February 13, 2019 02:46 pm Sheri Porter Washington, D.C. – The National Rural Health Association recently held its annual Rural Health Policy Institute here, a three-day event that included the opportunity for attendees to attend congressional meetings on Capitol Hill on Feb. 6 and to partake in a Rural Health Disparities Summit co-hosted by the AAFP on Feb. 7, the final day.
However, on the meeting's opening day, some of the most powerful messages came from U.S. Surgeon General Jerome Adams, M.D. He told a room packed with physicians and rural health policy advocates that he was pleased to assume the title of "the nation's doctor," and to advance the health of the American people.
"I'm honored to be in that role … and I know the plight of many of the constituents you all fight for," said Adams, who said he grew up on an old tobacco farm in rural southern Maryland -- both poor and a minority.
An anesthesiologist by training, Adams noted that he began to understand the plight of both patients and providers during his stint as Indiana's state health commissioner from 2014 to 2017.
U.S Surgeon General Jerome Adams, M.D., tells his audience at the Rural Health Policy Institute that the opioid epidemic is personal for him. "My brother Philip suffered from untreated mental illness and unfortunately turned to drugs to self-medicate. My baby brother is currently serving a 10-year prison sentence for crimes he committed to support addiction."
Adams laid out his three main areas of focus as surgeon general: addressing substance misuse and the opioid epidemic; improving the health of communities by making the connection between investments in health and resulting economic prosperity; and raising awareness of the link between the nation's health and national security.
Regarding the latter, he said, "70 percent of our young people are ineligible for military service right now because they can't meet the educational requirements, can't pass the physical or can't pass the background check. … Our patients' poor health is a direct threat to our national security."
As surgeon general, Adams' guiding principle is "better health for better partnerships," especially when solutions are complex and controversial. He pointed to the weighty issue of Medicaid expansion.
"It's not my job to determine whether or not your state expands or doesn't; it is my job to make sure that all states understand the array of tools that are available and that we continue to push to evaluate how these are playing out in different states so folks can make evidence-based decisions about what is best for their communities," said Adams.
When it comes to forging partnerships, Adams recounted his experience as state health commissioner overseeing the response to the largest HIV outbreak related to injection drug use in the history of the United States -- in Scott County, Ind.
This was a small, close-knit community with modest homes, several manufacturing plants and a handful of downtown restaurants within an hour of downtown Louisville, Ky., he said.
"It fell on hard times -- lost some businesses, some jobs, property value dropped, people vacated the community and young people would just say, 'My only goal is to get out of here.' A lot of the talent left, the streets became littered with trash, and vacant properties grew," said Adams.
To curb the opioid epidemic that was plaguing Scott County, Adams had to form strategic partnerships with local stakeholders. He also called the CDC, the local hospital and the Indiana University School of Medicine, but they weren't at the top of his list.
"The first person I talked to was the local sheriff," said Adams. "The second person I talked to was the local faith-based leader, and the third person I talked to to solve this rural health crisis was (with) the local chamber of commerce."
The sheriff was worried about his officers getting stuck by syringes' needles, said Adams. "So I shared with him how syringe-service programs actually lower needle-stick injuries by 60 percent.
"I learned that faith-based leaders were worried about enabling drug use. So we shared with them that syringe-service programs done right actually connect people to care and are a pathway to recovery."
All the partners Adams pulled together helped determine an evidence-based approach that addressed everyone's concerns and gave the community a solution to overcome the HIV outbreak.
"I'm proud to say that we went from 200 cases to just five new cases last year. It was nothing short of miraculous," said Adams.
Health disparities is another hot button issue for this surgeon general -- who noted that just 20 percent of health is influenced by health care, and the other 80 percent by behavior.
"The fact is, we're not going to realize our goal of healthier communities until we recognize and partner to address the determinants that impact that 80 percent in addition to that 20 percent," Adams said. And a couple of factors that help give people the opportunity to make healthier choices are housing and education.
"I was talking to the kids in Scott County, and you know, the one thing that gave them hope was the chance that they would be able to go to college. As surgeon general, nothing I said about health meant as much to them as me saying, 'If you all need a recommendation for college, call me up and I'll be glad to write it.'"
Jobs are also a determinant of health. "Increasingly, hospitals, health care providers and health care institutions -- as well as mayors and businesses -- are beginning to recognize the value of investing in environment and community, and how that investment is driving not just health metrics, but economic prosperity.
"This is extremely important in rural communities where large businesses and anchor institutions often employ a majority of workers in those communities," said Adams.
He said when he speaks before legislative bodies, he often takes hospital CEOs with him, but not to talk about health care. "I want them to come forward and say, 'I employ 30 percent of the people in your community. I represent jobs.' Because far too often, business is pitted against health."
Adams said that by investing in community health and those upstream determinants of health, "we can improve the health of populations, bring our unsustainable health care costs under control and better ensure a more prosperous future for our businesses, communities, workers and for all Americans."
To that end, he told audience members that his office was working with the CDC to write a surgeon general's report on community health and economic prosperity.
He pointed out that too often, "we pat ourselves on the back for improving our health statistics but ignore the fact that our disparities are widening," especially in rural communities.
The urban centers get the bulk of resources because they have the population base. "The resources go the places that already have them," said Adams. "I want to speak not just to the coastlines, but to the heart and the center of our great nation."
Adams challenged those in the audience to make sure they have the right players on their team and to bring nontraditional partners and policymakers into their huddle.
"Better yet, go to their huddle. Fit into their team meetings and figure out what they're prioritizing."
Adams threw out the term "servant leadership" and then defined it.
"It means you succeed when others succeed. When you meet their needs, then they succeed, and their success becomes your success."
Adams continued. "There's this saying, 'People need to know that you care before they care that you know.' That's what I discovered in Scott County and what led to the success we've had there."
In closing, Adams urged those before him to be game changers and disrupters.
"Continue to share best practices, and know that you have no bigger advocate out there than the United States surgeon general. I will fight for you as long as I'm in this role."
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