Forces of Change Assessment 2019 Summary Report
14
Mississippi State Department of Health Forces of Change Assessment 2019 Summary Report
Transcript of Forces of Change Assessment 2019 Summary Report
Mississippi State Department of Health
Forces of Change Assessment 2019 Summary Report
2019MSDHFOCA 1
ContentsExecutiveSummary ..................................................................................................................................... 2
Introduction................................................................................................................................................. 3
AssessmentFramework........................................................................................................................... 3
FOCAOverview ........................................................................................................................................ 3
AssessmentMethodology ....................................................................................................................... 4
Cross-CuttingForcesofChange................................................................................................................... 5
BehavioralHealth .................................................................................................................................... 5
AccesstoHealthCare .............................................................................................................................. 5
EconomicDisparity .................................................................................................................................. 6
BuiltEnvironment .................................................................................................................................... 7
Infrastructure&Funding ......................................................................................................................... 7
Misinformation ........................................................................................................................................ 8
Conclusion ................................................................................................................................................. 10
AppendixA:NarrativebyCategory ........................................................................................................... 11
Social...................................................................................................................................................... 11
Economic ............................................................................................................................................... 11
Political .................................................................................................................................................. 11
Technological ......................................................................................................................................... 11
Environmental ....................................................................................................................................... 12
Medical/Scientific .................................................................................................................................. 12
Legal/Ethical .......................................................................................................................................... 12
AppendixB:FOCAWorksheets
AppendixC:FOCAFlipCharts
2019MSDHFOCA 2
ExecutiveSummaryTheforcesofchangeidentifiedinthisassessmentrepresentimportantissuesaffectingthestateofMississippiandtheirpotentialimplicationsonthehealthandqualityoflifeofcommunitymembersandthelocalpublichealthsystem.TheForcesofChangeAssessment(FOCA)isoneoffourdistinctassessmentsusedaspartoftheMAPPprocesstocreateaStateHealthAssessment(SHA)thatisdata-drivenandsupportedbythecommunity.CommunityleadersandkeystakeholdersgatheredinJune2019tothinkstrategicallyaboutpotentialforcesofchangeandtheircorrespondingthreatsandopportunities.Participantslookedtothefuturetoanticipateforcesinadditiontolookingatcurrenttrends.Theyengagedinrichdialogueandidentifiedmanyforcesofchangealongwithrelatedthreatsandopportunitiesforthecommunityandpublichealthsystem.Analysisoftheinformationcompiledfromthediscussionsyieldedthefollowingcross-cuttingthemes(Figure1):
Figure1:FOCACross-CuttingThemes
! Behavioralhealthwasarecurringtheme,particularlyincreasedlegalandillegalsubstanceuseand
thelackofbehavioralhealthprofessionalsandtreatmentfacilitiestoaddresstheneed.! Participantsobservedanumberoftrendsthataffectaccesstohealthcare,includingchangestothe
AffordableCareAct(ACA),Medicaidexpansion,theclosureandconsolidationofruralhospitals,highratesofuninsuredandunderinsuredpatients,andhighutilizationofEmergencyDepartments(EDs)fornon-emergencycare.
! Unemployment,underemployment,lackofaccesstoandpreparednessforqualityjobs,andthegenderwagegapwereamongtheeconomicdisparitiesnotedbytheparticipants.
! Manyaspectsofthebuiltenvironmentinfluencequalityoflifeforcommunitymembers,includingaccesstohealthyfood,transportation,waterquality,andcommunitysafety.
! Infrastructureandfundingforthepublichealthsystemwasarecurringtheme,particularlylackoffundingforpublichealthandscience,thependingelectionandchangeinleadership,andtheincreasinglyimportantroleofinformationtechnology.
! Participantsobservedtheproliferationofmisinformationandtheneedtodevelopbettermessagingtocombatfalseandpotentiallyharmfulinformationrelatedtopublichealth.
BehavioralHealth
AccesstoHealthCare
EconomicDisparity
BuiltEnvironment
Infrastructure&Funding
Mis-information
2019MSDHFOCA 3
Introduction
AssessmentFrameworkIn2019,theMississippiStateHealthDepartment(MSDH)completedacomprehensiveStateHealthAssessment(SHA)usingtheMobilizingforActionthroughPlanningandPartnerships(MAPP)process(Figure2).MAPPutilizesfourassessmentstogainacomprehensivepictureofcommunityhealth.
