MOHAVE COUNTY DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT FISCAL YEAR 2008 - 2009 TABLE OF CONTENTS BOARD MEMBERS Page 1 MOHAVE COUNTY PROFILE Page 2 OFFICE LOCATIONS Page 3 DEPARTMENT ORGANIZATION Page 4 FINANCIAL INFORMATION Page 5 SUMMARY OF DIVISION PROGRAMS A. ENVIRONMENTAL HEALTH Page 6 - 10 B. NUTRITION AND HEALTH PROMOTION Page 11 - 12 C. PUBLIC HEALTH NURSING Page 13 - 18 D. SENIOR PROGRAMS Page 19 - 20 E. BIO TERRORISM & EMERGENCY RESPONSE Page 21 PATTERNS IN HEALTH, MORBIDITY & MORTALITY Page 22 - 25 BOARD MEMBERS BOARD OF SUPERVISORS Tom Sockwell, Chairman District 2 Gary Watson, Member District 1 Buster Johnson, Member District 3 COUNTY MANAGER Ron Walker BOARD OF HEALTH 2008 - 2009 Phil Moon Chairman Steve Greely Vice-Chairman Gary Watson Board of Supervisors Member Robin Gordon Member Doug Haslan Member Teri Wise Member Margaret Nyberg Member Kathy Bruck Member Dr. Lehi Barlow Physician Member HEALTH DIRECTOR Patty Mead, R.N., M.S. MOHAVE COUNTY PROFILE Mohave County is geographically the second largest county in the state and has a population just over 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 a senior nutrition site in Golden Shores and Nursing staff in Colorado City. July 1, 2008 Population Figures (from Arizona Dept of Commerce Estimates) Bullhead City Colorado City Kingman Lake Havasu City Unincorporated Total 41,187 4,042 28,823 55,429 76,381 205,862 2008 Age Distribution (from Arizona Vital Statistics) Age <1-14 15-19 20-44 45-64 65+ TOTAL Population 37,326 12,000 60,828 52,569 42,197 204,920 Percent of total 18.22% 5.86% 29.68% 25.65% 20.59% 100% 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 ‘ › 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 FROZEN Office Assistant – 1 FROZEN Office Clerk - .5 NURSING SERVICES MANAGER Christy Bronston SENIOR PROGRAMS MANAGER Brad Bixler Nursing Supervisor – 2 Nurse Midwife – 1 Office Assistant – 5 Public Health Specialist – 4 Public Health Nurse, RN – 8.5 Paraprofessional Temp – 2 Community Health Educators – 2 Clerical Temp - 5 Site Supervisor – 3 Site Coordinator – 1 Senior Programs Assistant – 4 Cook - 3 Prep Cook-3 Labor/Trades Temp 10 ENVIRONMENTAL HEALTH MANAGER Rachel Patterson NUTRITION/HEALTH PROMOTION MGR. Deborah Conter Environmental Health Supervisor – 2 Office Supervisor - 1 Environmental Health Specialist I/II –11 Environmental Health Technician – 1 Permit Technicians – 4 FROZEN Permits Tech - 3 FROZEN Env. Health Specialist I/II - 2 FROZEN Env Health Technician – 2.5 Community Nutrition Specialist Sr – 1 Community Health Education Spec. Sr - 1 Community Health Education Spec. I - 4 Community Health Education Spec. II - 1 WIC Eligibility Worker – 9 Office Specialist - 1 Office Assistant Senior– 1 Office Assistant - 1 Part Time WIC Breast Feeding Peer Counselor - 4 FROZEN Community Nutrition Specialist II - 1 BIOTERRORISM & EMERGENCY RESPONSE COORDINATOR Bruce Leeming Epidemiologist – 1 Volunteer Coordinator - 1 FINANCIAL INFORMATION July 1, 2008 – June 30, 2009 (from Mohave County Financial Services Budget Report) Revenues Federal Grants AHCCCS Reimbursement Fees from Services State Grants & Contracts County General Funds Miscellaneous & Donations $2,373,456 192,991 1,479,913 894,946 1,610,942 320,103 Total Revenues Expenditures Personnel Services Operating Supplies Other Charges/Services Capital Outlay $6,872,351 $5,085,202 665,969 1,305,086 29,995 Total Expenditures $7,086,252 Expenditures exceeded revenues due to expenditure of carry over funds and contract year dates. Fiscal Year 2008/2009 Funding Sources Annual Funding Miscellaneous & Donations 5% $7,100,000 General Fund 23% Federal Funding 34% $6,600,000 FY 07/08 FY 08/09 $6,100,000 State Funding 13% Fees from Services 22% AHCCCS Reimbursement 3% $7,115,581 $6,872,351 $5,600,000 1 DIVISION SUMMARIES ENVIRONMENTAL HEALTH The Environmental Health Division (EHD) is responsible for inspection of public places, enforcement of 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 operates in accordance with the EH policies and procedures and receives authority through delegation agreements with the Arizona Department of Environmental Quality (ADEQ) and the Arizona Department of Health Services (ADHS). EHD’s areas of responsibility include; food safety, public & semi-public swimming pools, RV parks, hotels/motels, pet shops, grooming parlors