Why is this goal important?
Each year approximately 70,000 babies are born in Minnesota representing a new cohort of children. Each new cohort in all geographic areas, racial and ethnic groups and socioeconomic strata should have access to preventive services, screening and early interventions that will help them lead healthy, productive lives. Reducing infant mortality rates, ensuring proper screenings, receiving on time immunizations and providing earlier interventions improve the lives of all Minnesotans by ensuring an equal opportunity to enjoy good health.

A healthy birth depends on many factors: the mother’s health before pregnancy, family and social support, access to health care, quality and content of prenatal care, nutrition and appropriate weight gain during pregnancy, the absence of violence and injury, and abstention from substances such as tobacco, alcohol and drugs. Although Minnesota’s overall infant mortality rate is low, some populations such as American Indians and African Americans, are higher than the majority white population. While gaps in infant mortality still exist among American Indians and populations of color in Minnesota, the data below shows that the gap has narrowed.

Immunizations protect children from diseases that used to take their lives or permanently damage them. It is important that children receive all recommended immunizations by the time they turn two years old, since it is during this time period that they are the most vulnerable to severe complications of diseases such as whooping cough, hepatitis B, and measles. Children may not have received all recommended vaccines because their parents do not understand the importance of vaccination, have competing priorities or do not know when the next shot is due. 

Lead poisoning is the most common pediatric environmental health problem for young children. It can damage a child's central nervous system, kidney and reproductive organs and cause learning and behavioral problems. Children are exposed to lead in the air, in food, in drinking water, from the glaze on pottery dishes and, most often, from lead-based paint, by eating lead-laced dust or paint chips. 

What is MDH doing to achieve this goal?
· Reduce infant mortality rates in every racial and ethnic population.
In 2001 the MDH launched a major initiative to address health disparities in several key areas, including infant mortality. In the last five years, over 50 community-based organizations have received grants to develop innovative and effective methods to reduce health disparities in American Indians and populations of color. The MDH is providing technical assistance and support to help these organizations reach out to their communities and find strategies that work.

· Improve on-time childhood immunization rates. In addition to measuring overall immunization rates, the MDH distributes publicly purchased vaccines for children whose families are unable to afford vaccines, communicates with schools and health care providers on the school immunization law, works with public health partners to develop immunization policies, maintains the Minnesota Immunization Information Connection (a statewide immunization registry), and provides information and education about vaccine-preventable diseases to public health professionals and the public in printed pieces and on the Web.

· Reduce childhood exposure to lead. With the leadership of MDH, the State of Minnesota continues to implement the "2010 Childhood Lead Poisoning Elimination Plan." This comprehensive plan has a goal of creating a lead-safe Minnesota where no child would have elevated blood lead levels by the year 2010. It recommends using a collaborative, housing-based approach to promote primary prevention of lead exposure while still incorporating ongoing state and local programs that are based on secondary prevention models. The threshold for environmental intervention was recently lowered to a single venous blood lead test above 15 ug/dl (see graph for historical trend). The MDH also continues to promote state guidelines on screening, case management, and clinical treatment of children and pregnant women exposed to lead and conducts and oversees inspections, assessments, and lead hazard abatements to help safely remove lead from the environment. 

How is the MDH’s progress?
The state’s target for 2010 is to reduce the health disparities between rates for populations of color and rates for whites. It will take time before a complex measure like infant mortality will reflect the actions MDH is taking today. However, there has been a slight decrease in all populations and there is a definite increase in awareness of the issues and a growing commitment among many communities to make a difference for tomorrow. Minnesota's overall infant mortality rate dropped from 5.5 per thousand live births in 2000-2002 to 4.9 deaths per thousand live births in 2002-2004. During these two comparison periods the rate dropped lower for whites (from 4.9 to 4.5), for African Americans (from 10.8 to 8.9), for American Indians (from 10.3 to 8.8), for Asians (from 6.1 to 3.6) and for Hispanics (from 6.5 to 5.0).
 
Our target for immunization rates is that at least 90 percent of all infants in all geographic areas, racial and ethnic groups, and socio-economic strata will receive, within two months of the recommended age, age-appropriate immunization against including diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, Haemophilus influenzae type B disease, hepatitis B, pneumococcal disease, and varicella.

National lead poisoning rates have declined dramatically over the past 25 years and have maintained a gradual decline in recent years. In general, Minnesota rates of lead exposure are generally slightly lower than the national average. As screening becomes more efficient and targets high-risk populations, the total number of elevated cases may actually increase, although the rates of cases compared to total population will continue to decline.
 

Learn more about:
Infant mortality
Child immunization
Lead

Why is this goal important?
Healthy communities and preventive practices are key to good health. Healthier people lead to a healthy society. Minnesotans need to understand the importance of prevention as the best way to maintain good health. Tobacco use is the leading cause of preventable death and disease in Minnesota. Smoking causes heart disease, cancer, chronic lung disease, and other diseases. Smokeless tobacco is associated with cancer of the gum, mouth, pharynx, larynx and esophagus. Cigar smoking can cause oral, esophageal, laryngeal and lung cancers. Smoking costs Minnesota approximately $2.64 billion in health-related economic costs each year. About one in five Minnesota adults smoke cigarettes. Most adult smokers began their habit as adolescents or earlier. The earlier one starts smoking, and the longer one continues, determines the severity of tobacco’s health impact on the individual. In addition, teens that smoke are also more likely to try other substances or to get involved in other unhealthy activities.