Figure2:TheMAPPProcess(NACCHO,2013)TheCommunityHealthStatusAssessment(CHSA)providesquantitativeinformationoncommunityhealthconditions.TheCommunityThemesandStrengthsAssessment
(CTSA)identifiesassetsinthecommunityandissuesthatareimportanttocommunitymembers.TheLocalPublicHealthSystemAssessment(LPHSA)
measureshowwelldifferentlocalpublichealthsystempartnersworktogethertodelivertheEssentialPublicHealthServices.TheForcesofChangeAssessment(FOCA)identifiesforcesthatmayaffectacommunityandtheopportunitiesandthreatsassociatedwiththoseforces.MSDHupdatedthe2014FOCAtoreflectthenewtrends,factors,andeventsthatareaffectingthecommunityin2019andbeyond.
FOCAOverviewTheFOCAidentifiesforces–suchastrends,factors,orevents–thatmayinfluencethehealthandqualityoflifeofthecommunityandtheeffectivenessofthelocalpublichealthsystem.Forcesareidentifiedacrossadiversesetofcategoriesandmaybecurrentoranticipatedforthefuture.
• Trendsarepatternsovertime,suchasmigrationinandoutofacommunityoragrowingdisillusionmentwithgovernment.
• Factorsarediscreteelements,suchasacommunity’slargeethnicpopulation,anurbansetting,orthejurisdiction’sproximitytoaparticularcommunityresource.
• Eventsareone-timeoccurrences,suchasahospitalclosure,anaturaldisaster,orthepassageofnewlegislation.
DuringtheFOCA,participantsanswerthefollowingquestions:
• Whatisoccurringormightoccurthataffectsthehealthofourcommunityorthelocalpublichealthsystem?
• Whatspecificthreatsoropportunitiesaregeneratedbytheseoccurrences?
2019MSDHFOCA 4
AssessmentMethodologyOnJune23,2019,theMississippiStateHealthDepartmentconvenedahalf-dayretreattoconducttheFOCAwithcommunityleadersandkeystakeholders.AneutralfacilitatorfromtheIllinoisPublicHealthInstitute(IPHI)guidedparticipantsthroughtheexercise.ThefacilitatorprovidedabriefoverviewoftheMAPPprocessandthedefinitionsandcomponentsoftheFOCAprocess.Thefacilitatorintroducedthefollowingsevencategoriesastheframeworkfortheassessment:
• Social• Economic• Political• Technological• Environmental• Medical/Scientific• Legal/Ethical
Smallgroupswereeachassignedacategoryandreviewedthe2014FOCAworksheetfortheirrespectivecategory.Theparticipantsremovedoutdateditems,addednewitems,orexpandedonexistingforces,threatsandopportunitiesonthe2014FOCAworksheet.EachgroupidentifiedthetoptwotothreeforcesintheircategorythatrequireattentionandinterventionfromMSDH,wrotetheseforcesonaflipchart,andreportedthisinformationtothefullgroup.Thesmallgroupsrotatedtoasecondcategoryandaddedtotheworkofthepreviousgroup.Inadditiontoforces,threats,andopportunities,participantsbrainstormedstrategiestoaddresstheforces.Eachsmallgroupthenreportedthesecondroundofanalysistothefullgroup.IPHIsummarizedthecommonthemesfromthereportout.FollowingtheFOCAevent,MSDHreviewedthecompilationofnotesfromthesmallgroupcharts,thecross-cuttingthemesthatsurfacedfromthediscussion,andthedraftFOCAreportsummarizingthecoreissuesthatemergedfromtheassessmentprocess.MSDHprovidedrecommendededitstofinalizethisreport.Thecross-cuttingthemesaredescribedin-depthwithinthebodyofthisreport.AnarrativeoftheforcesidentifiedattheMSDHFOCAeventcanbefoundinAppendixA.AppendixBcontainstheupdated2014FOCAworksheets.AppendixCcontainsthetranscribedflipchartsoutliningthetopforceswithineachcategory,asidentifiedbytheattendeesonJune23,2019.ThedescriptionsinthereportrepresenttheperceptionsandopinionssharedbytheparticipantsduringtheFOCAexercise.Wherepossible,participantstatementsaresubstantiatedbyresearchandsourcedinfootnotes.
