Transcript I. PUBLIC HEALTH OVERVIEW PUBLIC HEALTH

Overview
Public Health System
DSHS Advisory Council
May 5, 2005
Nick Curry, M.D., MPH, Deputy Commissioner
Prevention, Preparedness & Regulatory Services
I. PUBLIC HEALTH OVERVIEW
PUBLIC HEALTH: Science and art of
working in communities to promote
health, prevent disease and injury,
and prolong quality life.
A Public Health Model:
Sound Mind, Sound Body
DSHS consolidation promotes the use of the
public health model to integrate public
health, mental health and substance
abuse.
Core Public Health Functions
Assessment
Assurance
Policy Development
Core Public Health Functions
• Assessment: Monitor and assess health in
communities and populations to identify
problems and establish priorities.
• Policy Development: Formulate health
policies in cooperation with government and
community leaders to address problems and
priorities.
• Assurance: Work to assure that communities
and populations have appropriate and costeffective health services, including disease
prevention and health promotion services.
Essential Public Health Services
• Monitor the health status of individuals in the
community to identify community health
problems.
• Diagnose and investigate community health
problems and community health hazards.
• Inform, educate, and empower the community
with respect to health issues.
• Mobilize community partnerships in identifying
and solving community health problems.
• Develop policies and plans that support individual
and community efforts to improve health.
Essential Public Health Services
• Enforce laws and rules that protect the public
health and ensure safety in accordance with those
laws and rules.
• Link individuals who have a need for community
and personal health services to appropriate
community and private providers.
• Ensure a competent workforce for the provision of
essential public health services.
• Research new insights and innovative solutions to
community health problems.
Essential Public Health Services
• Evaluate the effectiveness, accessibility, and
quality of personal and population-based
health services in a community.
Leading Causes of Death–1900
Pneumonia
Tuberculosis
Diarrhea & Enteritis
Heart Disease
Stroke
Liver Disease
Injuries
Cancer
Senility
Diptheria
0
2
4
6
8
10
Source: Achievements in Public Health, 1900-1999: Control of Infectious Diseases.
MMWR, July 30, 1999.
12
14
Causes of Death in United States – 2000
Leading Causes of Death*
Heart Disease
Cancer
Stroke
Chronic lower respiratory
disease
Unintentional Injuries
Diabetes
Pneumonia/influenza
Alzheimer’s disease
Kidney disease
0
5
10
15
20
* Percentage (of all deaths)
25
30
35
10 Greatest Public Health Achievements
•
•
•
•
•
•
•
•
•
•
1900-2000
Vaccination
Motor vehicle safety
Safer workplaces
Control of infectious diseases
Reduction in heart disease and stroke fatalities
Safer, healthier foods
Healthier mothers & babies
Family planning
Fluoridated drinking water
Understanding tobacco use as a health hazard
Increased Life Expectancy
80
Increased years due to
public health measures:
25
60
40
20
0
77 years
47 years
1900
2000
Source: Centers for Disease Control and Prevention (CDC).
Increased years due to
medical care advances:
5
2002 Health Care Spending
60
50
54%
40
30
20
20%
16%
10
3%
0
Public Health
7%
Equipment &
Research
Administration &
Nursing Homes
Drugs &
Professional
Services
Physicians &
Hospitals
Health Care =
Public Health + Medical Care
Public Health
Medical Care
Two Guiding Public Health
Principles
Prevention
Evidence-based strategies
& interventions
Causes of Death in United States – 2000
Actual Causes of Death†
Leading Causes of Death*
Heart Disease
Tobacco
Cancer
Poor diet/
lack of exercise
Stroke
Alcohol
Chronic lower
respiratory disease
Infectious agents
Unintentional Injuries
Pollutants/toxins
Diabetes
Firearms
Pneumonia/influenza
Sexual behavior
Alzheimer’s disease
Motor vehicles
Kidney Disease
Illicit drug use
0
5
10
15
20
25
30
Percentage (of all deaths)
35
0
5
10
15
Percentage (of all deaths)
Sources: * National Center for Health Statistics. Mortality Report. Hyattsville, MD: US
Department of Health and Human Services; 2002
† Adapted from McGinnis Foege, updated by Mokdad et. al.
20
Is There a Public Health Solution?
1900: Population-based, public health efforts
won battle against infectious killers
2000: Can population-based public health
efforts win the battle against chronic
diseases?
