MOHAVE COUNTY DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT FISCAL YEAR 2006 - 2007 TABLE OF CONTENTS LETTER FROM THE DIRECTOR Page 1 BOARD MEMBERS Page 2 MOHAVE COUNTY PROFILE Page 3 OFFICE LOCATIONS Page 4 DEPARTMENT ORGANIZATION Page 5 FINANCIAL INFORMATION Page 6 SUMMARY OF DIVISION PROGRAMS A. ENVIRONMENTAL HEALTH Page 7 - 10 B. NUTRITION AND HEALTH PROMOTION Page 11 - 12 C. PUBLIC HEALTH NURSING Page 13 - 16 D. SENIOR PROGRAMS Page 17 E. BIO TERRORISM & EMERGENCY RESPONSE Page 18 PATTERNS IN HEALTH, MORBIDITY & MORTALITY Page 19 - 22 Director’s Message: Public health preparedness has been both an opportunity and a challenge for our department. Key challenges have included new partnerships, new workforce needs, new technologies and the integration of emergency preparedness with other public health functions. These challenges have created a lot of extra work for public health professionals but they have also created a better system. It has given public health the opportunity to educate the public about our role in protection every day and during emergencies. We have an exceptional team here at the Mohave County Department of Public Health. We are making significant strides in the realm of preparedness and within the more traditional roles of public health. We recognize the important role our partners play in working together with us. We are dedicated to performing our job with excellence and with the idea that our citizens can truly “count on us”. Patty Mead Health Director Mission Statement The mission of the Mohave County Department of Public Health is: To create a safe and healthy community. 1 BOARD MEMBERS BOARD OF SUPERVISORS Pete Byers, Chairman District 1 Tom Sockwell, Member District 2 Buster Johnson, Member District 3 COUNTY MANAGER Ron Walker BOARD OF HEALTH 2006 - 2007 Pete Byers Chairman Diane Vick Vice-Chairman Margaret Nyberg Member Vacant Member Loa Roberts Member Dr. Lehi Barlow Member Steve Greeley Member Phil Moon Member Dr. Julie Jervis Physician Member HEALTH DIRECTOR Patty Mead, R.N., M.S. 2 MOHAVE COUNTY PROFILE Mohave County is geographically the second largest county in the state and has a population of almost 200,000. Most of it is classified as desert, but of its 13,479 square miles, 186 square miles are water. The county has over 1,000 miles of shoreline and is a great water sports center with the Colorado River and Lake Mohave, Lake Havasu, and Lake Mead. Mohave County is situated in northwestern Arizona and is bordered by the states of Utah, Nevada and California and the counties of La Paz, Coconino and Yavapai. Mohave County has four incorporated cities: Bullhead City, Lake Havasu City, Colorado City, and Kingman (the County seat). The Mohave County Department of Public Health offices are located in Kingman, Bullhead and Lake Havasu with clinics and senior nutrition sites in Colorado City and Golden Shores. 2006 Population Figures (from DES Estimates) Bullhead City Colorado City Kingman Lake Havasu City Unincorporated Total 39,930 4,050 27,635 54,610 72,095 198,320 Age Distribution (from Arizona Vital Statistics) Age <1-14 15-19 20-44 45-64 65+ Population 36,201 11,632 56,388 50,190 40,509 Percent of total 18.57% 5.97% 28.93% 25.75% 20.78% 2006 Population Composition (from Arizona Vital Statistics) Race White Non-Hispanic Hispanic or Latino African American American Indian or Alaska Native Asian or Pacific Islander Population 160,871 24,335 2,181 5,129 Percent of total 82.53% 12.48% 1.12% 2.63% 2,404 1.23% 3 DISTRICT OFFICES Kingman Lake Havasu City 700 West Beale Street P.O. Box 7000 Kingman, AZ 86402-7000 2001 College Drive Box 9, Suite 115 Lake Havasu City, AZ 86403-1953 Bullhead City 1222 Hancock Rd Bullhead City, AZ 86442-5940 1230 Hancock Rd Bullhead City, AZ 86442 SATELLITE LOCATIONS Golden Shores Senior Nutrition Site Colorado City Clinic ‘ › 4 DEPARTMENT ORGANIZATION The Mohave County Department of Public Health is administered through six divisions including Administration, Bioterrorism Defense and Emergency Response, Public Health Nursing, Environmental Health, Senior Programs, and Nutrition & Health Promotion. Each division (except Administration and BT Defense) has program sites in each of the County’s major cities. The Department Director is responsible for the oversight of the department programs. The division managers are responsible for the implementation, management and operation of the programs in their division. DIRECTOR Patty Mead ASSISTANT DIRECTOR Jennifer McNally SECRETARY SENIOR Krista Gunnoe Account Specialist – 2 Office Specialist – 1 Office Assistant – 1 Office Clerk - .5 NURSING SERVICES MANAGER Christy Bronston SENIOR PROGRAMS MANAGER Brad Bixler Nursing Supervisor – 2 Nurse Midwife – 1 Office Assistant – 1 Public Health Specialist – 8 Public Health Nurse, RN – 8.5 Paraprofessional Temp – 2 Community Health Educators – 1 Site Supervisor – 3 Site Coordinator – 1 Senior Programs Assistant – 5 Cook - 3 Prep Cook-3 Labor/Trades Temp 9 ENVIRONMENTAL HEALTH MANAGER Rachel Patterson NUTRITION/HEALTH PROMOTION MGR. Carol Matthews Environmental Health Supervisor – 2 Office Supervisor - 1 Environmental Health Specialist I/II –11 Environmental Health Technician – 2 Environmental Health Tech P/T - 3 Office Clerk/Assistant – 6 Office Clerk – 4 Clerical/Paraprofessional Temp – 1.5 Community Nutrition Specialist Sr – 2 Community Nutrition Specialist II – 2 Community Nutrition Specialist I – 1 Community Health Education Spec. I - 5 Community Health Education Spec. II.