Transcript HealthChallengesUSA

Identifying and Understanding
the Major Public Health Issues in
the United States (U.S.)”
37th APACPH Conference
Taipei, Taiwan
November 19-23, 2005
Ann Hayashi
Michelle Wong
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General Information
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Map of the U.S.
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 Population: 295,734,134
 Age structure:
0-14 years: 20.6%
15-64 years: 67%
65 years and over: 12.4%
 Population growth rate:
0.92%
 Life expectancy at birth:
total population: 77.71
years
male: 74.89 years
female: 80.67 years
Ethnic Distribution
4.20%
1%
12.90%
0.20%
81.70%
Black
Asian
American Indian/Alaska Native
Native Hawaiian/Pacific Islander
White
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The U.S. Health System
Infrastructure
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Judicial
Branch
Executive Branch
Legislative
Branch
President George W. Bush
15 Executive Departments
Department of Health and Human Services
Secretary Michael O. Leavitt
ACF
FDA
SAMHSA
CMS
ATSDR
HRSA
AHRQ
AoA
NIH
CDC
PH Emergency
Response
U.S. Department of Health and Human Services
 Protects health of all Americans and provides
essential human services, especially for those who
are least able to help themselves
 > 300 programs
 Administered by 11 operating divisions, 8 U.S.
Public Health Agencies, 3 human service agencies
 HHS Budget: $581 Billion
 HHS Employees: 67,444
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Department of Health and Human Services
Human Services Agencies
 Center for Medicare and
Medicaid Services (CMS)
 Administration for
Children and Families
(ACF)
 Administration on Aging
(AoA)
Public Health Agencies
 National Institutes of Health (NIH)
 Food & Drug Administration
(FDA)
 Centers for Disease Control (CDC)
 Health Resources and Services
Administration (HRSA)
 Agency for Healthcare Research
and Quality (AHRQ)
 Indian Health Service (IHS)
 Substance Abuse and Mental
Health Service Adminstration
(SAMHSA)
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MANAGEMENT
Planning
Administration
Regulation
Legislation
RESOURCE
PRODUCTION
Manpower
Facilities
Commodities (drugs, etc.)
Knowledge
ORGANIZATION OF PROGRAMS
Ministry of Health (all levels)
Other public agencies
Voluntary Agencies
Enterprises
Private Market
DELIVERY OF
SERVICES
Primary Care (Treatment
and Prevention)
Secondary Care
Tertiary Care
Care of Special
Disorders and
Populations
ECONOMIC SUPPORT
Personal Households
Charity
Insurance (voluntary)
Governmental
Revenues
Foreign Aid
Source: Romer, M.I. 1985 as cited in Barton, Phoebe Lindsay (2003) Understanding the U.S. Health Services system. Health
Administration Press Chicago, Illinois
Goals of Health Care in the
U.S.
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• Increase Efficiency- How efficiently are
resources being converted into health gains?
• Increase Equity – Are health services and costs
distributed equally within a population? (ie,
accessibility)
• Self-Sustainability – Are health systems equipped
and capable to function independently?
• Address Social Justice
• Promote healthy lifestyles and a healthy
population
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Current Health Status of the
U.S. Population
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Leading Causes of Death, All Races and Both Genders, U.S.
(U.S. Department of Health and Human Services, 2002)
Rank Order and Number of Deaths
ALL CAUSES
2,403,351
Diseases of the Heart
710,760
Malignant Neoplasms
553,091
Cerebrovascular disease
167,661
Chronic lower respiratory disease
122,009
Unintentional injuries
97,900
Diabetes Mellitus
69,301
Pneumonia and influenza
65,313
Alzheimer’s Disease
49,558
Nephritis, nephritic syndrome,
and nephrosis
37,251
Septicemia
31,224
Current Challenges and Issues
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 Hurricane Katrina (New Orleans, LA)
•
•
•
•
August 29, 2005
Public Health Infrastructure extensively damaged
Limited surveillance for illnesses, injury, etc
Infectious diseases (high number of acute
respiratory infection cases)
 Health Care Financing- Cost rising rapidly, health
isn’t improving proportionally
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National Health Expenditure in the U.S., Selected Years
1960-2002
Dollar Amount (in Billions)
6000
5000
4000
3000
2000
1000
0
1955
1960
1965
1970
1975
1980
Year
1985
1990
1995
2000
2005
 Access to Care/Uninsured
• Need remains the primary determinant of
use of health services
• Health insurance vital; it reduces barriers to
health care
• 15.6 % of Americans were uninsured in
2004, compared to 15.2 percent in 2002, and
14.6 percent in 2001.
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 Poverty- Does illness cause poverty? Or does
poverty cause illness?
• Children & adults near or under poverty level
have worse health than those with higher
income (CDC, Health, 2004)
• Inadequate nutrition, substandard housing,
exposure to environmental hazards, unhealthy
lifestyles, decreased access to and use of health
services
CDC (Health, U.S., 2004) http://www.cdc.gov/nchs/data/hus/hus04.pdf
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Figure 4. Poverty rates by age: United States, 1966-2002
35
30
65 years and over
25
Under 18 years
Percent
20
15
10
18-64 years
5
0
1966
1970
1975
1980
Year
NOTES: Data shown are the percent of persons with family
income below the poverty level. See Data Table for data
points graphed and additional notes.
1985
1990
1995
SOURCE: U.S. Census Bureau, Current
Population Survey.
Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2004
2002
U.S.
•19 Million children
uninsured (11.2%)
25%
•Children in poverty
more likely to be
uninsured (19.2%)
15%
Source: Census Bureau, 2005
20%
10%
5%
0%
All Children
Children living below Poverty
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 Health Policy-
• Involves many factors, not just needs-based
 Chronic Diseases (“Diseases of Lifestyle”)
• On the rise
• Major Health risk factors
– Smoking
– Physical Activity
– Overweight/Obesity
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Thank you!
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