Transcript 0412ACADEMYMENSAH (Hypertension, Organ Damage

Chronic Illness and Disease Prevention
George A. Mensah, M.D.
Acting Director, National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
1900-1999
• Vaccination
• Motor-vehicle safety
• Safer workplaces
• Control of infectious
diseases
Adapted from MMWR 1999;48(50):1141
1900-1999
• Decline in deaths from
heart disease & stroke
• Safer and healthier
foods
• Healthier mothers and
babies
Adapted from MMWR 1999;48(50):1141
1900-1999
• Family planning
• Fluoridation of
drinking water
• Recognition of
tobacco use as a
health hazard
Adapted from MMWR 1999;48(50):1141
Achievements in Public Health, 20th Century
900
Deaths per 100 000
800
Total cardiovascular diseases
700
600
Diseases of the heart
500
400
300
200
Coronary heart disease
Stroke
100
0
1900
1910
1920
1930
1940
1950 1960
Year
1970
1980
1990
Age-adjusted to the 2000 US population.; Sources: NHLBI, Morbidity and
Mortality Chart Book 2000 CDC, Health, United States 2001
2000
Measuring State Successes:
Improvements from 1990 to 2004
ME
Infectious Disease
SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004
62%
Measuring State Successes:
Improvements from 1990 to 2004
ME
Infectious Disease
62%
RI
Smoking
35%
SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004
Measuring State Successes:
Improvements from 1990 to 2004
ME
Infectious Disease
62%
RI
Smoking
35%
VT
Infant Mortality
53%
SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004
Measuring State Successes:
Improvements from 1990 to 2004
ME
Infectious Disease
62%
RI
Smoking
35%
VT
Infant Mortality
53%
PA
Infant Mortality
30%
SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004
Measuring State Successes:
Improvements from 1990 to 2004
ME
Infectious Disease
62%
RI
Smoking
35%
VT
Infant Mortality
53%
PA
Infant Mortality
30%
IA
Infant Mortality
39%
SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004
Measuring State Successes:
Improvements from 1990 to 2004
ME
Infectious Disease
62%
RI
Smoking
35%
VT
Infant Mortality
53%
PA
Infant Mortality
30%
IA
Infant Mortality
39%
LA
Children in Poverty
34%
SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004
Measuring State Successes:
Improvements from 1990 to 2004
ME
Infectious Disease
62%
RI
Smoking
35%
VT
Infant Mortality
53%
PA
Infant Mortality
30%
IA
Infant Mortality
39%
LA
Children in Poverty
34%
AK
Infectious Disease
83%
SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004
Measuring State Successes:
Improvements from 1990 to 2004
Maine
Infectious Disease
62%
Rhode Island
Smoking
35%
Vermont
Infant Mortality
53%
Pennsylvania
Infant Mortality
30%
Iowa
Infant Mortality
39%
Louisiana
Children in Poverty
34%
Alaska
Infectious Disease
83%
SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004
Definition of Public Health
Public Health:
Population-based
Health
Health Care vs. Public Health
Public Health:
Population-based
Health
“Health care is
vital to all of us
some of the
time, but
public health is
vital to all of us
all of the time.”
C. Everett Koop
Health Promotion and Chronic Disease Prevention
Public Health; New York City, 1895
Department of Health, City of New York
We Face an Epidemic of
Unparalleled Proportions
• More than 1.7 million Americans die of a
chronic disease each year
• One-third of the years of potential life lost
before age 65 is due to chronic disease
• Four chronic diseases—heart disease, cancer,
stroke, and diabetes—cause almost two-thirds
of all deaths each year
We Face an Epidemic of
Unparalleled Proportions
• Approximately 33% of all U.S. deaths
(about 700,000 deaths each year) can be
attributed to these three health-damaging
behaviors …
– tobacco use
– lack of physical activity
– poor eating habits
Sources:
Deaths: Preliminary Data for 2002. NVSR Volume 52, Number 13. 48pp. (PHS) 2004-1120. Centers for Disease
Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2003).
McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:2207-12.
Disability and Diminished Quality of Life
Chronic, disabling conditions cause major
limitations in activity for 1 of every 10 Americans
(30 million people)
Arthritis
• number one cause of disability
• affects nearly 1 of every 3 adults in the US
Stroke
• left 1 million Americans with disabilities
Diabetes
• leading cause of kidney failure in adults
• more than 60% leg and foot amputations are
among people with diabetes
Health Care Spending is on the Rise
Our nation spends more on health care
than any other country in the world
$245 billion
1980
an average of $1,066 per person
2001
$1.4 trillion
an average of $5,039 per person
2011
$2.8 trillion
an average of $9,216 per person
Chronic diseases account for 75% of the $1.4 trillion
we spend on health care
SOURCE: Heffler et al., Health Affairs., Health Spending Projections For 2001-2011: The Latest Outlook, March/April 2002.
