Crisis in the Commonwealth:Prevention is the Key

Health & Wellness Champion Capstone Team

Presented by the

Health & Wellness Champion Capstone Team

Introduction

Cheryl Brown, EPPC – Team Leader

Cheryl Colvin, APA

Brian Judy, OAG

Vicki Newton, CHFS

Jeanne Olivas, Personnel

Mike Sanders, Voc. Rehab.

Environmental Background &

History

History

• 1979-The Surgeon General’s Report on

Health Promotion and Disease Prevention

• 1980- Promoting Health/Preventing

Disease: Objectives for the Nation

• 1990-Healthy People 2000

• 2000-Healthy People 2010

Goals

Two GoalsTwo Goals

1.1. Increase the quality and years of healthy lifeIncrease the quality and years of healthy life

2.2. Eliminate health disparitiesEliminate health disparities

Focus Areas

Access to Quality HealthServicesArthritis, Osteoporosis, andChronic Back ConditionsCancerChronic Kidney DiseasesDiabetesDisability and SecondaryConditionsEducational and Community-Based ProgramsEnvironmental HealthFamily PlanningFood SafetyHealth CommunicationHeart Disease and StrokeHIV

Immunization and InfectiousDiseasesInjury and Violence PreventionMaternal, Infant, and ChildHealthMedical Product SafetyMental Health and MentalDisordersNutrition and OverweightOccupational Safety and HealthOral HealthPhysical Activity and FitnessPublic Health InfrastructureRespiratory DiseasesSexually Transmitted DiseasesSubstance AbuseTobacco UseVision and Hearing

Healthy People 2010 Focus Areas

Approach

• A set of 10-year, evidenced-based disease prevention and

health promotion objectives

• The result of an extensive collaborative process

• A systematic approach for promoting Healthy People in

Healthy Communities

– A comprehensive set of national objectives

– Addresses all determinants of health

– Measures health status

A Rich Data Resource

• Healthy People draws from a variety of data

sources

• Healthy People reviews a large number of

data points

• Healthy People is the most comprehensive

source of health data in the nation

Implementation

• State Plans

• Consortium

• Partnerships

• Progress Reviews

• Midcourse Review

• Final Review

Health Care Spending is on the Rise…

5% Health Promotion/Disease Prevention

95% Direct Healthcare Treatment Cost

$1.9 Trillion

Courtesy of Michael H. Samuelson, Senior Management Lead, Health & Wellness, 401-274-7234

Health Care Spending is on the Rise…

1980 - $245 Billion ($1,066/Person)

2004 - $1.9 Trillion ($5,035/Person)

Courtesy of Michael H. Samuelson, Senior Management Lead, Health & Wellness, 401-274-7234

Health Care Spending is on the Rise…

1980 - $245 Billion

2004 - $1.9 Trillion 2012 - $4.3 Trillion

Courtesy of Michael H. Samuelson, Senior Management Lead, Health & Wellness, 401-274-7234

Leading High Risk

Factors

Leading High Risk Factors

Kentucky is ranked 50th in the nation

for smoking with 30.8% of our population that

smoke

Leading High Risk Factors

Kentucky also ranks 50th

for Cancer related deaths

47th for Cardiovascular deaths

Smoking is the leading cause of lung cancer and emphysema.Some other health risk associated with smoking are:

Leading High Risk Factors

•Heart attack & Stroke

•Cancer-larynx-mouth-throat-esophagus-intestines-bladder-kidney-pancreas

•Lesser known risks-Alzheimer’s-lupus-SIDS-colic-impotence-rheumatoid arthritis-snoring-acid reflux-breast cancer-colon cancer-thyroid disease

Leading High Risk Factors

Everyday, 3000 of our children and young teens in the US start smoking regularly and of those smokers one in three will die from smoke related disease.

Children in a smoke free home are less likely to start smoking.

