This week is National Public Health Week; this year's focus is on prevention and wellness

With a focus on prevention and wellness this year, the Kentucky Department of Public Health is promoting national Public Health Week, which kicked off yesterday and will be observed until Sunday. The prevention theme was chosen to underscore the impact of chronic disease on the American population.

Americans miss 2.5 billion days of work because of diseases like heart disease, cancer and diabetes, which costs the country $1 trillion. Unintentional injuries, such as those stemming from motor vehicle accidents, poisonings and burns, rank within the top 10 causes of death for people 44 and younger, according to a DPH press release.

"Often, these horrible diseases and injuries could have been prevented with more attention to lifestyle choices like physical activity and nutrition or preventive safety measures," said Dr. Steve Davis, acting DPH commissioner. "The health care community — as well as the individual — must work to understand the risk for developing chronic disease and avoiding injury so that we can prevent complications. This is key to improving the health of our state."

Public health is also crucial in emergency response, as witnessed with recent tornadoes that struck the state. "The contribution of public health is tremendous — both on a day-to-day basis and in times of crisis," Davis said. "I encourage everyone to go online to read more about our public health programs; talk to your health care provider about chronic disease and injury prevention; or, better yet, visit your local health department to learn more about how public health can — and does — improve your life." (Read more)

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Ky. recognized for high immunization rate; up 17% since 2007

For having childhood vaccination rates considerably higher than the national average, Kentucky's Department for Public Health was recognized by the Centers for Disease Control and Prevention this week.

Kentucky's childhood vaccination series coverage rate was about 80.6 percent in the last two quarters of 2010 and the first two quarters of 2011. Nationwide, the rate was 73.1 percent. Kentucky was also acknowledged for improving its childhood coverage from 63.3 percent in 2007. The data were collected from the annual National Immunization Survey.

Starting July 1, 2011, immunization requirements started being imposed for infants, toddlers and school-age children that were more in line with CDC recommendations and national pediatric standards.

"We have been working to increase immunization rates among Kentucky's children for several years now, including a campaign to make the public aware of the changes to the immunization schedule that took effect last July," said acting Health Commissioner Dr. Steve Davis. "The improvement in vaccine coverage helps improve the health and well-being of our fellow Kentuckians, and particularly our children." (Read more)

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March 24 is World Tuberculosis Day; 71 Kentuckians got the airborne disease last year

March 24 is World Tuberculosis Day, an observance meant to spread awareness about the disease, which is the second leading cause of death worldwide after HIV/AIDS. The Centers for Disease Control and Prevention estimate about 2 million people die each year from TB.

"Many people assume that TB is no longer a concern in this country, but we continue to see cases each year — in Kentucky and around the U.S.," said Steve Davis, acting commissioner of the state Department of Public Health. "While public health has made great strides in preventing the spread of the disease, our work continues."

In 2011, 71 active TB cases were diagnosed in Kentucky, though the state falls below the national average of 3.6 cases per 100,000 people.

TB is an airborne disease, transmitted when an infectious person coughs, shouts, sneezes, speaks or sings. It generally attacks the lungs, but can affect any part of the body, including the kidneys, spine and brain. If left untreated, the disease can be fatal.

People exposed to TB can also get a latent TB infection, which has no symptoms but can still be spread to others. That infection can progress into full-blown TB. Symptoms include coughing up blood, loss of appetite, chest pain and fatigue. (Read more)

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Storm victims need to be vigilant about avoiding tetanus and mold, and protecting food safety

As storm and and flood cleanup continues, Kentuckians need to be vigilant about tetanus, mold and food safety, the state Department for Public Health warns.

Regarding tetanus, the DPH recommends avoiding contact with flood waters, which can be a risk for contracting the disease for people who have open wounds.

Mold can develop in homes that have been flooded, but air conditioners or dehumidifiers can help prevent mold growth, the DPH advises. When cleaning affected areas, wear safety goggles, rubber boots and waterproof gloves. In areas of heavy mold growth, a respirator or suitable mask is advised.

The DPH recommends removing all items that have been wet for more than 48 hours and cannot be dried or cleaned. Mold can be removed from hard surfaces using cleaners, soap and water or a bleach solution of no more than 1 cup of bleach in 1 gallon of water. Severe cases should be cleaned by experts.

