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/