COMMUNITY HEALTH ASSESSMENTIN COLLABORATION WITH LOCAL HOSPITALS

& AS PART OF A REGIONAL COMMUNITY HEALTH ASSESSMENT & PLANNING COMMITTEE

PRELIMINARY REPORT of KEY FINDINGSand Request for Feedback

for the Essex County Board of Supervisors on September 9, 2019and the Public Health Advisory Committee on September 10, 2019

OUR PROCESS & OUR FINDINGS

OUR PROCESS: THE TAKE ACTION CYCLE

1. Assess needs

2. Focus on priorities

3. Choose evidenced based

interventions4. Act locally

5. Evaluate actions

PRELIMINARY REPORT SUMMARY

Essex County residents enjoy better health than peers across New York State

10th in Health Outcomes

13th in Contributing Factors

OUTCOMES INDICATORS & LEADING CAUSES OF DEATH

Quality of Life Poor physical health days

Poor mental health days

Poor or fair health

Low birthweight

Length of Life Premature Death (before age 65)

Leading causes of death Cancer

Heart Disease

Respiratory Disease

Unintentional Injury

Diabetes

• https://apps.health.ny.gov/public/tabvis/PHIG_Public/lcd/reports/#countyhttps://www.countyhealthrankings.org

PRELIMINARY FINDINGS: OUTCOMES

This presentation is a look at OUTCOMES - experiences

WHAT is going on in our County; not WHY

WHAT DID WE CONSIDER?

What is affecting many residents?

How do we compare to NYS or other Benchmark?

What are some significant trends in the wrong direction?

What are issues for sub-populations beyond: women, children, seniors

What do our stakeholders & residents identify as issues?

PRELIMINARY FINDINGS

(Alphabetical order)

Chronic Disease* Obesity & Diabetes* Lung Disease, Tobacco & Nicotine

Well-Being* Mental Health* Alcohol* Opioids & Other Drugs

Women, Infants & Children* Pregnancy & Breastfeeding* Child & Adolescent Health

A LOOK AT EACH OF THESE AREAS

CHRONIC DISEASES

Obesity & Diabetes

Lung Diseases, Tobacco & Nicotine

WHY IT MATTERS

Obesity increases risk of many other physical & mental health conditions & death:

Diabetes

High blood pressure, cholesterol & triglycerides

Heart disease

Stroke

Gall Bladder disease

Sleep Apnea & sleeping problems

Pain & Osteoarthritis

Some cancers

Depression, anxiety & other mental health disorders

Obesity itself can lead to premature death

OBESITY

of adults are obese

https://www.cdc.gov/obesity/adult/causes.html

Data Source: BRFSS

DIABETES

Data Source: NYSDOH & CDC

WHY IT MATTERS

Diabetes is a leading cause of disability & death

It causes other health conditions

Heart disease

Stroke

Kidney disease

Vision problems

Amputations due to circulatory problems

People with Diabetes use more healthcare & miss more work

It is largely preventable

https://www.cdc.gov/diabetes/basics/index.html

Data Source: BRFSS

LUNG DISEASE

Death from Respiratory Disease

13% of residents have ASTHMA9.6% across NY

Asthma WHY IT MATTERS

Asthma is a serious disease causing wheezing, trouble breathing & coughing

It is a leading cause of hospitalizations for children

Over a lifetime it can cause permanent lung damage

Respiratory Disease is a leading cause of death here

Smoking is the leading cause of disease including lung disease, heart disease & stroke.

https://www.cdc.gov/vitalsigns/childhood-asthma/

https://www.cdc.gov/ruralhealth/COPD/

https://www.cdc.gov/mmwr/volumes/66/ss/ss6602a1.htmData Source: NYSDOH & CDC

TOBACCO & NICOTINE

WHY IT MATTERS

Smoking is the leading cause of disease including lung disease, heart disease & stroke.

Health Advisory about Vaping-associated Pulmonary Illness

patients ages 18-49

progressive respiratory compromise

26% youth reported vaping in last month5% higher than nationally

• Sources: BRFSS & Essex County Youth Survey

WELL-BEING

Mental Health

Alcohol

Opioids & Other Drugs

MENTAL HEALTH

Data Source: NYSDOH BRFSS

WHY IT MATTERS

Mental health impacts includes emotional, psychological & social well-being

It affects how to think, feel and act

It affects how we handle stress, relate to others & make choices that impact our physical health & other aspects of our lives

It includes a range of periodic poor mental health to mental illness

Ongoing poor mental health or poorly managed illness can lead to death by suicide

Poor Mental Health days14+ days/month

• https://www.cdc.gov/mentalhealth/learn/index.htm

MENTAL HEALTH

Age disparity in ER Use for Mental HealthYounger adults (people ages 18-34) are using the ER for mental health care more than other age groups.

