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

August 31, 2015

Attendees: JudyAnn Bigby, Richard Binder, Valerie Brown, Johnathan Fielding, Ned Helms, Patrik Johansson, Jerry Johnson, Janet Kahn, Jeff Levi (Chair), Jacob Lozada, Elizabeth Mayer-Davis, Barbara Otto, Herminia Palacio, Linda Rosenstock, John Seffrin, Ellen Semonoff, Susan Swider, Sharon VanHorn, and Kimberlydawn Wisdom

Regrets: Charlotte Kerr and Dean Ornish

HHS Attendees: John Auerbach, Shavon Arline-Bradley, Melanie Ross, Brigette Ulin (Acting Designated Federal Officer), and Elizabeth Walker

8:30 a.m. – Roll Call and Meeting Overview

Brigette Ulin, Acting Designated Federal Officer (DFO), called the roll and confirmed a quorum was present. She thanked the public for attending and noted that one individual from the public registered to provide a comment.

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

9:00 a.m. – National Prevention Council Healthy Aging Action Plan

The Administration has challenged several federal departments to develop deliverables that align with the recent White House Conference on Aging. The Surgeon General and the Council are developing a Healthy Aging Action Plan (Action Plan) that will be released in spring 2016. The Action Plan will advance the National Prevention Strategy (Strategy) by identifying action steps to promote prevention and well-being among older Americans. The target audience includes policy makers, public health and aging service agencies, state and local communities, and federal government. “Healthy aging” is defined as the development and maintenance of optimal, physical, mental, and social well-being and function in older adults. A model of optimal aging has been developed that includes (1) promoting health, preventing injury, and managing chronic conditions; (2) optimizing physical, cognitive, and mental health; and (3) facilitating social engagement. This model encourages cross-sector collaboration and focuses on adding life to years. The Action Plan will not create new strategies, but will highlight best practices and resources in the federal and non-federal spaces. The Advisory Group was asked to provide specific partners and additional insight on the development and dissemination of this plan.

Discussion Highlights

  • The Action Plan is expected to focus on individuals aged 55 – 65 years. The Advisory Group members noted that adjustments to this range might be needed as some racial and ethnic groups have different life expectancies.
  • The Advisory Group members offered to connect the Council with their partners, such as the American Association of Retired People, Henry Ford Health System, American Society of Aging, University of Michigan, MacArthur Foundation, civil rights organizations, faith-based organizations, and minority resources centers. The Advisory Group members suggested that the Council work with the Centers for Medicare & Medicaid Services’ (CMS) Accountable Health Communities initiative and the Administration on Community Living, the latter of which is funding health promotion services within aging and disability resource centers. The CMS should also be consulted on how to best promote and implement various financial levers, services, and incentives with caregivers and providers. The Department of Transportation could be consulted on various programs and resources, such as Rides to “Wellness.”
  • The Advisory Group members noted that the optimal aging frame lends itself to social justice and equity. The members also noted that this frame aligns with the Surgeon General’s thoughts on happiness as depression and anxiety are prevalent in older adults.
  • The Advisory Group reminded that focus should be placed on the LGBTQ community, independent living facilities, worksite wellness, and economic development.
  • Resources and tools should be created for caregivers and home care nurses to help them have conversations with seniors about their long term and acute care needs, elder abuse, alcohol abuse, misuse of prescription drugs, economic well-being, and other issues.
  • The Advisory Group noted that the American Society of Aging’s spring conference would be a good opportunity to present the Action Plan and obtain feedback.
  • Some Advisory Group members noted that new strategies should be developed.

10:00 a.m. – Presentation and Discussion of the Surgeon General’s Priorities

The Surgeon General and the Council are engaged on several initiatives that align with the Strategy. The Surgeon General discussed these initiatives with the Advisory Group and sought their counsel on the development and implementation of these initiatives, including identifying potential partners and messaging.

National Prevention Council Efforts 

Earlier this year, the Surgeon General challenged the Council to:

  1. Adopt and implement tobacco-free policies, expanding on the 1997 Executive Order establishing smoke-free federal workplaces, by January 1, 2017 AND 
  2. Integrate healthy food service guidelines, such as the HHS/GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), into new and existing food service contracts and permits and/or establishing a policy that requires food service guidelines be integrated into contracts and permits upon rebid or renegotiation by January 1, 2017.

