Board of Health Chronic Disease Initiative

1
Board of Health Chronic Disease Initiative

• Joe Hilbert, Executive Advisor to the
  Commissioner
• November 6, 2006

2
VDH Strategic Plan

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

3
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

4
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

5
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

6
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
7
Average Virginia Medicaid Expenditures Per
Recipient (FY 2003)
Notes with diagnosis, without
diagnosis Source Virginia Department of Medical
Assistance Services
8
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)

9
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

10
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

11
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.

12
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

13
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

14
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

15
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

16
VDH CHAMPION Initiative

• Commonwealths Healthy Approach and Mobilization
  Plan for Inactivity, Obesity and Nutrition
  (CHAMPION)
• Goal of equipping local communities with
  effective tools to decrease obesity rates.
• Regional meetings were conducted from March to
  August 2005, more than 900 people representing
  250 organizations participated
• Participants identified and ranked more than
  4,500 factors they felt contributed to obesity,
  the barriers to overcoming them, and identified
  and ranked solutions to overcoming the barriers.

17
CHAMPION Initiative

• Four main themes will form the basis of
  comprehensive obesity prevention plan
• media intervention,
• nutrition education,
• community involvement,
• public policy.
• VDH will review public and private programs that
  relate to each of the four themes for proven
  practices that can be implemented in communities
  throughout Virginia.
• The programs will be judged on their cost
  effectiveness, ease of implementation, cultural
  sensitivity, and scientifically proven results.
• Once effective programs have been identified, VDH
  staff will train communities to implement them.

18
VDH Chronic Disease Prevention Grant Program

• 735,000 for FY07
• 385,000 in vital records revenue set aside by
  General Assembly for health care services
• 350,000 in Preventive Health and Health Services
  block grant funds
• VDH is committed to continuing this funding in
  FY08, when a greater amount of vital records
  revenue is expected to be available

19
Objective of Grant Program

• Support the Boards initiative
• Foster chronic disease prevention and control
  projects
• Add chronic disease prevention and control
  capacity

20
Selection Criteria

• Extent to which objectives are meaningful and
  measurable
• Extent to which private sector resources are
  leveraged
• Extent to which arrangements have been made for
  follow-up medical treatment
• Cost of existing positions could not be charged
  against the grant

21
16 Proposals Received from Local Health Districts

• 12 proposals approved for funding in FY07
• Proposals varied significantly in terms of focus,
  scope of work and amount of funding requested
• 1 additional proposal approved for funding in
  FY08
• 3 proposals not approved for funding

22
Chesterfield (33,069)

• Get L.E.A.N.! (Lessons on Exercise, Activity and
  Nutrition)
• Obesity prevention in low income adult females
• Programs will be held at county libraries
• Recruitment will target residential areas that
  have a high minority or underserved population

23
Peninsula (109,859)

• Chronic disease prevention and control among
  residents of Southeast Community (SEC) of Newport
  News
• Four part-time positions (2 outreach workers,
  social worker and health educator) will join a
  Sr. Public Health Nurse in creating a health
  district team to implement objectives of SEC
  initiative

24
Rappahannock Area (100,500)

• Implement Caroline County Wellness Campaign,
  which has already been designed by Caroline
  Health Advisory Commission following two years of
  work.
• Goals Reduce incidence of obesity, Reduce
  tobacco use

25
Prince William (89,914)

• Diabetes prevention and control among
  uninsured/underinsured, with a focus on minority
  populations.
• Funding will be used to underwrite part of a
  Nurse Practitioner position, to be employed by
  Greater Prince William Community Health Center
• Persons at risk for Type II diabetes will be
  identified among the CHC patient population

26
Roanoke City (29,299)

• Childhood obesity prevention in Hurt Park section
  of the city
• Focus on increasing physical activity, promoting
  health eating, and increasing family involvement
  in healthy lifestyles
• Roanoke City public schools, Roanoke City parks
  and recreation, and Carilion Health System are
  partners

27
Crater (71,917)

• Cardiovascular Risk Reduction Program
• Focus will be on worksites, faith based
  organizations and community settings
• Goals Decrease risks for CV disease and
  diabetes, provide early detection and prevention
  services to underserved populations,
  reduce/modify lifestyle risk factors

