Weld County Public Health Improvement Plan Priorities Meeting May 10, 2011

1. Weld County Public Health Improvement Plan Priorities MeetingMay 10, 2011

2. Today’s Plan • Review identified important issues • Brief summaries of data and possible broad strategies • Facilitated group discussion • Everyone will vote on overall importance, ability, and capacity to impact • Results tallied and presented • Discuss findings and make group decision on priority issues based on score results (i.e., “cut points”) • Reflect on the priorities and next steps

3. What is the point of choosing priorities? • With limited resources, intensive focus on a few areas, beyond the maintenance of effort, can make a difference • No single agency can not do it alone so we need to garner the resources and energy from other multiple sectors • Identifying a few key areas to collectively focus on results in improvement plans that are doable • Communications and talking points need to be direct and focused

4. Where We Want To Go – • All residents living, working, and playing in Weld County will benefit from physically, socially, emotionally, and spiritually enriched environments enhanced by the intentional, collaborative efforts among public & environmental health, health care, social service, education, community organizations and citizens-at-large.

5. Weld County Winnable Priorities • Infant health • Teen motor vehicle injury • Mental health & substance abuse • Nutrition, physical activity, obesity • Tobacco use • Teen pregnancy

6. As you review the data … • How important is this health issue? • How many people are currently impacted, rates of mortality, morbidity? • How many people are at risk, what does the trend data tell us? • What is the degree of health disparities inherent in this area? • Does this issue have a severe impact on the quality of life? • As we consider health care costs, what is the economic burden of this health issue?

7. As you review the data… • What is our ability to impact this area? • Do evidence-based strategies or best practices exist that can make a difference? • Is it likely, that with collective effort, we can make a difference? • Is there community level readiness and support for change?

8. As you review the data … • What is our capacity to impact this area? • Is there political will and champions to support the issue? • Are there organizations prepared to take the lead to move it forward? • Is there an adequate number of staff available ? • Is there funding available or obtainable?

9. Populations of interest total reach counts • Total Population: 252, 000 • 28% Hispanic/Latino • Children 0 – 18 yrs : 73,000 • Teens 15-19 yrs: 20,000 • Teen females 15-17 yrs: 5,250 • Teen mothers (15-17 yrs): 155/yr • Adults 18 – 64 yrs: 165,000 • Adults 65 and older: 22,000

10. Populations of interest total reach counts • 38,000 (15%) of Weld residents live below the federal poverty level • 14,000 (19%) of Weld children live below the federal poverty level • 58,000 (25%) of Weld residents under 65 yrs live below 200% of the federal poverty level Sources: 2009 FPL data from Colorado Health Institute, 2007 US Census SAHIE data compiled by WCDPHE

12. Using your keypad is easy… but don’t push any buttons yet!

13. Polling Open Let’s say you press 2/B Your answer will be displayed Note: after your selection is displayed the screen will go blank The check mark indicates the answer was received properly

14. Changing Your Answer Polling Open As long as Polling is Open, you can change your answer by pressing any other key. Note: If you have a problem, let the screen go blank and then try again

15. Practice: Who is your public health hero? • C. Everett Koop • Louis Pasteur • Jonas Salk • Erin Brockovich • Mark Wallace • Other

16. Some Demographics

17. Prior to today, how many of these meetings have you attended? • This is my first • One or two • Three or more

18. What sector of the public health system do you represent? Public Health Environmental Health Health Care Social Service Education Community Organization Citizen-at-large Other county or municipal government Media Other

19. Do you work directly with one or more of the target populations? • Yes • No

20. A little more depth on each of issue

21. Infant Health • Why is this important? • Infant mortality is associated with maternal health, quality and access to care, socioeconomic conditions, and public health practices. • Weld County’s infant mortality rate: 6.3 deaths per 1,000 live births; this translates to about 20–30 infants/yr or about 1 death every other week among 4,000 mothers annually • 2009 CDPHE analysis: Weld’s rate has not changed in the long-term and is far from the goal of 4.5/1,000 • A 2003 statewide analysis found that 30% of Weld County’s fetal and infant deaths were preventable. • VLBW infant NICU costs > $3,500 per infant; can exceed $1 million for an prolonged stay • Family financial and emotional costs can also be significant

