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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
Age-adjusted to the 2000 US population.; Sources: NHLBI, Morbidity and Mortality Chart Book 2000 CDC, Health, United States 2001
0
100
200
300
400
500
600
700
800
900
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Year
Dea
ths
per
100
000
Total cardiovascular diseases
Diseases of the heart
Coronary heart disease
Stroke
Measuring State Successes:Improvements from 1990 to 2004
ME Infectious Disease 62%
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%
SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004
Measuring State Successes:Improvements from 1990 to 2004
ME Infectious Disease 62%
VT Infant Mortality 53%
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%
VT Infant Mortality 53%
PA Infant Mortality 30%
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%
VT Infant Mortality 53%
PA Infant Mortality 30%
IA Infant Mortality 39%
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%
VT Infant Mortality 53%
PA Infant Mortality 30%
IA Infant Mortality 39%
LA Children in Poverty 34%
RI Smoking 35%
SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004
ME Infectious Disease 62%
VT Infant Mortality 53%
PA Infant Mortality 30%
IA Infant Mortality 39%
LA Children in Poverty 34%
AK Infectious Disease 83%
Measuring State Successes:Improvements from 1990 to 2004
RI Smoking 35%
SOURCE: America’s Health: State Health Rankings. United Health Foundation 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%
Measuring State Successes:Improvements from 1990 to 2004
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
“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.”
Public Health:Population-based
Health
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 ofUnparalleled 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 ofUnparalleled 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 RiseOur nation spends more on health care
than any other country in the world
Chronic diseases account for 75% of the $1.4 trillionwe spend on health care
$245 billionan average of $1,066 per person
1980
$1.4 trillionan average of $5,039 per person
2001
SOURCE: Heffler et al., Health Affairs., Health Spending Projections For 2001-2011: The Latest Outlook, March/April 2002.
$2.8 trillionan average of $9,216 per person
2011
Life Expectancy vs. Health Care Spending
Per Capita Health Care Spending in International Dollars
Lif
e E
xpec
tan
cy
30
40
50
60
70
80
90
0 500 1000 2000 3000 4000 50001500 2500 3500 4500
Sierra Leone
United States
Japan
Cuba
An Aging PopulationPercentage of U.S. Population over Age 65
0
5
10
15
20
25
1930 1950 1970 1990 2010 2030 2050
Year
Perc
en
t
Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
>80
75-7
9
70-7
4
60-6
4
55-5
9
50-5
4
45-4
9
40-4
4
35-3
9
30-3
4
25-2
9
20-2
4
15-1
9
10-1
4
0-4 5-9
65-6
9
Women
Men
Dollars
Age in Years
Estimated Per Capita Health Expenditures,by Age and Sex, 1995
Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996
Medicaid ExpendituresState FY 2003
actualFY 2004estimate
% of total expenditures
Alaska 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
Vermont 691 795 27.5
Source: National Association of State Budget Officers, 2003 State Expenditures Report
Predicted Likelihood of Developing Coronary Heart Disease, Stroke, or Diabetes by Age 65
SmokerOverweight
Inactive Ratio
11% 58% 5.5
Source: Jones et al. Arch Intern Med 2002;162:2565–71
Non SmokerNormal Weight
Active
Men, Aged 50
Disability Index,* by Age and Health Risk†
University of Pennsylvania Alumni
63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 780.00
0.05
0.10
0.15
0.20
0.25
0.30
Dis
abili
ty Index
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
High risk
Moderate risk
Low risk
Adult per Capita Cigarette Consumption and Major Environmental and Policy Changes in the
US 1900-1990
0
1
2
3
4
5
Great Depression
End ofWW II
First Medical reportslinking smoking and cancer
Thousands per year
US Surgeon General’s first
report
Broadcast advertising ban
Federal cigarette
tax doubles
Nonsmoker’s rights movement beginsFairness Doctrine messages on radio and television
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990
Year
Admissions for Acute Myocardial Infarction During 6-Month Periods June–November Before, During,
and After the Smoke-free Ordinance
Source: Sargent RP et al. BMJ 2004.
0
10
20
30
40
50
60
1998 1999 2000 2001 2002 2003
Year
Ad
mis
sio
ns
Helena
Outside Helena
New York Centers of Excellence
• 39% reduction in lower-extremity 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*
† Per 100,000 1970 standard population
Lung 90.6 75.1 -1.8
Prostate 38.6 29.1 -2.9
Colorectal 30.8 24.2 -2.1
Age-Adjusted Rate† Average Annual% Change1990 2001
Adapted from MMWR-SS 2004;53:SS-3*
Death Rate and Average Annual Percentage Change
3 Leading Cancers in Women, 1990 and 2001*
† Per 100,000 1970 standard population
Lung 36.8 40.9 + 0.9
Breast 33.1 25.9 -2.3
Colorectal 20.6 17.0 -1.7
Age-Adjusted Rate† Average Annual% Change1990 2001
Adapted from MMWR-SS 2004;53:SS-3*
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 faith- and 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
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