we may be rough, and we have to be tough. healthier, longer lives
TRANSCRIPT
We may be rough, and we have to be tough
Healthier, Longer Lives
Healthiest State in Nation
Where Have We Been?
100 years ago, how many babies born
in Maine died before their 5th birthday?
1 in 5 , 1 in 8 before their 1st birthday
Where Have We Been?
Where Have We Been?
Today, how many babies born in Maine die before their 5th birthday?
1 in 800
Or, 1 in 1,000 not counting prematurity
Where Have We Been?
Aren’t these successes due to advances in health care and education of mothers?
What did Maine children diefrom 100 years ago?
1. Diarrhea
2. Vaccine-Preventable Infections: Influenza, Diphtheria, Pertussis, Meningitis, Measles, Tetanus, Polio, Smallpox
3. TB
4. Pneumonia
INFANT DEATHS PER 1,000 LIVE BIRTHSMaine, 1892-2007
0
20
40
60
80
100
120
140
1892 1897 1902 1907 1912 1917 1922 1927 1932 1937 1942 1947 1952 1957 1962 1967 1972 1977 1982 1987 1992 1997 2002 2007
YEAR
Where Have We Been?
Top Reasons for Infant MortalityDecline:
• Sanitary conditions during birth and perinatal period
• Safe drinking water
• Vaccines
Where Have We Been?
What were the top causes of death among adults 100 years ago in Maine?
Where Have We Been?
Tuberculosis Deaths per 100,000 Population Maine, 1892-2007
0
50
100
150
200
250
1892 1897 1902 1907 1912 1917 1922 1927 1932 1937 1942 1947 1952 1957 1962 1967 1972 1977 1982 1987 1992 1997 2002 2007
Year
Where Have We Been?
My Own Journey to Public Health
Shirati, Tanzania
Shirati Tanzania
Where Are We Now?
Chronic Diseases
• Leading causes of death and disability
• ~75% of Mainers will die from 1 of 4 diseases – CVD, Cancer, Diabetes, Chronic Lung Disease
• Mostly preventable – Tobacco and Obesity
• Direct health care costs = 40% of Maine’s Health Care Budget
Cardiovascular Disease
• #1 cause of death and disability
• 40% of all deaths
• 25% of all hospital costs
Cancer
• #2 cause of death
• 65% due to Tobacco or Obesity
• Most are curable if screened, detected, and treated early
Lung Cancer Deaths per 100,000 Population Maine, 1900-2007
0
10
20
30
40
50
60
70
80
1900 1905 1910 1915 1920 1925 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Rat
e p
er 1
00,0
00 P
op
ula
tio
n
1918-1936 data unavailable
Leading 4 Cancers That Kill Maine PeopleIncidence And Mortality Rates
Age-Adjusted Rate Per 100,000 Population
Maine 2001-2003
76.9
131.1
167.7
56.961.4
24.329.1
20.7
15
35
55
75
95
115
135
155
175
Lung Cancer (both sexes) Female Breast Cancer Prostate Cancer (males) Colorectal Cancer (bothsexes)
Incidence Mortality
Note: Mortality rates would be expected to decline only if incidence and/or percentage of late-stage disease declines (treatment advances have not recently been responsible for dramatic changes in survival.)
Diabetes
• 8% of adult Mainers now have diabetes; - 3% did 10 years ago.
• 11% of pregnant Maine women have diabetes; - less than 2% did 20 years ago.
Mainers with Diabetes1988-2007
42,355
38,179
42,211
37,927
34,11432,331
39,449
45,848
33,495
50,415
56,449
64,931
71,557
74,67376,683 77,219
72,667
82,709
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
No data available for
1992 and 1993
Lung Disease
• Asthma
• Emphysema, Chronic Obstructive Pulmonary Disease
Proportion of Adults With AsthmaMaine and U.S. - 2007
8.4%
10.3%
0%
5%
10%
15%
Maine U.S.
Proportion of Children With Asthma2004
11.6%
15.8%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Maine U.S.
Dental Disease
• 1 in 3 Mainers over age 65 have lost all their teeth
• 40% of Maine 3rd graders have tooth decay
• Highly associated with other chronic diseases
Mainers suffering from frequentmental distress are twicetwice as likely to:
• Have Diabetes
• Be Tobacco Addicted
• Have Asthma
What Are Two Big Factors Associated with Poor Health?Poverty
Racial Discrimination
What Are Effective What Are Effective Strategies?Strategies?
