1ST MEETING

POLICY, SYSTEMS, AND ENVIRONMENTAL

CHANGES TASK FORCE

Guillermo Tortolero-Luna, MD, PhD

Director
Cancer Control and Population Sciences Program
UPRCCC
March 30, 2017
 University of Puerto Rico
Comprehensive Cancer Center

Law Nm. 230

August 26, 2004

Article 2 Creation of the Center

This Act hereby creates a public corporation, which shall

be known as the University of Puerto Rico
Comprehensive Cancer Center.
 UPRCCC ACT
Law Nm. 230
August 26, 2004

Article 4 Purposes

The University of Puerto Rico Comprehensive Cancer

Center shall be the institution mainly responsible for
executing public policy related to the prevention,
guidance, research and provision of clinical services and
treatment related to cancer in Puerto Rico.
 UPRCCC
RESEARCH PROGRAM
 UPRCCC Division

UPRCCC
IRB Research Director Executive
Director

Office Sponsored
Administration
Programs

Biostatistics/
Biorepository
Bioinformatics
Core
Core

Cancer Control
Basic Science Clinical
and Population
Research Research
Sciences
 UPRCCC
Cancer Control and Population
Sciences Program
 UPRCCC
Cancer Control & Population Sciences
Program
BIOSTATISTICS AND BIOREPOSITORY
BIOINFORMATICS
CORE
CCPSP CORE

RESEARCH CANCER PREVENTION AND CONTROL

PROGRAMS COORDINATING CENTER

EPIDEMIOLOGY PR-CCCP

BEHAVIORAL
SCIENCES PR-NBCCEDP

HEALTH SERVICES
REESEARCH PR-CCR
(CCDR)

PR-CRCSP
 CANCER CONTROL AND POPULATION
SCIENCE PROGRAM

MISSION
To develop a multi-disciplinary cancer
prevention and control program, with a strong
emphasis on cancer health disparities, to
reduce the burden of cancer among the
Puerto Rican population through research,
education, and implementation of evidence-
based interventions
 CANCER CONTROL AND
POPULATION SCIENCE PROGRAM

VISION
To become a model cancer control program in
the Caribbean and Latin America and to be
recognized as one of the best cancer control
programs in the US and the world
Cancer Prevention and Control
Coordinating Center
 UPRCCC
Cancer Control & Population Sciences Program
BIOSTATISTICS AND BIOREPOSITORY
BIOINFORMATICS
CORE
CCPSP CORE

RESEARCH COORDINATING CENTER

PROGRAMS CANCER PREVENTION AND CONTROL

EPIDEMIOLOGY PR-CCCP

BEHAVIORAL
SCIENCES PR-NBCCEDP

HEALTH SERVICES
RESEARCH PR-CCR
(CCDR)

PR-CRCSP
COMPREHENSIVE CANCER
CONTROL
 What is Comprehensive
Cancer Control

The Centers for Disease Control and Prevention defines

Comprehensive Cancer Control as:
"an integrated and coordinated approach to
reduce cancer incidence, morbidity, and mortality
through prevention, early detection, treatment,
rehabilitation, and palliation."
 Comprehensive Cancer Control
Comprehensive Cancer Control is a collaborative
process through which a community pools resources
to reduce the burden of cancer by working to
achieve:

Risk Reduction
Early Detection
Improved Treatment
Enhanced Survivorship
 Early Survivorship/
Prevention QOL/
Detection Diagnosis Treatment
Mortality

CANCER CONTROL CONTINUUM

 SOCIO-ECOLOGICAL MODEL

Effective cancer prevention and control requires

understanding of the factors that influence cancer
risk and cancer care along the cancer control
spectrum

This approach is more likely to sustain cancer

prevention and control efforts over time than any
single intervention
SOCIO-ECOLOGICAL MODEL
From: A Framework for Public Health Action: The Health Impact Pyramid, Thomas R. Frieden, MD, MPH
Puerto Rico Cancer Control
Coalition (PRCCC)
 Puerto Rico Comprehensive Cancer
Control Plan

Blueprint for comprehensive cancer control in Puerto

Rico
Document that contains:
Assessment of the cancer status in Puerto Rico
Priorities in cancer
Goals
Objectives
Evidence-Based strategies and activities
 Puerto Rico Comprehensive Cancer
Control Plan: 2015-2020

Prevention
HPV vaccination
Nutrition and Physical Activity
Use of Tobacco and other Products
Sun Exposure
Screening and Early Detection
Breast Cancer
Cervical Cancer
Colorectal Cancer
Prostate Cancer
 Puerto Rico Comprehensive Cancer
Control Plan: 2015-2020 (2)

Treatment
Access the High Quality Treatment
Access to Patient Assistant Program
Use of Treatment Guidelines
Access to Clinical Trials
Survivorship
Use Survivorship Care Plan
Services and Resources for cancer Survivors and Caregivers
Assess Economic Impact of Cancer Care
Implement Policy, Systems and Environmental (PSE)
Approaches
 PR COMPREHENSIVE CANCER
CONTROL PROGRAM

