Florida Department of Health Flagler County Robert Snyder, MPH Administrator

Who We Serve 14,699 In 2016 we touched the lives of Providing 177,198 Services to Flagler County residents.

Flagler CHD Services Prenatal Care: Medicaid funded prenatal care Family Planning: Federally funded grant to provide contraceptive choice for both male and female HIV and STD screening, treatment, clinic and surveillance: – Rapid access screening or provider visits ADAP- AIDS DRUG ASSISTANCE Program: Provide AIDS medication to affected individuals Tuberculosis Control: TB testing, treatment for active cases Immunizations: Required immunizations to infants, school age children, and adults, including for travel   Refugee Health: Health screenings, physical exams School Health: RN liaison services to the Flagler School Board Environmental Health Programs Epidemiology Programs: Conduct surveillance, investigation and control of cases, clusters and outbreaks of reportable diseases.  In addition, services are routinely performed in the following program areas: Food and Waterborne Disease Surveillance and Investigation, Florida ILINet Influenza Surveillance, Rabies Prevention and Control, Perinatal Hepatitis B Prevention, Mosquito-borne Disease Prevention & Control, & Residential Sharps Disposal. WIC: Nutrition program for Women, Infants, & Children (age 5 & under) to provide healthy foods, nutrition education & counseling, breastfeeding support, & referrals for health care & community services. Dental: Dental health services to Medicaid covered children and our pregnant women. Vital Statistics: Provide official Birth and death certificates Community Health Assessment Special Needs sheltering: Provide staffing for the County designated Special Needs Shelter during disasters. Healthiest Weight Initiative Medical Reserve Corps

Other Services Birth and Death Certificates Immunizations – 8,100 1,731 Birth Certificates issued (788 births) 7,444 Death Certificates issued (1,086 deaths) Immunizations – 8,100 STD – 5,137 services Family Planning – 2,693 patient visits Pre-natal – 1,000 patient visits Dental – 5,953 visits WIC – Nutrition & Breastfeeding Counseling's – 10,800 $1.3 million food benefits from local grocery stores 758 Communicable disease investigations 10 new AIDS cases diagnosed

Environmental Health 20 Environmental Health Programs (Onsite Sewage Treatment and Disposal System, Food Hygiene, Public Pools, Mobile Home Parks, Group Care, Migrant Labor Camps, Biomedical Waste, Tanning, Body Piercing, Tattooing, Limited-Use Water Systems, Well Construction, Coastal Beach Monitoring, Sanitary Nuisance Complaints, Arbovirus Surveillance, Rabies Surveillance, Communicable Disease Surveillance, Community Environmental Health Projects, Public Health Preparedness). 630 Permitted Facilities Over 800 Routine Facility inspections performed each year 2,500 Total services a year (Routine Inspections, Re-inspections, Construction inspections, sampling, surveillance, investigations, enforcement, etc.) Respond to Sanitary Nuisance Complaints within 2 days of Complaint (Untreated human waste, mosquito breeding, failing septic systems)

How Healthy is Flagler County? An Overview of Health Status in the Population

County Health Ranking Flagler’s Rank was 22

Health Outcomes State Ranking from 1 “Healthiest” to 67 “Least Healthy” (around the Region) County Health Outcomes Length of Life Quality of Life Flagler 14 26 10 Putnam 64 61 65 St. John’s 1 3 Volusia 42 44 46 Source: Mobilizing Action Toward Community Health (MATCH) collaboration project between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute

What comprises the Rankings? Outcomes Health outcomes represent the health of a county. A. Mortality (length of life) B. Quality of life Poor or fair health [ 14 %] Poor physical health days (30) [3.7] Poor mental health days [4.0] Low birth weight [ 7 %] Flagler Florida Male 76.7 76.6 Female 82.7 82.2

What comprises the Rankings? Factors Health Factors (determinants of health) are variables that influence health. Health behaviors: Smoking [14%] Obesity/Overweight [57%] Sexually transmitted disease* [284] Clinical care: Uninsured [19%] Diabetic monitoring [88%] Mammogram screening [74%] Physical Inactivity [22%] Binge drinking [17%] Alcohol impaired driving deaths [42%] Primary care physicians [2,130:1] Dentist [3,100:1] Mental health providers [2,030:1] * # of newly diagnosed chlamydia cases per 100,000 population

Health Factors continued Social & Economic: Unemployment [6.0%] Children in single parent households [36%] Children in poverty [21%] Physical Environment: Air Pollution* [6.5%] Severe housing problem [20%] Long commute driving along [37%] High School Graduation [77%] Violent Crime [265] Some College [60%] * # Average daily density of fine particular matter in micrograms per cubic meter

