William C. VanNess II, MDState Health Commissioner

January 21, 2014

ISDH Mission:◦To promote and provide essential

public health services

ISDH Vision:◦A healthier and safer Indiana

Governor Pence “Good to Great” book National Health Rankings has placed Indiana 41st

least healthy out of 50 states In February 2013, after extensive review of our

priorities, ISDH named the following public health needs as the top three priorities for Indiana for the next four years. They haven't changed.

They are:#1. Reduction in Infant Mortality rates#2. Reduction in Adult Obesity rates#3. Reduction in Adult Smoking rates

PLAN:◦ Analyze raw data◦ Convert to useful info & ◦ Distribute back to:

Regional partnerships which include the following members: Hospitals, LHDs, CHCs, Minority Health Coalitions, March of Dimes,

etc. “Sister” state agencies

FSSA, Medicaid, DOE, DCS, etc

◦ Learn from areas/regions/states that have been successful in improving their infant mortality Share with regional coalitions

e.g., Home Visiting Programs

Decrease smoking among pregnant mothers◦ ISDH is partnering with Indiana Medicaid

Decrease obesity among pregnant mothers◦ ISDH division of Nutrition & Physical activity

“Safe Sleep”◦ “Back to Sleep” campaign

1994 Reduced SIDS by 50%

◦ “Safe Sleep” campaign Expansion of “Back to Sleep” Describes actions parents/caregivers can take to reduce the risk of

other sleep-related causes of infant death e.g., accidental suffocation Encourage hospitals to become certified as “Baby Friendly”

Certified by the World Health Organization Goal.. To increase breastfeeding

Certification of OB & NICU’s ◦ Goal…ensure they meet the newly established Indiana

Perinatal Hospital Standards◦ Standards were adapted from the national set of standards

created by AAP, ACOG, and other important entities Obstetric Units…Levels of Care I, II, III Neonatal Units…Levels of Care I, II, III, IV

100% adoption of “Hard Stop” policies by Indiana hospitals

Goal…to prevent “elective” deliveries from occurring before 39 weeks

Insurers currently evaluating not paying providers for “elective” deliveries prior to 39 weeks

Evaluate “Perinatal Regionalization”◦ As noted…27 counties do not have a delivering hospital!!◦ Occurring “informally” now◦ Regional systems currently exist e.g. So. Carolina 

High-risk infants are born in hospitals that are able to provide the most “risk-appropriate” care  Thus…Level III hospitals provide the most appropriate care

for the sickest infants  Infants receiving risk-appropriate care are hypothesized to be

more likely to survive when born too little or too soon Healthy People 2020 Goal is that 83.7% of VLBW Infants be

born in a Level III Hospital Currently 69%

Indiana’s Comprehensive Nutrition and Physical Activity Plan…2010 to 2020◦ Collaborative effort involving a large and diverse group of Indiana

individuals and organizations◦ Action needed across all sectors of Indiana to address poor nutrition,

sedentary behaviors, and obesity◦ Focus on approaches that target specific needs of Indiana and support the

latest research for improving nutrition and increasing physical activity◦ Consists of 8 focus areas:

Breastfeeding Early childhood/child care Schools Health care Worksites Older adults Faith-based organizations, and Communities

Goals◦ Increase access to and consumption of healthy foods and

beverages◦ Increase opportunities for and engagement in regular

physical activity◦ Increase efforts aimed at enabling people to achieve and

maintain a healthy weight across the lifespan◦ Reduce environmental and policy-related disparities for:

breastfeeding, nutrition, physical activity, overweight, obesity, and chronic disease

Goals (continued)◦ Increase the capacity of communities and settings

within those communities (eg. School, worksites, faith-based organizations, etc.) to develop and sustain environmental and policy support systems that encourage healthy eating and active living

◦ Increase state and local strategic partnerships to more effectively coordinate efforts, share resources, and identify and reach priority populations

Partner with at least 3 organizations to plan and implement statewide activities that support ◦ eating better, ◦ moving more and ◦ avoiding tobacco

Through the Governor’s Healthy Lifestyle Award, ◦ Publicly recognize individuals and organizations that have made

committed efforts to live and/or support healthy lifestyles in their communities

Increase by at least 2 the number of state agencies that:◦ Adopt and implement food service guidelines/nutrition standards which

include sodium◦ Adopt and implement healthy meeting guidelines◦ Implement evidence-based physical activity strategies in worksites◦ Promote breastfeeding

January marks the 50th anniversary of the first US Surgeon General’s report on smoking and health◦ That report, released on January 11, 1964, definitely linked

cigarette smoking to lung cancer and other serious diseases◦ Historic turning point in the nation’s fight against tobacco

use. ◦ The US has made enormous progress, but ◦ Tobacco use remains the number one cause of

preventable death and disease in the US..◦ this battle is far from won!!

Our high smoking rate is ◦ Killing Hoosiers

More than 9,700 Hoosiers every year

◦ Inflating health care costs Costs the state over $2 billion in health care costs annually

◦ Making it harder for companies to do business in Indiana The economic burden of smoking is estimated to be about

$3,391 per smoker per year. Everyone shares in the annual expenses for smoking –

more than $559 per Hoosier household- whether they smoke or not

For every smoker that dies, two young people under the age of 26 start using tobacco

Tobacco use directly causes a majority of the chronic diseases including:◦ Heart diseases◦ Stroke◦ Cancer◦ Respiratory diseases◦ Type 2 Diabetes◦ Rheumatoid Arthritis◦ Macular Degeneration

For every death in Indiana (9,700) due to tobacco use, another 30 Hoosiers are living with a tobacco-related illness (194,000) inhibiting their quality of life from serious smoking-caused disease

The tobacco companies spend $271 million each year on marketing and promotion in Indiana◦ much of which influences kids to smoke Tobacco use costs Indiana $2.18 billion/year in health

care costs◦ The Indiana Medicaid program pays $487 million of the States

total smoking-related health care costs Half of Indiana’s births are to mothers in the Medicaid program 30% of pregnant Medicaid women in Indiana smoke leading to

premature birth, low birth-weight newborns and thus infant mortality Tobacco prevention programs are also a smart investment

for states that save money by reducing smoking-caused health care costs◦ In the short-term, the best state tobacco prevention programs have

saved $3 in health care costs for every dollar spent

Indiana’s tobacco prevention and cessation program is critical to the health of Hoosiers and to the fiscal environment of the state◦ Indiana’s tobacco prevention and cessation program is modeled after the

CDC’s Best Practices of programs around the country that have delivered solid results

2013 American Journal of Public Health article concluded that states can significantly reduce youth smoking by:◦ Implementing well-funded tobacco programs◦ Increasing the price of cigarettes, and◦ Enacting strong smoke-free air laws

Indiana must address the economic and health consequences of tobacco use in order to be competitive in today’s marketplace for businesses and workers

Questions??