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Men’s Health Week Time to Think about Our Health

June 13th, 2013

This week is Men’s Health Week – the worldwide event happens every year before Father’s Day calling attention to the issues that affect men’s health. Many groups take the opportunity to talk about men’s health – we should be thinking about our health every week.  The top health issues that impact men’s health are also some of the easiest issues to prevent.  Heart disease and cancer are leading causes of death for men.  The best way to fight heart disease is exercise and sensible eating.  Our Healthy Living website has some interesting ideas on being active and choosing healthy foods. 

If you’re 50 or older or at higher risk, make a pledge to yourself and your family get checked for prostate and colorectal cancer. Men’s Health Week is the perfect opportunity to schedule an appointment.   

Stress also leads to health problems in men, including depression.  If you’re suffering from depression, it’s harder to be physically active and eat well. Sometimes a chat with a professional can put you back on track or a doctor may prescribe medication to help put your life back in balance. Most employers offer an Employee Assistance Program that will offer free or low cost access to a mental health professional.  The parity law also makes your regular health insurance provide access to mental health care. 

If you’re still smoking, stop.  Every puff of a cigarette or cigar takes time off your life. Nicotine is a highly addictive substance – quitting isn’t easy, but it’s not impossible. If you need help, call the ASHLine at 1-800-556-6222. 

Finally, consider getting a physical this year to identify hidden health conditions.  If you don’t do it for yourself, do it for your family.

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AZ’s Trauma System: Moving to the Next Level

December 3rd, 2012

Injuries are the leading cause of death for Arizonans from age 1 to 44.  That means for the majority of the young and the middle-aged injury is more lethal than cancer, heart disease, hypertension and influenza combined.  The effectiveness of a State’s pre-hospital and Trauma System makes the difference when it comes to saving lives (and quality of life) from injuries.  That’s why we invited the American College of Surgeons to assess AZ’s Trauma System back in 2007…  to evaluate the effectiveness of our trauma system and to make recommendations.  

The main 2007 recommendations were to improve trauma care in the rural parts of the state by recruiting Level IV trauma centers in rural AZ, strengthen the State’s trauma registry, and to assess our system and make necessary updates to our state trauma plan.  We have.  

Over the last 3 ½ years, our EMS and Trauma System team has been able to recruit 17 rural hospitals (up from 0) into our trauma system.  For the first time, Arizona’s rural trauma patients have timely access to good trauma care.  Our State Trauma Registry has been strengthened by undergoing validation checks and audits and is now one of the best in the country, allowing us to conduct all kinds of research to improve care across the state.  Arizona’s trauma system today bears little resemblance to our system 4 years ago, and like any system, it’s important to re-assess how we’re doing and set new priorities to maximize our effectiveness.  

That’s why we invited the American College of Surgeons back last week…  to evaluate our system- to take a look at the progress we have made over the last several years and give us feedback on the best way to move forward- both in rural and urban Arizona.  The ACS met with our team and our EMS and hospital trauma Stakeholders- and we had great participation. 

The ACS had about a dozen nuts and bolts recommendations and 3 larger recommendations regarding AZ’s Trauma System in their report-out presentation. Their written report (in about 6 weeks) will recommend (among other things):

  1. A moratorium on new trauma center designations in the Valley and Tucson and at the same time recommending that the Department explore the statutory authority to have a “needs based” system for designation.
  2. During the moratorium (if we have one)- they recommend that we put together a destination protocol for the Valley for ambulance providers.
  3. Their report will recommend that we explore more effective ways to use the Prop 202 money that currently only goes to Level I Centers. 

We’ve just begun to explore the who, what, when, where, and how their initial recommendations. Once the actual written report comes in 5 or 6 weeks we’ll be in a better position to evaluate the recommendations. 

Finally…  three cheers for Dan Didier, Noreen Adlin, Donna Meyer, and Betty Yunick for preparing for this week’s evaluation.  To get ready, they had to respond to a detailed trauma system pre-review questionnaire; identify, copy and scan approximately 400 pages of trauma system reports developed over the past 5 years; and coordinate hotel and meeting room space for approximately 80 participants. Thanks!

