1. Murray Sagsveen State Health Officer North Dakota Department of Health

2. CHEMISTRY Myra Kosse ENVIRONMENTAL ENGINEERING Dana Mount MUNICIPAL FACILITIES Jack Long WASTE MANAGEMENT Neil Knatterud WATER QUALITY Dennis Fewless ENVIRONMENTAL HEALTH SECTION Francis Schwindt STATE HEALTH OFFICER Murray G. Sagsveen ADVISORY COUNCIL Jim Brosseau, M.D. Julie Blehm, M.D. Dennis Wolf, M.D. GOVERNOR Edward T. Schafer North Dakota Department of Health February 1, 1998

3. State Health Council Howard C. Anderson Chairman Health Care Industry Turtle Lake, ND Gary Riffe Vice Chairman Health Care Industry Jamestown, ND Darlene Rinn Secretary Consumer Minot, ND Ronald A. Anderson Consumer Keene, ND Jim Brosseau, M.D. Health Care Industry Grand Forks, ND Lowell Herfindahl Health Care Industry Tioga, ND Linda Nelson Consumer Casselton, ND Clifford R. Porter Energy Industry Bismarck, ND Joel Smith Manufacturing/Processing Industry Fargo, ND Carmen Toman Consumer Grand Forks, ND Lori Wightman Consumer Fargo, ND

4. Advisory Council  James D. Brosseau, M.D. Internal Medicine Altru Health Systems, Grand Forks, ND  Julie A. Blehm, M.D. Internal Medicine Medical Arts Clinic, P.C., Minot, ND  Dennis E. Wolf, M.D. Family Practice Great Plains Clinic, Dickinson, ND

5. Mission Statement We, as public employees, are dedicated to the goal of assuring that North Dakota is a healthy place to live and to the belief that each person should have an equal opportunity to enjoy good health. To accomplish this mission, we are committed to the promotion of healthy lifestyles, protection and enhancement of the environment and provision of quality health care services for the people of North Dakota.

6. Vital Signs On an average day in North Dakota:  23.5 babies are born, 5.5 of them are born out of wedlock and 2 are born to teenage mothers  16 people die, 5 of them from heart disease and 3.75 from cancer  13 people get married and 6 people get divorced Source: ND Dept. of Health, Vital Records

7. Vital Signs In an average week:  1.2 infants die  1.4 children between ages 1 and 19 die  1.5 people commit suicide  3 people die from diabetes  4 people die from influenza and pneumonia  4.4 people die as a result of accidents Source: ND Dept. of Health, Vital Records

8. Vital Signs In an average month:  1 person younger than age 20 commits suicide  2.7 people die as a result of some type of accident  75.81 is the average age at death Source: ND Dept. of Health, Vital Records

9. Resident Live Births North Dakota ~ 1980 - 1998 Source: ND Dept. of Health, Vital Records **Estimate **

10. Urban-Rural Population Distribution North Dakota, 1900-1996 Source: U.S. Bureau of the Census

11. Population Distribution North Dakota 1960-1990 Source: U.S. Bureau of the Census

12. Expenditures by Section July 1, 1995 through June 30, 1997 Total Expenditures = $65.6 Million Source: ND Dept. of Health, Administrative Services

13. Sections of the North Dakota Department of Health  Administrative Services  Preventive Health  Environmental Health  Health Resources

14. Administrative Services Section The Administrative Services Section provides support services to all divisions of the North Dakota Department of Health and assists in coordinating department activities. Administrative Services Section

15. Office of Statistical Services:  Collects data about the health of North Dakotans  Conducts research about North Dakotans’ health and use of health care services  Produces reports for external and internal audiences and  Conducts health policy research Administrative Services Section

16. The Crime Lab Division is responding to the growing problem of illegal drug use. Number of Forensic cases opened:  4,445 in 1997  4,022 in 1996  3,900 in 1995 Administrative Services Section

17. Preventive Health Section The goal of the Preventive Health Section is to promote good health and prevent illness and disease.

