SEPTEMBER 2009
Ohio to Join National Violent Death Reporting System (NVDRS)
Federal grant allows Ohio to join 17 other states in NVDRS
By Alvin D. Jackson, M.D.

Violent death is a pressing public health concern in Ohio and the United States. In fact, some 50,000 Americans die violently each year, according to the Centers for Disease Control and Prevention (CDC), and Ohio reported 2,007 violent deaths in 2007, the most recent year for which data are available.

The vast majority of violent deaths in Ohio were either suicides (63 percent) or homicides (32 percent); other categories accounted for about 5 percent of violent deaths.

In an effort to better understand – and ultimately prevent – violent deaths, CDC in 2002 established the National Violent Death Reporting System (NVDRS). And now, thanks to a four-year grant from CDC, the great State of Ohio is poised to become NVDRS’ 18th participant, joining Alaska, California, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia and Wisconsin in this important partnership

Beginning Sept. 1, the Ohio Department of Health (ODH) will receive about $274,000 from CDC annually and will use the funds to develop, administer and implement the Ohio Violent Death Reporting System (OVDRS). ODH will convene an OVDRS advisory board comprised of stakeholders and data owners to help with this process.

OVDRS, like NVDRS, will consider violent deaths to be homicides, legal interventions, suicides, unintentional firearms deaths, terrorism-related deaths and deaths of undetermined intent. While ODH and some of its sister agencies collect violent death and/or crime data, none of them maintain a single repository of all variables of interest. With the help of these federal funds, ODH will be able to capture data from multiple sources and analyze extenuating circumstances surrounding violent deaths in Ohio.

To streamline these data and make them more useful to partners, ODH will collect and link information from the following sources:

•  Death certificates.
• The Bureau of Criminal Identification and Investigation Crime Laboratory.
• The Office of Criminal Justice Services’ Ohio Incident-based Reporting System (law enforcement crime reports).
• Ohio’s 88 county coroners.
• ODH’s Child Fatality Review of violent deaths to Ohioans younger than 18.
• Local law enforcement (when needed).

These data will eventually allow local and state partners to develop and evaluate violence-prevention strategies and increase the public’s awareness of violence as a major public health problem. Counties with the highest numbers of violent deaths will be phased in first, with the goal of all 88 Ohio counties participating by the end of this four-year project.

The OVDRS will be housed jointly in ODH’s Violence and Injury Prevention Program and Data Center.

Editor’s Note: 2,007 violent deaths in Ohio in 2007 IS correct
Alvin D. Jackson, M.D., is director of the Ohio Department of Health.

AUGUST 2009
Prevention Key to Health Care Reform 

By Alvin D. Jackson, M.D.

As Congress and President Barack Obama wrangle over health care reform, I hope they remember one very important point: Any plan that doesn’t include prevention as a key element will not succeed.

In 2008, the United States spent nearly 17 percent of its total economy – that’s more than $2 trillion – on health care, yet 46 million Americans remain uninsured. While this is a staggering statistic, it’s important to remember, as the Robert Wood Johnson Foundation has correctly pointed out, that seeing a doctor has little to do with staying well.

In fact, preventable conditions and addictions such as obesity and smoking put millions of Americans at risk for preventable diseases such as cancer, diabetes and heart disease.

In my home state of Ohio, where I serve as director of Health, these risk factors are prevalent. Nearly one-quarter, 23.4 percent, of Ohio adults are cigarette smokers; 36.2 percent were overweight with a body mass index (BMI) between 25 and 29.9; and 26.5 percent were obese with a BMI of 30 or higher; an ideal BMI is between 18.5 and 24.9.

And on July 1, the Trust for America’s Health (TFAH) issued a report that called Ohio the 10th-fattest state in the nation with 63.6 percent of the population either overweight or obese.

