Mohave County Department of Public Health Annual Report 2014 Table of Contents Vision - Mission - Values - Strategic Priorities 03 Our Challenge 04 Strategic Map 05 Community Health Improvement Plan 06 Department Organization & Board of Health 07 Financial Information 08 Department Programs 09 Public Health Preparedness 10 Environmental Health 12 Nutrition and Health Promotion 16 Public Health Nursing 20 Senior Programs 24 Socioeconomic & Health Indicators 26 2020 Objectives 31 2 Our Vision Healthy people in healthy communities. Our Mission To promote, protect, and improve the health of our communities. Our Standards of Excellence Service, Quality, Integrity, Fiscal Responsibility, Responsibility, Timeliness, Professionalism, Teamwork, Resourcefulness, Development Our Strategic Priorities     To impact Mohave County’s winnable battles To strengthen the county public health system  Build awareness of public health value  Interpret the internal impact of healthcare legislation To maximize MCDPH effectiveness  Improve internal and external communication  Improve data utilization and surveillance  Improve employee engagement and training To promote and protect community safety 3 Our Challenge Fiscal year 2013-2014 was one full of challenges and accomplishments. During the previous year, we undertook the process of partnering with Kingman Regional Medical Center to conduct a Community Health Assessment (CHA). The CHA was the first part of a two-pronged approach for improving health and quality of life in Mohave County. This year, the community coalition used the data from the CHA to identify and address priority health issues. The results of analysis has resulted in a Community Health Improvement Plan (CHIP). The CHIP includes strategies and measures for acting on the selected community health issues. The CHA and CHIP are ongoing processes as they are performed every three years. This planning and working together as a community encourages collaboration among community partners and provides a more coordinated approach to current health issues. The resources developed in this collaborative process can be used by our community partners to improve the health of our citizens and visitors. During the year, our management team made the decision to pursue Public Health Accreditation. We received grant funding from the Arizona Department of Health Services to assist with the activities needed to meet accreditation. The major requirements for accreditation include conducting strategic planning, completing a CHA and CHIP, instituting continuous quality improvement, and establishing a performance management system. Accreditation is determined by the Public Health Accreditation Board (www.phaboard.org). We are pursuing accreditation in an effort to assure accountability to you, the community we serve; to meet our mission of promoting, protecting and improving the health of Mohave County; and to build on our strengths and improve upon our weaknesses. With technical assistance from the Arizona Department of Health Services, our management team developed a new strategic plan and resulting strategic map. This was presented to our department supervisors for review and input and then presented to division staff for review and input. The final document has been printed and distributed to all staff and posted in each of our divisions. We have five focus areas of improvement on our strategic map and staff is actively working on building awareness of public health value, improving internal and external communication, improving data utilization and surveillance, improving employee engagement and training, and determining the effects of the Affordable Care Act related to our core services and what the future of public health will look like. This is a challenging time for public health but our commitment remains the same – healthy people in healthy communities. 4 Mohave County Department of Public Health Strategic Map 2014 – 2019 Vision: Healthy People in Healthy Communities A Impact Mohave County’s Winnable Battles Mission: To Promote, Protect and Improve the Health of Our Communities Achieve Targeted Improvements in Health Outcomes B C D Strengthen the County Public Health System Maximize MCDPH Effectiveness Promote and Protect Community Safety Building Awareness of Public Health Value Improve Internal and External Communication Fulfill Statutory, Regulatory and Operational Requirements 1 Promote Nutrition & Physical Activity to Reduce Chronic Disease and Obesity 2 Reduce Tobacco Use and Substance Abuse Interpret the Internal Impact of Health Care Legislation Improve Data Utilization and Surveillance Enhance Capabilities for Emergency Response 3 Improve Maternal and Child Health Outcomes Leverage Community Resources Utilize Technology to Improve Services Promote Healthy Community Practices and Design 4 Decrease Youth Risk and Improve Protective Factors Work Toward Accreditation Standards Improve Employee Engagement and Training Control and Track the Spread of Disease 5 Improve Behavioral Health Outcomes Improve Access to Affordable Health and Dental Services Recruit, Train and Retain Volunteers Provision of Services for the Aging Population Measure Outcomes and Evaluate Progress Implement Evidenced-Based or Best Practices E Align Resources with Key Priorities Ensure Quality Customer Service 5 Community Health Improvement Plan The Community Health Improvement Plan (CHIP) was completed in May, 2014 and included input from over 50 organizations throughout the county. As the CHIP is 26 pages long, the full report can be found on both the Mohave County website (www.mohavecounty.us) and our department website (www.HealthELinks.com). Excerpt from the report follow: Healthy people are among a community’s most essential resources. Therefore, improving community health, improves quality of life for all of us. This is a daunting task. In all reality, there is only so much that can be done from a community standpoint because good health is a personal responsibility and a result of personal choices. However, as a community, we can work together to address certain barriers to good health that are under our control. The Mohave County community health assessment finds that far too many of our residents suffer from poor physical or mental health. When compared to state and national statistics, Mohave County ranks poorly in most health indicators. While some of this can be attributed to a higher than average population of senior citizens (who naturally have more chronic health conditions), our community health assessment indicates other larger causes: poor economic conditions, unhealthy behaviors and attitudes, restricted access to primary care and preventative healthcare services, and restricted access to mental health and substance