Public Health:

Prevent-Promote-Protect Frederick County’s Health

Barbara Brookmyer, MD, MPH Frederick County Health Officer Frederick County Health Department February 22, 2012

Objectives

 Review Key Indicators of Health Status and later …    Describe State Health Improvement Process Describe FC’s Local Health Improvement Process Identify opportunities for you to become engaged 

What is Public Health?

Definition:  Protect and improve health of communities and populations through education, promoting healthy lifestyles, and research for disease and injury prevention  ◦ ◦ How: ◦ Population or community level focus ◦ Surveillance and data gathering ◦ Develop plans, programs, and policies Implement plans, programs, and policies Evaluate performance and outcomes Reference:http://www.whatispublichealth.org/what/index.html

Demographics of Frederick County

 Total Population*

Age*, %

 Under 5 Years  

Demographics

Under 18 Years 65 Years and Older

Frederick

233,385 6.4% 25.3% 11.1%

Race/Ethnicity*, %

 White  Black    Native American Asian Hispanic or Latino origin 81.5% 8.6% 0.3% 3.8% 7.3% Median Household Income**$81,436 Households in Poverty**, % 5.5% 5,773,552 6.3% 23.4% 12.3% 58.2% 29.4% 0.4% 5.5% 8.2% $70,017 8.6%

Maryland

Pop. 25+ W/O H.S. Diploma** 8.4%

Pop. 25+ With Bachelor's Degree or Above**, %

36.2% 12.1% 35.6%

Sources: *U.S. Census (2010), **American Community Survey (2008-2010)

County Health Rankings

  All counties in the US 3 rd year in a row rankings to be released April    Frederick County ranked 3 rd years in a row!

overall in health outcomes 2 Frederick County Health Factors rank was 4 th Frederick’s physical environment ranked 16 th Reference:http://www.whatispublichealth.org/what/index.html

2007 Community Health Assessment Areas of Opportunity

 Access to Healthcare Services ◦ Routine Medical Care ◦ Availability (Inconvenient Office Hours) ◦ Health Disparities (Low-Income, Minorities)  Death, Disease & Disability ◦ Heart Disease & Stroke ◦ Cancer   Colorectal Cancer (Deaths) Prostate Cancer (Screening) ◦ Respiratory Disease   Asthma Chronic Lower Respiratory Disease  Maternal & Infant Health ◦ Prenatal Care  Mental & Emotional Health ◦ Alzheimer’s Disease ◦ Emotional Wellness   Stress Suicide  Modifiable Health Risks ◦ Overweight & Obesity ◦ Alcohol Abuse ◦ Tobacco Use

10 Leading Causes of Death in Frederick County, 2010

           Malignant Neoplasms (332 down from 385) Diseases of the Heart (316 down from 380) Chronic Lower Respiratory Diseases (92 up from 69) Cerebrovascular Diseases (88 up from 71) Accidents (62 up from 50) Influenza and Pneumonia (46 up from 39) Alzheimer’s (37 up from 23) Kidney Disease (31 up from 30) Diabetes Mellitus (23 down from 27) Septicemia (23 down from 33) Intentional Self-Harm (Suicide ) (21 down from 32) Reference: http://dhmh.maryland.gov/vsa/Documents/deaths/Frederick.pdf

Incidence Rates for All Cancers 1997-2007: Frederick County, Maryland, and U.S.

700 600 500 400 300 200 100 0 1997 1998 1999 2000 2001 2002

Year

2003 2004 2005 2006 All Rates are per 100,000. 1997 and 1998 rates are age-adjusted to the 1970 U.S. population, all other years are age-adjusted to the 2000 U.S. standard population Source: Maryland Department of Health and Mental Hygiene CRF Annual Reports 2000-2010.

2007 FC Total MD Total US Total

3500 3000 2500 2000 1500 1000 500 0

Years of Potential Life Lost (YPLL) Before Age 75, Frederick County, 2009, Selected Causes of YPLL Source of Data: Divsion of Health Statistics, DHMH

African American vs. Caucasian Mortality Data for the Top 15 Causes of Death, Maryland 2009

Ratio Disparity Rank Excess Rate of Disparity Rank Frederick Cause of Death Statewide Cause of Death Disease Age-Adjusted Mortality per 100,000 Black White Ratio Age-Adjusted Difference per 100,000 7 1 2 1 Heart Disease 238.3

184.3

1.29

54 9 8 4 7 1 3 2 3 Cancer Stroke 193 48.3

176.6

38.3

1.09

1.26

16.4

10 4 10 6 1 2 10 9 5 4 10 5 6 7 11 19 4 5 6 7 8 9 10 Chronic Lung Disease Diabetes Accidents Flu and Pneumonia Septicemia Alzheimer's Disease HIV 27.8

34.4

22.9

17.5

25.2

15.6

17.5

40.4

17.1

24.7

17.2

16.5

17.6

1.2

0.69

2.01

0.93

1.02

1.53

0.89

14.58

-12.6

17.3

-1.8

0.3

8.7

-2 16.3

5 2 6 3 9 15 12 8 11 12 13 14 Nephritis, Nephrotic Syndrome, and Nephrosis Homicide Chronic Liver Disease Suicide 22.1

19.1

6.2

5.2

11.8

2.4

7.2

11.4

1.87

7.96

0.86

0.46

10.3

16.7

-1 -6.2

3 8 18

Source: Maryland Vital Statistics Annual Report 2009

15 Certain conditions originating in the perinatal period 11.4

2.6

4.38

8.8

Frederick County Data: Heart Disease and Related Risk Factors

      Heart disease and cancer are the leading causes of death in Frederick County followed by stroke (Maryland VSA 2007-2009, Table 50).

