Report from Santa Fe; Michelle Lujan Grisham

Report from Santa Fe is made possible in part by a grant from the members of the National Education Association of New Mexico, an organization of professionals who believe that investing in public education is an investment in our state's economic future. I'm Lorraine Mills, welcome to report from Santa Fe. Our guest today is Michelle Luhangrisham, the Cabinet Secretary for New Mexico's Department of Health. Welcome. Oh, thank you for having me as a guest. Well, you've been on the show many times because we started doing shows in the last 14 years when you were the director of the agency on aging for 14 years and was elevated under your watch as it should have been to a cabinet secretary position. Well, thank you very much. It's absolutely correct, it was a long, wonderful collective effort by all in the Mexicans to improve the quality of life for older people. Well, as we're getting older, we're even more grateful. Good.

Now, you are in charge of the largest branch of state government, the largest department in state government is the Department of Health. That's right. 4,000 employees, half a billion dollar budget, not the largest budget, but by far the largest state organization. It's something that impacts our lives tremendously because if you're not healthy, I mean the consequences are severe. So we have a lot vested in your success because it is your job to keep us healthy and to keep us informed about what's happening in health care, which I asked you here today. Well, it's great. And actually, this is a great opportunity because it has to be a partnership. There's no amount of directing or rulemaking or policy setting that by itself will improve health care. I need Mexicans to care about this issue. So thank you for giving me the opportunity to talk about how important these issues are. Well, the overlooked facet is usually personal responsibility. People want to read about what everyone else is doing and how to take care of this person's problem, those teenagers and all this stuff.

So how do you evoke personal responsibility in the citizenry? Well, you know, I think we can start really from the basic level here, which is this is a very complex aspect, improving an individual or a state's health. First, I got to figure out health care access. Now, that's not something I have to do by myself, but it's a very fragile system. People don't have insurance, whether they're underinsured, they may be in rural or frontier in Mexico. There's not enough doctors. There's not enough nurses. There's not enough specialists. There's not enough hospitals. Hospitals are changing. There's not enough behavioral services. Right. So you take a step back then. I got to make sure that once we figure out access, that the services make sense for the people who we're providing them to. They got to be cost effective, otherwise we can't do it for very long. And then we have to be able to figure out where we have trouble. So who's at risk? Well, in New Mexico, we know that people who are poor, which is a significant number. We talked about this already, people who don't have insurance, significant number, and kids

are at risk. And where it's a constant battle for behavioral health services, for substance abuse, for alcohol, for sexual behaviors, for teen pregnancy, for suicide. And if we don't for obesity and physical fitness, and if we don't beat those issues today, we can't make New Mexicans healthier over the long haul and improve the quality of life for families. And tell you what we want. We don't want to just make those improvements. We want in New Mexico to be the healthiest place in the nation. Well, you have made some stellar improvements. For example, tell me about the immunization, the rate of the number of people who are immunizing the state. What was our earlier ranking and where are we now? We were 48, so you might as well be last. And in fact, we would bassulate, we would be 47th, then we would be 48th, then we would be back to 47th. And today, we're 15th best in the country. And that's remarkable.

And I'll tell you, I have to give almost full credit to the First Lady, because what she did is say, oh, look, you need a champion, and that's going to be me, because the best defense against needless childhood diseases, and often childhood death, is to vaccinate our babies and infants and toddlers against these very, you know, beatable childhood diseases. And doing that got the health care plans organized and got private pediatricians, and then the Mexico Department of Health. We created these shot team nurses and mobile clinics, and that's an easy word. We were mobilized as a group. There was a, that we created a coalition, and we went from, in fact, really just in two years, went from nearly the worst to nearly the best. And now our goal is to be first, because Lorraine, there's only a few states that have what we call a registry. So as parents, we both remember that you had to have a car or a piece of paper or something that listed all those immunizations.

And if you lost the card when your child was going in for the six, nine, two year checkup, then you couldn't do the shot, because you didn't know. And so that removed one bureaucratic layer by having this registry, where they knew the child, they could look and see what's going on. And it means that you have any number of access points. A school, your doctor's office, a public health clinic, a shot clinic, a primary health care center. I mean, the options then are endless, which means you open up access, you open up the ability to actually deliver that particular service to an individual or family. Our registry is finally up. And the other great news is the federal government paid for 90% of it, which means that we were smart, we were cost effective. It's good sound health policy, and in fact, we fully expect to be first by next year. By next year? That's my goal next year. I mean, I think that it's untenable to have as goals. You know, if we could be 14th and a half, or if we could hold 15th, what kind of a goal is that?

