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Prevention for the Health of our Country Thomas R. Frieden, M.D., M.P.H. Director Centers for Disease Control and Prevention.

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Presentation on theme: "Prevention for the Health of our Country Thomas R. Frieden, M.D., M.P.H. Director Centers for Disease Control and Prevention."— Presentation transcript:

1 Prevention for the Health of our Country Thomas R. Frieden, M.D., M.P.H. Director Centers for Disease Control and Prevention

2 Largest Impact Smallest Impact Factors that Affect Health Examples Eat healthy, be physically active Rx for high blood pressure, high cholesterol, diabetes Poverty, education, housing, inequality Immunizations, brief intervention, cessation treatment 0g trans fat, salt, smoke-free laws, tobacco tax Socioeconomic Factors Changing the Context to make individuals’ default decisions healthy Long-lasting Protective Interventions Clinical Interventions Counseling & Education

3 Strategic Directions for CDC  Strengthen surveillance and epidemiology  Improve ability to support state and local public health  Increase impact promoting global health  Increase prevention effectiveness of health policies including health reform  Better address leading causes of illness, disability, and death

4 Four Leading Causes of Death  Smoking – >400K US/>5M globally  Poor Nutrition  Physical Inactivity  Alcohol -- >60K US/>2M globally >100K US

5 Tobacco Use  In 2004, one in five Americans smoke  North Carolina State ranking  Smoking prevalence  Adult (23.2% or 1,475,000) – 34 th  Youth, Grades 9-12 (27.3% or 98,000) – 36 th  Nonsmoking policies  Work (67.4%) – 34 th  Home (57.1%) – 45 th  Price per pack  50 th  State tax per pack  45 th Source: CDC’s Sustaining State Programs for Tobacco Control Data Highlights 2006

6 NYC Youth Smoking Prevalence: 61% Decline in 10 Years 52% Decline Since 2001 YRBS, public high school students % of H.S. Students 9% 20% 11% 15% 18% 24% 23% 22% 29% 35% 36% 0% 5% 10% 15% 20% 25% 30% 35% 40% NYCU.S.

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8 MPOWER Reduced Smoking in New York City 18.9% 11% % of New York City Smokers 8% 10% 12% 14% 16% 18% 20% 22% P rotect people from tobacco smoke 18.3% W arn about the dangers of smoking 17.5% 350,000 fewer adult smokers >100,000 fewer smoking-related deaths in future years 15% 19.2% R aise taxes on tobacco (City & State) M onitor adult smoking prevalence 21.5% 18% M onitor youth smoking % 16.9% 15.8%

9 HIV and AIDS in North Carolina – 2007  MSM activity accounted for 54% of all new adult/adolescent HIV disease reports (including MSM/IDU)  Heterosexual sex accounted for 38% of all adult/adolescent HIV disease reports; 86% female adult/adolescent and 18% male adult/adolescent  1,746 reported and 1,465 diagnosed cases of HIV infection (not AIDS)  1,024 reported AIDS cases  13,122 estimated number of persons living with HIV infection (not AIDS)  9,129 estimated number of persons living with AIDS Source: CDC’s HIV/AIDS Surveillance Report, Volume 19 and the 2008 NC Epidemiologic Profile for HIV/STD Prevention and Care Planning (10/08)

10 Chlamydia Positivity among 15- to 24-year- old women tested in family planning clinics 2007 *Data not available in Note: Includes states and outlying areas that reported chlamydia positivity data on at least 500 women aged years screened during SOURCE: Chlamydia Prevalence Monitoring Project (Regional Infertility Prevention Projects); Office of Population Affairs; Local and State STD Control Programs; Centers for Disease Control and Prevention

11 Targeting Those at Highest Risk for STDs and Unwanted Pregnancy STD Prevention  Education…  Screening…  Abstinence  Condoms…  Brief intervention to reduce alcohol use Unwanted Pregnancy Prevention  Intergenerational transmission…  Education…  Birth Control…

12 A Policy Package to Prevent and Reverse Obesity  Price  Decrease cost of fruits and vegetables  Increase cost of unhealthy foods  Exposure/access  Increase exposure to healthy foods  Remove junk food from all schools, health care facilities, government institutions, at least  Image  Eliminate ads to children  Show human cost of empty calories  ARRA resources and potential health reform prevention dollars to accelerate state and local policy and program implementation

13 Data are from the Bureau of Labor Statistics and represent the U.S. city averages for all urban consumers in January of each year. Fresh fruits and vegetables Consumer-price index Sugar and sweets Carbonated drinks Price Index (1982 – 1984 = 100) Healthy Food Has Gotten More Expensive, Junk Food Cheaper

14 Winnable Battles in Nutrition  Elimination of artificial trans-fat  Significant health benefit  With phase in, no significant problem with supply  No significant increase in cost or change in taste  Eliminate artificial trans-fat AND reduce saturated fat 10-20% Data Source: Household Shortening 5% Potato Chips, Corn Chips, Popcorn 6% Fried Potatoes 10% Margarine 22% Other 6% Cakes, Cookies, Crackers, Pies, Bread, etc. 51% Major sources of artificial trans fats

