Tobacco Documents Online

---

t ! I 1 : Robert ~. Harmon, M.D., M22L In January 1990, as this publication was about to go to press, Dr. Robert Harmon announced his resignation after accepting a post as Administrator of ~ federal Health Resources and Services Ad~ra~stration in Washington, D.C. Dr. Harmon had served as director of the Mixsouri Department of Health from January 1986 to January 1990,Among his many accomplishments, he improved the department's. relatfonships with city and county health departments, developed a model AIDS prevention program, helped to create an Offu:e of Minority Health, and launched an aggressive tobacco awareness campaign that improved clean indoor air policies statewide. The stories and articles that follow his me~age here reflect many of these actu'evements. Missoud Department of Health From the Director When I accepted' the position of Administrator Of the DHHSFUSPHS Health Resources and Services Administration, it was with mixed feel- ings. I was pleased to m~e on the challenge of nmning a large federal health agency, but sony to leave my friends and colleagues in DOH and " Missouri. It has been a tree pleas- ure to work with the Governor and his staff, DOH employees, local health officials, legisla- tors, and many other Missourians to promote the public health agenda in Missouri. It appears that real progress has occurred in launching the Department of Health, reducing tobacco use, addressing minority health issues, controlling AIDS, improving the state/local public health parmership, promoting mammal and child health, and fighting chronic diseases. It was a real te~n effort. Governor Ashcroft has pledged to continue this agenda, tie has ap- pointed Charlie Stokes, an outstanding individ- ual, to ~ Interim Director effective Feb. I. A high le~,el s~areh com- mitme will he interview- ing top candidates ~o select the next Director as soon as possible. I am confident that DOH will be in good hands. The challenges at.HRSA are immense. I will be working closely with Dr. Louis Sullivan, DI-IHS Secretary; Dr. James Mason, Asst. Secretary for Health; Dr. Antonia Novelle, Surgeon Gen- eral Designee; Dr. Bill Roper, CDC Director, and others on such national issues as infant mortality, minority health, AIDS/HIV care, the maldistribution of health professionals, homeless health care, and tl~ need to strengthen our federal/state/local public health system. Let's look at it this way. DOH isn't just losing a Direetor...it's gaining a friend in the federal government. With 57% of DOH funds being federal, that can be important. Thank you for all the support you have given me and my wife Ca~_l over the past four years. I especially appreciate the amazing volume of congratulations messages over the past few weeks. We will miss you. I hope to see many of you as I return over the next year to speak at several events. Keep up the good work! 3 :~ -.... ..~ .~ ;. I TI2506-0917

i I I B, iennia.l Rep or t Missouri Department of Health John Ashcroft • Governor Robert G. Harmon, M.D., M.P~-I. Director Charles Stokes, M.~I. Deputy Director MISSOURI DEPARTMENT OF P.O. Box 570. 1738 East E~m Jefferson City, MO 65102 ~14/751-6400 TI2506-0918

Missouri Department of Health Table of Contents From the Director ................................................. 3 Board of Heal .th ......................... : .......................... 8 Department Organization .... : ...... : ....................... 10 Financial Summary ~ ........................................... 11 Office of the Director ......................................... 12 Chronic Disease Prevention and Health Promotion .... .'. ............................... 14 Environmental Health and Epidemiology .......... 24 Health Resources ............................................... 34 Local Health and Institutional Services ............. 37 Maternal, Child and Family Health .................... 43 Legislative Update .............................................. 53 District and County Health Sercices Map .......... 62 Introduction Divisions Addenda TI2506-0919

Biennial Report, FY 1988/1989 3tate B oard of Health :Tames M. Whittico, Jr., M.D. Chairman August, 1987~March, 1989 A physician in private practice in St. Louis. Thomas C. Schnurr, M.19. A practicing physi~z'an with Sale Hospital, Inc. in Neosho. Thomas & Thomas Chairman March, 1989-:-present Corporaie Director of Governmemal Affairs for Christian Health Services in Columbia. Elias E. Zh'ul, D.O. A practicing physician witk the Hiland Medical Group, [nc. in Kansas City. Roger D. Nail, D.O.S. A practicing dentist in Je~'erson City. William J. Poe, R.P h. A pharmacist in St. Louis. W.C. (Chad) McCoy, D.D.S. July, 1987--Nov, 1987 A practicing dentist in Chillicothe. Marilyn If. Nelson, RJV. June, 1986--April, 1989 A RegL~tered Nurse Team Leader at Research Medical Center in Ka~tzs City. .'% TI2506-0920

. The State Board o.f Health con sists of seven members appointed by the governor, by and'with tim advice and consent of the Missouri Senate. Members oftbe Board of Health serve four-year terms, with the terms of two members ending each year. A member may serve no more than two terms. Missouri Ia,~ (section 191.400) specifies that t~e members of the Board of Health shall be physicians and surgeons licensed by the State Board of Registration for the Healing Arts of Mis- souri; one member shall be a dentist licensed by the Missouri Dental Board, and the other persons other than those licensed by the State Board of Registration. for the Healing Arts or the Missouri Dental Board and shall be representa- tive of those persons, professions and busi- nesses which are regu- lated and supervised by the Department of Health and the State Board of HealflL Duties and services of the : Advises the director of the Department of Health regarding the priorities, policies and programs of the pamnent. • Reviews all rules promulgated by the Missouri Department of Hcalth~. • Reviews the budget of the Department of Health. • Administers the State Hospital Subsidy Program, the Medical and Osteopathio Student Loan Program and Family Practice Residency Program. Board of Hcal~ include: The defeat of"'Premier" Patrick Reynolds, grandson of tobacco baron RJ. Reynolds, tes~fiez against Premier, a nicotine-delivery deWce, at the Board of Heahh hearing on Dec. 16,1988. The board unanimously passed a resolution to ask the FDA to declare Premier a drug, ask R,L Reynolds to stop test marketing Premier in Missouri; ask retailers to voluntarily return the product to distn'butors, and advise consumers not to use Premier until the FDA makes its deeL'~on. R JR withdrew Premier from the market on Feb. 28,1989. TI2506-0921

