Active Living: Leadership in Kentucky

Chronic Disease in KentuckyWhy it should matter to you!

Rice C. Leach, M.D.Commissioner

Kentucky Department for Public HealthMay 8, 2003

Active Living: Leadership in Kentucky

Public Health Concerns

• Kentucky’s general health status• Obesity over the last 20 years• Conditions

– Diabetes– Cardiovascular disease (heart attacks)– Arthritis– Cancer– Birth Defects (heart, neural tube)– Strokes

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Causes

• Obesity– Too many calories– High fat content– Not enough fiber (fruits and vegetables)

• Lack of Exercise– Video games and television replaced playgrounds– Automobiles replaced bicycles– No more high school physical education requirement

• Smoking

Active Living: Leadership in Kentucky

Kentucky’s Rates

• Type II Diabetes in Kentucky—doubled since1990• Obesity in Kentucky—doubled since 1990• Obesity in the United States—doubled since

1985• Kentucky’s adults smoke more than any other

state• Kentucky’s youth most likely to smoke every day• Kentucky’s youth youth unlikely to exercise every day

Active Living: Leadership in Kentucky

Public Health—What helps?

• Population Issues– Training

• Large Groups

• Small Groups

– Environmental changes• School lunches

• Smoke-free areas

• School vending machine food

– Measure Success—learn from work being done

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Get With The Guidelines—Why Bother?

– Improved Quality of Life• Live Longer

• Stay out of the nursing home

• Pay less for my “golden years”

• Avoid side effects of medicines

• Avoid surgery

Active Living: Leadership in Kentucky

Prevention—Why Bother?

• What is in it for me?– Health Insurance costs– Medical Care Costs– State Budgets– State and Federal Income Taxes– Condition of Roads– Funding for Schools– College Tuition– Employment Opportunities

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Obesity Trends* Among U.S. AdultsBRFSS, 1987

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Obesity Trends* Among U.S. AdultsBRFSS, 1988

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Obesity Trends* Among U.S. AdultsBRFSS, 1989

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Active Living: Leadership in Kentucky

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Active Living: Leadership in Kentucky

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Active Living: Leadership in Kentucky

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Active Living: Leadership in Kentucky

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Active Living: Leadership in Kentucky

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Active Living: Leadership in Kentucky

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Active Living: Leadership in Kentucky

Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Active Living: Leadership in Kentucky

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

Active Living: Leadership in Kentucky

Impact of Obesity

• On people– More diabetes– More heart disease– More strokes– More kidney failure– More patients on dialysis– Earlier disability

Future Health Insurance Cost Increases

2015(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Future Health Insurance Cost Increases

2016(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Future Health Insurance Cost Increases

2017(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Future Health Insurance Cost Increases

2018(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Future Health Insurance Cost Increases

2019(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Future Health Insurance Cost Increases

2030(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Future Health Insurance Cost Increases

2031(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Future Health Insurance Cost Increases

2032(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Future Health Insurance Cost Increases

2033(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Future Health Insurance Cost Increases

2034(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Future Health Insurance Cost Increases

2035(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Future Health Insurance Cost Increases

2036(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Future Health Insurance Cost Increases

2037(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Future Health Insurance Cost Increases

2038(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Future Health Insurance Cost Increases

2039(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Future Health Insurance Cost Increases

2040(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Impact on Public Funds

• More people on disability • Fewer years in the work force• Earlier admission to nursing home• Increased demand for health care services ($3B today)• Increased demand on Medicaid and Medicare• Increased demand for public support of medical care• Decreased contribution to employee health insurance • More people without health insurance

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Tax Increases(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Other Impacts On Public Health Funds

• Money not available for public schools• Money not available for college tuition• Money not available for road construction• Money not available for water and sewer projects• Money not available for golf courses• Money not available for police and fire• Money not available for campaign promises

Active Living: Leadership in Kentucky

DRG=De Revenue…Gone!

• “The biggest difference between a Democrat and a Republican is going to be the reason they give you for why you can’t have what you want.”

John Chancellor, NBC News, at the American Hospital Association Winter Meeting, Washington D.C., 1985

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Active Living: Leadership in Kentucky

Current state initiatives

• NGA Best Practices—Chronic Disease Initiative• Diabetes Program and Coalition--$1.85M• Cardiovascular Disease Program--$865K• Get with the Guidelines• Exercise-Obesity—$1.2M• Tobacco Control--$4.2M• School Health Program• Cooperative Extension Service involvement• Local Health Department Contributions—

Active Living: Leadership in Kentucky

Food for thought

• No such thing as your side of the boat is leaking• It doesn’t have to be this way• Curative medicine helps• Primary prevention is better• New Public Policy Initiatives• Consider ways to pay providers to keep people

well• $14.5B—expenditure on medical care• $350M—estimated expenditure on prevention