State of Health in Nevada County

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Transcript State of Health in Nevada County

State of Health in Nevada County

Nevada County Community Leadership Institute February 24, 2012

Jeff Brown, Director Nevada County Health and Human Services Agency

Health & Human Services Agency

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Behavioral Health

– Children’s and adults mental health focused on mentally ill adults and emotionally disturbed children – Medi-Cal is priority – Crisis response – AOD Treatment – Odyssey House & Catherine Lane

Health & Human Services Agency

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Public Health

– Communicable disease control – Emergency preparedness – Nursing home visitation – Health and Wellness – Vital Records – Clinic services – WIC Nutrition

Health & Human Services Agency

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Social Services

– Adult and Child Protective Services – CalWORKS & Employment Services – Safety net programs – Food Stamps, GA, Medi Cal and CMSP – Veteran’s Services

Health & Human Services Agency

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Child Support and Collections

– Paternity establishment – Child support order establishment/enforcement – Child & spousal support collection/distribution – Medical support establishment/enforcement

Other Elements of Safety Net

• Clinical medical & behavior health services – hospitals, clinics and private medical providers and therapists • Foster families and group homes • Family resource centers • Non-profit service providers (e.g. hospice, domestic violence, homeless, housing, AOD treatment, child development, etc.)

The health status of Nevada County residents is better than

• True

the average Californian?

100%

• False

Tr ue 0% Fa lse

Nevada County Health Status

– Recent survey using 2003-09 data lists Nevada County overall health outcomes ranking as 11 th best of 56 California counties rated!

Health is most dependent on?

100%

1. Access to quality health care 2. Social factors -- education, housing, employment, income, neighborhood, etc.

3. Genetics

0% A cc es s t o qu al ...

So cia l f ac to rs ...

0% G en et ics

Determinants of Health

– Access to quality medical care only determines 15-20% of a person’s health.

– Up to 75% of a person’s health is dependent on the social determinants of health --- housing, education, employment, income, neighborhood, social support

Children and Adolescent Indicators

% Persons Under 18 in Poverty

20.0

18.0

16.0

14.0

12.0

10.0

8.0

6.0

4.0

2.0

0.0

12.4

17.0

18.0

Nevada Co.

California Nation California County Health Status Profiles 2011

1200

Vital Statistics 2004-2011

1000 962 952 1009 872 800 965 852 1040 937 1047 908 916 828 900 874 Births Deaths 972 875 600 400 200 0 2004 2005 2006 2007 2008 2009 2010 2011

Vital Statistics

2011 – 875 births - 464 Sierra Nevada Memorial Hospital (SNMH); 354 Tahoe Forest Hospital (TFH); 57 home births 2010 – 900 births - 457 SNMH; 394 (TFH); 49 home births 2009 – 916 births - 465 SNMH; 417 TFH; 34 home births 2008 - 1,047 births - 542 SNMH; 472 TFH; 33 home births 2007 - 1,040 births - 477 SNMH; 516 TFH; 47 home births 2006 – 965 births - 480 SNMH; 446 TFH; 39 home births

Estimate of Child Vaccination Rates

100%

1. 55% 2. 75% 3. 90%

55% 0% 75% 0% 90%

Immunizations

100 80 60 40 20 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 California Nevada Co

• 73.0% of Kindergarteners have obtained all required immunizations • 17.7% of Kindergarteners have Personal Belief Exemptions (PBE) California Department of Public Health 2011

Immunizations

Percentage of Nevada County Children 2 - 4 years of age with all recommended vaccinations in licensed childcare 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 California 93.4% 93.7% 93.3% 93.6% 93.5% 92.9% 91.9% Nevada Co. 81.7% 76.5% 77.6% 76.1% 74.4% 71.7% 71.9%

Vaccine Preventable Diseases and Immunization Coverage in California, SIRE, Immunization Branch California Department of Public Health (CDPH)

% Children’s Dental Insurance 2007

90 80 70 60 50 40 30 20 10 0 Nevada County California Dental

CHIS 2007

88 86 84 82 96 94 92 90

% Children’s Health Insurance 2007 & 2009

Nevada Co.

