As a newly practicing physician, you are going to see the adverse impacts of public health issues walk in your door every day. Sometimes you notice the underlying cause of illness and injury – like alcoholism; other times you notice only the injury itself – like a gunshot wound. Knowing the leading public health concerns in your state will provide context for you as a provider and information important to your daily practice. The CDC acknowledges this and has created Prevention Status Reports “to increase the use of evidence-based public health practices and improve health outcomes in each state”.
Prevention Status Reports list the 10 most important public health concerns across the country, by each state and Washington, DC. They are published specifically by the Centers for Disease Control’s (CDC) National Center for Injury Prevention and Control. The CDC updated these reports earlier this year, organizing information on the public health issues, state public health policies and practices so that those working in the field have an easy to use reference. The PSR website features an interactive map, tables summarizing state data and fact sheets. Quick links are posted at the bottom of this document for your convenience.
In some cases, you may be able to have an impact as a physician. In other cases, legislative and policy action is recommended to impact public health concerns. Regardless, your awareness will make a difference in the direct care of your patients and in your ability to advocate for improved population health and management.
What are the top 10 most important public health concerns and recommended remedial actions?
- Increase taxes and liability for commercial servers
2. Food safety
- Improve foodborne disease surveillance, detection, and prevention; including, increased speed in testing and reporting of E.coli, Salmonella, norovirus and other foodborne illnesses
3. Healthcare-associated infections and antibiotic resistance
- Implement state activities to build capacity for HAI prevention
- Implement stewardship programs to improve antibiotic use in acute care hospitals.
- Implement meaningful use of certified electronic health records
- Establish state collaborative drug therapy management (CDTM) policies that authorize pharmacists to provide certain patient services
- Promote team-based care
- Implement clinical decision support systems
- Use interventions that engage community health workers
- Reduce out-of-pocket costs for cardiovascular disease preventive services
- Reduce sodium consumption at the community level
5. HIV
- Facilitate state Medicaid reimbursement for HIV screening
- Make state HIV testing laws compatible with the 2006 CDC and 2013 US Preventive Services Task Force HIV testing recommendations
- Report all CD4 and all HIV viral load data to the state HIV surveillance program and complete lab reporting to CDC
- Increase the percentage of HIV-infected persons who have a suppressed viral load
- Use of antiretroviral medications by persons with HIV to prevent transmission to uninfected partners
- Implement primary enforcement seat belt laws that cover occupants in all seating positions
- Mandate the use of car seats and booster seats for motor vehicle passengers through at least age 8 years
- Implement comprehensive graduated driver licensing (GDL) systems, which help new drivers gain experience under low-risk conditions by granting driving privileges in stages
- Require the use of ignition interlock devices for everyone convicted of alcohol-impaired driving
- Enforce 0.08% blood alcohol concentration laws
- Enforce legal drinking age laws
- Publicize sobriety checkpoint programs
- Facilitate broad-based education campaigns regarding alcohol-impaired driving, car and booster seats
- Limit the availability of less nutritious foods and beverages in schools
- Implement nutrition standards for foods and beverages sold on government property
- Include obesity prevention standards in state regulations of licensed childcare facilities
- Promote evidence-based practices that support breastfeeding in hospitals and birth centers
- Require daily physical education in schools
- Design communities to support physical activity
- Improve the availability and promotion of healthier foods in the retail environment.
8. Prescription drug overdose
- Require timely data submission to the PDMP
- Require universal PDMP use by prescribers. These policies are especially promising but should be seen as key pieces in a much larger, multi-sector approach to preventing prescription drug abuse and overdose. Other important PDMP practices for states to consider include ensuring that their PDMP
- Is easy to use and access
- Can be linked to electronic health records for point-of-care decision making by providers
- Is accessible to public health agencies for tracking trends
- Has the capacity to proactively notify users of high-risk behaviors. Other priorities to advance a comprehensive approach to reversing the epidemic include
- Improve opioid prescribing practices
- Expand use and distribution of naloxone
- Expand medication-assisted treatment to reduce opioid use disorders and overdose.
- Increase access to contraceptive counseling by expanding the age and income eligibility levels for Medicaid coverage of family planning services to increase teens’ access to healthcare services, including contraception and other preventive services.
- Provide sexual health education for adolescents
- Use positive youth development approaches
- Improve parent-child communication and parental monitoring of youth behavior.
- Increase the price of tobacco products i.e. excise taxes
- Establish comprehensive, statewide smoke-free policies to protect all nonsmokers from exposure to secondhand smoke
- Sustain comprehensive tobacco control program funding
While many of these remedial actions seem to be common sense, it will take every provider to put these into action. As the population ages, Americans will face increased illness and disease. It would be helpful to enter old age on a foundation of wellness, rather than one of obesity and addiction.