Reforming Disease Prevention and Health Promotion: Population Health

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Slide 1

 

Reforming Disease Prevention and Health Promotion:
Population Health

Steven Teutsch, MD, MPH
Chief Science Officer
Los Angeles County Department of Public Health
September 15, 2009

 

Slide 2

Problem: America is Not Getting Good Health for Its Health Care Dollar

Prepared for the Robert Wood Johnson Foundation by the Center on Social Disparities in Health at the University of California, San Francisco. Source: OECD Health Data 2007.
Does not include countries with populations smaller than 500,000. Data are for 2003.
*Per capita health expenditures in 2003 U.S. dollars, purchasing power parity

Copyright 2008 Robert Wood
Johnson Foundation/
Overcoming Obstacles to Health.

 

Slide 3

White Female Survival in the United States: 1901 and 2003

 

Slide 4

Former Leading Causes of Death:
Crude Death Rate for Infectious Diseases,
U.S., 1900 - 2000

 

Slide 5

The Lifecourse Perspective:
Early Childhood Impacts Adult Health Status

 

Slide 6

Health Influences Over the Life Course

From Neal Halfon

 

 

Slide 7

How Risk Reduction and Health Promotion Strategies Influence Health Development

From Neal Halfon
 

 

Slide 8

The Social and Physical Environments are Among the Most Important Determinants of Health

 

Slide 9

Income is Linked to Longevity Regardless of Race/Ethnicity

"Copyright 2008 Robert Wood Johnson Foundation/Overcoming Obstacles to Health."
 

 

Slide 10

Education Matters:
Mother's Education Related to Infant Mortality

Babies born to mothers who did not finish high school are almost twice as likely to die before their first birthday as babies born to college graduates

"Copyright 2008 Robert Wood Johnson Foundation/Overcoming Obstacles to Health."

 

Slide 11

Education Matters: More Education Means Longer Life Expectancy

"Copyright 2008 Robert Wood Johnson Foundation/Overcoming Obstacles to Health."
 

 

Slide 12

The Toxic American Environment: Percent of Recent Immigrants and Long-term Residents with Diabetes, United States, 2006

The Hispanic Paradox: Recent Immigrants have less diabetes and other health problems than those who have had longer exposure to our toxic socioeconomic and physical environment

The Toxic American Environment:
Percent of Recent Immigrants and Long-term
Residents with Diabetes, United States, 2006

Steven P. Wallace, Xchitl Castaeda.
Migration and Health: Latinos in the United States. 2008
 

 

Slide 13

Economic Hardship & Childhood Obesity

Economic hardship and childhood obesity go hand in hand
 

 

Slide 14

Improving Health Requires Actions at Multiple Levels

 

Slide 15

Action Model to Achieve Healthy People 2020 Overarching Goals

 

Slide 16

Action Model to Achieve Healthy People 2020 Overarching Goals

 

Slide 17

Action Model to Achieve Healthy People 2020 Overarching Goals

 

Slide 18

Action Model to Achieve Healthy People 2020 Overarching Goals

 

Slide 19

Action Model to Achieve Healthy People 2020 Overarching Goals

 

Slide 20

Spectrum of Health and Strategies to Improve It

Well - Dead
Society - Individual



 

 

Slide 21

Spectrum of Health and Strategies to Improve It

Dead
Individual
Society
Well

Population Health Strategies
Clinical Strategies
 

 

Slide 22

Population Strategies

Dead
Individual
Society
Well
Education
Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.
Worksite Programs
School Health

 

 

Slide 23

Clinical Strategies

Dead
Individual
Society
Well
Disease Mgmt
Primary Care
Clinical Preventive Services
Tertiary Care
Assisted Living

 

 

Slide 24

Medical Care System Strategies

Dead
Individual
Society
Well
Disease Mgmt
Hospital Systems
Assisted Living
Integrated Health Systems

Medical Home
 

 

Slide 25

Spectrum of Health and Strategies to Improve It

Dead
Individual
Society
Well
Education
Disease Mgmt
Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.
Hospital Systems
Primary Care
Clinical Preventive Services
Worksite Programs
School Health
Tertiary Care
Assisted Living
Integrated Health Systems

 

 

Slide 26

How Do We Know What Works?
Evidence-based Recommendations

 

 

Slide 27

So How Do We Apply Them to Prevention & Control of Diabetes?

