1. William C. VanNess II, MD State Health Commissioner January 21, 2014

2.  ISDH Mission: ◦ To promote and provide essential public health services  ISDH Vision: ◦ A healthier and safer Indiana

3.  Governor Pence “Good to Great” book  National Health Rankings has placed Indiana 41 st least healthy out of 50 states  In February 2013, after extensive review of our priorities, ISDH named the following public health needs as the top three priorities for Indiana for the next four years. They haven't changed.  They are: #1. Reduction in Infant Mortality rates #2. Reduction in Adult Obesity rates #3. Reduction in Adult Smoking rates

5.  PLAN: ◦ Analyze raw data ◦ Convert to useful info & ◦ Distribute back to:  Regional partnerships which include the following members:  Hospitals, LHDs, CHCs, Minority Health Coalitions, March of Dimes, etc.  “Sister” state agencies  FSSA, Medicaid, DOE, DCS, etc ◦ Learn from areas/regions/states that have been successful in improving their infant mortality  Share with regional coalitions  e.g., Home Visiting Programs

6.  Decrease smoking among pregnant mothers ◦ ISDH is partnering with Indiana Medicaid  Decrease obesity among pregnant mothers ◦ ISDH division of Nutrition & Physical activity  “Safe Sleep” ◦ “ Back to Sleep” campaign  1994  Reduced SIDS by 50 % ◦ “ Safe Sleep” campaign  Expansion of “Back to Sleep”  Describes actions parents/caregivers can take to reduce the risk of other sleep-related causes of infant death e.g., accidental suffocation  Encourage hospitals to become certified as “Baby Friendly”  Certified by the World Health Organization  Goal.. To increase breastfeeding

7.  Certification of OB & NICU’s ◦ Goal…ensure they meet the newly established Indiana Perinatal Hospital Standards ◦ Standards were adapted from the national set of standards created by AAP, ACOG, and other important entities  Obstetric Units…Levels of Care I, II, III  Neonatal Units…Levels of Care I, II, III, IV  100% adoption of “Hard Stop” policies by Indiana hospitals  Goal…to prevent “elective” deliveries from occurring before 39 weeks  Insurers currently evaluating not paying providers for “elective” deliveries prior to 39 weeks

8.  Evaluate “Perinatal Regionalization” ◦ As noted…27 counties do not have a delivering hospital!! ◦ Occurring “informally” now ◦ Regional systems currently exist e.g. So. Carolina  High-risk infants are born in hospitals that are able to provide the most “risk-appropriate” care  Thus…Level III hospitals provide the most appropriate care for the sickest infants  Infants receiving risk-appropriate care are hypothesized to be more likely to survive when born too little or too soon  Healthy People 2020 Goal is that 83.7% of VLBW Infants be born in a Level III Hospital  Currently 69%

10.  Indiana’s Comprehensive Nutrition and Physical Activity Plan…2010 to 2020 ◦ Collaborative effort involving a large and diverse group of Indiana individuals and organizations ◦ Action needed across all sectors of Indiana to address poor nutrition, sedentary behaviors, and obesity ◦ Focus on approaches that target specific needs of Indiana and support the latest research for improving nutrition and increasing physical activity ◦ Consists of 8 focus areas:  Breastfeeding  Early childhood/child care  Schools  Health care  Worksites  Older adults  Faith-based organizations, and  Communities

11.  Goals ◦ Increase access to and consumption of healthy foods and beverages ◦ Increase opportunities for and engagement in regular physical activity ◦ Increase efforts aimed at enabling people to achieve and maintain a healthy weight across the lifespan ◦ Reduce environmental and policy-related disparities for:  breastfeeding,  nutrition,  physical activity,  overweight, obesity, and  chronic disease

12.  Goals (continued) ◦ Increase the capacity of communities and settings within those communities (eg. School, worksites, faith-based organizations, etc.) to develop and sustain environmental and policy support systems that encourage healthy eating and active living ◦ Increase state and local strategic partnerships to more effectively coordinate efforts, share resources, and identify and reach priority populations

13.  Partner with at least 3 organizations to plan and implement statewide activities that support ◦ eating better, ◦ moving more and ◦ avoiding tobacco  Through the Governor’s Healthy Lifestyle Award, ◦ Publicly recognize individuals and organizations that have made committed efforts to live and/or support healthy lifestyles in their communities  Increase by at least 2 the number of state agencies that: ◦ Adopt and implement food service guidelines/nutrition standards which include sodium ◦ Adopt and implement healthy meeting guidelines ◦ Implement evidence-based physical activity strategies in worksites ◦ Promote breastfeeding

15.  January marks the 50 th anniversary of the first US Surgeon General’s report on smoking and health ◦ That report, released on January 11, 1964, definitely linked cigarette smoking to lung cancer and other serious diseases ◦ Historic turning point in the nation’s fight against tobacco use. ◦ The US has made enormous progress, but ◦ Tobacco use remains the number one cause of preventable death and disease in the US.. ◦ this battle is far from won!!

16.  Our high smoking rate is ◦ Killing Hoosiers  More than 9,700 Hoosiers every year ◦ Inflating health care costs  Costs the state over $2 billion in health care costs annually ◦ Making it harder for companies to do business in Indiana  The economic burden of smoking is estimated to be about $3,391 per smoker per year.  Everyone shares in the annual expenses for smoking – more than $559 per Hoosier household- whether they smoke or not  For every smoker that dies, two young people under the age of 26 start using tobacco

17.  Tobacco use directly causes a majority of the chronic diseases including: ◦ Heart diseases ◦ Stroke ◦ Cancer ◦ Respiratory diseases ◦ Type 2 Diabetes ◦ Rheumatoid Arthritis ◦ Macular Degeneration  For every death in Indiana (9,700) due to tobacco use, another 30 Hoosiers are living with a tobacco-related illness (194,000) inhibiting their quality of life from serious smoking-caused disease

18.  The tobacco companies spend $271 million each year on marketing and promotion in Indiana ◦ much of which influences kids to smoke  Tobacco use costs Indiana $2.18 billion/year in health care costs ◦ The Indiana Medicaid program pays $487 million of the States total smoking-related health care costs  Half of Indiana’s births are to mothers in the Medicaid program  30% of pregnant Medicaid women in Indiana smoke leading to premature birth, low birth-weight newborns and thus infant mortality  Tobacco prevention programs are also a smart investment for states that save money by reducing smoking-caused health care costs ◦ In the short-term, the best state tobacco prevention programs have saved $3 in health care costs for every dollar spent

19.  Indiana’s tobacco prevention and cessation program is critical to the health of Hoosiers and to the fiscal environment of the state ◦ Indiana’s tobacco prevention and cessation program is modeled after the CDC’s Best Practices of programs around the country that have delivered solid results  2013 American Journal of Public Health article concluded that states can significantly reduce youth smoking by: ◦ Implementing well-funded tobacco programs ◦ Increasing the price of cigarettes, and ◦ Enacting strong smoke-free air laws  Indiana must address the economic and health consequences of tobacco use in order to be competitive in today’s marketplace for businesses and workers

20.  Questions??