State Of Health
In
Tennessee 2014
How Do
We Accelerate
Our Progress?
Tennessee Department of Health
Commissioner John Dreyzehner, MD, MPH, FACOEM
Tennessee Department of Health
Vision
To be a respected and trusted
leader, partnering and
engaging to accelerate
Tennessee to one of the
nation’s ten healthiest states.
In One Lifespan, Exceptional Work in
Public Health
And Advances in Medicine Combined to
Make A Difference
1937 U.S. Life
Expectancy:
Approximately 62 years
2013 U.S. Life Expectancy:
Approximately 78.5Years
Tennessee: 76.4 Years
In Tennessee in 1937:
1,072 people died from Tuberculosis
355(under age 2) died from Diarrhea/Enteritis
134 people died from Typhoid/Paratyphoid Fever
67 people died from Diphtheria
42 people died from Meningococcal Meningitis
40 people died from Whooping Cough
10 people died from Polio
7 people died from Measles
Infant mortality rate was 59 per 1,000 live births
State Population: 2,893,000
In Tennessee in 2013
15 people died from Tuberculosis
0 people died from Typhoid/Paratyphoid Fever
0 people died from Diphtheria
1 person died from Meningococcal Meningitis
1 person died from Whooping Cough
0 people died from Polio
0 people died from Measles
5 children (under 2) died from Diarrhea/Enteritis
Infant mortality was 6.8 per 1,000 live births
State Population: 6,496,000
Ten Greatest Achievements That
Accelerated Public Health Progress in the
United States in the 20th Century
Vaccination
Motor-vehicle safety
Safer Workplaces
Control of infectious diseases
Decline in heart disease and stroke
Safer and healthier foods
Healthier mothers and babies
Family planning
Fluoridation of Drinking Water
Recognition of tobacco use as a health hazard
-- MMWR, December, 1999
Infant Mortality Rate in Tennessee – 1920-2014
12
11
8.8
8.7
8.3
Infant(718)
Mortality
Rate8.0 8.0 7.9
(733)
9
(718) (686) (655)
Tennessee, 1920-2014*
(626)
Deaths per 1,000 Live Births
(Number of Infant Deaths)
10
100
Deaths per 1,000 Live Births
90
86.9
80
74.9
70
8
7
7.4 7.2
(587) (576) 6.8 6.3
(542)
(288)
6
5
4
3
2
1
60
53.2
0
2005
50
2006
2007
2008
2009
2010
2011
2012
2013
2014*
36.2
40
29.3
30
21.3
20
13.4
10
10.3
9.0
1990
2000
7.9 6.3
0
1920
1930
1940
1950
1960
1970
Year
1980
2010
Leading Causes of Death
In Tennessee In 2013
1. 14,723 people died from heart disease
2. 13,931 people died from cancer
3. 3,897 people died from chronic lower respiratory diseases
4. 3,497 people died from accidents/adverse effects
5. 3,123 people died from cerebrovascular disease
6. 2,526 people died from Alzheimer's disease
7. 1,815 people died from diabetes mellitus
8. 1,551 people died from pneumonia and influenza
9. 1,059 Kidney disease/failure
10. 1,017 Suicide
In 2013, 1,166 people in Tennessee died from drug overdoses
Environment
5%
Health
Care
10%
Health
Behaviors
40%
Genetics and
Development
30%
Social
Factors
15%
• Health care is not the
primary driver of an
individual’s overall health
and well-being
• Improving Health requires
comprehensive focus: a
public health approach
2014 Health Survey Ranks U.S. Last Among Rich Peers
USA Today – June 17, 2014
Tennessee’s Health Ranking for 2013
Tennessee
2013
OVERALL RANKING: 42
Tennessee is 42nd this year
It was 39th in 2012
2008
2009
2010
2011
2012
2013
30
35
39
40
45
50
44
48
42
41
42
Tennessee’s “Big Three”
Tobacco Use
U.S. Ranking:
Physical Inactivity
U.S. Ranking:
Obesity
U.S. Ranking:
47
45
40
These three directly influence seven of ten leading causes of death in
Tennessee.
