claims-based data. There are some good things that you can do with it, but it’s far from ideal. What would really be helpful is
much more data that actually speaks to the health status of populations from the standpoint of public health, and that’s harder to get at than it might appear. For instance, it’s one thing to know that a person might have a diagnosis of type 2 diabetes; it’s a different thing to know whether the disease is well-controlled or not, and you can’t often tell that from adminis- trative data. You can’t tell if the person is really doing great and is well-con- trolled and continues to have that di- agnosis, or is really poorly controlled and on the edge of experiencing some serious complications from that con- dition. There is still a gap. I don’t think it’s necessarily DSHS’ gap, per se. It’s part of what is out there in terms of all of public health and really all of health care management in the United States.
Texas Medicine: How does the an- ticipated transfer of a number of pro- grams to HHSC affect DSHS’ resourc- es and support?
Dr. Hellerstedt: The intent is to have DSHS remain an agency whose mis- sion is public health and not necessar- ily direct service to individual clients. I think again that the state psychiatric hospital system would be a primary example of that. Yes, it’s an important part of health care in the state of Tex- as. It’s an important part of the health of communities. But it is also much more a direct patient care service than some of the other efforts we engage in, for instance, promoting breastfeeding, trying to curtail tobacco use, our abil- ity to detect and respond to foodborne illnesses or other emerging illnesses, and tracking flu data and respira- tory syncytial virus data. A number of things we do are correctly viewed as true public health priorities.
My wish, my hope, my expectation
is that once the transformation is com- plete and the transfer of some of those programs is complete, DSHS will be even stronger in its public health role.
Texas Medicine: What is the depart- ment doing to address the spread of Zika virus; what do physicians need to know; and are there any other public health concerns of similar, immediate urgency that DSHS is examining?
Dr. Hellerstedt: I don’t think there’s anything that is quite at the level of Zika. It needs to be taken very seriously.
It is now entrenched in Puerto Rico, for example, where there’s confirmed widespread ongoing local acquisition of Zika via mosquito vector, and that species of mosquito is a species of mosquito that we have in some areas of Texas. The potential to have Zika come to Texas in the form of mosquito vector
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… is very, very real. It’s probably not a matter of if it gets here, it’s a matter of when. DSHS’ efforts at this point are to as much as possible take every step that we can to prevent that from happening or delay that from happen- ing and to greatly minimize as much as possible the footprint it might have here in Texas. (See “Zika Virus Facts From CDC,” page 59.) Right now, we know some about
Zika. There is a lot that is unknown. What we are basing our policies and our planning on is what is known and what we believe to be the most likely threats to public health. I’m talking about the fact that the most likely threat is going to be the Aedes aegypti species of mosquito and it being the primary mode of transmission. What is effective in terms of keeping Zika out or keeping it from spreading once it gets here has to do with the biology and ecology of that particular mos- quito species. We urge physicians to stay on top of the information. (Visit
http://texaszika.org.) Talk to your patients about travel,
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