Tuesday, August 27, 2013

Duke University roundtable

Twelve representatives from the Republic of China (Taiwan) were visiting Duke University in Durham, North Carolina to learn about the U.S. public health system and  share some of their successes and challenges. The delegation included the heads of the Taiwan FDA and the Taiwan CDC (they do use some of the same agency  names as the U.S.), the directors of their National Health Insurance Administration and their Department of Social Insurance, the Director-General of their Department of Medical Affairs, and several hospital administrators and clinicians. I was invited, along with several other state health officials, to provide some thoughts on "Driving Public Health Transformation in Communities."

I started my presentation by noting that this meeting was being held on the anniversary of what I consider to be the most significant U.S. public health achievement of the 20th century. On August 26, 1920 the 19th Amendment of the U.S. Constitution became law. That amendment stated:  "The  right of citizens of the United States to vote shall not be denied or abridged by the United States or by any State on account of sex." 

Because of the 19th Amendment several things occurred, but I highlighted the fact that it lead to the  passage of the Sheppard Towner Act which was a way to satisfy women voters. This Act was the first grants-in-aid program in the U.S. It also led to the  development of Maternal and Child Health Programs in all state health departments, the initiation of birth registries (vital records) in all state health departments, and the expansion of public health nursing. It established a partnership of federal and state government that continues to today. The passage of the 19th Amendment and the Sheppard Towner Act led to a precipitous drop in maternal and infant mortality rates. This was a great example of how public policies can dramatically influence health.

I linked the passage of the 19th Amendment to the topic of public health transformation by noting that Women's Suffrage did three things that we should consider today:

1. It demonstrated the need to engage ALL of the population in creating  health.
2. It demonstrated the power of engaged individuals and communities to create the conditions for health.
3. It changed the conversation about what creates health. It took the discussion about health beyond the clinical to include what we now speak of as the social determinants of  health.

Using those three learnings I explained how we put together our Healthy Minnesota Partnership and created our Healthy Minnesota Framework. I particularly  focused on how we are trying to change the conversation about what creates health. In doing that I used one of  the quotations on the first page of Healthy Minnesota 2020. It's from Antoine de Saint ExupĂ©ry - "If you want to build a ship, don't drum up people to collect wood and don't assign them tasks and work, but rather teach them to long for the endless immensity of the  sea." 

That quotation exemplifies what we are trying to do with our Healthy Minnesota Framework - expand people's vision and create a narrative about what a healthy community and a healthy future might really look like if we embraced a perspective based on possibilities and abundance rather than diseases and scarcity. 

I then went on to explain our Framework and how it is influencing our SHIP (Statewide Health Improvement Program) efforts and our SIM (State Innovation Model) grant. People were interested in this latter part of my talk but it was evident that the interest wasn't as high as it was for the first part. Several hours later while enjoying a lovely beverage during a reception in the backyard of a former NC State Health Official, I discovered the reason why.

The people from Taiwan had not been exposed to the notion of health in all policies and were still trying to comprehend the concept that Women's Suffrage is a public health issue (women in Taiwan got the right  to vote in 1945). The concept of community engagement and empowering communities to create the opportunities for health was also new. They were more interested in the concepts than in the specifics of what is happening in Minnesota.

The response from the U.S. attendees was also fascinating. They also weren't interested in the specifics but my presentation sparked an in-depth and engaging conversation about racism, cultural diversity, sexism, community engagement, and power and control. It was one of the most interesting and informative conversations in which I've participated. 

As I listened to the conversation, I silently thanked Genevieve Clark, Elizabeth Cady Stanton, Lucy Stone, Julia Ward Howe, Lucretia Mott, Susan B. Anthony, Sojourner Truth, Jeannette Rankin, and multitudes of others who worked hard for many years to gain this civil right for half of our citizens. Tonight's conversation  would not have been possible without them. However, it was also pointed out during the conversation - two days before the 50th anniversary of Martin Luther King's March on Washington - that the work of engaging and empowering communities to better the human condition of all of its members will never be done.

We all decided that we also have a dream - a dream that we will all, as a community, work collectively to assure the conditions in which  people can be healthy. While that may be the definition of public health, it's also the challenge and the vision of public health. It is a challenge that I hope we can meet in Minnesota and throughout our country. I also hope it is a challenge that will be met in Taiwan and every other country throughout  the world.


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