Sharon Moffatt ASTHO Chief of Health Promotion and Disease Prevention 1
Prevention and Public Health (PPH) Fund: establishes new mandatory spending for public health and community-based prevention, which can be allocated to a wide array of programs. $500 million in FY 2010 and growing each year to $2 billion in FY 2015 and each fiscal year thereafter Maternal, Infant, and Early Childhood Home Visiting Program: new mandatory funding intended to assure effective coordination and delivery of critical health, development, early learning, child abuse and neglect prevention, and family support services to children and families. $100 million in FY 2010 and growing to $400 million through FY 2014. Personal Responsibility Education: new mandatory funding to educate teens on both abstinence and contraception for the prevention of pregnancy and STIs, including HIV/AIDS. $75 million for each FY 2010 through 2014. $s in millions FY 2012 FY 2010 FY 2011 President s FY 2012 Program Enacted Enacted Request Senate* Chronic Disease State Grants 0 $52.2 $157.7 0 Community Transformation Grants 0 145.0 221.1 280.0 CDC Tobacco Prevention/Cessation 14.5 50.0 79.0 100.0 Baby Friendly Hospitals/Breast Feeding Promotion and Support 0 0 2.5 7.1 National Diabetes Prevention program expansion 0 0 0 10.0 Small Business Workplace Wellness 0 10.0 0 10.0 Racial and Ethnic Approaches to Community Health (REACH) 0 25.0 0 50.0 Section 317 Immunization Program 0 100.0 61.6 150.0 CDC Prevention of Healthcare- Associated Infections activities 0 11.8 20.0 11.8 * House Appropriations Bill rescinds the PPH Fund in FY 2012 www.astho.org 2
Institute of Medicine 2011 Deaths in women attributable to total effects of individual risk factors (in thousands), by disease. BMI- body-mass index; LDL low-density lipoproteins; NCD noncommunicable disease; PUFA polyunsaturated fatty acid; SFA saturated fatty acid * Danaei et al. (2009). 3
The data do not include the numbers for states that reported that a service is covered under the managed care program but not under the fee-for-service program. * Government Accountability Office analysis of survey of state Medicaid directors conducted between October 2008 and February 2009 State-mandated preventive benefits of importance to adult women, 2010. *BlueCross BlueShield Association, 2010. 4
Prematurity 5
55% of all Texas births (225,000) paid by Medicaid $2.2 billion per year in birth and delivery-related services for moms and infants through first year First year Newborn costs Preterm infant $63,124 Normal infant $404 Patient Protection and Affordable Care Act, Title IV Sec. 4107 Requires all states to provide Medicaid coverage for tobacco cessation services and NRTs for pregnant women effective October 1, 2010 6
Up to 20% of pregnant women smoke, causing 20 % of all low-birth weight births. More than half of all women (52 %) who quit during pregnancy started smoking again two to six months after delivery 94% of state and national quit lines use specialized protocol for pregnant women 98% quit lines send specialized materials to pregnant women Providing prenatal smoking cessation services and the 5 As A s (Ask, Advise, Assess, Assist, Arrange) as part of a 15-minute counseling session increases quit rates by 30 to 70 % Keller PA, Feltracco A, Bailey LA, Li Z, Niederdeppe J, Baker TB, et al. Changes in tobacco quitlines in the United States, 2005-2006. Prev Chronic Dis 2010;7(2). http://www.cdc.gov/pcd/issues/2010/ 7
Breastfeeding at Work Patient Protection and Affordable Care Act, Title IV. Sec 4207 Requires reasonable break time for an employee to express breast milk For each 1000 infants who were never breastfed, there are: 2,033 excess office visits 212 excess days of hospitalization 60 more episodes of lower respiratory tract illnesses 580 more episodes of otitis media, and 1,053 more episodes of gastroenteritis Ball TM, Wright AL. Health Care Costs of Formula-feeding in the First Year of Life. Pediatrics. 1999 April; 104(4): 870-876. 8
Connecticut: Breastfeeding Friendly Hospitals Initiative (CT) Patient Education Vermont: Awards for Breastfeeding Friendly Businesses 9
Maternal, Infant, and Early Childhood Home Visiting Programs Patient Protection and Affordable Care Act, Title II Sec. 2951 Grants to state to deliver services under early childhood home visiting gprograms to improve MCH, school readiness, and socioeconomic status and to reduce child abuse, neglect, and injuries Funding: 1.5 Billion over 5 years Serves all 159 counties in Georgia s 19 health districts. Serves at risk infants and children age 5 Gives family assessments, health education, and links to community resources and a primary care provider Annual cost $2.9 million (2006) 10
