Transcript Prevention and Wellness: Key Issues Senate Committee on Health and Human Services Tuesday, August 26, 2008 David L.

Prevention and Wellness:
Key Issues
Senate Committee on Health and Human Services
Tuesday, August 26, 2008
David L. Lakey, M.D.
Commissioner
Presentation Overview
• Public Health and Improvements in
Quality of Life
• Chronic Diseases
– Behavioral Changes
• Infectious Diseases
– Immunizations
Role of DSHS in Disease
Prevention and Management
• Population-based prevention and health
promotion
• Promoting healthy lives for Texas families
through education, prevention and early
detection
• Reduce premature disability and death by
promoting healthy lifestyles
U.S. Life Expectancy at Birth
80
75
70
65
60
55
50
45
40
35
1918 Flu
Epidemic
30
1900 1910 1918 1920 1930 1940 1950 1960 1970 1980 1990 2000
Increased Life Expectancy Driven by
Public Health Improvements
80
Increased years due to
public health measures:
25
60
40
20
0
77 years
5
47 years
1900
Increased years due to
medical care advances:
2000
Source: Ten Great Public Health Achievements – United States, 1900-1999 MMWR, April 02, 1999 /
48(12);241-243 http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm
Leading Causes of Death
•
•
•
•
•
1900
Pneumonia
Tuberculosis
Diarrhea
Heart Disease
Intracranial Lesions
•
•
•
•
•
1998
Heart Disease
Cancers
Cerebrovascular Disease
Chronic Obstructive
Pulmonary Disease
Accidents
Leading Causes of Death
Texas 2001
Heart Diseases
Cancer
Stroke
Accidents
Lower Respiratory Disease
Diabetes
Flu & Pneumonia
Alzheimers
0
10000
20000
DSHS Center for Health Statistics
30000
40000
50000
Chronic Disease Prevention
• Chronic diseases—such as heart disease, cancer,
and diabetes—are the leading cause of death and
disability in Texas
• Although they are among the most common and
costly health problems, they are also among the
most preventable
• Adopting healthy behaviors can prevent or control
the devastating effects of these diseases.
Actual Causes of Death*
Shaped by Behavior
Tobacco
Overweight/Obesity
Alcohol
Auto Accidents
Drugs
Suicide
DWI
Homicide
Sexual Behavior
0
*Texas 2001
5000
10000
15000
Chronic Disease in Texas 2007, DSHS
20000
25000
30000
Tobacco
Prevention and Cessation
• Tobacco is the number one preventable cause of premature
death and disability in Texas
• Costs nearly $11 billion annually in medical care and healthrelated productivity losses
• The Institute of Medicine has issued recommendations for a
multi-pronged approach to tobacco use including:
– Enact smoke-free legislation or ordinances for public spaces
– Increase unit price of tobacco products
– Conduct mass media education campaigns combined with other
community interventions
– Provide telephone-based cessation counseling
– Implement health care provider reminder systems
Percentage of Texas Municipal Population Protected by
100% Smoke-Free Ordinances in Five Settings*
Passage of
Smoke-Free Ordinances in Texas
Percentage of Texans
Protected by Smoke-Free
Ordinances Applicable to
Workplaces, Restaurants,
and Bars
Tobacco
Prevention and Cessation
• DSHS’ primary focus is on tobacco cessation and
prevention
• Initiatives include:
–
–
–
–
–
–
Quitline in partnership with American Cancer Society
Tobacco prevention and control coalitions
Interagency contract with TEA
Youth leadership activities
Smokeless tobacco prevention education
Targeted media messages
Proposals for Consideration
by the 81st Legislature – Tobacco
• DSHS will have an exceptional item to
expand existing tobacco prevention efforts
through:
– Increasing availability of cessation services
– Increasing the number of community coalitions
providing comprehensive activities
– Increasing youth prevention activities
Obesity Trends* Among U.S. Adults
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
1998
1990
2007
No Data
<10%
10%–14%
15%–19%
20%–24%
Source: CDC Behavioral Risk Factor Surveillance System
25%–29%
≥30%
Cost of Obesity for Texas
• Obesity, along with physical inactivity and poor
nutrition, is linked to many chronic diseases
• Human Costs
– Early disabilities and diminished quality of life
– Shorter than expected life span
• Financial Costs
– Obesity cost Texas businesses an estimated $3.3 billion
in 2005
– Includes the cost of healthcare,
absenteeism, decreased productivity
and disability
Obesity Prevention
• DSHS Nutrition, Physical Activity, and Obesity
Prevention Program initiatives include:
–
–
–
–
