Posts Tagged ‘blood pressure’

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Lower the Pressure

September 14th, 2012

About 1/3 of American adults have high blood pressure and more than half of them don’t have it under control.   The majority of people with high blood pressure are being treated with medicine and have seen a doctor at least twice in the past year…  but their pressure still isn’t under control, according to a new Vital Signs report from the CDC this week. 

High blood pressure means blood pressure greater than or equal to 140/90 mm- Hg…  and its direct health care cost is almost $131B per year.  To learn more about blood pressure, visit www.cdc.gov/bloodpressure/.   For more information on heart disease and stroke, visit http://www.cdc.gov/heartdisease/.  Controlling high blood pressure is also a key component of the Million Hearts initiative to prevent a million heart attacks and strokes by 2017.

 

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Looking for a Dynamic and Rewarding Career?

May 10th, 2011

Life expectancy improved by more than 30 years in the US during the 20th Century.  Advances in diagnosis and treatment of disease have played a role, but the real reason we’re living longer today has a lot more to do with public health interventions than advances in health care.  Interventions like vaccines, motor vehicle safety, safer workplaces, clean water and food safety, tobacco control and improvements in maternal and child health are responsible for most of the improvement.  You can see the top 10 public health interventions of the 20th century in an article I wrote awhile ago in the old Prevention Bulletin.

If you want to be part of the movement that pushes public health improvements into the 21st century, you’re in luck.  Arizona has one of the most dynamic and flexible School of Public Health in the country.

For starters, there’s the Mel & Enid Zuckerman College of Public Health is the first nationally accredited college of public health in the Southwest. They offer a dynamic academic curriculum that includes the undergraduate degree in public health and graduate degrees in public health, epidemiology, biostatistics, and environmental health sciences. They’ve gained national and international recognition for research productivity and integration into communities across Arizona, the Southwest, Mexico and the globe. The faculty, alumni and students are consistently finding new approaches to chronic disease prevention, community public health preparedness, family wellness and advocacy for public health policy.

There’s also a new Phoenix-Collaborative MPH in Public Health Practice program as well as a distance learning Graduate Certificate in Public Health; which are great options for folks looking to advance their knowledge about public health. The Master of Public Health in Public Health Practice is a new interdisciplinary program that prepares students to develop the public health skills needed to work in a variety of governmental and non-governmental settings including the local, county and state departments of health, Medicaid and Medicare programs, hospitals, and community health centers.

They also have 3 certificate programs that are completely on-line.  These are graduate level programs where students get accepted to our graduate college and take 15 units. The programs include:

Graduate Certificate in Public Health which includes 5 core MPH courses;

Graduate Certificate in Maternal and Child Health Epidemiology;

Graduate Certificate in Global Health; and

Clinical Research Training Program (This isn’t all online yet but they’re making progress).

Interested?  Spend some time on the links above, and remember, public health is full of old-timers like me whose careers are long in the tooth and who are poaching great jobs.  But a lot of us will be out of the way in the next few years, and public health needs a new generation work-force to move us into the 21st century.

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Incentivizing Chronic Disease Self-Management

April 12th, 2011

This month AHCCCS told us that they’ve picked our Bureau of Tobacco & Chronic Disease as the state applicant for HHS’ Medicaid Incentives for Prevention of Chronic Diseases Grant.  The grant proposal (which will be developed with AHCCCS) must be turned in to the Centers for Medicare and Medicaid Services early next month.  The grant is competitive, so we’re not certain whether we’ll be successful, but we like our chances.

The idea is to incentivize AHCCCS members to participate in the evidence-based Stanford Chronic Disease Self Management Program, which provides opportunities for members to build skills and gain the confidence to actively participate in their health management.  Our team would build on the current infrastructure and capacity to deliver workshops to include AHCCCS members through expansion of partnerships offering workshops in local communities across Arizona.

The program that we’ll be proposing will create rewards for incremental successes in the disease self-management process, including enrollment in program “adherence” and demonstrated reduction in risk factors (e.g. blood pressure, cholesterol and glucose levels, weight, and tobacco use).  The program would conduct assessments at client progress at 30, 60, and 90 days, and will conduct an analysis of continued reductions and/or maintenance after 12 months.  The specific rewards will be determined on the basis of focus groups findings conducted with adults with chronic disease.  There’s strong evidence that this program design is critical to promoting and enhancing disease self-management efforts, and improving the overall health and cost burdens of this population.

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Next Fiscal Year’s Budget Series

January 24th, 2011

On January 15, 2011, the Governor released her proposed budget for next fiscal year, which begins July 1, 2011. Our part of the budget in the link above is on pages 105 through 111.  You kinda need to be a budgeteer to understand some of it, so I’ll try to distill it down a little in several posts this week.

