Brady a public health_perspective projection
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Transcript of Brady a public health_perspective projection
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Arthritis from the Public Health Perspective
Teresa J. Brady, PhD
Arthritis Program
Centers for Disease Control and Prevention
ENACT: April 7, 2014
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Overview:
What is a public health perspective?
Why is arthritis a public health problem?
What does public health have to offer?
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What the heck is a
“public health perspective”?
(or …things I never learned in occupational therapy or psychology school…)
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Core Public Health Values
Utilize and expand the science base Reduce health disparities Work through partnerships Emphasize prevention
Primary Secondary Tertiary
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The Public Health Approach
Promotes activities to both measure and respond to health problems or risk factors in population groups
Fosters system changes to influence
health of populations
It is not the treatment of the individual
person
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Public Health’s ChallengeTo identify and help
implement strategies for improving the health of an entire population
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Individual
Interpersonal
Organizational
Community
Public Policy
Social-ecological model was modified from: McLeroy et al., 1988, Health Educ Q; Sallis et al., 1998, Am J Prev M
Public Health Works at Multiple Levels of Influence
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What makes arthritis a public health problem?
(or …why does public health even care about arthritis?…)
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Why is PH interested in Arthritis?(circa 1999)
Arthritis:A large and growing problem
Seriously impacts peoples’ lives
Costly to people, families and society
We can do something about it
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Why is PH interested in Arthritis?(circa 1999)
Arthritis:A large and growing problem
Seriously impacts peoples’ lives
Costly to people, families and society
We can do something about it
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Arthritis and other rheumatic conditions
“Arthritis” encompasses more than 100 diseases and conditions affecting joints, the surrounding tissues and other connective tissues
Characterized by pain, aching, stiffness, and/or swelling in and around a joint
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Over 100 forms of Arthritis
Rheumatoid arthritis
Osteoarthritis
Fibromyalgia
Lupus
Gout
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Prevalence of Select Types of Arthritis
http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm
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Snapshot:Arthritis in the United States
52.5 millionSelf-reported, Doctor-diagnosed
78 millionAmbulatory Care Visits
(5% of all amb. Visits)
22.7 million (9.8%)Limited in activities
9,500Deaths
750,000 Hospitalizations
http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm
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Public Health “Definition” of ArthritisDoctor-diagnosed arthritis:
“yes” to the question:
“Have you EVER been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
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Who has arthritis? 52.5 million U.S. adults have arthritis
>1 in every 5 adults ≥18 years old Approximately 50% of adults over 65 More than 2/3 of adults with arthritis are
younger than age 65 More women than men (24% vs 18%) More
White (23%) and Black (22%) than Hispanic (15%) or Asian (12%)
MMWR (2013) 62: 869-873
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A Growing Problem:Projected Prevalence Increases
Arthritis & Rheumatism 2006;54:226-9
Pre
vale
nce
(in
1,0
00s)
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Why is PH interested in Arthritis?(circa 1999)
Arthritis:A large and growing problem
Seriously impacts peoples’ lives
Costly to people, families and society
We can do something about it
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Most Common Causes of Disability U.S. Adults, 2005
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Projected Increases in Prevalence and Activity Limitations
52 56 59 63 67
19 21 22 24 25
0
20
40
60
80
2010 2015 2020 2025 2030
Mill
ion
s
Adults w/ Arthritis
Adults w/Arthritis-Attributable Activity Limitations
Arthritis & Rheumatism 2006;54:226-9
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Arthritis-Attributable LimitationsAmong: PWA Activity Limitations 43%
Work Limitations 31%
Severe Pain 26%
Social Participation 11%
Volunteerism 41% (Among those who volunteer)
Total adult population
10%
5%
http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm
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Why is PH interested in Arthritis?(circa 1999)
Arthritis:A large and growing problem
Seriously impacts peoples’ lives
Costly to people, families and society
We can do something about it
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Arthritis is Expensive
US Costs (2003 Estimate) Direct $81 B Indirect $47 B Total $128 B
(1.2% of GNP)
SOURCE: MMWR 2007 56:4-7
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Why is PH interested in Arthritis?(circa 1999)
Arthritis:A large and growing problem
Seriously impacts peoples’ lives
Costly to people, families and society
We can do something about it
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Current Opportunities Primary: Preventing disease onset
Obesity, injury prevention
Secondary: Early recognition and treatment (inflammatory arthritis)
Tertiary: Preventing disability or disease complications Strategies with strongest science base Size of target audience: 52.5 million
Projected to grow to 67 Million by 2030
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Arthritis –relatedPublic Health StrategiesWhat makes a difference? Appropriate self
management behaviors Physical activity Maintaining healthy
weight Self management
education programs Early diagnosis—
inflammatory arthritis
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Why is PH interested in Arthritis?(circa 1999)
Arthritis:A large and growing problem
Seriously impacts peoples’ lives
Costly to people, families and society
We can do something about it
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Why is PH interested in Arthritis?(circa 2014)
Large and growing problem Costly to people, families, society
Seriously impacts lives We can do something about it
Rate of activity limitation progressing faster than projected
Associated with obesity epidemic and physical inactivity
Co-occurs with, and complicates management of, other chronic conditions
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Why is PH interested in Arthritis?(circa 2014)
Large and growing problem Costly to people, families, society
Seriously impacts lives We can do something about it
Rate of activity limitation progressing faster than projected
Associated with obesity epidemic and physical inactivity