In Ohio, the five leading causes of death – heart disease, cancer, stroke, chronic lower respiratory and diabetes – all have risk factors associated with preventable conditions such as tobacco use, poor nutrition, sedentary lifestyle, etc. When you add unintentional injuries to the mix, these conditions caused 68.6 percent of Ohio deaths during 2004 through 2006.

So what do we do? We focus on prevention.

In fact, an investment of $10 per person per year in proven community-based prevention programs could save the United States more than $16 billion a year within five years, TFAH said in its F as in Fat report. That’s a big return on investment - $5.60 for every $1 spent, according to TFAH.

I believe in prevention so much, I incorporated it into my private practice in the holistic model of health care. That is care with a focus on chronic disease prevention, where patients partner with their providers to maintain good health and assist in coming up with treatment options when prevention alone is not enough.

I took this message to the White House in May when I – along with leaders of some of America’s largest companies – met with Mr. Obama to discuss innovative workplace practices designed to lessen the cost of providing health care to employees.

Simply stated, we must move from a “sick care” system to a true health care system. Today, the United States spends close to $100 billion – with Ohio spending about $3.3 billion; yes, with a ‘b,’ – to address the health consequences of insufficient physical activity and poor nutrition each year. Meanwhile, overweight- and obesity-related conditions accounted for 9.1 percent of U.S medical expenditures in 1998, according to the Journal of the American Medical Association.

Many of these overweight- and obesity-related conditions can be prevented or at least well-managed by targeting their major causes – poor nutrition and a lack of physical activity. There are no quick fixes, but if we work together to improve food choices in our schools and communities; to make communities more convenient for walking and bike riding; to make employee wellness a goal for all employers; and to stress to our children the importance of playing (physical activity) and eating well, someday, we can break the cycle of our enlarging national waistline.

In Ohio, the Department of Administrative Services launched its Take Charge! Live Well! program in 2005 after learning that 44 percent of health care costs were associated with preventable conditions, while just 27 percent were related to high-risk State of Ohio employees. Until Take Charge! Live Well was established, Ohio targeted its health care programs toward disease management and improving the health of high-risk workers.

Our Office of Healthy Ohio recently issued an Obesity Prevention Plan – available at http://www.healthyohioprogram.org – and made $1.1 million in grants available to 14 local health departments to help make physical activity and good nutritional options more readily available in their respective communities.

Ohio is now doing for its workers and residents what the United States needs to do for its citizens – focusing on prevention.

JULY 2009

Federal Tobacco Legislation another Tool in Anti-tobacco Arsenal

By Alvin D. Jackson, M.D.

President Barack Obama recently added a hammer to anti-tobacco advocates’ toolboxes.

That hammer came in the form of the Family Smoking Prevention and Tobacco Control Act, which the president signed June 22 granting the U.S Food and Drug Administration the authority to regulate all tobacco products.

I am grateful the president gave us this additional tool as we continue working to build a healthier Ohio because smoking is the No. 1 preventable cause of death and illness in the state.

Any healthy community must be built on a tobacco-free foundation.

Now is not the time to become complacent. We still have a long way to go. One in every five or 20.1 percent – of Ohio adults are smokers, and the Ohio Department of Health (ODH) has many programs and tools to help remove tobacco from the lives of Ohioans.

One important tool is the Ohio Smoke-free Workplace Act, which prohibits smoking in more than 280,000 public places and places of employment throughout the state. The Ohio Smoke-Free Workplace Act protects Ohioans from being exposed to secondhand smoke while at work or while in a public place. This is vital as secondhand – or passive – smoking is the third-leading cause of preventable death in Ohio behind only active smoking and alcohol use, respectively.  ODH also advises parents not to smoke in vehicles and homes when children are present to avoid exposing them to the many dangers of secondhand smoke.

The Ohio Tobacco Quit Line – 1-800-QUIT-NOW – is another important resource for those who want to quit.

