CDC Telebriefing: Potentially Preventable Deaths from the Five Leading Causes of Death

TOM SKINNER: Thank you all for joining us today for this telebriefing on the lead story in this week's MMWR on potentially preventable deaths from the five leading causes of death in the United States years 2008 to 2010. Joining us today is the director of the CDC, Dr. Tom Frieden who's going to provide some opening remarks, and then we will get to your questions. Dr. Frieden?

TOM FRIEDEN: Good afternoon, everyone, and thank you very much for joining us. This is a report which is unique. It's the first time CDC has reported on the number of preventable deaths from leading causes of death in the United States and the five leading causes of death in the United States account for nearly two out of every three deaths and once you get below those five, the portion is much smaller. This is a data-heavy report. Even more so than some of ours at CDC, but it's an important report, a very important report, because really it's compelling and it should make the reality of health and avoidable deaths much more apparent to all of us. The analysis looked at how many deaths from heart disease, cancer, lung disease, stroke and unintentional injuries could be prevented. This is important because it helps us understand better what works to prevent these deaths and there is enormous variability among states. States with the lowest death rates search as benchmarks for other states to follow and we see this particularly in some of the causes, but first to go through the top line findings. If we just look at deaths before age 80 in the United States from the five leading causes of death, about a third of these could be prevented. As a doctor, it's heartbreaking when we lose a single patient from a preventable condition but as the director of the nation's prevention agency, it's painful almost beyond towards know that we're losing well over 100,000 people every year in this country from diseases and injuries that could have been easily prevented. If all states were close to the benchmark, we would prevent a third of deaths from heart disease, that's 92,000 deaths a year; a fifth of deaths from cancer, that's about 85,000 deaths a year; 40 percent of deaths from lower respiratory disease, that's about 29,000 deaths; a third of stroke deaths, 17,000; and 39 percent of injury deaths, that's 37,000. Rates of death from each cause vary enormously across the 50 states. States in the southeast have the highest number and rates of preventable deaths, particularly for the non-injury causes of death. The numbers of preventable deaths from each cause can't be added together to get an overall total because prevention of some premature deaths may result in people dying from something else, so someone who dies of –someone who doesn't die of one disease may die from a different one in those leading causes. But the good news is that things that people can change -- what we call modifiable risk factors -- make a huge difference. And those modifiable risk factors include tobacco use, high blood pressure, high cholesterol, diabetes, overweight, lack of physical activity, poor nutrition, exposure to second-hand smoke, lack of seat belt or motorcycle helmet use, drug and alcohol use, including prescription opiate use as well as other risk factors. We have the biggest impact when we make the default choice to healthy choice and that's what states have done. This data is yet another demonstration that when it comes to health in this country your longevity and health are more determined by your zip code than they are by your genetic code. We can make it easier for people to be physically active, to avoid tobacco, to have access to healthy food, to get recommended clinical services such as blood pressure treatment and cancer checks and whether it's by investing resources or changing policies or coordinating with health care, even if each community just identifies one issue we can make a big difference in life expectancy and in the number of preventable deaths. One of the major efforts that we're working on is the issue of the program of million hearts which brings together communities, health systems, nonprofit organizations, federal agencies, private sector partners to prevent heart attacks and strokes as effectively as possible. We have seen states and communities around the country that are focusing on this and beginning to make a big difference. For example, now there are more than 40 million more Americans who have access to healthier food. And what we've seen in cities around the United States is opening of farmers' markets, use of vouchers for the snap program to receive fruit and vegetables, increases in physical activity for more than 40 million Americans, including schools that have implemented joint use agreements so that the community can use the playground after school as a park or places that have started walking clubs. And we've seen the portion of Americans who are walking increase as we've seen the proportion of mothers who are breast-feeding increase. So we're seeing positive trends in these areas. We're also seeing the expansion of smoke-free environment which is protects both non-smokers and helps smokers to quit. It is really troubling to me as the health officer for the country to see how big the variability is from one place to another. So if you look from the highest to the lowest rates -- and this is not in the report -- but the variability is twofold, threefold, more to some of the conditions such as injuries, it may be much higher than that. So your risk of death is much higher from these conditions in certain parts of the country or certain states than others and I think this should be a wakeup call to all of us to figure out how we can have a joint sense of responsibility so that we at the federal, state, and community levels as well as health care providers and individuals in the community can work together to reduce the number of preventable deaths. I'm optimistic because we have a better sense of what works in prevention, programs like the million hearts program that can prevent a million heart attacks and strokes over the coming decade -- coming five years, excuse me. I'm optimistic because we're seeing progress with things like our tips from former smokers campaign which has helped many American smokers quit for good. So there is both a good news and a bad news story here. The good news story is the health in our healthiest community is pretty good. Even by international standards where the United States often falls behind other countries. The bad news is there's far too much variability. There are far too many places in this country where just by the unfortunate fact that you live in a place you're much more likely to die from a preventable cause. With that I’ll stop and we'll be happy to take your questions.

