Focusing on Prevention for a Healthier North Carolina

Focusing on Prevention for a Healthier North Carolina

In the United States, North Carolina ranks 37th in overall health and 38th in premature death. Experts say the best way to improve the public’s health is to focus on prevention.

In 2008, the North Carolina Institute of Medicine and the state Division of Public Health convened a prevention task force with funding from four foundations: the Blue Cross and Blue Shield of North Carolina Foundation, the North Carolina Health and Wellness Trust Fund, the Kate B. Reynolds Charitable Trust and The Duke Endowment. Made up of a diverse group of 44 stakeholders, the task force identified the preventable risk factors that contribute to the leading causes of death and disability in the state. The group also researched evidence-based strategies that could prevent or reduce those factors. After months of meetings, the task force published “Prevention for the Health of North Carolina: Prevention Action Plan” in October 2009.

Pam Silberman is head of the North Carolina Institute of Medicine.

Pam Silberman, head of the North Carolina Institute of Medicine, talks about the report in the following interview, which has been edited for clarity and length. Silberman holds a doctorate in public health and a law degree from UNC Chapel Hill, and she has a bachelor’s degree in political science and psychology from the University of Illinois, Urbana.

How did the task force get started?

The genesis was interesting. This was the first time that we know of where the four major health foundations in the state decided they wanted to fund something collectively.

What was your role?

The North Carolina Institute of Medicine brought together a diverse group of stakeholders—health care professionals, hospitals, insurance companies, businesses, state government and the faith community. We brought experts to the table to tell us about what works, what doesn’t work, what we are already doing in North Carolina and how we can make a difference.

How was the task force structured?

For the first step, we looked at the leading causes of death and disability. Then we looked at the research: What are the preventable factors that contribute to those leading causes of death and disability? What can we do to prevent those risk factors? We came up with a list of 10 areas that the task force focused on. Next, we asked, “What does the evidence show we can do to try to prevent those risk factors?” And then, knowing that there is no single magic bullet, we developed multi-faceted strategies that build on each other to bring about meaningful change.

You presented the report “Prevention for the Health of North Carolina” at a summit in October 2009. What was the interest level?

We reached capacity quickly and had to turn people away.

If there’s one message to come from the report, what would that be?

If we work together and implement multi-faceted evidence-based strategies, we can improve population health in North Carolina. We know how to do it—we just need to do it.

Who do you hope hears that message?

We all need to hear it. Individuals need to take better care of themselves. Schools need to do a better job helping to improve the health of the students while they are in school. Clinicians need to focus more on clinical preventive services and providing the guidance that people need to know to be healthier. Insurers need to pay for preventive services so that we don’t have barriers to getting the services we need. Workplaces should be promoting healthy environments. Communities should support strong parks and recreation departments. Policymakers can support health-promoting policies. And funders can always play a critical role in being catalysts for change.

What has the response been so far?

It has been overwhelming. We’re about to do a second printing of the report because so many people have wanted this publication. That says a lot because it’s 350 pages.

If prevention is the most practical approach to addressing core health outcomes, why hasn’t it been emphasized in our health care system?

I think the reason we haven’t focused on it in the past is really three-fold. One is that population-based measures are harder to grab onto. There isn’t a compelling human interest story when you’re talking about the population as a whole.

Second, until recently we didn’t really know what works and what would make a difference. All of us think, “We should do this more” or “We should do that more” or “We shouldn’t eat that food” or “We should exercise more.” But we know how hard it is to change our individual behavior, so we then extrapolate and say “Well, it’s hard for me, so it’s going to be hard for everyone and therefore we cannot do anything.” But now, North Carolina has had success implementing multi-faceted tobacco prevention strategies and we have achieved positive results in reducing the North Carolina smoking rate. So we know how to do it.

Third, we have come to the point where we realize that we cannot afford the cost escalations that we have had for the last 20 to 30 years in our health care system.

Why does North Carolina come in so low when it comes to national health rankings?

Part of it is that we’re a very poor state. Another part of it is that we have poor educational outcomes. There is not one factor that you can say, “Because of this, we rank low.” Adult smoking, gonorrhea rates, air pollution, motor vehicle fatalities, low incomes, graduation rates, the number of uninsured: All those factors play together.

I’m convinced, and I really believe this, if we put the same kind of attention on prevention that we have historically put on access and quality and clinical care, we can make meaningful differences. Whether we are number 1, 10 or 15—it will be a huge improvement over where we are today.

According to the report, success will come when we approach the problem on multiple levels.

Right. If we improve the food that we serve in cafeterias, we can’t assume that kids suddenly won’t be obese anymore. We need to have better food in cafeterias and no junk food in vending machines, but we also need to have safe places where kids can play outside, we need to promote physical activity and we need to teach parents about nutrition. There is not one magic bullet.

What happens next?

A lot of things are coming out of this. Dr. Jeff Engel, the state health director, has said that focusing on the prevention action report is going to be one of his top priorities. Every 10 years, the Federal government does a Healthy People report and North Carolina has chosen to do one as well. They came to us and asked for help developing the Healthy People 2020 objectives, which will basically build off the work of the task force. When that gets launched, there will be a campaign to make North Carolina the healthiest state in the country. 

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    Expanding programs to promote health and prevent disease

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