Posts Tagged ‘diabetes’

The Health Care/Public Health Continuum

March 13th, 2013

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 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, 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. Does prevention sound like a good investment?

Mission of Mercy

December 7th, 2012

Oral health is more than a nice smile.  Having good oral health improves a person’s ability to speak, smile, smell, taste, touch, chew, and eat.  Plus, tooth decay and gum disease have been linked with other health problems like heart disease, stroke and diabetes, as well as premature births.  Given the link between oral diseases and other systemic health problems, it’s critical to maintain good oral health. 

To help folks who desperately need dental care, the Central Arizona Dental Society Foundation will host its first AZ Mission of Mercy event at the Arizona Fairgrounds December 7-8 using portable dental equipment and 1,000 volunteers.   Dental screenings and services will be provided on a first-come, first-served basis at no charge.  About $1M in free care is expected to be delivered to 2,000 patients (both adults and kids).  They’ll focus on basic dental care such as fillings, extractions and cleanings.  More than 70 Mission of Mercy dental programs have been conducted since 2000- providing free dental care to local residents who otherwise couldn’t get care. We’re supporting the event through Title V funds and providing health information and resources. 

Thanks go out to the following folks from Team ADHS that have volunteered to help out at this important event: Anna Alonzo, Amber Asbury, Stacy Beauregard, Brian Beebe, Elena Beeman, Anita Betancourt, Karen Boswell, Jennifer Botsford, Tracy Chisler, Omar Contreras, Juanita Dailey, Ali De La Trinidad, Willie Dennis, Erica Ferguson, John Fiorentino, Jan Ford, Amanda Gainey, Tiana Galindo, Ann Gardner, Cecilia Gaytan-Newberry, Margaret Hensell, Victoria Mieth, Kimberly Oneill, Elie Partida, Nicholas Pigg, Carmen Ramirez, David Ramirez, Deborah Reardon, Matthew Roach, Crystal Rodriguez, Ruthann Smejkal, Nicole Thurlow, Tina Wagner, Julia Wacloff, Virginia Warren, and Chelley Weber.  Also, thanks go out to Maricopa County Public Health for organizing the vaccine clinic that’ll be there too.

Prematurity Report Card

November 13th, 2012

The March of Dimes just released its annual report card marking how well states are doing in the battle to lower the percentage of babies born prematurely.  Being born too soon can cause long-term disabilities in children including cerebral palsy, developmental delay, respiratory problems and vision and hearing problems.  Sadly, prematurity is also the leading cause of infant death in Arizona.  In 2011, 199 Arizona infants died from being born too soon.

This year we launched a Healthy Babies initiative and pledged to reduce prematurity 8% by 2014.  We’ve been working hard with our partners, especially the March of Dimes Arizona Chapter and the Arizona Perinatal Trust to implement strategies, like reducing elective deliveries before 39 weeks.  We now know how important those last weeks of pregnancy are to a developing baby.  A baby’s brain at 35 weeks weighs only two thirds of what it will weigh at 39-40 weeks. 

The report card shows Arizona’s prematurity rate declined from 12.7% in 2009 to 12.1% in 2011.  This is a 4.7% reduction, meaning we are a little over half way there to meeting our goal of an 8% reduction.  The progress is good, but there’s more work to do.

One of our main leverage points in the battle to reduce prematurity is the multi-agency system of home visiting programs for pregnant women and families with young children.  The system – known as Strong Families Arizona – offers many home visiting programs that can help a pregnant woman learn about her pregnancy and her baby.  The home visitor can also teach a family about safe sleep for baby.  Click on this link to see if you are eligible for home visiting and if it is available in your neighborhood. 

Preterm birth can happen to anyone and most women who have a premature birth have no known risk factors.  We do know about half of premature births are as a result of preterm labor.  There are things that women can do to help their health and lower the risk of having a premature baby such as quit smoking and avoid alcohol or drugs; see your health care provider for a medical checkup before pregnancy; maintain a healthy weight; work with your health care provider to control diseases such as high blood pressure or diabetes; get prenatal care early, as soon as you think you may be pregnant, and discuss concerns during pregnancy with your health care provider.

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.

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.  


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.

