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

April 28–29, 2014

Attendees

Advisory Group Members:
Jeff Levi (chair), JudyAnn Bigby, Richard Binder, Valerie Brown, Jonathan Fielding, Patrik Johansson, Jerry Johnson, Charlotte Kerr, Jacob Lozada, Elizabeth Mayer-Davis (by phone), Barbara Otto, John Seffrin, Ellen Semonoff (by phone), Susan Swider, Sharon Van Horn, Kimberlydawn Wisdom

Regrets:
Ned Helms, Janet Kahn, Vivek Murthy, Dean Ornish, Herminia Palacio, Linda Rosenstock

HHS:
Boris Lushniak, Acting Surgeon General; Dawn Alley; Capt. Robert DeMartino; Corinne Graffunder; Brigette Ulin

9:00 a.m. Welcome and Roll Call

Dr. Corinne Graffunder called the roll and confirmed a quorum was present.
Dr. Jeff Levi reviewed the agenda, noting that the framework for the discussions was arranged around the Advisory Group’s recommendations to the Surgeon General, finalized during the March 2014 call. He also indicated there was time on the agenda for internal discussion about the Advisory Group’s future direction. This meeting was designed to emphasize conversation with National Prevention Council representatives.

9:45 a.m. Health Impact Assessments: Integrating Health into Decision Making

Brigette Ulin, Director, Office of the National Prevention Strategy, CDC
Ms. Ulin gave an overview of National Prevention Strategy’s mission and vision and highlighted the recommendation to use health impact assessments in making decisions. She outlined six steps in conducting a health impact assessment (HIA) and summarized CDC-funded work by the National Network of Public Health Institutes in fall 2011, which identified four projects that are aligned with the National Prevention Strategy goals: two by the Environmental Protection Agency (EPA), one by Department of Transportation (DOT), and one by Department of Housing and Urban Development (HUD). In the next few months, the National Network will release a report about these projects. Ms.
Ulin’s slides are available by request by emailing NPCSupport@cdc.gov.
 

Florence Fulk, EPA, Office of Research and Development
Ms. Fulk noted the benefits of the HIA in bringing health into sectors that are not health-related, like transportation, housing, community planning, energy, and resource management. She shared EPA’s Sustainable and Healthy Communities (SHC) Research Program, of which HIAs are an integral part. Last year, EPA conducted a review of HIAs in the United States to identify the state of HIA practice. The report highlights best practices and areas for improvement. Ms. Fulk also shared two case studies to

highlight EPA’s work with HIAs—one at the Gerena Community School in Springfield, MA, and the other in an Atlanta community. Slides are available by request by emailing NPCSupport@cdc.gov.

Question and Answer Session Highlights

Advisory Group members raised questions and suggestions about the following:

  • EPA consideration of incorporating HIAs in the agency’s granting process. Federal guidance would help open the conversation about HIAs at the local level. Presenters noted FEMA was interested in suggesting HIAs as part of receiving revitalization funds; and Community Transformation Grant (CTG) communities are encouraged to use HIAs and bring together multiple sectors.
  • The connection between the built and natural environment. Ms. Fulk referenced EPA’s Eco- Health Relationship Browser, a web-based tool for communities to determine connections between the environment and various other factors for community health.
  • Technical assistance (TA) for HIAs, repositories of Federal programs doing or supporting HIAs at the State/local level, and development of models that can be shared easily. Part of TA is developing tools and resources to scale up effective HIA practices and demonstrating the benefits and value of HIA. EPA is working on an HIA roadmap to provide easily accessible data and tools for the HIA community of practice.
  • Integrating HIAs into decision making so it is not a separate process. A goal of the National Prevention Strategy is to empower people to build HIAs into standard practice; EPA’s goal is to provide that capacity to any community across the United States.
  • Encouraging State and local agencies to include health as a key element in their planning requirements and to show the economic as well as environmental impacts.

