Transcript Slide 1

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
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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



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
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

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
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
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Shares community
responsibility
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Increases community
awareness of the
population’s health
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Integrates isolated
efforts

Works to prevent
duplication of efforts

Develops community
specific strategies
History of Assessment in Brown County
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Initial assessment in 1995
“Healthier Brown County 2000”
History: Community Health Assessment
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Teen Pregnancy Prevention
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Tobacco-free
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Part of adolescent parenting coalition
Regional coalition housed in Outagamie
County
Cardiovascular health
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Efforts throughout county
Who participated. . .
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Representatives of the community
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Knowledge of the community: assets,
resources, and health needs
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Interest and commitment to create a
healthier community
The How. . .
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Steering Committee
Formed
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Identify priority focus
areas
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Community Partners
brought together to
examine data
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Develop a health plan
to address priority
concerns
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Identify gaps and
resources
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Present the health plan
to the community
Areas Reviewed
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Health Focus Areas
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Overarching Focus Areas
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All twelve areas reviewed
Both areas reviewed
Infrastructure Focus Areas
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Emergency Preparedness area reviewed
Priority Matrix
Magnitude
Seriousness
Feasibility
TOTAL
Rank
1
2
3
4
5
Environmental and occupational
health
Emergency preparedness,
response and recovery
Oral health
Physical activity
Alcohol and other drug use
7
Adequate, appropriate, and safe
food and nutrition
Mental health
8
Injury and violence
9
Tobacco use and exposure &
Health care access
6
Tobacco use and exposure
Healthy growth and development
Adequate, appropriate, and safe food
and nutrition
Alcohol and other drug use
Mental health
Healthy growth and development &
Physical activity
Social/economic factors
Tobacco use and exposure
Physical activity
Environmental and occupational
health
Alcohol and other drug use
Healthy growth and
development
Reproductive and sexual health
Social/economic factors
Environmental and occupational
health
Oral health
Injury and violence
Oral health
Public health preparedness
Social/economic factors
Alcohol and other drug use &
Chronic disease prevention and
management
Adequate, appropriate, and
safe food and nutrition
Emergency preparedness,
response and recovery
Chronic disease prevention and
management &
Injury and violence
10
11
12
Social/economic factors
Chronic disease prevention and
management
13
Reproductive and sexual health
14
Healthy growth and development
15
Communicable disease
prevention and control
Environmental and
occupational health
Physical activity &
Tobacco use and exposure
Health care access
Mental health
Health care access
Injury and violence
Communicable disease prevention Chronic disease prevention and
and control &
management
Mental health
Health care access
Emergency preparedness, response
and recovery
Communicable disease prevention and Oral health
control
Adequate, appropriate, and safe
Reproductive and sexual health
food and nutrition
Reproductive and sexual health
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
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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
Wisconsin Seal-A-Smile:
~6300 children received sealants
51% 3rd graders with sealants