2019MSDHFOCA 5
Cross-CuttingForcesofChange
BehavioralHealthBehavioralhealthhasemergedasaprominentcommunityhealthissueinrecentyears,especiallyasdeathsfromopioidusehaverisendramaticallyacrosstheUnitedStates.1Participantsreportedanincreaseinsubstanceusedisordersyetalackofbehavioralhealthprofessionalsandtreatmentfacilitiestoaddresstheproblem.Furthermore,productsandsubstancesarecontinuallyevolving,makingitincreasinglydifficulttoidentifyandmonitorcontrolledsubstances.Participantsalsonotedincreasedratesoftobaccouseduetothepopularizationofvaping,andthepotentialforincreasedcannabisuseduetotherecentlegalizationofmarijuanaforrecreationaluseinseveralstates.Otherissuesrelatedtosocialenvironmentincludedincreasedisolationandprevalenceofmentalhealthissues.THREATS
• Insufficientcapacitytotreatsubstanceusedisorder• Userscaneasilyfindasubstitute(e.g.,heroininsteadofprescriptionopioids)
OPPORTUNITIES
• Engagementopportunitieso Communitycollectivevisioningo Workplaceawarenesscampaignso Schooldistrictengagemento Faith-basedinitiatives
• Changeinpublicpolicyandlaws(e.g.,includevapinginthedefinitionoftobaccouse)• Increasetheavailabilityofmentalhealthprofessionalsandtreatmentfacilities• ExpandMedicaidbenefitstocoverbehavioralhealthservices
AccesstoHealthCareParticipantsnotedanumberofhealthcaretrends,includingchangestotheAffordableCareAct(ACA),Medicaidexpansion,theclosureandconsolidationofruralhospitals,highratesofuninsuredandunderinsuredpatients,andhighutilizationofEmergencyDepartments(EDs)fornon-emergencycare.Theclosingofruralclinicshasdecreasedthenumberofdaysprovidersareopenandhasledtopatientstravelingfurthertoseekcare,tothedetrimentofthelocalfacilities.ThechangestotheACAincludeashorterenrollmentperiod(from3monthsto1month)andincreasedpremiums.Participantsnotedthattheapplicationprocessiscomplexanddifficulttonavigate,evenforthosewithhigheducationalattainment.Undocumentedpopulationsarenoteligibleforhealthinsuranceandmaynotseekneededhealthservicesduetofearofdeportationorotherlegalrepercussions.THREATS
• Increasedtransportationcostsaspatientstravelfurtherforhealthcare• FrequentuseofEDcareiscostlytohealthsystems• Lackofhealthcareaccessaffectscontinuityofcarewhenpatientsdonotgetneededfollow-up,
especiallyforchronicdiseasessuchasasthmaOPPORTUNITIES
1https://www.hhs.gov/opioids/about-the-epidemic/index.html
2019MSDHFOCA 6
• Workforceopportunitieso Openthedoorformid-levelproviderso Increasethequalityofthehealthcareworkforceo Increasethenumberofjobsthatofferaffordableinsurancebenefitso ImproveCommunityHealthWorkerpayo ExpandCommunityHealthWorkernetworkstohelpwithhealtheducationand
transportationtohealthcareo LeverageCommunityHealthWorkernetworkstofindvolunteersinsmallercommunities
• Dataopportunitieso Betterdatademonstratingtheimpactofincreasingaccesstohealthcareo Betterdataframinginpartnershipwithprivatesectorpartnerswhocanofferadifferent
perspective• Policyopportunities
o ImplementtheACAinsteadofimpedingito ExpandMedicaidorexplorealternativestotheACAo Implementuniversalhealthcareo ImplementaqualityteamtoaddresstheACAdeficiencieso Improvethehealthcareinsuranceexchangessotherearemoreoptionsforcoverageo OffercommunityandlegislativeeducationaroundMedicaidexpansionfrompublic
healthorganizations(MSPHI,MSPHA,universities,etc.)o Examinepaymentmodels
• Increaseopportunitiesfortelehealth
EconomicDisparityIncomeinequalityhastrendedupwardintheUnitedStatessincethe1970sandhasincreasedfollowingtheGreatRecessionin2008.2Unemployment,underemployment,lackofaccesstoandpreparednessforqualityjobs,andthegenderwagegapwereamongtheeconomicdisparitiesnotedbytheparticipants.Thegroupnotedanincreaseinlow-wagejobs,economicsegregation3,anddecliningsocioeconomicstatusinruralareas.Smallerjurisdictionshavedifficultyattractingbusinessesandareforcedtodependon“unhealthy”industries(e.g.,chemicalplant,prison)forsourcesofemployment.THREATS