When it comes to food safety, a full freezer will keep its temperature for 48 hours. A freezer that is half full will maintain its temperature for 24 hours. Refrigerated foods are safe as long as the power is not out for more than four hours. Any perishable food that has been above 40 degree for more than two hours should be discarded.

Freezer and refrigerators should be cleaned with a solution of 2 tablespoons baking soda dissolved in 1 quart of warm water. (Read more)

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Health departments face more cuts as demand for services grows

More cuts to Kentucky's public-health system have been proposed at a time when the demand for services is growing, officials say. In his state budget proposal, Gov. Steve Beshear suggested public health cuts of 8.4 percent in each of the next two budget years, the same cut he recommended for most other state agencies.

"It's going to have an impact on us being able to provide services (for poor patients)," Dr. Steve Davis, the acting public health commissioner, told the House human services budget subcommittee.

The cuts will mean "the 58 health departments that serve Kentucky's 120 counties will have fewer resources to provide services such as immunizations, cancer screening, diabetes care and maternal and child care," reports Deborah Yetter for The Courier-Journal. Public health will also likely be cut at the federal level. This budget year, public health received $239 million in federal funds. It received $59 million for its General Fund from the state, which would drop to about $56 million if the cuts pass.

Davis said there are no plans yet for how to absorb the cuts. "Every single program we have is going to be on the table," he said. (Read more)

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Shigellosis cases are on the rise in Louisville

There have been 60 confirmed cases of shingellosis in Louisville in the past three months, compared to an average of 62 per year in the area. About half of the new cases are in children who are 3 years old and younger.

"Shingellosis is caused by Shingella bacteria, which leaves the body of an infected person through the stool and enters another person's body when hands, food or objects contaminated with stool are placed in the mouth," reports Laura Ungar of The Courier-Journal. Because of the mode of transmission, maintaining personal hygiene is important.

"Hand washing is by far the most effective way to prevent shigellosis," said Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health & Wellness. "We urge everyone — particularly parents, children, childcare workers and teachers — to wash their hands often."

Symptoms, which can occur one to seven days after exposure, include watery or loose stools, sudden onset of fever, nausea, abdominal cramping or vomiting. (Read more)

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UK professor named chair of new national board that will grant accreditation to local, state and other health departments

Dr. F. Douglas Scutchfield, director of the National Coordinating Center for Public Health Services and Systems Research and the Peter P. Bosomworth Professor of Health Services Research and Policy at the University of Kentucky College of Public Health, has been named chair of the first Accreditation Committee of the Public Health Accreditation Board.

Jointly funded by the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, the board was created to  administer the new accreditation process for state, local, tribal, and territorial health departments. The program was launched in September 2011, and health departments are already beginning to apply. The 11-member Accreditation Committee will make accreditation decisions on behalf of the PHAB board of directors, a UK press release said.

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Now is the time to get flu vaccine, state health officials warn

State public health officials are encouraging Kentuckians to be vaccinated for flu now to reduce the spread of the illness. Steve Davis, M.D., acting commissioner of the Department for Public Health, said in a news release, “Getting the flu vaccine each year is the best way to protect against the flu’s spread and severity.”

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends flu vaccine for anyone older than 6 months. People who should especially receive the flu vaccine, because they may be at higher risk for complications or negative consequences, include:
• Children age 6 months to 19 years;
• Pregnant women;
• People 50 years old or older;
• People of any age with chronic health problems;
• People who live in nursing homes and other long-term care facilities;
• Health care workers;
• Caregivers of or people who live with a person at high risk for complications from the flu; and
• Out-of-home caregivers of or people who live with children less than 6 months old.

Healthy, non-pregnant people age 2-49 years can get either the flu shot or the nasal vaccine spray. Children younger than 9 who are being vaccinated against flu for the first time should receive a second dose four or more weeks after their first vaccination.

Flu is a very contagious disease caused by a virus. About 23,000 Americans die from seasonal flu and its complications in an average year, but actual numbers vary from year to year.

In addition to the flu vaccine, officials encourage all adults 65 or older and others in high-risk groups to ask their health care provider about the pneumococcal vaccine. This vaccine can help prevent a type of pneumonia, one of the flu’s most serious and potentially deadly complications.

For more information on influenza or the availability of flu vaccine, please contact your local health department or visit www.healthalerts.ky.gov.

