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The Changing Face of Health in North Carolina 2007 Conference for Excellence October 25, 2007

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Title: The Changing Face of Health in North Carolina 2007 Conference for Excellence October 25, 2007


1
The Changing Face of Health in North
Carolina2007 Conference for ExcellenceOctober
25, 2007
Steve Cline, DDS, MPH Deputy State Health Director
2
Public Health Mission
  • To promote and contribute
  • to the highest possible
  • level of health
  • for the people
  • of North Carolina

3
Public Health Goals
  • Improve health outcomes
  • Eliminate health disparities

4
Outline
  • Demographics of NC
  • Trends in Health Statistics
  • Challenges to Health
  • Strategies toward Better Health

5
The Changing Faceof North Carolina
  • The changing demographic characteristics of North
    Carolinas population affects trends in health
    indicators and also our standing on health
    measures relative to the United States.

6
North Carolinas Surging Population
  • According to estimates from the U.S. Census
    Bureau, North Carolina recently surpassed New
    Jersey to become the 10th most populous state in
    the country.
  • In 2005, there were more than 8.6 million
    residents in the state - an increase of 8 percent
    from 2000.
  • 86 of North Carolinas 100 counties experienced
    population growth from 2000-2005.
  • This growth may put a strain on an already
    overburdened public health infrastructure.

7
As the Baby Boom Generation reaches retirement
age, the growth of the elderly population (65)
in North Carolina is expected to accelerate
rapidly
8
The Growth of the Hispanic/Latino Population in
North Carolina
9
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10
  • In 2005, the leading cause of death for North
    Carolina Hispanics was Motor vehicle injuries
    (this ranked 10th for Non-Hispanics).
  • Homicide was the 3rd leading cause of death for
    Hispanics in 2005, while it did not appear in the
    10 leading causes of death for non-Hispanics.
  • In 2005 Hispanics made up 7 of HIV disease and
    in 2006 they made up 8

11
African Americans/Blacks remain North Carolinas
largest minority
12
Racial disparities in health persist in North
Carolina
13
African Americans as Percent of People Living
with AIDS Top 10 States, 2005
10 of top 10 in the South (U.S. percent 43.1)
  • District of Columbia 82.2
  • Maryland 80.5
  • South Carolina 73.9
  • Mississippi 73.1
  • Georgia 70.9
  • North Carolina 68.7
  • Delaware 66.9
  • Louisiana 66.5
  • Alabama 63.7
  • Michigan/Virginia 58.4

Sources Centers for Disease Control and
Prevention, Division of HIV/AIDS
Prevention-Surveillance and Epidemiology, Special
Data Request, October 2006. Available at
www.StateHealthFacts.org
14
Many North Carolinians live in rural areas
15
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16
Many North Carolinians Live in Poverty
Source Current Population Survey, U.S. Census
Bureau
17
Trends inNorth Carolina Health Statistics
18
Overall Mortality
Source National Center for Health Statistics
NC State Center for Health Statistics
19
HIV Disease Mortality
Source North Carolina HIV/STD Prevention Care
Branch
20
Persons Living with HIV/AIDS as of December 31,
2006 - race/ethnicity N19,996
non Hispanic
21
Heart Disease Mortality
Source National Center for Health Statistics
NC State Center for Health Statistics
22
Cancer Mortality
Source National Center for Health Statistics
NC State Center for Health Statistics
23
Stroke Mortality
Source National Center for Health Statistics
NC State Center for Health Statistics
24
Diabetes Mortality
Source National Center for Health Statistics
NC State Center for Health Statistics
25
TRENDS INCHILD ADOLSCENT HEALTH
26
Infant Mortality
Source National Center for Health Statistics
NC State Center for Health Statistics
27
Infant Mortality by Race
Source State Center for Health Statistics
28
Teen Births
Source CDC Division of Sexually Transmitted
Disease Prevention
29
Childhood Immunizations
Source CDC National Immunization Survey
30
North Carolina Trend Summary- Strengths
  • Ready access to prenatal care (rank 11)
  • High immunization coverage (rank 6)
  • Few poor physical and mental health days
  • Incidence of infectious disease decreased by 13
    in past year
  • Prevalence of smoking down 28 since 1990

31
North Carolina Trend Summary-Weaknesses
  • High infant mortality rate (8.6) (rank45)
  • High prevalence of smoking (22.6) (rank37)
  • Low high school graduation rate (rank 40)
  • Rate of uninsured increased from 12.6 to 16
    since 1990
  • High rate of premature deaths (rank38)
  • Health disparity in receipt of prenatal care
    70 for Hispanics and 91 for Whites