abuse services. Our community stakeholder coalition identified the top three priority issues affecting health in their respective communities: Kingman, AZ Bullhead City, AZ Lake Havasu City, AZ Economic Conditions (unemployment, poverty, etc.) Accessible/Affordable Health Care Accessible/Affordable Health Care Youth Risk/Protective Factors Substance Abuse Youth Risk/Protective Factors Substance Abuse Mental Health Mental Health Once the top three issues for each community were identified, the stakeholders with resources to address the issue, plus any other willing participants, signed-up to participate on respective committees to formulate goals, strategies, and measures for addressing the issue. MCDPH and KRMC will lead these committees to formulate goals, objectives, strategies and measures for addressing the selected priority health issues from a community perspective. MCDPH will continue to be an active participant in the community committees formed to address the priority health issues listed above. We are committed to collaborating with our community partners to provide appropriate resources and to assist however possible in meeting community-directed goals. In addition, we seek to identify and collaborate with key agencies within our county that are currently working on the priority areas. 6 Department Organization & Board of Health DIRECTOR Patty Mead ADMINISTRATION Jennifer McNally - Assistant Health Director Account Specialist - 2 Office Specialist - 2 SECRETARY Sue Frank ENVIRONMENTAL HEALTH Rachel Patterson - Manager PUBLIC HEALTH NURSING Christy Bronston - Manager Environmental Health Supervisor – 2 Office Supervisor - 1 Environmental Health Specialist I/II –8 Environmental Health Technician – .3 Permit Technicians – 3.5 Nursing Supervisor – 2 Nurse Midwife – 1 Office Assistant – 4 Community Health Education Specialist - 4 Public Health Specialist – 4 Public Health Nurse, RN – 7.5 Program Coordinator, RN - 1 Paraprofessional Temp – 1 Clerical Temp - 2 SENIOR PROGRAMS Rena Arnold - Senior Programs Coordinator NUTRITION & HEALTH PROMOTION Deborah Conter - Manager 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 - 7 Office Specialist - 1 Office Assistant Senior - 1 Office Assistant - 1 Temp WIC Breast Feeding Peer Counselor - 2 Site Coordinator – 2 Senior Programs Assistant – 2 Cook - 1 Prep Cook - 1 Labor/Trades Temp - 2 BIOTERRORISM & EMERGENCY RESPONSE Bruce Leeming - Program Coordinator Epidemiologist - 1 Volunteer Coordinator - 1 Professional Temp/Planner - 1 Board of Health Frank LeBarge Dr. Richard Hendrix Joy Brotherton Kathy Bruck Dr Dat Nguyen Donna Williamson Teri Williams Larry Carver Maggie Wilcox Margaret Nyberg 7 Financial Information July 1, 2013 – June 30, 2014 Revenues Federal Grants AHCCCS & Insurance Revenue $2,152,563 156,126 Fees from Services 1,537,066 State Grants & Contracts County General Funds 798,371 1,556,229 Miscellaneous & Donations Total Revenues 170,789 $6,371,144 Expenditures Personnel Services $4,424,759 Operating Supplies 432,750 Other Charges/Services Capital Outlay Total Expenditures 1,406,686 29,538 6,293,733 8 Department Programs Administration Healthy Arizona Policy Initiative Arizona Nutrition Network HIV Prevention Bioterrorism Immunizations Child Fatality Review Newborn Intensive Care Program Commodities Supplemental Food Program Public Health in Action County Nursing Senior Programs - Kingman County Nutrition Senior Programs - Lake Havasu Environmental Health Senior Programs - Golden Shores Environmental Health Clean Up Senior Volunteer Recognition Environmental Health Technology Fee Sexually Transmitted Disease Family Planning Title V Smoke Free Arizona Family Planning Title X TB Control Family Planning Title X HIV Teen Pregnancy Prevention Health Dept. Donations Tobacco Health Start WIC - Breast Feeding Peer Counseling Program Women Infants & Children (WIC) 9 Public Health Preparedness Our program conducts planning and preparedness activities for public health threats and emergencies. We work with local health care organizations, emergency management, and public safety to build an integrated emergency response system to achieve response capabilities to protect residents and visitors of Mohave County and to better recover from disasters. Training, Exercises, and Response Conducting and participating in exercises is an important part of our ongoing preparedness activities. Exercises are an effective and cost-efficient way to validate our emergency plans, identify areas for improvement, and get feedback from the people who will be executing the plans. The September 2013 Strategic National Stockpile (SNS)/Warehouse Exercise utilized Health Department staff and Medical Reserve Corps (MRC) volunteers to demonstrate various SNS capabilities from the request processes to distribution and dispensing activities. This exercise allowed us to test and make improvements to meet Medical Countermeasure Distribution and Dispensing Composite Measures established by the Centers for Disease Control and Prevention. In November we participated in the 2013 Arizona Statewide Exercise which provided our department with a learning environment to exercise our emergency response plans, policies and procedures as they pertained to response during an extended power outage. In conjunction with the Northern Arizona Consolidated Fire District, our June 2014 full scale exercise provided participants the opportunity to demonstrate capabilities related to a suspicious substance response. This exercise demonstrated the growing public safety partnership between Federal, State, and local jurisdictions regarding the challenges faced when responding to a suspicious substance incident. Medical Reserve Corps MRC volunteers participated in the September 2013 SNS/Warehouse Exercise and the 2013 Arizona Statewide Exercise. They received training in the operation of radiological monitoring equipment which included the basics of radiation. MRC assisted Public Health Nursing during back to school immunization clinics and provided clerical assistance throughout the year. During the FY 2013 – 2014, the Mohave County MRC volunteers donated over 1,000 hours of service to our communities. Due to budget reductions in the Public Health Emergency Preparedness (PHEP) grant, the Volunteer Coordinator position was eliminated in June 2014. Carry over grant funds had been used to maintain the position through that date. The elimination of the position will result in our MRC program being scaled back. 10 Planning Activities The emergency planner completed a radiological response plan/program to coincide with the State of Arizona's efforts in emergency response planning and exercises. This program included the acquisition of radiological monitoring equipment to enable monitoring a large