Chapter 1: Community
Increase support to and involvement by communities in developing healthy and environmentally sound communities
Attaining the vision of healthy people living in healthy communities is possible only if the community takes steps toward changing conditions for health. Public health has been vital in changing community health conditions through the years. By controlling disease outbreaks, vaccinating large populations, and overseeing safe food preparation, DHEC has carried out core public health functions. Environmental concerns also have great influence on the health of a community. Clean water to drink, safe air to breathe, and a landscape free of contamination are all necessary for good health. DHEC works with communities to show them how important and interconnected public health and environmental protection are to the overall wellness of their citizens.
DHEC, federal and local responders handle mercury event
A call in May 2011 from the town of Inman in Spartanburg County about several people coming into contact with elemental mercury led a number of agencies into action. First responders thought the mercury had been dumped in the grassy area between two homes. People on the scene said the children involved had scooped up some of the material and carried it into their yard. The inside of their home was thought to be contaminated as well.
Notification was initially made to DHEC’s Environmental Quality Control area. An on-call staffer from that branch of the agency notified a member of the agency’s Health Services section. DHEC health personnel were dispatched to coordinate and to respond to Spartanburg Regional Medical Center where the individuals were transported. DHEC personnel also coordinated with staff from the local EMS who had transported the affected family members.
Within an hour of the initial notification, internal communication was underway among the various groups within DHEC as well as communication with – and requests for assistance from – the U.S. Environmental Protection Agency.
Within 24 hours of the initial response, the hospital and DHEC had released the affected family. Less than 72 hours after the initial report, the home had been stripped of contaminated materials and deemed safe by the EPA for the family to return home. The immediate and well-coordinated efforts of those involved, from the local, state and federal response, prevented further spread of the contamination and further health effects to the family members involved.
DHEC selected for CDC program
DHEC has been selected by the national Centers for Disease Control and Prevention to participate in the National Environmental Public Health Tracking (EPHT) Network.
The primary purpose of South Carolina’s participation in the National EPHT Network is to provide a systematic, ongoing and sustainable approach for tracking environmental hazards and exposures to identify opportunities for public health intervention. The program provides access to both environmental and health-related data that can be utilized by public health practitioners, researchers, legislators, regulators, industry and the public.
Having the S.C. Environmental Public Health Tracking Network available will result in an increased level of awareness that ultimately improves the health of both individuals and the public.
Blue Ribbon Committee takes on shoreline management recommendations
South Carolina’s coastal communities and beaches are vulnerable to chronic and episodic erosion due to shifts in sediment pathways, human alterations, and coastal storms and hurricanes. Coupled with the long-term impact of a gradual rise in sea level, these factors make the coast as dynamic as it is beautiful. To better understand and prepare for these changes, DHEC established a multi-year Shoreline Change Initiative in 2007 to foster collaboration among coastal researchers, managers, local governments and other stakeholders.
As an integral part of this initiative, DHEC established a 23-member external Shoreline Change Advisory Committee (SCAC) comprised of a broad cross-section of individuals including scientists, coastal managers, municipal officials, developers, conservationists and legal professionals. In April 2010, the committee released a final report, containing 13 general recommendations, and numerous sub-recommendations for consideration by public officials and decision makers. Subsequently, in October 2010, the DHEC Board selected the membership of the Blue Ribbon Committee on Shoreline Management. Representing a broad range of interests, the Blue Ribbon Committee will develop specific regulatory recommendations to enhance the management of fragile coastal resources and habitats, improve coastal planning, and prepare S.C. for emerging challenges and opportunities for our beaches and estuarine shorelines.
Health advisory signs posted on natural water bodies
Since 2008, DHEC has posted health advisory signs on natural water bodies to notify the public of two health concerns. One set of signs advises the public of the dangers of consuming fish that contain high levels of mercury. The other signs warn the public about swimming in water with high levels of bacteria. Signs are posted where they are most likely to be seen by people using the water for recreation.
