State Health Improvement Plan Requires Strong Statewide Relationships

To kick off Public Health Week, the Oregon Health Authority pondered its State Health Improvement Plan -- from low-tech communicable disease interventions such as washing hands and food, taking shoes off outside and consuming only dairy products that have been pasteurized to more complex teaming up with partners to fight tobacco industry-backed efforts on retail tobacco sales, and pushing for vaccinations, fluoridation, opioid prescribing coordination and suicide prevention.

In recent years, overdoses have exceeded motor vehicle accidents as the number one cause of death in Oregon. With a quarter of Oregonians receiving prescriptions for opioids, new state-level prescribing guidelines and a loosing of federal rules allowing primary care physicians to administer daily opioid treatments should improve coordination among public health, CCOs and health systems and access to care for addicts, said Lisa Millet, manager of injury and violence prevention programs.

Suicide is the second leading cause of death for Oregonians under age 45 while men over age 65 are most prone, particularly if they have ready access to firearms.

“Oregon is known for having a suicide rate 50 percent higher than the national average,” for the past 30-40 years, said Dr. Katrina Hedberg, state epidemiologist and health officer at the Oregon Public Health Division.

But suicide prevention is complex. For veterans, suicide risk increases three to five years after they return home from deployment when they may live hundreds of miles away from a VA hospital and may not have bothered to sign up for benefits when they could get them because of the distance from care. When PTSD and other issues flare up, they can become homeless and face more difficulties obtaining help.

“We need to look at reintegration as a lifelong task. Once you become a veteran, you’ll always be a veteran.” Millet said. “There should be an enhanced safety net.”

People on Medicaid are twice as likely to smoke as their wealthier counterparts. “These are folks who can least afford tobacco products or their health impacts,” Hedberg said.

But efforts to restrict tobacco sales and increase taxes on tobacco products face stiff industry opposition. Public health coordinated with community partners to fend off legislation that would have prevented Oregon cities and towns from setting their own rules and taxes on tobacco products.

On oral health and vaccinations, “we’re doing pretty poorly overall,” said Hedberg. Less than 23 percent of Oregon community water is fluoridated, one of the lowest rates in the nation, while the state ranks 45th in immunization rates.

Jan can be reached at [email protected].

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