brown county health department & city of de pere health department community health improvement...
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Brown County Health Department & City of De Pere Health Department
Community Health Improvement Process
Overview
Core Functions of Public Health
1988 Institute of Medicine Report
Assessment
Policy Development
Assurance
Public Health Essential Services Monitor health status to identify community health
problems. Diagnose and investigate health problems and health
hazards in the community. Inform, educate, and empower people about health
issues. Mobilize community partnerships to identify and solve
health problems. Develop policies and plans that support individual and
community health efforts.
Public Health Essential Services Enforce laws and regulations that protect health and
ensure safety. Link people to needed health services and assure the
provision of health care when otherwise unavailable. Assure a competent public health and personal
healthcare workforce. Evaluate effectiveness, accessibility, and quality of
personal and population-based health services. Research for new insights and innovative solutions to
health problems.
What is a Community Health Improvement Process (CHIP)
Assess community assets, gaps and resources
Create a community health plan to address health priorities
Mobilize community resources to implement health plan
Required Services of Local Health Departments
Wisconsin State Statute 251.05(3)(c)
Involve key policymakers and the general public in determining and developing a community health improvement plan that includes actions to implement the services and functions specified
under s. 250.03 (1) (L).
Assessment to be completed every five years.
Healthcare System Partners
Patient Protection & Affordable Care Act Every three year assessment requirement Improved health of the population
Why do a community health assessment . . .
Forms and strengthens partnerships
Shares community responsibility
Increases community awareness of the population’s health
Integrates isolated efforts
Works to prevent duplication of efforts
Develops community specific strategies
History of Assessment in Brown County
Initial assessment in 1995
“Healthier Brown County 2000”
History: Community Health Assessment
Teen Pregnancy Prevention Part of adolescent parenting coalition
Tobacco-free Regional coalition housed in Outagamie
County
Cardiovascular health Efforts throughout county
Who participated. . .
Representatives of the community
Knowledge of the community: assets, resources, and health needs
Interest and commitment to create a healthier community
The How. . . Steering Committee
Formed
Community Partners brought together to examine data
Identify gaps and resources
Identify priority focus areas
Develop a health plan to address priority concerns
Present the health plan to the community
Areas Reviewed Health Focus Areas
All twelve areas reviewed
Overarching Focus Areas Both areas reviewed
Infrastructure Focus Areas Emergency Preparedness area reviewed
Priority Matrix Rank
Magnitude
Seriousness
Feasibility
TOTAL
1 Environmental and occupational health
Tobacco use and exposure Healthy growth and development Environmental and occupational health
2 Emergency preparedness, response and recovery
Adequate, appropriate, and safe food and nutrition
Social/economic factors Physical activity & Tobacco use and exposure
3 Oral health Alcohol and other drug use Tobacco use and exposure 4 Physical activity Mental health Physical activity Alcohol and other drug use5 Alcohol and other drug use Healthy growth and development &
Physical activityEnvironmental and occupational health
Healthy growth and development
6 Adequate, appropriate, and safe food and nutrition
Reproductive and sexual health Social/economic factors
7 Mental health Environmental and occupational health
Injury and violence Oral health
8 Injury and violence Oral health Public health preparedness Adequate, appropriate, and safe food and nutrition
9 Tobacco use and exposure & Health care access
Social/economic factors Alcohol and other drug use & Chronic disease prevention and management
Emergency preparedness, response and recovery
10 Chronic disease prevention and management &Injury and violence
Mental health
11 Social/economic factors Health care access Injury and violence12 Chronic disease prevention and
managementHealth care access Communicable disease prevention
and control & Mental health
Chronic disease prevention and management
13 Reproductive and sexual health Emergency preparedness, response and recovery
Health care access
14 Healthy growth and development Communicable disease prevention and control
Oral health Reproductive and sexual health
15 Communicable disease prevention and control
Reproductive and sexual health Adequate, appropriate, and safe food and nutrition
Communicable disease prevention and control
Questions
Oral Health
Healthiest Wisconsin 2020 Objectives
1. By 2020, assure access to ongoing oral health education and comprehensive preventions, screening, and early interventions, and treatment of dental disease in order to promote healthy behaviors and improve and maintain oral health.