The Council informally shared their progress in achieving these goals at their July meeting. A formal assessment will be disseminated in September to gather nationwide baseline data on these goals across the Council Departments. These assessments aim to amplify successes and highlight opportunities for technical assistance. The U.S. General Services Administration (GSA), which manages a significant number of Council Departments, has implemented the HHS/GSA Guidelines into their food service contracts and are working to include e-cigarettes in their tobacco policies. These goals are also being implemented in external facing facilities and services. The Department of Housing and Urban Development has implemented tobacco-free policies in their public housing. The Department of Defense’s Operation Live Well continues to improve nutrition and smoking habits at military bases. The Director of the National Park Service is reviewing a policy to limit the use of e-cigarettes in national parks.

Surgeon General Priority: Healthy Eating

The U.S. Department of Health and Human Services (HHS) has been addressing this priority by passing a ban on trans fat, improving nutrition labels, and updating the HHS/GSA Guidelines. The Surgeon General, along with integrating healthy food service guidelines into contracts and permits, is considering  an initiative on  reducing the amount of sugar consumed by Americans. Dr. Elizabeth Mayer-Davis suggested that he consult with food policy experts at the University of North Carolina – Chapel Hill to help conceptualize the health eating priority.

Surgeon General Priority: Tobacco-Free Living

Tobacco-free and smoke-free environment policies are moving forward with Council Department leadership support. Congressional or Presidential action would help accelerate success on this priority. The Advisory Group discussed the merits of restricting the hiring of tobacco users. The Advisory Group stated that this hiring practice could be seen as violating disability protections as nicotine is an addictive substance. Instead, employers should promote “Tobacco-Free, Every Day” policies, meaning employers do not provide designated areas for smokers and smoking is not allowed on facility grounds; employers could restrict employment to applicants that do not agree with that policy. Employers should provide support to current smokers, such as cessation services.

Surgeon General Priority: Active Living

On September 9th, the Surgeon General launched Step It Up! The Surgeon General's Call to Action on Walking and Walkable Communities, which will be promoted across the 50 states and territories. The 2008 Physical Activity Guidelines for Americans recommend adults get 150 minutes of moderate to brisk activity a week. However, only half of adults meet this recommendation. A fourth of youth are getting their recommended 60 minutes of physical activity a day. The Surgeon General wants all people, including individuals who use wheelchairs, to find ways to incorporate walking and movement into their daily activities. The Surgeon General will work with stakeholders to improve the safety and walkability of local communities.

The Advisory Group noted that activities should be community-driven and address the social determinants of health, reflecting the Empowered People Strategic Direction of the Strategy. The Advisory Group members suggested that the Surgeon General involve cross-sector stakeholders, such as city planners, public safety, faith-based organizations, employers, elected officials, health care, disability organizations, and schools. Specific organizations, such as Purpose Built Communities and the National Rural Health Association, were mentioned. The Advisory Group encouraged the Surgeon General to build upon existing initiatives, such as Safe Routes to Schools, Let’s Move!, and local walking clubs. The Advisory Group members suggested that research evidence, including community health assessments, should be used when developing local initiatives.

Surgeon General Priority: Prescription Opiate Abuse

Secretary Burwell has made prescription opiate abuse a priority. HHS is addressing this issue by: (1) changing prescribing practices; (2) getting treatment to people; and (3) making naloxone more accessible for emergency responders. The Surgeon General will focus on changing prescribing practices through provider and patient education. Experts should be consulted on dependency issues. The Advisory Group recommended that the Surgeon General meaningfully engage the pain community, the pharmaceutical industry, the aging population, and the Department of Veteran Affairs.

Surgeon General Priority: Mental and Emotion Well-Being

To address the stigma associated with mental illness, the Surgeon General will be encouraging faith leaders to discuss mental illness with their congregants. The Surgeon General will also work with cultural and ethnic minority leaders to disseminate effective and relevant messages concerning mental illness. Many individuals have lost faith in their ability to lead a healthy life due to external forces (e.g., complicated health system, pharmaceutical companies, lack of health insurance, etc.). The Surgeon General will also build upon tools and programs that promote happiness, social connectedness, and self-efficacy.

