warren countywarren county health department 315 w. washington ave. washington, new jersey 07882...

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WARREN COUNTY HEALTH DEPARTMENT315 W. Washington Ave.

Washington, New Jersey 07882Telephone: 908-689-6693

Fax: 908-689-3832ClAUD W. MITCHELL, MPH DOROTHY HARTH, RN, BSNHealth Officer Public Health Nurse Supervisor

January 30, 2007

Dear County Residents:

I am pleased to present this edition of the Warren County Health Department’s Community HealthImprovement Plan (CHIP).

This document creates a blueprint for health improvement in Warren County that links countywideefforts to the “Healthy New Jersey 2010” health objectives. The Warren County CHIP is an objective surveyof key health issues, resulting from a three pronged process: a data-driven assessment of health percep-tions; dialogue among community partners, county agencies and stakeholders; and the prioritization ofthose issues through the use of Coalition participation.

The Warren County CHIP identifies issues and concerns that have the potential to impact the health ofour citizens. It is a call to action for local communities and agencies to collaborate on ways to improvehealth status. Ultimately, the CHIP is a source for agencies, associations, health care institutions, government organizations and community leaders interested in linking their programs to address County-wide health concerns identified in the Plan.

In releasing Warren County’s CHIP, I want to acknowledge the contributions of many people whoworked on this document. They include members of the Warren County Health Department’s HealthEducation Staff, Public Health Nursing and the Environmental Heath Division, and the CHIP subcommitteesmade up of representatives from local community groups and agencies. I sincerely appreciate the dedication of both volunteers and staff, and it is gratifying to acknowledge their talent and commitment tothis project.

The responsibility for improved health status in not the sole responsibility of government, it is everyone’s. A healthy population begins when each person recognizes the significant degree to whichpersonal decisions influence personal health. Healthy people make health communities.

Sincerely,

Claude W. Mitchell, MPH

Claude W. Mitchell

Health Officer

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Introduction……...........................……………………………………………………………...........2

Acknowledgements………..……………………………………………………………...........3

Vision and Values……..…………………………………………………………………....................5

Methods……………………..........……………………………….…………….………………………7

Warren County Map………...……………….................………………..…….……………………...9Geographical Info……………...........……………………………………………..…………..10

Quality of Life in Warren County……………….........……………………………………….…….11

Health Issues to be addressed…………………………...........…………………………………...12

Access, Affordability and Appropriate Health Care………………………………..............13Work Plan………………………………….………………………….........................15

Fundamentals of Good Health…………………………………………….....………………..16Nutrition and Physical ActivityWork Plan……………………………………………………..........…………………..19Domestic Abuse and Sexual Violence………………........………………………….20Work PlanEnvironmental Concerns……………………...……………….……………………....21Work Plan……………………………………..............……………………………..…23

Preventing and Reducing Major Diseases..............………………………………………....24DiseasesWork Plan…………………............…………….……………………………………...26Substance Abuse..............……………………………….…………………………….27Tobacco UsageWork Plan……………………………………….……………..........………………….29Mental Health………………………….…….….................………………………….30Work Plan…………………………………...........…………………………………….32

Moving Strategies to Action…………………………………..……………………………………..33

Healthy Recommendations…………………………………..................…………………………..33

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Introduction

This Community Health Improvement Plan (CHIP) was developed to identify, prioritize and summarize important health issues for Warren County, NJ. The Warren County CHIP was developed over atwo year period by the strategic planning MAPP (Mobilizing for Action through Planning and Partnerships)Coalition.

Improving the health of Warren County residents requires the involvement and cooperation of individual residents, community-based organizations and the public health community. The MAPPCoalition is comprised of approximately 50 persons representing the general public, and staff from numerous local community organizations and service agencies.

In preventing disease and premature death neighborhood resources are required that allow for high-quality appropriate, affordable and accessible health care, as well as, promoting health and helpingpeople making healthy decisions and engaging in pro-healthy behaviors. The definition of a “healthy community” encompasses social and economic dimensions as well as areas traditionally defined as health.A broad definition of health is the foundation for this plan. It includes socioeconomic factors, cognitive andbehavioral factors, the physical environment, health issues and disease.

The 2006 Warren County Community Health Improvement Plan is a data driven approach to determining the health status, behaviors and needs of our resident population. The process to completethis health plan has involved input from a variety of community constituents, both public and privatestakeholders, and residents of all ages. This report was based on a series of county-wide needs assessments conducted during the last six years including: Behavioral Health Risk Surveys in 2001, 2003,and 2005; a Quality of Life Survey along with qualitative focus groups in 2005; an assessment of the localpublic health system using the National Public Health System tool in 2005; a review of existing health status indicators for the County in 2005; and interviews of local public officials in 2006. In areas wherethere were identified health issues, attempts were made to validate these claims through the collection ofdata to document evidence of these claims.

Overarching Concerns

Throughout the review of health issues there are demographic characteristics or factors that overarch all problems. They are age, gender, race, educational attainment, household income, andemployment. One additional factor includes access to transportation. These factors impact each area ofconcern reported in this plan. Some examples: l Age may affect whether a person is eligible for services;l Employment might determine someone’s health insurance status; l Available income may determine whether someone has a car for transportation; l Race is a risk factor that correlates with greater rates of disease; and l Educational level may determine one’s understanding of health education and/or health information.

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Quality of Life (QOL) is a concept that suggests an overall sense of well-being when applied to an individual and a supportive environment when applied to a community. Other characteristics of QOLinclude county residents’ perceptions regarding aspects of their neighborhoods and communities that eitherenhance or diminish their quality of life. While some dimensions of QOL can be measured by using indicators, research has shown determinants of individual health and community-well being are inter-related.

Measures of community environment reflect the reality that daily living conditions have a great effecton achieving optimal individual health. The presence of violence, illegal drugs, infectious disease and unsafeworkplaces are detrimental. In addition, studies indicate that the number of uninsured population and thesocio-economic conditions have a significant relationship to the overall level of health experienced by community residents. These components measure both positive and negative aspects of the community environment and their effects on the population's health. Again, there are many additional efforts of communities that improve the overall health of a population but are not directly reflected in these measures.Each community has its strengths, challenges and resources and should undertake a careful planning processto determine what action plans are best for them.

In compiling this report efforts were made to collect quantitative and qualitative data from residentsthat represent the needs and concerns of all living within Warren County. However, the information collected to provide evidence of the identified health problems discussed in this report may be limited bythe available data, and may not provide a comprehensive picture of all the potential health concerns of theCounty. Also, the scope of action delineated in this report only addresses those issues where the publichealth system can take initiatives that may have some impact towards improvement.

AcknowledgementsImproving the health of Warren County residents requires the involvement and cooperation of

individual residents, community-based organizations and the public health community. The following peopleparticipated on the MAPP Coalition and collaborated to complete this Plan.

