Making the healthy choice, the easy choice · 2014. 11. 17. · Making the healthy choice, the easy...
Transcript of Making the healthy choice, the easy choice · 2014. 11. 17. · Making the healthy choice, the easy...
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Making the healthy choice, the easy choice: Tobacco control and obesity prevention in Philadelphia
Giridhar Mallya, MD, MSHP
Director of Policy and Planning
Philadelphia Department of Public Health
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Schroeder S. We Can Do Better – Improving the Health of the American People. NELM;2007;357;1221-8.
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Health and economic costs
in Philadelphia
Poor Diet and Physical Inactivity
~2,000 deaths per year
~$750 million in health care costs annually
Tobacco use
2,200 deaths per year
$660 million in productivity losses annually
Philadelphia Vital Statistics Report, 2010, Philadelphia Department of Public Health Obesity health care costs estimated from Finkelstein et al, Health Affairs, 2009
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Health Impact Pyramid Examples
Eat healthy, be physically
active, have safe sex
Rx for acute and
chronic conditions
Poverty, education, housing, inequality
Immunizations, brief
intervention, cessation,
colonoscopy
Smoke-free laws; counter-
advertising campaigns;
immunization mandates;
pollution emissions standards
Socioeconomic Factors
Changing the Context to make individuals’ default
decisions healthy
Long-lasting
Protective Interventions
Clinical
Interventions
Counseling
& Education
Largest
Impact
Smallest
Impact
Frieden T, AJPH 2009
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Built environment
Workplaces
Media
Legislation and
regulation
Community retail
environment and
restaurants
Educational
institutions
Insurers and health
care providers
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CDC support for Get Healthy Philly
Philadelphia Department of Public Health, School District of Philadelphia
• Communities Putting Prevention to Work − 2010-2012
• Community Transformation Grant
− 2011-2014
• Sodium Reduction in Communities Program − 2011-2014
• State &Local Public Health Actions to Prevent
Obesity, Diabetes, Heart Disease, & Stroke − 2014-2018
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Schools – policy and systems change
Philadelphia Department of Public Health, School District of Philadelphia
134 129
89
48
5 0
20
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60
80
100
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School Wellness Council Interventions, 2010-2012 Number of Schools Selecting Wellness Goals
Healthy classroom rewards Healthy fundraisers
Socialized Recess Classroom movement breaks
Healthy school stores
• 1990s Universal feeding “pilot”
• 1999 Nutrition education for all SNAP- eligible children
• 2004 Comprehensive school nutrition policy
• 2009 1% milk and no fryers in school kitchens
• 2011 170 schools created Wellness Councils made up of teachers, principals, students, and parents
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Institutional nutrition standards – City agencies hospitals
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Built environment – smoke-free policies
• 12,000 acres of smoke-free parks, recreation centers, and playgrounds
• 5 Philadelphia universities with smoke-free policies
• Public housing agency with 80,000 residents pursuing a smoke-free policy
Leung R et al. Developing and Implementing a Smoke-Free Policy for Recreation Centers and Playgrounds in the City of Philadelphia. Preventing Chronic Disease. 2013;10:120294
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Built environment –planning and zoning
• Encouraging the incorporation of fresh food markets into commercial and mixed-use developments by offering density bonuses that don’t count the square footage of those markets against the maximum buildable area (14-603(7))
• Requiring the provision of secure bicycle parking in developments above a certain size, and allowing the removal of 1 automobile space in exchange for the provision of 5 bicycle parking spaces (14-804)
• Conducting targeted health impact assessments of planning decisions
• Making specific land use and zoning recommendations as part of district plans
http://phila2035.org/home-page/communities/
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Retail - Healthy Chinese take-out
restaurant initiative
• Over 400 take-out Chinese restaurants in Philadelphia, primarily in African American and Hispanic neighborhoods
• Partnered with Temple University Center for Asian Health, Asian Community Health Coalition, and Chinese Restaurant Association
• 200+ have been trained in low-sodium cooking methods
• Early analyses reveal a 30% reduction in sodium content of 2 popular dishes
– Chicken Lo Mein = 3,200 mg 2,300 mg
– Shrimp and Broccoli = 1,900 mg 1,235 mg
Ma, G. Temple University Center for Asian Health, 2013
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Media – sugary drinks, smoking cessation, salt reduction physical activity
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Insurers and health care providers – promoting and supporting quit attempts
• All Medicaid plans in Philadelphia provide coverage for 6 of the 7 FDA-approved smoking cessation medications
• Offering up to 8 weeks of free nicotine
replacement therapy via the Quitline (1-800-QUIT-NOW)
• Leading tobacco-related practice and culture transformation in the City’s behavioral health treatment system
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Primary care learning collaboratives
Improve the quality of care for 350,000 patients in 43 practices by: • Increase electronic health record adoption and use
• Increase the institutionalization and monitoring of
quality measures
• Increase engagement of non-physician team members
• Increase self-measures blood pressure monitoring tied with clinical support
• Implement systems to identify those with undiagnosed hypertension
• Increase engagement of community health worker and pharmacists
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Progress – adult smoking
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Progress – youth smoking
Youth smoking prevalence, U.S. and Philadelphia
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Progress – adult obesity
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Progress – child obesity
Robbins et al, Preventing Chronic Disease, 2012 Accompanying editorial from RWJF, “Philadelphia Freedom”
5% decrease
8% decrease 7% decrease
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Progress – youth obesity
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Thank you!
www.phila.gov/gethealthyphilly www.foodfitphilly.org
www.smokefreephilly.org