Transcript Slide 1

TPHA Conference
April 15, 2009
State of Texas
Health Report 2009
David L. Lakey, M.D.
Commissioner
Texas Department of State Health Services
1
Public Health: A Definition
The approach to health care that is concerned
with the health of the community as a whole.
Medical Care
Public Health
– focuses on individual
patients
– vital to all of us some
of the time
– saves lives one at a
time
– disease treatment
– focus on entire
populations
– vital to all of us all of the
time
– saves lives thousands at
a time
– prevention, protection
and promotion
2
U.S. Life Expectancy at Birth
70
60
1918 Flu
Epidemic
50
40
30
1900
1910
1918
1920
1930
1940
1950
1960
3
Increased Life Expectancy Driven
by Public Health Improvements
80
Increased years due to
public health measures:
25
60
40
20
0
77 years
Increased years due to
medical care advances:
5
47 years
1900
2000
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
4
Impact of Vaccines in the
20th Century
Disease
20th Century
Annual Morbidity
2006 Total
% Decrease
Smallpox
48,164
0
100
Diphtheria
175,885
0
100
Pertussis
147,271
15,632
89
Tetanus
1,314
41
97
Polio (paralytic)
16,316
0
100
Measles
503,282
55
>99.9
Mumps
152,209
6,584
96
Rubella
47,745
11
>99.9
Congenital rubella
823
1
99.8
Haemophilus
influenzae (<5 yrs)
20,000 (est.)
208
99
(serotype B or
unknown serotype)
5
Leading Causes of Death
•
•
•
•
•
1900
Pneumonia
Tuberculosis
Diarrhea
Heart Disease
Intracranial Lesions
•
•
•
•
•
2005
Heart Disease
Cancers
Cerebrovascular
Disease
Accidents
Chronic Lower
Respiratory Diseases
6
Leading Causes of Death
Texas 2005 and 2001
Heart Diseases
Cancer
Stroke
Accidents
Lower Respiratory Disease
2001
Diabetes
2005
Alzheimers
Flu & Pneumonia
0
10,000
20,000
30,000
40,000
50,000
Number of Deaths
DSHS Center for Health Statistics
7
Actual Causes of Death*
Shaped by Behavior
Tobacco
Overweight/Obesity
Alcohol
Auto Accidents
Drugs
Suicide
DWI
Homicide
Sexual Behavior
0
*Texas 2001
5000
10000
15000
Chronic Disease in Texas 2007, DSHS
20000
25000
30000
8
Reduce Adult Smoking
25
Percent
20
15
HP 2010 goal 12%
10
5
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Ye ar
US
Texas
HP 2010 goal
9
Percentage of the Texas Municipal
Population Protected by Smoke-Free
Ordinances By Number of Settings
3 or more settings Smoke Free
5 settings Smoke Free
50
45
40
35
30
25
20
15
10
5
0
2000 or
before
2000
2001
2002
2004
2005
2006
2007
2008
10
Rate of Illegal Sales of Tobacco
Products to Minors in Texas
(1996 – 2008)
60
40
30
20
10
0
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
Percent
50
11
Obesity Trends* Among U.S. Adults
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2006
1990
2007
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
12
Obesity Prevalence Trends in
Texas Adults 1990 to 2007
Obese
Normal Weight
60
50
40
~34% of Texans are
normal weight
30
20
10
0
~29% of Texans
are obese
19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07
Texas Comptroller: www.window.state.tx.us/specialrpt/obesitycost/summary/
13
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
14
Substance Free Youth
95
HP 2010 goal 91%
90
Percent drug & alcohol free
85
80
75
70
65
60
55
50
45
40
2001
2003
2005
2007
Year
US
TX
HP 2010 goal
15
HIV/AIDS in Texas
70,000
6,000
60,000
5,000
50,000
40,000
New Cases
4,000
PLWHA
3,000
30,000
2,000
20,000
Deaths
1,000
10,000
0
Number: New Cases and
Deaths
Number: PLWHA
HIV/AIDS in Texas: Persons Living with HIV/AIDS, New Diagnoses of HIV/AIDS,
and Deaths among those with HIV/AIDS
0
2003
2004
2005
2006
2007
New diagnoses are holding steady. The number of persons living with HIV/AIDS is
rising because they are surviving longer.
16
Childhood Immunizations
85
HP 2010 goal 80%
Percent
80
75
70
65
60
2002
2003
2004
2005
2006
2007
Year
US
Texas
HP 2010 goal
17
18
New Challenges
in Public Health
19
Serious Mental Illness compared to
Chronic Illnesses
30
% Adults
25
20
15
10
5
0
Serious
Mental
Illness
CVD
Diabetes
Cancer
Asthma
CDC BRFSS, SEER Cancer Statistics Review, 1975-2002, “Prevalence, Severity, and Co-morbidity20
of 12-Month DSM-IV Disorders” Arch Gen Psychiatry. Vol. 62, June 2005
Public Health Threats: 2008
Major Response Events
•
•
•
•
Hurricane Dolly
Tropical Storm Edouard
Hurricane Gustav
Hurricane Ike
21
Public Health Response
to 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
Partnerships Needed to Improve
Public Health
DSHS
Elected
Officials
IndustryGroups
Public Health
Community-based
Solutions
Worksites
& Schools
Higher
Education
Non-Traditional
Partners
Urban
Planners,
Developers
Architects
Providers &
Hospitals
Community
Groups
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
EXCEPTIONAL ITEM
BIENNIAL TOTAL
1.
Maintaining Current Operations
$
83,895,811
2.
Regulatory
18,786,207
3.
Health Data Collection & Analysis
24,958,173
4.
Vital Statistics
5.
Information Technology Support for Critical Programs
30,290,109
6.
Disaster Recovery and Public Health Preparedness
24,066,371
7.
Stipends for Psychiatrist and Medical Residents
8.
Building & Equipment Repair & Replace
70,854,048
9.
Substance Abuse Services
69,669,715
10.
Community Mental Health Services
85,536,497
11.
Chronic Disease Prevention
25,914,095
12.
Infectious Disease Prevention
16,906,613
13.
Community Mental Health Services - Maintenance of
Critical Services at LMHA
26,800,000
6,655,044
2,736,795
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
32