Transcript Prevention and Wellness: - Ottawa Area Intermediate School

Prevention and Wellness:
Is it the Future of Health Care?
Tom Peterson, M.D.
Healthier Communities
Spectrum Health
Public Health Contributions to Solving
Health Problems
The 10 leading causes of death as a percentage of all
deaths in the United States - 1900
Leading Causes of Death in United States and
Michigan 2002
Heart Dis
Cancer
Stroke
CLRD
Accidents
Diabetes
Pneum/Influ
Alzheimer's
Kidney Dis
Suicide
0
50
100
150
200
Age-Adj. Rate per 100,000
Michigan
250
300
United States
Sources: 2002 Michigan Resident Death File, Vital Records and Health Data Development Division, MI Dept of Community Health
“Deaths: Preliminary Data for 2002”. National Vital Statistics Reports Vo 52, No 13. CDC National Center for Health Statistics
Untitled
The 5 Big Ones in the
Century
Risks:
st
21
Diseases:
 Obesity
 Heart Disease
 Smoking
 Cancer
 High blood pressure
 Emphysema
 Stress
 Strokes
 Inactivity
 Diabetes
Our Population’s Health
• 17 million have diabetes, 5 million more have
diabetes and don’t know it
• 16 million have pre-diabetes
• 47 million have metabolic syndrome
• 17 million have heart disease
• 1.1 million heart attacks annually
• 50 million are obese, 110 million are overweight
• 45 million smoke
• 50 million have high blood pressure
All of which can be decreased simply by
increasing physical activity!
Medicare Spending Has
Doubled Since 1992 for:
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Cancer
$10 -19 billion
Arthritis
$3.4 –7.2 billion
Depression $1.3- 2.5 billion
Heart disease $21– 42 billion
Diabetes
$5.7-12.5 billion
Who’s Accountable?
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Health Care Providers
Health Plans
Employers
Employees/Patients
Government
Communities
Schools
Schools
What Can They Do?
• Increase activity
– After school programs
– Phys Ed per week
• Vending machines
• School lunches
• Be accountable
• Measure your kids!
Arkansas Alma School District
Healthy Risk for
Overweight
Weight Overweight
Males Number
2006-06 841
61.2%
18.7%
18.5%
2004-05 1190
59.9%
18.2%
20.4%
2005-06 750
67.2%
16.4%
14.3%
2004-05 993
65.5%
17.5%
16.1%
Females
2004-05
Overweight - 20
2005/2006
2004/2005
The Business World
How Sick, Really, Are Our Employees?
• 60+% of them are overweight, 30% of those
obese
• 1 out of every 4 of them smoke
• 1 out of every 5 of them have high blood
pressure
• 2 out of every 5 of them have high
cholesterol
• 1 out of every 5 have diabetes, pre-diabetes,
or unknown diabetes
• 80% are not active enough, 25% of those are
totally inactive
Increased Yearly Claims Cost of an Unhealthy
Employee
Employee Benefit News, May, 1997
Costs Associated with Risks
Medical Paid Amount x Age x Risk
$7,123
$5,813
$4,530
$4,401
$7,000
$3,216
$6,000
$4,718
$5,000
$2,098
$3,364
$4,000
$3,894
$2,667
$2,912
$1,550
$2,110
$1,351
$2,941
$3,000
$2,000
$1,000
$1,122
$1,523
$2,081
$3,069
$2,480
$2,605
$1,851
$2,200
$1,641
$0
19-34
35-44
Edington. AJHP. 15(5):341-349, 2001
45-54
55-64
65-74
75+
High Risk
Medium Risk
Non- Participant
Low Risk
Where are the Opportunities for
Population Health Management?
