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Healthy People Living in Healthy Communities

Chapter 2: Health

Improve the quality and years of healthy life for all and eliminate health disparities

South Carolina’s public health system is made up of a variety of partners and stakeholders. When all public and private health care providers, voluntary entities, associations and organizations join together, it benefits the entire system. This approach brings collective wisdom, assets and resources together to address public health and environmental issues that help shape the quality and years of healthy life for all.

To improve the overall health of the state, a concerted effort to address the racial and ethnic disparities in health outcomes is also critical. DHEC remains committed to working collaboratively with others on initiatives to address this issue.

Promoting healthy lifestyles

Tobacco use and obesity continue to be major contributors to poor health in South Carolina. During the past year, DHEC, through its many partners, has supported initiatives that will reduce the burden of tobacco use and promote healthy eating and active living.

Tobacco largest cause of preventable death

Tobacco use is the leading preventable cause of death and disease in South Carolina. It causes heart disease, lung cancer and other respiratory illnesses, and complicates chronic diseases.

The prevalence of smoking among S.C. adults 18 and older has steadily declined during the past eight years from 24.3 percent in 2004 to 21.1 percent in 2010. South Carolina’s rate is still above the Healthy People 2020 objective of 12 percent. The cost to our state due to smoking has escalated to more than $1 billion per year in direct health care expenses and another $1.94 billion in lost productivity.

To alleviate this health and economic burden, DHEC works to help South Carolinians quit using tobacco, promotes policies that protect residents from exposure to secondhand smoke, implements programs to prevent youth from starting tobacco use and addresses health disparities.

Project designed to help health clinic clients quit tobacco

Following the implementation of the Tobacco Cessation Collaborative project in 2008, DHEC successfully adopted an agency policy “2As+R” adapted from the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence, 2008 Update. This protocol outlines that health care providers ask patients about tobacco use, advise them to quit and refer them to cessation resources. DHEC providers are referring clients to the S.C. Tobacco Quitline, which offers comprehensive tobacco treatment services free of charge to all South Carolinians. Since the inception of the policy, DHEC providers have referred more than 1,400 clients to Quitline services.

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Sharon Biggers
(803) 545-4461

Fighting Chronic Diseases

Chronic diseases are the most prevalent and costly health care problems in South Carolina. Many chronic diseases are lifelong conditions, and their impact lessens the quality of life not only of those suffering from the diseases, but also of their family members, caregivers and others. DHEC partners with many community organizations, agencies and health care providers to prevent and reduce this burden.

Diabetes continues to cause significant death and disability

According to the national Centers for Disease Control’s 2011 Diabetes Fact Sheet, diabetes now affects 25.8 million people in the U.S. population. An estimated 350,000-400,000 people in S.C. have diabetes. More than 100,000 people have diabetes but have not been not diagnosed. South Carolina ranks seventh nationally in diabetes prevalence. Diabetes is the seventh leading cause of death in the state.

Approximately one in seven African-Americans in S.C. has diabetes – the 16th highest rate of diabetes among African-Americans in the nation. The prevalence of diabetes in the state increases with age – a dramatic increase can be seen among those 35 and older.

Uncontrolled diabetes can lead to many complications including blindness, heart attacks, strokes and amputations. It is the most common cause of kidney failure.

Diabetes Prevalence By Age Group

Data Source: SC BRFSS (2010)

Diabetes hospital costs in S.C. have increased by 50 percent in the past five years. In 2009, the total amount for hospital charges related to diabetes diagnosis in the state was $241.5 million.

Preventing and controlling diabetes

Diabetes complications can be prevented or delayed through control and management of the disease. There has been a decreasing trend in lower extremity amputations in people with diabetes during the past five years.

The A1c test is the gold standard measurement of a person's average blood glucose level over the most recent three months. The suggested target for a person with diabetes is below 7. In South Carolina, 68 percent of blacks and 73 percent of whites with diabetes have reported having an A1c test at least twice a year, close to meeting the Healthy People 2020 objective of 71 percent.

Other initiatives to reduce the burden of diabetes include community and professional educational programs, such as:

  • The Statewide Diabetes Advisory Council was established to serve as an advisory group to DHEC and provides statewide leadership in an effort to reduce the burden of diabetes. The Council advocates for legislation, policies and programs to improve the treatment and outcomes of people with diabetes.
  • Community Partnership: DHEC works with a number of coalitions and community groups that have adopted evidenced-based programs for environmental and systems change. Expected outcomes in these communities are greater access to physical activity and healthy food choices.
  • The Diabetes 101 Curriculum is a 90-minute community awareness presentation that focuses on increasing the awareness of the risks of diabetes and the importance of self-care. The goal is to have a minimum of two lay educators per county who are trained presenters for the curriculum. Currently, there are 165 trained educators in 36 of South Carolina’s 46 counties.
  • The ninth annual Diabetes, Heart Disease and Stroke Winter Symposium was held in March 2011. The day-and-a-half symposium is designed for primary health care providers who care for people with diabetes and cardiovascular disease. The symposium drew a record 219 attendees from South Carolina, Arizona, Florida, Georgia, North Carolina and Mississippi. This year included an intensive session on diabetes standards of care for primary care providers presented by nationally recognized experts.