Surgeon General Priority: Ending Violence

The Surgeon General will be addressing the growing epidemic of violence by building a community-driven campaign and encouraging people to discuss this difficult topic. People commonly associate violence with mental illness; however, not all acts of violence are committed by individuals suffering from a mental illness.

Closing Remarks

Many Americans feel the country is not heading in the right direction and that external forces are preventing them and others from being healthy and safe. Through his initiatives, the Surgeon General is attempting to restore agency, optimism, and efficacy among communities.

11:30 a.m. – Lunch Break

12:30 p.m. – Advancing the Surgeon General’s Priorities

The Director of External Engagement, Shavon Arline-Bradley, within the Office of the Surgeon General joined the Advisory Group to further discuss the Surgeon General’s priorities. The Surgeon General wants his initiatives to be creative, innovative, community-driven, and fun.

Discussion Highlights

When developing initiatives, the Advisory Group members suggested balancing the magnitude of the problem with the potential impact. They also suggested that the Surgeon General use a top-down, bottom-up approach:

  • Top-Down: The Surgeon General could use his bully pulpit to provide the country with a framework for discussing the effects of social determinants of health on an individual’s ability to make healthy lifestyle choices, using his Call to Action on Walking and Walkable Communities as an example. The Empower People Strategic Direction in the Strategy provides a framework for the Surgeon General to promote agency at the local level by highlighting what communities can do to combat external forces. The bully pulpit is an appropriate method for educating providers on palliative care.
  • Bottom-Up: Communities should be encouraged to adopt evidence-based interventions and develop creative initiatives that address their specific needs.

The Advisory Group was asked to respond to messaging the Office of the Surgeon General has developed on the Call to Action on Walking and Walkable Communities and the Prescription Opiate Abuse priority:

  • Key Messages on Call to Action on Walking and Walkable:
    • Make walking a national priority.
    • Promote policies and programs that support walking where people live, work, and play.
    • Design communities to make walking safe and easy.
  • Key Messages on Prescription Opiate Abuse:
    • Practitioners will be educated on the treatment of pain.

Engage Partners and Build upon Existing Initiatives:

The Advisory Group stressed the importance of building upon and adding messages to existing initiatives. Additionally, the Advisory Group noted that systems-level changes only result when cross-sector engagement occurs at every access point in that system.

Advisory Group members suggested the following partners and resources:

  • The Surgeon General could rally support of locally-elected officials through the National Association of Counties’ Healthy Counties Committee.
  • The Surgeon General could convene an advisory body of social entrepreneurs to develop initiatives.
  • The American Heart Association has an Annual Heart Walk, through which they engage corporations, hospitals, and providers.
  • The Surgeon General could pull messages from the 2005 Call to Action to Improve the Health and Wellness of Persons with Disabilities.
  • The University of Alabama has a center that focuses on health promotion and exercise for individuals living with disabilities.
  • The Surgeon General should reach out to the pain community to ensure his messages on prescription opiate abuse reach a critical mass.
  • The Drug Enforcement Agency also needs to be engaged with his prescription opiate abuse work.

Tailoring Messages

Messages should be appropriately tailored for their audience. Messages need to consider perspectives and biases of cultural and ethnic groups, urban and rural communities, and other populations. Messages should be developed with assistance from community leaders to ensure the initiative will be successful.

The type of message will depend on the largest hook. For example, if physical activity is being emphasized, then encourage movement of any kind. If walkability is the frame, then demonstrate how improving communities leads to increased physical activity and social cohesion. If the Strategy is being stressed, then a walkability campaign could be developed with Council Departments and their partners.

Importance of Data

Concrete, measurable tools and resources are needed to document and sustain success. Community health needs assessments, which are mandated by the IRS, allow communities to understand what is needed and feasible to implement. Community health improvement plans include components that relate to the Strategy and the Surgeon General’s priorities. The Surgeon General should leverage local data sources and existing resources, such as the “Triple Aim.”

