OA Action Alliance Inaugural Meeting

Panel

Casey Hannan: My name is Casey Hannan and I currently serve as the acting chief of the branch where the CDC arthritis program is housed. On behalf of CDC I would like to welcome you all to the Osteoarthritis Alliance kickoff meeting, and I would also like to join the Arthritis Foundation in thanking you for participating in today’s launch of the Action Alliance. As of the latest tally by my hand, we have over 50 individuals here representing about 40 different organizations, agencies, offices, and programs. In my view, these numbers bode very well for what we hope to achieve in the conclusion of today’s proceedings. And that is that we agree on action priorities plans to reduce the burden of osteoarthritis in this country.

Host:  How does the challenge of addressing osteoarthritis and the overall charge of the OA Action Alliance fit into chronic disease management prevention and with CDC’s priorities?

Ursula Bauer: The wonderful thing about osteoarthritis is that the prevention and management strategies that are effective with OA are the same prevention and management strategies that are effective for a range of chronic diseases and conditions- physical activity, weight management, and self management. So finding the synergies with other chronic diseases and conditions is important, crucial actually, as we look forward to decreasing budgets in the future; and as we’re held accountable for making progress across the spectrum of chronic diseases, more efficiently and effectively in this constrained budget environment.

So as we work in chronic disease prevention, it’s incumbent upon us to ramp up our efforts to delivery these strategies, improving opportunities for physical activity, increasing access to healthful nutrition, helping people take responsibility for their health including weight management, and ensuring that people have opportunities for chronic disease self management. We know that the strategies within chronic disease sell management that are so helpful for arthritis and osteoarthritis in particular, are so crucial for diabetes management, for heart disease and stroke management as well. Like you all, I think, will be discussing today, we focus on policy and environmental solutions- improvements that can increase access to those healthful nutrition and physical activity opportunities. We also focus on improving health systems so that we’re providing the technical assistance and support for the health system to better deliver clinical preventative service and other preventative services. And importantly, building the demand for those services and increasing the use of those services. We want to make sure that when people with OA visit the healthcare provider, they’re getting the resources and information that they need to take charge of their health. They’re also getting the information and the skills that they need to better manage their weight and to increase opportunities for physical activity, and to manage the other chronic conditions that they so often have. We’re also working in the area of community and clinical linkages, and this is where chronic disease self management, and self management in general come in. We want to make sure that when people leave the healthcare provider, they have the support in the community to actually follow the doctor’s orders, and that the community is supporting them in their efforts to take charge of their health, improve their quality of life, and avert complications.

I want to talk about several initiatives for just a moment, within the chronic disease center that are not arthritis specific, but kind of set the landscape within which we work, and improve the overall environment, especially with regard to the three priority areas that I mentioned. You may be familiar with the $650 million Communities Putting Prevention to Work Initiative that was funded by the American Recovery and Reinvestment Act. This is a two year program that wraps up just about a year from now. We’re midway through a whirlwind effort to improve opportunities for physical activity and healthful nutrition, and also prevent and reduce tobacco use. Over the 24 months what we’re doing is really demonstrating that investments in prevention in a large scale across the country really can change the environment to provide access to healthful nutrition, opportunities for physical activity, and motivation to decrease tobacco use, and protect our residents from secondhand smoke. And we will learn from these interventions what works at the community level and how to really ramp that up to scale across the country. The opportunity to do that, to take those lessons and delivery those interventions at scale, comes from a new initiative called Community Transformation Grants, which are funded out of the Prevention and Public Health Fund.  We are looking forward to starting that initiative in this fiscal year, assuming that the fund survives the current budget negotiations. And then continuing that over the long term of the Prevention and Public Health Fund, which as you know started at $500 million in ’10, and increases about $250 million a year, up through 2014 when it reaches a billion dollars, no two billion dollars. And then it stays at the two billion dollar level into the future.

 These Community Transformation Grants build on communities putting prevention to work by focusing on nutrition, physical activity, and tobacco control.  But also address many other policies, systems, environments, and chronic diseases, so per the statute, we’ll see things in there addressing the delivery and use of clinical preventative services, addressing the clinical and community linkages, addressing programs like Falls Prevention in the Elderly, and a range of other chronic disease self management in particular, and a range of interventions that can really improve the health of the population. Our goal is to deliver a healthier workforce to our employers, delivery a healthier population to the healthcare system, and for people who have chronic diseases and conditions, really provide the community level support and reinforcement that allows them to take charge of their health. 

And then the last point that I want to make is around our 2012 budget where so many of our chronic disease lines, our individual lines, for arthritis, for diabetes, for heart disease and stroke, are merged into one line in order to give us more flexibility to focus on those cross cutting areas that touch so many chronic diseases and conditions, including arthritis so that we can really forcefully address the policy environment, the community environment. We can ramp up the quality of clinical and other preventive services and really address the community and clinical linkages that are important to reinforce in self management activities. Thank you.

