T rJ£ KECOKD C C A '/ s / L Felix J, Underwood, M.D*, Executive Officer Mississippi State Board of Health SUMMARY OF ACTIVITIES AND DEVELOPMENTS IN PUBLIC HEALTH STATE OF MISSISSIPPI, 19U5-U6 Felix J. Underwood, M. D. Executive Officer INTRODUCTION ihrough the staff of its county, district, and state departments the Missis- oipi otate Board of Health has the responsibility for developing and maintaining a program of health services which will protect and promote the health of the State’s 2. million citizens. It has long been recognized that health problems can best be solved in the area where they exist by the cooperative and coordinated efforts of local citizens working under consultant professional guidance* Upon this basic truth rests the justification for establishing full time and well staffed local health departments on a county and district basis. The same health problems are not common to every area, therefore health programs and services are necessarily geared to the needs of the area which they are to serve and will change with the pattern of people’s living habits and with changing disease problems. The effective- ness ef these programs depends upon the active participation, understanding, and support of all citizens within the area. ORGANIZATION ihe Mississippi State Board of Health- was created by the Mississippi medical profession, and receives constant cooperation in the public health program. Nine physicians and one dentist, duly elected representatives of their professions, are appointed by the governor for staggered terms of service. The state and county health departments cooperate with every official, state, federal and county agency, with voluntary health agencies, and with unofficial agencies which contribute to the health and welfare of citizens. This cooperative working relationship exists with the State Divisions of the American Cancer Society, the National Foundation for Infantile Paralysis, National Tuberculosis Association, Mississippi Medical Education Board, Mississippi Commission on Hospital Care, Department of Public Welfare, Department of Public Education, Extension and Farm Home Administrators, and all civic and fraternal groups which can assist in promoting health, COUNTY HEALTH DEPARTMENTS Of the 82 counties in Itfississippi 65 have full time public health services. Of the 17 counties in the State which do not have full time services 12 have made the necessary appropriations for instituting health departments as soon as essential personnel can be recruited. It is* felt that the £ counties which have not made financial appropriations will do so immediately when' personnel is available. The state department staff acts in an advisory and consultant capacity to local staif personnel and advises with state and local governments on health protection measures. Local and state health officials call- to the attention of the courts any violation of regulations made to protect the health of the public. The state department of health advises with and assists all official and unofficial agencies in developing health education programs for their respective groups. This procedure is channeled through to the county level. The title of the personnel employed in county or district health departments is indicative of the service provided: The health officer has the responsibility for the over-all administration and direction of the county public health program and renders all professional medical services designated for the control of contagious disease and the promotion of public health. The sanitation officer is responsible for supervisory and consultant services in environmental sanitation. This involves milk, food and water supply, sewerage and excreta disposal, and channels of infections in the chain of disease trans-7 mission such as insect, rodent, and animal control. The public health nurse is a teacher in the care of the infectious case in the home, school, and community. In clinics and nursing conferences she teaches the positive approach to maternal and child health. In the home she advises on all phases of family living which will contribute to a healthier home. She follows up the communicable disease case of the private physician in home care with the idea of preventing the spread of the disease to other members of the family. In schools she instructs the teachers in referrals for medical examinations, in the control of communicable diseases, and makes follow-up visits in the home for the correction of physical defects found in the school child. The clerks are responsible for health records, reports, and the clerical services involved in county health work. The laboratory technician in health departments having laboratories renders a valuable service to local physicians as well as the health officer in the laboratory diagnosis of disease. A contribution is made to the community in the examination of water and milk samples. The health educator assists health department, school, and community groups in helping to solve health problems by extending, expanding, and coordinating educational services being rendered. She enlists community support of health services by encouraging interpretive educational programs in groups which lend community support and yet who may not come to the health department for personal services. She promotes and assists in a planned organized community wide health education program using all available media and tools such as the radio, newspaper, pamphlets and booklets. SPECIALIZED SERVICES OF THE STATE DEPARTMENT Vital Statistics A record of all births, deaths, stillbirths, marriages and divorces in the State are kept and filed in a fire-proof vault for safe-keeping after they have been analyzed and tabulated. The death rate in Mississippi in was 9.6 per thousand population, the lowest in the past 10 years with the exception of the year, 19U2, Maternal deaths have shown quite a drop in number during the past three years, I4.O per