DSHS Advisory Council Demographic

1
DSHS Advisory Council Demographic Health
TrendsMarch 3, 2005 Eduardo J. Sanchez, M.D.,
MPHCommissioner, Texas Department of State
Health Services
2
Texas Facts

• Population of 22.1 million
• 85 urban
• 15 rural

3
Texas on the Fast Track Population
Texas population 22 million Expected to
increase to 50 million by 2040 127
4
1,000 children born each day in Texas
Texas on the Fast Track Population
5
8 million seniors by 2040?
Texas on the Fast Track
3rd youngest population . . . . . . but 5th
highest number of elderly Presently, 1 in 10
over 65 . . . . . . by 2040, 1 in 6
Aging
6
Half of the 1,000 Babies Born Every Day in Texas
are Hispanic
7
Texas Population 2003 and 2040 Projection
60
50
40
2003
30
2040
20
10
0
Anglo
African- American
Hispanic
Other
Source Texas State Data Center, Texas AM
University.
8
Uninsured in Texas
9
Uninsured Population

• The uninsured population in Texas is typically
  the legal working population from ages 18 to 65
  years of age.
• United States 15.0
• Texas population 25.0
• Children under 18 years w/out health insurance
  22.7

10
Who are the Uninsured in Texas?

• They are of all ages
• They are from all income groups
• They live all over Texas
• Most of them work
• Most of them are legal, US citizens
• Their population is growing

11
Source of Insurance Coverage for Texans Under Age
65, 2002
12
People With Multiple Healthcare Needs May Choose
1 of 4Doorways into Care
Substance Abuse Mental Illness Physical
Illness Jail
13
Alcohol, Substance Abuse Mental Illnessin Texas

• Illicit drug use (other than marijuana) 674,000
• Binge alcohol w/in past month 4.1 million
• Tobacco use past month 5.1 million
• Alcohol or drug abuse or dependence 1.5 million
• Needing, not receiving treatment, drugs 427,000
• Needing, not receiving treatment, alcohol 1.3
  million
• Serious Mental Illness 1.3 million

14
Youth Suicide in the US

• Among youth aged 10-19
• 3rd leading cause of death
• 1883 suicide deaths in 2001 4.6 per 100,000 pop.
• 76,000 injuries treated in EDs in 2002 (est)
• Among high school students
• 1 in 12 reported a suicide attempt in 2003 over
  1/3 of these required medical attention
• 1 in 6 reported seriously considering suicide
• Trends unchanged in the last decade

15
Mental Illnesses are IllnessesWhy Treat Them
Differently?

• Mental illness is the 2nd largest cause of
  disability, ahead of cancer (in established
  market economies)
• By 2020, clinical depression is expected to rank
  as the 2nd leading cause of disability worldwide.
  
• Mental illnesses are regarded as diseases of the
  brain by medical science, yet 45 of those
  surveyed consider mental illness a matter of
  moral failure.

16
Mental health as a public health crisis
Comparative mortality statistics, 2001
Source Centers for Disease Control and
Prevention
17
Estimated cost of Providing SA treatment v.
Criminal Justice Processing, per Year

• Criminal Justice System
• Probation 1,407
• Parole Supervision 3,351
• Prison System 16,063
• TX Youth Com. 56,416

• Substance Abuse
• Treatment Programs
• Cost per Juvenile 1,934
• Cost Per Adult 914

18
Health Literacy

• More than 300 studies indicate that health
  materials cannot be understood by most of the
  people for whom they are intended.
• Institute of Medicine report says nearly half of
  all American adults 90 million people have
  difficulty understanding and using health
  information.
• Low health literacy adds 30-70 billion to annual
  medical care bill.

19
Health Literacy

• Most medical information on internet written
  at12th grade level
• Average American reads at 8th-9th grade level
• Average Medicaid recipient reads at 5th grade
  level

20
Education The Greatest Predictor of Longevity

• The lower the education level, the greater the
  likelihood that individuals will engage in
  unhealthy behaviors.
• Smoking, drinking to excess, poor dietary habits
  and lack of exercise result in chronic diseases
  and higher mortality rates.
• The overall death rate for people 25- 64 with
  less than 12 years education is more than twice
  that for people with 13 or more years of
  education.

