To promote and enhance the health of all individuals

through education, prevention, intervention, and

protection of the environment.

2011 Annual Report

Serving Crawford, Kalkaska, Lake, Manistee,

Mason, Mecosta, Missaukee, Newaygo, Oceana,

and Wexford counties.

2

Health Officer and Board of Health

Dear DHD#10 Constituents:

The work of District Health Department #10

continues to evolve around the core functions of

public health: assessment, assurance, and policy

development. Over the past year we began to work

with our healthcare partners to develop a community

health assessment and health improvement plan for

the health district. This work was initiated by

collaborating with the hospitals in our health

jurisdiction and with the Tencon Health Plan and will provide a strong foundation over the

next five years to target specific health priorities using evidence based strategies. The

Michigan Department of Community Health has also engaged in a community health

assessment process and established a Michigan Chartbook on key public health indicators.

DHD#10 has aligned our own databooks with the MDCH product and these can be found on

our website.

Governor Snyder has identified obesity and infant mortality as two key public

health priorities; we appreciate his recognition of the importance of these fundamental

public health needs. This past fall, a summit was held around each of these priorities.

Locally, DHD#10 has services which touch on each of the priorities and looks to the future

for collaborating with community partners to implement local initiatives.

The department continues to look to using quality improvement measurers as

financial resources to the department shrink. We strive to be as efficient as possible with

resources. A reduction to Essential Local Public Health Services and Healthy Michigan

Fund line items continues to create a challenge for the department in implementing

mandated services and complying with program requirements that are not shrinking along

with the funding.

The department continues to move forward with the implementation of

meaningful use for electronic medical records, has integrated human resources and the

finance department into an updated software system, and has the electronic foodservice

inspection portion of Healthspace operational.

I am proud of the work done by our public health staff; they continue to be client

centered, focused upon improving quality, and driven to be more efficient. They continue

to keep a positive attitude during these difficult times facing Michigan residents. We are

hopeful the future will bring a renewed emphasis upon population based outcomes and

primary prevention aimed at improving the health status of our residents.

Sincerely,

Linda VanGills, MA

Health Officer

2011

Board of Health

Crawford County

Shelley Pinkelman

Kathy Rogers

Kalkaska County

Carroll Sexton

Deb Kimball

Lake County

Ken Wenzel

Colleen Carrington

Manistee County

Ken Hilliard

Jim Krolczyk

Mason County

Robert Erickson

Susan Boes

Mecosta County

Art Adleman

Ray Steinke, Vice Chair

Missaukee County

Susan Rogers

Hubert Zuiderveen

Newaygo County

Stanley Nieboer

Simon (Sam) Scholtens,

Secretary

Oceana County

Evelyn Kolbe, Chair

Larry VanSickle

Wexford County

Jerry Bulock

Alan Devereaux

3

Public Health Core Functions:

Assessment, Assurance and Policy Development

District Health Department #10’s Accomplishments in Essential Public Health Services

1. Monitor health status to identify problems

Worked with local hospitals to move forward with a collaborative community health assessment between health care and public health.

Worked with Continue-Care of Spectrum Health Gerber Memorial Hospital to plan transitioning clients in their MIHP program into District Health Department #10’s MIHP.

2. Diagnose and investigate health problems and health hazards

Developed capacity to process surface water samples for beach testing.

Worked with several of the nursing home facilities in DHD#10’s jurisdiction on outbreaks of Norovirus and recommended follow-up procedures to decrease transmission of the virus.

3. Inform, educate and empower people about health issues

Expanded Breastfeeding Peer Counselor Program to all ten counties.

Increased participation in WIC nutrition education through quality improvement project.

Increased client assessments in the MIHP Program through the Assessment Quality Improvement Project in collaboration with the WIC Program.

4. Mobilize partnerships to identify and solve health problems

Worked with Manton and Mesick Public Schools to implement adolescent wellness program.

Collaborated on new prenatal smoking prevention program with Mercy Hospital Cadillac.

Conducted staff meetings with employees from Department of Human Services in Mecosta, Newaygo, Oceana, and Mason counties to review agency services and identify gaps in health care.

5. Develop policies and plans that support individuals and statewide health efforts

Completed a regional strategic plan by the Northwest Michigan Cancer Prevention and Awareness Coalition to improve cancer outcomes.

Worked with Michigan Department of Community Health on outcome based data in the MIHP Program.

Assisted the City of Ludington, City of Big Rapids, and Pere Marquette Township to adopt Complete Streets resolutions.

Secured financial resources to assist in the implementation of the Double Up Food Bucks program in Manistee.

6. Enforce laws and regulations that protect health and ensure safety

Followed up on complaints from the Smoke Free Law.

Enforced the school immunization laws by working with the schools and adding immunization clinics to reduce vaccine preventable diseases.

7. Link people to needed health services and assure the provision of health care when otherwise unavailable

Trained clinic staff in processing Medicaid and MiChild applications to improve health care access, specifically for pregnant women and children.

Trained Personal Health staff in child abuse updates and addiction to improve resource information for staff and clients.

8. Assure competent public and personal health care workforce

Worked with Ferris State University to expand public health nursing experience for BSN students.

Worked with Baker College to expand public health nursing in the pediatric field for their Associate nursing students.

Sent four staff members to nationally accredited, Tobacco Treatment Specialist training to provide intervention to pregnant women who smoke.

9. Evaluate effectiveness, accessibility and quality of personal and population-based health services

Collaborated with Tencon Health Plan to respond to health needs of the uninsured adult population.

10. Utilized research for new insights and innovative solutions to health problems

Implemented an electronic reporting system for the food inspection program.

Moved forward with implementation of electronic medical record.

Implemented an electronic communicable diseases reporting system for schools.

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Medical Director

Dear Community Residents,

Public Health’s ability to provide the ten essential services of Public Health is directly dependent, in large measure, by funding, so advocacy is very important to our success. DHD#10 provides the essential services with efficiency, ongoing training, and with the use of Information Technology (IT). In the future, our goals and services in the healthcare system in America will be more important because of the recognition of primary prevention. This recognition and reorganization will be necessary to assist with cost controls. The release of “National Prevention Strategy: America’s Plan for Better Health and Wellness” will assist all health care providers to move forward with disease prevention and management.

Public Health continues to recognize the role that social detriments, such as access to care, poverty, education, other psychosocial and environmental issues, have on human health. I am thankful I live in America, but I believe we can do better in this country to improve the lives and health of our citizens. We can assist in improving the general wellbeing. Our local District Health Department #10 has numerous programs to accomplish these goals.

Challenges this year are to integrate us with the Healthcare System using EMR (electronic medical records), to respond to the new Healthcare Law, to improve access to and quality of medical care, to be on the alert for new Novel Influenza virus outbreaks and other communicable diseases, to ensure a safe food and water supply, to help protect citizens against the adverse affects that tobacco has on health, and to immunize our population and to promote health.

Sincerely,

Dr. James Wilson, D.O., M.P.H.

Emergency Preparedness

Focuses on minimizing the effects of infectious disease outbreaks and other threats to

public health by collaborating with local, regional, state, and federal agencies.

Facts about Emergency Preparedness:

In 2011, DHD #10 Emergency Response Staff continued to review, update, or create guidelines to better prepare DHD #10 for public health emergencies that may occur within our jurisdiction. One example of a guideline created in 2011 was the Emergency Operations Guideline (EOP). This guideline is considered the “base” document that ties all other public health emergency response guidelines together. Another newly created guideline was the Mass Vaccination Guideline specifically developed to provide direction during an event like H1N1 pandemic flu.

Staff participated in several exercises in order to practice emergency response techniques. One example was a Distribution Node (DN) exercise. This was a full-scale exercise where staff had to receive a shipment of pretend medication, track the inventory, sort the medication, package the medication for distribution to our other counties, and communicate with internal staff and external partners.

Staff continued to work with our local partners in emergency management, law enforcement, health care, schools, and human service organizations to ensure our communities are ready to respond to a variety of public health challenges.

Participating in the Distribution Node Exercise is

Rich Kinsey, Ted Dohnal, and Karen Ripke.

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Our Values

Integrity

Responsibility

Accountability

Customer Service

Positive Attitude

Communication

Public Health Workforce

Employs and maintains a competent workforce through

consistent administration and application of the agency’s

personnel policies.

Years of Service

5 Years

Kyle Anderson, EH Sanitarian

Matt Fournier, EH Sanitarian

Frank Palatka, EH Sanitarian

Jessica Podbilski, WIC Tech

Kim Chandler, Health Educator

Barb Fox, Maternal/Child Nurse

10 Years

Darlene Ninnemann, PH Support

Lori Gelinas, Public Health Nurse

Gretchen Cooper, Public Health Nurse

Joanna Durfee, Maternal/Child Nurse

Pam Brown, Clerical Team

Mandy LaFave-Vogler, Maternal/Child Nurse

Lisa Burmeister, Maternal/Child Social Worker

Karen Gallucci, Maternal/Child Nurse

Brenda Freeman, EH Sanitarian

Robin Walicki, RN Case Manager

15 Years

Meryl Smith, WIC Lead

Terry Babcock, WIC Tech

Carol Lambert, Maternal/Child Nurse

Janelle McGinnis, WIC Nutritionist

20 Years

Tia Brown, Vision Tech

Sue Lucksted, Public Health Nurse

25 Years

Joyce Kelley, Executive Secretary

Trish Smith, Hearing and Vision Tech

Cel Southard, Clerical Team

Pattie Schneider, Public Health Nurse

Sharon Polek, MCIR System Coordinator

Carol Sellers, Clerical Team

30 Years

Chris Anthony, HP Support

Congratulations to Joan Wise,

Personal Health Director, who

celebrated 40 years of service with

District Health Department #10!

“Quality public health is all about great

teamwork. I have been blessed to be

part of the DHD#10 team.”

Facts about our staff:

The diverse work force includes registered nurses, health educators,

environmental health sanitarians, social workers, dietitians, support staff,

paraprofessionals, clinic technicians, computer technicians, accounting staff,

administrative assistants, and human resource staff.

Of the 170 employees, 144 are full time, 24 are part time, and 2 are contractual.

The average years of service is 13.7 years. Within our staff, 26% have 20 or

more years of service. Thirteen employees have over 30 years of service.

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Administrative Services

Comprises the financial management, accounting, billing, information systems,

and office support staff.

DHD#10 Revenues and Expenditures

FY11

State Funding 4,973,453 27.81%

County Appropriations & Space 2,879,262 16.10%

Insurance Collections/Fees 1,988,701 11.12%

Medicare/Medicaid 5,119,116 28.62%

Essential Local Public Health Services 1,292,357 7.23%

Other Grants/Contracts 583,394 3.26%

Tencon Services 1,019,555 5.70%

Cigarette Tax 29,769 0.17%

Total Revenues 17,885,607

Wages 7,238,680 42.62%

Fringes 3,923,668 23.10%

Travel 468,647 2.76%

Supplies 1,016,403 5.98%

Contractual 623,918 3.67%

Communications 119,694 0.70%

Capital Outlay 413,062 2.43%

VFC Vaccine Value 653,683 3.85%

Space 1,240,738 7.30%

Tencon Services 1,019,555 6.00%

Other: Maintenance, Education/Training, Liability Insurance, Board of Health

267,338 1.57%

Total Expenditures 16,985,386

Fund Balance 900,221

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Communicable Diseases

2008-9 2009-10 2010-11

Flu-like disease 5,886 11,785 5,850

Strep throat 865 529 1,012

Head lice 1,175 753 691

Chlamydia 452 476 526

Gastrointestinal n/a 335 491

Hepatitis C (chronic) 132 157 145

Campylobacter 34 48 48

Gonorrhea 26 27 36

Chicken pox 38 30 34

Salmonellosis 23 14 23

Crawford Kalkaska Lake Manistee Mason Mecosta Missaukee Newaygo Oceana Wexford

Flu-like disease 235 473 989 349 176 618 237 1804 74 895

Strep throat 137 100 7 73 67 115 79 242 44 148

Head lice 43 55 63 36 57 168 19 105 9 136

Chlamydia 28 43 16 30 28 136 30 82 48 85

Gastrointestinal 24 <5 0 0 0 <5 50 410 <5 0

Hepatitis C (chronic) 15 13 17 20 9 9 7 27 12 16

Campylobacter <5 0 <5 6 5 9 10 8 <5 5

Gonorrhea <5 <5 <5 <5 <5 7 <5 6 <5 11

Chicken pox <5 6 0 0 0 <5 <5 9 <5 11

Salmonellosis <5 <5 0 0 <5 7 <5 <5 <5 <5

Communicable Disease Facts:

Chlamydia and Chronic Hepatitis C are our most common

communicable diseases. Influenza-like illness has a greater

number of cases but those are not confirmed.

Trends in communicable diseases over the past three years show

increases in Chlamydia and Gonorrhea. A decrease was found in

pertussis. Gastrointestinal illness, Campylobacter, Salmonellosis,

and Hepatitis C remained about the same.

Although there was only one case of rabies this past year, the

high fatality rate and fear of this disease requires a great deal of

staff time to investigate, follow-up, and educate the public.

A suspected case of Botulism also required a great deal of staff

time, although it was not confirmed. This also involved

coordination with law enforcement, the court system, the

Michigan Department of Agriculture, the state laboratory, and

hospitals.

There was one confirmed case of Tetanus in 2010, demonstrating

how important immunizations are to prevent against this

disease.

8

DHD#10

Number of deaths

DHD#10

Death rate per

100,000

Michigan

Death rate per

100,000

Heart disease 615 187.4 206.5

Cancer 607 180.6 181.9

Chronic lower respiratory 185 55.4 45.1

Stroke 140 43.7 39.9

Unintentional injuries 134 49.0 35.4

Diabetes 78 23.4 24.3

Alzheimer’s disease 81 25.9 22.9

Kidney disease 41 12.8 15.5

Pneumonia/Influenza 45 13.7 13.9

Suicide 38 13.6 11.3

Leading Causes of Death

In Governor Snyder’s Health and Wellness message in September, 2011, he begins by talking about building a healthier Michigan, both on the individual and community level. When we look at the leading causes of death in our communities, almost all could be impacted by healthier behavior. Governor Snyder states, “Wellness and economics are linked. For example, costs due to coronary heart disease (CHD), the most prevalent and preventable form of heart disease, exceed $5.9 billion per year in Michigan. Treatment of heart disease accounts for 1 in every 6 health care dollars spent. But even modest improvements in wellness can significantly reduce our risk of CHD and similar chronic conditions. While economic considerations are certainly important, the real value of a healthy lifestyle is quality of life. The good news is that evidence-based practices have demonstrated that each of us can significantly improve our personal health by practicing four key healthy behaviors:

maintain a healthy diet;

engage in regular exercise;

get an annual physical examination; and

avoid all tobacco use.