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Patsy Myers
(803) 545-4933

Rhonda L. Hill
(803) 545-4469

Heart Disease and Stroke

Historically, heart disease had been the leading cause of death in S.C. The state is within the “Stroke Belt” and has had the highest or second highest mortality rate since 1983. However, in 2005, S.C. dropped to the fifth highest mortality rate in the nation and remained at that rank in 2007. In 2008, it dropped to the second leading cause, behind cancer, and accounted for 22 percent of all deaths in S.C.

The Stroke Systems of Care Study Committee Report was submitted to the governor and General Assembly in December 2010. This committee was comprised of 18 members representing organizations and health care disciplines involved in stroke treatment and prevention. Four dedicated subcommittees concentrated their efforts in the areas of public awareness, education, prevention and disparities; urgent response; hospital-based stroke treatment; and rehabilitation. As of March 2011, there are 11 Primary Stroke Centers in S.C., eight of which were certified within the past two years. Click here for up to date information regarding stroke policy based on the committee’s recommendations, as well as certified primary stroke centers in S.C.

DHEC’s public health regions continue to build capacity for heart disease and stroke prevention alliance building. Our regional offices around the state are engaging faith-based organizations, health systems and other partners to create alliances that address health inequities among the high-risk African-American population.

The purpose of the S.C. Stroke Belt Project is to counsel, educate and motivate patients through disease self-management. Health coaches provide personal health information to program participants within the worksite setting. Replicated after the nationally acclaimed Asheville Project Model, the S.C. Stroke Belt Project consistently demonstrates positive clinical outcomes from participating employers and DHEC continues to aggressively recruit additional worksites and participants.

DHEC is aligning programmatic goals with the CDC’s Heart Disease and Stroke Prevention strategic focus on the ABCs, Aspirin therapy, Blood pressure and Cholesterol control, and Smoking cessation. We have shifted resources in this direction, away from many training and educational efforts and toward policy, systems and environmental change with emphasis on hypertension and cholesterol control, as well as capacity building in the area of sodium reduction. The state has not yet met the Healthy People 2020 goal to reduce hypertension in S.C. among adults to 26.9 percent of the population, but will continue to forge ahead with a refined focus.

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Joy Brooks
(803) 545-4497

Cancer prevention and control

Burden of disease

Cancer continues to be a serious problem in S.C. South Carolinians face a greater disease burden than most people in other states when it comes to breast, cervical and colorectal cancer.

To address these most common preventable cancers, DHEC uses a variety of approaches, including prevention, early detection, patient and professional education, partnership building, and policy change to reach the general public and high-risk populations.

Breast cancer

According to 2008 S.C. data, breast cancer is the most commonly diagnosed cancer among women. The risk for breast cancer increases with age. It is the second leading cause of cancer death among women in S.C. and third largest cause overall. White women are more likely to be diagnosed with breast cancer than African-American women, but African-American women are more likely to die from breast cancer. According to the National Cancer Institute, if diagnosed early, the five-year survival rate is more than 98 percent.

According to the National Cancer Institute’s 2007 Surveillance, Epidemiology and End Results (SEER) mortality data, S.C. ranks 22nd of the 50 states and Washington D.C. in breast cancer mortality. Overall mortality from breast cancer in S.C. is slightly greater than the national average. Overall, the age-adjusted breast cancer mortality rate in S.C. in 2008 was 24.4/100,000 compared to the Healthy People 2020 goal of 20.6/100,000 women. The rate among African-American women is alarmingly high in S.C. at 30.4/100,000.

Cervical cancer

According to the SEER 2007 mortality data, S.C. ranks 11th in the nation in cervical cancer mortality. Using 2008 S.C. data, cervical cancer is the 12th most commonly diagnosed cancer among African-American women and the 15th most commonly diagnosed cancer among white women, excluding miscellaneous cancers. While the overall trend for cervical cancer mortality is decreasing, it is two times higher in African-American women than in white women. If caught early, the five-year survival rate is more than 90 percent.

The overall mortality rate of cervical cancer in S.C. is slightly more than the U.S. average. South Carolina has not met the Healthy People 2020 objective of reducing mortality rate from cervical cancer to 2.2/100,000. In 2008, the overall age-adjusted mortality rate from cervical cancer in S.C. was 3.0/100,000.