-United Health Foundation.org

“Kentucky ranks 46th in the nation in obesity with 25.6% with BMI of 30 or greater”

-united health foundation/shr2004

Body Mass Index

Overweight = 25 – 29.9 BMI

Obese = 30 - 34 BMI

Obese II = 35 – 39 BMI

Extreme Obesity = > 40 BMI

. Men are at risk who have a waist measurement > 40 inches.

. Women are at risk who have a waist measurement > 35 inches.

NOTE:

Courtesy of Michael H. Samuelson, Senior Management Lead, Health & Wellness, 401-274-7234

Overweight and obesity raise the risk for...

• type 2 diabetes• high blood pressure• high cholesterol• coronary heart disease• congestive heart failure• angina• stroke• asthma• osteoarthritis• musculoskeletal disorders• gallbladder disease• sleep apnea• gout

• Poor female reproductive health– pregnancy complications– menstrual irregularities– infertility– irregular ovulation

• Cancers of the:– uterus– breast– prostate– kidney– liver– pancreas– esophagus– colon and rectum

Courtesy of Michael H. Samuelson, Senior Management Lead, Health & Wellness, 401-274-7234

Costs associated with obesity risks…

Annual medical costs (including drug costs) by weight groups

$3,500

$3,000

$2,500

$2,000

$1,500

$1,000

$500

$0

$4,000

median ofmedical cost ($)

$3,184

$2,225$2,388

$2,801$3,182

$3,753

underweight

normal overweight

obesity obesity II extremeobesity

Obesity

No Data <10% 10%-14% 15%-19% 20%-24% 25%

Courtesy of Michael H. Samuelson, Senior Management Lead, Health & Wellness, 401-274-7234

U.S. Obesity - 1985

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1986

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1987

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1988

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1989

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1990

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1991

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1992

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1993

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1994

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1995

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1996

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1997

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1998

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 1999

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 2000

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 2001

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 2002

No Data <10% 10%-14% 15%-19% 20%-24% 25%

U.S. Obesity - 2003

No Data <10% 10%-14% 15%-19% 20%-24% 25%

Costs associated with obesity risks…

Life Expectancy

80 yrs

70 yrs

60 yrs

50 yrs

40 yrs

30 yrs

20 yrs

10 yrs

20–yr–old male/BMI = 24 20–yr–old male/BMI = >40

Estimates of the number of years of life lost as a result of overweight and obesity range as high as 20 years of life lost for certain age and racial/ethic groups. For example, a 20-year-old white male could realize a 17% reduction in life due to obesity.

Courtesy of Michael H. Samuelson, Senior Management Lead, Health & Wellness, 401-274-7234

Leading High Risk Factors

Physical Activity is the key to reversing the obesity trendThose who exercise regularly are decreasing their risk for:

• Coronary heart disease • Stroke• Colon Cancer• Diabetes• High blood pressure

Leading High Risk Factors

Despite the proven benefits of physical activity, more than 50% of American adults do not get enough physical activity to provide health benefits.

Insufficient physical activity is not limited to adults. Daily participation in high school physical education classes dropped from 42% in 1991 to 32% in 2001 (CDC, 2002)

State EmployeeWellness Programs

State Employee Wellness Programs

Employee Wellness Program Components

• Educational materials

• Screenings

• Seminars

• Fitness Centers

• Health Fairs

• Other services

State Employee Wellness Programs

Incentives

• Reduced insurance rates

• Cash rewards

• 401K Bonus

• Medical Spending Account bonus

• Exercising on work time

• Small knick-knacks

State Employee Wellness Programs

Options for Kentucky

• Partner with insurance carriers

• Increase budgets for cash incentives

• Time off to exercise during workday

• Partner with fitness clubs to get discounts

• Make program available to all state employees

Legislative Issues

Legislative Issues

15 of the 50 states, or 30%, have legislation addressing the prevention of:

•Obesity•Smoking•Stress Management•Promotion of Physical Activity

California, Florida, Hawaii, Illinois, Indiana, Louisiana, Massachusetts, Minnesota,

Mississippi, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Texas

12 states have legislation exempting food manufacturers,

marketers, packers, distributors, advertisers, and sellersfrom civil liability for an individual's weight gain or obesity or for a health condition related to the weight gain or obesity.