Warren County Health Department StaffDonna Rue, RN, MPH, CHES, Community Health Educator/Partnership Coordinator Donna Jenkins, Data Entry ClerkClaude Mitchell, MPH, Health OfficerTracey Hess, Chief SanitarianLiz Marrett, EpidemiologistSheila Risley, Risk Communicator, Health EducatorWendy Sheay, WC PlannerPaul Wegmann, WCHDDot Harth, Director WCPHNAMary Van Horn, Assistant Nursing Supervisor, WCPHNAKristen Brown, ESU InternLiliana Molina, WPU InternHeather Benamati, ESU InternSteve Godin, PhD, MPH, CHES, Consultant

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Coalition Members

Marie Accetturo – Public representativeLaura Andreano, Supervisor, WC Visiting Home MakersKaren Cassano – Director Big Brothers/Big SistersJo Cermele – Public/Office on AgingArt Charlton – WC Public Information OfficerMaria Chervenak – Manager of Center for Healthier Living,

Hackettstown Regional Medical CenterSherri Cirignano – WC Family and Consumer Health, Rutgers UniversityDiane Czar – WC Community CollegeFaye Dean – Social Worker, WC TASSDavid Dech – Director WC Planning Dept.Teri Eyler- Director WC Center for Prevention ResourcesPam Farago – Executive Director Domestic Abuse and Rape Crisis CenterJames Feldman - Director Warren Hospital Behavioral HealthDian Fitzpatrick – Public representativeSusan Frost – Manager of Marketing & PR, Hackettstown Regional Medical CenterSyria Geddis – WC Municipal Alliance CoordinatorAlyssa Hamilton – Blairstown Health Advisory Committee/School NurseBonnie Harr – Nursing Unit Supervisor, WC AbilitiesBill Hunt – Domestic Preparedness Planner, WC Public SafetyBill King – WC Superintendent of SchoolsLori Lupo – WC DYFSRichard McDonnell - Executive Director WC Family Guidance CenterSarah Price – Cancer Prevention Coordinator, Warren HospitalRobert Pruznick, Director WC Association of Retarded CitizensAnn Rhinesmith – Public RepresentativeMike Schwar – Phillipsburg Public Housing AuthorityJim Seng – Warren Hospital EAPDawn Slifer – Director Jos Firth Youth CenterAndrea Turek – Case Manager NORWESCAP, First Call for HelpChristina Woykowski – Councilwoman, Washington BoroTawny Youtz – Cancer Prevention Coordinator, Warren Hospital

Warren CountyMAPP Vision and Values Statements

Vision

Warren County will have life enhancing health services within the County through the integration of all community functions.

Values

Social

lCreate an informed public regarding available health care systems through health literacy efforts and effective dissemination of resource information.lPromote health education to encourage and model healthy behaviors to people of all ages, empowering citizens to take responsibility for their own good health.lProvide quality education for all residents, and provide diverse opportunities in the fields of art, science, technology and health. lProvide safe, suitable and affordable housing to those in need.lPromote personal safety to all communities within the County. Provide supportive services for those families who are in distress.lRespect and promote religious and cultural diversity, including intergenerational interactions within the County.lFacilitate exercise, leisure time and recreation for all ages by refocusing efforts and dollars to benefit all residents.lReduce the burden of mental retardation and disabilities through educational programs and policy development.lDeliver prevention programs to reduce substance use/abuse and advocate for strengthening existing drug and/or alcohol treatment programs.

Economic

lImprove access to affordable, comprehensive health care and needed specialized care such as psychiatric, dental, pre-natal, emergency and genetic counseling for all residents.lProvide adequate, accessible public transportation for all residents so they may receive needed health care, means to possible job opportunities and life essentials.lDevelop strong partnerships with businesses, members and associates of the community to promote employment opportunities.

PoliticallRecognize the health needs of all residents by adequately funding the health and social services sectorsto meet the needs of our growing County.lWork towards creating communities that achieve a culture whereby everyone may enjoy civil and political rights.lPromote universal respect for individual rights and freedoms to uphold the principles of a democratic society.

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Technology

l Provide quality education through new technology ensuring residents diverse opportunities in the fields of science, and health.

Environmental

l Promote worksite behaviors, community development patterns, and a county-wide culture that encourages protection of our environmental resources. l Promote health and safe food, water and air.

Legal

l Provide access to a wide variety of legal services and advocacy for all people, regardless of their financial resources.

Diversity

l Provide services that respect all human life regardless of race, creed, gender, political affiliation, religion, and ethnicity.

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METHODS

Planning Process

The Warren County MAPP Coalition used the planning process developed by theNational Association of County and City Health Officials. MAPP (Mobilizing for Actionthrough Planning and Partnerships) derives its value from community participation.This strategic planning tool uses the community’s strengths, needs and desires to

identify priority health issues and gather information on the resources needed to address them. The MAPPcoalition met quarterly and was comprised of five Health department core staff, working in collaborationwith stakeholders (i.e., professionals and county residents) in Warren County. The MAPP Coalition guidedthe entire planning process. Coalition members joined one of three working subcommittees:

These subcommittees were each charged with their own process component and encouraged to solicitinput from additional individuals for a wider, more comprehensive perspective. The results from eachassessment were used to identify the most important issues affecting the health of residents within WarrenCounty. Committee members worked to generate a list of health issues, and proceeded to rank theseissues according to importance. The most important issues were then reviewed according to size, severityand effectiveness of potential interventions. They were then narrowed to the three most significant andworkable health concerns.

Process Components

Upon the establishment of the Coalition a “Vision and Values” statement was developed. Thisstatement was designed to emphasize the absolute best in expectations for Warren County and a guide tohelp develop the Health Plan addressing the needs of the County.

The Community Health Status Assessment Subcommittee collected and analyzed an abundanceof data. Data, from the U.S. Census, New Jersey Department of Health and Senior Services (Vital Statistics,Behavioral Risk Factor Surveillance Survey, and Center for Health Statistics), and national sources, becamethe foundation for assessing the health of Warren County over time and relative to New Jersey. Areas inwhich the County fared poorly became candidates for “health problems” which were ranked in the priorityselection process.

The Community Themes and Strengths Subcommittee developed and administered a survey togather information about county residents’ perceptions and perspectives on Quality of Life. In addition,the Community Health Educator and a consultant from East Stroudsburg University also developed aHealth Behavior Risk Assessment Survey and held ten focus groups to gather additional data. As a complement to the quantitative (data) analysis, the focus groups results offered a “qualitative” look at ourcounty’s health problems.

l Community Health Status Assessment l Community Themes and Strengthsl Local Health System Assessment

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The Local Health System Assessment Subcommittee evaluated the strengths, assets andresources of the health infrastructure services within the county. Using a tool from the National PublicHealth Performance Standards Program, the Ten Essential Public Health Services were analyzed accordingto indicators and model standards defining performance.

The fourth assessment done was a review of the “Forces of Change” by the Coalition as a whole.These are factors that may influence or affect the public health system/services in either a positive or negative way and are usually fluid or may be constantly changing.

Existing Data Resources

A variety of data resources were used to complete this plan. In areas where there was no availabledata an attempt was made to collect or find evidence to support identified health issues. This may havebeen key stakeholder interviews, focus groups, mailed surveys, state and national statistics, and hospital/emergency room usage data.

l2000 U.S. CensuslWarren County Health DepartmentlCommunity Research PartnerslNew Jersey Department of Health Center for Health StatisticslNational Center for Health StatisticslNew Jersey, Department of Justice, Crime reportlWarren HospitallHackettstown Regional Medical CenterlFamily Guidance Center of Warren CountylWarren County Department of Human ServiceslNORWESCAP Poverty Study

Baseline Survey DataIn addition, baseline survey data shown throughout this report was obtained from:lWarren County Health Dept. 1999 Community Health Risk Assessmentl2001 Warren County Community Health Risk Assessmentl2003 Warren County Community Health Risk Assessment l2005 Warren County Quality of Life Surveyl2005 Warren County Behavioral Risk Survey

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Warren County

2006 Health Assessment

HARDWICK TOWNSHIP

BLAIRSTOWN TOWNSHIP

KNOWLTON TOWNSHIP

FRELINGHUYSEN TOWNSHIP

ALLAMUCHY TOWNSHIP

INDEPENDENCE TOWNSHIP

HOPE TOWNSHIP

BELVIDERE

WHITE TOWNSHIPOXFORD TOWNSHIP

MANSFIELD TOWNSHIP

HACKETTSTOWN

WASHINGTONBOROUGH

WASHINGTON TOWNSHIP

FRANKLIN TOWNSHIP

GREENWICH TOWNSHIP

POHATCONG TOWNSHIP

ALPHABOROUGH

PHILLIPSBURG

LOPATCONG TOWNSHIP

HARMONY TOWNSHIP

LIBERTY TOWNSHIP

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Warren County - General Information & Geographical Location

