Roderick L. Bremby, Secretary Kansas Department of Health and Environment

1. Healthy Kansas: An Opportunity to Transform the Health of Kansas Roderick L. Bremby, Secretary Kansas Department of Health and Environment United Methodist Health MinistryHealthy Congregations Retreat April 13, 2007

2. Greetings Gov. Kathleen Sebelius

3. Healthy Kansas An opportunity to expand the focus of current reform strategies through transformative policy making and shifting and broadening the discourse on health reform.

4. Healthy Kansas 3 Core Premises Goal - Optimal Health Status Health Status – a function of multiple determinants The Life Course Matters – risk and protective factors early in life affect health status later in life Move from a sick care system to a health systemthat provides vertical, horizontal, and longitudinal integration

5. Healthy Kansas – Premise 1: Optimal Health Status is the Goal Current discussion focus: cost, access, and quality. Cost - 1980 - $253.9B or $ 1,102 per person > 9.1% GDP 1990 - $714.0B or $ 2,813 per person > 12.4% GDP 2000 - $ 1.35T or $ 4,790 per person > 13.8% GDP 2005 - $ 1.98T or $ 6,697 per person > 16.2% GDP 2015 - $ 4.04T or $12,357 per person > 20.0% GDP (projected) Access - uninsured US:46.6 million (15.9%) / KS:300,000 (10.9%) Quality - 44-98Kdeaths annually from medical intervention – 1999 IOM – To Err is Human CMS

7. Healthy Kansas “The fact is that we don’t face an immediate crisis and so people say, What’s the problem ? The answer is we suffer from a fiscal cancer…and if we do not treat it, it could have catastrophic consequences for our country”. U.S. Comptroller General David Walker 3/1/07

8. Healthy Kansas– Premise 1: Optimal Health Status is the Goal Current discussion focus: cost, access, and quality. Cost - 1980 - $253.9B or $ 1,102 per person > 9.1% GDP 1990 - $714.0B or $ 2,813 per person > 12.4% GDP 2000 - $ 1.35T or $ 4,790 per person > 13.8% GDP 2005 - $ 1.98T or $ 6,697 per person > 16.2% GDP 2015 - $ 4.04T or $12,357 per person > 20.0% GDP (projected) Access - uninsured US:46.6 million (15.9%) / KS:300,000 (10.9%) Quality - 44-98Kdeaths annually from medical intervention – 1999 IOM – To Err is Human

9. What accounts for growth in health care spending ?

10. Healthy Kansas Premise 1: Optimal Health Status is the Goal US Health Status (W.H.O.) – 49th out of 50 industrialized nations U.S. infant mortality – 29th U.S. life expectancy – 25th

11. Healthy Kansas Premise 2: Health Status results from many factors Goal - Optimal Health Status Health Status – a function of multiple determinants The Life Course Matters – risk and protective factors early in life affect health status later in life

12. Healthy Kansas – Premise 2: Health Status results from many factors Heath Care Services Public Health Population Health (individual and population levels) Social Determinants Education Built environment Natural environment Social capital

13. Source: USDHEW, PHS, CDC. “Ten Leading Causes of Death in US 1975.” Atlanta, GA, Bureau of State Services, Health Analysis & Planning for Preventive Services, p 35, 1978

14. Healthy Kansas – Premise 3: Role of Life Course Development Goal - Optimal Health Status Health Status – a function of multiple determinants The Life Course Matters – risk and protective factors early in life affect health status later in life

15. Healthy Kansas Premise 3: Role of Life Course Development Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

16. Causes of Death United States, 2000 Actual Causes of Death† Leading Causes of Death* Heart Disease Tobacco Cancer Poor diet/lack of exercise Stroke Alcohol Chronic lowerrespiratory disease Infectious agents Unintentional Injuries Pollutants/toxins Diabetes Firearms Pneumonia/influenza Sexual behavior Alzheimer’s disease Motor vehicles Kidney Disease Illicit drug use Percentage (of all deaths) Percentage (of all deaths) * National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002 † Adapted from McGinnis Foege, updated by Mokdad et. al.