Legislative Issues

ColoradoFloridaGeorgiaIdahoLouisianaMichigan

MissouriOhioSouth DakotaTennesseeUtahWashington

Legislative Issues

Missouri circumvented the legislature and

through an Executive Order established the

Council on Physical Fitness and Health.

New York and Tennessee have recognized the

crisis, but the only legislation passed is to

investigate it.

Legislative Issues

Kentucky proposed legislation addressed:

•Overweight•Obesity•Smoking•Drug Use•Immunization•Transmission of STD’s•Dental care•School nutrition •Student fitness

Legislative Issues

California’s Two-Step Approach:

1. Legislative findings, declaration, and intent

2. Health and wellness program

Legislative Issues

California:

• Develop and coordinate state and local activities involving wellness and physical activity.

• Encourage local governments and communities to develop programs.

• Enlist the support of individuals, civic groups, and other organization.

• Recognize outstanding accomplishments.• Collect and disseminate information

Legislative Issues

Three Federal Legislations

1. “Healthy Lifestyles Act of 2004” (Senate Bill 2399)

2. “Improved Nutrition and Physical Activity Act” aka “IMPACT Act” (Senate Bill1172)

3. “Healthy Lifestyles and Prevention American Act” or “HeLP America Act”. (Senate Bill 2258)

Funding

• Self-funded

• Legislature Appropriations

• CDC Grant

• Tobacco Settlement Money  

Legislative Issues

Measure of Success

Measure of Success

Success:

the achievement of something desired, planned

or attempted.

Measure of Success

Motorola’s wellness program, with forty-five

thousand U.S. employees, family members,

retirees show for every $1 invested in wellness

benefits they save $3.93.

Note: they invest $6 million annually in

wellness and work/life programs.

Measure of Success

Seven Benchmarks of Success

1. Capturing on Senior Level Support

2. Creating Cohesive Wellness Teams

3. Collecting Data to Drive Health Efforts

4. Crafting an Operating Plan

5. Choosing Appropriate Interventions

6. Creating a Supportive Environment

7. Consistently Evaluating Outcomes

Measure of Success

Evaluation

• Did you get the results you were seeking?

• What interventions worked well?

• Did you meet your goals and objectives?

• Can you repeat the process?

Measure of Success

Guidelines for Successful Evaluation

1. Clear and measurable goals and objectives

2. Baseline data

3. Trained staff

4. Fair administration of incentives

5. Programs are well planned with evaluation tools in place

6. Budget for intervention is set; actual cost data is collected

7. A communication plan is established

Conclusions

Conclusions

• Research supports there is a crisis – it’s not “if”, but when we act

• The responsibility is at everyone’s doors – closing our eyes only prolongs the problem

• We need to be leaders in cultural change – behaviors are learned

• Change will take time and effort – we need to be patient with our results and persistent in our pursuit

Recommendations

Health & Family Services Cabinet Goals

• To provide the finest health care possible for people in our state facilities;

• To provide the best preventive services through our public health programs;

• To provide the most outstanding services for families and children;

• To protect and prevent abuse of children, elders and people with disabilities;

• To build quality programs across-the-board; and by doing all these things,

• To make a difference in the lives of 4 million Kentuckians.

Recommendations

•Support the pilot program

•Expand the pilot throughout the Cabinet for Health and Family Services

•Monitor the pilot program for possible statewide implementation

•Incorporate financial incentives and quality program components

What leadership can do:

Recommendations

•Partner with health insurance companies to investigate ways to cover costs

•Use future Capstones to expand on funding ideas

•Consider seeking a Governor’s Executive Order to establish a statewide program

•Focus on high-risk people.

What leadership can do:

Questions?