State Board of Health: Chronic Disease Prevention and Control Initiative

1
State Board of HealthChronic Disease Prevention
and Control Initiative

• Presentation to EPID 602
• Public Health Administration
• November 2, 2005
• Joseph Hilbert
• Executive Advisor to the State Health
  Commissioner

2
Chronic Disease Prevention and Control Initiative

• Background State Policy Approaches to Chronic
  Disease Prevention
• State Board of Health Overview
• Components of Boards Chronic Disease Initiative
• Next Steps

3
VDH Strategic Plan

• Vision Healthy people in healthy communities
• Mission VDH is dedicated to promoting and
  protecting the health of Virginians

4
VDH Strategic Plan - Goals

• Provide strong leadership and operational support
  for Virginias public health system
• Collaborate with partners in the healthcare
  system to assure access to quality health care
  services
• Promote systems, policies and practices that
  facilitate improved health for all Virginians
• Collect, maintain and disseminate accurate,
  timely, and understandable public health
  information
• Prevent and control exposure to toxic substances
  and radiation

5
VDH Strategic Plan - Goals

• Prevent and control the transmission of
  communicable diseases
• Respond timely to any emergency impacting public
  health through preparation, collaboration,
  education and rapid intervention
• Maintain an effective and efficient system for
  the investigation of deaths of unexplained or
  suspicious deaths of public interest
• Assure provision of clean and safe drinking water
  supplies
• Assure provision of safe food at restaurants and
  other places where food is served to the public

6
Chronic Disease Prevention is a Key Public Health
Issue

• Cancer, heart disease, diabetes, hypertension,
  obesity, asthma, etc.
• Effect on quality of life, beginning in childhood
• Impact on health care costs
• Effective prevention requires clinical and
  non-clinical interventions
• Effective prevention requires individual
  behavioral change, and environmental/policy
  changes in the community

7
Average Virginia Medicaid Expenditures Per
Recipient (FY 2003)
Notes with diagnosis, without
diagnosis Source Virginia Department of Medical
Assistance Services
8
Economic Impact of Chronic Disease

• Cancer - 64 billion direct medical costs, 125
  billion lost productivity
• Arthritis - 22 billion direct medical costs, 60
  billion lost productivity
• Smoking-Related Illnesses - 75 billion direct
  medical costs, 80 billion lost productivity
• Asthma - 1 billion direct medical costs, 719
  million lost productivity

Sources The Power of Prevention Reducing the
Health and Economic Burden of Chronic Disease,
U.S. Centers for Disease Control and Prevention,
2003 Direct and Indirect Costs of Asthma in
School-Age Children, Preventing Chronic Disease,
January 2005
9
Virginia Hospitalization Rates Due to Major
Cardiovascular Disease
Note Rate Per 1,000 population Source
Diabetes in Virginia, 2002, Virginia Department
of Health
10
Chronic Disease is a Challenging Issue for States

• Lifestyle decisions (diet, exercise, utilization
  of preventive services)
• Environmental and commercial issues involving
  non-traditional public health partners (schools,
  land use, transportation, food and beverage
  industries)
• Genetics also likely plays a role
• Interventions can require a long time to
  demonstrate measurable results
• Chronic diseases generally not reportable to VDH
  (cancer is an exception)

11
State Approaches to Addressing Chronic Disease

• Obesity prevention
• School nutrition and physical education
• Data collection/BMI measurements for students
• Insurance coverage
• Land use/transportation
• Work-site based programs
• Tobacco control
• Disease specific grants from CDC (e.g., asthma,
  cardiovascular, diabetes)
• VDH Division of Chronic Disease Prevention and
  Control has numerous programs in place other VDH
  divisions involved as well

12
CDC Obesity Prevention Strategies

• The U.S. Centers for Disease Control and
  Prevention (CDC) has identified ten recommended
  obesity prevention strategies for states. These
  strategies tend to be systemic in nature, focused
  on building a sustainable obesity prevention
  infrastructure. They are also premised on the
  notion that locally-based efforts and state
  leadership and support are both necessary
  components to an effective prevention system.

