1 TPHA Conference April 15, 2009 State of Texas Health Report 2009 David L. Lakey, M.D. Commissioner Texas Department of State Health Services

2 Public Health: A Definition 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 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 Source:Ten Great Public Health Achievements -- United States, MMWR, April 02, 1999 / 48(12); Increased years due to medical care advances: 5 Increased years due to public health measures : 25

5 Impact of Vaccines in the 20 th Century Disease20 th Century Annual Morbidity 2006 Total% Decrease Smallpox48, Diphtheria175, Pertussis147,27115,63289 Tetanus1, Polio (paralytic)16, Measles503,28255>99.9 Mumps152,2096,58496 Rubella47,74511>99.9 Congenital rubella Haemophilus influenzae (<5 yrs) 20,000 (est.)208 (serotype B or unknown serotype) 99

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 Chronic Disease in Texas 2007, DSHS *Texas 2001

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

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

13 Obesity Prevalence Trends in Texas Adults 1990 to 2007 ~34% of Texans are normal weight ~29% of Texans are obese Texas Comptroller:

14 Alcohol & Substance Abuse in Texas ( ) 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

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19 New Challenges in Public Health

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

21 Public Health Threats: 2008 Major Response Events Hurricane Dolly Tropical Storm Edouard Hurricane Gustav Hurricane Ike

22 Public Health Response to Hurricane Ike

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

24 Food Safety Salmonella – 2008 –Tomatoes, peppers Salmonella – 2009 –Peanuts, pistachios

25 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.

26 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

27 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

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

29 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

30 DSHS Exceptional Item Request Summary EXCEPTIONAL ITEMBIENNIAL TOTAL 1.Maintaining Current Operations$ 83,895,811 2.Regulatory18,786,207 3.Health Data Collection & Analysis24,958,173 4.Vital Statistics6,655,044 5.Information Technology Support for Critical Programs30,290,109 6.Disaster Recovery and Public Health Preparedness24,066,371 7.Stipends for Psychiatrist and Medical Residents2,736,795 8.Building & Equipment Repair & Replace70,854,048 9.Substance Abuse Services69,669, Community Mental Health Services85,536, Chronic Disease Prevention25,914, Infectious Disease Prevention16,906, Community Mental Health Services - Maintenance of Critical Services at LMHA 26,800,000

31 Major Public Health Initiatives in the 81 st Legislative Session SB 7 – obesity reduction for Medicaid/CHIP recipients HB 5 & SB 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

32 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