Transforming Our Public Health and Healthcare
By Lauren Raskin Ramos, MPH
Director of Programs, AMCHP
Nemours Health and Prevention Services and the California Endowment have supported a group of national and state policy experts in the development of a proposal to create a 21st Century Child Health System that better coordinates health care, education, child care and wellness in a way that makes sense for families today and helps parents raise healthy, happy and productive children. Below, Dr. Neal Halfon, Professor of Pediatrics, Public Health and Public Policy, and Director of UCLA Center for Healthier Children, Families & Communities, shares some of the rationale and components of a transformed child health system. To learn more, attend the opening session at the AMCHP Annual Conference, A Vision for Transforming our Public Health and Healthcare System to Better Serve America’s Women, Children, and Families, featuring Neal Halfon, Ed Shor, Debbie Chang, Charlie Bruner and Cathy Hess. The following is a summary of the key features of such a system:
National Child Health Outcomes Framework and System Transformation Plan
- A child-specific health outcomes framework can jump-start a roadmap for achieving system transformation goals. The framework would highlight the unique needs of children, use best evidence, present options to achieve integrated service delivery models and the rationale for more comprehensive and strategic funding mechanisms.
- Leadership from key sectors and stakeholders is critical in order to identify a set of measures and indicators that are universal (i.e., common across states, agencies and programs), and can be readily translated into improvement opportunities. A scientifically-based, consensus building process can help galvanize diverse constituencies around a common vision (e.g., National academies).
- These universal measures should have specifications that are applicable at multiple levels (i.e., provider, system, state, federal) permitting outcome measurement and monitoring at the community level as well as at higher levels. Accessibility of community level measures (in a timely manner) can facilitate engagement of appropriate stakeholders and decision makers in tracking and monitoring these outcomes, and encourage use of these metrics in planning. These tools support the notion of local (community-level) accountability, which in turn catalyzes local coordination in planning system improvements.
- A common set of measures not only engages multiple stakeholders in the process of ensuring positive outcomes, but creates more transparency about decisions and outcomes.
- Creation of a broadly-defined and high level, federal child health agency would demonstrate our national resolve to optimize child health through policy change. A comparable agency at the state level would help position a healthy child development agenda at the level where decisions are made. State, county and local level strategic planning can help to create a common vision.
- As interest in addressing the national health care reform crisis grows, launching a national reform process at the beginning of the life course might have growing appeal.
The following is a “Q&A” with Dr. Halfon:
Q: What are some critical ways that Title V fits into a transformed child health system?
The rich history and experience of 3/4 of a century of work is invaluable in moving forward improvements in children's health systems. We need to find a way to reposition Title V as a more significant player at the national level (not buried so far down in the governmental food chain).
Q: How do we build support among key players – providers, parents, advocates, elected and appointed officials at all levels, and employers – to work together to change the child health system?
The inherent transparency and local accountability of a common/universal measurement process become the basis for engagement. Ensuring that metrics are accessible, timely and applicable at the local level personalizes the outcomes in a way that engenders involvement. A commitment to the use of effective community engagement mechanisms (and there are many) will be needed to ensure involvement across sectors and stakeholders.
Q: What is the one thing you want to make sure people get from your talk at the Conference?
I hope participants leave with a keen understanding about the importance and greater yield of early investment in children, and the importance of those investments in ensuring the potential of our children and youth in ensuring the country's future.