22. Infant Health • What can we do? • American College of Obstetrician and Gynecologists Fetal and Infant Mortality Review (FIMR) program is well evaluated/evidence informed • What is our capacity? • Medical, public health, and human service community have champions and are ready. • Health department is prepared to take the lead. Staffing to be determined. Start-up and long-term funding needs to be identified. • $17 million is dedicated to child health issues by 11 organizations; 112 primary staff, 112 support staff, 28 volunteer staff • Several strong coalitions and/or networks focused on maternal and child health issues – Promises for Children, Early Childhood Council • There are no programs addressing this directly

23. Infant health

24. Preventable deaths

25. Infant health is a priority for Weld County. Strongly Agree Agree Neutral Disagree Strongly Disagree

26. Teen Motor Vehicle Safety Why is this important? • Motor vehicle crashes are the leading cause of death for U.S. teens • In 2009, about 3,000 teens in the United States aged 15–19 were killed and more than 350,000 were treated in emergency departments for injuries suffered in motor-vehicle crashes.   • Young people ages 15-24 represent only 14% of the U.S. population. However, they account for 30% ($19 billion) of the total costs of motor vehicle injuries among males and 28% ($7 billion) of the total costs of motor vehicle injuries among females. • 1 out of 6 drivers involved in a crash in Weld county are teens • The most cited violation was “inattention to driving” • 10% of teens involved in a crash in Weld County were not wearing a seatbelt. • 12% of District 6 students say they rarely/never wear a seatbelt when riding in a car (2007 YRBS)

27. Teen Motor Vehicle Safety What can we do? • Programs, policies, and social norms related to increasing awareness of high-risk driving, creating positive attitudes toward seat belt use, developing safer driving-related skills and decision-making abilities • What is our capacity? • DRIVE SMART Weld County is a strong nonprofit community coalition made up of members of law enforcement, business, insurance, media, concerned citizens, schools, fire departments, and health professionals working to reduce injuries and death from traffic crashes • Current funds < $100,000 / yr plus in-kind resources from coalition • Funding sources: MCH, CDOT, Banner, State Farm, All State • Staffing <.5 FTE plus 5.0 FTE volunteer hours

28. *Rates are per 100,000 teens ages 15-19 Source: Health Statistics Section, Colorado Department of Public Health and Environment

29. Motor vehicle crash hospitalization rates* to teens 15-19, 2007-2009 by Health Statistics Regions * Rates are hospitalizations to teens age 15-19 per 100,000 population age 15-19 in each region Source: Health Statistics Section, Colorado Department of Public Health and Environment

30. Disparities in (teen) motor vehicle crashes/deaths • Males (61% of teen crashes) • Geography -most crashes happen in southwest but origin of teen drivers is: • 25% Greeley/Eaton/Ft. Lupton • 34% other cities in Weld • 26% Denver and other cities outside Weld • 15% neighboring cites (Ft. Collins/ Brighton/Longmont)

31. Teen motor safety is a priority for Weld County. Strongly Agree Agree Neutral Disagree Strongly Disagree

32. Mental Health Why is this important? • Mental health disorders are the leading cause of disability in the US, accounting for 25% of all years of life lost due to disability and premature mortality • Depression and anxiety affect people’s ability to participate in health-promoting behaviors which, in turn, affects physical health • Suicide is the 8th leading cause of death in the Weld County • 27% of adults in Weld said their mental health was not good 1 – 7 of the previous 30 days and 14% said their mental health was not good for 1 week or more (Weld 2010 CHS)

33. Mental Health What can we do? • Ensure supply and access to effective & appropriate mental health & suicide prevention services • Shift norms & address stigma associated with seeking mental health services • Fill community gaps with effective & appropriate program interventions • What is our ability/capacity? • Northern Colorado Health Alliance and North Range Behavior Health are champions in this area • NOCOHA has a newly launched initiative called Project Launch - promotes maternal mental health and early social-emotional health in underserved children (from birth to age 8) who are experiencing or at risk for significant social stressors • About $16 million is dedicated to this area from 7 agencies; with 203 primary staff, 65 support staff, and 31 volunteer staff

