Collaborations to Reduce Health Disparities and Improve Wellness

Transcription

1 Collaborations to Reduce Health Disparities and Improve Wellness Congressional Black Caucus Braintrust National Minority Quality Forum 2008 Leadership Summit Washington, DC 14 April 2008 Bryan J. Alsip, MD, MPH, FACPM Assistant Director of Health San Antonio Metropolitan Health District

2 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2006 (*BMI 30, or about 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% BRFSS, Behavioral Risk Factor Surveillance System http: //

3 Risk Factors Women and persons of low socioeconomic status appear to be particularly affected by overweight and obesity Hispanics and African Americans tend to have lower socioeconomic status and lack educational attainment Studies have demonstrated individuals with low educational attainment are more likely to report factors that put them at risk for heart disease, such as smoking, obesity, hypertension, and poor diet* * Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992; 82:

4 % Economically Disadvantaged Children by School District 2005 Alamo Heights ISD Randolph Field ISD Lackland ISD North East ISD Ft Sam Houston ISD Northside ISD Judson ISD East Central ISD Somerset ISD Southw est ISD Edgew ood ISD Harlandale ISD San Antonio ISD South San Antonio ISD Southside ISD SAT Mean Total Score by School District Generally, SAT scores are lower for the largely Hispanic inner city schools

5 Risk Factors Urban and suburban designs discourage walking and other physical activities Pressures on families to minimize food costs, acquisition and preparation time, resulting in frequent consumption of convenient foods that are high in calories and fat Reduced access and affordability to fruits and vegetables and other nutritious foods Decreased opportunity for physical activity at school and after school Increased sedentary activity watching TV or playing computer games

6 Bexar County Age Distribution (Hispanic, NH White & African American) 85+ Hispanic Female Male 85+ NH White Female Male 85+ Female Black Male Age May 9-May 9-May Source: 2000 Census

7 2005 Bexar County Deaths by Cause* (Age-Specific Rate per 100k) Hispanic Rate NH White Rate Diabetes mellitus Chronic liver disease and cirrhosis Acute myocardial infarction Cerebrovascular diseases Malignant neoplasms of liver Alcoholic liver disease Chronic ischemic heart disease Malignant neoplasms of colon, rectum and anus Renal failure Septicemia Motor vehicle accidents Malignant neoplasm of stomach Malignant neoplasms of kidney and renal pelvis Hypertensive heart disease Human immunodeficiency virus (HIV) disease Viral hepatitis Bexar County Population Estimate 156, ,597 * Death rates are unstable when the frequency of deaths is fewer than 20 events

8 2005 Bexar County Deaths by Cause* (Age-Specific Rate per 100k) African-American Rate NH White Rate Acute myocardial infarction Cerebrovascular diseases Atherosclerotic cardiovascular disease, All other forms of heart disease All other and unspecified malignant neoplasms Malignant neoplasms of trachea, bronchus and lung All other forms of chronic ischemic heart disease Renal failure Diabetes mellitus Other chronic liver disease and cirrhosis Malignant neoplasm of breast Malignant neoplasms of colon, rectum and anus Accidental poisoning Septicemia Bexar County Population Estimate * Death rates are unstable when the frequency of deaths is fewer than 20 events 23, ,597 8

9 Bexar County 2005 Diabetes Mortality* by Zip Code Rates of Diabetes deaths 100 to to to to 20 to Rate per 100k of population Cases <10 were not included due to low numbers Source: * Deaths in which Diabetes listed as primary cause of death Source: 2005 Texas Department of State Health Services death certificates

10 Bexar County 2005 Diabetes Mortality* by Zip Code Rates of Diabetes deaths 100 to to 60 to to 20 to Rate per 100k of population Cases <10 were not included due to low numbers Source: * Deaths in which Diabetes listed as primary cause of death Source: 2005 Texas Department of State Health Services death certificates

