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6 Reflections on the Day
Pages 73-82

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From page 73...
... Michael Villaire commented that the health care system has been aware of inequities for many years, and while there have been approaches based on policy, legislative, and regulatory payment reforms, the needle has only moved in small increments. "In my opinion, we are essentially not much 73
From page 74...
... Noting that in many cases her organization spends so much time analyzing that it becomes paralyzed, and one way of breaking out of that mode is to look for a few steps that can be taken to get the ball rolling. She referred to the "Ask Me 3" campaign that aims to improve communication between patients and health care providers, encourage patients to become active members of their health care team, and promote improved health outcomes, and wondered if there was a similar campaign that could be aimed at providers to give them one or two tools they could implement immediately with a couple of patients per day.
From page 75...
... Robert Logan from the National Library of Medicine acknowledged hearing during the workshop's discussions that the NIH could better support cultural competence, language access, and intervention research; the development of more comprehensive, evidence-based best practices; and research demonstrating a return on investment from intervention efforts, similar to the work it funds on effectiveness research. He said he would mention these suggestions at future meetings where NIH staff collectively discusses funding priorities.
From page 76...
... The first was that culture is not just about race and ethnicity, and the second was that the culture of the health care
From page 77...
... "That should be the motivation for us to make an impact." She noted the stories she heard during the workshop showing the realworld impact of paying attention to health literacy, language, and culture should be a call to action. She endorsed the idea of calling for a surgeon general's report that would highlight the importance of health literacy, but also noted the need to make sure its effect filters down through all segments of the health care system, including professional education, health policy, and funding.
From page 78...
... He added the questions that he was looking forward to addressing would examine what a systems-level approach would look like and how systems research could be brought to bear on these issues. He noted the consumer products area, where innovations are incorporated so rapidly into product and consumers provide feedback through the choices they make, could offer some lessons on how to use market pressures and consumer feedback to produce change in the health care system through incremental but rapidcycle and continuous innovation.
From page 79...
... '" He then told how the chief executive officer of one of his organization's partners, Urban Health Plan, a federally qualified health center in one of the poorest congressional districts in the United States, went to neighborhood stores, asked them to start selling fruits and vegetables, and said that she would buy them if they had not sold by the end of the day. Pleasant said she had to buy that produce for a week and a half, but 7 years later that community now has farmers' markets and stores that exclusively sell tabletop fruits and vegetables.
From page 80...
... "It's a daunting task because it means that I cannot continue doing things the way I do them now, but I will change," said Dillaha. Winston Wong was struck by the need to come to grips with what the ACA offers as opportunities and what it does not, and to understand that the United States still has not embraced the notion that health care is a right.
From page 81...
... Steven Rush agreed that collecting stories and creating narratives is important and should continue, and that developing a business case is also necessary. He noted that changing the health care system, which has billions of dollars invested in the status quo, will require additional dollars, which would be the function of the business case.
From page 82...
... She believes that this policy has had detrimental effects with respect to the diversity of the health care workforce and wondered if there were some way to perhaps fast-track those professionals as one way of creating a medical system that reflects the overall population of the country. Marin Allen from NIH offered the final comment electronically.


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