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Public Health: A Definition

TPHA Conference April 15, 2009 State of Texas Health Report 2009 David L. Lakey, M.D. Commissioner Texas Department of State Health Services. Medical Care focuses on individual patients vital to all of us some of the time saves lives one at a time disease treatment. Public Health

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Public Health: A Definition

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  1. TPHA ConferenceApril 15, 2009State of Texas Health Report 2009David L. Lakey, M.D.CommissionerTexas Department of State Health Services

  2. Medical Care focuses on individual patients vital to all of us some of the time saves lives one at a time disease treatment Public Health focus on entire populations vital to all of us all of the time saves lives thousands at a time prevention, protection and promotion Public Health: A Definition The approach to health care that is concerned with the health of the community as a whole.

  3. U.S. Life Expectancy at Birth 1918 Flu Epidemic

  4. Increased Life Expectancy Driven by Public Health Improvements Increased years due to public health measures: 25 Increased years due to medical care advances: 5 Source:Ten Great Public Health Achievements -- United States, 1900-1999 MMWR, April 02, 1999 / 48(12);241-243 http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm

  5. Impact of Vaccines in the 20th Century

  6. Leading Causes of Death 1900 • Pneumonia • Tuberculosis • Diarrhea • Heart Disease • Intracranial Lesions 2005 • Heart Disease • Cancers • Cerebrovascular Disease • Accidents • Chronic Lower Respiratory Diseases

  7. Leading Causes of Death Texas 2005 and 2001 DSHS Center for Health Statistics

  8. Actual Causes of Death*Shaped by Behavior *Texas 2001 Chronic Disease in Texas 2007, DSHS

  9. Reduce Adult Smoking HP 2010 goal 12%

  10. Percentage of the Texas Municipal Population Protected by Smoke-Free Ordinances By Number of Settings

  11. Rate of Illegal Sales of Tobacco Products to Minors in Texas(1996 – 2008) Percent

  12. No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2006 1990 2007

  13. Obesity Prevalence Trends in Texas Adults 1990 to 2007 ~34% of Texans are normal weight ~29% of Texans are obese Texas Comptroller: www.window.state.tx.us/specialrpt/obesitycost/summary/

  14. Alcohol & Substance Abuse in Texas(2006-2007) For 18 & Older Drug abuse (other than marijuana) 616,000 Binge alcohol w/in past month 4.1 million Tobacco use past month 5.4 million Alcohol or drug abuse or dependence 1.5 million Note: Texas population is ~23 million

  15. Substance Free Youth HP 2010 goal 91%

  16. HIV/AIDS in Texas HIV/AIDS in Texas: Persons Living with HIV/AIDS, New Diagnoses of HIV/AIDS, and Deaths among those with HIV/AIDS New diagnoses are holding steady. The number of persons living with HIV/AIDS is rising because they are surviving longer.

  17. Childhood Immunizations HP 2010 goal 80% Percent

  18. New Challenges in Public Health

  19. Serious Mental Illness compared to Chronic Illnesses Serious Mental Illness CVD Diabetes Cancer Asthma CDC BRFSS, SEER Cancer Statistics Review, 1975-2002, “Prevalence, Severity, and Co-morbidity of 12-Month DSM-IV Disorders”  Arch Gen Psychiatry.  Vol. 62, June 2005

  20. Public Health Threats: 2008 Major Response Events • Hurricane Dolly • Tropical Storm Edouard • Hurricane Gustav • Hurricane Ike

  21. Public Health Responseto Hurricane Ike

  22. Emerging / Re-emerging Infectious Diseases • Pandemic Influenza • SARS • Dengue fever • MDR / XDR TB • West Nile

  23. Food Safety • Salmonella – 2008 • Tomatoes, peppers • Salmonella – 2009 • Peanuts, pistachios

  24. Health Care Improvement • Healthcare Associated Infections (HAI) • Leading cause of death from infectious disease in the U.S. • 200,000 infections and almost 9,000 deaths in Texas each year. • In Texas, HAI-related healthcare costs are estimated at more than $500 million annually. • Up to 60% of HAI infections are preventable through improved application of existing infection control recommendations and guidelines. • Medical Errors • Preventable medical errors are a leading cause of death in the U.S. that results in significant costs to patients, payers, and providers. • The Centers for Medicare and Medicaid Services began denying reimbursement to Medicare acute care hospitals on October 1, 2008 for 11 hospital acquired conditions. • Legislative Budget Board Effective and Efficiency Report recommends action by the legislature to collect never event and medical error information.

  25. Steps To Improve Health in Texas • Maintain public health activities • Monitor and control infectious diseases • Use health care data to improve services and guide decision-making • Prevent chronic disease • Prepare for and respond to public health threats • Prevent and treat substance abuse and mental illness

  26. Moving Health Forward: Building Public Health Partnerships • In our communities • Public & private resources • With our academic institutions • DSHS Office of Academic Linkages, Feb. 1 • Local, state, & federal agencies • With other public health organizations • TPHA, TALHO, TAMHO, ASAP • First responders • Including law enforcement, military • Other stakeholders

  27. DSHS Partnerships Needed to Improve Public Health Urban Planners, Developers Architects Industry Public Health Groups Community-based Solutions Elected Officials Providers & Hospitals Worksites & Schools Community Groups Higher Education Non-Traditional Partners

  28. Working with Texas Elected Officials to Improve Public Health • Effectively communicate an expanded role of public health • Compete for limited resources • Strategy: • Maintain existing programs • Ensure compliance with state/federal statutes • Move health forward wherever possible

  29. DSHS Exceptional Item Request Summary

  30. Major Public Health Initiatives in the 81st Legislative Session • SB 7 – obesity reduction for Medicaid/CHIP recipients • HB 5 & SB 544 - bans public smoking • SB 1329 & SB 1883 – licensing & testing to reduce foodborne illnesses • SB 1083 & HB 3066 – connects DSHS program registries to hospital discharge data • SB 1030, 1648, 1325, HB 4173 – veteran’s mental health care • HB 1379, 1381, 3427 & SB 877, 1886 – expand HIV testing • HB 1708 & SB 796 – substance abuse treatment for eligible Texans receiving Medicaid

  31. Conclusion • Public Health - dramatic positive effect on longevity and well-being • Old and new challenges in improving health in Texas • Meet challenges by working together to build stronger, more effective partnerships

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