1. 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

2. 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.

3. 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

4. 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

5. 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% %–14% %–19% %–24% %–29% ≥30%

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

7. Cigarette Use (Adults), 2010
Source: CDC. Tobacco Control Highlights, Tennessee, Retrieved November 4, 2011 from

8. 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, Retrieved November 5, 2011 from

9. Disability in Tennessee, 2010
An estimated 10.2 percent of civilian non-institutionalized, men and women, aged in Tennessee reported a work limitation.
About 391,000
$ 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
2. Social Security Administration. Annual Statistical Supplement to the Social Security Bulletin, SSA Pub. No Retrieved November 6, 2011 from

10. 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?

11. 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

12. 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

13. 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

15. National Prevention Strategy
America’s Plan for Better Health and Wellness
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

16. Determinants of Health
Behavior %
Genetics %
Environment %
Medical %
Source: McGinnis JM, Williams-Russo P, Knickman JR. Health Affairs Mar-Apr;21(2):78-93.

17. Life Course Perspective
Ecological Models and Social Determinants of Health
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

18. Life Course Perspective and Health Trajectories
Poverty
Lack of health services
Family Discord
Age
6 mo mo mo mo yrs 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

19. Thank You