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THIS IS NOT YOUR FATHER’S HEALTHCARE SYSTEM By Douglas Ratner, M. D THIS IS NOT YOUR FATHER’S HEALTHCARE SYSTEM By Douglas Ratner, M. D

INTRODUCING The wealth from the health program The Environmental house call program The hospital INTRODUCING The wealth from the health program The Environmental house call program The hospital without walls program

Recommended Competencies for Environmental health Practitioners Ø Assessment Ø Management Ø Communication Recommended Competencies for Environmental health Practitioners Ø Assessment Ø Management Ø Communication

Assessment Ø Information Gathering: The capacity to identify sources and compile relevant and appropriate Assessment Ø Information Gathering: The capacity to identify sources and compile relevant and appropriate information when needed. Ø Data Analysis and Interpretation: The capacity to analyze data, recognize meaningful test results, interpret results, and present the results in an appropriate way to different type of audiences. Ø Evaluation: The capacity to evaluate the effectiveness or performance of procedures, interventions, and programs.

Management Problem Solving: The capacity to develop insight into and appropriate solutions to environmental Management Problem Solving: The capacity to develop insight into and appropriate solutions to environmental health problems. Ø Project Management: The capacity to plan, implement and maintain fiscally responsible programs and projects using skills and prioritize projects across the employee’s entire workload. Ø The capacity to use Computer and Information Technology Ø The capacity to produce reports to document actions, keep records, and inform appropriate parties. Ø

Communication Educate public on environmental health issues. Ø Communicate risk and exchange information with Communication Educate public on environmental health issues. Ø Communicate risk and exchange information with colleagues, clients, policy makers and media through public speaking, print and electronic media and interpersonal relations. Ø Conflict resolution within the agency, in the community and with regulated parties. Ø Marketing: To convey the concepts, importance and value of environment and public health to clients and public. Ø

Environmental House Call Program Ø Target Audience Ø Environmental House Call kits. Ø Environmental Environmental House Call Program Ø Target Audience Ø Environmental House Call kits. Ø Environmental House Call Home visit.

Target Audience Ø Ø Ø Ø Pulmonary and Allergy patients. Cancer prevention Neurological problems Target Audience Ø Ø Ø Ø Pulmonary and Allergy patients. Cancer prevention Neurological problems like chronic headaches. Cardiac conditions like angina exacerbations. Renal failure. Gastrointestinal problems such as nausea and constipation. General such as fatigue, myalgias and unexplained malaise.

Environmental House Call Kits Environmental House Call Kits

Allergen control kit Ø Audio cassette. Ventpro TM-heating vent filter. Treated dust cloth. Vacu-filt Allergen control kit Ø Audio cassette. Ventpro TM-heating vent filter. Treated dust cloth. Vacu-filt TM-vacuum cleaner filter. Filtrete TM- air conditioner filter. Allergy Control pillow cover. Electronic carbon monoxide analyzer. Ø Allergy Control product material with coupons. Ø Ø Ø

Indoor Pollutant Control Kit Ø Audio Cassette. Electronic carbon monoxide detector. Lead-in-dust test kit. Indoor Pollutant Control Kit Ø Audio Cassette. Electronic carbon monoxide detector. Lead-in-dust test kit. Lead-in-water test kit. Lead-in-paint analysis. Radon alpha track canister. Ø Microwave leakage indicator. Ø Ø Ø

Safety Control Kit Ø Ø Ø Ø Ø Cord windups (2). VCR lock. Auto Safety Control Kit Ø Ø Ø Ø Ø Cord windups (2). VCR lock. Auto swivel outlet cover. Dual outlet covers (6). Switch locks. Oven lock. Stove knob covers (4). Cabinet and drawer latches (7). Medicine cabinet latch. Ø Ø Ø Ø Cabinet slide lock. Bath pal (thermometer for measuring water temp. Small object tester. Comer protectors (4) Bottle of ipecac syrup. Electronic carbon monoxide analyzer. Child safety booklet. Fire safety booklet.

Environmental House Call Home Visit Components. Ø Ø Ø Ø Comprehensive safety check. Lead Environmental House Call Home Visit Components. Ø Ø Ø Ø Comprehensive safety check. Lead and mercury in paint analysis. Lead in dust sampling. Lead, nitrates, and organics in drinking water analysis. Carbon monoxide, sulfur dioxide and nitrogen dioxide levels for furnaces and gas stoves. Ventilation assessment. Radon levels. Ø Ø Ø Methyl chloroform levels from shower heads. Asbestos friability and analysis. Electromagnetic radiation measurement. Mold spore evaluations in carpets and behind walls. Relative temperature and moisture levels. Environmental house call program video/tape/CD

