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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