Mid-Michigan District Health Department...• Oral Health program awarded grants to apply sealants and fluoride varnish ... department with any questions at (989) 831-3610. The Mid-Michigan

2011 MMDHD Annual Report 4

45thMID

-M

ICHIGAN DISTRICT

HEA LTH D E PA RT M

ENTANNIVERSARY1966 2011

Y o ur p ub l i c h ea l t h t ea m, c o nnec t i ng w i t h o ur c o mmuni t i e s t o a ch i e v e

h ea l t h i e r o u t c o mes

Mid-Michigan District Health Department

2011 Board of Health Annual Report

Serving Clinton, Gratiot & Montcalm Counties

4 2011 MMDHD Annual Report

45 years of service in 2011On May 17, 2011 MMDHD marked its 45th anniversary with an open house in Ithaca. Board of Health members, community partners, government representatives, and current and past employees joined together to celebrate MMDHDs many accomplishments and to look forward to another 45 years of providing top-notch public health care services to the residents of Clinton, Gratiot, and Montcalm counties.

2003• EnvironmentalHealthestablished“FoodBasics101course• Agencyworkedextensivelyonsmallpoxpreparedness2004• MISdevelopedvideoconferencingcapabilitiesbetweenbranchoffices2005• EHdevelopedpoliciesandproceduresforResidentialWellProgram2006• EstablishedPandemicInfluenzaCoordinatingCommittee• IncreasedaccesstoFamilyPlanningandPlanFirst• HostedPandemicInfluenzaSummit• Securedfundingtolocateandprocureabandonmentof oldunusedwater

wellsinpartnershipwiththeCityof Ithaca2007• Community-BasedAdultDentalClinicopenedinSt.Johns• NewClintonBranchOfficeopened• OralHealthprogramawardedgrantstoapplysealantsandfluoridevarnish• Agencyawardedover$600,000worthof vaccineforuninsuredresidents• AgencyawardedtwoKomengrantstoaddressbreastcancer2008• EnvironmentalHealthinvestigatesandstopsillegalsewagedischargeintoPine

River• MMDHDhosted“BiteFright”rabiesconference• WICprogramconvertedfrompapercouponstoelectronicbenefitcard2009• InitiatedacomprehensiveH1N1influenzaresponseandvaccinationcampaign• ExpandedandrelocatedtheStantonDentalCareCentertoSidney2010• Smoke-FreelawbeginsforlocalbusinessesinMichigan• SecuredfundingtoinstallindoorfitnesstrailsinGratiotandClintonschools

1966• Mid-MichiganDistrictHealthDepartmentwasorganized• Thefirstimmunizationclinictookplace• EnvironmentalHealthsanitarycodewasadopted• Eachbranchofficehadonenurse,onesanitarian,andoneclerk1967-1968• Thefirsthearingclinicwasheld• Thefirstfoodestablishmentpermitwasissued• Thefirstvisionscreeningclinicwasheld1972-1974• Beganconductinglandevaluations• Beganairsamplingtestsforairborneparticulates1975-1979• WICprogrambegan• StatePublicHealthCodeadopted• HealthyPeopleinitiativebegan1980s• BeganHIV/AIDScounselingandtesting• MaternalSupportServices(MSS)andEarlyOnprogramsbegan1990s• InfantSupportServicesbegan• NewMontcalmandGratiotbranchofficesopened2000• StantonDentalCareCenteropened• HealthyPeople2010initiativewasreleased• EnvironmentalHealth’s“RegisterforQuality”programbegan2001• Agency’swebsitewasestablished• Mid-MichiganHealthPlanestablished• Emergenceof bioterrorismasapublichealththreat2002• EnvironmentalHealth’sGISsystemwasimplemented

A look back...


Kim Singh,M.A., C.H.E.S.Health Officer

Onbehalf of theBoardof HealthandStaff,IampleasedtopresentyouwiththeMid-MichiganDistrictHealthDepartment’s2011AnnualReport.

Thisreportprovidesanoverviewof severalselectedhealthindicatorsandhighlightstheprogramsandservicesof theEnvironmentalHealth(EH)andCommunityHealthandEducationDivisions(CHED).Localhealthdepartmentsarefocusedonkeepingpeoplehealthybymakingsurethefoodyoueatissafe,ourdrinkingwaterisclean,andvaccinepreventablediseasesareeradicated.Allof ourservicesareprovidedbythededicatedstaff of theMid-MichiganDistrictHealthDepartmentfortheresidentsof Clinton,GratiotandMontcalmCounties.

Thisreportsummarizesdepartmentprioritiesandaccomplishmentsin2011.Ouremphasiscontinuestobeonmaximizingresources,seekingcreativepartnershipsandnewfundingopportunitiestomeetcurrentneedsandaddressnewchallenges.Highlightsfortheyearincluded:

• Celebratedour45thyearasadistricthealthdepartmentin2011andreflecteduponhowthedepartmenthasevolved tomeetthechangingneedsof ourcommunities.•ExpandedtheCommunity-BasedDentalClinicinSt.Johnsfrom3chairsto5chairsandincreasedthedaysof operationfrom2to5,morethandoublingcapacity.Theday-do-dayoperationswerealsotransitionedtotheMichiganCommunityDentalClinicswhohaveexpertiseinprovidingdentalservicestothelow-incomepopulation.•Adoptedanewvisionstatementandstrategicplanfortheagencyfocusingonqualityimprovement.•LaunchedacomprehensiveCommunityHealthAssessmentandImprovementplanningprocessinconjunctionwithcommunitypartnersineachcountytoimprovehealthandwell-being.• Collaboratingwithcommunitypartnerstoreducetheprevalenceof obesityinthedistrict.

