1. Health Status Health Behavior and Variability in Healthcare Spending
RADM Penelope Slade-Sawyer, P.T., M.S.W. Department of Health and Human Services (DHHS)
Director, Office of Disease Prevention and Health Promotion
Acting Director, President’s Council on Physical Fitness and Sports
Office of the Secretary, Office of Public Health and Science

2. Factors Contributing to Geographic Variation in Health Care Spending
Prices paid for medical services
Health and illness status of residents of a given region
Regional preferences about the use of healthcare services
Residual variation
By changing the way they live, individual Americans could change their personal health status and the health landscape of the Nation dramatically
Congressional Budget Office, Geographical Variation in Health Care Spending, 2008

4. Two thirds of Medicare spending is for people with
five or more chronic conditions

5. Percent of Healthcare Spending for Individuals with chronic conditions by type of insurance

6. People with Multiple Chronic Conditions are much more likely to be hospitalized

7. Spending for inpatient hospital care increases with the number of chronic conditions

8. Healthcare Spending Increases with the Number of Chronic Conditions

9. The Five Most Costly Conditions as a Percentage of Total Health Expenditures: United States, 2002
Source: Olin GL, Rhoades JA. The five most costly medical conditions, 1997 and 2002: estimates for the U.S. civilian noninstitutionalized population. Statistical Brief #80. Agency for Healthcare Research and Quality, Rockville, MD. Web site: Accessed April 7, 2006.

10. Smoking Prevalence of Adults* by state
* Persons aged > 18 years who reported having smoked over 100 cigarettes during their lifetime or who currently smoke everyday or some days. Estimates were weighted by age and sex distributions of each state or area population
Source: Behavioral Risk Factor Surveillance System (BRFSS), 2006

11. Developing chronic diseases is not an inevitable consequence of aging
Behaviors
Poor diet (low fruit and vegetable intake)
High cholesterol
High blood pressure
Lack of physical activity
Tobacco use
Chronic Diseases
Type 2 diabetes
congestive heart failure
Stroke
hypertension
Developing chronic diseases is not an inevitable consequence of aging; in many cases, their origins are grounded in health-damaging behaviors practiced by people every day for much of their lives. Evidence indicates that with education and social support, people can and will take charge of their health. For many Americans, individual behavior and lifestyle choices influence the development and course of these chronic conditions. Unhealthy behaviors, such as a poor diet, lack of physical activity, and tobacco use are risk factors for many chronic conditions and diseases. A high calorie diet and sedentary lifestyle commonly result in excessive weight gain. Overweight and obesity are risk factors for a large number of chronic diseases, most significantly, type 2 diabetes, congestive heart failure, stroke, and hypertension. Encouraging individuals to adopt healthy habits and practices may reduce the burden of chronic disease in communities throughout the United States.

12. Overweight and obesity raise the risk for:
type 2 diabetes
high blood pressure
high cholesterol levels
coronary heart disease
congestive heart failure
angina pectoris
stroke
asthma
osteoarthritis
musculoskeletal disorders
gallbladder disease
sleep apnea and respiratory problems
gout
bladder control problems
poor female reproductive health
– complications of pregnancy
– menstrual irregularities
– infertility
– irregular ovulation
cancers of the
– uterus
– breast
– prostate
– kidney
– liver
– pancreas
– esophagus
– colon and rectum

14. Geographic variation in Public Health Spending is even greater than variation in Medicare Spending
Public Health Activities
Monitor community health status
Investigate and control disease outbreaks
Educate the public about health risks and prevention strategies
Enforce public health laws and regulations
Inspect and assure the safety and quality of water, air, and other resources necessary for good health
Public Health Spending
State government’s per capita spending on public health activities varied by a factor of 30 in 2003 (more than 400$ per person in Hawaii, less than $75 per person in Iowa)
Variation even great on the local level (less than 1$ per capita to more than 200$ per capita in 2005)
It is important to recognize that geographic variation in public health resources may contribute to gaps and inequities in our population’s health and may drive the development of chronic health conditions in certain populations. Public health spending funds a wide range of activities including (listed above). The National Association of County and City Health Officials (NACCHO) reported spending a median of $30 per person

15. Based on analysis of public health expenditures among the nation’s nearly 3000 local public health agencies. Public health agencies in the highest quintile of spending provided a broader scope of clinical preventive services, population-based services, medical treatment services and specialty services when compared with their lower spending counterparts. Medical spending per medicare beneficiary was 11% higher in communities within the lowest quintile of public health agency spending, compared with communities with the highest level of spending. This inverse association existed for both inpatient and outpatient Medicare spending and after risk adjustment of data.
Glen P Mays, Sharla A. Smith. Geographic Variation in Public Health spending: correlates and consequences. Public Health Services and Systems Research

16. Percentage of Adults Who Are Obese,* by State
*Body mass index > 30, or ~ 30 pounds overweight for a 5'4" person Source: CDC, Behavioral Risk Factor Surveillance System.