thousand live births. Ten years ago the maternal death rate was 7.3 per thousand live births. Deaths under one year of age also have declined from a rate of 1+6.7 in 19U3 to 1+0.1+ in 191+5) • Tuberculosis deaths have declined 37 per cent during the past h years. There were 68 £ deaths from tuberculosis in Mississippi in 19h%» Cancer deaths have increased 6 per cent during the past h years. Deaths from heart disease have increased 10 per cent during the same period. The passage of Senate Bill #31 in the Mississippi Legislature authorized an increase of practically fifty per cent in fees to registrars for birth and death certificates filed by them. This law further provides that a county may appropriate up to fifty dollars a month exclusive of fees paid for certificates. About fifty counties of the State have appropriated funds for the registrar’s travel. This enables the gathering of more accurate information throughout the county. Mississippi is the only state known to provide travel expenses for registrars. Full-time registrars have been established in ten counties. Public Health Statistics All vital records,, communicable diseases sent in by private physicians-, activities of county health departments, venereal disease contact records, emergency maternal and infant care records and such data are mechanically tabulated in this division. Monthly, quarterly, semiannual, and annual tabulations on cases of reportable diseases are prepared. Special studies are made upon request. Examples of some of these studies are premature births in Mississippi from 19U3 through 19U5. Charts, graphs, and such statistical displays are made for use in professional and lay educational programs. Preventable Disease Control Developments have been in case-finding programs of major communicable diseases and in the early diagnosis and treatment of such cases with the purpose of pre- venting their spread. Mobile X-ray services and facilities in local health departments are making state-wide surveys possible in the location of tuberculosis cases. The Mississippi State Sanatorium is increasing and enlarging its facilities for treatment of cases. Mass blood testing surveys are being initiated to aid county personnel in investigating programs for locating venereal diseases. Three public health centers are conveniently located geographically for the rapid treatment of syphilis with no cost to the patient. Gonorrhea is treated in the local health departments. Typhus fever continues to require much attention. Since fleas living on rats transmit the endemic form of typhus to man, rat control programs are being initiated in such areas. Malaria seems to be under control as the result of proper drainage, screening, the use of DDT, and medical treatment of infectious cases of malaria. Blood surveys have been made in areas of impounded waters to show the necessity for control measures. Undulant fever has demanded popular interest. Education in the pasteurization of milk and testing of cows for Bang’s disease has been the front line of attack. Cancer control measures have been organized through a cooperative program between the State Board of Health and the Mississippi Division of the American Cancer Society. Education as to signs and symptoms, available facilities and funds are being emphasized. Smallpox, diphtheria and typhoid fever can be controlled by immunizations which are available to every citizen. The State Department of Health provides whooping cough vaccine and serum globulin for measles to private physicians for administration. Sanitation Environmental sanitation is a basic contribution in disease control by preventing the spread of disease transmitted through food, water, milk, excreta, garbage, insects, rodents, and animals. Public and private water supplies are tested for safety. Advisory assistance is given in providing safe water supplies, safe waste and swerage disposal. Special emphasis is placed upon the sanitation of public institutional buildings. Routine inspections are made of public eating, drinking, and food production places especially dairies and abattoirs. Measures aimed at rat control such as vent-stoppage, garbage disposal, rat- run dusting with DDT and rat poisoning are for the purpose of typhus fever control. The production of safe milk is receiving major emphasis. Milk is our most perfect food aid is a vital part of an adequate diet in every individual from birth to the grave. For this reason it should be safe for human consumption. Cows tested and free from Bang’s disease and tuberculosis, pasteurization, and milkers free from communicable disease help to insure the safety of milk, A clean and sanitary environment contributes to safe production. Diseases which can be trans- mitted through unsafe milk are: undulant fever, typhoid fever, scarlet fever, septic sore throat, diphtheria tuberculosis, and numerous others, DDT spraying in endemic malaria areas has proved effective in the contra! of malaria. Concerted efforts are being made in enforcing the 19U6 law relating to the inspection of frozen food locker plants. Industrial Hygiene Mississippi’s developments in industry justify an expanding industrial hygiene program. Physical examinations, immunizations, X-ray for tuberculosis, and laboratory tests are provided workers in industries. Factories are inspected for safety, sanitation, and freedom from occupational poisons and hazards. Nutrition and educational programs are being initiated. Full-time industrial nursing and sanitation advisory consultation are provided. Laboratory Services Reliable diagnostic services are provided practicing physicians and health officers in the state and county health department laboratories. Examples of these services are examinations of specimens of blood and spinal fluids for diagnosis of syphilis, smears for microscopic diagnosis of gonorrhea, Darkfield examinations for the diagnosis of syphilis, examination of feces and urine speci- mens for diagnosis of