For fish consumption advisories regarding high mercury levels, DHEC has posted signs on water bodies at public boat landings. The advisories were based on data collected from DHEC’s fish tissue monitoring program, as well as advisories issued by the U.S. Environmental Protection Agency and the U.S. Food and Drug Administration for saltwater fish. Currently, signs are posted at 50 saltwater public boat landings and 329 freshwater public boat landings.
For swimming advisories, DHEC placed signs near natural water bodies if they met the following three criteria:
- readily accessible to the general public
- heavily used for swimming
- exceeds the fecal coliform bacteria standard for swimming
Swimmers are advised not to swim, due to the risk of swallowing the contaminated water and getting sick. Signs have been placed at 22 water bodies that meet these three criteria.
All signs include a website address and a toll-free telephone number for more information.
Nursing home rating system
Ensuring appropriate care for the elderly and vulnerable residents living in S.C. nursing homes poses several unique challenges for DHEC. In addition to providing state regulatory oversight, the agency is also responsible for ensuring compliance with federal standards. DHEC licenses 194 nursing homes with a resident population of 1,800. Not only is the population of the elderly and vulnerable growing, consumer expectations and demands are expanding and changing. In recent years, there has been a substantial increase in the demands of residents and their families seeking information regarding the outcome of regulatory inspections and the regulatory compliance history of nursing homes.
To address the information request of residents and their families, the Centers for Medicare and Medicaid Services (CMS), which has federal oversight for Medicare and Medicaid reimbursements, created a Five Star Quality Rating System. The system was developed to help consumers, their families and caregivers compare nursing homes more easily, and to help identify areas of individual concern for which they might have questions. The Nursing Home Compare website now features this quality rating report.
The website is federally maintained and updated monthly.
DHEC collects and provides the data that is used for the rating system. Information from the inspections of each nursing home and complaint investigations for the last three years is one component of this rating system. Staffing information provided by the nursing home provider and collected during the inspection process contributes to the staffing ratings. This innovative rating system, in conjunction with DHEC regulatory oversight, will continue to improve and enhance the quality of life, safety and health of those living in nursing homes.
Smoke-free policies protect against exposure to health hazard
DHEC is working to increase the number of smoke-free indoor places throughout the state by developing model tobacco-free policies tailored to schools, hospitals, faith-based settings, worksites and recreation facilities. These policies outline how organizations can successfully go tobacco-free. Fifty-one S.C. hospitals have adopted tobacco-free policies to include buildings and grounds. As of July 2011, 33 of the state’s 85 public school districts have adopted comprehensive tobacco-free policies. Five counties and 36 cities and towns have adopted smoke-free workplace ordinances to protect citizens from exposure to secondhand smoke.
Program helps faith community implement tobacco-free policies
Mothers Eliminating Secondhand Smoke (M.E.S.S.) — a partnership of DHEC, Hold Out the Lifeline: A Mission to Families, and various faith-based and community groups — encourages women to promote the adoption of tobacco and smoke-free policies in homes, vehicles, schools, recreational facilities and faith-based organizations. DHEC and M.E.S.S. also developed Lighting the Path, a campaign encouraging churches to adopt tobacco-free policies, and hold educational sessions about the dangers of tobacco use. Since the program began in 2007, more than 100 churches have adopted comprehensive tobacco-free policies.
Merging faith and health
DHEC has been working with African-American churches across the state to address cardiovascular health issues. The implementation of tobacco free policies and activities to educate and inform the congregants about the tobacco prevention initiative has been integral to efforts to improve cardiovascular health. At the conclusion of the project last year, 20 of the 25 targeted churches implemented tobacco use prevention policies and the remaining churches were in the process of having policies vetted and approved by leadership. Additionally, on March 20, 2009, the Seventh Episcopal District of the AME Church signed a policy for tobacco use prevention on all church grounds. This policy applies to the 609 S.C. churches.
