Weld County Public Health Weld County Public Health Improvement Plan Improvement Plan Priorities MeetingPriorities MeetingMay 10, 2011May 10, 2011

Today’s PlanToday’s PlanReview identified important issues

◦Brief summaries of data and possible broad strategies

Facilitated group discussion◦Everyone will vote on overall importance,

ability, and capacity to impactResults tallied and presentedDiscuss findings and make group

decision on priority issues based on score results (i.e., “cut points”)

Reflect on the priorities and next steps

What is the point of choosing What is the point of choosing priorities?priorities?

With limited resources, intensive focus on a few areas, beyond the maintenance of effort, can make a difference

No single agency can not do it alone so we need to garner the resources and energy from other multiple sectors

Identifying a few key areas to collectively focus on results in improvement plans that are doable

Communications and talking points need to be direct and focused

Where We Want To Go –Where We Want To Go –All residents living, working, and

playing in Weld County will benefit from physically, socially, emotionally, and spiritually enriched environments enhanced by the intentional, collaborative efforts among public & environmental health, health care, social service, education, community organizations and citizens-at-large.

Weld County Winnable Weld County Winnable PrioritiesPriorities

Infant healthTeen motor vehicle injury

Mental health & substance abuse

Nutrition, physical activity, obesity

Tobacco useTeen pregnancy

As you review the data …

How important is this health issue? • How many people are currently impacted,

rates of mortality, morbidity? • How many people are at risk, what does

the trend data tell us?• What is the degree of health disparities

inherent in this area?• Does this issue have a severe impact on

the quality of life?• As we consider health care costs, what is

the economic burden of this health issue?

What is our ability to impact this area? • Do evidence-based strategies or best

practices exist that can make a difference? • Is it likely, that with collective effort, we

can make a difference? • Is there community level readiness and

support for change?

As you review the data…

What is our capacity to impact this area? • Is there political will and champions to

support the issue?• Are there organizations prepared to take

the lead to move it forward?• Is there an adequate number of staff

available ?• Is there funding available or obtainable?

As you review the data …

Populations of interest total Populations of interest total reach countsreach counts

Total Population: 252, 000◦ 28% Hispanic/Latino

Children 0 – 18 yrs : 73,000

Teens 15-19 yrs: 20,000◦ Teen females 15-17 yrs: 5,250

Teen mothers (15-17 yrs): 155/yr

Adults 18 – 64 yrs: 165,000Adults 65 and older: 22,000

Populations of interest total reach Populations of interest total reach countscounts

38,000 (15%) of Weld residents live below the federal poverty level

14,000 (19%) of Weld children live below the federal poverty level

58,000 (25%) of Weld residents under 65 yrs live below 200% of the federal poverty level

Sources: 2009 FPL data from Colorado Health Institute, 2007 US Census SAHIE data compiled by WCDPHE

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Q29. What assets can your organization possibly offer to help improve our community's health around any of the priority health issues?

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Practice: Who is your public health hero?

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Albert Sa

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1. C. Everett Koop

2. Louis Pasteur

3. Jonas Salk

4. Erin Brockovich

5. Mark Wallace

6. Other

SOME SOME DEMOGRAPHICSDEMOGRAPHICS

Prior to today, how many of these meetings have you attended?

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What sector of the public health system do you represent?

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1. Public Health

2. Environmental Health

3. Health Care

4. Social Service

5. Education

6. Community Organization

7. Citizen-at-large

8. Other county or municipal government

9. Media

10. Other

Do you work directly with one or more of the target populations?

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2. No

A LITTLE MORE A LITTLE MORE DEPTH ON EACH OF DEPTH ON EACH OF ISSUEISSUE

Infant HealthInfant Health

Why is this important?◦ Infant mortality is associated with maternal health, quality

and access to care, socioeconomic conditions, and public health practices.

◦ Weld County’s infant mortality rate: 6.3 deaths per 1,000 live births; this translates to about 20–30 infants/yr or about 1 death every other week among 4,000 mothers annually

◦ 2009 CDPHE analysis: Weld’s rate has not changed in the long-term and is far from the goal of 4.5/1,000

◦ A 2003 statewide analysis found that 30% of Weld County’s fetal and infant deaths were preventable.

◦ VLBW infant NICU costs > $3,500 per infant; can exceed $1 million for an prolonged stay

◦ Family financial and emotional costs can also be significant

Infant HealthInfant HealthWhat can we do?

◦ American College of Obstetrician and Gynecologists Fetal and Infant Mortality Review (FIMR) program is well evaluated/evidence informed

What is our capacity? ◦ Medical, public health, and human service community have

champions and are ready. Health department is prepared to take the lead. Staffing to be determined.

