active living: leadership in kentucky chronic disease in kentucky why it should matter to you! rice...
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Active Living: Leadership in Kentucky
Chronic Disease in KentuckyWhy it should matter to you!
Rice C. Leach, M.D.Commissioner
Kentucky Department for Public HealthMay 8, 2003
Active Living: Leadership in Kentucky
Public Health Concerns
• Kentucky’s general health status• Obesity over the last 20 years• Conditions
– Diabetes– Cardiovascular disease (heart attacks)– Arthritis– Cancer– Birth Defects (heart, neural tube)– Strokes
Active Living: Leadership in Kentucky
Causes
• Obesity– Too many calories– High fat content– Not enough fiber (fruits and vegetables)
• Lack of Exercise– Video games and television replaced playgrounds– Automobiles replaced bicycles– No more high school physical education requirement
• Smoking
Active Living: Leadership in Kentucky
Kentucky’s Rates
• Type II Diabetes in Kentucky—doubled since1990• Obesity in Kentucky—doubled since 1990• Obesity in the United States—doubled since
1985• Kentucky’s adults smoke more than any other
state• Kentucky’s youth most likely to smoke every day• Kentucky’s youth youth unlikely to exercise every day
Active Living: Leadership in Kentucky
Public Health—What helps?
• Population Issues– Training
• Large Groups
• Small Groups
– Environmental changes• School lunches
• Smoke-free areas
• School vending machine food
– Measure Success—learn from work being done
Active Living: Leadership in Kentucky
Get With The Guidelines—Why Bother?
– Improved Quality of Life• Live Longer
• Stay out of the nursing home
• Pay less for my “golden years”
• Avoid side effects of medicines
• Avoid surgery
Active Living: Leadership in Kentucky
Prevention—Why Bother?
• What is in it for me?– Health Insurance costs– Medical Care Costs– State Budgets– State and Federal Income Taxes– Condition of Roads– Funding for Schools– College Tuition– Employment Opportunities
Obesity Trends* Among U.S. AdultsBRFSS, 1985
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Obesity Trends* Among U.S. AdultsBRFSS, 1986
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Obesity Trends* Among U.S. AdultsBRFSS, 1987
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Obesity Trends* Among U.S. AdultsBRFSS, 1988
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Obesity Trends* Among U.S. AdultsBRFSS, 1989
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Obesity Trends* Among U.S. AdultsBRFSS, 1990
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Active Living: Leadership in Kentucky
Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Active Living: Leadership in Kentucky
Obesity Trends* Among U.S. AdultsBRFSS, 1992
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Active Living: Leadership in Kentucky
Obesity Trends* Among U.S. AdultsBRFSS, 1993
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Active Living: Leadership in Kentucky
Obesity Trends* Among U.S. AdultsBRFSS, 1994
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Active Living: Leadership in Kentucky
Obesity Trends* Among U.S. AdultsBRFSS, 1995
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Active Living: Leadership in Kentucky
Obesity Trends* Among U.S. AdultsBRFSS, 1996
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Active Living: Leadership in Kentucky
Obesity Trends* Among U.S. AdultsBRFSS, 1997
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Active Living: Leadership in Kentucky
Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Obesity Trends* Among U.S. AdultsBRFSS, 1999
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Obesity Trends* Among U.S. AdultsBRFSS, 2000
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
Active Living: Leadership in Kentucky
Impact of Obesity
• On people– More diabetes– More heart disease– More strokes– More kidney failure– More patients on dialysis– Earlier disability
Future Health Insurance Cost Increases
2015(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Future Health Insurance Cost Increases
2016(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Future Health Insurance Cost Increases
2017(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Future Health Insurance Cost Increases
2018(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Future Health Insurance Cost Increases
2019(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Future Health Insurance Cost Increases
2030(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Future Health Insurance Cost Increases
2031(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Future Health Insurance Cost Increases
2032(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Future Health Insurance Cost Increases
2033(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Future Health Insurance Cost Increases
2034(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Future Health Insurance Cost Increases
2035(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Future Health Insurance Cost Increases
2036(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Future Health Insurance Cost Increases
2037(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Future Health Insurance Cost Increases
2038(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Future Health Insurance Cost Increases
2039(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Future Health Insurance Cost Increases
2040(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Impact on Public Funds
• More people on disability • Fewer years in the work force• Earlier admission to nursing home• Increased demand for health care services ($3B today)• Increased demand on Medicaid and Medicare• Increased demand for public support of medical care• Decreased contribution to employee health insurance • More people without health insurance
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Tax Increases(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Tax Increases?(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Other Impacts On Public Health Funds
• Money not available for public schools• Money not available for college tuition• Money not available for road construction• Money not available for water and sewer projects• Money not available for golf courses• Money not available for police and fire• Money not available for campaign promises
Active Living: Leadership in Kentucky
DRG=De Revenue…Gone!
• “The biggest difference between a Democrat and a Republican is going to be the reason they give you for why you can’t have what you want.”
John Chancellor, NBC News, at the American Hospital Association Winter Meeting, Washington D.C., 1985
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Things we would like to do but can’t(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Active Living: Leadership in Kentucky
Current state initiatives
• NGA Best Practices—Chronic Disease Initiative• Diabetes Program and Coalition--$1.85M• Cardiovascular Disease Program--$865K• Get with the Guidelines• Exercise-Obesity—$1.2M• Tobacco Control--$4.2M• School Health Program• Cooperative Extension Service involvement• Local Health Department Contributions—
Active Living: Leadership in Kentucky
Food for thought
• No such thing as your side of the boat is leaking• It doesn’t have to be this way• Curative medicine helps• Primary prevention is better• New Public Policy Initiatives• Consider ways to pay providers to keep people
well• $14.5B—expenditure on medical care• $350M—estimated expenditure on prevention