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Advisory Group on Prevention, Health Promotion, and Integrative and Public Health Meeting Summary

May 9, 2016

Advisory Group Attendees: JudyAnn Bigby, Richard Binder, Jonathan Fielding, Ned Helms, Patrik Johansson, Janet Kahn, Charlotte Kerr, Jeff Levi (Chair), Dean Ornish, Barbara Otto, Herminia Palacio, Linda Rosenstock, Susan Swider, Kimberlydawn Wisdom

HHS Attendees: VADM Vivek H. Murthy, John Auerbach, Julie Bobitt, Shavon Arline-Bradley, Amanda Lehning, Brigette Ulin (Designated Federal Officer), and Elizabeth Walker

9:15 a.m.- Roll Call and Meeting Overview

Brigette Ulin, Designated Federal Officer (DFO), called the roll and confirmed a quorum was present.

Jeff Levi, Advisory Group Chair, reviewed the purpose of the meeting and the agenda items.

9:30 a.m. – Updates from Advisory Group Members

Kimberlydawn Wisdom: The National Academy for State Health Policy (NASHP) convened in September 2015. As a result of that meeting, NASHP released an issue brief entitled, “Advancing Healthcare Transformation through a State Surgeon General Model: Opportunities and Challenges.” Dr. Wisdom has been vocal on the need for additional leadership in the Flint water crisis. She has recently published blogs with the Huffington Post about the NASHP convening and the Flint crisis.

Herminia Palacio: Dr. Palacio has taken a new position as the Deputy Mayor for Health and Human Services in the New York City Mayor’s Office. The Mayor’s administration is focused on health equity. A primary issue in the city is homelessness, as approximately 58,000 people are sheltered and 4,000 people do not have housing of any kind. The Department of Mental Health and Hygiene and the Department of Health and Hospitals are currently in the process of financial, quality, and equity transformations to align with the administration’s focus on health equity

Dean Ornish: In April, the American College of Cardiology held a seminar on lifestyle medicine at its annual scientific session in Chicago, Illinois. Lifestyle medicine provides the opportunity for lifestyle changes to reverse the progression of chronic diseases, not merely preventing them.

9:45 a.m. – Legacy Report Overview

The Legacy Working Group is developing an outline of the Advisory Group’s legacy document, which will identify ways in which the Advisory Group and the National Prevention Council (Council) can better collaborate.  Other topics to be discussed in the legacy document, include: (1) additional investments to support multisector collaboration at the local level; (2) the National Prevention Strategy (Strategy)’s role as an organizing framework for national conversations around climate change; (3) the need to assess the effectiveness of current governmental prevention mechanisms; and (4) the Strategy’s overall impact and uptake in communities. The report will also review the Advisory Group’s resolutions that have been successfully implemented and those that will require action in the next Administration. The final report is expected to be released in the fall of 2016.

Discussion Highlights – The Advisory Group raised several topics for potential inclusion in their Legacy Report:

  • The role of the Advisory Group, including the outreach capacity in communities and across sectors and in addressing future membership composition
  • Future membership composition of the group
  • The role of social determinants of health in multisector collaborations
  • In the health sector there is a lot of learning pertaining to the social determinants of health, but limited replication of this learning at the systems level. Finding a vehicle or model for communicating this learning and engaging the community is important.
  • The historical value of public health prevention and promotion.
  • Promoting prevention culture changes
  • Examples referencing lifestyle medicine
  • A reference to the issue brief “Advancing Healthcare Transformation through a State Surgeon General Model: Opportunities and Challenges,” in terms of the leadership model that could help drive the desired cross-sector collaboration.
  • Budget silo breakdown and health integration.
  • Patrik Johansson, Barbara Otto, Susan Swider, and Elizabeth Walker have begun to collect and summarize Advisory Group members’ success stories, including activities and the outcomes of these efforts which will be summarized in the Legacy Report.

