State of Health in Nevada County
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Transcript of State of Health in Nevada County
State of Health in Nevada County
Nevada County Community Leadership InstituteFebruary 24, 2012
Jeff Brown, Director Nevada County Health and Human Services Agency
Health & Human Services Agency
• Behavioral Health– Children’s and adults mental health focused on
mentally ill adults and emotionally disturbed children – Medi-Cal is priority
– Crisis response– AOD Treatment– Odyssey House & Catherine Lane
Health & Human Services Agency
• Public Health – Communicable disease control– Emergency preparedness– Nursing home visitation– Health and Wellness– Vital Records– Clinic services– WIC Nutrition
Health & Human Services Agency
• Social Services – Adult and Child Protective Services– CalWORKS & Employment Services– Safety net programs – Food Stamps, GA, Medi-
Cal and CMSP– Veteran’s Services
Health & Human Services Agency
• Child Support and Collections – Paternity establishment– Child support order establishment/enforcement– Child & spousal support collection/distribution– Medical support establishment/enforcement
Other Elements of Safety Net• Clinical medical & behavior health services
– hospitals, clinics and private medical providers and therapists
• Foster families and group homes• Family resource centers• Non-profit service providers (e.g. hospice,
domestic violence, homeless, housing, AOD treatment, child development, etc.)
The health status of Nevada County residents is better than
the average Californian?• True• False
100%
0%
Nevada County Health Status
–Recent survey using 2003-09 data lists Nevada County overall health outcomes ranking as 11th best of 56 California counties rated!
Health is most dependent on?
Access
to qual...
Socia
l facto
rs...
Genetics
100%
0%0%
1. Access to quality health care
2. Social factors --- education, housing, employment, income, neighborhood, etc.
3. Genetics
Determinants of Health
– Access to quality medical care only determines 15-20% of a person’s health.
– Up to 75% of a person’s health is dependent on the social determinants of health --- housing, education, employment, income, neighborhood, social support
Children and Adolescent Indicators
% Persons Under 18 in Poverty
12.4
17.018.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
Nevada Co.
California
Nation
California County Health Status Profiles 2011
9621009
965
1040 1047
916 900875
952
872 852
937 908
828874
972
0
200
400
600
800
1000
1200
2004 2005 2006 2007 2008 2009 2010 2011
# of
Dea
ths/
Birt
hs
Births
Deaths
Vital Statistics 2004-2011
Vital Statistics2011 – 875 births
- 464 Sierra Nevada Memorial Hospital (SNMH); 354 Tahoe Forest Hospital (TFH); 57 home births
2010 – 900 births- 457 SNMH; 394 (TFH); 49 home births
2009 – 916 births- 465 SNMH; 417 TFH; 34 home births
2008 - 1,047 births- 542 SNMH; 472 TFH; 33 home births
2007 - 1,040 births- 477 SNMH; 516 TFH; 47 home births
2006 – 965 births- 480 SNMH; 446 TFH; 39 home births
Estimate of Child Vaccination Rates
55%75%
90%
0% 0%
100%
1. 55%2. 75%3. 90%
Immunizations
0
20
40
60
80
100
2002 2003 2004 2005 2006 2007 2008 2009 2010California Nevada Co
• 73.0% of Kindergarteners have obtained all required immunizations• 17.7% of Kindergarteners have Personal Belief Exemptions (PBE)
California Department of Public Health 2011
ImmunizationsPercentage of Nevada County Children 2 - 4 years of age with all recommended
vaccinations in licensed childcare
2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 California 93.4% 93.7% 93.3% 93.6% 93.5% 92.9% 91.9%
Nevada Co. 81.7% 76.5% 77.6% 76.1% 74.4% 71.7% 71.9%
Vaccine Preventable Diseases and Immunization Coverage in California, SIRE, Immunization Branch California Department of Public Health (CDPH)
% Children’s Dental Insurance 2007
0102030405060708090
Dental
Nevada County
California
CHIS 2007
% Children’s Health Insurance 2007 & 2009
2007 200982
84
86
88
90
92
94
96
Nevada Co.California
CHIS 2007 & 2009
3rd Graders with Cavities
62
70.9
35
40
45
50
55
60
65
70
Nevada County California
% C
arie
s
Nevada County PHD Healthy Smiles 2007 Survey
HP 2010 Goal – 42%
3rd Graders with Untreated Dental Decay
26
28.7
15
17
19
21
23
25
27
29
Nevada Co. California
% D
ecay
HP 2010 21%
Nevada County PHD Healthy Smiles 2007 Survey
7th Grade School Fitness Zone Results - % Not Passing
32.3
44.5
25.937
-55
15253545556575
Nevada County California
Body Composition Aerobic
California Dept of Education 2010-11 Physical Fitness Report
% Children Engaging in Vigorous Activity 3 or More Days Per Week
CHIS 2007 & 2009
Children with Entries into Foster Care
00.5
11.5
22.5
33.5
44.5
519
98
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Inci
denc
e pe
r 10
00
CaliforniaNevada Co.