13
CDC Obesity Policy Recommendations

• Coordinate and integrate efforts across state
  agencies and with non-governmental organizations
• Utilize state and local level data for
  decision-making and policy
• Support the development of school health councils
• Help schools assess their own health policies and
  programs
• Raise capacity of school staff through
  certification and professional development
• Establish strong wellness policies
• Promote the use of evidence based interventions
• Promote assessment of student achievement in
  physical education and nutrition education
• Support walk-to-school and co-curricular physical
  activity programs
• Participate in Team Nutrition

14
Governor Warners Healthy Virginians Initiative

• Launched November 2004
• Effort to promote health and wellness and reduce
  health care costs by combating obesity,
  hypertension and other preventable diseases
• Three components
• State employees
• Public school students
• Medicaid recipients
• www.healthyvirginians.virginia.gov

15
2005 Legislation (None Passed)

• HB2610 (Baskerville) Obesity, and health and
  physical education in the public schools. 
  Updates and strengthens the requirements for
  health and physical education instruction in the
  public schools, and to address the problem of
  obesity among students through required
  instruction concerning certain health issues and
  the health consequences of obesity.
• SB747 (Edwards) Childhood obesity.  Requires the
  Board of Education to promulgate, in cooperation
  with the State Health Department, regulations
  establishing standards to ameliorate childhood
  obesity in the public schools.

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2005 Legislation (cont.)

• SB1130 (Lambert) Physical Education. Requires
  physical education to include 30 minutes of daily
  cardio vascular, muscle building and stretching
  exercises, utilizing school personnel.
• HB2140 (Moran) Virginia Wellness-Related Fitness
  Test.  Requires the local school boards of each
  school division to annually administer the
  Virginia Wellness-Related Fitness Test that must
  include an assessment of students' height and
  weight. Height and weight must be measured in
  grades K, 3, 7, and 10 unless students are
  admitted for the first time to a public
  kindergarten or elementary school and have been
  weighed and measured as part of the comprehensive
  physical examination. The Department of Education
  must enter into a memorandum of agreement with
  the Department of Health for the sharing of
  aggregate information on physical fitness,
  height, and weight from which personal
  identifiers have been removed. 

17
Chronic Disease Prevention and Control Initiative

• Background State Policy Approaches to Chronic
  Disease Prevention
• State Board of Health Overview
• Components of Boards Chronic Disease Initiative
• Next Steps

18
State Board of Health

• 13 members appointed by Governor
• Consumers, physicians, nurses, hospitals, nursing
  homes, pharmacists, dentists, veterinarians,
  local government and corporate purchasers of
  health care required to be represented
• Staff support provided by VDH
• Provides leadership in planning and policy
  development
• Primary advocate for citizens in achieving
  optimal health

19
Board of Health Statutory Authority

• 32.1-13.1. Health policy responsibilities.
• The Board of Health may direct the Department to
  inform it regarding health care policy and
  financing concerns through such studies as the
  Board may deem necessary and appropriate to be
  conducted. The Board may make recommendations
  concerning health care policy to the Governor,
  the General Assembly, and the Secretary of Health
  and Human Resources.

20
Origin of Boards Role in Addressing Chronic
Disease

• Desire to become more proactive
• Governor Warner informed his appointees that he
  wanted to hear their policy and programmatic
  ideas
• August 2004 planning retreat selected chronic
  disease prevention as its top priority
• VDH staff developed workplan and position paper
  to guide the Board

21
Rationale for Boards Initiative

• Given the severe consequences for Virginias
  economy and to the quality of life of its
  residents, the Commonwealth can not afford to
  ignore the urgency of seeking new avenues to
  address chronic disease
• Board believes that it is uniquely positioned
  within the State to convene stakeholders, develop
  public policy proposals to address chronic
  disease prevention and control, and advocate for
  their adoption

22
Collaboration with State Board of Education (2004)

• Joint Committee established to examine issues
  pertaining to nutrition and physical activity
  levels among k-12 population, from the
  perspective of obesity prevention
• Improvements in the nutritional environment
  within schools and increase in student physical
  activity levels can create significant long-term
  improvements in health status and educational
  achievement, and reductions in health care
  expenditures
• Public health is driven towards interventions
  aimed at promoting healthy behavioral choices
  among young people so that they may carry them
  into adulthood

