The phrase “public health” elicits numerous images: first responders at a natural disaster, disease detectives peering through microscopes, posters, videos and flyers urging parents to vaccinate their children against deadly diseases, anti-smoking campaigns. Public health is all of this and more. It’s state and local government agencies, and individual physicians, working to detect, respond to, and prevent what’s bad for the health of Texans.
Investments in public health have a proven ROI — like every dollar spent on childhood vaccination saves a minimum of $10 in direct and indirect costs. In a classic example of “penny wise, but pound foolish,” though, public health budgets are constant targets for trimming. Failing to build and maintain our public health defenses definitely will cost Texas taxpayers far more in the long run.
Disaster Response
Preparedness is the key to an effective response to any disaster — from a hurricane to a mass shooting. Planning, practicing, and knowing ahead of time what you’ll need to know onsite are essential. And each new disaster exposes shortcomings in the plan that need to be corrected before the next storm.
TMA recommends that the Texas Legislature:
- Pass volunteer liability protections for physicians and institutions serving in disasters.
- Promote better access for first responders to vaccinations and to their vaccination records.
- Open the Adult Safety Net program to small and volunteer first responder organizations to ensure access to needed vaccines.
Immunizations and Infectious Disease
Vaccines are safe and effective. They prevent dangerous infections that can kill, maim, and readily spread to others. Through intensive immunization campaigns, we have eradicated smallpox from the planet and eliminated polio in the U.S. Other diseases, like measles, went away but came back — primarily among people who refuse vaccinations. The vast majority of Texans — including 86 percent of Republican primary voters — support strong immunization requirements for school children. And vaccinations aren’t just for kids. Nearly 12,000 Texans died of influenza in the 2017-18 season, and about 75 percent of them were 65 or older. The flu shot doesn’t provide perfect protection, but even among older people who live in long-term care facilities — where flu outbreaks are most common — the vaccine is 80-percent effective in preventing death from a flu complication.
TMA recommends that the Texas Legislature:
- Require public school campus-level reporting of vaccine exemption information.
- Reduce the number of children allowed into school provisionally when lacking full vaccination coverage.
- Protect and reform Adult Safety Net immunization funding.
- Improve outbreak reporting and response on flu and other infectious diseases in long-term care facilities.
- Improve surveillance and prevention of multi-drug resistant organism (MDRO) infections in long-term care facilities.
- Require long-term care facilities to maintain easily accessible information on the vaccine status of their patients and staff.
Obesity
Obesity and being overweight contribute to diabetes, hypertension, heart disease, cancer, stroke, and maternal health problems. Unfortunately, Texas has a growing obesity crisis. One third of adult Texans were obese in 2017, up from 21.7 percent in 2000. In the 2016-17 school year, 18.5 percent of Texans age 10 to 17 were obese, the seventh highest rate in the nation. For most of us, the cause of obesity is simple: too much food and not enough activity. The cure: eat less and move more.
TMA recommends that the Texas Legislature:
- Restore required credits in physical education for high school and middle school students.
- Place limits on using Supplemental Nutrition Assistance Program (SNAP) benefits to buy sugar-sweetened beverages and unhealthy foods.
- Allow SNAP benefits to be used at farmers’ markets to purchase locally grown fruits and vegetables.
Tobacco and Cancer
Tobacco use is the No. 1 cause of preventable disease and premature death in Texas. Approximately 28,000 Texans die from smoking every year. We spend an estimated $8.8 billion in annual direct health care costs attributable to tobacco use. Nearly 3 million Texas adults smoke cigarettes, and most smokers (95 percent) took their first puff well before the age of 21. Adolescent tobacco use leads to an increased risk of nicotine addiction. Continued use causes lung cancer, coronary heart disease, diabetes, other serious and costly chronic health conditions, and an early death.
TMA recommends that the Texas Legislature:
- Raise the minimum legal age for purchasing tobacco products to 21.
- Restore state funding for tobacco prevention and control programs and eliminate funding restrictions on statewide efforts to prevent tobacco usage.
- Ensure adequate funding for the Cancer Prevention and Research Institute (CPRIT) and the Texas Cancer Registry.
Behavioral Health and Substance Use Disorder
Behavioral and mental health have been an unintentional mainstay in the news for many months now, due to the increasing number of natural disasters, overdoses, and mass shootings. Those with substance use disorder (SUD) frequently also have a mental health illness or disorder. The physical devastation wrought by natural disasters leaves largely unattended emotional devastation it its wake. Although the 85th Legislature shined a bright light on mental health problems and made significant progress in understanding how to recognize them and provide options for treatment, more can be done. TMA’s recommendations will aid health care professionals, mental health professionals, and law enforcement to make sure that people living with SUD and behavioral health problems get appropriate help when needed.
TMA recommends that the Texas Legislature:
- To combat the opioid epidemic and SUD, expand access to Medication Assisted Treatment (MAT), expand available options for safe disposal of unused medications, consider incentives for physicians to train and be certified in MAT, and improve HHSC coordination with local mental health authorities in rural areas and small towns.
- Utilize innovative telemedicine initiatives to expand the ability of primary care physicians to treat and manage behavioral health disorders.
- Increase funding for jail diversion programs for people with mental health conditions and SUD.
- Expand availability of public school-based counselors and mental health programs to improve school safety.