number of potential victims from a radiological type incident. In April members of our Emergency Response Team received hands on training in the operation of radiological monitoring equipment which included the basics of radiation. MCDPH is part of the Western Region Healthcare Coalition (WRHC) and our emergency planner is currently the Chairman. The WRHC mission is to facilitate collaboration among public health, healthcare, pre-hospital entities, and various community partners to prepare for, respond to, and recover from an emergency or disaster. Child Fatality Review Reviews of child deaths are completed by local child fatality teams located throughout Arizona. Our Epidemiologist is the coordinator for the Mohave/LaPaz Child Fatality Review Team. When a child younger than 18 years of age dies, a copy of the death certificate is sent to the CFRT. The coordinator requests relevant documents that may include an autopsy report, hospital records, Child Protective Services records, law enforcement reports, and any other information that may provide insight into the death. If the child was younger than one year of age at the time of death, the birth certificate is also reviewed. The goal of the Child Fatality Review is to reduce preventable child fatalities through systematic, multidisciplinary, multi-agency, and multi-modality reviews of child fatalities in Arizona. This is accomplished through interdisciplinary training and community-based prevention education and through datadriven recommendations for legislation and public policy. Recommendations incorporate the Spectrum of Prevention: Spectrum of Prevention Influencing Policy & Legislation Changing Organizational Practices Fostering coalitions & Networks Educating Providers Promoting Community Education Strengthening Individual Knowledge and Skills Created by Larry Cohen, Contra Costa Health Services Prevention Program. A state team provides oversight to local teams and utilizes local team reports to produce an annual report summarizing review findings, and to make recommendations regarding the prevention of child deaths. These recommendations have been used to educate communities, initiate legislative action, and develop prevention programs. The Child Fatality Review Annual Reports are compiled by the Arizona Department of Health Services and can be found on their website at www.azdhs.gov 11 Environmental Health Environmental Health (EH) is responsible for inspection of public places, enforcement of various environmental laws, response to public nuisances, and response to emergencies as part of the department Emergency Response Team. The division receives authority through delegation agreements with the Arizona Department of Environmental Quality (ADEQ), the Arizona Department of Health Services (ADHS), and local Mohave County Ordinances and operates in accordance with division policies and procedures. Specific areas of responsibility include; food safety & education, public & semi-public swimming pools, RV parks, hotels/ motels, pet shops, grooming parlors and kennels, septic pumper trucks, refuse haulers, public nuisance complaints, wells, Smokefree Arizona, campgrounds/children’s camps, and school buildings. The wastewater program was transferred from Environmental Health to the Development Services Department in March 2014. Updated Food Code In October 2013, the Environmental Health Division (EHD) began working on updating the existing food code that had been in place since 2000. Over the next five months, meetings were held with key stakeholders as well as town hall meetings for anyone that would be affected by the change. A good response was received from the food service community. In addition, the Board of Health voted unanimously to support the change. In May 2014, the new food code was brought before the Board of Supervisors at a public hearing and was approved unanimously. The Mohave County Food Code is based on the 2009 FDA Model Food Code and went into effect July 1, 2014. Food Manager Class Since 1998 EH has offered food handler training and trains over 4,000 food handlers per year. In 2006 the local ordinance was updated to include a requirement for each food establishment to have at least one Certified Food Protection Manager (CFPM) on staff. Training for a CFPM was only available via third party vendors. In the interest and for the convenience of our clients, EH began to offer CFPM classes locally. Individuals can still obtain the training from another vendor, but they now have the option of attending training at the Department. New Food Safety Newsletter EH developed and distributed the first food safety newsletter this year. The newsletter is designed to highlight new legislation, clarify existing rules and provide information regarding best practices for food handling. The first newsletter focused on the Americans with Disabilities Act and animals in food establishments, employee hygiene, and getting the most out of the regulatory inspections. It also included a short quiz at the end for the employers to use with their employees. Our goal is to provide the food service community with information that is helpful and timely and we look forward to continuation of this service. 12 Fiscal Year 2014 Statistics In fiscal year 2014, the Division conducted 4,580 inspections in the various programs. This year the overall number of inspections throughout all the programs increased by a small percentage. Numbers in the wastewater and well programs will only reflect July 2013 through February 2014 as the program was transferred out of Environmental Health into Development Services on March 1, 2014. Other Highlights The number of nuisance complaints increased slightly this year, but the court hearings dropped off. As part of this program, seven abatements were conducted by EH at a cost of just under $11,000. Approximately $32,900 in lien payoffs and settlements was collected by EH. Smoke-free Arizona complaints dropped with only 27 received. Over 2,300 educational visits were made to area establishments to hand out signs, answer questions about the Act and provide information. Notice in the graph above that the trend in number of complaints received drops when more educational visits are conducted. Food handler card issuance went up this year by 588 cards, a 13.6% increase over last fiscal year. Health Impact Assessment Health Impact Assessments (HIA) are increasing in popularity across the country. An HIA is a way to assess how policy, future plans, or projects will impact the health of the surrounding community. When EH discovered there were plans to expand Rotary Park in Bullhead City, it was the perfect opportunity to conduct an HIA. With a grant from the Arizona Department of Health Services, the work was completed and recommendations made for the park which will serve to aid decision-makers and promote health in all policies. The report was finalized in September 2014. 13 Environmental Health Statistics Food Service Temporary Permits Annual Permits Annual Inspections Food Handler Cards On-Site Wastewater * Permits Issued * Inspections Pools/Spas Permits Inspections Kennels/Grooming Permits Inspections Hotel & Motel Permits Inspections Trailer Parks Permits Inspections Campgrounds/Children’s Camps Permits Inspections School Buildings Permits Inspections Nuisance Complaints Number Received – land use Inspections – land use Number Received – annually permitted establishments Court hearings Septic Haulers Permits Inspections Refuse Haulers Permits Inspections Wells (recommendation of approvals given to ADWR) * Notice of Intent approvals Smokefree Arizona (May—May reporting period) Complaints Inspections Educational Visits FY 12/13 FY 13/14 409 1356 2542 4315 473 1298 2753 4903 278 271 185 314 265 424 265 518 62 40 60 49 87 102 82 120 102 110 103 108 3 3 3 2 54 59 57 70 481 867 339 22 541 967 321 16 42 17 39 32 95 37 106 91 33 26 45 50 1549 27 30 2304 * Reflects activity July 1, 2013 – March 1, 2014 only. Program transferred to Development Services 03/01/2014 14 15 Nutrition & Health Promotion Special Supplemental Food Program for Women, Infants, and Children (WIC) & Breast Feeding Programs WIC celebrates its 40th Anniversary this year. For the past 40 years, the WIC program has had a positive impact on the health of low income pregnant, postpartum and breastfeeding women as well as infants and children up to the age of 5. It is estimated that one half of all infants and one fourth of all children are participating in WIC. This is good news in the sense that participation in WIC has been shown to have a positive impact on health outcomes and therefore, a reduction of health care costs. WIC currently provides vouchers that are redeemed at local grocery stores for specified healthy foods including; low fat milk, whole grain bread, fresh fruits, and vegetables. In December of 2014, Mohave County WIC will roll out a new software system that will make the enrollment process more efficient. This improvement will free up time to provide better individual nutrition education to the participants. Within the next two years, Arizona WIC will move to an EBT system which will be more convenient for participants and vendors who accept WIC. In 2014, Mohave County WIC served approximately 3,500 clients per month in the three sites of Kingman, Lake Havasu and Bullhead City. Caseload has dropped in recent years throughout the state of Arizona. Nevertheless, WIC continues to add to the local economy. Approximately $3,000,000 worth of WIC vouchers were redeemed in local stores in Mohave County. Nationally, WIC is tasked with the job of stemming the tide of childhood obesity. According to the Centers for Disease Control and Prevention (CDC), obesity now affects 17% of all children and adolescents in the United States - triple the rate from just one generation ago. Consequences of childhood obesity cited by the CDC are:  obese children are more likely to have high blood pressure and high cholesterol, which are risk factors for cardiovascular disease.  increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes.  breathing problems, such as sleep apnea, and asthma.  joint problems and musculoskeletal discomfort.  fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn). 16 Using research based strategies, such as teaching parents infant hunger cues, portion sizes for toddlers and encouraging physical activity, we have made modest improvements. Dropping from an all time national high of 27.6% of overweight and obese 2 to 5 years olds in 2008, the current rate is down to approximately 25.9%. The Mohave County rate is currently lower than the state of Arizona rate of 30%. Breastfeeding for any length of time has been shown to have a positive effect on the health of both mother and infant. In order to offer the support new mothers often need to breastfeed, Mohave County WIC offers all pregnant participants an opportunity to attend a class prior to delivery taught by a certified lactation consultant. After delivery, peer counselors are available to answer questions and offer support during the first few weeks. Peer counselors are chosen from past or present participants who have successfully breastfed a child. In addition to their own experience, they receive additional training. Nutrition & Physical Activity Education The Arizona Nutrition Network The Arizona Nutrition Network is funded by the USDA to provide nutrition education to the SNAP (Food Stamps) eligible population. The mission of the AzNN program is to shape food consumption in a positive way, promote health, and reduce disease among all people living in Arizona In Mohave County, education is directed primarily to children from Kindergarten to 8th grade. Nutrition educators go to classrooms and provide grade appropriate education that encourages consumption of low fat dairy, whole grain products, fruits and vegetables. Food demonstrations are also given at the local DES and WIC offices. The nutrition educators are now expanding their reach to include child care centers and low income housing for families and seniors. In addition to nutrition, physical activity will be promoted as part of a healthy lifestyle. Over the next few years, the focus of the program will move toward working with local government, schools, community organizations and businesses to change policies that impact the health of citizens. Commodity Supplemental Food Program (CSFP) In February, Congress passed the Agricultural Act of 2014 P.L. 113-79 (also known as the "Farm Bill") which changed CSFP to serve only low-income seniors, age 60 and over. CSFP continues to provide 350 boxes of nonperishable food to income eligible seniors. The foods are selected to improve the health people who are at least 60 years of age by providing supplemental healthy items that are high in protein, calcium, iron, and vitamins A and C. The benefits of this program include nutrition education, reduction of malnutrition, prevention of chronic diseases, and referrals to other nutrition and health care programs. Mohave County Department of Public Health works with local food banks in Kingman, Lake Havasu, and Bullhead City for the distribution of the boxes. Department staff determine eligibility and provide nutrition education for the recipients. 