S-0119

AN ACT Relating to establishment of regional health promotion and disease prevention programs; amending RCW 43.59.030; adding new sections to chapter 43.70 RCW; creating a new section; and making an appropriation.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature finds that:

(1) The current system of health care and public health has been remarkably successful in identifying and reducing or eradicating many contagious or infectious diseases that were major public health threats in years past.

(2) Chronic diseases account for three out of four deaths in Washington every year. Diseases such as heart disease, cancer, intentional and unintentional injuries, perinatal conditions, and other conditions can be prevented if individuals receive early detection of disease and periodic screening, and modify their personal behaviors and life styles.

(3) State, local, and private agencies have been established to plan and deliver social and health services. Many of these services are designed to arrest, treat, or cure illnesses and injuries, not to prevent them.

(4) While certain state agencies have responsibility for prevention of particular illnesses or injuries, such as the Washington traffic safety commission for prevention of traffic injuries and the department of social and health services for prevention of substance abuse, no single entity in state or local government is presently charged with the authority to oversee and coordinate all public and private efforts to address the factors which will promote health and prevent illness and injury, both intentional and unintentional. Of particular concern is the need to coordinate and lead existing public and private efforts to deal with chronic disease and its causes including tobacco use, misuse of alcohol and other drugs, intentional and unintentional injuries, diet, or other personal behaviors.

(5) These activities are essential to the protection and promotion of public health and should be pursued by individual citizens, communities, local governments, businesses, and public and private agencies with leadership from local health departments, the department of health, and the board of health through the state health report.

The purpose of this act is to provide health promotion and disease and injury prevention efforts within the public health system to empower individuals, voluntary community associations, health organizations, and others by providing information and resources to protect and promote health.

NEW SECTION. Sec. 2. There is established within the department of health a center for health promotion and disease and injury prevention whose principal administrator shall report to the secretary. The center shall contain departmental functions that the secretary determines are most directly related to the promotion of health and the prevention of diseases and intentional and unintentional injuries, consistent with the organizational principles set forth in RCW 43.70.020. The center shall collaborate with other entities within the department and other state, local, federal, and private agencies to use available information to:

(1) Identify the leading causes of death, disease, and injury to Washington citizens;

(2) Isolate the causes and risk factors for these illnesses and injuries, both intentional and unintentional;

(3) Identify geographic areas and population groups at risk for these illnesses and intentional and unintentional injuries;

(4) Identify strategies that have been demonstrated to be effective in reducing these illnesses, intentional and unintentional injuries, causes, or risk factors;

(5) Act as a clearinghouse and consultive resource for local health departments, other public and private groups, and voluntary community associations that wish to implement these strategies;

(6) Request and receive funds, gifts, grants, or appropriations from the legislature, the federal government, or private sources to pursue the department's duties under this section;

(7) Provide grants to local health jurisdictions for health promotion and disease and injury prevention to enable citizens and communities to adopt behaviors that have demonstrated effectiveness in promoting health and preventing illness and injury, both intentional and unintentional;

(8) Biennially establish state-wide objectives after consultation with the local health jurisdictions and state board of health as recommended in the state health report and considering United States public health service year 2000 objectives. Using data on Washington residents, the department shall adopt state-wide objectives in a manner that addresses at least the following national objectives to be achieved by the year 2000:

(a) Reduce cigarette smoking among people twenty years and over from 29.1 percent to no more than fifteen percent;

(b) Reduce cigarette smoking among people less than twenty years from 29.5 percent to no more than fifteen percent;

(d) Reduce prevalence of cholesterol levels of two hundred forty milligrams per deciliter among people twenty and older from 26.8 percent to no more than twenty percent;

(e) Reduce deaths from cancer of the uterine cervix from 3.2 per one hundred thousand women to no more than 1.5 per one hundred thousand women;

(f) Reduce serious nonfatal head injuries from one hundred eleven per one hundred thousand people to no more than eighty-three per one hundred thousand;

(g) Reduce drowning deaths from 2.6 per one hundred thousand persons to no more than 1.7 per one hundred thousand persons;

(h) Improve control of diabetes, as measured by a reduction in hospitalization from 13.8 per one thousand people with diabetes to 6.9 per one thousand people with diabetes;

(i) Reverse the rising incidence of physical abuse of children under age eighteen from 10.7 per one thousand children to no more than 10 per one thousand children;

(j) Reduce assault injuries among people age twelve and older from 1841.8 per one hundred thousand people to no more than 1650 per one hundred thousand people;

(k) Reduce alcohol-related motor vehicle crash deaths from 9.7 per one hundred thousand people to 8.5 per one hundred thousand people;

(l) Reduce by fifty percent the use of alcohol, marijuana, and cocaine among young people ages twelve to seventeen years from 25.2 percent for alcohol, 6.4 percent for marijuana, and 1.1 percent for cocaine;

(m) Reduce annual average alcohol consumption by people age fourteen and older by twenty-three percent from 2.6 gallons of ethanol per year to 2 gallons of ethanol per year;

(n) Reduce by twenty-five percent the number of infants born to chemical abusing women; and

(o) Reduce the incidence of gonorrhea from 297 cases per one hundred thousand people to 225 cases per one hundred thousand people;

(9) Biennially evaluate local health jurisdictions' progress in meeting objectives, according to subsection (8) of this section.

