Pima County Health Department Annual Report 2010 / 2011 board b d members b and d administration d i i i pima county board of supervisors Honorable Ann Day District 1 Honorable Ramón Valadez, Chair District 2 Honorable Sharon Bronson District 3 Honorable Ray Carroll District 4 Honorable Richard Elías District 5 county administration C. H. Huckelberry, County Administrator Jan Lesher, Deputy County Administrator Medical and Health Services pima county board of health Paul R. Horwitz, M.D., President Carolyn Trowbridge, Vice President Lidia Allen Kwang Chun An Bradley Brumm, D.D.S. Richard Elías, Pima County Supervisor Vincent A. Fulginiti, M.D. Mary Lou Gonzales Miguel Rojas Chuck Stopani pima county health department Sherry Daniels, Director Michelle McDonald, M.D., Chief Medical Officer Marcy Flanagan, Division Manager, Community Surveillance and Investigation Donald Gates, Program Manager, Communities Putting Prevention to Work Kim Janes, Division Manager, Pima Animal Care Center Diane Kerrihard, Division Manager, Clinical and Nutritional Services Kathy Malkin, Division Manager, Community Health Services Brad McKinney, Division Manager, Records and Administrative Services message from f the h director di It is my pleasure to present the 2010/2011 Annual Report for the Pima County Health Department. Over the past year, tremendous progress has been made in improving childhood immunization rates, and rates of communicable disease have fallen. These improvements in the community’s health are not by chance. The Health Department has worked hard to address these issues, and we acknowledge that sustained success can only be achieved in collaboration with our local partners, providers, and stakeholders. Many of the highlights from this past year are featured in this report. We know the future will be even more challenging with newly emerging diseases, an aging population, and an increasingly interconnected global community. The current atmosphere is complicated by a declining economy that burdens every member of the community. As a Department, one of our greatest challenges is that we must continue to improve the quality and efficiency of our services regardless of the economic environment. On behalf of Pima County, thank you for your continued efforts to help our community be a healthier, safer, and stronger place to live. Sherry Daniels, Director message ffrom the h pima i county board b d off health h l h During the course off this h past fiscal fi l year, the h Pima County Board d off Health l h had h d the h opportunity to workk closely with the Health Department’s leadership and learn about the ongoing challenges of supporting a community as large and diverse as ours. In support of the community’s health, the Board has advocated for changes in County ordinances, reviewed and made recommendations on budgeting, and challenged the Department’s leadership to do even more with less. The residents of Pima County deserve the very best, and I can say with confidence that their Health Department is top-notch. In every matter that came before this Board, the staff have consistently put the health of the public first and foremost. Together, the Board of Health and the Health Department will continue to advocate on behalf of the public’s health and strive to protect the community with persistence and dedication. Please enjoy this summary of the past year, and I look forward to sharing the progress we make together again next year. Paul R. Horwitz, M.D., Pima County Board of Health, President highlights h i gh h l i gh h ts in i n health h eall th h Assessing and addressing the public’s changing needs is a challenging task. The Health Department uses a variety of measures to evaluate program accomplishments while holding itself accountable to the taxpayers. The economic challenges faced by the County and its residents require the Department to rely more on quality improvement approaches to maximize the limited resources. Here are some highlights of the Health Department’s achievements in efficiently providing needed public health services. caring for the community To help community members in need and those at risk, the Health Department provides a variety of solutions to promote and support their health. Public health nurses organized the annual back-to-school immunization campaign in August during which they administered 7,196 vaccinations to 2,123 individuals. Low-income schoolchildren were provided oral health evaluations and dental sealants. Those children also received education on the value of basic dental care and how to take care of their teeth so their teeth can take care of them. The Community Nutrition Program continues to promote nutritious food and encourage healthy eating choices. During this past year, the program conducted more Pima Animal Care Center was able to place than 153,700 clinic visits providing services 10,452 animals into adoptive homes or for more than 13,600 participants. Of those, with rescue groups. Over 25,000 animals 3,271 were women who were pregnant were medically cared for at the or postpartum, 3,587 were animal shelter. This year, the infants to one year old and Animal Care Center supported 6,839 were children, ages “The kids walked the spaying and neutering of one to five years old. Of the around the rest of the nearly 11,000 animals. women who received services day showing their 1,000 were provided with The Health Department worked breast pumps. strong teeth with big with 292 child care programs and provided them with over smiles on their faces. The Farmers’ Market Nutrition consultations and safety Program provided 2,275 food They really got excited 1,000 evaluations. voucher booklets for seniors when they received a and children. The vouchers The Well Woman Health Check were redeemed at local new toothbrush!” program provided breast and farmer markets for fresh fruits cervical screening to 1,650 - School Nurse and vegetables. This program medically underserved women generated more than $36,000 from the community. for local growers. partnerships Partnering with other agencies and community groups fortifies the Health Department’s ability to extend services and strengthens the community’s health. The Department