Tertiary Prevention Strategies – Treating Illness
Secondary Prevention Strategies – Reducing Risks
Primary Prevention Strategies – Preventing Risks
• State and Community Interventions
• Health Communication
• Surveillance and Evaluation
Primary Prevention Strategies
Statewide Intervention:
Tobacco Tax
1991 $0.37
1997 $0.74
2001 $1.00
2004 $2.00
Statewide Intervention:Laws Banning Smoking
1981 Public meetings
1983 Court houses
1985 Stores
1986 Most workplaces
1989 Hospitals, except psychiatric patients and hospitals
1999 Restaurants
2003 Bars
2005 All loopholes closed2007 School grounds2009? Public beaches, outdoor eating
Community Intervention - Healthy Maine Partnerships
• 28 Comprehensive Community Health Coalitions
• Cover all of Maine
• Funded with Tobacco Settlement andFederal Funds
• Tobacco, Obesity, Substance Abuse community interventions
Smoke Free Parks
City/Town ordinances for walkable communities
Food policies for organizations
X
Health Communication Goals
• Change culture
– Secondhand smoke
– Children watching TV
– Walking
– Portion Sizes
• Support community and statewide interventions
• Promote quitting Tobacco
Secondary Prevention
Motivate Tobacco Users to Quit
Improved TreatmentImproved Treatmentof Chronic Diseasesof Chronic Diseases
Tertiary PreventionTertiary Prevention
Care Model
• Decision Support
• Information Systems
• Self-Management Support
Decision Support & Information Systems- Diabetes
• Diabetes Registries
• Learning Collaboratives
Self-Management Support
• Diabetes Educators
• Diabetes Support Groups
Examples of SuccessExamples of Success
Coronary Heart Disease DeathsAge-Adjusted Rate Per 100,000 PopulationMaine And US Selected Years 1990-2004
177.4
129.9143.4
150.8160.9
169.7176.7
187.5199.7195.5
207.3212.1220.8
212.7
238.6242.4
192.7183.8
200.3205.0
211.4220.3
227.2232.0
240.1239.6247.5
257.2
100
120
140
160
180
200
220
240
260
280
300
1990 1992 1994 1996 1998 2000* 2002 2004
Maine Coronary Heart Disease Deaths US Coronary Heart Disease Deaths
* Indicates preliminary data
Note: Coronary Heart Disease = ICD-9 Codes 402, 410-414, 429.2; and for years 1999 and 2000, ICD-10/11, I20-I25.
166.0
Stroke DeathsAge-Adjusted Rate Per 100,000 Population
Maine And US 1990-2005
60.9
56.6
59.6
53.6
58.6 58.0 58.0
55.754.2
57.055.5 55.6
50.9
51.8
53.7
51.4
54.255.8
62.9
60.759.8
60.9 60.9 61.5 61.059.8
57.659.8
58.7
40
45
50
55
60
65
70
1990 1992 1994 1996 1998 2000* 2002 2004
Maine Stroke Deaths US Stroke Deaths
51.0
* Indicates preliminary data
Note: Stroke = ICD-9 Codes 430-438; and for years 1999 and 2000, ICD-10 I60-I69.
Overall Cancer Incidence RatesAge-Adjusted Rate Per 100,000 Population
Maine And US 1990-2003
490.7
500.8
474.3 471.6
498.2
515.1
474.2465.8
458.5
449.0456.3456.3
446.0
419.5
467.7
487.5495.1
487.7494.5492.0
487.9480.8480.1
486.8
496.9
517.3510.8
489.5
400
420
440
460
480
500
520
540
1990 1992 1994 1996 1998 2000 2002 HealthyMaine2010
Target
Cas
es P
er 1
00,0
00
All Cancers, Total Maine All Cancers, Total US
Source: Maine Department of Human Services, Bureau of Health, Maine Cancer Registry.SEER (Surveillance Epidemiology and End Results) - whites only, NCHS (National Center for Health Statistics) - for Maine and for US whites at http://wonder.cdc.gov; Age-adjusted rate per 100,000.