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Cumberland Plateau (65,275)

• Target population 250 children enrolled in Head
  Start in Dickenson and Tazewell counties, as well
  as their parents
• Instill healthy physical activity and eating
  habits at an early age
• Proposed expansion to Buchanan and Russell
  counties in FY08

29
Piedmont (51,239)

• Diabetes prevention and control
• Enhancements to Steps to Family Fitness, offered
  by Prince Edward County Cooperative Extension
• High risk (e.g., African-American over age 65)
  diabetic education and screening program

30
Mount Rogers (82,000)

• Worksite Wellness Program utilizing 45 foot
  mobile health clinic
• Transferred from Arlington County health district
  via Washington County public schools
• Will hire an additional public health nurse
• Will include screenings for hearing loss and
  osteoporosis
• Agreements with Rural Health Clinics and
  Community Health Centers for follow-up care

31
Eastern Shore (50,000)

• Shape Up Eastern Shore
• Prevent chronic disease among adults, and prevent
  childhood obesity, through physical activity,
  healthy eating and weight management
• Wide range of community partners will be utilized

32
Three Rivers (30,405)

• Hypertension prevention and control
• Proposal based on a model that the district has
  utilized in working with its Native American
  population
• This model will be expanded to include other
  community partners, including faith based
  organizations and the Rappahannock AHEC, who have
  access to high risk populations

33
Hampton (22,313)

• Diabetes control through reactivation of the
  Diabetes Partnership of the Virginia Peninsula
• Diabetes screenings, referral/enrollment in a
  walking program in partnership with Hampton Parks
  and Recreation
• Nutrition education

34
Lenowisco (75,000 in FY08)

• Childhood obesity prevention in collaboration
  with Wise County and Norton City public schools
• Goal reduce the number of overweight and obese
  children
• Intervention will target 300 children, their
  participating families and school personnel

35
Reporting Requirements

• 3 month status report
• Subsequent progress reports
• Reports will be shared with the Board

36
Secretary Tavenner Directed VDH to Develop 8 Key
Objectives/Measures

• Selected/modified from the performance measures
  contained in the service area plans
• Key objectives pertain to obesity, smoking,
  drinking water, childhood immunization, adult
  immunization, infant mortality, teenage
  pregnancy, quality of long term care

37
Reduce the Prevalence of Obesity in Virginia

• The percentage of adults in Virginia who are
  obese will decrease 15
• Baseline 27.4 as of CY05
• Target Maximum of 23.3 (15 reduction) by end
  of FY09
• Data Source - BRFSS

38
Reduce the Prevalence of Smoking among Virginians

• The percentage of adults who smoke will decrease
  8, and the percentage of youth who smoke will
  decrease 6
• Baseline 20.8 of adults over age 18, and 15.5
  of middle and high school age students, as of
  2006
• Target 19 of adults (8 reduction) and 14.5
  of middle and high school age students (6
  reduction) by end of FY08
• Data Source BRFSS and Youth Tobacco Survey

39
Reduce Infant Mortality

• The infant mortality rate in Virginia will
  decrease five percent
• Baseline 7.4 deaths per 1,000 live births in
  2004
• Target 7.0 (5 reduction) by 2009
• Data Source VDH Center for Health Statistics

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Governors Health Reform Commission

• Access to Care/Uninsured
• Long Term Care
• Health Care Workforce
• Quality/Transparency/Prevention
• Lead Staff in Secretarys Office
• Aryana Khalid VDH Deputy Commissioner for
  Health Policy (on loan to Secretarys Office)
• Heidi Dix Assistant Secretary of Health and
  Human Resources

41
Focus on Prevention

• Obesity (VDH Key Objective)
• Tobacco (VDH Key Objective)
• Infant Mortality (VDH Key Objective)

42
VDH Role

• Provide staff support to workgroups
• Quality/Transparency/Prevention
• Access to Care/Uninsured
• Background information/issue clarification/brainst
  orming policy options
• School Health Standards

43
Commission Timeline

• Initial Commission Meeting Oct. 2006
• Workgroups meet November 2006 April 2007
• Prevention issues scheduled for March 2007
  workgroup meeting
• Commission meets again in May 2007
• Final report due September 2007

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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]