Prevention and Wellness:Key Issues

Senate Committee on Health and Human Services

Tuesday, August 26, 2008

David L. Lakey, M.D.Commissioner

Presentation Overview

• Public Health and Improvements in Quality of Life

• Chronic Diseases– Behavioral Changes

• Infectious Diseases– Immunizations

Role of DSHS in Disease Prevention and Management

• Population-based prevention and health promotion

• Promoting healthy lives for Texas families through education, prevention and early detection

• Reduce premature disability and death by promoting healthy lifestyles

U.S. Life Expectancy at Birth

30

35

40

45

50

55

60

65

70

75

80

1900 1910 1918 1920 1930 1940 1950 1960 1970 1980 1990 2000

1918 Flu Epidemic

Increased Life Expectancy Driven by Public Health Improvements

Source: Ten Great Public Health Achievements – United States, 1900-1999 MMWR, April 02, 1999 / 48(12);241-243 http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm

47 years

77 years

0

20

40

60

80

1900 2000

Increased years due to

medical care advances:5

Increased years due to

public health measures:25

Leading Causes of Death

1900

• Pneumonia

• Tuberculosis

• Diarrhea

• Heart Disease

• Intracranial Lesions

1998

• Heart Disease

• Cancers

• Cerebrovascular Disease

• Chronic Obstructive Pulmonary Disease

• Accidents

Leading Causes of Death

0 10000 20000 30000 40000 50000

Alzheimers

Flu & Pneumonia

Diabetes

Lower Respiratory Disease

Accidents

Stroke

Cancer

Heart Diseases

DSHS Center for Health Statistics

Texas 2001

Chronic Disease Prevention• Chronic diseases—such as heart disease, cancer,

and diabetes—are the leading cause of death and disability in Texas

• Although they are among the most common and costly health problems, they are also among the most preventable

• Adopting healthy behaviors can prevent or control the devastating effects of these diseases.

Actual Causes of Death*Shaped 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*Texas 2001

TobaccoPrevention and Cessation

• Tobacco is the number one preventable cause of premature death and disability in Texas

• Costs nearly $11 billion annually in medical care and health-related productivity losses

• The Institute of Medicine has issued recommendations for a multi-pronged approach to tobacco use including:– Enact smoke-free legislation or ordinances for public spaces– Increase unit price of tobacco products– Conduct mass media education campaigns combined with other

community interventions– Provide telephone-based cessation counseling– Implement health care provider reminder systems

Percentage of Texas Municipal Population Protected by 100% Smoke-Free Ordinances in Five Settings*

Passage of Smoke-Free Ordinances in Texas

Percentage of Texans Protected by Smoke-Free Ordinances Applicable to Workplaces, Restaurants, and Bars

TobaccoPrevention and Cessation

• DSHS’ primary focus is on tobacco cessation and prevention

• Initiatives include:– Quitline in partnership with American Cancer Society– Tobacco prevention and control coalitions– Interagency contract with TEA– Youth leadership activities– Smokeless tobacco prevention education– Targeted media messages

Proposals for Consideration by the 81st Legislature – Tobacco

• DSHS will have an exceptional item to expand existing tobacco prevention efforts through:– Increasing availability of cessation services– Increasing the number of community coalitions

providing comprehensive activities– Increasing youth prevention activities

1998

Obesity Trends* Among U.S. Adults(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2007

1990

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

Source: CDC Behavioral Risk Factor Surveillance System

Cost of Obesity for Texas

• Obesity, along with physical inactivity and poor nutrition, is linked to many chronic diseases

• Human Costs– Early disabilities and diminished quality of life– Shorter than expected life span

• Financial Costs– Obesity cost Texas businesses an estimated $3.3 billion

in 2005– Includes the cost of healthcare,

absenteeism, decreased productivity and disability

Obesity Prevention

• DSHS Nutrition, Physical Activity, and Obesity Prevention Program initiatives include:– Grants for community demonstration projects