Healthiest Wisconsin 2020 Objectives
2. By 2020, assure appropriate access to effective and adequate oral health delivery systems, utilizing a diverse and adequate workforce, for populations of differing races, ethnicities, sexual identities, and orientations, gender identities, and educational or economic status and those with disabilities.
Data Categories
• Fluoridation of water supply• Dental sealants• Caries Experience and untreated decay• Adult tooth loss d/t decay or disease• Oral and pharyngeal cancer• Dental visits• Medicaid utilization rate• Dental workforce
Percent of Population on Community Water Systems Who Have Access to Optimally Fluoridated Water
Brown County: 98%Wisconsin: 90%
Wisconsin Sealant Programs, 2009-2010
Seal Brown County:1013 children received sealants
Participating schools/groups:Boys & Girls Club, Danz , students from De Pere Schools (at Howe Dental Room), East High School, Edison Middle School, Eisenhower, Fort Howard, Howe, Jefferson, Nicolet, Oneida Nation School
Wisconsin Seal-A-Smile: ~6300 children received sealants 51% 3rd graders with sealants
Percentage of Wisconsin Adults with Tooth Loss Due to Decay/Gum Disease, BRFSS 2004, 2006 & 2008
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Surveillance System
Brown County: 32.1%
Wisconsin: 40%
Adults, 18 years and olderNo dentist visit in the past year
BRFS, 2004, 2006, 2008 combined
Brown County: 22%Wisconsin: 25%
Wisconsin County Health Rankings
Brown County rank: 23 of 72
Source: 2008 WCHR Full Report
Percentage of Medicaid Members
Receiving a Dental Service, 2008/2009
Wisconsin: 25%
Brown County: 20.1%
# Medicaid Dentists: 102# MA Members: 7,309Members per Dentist: 72
Federally Designated Dental Health Professional Shortage Areas
City of Green Bay
Wisconsin Dentists by County
Pop. (Est 2008)
# professionally active
Mean age
% female
Brown County 245,018 159 50.75 13%
72 county average 78,166 44 52.22 13%
Max county 953,328 622 60 33%
Min county 4,571 1 38 0%
Questions
Adequate, Appropriate &
Safe Food & Nutrition
Adequate, Appropriate & Safe Food & NutritionHealthiest Wisconsin 2020 Objectives
1. By 2020, people in Wisconsin will eat more nutritious foods and drink more nutritious beverages through increased access to fruits and vegetables, decreased access to sugar-sweetened beverages and other less nutritious foods, and supported, sustained breastfeeding.
Adequate, Appropriate & Safe Food & NutritionHealthiest Wisconsin 2020 Objectives
2. By 2020, all people will have ready access to sufficient nutritious, high-quality, affordable foods and beverages.
Adequate, Appropriate & Safe Food & NutritionHealthiest Wisconsin 2020 Objectives
3. By 2020, Wisconsin will reduce disparities in obesity rates for populations of differing races, ethnicities, sexual identification and orientations, gender identities, and educational or economic status.
Data categories
Fruit/Vegetable consumption
Beverage consumption
Breastfeeding rates
Fast food/Grocery store/Farmers market access
Food insecurity levels
Food assistance utilization
Obesity rates
Percentage of Adults in Wisconsin Report of 0-5 Servings of Fruits and Vegetables Consumed per Day
6
39
34
22
5
36 36
23
6
38
33
23
0
5
10
15
20
25
30
35
40
2000 2002 2004
Less than 1
1-2 Servings
3-4 Servings
5 or More
Source: Health Counts in Wisconsin. Wisconsin Behavioral Risk Factor Survey. DHS.