Environmental House Call Options Environmental House Call Options

Module 1 Comprehensive Safety Hazard Check. Ø Comprehensive Indoor Environmental Pollutant Check. Ø Environmental Module 1 Comprehensive Safety Hazard Check. Ø Comprehensive Indoor Environmental Pollutant Check. Ø Environmental House Call Manual Ø § § § Comprehensive computerized safety check report and solutions. Comprehensive environmental pollutant check report and solutions. General information on indoor pollutants and health effects. Wealth from health and general preventive medicine information section. Latest articles and research in these areas. Information on Overlook hospital, home care, and Managed Care. Environmental Symptoms Survey Questionnaire and analysis. Ø Product Catalog (Allergy Control Products, etc. ) at reduced prices. Ø

Module II For Pulmonary and Allergic patients only. It includes Ø All components for Module II For Pulmonary and Allergic patients only. It includes Ø All components for Module 1 except for Heavy Metal analyses such as lead, etc. Ø Environmental House Call

Module III Cancer Prevention and other systems other than pulmonary and allergic patients. It Module III Cancer Prevention and other systems other than pulmonary and allergic patients. It includes. Ø All components for Module I except for Dust mites, mold spore evaluations, etc

Institute for Healthcare Innovation Institute for Healthcare Innovation

“Hospital without walls” Training center Self Management of chronic diseases Deploy remote medical monitoring “Hospital without walls” Training center Self Management of chronic diseases Deploy remote medical monitoring and tele health for chronic disease sufferers. Ø Develop cost-efficient monitoring for the uninsured and underinsured population. Ø Create a training center to teach hospital systems to create hub for these activities in their catchments areas. Ø

“Environmental house call” Training center Decreasing health risk from indoor and outdoor Environmental exposures “Environmental house call” Training center Decreasing health risk from indoor and outdoor Environmental exposures Ø Ø Ø Identification of environmental causes of childhood and chronic diseases. To evaluate the effectiveness of environmental programs with special emphasis on lead, carbon monoxide poisoning, asthma, and cancer. Assess the knowledge of home inspectors, homecare nursing and other health care professionals. Develop community based approach to maximize detection and remediation of indoor pollutants. Enlist support of state representatives and public health officials. Partner with CDC and HUD’s “Healthy Housing” initiatives.

“Wealth from Health” Training Center Ø Enact an Innovative, Proven, Credit. Driven Incentive based “Wealth from Health” Training Center Ø Enact an Innovative, Proven, Credit. Driven Incentive based Behavioral Modification System to Improve prevention and self-management of one’s chronic diseases. Ø Involve community retailers, employers, and government officials in further enhancing such a system.

National Healthy Homes Training Center and Network National Healthy Homes Training Center and Network

Background Many environmental public health and housing practitioners lack the requisite training and tools Background Many environmental public health and housing practitioners lack the requisite training and tools to identify and respond to residential environmental health hazards. Ø To build Capacity and Competency among practitioners and to promote cross-disciplinary activities, the US Center for Disease Control funded the National Center for Healthy Housing (NCHH) to develop a Ø National Healthy Homes Training Center and Network.

In the first year CDC funding will enable NCHH to: Ø Design curriculum and In the first year CDC funding will enable NCHH to: Ø Design curriculum and course content to fulfill core competencies in classroom settings as well as through distance learning/e-learning. Ø Conduct at least on pilot training session. Ø Prepare existing academic partners to serve as pilot site and potential expansion sites.

Goals Ø Ø Ø Provide training for public health practitioners in the assessment and Goals Ø Ø Ø Provide training for public health practitioners in the assessment and treatment of housing related health hazards. Promote cross training of public health and housing practitioners. Create a forum for the exchange of practical guidance about healthy housing strategies among federal, state, tribal and local agency staff. Develop a mechanism for the ongoing introduction of new research findings into public health training and practice. Identify and optimize opportunities for networking, collaboration and partnership.

Classification Ø Irritants Sulfur dioxide, Nitrogen dioxide, Ozone, soaps, Bleach, Detergents, Pesticides etc Ø Classification Ø Irritants Sulfur dioxide, Nitrogen dioxide, Ozone, soaps, Bleach, Detergents, Pesticides etc Ø Narcotics and Anesthetics Acetone, Ethanol, Methanol, Toluene etc. Ø Allergens Viruses, Bacteria and Fungi. . Ø Pulmonary Toxicants. Sulfur dioxide, Ozone and Allergens e. g Molds/Mites. Ø Noise < 40 d. Ba- comfortable Ø Asphyxiates Nitric oxide, Nitrous oxide, Nitrogen and Carbon Monoxide. Ø Systemic Toxicant Lead, Arsenic, Mercury and Chlorinated hydrocarbons. Ø Carcinogens Radon, Asbestos, Cigarette smoke and Hydrocarbons. Ø Reproductive Toxicants Lead, Benzene and PCB’s