murray sagsveen state health officer north dakota department of health
TRANSCRIPT
Murray Sagsveen
State Health Officer
North Dakota Department of Health
STATE HEALTH COUNCILHoward C. Anderson, R.Ph.
Chairman
ADMINISTRATIVE ASSISTANT
Londa Rodahl
PUBLIC INFORMATION
Debra Anderson
STATE FORENSIC EXAMINER
George Mizell, M.D.
ACCOUNTING
Kathy Albin
CRIME LAB
Aaron Rash
HEALTH INFORMATIONSYSTEMS
PERSONNEL
Jennifer Bandy
VITAL RECORDS
Beverly Wittman
ADMINISTRATIVE SERVICESSECTION
Robert A. Barnett
EMERGENCY HEALTHSERVICES
Timothy Wiedrich
HEALTH FACILITIES
Fred Gladden
HEALTH RESOURCESSECTION
Fred Gladden
DISEASE CONTROL
Fred Heer
FOOD AND LODGING
Kenan Bullinger
HEALTH PROMOTIONAND EDUCATION
Sandra Adams
MATERNAL AND CHILDHEALTH
Sandra Anseth
MICROBIOLOGY
Jim Anders
PREVENTIVE HEALTHSECTION
Steve McDonough, M.D.
CHEMISTRY
Myra Kosse
ENVIRONMENTALENGINEERING
Dana Mount
MUNICIPAL FACILITIES
Jack Long
WASTE MANAGEMENT
Neil Knatterud
WATER QUALITY
Dennis Fewless
ENVIRONMENTAL HEALTHSECTION
Francis Schwindt
STATE HEALTH OFFICER
Murray G. Sagsveen
ADVISORY COUNCILJim Brosseau, M.D.Julie Blehm, M.D.Dennis Wolf, M.D.
GOVERNOR
Edward T. Schafer
North Dakota Department of Health
February 1, 1998
State Health CouncilHoward C. AndersonChairmanHealth Care IndustryTurtle Lake, ND
Gary RiffeVice ChairmanHealth Care IndustryJamestown, ND
Darlene RinnSecretaryConsumerMinot, ND
Ronald A. AndersonConsumerKeene, ND
Jim Brosseau, M.D.Health Care IndustryGrand Forks, ND
Lowell HerfindahlHealth Care IndustryTioga, ND
Linda NelsonConsumerCasselton, ND
Clifford R. PorterEnergy IndustryBismarck, ND
Joel SmithManufacturing/Processing IndustryFargo, ND
Carmen TomanConsumerGrand Forks, ND
Lori WightmanConsumerFargo, ND
Advisory Council
James D. Brosseau, M.D.Internal MedicineAltru Health Systems, Grand Forks, ND
Julie A. Blehm, M.D.Internal MedicineMedical Arts Clinic, P.C., Minot, ND
Dennis E. Wolf, M.D.Family PracticeGreat Plains Clinic, Dickinson, ND
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.
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
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
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
Resident Live BirthsNorth Dakota ~ 1980 - 1998
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
1980 1985 1990 1995 1998
Source: ND Dept. of Health, Vital Records **Estimate
**
Urban-Rural Population DistributionNorth Dakota, 1900-1996
0
20
40
60
80
100
1900 1910 1920 1930 1940 1950 1960 1970 1980 1996
Pe
rce
nt
of
Po
pu
lati
on
Urban Rural
Source: U.S. Bureau of the Census
Population Distribution North Dakota 1960-1990
0
20
40
60
80
1960 1970 1980 1990 1996
Pe
rce
nt
of
Po
pu
lati
on
Largest Cities (over 10,000 people) Rest of State
Source: U.S. Bureau of the Census
Expenditures by SectionJuly 1, 1995 through June 30, 1997
$5.5MAdministrative
Services8%
$16.8MEnvironmental
Health26%
$38.6MPreventive
Health59%
$4.6MHealth
Resources7%
Total Expenditures = $65.6 Million
Source: ND Dept. of Health, Administrative Services
Sections of theNorth Dakota Department of Health
Administrative Services
Preventive Health
Environmental Health
Health Resources
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
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
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
Preventive Health Section
The goal of the Preventive Health Section is
to promote good health and prevent illness
and disease.
