Madison County 2010 – 2013 Community Health Assessment Report
Madison County 2010 – 2013 Community Health Assessment Report SECTION ONE – POPULATIONS AT RISK A. Madison County Demographic and Health Status Information Demographics & Social Determinants General Health Status ...................................................................................................................................8 Demographic & Socio-Economic Status .......................................................................................................8 Population......................................................................................................................................................8 Population by Age .........................................................................................................................................8 Population by Gender....................................................................................................................................9 Population by Ethnicity ..................................................................................................................................9 Non-English Speaking ...................................................................................................................................9 Homeless Population.....................................................................................................................................9 Single Parent Households.............................................................................................................................9 Household Income.........................................................................................................................................9 Median Income ..............................................................................................................................................9 Poverty ..........................................................................................................................................................9 Unemployment ..............................................................................................................................................9 Jobs and Annual Pay...................................................................................................................................10 Health Status Information Mortality .......................................................................................................................................................10 Maternal and Child Health Status................................................................................................................10 Infant Mortality .............................................................................................................................................10 Maternal Mortality ........................................................................................................................................11 Child Mortality..............................................................................................................................................11 Parental Care ..............................................................................................................................................12 Adolescent Pregnancy.................................................................................................................................13 Teenage Births ............................................................................................................................................13 Short Gestation and Low Birth Rate............................................................................................................14 Alcohol and Substance Abuse During Pregnancy ......................................................................................15 Smoking Drinking Pregnancy ......................................................................................................................16 Childhood Lead Poisoning ..........................................................................................................................16 Communicable Diseases.............................................................................................................................16 Selected Communicable Diseases..............................................................................................................17 Campylobacteriosis ...........................................................................................................17 Campylobacteriosis and Salmonella .................................................................................17 Chronic B and C Hepatitis .................................................................................................17 Giardia ...............................................................................................................................19 Infectious Disease .............................................................................................................19 Vaccine Preventable Diseases....................................................................................................................21 Selected Chronic Disease Indicators ..........................................................................................................22 Heart Disease.......................................................................................................................23 Diabetes ...............................................................................................................................24 Respiratory Disease .............................................................................................................20 Chronic Liver Disease ..........................................................................................................25 Selected Cancers .................................................................................................................25 Health Related Behaviors............................................................................................................................32 Substance Abuse .................................................................................................................32 Alcohol Use ..........................................................................................................................32 Other Drug Use .....................................................................................................................33 B. Environmental Health Ambient Air Quality in Madison County..................................................................................................34 1 Madison County 2010 – 2013 Community Health Assessment Report Common Pollutants...........................................................................................................34 Air Pollutant Levels.............................................................................................................35 Respiratory Health..............................................................................................................36 Vehicle Emissions and Air Quality .....................................................................................36 Indoor Air Quality in Madison County.............................................................................................36 Radon ................................................................................................................................36 Environmental Tobacco Smoke ........................................................................................37 Health Effects of Environmental Tobacco Smoke.............................................................37 Water Quality in Madison Count.....................................................................................................39 Public Drinking Water........................................................................................................39 Public vs. Private Water Systems .....................................................................................39 Ambient Water Quality ......................................................................................................39 Toxic Substance Exposure in Madison County..............................................................................40 Lead Poisoning.................................................................................................................40 Hazardous Waste.............................................................................................................41 Chemical Exposure ..........................................................................................................42 Birth Defects .....................................................................................................................42 Climate and Disaster in Madison County .......................................................................................43 Climate ............................................................................................................................43 Health Effects ..................................................................................................................43 Natural Disasters and Sever Weather.............................................................................44 Food-Bourne and Vector-Bourne Disease in Madison County 44 Occurrence of Illness.......................................................................................................44 Land Use in Madison County .........................................................................................................40 Park Land ........................................................................................................................45 Injuries ............................................................................................................................................45 Intentional and Unintentional Injures..............................................................................45 Suicide............................................................................................................................45 Homicide ........................................................................................................................46 Unintentional Injuries......................................................................................................47 Safety and Injury Control................................................................................................................49 Seat Belt Use .................................................................................................................49 Bike Helmet Use............................................................................................................49 Smoke Detectors............................................................................................................49 Exercise and Nutrition ....................................................................................................................50 Overweight and Obesity ................................................................................................50 Eat Well Play Hard Survey 2007...................................................................................52 Childhood Obesity .........................................................................................................53 Cost to Madison County ................................................................................................53 County Employee Health Quotient................................................................................54 Overweight & Obesity – Home Care Patients...............................................................55 Sexual Behaviors ..........................................................................................................56 HIV Testing....................................................................................................................56 STD Testing ..................................................................................................................56 Local Health Care Environment .....................................................................................................56 Forces and Trends In Public Health...............................................................................56 Findings..........................................................................................................................56 Demographic Changes...................................................................................................56 Economic Forces............................................................................................................57 Access to Care ...............................................................................................................58 Geographical Barriers ....................................................................................................58 Medical Conditions and Emerging Diseases .................................................................59 Emerging Infectious Diseases........................................................................................59 Political ...........................................................................................................................................59 Madison County and New York Stat Politics..................................................................59 Inadequate Marketing of Public Health ..........................................................................60 2 Madison County 2010 – 2013 Community Health Assessment Report Environmental Threats ...................................................................................................60 Aging Infrastructure ........................................................................................................60 Technology.....................................................................................................................60 Social Forces..................................................................................................................60 SECTION TWO – LOCAL HEALTH UNIT CAPACITY PROFILE Local Health Department Capacity Profile..............................................................................................62 Health Department – Overview ........................................................................................62 Department Divisions .......................................................................................................63 Administrative Services..........................................................................................63 Environmental Health .............................................................................................63 Patient Services .....................................................................................................64 Preventive Health Services ....................................................................................64 Strategic Plan ...................................................................................................................64 Workforce Development...................................................................................................65 Program Re-Alignment.....................................................................................................65 Technology.......................................................................................................................66 Quality Improvement ........................................................................................................66 Community Health Assessment .......................................................................................67 SECTION THREE – PROBLEMS AND ISSUES IN THE COMMUNITY A. Profile of Community Resources Community Partnerships and Collaborations Efforts ...........................................................................69 Madison County Priorities Council .................................................................................................69 Living Well Partnership...................................................................................................................69 Diabetes Prevention Partnership....................................................................................................69 CNY Dental Coalition......................................................................................................................69 Healthy Living Partnership .............................................................................................................69 Madison County Local Early Intervention Coordinating Council ....................................................69 Reach CNY Madison County Sub Council.....................................................................................69 Tobacco Free Madison County Partnership...................................................................................69 Healthy Start Partnership ...............................................................................................................69 Asthma Coalition ............................................................................................................................70 Oneida/Herkimer/Madison County Adult Immunization Coalition ..................................................70 Disease Surveillance and Response Committee ...........................................................................70 School Superintendent/County Department Head Meetings .........................................................70 Child Obesity Prevalence Project...................................................................................................70 Child Fatality Review Team............................................................................................................70 Madison County Multidisciplinary Team.........................................................................................70 Madison County Domestic Violence Coalition ...............................................................................70 Early childhood Committee ............................................................................................................70 Hamilton-Bassett-Crouse Health Network .....................................................................................70 Other...............................................................................................................................................71 Profile of Community Resources and Assets ........................................................................................71 Partnerships in Madison County to Improve Health Status..................................................................74 Madison County Priorities Council .................................................................................................74 Living Well partnership ...................................................................................................................74 Diabetes Prevention Partnership....................................................................................................74 CNY Dental Coalition......................................................................................................................75 3 Madison County 2010 – 2013 Community Health Assessment Report Healthy Living Partnership .............................................................................................................75 Madison County Local Early Intervention Sub Council ..................................................................75 Reach CNY Madison County Sub Council.....................................................................................75 Tobacco Free Madison County ......................................................................................................75 Healthy Start Partnership ...............................................................................................................75 Asthma Coalition ............................................................................................................................75 Oneida/Herkimer/Madison County Adult Immunization Coalition ..................................................75 Disease Surveillance and Response Committee ...........................................................................75 Fit CNY ...........................................................................................................................................76 Superintendent/Department Head Meetings..................................................................................76 Obesity Primary Data Research Study...........................................................................................76 Infant Mortality Review Team.........................................................................................................76 Madison County Domestic Violence Coalition ...............................................................................76 Agency Collaboration .....................................................................................................................76 Health Department Services ..........................................................................................................76 Medicaid Providers .........................................................................................................................76 Medical Service Provision ........................................................................................................................77 Health Centers................................................................................................................................77 Dental Clinics..................................................................................................................................77 Pregnant Women............................................................................................................................77 Children ..........................................................................................................................................77 Outreach and Public Education......................................................................................................77 General Public Health Records ......................................................................................................78 Targeted High Risk Efforts .............................................................................................................78 B. Access to Care Primary Care Providers ............................................................................................................................79 Maternal & Child Health Care ...................................................................................................................79 Prenatal Care .................................................................................................................................79 Medicaid Obstetrical Maternal Services (MOMS) ..........................................................................80 Special Supplements Nutrition Program for Women, Infants and Children (WIC).........................80 Early Intervention Program.............................................................................................................81 Education Transportation of Handicapped Children (Pre-K)..........................................................81 Physically Handicapped Children’s Program .................................................................................81 Clinical Preventive Services.....................................................................................................................78 School Based Health Program .......................................................................................................79 Oneida Indian Nation Health Department ......................................................................................79 Other Non-Hospital-Based Health Clinics ......................................................................................81 Emergency Services .................................................................................................................................82 Emergency Medical Services .........................................................................................................83 The Upstate New York Poison Center ...........................................................................................83 Hospital-Based Emergency Departments ......................................................................................85 Secondary & Tertiary Care .......................................................................................................................86 Long-term Care & Rehabilitation Services .............................................................................................88 Home Care Services ......................................................................................................................88 Nursing and Adult Home ................................................................................................................89 Mental Health Services .............................................................................................................................90 4 Madison County 2010 – 2013 Community Health Assessment Report Madison County Mental Health Department ..................................................................................90 Mental Health Clinic ..........................................................................................................90 Crisis Services..................................................................................................................90 Inpatient Services.............................................................................................................90 Psychiatry Services ..........................................................................................................90 Day Treatment Services: Cedar House.........................................................................................90 Madison County ARC (Alternative, Resources and Choices)........................................................91 Liberty Resources...........................................................................................................................91 Heritage Farm.................................................................................................................................91 BRiDGES........................................................................................................................................91 Consumer Services of Madison County, Inc. .................................................................................91 Dental Health Services..............................................................................................................................92 Community Assessment ..........................................................................................................................92 Disparities in Accessing Care..................................................................................................................93 Financial Barriers............................................................................................................................93 Structural Barriers...........................................................................................................................95 Personal Barriers............................................................................................................................99 C. Profile of Unmet Need for Services Local Public Health System Assessment Results ...............................................................................101 Assessment Results .....................................................................................................................101 Essential Health Services.............................................................................................................101 Local Health Department (LHD) Contribution ..............................................................................102 SECTION FOUR – LOCAL HEALTH PRIORITIES Community Health Assessment: Our Road “MAPP”................................................................................108 The Assessments .........................................................................................................................108 Strategic Issue Development .......................................................................................................109 Health Priorities ............................................................................................................................110 NYS Prevention Agenda Priority Areas.....................................................................................................110 SECTION FIVE – OPPORTUNITIES FOR ACTION Madison County Opportunities for Action............................................................................................112 Strategy Development ..................................................................................................................112 Planning to Implementation ..................................................................................................................116 Action Cycle..................................................................................................................................116 Initial Opportunities.......................................................................................................................117 APPENDIX A – MADISON COUNTY DATA & CHARTS Indicators of Health Status: Indicators of Health Status: Indicators of Health Status: Indicators of Health Status: Indicators of Health Status: Indicators of Health Status: Indicators of Health Status: Socioeconomic Characteristics.......................................................120 Geographic Characteristics ............................................................124 Mortality...........................................................................................124 Sentinel Events ...............................................................................126 Maternal and Child Health ..............................................................126 Infectious Disease...........................................................................130 Environmental Health......................................................................134 5 Madison County 2010 – 2013 Community Health Assessment Report Cancer Incidents...........................................................................................................................140 Cancer Mortality ...........................................................................................................................141 Indicators of Health Status: Social and Mental Health ................................................................143 Indicators of Health Status: Resource Availability.......................................................................144 Indicators of Health Status: Social and Demographic Characteristics........................................145 Oral Health ...................................................................................................................................146 Tobacco........................................................................................................................................147 KWIC ............................................................................................................................................150 Literacy .........................................................................................................................................153 Madison County Indicators for Tracking Public Health Priority Areas..........................................153 Outdoor Air Quality .......................................................................................................................159 6 Madison County 2010 – 2013 Community Health Assessment Report SECTION I – POPULATIONS AT RISK 7 Madison County 2010 – 2013 Community Health Assessment Report Madison County Demographic & Health Status Information Demographic and Social Determinants General Health Status To assess the general health status of Madison County residents, a list of health indicators are presented in comparison, where possible, to New York State as a whole as well as with the objectives set by the U.S. Department of Health and Human Services’ Healthy People 2010. Data for these health indicators come from various sources, including the Behavior Risk Factor Surveillance System (BRFSS), New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS), Vital Statistics, New York State Cancer Incidence and Mortality by County, New York State Kids Well-Being Indicators Clearinghouse (KWIC), Teen Assessment Project Report (TAP), as well as Madison County Department of Health’s internal databases. Demographic and Socio-Economic Status Madison County is located in central New York State, bordering six other counties: Onondaga, Oswego, Oneida, Chenango, Cortland, and Otsego. According to the U.S. Census Bureau, Madison county has a total area of 662 square miles (1,713 km²), of which, 656 square miles (1,699 km²) of it is land and 6 square miles (15 km²) of it (0.86%) is water. Madison County has 107 persons per square mile compared to New York’s 414 persons per square mile. Population In 2008, Madison County’s population was estimated at 69,766. This is a 0.5% increase from April 1, 2000 to July 1, 2008. New York State had an increase in population of 2.7% over the same time period. Population by Age Comparing population rates from 2005 through 2007 with rates from 2000, Madison County’s infant population, 0-4 years of age, decreased from 5.9% to 5.0% while its senior population, 65+, increased from 12.5% to 13.0%. Youth population, 0-19 years of age, decreased from 29.9% to 27.6%. The median age of Madison County has increased from 36.1 years to 37.0. Age of Madison County Population (2000) 12000 Number of Individuals 10000 8000 6000 4000 2000 0 Under 5 years 5 to 9 10 to 14 15 to 19 20 to 24 25 to 34 35 to 44 Ages 8 45 to 54 55 to 59 60 to 64 65 to 74 75 to 84 85 and above Madison County 2010 – 2013 Community Health Assessment Report Population by Ethnicity The population of Madison County is predominantly White (96.2%) with a smaller number of minorities. Of the total population consisting of one race, 1.9% is Black or African American, 1.4% is Hispanic or Latino, 0.4% is American Indian or Alaskan Native, and 0.9% is Asian. Population by Gender Of the total Madison County population, 51.0% of the population is female with the remaining 49.0% being male. Non-English Speaking Population Language barriers and cultural differences can make it difficult for many culturally and linguistically diverse residents to gain access to health and human services and pertinent medical, health, and insurance information. In Madison County 4.7% of the population speaks a language other than English. Of that population 1.7% speaks Spanish and 1.9% speaks other Indo-European languages. Only 1.4% of the total population speaks English less than “very well.” Homeless Population The difficulties associated with locating individuals that are homeless create problems in determining the total number of persons within Madison County who experience homelessness. Factors associated with and contributing to homelessness include substance abuse, domestic violence, lack of education, unemployment and poverty. Single-Parent Households There are 25,967 total households in Madison County with 8,396 (32.3%) representing non-family households. Of the non-family households, 6,579 (25.3%) are householders living alone. Married couple families constitute 13,610 (52.4%) of the households in Madison County. Of the married coupled families, 5,397 (20.8%) are with their own children under the age of 18. There are 1,212 (4.7%) family households with a male householder and no wife. There are 2,749 (10.6%) family households with a female householder and no husband, which is lower than the state average of 14.6%. Since the 2000 census, married family households overall decreased from 13,968 to 13,610 in 20052007, while single family households have increased accordingly; male householders from 1,142 to 1,212 and female householders from 2,467 to 2,749. Household Income Median Income The 2005 through 2007 median household income in Madison County is $50,126 in comparison with the New York State median household income of $52,944. For Madison County, this is an increase of 4.5% from $47,899 in 2000. There are 25,967 households in Madison County and 24.6% of these earn less than the median income ($34,999 or less). Median income for males is $41,154 and for females is $28,876. Poverty According to the 2005-2007 Census, 10.1% of all people in Madison County are below the poverty line, which is below the State level of 14.0% and slightly above the county’s 9.8% level in 2000. The poverty level for persons 65 and older is 6.8% for Madison County. The rate for New York State is 12.2%. Unemployment Census 2005-2007 data reports that the unemployment rate for Madison County was 5.9% for the civilian labor force. This is compared to 6.7% in New York State. Data from the NYS Department of Labor shows the unemployment rate for Madison County increased from 5.2% in December 2007 to 7.6% in 9 Madison County 2010 – 2013 Community Health Assessment Report December 2008. During the same time period New York State unemployment increased from 4.7% to 6.8%. Jobs and Annual Pay 37% of Madison County’s employed population work in the management, professional, and related occupations fields. The largest industries in Madison County are educational services, health care, and social assistance (which are stated as one industry) with 28.5%. The majority of the civilian employed population 16 and over (73.5%) are private wage and salary workers. Of all females 16 years of age and older, 60.2% are in the civilian labor force compared to 56.9% in New York State. Health Status Information Mortality Leading causes of death in Madison County are cardiovascular disease (251.5), malignant neoplasm (cancer) (199.8), diseases of the heart (180.9), and coronary heart disease (136.0) per 100,000 populations. According to the CDC/NCHS National Vital Statistics System, the leading causes of death for New York State are diseases of the heart (270.0), malignant neoplasm (cancer) (184.7), chronic lower respiratory diseases (35.4), and cerebrovascular disease (34.4) per 100,000 populations. These leading causes of death have remained consistent over the last decade. Maternal and Child Health Status Maternal and child health status indicators are often used to reflect the overall health and well being of a population. Improvement of the health status of mothers and infants remains a national priority. This section describes birth to teens, infant mortality, low birth rate, prenatal care, maternal mortality, infants with gestational age less than 37 weeks, and child mortality. Infant mortality (death within the first year of life) is one of the most widely used markers for determining the health status of the population as a whole. As of 2009, the CIA World Fact book ranks the United States’ infant mortality rate (6.26 per 1,000 live births) 180th out 224 countries. In addition, the disparity in infant mortality rates between Whites and specific ethnic groups (i.e. African Americans, Hispanics, and American Indians) persists. Although the overall infant mortality rate has reached record low levels, the rate for African Americans remains twice that of Whites. Efforts, thus far, to improve the health of mothers and infants have concentrated on the prenatal/ postnatal periods. This focus provides the opportunity to identify and modify risks associated with pregnancy outcomes. Major contributing factors include maternal high-risk behaviors such as smoking, alcohol consumption, and illegal substance abuse. It has been proven that women who engage in these high-risk behaviors demonstrate a higher rate of poor birth outcomes including infant disease and death. Other contributing factors include unintended pregnancies, denial of pregnancy, pregnancy occurrence before age 15, and after age 44, inadequate spacing of pregnancies (less than two years apart), poor nutrition, pre-existing medical conditions, and socio-economic barriers to adequate care. Infant Mortality From 2004 to 2006 Madison County had an infant mortality rate of 4.6 per 1,000 live births. This rate is lower than the New York State average of 5.8 and just above the Healthy People 2010 goal of 4.5. During the same time period the neonatal mortality rate (death within the first 28 days of life) was 3.2 for Madison County. Seventy percent of infant deaths in Madison County took place within the first 28 days of an infant's life. Madison County is below the state average of 4.0 but is above the Healthy People 2010 goal of 2.9. The remaining infant deaths took place during the postnatal period from an infants 29th day of life until the first birthday. In Madison County the postnatal mortality rate was 1.4 per 1,000 live births, compared to 1.8 for New York State. In this instance Madison County achieved the goal of 1.5 set by Healthy People 2010. 10 Madison County 2010 – 2013 Community Health Assessment Report According to U.S. Department of Health & Human Services National Vital Statistics Report, infant mortality is highest among children of teenage mothers, followed by children of mothers over age 40. Infant mortality is also higher among women who smoke during pregnancy. NYSDOH data indicates that the primary cause of death for children less than 1 year of age is due to conditions originating in the perinatal period, especially due to immaturity or pre-term births. Sudden Infant Death Syndrome and respiratory ailments are also leading causes of death. Infant Mortality (2004-2006) 12 Deaths per 1,000 10 8 6 4 2 0 Infant Mortality Rate Neonatal Mortality Rate Post Neonatal Mortality Rate Madison County Fetal Death Perinatal Mortality Rate (20 weeks gest - 28 days life) Spontaneous Fetal Deaths 20+ Weeks New York State Maternal Mortality Madison County’s maternal mortality rate per 100,000 live births is 46.0 when compared to New York State (18.3) and especially the goal of Healthy People 2010 (3.3). For instance, between 2004 and 2006 there was only one maternal death. The rate is unstable due to low numbers in the numerator. Major causes of maternal death include hemorrhage, ectopic pregnancy (tubal pregnancy), pregnancy-induced hypertension, embolism (blood clot), infection, and other complications. Child Mortality Between 2004 and 2006, Madison County’s early childhood mortality rate (1-4 years) was 22.9 per 100,000 residents in that age group. This rate was higher than both New York City (21.5) and Healthy People 2010’s goal (18.6). Madison County’s childhood/ adolescent mortality rate (5-14 years) was 7.7 per 100,000 residents in that age group; lower than the rate of New York State (12.5). Madison County’s childhood/ adolescent mortality rate is also below the goal for Healthy People 2010 which is 16.8 for children aged 10-14 years and 12.3 for children aged 5-9 years. Between 2004 and 2006, Madison County experienced two deaths by children aged 1 to 4 years and two deaths by children aged 5 to 14 years. The leading cause of death for children of all ages is injury. Among children aged 1 to 4 years, the leading injury related causes of death are motor vehicle crashes, drowning, fires, and burns. Among those aged 5 to 14 years, the leading causes of death include motor vehicle crashes and firearms (including unintentional deaths, homicides, and suicides). Other leading causes of death among children that are less preventable include birth defects, malignant neoplasms, and diseases of the heart. 11 Madison County 2010 – 2013 Community Health Assessment Report Child and Young Adult Mortality Rates (2004-2006) 50 45 40 Deaths per 100,000 35 30 25 20 15 10 5 0 Ages 1-4 Ages 5-14 Madison County Ages 15-19 New York State Parental Care Early prenatal care is defined as pregnancy-related health care received by the mother in the first three months (first trimester) of her pregnancy. Early high quality prenatal care can help to prevent poor birth outcomes by enabling early identification and, where possible, treatment of health problems. Such care can also provide an opportunity to educate or counsel pregnant women about the adverse effects of behaviors such as alcohol, tobacco, or other drugs that increase the risks of poor outcomes for their baby. Such preventative measures as nutrition counseling and HIV testing can have important long term effects on the health and well being of the baby. In 2001, the U.S. Department of Health and Human Services found that infants of mothers who began prenatal care after the first trimester had an infant mortality rate 37% higher than those who received early prenatal care (care starting in the first trimester). The Healthy People 2010 goal for prenatal care is to increase the percentage of infants born to pregnant women receiving prenatal care in the first trimester to 90%. From 2004 to 2006 79.4% of Madison County women delivering live births receiving early prenatal care. This percentage was above that of New York State which had 74.9% early prenatal care. With the same time period the percentage of births with late or no prenatal care was 4.5% for Madison County and 5.0% for New York State. This met the Healthy People 2010 goal of 10%. According to 2003 data, teens are less likely to receive prenatal care than woman over age 24. In all regions of New York State, women of color were significantly less likely to receive prenatal care than White women. Women who had private insurance were far more likely to receive prenatal care than women who had Medicaid. 