10:30 a.m. – Healthy Aging in Action Report Update

The Administration challenged several federal departments to develop deliverables that align with the recent recommendations from the White House Conference on Aging. The Council is developing a Healthy Aging Action Report (HAIA) for release later this year. The HAIA will advance the Strategy by identifying actions to promote prevention and well-being among older Americans. The HAIA’s conceptual model of optimal aging includes (1) promoting health, preventing injury, and managing chronic conditions; (2) optimizing physical, cognitive, and mental health; and (3) facilitating social engagement. HAIA will highlight innovative best practices and resources in the federal and non-federal spaces that address the challenges that occur around physical well-being, emotional well-being, social well-being, and mental health as individual’s age. The Advisory Group’s Healthy Aging Working Group provided insight on the development and dissemination of the plan in March 2016. The Healthy Aging Working Group will reconvene to explore opportunities for the release as well as ongoing dissemination and support of the report.

Discussion Highlights

  • The aging adult population is vulnerable and important due to the vast growth of this demographic. Addressing the low wages and retaining of the caregiver workforce supporting the aging population is necessary.
  • Clinical and community prevention services must connect older adults to other social services and health care providers in the community.
  • Mental and behavioral health should be integrated into the plan’s clinical section.
  • Caregiver disparities exist between men and women. Women ages 55-70 are often the primary caregiver in families and need further support through creative solutions.
  • The report must distinguish a continuum of health isn’t solely age dependent.
  • Economic health is significant within the aging population and greatly influences their physical health.
  • Empowering caregivers involves more than just providing them with information. Caregivers should be included in health care decision teams and encouraged to make healthy decisions for themselves.
  • Currently federal agencies and aging organizations are collaborating to address ageism, through culture change efforts, education and training, and intergenerational activities, but a lot of work remains to be done.
  • Community-wide data will contribute to the awareness of needs for health issues critically impacting older adults.
  • It is important to educate the medical and clinical profession in order to facilitate collaboration across sectors, disciplines, and professions.
  • There are challenges in translating models, including the model of optimal aging and Masterpiece Living, into low-income communities.
  • The prevalent discrimination against Medicare and Medicaid patients among primary care physicians is an issue needing to be addressed.
  • The development of a logic model or infographic was recommended to connect with developed performance measures. A logic model could summarize the overall vision and display the pathway to outcomes.

11:30 a.m - Working Lunch – Update on the Surgeon General’s Priorities

The U.S. Surgeon General, Dr. Murthy, announced that Advisory Group Chair Dr. Jeff Levi received the Surgeon General’s medallion during the March 2016 Council meeting. Dr. Levi was commended for his extraordinary contribution to public health and commitment to well-being as the Chairperson for the Advisory Group.  Dr. Murthy provided an update on his priority activities. 

Surgeon General Priority: Addiction

OSG will be launching a prescription abuse campaign directed at prescribers along with public town halls and a facility tour. Dr. Murthy will distribute a targeted call to action letter to 1.2 million prescribers of opioids across the country. This will be the first time a Surgeon General has distributed a targeted letter to medical professionals. The next campaign to be launched later in 2016 will focus on e-cigarettes. A Surgeon General’s report on substance abuse and addiction will be released in the fall of 2016. The goal of the report is to change public perception of addiction.

Surgeon General Priority: Mental and Emotional Well-Being

Mental and emotional well-being are often overlooked in terms of importance, when compared to nutrition and physical activity. OSG would like develop framing language to discuss emotional well-being. OSG will aggregate the science-based and community program data on emotional well-being and also highlight models that are working in this area of health, which could aid in bringing together stakeholders.

Surgeon General’s Legacy Report Observations

  • The Advisory group can contribute to the shaping an update of the Strategy to further incorporate addressing climate change and firearm violence.
  • The Advisory Group can help assess OSG’s progress on meeting the benchmarks of the Strategy and also think of the desired change over the next Administration in terms of the community’s thoughts on prevention.
  • Accelerating discussions in the community on how to approach cross sector collaboration is key, and the group’s convening on the subject would be helpful to advance public health.
  • The cultivation of the Advisory Group and the Council’s relationship will allow the Advisory group to play a larger role in the efforts by the Council to implement the Strategy.
  • The group should work to meet the goal of setting metrics for evaluating the success of the Strategy.

