Prevention and Wellness

:

Is it the Future of Health Care?

Tom Peterson, M.D. Healthier Communities Spectrum Health

Public Health Contributions to Solving Health Problems The 10 leading causes of death as a percentage of all deaths in the United States - 1900

Leading Causes of Death in United States and Michigan 2002 Heart Dis Cancer Stroke CLRD Accidents Diabetes Pneum/Influ Alzheimer's Kidney Dis Suicide 0 50 100 150 200 Age-Adj. Rate per 100,000 Michigan United States 250 300

Sources: 2002 Michigan Resident Death File, Vital Records and Health Data Development Division, MI Dept of Community Health “Deaths: Preliminary Data for 2002”. National Vital Statistics Reports Vo 52, No 13. CDC National Center for Health Statistics

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The 5 Big Ones in the 21

st

Risks:

Century

Diseases:

 Obesity  Smoking  High blood pressure  Stress  Inactivity  Heart Disease  Cancer  Emphysema  Strokes  Diabetes

Our Population’s Health

• 17 million have diabetes, 5 million more have diabetes and don’t know it • 16 million have pre-diabetes • 47 million have metabolic syndrome • 17 million have heart disease • 1.1 million heart attacks annually • 50 million are obese, 110 million are overweight • 45 million smoke • 50 million have high blood pressure

All of which can be decreased simply by increasing physical activity!

Medicare Spending Has Doubled Since 1992 for:

• Cancer $10 -19 billion • Arthritis $3.4 –7.2 billion • Depression $1.3- 2.5 billion • Heart disease $21– 42 billion • Diabetes $5.7-12.5 billion

Who’s Accountable?

• Health Care Providers • Health Plans • Employers • Employees/Patients • Government • Communities • Schools

Schools

What Can They Do?

• • • • •

Increase activity

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After school programs

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Phys Ed per week Vending machines School lunches Be accountable Measure your kids!

Arkansas Alma School District Healthy Weight Risk for Overweight Overweight Males

Number 2006-06 841 2004-05 1190

Females

2005-06 750 2004-05 993 61.2% 59.9% 67.2% 65.5% 18.7% 18.2% 16.4% 17.5% 18.5% 20.4% 14.3% 16.1%

2004-05 Overweight - 20

2005/2006 2004/2005

The Business World

How Sick, Really, Are Our Employees?

• 60+% of them are overweight, 30% of those obese • 1 out of every 4 of them smoke • 1 out of every 5 of them have high blood pressure • 2 out of every 5 of them have high cholesterol • 1 out of every 5 have diabetes, pre-diabetes, or unknown diabetes • 80% are not active enough, 25% of those are totally inactive

Increased Yearly Claims Cost of an Unhealthy Employee

Employee Benefit News, May, 1997

Costs Associated with Risks Medical Paid Amount x Age x Risk $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 $7,123 $5,813 $4,530 $4,401 $3,216 $4,718 $1,122 19-34 $2,098 $3,364 $1,550 $1,351 $2,667 $2,912 $2,110 $3,894 $2,941 $1,523 35-44 $2,081 45-54 55-64 $3,069 $2,480 $1,851 65-74 $2,605 $2,200 $1,641

High Risk Medium Risk Non--Participant Low Risk

75+ Edington. AJHP. 15(5):341-349, 2001

Where are the Opportunities for Population Health Management?

9000 8000 1000 0 Serious disease 7000 Minor Disease 6000 5000 4000 No Disease Health Promotion Opportunity 3000 2000 Q_12 Q_9 Q_6 Medical and Drug Costs only Q_3 Q0 Medical & Care Management Opportunity Condition Management Opportunity Q3 Q6 Q9 Q12

The Health Care System

The New Paradigm of Health Care - Chronic Disease Care Requires:

• Long term sustainability • Major lifestyle changes • Silent killers, asymptomatic treatment • Multi faced problems • Not curable by drugs, surgeries or vaccinations • Readiness to change

“Never before has our health care system had available such tremendous clinical achievements and knowledge, that, unfortunately have not been directed to the patients who could benefit the most from them.”

Russell Ricci, M.D. IBM 2001

Traditional Physician Care

• • • • • • • •

Diagnosis focused Treatment decision making Procedural expertise Tell them what to do Result based Physiological weighted, not psychologically focused Start and finish oriented Not focused on readiness or sustainment

% of Recommended Care Received – Average – 54.9% 80 70 60 50 40 30 20 10 0 Low b ac k P ai n H ear t D ise as e H igh b lood p re ss ur e D ep re ss ion A sth ma H igh C hol es te rol

Thorpe K. Health Affairs Aug 25, 2004 McGlynn EA New Eng Journ Med, 2003,348:2635 45

D iab ete s

Failure to provide optimal treatment for asthma, depression, diabetes, heart disease, and high blood pressure results in:

• 41 million sick days per year • $11.5 billion in annual losses for American businesses • $ 1 billion per year in preventable hospital days • 57,000 death per year National Committee for Quality Assurance, Sept 2003

The Key: Collaboration and Integration of All Health Care Systems, Including:

• • • • •

Team management of the chronic disease (s) Continuum of care coordination from point A to Point B Improved reimbursement and incentives for healthy lifestyle changes and prevention of the chronic diseases, and to support chronic care management Measurable and reportable outcomes of management for the patient, employer, health plan and provider Coordination and communication of infrastructures in all systems

Lifestyle Choices

S edentary O besity S moking

The Triad of Poor Health

Sleep disorders Diabetes Sedentary/Inactivity -watching TV -sitting at a desk -driving Arthritis Metabolic syndrome Gall bladder disease Spinal disease Strokes Obesity -BMI >30 in adults -BMI% > 95 in children <18 Heart disease Unhealthy Eating saturated fats -high glycemic loads –Sugars and high caloric foods –large quantities Cancer

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50 years ago we were paid to exercise, while in todays society we have to pay to exercise

.

Human Beings Were Designed to Move!

Through continuous movement, our joints improve and become better oiled, our hearts beat more efficiently and the muscles strengthen, our brain receives better blood supply and oxygen, our muscles become more efficient using oxygen, clearing waste and responding to insulin, our immune system lessens inflammatory states, our circulatory system becomes less resistant, our blood becomes thinner, chemicals are released that improve attention and general feeling of well being, and our organs improve storage of glucose and use of fatty acids.

The Perfect Pill - Exercise!

Moderate Activity Reduces Risk of:

• Heart disease up to 80% • Mortality up to 50% • Stroke up to 34% • High blood pressure up to 20 pts.

• Diabetes up to 50% • Dementia up to 50% • Fractures up to 40% • Colon cancer up to 40% • Breast cancer up to 30%

What is “Moderate Activity”?

– Gardening, walking, golf, washing your car, etc.

– 10 minutes - 3 X per day OR, – 15 minutes - 2 X per day OR, – 30 minutes - 1 X per day – Aim for 2,000 steps a day or more

How Much Do We Really Need?

• • • ’70s – 30-60 minutes, continuous/ vigorous, 3 X per week ’90s – 30 minutes, moderate intensity, at least 3 times/week 2006 – 30 minutes, moderate activity, every day. No sweat required!

• 44.3 million Americans are obese • 47 million have metabolic syndrome • Number of adults with a BMI >40 has tripled in the last 10 years • African Americans highest with rate of 31.1% and rate of diabetes of 11.2% • Obesity rate (BMI>30) in 2003 is >30% of the population • Over 60% of population is overweight or obese

Obesity in America

Metabolic Syndrome

(3 of the 5)

• Central obesity – Women – waist > 35 inches – Men - waist > 40 inches • Low HDL – Men < 40 – Women < 50 • High blood pressure (> 140/90) • High triglycerides (> 150) • High fasting blood sugar (>100)

At the Current Rate

• One third of all children born in year 2000 will become diabetics, almost 50% of Hispanics and over 40% of African Americans • By the year 2020, virtually all Americans will be overweight • 80% of overweight adolescents will become obese adults, causing an average of 5-20 years of life lost for each individual • For the first time, children born after the year 2000 will be outlived by their parents

Our “Fat Economy”

Businesses thrive on people consuming more calories, while other businesses thrive on trying to “cure” the result.

Fast Food Restaurants Soft drink companies Snack foods Processed food companies Bariatric surgery Diet industry Diet medications Diet books

Childhood Obesity

Generation XXL

The Problem: In the last 30 years we have been been inundated with “labor-saving” devices and easily accessible, high fat, high caloric, foods

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Our kids are born into a world of physical inactivity !

Lifestyle Changes that Promote Sedentary Behavior

Childhood Obesity Morbidity

(5-17yo, BMI > 95%) • Twice the rate of elevated cholesterol • Twice as likely to have elevated diastolic BP • More than 4 times the rate of increased systolic BP • Over 12 times as likely to have fasting hyperinsulinemia • Obese teens who smoke are 4 times as likely to develop metabolic syndrome Freedman, Pediatrics 1999; 103:1175-82

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Americans run only 25% of all errands by foot, down 42% in the past 20 years

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Every day, 40% of adults eat out at a restaurant, sales to exceed $440 billion in 2004

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Americans spend $920 a person each year on food away from home

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25% of vegetables consumed in the U.S. are french fries

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Fast food spending has increased 18 fold since 1970

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The average hamburger has 3 times more calories today compared to 40 years ago

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While 50 million Americans diet every year, only 5% sustain weight loss for 12

• • • • • • • •

In most gym classes kids are aerobically active for just 3 minutes Nearly all high schools have vending machines, while the average teenager gets 10-15% of their daily calories from soda Soda consumption by children in US has increased by 500% in the last 40 years $13 billion per year, more than tobacco, is spent on food adds targeting children 70% of kids age 6-8 think fast food is healthier than home food For every hour of TV a child averages per day, obesity risks rise 6% 44% of Americans say it’s hard to walk anywhere from their house Only 17% of kids walk to school, 28% who live less than mile away a

“No epidemic has ever been resolved by paying attention only to the affected individual.”