has many long-standing relationships in the community with a variety of partners, and this year the Health Department added more to that list. Without the support and participation of local volunteers and community groups, the Health Department would be unable to place as many animals as it does into new permanent homes. The Pima Animal Care Center values its relationship with nearly 50 different community rescue groups and a half-dozen animal welfare organizations that help place surrendered and abandoned animals into new homes. Staff and Animal Care Center volunteers participated in 60 off-site adoption events which, in addition to providing new homes for dogs and cats, provided educational material for children and adults about responsible pet ownership, caring for pets, and the importance of vaccination. A relatively new group of collaborations began with the Communities Putting Prevention to Work (CPPW) program. This program partners with an interdisciplinary team to increase opportunities for improved nutrition awareness and active living opportunities via policy, systems, and environmental change with the focus on preventing and reducing the spread of obesity and related chronic diseases. Healthy living requires good dental hygiene which includes regular screenings and care. In partnership with the University of Arizona’s Mobile Health Program, El Rio Community Health Center, and Desert Senita Health Center, the Health Department provided over 3,000 early childhood oral health screenings, fluoride treatments, and referrals for additional oral care. This collaborative partnership also taught children how to take care of their teeth and gums. This year, more than 40 businesses and community organizations introduced smoking cessation and chronic disease education programs for their employees. With the help of the Health Department, representatives from each of these organizations were trained to promote physical exercise and healthy food choices for their staff. “Bear Essential News is excited to be part of this worthy new grass roots effort to help kids, classrooms and families in Pima County to lead healthier lifestyles. Working with Communities Putting Prevention to Work puts us on a team that’s coming up with practical solutions to childhood obesity and the health problems that come with it. This is all about improving the quality of life for those in our community.” - Stephen Gin, Bear Essential News Editor iinvesting ti iin th the community it Pima County is grand in both size and diversity, and as the community grows and changes, so do the needs of its residents. In support of the community, the Health Department employs a variety of strategies to promote stronger communities and encourage healthier behaviors. training and education Effective public education requires understanding the needs of the community in addition to having the knowledge and tools to help. Over the past year, Health Department staff conducted over 650 educational presentations for groups, organizations, faith communities, schools, and businesses. Here are a few highlights of the presentations and trainings. One of the more active programs providing education to the community is the Tobacco and Chronic Disease Prevention program. Staff taught an intensive tobacco prevention curricula at 150 elementary and middle schools. The staff also facilitated 35 youth coalitions that advocated for healthy choices in their schools and neighborhoods. The Tobacco and Chronic Disease Prevention program also developed and implemented a new educational program for schools and businesses promoting increased physical activity entitled “Be Well Arizona Live Smarter, Live Longer.” Working with four trained community representatives, Health Department staff enrolled over 480 people in this program. The Tuberculosis (TB) program worked with 14 occupational health offices, behavioral health providers, homeless shelters, and other community service agencies to improve and establish prevention and screening protocols. Child Care Health Consultants conducted 188 educational trainings for more than 1,100 child care center staff. The topics included safe infant sleep, Cats are child nutrition and typically very social physical activity, and enjoy being around playground safety people. While they are and disease prevention. waiting to be adopted, they can become anxious. The new Scratch and Stretch Blocks provided for the cats have helped to reduce their anxiety. Health Department staff worked closely with a variety of local agencies and institutions to adopt and promote healthy eating and active living programs. These programs included objectives for the development of a local, bilingual media and communications campaign to promote healthy eating and active living. compliance li One tenent of public health is assuring that the community is safe and that businesses and individuals are compliant with existing health regulations and ordinances. Health Department staff responded to 424 complaints of Smoke Free Arizona violations across the County. Staff visited more than 4,000 businesses and organizations to assure Smoke Free compliance and provide educational materials. The Public Health The Pima Animal Care Center responded Preparedness to over 35,000 animal welfare care calls, program facilitated emergency and issued 8,151 citations. Animal Care response exercises in the community Center staff licensed nearly 110,000 that brought together multiple dogs. agencies, jurisdictions, and municipalities. These exercises focused Consumer Health and Food Safety on how to best respond to natural or program staff conducted 14,421 man-made disasters. During the past inspections of restaurants, commercial year, staff worked in collaboration with kitchens, mobile food vendors, hotel/ the Centers for Disease Control and motels, and public swimming pools. The Prevention to host a regional training staff also issued nearly 9,000 operating focused on materials management and permits, and responded to and distribution procedures. Public health investigated more than 1,000 complaints preparedness staff also conducted filed by community members. a table-top exercise that focused on response protocols for