-I WIC Eligibility Worker – 10 Office Specialist - 1 Office Assistant Senior– 1 Part Time WIC Breast Feeding Peer Counselor - 2 BIOTERRORISM & EMERGENCY RESPONSE COORDINATOR Bruce Leeming Epidemiologist – 1 Volunteer Coordinator - 1 5 FINANCIAL INFORMATION July 1, 2006 – June 30, 2007 (from Mohave County Financial Services Adopted Budget Report, July 2007) Revenues Federal Grants Ventana Reimbursement Fees from Services State Grants & Contracts County General Funds Miscellaneous & Donations City Cost Sharing Total Revenues $1,974,156 80,400 1,765,255 750,408 1,365,117 196,379 0 $6,131,715 Expenditures Personnel Services Operating Supplies Other Charges/Services Capital Outlay $4,634,992 866,060 1,303,912 31,908 Total Expenditures $6,836,872 Expenditures exceeded revenues due to expenditure of carry over funds from prior years. 6 DIVISION SUMMARIES ENVIRONMENTAL HEALTH The Environmental Health Division (EHD) is responsible for inspection of public places, enforcing various environmental laws and response to public nuisances. In addition, EHD is involved in the Mohave County Department of Public Health’s (MCDPH) Emergency Response Team. EHD receives authority through delegation agreements with the Arizona Department of Environmental Quality (ADEQ) and the Arizona Department of Health Services (ADHS). EHD has approximately 14 areas of responsibility including; food safety, public & semi-public swimming pools, RV parks, hotels/motels, pet grooming parlors and kennels, septic pumper trucks, refuse haulers, on-site wastewater, public nuisance complaints, wells, Smokefree Arizona, school buildings, and campgrounds/children’s camps. As part of the food safety program, EHD offers food handler education. EHD continued to provide West Nile Virus (WNV) surveillance and educational outreach. WNV activities are provided through general fund monies. Mosquito trapping generally takes place from March through October. At fiscal year end, there were no WNV positive mosquito samples found in Mohave County; however the division continues to respond to nuisance complaints regarding standing water and sending dead birds to the ADHS lab as they are reported. The EHD policy and procedure manual was completed this year and each member of the division received a copy. The manual provides clear procedures to our staff and has made it easier to maintain consistency between our district offices. EHD has been working on a new ordinance that will revise and strengthen the regulations on pet grooming shops and kennels. This ordinance will be proposed to the Board of Supervisors in FY 07/08. Additionally, EHD is working on ordinances that will cover requirements for well setbacks from property lines and a body art ordinance. The fee schedule for EHD was revised with an approximate 10% increase for most fees. The increase was required to cover increased personnel costs due to a Cost of Living increase and increases in health insurance and retirement amounts. At the public hearing there were no objections and the fee schedule passed the Board of Supervisors unanimously. In December 2006, we completed a reorganization of the division. The division was changed from generalists to three units. The ADHS, ADEQ and Administrative staff units were formed. The supervisory staff is now based in Kingman and travel as needed to the outlying offices. This change has greatly improved efficiency, and has allowed more specialization for the Sanitarians. The reorganization will make it easier to determine where money is being spent in each program as well as where it is coming in. The Smokefree Arizona program is new to EHD as of May 1, 2007. As of 6/30/07, over 100 complaints have been registered with EHD and we have had very good compliance while trying to educate the public on the new law. We created a Registered Sanitarian position for the Smokefree Arizona program. This individual will primarily be responsible for responding to complaints across the county, educating the public on the law, and inspecting establishments as needed. 