1. Kansas Public Health: There and Back Again Healthy Kansans 2010 as a Common Language for Today’s Public Health Improvements Kansas Public Health Association, Inc. 2006 Fall Conference

2. First Official Public Health Body in Kansas: Kansas State Board, 1885 State and Local Boards of Health Chapter 129, Laws 1885 An Act to create a State and local boards of health, and to regulate the practice of medicine in the State of Kansas. Sec 4. The state board of health shall supervise the health interests of the people of this state….

3. Board was charged to… “…make careful inquiry in respect to the cause of disease, and especially of epidemics, and investigate the sources of mortality, and the effects of localities, employments, conditions; ingesta, habits and surroundings on the health of the people.”

4. Establish environmental policy… “…advise officers of government, or other state boards, in regard to location, drainage, water supply, disposal of excreta, heating, and ventilation of public buildings.”

5. Establish vital statistics tracking system… “…collect and preserve such information relating to forms of disease and death as may be useful in the discharge of the duties of said board.”

6. Become the state’s health data and information repository… …receive reports and publications from all health officers of local boards of health in the state, and such sanitary information as may be useful to people of the state.

7. Oversee the registration vital statistics, and track reportable diseases “…supervise the registration of marriages, births, and deaths, and also the registration of forms of disease prevalent in the state; and the secretary of said board shall superintend the registration of the vital statistics of the state.”

8. Create mortuary policy and procedures …prepare the forms and establish the rules by which permits for transporting the dead bodies of persons for burial beyond the county where the death occurs;

9. Conduct public health research and appoint special research committees “… appoint committees, or engage suitable persons to render special sanitary service, to make or supervise practical or scientific investigations and examinations, requiring expert skill, and to prepare plans and report thereon.”

10. Board was charged to improve the health of Kansans… with limited resources

11. Need for accurate statistics “Accurate and reliable compilation of vital statistics is of paramount importance and of inestimable value. We have inaugurated a system which is meeting with general approval, and promises, during the year 1886, to be very reliable and complete.”

12. And then there are the doctors… In Osage City, Kansas, a physician urged the local school board to refuse to carry out the vaccination order of the Kansas State Board of Health: ‘Personally, I cannot comply with such an order; experience has taught me better. They cannot disease my child with the pus of a brute, while God sees fit to make its check bloom with health, if I can prevent it.’ ”

13. What would a “Healthy Kansans 1890” planning process have looked like?

14. 1880 Kansas Population by Age

15. U.S. and Kansas in 1880 1880 U.S. Vital Statistics showed… –Nation struggling with infectious, preventable diseases –More than one in ten infants died before their first birthday –9 out of the top 10 ten causes of death were infectious diseases There were no official vital statistic records for Kansas in 1880 (no data)

16. Table 1. United States Leading Causes of Death, 1880 Cause Number of Deaths (Registered States) Percent of Known Causes of Death Consumption (Tuberculosis)91,27013.1% Pneumonia63,0539.1% Diphtheria38,1435.5% Heart disease26,0683.8% Cholera infantum24,9833.6% Typhoid fever22,8543.3% Malarial fever20,2312.9% Croup17,9662.6% Convulsions17,8442.6% Scarlet fever16,3882.4%

17. Actions of First State Board of Health focused on… Setting up appropriate systems and tools to allow them to identify health problems, track improvements, and set priorities –Created first vital statistics forms, which included marriage, birth, still-birth, death, and vaccination forms Promoting prevention policies – specifically, sanitation and hygiene –Included rules for appropriate sewer drainage, keeping water supplies clean, quarantining infectious diseases, disinfecting areas where disease had been present, and vaccination

18. Progress Efforts of first public health officials in state provided a foundation for Dr. Crumbine, appointed Secretary in 1904. Dr. Crumbine’s efforts resulted in rapid advancements in public health policy and health education in Kansas during his tenure (1904 – 1923).

19. Leading Causes of Death in U.S., 1920 CauseDeathsRate Pneumonia (all forms) and influenza 178,438207.3 Diseases of the heart 137,374159.6 Tuberculosis (all forms) 97,366113.1 Intracranial lesions of vascular origin 80,01993.0 Nephritis (all forms) 76,41088.8 Cancer and other malignant tumors 71,75683.4 Accidents excluding motor-vehicle 52,25560.7 Diarrhea, enteritis, and ulceration of the intestines 46,26653.7 Premature birth 37,56443.6 Puerperal causes (total) 16,32019.0

20. Leading Causes of Death in U.S., 1950 CauseNumberRate Diseases of the heart 535,705355.5 Malignant neoplasms (cancer) 210,733139.8 Vascular lesions affecting central nervous system 156,751104.0 Accidents 91,24960.6 Certain diseases of early infancy 60,98940.5 Influenza and pneumonia, except pneumonia of newborn 47,12031.3 Tuberculosis, all forms 33,95922.5 General arteriosclerosis 30,73420.4 Chronic and unspecified nephritis and other renal sclerosis 24,67716.4 Diabetes mellitus 24,41916.2

21. Leading Causes of Death in U.S., 1970 CauseNumberRate Diseases of heart 735,542362.0 Malignant neoplasms (cancer) 330,730162.8 Cerebrovascular diseases 207,166101.9 Accidents 114,63856.4 Influenza and pneumonia 62,73930.9 Certain causes of mortality in early infancy 43,20521.3 Diabetes mellitus 38,32418.9 Arteriosclerosis 31,68215.6 Cirrhosis of liver 31,39915.5 Bronchitis, emphysema, and asthma 30,88915.2

