1. The Goal

2. Note: Population figures for 1976-1978 do not add to the total because of rounding. Source: U.S. Census Bureau

3. Note: Age at death was not available for year s 1947-1948. Source: VDH, Division of Health Statistics, April, 2011

4. Infant Mortality – The last Sixty Years

5. How do we get there?

6. Chronic Disease in Virginia Estimated 3.5 million adults in Virginia have at least one or more chronic health conditions: arthritis, asthma, cancer, coronary heart disease, heart attack, stroke, high blood pressure, high cholesterol or diabetes 1.6 million have more than one type of chronic disease

7. Virginia Department of Health Chronic Disease Initiatives Cancer Control Diabetes Prevention and Control Heart Disease Prevention and Control Tobacco Use Control Chronic Disease Self Management Healthy Communities

8. An example- Heart Attacks Community environment, genetics Lifestyle, diet, activity Blood pressure, cholesterol and other risk factor mitigation Angioplasty Percutaneous intervention post- MI, Improved medical management Coronary Bypass procedure

9. By The Numbers Virginia Heart Attacks ^ ^ Myocardial infarctions (MI) † Age-adjusted mortality rates / 100,000 population. Population data from U.S. Census Bureau ‡ Unadjusted hospitalization rates / 100,000 population. Population data from U.S. Census Bureau Data Source: Mortality rate data – VDH Division of Health Statistics. Hospitalization rate data - Virginia Health Information via the VDH Data Warehouse Prepared by: Health Informatics & Integrated Surveillance Systems – Division of Disease Prevention - Office of Epidemiology 49% Drop in heart attack mortality rates † among females between 2000-2009 45 % Drop in overall heart attack mortality rates † between 2000- 2009 1,872 Fewer Virginians died from heart attacks in 2009 than 2000 22% 2000 1% 2009 % disparity between white and black female heart attack rates ‡

10. Heart Attack ^ Rates † Among Virginia Residents by Race, 2000 - 2009 ^ Acute myocardial infarctions, based on ICD-9 code 410. † Unadjusted rates of reported Virginia hospitalization data / 100,000 population. Population data from U.S. Census Bureau Data Source: Hospital inpatient data provided to VDH Data Warehouse via Virginia Health Information. Prepared by: Health Informatics & Integrated Surveillance Systems staff – Division of Disease Prevention - Office of Epidemiology

11. An example- Heart Attacks Community environment, genetics Lifestyle, diet, activity Blood pressure, cholesterol and other risk factor mitigation Angioplasty Percutaneous intervention post- MI, Improved medical management Coronary Bypass procedure

12. Demographics and Access to Health Care Source: http://www.communityhealth.hhs.gov

13. Chronic Disease HEART DISEASE____ Heart disease death is measured as the age-adjusted rate of deaths per 100,000 people. People at risk are those with high cholesterol and/or high blood pressure, those over the age 65, those who use tobacco and those who are overweight or obese. In 2008, 319 people died from Diseases of the Heart in Western Tidewater Health District. Although there was an average 30% decrease in the death rate for the localities from 2004 to 2008, their rates were still higher than the State. Virginia’s death rate in 2008 was 176.2

14. Chronic Disease CEREBROVASCULAR DISEASE_ Since 2004, Western Tidewater deaths due to stroke increased significantly while the Suffolk City and State rate declined. Cerebrovascular disease deaths, including stroke, are increasing in Isle of Wight, Southampton County and Franklin! Suffolk has shown a moderate decrease. Uncontrolled hypertension is a major cause of stroke. “The real tragedy is that overweight and obesity, and their related chronic diseases, are largely preventable.” ~ Robert Beaglehole

15. CHONIC DISEASE Diabetes Hospital Discharge Rate State 15.3WTHD 18.6

16. CHONIC DISEASE – Diabetes Mellitus

17. Deaths Caused by Diabetes In 2006, diabetes mortality rates for contributing cause of death were significantly higher in the Portsmouth (51.0/100,000) and Western Tidewater(43.4/100,000)health districts than any other district in the State.* *Diabetes in Virginia: A Comprehensive Data Report,2009, pg. 19

18. Percentage of Obese Adults The future looks ominous. Currently, one of every three children is overweight or obese, and more children than ever in our history have diabetes. Some predict that this pattern will result in a decrease in life expectancy for the first time in our country. *http://apps.nccd.cdc.gov/ “It’s bizarre that the produce manager is more important to my children’s health than the pediatrician.” _ Meryl Streep

19. Nursing Home Pre-Admission Screening As the population ages, the numbers of individuals needing nursing home pre-admission screening will increase. Majority of screening services used by individuals are those age 65 and older. 2009 estimated, 960,060 Virginians are age 65 and older (VDH, Division of Health Statistics)

20. Community-based Nursing Home Pre- admission Screening Local health department staff serve as members of the community-based screening teams. In 2010 10,036 pre-admission nursing home screenings were performed by LHDs in Virginia (VDH, WV Data). Western Tidewater Health District performed 365 screenings

21. Nursing Home Pre-Admission Screening Over the past 2 years LHDS have experienced a 41% increase in the number of families with disabled children seeking waiver services through this process. Western Tidewater conducts an average of 22 pre- admission nursing home screens per year on disabled children seeking long term care services.

22. Personal Care Program Established in Virginia in 1984 to offer in-home care in lieu of nursing home placement to Medicaid –eligible individuals (if the in-home care was less expensive than the cost of nursing home placement). Western Tidewater is one of two districts statewide that still offers this service.

23. Personal Care Program Western Tidewater Health District covers a largely rural area. The private sector has been unable to meet the total demand for personal care services. WTHD helps to close this gap.

24. Personal Care Services In FY 09, 245 individuals were provided personal care services compared to 200 individuals in FY 10. Western Tidewater Health District was the direct provider of personal care services to 94% of these individuals. Public health nurses generate over 3, 000 home visits to these clients every year.

25. Chronic Disease Initiatives Local health departments conduct various screening tests such as pap smears, and clinical breast exams. We also check for hypertension and diabetes. The Breast and Cervical Cancer Screening Program supports screening mammography to detect breast cancer in the pre-symptomatic stage. Services are offered at the Western Tidewater Free Clinic

26. Chronic Disease Initiatives WTHD has a diabetes/chronic disease program to assist patients with evaluation, screening, education, and referral for area residents living with chronic diseases. This community-based program provide patients with comprehensive care and case management.

27. Chronic Disease Initiatives Second program in WTHD to assist those with chronic diseases is Medication Assistance Program (MAP) established with Franklin/Southampton Charities. Assists medically indigent individuals obtain prescription and non-prescription items recommended by their physician that will benefit their health status and is not covered by their insurance coverage.