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Department of Health and Social Services
Public Health
Results Summary | Details | Questions/Comments
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| | To protect and promote the health of Alaskans.
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| | - Prevent and control epidemics and the spread of infectious disease.
- Prevent and control injuries.
- Prevent and control chronic disease and disabilities.
- Respond to public health emergencies, disasters and terrorist attack.
- Assure access to early preventative services and quality health care.
- Protect against environmental hazards impacting human health.
- Manage and administer public health programs and services effectively and efficiently.
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 End Result: |
Strategies to Achieve End Result
| | A: Healthy people in healthy communities. Details > |
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| A1: Reduce the risk of epidemics and the spread of infectious disease. Details > | |
| A2: Reduce suffering, death and disability due to chronic disease. Details > | |
| A3: Reduce suffering, death and disability due to injuries. Details > | |
| A4: Assure access to early preventative services and quality health care. Details > | |
| A5: Minimize loss of life and suffering from natural disasters and terrorist attack. Details > | |
| A6: Reduce Alaskans' exposure to environmental human health hazards. Details > | |
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| A:
Result - Healthy people in healthy communities. |
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Target #1: Alaska's tuberculosis (TB) rate is less than 6.8/100,000 population
Status #1: The rate of TB was unchanged between 2007 and 2008.
Annual TB Rate per 100,000 population
| Year |
US |
Alaska |
| 2008 |
4.2
-4.55%
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7.4
0%
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| 2007 |
4.4
-4.35%
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7.4
-28.85%
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| 2006 |
4.6
-4.17%
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10.4
+16.85%
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| 2005 |
4.8
-2.04%
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8.9
+34.85%
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| 2004 |
4.9
-3.92%
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6.6
-25%
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| 2003 |
5.1
-1.92%
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8.8
+15.79%
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| 2002 |
5.2
-7.14%
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7.6
-10.59%
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| 2001 |
5.6
-3.45%
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8.5
-50.58%
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Analysis of results and challenges: Tuberculosis (TB) has been a longstanding problem in Alaska and was the cause of death for 46% of all Alaskans who died in 1946. Major efforts, utilizing 10% of the entire 1946 state budget and additional federal resources, led to one of the state's most visible public health successes - major reductions in TB. Tremendous inroads have been made to control TB in Alaska, although periodic outbreaks, usually in rural Alaska, have taxed both local and state resources. In 2000, Alaska had the highest rate of TB of any state in the country and additional funding was needed to effectively control two large outbreaks. In 2004, a multi-village outbreak involving Bethel and several surrounding Yukon-Kuskokwim villages again required additional public health resources and enhanced local response efforts. Unrelated to that outbreak, four Alaskans died with TB in 2004 because of delayed diagnosis and treatment. In 2005 and 2006 Alaska had the highest rate of TB of the 50 states. This was the result of a large outbreak among the homeless in Anchorage. For 2007, Alaska has the third-highest TB rate in the country. On an ongoing basis, even when there are no outbreaks, significant resources are needed to do the TB case finding, diagnostic tests and treatment follow-up necessary to keep this disease in check. In addition, for every person with TB, there are, on average, 16 people who were exposed and must also be found, evaluated, and often treated as well.
Alaska's population is small, so a small number of cases can dramatically affect the statewide rate. Despite the recent outbreaks, the rate of TB in Alaska began to decline again in 2007 and has held steady in 2008. The state TB rate shows a downward trend over the past 12 months.
Because of a high rate of latent TB infection among residents, and Alaska's location as a global crossroads that attracts travelers, seasonal workers and new families, rates of TB are expected to fluctuate and remain higher than the national average over the next generation. TB remains deeply entrenched in many regions of Alaska, while the homeless and foreign-born residents also suffer disproportionate rates of the disease.
To control the ongoing challenge of TB, the department needs a strong and multi-pronged public health team of professionals knowledgeable about current issues of TB control as well as a strong public health nursing force. Such expertise will always be necessary if the disease once called the "Scourge of Alaska" is to be controlled and eventually eliminated.
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Target #2: Alaska's chlamydia rate is less than 590/100,000 population
Status #2: Alaska's chlamydia rate decreased from 725 to 718 or less than 1% decrease in 2008, and increased from 675 to 725 or 7.41% in 2007 per 100,000 population. Alaska ranked second in the nation for chlamydia rates in 2007.
