Transcript 2nd Annual Forum on Kansas Environmental Issues September

Healthy Kansas:
An Opportunity to Transform the Health of Kansas
Roderick L. Bremby, Secretary
Kansas Department of Health and Environment
United Methodist Health Ministry Healthy Congregations Retreat
April 13, 2007
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Greetings
Gov. Kathleen Sebelius
Healthy Kansas
An opportunity to expand the focus
of current reform strategies
through transformative policy making and
shifting and broadening the discourse on health reform.
Healthy Kansas
3 Core Premises
1. Goal - Optimal Health Status
2. Health Status – a function of multiple determinants
3. The Life Course Matters – risk and protective factors
early in life affect health status later in life
Move from a sick care system to a health system that
provides vertical, horizontal, and longitudinal integration
Healthy Kansas –
Premise 1: Optimal Health Status is the Goal
Current discussion focus: cost, access, and quality.
Cost
-
1980 - $253.9B
or $ 1,102 per person > 9.1% GDP
1990 - $714.0B
or $ 2,813 per person > 12.4% GDP
2000 - $
1.35T
or $ 4,790 per person > 13.8% GDP
2005 - $
1.98T
or $ 6,697 per person > 16.2% GDP
2015 - $
4.04T
or $12,357 per person > 20.0% GDP (projected)
Access -
uninsured US:46.6 million (15.9%) / KS:300,000 (10.9%)
Quality -
44-98K deaths annually from medical intervention –
1999 IOM – To Err is Human
CMS
Healthy Kansans 2010
Healthy Kansas
“The fact is that we don’t face an immediate crisis
and so people say, What’s the problem ? The
answer is we suffer from a fiscal cancer…and if
we do not treat it, it could have catastrophic
consequences for our country”.
U.S. Comptroller General David Walker
3/1/07
Healthy Kansas –
Premise 1: Optimal Health Status is the Goal
Current discussion focus: cost, access, and quality.
Cost
-
1980 - $253.9B or $ 1,102 per person > 9.1% GDP
1990 - $714.0B or $ 2,813 per person > 12.4% GDP
2000 - $
1.35T
or $ 4,790 per person > 13.8% GDP
2005 - $
1.98T
or $ 6,697 per person > 16.2% GDP
2015 - $
4.04T
or $12,357 per person > 20.0% GDP (projected)
Access -
uninsured US:46.6 million (15.9%) / KS:300,000 (10.9%)
Quality -
44-98K deaths annually from medical intervention –
1999 IOM – To Err is Human
What accounts for growth in
health care spending ?
Healthy Kansas
Premise 1: Optimal Health Status is the Goal
US Health Status (W.H.O.) –
•
49th out of 50 industrialized nations
•
U.S. infant mortality – 29th
•
U.S. life expectancy – 25th
Healthy Kansas
Premise 2: Health Status results from many factors
1. Goal - Optimal Health Status
2. Health Status – a function of multiple determinants
3. The Life Course Matters – risk and protective factors
early in life affect health status later in life
Healthy Kansas –
Premise 2: Health Status results from many factors
•
Heath Care Services
•
Public Health
•
Population Health (individual and population levels)
•
Social Determinants
–
Education
–
Built environment
–
Natural environment
–
Social capital
Health Factors
Genetic
Make-Up
17%
Medical
Care
10%
How We
Live Behavior
51%
Environment
22%
Source: USDHEW, PHS, CDC. “Ten Leading Causes of Death in US 1975.”
Atlanta, GA, Bureau of State Services, Health Analysis & Planning
for Preventive Services, p 35, 1978
Healthy Kansas –
Premise 3: Role of Life Course Development
1. Goal - Optimal Health Status
2. Health Status – a function of multiple determinants
3. The Life Course Matters – risk and protective factors
early in life affect health status later in life
Healthy Kansas
Premise 3: Role of Life Course Development
Source: Mark A. Peterson, PhD. UCLA Blue Sky Team
Causes of Death United States, 2000
Actual Causes of Death†
Leading Causes of Death*
Heart Disease
Tobacco
Cancer
Poor diet/lack of exercise
Stroke
Alcohol
Chronic lower
respiratory disease
Infectious agents
Unintentional Injuries
Pollutants/toxins
Diabetes
Firearms
Pneumonia/influenza
Sexual behavior
Alzheimer’s disease
Motor vehicles
Kidney Disease
Illicit drug use
0
5
10
15
20
25
30
35
Percentage (of all deaths)
*
†
0
5
10
15
20
Percentage (of all deaths)
National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002
Adapted from McGinnis Foege, updated by Mokdad et. al.
Predicted Likelihood of Developing
Coronary Heart Disease, Diabetes
or Stroke by Age 65
70%
58%
60%
Percent
50%
40%
30%
20%
11%
10%
0%
Non Smoker, Normal
Weight, Active
Smoker, Heavy,
Inactive
Source: Jones et al. Archives of Internal Medicine 2002;162:2565–71
Healthy Kansas
The Evolving Health System
• The First Era (Established the “operating system”)
•Focus on acute and infectious disease
•Medical care silo
•Insurance-based financing
• The Second Era (Operating System “patch”)
•Focus on chronic disease
•Increased technology ->increased costs
• The Third Era (Requires Policy to Replace Operating
System
• Focus on optimal health status and multiple forms
of integration
Source: Mark A. Peterson, PhD. UCLA Blue Sky Team
Healthy Kansas
The Evolving Health System
“I get no money to prevent an amputation. I
would get a whole bunch of money to perform
an amputation.”