, DIVISIONS Missouri Department of 1 I i I ! TI2506-0922

FY 87 . FY 88 FY 89 Missouri Department of Health Financial ,Summary General Revenue $44,019,674 $ 45,509,577 $44,540,623 Federal 49;455,344 51,785,621 67,210,559 Other 19,414,482 19,562,680 19,999,864 Total $112,889~00 $116,857,878 $131,751,046 Department of Health $ 80,284,888 $ 85,471,744 $106,426,336 Ellis Fisehel State Cancer Center 9,114,129 12,164,029 9,407,489 Missouri Rehabilitation Center 11.,708,414 11,189,391 11,015,513 Total $101,107,431 $108,825,164 $126,848,338 Dcparmmnt of Health 641 725 818 Ellis Fischel State Cancer Center 283 283 281 Missouri Rehabilitation Center 456 450 448 Total 1,381 1,460 1,547 H. Douglas Adams, M.P A. Director Office of Admz~istration Appropriations Expenditures Employees 11 TI2506-0923

• Biennial Report, FY 1988/1989 DOH I adds Office of Minority Health 12 n Missouri and in most states, being born into the .minor- ity population means having a shorler life span, a lower chance of'seeing your first birthday, and a greater chance of con- tracting cancer, diabetes and other chronic dis- eases. In a~mpt re address rite disparity between the health status of black, hispanic, native Ameri- can, asian pacific and white Missourians, an Office of Minority Health has been estab- ]isbed by the General Assembly in the Depart- ment of Health (DOH). The new office will monitor h~alth programs and minority health status and report directly to DOI-I director Dr. Rober~ Harmon. "Minorities, espe~ialty blacks, have a higber rate of death due to cancer, cardiovascular disease and stroke, diabetes, homicide and accidents, chemical dependency, infant mortality and A]DS,"'said Ennis McClanahan, chief of the Bureau of High Risk Jcu~e Herren was named Chief of the new Office of Minority Health in October 1989. Intervention and acting coordinator of the DOH Minority Health Advi- sory Committee. Although the life expec- tancy of all Americans has increased to 75 years, the life expectancy of a black American is 69 years, McClanaban said. The Office of Minority Health will develop educational and cultural awareness programs, promote inter-agency cooperation, review programs and legislative proposals, and develop community resources, according to legislation creating the office. The state is in the process of hiring a cider, McCla- nahan said? "All state health pro- grams serve minorities, but due to the disparities in health status, we n~ed more programs targeted toward minorities to address these problems," Mc~lanmhan sal& According to DOH statistics, blacks died at a significantly higher rate~. The. "excess death~" reported reflect the difference between the number of blacks who died and the number who would have died if they had died at the same rate as the white population. , Hear~ disease-16 percent higher • Stroke-31 percent higher • Cancer-39 percent higher. Cancer, the second leading cause of death among Missourians, and AIDS arc me only major disease categories on the increase. • Homicide-slightly more than 10 times the rate. Homicide is the leading cause of death among black males between the ages of 15 and 34. • Diabetes-slightly more than twice the rate. Black women die of diabetes at a higher rate than men. TI2506-0924

i I. I Office el the Director • Liver Disease and cirrhosis- about twice • Infant mortality- 69 percent higher. Nation wide, infant mo~tality accounts for 80 p~rcent • of rite excess deaths of blacks and minori tics over whites, It i.~ the eighth leading cause of death among blacks in Missouri. Missouri's morality among blacks, is not significantly different than the national average, except in homicide, where the. Missouri rate is 41 percent greater. The followihg initiatives have been sponsored, by DOH to reduce infant mortality, and encourage smoking cessation and chronic disease risk reduction in the minority population across the state. The programs arc: Operation CldldSave, Chronic Disease Risk Reduction Project, CommuniLT Organization for Smoking Cessation Among Blac~ Ameri- cans, St. Louis Regional Cancer Controt-Coatition, Hypertension Screening Projects, and Smoking Cessation in Pregnancy Project. Also, DOH sponsors AIDS prevention pro- grams in the Kahsas City, St. Louis and Springfield metropolitan areas Which are designH to provide local health departmenls with input into the design and implementation of state and natiuonal long- range goals. Uacqudine Herren was hired as chief on October 2, 1989. 2Figures compared arc overall age-adjusted and age.specific mortality rat~s for black and white Missouri residents for 1975-1985 adjusted to the 1980 U.S. population. • Source: Missouri State Center for Health Statis- tics. '7nfant Mortalityis the eighth leading cause of death among blacks in Missouri." Director's Office - Overview As chief executive officer, the department director is responsible for the management of DOH and the administration of its programs and services. The deputy director assist~ the director in the management of the department and acts for the director in his absence. The department's general counsel and governmental affairs staff are assigned to the director's office. Four other offices report to the director and deputy director: the Office of Minority Health, Office of Personnel and Training, the Office of Public Information, and the Office of Information Systera~. Charles Stokes, M.Ed. Deputy Director 13 TI2506-0925