State Of HealthIn

Tennessee 2014

How DoWe AccelerateOur Progress?

Tennessee Department of HealthCommissioner John Dreyzehner, MD, MPH, FACOEM

Tennessee Department of Health

VisionTo be a respected and trusted leader, partnering and engaging to accelerate Tennessee to one of the nation’s ten healthiest states.

In One Lifespan, Exceptional Work in

Public HealthAnd Advances in Medicine

Combined to Make A Difference

1937 U.S. Life Expectancy:

Approximately 62 years

2013 U.S. Life Expectancy:

Approximately 78.5Years

Tennessee: 76.4 Years

In Tennessee in 1937:

1,072 people died from Tuberculosis

355(under age 2) died from Diarrhea/Enteritis

134 people died from Typhoid/Paratyphoid Fever67 people died from Diphtheria42 people died from Meningococcal Meningitis40 people died from Whooping Cough10 people died from Polio 7 people died from Measles

Infant mortality rate was 59 per 1,000 live births

State Population: 2,893,000

In Tennessee in 2013

15 people died from Tuberculosis0 people died from Typhoid/Paratyphoid Fever0 people died from Diphtheria1 person died from Meningococcal Meningitis1 person died from Whooping Cough0 people died from Polio 0 people died from Measles5 children (under 2) died from Diarrhea/EnteritisInfant mortality was 6.8 per 1,000 live births

State Population: 6,496,000

Ten Greatest Achievements That Accelerated Public Health

Progress in the United States in the 20th Century

VaccinationMotor-vehicle safetySafer WorkplacesControl of infectious diseasesDecline in heart disease and strokeSafer and healthier foodsHealthier mothers and babiesFamily planningFluoridation of Drinking WaterRecognition of tobacco use as a health hazard -- MMWR, December, 1999

86.9

74.9

53.2

36.2

29.3

21.3

13.410.3 9.0 7.9 6.3

0

10

20

30

40

50

60

70

80

90

100

1920 1930 1940 1950 1960 1970 1980 1990 2000 2010

Dea

ths

per

1,0

00 L

ive

Bir

ths

Year

Infant Mortality RateTennessee, 1920-2014*

8.8(718)

8.7(733)

8.3(718)

8.0(686)

8.0(655)

7.9(626) 7.4

(587)7.2(576)

6.8(542) 6.3

(288)

0

1

2

3

4

5

6

7

8

9

10

11

12

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014*D

eath

s p

er 1

,000

Liv

e B

irth

s(N

um

ber

of

Infa

nt D

eath

s)

Infant Mortality Rate in Tennessee – 1920-2014

Leading Causes of Death In Tennessee In 2013

1. 14,723 people died from heart disease 2. 13,931 people died from cancer 3. 3,897 people died from chronic lower respiratory diseases4. 3,497 people died from accidents/adverse effects5. 3,123 people died from cerebrovascular disease6. 2,526 people died from Alzheimer's disease7. 1,815 people died from diabetes mellitus8. 1,551 people died from pneumonia and influenza9. 1,059 Kidney disease/failure10. 1,017 Suicide

In 2013, 1,166 people in Tennessee died from drug overdoses

• Health care is not the primary driver of an individual’s overall health and well-being

• Improving Health requires comprehensive focus: a public health approach

HealthBehavior

s40%

Environment5% Health

Care10%

SocialFactors

15%

Genetics and

Development

30%

Determinants of Health

2014 Health Survey Ranks U.S. Last Among Rich Peers

USA Today – June 17, 2014

Tennessee 2013OVERALL RANKING: 42Tennessee is 42nd this yearIt was 39th in 2012

2008 2009 2010 2011 2012 201330

35

40

45

50

48

4442 41

39

42

Tennessee’s Health Ranking for 2013

Tennessee’s “Big Three”

Tobacco UseU.S. Ranking:

47

Physical Inactivity

U.S. Ranking:

45

ObesityU.S. Ranking:

40

These three directly influence seven of ten leading causes of death in Tennessee.