21
Disease Burden by Illness Categoriesin Market
Economies

• All cardiovascular conditions 18.6
• All mental illness 15.4
• All malignant diseases (cancer) 15.0
• All respiratory conditions 4.8
• All alcohol use 4.7
• All infectious and parasitic diseases 2.8
• All drug use 1.5

Global Burden of Disease study,1 conducted by
World Health Organization
22
Health Care Cost Drivers

• 40 million uninsured
• Chronic diseases cause 7 of 10 deaths and over
  75 of U.S. health-care budget
• Serious mental illness affects 5.4 of the U.S.
  adult population but only 15 receive proper
  care.
• In a single generation, U.S. health-care costs
  more than doubled as a of GDP, from 7 in 1970
  to15 in 2002
• Health insurance increased 49 for families
  between 2002 2004, while wages rose 12.
• Aging workforce and the baby boomer bubble
• Health disparities

23
Obesity Trends Among U.S. Adults1991, 1996, 2003
1996
1991
2003
No Data lt10 10-14
15-19 20-24 ?25
Source Behavioral Risk Factor Surveillance
System, CDC.
24
Percentage of Overweight Children and Teens
196370
197174
197680
198894
19992000
16
14
12
10
8
Percentage
6
4
2
0
Male Teens 12-17
Female Teens 12-17
Boys 6-11
Girls 6-11
Source Ogden CL, et al. Prevalence and trends in
overweight among US children and adolescents,
1999 2000. JAMA 2881728-32.2002.
25

• We like to boast that every thing is bigger is
  Texas

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Americas Fattest Cities 2005

• 1. Houston
• 6. Dallas
• 10. San Antonio
• 11. El Paso
• 14. Fort Worth

Source Mens Fitness Magazine, 2005
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Overweight and Obesity-Associated Diseases

• Coronary heart disease
• Stroke
• Congestive heart failure
• Type 2 diabetes mellitus
• High Blood Pressure
• High Cholesterol
• Gallbladder disease

• Osteoarthritis
• Sleep apnea
• Asthma
• Cancer cervix, colon, endometrial, kidney,
  ovary, breast, prostate
• Complications of pregnancy
• Poor female reproductive health

Source Overweight and Obesity Health
Consequences. National Center for Chronic Disease
Prevention and Health Promotion.
28
Burden of Overweight and Obesity in Texas,
2010-2040
29
Two Causes of Overweight/Obesity

• 1. Too many calories in
• 2. Too few calories burned

30
Americans and Fast Food
1970 6 billion
2001 110 billion
2010 ?
31
Time in Leisure Activities
Source American Journal of Preventative
Medicine, 200427 (3S)
32
Prevalence of Obesity by Education
Source American Journal of Preventative
Medicine, 200427 (3S)
33
Growth in National Health Expenditures19802011
6167 (2004)
Per Capita Costs
Source Levit et al. Health Affairs
200221172181. Projection from
Heffler et al. Health Affairs 200221207218.
34
U.S. vs. 30 Other Advanced Nations (OAN)
Per Capita Health Care Spending 2000
Source Alliance for Health Reform, January 2003,
Health Affairs, May 6, 2003.
35
The Price is Not Right

• The U.S. Ranks
• Health Care Spending 1st
• Life Expectancy 28th
• U.S. 1.79 Trillion

Source The World Health Report 2003, Total
Population at Birth.
36
Where are We Heading?

• An epidemic of obesity
• An aging population with increasing medical care
  costs
• An increasing inability of small business to
  afford health insurance
• Increasing job outsourcing
• Rising health care costs threatening to bankrupt
  states

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Causes of Death in United States 2000
Leading Causes of Death
Heart Disease
Cancer
Stroke
Chronic lower respiratory disease
Unintentional Injuries
Diabetes
Pneumonia/influenza
Alzheimers disease Kidney disease

• Percentage (of all deaths)

38
Leading Causes of Death1900
Source Achievements in Public Health, 1900-1999
Control of Infectious Diseases. MMWR, July 30,
1999.
39
Increased Life Expectancy
Increased years due to public health measures 25
Increased years due to medical care advances 5
Source Centers for Disease Control and
Prevention (CDC).
40
2002 Health Care Spending
41
Public Health vs. Medical Care
Medical Care
Public Health
42
Public Health Medical Care Health Care
Public Health
Medical Care
43
Causes of Death in United States 2000
Actual Causes of Death
Leading Causes of Death
Tobacco
Heart Disease
Poor diet/lack of exercise
Cancer
Alcohol
Stroke
Infectious agents
Chronic lower respiratory disease
Pollutants/toxins
Unintentional Injuries
Firearms
Diabetes
Sexual behavior
Pneumonia/influenza
Motor vehicles
Alzheimers disease
Illicit drug use
Kidney Disease
Percentage (of all deaths)
Percentage (of all deaths)
Sources National Center for Health Statistics.
Mortality Report. Hyattsville, MD US
Department of Health and Human Services
2002 Adapted from McGinnis Foege, updated by
Mokdad et. al.
44
Is There a Public Health Solution?

• 1900 Population-based, public health efforts won
  battle against infectious killers
• 2000 Can population-based public health efforts
  win the battle against chronic killers?

45
The Healthcare EquationDemand Supply

• Older
• Larger
• More Sedentary
• Un Underinsured
• Health Illiterate

• Increasing Access
• Improving Quality
• Of Care
• Improving Technology
• Improving Meds
• Improving Workforce

Demand Reduction Is Imperative