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Undy 5000

November 13th, 2012

For the 5th year in a row, we’re participating in the Undy 5000 fun walk/run on November 17th. This event helps increase awareness of colon cancer and encourages folks to bite the bullet and get screened.  The run raises money for the Colon Cancer Alliance and half the profits stay here in Arizona. Half is spent on treatment services for Arizonans diagnosed with colorectal cancer through our Fit at 50 Healthcheck Program. This program provides colorectal cancer screening to low-income men and women between 50-64 who are uninsured. It also helps pay for treatment when uninsured Arizonans are diagnosed with colorectal cancer. 

Anna Alonzo is our Team Captain this year and she’s recruiting participants. Last year our “Undy Team” recruited 45 people and raised over $2,000. ADHS also won the “Best Team Award”. This year, we’re looking to meet or beat last year’s numbers and hold onto our title. But it won’t be easy – Game and Fish took last year’s loss seriously and it’s determined to win this year.  The cost to participate is only $30 and you even get a pair of boxers to wear at the run. Click here to register on line.  When you register look for Team ADHS (there’s a place to search for teams). The password is leroy12345 (you’ll need to enter that twice). If you register soon, you can use “CHONES” for a $5 discount!  Have fun and see you there! 

Everyone over 50 should get their colonoscopy, I did.  It’s the best way to identify polyps and cancer. Not every polyp turns into cancer, but just about every colon cancer starts as a polyp. And since colon cancer is the 2nd leading cause of cancer death, it’s important to find and remove those polyps early.

 

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Guide to Community Prevention Services

October 3rd, 2012

Every so often- you run into a resource guide that stands above the rest.  I discovered one of those a couple of weeks ago when I was at a conference with the people in my job from around the country.  It’s called the Guide to Community Preventive Services – and it’s a free resource to help you choose programs and policies to improve health and prevent disease in communities.  The easy to read resource guide answers questions like: 1) Which program and policy interventions have been proven effective; 2) Are there effective interventions that are right for my community; and 3) What might effective interventions cost and what’s the return on investment? 

There are modules on different public health topics- and the evidence-based information is printed in colorful, easy-to-read formats.  Subjects include much of our core strategic plan activities in health and wellness including: Adolescent Health; Alcohol; Asthma; Birth Defects; Cancer; Cardiovascular Disease; Diabetes; Emergency Preparedness; Health Communication; Health Equity; HIV/AIDS,STD’s, Pregnancy; Mental Health; Motor Vehicle Injury; Nutrition; Obesity; Oral Health; Physical Activity; Social Environment; Tobacco Use; Vaccines; Violence; and Worksites.  Learn more about The Community Guide, collaborators involved in its development and dissemination, and methods used to conduct the systematic reviews.

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Worksite Wellness- a Critical Public Health Lever

September 21st, 2012

Chronic diseases like heart disease, cancer, stroke, and diabetes cause 70% of deaths in the US these days… absorbing 75% of the $2.5T spent on annual medical care costs.  When it comes to employee healthcare expenses- the indirect costs of poor health like absenteeism, disability, and reduced work output can be several times higher than direct medical costs.  In fact, productivity losses from health problems cost employers $1,685 per employee per year! 

One of the provisions in the Affordable Care Act includes incentives for employers to implement worksite wellness programs to help them keep their workforce healthier.  When done well (using evidence-based and best practices) worksite health programs have a 3:1 payoff.  Like the odds? 

The Affordable Care Act contains some elements that will make worksite wellness programs more common and robust over the next couple of years.  There are basically 2 kinds of worksite wellness programs.  I’ll call them Wellness and Wellness Lite.  A “Wellness Lite” program doesn’t require a participant to meet any standard related to health status to receive a reward.  For example…  a wellness program could include a gym membership or tobacco cessation program but doesn’t require participants to actually lose weight or quit smoking.  