To accelerate our progress, we must address the big three.

Behavioral Risk Factor Surveillance System:Providing Beneficial Trend Data to Support

Accelerated Efforts

BRFSS data now include input from both landlines and cell phones, providing a more accurate sampling.

It is the world’s largest on-going telephone health survey system – more than one-half million interviewed.

21.2

19.6 19.0

23.0

24.924.3

10

15

20

25

30

35

40

2011 2012 2013

Pe

rce

nt

Current Cigarette Smoking among Adults (18+ Years)Tennessee and the U.S., 2011-2013

U.S.

TN

Key Findings From the 2014 BRFSS Report

Key Findings From the 2014 BRFSS Report

26.2

22.9

25.3

35.1

28.6

37.2

20

25

30

35

40

2011 2012 2013

Perc

ent

No Exercise in Past 30 Days among Adults (18+ Years)Tennessee and the U.S., 2011-2013

U.S.

TN

Key Findings From the 2014 BRFSS Report

27.8 27.629.4

29.231.1

33.7

10

15

20

25

30

35

40

2011 2012 2013

Perc

ent

Obesity among Adults (18+ Years),Tennessee and the U.S., 2011-2013

U.S.

TN

41.1

33.5

39.1

44.1 45.443.4

42.038.6

30.0

34.8

40.9

44.342.7

40.638.5

30.9

34.6

40.543.9

42.440.6

0

10

20

30

40

50

All Grades* K* 2nd* 4th* 6th* 8th HS*

Perc

ent

Overweight and Obesity Prevalence by Grade and School Year Tennessee Public Schools

2007-2008 2011-2012 2012-2013

*The difference in prevalence between 2007-2008 and 2012-2013 was statistically significant.

Obese/Overweight Tennessee Children:We Need To Accelerate BMI Reductions

Source: Tennessee Department of Education

TDH Customer Focused Government Plan

• Primary Prevention Initiatives (PPI) • Tobacco Settlement Funding

Effectiveness

• Controlled Monitoring Substance Database – CSMD

• America’s Health Rankings “Big 3” • Electronic Public Health Information

System

Obesity

Tobacco

Infant Mortality

Immunization

Substance Abuse

Teen Pregnancy

Other

0 20 40 60 80 100 120 140 160

All 95 County Health Departments are participating in this initiative

Primary Prevention Initiative Engages Communities to Promote Better Health

Total Completed Projects: 360Total PPI projects: 637

Tobacco Settlement Funds Used to Help Protect Tennesseans

1. Eliminate smoking during pregnancy2. Reduce infants’ and children’s exposure to second-hand smoke3. Prevent child and adolescent tobacco use

Pregnancy Smoking: Baby and Me Tobacco Free

Second Hand Smoke Exposure Projects

School Age Projects

0 20 40 60 80 100 120 140

4

13

3

2

16

8

5

36

65

53

19

33

2

14

Amended for no action this year Not started

Planning and development activities Active services

86 operational projects

64 operational projects

123 operational projects

All 95 counties set own

goals and projects

Prescription Safety & Population ProtectionDecrease in high-use patients since 3rd quarter 2012

Survey of 800 CSMD users found: • 71 % changed a treatment plan

• 73 % were more likely to discuss substance abuse issues with a patient

• 57 % were now more likely to refer a patient for substance abuse treatment

Cumulative milligram morphine equivalent dispensed decreased• 0.7 percent in 2013

• 6.7 percent thus far in 2014

1st quarter 2nd quarter 3rd quarter 4th quarter

0

500

1000

1500

2000

2500

Fig 1. Number of High Utilization Patients* in CSMD 2012-2014

2012

2013

2014

A New Tool To Combat Overdose Deaths:

Naloxone

Tennessee’s “Big Three”

Tobacco UseU.S. Ranking:

47

Physical Inactivity

U.S. Ranking:

45

ObesityU.S. Ranking:

40

These three directly influence seven of ten leading causes of death in Tennessee.

To accelerate our progress, we must address the big three.

