FALLING BEHIND West Virginia & USA Playing the Game of Health - - PowerPoint PPT Presentation

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FALLING BEHIND West Virginia & USA Playing the Game of Health - - PowerPoint PPT Presentation

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FALLING BEHIND West Virginia & USA Playing the Game of Health Without a Scoreboard Stephen Bezruchka MD, MPH Departments of Global Health & Health Services School of Public Health University of Washington My History Mathematics

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FALLING BEHIND West Virginia & USA Playing the Game of Health Without a Scoreboard

Stephen Bezruchka MD, MPH

Departments of Global Health & Health Services School of Public Health University of Washington

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My History

Mathematics Medical school Remote Nepal: infections there among poorest Emergency Medicine of poverty US health status Efforts since

Thanks Danae Bixler, MD, MPH

Director, Infectious Disease Epidemiology Bureau for Public Health

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AGENDA

SURVEILLANCE Quiz West Virginia Why is our health status so poor

– Inequality is killing us – First 1000 days matter most for our health

PREVENTION Challenge to everyone RESPONSE

– Make comparisons with healthier nations – Inform all of us – Push policies

WORKSHOP

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VITAL signs

Individual

– Infant – Child – Adult

Community State Country

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Killer Facts

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Surveillance QUIZ

True False A 15 year old girl in the US has a smaller chance of dying before reaching age 60 than a similarly aged girl in Sri Lanka. During the period of 1987 to 2007 life expectancy for women declined in about 30% of US counties (which was not so for the previous 20 years). Maternal mortality in the US has increased 50% over the last 15 years.

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Sri Lanka US Adult Female Mortality 1970-2010

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Surveillance QUIZ

True False A 15 year old girl in the US a smaller chance

  • f dying before reaching age 60 than a

similarly aged girl in Sri Lanka. During the period of 1987 to 2007 life expectancy for women declined in almost 30% of US counties (which was not so for the previous 20 years). Maternal mortality in the US has increased 50% over the last 15 years.

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Ezzati et. al 2008

Female Male

US County Life Expectancy Trends 1987-2007

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Surveillance QUIZ

True False A 15 year old girl in the US a smaller chance

  • f dying before reaching age 60 than a

similarly aged girl in Sri Lanka. During the period of 1987 to 2007 life expectancy for women declined in about 30% of US counties (which was not so for the previous 20 years). Maternal mortality in the US has increased 50% over the last 15 years.

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Australia, Canada, Japan, Sweden US Maternal Mortality 1970-2010

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Oh, that three billion dollars.

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SURVEILLANCE

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Time magazine July 30, 2012 + web update

2406 702.5

667 790.5

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How healthy is the US? Health Olympics

Number one Gold 1-5 _______ 6-10 _______ 11-15 _______ 16-20 _______ 21-25 _______ 26-30 _______ 31+ _______

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HEALTH OLYMPICS 2011

Life expectancy

5 15 10 25 20 30 United Nations Human Development Report 2011

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US WOMEN YEARS LEFT AT AGE 50

Glei et al. 2010

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0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0

deaths/100,000 births

5 15 30 10 20 25 35 40

Maternal Mortality Olympics (2008)

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Economist April 25, 2012

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US Health Rankings

IOM 2012

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1st & 4th yr US medical student knowledge of Population Health (2002)

Question INCORRECT

US has higher life expectancy than any other nation? 32% US has lower infant mortality than any other nation? 34%

Agrawal, J. R., J. Huebner, et al. (2005). "Medical students' knowledge of the U.S. health care system and their preferences for curricular change: a national survey." Acad Med 80(5): 484-8.

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How healthy is the US? Health Olympics

Number one Gold 1-5 _______ 6-10 _______ 11-15 _______ 16-20 _______ 21-25 _______ 26-30 _______ 31+ _______

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SUMMARY

AT BEST our health in USA that of middle- income country All of us die younger than we should History of political choices regarding sharing societal resources PRIME REASON Early life is critical for adult health Need set health goals for nation US states and local jurisdictions need inform National response is required

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Playing Game of Health without a scoreboard

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Health not a goal in the USA

Desired End Points? Life, Liberty, Pursuit

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POPULATION HEALTH

Health Inequalities (poorer people have poorer health) Early Life: critical for adult health

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Harvey 2005

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Wilkinson & Pickett 2009 Spirit Level

US MORTALITY RATES BY ZIP CODE INCOME

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PRIMAL PREVENTION

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Index of:

  • Life expectancy
  • Math & Literacy
  • Infant mortality
  • Homicides
  • Imprisonment
  • Teenage births
  • Trust
  • Obesity
  • Mental illness – incl.

drug & alcohol addiction

  • Social mobility

Health and Social Problems are Worse in More Unequal Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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People who create INEQUALITY KILL