32
Challenges to HealthTraditional Threats
  • Access to Health Care
  • Cost of Health Care
  • Health Equity

33
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34
Characteristics of Health Care System
  • Escalating costs and unequal access
  • Considerable variation in
  • primary care and specialists per population
  • coverage for vulnerable populations
  • coverage of mental health, substance abuse
    treatment and dental health
  • Expanding technologies and treatments
  • Financial pressures to control costs
  • Increased push for quality and electronic health
    records

35
Uninsured Rose 5.8 Million from 2000 to 2004,
with Adults Accounting for All of the Increase
45.8 million
40million
Source U.S. Census, March 2001 and March 2005
Current Population Surveys.
36
Percent of Nonelderly UninsuredPopulation Varies
Widely by State, 20012003
WA
ME
NH
VT
MT
ND
MN
OR
WI
NY
MA
ID
SD
MI
RI
WY
CT
PA
NJ
IA
OH
NE
DE
NV
IN
IL
MD
WV
UT
VA
DC
CO
CA
KS
MO
KY
NC
TN
OK
AR
SC
NM
AZ
AL
GA
MS
TX
LA
FL
18 or more
AK
1517.9
1214.9
HI
Less than 12
Source Health Insurance Coverage in America
2003 Data Update Highlights,Kaiser Commission on
Medicaid and Uninsured/Urban Institute, September
27, 2004. Uninsured rates are two year averages,
20012003.
37
Nearly 1 in 5 NC Residents have no Health
Insurance
Source Behavioral Risk Factor Surveillance System
38
U.S. Health Expenditures as Share of GDP Expected
to Rise Through Next Decade
Expenditures as percent of gross domestic product
(GDP)
Projected
Source Center for Medicare and Medicaid
Services, Office of the Actuary, 19982003
39
Disparities
  • Race/ethnicity
  • Language
  • Gender
  • Disability or functional status
  • Socioeconomic status
  • Geographic location

40
Major Health Disparities
  • Infant Mortality
  • Obesity/Diabetes
  • Cancer
  • Heart Disease
  • HIV/AIDS
  • Alcohol, Tobacco Other Drugs
  • Immunizations

41
Comparison of National Infant Mortality Rates
United States, 1998
28th in the world
Deaths per 1,000 Live Births
42
Challenges to HealthThe Real Threats
  • System Imbalance
  • Determinants of Health
  • Need for Change

43
The Problem
  • Current health care system is imbalanced
  • Health is influenced by factors in five domains
  • Determinants of Health and their Contribution to
    Premature Death- Adapted from McGinnis et al 2002

44
U.S. Investments in Health
  • US spends more on health care (16 of GPD) than
    any other country in the world, but has worse
    health outcomes on most measures of health status
  • US ranks 46th in life expectancy and 42nd in
    infant mortality
  • Estimates indicate that spending on prevention
    accounts for only 2-3 of health spending

45
The Real Threats to Our Health
46
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47
(No Transcript)
48
Obesity Among U.S. Adults 2001
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610. Data from Behavior Risk
Factor Surveillance System (BRFSS)
49
Overweight and Obesity
  • Prevalence has nearly quadrupled in American
    children
  • 2.5-fold increased risk of overall mortality
  • 4-fold risk of cardiovascular mortality
  • 5-fold risk of diabetes
  • Risk of hypertension, gall bladder disease, and
    some cancers

Source Willet et al., New Eng J Med, 1999
Source Willet et al., New Eng J Med, 1999
50
Environment and Obesity
Millions of Person-Miles in Automobiles, 1970-1990
Hours of TV Viewed Daily 1960-1992
  • Suburbs disconnected and pedestrian-unfriendly

Percent of Workforce in Sedentary Occupations
1950-1996
51
Why do these imbalances prevail?
  • The public and its leaders are unaware of these
    disproportions?
  • There are competing priorities?
  • Change is hard winners and losers?

52
How Do We Address Them?
  • To maximize the health of its citizens, society
    should pursue interventions in proportion to the
    ability of those interventions to improve
    outcomes
  • Need to Rebalance Health Spending - 38 of US
    deaths are attributable to 4 behaviors smoking,
    poor diet, physical inactivity, alcohol use

53
Who Has the Answers?
  • Bush Plan?
  • Clinton Plan?
  • Obama Plan?
  • Edwards Plan?
  • Massachusetts Plan?
  • North Carolina Plan?

54
Strategic Alignment of Governmental Health
Systems
  • Goals can only be reached if the visibility,
    importance and value of the governmental health
    enterprise with the health system are realized

55
Moving Forward
  • Its all about leadership
  • and
  • Its all about partnership

56
Key Principles of Practice
  • Prevention is the key.
  • Population-based approaches are most effective.
  • Public health is a network of essential services.
  • Public health is committed to partnerships.
  • Programs must be based in science.
  • Focus is on accountability (2010 Healthy
    Carolinians objectives).