Warren County, located in northwestern New Jersey, occupies an area of 364.55 square miles, is 32miles long with an average width of 13 miles, and ranks ninth in size among the State's 21 counties.Within the County are some of the most rugged and scenic terrain found in New Jersey. The landscape is characterized by a series of ridges and valleys in a northeasterly/southwesterly direction. Elevations rangefrom 125 feet to 1,600 feet above sea level. Mountain ranges and ridges that divide the county's fertileriver valleys include Kittatinny Mountain, Jenny Jump Mountain, Scott's Mountain and PohatcongMountain. These fertile valleys have enabled the County to become an important agricultural district in theGarden State. Streams and rivers, all emptying into the Delaware river, include the Musconetcong,Paulinskill and Pequest rivers; Dunnfield, Pohatcong and Lopatcong creeks; and Van Campens brook.

The Delaware river and the Commonwealth of Pennsylvania border the County to the west. TheCounty boundaries also include the Musconetcong River, Morris County and Hunterdon County to the eastand southeast, and Sussex County to the north and northeast. The County is highly accessible byInterstates 80 and 78, yet maintains a predominantly rural character.

Historically, Warren County had been part of the Allentown-Bethlehem-Easton (ABE) MetropolitanStatistical Area. For decades the commercial market area for the County was to the west in Lehigh Valley,Pennsylvania. In December 1992, the federal Office of Management and Budget reclassified WarrenCounty as part of the New York-Newark Primary Metropolitan Statistical Area. However, in January of 2006Warren County was moved back to the ABE Metropolitan Statistical Area.

August 2005 Farmers Fair

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Warren County Quality of Life

Although quality of life can be a difficult concept to measure, this indicator represents an effort toassess the overall health status of the community. In the summer of 2005, a Warren County Quality of LifeSurvey was distributed to approximately 550 residents at the Warren County Farmers Fair. In addition, a“Wailing Wall” was provided at the Fair for people to write their answers to three questions (see below).This week long cultural event is attended by a wide variety of county residents. Finally, there were 10focus groups conducted throughout the County in the summer of 2005 to collect additional input regarding these three questions. Below are the three questions posed, the summary of the findings andrecommendations offered by residents:

What are the Most Important Factors Which Most Improve the Quality of Life in Your Community?l Good place to raise children l Low crime/safe neighborhoods l Good schools l Clean environment

What are the Three Most Important ‘Health Problems’in Your Community?l Cancerl Heart Disease and Strokel Aging Problems (e.g. arthritis, hearing/vision loss, etc.)l Motor Vehicle Crash Injuries

What are the Three Most Important Risky Behaviors in Your Community? l Alcohol Abusel Being Overweightl Tobacco Usel Lack of Exercisel Drug Abuse

What Recommendations Would You Make to Improve the Quality of Life in Warren County?l Step up Efforts in Conservationl Make Improvements to the Public Transportation Systeml Expand Community-Based Public Health Interventions and Educationl Increase Community Member Involvement and Volunteerism

In the 2001, 2003 and the 2005 Behavioral Surveys sent out by the Warren County Health Dept., morethan 80% of WC residents ranked their health as either “good”, “very good” or “excellent.” The proportionof adults reporting that their general health is good to excellent is an indicator of overall health status of persons in the County.

Senior comment:“We need more activities and transportation for seniors all

around the County.”

Local citizen comment:“There are not enough accesible

recreational areas; we need more bike paths and walking paths.”

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Health Issues to be Addressed

The following issues represent areas to be addressed for health improvement in Warren Countybased on the information gathered through the 2006 MAPP Coalition Community Health Plan project. Anattempt was made to support each concern with evidence gathered through the planning process.

Access, Affordability and Appropriate Health Care

l Lack of Health Insurancel Lack of Appropriate and Available Health Care Servicesl Satisfaction with Health Care Servicesl Lack of Public Transportation

Fundamentals of Good Health

l Nutrition and Physical Activityl Domestic Abuse and Sexual Violencel Environmental Issues

Air associated problemsContamination sitesSentinel Events

Preventing and Reducing Major Diseases

l Chronic Disease/Illness – Cancer, Heart, COPDl Communicable/Infectious Diseasesl Substance Abuse

Tobacco Usagel Mental Health Problems

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Access, Affordability and Appropriate Health Care

As health care costs approach 20% of our gross domestic product, access to affordable health care has become a national issue as wellas key concern for residents of Warren County. Barriers such as cost, transportation, lack of physicians, and availability of convenient office hours to set appointments, are considered prohibitive for many residents. Access to healthcare remains particularly difficult for certain segments of the population, including those who are low-income, the disabled, seniors, and minorities.

Lack of Health Insurance

Gathering and comparing emergency room and inpatient admission data from bothWarren County hospitals (Warren Hospital and Hackettstown Regional Medical Center)for 2005, 87% of consumers reported they have health insurance coverage that wasprovided by either government or private carriers. However, 13% were found to beeither “self pay” or “charity care” which infers a lack of insurance. Interviews with keyinformants at the hospitals indicate that this percentage has been increasing each year.Currently, Warren County data indicates 80% to 85% of residents who have access to a primary care physician. Comparing Warren County to the Healthy NJ 2010 HealthObjectives, we are below the target objective of 89% for the state.

Lack of Appropriate and Available Health Care Services in Warren County

As this document goes to print in early 2007, there currently are few pediatric specialists, no dental clinics, and limited access to physicians who accept medical assistance (i.e., Medicaid HMO’s;Medicare). There are also a limited number of bilingual interpretators available for health and social serv-ice consumers who use a primary language other than English. However, Warren County is inline with theHealthy NJ 2010 Health Objective target for un/underinsured residents using ambulatory care services.

Warren Hospital reports: 80% of people visiting the emergency room in 2005-2006 indicated they do have a primary care physician.

Focus Group response: “There is a lack of health care specialists in and around the County….especially in areas of mental health and substance

abuse counseling, and pediatric care.”

56% 31% 13%

Hospital Usage by Insurance TypeWarren County 2005

Government Insurance

Private Insurance

Self Pay/Charity

Persons reporting satisfaction with the health care system in the community are also morelikely to report positive health status. The “positive health status” indicator is a broad measure of satisfaction, which could relate to many aspects of the health care system including access, cost, availabili-ty, quality and options of care. Currently there is no data being collected in this area. Furthermore,hospital satisfaction surveys do not address these issues.

Lack of public transportation Warren County has limited public transportation availability. Currently a shuttle program operates

along the Route 57 Corridor. The program operates two different routes, one from Phillipsburg toWashington and the other from Washington to Hackettstown. The Phillipsburg-Washington route operatesMonday – Friday from 6:00 am to 7:45 p.m. (until 9:50 p.m. on Tuesdays and Fridays). A Saturday shuttlerun is also available from 9:00 a.m. until 4:45 pm. The Washington-Hackettstown schedule operatesMonday – Friday from 8:00 am. to 4:55 p.m. Daily service is also available from Phillipsburg to Belvidere.Other transportation services do exist in Warren County but are mainly limited to commuter transportationto points outside of the County. NJ Transit operates rail service from Hackettstown to points east.Transbridge operates a bus line with a stop at the Phillipsburg Mall serving commuters heading both east and west. Martz Trailways bus lines serves commuters in Hackettstown and the Interstate 80/PantherValley area. NJ Transit also operates bus service known asthe Wheels Program in two geographic areas. One service covers Pohatcong, Lopatcong, Phillipsburg and Easton (two routes), and the other service coversHackettstown and Mansfield. These are shuttle routes that are available to all citizens within those geographic areas of service. For the disabled and elderly, transportation is available by scheduling twoweeks in advance and only available between the hours of 7:00am to 5:00pm.