and kennels, septic pumper trucks, refuse haulers, on-site wastewater (septic systems), public nuisance complaints, wells, Smokefree Arizona, campgrounds/children’s camps, and school buildings. As part of the food safety program, food handler education is offered. The fee schedule for EHD was revised for FY10 with an approximate 15% increase for most fees. At the public hearing there were few objections and the fee schedule passed the Board of Supervisors unanimously. During this fiscal year the on-site wastewater (septic) permits continued to drop in number. EHD issued 990 permits (compared with 1,255 last year) and performed 594 inspections. One inspector was recently moved out of the Environmental Quality program and into the Environmental Health program. The Division has left 1.5 FTE vacant due to the reduction in permits and to achieve some level of job security for existing staff. The food safety program has stayed consistent and even grown slightly. This year 4,213 food handler cards were issued; an increase of 15% from the 3,654 issued last fiscal year. 814 nuisance complaints were received from members of the public; 1,909 inspections were conducted on these complaints. This is an increase over the 739 complaints called in last fiscal year. Eighty cases were taken to court which is also an increase over the 44 taken to court last fiscal year. These complaints included nuisances associated with standing water, animal manure, trash/refuse, ground-feeding of pigeons and open sewage. The BOS unanimously passed a revised ordinance prohibiting the feeding of pigeons in the County. The former ordinance was difficult to enforce and the revision will make it much easier for inspectors in the field. EHD is statutorily required to ensure abatement of public health nuisances. The division attempts to work with property owners to get compliance on property clean ups. When this fails, the division arranges for clean up and places a lien on the property for the cost of the clean up. This year, EHD received approximately $90,000 in lien payments which have been deposited in a fund for future clean-ups of properties. The clean-up fund has grown from $20,000 approved by the BOS for property clean-up a few years ago and it continues to grow. While response to public health nuisance complaints is an unfunded mandate, EHD is working closely with Development Services and the Office of Management and Budget to find available funding sources. In October 2007, a new ordinance was approved which strengthened regulations on pet grooming shops and kennels. This year the final IGA was completed with the City of Kingman in order to enforce these regulations within the City limits. IGA’s had previously been completed with the Lake Havasu City and Bullhead City. Staff continues to work with local breeders and kennels to bring everyone up to code and under permit. Other activities EHD was involved in during FY09 include working on the Food and Drug Administration’s Program Standards which is a food safety standardization program many jurisdictions take part in on a national level. Staff has completed three of the seven total standards. At the end of FY08, the Environmental Health Manager was assigned to participate in the subdivision review committee, a group of individuals put together to review the land division regulations. Participation on this committee has been beneficial as EH has been able to promote Smart Growth Principles and the ideas of creating “Built Environments” in Mohave County. EHD also worked with the National Parks Service creating an informational brochure on bedbugs. This brochure is very timely as there has been a resurgence of bedbugs across the nation. STATISTICS BY CATEGORY FY 07/08 FY 08/09 Food Service Temporary Permits 257 309 Annual Permits 1233 1335 Annual Inspections 2090 2755 Food Handler Cards 3654 4213 On-Site Wastewater Permits Issued 1255 990 Inspections 2916 594 Pools/Spas Permits 272 271 Inspections 496 446 Kennels/Grooming Permits 53 61 Inspections 58 68 Hotel & Motel Permits 89 90 Inspections 94 106 Trailer Parks Permits 100 106 Inspections 122 123 Campgrounds/Children’s Camps Permits 3 4 Inspections 3 4 School Buildings Permits 53 53 Inspections 75 76 Nuisance Complaints Number Received – land use 739 814 Inspections – land use 1664 1909 Number Received – annually 289 352 permitted