Chlamydia rate per 100,000 of population
| Year |
Alaska |
U.S. |
| 2008 |
718
-0.97%
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N/A
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| 2007 |
725
+7.41%
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370
+6.32%
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| 2006 |
675
+2.9%
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348
+4.5%
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| 2005 |
656
+7.72%
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333
+4.06%
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| 2004 |
609
+1.16%
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320
+5.26%
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| 2003 |
602
+1.52%
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304
+5.19%
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| 2002 |
593
+36.64%
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289
+5.09%
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| 2001 |
434
+6.11%
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275
+9.56%
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| 2000 |
409
+34.98%
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251
+1.62%
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| 1999 |
303
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247
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Methodology: National data for CY 2008 will be available from CDC by January 2010. *2008 rates based on 2007 AK Department of Labor & Workforce Development Population Estimates. 2008 Population Estimates will be available in late 2009.
Analysis of results and challenges: Sexually transmitted infections remain major causes of illness in Alaska and may cause serious health consequences. Some diseases once under control have, in recent years reemerged, such as syphilis. As well, evolving antimicrobial resistance is rendering certain antibiotics ineffective.
Many challenges remain. More sensitive diagnostic technologies, targeted screening, and increased disease investigation activities have detected more infections, increasing the total numbers of chlamydia cases diagnosed. Rapid identification, notification, testing, and treatment of sexual contacts of individuals with chlamydia can make it possible to treat exposed individuals before they develop symptoms or further transmit infection. Conducted with sufficient intensity and sustained overtime, these activities have been shown to reduce the reservoir of infected individuals in the population, reducing case numbers and rates over time. Expanded programmatic efforts stabilized chlamydia rates in 2003-2004 but these efforts could not be sustained; rates have increased since that time.
The basic public health infrastructure for sexually transmitted disease (STD) and HIV prevention and control is in place: public health expertise for patient follow up and partner notification; high quality public health laboratory services; and capacity for epidemiologic support, data analysis, and data dissemination. Some elements of this infrastructure, especially trained personnel to conduct partner notification services, currently require additional resources to strengthen and expand them to a level sufficient to address needs. All elements require ongoing maintenance and monitoring. Most of the financial resources currently identified to support STD prevention and control are federal and have declined over the past six years. Buying power has been eroded by increased costs of living and increased Department of Health and Social Services indirect costs. New resources are needed to expand program efforts.
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Target #3: Alaska's coronary heart disease death rate is less than 120/100,000 population
Status #3: Coronary Heart Disease (CHD) rate is below the target for each year since 2004 which is 120 deaths per 100,000 population.
Age-Adjusted Coronary Heart Disease death rate per 100,000
| Year |
Alaska |
US |
| 2007 |
84.2
-3.22%
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125.2
-7.19%
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| 2006 |
87.0
-4.29%
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134.9
-6.58%
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| 2005 |
90.9
-4.11%
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144.4
-3.86%
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| 2004 |
94.8
-25.18%
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150.2
-7.74%
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| 2003 |
126.7
+7.28%
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162.8
-4.74%
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| 2002 |
118.1
-13.61%
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170.9
-3.88%
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| 2001 |
136.7
-0.73%
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177.8
-4.82%
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| 2000 |
137.7
+4.71%
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186.8
-4.01%
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| 1999 |
131.5
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194.6
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Analysis of results and challenges: Nationally, heart disease is the leading cause of death. An estimated 12 million men and women in the U.S. have a history of coronary heart disease, the most common form of heart disease. In 2005, 652,091 people (50.5% of them women) died of coronary heart disease in the U.S.. Although death rates from coronary heart disease have declined since the late 1960s, the decline has slowed since 1990. The lifetime risk for developing this disease is very high in the United States. One of every two males and one of every three females aged 40 years and under will develop heart disease some time in their lives.
Heart disease is the second leading cause of death in Alaska, and cerebrovascular disease (stroke) is the fourth. Over the past decade, Alaska's age-adjusted mortality rate for coronary heart disease has continued to decline. This mirrors the national trend, although Alaska's rates fall consistently below those found in the U.S. overall. Since 2004, Alaska's coronary heart disease death rates have been below the Healthy Alaskans 2010 target, which is 120 deaths per 100,000 population.