• Incomedisparityaffectstheabilitytopayforhealthcare,childcare,andotherbasicneeds• Structuralracismlimitseconomicopportunityandhealthattainmentamongpeopleofcolorand
minoritiesOPPORTUNITIES
• Economicdevelopmentand“employmentdiversity”(e.g.,increasenumberofhigh-payingjobs)• Addressstructuralbarriersandpromoteamoreinclusivesociety
2https://www.epi.org/publication/the-new-gilded-age-income-inequality-in-the-u-s-by-state-metropolitan-area-and-county/3“Economicsegregationreferstothedegreetowhichpeopleindifferentsocialclasseslivemostlyamongotherpeopleoftheirclass.”https://thesocietypages.org/socimages/2012/08/06/economic-segregation-in-u-s-neighborhoods/
2019MSDHFOCA 7
BuiltEnvironmentAccesstohealthyfood,transportation,andwaterqualityarecharacteristicsofthebuiltenvironmentthatinfluencequalityoflifeforcommunitymembers.Participantsnotedpooraccesstohealthyfoodinlocalcommunities,duetothelackoftimetoprocurehealthyfood;thehighcostofhealthyfoodrelativetounhealthyoptions;andalackofincentivesforfarmerstogrowhealthy,consumablefoods.EnvironmentaldisruptionhasincreasedfloodingintheMississippiRiver,whichhasincreasedthecostofproduce.ThegroupremarkedthattheHealthyFoodFinancingInitiativedoesnothaveafundingmechanismtosupportit.Neighborhoodslackkeyinfrastructureincludingpublictransportation,sidewalks,andbikelanes,whichaffectaccessibilityandsafety.ParticipantsalsoobservedincreasedsedimentintheMississippiRiverandincreasedplasticdebrisinthedrinkingwater.THREATS
• Communitymembersarenotconsuminghealthyfoods• Accessibilityandsafetyarecompromisedduetopoortransportationinfrastructure• SedimentintheMississippiRiverwilleventuallycausedivergenceintotheAtchafalayaRiver,
andfloodingwillcausedisplacementofpopulationinsouthernLouisianaOPPORTUNITIES
• Policyopportunitieso Lobbyatthefederallevelforhealthyfoodso ProvideSNAPincentives,WICincentivesforhealthyfoodso Strengthen/cleanuptheHealthyFoodFinancingInitiativetoincentivizegrocerystores
infooddessertsandcornermarkets/gasstationstoprovidehealthyfoodso Securefundsfortransportationsystemso EngageinenvironmentalplanningtomanagechangestoMississippiflooding
• Engagementopportunitieso Leveragecommunityengagementtodriveagency/organizationalstrategiesand
interventionstoimproveneighborhoodconditionso LeverageCHWswithclearstrategy,direction,androlestoalignlocalpartnerships
• Targetstructuralracismasarootcauseofsocial,economic,andenvironmentalinequities• Installfilterstoremoveplasticsfromthewatersupply• DevelopmobilenutritionoptionssuchasmobileWIC/healthyfoods
Infrastructure&FundingFunding,leadership,andinformationtechnology(IT)infrastructureareallcriticalforpublichealthsystemfunction.Recenttrendsinfundingincludeadecreasedtaxbaseforlocalcommunities,fundingprocessesthatdonotprioritizepublichealth,andlackoffundingforresearchandscience.The2020gubernatorialelectioninMississippiwasidentifiedasanimportantupcomingevent.Thecurrentgovernorwillhaveservedtwoterms(8years)andispreventedbytermlimitsfromseekingreelection.Participantsexpressedtheneedtodevelopcohesivemessagingsothatthenextgovernorprioritizespublichealth.ITisplayinganincreasinglyimportantroleinsociety,allowingpatientinformationtobestoredandsharedviaelectronichealthrecords(EHRs),HealthInformationExchanges(HIEs),andconsumerportals.Electronicdatacollectionandsharingrequiresadequatephysicalequipment,systeminterfacesthatareuser-friendly,andgovernmentandprivateconnectionstodatasystems.ParticipantsnotedsignificantgapsintheITinfrastructureinMississippi,includinglimitedaccesstotheinternet,poorconnectivity
2019MSDHFOCA 8
betweenagencies,andsystemslackinginteroperability.TheyreportedthatthecommunityhealthrecordwasnotreauthorizedinMississippi.Thegroupalsoremarkedonafailuretoadoptandeffectivelyutilizeexistingtechnologicalcapacityduetofearofchange.THREATS