establishments Court hearings 44 80 Septic Haulers Permits 57 Inspections 56 Refuse Haulers Permits 90 Inspections 90 Wells (recommendation of approvals given to ADWR) Notice of Intent approvals 144 44 Smokefree Arizona Complaints 188 95 Inspections 199 100 Food Service FY 05/06 2800 2600 2400 2200 2000 1800 1600 1400 1200 1000 800 600 400 200 0 FY 06/07 FY 07/08 1882 1189 2090 2755 temporary permits 1164 1175 1233 1335 226 258 257 309 FY 08/09 annual permits annual inspections On-Site Wastewater FY 05/06 3000 FY 06/07 FY 07/08 2500 FY 08/09 2000 1500 permits issued 594 2967 2536 1209 0 990 500 2903 2156 1255 1000 inspections Nuisance Complaints 2000 FY 05/06 1750 FY 06/07 1500 FY 07/08 1250 FY 08/09 1000 251 289 352 750 654 627 739 814 250 1340 1059 1664 1909 500 0 inspections number land use received - land use number received annual estab Inspection Percentage by Category Smokefree Arizona, 1.62% On-Site Wastew ater 37.79% School Buildings, 1.23% Nuisance Complaints - Land Use 21.56% Food Service Annual 27.08% Campgrounds Children's Camps, 0.06% Kennels/Grooming, 1.10% Trailer Parks, 1.99% Pools/Spas, 7.22% Hotel & Motel, 1.71% 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. WIC, the Special Supplemental Food Program for Women, Infants, and Children contracts with the Arizona Department of Health Services to serve 5200 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 AHCCCS or who are at 185% of poverty. In addition to vouchers for healthy foods, the WIC program also provides individual nutrition education care plans and referrals to health and social services. 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. Mohave County now employs four part time peer counselors to work with pregnant and postpartum women interested in breastfeeding. Each pregnant woman entering the WIC program is offered an opportunity to attend a breastfeeding class led by the peer counselor. Counselors are also available by phone to assist with questions and problems new mothers may encounter. 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. Walking clubs for adults have become part of the program in recent years. Future goals for this grant include working on environmental changes such as more sidewalks to make walking a safe option for both adults and children. This year, this grant is sponsoring “Walk to School Day” at a Kingman elementary school. The Commodity Supplemental Food Program (CSFP) provides 705 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 Local Incentive Award (LIA) is funded with State and Supplemental Nutrition Assistance Program Administration dollars through matching federal financial participation from the United States Department of Agriculture (USDA). The program provides nutrition education in local schools, Supplemental Nutrition Assistance Program (SNAP) offices and Woman, Infant, Children (WIC) offices. Curriculum includes healthy breakfast & whole grains for kindergarten and 4th grade, Fruits and Veggies More Matters for 1st and 3rd grade, MyPyramid for 2nd grade, and Building Better Bones for 5th grade. The importance of hand washing and food safety is taught to all Kindergarten through 5th grade classrooms. Last year, 3049 children in Mohave County received this education primarily in Kingman, Dolan Springs, Topock, and Littlefield. Bullhead City and Lake Havasu City schools conduct their own education under separate LIA grants. In addition to curriculum taught in the classroom, food demonstrations to promote healthy meals and nutrition education is provided monthly to SNAP and WIC offices. Last year, 1835 residents attended the food demonstrations. The Mohave County Tobacco Use Prevention Program (MCTUPP) works to eliminate tobacco use through a variety of programs. Services are provided through multiple sources and subcontractors including local school districts, charter schools, local hospitals and youth coalitions. Intensive tobacco education was provided countywide to 2,400 4th and 6th grade students and brief education was given to 2,500 high school freshman. In addition to education, Kingman and Lake Havasu City youth participated in the Attorney General’s Merchant Compliance Program which identifies local merchants who sell tobacco to minors. Kingman High School also adopted the Kingman Youth Coalition Beating Up Teen Tobacco (KYCBUTT) as a school club. These