presentation luci frameworkx - oregon...pneumonia/influenza alzheimer's disease diabetes...
TRANSCRIPT
7/12/2011
1
Seizing the Moment and the Momentum to
Improve Population Health
Luci Longoria, MPH, Community Programs Lead
Health Promotion and Chronic Disease Prevention
New Coordinator Orientation Meeting
July 26, 2011
Today We Will Talk About
• What risk factors are causing premature death and disease and how are they doing it?
• What can we do?
• Overview of policy and effective public health action strategies
Leading Causes of Death in Oregon, 2005
0% 5% 10% 15% 20% 25% 30%
Pneumonia/influenza
Alzheimer's disease
Diabetes
Unintentional injuries
Chronic lower respiratory disease
Stroke
Cancer
Heart Disease
Percentage (of all deaths)
Source : National Center for Health Statistics
Oregon adults (18 to 24 years old) who have at least one chronic
disease (arthritis, asthma, diabetes, heart attack, angina or stroke)
or hypertension or high cholesterol
55%
Disparities and Chronic Diseases
0
10
20
30
40
50
Per
cent
of
Adu
lts
Arthritis
Asthma
Heart Attack
Heart Disease
Stroke
Diabetes
Source : BRFFS, 2004-2005
Non-LatinoAfrican
Americans
American IndiansAnd Alaska
Natives
Asians andPacific
Islanders
Latinos Non-LatinoWhites
EconomicallyDisadvantaged*
* Household income <= 100% of Federal Poverty Level or not completed high school
Cost of Treating Chronic Diseases
• Overall 75¢ of every dollar
• Medicare96¢ of every dollar
• Medicaid83¢ of every dollar
(includes asthma, arthritis, cancer, heart disease, stroke, diabetes, and COPD)
Source : Partnership to Fight Chronic Disease at http://www.fightchronicdisease.org/issues/about.cfm ; An Unhealthy Truth
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What’s Really Killing Oregonians
0 1000 2000 3000 4000 5000 6000 7000 8000
Illicit Use of Drugs
Sexual behavior
Firearms
Motor Vehicles
Microbial Agents
Toxic Agents
Alcohol
Diet/Activity Patterns
Tobacco
* Includes alcohol-related crashes
Source : CD Summary, May 17, 2005, Vol. 54, No. 10
Up to 39% of the 30,813
deaths were attributable to behavioral causes
Disparities and Smoking (2004-2005)
Source : BRFSS, 2004-2005
0
10
20
30
40
Per
cent
of A
dul
ts
Non-LatinoAfrican
Americans
American IndiansAnd Alaska
Natives
Asians andPacific
Islanders
Latinos Non-LatinoWhites
EconomicallyDisadvantaged
There’s a health crisis in the USObesity & Chronic diseases: we eat…
There’s a health crisis in the USObesity & Chronic diseases: we’re inactive
Current Community Conditions
Often do not foster or encourage walking or biking
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13
Something Can Be Done
LargestImpact
SmallestImpact
Health Impact Pyramid: Factors that Affect HealthExamples
Your doctor tells you to eat healthy, and be physically active
Rx for high blood pressure, high cholesterol, diabetes
Poverty, education, housing, inequality
Cessation treatment, evidence-based self-management, colonoscopy
0g trans fat, smoke-free laws, tobacco tax
Socioeconomic Factors
Changing the Contextto make individuals’ default
decisions healthy
Long-lasting Protective Interventions
ClinicalInterventions
Counseling & Education
Frieden, TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J of Public Health., 2010
CDC Focus:
Policy, systems, environmental change(“changing the context”)
•Change the environment to make healthy choices the default value
•Be scalable to regional, state, and national levels
•Have a solid evidence base
•Be measurable to ensure progress is made
CDC’s Recommendations for Communities
• Smoke-free policies
• Taxation
• Hard-hitting counter-marketing
• Proactive earned media
• Marketing restrictions
• Surveillance data
CDC’s recommended core package for tobacco control in communities
Prevention is the best buy for healthier communities
• Prevention in community policy increases health value from health dollars
• Prevention can reduce per capita annual costs
• Health reform recognizes importance of prevention
• Coverage for preventive care
• Prevention funding
• Support for public health infrastructure
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HPCDP Framework based on:
� Socio-Ecological Model
� HPCDP Programs’ Best Practices
� HPCDP Vision and Mission
� Urgency and opportunity
PUBLIC POLICY
COMMUNITY
ORGANIZATIONAL
INTERPERSONAL
knowledge,attitudes, skills
INDIVIDUAL
Socio-Ecological Model
Oregon’s Tobacco Prevention and Education Program Works
85.8
82.1
77.4
73.771.7
67.965.1
63.361.1
58.9
55.552.6
84.2
79.9
72.0
68.666.6
60.9
55.253.2
54.7 55.5
50.448.4
93.1
90.689.5
87.7 86.9
98.796.6
94.6 94.3
89.5
20
30
40
50
60
70
80
90
100
FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09
Fiscal Year
Pac
ks p
er c
apita
US
Oregon
Oregon Tobacco Prevention
Program cut over 50%
Oregon Tobacco Prevention
Program started
Oregon Tobacco Prevention
Program funding reinstated
Looking towards the future…
7/12/2011
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“We know how to end the epidemic. Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking rates, tobacco-related deaths, and diseases caused by smoking.”
CDC Best Practices for Comprehensive Tobacco Control Programs, 2007
Healthy Communities, Healthy Living:A National Movement