17 Mohave County Tobacco Use and Chronic Disease Prevention Program Healthy Arizona Policy Initiative This grant focuses on improvements in public health through policy changes in our community. This is accomplished by working with community-based organizations and local decision makers to help them understand how they can improve the health of their communities by focusing on policy, systems and environmental change in the areas of schools, worksites, clinical care, and community design. The Special Needs Advocacy Coalition (SNAC) was organized through the efforts of this program and has been very successful. Other counties are looking to Mohave County as a model for creating their own groups. The mission of SNAC is to improve the health and quality of life for our special needs children, young adults and families. SNAC completed a Community Assessment for Children and Youth with Special Health Care Needs. The assessment findings will be used as awareness and educational tools to inform all county residents about the needs and barriers that children with special needs encounter every day. More information about SNAC can be found on their webpage at: www.snacmc.org The coalition has also developed a resource guide for services, a parent support network and a surveillance data system. Chronic Disease Self Management Program This grant allows us to help county residents suffering from chronic conditions, or caring for family members with chronic disease, by offering the Stanford University’s Chronic Disease Self-Management Program. According to the National Council on Aging, nearly 92% of older adults have at least one chronic condition, and 77% have at least two. This is a community based program that offers six sessions to teach how to self-manage conditions through diet, physical activity, attitude and adhering to medication schedules. Self-management programs have been shown to decrease medical costs and provide the patient with a better quality of life. Coordinate School Health Program This grant program supports and offers technical assistance to local schools to help them identify their social and health challenges. It consists of eight interactive components that encourage participation from both community and school members. It systematically promotes a group effort to maintain the well-being of the school and community. Services are currently offered in Bullhead City, Lake Havasu City and Kingman. Tobacco Education and Cessation Businesses, healthcare providers, schools, and community members are educated on the hazards of tobacco use and exposure throughout the county. On-going Stop Smoking classes are offered at Kingman Regional Medical Center through funding they provide to our program. Arizona Smokers’ hotline, telephone coaching and online quit services are offered to all Mohave County residents along with healthcare provider Ashline service trainings. 18 Mohave County Youth Anti Tobacco Coalitions Kingman Youth Coalition Beating Up Teen Tobacco (KYCBUTT) at Kingman High School and Kingman Academy of Learning  Lake Havasu High School Youth Health Club  Bullhead City’s Fox Creek Junior High School and Bullhead Junior High School  The goal is to reduce the early onset of youth tobacco use and exposure to second hand smoke. The youth coalitions participate in executive officer elections and are recognized as an official school club. The Mohave County Tobacco Use and Chronic Disease Prevention Program co-sponsors the clubs with a school club teacher. The students provide peer led education to elementary and middle school students on the dangers of tobacco use and secondhand smoke. In the community, both staff and students participate in and provide education through community events and activities such as parades, health fairs and other major events. Other activities of the youth coalitions include: participation in the Arizona Attorney General’s Office merchant compliance checks and education; adopt-a-block to maintain and keep their cities trash free; educating the public and city officials on the concerns of tobacco use and exposure in the city ball fields and parks; and participating in an annual statewide leadership conference. Four to six youth participate in the STAND (Students Taking a New Direction) train-the-trainer program; they train other youth throughout the state on coalition development and community education. Mohave County Youth Coalitions continue to be model programs. KYCBUTT is supporting the Kingman City Council with their Smoke Free Parks and Ball Field Pilot Program. Parks and ball fields are now smoke-free with designated smoking areas. They also have cigarette trash receptacles in all of the parks and ball fields Kingman High and Kingman Academy of Learning students were honored for their anti-tobacco educational actions. The Arizona Department of Health Services Bureau of Tobacco and Chronic Disease presented its “Outstanding Youth Advocacy Group” award to KYCBUTT this year. 19 Public Health Nursing The division provides professional nursing services and programs 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. Communicable Disease Registered Nurses and our Epidemiologist coordinate with local physicians, the 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 those who are infectious and their contacts, conducting laboratory testing, and 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. During FY 13-14 year, communicable disease staff investigated 2,701 communicable disease reports, excluding Tuberculosis. HIV Testing and Counseling Funding for this program has been reduced 64.4% over the last decade; in 2003 we received $55,649 and today we receive $19,805 annually. Due to the current amount of funding, our program provides a “safety net” of service that allows those who have been exposed or concerned about exposure to be tested for a nominal fee that is based on a sliding fee scale. HIV testing and counseling is provided utilizing the “same day” testing process. This process allows the client to obtain results of screening tests before leaving the office. During FY 2013-14, 68 screening tests and post-test counseling sessions were provided to Mohave County residents. Sexually Transmitted Disease Program Medical providers throughout Mohave County report cases of Gonorrhea, Chlamydia and Syphilis as required by Arizona Revised Statutes. Public Health Nurses contact clients to ensure completion of appropriate treatment and to refer contacts to local providers for testing, treatment and follow up. Mohave County continues to experience a moderate level of sexually transmitted disease activity in comparison to other Arizona counties. In 2013, Mohave County reported 0 Syphilis primary & secondary cases, 80 Gonorrhea cases, and 529 Chlamydia cases. 