Disclaimer: The Society of Actuaries makes no endorsement, representation or guarantee with regard to any content, and disclaims any liability in connection with the use or misuse of any information provided in this series of articles. Statements of fact and opinions expressed herein are solely those of the authors and are not those of the Society of Actuaries.
The Health of Populations
By SARA C. TEPPEMA
This past year, I read the incredible book, Mountains Beyond Mountains, by journalist Tracy Kidder. It chronicles the life and work of Paul Farmer, a physician and anthropologist, who transformed health and health care in some of the poorest regions of Haiti. He also changed the way tuberculosis is treated around the world. Dr. Farmer’s sheer determination to change the health of entire populations of people is inspiring.
One of the most important lessons of Dr. Farmer’s work is that the health of a population can be improved by addressing social factors that go far beyond the available health care that they receive. His tireless work has centered on treating the many upstream social issues such as clean water, safe shelter and nutrition. This is the heart of the work of public health: address the upstream drivers to improve the health of populations.
Addressing the Determinants of Health
Public health can be an emotional topic. Attendees of the Public Health Session at the 2016 SOA Health Meeting were moved to tears by stirring presentations by Laura Seeff, M.D., of the Centers for Disease Control and Prevention (CDC), and by Jim Toole, FSA, MAAA, CERA, FCA, former SOA Board member and active volunteer. Dr. Seeff presented the CDC’s work to date for its 6|18 Initiative, which is a partnership among health care purchasers, payers and providers focusing on 18 targeted interventions for six costly health conditions. Toole told stories about his public health volunteer work in his home community, including film screenings, prison health awareness and more. Hearing stories about real human beings and their struggles to maintain health under difficult conditions challenges us to step out of our comfortable lives and explore the why of our jobs as actuaries—instead of just the how.
As a society, we must be willing to invest in programs that address the determinants of health. Our work as actuaries benefits greatly when we recognize these upstream determinants or the very personal, human choices and consequences involved in areas such as family planning, mental health and addiction, gun control, tobacco use, and many other emotionally-charged areas.
As health actuaries, we must remember that the purpose of our work is to optimize the health of the populations we serve. Optimization of health necessarily involves allocation of finite and limited resources. We actuaries are numbers people, but the numbers side and the human side need not be at odds. In fact, I believe that we can add valuable perspective to the public health dialog by bringing actuarial rigor to the allocation of resources.
The Society of Actuaries (SOA) Health Section’s Strategic Initiative on Public Health
That 2016 Health Meeting session was the springboard for a new task force as part of the SOA Health Section’s Strategic Initiative to study the role of actuaries and public health. It has been a great honor and privilege to lead this amazing group of people, and I am so grateful to all of them for their passion and out-of-the-box thinking. I am especially grateful to Jim Mange, FSA, MAAA, who led our publication efforts of both this collection and several articles in the SOA Health Section’s Health Watch newsletter. The task force benefitted so much by the contributions of non-SOA members Arlene Ash, Ph.D., Lisa Macon Harrison, MPH, and Dr. Seeff, and the generous time and efforts of SOA members vice chair Julia Kraemer Lerche, FSA, MAAA, MSPH; Bethany McAleer, FSA, MAAA; Rebecca Owen, FSA, MAAA; Marjorie Rosenberg, FSA, Ph.D.; Geoffrey Sandler, FSA, MAAA; Shereen Sayre, ASA, MAAA; Norman Storwick, FSA, MAAA; and Toole. We are also grateful to the Health Section Council and its liaisons Greg Fann, FSA, FCA, MAAA; Jackie Lee, FSA, MAAA; and Geof Hileman, FSA, MAAA; and SOA staff members Joe Wurzburger, FSA, MAAA, and Dee Berger.
Over the past 18 months, we have educated actuaries on public health topics by:
Publishing several articles in Health Watch that have informed actuaries about the contributions of public health to society.
Encouraging updates to the Health Track’s Basic Education reflecting public health, with members of the task force writing material to be included in this new curriculum.
Presenting current public health topics at the 2017 Health Meeting (presented by task force members Sayre, Owen and Lerche). And I’m proud to say, the public health sessions at both the 2016 and 2017 Health Meetings won the distinction of being one of the meeting’s top three sessions.
Forming a Public Health subgroup. It includes periodic educational conference calls and an SOA Engage website. It began meeting in January 2018.
A Look at the Broader Community
We have also contemplated how we might contribute outside of the SOA in the broader public health community. In keeping with the concept of optimization of scarce resources, members of the task force collaborated to offer feedback to the Department of Health and Human Services (HHS) Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030, better known as Healthy People 2030. Our feedback can be summarized with the following excerpt from our comment letter:
“Actuaries … who work in the health field are focused on taking an objective, data-driven view to health and health care. With this view, we quantify the costs of programs and services (or a combination of these), as well as the downstream savings that various investments can generate. We believe that this objective view is sometimes missing from the clinical and public health discourse, and yet it is a view that is absolutely necessary to decision-making.”
This web-exclusive series of The Actuary includes a wide array of articles on topics ranging from some of the early successes of public health, such as vaccinations and family planning; to current headline issues such as suicide and opioids; to cutting-edge opportunities like community care organizations. Another article explores the complex but fragile system used to fund public health today. Mange’s article nicely frames the collection within the context of the evolution from Public Health 1.0 to 3.0. Actuaries can make significant and meaningful contributions in all of these areas and more. We hope that as you read the articles, your curiosity is piqued and you are inspired to consider how you might contribute to the broader public health discussion to improve the health of society as a whole.
While this web-exclusive series is our final act as a task force, it is not the final act of this remarkable group of people who have given so freely of their time and from whom I have learned so much. We invite you to join the Public Health subgroup, where we will continue to share the public health message with actuaries. In addition, many of us will continue working together to encourage actuarial participation in public health through:
Basic and continuing educational opportunities
Actuarial research and publications
Partnership opportunities, enabling the actuarial message to be shared more widely with the public health community
We look forward to connecting actuaries to public health in the years to come.
Sara C. Teppema, FSA, MAAA, is DVP and actuary, Provider Payment Innovation and Analytics, at Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas.