Transcript Multi-Dimensional Congregational Health: The New Vision

Multi-Dimensional
Congregational Health:
The New Vision
Dr. James Early
University of Kansas School of Medicine-Wichita
How reasonable is it to discuss
“health” in the congregational setting?
 Companies are getting involved as
payers and as agents of change: fitness
centers, company doctors, incentives for
good health habits, health fairs.
 Schools are involved through nurses,
education, immunization campaigns.
 The retail sector is becoming involved in
healthcare delivery.
Source: The Wall Street Journal: Wednesday, October 5, 2005 Personal Journal Section, pg. D1
How reasonable is it to discuss
“health” in the congregational setting?
 An increasing number of people are uninsured
or underinsured and not appropriately
accessing our healthcare system.
 Church affiliated indigent clinics are trying to
“pick up the slack”.
 The traditional healthcare system was never
designed to take on prevention.
 Decisions on life and death are even
uncomfortably becoming an issue for
legislation.
Church
Initiatives
How can the church become
involved in health and wellness?
 By providing a more comprehensive
understanding of the connection
between physical/emotional health and
our social and spiritual lives?
 By creating a common vision and plan
that congregants may choose to utilize?
 And then by fostering long-term
knowledge acquisition and skill
building?
Physical Health
Mental/Emotional
Health
Spiritual Health
Social Health
Leading Causes of Death in 1900
CVD Stroke
10%
CVD Heart
Disease
12%
Pneumonia &
Flu
18%
Cancer
6%
Kidney Disease
8%
Accident
7%
Other
8%
Diarrhea,
Enteritis, Ulcers
13%
Tuberculosis
18%
Leading Causes of Death
Final Data from the CDC for 1998
Kidney
Disease
1%
Suicide
1%
Liver
Disease
1%
All Other Causes
20%
Heart
Disease
31%
Accidents
4%
Pneumonia/Flu
4%
Diabetes
3%
COPD
5%
Stroke
7%
© 1992, 1996, 1999, 2001 Health Management Resources Corporation, Boston, MA
Cancer
23%
Trends in Age-Standardized Death Rates for
the 6 Leading Causes of Death in the
United States, 1970-2002
Rates are age-adjusted to the 2000 US standard population.
Jemal A, Ward E, Hao Y, & Thun, M. JAMA 2005;294:1255-1259.Trends in the Leading Causes of
Death in the United States, 1970-2002.
The Presence of 3 or More Risk
Factors Correlates With the
Metabolic Syndrome (ATP III)
Risk Factor
Defining Level
Abdominal obesity
Men
Women
Waist circumference
>40" (102 cm)
>35" (88 cm)
FBG
>110 mg/dL (>100)
Triglycerides
>150 mg/dL
HDL-C
Men
Women
<40 mg/dL
<50 mg/dL
BP
>130/> 85 mm Hg
Third Report of the National Cholesterol Education Program Expert Panel. Executive Summary.
NIH Publication No. 01-3670. May 2001.
Waist/Hip Ratio:
An Index of Abdominal Versus
Peripheral Obesity
High WHR
( 0.95 in men)
( 0.80 in women)
Low WHR
( 0.95 in men)
( 0.80 in women)
American Diabetes Association
Metabolic Syndrome
“In Action”
Cardiovascular Disease
Advancing Age
Source: Dr. LaSalle
The Economic Burden of CVD
$368
$350
$300
Billions
$250
$239
$200
$150
$133
$100
$54
$50
$56
$29
$0
Heart disease CAD
Stroke
HTN
CHF
CAD, coronary artery disease; CHF, congestive heart failure; CVD, cardiovascular
disease; HTN, hypertension.
Heart Disease and Stroke Statistical 2004 Update. American Heart Association.
Total CVD
Prevalence of Diagnosed
Diabetes Among US
Adults,1991-2001
Cost of Diabetes in the US, 2002
•Total (direct and
indirect):
$132 billion
•Direct medical
costs: $92 billion
•Indirect costs:
$40 billion (disability,
work loss, premature
mortality)
Obesity Trends* Among U.S. Adults
BRFSS, 1991, 1996, 2003
(*BMI 30, or about 30 lbs overweight for 5’4” person)
1991
1996
2003
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Economic Cost of Obesity
 Economic causes and costs of obesity study
presented at 14th European Congress on
Obesity
 $96.7 billion was spent on obesity in 2003 in
the U.S.