anti-tobacco youth members participate in local and statewide activities and team building skills. They develop and conduct Peer to Peer tobacco education programs to elementary and middle school age children. Their efforts reached more than 2,500 children in the school and 5,000 community members through parades, health fairs, fund raising activities and sporting events. The “Butthead Family”, a walking cigarette family, created and built by the youth coalition is a popular attraction at community events. MCTUPP launched and piloted the first stop smoking text messaging program in North America. Mohave County Stop Smoking On Mobile Phone (MCSTOMP) targets high school youth and young adults through the age of 24. MCSTOMP got international media coverage and was highlighted in the American Public Health Journal. A new pilot program which targets pregnant smokers and their families began this year. The “Mommy and Me, 0-3” is designed to educate and assist pregnant women to quit smoking and remain tobacco-free after the baby is born. In the community, county wide health providers were trained and given education materials and referral information to the Arizona Smokers Helpline, a cessation coaching service. Thirty three dental hygiene students and professionals earned Basic Skills Cessation Training Certifications. Limited on site intensive cessation classes were conducted at Kingman Regional Medical Center for adults in Kingman. Through a donation given by KRMC, 200 individuals had the opportunity to attend smoking cessation classes. PUBLIC HEALTH NURSING The Nursing Division of the Mohave County Department of Public Health 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 state and federal grants, fees, donations, and local and state revenues. This year has proven to be a very exhaustive and challenging year. Our department has been privileged to work directly with many departments and external agencies in response to the H1N1 Pandemic influenza. Staff has taken on roles with responsibilities that we have not previously encountered. We have also experienced, first hand, the significant challenges of continuity of operations. The experience and knowledge gained has prepared our team to more appropriately address issues during large-scale events. Newborn Intensive Care Program: This is a grant funded, free program that features home visits by a Registered Nurse and 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. 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. Referrals are often made to other agencies that can assist with the child’s special needs. The program serves both Mohave and LaPaz counties. The NICP program has been impacted by recent budget cuts from the state health department. The program is now limited to visitation for very high medical risk infants which impacts the ability of the nurse to visit all families who qualify for the program thereby reducing the number of visits. In additional to the limitation on visits, the number of newborns admitted to a Newborn Intensive Care Unit decreased from 180 to 141 which also impacts the number of visit conducted. Immunization Program: Free immunizations are provided to children and adolescents through the Vaccines for Children Program, a federally funded immunization grant, and general fund support. The available vaccines are routine childhood immunizations recommended by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices. This fiscal year, new vaccination requirements were implemented resulting in an increased number of children requiring vaccination before school entry. To accommodate the increase in demand for vaccinations, the Public Health Nursing division offered additional immunization clinics in each community. Immunizations were also provided at health fairs and other community events to improve access to vaccinations. Adults: Tetanus-diphtheria vaccine is recommended every ten years and Hepatitis B, Hepatitis A, Varicella, MMR, and pneumonia are also available for a minimal fee. Meningococcal is available and recommended for those entering into college or universities. Zostavax and Guardasil vaccines are also available for adults. Influenza Vaccine: Flu vaccine is offered to children 6 months – 18 years of age. Flu season typically begins in November and runs through April in the western region of the United