Remarks to the Annual Meeting of the National Association of County and City Health Officials

---

by HRSA Administrator Mary K. Wakefield

July 31, 2009
Orlando, Fla.

---

Thank you, Bruce  ( Dr. Bruce Dart, NACCHO President), for that introduction.

NACCHO is an organization I've had the pleasure of working with off and on for a number of years, and so it's wonderful to be here with you today.

Let me begin by introducing a couple of my HRSA colleagues who are here as speakers. I hope I can get them to stand and wave. Feel free to introduce yourselves to them later and consider attending their presentations. We have:

• Joan Weiss, director of the Division of Diversity and Interdisciplinary Education in our Bureau of Health Professions; and
• Amanda Reyes, who works on policy in our Bureau of Primary Health Care.

We also have an exhibit on site from our National Vaccine Injury Compensation Program. I hope you'll swing by that, too.

At HRSA, we see NACCHO as an extremely important partner and grantee. We count on your members to let us know what's going on in the field. We appreciate hearing from NACCHO as you frame issues for us and offer solutions. And to accomplish some of HRSA's work, we often rely on local health departments to provide services that we fund.

Like you, HRSA is “committed to building a 21st century U.S. health system that results in optimal health for all,” with a priority on prevention.

Like you, we want a system that provides “access to health care for every person,” and like you, we are working to establish measurable outcomes capable of showing taxpayers the importance and value of our work.

In spite of our shared focus, my guess is that you are perhaps much more familiar with CDC than with HRSA, so I appreciate the opportunity to be here and share some of what we do that is relevant to your work.

HRSA's support for activities carried out by local public health departments often is channeled indirectly to you through state and local executives. That tends to obscure the mission and goals we share. Because of that, my providing a brief overview of HRSA can help you see how often we, in fact, work together, and facilitate your helping us to leverage these efforts even more.

HRSA's key programs touch on the issues that concern you as county and city public health officials: access to quality care and improving the public's health:

• For example, our 1,100 health center grantees provide quality primary care to about 17 million medically underserved people at some 7,500 care delivery sites throughout the country. Several dozen local health departments are health center grantees.
• Our Ryan White grantees provide some of the best care for people living with HIV/AIDS that can be found anywhere -- a model, really, for HIV/AIDS care worldwide. HRSA directly funds 58 local or state health departments through Ryan White community-based programs. Local health departments also receive Ryan White funds from our city and state grantees to provide clinical care and case management.
• Our experts in HRSA's Maternal and Child Health Bureau lead the Federal government's efforts to fight infant mortality and improve the health of mothers and their children. A large part of the $660 million that we send to states each year through our MCH Block Grant program is eventually spent by local health departments in sites you run.
• Our health professions staff helps train and place health care professionals where they're needed most. I know that one of our programs, the Public Health Training Centers Program, trains a large number of staff at public health departments across the country. It's a great program because it looks at the training public health departments need and provides it in an accessible manner, with a lot of training available online. I was fortunate to meet with and speak to representatives from the 14 centers we support when they visited HRSA last month.
• And our rural health policy office provides community-based grants as well as financial and technical support to keep struggling rural hospitals open and strengthen the quality of care they provide. Local Health Departments are the lead entities in 26 of our current Rural Health Outreach and Network grants and a key part of the consortium in a quarter of our 300 community-based rural grants.
• In addition, many local health departments buy discounted pharmaceuticals through the 340B Drug Pricing Program, which HRSA administers through our Office of Pharmacy Affairs.

For 24 million people across the nation, HRSA's programs – and the services that many of you deliver on our behalf – are lifelines. We're the only federal agency that does what we do, on the scale that we do it.

We also have a range of other programs and initiatives – from Poison Control Centers, to Organ Procurement and Donation, to our exhibitors here, the National Vaccine Injury Compensation Program.

But for now, that's a quick summary of what we do. And because President Barack Obama signed the American Recovery and Reinvestment Act in mid-February, just a month after taking office, we're doing more of it than ever before. Let me take a minute to tell you what HRSA is doing.

The Recovery Act invested an additional $2.5 billion in HRSA's health center and workforce programs. That's a substantial boost to an agency with a $7 billion annual budget. It's the most decisive support for primary health care and workforce training in recent years, and it illustrates the depth of the President's commitment to our mission.

More than any executive before him, President Obama realizes the core role HRSA plays in delivering health care, especially to rural and underserved communities, and he has given us a great deal more responsibility.

Of that $2.5 billion total, $2 billion is targeted to health centers to expand services and operating hours, pay for capital improvements, and buy new equipment – including health information technology. Already we've awarded about three-quarters of the Recovery money to our health center grantees.

• At the end of June, First Lady Michelle Obama visited a health center to announce more than $850 million of the $2 billion in Recovery Act grants for health centers. Those funds will help health centers around the country buy and implement health information technology and make long-overdue capital improvements. That announcement followed the releases in March of $155 million to build 126 new health centers and $338 million to expand services and operations at existing centers.