In2011,GovernorSnyderheldastatewideObesitySummitandlaunchedtheMichiganHealthandWellness4X4Plan.Residentscanimprovetheirpersonalhealthbypracticingfourkeyhealthbehaviors:1)Maintainahealthydiet,2)Engageinregularexercise,3)Getanannualphysicalexaminationand4)Avoidalltobaccouseandexposure.Inconjunctionwiththesehealthybehaviors,weshouldallbeawareof fourkeyhealthmeasures:1)BodyMassIndex(BMI),2)Bloodpressure,3)Cholesterolleveland4)Bloodsugarlevel.If residentspracticethe4X4plan,theirliveswillbefullerandourhealthcarecostswillbereduced.

Inconclusion,theMid-MichiganDistrictHealthDepartmentwillcontinueeffortstoenhancethehealthandwell-beingof theresidentsof Clinton,GratiotandMontcalmCountiesbyprovidingexceptionalcustomerservice,enhancingcommunitypartnershipsandactivelyaddressingemergingissues.Iencourageyoutoreviewthereportandcallthehealthdepartmentwithanyquestionsat(989)831-3610.TheMid-MichiganDistrictHealthDepartmentappreciatesyourcontinuedsupportandlooksforwardtohelpingmakeourcommunitiessaferandhealthier.

A Message from the Health Officer

Sincerely,

KimberlySingh,M.A.,C.H.E.S.HealthOfficer

2


The Mid-Michigan District Health Department Board of Health governs the agency’s programming, finances and personnel. It is composed of two county commissioners, appointed by each of the three member counties (Clinton, Gratiot and Montcalm) served by the health department. It is the responsibility of the Board of Health to see that a plan is formulated and implemented which will provide long-term, continuing health protection for the residents of the district.

(front l-r) Roland Merignac and Carl Paepke. (back l-r) Health Officer Kimberly Singh, Teresa Hagerman, Medical Director Dr. Robert Graham, Tom Lindeman, Jack Enderle, and Bruce Delong.

JACK A. ENDERLE (CLINTON COUNTY)Mr.EnderleisservinghisfifthyearontheBoardof Health.AsChairpersonof theBoard,heisresponsibleforpreparingandapprovingmeetingagendasandpresidingatBoardmeetings.AsChairpersonof thePersonnelCommittee,hepresidesduringnegotiationswithcollectivebargainingunitsandpresentsrecommendedsalaryandbenefitchangestotheBoard.Healsoservesasamemberof theFinanceCommitteeandisViceChairpersonof theMid-CentralCoordinatingCommittee.HeisalsoarepresentativeontheMichiganAssociationforLocalPublicHealth(MALPH)Board.

BRUCE DELONG (CLINTON COUNTY)Mr.DelongisservinghisfirstyearontheBoardof Health.Heservesasamemberof theProgramCommittee.

ROLAND MERIGNAC (GRATIOT COUNTY)Mr.MerignacisservinghisthirdyearontheBoardof Health.AsChairpersonof theProgramCommittee,heisresponsiblefordevelopingandpresentingallproposedpoliciesandprogramchanges.Healsoservesasamemberof thePersonnelandMid-CentralCoordinatingCommittees.

TERESA HAGERMAN (GRATIOT COUNTY)Ms.HagermanisservingherfirstyearontheBoardof Health.Sheservesasamemberof theFinanceCommitteeandQualityVisionActionTeam(QVAT).

TOM LINDEMAN (MONTCALM COUNTY)Mr.LindemanisservinghiseighthyearontheBoardof HealthandisViceChairpersonfortheBoard.HealsoservesonthePersonnelCommittee.

CARL PAEPKE (MONTCALM COUNTY)Mr.PaepkeisservinghisseventeenthyearontheBoardof Health.AsChairpersonof theFinanceCommittee,heisresponsiblefordevelopingandpresent-ingtheproposedannualbudgetforBoardapproval.Healsoservesasamemberof theProgram,Mid-CentralCoordinating,andEmergencyPreparednessCoordinatingCommittees.

KIMBERLY SINGH, M.A., C.H.E.S. (HEALTH OFFICER)Ms.Singhisservingherfifteenthyearastheagency’sHealthOfficer.Sheisresponsibleforcarryingoutthepoliciesof theBoardof Healthandoverseeingtheinternaloperationsof theHealthDepartment.

ROBERT GRAHAM D.O., M.P.H., F.A.A.F.P. (MEDICAL DIRECTOR)Dr.GrahamisservinghistwentiethyearastheMedicalDirectorfortheMid-MichiganDistrictHealthDepartmentandisalsotheMedicalDirectorfortheCentralMichiganDistrictHealthDepartment.Heisresponsiblefordetermininganddirectingmedicalpoliciesandprocedures.

