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State Perspectives of Population Health
Lilian Peake, MD, MPHDirector, Public Health
Outline
• 20th Century Population Health Improvement
• 21st Century Challenges
• Population Health Trends in South Carolina
• Population Health Approach
http://www.livescience.com/21213-leading-causes-of-death-in-the-u-s-since-1900-infographic.html
Mortality from all causes declined 54% between 1900 and 2010.
Control of Infectious Disease
Source: http://www.dailymail.co.uk/sciencetech/article-3409908/The-seven-biggest-threats-humanity-revealed-nuclear-winter-devastating-supervolcano-experts-explain-violent-ways-world-end.html
Rahima Banu – October 1975
Variola Major - Bangladesh
Ali Maow Maalin – October 1977
Variola Minor - Somalia
** Two laboratory acquired cases occurred in UK in 1978
Eradication of Smallpox
Source: CDC
Source: http://www.hkma.org/english/cme/onlinecme/cme200305main.htm
Control of SARS
Source: CDC
Decrease in Infant Mortality
Control of Tobacco Use
Source: https://www.ahrq.gov/professionals/education/curriculum-tools/population-health/abrams.html
Decline in Rate of Lung Cancer
Source: https://www.ahrq.gov/professionals/education/curriculum-tools/population-health/abrams.html
Control of Coronary Heart Disease
Source: National Heart, Lung, and Blood Institute – NIH Age-Adjusted Death Rates for Coronary Heart Disease, U.S., 1950–2010. Actual Rate and Expected Rates if Rise Had Continued or Reached a
Plateau
Note: Due to changes in methodology, estimates are not comparable from 2005-2010 to 2011-2015Source: SC Behavioral Risk Factor Surveillance System. Division of Surveillance, Office of Public Health Statistics and
Information Services, SC DHEC
0
5
10
15
20
25
30
2005 2007 2009 2011 2013 2015
Pe
rce
nt
(%)
Year
Adult SmokingSouth Carolina
White
Black
All races
Note: Survey conducted every odd yearSource: SC Youth Risk Behaviors Survey. SC Department of Education.
0
5
10
15
20
25
30
35
2005 2007 2009 2011 2013 2015
Pe
rce
nt
(%)
Year
Youth Smoking (High School)South Carolina
White
Black
All races
Outline
• 20th Century Population Health Improvement
• 21st Century Challenges
• Population Health Trends in South Carolina
• Population Health Approach
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
77.0
78.0
79.0
80.0
81.0
82.0
83.0
84.0
85.0
86.0
Pe
r C
ap
ita
Sp
en
din
g -
20
12
Av
era
ge
Lif
e E
xp
ecta
ncy
20
15
Est
ima
tes
Life Expectancy Per Capita Spending
Source: Life Expectancy from CIA World Factbook (2015); Per Capita Spending on Healthcare in current US $ from OECD (2012)
“Americans have a longstanding pattern of poorer health…over the life course.”
Source: 2015 National Academy of Sciences
Higher Rates than Average of Peer Countries
• Infant mortality
• Low birth weight
• Adolescent pregnancy
• Sexually transmitted infections
• Injuries
• Heart disease
• Chronic lung disease
• Disability
• Obesity
• Diabetes
• Drug-related deaths
Source: U.S. Health in International Perspective, National Academy of Sciences, 2015, http://sites.nationalacademies.org/DBASSE/CPOP/US_Health_in_International_Perspective/
Source: http://www.commonwealthfund.org/~/media/images/publications/fund-report/2010/jun/mm2010l.gif
Comparison of Healthcare System Outcomes
Source: https://www.slideshare.net/kingcobra2012/ib-ess-topic-3-human-population
An Aging Population
Adverse Childhood Experiences Study
Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention
Source: CDC, https://www.cdc.gov/violenceprevention/acestudy/ace_graphics.html
Prevalence of Diagnosed and Projected Diagnosed
Diabetes Cases in the United States, 1960-2050
SOURCE: https://aspe.hhs.gov/report/diabetes-national-plan-action/introduction. Data for 1960–1998 from the National Health Interview Survey, National Center for Health Statistics (NCHS). Centers for Disease Control and Prevention (CDC) projected data for 2000–2050 from the Behavioral Risk Factor Surveillance System, Division of Diabetes Translation, CDC. (Note: The “Diagnosed cases” arrow refers to the section of the figure that includes diagnosed cases of diabetes versus the section that includes projected cases. The line graph and not the line arrow indicate the number of diagnosed cases.)