• HIPAAcanbearoadblockfordatasharing• LongitudinalclientrecordsmaynotbepreservedifproviderschangeEHRsystems• EHRscannottalktooneanother;lackofinteroperabilitymeansclientsareburdenedwithfilling
outredundantpaperwork• Withoutacohesivevoiceforpublichealth,itwillnotbepartofthenewgovernor'sagenda
OPPORTUNITIES
• Policyopportunitieso Developfederalandstatepoliciestoframeacollectivevisionoftechnology
infrastructureo Reauthorizeorreplacethecommunityhealthrecordo DeveloppoliciesthatauthorizedataaccessacrossMSDHsystem(e.g.,immunizations)o Prioritizepublichealthfundingo Advocateforincreaseddollarsforresearchandscienceo ExploreROIandshiftfocustoeconomicadvantageandcostcontrol
• Datasystemopportunitieso Shareinformationfromallorganizationsthatcollectdatao ShareinformationcapturedintheEHRwithproviderstoenablebetterdecision-makingo Buildconsumerportalsforoutreacheffortsandtoprovidereliableinformationtothe
publico Improvesysteminterfacesandinteroperabilitytoimprovedatalinkagesandenable
agenciestocommunicateeffectivelywithoneanothero Improvephysicalinfrastructure(e.g.,broadbandaccessinruralareas)
• Engagementopportunitieso Developacorevisionforthestate’sITinfrastructurethatinvolvesinputfromall
agencieso Buildsupportfromprivatecitizens,privateindustry,andgovernmenttoobtainneeded
ITinfrastructureo Buildkeystakeholderinvolvementearlyono Partnerwithuniversitiesforanewmodelofcommunicationo Developastatestrategyforwhowinstheelectionsatthenationalandstatelevelo Conveywhypublichealthisimportant(e.g.monitoringwater)o Buildstrategicpartnershipswithcoalitionsandstakeholdersfacingsimilarchallengesfor
abiggercollectiveimpact
MisinformationParticipantsobservedtheriseofsocialmedia,advertising,andtheproliferationofthreat-basedor“fakenews.”Thegroupnotedthatsocialmediaisheretostay,anditisconstantlyevolving.Evidence-basedmedicineandinterventionshavebeendevelopedtoaddressnumerousissuesincludingopioiduse,tobaccouse,vaccination,andmedicalmarijuana,however,itisincreasinglydifficultforpublichealthtocompeteforthepublic’sattentionanddisseminateaccurateinformation.THREATS
2019MSDHFOCA 9
• Industrysciencepromotinginformationforpoliticaloreconomicreasons(e.g.tobaccocompanies)versuspublichealthscience(e.g.NIH,FDA,HeartAssociation,AmericanCancerSociety)
• Polarizationandcitizensunabletocommunicate• Negativeeffectsofmisinformationonthepublic’shealthandindividualhealthcarecontinuity
OPPORTUNITIES
• Publichealtheducationonsciencevs.socialmedia(e.g.,vaccineslinkedtoautism);developtherightmessagestocounterthe“fakenews”(misinformation)onsocialmedia
• Medicalcommunityneedsbettermessagingaboutactualsciencevs.socialmediapostings• Re-examinecommunicationingeneral:howthestatecommunicatestothepublichealth
system,howstateorganizationscommunicatetoeachother,howtoadvertisewhatthestatedoesinordertobuildpublicsupport
• Peopleneedreliableinformationfromvariousperspectivestomakeaneducateddecision;communicationneedstobeculturallycompetentandreachpeoplewheretheyare
• MSDH,MSPHI,andotherpublichealthorganizationsneedtoengageinevidence-basedmediacampaigns;ifsomethingisincorrect,itshouldbecorrected
2019MSDHFOCA 10
ConclusionTheforcesofchangeidentifiedbytheMississippiStateHealthDepartmentFOCAparticipantsrepresentkeyissuesthatwillhaveimportantimplicationsforthelocalpublichealthsystemandthehealthandqualityoflifeforpeoplelivinginMississippi.Asstrategicthinkersandleadersofthecommunity,theattendeeswerekeenlyawareoftheforcesofchangeatthelocal,state,andfederallevelandtheybroughtvitalinsighttothisassessment.TheFOCAthemesincludedbehavioralhealth,accesstohealthcare,economicdisparity,builtenvironment,infrastructureandfunding,andmisinformation.
Figure1:FOCACross-CuttingThemes
! Behavioralhealthwasarecurringtheme,particularlyincreasedlegalandillegalsubstanceuseand
thelackofbehavioralhealthprofessionalsandtreatmentfacilitiestoaddresstheneed.! Participantsobservedanumberoftrendsthataffectaccesstohealthcare,includingchangestothe
AffordableCareAct(ACA),Medicaidexpansion,theclosureandconsolidationofruralhospitals,highratesofuninsuredandunderinsuredpatients,andhighutilizationofEmergencyDepartments(EDs)fornon-emergencycare.
! Unemployment,underemployment,lackofaccesstoandpreparednessforqualityjobs,andthegenderwagegapwereamongtheeconomicdisparitiesnotedbytheparticipants.
! Manyaspectsofthebuiltenvironmentinfluencequalityoflifeforcommunitymembers,includingaccesstohealthyfood,transportation,waterquality,andcommunitysafety.
! Infrastructureandfundingforthepublichealthsystemwasarecurringtheme,particularlylackoffundingforpublichealthandscience,thependingelectionandchangeinleadership,andtheincreasinglyimportantroleofinformationtechnology.
! Participantsobservedtheproliferationofmisinformationandtheneedtodevelopbettermessagingtocombatfalseandpotentiallyharmfulinformationrelatedtopublichealth.
Thecross-cuttingthemesidentifiedintheFOCAwillbeconsideredduringtheSHAprocess.SHAwillinformacomprehensiveStateHealthImprovementPlan(SHIP)toaddresscurrenthealthprioritiesaswellassupportincreasedresilienceandpreparednessforthefuture.
BehavioralHealth
AccesstoHealthCare
EconomicDisparity
BuiltEnvironment
Infrastructure&Funding
Mis-information
2019MSDHFOCA 11
AppendixA:NarrativebyCategory
AppendixAcontainsalloftheforcesthatparticipantsdiscussedinthesevenFOCAcategories.
SocialParticipantsdiscussedpovertyandincomedisparity,andhowracisminfluencesbothhealthattainmentandeconomicopportunity.Thegroupnotedtherelativeabsenceofa“cultureofhealth”andfatalisticattitudestowardschronicdisease.Healthliteracywasidentifiedasagap,includingbasicunderstandingofwellness,healthcare,andhealthbenefits.Behavioralhealthwasdiscussed,includingtheincreaseinsubstanceusedisorderandstigmatowardsHIVandmentalhealthissues.Otherforcesofchangeidentifiedbythegroupincludeddemographicshifts,theriseofsocialmediaandevolvingmethodsofcommunication,andlackofaccesstohealthyfoods.
EconomicParticipantsreportedinadequateresourcesforbothindividualsandthecommunity,suchasthreatenedwatersources,crumblinginfrastructure,anddiminishingtaxbase.Highunemployment,aninsufficientlyeducatedworkforce,andlowwageswereforcesofchangecontributingtohighlevelsofpovertyandalargenumberofSNAP,EBT,andWICrecipients.Ruralareashavebeenhardhitbylossofindustry,lossofretail,andlossofhealthcareproviders,withmanyphysiciansmovingoutofstate.Thegroupnotedpooraccesstohealthyfoodscombinedwiththehighcostofhealthyfoodshavecontributedtopoornutritionanddiet.Participantsobservedseveraltrendsinhealthindicators,includingahighrateofunplannedpregnancies,averyhighprematurebirthrate,andhighlevelsofheartdisease,obesity,anddiabetes.Participantsdiscussedtheincreasingimmigrantpopulation,inparticularundocumentedimmigrantsandSpanish-speakingimmigrants.Participantsreviewedseveralforcesrelatedtohealthcare,includingtheAffordableCareAct(ACA),risinghealthcarecosts(anddecreasingaffordability),andlowerreimbursementrates.Otherforcesofchangeidentifiedbythegroupincludedadesireforaccountabilityandhighfrequencyofnaturaldisasters.
