DEATH RATES

• United States 100%

• Missouri 100%

• Northwest Missouri 100%

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

Hea

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Can

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Stro

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Res

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Dis

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Acc

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0%

5%

10%

15%

20%

25%

30%

Number of Deaths Percent of Total Deaths

Total Number of Deaths = 2,443,908

2003 Leading Causes of Death in the US “Public Health Impact”

1990 & 2004 Leading Actual Causes of Death in the US—“Human Behaviors”

0.0%2.0%4.0%6.0%8.0%

10.0%12.0%14.0%16.0%18.0%20.0%

To

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Alc

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1990 2004

Source: CDC

Causes of Death and Major Illnesses in the U.S.

Source: CDCP, PHS, DHHS

0%

10%

20%

30%

40%

50%

60%

Lifestyle Access to Care Genetics Environment

Risky BusinessLarge numbers of Americans cling to lifestyles that greatly increase their risk of cancer,

heart disease, and diabetes. Over the past decade, the percentage of those who smoke has remained stubbornly unchanged, while more than one out of four has remained a couch

potato and nearly twice as many have become obese.

Source: National Center for Chronic Disease Prevention and Health Promotion Behavioral Risk Factor Surveillance System 2007

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

1997 2001 2007 1997 2001 2007 1997 2001 2007

Current Smokers No Leisure Time Physical Activity Obese

U.S. Missouri St. Joseph

Source: Behavioral Risk Factor Surveillance System, CDC.

19961991

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2004

(*BMI 30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10% – 14% 15% – 19% 20% –24% >25%

2004

No Data <4% 4%-6% 6%-8% 8%-10% >10%

Source:Mokdadet al., Diabetes Care2000;23:1278-83; J Am Med Assoc2001;286:10.

Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)

BRFSS, 1990,1995 and 20011990 1995

2001

Baseline 20th Century Annual Morbidity and 1999 Provisional Morbidity from Nine Diseases with Vaccines Recommended Before 1990 for Universal Use in Children –

United States

Diseases

Smallpox

Diptheria

Pertussis

Tetanus

Poliomyelitis

Measles

Mumps

Rubella

Congenital rubella

Haemophilus Influenza b

Baseline 20th

Century Annual

Morbidity

48,164

175,885

147,271

1,314

16,316

503,282

152,209

47,745

823

20,000

1999 Provisional

Morbidity

0

1

6,031

33

0

86

352

238

8

163

Percent

Decrease

100%

100%

95.9%

97.5%

100%

100%

99.8%

99.5%

99.0%

99.2%

Current & Future Health Challenges

% Overweight Boys1963 = 4.0% 1994 = 11.8% 2000 = 16%

% Overweight Girls1963 = 4.5% 1994 = 11.0% 2000 = 14.5%

• Early childhood education.

• Low birth weight/very low birth weight.

• High school completion.

• Teen birth rates.

• Motor vehicle crashes (with and without alcohol/drug factors).

Asthma>40 per 1000 children in 1982

>62 per 1000 children in 1996

Infant and Child Health

• Healthy weight.– % overweight in 1971 = 4%– % overweight in 1994 = 10.5%– % overweight in 2000 = 15.3%

• Smoking.• Violence.• Suicide.• Sexually transmitted disease.

The Dilemma

• So why are we afraid for our kids health?– Modern children’s health issues are preventable, yet

scary because of the illusion that science can fix everything like it did in the last century.

• Health happens at the intersection where science meets social, spiritual, educational, economic, family, behavioral and community circumstances.

• We can’t give a shot to become a better parent, or immunize a 14 year old to make wise choices. Science has limits!

The USA Ranks 37th in World Health.World Health Report 2000 (health system and performance in all member states, ranked by eight measures) places the USA 37th in overall system performance.

Missouri Ranks 38th in USA Health.There are several indicators to compare on health status. For the 2004 CDC BRFSS question: “How would you rate your health in general?” 84.1% of Missourians said excellent, very good, or good to the question. Missouri

ranks 38th in the nation. The top states are Minnesota and New Hampshire.

People 2004 USA

Deaths 2,397,615

Heart, Cancer, Stroke, Pulmonary,

Diabetes…

2000 Actual Causes of Death “Human Behaviors”

Tobacco, Obesity, Diet, Inactivity, Alcohol, Motor Vehicle…

Root Causes “Human Conditions”

Stress, Anger, Poverty, Economics, Education Levels, Depression, Unemployment, Broken Families,

Environmental Factors, Emptiness, Hopelessness, Disconnectedness

Provider Response & Individual Accountability

Individual Accountability

Individual & Community Accountability

Healthcare Policy

Public Health & Organizational Policy

Community, Economic, Education, & Social Policy

Adapted From: National Civic League, Healthy Communities Conference 1994 Updated With CDC Data & Best Practices

Policy

HEALTHY COMMUNITIES

The two key determinates of the health

status of a population:

• Education Levels

• Affluence (Jobs)

“If I had known I would live this long, I would have taken better care of myself.”

Mickey Mantle

0

.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

2002 2004 2006 2008 2010 2012 2014 2016

Year

Annual healthexpenditures

(trillions)Official CMS projectionof healthcare cost growth

With No Changes, Projected Cost Growth in Health Care Is Large

2.1 Trillion(100%)

10 Years

HEALTHY COMMUNITIESIDEAL APPROACH

• Individuals assume responsibility (maximum extent possible) for their own and their families’ health– Healthy behaviors

– Personal financial responsibility for health

• Health insurance designed to promote and encourage healthy life styles and wise buying practices– Encourage preventive care

– Design benefits to influence positive behavior

– Reward healthy behaviors

– Universal coverage and portability

HEALTHY COMMUNITIESIDEAL APPROACH

• Higher premiums for non-managed care – lower premiums for managed care.

• Comprehensive integrated health provider (like Heartland) that exist to serve the community interest