SECRETARY OF HEALTH AND HUMAN SERVICES KATHLEEN SEBELIUS SPEAKS ON ERADICATING POLIO WORLDWIDE

SEC. OF HHS KATHLEEN SEBELIUS

FROM: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
The Legacy of a Polio-Free World

September 27, 2012
New York, NY
Thank you, Senator Wirth. Excellencies and distinguished guests, on behalf of President Obama and the American people, I want to begin by saying how proud we are to be part of the international effort to eradicate polio.

When I was born, polio was still a feared disease in the United States. It was still common to see Americans stricken with the disease on crutches and in wheelchairs. In 1952, when I was four, our country suffered its worst outbreak yet. More than 21,000 people were paralyzed and 3,000 died, most of them children.

Three years later, the Salk vaccine was introduced. And over the course of the next decades, I got to witness a modern miracle: a disease that once struck fear into the heart of every American parent disappearing completely.

This January, I was fortunate to be in New Delhi as we marked the latest milestone in the world’s effort to eradicate the disease: a full year since India’s last case of polio. A decade ago, India accounted for 85 percent of new polio cases worldwide. Today, India is the latest proof that when a country makes polio eradication a social movement and creates an inescapable accountability process, we can eliminate polio anywhere.

I want to commend the governments of Pakistan, Afghanistan, and Nigeria for establishing their own emergency action plans. And I want to reiterate the United States’ continuing support for global eradication. We must get over the finish line. And that means strengthening systems down to the most remote village so that every child benefits from the protection vaccines can offer.

Over the last 20 years, the US has invested more than $2.1 billion in polio eradication, in partnership with WHO, UNICEF, Rotary International, additional donor nations, affected countries, and the Gates Foundation.

But if we are going to wipe out polio once and for all, now is the time to redouble our efforts. As long as the polio virus survives, there is risk of resurgence. And the longer we take to eradicate the disease, the longer we will have to wait to free up resources that can be devoted to other urgent health needs.

That’s why the United States has significantly increased our financial support for polio eradication over the last four years. And it’s why in December, we committed our full scientific capabilities to the effort as well, activating the CDC’s Emergency Operations Center, which allows for better coordination in our international efforts.

Now, we need all donors and partners to do their part, with affected countries in the lead. A future in which polio is a childhood memory for the people of every country is within reach. But we will only get there if each of us fully commits to the final push.

Thank you.

NEW HEALTH CARE LAW IMPLEMENTATION MOVES FORWARD

Photo:  President Obama Signs Affordable Care Act Into Law.  Credit: White House. 
FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICE
The Administration makes resources available to help states implement Affordable Insurance Exchanges.
Health and Human Services Secretary Kathleen Sebelius announced today a new funding opportunity to help states continue their work to implement the health care law -- the Affordable Care Act.  When the law is fully implemented in 2014, the affordable insurance exchanges will provide people and small businesses with one-stop shops to find, compare and purchase affordable, high-quality health insurance.  Today’s announcement makes more funding available to build all models of affordable insurance exchanges available to states. HHS also issued further guidance today to help states understand the full scope of activities that can be funded under the available grant funding as they work to build exchanges.

“The federal government and our state partners are moving forward to implement the health care law,” Secretary Sebelius said.  “This new funding opportunity will give states the resources they need to establish affordable insurance exchanges and ensure Americans are no longer on their own when shopping for insurance.”

The funding opportunity announced today will provide states with 10 additional opportunities to apply for funding to establish a state-based exchange, state partnership exchange, or to prepare state systems for a federally facilitated exchange.  To date, 34 states and the District of Columbia have received approximately $850 million in Exchange Establishment Level One and Level Two cooperative agreements to fund their progress toward building exchanges.

Under the new announcement, states can apply for exchange establishment cooperative agreements through the end of 2014. These funds are available for states to use beyond 2014 as they continue to work on their exchanges. This ensures that states have the support and time necessary to build the best exchange for their residents.

The guidance HHS issued today provides information on the exchange-building activities that states can fund with establishment cooperative agreements.
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HHS will conduct regional implementation forums in coming months to assist states and stakeholders on the work to be done in building exchanges, and to address their questions.  HHS will also engage with tribes, tribal governments, and tribal organizations on how exchanges can serve their populations.

For more information on exchanges, including fact sheets, visithttp://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html

MAKING PREVENTION WORK IN HEALTHCARE

Photo:  Secretary of HHS Kathleen Sebelius
FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Moving Academic Medicine Forward
June 11, 2012
Baltimore, MD
Johns Hopkins is a terrific place to be talking about the future of medicine.
More than 100 years ago, when Abraham Flexner had to decide which institution to use as his model of medical education, there was little question which it would be. The influence of Johns Hopkins, he wrote, can hardly be overstated. And a century later his words seem truer than ever.

