Advancing Health Equity and Tobacco Control Complementary and Essential Tasks for Achieving Optimal Health for All

Transcription

1 Advancing Health Equity and Tobacco Control Complementary and Essential Tasks for Achieving Optimal Health for All Edward P. Ehlinger, MD, MSPH Commissioner Minnesota Department of Health January 25, 2017

2 January 25, 1945: Grand Rapids, Mich., became the first U.S. city to begin fluoridating the drinking water.

3 January 11, 1964, Surgeon General Luther L. Terry released first Surgeon General's Report on Smoking and Health. January 25, 1964

4 Top Ten Achievements in Public Health in 20 th Century: Tobacco Use -- United States,

5 Adult Smoking Prevalence U.S. and MN, Sources: 2014 Minnesota Adult Tobacco Survey (MATS)

6 Student Commercial Tobacco Use Percent smoking cigarettes in past 30 days, by grade: % % 11.9% 10.2% 12.2% 7.5% 8.4% % 4.2% 2.8% Grade 8 Grade 9 Grade 11 Source: 2016 Minnesota Student Survey (MSS)

7 Robert Burns born on January 25, 1759 Scottish Poet best known for Auld Lang Syne The best laid schemes o' mice an' men Gang aft a-gley, An' lea'e us nought but grief an' pain For promis'd joy.

8 Tobacco is Still a Problem in Minnesota 5,900 Minnesotans die every year due to smoking. Smoking causes over $2.5 billion in medical costs annually in Minnesota. 580,000 Minnesotans, 14.4 percent of the state s population, still smoke. 102,100 Minnesota youth are projected to die from smoking. Tobacco kills more Minnesotans than alcohol, homicides, car accidents, AIDS, illegal drugs, and suicide combined.

9 Percent ever tried E-cigarette and Nicotine Poisonings In 2013: 74 e-cigarette poisonings overall, with 50 reports involving kids and teens Percent of students who have ever tried an e-cigarette middle school high school

10 Changing Landscape of Youth Tobacco Use As youth move away from cigarettes, they are also trying new, often flavored products.

11 Percent smoking menthols Tobacco is Still a Problem Percent of high school smokers who usually smoke menthols: Source: 2014 Minnesota Youth Tobacco Survey (MYTS)

12 Adult Tobacco Disparities 50.0% Percent of adults who are current cigarette smokers, by subgroup, % 43.4% 40.0% 38.6% 35.0% 30.0% 25.0% 22.3% 25.7% 24.0% 24.6% 27.8% 20.0% 15.0% 15.9% Statewide average percent of 16.3% 10.0% 5.0% 0.0% Amer Indian Black White Lesbian, gay, or bisexual HS grad or less Income <35K Binge drinking Psych distress Source: 2014 Behavior Risk Factor Surveillance System (BRFSS)

13 Percent conventional tobacco use Youth Tobacco Disparities Percent of 11th grade students using conventional tobacco in past 30 days, Statewide average percent of 12.8% 0 Amer Indian [2%] Asian [7%] Black [10%] Hispanic [7%] White [73%] Econ hardship [8%] Bi/gay/lesbian [6%] Town/rural [23%] Suicide thoughts [12%] Binge drinking [13%]

14 Why are Tobacco Use and Equity Still a Problem? Predominant U. S. Worldview Small Government Mistrust of Science Reliance on technology/specialization Boot Straps Individualism Virtue of Work Decreased investment in the commons and the public good. Socially irresponsible marketing and promotion of tobacco. Decreased investment in disadvantaged populations. Over investment in biomedical model Free Market Solutions Education is for job training Structural Discrimination is a thing of the Past

15 Advancing Health Equity and Optimal Health for All Minnesota Approach to Equity and Tobacco Control Social Cohesion

16 Expand the Understanding of Determinants of Health Genes and Biology Physical Environment Clinical Care Health Behaviors 10% 10% Determinants of Health Model based on frameworks developed by: Tarlov AR. Ann N Y Acad Sci 1999; 896: ; and Kindig D, Asada Y, Booske B. JAMA 2008; 299(17): World Health Organization. Ottawa charter for health promotion. International Conference on Health Promotion: The Move Towards a New Public Health, November 17-21, 1986 Ottawa, Ontario, Canada, Accessed July 12, 2002 at What Creates Health 10% 30% Social and Economic Factors 40% Necessary conditions for health (WHO) Peace Shelter Education Food Income Stable eco-system Sustainable resources IT connectivity Mobility Health Care Social justice and equity Social responsibility

17 Tobacco Industry Continues to Seek Ways to Addict People Tobacco industry continues to look for ways to addict people E-cigs Smokeless tobacco Flavored products Other products Creative Marketing and Promotion