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
Percentage of Wisconsin Adults with Tooth Loss Due
to Decay/Gum Disease, BRFSS 2004, 2006 & 2008
Brown County:
32.1%
Wisconsin:
40%
Source: Wisconsin Department of Health Services,
Behavioral Risk Factor Surveillance System
Adults, 18 years and older
No 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: 7,309
Members per Dentist: 72
Federally
Designated
Dental Health
Professional
Shortage Areas
City of Green Bay
Wisconsin Dentists by County
#
Pop.
Mean
professionally
(Est 2008)
age
active
Brown
County
72 county
average
%
female
245,018
159
50.75
13%
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 & Nutrition
Healthiest 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 & Nutrition
Healthiest Wisconsin 2020 Objectives
2. By 2020, all people will have ready
access to sufficient nutritious, highquality, affordable foods and
beverages.
Adequate, Appropriate & Safe Food & Nutrition
Healthiest 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
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Fruit/Vegetable consumption
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Beverage consumption
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Breastfeeding rates
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Fast food/Grocery store/Farmers market access
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Food insecurity levels
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Food assistance utilization
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Obesity rates
Percentage of Adults in Wisconsin Report of 0-5 Servings
of Fruits and Vegetables Consumed per Day
39
40
38
36
36
34
35
33
30
25
23
22
23
20
15
10
6
6
5
5
0
2000
2002
2004
Source: Health Counts in Wisconsin. Wisconsin Behavioral Risk Factor Survey. DHS.
Less than 1
1-2 Servings
3-4 Servings
5 or More
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
24%
22%
22%
Source: Health Counts in Wisconsin. Wisconsin Behavioral Risk Factor Survey. DHS.
23%
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
Five or More
Servings
19%
Less than 5
servings
81%
Source: 2009 Wisconsin Youth Risk Behavior Survey.
Wisconsin Department of Public Instruction.
Percent of Wisconsin Students in
Grades 9-12 Who Consumed 3 or More Glasses per
Day of Milk in the Past 7 Days-2009
3 or More
21%
Less than 3
79%
Source: 2009 Wisconsin Youth Risk Behavior Survey.
Wisconsin Department of Public Instruction.
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
One or More
24%
None
76%
Source: 2009Wisconsin Youth Risk Behavior Survey.
Wisconsin Department of Public Instruction.
Exclusively Breastfeeding Duration by
WIC Participants, Jan 2009 - Sept 2010
80%
69%
70%
60%
68%
50%
Brown County
40%
Wisconsin
20%
30%
9%
20%
22%
10%
9%
0%
0 mos
3 mos
Source: ROSIE WIC database; Accessed 10/1/10
6 mos
Breastfeeding Duration by WIC Participants, Jan
2009 - Sept 2010
80%
69%
68%
68%
66%
70%
60%
50%
44%
Brown County
40%
46%
30%
20%
25%
26%
Wisconsin
11%
10%
12%
0%
0 mos
1 mos
3 mos
Source: ROSIE WIC database; Accessed 10/1/10
6 mos
12 mos
Farmers Markets per 100,000 population,
2008 - 2009
Wisconsin = 3.2 / 100,000
Brown County = 2.9 / 100,000
0-5
6 - 10
11 - 25
26 - 101
Missing data
Source: Food Environment Atlas; Located @ http://maps.ers.usda.gov/FoodAtlas/foodenv5.aspx
Fast Food Restaurants per 100,000 population, 2007
Brown County = 62.5 / 100,000
152 fast food restaurants
6.3 - 50
51 - 100
Missing data
Source: Food Environment Atlas; Located @ http://maps.ers.usda.gov/FoodAtlas/foodenv5.aspx
Grocery stores per 100,000 population, 2007
Brown County = 13.6 / 100,000
33 grocery stores
1.5 - 25
26 - 100
Missing data
Source: Food Environment Atlas; Located @ http://maps.ers.usda.gov/FoodAtlas/foodenv5.aspx
Unduplicated Food Share Recipients:
Monthly Average,
Brown County 2005-2009
25,000
20,000
20,193
20,806
22,027
21,980
15,000
16,395
10,000
5,000
0
2005
2006
2007
2008
2009
Average # of monthly recipients per % overall population, 2009
Wisconsin = 10%
Brown County = 9%
Source: Wisconsin Department of Health Services 2010
Unduplicated WIC Participants
Brown County 2005-2009
10,600
10,400
10,539
10,434
10,200
10,000
9,800
10,162
9,911
9,600
9,741
9,400
9,200
2005
2006
2007
2008
2009
Number of recipients per % overall population, 2009
Wisconsin = 2.3%
Brown County = 4.2%
Source: USDA website and Department of Health Services, BHIP, Public Health Profiles
Food Insecurity in Wisconsin, 2007
Brown County Rank: 8 / 72
100%
80%
60%
Brown County
Wisconsin
40%
57%
20%
51%
16%
15%
0%
Low Food Security
Source: 2007 WIC Food Security Profile
Very Low Food Security
