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Health in All Policies Leaders to Leaders Conference July 8, 2008

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Indiana State Health Commissioner. President-elect ASTHO. Tools for Population Level ... State Fair. People Are Eating Out More. Menu Labeling. Menu Labeling ... – PowerPoint PPT presentation

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Title: Health in All Policies Leaders to Leaders Conference July 8, 2008


1
Health in All Policies Leaders to Leaders
Conference July 8, 2008
  • Judy Monroe, MD FAAFP
  • Indiana State Health Commissioner
  • President-elect ASTHO

2
Tools for Population Level Behavior Change
  • Education
  • Marketing/Motivating
  • Risk Communication
  • Leadership
  • Policy
  • Law

3
State Policy Opportunities
  • Agency policies
  • State employee policies
  • Public policies
  • Media
  • Schools
  • Universities
  • Businesses
  • Faith community

4
  • The first wealth is health.
  • Ralph Waldo Emerson

5
Economy
  • Health and wealth go together.
  • Health is a driver of economic development.
  • Governors support allows a more active
  • advocacy role in getting other agencies and
  • partners to take health seriously.

6
  • launched July 2005

7
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8
ISDH Smoking Policy
  • Challenge
  • Culture
  • Landlord
  • Opportunity
  • Mission
  • Educate
  • Leadership
  • Send a Message

9
  • "You can't not communicate. Everything you say or
    do or don't say and don't do sends a message to
    others."
  • John Woods

10
  • Execution Trumps Strategy

11
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12
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13
Tobacco Free School Map 2001
2008
14
100 Tobacco Free Colleges and Universities
  • Baseline 2001
  • 1 tobacco free college campus- Anderson College
  • 2008
  • 34 completely tobacco free college and university
    campuses
  • As of January 1, 2008, all Indiana University
    campuses system-wide have enacted individually
    tailored smokefree policies.

15
100 Smoke Free Hospital Grounds
  • 2001
  • No 100 smoke free hospital grounds
  • 2008
  • 124 hospitals 100
  • 32 of 36 critical access hospitals

16
Hoosiers Protected by Effective Local
Smokefree Workplace Laws
17
Barriers Worksite Wellness Policy
  • Culture eats strategy for lunch
  • it wont work for our people
  • Grumbling..Im only here because I have to be…
  • Fear of litigation
  • HR laws, discrimination issues
  • voluntary worksite wellness programs

18
Carrot or Stick?
  • For several years, weve had a reward program,
    where if you cease smoking and do a
    self-assessment, you receive a reduction in your
    health care premiums, Clarian president and
    CEO Daniel Evans told TODAY co-host Matt Lauer on
    Friday. "But our health care costs were going
    up and our employees were not taking full
    advantage of the programs we had in place.

19
Stick Approach
  • To combat the problem, beginning in 2009 Clarian
    employees will be charged up to 30 every two
    weeks for failing to meet standards set by the
    company in a number of areas.

20
Requirements
  • Quit smoking and maintain smoking abstinence 5
  • Keep blood pressure lower than 140 systolic and
    90 diastolic 5
  • Keep LDL cholesterol less than 130 5
  • Keep blood glucose under 120 and 5
  • Keep body mass index less than 30. 10

21
Challenge
  • These programs are highly invasive, he said.
    They
  • regulate private behavior. They amass huge
    amounts of
  • health information. Whats happening to this
    information?
  • What type of employees private behavior is being
  • regulated?
  • Were supposed to be living in a free country."
    he added.
  • How do we go about that when employers have
    policies
  • which dictate how we go about our lives?
  • Jeremy Gruber, legal director
  • National Workrights Institute

22
Worksite Wellness
  • Delaware improves the health and well being of
    state employees and the welfare of the state as a
    whole through its Delawell Program
  • Health Risk Assessments
  • Financial Incentives
  • StayWell Helpline
  • Weight Watcher Reimbursement
  • Lt. Governors Summer Challenge for State
    Employees
  • Online health resources and on-site biometric
    health screenings

23
Worksite Wellness
  • One Care Street is open to all state and spouses
    who are covered by the states health insurance
    program. The program focuses on helping state
    employees get and stay healthy.
  • There is an incentive of 260 for an employee
    with single coverage for an employee and covered
    spouse, the incentive is 390. Incentives are
    paid twice a year in April and October.

24
Worksite Wellness
  • Were saving 55 a pay period…thats money we
    can save for our childs college.
  • Employees Spouse
  • Community Hospital
  • Indianapolis

25
Worksite Wellness
  • Companies agreed to participate in company
    wellness programs that incorporate INShape
    Indiana. Anthem Blue Cross and Blue Shield in
    Indiana is leading the effort.
  • The participating employers represent more than
    120,000 employees around the state.