Changes to Medicaid

The proposed budget reduction that would have the largest impact to our mission is a proposal to temporarily (for 2 years) roll back a portion of the population (called childless adults) that are currently covered for Medicaid (AHCCCS) healthcare benefits (beginning October 1, 2011).  “Childless adults” refers to people who haven’t had kids or who had kids but the kids are grown (e.g. “empty nesters”).  Currently we’re one of a handful of states that cover childless adults all the way up to the 100% of federal poverty threshold.

The State would need to get permission from the federal government in order to temporarily drop this population from coverage under AHCCCS, so whether this actually happens or not will depend on what the US Department of Health and Human Services says.  The legislature took action in a special session last week that instructs the Executive branch to pursue a waiver to change eligibility levels.  Also, the Governor is pursuing congressional changes to give states more flexibility in this regard.

We currently provide behavioral health services to approximately 5,200 childless adults that have a serious mental illness. While it may appear, and we were originally concerned, that this would mean that childless adults with a serious mental illness may lose their current benefits if the proposal is implemented, we think there’s a way to ensure that more than 80% of these folks can maintain their current benefits under a different Medicaid category.

We believe that most of the childless adults that have a serious mental illness and are currently receiving services from the ADHS could still qualify for their full benefits including behavioral health services under a different federal category for the disabled (called Supplemental Security Income Medical Assistance Only). Qualifying for this new category requires a review of each person’s medical condition to see whether they meet the standard. We believe that more than 80% of the childless adults with a serious mental illness that are receiving behavioral health services can qualify under the Supplemental Security Income Medical Assistance Only category. This means they would maintain their current benefits.

In order to help these individuals retain coverage, we’ve instructed our Regional Behavioral Health Authorities (RBHAs) and our behavioral health providers to immediately implement a coordinated approach to screen every single childless adult with a serious mental illness that is currently receiving services from the ADHS for eligibility under the Supplemental Security Income Medical Assistance Only.  Just in case, the proposed budget includes extra funding to make sure that people with serious mental illnesses who don’t qualify for SSI Medical Assistance Only would still be able to keep their prescriptions for their illness.

Childless adults that currently receive general mental health services from our RBHAs through Medicaid would have their benefits suspended beginning October 2011 under the proposal, saving about $79M of general fund next fiscal year and our budget is reduced by that amount under the plan.

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Posted in Behavioral Health, General

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Personal BP Story

October 26th, 2010

When we implemented our Salt Initiative  earlier this year we asked people to know their blood pressure and consider reducing their sodium intake by shopping more carefully and preparing recipes that are lower in sodium.  One of the main messages was to encourage people to know their own blood pressure.  Then it occurred to me- I don’t know my own blood pressure.  So I went to the drug store and bought a blood pressure machine and used it at work.  Low and behold- I was consistently at 140/90 mmHg- which is too high.  I went downstairs and had our prevention staff check me and it was 140/90.  The next week, I had a checkup, and my pressure in the office was 140/90.

 She told me I needed to take these little pills every day, which I did for 3 days.  Then I took my own advice.  We cut down on sodium at home and I started doing the treadmill every day (instead of just 2-3 times a week).  Guess what.  It worked.  Not right away- but within a few weeks I was down in the 130/85 range- and by late summer it was down to about 120/78 mmHg- which is fine.  In the end I was able to do it with just diet and exercise.  It might not work the same for you, but it might- and it’s worth the try- because remember elevated blood pressure puts you at much higher risk for heart disease and stroke.  So give it a try.

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Heart Disease v. Cancer in AZ

October 25th, 2010

As predicted by our 1990 ADHS Vital Statistics Bureau in 1990- cancer is now the number one killer in Arizona – surpassing heart disease.  Does this mean that cancer is getting worse?  Probably not- it really says that because of better management, treatment, and prevention of heart disease- people with heart conditions are living longer.  Effective medications to control high blood pressure and reduce cholesterol levels (statins) have been developed, medical procedures have improved such as removal of coronary artery obstructions, coronary artery bypass, cardiac catheterization, pacemakers; and widely available supplements (certain Omega-3 fatty acids) or even a margarine such as ‘Promise’ which is ‘cardiologist endorsed’.  We’re also making more progress educating the public about the importance of controlling your blood pressure- which is the #1 risk factor for heart disease.  Check out the full report “Heart Disease vs. Cancer: An Epidemiologic Transition in Mortality Risks” on our website.

