The mission of the Office of Public Health is to take knowledge about wellness and prevention of illness, disability and premature death and translate that knowledge into health services for the people of Louisiana including children. This is done through the establishment and enforcement of the Louisiana Sanitary Code, provision of a wide range of health services and through community leadership at the state, regional and local levels. It is also the responsibility of this Office to minimize the cost of health care and environmental protection services provided.
The Office of Public Heath has five major goals:
To promote a reduction in infant and child morbidity and mortality,
To promote a reduction in communicable/infectious disease,
To promote a reduction in chronic disease morbidity and mortality,
To have in place in 1997 a comprehensive injury surveillance system which will enable control of injury morbidity and mortality,
To respond to all requests for the issuance of Louisiana vital records and evidentiary documents archived by the Agency within three days of receipt and within 15 minutes of receipt of requests at service counters; to provide timely analysis of vital records data.
The Office of Public Health administers a variety of State and federally supported programs that protect and promote the health of all Louisiana residents. Most of the programs directly address the needs of children. The work of the Office has been organized in three program areas: Personal Health Services, Environmental Health, and Vital Records and Statistics.
The Personal Health Services Program provides clinical and preventive services to promote reduced morbidity and mortality resulting from (1) chronic disease, (2)infectious/ communicable diseases; and (3) high risk conditions of infancy and childhood.
1. Goal: Provide clinical and preventive services to promote reduced morbidity and mortality resulting from chronic disease to the southern states average by 1997. Programs concerned with cancer control and hypertension that are largely adult focused have been excluded from this description.
1.A. Children's Special Health Services (Handicapped Children's Program): This program provides diagnostic and treatment services for physically disabled children from birth to 21 years who are medically and financially eligible for such services. An estimated 6% of Louisiana children have handicapping conditions. Services are provided statewide through specialty outpatient clinics in 9 locations. Of the estimated 6% (90,480) of children from birth to 21 who are handicapped in the State, the program provides services to approximately 15% (13,400) of this population. It is estimated the state charity hospital system serves an additional 15% (13,400). It is estimated that 60% (54,288) of this handicapped population has health insurance or other financial means to be served privately, leaving an estimated 10% unserved.
This program includes the following projects: Handicapped Children's (HCS) Services Program, HCS - Communicative Disorder, HCS - Eye Health, HCS - Case Management, Supplemental Security Income - Disabled Children, Community and Family Support, ChildNet, and Spinal Cord.
1.B. Commodity Supplemental Food Program: This program operates the Commodity Supplemental Food Program which provides recipients with food assistance and nutrition education. The program addresses unsatisfactory rates of growth, development and nutritional status in pregnant, postpartum and breast-feeding women, infants and children (to 6 years of age) and the elderly resulting from inadequate intake of essential nutrients. The USDA donates the food distributed to women, infants, children and the elderly.
1.C. Disability Prevention/Injury Control: This program works to collect and analyze data on the occurrence of disabling conditions and injury morbidity and mortality and to develop and promote strategies for their prevention. A high percentage of infants and toddlers receiving services in public health clinics are riding in motor vehicles without the required child safety seats. A child passenger safety education program is directed at assuring these children are properly restrained. One third of the disabling spinal cord injuries reported to Louisiana's surveillance system were caused by violence. The violence prevention program applies public health concepts to reducing the toll of violent injuries. The program includes a child safety seat loaner program, an Emergency Medical Technician training program and a statewide surveillance of head and spinal cord injuries. Although the program affects the entire population, much of its energy is directed toward improved outcomes for children and youth.
1.D. Environmental Epidemiology and Toxic Disease: Louisiana ranks among the top states in the United States in the amount of chemicals poured into the water, air, soil and in per capita production of hazardous waste. The purpose of this program is to identify toxic chemicals in the environment which are likely to make people sick and to evaluate the extent of risk and illness caused by exposure to these chemicals and to recommend steps that can reduce associated risk or illness. This program is designed to promote wellness for all citizens of the State, including children.
2. Goal: To provide clinical and preventive services to promote a reduction in communicable/infectious diseases to the southern states average by 1997.
The communicable/infectious disease program seeks to prevent and reduce the incidence of such illnesses as venereal disease, tuberculosis, rubella, mumps, diphtheria, HIV infection and AIDS. The AIDS/HIV program and the Venereal Disease program comprise the major portion of the State's disease control efforts. These services are offered in Sexually Transmitted Disease, Family Planning clinics, drug treatment centers, New Orleans prenatal clinic and other community-based clinics (290 sites statewide). Epidemiologic follow-up is available for diagnosed cases of HIV/AIDS, syphilis and gonorrhea. There are no client income or eligibility criteria for this program.
2.A. AIDS/HIV Surveillance and Control: The AIDS/HIV program includes the following projects: HIV /AIDS Health Education, Public Information and Minority Outreach and Counseling/Testing; HIV Seroprevalence Surveys; AIDS Clinical Diseases; AIDS Early Intervention; AIDS Ryan White Title 1.
2.B. Epidemiology and Rabies Control: The Epidemiology and Rabies Control program consists of three projects: Epidemiology, Rabies Control and Seafood Related Surveillance. This program provides professional consultation and supervision devoted to the containment of infectious disease outbreaks throughout the state. Of particular concern is the transmission of communicable diseases within child care settings. Program staff have initiated a training program for health care professionals and child care providers to minimize the transmission of communicable disease in child care settings.