To accelerate our progress, we must address the big
three.
Behavioral Risk Factor Surveillance System:
Providing Beneficial Trend Data to Support Accelerated Efforts
BRFSS data now include input from
both landlines and cell phones,
providing a more accurate sampling.
It is the world’s largest on-going
telephone health survey system –
more than one-half million
interviewed.
Key Findings From the 2014 BRFSS Report
Current Cigarette Smoking among Adults (18+ Years)
Tennessee and the U.S., 2011-2013
40
35
Percent
30
24.9
25
20
U.S.
24.3
23.0
21.2
19.6
19.0
2012
2013
15
10
2011
TN
Key Findings From the 2014 BRFSS Report
No Exercise in Past 30 Days among Adults (18+ Years)
Tennessee and the U.S., 2011-2013
40
37.2
35.1
35
Percent
U.S.
30
TN
28.6
26.2
25.3
25
22.9
20
2011
2012
2013
Key Findings From the 2014 BRFSS Report
Obesity among Adults (18+ Years),
Tennessee and the U.S., 2011-2013
40
33.7
35
31.1
Percent
30
29.2
U.S.
29.4
25
27.8
27.6
2011
2012
20
15
10
2013
TN
Obese/Overweight Tennessee Children:
We Need To Accelerate BMI Reductions
Overweight and Obesity Prevalence by Grade and School Year
Tennessee Public Schools
50
45.4 44.3
43.9
44.1
41.1
40
39.1
38.6 38.5
43.4 42.7 42.4
42.0
40.6 40.6
34.8 34.6
33.5
Percent
40.9 40.5
30.0 30.9
30
20
10
0
All Grades*
K*
2007-2008
2nd*
2011-2012
4th*
6th*
8th
HS*
2012-2013
*The difference in prevalence between 2007-2008 and 2012-2013 was statistically significant.
Source: Tennessee Department of Education
TDH Customer Focused Government Plan
• Primary Prevention Initiatives (PPI)
• Tobacco Settlement Funding Effectiveness
• Controlled Monitoring Substance Database – CSMD
• America’s Health Rankings “Big 3”
• Electronic Public Health Information System
Primary Prevention Initiative Engages Communities to
Promote Better Health
Total Completed Projects: 360
Total PPI projects: 637
0
50
100
150
Obesity
Tobacco
Infant Mortality
Immunization
Substance Abuse
Teen Pregnancy
Other
All 95 County Health Departments
are participating in this initiative
200
Tobacco Settlement Funds Used to Help
Protect Tennesseans
1. Eliminate smoking during pregnancy
2. Reduce infants’ and children’s exposure to second-hand smoke
3. Prevent child and adolescent tobacco use
School Age Projects 3 8
65
33
14
123 operational projects
Second Hand Smoke Exposure Projects
13
16
36
19
All 95
counties set
own goals
and projects
2
86 operational projects
Pregnancy Smoking: Baby and Me Tobacco Free
42 5
53
64 operational projects
0
20
Amended for no action this year
Planning and development activities
Activity completed
40
60
80
Not started
Active services
100
120
140
Prescription Safety & Population Protection
Decrease in high-use patients since 3rd quarter 2012
Survey of 800 CSMD users found:
• 71 % changed a treatment plan
• 73 % were more likely to discuss substance abuse issues with a patient
• 57 % were now more likely to refer a patient for substance abuse treatment
Cumulative milligram morphine equivalent dispensed decreased
Fig 1. Number of High Utilization Patients* in CSMD 2012-2014
• 0.7 percent in 2013
• 6.7 percent thus far in 2014
2500
2000
2012
1500
2013
2014
1000
500
0
1st quarter
2nd quarter
3rd quarter
4th quarter
A New Tool To Combat Overdose Deaths:
Naloxone
Tennessee’s “Big Three”
Tobacco Use
U.S. Ranking:
Physical Inactivity
U.S. Ranking:
Obesity
U.S. Ranking:
47
45
40
These three directly influence seven of ten leading causes of death in
Tennessee.
To accelerate our progress, we must address the big
three.
