Ka Wai Ola - Office of Hawaiian Affairs, Volume 33, Number 11, 1 November 2016 — Public health involves more than health care [ARTICLE+ILLUSTRATION]

Public health involves more than health care

ByTreenaShapiro What if small businesses staffed by uninsured parttimers began subsidizing gym memberships as an incentive for employees to keep themselves healthy? What if in addition to doctor's appointments, home visits were also used to assess environmental factors that might contribute to a patient's symptoms? What if community planners promoted healthy lifestyles by designing pedestrian-friendly neighborhoods with access to medical care, open spaces and community gardens? What if puhlie health considered social factors that impact wellness, such as poverty, hunger, insecure housing, education, jobs and cultural connections? These questions were among those discussed by puhlie heahh experts from across the nation at a recent Heahh 3.0 summit at The Queen's Medical Center. Presented by the Office of Hawaiian Affairs (OHA) and the Asian & Pacific American Heahh Forum (APAHF), with Nā Limahana O Lonopūhā, a Native Hawaiian Heahh Consortium, the daylong event was a ehanee to discuss systemic challenges and how to address social determinants of heahh. The highlight was a panel discussion featuring Debbie Chang, MPH, of Nemours Children's Heahh System in Philadelphia; Peter Long, Ph.D., of Blue Shield of California Foundation; and Dr. Denise Koo, Capt. USPHS, from the Centers for Disease Control. Having only one doctor on the panel emphasized a theme from the summit: Heahh is not only about heahh care. "In medicine we're often taught to think, 'What disease does this patient have?'" said Dr. Koo. "But in epidemiology we're actually looking at what kind of person has a given disease: Who's the person? Where's the family? What are their circumstances? What community do

they live in? What are all those factors and how do we address those determinants of heahh?" OHA's Ka Pouhana/CEO Kamana'opono Crabbe, who opened the summit, said he had been inspired by a similar panel discussion in Washington, D.C., and he thought Hawai'i heahh professionals could benefit from the national perspective. The summit was also a ehanee to share efforts already underway and strengthen collaboration among Native Hawaiian organizations and leaders looking for ways to improve heahh within their communities.

"We've been on this path for a while," Crabbe noted. In Hawai'i, state laws make heahh care nearly universal and the social determinants of heahh have been incorporated into the state Heahh Department's efforts to curb chronic disease. OHA not only advocated for Heahh 3.0 at the state level, the agency also incorporated the social determinants of heahh into its strategic plan. "Mauli Ola is one of OHA's six priorities and right now the (targeted) result is really to reduce the prevalence of chronic disease, especially obesity and diabetes," Crabbe

said. Other goals include reducing the incidence of substance abuse and expanding access prenatal care. Heahh 3.0 is an upgrade from the Heahh 2.0 movement that ushered medicine into the digital age. The new framework looks at how social challenges such as stress, discrimination and barriers to education and jobs that pay a living wage ean impact heahh at the individual, 'ohana and community level. It recognizes that action in one area ean result in positive change in another, so multipronged approaches are appropriate. "Many of our efforts have already been in play," said Crabbe. For instance, grants from OHA have helped establish community farms in Kalihi and Hāna that are focused on restoring the 'āina and reviving and perpetuating traditional farming practices. Diet and exercise are built in as volunteers exchange sweat equity in the fields for bags of fresh fruit, vegetables and medicinal plants. For more about the determinants of heahh, visitwww.oha.org/health. ■

In epidemiology we re actually looking at what kind of person has a given disease: Whos the person? Wheres the family? What are their circumstances? What community do they live in? What are all those factors and how do we address those determinants of health?"

— Dr. Denise Koo, Capt. USPHS

HEALĪH

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Llo R: Dr. Kamana'opono Crabbe (OHA), Dr. Denise Koo (CDC), Debbie Chang (Nemours Childrens Hospital), Kathy Ko Chin (APIAHF), Dr. Diane Paloma (Queens Health Systems), GayleTang (lndependent), Gail M Hannemann (APIAHF board chair), Dr. WalterTsou (Former APHA President) - Photo: Courtesy of Dr. Walter īsou