7 In this fiscal year, the on-site wastewater (septic) permits dropped considerably. EHD issued 2,156 permits and performed 2,536 inspections. Our food program stayed busy, and a few new establishments were added to the inspectors’ inventory. This year, 3,671 food handler cards were issued, representing a slight decline in number of cards issued over last year. This reduction in the number of cards issued is most likely due to the cards now being good for 3 years instead of 2 years. This year the price of the food handler training increased from $15.00 to $20.00. EHD conducted approximately 1,059 responses to approximately 627 public health nuisance complaints made to our offices. These complaints included nuisances associated with standing water, animal manure, trash/refuse, ground-feeding of pigeons and open sewage. 1,189 inspections of annually permitted establishments were made over the past year by EHD including: food establishments, RV parks, pet and grooming shops, hotel/motels, swimming pools, and septic and garbage haulers. EHD is behind in the inspection of annually permitted establishments due to vacancies in our ADHS programs. 8 STATISTICS BY CATEGORY FY 05/06 FY 06/07 Food Service Temporary Permits 226 258 Annual Permits 1164 1175 Annual Inspections 1882 1189 Food Handler Cards 4069 3671 On-Site Wastewater Permits Issued 2903 2156 Inspections 2967 2536 Pools/Spas Permits 251 257 Inspections 357 273 Kennels/Grooming Permits 34 40 Inspections 29 36 Hotel & Motel Permits 88 86 Inspections 56 99 Trailer Parks Permits 101 98 Inspections 120 92 Nuisance Complaints Number Received – land use 654 627 Inspections – land use 1340 1059 Number Received – annually 396 251 permitted establishments Wells (recommendation of approvals given to ADWR) Notice of Intent approvals 146 165 9 Food Service FY 03/04 FY 04/05 FY 05/06 annual permits 1189 1762 1940 1882 258 temporary permits 1175 1104 1156 1164 FY 06/07 189 231 226 2000 1800 1600 1400 1200 1000 800 600 400 200 0 annual inspections On-Site Wastewater 3000 2500 FY 03/04 2000 FY 04/05 FY 05/06 1500 FY 06/07 permits issued 2536 2967 3243 2681 2156 2903 0 2794 500 2567 1000 inspections Nuisance Complaints 2000 1800 1600 1400 1200 FY 03/04 1000 800 FY 05/06 FY 04/05 number received 1059 1340 1984 1729 627 654 911 200 0 1162 FY 06/07 600 400 inspections 10 NUTRITION AND HEALTH PROMOTION The Nutrition and Health Promotion Division works to promote healthy lifestyle choices through a variety of food assistance programs, tobacco use prevention and cessation programs, nutrition education, and physical activity programs. The budget for Nutrition and Health Promotion in 2007 exceeded $1.5 million. WIC, the Special Supplemental Food Program for Women, Infants, and Children contracts to serve 5300 participants per month in Mohave County. More than 55% of babies born in Mohave County are born to WIC mothers. About half of Mohave County infants and twenty five percent of children to age five are served by WIC. WIC is a supplemental food assistance program for pregnant, breastfeeding, and postpartum women, infants, and children to age 5. Income eligibility is met by families and clients enrolled in Food Stamp and ACCCHS or at 185% of poverty. The WIC program also provides individual nutrition education care plans and referrals to health and social services. The Mohave County WIC program continues to provide online nutrition education. Internet classes can be accessed by WIC clients in their own homes, at the public library, or in a friend’s home. About 40% of WIC clients now take classes at a location other than our clinics thereby reducing their appointment time by 10 to 15 minutes per visit and greatly improving clinic efficiency. The value of redeemed Mohave County food checks for this year exceeded $3,300,000.00. WIC Breast Feeding Peer Counseling Program Mohave County WIC was awarded a grant to initiate a breast feeding peer counseling program for WIC clients in Lake Havasu City, Kingman, Bullhead City, and Littlefield. Breast feeding rates have traditionally been low in Mohave County and we would like to move closer to the Healthy People 2010 goals of 75% of women breastfeeding their babies at birth , 50% of women breastfeeding their babies at 6 months of age and 25% of women breastfeeding their babies at one year of age. A peer counselor is often the ideal advisor because she offers more credibility to the participant than a professional. The Preventive Health and Health Services Block Grant is funded to reduce coronary heart disease by increasing the number of Arizona residents who get at least 30 minutes of physical activity on most days per week. Grant activities have targeted physical activity programs for youth. Program objectives include working with 4th through 8th graders at enrolled local schools to encourage daily, moderate intensity, physical activity. Additional community events targeting adults and families were also promoted through the community component of the program. The Commodity Supplemental Food Program (CSFP) provides 600 nonperishable food boxes to income eligible women, children to age 6, and seniors. As in years past, the contracted caseload has been inadequate to