The remaining $500 million in Recovery Act funds will be invested in workforce development, because the President understands that we need more health care professionals if we're going to provide more health care:

• $300 million of those funds will go to the National Health Service Corps, which places doctors, dentists, advanced-practice nurses and other professionals into our neediest communities in exchange for paying down their student debts. Dozens of NHSC clinicians currently work in sites run by local health departments, and the Recovery funds will support the hiring of 3,000 or more new clinicians. That virtually doubles our current field staff of 3,800! If your health department operates a primary care clinic and you need more staff, I invite you to visit the NHSC Web site at nhsc.hrsa.gov to find out if your clinic is an approved site. But don't delay: the opportunity to add talented health professionals to your team is remarkable, but the timeframe to access this resource is limited.

Earlier this week, I participated in an event with HHS Secretary Kathleen Sebelius to announce how we plan to spend the other $200 million dedicated to our health professions programs.

• The bulk of the money will go to scholarships, loans and loan repayments to students, health professionals and faculty, and to primary care training programs. But we will use $10.5 million to strengthen the public health workforce by supporting more public health traineeships and by training more individuals through preventive medicine and dental public health residencies.

In addition, support for health information technology is a big element of the Recovery Act. HRSA's Office of Health Information Technology received $125 million under ARRA. Discussions on how to use those funds continue, and we expect to announce our plans in the not-too-distant future.

And at the HHS level, the Office of the National Coordinator for Health Information Technology was allotted $2 billion to invest in electronic health records and other HIT efforts. Plans to invest those funds have not been announced, but we are working closely with the National Coordinator to make sure the interests of HRSA grantees and other safety-net agencies are included in the final product.

You may have heard HRSA called the “Access Agency” over the years and, certainly, providing care for medically underserved people is a large part of what we do. But it's only part of it.

After all, our health centers don't just provide clinical care, they also counsel patients on the steps they and other members of the community need to take to promote better health and prevent disease. These types of public health messages are also found in our HIV/AIDS and rural programs as well.

And, of course, our Maternal and Child Health Bureau has been a public health champion for almost a century. The contributions of the Bureau's pediatricians, epidemiologists and researchers to U.S. public health are legendary.

Few pieces of U.S. legislation match the work of Title V, which has helped instruct generations of Americans on issues like basic monitoring of a child's health, proper nutrition during pregnancy, prevention of childhood injuries, and strategies to avoid sudden infant death. These messages contain the life-giving essence of public health.

Since arriving at HRSA in mid-March, it has been a priority aim of mine to re-energize HRSA's public health and safety activities by hiring a public health expert as my advisor. That person will sit in the Office of the Administrator and will report directly to me. The individual in this new position will review all our programs and policies, and see what – from a public health perspective – needs to be dusted off and polished or rebuilt from the ground up.

I also plan to put this person in charge of making sure HRSA's 10 regional offices work more closely with state and local health departments to promote disease prevention and healthier living activities.

You may find yourselves coordinating activities with this new advisor, whom I hope to bring on board very soon. And as we restructure our field offices over the next few months, I recommend that you reach out to HRSA officials in those offices. They'll be reaching out to many of you.

My point: I want to make sure that people again think of HRSA as an agency that has much to offer in furthering both primary care and dimensions of public health.

Specific to maternal and child health issues, HRSA has been proud to work with NACCHO over the past few years to support efforts by local health departments to improve the health of women, children and families in their communities.

HRSA's five-year, $1 million grant to support your Maternal and Child Health Project has done a fine job promoting greater awareness and knowledge of MCH issues among local health officials. Employees from our two organizations have worked together to draft policy statements on MCH issues and identify funding resources that health departments can access to support their MCH-related programs.

I'm especially impressed by NACCHO's Rural Preconception Care Initiative, supported by the HRSA grant, which seeks to build capacity on women's health issues in three rural health departments in North Carolina, Washington state and Connecticut and improve pregnancy outcomes for women who live there.

As a nurse, I know the preconception window is a great time for health departments to educate their clients about things like:

• tobacco and substance use;
• domestic violence;
• STDs and HIV; and
• exercise and proper nutrition.

So that's been a very positive partnership between us.

Now I'd like to invite NACCHO and local health departments to join with HRSA once again to promote healthier mothers and healthy births.

Next week I'll be kicking off what we're calling the “Interconception Care Learning Community,” which will be set up in each of 100 communities where HRSA funds a Healthy Start grant. Healthy Start projects combat disturbingly high infant mortality rates in struggling communities across the country.

The aim of the new initiative will be to improve the health of high-risk women during their interconception period, the time between the end of one pregnancy and the beginning of the next one. It's a time when the mother should make sure she is healthy before becoming pregnant again. It's a time to modify risks such as disease, harmful health behaviors, and environmental hazards that can harm women and their infants.