WISEWOMEN implemented to provide cardiovascular screenings to women enrolled in BCN

WISEWOMAN (Well Integrated Screening for Women Across the Nation) adds cardiovascular screening and lifestyle intervention services to women at the time of their annual breast and cervical cancer screenings. During the program year ending June 29, 2011, more than 1,500 WISEWOMAN screenings were provided at federally qualified community health centers in Chesterfield, Clarendon, Darlington, Dillon, Florence, Georgetown, Horry, Kershaw, Lee, Marion, Marlboro, Sumter and Williamsburg counties.

Lifestyle intervention was provided to 793 women with 36 percent being a face-to-face meeting with a lifestyle interventionist. Forty-three percent of the women receiving blood pressure screenings had borderline values that might have required medical intervention and 1 percent had alert values. Forty-five percent had borderline fasting values for total cholesterol and 12 percent for glucose readings.

Project SCOPE implemented to address colorectal cancer

In 2008, colorectal cancer (CRC) was the fourth most commonly diagnosed cancer and the second leading cause of cancer deaths in S.C. Men are more likely to be diagnosed with CRC than women, and African-Americans are more likely to be diagnosed than whites. African-American men are the most likely to be diagnosed and die from this disease. In 2007, S.C. ranked 37th in the nation for colorectal cancer mortality.

South Carolina is behind the Healthy People 2020 overall goal of mortality from CRC. The Healthy People 2020 goal was an overall age-adjusted rate of 14.5 (2008 S.C. = 16.5, U.S. = 16.7). In 2008, African-American men in S.C. had an age-adjusted mortality rate of 28.6 and white men 17.5.

To address colorectal cancer with funding awarded through the S.C. General Assembly, DHEC developed the SCOPE SC program (Screening Colonoscopies for Everyone in South Carolina). The program was designed through collaboration between DHEC and other partners including the S.C. Cancer Alliance, the University of South Carolina’s Center for Colorectal Cancer Research and the S.C. Primary Health Care Association. Screening began in state fiscal years 2008-09 and 2009-10. Funding, appropriated through the General Assembly, totaled $1.6 million and was available only for two years.

To date, 1,163 clients have been screened. A total of 1,527 prior authorizations have been assigned. Seven SCOPE SC patients have been reported with diagnoses suggestive of colon cancer and referred for treatment. DHEC has applied for federal funding from the national Centers for Disease Control and Prevention to expand the program in future years.

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Lou-Ann Carter
(803) 545-4103

Improving the health of our children

Children are our most precious resource. What happens to children before they are born and early in life has long-term impact on their well-being as adults and for society as a whole.

DHEC is taking action to address several important public health issues affecting young children, including infant mortality, family planning, perinatal access to care, nutrition, oral health and immunizations.

Infant mortality

Infant mortality is defined as a death occurring during the first year of life. The infant mortality rate is an important health outcome measure. It is often used as a measure of the overall health status of a given population. It reflects the heath status of mothers and children, and is also indicative of underlying socioeconomic and racial disparities. In 2009, the S.C. infant mortality rate was 7.1 deaths per 1,000 live births. Racial and ethnic disparities related to infant mortality remain persistent. The 2009 infant mortality rate among the black population is 2.1 times greater than the white infant mortality rate.

In 2009, birth defects were the leading cause of infant death for all races combined. Premature births were the second leading cause of infant death among all races, and the leading cause of infant death among black infants. Sudden Infant Death Syndrome (SIDS), accidents and maternal complications of pregnancy and accidents constitute the remaining leading causes of infant death.

S.C. Infant Mortality Rates by Race, 2002-2009

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Breana Lipscomb
(803) 898-0771

SC Birth Defects Program

Birth defects are defined as an abnormality of structure, function or metabolism present at birth that results in physical or mental disabilities or death. According to 2009 S.C. Vital Records data, birth defects represent the leading cause of infant death. Data and information gained from birth defects surveillance systems have played a critical role in the development of effective strategies to prevent birth defects. Having a strong statewide surveillance system is critical to assuring the health and well-being of South Carolina's infants and children.

The Birth Defects Act of 2004 mandates that the S.C. Birth Defects Program (SCBDP) monitor all major birth defects identified prenatally through age 2. The SCBDP continues to utilize the surveillance system rate and trend data to identify risk factors and causes of birth defects.

As surveillance data becomes increasingly available, the SCBDP continues to work closely with other public health entities, university based researchers and advocacy groups to coordinate activities and assure provisions, outlined in the Birth Defects Act, are implemented. These partnerships promote effective referral of infants and families for appropriate services and facilitate development of public health strategies for prevention of birth defects.