meet demand. The dollar value of the food box was negatively impacted by the hurricane damage sustained by Florida agriculture. The Mohave County Community Nutrition Program provides a series of “FIVE a DAY” nutrition education classes to third graders at low income, participating schools. When possible, the presentations include a Smiths supermarket tour. Presentations are designed to encourage fruit and vegetable consumption. The Local Incentive Award contract was continued for the third year. These funds provide us with additional resources to provide nutrition education programs to food stamp participating children and families. This grant is also used to provide “Bone Building” classes for fifth graders at participating schools. 11 The Mohave County Tobacco Use Prevention Program (McTUPP) works to prevent youth from using tobacco, supports those youth and adult tobacco users to quit, and educates the community on the hazards of use and exposure to tobacco. Disparate populations are a major focus when providing services. Most services are provided through multiple subcontractors including some local school districts and charter schools, local hospitals, youth coalitions, after school programs, and a city police department. McTUPP also educates business on implementing written tobacco free worksite policies, onsite cessation classes and promoting smoke free home environments. Each of the major tri-cities offers youth the opportunity to become members in an anti tobacco youth coalition. These youth participate in local and statewide activities: Youth Leadership trainings which promote communication, leadership, and team building skills; Attorney General’s Merchant Compliance Program identifies local merchants that sell tobacco to minors; Peer-toPeer Tobacco Education presentation teach elementary age youth about the dangers of tobacco; and Media outlet projects whereby the youth participate in parades, health fairs, fund raising activities and sporting events. “Mr. Butthead” a 6’5” walking cigarette debuts in all of the local parades. Overall, approximately 2500 intensive tobacco prevention education interventions were provided to youth in grades 4 through 8. More than 5000 one-time tobacco education contacts were made with youth in school through peer presentations and special events. Community events occurred throughout the county reaching 25,000 individuals. Intensive stop smoking classes were held for community group and on-site work places, 547 adults participated. Those clients who enroll in our classes are offered vouchers to purchase nicotine replacement therapies at 100% of the cost. Youth cessation programming was held for students. More than 100 business contacts were made to provide tobacco free technical assistance and all school campuses remain tobacco free. 12 PUBLIC HEALTH NURSING The Nursing Division of the Mohave County Department of Public provides professional nursing services for high risk populations and is responsible for communicable disease control activities throughout the county. Many services are mandated in order to protect the health and safety of Mohave County residents and are free, regardless of household income. Other services are provided on a sliding fee scale basis and others are available at a low, fixed cost. Funding for Public Health programs comes from grants, taxes, fees, donations, and local and state revenues. Nursing shortages have been the most significant barrier to providing professional services throughout the county in 2006-07. Due to this shortage, services were limited to addressing the most significant public health threats. The staffing situation improved in the latter part of 2007 which has allowed us to increase services throughout our communities. Newborn Intensive Care Program: This is a grant funded program and the services are provided free to the clients. NICP features home visits by a Registered Nurse for children who were placed in Newborn Intensive Care at their birth and also includes developmental delay follow-up. Facilities such as St. Joseph’s Hospital in Phoenix and Flagstaff Medical Center refer babies with potential health problems to the local health department. In turn, a nurse arranges for home visits with the family to evaluate and monitor the child’s condition, screen for developmental delays, teach care taking techniques, and answer questions for the parents. Referrals are often made to other agencies that may be able to assist with the child’s special needs. Immunization Program: This is a grant funded program that is supported by the General Fund. Free immunizations are provided to children and adolescents through the Vaccines for Children Grant. The vaccines that are available are those routine childhood immunizations recommended by the American Academy of Pediatrics. Adult immunizations are also offered for a fee set by the Board of Supervisors based upon the cost