The initiative will sign up local teams of clinicians, public health professionals and community leaders in sessions designed to promote peer-to-peer learning and inter-team exchange. An Expert Work Group will improve grantees' current systems by implementing evidence-based practices and innovative, community-driven interventions.

We'll launch the Learning Community for a three-year term next week in Washington. I'm sure the teams will greatly benefit from the special expertise that local health departments bring to the table; please contact our Maternal and Child Health Bureau if you're interested.

Let me conclude by saying that I'm very hopeful and optimistic about the future, even with current events as unsettled as they are now.

After all, look for a moment at the progress in health and well-being that has occurred since President Obama took office:

• On Feb. 4, just two weeks into his term, the President proclaimed a “new day” in America when he reauthorized the Children's Health Insurance Program to expand health care coverage for children from low-income families by 4 million to 11 million children.
• Earlier this month, Secretary Sebelius announced the availability of up to $40 million in grants to help reach families whose children qualify for, but are not yet enrolled in, CHIP and state Medicaid programs. She encouraged community organizations and state and local governments, like those you serve, to apply.
• And in May, by setting new mileage standards for future automobiles, President Obama did more than any of his predecessors to fight global warming and limit America's dependence on foreign oil sources. By cutting auto emissions, the President will reduce the incidence of asthma, lung disease and cancer. That should prove to be a remarkable public health triumph. I tell you: It's a new day.

These are great strides of progress for the health of the nation. But they are only the first steps in a strenuous journey. We are, all of us, in the midst of one of the most decisive periods in our recent history. Congress is deep into debates over health care reform, and we hope lawmakers will send reform legislation to President Obama for his signature later this year.

Reforming health care is overdue. It has been delayed for too long, and it can wait no longer. The status quo is unsustainable for American families and businesses.

• More and more Americans are denied affordable health care coverage because of pre-existing conditions.
• More and more Americans face soaring co-pays and deductibles that take a bigger bite out of family budgets as insurance covers less.
• And more and more Americans can't afford coverage at all because they or their employers can't meet the cost of crushing health care premiums.

Unless we act now, these problems will only get worse, and each year millions more Americans will find themselves unable to get the health care they need.

President Obama knows that Americans value their relationship with their doctor and the care they receive. But as costs rise and insurance benefits erode, people are asking for reform that protects what works and fixes what's broken.

That's why the President is asking Congress for reform legislation that will:

• Reduce costs to make health care affordable;
• Protect a patient's choice of doctor and insurance plan; and
• Assure quality affordable health care for all Americans.

Today, the call for reform is coming from the bottom up and from all across the spectrum – from nurses, doctors, and patients; unions and businesses; hospitals, health care providers, and community groups; mayors, governors, and legislatures; and Democrats and Republicans.

Working together with the President and members of Congress, these groups have begun to take historic steps to ensure that reform will rein in health care costs for families, businesses and the government. We're closer to comprehensive health insurance reform than we've ever been.

You hear in the news about the different approaches to reform, but in reality many areas of agreement already exist. Most of the plans being debated have a great deal in common:

• They guarantee the availability of quality affordable health care so you don't have to worry about being denied coverage if you have a pre-existing condition, if you're sick, or if you lose or switch your job.
• They emphasize prevention and wellness so that Americans will be healthier and health care costs can be reduced.
• For people who can't afford insurance, they offer help paying their premiums, based on their ability to pay.
• They give people an opportunity to compare health plans and shop for the best price and plan that suits their needs.
• And each and every bill keeps faith with the fundamental principle that the President laid out for reform: “If you like what you have, you can keep it. Nothing in any bill will take this choice away from Americans.”

Working together, our goal is to enact health care reform by the end of this year.

I can't leave without saluting one of your Model Practice award winners:

• The Grand Forks City County Public Health Department from my home state of North Dakota, with a special shout out to one of their team members and my best friend back home, Twyla Streibel! Congratulations to all of you on this award, and for creating a strategy to make sure refugee children in the area get all their vaccinations.

And in the interests of being a good visitor, I should also congratulate the Orange County Health Department from right here in Orlando for winning two Model Practice Awards! They were honored for a project to promote healthy weight among post-partum women and another to improve prenatal care and life skills among expectant mothers.

To them and to all the other award winners, well done.

Let me close by emphasizing what I said in my opening comments: We see NACCHO and local health departments as important partners in our work.

We share your goals, and we want to strengthen the ties that unite us as we go forward.

We appreciate your expertise and your vantage point. You work on the streets and sidewalks of communities across America. We're in a big building on the outskirts of Washington, removed from the reality that all of you face every day.

So please let us know how we can help you do your jobs better, and let us know what we can do to better target our resources to assist you.

We are refining the role of our staff in the 10 regions across the country, and my hope is that their work will be increasingly intertwined with yours as the weeks pass.

I thank you for being here with me today, and for giving me this opportunity to speak with you.

Thank you.