women’s health across the nation: a federal perspective · a federal perspective national...

Women’s Health Across the Nation:A Federal Perspective

National Conference of State LegislatorsHealth Reform and Women’s Health in the States

December 11, 2008

Judy Hannan, RN, MPH

Overview of Today’s Talk

• Urgent Need.

• Many Opportunities.

• Myriad Resources.

Division for Heart Disease and Stroke Prevention:Mission and Vision

Our MissionTo serve as the nation’s public health leader for achieving cardiovascular health for all and eliminating the disparities in the burden of heart disease and stroke.

Our VisionA heart-healthy and stroke-free world.

Our Perspective

Heart Disease and Stroke are 1st and 3rd Leading Causes of Death

Source: CDC/NCHS National Vital Statistics Report, Vol 56, No 10. 2008.

More than 850,000 CVD Deaths per YearN

umbe

rs o

f dea

ths

AgeSource: CDC/NCHS. Compressed Mortality File 2005.

0

50,000

100,000

150,000

200,000

250,000

20-34 35-44 45-54 55-64 65-74 75-84 85+

MenWomen

One-third of events occur before age 75.

Num

bers

of e

vent

s (x

100

0)More than 3 Million CVD Events per Year

0

200

400

600

800

1000

1200

1400

Acute coronary events Strokes Hospitalizations forheart failure

TotalMenWomen

Sources: Acute coronary events/stroke - AHA HDS Stat 2008 Update; NHLBI: unpublished data; Hospitalizations - NHDS 2005.

Num

ber o

f eve

nts

(x 1

000)

Prev

alen

ce (%

)

Source: National Health and Nutrition Examination Survey, 1999-2006

Number of Risk Factors

Increased Risk of Cardiovascular Disease in Majority of Adults

Source: National Health and Nutrition Examination Survey, 1999-2006.

Many Opportunities

Prevent Risk Factors

Detect and Treat Risk Factors

Detect and Treat Acute Events

Reduce Disability and Risk of Recurrent CVD

Policy and Environmental Change

Behavior Change Risk Factor

Detection and Control Emergency

Care / Acute Case Management Rehabilitation

/ Long-term Case Management

End-of-Life Care

300,000,000 279,000,000 3,056,000






Behavior Change

Risk Factor Detection and Control

Emergency Care / Acute Case Management

Rehabilitation / Long-term Case Management

300,000,000 279,000,000 3,056,000

End ofEnd of

Life Care

Making the healthy choice the easy

choiceHealth Care System





Behavior Change Risk Factor

Detection and Control Emergency

Care / Acute Case Management Rehabilitation

/ Long-term Case Management

End-of-Life Care

Nutrition TobaccoPhysicalActivity

Program Priorities:

1. Control high blood pressure.

2. Control high blood cholesterol.

3. Improve emergency response.

4. Improve quality of care.

5. Increase awareness of signs and symptoms of heart attack and stroke and the need to call 9-1-1.

6. Eliminate disparities.

WISEWOMAN: Flow of Services

Recruited from

NBCCEDP Program

Cardiovascularrisk factor

screening and counseling

Lifestyle intervention

for diet, physical activity and

tobacco

Riskfactors

prevented

Abnormal

Medical referral, diagnosis,

and follow-up

Lifestyle intervention

Riskfactorsreduced

Current Initiatives

Measure, track, and improve the quality of care

for acute stroke patients.

Increase public awareness of stroke treatment

and prevention.

Decrease rate of premature death and disability.

Reduce disparities in acute stroke care.

Time Lost is Brain Lost

Make the Healthy Choice the Easy Choice

At Worksites

•Affordable healthy foods.

•Food labeling.

•Health education classes and

counseling

•On-site exercise equipment.

•Smoke-free envionment.

Making the Healthy Choice the Easy Choice

In the Community

•Fresh fruits and vegetables.

•Pedestrian friendly routes.

•Increasing physical activity.

