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Secretary Rod Bremby Presentation
- 1. Our Vision – Healthier Kansans living in safe and sustainable environments. Roderick L. Bremby Secretary Kansas Department of Health and Environment
- 4. Problem Definition Our Vision – Healthier Kansans living in safe and sustainable environments. Overflowing Sink Digital C. Print, 2002 40" x 49" edition of 6 / 2 AP Carlos and Jason Sanchez
- 5. Health Improvement Logic Model Our Vision – Healthier Kansans living in safe and sustainable environments. Health Care Costs
- 6. Health Improvement Logic Model Our Vision – Healthier Kansans living in safe and sustainable environments. Health Care Costs Chronic Illness and Disease
- 7. Health Improvement Logic Model Our Vision – Healthier Kansans living in safe and sustainable environments. Health Care Costs Chronic Illness and Disease Chronic Illness and Disease Risk Factors
- 8. Health Improvement Logic Model Our Vision – Healthier Kansans living in safe and sustainable environments. Health Care Costs Chronic Illness and Disease Chronic Illness and Disease Risk Factors Behaviors
- 10. Sick Care System Cost Drivers Our Vision – Healthier Kansans living in safe and sustainable environments.
- 11. WHO - U.S. Health Outcomes (2001) Our Vision – Healthier Kansans living in safe and sustainable environments. OCED – (2001)
- 12. Health Improvement Logic Model Our Vision – Healthier Kansans living in safe and sustainable environments. Health Care Costs Chronic Illness & Disease 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.
- 13. Health Improvement Logic Model Our Vision – Healthier Kansans living in safe and sustainable environments. Health Care Costs Chronic Illness and Disease Chronic Illness and Disease Risk Factors Hypertension High Cholesterol Overweight/Obesity Poor Oral Hygiene Depression
- 14. Causes of Death United States, 2000 Our Vision – Healthier Kansans living in safe and sustainable environments. * 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 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) How Why
- 15. Health Improvement Logic Model Our Vision – Healthier Kansans living in safe and sustainable environments. Health Care Costs Chronic Illness and Disease Chronic Illness and Disease Risk Factors Behaviors Tobacco use and exposure Poor nutrition Physical Inactivity
- 16. Our Vision – Healthier Kansans living in safe and sustainable environments. Source: USDHEW, PHS, CDC. “Ten Leading Causes of Death in US 1975.” Atlanta, GA, Bureau of State Services, Health Analysis & Planning for Preventive Services, p 35, 1978
- 17. Our Vision – Healthier Kansans living in safe and sustainable environments. Source: Schroeder SA. N Engl J Med 2007;357:1221-1228
- 19. Problem Definition Our Vision – Healthier Kansans living in safe and sustainable environments. Overflowing Sink Digital C. Print, 2002 40" x 49" edition of 6 / 2 AP Carlos and Jason Sanchez
- 20. Our Vision – Healthier Kansans living in safe and sustainable environments.
- 21. Our Vision – Healthier Kansans living in safe and sustainable environments.
- 22. Our Vision – Healthier Kansans living in safe and sustainable environments.
- 24. Our Vision – Healthier Kansans living in safe and sustainable environments. behaviors
- 27. Healthy Kansas Our Vision – Healthier Kansans living in safe and sustainable environments. Healthy People 2010—Physical Activity
- 28. Healthy Kansas Our Vision – Healthier Kansans living in safe and sustainable environments. Healthy People 2010—Nutrition
- 29. Our Vision – Healthier Kansans living in safe and sustainable environments. Source: Jones et al., Arch Intern Medicine, 1998; Vol 2436 Rx – Wellness
- 31. “ Working together we can create a 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 remain a humane and caring society.” Larry D. Jecha, M.D., M.P.H. Former Director/Health Officer Wichita-Sedgwick County Department of Health 1997
- 32. BMI and Cardiovascular Disease Mortality Risk Relative Risk of Death Body Mass index <18.5 Men Women 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
- 33. BMI and Risk of Type 2 Diabetes Age-Adjusted Relative Risk Body Mass index (kg/m 2 ) Men Women 1.0 2.9 1.0 4.3 1.0 5.0 1.5 8.1 2.2 15.8 4.4 27.6 40.3 54.0 93.2 6.7 11.6 21.3 42.1 Chan J et al. Diabetes Care 1994;17:961. Colditz G et al. Ann Intern Med 1995;122:481. <22 <23 23 - 23.9 24 - 24.9 25 - 26.9 27 - 28.9 29 - 30.9 31 - 32.9 33 - 34.9 35+
- 34. Citations 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
- 37. 1999 Obesity Trends* Among U.S. Adults BRFSS, 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%
- 38. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
- 39. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
- 40. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
- 41. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
- 42. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
- 43. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
- 44. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
- 45. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
- 46. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
- 47. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
- 48. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
- 49. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
- 50. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
- 51. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
- 52. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
- 53. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
- 54. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
- 55. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
- 56. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
- 57. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
- 58. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
- 59. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
- 60. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
- 61. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
- 62. Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI ≥30 kg/m 2 ) Diabetes CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics 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% 2008 2008
- 63. Obesity: Medical Complications Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Gall bladder disease Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Skin Gout Idiopathic intracranial hypertension Stroke Cataracts Coronary heart disease Diabetes Dyslipidemia Hypertension Severe pancreatitis Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Phlebitis venous stasis
- 70. 16 oz 32 oz 44 oz 52 oz 64 oz Dr. Stephen Aldana 48 Teaspoons Sugar
- 71. French Fries 20 Years Ago Today 210 Calories 2.4 ounces 610 Calories 6.9 ounces Dr. Stephen Aldana
- 92. Somewhere in Florida (?) Dr. Stephen Aldana
- 93. U.S. government’s entire budget for nutrition education is 1.12% of advertising budget for… Advertising Age, 2008 McDonalds
- 104. Programs, policies, and practices to shape the environment so that our default behavior is the healthy behavior.
