Presentation is loading. Please wait.

Presentation is loading. Please wait.

The Washington Post reports that the width of a standard movie seat used to be 19 inches…. It is now 23 inches.. Journal of Pediatrics, 2006, reported.

Similar presentations


Presentation on theme: "The Washington Post reports that the width of a standard movie seat used to be 19 inches…. It is now 23 inches.. Journal of Pediatrics, 2006, reported."— Presentation transcript:

1 The Washington Post reports that the width of a standard movie seat used to be 19 inches…. It is now 23 inches.. Journal of Pediatrics, 2006, reported that 1 percent of all American infants and children – more than 283,000 children – are too big to fit in a car seat…. The Current Situation Susan Combs, Texas Comptroller of Public Accounts

2 Since 1970, the prevalence of obesity has doubled for preschool children And tripled for school-aged children Currently, 37% of school aged children are obese or overweight. The Current Situation Strauss RS, Pollack HA. JAMA, 2001;286: Ogden et al JAMA 2006;295: Margellos-Anast et al; Public Health Reports. 123;

3 With a focus on obesity alone, 19% of school aged children are obese. Disproportionate numbers nationally: African Americans 22% Mexican Americans 23% Non-Hispanic white 18% The Current Situation Ogden et al JAMA 2006;295: Margellos-Anast et al; Public Health Reports. 123;

4 The Prevalence of Obesity Among Children in Six Chicago Communities Sinai Improving Community Health Survey Door to door, population based health survey 501 randomly selected children aged 2-12 years The Current Situation Margellos-Anast H, Shah AM, Whitman S. Public Health Reports. 123; Humboldt Park Roseland North Lawndale South Lawndale Norwood Park West Town

5 Three stage sample design Communities by probability proportionate to size (PPS) sampling Households selected at random Household screen survey to an adult and a child/caretaker. Survey methodology: Survey Research Laboratory of UIC The Prevalence of Obesity Among Children in Six Chicago Communities Margellos-Anast H, Shah AM, Whitman S. Public Health Reports. 123;

6 The Prevalence of Obesity Among Children in Six Chicago Communities Margellos-Anast H, Shah AM, Whitman S. Public Health Reports. 123; Percent

7 Major findings: Nearly half the children (aged 2 – 12) in five of six communities were obese compared to 16.8% nationally. Prior community-level evaluations have found only 23-25% of school children were obese. The prevalence of obesity exceeded the prevalence of overweight by a factor of four in Humboldt Park and a five in Roseland. Contrary to what would be expected. The Prevalence of Obesity Among Children in Six Chicago Communities Margellos-Anast H, Shah AM, Whitman S. Public Health Reports. 123;

8 The Decline in Cardiovascular Mortality Men Age Adjusted All Races; Out of hospital mortality per 100,000; NEJM, McGovern,et al, 334, 1996

9 The Decline in Cardiovascular Mortality Women Age Adjusted All Races; Out of hospital mortality per 100,000; NEJM, McGovern,et al, 334, 1996

10 While dramatic improvements in CVD mortality declines for over 40 years have been praised as one of the major health accomplishments of the twentieth century, recent data suggests that CVD mortality rate declines are slowing to 1.5% per year Despite significant and notable declines in stroke mortality for over 60 years, stroke mortality is no longer falling. The Current Situation - CVD R Cooper et al. Circulation, 102, no. 25 (2000):

11 Two well-designed population based studies Worchester, Mass Olmstead County, Minnesota have found that the rates of new cases of heart disease have not fallen from 1990 forward, and for women, may have actually risen. More recent concerns of potentially increasing incidence of CVD and CVD mortality in men and women. The Current Situation - CVD Goldberg RJ et al. JACC, 33 #6 (1999); Roger VL et al. Annals of Internal Med.136;#5 (2002): Anciero et al. American J of Med;117:4 (2004): Pearson TA. Health Affairs 26;1 2007): 49-60

12 The Reversal of Fortunes: Trends in County Mortality and Cross County Mortality Disparities in the US NCHS data used to calculate life expectancy for all US counties between 1961 and Between 1961 and 1982, life expectancy improved. From 1983 to 1999, life expectancy declined significantly by 1.3 years for men and women in 48 counties (men) and 783 counties (women) The Current Situation – Life Expectancy Ezzati M, Friendman AB, et al. PLoS Med (5)4;e66, April 2008

