MDHHS Winnable Battles

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1 Michigan Department of Health & Human Services MDHHS Winnable Battles Social Determinants of Health Eden V. Wells, MD, MPH, FACPM Michigan Department of Health and Human Services Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life.

2 Health: Michigan s Most Critical Resource Health is the main ingredient necessary to survive being born and to ultimately thrive! Our collective health is linked to living longer lives, the strength of our families and communities, a flourishing economy and makes Michigan a destination state for not only visiting but residing in. Each stage of life builds upon the next 2

3 Population Health vs Public Health Public health understood to be the critical functions of state and local public health departments preventing epidemics containing environmental hazards encouraging healthy behaviors. Population health is defined as: the health outcomes of a group of individuals, including the distribution of such outcomes within the group. Kindig, DA, Stoddart G. (2003). What is population health? American Journal of Public Health, 93, Kindig DA. (2007). Understanding Population Health Terminology. Milbank Quarterly, 85(1), Institute of Medicine. (2002). The Future of the Public's Health in the 21st Century. Washington, DC, The National Academies Press.

4 Population Health 4 health.html

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6 Population Health Impacts Michigan has a diverse population and health outcomes are different for people. Social determinants of health are the conditions in which people are: born grow live play work age 6

7 Health Impacts, continued Social determinants that have the most effect on our health: Race Social economic status Education Neighborhood and home safety Transportation Safe and affordable housing Access to nutritious foods 7

8 Population Health Across the Life Span What happens early in life impacts health status later in life: Health begins before birth A mother s health prior to and during pregnancy impacts the health of her baby. Early life experiences impact future health and development Brain, social, emotional, cognitive and physical development are most critical during very first years of life Life experiences can cause chronic stress resulting in poor health outcomes 8

9 Health Outcomes Health Disparities exist when health outcomes are worse for some groups of people than for others. Michigan s goal is Health Equity When health disparities are eliminated and all individuals and families can live health lives and reach their fullest physical, mental and social potential 9

10 MDHHS Winnable Battles The Population Health Approach

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12 MDHHS Winnable Battles Healthy Babies

13 Healthy Babies Where Are We Now? In 2013, 113,732 little Michiganders were born 1 out of 8 (13,648) of the babies were born too early (i.e. before 37 weeks) 1 out of 12 (9,397) were born too small (i.e. weighing less than 5.5 pounds) Babies that are born too small and too early are at the highest risk of dying Michigan ranks 8 th in the United States for the highest rate of infant deaths 13

14 Healthy Babies- cont. In 2013, 799 babies died before their first birthdays African American babies more than twice as likely than White babies to die before one year of age Native American and Hispanic babies are also at a higher risk of dying before they reach twelve months of age 1 out of 6 (142) infant deaths were due to unsafe sleep. These deaths are totally preventable and are increasing each year. All data from the MDHHS vital records and National Center for Health Statistics 14

15 Healthy Babies How Can We Improve? Focus on highest risk communities Effectively engage mothers and babies that are of the highest risk for poor outcomes Increase the number of mothers and babies who have a primary care medical home Increase the number of babies that are breastfed Make sure all babies are put to sleep using safe sleep practices Assure that all babies receive developmental screenings and follow-up, when needed Increase the number of eligible families enrolled in evidencebased home visiting 15

16 MDHHS Winnable Battles Immunizations

17 Where Are We Now? Vaccination prevents infections that may cause severe disability or death In U.S., vaccines save 42,000 lives and prevent 20 million diseases annually CDC: for every $1 spent on vaccines, $10.20 is saved in medical and societal costs. In t20 th century alone nine vaccines led to dramatic events such as: Eradication of small pox Elimination of polio in most regions of the world

18 Immunizations, cont. 1 in 3 Michigan children months of age have not received all recommended vaccines. (2014 National Immunization Survey) Michigan ranks fourth worst (47 th ) among all 50 states Michigan s coverage rates for adolescents is 68.7% (America s Health Rankings). Michigan is better than average (18 th ) Key factors to address include: Complex vaccination schedule Vaccine Cost Parents perceived risk of vaccine preventable diseases has declined and hesitancy about vaccination is increasing Interest in alternative schedules Steady loss of VFC providers 18