18. The Maternal and Child Health Division works to improve the health of:  Women  Infants and children  Adolescents Preventive Health Section

19. The Disease Control Division deals with:  Disease outbreaks  Immunizations  Sexually transmitted diseases  Injury prevention  Chronic diseases Preventive Health Section

20. The Health Promotion and Education Division educates North Dakotans about:  Cancer prevention and control  Tobacco prevention and control  Cardiovascular disease  Healthy lifestyles for school-age children Preventive Health Section

21. The Food and Lodging Division protects public health through licensure and inspection of:  Restaurants and bars  Hotels and motels  Mobile home parks  Campgrounds Preventive Health Section  Bed and breakfasts  Retail food stores  Meat markets and  Bakeries

22. The Microbiology Division provides diagnostic and referral services:  Conducts testing for many exotic diseases and emerging infections and  Serves as the state lab for FDA dairy and EPA water bacteriological testing programs Preventive Health Section

23. Local Public Health Units 24 single and multi-county health departments provide the following services:  Maternal and child health programs  Health promotion  Communicable disease programs  Spousal and child abuse programs  School health screening and education  Environmental health programs  Home health visits Preventive Health Section

24. Burleigh Oliver Dunn Slope Bowman Billings Golden Valley Stark Hettinger Adams Sioux Grant Mercer Morton Mountrail Williams McKenzie Divide Burke McHenry McLean Ward Renville Bottineau Kidder Dickey Emmons McIntosh Stutsman Logan La Moure Sargent Richland Barnes Ransom Cass Ramsey Eddy Wells Sheridan Foster Rolette Pierce Benson Towner Nelson Steele Griggs Traill Grand Forks Cavalier Walsh Pembina Multi County Health District Single County Health District City/County Health Department Single County Health Department None January 1999 Local Public Health Units Preventive Health Section City/County Health District

25. Environmental Health Section The goal of the Environmental Health Section is to safeguard the quality of North Dakota’s air, land and water resources.

26. EHS issues environmental permits for:  Wastewater discharges (800 facilities)  Air Pollution (900 facilities)  Hazardous wastes (9 facilities)  Solid waste (14 municipal, 25 industrial and special)  Feedlots (900 facilities) Environmental Health Section

27. Other EHS Programs  Drinking water (600 systems)  Radiation Control (80 radioactive licenses and 750 X-ray)  Underground storage tanks (3,450 tanks)  Revolving loan programs  Wastewater treatment - $6.5 million per year  Drinking water - $24 million the first two years  Groundwater quality Environmental Health Section

28. Chemistry Lab  Organic analysis (man-made components, such as pesticides)  Inorganic analysis (naturally occurring compounds, such as fertilizer) Environmental Health Section

29. The Division of Health Facilities works to: assure that services are consistent with accepted standards of practice and that building structures meet established requirements. Health Resources

30. The Division of Health Facilities monitors:  Buildings  Equipment and  Services to people Health Resources

31. Emergency Health Services The Division of Emergency Health Services is the lead agency for North Dakota’s Emergency Medical Services (EMS) System. Health Resources

32. Current Issues  Tobacco legislation  Teen suicide  Access to health care services in rural North Dakota  Partnership between the North Dakota Department of Health and local public health departments  Shaken Baby Syndrome Spring 1998

33. Source: ND Dept. of Health, Health Resources Section

34. Source: ND Dept. of Health, Health Resources Section and Office of Statistical Services

35.                                               Burleigh Oliver Dunn Slope Bowman Billings Golden Valley Stark Hettinger Adams Sioux Grant Mercer Morton Mountrail Williams McKenzie Divide Burke McHenry McLean Ward Renville Bottineau Kidder Dickey Emmons McIntosh Stutsman Logan La Moure Sargent Richland Barnes Ransom Cass Ramsey Eddy Wells Sheridan Foster Rolette Pierce Benson Towner Nelson Steele Griggs Traill Grand Forks Cavalier Walsh Pembina Hospitals North Dakota ~ 1999 Source: ND Dept. of Health, Health Resources Section