3

2011 BOARD OF HEALTH


TOTALEXPENSES................................

49%23%10%10%8%

$6,064,430

State&FederalFunds ....................................................................................Appropriations&CountyFunding .............................................................Other ................................................................................................................Fees&Collections .........................................................................................MedicaidandMedicareCollections ............................................................ TOTALREVENUES.................................

Revenues

70%11%9%6%3%1%0%

$6,064,430

Personnel..........................................................................................................Supplies..............................................................................................................Other................................................................................................................Contractual......................................................................................................Travel................................................................................................................Communication...............................................................................................Equipment........................................................................................................

Expenditures

2011 FINANCES

State&FederalFunds

Appropriations&CountyFunding

Fees&CollectionsOtherFunding

MedicaidandMedicare

8%

10%

49%

23%

10%MEDICAID & MEDICARECOLLECTIONSFEES & COLLECTIONS

STATE & FEDERALFUNDINGAPPROPRIATIONS &COUNTY FUNDINGOTHER FUNDING

Personnel

Supplies

Other

Contractual

Travel

CommunicationEquipment

70%

11%

6%1%

3%0%

9%

Series1

Series2

The accounting

and financial management of the

health department’s resources are

overseen by the Administrative

Services Division. The financial

management staff are responsible

for complying with budgeting

requirements and financial reporting

for the various state and federal

agencies that provide financial resources to the

agency.


Through community education and enforcement of laws designed to protect the public, the Environmental Health Division continually works to protect the environment in which we live by responding to emerging

issues in areas such as food safety, sanitation, drinking water supplies, and wastewater disposal.

5

Technology AdvancementsTheuseof technologywithinourEnvironmentalHealthDivisionhasadvancedgreatlyoverour45yearhistory.Intheearlydays,reportsandnoticeswerehandwrittenwithmanyissuessettledverbally.Theprogressiontotheuseof carbonpaper,thenprovidingahandwrittenlettertoclericalstaff toreceivinganactualprinteddocumentfromtheDivision’sonecomputerwasseenaslandmarkatthetime.Today,theDivisionstaff usetechnologyeveryday.Oncemaintainedbymemoryorasheetof paper,sitesaffectedbyenvironmentalcontaminationarenowavailableelectronicallyviawebsitelistingsandelectronicmapping.Withcriticalinformationmoreavailable,waterqualityissuesareaddressedquickerandmorecomprehensivelythaneverbefore.Oncehandwritten,foodserviceinspectionsarenowentered,printed,anddiscussedwithfacilitiesonthespotwithlaptopcomputers.Inspectionresultsarenowtrackedelectronicallyviadatabases,allowingforprogramplanningandtrendanalysis.Inthepast,theagency’sstandardformswerewhatevertheinspectorhadinoraroundtheiroffice.Today,ouragencymaintainspolicy,procedure,andapprovedforms,allavailabletoourstaff electronicallyonaninternalwebsite,assuringconsistency.Allof thesenewusesof technology

improveawarenessandresponsetoenvironmentalconcerns,notonlywithinourDivision,butalsowithinthecommunity.TheEnvironmentalHealthDivisionwillcontinuetolooktoprovideimprovementsinmakinginformationavailabletothepublicandcommunitypartners.

Environmental Health Standard AdvancementsOnecannotquicklylookbackacross45yearsof EnvironmentalHealthwithoutbrieflytouchinguponthemanychangesinenvironmentalregulations.Locally,theDistrict’sfirstEnvironmentalHealthRegulationswereadoptedandeffectivein1967.Undergoingfourrevisionsinthepast40years,thecurrentEnvironmentalHealthRegulationsnowcontainmodern,comprehensivelanguageconsistentwithlocalconditions.Thepast45yearshasseenchangesinthefoodsafetyprogramaswell.Foodserviceinspections,onceregulatedundera1976statute,arenowmanagedunderMichigan’sFoodLawof 2000.Michigan’sFoodLawwasamendedasrecentas2008andremainstheregulatorycornerstoneforlocalhealthdepartmentsandtheStateof Michigan.WaterregulationswithinMichiganhavealsochangedinthepast45years.Inadditiontochangesinlocalregulations,theStateof Michiganhashadseveralstatuteschangeovertimeincluding,butnotlimitedto,lawsfrom1976and1978aswellaslandmarkamendmentsin1994and1999.Theseincreasinglycomplexenvironmentalstandardshavespecificallyaddressedareassuchaswaterwellconstruction,watersampling,andgroundwaterwithdrawals;allof whichaffectthequalityof lifeinourlocalcommunities.TheEnvironmentalHealthDivisionhasremainedcommittedtonotonlykeeppacewiththechanginglandscapeof environmentalstandardsbutalsolookforwardforopportunitiestoeducateandensurehealthycommunities.Community Education AdvancementsIn1966,eachof ourthreeofficeshadoneEnvironmentalHealthSpecialistresponsibleformultipleprogramsandinspections.Educationeffortstookplace,buttypicallyonalimitedscale.Todaywemaintainmultipleeducationeffortsonamuchlargerscale.Thispastyearalone,ourDivisionhasinteractedwithamyriadof differentcommunitygroups.WepresentededucationalsessionsonenvironmentalhazardssuchasMercury,Lead,andRadontoCommissiononAginggroups,visitedlocalschoolstopresentonsubjects,suchasindoorairissues,andofferedsessionsupdatingcommercialwaterwellownersof currentandchangingregulationsaffectingtheirwatersupplysystems.TheDivisionalsocontinueditscommitmenttoprovidingfoodservicefacilityownersandmanagerswithstate-of-the-arttrainingandcertificationregardingbestpracticesinfoodsafety.Lookingforward,theEnvironmentalHealthDivisionwillcontinuetoseekevenmoreopportunitiestoprovideenvironmentaleducation.