Child Care Health Consultants launched a pilot program local hospitals and community reaching out to agencies providing child care services to health centers raise standards and assure a safe and healthy environment during a foodfor children. This grass roots project began in 1987, and borne outbreak. today the program has received national acceptance. Through improved data collection processes, the program has demonstrated a reduction in communicable disease, fewer injuries, and increased access to health care. the h organization i i the synergic approach The successes achieved this past fiscal year can be attributed to the collective energy and commitment of the 350 employees of the Health Department who have worked to improve services for Pima County residents despite the difficult economic climate. PimaCountyHealthDepartmentRevenueFY20102011 Directorand AdministrativeServices 3.8% GeneralFundContribution 23.0% ClinicalandNutritional Services 15.4% CommunitySurveillance andInvestigations 6.1% PimaAnimal CareCenter 12% !!! " !!  $ $!!  !! CommunityHealthServices 39.6% !! #!! A commitment to quality public health programs for the community can be seen in the high employee retention rate. Forty percent of the employees have celebrated 10 or more years with the Health Department and an additional 43 employees have celebrated 20 or more years. !! "!! !! ;=!$>! ;=!>! !! ;=!>!$ With a population of just under one million residents living in an area of more than 9,000 square miles, the Health Department is challenged to be better, smarter, and more efficient every day. Partnerships and collaborations have enhanced services for the community and strengthened relationships between the Health Department and community groups and agencies with similar goals. !! & '     , PimaCountyHealthDepartmentExpensesFY2010/2011 Directorand AdministrativeServices 3.1% ClinicalandNutritional Services 29.4% CommunityHealthServices 44.7% ChiefMedicalOfficer 2.6% CommunitySurveillance andInvestigations 7.5% PimaAnimal CareCenter 12.6%        () *+   - /, **+ * '7 :,* ; * <*,  * !  $ " " "# ! " ! ! !  #  ##      #! $   ! ;=!> ;=>" J, ? #!  by the b h numbers b When providing public health services, it is necessary for the Health Department to track and collect data that assesses the return on investment for current programs, assures the provision of high quality care, identifies community needs, and develops new programming to address those needs. Data helps to define roles, purposes, accomplishments, and areas for future growth. It reinforces the continued support for policy and program development while demonstrating the fiscal responsibility of the Health Department. The Tuberculosis (TB) program provided services to over 5,000 residents, initiated follow-up prevention therapy for 130 clients, diagnosed 19 new cases of TB, and conducted 13 contact investigations in the community to minimize the risk of TB transmission. Health Department epidemiologists investigated more than 6,000 possible infectious disease cases, of which 5,204 were confirmed and referred for appropriate treatment. Health Department epidemiologists also investigated 15 community outbreaks involving respiratory, gastrointestinal, and vaccine preventable diseases. Clinical staff provided over 4,800 rapid HIV tests in addition to more than 6,700 clinic visits at which clients received a comprehensive sexual health screening and treatment if necessary. Recognizing the sexual health needs of adolescents are unique, the Health Department offered specialized outreach and health screening services for those under 18 years of age. In addition to screening and treating sexually transmitted infections, the Health Department also offered family planning services to 6,845 uninsured and underinsured residents. This year, 12,013 birth certificates and 8,400 death certificates were issued by the Health Department. The Train to Adopt program at the Pima Animal Care Center trains dogs with the basic skills to help them behave more calmly and appropriately, increasing their adoptability. This program has trained 197 dogs which have been successfully adopted. The National Association of County and City Health Officials (NACCHO) recognized the Pima County Health Department for its ability to respond to public health emergencies. This recognition affirms that the Health Department has a comprehensive emergency response plan in place; staff is welltrained to execute the plan; and the plan is exercised and used during public health emergencies. “NACCHO commends the Pima County Health Department for being a model of public health emergency preparedness,” - Robert Pestronk, Executive Director of NACCHO looking forward To strengthen the Health Department’s capacity to better meet the community’s needs, the Department initiated a strategic planning process that began with a reorganization of the Health Department’s structure to be more responsive to client needs. The Health Department also facilitated and hosted a Community Health Assessment with local key stakeholders with a focus on identifying the most critical health issues in the community and making a commitment to address those issues. After review of the community data, the stakeholders identified these five community health priorities: t&TUBCMJTIFBTJFSBDDFTTUPSFTPVSDFTUIBUTVQQPSUIFBMUIJFSMJGFTUZMFT t&OHBHFBOEDPPSEJOBUFDPNNVOJUZSFTPVSDFTUPJNQSPWFUIFDPNNVOJUZT health status t%FWFMPQBDPNNVOJUZXJEFEBUBDPMMFDUJPO BOBMZTJTBOEEJTTFNJOBUJPO system to help track and monitor determinants of health t1SPNPUFIFBMUIFEVDBUJPOBOEIFBMUIMJUFSBDZ FTQFDJBMMZBNPOHQPQVMBUJPOT of need t*EFOUJGZQVCMJDQPMJDJFTUIBUOFHBUJWFMZJNQBDUDPNNVOJUZIFBMUI BOEXPSL  together to advocate for policy change The next step in this process is convening community groups to develop and implement plans to address the priorities, and track their progress over time. The Health Department anticipates repeating this cycle every three years, allowing for re-assessment of data and evaluation of progress. Pima County Board of Supervisors Honorable Ann Day District 1 Honorable Ramón Valadez, Chair District 2 Honorable Sharon Bronson District 3 Honorable Ray Carroll District 4 Honorable Richard Elías District 5 V2-122711