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OverviewPublic Health System
DSHS Advisory Council May 5, 2005
Nick Curry, M.D., MPH, Deputy CommissionerPrevention, Preparedness & Regulatory Services
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I. PUBLIC HEALTH OVERVIEW
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PUBLIC HEALTH: Science and art of working in communities to promote health, prevent disease and injury, and prolong quality life.
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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.
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Core Public Health Functions
Assessment
Policy Development
Assurance
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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.
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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.
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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.
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Essential Public Health Services
• Evaluate the effectiveness, accessibility, and quality of personal and population-based health services in a community.
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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
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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
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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
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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
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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
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Public Health Medical Care
Health Care =Public Health + Medical Care
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Two Guiding Public Health Principles
Prevention
Evidence-based strategies & interventions
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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.
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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?
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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
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II. HEALTH SERVICE REGIONS
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• 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
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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
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Each Regional Office is led by a licensed physician with expertise in medicine & public health
HEALTH SERVICE REGIONS
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25% of Texans are not served by a local health department
HEALTH SERVICE REGIONS
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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
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III. PREPAREDNESS
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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
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Bioterrorism Preparedness Priorities
• Surveillance
• Early detection
• Rapid Response
• Early Containment
• Capacity building/sustaining
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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)
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LRN Laboratories
*Expected boundaries. Some laboratories are not fully functional at this time.
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– 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
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SNS Components
• 12-hour Push Packages
Vendor Managed Inventory
• Vaccine
• Chempack
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12-Hour Push Package•Arrives in <12 hours
•50 tons
•Pre-packed
•Fills a jumbo jet
or multiple tractor
trailers
•Broad spectrum support
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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.
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State/Local Responsibilities
• Coordinate planning with regions, counties, and cities
• Receive, store, stage
• Distribute
• Manage inventory
• Protect operations
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U.S.-Mexico Border Region
• 2 countries
• 10 states
• 14 sister cities
• 12 million people
Texas: 5 states, 7 sister cities, 6 million people
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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
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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.
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More than half of all border crossings from Mexico to U.S occur into Texas.
52% Pedestrians
72% Trucks
89% Trains
Border Crossings
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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