1. Integrating to Improve
Chronic Disease Outcomes
Prevention Services Division
CCPD Review Committee November 4, 2011
Jason Vahling, Director of the Healthy Living and Chronic Disease
Prevention Branch

2. Today’s Purpose
To describe:
• How integration supports achieving positive
health outcomes in Colorado
• Discuss the Chronic Disease Prevention
Planning Process

3. PSD shares responsibility with state and local
partners for improving health-related quality of life
for all Coloradans by preventing and postponing
chronic disease and its complications.
Purpose

4. • Comprehensive Cancer
• Diabetes
• Heart Disease and Stroke
• Oral Health
• Tobacco
• Obesity, physical activity and nutrition
• *Breast and cervical cancer screening
• *Colorectal cancer screening
• *Chronic disease self-management
Department’s CDC Chronic
Disease Initiatives

5. Continuum of ‘Working Together’
Cooperation Coordination,
Collaboration
Integration
Increasing trust, time, dependence, relinquishing turf

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40
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50
60
70
Monitor
Educate
Partnerships
Policy
Link
Workforce
Evaluate
percent
PSD State
National Public Health Performance Standards
Assessment - 2005

7. Integration
• Formal reorganization - Prevention Services
Division
• Consolidated all evaluation and epidemiology
functions into a new branch
• Due to funding from A35 (~$50M/yr), began
consolidating grants process
• Created informal teams on crosscutting issues,
including health disparities and training

8. Underlying principles
• Use a comprehensive, strategic, holistic approach
to achieve specific health outcomes
• Be data driven - what/where/who to focus on
• Move toward increased use of evidence-based
practices and programs

9. Underlying Principles
(cont’d.)
• Focus on heath disparities and social
determinants
• Be more accountable to demonstrating health
outcomes
• Maintain program-specific content experts

10. Why Integrate?
• Efficiency: To promote streamlined business
processes
• Effectiveness: Preventing and reducing chronic
disease is a complex problem requiring the efforts
of many different programs working together
• Elegance: Chronic disease programs are
designed to work at the intersection of many
different systems

11. A Chronic Disease System Dynamics Map
Smoking
Obesity
Secondhand
smoke
Healthiness
of diet
Extent of
physical activity
Psychosocial
stress
Diagnosis
and control
CV events &
lung cancers
Deaths
Access to and marketing
of smoking quit products
and services
Access to and
marketing of mental
health services
Sources of
stress
Access to healthy
food options
Marketing & educ’n
around healthy
food options
Access to physical
activity options
Marketing of physical
activity options
Access to and
marketing of weight
loss services
Access to and
Marketing of
primary care
Particulate air
pollution
Utilization of
quality primary
care
Tobacco
taxes
Sales/marketing
regulation
Smoking bans at work
and public places
Junk food taxes
Sales/marketing
regulations
Downward
trend in CV
event fatality
Quality of primary
care provision
Anti-smoking
social marketing
High BP
High
cholesterol
Diabetes
Morbidity
Screening for
chronic disease
Chronic disease
management
Oral diseases
Colorectal
cancers
Breast
cancers
COPD

12. What’s Common?
• Targeting same populations – low income,
racial/ethnic and medically underserved
• Working through the same “channels” –
communities, schools, health care providers,
worksites
• Working with many of the same partners
• Working with many people have multiple risk
factors

13. CDC Integration
Demonstration Project
• Offered potential to remove external barriers
• Provided visibility within Department
• Created external products and deadlines
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your program logo

14. How We Got Here
• Developed mission, vision and health
outcomes
• Conducted, coordinated strategic planning
• Submitted single work plans and reports
• Aligned and assigned resources for each goal
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your program logo

16. Health Outcomes
• Maintain prevalence of obesity among adults
• Increase prevalence of healthy weight - youth and
children
• Reduce prevalence of smoking - adults and youth
• Reduce secondhand smoke exposure
• Increase smoking cessation attempts
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your program logo

17. Health Outcomes (cont’d.)
• Increase prevalence of recommended physical activity
- adults, youth, children
• Increase fruit and vegetable consumption
• Increase screening and early detection – pap test,
colonoscopy, mammography, lipid testing, smoking
cessation, weight management
• Increase participation in chronic disease self-management

18. Policy and Environmental
Change Strategies
• Primarily tobacco use, physical activity
and nutrition initiatives
• Healthy communities
• Oral health
• Policy and legal analysis

19. Links with Healthcare Systems
and Practices Strategies
• Primarily cancer, diabetes, heart disease, stroke,
oral health and smoking cessation initiatives
• Focus on screening, disease self-management
and health systems change

20. Health Communications,
Health Equity and Evaluation
Strategies
• Centralizing cross-cutting functions to better serve all
initiatives
– Media relations, marketing, written communications
and communications technology
– Language services
– Social determinants of health
– Resource development
– Coordinated surveillance and evaluation

21. Fiscal and Operations
• Incoming grants management, contract services
and procurement, monitoring and fiscal support
• Coordinates outgoing grant programs, including
Amendment 35 (State tobacco tax)

22. Benefits of Integration
• Brings categorical programs together to improve
health outcomes
• Facilitates the strategic alignment of resources
to maximize mutual benefits and opportunities
• Increases the effectiveness and efficiency of
individual programs
• Protects the integrity of categorical program
objectives

23. Lessons Learned from
Integration
• Is a process, not a point in time event
• Focuses limited resources on most pressing
public health issues
• Provides more flexibility to respond to emerging
issues
• Elevates focus on key winnable battles
• Makes sense when approached by sector

24. Integration

25. Next Steps in PSD
• Integration in the Division and Department
• Winnable Battles
• Division Priorities

26. CDC Coordinated Chronic
Disease Program
• Senate 2011 budget:
– Proposed collapsing 5 chronic disease lines
into one grant program
• President’s Proposed FY 2012 budget:
– Puts 8 chronic disease lines into a grant
program

27. CDC Coordinated Chronic
Disease Program (cont’d.)
• Develop a state chronic disease plan &
establish a statewide coalition of partners

28. CDC’S EXPECTATIONS OF STATESCDC’S EXPECTATIONS OF STATES

29. QUESTIONS?

30. THANK YOU!
Jason Vahling
Branch Director
303-692-2578
Jason.vahling@state.co.us