ENVIRONMENTAL HEALTH

Bob Gouin,R.S.,M.B.A.Environmental Health Division Director


In 2011, the Environmental Health Division provided service to 3,580 unduplicated clients or facilities throughout the district.

The focus of the food program is to assure a safe, clean food product for the public through regular inspections and education. Efforts in this program are key elements in assuring the meals we consume outside of home are safe.

Food Program Number of Services Provided (unduplicated)Clinton Gratiot Montcalm District

Advanced Food Training ClassesFood Service Inspections (Fixed) Food Service Inspections (Temporary)

94396108598

38313

65416

98471139708

2301180

3121,722TOTALS

13837

175

8640

126

551671

27993

372

One of the most important methods of preventing the spread of disease and viral infection is the proper treatment of human wastewater. These programs provide guidance and oversight for on-site sewage disposal.

WasteWater

management Number of Inspections and Permits Issued (unduplicated)Clinton Gratiot Montcalm District

On-Site Sewage Disposal PermitsSite EvaluationsTOTALS

TOTALS

Assuring a good quality of life where we liveand play is a key component of these programs.

Number of Clients Served (unduplicated)Clinton Gratiot Montcalm District

Campground ProgramDept. of Human Services InspectionsNuisance Complaint Investigations Radon Test Kits Distributed Public Swimming Pool Program

223998

1258

292

34112178949

521,325

72540

1147

193

54840

71037

840

environmental Quality

A fundamental component of public health met by these programs is the protection of our lakes, streams and the water we drink.

Number of Clients Served (unduplicated) Clinton Gratiot Montcalm District

Groundwater Quality ControlWell Contaminate Monitoring Septage Waste Haulers Trucks Inspected Sites Inspected Water System Evaluation Sewage Disposal Evaluation

1158

11412

141

12212

10312

150

28535

15101619

380

52255

36171823

671

surFace &groundWater control

TOTALS


The Community Health and Education Division provides a variety of preventative health services to individuals and families in a variety of settings, including health department clinics, homes, community centers, churches,

schools, and throughout the entire community.

7

Aswecelebrateour45thAnniversary,it’satimetoreminisce,trackourprogress,andbuildavisionforourfuture.

Forty-five years ago, ourstaff feltluckytohaveatypewriter,especiallyif ithadtheautocorrectfunction.Carbonpaperwasaneverydayofficeitem.Thisyear,wecontinuedthetransitiontoelectronichealthrecords.TheChildren’sSpecialHealthCareServicesprogramwasthefirstto“golive”onApril1,2011.AlongwiththeEZLinkelectronicrecordsystem,ourstaff cannowcommunicatechildren’sneedswiththestateelectronicallyandassistclientsdistrictwidefromanyMMDHDofficelocation.CSHCSstaff usesInsightAnywheresoftwaretocompletePlansof CareforSpecialNeedschildreninthehome.TheCommunicableDiseaseprogramrolledoutanelectronicreportingsystemfortheschoolswithfullimplementationatthestartof the2011schoolyear.Thesystemhasimprovedschoolcommunicablediseasereportingcompliance.OnOctober1,2011the

FamilyPlanningprogramwentliveonInsight.Thefamilyplanningstaff,alongwithManagementof InformationSystems(MIS)support,builttheirownrecordsystemfortheprogram.Theelectronicrecordshaveimproveddatacollectionandreportgeneration.Paperchartsandfilingcabinetsarebecomingthingsof thepast.

Thirty-five years ago, theWICprogrambeganatMMDHD.In1977MMDHDWICdistributedhandwritten,carboncopycouponsforfoodandserved350participants.In2011WICisfullyelectronicandservedover4,100participants.Inlate2010,MMDHDreceiveda$130,000granttohire4parttimeWICBreastfeedingPeerCounselors.ByJanuary2011thePeerCounselorsweremeetingwithpregnantWICclientstoexplainthebenefitsof breastfeedingandofferingin-officeandphonesupporttobreastfeedingmothers.Thepercentageof WICwomenwhoinitiallyfedtheirinfantbreastmilkincreasedfrom64%to70%.“Becauseratesof obesityaresignificantlylowerinbreastfedinfants,nationalcampaignstopreventobesitybeginwithbreastfeedingsupport.Thereisa15%to30%reductioninadolescentandadultobesityratesif anybreastfeedingoccurredininfancycomparedwithnobreastfeeding.”(Pediatrics.February27,2012)MMDHDcongratulatesemployeeAngieMartin,RD,whoreceivedInternationalBoardCertifiedLactationConsultantcertificationthisyear.Thisisachallengingandhighly-recognizedcredential.Breastfeedingsupportoffersthepromiseof ahealthierfutureforbabies.

