The first decade of the 21st century saw great advances in health care delivery systems, health technology innovations and illness prevention. The Centers for Disease Control [7] has compiled a list of ten key public health advances [8] that saved lives and reduced health care costs. In this feature, Forefront Austin details these national advances and highlights a Central Texas agency or initiative that has furthered these advances.
The advances include: cancer prevention, childhood lead poisoning prevention, success with vaccine-preventable diseases, maternal and infant health, prevention and control of infectious diseases, tobacco control, cardiovascular disease prevention, occupational safety, motor vehicle safety, and public health preparedness and response.
(Note: all national statistics are based on CDC figures [8]. Local statistics are provided by the reporting agencies.)
1. New Cancer Screenings Reduce Mortality Rate:
Nationwide: Evidence-based screening recommendations and collaboratively developed standards have improved cancer screening rates and reduced disparities among populations. From 1998 to 2007, colorectal cancer death rates decreased from 25.6 per 100,000 population to 20.0 (2.8% per year) for men and from 18.0 per 100,000 to 14.2 (2.7% per year) for women. During this same period, smaller declines were noted for breast and cervical cancer death rates (2.2% per year and 2.4%, respectively).
Texas: The Austin Affiliate of Susan G. Komen for the Cure [9] funds and promotes mobile screenings throughout Central Texas, extending the benefits of early screening to underserved populations, including minority and rural communities, to reduce cancer mortality rates. For example, a $96,033 grant to the National Center for Farmworker Health’s [10] Cultivando la Salud Breast Cancer Education Program provides comprehensive breast cancer education and screening programs for Hispanic women in Hays County.
- See all Komen Austin grantees [11].
2. Lead Poisoning Reduced Significantly:
Nationwide: In 2000, childhood lead poisoning remained a major environmental public health problem in the United States. Over the last decade, 23 states have implemented comprehensive lead poisoning prevention laws. The economic benefit of lowering lead levels among children is estimated at $213 billion per year.
Texas: In Texas, the Texas Childhood Lead Poisoning Prevention Program (TX CLPPP) [12] partners with local and regional health departments; city, state, and federal agencies; and other community organizations to protect children from lead poisoning.
In 2001, TX CLPPP, with the assistance of a Screening Advisory Group, developed a blood lead screening plan for Texas children. Locally, TX CLPPP notes that, for all age groups, the percentage of children with elevated blood lead levels decreased from 1997 to 2005.
- Learn More about the Texas Childhood Lead Poisoning Prevention Program [12]
3. Success With Vaccine-Preventable Diseases:
Nationwide: Cases, hospitalizations, deaths and health care costs associated with vaccine-preventable diseases declined dramatically from 2001 to 2010. For example, the pneumococcal conjugate vaccine (flu vaccine) prevented an estimated 211,000 serious pneumococcal infections and 13,000 deaths between 2000 and 2008. The routine rotavirus vaccination, which was implemented in 2006, now prevents an estimated 40,000 to 60,000 rotavirus hospitalizations each year.
Texas: Texas infant vaccination coverage for children aged 19 to 35 months improved 13.5 percent between 2004 and 2008, the highest increase in the nation, according to the Texas Medical Association [13], whose Be Wise-Immunize [14] initiative has dispensed more than 213,000 immunizations statewide. Locally, more than 100 doctors participate in a Travis County program to disseminate free vaccinations to children.
- Learn More about the Texas Medical Association Be Wise-Immunize Program [14]
4. Increased Early Screening for Birth Defects:
with neural tube defects (NTDs), and an expansion of screening of newborns for metabolic and other heritable disorders. Improvements in technology and endorsement of a uniform newborn-screening panel of diseases have led to earlier life-saving treatment and intervention for at least 3,400 additional newborns each year with selected genetic and endocrine disorders.
Texas: The National Newborn Screening and Genetics Resource Center [15], located in Austin, tracks statewide and national efforts for screening, offering specific screenings and programs to ensure comprehensive newborn screening in Austin. The March of Dimes Austin chapter [16] provides community awareness and parental education about prenatal health and genetic screenings.
- Learn more about the National Newborn Screening and Genetics Resource Center [15]
- Learn more about the March of Dimes [16]
5. Prevention and Control of Infectious Diseases:
Nationwide: An expansion in screening efforts has contributed to significant decreases in infectious diseases. From 2001 to 2010, tuberculosis cases in the United States declined 30 percent and central line associated blood stream infections declined by 58 percent. In addition, HIV testing, including expanded screening efforts, has enabled earlier access to life-saving treatment, care and pro-active protection against potential partner exposure.
