Overview of the State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors, and Promote School Health program (State Public Health Actions) for state health departments and the 4 domains of chronic disease prevention. The 4 domains provide focus for State Public Health Actions to address chronic disease at the individual level by promoting health care interventions and at the population level by developing policies and creating environments that promote health.

Endocrinology
State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors, and Promote School Health
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Barbara Z. Park, RDH, MPH; Letitia Cantrell, PhD; Holly Hunt, MA; Rosanne P. Farris, PhD; Patricia Schumacher, MS, RD; Ursula E. Bauer, PhD

Chronic diseases, including heart disease, cancer, stroke, diabetes, and related risk factors, are among the leading causes of death and disability in the United States. In 2010, 7 of the top 10 causes of death were chronic diseases, which account for 86% of US health care costs. Furthermore, half of all adults have one or more chronic health conditions, and one-fourth of adults have 2 or more.

For 25 years, the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) of the Centers for Disease Control and Prevention (CDC) has provided scientific leadership and technical expertise to state health and education departments to assist them in developing, implementing, and sustaining chronic disease prevention and health promotion programs. To facilitate greater progress in reducing the prevalence and incidence of multiple chronic diseases and their associated risk factors, NCCDPHP began funding programs to implement coordinated activities aligned with the 4 domains of public health action: 1) epidemiology and surveillance, 2) environmental approaches, 3) health care system interventions, and 4) community programs linked to clinical services. Together, the 4 domains provide a framework for addressing chronic conditions (eg, diabetes, hypertension) and their risk factors (eg, obesity) across multiple settings and sectors, and they allow CDC to support complementary strategies to prevent and manage the underlying risk factors for chronic diseases and to assist health care providers and individuals in self-managing multiple chronic conditions. By investing resources to implement key evidence-based strategies, NCCDPHP has sought to address multiple risk factors, conditions, and diseases simultaneously; improve program efficiency; increase program impact; and, ultimately, improve the health of communities.

To guide implementation of this new approach, the staff members of NCCDPHP programs reviewed evidence-based approaches and funding priorities across several chronic disease programs, developed a logic model of strategies and activities, and solicited partner feedback. This approach resulted in the creation of the program, State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors, and Promote School Health (State Public Health Actions), for state health departments.

Partnering with state health departments began in July 2013, and by June 2018, NCCDPHP will have partnered with 50 state health departments and the District of Columbia to address chronic diseases and other risk factors through the 4 domains. This approach leverages data to inform action, supports healthy choices and behaviors, strengthens delivery of clinical preventive services, and helps Americans better manage their health (3). The 4 domains provide focus for State Public Health Actions to address chronic disease at the individual level by promoting health care interventions and at the population level by developing policies and creating environments that promote health. We anticipate that this coordinated approach will lead to the following outcomes:

• Increased consumption of a healthy diet.
• Increased physical activity across the life span.
• Improved medication adherence for adults with high blood pressure or diabetes.
• Increased self-monitoring of high blood pressure tied to clinical support.
• Increased access to and participation in diabetes self-management programs and type 2 diabetes prevention programs.
• Increased breastfeeding.

If successful, this approach also could lead to long-term improvement in the prevention and control of hypertension, diabetes, and obesity (Figure 1).

​Strategies and Activities Within State Public Health Actions
Promote the adoption of food service guidelines and nutrition standards, including dietary sodium.

Promote the adoption of physical education and physical activity in schools.
Promote adoption of physical activity in early care and education and worksites.
Promote reporting of blood pressure and hemoglobin A1C control measures; as able, initiate activities that promote clinical innovations, team-based care, and self-monitoring of blood pressure to improve blood pressure control.

• Promote awareness of high blood pressure among patients.
• Promote awareness of prediabetes among people at high risk for type 2 diabetes.

Promote participation in diabetes self-management education programs.
Environmental approaches to promote health and support healthful behaviors

• Promote access to healthy food and beverages.
• Promote food service guidelines and nutrition standards where foods and beverages are available. Guidelines and standards should address sodium.
• Promote supportive nutrition environments in schools.
• Promote physical activity access and outreach.
• Promote physical activity in early care and education.
• Promote quality physical education and physical activity in grades kindergarten through 12 in schools.
• Promote access to breastfeeding-friendly environments.

Health system interventions to improve the delivery and use of clinical and other preventive services

• Develop quality improvement processes in health systems.
• Promote the use of team-based care in health systems.
  

​Community clinical linkages to support cardiovascular disease and diabetes prevention and control efforts

• Promote the use of diabetes self-management education programs in community settings.
• Promote the use of CDC-recognized lifestyle change programs in community settings for primary prevention of type 2 diabetes.
• Promote the use of non-medical doctor health care providers in the community to support self-management of high blood pressure and diabetes.
• Promote the use of chronic disease self-management programs in community settings.
• Develop policies, processes, and protocols in schools to meet the management care needs of students with chronic conditions.

Source: cdc.gov

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