Paul Jarris MD MBA Executive Director Association of State and Territorial Health Officials

Transcription

1 Paul Jarris MD MBA Executive Director Association of State and Territorial Health Officials

2 Crisis

3 The U.S. spends 16% of GDP on health care more than any other country in the world Journal of Public Health Management & Practice. 13(2): , March/April Sensenig, Arthur L. MA

4 Per Capita Total Current Health Care Expenditures, U.S. and Selected Countries, 2006 Notes: Amounts in U.S.$ Purchasing Power Parity, see includes only countries over $2,500. Total Current Expenditures on Health is defined by the OECD as the sum of expenditures on personal health care, preventive and public health services, and health administration and health insurance; it excludes investment. United Kingdom not included because it does not provide a breakdown of Total Health Expenditures into Current and Investment expenditures; the Total Health Expenditure Per Capita for the UK in 2006 was $2,760. Source: Organisation for Economic Co-operation and Development. OECD Health Data 2008, from the SourceOECD Internet subscription database updated October Copyright OECD 2008, Data accessed on 11/12/2008.

5 The U.S. Census Bureau indicates: 43 countries exceed the United States in life expectancy 40 countries have lower infant mortality rates than the United States. U.S. Census Bureau, International Data Base,

6 America s Health Rankings A Call to Action for People & Their Communities United Health Foundation, 2007 United States United Kingdom New Zealand Germany Canada Australia France Japan

7 The incidence of many major chronic diseases among adults age 50+ in the U.S. is higher compared to 10 European countries - heart disease, high blood pressure, high cholesterol, stroke, diabetes, chronic lung disease, arthritis and cancer. The incidence of obesity in these European countries is about half that of the U.S. Thorpe, KE, Howard, DH and Galactionova, K, Differences in Disease Prevalence as a Source of the U.S.- European Health Care Spending Gap, Health Affairs, Oct 2, 2007.

8 Poorer health exists at all income levels in the U.S. compared to England. Individuals in the top (half) of the education and income strata in the U.S. have comparable rates of diabetes and heart disease as those in the bottom (half) strata of income and education in England." Banks, J, Marmot, M, Oldfiled, Z and Smith, J.P., Disease and Disadvantage in the United States and in England, Journal of the American Medical Association, Vol. 295, No 17, pp , May 3, 2006

9 Income: Low income and uninsured rates would need to improve by about 33% to close the gap with higher incomes and the insured. Ethnicity: It would take a 20% decrease in Hispanic risk rates to reach benchmark white rates on key indicators. Race: It would require a 24+% improvement in African American mortality, quality, access, and efficiency indicators to approach benchmark white rates. The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from a National Scorecard on U.S. Health System Performance, The Commonwealth Fund, September 2006

10 Infant mortality by race/ethnicity, and mother s education, 2002 Infant mortality trends, U.S. National White Hispanic AI/AN Black Asian/PI White Black Hispanic Asian/PI AI/AN Less than high school * At least some college * For mothers age 20 and older. PI = Pacific Islander; AI/AN = American Indian or Alaskan Native. Data: National Vital Statistics System Linked Birth and Infant Death Data (AHRQ 2005a; NCHS 2005). Source: Commonwealth Fund National Scorecard on U.S. Health System Performance,

11 Age-adjusted per 100,000 population Coronary heart disease deaths 78 Diabetes-related deaths U.S. National White Black Hispanic Asian/PI AI/AN Less than high school 104 * At least some college * Total of 43 reporting states and D.C. for people ages PI = Pacific Islander; AI/AN = American Indian or Alaskan Native. Data: National Vital Statistics System Mortality (Retrieved from DATA2010 at Source: Commonwealth Fund National Scorecard on U.S. Health System Performance,

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13 The objective of health is twofold: goodness the best attainable average level fairness the smallest feasible differences among individuals and groups World Health Report 2000

14 We spend more on health care than any other nation in the world, yet we rank poorly on nearly every measure of health status. How can this be?

15 Determinants of Health and their Contribution to Premature Death, Adapted from McGinnis, et al.,

16 Actuarial studies show spending on public health accounts for only 2-3% of national health spending Journal of Public Health Management & Practice. 13(2): , March/April Sensenig, Arthur L. MA

17 What if our nation supported health care the way we do public health?

18 What if our nation supported health care the way we do public health? Would we ever role out chemotherapy is 20 states, heart surgery in a dozen, and newborn deliveries in a few more?

19 Chronic Disease Grants to States 19

20 The Real Threats to Our Health

21 Results of the Shrinking Public Health Budgets 64% of state health agencies have reduced services 33% have eliminated entire programs 24% have instituted layoffs and furloughs 40% expect to lose additional staff through layoffs or attrition 21

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23 Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people. Barack Obama, Obama 08

24 Reforming our system to focus on prevention will drive down costs and produce better health outcomes. That's why it is so important that we pass comprehensive health care reform this year." - Senate Finance Committee Chairman Max Baucus (D-Mont)

25 "Our country will never contain health care costs until we place a higher priority on public health and prevention programs. An investment of just $10 per person per year in proven community-based programs could save this country more than $16 billion annually within five years." - Congresswoman Kay Granger (R-TX) Co- Chair of Prevention Caucus

26 Not only does the science say we need to target disease before it strikes, but the American people are saying it too - loud and clear. Prevention is America's top health reform priority because it will not only lower disease rates across the population, eliminate health disparities and better ensure equality, it also saves us precious health care dollars as we prevent disease and not just treat it." - Congresswoman Lucille Roybal-Allard (D-CA), Chair of the Congressional Hispanic Caucus Health Care Task Force