Partnerships: A Key to Achieving
A Culture of Health
•
•
•
•
Local, state & federal government
Local providers & health professionals
Hospitals & clinics, & professional associations
Universities, schools of public health, academic
health science centers
• Community-based organizations, nonprofits,
foundations
• EMS & first responders, medical examiners
• Private sector
II. HEALTH SERVICE REGIONS
HEALTH SERVICE REGIONS
• Regions created in 1970
• Eleven regions today
• Mission:
– To provide public health services in
areas w/out local health departments
– To carry out required state
governmental functions and assist
local health departments
HEALTH SERVICE REGIONS
Each Region Provides:
• Direct services
• Health promotion and disease prevention
• Disease investigation and control
• Consumer health services
• Public health preparedness services
• A single point of access for DSHS
HEALTH SERVICE REGIONS
Each Regional Office is led by a
licensed physician with expertise
in medicine & public health
HEALTH SERVICE REGIONS
25% of Texans are not served
by a local health department
Population
Served by Public
Health Regions
PHR 01
791,000
N Dakota
PHR 10
733,000
Vermont
Hawaii
PHR 03
5,929,000
PHR 02
546,000
PHR 04
1,043,000
Delaware
PHR 09
526,600
PHR 07
2,477,000
S Dakota
PHR 08
2,258,000
Wyoming
Indiana
Source: Center for Health Statistics, Population Estimates for Counties, 2003
PHR 06
5,200,500
Maryland
W Virginia
2003 Texas Population,
22,118,500
PHR 05
748,000
PHR 11
1,866,000
Mississippi
Nevada
III. PREPAREDNESS
Preparedness Overview
DSHS is Texas lead for Health
and Medical response
Health and Medical response
plan is Annex H of state
emergency response plan
DSHS must ensure coordination
with regional and local
response plans
Bioterrorism Preparedness Priorities
• Surveillance
• Early detection
• Rapid Response
• Early Containment
• Capacity building/sustaining
Capacity Building
• $60 million/year, 75% spent locally
• 500 workers added in Texas since 9/11: Austin
office, 8 regions and 48 local health departments
• Laboratory Response Network (LRN) labs
increased from 5 to 10
• Established 8 Epidemiological Response Teams
across Texas
• Expanded Health Alert Network (HAN)
• Established partnerships with neighboring U.S
states (4) and neighboring Mexican states (4)
LRN Laboratories
*Expected boundaries. Some laboratories are not fully functional at this time.
Strategic National Stockpile
– A national repository of life-saving
pharmaceuticals and medical materiel
that will be delivered to the site of a
chemical or biological terrorism event,
or natural or technological disasters,
in order to reduce morbidity and
mortality.
SNS Components
• 12-hour Push Packages
Vendor Managed Inventory
• Vaccine
• Chempack
12-Hour Push Package
• Arrives in <12 hours
• 50 tons
• Pre-packed
• Fills a jumbo jet
or multiple tractor
trailers
• Broad spectrum support
CHEMPACK Project
• “Forward” placement of nerve agent antidotes
• Qualifies for shelf life extension program
• Two type of containers:
- EMS container: for emergency responders - material
packaged mostly in auto-injectors
- hospital container: for hospital dispensing - multiuse vials
for precision dosing and long term care.
State/Local Responsibilities
• Coordinate planning with regions,
counties, and cities
• Receive, store, stage
• Distribute
• Manage inventory
• Protect operations
U.S.-Mexico Border Region
• 2 countries
• 10 states
• 14 sister cities
• 12 million
people
Texas: 5 states, 7 sister cities, 6 million people
U.S.-Mexico Border Region
If this region were a state, it would…
…rank last in access to health care.
…rank 2nd in death rates from hepatitis.
…rank 3rd in deaths related to diabetes.
…rank as the 7th largest state.
U.S.-Mexico Border is busiest in the world.
Each year, more than
300 million people,
90 million cars, &
4.3 million trucks
cross the border
Laredo is home to
the largest inland
port in the US.
Border Crossings
More than half of all border crossings from Mexico
to U.S occur into Texas.
52% Pedestrians
72% Trucks
89% Trains
US Border State Health Officers Identify need for
“vertical planning” with Sister Mexico States
NM-TX-CHIH
El Paso Juarez
Presidio Ojinaga
TX-COAH
Del Rio
Ciudad Acuna
Eagle Pass
Piedras Negras
TX-NL-TAMPS
Laredo
Nuevo Laredo
McAllen Reynosa
Brownsville
Matamoras