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

December 22, 2015

Advisory Group Attendees: Richard Binder, Johnathan Fielding, Ned Helms, Patrik Johansson, Jerry Johnson, Janet Kahn, Jeff Levi, Jacob Lozada, Elizabeth Mayer-Davis, Dean Ornish, Barbara Otto, Susan Swider, Kimberlydawn Wisdom

HHS Attendees: Shavon Arline-Bradley, Vivian Duru, Melanie Ross (Acting Designated Federal Officer)

FHI 360 Attendees: Julianne Edelstein, Kelli Hunter

Summary

The Advisory Group on Prevention, Health Promotion, and Integrative and Public Health held a teleconference meeting to discuss activities and issues to be addressed before the next in-person meeting (date TBD). The Office of the Surgeon General (OSG) provided an update on the Surgeon General’s priorities and work in the coming year. The Legacy Working Group developed an outline of the Legacy Report and sought comments from the full Advisory Group. The report will communicate about the successes and value of the National Prevention Council (NPC), the Prevention Advisory Group (Advisory Group), and the National Prevention Strategy (NPS) to the next Administration. Feedback from the meeting will inform the full draft for discussion with the full Advisory Group at its next in-person meeting (date TBD). The group reviewed and approved resolutions about climate change and gun violence, topics they will discuss further during the next in-person meeting (date TBD). Highlights and action items from this discussion are below.

Roll Call and Review of Meeting Purpose

Melanie Ross, Acting Designated Federal Officer (DFO), called roll and confirmed.

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

Update from the Office of the Surgeon General

Shavon Arline-Bradley (OSG) provided an update to the Advisory Group, focusing on four specific areas pertaining to OSG’s current work.

Update # 1

  • OSG is currently working in partnership with the Centers for Disease Control and Prevention (CDC) on the assessments completed by NPC members.
    • This process began in October 2015, when NPC members received two assessments, one to assess food service guideline policies and one about tobacco-free policies.
    • The assessments are intended to identify where current council member agencies stand with these specific policies.
  • The OSG is currently in the process of finalizing the analysis on the data. The goal is to collect all data and complete the analysis during the first quarter of 2016.

Update # 2

  • The Surgeon General’s recent call to action—released on September 9, 2015—aimed to promote walkable communities.
  • The call to action yielded a significant amount of impressions on social media, and over 2,000 in-person and online activity partners who logged in via podcast or came on-site to see the call to action be launched.
  • Four partners announced their commitment to the call to action: The American College of Sports Medicine, NCAA, Johnson & Johnson, and the International Mall Society.
  • This call to action was very important to the Surgeon General and the Administration.
  • OSG is focused on two major issues, community-based prevention and health equity. The call to action focused on increasing opportunities for physical activity in communities throughout the country and assessing walkability in America.
  • In partnership with CDC, OSG addressed some of the health equity issues connected to the built environments including traffic safety and the prevalence of crosswalks.
  • The call to action led to two follow-up webinars on the subject by Grantmakers in Health and the Funders Network for Smart Growth and Livable Communities. In partnership with these groups, over 400 communities were identified who had interest in financial resources and technical assistance from the partner, America Walks.
  • With the call to action, a tremendous response came from communities across the country interested in working with OSG, including the Boy Scouts of America and the YMCA and its state affiliates.
  • The Surgeon General’s keynote at the walking summit yielded many positive responses about the call to action.

Update # 3

  • OSG previously shared in August 2015 several potential priorities. The Advisory Group expressed to OSG a need to narrow the focus.
  • In 2016, the OSG’s National priorities will include:
  • Addiction: this priority will be OSG’s major focus in the first half of 2016. Their goal is to address the opioid crisis as it pertains to prescribers and the general public. OSG is working to identify national and inter-governmental partners who will aid in identifying the best course of action for this campaign. The Surgeon General announced in October his intention to release a report on substance abuse. The opioid campaign has garnered national attention. President Obama and the U.S. Secretary of Health and Human Services have begun addressing the issue, and the OSG will respond with their campaign. As campaign details come forward, OSG will share plans for Q1 of 2016. The expectation is to create a prescriber campaign and general public campaign that will: 1) increase awareness of the prevalence of the opioid crisis, 2) support better prescribing practices and ensuring they have the best information available, and 3) specifically discuss the social issues connected to the addiction crisis. In November, the Surgeon General was featured on television discussing this issue.
  • Climate justice and climate change: OSG expects to hear from the Advisory Group and other partners to continue moving forward on this issue. OSG is committed to clean air and preventing climate change in the country. Specifically, the Surgeon General participated in a number of high-impact events to bring awareness to climate change.  The Surgeon General spoke at the White House Climate Change event in June 2015. Along with President Obama, the Surgeon General participated in a session on climate change and health recently at Howard University in Washington, D.C. The summit focused on the disproportionate impact of climate change on communities of color. During the August 2015 meeting, the Advisory Group held a session on climate change’s effects on health, agriculture, and quality of air and water supplies.
  • OSG is looking forward to receiving the Advisory Group’s resolution on this issue.

