1. DEATH RATES United States100% Missouri100% Northwest Missouri100%

2. Total Number of Deaths = 2,443,908 2003 Leading Causes of Death in the US “Public Health Impact”

3. 1990 & 2004 Leading Actual Causes of Death in the US—“Human Behaviors” Source: CDC

4. Causes of Death and Major Illnesses in the U.S. Source: CDCP, PHS, DHHS

5. Risky Business Large numbers of Americans cling to lifestyles that greatly increase their risk of cancer, heart disease, and diabetes. Over the past decade, the percentage of those who smoke has remained stubbornly unchanged, while more than one out of four has remained a couch potato and nearly twice as many have become obese. Source: National Center for Chronic Disease Prevention and Health Promotion Behavioral Risk Factor Surveillance System 2007 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 199720012007199720012007199720012007 Current SmokersNo Leisure Time Physical ActivityObese U.S.MissouriSt. Joseph

6. Source: Behavioral Risk Factor Surveillance System, CDC. 1996 1991 Obesity Trends* Among U.S. Adults BRFSS,1991, 1996, 2004 (*BMI  30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14%15%–19% 20%–24% >25% 2004

7. No Data <4% 4%-6% -8% -10% >10% Source:Mokdadet al.,Diabetes Care2000;23:1278-83;J Am Med Assoc2001;286:10. Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS, 1990,1995 and 2001 19901995 2001

9. Baseline 20 th Century Annual Morbidity and 1999 Provisional Morbidity from Nine Diseases with Vaccines Recommended Before 1990 for Universal Use in Children – United States Diseases Smallpox Diptheria Pertussis Tetanus Poliomyelitis Measles Mumps Rubella Congenital rubella Haemophilus Influenza b Baseline 20 th Century Annual Morbidity 48,164 175,885 147,271 1,314 16,316 503,282 152,209 47,745 823 20,000 1999 Provisional Morbidity 0 1 6,031 33 0 86 352 238 8 163 Percent Decrease 100% 95.9% 97.5% 100% 99.8% 99.5% 99.0% 99.2%

10. Current & Future Health Challenges % Overweight Boys 1963 = 4.0% 1994 = 11.8% 2000 = 16% % Overweight Girls 1963 = 4.5% 1994 = 11.0% 2000 = 14.5% Early childhood education. Low birth weight/very low birth weight. High school completion. Teen birth rates. Motor vehicle crashes (with and without alcohol/drug factors). Asthma >40 per 1000 children in 1982 >62 per 1000 children in 1996 Infant and Child Health Healthy weight. –% overweight in 1971 = 4% –% overweight in 1994 = 10.5% –% overweight in 2000 = 15.3% Smoking. Violence. Suicide. Sexually transmitted disease.

11. The Dilemma So why are we afraid for our kids health? –Modern children’s health issues are preventable, yet scary because of the illusion that science can fix everything like it did in the last century. Health happens at the intersection where science meets social, spiritual, educational, economic, family, behavioral and community circumstances. We can’t give a shot to become a better parent, or immunize a 14 year old to make wise choices. Science has limits!

12. The USA Ranks 37th in World Health. World Health Report 2000 (health system and performance in all member states, ranked by eight measures) places the USA 37 th in overall system performance.

13. Missouri Ranks 38 th in USA Health. There are several indicators to compare on health status. For the 2004 CDC BRFSS question: “How would you rate your health in general?” 84.1% of Missourians said excellent, very good, or good to the question. Missouri ranks 38 th in the nation. The top states are Minnesota and New Hampshire.

14. People 2004 USA Deaths 2,397,615 Heart, Cancer, Stroke, Pulmonary, Diabetes… 2000 Actual Causes of Death “Human Behaviors” Tobacco, Obesity, Diet, Inactivity, Alcohol, Motor Vehicle… Root Causes “Human Conditions” Stress, Anger, Poverty, Economics, Education Levels, Depression, Unemployment, Broken Families, Environmental Factors, Emptiness, Hopelessness, Disconnectedness Provider Response & Individual Accountability Individual Accountability Individual & Community Accountability Healthcare Policy Public Health & Organizational Policy Community, Economic, Education, & Social Policy Adapted From: National Civic League, Healthy Communities Conference 1994 Updated With CDC Data & Best Practices Policy

15. HEALTHY COMMUNITIES The two key determinates of the health status of a population: Education Levels Affluence (Jobs)

16. “If I had known I would live this long, I would have taken better care of myself.” Mickey Mantle

17. 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 20022004200620082010201220142016 Year Annual health expenditures (trillions) Official CMS projection of healthcare cost growth With No Changes, Projected Cost Growth in Health Care Is Large 2.1 Trillion(100%) 10 Years

18. HEALTHY COMMUNITIES IDEAL APPROACH Individuals assume responsibility (maximum extent possible) for their own and their families’ health –Healthy behaviors –Personal financial responsibility for health Health insurance designed to promote and encourage healthy life styles and wise buying practices –Encourage preventive care –Design benefits to influence positive behavior –Reward healthy behaviors –Universal coverage and portability

19. HEALTHY COMMUNITIES IDEAL APPROACH Higher premiums for non-managed care – lower premiums for managed care. Comprehensive integrated health provider (like Heartland) that exist to serve the community interest