Mar. 1, 2013 OHA Director's messages on the web
To: All OHA employees
From: Bruce Goldberg, M.D., Director

Big audacious goals

"All who have accomplished great things have had a great aim, have fixed their gaze on a goal which was high, one which sometimes seemed impossible." ~Orison Swett Marden

Dr. C. Everett Koop died this week at the age of 96. His passing has reminded me of the importance of setting big goals. During his tenure as Surgeon General in the 1980s he made it his personal mission to create a smoke-free America by the year 2000.

We know we didn't quite reach his goal but we did see great gains during his tenure.

Nearly 50 years ago one of Koop's predecessors issued the first Surgeon General's report that said smoking is deadly. Tobacco use became the most prominent public health issue of the 20th century. At that time, 46 percent of Americans smoked cigarettes and the surgeon general's report landed like a bombshell, changing the public's understanding of the effects of a habit that was an integral part of daily life.

Since then smoking rates have dropped to about 20 percent.

And I remember how dramatically things changed during Dr. Koop's tenure from 1981 to 1989. During that time 40 states banned or restricted smoking in public areas – places like office buildings and hospitals. Even though we didn't reach his no-smoking society goal, the fact that he had a goal gave us all a north star to point to. And when the AIDS epidemic was ravaging our communities, he challenged conventional wisdom at the time and spoke both eloquently and passionately about AIDS as the health issue it was.

The public health challenges of the 21st century – from obesity to health disparities to violence prevention – are going to require us to be equally visionary and aggressive in our approaches. In fact, even more so because we can't wait two generations to make the improvements we need.

I believe this is possible. In Oregon we have changed the conversation about health care and by changing the conversation we are changing expectations. Things that once were reality become inconceivable. I remember when smoking used to be so commonplace that patients smoked in their hospital beds – orderlies would dump out their ashtrays as part of patient care! Today that's inconceivable.

Conversely, things that once were inconceivable are becoming reality. For example, a health care system dedicated to improving the public's health. A system that focuses on health and preventing illness rather than treating disease will become the norm.

Success will come from setting big goals, measuring our progress toward those goals, and holding ourselves accountable to those goals.

That's why as part of the Medicaid transformation, Oregon is accountable for 33 quality metrics – or health measures – that we will be tracking in the years to come.

We will have specific targets for metrics we want to reduce: tobacco use and obesity rates of OHP members, hospital readmission rates, and low birth weights. And for those we want to increase: screenings for clinical depression and rates of primary care use. You can learn more about all the metrics here. The bottom line is that if we don't meet benchmarks for those metrics, we face serious financial penalties.

That's a great start. But we need to think bigger. We want to lean into the big audacious goals we are setting for ourselves. We don't have half a century to address all the public health concerns before us. The time for action is now.

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