Chronic Disease Prevention

Chronic Disease Prevention

November 20, 2008

Objectives

Background: Setting the Stage

Status of Chronic Diseases in San Diego

Evidenced-based Best Practices

HHSA Chronic Disease Prevention Model

Setting the Stage

Why Chronic Disease?

Why Chronic Disease?Why Chronic Disease?• California Conference for Local

Public Health Officers (CCHLO)– Chronic Disease Conference– Spurred Idea to develop CC Agency for

Agency • Two meeting held to date to develop an

inventory of Agency Chronic Disease activities

– SPOS came to PHS to conduct a “Focused Dialogue”

– Chronic Disease was chosen

What Is Chronic Disease?What Is Chronic Disease?

• According the U.S. National Center for Health Statistics, is a disease that lasts 3 months or more.

• Cannot be prevented by vaccines or cured by medications.

• Caused by health damaging behaviors - particularly tobacco use, lack of physical activity, and poor eating habits.

• Is the leading cause of death and disability in the United States.

• Accounts for 7 of the 10 U.S. leading cause of death.

Why Should We Care?

• Chronic diseases are prevalent, preventable and costly!

• Cause extended pain and suffering, associated with decreased quality of life for millions.

• Treatment for seven chronic diseases including cancers, mental illnesses, heart disease, lung conditions, hypertension, stroke, and diabetes ran to nearly $280 billion in 2003; now estimated to be to $1.3 trillion per year.

• Prevention programs are highly cost-effective

Top 10 Causes of Mortality in San Diego County

Rate

Rank 2004

Rank 2005

Cause of Death 2004 2005

1 1 Heart Disease 183.7 172.6

2 2 Cancer (any) 166.3 163.1

3 3 Stroke 49.8 41.3

4 5COPD/Chronic lower respiratory diseases

38.3 39.1

5 4 Alzheimer's Disease 38.1 36

6 6 Unintentional injuries 28.6 28.5

7 7 Diabetes mellitus 19.1 21.1

8 8 Influenza & pneumonia 16.6 14.3

9 9 Suicide 10.4 9.9

10 10Essential (primary) hypertension and hypertensive renal disease

9.1 9.4

Rates are per 100,000 population. Source: State of California, Department of Public Health, Center for Health Statistics, Vital Statistics Section, Death Statistical Master Files

= Chronic Diseases

Death by Risk Factors

Physical Activity by Gender

Per

cen

t

WomenNutrition by Gender

0

20

40

60

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

Men

Women

Men

PA and Nutrition Trends

Healthcare Cost in California and San Diego

• $130 Billion spent (treatment and lost productivity) by California in 2003

• $4.3 Billion in SD County (not including lung cancer treatment)

3 – FOUR – 503 RISK FACTORS

(Tobacco Use, Poor Diet, Lack of Physical Activity)

4 CHRONIC DISEASES(Heart Disease/Stroke, Type 2 Diabetes, Respiratory Disease, Cancer)

50% of DEATH

Status of Chronic Diseases

in San Diego

What Are the Statistics?

*2006 U.S. data are preliminary

Life Expectancy at Birth: San Diego vs. U.S. Population, 2000-2006*

80.6 80.580.7 80.7

80.580.7

77.077.2 77.3 77.4

77.8 77.878.1

80.8

75.0

76.0

77.0

78.0

79.0

80.0

81.0

82.0

2000 2001 2002 2003 2004 2005 2006*

Year

Age

San Diego U.S.

LIFE EXPECTANCY TRENDSSan Diego County vs United States, 2000-2006

San Diego County PopulationSan Diego County Populationby Race/Ethnicity, 2007by Race/Ethnicity, 2007

Source: SANDAG, San Diego County 2007 Population Estimates

• 3 million people

• Racial/Ethnic groups from around the world.

