david lakey, m.d. commissioner texas department of state health services

Healthy Communities: The Intersection of Community Development & Health

September 28, 2011

“State of the Health of Texas & Obesity”

David Lakey, M.D.Commissioner

Texas Department of State Health Services

Regulatory Services

Regulatory Services

Family & Community Health Services

Family & Community Health Services

Regional & Local Health Services

Regional & Local Health Services

Texas Department of State Health Services (DSHS)

Mental Health & Substance Abuse Services

Mental Health & Substance Abuse Services

Prevention & Preparedness Services

Prevention & Preparedness Services

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Life Expectancy in TexasTotal and by Race, 1989 - 2007

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Ten Leading Causes of Death in Texas, 2007

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Actual Causes of DeathShaped by Behavior

0 5000 10000 15000 20000 25000 30000

Sexual Behavior

Homicide

DWI

Suicide

Drugs

Auto Accidents

Alcohol

Overweight/Obesity

Tobacco

Chronic Disease in Texas 2007, DSHS 5

Texas County Health Factors

6Source: County Health Rankings, Robert Wood Johnson Foundation, University of Wisconsin

Texas County Health Outcomes

7Source: County Health Rankings, Robert Wood Johnson Foundation, University of Wisconsin

Social Determinants

• Education

• Employment

• Income

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General Health “Fair to Poor”in Texas by Education

(2000 – 2009 BRFSS)

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Some College Rankings, Texas

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General Health “Fair to Poor” in Texas by Income Level

(2000 - 2009 BRFSS)

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Median Income Rankings, Texas

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Employment Rankings, Texas

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The Health Impact PyramidA Framework for Public Health Action

Thomas Frieden, MD, MPH, American Journal of Public Health, 04/2010, Vol. 100, no. 4 14

Health Challenges

• HIV• Mental health• Substance abuse and smoking• Infant mortality / prematurity• Health care quality• Obesity

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Ten Leading Causes of Death in Texas, Ages 18 – 44 Years, 2007

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Newly Diagnosed HIV Cases, Deaths, & Persons Living with HIV

(Texas, 1980-2008)

New HIV Cases

Deaths among HIV Cases

Living with HIV

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Mental Health Disorders

• 3% of Texans suffer from a severe, persistent mental illness

• Mental health disorders: the leading cause of disability in U.S.

• Individuals with serious mental illness have a life expectancy 25 years shorter than the overall population

• Inadequate treatment leads to an increase in costs related to crime, homelessness and uncompensated health care.

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The Costs of Substance Abuse in Texas

• In 2009, ~24,500 Texans died as a result of smoking

• Of the 2,865 newly reported AIDS cases in 2008, 15.5% were drug related

• ~ 75% of Texas prisoners are involved with alcohol or drugs

• 47% of Texas motor vehicle fatalities (2009) were alcohol-related• 23% of fatally injured drivers tested in Texas were found positive for

drugs (2009)

• The cost related to alcohol and drug abuse to Texans (2007) was ~ $33 billion• This includes health care, lost productivity, motor vehicle

accidents and crime

• Annual per capita cost for Texas residents: $2,800

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Past-Month Cigarette Use among Adults in Texas and the United States

37%

34%37%

37%38%39%

25% 26% 25%26%25%

39%41% 40% 39%

24%25%24%24%25%

0%

10%

20%

30%

40%

2002-2003 2003-2004 2004-2005 2005-2006 2006-2007

Survey Year

Perc

enta

ge

Texas - 18 to 25 years Texas - 26 years+US - 18 to 25 years US - 26 years+

20NSDUH 2002-2007

Past Month Cigarette Use Among Youth in Texas & US

2121NSDUH 2002-2007

Smoke Free Ordinances,Texas

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Infant Mortality/ Prematurity

• The infant mortality rate rose 9% from 2000 to 2006

– 6.2 deaths per 1,000 live births

• Texas pre-term birth rate in 2009 was 13.6% – National average: 12.3%

• The percentage of Texas infants born with low birth weight (under 5.5 pounds) rose from 7% in 1990, to 8.4% in 2007

– Totaling nearly 34,000 Texas infants

• Infant mortality and prematurity rates are significantly higher among non-white Texans

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Texas Infant Mortality(IMR) Rates by Race (1995 – 2008)

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Preterm Births by Race(Texas, 2000 – 2007)

Preterm Births in Texas by Race, 2000-2007

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8

10

12

14

16

18

20

2000 2001 2002 2003 2004 2005 2006 2007

Per

cent

Total White Black Hispanic Other

HP2010 Target

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Health Care Quality

• Health care quality is an emerging responsibility for the DSHS

• In the past few years, the department has been pulled more and more into issues such as health care associated infections, quality of care in health facilities, and standards of care

• The number of preventable health care associated infections (HAIs) continues to increase year over year• Leading cause of death from infectious diseases in the U.S. and in

Texas • HAIs kill 99,000 people each year• Cause an estimated 1.7 million infections in the U.S.

