State Perspectives of Population Health · State Perspectives of Population Health Lilian Peake, MD, MPH Director, Public Health

State Perspectives of Population Health

Lilian Peake, MD, MPHDirector, Public Health

Outline

• 20th Century Population Health Improvement

• 21st Century Challenges

• Population Health Trends in South Carolina

• Population Health Approach

http://www.livescience.com/21213-leading-causes-of-death-in-the-u-s-since-1900-infographic.html

Mortality from all causes declined 54% between 1900 and 2010.

Control of Infectious Disease

Source: http://www.dailymail.co.uk/sciencetech/article-3409908/The-seven-biggest-threats-humanity-revealed-nuclear-winter-devastating-supervolcano-experts-explain-violent-ways-world-end.html

Rahima Banu – October 1975

Variola Major - Bangladesh

Ali Maow Maalin – October 1977

Variola Minor - Somalia

** Two laboratory acquired cases occurred in UK in 1978

Eradication of Smallpox

Source: CDC

Source: http://www.hkma.org/english/cme/onlinecme/cme200305main.htm

Control of SARS

Source: CDC

Decrease in Infant Mortality

Control of Tobacco Use

Source: https://www.ahrq.gov/professionals/education/curriculum-tools/population-health/abrams.html

Decline in Rate of Lung Cancer

Source: https://www.ahrq.gov/professionals/education/curriculum-tools/population-health/abrams.html

Control of Coronary Heart Disease

Source: National Heart, Lung, and Blood Institute – NIH Age-Adjusted Death Rates for Coronary Heart Disease, U.S., 1950–2010. Actual Rate and Expected Rates if Rise Had Continued or Reached a

Plateau

Note: Due to changes in methodology, estimates are not comparable from 2005-2010 to 2011-2015Source: SC Behavioral Risk Factor Surveillance System. Division of Surveillance, Office of Public Health Statistics and

Information Services, SC DHEC

2005 2007 2009 2011 2013 2015

Adult SmokingSouth Carolina

All races

Note: Survey conducted every odd yearSource: SC Youth Risk Behaviors Survey. SC Department of Education.

2005 2007 2009 2011 2013 2015

Youth Smoking (High School)South Carolina

All races

Outline

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

Life Expectancy Per Capita Spending

Source: Life Expectancy from CIA World Factbook (2015); Per Capita Spending on Healthcare in current US $ from OECD (2012)

“Americans have a longstanding pattern of poorer health…over the life course.”

Source: 2015 National Academy of Sciences

Higher Rates than Average of Peer Countries

• Infant mortality

• Low birth weight

• Adolescent pregnancy

• Sexually transmitted infections

• Injuries

• Heart disease

• Chronic lung disease

• Disability

• Obesity

• Diabetes

• Drug-related deaths

Source: U.S. Health in International Perspective, National Academy of Sciences, 2015, http://sites.nationalacademies.org/DBASSE/CPOP/US_Health_in_International_Perspective/

Source: http://www.commonwealthfund.org/~/media/images/publications/fund-report/2010/jun/mm2010l.gif

Comparison of Healthcare System Outcomes

Source: https://www.slideshare.net/kingcobra2012/ib-ess-topic-3-human-population

An Aging Population

Adverse Childhood Experiences Study

Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention

Source: CDC, https://www.cdc.gov/violenceprevention/acestudy/ace_graphics.html

Prevalence of Diagnosed and Projected Diagnosed

Diabetes Cases in the United States, 1960-2050

SOURCE: https://aspe.hhs.gov/report/diabetes-national-plan-action/introduction. Data for 1960–1998 from the National Health Interview Survey, National Center for Health Statistics (NCHS). Centers for Disease Control and Prevention (CDC) projected data for 2000–2050 from the Behavioral Risk Factor Surveillance System, Division of Diabetes Translation, CDC. (Note: The “Diagnosed cases” arrow refers to the section of the figure that includes diagnosed cases of diabetes versus the section that includes projected cases. The line graph and not the line arrow indicate the number of diagnosed cases.)