23
Collaboration with Board of Education (continued)

• Final Report with recommendations issued in
  September 2004
• State guidelines for development of nutrition and
  physical activity policies by local school
  divisions
• Mechanism for state level evaluations and
  technical assistance
• Continuing collaboration between VDH and DOE
  concerning health of the school age population
• Report adopted by Board of Health in October 2004
• Board of Education referred the report to the
  Department of Education for review

24
Local School Districts - Wellness Policies

• 2004 WIC Reauthorization Act requires local
  wellness policies by September 2006
• Nutrition education, physical education, and
  other school-based activities to promote student
  wellness
• Goals, nutrition standards with objective of
  promoting student health and reducing childhood
  obesity
• Plan for measuring implementation
• Involve parents, students, teachers,
  administrators, school nutrition service, school
  board and the public in developing the policy
• Status reports due to Department of Education by
  July 1, 2006

25
Chronic Disease Prevention and Control Initiative

• Background State Policy Approaches to Chronic
  Disease Prevention
• State Board of Health Overview
• Components of Boards Chronic Disease Initiative
• Next Steps

26
Prevention and Early Detection

• Board supports programs and policies that promote
  healthy behaviors avoidance of known risk
  factors and the evidence-based management of
  chronic diseases
• Greater utilization of preventive services, such
  as regular physical exams and health screenings
  would facilitate early detection and promote
  improved public health
• Making better use of these preventive measures
  and adopting a healthier lifestyle is critical to
  improving the health of Virginians

27
Best Practices

• Board supports a multi-pronged and
  well-coordinated effort employing the resources
  of subject matter experts, and public and private
  sectors in the institution and promotion of best
  practices in the prevention and management of
  chronic disease
• Among Public Healths roles
• Showcase prevention opportunities and promote
  their development
• Educate public/policymakers about benefit of
  these policies and programs
• Advocate for their widespread application

28
The Board of Health Will

• Be the unifying voice for the prevention and
  control of chronic diseases in Virginia
• Establish the burden associated with chronic
  diseases and frame the problem to be addressed
• Establish strong working relationships with other
  governmental agencies and governing boards, and
  with nongovernmental lay and professional groups
• Foster the development of public/private
  partnerships that will facilitate improved
  prevention and control of chronic disease

29
The Board of Health Will

• Establish systematic approaches for determining
  whether Virginias comprehensive chronic disease
  programs objectives are being achieved to
  improve the health and quality of life of
  Virginians

30
The Board of Health Will

• Support the National Chronic Disease Prevention
  Agenda established by the U.S. Centers for
  Disease Control and Prevention
• Promoting health and wellness programs as schools
  and work sites and in faith- and community-based
  settings
• Enacting policies that promote healthy
  environments
• Ensuring access to a full range of quality health
  services
• Implementing programs that focus on eliminating
  racial, ethnic and socioeconomic based health
  disparities
• Educating the public effectively about their
  health

31
The Board of Health Will

• Encourage the creation of financial and
  non-financial incentives and disincentives that
  will spur progress in chronic disease prevention
  and control efforts
• Use data and work with partners to develop
  comprehensive state plans to guide program
  efforts that emphasize quality of care,
  prevention measures and improved outcomes
• Focus on specific targets for change (population
  segments, organizations or environments), choose
  the best channels to effect such changes, and
  select appropriate strategies for doing so

32
Responses to Boards Position Paper

• March of Dimes
• Recommends that the Board consider the broad
  benefit of a comprehensive birth defects
  surveillance system. Proposes partnering with
  the Board on an effort to provide smoking
  cessation training to medical care providers.
  Recommends replication of a Winchester-based
  prenatal program for women with diabetes.
  Recommends attention to the needs of pregnant
  teens in public schools. Recommends that the
  Board advocate for walkways as part of new
  residential development.

33
Responses to Boards White Paper

• American Cancer Society, American Lung
  Association, American Heart Association
• We urge the Board to join us in advocating for
  funding to initiate a statewide tobacco cessation
  program to reduce the morbidity and mortality of
  individuals who use tobacco products.

