Health Professions and Public Health: compete or complement

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Health Professions and Public Health compete
or complement

• Don Lollar, Ed.D.
• Senior Research Scientist
• Centers for Disease Control Prevention
• National Center on Birth Defects and
  Developmental Disabilities
• dlollar_at_cdc.gov

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Professional ExperiencesHealth Professional
Psychologist, Rehabilitation, 25 yearsPublic
HealthCDC, 10 years Health in both titles
does not suggest automatic interplay
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Commonalities Bridges

• Health and well-being is goal
• Environment influences
• Case definition/diagnosis important
• Strength-based possibilities
• Framework for both is ICD/ICF
• Mortality
• Morbidity
• Disability
• Each can complement the other
• Use each other as leverage in larger systems
• Each can inform the other
• Research coordination

4
Differing points of view contrived, real, or
both

• Target Individual vs. Population
• Setting Clinical vs. Community
• Concepts Rehabilitation vs. Disability
• Treatment vs. prevention
• Model Medical vs. Social
• Is versus requiredor just learned?
• Research applications could often include both

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Barriers

• Mind set
• Different targetsindividual/population
• Different settingsclinical/community
• Different fundingreimbursement/not
• Different conceptsprevention vs. treatment
• Political constituencies
• professional associations/guilds
• advocates
• public health professionals/state and local
• Science and analysis
• F ratio and Risk/Odds Ratio
• Methods surveillance and research
• Resources
• Third party payers or public funds

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Translation

• Health Professions too focused on the individual,
  thereby not caring or knowing about the bigger
  picture
• But clinical experience asks relevant questions
• Public Health often uncomfortable with real
  people, content to deal with the population-based
  data and state programs
• But public health provides aggregate data for
  policy use, financing

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Observations while moving from Rehab to Public
Health

• Missionary from rehab/disability to public health
• Preventing disability is noble acknowledging
  primary prevention failures is crucial for
  public health to evolve beyond morbidity/mortality
  
• Case definition/standard framework
• ICD/DSM
• Disability does not equal illness
• Disability status is a demographic variable
• Toxic can be applied to the environment of
  people with disabling conditionsre-define
• Different science methods need for psychometric
  emphasis for instruments/tools

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Diagnosis to Function the real compete
complement

• Healthcare not health mostly medical
• Not paid for health, but managing illness
• Both clinical and public health practice are
  built on disease modeldiagnosis driven
• Evolution from dx to function also naturally
  evolution--Leaders or followers
• Diagnosis and function are both important in both
  health care and public health
• Diagnosis does not predict function

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Function Foundation for Coordination

• International Classification of Functioning,
  Disability, and Health (ICF)
• Approved in 2001 by World Health Assembly
• Companion to International Statistical
  Classification of Diseases, Injuries (ICD)
• Foundation for cooperation, coordinated projects,
  by use in practice and public health
• Function important for treatment planning, but
  also public health assessment, policy
  development, risk adjustment

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INTERNATIONAL CLASSIFICATION OF FUNCTIONING,
DISABILITY, AND HEALTH (ICF)

• DESCRIBES HEALTH STATE IN DOMAINS
• BODY FUNCTION/STRUCTURE
• Impairments
• ACTIVITIES/PERSONAL, and
• Activity Limitations
• PARTICIPATION/SOCIETAL
• Societal Restrictions
• ENVIRONMENTAL FACTORS

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INTERNATIONAL CLASSIFICATION OF FUNCTIONING,
DISABILITY, AND HEALTH (ICF)

• BODY FUNCTIONS/STRUCTURES
• PHYSIOLOGICAL and PSYCHOLOGICAL FUNCTIONS
• e.g. Mental, Sensory, Digestive, Respiratory
• ACTIVITIES/PARTICIPATION
• ACTIVITIES/PERSON-ORIENTED
• Mobility, Communication, Personal care..
• PARTICIPATION/LIFE SITUATION
• Work, School, Leisure, Economic, Civic
• ENVIRONMENT
• Physical/built, social/attitude, systems/policies