PoliticalParticipantsdiscussedkeyforcesinpoliticsaffectingpublichealth,includingchangeinleadership,upcomingelections,andpolicychange.Alackofunderstandingofpublichealthandlackofinvestmentinthepublichealthworkforcehasaffectedpoliticalsupportandengagementonpublichealthissues,accordingtoparticipants.ThegroupdiscussedtheACA,thestructureofhealthcarepayments,andthechallengeofprovidingcoverageforundocumentedpersons.Competingperspectivesonindividualrightsversuscommunitybenefit,andruralversusurbaninterests,areforcesthataffectresourceallocation,includingthefundingprocess,theuseoffederalversusstatefunding,andhowtoproperlybalancebudgets.
TechnologicalThegroupdiscussedtherapiddevelopmentofnewtechnologyandthecommensurateproliferationofdata.Electronichealthrecordsandhealthinformationsystemsarewidelyusednow.Theparticipantsnotedtheevolutionofsocialmediaplatformsandsmartphonesandtheireffectoncommunication.Technologicaladvancesareenablingtheuseofrealisticsimulationinmedicaltrainingandtelemedicinetoprovideremotecareforpatients.Thegroupidentifiedgapsinthetechnologicalinfrastructure,includingruralareaswithpooraccesstobroadbandinternet,lackofstandardrequirementsfornational
2019MSDHFOCA 12
components,andvulnerabilityoftechinfrastructureduringdisasters(e.g.,widespreadlossofpowerdisablessystems).Accordingtothegroup,thestateisnotutilizingitsexistingtechnologicalcapacityforanumberofreasons,includinglackoffundingforimplementationandfearofchange.
EnvironmentalWaterqualitywasdiscussed,includingdepletingwateraquifers,theBPoilspill,andtoxicalgae(whichclosedallofthebeachesinMississippiinJuly2019).Severeweatherevents,naturaldisasters,andglobalwarminghavecontributedtodecliningwaterquality,accordingtotheparticipants.Thegroupidentifiedissuesinthebuiltenvironment,includinglimitedaccesstosidewalksandfooddeserts.Participantsdiscussedfactorsrelatedtounintentionalinjuryandsafetysuchastextinganddriving,unsafeneighborhoods,childdeathsfromATVs,andrestrictedlegislationonguns.Otherforcesofchangeidentifiedbythegroupincludedlimitedphysicaleducationinschools,changesintheHealthySchoolAct,ruralhospitalclosure,andthenormalizationofvaping.
Medical/ScientificParticipantsdiscussedadvancesinmedicine,includingevidence-basedmedicine,telemedicine,newtestingandlabprocesses,stemcellresearch,andnewdrugsandmedicalinterventions.Theincreaseduseofelectronichealthrecordshasresultedinaproliferationdata,andconcernfortheprotectionofpersonalhealthinformation,includinggeneticinformation.Thegroupdiscussedtheincreasedavailabilityofnewsubstances,includingtobaccoproducts,syntheticopioids,andmedicalmarijuana.Otherforcesofchangeidentifiedbyparticipantsincludedanti-vaccinationgroupsandlimitedfundingformedicalandscientificresearch.
Legal/EthicalAmongthemanylegalandethicalforces,thegroupdiscussedchangestotheAffordableCareAct(ACA)andhowitaffectsaccesstohealthcare.TheparticipantsobservedanincreaseinhighutilizersofemergencycareandthehighcostofEmergencyDepartment(ED)visits.Thegroupdiscussedthelegalramificationsofnon-compliancewiththeAmericanswithDisabilitiesActandmobilitydifficultiesforpeoplewithdisabilities.Otherforcesofchangeincludedtortissues,immigration,andanincreaseintheincarceratedpopulation.
