SC Department of Health & Environmental Control

1. SC Department of Health & Environmental Control Impacting Health Disparities Through Public Health Policies and Programs

2. Eliminating Health Disparities is…. • One of the 2 overarching goals of the nation’s health promotion & disease prevention agenda – Healthy People 2010 • A complex and multi-factorial public health challenge • Must be addressed in order to increase the quality and years of healthy life for all

3. SC’s Health Disparities • SC is plagued by health disparities in • HIV/AIDS • Infant mortality • Cancer • Diabetes (& Related risk factors – HTN, obesity, etc) • Heart Disease/Stroke • Immunizations • And more….. • They are costly • More disability • More death • More health care expenditures

4. Historically Black Colleges and Universities African American Churches Breath and depthand reach….. • Through partners, policymakers, focus on prevention Partnerships

5. Translating what we know…..into what we do What is DHEC – “the health department” doing? HIV/AIDS Breast Cancer Stroke Tobacco Prevention & Control Influenza (“Flu”)

6. #1- Translating “Missed Opportunities” into Expanded HIV Testing • > 7 out of 10 newly diagnosed HIV infections occur among AA • Rate of persons living with HIV in SC has increased dramatically • Improved drug regimens help HIV infected people live longer, healthier lives • SC study found a high % of missed opportunities to test and diagnose HIV in several outpatient settings with the largest being emergency department settings

7. Expanded HIV Testing Program • Study results used to successfully secure a CDC grant to implement an “Expanded HIV testing” program • Within 6 months • Clinical setting – 27 HIV-infected individuals identified • Non-clinical setting – 21 HIV-infected individuals identified • All patients linked to care via a Ryan White provider • Important program & policy initiative to help more persons know their status early

8. #2: Translating a Federal Policy Option into the SC Breast & Cervical Cancer Treatment Program….and Expanded Screening The Best Chance Network Program (BCN) S.C Breast & Cervical Cancer Early Detection Program

9. Breast Cancer is the 2nd leading cause of death from cancer for women AA women 1.3 times more likely that white women to die from breast cancer 44% of breast cancers in SC occur in women 47–64 yrs of age Annually, >2700 women are diagnosed with breast cancer in SC Low income and uninsured women have lower screening rates Five Year Survival Rates by Percent for Breast Cancer Breast Cancer in SC

10. Established in 1991 with CDC grant Goal: to reduce mortality from breast and cervical cancer Approach: Partnerships Provider commitments to recommended screening Community/Patient education & outreach Eligibility Age: 47 – 64 < 200% FPL No health insurance or hospitalization only Benefits Mammogram Referral for diagnostic workup Linkage to provider for treatment SC BCN Program

11. Evolution of the SC BCN Program 1990 - 1991 1999 2000 -2001 2005 -2008 Breast and Cervical Cancer Mortality Prevention Act Public Law 101-354 All States, 4 US Territories, Washington, DC and 13 tribes funded to screen Low-income, uninsured women Breast and Cervical Cancer Mortality Treatment Act Public Law 106-354 2001 – SC made POLICY Decision to cover TX and adopted Option #1 for TX Breast and Cervical Cancer Prevention and Treatment Act Expanded to Option #3 for TX 9/1/08 – SC made POLICY decision to expand Screening to ages 40-64 1991 - SC 1 of 8 states funded

12. The Impact • Since 2001, 747 women have been treated under Medicaid Treatment Act Option 1 (women screened by BCN). • Since 2005, 1,128 uninsured women have been treated under Medicaid Treatment Act Option 3 (women not screened by BCN). • 1875 women received/ing treatment**; 44% AA women • With expanded screening, an additional 9000 women will be screened • Deaths due to breast cancer have declined and the disparities gap is narrowing • **TX may be for breast and/or cervical cancer

13. Breast Cancer Mortality in South CarolinaAges 45 – 64 and Age 65 and Older by Race US Death Rate 2003 – 119 per 100,000 Rates per 100,000 African Americans are 1.3 times more likely to die from breast cancer than White women in SC HP 2010 Goal 22.3 per 100,000 women

15. #3 – Translating Data & Science Into Systems Changes to Address STROKE • SC has a significant burden of stroke • AA are 40% more likely have a stroke in SC; and 31% more likely to die from a stroke than whites • Buckle of the stroke belt Figure 11. Stroke Death Rates, 2000-2004, Adults Age 35+ Years

16. #3 – Translating Data Into Systems Changes to Address STROKE Addressing stroke at all levels • Policy • Stroke System of Care Study Committee • Individuals & Community • Power To End Stroke Initiative • Faith & Health Initiatives • Pre-hospital (EMS) • Training and electronic data system • Hospital • Get With the Guidelines • Telemedicine Initiative • Providers • Hypertension Experts Training • Hypertension Initiative

17. Source: Khan et al. “Geographic Analysis of Travel Time to Certified Stroke Centers in the TSSN Region” Unpublished

18. MUSC – Telemedicine Georgetown Waccamaw McLeod Grand Strand Marion Williamsburg Source: Khan et al. “Geographic Analysis of Travel Time to Certified Stroke Centers in the TSSN Region” Unpublished

19. South Carolina Health Disparities: Age-adjusted Stroke Mortality Rates* HP 2010 US 46.6 (2005) • Age Adjustment Uses 2000 Standard Population • * Years prior to 1999 was multiplied by comparability ratio 1.0588. • Source: SC DHEC SCAN, CDC National Vital Statistics Report

20. #4- Tackling Tobacco through Policy & Environmental Change • Tobacco remains the leading cause of preventable death; contributing to heart disease, stroke, cancer, other respiratory illnesses and complicates other chronic diseases such as diabetes • 22.3% of SC Adults smoke • 18.7% of SC youth smoke • $1 billion per year in direct health care expenses

21. Tackling Tobacco…. • BRFSS data show that the highest proportion of smokers are of: • Lower education (34% have less than a high school education) • Lower socioeconomic status (58.5% make less than $24,999 household income) • Are often enrolled in Medicaid

22. Tackling Tobacco… Through Policy Change • DHEC developed model tobacco-free policies • 49 hospitals in SC adopted 100% tobacco-free policies • 26 local municipalities adopted smoke free workplace ordinances • 18 public school districts adopted 100% tobacco-free policies • Four out of every five people who use tobacco begin before they reach adulthood • Currently, 18.7% of S.C. high school students smoke cigarettes (steady decline from from 36% in 1999) – GOOD NEWS!!

23. SC’s Model Tobacco Free Policy for Schools

24. SC Adult Smoking RatesPercent 26.5% 22.3% SC Behavioral Risk Factor Surveillance Survey

25. #5 – Increasing Flu Vaccine Coverage Levels Translating Flu… • Each year over 700 persons die from the flu in SC • The best way to prevent the flu is to get a flu shot every year • Yet, many persons do NOT take advantage of this preventive service • In SC, 67% of whites received flu vaccine; 47% of AA

26. #5 – Flu Vaccinations • Enhanced the flu season campaign and outreach strategies • Engaged more partners • Initiated some new strategies

27. Summary • Through translation of policy change and targeted program expansions….. • Reducing missed opportunities for early identification of HIV infected individuals and linkages to care • Early identification and treatment of breast cancer and decreased deaths due to breast cancer • Reduction in tobacco use in both adults & youth in SC – a leading cause of preventable death and contributor to many chronic conditions • Improved outreach and coverage levels for AA for flu • Continued efforts in these areas and more are needed to eliminate disparities

28. Acknowledgements • Much appreciation to staff (especially K. Heidari and Mike Byrd) at the SC DHEC for use of their technical slides