Bernadette M

A healthy community is one in which its members have acknowledged the importance of social, economic, and political justice and personal wellbeing. The Carlisle Area Health and Wellness Foundation has numerous benefits for the Carlisle community, the foremost of these being that it has taken responsibility for affecting positive change in the community. By encouraging effective participation from community members, the Foundation is at the forefront of a building a community-wide commitment to the healthy development of community members. With a mission stating that the Foundation “identifies and addresses health care needs and policies, promotes responsible health practices, and enhances access to and delivery of health services,” employees, volunteers, and Board members of the Carlisle Area Health and Wellness Foundation provide immense benefit to our local community. One of the primary ways in which the Foundation benefits the community is through its grantmaking program. It distributes grants based on an applicant’s ability to manage a proposed program designed to elevate the status of the community’s health. Furthermore, the Foundation’s public policy program ensures the Foundation is involved in promoting health policies through its advocacy efforts and policy position papers. Developing connections with local, state, and national policymakers, the Foundation is in a stronger position to ensure that enacted policies will positively benefit our local community.

The benefit that I provided to the people of our region who realize the impact of the Carlisle Area Health and Wellness Foundation was in the policy department. Using current research, national models, and the Foundation’s own studies, I developed a policy position paper on rising prescription medication costs in the Foundation’s service area. Policy position papers make known the stance of the Foundation regarding a particular issue. The position paper on prescription medication costs may influence local public policies. These consist of political decisions for implementing programs to achieve goals that were mentioned in the policy position paper. These goals included providing funding for mobile pharmacies and expanded rural health care coverage and increasing public knowledge through health literacy campaigns so patients are informed consumers of health care services and medications. Additionally, the policy position paper supported requiring drug manufacturers to report costs of advertising and marketing of prescription drugs in the state in an annual report. After I completed the policy position paper, negotiations by the Board occurred over wording to ensure accuracy, balance, clarity of message, and relevance to understanding and policy. Ideally, the benefit I provided to the organization and community was that public policies will be formulated to aid consumers in purchasing required medications.

This experience connected to the classroom teachings in various ways. I learned that the Foundation employs a basic business model for evaluating organizational performance and for evaluating the effectiveness and management of potential grantees. This was made easier by adequate information systems and staffing which was facilitated by strong economic resources. Because the Foundation does not suffer financial strains as do other small nonprofit organizations, its organization was superior to that of other nonprofits we examined in class.

On April 22, 2006, Lu Conser forwarded a draft of the position paper on prescription medications to members of the Public Policy Committee. This committee contains both Board and non-Board members, including healthcare professionals, lobbyists and government officials. The Committee monitors the policy landscape and provides assistance and information for persons involved in shaping health policy.
Although I have concluded my service learning project with Lu and the Foundation, I continue to have regular contact with Lu regarding her position as Director of Grants, my future plans, and the role of nonprofit organizations in the healthcare sector. Additionally, she has invited me to attend the 2006 Legislative Breakfast & Briefing on May 11th. This will allow me to meet elected officials and discuss health issues that are vital to our local community. Lu has also offered to introduce me to a local lobbyist so I can spend a day shadowing and learning about the profession.

The service that the Foundation provides to our local community continues to amaze me. The way in which it not only financially supports local health-centered programs, but also addresses the underlying causes of local health issues through its policy branch makes the organization essential to making our community a more healthy place. The fact that the Foundation has become such an integral organization within five short years is testament to the fact that proper management and financial security are fundamental to the success of a nonprofit organization.
However, I wonder how communities and organizations without the financial resources such as those at the Foundation’s disposal seek to foster healthy communities. The formation of the Foundation is unique to Carlisle and occurred when the Carlisle Hospital was sold to a for-profit firm. This event fortunately benefited local residents. In communities without such benefit, or in Carlisle before the Foundation, it is apparent that local nonprofit organizations seeking to improve the health of local residents do not have as many financial resources to devote to their respective missions.