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Kentucky's adult smoking rate falls below 25% for the first time

For the first time since state smoking rates were measured, fewer than one in four Kentucky adults are smokers, according to a report by the Centers for Disease Control and Prevention. The rate in 2010 was 24.8 percent, down from 28.7 percent in 2009. The rates are based on a national survey of 17,000 adults.

The national average of 19.3 percent, down 1.6 percent from 2005, is "slower than in the previous five-year period," the CDC reports in a release. This decline may be due in part to "increases in federal and state taxes on cigarettes and new clean air laws," Dr. Tim McAfee, director of the CDC's office on smoking and health told Lindsey Tanner of The Associated Press. (Read more)

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Sept. 13 forum in Somerset will explore how rural communities can get healthier and get better care at lower cost

"In an era of tight budgets and strained resources, Kentucky and its rural communities can no longer afford 'business as usual' in the delivery of health care services," write Susan Zepeda and Amy Watts of the Foundation for a Healthy Kentucky. "As health care costs increase and health status declines, the question becomes: How can we ensure rural Kentuckians get better health care at lower costs?"

Zepeda, the foundation's president, and Watts, is senior program officer, see "promising opportunities" for rural communities to reshape health care, such as working with local health departments and civic leaders to "create communities that support healthy behaviors" and better integrate the health system, with special attention for the chronically ill.

These and other issues and ideas for rural health are on the agenda of the foundation's ninth annual Howard L. Bost Memorial Health Policy Forum, to be held Tuesday, Sept. 13 at the Center for Rural Development in Somerset. The forum will include state and national leaders. "Rather than wait for solutions from Washington, forum speakers will share strategies Kentucky’s civic leaders can put into place at the local, state and regional levels. Many will share ways that Kentucky is already doing this," Zepeda and Watts write in an op-ed article distributed to Kentucky newspapers.

The keynote speaker will be Dr. Len Nichols, who founded and directed Health CEOs for Health Reform, a group that helped policymakers see that reform of health insurance and health-care can be reformed together. Dr. Kavita Patel, a physician and former RAND Corp. researcher now at the Brookings Institution, will bring insights on how to achieve better care and better health at lower costs. Other experts from Kentucky, Virginia, Tennessee and North Carolina will share "practical policy strategies for positive health change in these challenging times," and smaller sessions will allow participants to engage with the speakers, Zepeda and Watts write, saying the forum's goal is to "provide accessible, safe and effective health care to nearly half of Kentucky’s citizens who call rural Kentucky home." More information is available on the foundation’s website, http://www.healthy-ky.org/.

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Weekly newspaper in Adair County does a special section on health and sends it to everyone in the county

Special sections on health are good for community newspapers and their readers. Health-care providers have money for advertising in such sections, and a section focused on health can have more impact on readers than individual, occasional stories.

Based on a pilot project it oversaw in 2007, the Institute for Rural Journalism and Community Issues began recommending to rural newspapers that they schedule health sections as part of editions that are mailed to every postal customer in a paper's home county, a standard circulation-building technique. If a newspaper wants to help improve the health of its community, why not reach everyone in the community?

Last week, one Kentucky newspaper did that. The Adair County Community Voice of Columbia included a 10-page broadsheet section on health in an edition that was mailed to everyone in the county. And though it got no advertising from the local public hospital, with which it has been embroiled in an open-meetings dispute, it did get ads from hospitals in other counties.

Newspapers can mail up to 10 percent of their annual circulation to non-subscribers in their home county at subscriber rates, and can sell "sponsored circulation" to pay the extra cost of printing and postage for the extra copies. The 2007 pilot project with another Kentucky weekly, The Berea Citizen, found that non-subscribers said they were more likely to subscribe if the paper regularly included health information. For a copy of the report on the project, click here. The health section is not online, but PDFs of its pages are posted on the Institute website in a 4.4 MB file, here.

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CDC hands out $49 million in public health grants; Kentucky gets more than $800k

The Centers for Disease Control and Prevention have issued $49 million in grants to improve public health, $815,000 of which is earmarked for Kentucky.

The Kentucky Cabinet for Health and Family Services will use the funds to expand its epidemiology, lab and health information systems and to detect and prevent healthcare associated infections. Each year, about 100,000 people die nationwide because of these infections, which are often acquired in hospital settings. The funds are meant to help states coordinate HAI prevention, implement multi-facility prevention efforts, improve monitoring of antimicrobial use and enhance electronic reporting.