34. Source: WCSD6 Youth Risk Behavior Survey, WCDPHE

35. Teen suicide *Rates are per 100,000 teens ages 15-19 Source: Health Statistics Section, Colorado Department of Public Health and Environment

36. Disparities in mental health

37. Substance Abuse Why is this important? • Excessive alcohol consumption is the third leading cause of preventable death in the US; 5% of US pop. drinks heavily & 15% binge drink • 17% of adult Weld residents binge drink; 5% exceeded guidelines for low-risk drinking; 3% drove after having too much to drink (2007-2008 BRFSS, COHID) • 28% of WCSD6 high school students binge drink (2007, YRBS) • 6% of Weld pregnant moms drank during pregnancy (PRAMS) • 2% of households had someone who needed and used alcohol or drug treatment services; another 3% said it was needed by someone but not used

38. Substance Abuse What can we do? • Shift norms associated with substance use/abuse • Reduce youth access (raise prices, promote alternatives) • Decrease the appeal of substance products (examining, publicizing, reducing advertising/marketing and by doing counter-advertising & programming) • What is our capacity? • Weld County Prevention Partners is a champion in this area • WCPP has a large multiyear federal grant focusing on underage binge drinking especially among Latinos. In depth readiness assessments have been done in four regions/school districts – Ault RE-9, Fort Lupton RE-8, Johnstown-Milliken RE-5J, and LaSalle, Gilcrest, Platteville RE-1 – to see if underage drinking interventions could be implemented • Over 80% of residents are concerned about alcohol or drug abuse

40. Disparities in Substance Abuse (binge drinking) • Males (higher) • Age (younger higher) • Race (Whites and Hispanics higher) • Income (higher income higher)

41. Mental health and substance abuse is a priority for Weld County. Strongly Agree Agree Neutral Disagree Strongly Disagree

42. Nutrition, Physical Activity, & Obesity • Why is this important? • Increased the risk for: • Coronary heart disease, type 2 diabetes, cancers (endometrial, breast, and colon), hypertension, dyslipidemia , stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, gynecological problems (abnormal menses, infertility) • US medical expenses alone attributed to both overweight and obesity may have reached as high as $78.5 billion • Weld County resident fruit and vegetable consumption and physical activity levels are below state averages • Weld County’s obesity rate is 25% which is significantly higher than the state rate of 19%

43. Nutrition, Physical Activity, & Obesity • What can we do? • Help change individual’s knowledge and skills • Reduce exposure to foods low in nutritional value and high in calories • Increase opportunities for physical activity • What is our capacity? • Healthy Weld 2020, WCDPHE, Banner/NCMC are champions in this area • $6.2 million is dedicated to chronic disease risk factor reduction by 11 organizations; 40 primary staff, 44 support staff and 1.4 volunteer staff are dedicated to this area

44. Percent of children aged 2-14 overweight or obese HP 2020 Obj: 5% Source: Colorado Child Health Survey, CDPHE

45. Sources: Weld County School District Six Youth Risk Behavior Survey (YRBS), WCDPHE & Colorado YRBS, CDPHE

46. Overweight & obesity trend HP 2020 Obj: 15%

47. Disparities in Obesity • Race (Hispanics higher) • Income (lower income higher) • Education (lower education higher) • Geography (Greeley/Evans and Southeast are higher)

48. Nutrition, physical activity and obesity are priorities for Weld County. Strongly Agree Agree Neutral Disagree Strongly Disagree

49. Tobacco • Why is this important? • Tobacco use is the single most preventable cause of death and disease in the United States • Each year, approximately 443,000 Americans die from tobacco-related illnesses • Tobacco use costs the U.S. $193 billion annually in direct medical expenses and lost productivity • Adult cigarette use in Weld County is decreasing but adolescent cigarette use has not • Chew tobacco rates are higher in Weld County compared to Colorado

50. Tobacco • What can we do? • Increase price of tobacco products • Promote comprehensive smoke-free policies • Reduce tobacco advertising and promotion • Implement anti-tobacco education or media campaigns • Encourage / assist tobacco users to quit • What is our capacity? • Tobacco Free Weld County Coalition is a strong champion • 80% of county residents are concerned about youth tobacco use