In conjunction with these key health behaviors, we should all be aware of four key health measures that are closely tied to the incidence of chronic disease:

body mass index (BMI);

blood pressure;

cholesterol level; and

blood sugar level. Taken together, these four behaviors, and four measures, can be characterized as the Michigan 4x4 plan. If each of us practice the Michigan 4x4 plan, our lives will be fuller, our health costs dramatically reduced, and our ability to take advantage of all that is Michigan enhanced.” District Health Department #10 and its partners provide a wide variety of programs, services, and policies to address building healthy individuals and communities within our jurisdiction, to support building a stronger Michigan.

9

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Data Source

Michigan 25.0% 25.4% 25.2% 25.4% 26.2% 28.8% 28.2% 29.5% 30.3% 31.7% Centers for Disease Control and Prevention U.S. 20.9% 21.9% 22.9% 23.2% 24.4% 25.1% 26.3% 26.7% 26.9% 27.5%

2006-2010 Overweight and Obesity

Overweight Obese

Michigan Behavior Risk Factor Survey,

2006-2010

Michigan 30.1% 35.6%

DHD#10 39.1% 31.1%

Crawford 45.6% 27.4%

Kalkaska 39.8% 29.5%

Lake 36.1% 43.1%

Manistee 49.8% 21.7%

Mason 53.0% 28.0%

Mecosta 32.2% 28.7%

Missaukee 33.5% 32.7%

Newaygo 31.7% 28.7%

Oceana 40.5% 38.5%

Wexford 39.6% 37.0%

The Healthy People 2020 target for obesity is 30.6% for adults

aged 20 and older.

Obesity is a major contributor to cardiovascular disease, cancer, and diabetes. It also negatively impacts public health costs and educational outcomes. Individuals with a body mass index (BMI) of 30 or greater are considered obese. Overweight is defined as a BMI greater than or equal to 25 but less than 30. Weight and height are used to calculate BMI, which provides a reasonable indicator of body fat and weight categories that may lead to health issues.

Public Health Priority:

Obesity

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Measure 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Data Source

Rate of infant deaths per 1,000 live births.

Michigan 8.1 8.1 8.1 8.4 8.2 7.8 7.8 7.6 7.6 7.7 America's Health

Rankings U.S. 7.1 7.0 6.9 6.8 6.7 6.7 6.8 6.8 6.8 6.7

Five year moving average

1997-2001

1998-2002

1999-2003

2000-2004

2001-2005

2002-2006

2003-2007

2004-2008

2005-2009

Michigan Department

of Community

Health

Michigan

Rate 8.1 8.1 8.2 8.1 8.0 7.9 7.9 7.6 7.6

A five year moving average is used to compare DHD#10 and counties to the five year moving average in Michigan because of the small number of deaths.

Deaths 1085.0 1078.8 1083.0 1065.6 1045.8 1020.6 1009.2 965.6 945.0

DHD#10 Rate 7.5 7.6 7.3 7.3 7.6 7.3 7.4 7.1 7.1

Deaths 22.8 23.4 22.6 22.4 23.2 22.6 23.2 22.2 21.8

Crawford Rate 12.5 14.3 15.7 13.1 10.7 8.9 13.5 12.1 13.6

Deaths 1.8 2.0 2.2 1.8 1.4 1.2 1.8 1.6 1.8

Kalkaska Rate 6.7 7.6 7.2 7.2 8.1 8.3 5.3 * *

Deaths 1.4 1.6 1.6 1.6 1.8 1.8 1.2 0.8 0.8

Lake Rate * * * * 12.8 14.0 13.7 * 10.5

Deaths 0.4 0.4 1.0 1.0 1.4 1.6 1.6 1.0 1.2

Manistee Rate * 4.9 8.6 9.4 11.9 11.4 9.8 6.0 6.2

Deaths 1.0 1.2 2.2 2.4 3.0 2.8 2.4 1.4 1.4

Mason Rate 11.7 9.1 9.0 8.2 5.9 5.7 5.6 4.9 5.6

Deaths 3.6 2.8 2.8 2.6 1.8 1.8 1.8 1.6 1.8

Mecosta Rate 9.2 9.4 7.1 8.6 7.7 6.9 6.3 8.9 6.6

Deaths 4.4 4.6 3.4 4.0 3.6 3.2 2.8 4.0 3.0

Missaukee Rate * * 8.0 7.0 * * * * *

Deaths 1.0 1.0 1.4 1.2 1.0 1.0 1.0 0.4 0.6

Newaygo Rate 5.4 5.4 4.8 5.2 5.2 5.4 7.1 7.5 7.6

Note: * indicates too small to calculate

Deaths 3.4 3.4 3.0 3.2 3.2 3.4 4.6 4.8 4.8

Oceana Rate 6.7 8.2 5.5 7.4 9.9 9.4 8.2 8.6 7.9

Deaths 2.4 3.0 2.0 2.8 3.8 3.6 3.2 3.4 3.0

Wexford Rate 8.8 8.6 7.6 4.6 5.4 5.3 6.6 7.3 7.8

Deaths 3.4 3.4 3.0 1.8 2.2 2.2 2.8 3.2 3.4

Public Health Priority:

Infant Mortality

Infant mortality is a critical indicator of the overall health and welfare of Michigan and the quality and accessibility of prenatal care for women. The infant mortality rate represents the number of infant deaths before age one per 1,000 live births.

The Healthy People 2020 Target for infant mortality is 6.0

deaths per 1,000 live births.

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Environmental Health Monitors and protects the public’s food, air, and water through community

inspection, education, and enforcement of environmental rules and laws.

Environmental Health

District Wide Data

Water Supply Program

Well Permits 1,312

Well Inspections 385

Type II Sanitary

Surveys 201

On-Site Sewage

Septic Permits 1,068

Denied Permits 6

Final Inspections 933

Mortgage Evaluations 250

Building Permit

Approvals 263

Soil Evaluations 47

Food Safety

Fixed Food

Establishment

Inspections

2,011

Temporary Food

Establishment

Inspections

615

Food-Borne Illness

Investigations 34

Community Health and Safety

Campground

Inspections 260

Swimming Pool

Inspections 165

Child Care Facility

Inspections 237

Complaint

Investigations 256

Environmental Health Highlights:

Through a two year grant from the US EPA, the health department will be able to conduct additional water sampling at four Lake Michigan beaches during high use times and after major rain episodes. DHD#10 has also created its own water sampling laboratory in the Ludington office, eliminating the cost of contracting out for this service.

The District purchased laptops for all of the food program inspectors. The use of computers during inspections will save time, allow for computer searches, and provide email delivery of the final report.

The District increased its outreach to the public by hosting training sessions for septic system contractors and for the contractors in the mortgage evaluation program. The District produced a newsletter for all licensed food operators to keep them informed on the new food safety issues. There were also many interviews with local radio, newspaper and television reporters.

Since the Michigan Smoke-Free Workplace law went into effect in May of 2010, the Division has been the main investigation and enforcement agent for the law. This has consisted of site visits for each complaint received, evening surveillance at some locations, informal hearings, and formal hearings.

Public Health Staff...Making a Difference

DHD#10 was in the news in July 2011 due to water samples taken at a

children’s camp showing E.coli bacteria. It is not uncommon to find E.coli in a well and

its presence is a high public health concern. The Health Department assisted camp

operators with a press release and letters to parents and fielded phone calls from

concerned parents. The camp was closed for two weeks while the well was chlorinated

several times and many samples were collected. Finally, an acceptable level of water

quality was obtained and the camp reopened. Environmental health staff make a

difference in protecting the health of our communities.

The Environmental Health Staff conduct campground inspections.

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Health Promotion

Provides health risk assessment, risk reduction, and health intervention services targeting

public health priorities aimed at improving health outcomes.

Health Promotion

Youth Programs

Girls on the Run

Participants 1,071

Students Served at

Wexford Adolescent

Wellness Center

302

Students Participating

in Teen Pregnancy

Prevention Initiative

824

Family Health Programs

Breast and Cervical

Cancer Screening 1,544

WiseWoman

Screenings 1,384

WiseWoman Follow-up

Contacts 2,981

Colorectal Cancer

Screening 393

Family Planning

Participants 2,889

Tencon Screenings 859

Health Promotion Highlights:

In addition to the Wexford Adolescent Wellness Center at Cadillac Junior High School, two new school-based health centers opened in Mesick High School and Manton High School. Services are offered for youth age 10-21 in Wexford County and include nursing services, mental health counseling and therapy, health education, and immunizations.

Building Healthy Communities grant funds from the Michigan Department of Community Health have promoted environmental and policy changes to improve healthy eating, physical activity, and tobacco-free lifestyles. Examples of environmental changes to promote healthy eating include a new community garden at Rapid City Elementary School, a new community garden in Fremont, and enhancements to the community garden at Cornerstone Apartments with the addition of a hoop house. An enhanced mountain bike trail in Ludington promotes physical activity. An example of policy changes

include designating the mountain bike trail and community gardens as tobacco-free. The adoption of Complete Streets resolutions in Big Rapids, Ludington, and Pere Marquette Township reflect policy changes to improve community health. This program was highlighted at the National Association of County and City Health Officials (NACCHO) conference last summer.