Additional Strategies

The Advisory Group proposed the following strategies to promote the Surgeon General’s priorities. Technology, such as smart phone apps, could be highlighted. The Surgeon General could identify a spokesperson or role model to raise awareness and motivate people. An article could be posted online and in magazines that cites the 100 best cities for walking, which could encourage competition among cities.

1:45 p.m. – Commission to Eliminate Child Abuse and Neglect Fatalities

The Commission to Eliminate Child Abuse and Neglect Fatalities was created as a result of the Protect Our Kids Act of 2012. The Commission is trying to improve response to potential child abuse and neglect fatalities; the current system of reacting to abuse and neglect is not effective. By March 2016, the Commission will release a report on how to (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 Commission wants to encourage community-driven strategies and the engagement of multiple sectors, including locally-elected officials. Strengthening the relationship between public health, child protective services, and child welfare services is critically important.

The Commission wants to promote systems-level change through a social determinants of health framework that emphasizes collective responsibility. The Advisory Group was consulted on how to leverage the Surgeon General and the National Prevention Council on this effort.

Discussion Highlights:

  • The Advisory Group recommended that the Commission consult with the National Association of Counties as some counties provide maternal and child health services.
  • Hospital systems have community engagement models and use community health workers to connect pregnant women to needed services, including family planning, health care services, and social services, such as housing and transportation. “Women Inspired Network” (Detroit, MI) was specifically mentioned as a model to explore.
  • The CMS could be consulted on providing Medicaid and CHIP services, such as EPSDT services, to mothers as addressing maternal needs benefits the child.
  • The Commission has explored incentives, such as an innovation fund that would allow communities to invest in cross-sector strategies. These investments would be time-limited and would help develop the empirical data that are lacking. Child welfare and Medicaid funding could be used to support these incentives and strategies.
  • Local communities should also be encouraged to develop place-based strategies that will target the areas most in need and to ensure sustainability of initiatives.
  • Some states have programs that help children under five years of age reach developmental milestones by addressing the social determinants of health. Data from these programs could help inform the Commission’s work.
  • The Advisory Group could assist the Commission by (1) providing input on a place-based approach; (2) providing external validation on recommendations and the final report; and (3) working with the Surgeon General to prioritize this issue as it relates to his priority of ending violence. A workgroup will be formed to help the Commission with this process.

3:00 p.m. – Panel Discussion on the Effects of Climate Change on Health, Agriculture, and Quality of Air and Water Supplies

John Balbus, National Institutes of Health: The social determinants of health impact a community’s vulnerability and ability to respond to a traumatic event. Communities that are impoverished are more susceptible to harm due to increased exposure to pathogens, prevalence of chronic diseases, lack of transportation, and poor access to care and prevention services. Mental health and stress levels are also impacted by changes in the environment and extreme weather events, such as Hurricane Katrina. Certain occupations, such as outdoor workers, are more exposed to heat stress and pathogens that can lead to allergies. Interventions, investments, and policies should address the social determinants of health and promote resiliency and empowerment in communities.

Kathy Sykes, Environmental Protection Agency: Climate change events, such as extreme heat, increased levels of ozone, temperature changes, and precipitation changes all impact health. Recent studies have demonstrated that the effects of climate change are worsening. The number of heating days, Lyme disease outbreaks, length of growing season, and amounts of ragweed pollen are increasing. Human activities are the largest drivers of climate change. Some populations, such as the poor, elderly, indigenous populations, and people living with chronic diseases, are more susceptible to the negative health effects of climate change. Congress in reviewing President Obama’s Clean Power Plan to reduce carbon emissions by 30% before 2030, which would have immense public health and economic benefits.

Wayne Casico, Environmental Protection Agency: The EPA documents the social, economic, and environmental impacts of wildfire smoke emissions. Annually, more than 70,000 wildfires happen each year in the United States. The annual amount of acreage burned has increased three fold since 1985. Smoke emissions contribute to increased particulate matter in the air, which increases the risk of asthma and heart failure. Individuals living in poverty are more vulnerable to smoke emissions because they are less likely to seek medical treatments. The EPA is working with the U.S. Forest Service, the Department of Interior, NASA, and NOAA to track and communicate the impacts of wildfire emissions on communities.