 Figures are comparable in western countries
with rising rates of obesity
Wolf, AM. Health Economics of Obesity- New Insights presented
at the 14th European Congress on Obesity
Prevalence of the Metabolic
Syndrome in the US
Prevalence (%)
Men
Women
60
50
40
30
20
10
0
20
-29
30
-39
40
-49
50
-59
Age (years)
Ford ES, et al. JAMA 2002;287:356-9
60
-69
>6
9
Metabolic Syndrome Costs
IGT
Dyslipidemia
IFG
HDL-C
TG
Fertility
Fluoride
Herbal
Resins
Diuretics
drugs
Pesticides
supplements
Fibrates
Ace inhibitors
Glitizones
Aspirin
Antibiotics
OTC
Statins
Beta blockers
Sulfonylureas
Fertilizers
Phentermine
Niacin
Alpha agonists
Biguanides
Sunblocks
Orlistat
OTC
ARBs
Antireflux
Sibutramine
Ezetimibe
Other
Insulin
Others
IGT
Dyslipidemia
IFG
HDL
Trig
Fertility
Fluoride
Herbal
Resins
Diuretics
drugs
Pesticides
supplements
Fibrates
Ace inhibitors
Glitizones
Aspirin
Antibiotics
OTC
Statins
Beta blockers
Sulfonylureas
Fertilizers
Phentermine
Niacin
Alpha agonists
Biguanides
Sunblocks
Orlistat
OTC
ARBs
Antireflux
Sibutramine
Ezetimibe
Other
Insulin
Others
$3.99 + $80.00 + $29.99 + $138.29 + $9.99 + $61.99 + $79.95 + $89.79 =
$493.99 per month
Total Yearly Cost for
Our Sample Patient
$5,927.88
“The average yearly pharmacy
cost of treating adult patients
over age 20 with metabolic
syndrome exceeds $4,000,
which is more than 4 times the
average annual drug cost for
all other patients.”
Medical Research News. May 9, 2005
Two Million Methodists with
Metabolic Syndrome
 If 2 million Methodists cut their metabolic
syndrome medications in half…..
 There would be 4 billion dollars more for
individuals and congregations to spend
on the church and families.
We are beginning to
understand the problem….
How did we get here?
Lack of leisure-time physical
activity among US adults
% Reporting No LeisureTime Physical Activity
70
60
50
40
30
20
10
0
18-24
25-44
45-64
65-74
>75
Source: Healthy People 2010.
JE Manson et al. Arch Int Med 2004 Feb 9; vol 164
Stereo
VCR
Remote Car Starter
and Door Opener
TV
Air Conditioning
Garage
Door
Fireplace
Now
Then
“Genetics loads the gun; the environment
pulls the trigger.”
George Bray
Physical Health
Mental/Emotional
Health
Spiritual Health
Social Health
K
T
A
SE
B
Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J. Are Current Health Behavioral
Change Models Helpful in Guiding Prevention of Weight Gain Efforts? Obes Res 2003 October
1;11(90001):23S-43.
Impact of Emotions on
Physical Health




Depression
Anxiety
Addiction
Stress/Time Management
– Family
– Worksite
– Community
Physical Health
Mental/Emotional
Health
Spiritual Health
Social Health
Impact of Social Health on
Physical/Emotional well being
 Connections
– Physical environment
 Built environment
 Your “space”
– Interpersonal environment
 Support
 Relationships
 Responsibilities
Physical Health
Mental/Emotional
Health
Spiritual Health
Social Health
But physical/emotional/social health
may still not be enough
Self-Actualization
Esteem Needs
Belonging Needs
Safety Needs
Physiological Needs
 Spiritual fulfillment can provide the
context and meaning to life
 Our spiritual health is reflected in
our desire to extend the quality and
quantity of our lives in order to have
the time to “get it right” and “pass it
on”
Physical Health
Mental/Emotional
Health
Spiritual Health
Social Health
What will it look like if we get it right?
Physical Health
Mental/Emotional
Health
Spiritual Health
Social Health
Physical Health Mental/Emotional
Health
Spiritual Health
Social Health
 “In the end, you want your congregational
home to reflect your deepest longings and
provide a haven for exploring life in an
environment that allows you to bring out the
best in each other, your families, your
communities, your nation, and your
world…God’s world.”