Transcript Jude VanBuren_4-17_09 - Evergreen State College Archives

Public health in Washington State
Jude Van Buren DrPH, MPH, RN
Assistant Secretary – Division of
Epidemiology, Health Statistics and Public
YOUR LOGO
HERE
Health Laboratories
Washington State Department of Health
Public Health:

of state and local public health agencies, 95 licensed hospitals, and
other partners.
Always Working
for
a Safer and
Healthier
Every Day in Washington
State…
Communities are prepared for health emergencies thanks to the work

About 210 babies get a healthy start through early detection of
treatable diseases by the Newborn Screening Program.

More than 5 million people have safe reliable drinking water because
of the efforts of Washington’s state and local health agencies.

About 50 people call the state Tobacco Quit Line daily to take the first
step toward kicking the habit.

Thousands of patients get safe quality health care from doctors,
nurses, and other health care professionals licensed by the
Department of Health.

Over 2.5 million people eat in restaurants with confidence thanks to
the efforts of local health departments and our Food Safety program.

About 95 percent of kids entering school are protected against
preventable diseases because of public health immunization and
education efforts.
Washington
Governmental Public Health Network
Local Health
Jurisdictions
Schools of
Public Health
Local
US
Department
of Agriculture
US Health & Human
Services (CDC,
Federal
HRSA)
US Environmental
Protection Agency
Washington
State Board
of Health
State
State Health
Departments
Tribes
US
Department of
Energy
Washington State Local Health Jurisdictions
Island County – 77,200
Kitsap – 243,400
Mason – 53,100
Thurston – 231,100
Whatcom County
Health Department
184,300
San Juan County Department of Health
and Community Services
15,700
Clallam County Department of Health
and Human Services
Island County Health
Department
67,800
Jefferson County Health and
Human Services
28,200
Grays Harbor County
Public Health and Social
Services Department
Skagit County
Department of Health
Okanogan County
Health District
113,100
39,800
Snohomish Health
District
Mason County
Department of Health
Services
70,100
3,900
Kittitas County Health
Department
37,400
Yakima Health
District
231,800
Cowlitz County Health
Department Skamania County Health
Department
96,800
Clark County Health
Department
403,500
10,600
7,500
42,100
12,300
Northeast Tri-County
Health District
35,700
Lincoln County Health
Department
Grant County
Health District
80,600
Spokane Regional
Health District
10,200
436,800
Adams County
Health District
Whitman County
Health Department
1,835,300
21,500
Wahkiakum County Department of
Health and Human Services
Pend
Oreille
Douglas
Chelan-Douglas
Health District
Public Health – Seattle
and King County
Tacoma-Pierce County
70,400
Health Department
Thurston County Public Health and 773,500
Social Services Department
Pacific County Public Health
and Human Services
Lewis County
Department
Public Health 72,900
Stevens
Chelan
671,800
Kitsap County
Health District
Ferry
17,300
42,800
Garfield County Health
District
64,200
Columbia County 2,400
160,600
Public Health
Benton-Franklin
Asotin County
57,900 District
Health District
Health District
Walla Walla County
21,100
Health Department
4,100
Benton
Franklin
Klickitat County Health
Department
19,800
Washington State Total Population as of June, 2006 – 6,375,600
WASHINGTON STATE
Department of Health
Organizational Chart w March 2009
PERFORMANCE &
ACCOUNTABILITY
Susan Ramsey
SECRETARY
Mary C. Selecky
Board of Health
STATE HEALTH OFFICER
Maxine Hayes, MD, MPH
DEPUTY SECRETARY
Bill White
FINANCIAL SERVICES
Lois Speelman, Assistant Secretary
HUMAN RESOURCES
Kathy Deuel, Director
INFORMATION RESOURCE MANAGEMENT
Frank Westrum, Chief Information Officer
RISK MANAGEMENT
Dennis Anderson, Director
ADJUDICATIVE SERVICES UNIT
Laura Farris, Senior Health Law Judge
PUBLIC HEALTH SYSTEMS
PLANNING & DEVELOPMENT
Allene Mares, Director
POLICY, LEGISLATIVE, &
CONSTITUENT RELATIONS
Brian Peyton, Director
COMMUNICATIONS
Tim Church, Director
PUBLIC HEALTH EMERGENCY
PREPAREDNESS & RESPONSE
John Erickson, Director
COMMUNITY & FAMILY
HEALTH
Mary Wendt
Assistant Secretary
Infectious Disease &
Reproductive Health
ENVIRONMENTAL
HEALTH
Gregg Grunenfelder
Assistant Secretary
EPIDEMIOLOGY, HEALTH
STATISTICS, & PUBLIC
HEALTH LABORATORIES
Jude VanBuren, DrPH
Assistant Secretary
HEALTH SYSTEMS
QUALITY ASSURANCE
Karen Jensen
Assistant Secretary
Epidemiology
Health Professions &
Facilities
Maternal & Child Health
Drinking Water
Community Wellness &
Prevention
Center for Health