– Farm-to-Work

– Statewide obesity partnership conference

– Technical assistance and training to communities on obesity prevention

– State employee wellness program

Obesity Prevention

• Other DSHS programs– Training and technical assistance to school districts on

coordinated school health programs (through TEA Education Service Centers contracts)

– Title V/WIC initiatives include:• Staff wellness program• Obesity prevention grants to local WIC agencies• Children’s and Postpartum physical activity programs• Nutrition classes and counseling for low income families

– Partnerships with academic institutions and the private sector

Proposals for Consideration by the 81st Legislature – Obesity

• DSHS will have an exceptional item to expand existing obesity prevention efforts through:– Healthy Communities Program– Mayor’s fitness council grants on behalf of Governor’s Advisory

Council on Physical Fitness– Continued implementation of State Employees Health Fitness and

Education Programs, including HB 1297 implementation

• TEA is requesting an exceptional to strengthen the coordinated school health program – A portion of that request would support DSHS’ contracts with

Education Service Centers for coordinated school health activities

Private Business Worksite Wellness• Employee healthcare costs consume half or more of corporate

profits• National trends show 7-10% health-insurance premiums increases

in 2008 and 2009• Physical inactivity and obesity are associated with 23% of

national healthcare charges• Worksite wellness programs can bring a $3 – $8 or more Return

on Investment for every dollar spent in a five year period• Reductions in absenteeism will increase productivity• Solutions:

– Keep healthy employees healthy– Have employees get routine health exams to detect problems early when

treatment can be most effective and least expensive– Ensure employees with chronic health conditions know how to manage

them and receive treatment to minimize disability

Worksite Wellness for State Agencies

• State Employees: HB 1297– Statewide Wellness Coordinator– Worksite Wellness Advisory Board– Development of model worksite wellness

programs– Baseline survey of state agency wellness activities– Annual wellness conference

Chronic Diseases Management• Texas Council on Cardiovascular Disease • Texas Diabetes Council and Program• Asthma Prevention and Management

– Asthma Coalition of Texas – In Texas, asthma remains one of the most prevalent chronic diseases

and growing health concerns. – In 2006, according to the Texas Behavioral Risk Factor Surveillance

System (BRFSS):• An estimated 2.1 million (12.4%) adult Texans (18 years or older)

had self-reported lifetime asthma and 1.3 million (7.3%) adult Texans had self-reported current asthma

• An estimated 854,000 (13.4%) children (0-17 years of age) had reported lifetime asthma and 599,000 (9.4%) children had reported current asthma.

Disease Prevention through Vaccines

• Childhood diseases – previously common and widespread are now preventable through vaccines

MeaslesChicken Pox

Immunizations• Availability

– Routine childhood vaccines available to all children in Texas – Adult safety-net program for uninsured and underinsured adults– Rely on private providers to ensure their patients get needed

immunizations on schedule

• Effectiveness– As vaccines are introduced, incidence of disease falls

significantly– Routine childhood immunizations are estimated to prevent 10.5

million cases of illness and 33,000 deaths for one birth cohort in the United States

2006 National ImmunizationSurvey Results

National Immunization Survey (NIS) Results for Texas 1995-2006

50.0

55.0

60.0

65.0

70.0

75.0

80.0

85.0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Tx 2006

Pe

rce

nt

4:3:1 4:3:1:3 4:3:1:3:3 4:3:1:3:3:1

Strategies to IncreaseVaccine Coverage Levels

• Promote concept of the medical home• Promote use of immunization registries• Promote use of reminder/recall systems for providers• Conduct provider education• Educate the public on the health benefits • Promote and participate in public/private collaborations

– Federal Vaccines for Children Program

– Texas Immunization Stakeholder Working Group

Concluding Thoughts

• Public health measures improve and extend Texans’ quality of life

• Behavioral strategies work to prevent and control chronic diseases

• Vaccines work to prevent infectious diseases