26
Worksite and Community Wellness
  • Kroger Co. will put fitness kiosks in its stores
    to help both employees and customers.

27
Born to be Breastfed A Call to Action to
Promote Breastfeeding
  • Senate Bill 219 breastfeeding policy passed (work
    place accommodation and storage)

28
Fresh Food
  • Pennsylvania Fresh Food Financing Initiative
    (FFFI) As of January 2007, it had committed
    nearly 38.9 million in grants and loans to 50
    stores across the state.

29
Trans Fat Bans
  • States that have introduced trans fat bans
  • CA, CT, DC, FL, HI, IL, MD, MA, MI, MS, NH, NJ,
    NM, RI, SC, TN, VT, VA

30
State Fair
31
People Are Eating Out More
Menu Labeling
32
Menu Labeling
  • Calorie Menu Labeling legislation has been
    introduced in 15 states and Washington, D.C.
  • Legislation Passed New York City
  • King County, Washington
  • Legislation Pending
  • California
  • Washington, D.C.
  • Hawaii
  • Chicago
  • Montgomery County, Maryland
  • Massachusetts
  • Michigan
  • New Jersey
  • New York
  • Philadelphia

Jan 2008
33
Childhood Obesity BMI Report Cards
  • Arkansas
  • Three years of statewide assessments of student
    BMIs reveals that the progression of the
    childhood obesity epidemic has been halted in
    Arkansas.

34
Childhood Obesity Legislation
Limits beverage sales in schools Prohibits the
sale of certain foods and beverages Establishes
the Fresh Start Pilot Program- fruits and
vegetables in schools Requires local wellness
policy Prohibits trans-fat in schools Performs
BMI screening
California
35
Increased Physical Activity
New York promotes healthy hearts through
comprehensive approaches to activity
  • Goals
  • Create walking and bicycle trails
  • Increase physical activity options in
    after-school programs
  • Open schools for physical activity use by
    residents before and after school hours

36
Increased Physical Activity
Missouris construction of 13 walking trails in
the rural, low-income Bootheel and Ozark
communities has resulted in
  • 42 of community residents using the walking
    trails.
  • 60 of residents reporting an increase in
    physical activity.

37
DNR and INDOT
38
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39
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40
House Enrolled Act (HEA) 1678
  • Effective July 2007
  • Increased cigarette tax
  • All of the revenue went to health

41
  • Created a tax credit for companies that had not
    been offering a health care benefit if the
    company started offering a qualifying benefit and
    maintained it for at least two years. The tax
    credit is the lesser of 2,500 or 50 per
    employee.

42
  • Increased Medicaid eligibility for pregnant
    women from 150 percent of poverty to 200 percent
    of poverty.

43
  • Established the Healthy Indiana Plan for
    families with incomes up to 200 percent of
    poverty.
  • Includes individual health care account
  • Includes 500 for prevention services
  • Covers medical care package similar to Medicaid
  • Limits individual deductible/co-insurance to no
    more
  • 2 percent for incomes below poverty level
  • 3 percent for incomes 100 125 percent
  • 4 percent for incomes from 125 - 150
  • 5 percent for incomes up to 200 percent

44
  • Established a tax credit for Small Employer
    Wellness Programs
  • Available for employers with 2 to 100 employees
  • Tax credit up to 50 percent of cost of providing
    program
  • Programs must include
  • Appropriate weight loss
  • Smoking cessation
  • Pursuit of preventive health services
  • Must be certified as qualified by the ISDH.

45
  • Raised the age for a child to be covered under
    parents health care plans (insurance and HMOs)
    from up to age 19 to up to age 23 (less than age
    24).

46
  • Appropriates an additional 1,200,000 for
    tobacco control
  • Appropriates 11,000,000 to the ISDH for
    childhood immunizations.

47
Indiana Hospital Association
  • Tobacco
  • Obesity
  • Diabetes
  • Immunizations
  • Mental health
  • Prenatal care

48
Medicaid Policy
  • A Healthy People 2010 national health objective
    calls for total health-insurance coverage for
    evidence-based tobacco-dependence treatments in
    all 51 Medicaid programs. (objective 27-8b).

49
Medicaid Policy
  • Approximately one third of adult Medicaid
    recipients smoke.
  • A 2006 survey determined that 39 state Medicaid
    programs (including the District of Columbia)
    covered some form of tobacco-dependence treatment
    (i.e., medication or counseling) for all Medicaid
    recipients and one state program provided
    coverage for all recommended treatments.
  • Center for Health and Public Policy Studies at
    the University of California, Berkeley.

50
  • We are all faced with a series of great
    opportunities brilliantly disguised as impossible
    situations.
  • Charles R. Swindoll
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