Obesity Trends Among U.S. Adults
BRFSS, 1991-2002
1991
1995
2002
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends Among U.S. Adults
2008
County Health Rankings: Obesity
Brown County 2001 - 2007
Health Behavior:
Adult Obesity
(% BMI > 30)
Brown County 24%
Brown County Rank = 26 / 73
Wisconsin 24%
Wisconsin range = 17% - 38 %
Source: 2008 WCHR Full Report
Percent of Wisconsin High School Students Who
are Obese based on Body Mass Index (≥ 95th % by age)
2010 target = 8%
Source: Wisconsin YRBS, DPI
Percent of Wisconsin Children Ages 2-4
Enrolled in WIC Who are Overweight (≥ 95 % by age)
th
2010 target = 9.4%
Source: CDC, Pediatric Nutrition Surveillance System
Questions
Unhealthy Alcohol
and Drug Use
Unhealthy Alcohol and Other Drug use
Healthiest 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 use
Healthiest 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 use
Healthiest 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
9
8
7
6
2003
2005
2007
2009
5
4
3
2
1
0
Males (>60 drinks, past month)
Female (>30 drinks, past
month)
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
100%
Males
75%
Females
50%
34%
25%
36%
36%
30%
17%
11%
14%
13%
33%
16%
30%
17%
30%
17%
0%
1992 1997 2002 2004 2006 2007 2009
Source: Wisconsin Department of Health Services,
Bureau of Health Information.
The 2009 Wisconsin Behavior Risk Factor Survey (BRFS).
2010 County Health Ranking: Binge Drinking
Brown County
Health Behavior: Binge Drinking
Brown County 27%
Wisconsin 23.2 %
Source: 2010 County Rankings
Percentage of HS Students Who Had at Least One Drink of
Alcohol on One or More of the Past 30 Days, WI, 2009
100
Trend 1993 – 2009:
80
59.9
60
41.3
41.8
44.1
40.8
40
31.3
30.0
9th
10th
20
0
Total
Male
Female
11th
12th
Source: Wisconsin Department of Public Instruction. 2009 Wisconsin Youth Risk Behavior Survey.
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
60
51
52
54
48
47
49
49
50
41
40
30
20
10
0
1993
1995
1997
1999
2001
2003
2005
2007
2009
Source: Wisconsin Department of Public Instruction. 2009 Wisconsin Youth Risk Behavior Survey.
Number of Residents per Liquor License
2003
Brown County 396
Wisconsin
County Average 343
Number of Residents
Per Liquor License
69 to 189
190 to 262
263 to 347
348 to 385
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
15%
10%
5%
5%
5%
5%
4%
0%
1992
1997
2002
Source: Wisconsin Department of Health and Family Services,
Bureau of Health Information.
The 2007 Wisconsin Behavior Risk Factor Survey (BRFS).
2007
Wisconsin High School Survey
Percentage 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
100
Trend 1993 – 2009:
80
60
39.9
40
25.2
26.9
23.3
20
27.6
16.7
16.3
9th
10th 11th 12th
0
Total
QN42 - Weighted Data
*Non-Hispanic.
Male Female
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
100
80
60
40
24.3
24.2
Total
Male Female
24.2
24.2
20
18.5
23.9
29.8
0
QN10 - Weighted Data
*Non-Hispanic.
9th
10th 11th 12th
Motor Vehicle Crash Statistics:
Brown County 2008:
Alcohol Related Drinking Driver Age in Crash
250
206
200
150
71
100
50
50
2
1
Source: Wisconsin Department of Transportation, Bureau of Transportation Safety.
ye
ar
s
25
+
ye
ar
s
22
-2
4
ye
ar
s
17
-2
1
ye
ar
s
15
-1
6
10
-1
4
ye
ar
s
0
Injury and Death from Alcohol Related Crashes
Brown County 2008
2008
Total Crashes
Alcohol Related
Crashes
Alcohol Related
Injuries
Alcohol Related
Deaths
4,072
327
213
9
Source: Wisconsin Department of Transportation, Bureau of Transportation Safety.
Snowmobile Fatalities In Wisconsin 2002-2010
Source: Wisconsin Department of Natural
Resources,
http://www.dnr.state.wi.us
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
100
80
60
40
20.5
20.4
Total
Male
20.6
18.1
20
0
Female
9th
24.6
23.8
11th
12th
14.9
10th
Source: Wisconsin Department of Public Instruction. 2009 Wisconsin Youth Risk Behavior Survey.
Percentage of Students Who used Marijuana One or More Times During the Past
30 Days, WI 2009
Trend 1993 – 2009:
100
80
60
40
22.2
18.9
21.8
15.6
14.4
27.0
12.2
20
0
Total
Male Female
9th
10th 11th 12th
Source: Wisconsin Department of Public Instruction. 2009 Wisconsin Youth Risk Behavior Survey.
Wisconsin High School Survey, 2009
Percentage of students who used any form of cocaine, including powder, crack, or freebase
one or more times during their life
100
Trend 1997 – 2009:
80
60
40
20
5.2
5.7
Total
Male Female
4.7
5.8
7.0
4.2
3.9
9th
10th 11th 12th
0
QN49 - Weighted Data
*Non-Hispanic.
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
100
Trend 1997 – 2009:
80
60
40
20
10.1
9.6
9.0
Total
Male Female
12.5
8.1
9.8
7.0
0
QN51 - Weighted Data
*Non-Hispanic.
9th
10th 11th 12th
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