Forging a Poison Prevention and Control System (2004) / Chapter Skim
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9 A Public Health System for Poison Prevention and Control
9 A Public Health System for Poison Prevention and Control
Pages 269-302
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From page 269... ...
needed to achieve the vision of "healthy people in healthy communities." A strong public health system needs to be in place to support the goal of a consistent, comprehensive, and communitybased Poison Prevention and Control System. An approach to addressing the health care needs of the population is to set goals and objectives for the nation.
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. These three core functions are helpful in describing the components of an integrated Poison Prevention and Control System at the federal, state, and local levels in the United States as they relate to the public health system.
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. Policy development is an important component of assuring a comprehensive Poison Prevention and Control System in every community in the United States.
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For example, state health departments have an infrastructure and experience with primary prevention and health education activities across the lifespan; they also have one or more individuals with training in health education and community prevention. These activities are funded with federal dollars through programs such as the Maternal and Child Health Block Grant, Substance Abuse Block Grant, and Women, Infant, and Children's Nutrition Service.
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Although there are a variety of interested programs and components of public health agencies involved in various aspects of poison prevention and control, some of which interact with the poison control centers, there is insufficient clarity in the roles of each entity in the maintenance of a system across any level of geography. For example, at a local and/or state public health level, it is not unusual for the following programs within a health department to have an interface with the poison control centers and larger Poison Prevention and Control System: emergency medical services, the injury prevention and control program, maternal and child health program, occupational health program, substance abuse program, health statistics, epidemiology, environmental health, emergency preparedness, and others.
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Local and State Health Department Involvement with Poison Prevention and Control Activities There is no single point of accountability for poison prevention and control activities at most local or state health departments.
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Data and surveillance are usually located in the health statistics and information unit with links to the state epidemiologist, the medical examiner, and the agency that collects hospital discharge data. Other programs within public health departments that may be involved with poison prevention and control activities are emergency medical services, maternal and child health, health education and promotion, emergency preparedness, substance abuse services, environmental health, occupational health, and the medical director.
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. Maternal and Child Health Linkages To understand the current linkages between poison control centers and various programs within state health departments, an informal survey of activities or linkages with the state Title V agencies was conducted in 2003 by the Association of Maternal and Child Health Programs.
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the relationship of the injury prevention and control programs in state public health departments to the poison control centers covering their state. Unlike the maternal and child health program, which receives a block grant for activities, there is no regular state or federal funding stream for injury prevention and control activities in states.
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Although the degree of health department involvement with the state or regional poison control center is common, the form and extent of involvement is variable and commonly linked to the extent of center financial support. Emergency Preparedness and Response Poison control centers can play an important role in all-hazards preparedness and response.
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The 2001 Presidential Task Force on Citizen Preparedness in the War on Terrorism recommended that poison control centers be used as a source of public information and public education regarding potential biological, chemical, and nuclear domestic terrorism (Pub.
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. State and local plans for public health and hospital emergency preparedness are beginning to acknowledge roles for poison control centers.
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It is evident from this review of plans that some public health departments are better integrated with poison control centers than others in support of bioterrorism preparedness and improvement of capacity to effectively respond to other public health critical incidents. Others have mentioned the possible role of centers in support of CDC's ChemPack program, in view of its characteristics, including 24hour-a-day/7-day-a-week coverage and specially trained staff.
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Office of National Drug Control Policy, involved with poison prevention and control activities. The primary leadership for the public health system at the federal level resides in the DHHS.
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In addition to dedicated funds for poison control centers and activities, there are several other major funding sources that flow from the federal level to states that can and are used to support poison prevention and control activities at state and local levels. These are the Title V Maternal and Child Health Block Grant, the Substance Abuse Block Grant, the Preventive Health Services Block Grant, Medicaid, and the State Children's Health Insurance Program.
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Two federal agencies (CDC and HRSA) have funds earmarked for poison control centers, but these funds have not been directed to and are not sufficient to support the core activities for the proposed Poison Prevention and Control System.
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disease Consumer and household · Consumer Product Safety Commission products Drugs of abuse · National Institute on Drug Abuse (NIH, DHHS) · Office of National Drug Control Policy · Substance Abuse and Mental Health Services Administration (DHHS)
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The set of performance measures for the state grants should be determined by a federal-state partnership process and complement the performance measures for poison control centers in each state. Rough estimates of the funds required for federal-level activities include $3 million for the development and maintenance of quality assurance and improvement mechanisms for every component of the Poison Prevention and Control System, including assessment of clinical practice; $3 million for training activities for health providers outside the poison control center who require training in toxicology, including emergency department workers such as nurses, physicians, and emergency medical technicians; and $4 million for a clearinghouse for primary prevention materials and resources (including media campaigns, material development, and dissemination, as discussed in Chapter 8)
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Research should be both field initiated and program specific so that the gaps in science related to the various aspects of the Poison Prevention and Control System are filled. In sum, the funds needed by state and federal agencies to assure a Poison Prevention and Control System are in addition to the $100 million estimated to be needed by the poison control centers.