Live Quit Line counselors are available to help from 9 a.m. to 11 p.m. Monday through Friday and from 10 a.m. to 6:30 p.m. Saturday and Sunday. Soon-to-be-former smokers can also leave a message 24 hours a day and request a call-back time that is convenient for them.

Quit Line services are available in 150 languages and TTY service is available for the deaf and hard of hearing at 1-888-229-2182. Only 5 percent of those who try to quit smoking alone are successful, compared to 22 percent who use the Quit Line.

ODH also provides more than $1.8 million to local health departments and nonprofit organizations for youth prevention programs and to encourage schools to adopt 100 percent tobacco-free-campus policies.

As you can see, we have many tobacco-fighting tools available to us. When the hammer begins to fall later this year, the Family Smoking and Prevention and Tobacco Control Act will begin banging away at tobacco use by:

• Requiring larger, more graphic, health warnings on cigarettes packs.
• Restricting tobacco advertising, sponsorships and promotion – particularly those aimed at children.
• Banning candy- and fruit-flavored cigarettes.
• Prohibiting the use of misleading terms such as “light” and “low tar” to describe cigarettes.
• Requiring tobacco companies to disclose all of the contents of their products.
• And much, much more.

We’ve made a lot of progress in the 45 years since the surgeon general first linked cigarette smoking to lung cancer, but we still have a long way to go. With the knowledge we have today, NO ONE should die of a smoking-related illness.

But sadly, they still do – as many as 400,000 Americans and 18,500 Ohioans annually.

There is a reason cigarettes are commonly referred to as “nails,” as in nails in the coffins of smokers.  Tobacco use kills. It is my hope we can use this new hammer’s claw to save lives and remove some of those nails before it’s too late.

Alvin D. Jackson, M.D., is director of the Ohio Department of Health.

JUNE 2009

Ohio’s Doctor Prescribes Summer Safety
By Alvin D. Jackson, M.D.

As spring turns to summer, the Ohio Department of Health (ODH) turns its attention to protecting and improving all Ohioans’ health during this most outdoorsy time of year. As Ohio’s doctor, I prescribe the following for healthy swimming, cooking out and avoiding mosquito bites.

Swim Safely

ODH and its partners regularly test select inland state parks and Lake Erie beaches for the presence of bacteria that may make some people – particularly children, the elderly and those in poor health – sick if exposed. During the testing season – from Memorial Day to Labor Day – ODH recommends posting warning signs at beaches with elevated levels of certain bacteria.

Check results for your favorite beaches online at http://www.odh.ohio.gov or by calling toll free 1-866-OHIO-BCH (644-6224).

Remember, lakes are untreated surface waters and, unlike swimming pools, are not designed for swimming. Gastroenteritis is the most common illness associated with swimming in contaminated water. Symptoms include nausea, vomiting, cramps, fever, headache and diarrhea.

Swimmers can reduce their chances of getting sick by steering clear of visible discharge pipes; keeping their head and face out of the water; not swallowing the water; showering after swimming; and waiting 24 hours after a heavy rainfall before swimming.

Cookout with Care

Each year, about 140 cases of illness due to E. coli O157:H7 are reported in Ohio. This bacterium typically causes diarrhea, which can be bloody and severe, and abdominal cramps two to eight days after infection.  People with these symptoms should see their physicians.

The E. coli O157:H7 microbe is blamed for roughly 73,000 infections and 61 deaths in the United States each year, according to the Centers for Disease control and Prevention (CDC). Most illnesses from E. coli O157:H7 are associated with eating undercooked, contaminated ground beef. Steps you should take to protect yourself and your family include:

• Wash your hands often, especially after using the bathroom or changing diapers, before and after eating or preparing food and after touching animals.
• Cook ground beef to 160° F. Test the meat by putting a food thermometer in the thickest part of the meat. Wash the thermometer after each use. Don’t eat ground beef that is pink in the middle. If a restaurant serves you an undercooked hamburger, send it back for more cooking. Ask for a new bun and a clean plate, too.
• Don’t spread bacteria in the kitchen. Keep raw meat away from other foods. Wash your hands, cutting board, counter, dishes and silverware with hot soapy water after they touch raw meat, spinach, greens or sprouts.  Never put cooked meat in a container that held uncooked meat.
• Drink only pasteurized milk, juice or cider. Frozen juice or juice sold in boxes and glass jars at room temperature has been pasteurized, although it may not say so on the label.
• Drink water from safe sources, such as municipal water that has been treated with chlorine, wells that have been tested or bottled water. Do not swallow lake or pool water while swimming.
• Wash all fruits and vegetables prior to eating them.

Fight the Bite

Mosquito season is upon us and that means Ohioans should take steps to protect themselves against mosquito bites and possible West Nile virus (WNV) infection. WNV was first detected in Ohio in 2001, and has infected people every year since 2002, when 441 Ohioans were sick; last year, 15 Ohioans contracted WNV. There is no way to predict how the virus will behave in 2009, but because it is spread only by bites from infected mosquitoes, I urge Ohioans to take the following personal protection measures:  

To avoid possible infection from mosquito bites:  Be aware that mosquitoes are most active and biting during the early morning and late evening hours.  If you plan to be outdoors at dawn or dusk, take extra care to use repellent and wear protective clothing that covers the skin.  Light colored fabrics are least attractive to mosquitoes.  When using repellents, be sure to follow the label directions.

To eliminate mosquito breeding sites near your home: Remove all discarded tires and other water-holding containers, such as tin cans and unused flower pots, from your property. Eliminate standing water from your property. Make sure all roof gutters are clean and properly draining. Clean and chlorinate pools, outdoor saunas and hot tubs. Keep them empty when not in use, and drain water from pool covers. Change water in bird baths weekly.

For more information on these topics – as well as tips on protecting against skin cancer, heat stroke and exhaustion and fireworks safety – check out ODH’s Summer Safety Web feature at: http://www.odh.ohio.gov/features/odhfeatures/summersafety.aspx.

Alvin D. Jackson, M.D., is director of the Ohio Department of Health.

APRIL 2009

Tackling Childhood Obesity is Hard Work, Um, Play
By Alvin D. Jackson, M.D.

Difficult problems typically are not solved without hard work, and this is also true for the childhood obesity epidemic sweeping Ohio and the nation. But, tackling childhood obesity is unique in that “hard work” is not the only phrase that describes what needs to be done.

What’s the other?

Play more.

Public health experts agree physical activity – along with good nutrition – is essential to achieving a healthy weight and saving not only lives but money. In fact, the cost of treating youngsters’ obesity-related healthy problems in U.S. hospitals spiked to $127 million in 1997-1999, compared to $35 million in 1979-1981, according to the Centers for Disease Control and Prevention.

Stated another way, one-third of American youth are either obese or at risk of becoming obese, according to the Institute of Medicine (IOM). Here in Ohio, 17 percent of third graders are obese and another 18 percent are overweight. And the numbers aren’t any better for our older children. In fact, 23.7 of Ohio’s seventh graders are obese and 19 percent are overweight, according to the Ohio Department of Health 7th Grade Body Mass Index Survey.  Overall, 35.6 percent of Ohio youth 10 to 17 are overweight or obese, according to the 2008 Ohio Family Health Survey.

If things don’t change, many experts agree, today’s children will be the first generation to live shorter lives than their parents.

So what can we do?

Play more.

Today’s children tend to spend more time in front of TV and/or computer screens than their parents did and; thus, spend less time being active. Being physically active does not require a family pass to the gym, nor does it require a complete change in lifestyle. In fact, it requires relatively little, according to the recently released Physical Activity Guidelines for Americans.

How little? As little as an hour of physical activity a day. Those 60 minutes should include aerobic exercise such as running, jumping, dancing or bicycling; muscle-strengthening activities such as using playground equipment or playing tug-of-war; and bone-strengthening activities such as playing basketball or tennis.