2011 AZ Diabetes Burden Report

May 17th, 2012

Our Tobacco and Chronic Disease team released the 2011 Diabetes Burden Report this week.   And you guessed it- a primary cause is a lack of physical activity and poor nutrition (I know I sound like a broken record).  Diabetes is linked to heart disease, stroke, high blood pressure, blindness, kidney failure, neuropathy and even amputations.  Sadly, AZ and the nation are on the wrong track when it comes to diabetes- and the number of folks living with diabetes has gone from about 7% to 9% in the last 5 years.    

Diabetes is largely preventable and manageable… and folks with well-managed diabetes do much better.   The cornerstone for prevention is better nutrition and more physical activity.  The cornerstone for treatment is self-management, education and training.  Our 2011 Diabetes Burden Report is a work in progress, as our staff will be updating it on a yearly basis in consort with our partners and other stakeholders across the state.  It’s a valuable resource for improving our collective efforts to fight the alarming trends of diabetes through prevention, early detection, and effectively disease management.

Healthy Babies are Worth the Wait

April 13th, 2012

Being born too soon is the number one killer of infants in Arizona and in the nation (birth defects is a close second).  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. Our latest March of Dimes Premature Birth Report Card was average- but there was good news related to the reduction in the percentage of uninsured women and the number of women who smoke.  

Some of the things that can cause prematurity include diabetes, high blood pressure, obesity, smoking, and alcohol or drug abuse.  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- all are part of our Preconception Health Strategic Plan and our Every Woman Arizona educational materials, grants to implement preconception health strategies, and home visitation programs that address many of the things that 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 births aren’t approved before 39 weeks gestation. 

BTW… This Saturday is the March for Babies in Phoenix.  The annual fundraiser for the March of Dimes started more than 30 years ago and helps moms in Arizona have full-term pregnancies and healthy babies.  What they’ve accomplished so far is phenomenal and you can help.  ADHS has a team and would love to have you join us or you can donate…  Registration starts at 7 am – it’s at Wesley Bolin Plaza by the Capitol.


Obesity & Autism Walking Hand in Hand?

April 9th, 2012

Another article came out this week in the journal Pediatrics that points toward the importance of preconception health including maintaining a healthy weight before and during pregnancy.  The authors explored the relationship between metabolic disorders like diabetes, hypertension, and obesity and outcomes such as autism and other developmental delays.  They found an association between metabolic disorders and neurological problems in kids. The article concludes that “With obesity rising steadily, these results appear to raise serious public health concerns”.  Add this article to the list of reasons why it’s important to eat right and get some physical activity. 

PS- Note the key word “associated with” in the article.  In the world of science there’s a big difference between association and causation.  The word association means things are somehow linked- but it’s not intended to imply causation.

Biomedical Roadmap

February 21st, 2012

A decade ago, AZ launched a plan to create an internationally competitive bioscience sector.  This roadmap is the long-term plan to combine leaders in business, basic sciences & research, and political entities in order to create an infrastructure and climate that would be ideal to propel AZ forward in the biosciences. 

The Flinn Foundation invested in this mission and hired Battelle to create this plan or roadmap.  The report recommended specific areas of focus for short-term growth in 3-5 years (bioengineering, cancer research, neurosciences, and bio-imaging) that needed to be implemented.  They also identified other areas for long-term growth (agricultural biotech, asthma, diabetes, and infectious disease) over the next 5-10 years that would help strengthen AZ’s medical research base and create new jobs that would be safe from cyclical fluctuations in the economic market.  This implementation effort is being led by the steering committee. 

The core of the initiative: 1) builds research infrastructure; 2) develops a critical mass of firms and new cutting edge businesses;  3) enhances the business environment to generate funding; and 4) prepares the workforce with educational initiatives

The latest status report on the roadmap shows major progress (95%) on the goals in the last 10 years.  Bioscience employment in AZ increased 32%, the number of firms has grown 28%, wages in bioscience fields have increased 47%, NIH funding grew 65% faster than other states, and R&D expenditures by academic research institutions grew 52%.  Venture capital investment dropped 11%, however the entrepreneurial initiatives to license and patent intellectual property increased steadily.  Check out the full report, Arizona’s Bioscience Roadmap Performance Assessment 2002-11 and a calendar of upcoming events at  The list of organizations involved in bioscience can be found at