Roderick L. Bremby, Secretary Kansas Department of Health and Environment
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Transcript of Roderick L. Bremby, Secretary Kansas Department of Health and Environment
Roderick L. Bremby, SecretaryKansas Department of Health and Environment
United Methodist Health Ministry Healthy Congregations Retreat April 13, 2007
Healthy Kansas:An Opportunity to Transform the Health of Kansas
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Greetings
Gov. Kathleen Sebelius
An opportunity to expand the focus
of current reform strategies
through transformative policy making and
shifting and broadening the discourse on health reform.
Healthy Kansas
1. Goal - Optimal Health Status
2. Health Status – a function of multiple determinants
3. The Life Course Matters – risk and protective factors
early in life affect health status later in life
Healthy Kansas 3 Core Premises
Move from a sick care system to a health system that provides vertical, horizontal, and longitudinal integration
Current discussion focus: cost, access, and quality.
Cost - 1980 - $253.9B or $ 1,102 per person > 9.1% GDP
1990 - $714.0B or $ 2,813 per person > 12.4% GDP
2000 - $ 1.35T or $ 4,790 per person > 13.8% GDP
2005 - $ 1.98T or $ 6,697 per person > 16.2% GDP
2015 - $ 4.04T or $12,357 per person > 20.0% GDP
(projected)
Access - uninsured US:46.6 million (15.9%) / KS:300,000 (10.9%)
Quality - 44-98K deaths annually from medical intervention – 1999 IOM – To Err is Human
Healthy Kansas – Premise 1: Optimal Health Status is the Goal
CMS
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“The fact is that we don’t face an immediate crisis
and so people say, What’s the problem ? The
answer is we suffer from a fiscal cancer…and if
we do not treat it, it could have catastrophic
consequences for our country”.
U.S. Comptroller General David
Walker
3/1/07
Healthy Kansas
Current discussion focus: cost, access, and quality.
Cost - 1980 - $253.9B or $ 1,102 per person > 9.1% GDP
1990 - $714.0B or $ 2,813 per person > 12.4% GDP
2000 - $ 1.35T or $ 4,790 per person > 13.8% GDP
2005 - $ 1.98T or $ 6,697 per person > 16.2% GDP
2015 - $ 4.04T or $12,357 per person > 20.0% GDP
(projected)
Access - uninsured US:46.6 million (15.9%) / KS:300,000 (10.9%)
Quality - 44-98K deaths annually from medical intervention – 1999 IOM – To Err is Human
Healthy Kansas – Premise 1: Optimal Health Status is the Goal
What accounts for growth in health care spending ?
US Health Status (W.H.O.) –
• 49th out of 50 industrialized nations
• U.S. infant mortality – 29th
• U.S. life expectancy – 25th
Healthy Kansas Premise 1: Optimal Health Status is the Goal
1. Goal - Optimal Health Status
2. Health Status – a function of multiple determinants
3. The Life Course Matters – risk and protective factors
early in life affect health status later in life
Healthy KansasPremise 2: Health Status results from many factors
• Heath Care Services
• Public Health
• Population Health (individual and population levels)
• Social Determinants
– Education
– Built environment
– Natural environment
– Social capital
Healthy Kansas –Premise 2: Health Status results from many factors
Health Factors
Environment22%
How We Live -
Behavior51%
Medical Care10%
Genetic Make-Up
17%
Source: USDHEW, PHS, CDC. “Ten Leading Causes of Death in US 1975.”Atlanta, GA, Bureau of State Services, Health Analysis & Planning
for Preventive Services, p 35, 1978
1. Goal - Optimal Health Status
2. Health Status – a function of multiple determinants
3. The Life Course Matters – risk and protective factors
early in life affect health status later in life
Healthy Kansas – Premise 3: Role of Life Course Development
Healthy Kansas Premise 3: Role of Life Course Development
Source: Mark A. Peterson, PhD. UCLA Blue Sky Team
* National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002 † Adapted from McGinnis Foege, updated by Mokdad et. al.
Actual Causes of Death†
Tobacco
Poor diet/lack of exercise
Alcohol
Infectious agents
Pollutants/toxins
Firearms
Sexual behavior
Motor vehicles
Illicit drug use
Causes of Death United States, 2000
Leading Causes of Death*
Percentage (of all deaths)
Heart Disease
Cancer
Chronic lower respiratory disease
Unintentional Injuries
Pneumonia/influenza
Diabetes
Alzheimer’s disease
Kidney Disease
Stroke
Percentage (of all deaths)0 5 10 15 20 25 30 35 0 5 10 15 20
Predicted Likelihood of Developing Coronary Heart Disease, Diabetes
or Stroke by Age 65
11%
58%
0%
10%
20%
30%
40%
50%
60%
70%
Non Smoker, NormalWeight, Active
Smoker, Heavy,Inactive
Per
cen
t
Source: Jones et al. Archives of Internal Medicine 2002;162:2565–71
Healthy KansasThe Evolving Health System
Source: Mark A. Peterson, PhD. UCLA Blue Sky Team
• The First Era (Established the “operating system”)•Focus on acute and infectious disease•Medical care silo•Insurance-based financing
• The Second Era (Operating System “patch”)•Focus on chronic disease •Increased technology ->increased costs
• The Third Era (Requires Policy to Replace Operating System
• Focus on optimal health status and multiple forms of integration
Healthy Kansas The Evolving Health System
“I get no money to prevent an amputation. I would get a whole bunch of money to perform
an amputation.”