Dr. Anne Peters, endocrinologist
Los Angeles Times, 2/26/07
Healthy Kansas
The Evolving Health System
The U.S. and 29 other developed nations
on average spend 2.8% of their health
care budgets on preventive care.
Organization for Economic Co-operation and Development - 2004
Source: Mark A. Peterson, PhD. UCLA Blue Sky Team
Source: Mark A. Peterson, PhD. UCLA Blue Sky Team
Source: Mark A. Peterson, PhD. UCLA Blue Sky Team
Healthy Kansas
4 parallel layers of health transformation needed:
Individual Change
Cultural Change
Institutional/Provider Change
Science Changes Everything
Source: Center for Health Transformation
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
A roadmap for health promotion and wellness, incorporating
community coalition building and private sector partnerships.
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Improving our Health
Many chronic diseases and illnesses
can be attributed to three modifiable
behaviors:
Tobacco use
Lack of physical activity
Poor nutrition
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Causes of Death United States, 2000
Actual Causes of Death†
Leading Causes of Death*
Heart Disease
Tobacco
Cancer
Poor diet/lack of exercise
Stroke
Alcohol
Chronic lower
respiratory disease
Infectious agents
Unintentional Injuries
Pollutants/toxins
Diabetes
Firearms
Pneumonia/influenza
Sexual behavior
Alzheimer’s disease
Motor vehicles
Kidney Disease
Illicit drug use
0
5
10
15
20
25
30
35
Percentage (of all deaths)
*
†
0
5
10
15
20
Percentage (of all deaths)
National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002
Adapted from McGinnis Foege, updated by Mokdad et. al.
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas
• Prevention Focus
– Tobacco Use
– Physical Inactivity (obesity)
– Poor Nutrition (obesity)
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Improving our Health
A third of all U.S. deaths are attributable to three
modifiable health-damaging behaviors:
– tobacco use – 440,000/yr
– lack of physical activity
– poor nutrition
365,000/yr
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas
Prevention focus -
• Tobacco use
• Physical inactivity (obesity)
• Poor nutrition (obesity)
$724M/yr
$657M/yr
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas
Chronic Disease Burden
– 81% of total health care
expenditures
– KS Diabetes - $1.3B/yr and growing
– New cases of diabetes can be
reduced by 60% with modest
increases in physical activity and
weight loss
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas
Healthy People 2010—Tobacco Use
Reduce cigarette
smoking by adults
Reduce cigarette
smoking by teens
0%
5%
10%
Kansas Rate
15%
20%
HP 2010 Goals
25%
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas
Healthy People 2010—Physical Activity
% adults doing
moderate activity (30
mins/day)
% teens doing
vigorous activity
(3x/week, 20
mins/event)
0%
20%
40%
Kansas Rate
60%
80%
HP 2010 Goal
100%
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas
Healthy People 2010—Nutrition
% Kansans age 2 and
up eating 3+
vegetable servings
daily (incl. 1+ serving
of dark green/yellow)
% Kansans age 2 and
up eating 2+ fruit
servings daily
0%
20%
40%
60%
Kansas Rate HP 2010 Goal
80%
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas
Placed Based Strategy • Children in schools
• Adults in the workplace
• Kansas seniors in community
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas –
Children in Schools
• Coordinated School Health Initiative
Infrastructure – >52 Districts, 224 Schools,
80,000 students
– Voluntary Body Mass Index (BMI) Testing
– Child Health Advisory Committee
– School Nutrition and Physical Activity
Committees
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas –
Seniors in the Community
– With Dept. on Aging (KDOA), provide
TA for local wellness programs for
seniors
– KDOA STEPS Program (Seniors
Together Enjoy Physical Success)
– Expansion of Senior Farmer’s Market
– Encourage community gardens
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas
• Media Campaign – partner with KHF
• Reactivate Governor’s Council on Physical
Fitness
• Governor’s/Secretary’s Awards
– Fitness Awards (youth focus)
– Local Community Health Heroes
– Healthy Community Designations
– Healthy School Designations
– Model Workplace Wellness Sites
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas - Pledge
• Increase activity level
• Eat healthy
• Avoid tobacco
YR 1: 6,000 Kansans
CheckUp
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
Healthy Kansas
Challenges to System Transformation
•
Requires suspension of existing beliefs
•
Final solution still unknown
•
Timeline inconsistent with policy agenda event horizon
•
Multiple layers of institutional structures need change
•
Requires convergence from the (liberal-conservative) extremes
•
Lack of stated agreement on the goal and principles
Healthy Kansas
An Opportunity to Transform the Health of Kansas
Q. – How do we improve the health of Kansans ?
First 2 Steps Begin with the end in mind.
First things first.
- Steven Covey
United Methodist Health Fund Ministry
Healthy Kansans 2010
6th Annual Healthy Congregations Retreat
www.healthykansas.org