• Over 100 languages

Asian 9.4%N=292,251

White 51.6%N=1,597,847

Black 5.4%N=166,486

Hispanic 29.3%N=906,898

Hawaiian/Pacific Islander 0.4%N=13,144American Indian

0.5 %N=15,946

San Diego County PopulationSan Diego County Populationby Race/Ethnicity, Census 1990 vs. 2000 vs. 2007by Race/Ethnicity, Census 1990 vs. 2000 vs. 2007

0

10

20

30

40

50

60

70

Hispanic White Black AmericanIndian

Asian

1990 2000 2006

Source: SANDAG, San Diego County 1990, 2000 Census, and 2007 Population estimates

Between 1990 & 2000:

• The population of Hispanics and Asian increased

• The population of Whites and Blacks decreased

Percent

105.7

145.4173.5

216.6

0

50

100

150

200

250

300

White Black Hispanic Asian/Other

Race/Ethnicity

Rat

e p

er 1

00,0

00

All Cancer DeathsAll Cancer Deathsby Race/Ethnicity, 2005by Race/Ethnicity, 2005

Note: All rates are adjusted to 2000 Standard U.S. Population.Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.

Cancer is the

second leading

cause of death

for San Diego

County

San Diego County Overall Rate, 2005: 163.1 / 100,000

HP 2010 Goal: 159.9

Selected Cancer DeathsSelected Cancer Deathsby Race/Ethnicity, 2005by Race/Ethnicity, 2005

0

10

20

30

40

50

Lung F. Breast Prostate Colorectal

Race/Ethnicity

Rat

e p

er 1

00,0

00

White Black Hispanic Asian/Other

Note: All rates are adjusted to 2000 Standard U.S. Population.Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.

HP 2010 Goal

Coronary Heart Disease and Stroke Deathsby Race/Ethnicity, 2005

0

50

100

150

200

250

300

White Black Hispanic Asian/Other

Race/Ethnicity

Rat

e p

er 1

00,0

00

CHD Stroke

Note: All rates are adjusted to 2000 Standard U.S. Population.Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.

Blacks have the highest rate of coronary heart disease deaths and stroke

deaths compared toother racial and ethnic groups.

HP 2010 Goal CHD: 166.0

HP 2010 Goal Stroke: 48.0

San Diego County Overall: CHD Rate - 128.4 / 100,000 Stroke Rate – 41.3 / 100,000

Diabetes Diabetes by Race/Ethnicityby Race/Ethnicity

Source: Youth Risk Behavior Survey (YRBS), San Diego City Schools; California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates; California Health Interview Survey (CHIS), California Department of Health Services, Death Statistical Master File.

R/E

HospitalAdmissions

2005

Deaths (underlyin

g)2005BlackWhite

HispanicAsian/Other

69.016.633.521.2

303.587.1236.087.6

10.77.7

18.47.4

% High School

Students Overweigh

t 2005

Prevalence of Diabetes

Among Adults 2005*

6.65.16.57.2

* - Percentage of adults who were ever diagnosed with diabetes

Diabetes Mortality

Among the top 53 U.S. City/County jurisdictions

San Diego County:

• Ranked 52 in 1990

• Ranked 46 in 2004

• Ranked 8th in the highest rate of change between 1990 and 2004

Source: NACCHO 53 Big Cities Health Inventory, 2007

Note: Ranking scheme - 1 being worst and 53 being best

Diabetes Mortality Among San Diego County Residents, 2000-2005

481 491 475499

531

60419.2 19.3

18.3 18.6 19.1

21.1

0

100

200

300

400

500

600

700

800

2000 2001 2002 2003 2004 2005

Dea

ths

0

5

10

15

20

25

Rat

e pe

r 10

0,00

0

Deaths Rate

Deaths and Age-adjusted Rates

HP2010= 45

Diabetes Hospitalizations Among San Diego County Residents, 2001-2005

28833041 3166 3244

3406108.1 111.8 112.9 113.8

118.1

0

1000

2000

3000

4000

5000

2001 2002 2003 2004 2005

Hos

pita

liza

tion

s

0

50

100

150

Rat

e pe

r 10

0,00

0

Hospitalizations Rate

Number and Age-adjusted Rates

Diabetes Hospitalizations Among San Diego County Residents, 2001-2005

276.7 283.4

327.7

274.6303.5

207.7 212.9 212224.6 236

87.7 88 87.5 88 87.173.1 75.3 78.1 75.4

87.6

0

100

200

300

400

2001 2002 2003 2004 2005

Rat

e pe

r 10

0,00

0

Black Hispanic White Asian/Other

By Race/EthnicityNumber and Age-adjusted Rates

Overweight & Obese Adults* Overweight & Obese Adults* by Race/Ethnicity, 2005by Race/Ethnicity, 2005

16.126.5 26.9

9.8

37.530.4 35.3

33.5

0

25

50

75

100

White Black Hispanic Asian

Race/Ethnicity

Per

cen

tag

e (%

)

Obese (BMI >30) Overweight (BMI 25-30)

* as Defined by Body Mass Index (BMI)* as Defined by Body Mass Index (BMI)Source: 2005 California Health Interview Survey (CHIS)

HP 2010 Goal

Obesity (BMI >30):

15%

Unhealthy weight (BMI>25): 40%

Asthma in San Diego CountyAsthma in San Diego Countyby Race/Ethnicityby Race/Ethnicity

Source: 2005 California Health Interview Survey (CHIS), California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates. California Department of Health Services, Death Statistical Master File

* - These results for Blacks reflect 2003 data results since sample size for Blacks in 2005 was statistically unreliable.

Race/Ethnicity

Hospitalization Rate, 2005

Average Annual Number

of Deaths2002-2004

BlackWhite

HispanicAsian/Other

318 3 4

204.759.374.962.6

Estimated Prevalenc

eAmong

Children 200513.8*

9.612.411.7

Selected Health Indicators*San Diego County, CA, & US, HP2010

Indicator

• Infant Mortality• Adults reporting poor/fair health• Incidence of AIDS• CHD Deaths• Suicides• F. Breast Cancer Deaths• Unintentional Injury Deaths

San Diego

County CA U.S.

Healthy People 2010 Goal

4.614.4%14.0

144.410.522.928.8

5.316.0%11.8

162.88.5

24.130.5

7.014.0%15.0

159.610.726.037.7

4.5None1.0

166.05.0

22.3

* - These data reflect the most current comparable data

The numbers above reflect either rates or percentages

Evidence-based Best

Practices

Do They Work?

Direction from the National Level

• Federal Government Agencies

– United States Department of Agriculture

– United States Surgeon General

– Centers for Disease Control

“Healthy places are those designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders -- where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options.”

CDC’s “Designing & Building Healthy Places”

• Leading Public Health Organizations– National Association of County and City Health Officials– National Task Force on Community Preventive

Services– Robert Wood Johnson Foundation – Kaiser Permanente– American Planning Association (funded by CDC)

Direction from the National Level

• Public– California Conference of Local Health

Officers– California Department of Public Health– Governor's Obesity Prevention Plan

• Private– The California Endowment– Strategic Alliance

Direction from the State Level

Best Practices and Promising Interventions

1. Healthy Community Improvements

2. Healthy Community Development

3. Healthy Community Plans & Policies

1. Healthy Community Improvements

Partnering with communities and cities to improve existing physical and social conditions that prevent physical activity and healthy eating

Best Practices and Promising Interventions

Healthy Community Improvements

• Safe and healthy routes to schools, parks, healthy foods, seniors– Traffic calming, improve street

crossings

• Installing/improving sidewalks & bike paths

• Community gardens

• School/community joint use agreements

Safe and Healthy Routes to Schools and Parks, Healthy Foods, Seniors

AARP

- assessments

- advocates

From abandoned lots to community gardens…

Create gardens for culturally appropriate foods reflective of the community.