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Brenda Martin
(803) 898-3780

Prematurity prevention

Prematurity is the birth of an infant before 37 completed weeks of gestation, and it is the second leading cause of death for South Carolina's infants of all races. Despite the fact that prematurity continues to be the leading cause of death among black infants, the rate has steadily declined.

S.C. Infant Mortality Rates Attributable to Prematurity by Race, 2002-2009

DHEC continues to promote preconception health and encourage women to plan their pregnancies and to be healthy before becoming pregnant. The agency is also working with the March of Dimes in support of its five-year campaign to look at causes and solutions to preterm birth. DHEC has focused educational materials, such as brochures and posters, on the consequences of early induction of labor, signs of preterm labor, maternal health and the importance of planned pregnancies.

Mothers who begin prenatal care early and continue care throughout their pregnancy reduce the risk of complications during childbirth, infant illness and infant deaths. DHEC programs stress early entry into care, including WIC, and the importance of a medical home.

‘ABCs’ of Safe Sleep Guidelines: Alone, On the Back, in a Crib

Sudden Infant Death Syndrome (SIDS) continues to be the third leading cause of death for infants during their first year of life. Accidental suffocation and strangulation in bed is the leading cause of accidental death in infants. Although SIDS and accidental suffocation and strangulation continue to be among the leading causes of infant death, there was a significant decline in sleep related infant deaths from 2008 (94) to 2009 (66).

S.C. Frequency of Sleep Related Infant Deaths by Cause of Death, 2002-2009

DHEC continues to support the American Academy of Pediatrics’ Back to Sleep program with the “ABCs” of Safe Sleep Guidelines: Alone, On the Back, in a Crib. Brochures, videos and posters have been distributed to hospitals, public health departments, health care providers, community organizations, childcare providers and other government agencies.

Additionally, in an effort to reduce infant deaths attributable to SIDS and unsafe sleeping environments, 2008 March of Dimes grants were used to develop training materials for providers to use in one-on-one settings with new mothers and caregivers and to implement a county level media campaign. This campaign consisted of billboards, educational materials, and community awareness trainings in churches informing expectant and new parents, along with their families, about the issue of safe sleep for infants.

DHEC is continuing work with the Children’s Trust of SC in its efforts to expand the Cribs for Kids program statewide, offering safe sleep education and a safe sleep environment to individuals that qualify. In 2009, the Cribs for Kids program expanded into the Midlands area, which serves 16 counties. The program utilizes several community partners to educate high-risk women and families on creating a safe sleep environment for their infants. The Cribs for Kids program in the Upstate is on-going.

Breana Lipscomb
(803) 898-0771

Family planning

The health status of the mother before pregnancy and having a pregnancy that is wanted and well-timed is essential to assuring optimal health and well-being for women, infants and families. Pregnancies that are unwanted or mistimed are referred to as “unintended.” Women with an unintended pregnancy are often in poor health status before pregnancy, or engage in behaviors detrimental for both mother and baby. In S.C., 48.3 percent of pregnancies in 2008 were considered unintended, representing an 8 percent increase from 2007 (44.7 percent). Certain subpopulations are at greater risk of having an unintended pregnancy. These subpopulations include teens, minority women and women from lower socioeconomic backgrounds. Unintended pregnancies can have a tremendous financial and social impact.

S.C. Percent Unattended Pregnancies by Population (2000-2007)

The Healthy People 2020 national goal is to increase the proportion of pregnancies that are intended to 56 percent. This can primarily be done through family planning. Services provided in family planning clinics are designed to improve the health and well-being of the mother before becoming pregnant, assure pregnancies are wanted and well timed, and ultimately improve birth outcomes. Family planning is a cost-effective service providing health education and personal reproductive health care services to women and families. It is estimated every $1 spent of family planning services saves more than $4 in expenditures.

DHEC provides family planning services in 64 clinic sites throughout the state. In 2010, 93,543 women and men received family planning services from DHEC. Fifty nine percent were minority women and men. In general, DHEC family planning clients come from lower socioeconomic backgrounds with more than 97 percent of clients falling below 185 percent of the federal poverty level.

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Beth DeSantis
(803) 898-0598

Perinatal regionalization

The primary goal of perinatal regionalization is to reduce the number of deaths in babies 28 days and younger by assuring access to regionalized neonatal intensive care units for the smallest and sickest babies. The number of very low birthweight babies (VLBW) delivered in Level III hospitals (or designated perinatal centers) often measures success of the perinatal regionalization programs. The Healthy People 2020 goal of VLBW babies born in Level III hospitals is 82.5 percent. In 2008, almost 74 percent of VLBW babies born in S.C. were delivered in a Level III hospital.

