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Blog Posts from 2016

Welcome to the blog for Health & Medicine. We're a 33-year old 501c3 nonprofit that operates as an independent, freestanding center driven by a singular mission: formulating health policy, advocacy and health systems to enhance the health of the public.

2016

Dec 21, 2016 Written By: Health & Medicine Policy Research Group (HMPRG)

Measuring Structural Racism in Chicago

Click here to download a PDF of  Recommendations for Measuring Structural Racism in Chicago

Background:
On September 7, 2016, Health & Medicine Policy Research Group staff attended a meeting jointly hosted by the Center for Community Health Equity (a joint DePaul-Rush center) and Health & Medicine’s Health Equity Initiative, to help advise the Chicago Department of Public Health’s (CDPH) Department of Epidemiology on how to both accurately and reliably measure experiences of racism in Chicago.  Health & Medicine would like to thank CDPH for their earnest inquiry and engagement on difficult questions about a long-term foundational problem in the United States context: racism, an impediment to our shared goal of achieving health equity.  

The September 7th meeting followed a series of smaller meetings in which Health & Medicine staff met with CDPH to discuss the results of questions pertaining to experiences of racial discrimination included in a recent Healthy Chicago Survey. This survey provides local Behavioral Risk Factor Surveillance System (BRFSS) data comparable across Chicago community areas, to which CDPH added some questions.  Health & Medicine and CDPH share the concern that a specific series of questions in the Healthy Chicago Survey are not accurately measuring experiences of racial discrimination.  This shared concern and the CDPH epidemiology staff’s increased inquiry into this issue together provide opportunities to develop better measures of racism and to expand anti-racist public health practice in Chicago.  

As past American Public Health Association President Dr. Camara Jones has said, we must first put racism on the agenda in order to work to eliminate it, which seems to be the intention with this area of inquiry.  We hope that the recommendations and notes herein help advance CDPH’s work toward accurately measuring racism, and ultimately aiding in the process of confronting structural racism and advancing toward achievement of health equity in Chicago—both monumental undertakings.

Recommendations and Action Steps:
1: CDPH is encouraged to remove measures of experiences of racial discrimination from the Healthy Chicago Survey. Several methodological problems with using the scale within the Healthy Chicago Survey have been identified by both CDPH and external partners. Pages three and six of the PDF have more detailed rationale. We recommend more robust measurement methods below.

2: CDPH should instead utilize an approach of mixed qualitative methods. This approach is likely to provide actionable information that may guide future data collection at a city-wide level. This method may reveal more accurate individual level racial discrimination measures and potential ideas for measuring structural racism as well. Page three of the PDF includes more exploration of this topic.

3: CDPH should develop ways to measure structural racism, vis-à-vis a structural determinants of health inequities approach that includes measuring governance processes, economic policy, and public and social policies. We suggest a methodological shift toward measuring the impacts of structural racism on health inequities, with a reduced focus on measuring the degree of racism at the interpersonal level. Given that there is already documented and objective evidence of racism at different levels—internalized, interpersonal, institutionalized, and structural—CDPH should focus on structural racism, as it is the most preventive level. To this end, CDPH staff might begin with the questions provided by Dr. Camara Jones during her presentation on the APHA webinar regarding measuring racism to help guide public policy decisions and actions. Page seven of the document has more information.

4: CDPH should utilize structural measures of racism in policing, as a goal in the violence prevention section of Health Chicago 2.0 requires structural measures and both structural (policy) and institution level interventions. For reference, the most pertinent goal in Healthy Chicago 2.0 is stated as, “Reduce mass incarceration and inequitable police attention in communities of color” and the most relevant associated objective is: “Decrease discriminatory treatment in the criminal justice system”.   More resources for inquiry pertinent to this recommendation are found on pages five and six of the PDF.

5: CDPH is encouraged to contextualize its use of “race” categories whenever sharing information about inequities in charts, graphs, maps, or in text.  Within the current context and history of racism in the US, this may help audiences understand these inequities as resulting in significant part from racism at different levels—internalized, interpersonal, institutionalized, and structural.  Two Health & Medicine staff members are collaborating with others to develop a Contextualizing the use of “race” in public health statement that may be helpful in this regard.  Among other reasons, this is essential for debunking the myth of biological “races” for various audiences, helping dismantle the ideology that underpins racism.

Other recommendations:
  • If CDPH decides to use a survey tool for this (against the recommendation herein), review and consider using the reactions to “race” module (mentioned in the 9/7/16 “Quantifying Racism” webinar)
  • If CDPH has not yet connected with Dr. Nancy Krieger on this subject, Health & Medicine staff would like to participate in the discussion to hear her feedback and suggestions for moving forward
  • Set and publish goals, objectives, and strategies for improving the diversity and inclusiveness of Healthy Chicago 2.0 committees
  • Develop and share a timeline for this project to improve measures of racism to advance accountability to both the general public and outside partners who are advising CDPH
Concluding Note:
Health & Medicine is enthusiastic about CDPH’s commitment to better measure racism in Chicago and regularly engage with external partners to work toward accurate measures.  We share these notes as feedback on this process and hope that they offer useful resources and recommendations.  We look forward to continued partnership on helping measure racism as a means of targeting resources and policies, and measuring progress on dismantling structural racism, a prerequisite to our shared goal of achieving health equity in Chicago and a socially just society.  Our notes associated with the above recommendations are found in the appendix, on pages 3-7 of the PDF.
Contributors:
Sekile Nzinga-Johnson, PhD, MSW, Senior Director of Programs
Wesley Epplin, MPH, Director of Health Equity
Tiffany Ford, MPH, Policy Analyst
Renae Alvarez, MPH, Policy Analyst
Editors:
Margie Schaps, MPH, Executive Director
Morven Higgins, Development & Communications Manager

Dec 14, 2016 Written By: Sharon Post

Center for Long-Term Care Reform Backs Enhanced Home- and Community-Based Services for People with Dementia

Medicaid pays for both institutional and home- and community-based long-term services and supports (LTSS). In 2014, the federal government issued new rules setting standards for what kind of LTSS setting qualifies as “community-based” rather than institutional. Some services are provided in settings that have characteristics of both institutions and community-based sites, and the new rules establish criteria for distinguishing a truly community-based setting that allows independence for program participants from those that restrict participants’ freedom to interact with the broader community.

Health & Medicine’s Center for Long-Term Care Reform has advocated for enhancing access to home- and community-based services and reducing the institutional bias in Illinois’ long-term care system. We therefore welcomed the new federal rules and have followed closely the State’s development of a Statewide Transition Plan to come into full compliance with the them.  In our comments on the latest revised Statewide Transition Plan, the Center highlighted two key issues in implementing the settings rule:
  1. Applying the rules carefully but rigorously to adult day centers that serve people with dementia,
  2. The need for rate reform to reflect the true cost of person-centered, community-integrated services for older adults and people with disabilities. 
These are two of many significant challenges facing Illinois’ long-term care system, and the Center expects to work together with advocates and State agencies to move forward with these reforms.


Jul 27, 2016 Written By: Sharon Post

Quality Matters: A Managed Care Approach to Disparity Reduction

The Center for Long-Term Care Reform has been monitoring and responding to the roll out of managed care in Illinois Medicaid since the launch of the managed long-term services and supports in 2010. Early in the process of transitioning to managed care, we advocated for transparency, consumer protections, and quality assurance. As managed care has matured and expanded to new areas and populations, notably to include newly eligible ACA enrollees, we have turned our attention to the capacity of managed care to reduce disparities and achieve health equity. This paper describes one managed care plan's experience with addressing health equity based on our interview with CountyCare CEO Steven Glass, and looks closer at one managed care strategy he highlighted, selective contracting with high-quality providers. View the paper below or CLICK HERE to download.

Jun 27, 2016 Written By: Martha Holstein

The Long-Term Care System for Older Individuals: From the 1930’s to Today

We're pleased to share the opening presentation from our recent forum, Caregiving: The Politics, Ethics, and Realities of Long-Term Care, part of our Chicago Forum for Justice in Health Policy series. Martha Holstein is a former Health & Medicine Board Member and currently serves as a consultant for our Center for Long-Term Care Reform.

I’m so glad to see you all here today for the first of two seminars that will systematically explore care provision in the United States today from multiple perspectives. We start from a fundamental commitment to social justice—the belief that we all deserve equal respect and unless there are specific reasons for doing so (like needs-based distribution of housing vouchers) likes ought to be treated alike. The “non-system system” of care provision fails on both counts.

I would like to note that I am using the word care as it has been developed among feminist ethicists as a shared commitment of mutual respect, competency in care provision and honoring the moral obligations on which relationships of unequal power rest. Feminist ethicists see us not as completely separate, independent and autonomous individuals but as essentially vulnerable to one another and enmeshed in relationships of care.  More about these views in the second seminar but I wanted to mention it this morning since the use of the word care may represent a difference among aging and disability communities.

My own work for many years has been at the nexus of ethics and policy with a particular focus on gender and age.  So it is no surprise that I have been critical of the ways in which our long-term care system is built around the care provided by family members, mostly women, and low paid women. How and why this is so tells us a great deal about the perpetuation of inequalities that persist no matter how much change has occurred in gender or race relations. It also tells us a great deal about the persistence of privilege that allows those with power to be absolved from noticing and empathizing with people whose lives are distinctly non-privileged.  It was what allowed a legislator during the debate on Medicaid in 1965 to ask—unchallenged-- “who wouldn’t want their beds made and their meals prepared,” as if he ever did either.