If this is the best defense, the best defense against absolutely childhood disease, why shouldn't our goal be, not one child gets hurt, not one family, will be first. Everybody that wants to be immunized, it has the ability to get that access, gets that service. So that's the kind of goal setting we're doing at the department, will be the best. If it's not good for New Mexicans, we get rid of it. Wow. Okay, we're on the brink of the legislative session and the governor, Governor Richardson has proclaimed this to be the year of the child. So how does that factor into your health care agenda for this year at the Department of Health? Well, the easy answer is, is that by focusing on kids and making this the year of the child, then we can turn the tides for generations. And that's so important. And we can also, one of my favorite examples is type 2 diabetes, adult onset diabetes, is now more prevalent among children than ever before. And it's terrifying because this is a terrible disease.

And in addition to the terrible personal health care consequences, we spend on diabetes in New Mexico, about $320 million a year. Now if we could redirect those funds to other health care issues, because we eliminated the risk of adult onset diabetes by improving nutrition, by improving health care access, by dealing with obesity issues for our young people, then we've provided resources for the future in the Mexican health care access. And we've eliminated a destructive, dangerous, devastating disease for this population. So it's a wonderful way to get at things early and again to be able to sustain them. And it means all sorts of stuff. I don't know that I can even pick an age group, but I'll tell you what it means. Well, no, so we're not feeling too bad. This is also a national problem. So it's not just that we're in New Mexicans and are poor and are eating wrong and have

certain genetic predisposition, but it's a whole national problem, the epidemic of obesity and the rising of the age when adult onset is coming on when they're teenagers. This is true. But New Mexico, like we talked about prior with immunizations, we do poorly in getting it addressed. So what I love about this administration and this governor is, all right, let's really do something aggressive then about that. If that's the issue, you can't have little band-aids or small incremental approaches. We have to declare that we're going to do something. This is the year of the child and we're going to put everything forward. It's just a couple quick examples. You know, we've got a universal breakfast program, which means that kids get nutrition early, immediately, and we deal with those high-risk groups and it's universal, which means every kid, which means you capture them all those high-risk and you spend less. Because if you don't do targeting and everybody has access, you spend less, more kids are

affected, higher quality, much better system. We're going to bring back physical education. We're going to phase that in into grade schools and mid-schools and high schools because right now, for all practical purposes, it's not available or required. Now, I'm over-generalizing, but we went from having PE in my age, for, you know, I went every day all the time through high school to having at the high school level one credit for your entire four-year, ninth through 12th grade and that's just wrong. And we are also working at teaching kids and their families about sound nutrition and health risks and recognizing the link between obesity, nutrition, physical fitness, and behavioral health issues. Kids who are depressed, kids who are alone too much, kids who have maybe a diagnosable disorder that can, with counseling or other treatment, can be positively affected, which means their esteem goes up and their ability to cope goes up.

Now, the locus for all of this is, of course, the school. And so tell me what you're doing with school-based health centers. I love this. I inherited this great concept. When I got to the Department of Health, there were 34 school-based health centers spread among New Mexico schools, grade schools to high schools. And the governor toured one and it was kids who talked about the incredible difference this made in their lives. And that's all it took. The governor listened to that constituent population and said, we'll double that number. The legislature was kind enough to give us some money to do that, both capital and operational funds, and we're doubling the number right now. Now, that's the good news. Of course, the bad news is, having 68 of these is not enough when you've got probably about 700 schools statewide. Do you need one in every school? I'm not sure that you do, but do you need more than 68? Absolutely. So, this is an opportunity and this is a great place for me to make a pitch.

The private sector support is welcome, welcome, welcome. And what this does is recognizing the parents are working, that we take our kids out of school to address easy things, vaccinations again, physicals for sports, antibiotic delivery, right? You can stop an epidemic in the school if you diagnose early with something like strep, you stop everyone else from getting it and there's such benefits. Oh, the prophylaxic abilities here are great. The ability to do dental services again in school, I mean, and we are going to be able to use telehealth, which means that we build these with great telehealth capacity, which means that you can then dial up if you, if you mind, don't mind me using that expression to specialists and counselors, to Albuquerque, Santa Fe, Las Cruces, Farmington, in areas where you have some of these practitioners. And it's a great partnership, I'll tell you, we got challenged. This is bad, it's redundant, your local pediatricians aren't going to like it. A local pediatricians, for the most part, have been absolutely very supportive because

ultimately, they want to improve the health status of their patients and their patients are at school, 35, 40 hours a week, minimally. And this is a place where we can join efforts and do much more productive work for these kids. The behavioral health aspects too. I heard you lecturing, and you told me a very disturbing statistic about six graders that we might as well let our viewers know what the statistics prove, that what 25%. One out of every four six graders is reporting engaging in some type of sexual behavior. Yeah, that is just a stunning, stunning statistic. I had to wake up, Colle, I think, for New Mexicans, and it's a touchy subject. No parent, no person, no individual is, nor should they be condoning early sexual activity by young people.

