Missouri’s Public Health System Missouri Department of Health and Senior Services Center for Local Public Health Services

What is Public Health?   Public health is often confused with health care. A health care provider diagnoses and treats individual patients. Public health professionals develop plans of action to improve the health status of the entire population. Public health is often confused with health care. A health care provider diagnoses and treats each of his/her individual patients. Public health professionals diagnose whole communities and develop a plan of action to improve the health status of the entire population. Public health professionals collaborate and bring together those who can affect a problem.

Public Health cont. Focus of public health has changed over the years.   Focus of public health has changed over the years. Early efforts directed toward disease prevention. Expanded insurance coverage to most people has allowed public health to focus on its principal roles of protecting the public and promoting health. Although the principal role of public health has remained the same, its focus has changed over the years. Early in the 20th century, public health efforts were primarily directed to disease prevention. Environmental safequards, such as assuring the safety of drinking water and sanitary disposal of sewage, along with the development of vaccines, greatly reduced disease incidence and increased life expectancy. In the latter part of the 20th century many public health agencies took on the responsibility of providing care to indigent populations. Because expanded insurance coverage has made personal health services more accessible to most people, public health is now able to focus more closely on its principal roles of protecting the public and promoting health.

Effective Public Health System Assesses and promotes health and safety Prevents or minimizes the occurrence of diseases and injuries Plans, prepares and responds to natural and manmade disasters Identifies barriers, and facilitates access to primary and preventive health care, and Enforces public health laws and regulations

CDC’s Ten Essential Services Monitor health status to identify and solve community health problems Diagnose and investigate health problems and health hazards in the community Inform, educate and empower people about health issues Mobilize community partnerships and actions to identify and solve health problems Another way of describing the core of public health is the ten essential services developed by a work group at the Centers for Disease Control and Prevention. Monitor health status to identify and solve community health problems: includes assessing the health status of people living in the community and identifying threats to health Diagnose and investigate health problems and health hazards in the community: includes active surveillance for infectious and chronic disease and investigation of outbreaks Inform, educate and empower people about health issues: involves providing accessible health information and collaborating with personal health care providers to reinforce health promotion messages Mobilize community partnerships and actions to identify and solve health problems: this service convenes and facilitates community groups in order to define what is needed in the community and bring resources to bear

Essential Services cont. Develop policies and plans that support individual and community health efforts Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services and assure the provision of health care when otherwise unavailable Develop policies and plans that support individual and community health efforts: requires leadership by public health officials to set goals and develop plans for health improvement Enforce laws and regulations that protect health and ensure safety: involves enforcement of sanitary codes for public facilities, protection of drinking water supplies, etc. Link people to needed personal health services and assure the provision of health care when otherwise unavailable: includes assuring that socially disadvantaged people can receive the care they need

Essential Services cont. Assure a competent public and personal health care workforce Evaluate effectiveness, accessibility and quality of personal and population based health services Research for new insights and innovative solutions to health problems Assure a competent public and personal health care workforce: includes education and training for public health and personal health care providers Evaluate effectiveness, accessibility and quality of personal and population based health services: involves ongoing evaluation of health programs to assess effectiveness and to gather information for allocating resources Research for new insights and innovative solutions to health problems: includes linkages with institutions of higher education and research

Public Health System vs. the Health System (medicine)   Public Health System Primary focus on population Emphasis on disease prevention and health promotion that shape a community’s overall health profile Health System Primary focus on individual Emphasis on diagnosis and treatment Sources Stony Brook State University of New York, School of Medicine, Graduate Program in Public Health For A Healthy Nation: Return on Investments in Public Health, U.S. Public Health Service, 1994

Health System Public Health System Hospital delivers the baby Regulates the hospital to ensure safety  

Missouri’s Public Health System Public health is credited with adding 25 years to the life expectancy of people in the United States in this century. Source Centers for Disease Control and Prevention, http://www.cdc.gov/od/oc/media/tengpha.htm

Great Public Health Achievements United States – 1900-1999 Vaccinations Motor-vehicle safety Safer workplaces Safer and healthier foods Decline in deaths from coronary heart disease and stroke According to CDC, many notable public health achievements have occurred during the 1900s, and other accomplishments could have been selected for the list. The choices for topics for this list were based on the opportunity for prevention and the impact on death, illness, and disability in the United States and are not ranked by order of importance. CDC's list of public health achievements in the 20th century was created to remind us of how far we've come, how we got here, and exactly what public health is: the active protection of our nation's health and safety, credible information to enhance health decisions, and partnerships with local minorities and organizations to promote good health. Vaccines: declines in morbidity for most vaccine preventable diseases (polio, measles, smallpox) Motor vehicles: first systematic approach to highway safety came from the first director of the National Highway Safety Bureau (now NHTSA) – a public health physician Workplace safety: systematic approach to identifying and correcting occupational health risks Foods: Upton Sinclair’s “The Jungle”; public health initiatives in sanitation, recognition of sources of food borne diseases, and advancement of nutritional sciences Heart disease/stroke: prevention efforts

