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Global Health

This page features information about the Center’s international, national, and regional work in global health, links to current projects, organizations, events, and reports concerning current global health issues. 

The Center for Global Health and Medical Diplomacy (the Center) at the University of North Florida was founded in February 2007, with the mission of promoting global understanding and collaborative action for improving health and medical care.    Center objectives include:

  • Promoting excellence and balance in the caring, ethics and science of health and medicine
  • Promoting the human, economic and diplomatic value of health and medical care
  • Promoting optimal health and medical education
  • Supporting leadership development in the health and medical professions
  • Integrating broad local, state, national and global participation in advisory committees, forums, publications, research, education and demonstration activities

 

 

International Efforts:
The Center for Global Health and Medical Diplomacy supports, participates in and collaborates with healthcare and medical care organizations around the globe, including the World Medical Association, the World Health Organization, the American Medical Association, the US Dept. of Health and Human Services, the American Association of Clinical Endocrinologists, and the Institute of Medicine.   Center Director, Dr. Yank Coble travels internationally to speak on the Center’s work in global health.

Much of our work in 2007 and 2008 has focused on the World Medical Association/Caring Physicians of the World Initiative (WMA/CPW), which works to improve the effectiveness of medical professionals around the world.  The Center collaborated with the WMA, the international business school, INSEAD and Pfizer, Inc. to create a Physicians’ Leadership Course designed to enhance the skills and knowledge needed to advocate for healthcare reform and improved patient care.  The six-day intensive curriculum focuses on proficiency in decision–making, participation in public debate and preparation to serve as spokespersons on key healthcare policy issues.  The first Physicians’ Leadership Course was held in December 2007, at INSEAD in Fontainebleau, France.  Thirty two physicians from 22 countries participate in the course.  As a result of the positive feedback from the inaugural course, a commitment has been made to sponsor an annual program.

 

National Efforts:
The Center convenes public- and private-sector experts to collaboratively address global health issues.   Center-sponsored conferences, committees and public forums   provide an opportunity for leading experts (regional, national and international) to discuss issues and share knowledge in an open environment that facilitates evidence-based dialogue.    The Center Director, Dr. Yank Coble actively participates in and holds leadership roles in many national medical associations and health organizations including the American Medical Association, the US Dept. of Health and Human Services, the American Association of Clinical Endocrinologists, and the Institute of Medicine.   Presently Dr. Coble serves on the boards of Research!America; the Institute of Medicine Roundtable on Environmental Health Sciences, Research and Medicine; the Campaign for Public Health; and the National Osteoporosis Foundation.   Dr. Coble travels nationally to speak on the Center’s work in global health.

 

Regional Efforts in Northeast Florida:
The Center serves as a focal point for global health activities within the University of North Florida and the broader community.  Educational events, public forums, seminars and conferences help to increase the visibility and awareness of local, national and global health issues.   The Center Director actively participates in and holds leadership roles in regional medical associations and health organizations including the Duval County Medical Society and the Florida Medical Association.

The Center planned and convened the 2007, 2008 and 2009 Caring Community Conferences, where northeast Florida community leaders met to collaborate on long range plans to enhance the health care and biomedical economy of Jacksonville and northeast Florida.  At each conference, healthcare and bioscience stakeholders discussed issues, assets and opportunities relating to the individual health, public health and economic health of northeast Florida. 

Following the 2007 Conference, the Center facilitated the formation of the Healthcare and Bioscience Council of Northeast Florida (the Council).  Council members were announced in April 2008.  Center Directory, Dr. Yank Coble currently serves as Chair of the Council, and Center staff provides administrative support for the Council.  The Council’s mission is to put into action the address the Final Recommendations from the 2007 Caring Community Conference.  The Council presented its first status report at the 2008 Caring Community Conference.

 

Click on the links below to read more about Center participation and sponsorship of Global Health Events

Announcement of the Center and Director, Feb. 13, 2007

Inaugural Forum, Feb. 26, 2007

Report on Economic Impact of Healthcare and Bioscience Industry, 2007 & 2008

Access to Care Forum, May 22, 2007

The Caring Community Conferences: 2007, 2008, and 2009

Face to Face Interview Dr. Yank Coble, April 9, 2008

The Global Medicine and Public Health Initiative, May 20, 2008

Institute of Medicine of the National Academies Roundtable on Environmental Health, Sciences, Research and Medicine

Research!America

Quality /Safety Forum, April 28, 2009

 

Links to Global Healthcare Associations & Institutions

American College of Physicians


American Medical Association

Centers for Disease Control and Prevention

DoD International Health

DoD Military Health

Duke-NUS Graduate Medical School Singapore

Global Health Council

INSEAD

Institute of Medicine

NIH Fogarty International Center

Project HOPE

Research!America Global Health
Research Ambassadors

World Health Organization

World Medical Association

 

Key References in Global Health

Proceedings of the Africa Command Health Symposium, Jan. 8-9, 2009
Institute of Medicine, Wash. DC


Is America Falling Off the Flat Earth?
by Norman R. Augustine
Learn more...


Global Health Leadership and Management
Editors William H. Foege, Nils Daulaire, Robert E. Black, Clarence E. Pearson
Learn more...

 

Medical Tourism: Global Competition in Health Care
by Devon M. Herrick
Learn more...

 

Display this report on your site

The U.S. Commitment to Global Health:
Recommendations for the New Administration

Institute of Medicine Report released Dec. 2008
Read the Executive Summary
Read the full report

 

book
Hot, Flat, and Crowded
Why We Need a Green Revolution - And How it Can Renew America

by Thomas L. Friedman


book
The World Is Flat, 3.0
A Brief History of the Twenty-First Century
by Thomas L. Friedman



book
The World Is Flat: Expanded Edition
A Brief History of the Twenty-first Century
by Thomas L. Friedman

 

 

Announcement of the Center and Director, Feb. 13, 2007
video

On Feb. 13, 2007, University of North Florida President John Delaney and Brooks College of Health Dean Pamela Chally announced the creation of the Center for Global Health and Medical Diplomacy.  Dr. Yank D. Coble was named Center Director and Distinguished Professor.  

