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Public health in Washington State Jude Van Buren DrPH, MPH, RN Assistant Secretary – Division of Epidemiology, Health Statistics and Public Health Laboratories Washington State Department of Health. YOUR LOGO HERE. Every Day in Washington State…. - PowerPoint PPT Presentation
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YOUR LOGO HERE
Public health in Washington State
Jude Van Buren DrPH, MPH, RNAssistant Secretary – Division of
Epidemiology, Health Statistics and Public Health Laboratories
Washington State Department of Health
Public Health:Public Health:
Always Working Always Working
forfor
a Safer and a Safer and
Healthier Healthier
WashingtonWashington
Public Health:Public Health:
Always Working Always Working
forfor
a Safer and a Safer and
Healthier Healthier
WashingtonWashington
Every Day in Washington Every Day in Washington State…State…
Communities are prepared for health emergencies thanks to the work of state and local public health agencies, 95 licensed hospitals, and other partners.
About 210 babies get a healthy start through early detection of treatable diseases by the Newborn Screening Program.
More than 5 million people have safe reliable drinking water because of the efforts of Washington’s state and local health agencies.
About 50 people call the state Tobacco Quit Line daily to take the first step toward kicking the habit.
Thousands of patients get safe quality health care from doctors, nurses, and other health care professionals licensed by the Department of Health.
Over 2.5 million people eat in restaurants with confidence thanks to the efforts of local health departments and our Food Safety program.
About 95 percent of kids entering school are protected against preventable diseases because of public health immunization and education efforts.
Governmental Public Health Network
Federal
State
Local
US Department of
Energy
US Health & Human Services (CDC,
HRSA)
US Environmental Protection Agency
Schools of Public Health
Washington State Board
of Health
State Health Departments
US Department
of Agriculture
Local Health Jurisdictions
Tribes
Washington State Local Health Jurisdictions
Adams County Health District
Benton-Franklin Health District
Chelan-Douglas Health District
Clallam County Department of Health and Human Services
Clark County Health Department
Columbia County Public Health
DistrictCowlitz County Health Department
Garfield County Health District
Grant County Health District
Island County Health Department
Jefferson County Health and Human Services
Kitsap County Health District
Kittitas County Health Department
Klickitat County Health Department
Lewis County Public Health
Lincoln County Health Department
Mason County Department of Health
Services
Northeast Tri-County Health District
Okanogan County Health District
Pacific County Public Health and Human Services
Department
Public Health – Seattle and King County
San Juan County Department of Health and Community Services
Skagit County Department of Health
Skamania County Health Department
Snohomish Health District
Spokane Regional Health District
Tacoma-Pierce County Health Department
Thurston County Public Health and Social Services Department
Wahkiakum County Department of Health and Human Services
Walla Walla County Health Department
Whatcom County Health Department
Whitman County Health Department
Yakima Health District
Grays Harbor County Public Health and Social
Services Department
Asotin County Health District
Chelan
Douglas
Ferry StevensPend
Oreille
BentonFranklin
17,300
21,100
160,600
70,10067,800
403,500
4,10096,800
35,700
7,500
64,200 2,400
80,60070,400
Island County – 77,200Kitsap – 243,400Mason – 53,100
Thurston – 231,100
28,200
1,835,300
37,400
19,800
72,900
10,200
39,800
21,500
12,300
773,500
113,100
10,600
671,800
436,800
42,100
3,900
15,700
57,900
184,300
42,800
231,800
Washington State Total Population as of June, 2006 – 6,375,600
WASHINGTON STATE
Department of HealthOrganizational Chart March 2009
SECRETARYMary C. Selecky
Board of Health
STATE HEALTH OFFICERMaxine Hayes, MD, MPH
Infectious Disease & Reproductive Health
Maternal & Child Health
Community Wellness & Prevention
COMMUNITY & FAMILY HEALTH
Mary WendtAssistant Secretary
Epidemiology
Center for Health Statistics
Public Health Laboratories
Informatics
EPIDEMIOLOGY, HEALTH STATISTICS, & PUBLIC
HEALTH LABORATORIESJude VanBuren, DrPH
Assistant Secretary
Drinking Water
Radiation Protection
Shellfish & Water Protection
Environmental Health & Safety
Environmental Health Assessments
ENVIRONMENTALHEALTH
Gregg GrunenfelderAssistant Secretary
POLICY, LEGISLATIVE, & CONSTITUENT RELATIONS
Brian Peyton, Director
Health Professions & Facilities
Customer Service
Inspections & Investigations
HEALTH SYSTEMS QUALITY ASSURANCE
Karen JensenAssistant Secretary
PUBLIC HEALTH SYSTEMS PLANNING & DEVELOPMENT
Allene Mares, Director
COMMUNICATIONS Tim Church, Director
PUBLIC HEALTH EMERGENCYPREPAREDNESS & RESPONSE
John Erickson, Director
FINANCIAL SERVICES Lois Speelman, Assistant Secretary
HUMAN RESOURCES Kathy Deuel, Director
INFORMATION RESOURCE MANAGEMENT Frank Westrum, Chief Information Officer
RISK MANAGEMENT Dennis Anderson, Director
ADJUDICATIVE SERVICES UNIT Laura Farris, Senior Health Law Judge
PERFORMANCE &ACCOUNTABILITY
Susan Ramsey
PERFORMANCE &ACCOUNTABILITY
Susan Ramsey
DEPUTY SECRETARYBill White
Legal Services
Community Health Systems
Dedicated Funds*
$240.1 Million23%
Fees$130.6 Million
13%
General Fund - State
$166.9 Million 16%
Federal$496.1 Million
48%
Department of Health’s Budget in Context:
Federal Funds are Major Fund Source
*Includes estimated Women, Infant, and Children (WIC) and AIDS Drug Assistance Program (ADAP) rebates of $64.1 million.*Includes estimated Women, Infant, and Children (WIC) and AIDS Drug Assistance Program (ADAP) rebates of $64.1 million.
