Legislature(1993 - 1994)
12/15/1993 01:00 PM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
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SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
Anchorage, AK
December 15, 1993
MEMBERS PRESENT
Senator Steve Rieger, Chairman
Senator Bert Sharp, Vice-Chairman
Senator Loren Leman
MEMBERS ABSENT
Senator Mike Miller
Senator Jim Duncan
Senator Johnny Ellis
Senator Judy Salo
OTHERS PRESENT
Representative Terry Martin
COMMITTEE CALENDAR
HEALTHY ALASKA 2000
WITNESS REGISTER
Larry Steuber, Planning Section Chief
Division of Administrative Services
Department of Health and Social Services
P.O. Box 110650
Alaska Office Bldg., Room 130B
Juneau, Alaska 99811-0650
ACTION NARRATIVE
TAPE 93-40, SIDE A
Number 001
CHAIRMAN RIEGER called the Senate Health, Education and Social
Services (HESS) Committee to order. He said the purpose of
the meeting was to have a overview of the draft of Healthy
Alaska 2000 from Larry Streuber. He emphasized the importance
of health promotion as opposed to focusing on how we can
better treat people when they are sick as well as the
financial aspect.
Number 205
LARRY STREUBER , Planning Section Chief, Division of
Administrative Services, Department of Health and Social
Services, explained that in the fall of 1991 Commissioner Mala
and Administrative Services Director Janet Clarke asked for
an outline for how to do a state health plan. Alaska has not
had a state health plan for nearly ten years, although many
in the public health community had advocated such a plan. He
attributed budget constraints for not allowing a replication
of the early 1980s health plan which consisted of Health
Systems Agencies and Statewide Health Coordinating Councils.
He explained Healthy People 2000 is based on health promotion
and disease prevention objectives which will be measured by
indicators in twenty-two different areas as to the plans
progress. He said that Healthy Alaska 2000 will be the first
phase of a comprehensive state health plan.
The coordination of this project was assigned to the Planning
Section of Social Services and a Steering Committee of Deputy
Commissioners Jay Livey and Brian Saylor, Administrative
Services Director Janet Clarke, Public Health Director Peter
Nakamura, Planning Coordinator Brad Whistler and himself. He
listed and described the four major categories of Healthy
People 2000: health promotion, health protection, preventative
services, and surveillance of the data system. He stated
that, unlike other states, all twenty-two areas of the plan
were undertaken. He emphasized the support received from
Commissioner Mala and the Governor's office.
Mr. Steuber then specified the reasons that the Healthy People
2000 was undertaken in Alaska. Firstly, Healthy Alaska 2000
is the best attempt of a comprehensive overview of the health
status of Alaskans while addressing most of the health areas
which state medical treatment public health systems are trying
to address, thus creating a foundation for other planning
efforts. He mentioned other plans which are developing from
the Healthy Alaska 2000. Secondly, the planning process
focuses on measurable objectives to assess program
effectiveness. Thirdly, the priority areas of Healthy People
2000 apply to Alaska. Fourthly, the plan is a major federal
health planning effort. He noted that about 80% of the states
are doing Healthy People 2000 plans. Finally, the plan
highlights public health issues as they relate to health care
reform. He discussed the health care reform debate and the
debate's focus on financial mechanisms for medical care, also
mentioning the high cost but still lagging treatment in the
U.S. He discerns meaningful health care reform must deal with
health care access, financing, public health, disease
prevention, health promotion and education,and early
intervention activities.
Mr. Steuber discussed other phases of the state health plan
such as a health care-provider plan, a study of core public
health services, and provision of Statute 18. He revealed the
three goals of Healthy Alaska 2000: to increase the life span
of Alaskans, to reduce health disparities among Alaskans, and
to achieve access to preventative services to all Alaskans.
He informed the committee of preliminary recommendations for
improving Alaskans health status which were developed in the
1992 Health Summit. He projected review and finalization of
the plan by February 1994, however, he asserted the published
plan will be the initial step in addressing the objectives.
He said so far Alaska has tracked 25% of the 300 national
objectives.
Mr. Steuber stated Healthy Alaska 2000 is twenty-two separate
planning efforts with three recurring issues: the need for
behavioral information on children and adolescence, the need
for provider information and data, and the need for health
education. He commented that the Healthy Alaska 2000 includes
the best information available on Alaska's health status. He
noted data is available from 1991 from the behavioral survey,
however, the data on children and adolescence is limited. He
said the issue of data collection will be addressed in the
Governor's recommendation for a Health Care Commission. He
stated alcohol is Alaska's main public health problem
contributing to poor birth outcomes, child abuse, injuries and
diseases directly related to alcohol. Intentional and
unintentional injuries combined were cited as generally
considered Alaska's first cause of death and major source of
premature deaths in Alaska. He said occupational injuries in
Alaska were well above the national average.
Mr. Steuber explained that the Healthy Alaska 2000 plan will
establish a base line of Alaska's health status and provide
recommendations to improve the indicators of health.
