Integration of 5 Public Health Programs Jan Norman, RD, CDE Chronic Disease Prevention Unit Washington State Department of Health

Permanent DOH Contractor Project December 18, 2006

Deaths Unfavorable Social & Environmental Conditions Adverse Behavioral Patterns & Risk Factors Diagnosis: screening, 1st event, or sudden death Disability or risk of recurrence Comprehensive Public Health Strategy for Chronic Disease Prevention and Health Promotion

Deaths Unfavorable Social & Environmental Conditions Adverse Behavioral Patterns & Risk Factors Diagnosis: screening, 1st event, or sudden death Disability or risk of recurrence Comprehensive Public Health Strategy for Chronic Disease Prevention and Health Promotion Policy & Environmental Change Behavior Change; Risk Factor Detection & Control Emergency Care/Acute Case Management Rehabilitation & long term Case Management End-of- Life Care

Deaths Unfavorable Social & Environmental Conditions Adverse Behavioral Patterns & Risk Factors Diagnosis: screening, 1st event, or sudden death Disability or risk of recurrence Comprehensive Public Health Strategy for Chronic Disease Prevention and Health Promotion Policy & Environmental Change Behavior Change; Risk Factor Detection & Control Detection, Emergency Care, Acute Case Management Rehabilitation & long term Case Management End-of- Life Care Basic food nutrition education, Diabetes, Asthma Obesity Prevention: State Plan for Physical Activity & Nutrition, Asthma Heart Disease & Stroke, Diabetes, Asthma Heart Disease & Stroke, Diabetes. Asthma

Complications/ Exacerbations from chronic disease Intensive case management Intensive risk factor management Specialized services Hospital care Promotion of healthy environments Acute care Post-acute care Represents promotion of health and well being and health-related quality of life across continuum of care and across the life course Each stage requires critical assessment of: workforce requirements, resource allocation, data requirements, evidence base for intervention (incl. cost effectiveness), quality measures, guidelines and standards, monitoring and evaluation, roles and responsibilities, (National/State, public/private), equity impact, consumer involvement, etc. Prevent movement to the “at risk” group Prevent progression to established disease and high use of medical care Prevent/delay progression to complications and prevent hospitalization and post-acute care Level of prevention Nature of intervention Responsible sectors Well population Primary Prevention Promotion of healthy behaviors Promotion of healthy environments Universal and targeted approaches Public health Primary health care Other sectors Stage of disease continuum Intervention objectives At risk Secondary Prevention/ Early Detection Screening & case finding Periodic health examinations Early intervention Control risk factors – (lifestyle & medication) Promotion of healthy behaviors Promotion of healthy environments Primary health care Public health Managed/controlled chronic disease Disease Management and Tertiary Prevention Treatment according to guidelines Complications management Rehabilitation Self management Disease registries Promotion of healthy behaviors Promotion of healthy environments Community care Primary health care Acute care Continuing care

Structures, Policies, Systems Local, state, federal policies and laws to regulate/support healthy actions Institutions Rules, regulations, policies & informal structures Community Social Networks, Norms, Standards Interpersonal Family, peers, social networks, associations Individual Knowledge, attitudes, beliefs Levels of Influence in the Social-Ecological Model

Activities Short-Term Outcomes Inter- mediate Outcomes Logic Model for Chronic Disease Prevention Unit Inputs Long- Term Outcomes Less obesity Living well with chronic disease Fewer deaths from chronic disease

Activities Short-Term Outcomes Inter- mediate Outcomes Logic Model for Chronic Disease Prevention Unit Changes in the health- care system Changes in the environment & availability of healthy foods Inputs Changes in Behavior Long- Term Outcomes Less obesity Living well with chronic disease Fewer deaths from chronic disease

Policy Changes: Policy & environmental supports for air quality, physical activity, nutrition & quality health care systems for chronic disease Activities Short-Term Outcomes Inter- mediate Outcomes Logic Model for Chronic Disease Prevention Unit Changes in the health- care system Changes in the environment & availability of healthy foods Inputs  Knowledge of recommendations & guidelines for Physical activity Nutrition Living well with chronic disease Policy & environmental approaches Changes in Behavior Long- Term Outcomes Less obesity Living well with chronic disease Fewer deaths from chronic disease

Secondary Prevention: Awareness Campaigns WA State Collaborative Asthma Educators Institute Policy Changes: Policy & environmental supports for physical activity, nutrition & Quality Health Care Systems for chronic disease Activities Short-Term Outcomes Inter- mediate Outcomes Logic Model for Chronic Disease Prevention Unit Changes in the health- care system Changes in the built environment & availability of healthy foods External Partners, Coalitions Networks Inputs DOH Staff; Leadership Time, Money & Technical assistance Primary Prevention: Access to Healthy Foods Active Community Environments BFNEP Healthy Communities Indoor & Outdoor Air quality laws Prevention of diabetes & CVD  Knowledge of recommendations & guidelines for Physical activity Nutrition Living well with chronic disease Policy & environmental approaches Funding from CDC, USDA& others Changes in Behavior Long- Term Outcomes Less obesity Living well with chronic disease Fewer deaths from chronic disease

Doing What Works Evidence of problem: The burden is great. Evidence of effective interventions: The science is convincing. Core elements of an effective program: Fidelity is possible with diverse populations and diverse organizations.

Words to Live By  Learn to Listen... Opportunity sometimes knocks very softly.

Margaret Mead Never doubt that a small group of thoughtful committed citizens can change the world... Indeed, it’s the only thing that ever has.