Judy Monroe, MD Indiana State Health Commissioner June 19, 2009

Primary Prevention - means it never occurs Secondary Prevention – detect and prevent progression of conditions before they are symptomatic Tertiary Prevention - prevent the progression and complications of disease and symptoms already occurring

Primary Prevention – largely the domain of public health (community prevention – aimed at the population) Secondary Prevention – largely the domain of primary care (clinical practice – aimed at the individual) Tertiary Prevention – largely the domain of subspecialists

Primary Prevention - $ immunizations weight control and exercise to prevent type 2 diabetes folic acid to prevent neural tube defects in newborns

Secondary Prevention - $$ control hypertension – prevent stroke control cholesterol – prevent heart disease mammograms

Tertiary Prevention - $$$$$$$ intensive care treatment for complications of pneumococcal pneumonia to prevent death intensive treatment of diabetes to prevent an amputation surgery to prevent complications of a neural tube defect

Tertiary Prevention - $$$$$$$ rehabilitation of a stroke victim to prevent being wheel chair bound management after a myocardial infarction to prevent another infarction treatment of later stage breast cancer after delayed diagnosis

ProgramSavings for Every $1 Spent Chronic disease$5.60 Immunizations$27 Smoking Cessation for Pregnant Women $6 Tuberculosis screening and Isoniazid $1.20 Water Fluoridation$38 Women, Infants, and Children$ $4.21

Healthy workforce benefits business more productive workers less absenteeism less injuries Healthcare is the most expensive benefit paid by U.S. employers

INShape Indiana nutrition, physical activity, and tobacco control Indiana Workplace Wellness Partnership Indiana Hospital Association State Employee Wellness – One Care Street Healthy Indiana Plan Wellness Tax Credit Lactation Support in the Workplace (IC )