Centers for Disease Control and Prevention The new CDC population health initiative to improve health in 5 years or less Office of the Associate Director for Policy Elizabeth L. Skillen PhD, MS Centers for Disease Control and Prevention Senior Advisor December 21, 2016
CDC Strategic Directions Better prevent Improve the leading causes health security at of illness, injury, home and around disability, and the world death Strengthen public health/ health care collaboration
The Changing Health System • 20 m i l l i on Am er i cans have i ns ur ance f or t he f i r s t t i m e � Fewer publ i c heal t h s af et y net s er vi ces • Shift from “Volume ‐ Based” Payment Model to “Value ‐ Based” Payment Model � Opportunities to improve population health and address health equity � Increased focus on prevention and wellness • E merging clinical care models � Need for more collaboration between clinical care and public health
Public Health as Chief Health Strategist Practice #2: Develop strategies for promoting health and well ‐ being that work most effectively Practice #5: Collaborate with a broad array of allies— including non ‐ health sectors—to build healthier and more vital communities
The “Buckets” of Prevention Framework
Buckets 1 and 2 traditional clinical | innovative clinical www.cdc.gov/sixeighteen
Bucket 3 Community ‐ Wide Prevention • How do we improve population health in our states and communities? • What is the best evidence of health and cost impact? • What can we do that will begin to show results soon?
A few caveats • CDC’s roles: summarizing evidence & offering tools – No funding for implementation • There are many other worthwhile efforts, some – take longer to work – are costly – haven’t been evaluated
Questions we have heard I lead a small I work for a governor How do I make the health department. who only wants health business case for my How do I address initiatives that will lead community ‐ wide the social to positive results before health strategies to a determinants of she runs for re ‐ election? hospital board? health? Got any of those?
14 evidence ‐ based, community ‐ wide, population health interventions: Improve health of community • (not clinical/patient ‐ oriented) Demonstrate positive health • impact in 5 yrs. or less & cost effectiveness &/or savings over time w w w. cdc. gov/ hi 5
How was the HI ‐ 5 List Developed? Step 1 Step 2 Step 3 Step 4 Excluded those not Excluded those without Excluded Bucket 1 & 2 Earned the highest implemented at policy evidence reporting : interventions and evidence rating from : level those with evidence of • The Guide to Community • measurable impact on health potential harm Preventive Services in five years (n=120 “Recommended”) • cost effectiveness and/or • Robert Wood Johnson savings over the lifetime of the Foundation/ U of Wisconsin population or earlier County Health Rankings/ Roadmaps What Works for • those not implemented in Health site (n=144 “Scientifically more than 85% of states Supported”) • CDC Experts
14 Evidence ‐ Based, Community ‐ Wide Interventions Change the Context: Address the Social Determinants of Making the Healthy Choice the Easy Choice Health • Early Childhood Education • School ‐ Based Programs to Increase Physical Activity • Clean Diesel Bus Fleets • Public Transportation System • School ‐ Based Violence Prevention Introduction or Expansion • Safe Routes to School (SRTS) • Home Improvement Loans and Grants • Motorcycle Injury Prevention • Earned Income Tax Credits • Tobacco Control Interventions • Water Fluoridation • Access to Clean Syringes • Pricing Strategies for Alcohol Products • Multi ‐ Component Worksite Obesity Prevention
Public Transportation System Introduction or Expansion Description – Includes a variety of transit options such as buses, light rail, and subways – Increases both access and use of public transit and to reduce traffic Health Impact – Reductions in health risk factors such as motor vehicle crashes, air pollution, and physical inactivity – Increases in walking per day Economic Impact – Typical American public transit service improved to high quality urban rail or bus rapid transit service would result in per capita annual health benefits of $354.86
Tobacco Control Interventions Description – Tobacco price increases – High ‐ impact anti ‐ tobacco mass media campaigns – Comprehensive smoke ‐ free policies Health Impact – Reduced hospitalizations for asthma and heart attacks – Reduced numbers of young people who start smoking – Increased quitting in youth and adults Economic Impact – Smoke ‐ free indoor policies = reduce hospital admissions by 5 ‐ 20% – Mass ‐ media campaigns = benefit ‐ to ‐ cost ratio up to 74:1 – Raising prices by 20% = healthcare savings up to $90 per person per yr
Tobacco Cessation in All Three Buckets Traditional Clinical Innovative Clinical Community-Wide Prevention Prevention Prevention 1 3 2 � Expand access to evidence ‐ based � Promote increased utilization of � Tobacco price increases � High ‐ impact anti ‐ tobacco mass tobacco cessation treatments covered treatment benefits by tobacco � Remove barriers that impede users media campaigns � Comprehensive smoke ‐ free access to covered cessation treatments policies Public Health Health Care
What’s Next? www.cdc.gov/hi5 Webinars to highlight specific HI ‐ 5 interventions • Webinar series to continue in 2017 Learn from cites, counties, communities, states and you! • Email us: Healthpolicynews@cdc.gov Evaluate our efforts to spread the word about HI ‐ 5
Ques t i ons ? w w w. cdc. gov/ hi 5
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