Cancer Program Update. April 15, 2011 Pam Hayes Policy Coordinator, MDH Comprehensive Cancer Program

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1 Cancer Program Update April 15, 2011 Pam Hayes Policy Coordinator, MDH Comprehensive Cancer Program

2 Updates Policy Grant Cancer Plan Cancer Facts and Figures

3 CDC Grant MN awarded CDC grant to develop a cancer specific policy agenda 5 year time period Funds a Policy Coordinator position Assistance from Public Health Law Center Focus on policy systems, and environmental change

4 Grant Implementation Engaging and expanding partners in prevention Aligning/leveraging cancer prevention with existing efforts Building and supporting a cancer policy workgroup Designing and implementing 3-5 evidence based cancer prevention interventions

5 Policy and Action for Cancer Prevention Report: Chronic and other disorders and diseases are not caused just by fate or unwise individual choices..... they are largely determined by environmental, economic, political, and social factors.

6 World Health Organization: Cancer: an environmental disease preventable by political initiatives treating the causes of causes Recommends a classic public health approach Major gains in length and quality of life in last 100 years from cleaning up water supplies, sewers, tenements, sweatshops Public health needs to do for diet and exercise what they did for water

7 Chronic Disease: Affluence Safer food/water/air/work led to longer lives. New threat: chronic disease -- public health response focused on individual choice Exception: tobacco advocates used pricing, access and availability policy change Smoking and related disease rates declined Food and fitness escaped regulation, and access and availability improvements

8 2009 Report s Conclusions Cancer is a preventable environmental disease: caused by poor diet / insufficient exercise /social determinants Public health should work upstream on policy and environmental issues Move beyond personal behavior to making sure healthful foods are available; improve built environment: assure healthy air, soil and water are public goods Policies should help people be lean, active, eat less sugar and energy dense foods; eat mostly plant foods, limit red and processed meat, limit alcohol and salt; limit supplements Mothers should breastfeed, children should be breastfed

9 Health Influences Versus Spending Behaviors 50% Environment 20% Genetics 20% Access to Care 10% Health Influences Prevention, 4% Medical Services 96% Health Spending Most of what influences health is preventable or modifiable Behaviors don t occur in a vacuum but are shaped by policy and environmental factors Environmental factors can negatively impact the community or support policies that encourage health and wellness Data Source: Lambrew JM. A Wellness Trust to Prioritize Disease Prevention. The Hamilton Project, Brookings Institution Discussion paper ; 1/36 University of California at San Francisco, Institute of the Future,

10 Friedan: Interventions to Improve Health Low Impact High Resource Behavioral Interventions (Counseling, Education) Clinical Interventions ( Rx for HBP, diabetes, Disease Management) One Time/Long-lasting Interventions (Immunization. Colonoscopy) Surveillance Epidemiology Evaluation Research High Impact Low Resource Change the Context Making the Default Option the Healthful Option ( Fluoridation, Smokefree Air, Trans Fat Ban)

11 Make the Healthy Choice the Easy Choice Policy: Changes to a law, ordinance, resolution, mandate, regulation, or rule both formal and informal: e.g. tobacco tax increase Systems: Changes that impact all or some elements of an organization, institution, or system: e.g. change in school menus Environmental: Physical or material changes to the economic, social, or physical environment: e.g adding walking paths into community design

12 New Cancer Plan Available on line

13 Overarching goals: unchanged Prevent cancer from occurring Detect cancer at its earliest stages Treat all patients with the most appropriate and effective therapy Optimize the quality of life for every person affected by cancer Eliminate disparities in the burden of cancer

14 Updates More SMART objectives Fewer proposed strategies More specificity More evidence-based or evidence-informed strategies Integration across chronic disease program areas Policy, systems and environmental change Health equity and social determinants of health

15 New areas: addressed Radon HPV vaccination Shared decision-making for prostate cancer screening and treatment Advance care planning Hospice utilization

16 New measures: tanning bed use Adult Tanning Bed Use Baseline: 37% Source: Minnesota State Survey

17 New measures: hospice utilization % Medicare recipients with a cancer diagnosis who die in hospital (79%) Median length of stay in hospice among cancer pts (23 days) % hospice stays < 7 days among cancer pts (25%) Source: Hospice Analytics

18 A framework for action Proposed focus areas for the next 2 years Tobacco (objectives 1-4) Obesity (objectives 5-7) Skin cancer (objectives 9-10) Colorectal cancer screening (objective 12) Vaccine preventable cancers (objective 11) Access to non-clinical resources (objective 18)

19 New focus area: obesity Objective 5: Increase health eating among people in Minnesota Objective 6: Increase physical activity among people in Minnesota Objective 7: Increase the number of people with healthy weight in Minnesota Source: Minnesota Obesity Plan

20 Implementation structure Project teams Project teams Defined by focus areas and others Charter, work plan, resource plan Task Forces Special Interest Groups Networking and coordination Policy Work Group Develop and implement policy agenda

21 Accountability: year-end reporting

22 Cancer Facts and Figures Also available on line 11.html

23 Cancer in Minnesota Online: css/documents/092010mcssreport.pdf

24 We want to partner with Rural Health so we can. Maximize organizational strengths and limit duplication Build upon and leverage existing prevention Strengthen multidisciplinary strategies Reduce healthcare costs better integrate population and clinical health care