10:15 a.m. Update from the Acting Surgeon General

RADM Boris Lushniak provided an update from the Surgeon General’s (SG) office. The process of confirming Dr. Vivek Murthy has been paused, and the Senate will continue the process after the November elections.
Highlights of recent activity include:

  • Efforts continue to get the word out about the National Prevention Strategy and promote practices in the strategy until they become routine.
  • With the 50th anniversary of the Surgeon General’s Report on Smoking, there is a large focus on tobacco use. This is expected to continue into 2015.
  • Access to healthy foods is still a major focus of the National Prevention Strategy. Progress continues in increasing healthy options in Federal facilities.

Staff transitions were noted: Dr. Dawn Alley is leaving the SG office and heading to the Center for Medicare and Medicaid Services (CMS); and Hallie Willis is leaving CDC for a position outside of government.
Question and Answer Session Highlights
Advisory group members asked about how the SG and the Federal Government are addressing e- cigarettes. Dr. Lushniak noted the Food and Drug Administration (FDA) is working to regulate e-cigarettes like they do burned-tobacco cigarettes, which brings restrictions on sales to minors. Some localities are banning e-cigarettes where they also ban tobacco use.

10:30 a.m. Collective Impact

Eve Birge, Department of Education (ED); Michelle Bechard, Substance Abuse and Mental Health Services Administration (SAMHSA); Ingrid Donato, SAMHSA; Janet Chiancone, Department of Justice (DOJ)
Ms. Birge gave an overview of the School Climate Transformation Grants, a program ED developed in collaboration with HHS and DOJ. The grants will help States and school districts build capacity to implement multi-tiered frameworks to improve school climate. There are two initiatives—one at the State level, and one at the local/districts level. The program is part of the national effort to promote emotional, mental, and behavioral health and improve conditions of learning. This interagency collaboration illustrates the President’s commitment to healthier, safer communities.

Ms. Bechard shared SAMHSA’s Project AWARE (Advancing Wellness and Resilience in Education) and Mental Health First Aid program. The programs share goals—to connect children and families to services and supports, improve conditions for learning, improve behavioral outcomes, increase ability to respond to issues among school-age youth, and reduce the “school-to-prison” pipeline. There are two requests for proposal (RFPs) for Project AWARE—one for local, and one for State. The local RFP focuses on training school personnel and other adults to detect and respond to mental health issues in kids (mental health first aid). SAMHSA will make 100 awards for $50,000 for 2 years. Local agencies must also apply for the School Climate Transformation Grants. The State AWARE program builds on Safe Schools/Healthy Students and aims to increase capacity and connect kids and families with services. Each State must select three local communities to partner with. SAMHSA will fund 20 State at about $1.2 million for 2 years.

Ms. Chiancone discussed DOJ’s School Justice Collaborative Program, which aims to build research- based initiatives and knowledge around what works in school safety and security. Applicants must also apply for the School Climate Transformation Grants and Project AWARE. Much of this work builds on the ongoing Supportive School Discipline Initiative and Safe Schools/Healthy Students programs. DOJ is working with partner agencies to bring together local and State teams to build consensus around appropriate responses for early intervention and prevention. This work complements the Comprehensive School Safety Initiative from the National Institute of Justice.

Question and Answer Session Highlights
Advisory Group members posed questions and suggestions about the following:

  • The preference for having one application for this funding stream instead of three, which also means three separate reporting systems. Presenters indicated that separate budgets and different curricula posed a challenge for one funding stream.
  • The desire to gather collective impact data at the State and local levels rather than having separate evaluations, and the need to think about common ways to measure across the three programs now, so evaluators are not retrofitting metrics to the programs.
  • Including the five elements of collective impact to achieve consistent and coordinated methodology and achieve the greatest impact possible.
  • Provision of TA—ideally, by the same TA provider across all three programs. Presenters indicated there are separate TA providers and although there is not a mechanism to allow them to work collaboratively, they do support one another in what they provide to grant recipients.