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Consumer Product Safety Commission, U.S. Environmental Protection Agency, and Office of National Drug Control Policy follow.
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With respect to lead poisoning, CDC initiated the Childhood Lead Poisoning Prevention Program (CLPPP) , which develops programs and policies to prevent childhood lead poisoning; educates the public and health care providers about childhood lead poisoning; provides funding to state and local health departments to screen children for elevated blood lead levels and to ensure follow-up; develops neighborhood-based efforts to prevent childhood lead poisoning; and supports research to determine the effectiveness of prevention efforts.
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The EEHS Emergency Preparedness and Response Branch (EPRB) coordinates CDC's activities in helping state and local health departments assure public health readiness in their emergency preparedness and response efforts.
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is the lead federal agency for injury prevention and for reducing injury, disability, death, and costs associated with injuries outside the workplace. NCIPC works closely with other federal agencies; national, state, and local organizations; state and local health departments; and research institutions to prevent and control injuries.
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HRSA's Maternal and Child Health Bureau promotes and improves the health of mothers and children by working in partnership with states, communities, publicprivate partners, and families. MCHB administers seven programs, one of which is the Poison Control Centers Program (developed as a result of the Poison Control Center Enhancement and Awareness Act)
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SAMHSA's programs support the adoption and adaptation, as well as the evaluation, of evidence-based, high-quality diagnostic, treatment, and prevention service practices. Under its block grant program, SAMHSA encourages the states and territories to address state and local substance abuse and mental health needs by supporting implementation and maintenance of specific service programs and assesses and reports on progress, needs, and ongoing activities.
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is the health services research arm of DHHS, complementing the biomedical research mission of its sister agency, the National Institutes of Health. AHRQ specializes in research on quality improvement and patient safety, outcomes and effectiveness of care, clinical practice and technology assessment, health care organization and delivery systems, primary care and preven
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supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. NIAAA aims its research at determining the causes of alcoholism, discovering how alcohol damages the organs of the body, and developing prevention and treatment strategies in the nation's health care system (http://www.niaaa.nih.gov)
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. National Institute of Child Health and Human Development The National Institute of Child Health and Human Development conducts and supports research to advance knowledge of pregnancy, fetal development, and birth for developing strategies that prevent maternal, infant, and childhood mortality and morbidity; identify and promote the prerequisites of optimal physical, mental, and behavioral growth and development through infancy, childhood, and adolescence; and contribute to the prevention and amelioration of mental retardation and developmental disabilities (http://www.nichd.nih.gov)
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OPHS experts monitor and analyze production processes; identify and evaluate potential foodborne hazards; determine estimates of risk to human health; respond to recognized, emerging, or potential threats to the food supply; investigate the origin of hazards; coordinate the recall of products when necessary; and provide emergency preparedness for foodborne problems (http://www.fsis.usda. gov/OPHS/ophshome.htm)
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develops and coordinates the implementation of a comprehensive national strategy to secure the United States from terrorist threats or attacks. Working with executive departments and agencies, state and local governments, and private entities, DHS ensures an adequate strategy for detecting, preparing for, protecting against, responding to, and recovering from terrorist threats or attacks within the United States.
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enforces compliance with mandatory safety and health standards to end fatal accidents, reduce the frequency and severity of nonfatal accidents, minimize health hazards, and promote improved safety and health conditions in U.S. mines.
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NDIC assists national policy makers and law enforcement with strategic domestic drug intelligence; supports the intelligence community counterdrug efforts; and produces national, regional, and state drug threat assessments. Among the many products produced by NDIC, The National Drug Threat Assessment is an annual report that provides information such as the current primary drug threat to the nation, fluctuations in consumption levels, and the effects of particular drugs on abusers and society as a whole (http://usdoj.gov/ndic)
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The director of ONDCP produces the National Drug Control Strategy to reduce illicit drug use and the manufacturing and trafficking of drugs, drugrelated crime and violence, and drug-related health consequences. For fiscal year 2004, the National Drug Control Strategy proposes three core priorities: (1)
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