Charles Walthall, U.S. Department of Agriculture: The USDA’s report entitled Climate Change and Agriculture in the United States: Effects and Adaptation summarizes the impacts of climate change on agriculture and the need for research. Changes in temperature, precipitation, intensity of events, and carbon emissions all impact agriculture. For example, temperature changes impact the reproductive cycles of pollinators, crop yield, and number of planting days. Excessive carbon dioxide encourages the growth of weeds and vines, which are showing increased vigor and resistance to herbicides. Livestock owners are using more supplemental nutrition because nutrients in plants are not matching the rate of growth and are being depleted from the soil. Pest populations are increasing and are being resistant to insecticides. Climate change does have some beneficial effects on agriculture; for example, growing seasons are longer, plants have a reduced exposure to frost, and some pest species are migrating or dying off. Overall, farmers will be able to cope with the short-term effects of climate change, but are not prepared for the long-term effects on yield quantity and quality and cost of production.

Paul Schramm, Centers for Disease Control and Prevention: Climate change threatens human health and wellbeing by posing new health threats and amplifying existing health threats. Preparedness and prevention can protect people from climate change. The CDC’s Climate and Health Program is exploring the health impacts of climate change and providing scientific guidance to help state and local organizations address and prepare for those effects. The Climate and Health Program has funded 16 state and 2 city health departments to implement evidence-based approaches. Tracking and monitoring are important in understanding historical trends and predicting future trends. CDC’s National Environmental Public Health Tracking Network has added metrics related to climate change.

Kim Knowlton, Natural Resources Defense Council: People with asthma are a greater risk for negative health effects due to poor air quality, increased ozone levels, ragweed pollen, and wildfire smoke emissions. Smoke emissions have also been linked to stroke, acute heart problems, anxiety, and low birth weights. Heat waves are also contributing to thousands of unintended deaths. With average daily temperatures increasing, heat exposures will continue to threaten lives, especially for vulnerable populations. Extreme precipitation is contributing to contaminated water supply, erosion, and low crop yield. Addressing these climate change effects now will avoid negative health effects and high health care costs. Communities should receive funding to develop initiatives that promote sustainable and resilient communities as well as to support public health tracking and surveillance.

Laura Anderko, Mid-Atlantic Center for Children’s Health and the Environment: Climate change work has been ongoing for many years. For example, the Intergovernmental Panel on Climate Change was developed in 1988 to address climate change issues. Climate change researchers have documented unusual trends, such as reports of malaria and dengue fever in the U.S. and increased potency of poison ivy. Children, the elderly, and those with chronic diseases are more sensitive to changes in the environment. More funding should be allocated to climate change research, developing public health messaging and programs, and improving communities’ ability to respond.

Edward Maibach, George Mason University: Most Americans understand that climate change is a real problem, but believe it is a distant problem that will not impact humans. Public health messaging can bridge this gap. Americans trust public health and medical experts. Americans want to hear more about health effects and ways to prevent them. Public health messages are not seen as polarizing or politicized. Public health messages are seen as actionable, needed, and relatable, especially when connections are made to children. Improvements can be made in articulating benefits, threats and action steps.

Discussion Highlights:

  • CDC is tracking the physical and social characteristics that influence climate change. However, obtaining the right metrics for physical characteristics is a challenge due to inadequate funding and infrastructure.
  • Clear and actionable public health messages should be communicated consistently by trusted voices. Messages should encourage individuals to address the immediate and long-term effects of climate change. People generally do not understand that they are currently living with the effects of climate change; messages that point to air quality and asthma attacks or increases in pest populations, such as mosquitoes, can help make that connection.  Messaging should also discuss the cumulative impacts of wildfires, droughts, and other extreme weather events.
  • Local impact stories and data will help gain support from policymakers.
  • The Advisory Group wants to capitalize on White House and federal actions by encouraging the Council and their partners to address this issue. Climate change is not specifically mentioned in the Strategy, but its effects are discussed. The Strategy provides a framework for having this discussion.
  • Council Departments could engage in co-funded projects that address climate change effects at all stages of life. For example, the Council could develop a report on how climate change research and initiatives have impacted community health.
  • Conversations and solutions should not be punitive, but should focus on improving quality of air, land, and water while balancing economic and community interests. For example, if the coal industry is diminished in West Virginia, then another industry would need to fill its place to prevent negative impacts to the economy and citizens.
  • A Health in All Policies framework could be applied to develop national and international interventions.