Every state in the country will receive a portion of the $49 million pot, which is double the size that was handed out in 2010. "This funding will be used to create jobs, enabling the hiring and training of epidemiologists, laboratory scientists and health information specialists in the field of infectious diseases," said Thomas Frieden, director at the CDC. "These grants will also make it easier for health departments to better manage and exchange important information." (Read more)

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Public health champion bravely fights cancer, inspires many

Dr. Rice Leach, who has championed public health in Kentucky for decades, is inspiring many by the upbeat way he is battling cancer. "He has talked about it at Lexington-Fayette County Board of Health meetings and at Rotary Club meetings. His hat of choice, a gift his son John bought at Cracker Barrel, reads 'I'm having a no hair day,'" the Lexington Herald-Leader's Mary Meehan reports.

Leach was Kentucky's commissioner for public health from 1992 to 2004. He is now commissioner of Fayette County's health department, which has undergone a tumultuous transition after the very public replacement of Dr. Melinda Rowe. "I've really admired his dedication to the job," Geoff Reed, a senior adviser to Mayor Jim Gray, told Meehan. "He's just that kind of person who shows real passion in everything he does."

Leach, 71, has lymphoma, a cancer of the lymph nodes for which he is being treated with several rounds of chemotherapy and radiation. Meehan reports how Leach drew inspiration from the example set by his daughter, Mary Leach Whitcomb, who bravely fought breast cancer until her death in 2007. "If that 37-year-old can handle that big mess, you better believe I can handle this," he said. Meehan's piece provides a good example of how to write sensitively and informatively about a difficult subject. (Read more)

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Program serving young, blind children hit hard by state budget cuts

A program that helps educate blind preschoolers throughout Kentucky has had its state funding drastically cut. Louisville-based Visually Impaired Preschool Services, also known as VIPS, will only receive $10,000 from the state this year, compared to $80,000 three years ago, The Courier-Journal's Deborah Yetter reports. (C-J photo by Michael Hayman)

The program provides free, at-home education for children who are considered legally blind until they turn 4. "The impact is that we won't be able to serve them as often," said Diane Nelson, the program's executive director. "It's so sad."

While the cut will not affect VIPS' preschool in Louisville, it will affect parents and children in more rural parts of the state because fewer specially trained teachers will be sent from Louisville and Lexington to help them. The program serves about 300 children in Kentucky and southern Indiana. Last year, about 50 of those children were outside Louisville and Lexington. This year, only 22 rural children are being helped. "We don't have the money to go out and find these kids," Nelson said.

The funding reduction is the latest in a series of cutbacks that have affected Kentucky public health in the past several years. All told, public health funding has been cut $12 million in recent years. (Read more)

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State health commissioner retiring after seven years in the job, fighting for public health and expanding its role

By Tara Kaprowy
Kentucky Health News

After dealing with the aftermath of 9/11, an anthrax scare, H1N1 flu, the worst ice storm in Kentucky's history and a series of budget cuts, it's been a busy decade for Dr. William Hacker at the state health department. But after 10 years at the agency, seven as its boss, Hacker will retire at the end of the month.

He is getting great reviews for his work as commissioner, which has included expanding the role of public health beyond its traditional roles, including disaster response and prevention.

"Dr. Hacker has always provided quality leadership," said Scott Lockard, president of the Kentucky Public Health Association. "He has been a great advocate for public health. He has been well respected both in state and on the national level and he will be deeply missed."

"Dr. William Hacker has been an exemplary leader for public health and has led by example with his professional and genteel leadership style," said Linda Sims, director of the Lincoln Trail District Health Department and president of the Kentucky Health Department Association. "Dr. Hacker has been instrumental in helping local health departments during budgetary challenges with guidance and support. The development of new services and screenings for children have increased under his efforts that will make a difference for many years to come."

Hacker, a native of Manchester, joined the department in February 2001 to work in the maternal and child health division. He'd practiced as a pediatrician in Corbin for 18 years and subsequently spent six years with Appalachian Regional Health Care.

