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OBESITY RATES. More than 65% US Adults Obese or Overweight

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Title: OBESITY RATES. More than 65% US Adults Obese or Overweight


1
NAACLS FORUM
  • Future of Health Care
  • October 1, 2004
  • Thomas W. Elwood, Dr.P.H.

2
FUTURE OF HEALTH CARE
  • Demography
  • Epidemiology
  • Technology
  • Federal Government Role

3
DEMOGRAPHY
  • Aging of Society
  • Related Aspects of Aging
  • Ethnic Composition

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RELATED ASPECTS OF AGING
  • Airplane Delays
  • Automobile Accidents
  • Voting Problems

8
ETHNICITY FACTORS
  • Hispanic/Asian Populations To Triple in Next 50
    Years
  • Non-Hispanic Whites 50 of Population by 2050
  • Hispanic Is Largest Minority Group
  • 39,000,000 (3 growth rate)
  • Not Monolithic
  • Health Care Disparities (Pap,BSE,BP/Cholesterol,ER
    ,Meds)

9
GENDER FACTORS
  • 16,400,000 More Women over Age 65 in Next 25
    Years
  • Increased Demand for Cardiovascular and Pulmonary
    Services
  • Cardiovascular Services Will Outstrip Obstetrical
    Services

10
EPIDEMIOLOGY
  • Causes of Death
  • Aging and Chronic Disease
  • Cultural Aspects of Health Care
  • Literacy and Compliance Issues
  • Obesity
  • Complementary Alternative Medicine
  • Infectious Diseases

11
LEADING CAUSES OF DEATH

12
ACTUAL CAUSES OF DEATH
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19
CULTURAL ASPECTS OF HEALTH CARE
  • Reluctance to Seek Care
  • Origin and Treatment of Disease
  • African-American VHA Patients
  • Tuskegee Syphilis Study

20
HEALTH LITERACY
  • 46 million Do Not Speak English As Primary
    Language
  • One-Half of Adults Have Trouble Interpreting
    Medical Information
  • Providers Tend Not to Offer Interpreter Services
  • Linked to Higher Rates Hospitalizations/ER Visits
  • Affects Compliance/Self-Management of Chronic
    Disease

21
COMPLIANCE/DISCHARGE
  • Non-Adherence Leads to Hospitalizations
  • Failure to Continue Taking Heart Medications
  • 33 Leave Hospital without ACE Inhibitors
    (One-Third Stop Using Within One Year)
  • 72 CHD Patients Dont Receive Discharge
    Instructions

22
OBESITY RATES
  • More than 65 US Adults Obese or Overweight
  • BMI of 20-22 Ideal
  • BMI of 25 or Higher Overweight
  • BMI of 30 or Higher Obese
  • BMI of 40 or Higher Severely Obese
  • 31 Adults Meet Obesity Criteria
  • 4.7 Adults Severely Obese
  • Highest Growth Rate Category

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24
CAUSES OF OBESITY
  • Eating Outside Home
  • Explosive Growth in Restaurants
  • Parent(s) Employed Full-Time
  • Decline in Smoking
  • Decline in Physical Activity

25
CONSEQUENCES OF OBESITY
  • Added Hospital Costs
  • Beds, Doorways, Toilets, HBP Cuffs, MRI
  • Shorter Life Spans
  • 2-5 Years Less for Moderately Obese
  • 5-20 Years Less for Severely Obese
  • Emotional Well Being
  • Lost Wages Due to Illness

26
COMPLEMENTARY AND ALTERNATIVE MEDICINE
  • Frequency of CAM Usage
  • 36 of Adults Use Some Form
  • 62 if Prayer Included
  • CAM Practices (herbs, diet therapy, chiropractic)
  • Relates to Self-Control/Self-Reliance Image
  • 28 Lack Belief in Conventional Medicine
  • Dietary Supplements
  • Deregulated Industry in 1994
  • Everything Allowed Except for Blatant Lies and
    Claims of Curing Disease

27
  • Mans only competitors for the dominion of the
    planet are the viruses and the ultimate outcome
    is not foreordained.
  • Joshua Lederberg
  • 1958 Nobel Prize

28
CAVALCADE OF DISEASE
  • 1940s
  • 1950s
  • 1960s

29
  • One can think of the middle of the 20th century
    as the end of one of the most important social
    revolutions in history, the virtual elimination
    of the infectious diseases as a significant
    factor in social life.
  • Sir Macfarlane Burnet
  • Nobel Prize 1960

30
FACTORS LEADING TO COMPLACENCY (1950s-1970s)
  • Vaccines
  • Antibiotics
  • Better Nutrition
  • Improved Housing
  • Sanitation
  • Medical Schools Closed Microbiology
    Departments/Ended Infectious Training Programs

31
INFECTIOUS DISEASES
  • AIDS (1981)
  • 4th Leading Cause of Death in World
  • 2nd Leading Cause for African-Americans
  • No Vaccine
  • No Curative Medication
  • Polio and TB

32
INFLUENZA
  • 36,000 Deaths in U.S. Each Year
  • 114,000-200,000 Hospitalizations
  • H5N1 Strain of Great Concern
  • High Case Fatality Rate
  • Cross-Animal Species Transmission
  • Danger of Evolving/Recombining to Produce a Virus
    Humans Can Transmit
  • Form Deadly Hybrid with Regular Flu Virus

33
FACTORS AFFECTING INFECTIOUS DISEASES
  • Human/Farm Animal Populations Increasing
  • Imported Foods
  • Global Urban Growth
  • Humans Moving to Wild Areas
  • Air Travel/Cargo Ship Traffic
  • Hospital Growth in Endemic Areas
  • Terrorism