Center for Social Services Research, UC Berkeley, 7/2011
Prevalence of Children inFoster Care
0
1
2
3
4
5
6
Jan 2009 July 2011
Per 1
000
Child
ren
Nevada Co.California
Center for Social Services Research, UC Berkeley 2/2011
Ozone - # of Days Above State 8 hr Standard
87 8371
66
81
55
42 38
18
0102030405060708090
100
2002 2003 2004 2005 2006 2007 2008 2009 2010
# of
Day
s
Western NCTruckeeSacto T St.
California Air Resources Board, 2011
Asthma• Approximately 1.7 million children in
California have been diagnosed with asthma.The Burden of Asthma in California, A Surveillance Report June 2007, California Department of Health Services.
• Nevada County’s age adjusted rate (per 10,000) for asthma hospitalizations for the years 2000-2005 is 6.0 (368 cases) compared with the state of California 10.5 (220,777 cases) The Burden of Asthma in California, A Surveillance Report June 2007, California Department of Health Services
% of Teens Diagnosed with Asthma
2007 20090
5
10
15
20
25
Nevada Co.California
CHIS 2007 & 2009
NU 9th
Truck
ee 9t
hSta
te
Nation
NU 11th
Truck
ee 11
thSta
te
Nation
NU Alte
rn.
05
101520253035404550
Tobacco Use
Cigarette Use - past 30 days
% o
f St
uden
ts
CHKS - NUJHSD 2010-11 & Truckee Unified 2009-10
Nevada County Teens’ Substance of Choice
0% 0%0%
100%1. Methamphetamine2. Marijuana3. Alcohol4. Prescription Pain
Killers
NU 11th Truckee 11th State Nation NU Altern.0
10
20
30
40
50
60
70
8011th Graders AOD Current
Use
Alcohol Marijuana Meth/other amphetamine
% S
tude
nts U
sing
CHKS - NUJHSD 2010-11 & Truckee Unified 2009-10
2004 2005 2006 2007 2008 2009 20100
5
10
15
20
25
30
35
% of NJUHSD 11th Grade Students Who Used Marijuana during the Past
30 Days
CHKS - NUJHSD 2010-11 & Truckee Unified 2009-10
% Students Using Prescription Painkillers 4 or More Times
0
2
4
6
8
10
12
NJUHSD 9th Graders NJUHSD 11th Graders TTUSD 9th Graders TTUSD 11th Graders
Perc
ent
2007-08 2009-10
NU 9th Truckee 9th NU 11th Truckee 11th0
10
20
30
40
50
60
70
80
90
% of Students Finding Substances Fairly Easy or Easy to Obtain
Alcohol Marijuana
% S
tude
nts
NU 9th Truckee 9th NU 11th Truckee 11th0
10
20
30
40
50
60
70
80
Perceived Harm of AOD Oc-casional Use
Perceived Harm Occasional Alcohol Use - Great/ModeratePerceived Harm Occasional Marijuana Use-Great/Moderate
% o
f St
uden
ts
NU 9th Truckee 9th NU 11th Truckee 11th NU Alternative0
10
20
30
40
50
60
Ever Driven after Drinking%
Stu
dent
s
NU 9th Truckee 9th NU 11th Truckee 11th0
5
10
15
20
25
30
35
% of Students Sad, Hopeless Feelings and Suicidal
Thoughts
Frequency of Sad or Hopeless Feelings
% o
f St
uden
ts
Teen Birthrates Ages 15-19
14.4
34.7
41.5
0
5
10
15
20
25
30
35
40
45
Birth Rate per 1000 pop
Nevada Co.