The County also provides “by-demand response” transportation to county residents who are disabled, senior citizens, veterans, low-income or those who live in certain areas of the county. To sched-ule a trip the client should contact First Transit at least 2 full work days in advance of the trip.

To improve access to healthcare the Vision and Values Statement of Warren Countyproposes to:

l Create an informed public regarding available health care systems through health literacy efforts and effective dissemination of health services resource information.l Improve access to affordable, comprehensive health care and needed specialized care such as psychiatric, dental, pre-natal, emergency and genetic counseling for all residents.l Provide adequate, accessible public transportation for all residents so they may receive needed health care, means to possible job opportunities and life essentials.l Recognize the health needs of all residents by adequately funding the health and social services sectors to meeting the needs of our growing townships and county.l Provide services that respect all human life regardless of race, creed, gender, political affiliation, religion, and ethnicity.

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Focus Group response: “There is a needfor public transportation north of route57, in the Oxford, Belvidere, Blairstown areas.”

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Access, Affordable and Appropriate Health Care Work Plan

Health Problem Outcome Objective/Indicators

Increase access to affordable and l Increase the number of residents who have appropriate health care access to affordable clinic care;

l Increase the availability of low costscreenings;l Reduce unnecessary use of emergencyfacilities.

Risk Factors Impact Objective

Elderly and disabled residents; l Improve access to primary care for all Low income residents; residents;Young residents; and l Increase awareness of low cost health care Recent immigrants facilities and services;

Contributing Factors Suggested Intervention Strategies

Direct:No coverage;Lack of adequate transportation services; Inappropriate use of services; andLack of awareness of available services.

Indirect: Rural nature of county and spacing of homes; andLack of employment with health benefits.

Resources Available Barriers

Federally funded health care clinic in Phillipsburg.Coventry Family Practice, in Phillipsburg.Developmental Medicine Clinic, CoventryFamily Practice, in Phillipsburg andWarren Hills Family Practice, in Washington.

l Promote enrollment into government provided health services;l Advocate for the establishment of non profithealth services; l Research solutions for health care needs;l Advocate for increased public transportationservices; l Increase awareness of low-cost prescriptionplans;l Update baseline data; andl Encourage local employers to provide healthbenefits or incentives.

Transportation services;Lack of health care funding; and Geographical location of services.

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Fundamentals of Good Health

Fundamentals of maintaining good health include understanding predisposing factors and/orbehaviors which are believed to cause, or contribute to injuries, disease, and death over the courseof the lifespan. These factors and/or behaviors significantly impact morbidity and mortality in laterlife. It is estimated that 50% of premature deaths in the United States are a result of lifestyle and/orhealth behaviors such as poor diet, lack of exercise and tobacco use. Domestic violence, sexual vio-lence and environmental issues also affect the health outcomes of a large portion of the population.

Nutrition and Physical ActivityAs the current “Obesity Epidemic” continues, lack of physical exercise and poor nutrition become

major areas of concern. Diet and exercise are continuous topics of discussion between professional and laypersons alike. Assessing weight status is achieved by determining the Body Mass Index (BMI) of individu-als in a population. In the 2001 Warren County Behavioral Survey respondents were asked to report theirgender along with their height and weight. A formula to calculate BMI was then used to find the averageBMI Index of respondents. This formula was developed by a Belgium statistician and designed for adultsover 20 years of age. While this formula does have some flaws, it is often used by public health practition-ers to roughly estimate the obesity problem in a given population. This formula was used with the 2001data on Warren County residents (N=672) to determine rough estimates of BMI. Below is a summary of the findings:

1% was below 18.5 kg/m2 - considered to be “underweight”37% were 18.5 to 24.9 kg/m2 - normal weight36% were 25 to 29.9 kg/m2 - considered to be “overweight”25% were 30 and above – considered to be “obese”

It should be noted that many people who fall into the “obese” category do not necessarily perceive themselves as being “obese.” Within our culture, there is considerable acceptance that as people age,they “naturally gain weight.” The problem of being overweight and obese in Warren County is not gender specific. Of the females surveyed, 28% were overweight and another 26% were obese. Of the males surveyed, 49% were found to be overweight with another 25% obese.

Adopting good nutritional habits and incorporating physical activity habits into daily routines andschedules, are critical in combating overweight and obesity. According to the 2003 WC Behavioral Survey74% report eating salads daily. While these data suggest a positive finding, it should be noted that this survey did not ask participants how much salad dressing was used or whether they used “fat free” saladdressing. While “eating salads” can be considered healthy, one needs to look at the specific ingredients of salads, and the amount of salad dressing that is used. Additional data was collected on the consump-tion of fruit and fruit juice. The analyses revealed that 41% of Warren County residents eat two or more servings of fruit per day while 50% drink 100% fruit juice daily. Given the FDA recommendation of 5 ormore servings of fruits and vegetables daily, there is considerable room for improvement, but this data is consistent with all of New Jersey residents with a reported 72% not consuming five or more servings offruits and vegetables a day. (CDC)

One fourth to one half of respondents state they eat high fat or fast foods (such as burgers, hot dogs orlunch meat), at least 1 to 2 times weekly. Approximately one third reported eating butter 1 to 2 timesdaily. One third of respondents also reported consuming bacon or sausage once or twice weekly.

When respondents were asked questions regarding their weight control, 59% reported trying tolose weight; slightly less than half (48%) by consuming less calories, and 50% by trying to increase their activities/physical exercise.

Comparison of the Healthy NJ 2010 Objectives and Warren County data:

With regard to physical activity, the Warren County Health Department 2005 Health Behavior RiskFactor Survey indicated that over 75% of residents surveyed participated in physical activities in themonth before being surveyed. This figure is slightly higher than the state average of 70% documented inthe statewide BRFSS study conducted by the CDC.

Access to recreational areas is a critical need if Warren County residents are to participate in physical activities. The 2005 Quality of Life Survey indicated that 74% of respondents reported having access to recreational areas such as parks, fitness facilities,hiking trails and pools within their community.

There was a significant difference in the types of recreational venues available based on the region of residence with more hiking trails being reported in the northern area of the county and more pools reported in the southern area of the county. In the focus groups conducted participants discussed identifying and advocating for recreational areasother than sports oriented fields. Residentsnoted not all recreational and open space areaswere readily accessible.

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Focus Group response: “There is a lack of ageappropriate recreational places. Youth as well asseniors need activity centers.”

Increase the percentage of adults eatingmore than 5 fruits and vegetables a day tothe target objective of 35%

Reduce the percentage of adults who areoverweight to the target objective of 28%

Reduce the percentage of adults who areobese to the target objective of 12%

Presently 28% of Warren County residentsconsume the recommended 5 fruits andvegetables a day

Presently 36% of Warren County residentsare overweight as reported in the 2001Warren County Health Behavioral Survey

Presently 25% of Warren County residentsare estimated to be obese

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To address the Fundamentals of Health, the Vision and Values Statement of Warren County proposes to:

l Promote health education to encourage and model healthy behaviors to people of all ages,empowering citizens to take responsibility for their health.

l Promote personal safety to all communities within the County. Provide supportive services for those families who are in distress.

l Facilitate exercise, leisure time and recreation for all ages by refocusing efforts and dollars to benefit all residents.

l Promote worksite behaviors, community development patterns, and a county-wide culture that encourages protection of our environmental resources.

l Promote health and safe food, water and air.