DCD PRCCCP PRCCC UPRCCC

Evaluation PSE
Team Task Force PRCCC
Board

Evaluation

Nutrition HPV & Breast Colorectal

& Physical Cervical Cancer Survivorship
Cancer
Activity Cancer

PSE Approaches
 POLICY, SYSTEM AND
ENVIRONMENTAL CHANGES
 BACKGROUND

More than half of Americans live with one or more chronic

diseases
Cancer
Heart disease
Hypertension
Mental disorders
Diabetes
Pulmonary conditions
stroke
7:10 annual deaths are attributed to Chronic Diseases
 BACKGROUND

Healthcare expenditures for the most common chronic

diseases is approximately $1.0 trillion dollars per year
It is projected to increase to $4.2 trillion dollars
Much of this burden is preventable modifying lifestyle
behaviors:
o reduce tobacco use
o increase physical activity
o consume nutritious foods
o limit alcohol consumption
 BACKGROUND

Current public health solutions fail to address barriers

and challenges in the environment that enable unhealthy
behaviors

Education can influence individual behavior choices;

however, addressing environmental barriers and
community conditions is a crucial for supporting and
encouraging healthy behavior

Manipulating the socioeconomic factors with PSE

provides the foundation for creating sustainable public
health change at the population level
 PSE CHANGES

The National Expert Panel on Community Health

Promotion was convened by the CDC in 2007.
Based on the findings of the 2003 IOM Report, (The
future of the publics health in the 21st century) the
panel recommended a renewed emphasis on
interventions that address the social, family, and
community networks. (Liburd and Sniezek, 2007).
The panel viewed health as a resource rather than
simply as the absence of disease, panel members
recommended new directions for community health
promotion.
(Liburd and Sniezek, 2007)
PSE CHANGES
 What Is Policy, Systems and
Environmental (PSE) Change?
PSE change go beyond programming and into the systems
that create the structures in which we work, live and play
PSE change make healthy choices to all community members
Feasible
Easy
Practical
Available
Safe
Affordable
 P S E Defined

Type of Change Definition Examples

Strategies to create or Increasing taxes on

Policy change formal (legislative) cigarettes
or informal (organizational) to discourage purchase and
policies use of tobacco
Improving school food
Strategies that impact
systems (nutrition
elements of an
Systems guidelines), and
organization, institution, or
parks/recreation systems
system
(community sidewalk plans)
Creating paths, water
Strategies that make
fountains, and volleyball
Environmental changes to the social, or
courts throughout the
physical environment
 PSE Changes

PSEs changes can significantly shape lives and health

creating and encouraging healthy behaviors :
Communities at large
Schools
Workplaces
Parks
Transportation system
Faith-based organizations
Healthcare settings
 PSE Changes Partners

Partnerships are essential for sustainable change

o Community leaders

o Education

o Government

o Transportation

o Health-systems

o Business
 IOM Recommendations for Faster Change
to Create Healthy Communities
(IOM 2005)

Empower communities and neighborhoods

Change the environment
Forge strategic partnerships
Educate stakeholders.
Identify leaders and build on cultural assets
Collect and share local data
Evaluate programs and interventions
Transfer successful interventions to other
communities
 Differences Between
Event/Program and PSE Change
 What is Policy Change?
Policy changes includes policies at the legislative or
organizational level.
Institutionalizes new rules or procedures
Types of Policies
Laws
Ordinances
Resolutions
Mandates
Regulations
 Who Makes Policy Change?
Government bodies (federal, state, local level)
School districts and schools
Park districts
Healthcare organizations (hospitals, health systems)
Worksites
Other community institutions:
Jails
Daycare centers
Senior living centers
Faith institutions
 What is Systems Change?

Systems change involves change made to the

rules within an organization.
Systems change and policy change often work
handinhand.
Systems change focuses on changing
infrastructure or instituting processes or
procedures
 Examples of Systems

o Individual hospitals or hospital systems

o Group practices
o Health insurance providers
o Preferred provider organizations (PPOs)
o Public health insurance programs, including Medicaid
and Medicare; GHP
o Public health systems such as community health
centers (e.g., FQHCs), Veterans Health Administration
medical centers
o Worksites
 What is Environmental Change?

Environmental change is change made to influence

peoples practices and behaviors:
o Physical Environment (Structural changes or
programs or service)
o Social Environment (a positive change in attitudes or
behavior about policies that promote health or an
increase in supportive attitudes regarding a health
practice),
o Economic factors (presence of financial disincentives
or incentives to encourage a desired behavior)
 Examples of Environmental Changes
at the Community Level

Incorporating sidewalks, paths, pedestrian friendly

intersections, and recreation areas into community
design (complete streets policy).

Installing signage on already established walking or

biking routes.

Municipality planning process to ensure better

pedestrian and bicycle access to main roads and
parks.
 Examples of Environmental
Changes
Availability of healthy food choices in restaurants or
cafeterias.

Increase in acceptance of limiting candy as rewards

in classrooms across a school district.

Charging higher prices for less healthy products to

decrease their use.

Provision of health insurance discounts or bonus

dollars for those who exercise frequently.
Thank you