Previous Year WinnersSullivan CountyBlount CountyCarter CountyClay CountyGrundy CountyHardin CountyGiles County Jackson CountyRutherford County Wayne CountyWeakley CountyOffice of Health Care Facilities Cancer Programs Collaborative

Applicants for 2014: Montgomery County Greene County,Morgan and Roane countiesFayette, Hardeman, and McNairy countiesHenderson and Decatur, Obion, Lake, and Dyer countiesOverton CountyPutnam CountySmith CountySoutheast Regional OfficeNortheast Regional OfficeDivisions of Policy, Planning, & AssessmentDivision of Information Technology Services

Promoting Performance Excellence through our Baldrige Journey

(TNCPE)

Promising Accelerants for Health Progress in Tennessee

Tobacco Settlement Prevention

• Primary Prevention Initiative• Neonatal Abstinence

Syndrome Subcabinet• Network of County Health

Departments• Alliances with key external

partners• Traumatic Brain Injury

Awareness/Prevention

• Immunizations Programs

• Controlled Substance Monitoring Database

• Vigorous Inspection Efforts – Food, Hotel/Motel/Pools – Other

• Health Care Professionals – Licensing and Regulation

• Public Health Training

Created in 2013 by Governor Bill Haslam. Focus on exercise, diet and reducing tobacco use.

January, 2014: Small Starts launched

March, 2014: Launched Small Starts @ Work

September, 2014: Small Starts @ Worship

Continuing work with the Tennessee Department of Education to increase activity in the Extended Learning programs.

• Co-chaired by Gov. Bill Haslam and First Lady Crissy Haslam

• In its first full year, kidentraltn.com had 66,000 visitors seeking information about health, education and development

• Kidcentraltn.com provides a directory of state-operated and state-funded services for children and families

• Mobile app provides convenient access to information about services

Preventing Injuries and Saving Lives On Tennessee’s Roads and Highways

Governor’s Highway Safety Office&

Department of Safety & Homeland Security

The Department of Safety’s “Drive to Zero Fatalities” campaign seeks to reduce traffic deaths in Tennessee by 15 percent in 2014. Thanks to aggressive promotion, Tennessee’s percentage of vehicle fatalities involving motorists not wearing seatbelts is at a five-year low.

Drive to 55

Education is linked to health: People with higher levels of education tend to be healthier, and people in good health tend to perform better in school

Governor Bill Haslam launched the Drive to 55 to increase the number of Tennesseans with a certificate or degree beyond high school to 55 percent by the year 2025 in order to help build a strong workforce

The Tennessee Promise

TennCare

Million Hearts: TennCare is a partner in the Million Hearts initiative to reduce the burden of heart disease

Presumptive eligibility for newborns – allows participating hospitals and birthing centers to enroll newborns who mothers are not enrolled in TennCare at the time of delivery

TennCare provides health care for 1.2 million Tennesseans and operates with an annual budget of $9 billion.

Continuous Preparation To Protect Against Emerging Threats to

Population Health:Invisible Services

Communicable Diseases

Ebola - Middle East Respiratory Syndrome - Chikunguna – SARS - LaCrosse Encephalitis - Polio - Measles - Rocky Mountain Spotted Fever West Nile Virus - Rabies - Dengue Fever – HIV/AIDS - Whooping Cough - Mumps

Emergency Preparedness

Tennessee Emergency Management Agency -- TN-CATTennessee Valley Authority – Generating Plant Accidents

Oak Ridge National Laboratory – Materials Accidents

Commissioner’s Charge

“And thus we protect from ills and griefThe rich man, poor man beggar and thief;

For the robber, too, must be germ-freeLest he transmit to the other three.”

-- 1937 TDH Annual Report

ACCELERATE!

Presentation by the

Tennessee Department of Health

Mission: Protect, promote and improve the health and prosperity of people in Tennessee.

Tennessee Department of Health710 James Robertson Parkway

Nashville, TN 37243

Produced by the Tennessee Department of Health in September, 2014.