chronic disease prevention november 20, 2008. objectives background: setting the stage status of...
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Chronic Disease Prevention
November 20, 2008
Objectives
Background: Setting the Stage
Status of Chronic Diseases in San Diego
Evidenced-based Best Practices
HHSA Chronic Disease Prevention Model
Setting the Stage
Why Chronic Disease?
Why Chronic Disease?Why Chronic Disease?• California Conference for Local
Public Health Officers (CCHLO)– Chronic Disease Conference– Spurred Idea to develop CC Agency for
Agency • Two meeting held to date to develop an
inventory of Agency Chronic Disease activities
– SPOS came to PHS to conduct a “Focused Dialogue”
– Chronic Disease was chosen
What Is Chronic Disease?What Is Chronic Disease?
• According the U.S. National Center for Health Statistics, is a disease that lasts 3 months or more.
• Cannot be prevented by vaccines or cured by medications.
• Caused by health damaging behaviors - particularly tobacco use, lack of physical activity, and poor eating habits.
• Is the leading cause of death and disability in the United States.
• Accounts for 7 of the 10 U.S. leading cause of death.
Why Should We Care?
• Chronic diseases are prevalent, preventable and costly!
• Cause extended pain and suffering, associated with decreased quality of life for millions.
• Treatment for seven chronic diseases including cancers, mental illnesses, heart disease, lung conditions, hypertension, stroke, and diabetes ran to nearly $280 billion in 2003; now estimated to be to $1.3 trillion per year.
• Prevention programs are highly cost-effective
Top 10 Causes of Mortality in San Diego County
Rate
Rank 2004
Rank 2005
Cause of Death 2004 2005
1 1 Heart Disease 183.7 172.6
2 2 Cancer (any) 166.3 163.1
3 3 Stroke 49.8 41.3
4 5COPD/Chronic lower respiratory diseases
38.3 39.1
5 4 Alzheimer's Disease 38.1 36
6 6 Unintentional injuries 28.6 28.5
7 7 Diabetes mellitus 19.1 21.1
8 8 Influenza & pneumonia 16.6 14.3
9 9 Suicide 10.4 9.9
10 10Essential (primary) hypertension and hypertensive renal disease
9.1 9.4
Rates are per 100,000 population. Source: State of California, Department of Public Health, Center for Health Statistics, Vital Statistics Section, Death Statistical Master Files
= Chronic Diseases
Death by Risk Factors
Physical Activity by Gender
Per
cen
t
WomenNutrition by Gender
0
20
40
60
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Men
Women
Men
PA and Nutrition Trends
Healthcare Cost in California and San Diego
• $130 Billion spent (treatment and lost productivity) by California in 2003
• $4.3 Billion in SD County (not including lung cancer treatment)
3 – FOUR – 503 RISK FACTORS
(Tobacco Use, Poor Diet, Lack of Physical Activity)
4 CHRONIC DISEASES(Heart Disease/Stroke, Type 2 Diabetes, Respiratory Disease, Cancer)
50% of DEATH
Status of Chronic Diseases
in San Diego
What Are the Statistics?
*2006 U.S. data are preliminary
Life Expectancy at Birth: San Diego vs. U.S. Population, 2000-2006*
80.6 80.580.7 80.7
80.580.7
77.077.2 77.3 77.4
77.8 77.878.1
80.8
75.0
76.0
77.0
78.0
79.0
80.0
81.0
82.0
2000 2001 2002 2003 2004 2005 2006*
Year
Age
San Diego U.S.
LIFE EXPECTANCY TRENDSSan Diego County vs United States, 2000-2006
San Diego County PopulationSan Diego County Populationby Race/Ethnicity, 2007by Race/Ethnicity, 2007
Source: SANDAG, San Diego County 2007 Population Estimates
• 3 million people
• Racial/Ethnic groups from around the world.
