Sustaining Healthy Sustaining Healthy Communities - A Communities - A
ChallengeChallenge
Maria Torroella Carney, MD, Maria Torroella Carney, MD, FACPFACP
March 23, 2010March 23, 2010
Long Island Center for Health Long Island Center for Health PolicyPolicy
AssessmentMonitor Health
Diagnose &Investigate
Policy DevelopmentInform & Educate
Mobilize CommunityDevelop Policy
AssuranceEnforce Law
Link to Provide CareAssure Competent Workforce
Evaluation
Public Health Core Functions
County Health RankingCounty Health Ranking
Health OutcomesHealth Outcomes – 6th– 6th• Mortality – 1stMortality – 1st• Morbidity – 17Morbidity – 17thth
Health Factors – 1stHealth Factors – 1st• Healthy Behaviors – 7Healthy Behaviors – 7thth (tobacco, diet, exercise, alcohol (tobacco, diet, exercise, alcohol
use, high risk sexual behavior)use, high risk sexual behavior)• Clinical Care – 3rdClinical Care – 3rd• Social and Economic Factors – 2ndSocial and Economic Factors – 2nd• Physical Environment – 32Physical Environment – 32ndnd
Environmental Quality Environmental Quality Built Environment Built Environment
Source: Robert Wood Johnson Foundation in partnership with University of Wisconsin Population Source: Robert Wood Johnson Foundation in partnership with University of Wisconsin Population Health Institute County Healthy Rankings 2010Health Institute County Healthy Rankings 2010
Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 1985BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 1990BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 1997BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 2000BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 2005BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 2007BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Community Health Community Health AssessmentAssessment
Nassau County Department of Health Nassau County Department of Health report to NY State Department of report to NY State Department of Health created every 5 years - contains:Health created every 5 years - contains:
Population ReportPopulation Report Health DataHealth Data Local Health Unit DescriptionLocal Health Unit Description Problems and Issues in the CommunityProblems and Issues in the Community Local Health PrioritiesLocal Health Priorities Opportunities for ActionOpportunities for Action
Average Age-Sex-Adjusted Death Rates from Selected Diseases*
(2005-2007)
0
100
200
300
400
500
600
700
800
New York State New York State(excluding NYC)
Nassau County
Region
Rat
e (p
er 1
00,0
00)
Total Death
Diseases of the Heart
Malignant Neoplasms
CerebrovascularDiseaseAIDS
Chronic LowerRespiratory DiseaseTotal Accidents
Diabetes
Homicide and LegalInterventionCirrhosis of the Liver
Suicide
Series12
NYS Vital Stats: Rates are directly standardized using Census 2000*Suicide w as included in 2007, only
Average Rates of Cardiovascular Disease Mortality 2005-2007
290
300
310
320
330
340
350
360
Rate
per
100
,000
pop
ulat
ion
New York State
NYS excluding NYC
Nassau County
Source: NYSDOH Vital Statitics 2005-2007
Average Rate of Cardiovascular Disease Mortality by Sex, Nassau & NYS, 2005-2007
0
50100
150
200
250300
350
400
Nassau County New York State
Rate
per
100
,000
pop
ulat
ion Female
Male
Source: NYSDOH Vital Statistics 2005-2007
Average Rate of Cardiovascular Disease Hospitalizations, 2004-2006
18501900195020002050210021502200225023002350
Rat
e pe
r 100
,000
pop
ulat
ion
New York State
NYS excluding NYC
Nassau County
Source: NYSDOH SPARCS 2004-2006
0
50
100
150
200
250
300
350
400
450
500
1976-
1980
1981-
1985
1986-
1990
1991-
1995
1996-
2000
2001-
2005
Nassau County
NYS
NYS excl. NYC
Source: NYS Cancer Registry 1976-2005
Cancer Incidence Rates among Females (All Invasive Malignant Tumors) 5 Year Trends
(1976-2005)Age-adjusted Rate per 100,000 Population
Cancer Incidence Rates among Males (All Invasive Malignant Tumors) 5 Year Trends (1976-2005)
0
50
100
150
200
250
300
350
400
450
500
1976-1980 1981-1985 1986-1990 1991-1995 1996-2000 2001-2005
Age-
Adju
sted
Rat
e pe
r 100
,000
pop
ulat
ion
Nassau County
NYS
NYS excluding NYC
Source: New York State Cancer Registry 1976-2005
Average Mortality Rate Among Females by Type of Cancer, 2001-2005
25.5
16.4
37.5
3 1.6
25.5
16.6
43.8
2.5
1.9
26.2
15.6
37.7
2.2
2.1
05
101520253035404550
Fem
ale
Brea
st
Col
orec
tal
Lung
and
Bron
chus
Live
r/int
rahe
patic
bile
duc
t
Mel
anom
a of
the
skin
Age
-adj
uste
d ra
te
per 1
00,0
00 p
opul
atio
n
NYS
NYS excluding NYC
Nassau County
Source: New York State Cancer Registry
Average Incidence Rate Among Malesby Type of Cancer, 2001-2005
63.5
166.