So, in the course of this morning’s seminar and its follow up, our intent is to:
  • Call attention to the hidden injustices within the long-term care system that relies on mostly unpaid work by family members, particularly women, and the woefully inadequate and insufficient workforce of paid caregivers in underfunded state Medicaid programs.
  • Examine deficiencies in workforce development as demand for services expands.
  • Propose a system of care based on the primacy of relationships that would demonstrate equal respect for all involved.
  • Explore and identify the common challenges and potential solutions among aging and disability stakeholders while being sensitive to the differences that may mark the two groups.
  • Challenge assumptions about aging, disabilities and caregiving.
To set the stage, I’ll offer a brief sketch of how the current non-system system came about.  It did not happen by chance.  Partly it is the result of deliberate policy choices and partly the result of the persistent inequalities arising in a society framed by relations of power and privilege and by somewhat tepid challenges to the status quo. Work within the existing system has prevailed. Unexamined assumptions, unintended and unexplored consequences—and for the past 30 years the ideology of neoliberalism with its overwhelming favor of markets and individual effort over public and collective action and the parallel emergence of the new aging that has also stressed individually achieved successful aging—has undercut justifications for well-developed public responses to an array of problems and issues. Hence, there has been little room for repair.  That needs to be changed.  

In my brief historical overview, I’ll focus on policies and programs put in place to meet the long-term care needs of older individuals and then Tamar Heller will focus on issues related to disability.

How did we arrive at the now?
  • A seemingly modest section of the Social Security Act of 1935 saying that benefits could not go to anyone in a public institution (intended as a way to close down almshouses) indirectly, but not surprisingly contributed to the growth of private, for–profit facilities
  • Thirty years later, the passage of Medicare and Medicaid in 1965 furthered that trend. Medicare, so strongly opposed by the AMA, was directed at acute care and Medicaid, the means-tested part of that big year’s legislative effort would pay for institutional but not care at home, which was assumed to belong to families.
  • The1970s, and early 1980s saw a critically important but often neglected pivot point in the history of public policy and also attitudes toward late life which set the direction for much of what we see today:
    • Massive changes in political ideology as the new conservatism and its ideology of neoliberalism triumphed.  Our already modest welfare state was under attack.
      • In short, neoliberalism advocated small government and championed individual responsibility while at the same time blaming programs for the old as the cause of childhood poverty and marked the beginning of crusade against entitlements.
    • The seemingly unrelated but important effects of the strengthening women’s movement on women’s employment and family structures challenged the old assumptions but did not redirect policy.
      • Assumptions about women’s availability to provide care did not change
      • Genderized workplaces made women the logical choice to be care givers
      • Cultural norms also supported that choice
      • Women were offered “sainthood” but not help beyond support groups, respite (which while important did not lead to structural changes)
    • The development of the “new aging” with its stress on successful and productive aging, filled with good intentions, began to undercut the justifications for making older people the target of heath, income and social welfare programs; it unintentionally became an ally of the neoliberal agenda.
    • We saw the emergence of the aging network, the professionalization of service provision and the strengthening of aging advocacy organizations (which now had policies to protect), but it also meant the development of territorial protectionism
    • Inroads into primacy of institutional care
      • Channeling grants (cost saving the core value)
      • Nursing home scandals
      • Little attention paid to the possibilities of creating “good” congregate living as exists in Scandinavia
      • Emergence of “any willing provider” as home care agency
    • Elevation of autonomy and independence, in their most individualistic form, as central values in long-term are ironically reinforced both neoliberalism and the new aging as ties among individuals and groups became secondary to individual achievement and the fracturing of strong social bonds
  • Much of this continued during the 1990s and beyond:
    • Era of cost containment
      • DRGs and “quicker and sicker”
      • Growth in numbers of people who needed care at home and increasing hours of care provided by family member
    • Passage of the ADA in 1990 and the subsequent consent decrees
      • Deepened commitment to deinstitutionalization; “rebalancing” as the buzzword and goal with little attention to the unintended consequences
    • Neoliberalism continued and, joined by the new aging, served as justification for reduced spending
    • Elevation of successful aging (i.e. the hurdle-jumping great-grandmother) the continuation of mid-life norms into old age; the commitment to an ageless society and other elements of the new aging upheld as the goal for an aging society; contributed to shame for not measuring up and a flight from old age.
Which bring us to 2016 and the critical question “What now?” How can we pivot away from neoliberalism and the assumptions that have dominated long-term care provision for more than half a century to achieve a more just system of care? Our task today and at the subsequent seminar is to get as clear as we can about the realities of the current non-system systems and to also challenge the taken-for-granted assumptions and underlying moral values that marginalize both care providers and care recipients and lead to indefensible injustices. If we can’t imagine a very different future, we cannot find our way there.
 
Jun 27, 2016 Written By: Sharon Post

Getting Readmissions Penalties Right: Comparing Medicare and Medicaid Hospital Readmission Reduction Programs

The Medicare Hospital Readmissions Reduction Program began four years ago, and has attracted both support for its overall efficacy and criticism for its impact on safety net hospitals.  Meanwhile, state Medicaid programs are using readmissions as a performance measure for hospitals and for managed care plans. This paper compares the federal HRRP with Illinois Medicaid’s Potentially Preventable Readmissions Program, and asks what Illinois can learn from the successes and shortcomings of the federal program. Sensitive to accusations of unfairness, we summarize some critiques of both programs and turn to our audience to ask what lies beyond readmissions penalties as we strive for a  health care delivery system that is more responsive to patients across the continuum of care. The Policy Brief can be downloaded here or viewed below.

Jun 22, 2016 Written By: Wesley Epplin

Health & Medicine Supports Paid Sick Leave for All Chicago Workers

Health & Medicine Policy Research Group supports the policy of paid sick leave for all workers in Chicago. The proposed City ordinance passed the Committee on Workforce Development last week and is being considered by the full City Council this week.

As Health & Medicine’s Director of Health Equity, I co-chaired the community development committee for Healthy Chicago 2.0, the community health improvement plan for Chicago (note: community development goals, objectives, and strategies are listed in the Root Causes section of the plan).  Among the strategies in Healthy Chicago 2.0, local public health experts included support for the Working Families Task Force recommendation that paid sick leave be required for all workers in the city.

Many thousands of Americans die each year from influenza and other communicable diseases.  Paid sick leave is a commonsense, evidence-based policy, supported at the Federal level by the Centers for Disease Control and Prevention.  Just last year, 82% of Chicago voters supported a nonbinding resolution on the citywide ballot.  

Ensuring that Chicago’s hardworking people have the opportunity to earn sick days would help us live up to our status as a global city, better aligning Chicago with many other countries that already require paid sick leave.  What these policies recognize is the basic science of communicable diseases: Reducing exposure to germs by providing anyone who falls ill–and that’s all of us at one time or another–allows people to get better at home (or care for loved ones) without the fear of losing income or employment because of it, while reducing the spread of diseases, such as influenza and colds.

Employees who are ill and do not have paid sick leave are much more likely to go to work and when they do, they’re more likely to infect others – when they go on public transit, when among their coworkers, and when they serve customers.   None of us wants to be served food at a restaurant or other businesses and service organizations by someone who is ill.  Chicagoans who become ill should be able to make a personal judgment to stay home and get better, or care for their sick child or other family, without a threat to their paycheck. There is no dignity or justice in forcing people to come to work when they are ill out of fear of losing wages.  

While there are some costs to providing paid sick leave on the front end, they are more than canceled out by the other costs associated with the spread of disease, a burden that taxpayers and businesses both bear. Healthcare expenses are far higher for people who cannot access timely preventive and primary care, as they seek care after health problems have gotten worse.  When people spread illness to others, it is costly to those who become ill and for employers when these employees are less productive due to illness.  

Paid sick leave can help reduce the transmission of illnesses, protecting health and saving money by reducing several of the costs associated with the spread of sickness. It protects health and saves lives—an invaluable savings.

We cannot continue to give people the false choice between (1) going to work while ill, or, (2) facing the financial burden of being docked pay or even risking one’s job by choosing to stay home when they are sick or are caring for a sick family member. Chicago can and should be better than that.  Requiring paid sick leave is evidence-based, data-driven policy backed by our local and national public health experts, and is supported by everyday Chicagoans. Ensuring paid sick leave will make Chicago more compassionate and it will save money by investing in people’s health and wellness.  Health & Medicine Policy Research Group urges the Chicago City Council to require paid sick leave for all Chicagoans.

May 25, 2016 Written By: Wesley Epplin

Health & Medicine Supports “Health in All Policies”

Over the last year, Health & Medicine has assisted the Chicago Department of Public Health (CDPH) develop Healthy Chicago 2.0, the recently released community health improvement plan for the city.  The plan includes pursuit of a “Health In All Policies” approach, a model for ensuring that all parts of policy, programs, and governmental agencies consider health impacts in decision-making.

On May 12, Health & Medicine provided testimony to Chicago’s City Council’s Committee on Health and Environmental Protection in favor of a Health in All Policies Resolution R2016-177 (here is the webpage for tracking the resolution).  Our testimony can be viewed here.
 
We’re pleased to share that the resolution has now passed both the Committee on Health and Environmental Protection and the full City Council (see the press release here). Along with the Health in All Policies approach, the resolution calls for a “Health in All Policies Task Force to identify and pursue opportunities to improve health, including but not limited to affordable, safe, and healthy housing; active living and transportation; access to healthy food; clean air, water, and soil; parks, recreation, and green spaces; economic opportunity; and safety and violence prevention”.
 
In addition to providing testimony, Health & Medicine staff worked with CDPH on a couple of edits to the resolution.  For example, we encouraged that the resolution notes structural racism as a causal factor for health inequities.
 
