Chronic disease in tennessee
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Chronic Disease in Tennessee. College of Public Health East Tennessee State University November 11, 2011. Cathy R. Taylor, DrPH , MSN, RN Assistant Commissioner Tennessee Department of Health [email protected] Objectives.

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Chronic disease in tennessee

Chronic Disease in Tennessee

College of Public Health

East Tennessee State University

November 11, 2011

Cathy R. Taylor, DrPH, MSN, RN

Assistant Commissioner

Tennessee Department of Health

[email protected]


Objectives

Objectives

  • Discuss chronic disease prevalence in the United States and Tennessee.

  • Discuss strategies to address selected chronic diseases.

  • Discuss Life Course Perspective implications for chronic disease prevention.


Tennessee department of health

Tennessee Department of Health

  • Tennessee has 6.3 million residents

    • 95 counties

  • Annual Budget

    • Health Services Administration - $478 million

    • TDOH - $550 million

    • We serve one million unduplicated patients annually


Chronic disease in tennessee

Other

Strategic Planning

Health Policy

Legislative Testimony

Budget & Grant Writing

Quality & Accreditation

International & Academic Partnerships

Workforce Development

CEPH & ETSU’s PHTC

  • Traditional Services

    • WIC

      • Community Nutrition

      • Health Promotion

    • Communicable Disease

      • General Environmental Health

      • Emergency Preparedness

    • MCH & Health Promotion

      • Home Visitation – MIECHV Lead

      • Family Planning

      • Injury Prevention

      • Medicaid/TennCare Outreach

  • Primary Care

    • 51 clinics (14 FQHC)

    • Dental


Chronic disease in tennessee

Obesity Trends* Among U.S. AdultsBRFSS,1990, 2000, 2010

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2000

1990

2010

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%


Tennessee challenges tfah 2011

Tennessee Challenges(TFAH, 2011)

  • Adults

    • 4nd – Obesity

    • 5th - Diabetes

    • 5th - Hypertension

    • 7th – Tobacco

  • 8th - Infant Mortality

  • Overall Rank - 42


Chronic disease in tennessee

Cigarette Use (Adults), 2010

Source: CDC. Tobacco Control Highlights, Tennessee, 2010. Retrieved November 4, 2011 from http://apps.nccd.cdc.gov/statesystem/HighlightReport/HighlightReport.aspx?FromHomePage=Y&StateName=Tennessee&StateId=TN


Chronic disease in tennessee

Past Month Cigarette Use among Youths Aged 12 to 17, by Gender: 2002-2010

Source: National Survey on Drug Use and Health, Summary of National Findings, 2010. Retrieved November 5, 2011 from http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm


Chronic disease in tennessee

Disability in Tennessee, 2010

  • An estimated 10.2 percent of civilian non-institutionalized, men and women, aged 18-64 in Tennessee reported a work limitation.

    • About 391,000

    • $300-400 million annually

Sources:

1. von Schrader, S., Erickson, W. A., Lee, C. G. (2010, March 17). Disability Statistics from the Current Population Survey (CPS). Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics (StatsRRTC). Retrieved November 6, 2011 from www.disabilitystatistics.org

2. Social Security Administration. Annual Statistical Supplement to the Social Security Bulletin, 2010. SSA Pub. No. 13- 11700. Retrieved November 6, 2011 from http://www.socialsecurity.gov/policy/docs/statcomps/supplement/2010/supplement10.pdf


Chronic disease cdc 2011

Chronic Disease (CDC, 2011)

  • 7 of 10 deaths

    • 75-80% healthcare spending

    • 50% attributable to heart disease, cancer, and stroke

  • Obesity

    • 30% adults

    • 20% youth aged 6-19 years

  • Arthritis most common cause of disability

  • Most common cause of school absence in Tennessee?


Cdc s winnable battles

CDC’s Winnable Battles

Evidence suggests rapid progress can be made (1-4 years):

Healthcare Associated Infections

HIV

Motor vehicle injuries

Obesity, nutrition, food safety

Teen and unintended pregnancy

Tobacco


Diabetes prevention and health improvement

Diabetes Prevention and Health Improvement

  • Project Diabetes

  • Obesity Prevention

    • State Plan – Eat Well, Play More

    • Menu Labeling and Sodium Reduction

  • Chronic Disease Management

    • Stanford Self-Management Model – aims to help patients gain self-confidence in their ability to control their symptoms

    • Small group workshops over 6 weeks

    • Meet once a week for about 2 hours

    • Led by a pair of lay leaders with health problems of their own

    • Meetings are highly interactive, focus on building self-care skills

    • Shared experiences and support strategies

  • Women Infants and Children (WIC)*

    • Healthy foods and education

    • Breastfeeding promotion

  • Nurse Home Visitation*

  • Gold Sneaker*

* Also has tobacco cessation component


Tobacco cessation and control

Tobacco Cessation and Control

  • Federal and State Legislation

  • Tennessee’s Non-Smoker

    Protection Act

    • Increased Tobacco Tax

    • Public smoking ban

  • 1-800-QUITNOW

    • Personal Telephone Quit Coach

    • Quit Plan

  • TV, radio, print ads


  • Chronic disease in tennessee

    National Prevention Strategy

    America’s Plan for Better Health and Wellness

    http://www.healthcare.gov/center/councils/nphpphc/strategy/report.pdf

    • 7 Priorities

    • Tobacco Free Living

    • Preventing Drug Abuse and Excessive Alcohol Use

    • Healthy Eating

    • Active living

    • Injury and Violence Free Living

    • Reproductive and Sexual Health

    • Mental and Emotional Well-Being

    • 4 Strategic Directions

    • Healthy and Safe Community Environments

    • Clinical and Community Preventive Services

    • Empowered People

    • Elimination of Health Disparities

    Released June 16, 2011


    Determinants of health

    Determinants of Health

    Behavior40%

    Genetics 30%

    Environment 20%

    Medical10%

    Source: McGinnis JM, Williams-Russo P, Knickman JR. Health Affairs. 2002 Mar-Apr;21(2):78-93.


    Life course perspective

    Life Course Perspective

    Ecological Models and Social Determinants of Health http://mchb.hrsa.gov/lifecourseapproach.html

    Today’s experiences & exposures determine tomorrow’s health

    Health status is strongly affected by the environment

    Outcomes reflect more than genetics & personal choice

    Weathering, cumulative or allostatic load

    Critical or sensitive periods for intervention

    17


    Chronic disease in tennessee

    Pre-school

    Ready to learn

    Health Services

    Appropriate Discipline

    Reading to child

    Parent education

    Emotional Health

    Literacy

    Late Preschool

    Late Infancy

    Late Toddler

    Birth

    Age

    6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs

    Early Infancy

    Early Toddler

    Early Preschool

    Life Course Perspective and Health Trajectories

    Family Discord

    Lack of health services

    “Healthy” Trajectory

    Poverty

    “At Risk” Trajectory

    “Delayed/Disordered ” Trajectory

    18

    Graphic Concept Adapted from Neal Halfon , UCLA


    Chronic disease in tennessee

    Thank You


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