Grants for community demonstration projects
Farm-to-Work
Statewide obesity partnership conference
Technical assistance and training to communities on
obesity prevention
– State employee wellness program
Obesity Prevention
• Other DSHS programs
– Training and technical assistance to school districts on
coordinated school health programs (through TEA
Education Service Centers contracts)
– Title V/WIC initiatives include:
•
•
•
•
Staff wellness program
Obesity prevention grants to local WIC agencies
Children’s and Postpartum physical activity programs
Nutrition classes and counseling for low income families
– Partnerships with academic institutions and the private
sector
Proposals for Consideration
by the 81st Legislature – Obesity
• DSHS will have an exceptional item to expand existing
obesity prevention efforts through:
– Healthy Communities Program
– Mayor’s fitness council grants on behalf of Governor’s Advisory
Council on Physical Fitness
– Continued implementation of State Employees Health Fitness and
Education Programs, including HB 1297 implementation
• TEA is requesting an exceptional to strengthen the
coordinated school health program
– A portion of that request would support DSHS’ contracts with
Education Service Centers for coordinated school health activities
Private Business Worksite Wellness
• Employee healthcare costs consume half or more of corporate
profits
• National trends show 7-10% health-insurance premiums increases
in 2008 and 2009
• Physical inactivity and obesity are associated with 23% of
national healthcare charges
• Worksite wellness programs can bring a $3 – $8 or more Return
on Investment for every dollar spent in a five year period
• Reductions in absenteeism will increase productivity
• Solutions:
– Keep healthy employees healthy
– Have employees get routine health exams to detect problems early when
treatment can be most effective and least expensive
– Ensure employees with chronic health conditions know how to manage
them and receive treatment to minimize disability
Worksite Wellness for State Agencies
• State Employees: HB 1297
– Statewide Wellness Coordinator
– Worksite Wellness Advisory Board
– Development of model worksite wellness
programs
– Baseline survey of state agency wellness activities
– Annual wellness conference
Chronic Diseases Management
• Texas Council on Cardiovascular Disease
• Texas Diabetes Council and Program
• Asthma Prevention and Management
– Asthma Coalition of Texas
– In Texas, asthma remains one of the most prevalent chronic diseases
and growing health concerns.
– In 2006, according to the Texas Behavioral Risk Factor Surveillance
System (BRFSS):
• An estimated 2.1 million (12.4%) adult Texans (18 years or older)
had self-reported lifetime asthma and 1.3 million (7.3%) adult
Texans had self-reported current asthma
• An estimated 854,000 (13.4%)
children (0-17 years of age)
had reported lifetime asthma and
599,000 (9.4%) children had
reported current asthma.
Disease Prevention through Vaccines
• Childhood diseases – previously common
and widespread are now preventable
through vaccines
Chicken Pox
Measles
Immunizations
• Availability
– Routine childhood vaccines available to all children in Texas
– Adult safety-net program for uninsured and underinsured adults
– Rely on private providers to ensure their patients get needed
immunizations on schedule
• Effectiveness
– As vaccines are introduced, incidence of disease falls
significantly
– Routine childhood immunizations are estimated to prevent 10.5
million cases of illness and 33,000 deaths for one birth cohort in
the United States
2006 National Immunization
Survey Results
National Immunization Survey (NIS) Results for Texas 1995-2006
85.0
80.0
Percent
75.0
70.0
65.0
60.0
55.0
50.0
1995
1996
1997
1998
4:3:1
1999
2000
4:3:1:3
2001
4:3:1:3:3
2002
2003
4:3:1:3:3:1
2004
2005
Tx 2006
Strategies to Increase
Vaccine Coverage Levels
•
•
•
•
•
•
Promote concept of the medical home
Promote use of immunization registries
Promote use of reminder/recall systems for providers
Conduct provider education
Educate the public on the health benefits
Promote and participate in public/private collaborations
– Federal Vaccines for Children Program
– Texas Immunization Stakeholder Working Group
Concluding Thoughts
• Public health measures improve and extend
Texans’ quality of life
• Behavioral strategies work to prevent and
control chronic diseases
• Vaccines work to prevent infectious diseases