Posts Tagged ‘diabetes’

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Do Yourself A Favor in 2012

January 4th, 2012

Life is a precious gift.  None of us knows long our gift will last, so it’s important to make the most of every day.  That means doing everything you can to stay healthy by eating well and exercising regularly.  A lot of folks will say – I’m stuck with my health because of my genes, or my doctor can’t do anything to help me.   The truth is, half your health depends upon your choices.  Only 20 percent of health is hereditary, 20 percent comes from your environment, and 10 percent is dependent on your doctor.  The bottom line – your health is largely in your own hands. 

Meet Matt Gainey. Matt works at the Department of Health Services.  About 3 years ago, he was tired of how he felt and looked.  He started walking at lunch, added more fruits and vegetables to his diet.  He didn’t notice a change immediately, but he kept going.  He wanted to feel better. 

As his energy increased, Matt added more to his routine – sit ups at night. He cut out soda and reduced the processed food he ate, like cookies and chips.  He started paying attention to what he ate, what he did and what he weighed – things he’d never really noticed before, even though diabetes and heart disease run in his family. 

Pretty soon Matt was taking longer walks – he changed from walking to running. He added push-ups and free weights to his evening activities.  Even when it’s hot, I see Matt running wind sprints on top of the parking garage. 

The changes paid off; Matt lost 160 pounds.  He has more energy and sleeps better.  Of course, he did have to buy new pants – the old ones were 9 sizes too big! 

As you can see with Matt’s story – you can change your bad habits.  It doesn’t take a miracle or a fortune – and you don’t have to do it alone. 

If you want to change your diet and activities, eatwellbewell.org can help you choose healthier foods. For example, switching to whole grain foods and adding fruits and vegetables will increase your fiber, give you more vitamins and let you eat less to feel full.  

For ideas to helping you increase activity and for healthy recipes on the website go to eatwellbewell.org. You can even have them emailed to you each week.  Myplate.gov helps you decide the right balance of foods to eat. 

There’s a worksite wellness website (azhealthyworksites.com), if you want to corral your coworkers into getting healthy in 2012. 

The Arizona Smokers’ Helpline will help you stop smoking.  Online (ashline.org) or by phone (800-55-66-222), ASHLine provides medication, tips and coaching to help you get through the urges – all for free.  There’s also an iPhone and Facebook app. 

So when you wake up tomorrow in the New Year – know that you have the power to make a change.  You have the power to choose how healthy you will be for the rest of your life.  Go for 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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The Health Care/Public Health Continuum

November 29th, 2011

In the world of health care- the clinician works with patients individually.  They examine various indicators of health for their patient including direct observations and laboratory or other diagnostic tests and implement interventions to help their patient improve their health.  Providers also encourage their patients to live healthy lifestyles and take safety precautions- and help patients with preventative care by providing vaccinations and the like. Over time, the health care provider follows the patient and measures how they’re doing with patient centered criteria.  

In the world of public health, the practitioner works with communities…  in other words the community is the patient.  Public health folks look at various outcome indicators to determine the health of the community so they can take action and implement interventions at the wholesale level to improve population health. In other words- public health uses community indicators like infant mortality, communicable disease rates, obesity and diabetes to assess the patient (the community).  Of course, public health relies on health care providers in the health care world to carry out public health objectives and interventions. 

So you can see that there is a strong interface between health care and public health- but the distinction is that in health care the patient is the patient while in public health the community is the patient- the interventions are community based, and community indicators are the primary assessment tool.  By the way, studies and reports suggest that behavior accounts for roughly 50% of health outcomes, genetics about 20%, the environmental about 20%, with medical care about 10%… 96% of our national health expenditures are focused on medical care with about 4% dedicated to prevention.

 

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What’s Preconception Health- and Why’s it Important?

November 7th, 2011

Being born too soon is the number one killer of infants in Arizona and in the nation.  Death rates from prematurity are declining but babies born too soon (before 37 weeks) often face medical, developmental and social challenges as they get older. More than 8,000 babies in Arizona were born too soon last year.   This week the March of Dimes released the 2011 Premature Birth Report Card that grades States on their premature birth rates.  While Arizona was average- there was good news related to the reduction in the percentage of uninsured women and the number of women who smoke.   