22. Fast Forward… …just a century or so! Phones, lights, and motor cars Who are we now?

23. Understanding our Population allows for good decisions on priority setting

24. 1920 Population by County

25. 2000 Population by County

26. 2000 Kansas Population by Age

27. Projected 2030 Kansas Population by Age

28. 2000 Hispanic Population by Age

29. Health Problems in the U.S., 2000 Leading Causes of Death* United States, 2000 Actual Causes of Death † United States, 2000 05101520253035 Percentage (of all deaths) Heart Disease Cancer Stroke Chronic Lower Respiratory Disease Unintentional injuries Diabetes Pneumonia / influenza Alzheimer’s disease Kidney disease Tobacco Diet / Physical Inactivity Alcohol consumption Microbial agents (e.g., influenza, pneumonia) Motor vehicles Toxic agents (e.g., pollutants, asbestos) Firearms Sexual behavior Illicit drug use Percentage (of all deaths) *Minino AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for 2000. National Vital Statistics Reports 2002; 50(15):1-20. † Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291 (10): 1238-1246. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Correction: Actual Causes of Death in the United States, 2000. JAMA. 2005;293 (3): 293.

30. Today Chronic disease are the new frontier Have enjoyed rapid advancements in medical technologies, pharmaceuticals but these have not solved the chronic disease problem Many chronic diseases share common risk factors Behavioral changes are key to reducing premature death Chronic diseases present complex, long-term challenge

31. Healthy Kansans 2010 Learning from the past… preparing for the future Encouraging change for healthier Kansans

32. Process Group of Kansans representing multiple decisions participated in priority-setting process Builds on comprehensive, nationwide health promotion and disease prevention agenda, Healthy People 2010

33. Healthy People 2010 Goals Increase quality and years of healthy life. The first goal is to increase our population’s life expectancy and improve their quality of life. Eliminate health disparities. The second goal is to eliminate health disparities among different segments of the population by specifically targeting the segments that need to improve the most.

34. Healthy Kansans 2010 Health Focus Areas  Maternal Infant Child Health  Oral Health  Hearing  HIV & STD  Family Planning  Arthritis  Childhood & Adult Immunization  Disability  Environmental Health  Nutrition and Physical Activity  Respiratory Health  Occupational Health  Vision  Heart Disease and Stroke  Diabetes  Mental Health  Substance Abuse  Injury and Violence  Cancer  Tobacco  Chronic Kidney Disease  Public Health Infrastructure  Access to Care

35. 10 Leading Health Indicators Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Responsible Sexual Behavior Mental Health Injury and Violence Environmental Quality Immunization Access to Health Care

36. Priorities Reducing and Eliminating Health and Disease Disparities Systemic Interventions to Address Social Determinants of Health Early Disease Prevention, Risk Identification, and Intervention for Women, Children and Adolescents

37. Reducing and Eliminating Health and Disease Disparities

38. Scope of Healthy Kansans 2010 Disparities Racial/ethnic Disability Age (particularly senior adults) Gender Geography (rural/urban) Socioeconomic status (education, income, insurance/health benefit coverage)

39. Percent of Self-Reported “Fair” or “Poor” Health Status by Selected Population Groups

40. Social determinants can be summarized by two variables –Class –Social supports and social connectedness Disparities related to Social Determinants –Income –Education –Social Determinants System Interventions to Address Social Determinants of Health

41. Four Points of Opportunity Where Policy or Systems Can Intervene to Affect Social Determinants of Health Decrease social stratification Decrease specific exposure to health- damaging factors suffered by people in disadvantaged positions Seek to lessen the vulnerability of disadvantaged people to the health-damaging conditions they face Intervene through healthcare to reduce the unequal consequences of ill-health and prevent further socio-economic degradation among disadvantaged people who become ill

42. Early Disease Prevention, Risk Identification, and Intervention for Women, Children and Adolescents Issues considered: –Interventions with pregnant women; –Interventions for pre-conceptional health; –Screening programs; –Substance abuse interventions during and immediately following pregnancy; –Early childhood interventions (0-5 years); –School-based initiatives (6-18 years); –After-school programs (6-18 years); –Chronic disease risk factors including tobacco use, physical inactivity and poor nutrition; –Disease prevention and management programs for asthma, cancer, diabetes, cardiovascular disease, etc.; –Immunization programs; –Injury prevention programs – intentional and unintentional; and –Oral health interventions

43. Early Intervention Progress

44. Growing Threat of Chronic Disease and Associated Risk Factors

45. Early Intervention Recommendations Assure access to health care and preventive services for children and parents. Integrate efforts to affect the whole child’s emotional and social well-being. Promote the development and adoption of healthy lifestyles

46. Action Steps Selected for Immediate Action Based on Three Cross-Cutting Priorities Tobacco Disparities Data Cultural Competency Overweight and Obesity Access

47. Tobacco #1 preventable cause of death in Kansas 17% of adults smoke Results in more than 3,800 deaths per year Cigarette use costs Kansas $724 million in direct medical costs If current trends continue, 54,000 children alive today will die of tobacco-related causes

48. Disparities Data Recommendation: Routinely collect and report data on all segments of the population (race/ethnicity, gender, rural/urban, economic status, disability status) to identify where improvements are most needed.

49. Cultural Competency Definition: Cultural competence: Having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and communities. An ability to relate to others in a trustworthy manner, with respect for individual cultural differences. Achieving cultural competency is a process rather than an outcome.

50. Adult Overweight/Obesity Trend

51. Overweight/Obesity Five national overweight/obesity prevention goals: 1.Increase fruit and vegetable consumption 2.Increase physical activity 3.Decrease “screen” time (TV, leisure computer, video games) 4.Increase breastfeeding 5.Balance caloric intake with expenditure

52. Access

53. What will we do to make a difference in Kansas’ future?

54. The time is now… …the place is here… …and it’s up to us.