Responses from the Advisory Group

  • Emotional well-being and substance abuse are connected. Underlying causes to deteriorated emotional well-being must be addressed.
  • OSG campaigns incorporate two key values, of prevention and health equity in order to advance the health priorities. Equity is a key part of the conversation around emotional well-being and addiction, since many impoverished and minority communities are more susceptible to particular toxic environmental stressors. From an equity perspective OSG is aiming to find simple, affordable tools that are evidence-based in terms of improving emotional well-being.
  • Overall, the concept of emotional well-being has yet to transition to being considered a community health problem rather than individual emotional health. The Advisory group suggests OSG begin this conversation. A variety of community data and program models have developed recently in New York, Washington, Chicago. The Adverse Childhood Experience (ACE) study examined the dose-response relationship in these communities.
  • The Strategy’s message can be further amplified and better operationalized through a systematic approach.
  • The Surgeon General’s outreach to prescription opiate providers will be powerful. The opiate problem arose due to multiple issues of health care and public health systems.
  • Prescription disposal was noted as a great problem for providers and payers.
  • The Advisory Group suggests providing further funding opportunities and considering public health undergraduate and graduate students as community groups of learning, as they are the future public health leaders.
  • The Advisory Group needs to further engage the health care delivery system in order to fulfill the goal of building healthy communities. The health care system has to understand how community relationships can be a long-term return on investment.
  • OSG is cautioned from creating a direct linkage between emotional well-being and substance abuse, as there are economic forces at play contributing to the spread of the epidemic. A lack of emotional well-being shouldn’t be noted as the main reason for substance abuse prevalence
  • OSG is seeking to improve people’s internal capacity to handle stress.

1:00 PM – Legacy Report Roundtable Discussion

Council representatives were asked to offer their perspectives on the future direction on the Council, the Strategy, and the Advisory Group.

Susan Damour (GSA): The Council allows federal agencies the opportunity to have beneficial discussions and Dr. Murthy offers inspiration and a vision for the Council’s overall efforts. Given the lack of awareness of the Strategy at the local level GSA recommends the Advisory Group to develop a website featuring success story content, in addition to including experts in mental and oral health on the Advisory Group roster. GSA would encourage further involvement from the local communities. Health issues within Region 8 tribal areas can be addressed on a collaborative basis if federal agencies work more closely together.

Christine Hunter (OPM):  OPM plays a key role in the health insurance sector, determining insurance coverage and facilitating the development of quality health for the public, with a renewed focus in prevention and wellness. OPM developed a health insurance program for current and former federal workers and their families, with an extension of coverage to tribes as a result of the Affordable Care Act (ACA).The Advisory Group could play a role in harmonizing the efforts or designating leads for agencies aiming to promote their individual products. OPM has been approached by Centers for Medicare and Medicaid Services, and the CDC Office of the Associate Director for Policy to take action on the patient safety issue. When patient safety and health care–associated conditions can be simplified, much success could be achieved.

Jane Kim, Department of Veterans Affairs (VA): The Strategy has been applied within the VA through the development of a clinical program geared toward encouraging physical activity and nutrition and behavior change in overweight and obese veterans, which are key health areas of interest in the VA’s work with the veteran population. The Advisory Group is recommended to emphasize chronic disease management in future discussions. The Advisory Group should consider adding experts in the areas of agriculture, natural resource sustainability, and marketing and promotion to the member ranks.