34
SPREAD OF INFECTIOUS DISEASES
  • Growth in Urban Populations
  • Population of Cities
  • 1950 Two with More Than 7,500,000
  • 2000 30 with More Than 7,500,000
  • Seven with More Than 15,000,000

35
AUM SHINRIKYO CULT
  • Released Sarin Gas in Tokyo Subway (1995)
  • Cult Previously Unknown to Intelligence
  • Thousands of Members, Well-Funded
  • Tried to Aerosolize Anthrax and Botulinum Toxin
    throughout Tokyo at Least Eight Times (1990-95)
  • Organized Team to Zaire to Obtain Ebola Virus
    (1993)
  • Threat Unknown, Non-State Sponsored
    Organization, Acting without Concern for Moral
    Deterrents

36
TECHNOLOGY
  • Genomics
  • Embryonic Stem Cells
  • Nanotechnology
  • Health Information Technology
  • Adoption of Innovations

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HUMAN FEMALE
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40
Stem Cell Research
  • Bush Administration Policy
  • Funding for Limited Set of 22 Lines Dating from
    2001
  • Potential Treatments and Cures
  • Alzheimers Disease
  • Retinal Disease

41
NANOTECHNOLOGY
  • Investment
  • 1Billion by Federal Government
  • Current Products (Sunscreens, Clothing, Computer
    Chips, Cosmetics)
  • Future Products (Body Armor, Prosthetics, CA
    Diagnosis/Treatment)
  • Bulk Particles - Nanoparticles

42
HEALTH CONCERNS
  • Workplace Dangers
  • Waste Streams from Industry/Labs
  • Surface Contact with Cosmetics
  • Ingestion of Food/Beverages Containing
    Nanoparticles
  • Injection of Medicinal Products
  • Excretion of Medical Particles That Are Not
    Biodegraded
  • Lack of Coordinated Federal Monitoring

43
HEALTH INFORMATION TECHNOLOGY
  • Other Industries
  • Costs
  • Legal Barriers
  • Translational Issues
  • 17 years Evidence to Clinical Practice

44
SLOW ADOPTION OF INFORMATION TECHNOLOGY
  • Lack of Access to Capital/Data Standards
  • MD Usage with Patients (8)
  • Handwritten Information/Scattered Records
  • Legal Barriers (Anti-Kickback, Tax Status, UBIC,
    Liability/Malpractice, Licensing)

45
DIFFUSION OF TECHNOLOGY INNOVATIONS
  • Rapid Adoption
  • Coronary Artery Calcium Screening
  • Cost Effectiveness
  • Differential Access to Innovations
  • Cascade Effects of Medical Technology
  • AMHT

46
FEDERAL GOVERNMENTS ROLE
  • Economic Considerations
  • Structure of Government
  • Congress

47
HEALTH INSURANCE
  • Need Broad Payment Reforms
  • Private Premiums Up 11.2 in 2004
  • Higher Tax Obligations for Workers
  • Small Firms Dropping Coverage
  • 68 in 2001
  • 63 in 2004
  • 17 Increase in Part B Premium
  • Health Costs Projected 18.4 of GDP by 2013

48
PROGRAM COSTS
  • Medicare Cost 281 B in 2003
  • Drug Costs to Be Added in 2006
  • 85 Beneficiaries 65 and Older
  • Medicaid Cost 270 B in 2003
  • Aged Are 10 Beneficiaries
  • Consume 60 of Spending
  • Plus 39 B on Veterans Health Care

49
MEDICARE
  • Medicare Outlays Exceed SS by 2024
  • 80,000,000 Beneficiaries by 2030
  • Spending Will Be 7 of GDP
  • Cost Projections Usually Exceeded
  • In 1965, projected 9 Billion for Part A in 1990
    (Actual Cost 67 Billion)
  • In 1988, projected 4 Billion for Home Care in
    1992 (Actual Cost 10 billion)

50
SOCIAL SECURITY
  • 1st Check Issued 1940
  • 42 Workers Per Retiree
  • Males Retired at Age 68
  • Males Retire at Age 62 Now
  • 4 Workers Per Retiree Today
  • 2 Workers Per Retiree by 2030

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52
RELATED CONSIDERATIONS
  • Fewer Non-Elderly Caregivers
  • Group in Bracket 20-54 Will Shrink As a
    Percentage
  • Labor Force Growth One-Third of Todays Growth
  • Slower Government Revenue Growth

53
HEALTH WORKFORCE
  • AHRA (S. 2491 and H.R. 4016)
  • Pipeline Problems
  • Faculty Shortages
  • Practitioner Shortages
  • Aging Factors Involved

54
CONGRESSIONAL PERFORMANCE
  • 108th Congress (2003-2004)
  • 2,810 Senate bills introduced
  • 82 Enacted (2.92)
  • 13 Honorific
  • 69 Substantive (2.45)
  • 157 Referred to HELP Committee
  • 9 Enacted (5.73)

55
CONGRESSIONAL PERFORMANCE
  • 108th Congress (2003-2004)
  • 5,103 House bills introduced
  • 150 Enacted (2.94)
  • 53 Honorific
  • 97 Substantive (1.90)
  • 590 Referred to E C Subcommittee
  • 7 Enacted (1.90)

56
CAPITOL HILL CLIMATE
  • More Fractious Atmosphere
  • Gerrymandering
  • Fewer Competitive Partisan House Races
  • Increased Polarization
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