13 Of note, the higher disparity partly resulted from stagnation or an increase in mortality among the worst-off segment of the population, with life expectancy for approximately 4% of the male population and 19% of the female population having either had statistically significant decline or stagnation. The Current Situation – Life Expectancy Ezzati M, Friendman AB, et al. PLoS Med (5)4;e66, April 2008

14 The Decline in Cardiovascular Mortality Men Age Adjusted All Races; Out of hospital mortality per 100,000; NEJM, McGovern,et al, 334, 1996

15 per 100,000. Ages 45 to 79. Arch Intern Med 2002;162: C. The Apache Heart Study Incidence of Confirmed CAD Cases

16 ACUTE MYOCARDIAL INFARCTION AMONG NAVAJO MEN Hospitalization rates per 1000 Klain, Coulehan, Arena, & Janett, AJPH, 1988

17 Acute MI and USA among the Hopi: The Hopi Heart Study

18 Acute Myocardial Infarctions Hopi Tribal Members Average values from Seivers and average for taken from Sievers and Fisher; p,0.001

19 INCIDENCE OF CVD The Strong Heart Study Fatal and Nonfatal Rates per 1000 person years. The Rising Tide of CVD in AI: The SHS, Circulation, 1999

20 American Indian/Alaska Native Mortality Rates Trends in Indian Health, 1997; Age-adjusted data

21 Roman MJ, Fabsitz RR, Crawford A, Lee ET, Fishman D, Howard BV. Circulation 1998;98(suppl):I-516 Carotid Atherosclerosis in Native Americans

22 Prevalence of CVD Among American Indians Compared with other Groups MMWR, Vol 52, Number 47, REACH Data, Nov. 28, p

23 MMWR: The REACH Survey Among men and women in these four groups, American Indians had the highest prevalence of Cardiovascular disease… as well as obesity, current smoking and diabetes. Men had the highest rates of hypertension and high blood cholesterol levels.

24 Alice K. Jacobs, M.D., President American Heart Association American Indians and Alaska Natives appear to have developed the highest rates of cardiovascular disease within the US.

25 Percentage of Premature Heart Disease Deaths by Ethnicity MMWR, February 28, 2004

26 Percent of Death from Strokes in Those < 65 years MMWR, May 20, 2005

27 Disparity in Average Age of Death from Strokes MMWR, May 20, 2005

28 Disparities Health Staff/100,000 people AI/AN US Gap MDs % lower DDS % lower Nurses % lower RPh % lower

29 Pathways into Health Issues of Health & Health Education Disparities Issues of Health & Health Education Disparities Quality of care improved when patient and provider of same ethnicity Quality of care improved when patient and provider of same ethnicity IOMs study, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care provided a clear connection between poorer health outcomes for minorities and the shortage of minority health care providers. IOMs study, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care provided a clear connection between poorer health outcomes for minorities and the shortage of minority health care providers.

30 Pathways into Health Issues of Health Education Disparities Issues of Health Education Disparities Within Arizona, only 31 American Indian students have graduated from medical school over the past two decades Within Arizona, only 31 American Indian students have graduated from medical school over the past two decades Very low enrollment rates Very low enrollment rates Very high drop out rates (3 to 5 x higher) Very high drop out rates (3 to 5 x higher)

31 Pathways into Health Issues of Health Education Disparities Issues of Health Education Disparities Native students represent only 0.3% of medical students Native students represent only 0.3% of medical students Only 98 Native students graduating from medical school in 2004 among 125 Medical Schools. Only 98 Native students graduating from medical school in 2004 among 125 Medical Schools. Only 9 Medical Schools across the nation have more than two American Indians in their graduating class. Only 9 Medical Schools across the nation have more than two American Indians in their graduating class. Sequist, TD. Journal of Interprofessional Care 21;(S2): 20-30