February 2009
Department of Health’s Budget in Context:
Majority of funds are passed through to community partners
All Other Objects$177.5 Million
17%
Salaries & Benefits
$235.2 Million23%
Pass Thru$621 Million
60%
February 2009
Drug poisonings are a leading cause of death
• Drug overdoses kill more people in Washington than motor vehicle crashes.
• From 1995-2007, there was a 19-fold increase in opioid-related deaths.
• The use of methadone for chronic pain increased 1,300% from 1997-2006, and Oxycodone by 600%.
• Our state’s drug overdose death rate is higher than the national rate.
0
100
200
300
400
500
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Num
ber o
f dea
ths
Prescription Opioid & alcohol or illicit drug
Prescription Opioid Only
23
447
Combating Drug Misuse and Abuse
• Prescription monitoring*– Helps detect and prevent
prescription drug abuse
• Tamper-proof prescription pads– Prevents fraud
• Drug take-back programs– Promotes safe disposal
of drugs
– Shown to be safe and effective in pilot programs
* Currently suspended
Climate Change: Predicted Changes in NW Climate
• Increased average winter and summer temperatures (~ 1 degree F / decade)
• Precipitation pattern changes– Increased precipitation– Reduced spring snow pack– Increased storm intensities– Increased flooding and drought– Increased surface water temperatures– Reduced weather predictability
All models predict warming in the Northwest
444546474849
5051525354
1900
s
1920
s
1940
s
1960
s
1980
s
2000
s
2020
s
2040
s
De
gre
es
F
warmest scenario
average
coolest scenario
observed
Executive Order 07-02 (Feb 7, 2007)
• Washington’s Climate Change Challenge
• Drivers are global – Effects are local
• Technical workgroups – greenhouse gas emission reductions; clean energy economic goals.
• Preparation & Adaptation workgroups: PAWG: Health, Agriculture, Forestry, Water, Coastal.
Health Implications of Climate Change
• Health effects of excessive heat.
• Health effects of air pollution.
• Health effects associated with infectious diseases.
• Health effects of extreme weather events and rising sea levels.
• Psychological and social disruption effects.
Environmental Changes Will Affect Zoonotic & Vector-Borne Diseases
• Mosquitoes• Ticks• Hantavirus• Cryptococcus gattii
• Enhanced surveillance
• The built environment
• Emergency planning and preparedness
Key Preparation & Adaptation Strategies
Two overarching considerations from the Health PAWG
• The clear need for public engagement and involvement.
• The importance of social justice considerations in all actions taken to address climate change impacts.
National Public Health Week –
April 7–13, 2008
Climate Change: Our Health In The Balance
It’s time for Public Health to have a voice in the conversation.
Current activities:
• Senator Rockefeller working on a climate change bill aimed at better organizing and prioritizing state activities on the issue.
• Climate Action Team proposals forwarded for legislative consideration by outside groups.
• CDC request for Climate Change grant applications.
