1、Chronic Disease Prevention,Objectives,Background: Setting the Stage Status of Chronic Diseases in San DiegoEvidenced-based Best PracticesHHSA Chronic Disease Prevention Model,Setting the Stage,Why Chronic Disease?,Why Chronic Disease?,California Conference for Local Public Health Officers (CCHLO) Ch
2、ronic Disease Conference Spurred Idea to develop CC Agency for Agency Two meeting held to date to develop an inventory of Agency Chronic Disease activities SPOS came to PHS to conduct a “Focused Dialogue” Chronic Disease was chosen,What Is Chronic Disease?,According the U.S. National Center for Heal
3、th Statistics, is a disease that lasts 3 months or more. Cannot be prevented by vaccines or cured by medications. Caused by health damaging behaviors - particularly tobacco use, lack of physical activity, and poor eating habits. Is the leading cause of death and disability in the United States. Acco
4、unts for 7 of the 10 U.S. leading cause of death.,Why Should We Care?,Chronic diseases are prevalent, preventable and costly! Cause extended pain and suffering, associated with decreased quality of life for millions. Treatment for seven chronic diseases including cancers, mental illnesses, heart dis
5、ease, lung conditions, hypertension, stroke, and diabetes ran to nearly $280 billion in 2003; now estimated to be to $1.3 trillion per year. Prevention programs are highly cost-effective,Top 10 Causes of Mortality in San Diego County,Rates are per 100,000 population. Source: State of California, Dep
6、artment of Public Health, Center for Health Statistics, Vital Statistics Section, Death Statistical Master Files,= Chronic Diseases,Death by Risk Factors,Physical Activity by Gender,Percent,Women,Nutrition by Gender,Men,PA and Nutrition Trends,Healthcare Cost in California and San Diego,$130 Billion
7、 spent (treatment and lost productivity) by California in 2003$4.3 Billion in SD County (not including lung cancer treatment),3 FOUR 50,3 RISK FACTORS (Tobacco Use, Poor Diet, Lack of Physical Activity),4 CHRONIC DISEASES (Heart Disease/Stroke, Type 2 Diabetes, Respiratory Disease, Cancer),50% of DE
8、ATH,Status of Chronic Diseases in San Diego,What Are the Statistics?,*2006 U.S. data are preliminary,LIFE EXPECTANCY TRENDS San Diego County vs United States, 2000-2006,San Diego County Population by Race/Ethnicity, 2007,Source: SANDAG, San Diego County 2007 Population Estimates,3 million people Rac
9、ial/Ethnic groups from around the world. Over 100 languages,Asian 9.4% N=292,251,White 51.6% N=1,597,847,Black 5.4% N=166,486,Hispanic 29.3% N=906,898,Hawaiian/Pacific Islander 0.4% N=13,144,American Indian 0.5 % N=15,946,San Diego County Population by Race/Ethnicity, Census 1990 vs. 2000 vs. 2007,S
10、ource: SANDAG, San Diego County 1990, 2000 Census, and 2007 Population estimates,Between 1990 & 2000: The population of Hispanics and Asian increasedThe population of Whites and Blacks decreased,Percent,All Cancer Deaths by Race/Ethnicity, 2005,Note: All rates are adjusted to 2000 Standard U.S. Popu
11、lation. Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.,Cancer is the second leading cause of death for San Diego County,San Diego County Overall Rate, 2005: 163.1 / 100,000,HP 2010 Goal: 159.9,Selected Cancer Deaths by Race/Ethnicity, 2005,Note: All rates a
12、re adjusted to 2000 Standard U.S. Population. Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.,HP 2010 Goal,Coronary Heart Disease and Stroke Deaths by Race/Ethnicity, 2005,Note: All rates are adjusted to 2000 Standard U.S. Population. Source: California Deat
13、h Statistical Master File; SANDAG January 1, Population Estimates.,Blacks have the highest rate of coronary heart disease deaths and stroke deaths compared to other racial and ethnic groups.,HP 2010 Goal CHD: 166.0,HP 2010 Goal Stroke: 48.0,San Diego County Overall:CHD Rate - 128.4 / 100,000Stroke R
14、ate 41.3 / 100,000,Diabetes by Race/Ethnicity,Source: Youth Risk Behavior Survey (YRBS), San Diego City Schools; California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates; California Health Interview Survey (CHIS), California Department of Health Services, Death