• HAIs are the leading cause of infectious deaths in Texas with:– 8,000-9,000 deaths each year– HAIs also add more than $500 million in annual medical costs

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Obesity

• 29% of Texans are obese• 66% of Texans are overweight or obese• >40% of Texans projected to be obese by 2040

• 3 of the 5 leading causes of death in Texas are:• chronic diseases linked with obesity• heart disease• cancer and • stroke

• Obesity cost Texas businesses 9.5 billion in 2009• Health care costs: $4 billion• Absenteeism costs: $1.6 billion• Disability costs: $322 million• Presenteeism costs: $3.5 billion• Total costs could reach $32 billion by 2030

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2006

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

2010

Obesity Trends* Among U.S. Adults

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Obesity Prevalence Trends in Texas Adults 1990 to 2010

33% of Texans are normal weight

29.5% of Texans are obese

Source: Texas Comptroller

140% increase in obesity

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39

9

28

15

41

23

0

10

20

30

40

50

Wei

gh

ted

%

White Black Hispanic

19902006

Obesity Adult Prevalence in TexasBRFSS 1990 vs. 2010

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Obesity Successes:

• Focus: – Community Wellness

• DSHS role: – Catalyst & Resource

• Strategy: – Work with broad array of partners

• Supports policy & environmental change around CDC target areas– One of 23 CDC-funded states conducting obesity

prevention activities

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CDC Targets for Obesity Prevention

Physical Activity

Fruits & Vegetabl

es

Breastfeeding

Sugar-Sweetened Beverages

High- Energy- Dense Foods

TV Viewing

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Fort Stockton & Corpus Christi

• Fort Stockton ISD worksite wellness program

• Pecos County Memorial Hospital breastfeeding promotion

• City Parks and Recreation Department program development

• Healthy entree restaurant initiative

Healthy Lifestyle Coalition

• CC in Motion worksite wellness initiative

• Coastal Bend Breastfeeding Coalition

• Walk Across Texas/Walk the Texas Star program

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Interagency Council on Obesity: DSHS, TEA & Texas Department of Agriculture

Interagency Obesity Council created to: • Enhance communication & coordination of obesity issues

among state leaders; • Guide planning around obesity prevention, health promotion

& improved nutrition

Recommendations (selected):• Continue collaboration between 3 agencies• Support social interventions• Strengthen K-12 nutrition education• Strengthen nutrition education & physical activities in early

childhood & after-school programs

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Coordinated School Health (CSH) and Campus Improvement Plans

• All elementary, middle and junior high schools required to implement a CSH Program

• Develop goals and objectives for CSH based on: • Fitness assessment data

• Academic performance

• Attendance rates

• Socioeconomic status

• The use of success of any method to ensure students are reaching required moderate or vigorous physical activity (MVPA)

• Any other indicator recommended by SHAC

• Include CSH Goals in all elementary, middle and junior high school Campus Improvement Plans

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State of Texas Nutrition Services & Education

• School district policy to prevent foods of minimal nutritional value

• Nutrition education to be provided in Kindergarten through 8th grade

• District-developed wellness policy required of each school district receiving reimbursable meal funding

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Breastfeeding & Obesity

• Infants who aren’t breastfed have increased risk for many acute and chronic conditions• Including a 32% excess risk for childhood obesity

• Many Texas mothers report barriers to achieving personal breastfeeding goals

• Breastfeeding activities coordinated across DSHS address barriers to optimal infant feeding outcomes

• Every Ounce Counts• http://www.breastmilkcounts.com/our-new-campaign.html

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Growing Communities Video

Highlights successful community-based strategies across Texas through short, documentary-style video clips• The videos were initially distributed to the 2009

Statewide Obesity Summit attendees • Recipients were charged to be “catalysts for change”

by hosting video screenings• Since the July 2009 launch, DSHS has made the

video series available online and in DVD format• www.dshs.state.tx.us/obesity/growingcommunity/default.shtm

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Partnerships Needed to Improve Health

DSHS

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ElectedOfficials

Non-TraditionalPartners

Providers & Hospitals

Higher Education

Community Groups

Community-basedSolutions

Urban Planners, Developers Architects

Worksites& Schools

Food Industry

Thank You!

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