Fifteen years ago,therewerenodentalclinicsintheMMDHDjurisdictionservinglowincome-residents.OralHealthpreventioninitiativeswerenonexistent.MMDHDplayedanintegralroleintheestablishmentof thetwodentalclinicscurrentlylocatedinSidneyandSt.Johns.In2011,throughtheassistanceof communitypartners,theSt.JohnsDentalCenterwasexpandedfromthreetofiveoperatories.OnSeptember1,2011,thedentalclinicoperationwastransferredtoMichiganCommunityDentalClinics,Inc.Wecontinuetoworkinacooperativeenvironmentsharingreferralsandofficespace.MMDHDsOralHealthCoordinatorcontinuestospearheadoralhealthinitiatives,suchasfluoridevarnishapplicationstochildrenthroughHeadStartandWICclinics.Throughhercollaborativeeffortswithlocalvolunteerdentists,2ndand6thgradestudentsinMontcalmCountyreceiveddentalsealantapplications.

Today, Mid-MichiganDistrictHealthDepartment’shighlyskilledandinnovativestaff continueworkingwithourcommunitypartnerstocreateahealthyfutureforourcommunities.

COMMUNITY HEALTH & EDUCATION

Bonnie Havlicek,R.N., B.S.N.Community Health & Education Division Director


In 2011, the Community Health and Education Division provided service to 37,800 unduplicated individuals and families.

The Community-Based Dental Clinic in St. Johns serves Medicaid-eligible adults from Clinton and Gratiot Counties who, without the clinic, would not have access to services. The sealant and fluoride varnish programs promote oral health education and prevention.

oral HealtH

N/A648198846

413648375

1,436


Community-Based Dental Clinic- St. JohnsSealants PlacedFluoride Varnish Application

250N/A12

262

163N/A165328

TOTALS

TOTALSThese activities target specific chronic diseases. Efforts focus on early detection and referral.

cHronic disease control

60290350

39466505

1801,0681,248

81312393

Number of Clients Served (unduplicated) Clinton Gratiot Montcalm DistrictBreast & Cervical Cancer ControlLead Poisoning Screening


Communicable Disease Control HIV Counseling/TestingImmunizations Sexually Transmitted Disease Control

32216

1,215339

1,892

52637

1,196476

2,235

33455

1,493633

2,515

1,182108

3,9041,4486,642TOTALS

These programs offer testing, education, prevention and treatment services to control communicable diseases within our communities. Many of these services may be available at low or no cost.

communicable disease control

Maternal and child health programs give financial, social, nutritional and medical support to qualified families. These programs benefit the community by reducing infant mortality, ensuring healthy births and maintaining infant and child health.

maternal & cHild HealtH


Hearing Screenings (# conducted) Vision Screenings (# conducted) Children’s Special Health Care Family Planning Services Women, Infants & Children Program Maternal Support Services Infant Support Services

2,8154,461

175461

1,138 N/A

N/A9,050

2,0883,282

152664

1,327176106

7,795

3,4885,045

266827

1,976N/AN/A

11,602

8,39112,788

5931,9524,441

176106

28,447

TOTALS


Ourhealthcaresystemisoutof date.

Thetwentiethcenturywitnessedanexplosionof medicalknowledge.Scientistdiscoveredgermsthatcauseacuteillnessesliketuberculosisandmeningitis.Immunizationshavenearlyconquereddiseasesthatroutinelykilledhalf of allchildrenbeforetheyturnedfiveyearsold.Aseptictechniques(proceduresperformedundersterileconditions)madesurgerysafer.Bytheendof thetwentiethcentury,mostacuteillnessrateshaddecreasedby99percent.Morepeoplewerelivinglonger.

Acuteillnessessuchaspolio,tetanus,andmeasleshavebeentamed.Chronicillnessessuchasdiabetes,heartdisease,andcancerhavetakenoverastheleadingkillerandcripplerof peoplein

thetwenty-firstcentury.Unfortunately,ourapproachtochronicillnessisthesameasforacutediseases.Wewantapilltotakecareof ourbloodsugar,wewantapilltolowerourcholesterol,wewantawonderdrugtoknockoutcancer.

Thetwentiethcenturyapproachtomedicinewillnotmakepeoplehealthierorlivelonger.Thecounties’medicalbudgetsaregrowing,yetwearegettinganawfulreturn.Diabetesisaperfectexampleof whatiswrongwithourmedicalsystem.MoreandmorepeoplearebecomingdiabeticsinAmerica.Thefinancialandillnessburdenof thischronicdiseasehasbecomesuffocating.Diabeticsaremorelikelytoneeddialysis,becomeblind,haveheartattacks,andloseextremitiestoamputation.

Whatcanbedone?

