1. Prevention and Wellness: Key Issues Senate Committee on Health and Human Services Tuesday, August 26, 2008 David L. Lakey, M.D. Commissioner

2. Presentation Overview Public Health and Improvements in Quality of Life Chronic Diseases –Behavioral Changes Infectious Diseases –Immunizations

3. Role of DSHS in Disease Prevention and Management Population-based prevention and health promotion Promoting healthy lives for Texas families through education, prevention and early detection Reduce premature disability and death by promoting healthy lifestyles

4. U.S. Life Expectancy at Birth 1918 Flu Epidemic

5. Increased Life Expectancy Driven by Public Health Improvements Source: Ten Great Public Health Achievements – United States, 1900-1999 MMWR, April 02, 1999 / 48(12);241-243 http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm Increased years due to medical care advances: 5 Increased years due to public health measures : 25

6. Leading Causes of Death 1900 Pneumonia Tuberculosis Diarrhea Heart Disease Intracranial Lesions 1998 Heart Disease Cancers Cerebrovascular Disease Chronic Obstructive Pulmonary Disease Accidents

7. Leading Causes of Death DSHS Center for Health Statistics Texas 2001

8. Chronic Disease Prevention Chronic diseases—such as heart disease, cancer, and diabetes—are the leading cause of death and disability in Texas Although they are among the most common and costly health problems, they are also among the most preventable Adopting healthy behaviors can prevent or control the devastating effects of these diseases.

9. Actual Causes of Death* Shaped by Behavior Chronic Disease in Texas 2007, DSHS *Texas 2001

10. Tobacco Prevention and Cessation Tobacco is the number one preventable cause of premature death and disability in Texas Costs nearly $11 billion annually in medical care and health- related productivity losses The Institute of Medicine has issued recommendations for a multi-pronged approach to tobacco use including: –Enact smoke-free legislation or ordinances for public spaces –Increase unit price of tobacco products –Conduct mass media education campaigns combined with other community interventions –Provide telephone-based cessation counseling –Implement health care provider reminder systems

11. Percentage of Texas Municipal Population Protected by 100% Smoke-Free Ordinances in Five Settings*

12. Passage of Smoke-Free Ordinances in Texas Percentage of Texans Protected by Smoke-Free Ordinances Applicable to Workplaces, Restaurants, and Bars

13. Tobacco Prevention and Cessation DSHS’ primary focus is on tobacco cessation and prevention Initiatives include: –Quitline in partnership with American Cancer Society –Tobacco prevention and control coalitions –Interagency contract with TEA –Youth leadership activities –Smokeless tobacco prevention education –Targeted media messages

14. Proposals for Consideration by the 81 st Legislature – Tobacco DSHS will have an exceptional item to expand existing tobacco prevention efforts through: –Increasing availability of cessation services –Increasing the number of community coalitions providing comprehensive activities –Increasing youth prevention activities

15. 1998 Obesity Trends* Among U.S. Adults (*BMI  30, or about 30 lbs. overweight for 5’4” person) 2007 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: CDC Behavioral Risk Factor Surveillance System

16. Cost of Obesity for Texas Obesity, along with physical inactivity and poor nutrition, is linked to many chronic diseases Human Costs –Early disabilities and diminished quality of life –Shorter than expected life span Financial Costs –Obesity cost Texas businesses an estimated $3.3 billion in 2005 –Includes the cost of healthcare, absenteeism, decreased productivity and disability

17. Obesity Prevention DSHS Nutrition, Physical Activity, and Obesity Prevention Program initiatives include: –Grants for community demonstration projects –Farm-to-Work –Statewide obesity partnership conference –Technical assistance and training to communities on obesity prevention –State employee wellness program

18. Obesity Prevention Other DSHS programs –Training and technical assistance to school districts on coordinated school health programs (through TEA Education Service Centers contracts) –Title V/WIC initiatives include: Staff wellness program Obesity prevention grants to local WIC agencies Children’s and Postpartum physical activity programs Nutrition classes and counseling for low income families –Partnerships with academic institutions and the private sector

19. Proposals for Consideration by the 81 st Legislature – Obesity DSHS will have an exceptional item to expand existing obesity prevention efforts through: –Healthy Communities Program –Mayor’s fitness council grants on behalf of Governor’s Advisory Council on Physical Fitness –Continued implementation of State Employees Health Fitness and Education Programs, including HB 1297 implementation TEA is requesting an exceptional to strengthen the coordinated school health program –A portion of that request would support DSHS’ contracts with Education Service Centers for coordinated school health activities

20. Private Business Worksite Wellness Employee healthcare costs consume half or more of corporate profits National trends show 7-10% health-insurance premiums increases in 2008 and 2009 Physical inactivity and obesity are associated with 23% of national healthcare charges Worksite wellness programs can bring a $3 – $8 or more Return on Investment for every dollar spent in a five year period Reductions in absenteeism will increase productivity Solutions: –Keep healthy employees healthy –Have employees get routine health exams to detect problems early when treatment can be most effective and least expensive –Ensure employees with chronic health conditions know how to manage them and receive treatment to minimize disability

21. Worksite Wellness for State Agencies State Employees: HB 1297 –Statewide Wellness Coordinator –Worksite Wellness Advisory Board –Development of model worksite wellness programs –Baseline survey of state agency wellness activities –Annual wellness conference

22. Chronic Diseases Management Texas Council on Cardiovascular Disease Texas Diabetes Council and Program Asthma Prevention and Management –Asthma Coalition of Texas –In Texas, asthma remains one of the most prevalent chronic diseases and growing health concerns. –In 2006, according to the Texas Behavioral Risk Factor Surveillance System (BRFSS): An estimated 2.1 million (12.4%) adult Texans (18 years or older) had self-reported lifetime asthma and 1.3 million (7.3%) adult Texans had self-reported current asthma An estimated 854,000 (13.4%) children (0-17 years of age) had reported lifetime asthma and 599,000 (9.4%) children had reported current asthma.

23. Disease Prevention through Vaccines Childhood diseases – previously common and widespread are now preventable through vaccines Measles Chicken Pox

24. Immunizations Availability –Routine childhood vaccines available to all children in Texas –Adult safety-net program for uninsured and underinsured adults –Rely on private providers to ensure their patients get needed immunizations on schedule Effectiveness –As vaccines are introduced, incidence of disease falls significantly –Routine childhood immunizations are estimated to prevent 10.5 million cases of illness and 33,000 deaths for one birth cohort in the United States

25. 2006 National Immunization Survey Results

26. Strategies to Increase Vaccine Coverage Levels Promote concept of the medical home Promote use of immunization registries Promote use of reminder/recall systems for providers Conduct provider education Educate the public on the health benefits Promote and participate in public/private collaborations –Federal Vaccines for Children Program –Texas Immunization Stakeholder Working Group

27. Concluding Thoughts Public health measures improve and extend Texans’ quality of life Behavioral strategies work to prevent and control chronic diseases Vaccines work to prevent infectious diseases