Protecting the Public’s Health:Protecting the Public’s Health:Chronic Disease Prevention and ControlChronic Disease Prevention and Control

Janet Collins, Ph.D.Janet Collins, Ph.D.Director, National Center for Chronic Disease Prevention and Director, National Center for Chronic Disease Prevention and

Health PromotionHealth Promotion

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

Vision and MissionVision and Mission

Our VisionOur Vision

All people living healthy lives free from the devastation All people living healthy lives free from the devastation of chronic diseasesof chronic diseases

Our MissionOur MissionLeading efforts to promote health and well-being Leading efforts to promote health and well-being through prevention and control of chronic diseasesthrough prevention and control of chronic diseases

Chronic DiseasesChronic Diseases

Are responsible for 7 of every 10 U.S. deathsAre responsible for 7 of every 10 U.S. deaths11

Cause major limitations in daily living for 1 in 10 Cause major limitations in daily living for 1 in 10 AmericansAmericans22

Cause significant racial/ethnic disparities in healthCause significant racial/ethnic disparities in health22

Account for about 75% of $2.2 trillion annual U.S. medical Account for about 75% of $2.2 trillion annual U.S. medical care costscare costs33

1 Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: final data for 2005. National Vital Statistics Reports 2008;56(10). Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf

2 Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: final data for 2005. National Vital Statistics Reports 2008;56(10). Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf. And National Center for Health Statistics. Health, United States, 2007. With chartbook on trends in the health of Americans. Hyattsville, MD: National Center for Health Statistics; 2007. Available from: http://www.cdc.gov/nchs/data/hus/hus07.pdf

3 Anderson G. Chronic conditions: making the case for ongoing care. Baltimore, MD: John Hopkins University; 2004.

Life Expectancy vs. Health Care Spending

Per Capita Health Care Spending in International Dollars

Lif

e E

xpec

tan

cy

30

40

50

60

70

80

90

0 500

1000 2000 3000 4000 50001500 2500 3500 4500

Sierra Leone

United States

Japan

Cuba Switzerland

National Center for Health Statistics. Health, United States, 1998 With Socioeconomic Status and Health Chartbook. Hyattsville, Maryland: 1998.

Life Expectancies in the “Eight Americas”

Population GroupPopulation Group Per Capita Per Capita IncomeIncome

Life Life ExpectancyExpectancy

AsianAsian $21,600$21,600 84.984.9

Northland Rural WhiteNorthland Rural White $17,800$17,800 7979

White Middle AmericaWhite Middle America $24,600$24,600 77.977.9

Appalachia/Mississippi Valley WhiteAppalachia/Mississippi Valley White $16,400$16,400 7575

Black Middle AmericaBlack Middle America $15,400$15,400 72.972.9

Western Native AmericanWestern Native American $10,000$10,000 72.772.7

Southern Rural BlackSouthern Rural Black $10,500$10,500 71.171.1

High-risk Urban BlackHigh-risk Urban Black $14,800$14,800 7171

Source: C. Murray, S. Kulkarni, M. EzzatiSource: C. Murray, S. Kulkarni, M. Ezzati. Eight Americas: New Perspectives on U.S. Americas: New Perspectives on U.S. Health Disparities Health Disparities American Journal of Preventive Medicine 2006;American Journal of Preventive Medicine 2006; 29(5):4-10. 29(5):4-10.

2006 U.S. National Health Expenditures

31%

31%

8%

13%

7%

7%3%

Hospital Care

Physician/ProfessionalServicesNursing Home andhome healthPrescription drugs andmedical productsAdministration

Research andInvestmentGovernment publichealth (prevention)

An Aging PopulationPercentage of U.S. Population Age 65 and Older

Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population Copyright 1996, Watson Wyatt Worldwide.

0

5

10

15

20

25

1930 1950 1970 1990 2010 2030 2050

Year

Pe

rce

nta

ge

of

Po

pu

lati

on

Pe

rce

nta

ge

of

Po

pu

lati

on

1998 20061990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Prevalence of ObesityObesity Among U.S. Adults

Prevalence of DiabetesDiabetes Among U.S. Adults

1990 1996 2006

No Data <4% 4%–6% 6%–8% 8%–10% >10%

Source: CDC, Behavioral Risk Factor Surveillance System

“People didn’t just wake up in 1980 and decide they were going to get obese.” –

CDC’s Dr. William Dietz

Personal Behavior ChoicesPersonal Behavior Choices

A brisk walk in the park keeps Marcy in shape between dog shows. His owner, Columbus resident Cathy Stambo got up early to give her 3 year old Doberman his regular workout.

