Healthy People 2010: Improving Health Through Collaboration First Annual National Leadership Conference for Students in Healthcare Public Health Student

Healthy People 2010: Improving Health Through Collaboration

First AnnualNational Leadership Conference for Students in Healthcare

Public Health Student CaucusAmerican Public Health Association

Philadelphia, PANovember 9, 2002





David Satcher, M.D., Ph.D.

Director, National Center for Primary Care, MSM

16th U.S. Surgeon General

Purpose of Lecture

• Offer the national prescription for building the next generation of Healthy People

• Discuss the important role Surgeon General’s Reports have played in the nation’s health

• Provide an overview of Healthy People 2010, its two major goals, and the 10 Leading Health Indicators and analyze their role in improving the nation’s health

• Discuss the challenges to and opportunities for protecting and advancing health

Healthy People 2010: Entering its third decade

1979 - Surgeon General’s Report on Health

Promotion and Disease Prevention

1980 - Promoting Health/Preventing Disease: Objectives of the Nation

1980 - Healthy People 1990



What is Healthy People?

• A comprehensive set of national 10-year health objectives• Developed by a collaborative process• Designed to measure progress over time• A public health document that is part

strategic plan, part national health data report, and part textbook on public health priorities

Healthy People 2010’s Format

•2 over-arching goals•28 focus areas (chapters)

•467 specific objectives•10 Leading Health Indicators

Increases in Objectives1990, 2000, 2010

050

100150200250300350400450500

1990 2000 2010

Objectives

467

Healthy People 2010 GoalsOverarching Goals

• Increase Years and Quality of Healthy Life

• Eliminate Racial and Ethnic Health Disparities

Goal #1: Increase Years and Quality of Healthy Life

We must look at health across the lifespan, beginning in early childhood all the way through the latter years.

Major Questions on Increasing Years and Quality of Life

• What is successful aging?• What are the major diseases of aging?• How do we prevent or delay the onset

of degenerative diseases?• What changes in American society are

needed to facilitate successful aging?

Goal #2: Eliminate Racial and Ethnic Disparities in Health

Despite notable progress in the overall health of the nation, health disparities exist among various racial/ethnic groups, as pointed out in recent SG Reports.

U.S. Race and Health Initiative

Six Initial Areas of Focus• Infant Mortality• Breast and Cervical Cancer• Cardiovascular Disease• Diabetes• Immunizations • HIV/AIDS

Leading Health Indicators

Lifestyle

• Physical activity

• Overweight and obesity

• Tobacco use

• Substance abuse

• Responsible sexual behavior

Health Systems

• Access to care

• Mental health

• Injury and violence

• Environmental quality

• Immunization

Ten Major Public Health Issues

Health System Indicators

• Access to Care• Mental Health• Injury and Violence

Prevention• Environmental

Quality• Immunization

Access to Health Care

• Uninsured

• Underinsured

• Underserved

• Underrepresented

• Uninspired

• Untrusting

• Uninformed

Major Barriers

54.6

5

25.2

15.2

4.7

69.6

13.1

12.6

white black hispanic other

total uninsured

Percent distribution of total population and the uninsured by race/ethnicity: People under age 65, first

half of 1999

• Although nearly 70% of non-elderly Americans were White, Whites accounted for only 55% of uninsured people.

• Hispanics and African-Americans were disproportionately represented among the uninsured.Source: AHRQ 1999 Medical Expenditure Panel Survey Household Component

Continue building the science base

Ensure the delivery of state-of-the-

art treatments

Overcome the stigma

Ensure the supply of mentalhealth servicesand providers

Mental Health Report

Increase public awareness of

effective treatments

Tailor treatmentsto age, gender, race and culture

Reduce the financial barriers

to treatment

Environmental Quality

Major Concerns

• Safe environments for walking/physical activity

• Environments safe from threats of bioterrorism

• Safe living environments: African-American and Hispanic children are much more likely to grow

up near hazardous waste sites than majority

children• 25% of preventable illnesses worldwide

are due to poor environmental quality

Lifestyle Indicators and the Surgeon General’s Rx

Lifestyle• Physical Activity• Overweight &

Obesity• Tobacco Use• Substance Abuse• Responsible

Sexual Behavior

• Lower risk of death for adults of any age

• Decrease risk of many types of cancer, including breast, prostate, and colon cancer

• Reduce deaths from cardiovascular disease by 50%

• Reduce the onset of Type II diabetes by 56%

• Decrease body fat

Physical ActivityHealth Impact

• Prevent and lower high blood pressure

• Increase muscle tone and fitness

• Increase bone strength

• Enhances sexual potency and enjoyment

• Reduce stress and enhance overall psychological well being

Physical ActivityPhysical Activity

Adolescents• 43% watch TV

> 2 hours each day

• Only 25% take recommended PE

Adolescents• 43% watch TV

> 2 hours each day

• Only 25% take recommended PE

Adults• < 1/3 engage in regular

physical activity

• 40% report no leisure time physical activity

Adults• < 1/3 engage in regular

physical activity

• 40% report no leisure time physical activity

Studies show that physical activity

reduces depression & elevates mood.


reduces stress and anxiety.