12 Madison County 2010 – 2013 Community Health Assessment Report Adolescent Pregnancy Rates Assuming the responsibility for parenting before one is financially, socially or emotionally prepared carries increased risks of later difficulties for the parent, the child and the community. Adolescent mothers are less likely than their non-parenting peers to complete high school and marry. They are more likely to have large families and live in poverty. Their children are at greater risk of infant mortality, poor health; lower cognitive development, poor educational outcomes, higher rates of behavior problems, and higher rates of adolescent childbearing themselves. Adolescent childbearing also places a greater financial burden on society in terms of increased supports required to assist these families. Between 2004 and 2006, Madison County’s age specific birth rates for teenagers was 26.1 (15-19 years), 0.3 (10-14 years), 14.2 (15-17 years), and 35.5 (18-19 years) per 1,000 females of the same age group. During the same time period, New York State’s age specific birth rates for teenagers was 61.3 (15-19 years), 1.5 (10-14 years), 36.7 (15-17 years), and 99.5 (18-19) per 1,000 females of the same age group. In all age groups Madison County’s birth rates are well below those of New York State. Healthy People 2010 has a goal of 43.0 birth rate for the 15-17 year age group which both Madison County and New York State have achieved. Age Specific Teen Birth Rates (2004-2006) 120 Births Per 1,000 100 80 60 40 20 0 Teen Pregnancy Rate 10-14 Years Teen Pregnancy Rate 15-17 years Madison County Teen Pregnancy Rate 15-19 Years Teen Pregnancy Rate 18-19 years New York State Teenage Births Teenage birth rates in this country have declined steadily since 1991. While this is good news, teen birth rates in the U.S. remain high, exceeding those in most developed countries. High teen birth rates are an important concern because teen mothers and their babies face increased risks to their health and their opportunities to build a future are diminished. From 2004 to 2006, Madison County’s percentage of teenage births aged 15 to 17 was 1.8% compared to New York State’s 2.1%. The percentages for teenage births from 10 to 17 were 1.9% for Madison County and 2.2% for New York State. In both cases Madison County’s percentages are below New York State’s average. Nationally, teen mothers are more likely than mothers over age 20 to give birth prematurely (before 37 completed weeks of pregnancy.) Babies born too soon face an increased risk of newborn health problems, lasting disability, and even death. Poor outcomes affecting the health of infants born to teens include poor eating habits, neglect to take their vitamins, smoking, drinking alcohol, and taking drugs. Pregnant teens are more likely to smoke than pregnant women over age 25. Pregnant teens are least likely of all maternal age groups to get early and regular prenatal care. A teenage mother is at greater risk than women over age 20 for pregnancy complications such as premature labor, anemia, and high 13 Madison County 2010 – 2013 Community Health Assessment Report blood pressure. Teenage mothers have a higher incident of LBW infants (infants >2500gms or 5.5lbs.) as well. Short Gestation and Low Birth Rate Nationally, short gestation (<37 weeks gestational age) and low birth weight (infants weighing < than 2500 grams or 5.5 pounds) are among the leading causes of neonatal death, accounting for 20 percent of neonatal deaths. From 2004 to 2006, 7.0% of Madison County births were low birth weight compared to 8.3% for New York State. Both percentages are above the target for Healthy People 2010 which is 5.0%. Also from 2004 to 2006, 1.0% of Madison County births were very low birth weight (infants weighing less than 1500 grams or 3.3 pounds) compared to 1.6% for New York State. Once again these percentages are above the target percentage for Healthy People 2010 which is 0.9%. Nationally, low birth weight (LBW) is associated with long-term disabilities, such as cerebral palsy, autism, mental retardation, vision and hearing impairments, and other developmental disabilities. Despite the low proportion of pregnancies resulting in low birth weight babies, expenditures for the care of LBW infants total more than half of the costs incurred for all newborns. The general category of LBW infants includes both those born too early (pre-term infants) and those who are born at full term but who are too small, a condition known as intrauterine growth retardation (IUGR). Maternal characteristics that are risk factors associated with IUGR includes maternal LBW, prior LWB birth history, low pre-pregnancy weight, cigarette smoking, multiple births, and low pregnancy weight gain. Cigarette smoking is the greatest known risk factor. VLBW usually is associated with pre-term birth. Relatively little is known about risk factors for pre-term birth, but the primary risk factors are prior pre-term birth and spontaneous abortion, low pre-pregnancy weight, and cigarette smoking. These risk factors account for only one-third of all pre-term births. Low birth weight is correlated by a number of factors such as high blood pressure, certain infections, and heart, kidney, or lung problems. An abnormal uterus or cervix can increase the mother’s risk of having a premature, low birth weight baby. The March of Dimes reports that socio-economic factors such as low income and lack of education are also associated with the risk of having a low birth weight infant. Healthy People 2010 breaks down premature births into 3 separate categories and has set goals for each; < 32 weeks gestation (goal: 1.0%), 32 to < 37 weeks gestation (goal: 6.4%), and < 37 weeks gestation (7.6%). Between 2004 and 2006, Madison County’s premature births percentage were 1.3%, 10.2%, and 11.5% respectively. New York State’s percentages for these categories were 2.1%, 10.2%, and 11.5% respectively. Madison County has not met the targets set by Healthy People 2010 for any category relating to premature births. According to March of Dimes in nearly half of all cases the reason for premature births is unknown. There are believed to be four main reasons leading to premature labor including maternal or fetal stress, infections, bleeding, and stretching. 14 Madison County 2010 – 2013 Community Health Assessment Report Low Birth Weight and Premature Births (2004-2006) 14 12 Percent (%) 10 8 6 4 2 0 Low Birth Weight Births (<2500 gm s) Low Birth Weight Singleton Births Very Low Birth Very Low Birth Weight Weight (<1500 Singleton Grams) Births Madis on County Premature Births <32 weeks gestation Premature Births 32 <37 weeks gestation Premature Births <37 weeks gestation New York State Alcohol and Substance Abuse During Pregnancy The use of alcohol, tobacco, and illegal substances during pregnancy is a major factor for low birth weight and other poor infant outcomes. Drinking alcohol during pregnancy can cause physical and mental birth defects. Each year in the United States more than 40,000 babies are born with some degree of alcohol related damage. In general, alcohol related birth defects (such as heart defects) are more likely to result from drinking during the first trimester, while growth problems are more likely to result from drinking in the third trimester. However, drinking at any stage of pregnancy can affect the fetus. Overall rates of alcohol use during pregnancy increased during the 1990’s and the proportion of pregnant women using alcohol at higher and more hazardous levels has increased substantially. The economic cost of services to substance exposed infants is great. Nationally, health expenditures related to fetal alcohol syndrome are estimated to be from $75 million to $9.7 billion each year. The American Pregnancy Association claims that marijuana, like cigarette smoke contains certain toxins that keep the fetus from getting the proper supply of oxygen that he or she needs to grow. Smoking marijuana during pregnancy can increase the chance of miscarriage, low birth weight, premature birth, developmental delays, behavioral and learning problems. Using heroin during pregnancy increases the chance of premature birth, low birth weight, and withdrawal syndromes in newborns. Withdrawal syndromes can cause abnormalities in an infant. Reports of substance use during pregnancy are documented on birth certificates based on information provided by the mother. It is believed that self-reporting of substance use behaviors is not fully reliable and that smoking and drinking behaviors re likely under-reported. Healthy People 2010 targets call for 94% of women to report abstaining from alcohol in the month prior to being surveyed and 100% of pregnant women abstaining from binge drinking in the month prior to testing. 15 Madison County 2010 – 2013 Community Health Assessment Report The newborn drug related discharge rate per 10,000 for Madison county in 2004 to 2006 was 59.4% compared to 59.9% from New York State. Smoking Drinking Pregnancy The U.S. Department of Health and Human Service has indicated that smoking during pregnancy can result in spontaneous abortion, low birth weight, and sudden infant death syndrome. It has been associated with infertility, miscarriages, tubal pregnancies, infant mortality, and childhood morbidity. Smoking attributed costs of complicated births in 1995 were estimated at 1.4 billion (17% of costs for all complicated births). According to the CNY and NENY Regional Perinatal Data System Survey given to area women in hospitals and birthing centers, younger women in the region are significantly more likely to report using tobacco while pregnant; although the rate of teenagers who report smoking has dropped to more than 4% since 1999. The Healthy People 2010 target is for 99% of women to abstain from smoking. In 2007 13.7% of pregnant women in New York State smoked during pregnancy. No current data for smoking in pregnant women in Madison County. Childhood Lead Poisoning Childhood lead poisoning is a serious health problem that can have a devastating effect on a child and has serious repercussions for society as a whole. Human interaction with lead in the environment is most dangerous for children under age six. Lead is a common element that has no biologic function; the human body has no need or use for it. Exposure to even small amounts of lead can contribute to behavior problems and learning disabilities and has been shown to lower intelligence. The most common source of lead exposure for children today is lead paint in older housing and the contaminated lead dust and soil it generates. Exposure to elevated levels of lead affects all socioeconomic levels, but children living in poverty tend to be at greater risk. Lower income families are more likely to live in older housing with deferred maintenance that may result in lead paint and hazards. Older homes, especially homes built prior to 1950, present the greatest risk to children because these homes are most likely to contain lead-based paint. Year 2000 census data indicate that over one-third (37%) of homes in New York State, excluding NYC, were built prior to 1950. New York State has a higher percentage of pre-built 1950 housing units available for occupancy than any other state. In 2004, 80.8% of children had at least one lead screening by the age of 36 months in Madison County compared to 82.8% in New York State. It is a New York State requirement that medical providers screen children at age 1 and 2 for elevated blood-levels. It was determined statewide that only 1/3 of children screened at age 1 were screened at age 2. Of those with an age 2 screen, 8% were found to have an elevated blood-lead level. Children are often more mobile after the age of one and often explore their world by mouthing objects, which makes them more susceptible to lead hazards. From 2003 to 2005, the incidence rate of elevated blood lead levels among children under age six years in Madison County was as follows; 10 – 14 mcg/dL (7.7 per 1,000), 15 – 19 mcg/dL (2.8 per 1,000), = 20 mcg/dL (0.0 per 1,000), and = 10 mcg/dL (10.5 per 1,000). At each level Madison County was close to or below the rates of New York State which were as follows; 10 – 14 mcg/dL (8.6 per 1,000), 15 – 19 mcg/dL (2.7 per 1,000), = 20 mcg/dL (2.0 per 1,000), and = 10 mcg/dL (13.3 per 1,000). Communicable Diseases The diagnosis, control, and prevention of communicable diseases are important aspects in public health. This requires the ongoing, and often concurrent, application of epidemiological techniques; disease and infection surveillance; laboratory confirmation; accurate and rapid diagnosis; case and suspect reporting; identifying, locating and clinically evaluating individuals exposed to the diseases; prompt and accurate treatment for case and suspect management and prevention. If correctly done, this can do much to 16 Madison County 2010 – 2013 Community Health Assessment Report prevent the spread of communicable diseases in a community, and/or reduce the occurrence or containment of an outbreak. The application of these techniques will be of significant importance if biological agents are deliberately used to harm human populations. These techniques are an integral part of health emergency response and preparedness. The reporting of suspect or confirmed communicable diseases is mandated under the New York State Sanitary Code (10NYCRR 2.10). The primary responsibility for reporting rests with the physician; moreover, laboratories, school nurses, day care centers, nursing homes/hospitals and state institutions or other locations providing health services. There are 75 communicable diseases that must be reported to the NYSDOH. Thirty-two of these warrants prompt action and should be reported immediately. In addition to these reportable diseases, any unusual disease (defined as a newly apparent or emerging disease or syndrome that could be caused by a transmissible agent or microbial toxin) or cluster or outbreak of non-reportable diseases (head lice, impetigo, pneumonia, and scabies) are also reportable. Communicable diseases remain major causes of illness, disability, and death. Moreover, new agents and diseases are being detected, and some diseases considered under control have reemerged in recent years. In addition, antimicrobial resistance is evolving rapidly in a variety of hospital and communityacquired infections. These trends suggest that many challenges still exist in the prevention and control of infectious diseases. Increases in international travel, importation of foods, inappropriate use of antibiotics on humans and animals, and environmental changes multiply the potential for epidemics of all types of infectious diseases. Some of these diseases and pathogens were unknown 20 years ago. Others are reemerging problems once thought under control. At-risk populations include persons with impaired host defenses; pregnant women and newborns; travelers, immigrants, and refugees; and older adults. Selected Communicable Diseases Campylobacteriosis Nationally, in 2003 it was estimated that there were approximately 56,400 cases for a case rate of 20 per 100,000 population. In 2007 the rate of Campylobacteriosis in Madison County was 2.8 per 100,000 population compared to 13.1 % for New York State. Campylobacteriosis and Salmonella Campylobacteriosis and salmonella are the most frequently reported food borne illnesses in the United States. Both are included in the Healthy people 2010 food safety objectives targeted to reducing food borne illness. More than30 million people in the Unites States are likely to be partially susceptible to food borne disease. Very young, elderly and immunocompromised persons experience the most serious food borne illnesses. They may become ill from smaller doses of organisms and may be more likely than other persons to die of food borne diseases. For example, children under age 1 have the highest rate of Campylobacter species infections. Other high-risk populations include residents in nursing homes or chronic care facilities; hospitalized cancer, and organ transplant patients; and individuals with AIDS, with cirrhosis, on anti-microbial treatment, or with reduced stomach acid such as due to antacid medications. Chronic B and C Hepatitis In recent years there has been national and state efforts to identify, diagnose, and report individuals with chronic Hepatitis B and/or Hepatitis C, to state and local health departments. 17 Madison County 2010 – 2013 Community Health Assessment Report Hepatitis B virus (HBV) infection can be reduced greatly as vaccinated infants and adolescents enter young adulthood, a period when the risk of HBV infection increases. Each year 16,000 to 18,000 children in the United States are born to mothers infected with HBV. Without prevention programs, about 8,000 of these infants would become infected with HBV. Ninety-five percent of the infections, however, are preventable through appropriate maternal screening and infant care. Screening pregnant women during an early prenatal visit is essential to identify those who are infected. Women at high risk should be retested late in pregnancy. In 1997, 14 states had laws or regulations to ensure such screening. To be maximally effective, steps to prevent transmission of HBV to infants born to mothers who are infected must begin as soon as the child is born. Such infants should receive a first dose of hepatitis B vaccine within 12 hours of birth, along with hepatitis B immune globulin (HBIG), and two more doses of vaccine by age 6 months. Children need to be tested between the ages of 12 and 15 months to ensure that they are not infected and have developed immunity to the virus. To reduce HBV transmissions vaccination programs must be targeted to adolescents and adults in highrisk groups. The primary means of achieving high levels of vaccination coverage in-groups with behavioral risk factors for HBV infection is to identify settings where these individuals can be vaccinated. Such sites include clinics that treat sexually transmitted disease (STDS), correctional facilities (juvenile detention facilities, prisons, jails), drug treatment clinics, and community-based HIV prevention sites. An estimated 1.25 million persons in the United States have chronic HBV infection. Routine infant vaccination eventually will produce a highly immune population sufficient to eliminate HBV transmission in the United States. However, high rates of acute hepatitis B continue to occur, with an estimated 65,000 cases in 1996. Most cases occur in young adult risk groups, including persons with a history of multiple sex partners, men who have sex with men, injection drug users, incarcerated persons, and household and sex contacts of persons with HBV infection. Investigation of reported cases of acute Hepatitis B indicates that as many as 70 percent of these individuals previously had been seen in settings, such as drug treatment clinics, correctional facilities, or clinics for the treatment of STD, where they could have received the vaccine. Hepatitis B vaccination has been recommended for persons with risk factors for Hepatitis B Virus infection since the vaccine was first licensed in 1981. These risk groups include the following: hemodialysis patients, men who have sex with men, incarcerated persons, health care and public safety workers who have exposure to blood in the workplace, persons with a history of sexually transmitted disease or multiple partners, injection drug users, and household and sex contacts of HBV-infected persons. Hepatitis C Virus (HCV) is the most common chronic blood borne viral infection in the Unites States. The virus usually is transmitted through large or repeated percutaneous exposures to blood, for example through sharing equipment between injection drug users. HCV infects persons of all ages, but most new cases are among young adults aged 20 to 39 years. The highest proportion of new cases is among Whites, but the highest rates of new cases are among non-White racial and ethnic groups. Nationally, there are no reliable national reporting data regarding individuals with chronic hepatitis. However, the Centers for Disease Control and Prevention (CDC) estimated that there are approximately 1.25 million people with chronic hepatitis B infection and 2.7 million with chronic hepatitis C infection. In addition, many people do not know they have either of the two conditions and do not seek medical screenings or diagnosis. Thus, the number of acute infections reported is much less than what is occurring. Despite declines in the number of new infections, the reservoir of chronically infected persons is at risk for the severe consequences of chronic liver disease. The reporting of cases became mandatory in 2002 and initiatives were taken to secure case reports in 2001 for those whose repeat blood tests yielded chronic hepatitis again in 2002. Thus, surveillance and reporting activities for Hep B & C intensified in 2002. Many of these individuals are reported from correctional facilities, drug treatment facilities, and/or have a history of drug use. 18 Madison County 2010 – 2013 Community Health Assessment Report From 2004 to 2006, Hepatitis B rate for Madison County was 0.5 per 100,000 population compared to New York State which was 1.2 per 100,000 population. Both rates are below the targets of Healthy people 2010 which range from 2.4 to 5.1 depending on age. In 2004 the Hepatitis C rate Madison County was 0.0 per 100,000 population compared to 0.2 per 100,000 population for New York State. Again, both rates were below the Healthy People 2010 target of 2.4. From 2004 to 2006, both Madison County and New York State had a Hepatitis A rate of 1.9 per 100,000 population. This was below the Healthy People 2010 goal of 4.5 per 100,000 population. Giardia Giardia infection has become recognized as one of the most common causes of waterborne disease (found both in drinking and recreational water) in humans in the United States. Giardia is found worldwide and within every region of the United States. Anyone can get giardiasis; however, persons more likely to become infected include international travelers and individuals who drink contaminated water. In 2007, the rate of giardiasis in Madison County was 12.8 per 10,000 compared to 11.0 per 10,000 for New York State. Infectious Disease During the past three decades, Sexually Transmitted Diseases (STDs) are among the few areas of infectious diseases that have changed the epidemiology and our understanding of clinical manifestations. Although the bacterial STDs declined in the 1990s in the United States and Western Europe, they remain epidemic in much of the world and in many parts of this country. The United States has many times higher rates of the classic bacterial STDs than any other industrialized country, demonstrating the influence of demographic, social, and behavioral factors on infectious diseases despite availability of effective diagnosis and treatment. Sexually transmitted diseases embody all the elements of “emerging” infections, including recognition of new or apparently new pathogens, syndromes and complications, emergence of antimicrobial resistance in formerly susceptible pathogens, the increasing importance of viral infections, and rapid international spread fostered by the increase in international travel and commerce. STDs are hidden epidemics because many Americans are reluctant to address sexual health issues in an open way due to the biologic and social characters of these diseases. Select Sexually Transmitted Disease Rates 100 90 Cases per 100,000 80 70 60 50 40 30 20 10 0 Early Stage Syphilis ^ Congenital Syphilis Rate (per 100,000 births )^^ Madis on County 19 Gonorrhea Rate^ New York State Madison County 2010 – 2013 Community Health Assessment Report The rate of primary and secondary syphilis reported in the U.S. decreased during the 1990s and 2000 was the lowest since reporting began in 1941. However, the rate of primary and secondary syphilis has been increasing since 2001. Overall, the increases have occurred only among men. Recent increases in syphilis among men who have sex with men (MSM) highlights the importance of continually reassessing and refining surveillance, prevention, and control strategies. From 2004 to 2006, Madison County had an early syphilis rate of 0.0 per 100,000 population compared to 8.6 per 100,000 population in New York State. From 2001 to 2003, the congenital syphilis rate per 100,000 births was 0.0 in Madison County and 16.0 in New York State. Madison County achieved the Health People 2010 goal of 1.0 per 100,000 births. From 2004 to 2006, Madison County had a gonorrhea rate of 12.3 per 100,000 population compared to New York State which had a rate of 93.4 per 100,000 population. Madison County was below the Healthy People 2010 target of 19.0 per 100,000 population. Chlamydia trachomatis is the most commonly reported notifiable disease in the United States followed by Neisseria gonorrhea. This disease became reportable in New York State in mid-2000. In 2003, a majority of cases (60%) continue to be reported among Whites, with 80% of those being female. Chlamydia is a disease identified primarily in women, though this may be misleading as men are not often routinely screened. From 2004 to 2006, the male Chlamydia rate for all ages in Madison County was 80.9 per 100,000 population compared to 189.3 for New York State. The male Chlamydia rate for men age 15 to 19 in Madison County was 354.7 per 100,000 and in New York State the rate was 576.2 per 100,000. From 2004 to 2006, the female Chlamydia rate for all ages in Madison County was 174.6 per 100,000 population compared to 576.2 for New York State. The female Chlamydia rate for women age 15 to 19 in Madison County was 808.4 per 100,000 and in New York State the rate was 2601.6 per 100,000. In each instance, the rate for female Chlamydia was over twice the rate as male Chlamydia. Chlamydia Rates (2004-2006) 3000 Cases per 100,000 2500 2000 1500 1000 500 0 Male Chlamydia (All Ages) Male Chlamydia (15-19 Female Chlamydia (All Years) Ages) Madison County Female Chlamydia (1519 Years) New York State In 2007, Madison County had 19 living cases of HIV and 29 living cases of AIDS, including prisoners. With prisoners excluded those numbers dropped to 15 living cases of HIV and 19 living cases of AIDS. In 2007, there were 3 newly diagnosed HIV cases including prisoners and 2 new cases excluding prisoners. There were no new diagnosed cases of AIDS in 2007 for Madison County. From 2004 to 2006, the HIV case rate in Madison County was 3.3 per 100,000 population, significantly lower than the New York State rate of 24.0 per 100,000 population. The AIDS case rate for Madison County (2.4) is also considerably 20 Madison County 2010 – 2013 Community Health Assessment Report lower than the AIDS rate for New York State (23.8). Although the rate for Madison County is lower than that of New York State is still does not meet the Healthy People 2010 goal of 1.0 per 100,000 population. Madison County has an AIDS mortality rate of 0.0 per 100,000 population which does meet the Healthy People 2010 goal of 0.7 per 100,000 population. The AIDS mortality rate for New York State was 8.0 per 100,000 population. Mycobacterium tuberculosis and less commonly, M bovis and M africanam are the infectious agents that cause the airborne disease tuberculosis. Eight million new tuberculosis (TB) cases occur each year in the world and 3 million people die of the disease. The United States experienced a resurgence of TB disease between 1985 and 1992. In 2003, 5.1 cases of TB per 100,000 population were seen on a national level. With infrastructure improvements and the advent of directly observed treatment (DOT), supervision of TB medication administration, as the standard of care, morbidity in the U.S. has decreased. Despite an overall reduction in cases of TB disease, among those diagnosed, an increase in foreign-born cases has continued for the past five years. The continued morbidity and mortality experienced in other parts of the world, combined with international commerce, travel and the U.S. history of welcoming immigrants and refugees account for the disease spread among these populations. Cases of multi-drug resistant disease challenge TB controllers and healthcare providers. Ensuring prompt diagnosis, patient isolation when indicated, identification and evaluation of close contacts, and treatment completion remain critical factors in the control of tuberculosis. From 2004 to 2006, the tuberculosis rate for Madison County was 0.0 per 100,000 population compared to 6.9 per 100,000 for New York State. Madison County achieved the Healthy People 2010 goal of 1.0 per 100,000 population. Vaccine Preventable Diseases Many once common vaccine preventable disease now are controlled. Smallpox has been eradicated, poliomyelitis has been eliminated from the Western Hemisphere, and measles cases in the United States are at a record low. Immunizations against influenza and pneumococcal disease can prevent serious illness and death. Pneumonia and influenza deaths together constitute the eighth leading cause of death in the United States. Influenza causes an average of 110,000 hospitalizations and 36,000 deaths annually; pneumococcal disease causes 10,000 to 14,000 deaths annually. Vaccines are among the greatest public health achievements of the 20th century. Immunizations can prevent disability and death from infectious diseases for individuals and can help control the spread of infections within communities. National coverage levels in children now are greater than 90 percent for each immunization recommended during the first 2 years of life, except for hepatitis B and varicella vaccines. Coverage levels for immunizations in adults are not as high as those achieved in children, yet the health effects may be just as great. Barriers to adult immunization include not knowing immunizations are needed, misconceptions about vaccines, and lack of recommendations from health care providers. Both influenza and pneumococcal immunization rates are significantly lower for African Americans and Hispanic adults than for White adults. In 2008, 41.9% of the Madison County population had a flu shot within the past 12 months compared to 41.7% in New York State. Both percentages fall below the Health People 2010 target of 60.0%. Among adults aged 65 and older 64.1% of Madison County residents and 74.4% of New York State residents had a flu shot. Once again both percentages fall below the Healthy People 2010 goal of 90.0%. In 2008, 30.0% of the Madison County population had a pneumonia shot or pneumococcal vaccine compared to 25.8% in New York State. Both percentages fall below the Health People 2010 target of 60.0%. Among adults aged 65 and older 71.3% of Madison County residents and 64.2% of New York State residents had a pneumonia shot or pneumococcal vaccine. Once again both percentages fall below the Healthy People 2010 goal of 90.0%. 21 Madison County 2010 – 2013 Community Health Assessment Report Select Vaccination Statistics (2008) 80 70 Percent (%) 60 50 40 30 20 10 0 Received Flu Shot within the Past 12 Months Received Flu Shot or Flu Vaccine Sprayed in Nose within the Past 12 Months Received Flu Shot (Adults Age 65 and Older) Madison County Received Pneumonia Received Pneumonia Shot or Shot or Pneumococcal Pneumococcal Vaccine Vaccine (Adults Age 65 and Older) New York State Selected Chronic Disease Indicators Heart Disease Heart Disease is the leading cause of death for all people in the Unites States. Coronary heart disease accounts for the largest proportion of heart disease. The death rate peaked in the mid-1960’s and has declined in the general population over the past 45 years. High blood cholesterol is a major risk factor for coronary heart disease that can be modified. More than 90 million adults have cholesterol levels that are higher than desirable. Life Style changes that prevent or lower high blood cholesterol include eating a diet low in saturated fat and cholesterol, increasing physical activity, and reducing excess weight. From 2004 to 2006, Madison County’s mortality rate for diseases of the heart was 180.9 per 100,000 population. New York State had a higher rate of 237.2 per 100,000 population. 22 Madison County 2010 – 2013 Community Health Assessment Report Heart Disease Mortality (2004-2006) 300 Deaths per 100,000 250 200 150 100 50 0 Diseases of the Heart Coronary Heart Disease Congestive Heart Failure Madison County Cerebrovascular Disease Cardiovascular Disease New York State Stroke is the third leading cause of death for all people in the United States. About 795,000 strokes occur each year in the United States, resulting in over 143,000 deaths. Like coronary heart disease, stroke death rates have declined over the past 30 years. This rate of decline, however, has declined in recent years. The overall decline has occurred mainly because of improvements in the detection and treatment of high blood pressure. Vital Statistic Data from 1998-2000 indicate that cerebrovascular disease is still the most prevalent of all cardiovascular diseases in the United States. From 2004 to 2006, Madison County had a cerebrovascular disease mortality rate of 43.6 per 100,000 population compared to 30.5 per 100,000 in New York State. Although Madison County is above the state average, the rate is still below the target rate of 48.0 per 100,000 population set by Healthy People 2010. Diabetes Diabetes is a heterogeneous group of metabolic disorders characterized by high blood glucose levels caused by a deficiency in insulin production. Most cases of diabetes fall into one of two clinical types: Insulin Dependent Diabetes Mellitus (Type 1) and Non-Insulin Dependent Diabetes Mellitus (Type 2). In general 5% to 10% of diabetics have Type 1 insulin dependent diabetes and the remaining have Type 2 non-insulin dependent diabetes. In both types of diabetes, patients are treated with a regimen of diet, physical activity, medication, and blood glucose monitoring. Nationally, the incidence of diabetes is consistently higher for females than males and for minorities than for Whites. This disorder is one of the most prevalent chronic conditions among Americans. Approximately 17.9 million people in the Unites States have been diagnosed with diabetes with another 5.7 million people unaware of their condition. There are 9.0 new cases per 100,000 persons of diabetes each year. From 2004 to 2006, Madison County had diabetes mellitus mortality rate of 11.6 per 100,000 population compared to New York State with a rate of 18.7 per 100,000 population. Both rates are below the Healthy People 2010 target rate of 45.0 per 100,000 population. The hospitalization rate during this time was 8.2 per 10,000 population for Madison County and 19.7 per 10,000 population for New York State. In 2008, the percentage of the adult population ever diagnosed with diabetes was 6.2% for Madison County and 9.7% for New York State. 23 Madison County 2010 – 2013 Community Health Assessment Report Selected Chronic Disease Indicators Respiratory Disease Asthma is a serious chronic condition with 34.1 million Americans being diagnosed by a health care professional in their lifetime. It is estimated that the number of people with asthma will grow by more than 100 million by 2025. For those under age 18 years of age, asthma is the most frequent cause of activity limitation. Nearly 20% of all people with asthma suffer some limitations due to the disease. Asthma is much more common among children than adults. There is no difference in asthma prevalence by gender. From 2004 to 2006, Madison County had an asthma mortality rate for all ages of 13.1 per 1,000, 000 population and New York State’s rate was 13.4 per 1,000,000 population. Target rates for Healthy People 2010 range from 1.0 deaths per 1,000,000 population for children under the age of 5 to 60 deaths per 1,000,000 population for adults aged 65 years and older. From 2004 to 2006, the total hospitalization rate for Madison County 10.1 per 10,000 population, less than half the rate of New York State at 21.0 per 10,000 population. Madison County has a hospital discharge rate of 30.3 per 10,000 for children under the age of five. Although this rate is less than half the rate of New York State (61.7 per 10,000), is still does not meet the goal established by Healthy People 2010 which is 25.0 per 10,000 children under the age of five. For children aged 5 to 14, Madison County’s hospital discharge rate for asthma (5.8 per 10,000) does meet the Healthy People 2010 goal of 7.7 per 10,000 children aged 5 to 14. New York State is above the goal with a rate of 23.4 per 10,000 children aged 5 to 14. For ages 0 to 17, Madison County had an asthma hospitalization rate of 10.6 per 10,000 and New York State had a rate of 31.5 per 10,000 kids aged 0 to 17 years. For residents aged 5 to 64 Madison County’s rate for asthma hospitalization (6.6 per 10,000) was again below the rate set by Healthy People 2010 of 7.7 per 10,000 population aged 5 to 64 years. The rate for New York State was considerably higher at 16.2 per 10,000. For residents over the age of 64, neither Madison County (21.6 per 10,000) nor New York State (30.0 per 10,000) was able to meet the goal established by Healthy People 2010 of 11.0 per 10,000 residents over the age of 64. In 2008, 18.1% of Madison County adult residents have at sometime been diagnosed with asthma. New York States average was slightly lower at 16.5%. Also, 15.8% of Madison County adult residents currently have asthma compared to 9.9% of residents in New York State. From 2004 to 2006, the mortality rate in Madison County for chronic obstructive pulmonary disease (COPD) was 64.8 per 100,000 population, over double the rate for New York State (31.3 per 100,000 population). Madison County also does not meet the goal set by Healthy People 2010 of 60.0 per 100,000 population. The hospitalization rate for COPD was lower in Madison County (28.6 per 10,000 population) than it was in New York State (36.7 per 10,000 population). 24 Madison County 2010 – 2013 Community Health Assessment Report Respiratory System Mortality (2004-2006) 70 60 D e a th s 50 40 30 20 10 0 Chronic Obstructive Pulmonary Disease* Chronic Lower Respiratory Disease* Asthma** Madison County Pneumonia* (2004 data only) New York State Chronic Liver Disease From 2004 to 2006, the mortality rate for cirrhosis in Madison County was 5.7 per 100,000 population, similar to that of New York State at 6.0 per 100,000 population. Both rates are above the target of Healthy People 2010 which is 3.0 per 100,000 population. The hospitalization rate for cirrhosis in Madison County was 28.6 per 10,000 population compared to 36.7 per 10,000 population for New York State. Selected Cancers Cancer is the second leading cause of death in the United States. In 2009, an estimated 1,479,350 new cases of cancer will be diagnosed in the U.S. (766,130 in men and 713,220 in women) and 562,340 people will die of the disease (292,540 men and 269,800 women). This means 1,500 deaths from cancer every day. About 491,400 persons who get cancer in a given year are expected to be alive in 5 years after diagnosis. In addition to the human toll of cancer, the financial costs of cancer are substantial. The overall annual costs for cancer are estimated at $107 billion, with 37 billion for direct medical costs, $11 billion for costs of illness, and $59 billion for costs of death. Treatment for lung, breast, and prostate cancer alone account for more than half of the direct medical costs. Evidence suggests that several types of cancer can be prevented and that the prospects for surviving cancer continue to improve. 25 Madison County 2010 – 2013 Community Health Assessment Report Malignant Neoplasm Mortality 60 Deaths per 100,000 50 40 30 20 10 0 Lung and Bronchus* Breast (Female)* Uterine Cervix* Prostate** Madison County Colorectal* Melanoma of the Skin** Oral Cavity and Pharynx** Ovary** New York State Lung cancer is one of the most common and also one of the most preventable forms of cancer in the United States. Lung cancer is also the leading cancer killer for both men and women in the United States. Cigarette smoking is the most important risk factor for lung cancer, accounting for 68-78 percent of lung cancer deaths among females and 88 to 91 percent of lung cancer deaths among males. One to two percent of lung cancer deaths are attributable to air pollution. After 10 years of abstinence, smoking cessation decreases the risk of lung cancer to 30 to 50 percent of that of continuing smokers. The lung and bronchus cancer mortality rate in Madison County was 54.2 per 100,000 population between 2002 and 2006. The rate for New York State was lower at 46.1 per 100,000 population. Both rates are above the target set by Healthy People 2010 of 44.9 per 100,000 population. Between 2001 and 2005, the lung and bronchus cancer incidence rate was 79.1 per 100,000 population in Madison County and 64.8 per 100,000 population in New York State. The percent of early stage lung and bronchus cancer from 2001 to 2005 was 25.0% for Madison County and 21.0% for New York State. 26 Madison County 2010 – 2013 Community Health Assessment Report Lung and Bronchus Cancer Incidence Rates (2002-2006) 120 Incidence per 100,000 100 80 60 40 20 0 Males Females Madis on County New York State Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Risk factors for colorectal cancer may include age, personal and family history of polyps or colorectal cancer, inflammatory bowel disease, inherited syndromes, physical activity (colon only), obesity, alcohol use, and a diet high in fat and low in fruits and vegetables. The incidence of deaths from colorectal cancers diagnosed in the later stages has decreased attributing to the decreased death rates from CRC. Cancer deaths vary by gender, race, and ethnicity. African Americans are 34% more likely to die of cancer than Whites and twice as likely to die from cancers than Asians, Pacific Islanders, American Indians, and Hispanics. African American males account for the greatest number of deaths from colon, rectum, lung, and prostate cancers. Studies indicated that African American males exhibit lower survival rates due to advanced stage diagnosis. Hispanics display lower survival rates than Whites also because of later stage diagnosis. Early detection, routine screening, and early treatment play a vital role in survival rates. The incidence of early CRC diagnosis has been increasing 0.8% per year, with the onset of improved screening methods. The age-adjusted death rate from CRC has been declining nationally, but declines in death rates have not been as substantial for the black population. Differences in rates among the different races poses a challenge to understand and reduce illness and death. From 2002 to 2006, the mortality rate for colorectal cancer in Madison County was 25.1 per 100,000 population. New York State had a lower rate of 18.3 per 100,000 population. Both rates are above the Healthy People 2010 goal of 13.9 deaths per 100,000 population. Between 2001 and 2005, the incidence of colorectal cancer for Madison County was 64.8 per 100,000 population. The rate for New York State was lower at 54.1 per 100,000 population. The percentage of early stage colorectal cancer for Madison County was 50.0% which equaled the goal of Healthy People 2010 which is 50.0%. New York State did not meet the goal with 41.0%. 27 Madison County 2010 – 2013 Community Health Assessment Report Colorectal Cancer Incidence Rates (2002-2004) 80 70 Incidences per 100,000 60 50 40 30 20 10 0 Males Females Madison County New York State Cervical cancer is the 10th most common cancer among females in the United States. Cervical cancer accounts for about 1.7 percent of cancer deaths among females. Considerable evidence suggests that screening can reduce the number of deaths from cervical cancer. If cervical cancer is detected early, the likelihood of survival is almost 100 percent with appropriate treatment and follow-up. From 2002 to 2006, the mortality rate for uterine cervix cancer was 3.0 per 100,000 female residents in Madison County. The rate for New York State was slightly lower at 2.6 per 100,000 female residents. Both rates are above the target for Healthy People 2010 which is 2.0 per 100,000 female residents. From 2002 to 2006, the incidence rare for uterine cervix cancer was 4.8 per 100,000 female residents in Madison County. The rate for New York State was higher at 7.5 per 100,000 female residents. Breast Cancer is the most common form of cancer among women in the United States. Risk factors for breast cancer include age, family history of breast cancer, reproductive history, mammographic densities, previous breast disease, weight, race, and ethnicity. The breast is one of the most common sites for cancer to develop in women of all racial and ethnic groups. Recently death rates from breast cancer have decreased, especially in Whites. The decrease in rates is attributed to the use of breast cancer screening, regular medical care, and testing. African American women continue to demonstrate higher death rates of 36.7 per 100,000 compared to 27.3 for Whites. New cases of breast cancer are increasing among Hispanic women who are diagnosed at later stages and result in lower survival rates. Death from breast cancer can be significantly reduced if the tumor is discovered and treated at an early stage. Mammography is the most effective method for detecting these early malignancies. Clinical trials have demonstrated mammography screening can reduce breast cancer deaths by 20 to 39 percent in women aged 50 to 74 years and about 17 percent in women aged 40 to 49 years. 28 Madison County 2010 – 2013 Community Health Assessment Report From 2002 to 2006, the mortality rate for female breast cancer was 29.1 per 100,000 population and for New York State the rate was 24.5 per 100,000 population. Both rates are above the Healthy People 2010 target of 22.3 per 100,000 population. The incidence rate for female breast cancer from 2002 to 2006 was 124.3 per 100,000 population in Madison County. The rate was higher for New York State at 134.2 per 100,000 population. Form 2001 to 2005, the percentage of early stage female breast cancer was 67.0% for Madison County and 63.0% for New York State. Both rates fall short of the Healthy People 2010 goal of 75.0%. Select Cancer Incidence Rates (2002-2006) Incidences per 100,000 120 100 80 60 40 20 C ol or ec ta l( M C ol al C or es ol e on ) c ta ,E l( xc F lu em C di ol al ng on es ,E R ) ec xc t um lu di ng (M al R es ec ) Lu tu m ng (F an em d al Br Lu es on ng ) ch an us d (M Br al on es ch M ) el us an ( Fe om m a al of M es el t h ) an e Sk om in a (M of N al t he on es Sk -H ) in od (F gk em in N on Ly al -H es m ph od ) om gk in a s Ly (M m al ph e) om as (F em al e) 0 Madison County New York State Prostate cancer is the most commonly diagnosed form of cancer in males and the second leading cause of cancer deaths among males in the United States. Prostate cancer is most common in men aged 65 years and older, who account for approximately 80 percent of all cases of prostate cancer. From 2001 to 2005, the mortality rate for prostate cancer was 26.7 per 100,000 male residents in Madison County. The rate for New York State was slightly lower at 25.7 per 100,000 male residents. Both rates are below the target for Healthy People 2010 which is 28.8 per 100,000 male residents. From 2002 to 2006, the incidence rare for prostate cancer was 178.9 per 100,000 male residents in Madison County. The rate for New York State was lower at 173.7 per 100,000 male residents. From 2001 to 2005, the percent of early stage prostate cancer was 88.0% for Madison County and 87.0% for New York State. Both percentages fail to meet the goal of 95.0% established by Healthy People 2010. In 2008, 65.0% of Madison County residents ever had a prostate specific antigen test among men age 40 and older. This is compared to 68.5% for New York State. Within the past two year, 54.6 % of Madison County residents had a prostate specific antigen test among men age 40 and older. This is compared to 58.7% for New York State. 29 Madison County 2010 – 2013 Community Health Assessment Report Oral and pharyngeal cancers comprise a diversity if malignant tumors that affect the oral cavity and pharynx. The overwhelming majority of these tumors are squamous cell carcinomas. Oral cancer is the 10th most common cancer among United States men and the 14th most common cancer among United States women. The five-year survival rate is only 53 percent. From 2001 to 2005, the mortality rate for oral cavity and pharynx cancer was 1.4 per 100,000 residents in Madison County. The rate for New York State was slightly higher at 2.4 per 100,000 residents. Both rates are below the target for Healthy People 2010 which is 2.7 per 100,000 residents. From 2001 to 2005, the incidence rare for oral cavity and pharynx cancer was 9.2 per 100,000 residents in Madison County. The rate for New York State was slightly higher at 9.8 per 100,000 residents. From 2001 to 2005, the percent of early stage oral cavity and pharynx cancer detected in an early stage was 56.0% for Madison County and 36.0% for New York State. Madison County meets the goal of 50.0% established by Healthy People 2010. From 2002 to 2006, the incidence rate was higher for males than females for both Madison County (13.3 per 100,000 for males vs. 4.7 per 100,000 for females) and New York State (14.9 per 100,000 for males vs. 6.1 per 100,000 for females). Esophagus Cancer Incidence Rates (2002-2006) 12 Incidences per 100,000 10 8 6 4 2 0 Males Females Madison County 30 New York State Madison County 2010 – 2013 Community Health Assessment Report Oral Cavity and Pharynx Caner Incidence Rates (2002-2006) 16 Incidences per 100,000 14 12 10 8 6 4 2 0 Males Females Madis on County New York State Although dental disease has been on the decline in the last decade, dental decay remains the most common preventable disease in children. This fact is disturbing because almost all oral diseases can be prevented. Practices that are instrumental in reducing dental caries in children include the use of optimal use of fluoride (especially community water fluoridation), dental sealant on permanent molars (and premolars, if indicated), a balanced diet, good personal dental hygiene and education. Tooth decay is also a problem for adults, especially for the increasing number of older adults who have retained most of their teeth. Despite this increase in tooth retention, tooth loss remains a problem among older adults. Almost 3 of every 10 adults over the age 65 have lost all of their teeth, primarily because tooth decay and gum disease, which affects about 25% of U.S. adults. Tooth loss has more than cosmetic effects; it may contribute to nutrition problems by limiting the types of food that a person can eat. The use of cigarettes, cigars or pipe smoking, smokeless tobacco and excess use of alcohol contribute to periodontal disease. Periodontal disease is an even greater problem for the elderly and individuals from lower socio-economic backgrounds because both groups often lack access to early and preventive dental care. Consequently, they are the least likely on any population group to either seek or complete care. National and State statistics have shown that the average number of decayed teeth increases as the household income decreases and educational attainment levels decrease. African Americans have higher rates of decay and many missing teeth and lower rates of filled teeth than Whites. Utilization of dental services is positively correlated with income and educational attainment. Immigrant children who had no benefit of fluoridated water supplies also have a high rate of tooth decay. For children, cavities are a common problem that begins at an early age. Tooth decay affects nearly a fifth of 2 to 4 year olds, more than half of 8-year-olds, and more than three-fourths of 17-year-olds. Hardest hit is low-income children. About half of all cavities among low-income children go untreated. Untreated cavities may cause pain, dysfunction, and absence from school, underweight, and poor appearance; problems that can greatly reduce a child’s capacity to succeed in life. In addition, children from high-risk groups do not receive adequate fluoride exposure or adhesive sealant. Furthermore, the ability to pay for the dental care is a barrier to receiving care for many children from low-income families. In 2008, Madison County had 4.4 licensed dentists per 10,000 residents. New York State had more licensed dentists with a rate of 7.9 per 10,000 residents. In Madison County, 64.6% of adults visited a dentist within the past year compared to 70.5% in New York State. Both percentages met the target set by Healthy People 2010 of 56.0%. In Madison County, 67.9% of adults had their teeth cleaned within the past year compared to 71.7% in New York State. In Madison County, 51.1% of adults had permanent teeth extracted due to decay or gum disease compared to 50.1% for New York State. Both percentages 31 Madison County 2010 – 2013 Community Health Assessment Report met the target set by Healthy People 2010 of 58.0%. In Madison County, 30.8% of adults aged 65 and older had all their permanent teeth extracted due to decay or gum disease compared to 18.4% in New York State. Madison County failed to meet the Healthy People 2010 goal of 20.0%. Children from low socio-economic areas have higher unmet dental health needs. Studies have correlated data on participation in the free school lunch program with areas of high risk for poor dental health outcomes. These studies reveal that children who participate in the free school lunch program are more likely to be without proper dental care and, therefore, have more dental caries. From 2002 to 2004, the New York State Bureau of Dental Health conducted an oral health survey of 3rd grade children. The children were categorized into two socioeconomic strata (SES) based on the percent of children in the free or reduced school lunch program. The six indicators used in the survey were the percent of 3rd grade children with caries experience, with untreated carries, with dental sealants, with dental insurance, with at least one dental visit in last year, and reported taking fluoride tablets on a regular basis. Of the six indicators, residents of Madison County with high socio-economic status faired better in four of the six indicators which include with caries experience, with untreated caries, with dental insurance, and with at least one dental visit in last year. Madison County residents with low socioeconomic faired better in only two indicators which include with dental sealants and reported taking fluoride tablets on a regular basis. Health Related Behaviors Substance Abuse Cigarette smoking is the single most preventable cause of disease and death in the United States. Among the leading causes of death such as heart disease, stroke, lung cancer, and chronic lung diseases, smoking is identified as a major risk factor. In fact, more deaths are attributed to smoking each year than aids, alcohol, cocaine, heroin, homicide, suicide, motor vehicle crashes, and fires- combined. Environmental tobacco smoke (ETS), also known as second-hand smoke, increases risk of heart disease and lung conditions, such as asthma and bronchitis, especially in children. In 2008, 91.5% of Madison County residents think breathing smoke from someone else’s cigarettes is very or somewhat harmful. This percentage is slightly higher for New York State at 93.8%. In Madison County, 79.7% of residents do not allow smoking in their home and 76.6% of residents do not allow smoking in their family vehicles. In Madison County, 45.3% of residents are employed by an organization that has a policy that prohibits smoking on the entire grounds of the workplace. In Madison County, 18.7% of adult residents are considered a current smoker. New York State has a slightly lower percentage at 16.3%. Of current smokers, about 70% for both Madison County and New York State attempted to quit smoking in the past three years at least one time. Among current smokers, 42.8% of residents in Madison County would like to quit smoking now. In New York State that number is higher at 49.7%. Alcohol Use The use of alcohol is associated with many societal and health related problems challenging our communities including child and spouse abuse; sexually transmitted diseases, including HIV infection; teen pregnancy; school failure; motor vehicle crashes; homicides, suicides, high health care costs; low worker productivity; disruptions in family and personal life; and homelessness. In addition, long-term heavy drinking can lead to heart disease, cancer, alcohol-related liver disease, and pancreatitis. Alcohol use during pregnancy can result in fetal alcohol syndrome, a leading cause of preventable mental retardation. In New York State, the risk for binge drinking decreases as the age of the respondent increases, with the highest level of risk for those respondents between 18 and 24 years of age. Whites (16.2%) tend to binge drink more, followed by Hispanics (12.7%) and blacks (6.8%). Additionally, binge drinking levels increase as education and income levels increase. Similarly, the percent of 18 to 24 year olds at risk for heavy 32 Madison County 2010 – 2013 Community Health Assessment Report drinking is almost two times higher than any other age group. The percent of Whites is three times higher than other ethnic groups. Again, those respondents with higher incomes and education levels tend to drink more heavily. In 2008, 19.5% of Madison County residents took part in binge drinking (5+ drinks in a row) within the past month among adults. New York State was similar at 19.6%. Of Madison County adult residents, 7.8% have participated in heavy drinking within the past month. New York State residents’ percentage is lower at 5.4%. In 2007, 31% of teens in Madison County reported drinking alcohol. In the past 6 months, 23% of teens drove or rode in a car with a driver who had been drinking alcohol. Of students in grades 9-12, 76% said is would be “easy” or “very easy” to get alcohol. Alcohol and Drug Related Social and Mental Health Indicator Rates 250 Incidences 200 150 100 50 0 Alcohol Related Motor Vehicle Injuries and Deaths*** (2004-2006 Data) Young Adults Driving While Intoxicated** (2007 Data) Madison County Young Adults Arrests for Drug Use/Possession/Sale** (2007 Data) Drug Related Hospitalizations** (20042006 Data) New York State Other Drug Use Illicit drug use, like alcohol, is associated with social, as well as health-related conditions similar to those listed in the alcohol use section. Although there has been a long-term drop in overall use, many people in the United States still use illicit drugs. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2001 National Household Survey on Drug Abuse, 15.9 million Americans ages 12 and older (7.1%) reported using an illicit drug in the month before the survey was conducted. More than 12% reported illicit drug use during the past year and 41.7% reported some use of an illicit drug at least once during their lifetimes. The most common illicit drugs used by current users over the age of 12 were marijuana (12.1 million users, or 5.4% of the population), cocaine (1.7 million users, or 0.7% of the population), and hallucinogens, which include LSD, PCP, and MDMA (1.3 million users, or 0.6% of the population). Approximately 37% of those over the age of 12 reported lifetime use of marijuana, 12.3% reported lifetime use of cocaine, and 12.5% reported lifetime use of hallucinogens. 33 Madison County 2010 – 2013 Community Health Assessment Report According to the National Institute on Drug Abuse's 2002 Monitoring the Future Study, 53% of high school seniors reported using an illicit drug at least once in their lives, 41% within the past year, and 25.4% within the past month. In 2007, 27.6 per 10,000 of Madison County young adults have been arrested for use/ possession/sale of drugs. New York State’s rate is over seven times higher than Madison County’s rate at 215.4 per 10,000 young adult residents. In Madison County, 7.6 per 10,000 residents had been hospitalized for drug related complications from 2004 to 2006. This rate was over four times higher for New York State with a rate of 34.0 per 10,000 residents. According to the 2007 Teen Assessment Project Report (TAP), 17% of students have tried marijuana. Also, 52% of 12th graders and 7% of 7th and 8th graders have tried marijuana. Environmental Health Ambient Air Quality in Madison County The quality of the ambient air affects an entire population. Both outdoor and indoor air impact an individual’s overall health, from worsening pre-existing respiratory conditions, to causing new health complications. Certain subsets of a population can more strongly and visibly exhibit the effects of poor air quality, such as children and the elderly, and individuals who suffer from asthma, allergies, or chronic pulmonary and cardiovascular diseases. While air pollution is often associated with high-density areas, such as major cities, air pollution is a danger to human health which cannot be contained by concrete borders and can have health impacts on geographic areas far from where they originated once they are carried by wind currents. Common Pollutants The Environmental Protection Agency has outlined the six most common air pollutants (known as “criteria pollutants”) which have negative impacts on human health and the environment, and which can cause property damage. They include: Sulfur Dioxide (SO2), Carbon Monoxide (CO), Particulate Matter (PM) 2.5, Ozone (O3), Nitrogen Oxides (NOx), and Lead (Pb). Four of these critical pollutants (SO2, CO, PM 2.5, O3) were monitored for the Madison County area by the EPA Air Quality Monitoring Stations located in Camp Georgetown and East Syracuse. Sulfur Dioxide is produced primarily by burning fuel which contains sulfur, such as coal and oil, primarily from electric facilities and industrial sources. Sulfur Dioxide, like many of the criteria pollutants, triggers respiratory difficulty and aggravates pre-existing heart disease issues. Additionally, it contributes to the prevalence of acid rain, which is not only destructive aesthetically to buildings and monuments, but changes the physical environment of the water and soil, and causing damage to aquatic life and plants. Carbon Monoxide is a colorless and odorless gas generated primarily by the burning of fossil fuels, and in particular by combustion in motor vehicles. The EPA estimates that 56% of all CO emissions are generated by motor vehicle use, with an additional 22% generated by non-road vehicles, such as construction equipment. Other sources include wood-burning stoves and natural sources such as wildfires. Carbon dioxide is dangerous, even for individuals without pre-existing health complications, by reducing the body’s oxygen intake in the presence of high concentrations of CO, and by causing central nervous system damage, or death. Individuals with cardiovascular health concerns are affected by lower levels of CO and may have trouble being active. Particulate Matter is a term for particles and liquid droplets of a wide variety of composition and sizes. The EPA classifies Particulate Matter (PM) as either “coarse inhalable particles”, between 10 and 2.5 34 Madison County 2010 – 2013 Community Health Assessment Report micrometers, or as “fine particles”, being smaller than 2.5 micrometers. These smaller particles pose the greater risk, as they can get deeper into an individual’s lungs and even into the bloodstream and do damage within the body. Particulate Matter 2.5 can cause respiratory trouble, decreased lung function, aggravated asthma, development of chronic bronchitis, irregular heartbeat, non-fatal heart attacks, and premature death in people with heart or lung disease. Particulate matter can also affect visibility by contributing to smog development and can cause ecosystem damage by carrying particles to other geographic locations which alter the chemistry of the soil and water. Ozone, while beneficial in the upper atmosphere, is damaging to respiratory health at the ground level. The health impacts of ozone include triggering chest pain, coughing, throat irritation and congestion, as well as worsening bronchitis, emphysema and asthma, and causing lung damage with long-term exposure. Ground-level ozone can also damage the abilities of plants to produce food and resist insect and climate threats, decreasing productivity and health. Ground-level ozone is created from Nitrogen Oxide (NOx) and Volatile Organic Compounds (VOC) molecules combining in the presence of sunlight, thus making low level ozone more of a concern during the summer. Sources of NOx and VOC include vehicle exhaust and industrial emissions, as well as natural sources. As mentioned in previous pollutants, while ozone is generally though to be a “city concern”, it can be carried to rural locations and impact the health and environment of other locations. Air Pollutant Levels New York State and Federal Ambient Air Quality Standards have determined concentration levels for the various pollutants which represent maximum levels which should not be exceeded in order to mitigate the hazardous effects of these air pollutants to human health and the environment. Monitoring stations around the state help to determine how current air quality of a region measures against these standards for air pollutants. The standard level for Sulfur dioxide is an annual value which is not to exceed .03 parts per million (ppm). New York was below this value, with an annual mean of .004 ppm for 2007. Madison County showed numbers consistently below the standard value, at .002 ppm. These values are consistent with values from ten years ago as well, showing that Madison County is maintaining these low levels. The average concentration of Carbon Monoxide in the New York State atmosphere was .35 ppm in 2007. Madison County was higher than this with an average concentration of .5 ppm for 2007. Both the state and the county had zero days where the eight-hour average maximum value of CO exceeded 9 ppm, which is the New York State and Federal Air Quality Standard maximum value for ambient CO concentration. The annual mean PM 2.5 level for the years 2005-2007 in New York State was 10.3 ug/m3, with ambient air levels for PM 2.5 lower than this at 9.8 ug/m3. Federal Air Quality Standards recommend the annual mean values for three years to not exceed 15 ug/m3. The average 98th percentile PM 2.5 value for 2005-2007 for New York State was 29.7 ug/m3. This value was 28 ug/m3 for Madison County during the same period. The federal maximum three year average 98th percentile value is 35 ug/m3, which both New York State and Madison County were below. Average ozone levels for Madison County are close the state average, with the New York State average ambient concentration of ground-level ozone at .030 ppm for 2007. Madison County was slightly higher than this at .031 ppm for the same year. New York State had 171 reports of days in which the eight-hour ozone levels exceeded the recommended levels of .075 ppm during 2008. The Georgetown monitoring station in Madison County recorded 3 days in which the ozone levels were greater than .075 ppm (1.8% of the total high ozone days in New York State). On occasion Madison County did have ozone levels higher than recommended, but they were less frequent than rates of high ozone levels in the counties of the New York City Metro Area, which generally had upwards of six days with higher than recommended eight-hour ozone levels for 2008. 35 Madison County 2010 – 2013 Community Health Assessment Report Respiratory Health The health effects of air quality, rates of asthma and chronic obstructive pulmonary disease (COPD) can be used as good indicators of poor air quality in a region. For individuals with pre-existing respiratory health concerns, the ambient air pollution conditions of certain days may be an additional cause for concern. The Environmental Protection Agency Air Quality Index rates the risk level of pollution found in the ambient air. Two categories describe air when it poses a risk to human health, “unhealthy” and “unhealthy for sensitive groups”. Analyzing the number of days in these two categories offers additional information on the relative quality of the air of region. New York State had 103 days labeled “unhealthy for sensitive groups” in 2008. Madison County had 3 days labeled “unhealthy for sensitive groups”, representing 2.9% of New York State’s total days in 2008. As a measure of more dangerous levels of pollutants in the air, in 2008 New York State had 3 days labeled “unhealthy”, whereas there were zero days labeled “unhealthy” in Madison County. Vehicle Emissions and Air Quality Vehicle emissions are also tied to the quality of the ambient air. The burning of fossil fuels and use of motor vehicles constitutes a large percentage of the pollutants released into the air from human causes. One easily identifiable source of vehicle emissions is the daily commute to and from individuals’ places of work. According to the 2000 United States Census, in New York State 65.5% of workers commute to work by car, van, or truck and 30.6% of workers utilize public transportation or walk to work. In comparison, in Madison County 88.1% of workers commute by car, van, or truck and 7% utilize public transportation or walk to work. This represents a difference in the reliance on personal motor vehicles in Madison County compared with all of New York State, suggesting a higher level of vehicle emissions pollutants released into the ambient air. The average commute time for New York State residents is 31.7 minutes. For Madison County residents, the average commute time is lower at 22.6 minutes. However, approximately the same percent (NYS 33.9%; MC - 33.3%) of individuals commuting to work using private transportation travel more than 30 minutes to reach their destination. While Madison County residents rely on their personal vehicles more than the New York State average, they are not using the vehicles for longer time periods than the New York State average. Indoor Air Quality in Madison County While ambient air quality is an important concern for all residents of a region, indoor air quality can be an equally grave health concern. Some sources of indoor air pollution are: indoor combustion sources, such as gas, kerosene, and wood burning heaters and tobacco products; certain building materials, such as asbestos insulation and some pressed wood materials; household cleaning supplies; central heating and cooling devices; radon; and pesticides. The risk associated with indoor pollutant sources relates to the levels of dangerous pollutant they release, how regularly or intermittently they release the pollutant, and how well ventilated a building may be. Common indoor pollutants listed by the Environmental Protection Agency include: asbestos, biological pollutants (mold/mildew), carbon monoxide, formaldehyde, lead, nitrogen dioxide, pesticides, radon, respirable particles, and second-hand smoke/environmental tobacco smoke. Radon and second-hand smoke were the major measurable concerns studied in Madison County. Radon Radon is an odorless, invisible naturally occurring gas which is the second leading cause of lung cancer in America, after smoking. Radon exposure can be a particular health risk when combined with a 36 Madison County 2010 – 2013 Community Health Assessment Report smoking habit. Radon gas seeps into homes from the bedrock, and with proper testing and mitigation techniques a problem with high levels of radon in a building can be fixed. In New York State, the average radon level for buildings tested in 2008 was 5.46 picocuries per liter (pCi/L). The average level for the same in Madison County was 6.11 pCi/L. The Environmental Protection Agency recommends that radon levels in buildings should not exceed 4 pCi/L. Radon levels are a particular concern in Madison County with an average value higher than the New York State average. There are fewer homes in Madison County with higher than recommended radon levels compared with the state. Sixty-five percent of the homes tested in 2008 in New York State have radon levels higher than 4 pCi/L. This number is slightly lower for Madison County at 58.3% of the homes tested. Radon levels are of particular concern in Georgetown, Eaton, and Hamilton. In Georgetown and Hamilton more than 60% of the homes have radon levels higher than 4 pCi/L. Eaton has the highest average radon levels at 9.05 pCi/L. More than 10% of the homes screened in both Eaton and Hamilton have radon levels higher than 20 pCi/L. Environmental Tobacco Smoke The personal health dangers of smoking are well publicized and attention has been given to the effect of second-hand smoke on others’ health, but the effects of the more ambiguous environmental tobacco smoke in the home is sometimes underappreciated. Second-hand smoke in the home affects all residents, but has a particularly strong influence on children living with a smoker. Children are susceptible to developing serious respiratory issues, such as asthma, bronchitis, and respiratory tract infections. Second hand smoking in the home is also associated with children’s ear infections, low birth weights, and Sudden Infant Death Syndrome. Children are particularly vulnerable because they are unable to choose their living environment and are in a period of development where they are more susceptible to the negative impacts of tobacco smoke. Adult residents of a home where they are exposed to second-hand tobacco smoke are at risk of developing lung cancer and heart disease. The Environmental Protection Agency estimates that secondhand smoke is responsible for 3,000 deaths a year among non-smokers, and the U.S Surgeon General estimates that living with a smoker increases a non-smoker’s chance of developing lung cancer by 20% to 30%. According to the National Cancer Institute, second-hand smoke exposure may increase the risk of heart disease by 25% to 30%, and is thought to cause 46,000 heart disease deaths per year in nonsmokers. In the region surrounding Madison County, only about 16.7% of adults smoke, which is comparable to the 16.8% of adults in Madison County found in a 2008 study by Tobacco Free Madison County. According to the same study, regionally 83% of homes do not allow smoking indoors compared to 79.7% of Madison County residents. In the work environment, 59.9% of work-places in the region have rules not permitting smoking on the grounds. In Madison County, this number is much lower at only 45.3% of work-places. While individuals’ homes may have a risk of environmental tobacco smoke pollution, the work-place environment is a greater risk location for tobacco smoke exposure. Health Effects of Environmental Tobacco Smoke It is difficult to assess whether or not the development of a case of lung or heart disease can be attributed to second-hand smoke or other causes. However, knowing that second-hand smoke exposure is a risk factor, we can analyze the following health statistics with a consideration for the role environmental tobacco smoke plays in the development of these diseases. Were indoor exposure to second-hand smoke to be reduced, presumably the portion of cases which were attributable to this risk factor would be reduced as well. 37 Madison County 2010 – 2013 Community Health Assessment Report Generally the risk of heart disease and cardiovascular complications which can be attributed to the negative effects of smoking was lower in Madison County than in the whole of New York State. Discharge rates per 10,000 individuals from 2004-2006 for hypertensive heart disease (NYS 1.79; MC 1.18), heart failure (NYS 36.55; MC 21.12), cardiovascular disease (NYS 206.38; MC 160.49), and heart attack (NYS 22.79; MC 19.76) were lower in Madison County than New York State averages. Mortality rates for cardiovascular diseases per 10,000 individuals (NYS 285; MC 251) were also lower in Madison County than New York State averages. The rates of acquiring one of these diseases or suffering from one of the complications associated with cardiovascular disease are less in Madison County than New York State. This can in part be attributed to the high level of homes that do not permit smoking indoors and thereby the relatively low level of exposure within the home to this particular pollutant. Only the discharge rate per 10,000 individuals for stroke (NYS .64; MC .91) is higher comparatively in Madison County than in New York State. Madison County has a disproportionately large death rate due to lung cancer compared with New York State average rates. Comparatively, there is a lower overall discharge rate for lung cancer in Madison County compared with the state average. In New York State from 2001-2005, an annual average of 64.1 out of 100,000 individuals were discharged with lung cancer. In Madison County this number was lower at 55.8 per 100,000 individuals. In contrast, an average of 47.1 out of 100,000 deaths were attributed to lung cancer in New York State annually from 2001-2005, while an average of 79.1 out of 100,000 deaths in Madison County were attributed to lung cancer annually. This is a 68% increase on the New York State annual average for this time period. One possible explanation for such high death rates from lung cancer is the combination of prevalence of smoking habits and high radon levels in homes in Madison County. The Environmental Protection Agency has issued warnings concerning the elevated risk of lung cancer among smokers who live in areas with high radon levels. Out of the 21,000 lung cancer deaths attributed to radon each year, approximately 18,000 (86%) are smokers and 2,900 (14%) are non-smokers. If both of these factors were to be reduced or eliminated, there would possibly be a decrease in the rates of lung cancer for residents of Madison County. The final indicator of indoor air quality can be seen in the health of the children of a region, as they are more sensitive to the detrimental effects of poor air. As mentioned above, children who live in a home with poor air quality due to second-hand smoke are more susceptible to ear infections, asthma, and being born with low birth weights. In all three of the indicators, Madison County showed less of the risk indicators of poor indoor air quality as it relates to children’s health. In Now York State in 2004-2006, there was an annual average rate of 4 out of 10,000 children ages 0-4 discharged with ear infections. In Madison County for this same time period, the annual average rate was only 1 out of 10,000 children 0-4 was discharged with ear infections. The childhood asthma rate for New York State in 2005-2007 for children 0-14 years of age was 31.4 out of every 10,000 children. In Madison County, this number was much lower at 13.7 out of every 10,000 children. The percent of live births in 2007 which were classified as “low” (below 2500 g) for New York State was 8.1% and 6.9% in Madison County. 38 Madison County 2010 – 2013 Community Health Assessment Report Water Quality in Madison County While overall America has some of the safest drinking water in the world, the exact quality of the water of a region varies widely depending on the source of the water we use for drinking, cleaning, and recreational uses. There are many factors which can influence the quality of ambient and drinking water, including the physical conditions, biological conditions, and chemical conditions of the source body of water. Pollution in ambient water and improper water purification in drinking water supplies are important sources of health risks for a community. Public Drinking Water Reviewing a list of the public water system violations for 2008, New York State had 4601 total violations for 9936 water systems. In Madison County, there were 26 violations for 122 public water systems recorded. This number represents .6% of the total water violations for the state for 1.2% of the total water systems of the state. Of the total water violations for New York State, 1468 of the violations were for reasons other than “No Monitoring and Reporting” (Reasons other than monitoring and reporting include “No MCL or Treatment Technique”, “No Bacteriological”, “No Public Health Hazards”) . This represents 31.9% of the total violations issued for New York State. In Madison County 12 violations issued were for reasons other than “No Monitoring and Reporting”, which represent 46.2% of the total violations issued for the county’s water supplies. Madison County’s 12 violations represent .8% of the total “No Monitoring and Reporting” violations of New York State, again for 1.2% of the total water systems in the state. Public vs. Private Water Systems Drinking water quality is regulated by federal and state standards, ensuring safe water from municipal sources. However the government does not have the authority to regulate private wells which serve many Americans. Private water suppliers do not have to regularly monitor their water source quality or assess the source’s exposure to materials which can cause illness. Some health concerns which can be caused by unmonitored water supplies include radon, fluoride, and heavy metal contamination; presence of bacteria, parasites and viruses; and high levels contaminants from human activities such as applying agricultural fertilizer or pesticides. It is recommended by the Environmental Protection Agency that if you get your water from a private well that you periodically have your water tested to assure good quality, and test your water particularly if you notice any changes or risk signals in water taste, clarity, and surrounding environment. A large proportion of residents in Madison County are served by private water systems and should be advised to follow the guidelines for keeping their water safe as recommended by the Environmental Protection Agency. According to the Madison County Department of Health in 2004, 38% of the county is served by municipal water sources, meaning water which is regulated and tested frequently. Thirty-seven percent (37%) of the county is served by private water sources, which do not have enforced regular testing and quality monitoring. The remaining 25% of the county is undeveloped and has no water service. According to this data from Madison County’s Department of Health, approximately half (49%) of the county is served by water which has no regular water quality enforcements, and could potentially be endangering residents’ health. Ambient Water Quality Fish consumption advisories also provide important information about the pollution levels in water bodies, and act as indicators regarding potential concerns for human health in ambient water sources. Common water pollutants of concern in New York State are polychlorinated biphenyl (PCB), mercury, cadmium, 39 Madison County 2010 – 2013 Community Health Assessment Report chlordane, DDT, dieldren, dioxin, and mirex. These pollutants come from a variety of sources such as pesticides, industrial uses, fertilizers, mining, hazardous waste site leaks, and natural sources. New York State prepares a regular report of contaminated waterbodies from which it is not advisable to regularly consume sportfish or game. There are 136 waterbodies in New York State which have specific fish consumption advisories. None of these waterbodies are located within Madison County. In the past year of 2008, there were no closures of beaches in Madison County due to an elevated health risk, such as contamination from human or animal fecal material or toxic chemicals. There was one delay of a beach opening due to suspected Volatile Organic Compound contamination, but this was later cleared and the beach was opened. Toxic Substance Exposure in Madison County Exposure to toxic substances can pose serious health risks, but the symptoms of toxic poisoning can be subtle and develop gradually so that many people do not even realize they have been exposed to toxins. Chemicals and toxic pollutants are part of the world around us, from household cleaning supplies and fertilizers, to local hazardous waste sites and even the food we eat. It is important to assess the possible contact points with toxic substances, particularly for the health of risk groups, such as developing children and pregnant women, who are more susceptible to the effects of elevated levels of toxic pollutants. The Environmental Protection Agency defines hazardous waste as any substance which poses a substantial present or potential threat to humans or the environment. Toxic chemicals such as these can come from specific sources that are easily identifiable, but they can also come from non-point specific sources, making it very difficult to determine the magnitude of the toxic threat. Hazardous waste and toxic substances include heavy metals such as lead, cadmium and mercury, as well as a wide variety of chemical compounds used and released by commercial and industrial uses, such as PCBs, dioxins, trichlorobenzenes, furons, and others. The exact nature and degree of risk these chemicals and waste products pose to human and environmental health are hard to accurately determine in many cases, making assessing statistics regarding exposure to toxic substances a difficult undertaking. The effects of heavy metals such as lead are clear cut, with easily visible neurological and developmental damage shown to be connected to high levels of lead exposure, especially during children’s developmental ages from birth to 6 years of age. Hazardous waste has been linked to various malfunctions of body systems, such as immune, reproductive, nervous and endocrine systems. Many are also known or suspected carcinogens. However, as mentioned above, it is hard to tie specific cancer cases to suspected toxic substance exposure, making it difficult to accurately determine the health risk residents of a region face from toxic substances. Lead Poisoning Lead poisoning is a serious risk for children. From a young age, children encounter their environment with their hands and their mouths, coming into contact with toxins in their surrounds. For children who live in high risk lead area, this may mean elevated lead levels which can lead to learning disabilities, behavioral problems, and speech problems, and at the higher levels, can cause kidney and central nervous system damage. A risk factor for lead exposure in children is primarily residing in a home or staying at a day-care center built before 1950, as houses built before this time used lead based paint almost exclusively. Houses built up through the 1970s used lead-based paint as well, but not as consistently, making them less of a risk-factor. Presently, Madison County has a larger percentage of housing which poses a potential healthy threat to children’s health than the state average. In New York State as of the 2000 Census 32.4% of the housing stock was built before 1950 – indicating a risky home environment. This proportion is higher in Madison County at 41.9% of the housing stock. Over time, these proportions are expected to decrease as older housing stock is cycled into newer buildings, but this expectation relies on redevelopment efforts in the area to encourage the speedy updating of older homes. 40 Madison County 2010 – 2013 Community Health Assessment Report Oneida, Hamilton, and Georgetown have the highest percentage of housing stock built during high-risk decades for lead in the home environment. Hamilton (56.3% of housing stock), Georgetown (56.2%), and Oneida (51.1%) may have the greatest risk of childhood lead exposure in the county. Early testing is important to assessing the risk of a child’s developmental environment. However, blood lead levels tests are prioritized for children living in high-risk lead environments (such as housing build before 1950 using lead-based paint), and as a result, some children do not have tests until a later age. According to New York State’s Report of Lead Exposure from 2002-2003, 82.8% of all New York State children were tested at least once for blood lead levels prior to 36 months of age. In Madison County, this number was slightly lower at 80.8% of all county children prior to 36 months. Madison County has been gradually improving the scope of early lead testing (0 to 1½ years of age) for children between 1998 to 2004. In the six years shown, Madison County has been consistently higher than the state averages for the number of children screened until 2004, where Madison County was slightly below the average. Since 1999 annually more than 60% of children in Madison County have been tested for elevated blood lead levels before 1½ years of age. In 2002 and 2003, New York State had an occurrence rate of 13.3 cases of elevated lead blood levels (greater than or equal to 10 micrograms per decoliter (mcg/dl)) for every 1,000 children. In Madison County during this same time the occurrence rate was 10.5 cases for every 1,000 children. The occurrence rate for children with blood lead levels in the highest classification (greater than 20 mcg/dl) was 2.0 cases per 1,000 children in New York State, and 0.0 per 1,000 children in Madison County. Madison County overall had lower rates of elevated blood lead levels in children compared with the New York State average, despite having more high-risk housing. Those cases of lead poisoning which do occur are able to be caught early by a relatively high screening rate of younger children. Hazardous Waste Hazardous waste sites are another potential health risk source. The New York State Department of Environmental Conservations has compiled a Site Remediation Database which is composed of both high and low ranking cleanup projects, ranging from class 01 to class 05. A 01 site poses an immediate threat to the surrounding environment and human health, and a 05 represents a site which has been cleaned up and any hazardous waste which remains does not represent a threat to human health or the environment. In addition to the site numerical classifications 01-05, there are also “active” (A) and “closed” (C) classifications for other types of waste cleanup activities, such as brownfield remediation or voluntary cleanup sites. A site can only earn the classification C once it has satisfied all the monitoring and reporting requirements for a satisfactory cleanup, and this classification can be given to a site on any registry (Superfund, Voluntary Cleanup, etc) once it has done so. There are 2056 sites listed on the New York State Department of Environmental Conservation Site Remediation Database. There are no 01 priority sites in New York State. There are 514 class 02 sites in the state, and 2 class 02 sites in Madison County, representing .4% of the total sites in the state. In New York State there are 681 sites classified as A. In Madison County there are 4 sites listed as A, representing .6% of the total sites in the state. Many of these category A and class 02 sites do not have residents living near them and the opportunities for exposure to toxins are relatively low, although the sites are not thoroughly cleaned up and still may pose a potential risk to human health. 41 Madison County 2010 – 2013 Community Health Assessment Report Chemical Exposure One means by which most individuals are exposed to toxic substances in their environment is through the food they consume, in particular fish caught in waters contaminated with various toxins. As discussed earlier, New York State has 136 bodies of water which have specific fish consumption advisories. None of these are within Madison County, showing that residents of this region are not facing exposure to toxic substances from this particular source. Another important source of toxic substance exposure originates in run-off from agricultural areas, causing contamination of ground water and surface water bodies. Pesticides and fertilizers are the main contaminants of concern. With the rising interest in organic farming and environmental health, more crops and livestock are being raised without harmful chemicals which can find their way into the surrounding community. According to the 2007 USDA Agricultural Census, there are 131,796 acres of total farmland in New York State, with 4741 of these acres in Madison County, representing 3.6% of the total state farmland. Of the total farmland acres in New York State, 1.8% of these are on property of USDA certified organic farms. This percentage is slightly higher in Madison County with 2.5% of the farmland acreage devoted to USDA certified organic farming. In absolute number of certified organic farms, Madison County is slightly behind New York State. Farms with organically produced crops and livestock represent 3.3% of the total number of farms in New York State. In Madison County, organic farms represent only 3.0% of the total farms in the county. Birth Defects Birth defects and reproductive disorders are common effects of toxic substance exposure. New York State has developed a congenital birth defect, in part as a response to the growing interest since the 1970s to track the trends in birth defects in conjunction with toxic chemical exposure. While there are many potential causes for congenital birth defects, the low percentage of children born in Madison County with some form of birth defect may suggest that there is little cause for concern regarding exposure to dangerous chemicals which affect child development and mothers’ reproductive health. Between 2005 and 2007, 4.7% of live births in New York State were born with some form of congenital defect. In Madison County, this proportion was lower, with 3.4% of live births being born with a congenital defect. Carcinogenic material is another concern regarding toxic chemical exposure. Reviewing the various cancer rates for New York State and Madison County, it is clear that Madison County does not exhibit inordinately elevated rates of cancer. This indicates that there is not a high risk of carcinogenic toxic chemical exposure in Madison County as compared with New York State. Madison County breast cancer rates are slightly higher than average New York State rates between 2001 and 2005, with 129.6 cases per 100,000 individuals in Madison County, compared with 124.6 cases per 100,000 individuals in New York State. The death rate for breast cancer as well in 2001-2005 was slightly elevated, with 25.6 deaths per 100,000 individuals in New York State, and 29.5 deaths per 100,000 individuals. Liver cancer occurrence and death rates were lower in Madison County, with 6.8 cases and 5.0 deaths each per 100,000 individuals in New York State and less than 3 cases and less than 3 deaths each per 100,000 individuals in Madison County. The incidence rate of lymphoma in Madison County was lower than the New York State average at 20.2 cases per 100,000 individuals in New York State and 17.6 cases per 100,000 individuals in Madison County. The death rate for lymphoma in Madison County was on par with New York State, with 6.7 deaths per 100,000 individuals in New York State and 7.0 deaths per 100,000 individuals in Madison County. 