Secretary Rod Bremby Presentation

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Our Vision – Healthier Kansans living in safe and sustainable environments.

Roderick L. BrembySecretary

Kansas Department of Health and Environment

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Health Reform:Complex Dual Narratives

• Health Care (Sick Care)– Cost– Access– Quality

• Caring about the health of the population

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Problem Definition

Overflowing SinkDigital C. Print, 200240" x 49"edition of 6 / 2 APCarlos and Jason Sanchez

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Health Improvement Logic Model

Health Care Costs

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Health Care Costs

Chronic Illness and

Disease

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Health Care Costs

Chronic Illness and

Disease

Chronic Illness and

Disease

Risk Factors

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Health Care Costs

Chronic Illness and

Disease

Chronic Illness and

Disease

Risk Factors

Behaviors

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Health Improvement Logic Model –

Health Care Costs

• 1980 - $ 253B or $ 1,100 per person

• 2001 - $1.46T or $ 5,148 per person

• 2002 - $1.60T or $ 5,560 per person

• 2003 - $1.73T or $ 5,952 per person

• 2004 - $1.85T or $ 6,301 per person

• 2005 - $1.97T or $ 6,649 per person

• 2006 - $2.10T or $ 7,026 per person

• 2007 - $2.24T or $ 7,421 per person

• 2008 - $2.37T or $ 7,804 per person

• 2018 - $4.35T or $13,001 per person

Centers for Medicare and Medicaid Services

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Sick Care System Cost Drivers

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WHO - U.S. Health Outcomes (2001)

OCED – (2001)

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Health Care Costs

Chronic Illness

& Diseas

e

More than 133 million Americans have at least one chronic condition, such as diabetes, cancer, glaucoma, and heart disease.

Accounts for 75-80% of US Health Care Costs.

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Health Care Costs

Chronic Illness and

Disease

Chronic Illness and

Disease

Risk Factors

Hypertension

High Cholesterol

Overweight/Obesity

Poor Oral Hygiene

Depression

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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

How Why

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Health Care Costs

Chronic Illness and

Disease

Chronic Illness and

Disease

Risk Factors

Behaviors

Tobacco use and

exposure

Poor nutrition

Physical Inactivity

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Health Factors

Environment22% How We Live -

Behavior51%

Medical Care10%

Genetic Make-Up17%

Source: USDHEW, PHS, CDC. “Ten Leading Causes of Death in US 1975.”Atlanta, GA, Bureau of State Services, Health Analysis & Planningfor Preventive Services, p 35, 1978

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Source: Schroeder SA. N Engl J Med 2007;357:1221-1228

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Demographic Projection

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Problem Definition

Overflowing SinkDigital C. Print, 200240" x 49"edition of 6 / 2 APCarlos and Jason Sanchez

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HealthyKansas

• Increased Physical Activity• Healthier Diet• Avoid Tobacco and Tobacco

Exposure

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behaviors

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Prevention focus -

• Tobacco use $927M/yr

• Physical inactivity (obesity)• Poor nutrition (obesity)

Healthy Kansas

$657M/yr

Smoking-caused health expenditures, productivity losses, tax burdensCDC, Data Highlights 2006

“State-Level Estimates of Annual Medical Expenditures Attributable to Obesity”, by Eric A. Finkelstein and Ian C. Fiebelkorn, RTI International, and Guijing Wang, CDC, Journal of Obesity Research (January 2004).

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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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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

cent

Source: Jones et al., Arch Intern Medicine, 1998; Vol 2436

Rx – Wellness

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“Working together we can createa culture that actively promotes

responsible behavior and the adoption

of lifestyles conducive to good health.

This is “prevention” in the broadest sense

and necessary if we are to remaina humane and caring society.”

Larry D. Jecha, M.D., M.P.H.Former Director/Health Officer

Wichita-Sedgwick County Department of Health1997

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0.6

1.0

1.4

1.8

2.2

2.6

3.0

BMI and Cardiovascular Disease Mortality Risk

Rela

tive R

isk

of

Death

Body Mass index

<18.5

MenMen

WomenWomen

Calle et al. N Engl J Med 1999;341:1097.

18.5–

20.4

20.5–

21.9

22.0–

23.4

23.5–

24.9

25.0–

26.4

26.5–

27.9

28.0–

29.9

30.0–

31.9

32.0–

34.9

35.0–

39.9

>40.0

Lean Overweight Obese

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0

25

50

75

100

BMI and Risk of Type 2 DiabetesA

ge-A

dju

sted

Rela

tive R

isk

Body Mass index (kg/m2)

MenMen

WomenWomen

<22 <23 23-

23.9

24-

24.9

25-

26.9

27-

28.9

29-

30.9

31-

32.9

33-

34.9

35+

1.0

2.91.0

4.31.0

5.01.5

8.12.2

15.8

4.4

27.6

40.3

54.0

93.2

6.711.6

21.3

42.1

Chan J et al. Diabetes Care 1994;17:961.Colditz G et al. Ann Intern Med 1995;122:481.

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CitationsCitations

BRFSS, Behavioral Risk Factor Surveillance System

http: //www.cdc.gov/brfss/

Mokdad AH, et al. The spread of the obesity epidemic in the United States, 1991—1998 JAMA 1999; 282:16:1519–22.

Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001; 286:10:1519–22.

Mokdad AH, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003: 289:1: 76–9

CDC. State-Specific Prevalence of Obesity Among Adults — United States, 2007; MMWR 2008; 57(36);765-8

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ObesityObesity Trends Among U.S. Adults Trends Among U.S. Adults between 1985 and 2007between 1985 and 2007ObesityObesity Trends Among U.S. Adults Trends Among U.S. Adults between 1985 and 2007between 1985 and 2007

Definitions:Definitions:• Obesity: Having a very high amount of Obesity: Having a very high amount of

body fat in relation to lean body mass, body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or or Body Mass Index (BMI) of 30 or higher.higher.

• Body Mass Index (BMI): A measure of an Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her adult’s weight in relation to his or her height, specifically the adult’s weight in height, specifically the adult’s weight in kilograms divided by the square of his kilograms divided by the square of his or her height in meters.or her height in meters.

Definitions:Definitions:• Obesity: Having a very high amount of Obesity: Having a very high amount of

body fat in relation to lean body mass, body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or or Body Mass Index (BMI) of 30 or higher.higher.

• Body Mass Index (BMI): A measure of an Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her adult’s weight in relation to his or her height, specifically the adult’s weight in height, specifically the adult’s weight in kilograms divided by the square of his kilograms divided by the square of his or her height in meters.or her height in meters.

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Obesity Trends Among U.S. Adults Obesity Trends Among U.S. Adults between 1985 and 2007between 1985 and 2007Obesity Trends Among U.S. Adults Obesity Trends Among U.S. Adults between 1985 and 2007between 1985 and 2007

Source of the data:Source of the data:• The data shown in these maps were collected The data shown in these maps were collected

through CDC’s Behavioral Risk Factor through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state Surveillance System (BRFSS). Each year, state health departments use standard procedures health departments use standard procedures to collect data through a series of monthly to collect data through a series of monthly telephone interviews with U.S. adults.telephone interviews with U.S. adults.

• Prevalence estimates generated for the maps Prevalence estimates generated for the maps may vary slightly from those generated for the may vary slightly from those generated for the states by BRFSS (http://aps.nccd.cdc.gov/brfss) states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used.as slightly different analytic methods are used.

Source of the data:Source of the data:• The data shown in these maps were collected The data shown in these maps were collected

through CDC’s Behavioral Risk Factor through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state Surveillance System (BRFSS). Each year, state health departments use standard procedures health departments use standard procedures to collect data through a series of monthly to collect data through a series of monthly telephone interviews with U.S. adults.telephone interviews with U.S. adults.

• Prevalence estimates generated for the maps Prevalence estimates generated for the maps may vary slightly from those generated for the may vary slightly from those generated for the states by BRFSS (http://aps.nccd.cdc.gov/brfss) states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used.as slightly different analytic methods are used.

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2008

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2008

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

10 <10%;

0 =>15%

1 <20%;

30 =>25%

0 <10%;

0 =>25%

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Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

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No Data <10% 10%–14%

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No Data <10% 10%–14% 15%–19%

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No Data <10% 10%–14% 15%–19% ≥20%

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No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

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No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes

Obesity (BMI ≥30 kg/m2)

Diabetes

1994

1994

2000

2000

No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%

No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

2008

2008

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Obesity: Medical Complications

Pulmonary diseasePulmonary diseaseabnormal functionabnormal functionobstructive sleep apneaobstructive sleep apneahypoventilation syndromehypoventilation syndrome

Nonalcoholic fatty Nonalcoholic fatty liver diseaseliver diseasesteatosissteatosissteatohepatitissteatohepatitiscirrhosiscirrhosis

Gall bladder diseaseGall bladder disease

Gynecologic Gynecologic abnormalitiesabnormalitiesabnormal mensesabnormal mensesinfertilityinfertilitypolycystic ovarian syndromepolycystic ovarian syndrome