Chronic Disease

Source: APHA

Emergent Infections and Antibiotic Resistance

Outline

South Carolina: 42nd out of 50

Source: http://www.americashealthrankings.org/

Leading of Causes of Death South Carolina, 2005 and 2015

2005 2015

1 Heart Disease

2 Cancer

3 StrokeChronic Lower Respiratory

Disease

4 Unintentional Injuries

5Chronic Lower Respiratory

DiseaseStroke

6 Alzheimer’s Disease

7 Diabetes

2005 2007 2009 2011 2013 2015

Heart Disease Deaths

All races

Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC

2005 2007 2009 2011 2013 2015

Cancer Deaths

All races

2005 2007 2009 2011 2013 2015

Chronic Lower Respiratory Disease Deaths

All races

2005 2007 2009 2011 2013 2015

Injury Deaths

All races

2005 2007 2009 2011 2013 2015

Overdose Deaths

All races

2005 2007 2009 2011 2013 2015Ag

Black HomicideWhite SuicideAll Races SuicideAll Races HomicideBlack SuicideWhite Homicide

2005 2007 2009 2011 2013 2015

Deaths Due to Falls

All races

2005 2007 2009 2011 2013 2015

Motor Vehicle Accident Deaths

All races

2005 2007 2009 2011 2013 2015

nStroke Deaths

All Races

2005 2007 2009 2011 2013 2015

Alzheimer's Disease Deaths

All races

2005 2007 2009 2011 2013 2015

Diabetes Deaths

All races

2005 2007 2009 2011 2013 2015

Adult Obesity

All races

Notes: Due to changes in methodology, estimates are not comparable from 2005-2010 to 2011-2015Source: SC Behavioral Risk Factor Surveillance System. Division of Surveillance, Office of Public Health Statistics and

Information Services, SC DHEC

Outline

Relative Contribution of Factors that Affect Health

Social and Economic

Factors

Health Behaviors

Medical

Environment

Source: Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012.

Effect of Population Level Interventions

Source: Frieden, A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health. 2010 April; 100(4): 590–595. doi: 10.2105/A JPH.2009.185652.

Source: http://www.americashealthrankings.org/

Opportunities

• Projected savings by 2023 with modest improvement in prevention and treatment of chronic disease

• Could avoid 40 million cases

• Cut treatment costs $220 billion

• Increase GDP $900 billion

• ROI = $5.60 for every $1.80 invested in proven community-based prevention program

• Challenge – Identify evidence-based programs shown to be cost-effective

Source: Chatterjee et al, Checkup Time: Chronic Disease and Wellness in America, Milken Institute, Jan 29, 2014, Trust for America’s Health, Bending the Obesity Cost Curve, January 2012, http://healthyamericans.org/assets/files/TFAH%202012ObesityBrief06.pdf

Collaborative CommunityHealth Improvement

• Collaborative Health Assessment – SHA/CHA• Primary causes of illness, injury and premature death

• Patterns of health determinants

• Collaborative Health Improvement –SHIP/CHIP• Plan

• Develop interventions and measure progress

• Quality Improvement approach

Food Access

Housing

Transportation

Education

Public Safety

Economic Development

Criminal Justice

Community Design

Water System

Health

Health in All Policies

Impact of North Carolina’s Motorcycle Helmet Law on Hospital Admissions and

Charges for Traumatic Brain Injuries• Compared North Carolina motorcycle related brain

injury cases with three states (Florida, South Carolina, Pennsylvania) that had repealed their motorcycle helmet law

• North Carolina’s law prevented 190-226 hospitalizations for TBI in 2011

• Averted hospital charges to taxpayer-funded sources of $9.5 million - $11.6 million

• Total averted hospital charges were $25.3 million -$31.0 million.

NC Medical Journal, 2015

Create Accountable Care Communities

• Assess and track health outcomes• Population

• Hot spotting

• Quality

• Prioritize and focus on key health issues• Collective Impact

• Create clinical-community linkages• Community health workers

• Care coordination

• Team-based clinical care• Team extends to community partners

Develop partnerships to:

Create policies, systems

and environmental

changes that support

healthy behaviors.

Fill gaps in needed

services.

Involve patient, family,

and community in

strategic planning and

improvement activities

Collective Impact• Common Agenda

• Shared Measurement

• Mutually Reinforcing Activities

• Continuous Communications

• Backbone Support

Isolated Interventions

Aligned Efforts

and Resources

SC Birth Outcomes Initiative

• Active coalition - DHHS, SC Hospital Association, DHEC, March of Dimes, and many partners

• Reduced Early Elective Deliveries

• Post-partum LARC Insertion

• Safe Sleep

• Perinatal Regionalization

• Breastfeeding Friendly• Milk Bank

The Power of Collaboration• BOI was launched in 2011

• From 2005–2007 to 2012–2014, infant mortality rates declined in a total of 33 states and the District of Columbia

• Declines of more than 20.0% were observed in Connecticut, South Carolina, Colorado, and D.C.

Thank You!

State Perspectives of Population Health · State Perspectives of Population Health Lilian Peake, MD, MPH Director, Public Health

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