Healthy Gente 2010: History and Health Measures

Sam NotzonSam NotzonNational Center for Health StatisticsNational Center for Health Statistics

Topics to Cover:

Background informationBackground information

Statistical considerationsStatistical considerations History of Healthy GenteHistory of Healthy Gente Health measuresHealth measures

Dangers of Statistical Analysis:

In a recent study of the effects of a In a recent study of the effects of a new chicken food:new chicken food:

33.3% gained weight;33.3% gained weight; 33.3% lost weight;33.3% lost weight; the other chicken ran away.the other chicken ran away.

(Source: anonymous reporter)(Source: anonymous reporter)

Statistical Issues:

Small number problemSmall number problem

Racial and ethnic identificationRacial and ethnic identification

U.S. Counties Included in Border Region

2000 Population

55.1 million

6.6 million

Population trends in U.S.-Mexico border 1970-2020

2.73.4

4.5

6.4

7.3

8.3

3.1

4.3

5.5

6.6

7.9

9.4

1

2

3

4

5

6

7

8

9

10

1970 1980 1990 2000 2010 2020

Mexico borderU.S. border

Population in millions

Projections

*Persons of Hispanic/Latino origin may be any race.Source: Census 2000 Summary File 1, U.S.Bureau of the Census.

0.7 3.7

69.1

12.612.1

0

20

40

60

80

Distribution of the population by specified race/ethnicity: United States, 2000

Black/African American,non-Hispanic

American Indian/Alaska Native,non-Hispanic

Hispanic/Latino*

White, non-Hispanic Asian/Native Hawaiianand Other Pacific Islander,

non-Hispanic

Percent

42.1

32.4

32.0

25.3

19.7

17.1

16.8

15.1

13.3

12.3

12.6

0 10 20 30 40

United States

New Mexico

California

Texas

Arizona

Nevada

Colorado

Florida

New York

New Jersey

Illinois

Percent of population that is Hispanic/Latino:United States and ten States with largestproportion of Hispanic/Latino residents, 2000

Source: Census 2000 Summary File 1, U.S.Bureau of the Census. Percent

Selected States

Source: Census 2000 Summary File 1, U.S.Bureau of the Census.

2.0

2.5

4.1

0

1

2

3

4

American Indian/Alaskan Native population, 1990 and 2000

2000AIANOr

Combination

1990 2000AIANalone

Number in millions

(+25%)

(+ 110%)

SocioeconomicDifferentials

Percent with education less than 9 years,United States 2000

0

5

10

15

20

25

30

35

USA State Border .

Per

cent NHWhite

HispanicAIAN

Source: 2000 Census, United States

Percent with education less than 9 years,United States 2000

0

5

10

15

20

25

30

35

USA State Border

Per

cent

0

5

10

15

NHWhite

Hispanic

AIAN

Ratio

Source: 2000 Census, United States.

Percent with no telephone access,United States 2000

Projections

0

1

2

3

4

5

6

USA State Border

0

1

2

3

4

5

NHWhite

Hispanic

Ratio

Source: 2000 Census, United States.

Per capita income, United States 1999

Projections

0

5000

10000

15000

20000

25000

30000

35000

USA State Border

0

1

2

3

NHWhite

Hispanic

Ratio

Source: 2000 Census, United States.

Health Disparities

Medically Underserved Border Counties, 1998

Underserved Border Counties Entire County

Portion

Not Underserved

Source: HRSA.

Death rates by cause, US border counties, 2000

0

100

200

300

400

500

600

700

800

900

Total Heart Cancer Stroke

NHWhiteHispanic

Source: NCHS/CDC.

Rate per 100,000

Note: Rates are age-adjusted to the US 2000 population.

Death rates by cause, US border counties, 2000

0

10

20

30

40

50

NHWhite

Hispanic

Source: NCHS/CDC.

Rate per 100,000

Note: Rates are age-adjusted to the US 2000 population.