5:15 p.m. – Public Comment

Taylor Walsh, Project Director, CoverMyCare: CoverMyCare is an integrative policy consortium and grassroots organization that advocates for the health plan coverage of integrative and alternative treatments. The organization is targeting state health commissioners and have demonstrated some success in Oregon, Rhode Island, Minnesota, California, and Hawaii. Creating conversation at the state level is a primary focus of the organization. The Advisory Group discussed following up on their previous discussions on Section 2706 of the Affordable Care Act.

September 1, 2015

Attendees: Richard Binder, Valerie Brown, Ned Helms, Patrik Johansson, Jerry Johnson, Janet Kahn, Jeff Levi (Chair), Jacob Lozada, Barbara Otto, Herminia Palacio, John Seffrin, Ellen Semonoff, Susan Swider, Sharon Van Horn, and Kimberlydawn Wisdom

Regrets: JudyAnn Bigby, Johnathan Fielding, Charlotte Kerr, Elizabeth Mayer-Davis, Dean Ornish, and Linda Rosenstock

HHS Attendees: Jon Auerbach, Melanie Ross, Brigette Ulin (Acting DFO), and Elizabeth Walker

8:45 a.m. – Roll Call and Meeting Overview

Brigette Ulin, Acting 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.

9:00 a.m. – Discussion of Work Plan

Resolution of Appreciation for Dr. Corinne Graffunder

Dr. Corinne Graffunder recently accepted a position as the Director of the Office of Smoking and Health at the CDC. Therefore, she will no longer serve as the DFO of the Advisory Group. The Advisory Group unanimously passed a resolution of appreciation for her service in this capacity.

The Advisory Group unanimously approved the following resolution:

Whereas Dr. Corinne Graffunder has served as our Designated Federal Official since our inception;

Whereas she helped guide the National Prevention Council (NPC) and shaped it into a meaningful institution for cross-departmental collaboration to promote the health of all Americans;

Whereas she was an instrumental leader in the development of the National Prevention Strategy, which now serves as a framework for federal and many state, local, and community public health efforts;

Whereas she has been a tireless supporter of the Advisory Group as a whole and its individual members;

Now therefore be it resolved, that the Advisory Group on Prevention Health Promotion and Integrative and Public Health expresses its gratitude for the leadership and support that Dr. Graffunder has provided to us, the NPC, and our nation and wishes her well as she takes on her new, vitally important role as director of the Centers for Disease Control and Prevention’s Office on Smoking and Health.

Resolution on Changes to the Healthy and Hunger Free Kids Act

Changes have been proposed to the Healthy and Hunger Free Kids Act of 2010 that negatively impact the U.S. Department of Agriculture’s (USDA) school lunch nutrition standards. The changes would allow organizations to waive requirements concerning whole grain foods and restrict USDA from moving forward with scheduled sodium reduction targets. The proposed changes would also inhibit USDA and HHS from finalizing the Dietary Guidelines for Americans, 2015. These efforts undermine scientific evidence and standards for federally-funded programs. The Advisory Group has issued resolutions when scientific evidence has been disregarded in policies or regulations, such as SNAP. Therefore, the Advisory Group decided to formally respond to these proposed changes.

The Advisory Group unanimously approved the following resolution:

Nutrition plays a large and important role in children’s brain development and academic performance. The Healthy, Hunger-Free Kids Act of 2010 directed the U.S. Department of Agriculture (USDA) to update nutrition standards for foods served in schools, including for the National School Lunch and School Breakfast Programs.

Unfortunately, language included in fiscal year 2015 appropriations law created the ability for school districts to request waivers that effectively exempt them from having to meet standards related to whole-grain foods. Additional language would restrict USDA from putting future scheduled sodium reduction targets into place. Similar language has been proposed by both the U.S. House of Representatives and U.S. Senate during consideration of appropriations for fiscal year 2016.  In addition, newly-proposed language would also severely restrict USDA and the Department of Health and Human Services (HHS) in their ability to finalize the 2015 Dietary Guidelines for Americans.