Provided that the resolution is passed by the Committee and City Council, success of this resolution in helping reduce health inequities and move the city toward health equity will rely on Mayoral, City Council and City Department leadership actively considering health impacts in decision-making and acting to integrate the goal of health equity into their decision-making regarding policies, practices, and programs. If successful, this could be a significant step forward for advancing the health of Chicagoans and it is a strong early step for implementation of Healthy Chicago 2.0.
 
Supporting all people’s health requires acting to ameliorate the maldistribution of money, power, and resources that shape people’s living conditions and ensuring equitable opportunities for all Chicagoans.  Taking on and changing the structural inequities in our economy, policing, education, transportation, and healthcare system (just for starters) are paramount for moving toward health equity.  Although it doesn’t fully address these, Healthy Chicago 2.0 includes some ideas for making progress on these areas.  The Health In All Policies Task Force should build on these recommendations further to try to make progress on Chicago’s extreme inequities—including those outside of health systems—that perpetuate health inequities.

May 12, 2016 Written By: Maggie Litgen

Laura Porter Shares National Perspective on Using ACEs to Shift Policy and Practice

In a talk titled “The Magnitude of the Solution: Building Self-Healing Communities,” Laura Porter, a national expert on adverse childhood experiences (ACEs), addressed an audience of over 200 clinicians, researchers, teachers, service providers and other community members on April 27, 2016 about the importance of understanding the impact of trauma on health. The talk was hosted by the Illinois ACEs Response Collaborative at Northwestern University’s Chicago Campus through generous support of the Health Federation of Philadelphia.

Porter’s talk emphasized a shift in her own philosophy from previous years – whereas in the past, she emphasized resilience as the end goal of ACE-informed practices, she now believes that resilience, as a concept, is too limited.

“Whenever I talk about the ACE study, people always really want me to emphasize resilience, but I also kind of feel like we’ve set our sights a little low when we’re talking about resilience,” Porter said. “Resilience means doing well in the face of great adversity, and don’t we want less adversity?”


Instead, Porter believes that those working with ACEs should look to increase the overall wellbeing of communities so that each individual – regardless of ACE score – can improve their standard of living. This requires de-emphasizing resilience and instead focusing on what Porter calls “flourishing.”

“I’m thinking more about this word ‘flourishing’ because that word is a journey word, and I think a big part of what we’re doing here is a journey,” Porter said. “We’re trying to learn how we prosper with sustained and continuous and steady and strong growing into wellness. Every single person can be on the path to be growing into wellbeing in their daily lives, whereas if we set our sights only on resilience, then we’re talking about the division of our people – those who have great adversity, and those who did not – as opposed to, together we have to be on this journey of flourishing.”

 

Porter also highlighted that ACEs and trauma must be addressed through a “layering of action” through a collective impact model across several sectors. The Illinois ACEs Response Collaborative is one of fourteen communities in the country that, with the support of the Mobilizing Action for Resilient Communities grant, are using collective impact to achieve systems-level change.

“I don’t need to spend my time thinking about what the policy-makers should do because they’ll be acting in their sphere of influence,” Porter said. “I need to be thinking about what my neighborhood should do, and vice versa. If we each act in our own sphere of influence, and we broadly disseminate the science with fidelity, we get this elegant layering of action that’s immediate and that’s multi-dimensional, and because of those two things, it’s very powerful.”

To learn more about Porter and her work, visit www.aceinterface.com.
To learn more about the IL ACEs Response Collaborative, click here or email Maggie Litgen at mlitgen@hmprg.org.


Apr 26, 2016 Written By: Wesley Epplin

Legislative Brief: Health and Healthcare Workforce-Related Bills

An important part of health reform is health workforce policy reform which can help clinicians safely provide care at the top of their license and that new health workforce categories are integrated into health and healthcare systems.

As part of our Health Workforce Initiative, Health & Medicine tracks state legislation that is related to health workforce reform.  Here is the May 23 publication of this report.  This link will be updated as updated reports are produced.

The purpose of this report is to provide an overview for government officials and health advocates of pending bills and public acts from the State of Illinois General Assembly that relate to the health and healthcare workforce during the Spring 2016 session.  Each bill is linked to the tracking page on the Illinois General Assembly website, so readers can see updates about progress and upcoming committee hearings.

This is a selection of legislation and is not meant to be inclusive of all legislation that is related to the health and healthcare workforce.  

We welcome feedback and ideas of other bills to include in future iterations of this report.  We’ll also be sharing updates throughout the remainder of the legislative session.  Feel free to email me at wepplin@hmprg.org with any thoughts or questions.

Apr 01, 2016 Written By: Guest Author

A Global Perspective: A Look at Japan’s Health Care System

Bonnie Ewald, former Program Coordinator with Health & Medicine’s Center for Long-term Care Reform and the Chicago Area Schweitzer Fellowship, left Health & Medicine in August 2015 and has been traveling around the U.S. and abroad since. In this guest post, she shares some public health-related insights from Japan. (For more on her travels, visit her blog at bgewald.tumblr.com.)

In my time at Health & Medicine, I was exposed to a range of issues related to population health, piquing my interest in continuing to work around developing effective systems to meet the healthcare and social needs of aging populations. We face many challenges in achieving this: people are living longer; Medicare only covers a fraction of the things they really need to have good quality of life as they age; we rely on the unpaid work of family members (more often than not, women) and the underpaid work of domestic care workers; and only a small fraction of older adults have private long-term care insurance to cover things like extended nursing home stays or in-home support to meet their daily needs. On top of that, a lifetime of social, economic, and environmental factors accumulate resulting in vastly different quality of life and support needs for those on opposite ends of the socioeconomic spectrum – so inequalities abound.

Countries all over the world – including Japan, Taiwan, and several in northern Europe – are facing similar challenges due to rapid population aging. In fall 2014, while attending the American Public Health Association (APHA) annual conference in New Orleans along with a few other staff from Health & Medicine, I met a researcher, Dr. Yoko Kawamura of Kumamoto University in southern Japan, studying the Japanese government’s policies with regard to aging and long-term care insurance, and how local communities are reacting. At the time, I was already planning a winter 2016 trip to Japan (where my brother and his family are stationed with the U.S. Air Force), so I was excited to connect with her. We stayed in touch, and now that I am actually in Japan, I was lucky to be able to meet with her for a few days! My visit fortuitously overlapped with two faculty members from the University of Georgia – Athens, who were visiting to explore the possibility of starting a short study abroad experience for their undergraduate public health students – so we were able to make visits to a few communities the students may spend time in. The info I share here is a mix of insights I learned from my conversations in these visits, and from some background reading from the Lancet, and I’d like to qualify it all by saying these issues are of course very complex and that my short immersion has likely simplified much of it.

Japan’s Aging Population
About 1 in 4 Japanese is 65 years old or older. Due to a lower-than-replacement birth rate (1.3), the proportion of 65+ year olds is estimated to rise to 1 in 3 by 2030. Japanese women have the longest life expectancy in the world at birth – 86.4 years (compared with 81.2 for women in the US). In our visit, we met with city leadership from a nearby town of 17,000 residents that is expecting a net population loss of 6,000 in the next 25 years. We also visited with the nurses from the public health department of a different municipality (36% 65+), as well as leaders from a farmers’ cooperative and community-building organization in a small village of 235 people (47% 65+). All of the communities we visited are considered rural, and on top of the general aging phenomena the country faces, are grappling with the rapid urbanization of their young people. (The short documentary Brain Drain gives a nice overview of the challenges the villages are facing.)

They all showed ingenuity and hope in being able to figure out a way forward, though. The farmers’ co-op, in anticipation of TPP reducing the market value of the high-end rice they produce, are taking on initiatives that will support the co-op farmers moving forward – growing and producing biofuels to run their farm equipment, hosting farming workshops for youth, adapting farming practices so people with aging-related ailments can still farm if they’d like, and providing eco-tourism opportunities including homestays and educational workshops. One of the municipalities is engaging older adults as community-health workers of sorts to provide social connection and basic health outreach. Kumamoto University itself is working to promote connections with these initiatives (a major reason we were meeting with them, in the first place!) – including a federally-funded initiative to provide interdisciplinary and community engagement for its medical and pharmaceutical research graduate students. It was so neat to meet with people working on all of these initiatives – initiatives similar to many in the U.S. that Health & Medicine supports.

Japan’s Health Care Landscape
To put this all in context, here’s some background on the healthcare system. Japan has had universal healthcare coverage since 1961, a combination of employer-provided and public option, with reimbursements for low-income and low-asset families. Their healthcare system achieves great results for comparatively little money (Japan is ranked as having the best health status in the world, yet spends 10.3% of GDP on healthcare, vs. the US’s 17.1%) even though it is a fee-for-service system and the delivery system is predominantly private hospitals and providers. This is in large part due to their nationally uniform fee schedule – none of the wide-ranging “chargemaster” rates negotiated behind back doors like we have in most US states.

One specific aspect about the Japanese healthcare system that impressed me was their robust maternal-child health initiatives. Each municipality’s public health department is actively involved in ensuring prenatal, post-natal, and child wellness care are all procured in a timely fashion. Japan actually has a nation-wide “Maternal and Child Health Handbook” that a pregnant mom receives upon registering her pregnancy at the public health department (which everybody does) and serves as a universal document that is to kept up-to-date from pregnancy until the child turns 18 – keeping track of things like rates of breastfeeding, height and weight, oral health, vaccinations. In our meeting with the public health nurses, a few Japanese people in the room proudly claimed that they still have their books today. While most births take place in hospitals, there is a shortage of OB-GYNs, and medically unnecessary C-section rates are low (0.4% vs 10.8% in U.S. - likely due to a few things, including a different culture of much less medicalization of birth and not having wide use of epidurals or other anesthesia, which can complicate the pushing stage of labor).

After the birth, moms are given lots of time to stay in the hospital, allowing for family visits and a visit from the public health nurse – after an uncomplicated birth, moms can stay in the hospital room for up to 5 days (many U.S. hospitals are 1 day). In terms of follow-up appointments, if parents miss the 6-week or 3 month check-up appointment and are unresponsive to telephone and mail outreach from the public health department, child protective services get involved (and the agencies seem to work efficiently and effectively together). When asked if there is an anti-vaccination movement at all in Japan, the nurses looked confusingly at us and shook their heads. In terms of services provided for adults of all ages, the public health departments often provide activities such as health fairs, exercise classes, and social support groups. Frequent hospitalizations do not seem to be a cause for concern.

Despite these many successes of the healthcare system, significant issues remain. The biggest red flag for me is the stigma around mental health issues. Apart from post-partum moms, nobody is routinely screened for depression or anxiety, and there is not wide availability of services such as psychotherapy (talk therapy), much less art therapy or other creative therapies that have been shown to be extremely effective in the U.S. – and there are less clear licensure standards for those that do offer counseling services. Stress and other potential symptoms are typically internalized to not shame one’s family. This is even more alarming given Japan’s high rates of cigarette smoking, alcoholism, and suicide attempts (all of which are the most common among working-age males).

I would be remiss to not mention the pervasive gender gap in economic and social roles in traditional Japanese culture, although this is changing as more and more women are working, especially young women. While the government is implementing measures to try to promote more paternity leave (as part of a range of initiatives to increase childbirth rates to try to address the aging conundrum), the latest survey showed that just 2.6% of new fathers take leave. Hormonal birth control pills were not legalized until 1999; they are still not widely used and are not covered by health insurance. However, early-term abortion seems to be more culturally accepted than in the U.S., possibly in part due to religious differences. There seems to be much room for improvement in terms of having a more open society for discussions of sexual and reproductive health across age spans.

The State of Long-Term Care in Japan
Now, back to aging, which is what started my interest in studying Japan’s public health system. After getting universal health coverage, one big issue presents itself: health coverage does not include social support services that help prevent the advancement of chronic conditions and maintain wellbeing and safety – services such as in-home support for daily activities, meal delivery services, or long-term nursing home care – known in the U.S. as “long-term services and supports” (LTSS) or “long-term care”. (Note that Medicare does not cover this either, leaving many people to rely on family caregivers or spend down their assets to qualify for Medicaid; a huge issue we face in the U.S.) In traditional Japanese society, daughters or daughters-in-law were expected to provide such care for aging parents; however, with more women in the workforce and a declining ratio of adult children to aging parents, Japan’s government anticipated the need to develop a system to provide LTSS, both community-based and institutional (in a nursing home).

So, in 2000, they launched a public system of mandatory long-term care insurance for those 65 and older, with varying benefit levels based on one’s physical need. (For those curious, it is funded by a combination of “premiums” from all individuals over 40 years old, general tax revenue, and a co-pay of 10% for those receiving services [capped or waived based on income]. Once one’s need level is identified [via an assessment by the local public health department], she can choose which services she’d like to “purchase” to meet her needs, and from which providers, up to the corresponding maximum benefit. Individuals can also elect to have a care manager who helps with service selection and coordination, for no out-of-pocket cost; such care managers receive a 44-hour training, none of which touches on counseling techniques – another sign that mental health is an afterthought in much of the Japanese care system.)

After working through some kinks and adjusting some of the financing, the long-term care insurance system is working overall and is largely well-liked. However, it still faces the challenge of having an increasing pool of people to cover and fewer people paying premiums; reducing eligibility and benefit levels is seen as politically unwise (such a move would not only reduce individuals’ benefits, but would likely increase costs paid out down the line by other agencies, such as by health coverage), so they may need to implement reforms to the calculus of premiums, tax revenue, and co-payments – and have changing expectations with regards to retirement age. Time will tell! But for now, the Japanese health system – and the challenges it faces—has many parallels to the U.S., something that all of us interested in population health, aging, and health policy can learn from.

Mar 11, 2016 Written By: Board and Community

The Health & Medicine Community Remembers Quentin D. Young

As we honor our founder Quentin D. Young and his extraordinary legacy working for social justice, single-payer healthcare, and progressive causes, we invite you to share your pictures, memories, and reflections. We will continue to update this page with remembrances from Health & Medicine Board Members, the community, and all those touched by Quentin. To share your thoughts, email us at info@hmrpg.org. We will strive to post as many messages as possible. If you would like to make a donation in Quentin's memory, you may do so here.

Click here to listen to a radio tribute to Quentin from WPFW featuring some Health & Medicine friends including Linda Rae Murray, Jack Geiger, and Gordy Schiff.

When I was a small child, I knew of Quentin because he was regarded with reverence by my parents because of his positions on civil rights and worker causes. I had encountered Quentin during my residency training at Michael Reese. As a result of all of his advocacy work, he often showed up at the hospital in the evenings to see his patients. He was always quite conversational at those times, and never missed the opportunity to extrapolate the plight of a patient who presented with a late diagnosis to the suffering of the masses and how this country’s failure to provide access to decent health care is killing people. It was seldom about the individuals, it was the application of the plight of the individual to the plight of society and its workers. With his help, I learned the aspect of Medicine that medical education fails to include, but is so crucial if you are going to practice medicine and make a difference.
-Claudia Fegan, Health & Medicine Board President

… the happiest, most indefatigable, unrelenting and optimistic warrior for justice that I have ever known. He walked the state for universal health care… was doctor, friend, and advisor to Mayor Harold Washington; and never missed a chance to weigh in on what is now known as Obamacare. My physician (until he retired without my permission) and friend, Quentin has been the nationally recognized, erudite and silver-tounged spokesperson and irrepressible cheerleader for a single-payner national health care system.
-US Congresswoman Jan Schakowsky

What a life! This genial and brilliant Colossus, who strode among us, so modestly, determinedly, productively, and with such humor, thank goodness, for so long.

-Jack Warren Salmon, Health & Medicine Board Member

A hero or heroine is someone that you admire for what they have accomplished, can look up to for guidance, and offers inspiration when you need support.  To have known Quentin Young in this capacity, not only as my personal hero, but as a dear friend for 35 years as well, is something that I will long treasure.
 
When you were in Quentin's presence, whether at a meeting or protest, as a radio listener or reader of his commentaries, you knew that no matter the invariably articulate point he was making, that he was a champion for not only what was right, but also for the rights of those who were marginalized, oppressed, or had no voice.

Quentin's legacy will be memorialized not only by his innumerable contributions -- such as the two causes I was fortunate enough to join with him, The Committee to Save Cook County Hospital, and the founding of the Health & Medicine Policy Research Group --- but his impact on future generations to come.   While Quentin was truly a leader in the sense that he created other leaders, he was even more of a role model consistent with the philosophy of Dr. Albert Schweitzer, "Do something wonderful, others may imitate it".

Quentin's spirit will live on in all those imitating and in solidarity with his lifelong fight for social justice and peace.  He will be missed.

-Lon Berkeley, Health & Medicine Board Member

…an agitator and health activist, whose lifelong question for equality inspired an degeneration of physicians, nurses and public health activists to follow his lead.
-David Ansell, MD

Quentin was our teacher and mentor… Quentin showed us the idea of having power by sharing information. Instead of hoarding information, Quentin was the opposite of that due to some combination of his ego, where he had to tell everybody everything, his democratic impulses and his strategic understanding of how information is power. He embodied his favorite quote of Fredrick Douglass, “knowledge makes a man unfit to be a slave.” Another illustration of something profoundly influential that Quentin taught us was speaking truth to power. He didn’t shrink away, never hid his politics and never compromised his ideas. At County, we would converge at his office at the end of the day, yell at him and he would tell us what happened and why. That message of open communication resonated with us County and that style of dealing with people is now widespread throughout this city because of Quentin.
-
Gordon Schiff, M.D.

…an “old” white doc (several years older than my parents) did not capture sustained attention of a young Black radical. Little did I realize in those early years how Quentin would intertwine with my life and profoundly affect my professional career…. He sat in our school’s Department of Preventative Medicine. He offered a clear understanding of the failures of American Medicine. He established a successful Urban Preceptorship for medical students, showing us the warts of the system and more importantly how to change things. “Everything, poverty, housing, jobs, racism… everything impacts the health of your patients.” This was Quentin’s message. Choosing to do my residency under Quentin at Cook County Hospital changed my life. I am a product of Quentin’s residency; I am one of his professional children. His style of medicine penetrated the entire department, his work ethic, his optimism, and his joy of caring for patients was imprinted on “his children.” His day to day work merged his high quality technical practice of clinical medicine with his insistence on fighting racism and injustice. Before Quentin, I had envisioned my career as a physician being my nine to five; saving my struggle for justice for after work hours. During the County years, Quentin seamlessly went from rounds to case discussions to phone conversations with reporters. He showed us that there was no way to practice medicine without including the fight to improve all of the conditions of life and society that make our patients healthy or sick. 
-Linda Rae Murray, Health & Medicine Board Member

My favorite memory: I was interviewing Quentin over Skype. All of a sudden he said he had  to cut the interview short.  He said he had to hurry over to the plaza at the federal building to attend an Occupy Wall Street rally.  It was a cold, blustery day in late October, a hint of snow.  And here was this man, almost 90, still so damn committed that he was braving elements that would have kept folks half or a quarter his age indoors.  What energy and passion. It's hard to imagine that he's gone.  I cherish the time I had working with him and learning from him.
-Steve Fiffer

What to say?? There are no words. He was a one-of-a-kind man. I will always remember him as the man who KNEW what America needed to do to provide real healthcare to ALL Americans and I predict he will smile down on us when the current system finally collapses upon itself and we get there. I am sorry for HMPRG’s loss and can only imagine how you are feeling. His vision lives on with you.