States. Clinics are held in Kingman, Bullhead, and Lake Havasu and usually begin early November. Pneumonia vaccine is also provided for a minimal fee for those with serious medical conditions and those over the age of 65. Communicable Disease Program: Registered Nurses and an Epidemiologist coordinate with local physicians, the Arizona Department of Health Services, and the Centers for Disease Control & Prevention to limit exposure to and control the spread of infectious diseases. Responsibilities includes identifying those who are infectious and individuals with whom they are in contact, conducting laboratory testing, and providing immunization, medications and other disease control interventions when necessary. Information is also provided to the public on health issues that may pose a public health risk. Ryan White Care Program: Assistance is available through this grant funded program for qualifying HIV positive clients. 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, and transportation to dental services and infectious disease specialists in Mohave County and Las Vegas, NV. Tuberculosis Control and Treatment: While Tuberculosis is decreasing in other states, Arizona continues to experience a steady number of TB cases each year. To help combat this disease, one-on-one case management is provided for each case of active Tuberculosis under the direction of the Mohave County TB Control Officer. Case management includes Direct Observed Therapy to ensure individuals complete their full course of 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. A Registered Nurse and TB Control Officer closely monitor the progress of each patient on medication. Pregnancy Testing: Healthy pregnancies start with early prenatal care. Pregnancy testing and counseling are provided on a sliding fee-scale basis as early as fourteen days after a missed menstrual period. Referrals are offered to assistance agencies for pregnant and non-pregnant clients. Reproductive Health: Some individuals have chosen to wait to begin or enlarge their families, so the Nursing Division conducts free and low cost Reproductive Health Clinics through grant funding. These clinics provide birth control to those who otherwise could not afford it. 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. This program has experienced an increase of 37.85% in the number of unduplicated clients. Sexually Transmitted Disease Clinic: As a result of reduced funding for this program, Mohave County has instituted a sliding fee schedule into this program to allow access to services based on income. According to Healthy People 2010, STD’s disproportionately affect adolescents and young adults. With funding received from the Infertility Prevention Program we have conducted STD testing for 677 females age 25 and younger 43% of the females in that age group. Nine hundred and forty one females were tested for gonorrhea and Chlamydia reflecting 33% of the same age group as above. Public Health Nursing has seen an increase in clinic visits requesting STD testing and treatment. HIV Testing and Counseling: HIV testing and counseling is provided by appointment only for a minimal fee. 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. Mohave County has implemented rapid testing services which allow same-day results. Each testing session lasts approximately 20-30 minutes. Blood specimens are submitted to Arizona State Laboratory for confirmation testing only with results provided within two weeks. In addition to offering testing to high risk individuals, HIV testing has been offered to all clients being screened and treated for Tuberculosis in an effort to identify those that may be co-infected. 109 HIV rapid tests were given during fiscal year 08/09. Health Start Program: This grant funded home visiting program is a free service that permits a lay health worker, or “promotora”, to be 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, home safety and many more. High risk mothers and infants are visited by a Registered Nurse to facilitate and encourage positive outcomes. Never Shake a Baby Arizona commitment form was implemented at the beginning of FY 08/09 to help parents have a plan for when their baby cries and who they can call for help. In 2008, the number of births in Mohave was 2,301 of which 44 (1.9%) had no prenatal care. 1,820 women who gave