Percentage of Adults in Wisconsin Report of 0-5 Servings of Fruits and Vegetables
Consumed per Day, 2001-2007
WI overall = 77.2%WI range = 64% – 86.3%
Brown County = 78.3%Brown County rank = 42/72
Source: 2008 WCHR Full Report
Percentage of Adults in Wisconsin Report of 5 or more Servings of Fruits and Vegetables
Consumed per Day 1996-2009
Source: Health Counts in Wisconsin. Wisconsin Behavioral Risk Factor Survey. DHS.
23%22%
24%
22%
Percent of Wisconsin Students in Grades 9-12 Who Consumed 5 or More Servings of
Fruits and Vegetables Per Day in the Past 7 Days - 2009
Source: 2009 Wisconsin Youth Risk Behavior Survey. Wisconsin Department of Public Instruction.
Five or More Servings
19%
Less than 5 servings
81%
Percent of Wisconsin Students in Grades 9-12 Who Consumed 3 or More Glasses per
Day of Milk in the Past 7 Days-2009
Source: 2009 Wisconsin Youth Risk Behavior Survey. Wisconsin Department of Public Instruction.
Less than 379%
3 or More21%
Percent of Wisconsin Students in Grades 9-12 Who Drank a Glass, Can, or Bottle of Soda
per Day in the Past 7 Days - 2009
Source: 2009Wisconsin Youth Risk Behavior Survey. Wisconsin Department of Public Instruction.
None76%
One or More24%
Exclusively Breastfeeding Duration by WIC Participants, Jan 2009 - Sept 2010
69%
20%
9%
68%
9%
22%
0%
10%
20%
30%
40%
50%
60%
70%
80%
0 mos 3 mos 6 mos
Brown County
Wisconsin
Source: ROSIE WIC database; Accessed 10/1/10
Breastfeeding Duration by WIC Participants, Jan 2009 - Sept 2010
69% 68%
44%
25%
11%
68% 66%
46%
26%
12%0%
10%
20%
30%
40%
50%
60%
70%
80%
0 mos 1 mos 3 mos 6 mos 12 mos
Brown County
Wisconsin
Source: ROSIE WIC database; Accessed 10/1/10
Farmers Markets per 100,000 population, 2008 - 2009
0 - 5
6 - 10
11 - 25
26 - 101
Missing data
Wisconsin = 3.2 / 100,000
Brown County = 2.9 / 100,000
Source: Food Environment Atlas; Located @ http://maps.ers.usda.gov/FoodAtlas/foodenv5.aspx
Fast Food Restaurants per 100,000 population, 2007
Source: Food Environment Atlas; Located @ http://maps.ers.usda.gov/FoodAtlas/foodenv5.aspx
Brown County = 62.5 / 100,000
152 fast food restaurants
6.3 - 50
51 - 100
Missing data
Grocery stores per 100,000 population, 2007
1.5 - 25
26 - 100
Missing data
Brown County = 13.6 / 100,000
33 grocery stores
Source: Food Environment Atlas; Located @ http://maps.ers.usda.gov/FoodAtlas/foodenv5.aspx
Source: Wisconsin Department of Health Services 2010
Unduplicated Food Share Recipients: Monthly Average,
Brown County 2005-2009
20,193 20,806 21,980
16,395
22,027
0
5,000
10,000
15,000
20,000
25,000
2005 2006 2007 2008 2009
Average # of monthly recipients per % overall population, 2009Wisconsin = 10%
Brown County = 9%
Unduplicated WIC ParticipantsBrown County 2005-2009
9,911
9,741
10,162
10,53910,434
9,200
9,400
9,600
9,800
10,000
10,200
10,400
10,600
2005 2006 2007 2008 2009
Number of recipients per % overall population, 2009Wisconsin = 2.3%
Brown County = 4.2%
Source: USDA website and Department of Health Services, BHIP, Public Health Profiles
Source: 2007 WIC Food Security Profile
Food Insecurity in Wisconsin, 2007
Brown County Rank: 8 / 72
57%
16%
51%
15%0%
20%
40%
60%
80%
100%