Early detection of cancer vastly improves an individual’s chance of survival. The U.S. Preventive Services Task Force, under the Department of Health and Human Services, recommends routine mammograms every 1-2 years for women 40 years of age and older, and routine cervical cancer screening for all women who are or have been sexually active and who have a cervix. The current recommendation is to begin Pap testing within 3 years of the onset of sexual activity or age 21 (whichever comes first) and screening at least every three years. Screening is not recommended for women older than age 65 who have had adequate recent screening with normal pap tests and who are not otherwise at high risk.

Regular physical activity reduces long-term risks to health, such as overweight and obesity, heart disease and stroke, arthritis, diabetes, osteoporosis, high blood pressure, and cancer. Unfortunately, for many reasons, the number of adults who do not get regular physical activity has been steadily going up. Physical inactivity creates a huge economic burden on the state: an estimated $495 million was spent during 2000 to treat diseases and conditions that could be avoided if all Minnesotans were physically active.

Although influenza and pneumonia cause disease in all age groups, they are the fifth leading cause of death among Americans age 65 and older. Vaccination reduces the risk of serious complications that can lead to hospitalizations and death.

One identified quality of life and health problem for nursing home residents is high rates of incontinence in residents who are not considered at high risk for incontinence. Incontinence in many cases is reflective of the quality of care provided. This area continues to fall within the top 10 problems identified in nursing home surveys. As an example, if low risk residents are not being offered proper assistance to ensure reasonable and timely assistance in toileting, it can be a signal of the culture, quality of care, and approaches being implemented within the facility.
 

What is MDH doing to achieve this goal?
· Reduce the percentage of youth who use tobacco. The MDH is using a community-driven, evidence-based approach to reduce tobacco use among young people. The approach includes strategies such as: helping communities work on policy changes to reduce exposure to second-hand smoke; implementing comprehensive school-based tobacco prevention programs; and reducing the number of businesses that sell tobacco to minors.

· Increase the percent of women who receive regular mammograms and pap smears to check for breast and cervical cancer. The MDH coordinates and funds free/low cost cancer screening services for women who are uninsured or underinsured, including women identified as needing follow-up to screening services. The MDH partners with the Minnesota Department of Human Services, city and county public health agencies and health providers as they develop strategies to find and assist women with breast or cervical cancer. The MDH also educates the public about the importance of screening and works to raise awareness of breast and cervical cancer screening among health professionals.

· Increase the percentage of adults who exercise on a regular basis. The MDH has drawn attention to this issue by providing information on the health care costs associated with a lack of physical activity. A more comprehensive approach, however, is needed to help Minnesotans of all ages become physically active. We need to address the issues in our physical environments that keep adults as well as children from regular walking, biking, or engaging in physically active recreation. Opportunities for physical activity are needed for people in worksites, schools and communities. Communication campaigns are needed to help people understand the importance of physical activity to their health and to learn how to incorporate more activity in their daily life.

· Increase the percentage of older adults who receive immunizations. The MDH provides guidance, support, and education to local public health agencies and providers of immunizations in Minnesota, including:

· MDH's goal is to remain below the current national average of 48% of low risk residents that are incontinent and to reduce to 42% over the next five years. Maintain the quality of life for our elderly and most vulnerable population living in nursing homes in regards to urinary incontinence. The Centers for Medicare & Medicaid Services (CMS) through the use of the Minimum Data Set (MDS) has a MDS Quality Measure/Quality Indicator for Elimination/Incontinence. The MDS instrument is data submitted by each nursing home to MDH based on the nursing home's assessment of the resident's functional and behavioral capacity, health conditions, and medical diagnosis. Minnesota has almost 18,000 nursing home residents identified as low risk for incontinence. MDS data has identified approximately 48% or approximately 8,000 of those residents as having frequent or persistent problems with incontinence.

The MDS quality indicator process is a practical means of helping facility staff to gather and analyze information to improve a resident’s quality of care and quality of life. The MDS incorporates all members of the interdisciplinary team in a proactive process. MDH will continue to work with the quality improvement organization, nursing home providers, consumers and families to improve resident quality of care and quality of life to ensure the number of residents impacted does not surpass the national average.

*Note: Starting in SFY’04, new federal protocols were introduced emphasizing the prevention of urinary incontinence and improving assessment of resident care needs by nursing home staff.
 

How is the MDH’s progress?
Tobacco use by Minnesota’s youth continues to decline dramatically, according to the Minnesota Youth Tobacco Study. Smoking has dropped by 43 percent among middle-school students and 31 percent among high-school students between 2000 and 2005.

The most recent data indicates that the percentage of women screened for breast and cervical cancer in Minnesota is somewhat higher than the national median. The breast cancer mortality rate has been decreasing significantly and steadily since the early 1990's in Minnesota and nationally.