Dr. Coble brings 35 years of experience in clinical medicine and medical diplomacy to the Center, including service as president of the World Medical Association, the American Medical Association, the American College of Physicians, and the Florida Medical Association. He has also served as a leader in national organizations committed to medical care quality and research, such as the Joint Commission on Accreditation for Healthcare Organizations, and the Agency for Healthcare Research and Quality, and the Physician’s Consortium for Quality Improvement and the National Quality Forum.  Dr. Coble explained that the mission of the Center is to promote excellence and balance in the caring, ethics and science of health and medical care, fostering global understanding and collective action for improving health and medical care.  The Center will work to bring regional, national and international experts together to discuss health care issues, sponsoring a series of forums to encourage discussion about local and global health issues, and foster activities to enhance healthcare quality and access to care.


Center Mission Statement

 

 

The Inaugural Forum: 
Global Health and Medical Diplomacy: Quiet Advocacy, Feb. 26, 2007

Event Program
Watch Video 
On February 26, 2007, the Center held the first Caring Community Forum with Dr. John Howe, President of Project Hope, as the Distinguished Lecturer on Medical Diplomacy.  Project Hope is an international health foundation with offices and programs in 30 countries, and publisher of "Health Affairs," a health policy journal. The reception was attended by nearly 150, and the lecture by over 500.  The forum was jointly sponsored by the Center and the World Affairs Council.  
 
Dr. Howe’s presentation illustrated the many ways in which Project Hope accomplishes its
stated mission: To achieve sustainable advances in health care around the world by implementing health education programs and providing humanitarian assistance in areas of need. A major success illustrated by Dr. Howe was the relief work Project HOPE performed following the Tsunami that devastated many areas of Asia in December 2004.  The U.S. Navy and a host of American doctors volunteered their services for disaster relief in a remarkable display of medical diplomacy.  Dr. Howe shared the results of a BBC study which showed dramatic improvement in global public perception of the United States in the months following this volunteer service. 

Earlier in the day, Dr. Howe met with leadership of the Jacksonville Chamber of Commerce and many health and medical professionals regarding the growth of high quality health and medical care and bioscience industry.
 


 

 

Economic Impact of the Healthcare and Bioscience Industry in Jacksonville, 2007 & 2008 Reports

On Feb. 26, 2007, Dr. John Howe, President of Project Hope, visited the Center to lecture on Medical Diplomacy. (Project Hope is an international health foundation with offices and programs in 30 countries, and publisher of "Health Affairs," a health policy journal.) Earlier in the day, Dr. Howe spoke to members of the Jacksonville Chamber of Commerce on the topic of healthcare and bioscience growth in San Antonio.

As a result of Dr. Howe’s presentation, the Center, in collaboration with the Jacksonville Chamber of Commerce and the Coggin College of Business at the University of North Florida, planned and commissioned the first Economic Impact Study of the Healthcare and Bioscience Industry in the Jacksonville MSA. Results showed that in 2005, healthcare and related industries in Jacksonville, Florida, employed 1/6th of the workforce, and contributed almost $22 billion dollars in direct economic impact. The total direct, indirect and induced impact was greater than $40 billion.  Results of the 2007 report were instrumental in the planning of the Caring Community Conference. The study was updated and republished in 2008.

Data provided by these reports allows for comparison to other cities, and indicates that healthcare industries make a major contribution to the Jacksonville economy. Cities that have been successful at nurturing healthcare and bioscience industries enjoy a higher per-capita income than cities without significant healthcare/bioscience industry. When considering the per-capita economic impact of healthcare and related industries, Jacksonville compares favorably to other prominent cities such as Raleigh, San Antonio, Houston and Atlanta. These studies provide a benchmark against which future growth in healthcare and bioscience will be measured. 

To view a copy of the 2007 Economic Impact Study click here.

To view a copy of the 2008 Economic Impact Study click here.

 

 



 

 

A  Community Forum: 
Access to Care: the Critical Conundrum, May 22, 2007
video part 1

video part 2

Event Program

On May 22, 2007, the Center hosted a community forum on “Access to Care: the Critical Conundrum”, addressing the serious issue of access for the uninsured and underinsured.  The forum was co-sponsored by the Duval County Medical Society and the Florida Medical Association. 

Welcoming remarks were made by Yank D. Coble, Jr., MD, MACE, MACP, Director, UNF Center for Global Health and Medical Diplomacy; and John M. Montgomery, MD, MPH, President, Duval County Medical Society.  
In the Plenary Session, National to State Perspectives:  William G. Plested, III, MD, President, American Medical Association,  addressed The National Approach to Access to Care & Health System Reform.   Patrick M.J. Hutton, MD, MBA, President, Florida Medical Association, addressed The State Approach to Access to Care & Health System Reform.  Robert Brooks, MD, MBA, FSU College of Medicine, Associate Dean for Health Affairs; Former Secretary, Florida Department of Health, addressed Government Role & Public Health Aspects of Access to Care.

The second session of the forum presented Access to Care: The Local Reality.    Floyd B. Willis, MD, Past President, Duval County Medical Society, moderated Panel 1, which addressed The Impact on Outpatient Care.  Panelists included: Sister DeSales Wisniewski, President, We Care Jacksonville;  James Borland, MD, CMO, VA Clinic Jacksonville; Jim Burt, MD, Medical Director, Volunteers in Medicine;  Robert Harmon, MD, Director, Duval County Health Dept.; Rhonda Davis Poirier, Dr. of P.H., CEO & President, JaxCare;  and Anne Waldron, MD, Secretary,Duval County Medical Society.

Panel 2 addressed The Impact on Area Hospitals / Institutions.  Pamela Chally, RN, PhD, Dean, University of North Florida College of Health, moderated the panel.  Panelists included Keith Stein, MD,CMO, Baptist Health; Angela Martin, MD, CMO, Memorial Health; Captain Raquel Bono, MC, USN, Commanding Officer, Navy Hospital Jacksonville;  Floyd B. Willis, MD, St. Luke’s Hospital / Mayo Clinic;  Phil Perry, MD, CMO, St. Vincent’s Healthcare;  and Mark Hudak, MD, Assistant Dean of Managed Care, UF & Shands.
Extensive participation of local health and medical professionals and institutions added to the success of this forum.
The video of the Access Forum is available at the Center.


 

Face to Face Interview with
Dr. Yank Coble, Director, Center for Global Health and Medical Diplomacy, April 9, 2008

video

The Face to Face Interview Series is an ongoing series of in-depth conversations with prominent members of the NEFL community.  The program was developed by the UNF Academic Enrichment Program and the Honors Program. Past interviews have been conducted with Governor Jeb Bush, Wayne Weaver, owner and CEO of the Jacksonville Jaguars, Delores Kesler, founder of Accustaff, a temporary staffing firm that was purchased by Modis Corporation, and Jay Stein, founder of Stein Mart.