0.6 Chlamydia Gonorrhea Syphilis (primary & secondary) rate per 100,00 population 50 0.5 40 0.4 30 0.3 280 260 240 220 200 180 160 140 120 100 20 0.2 10 0.1 0 0 2009 2010 2011 2012 rate per 100,000 population rate per 100,000 population 2013 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013 20 Tuberculosis (TB) Control and Treatment TB disease is caused by a bacterium called Mycobacterium tuberculosis that usually attack the lungs, but it can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. To combat this disease, we work with the Mohave County TB Control Officer to provide one-on-one case management on every active TB case. Case management includes Direct Observed Therapy (DOT) whereby nursing personnel watch the TB patient actually take their medication. It is extremely important that people with TB disease take their medicine exactly as prescribed and that they finish the medicine. If they stop taking it too soon, they can become sick again and if they do not take it correctly, the germs that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat. Public health nurses also respond to suspect cases of TB that result in considerable staff time to rule out active disease. Suspect cases are investigated and often receive medications for several months until the disease can be ruled out. During the fiscal year, MCDPH had one active case of TB; however, there were 14 suspect cases during the fiscal year that were ultimately ruled out. TB skin testing is provided for screening purposes and is offered for a fee. Individuals with a positive skin test receive counseling, a chest x-ray, and free medication if necessary. During the year, there has been a national shortage of Tubersol solution used for TB skin testing. This has been a challenge for healthcare providers throughout the nation as very limited doses were available for the highest risk contact and cases only. Maternal and Child Health Reproductive Health (RH) Reproductive health services are offered to both males and females in Bullhead City, Lake Havasu City, and Kingman. The program is funded by Title V with funds from the Arizona Department of Health Services, Title X funds through the Arizona Family Planning Council, and in-kind support from Mohave County. In 2013, we provided service to 1,335 unduplicated clients with 86.7% of clients reporting income below 100% of Federal Poverty Level. Although most of the clients served were between the ages 18-44, 12.7 % of clientele were age 15-17 and 3.7% were 45 years of age and older. During the 2013 year, the program provided 234 syphilis, 572 gonorrhea, 986 Chlamydia tests as well as 108 HIV screening tests throughout Mohave County. Newborn Intensive Care Program This home visitation program allows professional staff to visit high risk infants who have been in a newborn intensive care unit (NICU) unit for 72 hours or more following birth. It facilitates the transition of the child and family from the NICU to their home and community. Periodic monitoring of the child's medical and developmental needs identifies infants who would benefit from referral to other early intervention programs. Through these home visits, the family receives support and education as well as referral to appropriate community resources. During the fiscal year, 264 home visits were made to infants in the program. There has been in increase in the number of program referrals with the majority of the clients residing in the Kingman area. In addition, the NICP program requirements have mandated comprehensive training for Public Health Nurses who conduct home visits. This training has impacted the staff time and number of visits conducted as a result. 21 Teen Pregnancy Prevention Program Giving birth and raising a child during the teen years can carry high health, emotional, social, and financial costs for teen mothers and their children. Babies born from a repeat teen birth are often born too soon or too small which can lead to more health problems for the baby. The Teen Pregnancy Prevention Program provides instruction for teens in local schools and the juvenile detention center and presents parent workshops at the Ft. Mojave Indian Social Service facility to provide them with the tools necessary to talk with their adolescent or teen about sex and reproductive health issues. Advisory boards comprised of community members and leaders meet on a quarterly basis and provide input on the need for services, feedback on effective strategies and resources, and advocate for the program within their communities. The program provided education to 1,726 students during the year. In Mohave County, the teen pregnancy rate continues to show a significant decline of 52.12% over the past ten years (from a rate of 33 to 15.8). Mohave County Pregnancy Rate for Females 19 and Under (per 1,000 females in the age group) 35 30 25 20 15 10 5 0 Immunization Program Free immunizations are provided to children and adolescents during weekly immunization clinics in Bullhead City, Lake Havasu City, Kingman, and Colorado City. Immunizations include all vaccines recommended by the Advisory Committee on Immunization Practices and the American Academy of Pediatrics. The vaccine is provided through the federally funded Vaccines for Children (VFC) program. During the fiscal year, we provided 10,148 vaccines to 3,709 children throughout Mohave County. Our clinics have experienced a decline in the number of students requesting immunizations during back-toschool time. This, as well as an outbreak of vaccine preventable disease in one of our communities, led us to undertake a school immunization record assessment of all children enrolled in public and public funded schools throughout Mohave County. The assessment results were shared, follow up educational sessions with school health personnel were held, and tools were provided that can increase the vaccination rate at their schools. Each school has been able to identify students requiring additional vaccinations. The MCDPH Immunization Team received the “Hot Shot” award at the state immunization conference for this project. Maternal Infant Early Childhood Visitation This program funds a home visitation program coordinator for Mohave and LaPaz counties. The coordinator is responsible for development, implementation, and continued support of the Home Visitors Coalition. The coalition works to ensure families are receiving appropriate, comprehensive services that are not being duplicated by another program. 