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Chronic Disease Prevention

Chronic Disease Prevention. November 20, 2008. Objectives. Background: Setting the Stage Status of Chronic Diseases in San Diego Evidenced-based Best Practices HHSA Chronic Disease Prevention Model. Setting the Stage. Why Chronic Disease?. Why Chronic Disease?.

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Chronic Disease Prevention

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  1. Chronic Disease Prevention November 20, 2008

  2. Objectives • Background: Setting the Stage • Status of Chronic Diseases in San Diego • Evidenced-based Best Practices • HHSA Chronic Disease Prevention Model

  3. Setting the Stage Why Chronic Disease?

  4. Why Chronic Disease? • California Conference for Local Public Health Officers (CCHLO) • Chronic Disease Conference • Spurred Idea to develop CC Agency for Agency • Two meeting held to date to develop an inventory of Agency Chronic Disease activities • SPOS came to PHS to conduct a “Focused Dialogue” • Chronic Disease was chosen

  5. What Is Chronic Disease? • According the U.S. National Center for Health Statistics, is a disease that lasts 3 months or more. • Cannot be prevented by vaccines or cured by medications. • Caused by health damaging behaviors - particularly tobacco use, lack of physical activity, and poor eating habits. • Is the leading cause of death and disability in the United States. • Accounts for 7 of the 10 U.S. leading cause of death.

  6. Why Should We Care? • Chronic diseases are prevalent, preventable and costly! • Cause extended pain and suffering, associated with decreased quality of life for millions. • Treatment for seven chronic diseases including cancers, mental illnesses, heart disease, lung conditions, hypertension, stroke, and diabetes ran to nearly $280 billion in 2003; now estimated to be to $1.3 trillion per year. • Prevention programs are highly cost-effective

  7. Top 10 Causes of Mortality in San Diego County = Chronic Diseases Rates are per 100,000 population. Source: State of California, Department of Public Health, Center for Health Statistics, Vital Statistics Section, Death Statistical Master Files

  8. Death by Risk Factors

  9. PA and Nutrition Trends Physical Activity by Gender Percent Nutrition by Gender Men Women

  10. Healthcare Cost in California and San Diego • $130 Billion spent (treatment and lost productivity) by California in 2003 • $4.3 Billion in SD County (not including lung cancer treatment)

  11. 3 – FOUR – 50 3 RISK FACTORS (Tobacco Use, Poor Diet, Lack of Physical Activity) 4 CHRONIC DISEASES (Heart Disease/Stroke, Type 2 Diabetes, Respiratory Disease, Cancer) 50% of DEATH

  12. Status of Chronic Diseases in San Diego What Are the Statistics?

  13. LIFE EXPECTANCY TRENDS San Diego County vs United States, 2000-2006 *2006 U.S. data are preliminary

  14. San Diego County Populationby Race/Ethnicity, 2007 • 3 million people • Racial/Ethnic groups from around the world. • Over 100 languages Asian 9.4% N=292,251 Hawaiian/Pacific Islander 0.4% N=13,144 American Indian 0.5 % N=15,946 Black 5.4% N=166,486 Hispanic 29.3% N=906,898 White 51.6% N=1,597,847 Source: SANDAG, San Diego County 2007 Population Estimates

  15. San Diego County Populationby Race/Ethnicity, Census 1990 vs. 2000 vs. 2007 • Between • 1990 & 2000: • The population of Hispanics and Asian increased • The population of Whites and Blacks decreased Percent Source: SANDAG, San Diego County 1990, 2000 Census, and 2007 Population estimates

  16. All Cancer Deathsby Race/Ethnicity, 2005 Cancer is the second leading cause of death for San Diego County San Diego County Overall Rate, 2005: 163.1 / 100,000 HP 2010 Goal: 159.9 Note: All rates are adjusted to 2000 Standard U.S. Population. Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.

  17. Selected Cancer Deathsby Race/Ethnicity, 2005 HP 2010 Goal Note: All rates are adjusted to 2000 Standard U.S. Population. Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.

  18. Coronary Heart Disease and Stroke Deathsby Race/Ethnicity, 2005 Blacks have the highest rate of coronary heart disease deaths and stroke deaths compared to other racial and ethnic groups. San Diego County Overall: CHD Rate - 128.4 / 100,000 Stroke Rate – 41.3 / 100,000 HP 2010 Goal CHD: 166.0 HP 2010 Goal Stroke: 48.0 Note: All rates are adjusted to 2000 Standard U.S. Population. Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.

  19. Diabetes by Race/Ethnicity Prevalence of Diabetes Among Adults 2005* % High School Students Overweight 2005 Hospital Admissions 2005 Deaths (underlying)2005 R/E Black White Hispanic Asian/Other 69.0 16.6 33.5 21.2 10.7 7.7 18.4 7.4 6.6 5.1 6.5 7.2 303.5 87.1 236.0 87.6 * - Percentage of adults who were ever diagnosed with diabetes Source: Youth Risk Behavior Survey (YRBS), San Diego City Schools; California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates; California Health Interview Survey (CHIS), California Department of Health Services, Death Statistical Master File.

