HD58 - Report of the Joint Subcommittee on Studying Means of Reducing Preventable Death and Disability in the Commonwealth and Examining the Feasibility of Implementing a Comprehensive Prevention Plan in Virginia

  • Published: 1991
  • Author: Joint Subcommittee
  • Enabling Authority: House Joint Resolution 179 (Regular Session, 1990)

Executive Summary:
Authority and Study Objectives

Adopted by the 1990 Session of the General Assembly, House Joint Resolution No. 179 established a joint subcommittee to study means of reducing preventable death and disability and to examine the feasibility of implementing a comprehensive prevention plan in the Commonwealth. The Committee was directed to consider a number of specific issues regarding social and economic costs to the Commonwealth arising from preventable and premature deaths, disability, and lost productivity due to health risk behaviors. The Committee's work focused on specific state and national data reflecting the impact of certain lifestyle behaviors on health and longevity. In addition, the Committee explored the need for a comprehensive prevention plan as well as the roles of those state agencies charged with the development of a statewide prevention plan. The research and recommendations of state and federal agencies, the health care community, and the Virginia Council on Coordinating Prevention, as well as prevention alternatives implemented by sister states, also merited the Committee's attention.

A Renewed Commitment to Health Promotion and Disease Prevention

Background

The Development of health promotion and disease prevention initiatives has increased the average American life expectancy and has spawned a dramatic shift in the pattern of deadly and disabling diseases. Deaths due to acute infectious disease have dropped sharply, while deaths from chronic diseases, such as heart disease, cancer, and stroke, increased more than 250 percent between 1990 of 1970. Emerging in the medical community is the realization that premature deaths and disabilities from these diseases may be effectively reduced through health promotion and disease prevention.

Reinforced by changes in the overall health care environment, a renewed commitment to prevention seeks to address preventable loss in productivity, spiraling medical costs and insurance rates, and family tragedy. In the Commonwealth, it is estimated that at least 40 percent of lives lost to cardiovascular disease, cancer, liver disease, and automobile accidents in 1988 were directly attributable to unhealthy behaviors such as smoking, alcohol abuse, and lack of exercise. Addressing these lifestyles behaviors through prevention initiatives makes economic and "human" sense.

Federal Efforts and National Objectives

Federal health promotion and disease prevention efforts have become more prominent in recent years, arguably beginning with Surgeon General's 1964 report on smoking and health. A 1979 report on health promotion and disease prevention more clearly articulated the government's approach to prevention efforts and identified major behavioral risk factors contributing to premature mortality and morbidity. In 1980, an unprecedented 10-year health initiative was adopted by the U.S. Public Health Service as a framework for prevention programs. This initiative did not constitute a federal plan, but challenged both the public and private sectors to develop prevention efforts. The federal government has retained its commitment to developing viable health goals for the nation, having released in late 1990 its objectives for the year 2000. These new national objectives address health promotion, health protection, and preventive services, as well as health disparities among various population groups.

The Commonwealth's Prevention Efforts

The Commonwealth's initial response to the challenges contained in the 1990 national health objectives was characterized by increased efforts to study and explore the unique health needs of Virginians. Prevention issues have been the focus of numerous studies in the last decade, covering nutrition, injury prevention, AIDS, emergency medical services, and the needs of head and spinal cord injured persons. Leading Virginia's health promotion and disease prevention efforts, however, was the 1987 Governor's Task Force on Coordinating Preventive Health, Education and Social Programs, who recommendations ultimately led to the establishment of the Virginia Council on Coordinating Prevention. Although possessing no regulatory or enforcement authority, the Council is statutorily empowered to make recommendations to the Governor regarding policies, regulations, and funding that will further prevention initiatives.

Central to the Commonwealth's disease prevention and health promotion efforts is the Comprehensive Prevention Plan. Jointly developed biennially by a number of state agencies, the Plan is designed to coordinate state and private efforts to provide a broad prevention agenda for Virginia. The 1990-92 Plan includes nine positive "goal statements" for use by state agencies and the administration as a guide for budget and program planning. Although a seemingly ideal blend of agency cooperation, public and private sector collaboration, and legislative oversight, the Plan and the Council still need a clear mechanism for the implementation and funding of effective prevention measures in the Commonwealth. Conclusions and Recommendations

The Commonwealth's commitment to health promotion and disease prevention is evident in the plethora of programs offered at the state and local levels. Repeatedly the target of governmental study, prevention has been recognized by statute as a valuable tool in reducing unnecessary human suffering and avoiding needless expense. While progress has been made through a number of initiatives, such as school health education, independent living programs for youth and the elderly, community health coalitions, and worksite wellness programs, stable funding and program evaluation are necessary to ensure the continuation of the most effective initiatives. Increased focus on prevention and health promotion in the training of medical professionals, enhancement of data collection to reflect racial and ethnic subgroups, and exploration of insurance packages that incorporate health risk ratings have also been cited as measures warranting examination. The cost-effectiveness and proven success of current initiatives support the continued development, implementation, and evaluation of additional measures that will reduce premature and preventable death and disability.

