Transcript Kansas Public Health: There and Back Again

Kansas Public Health: There and Back Again
Healthy Kansans 2010 as a
Common Language for
Today’s Public Health Improvements
Kansas Public Health Association, Inc.
2006 Fall Conference
First Official Public Health Body
in Kansas:
Kansas State Board, 1885
State and Local Boards of Health
Chapter 129, Laws 1885
An Act to create a State and local boards of health, and to regulate the
practice of medicine in the State of Kansas.
Sec 4. The state board of health shall supervise the
health interests of the people of this state….
Board was charged to…
“…make careful inquiry in respect to the
cause of disease, and especially of
epidemics, and investigate the sources of
mortality, and the effects of localities,
employments, conditions; ingesta, habits
and surroundings on the health of the
people.”
Establish environmental policy…
“…advise officers of government, or other
state boards, in regard to location,
drainage, water supply, disposal of excreta,
heating, and ventilation of public
buildings.”
Establish vital statistics tracking
system…
“…collect and preserve such information
relating to forms of disease and death as
may be useful in the discharge of the
duties of said board.”
Become the state’s health data
and information repository…
…receive reports and publications from all
health officers of local boards of health in
the state, and such sanitary information as
may be useful to people of the state.
Oversee the registration vital
statistics, and track reportable
diseases
“…supervise the registration of marriages,
births, and deaths, and also the registration
of forms of disease prevalent in the state;
and the secretary of said board shall
superintend the registration of the vital
statistics of the state.”
Create mortuary policy and
procedures
…prepare the forms and establish the
rules by which permits for transporting the
dead bodies of persons for burial beyond
the county where the death occurs;
Conduct public health research
and appoint special research
committees
“…appoint committees, or engage suitable
persons to render special sanitary service,
to make or supervise practical or scientific
investigations and examinations, requiring
expert skill, and to prepare plans and report
thereon.”
Board was charged to improve
the health of Kansans…
with limited resources
Need for accurate statistics
“Accurate and reliable compilation of vital
statistics is of paramount importance and
of inestimable value. We have inaugurated
a system which is meeting with general
approval, and promises, during the year
1886, to be very reliable and complete.”
And then there are the doctors…
In Osage City, Kansas, a physician urged the local school
board to refuse to carry out the vaccination order of the
Kansas State Board of Health:
‘Personally, I cannot comply with such an order; experience
has taught me better. They cannot disease my child with
the pus of a brute, while God sees fit to make its check
bloom with health, if I can prevent it.’ ”
What would a “Healthy
Kansans 1890” planning
process have looked like?
1880 Kansas Population by Age
Figure 9. 1880 Kansas Population
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
<5
20%
15%
10%
5%
Male
0%
5%
10%
15%
20%
Female
U.S. Census Bureau
U.S. and Kansas in 1880
• 1880 U.S. Vital Statistics showed…
– Nation struggling with infectious, preventable
diseases
– More than one in ten infants died before their
first birthday
– 9 out of the top 10 ten causes of death were
infectious diseases
• There were no official vital statistic records
for Kansas in 1880 (no data)
Table 1. United States Leading Causes of Death, 1880
Number of Deaths
(Registered States)
Percent of Known
Causes of Death
Consumption
(Tuberculosis)
91,270
13.1%
Pneumonia
63,053
9.1%
Diphtheria
38,143
5.5%
Heart disease
26,068
3.8%
Cholera infantum
24,983
3.6%
Typhoid fever
22,854
3.3%
Malarial fever
20,231
2.9%
Croup
17,966
2.6%
Convulsions
17,844
2.6%
Scarlet fever
16,388
2.4%
Cause
Actions of First State Board of
Health focused on…
• Setting up appropriate systems and tools to allow them to
identify health problems, track improvements, and set
priorities
– Created first vital statistics forms, which included marriage, birth,
still-birth, death, and vaccination forms
• Promoting prevention policies – specifically, sanitation
and hygiene
– Included rules for appropriate sewer drainage, keeping water
supplies clean, quarantining infectious diseases, disinfecting
areas where disease had been present, and vaccination
Progress
• Efforts of first public health
officials in state provided a
foundation for Dr. Crumbine,
appointed Secretary in 1904.
