Overview Public Health System DSHS Advisory Council May 5, 2005 Nick Curry, M.D., MPH, Deputy Commissioner Prevention, 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, : Control of Infectious Diseases. MMWR, July 30, 1999.

Causes of Death in United States – 2000 * Percentage (of all deaths) Leading Causes of Death* Heart Disease Cancer Stroke Chronic lower respiratory disease Diabetes Pneumonia/influenza Unintentional Injuries Alzheimers disease Kidney disease

10 Greatest Public Health Achievements 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). Increased years due to medical care advances: 5 Increased years due to public health measures: 25

2002 Health Care Spending

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 Alzheimers disease Kidney Disease Stroke Percentage (of all deaths) 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 Achieving A 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

Source: Center for Health Statistics, Population Estimates for Counties, Texas Population, 22,118,500 Population Served by Public Health Regions N Dakota S Dakota Wyoming W Virginia Nevada Mississippi Maryland Vermont Indiana 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)

– 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 7 th 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-CHIH El Paso Juarez Presidio Ojinaga TX-COAH Del Rio Ciudad Acuna Eagle Pass Piedras Negras TX-NL-TAMPS Laredo Nuevo Laredo McAllen Reynosa Brownsville Matamoras US Border State Health Officers Identify need forvertical planning with Sister Mexico States