Public Health Staff...Making a Difference

When funds were available from the Michigan Department of Community Health to help WiseWoman clients with healthy eating goals, staff at the Health Department recruited seven clients to participate. Each woman received funding to set up a garden at her home to increase access to fresh, affordable, healthy foods. Staff from MSU Extension took them shopping for garden supplies and taught them how to garden. As part of the grant, they were required to attend nutrition and food preparation classes taught by the Health Department, MSU Extension, and the Manistee Community Kitchen. The program is now moving into the entrepreneurial segment, where the local gardens will generate some income for the women. With the help of the Health Department and its partners, the women have formed a WiseWoman Cooperative and applied for additional grant funding to expand their gardens. They plan to sell their products at the local farmers markets and are expanding to include honey, herbs, flavored vinegars, and artisan breads. Health Education staff recognized the unique opportunity for their clients and moved forward to make a difference.

13

Personal Health

Provides preventive health services to individuals and families in clinics, homes, schools and

other community settings, focused on communicable disease control, immunizations,

and maternal-child health programs.

A young Newaygo County girl who was diagnosed with cerebral palsy and a heart condition was enrolled in our Children’s Special Health Care Services Program. She was unable to speak and was in need of a Communication Board (the only way she would be able to communicate with others). The family had no health insurance; the CSHCS Program would not cover the Communication Board. We were able to help this girl with a grant from the Fremont Area Community Foundation to purchase the Communication Board.

Our staff sees this girl on a yearly basis and comment on how wonderful it is to see her interact with others; without the board, this would not be possible. We assist children with special needs to help improve their quality of life.

Public Health Staff...Making a Difference

Personal Health Services

Immunizations

Vaccines Administered 17,039

Influenza Vaccines

Administered 13,554

Maternal Infant Health Program (MIHP)

MIHP Maternal Clients 1,025

MIHP Maternal Visits 6,944

MIHP Infant Clients 774

MIHP Infant Visits 7,582

Hearing and Vision

Preschool Hearing Screenings 3,149

School Hearing Screenings 8,291

Preschool Vision Screenings 2,898

School Vision Screenings 16,159

Communicable Disease Control

Total Communicable Disease

Services 2,510

TB Tests 1,839

STD Services 716

HIV Tests 122

Personal Health Highlights:

The Personal Health Division took the lead to host 51 nursing students from Ferris State University and Baker College during their community health rotations.

A Prenatal Smoking Cessation Grant was awarded to DHD#10 from Mercy Hospital in Cadillac. Four staff members attended a training to become Tobacco Treatment Specialists.

Training for electronic recording took place with the Hearing and Vision staff as well as the staff that provide services in the Children’s Special Health Care Services Program.

An annual grant was received from The Fremont Area Community Foundation to provide services to special needs children in Newaygo County.

An electronic communicable disease school reporting program was implemented.

Patti Gasper provides vision screening.

14

Women, Infants, and Children (WIC)

Provides supplemental food and nutrition education for pregnant, postpartum,

and breastfeeding women as well as children up to the age of five.

WIC Services Provided

Average Monthly Resident Enrollment 9,592

Average Monthly Migrant Enrollment 279

Average Client Return Rate 91%

Average Breastfeeding Initiation Rate 73%

Project Fresh Coupons 3,227

$ Value of Project Fresh Coupons $64,540

Blood Lead Tests 1,273

Public Health Staff...Making a Difference

A mom brought a 10 day old baby into the WIC clinic for enrollment. The baby was taking an hour to drink two to three

ounces of formula and was below birth weight. The WIC Dietitian was concerned and requested a home visit from the MIHP nurse.

Weight gain was still inadequate and the infant’s health care provider was contacted. A referral was made to Devos Children’s

Hospital where a jaw muscle condition was identified and treated, allowing the baby to double his birth weight within the next

month. This is an example of excellent coordination of services between health department staff and community partners, focusing

on treating life threatening problems.

Ludington Community

Breast Feeding Walk participants

From Ludington Daily News

WIC Highlights:

A successful quality improvement project was initiated to “Increase WIC client participation/show rates in secondary nutrition education”. Staff developed and implemented special postcard and business card reminder systems encouraging clients to engage in internet and dietitian educational services.

DHD # 10 received $97,500 in special MDCH/USDA grant funds to implement a WIC Breastfeeding Peer Counselor Program in Lake and Mecosta Counties. The project was successful in improving breastfeeding initiation rates among the low-income WIC population.

Expansion of On-line Medicaid application service through the WIC Program; All WIC Clerk/technicians are trained and complete applications for pregnant women.

Reconvened Wexford-Missaukee Breastfeeding Coalition, established Lake County Breastfeeding Coalition, and participated in Breastfeeding Coalitions in Manistee, Mason, Mecosta, and Newaygo counties.

Local WIC authorized grocery stores, pharmacies, and our communities benefited from over $5.6 million in WIC food sales.

15

Essential Local Public Health Services

Includes eight fundamental public health services mandated in Part 24 of the

Public Health Code, Public Act 368.

