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July 12, 2019 - Work Worth Doing - Doug Burgum

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Medical Marijuana, Prevention and the ND Dept. of Health

Everybody around the world wants the same thing for their loved ones: long, healthy lives. State Health Officer Mylynn Tufte and the North Dakota Department of Health work to educate the public on ways to stay healthy and avoid preventable illnesses. To learn more about their efforts, visit www.ndhealth.gov

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	Everybody around the world, regardless of income, gender, race, or any other demographic characteristic you can think of, wants the same thing for their loved ones.
	Long, healthy lives.
	Due to improved access to healthcare, better treatment options and greater awareness, people around the world are indeed living longer, healthier lives.
	According to the World Health Organization, global average life expectancy increased by five and a half years between 2000 and 2016, the fastest increase since the 1960s.
	Locally, we've seen improvements in health outcomes as well.
	In 2018, North Dakota rose five spots in America's health rankings to be the 13th healthiest state in the nation.
	As the citizens of this state continue to strive for long, healthy lives, the North Dakota Department of Health is here to help.
	Today, we're talking to State Health Officer Mylynn Tufte.
	Prior to joining Governor Burgum's cabinet, Mylynn started out her career in health care as a critical care nurse before spending more than 15 years working in leadership roles at some of the largest companies in the health industry.
	In addition to a degree in nursing, she also has master's degrees in business administration and information management.
	My Lynn and her team with the Department of Health are involved in a wide variety of activities.
	Some probably sound familiar, and some may surprise you.
	In this episode, we'll discuss high-profile work the department does, like disease prevention and administering the state's new medical marijuana program, but we'll also learn about the multitude of other ways in which the health department ensures our communities are vibrant and happy, not just healthy.
	Let's get started.
	Here's Doug Burgum and my Lynn Tufte.
	Welcome to Work Worth Doing.
	It's great to be here with the State Health Officer of North Dakota, My Lynn Tufte.
	I had the honor of appointing My Lynn to this role in February of 2017. And boy, we're really happy to have My Lynn apply for this job.
	Former critical care nurse, former health management executive.
	She's got background in strategic management.
	She's a health advisory role to some of the largest payers and providers in the country.
	But Great to have you here.
	Great to have you on the show, and thanks for your service leading the Department of Health.
	Well, thank you, Governor.
	It's an honor and a privilege to serve the citizens of North Dakota.
	I think that that tells you that the health care system is very complicated and complex, and there are a lot of things that we can do better related to the health care system.
	So some people, of course, in the state, if they're living healthy lives, maybe have never had any interaction with the Department of Health, but your programs are wide-ranging, probably touch more people in the state than most people realize.
	But just for listeners, take a little bit and talk about the mission of the health department and talk about the major areas of focus and the size and scale and reach of this important organization that you're leading.
	Public health is complicated, and maybe people don't understand that, but if you've had a baby in North Dakota, you got a birth certificate.
	If you got a vaccination, you've interacted with public health.
	Death certificates come from vital records, and that's with the Department of Health.
	Emergency management is with the Department of Health.
	And so there are so many ways that public health touches the Department of Health.
	And our mission is to improve the length of life and quality of life for all North Dakotans.
	Hardly can think of a more important mission than improving the life and quality of life for North Dakotans.
	And of course, one thing that your team, when you talk about emergency preparedness and response, I mean, we're fortunate in North Dakota that we haven't had a large disease outbreak.
	But in the last decade, there have been concerns about Ebola and other sort of potential national emergencies like that.
	But your team is, if something were to rise, you've got a whole team of experts that are ready to leap into the fray and help Defend against those kinds of large-scale outbreaks.
	Right.
	We do have teams of experts that are here locally at the state as well as nationally, and we do want to be prepared, so we have to be ready and have systems in place.
	But we also need to focus on prevention, and that's what we want to do at the Department of Health, to focus on prevention and be in the community.
	And you've got a background in technology, and I know that we talk about technologies transforming every job and every company and certainly every agency in North Dakota.
	But just broadly, how is technology transforming health in general, and how is it transforming the health department in North Dakota?
	Well, technology is moving so fast in so many different ways.