Just eight months after he came on board at the health department, his role expanded drastically. "On 9/11, we were asked how many burn beds we had available in Kentucky because they felt they would be flying burn victims to us," he said. "We had never had funding to establish the ability to actually track the beds available. Public health did not have a role to play in critical health care. But they called on public health that day."

Three weeks later, suspicious white powder started appearing in the mail, and public health offices nationwide were called again. Though anthrax spores were not found in Kentucky, envelopes containing white powder were, and they needed to be tested by public-health officials.

Dr. Rice Leach, then the commissioner, asked Hacker to establish the Public Health Preparedness Branch of the Division of Epidemiology and Health Planning, marking a major shift for the department. Traditionally, public health had not been involved in incident management, which occurs when first responders are sent in to handle a crisis. "We were the backup to deal with consequence management," Hacker said. "But when you're dealing with bioterrorism, public health needs to step in. There was a lot of learning that went on between law enforcement, emergency medical services and public health. That was a cultural shift. We were forced through the natural evolution of events to step up to the plate."

In 2004, following Leach's retirement, Republican Gov. Ernie Fletcher named Hacker commissioner. He established the Kentucky Outreach and Information Network, which expanded the department's ability to reach vulnerable populations like senior citizens and people with language, hearing or motor difficulties. Partnerships are still in place with other state agencies, Family Resource Youth Service Centers, literacy programs and faith-based organizations such as the Christian Appalachian Project. "We'd say, 'Here's the message we need to get out, whether we were talking about a hot weather advisory or how long is it safe to eat food out of your refrigerator if your electricity is out," he said.

In 2005, Hurricane Katrina struck New Orleans, prompting several thousand people to come to Kentucky. "We had to figure out how to take care of these people without any resources and many times without any family connections," Hacker said. Hurricanes Gustav and Ike followed, presenting similar challenges.

The next major disaster was the 2009 ice storm. The role of public health was to provide shelter, which Hacker called "a major challenge." But emergency stockpiles obtained by the Public Health Preparedness Branch proved useful. "We use cots, satellite radios and generators that were supposed to be used for an inflatable hospital," he said. "That provided power in Elizabethtown."

Emergency stockpiles were also tapped for items like face masks in 2009-10, when people started getting sick with H1N1. "We responded efficiently because of the training we had been planning for," Hacker said. In 2006, department officials prepared extensively for a bird flu "that is still smoldering," Hacker said, but has never reached the ability to spread quickly from person to person.

In the middle of all this, the state changed governors, but not health commissioners. Democratic Gov. Steve Beshear, who took office in December 2007, appointed a new secretary of the Cabinet for Health and Family Services, but showed confidence in Hacker by keeping him as commissioner of the cabinet's Department of Public Health. "I was prepared for Gov. Beshear to select someone else, but I was very pleased when he gave me the opportunity to continue to serve," Hacker said. Apart from Leach and Dr. Carlos Hernandez, Hacker has served one of the longest terms of any commissioner in the past 40 years.

Beshear told Kentucky Health News in July 2011, "Dr. Hacker’s commitment to public health and education is unassailable, and he provided great leadership and vision for our Department of Public Health. Dr. Hacker built teams, mentored, encouraged and connected organizations and people to achieve better outcomes for Kentuckians’ health. His success is largely driven by his belief in inclusion -- that bringing together many organizations can improve health in Kentucky. Kentucky will miss him."

Beshear's retention of Hacker greatly pleased Al Smith, who had just concluded 33 years as producer and founding host of "Comment on Kentucky" on KET. A former newspaper publisher in London and Western Kentucky, Smith helped Hacker campaign for a comprehensive hospital to serve Corbin and London. "He was ahead of his time, as usual, and we lost the political game," Smith recalled. "Fortunately, his great gifts have been appreciated by the state and other health providers who have kept him in leadership for many years. I hope there will be other opportunities for his influence and service at another time. . . . In or out of public service, Dr. Bill Hacker is a leader who always seeks the best for Kentucky."

Asked his biggest accomplishment, Hacker named two: leaving behind a capable team and establishing the Preparedness Branch, which he said is now deeply embedded. "I have a personal relationship with senior FBI agents that did not exist before," he said. "We have a very close partnership with emergency management officials. And we're close with the Department of Agriculture because of the correlation between animal diseases and human diseases. All those partnerships have positioned Kentucky's government entities to be more responsive."

