Committee on Public Health Practices to Reduce and Control Hypertension

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1 Committee on Public Health Practices to Reduce and Control Hypertension Susan Cooper, MSN, RN Commissioner, Tennessee Department of Health January 8, 2009 Washington, DC

3 Today s s Key Messages n We cannot underestimate the power of building strong, wide, multi-disciplinary partnerships to promote healthy lifestyles and prevent heart disease and stroke. n Public Health must be the national leaders for these efforts, lead the charge, and set the example. n Public health challenges like heart disease and stroke are best approached through multifaceted approaches that target risk factors and improve lifestyles.

4 Fundamentals of State Initiatives n Policies: Moving forward put health in all policies n Programs: Contribute to utilizing and building the evidence base n Partnerships n Innovation, innovation, innovation

5 Preventing Chronic Disease n The work of state health agencies is essential to the prevention and control of numerous chronic diseases, including hypertension, diabetes, cancer, and cardiovascular disease, and to the encouragement of healthy behaviors and choices to help people avoid or control these diseases. Through chronic disease prevention programs, state health agencies work to prevent chronic diseases from occurring when possible and to improve the quality of care and health outcomes for Americans with chronic conditions.

6 The Real Threats to Our Health

7 Community Level Prevention n Agreement that prevention is a good thing, it increases length and quality of life n Community interventions address entire population: those well, those at risk, and those who are ill n Interventions promote healthy environments and behaviors making it easier to make healthy choices

8 Public Health n State public health serves as a facilitator and convener Coalition and social network building Informing the policy environment at multiple levels Increasing individual and community knowledge and skills through health education

9 Addressing Key Risk Factors for Hypertension n High Blood Pressure affected by : Tobacco Nutrition Physical Activity

10 Targeting Tobacco Use in the n Clean Indoor Air Legislation States n Tobacco Price Increases n Youth Prevention n State Quitlines

Physical Activity/ Obesity n Sixty-five percent of U.S. adults are overweight and 30 percent are obese; The cause of this problem is due to lack of physical activity and unhealthy eating patterns.

11 Physical Activity/ Obesity n Sixty-five percent of U.S. adults are overweight and 30 percent are obese; The cause of this problem is due to lack of physical activity and unhealthy eating patterns. Prevention n Overweight or obese adults are at risk for a number of health problems including heart disease, type 2 diabetes, high blood pressure, and some forms of cancer.

Mississippi Improves Stroke n Stroke is the fourth leading cause of death in Mississippi n The Mississippi Heart Disease and Stroke Prevention Program is working to increase awareness about the

12 Mississippi Improves Stroke n Stroke is the fourth leading cause of death in Mississippi n The Mississippi Heart Disease and Stroke Prevention Program is working to increase awareness about the signs, symptoms, and treatment of stroke. n Recent initiatives include Advanced Stroke Life Support training for hospital and prehospital staff, an educational tool kit for hospitals, and an awareness program targeting health care providers. Awareness

13 Get Fit Tennessee n GetFitTN is a statewide awareness program developed to address the behaviors that contribute to chronic disease physical inactivity and poor nutritional choices n Provides free tools to all Tennesseans n

16 Food Journal

17 Arkansas Addresses Childhood Obesity n Analysis of the third consecutive year of statewide BMI assessments of public school students reveals that the progression of the childhood obesity epidemic has been halted in Arkansas.

18 Menu Labeling

19 Eating out linked to obesity

20 Away-from-Home Food Consumption Has Doubled 50% 40% 34% 30% 20% 18% 10% 0 Calories Consumed

21 Restaurant foods Appetizers Calories Sat + Trans Fat (g) Buffalo Wings (12) w/ Dressing 1, Stuffed Potato Skins (8) 1, Cheese Fries (4 c) w/ Dressing 3, Entrees French Toast w/ Syrup & Margarine Caesar Salad w/chicken 1, Spaghetti with Meatballs 1, Fresh Chicken and Broccoli Pasta 2, (total fat) Meals Chicken Ranch Sandwich & Fries 1, BK Double Whopper w/ Cheese King Size Value Meal 1, Fried Seafood Platter 2, Sweets Cinnabon (1) Fudge Brownie Sundae 1, Cheesecake Factory Carrot Cake (1 s) 1,560 23

22 Growing support for menu labeling in chain restaurants

24 Menu Labeling of the Future n Do we push for salt content? n Salt is a hidden ingredient n Take a short salt quiz

25 Salt Quiz n How many mg of salt is in a teaspoon? n Which has more salt 1/2 cup serving of lowfat cottage cheese or 1 oz serving of regular potato chips? n One serving of Ruffles potato chips or one serving of baked chips?

26 n How many mg of salt is in a teaspoon? 2400 mg n Which has more sodium 1/2 cup serving of lowfat cottage cheese 360 mg or 1 oz serving of regular potato chips 180 mg? n One serving of Ruffles potato chips 10 g fat, 160 mg sodium or one serving of baked chips 3 g fat, 200 mg sodium

27 n The majority of sodium consumed is from processed foods: 77% processed foods 12% inherent 6% at the table 5% added while cooking n Understanding how much sodium one should consume and how much one is consuming can be difficult

28 n The 2005 Dietary Guidelines for Americans recommends Consume less than 2,300mg of sodium per day. Except individuals with hypertension, blacks and middle aged and older adults these groups aim to consume no more than 1,500 mg of sodium per day (and meet the potassium recommendation with food). n Average American daily intake of sodium is 3,375 mg n Sodium consumption has increased over the past few decades

29 Reducing Salt, Reducing Mortality n By decreasing the population intake of sodium from 3,500mg/day to 1,500mg/day it s s estimated there would be a 30% decrease in hypertension prevalence (CJC :437) n Reducing sodium levels in packaged foods and restaurant foods by half would save about 150,000 American lives per year from fatal heart attacks and strokes (AJPH 2004;1:19-22). 22).

30 Funding Concerns n Difficult economic times create funding challenges n States are facing shortfalls, investments must be sustained n At individual level, calorie dense foods and processed foods are cheaper

31 CDC Funds Heart Disease and Stroke Programs in the States

32 Prevention Block Grant Dollars at Work n The Prevention Block Grant is the only non- categorical funding states use for chronic disease prevention n Almost 30% of chronic disease dollars are targeted towards heart disease and stroke prevention n Each year, this funding is debated heavily and at risk for discontinuation

33 What State Health Departments Can Do n Promote policy development for system changes that ensure adherence to national guidelines for the prevention and control of high blood pressure n Create an environment of health inclusive of health in all policies ies n Model desired behavior n Participate in community based translational research what strategies work where and under what circumstances n Inform the public that having blood pressure checked is an important first step in identifying and controlling high blood pressure and reducing the risk of heart disease and stroke n Assure that detection and follow-up services are available n Collaborate on education and policy intervention programs to detect ect high blood pressure in high risk groups

34 ASTHO 65 Years as Your Voice in Washington and Resource At Home Association of State and Territorial Health Officials

North Carolina Legislative Task Force on Childhood Obesity

North Carolina Legislative Task Force on Childhood Obesity Suzanne Havala Hobbs, DrPH, MS, RD, FADA Clinical Associate Professor Director, Doctoral Program in Health Leadership Department of Health Policy