1. Heartland Health 2020 Population Health Unnatural Causes Vignette

2. Heartland Health Strategic Plan Update 2008

3. “It is unreasonable to expect that people will change their behavior easily when so many forces in the social, culture and physical environment conspire against such change.” The Institute of Medicine Heartland Health Strategic Plan Update 2008

4. Heartland Health Social Determinants (Poverty, economics, education, access…)

5. Heartland Health Strategic Plan Update 2008 A Mom’s Education, A Baby’s Chance of Survival Babies born to mothers who did not finish high school are nearly twice as likely to die before their first birthday as babies born to college graduates.

6. Heartland Health Strategic Plan Update 2008 Less Education, Worse Health Compared with college graduates, adults who have not finished high school are more than four times as likely to be in poor or fair health.

7. Persistent Gaps in Health Behaviors: Smoking Education disparities in cigarette smoking have persisted over decades and the gaps between college graduates and those with less education appears to have widened. Heartland Health Strategic Plan Update 2008

8. Parents’ Income, A Child’s Chances for Health Children in poor families are about seven times as likely to be in poor or fair health as children in the highest-income families. Heartland Health Strategic Plan Update 2008

9. Lower Income, More Chronic Illness Nearly one in every three poor adults has their activity limited by chronic illness, compared with fewer than one in 10 adults in the highest-income group. Heartland Health Strategic Plan Update 2008

10. Lower Income Is Linked With Worse Health Diabetes is twice as common among poor adults as among those in the highest- income group. The prevalence of heart disease is nearly 50 percent higher among poor adults than among adults in the highest-income group. Heartland Health Strategic Plan Update 2008

11. The High Economic Stakes of Health Disparities If Americans who have not completed college experienced the lower death rates and better health status of college graduates, these improvements would translate into potential gains of $1.007 trillion annually. Heartland Health Strategic Plan Update 2008

12. Heartland Health Lifestyle and Chronic Disease

14. Ten-Year Review – Greater St. Joseph Behavior Risk Factor Survey Locally, individuals with a lower level of education experience higher incidence of high blood pressure; overall the high blood pressure rate is higher than the U.S. rate.

15. The rate of smoking as increased locally among all populations, but more significantly among low income individuals; and overall is higher than the U.S. rate. Ten-Year Review – Greater St. Joseph Behavior Risk Factor Survey

16. The rate of persons reporting any physical activity in the past month has remained fairly stable; however, this is a 30 point difference of low to high income.

17. Ten-Year Review – Greater St. Joseph Behavior Risk Factor Survey The rate of obesity has increased locally among all populations, but more significantly among low income individuals; and overall is higher than the U.S. diabetes rate.

18. Heartland Health Strategic Plan Update 2008 Uninsured Missouri = 14.7% USA = 15.3 % NWMO Region = Average 14.8% PSA/SSA counties 8.3% - 22.4%

19. Heartland Health Strategic Plan Update 2008 Financially Vulnerable (underinsured) Medium House Income USA = $49,280 MO = $44,767 Only 2 counties in PSA/SSA meet Missouri median income rate, 0 above USA rate “Nearly 1/3 of service area are financially vulnerable”

20. Heartland Health Strategic Plan Update 2008 Education Bachelor degrees or higher USA = 24.4% Missouri = 21.6% PSA/SSA counties – only 2 counties meet Missouri rate, 0 at USA rate

21. Heartland Health Strategic Plan Update 2008 Youth Health Issues Youth Poverty –Transience/Mobility –Youth Obesity/Physical Activity Abuse/Neglect –Leads to mental health issues and current shortage of mental health services Obesity –Nutrition –Physical Activity

22. Heartland Health Strategic Plan Update 2008 Senior Health Issues Chronic health issues Transportation Need for physical activity Poverty Preventative health care Information and referral

23. Wellness Connections 6 Year Results Risk Factors present at HRS Screening 20012007% Improvement Blood Glucose26%5%520% Stress34%9%377% Blood Pressure25%11%227% Dietary Fat67%39%71% Tobacco8%6%33% Fruit/Veg92%73%26% Exercise65%56%16% Heartland Health employee Wellness Connections members measured in 2001 and again in 2007 (same employees) demonstrated significant reduction of health risk factors e.g. stress and exercise. These concepts are promoted in the market and community.

24. Heartland Health Strategic Plan Update 2008 What works Near Term Population Health Aggressive and comprehensive care management (both medical and social) Wellness education and promotion with self and group management Local/regional partnerships addressing targeted populations Lifestyle Medicine – “How daily lifestyle practices and habits impact short-term and long-term health and quality of life”.

25. Heartland Health Strategic Plan Update 2008 What works Long Term Population Health –Change from “medicalization” of social problems to integrated planning and development that address root causes in: Social Determinates (poverty, education …) Lifestyle and Chronic Disease Built Environment Do the right thing for human well being.