Data Sources: CMS, CDC & NYSDOH

Death by Suicide

12.9

ALCOHOL

25% reported binge drinking in the last month

WHY IT MATTERS

Excessive alcohol use results in short & long term health effects

Motor vehicle accidents, drownings, violence

Risky sexual behaviors-assault & unintended pregnancy, STIs

Chronic conditions:

High BP, Stroke, Liver Disease, Digestive some Cancers

Mental health problems:

Depression, Anxiety

Social problems:

Family disputes, financial loss, legal & employment problems

Data Sources: BRFSS• https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm

ALCOHOL

High BP Stroke Liver Disease

2 ½ Xalcohol-relatedcar crashes

020406080

100

Rate/100K

Essex County NYS Average

Data Sources: NYS Traffic Safety Statistical Repository, BRFSS, CHIR, US Census County Business Patterns

Exceed NYS Averages for deaths due to

OPIOIDS

Opioid Overdose Deaths higher than NYS

ED visitsHospital dischargesDependenceDeaths

Opioid Burden=

Data Sources: NYS DOH Opioid Dashboard

Opioid Prescription Ratebelow NYS

ADDICTION & OD PREVENTION-ANY DRUG

Overdose Deaths for Any DrugHighest Rate seen in Ages 45-64* Rate is unstable – fewer than 10 events

Crude Rate (All) Ages 18-24Essex = 191 NY = 181 Essex = 453 NYS = 272

Emergency Department Visits for Any Drug

Data Sources: NYS DOH Opioid Dashboard

WOMEN, INFANTS & CHILDREN

Pregnancy & Breastfeeding

Children & Adolescents

PREGNANCIES

34% of births are from UNINTENDED PREGNANCIESCompared to NYSaverage of 24%

WHY IT MATTERS

Unintended pregnancies can contribute to physical, psychological, emotional and social woes for moms & babies

It often means less adequate prenatal care, low birth weight, increased risk of infant mortality, child abuse and developmental deficits

It has been associated with increased socio-economic impacts on communities as well:

increased need/use of healthcare and social services

decreased educational attainment and economic contributions of mothers & babies

https://www.healthypeople.gov/2020/topics-objectives/topic/family-planning

Birthswithin 2 years of previous pregnancy

PREGNANCIES & BREASTFEEDING

Early prenatal care is accessed less here than on average in NYSEssex = 71% NYS = 75%

77% of new moms

initiate breastfeeding compared to NYS average 83%

WHY IT MATTERS

Early prenatal care helps prevent pregnancy complications and ensures a healthy pregnancy for moms and babies including nutrition, mental health, family/social planning & reducing harmful exposures

It can also help moms plan for breastfeeding

Breastfeeding is the best nutrition possible for most babies

It reduces risk of short & long term health conditions

Moms- diabetes, High BP & certain cancer) &

Babies -obesity, asthma, ear & respiratory infections, SIDS

https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care

https://www.cdc.gov/breastfeeding/about-breastfeeding/why-it-matters.html

CHILDREN & ADOLESCENTS

Children in Foster CareDOUBLED 2010-2017

WHY IT MATTERS

Children in foster and kinship care are often removed from their families due to neglect or abuse

Fostering provides safety, stability & nurturing these children often experience complex and serious problems

Yet these children still experience additional risks for medical, emotional, mental, behavioral, developmental, educational, and other health issues

https://pediatrics.aappublications.org/content/136/4/e1142Data Sources: KWIC

CHILDREN & ADOLESCENTS

Dental Visits for cavities in children ages 3-5

Essex Rate = 221 NYS Rate = 90

Well Child Visits at all ages

Childhood immunizations

Lead Screening by 3 years2 ½ X

Healthcare indicators lag behind NYSDOH Benchmarks

Data Sources: NYS DOH Dashboard & CHIRS

CHILDREN & ADOLESCENTS

WHY IT MATTERS

Risk of type II Diabetes, high blood pressure, high cholesterol & heart disease – as children

Risk of fatty liver disease, joint pain, asthma & breathing problems

Social problems including low self-esteem, anxiety & depression

More likely to become obese adults & suffer more severe health outcomes

https://www.cdc.gov/obesity/childhood/index.html

21% of school age children are OBESE5% higher than NY average

Nearly 40% of children are Overweight or Obese

This is an increase from the previous assessment & higher than current NY Average

Data Source: NYSDOH Dashboard

CHILDREN & ADOLESCENTS

26% reported vaping in last month5% higher than nationally

36% reported drinking in last month

DOUBLE national comparison

WHY IT MATTERS

Underage drinking causes serious physical & social health problems:

Decision-making, memory & brain development disruption

Depression & risk of suicide

Unplanned/unwanted sexual activity

Assault

Vape is most common used tobacco product among students

Severe pulmonary disease associated with the use of vaping products, have been reported by 25 states and additional pulmonary illnesses are under investigation.

https://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm https://www.cdc.gov/mmwr/volumes/67/wr/mm6706a5.htm?s_cid=mm6706a5_w https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm

CHILDREN & ADOLESCENTS

WHY IT MATTERS

Teen pregnancies bring substantial social & economic impacts for mothers, their babies & communities:

Increased health risks for moms & babies

Negative impact on social & educational development of moms & babies

Negative impact on earnings potential

Increased need of social services

https://www.cdc.gov/teenpregnancy/about/index.htm Source: NYSDOH CHIRS

2007 2016

NOW –

SUMMARY OF STAKEHOLDER & RESIDENT SURVEYS AND

YOUR PRIORITIES

WHAT DID STAKEHOLDERS & RESIDENTS TELL US?

Stakeholders’ Concerns Residents Concerns

Substance abuse

Access to healthcare

Chronic diseases

Overweight/obesity

Issues related to aging

Inclusive definition of health - physical, mental & social well-being

Substance abuse

Mental health

Child/adolescent emotional health

Overweight/obesity

Adverse childhood experiences

FEEDBACK

What are your top 2 priorities?

What isn’t here that is another priority for you?

WHAT’S NEXT