	Definitely the things that we're doing here at the state around cybersecurity, things that are happening at a federal level, things that are happening at the state.
	One of the areas that I'm really excited about, a program called Digital Bridge, where we're doing electronic case reporting.
	That helps us get real-time reporting for some of those reportable conditions.
	And the doctors just do their normal reporting in their electronic medical record but come into the state in a more timely manner.
	And be so much faster and more consistent and standardized across all the different states.
	So I'm really excited about the way that's moving across the country.
	While there are several exciting innovations that promise a brighter future for the way we manage our health, some people aren't taking advantage of basic steps available today to protect their health.
	Despite robust scientific evidence supporting vaccinations for children, the U.S. is struggling to keep up with immunization rates in other nations.
	The U.S. Centers for Disease Control and Prevention says that child vaccination rates have been steadily increasing over the past two decades, but there has been a recent rise in vaccine exemption rates among certain populations of infants and school-aged children.
	Here's an example.
	Developing herd immunity requires a 95% rate of immunization.
	In regions of New York where measles has spread rampantly this year, state health officials reported immunization rates as low as 60%.
	Educating the public about these simple steps to avoid illness is a core duty of the North Dakota Department of Health.
	When I was a kid, people had to worry about measles.
	Then we went through a period of time in our country where everybody was getting vaccinated and there was a bunch of diseases that kind of went away.
	And now back in the news, certain parts of our country were having measles outbreaks for the first time in decades, in part due to people choosing not to get vaccinated.
	But just talk a little bit about the health and the health science and the facts behind that.
	And where do we sit in North Dakota?
	Is there a chance we might have a measles outbreak in North Dakota?
	There's a chance.
	There's a chance that we might have a measles outbreak in North Dakota.
	We haven't seen one yet.
	We have been pretty good about immunizations rates.
	Our kindergarten immunization rates have been running around 93%.
	We've partnered very well with the school's DPI and have used technology to have some integration there with our immunization system.
	And we're not at what we'd like to see, the goal being 95%, which is what people tell me is the herd immunization rate.
	And I think that we can do better, but we're We're almost there.
	So I think that there's room for improvement.
	We've got good partnership with the schools.
	I think that the parents are doing their best in trying to make sure that they're following good guidelines, working with their health care providers.
	But there are things that we can do better to make sure that we're following guidelines and getting our kids immunized.
	Well, it's interesting.
	I think I've shared with you, vaccinations are sort of near and dear to my heart and our family.
	On my mom's side of the family, of course, my dad, born and raised in Arthur.
	But my grandfather, my mom's dad, was Fargo's first public health official.
	And then my uncle was...
	Sadly, the first polio case in Fargo.
	And of course, at that time, there weren't vaccinations.
	Terrifying disease, crippling children, taking lives.
	Very terrifying.
	And then, of course, now polio today with the support of the Gates Foundation and other volunteer and private organizations and World Health.
	I mean, we're now nearly have eliminated polio as disease on our planet.
	I mean, we're down to less than 100 cases in the world.
	And this was...
	Something that was, you know, transforming, taking lives of children all over the world.
	And so vaccines are a miracle not in terms of saving lives, but they also save cost because if you can take away a disease completely that creates a long-term chronic cost and long-term challenges for care and long-term for those that are afflicted, I mean, you're able to move those dollars away from that disease group to another one.
	And so vaccinations have sort of the double bonus because they not only protect people, but they free up scarce health resources to work on things where yet we don't have solutions for.
	Yeah, and I think that people, that's where the president and Dr. Robert Redfield from the CDC, that's where they see HIV and AIDS going too.
	That we, in our lifetime, will see elimination of AIDS, and we have the potential to do that.
	AIDS being almost a chronic illness, and our ability to eliminate that disease.
	I didn't think that that would be possible in our lifetime, We have that potential.
	If we can get education out there and do the things that we can do with modern medicine today, it's possible in our lifetime.
	And, of course, there's another disease which has a huge cost in our country right now and is getting attention, but sometimes it's not even discussed the disease, but the disease of addiction.
