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Reforming Disease Prevention and Health Promotion: Population Health Steven Teutsch, MD, MPH Chief Science Officer Los Angeles County Department of Public Health September 15, 2009 Problem: America is Not Getting Good Health for Its Health Care Dollar

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reforming disease prevention and health promotion population health

Reforming Disease Prevention and Health Promotion:Population Health

Steven Teutsch, MD, MPH

Chief Science Officer

Los Angeles County Department of Public Health

September 15, 2009

problem america is not getting good health for its health care dollar
Problem: America is Not Getting Good Health for Its Health Care Dollar

Prepared for the Robert Wood Johnson Foundation by the Center on Social Disparities in Health at the University of California, San Francisco. Source: OECD Health Data 2007.

Does not include countries with populations smaller than 500,000. Data are for 2003.

*Per capita health expenditures in 2003 U.S. dollars, purchasing power parity

Copyright 2008 Robert Wood

Johnson Foundation/

Overcoming Obstacles to Health.

former leading causes of death crude death rate for infectious diseases u s 1900 2000
Former Leading Causes of Death:Crude Death Rate for Infectious Diseases, U.S., 1900 - 2000

* Rate is per 100,000

4

MMWR, CDC, 1999

income is linked to longevity regardless of race ethnicity
Income is Linked to Longevity Regardless of Race/Ethnicity

“Copyright 2008 Robert Wood Johnson Foundation/Overcoming Obstacles to Health.”

education matters mother s education related to infant mortality
Education Matters:Mother’s Education Related to Infant Mortality

Babies born to mothers who did not finish high school are almost twice as likely to die before their first birthday as babies born to college graduates

“Copyright 2008 Robert Wood Johnson Foundation/Overcoming Obstacles to Health.”

education matters more education means longer life expectancy
Education Matters: More Education Means Longer Life Expectancy

“Copyright 2008 Robert Wood Johnson Foundation/Overcoming Obstacles to Health.”

slide12
The Toxic American Environment: Percent of Recent Immagrants and Long-term Residents with Diabetes, United States, 2006

The Hispanic Paradox:

Recent Immigrants have less diabetes and other health problems than those who have had longer exposure to our toxic socioeconomic and physical environment

Steven P. Wallace, Xóchitl Castañeda.

Migration and Health: Latinos in the United States. 2008

economic hardship childhood obesity
Economic Hardship & Childhood Obesity

Economic hardship and childhood obesity go hand in hand

slide15

Action Model to Achieve Healthy People 2020 Overarching Goals

Determinants of Health

Interventions

Outcomes

  • Behavioral
  • outcomes
  • Specific risk factors,
  • diseases, &conditions
  • Injuries
  • Well-being & health-
  • related Quality of Life
  • Health equity
  • Policies
  • Programs
  • Information

Assessment, Monitoring, Evaluation & Dissemination

slide16

Action Model to Achieve Healthy People 2020 Overarching Goals

Determinants of Health

Interventions

Outcomes

  • Behavioral
  • outcomes
  • Specific risk factors,
  • diseases, &conditions
  • Injuries
  • Well-being & health-
  • related Quality of Life
  • Health equity
  • Policies
  • Programs
  • Information

Smoking Quitlines

Assessment, Monitoring, Evaluation & Dissemination

slide17

Action Model to Achieve Healthy People 2020 Overarching Goals

Determinants of Health

Nurse Home Visits

Interventions

Outcomes

  • Behavioral
  • outcomes
  • Specific risk factors,
  • diseases, &conditions
  • Injuries
  • Well-being & health-
  • related Quality of Life
  • Health equity
  • Policies
  • Programs
  • Information

Smoking Quitlines

Assessment, Monitoring, Evaluation & Dissemination

slide18

Action Model to Achieve Healthy People 2020 Overarching Goals

Work

Safety

Determinants of Health

Nurse Home Visits

Healthy Homes

Interventions

Outcomes

  • Behavioral
  • outcomes
  • Specific risk factors,
  • diseases, &conditions
  • Injuries
  • Well-being & health-
  • related Quality of Life
  • Health equity
  • Policies
  • Programs
  • Information

Smoking Quitlines

Assessment, Monitoring, Evaluation & Dissemination

slide19

Action Model to Achieve Healthy People 2020 Overarching Goals

Work Safety

Determinants of Health

Walkable Communities

Nurse Home Visits

Healthy Homes

Interventions

Outcomes

  • Behavioral
  • outcomes
  • Specific risk factors,
  • diseases, &conditions
  • Injuries
  • Well-being & health-
  • related Quality of Life
  • Health equity
  • Policies
  • Programs
  • Information

Smoking Quitlines

Blood Alcohol Laws

Assessment, Monitoring, Evaluation & Dissemination

slide21

Population Health Strategies

Spectrum of Health and Strategies to Improve It

Society

Clinical Strategies

Well

Dead

Individual

slide22

Population Strategies

Society

Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.