-Marca Bristo

I feel privileged to have known him.  I loved reading his book that gave  great insight into Quentin, his motivations and the history of public health in Chicago.  I told him this and his face lit up with delight and asked if I liked it.  I was struck by his sincerity in asking the question.  I told him that I not only liked it but was inspired by the book, and by everything that Quentin stood/stands for.  He was a monumental leader whose influence will live on in all of the people he has touched with his commitment to health care and social justice. 
-Phyllis Mitzen, Consultant, Health & Medicine’s Center for Long-Term Care Reform

Quentin was a warrior for all that was right and true. But he was also a person of passion for many things (theater, art) and absolutely committed to the science of medicine. He, as much as anyone I have ever met, mixed a deep concern for the individual and the global. I loved that he cared equally about his patients and the national health system. And he always had a smile on his face and a wonderful twinkly in his eye.

On a personal level I will always be eternally grateful to Quentin. Chairing the Board of Health & Medicine was the first major civic role of my life. It opened to me a door to a new way to contribute. I very much hope Quentin would be happy with what I have done since.

-Hank Webber, Former Health & Medicine Board President


Even though it was clear that Quent's death was approaching, it was a blow. What I remember best is what a truly happy warrior Quent was--never crossing the line from moral outrage into empty zealotry but always taking personal action, and often leavened with humor. One of the great moments in Quent's career--and certainly the funniest transcript in the Congressional Record--was Quent's confrontation with the House Unamerican Activities Committee, during which he cheerfully but totally befuddled, confused, deranged and bewildered those eager communist-hunters until they just gave up in exasperation.

On that day, he was the Casey Stengel of the progressive movement. It's the way I would like to rremember him, among his many courageous episodes in our  long friendship that began in the mid-1940s.

-Jack Geiger

Quentin and I were companions on the road to social justice for 60 years. He had a relentless passion for the common good and fought and won many battles. But whatever the struggle or crisis, he was a Happy Warrior, never showing disrespect, always honoring civility.

Certainly his powers of persuasion were unequaled. He loved language and magically wove his words into an invincible argument.  When an adversary responded, he smiled. And then his magic won the day.

He was a man of great faith. No amount of national decline ever brought him low. He was committed year after year to the health of our people and our nation. His optimism sparked new fires in the hearts and souls of the thousands he inspired. And so his spirit lives on in the memory and commitment of all of us.

His spirit also lives on in the organization he created to embody and advocate for his vision - Health and Medicine Policy Research Group. His work in creating HMPRG's firm foundation has resulted in an enduring, visionary, tough and effective, citizen's health advocacy group unequaled in the United States.

So Quentin, you are with us. In our memories. In our commitments. And in the great organization you created to lead us on to social justice.

We thank you, good and loyal friend.
-John McKnight

This news made me sad, but the images and memories of Quentin made me smile. He was a warrior; but the nicest, most compassionate, and principled warrior ever. 

My sympathy to you and all of the great people at HMPRG who have been fighting the good fight and implementing Quentin’s vision and values all these years.

-Edward F. Lawlor, Dean and William E. Gordon Distinguished Professor, Brown School , Washington University in St. Louis

It was with great sadness but pride for his legacy that we learned of Dr. Quentin D. Young’s death on Monday.

Dr. Young dedicated his life to fighting for quality health care for all, particularly underserved patients, including people with disabilities. The Community Care Alliance of Illinois is so grateful for Dr. Young’s lifelong dedication to patient-centered health care and his tireless advocacy to improve health care for underserved communities.

In 2010, Dr. Young, the founder and long-time chairman of the Health & Medicine Policy Group, joined with other advocates for health care and people who are disabled to found the Community Care Alliance of Illinois.

“Dr. Young was an activist and an advocate for improved health care policy and improved public health. Truly “the people’s physician,” Dr. Young was a dedicated supporter of person-centered, coordinated care for people who are disabled,” said CCAI President Robert Currie.

CCAI is a Managed Care Community Network serving people with disabilities and seniors on Medicaid in Chicago and Rockford areas. For more information on our innovative Model of Care and service, please visit www.ccaillinois.com.
-Statement of Community Care Alliance of Illinois

I have very fond memories of Dr. Young from my young student nurse years at Cook County School of Nursing in the early to mid 70's. Our school supported the first physician house staff strike led by Dr. Young, our hero, teaching  us the important lesson that we weren't just new health professionals but modeling our future responsibility to the under-served in our society. Many of us have carried that vital message on through activism and advocacy throughout our careers.

One of my fellow Cook County alumna, though she lives in Florida, followed him for health care throughout  our adult lives; she just never quite felt comfortable with any other provider. Shirley Jackson Bovia, class of 1972 was also, like the rest of us was very saddened to hear of his passing. Oh the memories of us in those maidenly Cook County School of Nursing uniforms, with our little nursing caps propped properly on our heads, running out to assure the striking docs had hot coffee, snacks to eat and new signs, while fearing for our own potential back lash from our conservative powers to be at the School of Nursing. Many of us received our advocacy wings during this period and have been in flight since that period.

It is with much sadness that I received the  message of his passing but certainly he was one of the giants of public health and did much to contribute to the social well-fare of mankind. The world gained from his presence, which is the most anyone can hope for. R.I.P Dr. Quentin Young for a job well done and many lives that were touched!!
-Dorothy Wright Murphy, Retired-Cermak Health Services/Director of Infection Control/TB/STD/HIV

A friend told me he found a letter to the editor published in 1947 which Young wrote, when he was a medical student at Northwestern, to condemn the AMA for racism. His was a life of activism and principle. He was doctor to Martin Luther King and also at least some members of the Chicago 7.

-Howard Wolinsky, former Chicago Tribune reporter

While I have known Quentin  for many years, I worked closely with him (and 28 others) on the State of Illinois' Adequate Heath Care Task Force from 2005-2007.  This was legislation initiated by then State Senator Barack Obama and was charged with developing an approach to covering the under-and uninsured in Illinois.

29 members were appointed by legislators based on recommendations from community organizations. I was elected Chair of the group and had Quentin, Ruth Rothstein and David Koehler as the Vice Chairs.

After months of investigations and presentations, we developed an approach which pre-dated the ACA as it covered the uninsured via tax credits and subsidies and "gored everyone's ox" by recommending an insurance, employer and individual mandate. In the end, the model was passed unanimously with 2 minority reports, one of which was from Quentin and Ruth for a single payer plan, which I voted for as well.

As you might imagine, our deliberations were intense given the varied and disparate interests on the Task Force. Attempting to reign in such strong personalities was not easy, but, in the end, Quentin was an advocate for the plan even if it didn't go as far as he would have liked.

It was an honor to chair that group and get to know Quentin as well as I did.

While not all will agree with his approaches, no one can deny his intent and focus. Coverage, access, continuity of care, fairness/equity, and respect were just some of the tenets of his positions. We will miss Dr. Young, not only for what he accomplished but for what he reminded us of, each and every day.

- Wayne M. Lerner, Director, Cook County Health and Hospitals System Board

Quentin and I go back a very long ways together.  He always called me "young man" because I was younger than he by a miniscule number of months.  We never stopped agreeing to disagree!  When I was elected to the Illinois General Assembly, he was an ever-present enquirer about "what was going on in Springfield".  I urged him to run for a seat in the Illinois Senate and encouraged him to come on the Board of the Chicago Institute of Medicine, imploring him to join me in our joint "socialistic" endeavors, but the elective route was not his thing.  He was a born activist, and he even included his activism during his tenure as President of APHA and chief of medicine at Cook County Hospital.  What made Quentin different from others of us in the cause of health care justice was his extraordinary depth of knowledge of meaningful facts.  If you wanted to know "why", he had the numbers to back up his advocacies.  No one was a stronger advocate of "single payer".  He hooked on to that movement eons ago and never backed off.  When we stood side-by-side in Balboa Park, condemning our involvement in the Vietnam War, he was jotting down notes for a speech he was to give the following morning on National Health Insurance.  I don't know for sure, but I can't imagine that he was not one of Bernie Sanders' strongest teachers and backers.  Using his low-key sense of humor, he was very serious about the causes he espoused.  I don't believe that he ever achieved professorhood, but he was a professor to thousands of young people.  The sixties was our time because money flowed from Kennedy and Johnson's check books to Chicago and elsewhere.  One of my proudest moments was running the student health movement in Chicago in the mid-sixties with him, where an unbelievable number of health care programs and facilities originated, many of which are around (e.g. Mile Square) to this day.  My career recently led to my return to my roots at UIC,. The last time I saw him, I was proud to stand up with him as our presence was acknowledged by Dean Brandt-Rauf at a big UIC School of Public Health event at the Field Museum.  We hadn't seen each other since, but I always instinctively knew that his agile brain and unbelievable commitment to health care justice was keeping him active somewhere.  His physical presence will be missed, but his spirit and influence will be with us forever.
-Bruce Douglas, Professor, School of Public Health and College of Dentistry, UIC  

In early 1980 (maybe it was late '79) I attended a talk by Barry Commoner -- the Bernie Sanders of his day -- who was considering a run for President  (on a third party ticket against Carter and Reagan). Commoner gave a fine speech but I was more taken with the energetic young man who had Introduced him  -- a boyish and witty guy who spoke with passion in long compound sentences about the need for progressive change. He inspired me to introduce myself afterwards and I volunteered  to work in the campaign.

