Summer 2004 HealthConnection

Presenting the Health Connection

Greetings from the North Dakota you’ll find information about the Department of Health. I’m pleased to department’s recent performance standards present the latest edition of the Health assessment, as well as an explanation of Connection newsletter. possible changes to the nation’s rules governing lead levels in drinking water. In this issue, you’ll find an article about former ’s recent Look for an issue of Health Connection visit to North Dakota highlighting child- to be e-mailed or mailed to you quarterly. Dr. Terry Dwelle hood immunization efforts in the state. The We welcome any comments about the State Health Officer Healthy North Dakota article focuses on newsletter or any NDDoH-related issue. the importance of breastfeeding and ways Please send comments and suggestions to to increase breastfeeding rates. In addition, [email protected].

Every Child By Two Visits North Dakota Former First Lady Rosalynn Carter Promotes Immunizations

By Heather Weaver Former First Lady of the United States age 2. Mrs. Carter and Mrs. Bumpers have Immunization Program Manager Rosalynn Carter and former First Lady of worked on immunization issues since their Division of Disease Control Betty Bumpers visited North husbands were governors in the early 1970s Dakota June 10 to promote the importance and have been credited with the passage of of childhood immunizations. laws mandating school-age vaccination requirements. In 1991, the former first ladies founded (ECBT), an organiza- During the June 10 North Dakota event, tion that strives to raise awareness of the Mrs. Carter and Mrs. Bumpers held a news critical need for timely immunizations and conference at the Manvel Migrant School for a systematic method of ensuring the near Grand Forks, N.D., to highlight child- immunization of all American children by (ECBT Visit cont. on p. 2)

North Dakota Department of Health Creative Public Health Solutions 2 Health Connection ~ Summer 2004

ECBT Visit cont. from p. 1

hood immunization efforts and to promote the North Dakota state- wide immunization registry. The former first ladies also read a story about immunizations to the school children. Following the visit, Mrs. Carter and Mrs. Bumpers attended an immunization luncheon at the North Dakota Museum of Art, Grand Forks, N.D. Other guests Former First Lady of Arkansas Betty Bumpers (left), Former First Lady of the United States Rosalynn Carter (center) and First Lady of North Dakota included Mikey Hoeven, Mikey Hoeven (right) highlight the importance of immunizations with students First Lady of North from the Manvel Migrant School. Dakota and Healthy North Dakota spokesperson;Dr. Michael Brown, in North Dakota. In addition, 27 public mayor of Grand Forks; Dr. Stephen Cochi, health units and private clinics throughout acting director of the National Immuniza- the state received awards for achieving tion Program, Centers for Disease Control childhood immunization rates higher than and Prevention; and Dr. Terry Dwelle, 90 percent in 2003. North Dakota state health officer, North Dakota Department of Health. “At 83.9 percent, North Dakota’s immunization rate is seventh in the nation,” “We are honored to welcome Rosalynn said State Health Officer Terry Dwelle, Carter and Betty Bumpers and their Every M.D. “Although the majority of North Child By Two organization to North Da- Dakota children are immunized, we must kota,” First Lady Mikey Hoeven said. “We continue our efforts to immunize every in North Dakota cherish our children and North Dakota child. Unfortunately, too know that childhood immunizations are one many of our children still suffer unneces- key to becoming a healthy, productive sary vaccine-preventable diseases, such as adult.” whooping cough and chickenpox.”

At the luncheon, several individuals and For more information, contact Heather health organizations were honored for their Weaver, North Dakota Department of significant contributions to immunizations Health, at 701.328.3386.

