“Better Health Through Healthy Living”

“Better Health Through Healthy Living” Annual Conference Kansas Public Health Association October 2, 2012 Melvin D. Shipp, OD, MPH, DrPH President, American Public Health Association

“What is Public Health?”

Public Health • Prevention • Health equity • Health Economics • Where do we go from here?

Health A B Clinical Horizon C “Death” Primary Prevention Secondary Prevention Tertiary Prevention Health promotion & education Rehabilitative care Clinical care “$” “$$$” “$$$$$”

Time path of “Health Stock” Appendicitis Auto Crash Birth HEALTH Cancer (radiation therapy) Hmin Death TIME

Health Equity • The opportunity for everyone to attain full health potential • No one is disadvantaged from achieving this potential because of social position or circumstance. Reference: Whitehead M. et al

Conventional 10 Tips for Better Health • Don’t smoke. If you can, stop. If you can’t, cut down. • Stay on a balanced diet with plenty of fruits and vegetables. • Stay physically active. Exercise at least 3 times per week. • Manage stress: take time to slow down; take relaxing get-aways. • If you drink, do so in moderation. • Cover up in the sun. • Make sure you practice safer sex • Get regular check ups and get screenings for cancer. • Be safe on the roadways. Follow highway codes and wear your seatbelts. • Learn the first-aid ABCs: airway, breathing, circulation. Adapted from Dave Gordon, University of Bristol, and Dennis Raphael, York University

…What your doctor didn’t tell you • Don’t be poor. If you can, stop. If you can’t, try not to be poor for long. • Live near good supermarkets and affordable fresh produce stores. • Live in safe neighborhoods with parks and green spaces nearby. • Work in a rewarding and respected job with good compensation, benefits and control over your work. • If you work, don’t lose your job or get laid off. • Take family vacations and all the benefits you are entitled to. • Make sure you have wealthy parents. • Don’t live in damp, low-quality housing, next to a busy road or near a polluting factory. • Be sure to own a car if you have to rely on neglected public transportation. • Learn how to fill in the complex housing benefit application forms before you become homeless and destitute. Adapted from Dave Gordon, University of Bristol, and Dennis Raphael, York University

Health Inequities • Systematic and unjust distribution of social, economic, and environmental conditions • Unequal access to quality education, healthcare, housing, transportation, other resources (e.g., grocery stores, car seats) • Unequal employment opportunities and pay/income • Discrimination based upon social status/other factors Reference: Whitehead M. et al

Health Disparities Definition: Based on: • Differences in the incidence and prevalence of health conditions and health status between groups. • Age • Race/ethnicity • Socioeconomic status • Sexual orientation • Gender • Disability status • Geographic location • Combination of these

Social Determinants of Health • Life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education and health care, • whose distribution across populations effectively determines length and quality of life. Reference: James S. (2002)

Place Matters Good Health Status Communities of Opportunity Low- Income Communities Fast Food Restaurants Liquor Stores Unsafe/Limited Parks Poor Performing Schools Increased Pollution and Toxic Waste Sites Limited Public Transportation Parks Sidewalks Grocery Stores Financial Institutions Better Performing Schools Good Public Transportation • Poor Health Status • contributes to health disparities: • Obesity • Diabetes • Asthma • Infant mortality Reference: PolicyLink

Health A B Clinical Horizon C “Death” Primary Prevention Secondary Prevention Tertiary Prevention Health promotion & education Rehabilitative care Clinical care $ $$$ $$$$$

Time path of “Health Stock” Appendicitis Auto Crash Birth HEALTH Cancer (radiation therapy) Hmin Death TIME

America’s Health • In the last decade, America’s health indices have declined by 69% • 27.5% of people in the U.S are obese • 17.3% of people in the U.S. are smokers • 8.7% of people in the U.S. have diabetes

