SCR 4-PUBLIC HEALTH AND HEALTH COMPACT [Contains discussion of HCR 1.] 3:38:24 PM CHAIR WILSON announced that the only order of business would be SENATE CONCURRENT RESOLUTION NO. 4, Relating to public health and a health compact. 3:39:34 PM DON BURRELL JR., Staff to Senator Bettye Davis, Alaska State Legislature, introduced SCR 4 by paraphrasing from the sponsor statement, which read as follows [original punctuation provided]: The Health Compact encourages all Alaskans to: -Make healthy choices -Promote their own health and well being -Share their experiences and ideas on better health with one another Alaska faces a multilayered health crisis of growing proportion. An aging population is growing at a time when the ranks of our physicians are shrinking. The cost of medical care continues to rise as the number of uninsured Alaskans grows. The Legislature will continue to work to assist in achieving better health for every man, woman, and child in the state. Yet there are things that we as individual Alaskans can do to improve our own health, thereby minimizing our impact on the health care system. We put forth as a small step, this simple tool to help Alaskans help themselves. The resolution also dedicates the remainder of the year 2007 as a time to join the Compact, and dedicates 2008 as a year for sharing ideas and taking action. The cost is free but the rewards are priceless. 3:41:14 PM REPRESENTATIVE SHARON CISSNA, Alaska State Legislature, spoke to SCR4 as the sponsor of HCR1. She stated that, through her experience as a member of this committee and of the Health & Social Services Finance Subcommittee, she has learned that health problems are huge and resources are diminishing. Furthermore, research has shown that most health problems are caused by personal choices. She explained how difficult it is for people to change habits and that changes come with the support of other people. Representative Cissna said that SCR1 is an invitation, from the governor and the legislature, to Alaskans encouraging them to make changes for better health by celebrating their personal health with each other. She expressed her hope that profound changes often come from simple things; this simple act, to invite people to celebrate and talk about better health, will influence others to make healthful choices as well. 3:44:11 PM REPRESENTATIVE GARDNER asked which state ranks first in the nation in per capita public health costs. She also questioned the statement that Alaska ranks poorly in rates of obesity and lack of physical activity. REPRESENTATIVE CISSNA said that she did not remember the state that ranked first. In answer to the second question, her national research indicated that Alaska's rate of obesity is steadily increasing. Some of this increase is linked to rural areas where watching television, sedentary living, and poor nutrition are becoming more of a habit. 3:46:08 PM REPRESENTATIVE ROSES stated that if the intent of the resolution is to create the Alaska health pact, so information can be shared for long term benefits, the "whereas" that talk about the state's current response to issues are unnecessary. Issues such as the state's rank and the number of uninsured residents are not related to the sharing of information about heart disease and diabetes. Representative Roses explained his concern that these statements identify areas where the state may be deemed deficient in what is provided to its residents. He referred to a current inadequacy lawsuit against the state for not sufficiently funding education. He suggested that these statements will provide grounds for social service and health care agencies to sue. REPRESENTATIVE CISSNA replied that all of these statements are public information and have already been published. Furthermore, each statement is necessary to address the varied goals. She pointed out that the language section is part of the resolution because of the need to effectively communicate with non English speaking residents to help them change their habits. This is one of the important parts of the resolution; that people who speak a common language and are part one's culture will help one to understand and achieve goals. She concluded by saying that the intent is to encourage everyday conversation to include good health and supporting each other's good health through relationships. Making health a conversation point will result in richer friendships and closer relationships. 3:51:48 PM REPRESENTATIVE ROSES agreed. However, he questioned how it will diminish the intent of this resolution to remove the statement regarding the rising demand for financing of costly treatment. He asked, "How does that change my ability to go to a group and talk about diabetes, or heart disease, or smoking, or alcohol abuse, or mental illness, or any of the other concerns we have around the health care?" He explained that it is the financial obligation and financial diminishment addressed in the resolution that is causing his concern. Outlining all of the financial costs that the state is obligated to may lead to serious problems if this resolution is passed and then appropriations to address these problems are not passed. 3:53:55 PM REPRESENTATIVE CISSNA acknowledged that the last two paragraphs may have been sufficient for the resolution. However, she said that she felt that the enormity of the problem, and the possibility of a simple fix, is compelling to others. 