15、Statistical Master File.,R/E,Hospital Admissions 2005,Deaths (underlying)2005,Black White Hispanic Asian/Other,69.0 16.6 33.5 21.2,303.5 87.1 236.0 87.6,10.7 7.7 18.4 7.4,% High School Students Overweight 2005,Prevalence of Diabetes Among Adults 2005*,6.6 5.1 6.5 7.2,* - Percentage of adults who wer
16、e ever diagnosed with diabetes,Diabetes Mortality,Among the top 53 U.S. City/County jurisdictionsSan Diego County:Ranked 52 in 1990 Ranked 46 in 2004Ranked 8th in the highest rate of change between 1990 and 2004,Source: NACCHO 53 Big Cities Health Inventory, 2007,Note: Ranking scheme - 1 being worst
17、 and 53 being best,Diabetes Mortality Among San Diego County Residents, 2000-2005,Deaths and Age-adjusted Rates,HP2010 = 45,Diabetes Hospitalizations Among San Diego County Residents, 2001-2005,Number and Age-adjusted Rates,Diabetes Hospitalizations Among San Diego County Residents, 2001-2005,By Rac
18、e/Ethnicity Number and Age-adjusted Rates,Overweight & Obese Adults* by Race/Ethnicity, 2005,* as Defined by Body Mass Index (BMI) Source: 2005 California Health Interview Survey (CHIS),HP 2010 Goal,Obesity (BMI 30): 15%,Unhealthy weight (BMI25): 40%,Asthma in San Diego County by Race/Ethnicity,Sour
19、ce: 2005 California Health Interview Survey (CHIS), California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates. California Department of Health Services, Death Statistical Master File* - These results for Blacks reflect 2003 data results since sample size for Blac
20、ks in 2005 was statistically unreliable.,Race/Ethnicity,Hospitalization Rate, 2005,Average Annual Number of Deaths 2002-2004,Black White Hispanic Asian/Other,3 1834,204.7 59.3 74.9 62.6,Estimated Prevalence Among Children 2005,13.8* 9.6 12.4 11.7,Selected Health Indicators* San Diego County, CA, & U
21、S, HP2010,Indicator,Infant MortalityAdults reporting poor/fair healthIncidence of AIDSCHD DeathsSuicidesF. Breast Cancer DeathsUnintentional Injury Deaths,San Diego County,CA,U.S.,Healthy People 2010 Goal,4.6 14.4% 14.0 144.4 10.5 22.9 28.8,5.3 16.0% 11.8 162.8 8.5 24.1 30.5,7.0 14.0% 15.0 159.6 10.
22、7 26.0 37.7,4.5 None 1.0 166.05.0 22.3,* - These data reflect the most current comparable data,The numbers above reflect either rates or percentages,Evidence-based Best Practices,Do They Work?,Direction from the National Level,Federal Government Agencies United States Department of Agriculture Unite
23、d States Surgeon General Centers for Disease Control,“Healthy places are those designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders - where every person is free to make choices amid a variety of healthy, available, accessible,
24、 and affordable options.”,CDCs “Designing & Building Healthy Places”,Leading Public Health Organizations National Association of County and City Health Officials National Task Force on Community Preventive Services Robert Wood Johnson Foundation Kaiser Permanente American Planning Association (funde
25、d by CDC),Direction from the National Level,Public California Conference of Local Health Officers California Department of Public Health Governors Obesity Prevention Plan Private The California Endowment Strategic Alliance,Direction from the State Level,Best Practices and Promising Interventions,Hea
26、lthy Community Improvements Healthy Community Development Healthy Community Plans & Policies,1. Healthy Community Improvements,Partnering with communities and cities to improve existing physical and social conditions that prevent physical activity and healthy eating,Best Practices and Promising Inte
27、rventions,Healthy Community Improvements,Safe and healthy routes to schools, parks, healthy foods, seniors Traffic calming, improve street crossings Installing/improving sidewalks & bike paths Community gardens School/community joint use agreements,Safe and Healthy Routes to Schools and Parks, Healt
28、hy Foods, Seniors,AARP - assessments - advocates,From abandoned lots to community gardens,Create gardens for culturally appropriate foods reflective of the community.,CX3 Projects (Chula Vista & La Mesa) Communities of Excellence in Nutrition, Physical Activity and Obesity Prevention,Strong Partners
