A big part of the problems at the Mississippi State Department of Health revealed in Mississippi Senate hearings in 2006 stemmed from a reluctance to announce bad news. But Interim State Health Officer Dr. Ed Thompson says changes have been made to assure that vital information about public health issues such as rates of West Nile virus, tuberculosis (TB) and syphilis are reported quickly and accurately.
Thompson says the biggest flaw revealed in the hearings regarded communications. The health department failed to provide timely information about the incidence of disease in the state.
“I don’t know the reason for it, but before you didn’t hear a lot of bad news out of the health department,” Thompson says. “Since July 2, we have put out some bad news about TB, infant mortality, syphilis and staffing levels in the counties. It may not be pleasant, but people need to know about it or we will never address the problems. If our policymakers are going to help us with the resources, we need to staff our clinics, they have to know about the problems. If we don’t let policymakers know we have these needs, they don’t know how to meet those needs.”
Tracking and communicating
Thompson says the first responsibility of any health department is tracking communicable diseases and other health threats and communicating information about them to the public and healthcare providers.
“Making sure the latest numbers are available to everyone is one of our most important duties,” he says.
The bad news Thompson is referring to includes increasing rates of TB and syphilis in the state. He said the new numbers continue to confirm that syphilis and TB are significant problems in Mississippi that threaten to get out of control without immediate action.
“In the first six months of 2007, there was a significant increase in the numbers of syphilis cases over the same period in 2006,” he says. “Primary and secondary syphilis cases — the earliest and most contagious stages of the disease — increased by 75% from January through June of 2007 over January to June 2006. This increase represents the second year Mississippi has departed from a 10-year long-trend of declining or stable numbers of syphilis. We have to regain control of this public health threat before it becomes a full-scale epidemic and undoes all the progress we’ve made in the past decade.”
Also, last year Mississippi saw its first rise in new TB cases in 15 years. Thompson said the first step in controlling both of these diseases is making the public, the medical community and elected officials aware of the threats.
Providers and general public
Changes have been made to assure that the health department provides information about public health issues both to the healthcare community and the general public quickly and accurately.
“That was the critical thing to correct,” Thompson says. “The fundamental thing was the flow of information both inside the agency and outside to our ultimate customers had been choked off. We have opened that flow again, and if we find any more choke points, we will open them up.
“We encourage open communications from the county health departments to district health offices and to the technical experts in our central offices who are there as resources such as the state epidemiologist and the state entomologist. We have opened the communications the other direction, as well, from the central office experts to county and field experts. Every county in this state has the resources that our experts can provide.”
A second major issue for the health department is a lack of adequate staffing. Without adequate staffing, it isn’t possible to respond most effectively to controlling TB and syphilis rates, taking care of prenatal health and other important medical needs.
“We need more nurses, more nurse aides, more clerical workers and more disease investigators,” Thompson says. “We have lost much of our ability to do the work because we have lost the funding. We will go to the Legislature in August to submit appropriation requests for fiscal ‘09. We will present our request and defend and justify why we need additional resources. Eighty-seven percent of the new dollars we are requesting are for direct field services that mostly take place in county health departments or district health departments. Another 12% goes to activities that support field services such as the laboratory and training for environmentalists. One percent of requested new state dollars go to activities limited to the state office. That is where our priorities are.”
Another major need is for capital improvements, specifically a new state health laboratory. Thompson says the public health laboratory is in a building built more than 50 years ago that is not capable of being renovated to modern laboratory standards. There is not enough space or electrical capacity. There is no room for new laboratory instruments available to be paid for by federal dollars.
Thompson says while federal money would pay for a lot of the equipment, the health department needs state dollars for bricks and mortar. In the 2006 Legislature, a bond issue was approved that would have paid for the new laboratory out of new lab revenues for newborn screenings, work currently contracted out to a national lab.
“That approach was not feasible,” Thompson says. “It would not have worked from a financial standpoint. That was not a good idea.”
Thompson says the national lab that specializes in that kind of testing is more accurate and cost effective. The state lab needs to stick with current testing of food, milk and water supplies, and for chemical and biological bioterrorism agents, diabetes, prenatal care, etc.
“This time we are approaching the Legislature with an honest assessment of the laboratory,” Thompson says. “This is a public function that benefits all the people of Mississippi and requires some public funding. We can’t retire the bonds entirely out of fees. No public health function laboratory can be completely self supporting. There are some things the public has to pay for like telling if a white powder contains anthrax or a specimen contains bubonic plague.”
A properly functioning health department is an important business issue. Thompson says it helps businesses to maintain healthy workers.
“There are too many health problems like TB you can get without any choice,” Thompson says. “You can be a bank teller or lawyer and come into contact with someone with TB. If that person is detected and treated by a functioning health department, then you won’t be exposed to that person and you won’t get TB.”
“If you are going to attract investment to the state, new industry and business, it has to be a state where people want to live, where people will be adequately protected. For example, it has to be a state with adequate programs for basic prenatal care. No one benefits when a baby is born with severe health problems resulting in $50,000 to $100,000 in treatments that could have been prevented with simple pre-natal care. That is bad for businesses. It makes the cost of healthcare higher for private hospitals because it increases what they charge everyone else. An unhealthy population is always bad.”
‘We intend to earn that trust back’
The health department partners with the business community to get out messages about preventative healthcare with worksite wellness programs. Another important partnership is between the health department and physicians to let doctors know what diseases are being seen in the state. That helps them to be alert to communicable diseases.
“That part of our partnership has fallen away a bit,” Thompson says. “We want to improve our communication to physicians on routine disease numbers. They can click on the Web site, but this information needs to be sent to every physician in the state. We have to be sending this to physicians even if they don’t go and look for the numbers on a Web site. We are also getting that information to hospitals and infectious control practitioners around the state, and to the public. Whether good news or bad, whether TB cases are up or down, whether syphilis is getting better or worse, we will report to the public through media and other channels that we can identify.
“One thing we clearly have to do at the Mississippi State Department of Health is regain the trust of the public in the state, the policymakers and healthcare community so they know the Department of Health can and will protect their health. We must be a credible source of accurate, timely information about healthcare issues in the state. We have to regain the credibility. We intend to earn that trust back.”
Communicable and infectious disease numbers are now available online at www.HealthyMS.com/publications. To view the infectious disease report, click on “Mississippi Morbidity Reports.” The Mississippi Morbidity Report will be published online by the 15th each month and contain the previous month’s numbers.
Contact MBJ contributing writer Becky Gillette at firstname.lastname@example.org.