Texas Fights to Win Public Health Battles
Public Health Feature — March 2014
By Crystal Zuzek
Tex Med. 2014;110(3):57-62.
In the crusade to improve immunization rates, reduce obesity's health burden, prevent HIV, and tackle a whole host of crucial public health concerns, research shows certain evidence-based strategies can make a big impact in a short time. The Centers for Disease Control and Prevention (CDC) refers to such areas of public health as "winnable battles." Six items on the list of CDC's 10 winnable battles overlap with some of Texas' public health priorities:
Texas Department of State Health Services (DSHS) Commissioner David Lakey, MD, named other public health priorities that don't match the CDC's winnable battles. They include the DSHS Expanded Primary Health Care Program, birth outcomes, mental health, and substance use disorders. (See "Public Health in Action.")
The agency focuses on a list of Texas-specific priorities developed over time by examining statistics that determine drivers of poor health and considering those areas in which the state can provide effective interventions to improve health. Dr. Lakey says the legislature also requires the department to work to improve health in those priority areas.
"Texas is a large, diverse state with unique public health challenges. We have priorities we focus on that have the ability to improve health in Texas," Dr. Lakey said.
John Carlo, MD, chair of the Texas Medical Association Council on Science and Public Health, says many of the council's priorities — tobacco use, obesity, unintentional injuries, teen pregnancy, and immunizations — also align with CDC's winnable battles. (See "CDC's Top 10 Winnable Battles.")
"The council works specifically on policies and charges that relate to many of these targets, and our members are well-aligned and interested in tackling these public health challenges," he said.
Texas Public Health Coalition Chair Eduardo Sanchez, MD, says the state has an opportunity to make significant strides in the public health priority areas that intersect with CDC's winnable battles.
"A statewide indoor smoking ordinance would have a very big impact in a short period of time. Nutrition and physical activity policies, programs, and practices would improve health status in a shorter time frame than … it takes the long list of chronic diseases associated with unhealthy dietary habits, sedentary lifestyle, and obesity to destroy health," he said.
Striving to Improve Vaccination Rates
When it comes to vaccinating the residents of such a large, diverse state, Dr. Lakey says immunization "continues to be an issue," citing TMA as a "strong partner in working to improve immunization rates."
"We're very focused on improving immunization rates in Texas. We work with our partners to promote regular immunizations as well as the seasonal flu vaccine," Dr. Lakey said. (See "TMA's Immunization Resources.")
Dr. Lakey says reducing obesity's impact on the state has multiple benefits, including preventing diabetes and lowering rates of heart disease.
Keeping Food Safe
"The department is focused on addressing food safety and is ramping up the number of epidemiologists in the state who can identify the source of foodborne illness outbreaks quicker. We've also increased the number of inspectors and have rapid response teams that can quickly identify and respond to events," Dr. Lakey said.
Stamping Out Tobacco Use
The DSHS tobacco program provides technical assistance to community organizations, schools, worksites, health professionals, and law enforcement agencies on tobacco prevention. It also serves as a clearinghouse of information on tobacco prevention issues and conducts a media campaign to educate Texans about the dangers of tobacco use. For more information, visit the DSHS website.
"Texas has worked hard to require health facilities to report HAIs. The department collaborates with hospitals to implement best practices to prevent HAIs," Dr. Lakey said.
HIV prevention, testing, and treatment for infected individuals are priorities for Texas.
"Advances in medical care enable people with HIV to stay healthy and live longer. With access to effective treatment, the death rate among people with HIV infection has decreased dramatically," Dr. Lakey said.
Dr. Carlo says that while 72,932 HIV-infected Texans out of 26 million residents may not sound like a lot, each case of HIV and AIDS is costly.
"For example, a month's supply of anti-HIV medication can cost upwards of $20,000. As most people living with HIV are uninsured in Texas, the cost is substantially covered through public assistance funding that everyone ultimately pays for," said Dr. Carlo, chief executive officer of AIDS Arms.
He adds that he believes ending AIDS is a winnable battle.
"But I make an important distinction of ending AIDS versus preventing HIV. AIDS is 100-percent preventable through effective anti-HIV medications, so there is almost no reason why someone living in Texas today should receive an AIDS diagnosis. It is only because someone is not tested until late in the disease course or the infected person does not stay engaged in care that AIDS happens," Dr. Carlo said.
Crystal Zuzek can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email.
CDC's Top 10 Winnable Battles
The Centers for Disease Control and Prevention has identified the following 10 winnable battles in public health, with a focus on prevention:
TMA's Immunization Resources
TMA's Be Wise — ImmunizeSM program works with physicians, medical students, and TMA Alliance members to improve vaccination rates in Texas through education and hands-on immunization clinics. Be Wise — Immunize is made possible via a grant from the TMA Foundation, thanks to top donors H-E-B and the TMF Health Quality Institute, as well as gifts from physicians and their families. To access immunization resources for physicians and information for patients, click here.
Public Health in Action
Texas is a large state with a number of public health priorities, including the Texas Department of State Health Services (DSHS) Expanded Primary Health Care Program, birth outcomes, mental health, and substance use disorders.
The Texas Legislature appropriated $100 million to enhance women's health services in the DSHS Expanded Primary Health Care Program for 2014-15. The program contracts with community health clinics and nonprofit organizations to provide services for uninsured, poor Texans who don't qualify for other state health programs. DSHS estimates $60 million of the $100 million will fund family planning services.
Additional funds in the Expanded Primary Health Care Program will allow DSHS to serve approximately 170,000 adult women annually by offering well-woman checks, cancer screenings, and family planning.
DSHS Commissioner David Lakey, MD, says one of the department's major priorities is reducing prematurity and decreasing the number of babies who die during their first year of life.
The department's Healthy Texas Babies initiative helps Texas communities decrease infant mortality using evidence-based interventions.
"It involves community members, health care professionals, and insurance companies working together with the understanding that a reduction in preterm births leading to lower infant mortality will improve the health of Texas babies and mothers. This has the potential to save millions of dollars in health care costs," Dr. Lakey said.
Final DSHS data for 2011 and preliminary data for 2012 demonstrate the beginning of a downward trend in premature births in Texas. The rate fell from 13.3 percent in 2008 to 12.4 percent in 2012. Texas infant deaths per 1,000 live births are also down from 6.1 in 2008 to 5.5 in 2012.
The 2013 legislature provided DSHS an additional $332 million in mental health and substance abuse funding that Dr. Lakey says will help the department "improve services by reducing waiting lists for community mental health services and expanding treatment options."
Mental health funding includes $4 million to improve mental health services for veterans; $5 million to enhance prevention and early identification of mental illness in school-age children; $25 million for additional crisis services to be provided by local mental health authorities; and $25 million to promote public-private partnerships to improve mental health care delivery and services in the state.
Data from the state health department show 2.6 percent of Texas adults aged 18 and older and 5 percent of children aged 9 to 17 suffer from serious mental illness. Substance use disorders affect 1.4 percent of Texas adults aged 26 and older, 5.8 percent of Texans aged 18 to 25, and 4.4 percent of adolescents aged 12 to 17. For more information about the DSHS Mental Health and Substance Abuse Division, visit the DSHS website.