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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.
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