Perinatal regionalization also assures that community and rural hospitals have staff education and development opportunities to be prepared for emergency delivery and stabilization, if necessary, until transfer to a higher level of care can occur.

In the coming year, DHEC staff will continue to work with the S.C. Department of Health and Human Services to ensure continued Medicaid coverage for transports to the appropriate level of care. A partnership with the March of Dimes will facilitate development of a Perinatal Collaborative to examine perinatal trends and policy issues. Examining issues related to the late preterm infant will also be a priority in the coming year.

Amy Nienhuis
(803) 898-1287

DHEC Care Line

The DHEC Care Line is a statewide, toll-free service that provides referrals, resource information, education assistance and support to women for their children and families. The Care Line's goal is to improve access to and utilization of health care and health-related services not only in DHEC but other community programs and agencies across the state. During 2010, the Care Line received more than 17,000 calls.

The Care Line is essential in helping in many areas of need such as:

  • A recently evicted family with small children called the Care Line when they had no place to go. A Care Line representative was able to locate a church to assist the family with housing at a hotel for one week. The Care Line then assisted the family with securing an apartment through St. Lawrence Place.
  • An elderly couple with no air conditioning in their home called the Care Line during the hot summer months. A Care Line representative was able to make contact with a local home improvement store that not only gave the elderly couple a window air conditioning unit, but also sent someone out to install it free of charge.
  • A Hispanic mother called the Care Line in a panic because her 4-year-old daughter was having trouble breathing. The child had a foreign object lodged in her nose. The mother called 911 for help. No first responders could speak Spanish. The mother called the Care Line to explain what was happening. One of the Care Line's bi-lingual employees was able to provide interpretation services. The child was rushed to the hospital and the object removed.

DHEC Care Line
1-800-868-0404

Women, Infants and Children program launches new food package

The federal Special Supplemental Nutrition Program for Women, Infants and Children, known as WIC, assists in providing food security and addresses the special needs of at risk, low-income pregnant, breastfeeding and postpartum women, as well as infants and children up to age 5. Infants and children who participate in the WIC program are also screened to assure that their immunizations are up-to-date. Optimal nutritional status during pregnancy and early childhood provides the best chance for the future of South Carolinians.

In 2009, unprecedented changes were made to the WIC food package to help improve the variety of foods available to include more fruits, vegetables, whole grains and fiber. The changes are consistent with current federal dietary guidelines and solidifies WIC's role as the premier public health nutrition program.

In 2010, the state's WIC program served a total of 177,724 clients including, 51,499 infants, 105,656 children and 20,596 pregnant women.

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Burnese Walker
(803) 898-0744

Increased focus on breastfeeding

South Carolina's WIC program is recognized as a leading resource and advocate for breastfeeding promotion. The WIC Breastfeeding program efforts are intended to increase the initiation and duration of breastfeeding.

Breastfed infants have a reduced susceptibility to common childhood infections and better resistance to cope with them. Breast milk has all the nutrients infants need and is easy to digest. Breast milk is always ready, clean, and at the right temperature. Breastfeeding also helps in the recovery following pregnancy and childbirth and reduces the risk of postpartum anxiety, ovarian and breast cancers, and osteoporosis.

The national Healthy People 2020 goal is 60.6 percent. There is much work to be done to reach that goal. DHEC is committed to breastfeeding promotion and support. A statewide breastfeeding performance measure will be established to encourage a stronger emphasis on encouraging and promoting breastfeeding. DHEC continues to strengthen promotion and support efforts through the development of annual breastfeeding plans, and continued education and outreach.

Carmen Thompson
(803) 898 0895

WIC Farmers Market program

The WIC Farmer's Market Nutrition program (FMNP) is a seasonal program designed to provide participants with fresh, nutritious, unprepared foods from local farmers markets and to increase awareness, use and sales at community markets. The program runs from May 1 through October 15 each year. Select public health departments in S.C. participate in the FMNP. It's a joint effort with the S.C. Department of Agriculture that encourages WIC participants to add more fresh fruits and vegetables to their diets. Participants receive cash value vouchers that may be used only for fresh produce at local farmers markets and farm stands that have been approved by the FMNP administrative agencies. Participants also take part in nutrition education classes that help them to choose, store and prepare fresh produce.

Participant surveys indicate their appreciation for the program and how it has helped them to provide their families with a more nutritious diet. Benefits to farmers include increased sales, broader customer base and better utilization of farm resources. In 2010, there were 26 FMNP sites, 13,132 participants and 199 farmers participating in the program.