North Dakota Department of Health Creative Public Health Solutions 3 Health Connection ~ Summer 2004

Committee Focuses on Increasing Breastfeeding Rates By Karen Oby Nearly every day, the media carries The Healthy North Dakota Breast- Maternal and Child Health Nutrition Coordinator stories about rising medical costs, increased feeding Committee – comprised of stake- Division of Nutrition and insurance rates and the need for disease- holders from across the state – is focusing Physical Activity prevention efforts. Although many preven- on increasing breastfeeding rates by target- tion efforts take years to show results, one ing three areas: (1) the health-care system, intervention – increasing the breastfeeding (2) the community, and (3) the workplace. rates – could show results within one year. The Health-Care System Currently, fewer than 60 percent of Just providing literature or counseling North Dakota mothers are breastfeeding during routine office visits does not their babies when they leave the hospital, effectively promote breastfeeding. Instead, and only about 40 percent are still other supportive efforts have proven to breastfeeding when their babies reach 12 work. For example, referring pregnant weeks of age. Research shows that women and their significant-others to breastfeeding is necessary for healthy structured breastfeeding education and infants, children, mothers and society. behavioral-counseling programs increases Research also indicates that feeding babies the breastfeeding success rate. formula increases many health-related costs. In addition, supportive hospital proto- Nationally, the cost of treating diseases cols can be effective, such as the Baby- and conditions preventable by breastfeeding Friendly Hospital Initiative, which awards is more than $3.6 billion a year. Breast- hospitals “baby-friendly” status. To receive feeding protects children against asthma, the award, hospitals must meet rigorous allergies, diabetes, overweight and obesity, standards, such as rooming-in, helping and mothers who breastfeed are less likely mothers initiate breastfeeding within 30 to have premenopausal breast cancer, minutes of giving birth, and not accepting ovarian cancer, thyroid cancer, osteoporosis free or low-cost supplies of formula, bottles and lupus. or pacifiers.

The Workplace Because they plan to return to work, many women do not even begin breastfeeding, and many others quit breastfeeding when they return to work. Supportive workplaces are essential for women who breastfeed, especially in North

(Breastfeeding cont. on p. 5)

North Dakota Department of Health Creative Public Health Solutions 4 Health Connection ~ Summer 2004

U.S. Government Addresses Lead and Copper in Drinking Water By Larry Thelen The recent discovery of unusually high collecting samples once a year for three Drinking Water Program Manager levels of lead in drinking water in Washing- years and then once every three years if the Division of Municipal ton, D.C., could lead to major changes in action levels were not exceeded. Presently, Facilities the federal Safe Drinking Water Act and, 95 percent of systems are on these reduced- consequently, for drinking water systems in monitoring schedules. North Dakota. When the rule was first implemented, The Safe Drinking Water Act’s Lead and about 105 systems in North Dakota ex- Copper Rule, which took ceeded the lead and/or the effect July 1991, is de- copper levels. Today, none signed to protect public of the systems in North health by minimizing lead Dakota exceed the lead and copper levels in drink- level, and only 10 systems ing water. Exposure to lead, in North Dakota exceed which enters drinking water the copper level. The mainly from plumbing systems that exceed the material corrosion, can copper levels are using cause damage to brain cells, corrosion control treat- red blood cells, kidneys and ments to reduce their livers. The regulations copper levels. established requirements for corrosion- control treatment, source-water treatment, Because of the discovery of high lead lead service line replacement and public levels in Washington, D.C., the U.S. Envi- education. These requirements are triggered ronmental Protection Agency (EPA) and by the levels of lead and copper in the Congress are reviewing how states have water, which is measured in samples col- implemented the rule to determine if proper lected at consumers’ taps. The action level enforcement actions are being taken. In the for lead is 0.015 milligrams per liter, and U.S. Senate, a bill has been introduced the action level for copper is 1.3 milligrams called the Lead-Free Drinking Water Act of per liter. 2004, which would amend the Safe Drink- ing Water Act with regard to regulation of In North Dakota, 348 public water lead. If passed, the bill would: systems are required to monitor for lead and • Require EPA to establish a maximum copper. contaminant level to replace the action level for lead if it is “practicable.” Initially, the Safe Drinking Water Act • Accelerate the replacement of lead required systems to monitor during two service lines in systems that exceed the consecutive six-month periods, followed by (Drinking Water cont. on p. 5)

North Dakota Department of Health Creative Public Health Solutions 5 Health Connection ~ Summer 2004

