COMBINED COUNCIL & COMMITTEE MEETING HEALTH POLICY COUNCIL – YEAR TO DATE RECAP

October 30th, 2019

PAST CHAMBER ENGAGEMENT

HEALTH ENGAGEMENTS

Air Quality Smoking Ban Complete Streets Asbestos Removal Syringe Services Program, Marion County Public Health Food Desserts and Food Access Tech Tobacco Tax / T-21Indiana Workforce Recovery (Substance Abuse / Opioids)

2019 SPEAKERS

2019 SPEAKERS

Indiana Health Landscape – March• Dr. Box (FSSA)• Dr. Sullivan (ISDH)

Social Determinants of Health – May • Troy Hege, Sara Wiehe (CTSI)

Workforce Recovery – June • Jim McClelland (Drug Prevention, Treatment, Enforcement)

Food System Overview – September • Shellye Suttles (IU), Kate Howe (Indy Hunger Network)

Hospital and Healthcare Costs – September • Brian Tabor (IHA), Dave Kelleher (EFI)

HPC PRIORITIES ROOT CAUSES FOR INDIANA’S POOR HEALTH RANKINGS

TOBACCO – INDIANA

State Rank• 2016 – 39th

• 2017 – 41st

• 2018 – 44th

Smoking rate • 2016 – 20.6%• 2017 – 21.1%• 2018 – 21.8%

• Human cost§ Over 12,500 people (11,400 smokers and 1,400

nonsmokers) die annually in Indiana from tobacco-related illnesses

§ 3,700 minors become new daily smokers each year§ 29% of high school seniors use e-cigarettes

• Healthcare cost § Direct healthcare costs from tobacco use - $3.3 billion § Indiana Medicaid program bears $540 million of overall

healthcare cost § Secondhand smoke healthcare costs - $2.2 billion § Combined annual federal and state tax burden due to

healthcare costs due to tobacco use - $1,125 per Hoosier household

• Business cost§ Productivity loss due to tobacco use - $2.8 billion

annually ($2.1 billion from unsanctioned smoke breaks, $700 million due to higher absenteeism and lower performance while on the job)

§ Additional costs to businesses include higher insurance premiums, liability risks, and drag on economic development efforts.

Indiana Cost

Sources: Richard M. Fairbanks Foundation

• Usage increased 387% by high school students, 358% by middle school students

• 35k more Indiana students used e-cigarettes between 2016-2018

• CDC linked vaping to 24 respiratory illness cases in Indiana, including at least one death

E-cig / Vape

TOBACCO – INDIANAPOLIS

Marion County • Smoking rate

§ 2016 – 21.2% § Maternal smoking rate

– 9.9% (national rate of 7.2%)

• Business cost § $588 million annually

SDOHAmong adolescents and young adults, in particular, tobacco use is influenced by:

• The use of tobacco and approval of tobacco use by peers or siblings• Smoking by parents or guardians• Accessibility of tobacco products• Exposure to tobacco use promotional campaigns• Low self-image or self-esteem

Sources: Richard M. Fairbanks Foundation, County Health Rankings, US Office of Disease Prevention and Health Promotion

STATEWIDE EFFORTS – 2019

• Alliance for a Healthier Indianao Legislative advocacy to increase the tobacco tax by $2 o Upcoming pushes for T-21, tobacco tax, and e-cig tax

• Tobacco Cessation Programs • Youth-based Vaping Prevention and Cessation Initiativeo Toolkit for schools, parents, and students to raise awareness,

educate on riskso ISDH plans to launch a text-to-quit program and public

awareness program focused on prevention and cessation

SUBSTANCE ABUSE / MENTAL HEALTH – INDIANA

• Overdose deaths saw 75% increase between 2011-2017 across the state • Past 15 years - $43 billion in damages from opioid crisis• Business Impact of Opioids

§ 58% of individuals with substance use disorder currently employed§ 80% of Hoosier employers report being effected by substance misuse in the workplace

Sources: Bitter Pill, Richard M. Fairbanks Foundation, Indiana Workforce Recovery, Marion County Public Health

Metric Rate RankAdult prevalence of any mental illness

20.25% 4rd

Number of mental health providers per capita

700:1 (top US performers 330:1) 42nd

Opioid treatment programs 2.7 facilities per 1 million residents

42nd

SUBSTANCE ABUSE / MENTAL HEALTH –INDIANAPOLIS

Ranks / Rates• Past 15 years –

§ $7.4 billion in damages to Marion County from opioid crisis

§ $7,759 per resident• Women (~18% prevalence) in

Marion County are nearly twice as likely as men (10% prevalence) to be depressed.

• Lower income and self-reported depression were directly correlated in Marion County

SDOH• Biological, psychological, and genetic factors can

predispose an individual to substance abuse disorder or other mental health maladies.

• Substance use during youth can predict adult misuse.

• Familial, social, and environmental factors can also influence the likelihood of substance abuse or poor mental health.