The Maternal and Child Health Division works to improve the health of:
Women
Infants and children
Adolescents
Preventive Health Section
The Disease Control Division deals with:
Disease outbreaks
Immunizations
Sexually transmitted diseases
Injury prevention
Chronic diseases
Preventive Health Section
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
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
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
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
Burleigh
Oliver
Dunn
Slope
Bowman
Billings
Go
lden
Val
ley
Stark
Hettinger
Adams Sioux
Grant
Mercer
Morton
Mountrail
Williams
McKenzie
Divide Burke
McHenry
McLean
Ward
RenvilleBottineau
Kidder
Dickey
Emmons
McIntosh
Stutsman
LoganLa Moure
Sargent
Richland
Barnes
Ransom
Cass
Ramsey
Eddy
WellsSheridan
Foster
Rolette
Pierce
Benson
Towner
Nelson
SteeleGriggs Traill
Grand Forks
Cavalier
Walsh
Pembina
Multi County Health District
Single County Health District
City/County Health Department
Single County Health Department
NoneJanuary 1999
Local Public Health UnitsPreventive Health Section
City/County Health District
Environmental Health Section
The goal of the Environmental Health
Section is to safeguard the quality of North
Dakota’s air, land and water resources.
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
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
Chemistry Lab
Organic analysis (man-made
components, such as pesticides)
Inorganic analysis (naturally occurring
compounds, such as fertilizer)
Environmental Health Section
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
The Division of Health Facilities monitors:
Buildings
Equipment and
Services to people
Health Resources
Emergency Health Services
The Division of Emergency Health Services
is the lead agency for North Dakota’s
Emergency Medical Services (EMS)
System.
Health Resources
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 SyndromeSpring 1998
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Emergency ServicesNorth Dakota ~ 1996
v r ! !Ambulance Quick Response Unit 4 Mile/5 Minute 7 Mile/10 Minute
Source: ND Dept. of Health, Health Resources Section
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Other ClinicsNorth Dakota ~ 1996
# Rural Health Clinic 21 Mile Buffer- Other Clinics
Source: ND Dept. of Health, Health Resources Section and Office of Statistical Services
V
V
V
VV
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VVV
V
V
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V
V
V
V
VV
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V
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V
VV
VV
V
V
V V
Burleigh
Oliver
Dunn
Slope
Bowman
Billings
Go
lden
Val
ley
Stark
Hettinger
AdamsSioux
Grant
Mercer
Morton
Mountrail
Williams
McKenzie
Divide Burke
McHenry
McLean
Ward
RenvilleBottineau
Kidder
Dickey
Emmons
McIntosh
Stutsman
Logan La Moure
Sargent
Richland
Barnes
Ransom
Cass
Ramsey
EddyWellsSheridan
Foster
Rolette
PierceBenson
Towner
Nelson
SteeleGriggs Traill
Grand Forks
Cavalier
Walsh
Pembina
HospitalsNorth Dakota ~ 1999
Source: ND Dept. of Health, Health Resources Section
Total PopulationNorth Dakota ~ 1970 - 1998
600
610
620
630
640
650
660
1970 1980 1990 1998
Nu
mb
er
in T
ho
us
an
ds
Source: U.S. Bureau of the Census