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Yolanda Kennedy
(803) 898-0340

Less tooth decay in SC children

Tooth decay is a chronic disease that affects people of all ages. In adults, tooth decay has been associated with an increased risk for future tooth problems, heart disease and diabetes. When tooth decay occurs in children, the disease can affect their development and quality of life. Untreated decay can lead to poor nutrition, speaking problems, trouble sleeping and academic problems.

In 2000, DHEC reestablished its oral health program. Since that time, a comprehensive oral health plan has been developed, federal funding secured, and various partnerships and collaborations have been strengthened. This comprehensive approach to addressing oral health appears to be working. DHEC recently completed its second Oral Health Needs Assessment (OHNA) of kindergarten and third grade S.C. students. Of the 5,734 children screened, 47.1 percent (2,700) have experienced tooth decay. This is approximately a 5 percent decrease in the number of S.C. children younger than 8 who experienced tooth decay in 2002. Similarly, the percentage of children with untreated tooth decay has declined since the last needs assessment. The 2008 OHNA found that 22 percent of the children experienced untreated tooth decay as compared to 32 percent in 2002.

Although S.C. has experienced improvement in children's oral health status, the burden of oral disease disproportionately affects some children more than others. Black children who were participating in free and reduced lunch programs, and living in rural communities were most likely to have untreated tooth decay.

% of Tooth Decay in Kindergarten and Third Grade S.C. Students

Dental sealant use on the rise

Dental sealants are thin plastic coatings that are applied to the grooves on the chewing surfaces of the back teeth where most tooth decay occurs in children and teens. Sealants protect the chewing surfaces by keeping germs and food particles out of these grooves. From 2002 to 2008, the percentage of third grade children in S.C. with dental sealants increased from 20 percent to 24 percent. Even with the increase in sealant use, there is still more work to be done to reach the Healthy People 2020 goal of having 28.1 percent of 6-9 year old children with dental sealants.

School-based dental sealant programs deliver preventive services including dental sealants to school-aged children throughout S.C. who might otherwise not have access to preventive dental care. During the 2010-11 school year, the DHEC school-based sealant program served more than 22,000 children in 355 S.C. schools. The program continues to recruit new school districts in order to improve access to preventive dental health services.

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Christine Veschusio
(803) 898-0830

Reducing the threat and burden of infectious diseases

Infectious diseases such as the flu, tuberculosis, HIV/AIDS and other sexually transmitted diseases continue to be a public health problem in S.C. DHEC has a significant role in tracking and monitoring the spread of these diseases and works with community partners to provide effective prevention and treatment services to reduce the burden in our state.

Disease outbreak investigations remain a priority

In 2010, DHEC responded to 139 outbreaks, affecting more than 4,500 individuals. The most common disease outbreaks were norovirus or other unknown gastrointestinal illnesses, pertussis, salmonella, influenza and varicella. Close working relationships with hospital infection control offices and school nurses help DHEC respond quickly to outbreaks in schools, long-term care facilities, daycares and other group settings.

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Health Alert Network

DHEC uses the statewide Health Alert Network (HAN) to keep health care providers updated on events of public health significance. The HAN connects DHEC's central disease control program in Columbia to more than 4,000 recipients consisting of health care providers and the state's eight public health regions. Health care providers that are part of the Health Alert Network receive health notifications by fax, email, phone and/or pager via the ReachSC alerting system. The system offers high-speed, around the clock connection between network members who might need to respond quickly to a public health threat. In 2010, one health alert, 17 health advisories and 12 health updates were distributed to health care providers across the state.

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Preventing Health care Associated Infections

A health care associated infection (HAI) occurs when a patient gets an infection while being treated in a hospital, nursing home, outpatient surgical center, dialysis center or other health care facility. According to the national Centers for Disease and Prevention, Americans get 1.7 million HAIs each year, adding an additional 35.7 to 45 billion dollars to health care costs. Many of these infections are preventable.

South Carolina has been on the forefront of HAI prevention in the U.S. In 2006, the S.C. General Assembly passed the Hospital Infections Disclosure Act, which requires that hospitals report their rates of central line associated blood stream infections as well as certain types of surgical site infections. South Carolina is also one of the few states in the nation to validate its data by performing hospital chart audits. Since its inception, the health care associated infection prevention section of DHEC has reported a decrease in many types of HAIs.

While initially focusing mainly on hospital acquired infections, the agency is looking into expanding prevention efforts to nursing homes and dialysis centers.

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Dana Giurgiutiu
(803) 898-0933 

Overall burden of HIV/AIDS

For 2008, S.C. ranked 10th for new AIDS cases from all states, the District of Columbia, and U.S. dependent areas. For the two-year period 2008-2009, 1,496 people were newly diagnosed with HIV in S.C. Compared to the 2002-2003 period, there was a 12 percent decrease in cases diagnosed and reported in S.C. As of December 2009, 14,795 South Carolinians reported living with HIV infection, including AIDS. Of these, 10,267 are men and 4,528 are women. More than 9,000 of them are ages 25-49, and 180 are children or teenagers.