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Nutrition and Physical Activity Work Plan


Overweight and obesity are concerns for the chronic diseases they result in.


GeneticsNutrition Inactivity


Direct: Lifestyle behaviors Lack of recreational facilities Physical limitations Finances Lack of nutritional knowledgeIndirect:Family behaviors Media/Marketing influences Amount of nutrition education Prioritization of choices Convenience of fast food in the County Disabilities


Available local, state and national nutritional programs Area gymsLocal parks and walking/bike paths

l Identify existing local, state and national programs that could be used as resources forresidents.l Create a resource list of credible nutritionand physical activity websites.l Work with local radio stations, newspapersand other media to promote nutrition andphysical activity.l Advocate for additional recreational sitesand activities specifically designed for youthand for senior citizens.

TimeMoneyBuy-inNo County Parks and Recreation Program

l Identify successful local, state ornational nutrition and physical activity programs and provide these resources toWarren County residents.l Encourage residents to make healthyfood choices and increase physical activity.

l Promote and advocate for WarrenCounty residents to improve their nutrional practices and physical activities.l Increase awareness and access torecreational places and activities available in the communities.

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Domestic Abuse and Sexual Violence/Work PlanDomestic Abuse has been identified by the American Medical Association as a major women’s healthissue. Domestic violence is the leading cause of injury to US women. Approximately 50% of women inthe US will experience at least one episode of partner violence in their lifetime. One in three women willexperience a sexual assault or serious attempted sexual assault by the time they reach adulthood (i.e., 18 years of age).

In the 2005 Quality of Life Survey, 18% of County residents ranked Domestic Violence as one of thethree most important health problems for the County. Women (25%) in the study were more likely than men(16%) to indicate “Rape & Sexual Assault” as an important health problem. Furthermore, minors (ages 10-17) were also more likely to indicate this is an important health problem as compared to older adults.

In 2005, over 5,000 hotline calls were made to the Domestic Abuse and Rape Crisis Center. In addition, 829 individuals were assisted by the agency.

Health Problem Outcome Objective/IndicatorsDomestic violence and Sexual Violence are the two most under reported crimes that have long term impact on the survivors’ mental and physical health.


Family history and rural isolation which results in reduced access to existing services.


Direct:Lack of knowledge as to what domestic violence and sexual violence is;Lack of knowledge of available services;Lack of understanding of the impact on children and the stigma attached to it;Indirect:Substance abuse.


Domestic Abuse Rape Crisis Center for shelter, outreaches, hotline, advocacy, community education, and transition housing programs. The Judicial court system.

l Increased public awareness of resources such assheltering, outreach, and the hotline; l Parenting skills education; l Screening by medical providers and referrals tothe Domestic Abuse and Rape Crisis Center; l Increased public awareness of the universality ofdomestic violence; l Outreach to, and collaboration with, collegecommunities; l Referral to Warren County substance abuse programs; andl Increased, as well as more readily available community transportation.

Language; Culture; Transportation;Stigma attached to victimization; Decreased funding for legal services whichleads to fewer clients being represented; and Lack of volunteer attorneys.

l Enable clients to cope and deal with domesticand sexual violence.l Earlier intervention which will lead to adecreasedimpact on children and cyclic reoccurrence.

l Raise public awareness of domestic violence andsexual violence within WC.l Provide referrals and resources to address victim’s needs.

21

Environmental IssuesThe physical environment directly impacts health and quality of life. Clean air and water, as well

as safely prepared food are essential to physical health. Exposure to environmental substances such aslead or hazardous waste increases risk for a variety of diseases that are preventable.

As part of an effort to reduce adverse health effects from environmental contaminants, the communi-ty needs to develop an accurate surveillance information system that compiles information about the extentof contaminants, their sources, and their effects on human life.

Air, Land & WaterAir quality in Warren County has been a contentious public issue for many years. Emissions sources of

concern have included the County solid waste incinerator in Oxford, nearby power plants in PA, and largeindustrial facilities such as Atlantic States Cast Iron Pipe Co., Oxford Textile, Roche (now DSM) plant inBelvidere and the Warren County Landfill. Air quality can have significant impact on health, particularly forthose who have chronic respiratory conditions. Concerns about asthma incidence in the County promptedUMDNJ to conduct a controlled study in 2004 to determine if changes in respiratory function of asthmaticschool children were related to SO2 levels in our Belvidere area. The results indicated that SO2 levels evenbelow the federal standards, could pose potential threats, especially to sensitive persons.

Offensive odors from sludge, compost and industrial facilities have been a vexing source of com-plaints in Warren County for many years. Hundreds of odor complaints are received annually by the Countyhealth department. Such atmospheric releases continue to negatively impact Warren’s environmental healthand quality of life. At this time enforcement measures taken by the NJDEP and the Warren County HealthDept., and improved management at a number of facilities has helped improve the overall air quality in theCounty linked to odors.

Exposure to naturally occurring radon gas is a significant public health risk in Warren County. Theentire County is located in “Tier 1” designation that carries the highest potential for elevated levels of indoorradon. NJDEP estimates that 50% of the County population is potentially exposed to indoor radon above the4pCi/L action level, and that the average indoor radon concentration exceeds the action level in all County municipalities. The risk of radon is dramatically reduced if homes that have adequate ventilation systems forradon removal.

l Air associated problems: ozone, SO2, particulates, VOC’s, noxious odors, and naturally occurring radon.

Groundwater quality in Warren County is generally good, but sporadic well contamination events dooccur. The County does have one large superfund site, located in the Pohatcong Valley, that is being monitored by the NJDEP. Contaminants with the greatest frequency and concern in our County ground waterare: fecal coliform bacteria, nitrate, and volatile organic compounds (VOC’s). The primary sources of thesecontaminants are believed to be due to farming operations (bacteria and nitrate), septic systems (bacteriaand nitrates), historically improper disposal practices for solvents (i.e., chlorinated VOC’s), and leaky under-ground fuel tanks (VOC’s such as benzene and MTBE). In addition, underground fuel storage tanks (UST’s)are a significant source of VOC ground water contamination in Warren County. Another UST concern is theleaking benzene and MTBE from gasoline storage tanks. The NJDEP “Known Contaminated Sites in NewJersey” list contains over 50 Warren County locations where soil and/or groundwater contamination has beenidentified from leaking UST’s. The NJDEP continuously inspects UST facilities and monitors cleanups andremediation efforts.

l Contamination: due to faulty underground storage tanks, fuel tanks, abandoned wells, and illegal dumping.

22

The County has 25 large Public Community Water Supply Systems, which are regulated by NJDEP.The WCHD oversees the County’s 249 public non-community (PNC) water supply systems and approvesnew private wells. The majority of Warren County’s private drinking water comes from undergroundaquifers in the form of wells. There are approximately 15,000 private wells and septic systems in WarrenCounty. About 40% of County households use septic systems, which can threaten the quality of ground-water and public health if improperly designed, constructed and/or poorly maintained. Therefore, well andseptic system management is a top county environmental and public health priority.l Water quality monitoring: public drinking water, wells, streams and lakes.

Sentinel EventsSentinel events are those cases of unnecessary disease, disability, or untimely death that could be

avoided if appropriate and timely medical care or preventive services were provided. Sentinel events mayalert the community to health systems problems such as inadequate vaccine coverage, lack of primarycare and/or screening, a bioterrorism event, or the migration of globally transmitted infections to localareas. In Warren County these events are:l Seasonal floods that result in property damage, contaminated drinking water and septic systems as well as potential loss of life;l Epizootic Rabies incidence with one human death reported in 2002 and an average number of 12 cases of animal rabies per year; l Lyme Disease cases are the 2nd highest in the state (185 cases/100,000);l West Nile virus is endemic throughout the county, mosquito pools testing positive for West Nile Virus have been identified yearly along with positive cases affecting horses and birds;l Local flu outbreaks yearly and potential panendemic flu.