The man, of course, was Quentin, and he was not about my age of 28 as I'd thought from the back of the room, but as I found out later was more than twice as old. Quentin's youthful spirit was always to me his most prominent feature.

I ended up working full time for the Commoner campaign. Quentin was our spiritual leader and my political guru. There are lots if tales from that quixotic campaign but I remember the time he called to gently let me know that some people were concerned that the team of phone bankers I'd hired were members of a radical cadre devoted to one faction or another of a Chinese communist feud . I asked if they shoud be let go and he asked whether they were doing a good job on the phone. When I told him they were very effective he only said , "Good, then keep them." Quentin made sure the Citizens Party had a big (left) tent.

Anyhow, not  much came out of that campaign, at least not many votes in the election. But when I was out collecring ballot access signatures on North Avenue beach one Saturday, I met Myrtis, the love of my life. I give Quentin credit for that, and the three extraordinary daughters that resulted are part of the next generation of progressive activists that will help carry on his legacy.

-Marty Cohen

Quentin was such a giant influence on so many progressive health workers and his patients also. He is sorely missed. It is a great comfort though that so much of what he worked on is being carried forward by many more! Quentin Young, Presente!, Presente!, Presente!
-Tim K. Takaro, Professor and Chair, Simon Fraser University

We are all so much better for having known him. Certainly he will be missed, but will live on for all of us. He was always way ahead of most of us in terms of being on the right side of every issue. The man we would most like to be when we grow up.

-Jim Webster, Professor of Medicine Emeritus, Feinberg School of Medicine of Northwestern University

Quentin Young comforted the afflicted, and afflicted the comfortable.  His wit, political smarts, and deep humanity will surely always inspire the many who knew him.
-Ellen R. Shaffer, Co-Director, Center for Policy Analysis

We all thought he was immortal-- and somehow a world without QDY in it will lose the modicum of trenchant analysis of affronts to justice--presented civilly, rationally, passionately and eloquently. He was both mentor and monument to the successful way to bring about positive change.
-Karin Pritikin, Past Development Officer, Health & Medicine

I have been reminiscing a lot about Quentin, and remembering the first time I met him, which was in 1998, when he came to our community to help with our public health expansion effort. We spent the whole day together in meetings and events, and then when it was time for the Annual Awards Dinner, I brought him to the dinner, and I remember when he found out that I couldn't sit at the head table with him and he was really disappointed -- it was really sweet! He touched my heart. To see this sweetness from this fierce and dedicated and true activist was very touching.
-Claudia Lennhoff, Executive Director, Champaign County Health Care Consumers

Quentin was an unfailing source of energy and optimism.  When I worked on the newspaper HEALTH RIGHTS NEWS, he was the guiding light as well as the chairman of Medical Committee for Human Rights.  The most impressive event I attended was Quentin's 60th birthday party.  Person after person spoke and told how Quentin had founded the organization or campaign most dear to that speaker -- what seemed like all the Left organizations in Chicago and all the progressive medical organizations nationally.
-Judith Kegan Gardiner

Quentin gave a lecture for medical students at the U of Chicago. It was the only exposure we had to the problems with the economics of American health care. It was powerful and vital, and it informed my thinking and attitudes for the rest of my career.

Quentin also organized a meeting to keep radio station WFMT from using recorded advertisements.  It was so inspiring that I got up the courage to speak to a crowd of strangers. And it worked!

-Nada Stotland, MD, MPH

I will always respect him for his tremendous work in civil rights and equality especially in health care. Chicago is a much better city because of  his efforts for all of its citizens. I went to his talks and was personally and professionally enriched by his ideas.

My favorite memory of Dr. Young, however, is a personal one. He knew my husband for many years before we were married. When I was about 7 months, largely pregnant, with our son we were all talking and suddenly he asked me if he could rub my tummy. I, of course, said "Yes!" and this old as humankind, expression of reverence and joy for new life and a blessing for my son happened. I also think my son kicked him!

He will be missed by everyone.

-Margaret Aguilar RN, CNP

A great man will be missed. He was so passionate about the community at large and I was privileged to be a Schweitzer Fellow.
He invited us into his home and counseled us, guided us and taught us the true meaning of community health. Thank you Dr. Young.

-Gene Majka, MS ARNP

As a resident and junior attending in neurosurgery (1970s & 1980s)  I fondly recall presenting cases in his office in the back conference room, I believe on the second floor of the main building. As it was in the Department of Medicine it was not often neurosurgery presented there, but he was so friendly, congenial and genuinely happy I came there, and it was clear you were in the presence of a very special man. During the 1975 house-staff strike I was one of the few surgical residents (Surgical Department did not support the strike) to participate because I was on a laboratory research rotation, and fortunate to experience  Dr Young’s demeanor and role. Later he sent me several private patients from his Hyde Park office to be cared for at Cook County Hospital, and I was so honored to receive his patients, and provide feedback him after their surgery. I know of so many young physicians who were similarly impacted by the opportunities, and genuine confidence he instilled in them.
-James Stone

Quentin David Young was an extraordinary human.  But clearly I am biased by his many personal kindnesses and support to a young aspiring communist college activist and later as a medical student and still later as a resident and young physician.   Thank you for sharing your home and family with this outsider from NY.  Thank you for allowing me to get to know your children and feel some of their sorrow today.

Quentin’s presence was a constant provider of space for young physicians to develop progressive programs and ideas.  For over 60 years, he opened and stimulated debates on every socially progressive issue that was, either unpopular with or unknown to, the vast majority of physicians.  His participation in those movements was never without critique and differences in approach but the support was constant and committed.  On countless occasions, most unheralded and many without the knowledge of the beneficiaries, he provided interference and defense when the far more powerful enemy came knocking.   For his ideas, and not in small part for his support to others, he suffered a history of firings and exclusions extending from his sacrificial firing by Mayor Daley in the 1950s to the current day.   For this unstinting and unselfish support, his name and reputation became legend with all those movements confronting the status quo who understood Frederick Douglas’ famous quote that power concedes nothing without struggle. 

Yet through all the struggle and confrontations his ability to reach out and convince those on the fence or even in frank opposition never lessened.  I am sure the attendance at this memorial attests to these facts.  Thank you Quentin you will be missed.  It is comforting to note that as the movement continues to grow many will take your place but none replace you. 

-Peter Orris, MD, MPH

I was saddened to hear of the passing of Quentin Yoiung who has been such a catalyst for good during his entire educational and medical career.  I initially met Quentin when we were both members of the medical staff of Michael Reese Hospital, an institution very much in the mold of his view of health care delivery, which unfortunately eventually succumbed to "market forces." I was active in various south side public health efforts and served on Congressman Harold Washington's task force for greater access to medical services in his district.  As a Canadian medical graduate I had seen single payer work satisfactorily and not be a financial burden to the state.

I joined PHNP with the hope of advancing single payer, recognizing the huge impediment of the hundreds of members of the health care lobby  and the campaign spending of the pharmaceutical, health insurance, and hospital administrative staffs.  This was brought into sharp relief at a dinner hosted by Dr. Young in his Hyde Park apartment for the PHNP and Dr. Margaret Flowers, shortly after she had been jailed by Senator Baucus for demanding that single payer be "on the table" with a nascent Obamacare.  Glancing around the room at our group of predominantly older, tweed-jacketed, thoughtful physicians,  I imagined our little group oi thirty or so at one end of a football field and a herd of several hundred  pharma-insurance-MBA types at the other, and we were running to catch the football.  That   poignant fantasy has been rendered obsolete by the cheering crowds and multiple state primary wins by Bernie Sanders.  I am so happy that Quentin was present for this happy loud shouting for something he had long supported.   

-Charles N Swisher, MD

The life of Quentin Young had many facets over the years.  Our first meeting came in the fall of 1972 when I attended the monthly meeting of the Metropolitan Chicago Health Planning Agency.  He was a guest speaker who brought a special perspective to local and regional health issues.  We became much closer when, at the suggestion of the Director of the Illinois Department of Public Health, I met with Quentin to discuss my interest in joining the Board of  the Health and Medicine Policy Research Group, an association that lasted until 2014.  Quentin and I were sitting together in New York when he was elected President of the American Public Health Association, an honor he richly deserved.  His life has been a commitment to improving the life and health of those who through poverty or ignorance were destined to have lives filled with pain, anxiety and hopelessness.  He was always hopeful, fearless, and willing to make the effort to produce changes that would benefit everyone.  Of course we will miss him, but he has left a legacy of hope and commitment that will be a lasting contribution to all of us. 
-Benjamin Squires
Mar 10, 2016 Written By: Margie Schaps

Remembering the extraordinary intellect and moral compass of Quentin Young

Health & Medicine's Executive Director Margie Schaps shared the following statement on the passing of our founder, Dr. Quentin D. Young. Additional remembrances can be found on our blog. To make a gift in memory of Dr. Young, please click here.

“Margie, what have we done today to fight the forces of reaction?” This is how I was greeted every morning by my colleague, my mentor, my friend Quentin Young at the office we shared for over 20 years at Health & Medicine Policy Research Group, where I served as the Executive Director and Quentin was the Chairman.

We’d get to work each day, sometimes beginning with talk about the County health system, sometimes the state, sometimes the nation.  No matter what problem we were trying to solve, Quentin always had a quote from Shakespeare or George Bernard Shaw that would illuminate the issue. Only Quentin could pull up those quotes at exactly the right moment. He taught me that there were always lessons in great literature.