for the service. A Tetanus-diphtheria vaccine is recommended every ten years and Hepatitis B, Hepatitis A, Varicella, MMR, and pneumonia are also available. The Menimune vaccine is now available for those needing protection against Meningococcal disease. Most colleges now mandate this vaccine prior to acceptance. Also available is the new “HPV”, or Human Papillomavirus vaccine, that protects against 4 types of HPV. HPV vaccine can prevent most genital warts and most cases of cervical cancer. In FY 06/07, the Board of Supervisor also approved a fee for the new “Shingles” vaccine, or Zostavax. This vaccine is available for individuals age 60 and older to prevent shingles. Based upon vaccine recommendations, only those individuals who have not had shingles previously are eligible for the vaccination. Influenza Vaccine: Each fall, the Public Health Division offers “flu” vaccine clinics for Senior Citizens and other high-risk individuals, especially those with heart or lung disease. Typical flu season begins in November and runs through April in Arizona. Flu clinics are held in each city and usually begin early November. Clinic dates, times and locations are published in local newspapers and on our HealthELinks.com website. The vaccine is also given at the local Public Health Nursing offices. Pneumonia vaccine is also provided for a minimal fee for those with serious medical conditions and those over the age of 65. Our department bills Medicare Part B for flu and pneumonia vaccinations and charges those without Medicare. 13 Communicable Disease Program: Registered Nurses coordinate with local physicians, Arizona Department of Health Services, and the Centers for Disease Control & Prevention to limit exposure and control the spread of infectious diseases. This includes identifying individuals who are infectious and their contacts, conducting laboratory testing, providing immunization, medications and other disease control interventions when necessary. The public health nursing division also provides information to the public on health issues that may pose a public health risk. Ryan White Care Program: This is a grant funded program that is provided free of charge to eligible clients. Assistance is available for qualifying HIV positive individuals. Current services include case management provided by a registered nurse, client eligibility and advocacy, food and nutritional assistance, Health Insurance Continuation, medication and primary medical assistance as well as transportation to infectious disease doctors in Las Vegas. Tuberculosis Control and Treatment: While Tuberculosis (TB) is decreasing in other states, Arizona continues to see a steady number of TB cases each year. The Public Health Nursing Division, with assistance from a contracted Mohave County TB Control Officer, provides one-onone case management for each case of active Tuberculosis. This includes Direct Observed Therapy (providing medication to the patient and observing them take the medications) to ensure the health and safety of the public. Treatment for active Tuberculosis is recommended for 6-12 months. TB skin testing is provided for a minimal charge. Those with positive skin tests receive counseling, a chest x-ray, and free medication if necessary. The Registered Nurse and TB Control Officer closely monitor the progress of each patient on medication. Pregnancy Testing: Healthy pregnancies start with early prenatal care. For this reason, Public Health Nursing provides pregnancy testing and counseling on a sliding fee-scale basis as early as fourteen days after a missed menstrual period. Referrals to other agencies are offered for both pregnant and non-pregnant clients. Reproductive Health: Some women have chosen to wait to begin or increase their families, so the Public Health Division conducts free and low cost Reproductive Health Clinics which provide birth control to those who otherwise could not afford it. These services are provided through grant funding. Clinics are staffed by professionals who specialize in women’s health. Additional funding for this program has been provided by Arizona Family Planning Council to enhance the services available for our clients. Sexually Transmitted Disease Clinic: Clinics are held weekly to test for and treat the most common sexually transmitted diseases. For a charge, we will provide an exam, testing, counseling, treatment, and contact follow up if warranted. HIV Testing and Counseling: HIV testing and counseling is provided by appointment for a minimal fee. The Registered Nurses are trained and certified by the Arizona Department of Health Services to provide risk reduction counseling and testing for HIV. Testing is conducted using strict confidential procedures to ensure patient privacy. Each testing session lasts approximately 20-30 minutes. Blood specimens are submitted for testing to Arizona State Laboratory and results are provided within