Note: The Warren County Bioterrorism Preparedness and Epidemiologic Response Plan, available for a Public Emergency, is in place should the need arise.

23

Environmental Work Plan


The environment is intimately connectedwith human health, illness and mortality.


Naturally occurring pollutants (i.e., radon,lead, ozone)TechnologyFood production, processing and transportationToxic chemicals

Contributing Factors Suggested Intervention StrategiesDirect:Manufacturing and processing methodsWater borne diseasesAirborne toxinsPesticide usagePre-1950 housing units (i.e., lead)Indirect:Motor vehiclesAgricultural runoffNatural disasters (i.e., floods, fires)Epizootic diseases


Warren County Health Dept.NJDEP and EPALocal environmental commissionsAmerican Red Cross Disaster ProgramWarren County Public Safety/911 CenterLocal first respondersThe Warren County Bioterrorism Preparedness and Epidemiologic Response Plan

l Review of water testing reports (PWTA)l Air quality monitoringl Emission control monitoringl Enforcement powers to abate or correctenvironmental health problemsl Sanitation inspectionsl Food establishment inspectionsl Disaster preparedness educationl Occupational health and safety inspectionsand trainingsl Public Health Education and Promotion

Lack of funding for air monitoring

l Increase awareness of environmentalprotection and maintenance.

l Provide a safe and healthy environment for all of Warren County.

24

Preventing and Reducing Major Diseases

Like much of America, Warren County is impacted by chronic disease (see table). While chronicdisease numbers are decreasing overall, there is still much work to do to reduce, eliminate and controlchronic illness and disease. Since individual behaviors such as smoking, diet and exercise are precursors to these diseases, health education and promotion are the major prevention strategies that need to be implemented.

DiseasesBy reviewing the leading causes of death a basic understanding of the overall health status of the community can be obtained. These data should be examined by looking at gender, age, ethnicity/race, and geographic location so that preventive efforts can be tailored to the demographic characteristics of those at risk. It should be noted that in some Warren County communities the numbers ofdeaths by chronic disease are too small to develop usable data on rates. Nonetheless, it is important toknow the number of disease occurrences for these communities. Surveillance of disease is necessary forpublic health practitioners to prevent further spread of the chronic illness in the County population andreduce the burden of disease on the health care system.

l Cardiovascular disease remains the leading cause of death in the nation, New Jersey and WarrenCounty, despite the considerable reduction in the mortality rates. Warren County fares slightly worse thanthe State (a rate of 244 vs. 234.8 per 100,000), and men are affected consistently more than women byheart disease. Most deaths from heart disease are caused by preventable or controllable factors, such assmoking, high blood pressure, high cholesterol, diabetes, and obesity.

l Asthma and Chronic Obstructive Pulmonary Disease (COPD) cases - In reviewing respiratory diseases for 2003, the rates for Warren County (37.6% for lower respiratory disease and 27.8% for pneumonia and flu) consistently exceeds the State rate (31.4 % for lower respiratory diseases and 19.3 %for pneumonia and flu per 100,000 populations).

l Despite low crude incidence, Warren County has annual incidence rates for five different types ofcancer that exceed the average for the state of New Jersey. These cancers within Warren that exceed thestate average incidence rates are: 1) bladder; 2) breast; 3) colorectal; 4) lung; and 5) melanoma. In addition, Warren County residents have a higher mortality rate as compared to the state average in two different types of cancer. These include: 1) bladder cancer; and 2) melanoma. When comparing Warrenresidents to national data, only melanoma has a higher mortality rate.

Educating people on the leading causes of disease and injury will lead to more informed decisionsmade by individuals as well as the development of healthy behaviors. Promoting healthy behaviors (i.e.,good nutritional habits, increased physical activities, smoking cessation) will help improve overall healthand reduce the negative impact of chronic disease.

2003 Leading Causes of DeathWarren County New JerseyNumber Rate* Number Rate*

Heart disease 287 243.0 22,043 234.8Cancer 214 186.1 17,957 195.6Stroke 48 40.7 3,966 42.2Chronic Lower 42 37.6 2,910 31.4Respiratory Diseases (CLRD)

* Rate based on 100,000 populationSOURCE: New Jersey Department of Health and Senior Services, Center for Health Statistics

25

WC Reported Diseases 2005Warren County has a very high annual incidence ofLyme disease when compared to other counties in NewJersey. In 2005, Warren ranked only behind HunterdonCounty for the highest rate of Lyme (Warren185/100,000 pop; Hunterdon 251/100,000 pop; StateAverage 33/100,000 pop).

Salmonellosis and Campylobacteriosis are foodborneillnesses caused by bacteria and tend to occur in thewarmer months in temperate climates. Hepatitis C is agrowing concern throughout the state of New Jerseyand nationwide because those who are infected withthe virus may not exhibit symptoms for 10 to 20 yearsafter exposure to the disease. The “epidemic” that weare seeing now is often the identification of old casesthat were not previously diagnosed. Although many ofthese Hepatitis C infections are old cases, the burden tothe health care system is current. It should be noted,that even though the numbers are small in comparisonto the State and other counties, these are the top four reported diseases within Warren County.

Prevention efforts are paramount to reducing, elimi-nating and/or controlling the spread of illness and disease. Health promotion and education are thekey factors in intervention against these concerns.

To Prevent and Reduce Major Diseases, the Vision and Values Statement of Warren County proposes to:l Create an informed public regarding available health care systems through health literacy efforts and effective dissemination of resource information.l Reduce the incidence of mental retardation and disabilities through educational programs and policy development.l Deliver prevention programs to reduce substance use/abuse and advocate for strengthening existing drug and/or alcohol treatment programs.l Improve access to affordable, comprehensive health care and needed specialized care such as psychiatric, dental, pre-natal, emergency and genetic counseling for all residents.l Work towards creating communities that achieve a culture whereby everyone may enjoy civil and political rights.l Provide access to a wide variety of legal services and advocacy for all people, regardless of their financial resources.

Note: The Warren County Bioterrorism Preparedness and Epidemiologic Response Plan, available for a Public Emergency, is in place should the need arise.

County Totals:Lyme Disease n

Hepatitis C l

Salmonellosis z

Campyllobacteriosis h

HARDWICK TOWNSHIP

BLAIRSTOWN TOWNSHIP

KNOWLTON TOWNSHIP

FRELINGHUYSEN TOWNSHIP

ALLAMUCHY TOWNSHIP

INDEPENDENCE TOWNSHIP

HOPE TOWNSHIP

BELVIDERE

WHITE TOWNSHIPOXFORD TOWNSHIP

MANSFIELD TOWNSHIP

HACKETTSTOWN

WASHINGTONBOROUGH

WASHINGTON TOWNSHIP

FRANKLIN TOWNSHIP

GREENWICH TOWNSHIP

POHATCONG TOWNSHIP

ALPHABOROUGH

PHILLIPSBURG

LOPATCONG TOWNSHIP

HARMONY TOWNSHIP

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nnnnnnnnnnnnnnnnnnnn nnnnnnnnn zz

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Warren County2005

Cases by Township

LIBERTY TOWNSHIP

26

Preventing and Reducing Major Diseases Work Plan


Inform, educate and empower people about preventing and reducing disease.


