Making the healthy choice, the easy choice: Tobacco control and obesity prevention in Philadelphia

Transcription

1 Making the healthy choice, the easy choice: Tobacco control and obesity prevention in Philadelphia Giridhar Mallya, MD, MSHP Director of Policy and Planning Philadelphia Department of Public Health

2 Schroeder S. We Can Do Better Improving the Health of the American People. NELM;2007;357;

3 Health and economic costs in Philadelphia Tobacco use Poor Diet and Physical Inactivity 2,200 deaths per year ~2,000 deaths per year $660 million in productivity losses annually ~$750 million in health care costs annually Philadelphia Vital Statistics Report, 2010, Philadelphia Department of Public Health Obesity health care costs estimated from Finkelstein et al, Health Affairs, 2009

4 Health Impact Pyramid Examples Smallest Impact Largest Impact Counseling & Education Clinical Interventions Long-lasting Protective Interventions Changing the Context to make individuals default decisions healthy Socioeconomic Factors Eat healthy, be physically active, have safe sex Rx for acute and chronic conditions Immunizations, brief intervention, cessation, colonoscopy Smoke-free laws; counteradvertising campaigns; immunization mandates; pollution emissions standards Poverty, education, housing, inequality Frieden T, AJPH 2009

5 Media Educational institutions Community retail environment and restaurants Built environment Legislation and regulation Workplaces Insurers and health care providers

6 CDC support for Get Healthy Philly Communities Putting Prevention to Work Community Transformation Grant Sodium Reduction in Communities Program State &Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, & Stroke Philadelphia Department of Public Health, School District of Philadelphia

7 Schools policy and systems change School Wellness Council Interventions, Number of Schools Selecting Wellness Goals 1990s Universal feeding pilot Nutrition education for all SNAPeligible children Comprehensive school nutrition policy % milk and no fryers in school kitchens 20 0 Healthy classroom rewards Socialized Recess Healthy school stores 48 5 Healthy fundraisers Classroom movement breaks schools created Wellness Councils made up of teachers, principals, students, and parents Philadelphia Department of Public Health, School District of Philadelphia

8 Institutional nutrition standards City agencies hospitals 8

9 Built environment smoke-free policies 12,000 acres of smoke-free parks, recreation centers, and playgrounds 5 Philadelphia universities with smoke-free policies Public housing agency with 80,000 residents pursuing a smoke-free policy Leung R et al. Developing and Implementing a Smoke-Free Policy for Recreation Centers and Playgrounds in the City of Philadelphia. Preventing Chronic Disease. 2013;10:120294

10 Built environment planning and zoning Encouraging the incorporation of fresh food markets into commercial and mixed-use developments by offering density bonuses that don t count the square footage of those markets against the maximum buildable area (14-603(7)) Requiring the provision of secure bicycle parking in developments above a certain size, and allowing the removal of 1 automobile space in exchange for the provision of 5 bicycle parking spaces (14-804) Conducting targeted health impact assessments of planning decisions Making specific land use and zoning recommendations as part of district plans

11 Retail - Healthy Chinese take-out restaurant initiative Over 400 take-out Chinese restaurants in Philadelphia, primarily in African American and Hispanic neighborhoods Partnered with Temple University Center for Asian Health, Asian Community Health Coalition, and Chinese Restaurant Association 200+ have been trained in low-sodium cooking methods Early analyses reveal a 30% reduction in sodium content of 2 popular dishes Chicken Lo Mein = 3,200 mg 2,300 mg Shrimp and Broccoli = 1,900 mg 1,235 mg Ma, G. Temple University Center for Asian Health, 2013

12 Media sugary drinks, smoking cessation, salt reduction physical activity

13 Insurers and health care providers promoting and supporting quit attempts All Medicaid plans in Philadelphia provide coverage for 6 of the 7 FDA-approved smoking cessation medications Offering up to 8 weeks of free nicotine replacement therapy via the Quitline ( QUIT-NOW) Leading tobacco-related practice and culture transformation in the City s behavioral health treatment system

14 Primary care learning collaboratives Improve the quality of care for 350,000 patients in 43 practices by: Increase electronic health record adoption and use Increase the institutionalization and monitoring of quality measures Increase engagement of non-physician team members Increase self-measures blood pressure monitoring tied with clinical support Implement systems to identify those with undiagnosed hypertension Increase engagement of community health worker and pharmacists

15 Progress adult smoking

16 Progress youth smoking Youth smoking prevalence, U.S. and Philadelphia

17 Progress adult obesity

18 Progress child obesity 5% decrease 8% decrease 7% decrease Robbins et al, Preventing Chronic Disease, 2012 Accompanying editorial from RWJF, Philadelphia Freedom

19 Progress youth obesity

20 Thank you!