42 Madison County 2010 – 2013 Community Health Assessment Report Climate and Disaster in Madison County Environmental Risk factors can also include the effect of the natural environment, through weather and climate, natural disasters. Madison County encounters the dangers of the natural environment frequently, from heat waves to flooding to severe winter storms. Some of the health risks that stem from severe weather include: heat stroke and heat exhaustion; sun burn and melanoma from prolonged UV light exposure; frostbite and hypothermia from extreme cold temperatures; and sprains and broken bones from falls on ice and snow. Severe weather conditions can also cause extensive property damage and personal stress and anxiety. Climate The climate of Madison County is moderate compared with the range of temperature, precipitation, and snowfall values seen in New York State. The average annual temperature for New York State ranges from 40 to 55 degrees Fahrenheit. Madison County falls in the middle of these values at 46.5 degrees Fahrenheit. The yearly high temperature average for New York State is from 70 to 90 degrees Fahrenheit, depending on the geographic location. Madison County falls on the cooler side of this range with the highest monthly average temperature of 70.6 degrees Fahrenheit. In New York State, the monthly low average temperatures range from 16-31 degrees Fahrenheit. Madison County falls in the mid-range of these values at 22.7 degrees Fahrenheit for the average monthly lowest temperature. Average annual total precipitation values for New York State range from 30-50 inches, with Madison County in the mid-range at 40.05 inches. Madison County has a high average annual snowfall value compared with the state’s range. New York State’s average annual total snowfall values range from 30 inches to 180 inches, with Madison County in the upper third of these values with an average of 121.2 inches annually. Health Effects Melanoma rates for Madison County were slightly elevated compared to the New York State Average from 2001-2005, with a rate of 14.4 cases per 100,000 males in New York State compared with 26.1% rates per 100,000 males in Madison County. For females the new York State rate per 100,00 was 17.1 compared to 10.9% for females. The death rates from melanoma in 2001-2005, however, were comparable on the county and state levels, with 2.2 deaths per 100,000 individuals in New York State and less than 3 cases per 100,000 individuals in Madison County. Natural Disasters and Severe Weather There are limitations to the accessibility of injury, illness and death statistics attributable to severe winter conditions. However, any severe storm increases the risk of such health effects. In New York State between the years of 2007 and 2009, there were 3 federally declared severe winter storms. Madison County was included in the affected counties for 0 of these declarations. Between 2007 and 2009, there were 6 federally declared natural disasters for New York State. Again, Madison County was included in the affected counties for 0 of these declarations. 43 Madison County 2010 – 2013 Community Health Assessment Report Food-borne and Vector-borne disease in Madison County Exposure to illness and disease from factors in our surroundings is common. The vectors of disease transmission can be found in the food we eat or the water we drink or in the contact we have with pests indoors and outdoors. The most common food-borne diseases according to the Center for Disease Control are caused by the bacteria Campylobacter, Salmonella, E. coli, and the Norwalk viruses. Most of these bacteria and viruses are not life-threatening, particularly with proper medical care, but can cause extreme diarrhea, abdominal cramps, fever, and gastrointestinal sickness. The most common means of contact with these bacteria and viruses are from undercooked foods and cross-contamination of food during preparation. In regards to waterborne disease, the parasite Giardia intestinalis is the most common cause of illness from contaminated water in America. One common way of contracting Giardia is through consuming water which has been contaminated by the parasite, generally from feces of animals or humans who have already contracted the parasite. Common illnesses transmitted by insects include Lyme disease, encephalitis and West Nile Virus. Lyme disease is transmitted by infected ticks, while Encephalitis and West Nile Virus are transmitted by mosquitoes. Lyme disease can affect joints, the heart, and the nervous system, but most cases can be treated successfully with antibiotics. The strain of encephalitis found in the New York region is eastern equine encephalitis (EEE) and can cause headaches, muscle pains, seizures, coma, and, in approximately one third of the cases, death. Many of those who don’t die may have permanent brain damage and may need institutional care. West Nile Virus is a strain of encephalitis which has been confirmed to be a concern in the New York area, and can cause mild fever and infection, as well as severe or fatal infection in some cases. Occurrence of Illness New York State compiles an annual list of communicable diseases reported by local health departments and confirmed by laboratory testing to accurately determine the threat of each of these various infections, bacteria, and viruses. The following are averages gathered from annual statistics from the New York State Department of Health Communicable Disease Report. Refer to Communicable section for Giardia, Campylobacter and Salmonella rates. In New York State, there was annually an average of 233 cases of encephalitis (non-West Nile), while there was annually an average of only 1 case in Madison County. The one case in Madison County represents .4% of the total New York State cases. In New York State, there were annually an average of 17 cases of West Nile Virus between 2005 and 2007. During this period, there were consistently no cases of West Nile Virus in Madison County, representing 0% of the total state cases. In New York State between 2005 and 2007, there was annually an average of 3532 cases of Lyme disease, while there were 2 cases in Madison County, at .1% of the total cases. Land Use in Madison County How a region develops the land in which it is built conveys many ideas on how the residents value open space. Land can be developed for industrial, commercial, and residential purposes. However, land can also be developed for recreational, health, aesthetic, and environmental purposes as well. Federal, state, county and local parks, as well as hiking, biking, skiing and walking trails, can act as biological corridors 44 Madison County 2010 – 2013 Community Health Assessment Report and promote healthy wildlife in an area. They can provide opportunities for residents to be active and fit in their community. They help promote clean air and reduce the effects of flooding. They can foster an appreciation of nature and a healthy environment. The mental and physical health benefits of green space in a region are numerous, but often overlooked. Information on open spaces on the local scale is often difficult to gather, as public parks are controlled by many different governmental levels, from large federal forests and wildlife areas, to land on historic registers, to county parks and local, neighborhood parks controlled by cities and towns. However, an estimation of the park land in the area of Madison County and New York State can be made to judge the prevalence of green space in the regions. Park Land Madison County has a sizeable amount of park land within its borders which provides its residents with many opportunities for recreation and exercise, as well as reducing congestion within cities and towns and adding aesthetic and environmental benefits while creating a healthy living environment within the county. New York State has 1,016,000 acres of open park land, representing 3.5% of the total land of the state (excluding the land within the Adirondack Park). Parkland in Madison County covers approximately 19,773 acres of the county. This park land includes federal wildlife management areas, state forests, county parks, and local neighborhood parks. This represents 4.7% of the total land in Madison County, which is 1.3% more than for the overall percentage of land devoted to parks in New York State. Excluding the land in the Adirondack Park, there is approximately .05 acres of park land per person in New York State, compared with .35 acres per person in Madison County. Madison County also has approximately 500 miles of trails for public use made up of hiking trails, snowmobile and skiing trails, and horse trails. Injuries Intentional and Unintentional Injuries Injuries are classified into two categories, “Intentional and Unintentional Injuries.” Intentional injuries are injuries that occur with purposeful intent and include homicide, suicide, domestic violence, sexual assault and rape, bias related violence and firearms. Unintentional injuries are injuries that occur without purposeful intent, and are a leading cause of death and disability. Those at risk of unintentional injuries are young people up to 24 years of age and the elderly. These injuries are caused by falls, motor vehicle injuries, fires, sport, recreational, and occupational related injuries. More than 400 Americans die each day from injuries due primarily to motor vehicle crashes, firearms, poisonings, suffocation, falls, fires, and drowning. The risk of injury is so great that most persons sustain a significant injury at some time during their lives. Suicide Suicide (taking one’s own life) is a serious public health problem that devastates individuals, families, and communities. It is the 11th leading cause of death among Americans. More people are hospitalized or treated and released as a result of failed suicide attempts than are fatally injured. While suicide is often viewed as a response to a single stressful event, it is a far more complicated issue. Suicide results from complex interactions between biological, psychological, social, and environmental factors. 45 Madison County 2010 – 2013 Community Health Assessment Report Suicide accounted for 33,300 deaths in the United States in 2006. In 2002, 132,353 individuals were hospitalized following suicide attempts. Another 116,639 were treated in emergency departments and released. In 2001, 55% of suicides were committed with firearms. Suicide is the third leading cause of death among young people ages 15-24. In 2001, 3,500 suicides were reported in this age group. In 2001 firearms were used in 54% of youth suicides. In 2001, 5,393 Americans over 65 committed suicide. Firearms were used in 73% of suicides committed by adults over the age of 65. From 2004 to 2006, the suicide death rate for Madison County was 9.3 for 100,000 residents. New York State’s rate was lower at 6.4 per 100,000 residents. Both rates are above the target set by Healthy People 2010 of 5.0 per 100,000 residents. The adolescent/young adult suicide mortality rate was 0.0 per 100,000 for Madison County and 4.4 per 100,000 adolescent/young adult residents for New York State. Homicide Nationally, in 1997, 32,436 individuals died from firearm injuries; of this number, 42 percent were victims of homicide. In 1997, homicide was third leading cause of death among children aged 5 to 14 years, an increasing trend in childhood violent deaths. In 1996, more than 80 percent of infant homicides were considered to be fatal child abuse. Many factors that contribute to injuries also closely associated with violent and abusive behavior, such as low income, discrimination, lack of education, and lack of employment opportunities. Males are most often the victims and the perpetrators of homicides. African Americans are more than five times likely as Whites to be murdered. There has been a decline in the homicide of inmates, including spouses, partners, boyfriends, and girlfriends over the past decades but this problem remains significant. Homicide was the cause of death for 19,491 persons in the United States (7.2 per 100,000 population) in 1997. Homicide is the second leading cause of death for young people aged 15 to 24 years and the leading cause of death for African Americans in this age group. Homicide rates are dropping among all groups, but the decreases are not dramatic among youths, which already exhibit the highest rates. In 1997, 6,146 young persons aged 15 to 24 years were victims of homicide, accounting to almost 17 youth homicide victims in the United States per day. Of all homicide victims in 1997, 37 percent were under the age of 24 years. The homicide rate among males 15 to 24 years in the United States is 10 times higher than Canada, 15 times higher than Australia, and 28 times higher than France and Germany. From 2004 to 2006, the homicide death rate was 1.6 per 100,000 residents for Madison County. New York State’s rate was higher at 4.7 per 100,000 residents. Madison County achieved the goal established by Healthy People 2010 of 3.0 per 100,000 residents. 46 Madison County 2010 – 2013 Community Health Assessment Report Homicide and Suicide Mortality (2004-2006) 10 9 Deaths per 100,000 8 7 6 5 4 3 2 1 0 Homicide Death Rate Suicide Death Rate Madison County Ages 15-19 Suicide Death Rate New York State Unintentional Injuries More persons aged 1 to 34 years of age die as a result of unintentional injuries than any other cause of death. Across all ages, 121,599 persons died in 2006 as a result of unintentional injuries. Motor vehicle crashes account for approximately one-third of the deaths from unintentional injuries; unintentional poisonings rank second and unintentional falls third. Additionally, millions of persons are incapacitated by unintentional injuries, with many suffering lifelong disabilities. These events occur disproportionately among young and elderly persons. In 2007, 34 million persons were medically attended due to unintentional injury and poisoning episodes in the noninstitutionalized population. Although the greatest impact of injury is in human suffering and loss of life, the financial cost is staggering. Included in the costs associated with injuries are the costs of direct medical care and rehabilitation as well as lost income and productivity. By the late 1990’s, injury costs were estimated at more than $441 billion annually, an increase of 42 percent over the 1980’s. As with other health problems, it costs far less to prevent injuries than to treat them. For example: Every child safety seat saves $85 in direct medical costs and an additional $1,275 in other costs. Every bicycle helmet saves $395 in direct medical costs and other costs. Every smoke detector saves $35 in direct medical costs and an additional $865 in other costs. Every dollar spent on poison control centers saves $6.50 in medical costs. While every person is at risk for injury, some groups appear to experience certain types of injuries more frequently. American Indians or Alaska Natives have disproportionately higher death rates from motor vehicle crashes, residential fires, and drownings. In addition, their death rates are about 1.75 times higher than the death rate for the overall U.S. population. Higher death rates from unintentional injury also occur among African Americans. African Americans, Hispanic, and American Indian children are at higher risk than White children are for home fire deaths. Adults aged 65 years and older are at increased risk of death from fire because they are more vulnerable to smoke inhalation and burns and are less likely to recover. Sense impairment 47 Madison County 2010 – 2013 Community Health Assessment Report (such as blindness or hearing loss) may prevent older adults from noticing a fire, and mobility impairment may prevent them from escaping its consequences. Older adults also are less likely to have learned fire safety behavior and prevention information; because they grew up at a time when little fore safety was taught in schools and most current educational programs target children. In every age group, drowning rates are almost two to four times greater for males than for females. In 1997, the overall drowning rate for African Americans was 50 percent greater than that for Whites; however, the rate was not higher for all age groups. For example, among children aged 1 through 4 years, the drowning rate for Whites was slightly higher than the rate for African Americans. For children aged 5 to 19 years, African American children are twice as likely to drown as White children. Unintentional injury comprises a group of complex problems involving many different sectors of society. No single force working alone can accomplish everything needed to reduce the number of injuries. Improved outcomes require the combined efforts of many fields, including health, education, transportation, law, engineering, and safety sciences. Second, many of the factors that cause unintentional injuries are closely associated with violent and abusive behavior. Injury prevention and control addresses both unintentional and intentional injuries. From 2004 to 2006, the total unintentional injury mortality rate was 29.2 per 100,000 residents for Madison County. The rate was lower for New York State with a rate of 20.8 per 100,000 residents. Both rates are above the goal established by Healthy People 2010 of 17.5 per 100,000 residents. The unintentional injury mortality rate for 0-19 year olds was 12.2 per 100,000 for Madison County and 7.5 per 100,000 for New York State. The unintentional injury mortality rate by motor vehicle was 15.6 per 100,000 residents for Madison County and 7.7 per 100,000 residents for New York State. Madison County does not meet the target established by Healthy People 2010 of 9.2 per 100,000 residents. The unintentional injury hospitalization rate for Madison County was 52.3 per 10,000 residents. The rate was higher at 64.7 per 100,000 residents for New York State. Unintentional Injury and Motor Vehicle Injury and Death Rates (2004-2006) 70 60 Incidences 50 40 30 20 10 0 Unintentional Injury Death Rate*** (2004 Data) Unintentional Injury Hospitalizations** Madison County 48 Motor Vehicle Death Rate*** (2006 Data) New York State Motor Vehicle Injury Hospitalizations** Madison County 2010 – 2013 Community Health Assessment Report Safety and Injury Control Seat Belt Use The seatbelt law has been in effect since 1984. Prior to that time, only 16% of individuals used their seatbelt. In 1984, according to New York statistics, 1,012 people died because of injuries related to automobile crashes and were restrained. In 1985, a year after the law went into effect, the death rate was reduced to almost half, to 644 deaths. The compliance rate at that time was 57%. In 2003, the compliance rate was 85%. Most unrestrained deaths happen to individuals between the ages of 16 to 44. In a study done by the American Academy of Pediatrics, it was shown that when the drivers buckle up, so do the children riding with them. However, if the drivers are not restrained, only 24% of the children riding with them are. New York State Safety statistics also reveal that inpatient costs are 50% higher if the individual is unrestrained during a car crash. Taxpayers pay up to 85% of those costs of care. Motor vehicle crashes are the leading cause of injury-related deaths. The decision to wear a seatbelt occurs at an individual level. The answer remains unclear as to why people refuse to wear seatbelts, despite their value and laws in place. It is clear that seatbelts save live, especially with the combined use of airbags. Currently there is no data for seat belt use for Madison County. Bike Helmet Use Nationally, between 1984 and 1988, approximately 962 people died from injuries related to bicycle accidents. An astounding 557,936 people were injured with a cost to society of $8 billion. The use of bike helmets for people of all ages is not widely accepted. The barriers include social issues related to “being different,” income related issues, and most important, lack of education surrounding the use of bike helmets. These factors lead to the limited use of helmets and increased injuries related to accidents involving cyclists of all ages. Currently there is no data for bike helmet use for Madison County. Smoke Detectors The fact that smoke detectors save lives has been proven. The majority of fatal home fires happen at night, when people are asleep. Contrary to popular belief, the smell of smoke may not wake a sleeping person. The poisonous gases and smoke produced by a fire can numb the senses and put a person into a deeper sleep. Functioning smoke alarms on every level and in every sleeping area of a home can provide residents with sufficient warning to escape from nearly all types of fires. Therefore, functioning smoke alarms can be highly effective in preventing fire-related deaths. If a fire occurs, homes with smoke alarms are roughly half as likely to have a death occur as homes without smoke alarms. By giving you time to escape, smoke detectors cut your risk of dying in a home fire nearly in half. In 1997, 3,220 deaths occurred as a result of residential fires. Nationally, residential property loss caused by these fires was roughly $4.4 billion. In 1995, the cost of all fire-related deaths and injuries, including deaths and injuries to firefighters, was estimated at $15.8 billion. Fires are the second leading cause of unintentional injury death among children. Compared to the total population, fire death rates for children aged 4 years and under are more than twice the national averages. About 800 children aged 14 years and under die by fire each year and 65 percent of these children are under age 5 years. Children are disproportionately affected because they react less effectively to fire than adults and they also generally sustain more severe burns at lower temperatures than adults do. Two-thirds of fire-related deaths and injuries among children under age 5 years occur in homes without functioning smoke alarms. 49 Madison County 2010 – 2013 Community Health Assessment Report Currently there is no data on smoke detectors for Madison County. Exercise and Nutrition Overweight and Obesity Overweight and obesity is on the rise in Madison County, demonstrating rates similar to those observed in New York State and the Nation (New York State Department of Health, Madison County: Health Risks and Behavior Indicators, 2004-2006). Unfortunately, further observations and inferences about overweight and obesity in Madison County is challenged by the paucity of accurate, reliable local data. Information about overweight and obesity in adults is derived from a state-wide Behavioral Risk Factor Surveillance System survey whereby participants self-report their height, weight, leisure time, and other relevant information. The potential reporting bias that results lessons the reliability of the data. Moreover, the data collected from the survey for Madison County is arbitrarily combined with data for Chenango County and reported as a “locality,” further obscuring any inference we can make regarding overweight and obesity in Madison County. Demographic Characteristics A recent national report indicates that the prevalence of obesity in Madison County continues to rise with 28.1% of Madison County adults obese in 2006, up from 23.5% in 2003. (United States Department of Health & Human Services, 2007). Age In 2003, 62% of adults age eighteen and older were overweight or obese ranking Madison County as the county with the 6th highest prevalence of overweight and obesity in New York State, excluding New York City. Approximately 34% of children between the ages of 2 to 4 in Madison County are overweight or obese placing the County in the bottom 25% of the counties in New York State. Amongst our youngest children 0 to 5 years of age we tend to have children who are heavier than their peers from other counties. Birth Weight Between 2003 and 2005, 12.3% of the babies born in Madison County demonstrated high birth weights, ranking Madison County 56th out of 57 counties on this issue. Source: New York State Department of Health Expanded Behavioral Risk Factor Surveillance System, 2003 and the Center for Disease Control and Prevention 2003-2003 Pediatric Nutrition Surveillance, New York, Table 6B www.health.state.ny.us/nysdoh/brfss/expanded/2003/index. htm Accessed 10/21/08 Gender Almost 70% of adult men in Madison County are overweight or obese, compared to 54% of adult women. Education Individuals who have completed high school demonstrate a lower prevalence of overweight and obesity. 50 Madison County 2010 – 2013 Community Health Assessment Report Almost half (47%) of pregnant women certified for WIC are overweight or obese, i.e., with a BMI= 26.1 (WIC Report CT035T, 2007). According to a pediatric study by the Centers for Disease and Control Prevention (CDC), from 2003 to 2005, 61.4 percent of children younger than 5 years of age were ever breastfed, with only 12 percent breastfed for the recommended 12 month period. From 2003 to 2005, 66 percent of children under the age of 5 watched up to 2 hours of television a day (CDC Pediatric Survey 2003 to 2005, Web site). Indicator % Pregnant Women in WIC with Early (1st Trimester) Prenatal Care, Low SES (2005-07) % Pregnant Women in WIC with Anemia, Low SES (2005-07) % Pregnant Women in WIC Who Were Prepregnancy Underweight (BMI Under 19.8), Low SES (2005-07) % Pregnant Women in WIC Who Were Prepregnancy Overweight (BMI 26 - 29), Low SES (2005-07) % Pregnant Women in WIC Who Were Prepregnancy Very Overweight (BMI Over 29), Low SES (2005-07) % of Infants in WIC Who Were Breastfeeding at 6 Months, Low SES (2005-07) % Underweight Children in WIC, 0-4 years, Low SES (2005-07) % Overweight Children in WIC, 2-4 years, Low SES (2005-07) % Anemic Children in WIC, 6mo-4 years, Low SES (2005-07) % of Children in WIC Viewing TV <=2 Hours per Day 0-4 years, Low SES (2005-07) Behavior/Risk Indicator (2003) Chenango & Madison % adults overweight or obese (BMI 25+) % adults that participated in leisure time physical activity in last 30 days % adults smoking cigarettes % adult smokers that tried to quit smoking for one day or longer % adults that binge drink % adults eating 5 or more servings of fruit or vegetables daily 3 Year Total 850 County Rate 80.0 NYS Rate 84.0 No NYS Rate exc NYC 85.1 137 13.2 11.4 No 11.6 108 10.2 11.3 No 10.3 150 14.1 15.4 No 15.3 351 33.1 26.1 Yes 30.0 220 23.6 39.0 Yes N/A 65 1.2 4.7 Yes 3.9 361 14.3 14.7 No 15.0 388 9.7 11.4 Yes 11.8 1,677 67.0 76.0 Yes 76.5 County Rate 62.0 72.4 CI # CI # Upstate ± 4.4 ± 3.9 NYS Rate 56.7 74.6 ± 1.2 ± 1.0 57.6 77.6 29.3 47.9 ± 4.1 ± 8.6 20.3 58.0 ± 0.9 ± 2.3 22.1 55.6 15.8 20.6 ± 3.7 ± 3.5 14.1 25.8 ± 0.8 ± 1.4 15.2 N/A Sig.Dif. s: Total suppressed for confidentiality *: Fewer than 20 events in the numerator; therefore the rate is unstable #: 95% confidence interval for BRFSS/Expanded BRFSS indicators Source: Health Risks and Behavior Indicators 2004-2006 – Madison County – accessed NYSDOH web site on 10/17/08 www.health.state.ny.us/statistics/chac/chai/docs/beh_madison.htm Note: The BRFSS survey combines Madison County and Chenango County data in determining percentages. 51 Madison County 2010 – 2013 Community Health Assessment Report In 2003, adults in Madison County were less likely to eat the recommended number of servings of fruits and vegetables when compared to the NYS and National averages. The percentage of physician diagnosed diabetes among adults in Madison County (5.3%) is lower than the State level of 7.2%. Among the thirty-eight localities presenting like data, Madison/Chenango County locality demonstrated one of the lower percentages (ranked 3rd) for this issue. For heart attack, angina or stroke, the percent of adults (8.8%) diagnosed with these conditions in Madison County is higher than the State percentage of 6.9%. The Madison/Chenango County locality ranked 31 out of 38 localities. Adults living within the Madison/Chenango County locality tend to rank lower than most other localities when looking at the percent of individuals who are trying to lose or maintain weight, eating fewer calories, or exercising more. In 2007, Madison County students in grades 9 through 12 identified a variety of activities and the length of time spent on these activities that they might engage in during non-school hours. According to the survey, approximately two-thirds (66%) of the students spend two or more hours watching television, playing video or computer games; and over half of them (54%) spend two or more hours online. Both areas show a slight decrease in time spent doing these activities from the 2003 survey (Madison County, Teen Assessment Project (2007)). In recent focus group discussions held with youth from around the State, including Madison County, obesity was identified as one of the top five health concerns. Discussions with Madison County youths revealed that our youth demonstrate an awareness and understanding of the key factors (nutrition and physical activity) that contribute to obesity and other health issues. In addition, they were able to articulate credible solutions to address this issue, e.g., increase access to exercise by adding more activities and through increased upkeep of local parks (ACT for Youth Group Discussion results, Unpublished 2008). The Madison County Living Well Partnership (LWP), a public/private member group, promotes healthy living by encouraging families to eat well and be physically active. In carrying out this charge the LWP works in partnership with state agencies on grant-funded projects including “Eat well play hard” (EWPH). The goal of the EWPH project is to prevent childhood overweight by partnering with community organizations to implement programs, policies and environmental changes targeting children age two to ten and their families in Madison and Herkimer Counties. A component of their efforts included a parent survey targeting low-income families with children ages two to ten, and a survey or social audit of local churches (Eat Well Play Hard Community Assessment Report, 2007). Eat Well Play Hard Survey 2007 Parents indicated that having free or low-cost physical activity programs (67%), adding new playground toys in community parks and playgrounds (56%), and providing safe places to walk (45%), such as walking trails and marked routes, would help them and their families become more physically active. If organized programs were available, parents felt that they would most likely become involved with these activities if they were located in area parks (77%), at schools (68%), or at recreational/youth centers (48%). Parents also indicated that reducing the cost of fresh fruits and vegetables (82%), availing local farmers’ markets (47%), and having more healthy foods (i.e., fruits and vegetables) available in vending machines and grocery stores (40%) would support their efforts to eat more fruits, vegetables, and low fat dairy foods. The church survey identified several opportunities and potential venues for affecting positive change in the area of nutrition and physical activity including: “policies around food donations or foods served at church functions and in soup kitchens, offering a physical activity program for the community, and 52 Madison County 2010 – 2013 Community Health Assessment Report regularly disseminating nutrition and physical activity information in sermons, bulletins, or on bulletin boards.” Of the 24 churches responding to the survey, 19 indicated a willingness to collaborate on activities related to healthy eating and physical activity in their communities. Fifteen of those nineteen churches have existing task groups that provide health and social services to those in need. Child Obesity Prevalence Project Locally, as well as at the state and national levels, virtually no data exists on the prevalence of overweight and obesity for children and adolescents between the ages of 5 and 18 years. Recent New York State legislation now requires schools to begin reporting student’s body mass index (BMI) as part of the student’s health record, beginning in the 2008-2009 school year. (State of New York. Senate-Assembly Bill S.2108-C.A. 4308-C, R.R., 24 January 31, 2007). However, this data will not be available to the counties until 2010 or 2011. Local efforts are underway to establish baseline childhood overweight and obesity prevalence rates for Madison County. Through a collaborative partnership between the Madison-Oneida BOCES, the Morrisville State College’s Baccalaureate Nursing Program, and the Madison County Department of Health, a comprehensive prevalence study on childhood obesity is currently underway within the local school districts. Height and weight measurements for children between Pre-K and twelfth grade are being measured and BMI values calculated among students from participating schools. Prevalence of Obesity* Among U.S. Children and Adolescents (Aged 2–19 Years) Survey Periods Ages 2 through 5 Ages 6 through 11 Ages 12 through 19 NHANES II NHANES III NHANES NHANES Madison County Madison County Madison County Madison County Madison County 1976– 1980 1988– 1994 1999– 2002 2003– 2006 2008-2009 20082009 2008-2009 20082009 2008-2009 Underweight n=4 Healthy 216 Overweight 103 Obese 77 Combined 180 1.00% 54.00% 25.70% 19.30% 45.00% 5% 7.20% 10.30% 12.40% 6.50% 11.30% 15.80% 17.00% 5% 10.50% 16.10% 17.60% 27 1021 365 351 716 1.50% 57.60% 20.60% 19.80% 40.30% 17 781 246 228 474 1.00% 61.30% 19.30% 17.90% 37.30% Number Measured Data Producing Kids Sources: Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among U.S. children and adolescents, 1999– 2000. JAMA 2002;288:1728–1732. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 2004;291:2847–2850. Ogden CL, Carroll MD, Flegal KM. High Body Mass Index for Age Among US Children and Adolescents, 2003–2006. JAMA 2008;299:2401–2405. Argentine MS & Caldwell, MT. (2009). Prevalence of Overweight and Obesity in Our Madison County Kids. Unpublished research report. Morrisville State College, Morrisville, NY Cost to Madison County Determining an accurate picture of the medical health care costs attributable to obesity for Madison County is difficult and complex, requiring additional research and analytical efforts that are beyond the scope of this report. However, it is possible to generate a rudimentary understanding of the potential medical care costs attributed to obesity in Madison County by looking at the County’s Medicaid expenditures. 53 3592 3446 Madison County 2010 – 2013 Community Health Assessment Report It is estimated that in 2003 dollars, approximately $3.5 billion of the New York State’s $6.1 billion in total costs attributed to obesity, or 58%, were covered by Medicaid (Table 3). The total Medicaid expenditures for New York State in 2003 were $32 billion (NYSDOH Medicaid Statistics Reports for 2003). If we apply these Medicaid cost estimates to New York State’s actual expenditures for 2003, the medical care costs attributed to obesity would constitute roughly ten percent (10%) of the State’s total Medicaid expenditures. In 2003, Madison County’s total Medicaid expenditures were $61 million (NYSDOH Medicaid Statistics Reports for 2003). For Madison County, ten percent of the total Medicaid expenditures would result in medical care cost attributable to obesity of approximately $6.1 million. Madison County contributes a local share of approximately 17% towards the total costs to cover the Medicaid expenditures allocated to the County (M. Fitzgerald, email correspondence on November 6, 2008). Therefore, in 2003, the estimated local share of the medical costs to the County would be approximately $1,037,000. Using the percentages from Table 3 a rough estimate for Medicare costs attributable to obesity for Madison County can be calculated. In 2003 New York State Medicaid costs constituted 58% of the total medical costs attributed to obesity (Table 3). By applying this percentage (58%) to Madison County’s expenditures, the total medical costs attributed to obesity in Madison County would be approximately $10.5 million. Medicare costs related to obesity represented approximately 23% of the total medical costs for New York State, in 2003 (Table 3). Applying the same percent to Madison County expenditures results in Medicare costs related to obesity of approximately $2.4 million. County Employee Health Quotient For the past three years the American Cancer Society conducted a health survey of Madison County employees. The purpose of the survey is to understand certain health and wellness issues among county employees in order to develop and support employee wellness activities and health practices. The data collected allows for the determination of BMI, dietary and physical fitness practices, and assists the county in developing wellness-related programming activities for its employees. In the 2006 survey, approximately 57% of the women respondents were overweight or obese. Of the 30 male respondents, 28 were overweight or obese (93%). Follow up surveys conducted in 2007 and 2008 revealed that BMI for both males and females increased over this three-year period. Overweight & Obesity Among County Employees 2006-2008 100% 90% 80% 70% Percent 60% 50% 40% 30% 20% 10% 0% 92% 87% 57% 2006 45% 2007 89% 64% 2008 Year Male Female Source: Madison County Department of Health 2008 54 Madison County 2010 – 2013 Community Health Assessment Report Overweight & Obesity - Home Care Patients The Madison County Department of Health operates the County’s home health care agency and long-term home healthcare programs. These programs provide both short and long-term skilled nursing and therapeutic care within the home environment. Overweight and obesity among adult homecare patients presents a co-morbidity factor that could exacerbate a patient’s health condition as well as affect patient care. Percent Overweight & Obese Among Home Care Patients 1/1/08 to 6/30/08 68.3% 61.9% 37.4% 32.6% An internal analysis of overweight and obesity among adult home care patients was conducted in July 2008. During the first six months of 2008, 378 patients ages 18 to 101 were provided care through the agency. Of the total 378 patients, three hundred twenty-three (323) patients had complete height and weight data that allowed for a BMI determination. Approximately 64.7% of the patients were overweight or obese, consistent with the trends for adults; males = 68.3%; females = 61.9% 30.9% 29.3% Male Female Overweight Obese Source: Madison County Department of Health 2008 Weight Health Concerns Among Adults (2008) 100 90 80 60 50 40 30 20 10 Madison County 55 New York State Consume 5+ Servings of Fruits/Vegetables per Day No Leisure-Time Physical Activity Received Advice to Lose Weight From Healthcare Professional Received Advice About Weight From Healthcare Professional Classified "Overweight" and "Obese" Classified "Obese" 0 Classified "Overweight" Percent (%) 70 Madison County 2010 – 2013 Community Health Assessment Report Sexual Behaviors Adolescent sexual activity can have life-changing or life-threatening consequences. A variety of diseases can be transmitted through sexual intimacy, including Chlamydia, trichomoniasis, gonorrhea, human papilloma virus, genital herpes, syphilis, and HIV. In 2007, 80% of teens in Madison County have never had sex. More teenage males have had sex than females and males also have their first sexual experience at a younger age. HIV Testing No available data on HIV testing for Madison County. STD Testing No available date on STD testing for Madison County. Local Health Care Environment Forces and Trends in Public Health On September 5, 2008 Madison, Oneida and Herkimer Counties held a Forces of Change regional brainstorming session. Over 140 diverse representatives attended. This session was a collaborative community health assessment initiative of the Madison and Oneida county MAPP teams. The Forces of Change Assessment is one of the four assessments in the MAPP process. The purpose was to convene a broad section of stakeholders to identify major forces, or trends, factors and events that are currently affective or will affect the health of the community and/or the public health system. Common forces identified by attendees include: social climate, attitude/morale about region, aging population, diversity, economic conditions, access to healthcare, workforce shortages, geography, lack of coordination of services, political issues, regulations, environmental issues, aging infrastructure, increase in obesity, prevention/health education resources, education issues, technology, emergency response and preparedness planning. The results of this assessment were merged with the community vision and the results of the other MAPP assessments – health status data, public health system performance, and community input to determine and address priority health issues. Identification of these forces represent a critical phase of the larger analysis as it brings to light some of the parameters under which the current public health system operates. In one sense, the forces and trends represent the current “givens” of public health in Madison County, and if not considered they might render action in other areas of the community health assessment futile. See Forces of Change written document for further information on the Madison County Health Department website: www.healthymadisoncounty.org Findings The county health departments and brainstorming session attendees indentified 19 categories of forces and trends that are currently or could potentially impact the local public health system. While some of these trends may pose threats to public health, others may create opportunities that could strengthen the system. Demographic Changes Madison County experienced significant population growth in the 1950s and 60’s, dropped in the 1970’s then rebounded unlike other surrounding counties, although the rate of growth has remained very small. 