Comprehensive Health Services in Flagler County

1. Florida Department of HealthFlagler County Robert Snyder, MPH Administrator

2. Who We Serve In 2016 we touched the lives of 14,699 Providing 177,198 Services to Flagler County residents.

3. Flagler CHD Services Prenatal Care: Medicaid funded prenatal care Family Planning: Federally funded grant to provide contraceptive choice for both male and female HIV and STD screening, treatment, clinic and surveillance: – Rapid access screening or provider visits ADAP- AIDS DRUG ASSISTANCE Program: Provide AIDS medication to affected individuals Tuberculosis Control: TB testing, treatment for active cases Immunizations: Required immunizations to infants, school age children, and adults, including for travel   Refugee Health: Health screenings, physical exams School Health: RN liaison services to the Flagler School Board Environmental Health Programs Epidemiology Programs: Conduct surveillance, investigation and control of cases, clusters and outbreaks of reportable diseases.  In addition, services are routinely performed in the following program areas: Food and Waterborne Disease Surveillance and Investigation, Florida ILINet Influenza Surveillance, Rabies Prevention and Control, Perinatal Hepatitis B Prevention, Mosquito-borne Disease Prevention & Control, & Residential Sharps Disposal. WIC: Nutrition program for Women, Infants, & Children (age 5 & under) to provide healthy foods, nutrition education & counseling, breastfeeding support, & referrals for health care & community services. Dental: Dental health services to Medicaid covered children and our pregnant women. Vital Statistics: Provide official Birth and death certificates Community Health Assessment Special Needs sheltering: Provide staffing for the County designated Special Needs Shelter during disasters. Healthiest Weight Initiative Medical Reserve Corps

4. Other Services • Birth and Death Certificates • 1,731 Birth Certificates issued (788 births) • 7,444 Death Certificates issued (1,086 deaths) • Immunizations – 8,100 • STD – 5,137 services • Family Planning – 2,693 patient visits • Pre-natal – 1,000 patient visits • Dental – 5,953 visits • WIC – Nutrition & Breastfeeding Counseling's – 10,800 • $1.3 million food benefits from local grocery stores • 758 Communicable disease investigations • 10 new AIDS cases diagnosed

5. Environmental Health • 20 Environmental Health Programs (Onsite Sewage Treatment and Disposal System, Food Hygiene, Public Pools, Mobile Home Parks, Group Care, Migrant Labor Camps, Biomedical Waste, Tanning, Body Piercing, Tattooing, Limited-Use Water Systems, Well Construction, Coastal Beach Monitoring, Sanitary Nuisance Complaints, Arbovirus Surveillance, Rabies Surveillance, Communicable Disease Surveillance, Community Environmental Health Projects, Public Health Preparedness). • 630 Permitted Facilities • Over 800 Routine Facility inspections performed each year • 2,500 Total services a year (Routine Inspections, Re-inspections, Construction inspections, sampling, surveillance, investigations, enforcement, etc.) • Respond to Sanitary Nuisance Complaints within 2 days of Complaint (Untreated human waste, mosquito breeding, failing septic systems)

6. How Healthy is Flagler County? An Overview of Health Status in the Population

7. County Health Ranking Flagler’s Rank was 22

8. Health Outcomes State Ranking from 1 “Healthiest” to 67 “Least Healthy” (around the Region) Source: Mobilizing Action Toward Community Health (MATCH) collaboration project between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute

9. What comprises the Rankings? Outcomes • Health outcomes represent the health of a county. • A. Mortality (length of life) • B. Quality of life • Poor or fair health [ 14 %] • Poor physical health days (30) [3.7] • Poor mental health days [4.0] • Low birth weight [ 7 %]

10. What comprises the Rankings? Factors • Health Factors (determinants of health) are variables that influence health. Health behaviors: • Smoking [14%] • Obesity/Overweight [57%] • Sexually transmitted disease* [284] Clinical care: • Uninsured [19%] • Diabetic monitoring [88%] • Mammogram screening [74%] • Physical Inactivity [22%] • Binge drinking [17%] • Alcohol impaired driving deaths [42%] • Primary care physicians [2,130:1] • Dentist [3,100:1] • Mental health providers [2,030:1] * # of newly diagnosed chlamydia cases per 100,000 population

11. Health Factors continued Social & Economic: • Unemployment [6.0%] • Children in single parent households [36%] • Children in poverty [21%] Physical Environment: • Air Pollution* [6.5%] • Severe housing problem [20%] • Long commute driving along [37%] • High School Graduation [77%] • Violent Crime [265] • Some College [60%] * # Average daily density of fine particular matter in micrograms per cubic meter

12. Other Health Outcomes

13. Major Causes of Death Florida Department of Health, Bureau of Vital Statistics, 2014

14. Educational Attainment Around the Region 2014 Flagler Rates

15. Health Insurance Coverage Around the Region 2013 %

16. Median Household Income Around the Region 2014

17. Population Health & DOH-Flagler Taking Action • Zika Virus Response • Disaster Response, Hurricane Matthew and SpNs (Special Needs Shelter) • CHA and CHIP

18. FL Status • As of December 31, 2016 • 1,099 travel-associated cases were reported • 294 locally acquired cases • 4 areas of active transmission in Miami-Dade County; all lifted as sites • 2 travel-related cases in Flagler County • As of April 1, 2017 • 27 travel-associated cases • 2 locally acquired cases • 2 undetermined cases • 15 Pregnant women with lab evidence of Zika • 0 cases for Flagler County

20. Hurricane Matthew and Special Needs Shelter • Health Dept – Coordinates SpNS at Rymfire • Partnership btw us DOH-Flagler and School System • 29 staff, handful volunteers and 300+ residents, including Grand Oaks Nursing Home evacuees • We cared for medically needy, elderly, disabled, dialysis pts, Oxygen and electrically dependent, homeless, dementia pts, and their caregivers for 3 days, at Rymfire and Bunnell Elementary • Tested Ocean water for enterri bacteria

21. Community Health Assessment (CHA) + Community Health Improvement Plan (CHIP) • Every 3 year collaboration among hospitals, DOH, Flagler Cares, 50+ health and social service providers, civic, community faith based leaders met frequently in 2015-16 • On-line survey (600 respondents) • Reviewed and discussed 300+ health indicators and eco-social determinants of health

22. 5 Health Priorities for Flagler • Adult Behavioral Health • Youth Behavioral Health • Cardiovascular Disease and Diabetes (Healthier Eating and Physical Activity) • Mothers and Children under Age 5 (Prenatal Care, Birth Outcomes, Child development) • Family Violence (Domestic Violence)

23. Future DOH Priorities • Dental Services Expansion + Dental Sealant program at Elementary Schools • Began HIV Services, 7/1/16 • Healthiest Weight & Infant Mortality Initiative • Community Health Improvement Plan interventions • Community Water Fluoridation • Obtain additional Public Health funding for Flagler County