Available at:www.prevent.org

The Asheville, NC ProjectDecrease in blood pressure and cholesterol levels.

Decrease in CVD event rates.

Decrease in CVD related costs.

Decrease in costs of CVD events, to $9,931 from $14,343, or $4412 per event.

Community-Level Intervention Reduces Costs

Right thing.

Right people.

Right time.

Healthcare System

Provide appropriate health benefits.

Automated reminder systems.

Disease management programs.

Healthcare System Options

The Georgia Stroke and Heart Attack Prevention Program (SHAPP)

Components:EducationDirect Service

Fewer Events

Annual cost: $486

Usual care: $624

(+$138)

No care: $534

(+$ 48)

Scenario: Spend $5 for health prevention for every $100 of personal health care spending.

Investing in Prevention can Reduce Spending

Source: Prevention Institute. 2007. Reducing Healthcare Costs Through Prevention. Available at http://www.preventioninstitute.org/documents/HE_HealthCareReformPolicyDraft_091507.pdf.

Time Horizon Impact of investing in prevention

20 years

30 years

Scenario: Spend $5 for health prevention for every $100 of personal health care spending.




20 yearsThe investment in prevention pays for itself (break-even point).

30 years



20 yearsThe investment in prevention pays for itself (break-even point).

30 yearsPrevention spending: $1.28 trillion

Reduction in healthcare spending: $2.75 trillion.

National savings of $1.46 trillion


Time Horizon

Financial Outcomes

1-2 Years 5 Years 10-20 Years

Net Savings $2.8 billion $16 billion $18 billion

ROI 0.96:1 5.6:1 6.2:1Source: Trust for America’s Health. 2008 July. Prevention for a healthier America: Investments in disease prevention yield significant savings, stronger communities. Available at: http://healthyamericans.org/reports.

National Return on Investment in Prevention

Scenario: Invest $10 per person in proven community-based disease prevention programs.

Current use of Resources and Emerging Opportunities to Consider

Health Behaviors50%

Environment20%

Genetics20%

Access to Care, 10%

Medical Services96%

Prevention, 4%

Factors Influencing Health

National Health Expenditures

Discrepancy between health determinants and spending of $1.7 trillion, 2007.


Chronic Disease Cost Calculator

• Downloadable tool.

• Estimate state Medicaid costs for six chronic diseases.

• Customize inputs to test different scenarios.

Available at: http://www.cdc.gov/nccdphp/resources/calculator.htm

State health agencies’ total spending to address chronic diseases: Less than 3%.

Full Time Employees employed in chronic disease programs: 2%.

State Opportunities to Address Chronic Diseases

Source: Labarthe DR. (1996). Epidemiology and Prevention of Cardiovascular Diseases. A Global Challenge.

INSTITUTE FOR THE FUTURE

HEALTH & HEALTH CARE 2010: THE FORECAST, THE CHALLENGE

2nd ed., January 2003

A Call for an “Expanded View of Health…”






Behavior Change

Risk Factor Detection and Control

Emergency Care / Acute Case Management

Rehabilitation / Long-term Case Management

300,000,000 279,000,000 3,056,000

End ofEnd of

Life Care

Making the healthy choice the easy

choiceHealth Care System

www.prevent.org

http://healthyamericans.org

www.americanprogress.org

Resources

Select Online Tools and Resources:•Public Health Action Plan to Prevent Heart Disease and Stroke.

•Moving into Action: Promoting Heart-Healthy and Stroke-Free Communities

•Interactive heart disease and stroke maps.

•Atlas of Stroke Hospitalizations among Medicare Beneficiaries.

•Purchaser’s Guide to Clinical Preventive Services.

•Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit.

•The Community Health Worker's Sourcebook.

•State heart disease and stroke legislation database (updates coming soon).

•Indicators for Hypertension (coming soon).

•And more…

cdc.gov www.cdc.gov/dhdsp

[email protected]

The findings and conclusions in this presentation are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control and Prevention

Thank you

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