Jerold Mande, Department of Agriculture (USDA): USDA is commonly associated with agricultural work; however, a substantial part of the agency’s budget, programs, and guidelines also address nutrition, obesity, hunger, and food insecurity, which are significant health issues facing the nation and require more attention. With the passing of the Healthy Hunger Free Kids Act in this Administration, 97% of schools are following USDA guidelines successfully and are the healthiest in 30 years. The USDA strives to be a role model on the federal agency level for healthy cafeteria eating but faces challenges in acquiring data for their efforts. The Advisory Group must continue to underscore the importance of addressing tobacco use. For the Administration and Congress to consider addressing specific health and prevention issues, they must be framed as causing impacts beyond health.

Jack Smith, Department of Defense (DOD): DOD’s implementation of the Strategy is focused on tobacco and obesity, given the prevalence of tobacco use in the military is higher than in the general population. DOD’s Healthy Bases Initiative focuses on physical activity, children, schools, and families, healthy food options, physical environments, health and wellness, and tobacco use. The scope may broaden to include the issues of opioids and substance abuse. The Advisory Group can be helpful in broadening the strategy’s scope, considering ways to help the Council with coordination of services and efforts across communities.

Kathy Sykes (EPA): The Surgeon General’s focus on healthy aging is commendable, particularly with the all ages approach. The EPA applauded the Advisory Group’s focus on the social determinants of health and encourages the next administration to do the same. Bringing more partners to the table, in the housing and transportation sectors is critical. The Advisory Group is recommended to create an appendix in the President’s budget, identifying programs and spending on social determinants of health and displaying how benefits and savings of health and well-being relate to all the different programs. The Office of the Surgeon General should analyze the cross sector benefits for health.

Discussion Highlights

  • The Advisory Group should continue to consider what it would take to accomplish a coordinated but realistic approach for the strategy while working through the vast and complex governmental system.
  • Limited communication occurs between the Advisory Group and the Council. Some of the prevention strategy messages have penetrated into the council agencies, and the Advisory Group should aid in deeper penetration.
  • The Strategy should shift to be nationally applicable rather than federally. The federal government can drive change in the private sector.
  • Going forward the Advisory Group should consider several lessons.
  • It is important to have a strong constituency that is willing to support programs.
  • The Advisory Group is more equipped to consider constituencies than federal agencies are.
  • The Advisory Group should not be setting policy, rather policy should be set at the local and state level.
  • The group must be mindful of the importance in having a scientific basis when putting forward policies.

2:45 PM – Update from the Commission to Eliminate Child Abuse and Neglect Fatalities

The Commission to Eliminate Child Abuse and Neglect Fatalities provided an update on the report, “Within Our Reach: A National Strategy to Eliminate Child Abuse and Neglect Fatalities.” The report includes the Commission’s recommendations to the Administration and to Congress: (1) reduce or eliminate child abuse and neglect fatalities; (2) improve counting of child abuse and neglect fatalities; and (3) create a national strategy. The report reflects a need for states to provide a more coordinated public health approach around the prevention of child abuse fatalities. This approach may be integrated at the local level for planning of family-based services and single-case management. The commission considered focusing the report beyond fatalities. Children’s issues have become distant from federal leadership and sectors, which has resulted in decreases in budgets appropriated to services for women and children. The report provides considerations to restructure funding to reposition women and children’s programs from prevention services in the government.

Comments from the Advisory Group

  • The galvanization of the public and elected leaders to focus on the system as a whole, child development, and early education problems could better integrate social and medical services to address child neglect fatalities.
  • Congress needs to work in tandem with the presidential administration and advocate for child neglect issues.
  • The development of state plans around early childhood mortality could potentially advance funding to infant fatality teams and near-fatality teams. These approaches would be useful to creating more state accountability.
  • It is important to consider the role fathers in the criminal justice system and substance abuse play in child abuse fatalities.
  • The alignment of state programs to improve children’s families could result in desired outcomes.
  • Very few states have addressed the issue of child fatality prevention in a systematic way.
  • Childhood abuse and neglect fatality issues must become a public health priority.

