1. Active Living: Leadership in Kentucky Chronic Disease in Kentucky Why it should matter to you! Rice C. Leach, M.D. Commissioner Kentucky Department for Public Health May 8, 2003

2. Active Living: Leadership in Kentucky Public Health Concerns Kentucky’s general health status Obesity over the last 20 years Conditions –Diabetes –Cardiovascular disease (heart attacks) –Arthritis –Cancer –Birth Defects (heart, neural tube) –Strokes

3. Active Living: Leadership in Kentucky Causes Obesity –Too many calories –High fat content –Not enough fiber (fruits and vegetables) Lack of Exercise –Video games and television replaced playgrounds –Automobiles replaced bicycles –No more high school physical education requirement Smoking

4. Active Living: Leadership in Kentucky Kentucky’s Rates Type II Diabetes in Kentucky—doubled since1990 Obesity in Kentucky—doubled since 1990 Obesity in the United States—doubled since 1985 Kentucky’s adults smoke more than any other state Kentucky’s youth most likely to smoke every day youthKentucky’s youth unlikely to exercise every day

5. Active Living: Leadership in Kentucky Public Health—What helps? Population Issues –Training Large Groups Small Groups –Environmental changes School lunches Smoke-free areas School vending machine food –Measure Success—learn from work being done

6. Active Living: Leadership in Kentucky Get With The Guidelines—Why Bother? –Improved Quality of Life Live Longer Stay out of the nursing home Pay less for my “golden years” Avoid side effects of medicines Avoid surgery

7. Active Living: Leadership in Kentucky Prevention—Why Bother? What is in it for me? –Health Insurance costs –Medical Care Costs –State Budgets –State and Federal Income Taxes –Condition of Roads –Funding for Schools –College Tuition –Employment Opportunities

8. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

9. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

10. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

11. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

12. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

13. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

14. Active Living: Leadership in Kentucky Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

15. Active Living: Leadership in Kentucky Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

16. Active Living: Leadership in Kentucky Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

17. Active Living: Leadership in Kentucky Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

18. Active Living: Leadership in Kentucky Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

19. Active Living: Leadership in Kentucky Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

20. Active Living: Leadership in Kentucky Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

21. Active Living: Leadership in Kentucky Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

22. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

23. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19%  20%

24. Active Living: Leadership in Kentucky Impact of Obesity On people –More diabetes –More heart disease –More strokes –More kidney failure –More patients on dialysis –Earlier disability

25. Future Health Insurance Cost Increases 2015 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

26. Future Health Insurance Cost Increases 2016 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

27. Future Health Insurance Cost Increases 2017 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

28. Future Health Insurance Cost Increases 2018 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

29. Future Health Insurance Cost Increases 2019 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

30. Future Health Insurance Cost Increases 2030 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

31. Active Living: Leadership in Kentucky Future Health Insurance Cost Increases 2031 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

32. Active Living: Leadership in Kentucky Future Health Insurance Cost Increases 2032 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

33. Active Living: Leadership in Kentucky Future Health Insurance Cost Increases 2033 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

34. Active Living: Leadership in Kentucky Future Health Insurance Cost Increases 2034 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

35. Active Living: Leadership in Kentucky Future Health Insurance Cost Increases 2035 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

36. Active Living: Leadership in Kentucky Future Health Insurance Cost Increases 2036 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

37. Active Living: Leadership in Kentucky Future Health Insurance Cost Increases 2037 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

38. Active Living: Leadership in Kentucky Future Health Insurance Cost Increases 2038 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

39. Future Health Insurance Cost Increases 2039 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

40. Future Health Insurance Cost Increases 2040 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

41. Active Living: Leadership in Kentucky Impact on Public Funds More people on disability Fewer years in the work force Earlier admission to nursing home Increased demand for health care services ($3B today) Increased demand on Medicaid and Medicare Increased demand for public support of medical care Decreased contribution to employee health insurance More people without health insurance

42. Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

43. Tax Increases (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

44. Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

45. Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

46. Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

47. Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

48. Active Living: Leadership in Kentucky Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

49. Active Living: Leadership in Kentucky Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

50. Active Living: Leadership in Kentucky Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

51. Active Living: Leadership in Kentucky Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

52. Active Living: Leadership in Kentucky Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

53. Active Living: Leadership in Kentucky Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

54. Active Living: Leadership in Kentucky Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

55. Active Living: Leadership in Kentucky Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

56. Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

57. Tax Increases? (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

58. Active Living: Leadership in Kentucky Other Impacts On Public Health Funds Money not available for public schools Money not available for college tuition Money not available for road construction Money not available for water and sewer projects Money not available for golf courses Money not available for police and fire Money not available for campaign promises

59. Active Living: Leadership in Kentucky DRG=De Revenue…Gone! “The biggest difference between a Democrat and a Republican is going to be the reason they give you for why you can’t have what you want.” John Chancellor, NBC News, at the American Hospital Association Winter Meeting, Washington D.C., 1985

60. Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

61. Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

62. Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

63. Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

64. Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

65. Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

66. Active Living: Leadership in Kentucky Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

67. Active Living: Leadership in Kentucky Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

68. Active Living: Leadership in Kentucky Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

69. Active Living: Leadership in Kentucky Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

70. Active Living: Leadership in Kentucky Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

71. Active Living: Leadership in Kentucky Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

72. Active Living: Leadership in Kentucky Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

73. Active Living: Leadership in Kentucky Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

74. Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

75. Things we would like to do but can’t (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)

76. Active Living: Leadership in Kentucky Current state initiatives NGA Best Practices—Chronic Disease Initiative Diabetes Program and Coalition--$1.85M Cardiovascular Disease Program--$865K Get with the Guidelines Exercise-Obesity—$1.2M Tobacco Control--$4.2M School Health Program Cooperative Extension Service involvement Local Health Department Contributions—

77. Active Living: Leadership in Kentucky Food for thought No such thing as your side of the boat is leaking It doesn’t have to be this way Curative medicine helps Primary prevention is better New Public Policy Initiatives Consider ways to pay providers to keep people well $14.5B—expenditure on medical care $350M—estimated expenditure on prevention