Roderick L. Bremby, SecretaryKansas Department of Health and Environment

United Methodist Health Ministry Healthy Congregations Retreat April 13, 2007

Healthy Kansas:An Opportunity to Transform the Health of Kansas

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Greetings

Gov. Kathleen Sebelius

An opportunity to expand the focus

of current reform strategies

through transformative policy making and

shifting and broadening the discourse on health reform.

Healthy Kansas

1. Goal - Optimal Health Status

2. Health Status – a function of multiple determinants

3. The Life Course Matters – risk and protective factors

early in life affect health status later in life

Healthy Kansas 3 Core Premises

Move from a sick care system to a health system that provides vertical, horizontal, and longitudinal integration

Current discussion focus: cost, access, and quality.

Cost - 1980 - $253.9B or $ 1,102 per person > 9.1% GDP

1990 - $714.0B or $ 2,813 per person > 12.4% GDP

2000 - $ 1.35T or $ 4,790 per person > 13.8% GDP

2005 - $ 1.98T or $ 6,697 per person > 16.2% GDP

2015 - $ 4.04T or $12,357 per person > 20.0% GDP

(projected)

Access - uninsured US:46.6 million (15.9%) / KS:300,000 (10.9%)

Quality - 44-98K deaths annually from medical intervention – 1999 IOM – To Err is Human

Healthy Kansas – Premise 1: Optimal Health Status is the Goal

CMS

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“The fact is that we don’t face an immediate crisis

and so people say, What’s the problem ? The

answer is we suffer from a fiscal cancer…and if

we do not treat it, it could have catastrophic

consequences for our country”.

U.S. Comptroller General David

Walker

3/1/07

Healthy Kansas

Current discussion focus: cost, access, and quality.

Cost - 1980 - $253.9B or $ 1,102 per person > 9.1% GDP

1990 - $714.0B or $ 2,813 per person > 12.4% GDP

2000 - $ 1.35T or $ 4,790 per person > 13.8% GDP

2005 - $ 1.98T or $ 6,697 per person > 16.2% GDP

2015 - $ 4.04T or $12,357 per person > 20.0% GDP

(projected)

Access - uninsured US:46.6 million (15.9%) / KS:300,000 (10.9%)

Quality - 44-98K deaths annually from medical intervention – 1999 IOM – To Err is Human

Healthy Kansas – Premise 1: Optimal Health Status is the Goal

What accounts for growth in health care spending ?

US Health Status (W.H.O.) –

• 49th out of 50 industrialized nations

• U.S. infant mortality – 29th

• U.S. life expectancy – 25th

Healthy Kansas Premise 1: Optimal Health Status is the Goal

1. Goal - Optimal Health Status

2. Health Status – a function of multiple determinants

3. The Life Course Matters – risk and protective factors

early in life affect health status later in life

Healthy KansasPremise 2: Health Status results from many factors

• Heath Care Services

• Public Health

• Population Health (individual and population levels)

• Social Determinants

– Education

– Built environment

– Natural environment

– Social capital

Healthy Kansas –Premise 2: Health Status results from many factors

Health Factors

Environment22%

How We Live -

Behavior51%

Medical Care10%

Genetic Make-Up

17%

Source: USDHEW, PHS, CDC. “Ten Leading Causes of Death in US 1975.”Atlanta, GA, Bureau of State Services, Health Analysis & Planning

for Preventive Services, p 35, 1978

1. Goal - Optimal Health Status

2. Health Status – a function of multiple determinants

3. The Life Course Matters – risk and protective factors

early in life affect health status later in life

Healthy Kansas – Premise 3: Role of Life Course Development

Healthy Kansas Premise 3: Role of Life Course Development

Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

* National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002 † Adapted from McGinnis Foege, updated by Mokdad et. al.

Actual Causes of Death†

Tobacco

Poor diet/lack of exercise

Alcohol

Infectious agents

Pollutants/toxins

Firearms

Sexual behavior

Motor vehicles

Illicit drug use

Causes of Death United States, 2000

Leading Causes of Death*

Percentage (of all deaths)

Heart Disease

Cancer

Chronic lower respiratory disease

Unintentional Injuries

Pneumonia/influenza

Diabetes

Alzheimer’s disease

Kidney Disease

Stroke

Percentage (of all deaths)0 5 10 15 20 25 30 35 0 5 10 15 20

Predicted Likelihood of Developing Coronary Heart Disease, Diabetes

or Stroke by Age 65

11%

58%

0%

10%

20%

30%

40%

50%

60%

70%

Non Smoker, NormalWeight, Active

Smoker, Heavy,Inactive

Per

cen

t

Source: Jones et al. Archives of Internal Medicine 2002;162:2565–71

Healthy KansasThe Evolving Health System

Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

• The First Era (Established the “operating system”)•Focus on acute and infectious disease•Medical care silo•Insurance-based financing

• The Second Era (Operating System “patch”)•Focus on chronic disease •Increased technology ->increased costs

• The Third Era (Requires Policy to Replace Operating System

• Focus on optimal health status and multiple forms of integration

Healthy Kansas The Evolving Health System

“I get no money to prevent an amputation. I would get a whole bunch of money to perform

an amputation.”

Dr. Anne Peters, endocrinologistLos Angeles Times, 2/26/07

Healthy KansasThe Evolving Health System

The U.S. and 29 other developed nations on average spend 2.8% of their health

care budgets on preventive care.

Organization for Economic Co-operation and Development - 2004

Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

Source: Center for Health Transformation

Healthy Kansas 4 parallel layers of health transformation needed:

Individual Change Institutional/Provider Change

Cultural Change Science Changes Everything

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A roadmap for health promotion and wellness, incorporating community coalition building and private sector partnerships.

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Many chronic diseases and illnesses can be attributed to three modifiable behaviors:

Tobacco use Lack of physical activity

Poor nutrition

Improving our Health

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* National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002 † Adapted from McGinnis Foege, updated by Mokdad et. al.

Actual Causes of Death†

Tobacco

Poor diet/lack of exercise

Alcohol

Infectious agents

Pollutants/toxins

Firearms

Sexual behavior

Motor vehicles

Illicit drug use

Causes of Death United States, 2000

Leading Causes of Death*

Percentage (of all deaths)

Heart Disease

Cancer

Chronic lower respiratory disease

Unintentional Injuries

Pneumonia/influenza

Diabetes

Alzheimer’s disease

Kidney Disease

Stroke

Percentage (of all deaths)0 5 10 15 20 25 30 35 0 5 10 15 20

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Healthy Kansas

• Prevention Focus– Tobacco Use– Physical Inactivity (obesity)– Poor Nutrition (obesity)

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Improving our Health

A third of all U.S. deaths are attributable to three

modifiable health-damaging behaviors:

– tobacco use – 440,000/yr– lack of physical activity 365,000/yr – poor nutrition

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Prevention focus -

• Tobacco use $724M/yr

• Physical inactivity (obesity)• Poor nutrition (obesity)

Healthy Kansas

$657M/yr

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Healthy Kansas

Chronic Disease Burden– 81% of total health care expenditures– KS Diabetes - $1.3B/yr and growing– New cases of diabetes can be

reduced by 60% with modest increases in physical activity and weight loss

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Healthy Kansas

Healthy People 2010—Tobacco Use

0% 5% 10% 15% 20% 25%

Reduce cigarettesmoking by teens

Reduce cigarettesmoking by adults

Kansas Rate HP 2010 Goals

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Healthy Kansas

0% 20% 40% 60% 80% 100%

% teens doingvigorous activity

(3x/ week, 20mins/ event)

% adults doingmoderate activity (30

mins/ day)

Kansas Rate HP 2010 Goal

Healthy People 2010—Physical Activity

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Healthy Kansas

0% 20% 40% 60% 80%

% Kansans age 2 andup eating 2+ fruit

servings daily

% Kansans age 2 andup eating 3+

vegetable servingsdaily (incl. 1+ servingof dark green/ yellow)

Kansas Rate HP 2010 Goal

Healthy People 2010—Nutrition

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Healthy Kansas

Placed Based Strategy -

• Children in schools • Adults in the workplace• Kansas seniors in community

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Healthy Kansas – Children in Schools

• Coordinated School Health Initiative Infrastructure – >52 Districts, 224 Schools, 80,000 students– Voluntary Body Mass Index (BMI) Testing– Child Health Advisory Committee– School Nutrition and Physical Activity

Committees

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Healthy Kansas – Seniors in the Community

– With Dept. on Aging (KDOA), provide TA for local wellness programs for seniors

– KDOA STEPS Program (Seniors Together Enjoy Physical Success)

– Expansion of Senior Farmer’s Market– Encourage community gardens

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Healthy Kansas

• Media Campaign – partner with KHF• Reactivate Governor’s Council on Physical

Fitness• Governor’s/Secretary’s Awards

– Fitness Awards (youth focus)– Local Community Health Heroes– Healthy Community Designations– Healthy School Designations– Model Workplace Wellness Sites

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Healthy Kansas - Pledge

• Increase activity level• Eat healthy

• Avoid tobacco

YR 1: 6,000 KansansCheckUp

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• Requires suspension of existing beliefs

• Final solution still unknown

• Timeline inconsistent with policy agenda event horizon

• Multiple layers of institutional structures need change

• Requires convergence from the (liberal-conservative) extremes

• Lack of stated agreement on the goal and principles

Healthy Kansas Challenges to System Transformation

Q. – How do we improve the health of Kansans ?

First 2 Steps -

Begin with the end in mind.

First things first.

- Steven Covey

Healthy Kansas An Opportunity to Transform the Health of Kansas

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www.healthykansas.org