32 Pathways into Health Issues of Health Education Disparities Issues of Health Education Disparities AI/AN physicians make up only 0.002% of the total US physician workforce, AI/AN physicians make up only 0.002% of the total US physician workforce, compared to 4.4% African American, 5.1% Hispanic, 73.8% White and 14.9% Asian/Native Hawaiian/Pacific Islander. compared to 4.4% African American, 5.1% Hispanic, 73.8% White and 14.9% Asian/Native Hawaiian/Pacific Islander. Sequist, TD. Journal of Interprofessional Care 21;(S2): 20-30

33 Pathways into Health Issues of Health Education Disparities Issues of Health Education Disparities Native American students are frequently forced to endure educational environments that violate their rights to equal educational opportunity and ignore their cultural identities. Native American students are frequently forced to endure educational environments that violate their rights to equal educational opportunity and ignore their cultural identities. U.S. Commission on Civil Rights, A Quiet Crisis

34 Pathways into Health Issues of Health Education Disparities Issues of Health Education Disparities Issues related to consideration of college Issues related to consideration of college Issues related to leaving reservations Issues related to leaving reservations Cultural requirements Cultural requirements Absenteeism Absenteeism

35

36 Pathways into Health A focus on professional healthcare education for Native Americans A focus on professional healthcare education for Native Americans Built upon Academic – Tribal – Indian health collaborations Built upon Academic – Tribal – Indian health collaborations Regionalized centers of varied educational strengths Regionalized centers of varied educational strengths Arizona & the Southwest Arizona & the Southwest Northern Rockies Northern Rockies Great Plains Great Plains Alaska Alaska

37 Pathways into Health Objectives Objectives To recruit and educate Native American students in health career professions To recruit and educate Native American students in health career professions initially focusing on clinical laboratory science, followed by nursing and public health, radiology technology and subsequently pharmacy and medicine, among others. initially focusing on clinical laboratory science, followed by nursing and public health, radiology technology and subsequently pharmacy and medicine, among others. To create an inter-professional and culturally reinforcing educational environment using traditional and innovative curricular methods. To create an inter-professional and culturally reinforcing educational environment using traditional and innovative curricular methods. To improve the health and health care of Native American communities by producing high quality graduates who remain in their home communities. To improve the health and health care of Native American communities by producing high quality graduates who remain in their home communities.

38 Pathways into Health A collaborative & integrated approach to an issue of A collaborative & integrated approach to an issue of national importance national importance Academic collaborators: Academic collaborators: University of Arizona University of Arizona Northern Arizona University Northern Arizona University University of Alaska– Anchorage and Fairbanks University of Alaska– Anchorage and Fairbanks University of North Dakota University of North Dakota University of New Mexico University of New Mexico Arizona State University Arizona State University Georgetown University Georgetown University University of South Dakota University of South Dakota Montana State University Montana State University Harvard Harvard

39 Pathways into Health Tribal collaborators: Tribal collaborators: The Hopi Tribe The Hopi Tribe The Navajo Nation The Navajo Nation The White Mountain Apache Tribe The White Mountain Apache Tribe The Ute Mountain Ute Tribe The Ute Mountain Ute Tribe Pasqua Yaqui Tribe Pasqua Yaqui Tribe Tohono Oodham Nation Tohono Oodham Nation InterTribal Council of Arizona InterTribal Council of Arizona

40 Pathways into Health Further Tribal and Indian health collaborators: Further Tribal and Indian health collaborators: Southcentral Foundation, Alaska Southcentral Foundation, Alaska Ute Mountain Ute Tribe Ute Mountain Ute Tribe Southern Ute Tribe Southern Ute Tribe Pueblo of Zuni Pueblo of Zuni Mescalero Apache Tribe Mescalero Apache Tribe Seattle Indian Health Board Seattle Indian Health Board

41 Pathways into Health A collaborative & integrated approach to an issue of national importance… A collaborative & integrated approach to an issue of national importance… A Resolution from the National Congress of American Indians

