Making the healthy choice, the easy choice: Tobacco control and obesity prevention in Philadelphia

Giridhar Mallya, MD, MSHP

Director of Policy and Planning

Philadelphia Department of Public Health

Schroeder S. We Can Do Better – Improving the Health of the American People. NELM;2007;357;1221-8.

Health and economic costs

in Philadelphia

Poor Diet and Physical Inactivity

~2,000 deaths per year

~$750 million in health care costs annually

Tobacco use

2,200 deaths per year

$660 million in productivity losses annually

Philadelphia Vital Statistics Report, 2010, Philadelphia Department of Public Health Obesity health care costs estimated from Finkelstein et al, Health Affairs, 2009

Health Impact Pyramid Examples

Eat healthy, be physically

active, have safe sex

Rx for acute and

chronic conditions

Poverty, education, housing, inequality

Immunizations, brief

intervention, cessation,

colonoscopy

Smoke-free laws; counter-

advertising campaigns;

immunization mandates;

pollution emissions standards

Socioeconomic Factors

Changing the Context to make individuals’ default

decisions healthy

Long-lasting

Protective Interventions

Clinical

Interventions

Counseling

& Education

Largest

Impact

Smallest

Impact

Frieden T, AJPH 2009

Built environment

Workplaces

Media

Legislation and

regulation

Community retail

environment and

restaurants

Educational

institutions

Insurers and health

care providers

CDC support for Get Healthy Philly

Philadelphia Department of Public Health, School District of Philadelphia

• Communities Putting Prevention to Work − 2010-2012

• Community Transformation Grant

− 2011-2014

• Sodium Reduction in Communities Program − 2011-2014

• State &Local Public Health Actions to Prevent

Obesity, Diabetes, Heart Disease, & Stroke − 2014-2018

Schools – policy and systems change

Philadelphia Department of Public Health, School District of Philadelphia

134 129

89

48

5 0

20

40

60

80

100

120

140

160

School Wellness Council Interventions, 2010-2012 Number of Schools Selecting Wellness Goals

Healthy classroom rewards Healthy fundraisers

Socialized Recess Classroom movement breaks

Healthy school stores

• 1990s Universal feeding “pilot”

• 1999 Nutrition education for all SNAP- eligible children

• 2004 Comprehensive school nutrition policy

• 2009 1% milk and no fryers in school kitchens

• 2011 170 schools created Wellness Councils made up of teachers, principals, students, and parents

8

Institutional nutrition standards – City agencies hospitals

Built environment – smoke-free policies

• 12,000 acres of smoke-free parks, recreation centers, and playgrounds

• 5 Philadelphia universities with smoke-free policies

• Public housing agency with 80,000 residents pursuing a smoke-free policy

Leung R et al. Developing and Implementing a Smoke-Free Policy for Recreation Centers and Playgrounds in the City of Philadelphia. Preventing Chronic Disease. 2013;10:120294

Built environment –planning and zoning

• Encouraging the incorporation of fresh food markets into commercial and mixed-use developments by offering density bonuses that don’t count the square footage of those markets against the maximum buildable area (14-603(7))

• Requiring the provision of secure bicycle parking in developments above a certain size, and allowing the removal of 1 automobile space in exchange for the provision of 5 bicycle parking spaces (14-804)

• Conducting targeted health impact assessments of planning decisions

• Making specific land use and zoning recommendations as part of district plans

http://phila2035.org/home-page/communities/

Retail - Healthy Chinese take-out

restaurant initiative

• Over 400 take-out Chinese restaurants in Philadelphia, primarily in African American and Hispanic neighborhoods

• Partnered with Temple University Center for Asian Health, Asian Community Health Coalition, and Chinese Restaurant Association

• 200+ have been trained in low-sodium cooking methods

• Early analyses reveal a 30% reduction in sodium content of 2 popular dishes

– Chicken Lo Mein = 3,200 mg 2,300 mg

– Shrimp and Broccoli = 1,900 mg 1,235 mg

Ma, G. Temple University Center for Asian Health, 2013

Media – sugary drinks, smoking cessation, salt reduction physical activity

Insurers and health care providers – promoting and supporting quit attempts

• All Medicaid plans in Philadelphia provide coverage for 6 of the 7 FDA-approved smoking cessation medications

• Offering up to 8 weeks of free nicotine

replacement therapy via the Quitline (1-800-QUIT-NOW)

• Leading tobacco-related practice and culture transformation in the City’s behavioral health treatment system

Primary care learning collaboratives

Improve the quality of care for 350,000 patients in 43 practices by: • Increase electronic health record adoption and use

• Increase the institutionalization and monitoring of

quality measures

• Increase engagement of non-physician team members

• Increase self-measures blood pressure monitoring tied with clinical support

• Implement systems to identify those with undiagnosed hypertension

• Increase engagement of community health worker and pharmacists

Progress – adult smoking

Progress – youth smoking

Youth smoking prevalence, U.S. and Philadelphia

Progress – adult obesity

Progress – child obesity

Robbins et al, Preventing Chronic Disease, 2012 Accompanying editorial from RWJF, “Philadelphia Freedom”

5% decrease

8% decrease 7% decrease

Progress – youth obesity

Thank you!

www.phila.gov/gethealthyphilly www.foodfitphilly.org

www.smokefreephilly.org