By Wayne Jebian Living up to her reputation as an engaging speaker, former U.S. Surgeon General Joycelyn Elders informed and entertained an audience of reporters and local health policy professionals brought together recently by the Connecticut Health Foundation to discuss health equity. Elders followed a panel discussion on providing equal access to health care, participated in by Lieutenant Governor Nancy Wyman and Grace Damio of the Hispanic Health Council among others, a discussion that frequently returned to the topic of Obamacare, with the October 1 launch of Access Health CT, the state’s health insurance exchange, coming the heels of the event. For her part, Dr. Elders, now 80 years old, talked about the problems with health care in the United States, then explained how to fix it while fleshing out her talk with anecdotes about growing up in rural Arkansas and peppering it with laugh lines about the absurdity of the current system. Saying, ” “When we compare ourselves to other counties, we have the best doctors, the best nurses in the world. But we do not have the best health. So we have a very excellent sick care system. The problem is, we do not have a health care system. We spend ninety-plus percent on sick care, and we only spend eight percent or less on preventive care. If we want to improve health, we’ve got to address that issue.” Elders made the point that discussing health disparities over the years has not bridged the gaps in delivery of health care between populations, races and income brackets, so she urged the health care and policy communities to start thinking in terms of “health equity,” which involves improving health care delivery for all populations. She asserted that cultural sensitivity and cultural competency matters more than ever these days, as the twin goals of improving the health of the general population and controlling costs depend on effectively educating patients on how to take care of themselves and how to use the system effectively. “If we’re trying to fix the problems, we have to deal with cultural competency,” she said. Elders also spoke about the topic for which she is perhaps most famous, sexual and reproductive health. “Eighteen percent of the total global burden of disease is related to sexual and reproductive health,” she said. “And yet we live in a society where we can’t talk about reproductive health … yet we complain about having unplanned children.” Elders’ outspokenness on this topic had been a rallying point for her critics and helped end her tenure prematurely during the Clinton administration. She joked that had she been kept in office, Republicans would have had less time to go after President Bill Clinton himself. Addressing what the country needs to do to fix inequalities in health care, Elders projected the following list: – Continue to build a scientific base. – Overcome stigma. – Improve public awareness of effective treatment. – Ensure the supply of mental health services and providers. – Ensure the delivery of state-of-the-art treatments. – Tailor treatment to age, gender, race and culture. – Facilitate entry into treatment. – Reduce financial barriers to treatment. While Elders spoke in very broad strokes, some of the panelists addressed what different groups are doing in Connecticut to bring about these changes. “Are we really willing to advocate for prevention in its real sense?” asked Grace Damio, a nutritionist with the Hispanic Health Council. Specifically, Damio referred to a study linking prenatal depression to food security. “Looking at the screenings for prenatal depression that providers, are they looking at food security as an issue? We have to think about what we can fit into that very short medical encounter.” Wyman described what steps the state was taking during the last-minute run-up to opening the health insurance exchange that will match patients with insurance plans under Access Health CT. “We want people to sign up for Obamacare,” she said. “We can’t just do it from television ads or asking people to get on computers, because a lot of the people we are trying to reach don’t have computers.” She said that the state had trained more than 300 people, who among them speak approximately 30 different languages to fan out into storefronts, fairs and “everyplace where we can get to where people are.” CTLatinoNews asked specifically about families receiving their health care under Husky A Medicaid, and what the roll-out of Obamacare would mean for them. It turns out that these families will not have to do anything right now; however, all Husky recipients will have to fill out an electronic enrollment form this coming April for reauthorization, regardless of when their most recent term of enrollment through the Department of Social Services began. To date, re-enrollment for Husky Health through DSS has been done using paper forms through the mail.