Studies show that physical activityimproves mental

acuity.


improves sleeping.

Physical Activity & Mental HealthHealth Impact

The A-B-C’s of the DietaryGuidelines for All Americans

• Physical activity and good nutrition combined can save many lives each year -- over 300,000 of the premature deaths that occur in this country every year are the result of physical inactivity and poor nutrition, combined with a few other things.

NutritionNutrition

Only 3% of all individuals meet four of the five recommendations for the intake of grains, fruits, vegetables, dairy products, and meats.

Overweight and ObesityHealth Impact

•Higher body weights are associated with higher death rates

•Increased risk of high blood pressure, elevated cholesterol, Type 2 diabetes, heart disease and stroke, gallbladder disease, arthritis, sleep disturbances and problems breathing

•Increased risk of hip fractures, endometrial, breast, prostate and colon cancers

•Social stigmatization, discrimination, and lowered self-esteem

Overweight and ObesityChildren and Adolescents

•Thirteen percent of children ages 6-11 and 14 percent of adolescents ages 12-19 are overweight.

•During the past two decades, the percentage of children who are overweight has nearly doubled (from 7 to 13 percent). Current evidence suggests childhood overweight/obesity continue to adulthood.

•Studies have shown that physical activity can positively affect grade scores, alertness, energy level, and may enhance brain function and mood and that participation in school breakfast is positively associated with better test scores, better grades, better attention, and better behavior.

Body Mass IndexBody Mass Index

BMI = Weight (kg)/height squared (m2)BMI = Weight (kg)/height squared (m2)

Definitions

Overweight = 25-29.9 kg/m2

Obesity = 30 kg/m2

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20% Source: Mokdad

AH.




AH.




AH.




AH.




AH.




AH.




AH.




AH.




AH.



Source: Mokdad A H, et al. J Am Med Assoc 2000;284:13

No Data <10% 10%-14% 15-19% 20%



Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10

No Data <10% 10%-14% 15-19% 20%

4% 4-6% 6% n/a

Source: Mokdad et al., Diabetes Care 2000;23:1278-83

Prevalence of Diabetes among U.S. Adults BRFSS, 1993-94


4% 4-6% 6% n/a



4% 4-6% 6% n/a


Consequences of Childhood and Adolescent Obesity

Consequences of Childhood and Adolescent Obesity

• Growth• Psychosocial• Hyperlipidemia• Hepatic steatosis• Abnormal glucose

metabolism• Persistence into adulthood

• Growth• Psychosocial• Hyperlipidemia• Hepatic steatosis• Abnormal glucose

metabolism• Persistence into adulthood

• Hypertension• Sleep apnea• Pseudotumor• PCOD• Cholelithiasis• Orthopedic

• Hypertension• Sleep apnea• Pseudotumor• PCOD• Cholelithiasis• Orthopedic

CommonCommon UncommonUncommon

New: Increased prevalence of Type 2 diabetes

Less than Half of U.S. Adults Are a Healthy Weight

Less than Half of U.S. Adults Are a Healthy Weight

61% of Adults* are overweight or obese.

*20 years or older

Overweight Obese

Today 34% 27%

1970s 32% 15%

Overweight Obese

Today 34% 27%

1970s 32% 15%

$117.7 billion• Direct cost = $61.3

billion • Indirect cost = $56.4

billion

$117.7 billion• Direct cost = $61.3

billion • Indirect cost = $56.4

billion

Total Cost of Overweight and Obesity

Total Cost of Overweight and Obesity

Settings for ActionSettings for Action

• Families & Communities• Schools• Worksites• Health Care• Media and Communications

• Families & Communities• Schools• Worksites• Health Care• Media and Communications

•Tobacco use•Substance abuse

•Excessive alcohol use

•Poor dietary choices

Harmful Lifestyle Behaviors

Responsible Sexual BehaviorSTD’s and Other Sexual Health Concerns

•STDs infect approximately 15 million persons each year, including 4 million adolescents

•Over 1.3 million induced abortions occurred in 1996

•Nearly one-half of pregnancies are unintended

•An estimated 22% of women and 2% of men have been victims of a forced sexual act

•An estimated 104,000 children are victims of sexual abuse each year

What Is Responsible Sexual Behavior?

•Abstinence when appropriate

•Optimal protection of self and others when sexually active

Call to Action to Promote Sexual Health and Responsible Sexual Behavior

Released June 2001

Points of Attack

• Access to Care• Improving Quality of Care• Lifestyle Enhancement• Improving Environmental

Quality• A Balanced Research

Agenda

Life is filled with golden opportunities, carefully disguised as irresolvable problems.

-- John Gardnerformer Secretary of Health, Education & Welfare









David Satcher, M.D., Ph.D.

Director, National Center for Primary Care, MSM

16th U.S. Surgeon General

Documents

Healthy People 2010: Improving Health Through Collaboration First Annual National Leadership Conference for Students in Healthcare Public Health Student