9000
Serious disease
8000
7000
Minor Disease
6000
No Disease
5000
4000 Health Promotion
Opportunity
3000
2000
1000
0
Q_12 Q_9 Q_6 Q_3
Medical and Drug Costs only
Medical & Care
Management Opportunity
Condition Management
Opportunity
Q0
Q3
Q6
Q9
Q12
The Health Care
System
The New Paradigm of Health
Care - Chronic Disease Care Requires:
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Long term sustainability
Major lifestyle changes
Silent killers, asymptomatic treatment
Multi faced problems
Not curable by drugs, surgeries or vaccinations
Readiness to change
“Never before has our health care
system had available such
tremendous clinical achievements
and knowledge, that, unfortunately
have not been directed to the
patients who could benefit the
most from them.”
Russell Ricci, M.D.
IBM 2001
Traditional Physician Care
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Diagnosis focused
Treatment decision making
Procedural expertise
Tell them what to do
Result based
Physiological weighted, not
psychologically focused
• Start and finish oriented
• Not focused on readiness or sustainment
% of Recommended Care Received –
Average – 54.9%
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Thorpe K. Health Affairs Aug 25, 2004
McGlynn EA New Eng Journ Med, 2003,348:263545
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Failure to provide optimal treatment for
asthma, depression, diabetes, heart
disease, and high blood pressure results in:
• 41 million sick days per year
• $11.5 billion in annual losses for American
businesses
• $ 1 billion per year in preventable hospital
days
• 57,000 death per year
National Committee for Quality Assurance, Sept 2003
The Key: Collaboration and
Integration of All Health Care
Systems, Including:
• Team management of the chronic disease (s)
• Continuum of care coordination from point A to Point B
• Improved reimbursement and incentives for healthy
lifestyle changes and prevention of the chronic diseases,
and to support chronic care management
• Measurable and reportable outcomes of management for
the patient, employer, health plan and provider
• Coordination and communication of infrastructures in all
systems
Lifestyle Choices
Sedentary
Obesity
Smoking
The Triad of Poor Health
Sleep disorders
Diabetes
Metabolic syndrome
Sedentary/Inactivity
-watching TV
-sitting at a desk
-driving
Gall bladder disease
Arthritis
Spinal disease
Strokes
Unhealthy Eating
-saturated fats
Obesity
-high glycemic loads
–Sugars and high caloric foods
-BMI >30 in adults
-BMI% > 95 in children <18
Cancer
–large quantities
Heart disease
Untitled
50 years ago we were paid to
exercise, while in todays
society we have to pay to
exercise.
Human Beings Were Designed to Move!
Through continuous movement, our joints improve and
become better oiled, our hearts beat more efficiently and the
muscles strengthen, our brain receives better blood supply and
oxygen, our muscles become more efficient using oxygen,
clearing waste and responding to insulin, our immune system
lessens inflammatory states, our circulatory system becomes
less resistant, our blood becomes thinner, chemicals are
released that improve attention and general feeling of well
being, and our organs improve storage of glucose and use of
fatty acids.
The Perfect Pill - Exercise!
Moderate Activity Reduces
Risk of:
• Heart disease up to
80%
• Mortality up to 50%
• Stroke up to 34%
• High blood pressure
up to 20 pts.
• Diabetes up to 50%
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Dementia up to 50%
Fractures up to 40%
Colon cancer up to 40%
Breast cancer up to
30%
What is “Moderate Activity”?
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Gardening, walking, golf,
washing your car, etc.
10 minutes - 3 X per day OR,
15 minutes - 2 X per day OR,
30 minutes - 1 X per day
Aim for 2,000 steps a day or
more
How Much Do We
Really Need?
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’70s – 30-60 minutes, continuous/ vigorous, 3
X per week
’90s – 30 minutes, moderate intensity, at least
3 times/week
2006 – 30 minutes, moderate activity, every
day. No sweat required!
