Healthy Communities: The Intersection of Community Development & Health September 28, 2011 “State of the Health of Texas & Obesity” David Lakey, M.D. Commissioner Texas Department of State Health Services
Jan 24, 2016
Healthy Communities: The Intersection of Community Development & Health
September 28, 2011
“State of the Health of Texas & Obesity”
David Lakey, M.D.Commissioner
Texas Department of State Health Services
Regulatory Services
Regulatory Services
Family & Community Health Services
Family & Community Health Services
Regional & Local Health Services
Regional & Local Health Services
Texas Department of State Health Services (DSHS)
Mental Health & Substance Abuse Services
Mental Health & Substance Abuse Services
Prevention & Preparedness Services
Prevention & Preparedness Services
2
Life Expectancy in TexasTotal and by Race, 1989 - 2007
3
Ten Leading Causes of Death in Texas, 2007
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Actual Causes of DeathShaped by Behavior
0 5000 10000 15000 20000 25000 30000
Sexual Behavior
Homicide
DWI
Suicide
Drugs
Auto Accidents
Alcohol
Overweight/Obesity
Tobacco
Chronic Disease in Texas 2007, DSHS 5
Texas County Health Factors
6Source: County Health Rankings, Robert Wood Johnson Foundation, University of Wisconsin
Texas County Health Outcomes
7Source: County Health Rankings, Robert Wood Johnson Foundation, University of Wisconsin
Social Determinants
• Education
• Employment
• Income
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General Health “Fair to Poor”in Texas by Education
(2000 – 2009 BRFSS)
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Some College Rankings, Texas
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General Health “Fair to Poor” in Texas by Income Level
(2000 - 2009 BRFSS)
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Median Income Rankings, Texas
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Employment Rankings, Texas
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The Health Impact PyramidA Framework for Public Health Action
Thomas Frieden, MD, MPH, American Journal of Public Health, 04/2010, Vol. 100, no. 4 14
Health Challenges
• HIV• Mental health• Substance abuse and smoking• Infant mortality / prematurity• Health care quality• Obesity
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Ten Leading Causes of Death in Texas, Ages 18 – 44 Years, 2007
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Newly Diagnosed HIV Cases, Deaths, & Persons Living with HIV
(Texas, 1980-2008)
New HIV Cases
Deaths among HIV Cases
Living with HIV
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Mental Health Disorders
• 3% of Texans suffer from a severe, persistent mental illness
• Mental health disorders: the leading cause of disability in U.S.
• Individuals with serious mental illness have a life expectancy 25 years shorter than the overall population
• Inadequate treatment leads to an increase in costs related to crime, homelessness and uncompensated health care.
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The Costs of Substance Abuse in Texas
• In 2009, ~24,500 Texans died as a result of smoking
• Of the 2,865 newly reported AIDS cases in 2008, 15.5% were drug related
• ~ 75% of Texas prisoners are involved with alcohol or drugs
• 47% of Texas motor vehicle fatalities (2009) were alcohol-related• 23% of fatally injured drivers tested in Texas were found positive for
drugs (2009)
• The cost related to alcohol and drug abuse to Texans (2007) was ~ $33 billion• This includes health care, lost productivity, motor vehicle
accidents and crime
• Annual per capita cost for Texas residents: $2,800
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Past-Month Cigarette Use among Adults in Texas and the United States
37%
34%37%
37%38%39%
25% 26% 25%26%25%
39%41% 40% 39%
24%25%24%24%25%
0%
10%
20%
30%
40%
2002-2003 2003-2004 2004-2005 2005-2006 2006-2007
Survey Year
Perc
enta
ge
Texas - 18 to 25 years Texas - 26 years+US - 18 to 25 years US - 26 years+
20NSDUH 2002-2007
Past Month Cigarette Use Among Youth in Texas & US
2121NSDUH 2002-2007
Smoke Free Ordinances,Texas
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Infant Mortality/ Prematurity
• The infant mortality rate rose 9% from 2000 to 2006
– 6.2 deaths per 1,000 live births
• Texas pre-term birth rate in 2009 was 13.6% – National average: 12.3%
• The percentage of Texas infants born with low birth weight (under 5.5 pounds) rose from 7% in 1990, to 8.4% in 2007
– Totaling nearly 34,000 Texas infants
• Infant mortality and prematurity rates are significantly higher among non-white Texans
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Texas Infant Mortality(IMR) Rates by Race (1995 – 2008)
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Preterm Births by Race(Texas, 2000 – 2007)
Preterm Births in Texas by Race, 2000-2007
6
8
10
12
14
16
18
20
2000 2001 2002 2003 2004 2005 2006 2007
Per
cent
Total White Black Hispanic Other
HP2010 Target
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Health Care Quality
• Health care quality is an emerging responsibility for the DSHS
• In the past few years, the department has been pulled more and more into issues such as health care associated infections, quality of care in health facilities, and standards of care
• The number of preventable health care associated infections (HAIs) continues to increase year over year• Leading cause of death from infectious diseases in the U.S. and in
Texas • HAIs kill 99,000 people each year• Cause an estimated 1.7 million infections in the U.S.