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Health disparities

More than seven out of every 10 newly diagnosed HIV infections occur among African-Americans, though they only represent a third of South Carolina's population. The number of people living with HIV/AIDS in S.C. has increased dramatically in the past 10 years for all races and both genders. The rate of people living with HIV/AIDS per 100,000 was almost six times higher for African-American males than for white males, and close to 11 times higher for African-American females than white females. (See table.)

These disproportionate rates together with South Carolina's high rates of other sexually transmitted diseases, high rates of poverty and high proportion of non-urban dwellers combine for a major public health challenge for our African-American communities. To address this public health challenge, DHEC continued to focus on community planning, providing HIV prevention and treatment services, and expanding its HIV testing program.

Data Tables

SC Rates of Persons Living with HIV/AIDS by Race/Gender
Rates per 100,000 Pop.
 
2005
2006
2007
2008
2009
White Male
179.3
180.9
181.2
181.7
187.5
White Female
40.1
41.2
41.3
41.8
43.7
Black Male
1002.8
1014.2
1025.5
1038.2
1076.8
Black Female
489
497.9
499.1
503.7
509.8
Total
312
316
317.7
320.2
330.3


SC New HIV/AIDS Case Rates by Race/Gender
Rates per 100,000 Pop.
 
2002-2003
2004-2005
2006-2007
2008-2009
White Male
8.7
9.6
8.3
8.9
White Female
2.4
2.8
2.2
2.5
Black Male
65.6
60.2
57.6
58.3
Black Female
35.4
29.8
25.6
20.4
Total
20.6
19
17.4
16.7


AIDS Drug Assistance Program (ADAP)

Improved drug regimens continue to increase the lifespan of people living with HIV/AIDS, however, financial limitations might prevent patients from receiving the medications they need. As of March 15, 2011, DHEC's ADAP has had a wait list for direct dispensing services. Without sufficient funding the wait list will be in place for the foreseeable future. While patients on the wait list have access to medications through the pharmaceutical industry, the process for receiving the medications is very complicated. DHEC's ADAP serves more than 1,600 patients every month with direct dispensing of medications.

HIV counseling, testing and referral services increased

DHEC also provides HIV testing in its public health departments and through its community partners to reach those infected with HIV so they can be referred into medical care and treatment. In 2010, DHEC and its community partners tested more than 47,500 people.

As part of DHEC's comprehensive STD/HIV prevention program, Partner Services is essential for ensuring that sex and needle-sharing partners of STD/HIV-infected persons are confidentially notified about their risk, and offered STD/HIV prevention counseling, testing and referrals. In 2010, DHEC provided these important services to more than 1,040 individuals.

In 2010, DHEC's local public health departments and community partners reached almost 4,500 people with HIV prevention health education and risk reduction programs. These programs target those most at risk for becoming infected or infecting someone else with HIV.

Expanded HIV Testing

South Carolina is among 26 states and cities that have been awarded the Expanded Testing Initiative grant from the national Centers for Disease Control and Prevention. The goal of the grant is to identify the approximately 21 percent of HIV positive persons that do not know they are infected. In fiscal year 2009-10, in S.C. had five hospitals and four community-based organizations participating in the project. During the first three years of the grant period, more than 34,400 persons were tested in the expanded testing project.

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Tony Price
(803) 898-0338

Tuberculosis

Tuberculosis (TB) is a public health disease that requires continuous monitoring, surveillance and specific interventions to control. Ultimate eradication is possible. TB is a bacterial disease primarily found in the lungs, although it can be found in other parts of the body. Transmission is usually by inhalation of airborne droplets from a person with active pulmonary disease.

In 2010, S.C. reported a total of 153 cases, which ranks the state 16th nationally in TB incidence with a case rate of 3.4 per 100,000 individuals in the population. The Healthy People 2020 goal is 1.0 new case per 100,000 people. The 153 cases reported in 2010 represent a decrease of 9.3 percent compared to the 146 cases reported in 2009.

Reported TB Cases South Carolina, 2001 - 2010

Reported TB Cases South Carolina, 2001 - 2010

More than 53 percent of the TB cases were reported in seven counties. Twenty of the state's 46 counties meet or exceed the national case rate average of 3.6 cases per 100,000 people.

Fifty-five percent of all TB cases occurred among African-Americans. This represents a 3 percent increase from 2009. Thirty-five percent of cases occurred in the 45-64 age group, although the 25-44 age group follows closely with 28 percent. Of concern is the 15 percent of cases in the <15 age group. Males represented 66 percent of the cases while females represented 34 percent in 2010.