Foranswerstowhatneedstobedone,letuslookatanexampleof whatworks.Oneof themodernwondersof healthylivingissomethingsimplyamazing:sewagedisposal.Thisfeatissomethingwealltakeforgranted.Keepingpeopleseparatedfromsewagesavesmoreliveseverydaythanalltheopenheartsurgeriesthathavebeenperformedsincetheprocedurewasintroduced.

TherecentterribleearthquakeinHaitiisaperfectexampleof theconsequencesof thefailureof animportantinfrastructuresystem.Thesewagedisposalsystemwasdestroyed.Thewatersupplybecamecontaminatedbysewage.Thousandsof peoplecontractedCholeraandmanypeopledied.Itwasthelackof preventingtheco-minglingof drinkingwaterwithsewagethatcausedthedeaths.

Lookingbackatwhatworkedinthepasthasalwayscomedowntoprevention.Preventingtoothdecay,preventingdiphtheria,preventinginfantdiarrhealillnesses,preventingthespreadof diseasefromtaintedfoodallaresimplemethodsandsavelives.

Forchronicillnessesletusadoptpreventativemethods.Letuspouralittlemoreof today’smoneyintopreventingdiabetes,heartdiseaseandcancer.Weshouldmakethepracticeof preventionasimportantasthelatestsurgicalinnovation.Theeducationof doctorsandotherhealthcareprovidersshouldconcentrateonpreventingdiseaseaswellastreatingdisease.

The Medical Director provides general oversight of all health department programs, disease outbreak investigations and advises the MMDHD Board of Health in medical matters. He also provides consultation to

health care providers regarding diseases that affect the community.

9

A Message from the Medical Director

Robert GrahamD.O., M.P.H., F.A.A.F.P.Medical Director


Leading Causes of Death

1. Heart Disease2. Cancer3. Chronic Lung Disease4. Stroke5. Unintentional Injury6. Diabetes7. Alzheimer’s Disease8. Pneumonia/Influenza9. Kidney Disease10. Suicide Subtotal Age 65+

191.9152.6

31.245.722.220.527.69.98.49.3

519.3

11.9%

247.2180.3

61.360.430.422.722.918.518.510.0

672.2

13.7%

207.6196.8

49.153.850.221.023.219.920.915.0

657.5

13.0%

age-adjusted mortality Per 100,000PoPulation (2007-2009 average)

Clinton Gratiot Montcalm Michigan

NOTE: Values in red represent county rates greater than State of Michigan rate.

216.4184.8

45.541.735.425.323.215.315.211.2

614.0

12.7%

28.8%

23.7%

7.4%

3.4%

2.9%

2.1%

3.2%

2.1%

1.7%

1.5%

0% 10% 20% 30% 40%

Heart Disease

Cancer

Chronic Lung Ds.

Stroke

Unintentional Injury

Diabetes Mellitus

Alzheimer's Ds.

Kidney Disease

Pneumonia/Influenza

Suicide

Percent of All Deaths

Clinton County - 2009

34.1%

20.4%

6.2%

5.9%

3.1%

3.1%

2.6%

2.4%

2.1%

1.4%

0% 10% 20% 30% 40%

Heart Disease

Cancer

Chronic Lung Ds.

Stroke


Diabetes Mellitus

Alzheimer's Ds.

Kidney Disease

Pneumonia/Influenza

Suicide


Gratiot County - 2009

24.3%

24.3%

5.8%

6.9%

4.3%

2.8%

2.4%

2.6%

2.6%

1.7%

0% 10% 20% 30% 40%

Heart Disease

Cancer

Chronic Lung Ds.

Stroke


Diabetes Mellitus

Alzheimer's Ds.

Kidney Disease

Pneumonia/Influenza

Suicide


Montcalm County- 2009

26.7%

23.4%

5.7%

5.1%

4.3%

3.1%

3.0%

2.0%

1.8%

1.3%

0% 10% 20% 30% 40%

1. Heart Disease

2. Cancer

3. Chronic Lung Ds.

4. Stroke

5. Unintentional Injury

6. Diabetes Mellitus

7. Alzheimer's Ds.

8. Kidney Disease

9. Pneumonia / Influenza

10. Suicide


Michigan - 2009

The 10 disease categories shown in this table (lower right) represent the most frequent causes of death and account for about 75% of all deaths. The values represent the average number of deaths per 100,000 people for 2007-2009 (most recent data available). Mortality data helps provide a snapshot of the general health status of a community, which aids in the identification of health concerns and the development of intervention programs. This mortality data can also be used to compare the health status of one population to another (e.g., counties) or to evaluate the status of one population over time (e.g., county trends). The table provides a comparison of mortality rates between MMDHD’s 3 counties and Michigan. The bar charts below represent the proportion of all deaths during 2009 (most recent data available) attributable to each of the 10 leading causes of death.


