Transcript Creutzfeldt-Jakob Disease

Prevention Agenda 2013-2017:
New York State’s Health Improvement
Plan
Vision and Proposed Public Health
Priorities
Gus Birkhead, MD, MPH
New York State Department of Health
Presentation to the
New York State Public Health Association Annual Meeting
April 19, 2012
Presentation Outline
•
•
•
•
•
•
•
•
Vision
Scope
Goals
Context for Health Improvement Efforts
Cross Cutting Principles
Criteria to Select Priorities
Existing Prevention Agenda Priorities
Proposed New Priorities
2
Vision
New York is the Healthiest State
3
Context: The Public Health System
Adapted from : The Future of the Public’s Health in the 21st Century. IOM 2003
Goals
1.
Improve the health status of all New Yorkers
across selected public health priority areas and
close racial, ethnic, socio-economic and other
health disparities including those among
persons with disabilities in those areas.
5
Goals
2. Advance a “Health in All Policies” approach in
New York State
that addresses the broader determinants of health
by increasing awareness and action for health
outside the traditional health sector.
3. Strengthen governmental and non-governmental
public health infrastructure
at state and local levels.
6
Goals
4. Create and strengthen sustainable public-private
and multi-sector partnerships
that align policies and investments with public health
improvement goals at all levels.
5. Further strengthen and promote the case for
investment in prevention and public health
as a way to both control health care costs and
increase economic productivity by increasing the
health of individuals and communities.
7
Context
•
•
•
•
•
Progress on the Prevention Agenda 2008-12
New York State’s Health Status
Health Care Reform: National and State
Funding Environment for Public Health
How Health Improvement is Produced
8
Context: New
York Profile
Prevention Agenda 2008-2012
• Progress on Local Community Collaboration
• Progress on Key Health Indicators, including
diversity and disparities
http://www.health.ny.gov/prevention/prevention_agenda/health_improvem
ent_plan/docs/progress_to_date_prevention_agenda_color.pdf
• New York State’s Health Status
http://www.health.ny.gov/prevention/prevention_agenda/health_improvem
ent_plan/docs/population_and_general_health.pdf
9
County Health Department Priorities
Prevention Agenda, 2008-12
Prevention Agenda Priorities Selected by Counties
38
38
Number of Local Health Departments
40
35
35
35
31
31
• Chronic Disease
30
• Physical Activity
and Nutrition
25
• Access to health care
Access to Quality Health Care
Chronic Disease
Community Preparedness
Healthy Environment
20
Healthy Mothers, Babies, Children
Infectious Disease
15
12
12
Mental Health and Substance Abuse
13
Physical Activity and Nutrition
10
Tobacco Use
5
5
6
5
Unintentional Injury
2
0
*N=57
10
Hospital Priorities
Prevention Agenda, 2008-12
70%
Access to Quality Health
Care
Chronic Disease
% of CSPs with Selected Priority
62%
60%
50%
• Chronic Disease
50%
Community Preparedness
45%
• Access to health care
•
40%
32%
30%
•
0%
Tobacco
19%
18%
20%
10%
Physical Activity
and Nutrition
10%
6%
3%
6%
N* (number of CSPs submitted) = 132
* Multiple hospitals may have submitted one CSP
Healthy Environment
Healthy Mothers, Healthy
Babies, Healthy Children
Infectious Disease
Mental Health and
Substance Abuse
Physical Activity and
Nutrition
Tobacco Use
Unintentional Injury
11
LHD Progress on top five priorities
Prevention Agenda, 2010
12
Progress to Date:
2010 Status Of 51 Prevention
Agenda Indicators
• 35 Indicators improving
– 3 Indicators achieved target:
• Coronary Heart Disease Hospitalizations
• Newly Diagnosed HIV Case Rate
• Motor Vehicle Related Mortality
• 14 Indicators moving in the wrong direction
• 1 Indicator unchanged
• 1 Indicator no new data
• Disparities not improving
13
What is “Public Health”?
• Institute of Medicine (2003): The mission of
public health is to fulfill society’s interest in
assuring conditions in which people can lead
healthy lives.