Start-up and long-term funding needs to be identified.

◦ $17 million is dedicated to child health issues by 11 organizations; 112 primary staff, 112 support staff, 28 volunteer staff

◦ Several strong coalitions and/or networks focused on maternal and child health issues – Promises for Children, Early Childhood Council

◦ There are no programs addressing this directly

Infant healthInfant health

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3 Year Interval

Infant Mortality Rates, Weld, Larimer, El Paso & Colorado,1990-1992 to 2007-2009, 3 Year Averages

Weld ColoradoLarimer El Paso

Weld Trendline

6.3

8.2

6.4

Preventable deathsPreventable deaths

Table 1. Weld County Infant Deaths, 1997 – 2002Birthweight Fetal Neonatal Postneonatal Total

500 – 1,499 grams

Maternal Health / Prematurity63 deaths

63

≥ 1,500 grams

Maternal Care

38 deaths

Newborn Care

20 deaths

Infant Health40 deaths

98

Total 57 62 42 161

Infant health is a priority for Weld County.

1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

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Teen Motor Vehicle SafetyTeen Motor Vehicle Safety

Why is this important? Motor vehicle crashes are the leading cause of death for U.S.

teens In 2009, about 3,000 teens in the United States aged 15–19

were killed and more than 350,000 were treated in emergency departments for injuries suffered in motor-vehicle crashes.  

Young people ages 15-24 represent only 14% of the U.S. population. However, they account for 30% ($19 billion) of the total costs of motor vehicle injuries among males and 28% ($7 billion) of the total costs of motor vehicle injuries among females.

1 out of 6 drivers involved in a crash in Weld county are teens◦ The most cited violation was “inattention to driving”◦ 10% of teens involved in a crash in Weld County were not wearing a

seatbelt.

12% of District 6 students say they rarely/never wear a seatbelt when riding in a car (2007 YRBS)

Teen Motor Vehicle SafetyTeen Motor Vehicle Safety

What can we do? Programs, policies, and social norms related to

increasing awareness of high-risk driving, creating positive attitudes toward seat belt use, developing safer driving-related skills and decision-making abilities

What is our capacity?◦ DRIVE SMART Weld County is a strong nonprofit community

coalition made up of members of law enforcement, business, insurance, media, concerned citizens, schools, fire departments, and health professionals working to reduce injuries and death from traffic crashes

◦ Current funds < $100,000 / yr plus in-kind resources from coalition Funding sources: MCH, CDOT, Banner, State Farm, All State Staffing <.5 FTE plus 5.0 FTE volunteer hours

*Rates are per 100,000 teens ages 15-19Source: Health Statistics Section, Colorado Department of Public Health and Environment

* Rates are hospitalizations to teens age 15-19 per 100,000 population age 15-19 in each regionSource: Health Statistics Section, Colorado Department of Public Health and Environment

Motor vehicle crash hospitalization rates* to teens 15-19, 2007-2009 by Health Statistics Regions

Disparities in (teen) motor vehicle crashes/deaths

• Males (61% of teen crashes)

• Geography -most crashes happen in southwest but origin of teen drivers is:

• 25% Greeley/Eaton/Ft. Lupton• 34% other cities in Weld • 26% Denver and other cities outside Weld• 15% neighboring cites (Ft. Collins/

Brighton/Longmont)

Teen motor safety is a priority for Weld County.

1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

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Mental HealthMental Health

Why is this important? Mental health disorders are the leading cause of disability in

the US, accounting for 25% of all years of life lost due to disability and premature mortality

Depression and anxiety affect people’s ability to participate in health-promoting behaviors which, in turn, affects physical health

Suicide is the 8th leading cause of death in the Weld County 27% of adults in Weld said their mental health was not good

1 – 7 of the previous 30 days and 14% said their mental health was not good for 1 week or more (Weld 2010 CHS)

Mental HealthMental Health

What can we do? Ensure supply and access to effective & appropriate mental health &

suicide prevention services Shift norms & address stigma associated with seeking mental health

services Fill community gaps with effective & appropriate program interventions

What is our ability/capacity?◦ Northern Colorado Health Alliance and North Range

Behavior Health are champions in this area NOCOHA has a newly launched initiative called Project Launch -

promotes maternal mental health and early social-emotional health in underserved children (from birth to age 8) who are experiencing or at risk for significant social stressors

◦ About $16 million is dedicated to this area from 7 agencies; with 203 primary staff, 65 support staff, and 31 volunteer staff

Source: WCSD6 Youth Risk Behavior Survey, WCDPHE

*Rates are per 100,000 teens ages 15-19Source: Health Statistics Section, Colorado Department of Public Health and Environment