• 44.3 million Americans are
obese
• 47 million have metabolic
syndrome
• Number of adults with a BMI
>40 has tripled in the last 10
years
• African Americans highest
with rate of 31.1% and rate of
diabetes of 11.2%
• Obesity rate (BMI>30) in
2003 is >30% of the
population
• Over 60% of population is
overweight or obese
Obesity in
America
Metabolic Syndrome
(3 of the 5)
• Central obesity
– Women – waist > 35 inches
– Men
- waist > 40 inches
• Low HDL
– Men
< 40
– Women < 50
• High blood pressure (> 140/90)
• High triglycerides (> 150)
• High fasting blood sugar (>100)
At the Current Rate
• One third of all children born in year 2000 will
become diabetics, almost 50% of Hispanics and
over 40% of African Americans
• By the year 2020, virtually all Americans will be
overweight
• 80% of overweight adolescents will become obese
adults, causing an average of 5-20 years of life lost
for each individual
• For the first time, children born after the year 2000
will be outlived by their parents
Our “Fat Economy”
Businesses thrive on people consuming
more calories, while other businesses
thrive on trying to “cure” the result.
Fast Food
Restaurants
Soft drink companies
Snack foods
Processed food companies
Bariatric surgery
Diet industry
Diet medications
Diet books
Childhood Obesity
Generation XXL
The Problem:
In the last 30 years we have
been been inundated with
“labor-saving” devices and
easily accessible, high fat, high
caloric, foods.
Our kids are born
into a world of
physical
inactivity!
Lifestyle Changes that Promote
Sedentary Behavior
Childhood Obesity Morbidity
(5-17yo, BMI > 95%)
• Twice the rate of elevated cholesterol
• Twice as likely to have elevated diastolic BP
• More than 4 times the rate of increased systolic
BP
• Over 12 times as likely to have fasting
hyperinsulinemia
• Obese teens who smoke are 4 times as likely to
develop metabolic syndrome
Freedman, Pediatrics 1999; 103:1175-82
•Americans run only 25% of all errands by foot, down
42% in the past 20 years
•Every day, 40% of adults eat out at a restaurant, sales
to exceed $440 billion in 2004
•Americans spend $920 a person each year on food
away from home
•25% of vegetables consumed in the U.S. are french
fries
•Fast food spending has increased 18 fold since 1970
•The average hamburger has 3 times more calories
today compared to 40 years ago
•While 50 million Americans diet every year, only 5%
sustain weight loss for 12
• In most gym classes kids are aerobically active for just 3
minutes
• Nearly all high schools have vending machines, while the
average teenager gets 10-15% of their daily calories from
soda
• Soda consumption by children in US has increased by 500%
in the last 40 years
• $13 billion per year, more than tobacco, is spent on food adds
targeting children
• 70% of kids age 6-8 think fast food is healthier than home
food
• For every hour of TV a child averages per day, obesity risks
rise 6%
• 44% of Americans say it’s hard to walk anywhere from their
house
• Only 17% of kids walk to school, 28% who live less than a
mile away
“No epidemic has ever been
resolved by paying attention
only to the affected individual.”
George W. Albee
Founder of the American Psychological Society
• 1570’s Tobacco is prescribed by doctors
– good for colic, nephritis, falling fingernails, worms, halitosis,
lockjaw and cancer
• 1619 Tobacco is currency in Jamestown: a prospective
husband can pay for his mate to be shipped from
England for 120 lbs of tobacco
• 1650 Connecticut court orders no smoking under 21,
no smoking except with physician order
• 1855 Concerns of health effects of smoking raised in
Lancet
• 1884 Mass production began
• 1905 Tobacco is REMOVED from the US
pharmacopoeia, removing it from FDA supervision…
• 1909 15 states banned the sale of cigarettes
• 1998 National Tobacco Settlement – Michigan worst in
nation in using money for tobacco control
• 2006 15 states, 12 countries ban smoking in all
workplaces, bars and restaurants!
Fun
Facts
Most Cost Effective, Disease
Preventive Procedures in Health
Care Are:
Immunizations and Smoking Cessation
American Journal of Preventive Medicine, July, 2001 sponsored
by Center for Disease Control and Prevention
If you took 1,000 young
adult smokers, 1 will be
murdered, 6 will die from
traffic accidents, but 500
will die from smoking!
Richard Peto
Professor of Medical Statistics and Epidemiology,
University of Oxford
Is it just
parents
who need
more
education?
