Welcome to the Pueblo City-County Health Department Thank you for being here today! Restrooms are located by the elevators This is a tobacco-free campus. Thank you for not using tobacco on Health Department grounds We are a green building; green plastic bins in the back of the room are available for recycling In case of an emergency, please exit the building using the stairs at the front or back of the building

Agenda Introduction/Purpose of Meeting (15 minutes) Community Process to Determine Priorities (15 minutes) Overview of Public Health Priorities: statistics, capacity, possible strategies (60 minutes) Community Input (30 minutes) Break (10 minutes) Rank Public Health Priorities (30 minutes) Next Steps (10 minutes)

Process to Narrow Down Priorities Utilize this tool to help you rank each of the 8 health issue areas (listed on previous slide) in relation to the six questions (impact, disparities, strategies, support and lead organization, resources). Rank each using the scale (1-3). The scale ranges from 1 (No) to 2 (Some/Moderate) to 3 (Yes/Significant). Your scores on this tool will be added together with the other participants scores at the two priority meetings in order to narrow the 8 priorities down to at most 3. Completion of this tool prior to the meeting on the 21st will make the process much quicker during the meetings.

PUEBLO COMMUNITY HEALTH ASSESSMENT Thank you for your interest and support in this valuable process! Your input and dedication is invaluable.

Mission of Pueblo Community Health Assessment Pursuant to the Colorado Public Health Reauthorization Act –Colorado counties are required to complete a comprehensive community health assessment. To that end, Pueblo City-County Health Department is tasked to partner with various county-wide organizations and individuals to complete a community health assessment. The purpose of the assessment is to assist Pueblo in deciding what its community health priorities are for the next 5 years and what strategies will be used by various public health organizations and partners to improve the overall health of Pueblo residents. * Based on geography of Pueblo County *The health assessment is inclusive of all geographic areas and communities of Pueblo County (i.e. Pueblo West, Beulah, Greenhorn Valley, Vineland, Avondale, North side, Bessemer, etc.)

Contributions to Health Assessment Process PCCHD Community Health Assessment Team Internal (CHATI) Members: Heather Maio Chad Wolgram Jenna Ward Julie Kuhn Lynn Procell Kim Whittington Sarah Joseph Shylo Dennison Community Health Assessment Steering Committee Members Donald Moore Mary Gunn Randy Evetts Angela Jensen Tony LaCombe John LeFebre Charlotte Yianokopolus-Veatch Cindy Lau Kirsten Taylor Michelle DesLauriers Barb Mettler

Steps of the Community Health Assessment Community Health Assessment & Status Report (Data collection based on health indicators; strengths; & weaknesses) 2) Capacity Assessment & Report (Who is doing what & how well?) 3) Prioritization process of public health issues for community These are the steps that have been, or are being, undertaken to complete the community health assessment. We are currently in stage 3. First time we are doing this process 4) Community Health Improvement Plan (Priorities identified and responsibilities assigned) 5) Strategic Plan for Pueblo City-County Health Department

Top 8 Priorities *In alphabetical order Cardiovascular Disease Communicable/Infectious disease prevention Diabetes Lack of providers/Access to care Mental health Obesity (adult and childhood) Poverty Teen Pregnancy/Unintended pregnancy These are the top 8 priorities that the community health assessment has found to be the most significant in Pueblo. These were determined based on the data collected in the first 2 steps of the assessment process. These top 8 priorities need to be narrowed down to at most three that public health partners will work on for the next 5 years. Note- comment on data sources and trying to be consistent so that we are comparing similar years Community Health Rankings, Colorado Regional Profiles, Colorado Health Institute

Cardiovascular Disease Rate of Cardiovascular Disease 1074.2 per 100,000- Pueblo County 961.8 per 100,000- Colorado 26% of all deaths caused by Heart Disease in Pueblo Disparities Minority populations have greater disparities for CVD The remaining slides will describe each of the top 8 priorities in more detail. We will give you statistical information, if there are disparities related to this topic, and evidence based strategies recommended to address the issue. (Please refer to the ‘definition of terms’ document for more information on evidence based.) The evidence based recommendations are by no means complete, nor do they represent programs already happening in Pueblo County. These are just some examples to get people thinking about what can be done to address the issue. The information presented on these slides will help you answer the questions and provide a ranking on the prioritization tool.

Cardiovascular Disease Evidence based strategies Comprehensive strategies to reduce blood pressure (http://www.bmj.com/content/326/7404/1419.short) Ensure screenings for high risk individuals (http://www.bmj.com/content/326/7404/1419.short)

Communicable/Infectious Disease Influenza (flu) Pueblo County: 33 influenza-associated hospitalizations 2010-2011 Colorado average: 20.9 Disparities Elderly Infants Immune-compromised individuals Tuberculosis Pueblo County: 1.9 cases per 100,000 Colorado: 2.3 cases per 100,000 Prison and homeless populations Given the substantial impact of seasonal influenza and/or other potential influenza-like threats (H1N1 in the past), there is always a need to ensure that a majority of individuals are vaccinated. Influenza is contagious and can cause mild to severe illness, and at times lead to death.

Communicable/Infectious Disease Chlamydia in Pueblo: Almost 4000 per 100,000 cases among females; over 1000 cases per 100,000 for males Chlamydia in Colorado: Under 2500 per 100,000 cases among females; 1000 cases per 100,000 for males In 2009 nationally 1,244,180 cases of chlamydia were reported. Gonorrhea: In Pueblo: Under 100 cases per 100,000 population In Colorado: 70 cases per 100,000 population Nationally in 2009, 301,174 cases were reported to CDC (tremendous amount of underreporting). Disparities 18-24 year olds Minority females Those with multiple partners Drug users

Communicable/Infectious Disease Evidence based strategies (www.cdc.gov) Increase vaccines with chart reminders, electronic health records, mailed/telephoned reminders Comprehensive education on preventing transmission Increase and encourage testing

Diabetes 5% of all deaths in Pueblo are caused by Diabetes Mellitus, Type II Evidence based strategies (www.thecommunityguide.org) Case management interventions to improve glycemic control Self-management education in community- gathering places for adults with type 2 diabetes Disparities: More common among minority populations and those over 65. High prevalence in Pueblo county with about 7.4% of adults having been told by a doctor that they have diabetes, which is higher than the Colorado average at 5.4%. (This is probably underreported, too.)

Lack of Providers/Access to Care Dual eligible: patients are individuals who qualify for both Medicare and Medicaid based on income, health, and disability. These patients are generally poor and have complex health needs. Compared with other Medicare beneficiaries, dual eligible are more likely to be in poor health, have multiple chronic physical conditions, and more mental/behavioral health concerns. In Pueblo, 18.8% are enrolled in Medicare and dual eligible versus 12.4% in Colorado. The second graph refers to adults that report having one or more health providers. In Pueblo there is a higher percentage that claim having a medical home versus Colorado. Disparities Low socioeconomic individuals Ethnic and minority populations

Lack of Providers/Access to Care Evidence based strategies Ensuring eligible individuals are enrolled in available insurance programs (i.e. CHP+, Medicaid, etc.) Increase the number of physician assistants and nurse practitioners Safety Net Provider Locations in Pueblo County, 2007 Type # of Clinics Rural Health Clinics and Emergency Departments 2 Safety Net Dental Clinics 1 Safety Net Mental Health Clinics 3 School Based Health Centers 5 Clinic Delivery Sites Other Primary Care Clinics ClinicNet Clinics Public Health Departments and Nursing Services that Provide Primary Care Services Pueblo County has a number of safety net provider located throughout the County.

Mental Health Poor mental health days was highest at 31% for ages 18-24 in Pueblo County Disparities Greatest percentage of suicides occurred among non-Hispanic whites Highest race/ethnicity and age-specific rates were among American Indian/Alaska Native adolescents and young adults. There is a great concern that we in Pueblo are not adequately meeting the mental and behavioral health needs of youth. However, based on the BRFSS question: there are fewer parents in Pueblo that report behavioral or mental health problems among youth versus Colorado, 2007-2009. Among young adults, they reported the most number of poor mental health days (8 or more days) in 2008-2009 as compared to all the other age ranges from 25-65+.

Mental Health Evidence based strategies Collaborative care for managing depressive disorders Home and clinic-based depression care management The national benchmark strives for only 2.3 poor mental health days per month. Pueblo County reported an average of 3.9 poor mental health days in 2009. This is based on the question, “Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 was your mental health not good?”

Obesity Children Eating Fruits and Vegetables Pueblo County: 5.8% consumed five or more fruits and vegetables per day Colorado: 9.6% Pueblo has more obese and overweight/obese youth and adults than the Colorado average. The number of overweight and obese youth in Pueblo is over 30.4%; the number of overweight and obese adults is over 64% in Pueblo.

Obesity Disparities Lower socioeconomic status and middle income (living in suburban areas without connectivity) Minority populations Evidence based strategies (www.thecommunityguide.org) Behavioral interventions to reduce screen time Multi-component coaching or counseling interventions to reduce weight and maintain weight loss Worksite wellness programs (trainings, policy/system changes)

Poverty Pueblo’s poverty for both adults and children is higher than the Colorado average. Of special concern is that in 2009, 26.5% of children (18 years and younger) were living in poverty. Median household income in Pueblo is lower than the Colorado average. In 2009, the median income was around 39,000.

Poverty Disparities Evidence based strategies Ethnic and Minority Populations Evidence based strategies Increase financial literacy (http://www.practicalmoneyskills.com/foreducators/stat e_standards/process.php) Improve graduation rates (http://www.cdc.gov/PCD/issues/2007/oct/pdf/07_0 063.pdf)

Teen/Unintended Pregnancy Pueblo County: 55.6% unintended and 44.4% intended Pueblo County Hispanic population: 49.7% of pregnancies considered intended In 2009, 17% of all births in Pueblo County were to teens Looking at this graph can be very confusing. The data specifically asks women from all ages, whether the pregnancy was unintended. While intentional pregnancies among women 20+ are less of a concern to the community, intentional and unintentional teenage pregnancies cause a community to pause. Much like other adolescent/youth high risk behaviors, teen pregnancy can be linked to low graduation rates, poor performance in schools, substance abuse, etc. Children born as a result of an unintended pregnancy are at greater risk for child neglect and abuse and developmental delay. For the mother who experience and unintended pregnancy, there are correlations between lower education levels and socioeconomic status.

Teen/Unintended Pregnancy Disparities Lower socio-economic women Young women whose mothers were teen moms Hispanic teens Evidence based strategies (www.thecommunityguide.org) Youth development, behavioral interventions: interventions coordinated with community service to reduce sexual risk behaviors in adolescents Comprehensive risk reduction intervention for adolescents (abstinence as well as other scientifically proven prevention methods)

Questions?

For Further Questions Call Shylo Dennison, Public Health Planner 719-583-4353 dennison@co.pueblo.co.us