The interviews are conducted in a class that has a special interest in the specialty of the person being interviewed, and honor students and members of the University Scholars Honor Society are invited to attend.  Audience members have the opportunity to pose questions to the interviewee after the interview.

On April 8, 2008, Mr. Laurie DuBow, a board member of the Super Bowl XXXIX Host Committee and a partner in Jacksonville Jaguars Ltd., interviewed Dr. Yank Coble, Director of the Center for Global Health and Medical Diplomacy.  Audience members included pre-medical students and students interested in global health careers. 

 

 

 

 

 

 

The Global Medicine and Public Health Initiative, May 20, 2008
Obesity and Non-Communicable Diseases: Addressing the Epidemic through Science, Fitness and Behavior Modification
video: First Plenary Session
video: Second Plenary Session

Summary

The Global Medicine and Public Health Initiative was held on May 20, 2008 at the University of North Florida University Center. This event was co-hosted by the Center for Global Health and Medical Diplomacy, the Duval County
Medical Society, and the Duval County Health Department. The forum focused on the growing challenges of
obesity and other non-communicable diseases.

Welcoming remarks were made, and the program was introduced by Dr. Yank Coble, Director of the Center for Global Health and Medical Diplomacy, and Dr. Glenn Knox, President of the Duval County Medical Society.


The First Plenary Session was moderated by Dr. John Montgomery, Immediate Past President of the Duval County Medical Society.
The first presentation was given by Dr. Jeremy Lazarus, Speaker of the House for the American Medical Association. Dr. Lazarus presented AMA Perspectives on Analyzing and Understanding the Epidemic.
lazarus
Following Dr. Lazarus' presentation, Dr. Georges Benjamin, Executive Director of the American Public Health Association, presented Global Initiatives Regarding the Epidemic of Non-Communicable Diseases.
view Dr. Benjamin's presentation
The final presentation in the first plenary session was made by Dr. Robert Brooks, Associate Dean for Health Affairs at the Florida State University College of Medicine, and Former Secretary of the Florida Dept. of Health. Dr. Brooks presented Academic and State Perspectives: Training Healthcare Professionals to Address the Epidemic.
view Dr. Brook's presentation
Panel discussion and Q&A followed.
 

The Second Plenary Session was moderated by Dr. Pamela Chally, Dean of the Brooks College of Health at the University of North Florida.

The first presentation was made by Dr. Judy Perkin, Professor and Chair of the Department of Public Health, at the Brooks College of Health at the University of North Florida. Dr. Perkin presented The Obesity Epidemic: A Socio-Cultural Perspective on Causation and Prevention.
view Dr. Perkin's presentation

The second presentation was made by Dr. Robert Harmon, Director of the Duval County Health Department. Dr. Harmon presented Public Health and Local Community Perspectives.
view Dr. Harmon's presentation

The final presentation was made by Dr. Donald George, Pediatrician at Nemours Clinic, and Co-Chair of the Duval County Health Department Childhood Obesity Prevention Policy Development Workgroup. Dr. George presented Fostering a Healthy Beginning for Healthy Living, the Medical Perspective.
view Dr. George's presentation

Panel discussion and Q & A followed.  Dr. Coble adjourned the forum.

 

The forum was attended by over 100 healthcare and medical professionals, educators, and students. CME credit was offered (3.25 credits) for physicians.

 

The Global Medicine and Public Health Initiative, May 20, 2008
Obesity and Non-Communicable Diseases: Addressing the Epidemic through Science, Fitness and Behavior Modification

PROGRAM OF EVENTS

8:00 AM  Registration and Continental Breakfast

8:15 AM  Welcome & Introductions
Yank D. Coble, Jr., MD, MACE, MACP, Director, UNF Center for Global Health and Medical Diplomacy
Glenn W. Knox, MD, FACS, President, Duval County Medical Society

8:30 AM  Plenary Session I:  The Emerging Global Health Crisis
Moderator:  John M. Montgomery, MD, MPH, DCMS Immediate Past President

Analyzing and Understanding the Epidemic:  AMA Perspectives

Jeremy A. Lazarus, MD, AMA Speaker of the House
Global Initiatives Regarding the Epidemic of Non-communicable Diseases
Georges C. Benjamin, MD, FACP, FACEP, Executive Director, American Public Health Assoc.
Academic and State Perspectives – Training Healthcare Professionals to Address the Epidemic
Robert G. Brooks, MD, MBA, FSU College of Medicine, Associate Dean for Health Affairs Former Secretary, Florida Department of Health
Panel Discussion – Q&A

10:30 AM  Plenary Session II:  Obesity and Fitness – Addressing the Epidemic
Moderator:  PAM Chally, PhD, Dean, UNF Brooks College of Health
The Obesity Epidemic: A Socio-cultural Perspective on Causation and Prevention
Judy Perkin, DrPH, RD, CHES, Professor & Chair, Department of Public Health, UNF Brooks College of Health
Public Health and Local Community Perspectives
Robert G. Harmon, MD, MPH, Director Duval County Health Department
Fostering a Healthy Beginning for Healthy Living – The Medical Perspective
Donald E. George, MD, Pediatrician, Nemours Clinic, and Co-Chair DCHD Childhood Obesity Prevention Policy Development Workgroup
Panel Discussion – Q&A

12:00 PM Adjournment
Yank D. Coble, Jr., MD, MACE, MACP, Director, UNF Center for Global Health and Medical Diplomacy


 

 

 

2008 Caring Community Conference, September 17-18, 2008

Download the Summary Brochure

The Center for Global Health and Medical Diplomacy was pleased to host the second Caring Community Conference on September 17 and 18, 2008, at the University of North Florida University Center.  Session 1 of the Conference covered healthcare reform, Session 2 covered the progress of the Healthcare and Bioscience Council of NEFL and Session 3 addressed the Ethics of Human Research as codified in the Declaration of Helsinki. Keynote Speakers included Ian Morrison, PhD, an internationally known author, consultant and futurist; Cecil Wilson, MD, Past-chair of the American Medical Association and American College of Physicians; and Otmar Kloiber, MD, Secretary General of the World Medical Association.