Crawford Kalkaska Lake Manistee Mason Mecosta Missaukee Newaygo Oceana Wexford Total

Onsite Sewage

Septic Permits 63 98 100 121 95 138 45 183 139 86 1,068

Septic Failures 37 22 6 37 44 56 12 73 42 46 375

Water Program

Well Permits 75 109 123 133 132 188 88 206 149 109 1,312

Well Inspections 41 58 66 35 48 51 18 21 32 15 385

Food Service

Food Operation

Inspections 115 113 86 208 262 269 75 353 215 315 2,011

Temp Food Booth 14 18 53 69 76 106 37 46 87 109 615

Reported Food Borne 0 2 2 4 1 9 3 5 0 8 34

Immunizations

Vaccines Given 1,370 967 480 2,309 3,391 2,252 923 1,410 1,835 2,102 17,039

Influenza Vaccines 737 1,498 653 1,591 1,606 1,348 973 1,733 1,602 1,813 13,554

Communicable Disease

TB Skin Tests Given 73 143 44 264 331 204 119 189 155 317 1,839

TB Patients on 1 2 0 4 6 1 0 4 42 5 65

Communicable Disease 281 152 76 235 117 480 165 268 170 566 2,510

STD Services

STD Services 87 59 27 58 19 125 51 154 0 136 716

HIV Tests 4 8 0 8 14 5 16 25 13 29 122

Hearing Screenings

Preschool Hearing 225 358 117 128 328 258 314 562 321 538 3,149

School Hearing 280 311 134 732 1,098 1,485 374 2,078 755 1,044 8,291

Vision Screenings

Preschool Vision 182 285 122 121 322 282 246 571 323 444 2,898

School Vision Screenings 625 826 328 1,239 1,863 2,574 871 4,282 1,489 2,062 16,159

16

Health Care Access

Provides services and links to needed services for at-risk populations.

Crawford Kalkaska Lake Manistee Mason Mecosta Missaukee Newaygo Oceana Wexford Total

Maternal Infant Health Program (MIHP)

# of Maternal

Clients 64 68 54 66 101 146 78 169 115 164 1,025

# of Maternal

Visits 539 505 309 434 588 801 600 1,085 715 1,368 6,944

# of Infant

Clients 60 48 31 60 57 114 64 126 74 140 774

# of Infant

Visits 688 598 202 670 632 950 837 1,081 546 1,378 7,582

Children’s Special Health Care Service

# of Children 50 81 27 60 93 166 58 177 94 176 982

# of Service 133 192 69 162 160 414 104 365 168 1,141 2,908

Women, Infants, and Children (WIC)

Average

Monthly

Enrollment

424 567 324 578 1,036 1,330 331 2,137 1,248 1,617 9,592

% Return Rate 92% 93% 93% 90% 93% 92% 93% 93% 93% 91% 92%

# of Project

Fresh Books

Distributed

113 192 111 167 320 340 81 1,095 360 448 3,227

$ Value of

Project Fresh

Coupons

$2,260 $3,840 $2,220 $3,340 $6,400 $6,800 $1,620 $21,900 $7,200 $8,960 $64,540

Child Lead

Screening 55 55 52 56 91 202 47 279 170 266 1,273

Family Planning Services

# of Clients

Served 173 155 38 314 565 162 197 369 337 579 2,889

17

Crawford Kalkaska Lake Manistee Mason Mecosta Missaukee Newaygo Oceana Wexford Total

WiseWoman Program

# Screened 84 92 91 124 186 172 59 218 140 218 1,384

# Referred 58 73 73 80 127 114 38 123 83 143 912

# Counseled 171 188 176 293 295 467 117 538 283 453 2,981

Breast and Cervical Cancer Control Program (BCCCP)

# of Women

Screened 100 98 111 133 207 182 67 244 172 230 1,544

# Breast

Cancer Found 3 1 0 1 2 3 4 8 2 1 25

# Cervical

Cancer Found 2 1 2 2 2 0 1 5 3 2 20

Colorectal Cancer Screening Program

# Screened 15 24 27 53 56 56 14 62 44 42 393

# High Risk

Referrals 0 4 0 4 5 4 0 2 6 2 27

# Pre-

cancerous

polyps/cancer

0 2/1 0 2 2 2 0 0 2 0 10/1

Dental Health - services provided in partnership with Michigan Community Dental Clinics

# Clinic Clients 616 1,395 277 1,676 1,971 1,869 845 401 2,563 2,977 14,590

Tencon Program

Health Plan

Enrollments 268 234 217 263 312 335 196 428 364 432 3,049

Prescription

Drug

Coverage

Enrollments

102 52 65 119 132 120 21 160 119 120 1,010

Medicaid Application Assistance

# Served 53 47 100 126 384 119 146 58 394 1,396 2,823

Health Care Access, Continued

18

Environmental Health Services by County

Crawford Kalkaska Lake Manistee Mason Mecosta Missaukee Newaygo Total Oceana Wexford

