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Public Health PrioritiesMDH Perspective

Jeanne Ayers RN MPH

Assistant Commissioner of HealthAssistant Commissioner of Health

May 25, 2011

Ralph Waldo Emersonborn on May 25,1803

• Philosopher poet essayist He was thePhilosopher, poet, essayist. He was the main spokesman of his time for moral optimism and belief in the individual.

• “A chief event of life is the day in which we have encountered awhich we have encountered a mind that startled us.”

Ralph Waldo Emersonbborn on May 25,1803

• “Bad times have a scientific value.

Th i dThese are occasions a good

learner would not miss ”learner would not miss.

• “Fear defeats more people thanFear defeats more people than

any other one thing in the world.”

Beverly Sillsbborn on May 25, 1929.

• "You may be

disappointed if you fail,

but you are doomed if

you don't try.“

Central Role of Health in Our SocietyCentral Role of Health in Our Society

“Wh h lth i b t i d t l“When health is absent, wisdom cannot reveal itself, art cannot become manifest, strength cannot fight wealth becomes useless andcannot fight, wealth becomes useless, and intelligence cannot be applied.”

• Herophilus of Chalcedon, 335‐280 BC,

Ph i i Al d h G• Physician to Alexander the Great

WHAT IS HEALTH?WHAT IS HEALTH?

Health is a state of complete physical Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmitymerely the absence of disease or infirmity.--World Health Organization (WHO) 1948World Health Organization (WHO) 1948g ( )g ( )

((This definition has not been amended since 1948)This definition has not been amended since 1948)

MDH Prioritiesbl h l h• Maintain MDH as a premier public health agency

• Strengthen link between federal, state, and local public h lth ihealth agencies.

• Integrate medicine and public health

f f• Bring a public health framework to health reform

• Enhance health equity – eliminate health disparities

• Build the public/political will for creating conditions (through personal choices and public policies) that enhance healthenhance health.

• Enhance community engagement and community ownership of healthownership of health.

MDH Prioritiesbl h l h• Maintain MDH as a premier public health agency

• Strengthen link between federal, state, and local public h lth ihealth agencies.

• Integrate medicine and public health

f f• Bring a public health framework to health reform

What is public health?What is public health?

Health Care System Common View

Health Care System

PublicHealthSystem

MedicalCare System

Health Care System Public Health Subsystem + Medical Care SubsystemHealth Care System = Public Health Subsystem + Medical Care Subsystem

Public Health View of HealthHealthy People Healthy CommunityHealthy People –– Healthy Community

Health of the PublicHealth of the Public

l h Other InfluencesHealth Care Other InfluencesOn Health

M di l§Education§EMedical

CareClinicalPreventiveServices

CommunityHealth Services

§Economy §Housing§Scientific advances§Knowledge§S i l§Social norms§Recreation§Transportation§Media/Entertainment§Sense of community

§Health Promotion§Health Protection §Sense of community

§Many more§Health Protection§Disease/Injury Prevention§Surveillance & Monitoring

Evolving View of Health and Health CareEvolving View of Health and Health Care

• From disease to risk factors

• From treatment to prevention

• From short‐term to long‐term perspective

F i di id l t l ti• From individual to population

• From population to contextFrom population to context

– Context is the community

– Community issues are syndemic issues

How our healthcare money is spent

5%Medical CarePublic Health

95%

MDH Priorities

• Enhance health equity – eliminate health disparities

• Build the public/political will for creating conditions (through personal choices and public policies) that enhance health.

• Enhance community engagement and community ownership of health.

Top Causes of DeathU S 2008U.S. 2008

Cause of Death Number of Deaths

Heart Disease 617 527Heart Disease 617,527

Cancer 566,137

Respiratory disease 141,075p y

Stroke 133,750

Unintentional Injuries 121,207

Alzheimer’s 82,476

Diabetes 70,601

I fl / i 56 335Influenza/pneumonia 56,335

Kidney disease 48,283

Septicemia 35,961Septicemia 35,961

All other causes 599,347

The “Real” Top Causes of Death U.S. 2000

Cause of Death Number of Deaths PercentageTobacco 435,000 18%

Diet/activity 365,000 15%

Alcohol 85 000 4%Alcohol 85,000 4%

Microbial agents 75,000 3%

Toxic agents 55,000 2%Toxic agents 55,000 2%

Firearms 29,000 1%

Sexual behavior 20,000 <1%

Motor vehicles 43,000 <1%

Illicit use of drugs 17,000 <1%

Source: Mokdad et al, JAMA 2004 March 10; 291 (10):1238-45

Ten Great Public Health Achievements –United States 1900‐1999United States, 1900‐1999