Giving safety a boost in South Carolina
Motor vehicle crashes are the number one cause of fatalities in children and adults from ages 1 to 44. The observed misuse rate of child restraints in S.C. is approximately 85 to 90 percent.
DHEC provides child safety seat education and instruction to parents, caregivers and medical professionals. Agency staff members partner with Safe Kids Coalitions, law enforcement, fire departments and emergency medical services to set up fitting stations. Child safety seats are distributed through these sites when parents and caregivers present with safety seats that have missing parts and pieces, are outdated, have been in a crash or are on recall. . DHEC maintains a permanent CPS fitting station in which parents can make an appointment to have their car seats inspected for proper use and installation.
Keeping children safe while operating ATVs
A multi-year effort by a coalition of partners culminated in the reintroduction of All Terrain Vehicle (ATV) safety legislation in 2010 and final passage of the law in May 2011. South Carolina joined 44 other states with similar legislation. In addition to DHEC, the coalition includes the S.C. Children’s Hospital Collaborative, Safe Kids South Carolina, Child Law Office, Specialty Vehicle Institute of America, ATV dealers and the family of the boy for whom the law is posthumously named.
“Chandler’s Law” prohibits children under the age of six from operating an ATV and calls for all under the age of 16 to complete a safety course, wear a helmet and eye protection. Additionally, no one may ride an ATV in violation of the Manufacturer Age Restriction Warning Label. The law allows exceptions for children who are on family farms, hunting or on private property under the direct supervision of their parents or guardians. On average, six children die from ATV-related injuries in S.C. each year. From 1999-2009, 63 children died from ATV accidents (SCDHEC).
Federal funding for diesel emissions reduction
In 2009, the U.S. Environmental Protection Agency awarded more than $1.7 million to DHEC as part of the American Recovery and Reinvestment Act (ARRA) to reduce diesel emissions around the state. DHEC leveraged these funds to more than $2 million to reduce emissions from on-road, non-road and marine sectors. Projects included engine retrofits, engine replacements or repowers, vehicle replacements, idle reduction and the use of cleaner fuels. In 2010, DHEC completed 19 projects implemented with the ARRA funding. This grant program has had a positive impact on the air quality and public health in South Carolina, and has also helped to retain and create jobs. These projects are estimated to reduce 1,800 tons of nitrogen oxide and 70 tons of particulate matter (PM) over the lifetime of the equipment.
Since 2008, DHEC has also continued efforts in the annual state DERA allocation program. Funds from this program will allow the S.C. Public Railways to complete their third engine repower of a locomotive that services the S.C. State Ports Authority terminals. Other projects that have been implemented under the state DERA program include engine repowers, engine retrofits and the use of cleaner fuels. In addition to helping to create and retain jobs, these clean diesel projects will reduce asthma attacks, other respiratory ailments, lost workdays and premature deaths.
Abandoned vessel removal program gains new partners
DHEC continues its successful program aimed at removing derelict and abandoned vessels that threaten coastal waterways. By forging partnerships with municipalities, DHEC has raised greater awareness of the challenge and leveraged local support for the removal of priority debris items. In 2009, partnerships for additional removal operations were established with the Town of Mt. Pleasant, and the cities of Georgetown and Folly Beach. In 2011, a new partnership was also formed with Horry County for abandoned vessel removal. Since 2004, more than 80 vessels and large debris items have been removed from coastal creeks and rivers. Although much work remains to be done, these removal projects have been invaluable to our efforts to protect and restore the safety, health and beauty of our coastal waterways and marshes.
In 2010, DHEC partnered with other resource agencies to develop a volunteer-based program that recruits recreational boaters to assist with the identification and preliminary assessment of abandoned vessel sites. Once verified by DHEC staff, the detailed inventory of sites will be used to raise awareness among stakeholders and decision-makers and substantiate future removal funding requests.