Life Cycle Effects of Smoke Exposure
Asthma
Otitis Media
Fire-related Injuries
Cognitive Problems
Influence
to Start
Smoking
SIDS
RSV/Bronchiolitis
Meningitis
Childhood
Infancy
Adolescence
In utero
Adulthood
Low Birth Weight
Stillbirth
PROM
Prematurity
Nicotine
Addiction
Health
Effects
Cancer
Cardiovascular Disease
COPD
Strokes
Arch Pediatr Adolesc Med. 1997
The Pregnant Smoker
• 13-16% smoking prevalence, up to
35% in medicaid population
• Highest quit rate of all populations,
most spontaneous quitters
• 40-65% of moms quit on their own
before even receiving prenatal care
• Increasing relapse peaks by 6 months
post partum, almost 80% by 1 year
• Many moms quit to minimize risk to
baby, develop no coping mechanisms
for preventing relapse after birth “6
month honeymoon”
Ershoff,D Nic Tobacco Res, vol 6; April,2004
Parental Smoking Annual Damages to
Children:
 Nearly 1.8 million doctor visits for asthma
 Low birth weight –46,000, 2800 perinatal deaths
 SIDS – 2,000
 RSV/bronchiolitis –
22,000 hospitalizations, 1,100 deaths
 Up to 436,000 episodes of bronchitis in
children under five
 Fire related injuries – 10,000, 250 deaths
 Up to 190,000 cases of pneumonia in children under
five, 3.4 million ear infections
 8-26,000 new cases of asthma each year
Aligne et al, Arch Pediatr Adolesc Med, 1997
Teenagers and Tobacco Use:
• 2/3 of all 12th graders have tried
tobacco
• Almost 3,000+ teens become addicted
every day, 4-5 million teens total
• Addiction can begins within a few days
to a few weeks
• Spit tobacco is 4 times
• more addictive than cigarettes
• #1 cause of drug addiction in teens,
and of graduating seniors
Adult Tobacco Diseases
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Heart Disease/atherosclerosis
Cancer
- Lung, oral, laryngeal, colon, liver,
pancreas, renal, bladder, skin,
cervical
COPD
CVA
Peptic ulcer disease
Macular degeneration
Fractures
Hearing loss
Aortic aneurysm
Impotency
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Periondontitis
Tooth loss/cavities
Immune suppression
Liver disease
Asthma
Pneumonia
Sinusitis
Type II diabetes
– Negative effects on cholesterol
– Accelerates proteinuria,
atherosclerosis, and peripheral artery
disease
– Erectile dysfunction¹
•
1. Diabetes Care 2001, Sep 24:590-5
As adults, we are all educators. We
need to be in charge of our own
health.
If we don’t become involved in
influencing children’s health from
very young ages, there will be
serious future consequences.
We are all role
models
Do We Know Our Numbers?
• Cholesterol
(<200)
• HDL (>60)
• LDL (<130)
• Triglycerides
(<150)
Diabetics:
• Fasting blood
sugar (<100)
• Blood pressure
(<120/80)
• Smoking status
(NO)
• BMI (<25)
A1C (Hemoglobin A1C) (<7)
Keys to Future Health
Improvement
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Culture change
Know your health, and risks
Self management
Preventing the low risk from becoming high risk
Exercise
Active childhoods
Don’t focus on just the “diet”
Quit smoking, or help someone quit
Team management focused health care
We are the leaders !
An Ounce of Prevention is
Worth a Pound of Cure!
Businesses
Health Care
Healthy environments
Incentivised wellness programs
Top down leadership
Proper reimbursement
Integration of systems
Teams
Provide continuum of care
Accessible resources
Schools
Food restrictions and requirements
Increased phys ed and after school
programs
“Healthy” education and healthy role
models
Measure your kids !
Community/Govern.
Healthy culture
Activity friendly environments
Healthy legislation
Health promoted media and retail
“Somebody has to do
something, it’s just incredibly
stupid that it has to be us.”
Jerry Garcia