• Dr. Crumbine’s efforts resulted
in rapid advancements in
public health policy and health
education in Kansas during his
tenure (1904 – 1923).
Leading Causes of Death in U.S., 1920
Cause
Deaths
Rate
Pneumonia (all forms) and influenza
178,438
207.3
Diseases of the heart
137,374
159.6
Tuberculosis (all forms)
97,366
113.1
Intracranial lesions of vascular origin
80,019
93.0
Nephritis (all forms)
76,410
88.8
Cancer and other malignant tumors
71,756
83.4
Accidents excluding motor-vehicle
52,255
60.7
Diarrhea, enteritis, and ulceration of the
intestines
46,266
53.7
Premature birth
37,564
43.6
Puerperal causes (total)
16,320
19.0
Leading Causes of Death in U.S., 1950
Cause
Number
Rate
Diseases of the heart
535,705
355.5
Malignant neoplasms (cancer)
210,733
139.8
Vascular lesions affecting central nervous
system
156,751
104.0
Accidents
91,249
60.6
Certain diseases of early infancy
60,989
40.5
Influenza and pneumonia, except
pneumonia of newborn
47,120
31.3
Tuberculosis, all forms
33,959
22.5
General arteriosclerosis
30,734
20.4
Chronic and unspecified nephritis and other
renal sclerosis
24,677
16.4
Diabetes mellitus
24,419
16.2
Leading Causes of Death in U.S., 1970
Cause
Number
Rate
Diseases of heart
735,542
362.0
Malignant neoplasms (cancer)
330,730
162.8
Cerebrovascular diseases
207,166
101.9
Accidents
114,638
56.4
Influenza and pneumonia
62,739
30.9
Certain causes of mortality in early
infancy
43,205
21.3
Diabetes mellitus
38,324
18.9
Arteriosclerosis
31,682
15.6
Cirrhosis of liver
31,399
15.5
Bronchitis, emphysema, and asthma
30,889
15.2
Fast Forward…
• …just a century
or so!
• Phones, lights,
and motor cars
• Who are we
now?
Understanding our Population allows
for good decisions on priority setting
Figure 6. Kansas Population, 1860 - 2000
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
00
20
90
19
80
19
70
19
60
19
50
19
40
19
30
19
20
19
10
19
00
19
90
18
80
18
70
18
18
60
0
U.S. Census Bureau
1920 Population by County
2000 Population by County
2000 Kansas Population by Age
Figure 10. 2000 Kansas Population
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
<5
20%
15%
10%
5%
Male
0%
5%
10%
15%
20%
Female
U.S. Census Bureau
Projected 2030 Kansas Population by Age
Figure 11. Projected 2030 Kansas Population
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
<5
20%
15%
10%
5%
Male
0%
5%
10%
15%
20%
Female
U.S. Census Bureau
2000 Hispanic Population by Age
Figure 12. 2000 Kansas Hispanic Population
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
<5
20%
15%
10%
5%
Male
0%
5%
Female
10%
15%
20%
U.S. Census Bureau
Health Problems in the U.S., 2000
Actual Causes of Death†
United States, 2000
Leading Causes of Death*
United States, 2000
Heart Disease
Cancer
Tobacco
Diet / Physical Inactivity
Alcohol consumption
Stroke
Chronic Lower
Respiratory Disease
Unintentional injuries
Microbial agents
(e.g., influenza, pneumonia)
Toxic agents
(e.g., pollutants, asbestos)
Motor vehicles
Firearms
Sexual behavior
Illicit drug use
Diabetes
Pneumonia / influenza
Alzheimer’s disease
Kidney disease
0
5
10
15
20
0 5 10 15 20 25 30 35
Percentage (of all deaths)
Percentage (of all deaths)
*Minino AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for 2000. National Vital Statistics Reports
2002; 50(15):1-20.
†Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291
(10): 1238-1246. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Correction: Actual Causes of Death in the United
States, 2000. JAMA. 2005;293 (3): 293.
Today
• Chronic disease are the new frontier
• Have enjoyed rapid advancements in medical
technologies, pharmaceuticals but these have
not solved the chronic disease problem
• Many chronic diseases share common risk
factors
• Behavioral changes are key to reducing
premature death
• Chronic diseases present complex, long-term
challenge
Healthy Kansans 2010
Learning from the
past…
preparing for the future
Encouraging change
for healthier Kansans
Process
• Group of Kansans representing multiple
decisions participated in priority-setting
process
• Builds on comprehensive, nationwide
health promotion and disease prevention
agenda, Healthy People 2010
Healthy People 2010 Goals
• Increase quality and years of healthy
life. The first goal is to increase our
population’s life expectancy and improve
their quality of life.
• Eliminate health disparities. The
second goal is to eliminate health
disparities among different segments of
the population by specifically targeting the
segments that need to improve the most.
Healthy Kansans 2010 Health
Focus Areas











Maternal Infant Child Health
Oral Health
Hearing
HIV & STD
Family Planning
Arthritis
Childhood & Adult
Immunization
Disability
Environmental Health
Nutrition and Physical Activity
Respiratory Health
 Occupational Health
 Vision
 Heart Disease and Stroke
 Diabetes
 Mental Health
 Substance Abuse
 Injury and Violence
 Cancer
 Tobacco
 Chronic Kidney Disease
 Public Health Infrastructure
 Access to Care
10 Leading Health Indicators
•
•
•
•
•
•
•
•
•
•
Physical Activity
Overweight and Obesity
Tobacco Use
Substance Abuse
Responsible Sexual Behavior
Mental Health
Injury and Violence
Environmental Quality
Immunization
Access to Health Care
Priorities
• Reducing and Eliminating Health and
Disease Disparities
• Systemic Interventions to Address
Social Determinants of Health
• Early Disease Prevention, Risk
Identification, and Intervention for
Women, Children and Adolescents
Reducing and Eliminating Health
and Disease Disparities
Figure 14. Population by Race/Ethnicity (Excluding White)
200,000
180,000
160,000
140,000
120,000
100,000
80,000
60,000
Black/
African Amer.
Amer. Indian/
Native Amer.
Asian/Pacific
Islander
Other Race
40,000
Two Or More
Races
20,000
Hispanic
18
60
18
70
18
80
18
90
19
00
19
10
19
20
19
30
19
40
19
50
19
60
19
70
19
80
19
90
20
00
0
U.S. Census Bureau
Scope of Healthy Kansans 2010 Disparities
•
•
•
•
•
•
Racial/ethnic
Disability
Age (particularly senior adults)
Gender
Geography (rural/urban)
Socioeconomic status (education, income,
insurance/health benefit coverage)
Percent of Self-Reported “Fair” or “Poor” Health
Status by Selected Population Groups
Figure 19. 2005 Percent Self-Reported "Fair" or "Poor" Health Status
by Selected Population Groups
40
35
30
25
20
15
10
5
Em
pl
oy
ed
O
ut
of
W
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$1
5,
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$2
24
5,
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00
99
0
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$3
34
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00
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0
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00
0+
e
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Hi
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C
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Le
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Bl
ac
W
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18
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4
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ar
25
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45
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-5
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-6
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Kansas Behavioral Risk Factor Surveillance System
System Interventions to Address Social
Determinants of Health
• Social determinants can be summarized by
two variables
– Class