Low Food Security Very Low Food Security
Brown County
Wisconsin
1991 1995
2002
Obesity Trends Among U.S. AdultsBRFSS, 1991-2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends Among U.S. Adults2008
County Health Rankings: ObesityBrown County 2001 - 2007
Source: 2008 WCHR Full Report
Health Behavior: Adult Obesity (% BMI > 30)
Brown County 24%Brown County Rank = 26 / 73
Wisconsin 24%Wisconsin range = 17% - 38 %
Percent of Wisconsin High School Students Who are Obese based on Body Mass Index (≥ 95th % by age)
Source: Wisconsin YRBS, DPI
2010 target = 8%
Percent of Wisconsin Children Ages 2-4 Enrolled in WIC Who are Overweight (≥ 95th % by age)
Source: CDC, Pediatric Nutrition Surveillance System
2010 target = 9.4%
Questions
Unhealthy Alcohol and Drug Use
Unhealthy Alcohol and Other Drug useHealthiest Wisconsin 2020 Objectives
1. By 2020, reduce unhealthy and risky alcohol and other drug use by changing attitudes, knowledge, and policies, and by supporting services for prevention, screening, intervention, treatment, and recovery.
Unhealthy Alcohol and Other Drug useHealthiest Wisconsin 2020 Objectives
2. By 2020, assure access to culturally appropriate and comprehensive prevention, intervention, treatment, recovery support , and ancillary services for underserved and socially disadvantaged populations who are at higher risk for unhealthy and risky alcohol and other drug use.
Unhealthy Alcohol and Other Drug useHealthiest Wisconsin 2020 Objectives
3. By 2020, reduce the disparities in unhealthy and risky alcohol and other drug use among populations of differing races, ethnicities, sexual identities, and orientations, gender identities, and educational or economic status.
Percent of Wisconsin Adults Report Heavy Alcohol Consumption 2003-2009
0
1
2
3
4
5
6
7
8
9
Males (>60 drinks, past month) Female (>30 drinks, pastmonth)
2003
2005
2007
2009
Source: Division of Public Health.
Department of Health Services.
Health Counts in Wisconsin. Wisconsin Behavioral Risk Factor Survey, 2009
Wisconsin Adults Reporting Within the Past 30 Days They Had
5 or More Drinks On One Occasion By Gender
34% 36%30% 30%30%33%
36%
17%17%16%13%14%11%
17%
0%
25%
50%
75%
100%
1992 1997 2002 2004 2006 2007 2009
Males
Females
Source: Wisconsin Department of Health Services, Bureau of Health Information.
The 2009 Wisconsin Behavior Risk Factor Survey (BRFS).
Source: 2010 County Rankings
2010 County Health Ranking: Binge Drinking Brown County
Health Behavior: Binge Drinking
Brown County 27%
Wisconsin 23.2 %
59.9
44.1
30.031.3
40.841.841.3
0
20
40
60
80
100
Total Male Female 9th 10th 11th 12th
Percentage of HS Students Who Had at Least One Drink of Alcohol on One or More of the Past 30 Days, WI, 2009
Source: Wisconsin Department of Public Instruction. 2009 Wisconsin Youth Risk Behavior Survey.
Trend 1993 – 2009:
Percentage of Wisconsin 9-12th Grade Students Who Had at Least 1 Drink Of Alcohol on 1 or More of
the Past 30 Days 1993 - 2009
41
494947545251
48
0
10
20
30
40
50
60
1993 1995 1997 1999 2001 2003 2005 2007 2009
Source: Wisconsin Department of Public Instruction. 2009 Wisconsin Youth Risk Behavior Survey.