Other Health Outcomes Risk Factor Flagler Florida Infant Mortality (per 1,000 live births) 6.3 6.2 Black 11.1 11.4 White 4.6 4.4 Hispanic 11.2 4.8 Adults told they have Diabetes 9.8% 11.2% Hypertension 35% 34% High Blood Cholesterol 33% Melanoma Age Adjusted Death Rate 5.0 2.8 Prostate Cancer Age Adjusted Death Rate 22.5 17.3 Alcohol – Impaired Driving Deaths 42% 28% Cervical Cancer Age Adjusted Death Rate 2.0 2.7 Breast Cancer Age Adjusted Death Rate 20.4 19.8 Lung Cancer Age Adjusted Death Rate 46.2 42.1

Age-Adjusted Death Rate Major Causes of Death Rank Cause of Death Deaths Age-Adjusted Death Rate FLORIDA Death Rate   All Causes 1,224 703.5/100,000 679.8 1 Cancer 300 162.5 154.3 2 Heart Disease 283 156.3 152.9 3 Stroke 83 45.9 38.0 4 Chronic Lower Respiratory Disease 72 36.4 39.3 5 Suicide 26 23.9 14.6 Death rates are per 100,000 Florida Department of Health, Bureau of Vital Statistics, 2014 13

Educational Attainment Around the Region 2014 Flagler Rates Percentage of individuals 25 years and over with no high school diploma, Single Year Rates   Flagler Florida Year Rate 2014 10.2 13.5 2010 21.6 14.7 2000 14.1 20.1 1990 21.3 25.6

Adults with any type of health care insurance coverage, Overall Health Insurance Coverage Around the Region 2013 % Adults with any type of health care insurance coverage, Overall Year Flagler Florida 2002 85.20% 81.30% (79.7 - 89.3) (80.2 - 82.3) 2007 87.10% 81.40% (82.0 - 90.9) (80.3 - 82.4) 2010 83.60% 83.00% (78.8 - 88.5) (81.9 - 84.1) 2013 86.30% 77.10% (80.9 - 91.8) (76.0 - 78.2)

Median household income, Single Year Rates Around the Region 2014 Median household income, Single Year Rates   Flagler Florida Year Rate 2014 47733 47212 2013 38328 46956 2012 48134 47309 2011 48708 47827 2010 48090 47661 2009 38436 47450 2000 40214 38819 1990 28628 27483

DOH-Flagler Taking Action Population Health & DOH-Flagler Taking Action Zika Virus Response Disaster Response, Hurricane Matthew and SpNs (Special Needs Shelter) CHA and CHIP

FL Status As of December 31, 2016 As of April 1, 2017 1,099 travel-associated cases were reported 294 locally acquired cases 4 areas of active transmission in Miami-Dade County; all lifted as sites 2 travel-related cases in Flagler County As of April 1, 2017 27 travel-associated cases 2 locally acquired cases 2 undetermined cases 15 Pregnant women with lab evidence of Zika 0 cases for Flagler County http://www.floridahealth.gov/newsroom/2016/09/090116-zika-update.html Miami/Broward/Palm Beach situation (Press release 9-1-2016) DOH continues door-to-door outreach and targeted testing in Pinellas, Palm Beach and Miami-Dade counties and mosquito abatement and reduction activities are also taking place around the locations that are being investigated. (as of 9/1/16) DOH believes ongoing transmission is only taking place within the small identified areas in Wynwood and Miami Beach in Miami-Dade County, see maps next slide. The department is currently conducting 13 investigations. Information regarding the investigations can be found here. If investigations reveal additional areas of active transmission, the department will announce a defined area of concern. (detailed information in press release)

Hurricane Matthew and Special Needs Shelter Health Dept – Coordinates SpNS at Rymfire Partnership btw us DOH-Flagler and School System 29 staff, handful volunteers and 300+ residents, including Grand Oaks Nursing Home evacuees We cared for medically needy, elderly, disabled, dialysis pts, Oxygen and electrically dependent, homeless, dementia pts, and their caregivers for 3 days, at Rymfire and Bunnell Elementary Tested Ocean water for enterri bacteria

On-line survey (600 respondents) Community Health Assessment (CHA) + Community Health Improvement Plan (CHIP) Every 3 year collaboration among hospitals, DOH, Flagler Cares, 50+ health and social service providers, civic, community faith based leaders met frequently in 2015-16 On-line survey (600 respondents) Reviewed and discussed 300+ health indicators and eco-social determinants of health

5 Health Priorities for Flagler Adult Behavioral Health Youth Behavioral Health Cardiovascular Disease and Diabetes (Healthier Eating and Physical Activity) Mothers and Children under Age 5 (Prenatal Care, Birth Outcomes, Child development) Family Violence (Domestic Violence)

Future DOH Priorities Dental Services Expansion + Dental Sealant program at Elementary Schools Began HIV Services, 7/1/16 Healthiest Weight & Infant Mortality Initiative Community Health Improvement Plan interventions Community Water Fluoridation Obtain additional Public Health funding for Flagler County