1. Raising the Bar for Prevention:   National Prevention Strategy and CDC’s 6/18 Initiative
Boris D. Lushniak, MD, MPH, RADM (Ret), USPHS
Chair, Department of Preventive Medicine and Biostatistics
Uniformed Services University of the Health Sciences

2. Disclosures The presenter has no financial relationships to disclose.
This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS.
Neither PESG, AMSUS, nor any accrediting organization support or endorse any product or service mentioned in this activity.
PESG and AMSUS staff has no financial interest to disclose.
Commercial support was not received for this activity.

3. Disclaimer
The content of this presentation is the sole responsibility of the author and does not necessarily reflect the views or policies of the Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), or the Departments of the Army, Navy or Air Force.
Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.

4. Learning Objectives
At the conclusion of this activity, the participant will be able to:
1. List the three main categories of the determinants of health and disease.
2. Understand the role of prevention in the successes of public health in the 20th century.
3. Explore the vision of the National Prevention Strategy and how it relates to your role in healthcare.
4. List the high burden conditions targeted by the CDC’s 6/18 Initiative.

5. World Health Organization
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

6. Determinants of Health and Disease Where and How We Live, Learn, Work, and Play
Social
Environment
Physical
Environment
Genetic
Environment
Individual
Response
- Behavior
- Biology
Health & Function
Disease
Health Care
Well-Being
Prosperity
Evans, R. G., Barer, M. L., & Marmor, T. R. (1994)
Why Are Some People Healthy and Others Not?. New York: Aldine De Gruyter

7. Public Health
The science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.
CEA Winslow, 1920

9. $2.8 Trillion Spent on Health Care: 75% attributed to behaviors and lifestyle choices

10. 80% due to modifiable risk factors Approximates NCI estimates
What happens when we eat better, don’t smoke, increase activity, and limit alcohol?
Disease
Reduction Compared
to U.S.
Comment
Heart Disease
64%*−83%**
80% due to modifiable risk factors
Cancer
60%*
Approximates NCI estimates
Diabetes
91%**
No type 2 epidemic
All-cause Mortality
50%*
* Knoops et al and **Rimm, Stampfer, JAMA 2004;292:

11. Our Role in Prescribing Health
“If we had a pill that conferred all the proven health benefits of exercise, physicians would prescribe it to every patient and our healthcare system would find a way to make sure every patient had access to this wonder drug.”
(Exercise is Medicine)
*Robert E. Sallis, MD, FACSM, FAAFP

12. 10 Great Public Health Achievements-US 1900-1999
Vaccination
Motor-vehicle safety
Safer workplaces
Control of infectious diseases
Decline in deaths from heart disease and stroke
Safer and healthier foods
Healthier mothers and babies
Family planning
Fluoridation of water
Recognition of tobacco as a health hazard
MMWR 1999 Apr 2;48(12):241-3.

14. Vision
Working together to improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness.
Animated Slide
Overarching goal of the Strategy
This goal focuses on both increasing the length of people’s lives and ensuring that people’s lives are healthy and productive.
Strategic Directions
The four Strategic Directions provides the strong foundation for all of our nation’s prevention efforts.
Will discuss the four Strategic Directions in more detail in the following slides.
Priorities
The seven Priorities provides more focused areas to improve the nation’s health.
The Priorities of the National Prevention Strategy are designed to improve health and wellness for the entire U.S. population.
Each Priority area in the Strategy provides evidence-based recommendations that are most likely to reduce the burden of the leading causes of preventable death and major illness.
The following slides will outline the sections and components that are included in the Strategy for each Strategic Direction and Priority chapter.

15. Partners in Prevention
Federal government
State, tribal, local and territorial governments
Businesses and employers
Health care systems, insurers, clinicians
Education (early learning centers, schools)
Community and faith-based organizations
Individuals and families
Roles – policy maker, purchase, employer, funder, data collector and researcher, health care provider, communicator and educator
The establishment of the Advisory Group was also mandated by ACA Section 4001.
The Advisory Group consists of 23 non-federal members appointed by the White House.
The members represent a diverse group of health professionals with expertise in prevention and health promotion practices that brings a non-federal perspective to the Strategy’s policy and program recommendations and to its implementation.
The Advisory Group will:
Develop and suggest policy and program recommendations to the Council
Advise the Council on lifestyle-based chronic disease prevention and management, integrative health care, and health promotion practices

16. National prevention strategy
Animated Slide
Overarching goal of the Strategy
This goal focuses on both increasing the length of people’s lives and ensuring that people’s lives are healthy and productive.
Strategic Directions
The four Strategic Directions provides the strong foundation for all of our nation’s prevention efforts.
Will discuss the four Strategic Directions in more detail in the following slides.
Priorities
The seven Priorities provides more focused areas to improve the nation’s health.
The Priorities of the National Prevention Strategy are designed to improve health and wellness for the entire U.S. population.
Each Priority area in the Strategy provides evidence-based recommendations that are most likely to reduce the burden of the leading causes of preventable death and major illness.
The following slides will outline the sections and components that are included in the Strategy for each Strategic Direction and Priority chapter.

17. NPS 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
Source: National Vital Statistics Report, CDC, 2008

18. National prevention council action plan
Released as part of the National Prevention Council’s 2012 Annual Status Report
Implements the National Prevention Strategy at the federal level
Highlights over 200 federal actions from the 17 federal departments
Includes shared commitments aimed at accelerating health improvements

19. National prevention council commitments
Identify opportunities to consider prevention and health within its departments and encourage partners to do so voluntarily as appropriate.
Increase tobacco free environments within its departments and encourage partners to do so voluntarily as appropriate.
Increase access to healthy, affordable food within departments and encourage partners to do so voluntarily as appropriate.
The National Prevention Council recognized that some opportunities are shared across all departments and that synergies may occur when departments work together to make progress. As part of the National Prevention Council Action Plan, the Council identified specific Commitment areas in which prevention can be accelerated through the combined efforts of all National Prevention Council departments.

21. The Three Buckets of Prevention
Traditional clinical prevention
Increase the use of evidence-based services
Innovative clinical prevention
Provide services outside the clinical settings
Total population or community-wide prevention
Implement interventions that reach whole populations
John Auerbach, J Public Health Management Practice 2016

22. 18 evidence-based interventions that target 6 high-burden conditions
cdc.gov/sixeighteen

27. 10 Great Public Health Achievements-US 2000-2099 ??????
Elimination of tobacco as a health hazard
MMWR 2099??? Apr 2;48(12):241-3.???