42 Pathways into Health Current Directions: Current Directions: National Advisory Council National Advisory Council Everett Rhodes, MD, Former Director IHS (U of OK) Everett Rhodes, MD, Former Director IHS (U of OK) Bette Keltner, RN, Ph.D., Dean, Nursing, Georgetown University Bette Keltner, RN, Ph.D., Dean, Nursing, Georgetown University H. Sally Smith, Chair, National Indian Health Board H. Sally Smith, Chair, National Indian Health Board Margaret Knght, Executive Director, Association of American Indian Physicians Margaret Knght, Executive Director, Association of American Indian Physicians John Lowe, RN, PhD, Associate Professor, Florida Atlantic University John Lowe, RN, PhD, Associate Professor, Florida Atlantic University Judy Sherman, Friends of Indian Health Judy Sherman, Friends of Indian Health George Blue Spruce, DDS, MPH, Asst Dean, Indian Affairs, Arizona School of Dentistry & Oral Health George Blue Spruce, DDS, MPH, Asst Dean, Indian Affairs, Arizona School of Dentistry & Oral Health Don Davis, MPH, Director, Phoenix Area HIS Don Davis, MPH, Director, Phoenix Area HIS Wayne Taylor, Chairman, Hopi Tribe Wayne Taylor, Chairman, Hopi Tribe Jenny Joe, Ph.D., University of Arizona Jenny Joe, Ph.D., University of Arizona

43 Pathways into Health Organizational Structure Organizational Structure Chairperson: Michael Allison (Navajo) Chairperson: Michael Allison (Navajo) Vice Chair: Carl Fox, PhD (Montana State) Vice Chair: Carl Fox, PhD (Montana State) Secretary: Fred Kopacz (Alaska) Secretary: Fred Kopacz (Alaska) Treasurer: Sean Clendaniel, MPH (Arizona) Treasurer: Sean Clendaniel, MPH (Arizona) Executive Board Executive Board Membership Membership Subcommittees Subcommittees

44 Pathways into Health Current Directions: Current Directions: Development of Laboratory Science Program (Med Tech) Development of Laboratory Science Program (Med Tech) UND, NAU, IHS, e-HealthU Collaboration UND, NAU, IHS, e-HealthU Collaboration On-site Lab Science Bachelors and Certification On-site Lab Science Bachelors and Certification Front End Workers Program Front End Workers Program Nursing and Public Health Nursing and Public Health Radiology Technicians Radiology Technicians

45 Pathways into Health Laboratory Sciences Program: Laboratory Sciences Program: IHS and Tribal employees in multiple states IHS and Tribal employees in multiple states Currently employed in the laboratory Currently employed in the laboratory Long Term Training approval by IHS Long Term Training approval by IHS Small Foundation Funding for Tribal Scholarships Small Foundation Funding for Tribal Scholarships

46 Atlanta Begay, featured in the North Dakota Medicine, Pathways Into Health article of the Fall 2006 issue is the first student to train in CLS at UND under Pathways Into Health. Ms. Begay (top far right) is joined by other AI/AN students pursuing Health Professions education.

47 Pathways into Health Native Interprofessional Development in Health Initiative Nursing and Public Health Committee

48 Activating the Pipeline: New Horizons in Accredited Work-Based Learning In collaboration with the Robert Wood Johnson Foundation Cruz Begay, PhD

49 Native Interprofessional Development in Health Initiative Initial Focus: Frontline workers Initial Focus: Frontline workers CHRs, EMTs, Health Educators, Nurses, etc. CHRs, EMTs, Health Educators, Nurses, etc. Forefront of Indian health system Forefront of Indian health system Important pipeline Important pipeline Interprofessional Education Interprofessional Education Frontline workers need to be empowered to confidently contribute to Interprofessional teams. Frontline workers need to be empowered to confidently contribute to Interprofessional teams. Students in nursing, public health, and other disciplines need preparation to work with frontline workers. Students in nursing, public health, and other disciplines need preparation to work with frontline workers.