Breastfeeding cont. from p. 3

Dakota, where 77 percent of women who The Healthy North Dakota have young children are in the workforce – Breastfeeding Committee is planning the second highest rate in the nation. activities to develop community support for breastfeeding women, such as peer counsel- To promote breastfeeding, employers ing and mother-to-mother support groups. can provide health insurance coverage that supports breastfeeding and can make the In addition, state legislatures across the workplace baby-friendly by allowing a nation are taking steps to protect the rights mother to bring her baby to work for the of women and infants to breastfeed and to first six months, providing privacy and make it easier to continue breastfeeding. flexible work schedules, and increasing the Legislative proposals, laws and resources length of paid maternity leave. are available on the National Conference of State Legislatures website at www.ncsl.org/ The Community programs/health/breast.htm. To help increase the number of mothers who breastfeed their babies, communities For more information, contact Karen should create supportive environments Oby, Healthy North Dakota Breastfeeding where women may breastfeed comfortably. Committee, at 701.328.2496.

Drinking Water cont. from p. 4

accepted lead level. optimize corrosion control plans within • Require systems that exceed the lead one year of change in water treatment level to provide filters certified for lead or exceedance of lead levels. removal for each residence, school and • Revise the SDWA definition of “lead- day-care facility in the service area. free” from 8 percent to 0.2 percent lead • Establish routine public education and make it unlawful to install in any programs about lead. residence anything but lead-free plumb- • Require one-time testing for lead in all ing fixtures as of Jan. 1, 2005. community water systems within 18 • Provide $30 million per year to test and months of the bill’s enactment. remove lead from schools. • Develop protocols to ensure that tests for lead are conducted at six-month If this bill becomes law, it would place intervals and that increased testing is new demands on the resources of North conducted after any substantial modifi- Dakota and public water systems through- cation in drinking water treatment. out the state. For more information, contact • Require systems to reevaluate and Larry Thelen at 701.328.5257.

North Dakota Department of Health Creative Public Health Solutions 6 Health Connection ~ Summer 2004

Health Department Completes Performance Standards Assessment By Kelly Carlson Last fall, the North Dakota Department the public statewide. Partners from Local Health Liaison of Health began the process of assessing throughout the state public health system public health performance across the state gathered to develop a collective assess- in an effort to ensure the delivery of essen- ment. The partners included representatives tial public health services to the people of from higher education, associations of North Dakota. medical service providers, health-care associations, insurance providers, local and The National Public Health Performance state public health and other state govern- Standards Program (NPHPSP) is an initia- ment agencies. tive developed by national partners and led by the Centers for Disease Control and This spring, the Department of Health Prevention. The purpose of the program is received a CDC report summarizing the to provide measurable performance stan- assessment results. Next, the participants dards that center on the 10 Essential Public reconvened to discuss the results, to iden- Health Services, focus on the overall public tify challenges and opportunities, to estab- health system, describe an optimal level of lish strategies for inclusion in a health- performance and support a process of improvement plan and to move forward quality improvement. with quality improvement efforts. The action planning stage will be ongoing. The NPHPSP assesses public health capacities and activities in three areas: the The assessment process was beneficial state public health system, the local public in improving organizational communica- health system, and local public health tion, promoting cohesion and collaborative governance. work among the partners, and providing a system-wide view of the delivery of public The process began with an assessment health services. The Department of Health of the state system, which includes all looks forward to working with partners and public, private and voluntary entities that stakeholders to strengthen the effectiveness provide services essential to the health of of our state’s public health system.

The Health Connection is published quarterly by: In Upcoming Issues ... North Dakota Department of Health • Air Quality 600 E. Boulevard Ave., Dept. 301 • Emergency Bismarck, N.D. 58505 Preparedness and Phone: 701.328.2372. Response www.health.state.nd.us • Healthy North Dakota State Health Officer: Dr. Terry Dwelle Editor: Loreeta Leer Frank, public information officer

North Dakota Department of Health Creative Public Health Solutions