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Columnist Taylor Walsh: March Prevention-Madness in DC and Implications for Integrative Practice PDF Print E-mail
Written by John Weeks   

Columnist Taylor Walsh: March Prevention-Madness in DC and Implications for Integrative Practice

Summary: Beltway-based Integrator columnist Taylor Walsh specializes in examining policy changes with an eye on their potential meaning to integrative medicine and health care. In this column, Walsh offers a useful summary of a rash of developments as the National Prevention (and Public Health) Strategy begins to unfold. "Integrative health care" is a new concept right up front in the law behind this $16.5-billion effort. Are there explicit initiatives laid out in these plans? Walsh points to where there may be opportunity.      
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A major
Integrator editorial interest is in following the evolution, or devolution, of activity in the Capitol relative to the integrative practice community. In this work, Washington, D.C.-based Integrator columnist Taylor Walsh is an indispensable ally. Here he informs of events relative what may ultimately be $16.5 billion of new funds for prevention and public health. This is through a new Prevention and Public Health Council with 2 representatives from our fields. The law establishing the Council has 3 references to "integrative health care" in the list of the Council's top goals. Walsh's report is a useful orientation.

Walsh is a consultant, entrepreneur and writer on digital media and integrative health. His blog is
Getting to Integrative Health & Wellness. His Twitter account is @taylorw.

March Prevention-Madness Week in DC

-- Taylor Walsh

Taylor Walsh
Last week was March Prevention-Madness week in Washington.

Anticipating the imminent release of the National Prevention Strategy [draft], the health and prevention policy community held several roundtables and forums and published articles speculating on the potential of the strategy and its accompanying 10-year, $16.5 billion Prevention and Public Health Fund.  The administration is reportedly on the cusp of issuing its first hundreds of millions in grants scheduled for 2011.

If only we could find the National Prevention Strategy and get started.  Due for release March 23, the NPS, at this writing, remains unsighted.  It has apparently "hit a snag," probably one hammered into the wall outside Rep. Paul Ryan's [R-WI] office.  It is a slightly disconcerting way to start "Moving the nation from a focus on sickness to one of wellness and prevention" as the NPS mission statement asserts.

In deference to policy realities - the NPS is after all a creation of The Law - we'll assume that the Strategy and its Fund will appear, for this year at least.

"The prevention strategy appears
to be responsive to transitions
already in place in public life."
All this focus on "prevention" may barely warrant looking up from your appointment book, but just as the behemoth public health care enterprise has moved at the NIH National Center for Complementary and Alternative Medicine, elsewhere at NIH (behavior science), and through comparative effectiveness research (CER) to respond to real world demands, the prevention strategy, as part of the Accountable Care Act itself, appears to be responsive to transitions already in place in public life.

Defined in the 2010 ACA, the National Prevention Strategy and its fund have had an erratic ride through its organizational and definition process, with the first 13 members of a 25-person national advisory council appointed after the draft of the Strategy had been open and then closed to public comment. The Integrator Blog has reported this disconnect thoroughly.

But because the ACA embedded "integrative practice" into the language of the law and made it explicit if not yet defined in the National Prevention Strategy, it is worth looking at the initial areas of funding. (Two of the first 13 appointees to the advisory council are experienced integrative practitioners: Sr. Charlotte Kerr, RSM, MPH and Sharon Van Horn, MD, MPH.)

The anticipated areas of focus and funding amounts were set out last week by Jeffrey Levi, PhD, executive director of the Trust for America's Health (TFAH), addressing a policy roundtable hosted by the Altarum Institute. TFAH works closely with the Robert Wood Johnson Foundation.

Levi also wrote about the Fund for the Huffington Post here.  He said a major focus of the fund are the Community Transformation Grants (CTGs), intended to inspire local collaborations among "small business owners, faith leaders, youth leaders, employers, community groups, parents, law enforcement officials, schools, and health care providers."  Specific targets for these grants:

  • Improve nutrition and physical education programs in schools;
  • Launch initiatives to reduce tobacco use, especially among children and adolescents;
  • Improve access to healthful, affordable foods through farmers' markets and by making fresh fruits and vegetables available in local stores

Expanding the Prevention Paradigm?

It is notable that these areas -- apart from the ever-discouraging efforts to control smoking  -- reflect newly created, independent initiatives in place across the country that are not traditionally part of the lexicon or programmatic attention of the prevention and health promotion community.  This is important because -- at least in intent -- these areas start to take publicly supported prevention programs beyond their traditional boundaries.   But it will take some crowbarring to keep them there.

Levi showed the following breakout of $1.5 billion of anticipated funding for these categories for 2011.  The strong local focus is clear:
• Community Prevention ($298 million)

• Community and State Prevention ($222 million)

• Tobacco Prevention ($60 million)

• Obesity Prevention and Fitness ($16 million)

• Clinical Prevention ($182 million)

• Access to Critical Wellness and Preventive Health Services ($112 million)

• Behavioral Health Screening and Integration with Primary Health ($70 million)

• Public Health Infrastructure and Training ($137 million)

• Public Health Capacity ($52 million)

• Public Health Workforce ($45 million)

• Public Health Infrastructure ($40 million)

• Research and Tracking ($133 million)

• Health Care Surveillance and Planning ($84 million)

• Prevention Research ($49 million)

  "This list obviously does not clearly
set out where access to local farm
produce might be placed, for example,
or school nutrition programs, or
other health care providers not usually
associated with clinical prevention
(community acupuncture, for instance)."