Sources: Richard M. Fairbanks Foundation, US Office of Disease Prevention and Health Promotion

STATEWIDE EFFORTS – 2019

• 5 opioid treatment programs added in 2019 • 42% increase in treatment sites, 26% increase in treatment beds• IN Medicaid waiver expanded access to addiction treatment,

impacting 1.6 m Hoosiers (considering further expansions currently to allow for longer treatment times)

• Seeing a reduction in opioid prescription rates

INFANT MORTALITY – INDIANA

• In 2015, the Indiana infant mortality rate (IMR) was 7.3 infant deaths per 1,000 live births

• 2015 US national average IMR – 5.9 deaths per 1,000 live births

Ranks / Rates

Sources: Richard M. Fairbanks Foundation, ISDH, US Office of Disease Prevention and Health Promotion

SDOH• Obesity – 25% chance of prematurity, 33% chance with morbid obesity • Smoking – 13.4% of Indiana pregnant mothers smoke (2x national average),

Secondhand smoking contributes to 900 low-weight births annually• Limited Prenatal Care – 30.6% of Indiana pregnant mothers receive PNC in 1st

trimester

INFANT MORTALITY – INDIANAPOLIS

Marion County • IMR – 7.6 infant deaths per 1,000

live births • IMR for black infants (11.6) was

nearly 2.5 times that of white infants (4.5)

Sources: Richard M. Fairbanks Foundation, Marion County Public Health, Alliance for a Healthier Indiana

• Prenatal Care – Only 60.9% of pregnancies where care began during first trimester

• Premature births – 11.4% of Marion County births happen before 37 weeks. This is the leading cause of death during the first month of life.

• Prenatal Smoking – 10.5% of Marion County mothers smoked during pregnancy

STATEWIDE EFFORTS – 2019

• OB Navigatorso Identify high-risk Medicaid OB patients as early in pregnancy as possible

and deploy services in communities with limited access to careo Connect an OB Navigator to each patient to address issues that contribute

to infant mortality:§ Lack of prenatal care in first trimester§ Smoking, substance use disorder, prior preterm birth, diabetes, high blood

pressure, etc.§ Socio-economic factors that prevent women from seeking and following

through with care• Universal verbal screening for substance use disorder in pregnant women

o 44% of Indiana’s female overdose deaths were women aged 20-40 yearso Women more motivated to seek treatment when pregnant or have a

newborn at homeo Requires providers to connect women with positive screen to treatmento An estimated 578 babies born exposed to opioids in 2016, 140 percent

increase since 2003• 2019 budget request includes $6.6 million over two years for these efforts

OBESITY / NUTRITIONAL HEALTH – INDIANA

• Obesity rates have risen over past 20 years: § 1 in 3 Hoosier adults is obese,

more than 2 in 3 are overweight or obese

§ 1995 – 20%; § 2017 – 34%

• Diabetes – 12% of Indiana adults• Physical Inactivity – 27% of

Indiana adults 20 and over reporting no leisure time physical activity

• 910,000 people go hungry in Indiana

• Obesity costs the Indiana economy $8.5 billion in 2017 o $3.9 billion in labor market costs, absenteeism, lower

productivityo $2.9 billion in healthcare costso $1.7 billion in lost economic output from premature

mortality • Employers face 40-48% increase in annual healthcare

costs for obese employees

Ranks / Rates Cost

Sources: Richard M. Fairbanks Foundation, Alliance for a Healthier Indiana, Indy Hunger Network

SDOHThe built environment has a critical impact on behaviors that influence health. For example, in many communities, there is nowhere to buy fresh fruit and vegetables, and no safe or appealing place to play or be active.

These environmental factors are compounded by social and individual factors—gender, age, race and ethnicity, education level, socioeconomic status, and disability status—that influence nutrition, physical activity, and obesity.

OBESITY / NUTRITIONAL HEALTH – INDIANAPOLIS

Marion County • Obesity - 39% of adults obese, up from

26% in 2005 and 33% in 2012 • 11th highest obesity rate among largest

US cities• 69% of adults are overweight or obese• 4 in 10 (221k) Central Indiana kids are

an unhealthy weight

Sources: Richard M. Fairbanks Foundation, US Office of Disease Prevention and Health Promotion, Jump IN for Healthy Kids, SAVI

• 196,000 people need food assistance in Marion County

• Diabetes - 10% of Marion County adults

Areas Designated as Food Desserts

STATEWIDE EFFORTS – 2019

• State Diabetes Strategic Plan / National Diabetes Prevention Programs

• Food / Wellness Resources o WIC mobile app, collaboration with hospitals, farmers marketso Train employers on worksite wellness best practiceso Help schools incorporate more physical activity, including for

students with disabilities o Increase access to healthy foods through SNAP education and

encouraging farmers market managers to accept SNAP/WIC benefits

o Train community wellness coordinators on best practices for obesity prevention

• Office of Healthy Opportunities – prevention work

GOOD HEALTH IS MORE THAN MEDICINE

Accounts for 80% of

Health Outcomes

20%Clinical Care • Access to Care

• Quality of Care

10%Physical Environment • Air and Water

Quality• Housing and Transit

Socio-Economic • Education• Employment• Family and Social

Support• Income• Safety

40%

30%Health Behaviors • Alcohol and Drug Use

• Diet and Exercise• Sexual Activity• Tobacco Usage

FSSA SOCIAL CONTEXT SCREENING

INDIANA – 95k responses MARION COUNTY – 26k responses