Education

Well

Dead

Worksite Programs

School Health

Individual

slide23

Clinical Strategies

Society

Well

Dead

Disease Mgmt

Assisted Living

Clinical Preventive Services

Primary Care

Tertiary Care

Individual

slide24

Medical Care System Strategies

Society

Well

Dead

Hospital Systems

Integrated Health Systems

Disease Mgmt

Assisted Living

Medical Home

Individual

slide25

Spectrum of Health and Strategies to Improve It

Society

Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.

Education

Well

Dead

Worksite Programs

School Health

Hospital Systems

Integrated Health Systems

Disease Mgmt

Assisted Living

Clinical Preventive Services

Primary Care

Tertiary Care

Individual

spectrum of health and strategies to improve it
Spectrum of Health and Strategies to Improve It

Society

Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.

Education

Well

Dead

Worksite Programs

School Health

Hospital Systems

Integrated Health Systems

Disease Mgmt

Assisted Living

Clinical Preventive Services

Primary Care

Tertiary Care

Individual

28

preventing onset of diabetes reducing obesity
Preventing Onset of Diabetes: Reducing Obesity

Society

Street-scale urban design/land use

Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.

Enhanced School-based Physical Education

Point-of-decision Prompts

Behavioral interventions to reduce screen time

Education

Well

Dead

Worksite Programs

Worksite programs for overweight and obesity

School Health

Hospital Systems

Integrated Health Systems

Disease Mgmt

Screen adults for obesity and offer intensive interventions

Assisted Living

Screen hypertensives

Clinical Preventive Services

Primary Care

Tertiary Care

Individual

29

managing diabetes
Managing Diabetes

Society

Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.

Education

Social Support Interventions in Comm. Settings

Well

Dead

Worksite Programs

Worksite programs for overweight and obesity

Self-Mgmt Education (home /Community

School Health

Hospital Systems

Control BP / Lipids/ Smoking

Integrated Health Systems

Case Mgmt/ Disease Mgmt

Disease Mgmt

Assisted Living

Clinical Preventive Services

Primary Care

Tertiary Care

Individual

30

maintaining function in diabetes
Maintaining Function in Diabetes

Society

Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.

Education

Well

Dead

Worksite Programs

School Health

Hospital Systems

Integrated Health Systems

Disease Mgmt

Dialysis

Assisted Living

Clinical Preventive Services

Primary Care

Tertiary Care

Individual

31

a comprehensive approach to preventing and controlling diabetes
A Comprehensive Approach to Preventing and Controlling Diabetes

Society

Street-scale urban design/land use

Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.

Enhanced School-based Physical Education

Point-of-decision Prompts

Behavioral interventions to reduce screen time

Education

Social Support Interventions in Comm. Settings

Well

Dead

Worksite Programs

Worksite programs for overweight and obesity

Self-Mgmt Education (home /Community

School Health

Hospital Systems

Control BP / Lipids/ Smoking

Integrated Health Systems

Case Mgmt/ Disease Mgmt

Disease Mgmt

Screen adults for obesity and offer intensive interventions

Assisted Living

Screen hypertensives

Clinical Preventive Services

Primary Care

Dialysis

Tertiary Care

Individual

32

what we are striving to achieve
What We Are Striving to Achieve

Vision

A society in which all people live long, healthy lives.

Overarching Goals

  • Elimination of preventable disease, disability, injury, and premature death
  • Achievement of health equity, elimination of disparities, and improvement in the health of all groups
  • Creation of social and physical environments that promote good health for all.
  • Promotion of healthy development and healthy behaviors across every stage of life

33

Healthy People 2020

major opportunities health in all policies
Major Opportunities:Health in All Policies
  • Opportunities in all sectors e.g. agriculture, transportation, housing, environment, commerce, tax policy
  • In both public and private sector
  • Examples:
    • Menu labeling
    • Tax on sugared beverages
    • Transportation systems that encourage mass transit, biking and walking

34

slide35

35

http://www.ph.ucla.edu/hs/health-impact/

hia estimation of health benefits from a living wage ordinance
HIA: Estimation of Health Benefits from a Living Wage Ordinance

36

Bhatia , Katz, AJPH, 2001

summary
Summary
  • Prevention effective in clinical and population applications
  • Large differences between best evidence and current practice
  • Greatest opportunity: policies and programs targeting populations
  • Policies in all sectors affect health
  • Can’t eliminate health disparities without emphasis on social and physical determinants
the challenge closing the gap
The Challenge: Closing the Gap
  • Cannot be done by just fixing the health care system
  • Must address the underlying social and physical environment determinants
  • Must build a true population-oriented health system

38