Let’s carve a stake to drive into the heart of health promotion and prevention strategies that exclude sexual health as a vital and normal part of human health and health care. As a first step, you can speak up in the U.S. Health and Human Services’ process of developing a national prevention plan.
President Obama formed the National Prevention, Health Promotion, and Public Health Council in June 2010. The council posted a draft plan for moving “from a focus on sickness and disease to one based on wellness and prevention.” The goals include healthy communities, preventive clinical efforts, and empowered individuals. The four Cross-cutting Strategic Directions include:
- Healthy Physical, Social, and Economic Environments
- Eliminate Health Disparities
- Prevention and Public Health Capacity
- Quality Clinical Preventive Services
Complementing those Strategic Directions are six Targeted Strategic Directions:
- Tobacco-Free Living
- Reduce Alcohol and Drug Abuse
- Healthy Eating
- Active Living
- Injury-Free Living
- Mental and Emotional Wellbeing
You know what is missing. The National Healthy People goals for 2020 include specific objectives for family planning, sexually transmitted infections, maternal and child health, and adolescent health. In Wisconsin, our Healthiest Wisconsin 2020 goals include normalizing sexual health as well as objectives to reduce maternal and child health disparities related to sexual health risks and access to care.
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But in the National Prevention, Health Promotion, and Public Health Council draft, we have a “Waist-up Wellness” model that seems timid about even mentioning sex. There are a few references to testing and treatment of HIV and AIDS or other sexually transmitted infections, but they are buried in the subsections. If, as the plan asserts, we are going to “expand and connect prevention-focused health care and community prevention efforts,” and if we are going to “empower and educate individuals to make healthy choices,” then reproductive health and family planning clinics and providers must be a component of the transition.
By “Component” I don’t mean a sub-goal vaguely referenced. How about a specific and explicit Targeted Strategic Direction titled “Sexual Health and Wellbeing?” Paraphrasing a few recommendations from the existing targeted strategic directions, the recommendation for Sexual Health and Wellbeing might include:
- Use media and social support (e.g., social networks, shared space) to empower individuals to make responsible and well-informed choices about sexual health.
- Expand opportunities for health within communities and populations at greatest sexual health risk.
- Conduct research on promising strategies including research on reducing unintended pregnancy rates and measureable results for community-based and other types of reproductive health services.
- Establish and maintain clinical practice standards for preventive reproductive health services to encourage continuous improvement and collaboration across health care provider entities and types.
- Expand interoperable health information technology, including telemedicine and patient health records that are affordable to community-based primary prevention clinics and accessible to patients in rural areas.
- Strengthen capacity to control and prevent sexually transmitted infections and to effectively respond to outbreaks in communities.
- Protect the right of patients to choose a willing and qualified provider for the sexual health and family planning care they want and need.
- Link community-based reproductive health prevention services with clinical care, acknowledging that technological innovation will increasingly integrate patient health records and telemedicine so that for a patient, a “Medical Home” is not a place, but a care coordination concept. In sexual health, the patient is probably the best coordinator.
These are the four main points of consideration that I am inviting you to emphasize to our decision-makers and within our community of advocates and health care providers:
1) The right to confidential reproductive health doesn’t mean very much without access to confidential, affordable, comprehensive, competent, and willing health care providers.
2) When it comes to providing sexual health care, the realities are: sectarian provider institutions — gaps in insurance coverage — practitioners exercising a ‘right of conscience’ over their patient’s need for comprehensive care — and established institutions looking for ways to limit access to a full range of reproductive health care.
3) While the Patient Protection and Affordable Care Act will help, the right to choose a willing and capable sexual health care provider is still best left in the hands of the patient and not the private HMO, government regulation, or a hospital’s health information network. On a broader scale, the realities of a primary preventive health care delivery system with an existing and predictably continuing shortage of practitioners with extensive reproductive health care training and experience demands that we protect the existing infrastructure of family planning clinics and use technology to link it with other primary care providers.
4) Sexual health has been uniquely constitutionally-protected because reproductive self-determination is a core human right and because sexual behavior and decision-making is an extremely personal matter. Forty years ago, when legislators permitted Medicaid to establish managed care organizations, the regulations protected the right of patients to choose an out of plan reproductive health care provider. Sexual health lends itself to care models (such as individual Patient Health Records) which enable and empower patients to make their own choices. Advocates, community health providers, and public health policy-makers, must recognize that upholding the right of a patient to choose her own community provider or her own method or her own nurse practitioner is not only good policy — it leads to the best health results.
I hope you will take a few minutes before January 13th and go to http://www.hhs.gov/news/reports/nphps.html. Read the National Prevention and Health Promotion Strategy draft. Pick up that Boehner-sized mallet and help me drive that stake home.