Murray Sagsveen

Murray Sagsveen

State Health OfficerNorth Dakota Department of Health

STATE HEALTH COUNCILHoward C. Anderson, R.Ph.

Chairman

ADMINISTRATIVE ASSISTANT

Londa Rodahl

PUBLIC INFORMATION

Debra Anderson

STATE FORENSIC EXAMINER

George Mizell, M.D.

ACCOUNTING

Kathy Albin

CRIME LAB

Aaron Rash

HEALTH INFORMATIONSYSTEMS

PERSONNEL

Jennifer Bandy

VITAL RECORDS

Beverly Wittman

ADMINISTRATIVE SERVICESSECTION

Robert A. Barnett

EMERGENCY HEALTHSERVICES

Timothy Wiedrich

HEALTH FACILITIES

Fred Gladden

HEALTH RESOURCESSECTION

Fred Gladden

DISEASE CONTROL

Fred Heer

FOOD AND LODGING

Kenan Bullinger

HEALTH PROMOTIONAND EDUCATION

Sandra Adams

MATERNAL AND CHILDHEALTH

Sandra Anseth

MICROBIOLOGY

Jim Anders

PREVENTIVE HEALTHSECTION

Steve McDonough, M.D.

CHEMISTRY

Myra Kosse

ENVIRONMENTALENGINEERING

Dana Mount

MUNICIPAL FACILITIES

Jack Long

WASTE MANAGEMENT

Neil Knatterud

WATER QUALITY

Dennis Fewless

ENVIRONMENTAL HEALTHSECTION

Francis Schwindt

STATE HEALTH OFFICER

Murray G. Sagsveen

ADVISORY COUNCILJim Brosseau, M.D.Julie Blehm, M.D.Dennis Wolf, M.D.

GOVERNOR

Edward T. Schafer

North Dakota Department of Health

February 1, 1998

State Health CouncilHoward C. AndersonChairmanHealth Care IndustryTurtle Lake, ND

Gary RiffeVice ChairmanHealth Care IndustryJamestown, ND

Darlene RinnSecretaryConsumerMinot, ND

Ronald A. AndersonConsumerKeene, ND

Jim Brosseau, M.D.Health Care IndustryGrand Forks, ND

Lowell HerfindahlHealth Care IndustryTioga, ND

Linda NelsonConsumerCasselton, ND

Clifford R. PorterEnergy IndustryBismarck, ND

Joel SmithManufacturing/Processing IndustryFargo, ND

Carmen TomanConsumerGrand Forks, ND

Lori WightmanConsumerFargo, ND

Advisory Council

James D. Brosseau, M.D.Internal MedicineAltru Health Systems, Grand Forks, ND

Julie A. Blehm, M.D.Internal MedicineMedical Arts Clinic, P.C., Minot, ND

Dennis E. Wolf, M.D.Family PracticeGreat Plains Clinic, Dickinson, ND

Mission Statement

We, as public employees, are dedicated to the goal of assuring that North Dakota is a healthy place to live and to the belief that each person should have an equal opportunity to enjoy good health. To accomplish this mission, we are committed to the promotion of healthy lifestyles, protection and enhancement of the environment and provision of quality health care services for the people of North Dakota.

Vital Signs

On an average day in North Dakota:

23.5 babies are born, 5.5 of them are born out of wedlock and 2 are born to teenage mothers

16 people die, 5 of them from heart disease and 3.75 from cancer

13 people get married and 6 people get divorced

Source: ND Dept. of Health, Vital Records

Vital Signs

In an average week: 1.2 infants die 1.4 children between ages 1 and 19 die 1.5 people commit suicide 3 people die from diabetes 4 people die from influenza and pneumonia 4.4 people die as a result of accidents


Vital Signs

In an average month:

1 person younger than age 20 commits suicide

2.7 people die as a result of some type of accident

75.81 is the average age at death


Resident Live BirthsNorth Dakota ~ 1980 - 1998

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

1980 1985 1990 1995 1998

Source: ND Dept. of Health, Vital Records **Estimate

**

Urban-Rural Population DistributionNorth Dakota, 1900-1996

0

20

40

60

80

100

1900 1910 1920 1930 1940 1950 1960 1970 1980 1996

Perc

ent o

f Pop

ulat

ion

Urban Rural

Source: U.S. Bureau of the Census

Population Distribution North Dakota 1960-1990

0

20

40

60

80

1960 1970 1980 1990 1996

Perc

ent o

f Pop

ulat

ion

Largest Cities (over 10,000 people) Rest of State


Expenditures by SectionJuly 1, 1995 through June 30, 1997

$5.5MAdministrative

Services8%

$16.8MEnvironmental

Health26%

$38.6MPreventive

Health59%

$4.6MHealth

Resources7%

Total Expenditures = $65.6 MillionSource: ND Dept. of Health, Administrative Services

Sections of theNorth Dakota Department of Health

Administrative Services

Preventive Health

Environmental Health

Health Resources

Administrative Services Section

The Administrative Services Section provides support services to all divisions of the North Dakota Department of Health and assists in coordinating department activities.