21 Patient Protection and Affordable Care Act, Title IV. Sec 4204 Creates demonstration grants to states to improve access to immunizations 11
ACIP and ACOG recommend inactivated influenza vaccine for women who will be pregnant during influenza season, regardless of pregnancy trimester Influenza vaccine during pregnancy also protects infants < 6 months of age from laboratory-proven influenza Zaman et al., N Engl J Med 359:1555-64, 2008 ACOG Committee Opinion No. 468. Obstet Gynecol 2010;116:1006 7. CDC. Recommendations of the ACIP, 2010. MMWR 2010;59(No. RR-8). 2011 Prevention and Public Health Fund to assist states in increasing immunizations Pharmacists as Vaccinators Certifying and training pharmacists (AR, MN, WA) Coordinating with physicians offices in states (CT) Employee Immunization Work with local business association (AR, MA, WA) Collaborate with occupational nurse groups (MN) 12
March 2011 Percent of Adults Aged 65 and Older Who Reported Not Receiving Influenza Vaccination Within Past Year 23.2-27.3% Source: Behavioral Risk Factor Surveillance System, 50 states and the District of Columbia 27.4-29.3% 29.4-31.2% 31.3-32.8% 32.9-37.9% 13
85% of deaths and two-thirds of influenza hospitalizations are people p older than 65. Flu shots given to older adults reduces hospitalizations, lowers costs, and prevents deaths. One in three older adults reported not receiving a flu shot in the past year. 14
Vote & Vax is a SPARC (Sickness Prevention Achieved through Regional Collaboration) initiative providing flu shots at polling stations on Election Day. More than 120 million Americans go to the polls in Presidential election years and nearly 66% of these voters are age 50 and older. In 2008, 21,434 people were vaccinated on Election Day; 62% of vaccine recipients were age 50 and older. www.voteandvax.com Percent of Women Aged 65 to 74 Who Reported Not Receiving Mammogram Within Past Two Years 8.3 14.5% Source: Behavioral Risk Factor Surveillance System, 50 states and the District of Columbia 14.6-16.8% 16.9 18.1% 18.2 21.1% 21.2 27.5% 15
Almost half of all new cases and nearly 66% of deaths from breast cancer occur in women 65 years of age and older. Mammography screening every two years for women aged 65 to 74 has been shown to reduce mortality. Nearly one in five women this age reported not receiving a mammogram within the past two years 16
The Promoting Access to Health for Pacific Islander and Southeast Asian Women (PATH for Women) Coalition is one of CDC s C REACH U.S. grantees. Seeks to prevent breast cancer among women in California s Asian and Pacific Islander communities. REACH PATH for Women has educated more than 30,000 women on breast cancer prevention, early detection and treatment. Through these efforts the mammograms amongst Asian women over age 65 in the has increased by 20%. www.cdc.gov/reach/index.htm Smoking rates have been decreasing, but the decline is slowest in adults over 65. An estimated $73 billion is spent each year on smoking related medical care. The National Commission on Prevention Priorities ranks smoking cessation counseling the second most important preventive service, second only to daily aspirin use. 17
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Clinical Preventative Services for Women, Closing the Gaps. Institute of Medicine of National Academy of Science, 2011. Enhancing Use of Clinical Preventive Services Among Older Adults. Center for Disease Control, Agency on Aging, Center for Medicare. March 2011 www.immunizationforwomen.org Crossing the Quality Chasm: A New Health System for the 21 st Century, Institute of Medicine, National Academy of Sciences, 2001. To Err is Human: Building a Safer Health System, Institute of Medicine, National Academy of Sciences, 2000. Effects of a Self Management Program on Patients with Chronic Disease, Lorig, K. et al, Effective Clinical Practice Nov/Dec 2001, Vol 4. 19
Blueprint for a Healthier America, Trust for America s Health, Oct 2008 Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, Trust for America s Health, July 2008 The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine 2003, 348:26. Agency for Healthcare Research and Quality g y Q y www.guidelines.gov U.S. Preventive Services Guide to Clinical Preventative Care www.ahrq.gov/clinic Community Preventative Services Guide www.thecommunityguide.org Institute for Clinical Systems Integration www.icsi.org 20
Sharon Moffatt RN MSN Chief of Health Promotion and Disease Prevention Association of State and Territorial Health Officials smoffatt@astho.org www.astho.org 21