typhoid, paratyphoid and dysentery, and for the identifi- cation of intestinal parasites; examination of animal brains for the diagnosis of rabies, examination of blood for typhus and malaria, examination of milk and water samples from public and private supplies. Colorimetric determinations «n corn meal, grits, flour and bread to determine vitamin content of the various products are made. Gryoscopic examination of milk for the determination of added water have been made. A clinical laboratory advisory service is maintained for the hospital and clinic laboratories of the state. A well trained clinical laboratory technician has been employed for this service. Refresher courses have been given personnel of private hospitals. Special Services for Children Conservation of child health begins before birth through services rendered in the maternal and child health program. Medical and nursing supervision of mothers and babies is provided through county public health nurses and health officers. Nutrition of the mother and child receives major emphasis. Attractive educational materials have been prepared on maternal and child health. A number of projects have been initiated to train personnel in the field of maternal and child health services, such as postgraduate scholarships in obstetrics, gynecology and pediatric nursing. Three scholarships in nutrition have been awarded this year. Internships and externships have been promoted for medical students in county health departments. Institutes have been held with Farm Home Administration supervisors and administrators on health education and disease control programs. A recent development is the promotion of premature infant centers in hospitals desiring these facilities. Dental Health Dental education, inspection and hygiene services are provided by specially trained dental hygienists assigned to counties and districts. Program planning and consultant services are provided by the state supervisor. Child Guidance Opportunities for referrals for treatment and education in child guidance of normal children are provided through mobile clinics. These clinics are held in areas geographically located so as to make this service available to all Missis- sippi children eligible for referral. The personnel of the clinic is composed of a psychologist, psychiatric social worker, and psychiatrist. School Health The state department of education and the state health department share jointly the responsibility for health services and health education of the school age child. The school health unit offers consultant services to local health and school personnel. Medical corrections, nutrition, teacher training, physical education, health curricula, and environmental sanitation receive major emphasis. Public Health Nursing Public health nursing is a service that works closely with all health personnel in programs throughout the state which in no small part depend for their execution upon the work of public health nurses. It sets standards for the employment »f nurses as well as for their practice, and recruits personnel for positions with the state and local health departments. Since the continuous development of the worker is a requisite of all good professional work, the division plans and supervises the orientation of new employees, recommends individuals for advanced university study in public health nursing and arranges institutes and conferences as part of an in-service education program. Library The state board of health medical library has around 6000 well selected volumes for the use of physicians, public health personnel and interested lay groups. Periodicals on health and medical subjects are available. Current manuals and textbooks covering basic sciences are provided. Health Education Services are directed toward the promotion of understanding as to what constitutes optimum health, how it is attained, how disease is transmitted and how disease can be prevented and controlled. Understanding comes from correct and adequate information. Every known disease and technique is employed to disseminate information and bring about understanding. Nine counties have employed trained public health educators to promote an organized program of health education which will meet the needs of the county. These health educators are jointly employed by public health and education. Assistance is given teachers in improving the quality of health education of the school child. Study groups are organized and promoted among community groups. The services of agencies contributing to health are coordinated through planning conferences. An informational service is organized and promoted. The educators are consultants on matters of health education every summer in college sponsored workshops. The state office channels and distributes health information through a film library, pamphlet and poster library, weekly radio programs, and news releases* Assistance has been given in the preparation of materials on diet in maternal and child health, undulant fever, tuberculosis and the use of DDT. Monthly contributions are made to five magazines. Assistance has been given to several state agencies in planning health education programs. Colleges, U-H Clubs, public schools. Home Demonstration Club leaders. Farm Home Management supervisors and administrators and voluntary health and welfare agencies are among those receiving such assistance. Educational programs receiving major emphasis are: school health services, nutrition, tuberculosis, venereal disease, cancer, infantile paralysis, sex education, child guidance, typhus control, undulant fever, care of the premature infant, sanitation of the environment, foodhandling, hookworm, pediatric services, hospital facilities. All public health workers contribute to the educational program and each is a health educator in his field. Coordination, however, promotes integrated understanding, through which better and stronger citizens are produced.