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ICF UTILITY in DISABILITY and REHABILITATION

• ALLOWS CLINICAL CODING OF MULTIPLE DIMENSIONS OF
  DISABILITY
• IMPAIRMENTS
• PERSONAL ACTIVITY LIMITATIONS
• RESTRICTIONS IN PARTICIPATION
• ENVIRONMENTAL BARRIERS
• EACH DIMENSION IS CODED INDEPENDENTLY CAN BE
  USED ALONE OR IN COMBINATION
• CROSSES SETTINGSInpatient, Outpatient, Home,
  Community

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ICF UTILITY in DISABILITY and REHABILITATION

• Research
• Craig Velozoactivities tools
• David Grayparticipation and environmental
  barriers
• Rune Simeonssonchildren and school participation
  and barriers and facilitators
• Elena Andresen--caregivers
• Clinical practice
• ICF in patient encounters
• ICF in treatment planning

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UTILITY OF ICF IN PUBLIC HEALTH

• SURVEILLANCE
• National Survey of Children with Special Health
  Care Needs
• RESEARCH
• Psychiatric hospital to assess needs and progress
• PROGRAMS
• CDC Disability and Health state programs
• Early intervention assessing family perceptions
  and professional evaluation

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Functioning of Adolescent with Asperger Disorder

• Mental Functions
• b140.2 attention
• b164.1 higher-level cognitive
• Sensory Functions Pain
• b265.2 touch functions
• Learning Applying Knowledge
• d160.2 focused attention
• d165.2 solving problems
• d177.1 making decisions
• General Tasks Demands
• d240.2 handling stress other psychological
  demands

• Communication
• d315.1 communicating with receiving nonverbal
  messages
• d350.2 conversations
• Interpersonal Interactions Relationships
• d720.3 complex interpersonal interactions
• d750.3 informal social relationships
• Major Life Areas
• d820.1 school education
• Community, Social, Civic Life
• d910.1 community life

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SLAITS/CSHCN Survey--2005

• Learning, understanding, or paying attention?
  D155,159,160
• Speaking, communicating, or being understood?
  D330,350,349
• With feeling anxious or depressed? b152
• With behavior problems, such as acting-out,
  fighting, bullying, or arguing? D710, 750
• Making and keeping friends? D770

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Healthy People 2010 Vision for Health care and
Public Health

• Disability and Secondary Conditions
• GOAL PROMOTE THE HEALTH OF PEOPLE WITH
  DISABILITIES, PREVENT SECONDARY CONDITIONS, AND
  ELIMINATE DISPARITIES BETWEEN PEOPLE WITH AND
  WITHOUT DISABILITIES IN THE UNITED STATES
  POPULATION

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DISABILITY AND SECONDARY CONDITIONS

• CHAPTER 6 HAS 13 OBJECTIVES
• 10 DATA DRIVEN
• 3 DEVELOPMENTAL DATA CURRENTLY BEING COLLECTED
• DISABILITY INCLUDED AS A DESCRIPTIVE/DEMOGRAPHIC
  VARIABLE IN 100 OBJECTIVES IN OTHER 27 HEALTH
  CHAPTERSe.g. ORAL HEALTH, PHYSICAL ACTIVITY,
  NUTRITION, INJURY, SMOKING, VIOLENCE

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ICF BODY FUNCTIONSAND HP 2010

• HEART DISEASE/STROKE (12) CORONARY HEART DISEASE
  DEATHS,STROKE DEATHS
• MEDICAL PRODUCT SAFETY (17-3) PROVIDER REVIEW OF
  MEDICATIONS TAKEN BY PATIENTS
• NUTRITION AND OVERWEIGHT (19) HEALTHY WEIGHT IN
  ADULTS, OBESITY IN ADULTS, OVERWEIGHT OR OBESITY
  IN CHILDREN AND ADOLESCENTS
• ORAL HEALTH (21) UNTREATED DENTAL DECAY, DENTAL
  CARIES
• PHYSICAL ACTIVITY (P.A.) (22) NO LEISURE-TIME
  P.A., MODERATE P.A., VIGOROUS PA