• Vaccination • Motor‐vehicle safetyMotor vehicle safety • Safer workplaces • Control of infectious diseases• Control of infectious diseases • Fluoridation of drinking water S f d h lthi f d• Safer and healthier foods

• Healthier mothers and babies • Family planning • Decline in deaths from heart disease and stroke • Recognition of tobacco use as a health hazard

Public Health Longer LivesPublic Health = Longer Lives

70

80

(Yea

rs)

50

60

ecta

ncy

(

Life Expectancy at Birth,

30

40

Life

Exp

e p y ,United States, 1900 - 1996

301900 1910 1920 1930 1940 1950 1960 1970 1980 1990

L

25 of the 30 years of life gained in the 20thy gCentury resulted from public health

accomplishments

f d h h h dCauses of death may have changed. Have the determinants of health changed?

Contextual/Syndemic View of HealthContextual/Syndemic View of Health

TobaccoViolenceViolence

Alcohol

Depression

ObesityStressStress

What Determines Health?

Mission of Public HealthMission of Public Health

“ i h di i i hi h l b“assuring the conditions in which people can be healthy.”

“assuring the conditions in which ALL people g p pcan be healthy.”

Health System DynamicsHealth System Dynamics

db J A i f H l h il i H i ' ll i i i h l h f iPresented by: Jeanne F. Ayers, Minnesota Department of Health ‐ Milstein B. Hygeia's constellation: navigating health futures in a dynamic and democratic world. Atlanta, GA: Syndemics Prevention Network, Centers for Disease Control and Prevention; April 15, 2008. Available at: http://www.cdc.gov/syndemics/monograph/index.htm

Society's HealthResponse

Areas of Emphasis

Targetedprotection

Primaryprevention

Secondaryprevention

Tertiaryprevention

Response

Generalprotection

Medical and Public Health PolicyHealthy Public Policy & Public Work

Safer,HealthierPopulation Becoming

Becoming nolonger vulnerable

VulnerablePopulation Becoming

Afflictedwithout

Complications Developingl

Afflicted withComplications

pVulnerable Afflicted Complications

Dying fromComplications

Adverse LivingConditions

DISEASE AND RISK MANAGEMENT

World of Transforming… By Strengthening…

DEMOCRATIC SELF‐GOVERNANCE

World of Providing…

• Education• Screening• Disease management • Pharmaceuticals• Clinical services

• Deprivation• Dependency• Violence• Disconnection• Environmental decay• Stress

• Leaders and institutions• Foresight and precaution• The meaning of work•Mutual accountability• Plurality• Democracy

• Physical and financial access• Etc…

• Insecurity• Etc…

y• Freedom• Etc…

Presented by: Jeanne F. Ayers, Minnesota Department of Health ‐ Milstein B. Hygeia's constellation: navigating health futures in a dynamic and democratic world. Atlanta, GA: Syndemics Prevention Network, Centers for Disease Control and Prevention; April 15, 2008. Available at: http://www.cdc.gov/syndemics/monograph/index.htm

Prerequisite Conditions for Health

Peace

Shelter

Income

Stable eco-systemShelter

Education

F d

Stable eco system

Sustainable resources

S i l j ti d itFood Social justice and equity

O O f C fWorld Health Organization. Ottawa charter for health promotion. International Conference on Health Promotion: The Move Towards a New Public Health, November 17-21, 1986 Ottawa, Ontario, Canada, 1986. Accessed July 12, 2002 at <http://www.who.int/hpr/archive/docs/ottawa.html>.

