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Chronic Disease Prevention. November 20, 2008. Objectives. Background: Setting the Stage Status of Chronic Diseases in San Diego Evidenced-based Best Practices HHSA Chronic Disease Prevention Model. Setting the Stage. Why Chronic Disease?. Why Chronic Disease?.

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objectives
Objectives
  • Background: Setting the Stage
  • Status of Chronic Diseases in San Diego
  • Evidenced-based Best Practices
  • HHSA Chronic Disease Prevention Model
setting the stage

Setting the Stage

Why Chronic Disease?

why chronic disease
Why Chronic Disease?
  • California Conference for Local Public Health Officers (CCHLO)
    • Chronic Disease Conference
    • Spurred Idea to develop CC Agency for Agency
      • Two meeting held to date to develop an inventory of Agency Chronic Disease activities
    • SPOS came to PHS to conduct a “Focused Dialogue”
    • Chronic Disease was chosen
what is chronic disease
What Is Chronic Disease?
  • According the U.S. National Center for Health Statistics, is a disease that lasts 3 months or more.
  • Cannot be prevented by vaccines or cured by medications.
  • Caused by health damaging behaviors - particularly tobacco use, lack of physical activity, and poor eating habits.
  • Is the leading cause of death and disability in the United States.
  • Accounts for 7 of the 10 U.S. leading cause of death.
why should we care
Why Should We Care?
  • Chronic diseases are prevalent, preventable and costly!
  • Cause extended pain and suffering, associated with decreased quality of life for millions.
  • Treatment for seven chronic diseases including cancers, mental illnesses, heart disease, lung conditions, hypertension, stroke, and diabetes ran to nearly $280 billion in 2003; now estimated to be to $1.3 trillion per year.
  • Prevention programs are highly cost-effective
top 10 causes of mortality in san diego county
Top 10 Causes of Mortality in San Diego County

= Chronic Diseases

Rates are per 100,000 population.

Source: State of California, Department of Public Health, Center for Health Statistics, Vital Statistics Section, Death Statistical Master Files

physical activity by gender
PA and Nutrition TrendsPhysical Activity by Gender

Percent

Nutrition by Gender

Men

Women

healthcare cost in california and san diego
Healthcare Cost in California and San Diego
  • $130 Billion spent (treatment and lost productivity) by California in 2003
  • $4.3 Billion in SD County (not including lung cancer treatment)
3 four 50
3 – FOUR – 50

3 RISK FACTORS

(Tobacco Use, Poor Diet, Lack of Physical Activity)

4 CHRONIC DISEASES

(Heart Disease/Stroke, Type 2 Diabetes, Respiratory Disease, Cancer)

50% of DEATH

slide13
LIFE EXPECTANCY TRENDS

San Diego County vs United States, 2000-2006

*2006 U.S. data are preliminary

san diego county population by race ethnicity 2007
San Diego County Populationby Race/Ethnicity, 2007
  • 3 million

people

  • Racial/Ethnic

groups from

around the

world.

  • Over 100

languages

Asian 9.4%

N=292,251

Hawaiian/Pacific Islander 0.4%

N=13,144

American Indian 0.5 %

N=15,946

Black 5.4%

N=166,486

Hispanic 29.3%

N=906,898

White 51.6%

N=1,597,847

Source: SANDAG, San Diego County 2007 Population Estimates

san diego county population by race ethnicity census 1990 vs 2000 vs 2007
San Diego County Populationby Race/Ethnicity, Census 1990 vs. 2000 vs. 2007
  • Between
  • 1990 & 2000:
  • The population of Hispanics and Asian increased
  • The population of Whites and Blacks decreased

Percent

Source: SANDAG, San Diego County 1990, 2000 Census, and 2007 Population estimates

all cancer deaths by race ethnicity 2005
All Cancer Deathsby Race/Ethnicity, 2005

Cancer is the

second leading

cause of death

for San Diego

County

San Diego County Overall Rate, 2005: 163.1 / 100,000

HP 2010 Goal: 159.9

Note: All rates are adjusted to 2000 Standard U.S. Population.

Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.

selected cancer deaths by race ethnicity 2005
Selected Cancer Deathsby Race/Ethnicity, 2005

HP 2010 Goal

Note: All rates are adjusted to 2000 Standard U.S. Population.

Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.

coronary heart disease and stroke deaths by race ethnicity 2005
Coronary Heart Disease and Stroke Deathsby Race/Ethnicity, 2005

Blacks have the

highest rate of

coronary heart

disease deaths

and stroke deaths

compared to

other racial and

ethnic groups.