TOM SKINNER: Kathy, I think we're ready for questions please.

OPERATOR: Thank you. At this time if you would like to ask a question, please press "star 1." Please make sure you record your name. One moment, please, for that first question. Maggie Fox with NBC News. Your line is open.

MAGGIE FOX: Hi, this question is only a little bit tongue in cheek, but why don't we just move everybody to Colorado and Utah? What is it about these states that make them so much healthier than some of the other states?

TOM FRIEDEN: Well, it's a combination of factors. If you look at the risk factors, Maggie Fox it's not a big surprise they're better. Their smoking rates may be half the smoking rates in other parts of the country. Their rates of blood pressure control may be substantially higher. About a year ago the Minneapolis/St. Paul region reported their data which shows that in 1996 they had almost the same level of blood pressure control as the rest of the country. By 2008, they had a 50 percent higher rate of blood pressure controls, basically about 75 percent versus about 50 percent. So policies make a difference. Collaboration makes a difference. We don't have to move, but we do have to -- we don't have to move geographically, we do have to move in terms of our policies and our programs.

MAGGIE FOX: Thank you, our next question comes from Mike Stobbe with the Associated Press. Your line is open.

MIKE STOBBE: Hi, Thank you for taking my question. This is just, I guess, a clarification.

TOM FRIEDEN: Go ahead. Mike, you're cut off.

TOM FRIEDEN: Hello?

TOM SKINNER: Yeah, you're here, mike, we can hear you, go ahead.

MIKE STOBBE: Dr. Frieden, when you were talking about things that can be done to prevent these things like reduce smoking, blood pressure control, cholesterol, diabetes, overweight, I heard you say motorcycle use. Did you mean use helmets when you ride a motorcycle or did you mean driving a motorcycle?

TOM FRIEDEN: Motorcycle helmet use. At least I thought I said that.

MIKE STOBBE: Okay, thank you.

TOM FRIEDEN: Next question, Kathy.

OPERATOR: Our next question comes from Dennis Thompson with Health Day. Your line is open.

DENNIS THOMPSON: I just wanted to flip an earlier question around. Maybe you can go into a little more detail about what's going on in the southeastern states that their death rates for these preventable causes is just so amazingly high.
TOM FRIEDEN: Yeah, it is striking. If you look as an example at heart disease among 50 to 59-year-olds the rate in Minnesota, Utah, New Hampshire, is less than a third what the rate is in Mississippi. Three times more likely at that age. And it's a combination of factors. It’s higher smoking rates, greater obesity rates, greater rates of physical inactivity, lower rates of blood pressure control. There was a very well-done study in Arkansas a few years back that looked at the level of blood pressure control in the community in Arkansas, and the country has a whole it's not great, it's about 50 percent. In Minneapolis, St. Paul it's really good, it's about 75 percent. In Arkansas it was down around 30 percent. So these are things that we can change. Take a couple of specific examples. One: tobacco control. We know that communities that have implemented evidence-based policies have driven their tobacco control -- tobacco use numbers down rapidly and substantially. Take a second example. The million hearts program, blood pressure control. I gave the difference between Minneapolis,St. Paul and Arkansas. It's more than twofold. And that's not a question of necessarily big changes in life-style or things that may be seen as difficult to change, that's about making sure people know they have high blood pressure, giving them good medications so they'll get it, making sure they have access to health care and following up with health systems that ensuring that patients get the right medications and stay on them. Or physical activity. We're seeing an increase in walking. We know even if you don't lose any weight, being physically active the closest thing we have to a wonder drug. It reduces blood pressure, it reduces cholesterol, it reduces your risk of arthritis, it improves mood and improves independence, it improves mobility, obviously. So there are things that can be done that really do make a big difference.

MIKE STOBBE: Thank you.

TOM SKINNER: Next question, Kathy.

OPERATOR: And just a reminder, to ask a question please press "star 1" and record your name. Leighann Winick, your line is open. With CBS news.

LEIGHANN WINICK: Thank you for taking my call. I don't know if I’m missing a page but I’m wondering if there's a per capita listing of preventable deaths over all for each of the 50 states or it broken down by the five leading causes?

