1. Florida Department of Health Flagler County
Robert Snyder, MPH
Administrator

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

3. 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

4. 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

5. 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)

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

7. County Health Ranking
Flagler’s Rank was 22

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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%
( )
( )
2007
87.10%
81.40%
( )
( )
2010
83.60%
83.00%
( )
( )
2013
86.30%
77.10%
( )
( )

16. 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

17. 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

18. 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
Miami/Broward/Palm Beach situation (Press release )
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)

20. 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

21. 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
On-line survey (600 respondents)
Reviewed and discussed 300+ health indicators and eco-social determinants of health

22. 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)

23. 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