Texas: Aids Services of Austin (ASA) [17] has led HIV prevention and early screening services. ASA's HIV testing has more than doubled, from fewer than 700 people in 2010 to more than 1,800 in 2011. ASA extended educational outreach to more than 10,000 Central Texans and distributed more than 300,000 condoms in 2010.
The agency offers free testing to a diverse array of people at events such as the ASA AIDS Walk. It also offers highly targeted testing, going into the community and offering free, painless and rapid HIV testing at locations frequented by sex workers and injecting drug users.
- Learn more about Aids Services of Austin [17]
6. Growth of Non-Smoking Initiatives:
Nationwide: Since the publication of the first Surgeon General's Report on tobacco in 1964, implementation of evidence-based policies and interventions by federal, state, and local public health authorities has reduced tobacco use significantly. By 2009, 20.6 percent of adults and 19.5 percent of youths were current smokers, compared with 23.5 percent of adults and 34.8 percent of youths ten years earlier.
Despite this progress, smoking represents a significant national economic burden, including medical costs and lost productivity, of approximately $193 billion per year. This ongoing cost, reflected in the 2006 Surgeon General's Report, prompted 25 states to enact comprehensive smoke-free laws, prohibiting smoking in work sites, restaurants and bars.
Texas: The Texas Department of Health [18] and the City of Austin [19] have identified restrictions on smoking locations as key strategies in reducing exposure to second-hand smoke and economic impact on communities. The Texas SmokeFree Ordinance Database [20], sponsored by the Texas Department of Health, tracks all current Texas non-smoking initiatives statewide. Austin enacted a smoking ordinance in September 2005 that has been expanded over the past five years to include smoking bans at a variety of locations, including public parks.
- Learn about Austin's smoking ordinances [21]
- Learn about Austin's community leadership efforts to prevent smoking [22]
7. Improved Heart Health:
Nationwide: Heart disease and stroke have been the first and third leading causes of death in the United States since 1921 and 1938, respectively (37,38). However, in just the past decade (2001-2011), reduced tobacco use and programs promoting improved wellness, exercise and healthy eating have contributed to a national decline in coronary heart disease and stroke death rates, from 195 to 126 per 100,000 population.
Texas: Sperling's BestPlaces Report [23], along with the Centrum Pledge for Life Study, ranked Austin one of the ten healthiest cities based on five major categories: Physical Activity, Health Status, Nutrition, Lifestyle Pursuits, and Mental Wellness.
Several comprehensive programs promote Austin's health and vitality. Local programs, including the Mayor's Fitness Council [24], help Austin stay healthy by focusing on workplace and community action wellness efforts.
8. Decline in Workplace Injuries:
Nationwide: A preliminary total of 4,547 fatal work injuries were recorded in the United States in 2010, about the same as the final count of 4,551 fatal work injuries in 2009, according to results from the Census of Fatal Occupational Injuries (CFOI) program conducted by the U.S. Bureau of Labor Statistics.
Austin: The Workers Defense Project [25], an Austin-based non-profit organization whose mission is to help low-income workers achieve fair employment and safe working conditions, has developed a new worker health and safety program with assistance from a 2010 Occupational Safety and Health Administration Susan Harwood grant. [26]
- Learn about Workers Defense Project [25]
9. Greater Motor Vehicle Safety:
Nationwide: Safer vehicles, safer roadways and safer road use drove significant reductions in death and injury from motor vehicle crashes. From 2002 to 2009, while the number of vehicles on the road increased by 8.5 percent, the death rate from motor vehicle traffic declined from 14.9 to 11.00 per 100,000 population. Among children, the number of pedestrian deaths declined by 49 percent and the number of bicycle deaths by 58 percent.
Austin/Texas: Stronger bike safety laws and education initiatives such Bike Texas [27]'s Safe Routes to Schools are making the roads safer for bicyclists and pedestrians.
- Learn more about Bike Texas [27]'s statewide safety initiatives.
10. Heightened Preparedness and Response:
Nationwide: After the international and domestic terrorist actions of 2001 highlighted gaps in the nation's public health preparedness, public health officials significantly expanded the reporting, epidemiology and capacity of public health systems.
During the 2009 H1N1 influenza pandemic, these improvements facilitated the rapid detection and characterization of the outbreak, deployment of laboratory tests, distribution of personal protective equipment from the Strategic National Stockpile, development of a candidate vaccine virus, and widespread administration of the resulting vaccine.
These public health interventions prevented an estimated five to ten million cases, 30,000 hospitalizations, and 1,500 deaths (CDC, unpublished data, 2011).
Austin: The City of Austin has established a comprehensive Pandemic Flu Plan [28] to monitor, respond to and deploy resources to address outbreak of community-wide illnesses.
- Learn more about the City of Austin health disaster response plan [28]