69 to 189190 to 262263 to 347348 to 385
Number of Residents per Liquor License2003
WisconsinCounty Average 343
Number of ResidentsPer Liquor License
Brown County 396
Source: Wisconsin Department of Transportation,
Bureau of Transportation Safety.
2002 Wisconsin Alcohol Traffic Facts Books.
Percentage of Adults Reporting Within the Last 30 Days They Drove After Having Too Much to Drink
5%4%
5%5%
0%
5%
10%
15%
1992 1997 2002 2007Source: Wisconsin Department of Health and Family Services,
Bureau of Health Information.
The 2007 Wisconsin Behavior Risk Factor Survey (BRFS).
39.9
27.6
16.316.723.3
26.925.2
0
20
40
60
80
100
Total Male Female 9th 10th 11th 12th
Wisconsin High School SurveyPercentage of students who had five or more drinks of alcohol in a row, that is,
within a couple of hours, on one or more of the past 30 days
QN42 - Weighted Data*Non-Hispanic.
Trend 1993 – 2009:
29.823.9
18.524.224.224.224.3
0
20
40
60
80
100
Total Male Female 9th 10th 11th 12th
Wisconsin High School Survey
Percentage of students who rode one or more times during the past 30 days in a car or other vehicle driven by someone who had been drinking alcohol
QN10 - Weighted Data*Non-Hispanic.
Motor Vehicle Crash Statistics: Brown County 2008:
Alcohol Related Drinking Driver Age in Crash
Source: Wisconsin Department of Transportation, Bureau of Transportation Safety.
1 2
7150
206
0
50
100
150
200
250
10-1
4 ye
ars
15-1
6 ye
ars
17-2
1 ye
ars
22-2
4 ye
ars
25+
years
Source: Wisconsin Department of Transportation, Bureau of Transportation Safety.
Injury and Death from Alcohol Related Crashes Brown County 2008
2008Total Crashes
4,072
Alcohol RelatedCrashes
327
Alcohol RelatedInjuries
213
Alcohol Related Deaths
9
Snowmobile Fatalities In Wisconsin 2002-2010
Source: Wisconsin Department of Natural Resources,
http://www.dnr.state.wi.us
23.824.6
14.918.120.620.420.5
0
20
40
60
80
100
Total Male Female 9th 10th 11th 12th
Percentage of Students Who have Taken a Prescription Drug (such as OxyContin, Percocet, Vicodin, Adderall, Ritalin, or Xanax) Without a Doctor's
Prescription One or More Times During Their Life-2009
Source: Wisconsin Department of Public Instruction. 2009 Wisconsin Youth Risk Behavior Survey.
27.021.8
12.214.4
15.622.2
18.9
0
20
40
60
80
100
Total Male Female 9th 10th 11th 12th
Percentage of Students Who used Marijuana One or More Times During the Past 30 Days, WI 2009
Source: Wisconsin Department of Public Instruction. 2009 Wisconsin Youth Risk Behavior Survey.
Trend 1993 – 2009:
7.05.83.94.24.75.75.20
20
40
60
80
100
Total Male Female 9th 10th 11th 12th
Wisconsin High School Survey, 2009Percentage of students who used any form of cocaine, including powder, crack, or freebase
one or more times during their life
QN49 - Weighted Data*Non-Hispanic.
Trend 1997 – 2009:
7.09.88.112.5
10.19.09.6
0
20
40
60
80
100
Total Male Female 9th 10th 11th 12th
Wisconsin High School Survey, 2009
Percentage of students who sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high one or more times during their
life
QN51 - Weighted Data*Non-Hispanic.
Trend 1997 – 2009:
Questions
What’s Next? Identify Lead Organizations for each focus
area
Form Action Planning Teams with community partners
Develop a Health Plan for priority areas
Questions
City of De Pere
Health Department
Mary Dorn
920-339-4054
Brown County
Health Department
Judy Friederichs
920-448-6400
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