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Remarks on Advancing Health Practice through Science

ADM Brett P. Giroir, M.D.
American Public Health Association 2019 Annual Meeting & Expo
November 4, 2019
Philadelphia, PA

I am here with you, because like you, I can no longer accept a health care system that costs too much, and delivers too little.

As Prepared for Delivery

Thank you and good afternoon.  I am so pleased to welcome you to this afternoon’s General Session, Advancing Health Practice through Science.

I am here with you, because like you, I can no longer accept a health care system that costs too much, and delivers too little. 

For $3.6 trillion dollars - nearly 18% of our GNP, we deserve more than a life expectancy that ranks 28th, an infant mortality that ranks 32nd, a suicide rate that ranks 33rd, and health disparities that have had near zero improvement in the last 25 years.

So for the past 20 months that I have had the privilege to serve as the Assistant Secretary for Health, my office has been driven, and maybe a little obsessed, with how we can lead America to healthier lives – and the main way that we will achieve this goal is by focusing our guidance, policies, training, grants, contracts, and reimbursement reform on transforming the current sick care system into a health promoting system that provides every individual a fair and realistic opportunity to optimize their health.

One way my office will accomplish this is by creating an evidence-based roadmap for our nation’s health.   Some key examples are:

  • The Physical Activity Guidelines for Americans, which we released one year ago.   Just by improved adherence to these simple guidelines, we can immediately reduce avoidable mortality by at least 10%.
  • Other examples are Healthy People 2030, currently in draft, to be followed by the development of our nation’s leading health indicators
  • The Dietary Guidelines for America, to be completed with USDA in 2020
  • The National Vaccine Plan, The National Strategy for Viral Hepatitis, The National HIV/AIDS Strategy, and
  • For the first time, a Federal Action Plan for Sexually Transmitted Infections.

But a roadmap is itself insufficient, unless we actually begin walking down the road – together - to our destination.

My office is not afraid to take baby steps, when appropriate, like piloting programs nationwide to increase youth participation in team sports, or enabling SUD screening and PrEP counseling within our Title X programs.

Or sometimes we take larger steps, like implementing a plan to increase HPV vaccination to at least 80% nationwide. Or to incentivize quality care for the 100,000 people living with sickle cell disease in our country, and the hundreds of thousands of children who die of this disease every year in Sub Saharan Africa – unscreened, uncared for, and suffering for the want of a few simple interventions.

But sometimes we take historic steps, like leading the development and implementation of the initiative to End the HIV Epidemic in America, announced by President Trump in the State of the Union– and now underway in a community near you.

Or the whole of government approach to reverse the modern plague of drug overdose deaths; Our evidence-based, public health approach to this complex challenge has resulted in the first decrease in year-to-year overdose deaths in nearly 3 decades – but we still have a very long way to go.

So really, what is different now?  What will make these initiatives stick?

It is pretty clear.  All of us know prevention works, but the system – the $3.6 trillion dollar system - has been designed to reward sick care, procedures, stuff you do to people once they are sick or disabled.  

That is why Secretary Azar and all of HHS is committed to changing this sick care system into a value-based system that

  • First, pays for good outcomes, however they are achieved, including impacting the social determinants; and
  • Second, a system that prevents disease before it occurs.

If we are successful, incentives will finally be aligned with the public health and prevention strategies all of us champion.

Value-based transformation is no longer theoretical, it is being implemented through our primary care initiative, which will impact over 10 million Medicare FFS patients and a majority of dual eligible patients.

It is also being implemented through our highly innovative KIDNEY CARE initiative which completely realigns incentives toward prevention of chronic renal failure, and early transplantation when renal failure is inevitable.

As I conclude, I would like to offer a most sincere thanks to Dr. Georges Benjamin and the entire APHA Executive Board for inviting me; and for their continued communication and recommendations about what we can do better, together.

And finally, I want to thank each of you for your commitment to advancing public health in our nation and around the world.

Thank you, and have a great evening.

Content created by Speechwriting and Editorial Division 
Content last reviewed on November 5, 2019