State and Local Policy Initiatives to Reduce Health Disparities Workshop Summary (2011) / Chapter Skim
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3 The Phillips-Powderhorn Experience and the Allina Backyard Project
3 The Phillips-Powderhorn Experience and the Allina Backyard Project
Pages 15-32
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Adequate housing is another major component of reducing health disparities. Mayor Rybak developed a housing trust fund that spends $10 million each year on affordable housing efforts.
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Referencing the federal health care reform legislation then being discussed in the United States, Rybak observed that it is a "national disgrace" that children and adults in this country lack insurance coverage. At the same time, he said, the population needs to have dramatically different lifestyles.
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He noted that this is a two-way approach, in that community members must themselves participate in the local food initiative and in exercise. Health care reform cannot be expected to be successful without also focusing on changing individual behaviors, he said.
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However, Rybak noted, the dramatic cuts in health care being proposed at the state level will have a number of consequences for the health department in Minneapolis. Roundtable chair Nicole Lurie asked the final question.
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(Although the law was passed, regulations were never approved. Today, most health care deliverers are not part of an integrated system.)
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At the same time, housing initiatives were initiated to replace and rehabilitate existing housing on the 14 most blighted blocks. Other efforts included violence prevention; the creation of protocols to treat victims of abuse; and the establishment of an on-site family service center at a local elementary school that provided health care, social services, and mental health services to children and families.
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He used the ongoing federal debate over health care reform to frame his comments and began his remarks by stating that the current debate is not about reforming health; rather, it is about reforming how the nation finances health care. The nation's health care system is unaffordable, so a discussion of how to reallocate scarce resources is needed.
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Pettingill also raised the question of what it means to be a not-for-profit organization with a tax exemption. He described a meeting of community leaders where charity health care was discussed, noting that Allina provides free care in the community worth $135 million.
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The real challenge is to get these organizations to collaborate, not compete, and to direct the limited resources in the same direction. The Backyard Initiative also has a strong Residents Council and buy-in from community businesses.
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working with policy makers to reduce health disparities. Health Care Reform Efforts Sanne Magnan began her comments by describing the strengths of the state of health care in Minnesota.
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Upstream investments like those made by SHIP can help prevent disease before it starts. Other components of Minnesota's health care reform efforts include improving transparency about the quality and cost of health care, the creation of a quality incentive program for providers, and the implementation across the state of medical homes, which link the primary health care system with resources available in the community.
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The establishment and use of medical care homes are another way to increase social capital, link people with cultural resources, and enhance work to eliminate health disparities. Working with Policy Makers Sanne Magnan noted the importance of using language that policy makers (e.g., legislators)
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program currently funded by the CDC. Sanne Magnan also described the perception that the federal efforts in health care reform address only access to care and not the overuse and inefficiencies in the health care system.
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She noted that some members of the audience see health care reform efforts to be a move toward socialism. Additionally, some participants at the conference expressed negative feelings about using taxpayer dollars to try to change individual behavior.
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Richard Pettingill, in response to Sarah Greenfield's question, commented that it is essential to bring the mainstream health care delivery system into the debate as a collaborator with communities and public health officials. Rather than seeing the current efforts as either health reform or health care reform, it should be a dialogue that includes both health reform and health care reform.
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Explaining that philanthropies have few constraints on how funding is allocated, he said that as health care reform continues to be evaluated, the private foundation environment also needs to be examined. Mike Christensen, a member of Mayor Rybak's staff, also responded by saying that public health leadership needs to adopt a new "fundamentalism" about reducing health disparities in Minnesota.
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1992. Effectiveness in disease and injury prevention estimated national spending on prevention -- United States, 1988.
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