Chronic Disease
Source: APHA
Emergent Infections and Antibiotic Resistance
Outline
• 20th Century Population Health Improvement
• 21st Century Challenges
• Population Health Trends in South Carolina
• Population Health Approach
South Carolina: 42nd out of 50
Source: http://www.americashealthrankings.org/
Leading of Causes of Death South Carolina, 2005 and 2015
2005 2015
1 Heart Disease
2 Cancer
3 StrokeChronic Lower Respiratory
Disease
4 Unintentional Injuries
5Chronic Lower Respiratory
DiseaseStroke
6 Alzheimer’s Disease
7 Diabetes
0
50
100
150
200
250
300
2005 2007 2009 2011 2013 2015
Ag
e-a
dju
ste
d m
ort
ality
ra
te p
er
10
0,0
00
po
pu
lati
on
Year
Heart Disease Deaths
White
Black
All races
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
0
50
100
150
200
250
2005 2007 2009 2011 2013 2015
Ag
e-a
dju
ste
d m
ort
ality
ra
te p
er
10
0,0
00
po
pu
lati
on
Year
Cancer Deaths
White
Black
All races
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
0
10
20
30
40
50
60
2005 2007 2009 2011 2013 2015
Ag
e-a
dju
ste
d m
ort
ality
ra
te p
er
10
0,0
00
po
pu
lati
on
Year
Chronic Lower Respiratory Disease Deaths
White
Black
All races
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
0
10
20
30
40
50
60
70
2005 2007 2009 2011 2013 2015
Ag
e-a
dju
ste
d m
ort
ality
ra
te p
er
10
0,0
00
po
pu
lati
on
Year
Injury Deaths
White
Black
All races
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
0
5
10
15
20
25
2005 2007 2009 2011 2013 2015
Ag
e-a
dju
ste
d m
ort
ality
ra
te p
er
10
0,0
00
po
pu
lati
on
Year
Overdose Deaths
White
Black
All races
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
0
5
10
15
20
25
2005 2007 2009 2011 2013 2015Ag
e-a
dju
ste
d m
ort
ality
ra
te p
er
10
0,0
00
po
pu
lati
on
Year
Black HomicideWhite SuicideAll Races SuicideAll Races HomicideBlack SuicideWhite Homicide
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
0
1
2
3
4
5
6
7
8
9
10
2005 2007 2009 2011 2013 2015
Ag
e-a
dju
ste
d m
ort
ality
ra
te p
er
10
0,0
00
po
pu
lati
on
Year
Deaths Due to Falls
White
Black
All races
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
0
5
10
15
20
25
30
2005 2007 2009 2011 2013 2015
Ag
e-a
dju
ste
d m
ort
ality
ra
te p
er
10
0,0
00
po
pu
lati
on
Year
Motor Vehicle Accident Deaths
White
Black
All races
0
10
20
30
40
50
60
70
80
90
2005 2007 2009 2011 2013 2015
Ag
e-a
dju
ste
d r
ate
pe
r 1
00
,00
0 s
tan
da
rd p
op
ula
tio
nStroke Deaths
White
Black
All Races
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
0
10
20
30
40
50
60
2005 2007 2009 2011 2013 2015
Ag
e-a
dju
ste
d m
ort
ality
ra
te p
er
10
0,0
00
po
pu
lati
on
Year
Alzheimer's Disease Deaths
White
Black
All races
Source: Division of Biostatistics, Office of Public Health Statistics and Information Services, SC DHEC
0
10
20
30
40
50
60
2005 2007 2009 2011 2013 2015
Ag
e-a
dju
ste
d m
ort
ality
ra
te p
er
10
0,0
00
po
pu
lati
on
Year
Diabetes Deaths
White
Black
All races
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
2005 2007 2009 2011 2013 2015
Pe
rce
nt
(%)
Year
Adult Obesity
White
Black
All races
Notes: Due to changes in methodology, estimates are not comparable from 2005-2010 to 2011-2015Source: SC Behavioral Risk Factor Surveillance System. Division of Surveillance, Office of Public Health Statistics and
Information Services, SC DHEC
Outline
• 20th Century Population Health Improvement
• 21st Century Challenges
• Population Health Trends in South Carolina
• Population Health Approach
Relative Contribution of Factors that Affect Health
40%
30%
10%
20%
Social and Economic
Factors
Health Behaviors
Medical
Environment
Source: Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012.