Biomonitoring Grant Proposal to evaluate Arsenic exposures
Goals:• 1) to determine background urinary arsenic levels in population • 2) to determine if there are specific populations in state that are at
higher risk for arsenic exposure • 3) To inform and educate those with higher risk
Methods: • Collect urine samples to evaluate speciated arsenic levels to
determine exposure to arsenic in specific and general populations
• Randomly identify households - gather urine samples of all individuals 6 yrs and older in household. (all must have lived in house 6 months or longer
• Evaluate through epi studies risk factors for exposure and adverse health outcomes for exposed populations
Arsenic Properties
Environmental fate Elemental: Properties: Cannot be destroyed in environment –
only changes form
• When broken down into smaller particles: enters air, water and dust
• Organic forms dissolve in water – finfish & shellfish accumulate
• Most of arsenic in water will end up on soil or sediment in water
Arsenic Sources
Where is it found? – Naturally and anthropoegenic• Industrial processes: Tacoma and Everett – smelters – coal fired
plants• Spokane, Tri-County and Clark Co areas - Pockets of natural
arsenic in basalt formations – from ground water sources of drinking water
• Commercial products – commercial arsenic containing pesticides: orchards, vineyards, cotton dessicants, cattle and sheep dips, paints and pigments, antifouling paints, leaded gasoline and firs salts multicolor flame)
• Pressure treated lumber – CCA – copper chromated arsenic • Foods: wines, tobacco ( because of herbicides and pesticides)• Shellfish and finfish – bivalves, certain cold water and bottom-
feeding fish – finfish and seaweed
Arsenic Exposure
Ingestion – ( 60 – 90% absorption in GI tract)• From swallowing dirt or air particles and getting into
gastrointestinal system
From eating arsenic laden fish or shellfish
Inhalation ( 60 – 90% absorption across lung membrane)• From breathing air containing arsenic• Living in areas unusually high in arsenic• Working in a job that involves arsenic production: copper
or lead smelting – wood treating or pesticide application • Dermal – minimal absorption
Bioaccumulation and testing for Arsenic Exposure
• After absorption in lungs or GI tract – Arsenic initially accumulates in the liver, spleen, kidney, lungs and GI Tract - clearance in several days
• After 2 – 4 weeks after exposures – arsenic remaining is found in keratin rich tissues such as skin, hair, and nails -lesser extent – bones and teeth - Arsenic is excreted primarily through kidneys
• Arsenic is excreted primarily through kidneys - - best route (least harm/impact to person) to evaluate low level chronic exposure to arsenic
Toxicology of Arsenic Exposure
• Two mechanisms of arsenic toxicity - impairs tissue respiration:
1) Arsenic binds with sulfhydryl (-SH) groups and disrupts – SH containing enzymes – inhibition of TCA cycle ( Krebs cycle), gluconeogenesis and oxidative phosphorylation
2) Substitution of As(V) for phosphorus in many biochemical reactions - leads to loss of high energy phosphate bonds – and uncouples oxydative phosphorylation
Health Effects of Arsenic Exposure
• Skin lesions• Hemorrhagic gastroenteritis• Liver toxicity• Anemia• Cardiovascular effects - vasospasm - Peripheral vascular
insufficiency (Gangrene) • Neurologic effects - Peripheral neuropathy • Dermal changes – pigment changes and some malignant cancersAll hallmarks of chronic arsenic ingestion
Arsenic is strongly associated with lung and skin cancer in humans – esp work related exposures at high levels
• May cause other internal cancers as well – (hepatic angiosarcoma – rare form of cancer)
*
How to evaluate if populations with higher exposures have more adverse related health effects
Epidemiological studiesCase control study– retrospectiveCase: people with adverse health outcomeControls: people without adverse health outcomes:
Blackfoot disease, Raynaud’s syndrome, peripheral neuropathy, Cancers: rare liver cancer, dermal,
Look at: exposure levels in urine of those with disease and those without,
Statistically evaluate whether people with adverse health conditions had higher levels of arsenic: Odds Ratio
Rate of having adverse outcome – given exposureRate of having adverse outcome – given no exposure
How to evaluate if populations with higher exposures have more adverse related health effects
Epidemiological studiesProspective or Cohort Study: Look at: exposure levels in urine of all people –
follow them over time – to see if those with exposure have higher levels of disease than those without or with lesser exposure
Statistically evaluate whether people with higher exposures of arsenic had more disease and what kinds of disease: adverse health conditions had higher levels of arsenic
Calculate: relative riskEvaluate the statistical significance of the finding
Proving Disease Causation: Does the association meet the criterai for determining causality?
1) Strength of association – statistically significant or could “chance” be at play?
2) Consistencies with other studies?3) Is association – disease specific?4) Appropriate time relationship? 5) Dose response relationship6) Plausible relationship?7) Coherence – biologically plausible?8) Experimental evidence – in- vivo,in-vitro
YOUR LOGO HERE
Public health in Washington State
Jude Van Buren DrPH, MPH, RNAssistant Secretary – Division of
Epidemiology, Health Statistics and Public Health Laboratories
Washington State Departmen of Health
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