3
80.8
10.9 17
.1
64.5
172.
6
87.7
8.2 20
.5
64.5
163.
8
75.5
8.6 26
.1
020406080
100120140160180200
Color
ecta
l
Pros
tate
Lung
and
Bron
chus
Liver
/intra
hepa
ticbil
e du
ct
Mela
nom
a of
the
skin
Age-
adju
ted
Rate
per
100
,000
Po
pula
tion
NYS
NYS excluding NYC
Nassau County
Source: New York State Cancer Registry
Cancer Mortality among White and Black Females Nassau County, 2001-2005
05
1015202530354045
Fem
ale
Bre
ast
Col
orec
tal
Lung
&B
ronc
hus
Live
r/int
rahe
patic
bile
duc
t**
Mel
anom
a of
the
skin
**
Rat
e pe
r 10
0,00
0 po
pula
tion
White
Black
Source: NYS Cancer Registry 2001-2005** Rates for Blacks are based on fewer than deaths per year therefore are unstable.
Cancer Mortality among White and Black Males Nassau County, 2001-2005
010203040506070
Colo
rect
al
Pros
tate
Lung
&Br
onch
us
Live
r/int
rahe
pati
c bi
le d
uct**
Mel
anom
a of
the
skin
**Rat
e pe
r 100
,000
pop
ulat
ion
White
Black
Source: NYS Cancer Registry 2001-2005** Rates for Blacks are based on fewer than 5 deaths per year therefore are unstable.
Proportion of Average Injury Hospitalization Rate by Type within Age GroupNassau County, 2004-2006
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Age (years)
Perc
ent
Struck by Object/Person
Self Inf licted
Poisonings
Pedestrian
Motor Vehicle Crash
Falls
Assault
Source: NYSDOH SPARCS 2004-2006Age-adjusted to the US Projected Population
The Rate of Hospitalizations due to Falls 2005-2007
32
33
34
35
36
37
38
39
40
41
42
43
1
Age
-Adj
uste
d R
ate
per
10,0
00 P
opul
atio
n
Nassau County New York State New York State Excluding New York City
Rate difference is statistically significant between both Nassau County and NYS and NYS excluding NYCSource: NYSDOH County Health Assesment Indicators
Average Teenage (15-19 years) Pregnancy Rate 2005-2007
0
10
20
30
40
50
60
70
NYS NYS excluding NYC Nassau County
Rate
per
1,0
00 fe
mal
e po
pula
tion
aged
15-
19 y
ears
Source: NYS DOH Vital Statistics, 2005-2007 New York State
Communities with Highest Teen Pregnancy Rates Nassau County, 2005-2007
Nassau County, 24.2
0
20
40
60
80
100
120
140
Communities (Zipcode)
Rat
e pe
r 1,0
00 fe
mal
e po
pula
tion
aged
15-
19
*Average of Nassau CountySource: NYS DOH Vital Statistics, 2005-2007
% All Pregnances Vs. Teenage Pregnancies by TypeNassau County, 2005-2007
01020304050607080
Live Births InducedAbortion
Spon. FetalDeaths
Perc
ent
All Pregnancy
Teenage Pregnancy
Source: NYS DOH Vital Statistics, 2005-2007
Average Rate of Induced Abortion 2005-2007
0
100
200
300
400
500
600
NYS NYS excluding NYC Nassau County
*Rat
e
Source: Vital Statistics of New York State*Number of induced abortions per 1000 live births
Average Infant Death Rate 2005-2007
0
1
2
3
4
5
6
7
New York State NYS excluding NYC Nassau County
Rate
per
1,0
00 li
ve b
irths
Source: NYS DOH Vital Statistics
Communities with Highest Average Infant Death Rates, Nassau County 2005-2007
Average, 4.3
0
2
4
6
8
10
EASTMEADOW
UNIONDALE BALDWIN* BELLMORE* ROOSEVELT*
Deat
hs u
nder
1 y
ear o
f age
per
1,0
00
live
birth
s
Source: Vital Statistics of New York State* Frequency of Less than 5/yr Average: Average rate for Nassau County
0
20
40
60
80
100
Rat
e p
er 1
00,0
00
Po
pu
lati
on
Rates of Gonorrhea 2005-2007
Nassau County New York State
0
200
400
600
Rat
e pe
r 100
,000
Po
pula
tion
Males Females
Rates of Chlamydia by Sex, 2005-2007
Nassau County
New York State
Source: NYSDOH County Health Assessment Indicators
Average Chlamydia Rate Among Females by AgeNassau County, 2006-2008
29.85
1413.551315.01
148.6444.83 5.71
0200400600800
1000120014001600
14 andunder
15-19 20-29 30-39 40-49 50+Age Group (Years)
Rate
per
100
,000
po
pula
tion
Source: NYSDOH, Health Information Network, Communicable Disease Statistical Queries
Average Gonorrhea Rate Among Females By AgeNassau County, 2006-2008
130.04150.94
23.828.02 2.43
0.0020.0040.0060.0080.00
100.00120.00140.00160.00
15-19 20-29 30-39 40-49 50+Age Group (years)
Rat