Effect of Population Level Interventions
Source: Frieden, A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health. 2010 April; 100(4): 590–595. doi: 10.2105/A JPH.2009.185652.
Source: http://www.americashealthrankings.org/
Opportunities
• Projected savings by 2023 with modest improvement in prevention and treatment of chronic disease
• Could avoid 40 million cases
• Cut treatment costs $220 billion
• Increase GDP $900 billion
• ROI = $5.60 for every $1.80 invested in proven community-based prevention program
• Challenge – Identify evidence-based programs shown to be cost-effective
Source: Chatterjee et al, Checkup Time: Chronic Disease and Wellness in America, Milken Institute, Jan 29, 2014, Trust for America’s Health, Bending the Obesity Cost Curve, January 2012, http://healthyamericans.org/assets/files/TFAH%202012ObesityBrief06.pdf
:
Collaborative CommunityHealth Improvement
• Collaborative Health Assessment – SHA/CHA• Primary causes of illness, injury and premature death
• Patterns of health determinants
• Collaborative Health Improvement –SHIP/CHIP• Plan
• Develop interventions and measure progress
• Quality Improvement approach
Food Access
Housing
Transportation
Education
Public Safety
Economic Development
Criminal Justice
Community Design
Water System
Health
Health in All Policies
Impact of North Carolina’s Motorcycle Helmet Law on Hospital Admissions and
Charges for Traumatic Brain Injuries• Compared North Carolina motorcycle related brain
injury cases with three states (Florida, South Carolina, Pennsylvania) that had repealed their motorcycle helmet law
• North Carolina’s law prevented 190-226 hospitalizations for TBI in 2011
• Averted hospital charges to taxpayer-funded sources of $9.5 million - $11.6 million
• Total averted hospital charges were $25.3 million -$31.0 million.
NC Medical Journal, 2015
Create Accountable Care Communities
• Assess and track health outcomes• Population
• Hot spotting
• Quality
• Prioritize and focus on key health issues• Collective Impact
• Create clinical-community linkages• Community health workers
• Care coordination
• Team-based clinical care• Team extends to community partners
Develop partnerships to:
Create policies, systems
and environmental
changes that support
healthy behaviors.
Fill gaps in needed
services.
Involve patient, family,
and community in
strategic planning and
improvement activities
Collective Impact• Common Agenda
• Shared Measurement
• Mutually Reinforcing Activities
• Continuous Communications
• Backbone Support
Isolated Interventions
Aligned Efforts
and Resources
SC Birth Outcomes Initiative
• Active coalition - DHHS, SC Hospital Association, DHEC, March of Dimes, and many partners
• Reduced Early Elective Deliveries
• Post-partum LARC Insertion
• Safe Sleep
• Perinatal Regionalization
• Breastfeeding Friendly• Milk Bank
The Power of Collaboration• BOI was launched in 2011
• From 2005–2007 to 2012–2014, infant mortality rates declined in a total of 33 states and the District of Columbia
• Declines of more than 20.0% were observed in Connecticut, South Carolina, Colorado, and D.C.
Thank You!