  20. Diabetes Mortality Among the top 53 U.S. City/County jurisdictions San Diego County: • Ranked 52 in 1990 • Ranked 46 in 2004 • Ranked 8th in the highest rate of change between 1990 and 2004    Source: NACCHO 53 Big Cities Health Inventory, 2007 Note: Ranking scheme - 1 being worst and 53 being best

  21. Diabetes Mortality Among San Diego County Residents, 2000-2005 Deaths and Age-adjusted Rates HP2010 = 45

  22. Diabetes Hospitalizations Among San Diego County Residents, 2001-2005 Number and Age-adjusted Rates

  23. Diabetes Hospitalizations Among San Diego County Residents, 2001-2005 By Race/EthnicityNumber and Age-adjusted Rates

  24. Overweight & Obese Adults* by Race/Ethnicity, 2005 HP 2010 Goal Unhealthy weight (BMI>25): 40% Obesity (BMI >30): 15% * as Defined by Body Mass Index (BMI) Source: 2005 California Health Interview Survey (CHIS)

  25. Asthma in San Diego Countyby Race/Ethnicity Average Annual Number of Deaths 2002-2004 Estimated Prevalence Among Children 2005 Hospitalization Rate, 2005 Race/Ethnicity Black White Hispanic Asian/Other 13.8* 9.6 12.4 11.7 204.7 59.3 74.9 62.6 3 18 3 4 Source: 2005 California Health Interview Survey (CHIS), California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates. California Department of Health Services, Death Statistical Master File * - These results for Blacks reflect 2003 data results since sample size for Blacks in 2005 was statistically unreliable.

  26. Selected Health Indicators* San Diego County, CA, & US, HP2010 Healthy People 2010 Goal San Diego County Indicator CA U.S. • Infant Mortality • Adults reporting poor/fair health • Incidence of AIDS • CHD Deaths • Suicides • F. Breast Cancer Deaths • Unintentional Injury Deaths 4.6 14.4% 14.0 144.4 10.5 22.9 28.8 4.5 None 1.0 166.05.0 22.3 5.3 16.0% 11.8 162.8 8.5 24.1 30.5 7.0 14.0% 15.0 159.6 10.7 26.0 37.7 The numbers above reflect either rates or percentages * - These data reflect the most current comparable data

  27. Evidence-based Best Practices Do They Work?

  28. Direction from the National Level Federal Government Agencies United States Department of Agriculture United States Surgeon General Centers for Disease Control

  29. “Healthy places are those designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders -- where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options.” CDC’s “Designing & Building Healthy Places”

  30. Direction from the National Level Leading Public Health Organizations National Association of County and City Health Officials National Task Force on Community Preventive Services Robert Wood Johnson Foundation Kaiser Permanente American Planning Association (funded by CDC)

  31. Public California Conference of Local Health Officers California Department of Public Health Governor's Obesity Prevention Plan Private The California Endowment Strategic Alliance Direction from the State Level

  32. Best Practices and Promising Interventions • Healthy Community Improvements • Healthy Community Development • Healthy Community Plans & Policies

  33. 1. Healthy Community Improvements Best Practices and Promising Interventions Partnering with communities and cities to improve existing physical and social conditions that prevent physical activity and healthy eating

  34. Healthy Community Improvements Safe and healthy routes to schools, parks, healthy foods, seniors Traffic calming, improve street crossings Installing/improving sidewalks & bike paths Community gardens School/community joint use agreements

  35. Safe and Healthy Routes to Schools and Parks, Healthy Foods, Seniors AARP - assessments - advocates

  36. From abandoned lots to community gardens… Create gardens for culturally appropriate foods reflective of the community.

  37. CX3 Projects (Chula Vista & La Mesa)Communities of Excellence in Nutrition, Physical Activity and Obesity Prevention Strong Partnerships Leadership Training Youth & Mentors • Community Assessment • Advocacy

  38. 2. Healthy Community Development Best Practices and Promising Interventions Promoting healthy development and redevelopment projects in neighborhoods

  39. Healthy Community Development Integrating “Healthy Places” design into the Development Review process Redevelopment areas Grocery stores in underserved areas Facility design

  40. Helping Communities get Developments Designed for “Health”

  41. Trails and Trail Access Points

  42. Eliminating Food Deserts…Attracting a Grocery Store into East Oakland, CA

  43. Partners: East Oakland Diabetes Work Group, Alameda County Department of Public Health, Network for a Healthy California

  44. 3. Healthy Community Plans & Policies Best Practices and Promising Interventions Promoting healthy government, school and worksite policies and plans that support physical activity, healthy eating and tobacco-free environments

  45. Healthy Community Plans & Policies Land use & transportation planning Affordable housing policies Regional Food Systems & Urban Agriculture Worksite Wellness policies Government Wellness policies School Wellness policies

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