22 Health Start Program This is a neighborhood outreach program that works with women who are pregnant, or think they may be pregnant, and their families to help them improve their health. Health Start is designed to optimize prenatal health, improve birth outcomes, enhance positive family interaction, and enhance child health, safety and development. Services are provided utilizing a Community Health Worker who provides access to information, resources, and social support for pregnant families and families with infants through 24 months of age. Developmental screening is provided and clients referred as necessary. Birth defects, infant mortality, and low birth weight babies can be reduced by encouraging pregnant women to eat healthier, seek medical attention earlier in their pregnancy and stop smoking. FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 13/14 24 88 130 319 264 1485 1241 1540 2720 2701 4929 13,822 4159 13,921 3735 12,951 3959 11,126 3709 10148 92 292 72 61 206 30 24 85 21 63 8 13,232 15 69 118 3 26 2 606 26 150 201 32 140 59 56 84 2 3 3 130 8 40 241 15 71 59 37 69 2 3 4 206 0 20 164 18 86 37 39 42 0 0 0 39 1 812 240 303 3 70 37 696 331 120 4 69 45 851 129 199 2 55 30 510 247 281 5 80 45 562 108 159 1 37 27 756 680 1155 1351 763 1260 646 1474 548 1180 1376 623 1263 779 1419 138 86 85 55 34 84 84 126 126 120 120 85 85 68 68 358 315 302 598 515 1962 2000 1792 1612 1726 Newborn Intensive Care Program Home visits Communicable Disease Disease investigations Childhood Immunization Program Children vaccinated Vaccinations given Adult Immunizations Program Td/Tdap Hepatitis B Hepatitis A Twinrix Adacel Varicella MMR HPV Zostovax Meningococcal Influenza / H1N1 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 * RH/HIV Tests Unduplicated clients 1335 Sexually Transmitted Disease Clinic visits HIV Counseling and Testing HIV tests HIV post counsel Health Start Visits Teen Pregnancy Unduplicated Students 23 Senior Programs Senior Programs provides congregate meals at senior center sites and home delivered meals via the “meals on wheels” program. The centers also provide support services, socialization, and education with activities that include: bridge, tax aide, legal aide, yoga, crafts, Bingo, and exercise classes. Three senior centers are operated by Mohave County with sites in Golden Shores, Kingman and Lake Havasu City. Each Senior Center has a site council with a non-profit association established. They conduct numerous activities throughout the year raising money to help support the operations at the senior centers. Revenues are used to help pay for program expenses such as utilities, food, office supplies, equipment, and repairs and are considered in-kind donations. The total amount of in-kind received in FY 2014: 1st quarter $32,646.18 2nd quarter $38,430.78 3rd quarter $39,223.32 4th quarter $35,751.71 Total $146,051.99 Senior Programs Total Meals Served FY 11 w as the last year with BHC m eals 160000 140000 120000 100000 80000 60000 151758 143282 116647 113255 20000 145590 40000 FY 10 FY 11 FY 12 FY 13 FY 14 0 24 While the Kingman and Golden Shores Centers experienced a slight increase in the number of congregate meals served this fiscal year, the trend has been a reduction in the number of meals at each center over the past five years. 36.95% in Kingman, 23.92% in Golden Shores, and 25.23% in Lake Havasu. Congregate Clients Served Congregate Meals Served 800 35000 700 30000 600 25000 500 400 20000 300 15000 200 10000 100 5000 0 0 FY 10 332 Golden Shores 114 FY 11 257 147 705 FY 12 238 132 604 FY 13 173 69 481 FY 14 143 99 466 Kingman FY 10 King ma n 164 54 Gol den Shore s 854 4 Lake Hava su 303 47 FY 11 121 52 689 6 282 39 FY 12 106 27 619 9 264 16 FY 13 986 3 552 5 244 28 FY 14 103 75 650 0 226 89 Lake Havasu 711 The five year trend in Kingman and Lake Havasu is a reduction in the number of homebound meals provided: 16.79% and 22.63% respectively. The trend in Golden Shores is a fairly consistent number of homebound meals served (.95% increase). Hom ebound Meals Served Hom ebound Clients Served 300 50000 250 40000 200 30000 150 20000 100 10000 50 0 0 King ma n Gol den Shore s Lake Hava su FY 10 421 80 548 1 425 84 FY 11 522 82 531 4 468 75 FY 12 504 61 611 7 434 62 FY 13 366 49 533 3 348 49 FY 14 350 97 553 3 330 61 Kingman Golden Shores Lake Havasu FY 13 233 38 258 FY 14 225 40 281 There was an error in the report of homebound clients served in prior fiscal years; data is only available for FY 13 & FY14. comparisons. 25 Socioeconomic* and Health Indicators Mohave County Population from Office of Employment & Population Statistics, AzDOA Bullhead City Colorado City 39,495 4,813 Kingman 28,476 Lake Havasu City 52,908 Unincorporated 77,900 203,592 Total Of the total county population, 194,693 individuals reported they were of one race and 5,493 reported they were of two or more races. Those who reported one race were:       White Black or African American American Indian & Alaskan Native Asian Native Hawaiian & other Pacific Islander Some Other Race 173,878 1,882 4,500 2,103 341 11,989 29,569 individuals reported they were Hispanic or Latino. Of these, 24,760 were Mexican, 721 Puerto Rican, 272 Cuban and 3,816 Other. 2013 Age Distribution from Arizona Vital Statistics <1 - 14 15 - 19 20 - 44 $200,000 or more $150,000 - $199,999 $100,000 - $149,999 $75,000 - $99,999 $50,000 - $74,999 $35,000 - $49,999 $25,000 - $34,999 $15,000 - $24,999 $10,000 - $14,999 <$10,000 51162 58266 49476 11901 32786 Household income (in 2010 inflation-adjusted dollars) US Census 2010 45 - 64 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 65+ * Socioeconomic statistics are from the 2010 US Census unless otherwise noted. 26 Health Insurance Census data presents a “civilian noninstitutionalized population” of 198,223 in the county. 83.4 % of these individuals had health insurance coverage and 16.6% did not. Population 18 - 64 in Labor Force There are 77,987 county individuals ages 18 - 64 in the labor force. The chart on the right represents the employed and unemployed individuals in the labor force with and without insurance coverage: 70000 60000 50000 40000 30000 20000 10000 0 Employed = 66,700 with health insurance Unemployed = 11,287 no health insurance Education The population of the county age 25 and older is 145,074 and the educational attainment of these individuals is depicted in the chart below. Educational Attainm ent population 25 and older n = 145,074 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 27 Health Indicators The total number of births and the birth rate in Mohave County has declined over the past five years. The number of births has declined 21.5% and the birth rate has declined 21.1%. Birth Rate Total Births per 1,000 popoulation 12 2300 2200 11 2220 2100 10.9 2022 2000 10 1962 9.8 10.1 1900 9 1742 1800 1736 1700 2009 2010 2011 2012 8 2013 2009 2010 2011 8.5 8.6 2012 2013 While the number of births to unwed mothers had declined over the past five years by 9.9%, the rate of births to unwed mothers has increased by 14.7%. The number of teen births, as well as the rate of teen births, has decreased significantly over the past five years; 43% and 40.2% respectively. Characteristics of Mothers Characteristics of Mothers *per 100 live births **per 1000 fem ales 19 or under 2009 2010 1200 2011 1000 60 2009 2010 2012 600 30 2013 400 20 0 births to unwed mothers 211 215 176 309 275 967 963 974 1017 1069 200 2013 10 25.6 24 18.4 18.5 15.3 2011 40 2012 800 48.2 48.2 51.8 55.7 55.3 50 rate of births to unwed mothers* rate of births to mothers 19 or under** 0 births to mothers 19 or under The number of low birthweight babies has decreased over the past five years (18.4%), while the rate has remained relatively constant. While the number of fetal deaths has not fluctuated by more than 6 over the past five years; the rate was trending upward (a 72.5% increase from 2010 to 2012). 