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WellnessS Y M P O S I U M
WellnessS Y M P O S I U M
Darwin R. Labarthe, MD, MPH, PhD Director, Division for Heart Disease and Stroke Prevention
The national goal for heart disease and stroke prevention:
- detection and treatment of risk factors - early identification and treatment
of heart attacks and strokes
- prevention of risk factors
- prevention of recurrent cardiovascular events
CO-LEAD AGENCIES: CDC AND NIH
The Present Reality
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
A Vision of the Future
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
Target Population
Total Population300million
Total Population300million
TC 105million HBP 72million Smoking 46million Diabetes 20million
CHD 1,200,000 CHF 550,000 Stroke 500,000
CHD 15.8million Stroke 5.7million CHF 5.2million
CVD 871,000
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
PREVENTION$ .05
Target Population
Total Population300million
Total Population300million
TC 105million HBP 72million Smoking 46million Diabetes 20million
CHD 1,200,000 CHF 550,000 Stroke 500,000
CHD 15.8million Stroke 5.7million CHF 5.2million
CVD 871,000
TREATMENT$ .95
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
10 20
30
Target Population
Total Population300million
Total Population300million
TC 105million HBP 72million Smoking 46million Diabetes 20million
CHD 1,200,000 CHF 550,000 Stroke 500,000
CHD 15.8million Stroke 5.7million CHF 5.2million
CVD 871,000
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
Target Population
Total Population300million
Total Population300million
TC 105million HBP 72million Smoking 46million Diabetes 20million
CHD 1,200,000 CHF 550,000 Stroke 500,000
CHD 15.8million Stroke 5.7million CHF 5.2million
CVD 871,000
?
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
10
Target Population
Total Population300million
Total Population300million
TC 105million HBP 72million Smoking 46million Diabetes 20million
CHD 1,200,000 CHF 550,000 Stroke 500,000
CHD 15.8million Stroke 5.7million CHF 5.2million
CVD 871,000
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
2010
Target Population
Total Population300million
Total Population300million
TC 105million HBP 72million Smoking 46million Diabetes 20million
CHD 1,200,000 CHF 550,000 Stroke 500,000
CHD 15.8million Stroke 5.7million CHF 5.2million
CVD 871,000
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
10HP
Target Population
Total Population300million
Total Population300million
TC 105million HBP 72million Smoking 46million Diabetes 20million
CHD 1,200,000 CHF 550,000 Stroke 500,000
CHD 15.8million Stroke 5.7million CHF 5.2million
CVD 871,000
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
1000
Target Population
Total Population300million
Total Population300million
TC 105million HBP 72million Smoking 46million Diabetes 20million
CHD 1,200,000 CHF 550,000 Stroke 500,000
CHD 15.8million Stroke 5.7million CHF 5.2million
CVD 871,000
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyTo Prevent Heart Disease and Stroke
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
CONTINUUM OF
CARE
CONTINUUM OF
CARE
‘upstream’‘upstream’ ‘downstream’‘downstream’
Target Population
Total Population300million
Total Population300million
TC 105million HBP 72million Smoking 46million Diabetes 20million
CHD 1,200,000 CHF 550,000 Stroke 500,000
CHD 15.8million Stroke 5.7million CHF 5.2million
CVD 871,000
Fatal CVD Complica- tions/Decom-pensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Policy and Environmental Change Behavior
ChangeBehavior Change Risk Factor
Detection and Control
Risk Factor Detection and Control Emergency
Care/Acute CaseManagement
EmergencyCare/Acute CaseManagement Rehabilitation/
Long-term Case Management
Rehabilitation/ Long-term Case Management
InterventionApproaches
InterventionApproaches
End-of- Life CareEnd-of- Life Care
Action Framework for a Comprehensive Public Health StrategyFor Chronic Disease Prevention and Health Promotion
Goal 1 Goal 3 Goal 4 Goal 2
Increase Quality and Years of Healthy Life
Eliminate Disparities
The Healthy People 2010 Goals
CONTINUUM OF
CARE
CONTINUUM OF
CARE
‘upstream’‘upstream’ ‘downstream’‘downstream’
Target Population
Total Population300million
Total Population300million
Persons with increased risk
Persons first identified with chronic conditions
Persons living or disabled with chronic conditions
Deaths due to chronic conditions
The national goal for heart disease and stroke prevention:
- detection and treatment of risk factors - early identification and treatment
of heart attacks and strokes
- prevention of risk factors
- prevention of recurrent cardiovascular events
The national goal for chronic disease prevention and health promotion:
- management of risk factors
- response to acute event or first diagnosis
- maintenance of good health/low risk
- reduction of disability, improvement in quality of life, and prevention of disease progression or recurrent events
The 1st national goal for chronic disease prevention and health promotion:
- maintenance of good health/low risk
WellnessWellness
