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TRANSCRIPT
Mary Pesik, RDN, CD
Chronic Disease Prevention Unit Supervisor
Division of Public Health
May 1, 2015
Protecting and promoting the health and safety of the people of Wisconsin
Preventing and
Controlling Chronic
Disease in Wisconsin
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Presentation Outline
• Impact of Chronic Disease
• Population Health Approach
• Keys to Success
• Strategies for Improvement
Protecting and promoting the health and safety of the people of Wisconsin
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Chronic Disease
• Chronic diseases are illnesses that persist for a long time or last
at least three months. Chronic diseases are rarely cured and often
are progressive, resulting in disability later in life.
• Chronic diseases, such as heart disease, stroke, cancer, diabetes,
asthma and arthritis, are among the most common and costly of
all health problems in the United States; however, they are also
among the most preventable.
• Four modifiable health risk behaviors are responsible for much
of the illness, suffering and early death related to chronic
diseases: (1) unhealthy diet, (2) insufficient physical activity, (3)
tobacco use and secondhand smoke exposure, and (4) excessive
alcohol consumption.
Protecting and promoting the health and safety of the people of Wisconsin
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Percentage of coronary heart disease deaths under the age of
75, by race and ethnicity and sex, Wisconsin, 2006–2010
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.
42% 19% 73% 54% 68% 48% 71% 35% 73% 50% 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Male Female
WhiteBlackHispanicAsianAmerican Indian
Cardiovascular disease and risk factors
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Protecting and promoting the health and safety of the people of Wisconsin
Protecting and promoting the health and safety of the people of Wisconsin
Estimated prevalence of diabetes among Wisconsin adults,
age-adjusted percentage, by county, 2008–2010
Estimated prevalence of diabetes
Statewide = 10.1%
7.0 - 8.8%
8.9 - 9.2%
9.3 - 9.8%
9.9 - 10.6%
10.7 - 36.1%
Source: Wisconsin Department of Health Services, Division of Public Health, Wisconsin Diabetes Prevention and
Control Program, The 2011 Burden of Diabetes in Wisconsin.
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Prevalence* of Self-Reported Obesity Among U.S. Adults
by State and Territory, Behavioral Risk Factor Surveillance System, 2013
*Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence
estimates before 2011.
CA
MT
ID
NV
UT
AZ NM
WY
WA
OR
CO
NE
ND
SD
TX
OK
KS
IA
MN
AR
MO
LA
MI
IN
KY
IL OH
TN
MS AL
WI
PA
WV
SC
VA
NC
GA
FL
NY
VT
ME
HI
AK
NH
MA
RI
CT
NJ
DE
MD
DC
PR GUAM
15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%
WI
29.8%
Source: Behavioral Risk Factor Surveillance System, CDC, http://www.cdc.gov/obesity/data/index.html 6
Protecting and promoting the health and safety of the people of Wisconsin
Medical
Complications
of Obesity
Source: Adapted from Yale University Rudd Center for
Food Policy and Obesity
http://www.cdc.gov/vitalsigns/adultobesity/ 7
Chronic Disease Prevention and Control Outcomes
Long-term
Improve prevention and control of hypertension, diabetes, excess weight and
obesity.
Short-term
• Promote and reinforce healthful behaviors and practices across the life span
and settings.
• Improve quality and delivery of services for hypertension and diabetes
prevention and management.
• Support lifestyle change programs and self-management and control of
diabetes, hypertension and obesity.
Protecting and promoting the health and safety of the people of Wisconsin
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Source: Centers for Disease Control and Prevention 9
Impact = Reach X Exposure X Potency
Many people
With frequent exposure
In a comprehensive way
Focus on changing things that affect
Source: National Center for Chronic Disease Prevention
Division of Population Health
Maximizing Public Health Impact
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Keys to Success
• Innovation
• Technical Package
• Managing Performance
• Partnerships
• Communication
• Leadership and Commitment
• Stable and Flexible Funding
Adapted from: Frieden, T. Six Components Necessary for Effective Public Health Program Implementation.
American Journal of Public Health. November 14, 2013.
Protecting and promoting the health and safety of the people of Wisconsin
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Protecting and promoting the health and safety of the people of Wisconsin
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Environmental Approaches to Promote Health
Nutrition
Settings: early care and education (ECE), schools,
community, worksites
Access to healthy foods and beverages
Corner stores
Farmers’ Markets
Food service guidelines, including sodium
Supportive school nutrition environments
Protecting and promoting the health and safety of the people of Wisconsin
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Environmental Approaches to Promote Health
Physical Activity
Settings: ECE, schools, community, worksites
Physical activity access
Active community environments
Physical activity in ECE
Active Early
Quality physical education and physical activity in K-12
Active Schools
Comprehensive School Physical Activity Program
Protecting and promoting the health and safety of the people of Wisconsin
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Health System Interventions
• Promote reporting of blood pressure and A1c measures and promote clinical innovations
• Increase implementation of quality improvement processes o Electronic health record (EHR) adoption and use of health
information technology for hypertension and diabetes
o Monitoring of standard aggregated measures (provider and system level)
• Increase team-based care in health systems o Engagement of non-physicians (e.g., nurses, pharmacists, patient
navigators) for HTN and diabetes management
o Increase use of self-measured blood pressure tied with clinical
o support
NOTE: Strategies reflect those in Million Hearts®
Protecting and promoting the health and safety of the people of Wisconsin
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Community-Clinical Linkages
• Promote awareness of high blood pressure and prediabetes
• Promote participation in Diabetes Self-Management
Education (DSME)
o Access, referrals, reimbursement
• Increase utilization of lifestyle programs and chronic disease
self-management program in the community
• Increase engagement of community health workers
• Meeting the care needs of students with
chronic conditions
Expanded Chronic Care Model
Community
Health System
Build Healthy
Public Policy
Create
Supportive
Environments
Strengthen
Community
Action
Self-Management/
Develop
Personal Skills Delivery System
Design/
Re-orient Health
Services
Decision
Support
Information
Systems
Productive
Interactions and
Relationships
Population Health Outcomes/
Functional and Clinical Outcomes
Activated
Community
Prepared
Proactive
Community
Partners
Informed
Activated
Patient
Prepared
Proactive
Practice
Team
National Center for Chronic Disease Prevention
Division of Population Health
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Questions
Mary Pesik, RDN, CD
Chronic Disease Prevention Unit Supervisor
608-267-3694
Visit our website: http://www.dhs.wisconsin.gov/health/Chronic-Disease/index.htm
Protecting and promoting the health and safety of the people of Wisconsin
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