Our days would fly by…we’d write op-ed pieces together, we’d call our legislators, we’d plan a conference, we’d think of ideas for radio interviews he should have on his regular WBEZ talk show. We’d dream big and make plans, and grow our circle of colleagues every day. And did I mention that Quentin was funny—he knew so many jokes and he never tired of telling them, and I never tired of hearing them. 

Quentin’s extraordinary intellect, his moral compass, combined with his total recall of history always led us to a clear path as we tried to solve the challenges in front of us.  He taught me that the lessons of history should never be forgotten—that fighting for social justice, for racial justice, for health justice is not new. We must learn from struggles that came before us, learn from the failures, and build upon the successes.

Quentin taught me to always stand in solidarity with the struggles of working men and women, that no rally was too small to attend, that any opportunity to get our message across was worth taking, that every individual injustice is an injustice to all of us.  In his words, you could get a lot accomplished if you didn’t have to take the credit and if you linked arms with others in struggle.

I will keep up the struggle, Quentin, and I will link arms with the thousands of people you taught and befriended, and I will share the lessons you taught me.  I will do this, but some of the joy will be gone without you to share it with.


Mar 08, 2016 Written By: Mike Gelder

Lessons from Quentin Young: Bring equity into every decision

We're pleased to share a eulogy for our founder Quentin D. Young from founding Board Member Mike Gelder.

It was a beautiful spring day in St. Louis in 1972.  Another antiwar protest and demonstration was being held, this one at the McDonnell Douglas complex way out somewhere in St. Louis County.

As a graduate student in health care administration at Washington University, I would participate despite the transportation hassles and warnings from the very conservative faculty and hospital administrators who also taught our classes and had no interest in the Vietnam War and less in the protesters.

But, to me, this was no ordinary rally. The main speaker was going to be Quentin Young, a name I knew because of his leadership role with Medical Committee for Human Rights. MCHR was founded to provide medical support for Freedom Riders and others venturing into harm’s way in the 1960s to fight segregation in the south. Returning from those battles, Quentin helped it play an important role supporting radical doctors and providing an outlet for their political organizing around racial and economic injustice. And it offered a platform for Quentin to share his wisdom about the absolute necessity for current and wannabe physicians and health professionals to meld the “political” into being or becoming a health care clinician. 

I was especially excited because Dr. Young’s visit would give me the chance to meet him, and after some calls to the Chicago MCHR office ahead of the rally, interview him when it ended. I was a “health reporter” for KDNA, 102.5 FM, St. Louis’s listener-supported free-speech radio station. Having covered MCHR from a distance, the chance to actually interview its leader was a big coup.

During the speech, the doctor incredibly and eloquently tied together the shameful resources wasted on the country’s war effort, the death and destruction McDonnell Douglas airplanes were visiting on millions of innocent lives, the devastating health consequences for everyone throughout the southeast Asian peninsula, and the urgent need for all like-minded citizens to do everything in their power to stop the madness. Quentin and I got into the back seat while my friend Pete, the MCHR chapter president, drove Quentin back to Lambert Field for his trip home to Chicago.  

Unlike a lot of relationships that begin in back seats of cars, this one lasted nearly 45 years. Quentin, in his inimitable style, laid out for my KDNA listeners and me the thesis for why doctors (and by extension everyone in the health care field) must become political activists if they have any hope of helping their patients. In less than 30 minutes, he covered the abolitionist movement, women’s suffrage movement, civil rights movement, free speech movement, and the anti-war movement, always emphasizing the power of the “movement” over individual efforts. Quentin explained that nothing significant happens without large groups demanding change, and most of those movements appeared futile to those in the struggle until they prevailed. Throughout the discourse he quoted Aristotle, Dante, Shakespeare, Machiavelli, George Bernard Shaw, and a host of others, who I didn’t recognize at the time.

In that short car ride, Quentin revealed the few, simple truths that guided him and, by word and deed, he passed on to the next generation of health care providers and leaders: Changing the world is not easy, no one is going to give up power without a damned hard struggle, individuals must work together across race and class to overcome the incredible obstacles, but victory is ours to achieve if we keep up the fight long enough.  And if we don’t have the answer at hand, there’s a quote from a classic or contemporary play that will guide us toward it.

I knew in that car ride that this man needs a platform. His attitude and insights were unique. His role a few years later, as head of Medicine at Cook County Hospital, provided that perch for a while until the bureaucratic exigencies distracted too much from his work establishing Cook County neighborhood health centers in the poorest communities in Chicago.  There, young doctors and those still training could learn first hand what life was like for the patients they would treat.

And as that chapter came to a close, Quentin conspired with another mentor of mine, John McKnight, a professor at Northwestern University, and others to form a group that would hold the health system in Chicago accountable for helping keep people healthy. To be truly independent, it couldn’t be tied to an academic center, or any other institution that relied on “establishment” funding. That’s why so many of us were attracted to what became the Health and Medicine Policy Research Group. It was an opportunity at least once a month to get the exposure to Quentin we needed to be effective watchdogs, to hone our analysis to support what helps people and oppose what only helps the health system.  As that next generation moved along with our careers, that monthly “dose” of Quentin helped us get through our work days and direct our energy for the long battle ahead.

Whether board members always agreed with Quentin or not, we were overwhelmed with his incredible understanding of history, his thorough knowledge of the classics and his uncanny ability to apply their lessons to contemporary problems and commitment. He saw the issues of race and class as central to organizing and long before “social determinants of health” emerged in our vocabulary Quentin knew that “wealth makes health” and political organizing, education and jobs are just as important, or perhaps, more important to well-being than medicine. We learned from this sage to never, ever give up before winning. If you haven’t “won,” the battle is not over. His eternal optimism could be horribly frustrating if you simply wanted to whine or pout about the unfairness of it all. But that was who he was, our King Arthur, a true believer in right makes might.

When I saw Quentin several times last year at his daughter’s bright sunny home in California, where he had moved to be close to his family, he wanted to hear a thorough analysis of Illinois politics and how his good friend and single-payer compatriot, Pat Quinn, lost to the malicious Republican. Even as he was slowing down, he had little interest in looking back but wanted to hear every detail of what we were doing to prepare for the next election in four years. Despair was not in his repertoire. 

So now as we contemplate the struggle without Quentin, with us leading the charge, we are grateful for the long years we had together. We know that our exposure to his strategy, tactics, and most importantly his eternal optimism, makes us better people, better prepared to carry on the battle and right the wrongs about which Quentin cared so deeply.

We know how much work there still is to do to bring equity into every decision about resources, and to ensure that those facing the greatest challenges can achieve and maintain good health.  And all of us can draw from that reservoir of knowledge, confidence, humor, and optimism to guide us to victories.

Feb 17, 2016 Written By: Wesley Epplin

Key Lessons from Health & Medicine’s Budget Forum

On January 15, 2016, Health & Medicine hosted a meeting of The Chicago Forum for Justice in Health Policy: Creating a New Vision for Illinois’ Budget. Health & Medicine has put together forum proceedings notes as a reference guide for the forum’s content.

Our notes are written as a summary and while they can’t fully capture the presentations, videos of each of the five mini panels are available on the event webpage, as are slides from speakers who used them in their presentations. We thank CAN TV for recording, editing, and sharing videos of the forum, extending the potential impact of our panelists’ presentations.

We hope these notes will be useful for advocates and policymakers seeking to understand issues related to the budget, think about potential revenue solutions, and consider strategies, framing, and narratives likely to advance progress.  Health & Medicine will be convening a small group soon to review the forum proceedings and discuss next steps for our work on this critical area, which we’ll share on our website.

While the budget problems and solutions are more complex than this, here are some main points that have emerged for me from conversations and from the presentations and discussion at the conference:
  • Illinois lacks sufficient revenue, which represents a structural budget problem, priming the state to have recurring budget shortages and hampering our ability to provide Illinoisans with the public services they need and want, thus harming the health of the public, and disproportionately harming vulnerable communities.
  • The structural budget problems have several potential revenue solutions, including a progressive income tax structure and efforts to ensure corporations pay their fair share, both of which are more equitable than our current system and would better grow revenue in proportion to the size of Illinois’ economy.
  • State elected officials are collectively responsible for passing a budget and using a selection of revenue solutions that will help preserve and improve the vital health, social, and education programs and services that support people’s health and Illinois’ economy.  Inaction on the structural revenue shortages that Illinois faces is an unacceptable abdication of the governing duties our public officials share.
Of course, these salient points are based on a range of facts and history about Illinois’ taxes and budgets, beyond the scope of this post.  A significant amount of such relevant detail is covered in the forum proceedings notes, as well as the slides and videos on the event webpage (linked to above).

Also, related to this subject, Health & Medicine’s Executive Director, Margie Schaps, had two letters focused on Illinois’ budget published in the last couple of weeks:

Jan 22, 2016 Written By: Martha Holstein

A Rebuttal: What Conservatives Get Wrong About Social Security

If you watched the recent, Republican debate, you heard New Jersey Governor Chris Christie tell it “like it is” about Social Security.  Reforming, that is weakening, entitlements but especially Social Security, has become a centerpiece of the governor’s platform and a demonstration of his fearlessness.  His claims: Social Security is in crisis; most younger people today don’t believe that it will be there when they retire, diverting a portion of our FICA taxes earmarked for Social Security to private accounts is essential; the current surplus (Social Security intake vs. output), known as the Trust Fund, and invested in interest-bearing T-bills were worthless pieces of paper since that all that money had already been spent.  Thus, he maintained, it was essential to raise the age of eligibility for full Social Security benefits and to modify how the cost of living adjustment (COLA) is calculated.  He further claimed that he is the only politician who is telling a straight story about Social Security and its problems. Cutting entitlements, labelled more acceptably as entitlement reform, is also defended as a way to reduce the deficit.

