by Annee von Borg, MSW, MPH
Since Governor Kitzhaber has been non-responsive to Resources for Health’s youth-led H2Origami campaign in cooperation with Keep Nestlé Out of the Gorge Coalition’s larger effort, I was most pleased to find the opportunity to ask his Assistant Health Policy Adviser Sean Kolmer some pointed questions at the Kaiser Permanente Community Fund breakfast panel discussion on May 21, 2012.* Although he could not speak directly to the Governor’s position on Nestlé’s proposed bottling plant in the Columbia River Gorge, Mr. Kolmer’s answers revealed that a strong position against the Nestlé should follow naturally from the Governor’s health care transformation plan’s focus on social determinants of health. The plan promises to provide a win-win solution addressing both employment and environmental quality issues pertaining to Nestlé’s proposed bottling plant in the Columbia River Gorge.
Mr. Kolmer addressed an audience of approximately 300 Community Fund grantees, community partners, Kaiser Permanente executives and advisory board members, as well as selected guests from the health care, business, philanthropic, and public sectors to explicate Governor Kitzhaber’s proposed health care “transformation,” emphasizing how it will
- change the focus of the system from delivery of health care to delivery of health
- act with intentionality to deliver health outcomes
- incorporate social determinants of health into the health care model
Full appreciation of this third focal point – social determinants of health – is critical to understanding how the Governor’s commitment to health equals a commitment to the environment from which logically follows a strong position against Nestlé’s proposed water bottling plant in the Columbia River Gorge.
According to the World Health Organization, social determinants of health are “the circumstances in which people are born, grow up, live, work and age,” affecting “a wide range of health, functioning, and quality-of-life outcomes and risks” (US Department of Health and Human Services). These determinants include, but are not limited to
- Access to healthy food
- Public safety
- Employment / Economic development
- Environmental exposure / environmental quality
Research informs us that social determinants of health account for almost 80% of our health outcomes while access to health care accounts for only around 10% of health outcomes (KPCF). These conditions in which we live – our access to social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships – “explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be” (US Department of Health and Human Services). These conditions also explain in part the continued decline of America’s overall health and consequent escalation of our health care crisis.
“Action on social determinants to reduce health inequities” – and to improve the overall health of the population – “requires long-term, sustained implementation.” (WHO) Long-term implementation requires long-term vision to assess which programs, policies, and positions will improve conditions for generations to come while balancing the needs of the current generation in crisis. In the case of Nestlé’s proposed plant in relation to social determinants of health, the Governor must weigh the promise of possible short-term improvement in the area of employment/economic development with the certainty of long-term resultant degeneration of environmental quality and the possibility (probability?) of jeopardizing the safety and/or availability of a natural resource: water, the source of life.
Reflecting on the situation in Cascade Locks and our group’s recent visit to the capitol, I asked Sean Kolmer how the Governor’s plan would, in general, balance the social determinants of health perceived as immediate needs (such as employment) with those viewed as longer-term needs (such as environmental quality and protection of natural resources), especially during an election year when “jobs” is a buzz word?
Mr. Kolmer’s response indicated that, under the Governor’s health care transformation plan, it will not be necessary to choose between meeting immediate employment demands and addressing longer term environmental quality concerns. The system’s shift in focus from delivery of health care to delivery of health will itself create job growth as a new work force develops to fill the void, with thriving opportunities for employment expected. By making an economic investment to change the focus from health care to health, the Governor’s plan will create employment opportunities in the process.
From this response I understand that the community of Cascade Locks’ need for jobs should not compromise the Governor’s commitment to environmental quality and natural resource preservation, nor vice versa. In fact, his new health care plan itself ultimately could provide a number of jobs meeting or exceeding the 50 positions promised by Nestlé. My understanding is that Kitzhaber’s health care transformation plan holds promise to help a community in need of jobs to find solutions that do not lead to the environmental degradation of scenic areas and place our natural resources in jeopardy, but instead promote health. It seems the Governor does understand, as I stated to the media, that water is a basic human need, while jobs are one means to meet that need. Nestlé’s proposed jobs are not a sustainable means to meet needs when a bottling plant places plastic and pollution between humans and the source of life.
According to the US Department of Health and Human Services, examples of “resources that enhance quality of life” and “can have a significant influence on population health outcomes” include “safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins.” A health care plan should not require the sacrifice of one resource to choose another. Fortunately for Oregonians, Kitzhaber’s health care transformation plan provides a win-win solution to address both the employment and environmental quality issues pertaining to Nestlé’s proposed bottling plant in the Columbia River Gorge. Given this win-win, health-promoting solution, it logically follows that Governor Kitzhaber will take a strong position against Nestlé’s proposed water bottling plant in the Columbia River Gorge to address social determinants of health and to protect the long-term health interests of the citizens of Cascade Locks, Oregon, and beyond.
WHEN & WHERE: May 21, 2012 at the Lloyd Center Ballroom
WHAT: Kaiser Permanente Community Fund breakfast panel discussion:
“How to Improve the Social Determinants of Health in Our Community”
Six diverse community leaders discussed “ways to promote health in our region through strategies that improve sectors such as housing, education, economic development, environmental quality and access to nutritious foods.” These expert panelists included
• Sean Kolmer – Assistant Health Policy Adviser for Governor Kitzhaber
• Victor Merced – Executive Director of Hacienda CDC
• Tina Castanares – Medical Director, Providence Hospice of the Gorge
• Bruce Watts – Interim Executive Director, Urban League of Portland
• Maxine Fitzpatrick – Executive Director of Portland Community Reinvestment Initiatives
• Marcello Bonta – Executive Director of the Center for Diversity and the Environment
WHO: In attendance were approximately 300 community fund grantees, community partners, Kaiser Permanente executives and advisory board members, as well as selected guests from the health care, business, philanthropic, and public sectors.
Annee von Borg, MSW, MPH is a Director at Resources for Health, a Hillsboro based nonprofit empowering citizens to care for their health, the environment, and their communities. She earned her Master of Social Work degree from Columbia University, and her Master of Public Health from Yale University with a concentration in Health Policy and Administration. Committed to social and environmental justice and stewardship, she is also a homeschooling parent of five and carfree family matriarch of Hillsboro’s cycling seven, dubbed “suburban bike ninjas” by the 2012 BTA Alice Awards.