George W. Albee Founder of the American Psychological Society

• • • • • • • • •

1570’s

Tobacco is prescribed by doctors – good for colic, nephritis, falling fingernails, worms, halitosis, lockjaw and cancer

1619 Tobacco is currency in Jamestown: a prospective husband can pay for his mate to be shipped from England for 120 lbs of tobacco 1650 Connecticut court orders no smoking under 21, no smoking except with physician order 1855 Lancet Concerns of health effects of smoking raised in 1884 Mass production began

Fun

1905 Tobacco is REMOVED from the US pharmacopoeia, removing it from FDA supervision…

Facts

1909 15 states banned the sale of cigarettes 1998 National Tobacco Settlement – Michigan worst in nation in using money for tobacco control 2006 15 states, 12 countries ban smoking in all workplaces, bars and restaurants!

Most Cost Effective, Disease Preventive Procedures in Health Care Are:

Immunizations and Smoking Cessation

American Journal of Preventive Medicine, July, 2001 sponsored by Center for Disease Control and Prevention

If you took 1,000 young adult smokers, 1 will be murdered, 6 will die from traffic accidents, but 500 will die from smoking!

Richard Peto Professor of Medical Statistics and Epidemiology, University of Oxford

Is it just parents who need more education

?

Life Cycle Effects of Smoke Exposure Asthma Otitis Media Fire-related Injuries Cognitive Problems Influences to Start Smoking SIDS RSV/Bronchiolitis Meningitis Infancy Childhood Adolescence In utero Nicotine Addiction Health Effects Adulthood Low Birth Weight Stillbirth PROM Prematurity Cancer Cardiovascular Disease COPD Strokes

Arch Pediatr Adolesc Med.

1997

The Pregnant Smoker • 13-16% smoking prevalence, up to 35% in medicaid population • Highest quit rate of all populations, most spontaneous quitters • 40-65% of moms quit on their own before even receiving prenatal care • Increasing relapse peaks by 6 months post partum, almost 80% by 1 year • Many moms quit to minimize risk to baby, develop no coping mechanisms for preventing relapse after birth “6 month honeymoon” Ershoff,D Nic Tobacco Res, vol 6; April,2004

Parental Smoking Annual Damages to Children:

 Nearly 1.8 million doctor visits for asthma  Low birth weight –46,000, 2800 perinatal deaths  SIDS – 2,000  RSV/bronchiolitis – 22,000 hospitalizations, 1,100 deaths  Up to 436,000 episodes of bronchitis in children under five  Fire related injuries – 10,000, 250 deaths  Up to 190,000 cases of pneumonia in children under five, 3.4 million ear infections  8-26,000 new cases of asthma each year Aligne et al, Arch Pediatr Adolesc Med, 1997

Teenagers and Tobacco Use

: • 2/3 of all 12 th tobacco graders have tried • Almost 3,000+ teens become addicted every day, 4-5 million teens total • Addiction can begins within a few days to a few weeks • Spit tobacco is 4 times • more addictive than cigarettes • #1 cause of drug addiction in teens, and of graduating seniors

Adult Tobacco Diseases

• • • • • • • • • • Heart Disease/atherosclerosis Cancer - Lung, oral, laryngeal, colon, liver, pancreas, renal, bladder, skin, cervical COPD CVA Peptic ulcer disease Macular degeneration Fractures Hearing loss Aortic aneurysm Impotency • • • • • • • • Periondontitis Tooth loss/cavities Immune suppression Liver disease Asthma Pneumonia Sinusitis Type II diabetes – Negative effects on cholesterol – Accelerates proteinuria, atherosclerosis, and peripheral artery disease – Erectile dysfunction¹ • 1. Diabetes Care 2001, Sep 24:590-5

As adults, we are all educators. We need to be in charge of our own health. If we don’t become involved in influencing children’s health from very young ages, there will be serious future consequences

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We are all role models

Do We Know Our Numbers

?

• • • •

Cholesterol (<200) HDL LDL (>60) (<130) Triglycerides (<150)

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Fasting blood sugar (<100)

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Blood pressure (<120/80)

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Smoking status (NO)

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BMI (<25) Diabetics : A1C (Hemoglobin A1C

)

(<7)

Keys to Future Health Improvement

• Culture change • Know your health, and risks • Self management • Preventing the low risk from becoming high risk • Exercise • Active childhoods • Don’t focus on just the “diet” • Quit smoking, or help someone quit • Team management focused health care • We are the leaders !

An Ounce of Prevention is Worth a Pound of Cure!

Businesses Health Care

Healthy environments Incentivised wellness programs Top down leadership Proper reimbursement Integration of systems Teams Provide continuum of care Accessible resources

Schools

Food restrictions and requirements

Community/Govern.

Increased phys ed and after school programs “Healthy” education and healthy role Healthy culture Activity friendly environments Healthy legislation models Health promoted media and retail Measure your kids !

“Somebody has to do something, it’s just incredibly stupid that it has to be us.” Jerry Garcia