Some of the known factors impacting prematurity include having twins/triplets, having a chronic disease such as diabetes, high blood pressure, being obese, smoking, and alcohol or illegal drug use.  One of our main approaches to reducing prematurity rates is to improve the health of women before they get pregnant- called preconception health.   Prenatal care is still important- but poor health practices during pregnancy will usually trump good prenatal care.   

Our interventions include implementing evidence-based practices to get moms to stop smoking, improve physical activity and nutrition and behavioral health- and all are part of our Preconception Health Strategic Plan which includes Every Woman Arizona educational materials, grants to six local communities to implement preconception health strategies, and home visitation programs that address many of the factors that can lead to prematurity.  Our WIC program and clinics also work with young moms in their reproductive years to improve their health.  We also work with the Arizona March of Dimes and the Arizona Perinatal Trust to encourage hospitals to adopt policies designed to ensure that elective inductions aren’t approved before 39 weeks gestation.

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Multiple Chronic Conditions- an Expensive Public Health Threat

October 17th, 2011

I’ve written several pieces over the last few weeks highlighting our efforts to better integrate primary healthcare into the treatment plans for folks with mental illnesses- but the issue of providing better coordinated care for folks with multiple chronic medical conditions is really far bigger than this integration issue.  More than 25% of Americans have multiple chronic conditions like arthritis, asthma, chronic respiratory conditions, diabetes, heart disease, and high blood pressure.  Treating folks with multiple conditions is both complicated and expensive- and more coordinated efforts are a key to improving both.  In fact, 66% of all health care spending in the US goes toward caring for the 27% of folks with co-occurring chronic medical conditions. 

The US Department of Health and Human Services (HHS) knows full well that better care coordination for these folks is critical if the nation is going to do a better job of improving health care efficiency and containing costs.  There are a number of efforts underway to address these issues- many of which are summarized in a strategic framework document that HHS put out a few months ago called Multiple Chronic Conditions: A Strategic Framework.  The framework is just that- an outline of a strategy- and it includes a vision statement, goals, objectives, and discrete strategies to guide HHS in coordinating its efforts internally and collaborating with stakeholders externally. 

By the way, our tobacco & chronic disease team is leading the state’s efforts to help folks better manage their illness.  One of their tools is the Stanford Chronic Disease Self Management Program- which is an evidence-based program which empowers folks to recognize and address the factors which impact their chronic conditions.  Through Healthy Living, individuals can develop and implement personalized action plans, take ownership, and achieve improved health outcomes that are both manageable and sustainable.  Our team (under the leadership of Ramona Rusinak) and the Arizona Living Well Institute has identified this as a core element of its overall strategic direction.

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Own Your Own Health Data

September 20th, 2011

For years, you’ve heard that you should take your health care into your own hands.  It may soon be easier because HHS wants you to be able to access your electronic health care records.  One key argument to give people access is if they know what is there, they’ll ask better questions or even make notes about problems in your file before meeting a health care professional.  If this happens, it could be really good for folks with chronic diseases like diabetes, heart disease or cancer.  Stay tuned – it takes awhile to get changes like this through the system.  In the meantime, you can follow the progress on Health IT.

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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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Diabetes Awareness

February 22nd, 2011

More than 10% of Arizonans have diabetes.  But what’s even more alarming are the recent estimate by the CDC that about 1.5 million Arizonans (25%) have pre-diabetes, a condition in which blood sugar levels are higher than normal, but not high enough to be considered diabetes.  Pre-diabetes significantly raises a person’s risk of Type 2 Diabetes, heart disease and stroke.

To see if you’re at risk, visit www.azdiabetes.gov and click on the “Arizona Diabetes Program,” and then select the “Are You at Risk ?” button, which will direct you to our online risk assessment tool.  There’s a lot you can do to reduce your risk of getting diabetes, including eating healthy and exercising.  In fact, losing weight is a great way to reduce your risk as well – losing just 5% of total body weight can reduce a person’s risk.  For a 200 lb. person, that means they’d need to lose less than 15 lbs.

Statewide, the YMCA offers diabetes an evidence-based education and prevention program that’s open to adults who have a diagnosis of pre-diabetes or who have a Body Mass Index (BMI) at or over 25 (a risk factors for Type 2 Diabetes). For more information about diabetes, including Diabetes Self-Management classes, contact the Arizona Diabetes Program at www.azdiabetes.gov.

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