Session 1:  Healthcare Reform is among the top priorities of the 2008 national election agenda and of critical concern to those of us who aspire to enhance healthcare and bioscience in our community.  Keynote presentations by futurist Ian Morrison, PhD., American Medical Association Trustee and Past Chair, Cecil Wilson, MD and Otmar Kloiber, MD, Secretary General of the World Medical Association provided unique yet complementary views of national and global trends that may influence the future landscape of healthcare.

Session 2:  September 2008 marks the one year anniversary of the inaugural Caring Community Conference at Amelia Island which resulted in 12 final recommendations to enhance the individual and economic health of our northeast Florida Community.  Panelists from the Healthcare and Bioscience Council of Northeast Florida presented progress reports on work underway to implement these recommendations.

Session 3:  Dr. Otmar Kloiber, Secretary General of the World Medical Association, presented a seminar focused on the ethical principles for medical research involving human subjects as codified by the World Medical Association in the Declaration of Helsinki.

Almost 200 attended the forum, representing leadership from medicine and healthcare professions, health and medical education, research and biomedical industry, hospital administration, social services, government, professional associations, and community organizations.

 

 

2008 Caring Community Conference, September 17, 2008
Session 1: Forum on Healthcare Reform

invitation


Session 1: the Forum on Healthcare Reform was held on September 17, 2008, from 8AM till 10 AM, at the University of North Florida University Center. Welcoming remarks were made by UNF President John Delaney. The program was introduced by Dr. Yank Coble, Director of the Center for Global Health and Medical Diplomacy.

 

Dr. Coble presented a brief summary of the Caring Community Conference of Sept. 2007, which resulted in specific recommendations to improve the individual and economic health of northeast Florida. One specific recommendation was to create a Healthcare and Bioscience Council of Northeast Florida, which has now been formed and is working to address the other specific recommendations of the Caring Community Conference. Dr. Coble presented the 2008 Report of Economic Impact of the Healthcare and Bioscience Industry of Northeast Florida.

View the 2008 Report of Economic Impact of Healthcare and Bioscience Industry of NEFL

View Dr. Coble's presentation
coble

University of North Florida President John Delaney welcomed the participants to the 2008 Caring Community Conference.  President Delaney thanked participants for sharing their expertise in health care, medicine, public policy and community action to improve the individual and economic health of the NEFL community as well as the global community. 

President Delaney expressed his pride in the progress and growth of the Center for Global Health and Medical Diplomacy, having developed into “the place where the community comes together” for the dialogue on health reform and health policy. 

jd

 

Jacksonville Mayor John Peyton thanked attendees for participating in the second Caring Community Conference, welcoming returnees from the 2007 Conference, as well as new participants.  He highlighted the significance of the health sciences sector for NEFL, citing superior regional assets and targeted municipal efforts to grow the health sciences industry.    Peyton noted that through community action, NEFL can leverage its assets to attract industry and achieve better health systems.   He challenged the assembly to suggest new proposals for partnering with the city to advance health sciences. 

The Mayor saluted the collaborative work of the Center and the Caring Community Conference participants. He observed that the Center has a promising future as a sustainable and important asset for Jacksonville, due to its neutral positioning (as a non-governmental entity) and its extensive support from community leaders. 

 

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TRENDS IN HEALTHCARE REFORMIM

Ian Morrison, PhD
Healthcare Futurist

View Dr. Morrison's presentation

Healthcare futurist and author, Ian Morrison presented his research and vision for the future of healthcare in America, focusing on the quest for value for all Americans.  He discussed historical examples of political leadership and legislation which reformed healthcare systems in America, resulting in the current system, which falls short of meeting expectations and needs for many Americans.  It is the subject of much debate this election year.

Dr. Morrison explained various models of change, and the key political and economic forces that drive healthcare reform.  He presented international data comparing healthcare spending, mortality rates, lifespan expectancy, obesity, tobacco and alcohol use, and doctor visits per capita.  He discussed the growing problem of access to care for the uninsured, and the critical need for a balance between primary care and specialty care.  Morrison explored cultural differences in values and expectations for healthcare, including Republican and Democratic values, attitudes and beliefs and how they might impact healthcare reform. 

Dr. Morrison used the “Value Equation” to explain the current status of US healthcare.  The Value Equation looks at the balance between access to care, quality of care, security of benefits and cost.  The high cost of US healthcare as a percent of GDP (16%) is 6% greater than any other industrialized country, yet many quality measures suggest that a greater “value” per healthcare dollar could be achieved.  Dr. Morrison’s research indicates that “cost” and “quality” are inversely correlated, meaning that Americans spend more and get less for their healthcare dollars.  However, Dr. Morrison concedes that there is no perfect healthcare system; all countries struggle with the value equation and make necessary compromises.   Various healthcare reform options were discussed, including “the new American compromise” which is based on a value for healthcare as both a right and an obligation. 

Dr. Morrison noted that healthcare in northeast Florida is a key employer and a regional economic asset.  He observed that the Center for Global Health and Medical Diplomacy is well positioned as a neutral convening body, to spearhead regional efforts to improve health and healthcare.      A successful regional initiative would include advances in health information technology, improvements in transparency of quality and outcome measures, and expanded coverage.

 
Dr. Morrison concluded with optimistic comments about opportunities to make a meaningful difference in regional healthcare.  Community leadership is critical to engaging stakeholders in reform that focuses on finding value and providing a continuum of care.


 

NATIONAL HEALTHCARE REFORM

Cecil B. Wilson, MD
Past Chair, AMA Board of Trustees

View Dr. Wilson's presentation

NATIONAL HEALTHCARE REFORM
Dr. Wilson presented the American Medical Association’s (AMA) plan for health system reform and discussed the contributors to rising health care costs in the United States.  The AMA National Health Care Policy Agenda consists of working to improve the following: 

  • Health Care Environment
  • Clinical Excellence
  • Health of the Public
  • Physician Practice Viability and Patient Access
  • Physician Education and Professionalism

The key elements of the AMA strategy can be summarized by the three “C’s:” below
CASH:  Replace the current health insurance tax exclusion now available primarily for large businesses’ employees with a system of income-related tax credits. 
CHOICE:  Enable the selection, choice and purchase of individually owned insurance whether employer provided or on the open market.
CHANGE:  Facilitate the expansion of health insurance markets to increase choice with guaranteed renewal, limits on insurance premium cost variations and reinsurance to provide protection for those with chronic conditions and catastrophic illness. 