And what to do if an hour a day is not enough for your child?

Play more.

You can help by being an involved parent. Again, it doesn’t take much to set a healthy example for your young ones and spend more time together to boot. Being physically active as a family is not difficult.

If possible, walk your child to school in the morning and take a family stroll after your evening meal. When you and the kids hit the mall, park as far away as possible and walk to the entrance. Toss a baseball or football in the afternoon and go to the zoo – forget the stroller – on the weekends.

Overweight and obesity affect children of all ages and none are immune. Fourteen percent of 2- to 5-year-olds, 19 percent of 6- to 11-year-olds and 17 percent of 12- to 19-year-olds are obese, IOM says.

Do you find this alarming?

Do you want your children to live longer, healthier lives than you?

If so, it’s time to deliver one very important message to the young people in your life:

Play more.

Alvin D. Jackson, M.D., is director of the Ohio Department of Health.

MARCH 2009

Let’s Make Ohio the State of Living Well
By Alvin D. Jackson, M.D.

At the Ohio Department of Health (ODH), our mission is to protect and improve the health of all Ohioans.

As ODH director and Ohio’s Doctor, it’s my responsibility to further that mission by providing you, my patients, with helpful, healthful information to encourage you to make intelligent decisions about your health and your lifestyle.

But public health is more than encouraging and cajoling; it is with you every day. For example, if you go out for a meal, the restaurant was inspected by an ODH-regulated local program. ODH provides the first vaccines for many Ohio children. It offers family-planning services. And, ODH inspects nursing homes to ensure a safe environment for residents. These are just some examples of the more than 140 programs that make up your ODH.

Now, back to the encouraging and cajoling.

Making small changes in your life – exercising, eating more fruits and vegetables and avoiding tobacco – can lead to big changes in your overall health.

Those changes are sorely needed in the State of Ohio. But don’t take my word for it; here’s what your fellow Ohio adults reported in the 2006 Ohio Behavioral Risk Factor Surveillance Survey:

Nearly one-quarter – 22 percent – are smokers, 24.5 percent don’t get regular physical activity and only 23 percent eat five or more servings of fruits and vegetables daily.

So, it’s no surprise the same survey shows 28.4 percent of Ohio adults are obese and an additional 35.5 percent are overweight. Read that again. It’s a stunning reality.

And it follows that the five leading causes of death in Ohio – heart disease, cancer, stroke, chronic lower respiratory disease and diabetes – can all be linked at least in part to lifestyle issues.

If you see a pattern here, it’s because there’s a pattern here. Unhealthy behaviors lead to unhealthy lives and, conversely healthy behaviors lead to healthy lives.

It may seem simplistic, but it’s true. In my time as a practicing physician, I often encouraged patients to make lifestyle changes – changes they thought would be insignificant until the health benefits started to appear.

So I call on all of you to turnaround your lives one small step at a time. Here is my prescription. If you don’t exercise, check with your doctor to see if you are healthy enough to do so. Then start. Now. You don’t need to go to the gym every day or give up your favorite activities to make the time. Start with a short walk after dinner or park far from the entrance when running errands. You’ll soon find that exercise is relatively easy and yields terrific results. You never know, it may be habit forming.

Eat more fruits and vegetables. You can start slowly, but start. Pledge to have a glass of not-from-concentrate juice with breakfast, add an apple or a salad to your lunch and strive to have at least one veggie with each dinner. Before you know it, you’ll be eating five to nine servings a day and feeling better for it.

And if you don’t smoke – don’t start. If you do smoke – quit. Tobacco is the leading cause of preventable death and quitting is the best thing you can do for your health. For help, call the Ohio Tobacco Quit Line at 1-800-QUIT-NOW.

Try these small steps. If we all work to improve our health, Ohio will truly become the State of Living Well.

Alvin D. Jackson, M.D., is director of the Ohio Department of Health.