Kansas 2011 • Highlights • Preventable hospitalizations decreased from 55.1% to 52.9% • 640,000 obese adults; 229,000 more than 10 years ago • Smoking decreased from 21.0 %to 17.0 % (past 10 years) • Preventable hospitalization decreased from 75.3 to 70.5 • Diabetes increased from 6.9 %to 8.4 % (past 5 years) • Percentage of children in poverty increased from 18.0 %to 23.1 % • Rate of deaths from cardiovascular disease decreased from 324.3to 265.2 per 100K population (past 10 years)

Kansas 26th Overall (23rd in 2010) • Strengths • Low rate of death from cardiovascular disease • Low rate of uninsured population • High rate of high school graduation • Challenges • High incidence of infectious disease • Low per capita public health funding • High prevalence of binge drinking

Kansas(#26) vs. Vermont (#1) Vermont Kansas

Health Economics • The basic economic problem that arises because people have unlimited wants but resources are limited. Because of scarcity, various economic decisions must be made to allocate resources efficiently. • When we talk of scarcity within an economic context, it refers to limited resources, not a lack of riches.

Dr. Stephen Bezruchka, Population Health Forum http://depts.washington.edu/eqhlth/.

www.equalitytrust.org.uk Life expectancy in rich countries is no longer related to National Income per head Wilkinson & Pickett, The Spirit Level

www.equalitytrust.org.uk • Inequality... • How much richer are the richest 20% in each country than the poorest 20%? Income gaps How many times richer are the richest fifth than the poorest fifth? Wilkinson & Pickett, The Spirit Level

www.equalitytrust.org.uk Health and social problems are worse in more unequal countries • Index of: • Life expectancy • Math & Literacy • Infant mortality • Homicides • Imprisonment • Teenage births • Trust • Obesity • Mental illness – incl. drug & alcohol addiction • Social mobility Index of health and social problems Wilkinson & Pickett, The Spirit Level

Income, Poverty and Health Insurance Coverage in the United States: 2010-11 • Median family household income • Declined by 1.7% • Real income 8.1% lower than in 2007 (i.e. most recent U.S. recession) • Poverty number (rate) • Unchanged: 9.5 million (11.8%) • Health Insurance coverage • Increased from 256.6 million to 260.2 million • Income Inequality • 1.6% increase (Gini index=0.477) Source: U.S. Census [Sept. 12, 2012]

GDP for Selected Countries Source: Paul Krugman; Op Ed New York Times; March 28, 2008

The Current US Health Care System • Greatest acute care in the world • People come from around the world for treatment • But, 46 million Americans lack coverage • Uncoordinated • Unsustainable • Unsupported

A Future System • Affordable • Accessible • Coordinated • High quality • Person, family and community centered

Cataract

Health A B Clinical Horizon C “Death” Primary Prevention Secondary Prevention Tertiary Prevention Health promotion & education Rehabilitative care Clinical care “$” “$$$” “$$$$$”

History • Founded 1872 • Stephen Smith, physician, attorney, New York City Metropolitan Health Board Commissioner • Scientific advances reveal causes of communicable diseases • Mission: Improving health for all U.S. residents • Key functions • Policy advocacy • Improving community health • Education • Health services

Policies and Practices • Clean air and clean water • Safe and nutritious food supply • Encouraging health lifestyles • Monitoring health related environmental factors • Advocating maternal and child health services • Immunization programs • Safe work environments

APHA Strategic Map: 2010-2013 Be the “Go To” Organization for Public Health November 9, 2010 Improve Impact of Policy and Advocacy Implement a Sustainable Business Model Provide Service To Members and The Profession to Build Capacity Use Strategic Communications To Frame Issues & Increase Impact Create, Implement and Assess the Engagement Strategy Required for Future Success

Organization • Washington DC Headquarters • 53 State Affiliates • 49 unique states • Northern California • Southern California • New York City • Washington, DC • 27 Sections and 6 Special Primary Interest Groups

“Better Health Through Healthy Living”