Communicable Diseases, US border

Disease rates by ethnicity not currently Disease rates by ethnicity not currently available, but Hispanic excesses have been available, but Hispanic excesses have been documented for:documented for: Hepatitis AHepatitis A BrucellosisBrucellosis ShigellosisShigellosis TuberculosisTuberculosis OthersOthers

US-Mexico Border Health Commission:

Healthy Border/Healthy Gente Program

Healthy Border/Healthy Gente Program Timeline:

1998: First meeting of Design Team and birth of 1998: First meeting of Design Team and birth of Healthy Gente conceptHealthy Gente concept

Jan. 2000: US Section Commissioners appointedJan. 2000: US Section Commissioners appointed Jan. 2000: HG objectives finalized, presented at Jan. 2000: HG objectives finalized, presented at

launch conference for Healthy People 2010launch conference for Healthy People 2010 Nov. 2000: HG workshop, S. Padre IslandNov. 2000: HG workshop, S. Padre Island Mar. 2001: Second meeting of Commission; US & Mar. 2001: Second meeting of Commission; US &

Mexico agree to Healthy Border ProgramMexico agree to Healthy Border Program

Healthy Border/Healthy Gente Program

Program of health education and health promotionProgram of health education and health promotion Establishes priority health objectives for the Establishes priority health objectives for the

border regionborder region Healthy Healthy GenteGente Program based on U.S. Healthy Program based on U.S. Healthy

People 2010 ProgramPeople 2010 Program Healthy Border Program combines Healthy Healthy Border Program combines Healthy GenteGente

objectives with Mexico’s objectives with Mexico’s Indicadores de Indicadores de ResultadosResultados Program Program

Healthy Border/Healthy Gente Objectives

Focus attention on key health issuesFocus attention on key health issues Improve allocation of health resourcesImprove allocation of health resources Coordinate public and private actionCoordinate public and private action Inspire ownership of objectivesInspire ownership of objectives Achieve objectives through:Achieve objectives through:

coordinated program activitiescoordinated program activities community projectscommunity projects

Selection Criteria

Key health issues for borderKey health issues for border Measurable objectivesMeasurable objectives Limited numberLimited number Compatible with federal and state Compatible with federal and state

objectivesobjectives

Healthy Border/Healthy Gente Program

25 Healthy 25 Healthy Gente Gente objectivesobjectives

20 Healthy Border objectives20 Healthy Border objectives

Access to Care

25 percent reduction in persons lacking access to primary care provider in underserved areas

Medically Underserved Border Counties

Underserved Border Counties Entire County

Portion

Not Underserved

Cancer

Reduce breast cancer death rate by 20 Reduce breast cancer death rate by 20 percentpercent

Reduce cervical cancer death rate by Reduce cervical cancer death rate by 30 percent30 percent

Breast Cancer1998-2000

0.0 5.0 10.0 15.0 20.0 25.0 30.0Rate per 100,000 population

USABDR-TOTBDR-TXBDR-AZBDR-NMBDR-CAAZ-YMTX-HITX-MKTX-CMNM-DACA-SD

Border Breast Cancer Death Rates

0

5

10

15

20

25

30per 100,000 population

20%

Healthy GenteGoal

Diabetes

Reduce diabetes death rate by 10 Reduce diabetes death rate by 10 percentpercent

Reduce hospital admissions for Reduce hospital admissions for diabetes by 25 percent diabetes by 25 percent

Diabetes Mortality1998-2000

0 5 10 15 20 25 30 35 40 45 50 55 60Rate per 100,000

USABDR-TOTBDR-TXBDR-NMBDR-AZBDR-CATX-MKTX-ELAZ-SCTX-CMCA-IMCA-SD

Source: NCHS, CDC; age-adjusted to US 2000 population

Border Diabetes Death Rate

0

5

10

15

20

25

30per 100,000 population

10%

“Healthy Gente” Goal

Environment

All countries will meet or exceed EPA air quality standards All households will be connected to public

sewage systems or septic tanks Reduce hospitalization for acute pesticide poisoning by 25 percent

Border Counties and EPA Air Quality Standards

In Compliance

Not in Compliance

Compliance Status

HIV

Reduce adolescent and adult HIV cases Reduce adolescent and adult HIV cases by 50 percent by 50 percent

Border HIV+ Incidence Rate

0

1

2

3

4

5

6

7

8

9

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

per 100,000 population

50%

“Healthy Gente” Goal

Source: State Health Departments of Arizona, New Mexico, Texas.