e pe
r 100
,000
po
pula
tion
Source: NYSDOH, HIN, Communicable Disease Statistical Queries
HIV in CommunitiesHIV in Communities
3% 3% 4% 7%
21%
34%
21%
7%
0%
12 & under
13-19
20-24
25-29
30-39
40-49
50-59
60+
Unk
Living HIV and AIDS Cases by Age, Nassau County For Cases Diagnosed through December 2007
Source: New yrok State HIV/AIDS County Surveillance Report (Excludes State Prison Inmates), Bureau of HIV/AIDS Epidemiology, NYSDOH June 2009. Data as of April 2009
Asthma Prevalence by Community Asthma Prevalence by Community Nassau County Behavioral Risk Surveillance Survey 2006Nassau County Behavioral Risk Surveillance Survey 2006
0
5
10
15
20
25
Nassau New York US
Tobacco Use (%)
Source: Nassau County Behavioral Risk Factor Surveillance Survey 2006
35.5
36
36.5
37
37.5
38
38.5
39
Nassau New York US
Overweight (%)
Source: Nassau County Behavioral Risk Factor Surveillance Survey 2006
0
5
10
15
20
25
Nassau New York US
Obesity (%)
Source: Nassau County Behavioral Risk Factor Surveillance Survey 2006
Local Local HealthHealth Priorities Priorities
Cardiovascular Disease PreventionCardiovascular Disease Prevention Diabetes, Obesity, Nutrition Diabetes, Obesity, Nutrition
EducationEducation Tobacco Use CessationTobacco Use Cessation Fall Injury PreventionFall Injury Prevention Cancer Screening Promotion Cancer Screening Promotion Teenage Pregnancy PreventionTeenage Pregnancy Prevention
Access to Health Care
Built Environment
Community Economic Development
Health Literacy
Health MarketingNatural Environment
Public Policy
Public Well Being
Social Capital
Individual &
Family
Community
Nassau’s Access to Health Nassau’s Access to Health CareCare
12 Hospitals12 Hospitals 34 Nursing Home/Rehabilitation 34 Nursing Home/Rehabilitation
CentersCenters 6 Hospices 6 Hospices 21 Home Health Care Agencies21 Home Health Care Agencies 12 Long Term Care Agencies12 Long Term Care Agencies 8 Prenatal Care Assistance Programs8 Prenatal Care Assistance Programs 4 Community Health Centers4 Community Health Centers 12 HIV Testing Sites12 HIV Testing Sites Urgent Care Centers expandingUrgent Care Centers expanding
Nassau’s Access to Health CareNassau’s Access to Health Care
CHC HospicesPCAP
Hospitals
LTC
HIV
HHA
Nursing
Homes/Rehabilitation
Centers
0
5
10
15
20
25
30
35
Urgent Care Centers
7,411 beds
4,397 beds
Health Care Providers in Health Care Providers in NassauNassau
Over 8,000 PhysiciansOver 8,000 Physicians• 2666 Primary care2666 Primary care• 5368 Specialists5368 Specialists
1057 Physician Assistants1057 Physician Assistants 1,218 Nurse Practitioners1,218 Nurse Practitioners 2,019 Dentists2,019 Dentists
Health Care Providers in NassauHealth Care Providers in Nassau Physicians
Primary Care
Specialists
Physician Assistants
Nurse Practitioners
Dentists
0
1000
2000
3000
4000
5000
6000
7000
8000
Health Determinant
sBehaviors
Intermediate Outcomes
Environmental and Community
Factors
Health Outcomes
Mortality/ Morbidity aka
Longevity/Quality of Life
Steps to Sustain Healthy Steps to Sustain Healthy CommunitiesCommunities
Nassau County Legislation Nassau County Legislation Mandating Nutritional Mandating Nutritional
InformationInformation
Artificial Trans Fats Banned From Artificial Trans Fats Banned From RestaurantsRestaurants
On September 18, 2007, the NCBOH voted On September 18, 2007, the NCBOH voted to restrict the use of artificial trans fats to restrict the use of artificial trans fats from all permitted food service from all permitted food service establishments in the county. On April 1, establishments in the county. On April 1, 2008, the trans fat restrictions took effect 2008, the trans fat restrictions took effect for trans fats used for frying or in spreads for trans fats used for frying or in spreads and on April 1, 2011, the ban will go into and on April 1, 2011, the ban will go into effect for oils or shortening used for baking.effect for oils or shortening used for baking.
