The next Secretary of the US Department of Health and Human Services (DHHS) will have a plate that is not only full, but is overflowing. While all the political rhetoric is focused around access—health insurance for all—there are a number of other critical areas that need immediate attention as well.

Clearly there are many more than 10 priority areas. However, if I just so happened to find myself sitting across from the next Secretary of HHS, I would remind her (just indulge me on that) that she is the Secretary of Health AND Human Services—that for her to make a dent on the health side of things, she must take into account whether people have: the support systems they need, heat, a home, transportation, enough to eat.

Here is my list of the top 10 priorities, in no particular order:

1. Human Services—In other words, just because someone finally has access to health care, it may not be enough. Madam Secretary: Please consider creating a new position: the Assistant Secretary of Human Services to oversee the coordination of services that will surely make a difference in the outcome of someone’s health: From a process systems standpoint, Does the patient have transportation to get to a health provider? Will that patient have a working refrigerator to store medications that require colder temperatures? Is the patient able to feed himself? To understand all the discharge instructions? Is the patient living in a clean, warm, place? You get the point.
2. Mental Illness—Columbine/VA Tech shootings; depression in epidemic proportions; what will it take to get us to improve services, coordinate care, and erase the stigma.
3. Research—It is unconscionable to not: pursue to the fullest extent possible, the promise of stem cell research; fully mine the treasures that genomics, proteomics, and personalized medicine hold within our reach; create incentives for researchers and innovators to focus on rare diseases; develop exciting competitions for young scientists; include with greater frequency children, minorities, the elderly, and women in ethically sound and appropriate trials—we get sick too, you know.
4. Electronic Health Records/IT—Enough already with the red flags. Privacy is critical—but it shouldn’t be the distraction we have allowed it to be—there are ways to address the privacy concerns (look at other sectors, look at legislation such as GINA, the Genetic Information Nondiscrimination Act of 2008, and look at the American Medical Informatics Association concept of data stewardship).
   And, while Congress is twisting itself in knots in the name of privacy, (which I agree is of critical importance), there are thousands of patients and caregivers, especially those battling life-threatening illnesses, who are putting all their personal information on the Internet—they believe that by engaging with others globally, treatments and cures could come about faster. Sites such as Patients Like Me are gaining traction.
5. Adolescent Health (binge drinking, unsafe sex, obesity, stress, body image)—I have an 18 year old son and a 14 year old daughter; I am here to tell you it’s a scary world out there for adolescents and their parents and guardians. It would be fantastic to see a full blown Public Awareness/Education Campaign that addresses underage and binge drinking—(these college presidents who want to lower the legal drinking age should be ashamed of themselves).
6. Disparities—It is a national disgrace that in 2008, “despite continued advances in health care and technology, racial and ethnic minorities continue to have more disease, disability, and premature death than non-minorities.” We can no longer afford to wait to correct this injustice.
7. Workforce—We have documented shortages of nurses, of primary care physicians and certain specialties. We have shortages of provides in rural areas. And yet, we still can’t figure out a way to all get along—how about a real integrated team approach where multiple providers work together for the good of the patient? For that to happen, Madame Secretary, it is imperative that you strive to maintain a diverse health care workforce. I know, I know, there are some models out there, but so far, not much real progress. I know, I know, reimbursment’s an issue—for that, please see priority #9.
8. Health Literacy—In April 2004, the Institute of Medicine released a report entitled Health Literacy: A Prescription to End Confusion which found that “Nearly half of all American adults—90 million people—have difficulty understanding and using health information, and there is a higher rate of hospitalization and use of emergency services among patients with limited health literacy…Limited health literacy may lead to billions of dollars in avoidable health care costs.” For more information, check out http://nnlm.gov/outreach/consumer/hlthlit.html.
9. It’s the Reimbursement, Stupid—(Not you, Madame Secretary, it’s just an expression). Until we figure out how to pay all providers fairly, equitably, and dare I say simply (this SGR business is for the birds), it will be challenging indeed to move the health care needle forward.
10. Patient-Centered Care—With all the policies, politics, and regulatory hurdles that come along with the job, please don’t loose sight of the fact that at the end of the day it is about people. People who are frightened, who are in pain, who need to know there is someone out there who they can depend on when they need it most.

Hubert Humphrey once said, “The moral test of government is how it treats those who are in the dawn of life—the children; those who are in the twilight of life—the aged; and those who are in the shadows of life—the sick, the needy and the handicapped.”

Looks like you’ve got your work cut out for you.

This entry was posted on Monday, September 29th, 2008 at 12:00 pm and is filed under Policy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.