brown county health department & city of de pere health department community health improvement...

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