Teen suicideTeen suicide

21%15%

24%

15%

27%

18%12%

17% 17%13%

18%14%

0%

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50% Do you currently have depression, anxiety, or other mental health problem? (YES)

2010 Weld CHS

Disparities in mental health

Substance AbuseSubstance AbuseWhy is this important? Excessive alcohol consumption is the third leading

cause of preventable death in the US; 5% of US pop. drinks heavily & 15% binge drink

17% of adult Weld residents binge drink; 5% exceeded guidelines for low-risk drinking; 3% drove after having too much to drink (2007-2008 BRFSS, COHID)

28% of WCSD6 high school students binge drink (2007, YRBS)

6% of Weld pregnant moms drank during pregnancy (PRAMS)

2% of households had someone who needed and used alcohol or drug treatment services; another 3% said it was needed by someone but not used

Substance AbuseSubstance Abuse

What can we do?◦ Shift norms associated with substance use/abuse◦ Reduce youth access (raise prices, promote alternatives)◦ Decrease the appeal of substance products (examining,

publicizing, reducing advertising/marketing and by doing counter-advertising & programming)

What is our capacity?◦ Weld County Prevention Partners is a champion in this area◦ WCPP has a large multiyear federal grant focusing on underage

binge drinking especially among Latinos. In depth readiness assessments have been done in four regions/school districts – Ault RE-9, Fort Lupton RE-8, Johnstown-Milliken RE-5J, and LaSalle, Gilcrest, Platteville RE-1 – to see if underage drinking interventions could be implemented

◦ Over 80% of residents are concerned about alcohol or drug abuse

Disparities in Substance Abuse (binge drinking)

• Males (higher)• Age (younger higher)• Race (Whites and Hispanics higher)• Income (higher income higher)

Mental health and substance abuse is a priority for Weld County.

1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

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Nutrition, Physical Activity, & Nutrition, Physical Activity, & ObesityObesity

Why is this important?◦ Increased the risk for:

Coronary heart disease, type 2 diabetes, cancers (endometrial, breast, and colon), hypertension, dyslipidemia , stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, gynecological problems (abnormal menses, infertility)

◦ US medical expenses alone attributed to both overweight and obesity may have reached as high as $78.5 billion

◦ Weld County resident fruit and vegetable consumption and physical activity levels are below state averages

◦ Weld County’s obesity rate is 25% which is significantly higher than the state rate of 19%

Nutrition, Physical Activity, & Nutrition, Physical Activity, & ObesityObesity

What can we do?◦ Help change individual’s knowledge and skills

◦ Reduce exposure to foods low in nutritional value and high in calories

◦ Increase opportunities for physical activity

What is our capacity?◦ Healthy Weld 2020, WCDPHE, Banner/NCMC are

champions in this area◦ $6.2 million is dedicated to chronic disease risk factor reduction by 11

organizations; 40 primary staff, 44 support staff and 1.4 volunteer staff are dedicated to this area

Percent of children aged 2-14 overweight Percent of children aged 2-14 overweight or obeseor obese

Source: Colorado Child Health Survey, CDPHE

HP 2020 Obj: 5%

Sources: Weld County School District Six Youth Risk Behavior Survey (YRBS), WCDPHE & Colorado YRBS, CDPHE

Overweight & obesity Overweight & obesity trendtrend

HP 2020 Obj: 15%

Disparities in Obesity

• Race (Hispanics higher)• Income (lower income higher)• Education (lower education higher)• Geography (Greeley/Evans and

Southeast are higher)

Nutrition, physical activity and obesity are priorities for Weld County.1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

Stro

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Agree

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TobaccoTobaccoWhy is this important?

◦ Tobacco use is the single most preventable cause of death and disease in the United States

◦ Each year, approximately 443,000 Americans die from tobacco-related illnesses

◦ Tobacco use costs the U.S. $193 billion annually in direct medical expenses and lost productivity

◦ Adult cigarette use in Weld County is decreasing but adolescent cigarette use has not

◦ Chew tobacco rates are higher in Weld County compared to Colorado

TobaccoTobacco

What can we do?◦ Increase price of tobacco products ◦ Promote comprehensive smoke-free policies ◦ Reduce tobacco advertising and promotion ◦ Implement anti-tobacco education or media

campaigns ◦ Encourage / assist tobacco users to quit

What is our capacity?◦ Tobacco Free Weld County Coalition is a strong

champion◦ 80% of county residents are concerned about

youth tobacco use

Source: Weld Behavioral Risk Factor Surveillance Survey, WCDPHE Weld County Community Health Survey

Youth tobacco useYouth tobacco useGenerally, WCSD6 smoking rates are

lower than Colorado’s ◦ In 2007, 15.9% of WCSD6 9-12 grade

students smoked cigarettes.However, smoking rates significantly

increased among white, non-Hispanic youth◦ increasing from 12% to 18% from 2005

to 2007◦ In 2009-2010 HKCS for WCSD6, about

19% smoked cigarettes.