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Shea Rabley
(803) 898-0562

Drug resistant TB continues

Drug resistant tuberculosis continues to be a problem nationally and in S.C. Seven cases involving drug resistance occurred in 2010, down from 15 in 2009. These cases require extensive case management by public health nurses and 12-24 months for completion of an adequate course of treatment. Sustaining an expert team of public health professionals experienced in TB case management remains a challenge in the face of a shrinking public health workforce and budget.

Pediatric tuberculosis

Pediatric tuberculosis cases are a marker for a TB program. Children are not born with TB, but rather are exposed, become infected and progress rapidly. Although the state's overall number of TB cases continues to decrease, the number of pediatric cases in S.C. has remained consistent. Pediatric cases are approximately 10 percent of the TB cases in S.C.


Under 15 years of age

DHEC assures an adequate course of treatment for active tuberculosis disease is achieved through the use of directly observed therapy (DOT). DOT requires that a health care worker or other person in authority directly observe the patient take each dose of medication. In S.C., all pediatric cases are treated by DOT as well as many adults with other underlying medical or population risk factors for noncompliance. South Carolina had a 100 percent treatment completion rate in 2009, which is greater than the Healthy People 2020 goal of 93 percent.

DHEC provides diagnostic, treatment and prevention services. Examinations are available in each of the agency's county public health department and are provided by licensed health care professionals.

Prevention of vaccine-preventable diseases

Decreases in both state and national immunization coverage rates for children aged 19 to 35 months were noted in the results of the 2010 National Immunization Survey (NIS). DHEC works with both public and private immunization providers to assure immunization coverage in S.C. Annually, more than 900,000 doses of vaccines are distributed to more than 580 public and private immunization provider sites across the state.

DHEC's Childhood and Adolescent Immunization program works to ensure that all children are protected from vaccine-preventable diseases through age-appropriate immunization. The program works in partnership with immunization providers throughout S.C. to promote the Standards for Pediatric Immunization Practices. The current program is called the S.C. Vaccines for Children (VFC) Immunization Partnership and has more than 580 enrolled immunization practices. These practices include pediatricians, DHEC public health departments, community and rural health centers, hospitals, colleges, and universities, and a large number of family physicians practices.

DHEC's Perinatal Hepatitis B program focuses on the prevention of perinatal transmission of hepatitis B virus infection. The program works in partnership with obstetrical practices, birthing hospitals and pediatric practices to identify through prenatal screening women who test positive for hepatitis B virus infection and to provide case management for each exposed infant. Case Management assures the appropriate post-exposure treatment and follow-up to prevent mother-to-baby transmission of the hepatitis B virus.

DHEC's immunization registry, known as CARES Information System, is a secure statewide Internet-based information system. It allows health care providers immediate access to all recorded patient immunization records whether administered by a public or private provider. The system contains more than three million individual immunization records. The system has been deployed to 236 providers with approximately 114 providers actively entering immunization records.

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Leanne S. Bailey
(803) 898-0435

Health disparities seen in flu, pneumonia vaccination rates

While steady increases are being made in our state, South Carolina's pneumonia and influenza vaccination rates in 2009 for both non-Hispanic whites and non-Hispanic African-Americans over age 65 remain below the national average. The immunization rates for African-Americans remain lower than whites. Rates differ by approximately 20 percentage points and seem to vary slightly year to year.

Individuals who do not have access to health services, including flu and pneumonia shots, include a disproportionate number of minorities, especially those who are not fluent in English. Raising flu vaccination rates among minorities will require shattering some myths, including the myth that the vaccine causes the flu, increasing physician/patient encounters where influenza and pneumococcal vaccinations opportunities are not missed, and enhancing access to flu shots particularly in underserved and low income communities.

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Leanne S. Bailey
(803) 898-0435

Influenza, pneumonia takes toll on seniors

Influenza and pneumonia are the ninth leading cause of death in S.C., claiming 756 residents in 2009. Influenza epidemics cause an average 36,000 deaths and more than 200,000 hospitalizations in the U.S. every year. The best way to reduce the effect of influenza is getting the flu vaccine yearly.

Pneumonia, a bacterial infection in the lungs, is a common complication of the flu. A pneumococcal vaccine is recommended for people 65 and older. Most people need only one pneumococcal vaccine in a lifetime. Medicare Part B pays for both the flu and pneumococcal vaccines.

SC and US Influenza Immunization Rates by Race for Persons 65 and Over

Comparison of SC and US Pneumoccal Immunization Rates by Race for Persons 65 and Over