A Wellness program requires people to meet a health status standard to get a reward.  For example- an employer could ask employees to certify that they haven’t smoked during the previous year.  Enrollees who don’t could be assessed an annual surcharge of  20% of cost of the employee’s health insurance coverage.  Rewards may be in the form of premium discounts or rebates, lower cost-sharing requirements, waiving a surcharge, etc. Under the Affordable Care Act, wellness program rewards can be as high as 30% of the cost of the employee health plan- potentially going to 50% in the future.  

Our AZ Healthy Worksites web page provides businesses with information and tools to help them develop and implement an effective worksite wellness program.  For example, the Program Design page lists the eight steps for developing, implementing, and evaluating a comprehensive worksite program.  We’ve also contracted with the Arizona Small Business Association &  Viridian Health Management to develop a new toolkit for AZ businesses.  Viridian and the Arizona Small Business Association will teach businesses how to do effective wellness programs, understand their own particular issues/data, and develop effective strategies.  In all, our contract tasks the team to train 500 AZ employers.   Finally- the CDC is jumping into the fray with a variety of resources, which you can see at their worksite wellness hub website.  

 

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Posted in Affordable Care Act, Prevention

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Arizona’s New Chronic Disease Strategic Plan

September 10th, 2012

I’m happy to share our new Arizona Chronic Disease Strategic Plan.  This past year, our team from the Bureau of Tobacco & Chronic Disease worked with community partners from across the state on a new guiding document for chronic disease prevention and health promotion.  This strategic plan will be used by ADHS, county health departments, and community partners to advance chronic disease policies, systems and environmental change in the areas of where we work, live, learn, and get care.  At the same time, this plan will also help align activities around the CDC’s Chronic Disease Prevention and Health Promotion Four Domains.  

Funded through the CDC Coordinated Chronic Disease Program- the new plan identifies ways in which our partners can maximize the impact in the areas of heart disease, cancer, diabetes, obesity and tobacco.  The strategic plan includes a matrix of evidence-based strategies which can be used by the public health community..  and it provides clear direction for advancing nationally recognized recommended or promising evidence-based practices.  Congratulations and thank you to the many community partners and health department staff who contributed to the development of new plan.

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The Dose Makes the Poison

June 19th, 2012

The first thing that you learn in a Toxicology 101 class is the old saying coined by the Renaissance German scientist Paracelsus that: “All things are poison, and nothing is without poison; only the dose permits something not to be poisonous.” We’ve shortened that to: ‘the dose makes the poison”.  Anyway… a key question for public health is to figure out how much exposure (dose) to the thousands of chemicals that we’re exposed to every day is safe.  

Figuring out how toxic chemicals are and whether or not they cause cancer is really important- because without that kind of key information the international public health system can’t develop targeted interventions or inform regulatory policy makers as they develop regulations to limit human exposure. So who does the research and who decides how toxic things are and what causes cancer? 

A combination of forces do the work. Most of the primary research is done in Academia using various funding sources. Collections of researchers and experts evaluate published data to come up with consensus opinions. Internationally- the published work is evaluated by an arm of the World Health Organization International Agency for Research on Cancer (IARC). For example, this week IARC classified diesel engine exhaust as “carcinogenic to humans”. 

In the US- it’s the EPA’s job to decide how toxic things are and what causes cancer. Probably the best source of information is the EPA’s Integrated Risk Information System, which compiles and presents the data that comes out of their external peer review procedures that assess toxicity and carcinogenicity. Using these data sources, policy makers can develop better informed regulations to limit human exposure and improve health outcomes. The Agency for Toxic Substances and Disease Registry ATSDR- which is associated with the CDC- is the public health arm that works with EPA to apply toxicity information to practical matters at polluted sites etc. I started my career at ADHS in 1992 working in our ATSDR grant funded program.

