Good Health Powerpoint Introduction

Summary of the workshop’s vision for Good Health on Cape Cod:   All citizens on Cape Cod will enjoy the same access to healthcare and the same quality of healthcare regardless of their personal circumstances.   By 2020, we will be dedicated to creating health through preventive education, social well-being, communication, cooperation, regionalized services and environmental protection and cleanup.   By 2020, all residents will have developed a sense of community and responsibility for one another.

Breakout Group 1 Discussion

Imagine the year 2020:   Cape Cod’s total population has grown to 375,000 (an increase of 50% over 2005), 175,000 of whom are seniors/elders 55+ (an increase of 300% from 2005) and 75,000 are children/youth (an increase of 67% from 2005).   What percents of these two populations have adequate, affordable health insurance?   Prescription drug insurance?   Who pays for this coverage?   Are these percentages desirable? What are the indicators that will enable us to answer these questions?   What actions are needed?

The discussion began with participants noting that health care is a right, not a privilege, and that when this view is accepted, it will eliminate disparities among groups of people and barriers to access of equitable health care.   The group concurred that all citizens in 2020 will have the same access to healthcare, and the same quality of health care regardless of income.

Participants noted that we pay for health care now and we will pay for healthcare in the future, in one form or another, because citizens are the source of all money for health care.   Focusing on the cost of health care, the group envisioned that in 2020:

• the government and our employers will pay for healthcare
• the wealthy will pay more, the poor will pay less
• we will have a graduated system with 5 levels of payment
• the cost of healthcare can be reduced by reducing administrative costs
• there will be a wealth tax
• single-payer healthcare will eliminate separation
• “looser pays” will lead to a reduction in the number of frivolous lawsuits and the resulting higher costs
• the system will have reduced redundancies and scattershot services

Related to the cost of healthcare, the group noted thatthe system should be dedicated to creating Health, notWealth, and that in 2020 we will subsidize those practices that create good health while providing disincentives (i.e. taxes) for those products (i.e. pesticides, etc.) and practices that create bad health.  

Noting that the Barnstable County rate of violence is rising, and violence requires additional health care services, participants envisioned that in 2020 preventive education will be emphasized (in all areas that affect health) and that preventive healthcare will be emphasized.

Participants noted that in 2020, people will have a strong spirit, and that good health includes social well-being.   The conversation turned to cooperation and cooperative health care with participants noting that we will knock down the barriers through cooperation and that people will be helping people.   In 2020, participants envisioned a sense of community versus a sense of isolation (do you know the 3 neighbors on each side of you?).  

The group discussed the relationship between the care-giver and the care-receiver, noting that the absence of an adversarial relationship between the physician and the patient (cooperation and respect) will lead to healing.   A participant wondered how we could measure love-based and faith-based healing.

Suggested Action Items

• Farmers Market where WIC vouchers are accepted.
• Sponsor a public safety officers forum.
• Remove the barriers and incorporate complementary health care into the standard for regular traditional healthcare.
• Integrate existing databases (from schools, public health agencies, medical agencies, etc.).
• Look to other regions as models – i.e. real estate on Nantucket, Long Island, and “looser pays” lawsuits in Britain.

Suggested Indicators of Progress

• The rate of domestic violence and substance abuse as indicators of mental health
• Immunizations/teeth sealants/rate of dental care are indicative of the health of the community
• Basic childhood indicators such as access to a physician
• Prenatal care
•  Access to insurance
• When was the last time you saw your physician?
• Use survey instruments that have national data as well as local data
• Measure the quality years of life, not the length of life
• Develop an indicator correlating real estate prices and economic stress to the displacement of the working poor, including resident health-care    givers
• Emphasize hospice, palliative care and elder care
• Substance abuse, mental health and social services are not as strong as medical health care services
• Correlate environmental health to good health
• Nutrition, obesity, quality of food
• Measure court records of domestic violence 10 years ago and now for a level-of-violence indicator (Department of Justice)
• Measure assault & battery rates in Barnstable County – local police departments and court records document domestic assault
• Anecdotal evidence/testimony about domestic assault, including from public safety officers
• Repeat offenders statistics
• Measure complementary (alternative) health care

Breakout Group 2 Discussion

Imagine the year 2020:   The corporations, agencies, and health practitioners who serve residents and visitors to Cape Cod are linked/connected/integrated with one another in ways that everyone recognizes serve the public well.   How will we achieve this?   How are these links measured?   Who is responsible for measuring them?   What actions are needed to make this happen?