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Kondo et al. 2009

Deaths attributable to excess income inequality

1 / 3

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West Virginia SURVEILLANCE

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West Virginia Health Outcomes & Inequality

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West Virginia State Outcomes Better Compared to other states

Homicide Incarceration Teenage births

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West Virginia State Outcomes Poor Compared to other states

Obesity Child obesity Child conflict Doing better in a fist fight High school drop outs Mathematics & literacy scores age 15 Trust Women’s status Life expectancy Infant Mortality

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Wilkinson & Pickett 2009 Spirit Level

Child Obesity

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Wilkinson & Pickett 2009 Spirit Level

Child Conflict

% reporting they would do better than average in a fist fight

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Wilkinson & Pickett 2009 Spirit Level

Women's Status & Inequality among US States

Women's Status

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Wilkinson & Pickett 2009 Spirit Level

Income Inequality Infant Mortality

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WHERE IS OUR HEALTH

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Murray et. al. GH 515

County Female Life Expectancy 2009

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HIGH low US County Female Life Expectancy 2009

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Murray et. al. GH 515

McDowell WV County Male Life Expectancy

Welch, WV, McDowell county seat

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HIGH low US Black Male Life Expectancy 2006

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Yes! Summer 2011

Truman et al. 2011 MMWR

Mean # Healthy days & Inequality of Healthy Days

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Mechanisms through which inequality impacts health Stress Inflammation

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Yes! Summer 2011

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Early life lasts a lifetime

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Womb to Tomb

First 1000 days

9 months

– maternal grandmother

First two years outside

HALF of adult health programmed

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Disease

relative poverty in early life

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PUBLIC HEALTH

Assessment Policy Development Assurance

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RESPONSE

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Oh, that three billion dollars.

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What to do?

Inform the public Make comparisons with healthier nations Level the playing field Support early life

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http://www.phac-aspc.gc.ca/ph-sp/determinants/index-eng.php#determinants

Key Determinants

Income and Social Status Social Support Networks Education and Literacy Employment/Working Conditions Social Environments Physical Environments Personal Health Practices and Coping Skills Healthy Child Development Biology and Genetic Endowment Health Services Gender Culture

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Do we want health or health care?

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"As dramatic and consequential as medical care is for individual cases and for specific conditions, much evidence suggests that such care is not and probably never has been the major determinant of levels or changes in population health." Pg 4.

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SUMMARY

AT BEST our health in USA that of middle- income country All of us die younger than we should History of political choices regarding sharing societal resources PRIME REASON Early life is critical for adult health Need set health goals for nation US states and local jurisdictions need inform National response is required

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Stephen Bezruchka sabez@uw.edu

Resources: readings

http://depts.washington.edu/eqhlth/pages/resources.html

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PRIMAL PREVENTION RESPONSE

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PRIMAL PREVENTION

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What to do?

Inform the public Make comparisons with healthier nations

– How many of you do this to policy makers now?

Level the playing field Support early life

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What to do?

Inform the public Make comparisons with healthier nations Level the playing field Support early life

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Oh, that three billion dollars.

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Leveling playing field

INCREASE GOVERNMENT REVENUE Corporate: Individual Taxes

$1.50: $1 1950s, $0.25: $1 now

Individual taxes (1950s 91% marginal rate) Raise cap on social security Tax other forms of property (stocks, bonds, savings)

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Leveling playing field

SOCIAL SPENDING Early life focus

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Child Poverty Before and after taxes/transfers USA Canada

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What to do?

Inform the public Make comparisons with healthier nations Level the playing field Support early life

– Antenatal, maternal leave

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Heymann 2009

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Realistic issues

Collect Analyze

– data on various health, ses & social measures – Health disparities (Health INEQUALITIES)

Report comparing other areas, countries Highlight socioeconomic gradient

– Focus on income-health

Not income inequality – poor health

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Obesity & Poverty Mortality Rate (age-adjusted) 2005-9

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"This is our generation's Sputnik moment,"

State of the Union Jan 25, 2011

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State

  • r

County Level Interventions

SPUTNIK MOMENT

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Life expectancy Infant Mortality Disparities

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http://www.countyhealthrankings.org

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http://www.countyhealthrankings.org

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http://www.countyhealthrankings.org

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FOCUS? Disease prevention

Disease screening & treatment

Behavior Change

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CHRONIC DISEASE RISK

Disease approach

Birth DEATH

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CHRONIC DISEASE RISK

Risk factor approach

Birth DEATH

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PRIMAL PREVENTION

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Making Health a goal in the USA

Desired End Points Long Healthy Life

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Murray & Frenk 2010

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(last paragraph) "The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart."