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Prevention for the Health of our Country

Prevention for the Health of our Country. Thomas R. Frieden, M.D., M.P.H. Director Centers for Disease Control and Prevention. Factors that Affect Health. Smallest Impact. Largest Impact. Examples. Eat healthy, be physically active. Counseling & Education.

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Prevention for the Health of our Country

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  1. Prevention for the Health of our Country Thomas R. Frieden, M.D., M.P.H. Director Centers for Disease Control and Prevention

  2. Factors that Affect Health Smallest Impact Largest Impact Examples Eat healthy, be physically active Counseling & Education Rx for high blood pressure, high cholesterol, diabetes Clinical Interventions Immunizations, brief intervention, cessation treatment Long-lasting Protective Interventions 0g trans fat, salt, smoke-free laws, tobacco tax Changing the Context to make individuals’ default decisions healthy Poverty, education, housing, inequality Socioeconomic Factors

  3. Strategic Directions for CDC • Strengthen surveillance and epidemiology • Improve ability to support state and local public health • Increase impact promoting global health • Increase prevention effectiveness of health policies including health reform • Better address leading causes of illness, disability, and death

  4. Four Leading Causes of Death • Smoking – >400K US/>5M globally • Poor Nutrition • Physical Inactivity • Alcohol -- >60K US/>2M globally >100K US

  5. Tobacco Use • In 2004, one in five Americans smoke • North Carolina State ranking • Smoking prevalence • Adult (23.2% or 1,475,000) – 34th • Youth, Grades 9-12 (27.3% or 98,000) – 36th • Nonsmoking policies • Work (67.4%) – 34th • Home (57.1%) – 45th • Price per pack • 50th • State tax per pack • 45th Source: CDC’s Sustaining State Programs for Tobacco Control Data Highlights 2006

  6. 40% 36% 35% 35% 29% 30% 24% 23% 23% 22% 25% 18% % of H.S. Students 20% 20% 15% 15% 11% 10% 9% NYC U.S. 5% 0% 1997 1999 2001 2003 2005 2007 NYC Youth Smoking Prevalence: 61% Decline in 10 Years52% Decline Since 2001 YRBS, public high school students

  7. 18.9% • 350,000 fewer adult smokers • >100,000 fewer smoking-related deaths in future years 11% MPOWER Reduced Smoking in New York City Warn about the dangers of smoking Monitor adult smoking prevalence Protect people from tobacco smoke 21.5% 22% 20% Raise taxes on tobacco (City & State) 19.2% 16.9% 18% 18.3% 18% 17.5% 16% Monitor youth smoking % of New York City Smokers 15.8% 15% 14% 12% 8.5% 10% 8% 2008 1994 1995 1998 1999 2003 2007 1993 1996 1997 2000 2001 2002 2004 2005 2006

  8. HIV and AIDS in North Carolina – 2007 • MSM activity accounted for 54% of all new adult/adolescent HIV disease reports (including MSM/IDU) • Heterosexual sex accounted for 38% of all adult/adolescent HIV disease reports; 86% female adult/adolescent and 18% male adult/adolescent • 1,746 reported and 1,465 diagnosed cases of HIV infection (not AIDS) • 1,024 reported AIDS cases • 13,122 estimated number of persons living with HIV infection (not AIDS) • 9,129 estimated number of persons living with AIDS Source: CDC’s HIV/AIDS Surveillance Report, Volume 19 and the 2008 NC Epidemiologic Profile for HIV/STD Prevention and Care Planning (10/08)

  9. Chlamydia Positivity among 15- to 24-year-old women tested in family planning clinics 2007 *Data not available in 2007. Note: Includes states and outlying areas that reported chlamydia positivity data on at least 500 women aged 15-24 years screened during 2007. SOURCE: Chlamydia Prevalence Monitoring Project (Regional Infertility Prevention Projects); Office of Population Affairs; Local and State STD Control Programs; Centers for Disease Control and Prevention

  10. Targeting Those at Highest Risk for STDs and Unwanted Pregnancy STD Prevention • Education… • Screening… • Abstinence • Condoms… • Brief intervention to reduce alcohol use Unwanted Pregnancy Prevention • Intergenerational transmission… • Education… • Birth Control…

  11. A Policy Package to Prevent and Reverse Obesity Price Decrease cost of fruits and vegetables Increase cost of unhealthy foods Exposure/access Increase exposure to healthy foods Remove junk food from all schools, health care facilities, government institutions, at least Image Eliminate ads to children Show human cost of empty calories ARRA resources and potential health reform prevention dollars to accelerate state and local policy and program implementation

  12. Healthy Food Has Gotten More Expensive, Junk Food Cheaper Fresh fruits and vegetables Consumer-price index Price Index (1982 – 1984 = 100) Sugar and sweets Carbonated drinks Data are from the Bureau of Labor Statistics and represent the U.S. city averages for all urban consumers in January of each year.