Hopkins has been a leader time and time again: the first major medical school to admit women; the first to use rubber gloves during surgery; the first to develop renal dialysis and CPR. Hopkins helped develop new specialties from neurosurgery and urology to endocrinology and pediatrics.

More recently Hopkins scientists have made discoveries at the foundation of genetic engineering, neurotransmitter pathways, and that most cutting-edge medical technology of all, the checklist.

The last 15 years have been shaped by Dean Miller who came to Johns Hopkins with one of the hardest jobs possible. He was asked to take one of the most renowned medical schools and hospital systems in the world, and make it even better. But that’s exactly what he did.

So Dean Miller, let me add my congratulations to those you’ve received today.
But even here at Johns Hopkins, we must also acknowledge how far we still have to go.
Over the last couple decades there has been a growing consensus about where we need to move our health care system: toward a focus on prevention and maintaining health, a greater emphasis on primary care, more coordination between providers, greater value for dollars spent, and better use of evidence, leading to continuous improvement.

We’re moving in that direction. But I think it’s clear that we’re not moving fast enough. Though we’ve been talking about these reforms for decades in some cases, our health care system is still marked by uneven quality, unequal access, and runaway costs that put care out of reach for far too many families.

And yet, as I speak to you today, I’m very optimistic.
Over the last few years, we’ve seen a number of powerful trends converge: The rapid adoption of electronic health records, a growing public awareness about the importance of prevention, a new eagerness and willingness among providers to embrace change, and the Affordable Care Act – the most important health legislation in over 40 years.

The combination of these trends has created a unique opportunity for progress in health care.  And no one is better positioned to take advantage of that opportunity than Johns Hopkins and America’s teaching hospitals.
Today I want to talk about a few key areas where I believe we have the greatest potential for progress.

The first area is making prevention a priority. There is a growing body of evidence that people’s behaviors outside the health care system – what we eat, how much we exercise, whether we smoke or not – affect our health even more than the treatments and medicines we get when we visit a doctor.
For doctors, this meant experiences like designing the perfect regimen for your patient with diabetes, only to see them go home to a neighborhood where the lack of healthy food options meant their chances of sticking to that diet were almost zero.

So over the last three years, this Administration launched what is probably the most ambitious effort in our country’s history to help people make healthy choices: funding innovative local programs for reducing chronic disease; new laws to make sure kids get healthy school lunches; and historic legislation to make it harder for tobacco companies to market their products to kids -- since we know that every day, 3,800 young people smoke their first cigarette.

We’re also making it easier for doctors to promote good health in their practices.
A key benefit of the health care law is that recommended preventive services like cancer screenings and wellness visits are now available for Medicare beneficiaries and many other Americans at no additional cost.  So doctors no longer have to worry about those patients skipping their mammograms and checkups because they can’t afford the co-pay or deductible.

But prevention only works if leading institutions like Johns Hopkins make it a priority.
That starts in your clinical work where you can give your patients the tools to live healthy lives. Getting a teenager the support he needs to quit smoking may be more important than any test or exam you might provide. And helping a young parent identify asthma triggers in her home may determine whether or not her child truly thrives.

You have a unique role in your patients’ lives, and a powerful opportunity to affect their health well after they leave your offices.

But we also need better research about which community-based prevention programs work and which don’t – especially in areas where we’ve only just gotten started, like childhood obesity. We’ve seen the positive impact of programs like building safe routes to school and smoke-free public housing. But now we need to measure and study their results -- because we know that by honing and improving these interventions, we can reach more people in more communities more effectively.

Another area we’re focusing on is primary care which is fundamental to helping people stay healthy. Yet we face a dire shortage of providers across the country today. As chronic diseases continue to rise and our population continues to age, the need for primary care providers will only grow.

In the Obama Administration, we’re doing our part by increasing reimbursement rates for primary care.  And we’ve added thousands of slots to the National Health Service Corps.  If you go and practice primary care in an underserved community, we’ll help you repay your loans – a win/win.

But we also need academic medicine to further explore the importance of primary care in your research and underscore it in your training. Far too often, especially at our leading teaching hospitals, primary care has been treated like it was less challenging, less important, and a less worthy use of a physician’s skills. We need to change these attitudes, and that starts with our medical schools.

But ultimately, the choice belongs to the next generation of doctors. So, to the medical students here today, I ask you, directly, to consider becoming a primary care physician. If you want to help lead the biggest transformation of medicine in decades, there’s no better place to be.
That brings me to a third area where academic medicine can continue to lead. That is in moving our system toward care coordination.

Thanks to the medical breakthroughs of the last 50 years, millions of Americans today are living with chronic conditions that would have killed them 50 years ago.  It’s good news that we’re living longer.  But it also means we have a new group of patients who often suffer from multiple, chronic conditions.