Update # 4

  • The Surgeon General and NPC are in the final stages of developing a Healthy Aging Action Plan (Action Plan), slated for release in spring 2016. The goal is to define healthy aging as developing and maintaining optimal physical, mental, and social well-being in older adults. OSG wants to develop a model of optimal aging that includes promoting health; preventing injury; managing chronic disease; optimizing physical, cognitive, and mental health; and facilitating social engagement. 
  • The Action Plan will advance the Strategy by identifying action steps to promote prevention and well-being among older Americans.
  • The Action Plan will focus on individuals’ aged 55–65 years and vulnerable populations. It will focus this aging action plan on the best practices and opportunities for engaging support for older Americans.

Discussion Highlights

  • The Advisory Group expressed satisfaction with Ms. Arline-Bradley’s overall report update and acknowledged the Surgeon General’s attention to the presented issues and the OSG’s efforts towards health equity.
  • The group discussed OSG’s needs from the Advisory Group in terms of addressing addiction and opioid abuse issues at the first in-person meeting of 2016. Given the Advisory Group’s prior work, their interest may lie with the social issues associated with addiction, the social context of drug use, and considering primary prevention; primary prevention approaches tend to be overlooked. OSG is looking to work closely with the Advisory Group on:
  • Provider practices
  • Enlisting national partners that are essential to ensuring trainings to prescribers
  • General education messages for the general public, including seniors, young people, and parents.
  • Ensuring the relevant equity messaging.
  • Ensuring OSG addresses prevention.
  • The Advisory Group members suggested supporting states that require physicians to access the state Prescription Drug Monitoring Program database before providing prescriptions. Physicians are not uniformly accessing these registries, which are critical in reducing prescriptions. Establishing clear guidelines could also lessen physicians over-prescribing their patients.
  • The group suggested liaising with medical schools to begin education before students complete their programs and begin practicing medicine.
  • In terms of pain management, are there integrative approaches to pain management that help avoid addiction?
  • There is a desire to adapt the approach to pain management so there is less need for prescription drugs, which in a sense will be a form of primary prevention.
  • It is important to recognize the fear of opioid addiction could lead to a problem where people who are suffering are not getting enough narcotics in the hospital because of the fear of creating an addiction.
  • The Surgeon General could highlight areas that have done a commendable job reducing inappropriate prescribing. Kaiser has reduced prescriptions 60-70 percent.
  • Given recent events, the group discussed the Surgeon General’s actions and comments on gun violence as a public health issue. The Surgeon General has gone on record to show he has been in contact with the American Public Health Association about public health determinants as they relate to violence.
  • In the context of equity being a foundation of OSG’s strategy, there may be an opportunity to discuss the importance of diversity in the health profession’s workforce and student body. This issue has been raised recently in academic institutions. The Surgeon General recently spoke at two national meetings on the importance of a diverse and prepared workforce to address culturally sensitive issues occurring throughout the country.

Report from the Legacy Working Group

  • The Legacy Working Group shared an outline of the Legacy Report with the Advisory Group.
  • The report will be 10–12 pages on the following key points:
  • Demonstrate the importance and impact of NPS, NPC, and the Advisory Group.
  • Make a case for greater engagement.
  • Address subject areas requiring more attention (i.e. Empowered People Strategic Direction).