11:00 a.m. Incorporating Prevention into Health System Change

Patrick Conway, Chief Medical Officer, Center for Medicare and Medicaid Innovation (CMMI)
Dr. Conway shared that population health is a top priority of CMMI and highlighted four programs:

  • State Innovation Grants to improve health systems and achieve better population health, better health care quality, and lower health care costs.
  • Million Hearts®, a collaborative effort with CMS, CDC, and others, with the goal to prevent a million heart attacks and strokes over 5 years. Activities are aimed at transforming behavior and communities and developing a payment model to support this effort.
  • Health Care Innovation Awards, the first round of which had several initiatives and models focused on prevention. Round two focuses on population health specifically; those awards will be announced late May or early June.
  • Strong Start Initiative, which works across the Federal Government to reduce preterm birth and improve prenatal care. One key goal is to reduce early elective delivery, on which they are working with States and nonprofits, such as the March of Dimes.

>Question and Answer Session Highlights
Advisory Group members posed questions about the following:

  • States that are integrating population health and clinical care. Dr. Conway indicated six States are testing integration models, and 19 are designing interventions to be tested.
  • Clarification of how CMMI defines “population health,” as many using the term are really talking about population management. CMMI intends a broader construct when talking about population health; it looks at community investment with the denominator being the population in a whole community.
  • The distinction between prevention and health promotion. CMMI sees those as different, but related concepts; they have different levers.
  • Proximal measures to show progress as we work toward long-term outcomes. Dr. Conway acknowledged the need for diversity of investment with different time horizons: both quick wins and longer term investments.

11:30 a.m. Advisory Group Discussion

Dr. Levi noted there is still a challenge in defining community-wide interventions that can meet relatively short timeframes for return on investment. Good intermediate measures are needed to see return on investment in 3 years. Short-term initiatives with quick returns can subsidize longer term initiatives.
Discussion highlights:

  • How States can leverage Medicaid dollars for prevention made available under ACA and how to help people understand the expanded coverage and access to services.
  • Hennepin County is using Medicaid dollars to support social services like housing, employment, and expanded behavioral health. Hospitals can discharge people sooner if they have stable housing to return to. The question is whether savings go to social services or result in cost adjustments.
  • The relative costs of preventive interventions vs. medical treatments.
  • Consideration of health practices in other parts of the world.

1:00 p.m. Discussion of the State Surgeon General Concept

Kimberlydawn Wisdom, Henry Ford Health System
Dr. Wisdom discussed the idea of advancing health care through a State Surgeon General (SSG) model. She described her experience as Michigan’s SSG, outlined key roles of that position, and shared key activities: developing the report Prescription for a Healthier Michigan; the Michigan Steps Up program (focused on healthy eating, physical activity, and tobacco use prevention); the Health Risk Appraisal initiative; and the Healthy School Environment Recognition Program. She also shared a 2010 report evaluating the Michigan SSG experience and a broader review to explore the feasibility of implementing the SSG model in all States. Next steps include continuing to interview key stakeholders, producing recommendations, gathering expert opinion and feedback, convening focus groups, engaging professional associations, and identifying funding to advance the concept. Release of the report is expected in fall
2014. Dr. Wisdom’s full presentation is available by request by emailing NPCSupport@cdc.gov.

Question and Answer Session Highlights
Advisory Group members also discussed the following:

  • Feedback from the State health director and potential overlap between SSG and the chief medical officer, health directors, and similar positions. Dr. Wisdom noted that in Michigan, her post, community health, and the State health director worked closely together. Whether the health risk appraisal gained any traction and led to an integrative approach. Dr. Wisdom noted that 33,000 people did health risk appraisals, and in the final year, 200 schools received awards after their health risk appraisal.
  • The potential for division between health promotion and disease if roles of SSG and health officer were separated.

1:30 p.m. Update on Education & Health Working Group

Dr. Levi recapped the purpose of this working group and its discussions, which were reported to the Advisory Group on September 26, 2013, and announced a National Collaborative for Education & Health. Co-chaired by Dr. Levi and Rochelle Davis, the collaborative will bring multiple sectors to the
table, along with Federal agencies participating in an ex officio capacity; it is designed to generate dialog. A steering committee and two working groups will look at specific topics.

2:00 p.m. Health Metrics in Non-Health Programs: An Overview

George Washington University prepared an overview of metrics to begin this discussion. Dr. Levi opened the discussion with one key question to consider: What is the difference between health-related metrics and health-relevant metrics?
Goals of the discussion:

  • Start more direct interaction between the Advisory Group and the Council.
  • Begin the conversation about metrics and identify agencies to work with the group to identify useful data that already exist and can be packaged differently.