two weeks. Rapid testing, which allows same-day results, will be available soon. 14 Maternal Child Health Program: A nurse case manager coordinates the activities of the maternal child health programs in Mohave County. A few of the activities in which this program is involved are Health Start and Newborn Intensive Care Program case management. The Maternal Child Health personnel also work with local schools to provide health education for high risk groups. Health Start Program: This is a grant funded program that is free to our clients. The program provides home visits by a lay health worker, or “promotora”, who is a resource for pregnant women and their families. After the birth of the child, the promotora visits the family in the home to provide education on health and safety issues such as immunizations, car seat safety, and home safety. High risk mothers and infants are visited by a Registered Nurse to facilitate and encourage positive outcomes. 15 Mohave County Department of Public Health Nursing Division Statistics FY 02/03 FY 03/04 FY 04/05 FY 05/06 FY 06/07 Newborn Intensive Care Program Home visits 149 229 231 207 248 Communicable Disease Disease investigations 1,150 978 1,393 1,234 1,323 Childhood Immunization Program Children vaccinated Vaccinations given 5211 18,188 7448 15,989 5,816 13,955 3,898 13,090 5,612 20,406 Adult Immunizations Program Tetnus-Diptheria Hepatitis B Hepatitis A Varicella MMR HPV Zostovax Meningococcal Influenza Pneumonia 297 1,021 293 15 151 ---3,760 410 231 559 297 15 162 ---4,167 433 296 468 262 8 108 ---8,950 650 243 305 171 25 179 ---5,959 1,016 189 336 132 43 147 1 10 17 3,031 328 1,626 194 666 2 193 1532 219 468 2 155 1,712 252 513 4 158 88 1,149 179 291 7 162 60 1,207 107 321 3 139 59 Reproductive Health Pregnancy Tests New/Annual visits 855 772 1384 986 1,638 1,185 316 971 217 889 Sexually Transmitted Disease Clinic visits 311 380 394 150 76 Well Woman Clinic visits 112 51 40 9 0 HIV Counseling and Testing HIV tests HIV post counsel 334 253 365 278 139 97 146 112 101 95 DNA Lab Draws 33 0 1 0 0 Health Start Visits 531 458 259 236 530 Tuberculosis Control TB skin tests Latent TB infection Active case visits Active case Chest x-ray/clinics Primary Reactor Visit 16 SENIOR PROGRAMS The main purpose of Mohave County Senior Programs is to provide hot, nutritious meals to seniors and disabled citizens within the county. Senior Programs provides congregate meals at the senior center sites. Senior Programs also provides homebound seniors a hot meal and welfare check via the “meals on wheels” program. Senior Programs offers other programs such as socialization, education, and support services at each of the senior centers. These services range from Social Security offices located within several of the senior centers to activities such as bridge, yoga, crafts, parties, and exercise classes. The Senior Centers have volunteers who help seniors with problems related to Medicare Part D and the attorney generals satellite office. Four senior centers exist within Mohave County with sites in Bullhead City, Golden Shores, Kingman and Lake Havasu City. The majority of funds to run the senior center nutrition programs come from the Mohave County General fund, federal funds via the “Older Americans Act”, and donations from participants. There are thrift shops at the Bullhead City, Kingman and Lake Havasu Senior centers. The thrift shops are operated by senior non-profits and the revenues are used to help pay for a portion of program expenses such as utilities, food purchases, equipment purchases and emergency repairs. The thrift shops also provide enjoyable volunteer jobs for senior citizens. Senior Programs served 198,129 meals to senior citizens and handicapped persons during fiscal year 2006-2007. Volunteers are a key to the success of senior programs. During the past year over 300 volunteers donated their time to help with programming. The donation of time is worth hundreds of thousands of dollars in labor savings based on minimum wage. Senior Programs continues to seek ways to reduce expenditures and increase donations. Local grocers donate bread products and Little Debbie’s donates snacks to Senior Programs on a regular basis. During this fiscal year, Senior Programs began the process of transferring transportation to the cities. Since Kingman, Bullhead, and Lake Havasu have transit systems, there is some duplication of services with the transportation being provided by Senior Programs. The county has been working on Intergovernmental Agreements (IGA’s) with each of the cities and hopes to finalize them next fiscal year. In the IGA’s the county is transferring state LTAF II transit funds and some vehicles to the cities. The cities will use those funds plus increased revenues from the federal government to provide senior rides. In the rural area’s Senior Programs plans to donate a van to Dolan Springs, Golden Shores and Golden Valley for senior transit. Senior Programs is working with the Western Arizona Council of Governments to provide a plan for operations and maintenance of a vehicle for the rural areas. 