O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H Remarks to the AMSUS 2018 ANNUAL MEETING Admiral Brett P. Giroir, M.D. Assistant Secretary for Health Senior Advisor for Opioid Policy @HHS_ASH November 27, 2018
U.S. LIFE EXPECTANCY: 1900 - 2015 90 PUBLIC HEALTH SUCCESSES 80 Life Expectancy (years) • Influenza and Pneumonia 70 • Enteric Diseases • Stroke and CV Disease 60 • Tuberculosis 50 • Cancer 40 • Accidents 30 1900 1903 1906 1909 1912 1915 1918 1921 1924 1927 1930 1933 1936 1939 1942 1945 1948 1951 1954 1957 1960 1963 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011 2014 https://www.cdc.gov/nchs/data-visualization/mortality-trends/index.htm O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 2
U.S. HEALTH CHALLENGES IN THE 21 st CENTURY MASS GENERAL’S INPATIENT ADJUSTED COSTS PER LIVE DISCHARGE Highest global spending on health: $3.3 trillion (17.9% of GNP) Health care spending is predicted to reach $5.7 trillion by 2026 Meyer GS et al. N Engl J Med O F F I C E O F T H E 2012;366:2147-2149 A S S I S T A N T S E C R E T A R Y F O R H E A L T H 3
U.S. HEALTH CHALLENGES IN THE 21 st CENTURY • Life Expectancy - Among the 36 OECD* nations, the U.S. ranks 28th in life expectancy; 33rd in infant mortality; 32nd in suicide rate - In 2015 and 2016 life expectancy decreased in the United States • Sexually Transmitted Diseases - Highest number ever reported in U.S. in 2016; - >2 million; 50% in adolescents and young adults • Influenza and Infectious Diseases - Enhanced risks from pandemic influenza, emerging infectious diseases, anti-microbial resistance • Rogue States and Organizations - Intentional chemical, biological, radiological, and nuclear attack *Organization for Economic Development and Cooperation O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 4
5 U.S. DRUG OVERDOSE DEATHS THE MOST CRITICAL PUBLIC HEALTH CHALLENGE OF OUR TIME O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 5
6 OVERDOSE MORTALITY BY CLASS OF DRUG ADAPTED FROM CDC STATISTICS, NOVEMBER 2018 NAT & SEMI – SYNTHETIC PSYCHO- HEROIN METHADONE COCAINE SYNTHETIC OPIOIDS STIMULANTS 16,345 15,405 3,419 24,234 12,565 8,787 APRIL 2017 * APRIL 2018 * 15,357 14,264 3,279 30,545 14,830 11,398 Change -6.0% -7.4% -4.1% +26.0% +18.0% +29.7% * Number of deaths for the 12 months ending in April of the indicated year. O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 6
CRITICAL ROLE OF LAW ENFORCEMENT CURBING ILLICIT IMPORTATION State troopers seized 118 May 25, 2018 pounds of fentanyl Inside a truck in Nebraska, troopers found That amount of fentanyl enough fentanyl to kill millions of people would contain enough lethal doses to potentially kill more than 26 million people Largest fentanyl seizure in state history and one of the largest in the United States Nebraska State Patrol, courtesy O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 7
U.S. HEALTH CHALLENGES IN THE 21 ST CENTURY Recruits' Ineligibility Tests the Military More Than Two-Thirds of American Youth Wouldn't Qualify for Service, Pentagon Says June 27, 2014 “…the Defense Department estimates 71% of the roughly 34 million 17- to 24-year-olds in the U.S. would fail to qualify to enlist in the military if they tried....” Physical Fitness, Drug Abuse, Education O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 8
PREDICTED OBESITY OF TODAY’S TWO YEAR OLDS Ward ZJ et al. N Engl J Med 2017;377:2145-2153 N Engl J Med O F F I C E O F T H E Volume 377(22):2145-2153, November 30, 2017 A S S I S T A N T S E C R E T A R Y F O R H E A L T H 9
INEQUALITIES IN LIFE EXPECTANCY AMONG U.S. COUNTIES 1980 – 2014 (DWYER-LINDGREN, 2017) • Inequalities in life expectancy among counties are large and increasing over time • Difference in life expectancy between the lowest ranking county and the highest ranking county is 20.1 years (66.8 – 86.9 years) O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 10
GLOBAL HEALTH CHALLENGES IN THE 21 st CENTURY INFECTIOUS DISEASE Ebola Cases, DRC • Malaria: 216M cases and 445,000 deaths annually • Tuberculosis: 25% of world population infected 1.7M deaths annually • HIV/AIDS: 36.9M people infected 1.8M new cases in 2017 • Neglected Tropical Diseases: >140 diverse communicable diseases affecting the poorest 1B people on the planet (examples include Dengue, Hookworm, Schistosomiasis) NON COMMUNICABLE DISEASE RISKS OF PANDEMICS: • Cancer, Cardiovascular Disease, Diabetes, Chronic Lung Disease Influenza, SARS, MERS, caused 37% of deaths even in low income countries Ebola, others 16,000+ Children Die Every Day of Preventable Diseases O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 11
