“The department is focused on addressing food safety and is ramping up the number of epidemiologists in the state who can identify the source of food-borne illness outbreaks quicker.”


with unhealthy dietary habits, sedentary lifestyle, and obesity to destroy health,” he said.


Striving to improve vaccination rates Key stats:


• National Immunization Survey data for 2012 show vaccination coverage levels for Texas children aged 19 to 35 months were 64.8 percent, a de- crease of 7.9 percentage points from 2011 following a change in survey methodology.


• Texas is below the national immuni- zation average of 68.4 percent.


Key strategies:


• Last legislative session, DSHS re- ceived $168.5 million for 2014–15 — an $18 million increase from the previous biennium — to provide adult and childhood immunizations.


• To boost immunization rates, DSHS employs the following:


° Promoting full vaccination services in a medical home for children and


adolescents;


• Immunization, • Obesity, • Food safety, • Tobacco, • Health care-associated infections, and • HIV.


Texas Department of State Health


Services (DSHS) Commissioner David Lakey, MD, named other public health priorities that don’t match the CDC’s winnable battles. They include the DSHS Expanded Primary Health Care Program, birth outcomes, mental health, and sub- stance use disorders. (See “Public Health in Action,” page 61–62.)


The agency focuses on a list of Texas- specific priorities developed over time by examining statistics that determine drivers of poor health and considering those areas in which the state can pro- vide effective interventions to improve health. Dr. Lakey says the legislature also requires the department to work to improve health in those priority areas. “Texas is a large, diverse state with unique public health challenges. We have priorities we focus on that have


58 TEXAS MEDICINE March 2014


the ability to improve health in Texas,” Dr. Lakey said. John Carlo, MD, chair of the Texas


Medical Association Council on Science and Public Health, says many of the council’s priorities — tobacco use, obe- sity, unintentional injuries, teen preg- nancy, and immunizations — align with CDC’s winnable battles. (See “CDC’s Top 10 Winnable Battles,” opposite page.) “The council works specifically on pol-


icies and charges that relate to many of these targets, and our members are well- aligned and interested in tackling these public health challenges,” he said. Texas Public Health Coalition Chair


Eduardo Sanchez, MD, says the state has an opportunity to make significant strides in the public health priority ar- eas that intersect with CDC’s winnable battles. “A statewide indoor smoking ordi-


nance would have a very big impact in a short period of time. Nutrition and physical activity policies, programs, and practices would improve health status in a shorter time frame than … it takes the long list of chronic diseases associated


° Promoting the use of ImmTrac, the state’s immunization registry;


° Educating health care profession- als and the general public;


° Promoting immunization reminder and recall systems in medical of-


fices; and


° Increasing public and private col- laborations to improve each of the


above strategies. When it comes to vaccinating the


residents of such a large, diverse state, Dr. Lakey says immunization “continues to be an issue,” citing TMA as a “strong partner in working to improve immuni- zation rates.” “We’re very focused on improving im- munization rates in Texas. We work with our partners to promote regular immu- nizations as well as the seasonal flu vac- cine,” Dr. Lakey said. (See “TMA’s Immu- nization Resources,” page 60.)


Curtailing obesity Key stats:


• Behavioral Risk Factor Surveillance System data indicate the prevalence


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