He who has health has hope He who has hope has everything The value proposition for Health

1. He who has health has hopeHe who has hope has everythingThe value proposition for Health John R. Lumpkin, MD, MPH Robert Wood Johnson Foundation

2. What is Health?

3. HEALTH • WHO • HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY • HEALTH IS A STATE OF WELL-BEING AND THE CAPABILITY TO FUNCTION IN THE FACE OF CHANGING CIRCUMSTANCES

4. Health • Curative Services (Health Care) • Preventive Services (Public Health)

5. Health and Health CareDoes it work?

6. 1900 • LEADING CAUSE OF DEATH • PNEUMONIA • TUBERCULOSIS • DYSENTARY • LIFE EXPECTANCY 49 YEARS • 4-5% GNP EXPENDED ON HEALTH CARE

7. 1960 • LEADING CAUSES OF DEATH • HEART DISEASE • CANCER • STROKE • LIFE EXPECTANCY 65 YEARS • 4-5% GNP ON HEALTH CARE

8. 2000 • LEADING CAUSES OF DEATH • HEART DISEASE • CANCER • STROKE • LIFE EXPECTANT ABOUT 75 YEARS • 15% OF GNP ON HEALTH CARE • $1.7 Trillion dollars

9. Is there a relationship withEconomic Development?

10. Are there economic Costs for Poor Health? • Smoking • Increase Absenteeism • Increase Insurance Costs • Increase Maintenance and cleaning costs • Decrease productivity • PUD • $5 Billion Health Care Costs • $1 Billion Productivity Costs • Nosocomial Post Surgical Infections • $5,155 in follow up costs • ($1,773 for controls)

11. Health Care Expenditures result in Economic Development? • WHO Sachs Report • 10% increase in life expectancy • 0.3 to 0.4% rise in growth rate • Families USA • $1 Million Decrease in Medicaid • $3 Million in lost Business • $1.2 Million in wages • 37 jobs • Health Systems impacts on their communities

12. Relationship of Health to Economic Growth? Economic Growth Health Care Costs

13. Relationship of Health Care Costs to Economic Development?

14. Rocket Science?

15. Cell Science Rocket Science Brent Cell, 2000

16. Health and Health Care Complex Systems

18. Health is Complex

19. Broad social, economic, cultural, health, and environmental conditions and policies at the global, national, state, and local levels • Living and working conditions may include: • Psychosocial factors • Employment status and occupational factors • Socioeconomic status (income, education, occupation) • The natural and builtc environments • Public health services • Health care services Living and working conditions a Social, family and community networks Individual behavior Innate individual traits: age, sex, race, and biological factors --- The biology of disease Over the life span b NOTES: Adapted from Dahlgren and Whitehead, 1991. The dotted lines denote interaction effects between and among the various levels of health determinants (Worthman, 1999). Approach and rationale A guide to thinking about the determinants of population health IOM - 2002

20. Good Health Care is complex

21. Chronic Care Model Community Health System Resources and Policies Health Care Organization Self-Management Support DeliverySystem Design ClinicalInformationSystems Decision Support Informed, Activated Patient Prepared, Proactive Practice Team Productive Interactions Functional and Clinical Outcomes

22. Informed Activated Patient Results from Education, Decision Support (Care Management) and Active Involvement Self-Management Support Prepared, Proactive Practice Team Productive Interactions Informed, Activated Patient Decision Support

23. The success or failure of any government in the final analysis must be measured by the well-being of its citizens. Nothing can be more important to a state than its public health; the states paramount concern should be the health of its people. - Franklin Delanor Roosevelt (1932)

24. The value proposition for Health and Health Care?

26. Community Health Health Care Economic Health

27. WHAT A DIFFERENCE TWO YEARS MAKE! 2001: $127b. Surplus 2003: $401b. Deficit

28. WHAT HAPPENS BY 2014IF WE DO NOTHING? • With reasonable assumptions on: • Tax cuts • AMT • Growth of discretionary spending • Medicare • Deficit = almost $700b. or >$1t. • National debt = $5.7t.

29. ELIMINATING DEFICIT BY 2014: WHAT WOULD IT TAKE? • Assume : • No cuts in defense • Minimize tax increases • Elimination of unified budget deficit

30. ALL THESE ACTIONS COMBINED WOULD BE INSUFFICIENT: • Turning all education, housing, urban development, manpower, environment, and law enforcement programs back to states • Eliminating or privatizing 80 commercial subsidy programs • Undertaking significant fraud and abuse initiatives • Ending manned space flight • Ending earmarks for local highway construction • Slowing growth of NIH spending • Capping other discretionary spending

31. The next century will be dominated by economic rivalry between trading blocs, in Europe, North America, along the Pacific Rim, and in the Caribbean Basin. In this new order, winners and losers will be determined by the quality of a country's infrastructure, the stability of its economy, and the health and education of its workers. John Chancellor

32. He who has health has hopeHe who has hope has everything.