David Lakey, M.D. Commissioner Texas Department of State Health Services

1. Healthy Communities: The Intersection of Community Development & HealthSeptember 28, 2011“State of the Health of Texas & Obesity” David Lakey, M.D.CommissionerTexas Department of State Health Services

2. Texas Department of State Health Services (DSHS) Regional & Local Health Services Prevention & Preparedness Services Family & Community Health Services Mental Health & Substance Abuse Services Regulatory Services

3. Life Expectancy in TexasTotal and by Race, 1989 - 2007

4. Ten Leading Causes of Death in Texas, 2007

5. Actual Causes of DeathShaped by Behavior Chronic Disease in Texas 2007, DSHS

6. Texas County Health Factors Source: County Health Rankings, Robert Wood Johnson Foundation, University of Wisconsin

7. Texas County Health Outcomes Source: County Health Rankings, Robert Wood Johnson Foundation, University of Wisconsin

8. Social Determinants • Education • Employment • Income

9. General Health “Fair to Poor”in Texas by Education(2000 – 2009 BRFSS)

10. Some College Rankings, Texas

11. General Health “Fair to Poor” in Texas by Income Level(2000 - 2009 BRFSS)

12. Median Income Rankings, Texas

13. Employment Rankings, Texas

14. The Health Impact PyramidA Framework for Public Health Action Thomas Frieden, MD, MPH, American Journal of Public Health, 04/2010, Vol. 100, no. 4

15. Health Challenges • HIV • Mental health • Substance abuse and smoking • Infant mortality / prematurity • Health care quality • Obesity

16. Ten Leading Causes of Death in Texas, Ages 18 – 44 Years, 2007

17. Newly Diagnosed HIV Cases, Deaths, & Persons Living with HIV (Texas, 1980-2008) Living with HIV New HIV Cases Deaths among HIV Cases

18. Mental Health Disorders • 3% of Texans suffer from a severe, persistent mental illness • Mental health disorders: the leading cause of disability in U.S. • Individuals with serious mental illness have a life expectancy 25 years shorter than the overall population • Inadequate treatment leads to an increase in costs related to crime, homelessness and uncompensated health care.

19. The Costs of Substance Abuse in Texas • In 2009, ~24,500 Texans died as a result of smoking • Of the 2,865 newly reported AIDS cases in 2008, 15.5% were drug related • ~ 75% of Texas prisoners are involved with alcohol or drugs • 47% of Texas motor vehicle fatalities (2009) were alcohol-related • 23% of fatally injured drivers tested in Texas were found positive for drugs (2009) • The cost related to alcohol and drug abuse to Texans (2007) was ~ $33 billion • This includes health care, lost productivity, motor vehicle accidents and crime • Annual per capita cost for Texas residents: $2,800

20. Past-Month Cigarette Use among Adults in Texas and the United States NSDUH 2002-2007

21. Past Month Cigarette Use Among Youth in Texas & US 21 NSDUH 2002-2007

22. Smoke Free Ordinances,Texas

23. Infant Mortality/ Prematurity • The infant mortality rate rose 9% from 2000 to 2006 • 6.2 deaths per 1,000 live births • Texas pre-term birth rate in 2009 was 13.6% • National average: 12.3% • The percentage of Texas infants born with low birth weight (under 5.5 pounds) rose from 7% in 1990, to 8.4% in 2007 • Totaling nearly 34,000 Texas infants • Infant mortality and prematurity rates are significantly higher among non-white Texans

24. Texas Infant Mortality(IMR) Rates by Race (1995 – 2008)

25. Preterm Births by Race(Texas, 2000 – 2007)

26. Health Care Quality • Health care quality is an emerging responsibility for the DSHS • In the past few years, the department has been pulled more and more into issues such as health care associated infections, quality of care in health facilities, and standards of care • The number of preventable health care associated infections (HAIs) continues to increase year over year • Leading cause of death from infectious diseases in the U.S. and in Texas • HAIs kill 99,000 people each year • Cause an estimated 1.7 million infections in the U.S. • HAIs are the leading cause of infectious deaths in Texas with: • 8,000-9,000 deaths each year • HAIs also add more than $500 million in annual medical costs