Immunizations and Infectious Diseases

Reduce incidence of hepatitis A and Reduce incidence of hepatitis A and hepatitis B by 50 percenthepatitis B by 50 percent

Reduce incidence of tuberculosis by 50 Reduce incidence of tuberculosis by 50 percentpercent

Raise and maintain immunization Raise and maintain immunization coverage rate at 90 percentcoverage rate at 90 percent

Border Hepatitis A and B Rates

05

1015202530354045

Hepatitis A

Hepatitis B

per 100,000 population

50%

“Healthy Gente” Goal

Source: State Health Departments of Arizona, California, New Mexico, Texas.

Injury/Violence Prevention

Reduce motor vehicle crash deaths by 25 percent

Reduce childhood death rate due to unintentional injuries by 30 percent

Motor Vehicle Crash Deaths1998-2000

0 5 10 15 20 25 30Rate per 100,000

USA

BDR-TOT

BDR-NM

BDR-AZ

BDR-TX

BDR-CA

CA-IM

AZ-YM

TX-HI

CA-SD

TX-WB

Source: NCHS, CDC; rates age-adjusted to US 2000 population

Border Motor Vehicle Death Rate

0

2

4

6

8

10

12

14

16per 100,000 population

25%

“Healthy Gente” Goal

Maternal and Child Health

Reduce infant mortality rate by 15 percent. Reduce infant mortality rate due to all birth

defects by 30 percent Raise first trimester prenatal care initiation to 85

percent Reduce young teen pregnancy rate by 33 percent

Initiation of Prenatal Carein First Trimester, 2000

0 20 40 60 80 100Percentage

USABDR-TOTBDR-CABDR-AZBDR-NMBDR-TXCA-SDTX-VVAZ-PMTX-WBTX-HINM-LU

Source: NCHS, CDC

Border Prenatal Care in First Trimester

4045505560657075808590

percent “Healthy Gente”

Goal

Source: NCHS/CDC.

Mental Health

Reduce suicide death rate by 15 Reduce suicide death rate by 15 percentpercent

Suicide Mortality1998-2000

0 5 10 15 20Rate per 100,000

USABDR-TOTBDR-NMBDR-AZBDR-CABDR-TXAZ-PMAZ-YMNM-DACA-IMTX-VVTX-HI

Source: NCHS, CDC; rates are age-adjusted to the US 2000 population.

Border Suicide Death Rate

0

2

4

6

8

10

12

14per 100,000 population

15%

“Healthy Gente” Goal

Nutrition and Overweight

Reduce the proportion of adults who Reduce the proportion of adults who are obese to 15 percentare obese to 15 percent

Proportion Obese,1988-94

Source: NCHS, CDC

0 10 20 30 40 50

White

Black

M-A

Border M-A

Total

WomenMen

Percent

Oral Health

75 percent of population served by flouridated community water systems

75 percent of children and adults use oral health care system each year

Respiratory Diseases

Reduce asthma hospitalization rate by Reduce asthma hospitalization rate by 40 percent40 percent

Substance Abuse

Reduce the number of alcohol-related motor vehicle crash deaths by 50 percent

Increase to 89 percent the proportion of teenagers not using alcohol or any illicit drugs in past 30 days

Alcohol-Related Motor Vehicle Crash Deaths, 1998

Source: NHTSA, DOT.

36.6

44.2

54.0

31.6

45.6

35.6

52.5

49.2

47.1

44.7

38.6

0 10 20 30 40 50 60

Percentage

USA

BDR-TOT

BDR-NM

BDR-AZ

BDR-TX

BDR-CA

AZ-YL

CA-IM

TX-HI

TX-WB

CA-SD

BAC 0.01+Alcohol Related

BAC 0.01+ Border Alcohol-Related Motor Vehicle Crash

0.00

10.00

20.00

30.00

40.00

50.00

60.00

50%Percentage

“Healthy Gente” Goal

Percent

Tobacco Use

Reduce teen and adult tobacco use by Reduce teen and adult tobacco use by one-thirdone-third

Cigarette Use in Past MonthAdolescents 12-17 Years of Age, USA

0

5

10

15

20

25

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

Percent

Source: SAMHSA

Additional Statistical Resources

Additional Statistical Resources

Hospitalization/morbidity data: Asthma, diabetes: Hospital discharge data files from each state Pesticide poisoning: State poison control centers

Risk factor information (obesity, smoking, drug use, health insurance, dental care):

Border Binational RFSS - 2005