2013 saw the lowest number in the rate of fetal deaths in the past five years (a 50.7% reduction form 2012 to 2013). Characteristics of Newborns Characteristics of Newborns 140 2009 8 120 2010 7 2011 2012 100 2013 80 2009 2010 2011 2012 2013 6 5 6.3 fetal deaths 3.4 6.1 7 5.1 6 6.4 1 low birthweight babies rate* fetal death rate* 0 0 low birthweight babies 10 10 12 14 8 111 104 100 141 2 136 3 40 4 5.1 6.9 4 60 20 *rates per 100 live births 28 The combined total of alcohol abuse related inpatient discharges and ER visits in the county has steadily increased over the past five years by 16.02%. While the number of inpatient discharges has remained fairly consistent (5.8% variance from 2008 to 2012); the number of ER visits has increased 30.41% over the same time period. The number of alcohol abuse related visits among males and females has remained consistent with two-thirds of the visits male and one-third female. Alcohol Abuse Related Inpatient Discharges & ER Visits Alcohol Abuse Related Inpatient Discharges & ER Visits 2008 1900 2000 2009 1700 1800 2010 1500 1600 2011 2012 1400 70 0 800 50 0 600 1358 1728 1753 1706 1771 30 0 1038 1099 987 956 1009 0 1300 90 0 1000 200 # Female 1100 1200 400 # Male Inpatient Discharges ER Visits 10 0 The combined total of amphetamine related inpatient discharges and ER visits in the county has increased significantly over the past five years by 102%. Inpatient discharge numbers have increased by 15.38% over the past five years. ER visit numbers began to rise in 2009 compared to previous years and they have continued to increase significantly. Over the past five years, ER visit numbers have increased 198%. The greatest number of combined inpatient discharges and ER visits were in the 20 - 44 and 45 - 64 year old age groups; with 58.16% and 33.16% of the total respectively. Amphetamine Related Inpatient Discharges & ER Visits 450 300 250 350 300 250 200 200 150 150 100 Inpatient Discharges 330 420 141 208 260 160 180 0 100 156 150 128 50 2008 2009 2010 2011 2012 ER Visits 50 0 82 119 128 142 199 350 400 2008 2009 2010 2011 2012 187 218 238 315 349 400 Amphetamine Related Inpatient Discharges & ER Visits by Age 20 - 44 years 45 - 64 years 29 Patterns in Mortality Vital Records The Administration Division provides certified copies of death certificates for deaths that occurred from 2008 to present. We provide services to all county funeral homes for deaths that occurred in the county. There were 2,686 deaths in Mohave County in calendar year 2013 and staff issued 14,705 certified copies of death certificates during the fiscal year We began providing certified copies of birth certificates in November, 2011. During fiscal year 2014, staff issued 1,933 certified copies of birth certificates. This is an increase of 17% from the previous fiscal year. In addition to certified copies, staff register all home births and births occurring in facilities that are not on the state vital record system. Court ordered paternities and Acknowledgement of Paternities are processed for Mohave County births, and corrections and amendments for birth and death records are processed. Death Rate Number of Deaths per 10,000 of population 2800 135 2700 130 2600 125 2500 120 2400 2000 131.9 122.2 120.9 118.3 100 110.5 2686 2482 2100 2424 105 2368 2200 2260 110 2461 2300 120.1 115 95 2008 2009 2010 2011 2012 2013 2008 2009 2010 2011 2012 2013 Of the 2,686 deaths in Mohave County in 2013, the top ten causes of death were: number % of total deaths Major cardiovascular diseases 868 32% Malignant neoplasms 678 25% Chronic lower respiratory diseases 249 9% Accidents 113 4% Symptoms, signs, abnormal findings 77 3% Diabetes 73 3% Chronic liver disease & cirrhosis Intentional self harm 70 68 3% 3% Alzheimer's disease 42 2% Nephritis, nephrotic syndrome & nephrosis 40 2% 30 Selected National Year 2020 Objectives Healthy People is a set of goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the United States. Released by the U.S. Department of Health and Human Services each decade, Healthy People reflects the idea that setting objectives and providing science-based benchmarks to track and monitor progress can motivate and focus action. Maternal, Infant, and Child Health Reduce fetal and infant death rate during perinatal period Reduce fetal death rate at 20 or more weeks of gestation US Target 0 1 2 3 4 5 6 7 8 Maternal, Infant, and Child Health Reduce % very low birth weight Reduce % preterm births Reduce % low birth weight US Target 0 2 4 6 8 10 12 Maternal, Infant, and Child Health Increase abstinence from cigarette smoking among pregnant women (%) Increase proportion of pregnant wom en who receive prenatal care in 1st trimester (%) US Target 0 20 40 60 80 100 31 Responsible Sexual Behavior Responsible Sexual Behavior Reduce the incidence of primary and secondary syphilis ** Reduce gonorrhea rates among females aged 15 44 years ** US Target Reduce pregnancies among adolescent females aged 15 - 17 years* 0 0 US Target 50 100 150 200 250 300 5 10 15 20 25 30 35 40 Injury and Violence Reduce the suicide rate Reduce homicides Reduce deaths from falls Reduce deaths caused by motor vehicle crashes Reduce deaths caused by unintentional injuries Reduce fire arm-related deaths US Target 0 10 20 30 40 50 15 20 25 30 Substance Abuse Reduce drug-induced deaths Reduce cirrhosis deaths 0 5 10 US Target 32 Reduce the overall cancer death rate Cancer Reduce the prostate cancer death rate Mohave Rate Reduce the colorectal cancer death rate Reduce the breast cancer death rate US Target Reduce the lung cancer death rate 150 160 170 US Target 180 0 10 20 30 40 50 60 Heart Disease and Stroke Reduce stroke deaths Reduce coronary heart disease deaths US Target 0 25 50 75 100 125 150 175 Diabetes and Respiratory Diseases Reduce deaths from chronic lower respiratory disease among adults aged 45 years and older Reduce the diabetes-related death rate US Target 0 25 50 75 100 125 150 175 200 33 Mohave County Department of Public Health  700 W. Beale Street  P.O. Box 7000  Kingman, AZ 86402 Phone 928-753-0743  Fax 928-718-5547  Emergency Info 866-409-4099  www.HealthELinks.com Prepared by: Reviewed by: Jennifer McNally, Assistant Health Director Patty Mead, Health Director 34