3:55:14 PM REPRESENTATIVE NEUMAN expressed concerns similar to those of Representative Roses. He then recognized Representative Cissna for her work on health care issues over the years. He opined that several items in the resolution seem to be negative and there needs to be some balance. 3:56:38 PM KARLEEN JACKSON, Commissioner, Department of Health and Social Services, informed the committee that the concept of this resolution is important to the people of Alaska. She agreed with some of the reservations raised by Representatives Roses and Neuman and she noted that the resolution lacks a statement that good health is a common goal for all of the people of our state. Commissioner Jackson suggested that with a simple statement: "Whereas experts point to personal lifestyle choices as having a significant impact on a person's health" the resolution can avoid listing statistics. She agreed that there must be footnotes to support each statement and suggested keeping the statements on a broad, conceptual level. Commissioner Jackson repeated her support for promoting the health of Alaskans through talking about what each is doing to be healthy. 3:58:46 PM REPRESENTATIVE FAIRCLOUGH asked whether there has been time to organize events and declare 2008 a year of good health. She observed that this is polar year and next year Alaska will be celebrating its 50th birthday. She suggested that if the sponsors want to designate a year of health, events with municipalities, cities, and nonprofit partners may be needed to develop broad support for the resolution. She encouraged the sponsors to consider many options for activities and to allow time for planning statewide events. 4:01:25 PM REPRESENTATIVE CISSNA relayed her experience as an activist during the 60s and 70s, which was a time of minimal government [support] and grant opportunities. She pointed out that the resolution is an invitation given by the governor, without a fiscal note attached, or the complications that follow the costs of a big event. She cautioned that events require coordinators and expense. She expressed her belief that changing culture will not come from the state spending money, but from people willingly making a choice. 4:03:39 PM REPRESENTATIVE FAIRCLOUGH clarified that if a year is dedicated there should be some coordination; she was not suggesting requesting money or grants. More planning time may result in more interest and more participation by Alaskans. 4:04:42 PM REPRESENTATIVE CISSNA stated that this resolution does not have a specified date or time. The senate sponsor may have had a date in her statement but it does not appear in the resolution. 4:05:26 PM CHAIR WILSON referred to the governor's Health Care Strategies Council and asked Commissioner Jackson whether recommendations from that event will pertain to this resolution. COMMISSIONER JACKSON answered that the Health Care Strategies Council is charged with looking at plans that are available in the state and what can be recommended to the legislature for the short and long term that will balance quality, access, and cost of health care. She advised that this resolution could be passed without fanfare or a time line, as an encouraging statement; or it could be expanded to be part of the Health Care Strategies Council agenda to promote health for a year. 4:07:04 PM REPRESENTATIVE NEUMAN asked the commissioner to comment on whether this resolution could bring the state into a lawsuit to try and force increased funding of health and social services. COMMISSIONER JACKSON stated that she is not an attorney, but opined that unintended consequences can occur in a litigious environment. She recommended framing the resolution in a manner to prevent possible litigation. 4:08:00 PM REPRESENTATIVE ROSES expressed his agreement with the intent of the resolution: to encourage conversation. He re-stated his objection to the statistics presented in the "whereas" statements. He opined that using the statistics does not encourage conversation or create the health pact. Furthermore, if he supports the resolution, his constituents may question why there are not appropriations to do what is needed. The statistical references will not allow him to support the resolution as written. 4:11:10 PM REPRESENTATIVE SEATON agreed with Representative Roses and Representative Neuman on the wording of the legislation. Additionally, he encouraged further re-writing of the "resolved" and "further resolved" section. 4:12:42 PM CHAIR WILSON announced that the resolution would be held with the intent of improving the language. She encouraged committee members to contribute suggestions so SCR4 can be moved at a future meeting. 4:13:34 PM BONNIE MURPHY, Fitness Professional, said that, in her experience with mature women, speaking about their health in a positive way would be helpful. She said that she supports talking about preventive measures before one's health declines. 4:15:55 PM CHAIR WILSON closed public testimony. 4:16:08 PM REPRESENTATIVE ROSES asked where to send his suggestions for a committee substitute. CHAIR WILSON asked to have them come to her office as well as to the bill sponsors. 4:16:46 PM REPRESENTATIVE FAIRCLOUGH asked for copies of the changes to the language suggested by Commissioner Jackson, Representative Roses, and Representative Seaton. [SCR 4 was held over for further discussion]