56 Madison County 2010 – 2013 Community Health Assessment Report There has been a recent increase in the Amish population and migrant workers within Madison County. This creates cultural and language barriers when accessing health. The department’s relationship with both groups is developing slowly. Public health staff have provided some immunizations and visiting for newborn screening. In addition there is a Native American population present in the county who receive health and social services through the Oneida Indian Health Center and surrounding areas. Increasing life expectancy and a growing elderly population is placing increased demand on health care and public health systems. Older people with the means are leaving to enjoy retirement in other locales and those who remain tend to be more dependent on government programs. The aging of the population poses problems to public health including the need to focus on health and issues specific to the elderly, increased cost of providing service with no increase in resources to provide them and decreased tax base and lack of service providers. Access to community-based long term care options is also limited. A Madison County Office for the Aging survey from 2008 identified that the top concerns of those surveyed aging included: medical costs, prescription costs, health care, and being alone. The rate of growth in the county population is small due to the exodus of major employers and jobs. Many young people leave the area to obtain employment. This decreased younger population affects health in a variety of ways including a smaller tax base to support public health and rising Medicaid/Medicare costs, fewer skilled employees are available including public health and other health care workers, and many working poor. Poverty continues to rise in Madison County and the Mohawk Valley in general. Problems posed by this include: increased reliance on government support, a smaller tax base, increased persons unable to afford prescription medications and health care, increase in crime and substance abuse, school with inadequate resources and as a result a less educated workforce, poorer health and nutrition, and an increase in stress and mental health issues. Economic Forces The increasing costs of healthcare and the lack of funding for public health activities pose a financial burden on the public health system, and make it difficult for public health agencies to perform their jobs adequately. Some factors are unique to the county and state and others are nationwide trends. At the county, state and national level, the cost of Medicaid is steadily rising and overwhelming to county budgets. Monies that could be available to public health must support Medicaid costs. Because only a limited number of providers are willing to accept Medicaid, recipients go untreated, must leave the county for treatment. While prevention is regularly less expensive than treatment, the significantly greater availability of funds to support treatment activities creates a tension between prevention and treatment services. The focus of prevention dollars tends to support more personal preventive services than those with a population based focus. With the initiation of the NYSDOH Prevention Agenda, the call for LHD, hospitals and community agencies to work toward preventing disease, more funding may be made available to address the risk factors for chronic diseases. Funding for public health services has remained relatively flat in recent years, and in the midst of increasing costs often leads public health providers to reduce the numbers of persons served or the amount of services that can be provided. There is a limited pool of resources for all public agencies, with county, state and federal budgets being cut and agencies competing for public funding, and as funding is being reduced, public health agencies must do more with less. 57 Madison County 2010 – 2013 Community Health Assessment Report Changes in funding mechanisms are barriers to public health activity. Block grants and categorical funding has increasingly focused limited resources narrowly on specific issues. This “silo” funding creates a disproportionate allocation of public health resources relative to public health. A narrow funding stream prevent public health from providing a comprehensive and holistic approach to public health delivery and forces the delivery of discretely focused programs that often fail to acknowledge relationships between conditions. This approach hampers collaboration among providers, creates turf issues and unhealthy competition for limited funds. Rural hospitals and health systems will have limited availability of capital for major investment over the next few years. Federal stimulus money is targeted more at operating rather than capital improvement. Many residents of the county are under- or uninsured. This leads to problems including increased health risks and disease burden in the county, creating more funds towards treatment, which is more expensive than prevention, the creation of disparities in health access and quality of care; and the need for government to fund and/or to provide services to these people as public health becomes the provider of last resort. There is an expectation that there will be increasing numbers of uninsured and underinsured adults and children as employers continue to reduce workforce numbers, health care benefits and put more responsibility for coverage onto the employee. Resource allocation for Madison County, like other rural counties will always be less based on population size. Collaboration with other counties is necessary in order to apply for grant funding. As a result grant opportunities may not be available for specific Madison County needs. Health care reform bills under consideration include establishment of a prevention and wellness trust fund that would ensure stable funding for evidence- based public health activities. The public health system needs a stable, reliable funding source and a highly skilled workforce to achieve the promise of health care reform to help make Americans be healthy. The public health system provides population-wide prevention and protection beyond the capacity of the medical system or health insurers. Access to Care See access section for more complete analysis. Geographical Barriers The geography of the county affects the health care environment. Madison County is an upstate rural county with an area of 661 square miles, centrally located between the cities of Syracuse and Utica. Madison County contains one city, 15 towns, and 10 villages. The county is divided north and south by Route 20, with higher populated areas with the more resources located in the northern end of the county. Time and distance present a problem as many of the rural residents are not in densely populated areas and often do not have access to a broad variety of services (specialty care, public transportation, less availability of technology). Services tend to be fragmented rather than grouped, so individuals who need multiple services may have to travel in completely different directions to access those services. The significant snowfall that we typically experience each winter further exacerbates this problem. Physical and social isolation are pervasive due to geography, weather and changing populations. The rural and somewhat isolated location of our county also makes it difficult to communicate public health messages and preventive health care information to county residents, especially when a sustained media campaign is needed. Many county residents receive their television, radio, and newspapers from varying sources outside the county; there is no common media link in the county. There are three daily newspapers distributed in the county: Oneida Daily Dispatch primarily covering the city of Oneida, the Syracuse Post Standard which has a Madison Section and the Utica Observer Dispatch. Weekly newspapers include: the Cazenovia Republic covering Cazenovia, New Woodstock, Nelson, Erieville, and Fenner; Madison Eagle covering Madison, Chittenango, Bridgeport, Lakeport, Perryville, Kirkville, Hamilton, Eaton, Morrisville, Canastota, Lincoln, Lenox and city of Oneida. In 2009 the Madison Courier, an electronic newspaper became another source of media for the entire county In 58 Madison County 2010 – 2013 Community Health Assessment Report Good Health, a general circulation newspaper which covers the healthcare industry in Central New York is distributed in Madison County and has been used by staff in the department. One radio station, WMCR is located within the county in the city of Oneida. The county lacks its own television station and relies on network news from stations located in Syracuse and Utica. PAC 99 the local cable station is used to promote local events and information. There are few billboards in the county through Park Outdoors but there is a lack of resources to pay for using this media outlet. Medical conditions and emerging diseases Medical conditions and emerging diseases are driving the public health system to change its focus and approach. For example, obesity, H1N1 and antibiotic resistant TB. Emerging infectious diseases The emergence of new infections has been a major concern in public health in recent years. Increased numbers and frequency of vector-borne diseases have become more problematic. In addition to treatment issues, the issue of widespread spraying to kill mosquito populations is healthy and appropriate is debated. Public health’s role in monitoring and enforcement of public health laws to prevent these diseases has been highly publicized, costly and at times controversial. The potential for pandemic flu and the recent emergence of H1N1 have affected the public health system. Public health’s role in surveillance, mass immunizations, risk communication can be overwhelming with limited staff and resources. Chronic diseases and conditions have become the focus of public health due to their increased frequency in the nation as well as Madison County. These include: Diabetes, heart disease, cancer, respiratory disease and obesity. The rise in obesity in Madison County as well as the nation overall has serious consequences for the public health system. Obesity is a risk factor or an aggravating agent for 32 co-morbidities or health conditions. Physical activity and dietary patterns, the major causes of obesity are second only to tobacco use as a leading cause of preventable death in the United States. In addition, the rise of obesity substantially increases health care costs. Addressing obesity, especially among children, has been expressed as a need in the county. While there is an identified need to promote physical activity, the geography of the county makes it difficult for all communities to offer safe opportunities for physical activity. Many communities do not have sidewalks or biking trails. Political Madison County and New York State politics Policymakers represent a segment of the population where a gap in the understanding of public health is present. Few legislators have a basic understanding of the work of public health and the difference between personal and population-based services. Without a complete understanding of public health, legislative support may continue to come for problems that tug most strongly at the heartstrings or perhaps affect family members. There is a real need for advocacy for public health especially in light of the present health care reforms bills. Attendees identified the following forces that affect public health: lack of trust in the government, centralized government being a threat, lack of power by public health system, over regulation and unfunded mandates, and funding cuts. 59 Madison County 2010 – 2013 Community Health Assessment Report Inadequate marketing of public health One of the reasons for the lack of understanding about public health by legislators and the general public is the failure for public health to market itself appropriately. Agencies are unable to properly inform the public of the services provided. Several factors contribute to this: lack of funding for marketing, too much focus on providing service and not on self-promotion of services, lack of staff training and understanding of marketing, attitudes around “we’ve always done it this way”. The Madison County Department of Health strategic plan for 2008-2012 has identified increasing public awareness, knowledge and use of health information, services and programs as one of its strategic issues. Environmental threats Environmental issues such as gas drilling and power line expansion were factors mentioned which may have environmental as well as potential health impacts. Aging infrastructure Madison County’s infrastructure, including its roads, bridges, sidewalks, sewers and water systems, and housing stock is old. This leads to safety issues including traffic hazards. It also promotes health hazards including lead poisoning. Housing stock in Madison County is relatively old. In fact, over 60% of housing was built before 1960 which present an issue with lead paint and exposure to children. Many townships in Madison County have a high percentage of homes with high radon levels. Technology Public health is affected by technology. While frequently helpful, technological advances also can cause problems for public health. New technologies are expensive for public health agencies to purchase and maintain, in light of the ever decreasing pool of public health resources. Technology is advancing faster than public resources can afford. For example, Madison County Department of Health Certified Home Health Aids are using tele Health technology to help patients manage their disease processes for better patient outcomes. Social Forces The social attitudes and behaviors and economic realities in Madison County also impact the local health environment. While a strong sense of community is evident in many of our rural towns and villages, many county residents value self-reliance and independence and are, therefore, reluctant to accept charity. There is a strong sense of familiarity which helps with people looking out for each other, but can be a negative factor in willingness to sign up for social service programs or use a local facility due to privacy issues and embarrassment. There is also often a mistrust of government. These attitudes prevent many residents from accessing public health information, programs, and services. This is true of their attitudes regarding social services such as food stamps and Medicaid. The attendees identified the following social forces affecting the public health system: moral decline, child abuse, and adverse childhood experiences, increase in crime especially related to substance abuse, teen pregnancy and youth issues. 60 Madison County 2010 – 2013 Community Health Assessment Report SECTION II – LOCAL HEALTH UNIT CAPACITY PROFILE 61 Madison County 2010 – 2013 Community Health Assessment Report LOCAL HEALTH DEPARTMENT CAPACITY PROFILE Health Department - Overview The Madison County Department of Health (MCDOH) is the local public health agency charged with ensuring the health and wellbeing of the residents of Madison County. MCDOH works in close collaboration with local, state, and federal agencies, organizations, and governments, and with the community and local health care providers. MCDOH is one of 36 full service county health departments, i.e., one in which the county is responsible for the local environmental health program activities. Although the public health programs that are available in each county may vary, each county is required, by Public Health Law, to address five basic service areas, i.e., community health assessment, disease control, environmental health, family health, and health education. In addition to the five basic service areas, the Madison County Department of Health elected to provide home health services that are deemed optional services by NYSDOH. The MCDOH is comprised of four main divisions: Administration, Environmental Health, Patient Services, and Preventive Health (Figure 1). These divisions provide thirty-five service areas that include disease control and prevention, field nursing, public health preparedness, health promotion, and regulatory activities. MCDOH executes its statutory responsibilities through these numerous program areas as depicted in the table below. Figure 1: MCDOH Organizational Structure Madison County Residents Madison County Board of Supervisors Madison County Board of Health Medical Director Public Health Director Division of Administration Division of Environmental Health 62 Division of Patient Services Division of Preventive Health Madison County 2010 – 2013 Community Health Assessment Report MCDOH Divisions & Program Areas Division Administration Environmental Health Program Areas Clerical Support Contracts & Grants Finance & Budget Information Systems Education and Outreach Water Supply Protection Sewage Disposal Reality Subdivisions Community Sanitation Record Keeping Work Environment Emergency Preparedness Food Protection Vector Control Rabies Adolescent Tobacco Use Prevention Clean Indoor Air Home Care Services Certified Home Health Care Long Term Home Health Care Preventive Health Tuberculosis Clinic Disease Investigations Immunization Clinic Sexually Transmitted Diseases Influenza Clinic Chest Clinic Child Passenger Safety Diabetes Prevention “Eat Well Play Hard” Healthy Women Partnership & Colorectal and Prostate Screening Starting Teen Abstinence Today In Communities Maternal & Child Health Childhood Lead Prevention Dental Medicaid Obstetrical and Medical Services Pap Clinic Early Intervention Child Find Pre-school Special Education and Services Children with Special Health Care Needs Physically Handicapped Children’s Program To carry out this diverse portfolio of responsibilities, MCDOH has evolved into an operation with emphasis on a functional structure. MCDOH’s main office of operations is located in Wampsville, NY with a “drop off” site located at the Cornell Cooperative Extension office in Morrisville, NY that serves the southern part of the County. Department Divisions Administrative Services: The Administrative Services Division provides critical operational support to the three service-based divisions of the Health Department (Environmental Health, Preventive Health, and Patient Services). Administrative Services responsibilities include: strategic planning, technology management, data and records management, finance and budget, contracts and grant management, quality improvement, resource management, personnel management, emergency preparedness, worker safety, and clerical support. Environmental Health: The Environmental Health Division applies the principles of engineering, biological and social sciences for the detection, evaluation, control and management of those factors in the environment which influence public health. The division is charged with the enforcement of Public Health Laws and Sanitary Codes, which are utilized for the detection, prevention and mitigation of risks to human health associated with Madison County's living, working and recreational environments. The Division of Environmental Health responds and provides assistance to local municipalities as well as the general public, in addition to regulatory activities associated with facilities permitted under New York State Sanitary Codes. Patient Services: The department continues to operate the only certified home health agency providing skilled nursing, home health aides, and ancillary services to Madison County Residents. In-home long term care services provided through the Long Term Home Health Care Program (LTHHCP) is a cost effective alternative to nursing home placement. The care delivered effectively assists and supports Madison County's aging population, including the frail elderly, with the ability to remain in their own homes. This professionally managed plan of care addresses health and safety issues, coordinates with community agencies, and encourages family support. Providing safe, appropriate care is a primary goal of the Long Term Home Health Care Program and continues to be a cost effective alternative to 63 Madison County 2010 – 2013 Community Health Assessment Report institutionalization. The LTHHCP provides wavered services including a life line which is a personal emergency response system that allows a patient to summons help when needed. Preventive Health Services: The Madison County Preventive Health Services division focuses on health promotion, illness and injury prevention, and health maintenance. Programming is designed to promote the highest level of health for Madison County residents through health education and out reach, anticipatory guidance, prevention of illness and injury, control of community infection, advocacy, and health care planning. Ongoing collaboration with other community agencies and providers helps to ensure that comprehensive services are available to the populations served. The division was restructured in 2008 into four main program areas: disease control and prevention, family health, children with special health care needs, and injury prevention. Strategic Plan In April 2008, the Department’s first ever strategic plan was published. This plan was built on past achievements and current initiatives, while providing the necessary direction for future improvements that will contribute towards the overall health and well being of our community. The plan, including the goals and their respective strategies, is consistent with State mandates, stakeholder input, and the five priority health issues identified by the Madison County Priorities Council. The MCDOH strategic plan focuses time and resources on those initiatives that are poised to return the greatest value to the Madison County residents by employing strategies that will most effectively use the skills and resources at MCDOH. The strategic plan works in concert with the development and implementation of existing and proposed annual performance plans for department personnel and division areas, as well as with current NYSDOH performance measures and with the anticipated movement towards local health department accreditation requirements. The MCDOH strategic initiatives direct department resources and efforts towards addressing the following goals: Insure an involved, motivated and competent public health work force; Increase the public awareness, knowledge and use of health information, services and programs; Provide the most appropriate services in the most efficient way; Maximize partnerships to ensure community needs are met; and Identify and adapt to address emerging health issues challenging our community Workforce Development MCDOH has a full-time staff of 80 individuals, 18 per diem staff, and 11 contractual staff. A dedicated and professional health department staff carry out the department’s responsibilities that include: preventing epidemics and the spread of disease, protecting against environmental hazards, preventing injuries, encouraging healthy behavior, helping communities to recover from disasters, and ensuring the quality and accessibility of health services. MCDOH assures an adequate statutory base for local public health activities, advocates with system partners for local policy changes to improve health, and assures that funding for public services meet the critical health needs of our County’s populace. In addition, MCDOH provides important leadership in maintaining and improving the performance and capacity of the local public health system to provide appropriate public health services. Beginning in 2008, attention was directed towards workforce development. The MCDOH staff continues to take on emerging and complex health issues in the face of significant challenges including staffing shortages, an aging workforce, advances in technology, and financial constraints. Therefore it is imperative that MCDOH be adequately staffed and that this staff is experienced, motivated, and well trained. At the request of the Chairman of the Board of Supervisors, MCDOH developed a five-year plan that profiled the current county health department workforce and provided workforce projections over the next five years. An internal study of Department staff revealed that through retirements, resignations, budgetary constraints, programmatic changes at both state and local levels, the available pool of potential employees, and other factors affecting staff recruitment and retention, we could potentially see up to a 35% turnover in staff over the next 5 years. The MCDOH initiated several courses of action to address 64 Madison County 2010 – 2013 Community Health Assessment Report this potential threat and ensure that the Department retains our ability to provide quality, professional services to our residents in the most efficient and effective manner. Budget allocations for 2008 were specifically earmarked for work force development activities that include enhanced training and continuing education opportunities, recruitment and retention efforts, and work environment modifications. An internal Career Development Task Force established a framework for a comprehensive career development program. The first phase of this project included the identification and development of assessment tools to gauge staff skills, abilities, knowledge and overall competencies in relationship to professional standards. The MCDOH participated as a pilot site for the NYSDOH Learning Management System (LMS) —a distance learning initiative designed to facilitate and enhance professional staff development and competency building. Through use of the LMS system staff were able to assess their individual training and skill development needs. Once determined, staff was able to select and complete free distance learning training modules available through the LMS system. MCDOH also participated in a NYDOH Leadership Competency Assessment project to develop and improve leadership competencies among public health professionals. Assessments were conducted on twenty-seven health department management and nonmanagement staff to identify training and staff development needs. Program Re-Alignment Federal and State Health Department initiatives, coupled with current and future community health trends will require the Department to demonstrate a greater capacity and application of human, technological and financial resources to address rising health concerns in the areas of prevention, including surveillance and program coordination, especially as they pertain to chronic disease, injury prevention, obesity, and child health. The Prevent Division contains the majority of the programs and services offered by the Department. However the organizational structure of the division was somewhat loosely defined. The Strategic Plan led the Department to review and re-align the programs and services to better reflect community health needs, information and technology needs and applications, and funding streams and accounting practices. As such, three branches were established (Disease Control & Prevention; Family Health; and Children with Special Health Care Needs). Our current health education activities involve health educators working independently of each other within 65 MCDOH Staff Profile Position (As of 09/08/09) Full Time Asst Director of Patient Services Asst Director of Admin Services Asst Director of Environmental Health Children w/ Spec Needs Coordinator Clinical Field Coordinator Confidential Secretary Deputy Director of Health Director of Environmental Health Director Admin Services Director of Public Health Director of Community Health Director of Patient Services Environmental Specialist Financial Investigator Home Health Aide LPN Office Assistant II Office Assistant I Physical Therapist Coordinator Principle Account Clerk Public Health Educator Public Health Educator II Public Health Nurse Public Health Sanitarian I Public Health Sanitarian II Public Health Tech Registered Nurse Registered Nurse II Service Coordinator Total Per Diem Summer Mosquito Intern Registered Nurse Public Health Nurse Home Health Aide Teachers of the Speech and Hearing Total Contractual Physical therapist Occupational Therapist Speech Therapist MSW Nutritionist Medical Director Total # 3 2 1 1 1 1 1 1 1 1 1 1 1 1 12 3 11 4 1 1 3 1 4 2 1 1 17 1 1 80 1 4 4 4 5 18 4 3 1 1 1 1 11 Madison County 2010 – 2013 Community Health Assessment Report individual divisions. Although our individual educators perform well on their own, the department lacks a coordinated, effective, and efficient health education effort. Efforts are underway to establish a health promotion and planning division that would position the department to maximize its health education and promotion activities. Technology Technology offers opportunities to enhance the quality, quantity, and efficacy of the programs and services the department provides to Madison County residents. By maximizing the use of current technologies such as wireless internet and communication access and web-based training, department staff was able to spend more time in the field, serving our clients and citizens. Recently the County switched from ATT to Verizon resulting in improved communication capabilities for staff, especially for those in the field. Field staff, e.g., home care nurses, sanitarians, etc. are now provided with Blackberry phones. In addition to overall better cell phone reception and coverage throughout the county, the phones are equipped with cameras and air card capabilities. Field staff can use the Blackberry’s in concert with their laptop computers to access the internet and transfer data, including digital photos. Through a collaborative partnership with Colgate’s Upstate Institute, student interns assisted the Department’s Environmental Health Division in converting our regulated facility information into GIS mapping data. GIS mapping expands our department’s capacity to manage the regulated facilities, as well as our ability to respond promptly to community and agency information requests The MCDOH website is an important, credible health resource for our community. The site provides upto-date information and resources on a variety of health topics and local health resources such as event and clinic schedules, fact sheets, local disease surveillance information, data and reports. Since the launch of the website (www.healthymadisoncounty.org) in May of 2007, over 25,000 visits were recorded. The number of new visitors, repeat visitors, and time spent using the site increased, in 2008. By monitoring the types of information that individuals are seeking, the department is able to adjust our messages and health information resources to respond to the community’s health information needs. Within the Administrative Services Division, the continued analysis and redesign of our billing processes, led to the department’s ability to post all Medicaid remittances electronically, thereby improving billing efficacy and facilitating timely reimbursement and cash flow. Quality Improvement Several initiatives and activities were put into practice that contributed to improvements in the overall quality of the programs and services the MCDOH provides to the community. The application of a business process analysis (BPA) methodology within the Patient Services Division continued to streamline service delivery and patient care processes that ultimately brought about improved patient care. Additionally, the BPA represents an important phase in MCDOH’s migration of departmental records to the County’s Electronic Data Management System. The MCDOH’s Staff-Management Committee, established at the end of 2007, spearheaded several initiatives leading to improvements in overall communication within the department including a departmental newsletter, email accessibility, and expansion of communications technology capabilities to field staff. A survey of department staff indicated that overall communication had improved in 2008. In addition, several internal policies and procedures were developed or revised that brought about improvements in our daily operations. Investments in staff development and training, including distance learning technology, the recruitment of key staff including a part-time quality assurance personnel, physical therapy coordinator and wound specialist, the establishment of an active Quality Control Committee, organizational restructuring activities, and the implementation of the County’s Management Performance Program further contributed to overall quality improvements to the MCDOH, and ultimately to the benefit of those we serve. 66 Madison County 2010 – 2013 Community Health Assessment Report Community Health Assessment The Madison County Department of Health staff have traditionally prepared the community health assessments for the County. A comprehensive strategic planning and assessment of our community’s health was initiated in January 2008 using the MAPP methodology, a nationally recognized community health assessment process, to identify and prioritize health issues in a community, and develop strategies to address these issues. The MAPP process consists of forming a sixty member project team, establishing a vision for the county, conducting four assessment activities, and identifying and prioritizing health issues for strategic implementation. Our ability to successfully complete the CHA is founded on strong collaborative efforts with our community partners. In-kind contributions, including personnel time, meeting space, supplies/printing, professional expertise, student internships with local universities, along with financial contributions make the assessment activities possible. Outside consultation is used for activities such as meeting facilitation and community surveys. Ongoing data collection and analysis is a critical component of successful program planning, service delivery, and health promotion efforts. Although a comprehensive CHA is required once every four years, a local health department must have the capacity to engage in ongoing data collection and analysis. One issue that arose through the current CHA process is the need for the community to develop and maintain a health data base from which all agencies can benefit. The County Health Department was identified by the community agencies to be the “keeper and maintainer” of this data base. The Department currently lacks the capacity to perform this function both in terms of manpower and technology. An additional challenge is the numerous data bases that the county must access to collect the data. A significant portion of the data comes from state data systems. These systems tend to be “siloed” based on program. At a county level this requires a significant amount of manpower hours to collect the data. Our efforts could be greatly improved if the County had the capability of integrating the various data systems. As mentioned earlier, the Department considering forming a Health Promotion and Planning Division. In addition to health promotion activities, the division would be responsible for planning activities including the CHA and MPHSP. This would require additional personnel, including an epidemiologist and biostatistician. 67 Madison County 2010 – 2013 Community Health Assessment Report SECTION III – PROBLEMS AND ISSUES IN THE COMMUNITY 68 Madison County 2010 – 2013 Community Health Assessment Report COMMUNITY PARTNERSHIPS AND COLLABORATIONS EFFORTS Madison County Priorities Council The Madison County Priorities Council formed in 1998, is composed of governmental, non-profit, hospital, and college representatives. The purpose of the council is to address priority health and social issues and plan collaborative interventions to improve the health of county residents. This group is involved in setting the health priorities for the county and developing strategies to address gaps in services and programming. Members of the priorities council use data from the Madison County Community Health Assessment in their planning processes. Members of this council have been actively participating in the Madison County MAPP process engaging in the assessment process. Living Well Partnership The Living Well Partnership promotes community change that encourages people to eat well and be physically active. Subcommittees address objectives of the Eat Well Play Hard grant that Madison County administers for Madison and Herkimer counties, Healthy Start, TV Turnoff Week, and a yearly which is addressing childhood obesity through family education. Diabetes Prevention Partnership The CNY Diabetes Prevention Partnership is a five-county consortium including Tompkins, Cortland, Cayuga, Onondaga and Madison Counties. The partnership is led by the Seven Valleys Health Coalition, and through grant funding the counties educate residents on self-management and promote prevention of Type II Diabetes. CNY Dental Coalition The lead agency is the Mohawk Valley Network in Oneida County and outreach is focused on Madison, Oneida, Herkimer, and Otsego Counties. The Coalition addresses dental access issues, preventive dentistry, and education needs, and also provides screening, education, and sealants in schools. Healthy Living Partnership This three county partnership serves Oneida, Herkimer and Madison Counties. Clinical breast exams, mammograms, Cervical and colorectal cancer screening are provided at no cost to men and women who meet the program eligibility requirements. Madison County Local Early Intervention Coordinating Council The Council is a group of local agencies providing services to parents of small children (ages 0-3). The goal is to identify gaps in services and initiate interventions to address the needs of children with developmental delays, children at risk for delays, and children with special health care needs. Reach CNY Madison County Sub council. The perinatal network covers Madison, Oswego, Onondaga, and Cayuga Counties. Each county has a sub-council that meets quarterly. The network is a collaboration of health and human service providers and community members that seek to ensure that families have access to the full range of quality, accessible, culturally sensitive, and continuous health and social services needed to improve pregnancy outcomes, infant health, and to promote the health and well-being of the entire family. Tobacco Free Madison County Partnership The lead agency is BRiDGES, the Madison County Council on Alcoholism and Substance Abuse. The mission of the FRMC is to prevent and reduce tobacco use in Madison County. The partnership recently updated tobacco survey. Healthy Start Partnership HSP is an eight-county Coalition whose goal is to promote healthy weights in prenatal women and infants. Goals include: improving accommodation of lactating women in the workforce and public spaces in community, affecting positive changes in attitude toward breastfeeding at a point of early decisionmaking, improving availability of information and support to breastfeeding women to maximize health 69 Madison County 2010 – 2013 Community Health Assessment Report benefits to community, developing more supportive environment for maintaining weight by encouraging access to physical activity at low or no cost for county residents. Asthma Coalition The lead agency is the American Lung Association in Fulton. Grant funding provides an asthma case management program for asthmatic children in the county and education and outreach activities to the community, school nurses, providers, and families. Oneida/Herkimer/Madison County Adult Immunization Coalition This Coalition includes three county health departments, private immunizers, vaccine representatives, colleges, the Oneida Indian Nation Health Department, and NYSDOH representatives. The goal is to increase adult immunization rates by increasing awareness of need for adult immunizations. Disease Surveillance and Response Committee: Ongoing active disease surveillance system with health department and other partners including schools, hospitals, providers, daycares, NYSDOH, other county HD, Community based partners, colleges. The purpose is to communicate timely and factual health information in preparation for pandemic influenza or other outbreaks. This includes a Weekly human disease/influenza risk report to network partners. Report disease activity e.g., flu during flu season at the local, state and national levels and other diseases that are prevalent. This year MCDOH developed an animal disease report addressing zoonotic diseases. School Superintendent/County Department Head meetings: Quarterly meetings with Madison County Department heads from public health, probation, mental health and DSS meet the superintendents from 12 school districts in Madison County to Child Obesity Prevalence Project Through a collaborative partnership between the Madison-Oneida BOCES, the Morrisville State College’s Baccalaureate Nursing Program, and the Madison County Department of Health, a comprehensive prevalence study on childhood obesity is currently underway within the local school districts. Height and weight measurements for children between Pre-K and twelfth grade are being measured and BMI values calculated among students from participating schools. Approximately 4000 children have been measured to date. Data collection activities are scheduled to be completed by early 2009, with the study report available sometime in fall2009. Child Fatality Review Team A multidisciplinary team collects data regarding the number and caused of child deaths in Madison County, review and analyze causes and potential patterns in childhood deaths, and work to prevent or lesson the incidence of childhood death, where possible. Madison County Multidisciplinary Team Multidisciplinary team response to child sexual abuse, severe physical abuse and child fatality Madison County Domestic Violence Coalition Lead agency Liberty Resources, community and governmental agencies meet three times yearly to provide updates, training and advocacy for DV issues. Early Childhood Committee: The ECC addresses issues with social and emotional needs of children 0-5 in Madison County. The group was formed to identify services that could be provided to children exhibiting severe emotional behavioral or psychiatric problems. Members include: county agencies, school districts, community agencies. Provides training for staff serving this population. Hamilton-Bassett-Crouse Health Network Community Memorial Hospital, Crouse Hospital and Bassett Healthcare form a hospital-based health network. The Hamilton-Bassett-Crouse Health Network through grant funding under the New York State 70 Madison County 2010 – 2013 Community Health Assessment Report Department of Health's Rural Health Network has worked to improve hospital-based care in Madison County in several ways including: The development of video-teleconferencing facilities that allows continuing education opportunities to hospital and medical staff, Graduate medical education affiliations and student placements with Crouse, Bassett and SUNY Health Science Center. The Science Center's RMED program allows a medical student to complete a nine-month rotation with family practice physicians. Community Memorial also has an affiliation with the Crouse Family Practice Residency training program, SUNY Health Science Center at Binghamton clinical obstetrics and gynecology program, and the Columbia University and Dartmouth College externship programs. These affiliations provide Community Memorial with increased exposure for future physician recruitment; and the design and implementation of Community Wellness Program. The Community Wellness Program began operation two years ago and has experienced tremendous support from the area. The program is designed to encompass the physical, nutritional and emotional needs of participants, emphasizing the involvement of primary care physicians. Other Health and human service agencies and governmental agencies in Madison County work in a cooperative manner. The high level of cooperation is related to the rural nature of the county, large geographic area, with small population. Community organization staff has strong professional commitments to their community and are willing to work collaboratively, and be accessible to meet the need of clients. There is a need to share resources as many of these agencies have limited staff and fiscal resources. Collaborative efforts are more frequent as funding agencies require collaboration and demonstration of sustainability, in which collaboration is a critical factor. Profile of Community Resources and Assets HOSPITALS 1. Oneida Healthcare Center (Oneida) 2. Community Memorial Hospital (Hamilton) URGENT CARE No facilities within Madison County RURAL HEALTH NETWORK 1. Hamilton-Bassett-Crouse Health Network ARTICLE 28 PRIMARY CARE HEALTH CENTERS Oneida Health Care Center 1. Canastota- Lenox Health Center 2. Chittenango Family Care Community Memorial Hospital 1. Munnsvi1le Family Health Center 2. Morrisville Family Health Center 3. Hamilton Family Health Center 4. Cazenovia Family Health Center 5. Waterville Family Health Center ( Oneida County) but serves Oneida County residents Family Health Network of Central New York 1. DeRuyter Healthcare Bassett Health Care 1. Bassett Health Care Hamilton- medical,dental, specialty St. Joseph’s Hospital 71 Madison County 2010 – 2013 Community Health Assessment Report 1. Heritage Family Medicine- Cazenovia SCHOOL-BASED HEALTH CENTERS 1. DeRuyter Central School MADISON COUNTY DEPARTMENTS 1. Madison County Health Department 2. Madison County Mental Health Department 3. Madison County Department of Social Services 4. Madison County Youth Bureau 5. Madison County Employment and Training 6. Madison County DWI 7. Madison County Emergency Management CERTIFIED HOME HEALTH AGENCIES 1. Madison County Health Department LONG TERM CARE FACILITIES 1. 2. 3. 4. Stonehedge Health and Rehabilitation Center Community Memorial Hospital ECF Oneida Healthcare Center ECF Crouse Community Center ADULT CARE FACILITIES 1. Hazel Carpenter Home 2. Hamilton Manor PRENATAL CARE CLINIC PROVIDERS 1. Oneida Healthcare Center 2. Bassett Healthcare Cooperstown- satellite office in Hamilton NY MOMS PROVIDERS 1. Heritage Family Medicine 2. Women’s Health Associates 3. Dr. Berry 4. American Med Well – Dr. Ojibeli 5. Oneida OB/GYN 6. Advanced Ob/GYN AMBULANCE SERVICES 1. Cazenovia Area Volunteer Ambulance Corp 2. Eaton Fire Department 3. Georgetown Emergency Squad 4. Greater Lenox Ambulance Service 5. Madison Fire Corp 6. Morrisville Fire Company 7. Smith Ambulance Service DeRuyter 8. Smithfield Eaton Volunteer Ambulance Corp 9. Southern Madison County Vol Ambulance Corp 10. Village of Madison Ambulance 11. Vineall Ambulance Inc. 12. West Eaton Volunteer Ambulance Corp NON-TRANSPORTING FIRST RESPONDERS 1. Bridgeport Fire Department 2. Brookfield Fire Department 72 Madison County 2010 – 2013 Community Health Assessment Report 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Canastota Fire Department Cazenovia Fire Department Chittenango Fire Department Earlville Fire Department Erieville Fire Department Hamilton Fire Department Hubbardsville Fish and Game Club Fire Department 10.Lincoln Fire Department 11.Munnsville Fire Department New Woodstock Fire Department North Brookfield Fire Department Oneida Fire Department Smithfield Fire Department Wampsville Fire Department COMMUNITY AGENCIES- NON PROFITS AND GOVERNMENTAL 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. American Cancer Society – Utica/Syracuse American Lung Association- Rochester office AIDS Community Resources - Syracuse Alcoholics Anonymous AL-Anon Consumer Services of Madison County American Diabetes Association- Utica American Heart Association - Utica American Red Cross Madison/Cortland ARC Arise - Syracuse Arthritis Foundation of Central NY - Syracuse Berkshire Farm Centers Madison Transit System BRiDGES- MC Council on Alcoholism and Substance Abuse Catholic Charities Central Association for the Blind and Visually Impaired - Utica Central New York Developmental Disabilities Services Office Central New York Poison Control Emergency Madison County Community Action Program Madison County Cornell Cooperative Extension Early Childhood Direction Center- Syracuse Enable- Syracuse Reach CNY Syracuse Perinatal Network Ferre Institute~ Utica Heritage Farm Hospice of CNY- Syracuse Hospice Care, Inc. - Utica Leukemia Society of America - Syracuse Liberty Resources, Inc. Lupus Foundation of America - Binghamton Madison County Head Start Madison County Office for the Aging Madison County DWI Madison Family Outreach March of Dimes Birth Defects Foundation - Syracuse Medical Society of Madison County- Utica Mid-York Child Care Council – Oriskany Migrant Educational and Outreach Program- Herkimer Multiple Sc1erosis- Syracuse 73 Madison County 2010 – 2013 Community Health Assessment Report 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. Muscular Dystrophy- Syracuse National Kidney Foundation of CNY- Syracuse Oneida Indian Nation Health Center Oneida City Youth and Recreation Services Department Planned Parenthood Mohawk Hudson, Inc. Resource Center for Independent Living -Utica Ronald McDonald House - Syracuse Madison County Retired and Senior Volunteer Program Tri Valley YMCA United Cerebral Palsy Association - Utica Madison-Herkimer County WIC Program Care Net Maxim Health Services Syracuse – mass immunizations SCHOOL DISTRICTS 1. Brookfield 2. Canastota 3. Cazenovia 4. Chittenango 5. DeRuyter 6. Hamilton 7. Madison 8. Morrisville-Eaton 9. Oneida 10. Otselic 11. Stockbridge COLLEGES AND UNIVERSITIES 1. Colgate University 2. Cazenovia College 3. Morrisville State College 4. Utica School of Commerce Partnerships in Madison County to Improve Health Status Madison County Priorities Council The Madison County Priorities Council formed in 1998, is composed of governmental, non-profit, hospital, and college representatives. The purpose of the council is to address priority health and social issues and plan collaborative interventions to improve the health of county residents. This group is involved in setting the health priorities for the county and developing strategies to address gaps in services and programming. Members of the priorities council use data from the Madison County Community Health Assessment in their planning processes. Members of this council have been actively participating in the Madison County MAPP process engaging in the assessment process. Living Well Partnership The Living Well Partnership promotes community change that encourages people to eat well and be physically active. Subcommittees address objectives of the Eat Well Play Hard grant that Madison County administers for Madison and Herkimer counties, Healthy Start ,TV Turnoff Week, and a yearly which is addressing childhood obesity through family education. Diabetes Prevention Partnership: The CNY Diabetes Prevention Partnership is a five-county consortium including Tompkins, Cortland, Cayuga, Onondaga and Madison Counties. The partnership is led by the Seven Valleys Health 74 Madison County 2010 – 2013 Community Health Assessment Report Coalition, and through grant funding the counties educate residents on self-management and promote prevention of Type II Diabetes. CNY Dental Coalition. The lead agency is the Mohawk Valley Network in Oneida County and outreach is focused on Madison, Oneida, Herkimer, and Otsego Counties. The Coalition addresses dental access issues, preventive dentistry, and education needs, and also provides screening, education, and sealants in schools. Healthy Living Partnership. This three county partnership serves Oneida, Herkimer and Madison Counties. Clinical breast exams, mammograms, Cervical and colorectal cancer screening are provided at no cost to men and women who meet the program eligibility requirements. Madison County Local Early Intervention Coordinating Council. The Council is a group of local agencies providing services to parents of small children (ages 0-3). The goal is to identify gaps in services and initiate interventions to address the needs of children with developmental delays, children at risk for delays, and children with special health care needs. Reach CNY Madison County Sub council. The perinatal network covering Madison, Oswego, Onondaga, and Cayuga Counties. Each county has a sub-council that meets quarterly. The network is a collaboration of health and human service providers and community members that seek to ensure that families have access to the full range of quality, accessible, culturally sensitive, and continuous health and social services needed to improve pregnancy outcomes, infant health, and to promote the health and well-being of the entire family. Tobacco Free Madison County Partnership. The lead agency is BRiDGES, the Madison County Council on Alcoholism and Substance Abuse. The mission of the FRMC is to prevent and reduce tobacco use in Madison County. The partnership recently updated tobacco survey. Healthy Start Partnership. Eight county Coalition with goals to promote healthy weights in prenatal women and infants. Goals include: improving accommodation of lactating women in the workforce and public spaces in community, affecting positive changes in attitude toward breastfeeding at a point of early decision-making, improving availability of information and support to breastfeeding women to maximize health benefits to community, developing more supportive environment for maintaining weight by encouraging access to physical activity at low or no cost for county residents. Asthma Coalition. The lead agency is the American Lung Association in Fulton. Grant funding provides an asthma case management program for asthmatic children in the county and education and outreach activities to the community, school nurses, providers, and families. Oneida/Herkimer/Madison County Adult Immunization Coalition. This Coalition includes three county health departments, private immunizers, vaccine representatives, colleges, the Oneida Indian Nation Health Department, and NYSDOH representatives. The goal is to increase adult immunization rates by increasing awareness of need for adult immunizations. Disease Surveillance and Response Committee: Ongoing active disease surveillance system with health department and other partners including schools, hospitals, providers, daycares, NYSDOH, other county HD, Community based partners, colleges. The purpose is to communicate timely and factual health information in preparation for pandemic influenza or other outbreaks. This includes a Weekly human disease/influenza risk report to network partners. Report disease activity esp flu during flu season at the local, state and national levels and other diseases that are prevalent. In 2009 an animal disease report for zoonotic diseases 75 Madison County 2010 – 2013 Community Health Assessment Report was developed. Fit CNY: Eight CNY counties have compiled information about resources within their counties for nutrition and physical activity opportunities. Superintendent/department head meetings: Quarterly meetings with Madison County Department heads from public health, probation, mental health and DSS meet the superintendents from 12 school districts in Madison County to discuss health and social issues and solutions. Obesity Primary Data Research Study A partnership between Madison-Oneida BOCES, Morrisville State College’s Baccalaureate Nursing Program and Madison County DOH for a comprehensive prevalence study of childhood obesity within local school districts. BMI values are being calculated for children from Pre-K -12th grade to provide primary data to the county on childhood obesity rates. Infant mortality review team Madison County team of representatives from MCDOH, DSS, Mental health, community agencies with goal of preventing child deaths and promoting child safety, through review of child fatalities, recommendation of measures to prevent future child fatalities and promote overall child safety. Madison County Multidisciplinary Team Multidisciplinary team response to child sexual abuse, severe physical abuse and child fatality. Madison County Domestic Violence Coalition Lead agency Liberty Resources, community and governmental agencies meet three times yearly to provide updates, training and advocacy for DV issues. Early Childhood Committee: Addresses issues with social and emotional needs of children 0-5 in Madison County. The group was formed to identify services that could be provided to children exhibiting severe emotional behavioral or psychiatric problems. Members include: county agencies, school districts, community agencies. Provides training for staff serving this population. Agency collaboration: Like many rural communities, there is a strong sense of community responsibility and a propensity for collaboration among health and human service non profit and governmental agencies in Madison County. There is a need to share resources as many agencies have limited staff and fiscal resources. Collaborative efforts are more frequent as funding agencies require collaboration and demonstration of sustainability, in which collaboration is a critical factor. Health Department services: The Health Department holds evening and weekend flu, immunization and rabies clinics to make them more accessible to the public. Some of the clinics and private providers, including Planned Parenthood, offer evening and weekend hours. The majority of clinic providers operate weekdays with daytime hours only and generally are closed by 5 PM. There is no urgent care facility in the county and so the emergency departments at local hospitals are the only facility open in the pm or weekends. The Health Department does provide charity care and has a sliding fee scale for home care and preventive services. Medicaid providers There seems to be adequate facilities to meet the primary care needs of the Medicaid population. However, some specialty health care resources are difficult to access. There are limited private provider resources for the adult Medicaid population. In terms of mental health services, Medicaid recipients can 76 Madison County 2010 – 2013 Community Health Assessment Report go to the Madison County Mental Health Department for services, but there are limited private providers' resources for these patients. There are waiting lists at times for services through the Mental Health Department. Dental health access for CHP, FHP and the uninsured has been on ongoing issues. Lack of orthodontic providers for Medicaid population in the county and oral surgeons continues to be present. Private dentists in the county do not accept Medicaid so that population uses the article 28 dental providers in the county or goes out of county for services in general. Anecdotally, private providers will take some uninsured and does charity care in their offices, but this is not provided in any coordinated manner within the county. Medicaid Service Provision 1. Health Centers. The following health centers: Canastota Lenox, Chittenango, Munnsville, Morrisville, Hamilton, Cazenovia, DeRuyter, Bassett, and Planned Parenthood in Madison County accept Medicaid, Child Health Plus and Family Health Plus. They also accept self-pay clients and have fee scales. There are private providers in the county accepting Medicaid clients, but they often limit the number of patients they see with this payment source or accept only established patients. 