This list obviously does not clearly set out where access to local farm produce might be placed, for example, or school nutrition programs, or other health care providers not usually associated with clinical prevention (community acupuncture, for instance).

And while viewing wellness and prevention in a broader context is cheering, the reality reflected in the above funding categories is depressingly old-time: we have the smallest commitment for what is quite obviously the biggest, most serious long term health issue the country faces: "Obesity Prevention and Fitness" - $16 million or just 1.07%.

One hopes that somebody's computer just cut-and-pasted in the $1.5 billion into the 2011 spreadsheet and let the pre-set formulas spit out the dollar amounts.  (Those existing independent local initiatives, scratching and clawing for funds and resources, are probably many times more than $18 million already.)

After the BigJob.Gov: Go Bipartisan

One also hopes that another initiative announced last week will seriously adjust the percent allotted to Obesity Prevention and Fitness in the Prevention Fund.

The Bipartian Policy Center (BPC) introduced its "Nutrition and Physical Activity Initiative," a year-long effort to identify factors that will:

  • Improve Nutrition Education (consumer messaging; training physicians and teachers)
  • Dismantle Barriers to Physical Activity (time and place; in the workplace)
  • Accelerate Availability of Nutritious Foods (schools and communities)
  • Harness Institutional Involvement (hospitals, national parks, large food preparers)

The BPC was formed in 2007 by former Senate majority leaders Baker, Mitchell, Dole and Daschle and engages former senior federal agency and congressional leaders to take on from the outside what they were constrained from doing while in government. Other areas of focus: transportation, energy, national security and democracy.

The "Nutrition and Physical Activity Initiative" is led by two former Agriculture secretaries: Dan Glickman and Ann Veneman (both of whom who attended); and two former HHS secretaries: Donna Shalala and Mike Leavitt. 

This event drew a large audience from the physical education, nutrition and food, and parks and rec sectors, including Michelle Obama's White House food coordinator.  Massachusetts Congressman James McGovern recommended that the White House convene a conference on Food and Nutrition (which was of interest to at least one attendee who was at the last such conference, in 1969.)

"The initiative will clearly attempt
to aggregate the experiences that
are being created in individual
communities but whose stories are
not well known ..."
Glickman, who MC'd the event, noted: "There are many good things going on."  The job, he said, will be to "identify what works and scale-up the good ones." Worksite wellness programs were inevitably mentioned. Anne Veneman was emphatic about the potential for improving nutrition awareness: "Teach nutrition education (in K-12)," she said.  "Put in school gardens; teach the science of growing food."

The process will include local public forums, white papers, and other data collection efforts that will result in a set of "comprehensive, actionable" policy recommendations in early 2012. 

The initiative will clearly attempt to aggregate the experiences that are being created in individual communities but whose stories are not well known outside those communities.  This is a commendable activity, and necessary to give prevention and wellness an underlying cohesion on which more can be built; despite the errors in spreadsheet data entry (one hopes).

  "There appears to be an opportunity
this year to stretch 'integrative practice'
from the language of the Accountable
Care Act and the National Prevention
Strategy to these public forums on
prevention and wellness."

While you may respond to this account with "enough with all this Washington hoodoo," if you are providing services in local settings it could be worth following the BPC and NPS programs.  They will be on the ground in communities around the country.  The first public forum to be held by BPC's Nutrition and Exercise Initiative will be held at the University of Miami, April 20.   

It is possible that their representatives may arrive with preconceived notions about what constitutes prevention.  Or the local event may well be a creation of the local community.  Either way, there appears to be an opportunity this year to stretch "integrative practice" from the language of the Accountable Care Act and the National Prevention Strategy (wherever it is) to these public forums on prevention and wellness.

Comment: Walsh's report, and conclusion, underscore a truism in politics. Any significant appreciation of how "integrative health care" and "integrative health" may represent new models and new ways of thinking in the new prevention and health promotion plan will be largely absent unless the integrative practice community actively educates the relevant regulators.

For reference, these are the footholds for integrative health right up front, in the "Purposes and Duties" in Section 4001 of the A.C.A.:

    (1) provide coordination and leadership at the Federal level, and among all Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system, and integrative health care in the United States;

    (2) after obtaining input from relevant stakeholders, develop a national prevention, health promotion, public health, and integrative health care strategy that incorporates the most effective and achievable means of improving the health status of Americans and reducing the incidence of preventable illness and disability in the United States;

    (3) provide recommendations to the President and Congress concerning the most pressing health issues confronting the United States and changes in Federal policy to achieve national wellness, health promotion, and public health goals, including the reduction of tobacco use, sedentary behavior, and poor nutrition;

    (4) consider and propose evidence-based models, policies, and innovative approaches for the promotion of transformative models of prevention, integrative health, and public health on individual and community levels across the United States ...

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