• Three core functions:
• Assessment
• Policy Development
• Assurance
IOM. The Future of Public Health, 1988
Characteristics of a
Public Health Approach
• Prevention
• Population Health Perspective
• “Environmental” as opposed to individual
focus
• Interdisciplinary and intersectoral
• Community involvement
1. Access to Quality Health Care
Percentage Difference From Current Rate to PA Objective
Goal: Increase <|> Goal: Decrease
2. Tobacco Use
Percentage Difference From Current Rate to PA Objective
Goal: Increase <|> Goal: Decrease
17
3. Healthy Mothers, Babies & Children
Percentage Difference From Current Rate to PA Objective
Goal: Increase <|> Goal: Decrease
4. Physical Activity and Nutrition
Percentage Difference From Current Rate to PA Objective
Goal: Increase <|> Goal: Decrease
5. Unintentional Injury
Percentage Difference From Current Rate to PA Objective
Goal: Increase <|> Goal: Decrease
0.0% -- Met Prevention Agenda Objective
6. Healthy Environment
Percentage Difference From Current Rate to PA Objective
Goal: Increase <|> Goal: Decrease
7. Chronic Disease
Percentage Difference From Current Rate to PA Objective
Goal: Increase <|> Goal: Decrease
Met Prevention Agenda Objective
8. Infectious Disease
Percentage Difference From Current Rate to PA Objective
Goal: Increase <|> Goal: Decrease
Met Prevention Agenda Objective
9. Mental Health/ Substance Abuse
Percentage Difference From Current Rate to PA Objective
Goal: Increase <|> Goal: Decrease
Context: National
Health Care Reform
• Increased number of insured individuals,
• Expanded set of services: preventive services rated
as A or B by U.S. Preventive Services Task Force to
be provided without cost sharing,
• Improved coordination of care through Medical and
Health Homes and Accountable Care Organizations.
25
Context: State
Health Care Reform
• Increased support for preventive services and
community-based supportive services through
Medicaid Redesign Team proposals.
• Health Exchange for Value Based Purchasing.
• Improvements in Information Technology including
all payer data base and development of State Health
Information Network-NY.
26
Context: Shrinking
funding for public
health
• Federal grant reductions to NY in past 2 yrs:
– Preventive Health Services Block Grant
– Lead Poisoning
– HIV Prevention
• State Reductions in 2011-12
– Tobacco Control
– State Aid for optional programs operated by Local Health
Departments
• Local county reductions
27
Context:
How Health Improvement is Produced
Dahlgren G, Whitehead M. 1991. Policies and Strategies to Promote Social Equity in Health. Stockholm, Sweden: Institute for
Futures Studies.
28
Context: Framework for improving health
Frieden T., A Framework for Public Health Action: The Health Impact Pyramid.
American Journal of Public Health. 2010; 100(4): 590-595
29
Cross Cutting Principles
1. The broad determinants of health are an essential area for
intervention that can yield benefits for multiple health
issues.
2. The voice of the most affected communities must be part of
the improvement process at all stages.
3. The awareness and capacity for local communities to
actively address their health problems should be
strengthened.
30
Cross Cutting Principles
4. Infrastructure capacities (workforce, IT, data
availability, emergency preparedness,
convening partnerships) are uneven across the
governmental public health system and need
to be bolstered to yield improvements in all
target areas.
31
Cross Cutting Principles
5. Collaboration is critical across multiple domains
and at all levels: across agencies, between
state and local agencies, among counties and
cities and between public and private
organizations.
32
Cross Cutting Principles
6. The integration of public health and personal
health care systems (especially primary care)
across all settings and across the lifespan
should be strengthened.
7. Evidence-based strategies are best, but not
always available. Promising Practices and
Next Practices should also be acceptable
strategies for improvement.
33
Suggested Criteria to Consider in Selecting
Priority Actions
• Disease burden
• There are evidence-based
(or promising or “next
practice”) interventions
to prevent causes of the
health problem
• Feasibility (resources,
infrastructure)
• Health departments have
leverage to make change
• Can move the needle on
health disparities
• Can be monitored with
specific, quantifiable
measures
• Community/partner
support
34
Prevention Agenda 2008-2012
Priorities Areas
•
•
•
•
•
•
•
•
•
•
Access to Quality Health Care
Chronic Disease
Community Preparedness
Healthy Environment
Healthy Mothers, Healthy Babies, Healthy Children
Infectious Disease
Mental Health and Substance Abuse
Physical Activity and Nutrition
Tobacco Use
Unintentional Injury
35
Proposed Priority Areas
Prevent Chronic Diseases
Advance a Healthy Environment
Promote Healthy Mothers, Healthy Babies,
Healthy Children
Prevent Substance Abuse, Depression, and
other Mental Illness
Prevent HIV, STIs and Vaccine Preventable
Diseases
36
Proposed Priorities:
Prevent Chronic Diseases
Heart disease, cancer, respiratory disease, and
diabetes all share the risk factors of diet, exercise,
tobacco, alcohol and associated obesity
– Example Strategies: increase access to healthy foods
and active transit; decrease access to alcohol and
tobacco;
– Example Measures: obesity rates; tobacco use among
adults and youth; tobacco use among the Medicaid
population; diabetes prevalence; prevalence of heart
disease.