Dr. Wilson described the rising cost of medical care as a critical discussion which must accompany health system reform proposals.  Among the factors contributing to increasing costs are:  an aging population, an increase in chronic disease much of which is caused by lifestyle behaviors, new technology, defensive medicine, prescription drugs ( the highest growing component of healthcare costs) and others.  Dr. Wilson reminded the audience that over 50% of health is determined by lifestyle behaviors, noting that in the past 20 years obesity has doubled and healthcare spending on obesity has tripled.

The AMA has four key strategies to manage rising healthcare costs:

  • Reduce the burden of preventable disease
  • Make the delivery of health care more efficient
  • Reduce nonclinical health system costs
  • Promote value-based decision making at all levels

In conclusion, Dr. Wilson applauded the work of the Center and outlined the AMA’s actions steps for change (below).

AMA’s Actions Steps for Change

  • Promote patient lifestyle counseling
  • Support cost-effectiveness research
  • Develop health information technology
  • Use quality measurement to improve efficiency
  • Encourage targeted design by insurers (lower fees for preventive care)
  • Reduce health disparities based on race and ethnicity
  • Build broad coalitions of healthcare industry stakeholders
 

 

GLOBAL HEALTHCARE REFORM

Otmar Kloiber, MD
Secretary General, World Medical Association

View Dr. Kloiber's presentation

Dr. Kloiber focused his remarks on the global situation for health system reform, reviewing prevailing models and discussing current trends in international health care policy.

He began by reminding the audience that all health care systems are deeply rooted in their cultures and values.  Because of this plurality, there is no universal fix or model to copy.   In addition, only the wealthiest nations have any system of healthcare at all.  The vast majority of the world, the developing and underdeveloped countries, including even China, essentially have no organized system of health care. 

Dr. Kloiber described the critical current human resource shortage of health professionals.  He explained the global migration of healthcare professionals from the poorest countries of the world to the wealthiest countries of the world.  The reasons for this migration include the opportunity for improved lifestyle, better reimbursement, as well as better conditions in which to serve ones patients.  The impact of this migration is that the poorest countries with the highest burden of disease now have an increasingly smaller share of the world’s healthcare workforce. 

Dr. Kloiber reviewed the founders of  the current models of health care:  Bismark of Germany, Semashko of Russia and Beveridge of Britain  The most significant difference in systems of care relates to the inherent underlying philosophy, for example, the individual right to healthcare versus the collective right to healthcare.  A country’s philosophical base will have profound implications for the health care system that country will ultimately put in place.

Dr. Kloiber concluded that traditional models of health care are eroding rapidly and that all systems are “on the move.”  When countries consider health care policy and reform it is essential to agree on the most important values, e.g., freedom, choice, social protection, profits, etc.  A national consensus based on values is the most important consideration for effective change.

Finally Dr. Kloiber reminded the audience that we must keep our problems in perspective.  In the wealthiest nations of the world most regions enjoy a ratio of one doctor for every 500 persons.  In the poorest countries, the ratio is one doctor for every 50,000 persons.

 

2008 Caring Community Conference, September 17, 2008
Session 2: Report from the Healthcare and Bioscience Council of NEFL

Session 2: Report from the Healthcare and Bioscience Council of NEFL, was held on September 17, 2008, from 10 AM till noon, at the University of North Florida University Center. Two panel discussions addressed the ways in which healthcare reform may impact health, medical care and biomedical industry in the northeast Florida region. Members of the Healthcare and Bioscience Council of Northeast Florida and other regional experts served as panelists. Each panelist discussed a specific recommendation from the 12 Final Recommendations of the 2007 Caring Community Conference. A Question and Answer period followed the panel discussions.

 

Report from the Patient Care Panel
The Patient Care Panel
included Mr. Hugh Greene, Dr. Robert Harmon, Dr. Helen Jackson, and Dr. Floyd Willis.

Improving Access to Care
Mr. Hugh Greene,  President and CEO, Baptist Health
Mr. Greene reported on the development of the JaxCare pilot program, a multi-payor public-private partnership funded by government, providers, businesses and employers to provide access to care for the working uninsured of Jacksonville (estimated to be 100,000 and 120,000 people).  The JaxCare program was effective, and community collaboration was extraordinary; however the program was not scalable or sustainable and it closed in June 2008. 

A new medical home model is being explored as a replacement for JaxCare, which would provide the continuity of care that exists when patients have a relationship with a primary care doctor.  Funding sources are critically needed.  Mr. Greene noted the need to celebrate the many people, organizations, and clinics that are committed to making a difference by improving or providing access to care in Jacksonville and have done so for many years.  The common thread is partnership and collaboration.

 

Health and Wellness
Dr. Helen Jackson, Director of Community Nutrition Services, Duval County Health Dept.
Dr. Jackson explained that improving health and wellness requires the collaborative efforts of the entire community and its resources, including business partners.   She elaborated on two specific collaborative initiatives in Jacksonville: childhood obesity and infant mortality. 

The Childhood Obesity Prevention Coalition was formed to prevent and reduce childhood obesity in Duval County.  The Coalition successfully implemented Body Mass Index (BMI) screening in Jacksonville public schools and compiled a guide of local resources for families of overweight children. 

The Jacksonville Community Council Infant Mortality Study (www.jcci.org) looked at Jacksonville’s exceedingly high, racially and socio-economically disparate Infant Mortality Rate (IMR).  The study found that the greatest direct cause of infant mortality is the birth of premature and underweight babies due to poor health of the mother.  The Study produced 15 recommendations to reduce infant mortality, including education, awareness, making healthcare services affordable, and attending to a woman’s health prior to pregnancy. 

 

Reducing Health Disparities and Inequities 
Dr. Floyd Willis, Chair of Family Medicine, Mayo Clinic  
Dr. Willis explained the enormous complexity of the health disparities problem in the US, noting that every major disease category disproportionately affects the less affluent or the racial minorities.  Racial and socioeconomic inequalities in health must be addressed in order to move forward building individual and economic health in the community.

Dr. Willis complimented all regional hospitals and clinics for the work being done on disparities issues.  He described a new health disparities project in Jacksonville, the Community Research Advisory Board (CRAB) which works to address the questions of healthcare disparities through the community members that suffer most from disparities, examining the complex issues of access to care, genetics, environment and behavior. 

