In Jacksonville, we have a healthcare system that is far above many other Florida communities. We have an extensive hospital system, including the Mayo Clinic and a university-affiliated research hospital, UFHealth at Jacksonville. According to JCCI’s local research, 68 percent of residents think the health and medical care in Jacksonville is good or excellent.
In your opinion, is the health and medical care available in Jacksonville excellent, good, fair, or poor?
As evident from the chart above, in 2012, Jacksonville residents seemed to lose confidence in our local healthcare. I don’t know why that is. I do know that overall, we also have poor health outcomes. Having a high-quality healthcare doesn’t seem to equal better health.
Last summer, Jacksonville was shocked to learn of a tuberculosis outbreak amongst its homeless residents. Why did we have a tuberculosis (TB) outbreak here?
The transmission of HIV, West Nile virus, rabies, Lyme disease, tuberculosis, and other similarly communicable diseases have little to do with our healthcare system and the quality of our hospitals and doctors. Public health, which is the province of federal and local health departments and is funded by our tax dollars, protects us from these health dangers.
The Duval County Health Department, our local public health agency, is responsible for a wide range of threats to our health, including notifying us of beach and River water quality, permitting tanning facilities, oral health, prevention of chronic disease, pre-natal care, expansion of nutrition assistance to pregnant moms (e.g. WIC), low-income healthcare, emergency preparedness and bioterrorism, just to name a few.
Here’s a quick sketch of what happened last summer with Jacksonville’s TB outbreak:
Back in the day, when strains of bacteria were identified, persons who tested positive for TB were treated and then as many people that they came in contact with were tested. These are called contact investigations.
Now microbiologists study the genotype of TB bacteria, finding clusters of infection that were not visible before advances in microbiology.
In the past 10 years or so, new technologies have made the tracking of TB transmission a much more labor-intensive affair because far more contact investigations are made much more quickly.
Last summer, the Centers for Disease Control and Prevention (CDC) in Atlanta found a cluster of infection called FL 046, suggesting that TB was spreading from Jacksonville to 18 counties in Florida.
FL 046 had appeared four years earlier, in 2008, in Jacksonville. According to the Palm Beach Post, “the CDC sent a $275,000 grant to help pay for the staff needed to contain it.”
The same article from the Palm Beach Post, reported: “In 2008, when the TB outbreak hit, [the health department] employed 946 staff with revenues of $61 million. ‘Now we’re down to 700 staff and revenue is down to $46 million,’ [Health Department Director Bob Harmon] said. ‘It has affected most areas of the organization.’”
In 2012, more than 5,000 thousand contact investigations had to be made as a result of the new outbreak. Those contact investigations required field work in and outside Jacksonville as well as Florida.
An interim Director stepped in, and her immediate assessment was that $1 million was needed to get enough people and resources to contain the FL 046 outbreak. An Incident Command Structure was stood up until the Duval County Health Department contacted as many people as it possibly could, tested them, and treated them. In the end, more than 300 persons were found infected with TB. They did not necessarily have the disease; they might only carry the bacteria. An important finding from this past year is that sleeping quarters in our homeless shelters’ placed people’s heads all in the same direction. This was remedied quickly.
Last summer, advances in microbiology collided with reductions in our public health department budget. And it was not pretty.
These collisions are not unique to Jacksonville, however. Right now, Los Angeles faces a much larger outbreak among homeless people living on Skid Row. In that case, tens of thousands of contact investigations are being made to prevent transmission of TB. And just this week, a student at University of South Florida was diagnosed with TB. Ninety contact investigations were required as a result of that one case of TB.
Bacteria and disease do not know about income levels, homelessness, or quality healthcare. And microbes don’t keep track of budget discussions in Tallahassee. So TB will continue to spread; it will continue to live as bacteria no matter what happens in our larger political world. We cannot control that aspect of the spread of disease. So Jacksonville might see another outbreak of FL 046 before the nation’s economy really does recover. If that happens, and it very well might, there is something we, as a community can control.
We can be ready with a response that is quick and strong. The good news is that we have a new Director at the Duval County Health Department, Dr. Kelli Wells.