36. Total Population North Dakota ~ 1970 - 1998 Source: U.S. Bureau of the Census

37. Population Age 65 and Over North Dakota ~ 1970 - 1990 Source: U.S. Bureau of the Census

38. Population Age 65 and Over North Dakota Vs United States Source: U.S. Bureau of the Census

39. Coronary Heart Disease 1980 - 1996 Risk Factors for Coronary Heart Disease High blood pressure Smoking High fat diet Sedentary lifestyle Excessive alcohol use Male and Female Coronary Heart Disease Death Rates  Age-adjusted death rate per 100,000 North Dakotans * Source: ND Dept. of Health, Vital Records

40. Lung Cancer 1980 - 1996 Male and Female Lung Cancer Death Rates *Age-adjusted death rate per 100,000 North Dakotans * Risk Factors for Lung Cancer  Smoking  Environmental tobacco smoke  Exposure to radon decay products, asbestos or ionizing radiation Source: ND Dept. of Health, Vital Records

41. Diabetes Death Rate* All Races *Diabetes as an underlying and contributing cause. **Age-adjusted death rate per 100,000 North Dakotans ** Source: ND Dept. of Health, Vital Records

42. Diabetes Death Rate* Native Americans *Diabetes as an underlying and contributing cause. **Age-adjusted death rate per 100,000 North Dakotans ** Source: ND Dept. of Health, Vital Records

43. Diabetes Risk Factors for Diabetes  Overweight (20 percent or more above ideal weight)  Family history of diabetes  Personal history of diabetes during pregnancy  Member of an ethnic group with high prevalence of diabetes

44. North Dakota Community Hospitals Admissions: 1980-1993 Source: Office of National Health Statistics in HCFA Office of Actuary

45. North Dakota Community Hospitals Outpatient Visits: 1980-1993 Source: Office of National Health Statistics in HCFA Office of Actuary

47. Source: Federal Reserve Bank of Minneapolis (http://woodrow.mpls.frb.fed.us)

49. Burleigh Oliver Dunn Slope Bowman Billings Golden Valley Stark Hettinger Adams Sioux Grant Mercer Morton Mountrail Williams McKenzie Divide Burke McHenry McLean Ward Renville Bottineau Kidder Dickey Emmons McIntosh Stutsman Logan La Moure Sargent Richland Barnes Ransom Cass Ramsey Eddy Wells Sheridan Foster Rolette Pierce Benson Towner Nelson Steele Griggs Traill Grand Forks Cavalier Walsh Pembina Counties with Greatest Population Loss 1990-96 Counties with Greatest Populaiton Gain 1990-96 18.4%24.5% 11.1% 16.8% 17.4% 15.7% 11.3%21.1% 13.7% 17.3% 16.3% 15.1% 14.5% 1.3% 11.3% 5.4% 13.6%.7% 11.2% 3.7% 4.5% 11.5% North Dakota Population Statistics Source: North Dakota Census Data Center Counties with Greatest Population Loss 1990-98 Counties with Greatest Population Gain 1990-98 14.4% 14%

50. Nursing Facility Residents by Age ND vs US ~ 1995 Sources: US: National Center for Health Statistics - 1995 National Nursing Home Survey ND: ND Department of Human Services - 1995

52. Department of Health General Fund 1987 to 2001 $8,000,000 $10,000,000 $12,000,000 $14,000,000 $16,000,000 Biennium General Fund Appropriations General Fund $11,972,221$11,902,613$14,109,924$13,655,186$14,366,079$14,934,440$14,456,044 1987-891989-911991-931993-951995-971997-991999-2001

53. General Funding for Key Programs

54. 260 270 280 290 300 310 320 330 1987- 89 1989- 91 1991- 93 1993- 95 1995- 97 1997- 99 1999- 2001 Summary of FTEs 1987 to 2001 Biennium Number of FTEs

55. Register of Deeds Mitigation Project Document Microfilm Digital Storage

56. General Funds Allocated to Local Health Units

57. 94% 96% 98% 100% 102% 104% 106% 108% 1991-19931993-19951995-19971997-19991999-2001 Biennium Comparison of General Funds 1991-1993 through 1999-2001 Biennia 100% 97% 102% 106% 102% Percentage Change from 1991-1993