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AZ Obesity Update

July 6th, 2010

The Trust for America’s Health released their annual obesity report.  Overall, the national trend toward increasing obesity rates continued it’s march forward.  Arizona ranked in the middle of the pack, but the pack itself in increasingly unhealthy.  More than two-thirds of states have adult obesity rates above 25 percent. In 1991, no state had an obesity rate above 20 percent.

Most Americans think that being overweight is a simple matter of personal responsibility.  While it’s clear that people need to make healthy choices and get more exercise if we’re going to turn this thing around, there are some other factors.  Healthy foods cost more than junk food and good food is hard to find in many neighborhoods.  But you can be sure that cheap processed foods are available everywhere.  Also, finding safe, accessible places to be physically active can be a challenge.  While everyone faces barriers to healthy choices, the obstacles are often higher for people with lower incomes and less education.

Those of you that work on public health prevention should become familiar with the key elements in the report, especially the intervention strategies  in the second half of the report.  By the way…  our Empower Pack is an example of the kind of strategy that we need more of to turn this ship around.

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New Strategies to Reduce NaCl Intake

April 26th, 2010

Last Wednesday, April 21, the Institute of Medicine (IOM) released a new report on high blood pressure entitled Strategies to Reduce Sodium Intake in the United States.  The report was sponsored by the CDC, FDA, and  NIH. High blood pressure is one of the nation’s leading causes of death, responsible for roughly one in six deaths among adults annually. Nearly one in three adults have high blood pressure, placing huge economic demands on the health care system- estimated at $73.4 billion in direct and indirect costs in 2009 alone.  We’re still in the process of reviewing the report to see how we could leverage some of our nutrition programs to make a difference.

The report concludes that a coordinated approach is needed to reduce sodium content in food including the setting of standards for acceptable sodium levels in processed foods. The report recommends setting a national goal to slowly, over time, reduce the sodium content of the food supply in a way that goes unnoticed by most consumers as individuals’ taste sensors adjust to the lower levels of sodium.

The FDA issued a  Statement on IOM Sodium Report this week that they will be reviewing the IOM report over the coming weeks and build plans for how they can work with other federal agencies, public health and consumer groups, and the food industry to support the reduction of sodium levels in the food supply. The Department of Health and Human Services will be also establishing an interagency working group on sodium at the Department that will review options and next steps.

Don’t forget you can pledge to eat less sodium, sign up for healthy recipes and learn more about sodium reduction at Eatwellbewell.org.

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Do You Know Your Blood Pressure?

March 1st, 2010


High blood pressure is at the source of roughly one in six deaths among adults annually. About one in three adult Arizonans have blood pressure that’s too high, putting huge economic demands on Medicaid, Medicare (AHCCCS) and our private health insurers (plus, of course, the loss of life).  The Institute of Medicine put out a report last week that identifies  high-priority areas on which we (public health & Arizona’s medical system) should focus in order to accelerate progress in hypertension reduction and control.

The IOM report recommends that we focus on population-based strategies that can reach large numbers of people. The keys are really behavioral and lifestyle interventions like reducing sodium (salt) intake, eating more fruits and vegetables, and increasing physical activity www.eatwellbewell.org.  The report also calls for the country’s public health system to promote policies that make it easier for people to engage in regular physical activity, cut calories, and reduce their intake of foods containing high levels of sodium while increasing their exposure and access to produce and other foods containing potassium.  This new IOM report fits quite well with our new Champions for Change salt initiative www.azdhs.gov/salt. Touche´.

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Salt Initiative

February 22nd, 2010


We launched our salt reduction initiative this week http://www.azdhs.gov/salt/.  The overall goal is to get Arizonans to reduce their salt intake by paying more attention to the Sodium line in the nutrition facts and being a better- by selecting foods for the family that are lower in sodium.

Sodium can increase your blood pressure and the chances of you having a heart attack or stroke… and heart disease is the leading cause of death in Arizona.  National dietary guidelines recommend that many adults eat no more than 2,300 milligrams of sodium each day.  For best health, some adults should eat no more than 1,500 milligrams of sodium each day, and you should really pay attention if you’re over 40, are African American or if you already have high blood pressure.

Most people think that they get their salt mostly from adding it with the shaker- but in reality, 80% of the salt that we get is from processed foods.  That’s the reason why it’s so important to read the label and buy foods that are lower in sodium.

 

Start today and become a “Champion for Change” to cut back on your sodium intake. A Champion for Change” is anyone that makes healthy changes in their home or community. Being a Champion is about being committed to keeping you and your family healthy.

You can begin today by looking at our salt education resources on the www.eatwellbewell.org web site, pledge to eat less salt, and signing up for email alerts and pledge to reduce your salt intake.

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