Office of Statistical Services:

Collects data about the health of North Dakotans

Conducts research about North Dakotans’ health

and use of health care services

Produces reports for external and internal

audiences and

Conducts health policy research


The Crime Lab Division is responding to the growing problem of illegal drug use.

Number of Forensic cases opened:4,445 in 19974,022 in 19963,900 in 1995


Preventive Health Section

The goal of the Preventive Health Section is

to promote good health and prevent illness

and disease.

The Maternal and Child Health Division works to improve the health of:

WomenInfants and childrenAdolescents


The Disease Control Division deals with:

Disease outbreaks Immunizations Sexually transmitted diseases Injury prevention Chronic diseases


The Health Promotion and Education Division educates North Dakotans about:

Cancer prevention and controlTobacco prevention and controlCardiovascular diseaseHealthy lifestyles for school-age children


The Food and Lodging Division protects public health through licensure and inspection of:

Restaurants and bars

Hotels and motels

Mobile home parks

Campgrounds


Bed and breakfasts

Retail food stores

Meat markets and

Bakeries

The Microbiology Division provides diagnostic and referral services:

Conducts testing for many exotic diseases and emerging infections and

Serves as the state lab for FDA dairy and EPA water bacteriological testing programs


Local Public Health Units

24 single and multi-county health departments provide the following services: Maternal and child health programsHealth promotionCommunicable disease programsSpousal and child abuse programs School health screening and educationEnvironmental health programsHome health visits


BurleighOliver

Dunn

Slope

Bowman

Billings

Gol

den

Valle

y

Stark

Hettinger

Adams Sioux

Grant

Mercer

Morton

Mountrail

Williams

McKenzie

Divide Burke

McHenry

McLean

Ward

RenvilleBottineau

Kidder

Dickey

Emmons

McIntosh

Stutsman

Logan La Moure

Sargent

Richland

Barnes

Ransom

Cass

Ramsey

EddyWellsSheridan

Foster

Rolette

Pierce

Benson

Towner

Nelson

SteeleGriggs Traill

Grand Forks

Cavalier

Walsh

Pembina

Multi County Health District

Single County Health District

City/County Health Department

Single County Health Department

NoneJanuary 1999

Local Public Health UnitsPreventive Health Section

City/County Health District

Environmental Health Section

The goal of the Environmental Health

Section is to safeguard the quality of North

Dakota’s air, land and water resources.

EHS issues environmental permits for:

Wastewater discharges (800 facilities) Air Pollution (900 facilities) Hazardous wastes (9 facilities) Solid waste (14 municipal, 25 industrial

and special) Feedlots (900 facilities)


Other EHS Programs

Drinking water (600 systems) Radiation Control (80 radioactive licenses and

750 X-ray) Underground storage tanks (3,450 tanks) Revolving loan programs

Wastewater treatment - $6.5 million per year Drinking water - $24 million the first two years

Groundwater quality


Chemistry Lab

Organic analysis (man-made components, such as pesticides)

Inorganic analysis (naturally occurring compounds, such as fertilizer)


The Division of Health Facilities works to:

assure that services are consistent with accepted standards of practice and that building structures meet established requirements.

Health Resources

The Division of Health Facilities monitors:

Buildings

Equipment and

Services to people

Health Resources

Emergency Health Services

The Division of Emergency Health Services is the lead agency for North Dakota’s Emergency Medical Services (EMS) System.

Health Resources

Current Issues

Tobacco legislation Teen suicide Access to health care services in rural

North Dakota Partnership between the North Dakota

Department of Health and local public health departments

Shaken Baby SyndromeSpring 1998

v

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Emergency ServicesNorth Dakota ~ 1996

v r ! !Ambulance Quick Response Unit 4 Mile/5 Minute 7 Mile/10 Minute

Source: ND Dept. of Health, Health Resources Section

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Other ClinicsNorth Dakota ~ 1996

# Rural Health Clinic 21 Mile Buffer- Other Clinics

Source: ND Dept. of Health, Health Resources Section and Office of Statistical Services