That responsiveness, however, has a lot to do with funding, which Hacker said is his biggest worry, because public health tends to be invisible. "If you ask, most people think public health just takes care of poor people. We, in fact, take care of all forms of people. It's just we do our jobs well and so it's invisible to those folks unless they need a public health service."

Already, Hacker has dealt with several rounds of budget cuts and is worried that "political leaders and the public don't really understand the impact of what the future may look like" with a less well funded public health system. "It could mean slower response to diseases, slower response to disasters, less cervical cancer screening, less prenatal care. There's a whole host of services being provided but they cost money," he said.

Still, though it's not without concern for the future of the department, Hacker, 64, said it's time to head home. He will continue to live in Lexington. "My wife has some health problems and for 44 years she's made sacrifices to support my career. I think the time has come to reverse the equation," he said. "My decision to leave was a difficult one because I love the mission of public health. But it became clear to me that this was the right time to transition from employment to retirement. I will continue to support the mission of public health in any way I can contribute."

Dr. Steve Davis, longtime deputy commissioner of the department, will take over as interim commissioner Aug. 1. He called Hacker "a good doc and a good man. Simply put, we have been blessed to have him for many years."

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Webinar next week will spotlight county-by-county health data

How can you find by-county health statistics and other other key health resources? That will be the focus of a July 13 webinar, hosted by the Foundation for a Healthy Kentucky.

The free webinar, which starts at 3 p.m. EST next Wednesday, will teach listeners how to navigate the Kentucky Health Facts website and point listeners to other resources like the Kentucky Cancer Registry.

It will be hosted by Sarah Walsh, the senior program officer at the foundation's Local Data for Local Action Initiative. The goal of the intiative is to provide access to key state and local health data to help decision making at the local level. "At the foundation, we take a lot of inspiration from the words of Arthur Ashe, 'Start where you are. Use what you have. Do what you can'," Walsh said. "I love that the data on our Kentucky Health Facts website can help local health advocates understand where they are starting from, so they can really do something to make their community a healthier place to live."

Under the moniker "Health for a Change: Ignite — Unite — Act," this is the first in a series of webinars hosted by the foundation. On July 27, Walsh will discuss how to plan a community health needs assessment. For more information about future webinars, click here.

To register for the webinar, click here.

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CDC names top 10 public health achievements in past decade, including tobacco control; Ky. still leads nation in tobacco use

The Centers for Disease Control and Prevention have named the top 10 public health achievements of the last decade. They include controlling infectious diseases like AIDS and tuberculosis; fighting tobacco use; improving motor-vehicle safety by having safer vehicles, roads and driving; reducing heart disease and death; and improving public safety preparedness following Sept. 11, 2001.

The 10 were not ranked. "Others include improvements in vaccine-preventable diseases, better maternal and infant health, better cancer prevention, improved occupational safety, and the aggressive steps that have led to fewer childhood lead poisonings," reports Bill Hendrick of WebMD Health News.

"Americans are living longer, healthier and more productive lives than ever before thanks in part to extraordinary achievements in public health over the past decade," CDC Director Thomas R. Frieden said in a press release. "Continued investments in prevention will help us and our children live even longer, healthier and more productive lives while bringing down health care costs."

The report shows the improvements have saved billions of dollars nationwide. Fortifying food with folic acid, which reduced neural tube defects like spina bifida, has alone resulted in a savings of $4.6 billion in the past 10 years. Preventing motor vehicle crashes could save $99 billion in medical and lost work costs each year. Preventing lead exposure in children could save $213 billion each year.

While tobacco control has advanced nationally, and Kentucky's smoking rate has dropped slightly, the state continues to lead the nation in tobacco use, at 25 percent of adults. While about two dozen Kentucky communities have passed smoke-free laws, a statewide ban has never gotten anywhere in the legislature. The number of states with comprehensive smoke-free laws increased from zero in 2000 to 25 states (plus Washington, D.C.) in 2010.

Motor vehicle safety has improved, a trend that has been noted in Kentucky. The number of traffic-related fatalities in Kentucky has decreased for the past six years. In 2010, 759 people died on Kentucky roads compared to 791 the year before. This year so far, 220 people have died in traffic-related accidents compared to 237 last year. Nationwide, the death rate related to motor vehicle accidents went from 14.9 per 100,000 people in 2000 to 11 per 100,000 in 2009. (Read more)

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