Statistics
Customer Service
Shellfish & Water
Protection
Public Health
Laboratories
Inspections &
Investigations
Environmental
Health & Safety
Informatics
Radiation Protection
Environmental
Health Assessments
Legal Services
Community Health
Systems
Department of Health’s Budget
in Context:
Federal Funds are Major Fund Source
Dedicated
Funds*
$240.1 Million
23%
General Fund State
$166.9 Million
16%
Fees
$130.6 Million
13%
*Includes estimated Women, Infant, and Children (WIC) and AIDS
Drug Assistance Program (ADAP) rebates of $64.1 million.
February 2009
Federal
$496.1 Million
48%
Department of Health’s Budget
in Context:
Majority of funds are passed through
to community partners
All Other Objects
$177.5 Million
17%
Salaries &
Benefits
$235.2 Million
23%
Pass Thru
$621 Million
60%
February 2009
Drug poisonings are a leading cause of death
447
400
300
200
100
Prescription Opioid & alcohol or illicit drug
Prescription Opioid Only
• The use of methadone for chronic pain increased
1,300% from 1997-2006, and Oxycodone by 600%.
• Our state’s drug overdose death rate is higher than
the national rate.
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
0
1996
23
1995
Number of deaths
• Drug overdoses kill more
people in Washington
than motor vehicle
crashes.
• From 1995-2007, there
was a 19-fold increase in
opioid-related deaths.
500
Combating Drug Misuse and Abuse
• Prescription monitoring*
– Helps detect and prevent
prescription drug abuse
• Tamper-proof
prescription pads
– Prevents fraud
• Drug take-back
programs
– Promotes safe disposal
of drugs
– Shown to be safe and effective in pilot programs
* Currently suspended
Climate Change: Predicted
Changes in NW Climate
• Increased average winter and summer
temperatures (~ 1 degree F / decade)
• Precipitation pattern changes
–
–
–
–
–
–
Increased precipitation
Reduced spring snow pack
Increased storm intensities
Increased flooding and drought
Increased surface water temperatures
Reduced weather predictability
Degrees F
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All models predict warming in the
Northwest
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0
0
9
1
warmest scenario
average
coolest scenario
observed
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Executive Order 07-02 (Feb 7, 2007)
• Washington’s Climate Change Challenge
• Drivers are global – Effects are local
• Technical workgroups – greenhouse gas
emission reductions; clean energy economic
goals.
• Preparation & Adaptation workgroups: PAWG:
Health, Agriculture, Forestry, Water, Coastal.
Health Implications of Climate Change
• Health effects of excessive heat.
• Health effects of air pollution.
• Health effects associated with infectious
diseases.
• Health effects of extreme weather events and
rising sea levels.
• Psychological and social disruption effects.
Environmental Changes Will Affect Zoonotic
& Vector-Borne Diseases
•
•
•
•
Mosquitoes
Ticks
Hantavirus
Cryptococcus gattii
Key Preparation & Adaptation Strategies
• Enhanced surveillance
• The built environment
• Emergency planning and preparedness
Two overarching considerations from the
Health PAWG
• The clear need for public engagement and
involvement.
• The importance of social justice
considerations in all actions taken to address
climate change impacts.
National Public Health Week –
April 7–13, 2008
Climate Change: Our Health In The Balance
It’s time for Public Health to have a voice in
the conversation.
Current activities:
• Senator Rockefeller working on a climate
change bill aimed at better organizing and
prioritizing state activities on the issue.
• Climate Action Team proposals forwarded for
legislative consideration by outside groups.
• CDC request for Climate Change grant
applications.
Biomonitoring Grant Proposal to
evaluate Arsenic exposures
Goals:
• 1) to determine background urinary arsenic levels in population
• 2) to determine if there are specific populations in state that are at
higher risk for arsenic exposure
• 3) To inform and educate those with higher risk
Methods:
• Collect urine samples to evaluate speciated arsenic levels to
determine exposure to arsenic in specific and general populations
•
Randomly identify households - gather urine samples of all
individuals 6 yrs and older in household. (all must have lived in
house 6 months or longer
•
Evaluate through epi studies risk factors for exposure and adverse
health outcomes for exposed populations
Arsenic Properties
Environmental fate
Elemental:
Properties: Cannot be destroyed in environment –
only changes form
• When broken down into smaller particles:
enters air, water and dust
• Organic forms dissolve in water – finfish &
