Post on 30-Dec-2015
Healthy Vision 2010 August 30, 2006
“Framework for Health: Population-based Components of
the Health System”Eduardo J. Sanchez, MD, MPH
Commissioner, Texas Department of State Health Services
Evidence of Effectiveness
A growing body of evidence indicates that population-based interventions:– Promote health– Prevent disease– Generate a favorable Return on
Investment (ROI)– Compliment efforts of the medical care
delivery system– Reduce demand for medical care
Growth in National Health Expenditures 1980–2011 from $1,000 to $9,000
Levit et al. Health Affairs 2002;21:172–181. *Projection from Heffler et al. Health Affairs 2002;21:207–218.
0
2,000
4,000
6,000
8,000
10,000
1980 1998 2004 2011*
Per
Cap
ita C
osts
$6280 (2004)
Public Health
$
Health Care: Are We Getting Our Money’s Worth?
65 years +
MedicalCare
0 years
People of Texas
Dollars Expended$
Determinates of Premature Mortality
• 50% behavior & lifestyle
• 20% environmental exposure
• 10% access to health care
Alder, Newman “Socioeconomic Disparities in Health,” Health Affairs Vol 21 #2
Public Health
$
Health Care: Are We Getting Our Money’s Worth?
65 years +
MedicalCare
0 years
People of Texas
Dollars Expended$
Tobacco Interventions
Leading Actual Causes of DeathTexas, 2001
Tobacco is the single most preventable cause of death & disease in Texas
2181,0521,4051,8072,214
2,8513,736
11,13218,649
24,899
0 5000 10000 15000 20000 25000 30000
Fire
AIDS
Homicide
DWI**
Suicide
Drugs*
Auto Accidents
Alcohol*
Overweight/Obesity
Tobacco
Smoking Rates for Harris & Jefferson Counties 2000-2005
Reducing tobacco use requires a comprehensive & sustained approach. Gains in Harris County regressed as
resources/efforts were reduced.
10.0
12.0
14.0
16.0
18.0
20.0
2000 2001 2002 2003 2004 2005
Year
Pre
vale
nce
Jefferson Harris
• Funding for Comprehensive Tobacco Prevention and Cessation Programs
• Tobacco Excise Tax Increases
• Restrictions on Secondhand Smoke
• Coverage for Smoking Cessation
Policies That Make a Difference
Texas Tobacco Task Force ReportProgram Elements and Best Practices
• Community & School Programs
• Media Campaigns• Cessation• Enforcement• Efforts Targeted to
Diverse/Special Populations
• Surveillance & Evaluation Research
Comprehensive Program Results(For Only $3 Per Capita)
• 36% reduction in smoking, 6th-12th grade
• 26% reduction in adult smoking
Double the statewide rate of reduction
Texas Community-BasedTobacco Cessation Initiatives
• a Smoke Free Paso del Norte - $3.3 million 4-year program
• Tobacco Free Amarillo - $400,000 grant from the Amarillo Hospital District (Tobacco Settlement Funds)
Financial Returns from Investments in Tobacco Control
After 5 years a one-time investment of $68 million ($3 per capita) would save:
More than $1 billion in medical costs
~ $400 million in productivity costs
~ 163,000 fewer smokers
This represents a 20:1 ROI
Center for Health Research, Kaiser Permanente Northwest, June 2006
Obesity Interventions
States With Highest Prevalenceof Adult Obesity
1. Mississippi2. Alabama3. West Virginia4. Louisiana5. Tennessee6. Texas, Kentucky, Michigan
“How Obesity Policies are Failing in American” Trust for America’s Health August 2005,
Adult Obesity Prevalence U.S & Texas, 1990-2004
0
5
10
15
20
25
30
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Perc
enta
ges
U. S.
Texas
Obesity (BMI >=30), BRFSS, 1990-2004
Overweight Youth in TexasCompared to National Data
0
5
10
15
20
25
30
35
40
45
1963 to69
1971 to74
1976 to80
1988 to94
1999 to2002
2003-2004
TX '00-02 TX '04-05
6-11 Yrs/4th
12-19 Yrs/8th
11th grade
Source: Hoelscher et al., 2004; Ogden et al., 2006; SPAN, 2004-2005
HealthyPeople
2010Goal
*Percent
Overweight
Obese
Can We Identify a “$3 Per Capita” Strategy To Address Obesity in Texas?
Community-based interventions
– Where we work
– Where we learn
– Where we play
– Where we pray
2006 SPAN Data Suggest School-Based Interventions Are Having An Impact
• Texas-wide, 8th graders same level of overweight as 4 years ago
• 4th graders had a slight decrease
• 11th graders showed a 1/3 increase in overweight (14.5% to 19%)
• Region 9/10 (El Paso) showed ~25% reduction in obesity among 4th graders
Cost of Gastric Bypass Surgeries
$25,000
x 1,000,000Morbidly obese Texans
$25 Billion
Comprehensive School Health Programs
4,258 Texas Public Elementary Schools
$2,500 Average Cost for Coordinated School Health
4258
x 2500
$10,645,000
1/10 of 1% reduction in obesity would pay for program
Mental Health Interventions
Mental Illness Strikes More Americans Each Year Than Other Serious Illnesses
0
5
10
15
20
25
30
% A
du
lts
Mental Illness
Serious Mental Illness
CVD Diabetes Cancer Asthma
CDC BRFSS, SEER Cancer Statistics Review, 1975-2002, “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders” Arch Gen Psychiatry. Vol. 62, June 2005
Mental Health Community Crisis Services for Children and Adults
Total ER Visits
46%54%
46% of all ER visits have behavioral health issues as a basic or contributing factor
Mental Health Community Crisis Services for Children and Adults
• Reduced use of costly care settings, i.e., emergency rooms, state hospitals and jails
• Reduced need for transportation to state hospitals for short-term stabilization
• Reduced homicide and suicide• Minimized impact on the health and social
services system• Every $1 spent on mental health services saves $5
in overall health care (Am. Psychological Association)
Mental Health Community Crisis Services for Children and Adults
$0
$93
Average MonthlyER Costs
per Medicaid Client
ER COST OFFSET (- $25) Average per Client per Month27 percent reduction
Fiscal Year 2005 Texas average monthly Emergency Room (ER) costs were 27 percent lower for Medicaid clients receiving needed
DSHS community mental health treatment.
$93 Untreated(N=13,642) $68
Treated(N=33,472)
Public Health & Mental Health
• Ensure that Texans understand mental health is essential to overall health
• Expand efforts to prevent or delay onset and reduce severity of mental illness & substance abuse
• Incorporate competent mental health screening, assessment, brief intervention & referral into primary care settings
• Eliminate disparities of access, outcomes & resources
Opportunities for Texas
• Better understand epidemiology of mental health and substance abuse
• Integrate care at the local level
• Build capacity of primary care providers & ER departments to identify, treat and refer across disciplines
• Reduce barriers to treatment
Evidence of Effectiveness
A growing body of evidence indicates that population-based interventions:– Promote health– Prevent disease– Generate a favorable Return on
Investment (ROI)– Compliment efforts of the medical care
delivery system– Reduce demand for medical care
Will Strategies to Improve Access to Medical Care Improve Health?
In response to a high incidence of 911 calls for heart attacks in a given zip code, should we:
• Keep an ambulance ready to go in the community?
• Establish a primary care facility in the community?
• Improve parks, walking trails & access to fresh produce?