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ICF ACTIVITIES ANDHP 2010

• DEPRESSION AMONG CHILDREN WITH DISABILITIES 6-2
• DEPRESSION AMONG ADULTS WITH DISABILITIES 6-3
• ACTIVITY LIMITATIONSARTHRITIS (2-11), CHRONIC
  LUNG PROBLEMS (24-9)

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ICF PARTICIPATION AND HP 2010 OBJECTIVES

• SOCIAL PARTICIPATION OF ADULTS (6-4)
• EMPLOYMENT PARITY (6-8)
• INCLUSION OF CHILDREN IN REGULAR EDUCATION
• HIGH SCHOOL COMPLETION (7-1),
• OLDER ADULT PARTICIPATION IN COMMUNITY HEALTH
  PROGRAMS (7-12)
• EMPLOYMENT OF PERSONS WITH SERIOUS MENTAL ILLNESS
  (18-4)
• SCHOOL OR WORK DAYS LOST, RESPIRATORY DISEASES
  (24-5)

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ICF ENVIRONMENT AND HP 2010 OBJECTIVES

• 6-7 CONGREGATE CARE DECREASE
• 6-10 ACCESSIBILITY OF HEALTH/WELLNESS PROGRAMS
• 6-11 ASSISTIVE DEVICES AND TECHNOLOGY
• 6-12 ENVIRONMENTAL BARRIERS AFFECTING
  PARTICIPATION
• 6-13 DATA SYSTEMS AND PROGRAMS IN STATES

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ICF ENVIRONMENT AND HP 2010 OBJECTIVES

• ACCESS TO HEALTH SERVICES 1-1,4,5 HEALTH
  INSURANCE, ONGOING CARE, PRIMARY CARE PROVIDER
• CANCER 3-11, 12, 13 PAP TESTS, COLORECTAL
  SCREENING, MAMMOGRAMS
• EDUCATION/COMMUNITY-BASED PROGRMS 7-6 EMPLOYER
  SPONSORED HEALTH PROMOTION ACTIVITIES

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Barriers to ScreeningIndividual and Population

• Difficulty with positioning
• Inaccessible facilities and equipment
• Provider attitudes
• Manufacturers and where distributed

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HP2010 CHAPTER 6 NEW FREEDOM INITIATIVE

• HP2010 CHAPTER 6 IS THE CLEAREST WAY TO
  OPERATIONALIZE THE GOALS OF THE NEW FREEDOM
  INITIATIVE
• SPECIFIC OBJECTIVES ADDRESS
• REDUCTION IN CONGREGATE CARE
• REMOVING ENVIRONMENTAL BARRIERS
• INCREASING COMMUNITY PARTICIPATION
• IMPROVING EMOTIONAL SUPPORT FOR PEOPLE WITH
  DISABILITIES CAREGIVERS
• INCLUDING CHILDREN, ADOLESCENTS, ADULTS

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DIRECTIONS

• Global perspective greater continuity
• Individual and population based emphasis on
  health promotion and prevention of secondary
  conditions CARF Credential
• Disability and public health courses, integrating
  disability concepts, methods, examples, into
  curriculum
• OHSU
• Boston U

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Competition, Communication, Cooperation,
Coordination

• Competitionone side wins if not each battle,
  certainly the war (for funds, emphasis.)
• Communicationlets talk about similarities and
  differences in what we do, and how we see our
  professional worlds
• Cooperationmaybe, lets look at how we might
  work together on a project(s)
• Coordinationlets see how our visions for future
  work can fit together
• Not immersion, Coordination

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Health Professions and Public Health combined
make each stronger

• With whom can you work to communicate,
  cooperate, and collaborate?