Carrying On

Taking over as state health officer during a time of budgetary constraints and dismal economic conditions, Mary Currier, MD, MPH, said meeting public health challenges from the state level will be done “the best we can with what we have.”

“However, with less and less funding, we’ll have difficulties filling positions, and the area I’m most concerned about are those that provide services at the county level,” she said. “Without being able to fill local positions, I’m concerned we’ll have less ability to provide preventive services, including timely TB, syphilis and HIV contact tracing and follow-up.”

Long-term goals will also be tied to financial availability, said Currier.

“Being able to work more in the area of chronic disease and obesity prevention even at the local level is a long term goal and something we’re going to evaluate,” she said.

Mississippi Medical News asked Currier about other challenges facing public health in the state.

With the January release of a report that the federal government is not well prepared to handle a bioterrorist attack, how is Mississippi prepared?

We’re very prepared. We’ve had a lot of practice dealing with disaster—granted, it’s not the same kind of disaster—and about getting the right people to the right place at the right time. We have a very good relationship with MEMA and dealing with communication issues that occur with any disaster. We’ve practiced those things over and over. We’ve got businesses and communities that have developed or are developing their own plans. With that said, one issue with bioterrorism is laboratory services. We have to continue to make sure we support our laboratory and have funding for the things they do during a bioterrorism attack. They are the only lab in the state that can do some of those things.

What changes are you mulling at the state health department?

There’s time to make decisions, and I have a pretty open door policy. There are things people have been talking about, and we’re reviewing everything, but I don’t see making a lot of changes. I don’t see the point in changing something that’s working well. One of the things with the accreditation process is identifying something that might not be working as well as it could, and look at changes that need to be made, but there’s not anything obvious I’d like to do right now.

What other public health concerns need to be addressed?

Our biggest problem right now is obesity. We lead the country right now in obesity; it’s the second leading preventable factor in disease, with smoking being the first. Obesity is more difficult to deal with because with smoking, there’s nothing good about a cigarette. It does nothing for you. But, you have to eat. It’s a much more difficult problem to deal with, and there are a whole lot of different ways to deal with it.

We really need to gel our role in dealing with obesity in the state. It’s a complicated issue. Prevention for obesity and all the health issues it leads to is difficult and includes everything from local to state and national policy, to education. Every prevention method you can find could have a role in it.

With H1N1 turning out to be overhyped by the national media, do you worry that it may have created a sense of boy-crying-wolf mentality and that when we have a truly serious crisis, people won’t respond or react as they should?

I think you’ll notice that if you look at what the health department has put out, it’s always been pretty even-handed and we didn’t predict gloom and doom. We just said: ‘Here’s the way to prepare in case gloom and doom arrive.’ This could’ve been a horrible thing and I’m very grateful it wasn’t. When we first identified this disease last spring, we didn’t know how severe an influenza it was going to be. We’ve had two waves of this disease that we don’t usually see in the summer and fall, with deaths and severe hospitalizations, so it’s not something we ever needed to take for granted. All that said, yes, it does bother me that the public perception is we cried wolf when there was no wolf, and that if we bring something to the public again, it might be ignored.

Testing Mississippi for National Model

Recently, the Public Health Accreditation Board (PHAB) selected the Mississippi State Department of Health (MSDH) among 30 health departments nationwide, from an application pool of 145, to participate in the testing of the new national voluntary public health accreditation program, which will launched in 2011.

“We’re pleased to be part of this ground-breaking program,” said Currier. “By serving as a test site, we’re afforded the early opportunity to influence the accreditation process and ensure our state public health standards are aligned with the national standards.”

Even though standards exist for hospitals, schools, law enforcement agencies and even daycare centers, there has not previously been a nationally recognized set of standards for public health departments despite the critical role they play in preserving and promoting the health of communities and residents. The goal of public health accreditation, Currier pointed out, is to improve and protect the health of the public by advancing the quality and performance of all health departments in the country.

“The launch of the test is a critical step that moves us closer to a national voluntary accreditation program that is practical and promotes continuous quality improvement in all health departments,” said Kaye Bender, PhD, CEO of PHAB, a fellow Mississippian and a registered nurse who also worked under Thompson. “With accreditation status, public health departments will be able to demonstrate increased accountability and credibility to the public, funders, elected officials and other stakeholders.”

Currier pointed out that health departments around the country are structured differently and that Mississippi is one of few states with a centrally organized health department.

“For example, Alabama has a state health department that oversees most of the state, but some areas like Mobile have a separate health department,” she said. “We want to assure that every health department has accreditation is actually doing the 10 essential services of public health. It allows them to identify service gaps and shore up those gaps. It’s a way to identify strengths and weaknesses and actually go to the legislature and say ‘look, these are the things that are necessary for public health everywhere. These are the gaps we’ve identified, please help us with this.’ Of course, right now, there’s just no money, so it’s a totally moot point.”

Appropriately Named

Even before his death at the age of 62 following a long battle with cancer, the Mississippi State Board of Health had unanimously adopted a resolution requesting legislative approval to name the state’s new public health laboratory after former state health officer Ed Thompson, MD, who served as state epidemiologist from 1983 to 1993, and state health officer for the Mississippi Department of Health from 1993 to 2002, and 2007 until Dec. 1, 2009.

The F.E. Thompson Jr. Public Health Laboratory is a fitting tribute to Thompson’s contributions to Mississippi, say medical leaders.

“The loss of Dr. Ed Thompson is a great tragedy for our state,” said Mississippi State Board of Health Chairman Lucius “Luke” Lampton, MD. “We've lost a gifted and extraordinary leader in his prime, who still had much to contribute. His seasoned leadership of the department during two critical time periods should be remembered with appreciation by the state's citizens.”

State health officer Mary Currier, MD, MPH, said Thompson—recognized by the National Association of Local Boards of Health as Outstanding Health Officer in the United States—made significant strides in addressing several key health concerns such as infant mortality, sexually transmitted diseases and increasing the number of public health field staff.

“He also played a key role in obtaining funding and starting the current construction of the new public health laboratory,” she pointed out.

Between stints as the state health officer, Thompson served as the chief of Public Health Practice and deputy director for Public Health Services for the Centers for Disease Control and Prevention in Atlanta, Ga., and served as both a professor and chairman of the Department of Preventive Medicine at the University of Mississippi School of Medicine, and professor of medicine in the Department of Medicine's Division of Infectious Diseases.