2:45 p.m. Roundtable Discussion w/ National Prevention Council Members: Incorporating Health metrics into Cross-Sector Programs
Each Council representative briefly summarized his or her agency’s activities that relate to health metrics.

Dr. Christine Hunter, Office of Personnel Management (OPM): OPM handles health care benefits and work-life policy for 8.2 million covered lives and offers 150 plan options available in 31 States for care at all stages of life. OPM measures tobacco use behavior through the Federal Employee Benefits Survey and through the Consumer Assessment of Health Plans Survey (CAPS). They found 12% prevalence of active smokers/tobacco users, but most users do not know a tobacco cessation benefit is available; OPM is working to get that word out. The third measure is the percentage of women who receive prenatal care in the first trimester. Early data suggest women in HMOs do better than those in PPO plans. OPM is working to identify barriers not related to cost and coverage.

Ms. Linda Cook, Corporation for National and Community Service (CNCS): CNCS funds national service programs such as Americorps Vista and the Social Innovation Fund, engaging volunteers to improve communities. Every year, their research department looks at the impact of volunteering on health. Grantees are required to collect national performance measures—preset outputs and outcomes. Many are related to education, the environment, and disaster preparedness as well as healthy future measures— aging in place, health education, childhood obesity, and access to care.

Ms. Ellen Bosley, Veterans Administration (VA): The Veterans Health Administration offers patient care services and looks at the health of all veterans, more than 8 million enrolled. The VA External Peer Program is a contract program to implement metrics in all facilities. VA’s Healthy Teaching Kitchen is working to change eating habits of veterans and through that program, VA collects weight, BMI, and A1c levels. Each VA Medical Center has a department to operationalize metrics on diabetes, hypertension, heart disease, tobacco use, and flu immunization.

Dr. Larry Raine, Department of Homeland Security (DHS): The DHS Office of Health Affairs looks at the health and well-being of the DHS workforce, which consists of 240,000 employees. Health Threats Resilience Division looks at surveillance activities that are health related. Workforce Health and Medical Support Division addresses occupational health and medical countermeasures. DHS Together is an employee resilience-building and suicide-prevention initiative; pilots are underway of various elements of the program.

Ms. Elena Lynett, Department of Labor (DOL): Many areas within DOL influence health. The Employee Benefits Security Administration implements laws that apply to group plans and other health-related laws (e.g., Health Insurance Portability and Accountability Act [HIPAA]). They partner with Treasury and HHS. The Office of Enforcement looks at compliance with laws; this information helps them target resources for training and outreach. Through the Health Benefits Campaign, DOL partners with other Federal and State departments to provide outreach and training on their laws to improve compliance and, in turn, the health of people covered under those plans. DOL is also implementing the Mental Health Parity Act and regulations on wellness through ADA and HIPAA.

Ms. Kathy Sykes, Environmental Protection Agency (EPA): EPA’s mission is to protect human health and the environment. The agency participates in a Federal interagency forum on aging-related statistics and a forum on children and families, which look at key indicators, such as affordable housing and safe drinking water. Health-relevant indicators can be mined. EPA also works with OMB, Housing and Urban Development, and DOT on environmental standards. One measure is the percentage of people living in counties with poor air quality. EPA also participates in an environmental justice interagency forum, efforts to create walkable communities for active aging, and work to integrate health into the built environment.

Ms. Sue Damour, General Services Administration (GSA): GSA is the Federal infrastructure agency. GSA sponsors 104 child care centers in the United States; all have adopted and met Let’s Move! criteria for child care, and 97% are certified. They use a walkability index when siting buildings and piloted FitWel (similar to Leadership in Energy & Environmental Design) for healthy building environments. Additionally, GSA is working to improve food offerings in vending machines in the 1,500 buildings it owns and more than 8,000 it leases.