 

Advancing Health Information Technology
Dr. Robert Harmon, Director, Duval County Health Dept.
Dr. Harmon advocated more rapidly adopting major changes in Health Information Technology (HIT) to improve healthcare access and quality, and contain costs. He noted that Florida is underinvested in health, especially for the uninsured, and he suggested the Council work to

  • Increase delivery of preventive services 
  • Increase primary care medical homes 
  • Improve lifestyles
  • Increase and improve HIT systems

Dr. Harmon reported on the regional state of HIT, noting that most area hospitals and large group practices have modern electronic health records.  Many partners in Jacksonville are leading the expansion of e-prescribing.   Most recently, the NEFL Health Information Consortium including the Duval County Health Department and Duval County Medical Society obtained a Health and Human Services grant for a Medicare Electronic Health Records Demonstration Project to be implemented in 2009.

 

Report from the Education and Research Panel
The Education and Research Panel
included Judge Susan Black (by video), Mr. Marshall Criser, Dr. Robert Nuss, and Mr. Art Wotiz.

Increasing Medical Residencies
Judge Susan Black (by video), Federal Judge of the US Court of Appeals for the Eleventh Circuit
Judge Black explained that a critical global shortage of physicians is predicted, as many physicians are among the 79 million baby boomers heading toward retirement over the next 15 years.   One way to address that shortage of physicians is by increasing medical residency programs, as statistics show that 60% of graduating doctors decide to reside and practice in the region where they complete their residency training.

Judge Black and co-chair Mr. Laurie DuBow are working to develop a program designed to keep the residency programs currently in existence in Jacksonville, and to increase the number of residency positions.  From May – September 2008, they conducted interviews with leaders of NEFL hospitals and medical schools, meeting with every institution that currently has or might want to have a residency program.  They found that there are currently over 500 residents in Jacksonville Florida. The two largest residency programs are Family Medicine and Internal Medicine.  Nationally, critical shortages of practitioners in Family Medicine and Internal Medicine are predicted, therefore it is particularly important to keep those residency programs in our community.

 

Medical Education
Dr. Robert Nuss, Dean, Regional Campus, University of Florida College of Medicine,   
Associate VP for Health Affairs, University of Florida Health Science Center, Jacksonville
Dr. Nuss explained that the US medical education system is under significant stress.  To  address the coming medical manpower shortage states are increasing the number of regional medical campuses, building new medical schools, and adding residency positions to existing programs.  Dr. Nuss noted that the annual cost of training a resident is approximately $88 thousand dollars per resident, not including faculty salaries. 


Dr. Nuss elaborated on current problems in medical education including:  decreasing state and federal funds for education; lack of funding for additional residency positions; increasing competition for faculty; increasing debt for medical residents; a new policy instituting an 80 hour work rule, reducing resident training hours and work output; and a critical shortage of  medical student clerkship spots.  Dr. Nuss speculates that future residents may need to pay, rather than be paid, to perform a residency. 

 

Establishing a Regional Bioscience Academic Institute in Jacksonville
Mr. Marshall Criser, Past-president of the University of Florida
Mr. Criser provided an excellent historical summary and analysis of the circumstances leading up to the recruitment and startup of a subsidiary of The Scripps Research Institute (TSRI) in Palm Beach County.  Governor Jeb Bush initiated the process with Scripps and the legislature appropriated $310 million to support the operational start up costs.  Palm Beach Country was largely selected because of the opportunity for philanthropic support in that area.  Scripps will be housed in a building on the Jupiter campus of Florida Atlantic University with opening planned for the first quarter 2009. Two additional California research centers announced soon thereafter that they will be opening satellites in Florida. The Torrey Pines Institute for Molecular Science will open a facility in Port St. Lucie and the Burnham Institute for Medical Research will open a laboratory in association with the University of Central Florida in Orlando. 

Mr. Criser commented that the area’s outstanding healthcare resources, the consolidated government of Duval County coupled with the collaboration within the Northeast Florida region will benefit the long term development of the healthcare and bioscience industry.

 

Establishing a NEFL Bioscience Industry Campus
Mr. Art Wotiz, President & CEO NovaBone Products, LLC (NBP)
Mr. Wotiz explained that NEFL resources, including outstanding universities, hospitals, and research facilities, an educated workforce, low taxes, and an excellent quality of life, should serve as a major attraction to hi-tech businesses to form a NEFL Bioscience Industry Campus in Jacksonville (similar to the Research Triangle in NC).  The city of Jacksonville has already funded a medical tourism initiative, all of which will enhance the individual and economic health of the community.

The city of Jacksonville is fortunate to have the same demographic makeup as the nation, making it an excellent site for clinical trials, which are an important step in the path of transforming scientific research into treatment for diseases.  Mr. Wotiz explained that the establishment of a bioscience industry campus and a regional bioscience academic institute will require significant resources (including a major investment at the local level) and a long range plan of life sciences economic development.  A major focus should be the establishment of an economic development zone between Alachua and Duval Counties, with a strong emphasis on collaboration:  business to business, government to government, and research to research. 

View the Agenda Book

view video of Welcome (UNF President Delaney), Introduction (Center Director, Dr. Coble) and
Dr. Morrison's presentation

view video of Dr. Wilson's presentation

view video of Dr. Kloiber's presentation

view video of Mayor Peyton's remarks

view video of Panel 1

view video of Panel 2

 

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2008 Caring Community Conference, September 18, 2008
Session 3: The Ethics of Human Experimentation
The Global Standard: The Declaration of Helsinki Revisited

Session 3: The Ethics of Human Experimentation, The Global Standard: The Declaration of Helsinki Revisitedwas held on September 18, 2008, from 6 PM till 8PM, at the University of NorthFlorida University Center.

The Declaration of Helsinki (DOH) was developed by the World Medical Association (WMA) as a set of ethical principles for the medical community regarding human experimentation. It is widely regarded as the cornerstone document of human research ethics, although it is not a legally binding instrument in international law. It draws its authority from the degree to which it has been codified in or influenced national or regional legislation and regulations.