It's emotionally damaging, they're too immature, there can be physical consequences. Not to mention just the obvious, the sexual transmitted disease rates, the HIV AIDS issues. I mean, there's a whole host of reasons that this is not something that we want kids to do. But the other side of it is, is that you're going to commit this both sides. How do I get kids not to do it, to abstain, because that's the best prevention? But I also have to recognize that if one out of four by the sixth grade is engaging in some kind of activity, then I got to provide more comprehensive sex education and support to families and children, and I need parents and teachers to come to the table and work more collectively on this, or we won't turn the tide. We are one of the worst in the country, I mean, we've got a higher teen pregnancy rate than any other industrialized nation. New Mexico? Yeah, in the world, right? Well, it seems to me you're dealing with, this wants to be the hardest part of your

job. I'm dealing with, because parents are certainly going to be in denial, not my kid. And then there's the whole religious aspect that something should be only dealt with at home with a family and not in a health context, and then the health staff is overworked and getting a lot of pressure from the parents, and how are you going to deal with this? You know, head on. The facts speak for themselves. These are tough health policy decisions. I'm a mother of two daughters, and the thought of my young daughters in mid-school, engaging in sexual activity like you, is more than I can almost cope with. But I'll tell you what's harder for me to cope with. The fact that their lives are forever altered, because they go undiagnosed with something like chlamydia, which makes them sterile, that they transmit or contract HIV AIDS or hepatitis, that they become pregnant at 14, 15, 16, and have their lives altered as a result and are permanently, emotionally damaged and scarred.

So just taking that example, I think that in the Mexico has a responsibility to protect these children, and to protect them. This is what we've absolutely, that if a school district wants family planning services in a school-based health center, they have it. If they don't, we will never mandate it, because we want parents to have as much say so in their child's education issues as possible. We are working on a comprehensive sex education curriculum that will be required in schools. Parents will have the ultimate say so about whether their child attends, so that you maintain that level of responsibility, and nothing we do will be to the exclusion of abstinence. But abstinence only education is going to be then in sixth grade and lower, because if I have this statistic, a 25% statistic, then the best approach is to prevent that as early as possible, which means talking to kids about how to make healthy choices, how

to have good self-esteem, how to build character, because how to deal with peer pressure. All the things that we know make a difference, and I want to make one more plug, parents, I got to have parents helping talk to your kids, take them to a class, reach out to public health clinics, anything that you need, your relationship is the best defense against your child engaging in any risky behavior, unequivocally. One other hard statistic, where do we stand with youth suicide? That's another area, we're not good, which is why I'm still championing school based health centers and related new services. We're launching right now, Lorraine A., we're calling it a teen line. We don't want everything to be about crisis, but we recognize that kids got to have the ability to reach out, and they got to be able to deal with crisis counselors. So we're going to have a 24, 7-day teen line toll-free, and I don't have information

yet, but I'm hopeful that some of our private sector companies will make these all not charge against minutes on cell phone users, because that's how kids are going to call us. Text messaging should also be free against their particular plans, because what we want to do is encourage kids to call. And we think that this is one of the missing components, A, they have no place to reach out to when they're at risk, two, that they respond well to peer counselors. So that can't be the end of the sort of professional access, because some of these kids are going to need psychiatrists, psychologists, paraprofessionals that are trained specifically to do with these issues. But imagine the power we have to get to every kid who at any time, night or day, needs to reach out and talk them through it. We're launching that.

We're doing tons of training, because the biggest issue in addition to making sure kids can reach out is nobody recognizes when kids are at risk early enough to stop it. We can prevent every one of these. So we're training parents, and we're training communities, and we're training schools, and we're training counselors, and we're training other kids. And we've been paying for that all year, and we're going to do huge outreach campaigns, so that just a general public, we kind of remove the stigma from it's okay to be distressed, and it's okay to need someone, and to need help we all do. Not okay to feel like there are no options for you, never okay. I love the fact that you're doing this in grade school, doing things like peer pressure and self-esteem, because that's where all of this starts. And so to get the parent child communication amplified, and then to take care of the self-esteem and peer pressure, I think it's wonderful. I'm really, really happy to hear that you're addressing these very hard issues. And it's not rocket science.

Now folks are talking about all these kids who go to college who rack up incredible debt on credit cards and get 20-year-olds declaring bankruptcy. So what's that, what are people saying? We should teach money management in high school. We should teach money management, then it's too late in junior high. We should teach money, well, exactly. The sooner that you teach a young person, how to be responsible, and how to reach out, and how to have relationships that are meaningful, the better our options or odds are at turning the tides for them forever on all risky, poor behaviors, poor decision making. So what we're doing is inviting the real world and all the things that we, as grown-ups, saying, well, why can't we never learn that in school? Right. Finally, we're introducing that into school. So, now, what about the older boys and girls? What do you have for grown-ups and for the elderly? What's the health department? What are our causes to champion in? Well, you know, I'll tell you, another area that we really struggle with as New Mexicans is substance abuse.