  13. Winnable Battles in Nutrition Elimination of artificial trans-fat Significant health benefit With phase in, no significant problem with supply No significant increase in cost or change in taste Eliminate artificial trans-fat AND reduce saturated fat 10-20% Household Shortening Other 5% 6% Major sources of artificial trans fats Potato Chips, Corn Chips, Popcorn 6% Cakes, Cookies, Crackers, Pies, Fried Potatoes Bread, etc. 10% 51% Margarine 22% Data Source: http://www.fda.gov/fdac/features/2003/503_fats.html

  14. Winnable Battles in Nutrition Salt reduction “Age-related hypertension” may not be inevitable Calories  Salt 50% reduction in 10 years is feasible and would have significant health benefits Major health organizations support salt reduction

  15. Alcohol Use Persons Aged 12 and Older United States 2008 • 52% reported being current drinkers of alcohol; an estimated 129 million people • 23% (58 million people) reported binge drinking in the 30 days prior to the survey • 7% reported heavy drinking; an estimated 17 million people Source: SAMHSA; Results from the 2008 National Survey on Drug Use and Health: National Findings

  16. Consequences of Alcohol Abuse • Injuries (~40%) • Motor vehicle crashes and other unintentional injuries • Homicides • Suicides • Liver disease • Hypertension and stroke • Cancers of esophagus, stomach, and colon • Sexually transmitted diseases (including HIV) due to disinhibition effect • Fetal Alcohol Syndrome

  17. On ABCS, the USA Gets an “F” • People at increased risk of CVD who are taking Aspirin – 33% • People with hypertension who have adequately controlled Blood pressure – 44% • People with high Cholesterol who have adequately controlled hyperlipidemia – 29% • Smokers who try to quit get help – 20% Despite spending nearly 1 out of every 5 dollars on health care

  18. AspirinUnder-prescribed for U.S. Patients with Coronary Heart Disease 100 90 80 70 60 National Ambulatory 50 Medical Care Surveys 40 30 20 10 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Source: Stafford RS, Radley DC. The underutilization of cardiacmedications of proven benefit, 1990 to 2002. J Am Coll Cardiol, 2003; 41:56-61.

  19. BloodPressure Awareness, Treatment and Control NHANES, 2005-6, Ages 18 and older

  20. Statins Greatly Increase Cholesterol Control Statin Use Low in People with High LDL Overall Control Remains Low Mann D, Reynolds K, Munther P. Annals of Pharm 2008; 42.

  21. Heart Disease is Leading Preventable Cause of Death • 80 million people in U.S. have heart disease • >860,000 die each year • >24,000 of those deaths in NYC • >1,500 New Yorkers die of stroke • annually • Heart disease and stroke are preventable • Awareness of risk low • Not enough people take advantage of treatment Source: American Heart Association, Heart Disease and Stroke Update, 2009

  22. Stroke is Leading Cause of Adult Disability in U.S. >4 million people in U.S. have survived a stroke and live with impairments 500,000 could have been prevented 800,000 strokes will occur in U.S. this year

  23. Heart Disease and Stroke Can Be Reduced • Change the environment • Improve nutrition (reduce trans fat, salt, calories) • Increase physical activity • Improve care • Blood pressure and cholesterol monitoring and control • More affordable medications and simpler regimens • Focused EHR implementation • Attention and accountability with programmatic monitoring through health care data • Prioritization within EHR programs and health reform

  24. HEALTH INFORMATION SYSTEMS oriented toward prevention CARE MANAGEMENT so practice workflows support preventionand PAYMENT that rewards diseaseprevention and effective chronic disease management PATIENT EMPOWERMENT to prevent disease and disability Health Care that Maximizes Health

  25. Challenges • Decreased budgets • Hiring freezes, contracting/procurement slowdowns • Layoffs – • 7,000 local health dept jobs lost in 2008 • At least 40% of states expect layoffs or attrition in FY09 • Vacancy rates range from 2% to 18% • Retirement – • 20% eligible in 2010 • 50% eligible in 2012

  26. Funding Opportunities • ARRA Communities Putting Prevention to Work initiative • Total of $650 million for public health efforts to address obesity, increase physical activity, improve nutrition, and decrease smoking. • $373 million for communities and tribes around the country • $120 million for prevention and wellness programs for U.S. states and territories • $40 million to state health departments for HAI • $300 million to the Section 317 Immunization programs in all 50 states, Washington DC, 5 urban areas, the U.S. Territories, and selected Pacific Island nations • More information is at www.grants.gov • Fiscal intermediaries -- better, faster, cheaper

  27. H1N1 Outbreak Influenza is perhaps the most unpredictable of all infectious diseases • Occurred very late in the season • Remarkable heterogeneity across United States • Affected young people disproportionately • Caused widespread illness, some severe or fatal • Socially disruptive, especially for schools • Tens of thousands of health workers and others responding worldwide

  28. State/Local Support Necessary for Seasonal and H1N1 Vaccine • Fund and provide contractual services at the local level • Establish school-located vaccination clinics • Strengthen public immunization clinics and other public vaccination efforts • Facilitate private provider sign-up • Encourage primary care providers to see and take care of people with high-risk conditions • Ensure that vaccine ordering and onward distribution systems, if applicable, run smoothly • Communicate effectively so people know where to get vaccinated, providers are encouraged to vaccinate patients, rumors are addressed rapidly, and vaccine uptake increased

  29. H1N1 in Your Community • Keep healthy students in school and sick people at home • Promote appropriate use of antiviral medications to maximize their benefit and preserve their effectiveness • Encourage self-triage to discourage unnecessary visits • Emergency department preservation • Intensive care unit planning • VACCINATION!

  30. Flu Preparedness Is a Shared Responsibility • Keep yourself well informed: • Know What to do About Flu: www.Flu.gov • CDC recommends a yearly seasonal flu vaccine as the most important step to prevent seasonal flu • Get vaccinated as H1N1 shots become available

  31. Prevention is on the map and in public consciousness as never before The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people 10th Amendment of the U.S. Constitution

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