San Diego County Overall:

CHD Rate - 128.4 / 100,000

Stroke Rate – 41.3 / 100,000

HP 2010 Goal CHD: 166.0

HP 2010 Goal Stroke: 48.0

Note: All rates are adjusted to 2000 Standard U.S. Population.

Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.

slide19
Diabetes by Race/Ethnicity

Prevalence of Diabetes Among Adults 2005*

% High School Students Overweight 2005

Hospital

Admissions 2005

Deaths (underlying)2005

R/E

Black

White

Hispanic

Asian/Other

69.0

16.6

33.5

21.2

10.7

7.7

18.4

7.4

6.6

5.1

6.5

7.2

303.5

87.1

236.0

87.6

* - Percentage of adults who were ever diagnosed with diabetes

Source: Youth Risk Behavior Survey (YRBS), San Diego City Schools; California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates; California Health Interview Survey (CHIS), California Department of Health Services, Death Statistical Master File.

diabetes mortality
Diabetes Mortality

Among the top 53 U.S. City/County jurisdictions

San Diego County:

  • Ranked 52 in 1990
  • Ranked 46 in 2004
  • Ranked 8th in the highest rate of change between 1990 and 2004

Source: NACCHO 53 Big Cities Health Inventory, 2007

Note: Ranking scheme - 1 being worst and 53 being best

diabetes mortality among san diego county residents 2000 2005
Diabetes Mortality Among San Diego County Residents, 2000-2005

Deaths and Age-adjusted Rates

HP2010

= 45

diabetes hospitalizations among san diego county residents 2001 20051
Diabetes Hospitalizations Among San Diego County Residents, 2001-2005

By Race/EthnicityNumber and Age-adjusted Rates

slide24
Overweight & Obese Adults* by Race/Ethnicity, 2005

HP 2010 Goal

Unhealthy weight

(BMI>25): 40%

Obesity (BMI >30): 15%

* as Defined by Body Mass Index (BMI)

Source: 2005 California Health Interview Survey (CHIS)

asthma in san diego county by race ethnicity
Asthma in San Diego Countyby Race/Ethnicity

Average Annual Number of Deaths

2002-2004

Estimated Prevalence

Among Children 2005

Hospitalization Rate, 2005

Race/Ethnicity

Black

White

Hispanic

Asian/Other

13.8*

9.6

12.4

11.7

204.7

59.3

74.9

62.6

3

18

3

4

Source: 2005 California Health Interview Survey (CHIS), California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates. California Department of Health Services, Death Statistical Master File

* - These results for Blacks reflect 2003 data results since sample size for Blacks in 2005 was statistically unreliable.

slide27
Selected Health Indicators*

San Diego County, CA, & US, HP2010

Healthy People 2010 Goal

San Diego County

Indicator

CA

U.S.

  • Infant Mortality
  • Adults reporting poor/fair health
  • Incidence of AIDS
  • CHD Deaths
  • Suicides
  • F. Breast Cancer Deaths
  • Unintentional Injury Deaths

4.6

14.4%

14.0

144.4

10.5

22.9

28.8

4.5

None

1.0

166.05.0

22.3

5.3

16.0%

11.8

162.8

8.5

24.1

30.5

7.0

14.0%

15.0

159.6

10.7

26.0

37.7

The numbers above reflect either rates or percentages

* - These data reflect the most current comparable data

direction from the national level
Direction from the National Level

Federal Government Agencies

United States Department of Agriculture

United States Surgeon General

Centers for Disease Control

slide30
“Healthy places are those designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders -- where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options.”

CDC’s “Designing & Building Healthy Places”

slide31
Direction from the National Level

Leading Public Health Organizations

National Association of County and City Health Officials

National Task Force on Community Preventive Services

Robert Wood Johnson Foundation

Kaiser Permanente

American Planning Association (funded by CDC)

slide32
Public

California Conference of Local Health Officers

California Department of Public Health

Governor's Obesity Prevention Plan

Private

The California Endowment

Strategic Alliance

Direction from the State Level

slide33
Best Practices and Promising Interventions
  • Healthy Community Improvements
  • Healthy Community Development
  • Healthy Community Plans & Policies
1 healthy community improvements
1. Healthy Community Improvements