Great Public Health Achievements cont. United States – 1900-1999 Healthier mothers and babies Fluoridation of drinking water Recognition of tobacco use as a health hazard Control of infectious diseases Moms/babies: infant mortality rates have declined significantly via nutrition programs, prevention and education (SIDS) Fluoridation of drinking water Recognition of tobacco use as a health hazard Infectious diseases: disease control accomplished through improved sanitation and hygiene, medications and disease surveillance

Missouri’s Public Health System Public health’s disease control efforts have led to a sharp decline in deaths from infectious diseases since 1900. So now the focus of public health has shifted to respond to the effects of chronic diseases on the public’s health, while continuing to develop and refine interventions using enhanced surveillance. Examples of interventions include: the telephone counseling that Missourians can receive through the Missouri Tobacco Quitline, the chronic disease consumer education campaign, and DHSS contracts with local public health agencies for evidence-based approaches. The shift in focus has also led to improved capacity of epidemiology (study of disease occurrence) and to changes in public health training and programs. Source CDC. Ten great public health achievements--United States, 1900-1999. MMWR 1999;48:241-3.

Missouri’s Public Health System However, as these infectious diseases decreased, chronic diseases increased. Individuals are living longer because they are much less likely to die from infectious diseases; however, chronic diseases, such as cardiovascular disease and cancer are on the rise. Source CDC. Ten great public health achievements--United States, 1900-1999. MMWR 1999;48:241-3.

“Health is worth more than learning.” -Thomas Jefferson (1743 - 1826) Missouri’s Public Health System “Health is worth more than learning.” -Thomas Jefferson (1743 - 1826) letter to his cousin John Garland Jefferson, June 11, 1790

Top Five Leading Causes of Death, Missouri 2005 54,324 Missourians died in 2005. The top five leading causes of death, heart disease, cancer, stroke, chronic lower respiratory diseases, and unintentional injuries accounted for two-thirds (67%) of the total number of deaths. Half of the total deaths were caused by heart disease (27%) and cancer (23%).

Tobacco Use Proportion of Current Smokers Among Adults Aged 18 Years and Older, Missouri and the U.S., 1990-2006 Smoking damages nearly every organ in the human body, causing many diseases such as heart disease and many types of cancer, most notably lung cancer. The proportion of Missourians who are current smokers has been relatively unchanged, and consistently higher than that in the U.S. since 1990. In 2006, 23% of Missouri adults reported they were current smokers, compared with 20% nationally. Missouri Tobacco Quitline: offers telephone counseling and resource materials at no cost to assist Missourians who want to quit smoking. It can assist tobacco users in any stage of readiness to quit, former smokers seeking relapse prevention support, and health care providers wanting assistance with patient treatment. Mo Model for Brief Smoking Cessation Intervention: trains health care professionals throughout the state with specific techniques to help reduce smoking among pregnant and women of child-bearing age. Tobacco Use Prevention and Cessation Program: promotes and assists employers to voluntarily adopt smokefree workplace policies, owners of public places such as restaurants, to adopt smokefree policies, and schools and hospitals to adopt tobacco-free campus policies. In addition, the program provides support for building youth advocacy groups to discourage smoking and to advocate tobacco control policies. WISEWOMAN: program helps underinsured, low-income women gain access to health screenings and lifestyle education that can reduce the risk of heart disease and stroke. WISEWOMAN stands for Well-Integrated Screening and Evaluation for Women Across the Nation.

Tobacco Use Proportion of Current Smokers Among Adults Aged 18 Years and Older, by Region, Missouri, 2006 BOONE AUDRAIN HOWARD CHARITON SALINE MORGAN PETTIS CARROLL COLE COOPER MILLER CAMDEN MONT-GOMERY GASCONADE PULASKI LACLEDE DENT POLK GREENE WEBSTER WRIGHT DOUGLAS HOWELL SHANNON CARTER WAYNE MADISON BOLLINGER FRANCOIS ST. STE. GENEVIEVE WASHINGTON JEFFERSON PERRY GIRARDEAU CAPE SCOTT MISSISSIPPI STODDARD BUTLER PEMISCOT DUNKLIN ST. LOUIS ST. CHARLES LINCOLN PIKE MACON MONROE JOHNSON LAFAYETTE JACKSON RAY CLAY PLATTE CLINTON BUCHANAN ATCHISON NODAWAY LAWRENCE JASPER BARRY TANEY WORTH HARRISON MERCER PUTNAM SCHUYLER SCOTLAND CLARK HOLT ANDREW GENTRY DEKALB GRUNDY DAVIESS SULLIVAN ADAIR LINN LIVINGSTON CALDWELL KNOX SHELBY RANDOLPH LEWIS MARION RALLS CALLAWAY CASS WARREN FRANKLIN CRAWFORD IRON REYNOLDS TEXAS MARIES MADRID NEW RIPLEY OREGON DALLAS HICKORY BENTON ST. CLAIR HENRY CEDAR DADE BARTON VERNON BATES STONE McDONALD NEWTON CHRISTIAN OZARK MONITEAU OSAGE PHELPS Northeast: 26.6% Northwest: 23.4% Central: 31.1% Kansas City Area: 20% St. Louis Area: 19.8% Regional differences are seen in current smoking prevalence, from the highest in Central (31%) and Southeast (30%) regions to lowest in the Kansas City (20%) and St. Louis (20%) regions. Southeast: 29.7% Southwest: 23.8%

