Who would’ve thought a Leadership Blount summit on healthcare would end up focusing on how to cure sick communities.
That’s what happened when Dr. John McKnight of Northwestern University explained the connection between public health and a community’s ability to rebuild itself.
McKnight co-founded the Asset-based Community Development Institute of Northwestern University. One of the first aspects he covered was to explain how a group of medical professionals were asked to explain the five basic determinants of a healthy community. They listed them, in no particular order, as: Personal behavior, relationships, physical environment, economic status and access to medical care. “They could not agree on the order, but they all agreed the last determinant, medical care, has less to do with health than anything else,” he said. “We realized if we were going to focus on access to medical care, we were not about health - we have to focus on the first four and the first four dealt with the community.”
As part of this approach, McKnight said he and his staff went into low income communities and surveyed neighborhoods. Instead of asking about negative aspects, they asked for positives.
“We knocked on people’s doors and asked, ‘Can you tell us what you or your neighbors have done to make things better?’ We did that four years in 20 cities in 300 neighborhoods.”
McKnight said there were six building blocks for any successful community initiative. “We called these assets, and that’s why we’re an asset-based foundation,” he said.
The professor said the first asset is the community’s individual local residents. Often universities or organizations that come into a community to help start out by surveying and determining weaknesses. This focuses their attention on the negative that local residents already know. “If you look at how people get things done, they focus on capabilities. The question is, ‘Are you going to focus on gifts and capabilities or are you focus on deficits?’”
McKnight said the second asset is groups of people who come together to do something and are not paid. “One of the things that was surprising was in the older, low income neighborhoods, there are more of these associations. We think they allow people to come together to magnify their gifts,” he said.
The professor said the third asset is groups of people who work in neighborhoods and are paid, including business people, people in non-profits and people in government. “The words we’ve used are institutions,” he said.
The speaker said that often hospital are treasure chests for neighborhoods because they have people with expertise, equipment, room and economic muscle.
McKnight said the four and fifth assets are land and people buying and selling. “That’s what makes a neighborhood’s economy,” he said.
McKnight said the sixth asset is stories of a community’s past that are stories of success.
“Every story we collected is a story about assets that had not been connected and then become connected,” he said.
Blount County Health Department director Micky Roberts was happy with how the event turned out. “I think the challenge for us in the community is to look at what would it be like if we utilized a similar approach to address change in Blount County,” said Roberts.
Leadership Blount executive director Cathy Cate said this kind of dialogue was exactly what the Leadership Summit was about when it was created. “It is meant to pull people together to talk about issues. Health care is something that is a concern, but we also want to move into preventative care,” she said.
Teri Brahams, chair, was pleased as well. “I think it was great,” said Brahams. “The discussions and ideas really will help us be a healthier community.”
Healthy kids make better learners
The morning session brought together the school health coordinators from Blount County and the cities of Alcoa and Maryville school systems. Leading the discussions were Mary Beth Blevins with Blount County Schools, Heather Ledbetter with Alcoa City Schools and Kelly Gallemore with Maryville City Schools. They shared thoughts on the importance of healthy students in the classroom.
“What’s more important, health or an education? You can not have one without the other,” Blevins said. “We can not help educate children if we do not help them be well.”
Gallemore said students may get to school and into class but if they are not healthy, they’re in no position to learn. “He’s not thinking about math,” she said of a student who is sick.
Ledbetter said Coordinated School Health is a way to prevent illnesses in children. “Coordinated School Health is proactive,” she said. “We look at all components of a child. Coordinated School Health works with parents to apply local solutions.”
Gallemore said one way they reached children in schools through education was by having an “answer” focused on health read to them. They had to explain what it meant. For an example, Gallemore said, “The answer is 54.”
Students repeatedly made incorrect guesses.
“Then we told them it is how many people die every day from tobacco use. It drove them crazy.”
The school health coordinators also do body mass inventories on students in grades 2,4, 6, 8 and 9 in addition to other health screenings such as blood pressure, weight, dental, vision, hearing and scoliosis.
Blevins said it is important to reach these students while they are young. “Parents need help now. Based on state-wide coordinated school health data, 39 percent of all kids are either overweight or obese, and they have a 70 percent chance of becoming obese or overweight adults,” she said.
Carole R. Myers, PhD, APRN with the UT College of Nursing, led the concurrent session on health care legislation pending in the U.S. House and Senate. “I think I can say with some degree of certainly across the political spectrum that something is wrong,” said Myers. “Where they disagree on is how to fix it. What divides us is what we think government’s responsibility should be.”
Myers sited five principle for health insurance gleaned from opinions released by the Institute of Medicine for legislative proposals. She said health care should be continuous, affordable to individuals and families, affordable and sustainable for society, enhance well being and promote access to high quality health care that is effective and patient-centered. “All these need to work together,” Myers said.
Myers said current legislation would mandate everyone purchase insurance. “Opponents say this might make employees quit insurance all together, and some ask if it is legal. We have precedents. You have wear seatbelts and have car insurance,” she said.
The speaker said current legislation would have subsidies that would be provided by the government to those who can not afford to buy insurance. The opposition says this is the biggest cost.
Myers said current legislation would allow for insurance exchange websites to bring sellers and buyers together. “They level the playing field, but they’re only as good as the number of plans that participate.”
The speaker said there is broad-based support for doing away with pre-existing condition clauses in policies.
Myers said current legislation would seek to expand Medicaid/Medicare. “The majority of uninsured Americans come from a family with a working adult,” she said. “Many of the uninsured could benefit from expanding Medicaid/Medicare.”
The speaker said current legislation streamlines administrative costs. “In the United States, 20 cents of every dollar goes to administration. Canada, France and Taiwan have 6 percent, 2 percent and 4 percent, respective.
Myers said the president wants to use the reconciliation, meaning it would be a straight up or down vote on the Senate bill. It allows for the consideration of contentious bills without the threat of a filibuster and limits debates and amendments. The Republicans want to start over and create a different bill, said Myers.
In addition to the Health care legislation session, two other break out sessions gave attendees the opportunity to learn more about healthcare and preventative care. In the health and productive sessions, professionals from several companies made presentations on what their companies are doing to make for a healthy workplace. Jim Richards represented Mast General Store, Margie Kidd represented Clayton Homes, Becka Wilson represented Radio Systems/ PetSafe and Bruce Guillaume, Mountain Challenge.
In the Perspectives on Care break-out session, Dr. Clint Wight represented Blount Memorial Hospital, and Dr. John Pittenger represented East Tennessee Medical Center.