birth received prenatal care during the first trimester, which is 79.1% of the total births in 2008. Teen Pregnancy Prevention Program: This grant funded program was implemented in March 2008 to address teen pregnancy rates in Mohave County. The program provides educational sessions for adolescents and parents in a school-based setting. Highly trained and professional educators provide a series of classes to teach students pregnancy prevention strategies. Educators utilize curriculum authorized by the Department of Education and local school administrations. The 2008 teen pregnancy rate (number of pregnancies per 1,000 females age 10 - 19) for Mohave County was 28.1 and the birth rate was 27.3. Of 340 pregnancies among females 19 and younger 331 were live births. Mohave County Department of Public Health Nursing Division Statistics Newborn Intensive Care Program Home visits Communicable Disease Disease investigations Childhood Immunization Program Children vaccinated Vaccinations given Adult Immunizations Program Tetnus-Diptheria Hepatitis B Hepatitis A Varicella MMR HPV Zostovax Meningococcal Influenza Pneumonia Tuberculosis Control TB skin tests Latent TB infection Active case visits Active case Chest x-ray/clinics Primary Reactor Visit Reproductive Health Pregnancy Tests New/Annual visits * Unduplicated clients Sexually Transmitted Disease Clinic visits Well Woman Clinic visits HIV Counseling and Testing HIV tests HIV post counsel DNA Lab Draws Health Start Visits Teen Pregnancy FY 05/06 FY 06/07 FY 07/08 FY 08/09 207 248 367 306 1,234 1,323 1,453 1118 3,898 13,090 5,612 20,406 7,006 18,541 6,994 19,121 243 305 171 25 179 ---5,959 1,016 189 336 132 43 147 1 10 17 3,031 328 169 359 66 17 115 4 155 14 2,969 620 186 325 73 41 201 44 157 14 845 41 1,149 179 291 7 162 60 1,207 107 321 3 139 59 1,657 568 113 4 322 164 1304 733 407 3 305 114 316 971 708 889 710 869 885 1220 150 76 126 133 9 0 0 0 146 112 0 101 95 0 199 143 0 109 109 0 236 530 441 249 *New/Annual visits-change in data reporting to reflect unduplicated client count FY 05/06 Nursing Division FY 06/07 FY 07/08 600 FY 08/09 500 400 300 200 NICP Home Visits STD Clinic Visits HIV Tests 249 441 530 236 109 199 101 146 133 126 76 150 306 367 0 248 207 100 Health Start Visits Communicable Disease Number of Investigations FY 08/09 1118 FY 07/08 1453 FY 06/07 1323 FY 05/06 1234 0 200 400 600 800 1000 1200 1400 1600 Childhood Immunization Program 21000 FY 05/06 FY 06/07 18000 FY 07/08 FY 08/09 15000 12000 9000 children vaccinated 19121 18541 20406 13090 6994 7006 0 5612 3000 3898 6000 vaccinations given Tuberculosis Control Program Number of Skin Tests Conducted FY 08/09 1304 FY 07/08 1657 FY 06/07 1207 FY 05/06 1149 0 200 400 600 800 1000 1200 1400 1600 1800 number Tuberculosis Control Program 800 700 FY 06/07 600 FY 07/08 500 FY 08/09 400 300 latent infection active case visits chest xray clinics 164 114 60 59 322 305 162 139 407 321 113 0 291 100 568 733 200 179 107 number FY 05/06 primary reactor visits SENIOR PROGRAMS The main purpose of Mohave County Senior Programs is to provide hot, nutritious meals to seniors and disabled citizens within the county. This is accomplished by providing congregate meals at senior center sites and by providing homebound seniors a hot meal and welfare check via the “meals on wheels” program. Due to an increase in fuel, food prices and units of service, some remote areas receive one hot meal with the remaining meals frozen. This reduces fuel and personnel expenses as a result. Senior Programs conducts daily phone checks in these instances and continues to call until we connect with the senior receiving frozen meals. Senior Programs offers other programs such as socialization, education, and support services at each of the senior centers. These services range from Social Security and Attorney General satellite offices located within several of the senior centers to activities such as bridge, tax aide, legal aide, yoga, crafts, parties, and exercise classes. The Senior Centers have volunteers who help seniors with problems related to Medicare Part D. Four senior centers exist within Mohave County with sites in Bullhead City, Golden Shores, Kingman and Lake Havasu City. The funds to run the senior center nutrition programs come from federal funds via the “Older Americans Act”, Mohave County general fund, and donations from participants. AHCCCS/ALTCS also contracts for services for home delivered meals for their clients. 