The Foundation’s 2001 Carlisle Regional Health Status Assessment provided data and set the stage for health improvements in the years to come. The organization’s outsight to perform this local assessment at its inception will allow it a background against which it can monitor its progress. We have read that many nonprofit organizations have difficulty determining efficiency and effectiveness because of a lack of measurement techniques. The quantitative measurements inherent in the Regional Health Status Assessment will allow the Foundation to quantitatively define the value it has brought to the community it serves. Unfortunately, most nonprofits do not have the financial resources to so thoroughly monitor that progress and success.

In the past few weeks, I have concluded my research prescription drug issues in Cumberland, Perry, Franklin, and Adams Counties. Prescription medications are an essential tool in preventing and managing illness. Without these medications, the health of area residents is inevitably compromised and the cost of delayed treatment resulting from improperly followed prescription regimens may be more expensive. The CAHWF’s 2002 Carlisle Regional Health Status Assessment found that approximately one in six area residents had skipped medication or treatment because of cost. Even more significantly, 30.2% of residents in fair or poor-health reported skipping medications or treatments because they were too expensive.
Prescription medications are costly. In 2004, Pennsylvanian’s spent almost $7.5 billion on prescription medications. The rising cost of prescription medications affects everyone, but especially seniors, persons with chronic conditions and mental illnesses, and the uninsured. 1.4 million Pennsylvanians do not have insurance that covers prescription medications. Of these, about 75% are not eligible for Medicare, so the new Part D prescription medication benefit does not help them.
For local analysis of the situation, I spoke on the phone with Scott Gobin, a pharmacist at Smartmed Prescription Center in Carlisle. He sees an increasing frustration in patients who cannot afford medications and small businesses which can no longer provide insurance due to huge premium increases. He remarked: “If any other business tried to increase prices by 30-40% every year, they wouldn’t stay in business very long. These kinds of price increases are very common in the insurance industry. It’s a no-win situation for consumers.” The half hour phone conversation was highly insightful
After submitting my draft of the policy position paper to Lu, we arranged a lunch meeting for editing purposes. Email communication has greatly facilitated our interactions. After writing the position paper, I had difficulty thinking of recommendations for how to make an impact on the local level. Lu and I discussed how the CAHWF should strive to ensure the continuation and expansion of the Healthy Community Rx program. Additionally, on a county-level, maintaining a commitment to the Catalyst Scripts discount prescription medication program is important for uninsured area residents.
Now that the position paper is in the concluding stages of editing, it needs to be formatted, a part of the process in which Lu hopes I will be engaged. The paper then goes to the Public Policy Committee on Thursday, April 4, 2006, for review and approval. The Committee may also make additional recommendations to add to the paper. Finally, the Board will give its stamp of approval and the policy position paper will be completed.

Listening to comments at the Service Learning Common Hour has allowed me to reflect on the impact the policy position paper will have in the community. I did not initially realize that the service learning class would actually provide me with an opportunity to meet community needs and foster a sense of civic responsibility. I did, however, see the service learning placement on a more selfish basis of allowing me to integrate classroom theory with the real world. I now realize the policy position paper and the other projects that students are working on will actually impact organizations, thereby fulfilling the service learning mission of providing a useful education that benefits both students and the community.

Speaking with Lu has provided me insight into the ways in which Carlisle nonprofit agencies serve the community by building coalitions. Collectives form to overcome limitations that individual organizations do not have the capacity to independently address. Because many of the nonprofit organizations in Carlisle appear to be minimally sized, we have seen they suffer from organization, strategic, and budgetary constraints. In my opinion, there appears to be little interagency collaboration between nonprofit organizations serving overlapping populations. These organizations could potentially benefit from building alliances as a more efficient way to garner scarce resources and increase their overall stability and legitimacy. However, our classroom reading and lectures have shown me that this interagency collaboration is not easy to achieve. As John Zarafonetis pointed out, achieving collaboration when individual, autonomous organizations each have an allegiance to their own missions, stakeholders, and constituencies is not an easy task. Nevertheless, I believe building coalitions, especially those based on information exchange, may be one way to maintain and increase the overall health of the Carlisle region.

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