SENATE BILL REPORT

SB 6274

BYSenator West

Establishing regional health promotion and disease prevention districts.

Senate Committee on Health & Long Term Care

Senate Hearing Date(s):January 24, 1990; January 30, 1990

Majority Report:  That Substitute Senate Bill No. 6274 be substituted therefor, and the substitute bill do pass and be referred to Committee on Ways & Means.

      Signed by Senators West, Chairman; Smith, Vice Chairman; Amondson, Johnson, Kreidler, Niemi, Wojahn.

Senate Staff:Don Sloma (786-7414)

                  February 2, 1990

Senate Committee on Ways & Means

Senate Hearing Date(s):February 5, 1990; February 6, 1990

Majority Report:  That Second Substitute Senate Bill No. 6274 be substituted therefor, and the second substitute bill do pass.

      Signed by Senators McDonald, Chairman; Craswell, Vice Chairman; Amondson, Bailey, Bauer, Bluechel, Cantu, Fleming, Gaspard, Hayner, Johnson, Lee, Moore, Newhouse, Saling, Smith, Talmadge, Warnke, Williams, Wojahn.

Senate Staff:Randy Hodgins (786-7715)

                  February 7, 1990

AS REPORTED BY COMMITTEE ON WAYS & MEANS, FEBRUARY 6, 1990

BACKGROUND:

Legislation creating Washington's Department of Health states the Legislature's intention to "×××improve illness and injury prevention and health promotion×××" and to fill the need for a "×××clear focus on health issues in state government and among state health agencies to give expression to the needs of individual citizens and local communities as they seek to preserve the public health×××"  This reiteration of public responsibility regarding public health protection has caused some to reassess current programs and responsibilities.

Most public health programs were developed to prevent and eradicate contagious and infectious diseases such as tuberculosis, small pox, and polio.  These diseases accounted for the majority of illness, disability and death in the early part of the century.  Today, however the Office of Financial Management reports that the leading causes of death in Washington include accidents, cancer, heart disease, cirrhosis, homicide and suicide.  These are not contagious or infectious diseases, but rather maladies which result from personal choices regarding lifestyle and behavior.

In recent years, public health experts have begun isolating certain "high risk behaviors" which are correlated with causes of illness and death.  A September 1989 draft report by the U.S. Public Health Service suggests health promotion and disease prevention objectives for the nation which involve promoting health by reducing these illnesses and some of the risk factors known to be correlated with them.  Washington's new department of health has created a sub-unit entitled Health Promotion and Chronic Disease Prevention.  However the unit lacks specific authority to set health promotion objectives, to work with local health departments to mount health promotion strategies, or to address risk factors correlated with today's major causes of illness and death.  Other authority to promote health and prevent injury or disease is scattered throughout the Department of Health, the Department of Social and Health Services, the Department of Labor and Industries, the Traffic Safety Commission, the Department of Ecology and other state agencies with no single agency responsible to provide leadership and coordination.

SUMMARY:

The Legislature finds that state, local and private agencies have been established to plan and deliver social and health services to arrest, treat or cure illnesses and injuries, not to prevent them or the conditions under which they are known to spread.  The Legislature further finds that no entity in state or local government is presently charged with the duty to determine the risk factors that cause illness, injury and death, or to take action to reduce these risk factors, prevent illness or promote health.

The Legislature finds these duties to be essential to the protection of public health and that they should be pursued by state and local health departments.

A division of health promotion and disease prevention is established within the Department of Health which must contain those functions the secretary determines are most directly related to the promotion of health and the prevention of disease.  The division, in collaboration with state, local, federal and private groups must use available information to (1) identify the leading causes of illnesses and injury in Washington, (2) isolate the causes and risk factors for these illnesses, (3) identify strategies that have been demonstrated effective in reducing these illnesses, injuries, causes or risk factors, (4) act as a clearinghouse for local health departments or private groups wishing to implement these strategies, (5) assess and report on promising strategies, and (6) receive funds and provide grants to local health departments.

The department must establish a statewide system of regional health promotion and disease prevention districts by (1) designating six districts encompassing the state, (2) requesting that the most populace county within each district develop a health promotion and disease prevention plan by November 1990 which must contain specified elements.  The plan may not include the delivery of direct social or health services.  If the department is unable to establish a district by an agreement solely with counties, the department may contract with nonprofit agencies for any or all of the designated district responsibilities.

EFFECT OF PROPOSED SUBSTITUTE:

The division of health promotion and disease prevention is renamed a center for health promotion and disease prevention whose principal administrator must report to the secretary.

The center's duties are expanded to include the biennial establishment of statewide health promotion and disease prevention objectives, after consultation with the state Board of Health.  A minimum list of objectives is stated involving reductions in: smoking among adults and children; breast cancer deaths; cholesterol levels; certain cancer deaths; non-fatal head injuries; drowning deaths; diabetes related hospital admissions; physical abuse of children; alcohol-related motor vehicle deaths; and alcohol, and other specified drug use among teenagers.  The center must also evaluate local health jurisdictions' efforts in achieving these objectives biennially.

The department's duty is modified to allow the establishment of regions based on the department's organizational principals stated in Chapter 43.70 RCW.  The department must designate regions based on consultation with local health jurisdictions that reflect unique groupings of disease and injury within areas of the state, to the extent possible. 

In addition, the department must establish priority health promotion and disease prevention objectives for local jurisdictions, based on data on illness and injury.

Throughout the bill, references to injury are specified to include both intentional and unintentional injury.

Implementation requirements are modified as follows:  At least three regions encompassing no less than 35 percent of the state population must be established by July 1, 1990.  A metropolitan area, a rural area and at least one area in eastern Washington must be included in these regions.  These regions must begin implementation of strategies to address the objectives of the act by October 1, 1990.

All remaining regions must be designated by May 1, 1991 and must submit health promotion and injury and disease prevention strategies within six months of designation.  The Department of Health must prepare a statement of regions' progress toward meeting the objectives of the act biennially.

Health promotion and disease prevention strategies may include screening, assessments, and education efforts, but may not include the delivery of primary health or social services.

Local health jurisdictions must administer the regions, and may combine to do so.  Combined jurisdictions may determine by mutual agreement which will assume lead responsibility.  If no such agreement is reached, the department must determine the lead jurisdiction.

Per capita funding is replaced with requirements that available funding for the regions must be allocated in grants based on priorities established under the act and the relative cost of interventions.

EFFECT OF PROPOSED SECOND SUBSTITUTE:

The appropriation of $1 million is deleted and the bill is made contingent upon funding in the budget.

Appropriation:    none

Revenue:    none

Fiscal Note:      available

Senate Committee - Testified: HEALTH & LONG-TERM CARE:  Len Eddinger, Washington State Medical Association (pro); Kristine Gebbie, Department of Health (pro); John A. Beare, Spokane Health District (pro); Bud Nicola, Seattle-King County Health Department (pro); Pat Libbey, Thurston County Health Department (pro)

Senate Committee - Testified: WAYS & MEANS:  Len Eddinger, WA State Medical Association (pro)