37
Proposed Priorities:
Advance a Healthy Environment
where people live, work, play and learn
– Example strategies: anti-idling ordinances; lead
remediation in housing; healthy community design;
education to prevent food-borne disease; school-based
violence prevention; healthy homes.
– Example measures: asthma hospitalization rate, homicide
rate by race/ethnicity; outdoor air quality; falls-related
hospitalizations.
38
Proposed Priorities:
Promote Healthy Mothers, Healthy
Babies, Healthy Children
– Example strategies: increase access to reproductive health
services and prenatal care; promote breastfeeding friendly
hospitals; support water fluoridation; ensure sex education
in schools.
– Example measures: teen pregnancy rate; maternal
mortality; low birthweight; prenatal care by race/ethnicity;
percent of 3rd grade children with untreated tooth decay;
prevalence of breastfeeding among WIC mothers.
39
Proposed Priorities:
Prevent Substance Abuse, Depression,
and other Mental Illness
– Example strategies: reduce alcohol access to
youth; promote responsible prescribing practices
for opioids; increase depression screening and
referrals in primary care and other health care
settings.
– Example measures: percent reporting poor mental
health status 14+ days/month; hospitalizations
due to drug overdoses; suicide rate.
40
Proposed Priorities:
Prevent HIV, STIs and VaccinePreventable Diseases
– Example strategies: test and treat policies; drug
treatment referrals; increasing community
demand for vaccines; promote safer sex practices.
– Example measures: new case rates, newly
diagnosed HIV case rate by race/ethnicity,
immunization rates.
41
Please Provide Feedback
• To provide feedback on Prevention Agenda 2008-12
and proposed priorities for Prevention Agenda 2013,
please contact a member of the Ad Hoc Committee
to Lead the State Health Improvement Plan at:
[email protected]
• For more information on the Prevention Agenda,
visit:
www.health.ny.gov/PreventionAgenda2013
42
Tobacco Use
Percentage Change From Baseline to Current
Indicators with Improvement
• % Cigarette Smoking in Adolescents (-22.7%)*
• % Smoking in Adults (-14.8%)
• Lung Cancer Incidence: Male (-8.5%)
Indicators Moving in the Wrong Direction
• COPD Hospitalizations among Adults (+3.8%)
• Lung Cancer Incidence: Female (+2.8%)
*Meets HP2020 Target
Estimated Number of Deaths Due to Modifiable Behaviors,
New York State, 2009
30,000
46% of all deaths are attributed to these
eight modifiable behaviors
26,222
25,000
22,021
20,000
15,000
10,000
5,071
5,000
4,521
3,315
2,592
1,748
1,206
Incidents
involving
firearms
Unsafe sexual
behaviors
0
Tobacco
Poor diet and
Alcohol
physical
Consumption
inactivity
Microbial
agents
Toxic agents Motor vehicle
crashes
Estimates were extrapolated using the results published in "Actual Causes of Death in the United States, 2000", JAMA, March 2004,
45
291 (10) and NYS 2009 death data
Percentage of Adults Who are Current Smokers,
New York State and U.S., 2001-2010
HP2020: 12%
46
Source: Behavioral Risk Factor Surveillance
A
Age-adjusted Percentage of Adults 18 Years and Older Who Were
Current Smokers by Race/Ethnicity, New York State, 2001-2009
30
25
20
15
HP2020: 12%
10
5
0
2001-2003
2002-2004
White non-Hispanic
Source: BRFSS
2003-2005
2004-2006
Black non-Hispanic
2005-2007
2006-2008
Asian non-Hispanic
2007-2009
Hispanic
Total
47