Life Expectancy vs. Health Care Spending
90
Japan
80
Cuba
Life Expectancy
United States
70
60
50
40
Sierra Leone
30
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Per Capita Health Care Spending in International Dollars
5000
An Aging Population
Percentage of U.S. Population over Age 65
25
Percent
20
15
10
5
0
1930
1950
1970
1990
2010
2030
2050
Year
Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population.
Washington, DC: Watson Wyatt Worldwide, 1996
Estimated Per Capita Health Expenditures,
by Age and Sex, 1995
Dollars
18,000
16,000
Men
14,000
Women
12,000
10,000
8,000
6,000
4,000
2,000
0
Age in Years
Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population.
Washington, DC: Watson Wyatt Worldwide, 1996
Medicaid Expenditures
State
Alaska
FY 2003
actual
FY 2004
estimate
% of total
expenditures
786
638
8.4
Iowa
2,436
2,124
15.6
Louisiana
4,450
4,772
24.5
Maine
1,712
1,772
29.0
Pennsylvania
13,623
14,375
29.5
Rhode Island
1,450
1,568
25.5
691
795
27.5
Vermont
Source: National Association of State Budget Officers, 2003 State Expenditures Report
Predicted Likelihood of Developing Coronary Heart
Disease, Stroke, or Diabetes by Age 65
Men, Aged 50
Non Smoker
Normal Weight
Active
Smoker
Overweight
Inactive
Ratio
11%
58%
5.5
Source: Jones et al. Arch Intern Med
2002;162:2565–71
Disability Index,* by Age and Health Risk†
University of Pennsylvania Alumni
Disability Index
0.30
0.25
0.20
High risk
0.15
Moderate risk
0.10
Low risk
0.05
0.00
63 64
65 66 67 68 69 70 71 72 73 74 75 76 77 78
Age
* Progression of disability was postponed by approximately 7 years in low risk vs. high risk.
† Risk based on body mass index, smoking, exercise; 0-3 point scale for each; low = 0–2
points, moderate = 3–4 points, high = 5–9 points.
Note: A disability index of 0.1 = minimal disability.
Source: Vita et al. N Engl J Med 1998;338(15):1035–41
Adult per Capita Cigarette Consumption and
Major Environmental and Policy Changes in the
US 1900-1990
Fairness Doctrine messages
on radio and television
Thousands per year
5
4
First Medical reports
linking smoking and cancer
US Surgeon
General’s first
report
3
2
End of
WW II
1
Nonsmoker’s rights movement begins
Broadcast
advertising ban
Great Depression
Federal
cigarette
tax
doubles
0
1900
1910
1920
1930
1940
Year
1950
1960
1970
1980
1990
Admissions for Acute Myocardial Infarction During
6-Month Periods June–November Before, During,
and After the Smoke-free Ordinance
60
Helena
Admissions
50
Outside Helena
40
30
20
10
0
1998
1999
2000
2001
2002
Year
Source: Sargent RP et al. BMJ 2004.
2003
New York Centers of Excellence
• 39% reduction in lowerextremity amputation
• 35% reduction in
hospitalization for
persons with diabetes
Promising Practices in Chronic Disease Prevention and Control, DHHS, 2003
Return on Investment in Worksite
Health Promotion
• Citibank: in 1994, return on investment =
$4.56-$4.70 per dollar invested in the
program (Ozminkowski et al. AJHP Jan/Feb 1999)
• Johnson & Johnson: reduction of medical
care costs of $224.66 per employee per
year (Ozminkowski RJ et al. Environ Med 2002; 44:21-29)
• 13 health promotion programs reported
cost benefits ratios suggest improved
financial outcomes (Aldana AJHP May/June 2001)
Cigarette Use:
40% middle school students
18% high school students
The addition
of walking
trails can
promote
physical
activity,
especially
among
women.
Death Rate and Average Annual
Percentage Change
3 Leading Cancers in Men, 1990 and 2001*
Age-Adjusted Rate†
1990
2001
Average Annual
% Change
Lung
90.6
75.1
-1.8
Prostate
38.6
29.1
-2.9
Colorectal
30.8
24.2
-2.1
* Adapted from MMWR-SS 2004;53:SS-3
† Per 100,000 1970 standard population
Death Rate and Average Annual
Percentage Change
3 Leading Cancers in Women, 1990 and 2001*
Age-Adjusted Rate†
Average Annual
% Change
1990
2001
Lung
36.8
40.9
+ 0.9
Breast
33.1
25.9
-2.3
Colorectal
20.6
17.0
-1.7
* Adapted from MMWR-SS 2004;53:SS-3
† Per 100,000 1970 standard population
Implement programs that focus
on eliminating health disparities.
REACH 2010:
Charleston And
Georgetown
Diabetes Coalition
Arlene Case-The Lesson
Ensure access to quality
health services.
Enact policies that promote
healthy environments.
Promote wellness programs in
schools, work sites, and in faithand community-based settings.
Summary
• Remarkable achievements in
health over last century
• Chronic diseases and risk factors
now pose major challenges – a
cause for ALARM!
• Power of prevention, and role of
policy & environmental change –
reasons for HOPE!
• We need to act NOW!
Partnerships