• Over 100 languages
Asian 9.4%N=292,251
White 51.6%N=1,597,847
Black 5.4%N=166,486
Hispanic 29.3%N=906,898
Hawaiian/Pacific Islander 0.4%N=13,144American Indian
0.5 %N=15,946
San Diego County PopulationSan Diego County Populationby Race/Ethnicity, Census 1990 vs. 2000 vs. 2007by Race/Ethnicity, Census 1990 vs. 2000 vs. 2007
0
10
20
30
40
50
60
70
Hispanic White Black AmericanIndian
Asian
1990 2000 2006
Source: SANDAG, San Diego County 1990, 2000 Census, and 2007 Population estimates
Between 1990 & 2000:
• The population of Hispanics and Asian increased
• The population of Whites and Blacks decreased
Percent
105.7
145.4173.5
216.6
0
50
100
150
200
250
300
White Black Hispanic Asian/Other
Race/Ethnicity
Rat
e p
er 1
00,0
00
All Cancer DeathsAll Cancer Deathsby Race/Ethnicity, 2005by Race/Ethnicity, 2005
Note: All rates are adjusted to 2000 Standard U.S. Population.Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.
Cancer is the
second leading
cause of death
for San Diego
County
San Diego County Overall Rate, 2005: 163.1 / 100,000
HP 2010 Goal: 159.9
Selected Cancer DeathsSelected Cancer Deathsby Race/Ethnicity, 2005by Race/Ethnicity, 2005
0
10
20
30
40
50
Lung F. Breast Prostate Colorectal
Race/Ethnicity
Rat
e p
er 1
00,0
00
White Black Hispanic Asian/Other
Note: All rates are adjusted to 2000 Standard U.S. Population.Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.
HP 2010 Goal
Coronary Heart Disease and Stroke Deathsby Race/Ethnicity, 2005
0
50
100
150
200
250
300
White Black Hispanic Asian/Other
Race/Ethnicity
Rat
e p
er 1
00,0
00
CHD Stroke
Note: All rates are adjusted to 2000 Standard U.S. Population.Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.
Blacks have the highest rate of coronary heart disease deaths and stroke
deaths compared toother racial and ethnic groups.
HP 2010 Goal CHD: 166.0
HP 2010 Goal Stroke: 48.0
San Diego County Overall: CHD Rate - 128.4 / 100,000 Stroke Rate – 41.3 / 100,000
Diabetes Diabetes by Race/Ethnicityby Race/Ethnicity
Source: Youth Risk Behavior Survey (YRBS), San Diego City Schools; California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates; California Health Interview Survey (CHIS), California Department of Health Services, Death Statistical Master File.
R/E
HospitalAdmissions
2005
Deaths (underlyin
g)2005BlackWhite
HispanicAsian/Other
69.016.633.521.2
303.587.1236.087.6
10.77.7
18.47.4
% High School
Students Overweigh
t 2005
Prevalence of Diabetes
Among Adults 2005*
6.65.16.57.2
* - Percentage of adults who were ever diagnosed with diabetes
Diabetes Mortality
Among the top 53 U.S. City/County jurisdictions
San Diego County:
• Ranked 52 in 1990
• Ranked 46 in 2004
• Ranked 8th in the highest rate of change between 1990 and 2004
Source: NACCHO 53 Big Cities Health Inventory, 2007
Note: Ranking scheme - 1 being worst and 53 being best
Diabetes Mortality Among San Diego County Residents, 2000-2005
481 491 475499
531
60419.2 19.3
18.3 18.6 19.1
21.1
0
100
200
300
400
500
600
700
800
2000 2001 2002 2003 2004 2005
Dea
ths
0
5
10
15
20
25
Rat
e pe
r 10
0,00
0
Deaths Rate
Deaths and Age-adjusted Rates
HP2010= 45
Diabetes Hospitalizations Among San Diego County Residents, 2001-2005
28833041 3166 3244
3406108.1 111.8 112.9 113.8
118.1
0
1000
2000
3000
4000
5000
2001 2002 2003 2004 2005
Hos
pita
liza
tion
s
0
50
100
150
Rat
e pe
r 10
0,00
0
Hospitalizations Rate
Number and Age-adjusted Rates
Diabetes Hospitalizations Among San Diego County Residents, 2001-2005
276.7 283.4
327.7
274.6303.5