Physical inactivity is a complex issue, with many significant barriers to change. In addition, older adults are least likely to achieve the recommended minimums for physical activity, so as the state’s population ages this issue will become even more challenging.

The most recent data show a slight upturn in immunization rates for older adults. To raise these rates, more messages need to be delivered about the importance of older adult immunizations and where to go for shots. More effort also needs to be targeted at populations of color and Native American communities.

CMS data shows Minnesota is currently near the national average and is not performing as well as other states in our region when preventing conditions of resident incontinence. The average number of residents with urinary incontinence across CMS-Region 5 is approximately 45.2% with Illinois having the lowest average at 40.6% and Ohio with the highest number of residents at 49.6%. Nationally, the number of nursing home residents with urinary incontinence has risen from 47.2% in the first quarter of 2005, to 48% in the last quarter of 2006. Minnesota's average is 48% in the 4th quarter of 2006. Better performance in nursing home incontinence can affect the quality of life and health of thousands of nursing home residents.
 

Learn more about:
Adult immunization
Youth tobacco use prevention
Community strategies and resources to promote physical activities

Why is this goal important?
Access to clean water and food and early intervention of emerging health threats leads to a healthier population and a healthier society. Arsenic occurs naturally in the environment and can work its way into groundwater. Long-term exposure to elevated levels of arsenic is associated with an increased risk of some cancers and problems with the circulatory and nervous systems. Long-term exposure to elevated levels of radium is associated with an increased risk of cancer. Research, and experience, has shown that restaurants and other food establishments that have professionally trained personnel are performing better at following safe food handling practices. Safe food handling prevents food borne disease. Through a public-private partnership between the Minnesota Public Health Laboratory and laboratories statewide, Minnesota will be better able to detect and respond rapidly to a suspected terrorism event involving biological agents.
 

What is MDH doing to achieve this goal?
· Reduce exposure to arsenic and radium in the water supply.  Minnesota's public water systems must meet new Safe Drinking Water Act (SWDA) standards for arsenic and radium. Most drinking water systems have taken a proactive approach in meeting these standards before regulatory deadlines occurred. Early compliance with the new standards has reduced the amount of public exposure to these contaminants, prevented SDWA violations and related enforcement activities, and provided a better opportunity for systems to obtain low interest loans and grants.

The MDH monitors Minnesota's 962 community public drinking water systems serving 75% of our residential population and 6383 non-community public drinking water systems serving Minnesota citizens and visitors. The MDH originally identified 90 systems with results exceeding the arsenic standard, and 60 systems with results exceeding the radium standard.

Compliance with these standards requires expensive and time-consuming infrastructure improvements, making it difficult for many systems to come into compliance before the regulatory deadlines. Despite these difficulties, the number of systems with arsenic exceedances have been reduced to less than 20, and systems with radium exceedances have been reduced to less than 20.

· Increase the percent of eating places that have trained and certified food managers, to ensure safe food handling practices. The MDH is taking a very proactive approach to regulation in food establishments, working with owners and managers to prevent problems before they occur. Previous approaches to food safety in restaurants depended more heavily upon inspections and corrective actions. The requirement that food establishments have a certified food manager began in 2001, opening the door for the MDH to provide preventive technical assistance to food establishments.

· Increase the percent of Minnesota laboratories with the ability to recognize possible agents of bioterrorism. The State Public Health Laboratory provides hands-on laboratory training to assure that Minnesota laboratories have the ability to recognize possible agents of bioterrorism. Possible agents must be sent to the State Public Health Laboratory for further analysis and specific identification.

How is the MDH’s progress?
Based on MDH’s monitoring program, 70 systems have made modifications to their water system to reduce their arsenic to acceptable levels, and more than 40 systems have made modifications to reduce radium levels. Our staff worked with these systems to determine options for reducing the levels of contamination in the water. We have also conducted seminars to disseminate information about each contaminant. Minnesota is ahead of most states in meeting these goals because of our proactive drinking water monitoring and technical assistance programs.

The Certified Food Manager (CFM) program began in 2000. This program is an important component to ensuring that food is served safely in food establishments throughout Minnesota. Managers and employees become certified food managers after attending an educational course about how to control risk factors that cause foodborne illness and passing an exam. A certified food manager works in partnership with the Minnesota Department of Health, the Minnesota Department of Agriculture, local health agencies, and establishment owners to prevent problems before they occur in food and lodging establishments.

The food service industry has a constantly changing workforce. Over the past seven years, the CFM program has issued 58,244 certificates. As of June 2007, there are 25,556 current certified food managers in Minnesota.

In 2006, 6,998 food inspections conducted by the Minnesota Department of Health required a certified food manager. Of those inspections, 15% or 1,039 establishments' owners were told to employ a certified food manager; 85% of the establishments inspected in 2006 had a certified food manager.

The MDH Public Health Lab has worked with laboratories across the state to achieve their goal of increasing capacity for recognizing possible agents of bioterrorism. In 2005, all licensed laboratories had the ability to recognize Anthrax and 85% could detect Brucella, achieving the department’s goal.
 

Learn more about:
Water supply and exposure to arsenic and radium

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