While there is no hard data to explain the downward trend in coronary heart disease deaths, it is likely that improvements in medical care are prolonging life, even for patients with advanced heart disease. In addition, Alaskans diagnosed with heart disease sometimes move south to receive treatment; their eventual deaths are not recorded in this state.
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Target #4: Alaska's overall cancer death rate is less than 162/100,000 population
Status #4: Cancer rate declined from 2000 through 2005, with a slight increase subsequently. Cancer is still the Number 1 killer in Alaska.
Age-adjusted cancer death rate per 100,000 of population
| Year |
Alaska |
US |
| 2007 |
183.9
+3.43%
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177.5
-1.77%
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| 2006 |
177.8
+4.77%
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180.7
-1.69%
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| 2005 |
169.7
-7.87%
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183.8
-1.08%
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| 2004 |
184.2
-1.97%
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185.8
-2.26%
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| 2003 |
187.9
-0.9%
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190.1
-1.76%
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| 2002 |
189.6
-1.35%
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193.5
-1.28%
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| 2001 |
192.2
-8.3%
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196.0
-1.8%
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| 2000 |
209.6
+8.88%
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199.6
-0.6%
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| 1999 |
192.5
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200.8
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Analysis of results and challenges: Cancer has been the leading cause of death in Alaska since 1993, one of the few states in the United States for which this occurs. There are more than 100 different types of cancer that comprise this group of diseases characterized by the uncontrolled growth and spread of abnormal cells. These abnormal cells can invade surrounding tissues and spread to other parts of the body through the blood and lymph systems. If the spread is not controlled, it can result in death.
In the United States, cancer is the second-leading cause of death after heart disease, accounting for 1 of every 4 deaths. Over the past ten years there has been a declining trend in the cancer death rate in the United States. Alaska has generally mirrored that trend with the exception of the last two years, where an increase was noted. The Healthy Alaskans 2010 target is 162 deaths per 100,000 population.
The most common types of cancer deaths in Alaska for women are, in order, lung, breast and colorectal cancers. For men, the most common types of cancer deaths are lung, colorectal and prostate. Although some cancer risk factors are not modifiable such as heredity, age and sex, it is estimated that up to two-thirds of cancer deaths may be prevented by changing unhealthy behaviors. These behaviors include tobacco use, excessive alcohol intake, poor diet, lack of exercise, excessive sunlight exposure, and sexual behaviors that increase exposure to certain viruses.
The Alaska Comprehensive Cancer Control Program works collaboratively with communities and partners around the state to positively impact the cancer burden in Alaska. Goals are established that promote cancer prevention, improve early detection, increase access to health and social services, maximize the quality of life for cancer survivors, and reduce suffering and death from cancer. The Alaska Tobacco Prevention and Control Program works toward “a tobacco-free Alaska” through goals around prevention, cessation, education, advocacy and public policy.
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Target #5: Reduce Alaska's unintentional injury death rate to 50/100,000 population
Status #5: The 2007 death rate caused by unintentional injuries was 57.3 per 100,000 population, above the 50/100,000 target and representing a nearly 10% increase from the 2006 rate. The rate dropped by 12% from 2002 to 2006.
Unintentional injury death rate per 100,000 population
| Year |
Alaska |
US |
| 2007 |
57.3
+9.98%
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N/A
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| 2006 |
52.1
+2.96%
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N/A
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| 2005 |
50.6
-8%
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39.7
+4.2%
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| 2004 |
55.0
-0.54%
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38.1
+1.33%
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| 2003 |
55.3
-6.59%
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37.6
+1.62%
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| 2002 |
59.2
-3.11%
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37.0
+3.64%
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| 2001 |
61.1
-4.38%
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35.7
+2.59%
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| 2000 |
63.9
+11.13%
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34.8
-0.85%
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| 1999 |
57.5
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35.1
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Methodology: U.S. data will be updated once it is approved and released by the CDC's National Center for Health Statistics.
Analysis of results and challenges: Injuries are a significant public health and social services problem because of Alaska's high prevalence, the toll on the young and the high cost in terms of resources and suffering. Alaska has one of the highest injury rates in the nation. Both the intrinsic hazards of the Alaska environment and low rates of protective behavior contribute to injuries. Unintentional injuries are the third leading cause of death in Alaska. Cancer and heart disease are the leading causes of death among the elderly, but injuries are the leading cause of death in children and young adults.