Disparities in tobacco

• Age (18-34 year olds higher)• Gender (males higher)• Income (lower income higher)• Education (lower education

higher)• Geography (Greely/Evans &

Southeast higher)

Tobacco use is a priority for Weld County.

1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

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Agree

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Teen PregnancyTeen PregnancyWhy is this important?

◦ Delays in initiating prenatal care, reduced likelihood of breastfeeding, poor maternal mental health

◦ 76% of teens pregnancies were unintended◦ 46% of teens entered into prenatal care after 1st

trimester ◦ Children born as a result of an unintended

pregnancy are more likely to experience poor mental and physical health and poor educational and behavioral outcomes

◦ 8% of Weld teen infants were born at a low birth weight

◦ Direct medical costs associated with unintended pregnancies in 2002 were $5 billion, or an average of $1,609 for each unintended pregnancy

Teen PregnancyTeen Pregnancy

What can we do?• Develop multi-faceted programs that support prevention• Reduce cost barriers to family planning services and

contraceptives• Increase access to reproductive health services• Provide comprehensive family planning services specifically

designed to meet cultural, age, and gender needs of clients in a variety of settings

• Provide assessment, policy development and planning, and assurance activities to reduce unintended pregnancy rates

What is our capacity?◦ $6.5 million is dedicated to adolescent health issues by

12 organizations; 52 primary staff, 17 support staff, 38 volunteer staff

◦ Over 80% of residents are concerned about teen sexual activity and pregnancy

Teen (15-17 yrs) Birth Teen (15-17 yrs) Birth RateRate

Disparities in unintended pregnancy

• Race (Hispanic higher)

• Income (lower income higher)

• Education (lower education higher)

• Geography

Teen pregnancy is a priority for Weld County.

1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

Stro

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Agree

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Disa

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Health equity/disparities (in any area just mentioned) is a priority for Weld County.

1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

Stro

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Health care access & utilizationis a priority for Weld County.

1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

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Agree

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Disa

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PRIORITIZING THE PRIORITIZING THE SIX WINNABLE SIX WINNABLE BATTLESBATTLES

The three criteriaThe three criteriaHow important? Number of people,

mortality, morbidity, at risk, trend, disparities, quality of life, economic burden

What is the ability to impact? Strategies to make a difference, community readiness

What is the capacity to impact? Political will, organizations to lead, staff, funding

The first three items…The first three items…Infant healthTeen motor vehicle injuryMental health & substance abuse

AbilityInfant health

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AbilityTeen motor safety

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AbilityMental health & substance

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CapacityInfant health

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CapacityTeen motor safety

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CapacityMental health & substance

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ImportantInfant health

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ImportantTeen motor safety

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ImportantMental health & substance

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Ability

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The next three…The next three…Nutrition, physical activity,

obesityTobacco useTeen pregnancy

AbilityNutrition, activity, obesity

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AbilityTobacco

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AbilityTeen pregnancy

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CapacityNutrition, activity, obesity

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CapacityTobacco

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CapacityTeen pregnancy

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ImportantNutrition, activity, obesity

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ImportantTobacco

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ImportantTeen pregnancy

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Bubble size = Important

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Based on your own personal sense of what is important, pick your top two public health priorities.

Infan

t health

Teen moto

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Menta

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Nutri

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Tobacco use

Teen pregnancy

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1. Infant health

2. Teen motor vehicle injury

3. Mental health & substance abuse

4. Nutrition, physical activity, obesity

5. Tobacco use

6. Teen pregnancy

7. Other

Select as many choices as you want, then push “Enter” on keypad.

DiscussionDiscussionBased on the data and

discussion, what should be the public health priorities?

If these are our priorities, what should we be doing next?

QUICK EVALUATIONQUICK EVALUATION

I learned a lot about Weld County’s six winnable public health priorities.

1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

Stro

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Agree

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This was a good process to learn about and prioritize public health issues.

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1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

I have a clear sense of what Weld county public health priorities should be.

1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

Stro

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Agree

Neutra

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I am confident that Weld County can make significant progress over the next few years on its priorities.

Stro

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Stro

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1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

THANKS FOR THANKS FOR PARTICIPATINGPARTICIPATING

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