	And with the opioid crisis going on and the overdose deaths that are spreading across the country and the abuse of prescription drugs, which can lead to street drugs,
	it's sort of a terrifying trend when we take a it's sort of a terrifying trend when we take a look at the potency and the power of all these drugs and how they're coming into America sometimes now just through mail order from overseas as opposed to coming through some kind of drug cartel.
	But it's a big challenge.
	But I know that part of the work of the Department of Health is on prevention, awareness, Just share a little bit about some of the things that you do and your team does to help make sure that North Dakotans are aware about the disease of addiction.
	We've been partnering with the Department of Behavioral Health Services to help really spread that message that this is a disease of addiction.
	The disease of addiction is a chronic disease.
	It's a brain disease.
	And understanding that.
	But one of the other things when we talk about the 25 million people that have this disease, the chronic disease of addiction, is to understand that it's not a moral failing.
	To understand that we can treat someone for 28 days of inpatient treatment that people will have a relapse and that we have to surround them with support.
	One of the things that you mentioned earlier about the full breadth of life from birth certificates to death certificates, but we still have some very basic, well-known things that are leading causes of death in North Dakota.
	And on the Maybe just share what's on the top of the list in North Dakota in terms of things that the state needs to think about or keep thinking about.
	We, I think, are a lot like other states that we have cardiac disease being our number one and number two.
	I say number one and number two because hypertension, cardiovascular disease being our number one and number two leading cause of death.
	Number three, Alzheimer's would be the third leading cause of death for us in North Dakota.
	Those areas are of concern for us.
	Following that, we also have, from a preventable cause of death, would be tobacco.
	We still have probably a 19.8% right at the U.S. trend line of people that are using tobacco, and that's a preventable cause of death.
	We need to really get out the word that people need to.
	And can find help, which is another addiction, tobacco, that they can stop and we can help them quit using tobacco.
	And it's not just traditional forms of tobacco.
	People, especially our younger populations, are now using electronic nicotine delivery systems or vaping that has been at epidemic levels.
	And the nicotine is really the super addictive component within tobacco.
	And so with a vaping device, you get high levels of nicotine and get addiction very quickly.
	More so than people realize that these vaping devices are delivering nicotine at extraordinary levels.
	One of the essential determinants of health is access to care.
	In 2016, voters in North Dakota approved a measure to create a medical marijuana program in the state, providing access to a new type of treatment for patients with certain medical conditions.
	After the legislature worked out a regulation structure, the Health Department began implementing the program with input from various stakeholders and experts.
	This spring, the first dispensaries opened in the state.
	Mylynn gave us an update on the program and how her team will help oversee the opening of more facilities, bringing the total up to eight dispensaries and providing coverage for patients across the state.
	In November of 2016, at the ballot box passed by the citizens of North Dakota, the Compassionate Care Act, and that went through legislative work in the next session starting then in the spring of 2017. To help take that initiated measure and turn it into a set of rules and laws for regulating medical marijuana in North Dakota.
	And the Department of Health was the lucky agency that had a chance to undertake monitoring and supporting the growth of a whole new industry.
	Maybe just share with us a little bit about that journey and what you've learned from, because I know you and your team have worked very hard to get to where we are today, and you've also learned a lot from other states that were further ahead of us down the road in terms of implementation on medical marijuana.
	Yeah, it's been quite a journey, and I really salute the team that has been working on this and our legislators.
	I will say that it's not been fast enough for a lot of people, but for us to go slow and get it right has been really important.
	When I hear my team tell me that the patient's designated caregiver would say, I got a call from a family member who said, I got my husband back from this product.
	That really is telling.
	This program meant that much.
	She got her husband back.
	So it's that meaningful.
	It really has made a difference.
	I've had a chance to meet some of the families here when we were doing one of the bill signing, and there's some people that are passionate supporters of this because of the challenges they've had with either, you know, children or long-term, you know, chronic illnesses, and people that have sought and found real relief.
	And so it's, again, like all the work that your team does makes a difference in people's lives, but thank you all for working on And I know, having talked to other governors who have gone too fast on this and all the issues that's created, I appreciate both the speed and the care that your team has delivered in getting us to where we are today.