V

V

V

VV

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VVV

V

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BurleighOliver

Dunn

Slope

Bowman

Billings

Gol

den

Valle

y

Stark

Hettinger

AdamsSioux

Grant

Mercer

Morton

MountrailWilliams

McKenzie

Divide Burke

McHenry

McLean

Ward

RenvilleBottineau

Kidder

Dickey

Emmons

McIntosh

Stutsman

Logan La Moure

SargentRichland

Barnes

Ransom

Cass

Ramsey

EddyWellsSheridan

Foster

Rolette

PierceBenson

Towner

Nelson

SteeleGriggs Traill

Grand Forks

Cavalier

Walsh

Pembina

HospitalsNorth Dakota ~ 1999

Source: ND Dept. of Health, Health Resources Section

Total PopulationNorth Dakota ~ 1970 - 1998

600

610

620

630

640

650

660

1970 1980 1990 1998

Num

ber i

n Th

ousa

nds


Population Age 65 and OverNorth Dakota ~ 1970 - 1990

0

20

40

60

80

100

1970 1980 1990 1998

Num

ber i

n Th

ousa

nds


Population Age 65 and OverNorth Dakota Vs United States

0

5

10

15

1970 1980 1990 1996

Perc

ent o

f Pop

ulat

ion

North Dakota United States


Coronary Heart Disease1980 - 1996

Risk Factors for Coronary Heart Disease

High blood pressure Smoking High fat diet Sedentary lifestyle Excessive alcohol use0

50

100

150

200

250

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96

Male Female

Male and FemaleCoronary Heart Disease Death

Rates

Age-adjusted death rate per 100,000 North Dakotans

*


Lung Cancer1980 - 1996

0

20

40

60

80

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96

Male Female

Male and FemaleLung Cancer Death Rates

*Age-adjusted death rate per 100,000 North Dakotans

* Risk Factors for Lung Cancer

Smoking Environmental tobacco

smoke Exposure to radon decay

products, asbestos or ionizing radiation


Diabetes Death Rate*All Races

*Diabetes as an underlying and contributing cause. **Age-adjusted death rate per 100,000 North Dakotans

0

10

20

30

40

50

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96

Diabetes HP 2000

**


0

50

100

150

200

250

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96

Native Americans HP 2000

Diabetes Death Rate*Native Americans

*Diabetes as an underlying and contributing cause. **Age-adjusted death rate per 100,000 North Dakotans

**


DiabetesRisk Factors for Diabetes

Overweight (20 percent or more above ideal weight)

Family history of diabetes Personal history of diabetes during

pregnancy Member of an ethnic group with high

prevalence of diabetes

North Dakota Community HospitalsAdmissions: 1980-1993

0

20

40

60

80

100

120

140

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993

Num

bers

in T

hous

ands

Source: Office of National Health Statistics in HCFA Office of Actuary

North Dakota Community HospitalsOutpatient Visits: 1980-1993

0

100

200

300

400

500

600

700

800

900

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993

Num

bers

in T

hous

ands

Source: Office of National Health Statistics in HCFA Office of Actuary

)

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Affiliation% Medcenter One - Bismarck (10)

$ St. Alexius/Bis/Unimed/Minot (1)

’ MeritCare - Fargo (6)

¹ Grand Forks Clinics (3)

» Trinity - Minot (1)

ž Unimed - Minot (2)

= West River Reg. - Hettinger (4)

Johnson Clinic - Rugby (5)

u Trinity & Western Dakota (1)

Tioga Medical Center (4)

N SW Medical Center - Oakes (7)

Y St. Joseph's - Dickinson (3)

˜ Carrington Health Center (5)

œ Wishek Community Hospital (3)

› Ashley Medical Center (2)

) No Affiliation Known (22)

Rural Health Clinic NetworksNorth Dakota ~ 1997

Source: North Dakota Department of Health, Health Information Systems Division, December 1996

BurleighOliver

Dunn

Slope

Bowman

Billings

Gol

den

Valle

y

Stark

Hettinger

Adams Sioux

Grant

Mercer

Morton

MountrailWilliams

McKenzie

Divide Burke

McHenry

McLean

Ward

RenvilleBottineau

Kidder

DickeyEmmons

McIntosh

Stutsman

Logan La Moure

SargentRichland

Barnes

Ransom

Cass

Ramsey

EddyWellsSheridan

Foster

Rolette

Pierce

Benson

Towner

Nelson

SteeleGriggs Traill

Grand Forks

Cavalier

Walsh

PembinaPercent of Change

=<1 percent

-1 to 0 percent

0 - 1 percent

=>1 percent

North Dakota CountiesPopulation Changes

1980 - 1990, Annual Rates

Source: Federal Reserve Bank of Minneapolis (http://woodrow.mpls.frb.fed.us)

Burleigh

Oliver

Dunn

Slope

Bowman

Billings

Gol

den

Valle

y

Stark

Hettinger

Adams Sioux

Grant

Mercer

Morton

Mountrail

Williams

McKenzie

Divide Burke

McHenry

McLean

Ward

RenvilleBottineau

Kidder

Dickey

Emmons

McIntosh

Stutsman

Logan La Moure

Sargent

Richland

Barnes

Ransom

Cass

Ramsey

Eddy

WellsSheridanFoster

Rolette

Pierce

Benson

Towner

Nelson

SteeleGriggs Traill

Grand Forks

Cavalier

Walsh

Pembina

North Dakota Frontier CountiesBased on 1990 Census Estimates

35 of 53 North Dakota counties are designated as Frontier (less than six persons per square mile). #