The group began by noting that the ultimate goal is to improve outcomes, and that this goal should be used to guide the actions that are needed.   Participants noted that improved communication is needed about healthcare and other issues – that communication leads to the formation of coalitions, and that this increases trust, reduces competition for money, and improves the sharing of data and information.   The consensus of the group was that Cape Cod needs to improve communications among healthcare service and delivery groups by forming coalitions between towns, regions and states.   It was noted that the Lower/Outer Cape Community Coalition is working with Rhode Island Geriatric Education Center, and that similar types of coalitions needed to address the health needs of children and other populations.

The group discussed the importance of regionalization on Cape Cod, noting that Massachusetts has 351 towns and that it is very difficult for them all to pull together.  However, because it is also very difficult for each individual town to offer a full range of services, participants noted that collaboration is critical.   Participants agreed that collaboration among the 15 towns (regionalization) is very important for Cape Cod.  Participants noted that collaborations and integration should be based on various service offerings that already exist – that we need to identify gaps and align service providers with them.   It was noted that there are overlaps that need to be eliminated; resources need to be redirected to priority gaps, where integration can fill/span them.

It was noted that the Lighthouse Health Alliance is an effective regional model, and that with Cape Cod Healthcare, we already have a leg up.   The group wondered where the regional model works and does not work, i.e. what Barnstable County should offer vs. what the towns should offer.

It was noted that communication and education about regionalization is very important and that there needs to be some selling done - on integration - to providers, consumers and towns.   It was noted that there is a need to distribute data and information through education both to citizens and decision-makers.   The group agreed that in some instances, there is a need to educate physicians about available services – they don’t always know and often don’t have time to learn.

The discussion turned to health care and environmental health.   It was noted that environmental health is a big concern now (water, air, and climate).   Participants noted that Cape water issues are closely related to future health, and that five towns have public water supplies affected by plumes of contamination.   A participant suggested that we look to places like Long Island for planning purposes so we can avoid future problems.   The group discussed the role of local health and human services departments, asking what is the best way to use public resources, and what role these departments have in town decisions.   It was suggested that these departments have a more proactive front-end role to better avoid problems and bandaid fixes.

The group concluded by discussing the changing American culture, and the activities (or lack thereof) that are offered that lead to obesity, isolation and increased stress.   A participant said that the prevalent use of virtual reality and AI (artificial intelligence) devices could lead to a fearsome future.   The group wondered if this causes a loss of community and an increase in isolation.   They also wondered if kids are able to pay attention in school and whether teachers have to work harder as a result.

Suggested Action Items

• “Loser pays” legal system.
• There should be a wealth tax to pay for healthcare for all.
• Tax the negatives in our food chain/economy; subsidize the positives.
• Doctors should prescribe organic food.
• Use public resources efficiently and wisely.
• Protect the environment and clean it up where necessary.
• Educate physicians about social and environmental health impacts, preventive healthcare and complementary types of healthcare.

Suggested Indicators of Progress

• Environmental sources of health problems – changing face of healthcare; how do you measure these?   Very difficult
• Can we look to Long Island – what are indicators there vs. here – are there historical data there that correspond to current conditions here?
•  Services offered at County level; is level of services rising? In what areas? Are town services dropping in corresponding areas, or is County        filling  gaps? Is efficiency increasing?
• How many physicians have been trained to know what services are available, and where they can be accessed?
• Communications, integration
• % of household income going to healthcare
• Level of coverage for children
• Percent of children with/without health care/dental care
• Amount of patient services delivered/visits occurring on Cape vs. off Cape (outmigration; availability of specialists locally)
• Visits to healthcare centers
• Number of uninsured by percentage
• Clean up of contaminated sites; number of contaminated sites
• Number of Title V systems/advanced systems
• Nitrates in water; pollution from Canal plant and other sources
• Landfill plumes – are they being tracked? What’s in them?
• Cancer rates (environmental health cause?)
• Violence in community (reflection of breakdown of society/community health)
• Violence in video games
• Weight in young children – trend
• ADD/ADHD diagnoses
• Hours of TV per day
• Existence/type of physical education activities in public schools
• What has happened to exercise? Where is it occurring? Who isn’t doing enough?
• Absenteeism
• Community involvement – are people helping people? Do they know their neighbors
• Legal/medical system interactions