Mr. Jake Welman, Department of Transportation (DOT): DOT is exploring the overlap of health and transportation. Two of the secretary’s priorities for the department are relevant to health: safety for pedestrians and bicyclists; and ladders of opportunity, building infrastructure to connect people via transportation to services. The National Highway Transportation Safety Administration (NHTSA) collects data on seat belt use, child safety seat use, and other measures and just started developing performance measures for road safety to get uniform data on fatalities and serious injuries across States. DOT is also working with CDC to develop a transportation and health tool to give developers and planners data on the health factors related to transportation. The challenge is being able to boil down data to the smallest unit that can be useful for local municipalities.

Ms. Jane Sanville, representing Mr. David Mineta, Office of National Drug Control Policy (ONDCP): ONDCP, seated in the Executive Office of the President, oversees all agencies that have drug control as part of their mission. The goal of the National Drug Control Strategy—to reduce use and consequences of drug use—involves prevention, early intervention, treatment, and interdiction. ONDCP has brought together seven working groups, one for each of its initiatives. Each group was asked what success would look like in their areas and identified and ranked the ideal measures for each area to determine success. ONDCP then looked at what data it already has to inform those measures. Data had to be reliable and related to the measure, beyond compromise, and collected in the past and obtainable in the foreseeable future. The greatest challenge in choosing measures was lack of data availability. For prevention, there are six measures: three for intent to use, and three for age of initiation.

Dr. Warren Lockette, Deputy Assistant Secretary for Health Affairs, Department of Defense (DOD): Between active members, families, and Federal civilian employees, DOD has 9.6 million beneficiaries. DOD does an annual assessment of health for all active members; these assessments include HEDIS measures to address prevention, as in any health care system. DOD also does a survey of health behaviors, which looks at sexual behavior, sleep patterns, drug and alcohol use, and behavioral health. Data come out every 3 years. The DOD health system is the only one that tracks the behavioral health of every person that shows up for an appointment; they can tell if a service member or beneficiary is improving over time.

Mr. Jerald Mande, U.S. Department of Agriculture (USDA): USDA has a food and nutrition mission area and consumer services. It implements 15 feeding programs—including SNAP, WIC, and school meals program. USDA updated standards in all school meals and now has jurisdiction on all foods served during the school day through Healthy Hunger-free Kids. The SNAP food stamps program serves 48 million Americans, half of which are children under age 18. It provides cash benefit for buying food with few restrictions. This population has the same problems with obesity and nutrition as the rest of the U.S. population, so USDA has an initiative to improve nutrition and health. SNAP-Ed provides $400 million, provided through grants to States, for nutrition education, obesity prevention, and policy systems and environmental changes. For SNAP-Ed, they measure what people know before and after training and changes that were made. Mr. Andy Reisenberg, USDA, added that the challenge is finding common metrics to use in measuring success of programs and policy changes. They identified 51 indicators of program success across all levels of the socio-ecological model. They will focus on 14 priority indicators for 2015 and test within one region.

Ms. Rodina Cave, Senior Policy Advisor to the Secretary for Indian Affairs, Department of Interior (DOI): DOI has two council designees—Bureau of Indian Affairs (BIA) and the National Park Service. BIA works on a range of issues relating to 166 tribes: water, public safety, child welfare, etc. Their new initiative called Tawahi (family in Lakota) is meant to take a more holistic view of problems in Indian communities—looking at issues such as poverty, violence, recidivism, and substance abuse; and enhancing social services, job training, and housing. BIA is working with DOJ to address children’s exposure to violence. BIA’s Strengthening Tribal Communities initiative has $1 million earmarked for metrics and measuring.

Dr. Levi noted it would be great to collect data directly related to the National Prevention Strategy to include in the annual report. These measures fall into two categories: 1) measures of what is happening within the Government; and 2) measures of external impact, both directly and indirectly related to health outcomes. The challenge for the Advisory Group and Council representatives is that it is not possible to do all of these, so what is the best way to leverage efforts to move metrics forward to create measurable impact?