The World Medical Association was founded in 1947.  In 1954 the first principles to guide physicians in human research and experimentation were developed.  In 1964, after numerous drafts, the Declaration of Helsinki was officially adopted.  There have been several revisions over the intervening years and in 2008 another formal revision process is underway.  Dr. Kloiber discussed some of the many ethical issues under consideration by the WMA as it strives to continually keep the Declaration current and  “fit with today’s landscape of research.”  As the Declaration of Helsinki is a consensus-based document with no legally binding status, it’s effectiveness and “authority” derives from the credence it has earned as a valuable instrument to guide physicians in the often ethically murky waters of human research.p

Dr. Kloiber discussed at some length one such area where there has been and continues to be significant debate – testing of new drugs using a placebo as the control versus the current therapy.  

When a research trial compares a new drug to a placebo, the results are generally dramatically in favor of the new therapy.  Yet when compared against the current best treatment, differences of the new therapy can appear considerably less significant.   After over a decade of debate on the issue, the latest revision of the DOH will recommend that a new method should be tested against the best current method unless there are compelling scientific and safety reasons to use a placebo as the control.

Dr. Kloiber reviewed some of the current sensational news coverage regarding human research, including particularly severe side effects of new therapies and the fraudulent cloning research by a Korean scientist.

There are a myriad of reasons the Declaration requires revision.  Today these include the need to develop principles for the conduct of research with children, pregnant or nursing women, and the elderly, as well as the rights of research participants to learn of the results of the study in which they participate.

Dr. Kloiber reviewed DOH revisions currently under consideration, such as:  1)  should the DOH state general principles or provide guidance on the application of the principles; 2)  is the DOH applicable to physicians only, or to all researchers; 3)  should the DOH deal with all types of research or just “interventional” research; 4)  should the DOH use the verb “must” rather than “should” and 5)  should unidentifiable human data be included in research results?  Dr. Kloiber speculated on the answers to these questions, which would be determined by the Council and full Assembly of the World Medical Association in Seoul, Korea, October 15-18, 2008.

view the presentation

view the program

 

 

 

 

Institute of Medicine of the National Academies Roundtable on Environmental Health, Sciences, Research and Medicine, Workshop January 15-16, 2009


Center Director, Dr. Yank Coble was appointed to the Institute of Medicine Roundtable on Environmental Health Sciences, Research and Medicine in 2003, and currently serves as co-chair of the Committee on Climate Change and Human Health.   The Institute of Medicine (IOM) is an independent nonprofit organization which advises policymakers, health professionals, the private sector and the public on matters of biomedical science, medicine and health.   The Institute provides unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large.  The Committee on Climate Change and Human Health will examine the ways in which climate change may impact public health globally. 


The Institute of Medicine is both an honorific membership organization and a policy research organization. The Institute's members, elected on the basis of their professional achievement and commitment to service, serve without compensation in the conduct of studies and other activities on matters of significance to health. Diversity of talent among Institute members is assured by a charter stipulation that at least one-quarter be selected from outside the health professions, from such fields as the natural, social and behavioral sciences, as well as law, administration, engineering and the humanities.

Dr. Coble attended the January 15-16, 2009 workshop sponsored by the Roundtable on Environmental Health Sciences, Research, and Medicine. The workshop addressed Scientific Needs and the Research Agenda for the Health Risks of Climate Change. Speakers discussed strategies for identifying priority areas for a health research agenda, ensuring scientific responses to unanticipated health outcomes, developing training opportunities for scientists and institutions, and adapting decision-making tools for action.

Learn more about the Institute of Medicine and Global Health   

 

 

 

Research!America

Research!America is the nation's largest not-for-profit public education and advocacy alliance. Research!America is committed to making research to improve health a higher national priority. Through advocacy, leadership, outreach, public opinion polls and public education, Research!America strives to:

  • Achieve funding for medical and health research
  • Inform the public of the benefits of medical and health research
  • Motivate the public to actively support medical and health research
  • Promote a more active public and political life by individual members of the research community

Dr. Yank Coble, Director of the Center for Global Health and Medical Diplomacy, serves as a member of the Board of Directors of Research!America, and joins in their commitment to making research to improve health a national priority. 
Research!America sponsors the Paul G. Rogers Society for Global Health Research.  The Rogers Society was named for the Honorable Paul G. Rogers (1921-2008), former Florida Congressman, renowned champion for health research, and Research!America chair emeritus. 

Currently, 75  global health experts have been named as Ambassadors to the Paul G. Rogers Society for Global Health Research.  These scientist-advocates were selected by an advisory council comprised of renowned leaders in science, public policy and communications, including four Nobel Laureates.

Ambassadors include experts in pediatrics, nursing and dentistry who specialize in critical areas of global health, neglected and emerging tropical diseases, TB and polio. Ambassadors advocate for greater U.S. investment in research to fight diseases that disproportionately affect the world’s poorest nations.

 

 

 

 

2009 Quality Safety Forum, April 28, 2009
Building a Region of Medical Excellence,
Working Together to Enhance Quality, Safety and Service

Hosted by the Center for Global Health and Medical Diplomacy and the Duval County Medical Society

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On April 28, 2009, 162 attended the Quality and Safety Forum: Building a Region of Medical Excellence,
Working Together to Enhance Quality, Safety, and Service. Keynote Speakers included
Carolyn Clancy, MD
Director, Agency for Healthcare Research & Quality (AHRQ)
and
James Rohack, MD
President-elect of the American Medical Association

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On April 28, 2009, the Center for Global Health and Medical Diplomacy and the Duval County Medical Society hosted the Quality and Safety Forum: Building a Region of Medical Excellence, Working Together to Enhance Quality, Safety, and Service.  The Forum was attended by 162 quality/ safety professionals, regional leaders in health and medical care, and health and medical educators.   Keynote Speakers included Carolyn Clancy, MD, Director, Agency for Healthcare Research & Quality (AHRQ) and James Rohack, MD, President-elect of the American Medical Association. 

The Forum began with welcoming remarks from Yank Coble, MD, Director of the Center for Global Health and Medical Diplomacy and Jay Millson, Executive Vice President, Duval County Medical Society, on behalf of Steve Lucie, MD, President, Duval County Medical Society.