2006-2007 Home Delivered Meal statistics by location: Bullhead City Golden Shores Kingman Lake Havasu Total 29,968 5,955 34,856 32,224 103,003 2006-2007 Congregate Meal statistics by location: Bullhead City Golden Shores Kingman Lake Havasu Total 11,460 7,249 22,885 53,532 95,126 2006-2007 Total persons served meals: 3,063 17 BIO TERRORISM Preparedness planning with emphasis on Pandemic Influenza planning continued to be the key focus during fiscal year 2006-2007. In April, we conducted Pandemic Flu Seminars for senior leaders in Kingman, Lake Havasu and Bullhead City. The seminars were designed to focus on the overall response and decision-making process for public health emergencies. The seminars were not a test of detailed response procedures; they emphasized initial communication and collaboration, emergency response coordination, and problem identification and resolution. Each seminar was designed to be an open, thought-provoking exchange of ideas to help the county and all partner agencies and stakeholders to evaluate procedural capabilities in response to a communicable infection outbreak, particularly pandemic influenza. Participants included representatives from stakeholder agencies and organizations having emergency response roles in a pandemic influenza outbreak affecting the citizens of Mohave County. Much of the discussion was based on the information developed or obtained from the meetings conducted during the past year. Many participants left each seminar feeling that their work on these committees was not fruitless; they were motivated to move to the next level of pandemic influenza preparedness. We have established Pandemic Coordinating Committees in Kingman, Bullhead, and Lake Havasu to address preparedness for each of these regions. The committees are comprised of governmental, public health, healthcare, emergency response, agriculture, animal health, education, business, communication, community based, and faith-based sectors along with private citizens. The committees meet to discuss planning efforts in their regions and develop policies and plans for a pandemic. The Pandemic Influenza Response & Recovery Plan was developed and has gone through a few revisions. This plan will continue to be updated as new information is received from the CDC and Arizona Department of Health Services, as well as with input from the Pandemic Coordinating Committees. Our volunteer core remains crucial to our successful response to a major event. We currently have approximately 300 volunteers signed up with the health department and continue to recruit new volunteers. The volunteers were known as the Health Emergency Assistance Response Team (H.E.A.R.T.); however, we recently formed the Mohave County Medical Reserve Corps (MRC) and our volunteers were transitioned over to this program. Our health department staff continues to receive training on a regular basis with regard to emergency response. Training and exercises this past year has included NIMS (National Incident Management System) certification, SNS Distribution (Strategic National Stockpile), Pandemic Influenza Response, School Closures exercises and biological attacks on the food system. 18 PATTERNS IN HEALTH, MORBIDITY, AND MORTALITY Characteristics of Newborns 180 Characteristics of Mothers Total Births 160 1400 140 1200 2400 2350 120 1000 2002 800 2003 2250 2200 2003 2004 80 2004 600 2005 60 400 2006 200 2191 2237 2468 2002 2003 2004 2005 2006 0 Characteristics of Mothers * rates per 100 live births 2006 low birthw eight babies fetal mortality Characteristics of Newborns *rates per 100 live births 50 8 45 7 40 35 2002 30 2003 6 2002 5 2003 2004 3 2005 0 0.84 0.6 mothers 19 or under rate* 0.47 0.55 unw ed mother rate* 0.66 1 2006 6.3 5 16.3 15 13.8 16.1 15.8 2 42.3 40.7 39.9 45.1 47.3 10 5.9 2006 15 2004 6.7 2005 20 4 6.8 25 0 0 unw ed mothers mothers 19 or under 2005 40 20 6.8 1900 2135 1950 1983 2000 323 320 303 361 390 2050 839 869 874 1009 1167 2150 2100 2002 100 2300 12 10 11 19 15 2450 134 145 146 133 155 2500 low birthw eight babies rate* fetal mortality rate* The total number of births has steadily increased over the past five years with an overall increase of 24.5%. The number of unwed mothers has increased 39% from 2002 to 2006; however the rate of unwed mothers per 100 live births has only increased 11.8% during that period of time. The number of mothers 19 or under has shown an increase over the past five years. However; due to the increase in the number of births from 2002 - 2006, the rate of mothers 19 or under has actually decreased by 3% during that period of time. The trend in the number of low birthweight babies has been an increase over the past five years. However, from 2002 – 2006 the rate of low birthweight babies has seen a slight decrease of 7%. The trend in both the number and rate of fetal mortality has remained fairly constant during the past five years. 19 Death Rate *per 10,000 population Number of Deaths 2400 127 2350 126 2300 125 2250 2200 124 2150 123 2100 122 2050 121 2000 2005 2006 118 121 2354 2004 125 2345 2003 125 2253 2002 119 126 2151 1850 2047 1900 123 120 1950 2002 2003 2004 2005 2006 The number of deaths has increased 15% from 2002 to 2006; however, the death rate has remained fairly constant. The death rate decreased 1.6% from 2002 to 2006 after three successive years of an increase from 2002 rates. Patterns in Cause-Specific Mortality Rates per 100 deaths 2005 500 2006 400 300 183 182 219 225 217 0 221 255 265 132 74 100 614 734 762 769 707 200 major cardiovascular disease acute myocardial infarction lung, trachea, bronchus cancer 2006 8.9 8.5 9.7 9.6 9.2 2004 2005 lung, trachea, bronchus cancer rate 600 2004 myocardial infarction rate 2003 35 30 25 20 15 10 5 0 10.8 11.9 11.8 5.6 3.1 2002 700 2003 cardiovascular disease rate 800 2002 30 34.1 33.8 32.8 30 Patterns in Cause-Specific Mortality The number of deaths from cardiovascular disease, acute myocardial infarction, and lung, trachea, and bronchus cancer had increased each year from 2002 – 2004. In 2006, the number of deaths from each of these conditions decreased; acute myocardial infarction to its lowest level in the past five years. From 2005 to 2006, the number of deaths has decreased: 8% for cardiovascular disease, 44% for acute myocardial infarction, and 3.5% for lung, trachea, and bronchus cancer. The rate of death for cardiovascular disease and myocardial infarction has been decreasing since 2003. From 2005 to 2006, the rate of death has decreased: 8.5% for cardiovascular disease, 44.6% for acute myocardial infarction. The overall trend for the rate of death for lung, trachea, and bronchus cancer has remained fairly constant over the past five years 20 2002 2003 50 40 Patterns in Cause-Specific Mortality 2004 Patterns in Cause-Specific Mortality Rates per 100 deaths 2.5 2005 2006 2002 2003 2004 2005 2006 2 30 1.5 20 1 1.6 1.9 1.3 1.7 2.2 0 2.3 1.6 1.8 1.8 2.2 intentional motor self harm vehicle (suicide) accidents 1.4 1.3 1.8 1.4 1.4 0.5 1.3 1.5 1.2 1.7 1.4 prostate cancer 33 41 29 39 51 breast cancer 48 35 40 41 52 29 29 41 32 34 0 27 32 28 39 32 10 breast prostate suicide rate motor cancer rate cancer rate vehicle rate The number of deaths from breast cancer has fluctuated from 2002 – 2006 with an overall trend of an increase (18.5% from 2002 – 2006). However, the death rate from breast cancer has increased only 7.7% during that period of time. The number of deaths from prostate cancer increased significantly in 2004 but dropped off in subsequent years. The overall trend is an increase of 17.2% from 2002 – 2006. The death rate from prostate cancer saw an increase in 2004; however, the overall trend in the death rate from prostate cancer has remained the same. The trend for the number of deaths from intentional self harm has been an increase in deaths. From the lowest number in 2003 to 2006, the number of deaths has increased 48.6%. The death rate from intentional self harm has followed the same pattern with an increase of 37.5% from the lowest rate in 2003 to 2006. The number of deaths from motor vehicle accidents has fluctuated from 2002 – 2006; however, the overall trend is an increase of 54.5% from 2002 to 2006. The death rate has seen the same fluctuation with an increase of 37.5% from 2002 to 2006. 21 Patterns in Morbidity Number of Reported Cases 60 35 2002 30 2004 2005 25 2006 40 2002 2003 2003 50 Patterns in Morbidity rate per 100,000 of population 2004 2005 2006 20 30 0 6 5 6 0 tuberculosis gonorrhea tuberculosis rate 9 15.2 27.7 28.7 28.7 hepatitis A 0 4.3 4.7 8.3 1.1 0.5 5 15 26 50 54 57 10 7 8 15 2 1 10 2 20 3.7 1.2 0 3.2 2.5 15 hepatitis A rate gonorrhea rate The number of tuberculosis cases consistently fluctuates; from six confirmed cases in 2002 to zero confirmed cases in 2004 to five cases in 2006. The number of hepatitis A cases had been consistently increasing but saw a significant decrease of 93.3% in 2006 compared to 2004. The number of cases of gonorrhea has consistently increased since 2002 but has experienced a more gradual increase in cases in the past three years. In 2006, the number of cases increased 280% compared to 2002 and increased 5.5% compared to 2005. As noted above for the number of confirmed tuberculosis cases, the rate of reported cases consistently fluctuates from year to year. The rate of hepatitis cases has seen significant decreases from 2004 to 2006; down 94% in that time frame. The rate of gonorrhea remained the same in 2006 compared to 2005; however, the trend continues to show a significant increase in the rate of cases (218% from 2002 to 2009). 22 Fiscal Year 2006 – 2007 Annual Report 23