50 Pathways into Health Frontline workers are an important pipeline. Frontline workers are an important pipeline. AWBL may address many needs: AWBL may address many needs: Place-bound adult learners. Place-bound adult learners. Need for collaborative, experiential learning. Need for collaborative, experiential learning. Learning that improves organizational performance. Learning that improves organizational performance. Orientation and preparation for additional degree Orientation and preparation for additional degree programs. programs. Credit toward degree completion or new degree. Credit toward degree completion or new degree. Setting for interprofessional training Setting for interprofessional training Provide Stimulus for Systems Change Provide Stimulus for Systems Change

51 Learning Circles for Health Technicians: The Robert Wood Johnson Foundation

52 Pathways into Health Initial sites: Chinle Comprehensive Health Care Center (IHS) Chinle Comprehensive Health Care Center (IHS) Winslow Indian Health Care Center (Tribal) Winslow Indian Health Care Center (Tribal) Future plans: Future plans: Expand to Alaska Expand to Alaska Expand to Great Plains Expand to Great Plains Expand to other sites in the southwest Expand to other sites in the southwest

53 Examples of Building Blocks… Apprenticeships Apprenticeships Internships Internships Residency/Field Work Residency/Field Work On Site courses On Site courses OJT OJT Service Learning Service Learning Collaborative Learning Problem-based Learning Experiential Learning Reflective Practice Activity-based Learning Community of Practice Settings:Methods:

54 Learning Circles for Health Technicians What are we teaching?

55 Learning Experiences Problem-based learning sets in health promotion and disease control. Problem-based learning sets in health promotion and disease control. Collaborative proposal development Collaborative proposal development Summer/Winter Institute at THealth Center. Summer/Winter Institute at THealth Center.

56 Native Interprofessional Development in Health Initiative Teams Nursing Courses Others Health Education Courses CHR, ANHA Training Interprofessional Learning Experiences Students Employees Existing

57 Interprofessional Teams CHR, Community Health Aides (Alaska) CHR, Community Health Aides (Alaska) Pre-baccalaureate Nurses Pre-baccalaureate Nurses Nursing Students Nursing Students Health Education Students Health Education Students Others Others Workers Students Ad Hoc members, mentors from across the country, can be brought into Teams.

58

59 Additional Successes Pathwaysintohealth.org Pathwaysintohealth.org Description, Information on Partners Description, Information on Partners Mentorship Availability Mentorship Availability Educational Opportunities Educational Opportunities A searchable national registry of successful pipeline activities underway in Indian communities A searchable national registry of successful pipeline activities underway in Indian communities Pathways Into Health Professional Development Conference Pathways Into Health Professional Development Conference Denver, Sept 2006 Denver, Sept 2006 Supplemental issue of Journal of Interprofessional Care Supplemental issue of Journal of Interprofessional Care Chicago, September 14, 2007 Chicago, September 14, 2007 Alaska, September 9 & 10, 2008 Alaska, September 9 & 10, 2008

60 Additional Successes Interprofessional Education in Nursing & Public Health Disciplines Interprofessional Education in Nursing & Public Health Disciplines Followed by Dental, Pharmacy and Medicine integration Followed by Dental, Pharmacy and Medicine integration Regional Collaborative Grants Regional Collaborative Grants Regional Collaborative Conferences Regional Collaborative Conferences Business Plan Development Business Plan Development Further expansion of Clinical Laboratory Sciences training opportunities nationally Further expansion of Clinical Laboratory Sciences training opportunities nationally

61 Building a Healthier Chicago Community HeAlth Mobilization Projects

62 Building a Healthier Chicago VISION Build model community-wide partnerships for health promotion that can be replicated nationwide

63 Building a Healthier Chicago GOAL To improve the health of Chicagos residents and employees through integration of existing public health, medicine and community health promotion activities

64 Building a Healthier Chicago Our Objectives: Convene a model collaboration of local and national stakeholders dedicated to building a Healthier Chicago. Strengthen and sustain our partners current and new efforts to promote health in Chicago.

65 Building a Healthier Chicago Our Objectives: (cont.) Promote and track the adoption of selected programs, practices, policies, and supportive environments throughout the health care organizations, worksites, schools, and neighborhoods of Chicago.

66 Building a Healthier Chicago Our Objectives: (cont.) Create a system of interventions that complement and reinforce each other to maximize reach and effectiveness Build Synergy!