You may see a patient with congestive heart failure.  But she also has chronic asthma, uncontrolled diabetes, and is a smoker. As she sees more and more individual doctors, the chances that something may fall through the cracks increase. And then, so do the costs of her care.

But we know that doing something right often costs less than doing it wrong. And under the health care law we’re changing the way we pay for care -- to get high value for the dollars we spend.

We’re supporting models like Accountable Care Organizations that will get paid for keeping their patients healthy and not just how many tests and procedures they do. Many of them are led by teaching hospitals, and we need you there going forward on the frontlines of our work to deliver higher value care.

But if we are going to make coordinated care the rule and not the exception, we also need to make sure it’s at the heart of our medical school curricula. There was a time when it was good enough just to train the best specialist in every field. But today, no one person alone can keep their patient healthy. It requires primary care doctors and specialists, but also nurses, community health workers, and substance abuse counselors.

And this multidisciplinary, team-based care, must be part and parcel of training the next generation of physicians. It’s why the surgeon and author Atul Gawande likes to say: today, we need pit crews, not cowboys.

These are three areas where Johns Hopkins can lead the way.  But I also want you to think beyond your own patients, your own students, and your own research grants.    

One of the most important breakthroughs in medicine over the last 10 years was the surgical checklist developed right here at Hopkins. When ICU doctors and nurses implemented the checklist, you saw a real difference.

But what really made the checklist so powerful was when other leaders and other institutions took it up. Michigan hospitals gave it a try and ended up saving 1,500 lives and reduced health care costs by $200 million in just 18 months. Now, hospitals everywhere have embraced it.

So this is the final place I’d like to ask you to step forward. Beyond the three pillars of research, education, and patient care at the heart of academic medicine, we need you to take on another mission. We need you to serve as a model for the future of health care.

Change is hard. People often see the initial advantage of trying something new. But then there are costs and risks involved, and after a few bumps in the road, the temptation is to stick with what you know – even if it’s not working well.

But change becomes easier, if someone creates a path for you to follow. Institutions like Johns Hopkins have always been models for the rest of the nation. But that has been about more than just new facilities or the latest ranking in a particular publication.

It’s also means pushing this country forward, even from the front of the pack, to build a better health care system for all Americans.

I look ahead with great hope for the future of medicine. There will be more obstacles to overcome. But in the face of great challenges, the pioneers of American medicine have never been discouraged. We’re going forward together -- because today, a stronger, healthier America is on the horizon.

U.S. SECRETARY OF HHS KATHLEEN SEBELIUS SPEECH AT WORLD MEDICAL ASSOCIATION IN GENEVA, SWITZERLAND

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
World Medical Association
May 22, 2012
Geneva, Switzerland
Every country in the world recognizes the huge benefits of investing in health. Healthy children are better students. Healthy adults are more productive workers. Healthy families can make greater contributions to their communities. And when we live longer, healthier lives, we have more time to do our jobs, play with our children, and watch our grandchildren grow up.

And yet, in too many countries, including my own, we fall short when it comes to the health of women.

One reason for this is that women are more likely to depend on a male partner to access health care. And they’re often less likely to have the resources they need to get care on their own.

Another obstacle is health systems that too often fail to consider the unique health needs of women.

In the United States, it wasn’t until the 1980s that women were even included in clinical trials. As a result, we had no idea what treatments or medicines were particularly effective for women. We didn’t know what might happen when a drug that had been tested on a 180-pound man, was given to a 110-pound woman.

Despite the progress we’ve made since then, disparities persist to this day. Women in America often pay more for health insurance, just because they’re women. And to add insult to injury, these plans often don’t even cover the basic care they need. In my country, just one out of 8 plans for those who buy their own insurance cover maternity care -- as if getting pregnant were some very rare condition.

The result is that far too many women, who often serve as the health care gatekeepers for their families, go without care themselves.

Of course, we see the same thing around the world. Every two minutes, a woman dies from complications related to pregnancy or childbirth. The risks are even greater if you live in the developing world -- where three out of every four women needing care for complications from pregnancy do not receive it.

Even in places where care is available, the demand is so great that it often stretches resources to their limits.

Last year I visited the maternity ward of the Mnazi Mmoja Hospital in Zanzibar, Tanzania. There were so few beds and nurses that some women had to share beds in the post-natal room. And others were discharged just hours after giving birth. The hospital was doing heroic work. And the women who were able to deliver there, were among the lucky ones. Yet, so much need still went unmet.

We know that when we under-invest in women’s health, whole families pay the price. When a mother dies the chance of her child dying within 12 months, increases seven fold.
So under President Obama, we’re putting a new focus on women’s health – at home and abroad.

In the United States, the key to those efforts is the Affordable Care Act, our most important women’s health legislation in years.
The health care law starts by ending discrimination against pre-existing conditions. Insurers are already prohibited from denying coverage to children because they have asthma or diabetes. And beginning in 2014, all women will be protected from being locked out of the market because they’re a breast cancer survivor, or gave birth by c-section, or were a victim of domestic violence.