	And maybe for listeners, where are we today in terms of what's the process if a person wants to get a prescription?
	Do they go to a doctor?
	How many...
	How many dispensaries there are?
	How many growers are there?
	But just give listeners a little bit of where we are in terms of medical marijuana industry in North Dakota.
	Sure.
	We are up and running.
	There are two manufacturers that are approved in the state.
	Currently, there are two dispensaries that are open in the state.
	Those are in Fargo and Grand Forks.
	All of the dispensaries are approved There are eight regional dispensaries.
	We anticipate that the remaining two dispensaries that will come available will be in Bismarck and Williston this summer, and the other four will be open by the end of the calendar year.
	So the products that would be available, both dried leaves and flowers, for pediatrics and adults, they could get tinctures, there's disposable vape pens, and then there's salves and lotions, waxes, and a product called Shatter.
	If you were a patient or a designated caregiver, you could go online to our website and make an application and it's as easy as that and that would get approved through the Department of Health.
	There is Through this last legislative session, there were a lot of enhancements and improvements that were made and approved through the legislature.
	We listened to the providers who were asking for some changes to be made.
	We listened to the patients that had made some requests in conditions, and there were some cleanup things that occurred.
	So I think that there were a lot of changes.
	One of the things that I think improved access to patients was that physicians' assistants were able to...
	In addition, healthcare providers had asked that the designation for them not having to state that this was going to be a therapeutic benefit, knowing that it's a federally illegal substance, that that was something that was important for them.
	In addition, for veterans, because it is a federally illegal substance, that if they were discharged and they could show that they were discharged, that there's an avenue for them to go through this program.
	Twelve conditions were added to the list.
	So I think that there were some really good enhancements.
	Well, great.
	Well, again, thanks to your team for everything, all the work that's gone to launch an entire new system, from growing to dispensing to regulating to issuing the cards and monitoring.
	It's an enormous amount of work.
	A very small team.
	Very small team, but thank you for doing it, and thanks for reaching out to other states and learning about the best way to do it so we can be safe and smart and efficient as we do things here in North Dakota.
	And from an innovation standpoint, we are the first state to offer an electronic card for caregivers so that they can, in case they forgot their paper card, they could just use an electronic card on their smartphone.
	Oh, that's terrific.
	That's great.
	Maybe that electronic driver's license will be in our future sometime, too, and a lot of other state pieces of paper, hunting license and everything else.
	So thanks for leading the way on the electronic front.
	For more information on the medical marijuana program, visit ndhealth.gov.
	Our final topic of discussion today is perhaps the most important lesson that a public health official can teach.
	Everyone can take steps to avoid preventable illnesses.
	Prevention can take many forms, ranging from small, everyday actions to large-scale initiatives.
	I know one of the things that you're passionate about my Lynn is the social determinants of health and health equity and these are so important in determining outcomes for people not you know in communities in neighborhoods in states and across our nation and across the world but maybe just for those that aren't as familiar about what it what is a social determinant of health and what does it mean to everybody that lives in North Dakota?
	I think that that term is hard to fathom.
	It really means understanding the things that impact where we live, work, and play.
	If you looked at a map of North Dakota that there are certain zip codes and areas where the life expectancy might be different based on your zip code, and should it be that way?
	Do you have the same access to It could be a lot of different areas where these Social determinants of health are at play.
	So really for us in the Department of Health to look at these different factors and how it impacts our mission of length of life and quality of life.
	And when you talk about food, of course, food and high-quality food, there's been a big surge in the last 10 years of awareness about locally grown, locally sourced, organic.
	It's interesting that we're in a state that is such a powerhouse agricultural state, and yet a lot of the food on our table comes from out-of-state.
	And in certain places of the state, the lack of grocery stores, hard in any season, but certainly in the wintertime, to get access to fresh fruits and vegetables that we might take for granted in our larger metro areas.
	But is this where the term food desert comes from, which is meaning that people in certain areas may not have either the income or the transportation to actually get to a place where there's fresh food?
	Absolutely.
	And I'll go back to the Main Street dashboard.
