OverviewPublic Health System

DSHS Advisory Council May 5, 2005

Nick Curry, M.D., MPH, Deputy CommissionerPrevention, 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

Policy Development

Assurance

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 cost-effective 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

Source: Achievements in Public Health, 1900-1999: Control of Infectious Diseases. MMWR, July 30, 1999.

0 2 4 6 8 10 12 14

Diptheria

Senility

Cancer

Injuries

Liver Disease

Stroke

Heart Disease

Diarrhea & Enteritis

Tuberculosis

Pneumonia

Causes of Death in United States – 2000

* Percentage (of all deaths)

0 5 10 15 20 25 30 35

Leading Causes of Death*

Heart DiseaseCancerStroke

Chronic lower respiratory disease

DiabetesPneumonia/influenza

Unintentional Injuries

Alzheimer’s diseaseKidney disease

10 Greatest Public Health Achievements1900-2000

• 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

Source: Centers for Disease Control and Prevention (CDC).

77 years

47 years

0

20

40

60

80

1900 2000

Increased years due to medical care advances:

5

Increased years due to public health measures:

25

2002 Health Care Spending

3% 7%

16%20%

54%

0

10

20

30

40

50

60

Public Health Equipment &Research

Administration &Nursing Homes

Drugs &Professional

Services

Physicians &Hospitals

Public Health Medical Care

Health 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†

Tobacco

Poor diet/lack of exercise

Alcohol

Infectious agents

Pollutants/toxins

Firearms

Sexual behavior

Motor vehicles

Illicit drug use

Leading Causes of Death*

Percentage (of all deaths)

Heart Disease

Cancer

Chronic lower respiratory disease

Unintentional Injuries

Pneumonia/influenza

Diabetes

Alzheimer’s disease

Kidney Disease

Stroke

Percentage (of all deaths)

0 5 10 15 20 25 30 350 5 10 15 20

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.

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 AchievingA 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

• 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

HEALTH SERVICE REGIONS

PHR 01791,000

PHR 02546,000

PHR 035,929,000 PHR 04

1,043,000

PHR 05748,000

PHR 065,200,500

PHR 072,477,000

PHR 082,258,000

PHR 09526,600

PHR 10733,000

PHR 111,866,000

Source: Center for Health Statistics, Population Estimates for Counties, 2003

2003 Texas Population,22,118,500

Population Served by Public Health Regions

N Dakota

S Dakota

WyomingW Virginia

Nevada

Mississippi

Maryland

VermontIndiana

Hawaii

Delaware

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.

– 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.

Strategic National Stockpile

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

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 Region

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.

More than half of all border crossings from Mexico to U.S occur into Texas.

52% Pedestrians

72% Trucks

89% Trains

Border Crossings

NM-TX-CHIHEl Paso Juarez Presidio Ojinaga

TX-COAHDel Rio Ciudad AcunaEagle Pass Piedras Negras

TX-NL-TAMPSLaredo Nuevo LaredoMcAllen ReynosaBrownsvilleMatamoras

US Border State Health Officers Identify need for “vertical planning” with Sister Mexico States