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Preventing and Managing Chronic Conditions in

ChildrenFebruary 7, 2006

Debbie I. Chang, MPHExecutive Director and Senior Vice President

Nemours Health and Prevention Services

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Presentation Overview

Introduction to the Problem

Approaches to address the Problem

Nemours Community-Based Approach

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Healthcare Environment

Estimated $1.6 trillion spent on health care in 2003

70-80% of national health expenditures related to chronic conditions

Children consumed about 12% or $200 billion

The 10% of the sickest children consumed 69%; the top 20% accounted for 81%

Source: McGinnis, Health Affairs, 2002 & CDC, Wennberg

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Chronic Diseases

Influence Expenditures

10%

20%

70%

Moderate to Severe Chronic

Mild Chronic

Well andAcute Care 70%

20%

10%

2002

Increasing Prevalence of Chronic Diseases in Children

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Chronic Diseases Chronic conditions affect 3X as many children now

compared to 1960’s

Asthma:160% increase in rate over past 15 years for children <5 yr

Overweight: prevalence in children and youth (ages 6-19) has more than tripled over the last 35 years to over 15%

Many chronic diseases previously associated with adulthood are quickly becoming childhood concerns– 60% of overweight children aged 5-10 already have

a risk factor for heart disease such as high blood pressure or elevated insulin levels

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Health Promotion: Opportunities to address

chronic conditions Of the $1.6 trillion spent on health care annually

– 95% on direct medical care services– 5% on prevention/health promotion

Behavior and environment account for over 70% of avoidable mortality

Comprehensive health promotion involves: – The medical model– The lifestyle or behavioral approach– The social-environmental model

Socio-Environmental

Model

Lifestyle or behavioral approach

Medical Model

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Approaches to Children’s Health

Traditional Medical Model

Rigid adherence to biomedical view of health

Focused primarily on acute episodic illness

Focus on individuals

Cure as uncompromised goal

Focus on disease

Expanded Approach

Incorporate a multifaceted view of health

Chronic disease prevention and management

Focus on communities

Prevention as a primary goal

Focus on health

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4 Promising Approaches1. Debbie Chang – Nemours community-based health

promotion to address overweight in children

2. Tricia Leddy– Rhode Island’s systematic approach to understanding the problem with data, developing innovative solutions and evaluating results (case studies from lead paint and CSHCN in child care)

3. Charlie Homer – A medical home/chronic care model and practice improvements through learning collaboratives

4. Peggy McManus– Promising approaches to improving the interface between primary and specialty care in pediatrics

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Nemours Community-Based Health Promotion for

Children

First Approach:

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Nemours Overview Operating Foundation that provides pediatric

primary and specialty health care throughout DE, northern Florida, and also parts of southeastern PA, and southern NJ.

At these various operating sites, Nemours cares for more than 225,000 children annually through 870,000 patient visits.

In DE, Nemours cares for almost 55,000 children (1/4 of the state’s population of 0-17 year olds).

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NHPS Background 2003 Nemours redefined its approach: health as

well as health care

Nemours Health and Prevention Services (NHPS) was created and focuses on child health promotion & disease prevention to address root causes of health problems

Complements and expands the reach of clinicians with a broader, community-based perspective

Traditional Medical Care

Community-based health promotion

Nemours

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NHPS Philosophy

Health promotion must extend beyond the clinical setting to the whole child in his/her family & community

Long-term commitment; impact takes years to realize

Focus on broad health determinants; not medical care

Build on community strengths; do not duplicate existing efforts nor supplant existing resources

Collaborate with the community to leverage resources and maximize the reach and impact of our efforts

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Vision for Healthy Children requires a Cultural Shift

We are a catalyst, a change agent

Cultivate an environment that supports both behavior change and systems change for child health promotion– Behavior change means children choosing

healthier lifestyles – Systems change means the greater DE

community supporting these choices

Only this combination can result in lasting improvements in child health

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Our First Focus Area: Childhood Obesity

Prevention

Why must we move beyond the primary care office?

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The new social norm?

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Our children’s food environment

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Drive-thru makes it easy

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Even in hospitals and museums!

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Our Aspiration

To see a cultural change in which people place a high value on health, wellness and prevention. Where:– Children choose fruit instead of fries – Child care providers offer nutritious

snacks and physical activity – Families spend less time in front of a

screen– Insurers pay for health promotion and

prevention services

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Our Plan

NHPS catalyzes and supports changes in policy, programs and practices across the state

Unique role includes 3 core components:– Coalition Building and Strategic Partnerships– Dissemination of Knowledge and Best

Practices– Social Marketing

Strategically chosen to impact the most children in the shortest time

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Targets and Outcomes

Content Areas1) Healthy

Eating & Physical Activity

2) Emotional/ Behavioral Health

3) Community Capacity

Target Sectors1) Childcare2) Primary Care3) Schools4) Community

OutcomesImpact onDelawareChildren andCommunities

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Child Health Outcomes for 2015:

Obesity Prevention Improved child health behaviors

Policy changes and additional environmental/system supports in place to promote healthy eating and physical activity

Reduction in overall trajectory of overweight for children

Specific measures will be tracked over time in each area

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NHPS MissionTo be a leading catalyst for improving children’s

health in Delaware. To engage communities and work with partners to find, develop,

implement, evaluate and promote successful strategies to help children and their families

live healthier lives.

NHPS VisionOptimal health and development for all

children

Debbie I. Chang, MPHSenior Vice President and Executive DirectorNemours Health and Prevention Services252 Chapman Road, Christiana Bldg, Suite 200Newark, DE 19702dchang@nemours.org(302) 444-9100 (Office) (302) 444-9200 (Fax)

SummaryWe work with families and

communities to help children grow up healthy.

All the flowers of all the tomorrows are in the

seeds of today. - Anonymous