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The Texas Sharpshooter

June 1st, 2012

There’s an old tale about a Texas “Sharpshooter” that pulls his pistol out of his holster and shoots at the broad side of a barn pretty much at random without aiming.  Then he goes up to the barn with a paintbrush and draws a circle around the bullet holes and says: “See, I have perfect aim”.  That’s kinda how a lot of cancer clusters are. 

People generally get cancer at random (with some exceptions like occupational exposures, gross environmental contamination & genetic risk etc.).  But, the laws of statistics state that even when cases of cancer are randomly distributed, there’ll be some groupings that form at random- giving the false appearance that there’s a geographic cluster- when it’s really just random. 

Back in the day, our Arizona Cancer Registry calculated cancer rates etc. on a county by county level- but didn’t have any pre-calculated analyses on a smaller scale. That policy led to tons requests for special analyses for smaller areas (with perceived “cancer clusters”)- creating lots of extra work and with little to no public health payoff.  So, Dr. Bob England (when he was our State Epi) had an idea to revamp our cancer registry so that we constantly calculated rates in smaller areas of the state.  With this uniform approach- we could stop chasing our tail and actually provide some useful public health information.  That’s when the (now famous because of medical marijuana) 126 Community Health Analysis Areas (CHAAs) were born.  Using CHAAs, we can map cancer rates over time in smaller areas. 

Nowadays our Arizona Cancer Registry has a highly interactive website that uses state-of-the-art GIS technology- which lets ordinary folks as well as researchers to access cancer data by CHAA.   The website visualizes cancer data with interactive maps, tables and graphs including a rate distribution graph, a time series chart and a rate classification chart.  All the elements are linked, so a selected community in one chart or map will be selected in all others. Explore this link to explore the website and its many features- have at it.

 

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Medicare Moves Upstream

December 13th, 2011

Keeping off the pounds is tough at any age. Now seniors are getting a helping hand from Medicare.  Last month Medicare announced that it’s adding coverage for nutritional and behavioral counseling for those who are obese as measured by body mass index or BMI.  BMI is a tool which measures weight status for adults- and it’s broken into several categories: Underweight (Below 18.5), Normal (18.5 – 24.9), Overweight (25.0 – 29.9) and Obese (30.0 and above).  This new program for Medicare beneficiaries is for folks with a BMI of 30 or more.    You can use this BMI calculator to see where you stand.  

The objective of this new preventive coverage is to reduce the impact of obesity and chronic disease among the 30% of folks men and women within Medicare are obese.  For Medicare beneficiaries with a BMI over 30, counseling coverage includes: 1) One face-to-face visit every week for the first month; One face-to-face visit every other week for months 2 – 6; and One face-to-face visit every month for months 7 – 12 if the individual meets their weight-loss goals.  Additional information on this exciting new preventive coverage can be found on the Medicare website. 

Why is this new benefit important? Because most states now have adult obesity rates over 25%- resulting in higher risks for stroke, heart disease, diabetes, cancer, respiratory diseases and arthritis.  In other words- obesity results in all kinds of bad health outcomes and cause a host of expensive down-stream treatment costs.

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Leveraging Community Partners for Change

December 9th, 2011

A few months ago our tobacco & chronic disease prevention team was awarded a CDC grant to increase coordination and collaboration on evidence-based interventions addressing the leading causes of chronic diseases in Arizona (heart disease, cancer, pulmonary disease, stroke, diabetes, and arthritis).  The Chronic Disease Prevention and Health Promotion grant will look for ways we can leverage community partners to improve the health of all Arizonans through health policy, school-based initiatives, community health impact assessments, increased preventive health screenings, chronic disease self-management and worksite wellness.  

From now through December 12th our team will be meeting with stakeholders throughout Arizona in a series of partner meetings to gather input on the development of a chronic disease strategic plan surrounding these issues and interventions.  Hundreds of community partners have been invited to participate in sessions taking place in Yuma, Tucson, Flagstaff and Phoenix.  Simply visit our Chronic Disease Blog for details.

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