1. Roderick L. Bremby, Secretary Kansas 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

2. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat Greetings Gov. Kathleen Sebelius

3. 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

4. 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

5. 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

7. Healthy Kansans 2010 “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

8. 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

9. What accounts for growth in health care spending ?

10. US Health Status (W.H.O.) – 49 th out of 50 industrialized nations U.S. infant mortality – 29 th U.S. life expectancy – 25 th Healthy Kansas Premise 1: Optimal Health Status is the Goal

11. 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 2: Health Status results from many factors

12. 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

13. 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

14. 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

15. Healthy Kansas Premise 3: Role of Life Course Development Source: Mark A. Peterson, PhD. UCLA Blue Sky Team

16. *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)

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

18. Healthy Kansas The 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

19. 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, endocrinologist Los Angeles Times, 2/26/07

20. Healthy Kansas The 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

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

24. Source: Center for Health Transformation Healthy Kansas 4 parallel layers of health transformation needed: Individual Change Institutional/Provider Change Cultural Change Science Changes Everything

25. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat A roadmap for health promotion and wellness, incorporating community coalition building and private sector partnerships.

26. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat Many chronic diseases and illnesses can be attributed to three modifiable behaviors: Tobacco use Lack of physical activity Poor nutrition Improving our Health

27. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat *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)

28. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat Healthy Kansas Prevention Focus –Tobacco Use –Physical Inactivity (obesity) –Poor Nutrition (obesity)

29. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat 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

30. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat Prevention focus - Tobacco use $724M/yr Physical inactivity (obesity) Poor nutrition (obesity) Healthy Kansas $657M/yr

31. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat 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

32. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat Healthy Kansas Healthy People 2010—Tobacco Use

33. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat Healthy Kansas Healthy People 2010—Physical Activity

34. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat Healthy Kansas Healthy People 2010—Nutrition

35. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat Healthy Kansas Placed Based Strategy - Children in schools Adults in the workplace Kansas seniors in community

36. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat 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

37. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat 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

38. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat 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

39. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat Healthy Kansas - Pledge Increase activity level Eat healthy Avoid tobacco YR 1: 6,000 Kansans CheckUp

40. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat

41. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat

42. 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

43. 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

44. Healthy Kansans 2010 United Methodist Health Fund Ministry 6 th Annual Healthy Congregations Retreat www.healthykansas.org