Calorie Menu LabelingCalorie Menu Labeling On September 10, 2009, the NC Legislature On September 10, 2009, the NC Legislature
voted into law Calorie Menu Labeling voted into law Calorie Menu Labeling legislation. legislation.
NCDOH Recommendations NCDOH Recommendations for Actionfor Action
1.1. Promote activity, lessen sedentary Promote activity, lessen sedentary behavior (30 minutes a day/5-7 days behavior (30 minutes a day/5-7 days a week)a week)
2.2. Create safe walking environments Create safe walking environments
3.3. Create safe biking pathsCreate safe biking paths
4.4. Create a Nassau Walking Trail Create a Nassau Walking Trail throughout the county connecting throughout the county connecting communitiescommunities
5.5. Encourage access to grocery stores Encourage access to grocery stores and markets/fresh fruits and and markets/fresh fruits and vegetables vegetables
Recommendations for Action Recommendations for Action (Continued)(Continued)
5.5. Grab bars in every new or Grab bars in every new or renovated bathroomrenovated bathroom
6.6. Promote use of handrails to Promote use of handrails to prevent injury prevent injury
7.7. Senior-friendly housing needed Senior-friendly housing needed within neighborhoods with close within neighborhoods with close access to public transportation, access to public transportation, shopping and health care shopping and health care
8.8. Expand on Delivery of Health care Expand on Delivery of Health care needs in home needs in home
SidewalksSidewalks
Walking and Bike PathWalking and Bike Path
BeforeBefore AfterAfter
BeforeBefore AfterAfter
BeforeBefore AfterAfter
Parks and Seating – Parks and Seating – Universal UseUniversal Use
Grab barsGrab bars
HandrailsHandrails
Next Steps for Long Island Next Steps for Long Island Center for Health Policy?Center for Health Policy?
Of Possible Interest…Of Possible Interest… AgingAging
• Study falls etiology and risks in region Study falls etiology and risks in region • Evaluate quality of care in nursing homes Evaluate quality of care in nursing homes • Educate public and physicians re Advance Educate public and physicians re Advance
Directives – poorly utilized tool and not diversely Directives – poorly utilized tool and not diversely utilizedutilized
• Expand home care delivery Expand home care delivery Health DisparitiesHealth Disparities
• Prevent Teenage Pregnancy Prevent Teenage Pregnancy • Promote concept and use of Medical Home Promote concept and use of Medical Home
Health PromotionHealth Promotion• Evaluate School WellnessEvaluate School Wellness• Improve quality of care and access to quality careImprove quality of care and access to quality care
Eg Falls and Coumadin useEg Falls and Coumadin use• Promote wellness across the age spectrumPromote wellness across the age spectrum
ResourcesResources
www.countyhealthrankings.orgwww.countyhealthrankings.org www.cdc.govwww.cdc.gov www.nassaucountyny.govwww.nassaucountyny.gov
/agencies/Health//agencies/Health/index.htmlindex.html www.thecommunityguide.orgwww.thecommunityguide.org www.healthymadisoncounty.orgwww.healthymadisoncounty.org www.HumanCenteredDesign.orgwww.HumanCenteredDesign.org
/pedestrian/pedestrian