CX3 Projects (Chula Vista & La Mesa)Communities of Excellence in Nutrition, Physical Activity and Obesity

Prevention

• Strong Partnerships• Leadership Training• Youth &

Mentors

• Community Assessment• Advocacy

OutcomesLa Mesa Chula Vista

$550,000 Safe Routes to School grant to improve sidewalk connectivity

Community “reclaimed” Lauderbach Park

2. Healthy Community Development

Promoting healthy development and redevelopment projects in neighborhoods

Best Practices and Promising Interventions

Healthy Community Development

• Integrating “Healthy Places” design into the Development Review process

• Redevelopment areas

• Grocery stores in underserved areas

• Facility design

Helping Communities get Developments Designed for “Health”

Trails and Trail Access Points

Eliminating Food Deserts… Attracting a Grocery Store into East Oakland, CA

Partners: East Oakland Diabetes Work Group, Alameda County Department of Public Health, Network for a Healthy California

3. Healthy Community Plans & Policies

Promoting healthy government, school and worksite policies and plans that support physical activity, healthy eating and tobacco-free environments

Best Practices and Promising Interventions

Healthy Community Plans & Policies

• Land use & transportation planning

• Affordable housing policies

• Regional Food Systems & Urban Agriculture

• Worksite Wellness policies

• Government Wellness policies

• School Wellness policies

City of Richmond General Plan Update

City of Richmond Health and Wellness Element

Policy Framework

www.healthycommunitiesbydesign.org

School Wellness Gardens

Classroom Garden Beds Quad Area with Gardening

Healthier Vending Machines

→

→

Chronic Diease Model

Will it Work?

Individuals Families

Neighborhoods

Policies and

Laws

Socio-Ecological Model

Businesses

Environmental Approaches to Tobacco: The California Model

• Prop. 99 Tobacco Tax Funds

• Local Ordinances and State Legislation for Smoke-Free Environments

• Massive Anti-Tobacco Campaign

California vs. The US

• Smoking Rates

• Lung Cancer Death Rates

Pe

rce

nt

American Lung Association of California

Centers for Disease Control, National Cancer Institute, statecancerprofiles.cancer.gov

Tobacco and Heart Attacks• Pueblo, Colorado

– Decrease in heart attack rates by 28% after smoke-free ordinance

• 399 HA pts in 1.5 yrs prior to ordinance, only 291 HA pts in 1.5 yrs after

• Helena, Montana– Decrease in heart attack rates by 40% during

first 6 months of smoke-free ordinance

Why Act Now?

Chronic Disease Prevention is strategic:

– Fundamental to reducing death and disability and improving community health

– Critical to cutting health care costs

– Experience to-date shows that strategies can be very cost-effective

– Funding opportunities for strategies that focus on environmental change

At its Foundation…

Place Matters

Adopting the concept that neighborhood environmental

factors all affect individual behaviors and health

From Policy Link and

The California Endowment

Why Place Matters: Environmental Strategies

• Physical Environment– Safe parks; full-service grocery stores

and farmers’ markets; safe, walkable streets; less truck and bus traffic; well-maintained housing; open spaces.

• Social Environment– Strong social networks that bring

neighbors together—whether to advocate for change, cultivate a community garden, or provide services.

Why Place Matters: Environmental Strategies

• Economic Environment– Commercial investment, jobs that take

people out of poverty, businesses that provide healthy food options.

• Service Environment– Access to quality healthcare services,

public safety, and community support services.

Understanding the problem

Heart Disease/StrokeType 2 Diabetes

CancerRespiratory Disease

Poor environments Unhealthy behaviors Chronic Diseases  

Adopting a new solution

Healthy environments Healthy Behaviors Disease Reduction

Reduction in:Heart Disease/Stroke

Type 2 DiabetesCancer

Respiratory Disease

QA & Comments