Keynote Session 1

Keynote Speaker Carolyn Clancy, MD, Director, AHRQ, was presented by videoconference from Washington, DC. Dr. Clancy presented All Health Care is Local: Driving System Transformation through Local, Regional and National Collaboration. Q & A with Dr. Clancy follows her remarks. Special thanks to John McDonough, PhD, and Jonathan Pabalate from the UNF School of Nursing for their technical assistance in arranging the video conference. (view video)

Panel 1, Quality Improvement: Best Practice as a Healthcare Institution
Pamela Chally, PhD
, Dean of the  Brooks College of Health at the University of North Florida, served as moderator.  The first two panelists were Connie Haan, MD, Associate Dean for Educational Affairs and Associate Professor of Surgery at the University of Florida College of Medicine-JacksonvilleUF/Shands Jacksonville Regional Academic Health Science Center; and Paul Pitel, MD, Chair, Department of Pediatrics and Associate Medical Director of Nemours Children’s Clinic in Jacksonville, FL. (view video)

The second two panelists were Phil Perry, MD, Chief Medical Officer, Ascension/St. Vincent’s HealthCare; and Captain Bruce Gillingham, MD, Commanding Officer of Naval Hospital Jacksonville, FL. (view video)

A Question and Answer period followed Panel 1. (view video)

Keynote Session 2: James Rohack, MD
James Borland, MD, Associate Chief of Staff for Outpatient Clinics, North Florida/South Georgia Veterans Health System, introduced keynote speaker James Rohack, MD, President-Elect of the American Medical Association. Dr. Rohack presented Lessons Learned from the Quality Journey, followed by a Q & A period. (view video)

Panel 2, Quality Improvement as a Community Challenge
Keith Stein, MD, Chief Medical Officer of Baptist Health, served as moderator. Anne Waldron, MD, Vice President of the Duval County Medical Society, presented the Private Practice Perspective (PQRI/HIT). Robert Harmon, MD, Director of the Duval County Health Department,. presented  Quality Improvement in Public Health. (view video)

Safety and Medical Errors was presented by Cory Meyers, RN, Patient Safety Officer and Director of Risk Management/Corporate Compliance for Baptist Health. William Maples, MD, Chair of the Mayo Clinic Clinical Practice Quality Oversight Committee, presented Enhancing a Culture of Teamwork. (view video)

A Question and Answer period followed Panel 2. (view video)
                       
Leadership Perspective: CEO Panel Discussion

John Montgomery, MD, Senior Medical Director, Blue Cross and Blue Shield of Florida, Inc., moderated the Leadership Perspective Panel Discussion. Panel participants included Doug Baer, President and Chief Exectutive Officer of Brooks Health System; Bob Brigham, Chief Administrative Officer for Mayo Clinic Jacksonville; Jim Burkhart, President and Administrator of Shands Jacksonville; Gene Miyamoto, System Chief Operating Officer and Executive Vice President for St. Vincent’s HealthCare (serving in place of Scott Whalen, PhD, President and Chief Operating Officer of St. Vincent’s HealthCare); John Wilbanks, Executive Vice President and Chief Operating Officer of Baptist Health and Jim Wood, President and Chief Operating Officer of Memorial Health. (view video)

Transitional Comments
Yank Coble, MD thanked the CEO Panel and all Forum speakers and participants. Carl Rider, Senior Fellow for the Center, gave instructions for participation in the concurrent Breakout Sessions on Quality and Safety or Communication and Service. Forum participants divided according to interest and regrouped for final reports and deliberations on next steps. (view video)

Breakout Session on Quality and Safety moderated by Paul Pitel, MD and Connie Haan, MD.
(view video)

Breakout Session on Communication and Service moderated by Bill Maples, MD.
(view video)

Recommendations from the Breakout Session on Quality and Safety
(view video)

Recommendations from the Breakout Session on Communication and Service
(view video)

Wrap up, and next steps for the community.
(view video)

 

Welcoming remarks by Yank Coble, MD, Center for Global Health and Medical Diplomacy
Welcoming remarks by Jay Millson, MBA, for Steve Lucie, MD, Duval County Medical Society
Keynote speaker Carolyn Clancy, MD, Director, Agency for Healthcare Research & Quality,
b
y videoconference. Dr. Clancy presented All Health Care is Local: Driving System Transformation through Local, Regional and National Collaboration
(view video)
Q & A with Keynoter Carolyn Clancy, MD
clancy
Pamela Chally, PhD, Brooks College of Health, UNF, moderates Panel 1
(view video)
chally
Panelists Connie Haan, MD, UF Jacksonville Regional Academic Health Science Center, and Paul Pitel, MD, Nemours Children's Clinic
(view video)
Panelists Phil Perry, MD, Ascension/St. Vincent's HealthCare, and Capt. Bruce Gillingham, MD, Naval Hospital Jacksonville
(view video)
Q & A with Panel 1
(view video)
James Borland, MD, Veterans Administration, introduces Keynote Speaker James Rohack, MD, President-elect of the American Medical Association
Keynote Speaker James Rohack, MD, presents Lessons Learned from the Quality Journey
(view video)
Keith Stein, MD, Baptist Health, moderates Panel 2.
(view video)
stein

Anne Waldron, MD, Duval County Medical Society, presented the Private Practice Perspective (PQRI/HIT).

Robert Harmon, MD, Duval County Health Dept., presented  Quality Improvement in Public Health.
(view video)

Safety and Medical Errors was presented by Cory Meyers, RN, Baptist Health.

William Maples, MD, Mayo Clinic, presented Enhancing a Culture of Teamwork.
(view video)

John Montgomery, MD, Blue Cross Blue Shield FL, moderated the Leadership Perspective CEO Panel Discussion.
(view video)
CEO Panel participants included Doug Baer, Brooks Health System; Bob Brigham, Mayo Clinic; Jim Burkhart, Shands Jacksonville; Gene Miyamoto (serving in place of Scott Whalen), St. Vincent’s HealthCare; John Wilbanks, Baptist Health and Jim Wood, Memorial Health.
Carl Rider, Center for Global Health and Medical Diplomacy, gives instructions for the concurrent Breakout Sessions on Quality and Safety or Communication and Service.
(view video)

Breakout Session on Quality and Safety, moderated by Paul Pitel, MD and Connie Haan, MD.
(view video)

 

Breakout Session on Communication and Service, moderated by Bill Maples, MD.
(view video)


Bill Maples, MD (view video)and Paul Pitel, MD (view video) report back to the full group on the recommendations from the Breakout Sessions on Quality and Safety, and Communication and Service.
Forum participants prioritize next steps for the community. (view video)

 

      

Center for Global Health and Medical Diplomacy at the University of North Florida
1 UNF Drive, Building 53, Suite 2750 Jacksonville, FL 32224
PHONE (904) 620-1211 FAX (904)1943