California 2007 2009 CHIS 2007 & 2009

70 65 60 55 50 45 40 35

3 Graders with Cavities

70.9

62 HP 2010 Goal – 42% Nevada County California Nevada County PHD Healthy Smiles 2007 Survey

21 19 17 15 29 27 25 23

3 Graders with Untreated Dental Decay

28.7

26 HP 2010 21% Nevada Co.

California Nevada County PHD Healthy Smiles 2007 Survey

75 65 55 45 35 25 15 5 -5

7 Grade School Fitness Zone Results - % Not Passing

32.3

25.9

44.5

37 Nevada County Body Composition California Aerobic

California Dept of Education 2010-11 Physical Fitness Report

% Children Engaging in Vigorous Activity 3 or More Days Per Week

CHIS 2007 & 2009

Children with Entries into Foster Care

5 4.5

4 3.5

3 2.5

2 1.5

1 0.5

0 California Nevada Co.

Center for Social Services Research, UC Berkeley, 7/2011

Prevalence of Children in Foster Care

6 2 1 0 5 4 3 Nevada Co.

California

Jan 2009 July 2011

Center for Social Services Research, UC Berkeley 2/2011

Ozone - # of Days Above State 8 hr Standard

100 90 80 70 60 50 40 30 20 10 0 87 83 71 66 81 55 42 38 18 2002 2003 2004 2005 2006 2007 2008 2009 2010 Western NC Truckee Sacto T St.

California Air Resources Board, 2011

Asthma

• Approximately 1.7 million children in California have been diagnosed with asthma.

The Burden of Asthma in California, A Surveillance Report June 2007, California Department of Health Services. • Nevada County’s age adjusted rate (per 10,000) for asthma hospitalizations for the years 2000-2005 is 6.0 (368 cases) compared with the state of California 10.5 (220,777 cases) The Burden of Asthma in California, A Surveillance Report June 2007, California Department of Health Services

% of Teens Diagnosed with Asthma

25 20 15 10 5 0 Nevada Co.

California 2007 2009 CHIS 2007 & 2009

Tobacco Use

50 45 40 15 10 5 0 35 30 25 20

NU 9th Truckee 9th State Nation NU 11th Truckee 11th State CHKS - NUJHSD 2010-11 & Truckee Unified 2009-10 Nation NU Altern.

Nevada County Teens’ Substance of Choice

1. Methamphetamine 2. Marijuana 3. Alcohol 4. Prescription Pain Killers

100% 0% Met ha mp het ami n.

Ma rij ua na 0% 0% A lco ho l P res cr ip tio n P.

11th Graders AOD Current Use

10 0 30 20 80 50 40 70 60

NU 11th Truckee 11th State

Alcohol Marijuana Meth/other amphetamine

CHKS - NUJHSD 2010-11 & Truckee Unified 2009-10 Nation

Any AOD use

NU Altern.

10 5 20 15 35 30 25 0 2004 % of NJUHSD 11th Grade Students Who Used Marijuana during the Past 30 Days 2005 2006 2007 2008 CHKS - NUJHSD 2010-11 & Truckee Unified 2009-10 2009 2010

% Students Using Prescription Painkillers 4 or More Times

12 10 8 2 0 6 4 NJUHSD 9th Graders NJUHSD 11th Graders 2007-08 TTUSD 9th Graders 2009-10 TTUSD 11th Graders

90 80 70 20 10 0 60 50 40 30 % of Students Finding Substances Fairly Easy or Easy to Obtain NU 9th Truckee 9th Alcohol NU 11th Marijuana Truckee 11th

Perceived Harm of AOD Occasional Use 80 70 60 50 40 30 20 10 0 NU 9th Truckee 9th Perceived Harm Occasional Alcohol Use - Great/Moderate Perceived Harm Occasional Marijuana Use-Great/Moderate Perceived Harm Occasional Smoking-Great/Moderate NU 11th Truckee 11th

10 0 30 20 60 50 40 NU 9th Ever Driven after Drinking Truckee 9th NU 11th Truckee 11th NU Alternative

35 30 25 5 0 20 15 10

% of Students Sad, Hopeless Feelings and Suicidal Thoughts NU 9th Truckee 9th

Frequency of Sad or Hopeless Feelings

NU 11th Truckee 11th

Seriously considered attempting suicide

45 40 35 30 25 20 15 10 5 0

Teen Birthrates Ages 15-19

41.5

34.7

14.4

Nevada Co.

California Nation Birth Rate per 1000 pop California County Health Status Profiles 2011

Adult Indicators

Vital Statistics

Leading Causes of Death for 2010

• Male – Heart Disease – Prostate Cancer – Chronic Obstructive Pulmonary Disease (COPD) – Pneumonia – Lung Cancer • Female – Heart Disease – Pneumonia – Lung Cancer – Breast Cancer – COPD – Alzheimer’s Disease/Dementia Nevada County PHD 2010

Mortality per 100,000 – The Good

State Rank

7 21 6 9 24 24 23

Indicator

Liver disease/cirrhosis Lung Cancer Homicide Diabetes Alzheimer’s Disease All Cancers All Causes