34
Responses to Boards White Paper (continued)

• Virginia Association of Free Clinics
• Virginia Association for Home Care
• Virginia Rural Health Association
• Virginia Dental Association VCU School of
  Medicine, Department of Human Genetics
• Medical Society of Virginia
• Virginia Public Health Association

35
Comments from Local Health Departments

• Increase VDH Funding and Staffing
• Hire full-time dedicated staff to address chronic
  disease issues in each local health district
• Promote Environmental Changes Designed to Reduce
  Chronic Disease Risk Factors
• Improve Nutritional Status and Physical Activity
  Levels of Children
• Improve Nutritional Status and Physical Activity
  Levels of Children
• Conduct Outreach and Develop Partnerships
• Encourage Development of Financial Incentives for
  Healthy Lifestyles
• Promote Chronic Disease Case Management

36
Chronic Disease Initiative - Subsequent
Activities

• April 2005 Board meeting in conjunction with VDH
  Chronic Disease Conference in Roanoke
• Power Point Roadshow Presentation
• Site visits to Kuumba Community Health Center in
  Roanoke, and Atlantic Community Health Center on
  Eastern Shore
• Presentations from DMAS, Anthem Blue Cross Blue
  Shield, Virginia Association of Free Clinics,
  Virginia Primary Care Association, Prospect
  Empowerment Center (Yorktown), Diabetes Coalition
  of Eastern Shore, Accomack County Cooperative
  Extension, Eastern Shore Rural Health System

37
Chronic Disease Prevention and Control Initiative

• Background State Policy Approaches to Chronic
  Disease Prevention
• State Board of Health Overview
• Components of Boards Chronic Disease Initiative
• Next Steps

38
VDH Budget Amendment Requests

• 1.65 million annually to provide for 35
  additional health educator positions in local
  health districts across the state. Would be used
  to establish community-based health promotion
  programs, increase chronic disease prevention
  capacity in local communities, provide technical
  assistance and guidance to other community health
  care providers, and monitor and evaluate
  processes to determine whether objectives are
  reached.
• 2.9 million annually for Virginias Quitline,
  which provides tobacco cessation counseling and
  support services. Would enable the number of
  people receiving Quitline services to increase
  from the current 300 to approximately 22,000.

39
VDH CHAMPION Initiative

• Commonwealths Healthy Approach and Mobilization
  Plan for Inactivity, Obesity and Nutrition
  (CHAMPION).
• VDHs Division of WIC and Community Nutrition
  Services (DWCNS) has adopted a process for
  developing a state wide plan addressing
  prevention and control of obesity in Virginia.

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CHAMPION (cont.)

• In order to assure the participation of
  stakeholders throughout Virginia, DWCNS has
  conducted 6 regional meetings.
• To date, over 840 people have participated in
  CHAMPION meetings.

41
Governors Office Has Requested Additional Policy
Options from VDH

• Focusing on strategies to promote wellness in
  order to help mitigate certain chronic disease
  risk factors (e.g., poor nutrition, inadequate
  physical activity
• School-based
• State-employee health insurance plan
• State offices
• Governor is also examining ways to improve Early
  Childhood services

42
Future Direction for Board of Health

• Seek to establish public/private partnerships to
  further the accomplishment of its objectives
• Focus on encouraging the development of financial
  and non-financial incentives and disincentives
  for chronic disease prevention and control

43
Future Direction for Board of Health (cont.)

• Work with other stakeholders to deliver education
  and outreach activities to make the public health
  and economic case for chronic disease prevention
  and control efforts.
• Potential options for education and outreach
• Early prevention and intervention with children
• Target worksites in order to reach the adult
  population
• Focus on older adults
• Focus on an underserved population (i.e.,
  Medicaid recipients)

44
Future Direction for Board of Health (cont.)

• Develop a set of consistent, simple public health
  messages that underscore what individuals can do
  to prevent or delay the onset of various chronic
  diseases
• Individual board members will meet with
  representatives of their constituent
  organizations in order to raise the level of
  awareness of, and increase public support for,
  public health efforts to prevent and control
  chronic disease

45
Longer Term Goals for Board

• Development of and advocacy for public policy
  proposals, including legislative, regulatory and
  budgetary initiatives that would support improved
  chronic disease prevention and control in
  Virginia

46
State Board of Health Chronic Disease Initiative

• Questions???
• Comments???
• Suggestions???
• Joe Hilbert
• Executive Advisor to State Health Commissioner
• Joe.hilbert_at_vdh.virginia.gov
• [phone]