11 Prevalence of End-Stage Renal Disease National (U.S.) 352,868 (122.3 Rate per 100k*) Texas 35,710 (160.3 Rate per 100k*) Bexar County 3,717 (250.7 Rate per 100k**) The rate of ESRD in Bexar County is more than twice the national rate Poor medical management of diabetes may lead to renal failure (ESRD) In the U.S. 45% of ESRD patients have diabetes listed as their cause of renal failure (up from 18% in 1980) In Bexar County 60% of ESRD patients have diabetes listed as their cause of renal failure (2006) Numerically, diabetes is the leader for a chronic disease that can lead to end stage renal disease (ESRD) The Kidney Health Care Program Fiscal Year 2006 Annual Report *2004/**2006 End Stage Renal Disease Network of Texas, Inc.*

12 Diabetes Registry Initiative San Antonio City Council authorizes Metropolitan Health District to seek State legislation to make Diabetes Mellitus a reportable disease The Texas Diabetes Council recommends a pilot project in Bexar County initially, to serve as a potential model for future Statewide application State Representative Joe Straus of San Antonio authors HB 2132, which authorizes the collection and study of hemoglobin A1C test results from Bexar County labs

13 Diabetes Registry Initiative Three (3) commercial laboratories and one (1) hospital laboratory (UHS) have been identified as participating laboratories for the study These labs report an average 10,000-12,000 A1C tests per month; project scope approximately 18 months Negotiations are being finalized for a Vermont-based clinical software company to assist Metro Health in gathering, storing, and analyzing the A1C Registry data for Bexar County

14 Diabetes Registry Initiative Metro Health s A1C Registry represents only the second public health agency in the United States to seek A1C data to measure how well diabetes is being managed among those diagnosed with the condition at the community level The aggregate data and analysis gathered during the San Antonio pilot project will be reported back to the Governor and Texas State Legislature in 2009 Launch of the A1C Registry to occur in May 2008

15 Steps to a Healthier San Antonio Five-year cooperative agreement to implement chronic disease prevention efforts to reduce the burden of diabetes, overweight, obesity, and asthma and addressing related risk factors Partners American Cancer Society San Antonio Mayor s Office & City Council South Texas Asthma Coalition Social and Health Research Center: Project Bienestar Bexar County Community Health Collaborative San Antonio Independent School District American Lung Association University Health System Texas Diabetes Institute San Antonio Bexar County Metropolitan Planning Organization YMCA

16 Steps to a Healthier San Antonio Project Area: Residents, students, employers and employees within the geographic boundaries of the San Antonio Independent School District Approximately 79 square miles with a population of about 316,000 residents The San Antonio Independent School District consists of 92 schools, 57,462 students and 3,674 classroom teachers 85% of the student population is either Hispanic or African American Target population for Steps interventions Elementary, middle, and high school students; parents; teachers; school administrators; PTA groups and members of the SAISD school board. Low-income school age children and families Employers and employees in work sites Interventions Media, Policy, School-based, Community-based, Work place, Healthcare

17 Other Metro Health Initiatives Provision of Care and Services Transition of Clinical Preventive Services to University Health System focus on Population-based Services Good Health at Goodwill immunizations, WIC services, and primary care provided at Goodwill stores Periodontal care for diabetic patients referred from the Texas Diabetes Institute Population-based Services Families Preventing Diabetes work in the communities with nurses and promotoras Project WORTH (Working on Real Teen Health) to reduce the rates of unplanned teenage pregnancies School Nurse Liaison for ISDs in San Antonio Wellness initiatives and the Built Environment Healthy Start reduce the incidence of infant mortality Tobacco Prevention Coalition

18 Other Metro Health Initiatives Immunization Programs IZSA Community Immunization Collaborative SAIRS vaccine registry Vaccine research study center Donations from private companies School-based influenza immunization program Technology Health Access San Antonio (HASA) using information technology to provide network across health care organizations Research (in conjunction with the UTHSCSA) National Children s Study (NCS) Clinical Translational Science Award (CTSA)

19 Obesity and Public Health Law The law in general is established as a powerful instrument of public health One of the newest targets of public health law is obesity * Education and public health leaders can use specific laws and policies to promote programs and strategies that foster an environment in which children and adolescents can thrive and learn** * Obesity The New Frontier of Public Health Law ** A CDC Review of School Laws and Policies Concerning Child and Adolescent Health

20 Questions