	That's one of the things that when I talk to people about the Main Street Initiative and show them, I'll say, county health rankings, and look at the area where I live or the area where maybe one of our tribal neighbors lives and say, okay, where's the nearest grocery store?
	Well...
	It's 60 miles away, or it's a gas station, and the gas station only has what for your food?
	Then you think about the levels of obesity.
	I think those are the trade-offs and the questions that people are making when it comes to getting good food or quality food for their family.
	Back on diseases of the heart, number one, the cardiovascular, the hypertension.
	Of course, one of the things, if our plumbing's not working, partly because maybe it's been underutilized in some ways, isn't the science show that one of the great things to do for heart health is just walk more?
	It's something that you can do, definitely.
	And the science is saying that you don't have to take a half an hour or a large amount of your day.
	You can do it in small increments at a time.
	You can walk 10 minutes and it all adds up.
	And so one of the things, I suppose, as we think about healthy cities and we think about walking, it's maybe we should become as passionate about walking as we've been about parking.
	Because I know that in North Dakota, certain times a year, if we can't park within a few steps of the door, then there's something wrong.
	And so that's almost become like a right or an entitlement.
	But I suppose if we're...
	Thinking about the other aspects and the other costs associated with the societal cost of this thing is that probably maybe some days when everybody's working hard and heads down and at their desk, whatever, that walking an extra block to the door is probably the best thing you could do.
	It's great for stress management and it's great for your heart.
	So absolutely.
	I think that's one of the great things about the Main Street dashboard.
	When you want to evaluate your city or town, you can go out there and look and see how healthy is Dawson, North Dakota.
	I can look and see the walkability score.
	I can see the smoking prevalence rate.
	I live in Kidder County, so I can say Robinson, North Dakota versus Steele, North Dakota.
	us.
	Myline, on the show we talk about here is, of course, the great prize in life is the opportunity to work hard at work worth doing, and certainly there's so much purpose to what your department works on, your mission focused on, and proving the length and the quality of life for all North Dakotans.
	But for you personally, what drew you into the health field when you decided to become a critical care nurse, and what draws you to it today, and what part of the work that you do is most enriching in terms of the work worth doing?
	Wow, that's a big question.
	I guess I always wanted to give back or make a difference.
	I was really excited to join the Department of Health to focus on population health, being data-driven and doing predictive analytics and focusing on the whole state for improving the population.
	The state's population health.
	I think that if I could make a call to action for the state, I would say be connected in your community.
	Be kind and think that a kind word or just to be aware.
	There's a lot going on.
	If you think about the behavioral health aspect When we do community health needs assessments in the different communities that we serve, behavioral health comes to the top as a need for all of the communities.
	It's either number one or number two.
	Having empathy or being connected would be one of the things I'd say.
	If we could be connected, be kind, have some empathy, that would be great.
	Well, I think that's a powerful call to action because, again, as we, in our small state, one of the incredibly research-ist states in terms of our water, clean water, our amazing soil resources, our mineral resources, but we've got a small population.
	And yet, with North Dakota and the rural areas, a lot of people live in relative isolation, and that is also not a good determinant of health.
	With neighbors, with community, whatever organizations that might be, keeping people connected is one way for us to understand, as you say, to be kind, be empathetic, and understand because there's people facing all kinds of health challenges maybe right next door that we don't know, and there's ways that we have resources that we can help, and I know your team is there with those resources.
	So again, thanks for your leadership, thanks for your dedication, and thanks to your team for everything they do to keep North Dakota healthy.
	Thank you.
	The Department of Health is a great resource for information about staying healthy in North Dakota.
	You can find out more at ndhealth.gov.
	If you're interested in exploring the Main Street dashboards my Lynn mentioned earlier, you can visit MainStreetND.com.
	While you're there, register for the Main Street Summit coming up at the end of October.
	A community can only be healthy and vibrant if its citizens feel the same.
	Come share your ideas and learn how towns and cities around the state are creating healthier places to live.
	That's all for today's show.
	Thanks to State Health Officer Mylynn Tufte for joining us, and thanks as always to our audio producer, Alicia Jolliffe.
	We'll see you next time for more stories of work worth doing.

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