Best Practices and Promising Interventions

Partnering with communities and cities to improve existing physical and social conditions that prevent physical activity and healthy eating

healthy community improvements
Healthy Community Improvements

Safe and healthy routes to schools, parks, healthy foods, seniors

Traffic calming, improve street crossings

Installing/improving sidewalks & bike paths

Community gardens

School/community joint use agreements

slide36
Safe and Healthy Routes to Schools and Parks, Healthy Foods, Seniors

AARP

- assessments

- advocates

slide37
From abandoned lots to community gardens…

Create gardens for culturally appropriate foods reflective of the community.

slide38
CX3 Projects (Chula Vista & La Mesa)Communities of Excellence in Nutrition, Physical Activity and Obesity Prevention

Strong Partnerships

Leadership Training

Youth & Mentors

  • Community Assessment
  • Advocacy
2 healthy community development
2. Healthy Community Development

Best Practices and Promising Interventions

Promoting healthy development and redevelopment projects in neighborhoods

healthy community development
Healthy Community Development

Integrating “Healthy Places” design into the Development Review process

Redevelopment areas

Grocery stores in underserved areas

Facility design

slide44
Partners: East Oakland Diabetes Work Group, Alameda County Department of Public Health, Network for a Healthy California
3 healthy community plans policies
3. Healthy Community Plans & Policies

Best Practices and Promising Interventions

Promoting healthy government, school and worksite policies and plans that support physical activity, healthy eating and tobacco-free environments

healthy community plans policies
Healthy Community Plans & Policies

Land use & transportation planning

Affordable housing policies

Regional Food Systems & Urban Agriculture

Worksite Wellness policies

Government Wellness policies

School Wellness policies

slide56
City of Richmond

Health and Wellness Element

Policy Framework

www.healthycommunitiesbydesign.org

school wellness gardens
School Wellness Gardens

Classroom Garden Beds

Quad Area with Gardening

slide60
Socio-Ecological Model

Businesses

Neighborhoods

Policies and Laws

Individuals

Families

environmental approaches to tobacco the california model
Environmental Approaches to Tobacco: The California Model
  • Prop. 99 Tobacco Tax Funds
  • Local Ordinances and State Legislation for Smoke-Free Environments
  • Massive Anti-Tobacco Campaign
california vs the us
California vs. The US
  • Smoking Rates
  • Lung Cancer Death Rates

Percent

American Lung Association of California

Centers for Disease Control, National Cancer Institute, statecancerprofiles.cancer.gov

tobacco and heart attacks
Tobacco and Heart Attacks
  • Pueblo, Colorado
    • Decrease in heart attack rates by 28% after smoke-free ordinance
      • 399 HA pts in 1.5 yrs prior to ordinance, only 291 HA pts in 1.5 yrs after
  • Helena, Montana
    • Decrease in heart attack rates by 40% during first 6 months of smoke-free ordinance
why act now
Why Act Now?

Chronic Disease Prevention is strategic:

  • Fundamental to reducing death and disability and improving community health
  • Critical to cutting health care costs
  • Experience to-date shows that strategies can be very cost-effective
  • Funding opportunities for strategies that focus on environmental change
at its foundation
At its Foundation…

Place Matters

Adopting the concept that neighborhood environmental factors all affect individual behaviors and health

From Policy Link and

The California Endowment

why place matters environmental strategies
Why Place Matters: Environmental Strategies
  • Physical Environment
    • Safe parks; full-service grocery stores and farmers’ markets; safe, walkable streets; less truck and bus traffic; well-maintained housing; open spaces.
  • Social Environment
    • Strong social networks that bring neighbors together—whether to advocate for change, cultivate a community garden, or provide services.
why place matters environmental strategies1
Why Place Matters: Environmental Strategies
  • Economic Environment
    • Commercial investment, jobs that take people out of poverty, businesses that provide healthy food options.
  • Service Environment
    • Access to quality healthcare services, public safety, and community support services.
understanding the problem
Understanding the problem

50% of Deaths

environments

Tobacco

Chronic Disease

Nutrition

*Service*

*Physical*

Heart Disease/Stroke

Type 2 Diabetes

Cancer

Respiratory Disease

Physical Activity

$4.3 Billion Annually

*Economic*

*Social*

Poor environments a Unhealthy behaviors a Chronic Diseases

slide69
Adopting a new solution

Creating Environments to Support Healthy Behaviors

environments

Tobacco

Chronic Disease

Nutrition

*Service*

*Physical*

Reduction in:

Heart Disease/Stroke

Type 2 Diabetes

Cancer

Respiratory Disease

Physical Activity

*Economic*

*Social*

Healthy environments a Healthy Behaviors a Disease Reduction

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