Community Indicators

Community Health Status

0

2

4

6

8

10

98-02 99-03 00-04 01-05 02-06 03-07 04-08 05-09

Infa

nt

Dea

ths

per

1,0

00 B

irth

s

Combined Years

Infant Mortality Rate (us ing 5-year averages)

C lin ton G ra tio tM ontca lm M ich iganM I - W h ite H .P . 2010 G oal

Infant Mortality RateTheinfantmortalityrateisameasureof thenumberof infantdeaths(undertheageof 1year)per1,000livebirths.Infantsatgreatestriskof deatharethosebornprematurely,havinglowbirthweightorbornwithmajorcongenitalanoma-lies.Otherfactorsinfluencinginfantmortalityincludesocioeconomicstatus,ageandhealthof themother,riskof infantinjury,theextentof prenatalcare,andtheinfant’smedicalcareduringthefirstyearof life.Infantmortalityisoftenusedasanindexof thegeneralhealthof thecommunitysincemanyof theriskfactorsreflectoncommunityissuessuchashealthcareaccess,education,poverty,andlifestylechoices.Afterseeingasteadyimprovementininfantmortalityfromtheearly1970stoearly1990s,therateinMichiganhaschangedlittleinthe10yearsleadingupto2009,hoveringnear8deathsper1,000infants.Duringthemostrecentdecade,Clinton,Gratiot,andMontcalmCountieshavegenerallymaintainedalowerinfantmortalityratethanMichigan,andhavecomparedsimi-larlytothemortalityrateforCaucasian/whiteinfantsborninMichigan(approxi-mately6deathsper1,000infants).NationallyandforMichigan,themortalityrateforAfricanAmerican/blackinfantscontinuestobemorethantwicethatof Caucasianinfants.MMDHDcontinuestoadvocateforacommunity-widecol-laborativeefforttoexamineandreducefactorsthatleadtoinfantmortality.

0

10

20

30

40

50

00-02 01-03 02-04 03-05 04-06 05-07 06-08 07-09 08-10

Pre

gn

anci

es p

er 1

,000

Tee

ns

15-1

7

Combined Years

Teen Pregnancy (Age 15-17 yrs.)(us ing 3-year averages)

C lin ton G ra tio tM ontca lm M ich iganH P 2010 G oa l

Teen Pregnancy RateTheteenpregnancyratetypicallyrepresentsthenumberof women15to19yearsof agewhohavegivenbirth,experiencedanabortionormiscarriedper1,000teensof thesameage.Forthisreport,however,thedatarepresentsamorespecificgroupof teens,age15to17yearsonly.From1990to2005,Michiganexperiencedacontinuousdeclineintherateof teenpregnancy.Since2005,theratefor15-17year-oldshasleveledoff atapproximately28pregnanciesper1,000teens.ThecountiesservedbyMMDHDhavegenerallyshowndeclinesintheteenpregnancyrateoverthepast15years.GratiotandClintonCountyrateshaveremainedbelowthatof Michigan,whiletheMontcalmCountyratehasgenerallyremainedabovethatof Michigan.Effortstoencour-ageabstinence,responsiblesexualdecisionmaking,andincreaseduseof contraceptivesareimportantcontributorstothedecreaseinteenpregnancy.MMDHDoffersFamilyPlanningservicesinall3counties.

11

Many indicators are used to measure the health of the population. The following two pages summarize select indicators which help create a snapshot of the health status of the residents living in Clinton, Gratiot, and Montcalm counties. In some cases, Michigan data has also been provided to allow for comparison between the counties and State of Michigan.


Selected Birth IndicatorsSelected Birth CharacteristicsFindingsfromtheCentersforDiseaseControlandPrevention(CDC)indicatethatsomemothers-to-beengageinhigh-riskbehaviorsorexperiencehigh-riskconditionsbefore,during,andshortlyafterpregnancy.Thisisimportantbecausehowmomsbehaveandwhathappenstothemcaninfluencethehealthof theirgrowingbaby,evenbeforebirth.Someof thesecharacteristicsaremonitoredatthecountyandstatelevelssotrendscanbeobservedandevaluated.Thesefindingsareusefulindesigningpublichealthprogramsandpoliciesthataddressthesebehaviorsandexperiencessothatthehealthof mothersandtheirinfantscanbeimproved.Thetable(above right)comparesselectedbirthcharacteristicsforClinton,Gratiot,andMontcalmCountiesaswellastheStateof Michigan.

Selected Maternal Birth TrendsThegraphsbelowrepresenttrendsof selectedmaternalbirthcharacteristics.Atthestatelevel,both“RepeatTeenBirths”(womengivingbirthtoasecondchildwhileateen)and“BirthstoMotherswhoSmokedDuringPregnancy”appeartobemovinginafavorabledirection(ratesdecreasing)overthepastdecade;whereas“BirthstoUnwedMothers”and“BirthswithMedicaidasSourceof Payment”appeartobemovinginanunfavorabledirection(ratesincreasing).County-leveltrendsgenerallymirrorthestatetrendforeachindicator,withtwominorexceptions:GratiotCountyhasexperiencedarecentfluctuationinthepercentageof repeatteenbirthsandthepercentageof GratiotCountymotherswhosmokedduringpregnancygenerallyincreasedduringtheperiodindicatedinthechart.

12

0%

6%

12%

18%

24%

2000 01 02 03 04 05 06 07 08 09 10

Repeat Teen Births(as a percentage o f to ta l teen b irths)

Clinton Gratiot Montcalm Mich.