Obesity Proportion of Obesity Among Adults Aged 18 Years and Older, Missouri and the U.S., 1990-2006 Obesity is on the rise in Missouri, and contributes to various serious health problems such as heart disease, stroke and diabetes, which are among the top 10 leading causes of death. The proportion of obesity among Missouri adults has more than doubled since 1990, mirroring with the national trend. In 2006, 27% of Missouri adults were obese. The proportion of obesity in Missouri has been consistently higher than the national figure since 1994. Nutrition and Physical Activity Programs to Prevent Obesity: works with partner organizations through the Missouri Council for Activity and Nutrition (MoCAN) to implement the state plan. The program also provides technical assistance to local groups working on childhood obesity to increase physical activity and improve nutritional status of youth in several areas such as the St. Louis area, Jackson, Jasper and Newton counties. Funding for other areas is also provided. Environmental and policy changes are encouraged to impact the largest number of individuals.

Obesity Proportion of Obesity Among Adults Aged 18 Years and Older, by Region, Missouri, 2006 BOONE AUDRAIN HOWARD CHARITON SALINE MORGAN PETTIS CARROLL COLE COOPER MILLER CAMDEN MONT-GOMERY GASCONADE PULASKI LACLEDE DENT POLK GREENE WEBSTER WRIGHT DOUGLAS HOWELL SHANNON CARTER WAYNE MADISON BOLLINGER FRANCOIS ST. STE. GENEVIEVE WASHINGTON JEFFERSON PERRY GIRARDEAU CAPE SCOTT MISSISSIPPI STODDARD BUTLER PEMISCOT DUNKLIN ST. LOUIS ST. CHARLES LINCOLN PIKE MACON MONROE JOHNSON LAFAYETTE JACKSON RAY CLAY PLATTE CLINTON BUCHANAN ATCHISON NODAWAY LAWRENCE JASPER BARRY TANEY WORTH HARRISON MERCER PUTNAM SCHUYLER SCOTLAND CLARK HOLT ANDREW GENTRY DEKALB GRUNDY DAVIESS SULLIVAN ADAIR LINN LIVINGSTON CALDWELL KNOX SHELBY RANDOLPH LEWIS MARION RALLS CALLAWAY CASS WARREN FRANKLIN CRAWFORD IRON REYNOLDS TEXAS MARIES MADRID NEW RIPLEY OREGON DALLAS HICKORY BENTON ST. CLAIR HENRY CEDAR DADE BARTON VERNON BATES STONE McDONALD NEWTON CHRISTIAN OZARK MONITEAU OSAGE PHELPS Northeast: 30.5% Northwest: 28.6% Central: 25.1% Kansas City Area: 28.3% St. Louis Area: 23% In 2006, 27% of Missouri adults were obese (BMI >=30). The percentage of obesity tended to be higher in the Northeast (31%) and Southeast (33%) regions. Southeast: 32.6% Southwest: 26.7%

Core Public Health General Revenue Funding Per Capita This chart shows per capita general revenue funding for core public health rather than the total amount appropriated. The blue line demonstrates the negative effect of inflation. The amount available for each citizen is further diminished due to population increases. Contiguous States Missouri’s performance on a wide range of activities is often judged by comparison to its eight contiguous states. By that standard, Missouri’s per capita spending for public health is considerably lacking. Missouri ranks 44th in the nation according to the Trust for America’s Health. Only one of our contiguous states—Iowa—ranks worse than Missouri, and Kansas is the only other state that ranks in the 30s. The other six states range from the outstanding (Oklahoma at #7) to solidly in the middle (Illinois at #28). Fiscal Year

Local Public Health Agency Revenue Growth (Local Revenues vs Local Public Health Agency Revenue Growth (Local Revenues vs. State Core Public Health GR Funding) Missouri partners with Local Public Health Agencies to enhance public health for all citizens. State funding was reduced significantly during the previous economic downturn, and it has not recovered—remaining flat from FY-04 onward (see orange line). In contrast, local governments have continued to support public health efforts, increasing revenues at the local level each year (see blue line). The state demands a great deal from the LPHAs, so it is incumbent upon the state to be a good financial partner—increasing support for core public health rather than expecting local governments to shoulder the burden.

Missouri Public Health and You In action every day, in every county of the state Assures our children are immunized Puts plans in place for emergency and disaster management Detects and curtails infectious diseases Reduces effects of diseases like diabetes and asthma Monitors drinking water quality, and Helps keep restaurant food safe Glenda: Show booklet, Missouri’s Public Health System at a glance. Discuss “time of day” scenarios.