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. Senior Programs served 188,858 meals to a total of 2,826 people during fiscal year 2008-2009. Volunteers are a key to the success of senior programs and during this year over 300 volunteers donated their time to helping at the Senior Centers. Senior Programs continues to seek ways to reduce expenditures and increase donations. Local grocers donate bread products and Senior Programs completed its first year of a cooperative purchasing partnership via the ASPIN (Arizona School Partners in Nutrition) cooperative food service purchasing program. By becoming part of a partnership, Senior Programs gets guaranteed prices on food product and prices can’t be raised without ample justification. Senior Programs completed a Community Development Block Grant (CDBG) Program at the Golden Shores Community Center. A new roof was installed as were air-conditioners and flooring. The kitchen serving area and the bathrooms and were also made ADA compliant. Senior Programs received CDBG funds from the county to purchase ten (10) new meal delivery vehicles in order to increase the number of home delivered meal routes and participants served. We also received CDBG funding from the City of Kingman to purchase kitchen equipment for the Kingman Senior Center. Number of Meals Served: Bullhead City Golden Shores Kingman Lake Havasu Total Home Delivered 26,147 5,212 33,575 47,698 112,632 Congregate 13,168 8,712 21,783 32,563 76,226 Senior Programs Homebound Meals Served 50000 Senior Programs Congregate Meals Served 35000 45000 30000 2007-2008 2008-2009 25000 25000 2006-2007 20000 15000 15000 10000 Kingman Bullhead Golden Shores 5000 32224 42360 47698 0 29968 30448 26147 5000 34856 37214 33575 10000 5955 5735 5212 20000 0 Lake Havasu 2007-2008 2008-2009 Kingman Bullhead 29532 30479 32563 30000 7249 7356 8712 2006-2007 11460 13126 13168 35000 22885 21717 21783 40000 Golden Shores Lake Havasu Senior Programs Congregate Clients Served Senior Programs Homebound Clients Served 400 1200 2006-2007 350 2007-2008 1000 300 250 2006-2007 200 2007-2008 2008-2009 800 600 2008-2009 150 400 100 200 144 171 1044 1069 874 Lake Havasu 392 333 310 Golden Shores 0 564 582 575 Bullhead 261 323 352 Kingman 39 61 62 263 307 248 0 200 270 261 234 50 Kingman Bullhead Golden Shores Lake Havasu BIO TERRORISM DEFENSE AND EMERGENCY RESPONSE In August 2008 the Health Department began their first steps toward Project Public Health Ready (PPHR) recognition. PPHR is a competency-based training and recognition program that assesses preparedness and prepares health departments to respond to emergencies. The PPHR process helps agency staff prepare to respond to emergencies, integrates emergency preparedness into daily public health activities and helps staff better understand their unique roles and responsibilities in an emergency. PPHR maintains emergency preparedness criteria that are divided into three main goals: • • • All Hazards Preparedness Planning Workforce Capacity Development Exercises/responses to real events to evaluate preparedness PPHR is a framework that assists agencies to reach a level of excellence in public health preparedness with national recognition through utilizing a continuous quality improvement process (CQI) of planning, training and exercising. While the Bio Defense Division coordinated PPHR, revised the all hazards plan and epidemiology sections, every division in the health department participated and contributed to the process. Almost 2000 pages in length, the PPHR submission includes 23 annexes, 16 appendices and 37 other documents. In September 2008 we conducted an Isolation & Quarantine tabletop exercise. The purpose of this exercise was to evaluate an isolation and quarantine (I & Q) response resulting from an influenza pandemic and to strengthen I & Q plans and capabilities within a local jurisdiction. The exercise tested Mohave County’s ability to protect the health of the population through the use of isolation and/or quarantine measures in order to contain the spread of disease. The health departments of Mohave, LaPaz and Yavapai joined together and obtained a state homeland security RAC grant to test the regions ability to share resources and provide mutual aid response. In