In the past -- because they were worried about losing their health coverage -- too many women didn’t have the freedom to make important decisions like changing jobs, starting a new company, even leaving a bad marriage. Now that women know they can’t be turned away because of their health status, we’re taking those choices back from the insurance companies and returning them to the women where they belong.

Next, the law prohibits insurers from charging women more just because they’re women. To put it another way: this means that being a woman is no longer a pre-existing condition.

And the law helps women get the preventive care they need to stay healthy, from mammograms to contraception to an annual check-up where you get to sit down and talk with your doctor, as a basic part of any insurance plan.
These improvements are happening across the lifespan. Young girls now have access to the vaccinations they need stay healthy without their parents worrying about additional costs. And seniors are getting better care to help manage their chronic conditions.
Put all these changes together and they represent the most important and comprehensive American law affecting women’s health in decades.

Now, we’ve also made women and girls a priority for our Global Health Initiative -- a new approach to coordinating the US government’s global health work around the world.
With a focus on collaboration, and innovation, this initiative -- launched by President Obama -- allows us to maximize America’s own strengths and support other nations as they work to improve their people’s health.

We are integrating our programs across the U.S. Government so they can work together more effectively. And we are looking for new and better ways to work with international partners, multilateral organizations, NGOs and foundations to meet our common goals
Through it all, we’ve made women’s health a key priority – and that includes family planning. We know that access to contraception allows women to space their pregnancies and have children during their healthiest years. And delaying pregnancy beyond adolescence can reduce infant mortality and dramatically improve a child’s long-term health. Providing a woman the tools to plan how many children she has, and when she has them, is essential to her health and her family’s health.

Now, just as important is making sure that, when women are pregnant, they get the care and support they need to have a safe and healthy pregnancy and delivery.
The Global Health Initiative’s ‘Saving Mothers Giving Life’ campaign is a great example of these efforts. We know that for mothers and children at risk, the first 24 hours postpartum are the most dangerous. That’s when two out of every three maternal deaths, and almost half of newborn deaths occur.

So we’re working together with groups like Merck for Mothers, the American College of Obstetricians and Gynecologists, Every Mother Counts, and the Government of Norway, to make sure mothers get the essential care they need during labor, delivery, and those crucial first 24 hours, so they can survive and thrive.
We’re focusing on countries with the political will to bring about change. And with more than $90 million in generous support from our non-governmental partners, we have begun selecting pilot sites in the regions of Uganda and Zambia where women are facing some of the highest maternal mortality ratios in the world.

‘Saving Mothers Giving Life’ is just one example. But it illustrates an approach that runs throughout the Global Health Initiative. It starts by identifying the most urgent health challenges affecting some of the world’s poorest nations. Next, we identify the best people in the world with the specific expertise to solve these problems. Then we bring them together, and make sure they have the tools, resources and flexibility to take action.
For too long, too many women and girls have had their lives marred by illness or disability, just because they didn’t have access to health services. When we deprive women of the care and support they need to stay healthy or get well, we’re also robbing them of hope for the future.

That’s the moral argument for making women’s health a priority. But there’s a strategic argument too.

Women are gateways to their communities. Around the world, women are primarily responsible for managing water, nutrition, and household resources. They’re responsible for accessing health services for their families. Many of them are closely involved in actually providing health care for those around them.So by improving the health of women, we can improve the health of communities too.

Consider the story of Jemima, a woman living with HIV in rural western Kenya. At one point, the effects of her HIV got so bad she had wasted to 77 pounds. That’s when a volunteer brought Jemima, her husband, and her sick grandchild to a U.S. government-supported health clinic.

They went home with what is called a “Basic Care Package” – a bundle of low-cost health interventions, developed by public health researchers from our CDC Global AIDS Program to prevent the most debilitating, opportunistic infections among people living with HIV.

Jemima bounced back. She regained a healthy weight. And today she is a health leader in her community. She founded a group that offers emotional support and small loans to families touched by HIV. She sells health products to help support the eight sick and orphaned children she has adopted. And she has referred more than 100 HIV-infected men, women, and children to receive care at the same facility where she got help.
In Jemima, our investment saved not only a life, but a mother, a community leader, an entrepreneur and a health advocate.

What we know from our work with partners around the world is that improving the health of women and girls, unleashes powerful new opportunities – not just for them or their families – but for their communities and countries.

If we want to improve education, we should be giving our young women the healthy start they need to succeed in school. If we want to boost productivity, we can make sure women have access to health care, including family planning and other reproductive health services. If we want to build stronger communities, let’s enable women to teach their neighbors how to prevent disease and stay healthy.

Around the globe, our nations face many challenges. And investing in women’s health is one of the best ways we can address them together.
Thank you.