view from a state north carolina public health
DESCRIPTION
View from a State North Carolina Public Health. Population 9.5M 54,000 square miles 5 th in growth rate in US 100 counties Decentralized Public Health system 85 local health departments (county or district). Jeffrey Engel, M.D. Former State Health Director - PowerPoint PPT PresentationTRANSCRIPT
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View from a StateNorth Carolina Public Health
• Population 9.5M• 54,000 square miles• 5th in growth rate in US• 100 counties• Decentralized Public
Health system• 85 local health
departments (county or district)
Jeffrey Engel, M.D.Former State Health Director
Senior Advisor for Health PolicyNC DHHS
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Major Investments in PreparednessNCPH 2002-2008
• State Capacity– Epidemiology– Laboratory– Informatics
• Regional Capacity– Epidemiology, Planning, Response– Laboratory
• Local Capacity– Preparedness Coordinators
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New Capacity in Public HealthStrategic Building of an Integrated System
• State (Division of Public Health)– Office of Public Health Preparedness and Response
– State Laboratory: Bioterrorism and Emerging Pathogens Program
– Biosurveillance and Informatics• Syndromic surveillance system with NC Hospital Association
• National Electronic Diseases Surveillance System
• Regional– Regional epidemiology offices
– Hospital-based epidemiologists
– Regional labs (Charlotte, Asheville, Greenville)
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E. coli Outbreak* at E. coli Outbreak* at State Fair ResponseState Fair Response
October 2011October 2011North CarolinaNorth Carolina
Departments of Health and Human ServiceDepartments of Health and Human Serviceandand
Agriculture and Consumer ServicesAgriculture and Consumer Services
*25 ill, 6 hospitalized, 3 needing dialysis
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Public Health Operations Organization
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Public Health Operations Organization
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Information Fusion for Outbreak Investigation
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Joint Operations
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Epidemiology with context
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Successful Outcome
Eight days following initial reported cases
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State Reductions2011 Budget
• Elimination of Public Health Pest Management Program– NC no longer has any entomologists, so….– Hurricane Irene August 2011
• Post-hurricane marsh mosquito nuisance• No state capacity to respond• Every county “on their own”• Aerial spraying costly ($100,000 per application)• FEMA reimburses 75%• Dare County sprays, Pamlico County does not
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Irene: August 27, 2011
cbsnews.com, accessed Feb. 1, 2012
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PHEP Funding Awards to North Carolina 2002-11
24.125.8
20.3
25.9
17.7
21.1
16.5 16.1 16.4
13.4
$0
$5
$10
$15
$20
$25
$30
2002 '03 '04 '05 '06 '07 '08 '09 '10 '11
Year of Award
(Mil
lion
s)
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Recent ReductionsPHEP Grant 2008-2011
• State Position Eliminations– Two lab positions– Two epidemiologist positions– One vet position (Dept. of Agriculture)
• Regional– 7 teams of 4 people down to 4 teams of 5 people (8
positions)– 13 hospital epidemiologists down to 8 (5 positions)
• Local– 70% down to 25% of local health departments who can
support a full-time preparedness coordinator (38 positions)
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North Carolina Summary
• Public Health Preparedness and Response– PH major critical infrastructure is a trained and
adequate workforce– Technical resources: lab, informatics– Communication: common language (National
Incident Management System), protocols and plans
• Since 2008, Federal and State Reductions Resulted in Loss of 60 Positions