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Healthy Communities: The Intersection of Community Development & Health September 28, 2011 “State of the Health of Texas & Obesity”. David Lakey, M.D. Commissioner Texas Department of State Health Services.
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Healthy Communities: The Intersection of Community Development & HealthSeptember 28, 2011“State of the Health of Texas & Obesity” David Lakey, M.D.CommissionerTexas Department of State Health Services
Texas Department of State Health Services (DSHS) Regional & Local Health Services Prevention & Preparedness Services Family & Community Health Services Mental Health & Substance Abuse Services Regulatory Services
Actual Causes of DeathShaped by Behavior Chronic Disease in Texas 2007, DSHS
Texas County Health Factors Source: County Health Rankings, Robert Wood Johnson Foundation, University of Wisconsin
Texas County Health Outcomes Source: County Health Rankings, Robert Wood Johnson Foundation, University of Wisconsin
Social Determinants • Education • Employment • Income
General Health “Fair to Poor”in Texas by Education(2000 – 2009 BRFSS)
General Health “Fair to Poor” in Texas by Income Level(2000 - 2009 BRFSS)
The Health Impact PyramidA Framework for Public Health Action Thomas Frieden, MD, MPH, American Journal of Public Health, 04/2010, Vol. 100, no. 4
Health Challenges • HIV • Mental health • Substance abuse and smoking • Infant mortality / prematurity • Health care quality • Obesity
Ten Leading Causes of Death in Texas, Ages 18 – 44 Years, 2007
Newly Diagnosed HIV Cases, Deaths, & Persons Living with HIV (Texas, 1980-2008) Living with HIV New HIV Cases Deaths among HIV Cases
Mental Health Disorders • 3% of Texans suffer from a severe, persistent mental illness • Mental health disorders: the leading cause of disability in U.S. • Individuals with serious mental illness have a life expectancy 25 years shorter than the overall population • Inadequate treatment leads to an increase in costs related to crime, homelessness and uncompensated health care.
The Costs of Substance Abuse in Texas • In 2009, ~24,500 Texans died as a result of smoking • Of the 2,865 newly reported AIDS cases in 2008, 15.5% were drug related • ~ 75% of Texas prisoners are involved with alcohol or drugs • 47% of Texas motor vehicle fatalities (2009) were alcohol-related • 23% of fatally injured drivers tested in Texas were found positive for drugs (2009) • The cost related to alcohol and drug abuse to Texans (2007) was ~ $33 billion • This includes health care, lost productivity, motor vehicle accidents and crime • Annual per capita cost for Texas residents: $2,800
Past-Month Cigarette Use among Adults in Texas and the United States NSDUH 2002-2007
Past Month Cigarette Use Among Youth in Texas & US 21 NSDUH 2002-2007
Infant Mortality/ Prematurity • The infant mortality rate rose 9% from 2000 to 2006 • 6.2 deaths per 1,000 live births • Texas pre-term birth rate in 2009 was 13.6% • National average: 12.3% • The percentage of Texas infants born with low birth weight (under 5.5 pounds) rose from 7% in 1990, to 8.4% in 2007 • Totaling nearly 34,000 Texas infants • Infant mortality and prematurity rates are significantly higher among non-white Texans
Health Care Quality • Health care quality is an emerging responsibility for the DSHS • In the past few years, the department has been pulled more and more into issues such as health care associated infections, quality of care in health facilities, and standards of care • The number of preventable health care associated infections (HAIs) continues to increase year over year • Leading cause of death from infectious diseases in the U.S. and in Texas • HAIs kill 99,000 people each year • Cause an estimated 1.7 million infections in the U.S. • HAIs are the leading cause of infectious deaths in Texas with: • 8,000-9,000 deaths each year • HAIs also add more than $500 million in annual medical costs
Obesity • 29% of Texans are obese • 66% of Texans are overweight or obese • >40% of Texans projected to be obese by 2040 • 3 of the 5 leading causes of death in Texas are: • chronic diseases linked with obesity • heart disease • cancer and • stroke • Obesity cost Texas businesses 9.5 billion in 2009 • Health care costs: $4 billion • Absenteeism costs: $1.6 billion • Disability costs: $322 million • Presenteeism costs: $3.5 billion • Total costs could reach $32 billion by 2030
Obesity Trends* Among U.S. Adults (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1990 2006 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Prevalence Trends in Texas Adults 1990 to 2010 33% of Texans are normal weight 140% increase in obesity 29.5% of Texans are obese Source: Texas Comptroller
1990 2006 Obesity Adult Prevalence in TexasBRFSS 1990 vs. 2010 White Black Hispanic
Obesity Successes: • Focus: • Community Wellness • DSHS role: • Catalyst & Resource • Strategy: • Work with broad array of partners • Supports policy & environmental change around CDC target areas • One of 23 CDC-funded states conducting obesity prevention activities
CDC Targets for Obesity Prevention Sugar-Sweetened Beverages Physical Activity Fruits & Vegetables High- Energy- Dense Foods TV Viewing Breastfeeding
Healthy Lifestyle Coalition Fort Stockton & Corpus Christi • Fort Stockton ISD worksite wellness program • Pecos County Memorial Hospital breastfeeding promotion • City Parks and Recreation Department program development • Healthy entree restaurant initiative • CC in Motion worksite wellness initiative • Coastal Bend Breastfeeding Coalition • Walk Across Texas/Walk the Texas Star program
Interagency Council on Obesity: DSHS, TEA & Texas Department of Agriculture Interagency Obesity Council created to: • Enhance communication & coordination of obesity issues among state leaders; • Guide planning around obesity prevention, health promotion & improved nutrition Recommendations (selected): • Continue collaboration between 3 agencies • Support social interventions • Strengthen K-12 nutrition education • Strengthen nutrition education & physical activities in early childhood & after-school programs
Coordinated School Health (CSH) and Campus Improvement Plans • All elementary, middle and junior high schools required to implement a CSH Program • Develop goals and objectives for CSH based on: • Fitness assessment data • Academic performance • Attendance rates • Socioeconomic status • The use of success of any method to ensure students are reaching required moderate or vigorous physical activity (MVPA) • Any other indicator recommended by SHAC • Include CSH Goals in all elementary, middle and junior high school Campus Improvement Plans
State of Texas Nutrition Services & Education • School district policy to prevent foods of minimal nutritional value • Nutrition education to be provided in Kindergarten through 8th grade • District-developed wellness policy required of each school district receiving reimbursable meal funding
Breastfeeding & Obesity • Infants who aren’t breastfed have increased risk for many acute and chronic conditions • Including a 32% excess risk for childhood obesity • Many Texas mothers report barriers to achieving personal breastfeeding goals • Breastfeeding activities coordinated across DSHS address barriers to optimal infant feeding outcomes • Every Ounce Counts • http://www.breastmilkcounts.com/our-new-campaign.html
Growing Communities Video Highlights successful community-based strategies across Texas through short, documentary-style video clips • The videos were initially distributed to the 2009 Statewide Obesity Summit attendees • Recipients were charged to be “catalysts for change” by hosting video screenings • Since the July 2009 launch, DSHS has made the video series available online and in DVD format • www.dshs.state.tx.us/obesity/growingcommunity/default.shtm
Partnerships Needed to Improve Health DSHS Food Industry Urban Planners, Developers Architects Community-based Solutions Elected Officials Providers & Hospitals Worksites & Schools Higher Education Community Groups Non-Traditional Partners