3:15 PM – Panel Discussion on Violence Prevention

Federal Panel

Nadine Gracia, Office of Minority Health: It is important to address violence through a broad social determinants of health lens, with collaborations with the community and federal colleagues, and by embracing the trauma-informed approach. Youth empowerment models address violence by bringing together the school system and community organizations to provide at-risk youth the opportunity for academic enrichment and leadership. OMH follows a holistic approach to violence prevention. In terms of violence data, it is important to look beyond the justice system; however, there is a lack of a national data reporting system for gun violence, which is necessary to understanding the right data.

Jim Mercy, Centers for Disease Control and Prevention (CDC): Violence prevention is an urgent and strategic issue, as violence is costly and destructive to children and youth and impacts a broad range of health outcomes. There are substantial racial and socioeconomic disparities with respect to violence and there are viable policy and programmatic options to address them. The CDC is aiming to expand the National Violence and Death Reporting System to all 50 states to provide more detailed data, and to support the need to bring forth better evidence in terms of firearm access by children and youth and at-risk individuals. The CDC is working to build the infrastructure for successful violence intervention implementation at the state and local level.

Theron Pride, U.S. Department of Justice (DOJ): Attorney General Holder and Attorney General Lynch have considered public safety to be an important public health issue and hope to address violence more in terms of universal prevention and primary prevention. Through the National Forum on Youth Violence Prevention, DOJ helps communities address youth violence and improve criminal justice comprehensively through engaging a number of stakeholders, including law enforcement, state, local, and federal partners and leaders, and the public health community. The alignment of federal agencies’ violence efforts could increase more positive opportunities for people across education outcomes, employment, and community engagement. A national campaign will aid in people understanding the science behind the issue of violence and what can be done to address it.

David Esquith, U.S. Department of Education (ED): The educational system is not positioned to be helpful in violence prevention due to safety being seen as a local issue outside the school’s scope of interest. Data indicates schools are safer than they’ve ever been; however, much violence still occurs in schools and occurs disproportionately to the most vulnerable populations. Within schools, there has been an increase in the use of social-emotional learning and positive behavior supports, but the academic system lacks the infrastructure for schools to provide the services and interventions to prevent violence. There are effective initiatives occurring in a small percentage of the nation’s schools, but the challenge lies in finding the right service delivery system for violence prevention in schools.

Federal Panel Discussion Highlights

  • There is a lack of infrastructure at the community level to address violence. It is necessary to have a core at the local level and a commitment among decision makers to solve the violence issue.
  • At the federal level many agencies offer technical assistance to help communities build the capacity and address challenges in building infrastructure, but communities need help connecting with various experts. Designated federal staff must work with school systems on a continuous basis to implement evidence-based information interventions addressing school violence prevention.
  • Changes in policy and funding are necessary in order for local communities, states, and private organizations to implement sustainable programs. Demonstration projects provide the opportunity to test innovative models that can then lead to replicability of models across the nation that are effective in addressing disparities. The issue can’t be addressed solely through programs; a programmatic investment must occur to support quality funding opportunities. Federal agencies must invest programmatically among one another in order to support quality funding opportunities for violence prevention programs.
  • The DOJ is working to get materials available to the public to aid their understanding of violence on the developing brain of youth and how there are various factors in the home and neighborhood that come into play.
  • Faith-based organizations should be involved in policy work, primary, secondary, and tertiary prevention of violence. Faith leaders are an important aspect of the violence prevention infrastructure.

Non-Federal Panel

Larry Cohen, Prevention Institute: Youth violence could be reduced by fifty percent in most communities through the reallocation of resources and political will. A variety of forces in adverse social, cultural, and physical environments often conspire against behavior change and adults must be involved in supporting the alteration of these environments to be healthy and thriving for youth. Cities with the greatest collaboration and coordinated, prevention-based approach have achieved the lowest rates of youth violence. In order to address violence, it is important to understand the links between different forms of violence and health, the importance of trauma, and trauma-informed prevention. The incorporation of the youth voice and community wisdom into violence prevention work is vital to its success.