Death What D i

EarlyDeath

Determines Health?Death

Disease, Disabilityand Social Problems

Adoption of Health-risk Behaviors

Social, Emotional, & Cognitive Impairment

Adverse Childhood Experiences

ConceptionConceptionAdverse Childhood Experiences: childhood abuse and neglect growing up with domestic violence, substance abuse or mental illness in the home, parental discord, crime

ACE Score andAlcoholism, Suicide Attempts, or Sexual Assault

30

35

%)

Number of adverse factors:

25

robl

em (

%

0 1 2 3 4 or moreNumber of adverse factors:

15

20

Hea

lth P

10

cent

With

0

5Perc

S ll lt dConsiders selfan alcoholic

Ever attemptedsuicide

Sexually assaultedas an adult (women)

Society's HealthResponse

Areas of Emphasis

Targetedprotection

Primaryprevention

Secondaryprevention

Tertiaryprevention

Response

Generalprotection

Medical and Public Health PolicyHealthy Public Policy & Public Work

Safer,Healthier

Population Becoming

Becoming nolonger vulnerable

VulnerablePopulation Becoming

Afflictedwithout

Complications DevelopingC li i

Afflicted withComplications

opu at o gVulnerable

gAfflicted Complications

Dying fromComplications

Adverse LivingConditions

DISEASE AND RISK MANAGEMENT

World of Transforming… By Strengthening…

DEMOCRATIC SELF-GOVERNANCE

World of Providing…

• Education• Screening• Disease management • Pharmaceuticals• Clinical services

g

• Deprivation• Dependency• Violence• Disconnection• Environmental decay• Stress

y g g

• Leaders and institutions• Foresight and precaution• The meaning of work• Mutual accountability• Plurality• Democracy

• Physical and financial access• Etc…

• Insecurity• Etc…

y• Freedom• Etc…

Centers for Disease Control and Prevention Bobby Milstein

Seeing a Wider Set of Relationships

Health

Capacity toAct

LivinggConditions

Centers for Disease Control and Prevention, Bobby Milstein

What Determines Health?Education and Health

7 5

10

000

5

7.5

hs p

er 1

,

0

2.5

Dea

th

0 0-11 12 13-15 >16

Education Years Completed

Percent reporting poor or fair health by education and household incomeby education and household income

Hennepin County Adults 2010

34.5

40

20 7 21.6

30

t 20.7

13.6

10

20

Perc

ent

4.6 5.9

0

10

Less thanhigh

school

Highschool

Somecollege

College orhigher

<200% FPL 200+% FPL

Educational attainment Household income

35

Place mattersCommunity mattersCommunity matters

Health OutcomesHealth Factors

Obesity Trends* Among U.S. AdultsBRFSS 1985BRFSS, 1985

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

No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19% ≥20



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

Obesity Trends* Among U.S. AdultsBRFSS 2002

(*BMI ≥30, or ~ 30 lbs overweight for 5’4” person)(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)BRFSS, 2002

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



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


(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

What Determines Health?Socioeconomic Status and HealthSocioeconomic Status and Health

Income12.5

0

7.5

10

per 1

,000

2.5

5

Dea

ths

p

00 1 2 3 4 5

lowest Income Groups highest

Percent reporting poor or fair health by education and household incomeby education and household income

Hennepin County Adults 2010

34.5

40

20 7 21.6

30

t 20.7

13.6

10

20

Perc

ent

4.6 5.9

0

10

Less thanhigh

school

Highschool

Somecollege

College orhigher

<200% FPL 200+% FPL

Educational attainment Household income

62

Individual health is influenced by the health of the communityby the health of the community

County Health Rankings Model

YO YO versus WIITYO YO versus WIIT

YOU Are ON YOUR OWN

versus

WE ARE IN IT Together

Seeing a Wider Set of Relationships

Health

Capacity toAct

LivinggConditions

Centers for Disease Control and Prevention, Bobby Milstein

Public health is the constant redefinition of the unacceptable.

Geoffrey Vickers

“Public sentiment is everything. With public sentiment nothing can fail; withoutpublic sentiment, nothing can fail; without it nothing can succeed. Consequently he who moulds public sentiment, goes deeper than he who enacts statutes or pronounces decisions.

He makes statutes and decisions possible or impossible to be executed.” Abraham LincolnAbraham Lincoln

Ralph Waldo Emersonborn on May 25,1803

“The creation of a thousand forests is in one acorn ”forests is in one acorn.

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