0%

10%

20%

30%

40%

50%

2000 01 02 03 04 05 06 07 08 09 10

Births to Unwed Mothers(as a percentage o f to ta l b irths)


0%

10%

20%

30%

40%

50%

60%

2000 01 02 03 04 05 06 07 08 09 10

Births with Medicaid as Source of Payment (as a percentage o f to ta l b irths)


0%

5%

10%

15%

20%

25%

30%

1997 98 99 2000 01 02 03 04 05 06 07

Births to Mothers who Smoked During Pregnancy


Total Live Births – to women under age 20 years (teens) – to women over age 40 years% birth mothers under 20 years of age% birth mothers w/less than 12 yrs education% birth mothers unmarried% birth mothers enrolled in Medicaid% birth mothers who smoked while pregnant% received prenatal care during 1st trimester% low birth weight (under 5 lbs. 8 oz.)% very low birth weight (under 3 lbs. 5 oz.)% pre-term birth (born before 37 complete weeks)

7063527

5.05.0

23.129.615.483.6

9.61.39.5

419405

9.513.443.054.227.467.16.71.99.3

7919711

12.318.341.757.426.370.8

6.80.88.6

114,71710,944

2,8239.5

15.442.145.317.874.38.41.79.8

selected birtH cHaracteristics - 2010Clinton Gratiot Montcalm Michigan

NOTE: Values in red indicate specific county results that are less favorable than state results. SOURCE: Birth Characteristics data from Michigan 2008 Resident Birth Files, Michigan Department of Community Health, 2011.

4 2011 MMDHD Annual Report13

We take action to assure the health and well-being of our community and the environment by responding to public health needs

and providing a broad spectrum of prevention and educational services.

Our Mission

2011 MMDHD Annual Report 4www.mmdhd.org

BOARD OF HEALTH/ADMINISTRATIVE OFFICES

615 N. State St., Ste. 2Stanton, MI 48888

989.831.5237fax 989.831.5522

CLINTON BRANCH OFFICE 1307 E. Townsend Rd.

St. Johns, MI 48879989.224.2195

fax 989.224.4300Off-site clinic: DeWitt

GRATIOTBRANCH OFFICE

151 Commerce Dr.Ithaca, MI 48847

989.875.3681fax 989.875.3747

Off-site clinic: Alma

MONTCALMBRANCH OFFICE

615 N. State St., Ste. 1Stanton, MI 48888

989.831.5237fax 989.831.3666

Off-site clinics: Greenville, Howard City

www.mmdhd.org

PREVENTIVE HEALTH SERVICES

CLINTON*MONTCALM*GRATIOT

MID-MICHIGANDISTRICT

HEALTH DEPARTMENT

Environmental Health Programs• Overseeoperationalstatusof septicsystemsanddrinkingwaterwells• FoodServiceSanitationProgram• Issuepermitsforinstallingorrepairingsewagedisposalandwatersupplysystems• Departmentof HumanServices-LicensedFacilityInspections• Inspectpublicswimmingpools,spasandhottubs• Rabiescontrolthroughinvestigationof animalbitecomplaints• Annualinspectionsof campgrounds• Regulatetheserviceof septictanks,portabletoiletsandseptagewastehaulers• Providetestkitsforradon• Reviewnewpublicpoollocationplansandmonitorpoolsamplequalityreports• Leadtestinginhomes

Services Provided

Graph ic des ig n and l ayout : L es l i e Ki n nee, MMDHD

Community Health And Education Programs• WIC(Women,InfantsandChildren)• FamilyPlanningProgram• ImmunizationProgram• CommunicableDiseaseControl• SexuallyTransmittedDiseasetesting,treatment,counselingandfollow-up• TuberculosisControl• HIVCounselingandTesting• Children’sSpecialHealthCareServices• MaternityOutpatientMedicalServices(M.O.M.S.), MIChildHealthyKids

Enrollment• MaternalandInfantSupportServices• BreastandCervicalCancerControlProgram(BCCCP)• Oralhealth(fluoride,varnish,andsealant)applications• HearingandVisionScreening• HealthEducation• Bloodleadtestingandeducation• Rabiesinvestigation• Mid-MichiganHealthPlanenrollmentcoordination


PRSRT STDU.S. POSTAGE PAID

PERMIT #110MT. PLEASANT, MI

48858

MID-MICHIGAN DISTRICT HEALTH DEPARTMENTADMINISTRATIVE OFFICES615 N. STATE ST., SUITE 2STANTON, MI 48888-9702

PREVENTIVE HEALTH SERVICES

CLINTON*MONTCALM*GRATIOT

MID-MICHIGANDISTRICT

HEALTH DEPARTMENT

MID-MICHIGAN DISTRICTHEALTH DEPARTMENTYour public health team, connecting with

our communities to achieve healthier outcomes.

www.mmdhd.org

Gratiot Branch Office (Ithaca)

Clinton Branch Office (St. Johns)

Montcalm Branch Office (Stanton)

Documents

Mid-Michigan District Health Department...• Oral Health program awarded grants to apply sealants and fluoride varnish ... department with any questions at (989) 831-3610. The Mid-Michigan