Life style;Physical environment; Genetics; Family history;Race; and Educational attainment


Direct:Access to care;Lack of knowledge/education;Poor health literacy; Poor nutrition;Lack of physical exercise;Indirect:Lack of knowledge of existing services; and Lack of understanding of diseases and/or disease process;Low incomes;Lack of or not sufficient health insurance.


Area hospitals offer free cancer screenings; Both hospitals and the WCHD offer health education/health promotion for disease prevention; WCPHNA Child Health Clinics; Warren Hospital Adult Health Clinic; andNORWESCAP 211Warren County Bioterrorism Preparedness and Epidemiologic Response Plan

l Increase health education outreach efforts; l More awareness of prevention services; l Increased screenings; lImprove accessibility by increasing times and days of operation; l Initiate more community clinics;l Increase promotion of free or low cost services; l Increase worksite health initiatives; l Identify and outreach to vulnerable populations; andl Link people to personal health services as needed.

No free public clinics; Few Medicaid doctors; Health literacy;Rural nature of County; andPoor transportation to health care services;

l Increase awareness and knowledge ofdisease transmission and causation; andl Promote a safe and healthy life styleand environment.

l Decrease the amount of cases of communicable disease by 2010;l Reduce the number of chronic disease by 2010 ; andl Increase prevention education efforts throughout the County.

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Substance Abuse

Drug abuse problems are not simple to identify, quantify, and categorize. Drug abuse is a constantly changing and complex phenomenon, driven by substance supply, user demand and consequences of use. Therefore collecting substance abuse related data has been a challengingtask.Warren County has traditionally relied on the substance abuse data collected at the State level due to lackof local resources to monitor these problems. Many important substance abuseindicators are not collected or maintained at the county or community level.l Development of an effective local surveillance system can demonstrateneed, as well as, increase and broaden community support leading to expasionof resources to address the problem. A more effective surveillance system canalso lead to better use of the limited resources available in Warren County. l According to the 2007 Warren County Comprehensive Alcoholism and DrugAbuse Plan, there has been a 50% increase in substance abuse treatmentadmissions. This dramatic increase in the 2005 substance abuse admissionsdemonstrates an increasing trend of alcohol/substance abuse in the County thathas been underreported for years. Reported substance abuse admissions for2005, totaled 1,125. Most of the admissions were alcohol related (n=403) followed by heroin use(n=284). The statistics from the New Jersey Department of Human Services, Division of Addiction (DAS)services reflect the following for Warren County:

1. Arrests Attributable to Alcohol, 1999-2003 (5 yr. average)DUI 385 total cases 380 adults 5 juvenilesLiquor Laws Violations 119 total cases 73 adults 46 juveniles

2. Arrests Attributed to Drug use, 1999-2003 (5 yr. average)Drug Law Violations 414 total cases 352 adults 62 juveniles

Warren County Prosecutor’s Office reports:Thirty deaths caused by drug overdose in Warren County between 2000 and 2004.Twelve deaths confirmed to have been directly caused by a drug overdose since 2004.

The NJ Department of Human Services, Division of Addiction Services estimates that 6,633 WarrenCounty adults residents are chronic abusers of alcohol and 2,200 are chronic abusers of illicit drugs.

Publicly funded substance abuse treatment serviceproviders report 75% of their clients have co-occurring substance abuse disorders.The treatment needs for this population continues to increase substantially as demonstrated by growing numbers of clients on long waiting lists to receive services. The County presentlylacks the continuum of services required to provide adequate care for residents with alcohol and/or sub-stance abuse problems as well as mental health conditions and illnesses.

Focus Group response: “There are notenough health care services availablethroughout the County. (i.e, mental healthand substance abuse treatment).”

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Tobacco Usage

Research has demonstrated the negative health consequences of tobacco use. Smoking causesheart disease, and cancer of the larynx, esophagus, pharynx, mouth and bladder. Consequences of smoking during pregnancy include spontaneous abortion, low birth weight babies and sudden infant death syndrome. Forty years after the first Surgeon General’s Report published in 1964, the list of diseases andother adverse effects caused by smoking continues to expand. Epidemiologic studies are providing a comprehensive assessment of the risks faced by smokers who continue to smoke throughout the lifespans. Laboratory research now reveals how smoking causes disease at the molecular and cellular levels.Fortunately for former smokers, studies show that the substantial risks of smoking can be reduced by successfully quitting at any age. The evidence reviewed by the Surgeon General leads to the followingmajor conclusions:

l Smoking harms nearly every organ of the body, causing many diseases and reducing the overallhealth of smokers in general.

l Smoking Cessation has immediate as well as long term health benefits, reducing risks for health conditions and diseases caused by smoking and improving health in general.

Respondents (847) reporting from the WCHD 2005 Behavioral Risk Survey Warren County residents were asked to self report ** the following regarding smoking behaviors:

Data on Smoking **Smoked cigarettes dailySmoked cigars dailyDid not smokeTried to stop in past year

While the number of smokers is decreasing annually we still have one in eight residents who reportsmoking. Since second hand smoke and environmental exposure also impacts residents, smoking negatively affects a much higher percentage of residents. Efforts are needed to continue implementingmeasures for people to stop smoking so they may improve their health and their immediate environmentaround them. Primary prevention programs are also needed to decrease the number of teens and youngadults who start this unhealthy habit.

The annual costs for state and public employers for untreated or under-treated drug addiction in New Jersey are approximate $260 million annually. These costs are

associated with alcohol related health care, lost worker productivity, and absenteeism. Another $2.6 million is lost due to drug-related absenteeism and lost productivity.

Overall private employer losses are estimated to exceed $3 billion annually.

12%2.4%79%8%

Substance Abuse Work Plan

29

Outcome Objective/Indicatorsl Reduce the number of Warren County alcohol and/or substance abuse treatmentadmissions as reported by NJ SAMS and Countysubstance abuse service providers.

Health ProblemSubstance Abuse - Alcohol, Tobacco and Other Drugs

Impact Objectivesl Discourage the use of illegal drugs or tobacco.l Decrease alcohol abuse.l Increase funding for alcohol and/or substance abuse prevention, education and treatment efforts.

Suggested Intervention Strategies

l Increase community awareness on issues related to substance abuse prevention and treatment;l Coalition development;l Improve data collection;l Address needs and gaps identified with data collection;l Advocate for increase in funding;l Increase access to treatment and recovery services; andl Expand public education to decrease stigma attached to alcoholism diagnosis and treatment.

BarriersAvailability of appropriate level of treatmentmodalities.TransportationCommunity norm.Lack of or inadequate health insurance.Insufficient funding for treatment

Risk FactorsEarly onset of substance abuse in youthFamily history of substance abuse

Contributing FactorsDirect:Negative peer influenceLack of adequate parental supervisionGenetic predispositioParental and familial history of alcohol use/abuseInadequate treatment resources for specific population (i.e., co-occurring disorders, adolescents).Community cultural and social norms favorable to alcohol useIndirect:Availability of alcoholLack of supervisionSchool failure/ DelinquencyLimited alternative activitiesFamily stress/ DivorcePovertyLearning disabilitiesCultural attitudes/apathyEnvironmental factorsAccess to treatment/costStigma

Resources AvailableWarren Hospital ADRC

Hackettstown Hospital

IDRC Initiative; AA; Al-Anon; MADD; SADD

Family Guidance & Catholic Charities

WorkFirst NJ Substance Abuse Iniative

30

Mental HealthMental illnesses are common in the United States. An estimated 26.2 percent of Americans

ages 18 or older suffer from a diagnosable mental illness in a given year. Even though mental problems are widespread in the population, the main burden of illness is concentrated in a muchsmaller proportion, about 6 percent, who suffer from a serious mental illness. In addition, mental illnesses are the leading cause of disability in the U.S. for ages 15-44. It should be noted, many people suffer from more than one mental illness at a given time. Nearly half (45%) of those with a mentalhealth problem meet criteria for two or more illnesses, with severity strongly related to co-morbidity(NIMH statistics). Due to the escalating costs of health insurance, many employers have dropped mentalhealth coverage completely from their policies. Since mental health issues are still stigmatized in society,few employers advocate for maintaining this fringe benefit.