2.C. Immunization Program: Polio, diphtheria, tetanus, pertussis, measles, mumps and rubella are potentially crippling and/or lethal diseases. The program's purpose is to maintain and provide vaccines and supplies to continue at least a 90% immunization level among Louisiana children. Seventy percent of the children in Louisiana receive their immunizations through local parish health units (244,000 children immunized). There are no eligibility criteria and services are provided statewide to children up to the age of 18. The program also includes an initiative to screen antepartum females and their infants for Hepatitis B. Hepatitis B virus is a major cause of acute and chronic hepatitis.
2.D. Sexually Transmitted Disease (STD) Control: Louisiana ranks 1st in the nation in rates of syphilis and 9th in rates of gonorrhea. Untreated syphilis can result in congenital abnormalities in children and severe neurological impairment or death in adults. Untreated gonorrhea and chlamydia lead to pelvic inflammatory disease in women and increases the risk AIDS/HIV transmission. The purpose of the STD Program is to prevent and/or reduce the incidence of sexually transmitted diseases through the identification of potentially infectious patients and their referral to treatment. The program conducts four basic functions: clinic services - testing, diagnosis and treatment; partner notification - location and referral of persons suspected of having the disease for examination; screening to identify infections in high risk populations; and public education. The program collects a $5 service fee from STD clinic patients if they can afford to pay and bills Medicaid for eligible patients.
3. Goal: To promote a reduction in infant and child morbidity and mortality to the Southern States' average by 1997.
To accomplish this objective, the Personal Health Services Program will implement the following strategies: (1) provide clinical services, education, information and counseling pertaining to contraception and natural family planning; (2) provide screening, diagnosis, counseling and educational services to individuals with genetic disorders, their families and the general public; (3) provide medical habilitative, and rehabilitative services to handicapped children under the age of 21, coordinating through a multi disciplinary team approach; (4) prevent health related problems in children and women of child bearing age and promote and maintain their optimal health; (5) and provide essential nutrients for pregnant, postpartum and breast-feeding women, infants and children up to the age of 5.
3.A. Family Planning: Family planning and related health services for women and adolescents are provided to reduce the incidence of unplanned, unwanted pregnancies. Family planning services include education and information, physical exams, pregnancy testing, laboratory testing, prescriptions, referrals, nutrition counseling and contraception. The family planning services are currently provided in all but two parishes, Plaquemines and LaSalle. However, persons in those parishes have access to family planning services in adjacent parishes. The Family Planning Program currently serves over 70,500 persons in its clinics, about 46% of the estimated need. Federal funding sources include Title V - Maternal and Child Health, Title X, and Title XIX of the Social Security Act.
3.B. Genetic Diseases: The purpose of this program is to provide screening, diagnosis, counseling, and education to reduce the incidence of such crippling inherited conditions as Tay Sachs disease, Cooley's anemia, and sickle cell anemia. It is projected that in 73,000 births per year, an estimated 2,190 children will be born with birth defects. Approximately 95% of the infants born in the State are screened for PKU and congenital hypothyroidism. Genetic evaluation is available and accessible in all regions of the State.
3.C. Maternal and Child Health: Louisiana has a high infant mortality rate. It has a disproportionately high number of health problems and developmental delays of children in indigent families. The goals of the Maternal and Child Health (MCH) Program are to help prevent disease and handicapping conditions among infants, children and adolescents and include health guidance for children and their families, pre- and post- natal care, physical examinations, immunizations, dental care, school health services, counseling, follow-up and referral. In providing these services, health officials place primary emphasis on children who would otherwise be unable to secure needed care. MCH services provided to Medicaid/EPSDT eligible children are reimbursed by the Bureau of Health Services Financing through Medicaid.
An estimated 30,000 low-risk maternity patients and 160,000 children ages 0 - 21 receive services in MCH clinics. The MCH program provides either partial or total prenatal care to 37% of the women giving birth in Louisiana. Fifty percent of the birth to six year old Medicaid eligible population receives preventive health services through the MCH program. The program also provides case management services for low income pregnant women at risk and to low income high risk infants.
3.D. Supplemental Food Program for Women, Infants and Children (WIC): WIC, designed to improve the nutritional status of mothers and children, provides selected health services, nutrition education and supplemental food for the eligible population. The program is for pregnant and postpartum women, infants and children under five years of age who are below 185% of Federal poverty guidelines and who are at nutritional risk. WIC operates at least one clinic in every parish and offers its services in 120 clinic sites statewide.
The vast majority of the Personal Health Services programs supported by the Office of Public Health directly address the needs of children and their families. Consequently it is estimated that, on average, 94% of the total Personal Health Services program expenditures benefit children.
Environmental Health Services are directed toward improving the health of the entire population including children. They promote control of, and reduction of, infectious and chronic disease morbidity and mortality through the promotion and implementation of the State Sanitary Code. Activities of this program include restaurant and food inspection, mosquito control, oyster water monitoring, commercial sea food inspection, and assuring safe drinking water.
This program includes inspections of day care centers, school buildings and lead poisoning inspections. While these services enhance the health of children, they are directed at the entire population. Assuming children constitute one-third of the population, one-third of the costs associated with this program have been allocated for children.
The Vital Records and Statistics Program collects and stores public health - related documents, such as birth and death certificates and other evidentiary documents needed by citizens. Data is analyzed and used by all public health programs and other health care providers to monitor health status indicators of the effectiveness of public and other health care programs. While these services enhance the health of children, they are directed at the entire population. Assuming children constitute one-third of the population, one-third of the costs associated with this program have been allocated for inclusion in the Children's Budget.
RESOURCE ALLOCATION FOR CHILDREN
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