The Division of Public Health along with its many partners continues to see the benefits of actions related to injury control and prevention. The Safe Boating Act and Kids Don't Float programs are two examples of successful activities. DPH's Injury Control program will continue to partner with others and to use data analysis and prevention strategies to understand and target interventions.
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| A1:
Strategy - Reduce the risk of epidemics and the spread of infectious disease. |
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Target #1: 95% of persons with TB will complete adequate treatment within one year of beginning treatment
Status #1: In 2007, 90% of persons with TB completed adequate treatment, this was in line with prior year performance. This was below the target rate of 95% primarily due to some difficult cases.
% of Persons with TB Completing Treatment Regimen
| Year |
Annual |
| 2008 |
N/A*
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| 2007 |
90%
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| 2006 |
90%
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| 2005 |
92%
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| 2004 |
86%
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| 2003 |
93%
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| 2002 |
93%
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Methodology: *TB treatment requires 6-9 months for completion. Some 2008 cases are still being treated.
Analysis of results and challenges: The highest priority for TB control is to ensure that persons with the disease are diagnosed early and complete curative therapy. If treatment is not continued for a sufficient length of time, people with TB become ill and contagious again, sometimes with resistant TB the second time. However, some TB patients are difficult to locate, are noncompliant or have medical complications that don't allow them to receive full treatment within the allotted time period. Completion of therapy is essential to prevent transmission of the disease as well as to prevent the development of drug-resistant TB. The measurement of completion of therapy is an important indicator of the effectiveness of community TB control efforts.
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Target #2: At least 98% of chlamydia cases will be prescribed adequate treatment, as defined by CDC's STD Treatment Guidelines
Status #2: 99.6% of Alaskans diagnosed with Chlamidia in calendar year 2008 received adequate treatment, exceeding the 98% target.
% of Chlamydia cases prescribed adequate treatment
| Year |
Annual |
| 2008 |
99.6%
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| 2007 |
99.8%
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| 2006 |
97.9%
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| 2005 |
99.8%
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| 2004 |
99.6%
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| 2003 |
99.5%
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Analysis of results and challenges: Analysis of results and challenges: HIV/STD program staff follow up to assure adequate treatment is prescribed for all reported chlamydia cases. Given such follow up, the majority of cases are ultimately treated in a manner consistent with the national guidelines. Challenges include maintaining resources necessary to conduct necessary follow up and carefully monitoring disease trends to identify emerging problems.
There were a total of 4,860 reported chlamydia cases in 2008, compared to 4,911 in 2007. A small number of cases don't get adequate treatment, due primarily to individuals refusing treatment or an inability to locate them.
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| A2:
Strategy - Reduce suffering, death and disability due to chronic disease. |
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Target #1: Less than 17% of high school youth in Alaska smoke
Status #1: There has been a 51% decline in youth smoking over 12 years, bringing the 2007 prevalance rate of 18% within 1 percentage point of the 17% target.
Prevalence of cigarette smoking in Alaska youth in past 30 days (per YRBS survey)
| Year |
Alaska |
US |
| 2007 |
17.8
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20.0
-13.04%
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| 2005 |
NA
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23.0
+5.02%
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| 2003 |
19.2
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21.9
-23.16%
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| 2001 |
NA
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28.5
-18.1%
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| 1999 |
NA
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34.8
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Methodology: Data is collected every other year. Alaska data not released in years when a statistically valid sample is not available. U.S. data will be reported when released by the CDC.
Analysis of results and challenges: Many Alaskans are currently at risk for developing cardiovascular disease due to such risk factors as smoking, being overweight, poor diet, sedentary lifestyle, high blood pressure and cholesterol, and lack of preventive health screening. Smokers' risk of heart attack is more than twice that of nonsmokers. Chronic exposure to environmental tobacco smoke (second-hand smoke) also increases the risk of heart disease. Cigarette smoking is also an important risk factor for stroke.
Tobacco is a leading cause of preventable disease and death in the United States. The majority of Alaska smokers (almost 80%) began smoking between the ages of 10 and 20. Alaskans have been working to decrease youth tobacco use through increasing the tax on tobacco products, education of young people, enforcement of laws restricting sales to minors, and a statewide ban on self-service tobacco displays.