57
Governmental Public Health Officials Strategic
Map 2007-2009
Draft 06/22/07
Ensure Health Protection Create the 21st Century
Health System to Help the U.S. Become the
Healthiest Nation in the World
Provide Unified Leadership and Visibility in
Creating the 21st Century Health System
A
B
C
Assure System Accountability, Capabilities
and Improvement
Define, Deliver and Communicate Health Value
and Equity
Strengthen Alignment and Collaboration
of Governmental Public Health
Develop and Implement a Policy, Legal and
Investment Framework
58
NC IOM Task Force on Prevention
  • NC IOM, in partnership with the NC Division of
    Public Health, is proposing to create a Task
    Force to develop a comprehensive Prevention Plan
    for the State
  • Funded collaboratively by
  • NC Health and Wellness Trust Fund
  • Blue Cross Blue Shield Foundation of North
    Carolina
  • Kate B. Reynolds Charitable Trust
  • The Duke Endowment
  • Each foundation will be asked to have
    representatives on the Task Force

59
Comprehensive Prevention Plan
  • The Task Forces Prevention Plan will focus on
    broad topic areas, including
  • 1) Preventing/reducing chronic diseases,
    morbidity and mortality
  • 2) Integrating preventing health strategies into
    primary care
  • 3) Preventing/responding to infectious diseases
    and emerging public health threats
  • 4) Reducing intentional and unintentional
    injuries

60
Goal is to Create a Statewide Action Agenda
  • The goal of the NC IOM Task Force on Prevention
    will be to create a statewide action agenda to
    improve population health
  • Will identify strategies that have the best
    chance of improving population health, in the
    areas of
  • Personal behaviors
  • Public and health policies
  • Community and environment
  • Clinical care

61
Timetable
  • Funding for three years
  • Year 1 (Oct. 2007-June 2008)
  • August-Nov Seek funding from NC foundations
  • Oct.-Dec Create task force
  • Dec.-June Monthly meeting of task force
  • Year 2 (July 2008-June 2009) Task Force
    continues to meet (12 months) and completes
    report
  • Year 3 (July 2009-June 2010)
  • July-September NC IOM publishes report, hosts
    Prevention Summit in collaboration with DPH and
    four foundations
  • July-June DPH take the lead in implementing Task
    Force recommendations

62
For More Questions
  • Contact
  • Pam Silberman, JD, DrPHPresident CEONC
    Institute of Medicinepam_silberman_at_nciom.org919-
    401-6599 Ext. 23
  • Steve Cline, DDS, MPHAssistant State Health
    DirectorNC Division of Public Healthsteve.cline_at_
    ncmail.net919-707-5024

63
Parting Shots
  • Global Health
  • Zoonotic Diseases
  • Pandemic Influenza
  • Disasters

64
Global Health-Global Poverty
65
Zoonotic Diseases
  • Zoonosis - When a pathogen from a non-human
    animal results in human disease
  • Common occurrence 60-75 of all human
    infectious diseases shared with animals
  • 5 of the 6 Bioterrorism Select Agents (A)
  • Examples bubonic plague, yellow fever, West
    Nile fever, rabies, HIV, SARS

66
Types of Influenza Viruses
  • Influenza A
  • epidemic or pandemic
  • animals and humans
  • differing pathogenicities
  • divided into subtypes
  • based on surface proteins (H N)
  • 144 combinations
  • constantly mutate
  • variation within subtype
  • Influenza B
  • epidemic
  • humans (primarily)
  • not divided into subtypes
  • Influenza C
  • humans
  • mild respiratory illness

67
Pandemic Influenza
  • Major mutation occurs
  • Genetic reassortment of human and avian influenza
    viruses
  • Direct animal (poultry) to human transmission
  • Results in new subtype of influenza A
  • Avian origin
  • Adapted to humans
  • No immunity in the human population
  • Results in multiple simultaneous epidemics
    worldwide with enormous numbers of deaths and
    illness
  • Six to eight weeks
  • Multiple waves

68
Pandemics of the 20th Century
69
Global Migration of H5N1
October 5, 2007
70
Change Driven By Highly Visible Public Health
Events Natural Disasters
  • Security Now dominates national agenda
  • Public health is part of national security agenda
  • Growing public interest in health
  • Protection prevention

71
After 9/11 Majority of Americans Understand
They Benefit from Public Health
Would you say you and your community have
benefited from public health services?
Source Research!America/APHA National Survey,
2004 Harris
Interactive for Research!America
72
  • Without health there is no happiness.
  • An attention to health then,
  • should take the place of every other object.
  • Thomas Jefferson 1787

73
Creating A National Movement
All Americans need to be able to protect
themselves, their families, and their communities
from preventable, serious health threats.
74
Questions?
  • Steve Cline, DDS, MPH
  • Deputy State Health Director
  • NC Division of Public Health
  • steve.cline_at_ncmail.net
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