Protecting the Public’s Health: Chronic Disease Prevention and Control Janet Collins, Ph.D. Director, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention

Vision and Mission National Center for Chronic Disease Prevention and Health Promotion Vision and Mission Our Vision All people living healthy lives free from the devastation of chronic diseases Our Mission Leading efforts to promote health and well-being through prevention and control of chronic diseases

Chronic Diseases Are responsible for 7 of every 10 U.S. deaths 1 Are responsible for 7 of every 10 U.S. deaths 1 Cause major limitations in daily living for 1 in 10 Americans 2 Cause major limitations in daily living for 1 in 10 Americans 2 Cause significant racial/ethnic disparities in health 2 Cause significant racial/ethnic disparities in health 2 Account for about 75% of $2.2 trillion annual U.S. medical care costs 3 Account for about 75% of $2.2 trillion annual U.S. medical care costs 3 1 Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: final data for National Vital Statistics Reports 2008;56(10). Available from: 2 Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: final data for National Vital Statistics Reports 2008;56(10). Available from: And National Center for Health Statistics. Health, United States, With chartbook on trends in the health of Americans. Hyattsville, MD: National Center for Health Statistics; Available from: 3 Anderson G. Chronic conditions: making the case for ongoing care. Baltimore, MD: John Hopkins University; 2004.

Life Expectancy vs. Health Care Spending Per Capita Health Care Spending in International Dollars Life Expectancy Sierra Leone United States Japan Cuba Switzerland National Center for Health Statistics. Health, United States, 1998 With Socioeconomic Status and Health Chartbook. Hyattsville, Maryland: 1998.

Life Expectancies in the “Eight Americas” Population Group Per Capita Income Life Expectancy Asian$21, Northland Rural White $17,80079 White Middle America $24, Appalachia/Mississippi Valley White $16,40075 Black Middle America $15, Western Native American $10, Southern Rural Black $10, High-risk Urban Black $14,80071 Source: C. Murray, S. Kulkarni, M. EzzatiAmericas: New Perspectives on U.S. Health Disparities American Journal of Preventive Medicine 2006; 29(5):4-10. Source: C. Murray, S. Kulkarni, M. Ezzati. Eight Americas: New Perspectives on U.S. Health Disparities American Journal of Preventive Medicine 2006; 29(5):4-10.

2006 U.S. National Health Expenditures

An Aging Population Percentage of U.S. Population Age 65 and Older Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population Copyright 1996, Watson Wyatt Worldwide Year Percentage of Population

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Prevalence of Obesity Among U.S. Adults Diabetes Prevalence of Diabetes Among U.S. Adults No Data 10% Source: CDC, Behavioral Risk Factor Surveillance System

“People didn’t just wake up in 1980 and decide they were going to get obese.” – CDC’s Dr. William Dietz

Personal Behavior Choices A brisk walk in the park keeps Marcy in shape between dog shows. His owner, Columbus resident Cathy Stambo got up early to give her 3 year old Doberman his regular workout.

But, Something Can Be Done …. Maintain health in the first place Maintain health in the first place Living well with chronic disease Living well with chronic disease

Prevention U.S. Cigarette Consumption

Hospitalizations for Heart Attacks Before and After Smoking Ordinance — Pueblo, Colorado, Jan June 2006 Rate per 100,000 CDC, MMWR, January 2, 2009 / Vol. 57 / No. 51 Intervention Area Control Areas

Percentage of US Women (Age 40+) Having Had a Mammogram Within the Past 2 Years by State Note: Estimates are weighted and are age-adjusted to the 2000 U.S. standard population. Source: Behavioral Risk Factor Surveillance System, CDC Early Detection

Breast Cancer Death Rates Age-adjusted U.S. breast cancer mortality rate/100,000 women 1992 to % drop Source: US Mortality Files, National Center for Health Statistics, CDC.

Living Well with Diabetes Narayan et al.: Disease Control Priorities in Developing Countries, % decrease Vision Loss Foot ulcers and amputations Kidney failure, Vision loss leads to Eye exams Foot exams lead to 45-85% decrease 20-50% decrease lead to Glucose control Flu vaccine lead to Lipid control 40% decrease 32% decrease Hospitalization Cardiovascular Disease Control

Progress in Control: Diabetes Outcomes to 2005 Vision Loss25% Amputation36% End Stage Renal Disease23% CVD Hospitalization16% Total Hospitalization33%

National Center for Chronic Disease Prevention and Health Promotion Office of Public Health Genomics Division of Adult and Community Health Division of Nutrition, Physical Activity, and Obesity Office on Smoking and Health Division of Cancer Prevention and Control Division of Diabetes Translation Division for Heart Disease and Stroke Prevention Division of Oral Health Disease-Focused Divisions Risk Factor Divisions Division of Adolescent and School Health Division of Reproductive Health Population/Setting Divisions

BRFSS/YRBS PRAMS Prevention Research Centers School Health Policy and Program Survey Schools Communities Worksites Health Care Settings Healthy Communities / REACH Breast and Cervical Cancer Early Detection Program WISEWOMAN National Diabetes Education Program National Center for Chronic Disease Prevention and Health Promotion

American Recovery and Reinvestment Act of 2009 Public Law Prevention and Wellness Provisions Section 317 immunization program - $300 million to CDC Healthcare-associated infections - $50 million to HHS Evidence-based clinical and community-based prevention and wellness strategies that deliver specific, measurable health outcomes that address chronic disease - $650 million to HHS

American Recovery and Reinvestment Act “A historic commitment to wellness initiatives will keep millions of Americans from setting foot in the doctor's office in the first place – because these are preventable diseases and we're going to invest in prevention.” – President Obama February 21, 2009 February 21, 2009

Comprehensive Health Reform Health in all policies Population/Community-based disease prevention and health promotion Health care service and delivery improvement Adapted from Finding the Voice of Public Health in National Health Reform Dialogue - An Integrative Model for Health System Transformation