California Public Health Association: The Power of Collaboration
April 4 & 5, 2005, Oakland, CA

Sylvia Caras, PhD

First registration, then, displays, and the first table I saw was from the Pacific Disability Technical Assistance Center (regional DBTACs were formed after the ADA was passed). I chatted for a while with the staffer, solidifying the collaboration between CA PAI and their center.  Perhaps 150 attending were gathered at round tables, enjoying fruit, muffins and coffee as the meeting convened.  I haven't seen a wheelchair, crutches, white cane, signing, braille  … I'm confused as to how to introduce myself, disability, mental health, internet access issues, Santa Cruz  ….  (I found that different introductions produced different connections, and networked well.)

From the opening presentations:

CA fails to fund prevention.

Mental acuity test: Physician is interviewing, asks Man One, "What is 3 times 3?" After thinking, Man One replies,"274." Physician asks Man Two, "What is 3 times 3? Man Two: "Tuesday." Asks Man Three.  Man Three replies: "9." Physician, "Good. How did you reach that correct answer, and so quickly.?" Man Three: "Easy. I subtracted Tuesday from 274."

School gardens are effective in creating student buy-in, interest in healthier food, might effect obesity, grades, other health.

Whybrow: from a psychiatric point of view, most interventions are creating bad outcomes.

Deterioration of medical care.

Public health emphasis and advocacy is even more important in the current managed care environment.

From the posters:

Coelho: Racial disparities in healthcare: are we prepared for the future?

Ethnic minority populations were more likely to choose providers from similar cultural backgrounds and were more likely to be satisfied, compliant and adherent to medical treatments they recommended.

Li: Effect of financial incentives on physician production efficiency.

Results highlight the importance of financial incentives in determining physician behavior and provide medical group administrators evidence to improve the organizational structure of the groups and use proper financial incentives to increase physician productivity and achieve the most efficient intra-organizational structure

Hagaznen: Integrating epidemiologic evidence and economic evaluation: a contingent valuation approach.

Contingent valuation is an economic strategy used to assess how much individuals would be willing to pay for a particular non-market good in order to understand how a value would be assigned to possible interventions, medications, or policies that would reduce number of or severity of symptoms. Through assignment of a dollar value to hypothetic scenarios, the community-level perception of the importance of health issues and behaviors can be assessed. Using this approach, assessment of current perceptions can inform the design of interventions to mitigate the burden … in the community

 Hyun: Graduate student mental health: needs assessment & utilization of counseling service

Method: An online survey was emailed to all registered (n=9,231) graduate students with valid email addresses at a large western university. The response rate was 33.8% Results were weighted to account for a disproportionately high response rate among women.

Results: Approximately 44.7% of graduate students reported having an emotional or stress related problem over the past year. Another 50.2% considered seeking help for their problem, but only 26.2% utilized on-campus services and 10.5% used off-campus services. Being a female graduate student, ratings of competitiveness within a program, and the number of semesters spent in school were negatively related to emotional well-being.

Lunch was healthy, lettuces, bean sprouts, broccoli, roasted green, yellow, red peppers, eggplant, tuna salad, chicken salad, pasta salad, rolls and butter, cut fruit, and an apple cake square.

Awards were presented, including the CPHA Myers Award to Bob Ross, CA Endowment. One went to a person interested in exercise who led the group in a series of standing exercises which were difficult or impossible for anyone with a mobility impairment, a balance problem, …

Greed was an issue raised, and judged as an evil.

I went to a breakout on collaboration, excercises, handouts, basics. 
Guiding principles:

Determine roles in advance
Establish decision-making parameters up front; make sure everyone know
Create accountability agreements
Articulate community and agency contributions/value
Proactively invovle community
Make informaton available and accessilbe in a timely manner
Be honest about limits to sharing power

Can one make social change in a capitalist society without depending on grants and funders?  Is this more likely is a society where health care, housing, basic needs are provided so there might be more time for volunteering, more goods and services donated, ... ?  Because politics is the struggle over the allocation of resources.  

Collaboration may start chaotically, which leads some to quickly want to impose structure but that can subvert respect for an inclusive process, and systems and groups eventually self-organize.

I went to a breakout on building capacity for community action to improve health.

    Tony Iton, Alameda County Public Health Department - public health needs to change, tobetter fouces upstream, working with larger society and policy and communities instead of what we do now, groups and individuals.  (the spectrum of prevention).  Equitable distribution of resources. on the gournd, door-to-door, one-to-one.  The community will bring about the health in the community.

I stayed overnight and was asked for ID at the hotel check-in. I presented my passport (I use that for airport ID; it's easier to replace if lost than a driver license) but the receptionist was disgruntled - "Don't you have a driver's license? I know you drove here.  What kind of ID is this?  Well, I guess I can take it, but it's harder for me."