Population Age 65 and OverNorth Dakota ~ 1970 - 1990
0
20
40
60
80
100
1970 1980 1990 1998
Nu
mb
er in
Th
ou
san
ds
Source: U.S. Bureau of the Census
Population Age 65 and OverNorth Dakota Vs United States
0
5
10
15
1970 1980 1990 1996
Pe
rce
nt
of
Po
pu
lati
on
North Dakota United States
Source: U.S. Bureau of the Census
Coronary Heart Disease1980 - 1996
Risk Factors for Coronary Heart Disease
High blood pressure Smoking High fat diet Sedentary lifestyle Excessive alcohol use
0
50
100
150
200
250
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96
Male Female
Male and FemaleCoronary Heart Disease Death
Rates
Age-adjusted death rate per 100,000 North Dakotans
*
Source: ND Dept. of Health, Vital Records
Lung Cancer1980 - 1996
0
20
40
60
80
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96
Male Female
Male and FemaleLung 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
Diabetes Death Rate*All Races
*Diabetes as an underlying and contributing cause. **Age-adjusted death rate per 100,000 North Dakotans
0
10
20
30
40
50
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96
Diabetes HP 2000
**
Source: ND Dept. of Health, Vital Records
0
50
100
150
200
250
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96
Native Americans HP 2000
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
DiabetesRisk 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
North Dakota Community HospitalsAdmissions: 1980-1993
0
20
40
60
80
100
120
140
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993
Nu
mb
ers
in T
ho
us
an
ds
Source: Office of National Health Statistics in HCFA Office of Actuary
North Dakota Community HospitalsOutpatient Visits: 1980-1993
0
100
200
300
400
500
600
700
800
900
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993
Nu
mb
ers
in T
ho
us
an
ds
Source: Office of National Health Statistics in HCFA Office of Actuary
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Affiliation
% Medcenter One - Bismarck (10)
$ St. Alexius/Bis/Unimed/Minot (1)
’ MeritCare - Fargo (6)
¹ Grand Forks Clinics (3)
» Trinity - Minot (1)
ž Unimed - Minot (2)
= West River Reg. - Hettinger (4)
Johnson Clinic - Rugby (5)
u Trinity & Western Dakota (1)
Tioga Medical Center (4)
N SW Medical Center - Oakes (7)
Y St. Joseph's - Dickinson (3)
˜ Carrington Health Center (5)
œ Wishek Community Hospital (3)
› Ashley Medical Center (2)
) No Affiliation Known (22)
Rural Health Clinic NetworksNorth Dakota ~ 1997
Source: North Dakota Department of Health, Health Information Systems Division, December 1996
BurleighOliver
Dunn
Slope
Bowman
Billings
Go
lden
Val
ley
Stark
Hettinger
Adams Sioux
Grant
Mercer
Morton
MountrailWilliams
McKenzie
Divide Burke
McHenry
McLean
Ward
RenvilleBottineau
Kidder
Dickey
Emmons
McIntosh
Stutsman
Logan La Moure
SargentRichland
Barnes
Ransom
Cass
Ramsey
EddyWellsSheridan
Foster
Rolette
Pierce
Benson
Towner
Nelson
SteeleGriggs Traill
Grand Forks
Cavalier
Walsh
Pembina
Percent of Change
=<1 percent
-1 to 0 percent
0 - 1 percent
=>1 percent
North Dakota CountiesPopulation Changes
1980 - 1990, Annual Rates
Source: Federal Reserve Bank of Minneapolis (http://woodrow.mpls.frb.fed.us)
Burleigh
Oliver
Dunn
Slope
Bowman
Billings
Go
lde
n V
alle
y
Stark
Hettinger
Adams Sioux
Grant
Mercer
Morton