The Committee makes the following recommendations:

Recommendation 1:
That patient and community health education be identified as a "core program" within the Department of Health.

Recommendation 2:
That the Department of Health give greater visibility and support to health promotion and chronic disease and injury prevention initiatives.

Recommendation 3:
That the Department of Health facilitate an in-depth evaluation of current health education demonstration projects to identify elements for successful implementation of health education and health promotion programs in those agencies receiving funding through the Office of Health Education and Information and that the Department seek additional funding for such evaluation through federal block grants.

Recommendation 4:
That the Department of Health develop a statewide health promotion initiative to target a major behavioral risk factor and that this proposed initiative be presented to the Council on Coordinating Prevention and the 1992 General Assembly.

Recommendation 5:
That local health districts be encouraged to form local health services advisory boards with broad representation to assist health districts in the development and implementation of community-based public health objectives and strategies.

Recommendation 6:
That community health education specialist positions be funded as full-time state employees within each local health district's budget and that these employees serve as members of local district management teams under the supervision of the local health director.

Recommendation 7:
That the Commission on Health Care for All Virginians include in its study an examination of health promotion efforts, particularly those at the worksite, and their overall effectiveness and utility as cost containment measures.

Recommendation 8:
That the Commonwealth establish a $900,000 small grants program, to be administered by the Department of Health, for application in every health district for the implementation of quality worksite health promotion programs.

Recommendation 9:
That the Department of Health establish a task force to develop a plan for the delivery of worksite health promotion information and services to small and large employers.

Recommendation 10:
That the Department of Personnel and Training undertake a demonstration project that evaluates the feasibility and potential cost benefits of providing risk-rated health insurance for all state employees and retirees.

Recommendation 11:
That the Department of Health (Bureau of Vital Statistics) coordinate with sister states to explore the efficacy of modifying current death certificate forms to require information on behavioral risk factor history.

Recommendation 12:
That the Department of Health study the feasibility of refining its analysis and collection of vital statistics data to include the more specific presentation of racial and ethnic data.

Recommendation 13:
That the Department of Health develop methods of securing and utilizing existing data sources, such as hospital, public care and emergency care discharge data, and other sources of health information as part of a pilot project morbidity index sampling system.

Recommendation 14:
That the Minority Health Advisory Committee develop long-range minority initiatives in state health and human services and that the Department of Health continue its efforts to provide necessary staff support to assist the Advisory Committee.

Recommendation 15:
That the Department of Education study current school health education programs, including present curricula requirements and instructor qualifications and training, and the efficacy and appropriateness of adopting a comprehensive approach to school health education.

Recommendation 16:
That incentives be developed to encourage the Commonwealth's medical schools to increase emphasis on primary care, health promotion, and disease prevention in the curriculum and training requirements for health care professionals.

Recommendation 17:
That additional funding be provided to ensure the ongoing focus and coordination of injury prevention within the Department of Health.

Recommendation 18:
That the Code of Virginia be revised to make seat belt non-use a violation reportable to the Division of Motor Vehicles for the assignment of demerit points and that the traffic violation form be amended to require information on seat belt use.

Recommendation 19:
That the Department of Public Safety increase its public education effort regarding injury and accident prevention, including seat belt and child safety seat use.

Recommendation 20:
That the Board of Housing and Community Development review current injury prevention initiatives in the Uniform Statewide Building Code and consider specific revisions to incorporate anti-scald requirements for new construction and renovation, stricter safety standards for steps, stairs, curbs, railings, and flooring, and requirements for fencing around residential pools.

Recommendation 21:
That data collection for the compilation of injury statistics and description of injury events reflect the preventability of these occurrences and that "injuries" includes accidental as well intentional injuries.

Recommendation 22:
That the joint subcommittee be continued for one additional year to continue its examination of health promotion and disease prevention and to incorporate in its study emphasis on the Comprehensive Prevention Plan and initiatives addressing social services, independent living, and other related concerns.