Transcript TPHA Conference April 15, 2009 State of Texas Health

Healthy Communities: The Intersection
of Community Development & Health
September 28, 2011
“State of the Health of Texas
& Obesity”
David Lakey, M.D.
Commissioner
Texas Department of State Health Services
Texas Department of
State Health Services (DSHS)
Regional & Local Health
Services
Prevention & Preparedness
Services
Family & Community
Health Services
Mental Health &
Substance Abuse Services
Regulatory
Services
2
Life Expectancy in Texas
Total and by Race, 1989 - 2007
3
Ten Leading Causes
of Death in Texas, 2007
4
Actual Causes of Death
Shaped by Behavior
Tobacco
Overweight/Obesity
Alcohol
Auto Accidents
Drugs
Suicide
DWI
Homicide
Sexual Behavior
0
5000
10000
15000
20000
Chronic Disease in Texas 2007, DSHS
25000
30000
5
Texas County Health Factors
Source: County Health Rankings, Robert Wood Johnson Foundation, University of Wisconsin
6
Texas County Health Outcomes
Source: County Health Rankings, Robert Wood Johnson Foundation, University of Wisconsin
7
Social Determinants
• Education
• Employment
• Income
8
General Health “Fair to Poor”
in Texas by Education
(2000 – 2009 BRFSS)
9
Some College Rankings,
Texas
10
General Health “Fair to Poor” in
Texas by Income Level
(2000 - 2009 BRFSS)
11
Median Income Rankings,
Texas
12
Employment Rankings,
Texas
13
The Health Impact Pyramid
A Framework for Public Health Action
Thomas Frieden, MD, MPH, American Journal of Public Health, 04/2010, Vol. 100, no. 4
14
Health Challenges
•
•
•
•
•
•
HIV
Mental health
Substance abuse and smoking
Infant mortality / prematurity
Health care quality
Obesity
15
Ten Leading Causes of Death in
Texas, Ages 18 – 44 Years, 2007
16
Newly Diagnosed HIV Cases, Deaths,
& Persons Living with HIV
(Texas, 1980-2008)
Living with HIV
New HIV Cases
Deaths among HIV Cases
17
Mental Health Disorders
• 3% of Texans suffer from a severe, persistent
mental illness
• Mental health disorders: the leading cause of
disability in U.S.
• Individuals with serious mental illness have a
life expectancy 25 years shorter than the overall
population
• Inadequate treatment leads to an increase in
costs related to crime, homelessness and
uncompensated health care.
18
The Costs of Substance
Abuse in Texas
• In 2009, ~24,500 Texans died as a result of smoking
• Of the 2,865 newly reported AIDS cases in 2008, 15.5% were
drug related
• ~ 75% of Texas prisoners are involved with alcohol or drugs
• 47% of Texas motor vehicle fatalities (2009) were alcoholrelated
• 23% of fatally injured drivers tested in Texas were found positive for
drugs (2009)
• The cost related to alcohol and drug abuse to Texans (2007)
was ~ $33 billion
• This includes health care, lost productivity, motor vehicle
accidents and crime
• Annual per capita cost for Texas residents: $2,800
19
Past-Month Cigarette Use among
Adults in Texas and the United States
41%
40%
39%
40%
38%
39%
37%
39%
37%
37%
34%
Percentage
30%
26%
25%
25%
24%
24%
2002-2003
2003-2004
25%
26%
25%
25%
24%
20%
10%
0%
2004-2005
2005-2006
2006-2007
Survey Year
Texas - 18 to 25 years
US - 18 to 25 years
NSDUH 2002-2007
Texas - 26 years+
US - 26 years+
20
Past Month Cigarette Use
Among Youth in Texas & US
NSDUH 2002-2007
21
Smoke Free Ordinances,
Texas
22
Infant Mortality/ Prematurity
• The infant mortality rate rose 9% from 2000 to
2006
– 6.2 deaths per 1,000 live births
• Texas pre-term birth rate in 2009 was 13.6%
– National average: 12.3%
• The percentage of Texas infants born with low
birth weight (under 5.5 pounds) rose from 7% in 1990,
to 8.4% in 2007
– Totaling nearly 34,000 Texas infants
• Infant mortality and prematurity rates are
significantly higher among non-white Texans
23
Texas Infant Mortality
(IMR) Rates by Race (1995 – 2008)
24
Preterm Births by Race
(Texas, 2000 – 2007)
Preterm Births in Texas by Race,
2000-2007
20
18
Percent
16
14
12
10
8
HP2010
Target
6
2000
2001
2002
Total
2003
White
2004
Black
2005
Hispanic
2006
2007
Other
25
Health Care Quality
•
Health care quality is an emerging responsibility for the DSHS
•
In the past few years, the department has been pulled more
and more into issues such as health care associated
infections, quality of care in health facilities, and standards of
care
•
The number of preventable health care associated infections
(HAIs) continues to increase year over year
• Leading cause of death from infectious diseases in the U.S. and in
Texas
• HAIs kill 99,000 people each year
• Cause an estimated 1.7 million infections in the U.S.