67 Issues of organization: Collaborative Community leadership Trust Commitment to each other and the intervention Culturally appropriate Community Level Interventions

68 Stages of Intervention Utilization Stage 2 Intent to Adopt Stage 1 Dissemination Stage 3a Implementation Stage 0 Research Development Stage 3b Adaptation Stage 4 Institutionalization Stage 5 Diffusion Decision to Adopt Source: Davis SM et al. Introduction and Conceptual Model for Utilization of Prevention Research. Am J Prev Med. 2007; 33(1S):S1-S5.

69 Building a Healthier Chicago Partners City of Chicago (DPH, Parks & Rec, etc.) American Medical Association American Diabetes Association American Heart Association Midwest Business Group on Health Shaping Americas Health American Cancer Society American College of Cardiology Multiple Academic Institutions and Community Organizations

70 Building a Healthier Chicago Our Federal Partners: Federal Occupational Health – Health Risk Appraisal The Presidents Council on Physical Fitness – The Presidents Challenge The Surgeon Generals initiative on Obesity

71 Building a Healthier Chicago Our Federal Partners (continued): The Office of Health Promotion and Disease Prevention – Metrics from Healthy People 2010/2020 Centers For Disease Control and Prevention The Office of Public Health and Science Regional Health Administrators

72 Building a Healthier Chicago Source: CDPH

73 Building a Healthier Chicago Source: CDPH

74 Building a Healthier Chicago Source: CDPH

75 Building a Healthier Chicago

76 The idea that individual health choices and personal behaviors are the most important determinants of chronic disease is an idea whose time has come and gone. George Mensah, MD.

77 Individual choices are important… However, it is unlikely that individually attempted changes in lifestyles and behaviors alone can avert the growing epidemic of chronic disease that we are witnessing.

78 Environmental, System & Policy Changes are extremely important… Based on our messages, will people choose to change their lifestyle when we have not corrected the issues that make that choice difficult? When there have no safe place to walk? When there is no produce in the local grocery store? When the health care provider is only financed for fixing the current illness? When the worksite is a place to sit, stress - and gain weight? When their school has no physical education?

79 It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change Institute of Medicine, 2003

80 The aim must be to establish a health promoting environment in the social space in which persons make significant health decisions. The struggle is for the relevant space that various forces, some unconcerned with health ad some actually detrimental to it, have thus far too loosely preempted. Social ecology for health means deliberately occupying more of that social space and using it in the interest of health. The Social Ecological Model Breslow L. Am J Health Promotion 10:

81 are shaped by the choices we have The choices we make

82 Building a Healthier Chicago How can we most effectively address these issues ?

83 Environmental Change: Policies Practices Programs Healthy Chicago Healthy Behavior Less Illness & Death Collaborative Partnership Changing Individual Behaviors

84 Environmental Change: Policies Practices Programs Healthy Chicago Healthy Behavior Less Illness & Death Collaborative Partnership Although partnerships have affected change in community- wide behavior, the strongest evidence shows that coalitions most effectively contribute to changes in programs, services and practices. Butterfloss FD & Francisco VT. (2004) Health Promotion Practice 5(2): Roussos ST and Fawcett SB (2000) Annu Rev of Public Health 21:

85 The Social Ecological Model cuts across disciplinary lenses and integrates multiple perspectives and theories. This framework recognizes that behavior is affected by multiple levels of influence, including interpersonal factors, interpersonal processes, institutional factors, community factors, environmental factors, social factors and public policy. The Social Ecological Model

86 Partnership Functions Build Awareness of What Works Information Sharing, Training, & Collaborative Learning Tackle Barriers Mobilize Assets Market Effective Prevention & Provide Incentives Build Synergies Between Prevention Initiatives Joint Projects Healthy Chicago Healthy Places & Environments Evidence-Based Preventive Care Effective Health Promotion Interventions Widely Adopted, Strengthened & Sustained Prevention Measures

87 We must ignite and build a social movement at private, public and policy levels in order to change broad scale social norms and create a social envionment supportive of health. The Social Ecological Model Sorenson G et al. Ann Rev Public Health; :

88 Building a Healthier Chicago

89


Download ppt "The Washington Post reports that the width of a standard movie seat used to be 19 inches…. It is now 23 inches.. Journal of Pediatrics, 2006, reported."

Similar presentations


Ads by Google