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NRPCA/CHAMP Fall Primary Care Conference:
Sustainability of Health Care Services to People in Need

Renaissance Seattle Hotel
515 Madison St.
Seattle, Washington
Monday, Oct. 24, 2005

(Note: Remarks given at a conference co-sponsored by the Northwest Regional Primary Care Association and the Community Health Association of the Mountains and Plains States focusing on finding sustainable ways to provide service for people in need.)

Good morning.

For those of you from outside of the immediate area, I'd like to offer you a hearty welcome to beautiful King County.

I would first like thank the team of people from the Northwest Regional Primary Care Association, the Community Health Association of the Mountains and Plains States, and other members of the planning committee who have played a major part in organizing and hosting this event.

This has truly been a collaborative effort and I think this sets a positive tone and precedent for a healthy and spirited discussion.

As many of you may know, reforming and improving our health care system is an issue that is close to my heart. I believe that in the richest and most powerful country in the world, we ought to be able to provide basic health care to all of our citizens.

Quality health care must be readily available to all of our citizens. You all have a tough job ahead of you today. Discussions today are critically important to rectifying the injustices and disparities that many people face in our current health care system. Today's conference signifies an increased call for action. It is a call for our region's top health care professionals to collaborate and figure out ways to improve the quality of healthcare provided to ALL people.

There is a quote I would like to share with you. I've used it a few times, but I really think it gets to the core of this conference's theme. The great 19th century British Prime Minister Benjamin Disraeli once said, "The health of the people is really the foundation upon which all their happiness and all their powers as a state depend." I worry sometimes that we have forgotten that insight in modern day America. Well, I can tell you that I have not forgotten. I believe that our communities are only as strong as their people. If people are not getting the adequate health care they need, particularly underserved communities, our foundation – as Disraeli said – is truly in jeopardy. Helping these communities is a critical step in sustaining such a foundation and I believe there is no greater value that this government holds than the health and welfare of its people.

Reducing Health Care Costs

As I mentioned last week in my budget address, growth in health care costs has skyrocketed over the years. Never in my years of government had I seen a major expense grow so fast with no apparent means of managing it.

Over the last four years, like every other major employer, King County struggled financially as health care costs skyrocketed at an 11 percent annual clip.

But I refused to accept that our only options were to slash health care benefits or shift costs to our hard working and dedicated employees.

Instead the health care experts of this region showed us a third way. They taught us that 41 cents of every health care dollar we pay does nothing to make us healthier. They told us that we could recapture those 41 cents by transforming the way healthcare is consumed and supplied in this region. And that is exactly what we are doing.

In 2005, I launched the Health Reform Initiative. The Health Reform Initiative rewards accountability for health and health care related decisions. Employees and their families are given the tools to be responsible consumers of their own health care and to improve their health. We implemented five new pilot projects in 2005, and are set to unveil more cutting-edge strategies in 2006 and 2007.

Today, I am excited to report to you that our efforts are working. Through the first nine months of 2005, King County 's self-insured medical and drug costs have risen only 2.4 percent from the comparable period last year.

This is a remarkable achievement when you consider that the state of Washington will see its health care costs rise 10.6 percent this year and during the same period of time health insurance costs for businesses throughout the US increased by 9.2 percent.

But health experts told me that, in addition to changing behaviors, we will not fix the health care crisis without reforming our region's health care delivery system.

This is why I founded the Puget Sound Health Alliance, a unique consortium of public and private employers, providers and health plans that will bring the Puget Sound region the best health care system in the world. It will achieve healthier people, high quality care, and affordable costs.

Today, over 60 organizations including Boeing, Washington Mutual, the State of Washington, Virginia Mason, GroupHealth Cooperative, the PolyClinic, among others -- have joined. This represents over 700,000 employees and family members.

With King County 's initial success with our internal health initiative, and with the Alliance 's promise to deliver high quality care and results, we are revolutionizing the health care system to provide better care and lower costs.

Pandemic Flu Initiatives

But even with these promising innovations, caring for the health and welfare of the people of King County remains extremely challenging. Public health authorities face the ominous threat of pandemic flu. The last major pandemic, in 1918, killed 50 million people around the globe. We could see similar loss of life if the current bird flu spreading across Asia and mutates into a lethal form. Thousands of people could die in King County alone if a pandemic materializes. The elderly and our children would be at highest risk. Billions of dollars could be lost from our local economy.

But simply worrying about the possibility of pandemic flu is unacceptable. We must hope for the best but prepare for the worst.

Two weeks ago — unprecedented for a local government — I requested six million dollars to combat the pandemic flu threat. That money will fund an outreach campaign to inform people how to protect themselves. It will also enable us to purchase major stocks of Tamiflu, the only medical intervention currently known to combat the illness. It will buy enough supplies to treat 62,000 front-line responders: doctors, nurses, police officers and firefighters. This will enable them to keep working to provide life saving treatment to those most at risk. We will also purchase additional Tamiflu to treat the estimated 57,000 critically ill who could be hospitalized by the pandemic. This initiative could well save thousands of lives. But despite these efforts more needs to be done.