And we're a clear partner in this brand new behavioral health reform. So we're putting all of our money, and we're fighting it collectively every department, so that we're not fighting and having contra or competing. I'm sorry, policies and programs with different categories and different eligibility and different rules and different admissions, and that's fabulous, and that's where the only state in the country to do that, and that's called the behavioral health collaborative. And so I've got a significant number of older adults that will be in a much better situation and treating mental illness. We don't have enough access for those basic services in New Mexico, and we're creating brand new math treatment programs, recognizing that that's significant. We're dealing with opiate treatments in jails, which is, I think, really productive public health work, because, you know, people go to jail because I've got a drug issue. They don't come, once you're an addict, you're an addict. You don't come out ready to face the world and deal with treatment issues, so let's get you on.

That's what's a revolving door. That jails in New Mexico, jails across the country are the largest residential behavioral health treatment centers for drug addiction, you know, that we've got, but I'm not sure that they're the most successful. So we're going to do, we're working on that. We've got a really fabulous disease management program for hepatitis C, which is the leading cause of liver cancer and liver transplant and liver damage and hospitalizations. And you are absolutely debilitated. You can't work. You can't function. So we've got to do something about that. And that's a big epidemiological, taking time bomb, that's about to... 32,000 people we think in New Mexico have hepatitis C. And so that's something that we've got to do. And we're doing some great work around, you know, smoke cessation. New Mexico is doing very well with young adults and older adults in cessation and quitting. And I'm really excited about that. And we talked about making sure that we have insurance access and one of my favorite subjects working on better pharmacy prices and prescription drug access.

There's a whole bunch of stuff from new discount cards to broader populations and certainly last but not least one of my favorites is quality of healthcare. From hospital care all the way to nursing home care, zero tolerance for poor service period. I'm looking at a brand new workforce recruitment and retention design so that we really do have good quality people out there. And you may or may not know, we're now requiring people in hospitals to get criminal background checks. So that... The people who work in hospitals. You bet. Yeah. So of all these things which you are so enthusiastic about, what is your pet project? What would... You will know that you've achieved your goals if this one project happens. So you have... these are all wonderful projects. It's like asking you to choose your favorite child. But what just makes your heart sing? Oh, that's really hard because they're all connected. I'll tell you, if kids, if we begin to turn for adolescents, and I'm going to cheat just in real quick minute, if they begin to care about their healthcare and to care

about their destiny, we have done such incredible work that that will make my heart sing. And that leads to everything else. I'm never going to stop doing zero tolerance. If you do something, if you hurt someone in a healthcare facility, I'm coming after you. That's in public and private and we took over a couple of our own facilities for just that reason, zero tolerance. But here's my plug. We're looking at programs that would basically sponsor whole families for their whole lives so that we stop this epidemic of generational poverty, addiction, alcoholism, because that's redundant for addiction and poor healthcare outcomes. And I think if we do that, because we know we're in and out all the time, that's the problem. When you're at risk, we're in, when you're stabilized, we're out, and you're at risk a few months later, we're back in, but we've lost ground.

Let's stick with it. Let's prove that we can be successful. And I think New Mexico could be the first state that actually solves some of these issues related to poverty, socioeconomic status, and healthcare status. And I'm really excited about that opportunity. Well here we are at the start of a new year, and these are beautiful, ambitious, delightful goals. The one that is so fantastic to think if we could actually become number one in the immunization rate, that would be phenomenal to have come from the very bottom to the very top. And there's really nothing keeping us, you know. So I say more power to us all and a year of health and prosperity. Absolutely. And let me come back next year and we'll brag about how we did that. Okay. Okay. I'd be delighted. That would be fabulous. Yes. So I need to thank you today for coming in. Our guest today is Michelle Luhan Grisham, the Cabinet Secretary for the Department of Health and give us your last pitch for healthcare for the state.

What one idea do you want people to take with them? Oh, you did it to me again, all I did is that, you know, you can help me make a difference. That's how I leave here. You can stop smoking, you can be healthier, we can provide you access, we can get you insured. So help us reach out, contact us, and help us turn the tide for all the Mexicans. Fabulous. All right. Thank you very much. You're welcome. Our Department of Health, Cabinet Secretary, and we will do the show in a year and see where we stand. I'll be here. Okay. And I hope you'll be here too next week on report from Santa Fe. I'm Lorraine Mills. Thank you for joining us. Report from Santa Fe is made possible in part by a grant from the members of the National Education Association of New Mexico, an organization of professionals who believe that investing in public education is an investment in our state's economic future.