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Because All We Have Is Each Other
Ben Hoffman, MD Oregon Health Sciences University
Lisa Chamberlain, MD, MPH
Stanford University
Why Children Need Us To Be Effective Advocates
• We have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this session.
• We do not intend to discuss an unapproved/investigative use of a commercial product/device in our presentation.
Disclosure Statement
March 4, 1889
Objectives
• By the end of this workshop, you should
be able to:
– Define Advocacy as it pertains to child health
– Articulate why pediatricians must be skilled
and humanistic advocates for children
– Discuss innovative approach to building
power and capacity for child advocacy
– Brainstorm ways tp advocate the well-being of
kids in South Carolina
Maslow’s Hierarchy of Needs
Why us? “Pediatricians are the
ultimate witnesses to
failed social policy”
Paul Wise, MD, MPH
Advocacy is the pursuit of influencing
outcomes including
public-policy and resource allocation decisions
within political, economic, and social systems and
institutions that directly affect
people’s current lives.
David Cohen, 2001
Role of the Health Professional?
Bear Witness
Community Role
Moral Imperative Standard of professionalism
Powerful and credible source
Respect
“Action by a physician to promote those social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being that he or she identifies through his or her professional work and expertise.”
Earnest et al. Acad Med 2010
Practice
Community Government
Individual
Advocacy
Community
Advocacy
Systems-level
Advocacy
“In the long run, child
health is about advocacy… ”
Health Affairs, 2004
University of Mississippi Center for Population Studies, 2013
University of Mississippi Center for Population Studies, 2013
CDC - Preventing Chronic Disease: Volume 9, 2012: 11_0120
Premature Infants Born in Low-Income Counties Have Higher Mortality
Children need us to become more
powerful on their behalf
“What is needed is a
realization that power without love is
reckless and abusive,
And love without power is sentimental and
anemic.”
~ Martin Luther King, Jr.
.27
Child Health
Professionals
Love Community
Power/Authority Ability to Act
Science Knowledge
K Plax, Donnelly J, Federico SG, Brock L, Kaczorowski J, “An
Essential Role for Pediatricians: Becoming Child Poverty Change
Agents for a Lifetime,” Acad Peds 2016.
Stories
are the
most
powerful
tool in a
leader’s
toolkit
Howard Gardner
Maslow’s Hierarchy of Needs
New Advocacy Models
Emerging threats
UC Davis
CHRC Oakland UC San Francisco
Lucile Packard CH
UC San Diego
Navy Medical San Diego
CH Orange County
Harbor Medical UCLA
Kaiser LA UC Irvine
Loma Linda
CHLA
UCLA
California
Pediatric Training Collaborative
• Collaborating to address health inequities
• Community peds training
• Leg advocacy training and statewide advocacy
Advocacy Role – State Partnership with AAP
Budget “raid” Protect WIC and SNAP
Residents come to Sacramento 2009: 40 2010: 65
2011: >100 2012: >110 2013 = 120 2014 = 126 2015 = 134 2016 = 130
AB2109
Today…in your backyard…
5
3
Built / Funded / Underway (2016)
TOTAL: 57
MO: 4
CA Total: 15 NC: 5
SC: 3
NY: 30
Assessing Feasibility / Needs Assessment (2017)
TOTAL: 42
TX: 13
IL: 11
NJ: 9 MI: 9
Potential (2020)
TOTAL: 31
FL: 8
VA: 6
PA: 8
OH: 9
The Vision - 2022
TOTAL: 130/199
5
3 MO: 4
CA Total: 15 NC: 5
SC: 3
NY: 30
TX: 13
IL: 11 NJ: 9
OH: 9
FL: 8
VA: 6
PA: 8
MI: 9
5
3
Built / Funded / Underway (2016)
TOTAL: 57
MO: 4
CA Total: 15 NC: 5
SC: 3
NY: 30
Wins • Child safe nicotine cartridge packaging in MO
before the federal law
• Safe sleep practices in accordance with the AAP child safe sleep policy statement for all licensed day care centers in MO.