Gretchen Musicant, Minneapolis Health Department: In 2006, Minneapolis had a peak of youth violence, and in response, the local community pushed for the declaration of youth violence as a public health issue. Between 2007 and 2015, Minneapolis saw a 34-percent decrease in youth victims of crime, 76-percent decrease in youth arrests with a firearm, and a 62-percent decrease in youth gunshot victims. Communities should plan a public health approach to violence in addition to supporting the development of a community engaged strategic action plan. The social conditions related to violence must be strengthened, and communities should communicate with the youth to assess their needs in employment, housing, and education.

Kristin Rzeczkowski, Baltimore City Health Department: Baltimore, Maryland utilizes a threefold public health approach: 1) acknowledge where people are, 2) engage the community in setting goals, and 3) address social determinants of health in an upstream fashion. 2015 was Baltimore’s deadliest year per capita, with 344 homicides, 90 of which resulted in sub-shootings, and gun violence increased about 75 percent and 900 victims. Involving people who are respected within the community, the creation of new entry points, and the establishment of a sustainable funding model are imperative for violence prevention programs. To address violence communities must mobilize and engage to change the norm and communicate that gun violence is not the answer.

Marc A. Zimmerman, University of Michigan: Youth violence has decreased slightly, but the disparities are still vast as African American youth are 15 times more likely to die by the age of 30 than white youth. Conversations pertaining to violence must include the mental health discussion, and the idea of youth as the problem in terms of violence should be shifted to recognize adults as the problem. Programs that initiate community and youth engagement in environmental change can help lead to a solution to violence. Adults and youth can work together to make changes to the social context of communities and physical environments.

Non-federal Panel Discussion Highlights

  • The issue of program sustainability must be addressed in addition to the expansion of the definition of violence.
  • The Advisory Group and Council should take an “us helping us” rather than “us helping them” approach. The connections between different types of violence has to be made. Violence affects everyone because it affects the community climate.
  • Safety is a fundamental determinant of the value of cities—a thriving community and working educational system. This must be a key agenda for the next Administration.
  • The establishment of a national institute of violence could help keep the topic in the view and minds of people, showing it impacts everyone. For example, the National Institutes of Health focuses on a variety of human health issues.
  • The issue of violence must be framed in terms of common values. “Our children should grow up and develop in a way that’s very healthy and beneficial.”
  • Economic development is a critical contributor to violence prevention.
  • Firearms in terms of youth and accidental gun fatalities needs to be considered a multigenerational problem.
  • People must get involved where they can serve as problem solvers from a public health perspective.

May 10, 2016

Advisory Group Attendees: JudyAnn Bigby, Jonathan Fielding, Ned Helms, Patrik Johansson, Janet Kahn, Jeff Levi (Chair), Barbara Otto, Herminia Palacio, Linda Rosenstock, Susan Swider, Kimberlydawn Wisdom

HHS Attendees: Karen DeSalvo (Acting Assistant Secretary for Health), Brigette Ulin (Designated Federal Officer), and Elizabeth Walker

9:15 a.m.- Roll Call

Brigette Ulin, Designated Federal Officer (DFO), called the roll and a quorum was not achieved; therefore, the attendees acted as a working group during the early portion of the meeting. At 9:57 a.m., Jonathan Fielding joined via the teleconference line, which brought the group to a quorum.

9:30 a.m.- Remarks from Karen DeSalvo, Acting Assistant Secretary for Health

Public Health 3.0 is an iteration of public health that many health departments are currently engaged in and consists of several key elements: 1) enhanced leadership and workforce; 2) strategic partnerships; 3) accreditation; 4) technology, tools, and data that matter; 5) new metrics of success; and 6) sufficient and flexible funding. A coordinated approach to address medical and non-medical determinants is required even with the broad public health system collectively working to assure the conditions in which everyone can be healthy. Various sectors (e.g., employers) are becoming aware of particular elements in the health system, realizing the conditions and environment of communities’ matters in health and wellness. Public health departments are under resourced, marginalized, and mistrusted which results in unhealthy consequences. The importance of public health departments, systems, and social determinants needs to be realized; otherwise, public health is in danger. By fall 2016, HHS is hoping to develop a report on community grassroots efforts. Dr. DeSalvo welcomes input from the Advisory Group about how the federal government could service health better programmatically in terms of the leading preventable causes of death.