- 105. Factors That Affect Health Our Vision – Healthy Kansans living in safe and sustainable environments
- 108. Our Vision – Healthier Kansans living in safe and sustainable environments. "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 02/21/2009
Notes de l'éditeur
- Sometimes to address problems you much change the context.
- Logic Model If we wish to address health care costs
- WE Smoking === atod === copd=== Alcohol use === intoxication ==== cirrhosis of the liver===
- Smoking === atod === copd=== Alcohol use === intoxication ==== cirrhosis of the liver===
- Smoking === atod === copd=== Alcohol use === intoxication ==== cirrhosis of the liver===
- Smoking === atod === copd=== Alcohol use === intoxication ==== cirrhosis of the liver===
- Thorpe
- Smoking === atod === copd=== Alcohol use === intoxication ==== cirrhosis of the liver===
- Smoking === atod === copd=== Alcohol use === intoxication ==== cirrhosis of the liver===
- Tobacco kills 400K Americans each year. More Americans lost in all of WWII. Poor nutrition / lack of exercise accounts for another 300K
- Smoking === atod === copd=== Alcohol use === intoxication ==== cirrhosis of the liver===
- 73% of the factors that determine our health status are related to how we live and the environment in which we live.
- 73% of the factors that determine our health status are related to how we live and the environment in which we live.
- Sometimes to address problems you much change the context.
- How important is prevention? If you are a 50-year-old baby boomer, male, though data is not that dissimilar for women, and you are a non-smoker, you are normal weight and you are active, by age 65, 11 percent of you will have had coronary heart disease, stroke, or diabetes. If, at age 50, you are a smoker, you are heavy and you are inactive, 58 percent of you, by age 65, will have one of those three conditions. A 500 percent difference. If we had a drug, a single drug, that, when taken, would lower the risk of heart disease, stroke and diabetes by 500 percent, everyone would be on it. We are not going to get there by what we do in our clinical care system. We are only going to get there with what we can do in public health. This is where we are right now. The baby boom wave is in their early to mid 50s, the beginning edge of it. We have this time to change things before they turn age 65.
- NEW Measure – 15-19%
- NEW MEASURE – 20%
- NEW MEASURE – 25%
- We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
- NEW MEASURE – 30% We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
- We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
- We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
- School stores, snack bars, and, of course, school vending machines.
- 106 schools serving 66,000 kids in 27 counties
- Most people think of the top of this pyramid as being the essence of public health work – there is a misperception that if we just tell people to be physically active, how to eat healthy, to not smoke, etc., then our work is done in public health. Similarly, we work hard to educate the public on the importance of screening and early diagnosis for cancer, high blood pressure, diabetes to help manage these diseases and avoid painful and costly complications from these diseases. We work to provide cessation for tobacco addictions and treatment for alcohol and other drugs. The reality is that the environments we live in are constantly pushing adults and children in the opposite direction! We teach good nutrition in schools and kids pass by a bank of candy bars in the vending machines on their way to the next class. Sure, if we could change the socioeconomic factors to assure that all Kansans have equal access to health care, equally safe neighborhoods to be active in, grocery stores within walking distance, communities where active transit is the norm, etc., our public health challenges would diminish considerably. Knowing that we don’t have the ability to instantly change the socioeconomic factors that influence health, we have to look at where we CAN make a difference – changing the context in which people make decisions – to make the healthy choice, the easy choice.