Overall Report Discussion

  • The Advisory Group discussed how their work resonates with OSG’s thinking pertaining to the Call to Action. The group considered how the Legacy Report will make the case for the continuous emphasis of health prevention and promotion and to the continuation of agencies working together.
  • OSG is committed to the full integration of NPS as deemed appropriate by the Affordable Care Act. One of OSG’s internal goals is to ensure NPC serves as a national model for groups to replicate at the regional, state, and local levels. The intention is to meet the goals laid out by NPC so communities can implement the same strategies. OSG sees the Advisory Group’s goals as being aligned.
  • OSG cannot discuss climate change, gun violence, and mental health yet, as they have not moved forward on their work on these issues. The Advisory Group is welcome to share feedback with OSG about these subjects. OSG values the subcommittee’s ideas to sustaining its legacy.
  • With the group’s interest in personal and planetary health, and with the large misconception about the major causes of global warming, it was suggested that the report mention the role of personal sustainability in global sustainability.

Discussion on Part One of Report

  • The group discussed recommending that, at the start of the new administration, the NPS should be updated as appropriate with a number of issues including climate change, gun violence, and others not currently included in the NPS. The update is also a way of reengaging the administration and gaining investment in the NPS. 
  • This report will highlight the Prevention Council’s and the Advisory Group’s successes. The Legacy Working Group is seeking examples from the Office of the National Prevention Strategy, OSG, and various agency representatives. Patrik Johansson has reached out to the full Advisory Group to gather examples of work they have done to bring the NPS to communities.
  • The group is satisfied with the direction of the Legacy Report. They agree that including a concise, focused set of missing subjects is the best approach. If too many subjects are mentioned, the report will lose impact.
  • The group prefers to focus on climate change and gun violence and feels there is already enough existing content related to mental health. However, the working group should revisit the “laundry list” of issues once more to ensure there are no additional issues missing in the NPS.
  • The group mentioned establishing criteria for Advisory Group successes highlighted in the report.

Discussion on Part Two of Report: Making the Case for Greater Engagement of the Advisory Council and Advisory Group for Cross-Sector Collaboration

  • Shavon spoke to the desire of OSG to make better use of NPC.
  • The group discussed possible models created by OSG and NPC for replication at the local level. The group is looking to OSG for guidance on whether the model is a call to action for multi-sector work.
  • OSG established the call to action on walking as an example of engaging different sectors including educators, business owners, parents, and government leaders. It is important to house these coalitions and councils in a local area working to change policies in their communities pertaining to walkability and spaces to play. OSG wants NPC to analyze public health issues through a diverse lens going forward.
  • How can OSG and NPC work together to prepare communities and help them understand their role in their community’s health?
  • It is important to collect stories and retell how multi-sector efforts at the local level have contributed to health equity.
  • Barbara Otto expressed her interest in drafting a piece on multi-sector engagement for the group’s consideration.
  • To inspire multi-sector engagement, the Advisory Group’s representation should be diverse. There are currently four vacancies in the Advisory Group highlighting gaps in representation.

Discussion on Part Three of Report: Specific Initiatives for Empowered People

  • The group discussed the necessity of the third section and the content to be included if it remains.
  • The group agrees on highlighting climate change and gun violence here. It is important to gather stories of communities coming together and the mechanisms to change health. As the mechanisms are adopted, they must include efforts that focus on the topic areas (climate change and gun violence).
  • The group would like to see a focus on community engagement and empowered people, because it is has not garnered much attention.
  • Who you empower in multi-sector engagement is important. Being inclusive and approaching the multi-sector engagements with an equity lens could allow the Advisory Group to better integrate empowered people into the NPS.
  • The group discussed bringing forth the issue of empowerment and using the key issues to display what engagement looks like. Empowerment is not only knowledge, but also the skills and resources that can enable people to move forward and be agents of change. This should be included in the engagement piece.
  • Based upon the discussion, the report may require reframing to reflect the comments.

Discussion on Part Four of Report: Stance on Prior Resolutions

  • To retain the report’s main focus, the group agreed the prior resolutions should be included as an appendix.
  • The working group can pull together the previous resolutions to share with the larger group.