27. Obesity • 29% of Texans are obese • 66% of Texans are overweight or obese • >40% of Texans projected to be obese by 2040 • 3 of the 5 leading causes of death in Texas are: • chronic diseases linked with obesity • heart disease • cancer and • stroke • Obesity cost Texas businesses 9.5 billion in 2009 • Health care costs: $4 billion • Absenteeism costs: $1.6 billion • Disability costs: $322 million • Presenteeism costs: $3.5 billion • Total costs could reach $32 billion by 2030

28. Obesity Trends* Among U.S. Adults (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1990 2006 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

29. Obesity Prevalence Trends in Texas Adults 1990 to 2010 33% of Texans are normal weight 140% increase in obesity 29.5% of Texans are obese Source: Texas Comptroller

30. 1990 2006 Obesity Adult Prevalence in TexasBRFSS 1990 vs. 2010 White Black Hispanic

31. Obesity Successes: • Focus: • Community Wellness • DSHS role: • Catalyst & Resource • Strategy: • Work with broad array of partners • Supports policy & environmental change around CDC target areas • One of 23 CDC-funded states conducting obesity prevention activities

32. CDC Targets for Obesity Prevention Sugar-Sweetened Beverages Physical Activity Fruits & Vegetables High- Energy- Dense Foods TV Viewing Breastfeeding

33. Healthy Lifestyle Coalition Fort Stockton & Corpus Christi • Fort Stockton ISD worksite wellness program • Pecos County Memorial Hospital breastfeeding promotion • City Parks and Recreation Department program development • Healthy entree restaurant initiative • CC in Motion worksite wellness initiative • Coastal Bend Breastfeeding Coalition • Walk Across Texas/Walk the Texas Star program

34. Interagency Council on Obesity: DSHS, TEA & Texas Department of Agriculture Interagency Obesity Council created to: • Enhance communication & coordination of obesity issues among state leaders; • Guide planning around obesity prevention, health promotion & improved nutrition Recommendations (selected): • Continue collaboration between 3 agencies • Support social interventions • Strengthen K-12 nutrition education • Strengthen nutrition education & physical activities in early childhood & after-school programs

35. Coordinated School Health (CSH) and Campus Improvement Plans • All elementary, middle and junior high schools required to implement a CSH Program • Develop goals and objectives for CSH based on: • Fitness assessment data • Academic performance • Attendance rates • Socioeconomic status • The use of success of any method to ensure students are reaching required moderate or vigorous physical activity (MVPA) • Any other indicator recommended by SHAC • Include CSH Goals in all elementary, middle and junior high school Campus Improvement Plans

36. State of Texas Nutrition Services & Education • School district policy to prevent foods of minimal nutritional value • Nutrition education to be provided in Kindergarten through 8th grade • District-developed wellness policy required of each school district receiving reimbursable meal funding

37. Breastfeeding & Obesity • Infants who aren’t breastfed have increased risk for many acute and chronic conditions • Including a 32% excess risk for childhood obesity • Many Texas mothers report barriers to achieving personal breastfeeding goals • Breastfeeding activities coordinated across DSHS address barriers to optimal infant feeding outcomes • Every Ounce Counts • http://www.breastmilkcounts.com/our-new-campaign.html

38. Growing Communities Video Highlights successful community-based strategies across Texas through short, documentary-style video clips • The videos were initially distributed to the 2009 Statewide Obesity Summit attendees • Recipients were charged to be “catalysts for change” by hosting video screenings • Since the July 2009 launch, DSHS has made the video series available online and in DVD format • www.dshs.state.tx.us/obesity/growingcommunity/default.shtm

39. Partnerships Needed to Improve Health DSHS Food Industry Urban Planners, Developers Architects Community-based Solutions Elected Officials Providers & Hospitals Worksites & Schools Higher Education Community Groups Non-Traditional Partners

40. Thank You!