Well ness S Y M P O S I U M

1. WellnessS Y M P O S I U M Darwin R. Labarthe, MD, MPH, PhD Director, Division for Heart Disease and Stroke Prevention

3. CO-LEAD AGENCIES: CDC AND NIH The national goal for heart disease and stroke prevention: - prevention of risk factors - detection and treatment of risk factors - early identification and treatment of heart attacks and strokes - prevention of recurrent cardiovascular events

4. The Present Reality

5. The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors

6. A Vision of the Future

7. A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death

8. The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death

9. Behavior Change Risk Factor Detection and Control EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management End-of- Life Care Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death Policy and Environmental Change Intervention Approaches The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors

10. Goal 1 Goal 2 Goal 3 Goal 4 Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death Policy and Environmental Change Behavior Change Risk Factor Detection and Control EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities

11. Goal 1 Goal 2 Goal 3 Goal 4 Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death Policy and Environmental Change Behavior Change Risk Factor Detection and Control EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities Target Population CVD 871,000 Total Population300million Total Population300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million

12. TREATMENT $ .05 $ .95 PREVENTION Goal 1 Goal 2 Goal 3 Goal 4 Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death Policy and Environmental Change Behavior Change Risk Factor Detection and Control EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities Target Population CVD 871,000 Total Population300million Total Population300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million

13. 20 10 30 Goal 1 Goal 2 Goal 3 Goal 4 Target Population CVD 871,000 Total Population300million Total Population300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death Policy and Environmental Change Behavior Change Risk Factor Detection and Control EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities

14. Goal 1 Goal 2 Goal 3 Goal 4 Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death Policy and Environmental Change ? Behavior Change Risk Factor Detection and Control EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities Target Population CVD 871,000 Total Population300million Total Population300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million

15. Goal 1 Goal 2 Goal 3 Goal 4 Target Population CVD 871,000 Total Population300million Total Population300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death Policy and Environmental Change 10 Behavior Change Risk Factor Detection and Control EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities

16. 10 20 Goal 1 Goal 2 Goal 3 Goal 4 Target Population CVD 871,000 Total Population300million Total Population300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death Policy and Environmental Change Behavior Change Risk Factor Detection and Control EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities

17. 10 Goal 1 Goal 2 Goal 3 Goal 4 Target Population CVD 871,000 Total Population300million Total Population300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death Policy and Environmental Change HP Behavior Change Risk Factor Detection and Control EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities

18. 10 Goal 1 Goal 2 Goal 3 Goal 4 Target Population CVD 871,000 Total Population300million Total Population300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death Policy and Environmental Change 00 Behavior Change Risk Factor Detection and Control EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities

19. Goal 1 Goal 2 Goal 3 Goal 4 Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death CONTINUUM OF CARE Policy and Environmental Change Behavior Change Risk Factor Detection and Control ‘upstream’ ‘downstream’ EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities Target Population CVD 871,000 Total Population300million Total Population300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million

20. Goal 1 Goal 2 Goal 3 Goal 4 Action Framework for a Comprehensive Public Health StrategyFor Chronic Disease Prevention and Health Promotion A Vision of the Future Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Few Events/ Only Rare Deaths Full Functional Capacity/Low Risk of Recurrence Low Population Risk Good Quality of Life Until Death CONTINUUM OF CARE Policy and Environmental Change Behavior Change Risk Factor Detection and Control ‘upstream’ ‘downstream’ EmergencyCare/Acute CaseManagement Rehabilitation/ Long-term Case Management Intervention Approaches End-of- Life Care The Present Reality Unfavorable Social and Environmental Conditions Fatal CVD Complica- tions/Decom-pensation Adverse Behavioral Patterns First Event/ Sudden Death Disability/ Risk of Recurrence Major Risk Factors The Healthy People 2010 Goals Increase Quality and Years of Healthy Life Eliminate Disparities Target Population Deaths due to chronic conditions Total Population300million Total Population300million Persons with increased risk Persons first identified with chronic conditions Persons living or disabled with chronic conditions

21. The national goal for heart disease and stroke prevention: - prevention of risk factors - detection and treatment of risk factors - early identification and treatment of heart attacks and strokes - prevention of recurrent cardiovascular events

22. The national goal for chronic disease prevention and health promotion: - maintenance of good health/low risk - management of risk factors - response to acute event or first diagnosis - reduction of disability, improvement in quality of life, and prevention of disease progression or recurrent events

23. Wellness The 1st national goal for chronic disease prevention and health promotion: - maintenance of good health/low risk