2. Dental clinics. Sitrin Dental- Oneida – Medicaid only Morrisville Dental Clinic - Morrisville Medicaid, private insurance and self-pay Bassett Health Care - Hamilton Medicaid, FHP, CHP, private insurance and self pay 3. Pregnant Women. Oneida Healthcare Center prenatal clinic Bassett Healthcare – provide prenatal care at a Hamilton but must deliver out of county at Cooperstown beginning Sept 1, 2009- Community Memorial Hospital will no longer have OB services at their facility so women can deliver in county at Oneida Healthcare only or leave the county to deliver Six MOMS providers – listed prior in resources 4. Children. Medicaid accepted at above health centers and three pediatric groups in the county accept Medicaid and Child Health Plus Outreach and public education One of the strategic issues identified in the Madison County Department of Health Strategic Plan for 2008-2010 is to increase the public’s awareness, knowledge and use of health information, services and programs. The department has a Health Promotion Task force developing a health marketing process for the department. The department is committed to be a leader in ensuring that public health messages are marketed in the most effective manner to county residents. The following strategies are being implemented: 1. Develop and institutionalize a marketing process that maximizes use of various marketing medium to positively affect targeted populations. 2. Develop, disseminate, and maintain a public health resource guide and directory 3. Establish a recognized public health identity that may include 4. Establish a health promotion division within the department to centralize and direct health promotion efforts for the entire department The department has designed a new website and is committed to being the source for local health information for county residents. The website contains information MCDOH programs and services, 77 Madison County 2010 – 2013 Community Health Assessment Report new, health information A to Z, data and publications, events and activities. The Madison County Health Department provides ongoing outreach and public health education. Depending on the program or issue, health education efforts can be targeted to the general population or targeted to specific groups. Some outreach and educational efforts are performed primarily by Health Department staff while others are in conjunction with partnering agencies and with other counties. General public health efforts: Immunization - children and adults HINI Family preparedness for emergencies Dental- children and adults Healthy lifestyles - tobacco, physical activity, and nutrition Communicable disease prevention Need for age and sex appropriate screenings Communicable disease Information on all programs available through the Health Department Injury control, poisoning, and lead screening Tobacco cessation Rabies prevention and treatment Vector borne disease prevention Targeted high risk populations: Lead - parents of children 0-18 years and pregnant women and providers working with this population Car seat safety program- low income parents and guardians Diabetes- type II and persons at risk - obese population Healthy living Partnership- general public on need for age and sex appropriate screenings but specific to income and age eligible and un- and underinsured populations and targeted age groups for program Asthma management - families of children 3-12 years old, providers, and school nurses Healthy births - women of childbearing age STD prevention – adolescents, college students MOMS -low income women Radon- homeowners in targeted areas of county with high levels in home Obesity: children H1N1 – high risk groups for vaccination and at risk for complications 78 Madison County 2010 – 2013 Community Health Assessment Report ACCESS TO CARE Primary Care Providers There are 124 listed general practice physicians (MD or DO) in Madison County. Additionally, County residents have access to general and family physicians and other specialists in neighboring counties and urban areas such as Syracuse and Utica/Rome. Seven eye doctors, five podiatrists, and eight pediatricians, and other specialists are located in Madison County providing services to our residents. Madison County surpasses New York State for the number of licensed nurses, physician assistants and physical therapists. The number of licensed physicians and dentists per 10,000 population is significantly lower than the state rates. Health Resource Availability: Licensed Professionals per 10,000 Health Resource Madison County New York State Physicians 13.8 34.0 Physician Assistant 5.3 3.9 Dentists 4.4 7.9 Podiatrists 0.1 1.1 Optometrists 0.9 1.3 Pharmacists 7.5 8.7 Licensed Practical Nurse 135.0 106.5 Licensed Registered Nurse 74.3 33.5 Licensed Advanced Registered 9.5 6.5 Occupational Therapists 3.4 4.4 Physical Therapists 8.5 7.5 Source: NYSDOH Maternal & Child Health Care Madison County Early Prenatal Care & Late/No Prenatal Care Percent of Live Births 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1998 1999 2000 MC-Early PNC Source: NYSDOH 2001 2002 2003 NYS 2004 2005 2006 MC- Late/No PNC 79 2007 NYS Prenatal Care Early prenatal care, i.e., women who began prenatal care within the first three months of pregnancy (first trimester), for Madison County between 2005 to 2007 averages 80.6 per hundred live births, while the CNY Region averages 76.5 per hundred, and New York State averages 74.6 per hundred during the same period. However, from 1998 to 2007, Madison County 2010 – 2013 Community Health Assessment Report prenatal care during the first trimester of pregnancy has decreased from 83.8 to 80.1 per hundred births in Madison as shown in the chart above. The Healthy People 2010 goals state that 90% of live births should receive prenatal care during the first trimester. For women who did not receive prenatal care until the third trimester, or not at all, the average for Madison County between 2005 to 2007 was 4.5 per hundred live births, compared to the CNY Region average of 3.9 per hundred, and the New York State average of 5.1 per hundred during the same period. Since 1998 the percent of women in Madison County receiving no or late prenatal care has increased from 2.7, in 1998, to 4.9 in 2007. There are two Prenatal Care Providers (a.k.a. PCAP) in Madison County, Oneida Healthcare Center and Bassett Healthcare. The PC providers offer comprehensive prenatal care services to women and teens that live in New York State and meet eligibility income guidelines (up to 200% of the federal poverty level). Health care is provided to the woman for at least two months after delivery and to the baby for up to one year. Women who utilized Bassett Healthcare prenatal services and are now ready to deliver will need to go to Cooperstown, outside of Madison County. Community Memorial Hospital in Hamilton, which served southern Madison County, announced that it will discontinue its Maternity services effective September 1, 2009, leaving Oneida Healthcare Center as the only provider of maternity services within Madison County. Medicaid Obstetrical Maternal Services (MOMS) The MOMS program was created in 1992 to provide health supportive services for Medicaid eligible women that had no PCAP program available in their area. The Madison County Department of Health (MCDOH) administers the MOMS program in Madison County. Medicaid eligible woman are enrolled in MOMS through the MCDOH and linked to community based agencies that provide health supportive services and education on all aspects of their pregnancy and postpartum period. The MOMS program provides a client access to prenatal care in the private physician’s office. The MOMS program offers Madison County residents the availability to seek care with physicians that deliver at Oneida Healthcare Center, St. Joseph Hospital, Crouse Hospital and Community General Hospital. Between 2005 and 2008 number of clients enrolled in MOMS has increased from 106 to 128, with a high of 174 in 2007. In addition, during this same time period, the number of providers that accept the MOMS program has increased from two (2) in 2005, to six (6) in 2008. Women, Infants & Children (WIC) Participation Participant Estimated WIC Eligible March 2009 Participation % Eligible Served Women 1167 423 36% Infants 700 439 63% Children 2075 1002 48% Total 3942 1864 47% Source: NYSDOH Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Planned Parenthood of Mohawk-Hudson administers the WIC program in Madison County with their main office in the City of Oneida. WIC services are provided throughout the county at various locations. WIC services are available Monday-Friday 8am-3:30pm, with three late clinics available from 11:30-7pm each month. There is no fee for services. Participation in Medicaid confers eligibility for WIC. WIC serves Infants, children between 2 and 5 years old, pregnant women and new mothers. The program provides infants, children, and pregnant and postpartum women with nutritional counseling, support, and education. To be eligible for the WIC program, participants must meet or fall below the 185% 80 Madison County 2010 – 2013 Community Health Assessment Report of the United States Poverty Income Guidelines, which is currently an annual income of $40,793 for a family of four persons. Participants must also provide proof of NYS residency and show identifiable nutrition risk. As depicted in the chart below, less than half of those eligible for WIC services participate in the program. Early Intervention Program The Early Intervention Program is a state mandated program, administered by the Madison County Department of Health that provides services to infants and toddlers (0-2 yrs old) with disabilities. To be eligible for services, children must be less than 3 years of age and have a confirmed disability or established developmental delay, as defined by the State, in one or more of the following areas of development: physical, cognitive, communication, social-emotional, and/or adaptive. The EI program offers a variety of therapeutic and support services to eligible infants and toddlers with disabilities including: family education and counseling, home visits, and parent support groups nursing services special instruction nutrition services speech pathology and audiology social work services occupational therapy vision services physical therapy assistive technology devices and services psychological services service coordination The number of children served through the EI program demonstrated a decrease (23%) between 2004 and 2007. However, a significant increase (95%) in the number of children served (from 101 in 2007 t0 195 in 2008) was observed between 2007 and 2008. Education and Transportation of Handicapped Children (Pre-K) The Education and Transportation of Handicapped Children Program is a state mandated program that provides special education service to three and four year old children with disabilities according to provisions under Section 4410 of the New York State Education Law. Administered by the Madison County Department of Health, services are provided to children include special education center-based programs or itinerant related services such as speech, physical, and occupational therapies along with a special education itinerant teacher and transportation. Referral and approval for services are made through each child’s school district’s Committee on Pre-School Special Education (CPSE). The number of itinerant and center-based services has increased each year from 2004 to 2008. Physically Handicapped Children’s Program The Physically Handicapped Children’s Program (PHCP), administered by the Madison County Department of Health, serves children birth to 21 years of age who have a handicapping condition or chronic illness, such as heart problems, orthopedic conditions, asthma, cancer, blood disorders and handicapping dental conditions. If the child’s condition falls within the scope of the program, and the family is financially eligible, PHCP can then assist with paying for the treatment of the child’s specific condition. Services that are covered include office visits, surgery, orthopedic appliances, outpatient lab work, x-rays, and other needed tests and medications. Between 2004 and 2008, the number of children served has decreased from 157 (2004) to 88 (2008), representing a 44% decrease. This decrease is due mainly to more children with insurance coverage, because of expanded eligibility in Child Health Plus and Medicaid. Therefore they are going to the providers directly as opposed going through the County’s program to link to providers. In addition, there appears to be an overall lack of knowledge of about the PHCP program. 81 Madison County 2010 – 2013 Community Health Assessment Report Clinical Preventive Services Eleven Article 28 Diagnostic and Treatment clinics are located throughout Madison County, providing primary care services to people of any age, weekdays from 8:30 to 5:00. All clinics accept Medicare, Medicaid, Child Health Plus, Family Health Plus, private insurance and self pay. All have a sliding fees scale available based on income. Most provide some level of charity care for clients who are unable to pay. One clinic indicated that although it does not provide charity care they do provide free samples of medication to those who are unable to pay. There are no urgent care facilities in Madison County. Local data indicates that the use of clinical preventative services is below the Health 2010 target among adults for immunizations, i.e., 60 percent for both flu and pneumonia vaccinations for adults aged 18 to 64 years, and 90 percent for both for adults 65 years and older. According to the expanded 2008 BRFSS, 42.1percent of adults 18 – 64 years of age in Madison County received a flu shot or flu vaccine sprayed through the nose within the past 12 months, slightly higher than the state (41.7%). Madison County adults aged 65 and older were the most likely to have received this vaccine; with 64.1percent indicating that they had a flu shot within the past 12 months. The percentages for the pneumonia vaccine is even less among adults 18 to 64 years of age; 30.0 percent of adults 18 to 64 have had this vaccine, while 71.3 percent of those over 65 years of age receiving it. For women age 40 and older in Madison County, 89 percent indicated that they had a mammogram within the last two years. This percentage significantly exceeds both the percentage for New York State (77.9%) and HP 2010 (70%). Conversely, 79.5 percent of Madison County women aged 18 years and older have had a Pap test within the past three years compared to New York State (83.8%) and HP 2010 (90%). Selected Clinical Service Indicators – Madison County Madison County New York State Healthy People 2010 42.1 41.7 60.0 30.0 25.8 60.0 % had Mammogram within the past 2 yrs among women age 40 and older 89.0 77.9 70 % women 18 and older who had a Pap Test with the past 3 yrs 79.5 83.8 90 % men age 40 and older who had a digital rectal exam within the past 2 yrs 62.1 54.9 NA % of men age 40 and older who had a prostate specific antigen test within the past 2 yrs. 54.6 58.7 NA 71.6 64.3 50 72.4 78.4 NA 80.8* 82.8 NA Indicator % adults 18 – 64 who had Flu shot or Flu vaccine sprayed in nose within the past 12 months % adults 18-64 who had Pneumonia shot or Pneumococcal vaccine % of adults age 50 and older who had a sigmoidoscopy or colonscopy within the past 10 years % of adults who had their blood cholesterol checked within the past 5 years % of children with at least one lead screening by age 36 months Source: NYSDOH Expanded BRFSS Interim Report – Madison County, 2008 82 *2004 data Madison County 2010 – 2013 Community Health Assessment Report For men age 40 and older in Madison County, 79.5 percent indicated that they had a digital rectal exam within the last two years. This percentage exceeds the percentage for New York State (54.9%). Conversely, 54.6 percent of Madison County men aged 40 years and older have had a prostate specific antigen test within the past two years compared to New York State (58.7%). A significantly higher percentage of Madison County adults age 50 and older have had either a sigmoidoscopy or colonoscopy within the past 10 years (71.6 percent), compared to New York State (64.3%) and Healthy People 2010 target of 50 percent. The percent of adults in Madison County who had their blood cholesterol checked within the past five years (72.4%) is lower than the NYS (78.4%). Likewise, 2004 data indicates that 80.8% of children in Madison County had at least one lead screening by age 36 months compared to 82.8 percent for children of the same age group across New York State. In 2007, the Madison County Department of Health conducted immunization assessments in local provider’s offices and the county’s immunization clinic to determine the proportion of children two years of age who have been fully immunized. Through provider chart audits approximately 25 percent of the two year old population was surveyed. The results indicated that 76 percent of children were fully immunized by two years of age for Tdap, polio, MMR, Hib and hep B vaccines. The Healthy People 2010 goal is 90 percent immunization rates for individual vaccines and 80 percent for the vaccine series for children two years of age. Immunization rates for children in Madison County increase by the age of five due to school mandates. The Department of Health’s Immunization program provides information on the proportion of children entering school that are fully immunized. Immunization rates for children have been consistently high and stable (around 98% of children entering kindergarten are completely immunized). School- Based Health Program There is one School-Based Health Centers (SBHC) in Madison County at De Ruyter Central School that provide vital primary and preventive services for students or their families; the School-Based Health Centers provides comprehensive primary health care services (including mental and dental health). Madison Central School is currently going through the process to establish a school based health center. Oneida Indian Nation Health Department. The Oneida Indian Nation Health & Human Services Department provides direct primary and preventive medical, dental, behavioral health and community health services to American Indians living in central New York, and referrals to off-site providers for services not available at the Oneida Nation Health Center on the Oneida Nation Territory or at its Behavioral Health Services sites in Oneida and Syracuse. Services are available Monday through Friday by appointment and include the following: Information and education regarding health and wellness Age-appropriate health maintenance services Triage and assessment of presenting problems Diagnosis and treatment of common health problems Identification and management of chronic disease Ordering and interpreting laboratory tests Ordering, conducting and interpreting diagnostic tests Dental examination, prophylaxis, oral hygiene instruction, oral health education Fillings, anterior endodontic (root canal), routine extractions, periodic screening, pediatric dentistry, soft tissue evaluation and biopsy Crowns, partials, and complete dentures to qualified patients with excellent oral hygiene Comprehensive behavioral health assessments Individual, family and group counseling Crisis intervention Client and family advocacy Case management Psychiatric management of psychotropic medications Aftercare 83 Madison County 2010 – 2013 Community Health Assessment Report Promotion of self-help and support group activities Community health outreach Outreach, case finding, screening, and patient monitoring Patient advocacy Home and hospital visits Processing orders for durable medical equipment Medical nutrition therapy Nutrition/exercise counseling Goal-setting/lifestyle adaptation counseling Patient, family, caregiver and group education Community-focused health promotion and disease and injury prevention activities Activities for special populations, such as elders and youth Activities promoting home and traffic safety, including car seat and bicycle helmet programs Water quality testing Emergency preparedness planning Youth development programming Referrals to appropriate providers for types or levels of care not available within the Health Department Transportation Coordination of client services 84 Madison County 2010 – 2013 Community Health Assessment Report Other Non-Hospital-Based Health Clinics Planned Parenthood Mohawk Hudson, Inc. located in Oneida, NY provide various health services for men and women including HIV testing, STD testing and treatment, and health screening exams (e.g., annual exams, breast exams, Pap tests, cervical cancer screening). Their services are available 8:00 am to 6:00 pm Monday thru Wednesday, and Fridays. Free services are available to people who qualify. Emergency Services Emergency Medical Services (EMS) Madison County pre-hospital emergency medical services are provided by a combination of career and volunteer agencies. Responses to medical emergencies are delivered in a tiered type response, generally the closest basic life support (BLS) agency responds to the emergency followed by an advanced life support (ALS) ambulance. The county is divided into districts, with assigned fire/ambulance agencies responsible for responses in those areas. Public access automatic external defibrillators (PAD sites) are located at various sites throughout the county and have enhanced emergency care in Madison County. Patients requesting EMS in Madison County are routinely transferred to Emergency Departments within and adjacent to the County. Recent trends demonstrate an increase in service requests to transport mental health patients to designated “939” hospitals located outside of Madison County. Previously, such transportation services were provided by other agencies, e.g., law enforcement. As a result, the increased use of ambulance services to transport mental health patients has affected EMS coverage in the County. When an ambulance service is transporting a mental health patient out of county, the other ambulance services need to cover the area assigned to the transporting ambulance. EMS Providers by Level of Care – 2009 Provider Number Advanced Providers (Certified) Paramedic 29 Critical Care 24 Intermediate 5 Basic Providers Certified First Responder 26 Basic EMT 199 Source: Mid-State EMS, August 2009 Currently there are twelve ambulance services and sixteen non-transporting first response services located in Madison County. Eighteen agencies are a Basic First Response Agency; seven are Paramedic Agencies, with one Critical Care Agency. A breakdown of the EMS providers is as follows: Madison County ambulance services are certified by the NYS Department of Health and are authorized to provide ALS service. Pre-hospital Emergency Medical Services are coordinated through the state appointed Resource Hospital, Faxton-St. Luke’s Healthcare located in Utica. Madison County has E911access in place, which allows EMS staff to identify the calling number and their address. Since April of 2005, the dispatchers of Madison County provide callers who have medical emergencies with Emergency Medical Dispatching. These nationally accepted protocols, from the National Academy of Emergency Medical Dispatchers, are used to gain further information for responding EMS agencies. The dispatchers can also assist the lay person with performing Cardiopulmonary Resuscitation and even the birth of a child. The Upstate New York Poison Center Located at Upstate Medical University in Syracuse, the Upstate New York Poison Center serves a 34 county area including Madison County. The Center assists the medical community and general public 85 Madison County 2010 – 2013 Community Health Assessment Report with poison emergencies by providing state of the art management expertise. Calls are answered by Specialists in Poison Information (SPIs), registered nurses trained in toxicology who provide efficient and up-to-date poison information. Physicians and toxicologists are on-call 24 hours a day for consultation purposes. Each year the center receives over 50,000 calls from health care providers, 911 operators, hospitals, industry, schools, and the general public throughout 34 county service area. Of these calls: 85% are unintentional poisonings 62% involve children under age 5 26% are for information only 82% can be managed over the phone and do not require a visit to a doctor and/or a hospital Hospital Based Emergency Departments Federal law requires Emergency Departments to evaluate anyone seeking care and to at least stabilize the most severely ill and injured patients. Additionally, the EDs provide walk-in care for a number of individuals seeking care. In Madison County, approximately ninety percent (90%) of visitors to the ED receive their care in the ED, with the remaining ten (10%) receiving their initial care in the ED and then moved to inpatient for further care. In 2006, there were 30,699 visits to the EDs in Madison County (Oneida Healthcare = 20,187 and Community Memorial = 10,512). Of those visits sixty-five percent (65%) were illness-related, while the remaining thirty-five percent (35%) were the due to injury. Secondary & Tertiary Care Madison County is home to two hospitals; Oneida Healthcare Center and Community Memorial Hospital. As of 2007, there are 141 licensed beds in Madison County; Oneida Healthcare Center – 101, and Community Memorial Hospital – 40. The number of licensed beds per 10,000 population is considerably lower in Madison County (20.2) compared to New York State (32.0). According to the NYSDOH Inpatient Data for 2006, 7011 Madison County residents were hospitalized. Health Resource Availability: Licensed Beds Health Resource Madison County New York State Licensed Beds per 10,000 Hospital Beds 20.2 32.0 Licensed Beds per Hospital Oneida Healthcare 101 Community Memorial 40 Source: NYSDOH Hospital Profiles, 2007 Approximately 54 percent of the residents were hospitalized out of the county. Of the total number of hospitalizations within the County (6456) half were Madison County residents and half were nonresidents. Oneida Healthcare Center (OHC) located in the northeastern portion of Madison County, serves an area comprised of approximately 24 communities in Madison and western Oneida counties with a population of about 80,000 from its main campus in the city of Oneida. In addition OHC operates primary health centers in the villages of Canastota and Chittenango; a maternal/child clinic at the Northside Health Center in Oneida; four outreach laboratory draw stations in Oneida, Chittenango and Camden; and a rehabilitation & wellness center in Oneida. Oneida Healthcare Center is a full service community hospital offering a complete range of health services. In 2007, OHC had 3,900 inpatient visits, approximately 133,000 outpatient visits and procedures, 22,000 emergency room visits, 160 skilled nursing facility residents, and 567 deliveries in their maternity unit. To better accommodate the already-outstanding services provided by Oneida Surgical Group and other surgical specialties, OHC is set to unveil four new state-of-the-art operating rooms in the fall of 2009. 86 Madison County 2010 – 2013 Community Health Assessment Report Community Memorial Hospital located in the in Southern Madison County, serves a population of 45,000 people in 27 communities throughout Madison County and the eastern sections of Onondaga County as well as parts of Chenango and Oneida Counties. In 2006 the hospital admitted 2,511 patients, treated 11,517 patients in emergency services, and had 26,807 patient visits to the five hospital-owned Family Health Centers. The Skilled Nursing Facility at Community Memorial, a 40-bed unit attached to the hospital, is home to several residents and post-surgical rehabilitation patients. The Hamilton Heart Center, Community Memorial Hospital provides cardiology care including non-invasive diagnostic testing. Community Memorial Hospital provides primary care, orthopedic surgery, same day surgery, skilled nursing facilities for the elderly and convalescing patients, and a complete roster of diagnostic testing and ancillary services. Today there are 11 surgeons and the number of annual procedures has risen to 2,400. To meet this need, the hospital has doubled the size of its operating room area. The hospital has also added an ambulatory surgery center, to help streamline procedures that do not require overnight hospitalization, such as knee arthroscopy and cataract surgery. The addition of two new operating rooms means total joint replacements can be performed simultaneously. Hospitalization Data 7011 8000 6456 7000 Number of Hospitalizations 6000 5000 3784 3227 4000 3229 3000 2000 1000 0 Total County Hospitalizations Total County Residents Total Madison ResidentsTotal Madison Residents Total Non Residents Hospitalized Hospitalized In County Hospitalized Out of Hospitalized in County County Source: NYSDOH SPARCS Inpatient Data 2006 Residents of Madison County are also within easy travel distance to two larger medical centers: Syracuse and Utica/Rome. In addition to hospitals in the county, specialty care services are provided by nearby hospitals. Some of these service areas, as well as other areas of special focus are as follows: AIDS: SUNY Upstate Medical Center has been designated as an AIDS Care Center. The Designated AIDS Center (DAC) provides outpatient and inpatient medical care for HIV infected people from the 15 county Central New York area. The DAC is staffed by Infectious Disease physicians, nurse practitioners, registered nurses, and licensed social workers. Patient care is provided through a medical case management model with the nurse practitioner as case manager. The DAC accepts all insurances that University Hospital currently participates with including Medicaid, Medicare, ADAP Plus, Family Health Plus and commercial insurances. HMO insurance may require prior approval from the patient's primary physician for treatment at the DAC. 87 Madison County 2010 – 2013 Community Health Assessment Report Cardiac: The Mohawk Valley Heart Institute is a cooperative venture of Faxton-St.Luke’s Healthcare (FSLH) and St. Elizabeth Medical Center. MVHI provides cardiac surgery and coronary angioplasty, cardiac catherizations, and rehabilitation services. Stroke: There are two designated Stroke Centers that serve the region- SUNY Upstate University Hospital in Syracuse (Onondaga County), and Faxton-St.Luke’s Healthcare in New Hartford (Oneida County). Perinatal: One hospital (SUNY Upstate University Hospital) serves as the regional perinatal center. Faxton St. Luke’s Hospital provides a Level II nursery, which helps parents to access a higher level of care. Infants who need Level I care are sent to the Perinatal Center at Crouse-Irving Hospital in Syracuse. Trauma: SUNY Upstate University Hospital is Central New York's only Level I Trauma Center serving the 14 counties stretching from Canada to the Pennsylvania border. St. Elizabeth's Medical Center is a Level II Area Trauma Center. Injury Prevention is a major focus of the Trauma Department. The St. Elizabeth Trauma Center spearheads injury prevention education and programs aimed at senior citizens Burn Center: The Clark Burn Center at SUNY Upstate University Hospital, is a four-bed Intensive Care Unit that is a regional referral center providing state-of-the-art burn care. The Clark Burn Center serves over 27 counties from as far north as the St. Lawrence River to the southern borders of New York State, and from Rochester to Albany, including the northern areas of Pennsylvania and parts of Canada. The Center cares for both adult and pediatric patients in the inpatient and outpatient settings. Cancer: Faxton/St. Luke's Hospital operates the Cancer Center and provides access for outpatient cancer care with state-of-the-art equipment, advanced technology, inpatient oncology unit, and skilled staff with specialized training in Cancer care. SAFE Site: SUNY Upstate University Hospital is a designated SAFE site in the central New York region. SUNY provides sexual assault services modeled upon the State's trauma centers. University Hospital is currently the only hospital designated as a SAFE Center of Excellence in Onondaga County. University Hospital has a contract with Vera House, Inc. to provide SAFE services. These services include: 12 Sexual Assault Nurse Examiners (SANE's) are trained and available to respond to sexual assault victims in Onondaga County Of the 158 victims of sexual assault seen by SANE in Onondaga County in 2006, 105 were seen at University Hospital Oneida Healthcare Center in Madison County currently has two SANE-trained nurses on staff. Long-Term Care & Rehabilitative Services Home Care Services Home health care continues to be the fastest growing component of personal health care spending. It is expected to grow an average of 7.7 percent per year from 2007 to 2017. The Madison County Health Department operates the county’s only CHHA and a Long Term Home Health Care Program (LTHHCP) providing home care services to clients throughout Madison County. Under Article 36 of the NYS Public Health Law, a Certified Home Health Agency (CHHA) must provide nursing services, home health aides, medical supplies and equipment, and physical, speech and occupational therapies. The CHHA provides skilled nursing, home health aide, physical, occupational and speech therapies, medical social work, and nutrition counseling to populations ranging from newborn to the elderly. Home care services are accessible 24 hours per day/7 days per week for both acute and chronic health care 88 Madison County 2010 – 2013 Community Health Assessment Report problems. The MCDOH adult client unduplicated census for the CHHA for the first half of 2009 was 550 and 104 for Maternal Child Health. The Long Term Home Health Care Program (LTHHCP) serves clients with complex needs who would otherwise require skilled nursing facility placement. Services provided include nursing, therapies and waived services. The LTHHCP client unduplicated census during the first half of 2009 was 50. Madison County DOH provides tele-monitoring functions as a supplementary component for assessing, planning and implementing patient care in day to day situations. This is especially helpful with rural populations, where accessibility becomes a factor in making patient visits. Madison County Department of Health Patient Services Division has the capacity for 20 tele-monitors. Eight monitors are presently in use primarily for patients with chronic diseases such as COPD, coronary artery disease and CHF. Presently, the use of monitors for MCH patients is being explored for monitoring women with high risk pregnancies. In accordance with Section 763.11 (a) (11) of Title 10 of the New York State Compilation of Codes, Rules and Regulations, CHHAs must provide charity care in each fiscal year in an amount no less than twopercent of the total operating costs of the agency for private agencies and three and one-third percent for public agencies. Charity care is provided at no cost or reduced charge for those without insurance and with incomes less than 200% of the federal poverty level. The CHHA does serve the hard-to reach population and poses no financial barrier by accepting private health insurances, Medicaid, Medicare and offering services on a sliding fee scale. Nursing and Adult Homes There are four nursing homes within Madison County; Oneida Healthcare Center Extended Care Facility, Community Memorial Hospital NH Unit, Crouse Community Center, and Stonehedge Health and Rehabilitation Center with a certified bed capacity of 400. This equates to approximately 57.4 nursing home beds per 10,000 population, somewhat slightly lower than the State rate of 61.2 per 10,000. Health Resource Availability: Certified Beds Health Resource Madison County New York State Certified Beds per 10,000 Nursing Home Beds 57.4 61.2 Certified Beds per Facility Community Memorial 40 Crouse Memorial 120 The Oneida Healthcare Center Extended Care Facility (ECF) provides long term 160 extended care and rehabilitative services to Oneida Healthcare Residential = 149 the Greater Oneida Community. The total Ventilator Dependent = 11 number of certified beds is 160; 149 skilledStonehedge 80 nursing/restorative and 11 ventilatordependent beds. The ECF provides an array Source: NYSDOH of services that includes restorative and maintenance therapies (Physical, Occupational, Speech, Recreational and Massage Therapies). Admissions to the ECR are based on medical necessity. Criteria for admission are based on the level of care needed by the applicant and the ability of the facility to meet all of the applicant's needs. Priority for admission to the facility is given to those residents who are inpatients at the Oneida Healthcare Center's Acute Care Hospital who are awaiting transfer to a long term/rehabilitative nursing facility. The facility does incur situations where there is a vacancy for which there is not an applicant currently in the Oneida Healthcare Center's Hospital. During these situations, the Admissions Coordinator and Screening Nurse will assess applicants in other hospitals, nursing facilities, or at community residences to offer the vacancy to the applicant who is in greatest need of the facility's services. The ECF accepts Medicare, Medicaid, and Private-Pay residents and currently has a contract with Hospice Care, Inc., of New Hartford, New York. 89 Madison County 2010 – 2013 Community Health Assessment Report Community Memorial Hospital Skilled Nursing Facility in Hamilton is a 40-bed unit attached to the hospital, and is home to several residents and post-surgical rehabilitation patients and provides baseline services. Crouse Community Center, a 120 certified bed facility is centrally located in Morrisville providing baseline services. Stonehedge Health and Rehabilitation Center, an 80 bed certified facility is located in Chittenango serving the northwestern section of Madison County. Mental Health Services Madison County Mental Health Department The Madison County Mental Health Department is an umbrella agency that encompasses several programs that work together to provide comprehensive services to Madison County residents of all ages. Under the NYS Mental Hygiene Law Madison County has created a Community Services Board (CSB) to act as the local government unit in providing planning implantation and oversight of certified programs of care in the County. The CSB has responsibility for services provided by the Mental Health Department and the other agencies identified. Mental Health Clinic: The Outpatient Clinic provides the single entry point for persons requesting any type of Mental Health services. This program is divided into four service units - Adult, Children and Youth, Crisis, and Forensic Services. The Clinic provides emergency mental health services and coordinates the Department's 24-hour crisis line. Crisis intervention may range from one contact with a distressed person, to several psychotherapeutic sessions with the person and family members. The Outpatient Clinic provides regularly scheduled assessment and treatment for on-going mental health problems. Services may include verbal therapy, medication management, skills training, and psycho-educational modules. Psychotherapy is available to individuals (of all ages), families, couples, and groups at the Wampsville office. Contracted consultation services are also provided to areas BOCES, Cazenovia and Chittenango Schools and Head Start programs. Fees are set on a sliding scale according to household income. Fees can range between $10 per visit and $150 dollars per visit. Payment plans can be arranged by special request. Medicaid, Medicare, and most health insurance plans are accepted. Crisis Services: The Mental Health Department offers a 24-hour crisis line. Callers can access a clinic staff member at anytime. The Crisis Line also provides information and referral services from 9AM-5PM. Crisis workers are available on site at the Mental Health Department from 9AM-5PM and by telephone from 5PM-9AM to deal with emergency situations. Individuals are also seen at the office on an emergency walk-in basis. Crisis workers also go to area hospitals, jails and schools when necessary for emergency mental health assessments. Crisis Services are provided at no cost to the client. Inpatient Services: Madison County does not have any inpatient psychiatric hospitals. Most inpatient referrals are made through CPEP, the Comprehensive Psychiatric Evaluation Program, located at St. Joseph’s hospital in Syracuse. A person referred to CPEP would be evaluated to determine the need for inpatient treatment and CPEP would facilitate the admission process into one of the several area hospitals. These hospitals include St. Joseph’s, Benjamin Rush, Community General, Hutchings Psychiatric Center and SUNY Health Sciences Center in Syracuse, and St. Luke’s and St. Elizabeth’s in Utica. Psychiatry Services: Many clients may require medication to help manage their symptoms and restore their ability to carry out daily activities. Madison County Mental Health Department employs several parttime Psychiatrists to address this need for both children and adults. Psychiatry referrals are received through the regular intake process. Day Treatment Services: Cedar House Cedar House is a continuing day treatment program using a psycho-social clubhouse