1. PUBLIC HEALTH TRENDS Michael R. Spence, MD, MPH Medical Officer Montana DPHHS

2. INFLUENCING FACTORS Magnitude of the Population Distribution of the Population Aging of the Population Emerging Infectious Diseases The Obesity Epidemic Our Natural Environment

3. POPULATION SIZE Increased Number at Risk –Socioeconomic Distribution Increased Demand on Food Supply Increased Crowding –Increased Diseases of Poverty –Urban issues of crime Increased Transportation Demands

4. POPULATION DISTRIBUTION Age Distribution –Baby Boomer Impact –Life Expectancy Increases Geographic Distribution –Urban Migration

5. POPULATION AGING Increased Chronic Diseases Increased Cancers Increased Hospitalizations Increased Nursing Home Utilization

6. EMERGING INFECTIOUS DISEASES Legionnaire’s Disease E. Coli H7/0157 Hantavirus West Nile Virus Severe Acute Respiratory Syndrome Influenza Pandemic Influenza

7. OBESITY ASSOCIATED MORBIDITY High Blood Pressure Type 2 Diabetes Coronary Artery Disease Stroke Gall Bladder Disease Osteoarthritis Respiratory Problems

8. HYPERTENSION COMPLICATIONS Heart Attack Stroke Heart Failure Kidney Failure

9. DIABETES COMPLICATIONS Blindness End Stage Renal Disease Peripheral Vascular Disease –Lower Extremity Amputations

10. OBESITY ASSOCIATED CANCERS Breast Colon Prostate Gall Bladder

11. NATURAL ENVIRONMENT IMPACT Air Pollution –Industrial Emissions –Tobacco Smoke –Forest Fires Water pollution –Industrial Waste Contaminated Food Supply –Mercury and PCBs in Fish Decreased Food Supply –Drought

12. SUMMARY Public Health Trends are Multifactorial. Health Care Delivery will continue to improve to meet the needs, at a cost. Improved tracking of disease driving the development of prevention intervention policies will be needed.