an appropriate outgrowth of developing new competencies for nurse practitioners and others. A third type of project, advocated and pioneered by Dr. Victoria Maizes, organizes training programs built around core competencies in integrative health.

Regardless of professional and specialty mix, health care practitioners today are not able to overcome some of the most important factors in health and disease—the socioeconomic factors raised by Black, such as employment, education, and poverty. In many respects, Cooper said, poverty constitutes the greatest of all the challenges facing the health care system.

WORKFORCE AND EDUCATION KEYNOTE ADDRESS

Carol M. Black, Academy of Medical Royal Colleges

Even in the most affluent countries, people who are less well off have substantially shorter life expectancies and more illnesses than the rich.

—Richard Wilkinson and Michael Marmot


Black began her keynote address by observing that the challenges facing the American and British health systems are remarkably similar and reflect global forces. There are several drivers to change within the realm of health care, many of which were described by other presenters throughout the summit and many of which are globally applicable. These drivers include expectations of the public and of individual patients, inequalities in health and health care, variations in the quality of care, health needs reflecting demographic shifts, the impact of lifestyle on health, advances in medical sciences, rising costs, and inefficiencies and failings of the system, Black noted. These many drivers suggest a needed analysis of whether education is appropriately aligned to overcome important barriers to change and meet the needs of the population.

Person-Centered Care and the Social Determinants of Health

Expectations of the health care system begin with care that is safe, effective, easy to access, and of high quality. People also want care that is personal; they want it to be geared to their own understanding of health and their expectations for restored or maintained capacity. Person-centered care should provide direct advice and support on lifestyle



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