Healthcare Issues from the State Perspective and Plan for a Healthier Indiana

1. Healthcare Issues from the State Perspective and Plan for a Healthier Indiana William C. VanNess II, MD State Health Commissioner January 21, 2014

2. Indiana State Department of Health • ISDH Mission: • To promote and provide essential public health services • ISDH Vision: • A healthier and safer Indiana

3. ISDH - Top Priorities • Governor Pence “Good to Great” book • National Health Rankings has placed Indiana 41st least healthy out of 50 states • In February 2013, after extensive review of our priorities, ISDH named the following public health needs as the top three priorities for Indiana for the next four years. They haven't changed. • They are: #1. Reduction in Infant Mortality rates #2. Reduction in Adult Obesity rates #3. Reduction in Adult Smoking rates

4. Reduction in Infant Mortality

5. Reduction in Infant Mortality Rates • PLAN: • Analyze raw data • Convert to useful info & • Distribute back to: • Regional partnerships which include the following members: • Hospitals, LHDs, CHCs, Minority Health Coalitions, March of Dimes, etc. • “Sister” state agencies • FSSA, Medicaid, DOE, DCS, etc • Learn from areas/regions/states that have been successful in improving their infant mortality • Share with regional coalitions • e.g., Home Visiting Programs

6. Reduction in Infant Mortality Rates • Decrease smoking among pregnant mothers • ISDH is partnering with Indiana Medicaid • Decrease obesity among pregnant mothers • ISDH division of Nutrition & Physical activity • “Safe Sleep” • “Back to Sleep” campaign • 1994 • Reduced SIDS by 50% • “Safe Sleep” campaign • Expansion of “Back to Sleep” • Describes actions parents/caregivers can take to reduce the risk of other sleep-related causes of infant death e.g., accidental suffocation • Encourage hospitals to become certified as “Baby Friendly” • Certified by the World Health Organization • Goal.. To increase breastfeeding

7. Reduction in Infant Mortality Rates • Certification of OB & NICU’s • Goal…ensure they meet the newly established Indiana Perinatal Hospital Standards • Standards were adapted from the national set of standards created by AAP, ACOG, and other important entities • Obstetric Units…Levels of Care I, II, III • Neonatal Units…Levels of Care I, II, III, IV • 100% adoption of “Hard Stop” policies by Indiana hospitals • Goal…to prevent “elective” deliveries from occurring before 39 weeks • Insurers currently evaluating not paying providers for “elective” deliveries prior to 39 weeks

8. Reduction in Infant Mortality Rates • Evaluate “Perinatal Regionalization” • As noted…27 counties do not have a delivering hospital!! • Occurring “informally” now • Regional systems currently exist e.g. So. Carolina  • High-risk infants are born in hospitals that are able to provide the most “risk-appropriate” care  • Thus…Level III hospitals provide the most appropriate care for the sickest infants  • Infants receiving risk-appropriate care are hypothesized to be more likely to survive when born too little or too soon • Healthy People 2020 Goal is that 83.7% of VLBW Infants be born in a Level III Hospital • Currently 69%

9. Reduce Adult Obesity

10. Reduce Adult Obesity • Indiana’s Comprehensive Nutrition and Physical Activity Plan…2010 to 2020 • Collaborative effort involving a large and diverse group of Indiana individuals and organizations • Action needed across all sectors of Indiana to address poor nutrition, sedentary behaviors, and obesity • Focus on approaches that target specific needs of Indiana and support the latest research for improving nutrition and increasing physical activity • Consists of 8 focus areas: • Breastfeeding • Early childhood/child care • Schools • Health care • Worksites • Older adults • Faith-based organizations, and • Communities

11. Indiana’s Comprehensive Nutrition and Physical Activity Plan, 2010 to 2020 (continued) • Goals • Increase access to and consumption of healthy foods and beverages • Increase opportunities for and engagement in regular physical activity • Increase efforts aimed at enabling people to achieve and maintain a healthy weight across the lifespan • Reduce environmental and policy-related disparities for: • breastfeeding, • nutrition, • physical activity, • overweight, obesity, and • chronic disease

12. Indiana’s Comprehensive Nutrition and Physical Activity Plan, 2010 to 2020 (continued) • Goals (continued) • Increase the capacity of communities and settings within those communities (eg. School, worksites, faith-based organizations, etc.) to develop and sustain environmental and policy support systems that encourage healthy eating and active living • Increase state and local strategic partnerships to more effectively coordinate efforts, share resources, and identify and reach priority populations

13. Plan • Partner with at least 3 organizations to plan and implement statewide activities that support • eating better, • moving more and • avoiding tobacco • Through the Governor’s Healthy Lifestyle Award, • Publicly recognize individuals and organizations that have made committed efforts to live and/or support healthy lifestyles in their communities • Increase by at least 2 the number of state agencies that: • Adopt and implement food service guidelines/nutrition standards which include sodium • Adopt and implement healthy meeting guidelines • Implement evidence-based physical activity strategies in worksites • Promote breastfeeding

14. Reduction in Adult Smoking Rates

15. Tobacco’s Burden on Indiana • January marks the 50th anniversary of the first US Surgeon General’s report on smoking and health • That report, released on January 11, 1964, definitely linked cigarette smoking to lung cancer and other serious diseases • Historic turning point in the nation’s fight against tobacco use. • The US has made enormous progress, but • Tobacco use remains the number one cause of preventable death and disease in the US.. • this battle is far from won!!

16. Tobacco’s Burden on Indiana • Our high smoking rate is • Killing Hoosiers • More than 9,700 Hoosiers every year • Inflating health care costs • Costs the state over $2 billion in health care costs annually • Making it harder for companies to do business in Indiana • The economic burden of smoking is estimated to be about $3,391 per smoker per year. • Everyone shares in the annual expenses for smoking – more than $559 per Hoosier household- whether they smoke or not • For every smoker that dies, two young people under the age of 26 start using tobacco

17. Tobacco’s Burden on Indiana • Tobacco use directly causes a majority of the chronic diseases including: • Heart diseases • Stroke • Cancer • Respiratory diseases • Type 2 Diabetes • Rheumatoid Arthritis • Macular Degeneration • For every death in Indiana (9,700) due to tobacco use, another 30 Hoosiers are living with a tobacco-related illness (194,000) inhibiting their quality of life from serious smoking-caused disease

18. Tobacco Prevention Programs Work • The tobacco companies spend $271 million each year on marketing and promotion in Indiana • much of which influences kids to smoke • Tobacco use costs Indiana $2.18 billion/year in health care costs • The Indiana Medicaid program pays $487 million of the States total smoking-related health care costs • Half of Indiana’s births are to mothers in the Medicaid program • 30% of pregnant Medicaid women in Indiana smoke leading to premature birth, low birth-weight newborns and thus infant mortality • Tobacco prevention programs are also a smart investment for states that save money by reducing smoking-caused health care costs • In the short-term, the best state tobacco prevention programs have saved $3 in health care costs for every dollar spent

19. Tobacco Prevention Programs Work • Indiana’s tobacco prevention and cessation program is critical to the health of Hoosiers and to the fiscal environment of the state • Indiana’s tobacco prevention and cessation program is modeled after the CDC’s Best Practices of programs around the country that have delivered solid results • 2013 American Journal of Public Health article concluded that states can significantly reduce youth smoking by: • Implementing well-funded tobacco programs • Increasing the price of cigarettes, and • Enacting strong smoke-free air laws • Indiana must address the economic and health consequences of tobacco use in order to be competitive in today’s marketplace for businesses and workers

20. Questions??