Radon Kits

Distributed 52 7 50 91 92 143 98 46 923 60 284

Soil

Evaluations 1 6 0 8 5 8 2 13 47 3 1

Mortgage

Evaluations 0 2 2 61 12 18 1 126 250 26 2

Building

Permit

Approvals

2 86 24 9 19 34 5 30 263 52 2

Complaints

(all) 17 18 7 9 46 26 3 71 256 23 36

Child Care

Inspections 9 34 8 21 19 26 8 51 237 23 38

Campground

Inspections 32 11 29 24 24 24 14 37 260 37 28

Swimming

Pool

Inspections

5 6 1 21 53 19 0 10 165 35 15

Type II

Sanitary

Surveys

10 31 11 2 11 36 21 32 201 18 29

Tanning

Inspections 4 4 3 6 6 4 2 13 57 6 9

Animal

bites/

exposure

15 7 6 15 15 20 8 15 13 16 130

19

Community Health Indicators

Crawford Kalkaska Lake Manistee Mason Mecosta Missaukee Newaygo Oceana Wexford Michigan

Total

Population 14,074 17,153 11,539 24,733 28,705 42,798 14,849 48,460 26,570 32,735 9,883,640

Number of

Births 134 193 111 203 295 460 181 570 339 400 117,309

Birth Rate

(per 1,000) 9.4 11.4 10.2 8.3 10.3 11.0 12.2 11.7 12.3 12.7 11.8

Number of

Deaths 149 154 142 283 283 317 149 461 247 295 86,310

Death Rate

(per 100,000) 10.5 9.1 13.0 11.6 9.9 7.6 10.0 9.5 9.0 9.3 8.7

Cancer

Mortality

Age Adjusted Rate

per 100,000

199.1 223.6 233.1 198.1 168.0 157.3 182.1 196.6 164.3 168.9 184.8

Cardiovascular

Disease

Mortality

Age Adjusted Rate

per 100,000

253.1 241.9 263.0 241.1 244.3 255.2 333.9 250.0 268.3 253.6 276.2

Median

Household

Income

$35,866 $40,052 $29,373 $41,067 $38,073 $37,840 $38,657 $39,059 $37,655 $38,587 $45,254

Persons below

Poverty 19.2% 16.7% 23.4% 13.9% 17.8% 20.9% 15.0% 18.6% 20.6% 17.0% 16.1%

Medicaid

Covered Births 70.1% 63.7% 70.3% 55.2% 58.3% 56.1% 47.0% 56.1% 68.4% 53.0% 44.0%

Teen Pregnancy

Rate per 1,000 64.8 68.2 68.5 54.4 55.1 32.4 56.4 61.2 75.2 63.1 53.6

Smoked while

Pregnant 45.5% 35.8% 35.1% 39.9% 26.4% 32.4% 26.0% 26.8% 20.1% 30.3% 18.2%

Data Source: Michigan Department of Community

Health and US Census Bureau

20

DHD#10 Office Directory

Crawford County

202 Meadows Drive

Grayling, MI 49738

989 348-7800

Kalkaska County

625 Courthouse Drive

Kalkaska, MI 49646

231 258-8669

Lake County

5681 S M-37

Baldwin, MI 49304

231 745-4663

Manistee County

385 Third Street

Manistee, MI 49660

231 723-3595

Mason County

916 Diana Street

Ludington, MI 49431

231 845-7381

Mecosta County

14485 Northland Drive

Big Rapids, MI 49307

231 592-0130

Missaukee County

6180 W Sanborn, Suite #1

Lake City, MI 49651

231 839-7167

Newaygo County

1049 Newell Street

White Cloud, MI 49349

231 689-7300

Oceana County

3986 N Oceana Drive

Hart, MI 49420

231 873-2193

Wexford County

521 Cobbs Street

Cadillac, MI 49601

231 775-9942

Community Partners

0-5 Parents as Teachers Grant, Newaygo County

Airway Oxygen in Cadillac

Cadillac Area Public Schools

Cadillac Family Physicians

Cadillac Family Practice

Cadillac Rotary

Dynamic Physical Therapy

Early on Program: Manistee, Crawford, and Newaygo counties

Evergreen Physical Therapy

Fremont Area Community Foundation

Fremont Christian Church

General Mills

Great Lakes People Fund

Great Parents/Great Start, Manistee, Mason, Lake, Oceana, and Newaygo counties

Ice Mountain

Lake City Family Dentistry

Lake County Children’s Trust Fund

Lake County Community Foundation

Magna Mirrors

Manistee County Community Foundation

Manton Consolidated Schools

Manton Rotary

Mason County Community Foundation

MC Sports

Meceola Children’s Council

Mecosta County Community Foundation

Mecosta County Medical Center

Mercy Hospital Cadillac

Mesick Consolidated Schools

Michigan Hearing Systems

Oceana Intermediate School District

Peacock Industries

Pentwater Junior Women’s Club

Three Generations Circle of Women Givers

United Way of Mason County

United Way of Northwest Michigan

United Way of the Lakeshore

Visit Us Online at

www.dhd10.org