Fire and life safety in health care facilities
Reducing the number of tragic deaths associated with fires is a goal shared and supported by every S.C. citizen, yet in the first 60 days of 2011, there were 19 fire deaths in the state. Assuring a safer environment in the health care facilities DHEC licenses and regulates saves lives, as well as, millions of dollars attributed to property loss.
Issues related to fire and life safety are particularly challenging in health care settings that often involve people who are unable to evacuate without assistance. Six DHEC staff members are state-certified fire marshals. They ensure that all licensed health care facilities are in compliance with licensing standards and state adopted fire and building codes.
The primary emphasis of the program is to ensure the safest possible environment for patients and residents. These preventions are accomplished both through the design phase of the facility and its subsequent maintenance. Day-to-day operations are monitored through routine inspections, follow-up inspections and investigations. Inspections include examining door operations, chemical labeling, personal safety and equipment accessibility. DHEC also conducts investigations for fires, life safety accidents or other significant safety incidents at licensed facilities. If inspections or investigations identify potential or actual fire and life safety threats, corrective actions are required to address the hazardous conditions.
Obesity major contributor to poor health in SC
South Carolina’s obesity rates have more than doubled since 1990. In 2009, S.C. had the 14th worst overweight or obesity rate in the nation, with more than 67 percent of adults either overweight or obese. During the past year, DHEC, through its many partners, has supported initiatives that promote healthy eating and active living. Some of the projects include:
Local Nutrition and Physical Activity Coalition
The Recommended Community Strategies includes a strategy on the value of local communities organizing to impact change to promote healthy eating and active living. In S.C., there is an increasing interest and commitment from local communities to mobilize and work together to increase access to healthy foods and to create safe places to be physically active. In 1993, there was one local coalition.
There are currently more than 25 local coalitions addressing healthy eating and active living in S.C. These coalitions champion efforts within local communities and settings to address many different settings including child care; schools; healthy systems; worksites; as well as how our communities are designed. This growing capacity and community commitment is critical to the efforts of S.C. to ‘eat smart’ and ‘move more.’
Emergency Medical Technician training
When urgent medical emergencies occur, we all know that dialing 9-1-1 will bring immediate medical help. We depend on this service as a way of life. We give very little thought to what it takes to maintain this reliable emergency system.
One of the many components of this system involves ensuring that the state’s emergency medical technicians (EMTs) have the knowledge, skills and equipment necessary to respond to a variety of emergencies. Providing more than a taxi ride to the hospital, EMTs are able to perform life-saving procedures while transporting their patient. They can shock the heart with electricity to make it beat, insert a breathing tube or give various medications depending on the situation.
There are three levels of EMTs in S.C., EMT-Basic, EMT-Intermediate and Paramedic. DHEC is responsible for determining the educational and training standards for the these three levels. DHEC also establishes the standards for medications used in the field and provides approval and oversight for each of the state’s EMT training institutions. All EMTs and paramedics must have a valid certification issued by DHEC. Certification is valid for four years, during which EMTs must obtain at least 144 hours of continuing education and have their skills verified by an EMS agency.
The availability of emergency medicine is critical to the well-being of every citizen in this state. The training and certification requirements of DHEC ensure that quality emergency medical care is provided when the citizens of this state need it most.
Best Chance Network reaching high-risk populations
To address breast and cervical cancer, DHEC coordinates the Best Chance Network (BCN). BCN is funded through the national Centers for Disease Control and Prevention. Screening and diagnostic services are offered throughout the state by a network of more than 250 health care providers. The American Cancer Society participates as a partner in the program by providing outreach services to recruit eligible women into screening, and providing training and consultation to screening providers. In South Carolina, the program pays for breast and cervical cancer screening for women ages 47-64 who are uninsured and have family incomes at or below 200 percent of the federal poverty level.
During the program fiscal year ending June 29, 2011, BCN provided screening and follow-up to more than 9,000 women. African-American women accounted for 63 percent of the women screened. Efforts to reach this high-risk population continue as the agency strives to eliminate this health disparity.