With healthcare reform high on President Barack Obama’s agenda, issues related to health policy are suddenly in the national spotlight. The annual minority health policy meeting, sponsored by the HMS Office for Diversity and Community Partnership, directed by Joan Reede, gives a preview of future leaders who are already contributing to the national conversation.
At this year’s practicum presentations, held on May 7, fellows and alumni from the Commonwealth Fund/Harvard University Minority Health Policy Fellowship and the California Endowment Scholars in Health Policy program provided a broad view of the way health inequalities affect different populations. The program also included poster presentations by Dana-Farber/Harvard Cancer Center junior investigators and culminated in a keynote address by Regina Herzlinger.
Fellows’ presentations tackled policy change from the local to national and even international level. Thomas Halligan, a Commonwealth Fund fellow, reported on a policy brief he wrote describing immigrants’ access to healthcare in Massachusetts. He used the results of surveys conducted by the Blue Cross Blue Shield of Massachusetts Foundation (BCBSMA) along with national data. The project, he said, combined his professional experience as a physician at a community healthcare center in California with his desire to learn more about how advocacy groups promote change. According to the BCBSMA surveys, even in the wake of healthcare reform in Massachusetts, immigrants still disproportionately lack health coverage and access to quality care as compared to native-born residents, making immigrant healthcare a priority for the foundation. After studying this data, Halligan began looking for ways to advance the foundation’s priorities, landing on the New Americans Agenda, an initiative to better integrate immigrants into economic and civic life that has been launched in several states, including Massachusetts. He attended community meetings on the initiative and identified intersections between BCBSMA’s priorities and those of the state government. In his brief, he pinpointed strategies to integrate the objectives of these two parties, made policy recommendations for the foundation and suggested next steps.
Taking a more global approach, Sanjeev Sriram, another Commonwealth Fund fellow, presented a policy analysis of the U.N. Convention on the Rights of the Child (CRC), which spells out basic human rights for children and sets standards in healthcare; education; and legal, civil and social services.
Near the beginning of his talk, Sriram dropped an illuminating statistic: “As of today, the United States and Somalia are the only two countries who have not ratified the CRC.” His practicum explored the political and cultural reasons the U.S. has failed to ratify the treaty and ways to overcome these objections through the use of the legal tools known as reservations, understandings and declarations (RUDs). Sriram found that opponents of the treaty have political concerns, such as interference in U.S. federalism and sovereignty, and cultural concerns, such as the undermining of parental authority. Though some critics fear the use of RUDs would “declaw” the treaty by creating stipulations, Sriram argued that ratification needed to be viewed differently. “It is not so much a defining victory as the start of a developmental process in our policymaking,” he said. His work demonstrated that ratification of the CRC would help the efforts of child advocates and policymaking, especially as health disparities continue to grow.
In her keynote address, Herzlinger, the Nancy R. McPherson professor of business administration at Harvard Business School, shared her vision of the future of healthcare, which she calls “consumer-driven healthcare.”
“The U.S. healthcare system is a very bad value for the money,” she said. She described a system in which individual consumers, not employers, purchase health insurance, picking the kinds of medical services they want. Citing Switzerland as a model for a consumer-driven system, Herzlinger described how that country makes it work and how it can be translated for the U.S. At the end of her talk, she challenged the fellows to be the visionaries who will create a whole new healthcare industry.
