Friday, March 28, 2008

Grassroots Network: Healthy People 2020 Meeting, Atlanta

From Susan Hodges:

On March 17 I attended the first regional planning meeting (in Atlanta) for the development of Healthy People 2020, a federal document outlining public health goals for the US. Will maternity care even be mentioned in HP 2020? You can be involved, because ANYONE can comment on-line regarding HP 2020. Read more below.

First, take a look at the site
to get a brief idea of what this is about.

Here are some of the things I learned at the Atlanta meeting. First, unlike previous Healthy People documents (such as HP 2000, HP 2010), this time there is a concerted effort to solicit input from the public and from public health workers in this early planning stage. This input includes what health areas or topic should be included, how many should be included, and how to organize them. Some work has already been done to come up with a suggested framework. There is a lot of concern about disparities or inequities in health care especially with regard to minorities and also demographic groups such as people living in rural areas and low-income people. There is concern that HP 2010 had too many objectives (ie, specific goals, such as reducing the c-section rate to 15%) and that HP 2020 should have fewer objectives.

There are Regional Meetings coming up between April 1 and May 28, in San Francisco; Ft. Worth, TX; Chicago; New York, NY; Bethesda, MD. Find out more information here.

The Atlanta meeting included presentations about the project, the preliminary work that has been done regarding a suggested framework, etc. There were several sections of time for public comments (limited to 3 minutes per person), and a panel of people from several organizations and city government who shared their experiences of actually using HP 2010 to work on specific objectives. In the afternoon we were divided into breakout groups each for one of four over-riding topics: Developmental States, Life Stages, and Health Outcomes; Environment and Determinants of Health; Priorities and New and Emerging Issues; Health Equity and Disparities. Each group had a facilitator and brainstormed and discussed several questions to do with how HP 2020 might be used, and how issues and goals might be defined and prioritized. At the end of the afternoon the facilitators presented the main points from the breakout sessions. I would say that there was at least some concern that reducing the number of objectives would not be good, and there was at least some concern about the need to have more “teeth” so objectives could be achieved (although this is beyond the purview of the CDC etc.). It is likely that the other regional meetings will be organized similarly to this one in Atlanta.

Probably because the Atlanta meeting was the first of the regional meetings, we didn’t receive much information until the last few days before the meeting. For example, we did not know whether or how oral comments might be made, and on-line comments that could be made in the last few days were limited to about 400 words. So CfM submitted an on-line comment prior to the meeting, we later wrote a more detailed comment with supporting documents to hand in at the meeting (when we found out that was possible), and I made a 3-minute oral comment at the meeting. Virtually everyone who made oral comments was representing some kind of interest group (oral health, elder care, mental health, etc.) and basically presenting the public health importance of their issue. While some of these may have been more specific than the organizers desired, hearing the concerns about specific issues or health topics surely will help to inform the final decisions about the framework and scope of HP 2020.

I was the only speaker at the Atlanta meeting who brought up maternity care (though there were at least two people who spoke about breastfeeding). I did my best to address public health themes (health outcomes, evidence-based care), name “midwives” as an important part of the solution, and request that HP 2020 have more “teeth” for achieving objectives -- HP 2010 goals for reducing the rate of cesarean section and increasing VBAC have been completely ignored, with both rates going sharply in the opposite direction from the objective rates.

If you are thinking about attending one of the regional meetings, here are some suggestions.
  • Do read over the information about the planning process that is available on-line (and I am happy to forward documents that were sent to me right before the Atlanta meeting). Think about the overall aspects of the suggested structure and questions regarding HP 2020 and how any comments you make can address those issues that are the focus in this planning stage. Probably, the more that remarks from birth activists also relate to the framework/vision/mission planning topics, the more likely the remarks will be read and noted at this stage.
  • If you comment, on-line or orally, consider that your “audience” for these comments are public health officials. Therefore, it is a good idea if your comments about maternity care and midwives are oriented around one or more public health issues such as: access to care; health disparities; having fewer low birth weight and premature babies; healthy mothers and babies (which means not using unnecessary interventions); evidence-based care (most maternity care is not evidence-based); how midwives experienced in out-of-hospital birth would be an asset in the event of pandemic flu, drug resistant infections, and/or bio-terrorism; etc. If there is one particular aspect of the maternity care issue that you feel most passionate about or are most knowledgeable about, by all means focus on that.
  • I think it would be great for at least a few birth activist people to attend each regional meeting in person, especially individuals who represent an organization or a practice. (For oral comments, only one person per organization was permitted.) Hearing the oral comments and participating in the breakout group will give you insights into the development process and how maternity care might fit into the overall plan of HP 2020.
  • In my opinion, it is not necessary (or even advisable) to have more than one or two birth people making oral comment, since only a relatively few participants get to speak (in Atlanta it was first come first served to sign up, and the total number was limited by time). In Atlanta it was pretty obnoxious to hear the same thing from multiple people. Therefore, if there is any way to coordinate so that if several birth people want to speak, it would be useful if they can each acknowledge agreement with the one before, but address a different aspect. Be ready to rethink, rewrite, or rearrange your remarks to take advantage of what has already been said, etc.
  • Keep in mind that maternity care is just one of many, many important issues and health topics.
  • Keep in mind that disparities in health care is a major important topic that WILL be part of HP 2020.
  • The time is so short, it is important to bring up the big issues. I spoke about the lack of evidence-based care in hospitals and how that is harming women and babies, and that we already have a solution: midwives. I did not address birth centers or OOH births these were too detailed to get into. I also did not address the AMA’s Scope of Practice Partnership. While this is a big issue, it is not really within the purview of HP 2020; however, if someone figures out a useful way to present this issue, all power to you!
Meanwhile, ANYONE and EVERYONE can make comments online. Right now they are specifically interested in comments relating to the overall framework, vision, mission, overarching goals, more or fewer topics, etc. They are not seeking comments on specific objectives now, but will in 2009. However, suggesting that an issue (like the problems with maternity care) be included is not the same thing as suggesting a specific objective (such as: increase the % of VBACs to a specific number). One would think that if HP 2020 receives many thoughtful comments about the problems with current maternity care, why these problems are a public health challenge, and the need for more midwives as a way to address some of those problems, the more likely it is that health objectives relevant to improving maternity care just might be included. It can’t hurt, anyway!

I have posted both the short and long versions of the testimony I submitted for CfM at the Atlanta meeting, along with some additional “tips” in the files section of the Grassroots Network yahoo page.

Susan Hodges, "gatekeeper"

No comments: