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Advisory Group on Prevention, Health Promotion, and Integrative and Public Health - Meeting Summary April 20, 2015

April 20, 2015

Attendees

Advisory Group Members: Jeff Levi (Chair), JudyAnn Bigby, Valerie Brown, Johnathan Fielding, Ned Helms, Patrik Johansson, Jerry Johnson, Janet Kahn, Jacob Lozada, Elizabeth Mayer-Davis, Dean Ornish, Barbara Otto, Herminia Palacio, John Seffrin, Susan Swider, and Kimberlydawn Wisdom

Regrets: Richard Binder, Charlotte Kerr, Ellen Semonoff, Linda Rosenstock, and Sharon Van Horn

HHS: Corinne Graffunder (DFO), Brigette Ulin, and Elizabeth Walker

2:00 p.m. - Roll Call and Introductions

Dr. Corinne Graffunder called the roll and confirmed a quorum was present. She thanked the public for attending and noted that no one from the public registered to provide a comment.

Dr. Jeff Levi, Chair, stated that the purpose of the meeting was to discuss the three recommendations developed by the drafting committee and a recommendation (#4) proposed by Dr. Dean Ornish.

2:15 p.m. - Discussion of Proposed Recommendations

Recommendation 1

This recommendation reflects the Surgeon General’s priority to make prevention and equity the bedrock of his efforts, particularly in reducing tobacco use and obesity. The draft recommendation presented to the Advisory Group read as follows: “The Advisory Group urges the Surgeon General to consider the constellation of approaches to addressing tobacco and nicotine use and obesity as a lens through which all sectors in American society can better understand how to use the four strategic directions of the National Prevention Strategy to improve the health of the nation.”

Discussion Highlights

  • Dr. Janet Kahn voiced that the recommendation is well-written, clear, and succinct.
  • No edits were suggested for this recommendation.

Recommendation 2

This recommendation is in response to Dr, Dawn Alley’s presentation at the March 2015 Prevention Advisory Group meeting on the Centers for Medicare and Medicaid Innovation’s (CMMI) evaluation of various delivery service models that coordinate social services (i.e., housing, education, etc.) and health care services. The draft recommendation presented to the Advisory Group read as follows: “The Advisory Group urges the National Prevention Council to actively engage with the Center for Medicare and Medicaid Innovation to assure that as communities consider responding to the solicitation to identify models that address beneficiaries’ health-related social needs, all federal partners support strategies to ensure successful partnerships and collaborations so that local resources can be accessed to most effectively improve the lives of their residents.”

Discussion Highlights

  • Dr. Kahn supports the recommendation, but suggested the following changes: (1) “consider responding” to “respond” and (2) “are prepared to help ensure successful partnerships” instead of “support strategies to ensure successful partnerships.”
    • Dr. Susan Swider, Barbara Otto, Dr. Herminia Palacio, and Dr. Kimberlydawn Wisdom all agreed with these changes.
  • Dr. Wisdom expressed concern that the intent of the recommendation would be lost if the introductory paragraph and recommendation were separated.
    • Dr. Levi suggested combining each introductory paragraph with its recommendation, highlighting the specific recommendation by using a boldface font. Dr. Elizabeth Mayer-Davis, Dr. Wisdom, and Dr. Kahn all agreed with this formatting change.
  • Dr. Mayer-Davis suggested adding a sentence indicating that the CMMI grants might serve as potential models for multi-sector collaborations. Dr. Levi expressed concern that the Advisory Group might not want to endorse these grants as potential models until the final solicitation has been released.
    • Dr. Johnathan Fielding suggested adding the following language to address this concern: “These grants could serve as a model for future public and private multi-sector collaboration.”

Recommendation 3

The third recommendation relates to the presentation at the March 2015 Prevention Advisory Group meeting on chronic absenteeism. The draft recommendation presented to the Advisory Group read as follows: “While a significant number of federal agencies are already engaged in My Brother’s Keeper, the Advisory Group recommends that the members of the National Prevention Council engage in this effort to amplify the impact of the federal government’s leadership and assure interagency collaboration and action to improve attendance especially among the school children most at risk. We recognize that school policies are very local and state based, but the federal government, and public-private partnerships like the National Collaborative on Education and Health can be the catalyst for greater impact at the community level.”

Discussion Highlights

  • Dr. Kahn suggested that a sentence in the introductory paragraph be revised to read as follows: “Chronic absenteeism is an early warning signal of concern regarding future success in school.”
  • Dr. Mayer-Davis suggested that the same sentence read: “Chronic absenteeism is an early warning signal predicting success in school.”
    • Dr. Kahn and other Advisory Group members agreed to use Dr. Mayer-Davis’ language suggestion.

Recommendation 4

Dr. Ornish stated that evidence from randomized control trials and demonstration projects shows that comprehensive lifestyle changes can prevent and even treat (i.e., slow, stop, or reverse) the progression of chronic diseases. Research is simultaneously showing that traditional medicine is not as effective at treating chronic diseases as originally thought. Therefore, he proposed the following recommendation for the Advisory Group’s consideration: “The Advisory Group encourages the Surgeon General, the National Prevention Council, and the Center for Medicare and Medicaid Innovation to support research on and implementation of Lifestyle Medicine—i.e., beneficial lifestyle changes (including optimal nutrition, exercise, stress management, and social support) for treating chronic diseases.”

Discussion Highlights

  • The Advisory Group should encourage the National Prevention Council and CMMI to promote a better understanding of how Lifestyle Medicine can be effectively implemented in communities with the greatest need, risk, and disease burden.
  • Lifestyle Medicine is sometimes used as an alternative to traditional medicine, but the Advisory Group believes Lifestyle Medicine should be provided in addition to traditional medications and surgical treatments.
  • The recommendation needs to be tailored to focus on prevention. Dr. Fielding suggested adding language about how the adoption of Lifestyle Medicine can optimize health and prevent complications and future diseases, not just manage or treat a chronic disease.
  • The Advisory Group would like to know if a workforce training or education component could be added. Providers need to understand the value of this type of medicine and incorporate it into their practices.
  • Dr. Mayer-Davis proposed that the recommendation should read: “The Advisory Group encourages the Surgeon General, the National Prevention Council, and the Center for Medicare and Medicaid Innovation to promote Lifestyle Medicine as part of population health —i.e., beneficial lifestyle changes (including optimal nutrition, exercise, stress management, and social support) that can complement traditional medicine or surgical approaches for optimized health for individuals living with chronic disease, particularly in communities with the greatest burden of disease.”

3:15 p.m. - Next Steps and Conclusion

Dr. Levi suggested that a drafting committee be formed to refine the fourth recommendation to include the views expressed during the call. Members will include: Dr. Ornish, Dr. Bigby, Dr. Mayer-Davis, Dr. Wisdom, Mr. Helms, and Dr. Fielding; Dr. Levi will facilitate. Electronic draft language will be circulated prior to the committee meeting. The fourth recommendation will be presented for consideration and voted on at the next Advisory Group meeting in June. Consensus was reached on Dr. Levi’s suggestion.

Dr. Levi suggested that the Advisory Group vote on the first three recommendations as a block. Dr. Fielding and Mr. Jerry Johnson supported this decision to vote as a block. All Advisory Group members voted to approve the first three recommendations; there were no votes in opposition.

Dr. Levi reminded everyone to respond to the availability request for the June teleconference and the August/September meetings.

3:30 p.m. - Adjourn