Preventing and Managing
Chronic Conditions in Children
February 7, 2006
Debbie I. Chang, MPH
Executive Director and Senior Vice President Nemours
Health and Prevention Services
1
Presentation Overview
 Introduction to the Problem
 Approaches to address the Problem
 Nemours Community-Based Approach
2
Healthcare Environment
 Estimated $1.6 trillion spent on health care in 2003
 70-80% of national health expenditures related to chronic
conditions
 Children consumed about 12% or $200 billion
 The 10% of the sickest children consumed 69%; the top
20% accounted for 81%
Source: McGinnis, Health Affairs, 2002 & CDC, Wennberg
3
Chronic Diseases
Increasing Prevalence of Chronic Diseases in Children
Moderate to Severe
Chronic
Mild Chronic
Well and
Acute Care
Expenditures
Influence
10%
20%
70%
70%
20%
10%
2002
4
Chronic Diseases
 Chronic conditions affect 3X as many children now
compared to 1960’s
 Asthma:160% increase in rate over past 15 years for
children <5 yr
 Overweight: prevalence in children and youth (ages 6-19)
has more than tripled over the last 35 years to over 15%
 Many chronic diseases previously associated with
adulthood are quickly becoming childhood concerns
– 60% of overweight children aged 5-10 already have a
risk factor for heart disease such as high blood pressure
or elevated insulin levels
5
6
Health Promotion: Opportunities to
address chronic conditions
 Of the $1.6 trillion spent on health care annually
– 95% on direct medical care services
– 5% on prevention/health promotion
 Behavior and environment account for over 70% of
avoidable mortality
 Comprehensive health promotion involves:
– The medical model
– The lifestyle or behavioral approach
– The social-environmental model
7
Approaches to Children’s Health
Traditional Medical Model
Expanded Approach
Rigid adherence to biomedical
view of health
Incorporate a multifaceted
view of health
Focused primarily on acute
episodic illness
Chronic disease prevention
and management
Focus on individuals
Focus on communities
Cure as uncompromised goal
Prevention as a primary goal
Focus on disease
Focus on health
8
4 Promising Approaches
1.
Debbie Chang – Nemours community-based health promotion to
address overweight in children
2.
Tricia Leddy– Rhode Island’s systematic approach to
understanding the problem with data, developing innovative
solutions and evaluating results (case studies from lead paint and
CSHCN in child care)
3.
Charlie Homer – A medical home/chronic care model and practice
improvements through learning collaboratives
4.
Peggy McManus– Promising approaches to improving the
interface between primary and specialty care in pediatrics
9
First Approach:
Nemours
Community-Based
Health Promotion for
Children
10
Nemours Overview
 Operating Foundation that provides pediatric primary
and specialty health care throughout DE, northern
Florida, and also parts of southeastern PA, and
southern NJ.
 At these various operating sites, Nemours cares for
more than 225,000 children annually through 870,000
patient visits.
 In DE, Nemours cares for almost 55,000 children (1/4
of the state’s population of 0-17 year olds).
11
NHPS Background
 2003 Nemours redefined its approach: health as well as
health care
 Nemours Health and Prevention Services (NHPS) was
created and focuses on child health promotion & disease
prevention to address root causes of health problems
 Complements and expands the reach of clinicians with a
broader, community-based perspective
Traditional
Medical Care
Nemours
Communitybased health
promotion
12
NHPS Philosophy
 Health promotion must extend beyond the clinical
setting to the whole child in his/her family & community
 Long-term commitment; impact takes years to realize
 Focus on broad health determinants; not medical care
 Build on community strengths; do not duplicate existing
efforts nor supplant existing resources
 Collaborate with the community to leverage resources
and maximize the reach and impact of our efforts
13
Vision for Healthy Children
requires a Cultural Shift
 We are a catalyst, a change agent
 Cultivate an environment that supports
both behavior change and systems
change for child health promotion
– Behavior change means children choosing healthier
lifestyles
– Systems change means the greater DE community
supporting these choices
 Only this combination can result in lasting improvements
in child health
14
Our First Focus Area: Childhood
Obesity Prevention
Why must we move beyond the
primary care office?
15
The new social norm?
16
Our children’s food environment
17
Drive-thru makes it easy
18
Even in hospitals and museums!
19
Our Aspiration
To see a cultural change in which people place
a high value on health, wellness and
prevention. Where:
– Children choose fruit instead of fries
– Child care providers offer nutritious snacks
and physical activity
– Families spend less time in front of a
screen
– Insurers pay for health promotion and
prevention services
20
Our Plan

NHPS catalyzes and supports changes
in policy, programs and practices across
the state

Unique role includes 3 core components:
– Coalition Building and Strategic Partnerships
– Dissemination of Knowledge and Best
Practices
– Social Marketing

Strategically chosen to impact the most children in
the shortest time
21
Targets and Outcomes
Content Areas
1) Healthy Eating
& Physical
Activity
2) Emotional/
Behavioral Health
3) Community
Capacity
Target Sectors
1) Childcare
2) Primary Care
3) Schools
4) Community
Outcomes
Impact on
Delaware
Children and
Communities
22
Child Health Outcomes for 2015:
Obesity Prevention
 Improved child health behaviors
 Policy changes and additional
environmental/system supports
in place to promote healthy eating
and physical activity
 Reduction in overall trajectory of overweight for children
Specific measures will be tracked over time in each area
23
NHPS Mission
To be a leading catalyst for improving children’s health
in Delaware. To engage communities and work with
partners to find, develop, implement, evaluate and
promote successful strategies to help children and
their families live healthier lives.
NHPS Vision
Optimal health and development for all children
Summary
We work with families and
communities to help children grow
up healthy.
Debbie I. Chang, MPH
Senior Vice President and Executive Director
Nemours Health and Prevention Services
252 Chapman Road, Christiana Bldg, Suite 200
Newark, DE 19702
dchang@nemours.org
(302) 444-9100 (Office) (302) 444-9200 (Fax)
24
All the flowers of all the
tomorrows are in the seeds of
today.
- Anonymous