29、hips Leadership Training Youth & Mentors,Community Assessment Advocacy,2. Healthy Community Development,Promoting healthy development and redevelopment projects in neighborhoods,Best Practices and Promising Interventions,Healthy Community Development,Integrating “Healthy Places” design into the Deve
30、lopment Review process Redevelopment areas Grocery stores in underserved areas Facility design,Helping Communities get Developments Designed for “Health”,Trails and Trail Access Points,Eliminating Food Deserts Attracting a Grocery Store into East Oakland, CA,Partners: East Oakland Diabetes Work Grou
31、p, Alameda County Department of Public Health, Network for a Healthy California,3. Healthy Community Plans & Policies,Promoting healthy government, school and worksite policies and plans that support physical activity, healthy eating and tobacco-free environments,Best Practices and Promising Interve
32、ntions,Healthy Community Plans & Policies,Land use & transportation planningAffordable housing policies Regional Food Systems & Urban AgricultureWorksite Wellness policiesGovernment Wellness policiesSchool Wellness policies,City of Richmond General Plan Update,City of Richmond Health and Wellness El
33、ement,Policy Framework,www.healthycommunitiesbydesign.org,School Wellness Gardens,Classroom Garden Beds,Quad Area with Gardening,Healthier Vending Machines,Chronic Diease Model,Will it Work?,Individuals,Families,Neighborhoods,Policies and Laws,Socio-Ecological Model,Businesses,Environmental Approach
34、es to Tobacco: The California Model,Prop. 99 Tobacco Tax FundsLocal Ordinances and State Legislation for Smoke-Free EnvironmentsMassive Anti-Tobacco Campaign,California vs. The US,Smoking RatesLung Cancer Death Rates,Percent,American Lung Association of California,Centers for Disease Control, Nation
35、al Cancer Institute, statecancerprofiles.cancer.gov,Tobacco and Heart Attacks,Pueblo, Colorado Decrease in heart attack rates by 28% after smoke-free ordinance 399 HA pts in 1.5 yrs prior to ordinance, only 291 HA pts in 1.5 yrs after Helena, Montana Decrease in heart attack rates by 40% during firs
36、t 6 months of smoke-free ordinance,Why Act Now?,Chronic Disease Prevention is strategic: Fundamental to reducing death and disability and improving community health Critical to cutting health care costs Experience to-date shows that strategies can be very cost-effective Funding opportunities for str
37、ategies that focus on environmental change,At its Foundation,Place MattersAdopting the concept that neighborhood environmental factors all affect individual behaviors and health From Policy Link and The California Endowment,Why Place Matters: Environmental Strategies,Physical Environment Safe parks;
38、 full-service grocery stores and farmers markets; safe, walkable streets; less truck and bus traffic; well-maintained housing; open spaces.Social Environment Strong social networks that bring neighbors togetherwhether to advocate for change, cultivate a community garden, or provide services.,Why Pla
39、ce Matters: Environmental Strategies,Economic Environment Commercial investment, jobs that take people out of poverty, businesses that provide healthy food options.Service Environment Access to quality healthcare services, public safety, and community support services.,Understanding the problem,$4.3
40、 Billion Annually,*Social*,*Economic*,*Physical*,*Service*,50% of Deaths,Physical Activity,Tobacco,Nutrition,Heart Disease/Stroke Type 2 Diabetes Cancer Respiratory Disease,Poor environments a Unhealthy behaviors a Chronic Diseases,Chronic Disease,environments,Adopting a new solution,Healthy environments a Healthy Behaviors a Disease Reduction,*Social*,*Economic*,Reduction in: Heart Disease/Stroke Type 2 Diabetes Cancer Respiratory Disease,*Physical*,*Service*,Creating Environments to Support Healthy Behaviors,Physical Activity,Tobacco,Nutrition,environments,Chronic Disease,QA & Comments,