18 Tobacco Industry vs. Prevention Spending Minnesota $ $ $ $135.5 Million INDUSTRY $24.3 Million PREVENTION

19 Social/economic inclusion Thriving small businesses and entrepreneurs Financial institutions Good transportation options and infrastructure Home ownership Better performing schools Sufficient healthy housing Grocery stores IT connectivity Strong local governance Parks & trails Tobacco controls Good Health Status Poor Health Status Contributes to health disparities: Diabetes Cancer Asthma Obesity Injury Tobacco use Social/economic exclusion Few small businesses Payday lenders Few transportation options Rental housing/foreclosure Poor performing schools Poor and limited housing stock Increased pollution and contaminated drinking water Fast food restaurants Limited IT connections Weak local governance Unsafe/limited parks Limited tobacco restrictions

20 What Creates Health? Health is not created by health care and personal choices. Health is created in communities through policies, systems, and environments.

21 Expand the Understanding of What Creates Health Ehlinger s beliefs about the contributions to health determinants Physical Environment Clinical Care Health Behaviors Genes and Biology 10% 10% 10% 10% 60% Social and Economic Factors Determinants are created & enhanced mostly by policies and systems that impact the physical and social environment

22 Change the Narrative about What Creates Health Alternative Worldview Interdependence Social Cohesion Collective Action Virtue of Work Necessary Government Data, Evidence, Experience - Informed Increased investment in the commons and the public good. Investment in the disadvantaged. Socially responsible business practices. Balanced investment in care and prevention Social Responsibility Education is for enlightenment Need for Generalists Equity is the challenge of the present

23 Implement a Health in All Policies Approach with Health Equity as the Goal

24 Founder of modern chemistry Robert Boyle born on January 25, 1627 Founding member London s Royal Society. Noted for pioneering experiments on the properties of gases and his corpuscular view of matter that was a forerunner of the modern theory of chemical elements. It is my intent to beget a good understanding between the chymists and the mechanical philosophers who have hitherto been too little acquainted with one another s learning.

25 Implement a Health in All Policies Approach with Health Equity as the Goal Minimum Wage Paid Leave Ban the Box Transportation Policy Broadband connectivity E-Health Policies Ag Buffer strips Food Charter Marriage Equity Payday Lending Minimum legal Age Smoke Free Air/FTB Parks Child Care/Foster Care Autos Treatment Centers Prisons Tobacco Tax Couponing Flavors Sponsorship/Marketing/ Promotion

26 CityHealth Recommendations Tobacco Control: Tobacco 21 policies set the minimum age to purchase tobacco products at 21. Curbing tobacco use among young adults has been shown to decrease the number of people who start and continue smoking.

27 UN Sustainable Development Goals Set Includes Tobacco Tax

28 Strengthen the Capacity of Communities to Create Their Own Healthy Future Traditional Public Health Primary Prevention Medical and Public Health Work Primary Care Secondary Prevention Specialty Care Tertiary Prevention World of Providing Health education Screening tests Disease management Pharmaceuticals Clinical services Physical and financial access Etc MANAGEMENT OF RISKS & DISEASES Milstein B. Hygeia's constellation: navigating health futures in a dynamic and democratic world. Atlanta, GA: Syndemics Prevention Network, Centers for Disease Control and Prevention; April 15, Available at:

29 Strengthen the Capacity of Communities to Create Their Own Healthy Future Healthy Public Policy & Public Work Community Primary Prevention Health Promotion Medical and Public Health Policy Traditional Public Health Primary Care Primary Prevention Secondary Prevention Specialty Care Tertiary Prevention DEMOCRATIC SELF-GOVERNANCE Improving Living Conditions Milstein B. Hygeia's constellation: navigating health futures in a dynamic and democratic world. Atlanta, GA: Syndemics Prevention Network, Centers for Disease Control and Prevention; April 15, Available at: MANAGEMENT OF RISKS & DISEASES the community in the fullest sense is the smallest unit of health to speak of the health of an isolated individual is a contradiction in terms. Wendell Berry in Health is Membership

30 Partnerships Youth Local Public Health Community Based Organizations Tobacco Control Health Care Providers Parents Voluntaries Community Members

31 Group discussions with communities Online Survey Over 350 community participants Interviews

32 Local and Community Connections Local-level momentum State-level impact

33 The absolute pressure exerted by a given mass of an ideal gas is inversely proportional to the volume it occupies if the temperature and amount of gas remain unchanged within a closed system. P 1 /V P V = k Boyle s Law

34 Bold Steps for Action

35 Advancing Health Equity and Optimal Health for All Minnesota Approach to Equity and Tobacco Control Social Cohesion EDWARD P. EHLINGER, MD, MSPH Commissioner Minnesota Department of Health