BurleighOliver

Dunn

Slope

Bowman

Billings

Gol

den

Val

ley

Stark

Hettinger

AdamsSioux

Grant

Mercer

Morton

MountrailWilliams

McKenzie

Divide Burke

McHenry

McLean

Ward

Renville Bottineau

Kidder

Dickey

Emmons

McIntosh

Stutsman

Logan La Moure

SargentRichland

Barnes

Ransom

Cass

Ramsey

EddyWells

SheridanFoster

Rolette

Pierce

Benson

Towner

Nelson

SteeleGriggs Traill

Grand Forks

Cavalier

Walsh

Pembina

Counties with Greatest Population Loss 1990-96 Counties with Greatest Populaiton Gain 1990-96

18.4% 24.5%11.1% 16.8%

17.4%

15.7%11.3%21.1%

13.7%

17.3%16.3%

15.1%

14.5%

1.3%

11.3%

5.4%

13.6%

.7%

11.2%3.7%

4.5%

11.5%

North Dakota Population Statistics

Source: North Dakota Census Data Center

Counties with Greatest Population Loss 1990-98Counties with Greatest Population Gain 1990-98

14.4%

14%

Nursing Facility Residents by AgeND vs US ~ 1995

0 - 64 65 - 74 75 - 84 85+

4.32

10.9 7.06

15.622.58

37.6

66.03

35.8

0

10

20

30

40

50

60

70

Perc

ent o

f Res

iden

ts

0 - 64 65 - 74 75 - 84 85+

North Dakota United States

Sources: US: National Center for Health Statistics - 1995 National Nursing Home Survey ND: ND Department of Human Services - 1995

1990 to 1998 Population Shifts in North Dakota

-30

-25

-20

-15

-10

-5

0

5

10

15

20

1

Counties

Perc

ent C

hang

e

North Dakota Adams Barnes Benson Billings Bottineau Bowman Burke

Burleigh Cass Cavalier Dickey Divide Dunn Eddy Emmons

Foster Golden Valley Grand Forks Grant Griggs Hettinger Kidder LaMoure

Logan McHenry McIntosh McKenzie McLean Mercer Morton Mountrail

Nelson Oliver Pembina Pierce Ramsey Ransom Renville Richland

Rolette Sargent Sheridan Sioux Slope Stark Steele Stutsman

Towner Traill Walsh Ward Wells Williams

Department of Health General Fund 1987 to 2001

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

Biennium

Gen

eral

Fun

d A

ppro

pria

tions

General Fund$11,972,221 $11,902,613 $14,109,924 $13,655,186 $14,366,079 $14,934,440 $14,456,044

1987-89 1989-91 1991-93 1993-95 1995-97 1997-99 1999-2001

100%

82% 83%

100%

5%

68%

43%

55%

12%

100%

0% 5%

40% 40%

20% 20%25%

0%

18% 17%

0%

90%

32%

57%

45%

88%

0%

100%

40%

20%

40%73%

80%

50%

0% 0% 0% 0%5%

0% 0% 0% 0% 0% 0%

55%

40%

20%

7%

0%

25%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Admini

strati

ve

Vital R

ecord

s

Crime L

ab

Forens

ic Exa

miner

Health

Facilit

ies EMSMCH

Micro L

ab

Diseas

e Con

tol

Food &

Lodg

ing

Health

Prom

. & E

d.

Enviro

n. Eng

.

Chief E

nviro

n. Hea

lth

Chemist

ry La

b

Wate

r Qua

lity

Munici

pal F

acilit

ies

Was

te Man

agem

ent

Perc

ent o

f Fun

ding

SpecialFederalGeneral

General Funding for Key Programs

260

270

280

290

300

310

320

330

1987-89

1989-91

1991-93

1993-95

1995-97

1997-99

1999-2001

Summary of FTEs 1987 to 2001

Biennium

Num

ber

of F

TE

s

Register of Deeds Mitigation Project

DocumentMicrofilm

Digital Storage

General Funds Allocatedto Local Health Units

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

Dol

lars

Series1 975,000 950,000 508,093 975,000 1,000,000 950,000 990,000 1,000,000

1985-87 1987-89 1989-91 1991-93 1993-95 1995-97 1997-99 1999-01

$1,000,000 plus $100,000

94%

96%

98%

100%

102%

104%

106%

108%

1991-1993 1993-1995 1995-1997 1997-1999 1999-2001

Biennium

Comparison of General Funds1991-1993 through 1999-2001 Biennia

100%

97%

102%

106%

102%

Perc

enta

ge C

hang

e fr

om 1

991-

1993

Documents

Murray Sagsveen