The Advisory Group believes that the language is inconsistent with the factual information and strategic perspective of the National Prevention Strategy (Strategy). The Strategy highlights the importance of healthy eating and proven programmatic nutrition standards and policies including those in schools and early learning centers.

At a time when there is more scientific evidence than ever proving the importance of good nutrition, we find it profoundly unwise, morally reprehensible, and harmful to health to use the appropriations process to rollback efforts to improve the nutritional quality of foods eaten by our nation's children in school.

We urge the Administration to continue to oppose legislative modifications to evidence-based nutrition standards and guidelines or restrictions that would undermine the scientific process.

The health of the American people – and in this instance the health of the children of America – is jeopardized when proven approaches to health and well-being are disregarded.

Dr. Herminia Palacio excused herself from this conversation concerning pending legislation.

Follow-Up on Chronic Absenteeism Presentation from March 2015

At the Advisory Group’s meeting on March 9 – 10, 2015, presentations were heard on chronic absenteeism. An article from the Washington Post was distributed about recent research on how chronic absenteeism is contributing to academic gaps. In October, the Department of Education will hold an event announcing an interdepartmental initiative.  The National Collaborative on Education and Health, which grew out of an Advisory Group working group, has advised in the development of his initiative.

Healthy Aging Action Plan

Dr. Johnathan Fielding, Ned Helms, Dr. Jeff Levi, Barbara Otto, and Ellen Semonoff will form a workgroup to assist the Council in developing the Action Plan. The workgroup will focus on incorporating non-federal expertise. The National Association of Counties is hosting a healthy aging summit on January 25 – 27, 2016, which could be an opportunity to announce this initiative and obtain feedback.

The Commission to Eliminate Child Abuse and Neglect Fatalities

Dr. Kimberlydawn Wisdom, Dr. Jeff Levi, Dr. Susan Swider, RN, and Dr. Herminia Palacio will form a workgroup to assist the Commission with applying a public health frame to their work.

Advancing the Surgeon General’s Priorities

The Advisory Group would like to be engaged earlier in the development of initiatives in order to make timely suggestions for potential directions and partners. The Advisory Group believes frequent conversations with the Surgeon General and the Council are important and consistent with their role in advising the Council and the Surgeon General, as the Chair of that body.

The Advisory Group stressed the importance of leveraging existing initiatives in ensuring sustainability of his priorities in the next Administration. However, Advisory Group members warned that the Surgeon General should think carefully about his approach when aligning with other Administration initiatives, such as Let’s Move!  Communities might be confused by seemingly competing initiatives from the Administration. Also, current Administration initiatives might not be maintained in a new Administration.

Advisory Group members suggested that the Surgeon General keep his priorities and initiatives broad to allow for more flexibility and increased partner base. Additionally, the Surgeon General should highlight how his priorities are interconnected and address the social determinants of health. For example, individuals who live in safe, well-designed communities are more physically active and are less likely to have poor diets or abuse drugs.

The Advisory Group believes the bully pulpit is a highly effective approach the Surgeon General should use to address certain priorities. However, the Advisory Group noted that some priorities will need a more targeted campaign. To determine the appropriate forum, the Advisory Group stressed the importance of understanding the magnitude of the problem and the potential for impact.

Climate Change Effects on Health, Agriculture, and Quality of Air and Water Supplies

The Advisory Group would like the Surgeon General to integrate climate change into his existing priorities and encourage partners to work on this issue. Existing federal collaborations and the Administration’s leadership on this issue needs to be praised.

Bully Pulpit

Public health officials are trusted messengers. Therefore, the Surgeon General and Council Departments should use their bully pulpits to raise awareness of climate change issues and catalyze action. Messaging needs to include information on the immediate public health effects (i.e., increased asthma due to ragweed pollen and poor air quality) and international insecurity (i.e., drought and famine). No one, regardless of socioeconomic status, race/ethnicity, or geographic location, is exempt from the effects of climate change. However, vulnerable populations are the most impacted.

Urge the Council to Act

The Advisory Group would like to support the Council in developing and implementing collaborative and measureable approaches to addressing the effects of climate change. The Advisory Group members raised the following potential Council actions for consideration:

  • Establishing funding priorities for their states and grantees to operationalize and measure the impact of climate change initiatives
  • Incorporating climate change messaging into daily operations, especially public-facing services and programs
  • Completing an assessment of current federal efforts to address climate change
  • Reviewing, and potentially revising, the Healthy and Safe Community Environment Strategic Direction of the Strategy
  • Reconsidering the make-up of the public health workforce
  • Developing a Council action plan to combat climate change
  • Enhancing public health tracking

A formal recommendation will be drafted for considered by the Advisory Group at a future teleconference meeting.

10:30 a.m. – Discussion with the Acting Assistant Secretary for Health

Dr. Karen DeSalvo is the Acting Assistant Secretary for Health. She wanted to speak with the Advisory Group to demonstrate her commitment to and discuss potential opportunities for collaboration with the Council and the Advisory Group.

Dr. DeSalvo practiced and taught medicine and public health at Tulane University. She was also engaged in health systems research. After Hurricane Katrina, she served as the Health Commissioner for the City of New Orleans. In her current position, Dr. DeSalvo is building initiatives with communities, demonstrating collective impact, and addressing the social determinants of health. Dr. DeSalvo noted that agencies, such as CMS, are incorporating the social determinants of health framework into their programs and policies. Her office is trying to implement public health initiatives that matter to and will be sustainable in communities.

Dr. DeSalvo noted that the key methods for communicating public health issues and initiatives are convening, bully pulpit, policy, budgeting, reports, and science. She highlighted the importance of shared language and strong public health infrastructure. She stated that the public health workforce, both future and existing, needs to be strengthened through training and improved curricula. Funding systems need to be more cross-cutting to allow more flexibility and support in implementing initiatives. Dr. DeSalvo spoke of the need for more cross-sector engagement. For example, HHS has made great strides in incorporating public health into health care, but more work can be done, especially at the community level.

Discussion Highlights

  • Dr. DeSalvo highlighted that efforts should be made to retain, support, and build upon existing public health workforce, especially individuals working in information technology. Building and managing real-time public health data are of critical importance.
  • Public health leaders need to understand how to be more flexible and innovative. Dr. DeSalvo suggested that strategic leadership courses should be developed that build cross-sector experience and explain the instant command structure in emergency situations.
  • The group discussed the differences between population health and public health. Public health is critical and should be recognized, named, and respected as a field, discipline, and infrastructure in society. The health of the public is a broader notion that everyone should have the right to be healthy and that the healthy choice should be the easy choice. Population health is more defined by population, neighborhood, or other characteristics. The medical field needs to understand that distinction and partner with public health.
  • Community health workers are new tools public health has acquired. Dr. DeSalvo believes that every community will know if utilizing community health workers is important and feasible for them.

11:00 a.m. – Discussion of Work Plan and Legacy

Patrik Johansson shared a video developed by the University of Nebraska about the importance of data and partnerships in addressing health disparities. Strong data and partnerships at all levels and among all sectors ensure positive outcomes. The Advisory Group will further discuss, perhaps in a workgroup, ways to improve inter-professional education.

Discussions of the Advisory Group’s legacy will center on the role and vision of the Council, Surgeon General, and the Advisory Group as well as if the Strategy is a static or living document. The Advisory Group will assess their accomplishments as well as the barriers they experienced. In reflection of this meeting’s deliberations, the Advisory Group felt strongly that their legacy document should emphasize that public health and medical messengers are the most trusted, and scientific evidence should be the basis for all policy and programmatic decisions. The Advisory Group believes that more actions should be taken regarding the Empowered People Strategic Direction, especially around engaging communities. Communities need to understand why the initiatives are important and need to believe they can implement the initiatives. The Advisory Group would like a more structured way to provide recommendations and feedback to the Council, suggesting that the Advisory Group and Council should have regular meetings. Jerry Johnson, Barbara Otto, Susan Swider, Valerie Brown, Janet Kahn, Patrik Johannson, Kimberlydawn Wisdom, and Jeff Levi will form a workgroup and develop a document for the full Advisory Group’s review.

11:30 a.m. – Adjourn