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 cathy.taylor@tn.gov

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 has 6.3 million residents 95 counties Annual Budget Health Services Administration - $478 million TDOH - $550 million We serve one million unduplicated patients annually

Traditional Services Primary Care Other WIC Communicable Disease 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 Other Strategic Planning Health Policy Legislative Testimony Budget & Grant Writing Quality & Accreditation International & Academic Partnerships Workforce Development CEPH & ETSU’s PHTC

Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1990 2000 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Tennessee Challenges (TFAH, 2011) Adults 4nd – Obesity 5th - Diabetes 5th - Hypertension 7th – Tobacco 8th - Infant Mortality Overall Rank - 42

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

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

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) 7 of 10 deaths Obesity 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 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 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 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

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 Behavior 40% Genetics 30% Environment 20% Medical 10% Source: McGinnis JM, Williams-Russo P, Knickman JR. Health Affairs. 2002 Mar-Apr;21(2):78-93.

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

Life Course Perspective and Health Trajectories Poverty Lack of health services Family Discord Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs Ready to learn Pre-school “Healthy” Trajectory Health Services Appropriate Discipline Reading to child “At Risk” Trajectory Parent education Emotional Health Literacy “Delayed/Disordered ” Trajectory Birth Early Infancy Late Infancy Early Toddler Late Toddler Early Preschool Late Preschool 18 Graphic Concept Adapted from Neal Halfon , UCLA 18

Thank You