Advisory Group members offered a range of suggestions and comments:

  • The Advisory Group should highlight best practices between and among some of the Council members. A clearer logic model, such as the Healthy People 2020 objectives is also needed, along with the identification of common metrics for given populations.
  • A big chart that shows current measures, how they are being measured, and how robust they are would be helpful, as would a simplified, common vocabulary in achieving consistent measures across a wide range of activities.
  • The need to cross-fertilize and set common goals to unify activities. A Federal report by the interagency forum on aging is a good starting point.
  • It is important to assess multi-level data at the community level, to look at health attributes of communities. Resilience is one key factor both when facing emergencies and for day-to-day difficulties. The Institute of Medicine wrote a report, Ready and Resilient Communities; this report helped DHS develop its plan for resilience.
  • The Strategy has process measures; discussion of metrics needs to focus on outcome measures.

Dr. Levi thanked the panelists and acknowledged that this was just the beginning of the conversation and that it provided a lot of helpful information for the Advisory Group to think about.

4:45 p.m. Public Comment

Dr. Paige Estag, physician in Tampa, Florida
She is preparing to open a preventive medicine specialty practice and wants to be a well-visit practice. Although there is guidance from the U.S. Preventive Services Task Force regarding which preventive services are worthwhile, there is no guidance for establishing a preventive medicine practice. She asked if Advisory Group members know of preventive medicine practices or individuals whom she might talk with. Several panelists or Advisory Group members offered to speak with her or refer her to others who might be helpful. Dr. Levi will connect the caller with those individuals.

5:00 p.m. Adjourned

Advisory Group on Prevention, Health Promotion, and Integrative and Public Health
April 29, 2014

Attendees for Day 2
Advisory Group:

Jeffrey Levi (chair), JudyAnn Bigby, Richard Binder, Valerie Brown, Jonathan Fielding, Patrik Johansson, Charlotte Kerr, Jacob Lozada, Barbara Otto, Ellen Semonoff (by phone), Susan Swider, Sharon Van Horn (by phone)

HHS:
Corinne Graffunder, Brigette Ulin, Dawn Alley, Capt. Robert DeMartino

8:30 a.m. Review of Day 1

Dr. Levi asked for thoughts about the first day’s discussions. Comments from Advisory Group members included:

  • Interagency collaboration is difficult; agencies’ capacities regarding health differ; and holding an
  • Advisory Group meeting outside of DC might provide new perspectives.

  • Health care providers need to better understand public health and population health. There is a movement to integrate population health in medical school curricula, but resources are lacking.
  • More time is needed to discuss implications of what was covered in the presentations about HIAs and collective impact in order to provide more specific advice to the Council.
  • A working group might be needed to help monitor interagency collaboration and collective impact and offer recommendations to the Council.

9:00 a.m. Presentation on the Robert Wood Johnson Foundation (RWJF) Commission to Build a Healthier America Report
Dr. David Williams, Staff Director for the Commission
Dr. Williams provided an overview of the Commission and its report released in January 2014, which builds on the Commission’s recommendations in its 2009 report. Dr. Williams noted the Commission represents a wide range of sectors, important for cross-sector collaboration.

The Commission’s report highlights several key findings. To improve health we must:

  • Improve opportunities to make healthy decisions where we live, learn, work, and play.
  • Revise 20th century strategies that don’t effectively address 21st century problems.
  • Revisit current investments that reflect outdated strategies.
  • Work across sectors, collaborating to improve the health of all Americans.
  • Build on the “pockets of success” that exist around the country.

The report also outlines three recommendations to achieve those objectives:

  • Make investing in America’s youngest children a high priority.
  • Fundamentally change how we revitalize neighborhoods, fully integrating health into community development.
  • Broaden the mindset, mission, and incentives for health professionals and health care institutions from treating illness to helping people lead healthy lives.

Each recommendation features several sub-recommendations and examples of successful programs, which Dr. Williams described briefly. Slides of Dr. Williams’ presentation are available by request by emailing NPCSupport@cdc.gov.

Question and Answer Session Highlights
Advisory Group members raised a number of questions and observations:

  • The need to reconsider how Federal and State dollars are spent and finding ways to bring funding together. Showing the cost of gaps in factors like education and housing will help bring about changes and maximize funding for cross-sector collaboration.
  • The notion of including non-medical variables in community health needs assessments (CHNA) or public health surveillance systems and the importance of getting health care providers and systems to realize the influence of these non-medical determinants.
  • Opportunities missed by spending so much on medical care and the need to raise concern about wasted medical spending among non-health sectors.
  • The need to require nonprofit hospitals to not only plan for preventive services, but also do what they planned (current IRS requirements only call for planning such services).