shellfish accumulate
• Most of arsenic in water will end up on soil or
sediment in water
Arsenic Sources
Where is it found? – Naturally and anthropoegenic
• Industrial processes: Tacoma and Everett – smelters – coal fired
plants
• Spokane, Tri-County and Clark Co areas - Pockets of natural
arsenic in basalt formations – from ground water sources of
drinking water
• Commercial products – commercial arsenic containing pesticides:
orchards, vineyards, cotton dessicants, cattle and sheep dips,
paints and pigments, antifouling paints, leaded gasoline and firs
salts multicolor flame)
•
Pressure treated lumber – CCA – copper chromated arsenic
• Foods: wines, tobacco ( because of herbicides and pesticides)
• Shellfish and finfish – bivalves, certain cold water and bottomfeeding fish – finfish and seaweed
Arsenic Exposure
Ingestion – ( 60 – 90% absorption in GI tract)
• From swallowing dirt or air particles and getting into
gastrointestinal system
From eating arsenic laden fish or shellfish
Inhalation ( 60 – 90% absorption across lung membrane)
• From breathing air containing arsenic
• Living in areas unusually high in arsenic
• Working in a job that involves arsenic production:
copper or lead smelting – wood treating or pesticide
application
• Dermal – minimal absorption
Bioaccumulation and testing for
Arsenic Exposure
•
•
•
After absorption in lungs or GI tract – Arsenic initially
accumulates in the liver, spleen, kidney, lungs and GI
Tract - clearance in several days
After 2 – 4 weeks after exposures – arsenic remaining
is found in keratin rich tissues such as skin, hair, and
nails -lesser extent – bones and teeth - Arsenic is
excreted primarily through kidneys
Arsenic is excreted primarily through kidneys - - best
route (least harm/impact to person) to evaluate low level
chronic exposure to arsenic
Toxicology of Arsenic Exposure
•
Two mechanisms of arsenic toxicity - impairs
tissue respiration:
1) Arsenic binds with sulfhydryl (-SH) groups and
disrupts – SH containing enzymes – inhibition
of TCA cycle ( Krebs cycle), gluconeogenesis
and oxidative phosphorylation
2) Substitution of As(V) for phosphorus in many
biochemical reactions - leads to loss of high
energy phosphate bonds – and uncouples
oxydative phosphorylation
Health Effects of Arsenic Exposure
•
•
•
•
•
Skin lesions
Hemorrhagic gastroenteritis
Liver toxicity
Anemia
Cardiovascular effects - vasospasm - Peripheral vascular
insufficiency (Gangrene)
• Neurologic effects - Peripheral neuropathy
• Dermal changes – pigment changes and some malignant cancers
All hallmarks of chronic arsenic ingestion
Arsenic is strongly associated with lung and skin cancer in humans –
esp work related exposures at high levels
• May cause other internal cancers as well – (hepatic angiosarcoma
– rare form of cancer)
*
How to evaluate if populations with higher
exposures have more adverse related health effects
Epidemiological studies
Case control study– retrospective
Case: people with adverse health outcome
Controls: people without adverse health outcomes:
Blackfoot disease, Raynaud’s syndrome, peripheral
neuropathy, Cancers: rare liver cancer, dermal,
Look at: exposure levels in urine of those with disease and
those without,
Statistically evaluate whether people with adverse health
conditions had higher levels of arsenic: Odds Ratio
Rate of having adverse outcome – given exposure
Rate of having adverse outcome – given no exposure
How to evaluate if populations with higher
exposures have more adverse related health effects
Epidemiological studies
Prospective or Cohort Study:
Look at: exposure levels in urine of all people –
follow them over time – to see if those with
exposure have higher levels of disease than
those without or with lesser exposure
Statistically evaluate whether people with higher
exposures of arsenic had more disease and
what kinds of disease: adverse health
conditions had higher levels of arsenic
Calculate: relative risk
Evaluate the statistical significance of the finding
Proving Disease Causation: Does the association meet
the criterai for determining causality?
1) Strength of association – statistically
significant or could “chance” be at play?
2) Consistencies with other studies?
3) Is association – disease specific?
4) Appropriate time relationship?
5) Dose response relationship
6) Plausible relationship?
7) Coherence – biologically plausible?
8) Experimental evidence – in- vivo,in-vitro
Public health in Washington State
Jude Van Buren DrPH, MPH, RN
Assistant Secretary – Division of
Epidemiology, Health Statistics and Public
YOUR LOGO
HERE
Health Laboratories
Washington State Departmen of Health