17. Source: Jones et al. Archives of Internal Medicine 2002;162:2565–71

18. Healthy Kansas The Evolving Health System • The First Era (Established the “operating system”) • Focus on acute and infectious disease • Medical care silo • Insurance-based financing • The Second Era (Operating System “patch”) • Focus on chronic disease • Increased technology ->increased costs • The Third Era (Requires Policy to Replace Operating • System • Focus on optimal health status and multiple forms • of integration Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

19. Healthy Kansas The Evolving Health System “I get no money to prevent an amputation. I would get a whole bunch of money to perform an amputation.” Dr. Anne Peters, endocrinologist Los Angeles Times, 2/26/07

20. Healthy Kansas The Evolving Health System The U.S. and 29 other developed nations on average spend 2.8% of their health care budgets on preventive care. Organization for Economic Co-operation and Development - 2004

21. Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

22. Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

23. Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

24. Healthy Kansas 4 parallel layers of health transformation needed: Individual Change Institutional/Provider Change Cultural Change Science Changes Everything Source: Center for Health Transformation

25. A roadmap for health promotion and wellness, incorporating community coalition building and private sector partnerships.

26. Improving our Health Many chronic diseases and illnesses can be attributed to three modifiable behaviors: Tobacco use Lack of physical activity Poor nutrition

27. Causes of Death United States, 2000 Actual Causes of Death† Leading Causes of Death* Heart Disease Tobacco Cancer Poor diet/lack of exercise Stroke Alcohol Chronic lowerrespiratory disease Infectious agents Unintentional Injuries Pollutants/toxins Diabetes Firearms Pneumonia/influenza Sexual behavior Alzheimer’s disease Motor vehicles Kidney Disease Illicit drug use Percentage (of all deaths) Percentage (of all deaths) * National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002 † Adapted from McGinnis Foege, updated by Mokdad et. al.

28. Healthy Kansas • Prevention Focus • Tobacco Use • Physical Inactivity (obesity) • Poor Nutrition (obesity)

29. Improving our Health A third of all U.S. deaths are attributable to three modifiable health-damaging behaviors: • tobacco use – 440,000/yr • lack of physical activity 365,000/yr • poor nutrition

30. Healthy Kansas Prevention focus - • Tobacco use $724M/yr • Physical inactivity (obesity) • Poor nutrition (obesity) $657M/yr

31. Healthy Kansas Chronic Disease Burden • 81% of total health care expenditures • KS Diabetes - $1.3B/yr and growing • New cases of diabetes can be reduced by 60% with modest increases in physical activity and weight loss

32. Healthy Kansas Healthy People 2010—Tobacco Use

33. Healthy Kansas Healthy People 2010—Physical Activity

34. Healthy Kansas Healthy People 2010—Nutrition

35. HealthyKansas Placed Based Strategy- • Children in schools • Adults in the workplace • Kansas seniors in community

36. Healthy Kansas– Children in Schools • Coordinated School Health Initiative Infrastructure – >52 Districts, 224 Schools, 80,000 students • Voluntary Body Mass Index (BMI) Testing • Child Health Advisory Committee • School Nutrition and Physical Activity Committees

37. Healthy Kansas– Seniors in the Community • With Dept. on Aging (KDOA), provide TA for local wellness programs for seniors • KDOA STEPS Program (Seniors Together Enjoy Physical Success) • Expansion of Senior Farmer’s Market • Encourage community gardens

38. Healthy Kansas • Media Campaign – partner with KHF • Reactivate Governor’s Council on Physical Fitness • Governor’s/Secretary’s Awards • Fitness Awards (youth focus) • Local Community Health Heroes • Healthy Community Designations • Healthy School Designations • Model Workplace Wellness Sites

39. Healthy Kansas - Pledge • Increase activity level • Eat healthy • Avoid tobacco YR 1: 6,000 Kansans CheckUp

42. Healthy Kansas Challenges to System Transformation Requires suspension of existing beliefs Final solution still unknown Timeline inconsistent with policy agenda event horizon Multiple layers of institutional structures need change Requires convergence from the (liberal-conservative) extremes Lack of stated agreement on the goal and principles

43. Healthy Kansas An Opportunity to Transform the Health of Kansas Q. – How do we improve the health of Kansans ? First 2 Steps - Begin with the end in mind. First things first. - Steven Covey

44. www.healthykansas.org