Mountrail
Williams
McKenzie
Divide Burke
McHenry
McLean
Ward
RenvilleBottineau
Kidder
Dickey
Emmons
McIntosh
Stutsman
Logan La Moure
Sargent
Richland
Barnes
Ransom
Cass
Ramsey
Eddy
WellsSheridan
Foster
Rolette
Pierce
Benson
Towner
Nelson
SteeleGriggs Traill
Grand Forks
Cavalier
Walsh
Pembina
North Dakota Frontier CountiesBased on 1990 Census Estimates
35 of 53 North Dakota counties are designated as Frontier (less than six persons per square mile). #
BurleighOliver
Dunn
Slope
Bowman
Billings
Gol
den
Val
ley
Stark
Hettinger
AdamsSioux
Grant
Mercer
Morton
MountrailWilliams
McKenzie
Divide Burke
McHenry
McLean
Ward
Renville Bottineau
Kidder
Dickey
Emmons
McIntosh
Stutsman
Logan La Moure
Sargent
Richland
Barnes
Ransom
Cass
Ramsey
EddyWells
SheridanFoster
Rolette
Pierce
Benson
Towner
Nelson
SteeleGriggs 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%
Nursing Facility Residents by AgeND vs US ~ 1995
0 - 64 65 - 74 75 - 84 85+
4.32
10.9 7.06
15.622.58
37.6
66.03
35.8
0
10
20
30
40
50
60
70
Pe
rce
nt
of
Re
sid
en
ts
0 - 64 65 - 74 75 - 84 85+
North Dakota United States
Sources: US: National Center for Health Statistics - 1995 National Nursing Home Survey ND: ND Department of Human Services - 1995
1990 to 1998 Population Shifts in North Dakota
-30
-25
-20
-15
-10
-5
0
5
10
15
20
1
Counties
Pe
rce
nt
Ch
an
ge
North Dakota Adams Barnes Benson Billings Bottineau Bowman Burke
Burleigh Cass Cavalier Dickey Divide Dunn Eddy Emmons
Foster Golden Valley Grand Forks Grant Griggs Hettinger Kidder LaMoure
Logan McHenry McIntosh McKenzie McLean Mercer Morton Mountrail
Nelson Oliver Pembina Pierce Ramsey Ransom Renville Richland
Rolette Sargent Sheridan Sioux Slope Stark Steele Stutsman
Towner Traill Walsh Ward Wells Williams
Department of Health General Fund 1987 to 2001
$8,000,000
$10,000,000
$12,000,000
$14,000,000
$16,000,000
Biennium
Gen
eral
Fu
nd
Ap
pro
pri
atio
ns
General Fund$11,972,221 $11,902,613 $14,109,924 $13,655,186 $14,366,079 $14,934,440 $14,456,044
1987-89 1989-91 1991-93 1993-95 1995-97 1997-99 1999-2001
100%
82% 83%
100%
5%
68%
43%
55%
12%
100%
0% 5%
40% 40%
20% 20%25%
0%
18% 17%
0%
90%
32%
57%
45%
88%
0%
100%
40%
20%
40%73%
80%
50%
0% 0% 0% 0%
5%
0% 0% 0% 0% 0% 0%
55%
40%
20%
7%
0%
25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Admini
strat
ive
Vital R
ecor
ds
Crime
Lab
Foren
sic E
xam
iner
Health
Fac
ilities
EMS
MCH
Micr
o La
b
Diseas
e Con
tol
Food
& Lod
ging
Health
Pro
m. &
Ed.
Enviro
n. E
ng.
Chief E
nviro
n. H
ealth
Chem
istry
Lab
Wat
er Q
uality
Mun
icipa
l Fac
ilities
Was
te M
anag
emen
t
Per
cen
t o
f F
un
din
g
Special
Federal
General
General Funding for Key Programs
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
Nu
mb
er o
f F
TE
s
Register of Deeds Mitigation Project
Document
Microfilm
Digital Storage
General Funds Allocatedto Local Health Units
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
Dol
lars
Series1 975,000 950,000 508,093 975,000 1,000,000 950,000 990,000 1,000,000
1985-87 1987-89 1989-91 1991-93 1993-95 1995-97 1997-99 1999-01
$1,000,000 plus $100,000
94%
96%
98%
100%
102%
104%
106%
108%
1991-1993 1993-1995 1995-1997 1997-1999 1999-2001
Biennium
Comparison of General Funds1991-1993 through 1999-2001 Biennia
100%
97%
102%
106%
102%
Per
cen
tage
Ch
ange
fro
m 1
991-
1993