Forum for

Connecting Health Care to Healthy Choices

#hbc13

Behavior Change: A Total Health ImperativeRAYMOND J. BAXTER, PHDSenior Vice President, Community Benefit, Research and Health Policy, Kaiser Permanente

What Is This?

Environmentaland Social

Factors20%

Family History and Genetics

30%

Personal Behaviors 40%

Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993

Health is driven by multiple factors that are intricately linked – of which medical care is one component.

Medical Care

10%

Drivers of Health

Health is About More Than Access to Care

Actual Causes of Death in the U.S. in 1990 and 2000

*Data are from McGinnis and Foege. Percentages are for all deaths.

Actual CauseNumber (and %)

1990*Number (and %)

2000

Tobacco 400,000 (19%) 435,000 (18.1%)

Poor diet and physical inactivity 300,000 (14%) 400,000 (16.6%)

Alcohol consumption 100,000 (5%) 85,000 (3.5%)

Microbial agents 90,000 (4%) 75,000 (3.1%)

Toxic agents 60,000 (3%) 55,000 (2.3%)

Motor vehicle 25,000 (1%) 43,000 (1.8%)

Firearms 35,000 (2%) 29,000 (1.2%)

Sexual behavior 30,000 (1%) 20,000 (0.8%)

Illicit drug use 20,000 (<1%) 17,000 (0/7%)

Total 1,060,000 (50%) 1,159.000 (48.2%)

Many Factors Shape Health

We Have to Disrupt Current Defaults

RISK FACTORS

Unhealthy Diet

Inactivity

Tobacco

Harmful use of Alcohol

Diabetes

Cardiovascular Disease

Cancer

Chronic Respiratory

Disease

Support Individuals Encourage Groups

Change Communities Track Outcomes

4 Diseases, 4 Risk Factors* 4 Kaiser Permanente Actions

*Aligns with World Health Organization’s framework for monitoring non-communicable diseases

An Integrated Approach to Diseases and Risk Factors

Deploying Kaiser Permanente Assets for Total Health

1Neighborhood /

Community

Society

Individual / Family

Home / School /Worksite

CommunityHealth

Initiatives

Environmental Stewardship

Clinical Prevention

Access to Social and Economic

Supports

Health Education

Public Education

WorksiteWellness

Public Policy

Research

Physical and Mental Health Care

Walking Promotion

Purchasing and Employment Practices

We Have to Deploy All Our Assets for Total Health

What We’re Up Against

What We’re Up Against

Susan Roberts, Wk Kellogg Foundation, 2005

What We’re Up Against

Pre-Diabetes, 2013: 852,031

Diabetes, 2013: 477,383$3.48 Billion/Year

Source: Kaiser Permanente Care Management Institute, Pre-Diabetes Cohort Data, 2013. Projected cohort costs estimated based on average annual medical expenditures from Vojta et al, Hlth Aff, Jan 2012.

If we do nothing, more than half will become diabetic by 2023,

adding $3.2 billion/year in costs

Failure to Act Is Not an Option

Help me build self-efficacy and leverage my habits to make sustained behavior

change.

BOOST ME

CONNECT ME

CELEBRATE ME

Celebrate and reinforcemy ongoing successes.

ENGAGE ME

Get me started onmy journey to better health.

OUTSIDE

INFLUENCES

• Programs and policies• Social and economic factors• Physical environments• Family, community and

social networks

NEIGHBORHOOD

DIGITAL

CLINICAL

WORKPLACE

SCHOOL

HOME

Behavior Change Pathway

SIMPLIFY IT for

ME

Help me make easy, small changes that lead to bigger

success.

GUIDE ME

Advise, support,coach and help me

develop a shared plan.

KNOW ME

Know what change I want to make, my motivation and

what is important to me.

Idealized Behavior Change Navigation

Help me find my way by linking me to internal and

external resources, connecting with others.

13© 2013 Copyright, Kaiser Permanente, All rights reserved

DATA

Changing Norms and Behavior: Tobacco

Smoking prevalence among California adults, 1984-2010

Source: Behavioral Risk Factor Surveillance System (BRFSS) 1984-2010. The data are weighed to the 2000 California population. California Department of Public Health, California Tobacco Control Program, April 2011.

Changing Norms and Behavior: Auto Safety

Changing Norms and Behavior: Breastfeeding

Sources: 1970–1998, Ross Mothers Survey; 1999–2007, Centers for Disease Control and Prevention, National Immunization Survey.

Source: EPA, 2013

Changing Norms and Behavior: Waste

The Road Ahead is Challenging…But We Can Find a Way

Forum for

Connecting Health Care to Healthy Choices

#hbc13