 

Slide 28

Spectrum of Health and Strategies to Improve It

28
Dead
Individual
Society
Well
Education
Disease Mgmt
Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.
Hospital Systems
Primary Care
Clinical Preventive Services
Worksite Programs
School Health
Tertiary Care
Assisted Living
Integrated Health Systems

 

 

Slide 29

Preventing Onset of Diabetes: Reducing Obesity

29
Dead
Individual
Society
Well
Education
Disease Mgmt
Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.
Hospital Systems
Primary Care
Clinical Preventive Services
Worksite Programs
School Health
Tertiary Care
Assisted Living
Integrated Health Systems

Screen hypertensives
Behavioral interventions to reduce screen time
Worksite programs for overweight and obesity
Screen adults for obesity and offer intensive interventions
Street-scale urban design/land use
Point-of-decision Prompts
Enhanced School-based Physical Education
 

 

Slide 30

Managing Diabetes

30
Dead
Individual
Society
Well
Education
Disease Mgmt
Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.
Hospital Systems
Primary Care
Clinical Preventive Services
Worksite Programs
School Health
Tertiary Care
Assisted Living
Integrated Health Systems

Worksite programs for overweight and obesity
Social Support Interventions in Comm. Settings
Case Mgmt/ Disease Mgmt
Self-Mgmt Education (home /Community
Control BP / Lipids/ Smoking
 

 

Slide 31

Maintaining Function in Diabetes

31
Dead
Individual
Society
Well
Education
Disease Mgmt
Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.
Hospital Systems
Primary Care
Clinical Preventive Services
Worksite Programs
School Health
Tertiary Care
Assisted Living
Integrated Health Systems

Dialysis
 

 

Slide 32

A Comprehensive Approach to Preventing and Controlling Diabetes

32
Dead
Individual
Society
Well
Education
Disease Mgmt
Social and Physical Environment: e.g., Jobs, Urban Design, Transportation, Agriculture, Criminal Justice.
Hospital Systems
Primary Care
Clinical Preventive Services
Worksite Programs
School Health
Tertiary Care
Assisted Living
Integrated Health Systems

Screen hypertensives
Behavioral interventions to reduce screen time
Worksite programs for overweight and obesity
Screen adults for obesity and offer intensive interventions
Street-scale urban design/land use
Point-of-decision Prompts
Enhanced School-based Physical Education
Social Support Interventions in Comm. Settings
Case Mgmt/ Disease Mgmt
Self-Mgmt Education (home /Community
Dialysis
Control BP / Lipids/ Smoking
 

 

Slide 33

What We Are Striving to Achieve

Vision
A society in which all people live long, healthy lives.

Overarching Goals

• Elimination of preventable disease, disability, injury, and premature death
• Achievement of health equity, elimination of disparities, and improvement in the health of all groups
• Creation of social and physical environments that promote good health for all.
• Promotion of healthy development and healthy behaviors across every stage of life
  

 

Slide 34

Major Opportunities:
Health in All Policies

• Opportunities in all sectors e.g. agriculture, transportation, housing, environment, commerce, tax policy
• In both public and private sector
• Examples:
  • Menu labeling
  • Tax on sugared beverages
  • Transportation systems that encourage mass transit, biking and walking
    

 

Slide 35

Health Impact Assessment
http://www.ph.ucla.edu/hs/health-impact/
 

 

Slide 36

HIA: Estimation of Health Benefits from a Living Wage Ordinance

Bhatia , Katz, AJPH, 2001
 

 

Slide 37

Summary

• Prevention effective in clinical and population applications
• Large differences between best evidence and current practice
• Greatest opportunity: policies and programs targeting populations
• Policies in all sectors affect health
• Can't eliminate health disparities without emphasis on social and physical determinants

 

Slide 38

The Challenge: Closing the Gap

• Cannot be done by just fixing the health care system
• Must address the underlying social and physical environment determinants
• Must build a true population-oriented health system