TOM FRIEDEN: We did not provide that in this report but just to give you a sense, if you look at heart disease or injury from table one and you think of the population of California being quite large but there are states that have nearly as many or even substantially more deaths from those causes as California, which is not even one of the healthiest, but just to give you a sense, the rates vary twofold, threefold, and in some cases fivefold for some of the causes so there are big differences by cause and by rate among states. In this report, we're focusing on the numbers because public health is at its best when we see and we help other people see the faces and lives behind the numbers. And I’m sure everyone on the call knows someone who died of one of these causes, heart attack, preventable cancer, lung disease, stroke, or overdose or car crash in their 50s or 60s or 70s and many of those deaths, potentially even most of them for some of the conditions, are preventable with the tools that we have today but aren't yet implementing effectively all across the country.

LEIGHANN WINICK: When you look at the regional on table two, what is your explanation for the southeast having the highest rates?

TOM FRIEDEN: These are numbers, not rates, just to be clear. But the southeast has sometimes been referred to as the stroke belt and this data confirms that. It's a confluence of more smoking, more obesity, less physical activity, less access to primary health care resulting in challenges with treatment of high blood pressure and cancer screening and follow-up.

LEIGHANN WINICK: Thank you.

TOM SKINNER: Next question, Kathy.

OPERATOR: Thank you, our next question comes from Niraj Chokshi from the Washington Post. Your line is open.

NIRAJ CHOKSHI: Thanks, I think my question was answered but I wanted to be sure. When you talk about southeastern states, are you referring to region four?

TOM FRIEDEN: Yes.

NIRAJ CHOKSHI: Thank you.

OPERATOR: Thank you, our next question comes from Ferdous Al-Faruque from The Hill. Your line is open.

FERDOUS AL-FARUQUE: Thanks for taking my questions. I have two questions. First one is what states are you using as your baseline and could you tell me a little bit about what you found in the states that could account for why they did better than other states? And secondly, you know, you said that your zip code might determine your longevity and then you also answered one of the questions by saying that if we do not move in terms of our policies and programs then these things will continue to happen. Would you talk a little bit about what kind of policies and programs you're thinking of and does Obamacare in any way play into this?

TOM FRIEDEN: Sure. So what we did come up with a benchmark that was objective was for each age group and each of the five causes we identified the three healthiest states and used that as the benchmark for the others. In terms of policies, I would highlight million hearts. Million hearts is a joint public/private initiative which can prevent a million heart attacks and strokes over a five-year period by improving health in the community through tobacco control and improved nutrition and improved care in the health care system by focusing on what we call the ABCS -- aspirin for high-risk people, blood pressure for control with everyone for high blood pressure, cholesterol management and smoking cessation. And the million hearts program would prevent a million heart attacks and strokes and many of the preventable deaths that we're outlining here. We've identified very specific programs and projects and policies that can be scaled up through million hearts, for example, focusing on blood pressure control and how to increase blood pressure control rates. And I’ve given examples nationally, Minneapolis and Arkansas, as really the average and a positive and negative boundary of what we're seeing of data that's been published. In terms of the Affordable Care Act, as more people get access to health care, they have potential of getting preventative screenings for cancers and treatment for high blood pressure, high cholesterol and smoking cessation and what we've seen is with increasing access people can get access to preventative care and with preventative care we can drive down heart disease, stroke in particular, as well as address improvement in cancer screening. What you see the from the press release here is that the variability or the amount that could be prevented is a little less for cancer where there are some cancers that we are not as able with current technologies to prevent and a little more for lung disease which is primarily smoking and unintentional injuries where, with motor vehicle policy and opiate and prescription drugs epidemic patterns we can do more.

FERDOUS AL-FARUQUE: Thank you.

TOM SKINNER: Next question, Kathy

OPERATOR: And I’m showing no further questions that the time, sir.

TOM FRIEDEN: Great, so we'll stop here and I want to thank you for joining us. Just to reiterate that what today's report shows is that well over 100,000 Americans a year die from preventable causes and these deaths are not random. They are clustered by geography, by state, and that’s a reflection of the huge impact that healthier policies can have. Someone asked if everyone should just move to the healthier states and that’s not necessary, but it is important that we move needle on programmatic changes and policy changes that increase people's likelihood of living free of disease, injury, illness, that could be prevented by action that we can take together. So thank you all very much for joining us.

TOM SKINNER: Kathy, this concludes our call. Reporters wanting additional information or having questions can call the CDC press office at 404-639-3286. So thank you once again for joining us.

OPERATOR: This now concludes today's conference. Thank you for your participation. You may now disconnect.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES