1. State of Health in Nevada County Nevada County Community Leadership Institute February 24, 2012 Jeff Brown, Director Nevada County Health and Human Services Agency

2. 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

3. Health & Human Services Agency Public Health –Communicable disease control –Emergency preparedness –Nursing home visitation –Health and Wellness –Vital Records –Clinic services –WIC Nutrition

4. 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

5. Health & Human Services Agency Child Support and Collections –Paternity establishment –Child support order establishment/enforcement –Child & spousal support collection/distribution –Medical support establishment/enforcement

6. 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.)

7. The health status of Nevada County residents is better than the average Californian? True False

8. Nevada County Health Status –Recent survey using 2003-09 data lists Nevada County overall health outcomes ranking as 11 th best of 56 California counties rated!

9. Health is most dependent on? 1.Access to quality health care 2.Social factors --- education, housing, employment, income, neighborhood, etc. 3.Genetics

10. 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

11. Children and Adolescent Indicators

12. % Persons Under 18 in Poverty California County Health Status Profiles 2011

13. Vital Statistics 2004-2011

14. Vital Statistics 2011 – 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

15. Estimate of Child Vaccination Rates 1.55% 2.75% 3.90%

16. Immunizations 73.0% of Kindergarteners have obtained all required immunizations73.0% of Kindergarteners have obtained all required immunizations 17.7% of Kindergarteners have Personal Belief Exemptions (PBE)17.7% of Kindergarteners have Personal Belief Exemptions (PBE) California Department of Public Health 2011

17. Immunizations Percentage 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 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% 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% 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)

18. % Children’s Dental Insurance 2007 CHIS 2007

19. % Children’s Health Insurance 2007 & 2009 CHIS 2007 & 2009

20. 3 rd Graders with Cavities Nevada County PHD Healthy Smiles 2007 Survey HP 2010 Goal – 42%

21. 3 rd Graders with Untreated Dental Decay Nevada County PHD Healthy Smiles 2007 Survey

22. 7 th Grade School Fitness Zone Results - % Not Passing California Dept of Education 2010-11 Physical Fitness Report

23. % Children Engaging in Vigorous Activity 3 or More Days Per Week CHIS 2007 & 2009

24. Children with Entries into Foster Care Center for Social Services Research, UC Berkeley, 7/2011

25. Prevalence of Children in Foster Care Center for Social Services Research, UC Berkeley 2/2011

26. Ozone - # of Days Above State 8 hr Standard California Air Resources Board, 2011

27. Asthma Approximately 1.7 million children in California have been diagnosed with 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)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

28. % of Teens Diagnosed with Asthma CHIS 2007 & 2009

30. Nevada County Teens’ Substance of Choice 1.Methamphetamine 2.Marijuana 3.Alcohol 4.Prescription Pain Killers

32. CHKS - NUJHSD 2010-11 & Truckee Unified 2009-10

33. % Students Using Prescription Painkillers 4 or More Times 0 2 4 6 8 10 12 NJUHSD 9th GradersNJUHSD 11th GradersTTUSD 9th GradersTTUSD 11th Graders Percent 2007-082009-10

38. Teen Birthrates Ages 15-19 California County Health Status Profiles 2011

40. Adult Indicators

41. Vital Statistics Leading Causes of Death for 2010 MaleMale –Heart Disease –Prostate Cancer –Chronic Obstructive Pulmonary Disease (COPD) –Pneumonia –Lung Cancer FemaleFemale –Heart Disease –Pneumonia –Lung Cancer –Breast Cancer –COPD –Alzheimer’s Disease/Dementia Nevada County PHD 2010

42. Mortality per 100,000 – The Good State Rank IndicatorAge Adjusted Death Rates 2007-09 7Liver disease/cirrhosis 7.8* 21Lung Cancer37.2 6Homicide 1.3* 9Diabetes 11.9* 24Alzheimer’s Disease18.4 24All Cancers151.5 23All Causes640.6

43. Mortality Per 100,000 – The Bad State Rank IndicatorAge Adjusted Death Rate 2007-09 35Stroke40.0 37Female Breast Cancer 22.1* 30Unintentional Injuries36.7 51Suicide 20.0 33Drug Induced Deaths 13.6* 50Firearm Related Deaths 13.2*

44. Communicable Diseases – Incidence Rates per 100,000 State Rank IndicatorAverage Crude Case Rate 2007-09 16AIDS 1.9* 11Chlamydia128.7 13Gonorrhea9.6* 17Tuberculosis1.0* California County Health Status Profiles 2011

45. Communicable Disease 2005200620072008200920102011 Campylobacteriosis45129181323 Chlamydial Infections 121111133140113141137 Escherichia coli 1812241 Giardiasis239141312911 Gonococcal Infections 1061667614 Hepatitis A 1116631 Hepatitis B, acute 1001101 Hepatitis B, chronic 33529612 Hepatitis C, acute 1000000 Lyme Disease 567145815 Meningitis, viral 61054320 Pertussis15191852225 Salmonellosis131181312178 Tuberculosis1202101 *Not all reportable communicable diseases listed

46. % Adults with Chronic Diseases CHIS 2009 *Data from CHIS 2005 ^Data from CHIS 2007

47. www.cdc.gov/diabetes 2008 County-level Estimates Diabetes Adults aged ≥ 20 years Age-adjusted percent

48. Health & Dental Insurance CHIS 2009 *Dental is CHIS 2007 data

49. 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

50. Group with Greatest Suicides 1.0-17 years of age 2.18-39 years of age 3.40-64 years of age 4.65+ years of age

51. % of Suicides by Age Group 2011 Sheriff/Coroner 2011

52. Suicide deaths 1991-2011 California County Health Status Profiles, CDPH, & Nevada County Chief Deputy Coroner/NC Sheriff’s Office

54. Drug Induced Deaths, 2002-09 YearSuicideUndeterminedAccidentalTotal 20021067 200304610 20041359 20050167 200613812 2007451322 200821710 200942410 Nevada County Sheriff’s Department Coroner Report

55. Adult Current Smoker CHIS 2009

56. % Nevada County Adults Obese or Overweight 1.20% 2.33% 3.55% 4.65%

57. % Adults Overweight and/or Obese CHIS 2009

58. Definitions: Definitions: Obesity: Body Mass Index (BMI) of 30 or higher. 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. 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

59. Source: Behavioral Risk Factor Surveillance System, CDC. 2000 Obesity Trends* Among U.S. Adults BRFSS, 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%

60. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

61. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

62. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

63. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

64. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

65. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

66. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

67. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

68. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

69. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

70. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

71. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

72. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

73. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

74. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

75. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

76. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

77. Source: Behavioral Risk Factor Surveillance System, CDC. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

78. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

79. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

80. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

81. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

82. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

83. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

84. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

85. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

86. 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%

87. 2009 Homeless Count 345 Individuals Sex – 68% Male 32% Female Transitional Aged Youth 18-24 years – 29% Veterans – 13%

88. 2009 Homeless Count - Race/Ethnicity Caucasian – 89.9% American Indian – 7.1% Hispanic – 6.3% African American – 2.6% Other – 1.6%

89. 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%

90. References mynevadacounty.com www.chis.ucla.edu/ http://www.wested.org/chks/