12 HHS PRIORITIES THE OPIOID CRISIS HEALTH INSURANCE REFORM HHS is committed to ending the HHS is working to improve crisis of opioid addiction and the availability and affordability overdose in America of health insurance DRUG PRICING VALUE-BASED CARE HHS is determined to lower the HHS is working to transform costs of prescription drugs for all our system to one that pays Americans without discouraging for value Secretary Alex M. Azar II innovation O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 12
Assistant Senior Advisor Secretary for for Opioid Health Policy OPPORTUNITIES TO EFFECT CHANGE USPHS World Health Commissioned Organization Corps O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 13
OASH OPPORTUNITY - Develop and coordinate the implementation of policies, investments, and frameworks to transform the current “sick-care system” into a “health-promoting system” OPIOID POLICY OPPORTUNITY - Whole of society, evidence-based, public health approach emphasizing prevention, naloxone access, treatment of addiction as a disease, and holistic needs for successful recovery USPHS OPPORTUNITY - Modernize the Commissioned Corps and employ it as an “agent of change” for those with the highest acute and/or chronic public health needs WHO OPPORTUNITY - Build resilient national public health primary care systems to enhance global health security O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 14
OASH: DEVELOPING THE ROADMAP FOR A HEALTHIER NATION O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 15
BULLY PULPIT OF THE SURGEON GENERAL VADM Jerome Adams O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 16
SELECT OASH PRIORITY INITIATIVES • Infectious Diseases - Reducing new cases of HIV by 50% within 5 years - Increasing HPV coverage rate to 80% within 5 years - Incentivizing adult vaccination through reimbursement reform - Developing a national plan to combat STDs • Meeting the Physical Activity Guidelines for Americans - Developing a national plan for youth sports participation and physical activity targeting underserved communities and girls O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 17
SELECT OASH PRIORITY INITIATIVES • Digital Determinants of Health - Developing the ethical, legal, and scientific frameworks to fully leverage social media for public health applications • Chronic Kidney Disease - HHS wide comprehensive plan to improve the outcomes and cost of chronic renal failure • Implementing the revised “Common Rule” O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 18
SELECT OASH PRIORITY INITIATIVES • Health Disparities - Developing Office of Minority Health programs that serve as a catalyst and new framework for change - Implementing public health “turn around teams” focused on zip codes suffering worst health inequities - Improving sudden cardiac death and availability of CPR - Developing exemplar initiatives O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 19
SICKLE CELL DISEASE NEW FEDERAL WORKING GROUP Together with OASH and multi- sector partners, developing a national action plan for sickle cell disease OMH’s #SickleCellStories O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 20
TOOLS AND APPROACHES Guidelines Global Agreements Policies Grants and Contracts Regulations Reimbursement and Workforce O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 21
22 O F F I C E O F T H E https://www.hhs.gov/opioids/ A S S I S T A N T S E C R E T A R Y F O R H E A L T H 22
23 HHS OPIOIDS STRATEGY UPDATE RELEASED SEPTEMBER 17, 2018 “The five-point HHS strategy to end the opioid crisis, unveiled under President Trump in 2017, uses the best science and evidence to directly address this public health emergency. Now, HHS is expanding the scope and improving the effectiveness of the strategy.” Secretary Alex Azar O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H 23
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