advisory Group has been concerned about allocation of the Prevention and Public Health Fund. Congress did appropriate the entire amount (minus sequestration) to prevention and public health programs. That has permitted an increase in the CDC budget and total funding amount available for community prevention programs. But there were some notable changes. The Community Transformation Grants (CTGs), the signature program in the Affordable Care Act around community prevention, have ended in year 3 of what was meant to be a 5-year program. Funding that previously went to the CTGs was redistributed to two divisions of CDC in the National Center for Chronic Disease Prevention and Health Promotion for related prevention activities. Congress created an $80 million/year community prevention program; funding can go to local health departments and non-governmental organizations to do prevention. All funding is explicitly focused on primary prevention. The REACH program, which experienced cuts in FY 2013, was restored to the $50 million level in FY 2014. The Preventive Health Services Block Grants were funded at $180 million, about double current spending.

Some funding line items were merged or disappeared. The Community Preventive Services Task Force line item in the Prevention Fund was eliminated; appropriators have communicated that the CDC base budget can take care of that. The $1 million line item for the National Prevention Council is no longer there; however, CDC and the HHS Secretary’s office have communicated commitments for resources to continue the work of the Council and Advisory Group.

Advisory Group comments/suggestions:

  • The allocations for public health and prevention is excellent news. It is important for the Advisory Group to voice not only what the group feels is not going well, but also to affirm favorable decisions.
  • The Advisory Group agreed with moving the resolution forward. No comments were voiced related to the first two paragraphs.
  • In paragraph 3, it was suggested to add a couple of words about health equity or health care equity.
  • Consider incorporating the idea of breaking down silos of public health and medicine and noting the need to address collaboration across the public and private sectors. Although the resolution includes the term multisector, consider making the public-private aspect more explicit.
  • Proposed edits to the third paragraph are as follows: “It is our hope that as the Administration implements these new or increased funding streams, it will ensure that activities supported are consistent with the National Prevention Strategy’s vision of multisector, public-private collaborative efforts that promote health and health and health care equity.”
  • It was noted that as funding streams have expanded and contracted, sustainability is key, and why, in part, public-private partnership is important. The private sector can support traditionally public sector efforts. It’s important to look at sustainable models as well.
  • Building in sustainability is hard to do that through the block grant program because funding vacillates.
  • Inherent in most grants is a requirement that work be evidence-based. For the Advisory Group’s purposes, grantees are driven to do evidence-based work, because it is the most supported by the most people. Priority should be given to evidence-based programs.

Dr. Levi asked for other comments and a vote. All members were in favor; there were zero “no” votes or abstentions. Let the record show who were absent for voting: Dr. Fielding, Dr. Seffrin, Dr. Murthy, Mr. Johnson, Dr. Palacio, and Dr. Lozada.

Dr. Levi called for additional updates.

Dr. Janet Kahn provided an update on Section 2706. The Office of Personnel Management (OPM) is now requiring that insurance plans that cover Federal employees have explicit wording that they now cover any licensed practitioner within the scope of their licensing. Additionally, a petition is being circulated by an individual who was denied coverage for services she thought this section addressed. This change is significant as OPM collects a lot of data and could get some meaningful information; it would be worth reconvening the data working group and engaging OPM up front about collecting data.

Dr. Levi also shared an update on behalf of Dr. Herminia Palacio. The Robert Wood Johnson Foundation’s Commission to Build a Healthier America released its recommendations on January 13, 2014. Many of the recommendations are in line with what the Advisory Group has talked about. The staff director for the report offered to do a webinar to brief Advisory Group members; they are working to schedule that soon.

Discussion about Next Advisory Group Meeting

Dr. Levi noted the dates of the next meeting, April 28–29, 2014. If a new Surgeon General has been confirmed, Dr. Levi proposed allowing time for him or her to lay out a vision and get feedback from the group about that vision.

To move forward with the recommendations in the report the Advisory Group voted on, it was suggested to hold Council roundtable discussions on 1) braiding funding and common data collection and 2) health impact assessments. The Advisory Group agreed with this approach and will move in that direction.

Public Comment

No requests were received for public comment.

Dr. Levi adjourned the meeting.