Cancer Program Update
April 15, 2011
Pam Hayes
Policy Coordinator, MDH
Comprehensive Cancer Program
Updates
• Policy Grant
• Cancer Plan 2011-2016
• Cancer Facts and Figures
CDC Grant
•
MN awarded CDC grant to develop a cancer
specific policy agenda
•
5 year time period
•
Funds a Policy Coordinator position
•
Assistance from Public Health Law Center
•
Focus on policy systems, and environmental
change
Grant Implementation
• Engaging and expanding partners in prevention
• Aligning/leveraging cancer prevention with existing
efforts
• Building and supporting a cancer policy workgroup
• Designing and implementing 3-5 evidence based
cancer prevention interventions
Policy and Action for Cancer Prevention Report:
“Chronic and other disorders and diseases are not caused just by fate or unwise individual choices . . . . . they are largely determined by environmental, economic, political, and social factors.”
World Health Organization:
• Cancer: an environmental disease preventable by
political initiatives treating the “causes of causes”
• Recommends a classic public health approach
• Major gains in length and quality of life in last 100
years from cleaning up water supplies, sewers,
tenements, sweatshops
• Public health needs to do for diet and exercise what
they did for water
Chronic Disease: Affluence
• Safer food/water/air/work led to longer lives.
• New threat: chronic disease -- public health
response focused on individual choice
• Exception: tobacco – advocates used pricing, access
and availability policy change
• Smoking and related disease rates declined
• Food and fitness escaped regulation, and access
and availability improvements
2009 Report’s Conclusions
• Cancer is a preventable environmental disease: caused by
poor diet / insufficient exercise /social determinants
• Public health should work “upstream” on policy and
environmental issues
• Move beyond personal behavior to making sure healthful
foods are available; improve built environment: assure
healthy air, soil and water are public goods
• Policies should help people be lean, active, eat less sugar
and energy dense foods; eat mostly plant foods, limit red
and processed meat, limit alcohol and salt; limit
supplements
• Mothers should breastfeed, children should be breastfed
Health Influences Versus Spending
Behaviors
50%
Environment
20%
Prevention, 4%
Medical
Services
96%
Genetics
20%
Access to Care 10%
Health
Influences
Health
Spending
Data Source: Lambrew JM. A Wellness Trust to Prioritize
Disease Prevention. The Hamilton Project, Brookings
Institution. 2007. Discussion paper 2007-04; 1/36
University of California at San Francisco, Institute of the
Future,
• Most of what influences health
is preventable or modifiable
• Behaviors don’t occur in a
vacuum but are shaped by
policy and environmental
factors
• Environmental factors can
negatively impact the
community or support policies
that encourage health and
wellness
Friedan: Interventions to Improve Health
Low
Impact
High
Resource
Behavioral
Interventions
(Counseling, Education)
Clinical
Interventions
( Rx for HBP, diabetes,
Disease Management)
One Time/Long-lasting
Interventions
Surveillance
Epidemiology
Evaluation
Research
(Immunization. Colonoscopy)
Change the Context
High
Impact
Low
Resource
“Making the Default Option the Healthful Option”
( Fluoridation, Smokefree Air, Trans Fat Ban)
Make the Healthy Choice the Easy Choice
• Policy: Changes to a law, ordinance, resolution, mandate, regulation, or rule ‐ both formal and informal: e.g. tobacco tax increase
• Systems: Changes that impact all or some elements of an organization, institution, or system:
e.g. change in school menus
• Environmental: Physical or material changes to the economic, social, or physical environment: e.g adding walking paths into community design
New Cancer Plan
• Available on line
• http://www.mncanceralliance.org/plan.html
Overarching goals: unchanged
• Prevent cancer from occurring
• Detect cancer at its earliest stages
• Treat all patients with the most appropriate and
effective therapy
• Optimize the quality of life for every person
affected by cancer
• Eliminate disparities in the burden of cancer
Updates
•
•
•
•
•
•
•
More “SMART” objectives
Fewer proposed strategies
More specificity
More evidence-based or evidence-informed strategies
Integration across chronic disease program areas
Policy, systems and environmental change
Health equity and social determinants of health
New areas: addressed
• Radon
• HPV vaccination
• Shared decision-making for prostate cancer
screening and treatment
• Advance care planning
• Hospice utilization
New measures: tanning bed use
Adult Tanning Bed Use
Baseline: 37%
Source: Minnesota State Survey
New measures: hospice utilization
% Medicare recipients with a cancer
diagnosis who die in hospital (79%)
Median length of stay in hospice among
cancer pts (23 days)
% hospice stays < 7 days among cancer
pts (25%)
Source: Hospice Analytics
A framework for action
• Proposed focus areas for the next 2 years
–
–
–
–
–
–
Tobacco (objectives 1-4)
Obesity (objectives 5-7)
Skin cancer (objectives 9-10)
Colorectal cancer screening (objective 12)
Vaccine preventable cancers (objective 11)
Access to non-clinical resources (objective 18)
New focus area: obesity
Objective 5: Increase health eating among people
in Minnesota
Objective 6: Increase physical activity among
people in Minnesota
Objective 7: Increase the number of people with
healthy weight in Minnesota
Source: Minnesota Obesity Plan
www.health.state.mn.us/cdrr/obesity/index.html
“Implementation” structure
• Project teams → Project teams
– Defined by focus areas and others
– Charter, work plan, resource plan
• Task Forces → Special Interest Groups
– Networking and coordination
• Policy Work Group
– Develop and implement policy agenda
Accountability: year-end reporting
Cancer Facts and Figures
• Also available on line
• http://www.mncanceralliance.org/cancer_facts_and_figures_20
11.html
Cancer in Minnesota1988 - 2006
• Online:
http://www.health.state.mn.us/divs/hpcd/cdee/m
css/documents/092010mcssreport.pdf
We want to partner with
Rural Health so we can .
• Maximize organizational strengths and limit
duplication
• Build upon and leverage existing prevention
• Strengthen multidisciplinary strategies
• Reduce healthcare costs – better integrate
population and clinical health care