Critical Systems Challenges for Chronic Diseases George A. Mensah, M.D. Associate Director for...
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Critical Systems Challenges for Chronic Diseases
Critical Systems Challenges for Chronic Diseases
George A. Mensah, M.D.Associate Director for Medical AffairsNational Center for Chronic Disease
Prevention and Health Promotion
George A. Mensah, M.D.Associate Director for Medical AffairsNational Center for Chronic Disease
Prevention and Health Promotion
2006 National 2006 National
Health Policy Health Policy
Conference Conference
Adjunct Adjunct
MeetingMeeting
Feb. 8, 2006
2006 National 2006 National
Health Policy Health Policy
Conference Conference
Adjunct Adjunct
MeetingMeeting
Feb. 8, 2006
Public Health Response in Disasters
Disclosure Statements
• No conflicts of interest
• Statements made in this presentation do not necessarily represent the views of the CDC, DHHS, or the US Government
Katrina and Other Natural Disasters
•Panel 1: Lessons Learned– Impact on public health systems –Deployment of mobile hospitals–System evacuation issues–Mental health transformations
•Panel 2: Critical System Challenges–Surge Capacity Issues –Legal Issues–Chronic Disease Issues
Chronic Disease Issues in Natural Disasters - The Outline
•Triumphs and Successes
•Tradition of Neglect
•Critical Challenges
•Opportunities and Hope
Triumphs and Successes
• Civil society response
• International collaboration
• Attention to provision of shelter, food and water for evacuees
• Fatality from malnutrition
•Control of infectious outbreaks
Mokdad, Mensah, Posner, Reed, Simoes, Engelgau, and the Chronic Diseases and Vulnerable Populations in Natural Disasters Working Group. Prev Chronic Dis 2005 Novhttp://www.cdc.gov/pcd/issues/2005/nov/05_0201.htm
Persons at Risk from Disasters – 1
•Persons with underlying chronic diseases; mental illness
•Persons without health insurance
•Persons with low income, SES, and educational attainment
•Homeless persons
Mokdad, Mensah, Posner, et al. Prev Chronic Dis 2005 Novhttp://www.cdc.gov/pcd/issues/2005/nov/05_0201.htm
•The elderly•Pregnant women and infants•Children and adolescents•Mentally impaired•People living with disabilities•Prisoners and other
institutionalized persons
Persons at Risk from Disasters – 2Other Vulnerable Populations
Chronic Diseases and Vulnerable Population Issues
•Lack of access to routine health care and medications
•Significant interruption in life-supporting treatments– home oxygen use– renal dialysis– insulin injections
Mokdad, Mensah, Posner, et al. Prev Chronic Dis 2005 Novhttp://www.cdc.gov/pcd/issues/2005/nov/05_0201.htm
Selected Observations from Surveys of Hurricane Evacuees
•Most health care visits were for chronic health conditions
•Up to 41% had at least one major chronic health condition.
•Non-traumatic deaths often result from existing chronic conditions.
Needs Assessment in Persons Staying in Evacuation Centers
•Leading the list of top 10 conditions were:
–Hypertension
–Cardiovascular diseases
–Diabetes
–Psychiatric disorders
Chronic Disease Issues in Natural Disasters - The Outline
•Triumphs and Successes
•Tradition of Neglect
•Critical Challenges
•Opportunities and Hope
Chronic Disease Management During Disasters and Emergencies
“No generally accepted guidance on the management of chronic diseases during disasters has previously been established.”
Humanitarian Charter and Minimum Standards; p 294
Priority Chronic Conditions During Disasters or Complex Emergencies
Conditions for which an acute cessation of therapy was likely to result in death, including:–Dialysis-dependent chronic
kidney failure
– Insulin-dependent diabetes
–Certain childhood cancers
Humanitarian Charter and Minimum Standards; p 294
Frequency of Selected Terms inThe National Response Plan
http://www.dhs.gov/interweb/assetlibrary/NRP_FullText.pdf
TERM FREQUENCY
Outbreak 62
Infection/infectious disease 18
Cancer 1
Heart disease 0
Diabetes 0
Pregnant/pregnancy 0
Mental Illness 0
Chronic Disease Issues in Natural Disasters - The Outline
•Triumphs and Successes
•Tradition of Neglect
•Critical Challenges
•Opportunities and Hope
Data to Guide Chronic Disease Disaster Preparedness
1.Pre-disaster burden data
2.Estimates of immediate needs
3.Surge capacity of local and neighboring health care systems
4.Ability to rebuild infrastructure needed to support care
Surveillance Needs Before, During, and After a Disaster
1. Size, functional status, and needs prior to the disaster
2. Ability to assess the needs and levels of actual response during the disaster;
3. Ability to monitor the long-term effects of the disaster.
Chronic Disease Issues in Natural Disasters - The Outline
•Triumphs and Successes
•Tradition of Neglect
•Critical Challenges
•Opportunities and Hope
Standard 2: Reproductive Health Guidance Note
1.Minimum Initial Service Package
2.Gender-based violence (GBV)
3.Emergency obstetric care
4.Comprehensive reproductive health services:
Humanitarian Charter and Minimum Standards; p 290
Essential Drugs and Supplies
•Life-threatening conditions–Acute heart attack & stroke care–Oxygen in severe lung disease–Insulin in type 1 diabetics–Dialysis in kidney failure–Obstetric complications–Acute care in certain cancers
•Medications for routine care
Chronic Disease and Vulnerable Populations: Research Issues
•Direct morbidity & mechanisms
•Specific preventive strategies
•Determinants of rate of recovery
• Impact on mental health and overall long-term health status
•Essential medications and supplies for stockpiles
Summary & Conclusions•Previous preparedness efforts often
neglected chronic diseases and vulnerable populations
•New emphasis offers opportunities for improved preparedness and health protection
•Surveillance, policy development, and assurance remain core functions
Chronic Disease and Vulnerable Populations in Natural Disasters
Working Group at CDC
•Coordinating Center for Health Promotion•Coordinating Office for Terrorism
Preparedness and Emergency Response•Other CDC Centers, Institutes,
Offices•Public health partners