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Chronic Illness and Disease Prevention

Chronic Illness and Disease Prevention. Impact and Opportunity. George A. Mensah, M.D. Acting Director, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention. 1900-1999. Greatest Achievements in Public Health. Vaccination

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Chronic Illness and Disease Prevention

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  1. Chronic Illness and Disease Prevention Impact and Opportunity George A. Mensah, M.D. Acting Director, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention

  2. 1900-1999 Greatest Achievements in Public Health • Vaccination • Motor-vehicle safety • Safer workplaces • Control of infectious diseases Adapted from MMWR 1999;48(50):1141

  3. 1900-1999 Greatest Achievements in Public Health • Decline in deaths from heart disease & stroke • Safer and healthier foods • Healthier mothers and babies Adapted from MMWR 1999;48(50):1141

  4. 1900-1999 Greatest Achievements in Public Health • Family planning • Fluoridation of drinking water • Recognition of tobacco use as a health hazard Adapted from MMWR 1999;48(50):1141

  5. Achievements in Public Health, 20th Century Total cardiovascular diseases Diseases of the heart Coronary heart disease Stroke Age-adjusted to the 2000 US population.; Sources: NHLBI, Morbidity and Mortality Chart Book 2000 CDC, Health, United States 2001

  6. Measuring State Successes:Improvements from 1990 to 2004 ME Infectious Disease 62% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

  7. Measuring State Successes:Improvements from 1990 to 2004 ME Infectious Disease 62% RI Smoking 35% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

  8. Measuring State Successes:Improvements from 1990 to 2004 ME Infectious Disease 62% RI Smoking 35% VT Infant Mortality 53% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

  9. Measuring State Successes:Improvements from 1990 to 2004 ME Infectious Disease 62% RI Smoking 35% VT Infant Mortality 53% PA Infant Mortality 30% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

  10. Measuring State Successes:Improvements from 1990 to 2004 ME Infectious Disease 62% RI Smoking 35% VT Infant Mortality 53% PA Infant Mortality 30% IA Infant Mortality 39% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

  11. Measuring State Successes:Improvements from 1990 to 2004 ME Infectious Disease 62% RI Smoking 35% VT Infant Mortality 53% PA Infant Mortality 30% IA Infant Mortality 39% LA Children in Poverty 34% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

  12. Measuring State Successes:Improvements from 1990 to 2004 ME Infectious Disease 62% RI Smoking 35% VT Infant Mortality 53% PA Infant Mortality 30% IA Infant Mortality 39% LA Children in Poverty 34% AK Infectious Disease 83% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

  13. Measuring State Successes:Improvements from 1990 to 2004 Maine Infectious Disease 62% Rhode Island Smoking 35% Vermont Infant Mortality 53% Pennsylvania Infant Mortality 30% Iowa Infant Mortality 39% Louisiana Children in Poverty 34% Alaska Infectious Disease 83% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

  14. Definition of Public Health Public Health:Population-basedHealth

  15. Health Care vs. Public Health “Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.” Public Health:Population-basedHealth C. Everett Koop

  16. Health Promotion and Chronic Disease Prevention

  17. Public Health; New York City, 1895 Department of Health, City of New York

  18. We Face an Epidemic ofUnparalleled Proportions • More than 1.7 million Americans die of a chronic disease each year • One-third of the years of potential life lost before age 65 is due to chronic disease • Four chronic diseases—heart disease, cancer, stroke, and diabetes—cause almost two-thirds of all deaths each year

  19. We Face an Epidemic ofUnparalleled Proportions • Approximately 33% of all U.S. deaths (about 700,000 deaths each year) can be attributed to these three health-damaging behaviors … • tobacco use • lack of physical activity • poor eating habits Sources: Deaths: Preliminary Data for 2002. NVSR Volume 52, Number 13. 48pp. (PHS) 2004-1120. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2003). McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:2207-12.

  20. Arthritis • number one cause of disability • affects nearly 1 of every 3 adults in the US Stroke • left 1 million Americans with disabilities Diabetes • leading cause of kidney failure in adults • more than 60% leg and foot amputations are among people with diabetes Disability and Diminished Quality of Life Chronic, disabling conditions cause major limitations in activity for 1 of every 10 Americans (30 million people)

  21. $245 billionan average of $1,066 per person 1980 $1.4 trillionan average of $5,039 per person 2001 $2.8 trillionan average of $9,216 per person 2011 Health Care Spending is on the Rise Our nation spends more on health carethan any other country in the world Chronic diseases account for75%of the $1.4 trillionwe spend on health care SOURCE: Heffler et al., Health Affairs., Health Spending Projections For 2001-2011: The Latest Outlook, March/April 2002.

