making the healthy choice, the easy choice · 2014. 11. 17. · making the healthy choice, the easy...
TRANSCRIPT
Making the healthy choice, the easy choice: Tobacco control and obesity prevention in Philadelphia
Giridhar Mallya, MD, MSHP
Director of Policy and Planning
Philadelphia Department of Public Health
Schroeder S. We Can Do Better – Improving the Health of the American People. NELM;2007;357;1221-8.
Health and economic costs
in Philadelphia
Poor Diet and Physical Inactivity
~2,000 deaths per year
~$750 million in health care costs annually
Tobacco use
2,200 deaths per year
$660 million in productivity losses annually
Philadelphia Vital Statistics Report, 2010, Philadelphia Department of Public Health Obesity health care costs estimated from Finkelstein et al, Health Affairs, 2009
Health Impact Pyramid Examples
Eat healthy, be physically
active, have safe sex
Rx for acute and
chronic conditions
Poverty, education, housing, inequality
Immunizations, brief
intervention, cessation,
colonoscopy
Smoke-free laws; counter-
advertising campaigns;
immunization mandates;
pollution emissions standards
Socioeconomic Factors
Changing the Context to make individuals’ default
decisions healthy
Long-lasting
Protective Interventions
Clinical
Interventions
Counseling
& Education
Largest
Impact
Smallest
Impact
Frieden T, AJPH 2009
Built environment
Workplaces
Media
Legislation and
regulation
Community retail
environment and
restaurants
Educational
institutions
Insurers and health
care providers
CDC support for Get Healthy Philly
Philadelphia Department of Public Health, School District of Philadelphia
• Communities Putting Prevention to Work − 2010-2012
• Community Transformation Grant
− 2011-2014
• Sodium Reduction in Communities Program − 2011-2014
• State &Local Public Health Actions to Prevent
Obesity, Diabetes, Heart Disease, & Stroke − 2014-2018
Schools – policy and systems change
Philadelphia Department of Public Health, School District of Philadelphia
134 129
89
48
5 0
20
40
60
80
100
120
140
160
School Wellness Council Interventions, 2010-2012 Number of Schools Selecting Wellness Goals
Healthy classroom rewards Healthy fundraisers
Socialized Recess Classroom movement breaks
Healthy school stores
• 1990s Universal feeding “pilot”
• 1999 Nutrition education for all SNAP- eligible children
• 2004 Comprehensive school nutrition policy
• 2009 1% milk and no fryers in school kitchens
• 2011 170 schools created Wellness Councils made up of teachers, principals, students, and parents
8
Institutional nutrition standards – City agencies hospitals
Built environment – smoke-free policies
• 12,000 acres of smoke-free parks, recreation centers, and playgrounds
• 5 Philadelphia universities with smoke-free policies
• Public housing agency with 80,000 residents pursuing a smoke-free policy
Leung R et al. Developing and Implementing a Smoke-Free Policy for Recreation Centers and Playgrounds in the City of Philadelphia. Preventing Chronic Disease. 2013;10:120294
Built environment –planning and zoning
• Encouraging the incorporation of fresh food markets into commercial and mixed-use developments by offering density bonuses that don’t count the square footage of those markets against the maximum buildable area (14-603(7))
• Requiring the provision of secure bicycle parking in developments above a certain size, and allowing the removal of 1 automobile space in exchange for the provision of 5 bicycle parking spaces (14-804)
• Conducting targeted health impact assessments of planning decisions
• Making specific land use and zoning recommendations as part of district plans
http://phila2035.org/home-page/communities/
Retail - Healthy Chinese take-out
restaurant initiative
• Over 400 take-out Chinese restaurants in Philadelphia, primarily in African American and Hispanic neighborhoods
• Partnered with Temple University Center for Asian Health, Asian Community Health Coalition, and Chinese Restaurant Association
• 200+ have been trained in low-sodium cooking methods
• Early analyses reveal a 30% reduction in sodium content of 2 popular dishes
– Chicken Lo Mein = 3,200 mg 2,300 mg
– Shrimp and Broccoli = 1,900 mg 1,235 mg
Ma, G. Temple University Center for Asian Health, 2013
Media – sugary drinks, smoking cessation, salt reduction physical activity
Insurers and health care providers – promoting and supporting quit attempts
• All Medicaid plans in Philadelphia provide coverage for 6 of the 7 FDA-approved smoking cessation medications
• Offering up to 8 weeks of free nicotine
replacement therapy via the Quitline (1-800-QUIT-NOW)
• Leading tobacco-related practice and culture transformation in the City’s behavioral health treatment system
Primary care learning collaboratives
Improve the quality of care for 350,000 patients in 43 practices by: • Increase electronic health record adoption and use
• Increase the institutionalization and monitoring of
quality measures
• Increase engagement of non-physician team members
• Increase self-measures blood pressure monitoring tied with clinical support
• Implement systems to identify those with undiagnosed hypertension
• Increase engagement of community health worker and pharmacists
Progress – adult smoking
Progress – youth smoking
Youth smoking prevalence, U.S. and Philadelphia
Progress – adult obesity
Progress – child obesity
Robbins et al, Preventing Chronic Disease, 2012 Accompanying editorial from RWJF, “Philadelphia Freedom”
5% decrease
8% decrease 7% decrease
Progress – youth obesity
Thank you!
www.phila.gov/gethealthyphilly www.foodfitphilly.org
www.smokefreephilly.org