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.