1. 1 Preventing and Managing Chronic Conditions in Children February 7, 2006 Debbie I. Chang, MPH Executive Director and Senior Vice President Nemours Health and Prevention Services

2. 2 Presentation Overview Introduction to the Problem Approaches to address the Problem Nemours Community-Based Approach

3. 3 Healthcare Environment Estimated $1.6 trillion spent on health care in 2003 70-80% of national health expenditures related to chronic conditions Children consumed about 12% or $200 billion The 10% of the sickest children consumed 69%; the top 20% accounted for 81% Source: McGinnis, Health Affairs, 2002 & CDC, Wennberg

4. 4 Chronic Diseases Influence Expenditures 10% 20% 70% Moderate to Severe Chronic Mild Chronic Well and Acute Care 70% 20% 10% 2002 Increasing Prevalence of Chronic Diseases in Children

5. 5 Chronic Diseases Chronic conditions affect 3X as many children now compared to 1960s Asthma:160% increase in rate over past 15 years for children <5 yr Overweight: prevalence in children and youth (ages 6-19) has more than tripled over the last 35 years to over 15% Many chronic diseases previously associated with adulthood are quickly becoming childhood concerns – 60% of overweight children aged 5-10 already have a risk factor for heart disease such as high blood pressure or elevated insulin levels

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7. 7 Health Promotion: Opportunities to address chronic conditions Of the $1.6 trillion spent on health care annually –95% on direct medical care services –5% on prevention/health promotion Behavior and environment account for over 70% of avoidable mortality Comprehensive health promotion involves: –The medical model –The lifestyle or behavioral approach –The social-environmental model

8. 8 Approaches to Childrens Health Traditional Medical Model Rigid adherence to biomedical view of health Focused primarily on acute episodic illness Focus on individuals Cure as uncompromised goal Focus on disease Expanded Approach Incorporate a multifaceted view of health Chronic disease prevention and management Focus on communities Prevention as a primary goal Focus on health

9. 9 4 Promising Approaches 1.Debbie Chang – Nemours community-based health promotion to address overweight in children 2.Tricia Leddy– Rhode Islands systematic approach to understanding the problem with data, developing innovative solutions and evaluating results (case studies from lead paint and CSHCN in child care) 3.Charlie Homer – A medical home/chronic care model and practice improvements through learning collaboratives 4.Peggy McManus– Promising approaches to improving the interface between primary and specialty care in pediatrics

10. 10 Nemours Community-Based Health Promotion for Children First Approach:

11. 11 Nemours Overview Operating Foundation that provides pediatric primary and specialty health care throughout DE, northern Florida, and also parts of southeastern PA, and southern NJ. At these various operating sites, Nemours cares for more than 225,000 children annually through 870,000 patient visits. In DE, Nemours cares for almost 55,000 children (1/4 of the states population of 0-17 year olds).

12. 12 NHPS Background 2003 Nemours redefined its approach: health as well as health care Nemours Health and Prevention Services (NHPS) was created and focuses on child health promotion & disease prevention to address root causes of health problems Complements and expands the reach of clinicians with a broader, community-based perspective Traditional Medical Care Community- based health promotion Nemours

13. 13 NHPS Philosophy Health promotion must extend beyond the clinical setting to the whole child in his/her family & community Long-term commitment; impact takes years to realize Focus on broad health determinants; not medical care Build on community strengths; do not duplicate existing efforts nor supplant existing resources Collaborate with the community to leverage resources and maximize the reach and impact of our efforts

14. 14 Vision for Healthy Children requires a Cultural Shift We are a catalyst, a change agent Cultivate an environment that supports both behavior change and systems change for child health promotion –Behavior change means children choosing healthier lifestyles –Systems change means the greater DE community supporting these choices Only this combination can result in lasting improvements in child health

15. 15 Our First Focus Area: Childhood Obesity Prevention Why must we move beyond the primary care office?

16. 16 The new social norm?

17. 17 Our childrens food environment

18. 18 Drive-thru makes it easy

19. 19 Even in hospitals and museums!

20. 20 Our Aspiration To see a cultural change in which people place a high value on health, wellness and prevention. Where: – Children choose fruit instead of fries – Child care providers offer nutritious snacks and physical activity – Families spend less time in front of a screen – Insurers pay for health promotion and prevention services

21. 21 Our Plan NHPS catalyzes and supports changes in policy, programs and practices across the state Unique role includes 3 core components: –Coalition Building and Strategic Partnerships –Dissemination of Knowledge and Best Practices –Social Marketing Strategically chosen to impact the most children in the shortest time

22. 22 Targets and Outcomes Content Areas 1)Healthy Eating & Physical Activity 2)Emotional/ Behavioral Health 3)Community Capacity Target Sectors 1)Childcare 2)Primary Care 3)Schools 4)Community Outcomes Impact on Delaware Children and Communities

23. 23 Child Health Outcomes for 2015: Obesity Prevention Improved child health behaviors Policy changes and additional environmental/system supports in place to promote healthy eating and physical activity Reduction in overall trajectory of overweight for children Specific measures will be tracked over time in each area

24. 24 NHPS Mission To be a leading catalyst for improving childrens health in Delaware. To engage communities and work with partners to find, develop, implement, evaluate and promote successful strategies to help children and their families live healthier lives. NHPS Vision Optimal health and development for all children Debbie I. Chang, MPH Senior Vice President and Executive Director Nemours Health and Prevention Services 252 Chapman Road, Christiana Bldg, Suite 200 Newark, DE 19702 dchang@nemours.org (302) 444-9100 (Office) (302) 444-9200 (Fax) dchang@nemours.org Summary We work with families and communities to help children grow up healthy.

25. All the flowers of all the tomorrows are in the seeds of today. - Anonymous