In 1995, 37% of Alaska youth reported smoking at least once in the last thirty days, compared with 19.2% in 2003 and 17.8% in 2007. Data are available from the Youth Risk Behavior Survey when enough Alaska schools participate to give results that can be generalized to the high school population as a whole in the state. This was the case only in 1995, 2003 and 2007. Surveys occurred in other years; however, schools did not have enough participants to provide statewide results. It is the goal of the Division of Public Health to continue to work with schools to collect a representative sample every other year.
The Healthy Alaskans 2010 target is 17.0%.
Related links:
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| A3:
Strategy - Reduce suffering, death and disability due to injuries. |
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Target #1: Increase seatbelt use to 80%
Status #1: Alaska has exceeded target since mandatory seatbelt law took effect in 2006.
Methodology: Alaska Highway Safety Office and U.S. National Occupant Protection Use Survey (NOPUS-2007)
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Seat Belt Use by Drivers and Passengers
| Year |
Alaska |
US |
| 2008 |
84.9%
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83%
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| 2007 |
82.4%
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82%
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| 2006 |
83.2%
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81%
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| 2005 |
78.4%
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82%
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| 2004 |
77.0%
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80%
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| 2003 |
78.9%
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79%
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| 2002 |
65.8%
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73%
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| 2001 |
62.6%
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73%
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| 2000 |
61.3%
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71%
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| 1999 |
60.6%
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67%
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Analysis of results and challenges: Injuries are a significant public health and social services problem because of their prevalence, the toll of injuries on the young and the high cost in terms of resources and suffering. Alaska has one of the highest injury rates in the nation. Both the intrinsic hazards of the Alaska environment and low rates of protective behavior contribute to injuries and death. Unintentional injuries are the third leading cause of death in Alaska.
Studies have shown that a primary seatbelt enforcement law that allows police to stop and cite motorists for failing to comply with the seatbelt law is most effective in reaching a higher level of seatbelt use compliance.
Alaska's manadatory seatbelt law took effect in 2006. In addition, efforts are ongoing to increase seatbelt use through public information messages and other targeted activities.
The Healthy Alaskans 2010 target is 80 percent seatbelt usage.
Related links:
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| A4:
Strategy - Assure access to early preventative services and quality health care. |
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Target #1: More than 60% of women of childbearing age will report knowledge that taking folic acid during pregnancy can reduce the risk of birth defects.
Status #1: In 2007, there was a significant decrease in the knowledge of folic acid benefits.
Knowledge of Folic Acid Benefits, Alaska
| Year |
Overall |
Alaska Native |
| 2007 |
77.0
-6.78%
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61.5
-10.09%
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| 2006 |
82.6
+1.47%
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68.4
+3.48%
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| 2005 |
81.4
-0.49%
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66.1
-3.36%
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| 2004 |
81.8
-0.24%
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68.4
+4.75%
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| 2003 |
82.0
+1.49%
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65.3
+2.83%
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| 2002 |
80.8
+0.37%
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63.5
+0.63%
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| 2001 |
80.5
-0.37%
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63.1
+1.28%
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| 2000 |
80.8
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62.3
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Analysis of results and challenges: From 2000 to 2006, the knowledge of folic acid benefits among Alaska mothers had remained at about the same level, around 81% to 83%. However, in 2007 there was a 7% decline in the proportion of mothers who had folic acid knowledge.
The proportion of Alaska Native mothers who know about the benefits of folic acid steadily increased to a high of 68.4% in 2004, fell slightly following year, and then rose again to 68.4%, only to fall below 2000 levels, to 61.5%. The gap in knowledge between Alaska Natives and Alaskan mothers still exists.
For women of childbearing age, increasing folic acid use by taking multivitamins before and during pregnancy can reduce the risk of neural tube birth defects. Numerous public education campaigns have sought to increase women's knowledge of the benefits of folic acid supplementation and educate them especially about the importance of the timing (pre-pregnancy supplementation is ideal). Efforts should focus on increasing the overall knowledge prevalence to 90% and minimizing racial disparities.
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Target #2: 100% of Alaska's licensed and certified long-term care facilities are surveyed and recertified annually
Status #2: In FY09, the state is on track to meet licensure survey timelines.