Secondly, the plan will be used as an educational tool
describing the status, trends, and implications for the
twenty-two priority areas. Lastly, the plan will establish
a planning process to define an agenda for public health in
Alaska for the 1990s decade. He commented that the
recommendations in the report are means in which the health
status areas could be addressed, but not necessarily
reflecting the Governor's or the Department's positions.
Mr. Steuber further informed the committee of Alaska's low
health status in some national reports and projected Alaska's
continued low status based on the indicators in Healthy Alaska
2000. He still feels significant progress has been made in
public health in the past forty years in Alaska.
Mr. Steuber stressed the importance of improved data
collection in the areas outlined in Healthy Alaska 2000,
emphasizing the importance of base line data and periodic
progress measurements. He stated the department is not
finished with this project, therefore, no specific
recommendations for action can be made. He said the Healthy
Alaska 2000 project is so comprehensive no one person can talk
about the specifics of every priority area. He suggested
setting up subcommittees or groups of subcommittees to meet
with the coordinators of each area to discuss specific
recommendations.
SENATOR RIEGER , asked for questions.
SENATOR LEMAN asked how much of the document reflected the
views of the administration. LARRY STEUBER replied that the
document was a needs assessment, a sort of consensus of the
public health community on where we should go as well as
potential recommendations to achieve the goals. He asserted
his inability to acknowledge specific support from the
administration while emphasizing that the project is still
unfinished. He told them he had heard the Governor's budget
listed alcohol and tobacco taxes which is also found in
Healthy Alaska 2000. He cited the next task as deciding what
exactly to undertake.
SENATOR LEMAN questioned if they used the technique of a
consensus point, when two-thirds of a group agrees, in order
to advance recommendations. LARRY STEUBER said the method
Senator Leman described was not used. He explained they asked
for volunteers for each area. The department provided the
coordinator, the data and set up a template for the report.
Then the groups would evaluate the problems and attempt to
form a consensus as to what should be achieved to solve the
problems.
SENATOR LEMAN asked if some proposals would be advanced by
the administration this year fairly early in the session.
LARRY STEUBER replied he had been urging the Commission to
present some salient areas to support.
SENATOR SHARP asked if Alaska has any mandatory inoculation
requirements prior to receiving public assistance eligibility.
LARRY STEUBER stated inoculations are most effective in
children and did not know about any such requirements.
SENATOR SHARP explained the relevance of promoting wellness
and healthy lifestyles by requiring such mandatory
inoculations before the state accepts persons applying for
any form of public assistance, thus creating a preventative
measure.
LARRY STEUBER mentioned the Healthy Kids program which deals
with Medicaid and promoting immunizations, however, he did not
know of any such statutes, but could look into such
requirements.
SENATOR SHARP commented that the inoculations could be a
choice in case a person needed public assistance.
SENATOR RIEGER asked if the report affected the Governor's
alcohol and tobacco tax recommendations. LARRY STEUBER said
he did not know and speculated the recommendations could be
used to raise revenue.
SENATOR RIEGER reiterated the desire to know if the Governor
would be isolating any of the areas of Healthy Alaska 2000 to
support as legislation. He further stated the Healthy Alaska
2000 plan could be used by the HESS Committee as a list of
suggestions which could be sanctioned by the Committee. He
commended the comprehensive view of the plan. He asked what
type of format would be used in rural health care. LARRY
STEUBER informed the members that Alaska does have a Rural
Health Office.
SENATOR RIEGER referred to a study at the University of
Washington which found a lot of fragmented money that often
returned to the urban areas due to lack of trust in the rural
health care delivery system. In Alaska, most money is
federally controlled which will require new levels of
coordination to address the rural issue in a cost efficient
manner. LARRY STEUBER emphasized the aforementioned theme of
education. He reiterated Senator Rieger's reference to the
University of Washington study and stressed the need to create
a dialogue between states and the federal government.
SENATOR RIEGER thanked Larry Steuber for the recommendations
and stated if any legislation evolves he would take them under
consideration in committee sessions.
LARRY STEUBER offered assistance with specifics of any area
within the Healthy Alaska 2000.
SENATOR RIEGER stated the committee would be most interested
in items of legislation.
SENATOR SHARP expressed his desire to place responsibility on
the individual with regard to health issues. He explained the
financial pool created by President Clinton's Health Care
Reform makes those with good health patterns pay for those who
do not.
LARRY STEUBER replied that health prevention is one way to
change bad health patterns. SENATOR SHARP and SENATOR RIEGER
both commented on voluntarily assumed health risks in various
areas.
TAPE 93-40 SIDE B
SENATOR SHARP said he was hesitant to mandate certain things
because some people do want the choice. Then a group
discussion ensued with regard to mandatory health care
legislation.
SENATOR RIEGER discussed community ratings with regard to
voluntarily assumed health risks such as smoking. He
suggested promoting good health behaviors with appropriate
cost incentives.
SENATOR RIEGER thanked Mr. Larry Steuber for appearing before
the committee and then adjourned the meeting.
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