Medical News: Looking back on the past year, how has the healthcare changed and how should cities and public health adapt to the changing environment?

Sarah Moyer, MD: Healthcare continues to evolve by looking at the value and quality of care and not just the quantity of services provided. With quality metrics, physician’s offices can increase their focus on social determinants of health to drive compliance and improve health outcomes for their patients.

Physician offices are now partnering with food banks. Physicians are also screening for Adverse Childhood Experiences (ACE’s) and for social determinants of health. Insurers like Humana are intentionally partnering with the community to increase the number of healthy days people enjoy through their work with the Louisville Health Advisory Board (LHAB) and commitments from their foundation to address social determinants of health.

All this will improve the health and quality of life of patients, as much, if not more, than medical treatments. Healthcare systems are starting to collaborate with the private sector and with public health for collective impact. The bottom line is healthy people means reduced costs, stronger employees and happier citizens.

MN: What is the role of public health in the healthcare system?

SM: Our vision is a healthy Louisville where everyone and every community thrives. And our mission is to achieve health equity and improve the health and well-being of all Louisville residents. We work strategically, collaboratively and innovatively with the community to ensure that everyone who lives in Louisville enjoys the best health and well-being possible.

This has many different roles from serving as a convener to connect the community and healthcare systems to improve care, to providing services like harm reduction with our syringe exchange program and surveillance for contagious diseases. Our role is also to collect, find and analyze reliable, diverse, real-time data to help drive decision making.

MN: How do you address the social determinants of health as a chief health strategist?

SM: How would you like to see the community address these issues? At the end of this month Mayor Fischer and my team will release our 2017 Health Equity Report that documents the links between the root causes of health, such as housing, food and education, and the health outcomes our communities experience, all of which influence both the quality and length of our residents’ lives.

Using various sources of data including Vital Statistics and American Community Survey data from 2011-2015, health outcomes are explored through maps, graphs and statistics. The report also highlights how we can work together collectively, at individual, interpersonal, organizational, community and policy levels to implement evidence-based practices to improve health outcomes and create a Louisville Metro where everyone can thrive.

A vital method of intervening in poor health outcomes is to build coalitions so that a variety of perspectives are included as solutions are developed. It’s essential that these coalitions are made up of not only decision makers and people who hold power in their organizations or business, but also community members, those most affected.

We have several coalitions in Louisville right now where physicians are involved. They are working on issues such as reducing infant mortality and improving overall maternal child health, improving asthma, embarking on our city becoming a Zero Suicide city and improving rates of diabetes in adults. Coalitions can bring an innovative, multi-sector approach to shape policies, practices and systems that can transform our communities so that everyone can thrive.

MN: How has the practice of medicine changed over your career?

SM: Through the Affordable Care Act, access to clinical care has improved which has allowed public health to move away from providing direct clinical services and toward health in all policies. I would like to continue to see more physicians joining with us in our work and getting actively involved in their community. I would like to see an even bigger focus on reimbursing health systems and physicians more for prevention and addressing social determinants and improved health outcomes of their patients. We still spend majority of healthcare dollars at the end of life – think of all the possibilities if we could reverse that!

MN: What can Kentucky do to create a better environment?

SM: Pass policies that help make the healthy choice the easy choice: increase taxes on cigarettes substantially since we know in other states with high cigarette tax rates smoking rates have decreased; expand access to high quality food; paid parental leave policies which we know improve the health of parents and children lifelong; invest in education and training to lead to good paying jobs; invest in quality affordable and abundant treatment for behavioral health and substance use disorder; reduce stigma associated with mental illness, substance use disorder and violence.