• HAIs are the leading cause of infectious deaths in Texas with:– 8,000-9,000 deaths each year– HAIs also add more than $500 million in annual medical costs
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Obesity
• 29% of Texans are obese• 66% of Texans are overweight or obese• >40% of Texans projected to be obese by 2040
• 3 of the 5 leading causes of death in Texas are:• chronic diseases linked with obesity• heart disease• cancer and • stroke
• Obesity cost Texas businesses 9.5 billion in 2009• Health care costs: $4 billion• Absenteeism costs: $1.6 billion• Disability costs: $322 million• Presenteeism costs: $3.5 billion• Total costs could reach $32 billion by 2030
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2006
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
2010
Obesity Trends* Among U.S. Adults
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Obesity Prevalence Trends in Texas Adults 1990 to 2010
33% of Texans are normal weight
29.5% of Texans are obese
Source: Texas Comptroller
140% increase in obesity
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9
28
15
41
23
0
10
20
30
40
50
Wei
gh
ted
%
White Black Hispanic
19902006
Obesity Adult Prevalence in TexasBRFSS 1990 vs. 2010
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Obesity Successes:
• Focus: – Community Wellness
• DSHS role: – Catalyst & Resource
• Strategy: – Work with broad array of partners
• Supports policy & environmental change around CDC target areas– One of 23 CDC-funded states conducting obesity
prevention activities
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CDC Targets for Obesity Prevention
Physical Activity
Fruits & Vegetabl
es
Breastfeeding
Sugar-Sweetened Beverages
High- Energy- Dense Foods
TV Viewing
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Fort Stockton & Corpus Christi
• Fort Stockton ISD worksite wellness program
• Pecos County Memorial Hospital breastfeeding promotion
• City Parks and Recreation Department program development
• Healthy entree restaurant initiative
Healthy Lifestyle Coalition
• CC in Motion worksite wellness initiative
• Coastal Bend Breastfeeding Coalition
• Walk Across Texas/Walk the Texas Star program
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Interagency Council on Obesity: DSHS, TEA & Texas Department of Agriculture
Interagency Obesity Council created to: • Enhance communication & coordination of obesity issues
among state leaders; • Guide planning around obesity prevention, health promotion
& improved nutrition
Recommendations (selected):• Continue collaboration between 3 agencies• Support social interventions• Strengthen K-12 nutrition education• Strengthen nutrition education & physical activities in early
childhood & after-school programs
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Coordinated School Health (CSH) and Campus Improvement Plans
• All elementary, middle and junior high schools required to implement a CSH Program
• Develop goals and objectives for CSH based on: • Fitness assessment data
• Academic performance
• Attendance rates
• Socioeconomic status
• The use of success of any method to ensure students are reaching required moderate or vigorous physical activity (MVPA)
• Any other indicator recommended by SHAC
• Include CSH Goals in all elementary, middle and junior high school Campus Improvement Plans
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State of Texas Nutrition Services & Education
• School district policy to prevent foods of minimal nutritional value
• Nutrition education to be provided in Kindergarten through 8th grade
• District-developed wellness policy required of each school district receiving reimbursable meal funding
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Breastfeeding & Obesity
• Infants who aren’t breastfed have increased risk for many acute and chronic conditions• Including a 32% excess risk for childhood obesity
• Many Texas mothers report barriers to achieving personal breastfeeding goals
• Breastfeeding activities coordinated across DSHS address barriers to optimal infant feeding outcomes
• Every Ounce Counts• http://www.breastmilkcounts.com/our-new-campaign.html
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Growing Communities Video
Highlights successful community-based strategies across Texas through short, documentary-style video clips• The videos were initially distributed to the 2009
Statewide Obesity Summit attendees • Recipients were charged to be “catalysts for change”
by hosting video screenings• Since the July 2009 launch, DSHS has made the
video series available online and in DVD format• www.dshs.state.tx.us/obesity/growingcommunity/default.shtm
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Partnerships Needed to Improve Health
DSHS
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ElectedOfficials
Non-TraditionalPartners
Providers & Hospitals
Higher Education
Community Groups
Community-basedSolutions
Urban Planners, Developers Architects
Worksites& Schools
Food Industry
Thank You!
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