Promoting Performance Excellence
through our Baldrige Journey (TNCPE)
Previous Year Winners
Sullivan County
Blount County
Carter County
Clay County
Grundy County
Hardin County
Giles County
Jackson County
Rutherford County
Wayne County
Weakley County
Office of Health Care Facilities
Cancer Programs Collaborative
Applicants for 2014:
Montgomery County
Greene County,
Morgan and Roane counties
Fayette, Hardeman, and McNairy
counties
Henderson and Decatur, Obion,
Lake, and Dyer counties
Overton County
Putnam County
Smith County
Southeast Regional Office
Northeast Regional Office
Divisions of Policy, Planning, &
Assessment
Division of Information
Technology Services
Promising Accelerants for Health Progress in Tennessee
Tobacco Settlement Prevention
• Primary Prevention Initiative
• Neonatal Abstinence Syndrome
Subcabinet
• Network of County Health
Departments
• Alliances with key external
partners
• Traumatic Brain Injury
Awareness/Prevention
• Immunizations Programs
• Controlled Substance Monitoring
Database
• Vigorous Inspection Efforts –
Food, Hotel/Motel/Pools – Other
• Health Care Professionals –
Licensing and Regulation
• Public Health Training
Created in 2013 by Governor Bill Haslam.
Focus on exercise, diet and reducing tobacco use.
January, 2014: Small Starts launched
March, 2014: Launched Small Starts @ Work
September, 2014: Small Starts @ Worship
Continuing work with the Tennessee Department of Education
to increase activity in the Extended Learning programs.
• Co-chaired by Gov. Bill Haslam and First Lady Crissy Haslam
• In its first full year, kidentraltn.com had 66,000 visitors seeking information
about health, education and development
• Kidcentraltn.com provides a directory of state-operated and state-funded
services for children and families
• Mobile app provides convenient access to information about services
Preventing Injuries and Saving Lives On Tennessee’s Roads and Highways
Governor’s Highway Safety Office
&
Department of Safety & Homeland Security
The Department of Safety’s “Drive to Zero Fatalities”
campaign seeks to reduce traffic deaths in Tennessee by 15
percent in 2014. Thanks to aggressive promotion,
Tennessee’s percentage of vehicle fatalities involving
motorists not wearing seatbelts is at a five-year low.
Drive to 55
Education is linked to health:
People with higher levels of education tend to be healthier,
and people in good health tend to perform better in school
Governor Bill Haslam launched the Drive to 55 to increase the
number of Tennesseans with a certificate or degree beyond
high school to 55 percent by the year 2025 in order to help
build a strong workforce
The Tennessee Promise
TennCare
Million Hearts: TennCare is a partner in the Million Hearts
initiative to reduce the burden of heart disease
Presumptive eligibility for newborns – allows participating
hospitals and birthing centers to enroll newborns who
mothers are not enrolled in TennCare at the time of
delivery
TennCare provides health care for 1.2 million Tennesseans
and operates with an annual budget of $9 billion.
Continuous Preparation To Protect Against
Emerging Threats to Population Health:
Invisible Services
Communicable Diseases
Ebola - Middle East Respiratory Syndrome - Chikunguna –
SARS - LaCrosse Encephalitis - Polio - Measles - Rocky Mountain Spotted Fever
West Nile Virus - Rabies - Dengue Fever – HIV/AIDS - Whooping Cough - Mumps
Emergency Preparedness
Tennessee Emergency Management Agency -- TN-CAT
Tennessee Valley Authority – Generating Plant Accidents
Oak Ridge National Laboratory – Materials Accidents
Commissioner’s Charge
“And thus we protect from ills and grief
The rich man, poor man beggar and thief;
For the robber, too, must be germ-free
Lest he transmit to the other three.”
-- 1937 TDH Annual Report
ACCELERATE!
Presentation by the
Tennessee Department of Health
Mission: Protect, promote and
improve the health and prosperity of
people in Tennessee.
Tennessee Department of Health
710 James Robertson Parkway
Nashville, TN 37243
Produced by the Tennessee Department of Health in September, 2014.