% of licensed and certified long-term care facilities surveyed and re-certified annually
| Year |
Quarter 1 |
Quarter 2 |
Quarter 3 |
Quarter 4 |
YTD Total |
| 2009 |
6.67
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26.67
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33.33
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0
|
66.67
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| 2008 |
13.33
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33
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27
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26.67
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100%
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| 2007 |
6.67
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20
|
40
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26.67
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93.34%
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| 2006 |
20
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26.7
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40
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20
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106.7%
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| 2005 |
26.67
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33.33
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13.33
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20
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93.33%
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| 2004 |
35.71
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21.43
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21.43
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14.29
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92.86%
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| 2003 |
21.43
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42.86
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14.29
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21.43
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100%
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| 2002 |
42.86
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21.43
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21.43
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14.29
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100%
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Analysis of results and challenges: The annual required schedule for nursing home licensure surveys is driven by the federal Medicare certification survey scheduling mandate. The two surveys are always conducted simultaneously. The Center for Medicare and Medicaid Services (CMS) requires that long-term care (LTC) surveys are to be completed within a 9- to 15-month period with an average not to exceed 12.9 months. The Section of Certification and Licensing has consistently met federal and state certification and licensing LTC survey percentage requirements for licensed and certified long-term care facilities within the 9- to 15-month period. The Section's scheduling is affected by significant increases or decreases in complaints or reports of harm, and by significant changes in staff resources.
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| A5:
Strategy - Minimize loss of life and suffering from natural disasters and terrorist attack. |
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Target #1: 25% of the Division of Public Health (DPH) staff is trained in disaster response techniques and procedures
Status #1: Target exceeded - in FY09 29% of all DPH staff received preparedness training.
# and % of Division of Public Health staff trained in disaster preparedness
| Fiscal Year |
Quarter 1 |
Quarter 2 |
Quarter 3 |
Quarter 4 |
YTD Total |
| FY 2009 |
89
|
60
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0
|
0
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29%
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| FY 2008 |
177
|
|
|
|
34%
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| FY 2007 |
27
|
106
|
17
|
31
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35%
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| FY 2006 |
|
|
|
144*
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28%
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| FY 2005 |
|
|
70
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103
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27%
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Analysis of results and challenges: Disaster response training for Division of Public Health (DPH) staff is enabling DPH to carry out its role in disaster response operations. Training is the critical link between planning and action, and permits all concerned to maintain a common knowledge base.
The FY09 percentage reflects the following: 519 permanent full time DPH positions, with an estimated 149 individuals receiving disaster preparedness training, a total of 29 percent trained. This meets the division goal of 25 percent annually.
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| A6:
Strategy - Reduce Alaskans' exposure to environmental human health hazards. |
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Target #1: State lab has validated methods to test people for 100% of the important PCBs, pesticides and trace heavy metals
Status #1: In FY08 100% certification has been maintained for heavy metals; PCB and Pesticides validation is on hold.
Methodology: FY2008 data is for metals only
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% testing methods for PCBs, pesticides and heavy metals validated by CLIA
| Year |
Target |
Actual |
| 2008 |
75%
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75%
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| 2007 |
75%
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60%
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| 2006 |
75%
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50%
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| 2005 |
75%
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50%
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| 2004 |
10%
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10%
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Analysis of results and challenges: PCBs, pesticides and trace heavy metals can affect human health, especially that of the developing fetus and young children. The chief concern in Alaska centers on the presence of contaminants in traditional foods. Generally these foods are very nutritious and offer a number of health benefits. Direct analytical testing of human blood and hair for these compounds provides a real measure of human exposure to contaminants, rather than relying on hypothetical risk models. To date this type of testing has confirmed the safety of traditional foods. Mercury monitoring data has also provided a scientific basis supporting State recommendations regarding a healthy diet for rural and urban Alaskans.
During FY09, the hair mercury testing program will continue and we anticipate increasing throughput capacity for children’s blood lead (Pb) testing. As a pilot, capillary blood lead testing was provided to a small subset of Head Start program children. Data from blood lead testing may be useful in identifying communities potentially at risk possibly due to poor practices in handling lead used during subsistence food gathering (i.e. fishing), or improved practices for cleaning lead shot game meats.
Currently there has been little community interest in PCB or pesticides testing conducted by the State. These tests are more expensive to complete, therefore further work on these compounds has been put on hold.
Related links:
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Current as of Nov 18 2009 14:05:04 |
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