10:00 a.m. Advisory Group Updates and Next Steps
National Prevention Council Update
The National Prevention Council is working to move forward with the shared commitments, particularly increasing access to healthy, affordable food and access to tobacco-free environments. The National Prevention Strategy office is building Action Teams to accelerate these efforts. The CDC centers and divisions with subject matter experts in those areas provide TA for Action Teams.
One goal in the healthy food arena is promoting the Health and Sustainability Guidelines. In partnership with GSA, CDC is building a TA plan to help implement guidelines. The first year focuses on cafeterias; future efforts will move into vending. There is some challenge related to vending because of the Randolph Shepherd Act, which requires the Federal Government to allow blind and visually impaired persons or organizations to operate snack shops and vending machines. Operators have autonomy in deciding what is sold in those shops; there is concern a requirement for healthy foods could result in lost revenue. Dr. Bigby and Ms. Otto shared State-level successes in this arena and recommended people for Ms. Ulin to talk to.
The goal for the tobacco space is increasing the number of Federal agencies that have smoke- free/tobacco-free workplace policies. CDC is working with the Office on Smoking and Health and Assistant Secretary Dr. Howard Koh. They are also looking at e-cigarettes.

New Working Groups
Dr. Levi proposed the Advisory Group not meet in September as planned, but rather wait a couple of months to allow time for SG confirmation. The group discussed budget implications of this decision. Dr. Graffunder noted that although funding has been allocated from CDC for FY 2014, there is no committed funding in the overall Federal budget for FY 2015, so the future of funding for staff support is uncertain. Dr.. Alley added there is strong departmental commitment to the Council as a free-standing program and for the Advisory Group to continue as a separate endeavor. But there is concern about funding and staffing support.

The group discussed the importance of showing how the Council is making strides, particularly by reaching out to individual contacts to personalize the value of these efforts. The Council Annual Status Report (ASR), coming out July 1, emphasizes impact.
Dr. Levi proposed several topics for future discussion and action:

  • Further discussion of the collective impact approach
  • Closer look at health impact assessments
  • Population health, prevention, and health system change, particularly regarding CMS
  • NIH and prevention research investment
  • Metrics
  • Health literacy

Advisory group members suggested additional topics or refinements to Dr. Levi’s list, including:

  • Broadening the discussion about prevention and health system change beyond CMS
  • Folding health literacy into a discussion on population health, prevention, and health system change
  • Digging deeper into the topic of collective impact
  • Refining priorities based on evidence of the biggest impact, from the perspective of both a research agenda and programmatic development
  • Having two groups: one to explore short-term successes and another to look at longer-term issues to address
  • Aligning the topics discussed under the umbrella of the Council’s focuses—access to healthy foods and increase in tobacco-free policies
  • Identifying programmatic and research gaps where NIH could have an impact and noting gaps that are priorities.

Dr. Levi suggested two working groups and called for volunteers:

  • Working group 1: Research, programs, policy, and process changes; will identify gaps and areas for reprioritization (e.g., health literacy, prevention research questions, metrics).
    • Participants: Dr. Binder, Ms. Brown, Dr. Fielding, Dr. Johansson, Dr. Lozada
  • Working group 2: Collective impact; will promote more interaction with the National Prevention Council and help move forward with topics of interest.
    • Participants: Dr. Bigby, Sister Kerr, Dr. Swider, Dr. Van Horn

More interaction, communication, and public engagement at the regional level are important, where there is interest. Dr. Levi suggested that Advisory Group members do that in their own way. Until a new SG is confirmed, anyone can request the Acting SG to speak at their event, and Assistant SGs that can speak in their region. The Annual Status Report expands partners’ and Departments’ stories, and partner stories will be released quarterly. Additionally, there will be an online tool for partners to share their stories.

Dr. Levi will send out working group descriptions and capture participation from those who were not present.

11:30 a.m. Discussion and Wrap Up

Dr. Levi thanked Dr. Alley and Ms. Willis for their service and wished them well in their new endeavors.
He adjourned the meeting.