model. Day Treatment services provide socialization and prevocational services to Madison County residents with 90 Madison County 2010 – 2013 Community Health Assessment Report severe mental illness. Members may be returning to the community from long or repeated stays in psychiatric hospitals or may attend in order to prevent hospitalization. Cedar House provides a track for individuals who have co-occurring disorders of substance abuse and mental health. The program provides individual, family, and group treatment when indicated; coordination with other social and vocational agencies; and a medication clinic. Madison County ARC (Alternatives, Resources, and Choices) The Madison Cortland ARC provides services to individuals with developmentally disabilities. Preschool programs, prevocational/vocational training, community residences, family support services, service coordination, respite care, and a sheltered workshop are their main services. Liberty Resources Liberty Resources is a private, not-for-profit agency that provides an array of services that include supervised residences where skills are taught in the activities of daily living, case management, children and youth life enhancement, and other supportive services. Liberty Resources provides services to individuals and families with developmental disabilities, problems with alcohol and other substances, and mental health issues. Its tax-exempt status allows Liberty Resources to seek charitable contributions from interested benefactors. Heritage Farm Heritage Farm provides a family farm setting for prevocational activities, income-producing work, and supportive services to individuals with developmental disabilities and their families. They are a not-forprofit group under contract to the Mental Health Department in addition to accepting charitable contributions. BRiDGES BRiDGES provides advocacy services, establishes educational and referral services such as Employee Assistance Programs, and operates the County Drinking Driver Program. Under contract to the Mental Health Department, BRiDGES main purpose is public awareness, intervention, and education. Consumer Services of Madison County, Inc. Consumer Services of Madison County, Inc. is a private not-for-profit agency that provides the following services: Both intensive case management (ICM) and supportive case management (SCM) resources for children with emotional and behavioral problems Coordinated children’s services initiative (CCSI) which is a program that also works to provide community based resources for children with emotional and behavioral problems. This service provides peer supports to parents, flexible fund dollars, advocacy and parent support groups A Peer Specialists to provide community based support services to the seriously and persistently mentally ill adults in Madison County The only agency in Madison County currently accepting new referrals for a representative payee services for SSI Care-Free Drop-In-Center Early Education Intervention CSMC Food Services 91 Madison County 2010 – 2013 Community Health Assessment Report Dental Health Services There are three dental providers within Madison County accepting Medicaid. Bassett Healthcare Dental serves the southeast section of the county and accepts all forms of payment including a sliding fee scale. Sitrin Oneida Dental Clinic serves the northeast section of the County accepting Medicaid only clients. The third clinic is Morrisville Dental Clinic located in the central region of the County. Dentistry – Registered Licenses 2008 Type Dentists Dental Hygienist Certified Dental Assistant # Registered 31 69 4 There are thirty-one dentists, sixty-one dental hygienists, and four certified dental assistants are licensed in Madison County. Although Madison County is not designated a health professional shortage area for dental health, there are parts of the County that lay outside the normal dental coverage area specifically in the south-central and southeastern sections (see map below). Source: The Commission for a Healthy Central New York, June 2007. http://www.upstate.edu/healthycny/dental.php Community Assessment Access to affordable healthcare services is a priority concern for Madison County residents as identified in community surveys and forums: this issue ranked among the top health issues facing the community in a Zogby Survey of 400 Households in Madison County. It was also dominant theme in the 2008 Visioning and Forces of Change Session attended by representatives from the local public health system. According to the 2008 Zogby survey, most respondents said that access to health care and other services has a positive impact, and two-thirds agree they have better access to health care services today 92 Madison County 2010 – 2013 Community Health Assessment Report compared to ten years ago. Generally speaking, about half said their health is about the same as it was ten years ago, while a third said it is worse than it was ten years ago. Access to health care and other services (21%) represents one of the top the three things cited as positively impacting a person’s health in Madison County. Men (25%) are more likely than women (18%) to think access to health care and other services is one of the three things that positively impact a person’s health in Madison County. College graduates are more than twice as likely as high school graduates to think a lack of access to available health care (20% vs. 9%) is among the greatest potential risks to a person’s health in Madison County. The survey further revealed that when looking for medical/health information, two-thirds (67%) say they most often turn to a medical provider, while more than a third (35%) say they turn to family and friends most. A fifth each say they most often turn to the Internet or blogs (22%) or the Madison County Health Department (20%). College graduates (39%) and women (27%) are more likely to say they most often turn to the Internet or blogs when looking for medical/health information than men (16%) and high school graduates (11%). A majority across most demographic subgroups say they would not likely access their medical records electronically through a secure Web site, with the exception of college graduates, as more than half (54%) say they would likely access their records. Disparities in Accessing Care Improving access to appropriate preventive care requires addressing many barriers. Many of these disparities relate to affordability, accessibility, and availability. Three common barriers include: financial, structural, and personal. Financial Barriers Lack of Insurance/Limited Coverage /Cost: The percent of adults (age 18 and older) without health care coverage remained relatively stable with 13.8 percent uninsured in 2003 compared to 14 percent in 2008. Health insurance is defined as having no kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare. In Madison County; men, individuals under the age of 35, individuals with less than or equal to a high school education, and those having an annual income under $50,000 are less likely to have health insurance coverage According to the 2007 Census Bureau’s Current Population Survey, an estimated 7percent (1,169) children under the age of 19 years of age are uninsured. The estimate for NYS is 9.2 percent. In Madison County having an annual income under $50,000 are less likely to have health insurance coverage. According to the 2009 Expanded Interim BRFSS Report, 11.0% (5,898) of Madison County adults aged 18 and older reported that cost prevented a visit to a doctor within the last year. This is lower than the 12.6% reporting the same for all of NYS. In Madison County, 3.4 percent of adults 65 and older surveyed reported that cost prevented a visit to a doctor within the past year with 4.9% reporting the same for NYS. Although a portion of these individuals are Medicare beneficiaries, they may not be able to afford supplemental insurance to pay for needed services not covered by Medicare Part A, including high cost prescription drugs. Some Medicare beneficiaries are able to cover these costs through private insurance plans; however, those that lack this type of coverage are not likely able to afford the considerable expense of out-of-pocket costs for supplemental insurance plans including deductibles and co-pays. In 2005, 13.8 percent of children in Madison County under age 18 were at or below poverty. In 2008, the CHPlus income eligibility threshold increased from 250 to 400 percent of the federal poverty level which should increase access to insurance coverage for vulnerable low-income children. 93 Madison County 2010 – 2013 Community Health Assessment Report Due in part to the continual and substantial increases in insurance premiums, co-pays and deductibles, many working family members cannot afford, or are not offered, employer-sponsored insurance as contributions for health insurance have substantially increased for both employee and employer. The likelihood of being uninsured decreases as income rises; not surprisingly then the uninsured tend to fall in the lower income brackets of the population despite public programs that serve these vulnerable populations. Lower income adults have less of a safety net in public programs than children do as adults, and adults without dependent children have more restrictions for eligibility and limited coverage. Studies show that when health insurance coverage is disrupted, children are more likely to have an unmet need for care, receive delayed care, and go without prescription drugs in comparison to those with uninterrupted health insurance coverage. In December 2006, New York State took a step toward achieving parity in mental health benefits for New Yorkers with the passage of “Timothy’s Law” (Chapter 748 of the Laws of 2006, as amended by Chapter 502 of the Laws of 2007). Timothy’s Law requires that, as of January 1, 2007, insurers issuing group or school blanket health insurance policies or contracts in New York must include certain minimum mental health benefits and coverage levels. Generally, for mental, nervous or emotional disorders, insurers must offer inpatient care of not less than thirty days per year and outpatient care of not less than twenty visits per year at the same cost sharing limits as applicable to other health coverage plans (the “30/20 benefit”). Timothy’s Law further requires that large group policies or contracts (over 50 employees) and school blanket policies also provide additional coverage above the basic 30/20 minimum benefit levels for treatment of adults and children with biologically based mental illnesses (“BBMI”) and for treatment of children with serious emotional disturbances (“SED”). The added level of BBMI/SED coverage is not required in small group policies or contracts (50 or fewer employees), but insurers are required to offer it on a “make available” basis (i.e., if requested by a small group purchaser). The premium cost to small employers for the 30/20 benefit is fully subsidized by an appropriation from the State’s General Fund. The BBMI and SED “make available” benefits are not subsidized. Unless extended, Timothy’s Law sunsets on December 31, 2009. Medicaid Although pubic insurance programs like Medicaid provide medical and some dental care coverage for adults and children with low socioeconomic status there are additional barriers related to provider acceptance of Medicaid. A significant number of providers do accept Medicaid due to low reimbursement rates. Shortages of providers compounded with a limited number that will accept Medicaid create disparities for the publicly insured. This limited provider base makes Medicaid patients more likely to use outpatient hospital services, emergency rooms and health clinics. A smaller pool of providers can create even more access barriers, including long wait times, difficulty making appointments, and having to travel longer distances to receive care The Madison County Department of Social Services reported that caseloads in the Medicaid unit increased in 2008. Beginning in January there were 3,877 cases. This number increased to a high of 4,241 in November before leveling out to 4,160 by the end of the year. According to the NYSDOH, the total monthly average number of Medicaid eligible individuals in Madison County increased from 9,141 in 2004 to 9,911 as of April 2009, representing an 8 percent increase over this time period. However, within this same time period the average number of beneficiaries for Family Health Plus in Madison County decreased from 1,075 in 2004 to 813 as of April 2009, representing a 24percent decrease over this time period. There are three dental providers within Madison County accepting Medicaid. A fourth dental clinic, Crouse Community Dental recently closed. The ability to pay for dental care is a barrier to receiving care for many children from low-income families. For all underserved children in the area, there is a shortage of providers of dental services. It appears that few dental practices see Medicaid and Child Health Plus and uninsured children that are in any way comparable to the need. In 2008, only 64.6 percent of adults have visited a dentist within the past year. This compares to 70.5 percent for NYS. Those who are less likely to visit the dentist include men, individuals between 18-34 and over 64 years of age, individuals with only a high school education or less, and those with annual incomes under $75,000. 94 Madison County 2010 – 2013 Community Health Assessment Report According to the NYSDOH, Child Health Plus enrollment for Madison County is 1,369 as of July 2009. In the Central New York Region, which includes Madison County, the proportion of women using Medicaid to pay for their births was 45.1 percent in 2007. Women who have private insurance are far more likely to obtain early prenatal care than women who have Medicaid for health insurance. Low levels of reimbursement and onerous paperwork may discourage providers (physicians, dentists) from participating in Medicaid or cause them to limit the number of Medicaid patients they will see. In the 2008 the Community Health Foundation of Western and Central NY’s Survey of CNY Providers, identified the underinsured and uninsured and overall low reimbursement levels as two of the top five priorities that create barriers to care. Relationship with insurers was also a major concern as some primary care providers noted that Medicare reimbursement has not changed in 7 years. Since 2004, one Medicaid managed care plan has become available in Madison County. According to the NYSDOH, the NYS Catholic Health Plan, which is a voluntary plan, has a current enrollment of 18 of a possible 6,517 eligible. The shift to managed care focuses more on preventive health with higher reimbursement fees for primary care providers. The incentives of higher enrollments and reimbursements through managed care programs could help to improve access by increasing the number of Medicaid providers in the community. In 2008, several new State Medicaid initiatives were introduced that could medical assistance for individuals on Medicaid including: renewal simplification for Medicaid and Family Health Plus recipients, Medicaid eligibility for incarcerated individuals, continued Medicaid eligibility for recipients who change residency, and an increase in Medicaid eligibility resource standards. Provider Reimbursement As mentioned previously, Medicaid’s noted low reimbursement rates for various provider services (medical, dental) deter providers from accepting Medicaid clients. Hospitals face real challenges that can restrict the care and services they are able to provide for the uninsured; most have limited financial resources to subsidize the costs of delivery of care for the uninsured because of their need to maintain adequate revenues to cover the significant and everincreasing operating costs needed to stay in business. Hospitals may try to ease financial strain by eliminating and/or reducing valuable specialized services. Although reimbursement for common screening tests, such as mammograms and Pap tests is provided by most health insurance plans; reimbursement for effective counseling interventions, such as smoking cessation or weight management, is less common. Other Financial-related Concerns A considerable number of businesses in Madison County employ 99 people or less with many of these being businesses that employ less than 10 people. This employment base, with its dependence on small businesses, has significant implications for the county’s health care system. Many small businesses are challenged to provide health benefits for their employees. A 2000 study of health care benefits provided by businesses of varying size in New York State shows that the percentage of businesses offering health benefits to their employees increases with the size of the company. Recognizing that a large proportion of Madison County businesses have a low number of employees then by inference it can be assumed that many do not provide health insurance. Structural Barriers Provider Availability Several areas within Madison County are designated as Health Professional Shortage Areas. HP Shortage Areas exist for both Primary Medical Care and Mental Health Providers. Since PCPs are able to serve only a limited number of patients, health disparities occur when there are not enough providers for a given area. Patients with and without insurance may be unable to access a primary care physician. These areas are predominantly in the southern tier of the County: 95 Madison County 2010 – 2013 Community Health Assessment Report Health Professional Shortage Areas: Primary Medical Care & Mental Health Primary Medical Care Mental Health Brookfield Town Eaton Town Georgetown Town Hamilton Town Low-Income- Hamilton Lebanon Town Madison Town Oneida Nation of NY Health Program Brookfield Town DeRuyter Town Eaton Town Fenner Town Georgetown Town Hamilton Town Lenox Town Lincoln Town Madison Town Oneida City Low Income – Oneida City Smithfield Town Stockbridge Town Source: U.S. HRSA, 2009 According to the 2007 Annual Physician Workforce Profile, despite the overall growth in physicians statewide, the Mohawk Valley (Fulton, Herkimer, Madison, Oneida, Montgomery and Schoharie Counties) experienced the greatest decline (7%) in active patient care FTE (full-time equivalent) physicians. In rural areas such as Madison County, having “breadth” and “depth” of providers is an issue. First, we lack the breadth of specialists available to serve our residents (e.g., neurologists); and second for those that are available we lack “depth” or a redundancy of these types of providers. One specialty provider leaving the area could seriously affect our local health care system. According to the NYSDOH 2008 BRFSS, 15.2 percent of adults in Madison County do not have a regular health care provider, compared to 17.2 percent for New York State. However, in a local survey conducted by Zogby International of 400 Madison County residents in 2008, only 8 percent said they do not have a primary care physician. Women (97%) are more likely than men (86%) to say they have a Primary Care Physician. Of those who said they do not have a Primary Care Physician, 44 percent indicated that they would be most likely to receive treatment from an urgent care or immediate care facility when they are experiencing a medical problem, while more than a third (35%) indicated they would be most likely to receive treatment from a hospital emergency room. Another 9 percent indicated they would not likely seek treatment. In the 2008 Zogby survey, 57 percent of the respondents said they seek medical services outside of Madison County, with more than a third saying they received a recommendation for the provider from another health care professional, while some say they received a recommendation for the provider from family and friends or the provider has treated other family members or knows their family history. The medically disenfranchised are people with no or inadequate access to a primary care physician due to the local shortage of physicians. According to the report Access Denied: A Look at America’s Medically Disenfranchised, the 2005 Estimated Percent of Medically Disenfranchised People for Madison County is approximately 10%; this translates to as many as 7000 individuals in the County may be disenfranchised. In 2008, 66.9 percent of adults surveyed in Madison County reported having visited the doctor for a routine check up in the last year; this is comparable to 75.4 percent reporting the same for NYS. Similar results were observed for dental visits within the last year for adults in Madison County (64.6%) compared to NYS (70.5%). Community Memorial Hospital in Hamilton, which served southern Madison County, announced that it will discontinue its Maternity services effective September 1, 2009, leaving Oneida Healthcare Center as the only provider of maternity services within Madison County. Although Bassett Healthcare will 96 Madison County 2010 – 2013 Community Health Assessment Report provide some prenatal services, when a woman is ready to deliver she will either have to deliver at a facility out of the county or change their provider in order to deliver at Oneida Healthcare. In addition to having enough providers, the ability or availability of a provider to spend time with a patient or receive ongoing training has greatly diminished. Although consensus is growing regarding the value of a range of preventive services, providers identify lack of time and reimbursement as specific barriers to more consistent delivery of counseling about behavioral risk factors such as diet and exercise. Currently no urgent care centers exist in Madison County. According to the CHFWCNY 2008 Provider Survey, providers saw a lack of access to free and low-cost clinic care as one of the top five health care accessibility issues in the CNY region. The health department continues to be the only referral source for agencies seeking specialty care for TB, along with immunization expertise. Healthcare providers refer Medicaid and uninsured patients for TB and Immunization services to the Madison County Health Department. Primary care providers may lack the financial incentive to locate in areas with high uninsured rates, leading to physician shortages and limited access to primary care for everyone regardless of insurance status. In addition to the lack of primary and specialized health care professionals, the county is further burdened by an overall healthcare workers shortage. In the 2008 Zogby survey, there were numerous references to the need for more providers (primary care, mental health, and dental), closer locations of medical facilities, need for more specialists, need for more home care services, and a lack of low cost services to name a few. In the 2008 CHFWCNY Survey of Providers in CNY health care providers stated that the most significant barriers to addressing unmet health care needs were workforce recruitment and retention, and provider reimbursement. Nursing, nursing assistant, and physician shortages were chief concerns especially in the areas of primary care providers and psychiatrists; these issues were applicable to both urban and rural areas in the region. Transportation Madison County is primarily a suburban and rural community. The relationship between where people live and the location of the health care facilities can characterized in many instances by long travel distances, particularly as it pertains to accessing specialized medical services. This is particularly true of travel on country roads during the winter months. Furthermore, many families may possess only one car, which is typically driven by the wage earner to his/her job. The availability of public transportation is consistently viewed as a barrier to health care in all geographic areas. In the 2008 Zogby survey, 89 percent say they usually get to their medical appointments or health care treatment centers by their own vehicle. Additional challenges exist in accessing health care providers and services for those living in the southern portion of the county, particularly those living south of Route 20 which bisects the middle of the county in an east/west direction. Most providers tend to locate in the more densely populated areas in the northern half of the county. The Madison County Department of Social Services provides transportation to and from medical appointments for Medicaid recipients in hardship situations. The year 2008 was marked with several challenges to provide this service including: internal staffing changes, an increase in requests that exceeded the vendor capacity to provide them, the lone taxi provider discontinued medical transport services, an increase in out-of-state transports for major medical issues, an increase in demand routine medical transports for such services as dialysis, and an increase in mileage reimbursement rates for those Medicaid clients that drove themselves, which was further exacerbated by rising gas prices. In previous years, some dentists in the county have complained that Medicaid-eligible patients do not consistently honor their appointments. This problem has intensified due to the lack of public and private transportation, as well as the long distances between patient residences and dental offices. 97 Madison County 2010 – 2013 Community Health Assessment Report Health System Issues In the 2008 CHFWCNY Provider Survey, CNY providers identified as one of the top five barriers to care, that a our healthcare system is fragmented and that it requires improved coordination of care and collaboration with other providers including, but not limited to, Electronic Medical Records. In a similar report from CHFWCNY issued in June 2009, the authors identified significant system and capacity deficits throughout the rural communities. Specifically they identified the following: The lack of “systemness” affects accessibility, service continuity, and quality There is a lack of focus on system performance and quality There is a continuing challenge of sustainability: smaller populations means lower volumes and higher per person costs The continual struggle of health service organizations to keep up with sometimes overbearing and constantly changing NYS regulations puts rural providers proportionately at greater risk for non-compliance due to fewer resources (e.g. staff) to respond to regulatory requirements. There is a lack of capacity for management level personnel and resource development for sustainability The array of services does not provide the critical mass necessary to provide comprehensive and coordinated care, and The demand for resources exceeds the supply. Results from the 2008 Madison County’s Local Public Health System Performance Assessment conducted by representatives of the local health system identified several areas where our local performance was low and should be considered as high priority items to be addressed. These include: Utilizing current technology to manage and communicate population health data Mobilizing community partnerships Identification of personal health service needs of populations Assuring the linkage of people to personal health services Evaluation of personal health services Identification and surveillance of public health threats, and Community health improvement process and strategic planning Based on demographic trends in recent decades, the nursing home capacity in the county will need to expand as a means of accommodating the growth in the aging population. Currently most nursing homes in Madison County are at or very near capacity of beds being utilized. In the 2008 forum with local agencies, the aging population was identified as a significant “force of change” that has impact on the health of the community. Some of the community challenges include a lack of resources for the aged to stay in their homes when they are sick, the need for more healthcare staff and a shortage of residential health care facilities. To further compound this issue, the CHFWCNY 2009 report identified that the frail elderly tend to be placed in nursing homes at a higher rate than in other regions due to a lack of alternatives. Nursing home care places an additional burden on communities as the cost for nursing home care is considerably higher. Emergency Medical Services Not all towns have an EMS squad and those lacking a locally based squad typically contract with another town for service. The rural topography, dispersed population of the county, and a predominantly volunteer-based staffing pool, pose significant challenges to our local EMS organizations to deliver quality services. The travel distance required transporting victims to medical facilities places considerable burdens on volunteers and affects overall response capabilities. Most of the County’s ambulatory squads and first response units are operated with volunteers and it has become increasingly difficult for communities to keep these emergency medical services fully staffed and trained in advanced medical techniques. The lack of volunteers is due to a number of factors including fewer residents interested in volunteering, the significant time required for training, the increased sophistication of training skills and levels required and the reluctance of many employers to allow employees to leave their worksite to serve as an EMS volunteer. 98 Madison County 2010 – 2013 Community Health Assessment Report A recent growing trend is that local EMS services are being asked to provide non-emergency transportation for mental health patients to out-of-county providers. Transport in the past was traditionally provided by local law enforcement. This has created coverage concerns during times of such tranports. In many cases, there is at least a 20 minute drive from a person’s home to the nearest hospital. Also, many elderly people live alone and others have little or no family support. Thus, EMS services are a critical community resource. Personal Barriers Socio-demographic According to the Census Bureau, in 2005 11.3% of the entire population in Madison County was at or below the poverty level. The declining economic conditions has impacted and will continue to impact the health status of the residents of Madison County; and it is a significant barrier to families and individuals that may be facing loss of employment, low-income jobs and/or poverty. Even when services are readily available, individuals in poverty must often make the choice between paying for vital health services and their immediate food and sheltering needs Population projections show an increase in the number and percent of aging adults for Madison County. Estimates suggest that by 2025 the elderly will comprise approximately 16% of the population, an increase from 13% in 2006. With an increasing aging population a parallel increased need and cost for health care services should be observed, as older adults consume a greater share of these resources The aging population was identified as a significant “force of change” that has impact on the health of the community. Some of the community challenges include a lack of resources for the aged to stay in their homes when they are sick, the need for more healthcare staff and a shortage of residential health care facilities. Patients that face barriers to care may become chronic no-shows and/or noncompliant which can create liability issues for providers. People with disabilities are four times more likely than those without to have special needs that are not covered by their health insurance. People with disabilities are also more likely to put off or postpone medical care because they cannot afford it. For Madison County, the disability status of the civilian non-institutionalized population 5 years and over is 17.3 percent, higher than the NYS average of 14.1 percent. Perception Personal barriers also include skepticism about the effectiveness of prevention. Although patient awareness and acceptance of some interventions are high (such as screening for breast cancer) other interventions (for example, colorectal cancer screening and sexually transmitted disease [STD] screening) are less uniformly accepted. A small but significant number of patients remain skeptical of even widely accepted preventive measures, such as immunizations. Increasing numbers of elderly people have sought to remain at home and this has left many elderly in rurally isolated towns and villages without the benefit of care from extended family. In addition, because of their age and/or condition they are typically not able to drive. This situation posses a serious problem, since elderly living in rural communities in the county have little or no access to public transportation. Most elderly therefore must rely on private transportation provided by family members or friends. All of these factors have greatly increased the social and psychological stress experienced by elderly people, particularly those living in the more rurally isolated areas of the county. Culture Approximately 300 migrant farm workers. For most, English is a second language and therefore efforts to convey information about access to health care services and healthcare education must be presented in English and Spanish. Second, as they are a mobile group, sustaining continuity in receiving care is extremely difficult. 99 Madison County 2010 – 2013 Community Health Assessment Report Over the recent yeas there has been an in-migration of Amish and/or Mennonite. There religious and cultural beliefs and practices limit their interaction with the local health care system. This challenge is further heightened due to a limited or lack of cultural competency training for health care workers and providers. Veterans Soldiers returning from Iraq and Afghanistan, and/or their families, face barriers to health and mental health care because the veteran’s system is strained causing delayed access to critical services; and local providers often lack an understanding of veteran’s issues (e.g., trauma related disorders) and have a lack of expertise and/or capacity to serve them. Education and Health Literacy Health literacy barriers can be caused by health care providers who use words that patients don’t understand, low educational skills, cultural barriers to health care, and Limited English Proficiency (LEP). Problems with health literacy can make it difficult to locate providers and services, complete health forms, explain medical history to providers, seek preventive health care, manage chronic conditions and understand directions for medicine or healthy behaviors. According to the 2009 Literary Needs Assessment for Madison County report, approximately 10% of the adult population (5,520 individuals) functions below the basic literacy skill level. According to the 2003 National Health Literacy report for health literacy levels, i.e., the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions, the percentage of adults who score below a basic level increases to 14%. According to the 2009 NYSDOH Expanded BRFSS, in Madison County, 13.4% of those reporting no health insurance had a high school or lower level of education in comparison to 2% reporting a college degree or higher. 100 Madison County 2010 – 2013 Community Health Assessment Report PROFILE OF UNMET NEED FOR SER VICES Local Public Health System Assessment Results Purpose The purpose of the Local Public Health System Assessment (LPHSA) was to identify how organizations and institutions contribute to the delivery of public health services in Madison County. Any organization or entity that contributes to the health or well-being of a community is considered a part of the public health system. This assessment was performed in order to gain understanding of the existing infrastructure and identify strengths, potential gaps and/or challenges within the Local Public Health System (LPHS). This assessment is meant as a descriptive profile rather than a complete index or evaluation of all current activities. Within these parameters, this assessment provides a clear overview and preliminary analysis of the public health system in Madison County. Approach The LPHSA was completed as part Madison County’s “MAPP Process”. During a series of two forums held in the fall of 2008, the formal assessment was conducted utilizing the CDC’s National Public Health Performance Standards Program (NPHPSP) instrument, the Local Public Health Performance Assessment (LPHSA). In addition, prior to the assessment, meetings were held to familiarize system partners to the process, framework, tool and timeframe. Subsequent meetings were held to present findings and begin a process of identifying strategic issues, formulating goals, and planning. Healthy People 2010 describes public health as having three core functions: assessment of community health information, the development of comprehensive public health policy, and assuring that the public health services be provided to the community. These functions have been broken down further into 10 essential public health services. The LPHSA is structured around these 10 Essential Public Health Services (see Table 1, below). These are the performance standards that the local and state public health systems should strive to achieve in their delivery of essential public health services (EPHS) of their communities. Each EPHS includes between 2-4 model standards that describe the key aspects of an optimally performing public health system. The standards describe an optimal level of performance rather than provide minimum expectations. This ensures that the standards maybe used for continuous quality improvement. 10 Essential Public Health Services 1. Monitor health status to identify community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure a competent public and personal health care workforce. 9. Evaluate effectiveness, accessibility and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems. Assessment Results The Madison County LPHSA was successfully conducted in a two-part Health Forum. Over 70 individuals from almost 50 different agencies participated in this assessment process. This group of partners was broadly representative of Madison County’s public health system including public health professionals, business persons, health care providers, educators, insurers, government leaders, foundations, advocacy 101 Madison County 2010 – 2013 Community Health Assessment Report groups, faith community leaders, community based organizations, and agencies. It is hoped that through their engagement in the assessment process and by sharing their diverse perspectives, all partners will gain a better understanding of each organization’s contributions, the interconnectedness of activities, and how the public health system can be strengthened. The first LPHSA forum was to discuss the Essential Services and identify how each of the health system’s partners contributes and rate the performance in comparison to the program’s model or ideal standards. Participants responded to the assessment questions following each model standard, indicating how well that model standard is currently being met. The discussion helped identify opportunities for collaboration, gaps in service provision, and overlapping activities. Additionally, the participant’s qualitative feedback was captured to provide further insight into the rational of the performance ratings. The collective responses were then submitted to the CDC for analysis and scoring. At the follow-up performance improvement forum partners reviewed the results and used the data to identify strengths and weaknesses within the LPHS and prioritized the areas they wish to address. Through discussion, participants were able to categorize the indicators based on the priority ratings and performance scores to determine which areas required greater community focus. According to the CDC Healthy People 2010 initiative, the purpose of a public health system is to assess information on the health of the community, develop public health policies, and assure that public health services are provided to the community. These three core areas are further broken out into the 10 essential services. The overall assessment score for Madison County’s Public Health System was 55%. Individual essential service scores ranged from 44% to 69%. The scores suggest that there is room from improvement in all areas. EPHS SCORE 1 2 3 4 5 6 66 69 59 39 63 54 44 Monitor Health Status to Identify Community Health Problems Diagnose and Investigate Health Problems and Health Hazards Inform, Educate and Empower People about Health Issues Mobilize Community Partnerships to Identify and Solve Health Problems Develop Policies and Plans that Support Individual and Community Health Efforts Enforce Laws and Regulations that Protect Health and Ensure Safety Link People to Needed Personal Health Services and Assure the Provision of Health 7 Care when Otherwise Unavailable 8 Assure a Competent Public and Personal Health Care Workforce 9 Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services 10 Research for New Insights and Innovative Solutions to Health Problems Overall Performance Score 60 44 56 55 As a result of the two health forums six essential service areas were chosen for greater community focus. Of the areas chosen, all received high priority ratings from the forum participants. Some of the chosen areas were areas deemed to have the lowest performance levels by the local public health system indicating areas where there were serious gaps in services. Other focus areas selected received higher performance scores indicating that the participants recognize that although these services were being provided in our community, they still deserve increased attention. Overall, most forum participants were unsurprised with the final results of the assessment given the fact there are limited resources within the public health system. The six focus areas chosen, together with their priority ratings and performance scores, are listed below. The full report of the NPHPSP results can be found on the Madison County Department of Health web site at: www.healthymadisoncounty.org. 102 Madison County 2010 – 2013 Community Health Assessment Report Priority Performance Score Rating (level of activity) Quadrant I (High Priority/Low Performance – These important activities may need increased attention: 1. Monitor Health Status to Identify Community Health Problems 8 66 (Significant) 2. Diagnose and Investigate Health Problems and Health Hazards 8 69 (Significant) 3. Inform, Educate and Empower People about Health Issues 9 59 (Significant) 4. Mobilize Community Partnerships to Identify and Solve Health 8 39 (Moderate) Problems 5. Develop Policies and Plans that Support Individual and Community Health Efforts 8 63 (Significant) 7. Link People to Needed personal Health Services and Assure the 9 44 (Moderate) Provision of Health Care when Otherwise Unavailable Essential Service Essential Service 1: Monitor Health Status to Identify Community Health Problems. This service includes: 1) Accurate, periodic assessment of the community’s health status, including: identification of health risks, determinants of health, and determination of health service needs; attention to the vital statistics and health status indicators of groups that are at higher risk than the total population; and identification of community assets that support the local public health system (LPHS) in promoting health and improving quality of life. 2) Utilization of appropriate methods and technology, such as geographic information systems (GIS), to interpret and communicate data to diverse audiences. 3) Collaboration among all LPHS components, including private providers and health benefit plans, to establish and use population health registries, such as disease or immunization registries. Although some data for a Community Health Profile was available, substantial helpful data was missing. Of greatest concern among the participants was that the available statistical data was not only difficult to attain but also out dated. All kinds of health data needs to be accessible to the public including health outcomes, utilization statistics from managed care organizations, infrastructure data, health risk data and community report cards. Although much data is available throughout the community, it is housed in separate isolated systems and various agencies. The Madison County Health Department and New York state have recently begun using several new information databases, Lead Web, New York State Immunization Information System (NYSIIS), and the Geographical Information System (GIS), which should greatly increase accessibility and timeliness of data. The participants also believe that although good sources of health status information do exist in our community, there is a lack of active agency sharing of this data. There was a general consensus that by recently initiating the Mobilizing for Action through Planning and Partnerships (MAPP) process, to complete this assessment, improvement in inter-agency information sharing has already begun and will continue to improve. A major challenge will be to increase public access to information without compromising confidentiality. Essential Service 2: Diagnose & Investigate Health Problems & Health Hazards in the Community. This service includes: 1) Epidemiological investigations of disease outbreaks and patterns of infectious and chronic diseases and injuries, environmental hazards, and other health threats. 2) Active infectious disease epidemiology programs. 