ANNUAL REPORT STATE COMMITTEE OF PUBLIC HEALTH Jorge A. Juan Donald E. Alsip, MD Johnson, MD Williamson, MD Chair Vice Chair Secretary Kenneth W. James G. Edward C. Richard M. Steven P. Aldridge, MD Davis, MD Facundus, MD Freeman, MD Furr, MD J. Daniel B. Jerome David P. Paul M. George C. “Buddy” Gifford, MD Harrison, MD Herrick, MD Nagrodzki, MD Smith, Jr., MD Council On Animal and Council on Dental Health Council on Health Costs, Council on Prevention of Environmental Health Administration and Organization Disease and Medical Care Jim W. Richard A. Kean, Linda U. Charlotte Benefield, DVM DDS, MD Jordan Wynn, CRNP VALUE STATEMENT TABLE OF CONTENTS The purpose of the Alabama Department Letter to the Governor ..................................................2 of Public Health is to provide caring, high Bureau of Communicable Disease ...............................4 quality, and professional services for the improvement and protection of the public’s Center for Emergency Preparedness ..........................13 health through disease prevention and Office of Emergency Medical Services andT rauma ....15 the assurance of public health services to Bureau of Health Promotion and Chronic Disease ....16 resident and transient populations of the state regardless of social circumstances or the Bureau of Clinical Laboratories .................................30 ability to pay. Bureau of Environmental Services ..............................36 The Department of Public Health works Bureau of Professional and Support Services .............40 closely with the community to preserve and Bureau of Children’s Health Insurance ......................49 protect the public’s health and to provide Bureau of Family Health Services ..............................51 caring, quality services. Bureau of Home and Community Services .................60 Bureau of Health Provider Standards ........................63 AUTHORITY Bureau of Information Services ..................................64 Alabama law designates the State Board of Bureau of Financial Services ......................................69 Health as an advisory board to the state in Office of Program Integrity .......................................72 all medical matters, matters of sanitation and public health. The Medical Association, which Office of Personnel and Staff Development ................73 meets annually, is the State Board of Health. Office of Radiation Control .......................................75 The State Committee of Public Health meets County Health Department Services .........................77 monthly and is authorized to act on behalf of the State Board of Health. The State Health ADPH Address Roster ..............................................78 Officer is empowered to act on behalf of the Public Health Areas ..................................................82 State Committee of Public Health when the Committee is not in session. More than 130 years ago medical leaders in Alabama advocated constitutional authority to oversee matters of public health. The purpose of the authority was to preserve and prolong life; to plan an educational program for all people on rules which govern a healthful existence; and to determine a way for enforcing ANNUAL health laws for the welfare of all people. REPORT 1 MISSION To serve the people of Alabama by assuring conditions in which they can be healthy. LETTER TO THE GOVERNOR The Honorable Bob Riley Governor of Alabama State Capitol Montgomery, Alabama 36130 Dear Governor Riley: I am pleased to present the 2007 Annual Report of the This expanded screening provides Alabama babies with Alabama Department of Public Health. This past year a better start in life. the Department provided opportunities for Alabamians to take steps toward a healthier lifestyle, created access to A key issue for many in preventing death and disability health care resources, and sustained programs that offer is access to health care. Several Departmental programs valuable services to the public. provided many Alabamians access to health care services that they would not otherwise be able to receive. The Preventive health remains a primary goal of the ALL Kids program, administered by the Department, Department. In an effort to fulfill this goal, the marked a decade of providing health care coverage to Department implemented and maintained programs children this past year. During this decade, ALL Kids that assist Alabamians in increasing their probability provided comprehensive health care coverage to nearly of avoiding serious health issues. One health issue that 186,000 children, making a profound contribution toward continues to affect the state’s population is obesity. At reducing the number of uninsured children in the state. least two-thirds of Alabamians are overweight or obese, While the national rate for uninsured children is currently and these weight issues will cause premature death rates 11.5 percent, Alabama’s rate has declined from 15 percent for decades to come. prior to ALL Kids to 7.2 percent at present, well under the national average. At the end of 2007, a total of 69,076 To address this issue, the Department helped launch children were enrolled in ALL Kids, which represents a the Scale Back Alabama program. This program 5.7 percent increase over 2006. encouraged teams of three to five people to lose weight and exercise. More than 5,000 teams participated in the In addition to ALL Kids, health care access was contest, representing 46 of the state’s 67 counties, losing provided through the Plan First Program, which provided a grand total of 78,000 pounds. physical examinations, family planning services, and education to over 57,493 women ages 19-44 at or below the In an effort to assist Alabama’s future citizens, the poverty level. The Alabama Breast and Cervical Cancer Newborn Screening Program started several initiatives to Program provided women ages 50 or older with pelvic provide even better protection. The program now screens exams, pap smears, breast exams, and mammograms, newborns for 28 inherited disorders that could have and diagnosed 175 women with breast or cervical cancer serious long-term effects if left undetected or untreated. during 2007. The Rural Health Section processed waivers 2 To serve the people of Alabama by assuring conditions in which they can be healthy. for 16 physicians to provide accessible health care to over Alabama’s infant mortality rate in 2006, with a rate of 9.0 170,000 rural and medically underserved Alabamians. deaths per 1,000 live births compared to the 2005 infant mortality rate of 9.3, there is still work to be done. The The Department continued to provide services last percentage of births to teens went up and the percentage year that focused on enabling citizens to have a better of births to mothers with adequate prenatal care fell to its quality of life. WIC provides nutritious foods to pregnant, lowest level in more than a decade. As in previous years, breastfeeding, and postpartum women, and infants and having no insurance is associated with the highest infant children up to age 5. The program served an average of mortality. 126,212 participants per month, including approximately 31,486 women, 36,204 infants, and 58,513 children. Over Sexually transmitted disease rates continue to increase $105 million was spent by WIC participants in retail in the state. Alabama has among the highest rates in the grocery stores purchasing WIC foods. nation for syphilis, gonorrhea, and chlamydia. These diseases pose serious threats to young Alabamians age The Alabama Tobacco Quitline, a toll-free tobacco 15 to 24. The Department, working with our health care cessation line that helps Alabamians quit tobacco, served partners, must do more to prevent a further increase in more than 11,000 callers in 2007. The service provides these rates. callers with free individualized counseling, educational materials, referrals to local programs, and a four-week As always, the Department will continue to work supply of nicotine replacement patch therapy. diligently during the upcoming year to address health concerns in the state and to ensure that all Alabamians The Home Health Program provided nursing, physical receive quality health care services and information, therapy, and speech therapy to homebound Alabamians. regardless of social circumstances or the ability to pay. Approximately 361,899 home health visits were made in 2007 to assist these citizens in reaching their optimal Sincerely, health goals. While the Department is proud of its accomplishments in 2007, there are still many issues in the state that Donald E. Williamson, M. D. need to be addressed. Although there was a decline in State Health Officer 3 BUREAU OF COMMUNICABLE DISEASE BUREAU OF COMMUNICABLE were ill had eaten at one restaurant within two days’ DISEASE time. Again, Epidemiology staff traveled to the area to provide assistance and consultation. There was a strong DIVISION OF EPIDEMIOLOGY association between illness and consumption of lettuce at the implicated restaurant. In August, there was an outbreak The mission of the Division of Epidemiology is to of cryptosporidiosis among attendees of a daycare protect the residents of Alabama by monitoring and facility in Public Health Area 8. Epidemiology staff, responding to cases of communicable, zoonotic, and along with area surveillance nurses, conducted an onsite environmentally-related human diseases. The division investigation and determined the outbreak originated strives to: from an outdoor