According to the Healthy NJ 2010 report, only 25% of persons with a mental illnessobtain professional help. It has been estimated that two-thirds of youths with mentalhealth problems do not get treatment and according to the CDC, the suicide rate hasmore than doubled in just over ten years for those between the ages of 15 to 24 yearsold. Furthermore, mental health problems in the elderly may be dismissed as part of thenatural aging process, yet assessments to differentiate causes of cognitive, emotional and

behavioral dysfunction are rarely performed. Normal aging is not characterized by mentalor cognitive illness, yet an estimated 25% of people 65 and older experience specific mental

problems with depression, anxiety, and/or substance abuse being the most common. As aging continues,forms of dementia increase in incidence which can account for the rise of mental health illness in the aging population in Warren County.

Applying the national rate of mental illness to the 2005 census data for the County about 5.3% orapproximately 4,375 adults in Warren County are estimated to have a serious mental illness. In 2005, approximately 2,998 people living in the County received publicly funded mental health services (slightlyless than 50% of those estimated to be affected by mental illness). Examples of the services providedwere: outpatient therapy and medication monitoring; partial hospitalization; crisis intervention and casemanagement.

As this document goes to publication, there are few psychiatric specialists, no inpatient treatment programs, and seriously insufficient specialized outpatient treatment resources, and partial care programsfor children and youth living in Warren County.

For persons over 65 years of age, psychiatric care is also virtually non-existent, unless they pay privately. There is only one hospital located in the County that provides inpatient treatment. If a person’sincome meets the poverty level, making them eligible for Medicaid, there is one outpatient service available and there may be a waiting period before services are available. The County Office on Agingcontracts with the Family Guidance Center of Warren County to provide in-home counseling services forclients referred by the local home care nursing programs.

Local health professional quote: "Timely access to mental health services is the major problem in the Warren County mental health system. The inability to provide timely access to services is detrimental to clients, their families and the community

as evidenced by the high use of costly acute care services. Early intervention outpatientservices can preclude psychiatric deterioration and suffering for the client and

family members and are much less costly then acute care services.”

Adults 18 to 65, low income or uninsured, Medicaid eligible, have one publicly funded outpatient program available, the Family Guidance Center (FGC) of Warren County. They serve approximately 1,100clients per year in this program of which 410 are new clients who entered into mental health services during the year. The waiting list for services is 6.2 weeks on average with the shortest wait time of oneday and the longest 91 days. Persons with “Co-Occurring Disorders”, (i.e., individuals who are diagnosedwith both mental illness and substance abuse/dependence), may be eligible for the program and therapy.The FGC perform 60 intakes a month for mental health services and 23 intakes per month for substanceabuse services.

With lack of services available for persons suffering from mental illness, the community and emergency rooms of our local hospitals are receiving increased use to service Mental Health needs. In2006, Warren Hospital saw 739 psychiatric patients in the emergency room. A total of 477 clients wereadmitted to psychiatric facilities. Of those clients that were hospitalized, 40 were children/adolescentsrequiring the highest most intensive level of psychiatric care. The number of children/adolescents referredfor psychiatric care continues to grow on a yearly basis. The remainder of clients seen by the WarrenHospital mental health staff was referred for some other form of outpatient psychiatric care, which oftenincluded the need for psychiatric medications.

There is also a need for housing for people with mental illness. The Crisis Intervention staff ofWarren Hospital routinely sees 2 to 3 homeless mentally ill individuals monthly throughout the year. TheFamily Guidance Center, Crisis Intervention Program, serves approximately 534 clients per year, andresponds to 3,000 hot line emergency phone contacts yearly.

Mental illnesses affect people of all ages, races, ethnicity, socioeconomic status, and gender,although differences in prevalence can correspond to these factors. Minority populations are especially unlikely to seek and get mental health services. The reasons are varied and complex, andinclude reluctance to seek treatment due to the persistence of stigma associated with mental illness. Otherproblems affecting the mentally ill are:

l Inadequate screening of patients by primary care providers for mental illnesses;l Lack of available mental health care, particularly culturally competent care;l Cost barriers;l Lack of sufficient and accessible affordable housing for the mentally ill with appropriate support services;l Lack of timely access and/or long waiting lists for outpatient mental health services that include therapy and medication monitoring; andl Lack of sufficient and appropriately trained mental health professionals.l Furthermore, stigmatization precludes almost half of all mentally ill persons or their family membersfrom seeking services.

31

A review of Warren County EMS/911 calls for a 5 year period(2000-2004), reported 430 emergecy calls psychiatric help.

32

Mental Health Work Plan


Advocate for increased Mental Health services in Warren County


Biological InfluencesGenetic/inheritedEnvironmental/Not inheritedPsychosocial ExperiencesFamily lifeHardshipViolencePeer influences


Direct:Treatment and medication costsLack of adequate insuranceLack of treatment resourcesLack of bilingual/culturally competent services.Indirect: StigmaLack of understanding regarding treatment successOther health issues


County and state supported mental health systemNAMI Warren CountyWarren HospitalHackettstown Regional Medical Center

l Increase community awareness of mentalhealth referral sources;l Promote mental health screening by medicalproviders;l Advocate for expanded public mental healthservices and parity with insurance providers;l Advocate and promote culturally competentservices; andl Provide community education regardingmental health.

StigmaLanguage/cultureFunding for treatment servicesLack of insuranceLack of housing

l Reduce Stigma of mental illness in thecommunityl Improve coordination among mentalhealth and non-mental health providers.

l Increase community awareness and understanding regarding mental health issues.l Increased access and availability of MentalHealth services throughout the County.

33

Moving the Strategies to Actions

With the completion of the Warren County Community Health Improvement Plan, the next phase isto move forward with the development of interventions. The process will include planning, implementingand evaluating strategies to meet the identified measurable objectives. The MAPP Coalition along witharea agencies, organizations and residents will create various work groups to address each identified problem and solicit community and agency members to work toward accomplishing our goals.

Tips to Lead Warren County Citizens to Good Health:

1. Take time to include at least 30 minutes of moderate exercise most days of the week.

2. Eat 5-9 servings of fruits and vegetables in your daily diet.

3. Strive for a healthy lifestyle that promotes and achieves a desirable weight.

4. Develop open communication skills to improve the quality of communicating within your home.

5. Recognize that mental illness can happen to anyone and can be treated.

6. If you drink alcohol, limit use to no more than one drink a day for women and two drinks a day formen.

7. Dispose of hazardous materials that would be harmful to the environment according to municipalityregulations.

8. Identify a primary care doctor, use hospital emergency facilities for emergencies only.

9. Participate in health screenings and yearly check-ups to develop healthy lifestyles.

10. In the event of an emergency, have a list of emergency contacts available and keep updated.

11. Have a family/personal disaster plan for unexpected emergencies.

12. Get your necessary immunizations/vaccinations and keep them current.

For more information or to obtain a copy of this Community Health Improvement Plan

Contact: Donna Rue, RN, MPH, CHES, Health Educator/Partnership CoordinatorWarren County Health Department

315 West Washington Avenue, Washington, NJ 07882908-689-6693

[email protected]

warren countywarren county health department 315 w. washington ave. washington, new jersey 07882...

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