15 Winnable Battles in Nutrition  Salt reduction  “ Age-related hypertension ” may not be inevitable  Calories  Salt  50% reduction in 10 years is feasible and would have significant health benefits  Major health organizations support salt reduction

16 Alcohol Use Persons Aged 12 and Older United States 2008  52% reported being current drinkers of alcohol; an estimated 129 million people  23% (58 million people) reported binge drinking in the 30 days prior to the survey  7% reported heavy drinking; an estimated 17 million people Source: SAMHSA; Results from the 2008 National Survey on Drug Use and Health: National Findings

17 Consequences of Alcohol Abuse  Injuries (~40%)  Motor vehicle crashes and other unintentional injuries  Homicides  Suicides  Liver disease  Hypertension and stroke  Cancers of esophagus, stomach, and colon  Sexually transmitted diseases (including HIV) due to disinhibition effect  Fetal Alcohol Syndrome

18 On ABCS, the USA Gets an “F”  People at increased risk of CVD who are taking Aspirin – 33%  People with hypertension who have adequately controlled Blood pressure – 44%  People with high Cholesterol who have adequately controlled hyperlipidemia – 29%  Smokers who try to quit get help – 20% Despite spending nearly 1 out of every 5 dollars on health care

19 A spirin Under-prescribed for U.S. Patients with Coronary Heart Disease Source: Stafford RS, Radley DC. The underutilization of cardiacmedications of proven benefit, 1990 to J Am Coll Cardiol, 2003; 41: National Ambulatory Medical Care Surveys

20 B lood Pressure Awareness, Treatment and Control NHANES, , Ages 18 and older

21 Statins Greatly Increase Cholesterol Control Statin Use Low in People with High LDL Overall Control Remains Low Mann D, Reynolds K, Munther P. Annals of Pharm 2008; 42.

22 Heart Disease is Leading Preventable Cause of Death  80 million people in U.S. have heart disease  >860,000 die each year  >24,000 of those deaths in NYC  >1,500 New Yorkers die of stroke  annually  Heart disease and stroke are preventable  Awareness of risk low  Not enough people take advantage of treatment Source: American Heart Association, Heart Disease and Stroke Update, 2009

23 Stroke is Leading Cause of Adult Disability in U.S. >4 million people in U.S. have survived a stroke and live with impairments 800,000 strokes will occur in U.S. this year 500,000 could have been prevented

24 Heart Disease and Stroke Can Be Reduced  Change the environment  Improve nutrition (reduce trans fat, salt, calories)  Increase physical activity  Improve care  Blood pressure and cholesterol monitoring and control  More affordable medications and simpler regimens  Focused EHR implementation  Attention and accountability with programmatic monitoring through health care data  Prioritization within EHR programs and health reform

25 Health Care that Maximizes Health HEALTH INFORMATION SYSTEMS oriented toward prevention PAYMENT that rewards disease prevention and effective chronic disease management CARE MANAGEMENT so practice workflows support prevention and PATIENT EMPOWERMENT to prevent disease and disability

26 Challenges  Decreased budgets  Hiring freezes, contracting/procurement slowdowns  Layoffs –  7,000 local health dept jobs lost in 2008  At least 40% of states expect layoffs or attrition in FY09  Vacancy rates range from 2% to 18%  Retirement –  20% eligible in 2010  50% eligible in 2012

27 Funding Opportunities  ARRA Communities Putting Prevention to Work initiative  Total of $650 million for public health efforts to address obesity, increase physical activity, improve nutrition, and decrease smoking.  $373 million for communities and tribes around the country  $120 million for prevention and wellness programs for U.S. states and territories  $40 million to state health departments for HAI  $300 million to the Section 317 Immunization programs in all 50 states, Washington DC, 5 urban areas, the U.S. Territories, and selected Pacific Island nations  More information is at  Fiscal intermediaries -- better, faster, cheaper

28 H1N1 Outbreak Influenza is perhaps the most unpredictable of all infectious diseases  Occurred very late in the season  Remarkable heterogeneity across United States  Affected young people disproportionately  Caused widespread illness, some severe or fatal  Socially disruptive, especially for schools  Tens of thousands of health workers and others responding worldwide

29 State/Local Support Necessary for Seasonal and H1N1 Vaccine  Fund and provide contractual services at the local level  Establish school-located vaccination clinics  Strengthen public immunization clinics and other public vaccination efforts  Facilitate private provider sign-up  Encourage primary care providers to see and take care of people with high-risk conditions  Ensure that vaccine ordering and onward distribution systems, if applicable, run smoothly  Communicate effectively so people know where to get vaccinated, providers are encouraged to vaccinate patients, rumors are addressed rapidly, and vaccine uptake increased

30 H1N1 in Your Community  Keep healthy students in school and sick people at home  Promote appropriate use of antiviral medications to maximize their benefit and preserve their effectiveness  Encourage self-triage to discourage unnecessary visits  Emergency department preservation  Intensive care unit planning  VACCINATION!

31 Flu Preparedness Is a Shared Responsibility  Keep yourself well informed:  Know What to do About Flu:  CDC recommends a yearly seasonal flu vaccine as the most important step to prevent seasonal flu  Get vaccinated as H1N1 shots become available

32 Prevention is on the map and in public consciousness as never before The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people 10 th Amendment of the U.S. Constitution


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