Among chronic disease risk factors, 15% of adults smoke, 25% report having high blood pressure and well over a third report having high cholesterol (Maryland BRFSS, 2009).

25% of adults are classified as obese; 40% are classified as overweight, which is 5 th worst in the State (Maryland BRFSS, 2010).

72% of adults, 4 th highest in the State, describe their activity level at work as “mostly sitting/standing” (Maryland BRFSS, 2010).

With regards to chronic disease disparities, the rate (per 100,000) of diabetes-related ED visits is 536 for Blacks vs. 197 for Whites (2.7 times greater), and hypertension-related ED visits is 426.8 for Blacks vs. 142.9 for Whites (3 times greater) (HSCRC, 2010).

Age-adjusted mortality data for Frederick County also shows that Blacks, when compared to Whites, suffer a higher rate of death from stroke (1.26 times greater), heart disease (1.29 times greater), and diabetes (2 times greater) (Maryland Vital Statistics Annual Report 2009).

# Marylanders Estimated to be Receiving Expanded Preventive Services Under the ACA

     

Total 1,153,000 Children 297,000 Women 448,000 Men 408,000 Based on expanded coverage though employer-sponsored health plans Source = February 2012 ASPE Issue Brief

◦

available on the Internet at:

http://aspe.hhs.gov/health/reports/2012/Preventiv eServices/ib.shtml

accessed February 21, 2012

BMI-For-Age 2 to 18: >=95th Percentile Frederick County / Maryland vs. Healthy People 2020 Target

30 25 20 15 10 5 0 2006 2007 2008 2009 2010 Frederick County Maryland 20,6 21,9 14,2 22,3 19,2 22,3 23 23,1 17,4 25,7 HP 2020 Target 14,6 HP Objective NWS-10: Reduce the proportion of children and adolescents who are considered obese (target for ages 2-19). Note: BRFSS data & HP objective- similar but not exact.

Maryland Behavioral Risk Factor Surveillance System, BRFSS-2006- 2010, Retrieved from: www.marylandbrfss.org

Adults ever told they had high cholesterol

45 40 35 30 25 20 15 10 5 0 Frederick County Maryland HP 2020 Target 2001 30,8 31,1 2003 32,9 33,9 2005 30,6 33,2 2007 39,1 36,9 2009 35,5 37,4 HP Objective HDS-7: Reduce the proportion of adults with high total blood cholesterol levels 13,5 Maryland Behavioral Risk Factor Surveillance System, BRFSS-2001- 2009, Retrieved from: www.marylandbrfss.org

Ever Had Sigmoidoscopy or Colonscopy Exam Age 50+ Frederick County / Maryland vs. Healthy People 2020 Target

80 30 20 10 0 70 60 50 40 Frederick County Maryland HP 2020 Target 2002 66,8 54,8 2004 48,2 61,1 2006 67,3 65,7 2008 73,8 71,3 2010 70 72,3 70,5 HP Objective C-16: Increase the proportion of adults who receive a colorectal cancer screening based on the most recent guidelines Maryland Behavioral Risk Factor Surveillance System, BRFSS-2002- 2010, Retrieved from: www.marylandbrfss.org

Last Mammogram Less than 2 years ago - Women 40+ Frederick County / Maryland vs. Healthy People 2020 Target

84 82 80 78 76 74 72 70 68 Frederick County Maryland HP 2020 Target 2000 77,5 81,6 2002 81 82,1 2004 73,7 79 2006 80,1 79,8 2008 78,7 77 2010 80 80,8 81,1 HP Objective C-17: Increase the proportion of women who receive a breast cancer screening based on the most recent guidelines Maryland Behavioral Risk Factor Surveillance System, BRFSS-2000- 2010, Retrieved from: www.marylandbrfss.org

Pap Smear Within Past Two Years - Women 18+ Frederick County / Maryland vs. Healthy People 2020 Target

95 90 85 80 75 70 Frederick County Maryland HP 2020 Target 2000 86,8 87,1 2002 89,2 88,4 2004 84,2 84,1 2006 83,9 83,1 2008 85,9 78,2 2010 83,3 82 93 HP Objective C-15: Increase the proportion of women who receive a cervical cancer screening based on the most recent guidelines Maryland Behavioral Risk Factor Surveillance System, BRFSS-2000- 2010, Retrieved from: www.marylandbrfss.org

Tobacco Use in Frederick County

25 20 15 10 5 0 2008 State of Maryland

2 0 8 6 4 20 18 16 14 12 10

Frederick County Drunk Driving Fatalities

3 6 10 12 Number of Drunk Driving Fatalities 2002 2003 2004 2005

40 35 30 25 20 15 10 5 0

Coverage Source for Overall Mental Health Related ER Visits

45 Mental Health Visits All Other ER Visits Medicare Medicaid No Insurance Private

Dental Care - Adults

    Calls seeking care received by FCHD >10/wk Religious Coalition for Emergency Human Needs – # served limited by funding for vouchers: ◦ 2010 = 122 ◦ 2011 = 238 ◦ 2012 = ?>350 ◦ ◦ Mission of Mercy free dental services ◦ 2011 = 338 Others ◦ Dentists – charity care in office Seton Center FCAA

Thank You!

Frederick County Health Department Is Your Health Department