19 How Can We Improve? Enhance current and implement new strategies to improve immunization rates Improve access by: Recruiting additional VFC providers - statewide Integrate into home visitation programs (vaccine education, assessment, referral) - targeted Coordinate education, assessment and referral functions with WIC - targeted Increase awareness of immunization sites/clinics, including local health departments statewide Increase Community Demand by: Use of MCIR to issue reminder/recalls with an emphasis on children 19 to 36 months of age - targeted Continue local health department immunization exemption education requirement statewide

20 How Can We improve, cont. Expand Provider and System-Based Strategies by: Expanding quality assurance visits to non-vfc providers - targeted. Develop quality assurance reports such as list of overdue children for practices - targeted. Promote use of standing orders and assess during quality assurance site visits targeted. Continue quality assurance reports for local health departments - statewide Other possibilities Investigate utilization of pharmacies as alternative vaccination sites for adolescents - targeted. Use social media to increase parental knowledge of the importance of vaccines - statewide 20

21 MDHHS Winnable Battles Nutrition, Physical Activity and Obesity

22 Where Are We Now? 31.5% of Michigan residents are obese, increasing their risk of chronic conditions. >25% of MI deaths result from cardiovascular disease and stroke. $10.2 billion is spent in healthcare costs for heart diseaserelated medical costs per year. Michigan s current obesity trend: Inadequate physical activity Poor fruit/vegetable consumption Limited access to opportunities to choose activity and healthy eating

23 How Can We Improve? Provide equitable healthy food access in communities. Increase active transportation and encourage walking. Strengthen partnerships between physicians and community-based organizations. Reduce the risk of obesity and chronic disease among children and youth by creating and maintaining healthy school and child care environments where breastfeeding and healthy, age-appropriate feeding is normalized and physical activity is abundant.

24 MDHHS Winnable Battles Heart Disease and Stroke

25 Where Are We Now? Heart Disease is the leading cause of death in the U.S. and Michigan. Risk factors for cardiovascular disease include inactivity, obesity, hypertension, smoking, high cholesterol, and diabetes. Hypertension, or high blood pressure, is a primary risk factor for heart disease and is the leading cause of stroke. 34.6% of Michigan adults self-report that they have ever been told they have high blood pressure, and approximately 63% to 70% of Michigan adults with hypertension are in control.

26 How Can We Improve? Identify additional opportunities to increase awareness among populations who are at high risk of chronic disease about hypertension and how it can cause heart disease and stroke. Continue to work with our partners on assisting providers on using EHR data to help their clients in controlling their high blood pressure. Strengthening our partnership with Medicaid to increase reporting by primary care providers on the percentage of their of patients who have their high blood pressure under control. Support the use of health care teams with different types of health care providers (i.e., primary care providers, pharmacists, oral health providers, community health workers) to improve hypertension control among their patients. Increase our efforts to implement programming in communities with Michigan residents who have high rates of heart disease and stroke.

27 MDHHS Winnable Battles Tobacco

28 Where Are We Now? Tobacco Use is the leading preventable cause of disease and death in Michigan. Approximately 21.4% of Michigan s adult population smoke cigarettes. $3.4 billion is spent each year in health care cost for tobacco-related illnesses. Tobacco-related illnesses cost Michigan s Medicaid program $1.1 billion annually. Limited funding for the state prevention program, industry marketing and failure to increase the cigarette tax contribute to Michigan s current smoking trend.

29 What Are We Doing Now? Collaborating with Medicaid to ensure all managed care plans approved cessation products and interventions. Working with health care systems to institutionalize tobacco cessation into routine clinical care. Legislative initiative to increase the tobacco tax.

30 How Can We Improve? Continue to Implement comprehensive tobacco-free and smoke-free policies for schools and colleges, public housing, and casinos. Increase communication and efforts to outreach to disparately affected populations mental illness, racial and ethnic minorities, those with disabilities, LGBT, low SES, pregnant women, people living with HIV/AIDS, youth Expand qualifications to allow community health workers, nurses, and counselors to be certified tobacco dependence treatment specialists.

31 Actions MDHHS Strategies Identification of processes needed to move from where we are to where we want to be Partnerships and collaboratives Local community Public Private Non-governmental Process and outcome evaluation 31

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