We may be rough, and we have to be tough

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We may be rough, and we have to be tough
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Healthier, Longer Lives
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Healthiest State in Nation
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Where Have We Been?
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Where Have We Been?

• 100 years ago, how many babies born
• in Maine died before their 5th birthday?
• 1 in 5 , 1 in 8 before their 1st birthday

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Where Have We Been?

• Today, how many babies born in Maine die before
  their 5th birthday?
• 1 in 800
• Or, 1 in 1,000 not counting prematurity

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Where Have We Been?

• Arent these successes due to advances in health
  care and education of mothers?

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What did Maine children diefrom 100 years ago?

• Diarrhea
• Vaccine-Preventable Infections Influenza,
  Diphtheria, Pertussis, Meningitis, Measles,
  Tetanus, Polio, Smallpox
• TB
• Pneumonia

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Where Have We Been?

• Top Reasons for Infant MortalityDecline
• Sanitary conditions during birth and perinatal
  period
• Safe drinking water
• Vaccines

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Where Have We Been?

• What were the top causes of death among adults
  100 years ago in Maine?

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Where Have We Been?
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Where Have We Been?
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My Own Journey to Public Health
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Shirati, Tanzania
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Shirati Tanzania
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Where Are We Now? Chronic Diseases

• Leading causes of death and disability
• 75 of Mainers will die from 1 of 4 diseases
  CVD, Cancer, Diabetes, Chronic Lung Disease
• Mostly preventable Tobacco and Obesity
• Direct health care costs 40 of Maines Health
  Care Budget

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Cardiovascular Disease

• 1 cause of death and disability
• 40 of all deaths
• 25 of all hospital costs

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Cancer

• 2 cause of death
• 65 due to Tobacco or Obesity
• Most are curable if screened, detected, and
  treated early

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Diabetes

• 8 of adult Mainers now have diabetes - 3 did
  10 years ago.
• 11 of pregnant Maine women have diabetes -
  less than 2 did 20 years ago.

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Lung Disease

• Asthma
• Emphysema, Chronic Obstructive Pulmonary Disease

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Dental Disease

• 1 in 3 Mainers over age 65 have lost all their
  teeth
• 40 of Maine 3rd graders have tooth decay
• Highly associated with other chronic diseases

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Mainers suffering from frequentmental distress
are twice as likely to

• Have Diabetes
• Be Tobacco Addicted
• Have Asthma

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What Are Two Big Factors Associated with Poor
Health?

• Poverty

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Racial Discrimination
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What Are Effective Strategies?
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Tertiary Prevention Strategies Treating Illness
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Secondary Prevention Strategies Reducing Risks
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Primary Prevention Strategies Preventing Risks

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Primary Prevention Strategies

• State and Community Interventions
• Health Communication
• Surveillance and Evaluation

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Statewide InterventionTobacco Tax

• 1991 0.37
• 1997 0.74
• 2001 1.00
• 2004 2.00

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Statewide InterventionLaws Banning Smoking

• 1981 Public meetings
• 1983 Court houses
• 1985 Stores
• 1986 Most workplaces
• 1989 Hospitals, except psychiatric patients
  and hospitals
• 1999 Restaurants
• 2003 Bars
• All loopholes closed
• 2007 School grounds
• 2009? Public beaches, outdoor eating

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Community Intervention - Healthy Maine
Partnerships

• 28 Comprehensive Community Health Coalitions
• Cover all of Maine
• Funded with Tobacco Settlement andFederal Funds
• Tobacco, Obesity, Substance Abuse community
  interventions

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Smoke Free Parks
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City/Town ordinances for walkable communities
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Food policies for organizations
X
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Health Communication Goals

• Change culture
• Secondhand smoke
• Children watching TV
• Walking
• Portion Sizes
• Support community and statewide interventions
• Promote quitting Tobacco

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Secondary Prevention
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Motivate Tobacco Users to Quit
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Improved Treatmentof Chronic DiseasesTertiary
Prevention
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Care Model

• Decision Support
• Information Systems
• Self-Management Support

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Decision Support Information Systems- Diabetes

• Diabetes Registries
• Learning Collaboratives

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Self-Management Support

• Diabetes Educators
• Diabetes Support Groups

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Examples of Success
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Where Are We Going?
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Patient Centered Medical Home
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Public Health Infrastructure
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• Existing players, new
• model for coordination
• 8 DHHS Districts
• Strengthened Local Health Officer system
• Some core public health functions carried out by
  Healthy Maine Partnerships
• 8 District Coordinating Councils (DCCs)
• District Public Health Units
• MCDC Office of Local Public Health

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Goals of thePublic Health System

• helping Maine become the healthiest state in the
  nation
• readying and maintaining the state public health
  system for national federally-recognized public
  health accreditation
• assuring the effectiveness, efficiencies, and
  evidence-based delivery of the essential public
  health services.

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Healthy Communities
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But the cause for which we fought was higher our
thought wider... That thought was our power.
- Joshua Chamberlain
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If facts are the seeds that later produce
knowledge and wisdom, then the emotions and the
impressions of the senses are the fertile soil in
which the seeds must grow.
- Rachel Carson