207.7 212.9 212224.6 236
87.7 88 87.5 88 87.173.1 75.3 78.1 75.4
87.6
0
100
200
300
400
2001 2002 2003 2004 2005
Rat
e pe
r 10
0,00
0
Black Hispanic White Asian/Other
By Race/EthnicityNumber and Age-adjusted Rates
Overweight & Obese Adults* Overweight & Obese Adults* by Race/Ethnicity, 2005by Race/Ethnicity, 2005
16.126.5 26.9
9.8
37.530.4 35.3
33.5
0
25
50
75
100
White Black Hispanic Asian
Race/Ethnicity
Per
cen
tag
e (%
)
Obese (BMI >30) Overweight (BMI 25-30)
* as Defined by Body Mass Index (BMI)* as Defined by Body Mass Index (BMI)Source: 2005 California Health Interview Survey (CHIS)
HP 2010 Goal
Obesity (BMI >30):
15%
Unhealthy weight (BMI>25): 40%
Asthma in San Diego CountyAsthma in San Diego Countyby Race/Ethnicityby Race/Ethnicity
Source: 2005 California Health Interview Survey (CHIS), California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates. California Department of Health Services, Death Statistical Master File
* - These results for Blacks reflect 2003 data results since sample size for Blacks in 2005 was statistically unreliable.
Race/Ethnicity
Hospitalization Rate, 2005
Average Annual Number
of Deaths2002-2004
BlackWhite
HispanicAsian/Other
318 3 4
204.759.374.962.6
Estimated Prevalenc
eAmong
Children 200513.8*
9.612.411.7
Selected Health Indicators*San Diego County, CA, & US, HP2010
Indicator
• Infant Mortality• Adults reporting poor/fair health• Incidence of AIDS• CHD Deaths• Suicides• F. Breast Cancer Deaths• Unintentional Injury Deaths
San Diego
County CA U.S.
Healthy People 2010 Goal
4.614.4%14.0
144.410.522.928.8
5.316.0%11.8
162.88.5
24.130.5
7.014.0%15.0
159.610.726.037.7
4.5None1.0
166.05.0
22.3
* - These data reflect the most current comparable data
The numbers above reflect either rates or percentages
Evidence-based Best
Practices
Do They Work?
Direction from the National Level
• Federal Government Agencies
– United States Department of Agriculture
– United States Surgeon General
– Centers for Disease Control
“Healthy places are those designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders -- where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options.”
CDC’s “Designing & Building Healthy Places”
• Leading Public Health Organizations– National Association of County and City Health Officials– National Task Force on Community Preventive
Services– Robert Wood Johnson Foundation – Kaiser Permanente– American Planning Association (funded by CDC)
Direction from the National Level
• Public– California Conference of Local Health
Officers– California Department of Public Health– Governor's Obesity Prevention Plan
• Private– The California Endowment– Strategic Alliance
Direction from the State Level
Best Practices and Promising Interventions
1. Healthy Community Improvements
2. Healthy Community Development
3. Healthy Community Plans & Policies
1. Healthy Community Improvements
Partnering with communities and cities to improve existing physical and social conditions that prevent physical activity and healthy eating
Best Practices and Promising Interventions
Healthy Community Improvements
• Safe and healthy routes to schools, parks, healthy foods, seniors– Traffic calming, improve street
crossings
• Installing/improving sidewalks & bike paths
• Community gardens
• School/community joint use agreements
Safe and Healthy Routes to Schools and Parks, Healthy Foods, Seniors
AARP
- assessments
- advocates
From abandoned lots to community gardens…
Create gardens for culturally appropriate foods reflective of the community.
CX3 Projects (Chula Vista & La Mesa)Communities of Excellence in Nutrition, Physical Activity and Obesity
Prevention
• Strong Partnerships• Leadership Training• Youth &
Mentors
• Community Assessment• Advocacy
OutcomesLa Mesa Chula Vista
$550,000 Safe Routes to School grant to improve sidewalk connectivity
Community “reclaimed” Lauderbach Park
2. Healthy Community Development
Promoting healthy development and redevelopment projects in neighborhoods
Best Practices and Promising Interventions
Healthy Community Development
• Integrating “Healthy Places” design into the Development Review process
• Redevelopment areas
• Grocery stores in underserved areas
• Facility design
Helping Communities get Developments Designed for “Health”
Trails and Trail Access Points
Eliminating Food Deserts… Attracting a Grocery Store into East Oakland, CA
Partners: East Oakland Diabetes Work Group, Alameda County Department of Public Health, Network for a Healthy California
3. Healthy Community Plans & Policies
Promoting healthy government, school and worksite policies and plans that support physical activity, healthy eating and tobacco-free environments
Best Practices and Promising Interventions
Healthy Community Plans & Policies
• Land use & transportation planning
• Affordable housing policies
• Regional Food Systems & Urban Agriculture
• Worksite Wellness policies
• Government Wellness policies
• School Wellness policies
City of Richmond General Plan Update
City of Richmond Health and Wellness Element
Policy Framework
www.healthycommunitiesbydesign.org
School Wellness Gardens
Classroom Garden Beds Quad Area with Gardening
Healthier Vending Machines
→
→
Chronic Diease Model
Will it Work?
Individuals Families
Neighborhoods
Policies and
Laws
Socio-Ecological Model
Businesses
Environmental Approaches to Tobacco: The California Model
• Prop. 99 Tobacco Tax Funds
• Local Ordinances and State Legislation for Smoke-Free Environments
• Massive Anti-Tobacco Campaign
California vs. The US
• Smoking Rates
• Lung Cancer Death Rates
Pe
rce
nt
American Lung Association of California
Centers for Disease Control, National Cancer Institute, statecancerprofiles.cancer.gov
Tobacco and Heart Attacks• Pueblo, Colorado
– Decrease in heart attack rates by 28% after smoke-free ordinance
• 399 HA pts in 1.5 yrs prior to ordinance, only 291 HA pts in 1.5 yrs after
• Helena, Montana– Decrease in heart attack rates by 40% during
first 6 months of smoke-free ordinance
Why Act Now?
Chronic Disease Prevention is strategic:
– Fundamental to reducing death and disability and improving community health
– Critical to cutting health care costs
– Experience to-date shows that strategies can be very cost-effective
– Funding opportunities for strategies that focus on environmental change
At its Foundation…
Place Matters
Adopting the concept that neighborhood environmental
factors all affect individual behaviors and health
From Policy Link and
The California Endowment
Why Place Matters: Environmental Strategies
• Physical Environment– Safe parks; full-service grocery stores
and farmers’ markets; safe, walkable streets; less truck and bus traffic; well-maintained housing; open spaces.
• Social Environment– Strong social networks that bring
neighbors together—whether to advocate for change, cultivate a community garden, or provide services.
Why Place Matters: Environmental Strategies
• Economic Environment– Commercial investment, jobs that take
people out of poverty, businesses that provide healthy food options.
• Service Environment– Access to quality healthcare services,
public safety, and community support services.
Understanding the problem
Heart Disease/StrokeType 2 Diabetes
CancerRespiratory Disease
Poor environments Unhealthy behaviors Chronic Diseases
Adopting a new solution
Healthy environments Healthy Behaviors Disease Reduction
Reduction in:Heart Disease/Stroke
Type 2 DiabetesCancer
Respiratory Disease
QA & Comments