Discussion Highlights

  • HHS is focused on educating the public on the role of public health; however, the field is losing ground as it is reinterpreted through health care.
  • In Los Angeles, public health was integrated back into the larger health services department, rather than remaining its own entity. This situation continues to be a serious threat. Health departments should be able to keep funding for investment in “real” public health work.
  • Local communities are experiencing a variety of public health challenges. Chicago, Illinois, struggles as they are caught between the role of providing care and forming a public health infrastructure. Flint, Michigan, is a “canary in the American coal mine.” Aid is needed on the ground in cities like Flint in order to address health issues directly at the state level.
  • Dr. DeSalvo sees work with other sectors as critical, but funding inequality amongst local and state health departments must be considered.
  • A challenge lies in the tension between the state and local public health structure. There is great variation in how states operate; some are centralized while others aren’t.
  • Dr. DeSalvo noted if a sixth area could be included in Public Health 3.0, public health law and structure would be desirable. More lawyers in the public health policy spectrum are necessary at the state and local level.
  • There are countless public health success stories across the nation, and a shift to an immediate process of success story translation, action, and storytelling would be beneficial to public health learning.
  • In future funding cycles, non-traditional partners should be engaged, with the purpose to raise awareness of the purpose of public health. The American Public Health Association (APHA)’s efforts in engaging non-traditional entities could offer best practices or lessons learned.

10:00 a.m.- Debrief of Violence Prevention Panel Discussion and Discussion Legacy Report Draft Outline

Several questions from the overall meeting’s discussion were posed to the group for their input.

  • Does everything have to happen through the Council as it relates to prevention and interagency activities?
  • How does creating a common infrastructure at the local level for multisector work relate to  sustaining governmental public health/
  • What issues do we want to highlight?

Discussion Highlights

  • Violence prevention is a leading issue for the next Administration to address.
  • There is an increase in literature related to the connection between health and income inequality, and the Advisory Group is missing the opportunity to address these issues.
  • The Advisory Group plays an important role in advising the Council, but must consider how to have a stronger, more directive voice.
  • Many regions are unaware of the Council and the Strategy, which emphasizes the need for further promotional efforts.
  • A forum where the Advisory Group and Council communicate directly with each other would be beneficial.
  • There is value in assessing the level of coordination among the federal agencies and exploring shared visions of health and well-being.
  • The Public Health 3.0 framework could prove useful for efforts in terms of cross-sector collaborations in addressing violence.
  • The Legacy Report should be distributed to the incoming and outgoing secretaries and a peer-reviewed publication in health journal should be considered.
  • The purpose of the Legacy Report is to communicate a vision regarding the role of the Council and the continued value of the Strategy. The report will:
    • Communicate what has been learned and what needs to be done moving forward in public health prevention efforts.
    • Inspire efforts while also noting key issues in the public health sector.
    • Define the benefits of having a prevention focus in public health work.
    • Elaborate on the inspirational efforts taking place in local communities and explore how they could be replicated.
    • Communicate the need for the government to incentivize communities appropriately, in order for the Strategy to continue momentum.
    • Be data-supported and results-oriented, indicating “what could be different” if the legacy recommendations were supported broadly by the public health community.

Next Steps

  • Jeff Levi will email the Advisory Group to request volunteers to contribute to the Legacy report draft.
  • Patrik Johansson, Barbara Otto, Susan Swider, and Elizabeth Walker will continue to collect and summarize success stories and outcomes and create a matrix for inclusion in the report.
  • The Legacy Working Group will reconvene in June.
  • The Advisory Group will discuss feedback to the updated report during the July 11th teleconference.
  • The Advisory Group will finalize their report during the September meeting.
  • The final report will be presented to the Surgeon General and the National Prevention Council.