1. Chronic Illness and Disease Prevention George A. Mensah, M.D. Acting Director, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention

2. 1900-1999 Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Adapted from MMWR 1999;48(50):1141

3. 1900-1999 Decline in deaths from heart disease & stroke Safer and healthier foods Healthier mothers and babies Adapted from MMWR 1999;48(50):1141

4. 1900-1999 Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard Adapted from MMWR 1999;48(50):1141

5. Achievements in Public Health, 20 th Century Age-adjusted to the 2000 US population.; Sources: NHLBI, Morbidity and Mortality Chart Book 2000 CDC, Health, United States 2001 Total cardiovascular diseases Diseases of the heart Coronary heart disease Stroke

6. Measuring State Successes: Improvements from 1990 to 2004 ME Infectious Disease 62% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

7. Measuring State Successes: Improvements from 1990 to 2004 ME Infectious Disease 62% RI Smoking 35% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

8. Measuring State Successes: Improvements from 1990 to 2004 ME Infectious Disease 62% VT Infant Mortality 53% RI Smoking 35% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

9. Measuring State Successes: Improvements from 1990 to 2004 ME Infectious Disease 62% VT Infant Mortality 53% PA Infant Mortality 30% RI Smoking 35% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

10. Measuring State Successes: Improvements from 1990 to 2004 ME Infectious Disease 62% VT Infant Mortality 53% PA Infant Mortality 30% IA Infant Mortality 39% RI Smoking 35% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

11. Measuring State Successes: Improvements from 1990 to 2004 ME Infectious Disease 62% VT Infant Mortality 53% PA Infant Mortality 30% IA Infant Mortality 39% LA Children in Poverty 34% RI Smoking 35% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

12. ME Infectious Disease 62% VT Infant Mortality 53% PA Infant Mortality 30% IA Infant Mortality 39% LA Children in Poverty 34% AK Infectious Disease 83% Measuring State Successes: Improvements from 1990 to 2004 RI Smoking 35% SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

13. MaineInfectious Disease62% Rhode IslandSmoking35% VermontInfant Mortality53% PennsylvaniaInfant Mortality30% IowaInfant Mortality39% LouisianaChildren in Poverty34% AlaskaInfectious Disease83% Measuring State Successes: Improvements from 1990 to 2004 SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004

14. Definition of Public Health Public Health: Population-based Health

15. Health Care vs. Public Health “Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.” Public Health: Population-based Health C. Everett Koop

16. Health Promotion and Chronic Disease Prevention

17. Public Health; New York City, 1895 Department of Health, City of New York

18. We Face an Epidemic of Unparalleled Proportions More than 1.7 million Americans die of a chronic disease each year One-third of the years of potential life lost before age 65 is due to chronic disease Four chronic diseases—heart disease, cancer, stroke, and diabetes—cause almost two-thirds of all deaths each year

19. We Face an Epidemic of Unparalleled Proportions Approximately 33% of all U.S. deaths (about 700,000 deaths each year) can be attributed to these three health-damaging behaviors … – tobacco use – lack of physical activity – poor eating habits Sources: Deaths: Preliminary Data for 2002. NVSR Volume 52, Number 13. 48pp. (PHS) 2004-1120. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2003). McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:2207-12.

20. Disability and Diminished Quality of Life Chronic, disabling conditions cause major limitations in activity for 1 of every 10 Americans (30 million people) Arthritis number one cause of disability affects nearly 1 of every 3 adults in the US Stroke left 1 million Americans with disabilities Diabetes leading cause of kidney failure in adults more than 60% leg and foot amputations are among people with diabetes

21. Health Care Spending is on the Rise Our nation spends more on health care than any other country in the world Chronic diseases account for 75% of the $1.4 trillion we spend on health care $245 billion an average of $1,066 per person 1980 $1.4 trillion an average of $5,039 per person 2001 SOURCE: Heffler et al., Health Affairs., Health Spending Projections For 2001-2011: The Latest Outlook, March/April 2002. $2.8 trillion an average of $9,216 per person 2011

22. Life Expectancy vs. Health Care Spending Per Capita Health Care Spending in International Dollars Life Expectancy 30 40 50 60 70 80 90 0500100020003000400050001500250035004500 Sierra Leone United States Japan Cuba

23. An Aging Population Percentage of U.S. Population over Age 65 0 5 10 15 20 25 1930195019701990201020302050 Year Percent Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996

24. 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 > 8 0 7 5 - 7 9 7 0 - 7 4 6 0 - 6 4 5 5 - 5 9 5 0 - 5 4 4 5 - 4 9 4 0 - 4 4 3 5 - 3 9 3 0 - 3 4 2 5 - 2 9 2 0 - 2 4 1 5 - 1 9 1 0 - 1 4 0 - 4 5 - 9 6 5 - 6 9 Women Men D o l l a r s Age in Years Estimated Per Capita Health Expenditures, by Age and Sex, 1995 Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996

25. Medicaid Expenditures StateFY 2003 actual FY 2004 estimate % of total expenditures Alaska7866388.4 Iowa2,4362,12415.6 Louisiana4,4504,77224.5 Maine1,7121,77229.0 Pennsylvania13,62314,37529.5 Rhode Island1,4501,56825.5 Vermont69179527.5 Source: National Association of State Budget Officers, 2003 State Expenditures Report

26. Predicted Likelihood of Developing Coronary Heart Disease, Stroke, or Diabetes by Age 65 Smoker Overweight Inactive Ratio 11%58%5.5 Source: Jones et al. Arch Intern Med 2002;162:2565–71 Non Smoker Normal Weight Active Men, Aged 50

27. Disability Index,* by Age and Health Risk † University of Pennsylvania Alumni 63646566676869707172737475767778 0.00 0.05 0.10 0.15 0.20 0.25 0.30 Disability Index Age *Progression of disability was postponed by approximately 7 years in low risk vs. high risk. †Risk based on body mass index, smoking, exercise; 0-3 point scale for each; low = 0–2 points, moderate = 3–4 points, high = 5–9 points. Note: A disability index of 0.1 = minimal disability. Source: Vita et al. N Engl J Med 1998;338(15):1035–41 High risk Moderate risk Low risk

28. Chicago Heart Association Detection Project in Industry MenWomen Percent of Population (10,503 men and 8,686 women) with or without risk factors Lowe et al. (Stamler). Arch Intern Med 2000; 158:2007-2014

29. Adult per Capita Cigarette Consumption and Major Environmental and Policy Changes in the US 1900-1990 Great Depression End of WW II First Medical reports linking smoking and cancer Thousands per year US Surgeon General’s first report Broadcast advertising ban Federal cigarette tax doubles Nonsmoker’s rights movement begins Fairness Doctrine messages on radio and television 1900191019201930194019501960197019801990 Year

30. Admissions for Acute Myocardial Infarction During 6-Month Periods June–November Before, During, and After the Smoke-free Ordinance Source: Sargent RP et al. BMJ 2004. Helena Outside Helena

31. New York Centers of Excellence 39% reduction in lower- extremity amputation 35% reduction in hospitalization for persons with diabetes Promising Practices in Chronic Disease Prevention and Control, DHHS, 2003

32. Return on Investment in Worksite Health Promotion Citibank: in 1994, return on investment = $4.56-$4.70 per dollar invested in the program (Ozminkowski et al. AJHP Jan/Feb 1999) Johnson & Johnson: reduction of medical care costs of $224.66 per employee per year (Ozminkowski RJ et al. Environ Med 2002; 44:21-29) 13 health promotion programs reported cost benefits ratios suggest improved financial outcomes (Aldana AJHP May/June 2001)

33. Cigarette Use: 40% middle school students 18% high school students

34. The addition of walking trails can promote physical activity, especially among women.

35. Death Rate and Average Annual Percentage Change 3 Leading Cancers in Men, 1990 and 2001 * †Per 100,000 1970 standard population Lung90.675.1-1.8 Prostate38.629.1-2.9 Colorectal30.824.2-2.1 Age-Adjusted Rate † Average Annual % Change 19902001 Adapted from MMWR-SS 2004;53:SS-3 *

36. Death Rate and Average Annual Percentage Change 3 Leading Cancers in Women, 1990 and 2001 * †Per 100,000 1970 standard population Lung36.840.9+0.9 Breast33.125.9-2.3 Colorectal20.617.0-1.7 Age-Adjusted Rate † Average Annual % Change 19902001 Adapted from MMWR-SS 2004;53:SS-3 *

37. Implement programs that focus on eliminating health disparities.

38. REACH 2010: Charleston And Georgetown Diabetes Coalition Arlene Case-The Lesson

39. Ensure access to quality health services.

40. Enact policies that promote healthy environments.

41. Promote wellness programs in schools, work sites, and in faith- and community-based settings.

42. U.S. Department of Health and Human Services. Healthy People in Healthy Communities. Washington, DC: U.S. Government Printing Office, January 2001.

43. Summary Remarkable achievements in health over last century Chronic diseases and risk factors now pose major challenges – a cause for ALARM! Power of prevention, and role of policy & environmental change – reasons for HOPE! We need to act NOW!

44. Partnerships