But, Something Can Be Done ….

Maintain health in the Maintain health in the first placefirst place

Living well with chronic Living well with chronic diseasedisease

Prevention

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,00019

60

1965

1970

1975

1980

1985

1990

1995

2000

Year

Per

Cap

ita C

igar

ette

Con

sum

ptio

n

U.S. Cigarette Consumption

Hospitalizations for Heart Attacks Before and Hospitalizations for Heart Attacks Before and After Smoking Ordinance — Pueblo, Colorado, After Smoking Ordinance — Pueblo, Colorado,

Jan 2002 - June 2006Jan 2002 - June 2006

0

50

100

150

200

250

300

City ofPueblo

PuebloCounty

El PasoCounty

Pre-implementation

Post-implementation

Rat

e p

er 1

00,0

00

CDC, MMWR, January 2, 2009 / Vol. 57 / No. 51

Intervention Area

Control Areas

Percentage of US Women (Age 40+) Having Had Percentage of US Women (Age 40+) Having Had a Mammogram Within the Past 2 Years by Statea Mammogram Within the Past 2 Years by State

Note: Estimates are weighted and are age-adjusted to the 2000 U.S. standard population. Source: Behavioral Risk Factor Surveillance System, CDC

19911995

2000 2006

60% -69.9%

<60%

70% -79.9%

80+%

D id notpartic ipatein the survey

Early Detection

Breast Cancer Death RatesBreast Cancer Death RatesAge-adjusted U.S. breast cancer mortality rate/100,000 women Age-adjusted U.S. breast cancer mortality rate/100,000 women

1992 to 20051992 to 2005

24

31.6

20

22

24

26

28

30

32

34

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

24% drop

Source: US Mortality Files, National Center for Health Statistics, CDC.

Living Well with Diabetes

Narayan et al.: Disease Control Priorities in Developing Countries, 2006

50-60% decrease

Vision Loss

Foot ulcers and amputations

Kidney failure,Vision loss

leads to

Eye exams

Foot exams lead to

lead to

45-85% decrease

20-50% decrease

lead toGlucosecontrol

Flu vaccine

lead to

lead to

Lipidcontrol

40% decrease

32% decrease

Hospitalization

Cardiovascular Disease

Control

Progress in Control: Diabetes Outcomes - 1995 to 2005

Vision Loss 25% Amputation 36% End Stage Renal Disease 23% CVD Hospitalization 16% Total Hospitalization 33%

www.cdc.gov/diabetes

National Center for Chronic Disease Prevention and Health Promotion

Office of PublicHealth Genomics

Division of Adult andCommunity Health

Division of Nutrition,Physical Activity,

and Obesity

Office onSmoking and Health

Division of CancerPrevention and Control

Division ofDiabetes

Translation

Division for Heart Disease and

Stroke Prevention

Division ofOral Health

Disease-Focused Divisions

Risk Factor Divisions

Division of Adolescent

and School Health

Division ofReproductive Health

Population/Setting Divisions

BRFSS/YRBS

PRAMS

Prevention Research Centers

School Health Policy and Program Survey

Schools

Communities

Worksites

Health Care Settings

Healthy Communities / REACH

Breast and Cervical Cancer Early Detection Program

WISEWOMAN

National Diabetes Education Program

National Center for Chronic Disease Prevention and Health Promotion

American Recovery and Reinvestment Act of 2009

Public Law 111-5

Prevention and Wellness Provisions

Section 317 immunization program - $300 million to CDC

Healthcare-associated infections - $50 million to HHS

Evidence-based clinical and community-based prevention and wellness strategies that deliver specific, measurable health outcomes that address chronic disease - $650 million to HHS

American Recovery and Reinvestment Act

““A historic commitment to A historic commitment to wellness wellness initiatives will keep millions of initiatives will keep millions of Americans from setting foot in Americans from setting foot in the doctor's office in the first the doctor's office in the first place – because these are place – because these are preventablepreventable diseases and we're diseases and we're going to invest in going to invest in preventionprevention.”.”– – President ObamaPresident Obama

February 21, 2009February 21, 2009

Comprehensive Health Reform

Health in all policies

Population/Community-based disease prevention and health promotion

Health care service and delivery improvement

Adapted from Finding the Voice of Public Health in National Health Reform Dialogue - An Integrative Model for Health System Transformation