As noted in a previous blog post about Social Security, most of these ideas have been in circulation for over 30 years.  In the 1980s, the attack on Social Security—probably the most popular and successful program ever created by the U.S. government with support across the political spectrum and across all age groups—were far from subtle.  Old people were “greedy geezers,” robbing children of their right to a secure future.  Americans for Generational Equity (AGE) built its entire platform around this purported unfairness.  It’s no surprise since Social Security represents the proverbial elephant in the room for conservatives—a large public program that is administratively simple, cost effective, essential for the well-being of individuals and families, and favorably viewed even by many Tea Party adherents. President Bush’s second term agenda to partially privatize Social Security gained no traction as many retirees and future retirees saw what a plunge in the market could do to their lifetime savings.

Lacking the opportunity to challenge Governor Christie immediately following his remarks, I take the opportunity to do so now.  This task—challenging comments such as Governor Christie made—should be part of any liberal’s political agenda.  His remarks (straight out of the neoliberal playbook) reflect the view that individual effort rather than government represent the best ways to address economic and social needs. The neoliberal goal is to privatize everything that can be privatized; Social Security privatization would be a huge prize achieving twin conservative agendas.  It would be a boon to Wall Street for that money would need to be invested somewhere. It would show that conservatives were doing something about reforming entitlements, an agenda that has also unfortunately become part of their conventional wisdom. 

If I had a chance to confront Governor Christie, I make the following points:

Social Security is in Crisis   
The Social Security Trustees estimate that around 2034, if nothing is done, Social Security will only be able to pay 75% of earned benefits to beneficiaries. Predictions made that far into the future are always iffy because they can’t account for the size of the workforce, immigration, or other unknown factors.  But let us accept the estimate.  Does that create a crisis for which otherwise unacceptable responses are necessary? I submit that the answer is no.  Here’s why: rather than reduce benefits that would be particularly damaging to single women, women of color, and low-earning men, the National Academy of Social Insurance, Social Security Works, and other national organizations that have as their goal a strong, responsive Social Security program have proposed modest changes in revenues as a means to narrow the anticipated future gap between income and expenditures. This would be done by increasing the payroll taxes in a way that protects low earners and through lifting the income levels at which one continues paying Social Security taxes.

These solutions are not radical; they would protect low earners and would go a long way to solving the anticipated shortfall. Because earnings at the top have grown so much, more and more people are exempted earlier and earlier from paying FICA taxes.  Some maintain that the ceiling should be eliminated completely while others propose that it be set at 90% of payroll where it has historically rested. It might also include unearned income that is now exempt from payroll taxes. These approaches, which focus on revenue, should be relatively easy to manage for most people and are supported by a majority of those polled.  They are, however, ruled out by the conservative anti-tax agenda. Because, Social Security is legally required to pay out only from what it takes in, politicians like Chris Christie have nowhere to go but benefit cuts achieved primarily through raising the age for full retirement and going to the chained CPI for calculation of the COLA.  

Younger People Believe it Won’t Be There for Them
In the early 1980s, two researchers at the Cato Institute, a libertarian think tank, published a paper that focused on undermining popular support for Social Security by predicting its demise. In this way, they reasoned, younger voters would act in their self-interest and support efforts to privatize it or change it in other ways.  The result of this strategy was not what they expected.  Although many younger people believe that it won’t be around when they need it, their response, according to polling data, is to support whatever changes are necessary to assure that it will be there.  Hence, younger voters support both major revenue enhancers noted above.  The future survival of Social Security is a political and not an economic problem.  Conservative efforts to undermine political support have so-far failed.

Privatization
The first practical problem with privatization is implementation.  If any portion of the FICA taxes are diverted to private accounts, the gap between what Social Security takes in and pays out in benefits will widen significantly, thus adding to the crisis mentality. But, perhaps most importantly, private accounts are risky (recall 2008 when retirees and near retirees lost as much as 40% of their retirement savings); they serve high earners (people making more than $100,000 a year) far better than others as demonstrated by the uptake of 401 (k) plans—a program the Reagan administration introduced to enhance comfort with private plans but also to permit savings that reduced one’s tax burden. Financial illiteracy, retirement advisers who put their interests ahead of their clients (efforts by the Consumer Finance Protection Agency to halt this practice are strongly opposed by Republicans in Congress), and the volatility of the market make privatization a bad bet for any but the affluent. 

The Social Security and Trust Fund Consists of Worthless IOUs
This theme, embraced by President Bush and other conservatives, on the surface may make sense. The surplus of intake over output of FICA taxes, is not placed in the “lockbox” we often heard about in the Bush-Gore presidential race. Instead it is invested in interest-bearing T-bills, backed by the U.S. government.  The money is then used to support other programs and services as is any money that the government borrows. But that fact does not mean T-bills are “worthless” IOUs.  If that were so it would be true for any individual or country, like China, that heavily invests in U.S. securities.  If T-bills are worthless, that is, unavailable to be redeemed when needed to pay Social Security benefits, then they are also worthless when China wants to sell off its holdings.

Social Security reforms passed in 1983 and designed by a commission that Ronald Reagan appointed deliberately created the surplus in anticipation of the time when Baby Boomers would retire.  These reforms, which gradually raised the age for full retirement, have already resulted in benefit cuts for Baby Boomer retirees. Ironically, this move made to anticipate the surge of retirees, is now being used to justify further cuts to benefits. Rather than be seen as an asset, anticipatory planning becomes a liability in the neoliberal political environment.

Conclusion
In my next post, I will turn to the relationship of entitlements, especially Social Security, to the deficit and also look further into the implications of cashing in the T-bills if and when that is needed to finance benefits. For now, I hope that the above has offered suggested directions for arguments against Chris Christie and so many others, including some liberals, who have adopted the now-conventional idea that entitlement reform is essential.  This idea has become so widespread that its proponents no longer feel the need to offer any defense of their position because it is what “everyone knows,” everyone except legislators like Elizabeth Warren, Sherrod Brown, Jan Schkowsky, and others who argue for enhancing rather than reducing benefits.  For further information, take a look at Social Secuirty Works by Nancy Altman and Eric Kingson and the websites of Social Security Works (www.socialsecurityworks.org) and the National Academy of Social Insurance (www.nasi.org). 
Jan 08, 2016 Written By: Sharon Post

Health & Medicine at CBHA

In December I attended my first Community Behavioral Healthcare Association (CBHA) conference. I saw a few old allies, a handful of new partners from our Learning Collaborative, and made some new contacts. As the Center for Long-Term Care Reform continues to wade into the choppy waters of behavioral health policy, I wanted to share a few of my reflections from the 2015 CBHA conference:

1. Make data meaningful. Data is how we communicate, and how we communicate matters.
  • Laura Galbreath from the National Council reminded us that data analytics are the key to identifying community needs, measuring the success—in terms of both quality outcomes and total costs—of preventive interventions, and thereby fulfilling the promise of population health approaches.
  • Tia Goss Sawhney of Milliman pointed out that access to care isn’t assured by federal rules alone, and we need to advocate for reimbursement in the context of access requirements. We get what we pay for, and we need to pay more attention to what we pay for, how we pay for it, and whom we pay to do it so that we can find ways to improve incentives and align reimbursement with our goals of quality, access, and integration.
  • Joseph West from NextLevel Health reminded us that the current state of data analytics is pretty lousy. State data and data systems are woefully inadequate to support care coordination. Insurers’ data dashboards collect claims data but have not yet mastered connecting those data to real time demographic data that help us understand the populations we serve. Without this information, we can’t identify what’s driving poor outcomes and costs, develop a strategy that makes sense for that community, or show the value of those interventions.
  • We have to understand populations to manage their health, but as John Lyons from Chapin Hall reminded us, you manage what you measure. So if agencies are measuring state licensing requirements, that’s what they will manage. And if the only data providers give to the State is about billing, then State agencies will manage bills (i.e. make cuts). State agencies in particular need to collect and use data in a way that tracks clinical and functional outcomes and measures the value of the programs they pay for, rather than for auditing and licensure compliance checks.
  • We heard about innovative programs that are getting results in the Quad Cities, Dixon, Lawndale in Chicago, and Franklin County. If something does work, payers, providers and advocates need to do a better job identifying the foundations of success, who is going to invest in it, and who is going to actually do it.
2. Promise of breathtaking transformation in the state behavioral health system. Despite the current budget impasse and the damage it has done to Illinois’ behavioral health infrastructure, the state agency directors on the State Direction panel spoke hopefully about the unprecedented level of collaboration among their departments and the system reform that is coming in 2017. We’ll be keeping our eye out for news of those big changes in the new year.

3. You’re gonna die… It’s jarring to hear that but we say it all the time when we cite research that shows a shocking disparity in mortality for people with serious mental illness. Instead of saying, “If you have mental illness, you’re going to die 25 years earlier than other people,” we need to  shift the focus to the system failures that actually underlie this statistic, and what we can do to reverse it. For a start, I think it could be as simple as saying, “People with mental illness lose, on average, 25 years of life due to our failure to provide quality, integrated health care,” and then talk about what we can do about it.

4. Marvin Lindsey! This was my first every CBHA conference and it was Marvin’s first as CEO. Marvin has been a great supporter of Health & Medicine’s Learning Collaborative from the very beginning (when it was just an idea I shared with him at a West Loop coffee shop). One of the qualities that define Marvin for me is his insuppressible joy in the face of enormous challenges, a joy that does not take away from the seriousness with which he approaches the mission of community behavioral health agencies and strengthens the resolve of everyone around him.
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