– Social supports and social connectedness
• Disparities related to
Social Determinants
– Income
– Education
– Social Determinants
Four Points of Opportunity Where Policy or
Systems Can Intervene to Affect Social
Determinants of Health
• Decrease social stratification
• Decrease specific exposure to healthdamaging factors suffered by people in
disadvantaged positions
• Seek to lessen the vulnerability of disadvantaged
people to the health-damaging conditions they
face
• Intervene through healthcare to reduce the
unequal consequences of ill-health and prevent
further socio-economic degradation among
disadvantaged people who become ill
Early Disease Prevention, Risk Identification,
and Intervention for Women, Children and
Adolescents
• Issues considered:
–
–
–
–
–
–
–
–
–
–
–
–
Interventions with pregnant women;
Interventions for pre-conceptional health;
Screening programs;
Substance abuse interventions during and immediately following
pregnancy;
Early childhood interventions (0-5 years);
School-based initiatives (6-18 years);
After-school programs (6-18 years);
Chronic disease risk factors including tobacco use, physical
inactivity and poor nutrition;
Disease prevention and management programs for asthma,
cancer, diabetes, cardiovascular disease, etc.;
Immunization programs;
Injury prevention programs – intentional and unintentional; and
Oral health interventions
Early Intervention Progress
140
Figure 25. Infant Mortality Rate for U.S. (1880-2000)
120
100
80
60
40
20
0
1880 1890 1900 1915- 1920- 1930- 1940 1950 1960 1970 1980 1990 2000
1919 1924 1934
Deaths per 1,000 births
U.S. Census Bureau
Growing Threat of Chronic Disease
and Associated Risk Factors
30%
Figure 27 . Kansas Obesity and Diabetes Prevalence
(1992-2005)
25%
20%
15%
10%
5%
0%
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Obesity
Diabetes
Kansas Behavioral Risk Factor Surveillance
Early Intervention
Recommendations
• Assure access to health
care and preventive
services for children and
parents.
• Integrate efforts to affect
the whole child’s
emotional and social
well-being.
• Promote the
development and
adoption of healthy
lifestyles
Action Steps Selected for
Immediate Action Based on
Three Cross-Cutting Priorities
• Tobacco
• Disparities Data
• Cultural Competency
• Overweight and Obesity
• Access
Tobacco
•
•
•
•
#1 preventable cause of death in Kansas
17% of adults smoke
Results in more than 3,800 deaths per year
Cigarette use costs Kansas $724 million in
direct medical costs
• If current trends continue, 54,000 children
alive today will die of tobacco-related
causes
Disparities Data
• Recommendation: Routinely collect and
report data on all segments of the
population (race/ethnicity, gender,
rural/urban, economic status, disability
status) to identify where improvements are
most needed.
Cultural Competency
• Definition: Cultural competence: Having the
capacity to function effectively as an individual
and an organization within the context of the
cultural beliefs, behaviors and needs presented
by consumers and communities. An ability to
relate to others in a trustworthy manner, with
respect for individual cultural differences.
• Achieving cultural competency is a process
rather than an outcome.
Adult Overweight/Obesity Trend
Figure 30. Adult Obesity (BMI >=30)
and Overweight (BMI >=25) by Year
65%
60%
55%
50%
45%
40%
35%
30%
25%
20%
15%
10%
Healthy People 2010 Obesity Target
5%
0%
1990
1992
1994
1996
Kansas Obesity
Kansas Overweight
1998
2000
2002
2004
U.S. Obesity
U.S. Overweight
Kansas Behavioral Risk Factor Surveillance System
Overweight/Obesity
• Five national overweight/obesity
prevention goals:
1. Increase fruit and vegetable
consumption
2. Increase physical activity
3. Decrease “screen” time (TV,
leisure computer, video games)
4. Increase breastfeeding
5. Balance caloric intake with
expenditure
Access
50
Figure 31. Percentage of Adults Who Lacked Health
Care Coverage
All Adults
45
Adults 18-64
40
45.2
Hispanic
Percent
35
36.2
33.6
30
31.5
30.0
25
26.8
25.9
20
15.3
15.6
15
10
13.1
10.4
10.7
10.1
1999
2000
2001
11.1
13.0
13.2
5
0
2002
2003
2004
2005
Year
Kansas Behavioral Risk Factor Surveillance System
What will we do to make a
difference in Kansas’ future?
The time is now…
…the place is here…
…and it’s up to us.