Dr. Anne Peters, endocrinologistLos Angeles Times, 2/26/07
Healthy KansasThe Evolving Health System
The U.S. and 29 other developed nations on average spend 2.8% of their health
care budgets on preventive care.
Organization for Economic Co-operation and Development - 2004
Source: Mark A. Peterson, PhD. UCLA Blue Sky Team
Source: Mark A. Peterson, PhD. UCLA Blue Sky Team
Source: Mark A. Peterson, PhD. UCLA Blue Sky Team
Source: Center for Health Transformation
Healthy Kansas 4 parallel layers of health transformation needed:
Individual Change Institutional/Provider Change
Cultural Change Science Changes Everything
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A roadmap for health promotion and wellness, incorporating community coalition building and private sector partnerships.
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Many chronic diseases and illnesses can be attributed to three modifiable behaviors:
Tobacco use Lack of physical activity
Poor nutrition
Improving our Health
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* National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002 † Adapted from McGinnis Foege, updated by Mokdad et. al.
Actual Causes of Death†
Tobacco
Poor diet/lack of exercise
Alcohol
Infectious agents
Pollutants/toxins
Firearms
Sexual behavior
Motor vehicles
Illicit drug use
Causes of Death United States, 2000
Leading Causes of Death*
Percentage (of all deaths)
Heart Disease
Cancer
Chronic lower respiratory disease
Unintentional Injuries
Pneumonia/influenza
Diabetes
Alzheimer’s disease
Kidney Disease
Stroke
Percentage (of all deaths)0 5 10 15 20 25 30 35 0 5 10 15 20
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Healthy Kansas
• Prevention Focus– Tobacco Use– Physical Inactivity (obesity)– Poor Nutrition (obesity)
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Improving our Health
A third of all U.S. deaths are attributable to three
modifiable health-damaging behaviors:
– tobacco use – 440,000/yr– lack of physical activity 365,000/yr – poor nutrition
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Prevention focus -
• Tobacco use $724M/yr
• Physical inactivity (obesity)• Poor nutrition (obesity)
Healthy Kansas
$657M/yr
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Healthy Kansas
Chronic Disease Burden– 81% of total health care expenditures– KS Diabetes - $1.3B/yr and growing– New cases of diabetes can be
reduced by 60% with modest increases in physical activity and weight loss
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Healthy Kansas
Healthy People 2010—Tobacco Use
0% 5% 10% 15% 20% 25%
Reduce cigarettesmoking by teens
Reduce cigarettesmoking by adults
Kansas Rate HP 2010 Goals
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Healthy Kansas
0% 20% 40% 60% 80% 100%
% teens doingvigorous activity
(3x/ week, 20mins/ event)
% adults doingmoderate activity (30
mins/ day)
Kansas Rate HP 2010 Goal
Healthy People 2010—Physical Activity
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Healthy Kansas
0% 20% 40% 60% 80%
% Kansans age 2 andup eating 2+ fruit
servings daily
% Kansans age 2 andup eating 3+
vegetable servingsdaily (incl. 1+ servingof dark green/ yellow)
Kansas Rate HP 2010 Goal
Healthy People 2010—Nutrition
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Healthy Kansas
Placed Based Strategy -
• Children in schools • Adults in the workplace• Kansas seniors in community
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Healthy Kansas – Children in Schools
• Coordinated School Health Initiative Infrastructure – >52 Districts, 224 Schools, 80,000 students– Voluntary Body Mass Index (BMI) Testing– Child Health Advisory Committee– School Nutrition and Physical Activity
Committees
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Healthy Kansas – Seniors in the Community
– With Dept. on Aging (KDOA), provide TA for local wellness programs for seniors
– KDOA STEPS Program (Seniors Together Enjoy Physical Success)
– Expansion of Senior Farmer’s Market– Encourage community gardens
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Healthy Kansas
• Media Campaign – partner with KHF• Reactivate Governor’s Council on Physical
Fitness• Governor’s/Secretary’s Awards
– Fitness Awards (youth focus)– Local Community Health Heroes– Healthy Community Designations– Healthy School Designations– Model Workplace Wellness Sites
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Healthy Kansas - Pledge
• Increase activity level• Eat healthy
• Avoid tobacco
YR 1: 6,000 KansansCheckUp
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• Requires suspension of existing beliefs
• Final solution still unknown
• Timeline inconsistent with policy agenda event horizon
• Multiple layers of institutional structures need change
• Requires convergence from the (liberal-conservative) extremes
• Lack of stated agreement on the goal and principles
Healthy Kansas Challenges to System Transformation
Q. – How do we improve the health of Kansans ?
First 2 Steps -
Begin with the end in mind.
First things first.
- Steven Covey
Healthy Kansas An Opportunity to Transform the Health of Kansas
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www.healthykansas.org