Adequate Safety Nets

Although we are the wealthiest country in the world, and 13% of our GDP is spent on health-related expenditures, there are still startling disparities in the well-being of our citizens.

The U.S Census Bureau reports the number of uninsured people in our country has increased by 800,000. This translates into 45.8 million Americans. And among the uninsured; low-income and minority communities make up the majority.

As most of you know, the uninsured are less likely to receive preventative care, have regular checkups, get treatment for mental illness, and be admitted to the hospital for treatment on pre-existing conditions like heart disease or diabetes.

Locally, King County has one of the largest metropolitan health departments in the country. And based on per capita income, we are one of the wealthiest counties in the state. Fortune has smiled on us here — or on most of us, at least. Because, unfortunately, 15% of adults in King County are uninsured and 4% of our children go without health insurance. That is simply unacceptable to me.

King County suffers from a number of health disparities like:

• Diabetes rates which are significantly higher among African American, Latino, and American Indian compared to the rest of the general population
• Infant mortality which is 2.5 times higher in African Americans and 3 times higher in native Americans and
• Lower screening rates for breast and cervical health among poor communities and ethnic minorities

It is obvious that King County is not immune to these public health problems. For all the strides we have made as a county in recent years, disparities in health care very much remain a powerful factor in the determination of health outcomes for impoverished communities.

For many people, it is too easy to become accustomed to these problems, and assign them to factors beyond our control. It is easier to accept them as realities not likely to improve in our lifetime because of political inertia or indifference. This would be the wrong way to think, and I refuse to think that way. Our goal must be to find solutions, not excuses.

The right way to think is that we can correct problems in our health care system. To many of you — Today is a great opportunity. Today is an opportunity to revisit and reform these social injustices. We can implement thoughtful, strategic, and continuous actions to bridge this gap – through policy, implementation and execution.

Let me tell you some of the ways, King County has responded to these health care problems. They have been internal and external in scope.

Internally, our public health department has formed a Diversity Management Committee.

This committee is comprised of our public health department which is linked to City and County agencies and communities. The committee focuses on promoting cultural competency, policy changes, social justice and undoing Institutional Racism.

Externally, we have forged partnerships:

• The Breast and Cervical Health Program - The Breast and Cervical Health Program (BCHP) is a population-based demonstration project in cancer control and prevention The Breast and Cervical Health Program (BCHP), funded by the Centers of Disease Control and Prevention and Washington State, provides free breast and cervical cancer screening for low-income women. The program in King County targets women with lower screening rates.
• The REACH Coalition - The REACH coalition is a major program funded by the Center for Disease and Control. It is run locally by our Public Health Department, in collaboration with community organizations. Their mission is to reduce diabetes health disparities experienced by communities of color. There are already close to 700 participants in this program with African-American, Asian-American, and Latino representation. REACH's goals will help create opportunities for diabetes education and self-care through community and individual support.
• The Steps-to-Health Program - The Steps-to-Health program is a federally-funded program led by community partners and our King County Department of Public Health. The Steps program has the task of reducing health disparities due to chronic illness by reaching social and ethnic groups that are disproportionately affected by diabetes, obesity, and asthma. Steps have been instrumental in developing ways to fight these deadly illnesses. I love this program, because it deploys a multi-pronged strategy that coordinates actions at the individual, family, clinical, school, and community levels.

These chronic disease prevention initiatives are model programs due to their ability to serve diverse populations in a culturally-competent manner. And because of this, they are directly improving the sustainability of services to people in need. But, we need these kinds of practices and strategies to become the norm for the entire County and state.

We understand the problem and we have identified many of the proven strategies that will assist us in solving them. But it is up to us to make sure we implement these strategies.

So we have more work to do.

We can look at our own practices in our daily work and re-examine how our efforts contribute to healthy communities for everyone.

We can take action in our personal and professional lives. Through generosity of time and money, we must make an effort to improve our health care system. We need to educate our children in the pursuit of social justice and engage them in our current actions. The decisions and actions we make today will dictate whether we succeed in reducing the health disparities of tomorrow.

Can we close the gap or will we see more impoverished communities suffer needlessly under the disproportionate burden of disease?

Will we strive to protect the health and well-being of all children, regardless of social status?

Will we secure their right to a healthy life?

Will we have one standard for healthy communities or will we continue along with the same faulty standards?

This is the challenge I pose to you all.

Thomas Edison once said, "If we did the things we are capable of, we would astound ourselves."

I love that sentiment. So I say to you today, let us astound ourselves. Let's work for a better tomorrow for everyone in our amazing and diverse community.

Thank you and enjoy the rest of the conference.

Updated: Nov. 28, 2005

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