NEW SECTION. Sec. 3. The department shall establish a state-wide system of health promotion and disease prevention regions as follows:

(1) The department, in collaboration with local health jurisdictions, shall designate regions and assist these regions in establishing local health promotion and disease and intentional and unintentional injury prevention priority objectives based on analysis of the information in section 2 of this act. Regions shall be consistent with the organizational principles in chapter 43.70 RCW, and, to the extent possible, reflect unique grouping of disease or injury incidence or populations identified at risk.

(2) The department shall designate regions incorporating the entire state by January 1, 1992.

(3) Each region shall prepare, through a cooperative effort of local health departments, other health care providers, schools, community, business, and health organizations within the region, a regional health promotion and disease and intentional and unintentional injury prevention strategy that addresses the objectives established under subsection (1) of this section. The strategy shall incorporate existing efforts where appropriate. The strategies shall place emphasis on collaboration with local voluntary organizations within the region. Regions designated under subsection (2) of this section shall submit a regional health promotion and disease prevention strategy within six months of regional designation. All regions shall submit a regional health promotion and disease and intentional and unintentional injury prevention strategy for the following biennium by July 1, 1993, and biennially thereafter.

(4) The department shall biennially prepare a statement of progress toward meeting state-wide health promotion and disease and intentional and unintentional injury prevention objectives specified in section 2 of this act. The statement shall also reflect regional strategy implementation accomplishments of the preceding biennium.

(5) Health promotion and disease and intentional and unintentional injury prevention interventions under sections 2 through 4 of this act shall include measures with demonstrated effectiveness in meeting regional health promotion and disease and intentional and unintentional injury prevention objectives. Interventions may include at least health screening services and assessments, public education campaigns, and targeted education efforts. In no case may interventions under sections 2 through 4 of this act include the delivery of primary health or social services.

(6) In developing intervention strategies regarding the health of children and adolescents, the region shall cooperate with all local school districts within the region. It is the region's obligation to involve local school districts in planning these interventions for children and adolescents. If a local school district declines to participate, the school district shall submit a written statement to this effect to the region. This statement must be submitted by the region with their regional health promotion and disease and intentional and unintentional injury prevention strategy.

(7) The regional health promotion and disease and intentional and unintentional injury prevention strategy shall be developed and administered by the local public health jurisdiction within the region. If a region encompasses more than one local public health jurisdiction, those jurisdictions shall select a jurisdiction to develop and administer the regional strategy. In the event agreement cannot be reached, the department shall determine the lead jurisdiction.

(8) Available funding for health promotion and disease and intentional and unintentional injury prevention regions shall be allocated in grants based on priorities established under subsection (1) of this section and the cost efficiencies of interventions associated with those priorities.

(9) If the department is not able to establish a region by agreement solely with local health jurisdictions, it may contract with nonprofit agencies for any or all of the development and administration of the regional health promotion and disease and intentional and unintentional injury prevention strategy.

(10) The department shall reflect the funds necessary to implement this section in its departmental biennial budget request.

NEW SECTION. Sec. 4. The state board of health shall review the health promotion and disease and intentional and unintentional injury prevention objectives established in section 2 of this act and recommend modification as part of the state health report.

NEW SECTION. Sec. 5. Sections 2 through 4 of this act are each added to chapter 43.70 RCW.

Sec. 6. RCW 43.59.030 and 1982 c 30 s 1 are each amended to read as follows:

The governor shall be assisted in his or her duties and responsibilities by the Washington state traffic safety commission. The Washington traffic safety commission shall be composed of the governor as ((~~chairman~~)) chair, the superintendent of public instruction, the director of licensing, the secretary of transportation, the chief of the state patrol, the secretary of social and health services, the secretary of health, a representative of the association of Washington cities to be appointed by the governor, a member of the association of counties to be appointed by the governor, and a representative of the judiciary to be appointed by the governor. Appointments to any vacancies among appointee members shall be as in the case of original appointment.

The governor may designate an employee of the governor's office to act on behalf of the governor during the absence of the governor at one or more of the meetings of the commission. The vote of the designee shall have the same effect as if cast by the governor if the designation is in writing and is presented to the person presiding at the meetings included within the designation.

The governor may designate a member to preside during the governor's absence.

NEW SECTION. Sec. 7. The sum of .......... dollars, or as much thereof as may be necessary, is appropriated from the general fund to the department of health for the biennium ending June 30, 1993, to carry out the purposes of this act.