Slightly Lower
Incidence Rate
Overall Cancer DeathsAge-Adjusted Rate Per 100,000 Population
Maine And US 1990-2003
204.1
212.5207.5
213.9
226.3
234.5230.7
233.6
227.1 227.2
218.9 217.5
210.2214.4
188.3191.8
193.6196.3
210.4 210.6 209.2 209.2 207.8206.1
203.4199.9
197.6 197.8
180
190
200
210
220
230
240
250
1990 1992 1994 1996 1998 2000* 2002 HealthyMaine2010
Target
Maine Overall Cancer Deaths US Overall Cancer Deaths
*Note: Because 1999 data is coded according to ICD-10 Coding rules and 1990-1998 is coded using ICD-9 coding rules,
comparisons between 1998 and 1999 may not be accurate. Mortality rates would be expected to decline only if incidence
and/or percentage of late-stage disease declines (treatment advances have not recently been responsible for dramatic
changes in survival).
Slight
Decrease
in Mortality
Smoking Rates - High School Students Maine & US, 1993-2007
14
28.5
23
16.2
20.5
25
28.6
39.237.8
32.6
30.5
34.836
34.6
21.9
0
50
1993 1995 1997 1999 2001 2003 2005 2007
Per
cen
t
Maine High School Students
US High School Students
Smoking Rates - High School Students, Maine & US, 1993-2007Source: Maine Department of Education, Youth Risk Behavior Survey, 1993, 1995, 1997, 1999, 2001, 2003, 2005, 2007 1999 data is unw eighted .
64%
Drop!
Smoking Rates - Middle School Students Maine 1997-2007
21.0
7.5
5.7
8.79.9
0
25
1999 2001 2003 2005 2007
Per
cen
t
Smoking Rates, Middle School Students, Maine 1997-2007Source: Maine Department of Education, Youth Risk Behavior Survey, 1997, 2001, 2003, 2005, 2007
73%
Drop!
Cigarette Consumption - Packs Sold Per Capita Maine and US 1990-2006
60
70
80
90
100
110
120
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
Pac
ks p
er C
apit
a
Packs per capita Maine
Packs per capita US
Source: The Burden on Tobacco, Orzechowski and Walker
Maine Consumption of CigarettesPacks per Capita Sold
116.1114.5
108.5
101.6 102.3100 101.1
94.5
85.582.9
81.279.6
74.672.4 71.5
64.8
117.5
60
70
80
90
100
110
120
130
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
Nu
mb
er
of
packs s
old
per
cap
ita
**
** Excise Tax Increases
*
Maine Revenue Service, published in The Tax Burden On Tobacco, Orzechowski and Walker
Cigarette Smoking AdultsMaine And US 1990-2005
27.0%
26.1%
23.3%
24.7%
23.6%
25.0%25.3%
22.7%22.4%
23.3%23.8%
23.8%
23.2%22.0%
20.9% 20.6%
23.0%
23.1%
22.2%
22.6% 22.7%22.4%
23.4%
23.2%22.9%
22.6%23.2%
23.9%23.6% 23.7%
21.0%20.8%
15%
20%
25%
30%
1990 1992 1994 1996 1998Baseline
2000 2002 2004 HealthyMaine2010
Target
Maine Adults US Adults
19%
Where Are We Going?
Patient Centered Medical Home
Public Health Infrastructure
Existing players, newmodel for coordination
• 8 DHHS Districts
• Strengthened Local Health Officer system
• Some core public health functions carried out by Healthy Maine Partnerships
• 8 District Coordinating Councils (DCCs)
• District Public Health Units
• MCDC Office of Local Public Health
Goals of thePublic Health System:
• helping Maine become the healthiest state in the nation;
• readying and maintaining the state public health system for national federally-recognized public health accreditation;
• assuring the effectiveness, efficiencies, and evidence-based delivery of the essential public health services.
Healthy Communities
But the cause for which we fought was higher; our thought wider... That thought was our power.
- Joshua Chamberlain- Joshua Chamberlain
If facts are the seeds that later produce knowledge and wisdom, then the emotions and the impressions of the senses are the fertile soil in which the seeds must grow.
- Rachel CarsonRachel Carson