Climate Change Resolution

  • The group discussed the proposed climate change resolution.
  • The resolution appeared more focused on disaster management than primary prevention. The element of primary prevention is important to include. The group needs to add specific language for an amendment to the resolution.
  • The term public in the resolution refers to the “American public”.
  • The Advisory Group decided to amend the second sub-bullet within the climate change resolution to “Any updates to the NPS implementation plan and specific/detailed discussion of climate change building from their agency climate plans—both in terms of primary prevention and response to health challenges posed by climate change”.
  • The Advisory Group voted in favor of the amended resolution presented below:

At our August 31, 2015 meeting, the Advisory Group heard compelling presentations from government officials, scientists and other experts on the dramatic impact of climate change on the health of Americans.  That threat is not abstract: we already are witnessing the direct effects of climate change on the health of Americans such as increased respiratory illness due to heightened air pollution, new infections disease outbreaks and health threats caused by increased natural disasters.  The health impact of climate change is disproportionately felt by vulnerable populations.  Unless brought under control the direct health effects will only increase in frequency and magnitude.  Further, the indirect health effects from a changing environment due to climate change - from its impact on water supplies and agriculture to food production, to name a few- also pose major threats. 

Addressing climate change is a high-priority public health issue critical to the future of our nation’s health and well-being.  We have been pleased to see greater attention paid to the public health implications of climate change from the White House and an increasingly diverse group of federal agencies having direct responsibilities related to climate change.  But much more needs to be done to rally the nation and our society to address this critical challenge to our well-being.  To that end, the Advisory Group:

  • Calls on the Surgeon General to use his bully pulpit to educate the public and catalyze the health community to specifically engage in addressing the consequences of climate change and preventing its worsening.  We also call on the Surgeon General to integrate climate change into his existing and future priorities.
  • Calls on the National Prevention Council to consider the health-related effects of climate change as essential to achieving the goals of the National Prevention Strategy (NPS).  We note with regret that the NPS in its current form makes no mention of climate change.  We recommend:
  • That any updates to the NPS or the NPS Implementation Plan add specific and detailed discussions of climate change, building from their agency climate change plans – both in terms of primary prevention and response to the health challenges posed by climate change.
  • That all agencies that are part of the NPC require that their grantees have climate change mitigation and plans.
  • That all agencies use should educate their constituencies to increase awareness of the implications of climate change, including the health impacts, on society.
  • That all agencies, as they work to create more resilient communities as part of their larger mission, take into account resilience in the face of climate change.
  • Calls on the federal government and the nation’s governors to assure that the health implications of climate change are a part of every state’s climate action plans through formal agreements between the federal government and the states.  Currently only 15 states have completed such adaptation plans.   The federal government should also assure that all states have health tracking capacity so that we can measure the health impact of climate change in real time and assess interventions that are deployed to address it.

Gun Violence Resolution

  • For now, the group decided to provide a general statement on the resolution. At the next in-person meeting, the group can clearly develop the public health case around gun violence. This will provide more details for recommendations.
  • The resolution will use “majority of Americans” rather than “millions of Americans”.
  • Overall, the group acknowledged the issue was captured well in the resolution.
  • The Advisory Group voted in favor of the gun violence resolution presented below:

The Advisory Group, along with the majority of Americans, has been shocked and saddened by the recent mass killings in the United States as well as the regular gun violence and gun-related suicides experienced in the U.S. virtually on a daily basis. Guns kill almost 30,000 people and cause 60,000 injuries every year. This is a complex issue driven by multiple factors but it is ultimately a public health problem that would have mobilized a comprehensive public health response years ago if it were not associated with the volatile politics surrounding this issue.  Indeed, the failure to even reference gun violence in the National Prevention Strategy is a major gap that needs to be filled.  To that end, the Advisory Group plans to begin a discussion of the issue of gun violence and how a more comprehensive response can be framed within the context of the National Prevention Strategy.  In the short term, we join others in the public health community in calling for Congress to lift the restrictions on Centers for Disease Control and Prevention (CDC) research on gun violence.  Without comprehensive, objective public health data and science to support our decision making, our ability to respond to this public health crisis with effective prevention efforts is dramatically weakened.

Next Steps 

  • Once criteria are established, Patrik will reach out to the group for input into specific success stories for inclusion in the Legacy Report.
  • The Legacy working group will schedule their next teleconference call in 2016.
  • The agreement on the resolutions will help frame the next Advisory Group meeting’s overall focus (legacy issues, gun violence issues, climate change issues).
  • Planning will begin for the 2016 calendar year Advisory Group meetings.

Adjourn