17. Differences in Prevalence of Obesity 2006--2008
Hispanic
White – Non Hispanic
Black Non-Hispanic
Especially important is the increase in the number of people treated for conditions clinically linked to obesity. Common morbidities associated with obesity include coronary heart disease, hypertension and stroke, type 2 diabetes, and certain types of cancer, chronic conditions that account for the largest percentage of healthcare costs.
Source: CDC, MMWR. Differences in Prevalence of Obesity Among Black, White, and Hispanic Adults --- United States, For this study analysis, CDC analyzed the 2006−2008 BRFSS data.

18. Prevalence of Physical Activity*, 2007
This map displays the prevalence of people in each state meeting physical activity recommendations. Recommended physical activity is defined as at least 5 days a week for 30 minutes a day of moderate intensity activity or at least 3 days a week for 20 minutes a day of vigorous intensity activity.
*Recommended physical activity is defined as at least 5 days a week for 30 minutes a day of moderate intensity activity or at least 3 days a week for 20 minutes a day of vigorous intensity activity

19. times/day and vegetables three or more times/day, by state (2007)
Percentage of U.S. adults aged ≥ 18 years who consumed fruit two or more
times/day and vegetables three or more times/day, by state (2007)
Source: Behavioral Risk Factor Surveillance System 2007

20. Percent of Adults Ages 18+ with Diagnosed Diabetes, by State, 2007
7% – 7.9%
6% – 6.9%
≥ 8%
< 5.9%
National Average = 7.8%
Source: Centers for Disease Control and Prevention. (2009). Percentage of Adults with Diagnosed Diabetes By State, Link:

21. County Level Estimates of Diagnosed Diabetes —
County Level Estimates of Diagnosed Diabetes — Percentage of Adults in Texas, 2005
County Level Estimates of Diagnosed Diabetes —
Percentage of Adults in Colorado, 2005
However, variability exists even at the county level

22. Healthy People 2010
Overarching goals: 1) increase quality and years of healthy life ) eliminate health disparities
Focus Areas include
Physical Activity and Fitness
Nutrition and Weight Status
Diabetes
Heart Disease and Stroke
Tobacco Use
Cancer
Examples of New Objectives (for Healthy People 2020)
Early and Middle Childhood Health, Adolescent Health
Healthcare Associated Infections
Healthy People 2010 presents a comprehensive set of disease prevention and health promotion objectives developed to improve the health of all people in the United States during the first decade of the 21st century. Aims to address risk factors and determinants of health and the diseases and disorders that affect our communities. Set targets for the nation. Recognizing the variability in populations and the importance of targeting messages and resources at certain groups is important. These are just an example of a few objectives retained from 2010 and some new objectives which will be included in the 2020 Objectives.
As the population of the United States ages substantially over the next several decades, the prevalence of chronic diseases--and their impact on health care costs--will likely increase.Each individual's health is shaped by many factors including medical care, social circumstances, and behavioral choices.(4) Increasingly, there is clear evidence that the major chronic conditions that account for so much of the morbidity and mortality in the U.S., and the enormous direct and indirect costs associated with them, in large part are preventable-and that to a considerable degree they stem from, and are exacerbated by, individual behaviors. In particular, overweight and obesity, lack of physical activity, and smoking greatly increase the risk of developing the most serious chronic disorders. Most of the dollars spent on health care in the United States, however, are for the direct care of medical conditions, while only a very small portion is targeted on preventing those conditions.(5) As Americans see health care expenditures continue to increase, it is important to focus on strategies that reduce the prevalence and cost of preventable diseases.

23. By changing the way they live, Americans could change their personal health status and the health landscape of the Nation dramatically.
"So many of our health problems can be avoided through diet, exercise and making sure we take care of ourselves. By promoting healthy lifestyles, we can improve the quality of life for all Americans, and reduce health care costs dramatically." By changing the way they live, individual Americans could change their personal health status and the health landscape of the Nation dramatically.