May 2009, a Tri-County PODEX Full Scale Exercise was held at the Fort Mojave Event Center to test the tri-counties capability to activate and set up a Points of Dispensing (POD) center in response to a pandemic. Operating with the funding from the same grant, in June 2009 the Western Regional Special Needs Shelter table top exercise was held in Prescott. The purpose of this exercise was to assess the adequacy of local plans and the abilities of multiple organizations in the Western Region to work together, communicate and respond to a natural disaster triggering a large-scale population evacuation. Health department staff along with Medical Reserve Corp (MRC) volunteers participated in the exercises. Our MRC volunteers participated at many emergency preparedness and community events such as the Lake Havasu Winterfest, the Mohave County Fair, the Bullhead City Safety Fair, Hardyville Days, and the "Havasu Stick'em" Health Fair and Immunization clinic. MRC volunteers operated the health department phone bank in April 2009 to support a response for the H1N1 (swine flu) outbreak. Overall, MRC volunteers donated a total of over 1,500 hours in 2008. In 2008, the Independent Sector (IS), a Washington, D.C.-based coalition of nonprofits and foundations, valued the hourly rate of volunteer hours at $20.25. This equates to our MRC volunteers contributing $30,375 in time to Mohave County in 2008. PATTERNS IN HEALTH, MORBIDITY, AND MORTALITY Total Births Birth Rate per 1,000 popoulation 13 2500 2450 2400 2350 2300 2250 2200 2150 2100 2050 2000 1950 1900 12.5 12 11.5 2008 11.2 2301 2007 12.1 2439 2006 12.7 2468 2005 10.5 11.9 2237 11 2005 2006 2007 2008 10 Characteristics of Mothers Characteristics of Mothers 60 *rates per 100 live births **rates per 1000 females 19 or under 2005 2005 1400 1200 1000 2006 50 2007 40 2008 800 2006 2007 2008 30 600 births to unwed mothers births to mothers 19 or under 2006 140 2007 120 2008 27.3 31.1 32.7 rate of births to mothers 19 or under** Characteristics of Newborns *rates per 100 live births 2005 160 31.7 rate of births to unwed mothers* Characteristics of Newborns 180 51.5 0 47.2 10 47.3 331 370 390 361 1184 1150 1167 0 1009 200 45.1 20 400 8 2005 7 2006 6 low birthweight babies fetal mortality 6.1 7.4 6.3 0 5.9 0 low birthweight babies rate* 0.39 1 0.72 20 0.6 2 0.84 40 9 3 17 60 15 2008 19 4 141 80 180 2007 155 5 133 100 fetal mortality rate* Death Rate Number of Deaths per 10,000 population 130 120 110 Patterns in Cause-Specific Mortality Patterns in Cause-Specific Mortality 2004 2.5 Rate per 100 deaths 2004 2005 2005 50 2006 2006 2 2007 2007 40 2008 2008 1.5 30 1 20 10 motor vehicle accidents 0 1.3 1.7 2.2 1.6 1.5 intentional self harm (suicide) 1.8 1.8 2.2 2.4 1.9 29 39 51 35 36 0.5 40 41 52 51 46 0 120.1 107 121 2004 2005 2006 2007 2008 2004 2005 2006 2007 2008 60 125 80 125 90 2461 2153 2354 2345 100 2253 2500 2450 2400 2350 2300 2250 2200 2150 2100 2050 2000 1950 suicide rate motor vehicle rate Patterns in Cause-Specific Mortality Patterns in Cause-Specific Mortality 20 800 10 34 30 32 prostate cancer Rate per 100 deaths 2004 600 2005 35 2006 30 2007 500 2008 25 100 5 major acute cardiovascular myocardial disease infarction 208 10 219 225 217 173 200 77 15 265 132 74 56 300 808 20 762 769 707 695 400 0 prostate cancer rate Patterns in Cause-Specific Mortality Patterns in Cause-Specific Mortality 700 breast cancer rate lung, trachea, bronchus cancer 0 2004 2005 2006 2007 2008 9.7 9.6 9.2 8 8.5 breast cancer 41 39 32 34 39 0 28 10 1.8 1.4 1.4 1.4 0.4 30 2004 2005 2006 2007 2008 11.8 5.6 3.1 2.6 3.1 40 2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 33.8 32.8 30 32.3 32.8 50 Rates per 100 deaths 1.2 1.7 1.4 1.6 1.6 2004 2005 2006 2007 2008 cardiovascular myocardial lung, trachea, disease rate infarction rate bronchus cancer rate Patterns in Morbidity Number of Reported Cases 30 2004 2004 2005 2006 2006 2007 20 2008 30 15 20 10 0 6 5 3 3 15 2 1 0 1 50 54 57 30 14 tuberculosis hepatitis A gonorrhea 0 3.2 2.5 1.5 1.5 5 10 0 tuberculosis rate Patterns in Morbidity - 2008 rate per 100,000 of population 80 county rate state rate 70 60 50 40 30 valley fever 1.7 w est nile virus 30.7 0 0 10 73 20 28.8 0 2008 21.7 40 2007 MRSA 27.7 28.7 28.7 14.9 6.8 50 2005 25 8.3 1.1 0.5 0 0.5 60 Patterns in Morbidity rate per 100,000 of population hepatitis A rate gonorrhea rate