• HAIs are the leading cause of infectious deaths in Texas with:
– 8,000-9,000 deaths each year
– HAIs also add more than $500 million in annual medical costs
26
Obesity
• 29% of Texans are obese
• 66% of Texans are overweight or obese
• >40% of Texans projected to be obese by 2040
• 3 of the 5 leading causes of death in Texas are:
• chronic diseases linked with obesity
• heart disease
• cancer and
• stroke
• Obesity cost Texas businesses 9.5 billion in 2009
•
•
•
•
•
Health care costs: $4 billion
Absenteeism costs: $1.6 billion
Disability costs: $322 million
Presenteeism costs: $3.5 billion
Total costs could reach $32 billion by 2030
27
Obesity Trends* Among U.S. Adults
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
1990
2006
2010
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
28
Obesity Prevalence Trends in
Texas Adults 1990 to 2010
33% of Texans are
normal weight
140% increase in obesity
29.5% of Texans
are obese
Source: Texas Comptroller
29
Obesity Adult Prevalence in Texas
BRFSS 1990 vs. 2010
50
1990
2006
Weighted %
40
30
39
41
28
20
23
10
15
9
0
White
Black
Hispanic
30
Obesity Successes:
• Focus:
– Community Wellness
• DSHS role:
– Catalyst & Resource
• Strategy:
– Work with broad array of partners
• Supports policy & environmental change
around CDC target areas
– One of 23 CDC-funded states conducting obesity
prevention activities
31
CDC Targets
for Obesity Prevention
Physical
Activity
SugarSweetened
Beverages
Fruits &
Vegetables
High- EnergyDense Foods
Breastfeeding
TV
Viewing
32
Fort Stockton &
Corpus Christi
Healthy
Lifestyle
Coalition
• Fort Stockton ISD worksite
wellness program
• CC in Motion worksite wellness
initiative
• Coastal Bend Breastfeeding
Coalition
• Walk Across Texas/Walk the
Texas Star program
• Pecos County Memorial
Hospital breastfeeding
promotion
• City Parks and Recreation
Department program
development
• Healthy entree restaurant
initiative
33
Interagency Council on Obesity: DSHS,
TEA & Texas Department of Agriculture
Interagency Obesity Council created to:
• Enhance communication & coordination of obesity issues
among state leaders;
• Guide planning around obesity prevention, health promotion
& improved nutrition
Recommendations (selected):
•
•
•
•
Continue collaboration between 3 agencies
Support social interventions
Strengthen K-12 nutrition education
Strengthen nutrition education & physical activities in early
childhood & after-school programs
34
Coordinated School Health (CSH)
and Campus Improvement Plans
• All elementary, middle and junior high schools required to
implement a CSH Program
• Develop goals and objectives for CSH based on:
•
•
•
•
•
Fitness assessment data
Academic performance
Attendance rates
Socioeconomic status
The use of success of any method to ensure students are reaching
required moderate or vigorous physical activity (MVPA)
• Any other indicator recommended by SHAC
• Include CSH Goals in all elementary, middle and junior high
school Campus Improvement Plans
35
State of Texas Nutrition
Services & Education
• School district policy to prevent foods of
minimal nutritional value
• Nutrition education to be provided in
Kindergarten through 8th grade
• District-developed wellness policy
required of each school district receiving
reimbursable meal funding
36
Breastfeeding & Obesity
• Infants who aren’t breastfed have increased risk for
many acute and chronic conditions
• Including a 32% excess risk for childhood obesity
• Many Texas mothers report barriers to achieving
personal breastfeeding goals
• Breastfeeding activities coordinated across DSHS
address barriers to optimal infant feeding outcomes
• Every Ounce Counts
• http://www.breastmilkcounts.com/our-new-campaign.html
37
Growing Communities Video
Highlights successful community-based
strategies across Texas through short,
documentary-style video clips
• The videos were initially distributed to the 2009
Statewide Obesity Summit attendees
• Recipients were charged to be “catalysts for change”
by hosting video screenings
• Since the July 2009 launch, DSHS has made the
video series available online and in DVD format
•
www.dshs.state.tx.us/obesity/growingcommunity/default.shtm
38
Partnerships Needed
to Improve Health
DSHS
Food Industry
Elected
Officials
Worksites
& Schools
Higher
Education
Community-based
Solutions
Non-Traditional
Partners
Urban Planners,
Developers
Architects
Providers &
Hospitals
Community
Groups
39
Thank You!
40