7/12/2011

1

Seizing the Moment and the Momentum to

Improve Population Health

Luci Longoria, MPH, Community Programs Lead

Health Promotion and Chronic Disease Prevention

New Coordinator Orientation Meeting

July 26, 2011

Today We Will Talk About

• What risk factors are causing premature death and disease and how are they doing it?

• What can we do?

• Overview of policy and effective public health action strategies

Leading Causes of Death in Oregon, 2005

0% 5% 10% 15% 20% 25% 30%

Pneumonia/influenza

Alzheimer's disease

Diabetes

Unintentional injuries

Chronic lower respiratory disease

Stroke

Cancer

Heart Disease

Percentage (of all deaths)

Source : National Center for Health Statistics

Oregon adults (18 to 24 years old) who have at least one chronic

disease (arthritis, asthma, diabetes, heart attack, angina or stroke)

or hypertension or high cholesterol

55%

Disparities and Chronic Diseases

0

10

20

30

40

50

Per

cent

of

Adu

lts

Arthritis

Asthma

Heart Attack

Heart Disease

Stroke

Diabetes

Source : BRFFS, 2004-2005

Non-LatinoAfrican

Americans

American IndiansAnd Alaska

Natives

Asians andPacific

Islanders

Latinos Non-LatinoWhites

EconomicallyDisadvantaged*

* Household income <= 100% of Federal Poverty Level or not completed high school

Cost of Treating Chronic Diseases

• Overall 75¢ of every dollar

• Medicare96¢ of every dollar

• Medicaid83¢ of every dollar

(includes asthma, arthritis, cancer, heart disease, stroke, diabetes, and COPD)

Source : Partnership to Fight Chronic Disease at http://www.fightchronicdisease.org/issues/about.cfm ; An Unhealthy Truth

7/12/2011

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What’s Really Killing Oregonians

0 1000 2000 3000 4000 5000 6000 7000 8000

Illicit Use of Drugs

Sexual behavior

Firearms

Motor Vehicles

Microbial Agents

Toxic Agents

Alcohol

Diet/Activity Patterns

Tobacco

* Includes alcohol-related crashes

Source : CD Summary, May 17, 2005, Vol. 54, No. 10

Up to 39% of the 30,813

deaths were attributable to behavioral causes

Disparities and Smoking (2004-2005)

Source : BRFSS, 2004-2005

0

10

20

30

40

Per

cent

of A

dul

ts

Non-LatinoAfrican

Americans

American IndiansAnd Alaska

Natives

Asians andPacific

Islanders

Latinos Non-LatinoWhites

EconomicallyDisadvantaged

There’s a health crisis in the USObesity & Chronic diseases: we eat…

There’s a health crisis in the USObesity & Chronic diseases: we’re inactive

Current Community Conditions

Often do not foster or encourage walking or biking

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13

Something Can Be Done

LargestImpact

SmallestImpact

Health Impact Pyramid: Factors that Affect HealthExamples

Your doctor tells you to eat healthy, and be physically active

Rx for high blood pressure, high cholesterol, diabetes

Poverty, education, housing, inequality

Cessation treatment, evidence-based self-management, colonoscopy

0g trans fat, smoke-free laws, tobacco tax

Socioeconomic Factors

Changing the Contextto make individuals’ default

decisions healthy

Long-lasting Protective Interventions

ClinicalInterventions

Counseling & Education

Frieden, TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J of Public Health., 2010

CDC Focus:

Policy, systems, environmental change(“changing the context”)

•Change the environment to make healthy choices the default value

•Be scalable to regional, state, and national levels

•Have a solid evidence base

•Be measurable to ensure progress is made

CDC’s Recommendations for Communities

• Smoke-free policies

• Taxation

• Hard-hitting counter-marketing

• Proactive earned media

• Marketing restrictions

• Surveillance data

CDC’s recommended core package for tobacco control in communities

Prevention is the best buy for healthier communities

• Prevention in community policy increases health value from health dollars

• Prevention can reduce per capita annual costs

• Health reform recognizes importance of prevention

• Coverage for preventive care

• Prevention funding

• Support for public health infrastructure

7/12/2011

4

HPCDP Framework based on:

� Socio-Ecological Model

� HPCDP Programs’ Best Practices

� HPCDP Vision and Mission

� Urgency and opportunity

PUBLIC POLICY

COMMUNITY

ORGANIZATIONAL

INTERPERSONAL

knowledge,attitudes, skills

INDIVIDUAL

Socio-Ecological Model

Oregon’s Tobacco Prevention and Education Program Works

85.8

82.1

77.4

73.771.7

67.965.1

63.361.1

58.9

55.552.6

84.2

79.9

72.0

68.666.6

60.9

55.253.2

54.7 55.5

50.448.4

93.1

90.689.5

87.7 86.9

98.796.6

94.6 94.3

89.5

20

30

40

50

60

70

80

90

100

FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09

Fiscal Year

Pac

ks p

er c

apita

US

Oregon

Oregon Tobacco Prevention

Program cut over 50%

Oregon Tobacco Prevention

Program started

Oregon Tobacco Prevention

Program funding reinstated

Looking towards the future…

7/12/2011

5

“We know how to end the epidemic. Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking rates, tobacco-related deaths, and diseases caused by smoking.”

CDC Best Practices for Comprehensive Tobacco Control Programs, 2007

Healthy Communities, Healthy Living:A National Movement