• Strictest vaccine exemption law in the country.
• Participation in state committees related to children in foster care, juvenile justice, CSHCN.
45
Wins
• Rochester Monroe Anti-Poverty Initiative (RMAPI) achieves $110 Million/5 years from NY State Economic Development funding to reduce poverty
• Paid Family Leave in New York State
• High quality Pre-K for all 4 year olds and half of the 3 year olds in Rochester, NY
46
47
Levine/Carolinas HC Sara Hostmann, Shivani Mehta & Stefanie Reed
Wake Forest Julie Linton
Laurie Albertini Meggan
Goodpasture
UNC Emily VanderSchaaf,
Darragh Davis Melissa Fitzpatrick
Palmetto Katie Stevenson
Greenville: Kerry Sease,
Lochrane Grant, Nancy Henderson
MUSC Kristina Gustafson
Jimmy Roberts Liz Wallis
ECU Karin Hillenbrand
Jenn Crotty
Duke: Debi Best
Richard Chung
SCCHC 2017 Legislative Agenda:
1. Educate legislators on importance of Medicaid to children’s health.
2. Restore funding for child abuse medical evaluations to pre-recession funding levels
“Highlights from SC DHHS Director Soura’s presentation: SC DHHS spending is on target but tremendous
uncertainty about federal action on Medicaid makes planning challenging.”
What did he do?
Urged government departments to "waive, defer, grant exemptions
from, or delay the implementation" of
provisions that imposed fiscal burdens on states,
companies or individuals.
What’s at stake: Coverage of pre-existing conditions
Coverage of kids to 26 on parents plans Lifetime Caps - eliminated
20 million Americans covered under “Marketplace” plans +
Medicaid expansion
Medicaid expansion + Marketplace
Repeal and Replace… with what?
Paul Ryan’s “A Better Way”
Secretary Price
Sen Orrin Hatch
Sen Ted Cruz
Pres Trump
American Enterprise Institute
Modernize Medicaid
Enhance Health Savings Accounts
Provide Portable, Monthly Tax Credits
“Block Granting” Medicaid
The Debate
Leave it like it is
• Entitlement
• Federal Program
• Mandated Coverage
Modernize Medicaid
• Block Grant
• State Program
• Flexibility to save money
Trend – no question Amount of Decrease - ???
Take Action! Our job is to understand the data,
get it out there, and tell our stories.
• The threat to Medicaid is the biggest threat to child health in decades.
• We have new models, uniting our voices, to advocate on behalf of kids.
70
You all are great leaders in North and
South Carolina
Peditricians and the folks who care for
kids are just finding their voice – we’ve only seen the tip of
the iceberg
Thank You for all your hard work on
behalf of kids
SCCHC 2017 Legislative Agenda:
1. Educate legislators on importance of Medicaid to children’s health.
2. Restore funding for child abuse medical evaluations to pre-recession funding levels
Questions?
What is the national
membership of the AARP?
35 Million
How many of them vote?
35 Million
How many children under
the age of 18 are there in
the US?
72 Million
How many of them vote?
• Last year, roughly 4 in 5 S.C. children who could have benefited from a medical evaluation by a child abuse pediatrician went without one, said Rosa, medical director of the S.C. Children’s Advocacy Medical Response System and a University of South Carolina clinical pediatrics professor.
• For years, the program has been underfunded, advocates say, and the extra money would help the network train more doctors to perform more medical evaluations.
• Now, the program’s leaders want lawmakers to restore its state funding to $1.4 million, its 2008 level. State money dropped to $690,082 in 2009 as the Great Recession forced cuts, and has ticked up only slightly since then. Last year, the state gave the program
$750,000.
Here is what you can do
• Work with you AAP chapter to write a letter, make a phone call, make a visit to your local official.
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