Age Adjusted Death Rates 2007-09

7.8* 37.2

1.3* 11.9* 18.4

151.5

640.6

Mortality Per 100,000 – The Bad

35 37 30 51 33 50

State Rank Indicator

Stroke Female Breast Cancer Unintentional Injuries Suicide Drug Induced Deaths Firearm Related Deaths

Age Adjusted Death Rate 2007-09

40.0

22.1* 36.7

20.0

13.6* 13.2*

State Rank

16 11 13 17

Communicable Diseases – Incidence Rates per 100,000

Indicator

AIDS Chlamydia Gonorrhea Tuberculosis California County Health Status Profiles 2011

Average Crude Case Rate 2007-09

1.9* 128.7

9.6* 1.0*

Communicable Disease

Campylobacteriosis Chlamydial Infections Escherichia coli Giardiasis Gonococcal Infections Hepatitis A Hepatitis B, acute Hepatitis B, chronic Hepatitis C, acute Lyme Disease Meningitis, viral Pertussis Salmonellosis Tuberculosis 2005 4 121 1 23 10 1 1 3 1 5 6 15 13 1 2006 5 111 8 9 6 1 0 3 0 6 10 19 11 2 2007 12 133 1 14 16 1 0 5 18 8 0 0 7 5 2008 9 140 2 13 6 6 1 2 0 14 4 5 13 2 2009 18 113 2 12 7 6 1 9 0 5 3 2 12 1 2010 13 141 4 9 6 3 0 6 0 8 2 22 17 0

*Not all reportable communicable diseases

2011 23 137 1 11 14 1 1 12 0 15 0 5 8 1

% Adults with Chronic Diseases

35 30 25 20 15 10 5 0 Nevada Co.

California CHIS 2009 *Data from CHIS 2005 ^Data from CHIS 2007

2008 County-level Estimates Diabetes Adults aged ≥ 20 years Age-adjusted percent 0 - 6.3

6.4 - 7.5

7.6 - 8.8

8.9 - 10.5

www.cdc.gov/diabetes > 10.6

100 90 80 70 60 50 40 30 20 10 0

Health & Dental Insurance

86,2 82,1 58,6 66,3 Nevada Co.

California *Dental is CHIS 2007 data Health CHIS 2009 *Dental

Mental Health

• 4.7% of county adults likely had psychological distress within the last year • 13.7% of residents needed help for emotional/mental health problems or alcohol/substance abuse issues • 11.5% had thoughts of committing suicide CHIS 2009

Group with Greatest Suicides

100%

1. 0-17 years of age 2. 18-39 years of age 3. 40-64 years of age 4. 65+ years of age

0% 0% 0% 0 -1 7 yea rs o f .

1 8 39 yea rs o f..

4 0 64 yea rs o f..

6 5+ yea rs o f a ...

% of Suicides by Age Group 2011

30 20 10 0 60 50 40 5 27 50 18 0-17 years 18-39 years 40-64 years 65+ years % of Suicides by Age Group

Sheriff/Coroner 2011

Suicide deaths 1991-2011

30 25 20 15 10 14 16 21 13 16 9 16 16 13 22 14 17 19 10 15 13 24 18 18 11 22 5 0

California County Health Status Profiles, CDPH, & Nevada County Chief Deputy Coroner/NC Sheriff’s Office

AOD Related Arrests 2001-2009

1,600 1,400 1,200 1,000 800 600 400 200 -

2001 2002 2003 2004 2005 Year 2006 2007 2008 2009

Controlled Substances Marijuana Possession Meth Possession DUI Drunk in Public

Drug Induced Deaths, 2002-09

Year 2002 2003 2004 2005 2006 2007 2008 2009 Suicide 1 0 1 0 1 4 2 4 Undetermined Accidental 0 4 3 1 3 5 1 2

Nevada County Sheriff’s Department Coroner Report

6 6 5 6 8 13 7 4 Total 7 10 9 7 12 22 10 10

18 16 14 12 10 8 6 4 2 0

Adult Current Smoker

2007 2008 Nevada Co.

California CHIS 2009

% Nevada County Adults Obese or Overweight

1. 20% 2. 33% 3. 55% 4. 65%

25% 25% 25% 25% 20% 33% 55% 65%

% Adults Overweight and/or Obese

56.4

56.3

56.2

56.1

56 55.9

55.8

56 56.3

Nevada County California

CHIS 2009

Obesity Trends Among U.S. Adults between 1985 and 2010

•

Definitions:

Obesity: Body Mass Index (BMI) of 30 or higher.

• Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the square of his or her height in meters.

Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010 (*BMI



30, or about 30 lbs. overweight for 5’4” person) 1990 2000 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%