William C. VanNess II, MD State Health Commissioner January 21, 2014
Dec 26, 2015
ISDH Mission:◦To promote and provide essential
public health services
ISDH Vision:◦A healthier and safer Indiana
Governor Pence “Good to Great” book National Health Rankings has placed Indiana 41st
least healthy out of 50 states In February 2013, after extensive review of our
priorities, ISDH named the following public health needs as the top three priorities for Indiana for the next four years. They haven't changed.
They are:#1. Reduction in Infant Mortality rates#2. Reduction in Adult Obesity rates#3. Reduction in Adult Smoking rates
PLAN:◦ Analyze raw data◦ Convert to useful info & ◦ Distribute back to:
Regional partnerships which include the following members: Hospitals, LHDs, CHCs, Minority Health Coalitions, March of Dimes,
etc. “Sister” state agencies
FSSA, Medicaid, DOE, DCS, etc
◦ Learn from areas/regions/states that have been successful in improving their infant mortality Share with regional coalitions
e.g., Home Visiting Programs
Decrease smoking among pregnant mothers◦ ISDH is partnering with Indiana Medicaid
Decrease obesity among pregnant mothers◦ ISDH division of Nutrition & Physical activity
“Safe Sleep”◦ “Back to Sleep” campaign
1994 Reduced SIDS by 50%
◦ “Safe Sleep” campaign Expansion of “Back to Sleep” Describes actions parents/caregivers can take to reduce the risk of
other sleep-related causes of infant death e.g., accidental suffocation Encourage hospitals to become certified as “Baby Friendly”
Certified by the World Health Organization Goal.. To increase breastfeeding
Certification of OB & NICU’s ◦ Goal…ensure they meet the newly established Indiana
Perinatal Hospital Standards◦ Standards were adapted from the national set of standards
created by AAP, ACOG, and other important entities Obstetric Units…Levels of Care I, II, III Neonatal Units…Levels of Care I, II, III, IV
100% adoption of “Hard Stop” policies by Indiana hospitals
Goal…to prevent “elective” deliveries from occurring before 39 weeks
Insurers currently evaluating not paying providers for “elective” deliveries prior to 39 weeks
Evaluate “Perinatal Regionalization”◦ As noted…27 counties do not have a delivering hospital!!◦ Occurring “informally” now◦ Regional systems currently exist e.g. So. Carolina
High-risk infants are born in hospitals that are able to provide the most “risk-appropriate” care Thus…Level III hospitals provide the most appropriate care
for the sickest infants Infants receiving risk-appropriate care are hypothesized to be
more likely to survive when born too little or too soon Healthy People 2020 Goal is that 83.7% of VLBW Infants be
born in a Level III Hospital Currently 69%
Indiana’s Comprehensive Nutrition and Physical Activity Plan…2010 to 2020◦ Collaborative effort involving a large and diverse group of Indiana
individuals and organizations◦ Action needed across all sectors of Indiana to address poor nutrition,
sedentary behaviors, and obesity◦ Focus on approaches that target specific needs of Indiana and support the
latest research for improving nutrition and increasing physical activity◦ Consists of 8 focus areas:
Breastfeeding Early childhood/child care Schools Health care Worksites Older adults Faith-based organizations, and Communities
Goals◦ Increase access to and consumption of healthy foods and
beverages◦ Increase opportunities for and engagement in regular
physical activity◦ Increase efforts aimed at enabling people to achieve and
maintain a healthy weight across the lifespan◦ Reduce environmental and policy-related disparities for:
breastfeeding, nutrition, physical activity, overweight, obesity, and chronic disease
Goals (continued)◦ Increase the capacity of communities and settings
within those communities (eg. School, worksites, faith-based organizations, etc.) to develop and sustain environmental and policy support systems that encourage healthy eating and active living
◦ Increase state and local strategic partnerships to more effectively coordinate efforts, share resources, and identify and reach priority populations
Partner with at least 3 organizations to plan and implement statewide activities that support ◦ eating better, ◦ moving more and ◦ avoiding tobacco
Through the Governor’s Healthy Lifestyle Award, ◦ Publicly recognize individuals and organizations that have made
committed efforts to live and/or support healthy lifestyles in their communities
Increase by at least 2 the number of state agencies that:◦ Adopt and implement food service guidelines/nutrition standards which
include sodium◦ Adopt and implement healthy meeting guidelines◦ Implement evidence-based physical activity strategies in worksites◦ Promote breastfeeding
January marks the 50th anniversary of the first US Surgeon General’s report on smoking and health◦ That report, released on January 11, 1964, definitely linked
cigarette smoking to lung cancer and other serious diseases◦ Historic turning point in the nation’s fight against tobacco
use. ◦ The US has made enormous progress, but ◦ Tobacco use remains the number one cause of
preventable death and disease in the US..◦ this battle is far from won!!
Our high smoking rate is ◦ Killing Hoosiers
More than 9,700 Hoosiers every year
◦ Inflating health care costs Costs the state over $2 billion in health care costs annually
◦ Making it harder for companies to do business in Indiana The economic burden of smoking is estimated to be about
$3,391 per smoker per year. Everyone shares in the annual expenses for smoking –
more than $559 per Hoosier household- whether they smoke or not
For every smoker that dies, two young people under the age of 26 start using tobacco
Tobacco use directly causes a majority of the chronic diseases including:◦ Heart diseases◦ Stroke◦ Cancer◦ Respiratory diseases◦ Type 2 Diabetes◦ Rheumatoid Arthritis◦ Macular Degeneration
For every death in Indiana (9,700) due to tobacco use, another 30 Hoosiers are living with a tobacco-related illness (194,000) inhibiting their quality of life from serious smoking-caused disease
The tobacco companies spend $271 million each year on marketing and promotion in Indiana◦ much of which influences kids to smoke Tobacco use costs Indiana $2.18 billion/year in health
care costs◦ The Indiana Medicaid program pays $487 million of the States
total smoking-related health care costs Half of Indiana’s births are to mothers in the Medicaid program 30% of pregnant Medicaid women in Indiana smoke leading to
premature birth, low birth-weight newborns and thus infant mortality Tobacco prevention programs are also a smart investment
for states that save money by reducing smoking-caused health care costs◦ In the short-term, the best state tobacco prevention programs have
saved $3 in health care costs for every dollar spent
Indiana’s tobacco prevention and cessation program is critical to the health of Hoosiers and to the fiscal environment of the state◦ Indiana’s tobacco prevention and cessation program is modeled after the
CDC’s Best Practices of programs around the country that have delivered solid results
2013 American Journal of Public Health article concluded that states can significantly reduce youth smoking by:◦ Implementing well-funded tobacco programs◦ Increasing the price of cigarettes, and◦ Enacting strong smoke-free air laws
Indiana must address the economic and health consequences of tobacco use in order to be competitive in today’s marketplace for businesses and workers