California
Nation
California County Health Status Profiles 2011
Adult Indicators
Vital Statistics Leading Causes of Death for 2010
• Male– Heart Disease– Prostate Cancer– Chronic
Obstructive Pulmonary Disease (COPD)
– Pneumonia– Lung Cancer
• Female– Heart Disease– Pneumonia– Lung Cancer– Breast Cancer– COPD– Alzheimer’s
Disease/Dementia
Nevada County PHD 2010
Mortality per 100,000 – The GoodState Rank
Indicator Age Adjusted Death Rates
2007-097 Liver disease/cirrhosis 7.8*
21 Lung Cancer 37.26 Homicide 1.3*9 Diabetes 11.9*
24 Alzheimer’s Disease 18.424 All Cancers 151.523 All Causes 640.6
Mortality Per 100,000 – The BadState Rank
Indicator Age Adjusted Death Rate
2007-09
35 Stroke 40.0
37 Female Breast Cancer 22.1*
30 Unintentional Injuries 36.7
51 Suicide 20.0
33 Drug Induced Deaths 13.6*
50 Firearm Related Deaths 13.2*
Communicable Diseases – Incidence Rates per 100,000
State Rank
Indicator Average Crude Case Rate 2007-09
16 AIDS 1.9*
11 Chlamydia 128.7
13 Gonorrhea 9.6*
17 Tuberculosis 1.0*
California County Health Status Profiles 2011
Communicable Disease 2005 2006 2007 2008 2009 2010 2011Campylobacteriosis 4 5 12 9 18 13 23Chlamydial Infections 121 111 133 140 113 141 137Escherichia coli 1 8 1 2 2 4 1Giardiasis 23 9 14 13 12 9 11Gonococcal
Infections 10 6 16 6 7 6 14Hepatitis A 1 1 1 6 6 3 1Hepatitis B, acute 1 0 0 1 1 0 1Hepatitis B, chronic 3 3 5 2 9 6 12Hepatitis C, acute 1 0 0 0 0 0 0Lyme Disease 5 6 7 14 5 8 15Meningitis, viral 6 10 5 4 3 2 0Pertussis 15 19 18 5 2 22 5Salmonellosis 13 11 8 13 12 17 8Tuberculosis 1 2 0 2 1 0 1*Not all reportable communicable diseases
listed
% Adults with Chronic Diseases
05
101520253035
% o
f Res
pond
ents
Nevada Co.California
CHIS 2009 *Data from CHIS 2005^Data from CHIS 2007
www.cdc.gov/diabetes
2008 County-level Estimates Diabetes Adults aged ≥ 20 years
Age-adjusted percent0 - 6.36.4 - 7.57.6 - 8.88.9 - 10.5> 10.6
Health & Dental Insurance
Health *Dental0
102030405060708090
10086.2
58.6
82.1
66.3
Nevada Co.California
CHIS 2009
*Dental is CHIS 2007 data
Mental Health
• 4.7% of county adults likely had psychological distress within the last year
• 13.7% of residents needed help for emotional/mental health problems or alcohol/substance abuse issues
• 11.5% had thoughts of committing suicide
CHIS 2009
Group with Greatest Suicides
0-17 years
of ...
18-39 years
of...
40-64 years
of...
65+ years of a
...
0%
100%
0%0%
1. 0-17 years of age2. 18-39 years of age3. 40-64 years of age4. 65+ years of age
% of Suicides by Age Group 2011
5
27
50
18
0
10
20
30
40
50
60
% of Suicides by Age Group
% o
f Tot
al S
uici
des
0-17 years18-39 years40-64 years65+ years
Sheriff/Coroner 2011
Suicide deaths 1991-2011
1416
21
1316
9
16 1613
22
1417
19
10
1513
24
18 18
11
22
0
5
10
15
20
25
30
California County Health Status Profiles, CDPH, & Nevada County Chief Deputy Coroner/NC Sheriff’s Office
AOD Related Arrests 2001-2009
-
200
400
600
800
1,000
1,200
1,400
1,600
2001 2002 2003 2004 2005 2006 2007 2008 2009Year
Num
ber o
f Arr
ests
Controlled Substances
Marijuana Possession
Meth Possession
DUI
Drunk in Public
Drug Induced Deaths, 2002-09Year Suicide Undetermin
edAcciden
talTotal
2002 1 0 6 72003 0 4 6 102004 1 3 5 92005 0 1 6 72006 1 3 8 122007 4 5 13 222008 2 1 7 102009 4 2 4 10
Nevada County Sheriff’s Department Coroner Report
Adult Current Smoker
02468
1012141618
2007 2008
% o
f Adu
lts
Nevada Co.California
CHIS 2009
% Nevada County Adults Obese or Overweight
25% 25%25%25%1. 20%2. 33%3. 55%4. 65%
% Adults Overweight and/or Obese
56
56.3
55.8
55.9
56
56.1
56.2
56.3
56.4
Nevada County California
Perc
ent
CHIS 2009
Definitions:• Obesity: Body Mass Index (BMI) of 30 or higher.
• Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the square of his or her height in meters.
Obesity Trends Among U.S. Adults
between 1985 and 2010
Source: Behavioral Risk Factor Surveillance System, CDC.
2000
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2010
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2009
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2010
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
2011 Homeless Count
• 190 individuals (vs 345 individuals 2009)• Chronically homeless – 21%• Veterans – 6%• Severely mentally ill - 25%• Chronic substance abuse – 26%• HIV/AIDS – 1%• Domestic violence victims – 15%
2009 Homeless Count
• 345 Individuals• Sex – 68% Male 32% Female• Transitional Aged Youth 18-24 years – 29%• Veterans – 13%
2009 Homeless Count - Race/Ethnicity
• Caucasian – 89.9%• American Indian – 7.1%• Hispanic – 6.3%• African American – 2.6%• Other – 1.6%
2009 Homeless Count Housing Barriers • Disabled – 55%• Chronic substance abuse – 40%• Physically Disabled – 31%• Mental Illness – 31%• Co-occurring disorder – 13%• Learning disabilities – 9%• HIV/AIDS – 1%• Past Foster Care – 43%• Domestic/family violence – 13%
References
• mynevadacounty.com
• www.chis.ucla.edu/
• http://www.wested.org/chks/