Host: Thanks. Great job. So Doctor Klippel, the Arthritis Foundation along with the CDC, is a sponsor of this event. So I wonder if you could tell us about how the charge of this Action Alliance fits in with the Arthritis Foundation’s priorities.

Jack Klippel:  Well first, I can say on behalf of the Arthritis Foundation I am thrilled to see all of you here. Back in 2005, I can remember when the board was trying to strategically think about where the Arthritis Foundation really needs to begin to focus. We came to the recognition that very few people were paying attention to what was a very serious disease. The truth is, and there are people in this room that know these numbers better than I, it’s actually a staggering problem that is not even on the radar screen for this country; 27 million people we believe have osteoarthritis. That’s 27, and the denominator is 50 million people, so it’s the most common form of arthritis. What’s even more daunting is the fact that that number is projected to increase over the next two decades because we have baby boomers who are only now getting to the age where they are going to start to get this disease. If we don’t pay attention to this disease, I don’t know that we can continue to afford to replace joints, and there are many people in fact who still need joint replacement. It is the only way that we are going to be able to reduce their disability. The other challenge that we’ve got is that there are many people in this country who when they begin to get the signs of this problem do not recognize that they have a disease. They chose to live with it. They don’t seek medical care. So although we use this number, 27 million people with doctor diagnosed osteoarthritis, we need to understand that the number is actually much, much higher than that. To play on a point that Ursula commented, if we’re going to address chronic disease in this country, and I think we’re making real progress focusing on the importance of chronic disease, it strikes us at the foundation that arthritis is really at the center of that activity. If you look at people with heart disease, half those people have arthritis. And so if we’re advising them to be physically active, it is the group who has arthritis that cannot be physically active, and it is that group that progresses more rapidly. And we make the same point for people with diabetes.

Over the last year we’ve actually gone through a strategic planning exorcise. I was advised you don’t really do a strategic plan because life changes, but you can do strategic planning. We’d like to be known as a metric driven organization and to lay out a goal. So the goal that we’ve set, I will read it: By 2030, and it’s terribly relevant to this coalition, by 2030 the Arthritis Foundation in conjunction with it’s partners will achieve a 20 percent reduction in the number of people who have freedom of movement stolen by arthritis. That’s what the CDC calls Arthritis Associated Activity Limitations. That’s what the average person sees as a loss. Life is being taken away from me because of my arthritis. So if we’re actually going to achieve that goal, this coalition is going to have to agree that that’s an important goal, and is going to have to work with us in all the ways that you have within your organizations to help contribute to reduce the impact of this disease. We’ve actually set five strategies, and in fact patients right before I came up pointed out that many of these are very similar to the ten recommendations that are actually part of the Public Health Agenda for osteoarthritis.

So the first has to do with awareness. If people don’t think they have a disease, we have to do a better job of communicating about the seriousness of this disease. The term that resonates with the patient community is to lay a stake in the ground and say that what is currently happening with arthritis is simply unacceptable. And I think we’re going to have to be consistent in that message. More attention needs to be paid to this disease. A lot of this conference is going to be talking about things that people need to do for themselves as they take ownership for their own health. So, our verbage says, provide universal access to knowledge, skills, and resources that people need to minimize the impact of arthritis on their lives. This conference is not really focusing on pure, basic research for this disease but I think it would be important to acknowledge that we know very little about what causes this disease. We are going to try to focus our resources on trying to understand this disease better. I think that would help a lot of us. As our colleagues at the CDC have taught us, paying attention to policies and strategies in this country that are really focused on improving the outcome of this disease is really going to become important. I think that needs to be a focus of our activities.  And finally, and I’m pleased to see that minority communities are represented here because I think all of us need to pay attention to health and health care disparities that are associated in this country. The last time Dr. Giles and I were here, it was actually to talk about new CDC data, along with the National Alliance for Hispanic Health talking about the high risk of disability for Hispanics, particularly Puerto Ricans, who develop this disease. I think it’s very important that we focus on this.

Host: Okay, Dr. Giles you are doing cleanup here. Alright, so you’ve heard from Dr. Bauer and Dr. Klippel about where OA fits into their organizations. As the head of the CDC division that’s charged with providing surveillance of arthritis, can you tell us about the specific burden associated with OA, and the division’s efforts to address it.

Wayne Giles: Sure, great. What I thought I would do over the next couple of minutes is spend a few minutes just giving you information about what we were doing at CDC in terms of the burden of arthritis, why we think osteoarthritis is such an important issue that we need to address, and then also to talk about what are some of the things that we can do to turn these numbers around, and really want to focus on how we can turn this around, because I think that’s part of what we want to do.

As Dr. Klippel mentioned, there are 50 million Americans in this country that have arthritis. It’s the leading cause of disability in the United States. 27 million Americans have osteoarthritis. Important risk factors for osteoarthritis: one is the aging of the population, so as one gets older the chances of developing osteoarthritis are increasing. But remember, I think it’s important that we don’t make the mistake in thinking that osteoarthritis is only a condition of older adults. But really, it cuts across the lifespan. So I think, as we think about the work, we’ve got to think about what are the things we can do that cut across the lifespan in strategies.

The other very important risk factor is obesity. We know that about 30 percent of people that are obese have osteoarthritis compared to 17 percent of people who are not obese. So as I think about the aging of the population, and the obesity epidemic, we can see what’s going to happen in terms of the 27 million Americans with osteoarthritis. This is going to increase. That for us is the urgency of the issue. We also know that in terms of obesity, people who are obese, about three fifths of them will go on to develop knee osteoarthritis. And that gets me into the 633,000 knee replacements which occur each and every year. That number, one can expect to increase over time. While joint replacements are very important, as I’ve heard from a number of you in the room, we’ve also got to think about what we can do in terms of preventing those joint replacements. And how can we improve quality of life, improve function among people with osteoarthritis.

 And so it was because of all of that that we started this journey two years ago and I can remember folks from the Arthritis Foundation and us, and a number of us came together and had a meeting in Atlanta to talk about the development of a public health agenda around osteoarthritis and we really have come a huge way and it was great a year ago, to see the release of this public health agenda for osteoarthritis because this is really a fantastic document.

There really are four overarching areas that we really think it’s important for us to be focused on if we’re going to turn around these numbers. And number one, as Dr. Bauer mentioned, is the very important work around disease self management, specifically self management education. And we do know that for about half of the people with osteoarthritis, they really want interventions that are very specific to arthritis, and that’s what they really resonate.

We also know because of what Dr. Klippel mentioned that 56 percent of people with heart disease also have arthritis. Fifty percent of people with diabetes also have arthritis. Some people also want more of a generic chronic disease self management program education as part of this work. So we’ve got to think about, and what I hope we’ll hear from you, are what are the strategies that we can use to help to do a better job of disseminating some of these chronic disease self management education. We want to hear from you about strategies to do this. Dr. Bauer talked about the importance of the clinical community linkages. But how do we make it so that people are seamless referred from healthcare to these very important supports in the community.

A second really important issue that cuts across all of this is the importance of physical activity. How can we encourage changing the environment, how can we encourage folks to be able to engage in safe opportunities for physical activity within their community. Particularly light and moderate forms of physical activity; Walking, biking, water aerobics, etc.  how do we encourage those. I am reminded when, when I was doing clinical work in Burminghmam, I am reminded of a patient, Mrs. Meins, who had arthritis, diabetes, and hypertension, was overweight and really wanted to lose weight. I said well why don’t you just start by walking up and down your block. Her comment to me was it was not safe for me to go walking up and down my block. So I said “well go to the mall, and walk at the mall”. You know, for her to get to the mall meant she had to take three buses. It took her 90 minutes. We can’t expect that to occur. We’ve got to create these environments so that people can engage in physical activity.
That very nicely I think falls into the issues around weight management.  We know that people, if they’re able to lose 5, 10 pounds, can have huge improvements in terms of pain, function, quality of life. Just moderate amounts of weight loss can have huge impacts.

The final area that we think is really important is the issue of injury prevention, and preventing that very important joint injury. There are two key, potential strategies that you should think about. One, neuromuscular strength training, in particular for young people. Particularly we’re seeing an increasing number of adolescent girls who are having injuries to the ACLs, but having neuromuscular strength training can be extremely important in reducing injuries to their ACLs.

So let me really quickly talk about what the arthritis program at CDC is particularly focused on. Number one is describing the problem. We’ve done, I think, a very good job of getting the data out in a timely manner. I presented some of that, but that for us is a vitally important part. The other important component of the work that we do is expanding the science base. What are the effective interventions that we have in making sure that we rigorously evaluate them so that we know what we are disseminating is evidence based. And I do think that while there is a lot we don’t know in terms of the causes of osteoarthritis, I think it’s also important for us to remember there’s a lot that we do know in terms of what are effective interventions. And we really have to do a better job of translating and disseminating those interventions out. The third area is health communications messages; particularly around physical activity. We’ve got some messaging that we target to the African American and the Caucasian community and then we’ve also go other health communication messages about physical activity that we target to the Latino community as well. And then finally, and we’ve got partners here from the states, but we also partner with the State Health Departments across the country to help us in terms of the delivery of those evidence based interventions. So, that was a broad overview. It gives you a little about the statistics, and what we at CDC are doing to try to turn it around. Thank you.

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