Transcript Slide 1

Protecting the Public’s Health:
Chronic Disease Prevention and Control
Janet Collins, Ph.D.
Director, National Center for Chronic Disease Prevention and
Health Promotion
Centers for Disease Control and Prevention
National Center for Chronic Disease
Prevention and Health Promotion
Vision and Mission
Our Vision
All people living healthy lives free from the devastation
of chronic diseases
Our Mission
Leading efforts to promote health and well-being
through prevention and control of chronic diseases
Chronic Diseases
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Are responsible for 7 of every 10 U.S. deaths1
Cause major limitations in daily living for 1 in 10
Americans2
Cause significant racial/ethnic disparities in health2
Account for about 75% of $2.2 trillion annual U.S.
medical care costs3
1 Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: final data for 2005. National Vital Statistics Reports 2008;56(10).
Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf
2 Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: final data for 2005. National Vital Statistics Reports 2008;56(10).
Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf. And National Center for Health Statistics.
Health, United States, 2007. With chartbook on trends in the health of Americans. Hyattsville, MD: National Center
for Health Statistics; 2007. Available from: http://www.cdc.gov/nchs/data/hus/hus07.pdf
3 Anderson G. Chronic conditions: making the case for ongoing care. Baltimore, MD: John Hopkins University; 2004.
Life Expectancy vs. Health Care Spending
9
0
Japan
Life Expectancy
8
0
Cuba
Switzerland
United States
7
0
6
0
5
0
4
0
3
0
Sierra Leone
0
50
0
100
0
150
0
200
0
250
0
300
0
350
0
400
0
450
0
Per Capita Health Care Spending in International Dollars
National Center for Health Statistics. Health, United States, 1998 With Socioeconomic Status and Health Chartbook. Hyattsville, Maryland: 1998.
500
0
Life Expectancies in the “Eight Americas”
Population Group
Asian
Northland Rural White
White Middle America
Appalachia/Mississippi Valley White
Black Middle America
Western Native American
Southern Rural Black
High-risk Urban Black
Per Capita
Life
Income
Expectancy
$21,600
84.9
$17,800
79
$24,600
77.9
$16,400
$15,400
$10,000
$10,500
$14,800
75
72.9
72.7
71.1
71
Source: C. Murray, S. Kulkarni, M. Ezzati. Eight Americas: New Perspectives on U.S.
Health Disparities American Journal of Preventive Medicine 2006; 29(5):4-10.
2006 U.S. National Health
Expenditures
7%
3%
Hospital Care
7%
31%
13%
Physician/Professional
Services
Nursing Home and
home health
Prescription drugs and
medical products
Administration
Research and
Investment
Government public
health (prevention)
8%
31%
An Aging Population
Percentage of U.S. Population Age 65 and Older
Percentage of Population
25
20
15
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 Copyright 1996,
Watson Wyatt Worldwide.
Prevalence of Obesity Among U.S. Adults
No Data
2006
1998
1990
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Prevalence of Diabetes Among U.S. Adults
1990
No Data
2006
1996
<4%
4%–6%
6%–8%
8%–10%
>10%
Source: CDC, Behavioral Risk Factor Surveillance System
“People didn’t just wake up in 1980 and
decide they were going to get obese.” –
CDC’s Dr. William Dietz
Personal Behavior Choices
A brisk walk in the park keeps Marcy in shape between dog shows.
His owner, Columbus resident Cathy Stambo got up early to give
her 3 year old Doberman his regular workout.
But, Something Can Be Done ….
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Maintain health in the
first place
Living well with chronic
disease
Prevention
U.S. Cigarette Consumption
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
Year
2000
1995
1990
1985
1980
1975
1970
1965
0
1960
Per Capita Cigarette Consumption
5,000
Hospitalizations for Heart Attacks Before and
After Smoking Ordinance — Pueblo, Colorado,
Jan 2002 - June 2006
300
Rate per 100,000
250
200
150
Pre-implementation
100
Post-implementation
50
0
City of
Pueblo
Intervention
Area
Pueblo
County
El Paso
County
Control Areas
CDC, MMWR, January 2, 2009 / Vol. 57 / No. 51
Early Detection
Percentage of US Women (Age 40+) Having Had
a Mammogram Within the Past 2 Years by State
1995
1991
80+%
70%-79.9%
60%-69.9%
<60%
Did not
participate
in the survey
2000
Note: Estimates are weighted and are age-adjusted to the 2000 U.S. standard population. Source: Behavioral Risk Factor Surveillance System, CDC
2006
Breast Cancer Death Rates
Age-adjusted U.S. breast cancer mortality rate/100,000 women
1992 to 2005
34
32
31.6
30
28
24% drop
26
24
24
22
20
1992
1993
1994
1995
1996
1997
1998
1999
2000
Source: US Mortality Files, National Center for Health Statistics, CDC.
2001
2002
2003
2004
2005
Control
Living Well with Diabetes
Eye exams
lead to
Foot exams lead to
Glucose
control
Lipid
control
50-60%
decrease
Vision Loss
45-85% Foot ulcers and
amputations
decrease
Kidney failure,
Vision loss
lead to
40%
decrease
lead to
20-50% Cardiovascular
Disease
decrease
Flu vaccine leads
lead to
to
Narayan et al.: Disease Control Priorities in Developing Countries, 2006
32%
Hospitalization
decrease
Progress in Control:
Diabetes Outcomes - 1995 to 2005
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Vision Loss
Amputation
End Stage Renal Disease
CVD Hospitalization
Total Hospitalization
www.cdc.gov/diabetes
25%
36%
23%
16%
33%
National Center for Chronic Disease
Prevention and Health Promotion
Disease-Focused
Divisions
Risk Factor
Divisions
Population/Setting
Divisions
Division of Cancer
Prevention
and Control
Division of Nutrition,
Physical Activity,
and Obesity
Division of
Adolescent
and School Health
Division of
Diabetes
Translation
Office on
Smoking and Health
Division of Adult and
Community Health
Division for Heart
Disease and
Stroke Prevention
Office of Public
Health Genomics
Division of
Reproductive Health
Division of
Oral Health
National Center for Chronic Disease
Prevention and Health Promotion
BRFSS/YRBS
Schools
PRAMS
Communities
Prevention
Research Centers
Worksites
School Health
Policy and Program
Survey
Health Care Settings
Healthy Communities /
REACH
Breast and Cervical
Cancer Early Detection
Program
WISEWOMAN
National Diabetes
Education Program
American Recovery and
Reinvestment Act of 2009
Public Law 111-5
Prevention and Wellness Provisions
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Section 317 immunization program - $300 million to CDC
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Healthcare-associated infections - $50 million to HHS
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Evidence-based clinical and community-based prevention and
wellness strategies that deliver specific, measurable health
outcomes that address chronic disease - $650 million to HHS
American Recovery and Reinvestment Act
“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 Obama
February 21, 2009
Comprehensive Health Reform
Health in all policies
Population/Community-based
disease prevention and health
promotion
Health care
service and
delivery
improvement
Adapted from Finding the Voice of Public Health in National Health Reform Dialogue - An Integrative Model
for Health System Transformation