  22. Japan Cuba United States Sierra Leone Life Expectancy vs. Health Care Spending 90 80 70 Life Expectancy 60 50 40 30 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 Per Capita Health Care Spending in International Dollars

  23. An Aging PopulationPercentage of U.S. Population over Age 65 25 20 15 Percent 10 5 0 1930 1950 1970 1990 2010 2030 2050 Year Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996

  24. Estimated Per Capita Health Expenditures,by Age and Sex, 1995 18,000 Men 16,000 14,000 Women s r 12,000 a l l 10,000 o D 8,000 6,000 4,000 2,000 0 9 9 9 9 4 4 4 4 9 4 9 9 9 4 4 4 0 - 1 2 3 4 - 1 2 3 4 5 6 6 7 5 7 8 0 - - - - - - - - 5 - - - - - - > 5 0 5 0 5 0 5 0 0 5 0 5 0 5 1 2 3 4 2 3 4 5 5 1 6 6 7 7 Age in Years Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996

  25. Medicaid Expenditures Source: National Association of State Budget Officers, 2003 State Expenditures Report

  26. Predicted Likelihood of Developing Coronary Heart Disease, Stroke, or Diabetes by Age 65 Men, Aged 50 Non SmokerNormal WeightActive SmokerOverweightInactive Ratio 11% 58% 5.5 Source: Jones et al. Arch Intern Med 2002;162:2565–71

  27. Disability Index,* by Age and Health Risk† University of Pennsylvania Alumni 0.30 0.25 0.20 High risk Disability Index 0.15 Moderate risk 0.10 Low risk 0.05 0.00 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 Age * Progression of disability was postponed by approximately 7 years in low risk vs. high risk. † Risk based on body mass index, smoking, exercise; 0-3 point scale for each; low = 0–2 points, moderate = 3–4 points, high = 5–9 points. Note: A disability index of 0.1 = minimal disability. Source: Vita et al. N Engl J Med 1998;338(15):1035–41

  28. Adult per Capita Cigarette Consumption and Major Environmental and Policy Changes in the US 1900-1990 Fairness Doctrine messages on radio andtelevision Nonsmoker’s rights movement begins Thousands per year First Medical reports linking smoking and cancer US Surgeon General’s first report Federal cigarette tax doubles End of WW II Broadcast advertising ban Great Depression 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 Year

  29. Admissions for Acute Myocardial Infarction During 6-Month Periods June–November Before, During, and After the Smoke-free Ordinance Helena Outside Helena Source: Sargent RP et al. BMJ 2004.

  30. New York Centers of Excellence • 39% reduction in lower-extremity amputation • 35% reduction in hospitalization for persons with diabetes Promising Practices in Chronic Disease Prevention and Control, DHHS, 2003

  31. Return on Investment in Worksite Health Promotion • Citibank: in 1994, return on investment = $4.56-$4.70 per dollar invested in the program (Ozminkowski et al. AJHP Jan/Feb 1999) • Johnson & Johnson: reduction of medical care costs of $224.66 per employee per year (Ozminkowski RJ et al. Environ Med 2002; 44:21-29) • 13 health promotion programs reported cost benefits ratios suggest improved financial outcomes (Aldana AJHP May/June 2001)

  32. Cigarette Use: 40% middle school students 18% high school students

  33. The addition of walking trails can promote physical activity, especially among women.

  34. Death Rate and Average Annual Percentage Change 3 Leading Cancers in Men, 1990 and 2001* Age-Adjusted Rate† Average Annual % Change 1990 2001 Lung 90.6 75.1 - 1.8 Prostate 38.6 29.1 - 2.9 Colorectal 30.8 24.2 - 2.1 * Adapted from MMWR-SS 2004;53:SS-3 † Per 100,000 1970 standard population

  35. Death Rate and Average Annual Percentage Change 3 Leading Cancers in Women, 1990 and 2001* Age-Adjusted Rate† Average Annual % Change 1990 2001 Lung 36.8 40.9 + 0.9 Breast 33.1 25.9 - 2.3 Colorectal 20.6 17.0 - 1.7 * Adapted from MMWR-SS 2004;53:SS-3 † Per 100,000 1970 standard population

  36. Implement programs that focus on eliminating health disparities.

  37. Arlene Case-The Lesson REACH 2010: Charleston And Georgetown Diabetes Coalition

  38. Ensure access to quality health services.

  39. Enact policies that promote healthy environments.

  40. Promote wellness programs in schools, work sites, and in faith- and community-based settings.

  41. Summary • Remarkable achievements in health over last century • Chronic diseases and risk factors now pose major challenges – a cause for ALARM! • Power of prevention, and role of policy & environmental change – reasons for HOPE! • We need to act NOW!

  42. Partnerships

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