OsteoarthritisOsteoarthritis

SkinSkin

GoutGout

Idiopathic intracranial Idiopathic intracranial hypertension hypertension

StrokeStroke

CataractCataractss Coronary heart Coronary heart

diseasedisease DiabetesDiabetes DyslipidemiaDyslipidemia HypertensionHypertension

Severe pancreatitisSevere pancreatitis

CancerCancerbreast, uterus, cervixbreast, uterus, cervixcolon, esophagus, colon, esophagus, pancreaspancreaskidney, prostatekidney, prostate

PhlebitisPhlebitisvenous stasisvenous stasis

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Kansas Experience

• Number of Obese Adults– 25.8% of Kansans (23rd Nationally)

• Number of Overweight Adults– 62% of Kansans are overweight and obese

(23rd)

• Number of Obese Children– 14% of Kansas children are obese (24th)

• Number of Overweight Children– Three of every 10 Kansas children

– F as in Fat: How Obesity Policies are Failing in America (2008)

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Kansas Experience• Adults with Diabetes

– 7.2% of Kansas adults (33rd)

• Adults with Hypertension– 25.6% of Kansans (36th)

• Physical Inactivity– 23% of Kansas Adults, 54% of Kansas

High School students, and 25% of Kansas children (age 10-14) do NOT meet recommended physical activity levels.

– F as in Fat: How Obesity Policies are Failing in America (2008)

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Intervention

• Our fast paced society• Fast food• Technology• Current health care system• School systems• Churches• City planners and others…

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How did we get this way?


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16 oz 32 oz 44 oz 52 oz 64 oz

48 Teaspoons Sugar

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French Fries

20 Years Ago Today

210 Calories2.4 ounces

610 Calories6.9 ounces

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Dr. Stephen Aldana

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Dr. Stephen Aldana

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Dr. Stephen Aldana

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Dr. Stephen Aldana

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Somewhere in Florida (?)

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U.S. government’s entire budget for nutrition education is 1.12% of advertising budget for…

Advertising Age, 2008

McDonalds

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US Advertising

Food and Candy Category 2008 1st 6 Months

$3.17B TNS Media Intelligence

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Challenge of messaging

• McDonald’s $ 808M• Subway 360

• Wendy’s 304• Burger King 274• KFC 261• Taco Bell 239• Pizza Hut 199• Applebee’s 168• Sonic 134• Domino’s 132• National 5 A Day Program 9

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The Challenge

• Children between 8 and 12 see an average of 21 television ads each day for candy, snacks, cereal and fast food — more than 7,600 a year.

• Not one of the 8,854 ads reviewed promoted fruits or vegetables.

- Kaiser Family Foundation

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Assuring A Healthy Kansas

• Children In Schools• Adults in the Workplace• Seniors in Community

• Hometown Health Heroes• Healthy Schools Designation• Healthy Restaurant Designation• Healthy Community Designation

»7000 Kansans Taken the Pledge

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www.healthykansas.org

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Healthy Kansas - Pledge

• Increase activity level• Eat healthy• Avoid tobacco

YR 1: 6,000 KansansCheckUp

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Healthy Kansas – Children in Schools

• Coordinated School Health Initiative Infrastructure – >109 Schools– Voluntary Body Mass Index (BMI)

Testing– Child Health Advisory Committee– School Nutrition and Physical

Activity Committees

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Healthy Kansas – Adults in the Workplace

• Formalize workplace wellness program

• Technical Assistance (TA) to other state agencies – HRA program

• Pilot business workplace wellness programs with toolkits and website support

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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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Creating a Culture of Wellness

New or Modified– Programs– Policies– Practices

>Tobacco Use/Exposure>Physical Inactivity>Poor Nutrition

Healthy Homes

Healthy Neighborhoods

Healthy Congregations

Healthy Schools

Healthy Businesses

Healthy Communities

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Programs, policies, and practices to shape the environment so that our default behavior is the

healthy behavior.

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Factors That Affect Health

Our Vision – Healthy Kansans living in safe and sustainable environments

The Solution is Environmental

How can we make it easy for people to make the right choices?

If only 10% of sedentary Americans could walk for 30 minutes a day, we could save $5.6 billion in heart disease treatment

Where can they walk?

Can we build walking into their daily lives?

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"A historic commitment to wellness initiatives will keep millions of Americans from setting foot in the doctor's office in the first place -- because these are preventable diseases and we're going to invest in prevention.”

President Obama02/21/2009

Secretary Rod Bremby Presentation

Documents

Transcript of Secretary Rod Bremby Presentation