Co-occurs with, and complicates management of, other chronic conditions
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Activity Limitations Increasing Faster than Projected
MMWR (2013) 62; 44: 869-873
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Why is PH interested in Arthritis?(circa 2014)
Large and growing problem Costly to people, families, society
Seriously impacts lives We can do something about it
Rate of activity limitation progressing faster than projected
Associated with obesity epidemic and physical inactivity
Co-occurs with, and complicates management of, other chronic conditions
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More Adults with Arthritis are Obese
Arthritis Rheum 1998;41(8):1343–1355
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More Adults with Arthritis are Inactive
Am J Prev Med 2006;30(5):385-93
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Arthritis ShacklesObesity & Inactivity Efforts
People with arthritis are:more often obese
more often inactive
People who are obese:more often have arthritis
People who are physically inactive:more often have arthritis
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A bit of chicken and egg…
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Arthritis + Obesity = Inactivity
Physical Inactivity
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And this is a problem because…
Arthritis creates unique barriers to physical activity
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Audience Research: Barriers to Exercise among People with ArthritisCommon Barriers Fatigue Lack time No exercise buddy “I should, but I don’t” “It’s not a priority” “I have other priorities” “Just don’t enjoy exercise”
http://www.cdc.gov/pcd/issues/2006/jul/05_0220.htm
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Audience Research: Barriers to Exercise among People with ArthritisArthritis-specific Barriers Pain (before, during, after exercise) Perceived neg. outcomes No arthritis specific program No specific info (type, amount) Dr. did not mention Weather
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Why is PH interested in Arthritis?(circa 2014)
Large and growing problem Costly to people, families, society
Seriously impacts lives We can do something about it
Rate of activity limitation progressing faster than projected
Associated with obesity epidemic and physical inactivity
Co-occurs with, and complicates management of, other chronic conditions
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Common Co-morbidities
MMWR (2013) 62: 869-873
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Greater Arthritis-Attributable Activity Limitations with Co-morbidities
MMWR (2013) 62: 869-873
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Arthritis + Diabetes = Inactivity
10.9
17.3
21.0
29.8
0
5
10
15
20
25
30
35
Neither Arthritis only Diabetes only Both
Per
cen
t (%
) in
acti
ve Physical Inactivity
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Arthritis + Heart Disease = Inactivity
Physical Inactivity
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The Good News… People are managing multiple chronic
conditions (and may be more concerned about another condition)
Arthritis-specific barriers present a barrier to management of other chronic conditions
Many self management behaviors (physical activity, self management education) beneficial to arthritis and co-morbidity
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What does public health have to offer the arthritis field?
(or …who cares if arthritis is
recognized as a
public health problem?…)
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Why does Arthritis need PH?
Most “health care” takes place outside of the health care delivery system Assuming a person has a 30
minute visit 3 times a year…
…less than 0.02% of time spent with a health care provider.
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Public Health Contributions Conduct surveillance and prevention
research Place arthritis on the national health
agenda Increase availability of evidence-based self
management interventions Address arthritis through multiple levels Foster collaborative efforts/collective action Provide research support and translation
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National Health Agenda
Decrease Level of joint pain Activity/personal
care limitations Work limitations Racial disparities
in TKR
Increase Arthritis education Provider counseling
Weight control Physical activity
Seeing HCP for Dx PA and Obesity
(other chapters)
Healthy People 2020 Objectives
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Expanding Self-Management Intervention AvailabilityState Arthritis Programs California Kansas Kentucky Michigan Missouri Montana New York Oregon Pennsylvania Rhode Island South Carolina Utah
National Delivery Systems Y-USA National Association of
County and City Health Officials
National Recreation and Parks Association
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Address Arthritis Through Multiple Levels of Influence
Socioeconomic Factors
Changing Environmental Context
Long-lastingProtective Action
Clinical Care
Counseling/Education
Increasing Population Impact
Increasing Individual Effort Needed
AJPH (2010) 100: 590-595
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Addressing Arthritis through Multiple Levels Changing the
Context: Environmental Policy
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Collective Action OA Action AllianceCoalition of stakeholdersMission: work collectively to advance recommendations in the OA Agenda“Action Teams”
Physical Activity Weight management Self management education Injury prevention
Oaaction.org
Public Health Agenda for OA
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Research Support and Translation Limited (and select) research funding
Translating evidence-based interventions into wide-scale public health impact
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Intervention Research Evaluation of existing programs
Arthritis Foundation Exercise Program Walk with Ease Active Living Every Day Comparing generic and disease specific self
management education Development/Evaluation of new programs
Mail-delivered self management education Shortened self management education Conditioning exercise program Health communications campaigns
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Supporting Intervention Delivery Systems approach to dissemination
Reinforcing program infrastructure
Increasing availability and accessibility of intervention programs through state health departments and national delivery system partners
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Arthritis-A Public Health Perspective
Arthritis is a large and growing is costly in economic and QOL terms shackles efforts to address obesity and
physical inactivity sabotages diabetes and heart disease control
efforts
Multiple opportunities to make a difference Need to work at multiple venues and levels
of influence
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QuestionsTeresa J. Brady, PhD
Senior Behavioral Scientist
Arthritis Program
Centers for Disease Control and Prevention
4770 Buford Hwy MS K-51
Atlanta GA 30341
770-488-5856