A proactive health plan: taking action on tobacco control

It is no secret that the health of most Americans is not as good as it could be.Quality of care is poor, health equity is low, and our health system is in crisis.For health organisations, this myriad of challenges and the massive scope of the problem makes it diYcult to prioritise health improvement initiatives.At HealthPartners, a Minnesota based health care organisation with 800 000 members, we have defined our initiatives by looking at the health of our members and our community and what we want the future to reflect in terms of good health and organisational values.At the heart of one of our key initiatives is tobacco control. Goal settingOur mission at HealthPartners is to improve the health of our members and the community.To achieve this, we must be competent not only in managing disease, but also in managing the major risk factors for disease.In 1993, we began thinking about how to best identify and aVect these risk factors.Our first step was to survey our population for risk factors for illness such as tobacco use, dietary indiscretion, and inactivity.This drew attention to the fact that these risk factors were a problem for HealthPartners' enrolled population.Next we established a model that illustrated the linkage of risk factors to disease and emphasised the opportunities for intervention.For example, for a person with high blood pressure, a low sodium diet and increased exercise could be an early intervention point.If high blood pressure is not dealt with eVectively, heart disease may result, and so on.The objective of this model was to show that we must have interventions and programs along the whole spectrum from being well, to being well with risk factors, to having established disease.Our third step was to set eight compelling goals for HealthPartners.The first was to reduce the number of cardiac events in our system by 25%.We also set goals for diabetes, immunisation, dental health, breast cancer, prenatal outcomes, childhood injury, and violence.Our hope in creating these goals was to call on individuals across HealthPartners and the region we serve to think about and take action on these issues.Our goal setting quickly led us to tobacco control as we looked for ways to reduce cardiac events.