Healthy Vision 2010 August 30, 2006 “Framework for Health: Population-based Components of the Health System” Eduardo J. Sanchez, MD, MPH Commissioner, Texas Department of State Health Services

Evidence of Effectiveness A growing body of evidence indicates that population-based interventions: –Promote health –Prevent disease –Generate a favorable Return on Investment (ROI) – Compliment efforts of the medical care delivery system –Reduce demand for medical care

Growth in National Health Expenditures 1980–2011 from $1,000 to $9,000 Levit et al. Health Affairs 2002;21:172–181. *Projection from Heffler et al. Health Affairs 2002;21:207–218. Per Capita Costs $6280 (2004)

Public Health $ Health Care: Are We Getting Our Money’s Worth? 65 years + Medical Care 0 years People of Texas Dollars Expended $

Determinates of Premature Mortality 50% behavior & lifestyle 20% environmental exposure 10% access to health care Alder, Newman “Socioeconomic Disparities in Health,” Health Affairs Vol 21 #2

Public Health $ Health Care: Are We Getting Our Money’s Worth? 65 years + Medical Care 0 years People of Texas Dollars Expended $

Tobacco Interventions

Leading Actual Causes of Death Texas, 2001 Tobacco is the single most preventable cause of death & disease in Texas

Smoking Rates for Harris & Jefferson Counties Reducing tobacco use requires a comprehensive & sustained approach. Gains in Harris County regressed as resources/efforts were reduced.

Funding for Comprehensive Tobacco Prevention and Cessation Programs Tobacco Excise Tax Increases Restrictions on Secondhand Smoke Coverage for Smoking Cessation Policies That Make a Difference

Texas Tobacco Task Force Report Program Elements and Best Practices Community & School Programs Media Campaigns Cessation Enforcement Efforts Targeted to Diverse/Special Populations Surveillance & Evaluation Research

Comprehensive Program Results (For Only $3 Per Capita) 36% reduction in smoking, 6 th -12 th grade 26% reduction in adult smoking Double the statewide rate of reduction

Texas Community-Based Tobacco Cessation Initiatives a Smoke Free Paso del Norte - $3.3 million 4-year program Tobacco Free Amarillo - $400,000 grant from the Amarillo Hospital District (Tobacco Settlement Funds)

Financial Returns from Investments in Tobacco Control After 5 years a one-time investment of $68 million ($3 per capita) would save: More than $1 billion in medical costs ~ $400 million in productivity costs ~ 163,000 fewer smokers This represents a 20:1 ROI Center for Health Research, Kaiser Permanente Northwest, June 2006

Obesity Interventions

States With Highest Prevalence of Adult Obesity 1.Mississippi 2.Alabama 3.West Virginia 4.Louisiana 5.Tennessee 6.Texas, Kentucky, Michigan “How Obesity Policies are Failing in American” Trust for America’s Health August 2005,

Adult Obesity Prevalence U.S & Texas, Obesity (BMI >=30), BRFSS,

Overweight Youth in Texas Compared to National Data Source: Hoelscher et al., 2004; Ogden et al., 2006; SPAN, Healthy People 2010 Goal * PercentPercent Overweight Obese

Can We Identify a “$3 Per Capita” Strategy To Address Obesity in Texas? Community-based interventions –Where we work –Where we learn –Where we play –Where we pray

2006 SPAN Data Suggest School-Based Interventions Are Having An Impact Texas-wide, 8 th graders same level of overweight as 4 years ago 4 th graders had a slight decrease 11 th graders showed a 1/3 increase in overweight (14.5% to 19%) Region 9/10 (El Paso) showed ~25% reduction in obesity among 4 th graders

Cost of Gastric Bypass Surgeries $25,000 x 1,000,000 Morbidly obese Texans $25 Billion

Comprehensive School Health Programs 4,258 Texas Public Elementary Schools $2,500 Average Cost for Coordinated School Health 4258 x 2500 $10,645,000 1/10 of 1% reduction in obesity would pay for program

Mental Health Interventions

Mental Illness Strikes More Americans Each Year Than Other Serious Illnesses Mental Illness Serious Mental Illness CVD DiabetesCancerAsthma CDC BRFSS, SEER Cancer Statistics Review, , “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders” Arch Gen Psychiatry. Vol. 62, June 2005

Mental Health Community Crisis Services for Children and Adults 46% of all ER visits have behavioral health issues as a basic or contributing factor

Mental Health Community Crisis Services for Children and Adults Reduced use of costly care settings, i.e., emergency rooms, state hospitals and jails Reduced need for transportation to state hospitals for short-term stabilization Reduced homicide and suicide Minimized impact on the health and social services system Every $1 spent on mental health services saves $5 in overall health care (Am. Psychological Association)

Mental Health Community Crisis Services for Children and Adults ER COST OFFSET (- $25) Average per Client per Month 27 percent reduction Fiscal Year 2005 Texas average monthly Emergency Room (ER) costs were 27 percent lower for Medicaid clients receiving needed DSHS community mental health treatment. $93 Untreated (N=13,642) $68 Treated (N=33,472)

Public Health & Mental Health Ensure that Texans understand mental health is essential to overall health Expand efforts to prevent or delay onset and reduce severity of mental illness & substance abuse Incorporate competent mental health screening, assessment, brief intervention & referral into primary care settings Eliminate disparities of access, outcomes & resources

Opportunities for Texas Better understand epidemiology of mental health and substance abuse Integrate care at the local level Build capacity of primary care providers & ER departments to identify, treat and refer across disciplines Reduce barriers to treatment

Evidence of Effectiveness A growing body of evidence indicates that population-based interventions: –Promote health –Prevent disease –Generate a favorable Return on Investment (ROI) – Compliment efforts of the medical care delivery system –Reduce demand for medical care

Will Strategies to Improve Access to Medical Care Improve Health? In response to a high incidence of 911 calls for heart attacks in a given zip code, should we: Keep an ambulance ready to go in the community? Establish a primary care facility in the community? Improve parks, walking trails & access to fresh produce?