3) Access to a public health laboratory capable of conducting rapid screening and high volume testing. Although the Madison County Health Department collects and disseminates data on a number of health status indicators, its success for true representation is dependant on accurate compliance with disease reporting regulations. It is believed that under reporting, as well as under testing in some areas, such as sexually transmitted illnesses and lead poisoning, may be significant. The recent improvements in information sharing among healthcare partners throughout the county, due to the MAPP process, may have a positive effect on both reporting and testing in the future. The local health department is being continuously challenged financially in this area. Recent changes in regulations has increased the level of 103 Madison County 2010 – 2013 Community Health Assessment Report lead poisoning screening, assessment and abatement activities but not the funding levels to adequately perform these activities. Programs are in place to identify and monitor many health threats; however, at this time we do not have a qualified laboratory with in the county for timely and effective investigative measures. In an emergency situation, the time it takes to get samples to a qualified laboratory for evaluation could be critical. Forum participants expressed concern that the Madison County emergency/disaster response personnel are 80% volunteer based and that it is in crisis. Scarce resources, human and monetary, may make a response to any major event extremely difficult in our county. Another challenge faced by emergency personnel is the vast ruralness of our county is a challenge in itself. Both distance between emergency services and the terrain adds to the challenge of providing quality care. The forum participants believe that the people of Madison County are remarkably independent and that in a true emergency many will be able to provide for themselves, their families, and their neighbors for a short time until more help arrives. Essential Service 3: Inform, Educate, and Empower People about Health Issues. This service includes: 1) Health information, health education, and health promotion activities designed to reduce health risk and promote better health; 2) Health education and health promotion program partnerships with schools, faith communities, work sites, personal care providers, and others to implement and reinforce health promotion programs and messages that are accessible to all populations; 3) Health communication plans and activities such as media advocacy and social marketing; 4) Accessible health information and educational resources; and 5) Risk communication processes designed to inform and mobilize the community in time of crisis. Educational programs (health fairs, classes, onsite trainings) and outreach activities are the most common activities reported in this service. Many agencies report that the most frequent program evaluation method consists of counting the number of brochures handed out. While the distribution of health education materials is a key method of education and possibly empowerment, it does not imply behavior or attitude changes. The health literacy and cultural barriers of the population need also be taken into consideration. Although an individual may possess a quality informational brochure, it does not mean that they are able to read it, understand it, or apply it. Forum attendees reiterated that the agencies may be disseminating information, but that the data and statistical information is outdated leaving the ability to accurately describe the situation questionable. Many community organizations do not have comprehensive health communication plans. Until now, there has been little collaboration between organizations to link health plans or to form partnerships to plan and implement health promotion programs. Recently there has been an increase in partnerships to plan and implement health promotion programs. The local partnerships developed as part of this assessment can be enhanced to include joint health promotion programs and activities and continue forward to formulate a. Coalitions can be formed to target specific health problems. Expertise sought can be provided through cooperation with other agencies that may already have the skills and capabilities needed. There is a community wide need to establish and utilize media relationships across the board. Essential Service 4: Mobilize Community Partnerships to Identify and Solve Health Problems. The Local Public Health System received the lowest performance score for this essential service (39%). This service includes: 1) Identifying the potential service providers who contribute to or benefit from public health and increase their awareness of the value of public health; 2) Building new coalitions and/or working with existing coalitions to draw upon the full range of potential human and material resources to improve community health; 3) Convening and facilitating partnerships among groups and associations to undertake health improvement activities, including preventive, screening, rehabilitation, and support programs, and establishing the social and economic conditions for long-term health. Currently, there is no formal process for constituency development. There are several lists of service providers in the county but no master list encompassing all area services/providers. During the current 104 Madison County 2010 – 2013 Community Health Assessment Report MAPP process a large list of possible partners was developed but it needs to be expanded, refined and more accessible to the LPHS. Some coalitions/partnerships exist, but only within pockets of the LPHS and only focused on specific and narrow health issues. Their memberships, in many instances, are not considered to be comprehensive. Thus the existing coalitions are unable to reach their full potential. The health forum participants agreed that there were currently few partnerships in the community that maximize public health improvement activities. Information exchange with in existing partnerships and throughout the county is on the rise but still in need of expansion. Presently, the activities being performed and the services provided are not designed around the EPHS. Throughout the county, resources are continuously being stretched thin. Recent budget cuts and increases in demand for services continue to tax existing service providers. County resources are not being pooled or effectively optimized to deliver the essential services. Madison County does have a community health improvement committee. It was expressed that this committee is not working at its full potential, should increase participation in the community health improvement process, play a larger role in the monitoring and evaluation of community health goals and may be best to leverage community resources. The LPHS does not review the effectiveness of the existing community partnerships. This too may be tasked to the community health improvement committee. Essential Service 5: Develop Policies and Plans that Support Individual and Community Health Efforts. This service includes: 1) An effective governmental presence at the local level. 2) Development of policy to protect the health of the public and to guide the practice of public health. 3) Systematic communitylevel planning for health improvement and public health emergency response in all jurisdictions. 4) Alignment of local public health system (LPHS) resources and strategies with a community health improvement plan. The LPHS scored lowest for the indicators that focus on governmental presences and its assurance of broad participation in a community health plan. The local health department is in the process, using MAPP, of developing and implementing a community health improvement plan. Services delivery plans have also been created through the collaborative efforts of agencies convened to address specific issues. The participants expressed concern that due to continued budget cuts, the local health department lacks the resources -funding, personnel, facilities, equipment and supplies - required to deliver essential services to the community. Even the mandated public health programs are minimally funded. The assessment shows that there is only moderate activity by the LPHS in the area of policy development. Although the LPHS alerts the policy makers and the public of the impact current or proposed policies may have on their health, levels of development and the periodic review of health policies remain low. Essential Service 7: Link People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable. This service includes: 1) Identifying populations with barriers to personal health services. 2) Identifying health needs of populations with limited access services. 3) Assuring the linkage of people to appropriate health services through coordination of provider services and development of interventions that address alleviate barriers to services. The LPHS has not fully assessed the extent to which personal health services are available and accessible to populations in the county who may experience barriers to care. Although the LPHS has some initiatives in place to enroll eligible individuals in public benefit programs, the promotion of such delivery services is not broad enough to reach all of the populations with in the county. Minimal assistance is provided to vulnerable populations in accessing needed health services. Forum participants’ main concern in this area is that the cultural barriers are not being addressed. In Madison County, there is minimal availability of linguistically appropriate materials and staff to assist the diverse population groups in obtaining personal health services. The development of such materials is also cost prohibitive for our 105 Madison County 2010 – 2013 Community Health Assessment Report LPHS. Many special needs services are currently unavailable within the county and transportation issues continue to make access to out-of-county services difficult. Local Health Department (LHD) Contribution Although the primary focus of the NPHPSP assessment tool is on the public health system in its entirety, estimating how much of each model standard is achieved by the public heath system collectively, the percentage of this amount that is the direct contribution of the local health department is also reviewed. The LHD contribution percentages for all essential services were above 50% with performance scores ranging from moderate to significant. Essential Service by Perceived LHD contribution and score. Essential Service 1. Monitor Health Status to Identify Community Health Problems 2. Diagnose and Investigate Health Problems and Health Hazards 3. Inform, Educate and Empower People about Health Issues 4. Mobilize Community Partnerships to Identify and Solve Health Problems 5. Develop Policies and Plans that Support Individual and Community Health Efforts 6. Enforce Laws and Regulations that Protect Health and Ensure Safety 7. Link People to Needed personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable 8. Assure a Competent Public and Personal Health Care Workforce 9. Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services 10. Research for New Insights and Innovative Solutions to Health Problems Priority Rating 58% 58% 83% 88% Performance Score (level of activity) Significant (66) Significant (69) Significant (59) Moderate (39) 94% Significant (63) 83% 50% Significant (54) Moderate (44) 69% 75% Significant (60) Moderate (44) 58% Significant (56) Results indicate that the LHD largest contribution (94%) is in EPHS 5 (Development of Policies and Plans) yet the performance score for this service for the public health system as a whole was low indicating that the Health Department plays a larger role in this area than other community partners. The lowest LHD performance score for both the LHD and the collective health system was in EPHS 7 (Linking People to and Assuring the Provision of Needed Services) which demonstrates a gap in services provided in the county. Outside factors affecting this service as well as the level of effort exerted by the LHD and other agencies need further scrutiny. Also of note is that the Health Department contributes only 25% to three of the model standards: Model Standard 1.3: Maintenance of Population Health Registries; Model Standard 2.3: Laboratory Support for Investigation of Health Threats; and Model Standard 8.2: Public Health Workforce Standards. Such scoring indicates room for improvement in the Health Department’s capacity to provide these services. Health data collection systems are crucial to assessment and evaluation for the community’s health. Madison County Department of Health requires up-to-date information systems and technological support to meet these needs. The local health department must have up-to-date knowledge, skills and abilities to deliver services effectively and carry out the core functions of assessment, policy development and assurance of services. Funding for essential service activities is limited and may be a contributing factor to these lower scores. 106 Madison County 2010 – 2013 Community Health Assessment Report SECTION IV – LOCAL HEALTH PRIORITES 107 Madison County 2010 – 2013 Community Health Assessment Report LOCAL HEALTH PRIORITIES Community Health Assessment: Our Road “MAPP” In January 2008, Madison County initiated a comprehensive strategic planning and assessment project using the nationally recognized community health assessment process called the Mobilizing for Action through Planning and Partnerships (MAPP) Process. The “MAPP Project” sought to better understand and prioritize for action the health issues important to Madison County residents. A committee of agencies representing diverse interests with a common interest of improving health was established to oversee and implement the MAPP assessment process and identify and prioritize for action health issues and concerns deemed most important by the community. This committee, known as the Madison County MAPP Team, has been involved throughout the MAPP Process. Over 60 agencies serving Madison County are represented on the Committee. Agencies have committed time and resources, while strengthening local partnerships and networks. Through this process, data was compiled into a meaningful A Vision for a Healthy Madison County community resource that identified locally important public health A Place of Natural Beauty Where Individuals and Families Thrive issues. The sharing of findings with key stake holders enabled and This vision characterizes our community by: mobilized community members to Welcoming neighborhoods and a sense of individual work collaboratively towards belonging Values that protect its agricultural traditions, rich history prioritizing the local public health and natural scenic beauty issues. The Madison County MAPP process involves a number of steps that lead to the development of a planning report and action plan. In May of 2008, through input from community members a Vision for a Healthy Madison County was developed. This vision statement provided the foundation for data collection, identifying health priorities, and subsequently the development of strategies for implementation. Maintenance of its clean environment through planning and preservation Safe, affordable housing for all ages Access to affordable health care, education and recreation, promoting health and wellness for all Opportunities for ample employment and business prospects for all A dynamic partnership of citizens, government agencies, employers, and faith based, educational, community, and service organizations The Assessments The MAPP Process evaluates four components of the community that provide critical insights into health challenges and opportunities. Community members and key local individuals and agencies participated in assessing one or more of these areas: Community Themes & Strengths Assessment: Zogby International, a professional polling agency, surveyed 400 residents to determine priority health issues, quality of life, and access to care issues. Cancer, Heart Disease, and Obesity represent the community’s top 3 health concerns. Local Public Health System Assessment (LPHSA): Over the course of two meeting held in October/November of 2008 sixty-five individuals representing various agencies that comprise our local health system assessed the performance of our local public health system using the National Public 108 Madison County 2010 – 2013 Community Health Assessment Report Health Performance Standards assessment tool for local health systems and identified areas for improvement. For the full report see website: www.healthymadisoncounty.org/ Community Health Status Assessment: In partnership with Colgate University’s Upstate Institute, data was collected and tabulated. Resulting tables, statistics, and graphs were created and organized. Note: Lack of child obesity data lead to the creation of the Child Obesity Prevalence Study or “BMI Project”, a collaborative research project between, Morrisville State College, M-O BOCES, and MCDOH. Forces of Change Assessment: In September 2008, the Forces of Change Regional Brainstorming Session was held. Over 140 diverse professionals from Herkimer, Madison, and Oneida Counties attended the event. Nineteen “forces” or themes were identified that positively or negatively effect health and health care in our communities. For the full report see website: www.healthymadisoncounty.org/ May 14, 2008 - Health Symposium: MCDOH and Colgate University hosted a symposium entitled Healthy People, Healthy Places, & Health in All Policies. Dr. Cathleen Walsh, Goal Team Leader, CDC provided the keynote address, which was followed by a panel discussion of local leaders. The local leader discussions focused on health impacts and issues in the areas of business, non-profit sectors, agriculture, and religious communities. Issues raised during the discussions were incorporated into the MAPP process. One hundred six individuals were in attendance. Strategic Issue Development Between January and April of 2009 the MAPP Committee members reviewed the findings from the four assessments, and through a series of discussions and exercises identified eighty-five strategic issues. In addition to the issues, the Committee felt that it was imperative that our primary focus for subsequent strategy development should have a family/individual focus, i.e., how can we help families/individuals thrive and be healthy? This focus should also recognize that ensuing strategy implementation will need to be further tailored to the individual/family dependent on their respective stage in life, i.e., infant, child, adolescent, adult, and older adult. A subcommittee was established to further review and refine and consolidate the strategic issues within a family/individual centric construct. Madison County Strategic Issue Conceptual Model Nine strategic areas or “elements” were developed through the subcommittee work. A strategic issue conceptual model (see Diagram) was developed by the MAPP subcommittee derived from an underlying socio-ecological based model that has been adapted to include Madison County’s community specific data and input. Community The two large concentric circles of the model, which have a common center, represent a strategic approach that focuses on the community and individual/family. The model incorporates two strategic issue statements that capture our focus on the community, individual/family, and were used to help frame and refine strategies. Nine “elements” represent the strategic areas of interaction 109 Madison County 2010 – 2013 Community Health Assessment Report between the “community” (including the various “systems”) and the family or individual, that the data and community indicate are important for Madison County to address in order to achieve our Vision for a Healthy Madison County. These elements may negatively or positively impact health. Strategy development was targeted towards the areas where the two large circles, representing community (or system) and individual and family, overlap with the strategic areas. A second sub-committee meeting was held to define the nine strategic areas, develop goals statements, and further describe the strategic components of the issue. For the full report see website: www.healthymadisoncounty.org/ The definitions and goal statements were presented to the larger Committee for approval and adoption. Strategic Issue Statements Issue 1: How does the local public health system or community affect positive change on the elements that have an impact on a family’s health? Issue 2: How do we strengthen individuals and families to thrive? Health Priorities Health Summit: On July 15, 2009 seventy-five individuals convened at a Health Summit to prioritize the strategic issues and initiate strategy development activities. Following a series of discussions and breakout workgroup sessions, the participants selected four priority areas for initial strategy development. These four strategic areas were: Access to Health Systems, Health Literacy, Community Economic Development, and Public Policy. NYS Prevention Agenda Priority Areas The NYS Prevention Agenda Priority Areas were included and considered throughout strategic issue, goal and strategy development, and health prioritization activities. The MAPP Committee, which included representatives from both county hospitals, determined that to affect greater change and have a more significant impact on the health of our community, our efforts should be directed at underlying systemic issues; issues that occur further “upstream” from the disease and health outcome focal points of past efforts, to those that better address the underlying social determinants that affect health outcomes and create health disparities within our communities. The MCDOH, Oneida Healthcare Center and Community Memorial Hospital have enjoyed a professional and collaborative working relationship prior to the release of the Prevention Agenda Priority Areas, but even more so since January 2008 when we partnered on the comprehensive community health assessment (aka MAPP Project). In meetings with the Hospitals, along with ongoing communications and participation in the MAPP process, we believe that the strategic issues identified through our assessment activities best reflect where these changes need to occur, regardless of the specific health issue (e.g. chronic disease). Except for Access to Health Systems, Madison County’s issues do not directly correlate with the State’s Agenda items. The MAPP Committee, including our hospital partners, agreed that the Prevention Agenda items should be incorporated into the development and tactical implementation of the strategies identified for the priority issues. For example: Strategic Area: Strategy: Prevention Agenda Item: Tactical Strategy: Health Literacy Improve usability of health information Chronic Disease & Cancer Improve usability of health information specific to chronic disease and cancer. The above NYS Prevention Agenda Areas were selected for tactical implementation within our priority health areas: Access to Quality Health Care, Chronic Disease & Cancer, and Healthy Environments. 110 Madison County 2010 – 2013 Community Health Assessment Report SECTION V – OPPORTUNITIES FOR ACTION 111 Madison County 2010 – 2013 Community Health Assessment Report OPPORTUNITIES FOR ACTION Strategy Development During the second half of the July 15th Health Summit session, the participants identified strategies for each priority health issue: Access to Health Systems, Health Literacy, Community Economic Development, and Public Policy. Some initial strategies, along with additional concepts and ideas were generated during this session. In August 2009, the MAPP Committee members reviewed and finalized the strategies developed at the Health Summit to ensure that the resulting strategies best reflected the assessment findings and the community’s input and vision. The following section includes a definition for each priority health area, an overarching goal statement, and the suggested strategies for each priority health area: Access to Health Systems The ability and means to obtain, and sustain access to preventive services and health education, primary care, chronic disease care, mental health care, oral health care, and vision and hearing services. It includes the concept of universal health coverage that ensures access to health care regardless of income, age, employment or health status in a manner that will increase positive health outcomes and improve the health status and health equity of all persons. This definition includes both the use and effectiveness of health services. The concept of access also encompasses physical accessibility of facilities. Goal: Improve access to comprehensive, high quality health care services Suggested Strategies Dental Services/health Increase oral Health workforce by subsidizing dental providers who serve those living in poverty to reduce necessary fees Explore state loan repayment program to attract dentists to the County Educate dentists and dental staff about: improvements in the Medicaid system, the impact of the culture of poverty, how to organize/schedule to compensate for the no-show rate, the rationale for seeing children ages 0-5, the need for comprehensive exams for those at risk, how to assess, treat and refer infants, toddlers, MRDD and other special needs populations Establish case management positions to coordinate oral health & access issues for Medicaid, special needs population, and the un-insured Conduct assessment to identify need for additional dental clinics and mobile dental vans Mental Health Identify and adopt a model of service delivery that clearly identifies the continuum of care that is appropriate for the County. Increase collaboration and coordination between service providers in the planning, service delivery and assessment of service adequacy for the County Enhance relationships and partnerships with regional medical schools to encourage providers to practice within the County Provide mobile services/van/response team Medical Care Develop and maintain a current directory of organizations that comprise the Local Public Health System and include: 112 Madison County 2010 – 2013 Community Health Assessment Report Managed care organizations Local businesses and employees Neighborhood organizations Faith institutions Local officials who impact policy and fiscal decisions Conduct awareness campaign on the importance of a medical home, Establish access to primary care office technology with interconnectivity capabilities, technical support to ensure that the medical home is the starting point connecting via EMR’s, effective use of that technology, and formalize referral relationships between primary care physicians and specialists and using telemedicine to link patients with doctors. Establish primary care and preventive services in community settings such as schools and senior centers to include training aimed at enhancing the roles of primary care and mid-level practitioners that have a shortage of such individuals to strengthen the primary care safety net and implement programs to reduce emergency room usage Develop technological capabilities and payer acceptance for tele-health for specialty care, behavioral health, home care, and care for incarcerated individuals, and emergency medicine Increase number of providers through development of incentives that focus on recruitment & retention. Advance tele-specialty services, including but not limited to psychiatry, dermatology, radiology and emergency medicine Increase number of NP by utilizing local educational programs and encourage local targeted retention. Develop and implement medical education models that address the core problem of physician supply for Madison County Support efforts for both regulatory and reimbursement reform that better incentivizes our communities’ investments in fairly distributed comprehensive primary care. Increase the use of incentives to recruit and retain providers such as Exploring state loan repayment programs to attract providers to the County and Subsidize providers who serve those living in poverty to reduce necessary fees Establish patient-centered care focused on the integration of primary and specialty care with behavioral health, dental care, and other services. Establish an association of local Health Care Providers to develop a comprehensive Employee Advocate program accessible to participating providers, with the goal of improving retention rates and improving the overall image of entry level positions in the health care field. Develop multi-community and provider networks to expand access to high quality, specialty mental health services. Develop regional hub networks with a focus on prevention and health that have broader programs that are shared by multiple organizations rather than a burden on each organization. Foster pooling of resource Explore the feasibility of the creation of a Madison County Rural Health Network Establish a collaborative Health Care Team charged with developing coordinated strategies to expand services with an emphasis on establishing primary care “medical home” for residents and comprehensive disease management to address chronic illness. 113 Madison County 2010 – 2013 Community Health Assessment Report Health Literacy Health Literacy is the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions. Goal: Improve the degree to which people can obtain and process basic health information and services they need to make appropriate health decisions. Suggested Strategies Design a community calendar which includes different venues, different dates, communicating health to the general public on a topic per month Develop a database with health and human resources that explore feasibility with project health. Enhance access to health information including materials, media, oral and other non-written forms of communication, collaboration among all professional groups and establish standards and process for readability and understanding of materials that is used by all providers. Improve the usability of health information and health services by including: Involve intended user group/target population in design and testing of health messages and services information Improve the usability of information on the internet Make written materials easier to read Ensure the health information is relevant to the intended users’ social and cultural contexts Improve usability of health forms and instructions Improve accessibility of the physical environments Establish a patient navigator program Create mechanisms for sharing and distributing plain language materials among health professionals Change professional practice for health care providers and public health professionals, including health educators and pharmacists: Encourage professional organizations and secure commitments to make health literacy issues a high priority on their policy, research and practice agendas and to develop position and issue policy statements and papers (e.g., CNY Academy of Medicine) [cross walk with Public Policy] Connect health literacy issues to ongoing efforts to improve the cultural competence of healthcare providers. Develop and implement educational curricula in professional and continuing education programs Ensure that health and health care providers are represented on the proposed literacy coalition to help coordinate decision making and implementation of the community literacy plan. Consider establishing a working sub-group to the coalition specific to health literacy Advocate for health literacy in our organizations Include health literacy in staff training and orientation Identify specific programs and projects affected by low health literacy Target key opinion leaders with health literacy information Incorporate health literacy into mission and planning Convene a work group to develop a health literacy agenda for local organizations Include health literacy in grants, contracts, and memorandums of understanding Establish organizational accountability Include health literacy improvement in program evaluation and quality improvement plans Include health literacy improvement in budget requests Implement health literacy metrics or measurable objectives in our organizations. Develop a county focus and agenda for health literacy Convene an exploratory planning committee to assess opportunities for a county/regional conference such as Madison County Conference on Health Literacy to include a Health Literacy Plan (e.g., Onondaga County’s Conference on Obesity). 114 Madison County 2010 – 2013 Community Health Assessment Report Convene a working group to collaborate on a county report on health literacy and report findings of this report. Raise awareness of health literacy through a defined marketing strategy Community Economic Development Action taken locally by a community to provide economic opportunities and improve social conditions in a sustainable way. CED is a community-centered process that blends social and economic development to foster the economic, social, ecological and cultural well-being of communities. Goal: Improve economic opportunities and social conditions in a sustainable way. Suggested Strategies Advocate for health representation on the Madison County Transportation Coordination Steering Committee Conduct a promotional campaign regarding assets of the county to attract and maintain business. Identify funding sources. Implement a county planning committee to develop a comprehensive strategic community Development Plan and identify in each community what we want to maintain, develop and sustain Create a workshop forum for communities to share best practices (include education component to public) from places in county and other examples of smart growth for planners. Public Policy That which the law encourages for the promotion of the public good, including health. Goal: Improve the health of the community through legislative action at the federal, state and local levels. Suggested Strategies Encourage professional organizations to make health literacy issues a high priority on their policy, research, and practice agendas and to develop positions and issue policy statements and papers (e.g., CNY Academy of Medicine) Establish public health and adult literacy education policy and funding that provides opportunities for the health and literacy education communities to come together for program and staff development. Develop and adopt a Madison County Sanitary Code that addresses local health issues to include modifying current county, town, city and village general plans, zoning and subdivision ordinances, land use policies, and other planning practices so that walking and cycling paths are incorporated into existing communities to safely accommodate pedestrians, cyclists and others using non-motorized transportation. Priorities should be paths that lead to food outlets that serve healthy foods as well as to parks and other venues that provide opportunities for physical activity. Pass and promote laws and regulations to create new or expand existing efforts to promote active living. Local governments should examine planning, zoning efforts to ensure that children’s ability to walk, play, and get to school safely are a top priority then create and maintain playgrounds, parks, and green spaces within communities as well as the means to access them safely. Prioritize resources to low-income neighborhoods to ensure that all children and adolescents have access to safe and desirable opportunities for play and active lifestyles. Funding should also be prioritized to 115 Madison County 2010 – 2013 Community Health Assessment Report support specific evidence-based goals, such as building sidewalks in new and existing neighborhoods to create safe corridors to schools and neighborhood parks County and municipal governments should serve as a model for communities. Whenever possible: New government buildings should be sited within walking distance of public transportation, walking trails, and residential areas to promote active living. Encourage county government and local organizations/businesses to establish an Environmental Purchasing Policy and/or local ordinance that would incorporate guidance and requirements to purchase environmentally preferable products whenever practical. Encourage county government to implement an Environmental Management System in accordance with, as appropriate, the requirements of ISO 14001 to coordinate actions and resources across the county. Encourage county government and local organizations/businesses to adopt and implement effective management of natural assets through actions to protect biodiversity, habitats and species from the adverse effects of these organizations activities. Strengthen school based wellness policies to ensure healthy environments for kids. Encourage county government and local organizations/businesses to adopt a renewable energy and related economic development policy that would require that a certain percentage (e.g. 50%) of Madison County’s total non-transit energy use come from renewable energy sources by the year 2015. Advocate for adequate Medicaid reimbursement for dental services Determine whether laws and regulations provide the authority to carry out the essential public health services Determine the impact of existing laws and regulations on the health of the community Assess the opinions of constituents of the Local Public Health System Determine whether laws and regulations require updating Assess compliance with public health laws and regulations Engage key state and regional stakeholders in this process Educate policymakers regarding priority issues identified in the Community Health assessment Review public health policies at least every two years Planning to Implementation The first phase of the MAPP process concluded with the completion of the community health assessment. The Madison County Health Improvement Planning Report is currently being developed and will be released in October 2009 pending MAPP Committee approval. A marketing advisory committee was established in 2008 to develop and implement a marketing plan for the Report. The marketing campaign is targeted to begin in January 2010. The Report will provide the basis for the next phase of the MAPP process – Action Cycle. Action Cycle: October 2009 – December 2009 The second phase of the MAPP process involves the development and implementation of an action plan. During this phase the strategies identified during the community health assessment activities will be further refined to incorporate the selected NYS Prevention Agenda Priority Areas (Access to Health Care, Chronic Disease and Cancer, and Healthy Environments). Action plans will be developed detailing specific activities to implement along with responsible agencies and resource allocation. To guide the action planning and implementation phase, a steering committee comprised of key community partners will be established. Four working groups, one for each priority area, have been established to develop the action plans. At the Health Summit held in July 2009, individuals signed up to work on one or more of the priority area work groups. Additional group members were identified for recruitment. 116 Madison County 2010 – 2013 Community Health Assessment Report In August, personal contact was made with key individuals seeking their participation on the priority work groups. In addition, presentations to stakeholder groups, e.g. Rotary, were made to discuss the health priorities for Madison County and seek their involvement. Initial Opportunities The Madison County’s Comprehensive Economic Development Strategy Committee discussed the MAPP process and health priority areas at their August meeting. Members were very excited to hear that Madison County citizens recognize economic development as a key component of a "healthy MC" and were eager to figure out how to incorporate MAPP's results in the strategic plan. They have requested a copy of the Health Improvement Planning Report and have invited the Director of Public Health to attend their next meeting on September 30th. The Madison County Department of Planning recently established a Transportation Steering Committee for the purpose of creating a comprehensive Transportation Plan for the County with a special focus on health and human services. The ultimate goal of the plan will be to develop a comprehensive transportation plan that efficiently and effectively links existing vulnerable populations (i.e., elderly, disabled, low income, and those without personal transportation) to key destinations (place of employment, hospitals and clinics, human service agencies, etc.). Several of the MAPP Committee representatives were invited to be members of the Transportation Steering Committee. The Madison County Literacy Report was published in 2008. The report included the issue of health literacy as an important component of the overall literacy issue in Madison County. Through a focus group format, representatives from the local health and medical system identified the impacts of literacy on health and medical care and the potential barriers to accessing care due to low health literacy levels. Recommendations from the plan include the formation of work groups to address targeted issues, such as health literacy. In August, the Madison County Board of Health conducted a one day strategic planning session to set the course for health in Madison County. The Board identified opportunities to strengthen its activities in the area of health policy development. The BOH has called for the development of a County Sanitary Code, and to include in this code language that addresses key health issues and emerging concerns (e.g., tattoo businesses, gas drilling, health impact assessments, land use planning and zoning, immunization and vaccination requirements, etc.). In 2008, the Madison County Department of Health issued its first health profile on obesity and overweight. The Profile describes the obesity and overweight issue in Madison County and introduces approximately 235 strategies to address obesity in Madison County, based on an ecological model and state and national reports. The Report also identified new and ongoing activities in the county including the Childhood Obesity Prevalence Study, a collaborative partnership between the Morrisville State College, Baccalaureate School of Nursing, the Madison-Oneida BOCES, and the Madison County Department of Health. Through a unique relationship between the MSC Nurses and the school districts, over 4000 children between pre-k and twelfth grade were measured and BMI’s determined. Preliminary data shows that national childhood overweight and obesity figures are significantly under estimated for Madison County children. For several years the Living Well Partnership (LWP), a multi-agency group, has worked to address the issue of obesity in children 6 – 10 years of age in certain areas of the county. They have had tremendous success including an annual family fun day where attendance has increased each year for the past five years, T.V. turn off week, and most recently the introduction of EBT’s at the local farmer’s markets, where individuals on the food stamp program can electronically purchase fresh produce. The LWP also conducts diabetes workshops to educate individuals with diabetes on proper diet and food preparation, and diabetes management. Most recently, the Madison County Department of Health submitted an application request for state funding through the Healthy Communities Capacity Building Initiative (NYSDOH). These funds will assist Madison County’s further efforts to address this issue. 117 Madison County 2010 – 2013 Community Health Assessment Report Since June 2008, the Madison County Department of Health has been collaborating with Dr. Danielle Varda at the University of Colorado in Denver to evaluate the strength of our local partnerships and networks. In the fall of 2009 MCDOH will be conducting an internet-based survey of its community partners using the PARTNERTool developed by Dr. Varda. We anticipate using the results of the survey to identify the areas of our public health networks that are strong, and those areas that need further development. These results will be considered as we develop the health improvement action and implementation plan to enhance our chances of success by focusing on strategies that have strong established networks and partnerships. Internally, the Madison County Department of Health will continue to implement its strategic plan. The Department’s Plan directs its efforts and resources to address the strategic initiatives with a specific focus on five specific health issues (cancer, heart disease, respiratory disease, maternal and child health, and injury prevention). The Department has realigned its resources along with instituting a policy for prioritizing resource allocations to these specific health issues. For example: for the strategic initiative regarding workforce development, an additional $20,000 was approved by the Board of Supervisors in our budget for staff development and training activities. The funds are used for staff trainings that are specific to the five health issues. 118 Madison County 2010 – 2013 Community Health Assessment Report APPENDIX A – MADISON COUNTY DATA & CHART BOOKS 119 Madison County 2010 – 2013 Community Health Assessment Report Indicators of Health Status: Socioeconomic Characteristics SES.1 SES.2 SES.3 SES.4 SES.5 SES.6 SES.7 SES.8 SES.9 SES.10 SES.11 SES.12 SES.13 SES.14 SES.15 SES.16 SES.17 SES.18 SES.19 SES.20 SES.21 SES.22 SES.23 SES.24 Socioeconomic Characteristics Educational Attainment (Population 25 years and over): Less than 9th grade (%) 9th to 12th grade, no diploma (%) High school graduate (includes equivalency) (%) Some college, no degree (%) Associate's degree (%) Bachelor's degree (%) Graduate or professional degree (%) % High School Graduate or higher % Bachelor’s Degree or Higher Civilian Non-institutionalized Population with Disability: Population 5 years and over (%) Population 5 years to 15 years (%) Population 16 to 64 years (%) Population 65 years and over (%) Civilian Veteran Population 18 years and older Language Spoken at Home (Population 5 years and older): English Only (%) Language other than English (%) Spanish (%) Per Capita Income ($) Median household income (dollars) Mean household income (dollars) % Unemployed Civilian employed population 16 years and over by Occupation: Management, professional, and related occupations (%) Service occupations (%) Sales and office occupations (%) Year 2005-07 Madison County 2.6 New York State 7.0 Healthy People 2010 N/A 2005-07 10.1 9.1 N/A 2005-07 34.1 29.6 90.0 2005-07 17.3 15.1 N/A 2005-07 2005-07 2005-07 12.0 13.1 10.9 8.1 17.9 13.3 N/A N/A N/A 2005-07 87.3 83.9% N/A 2005-07 24.0 2005-07 17.3 14.1 N/A 2005-07 9.8 6.1 N/A 2005-07 14.5 11.1 N/A 2005-07 40.0 39.0 N/A 2005-07 11.3 7.3 N/A 2005-07 95.3 71.4 N/A 2005-07 4.7 28.6 N/A 2005-07 2005-07 2005-07 1.7 23,256 50,126 14.1 29,230 52,944 N/A N/A N/A 2005-07 61,853 76,247 N/A 2005-07 2005-07 5.9% 34.3 6.7% 37.0 N/A N/A 2005-07 2005-07 20.0 21.7 18.8 25.9 N/A N/A 120 N/A Madison County 2010 – 2013 Community Health Assessment Report SES.25 SES.26 SES.27 SES.28 SES.29 SES.30 SES.31 SES.32 SES.33 SES.34 SES.35 SES.36 SES.37 SES.38 SES.39 SES.40 SES.41 SES.42 SES.43 SES.44 SES.45 BR.1 BR.2 BR.3 BR.4 Farming, fishing, and forestry occupations (%) Construction, extraction, maintenance and repair occupations (%) Production, transportation, and material moving occupations (%) Civilian employed population 16 years and over by Industry: Agriculture, forestry, fishing and hunting, and mining (%) Construction (%) Manufacturing (%) Wholesale trade (%) Retail trade (%) Transportation and warehousing, and utilities (%) Information (%) Finance and insurance, and real estate and rental and leasing (%) Professional, scientific, and management, and administrative and waste management services (%) Educational services, and health care and social assistance (%) Arts, entertainment, and recreation, and accommodation, and food services (%) Other services, except public administration (%) Public administration (%) % Population below Poverty Level % Population < 18 years and over below Poverty Level % Population 18 to 64 years below Poverty Level % Population 65 years and over below Poverty Level % Population 18 below Poverty Level % Health Insurance among Adults % Health Insurance among Adults age 18 - 64 % No Health Insurance among Adults % No Health Insurance 2005-07 2.4 0.3 N/A 2005-07 9.4 7.9 N/A 2005-07 12.2 10.2 N/A 2005-07 4.6 0.6 N/A 2005-07 2005-07 2005-07 2005-07 2005-07 8.0 11.2 3.5 10.4 3.2 6.1 7.6 3.1 10.6 5.3 N/A N/A N/A N/A N/A 2005-07 2005-07 1.3 5.2 3.4 8.8 N/A N/A 2005-07 6.6 10.7 N/A 2005-07 28.5 25.6 N/A 2005-07 9.3 8.5 N/A 2005-07 4.4 4.9 N/A 2005-07 2005-07 3.8 10.1 4.8 14.0 N/A N/A 2005-07 12.7 19.6 N/A 2005-07 9.4 12.3 N/A 2005-07 9.9 12.3 N/A 2005-07 6.8 12.2 N/A 2008 86.0 86.3 100.0 2008 83.2 83.8 100.0 2008 14.0 13.7 0.0 2008 16.8 16.2 0.0 121 Madison County 2010 – 2013 Community Health Assessment Report BR.5 BR.6 BR.7 BR.8 Kwic.1 Kwic.2 Kwic.3 Kwic.4 Kwic.5 Kwic.6 Kwic.7 Kwic.8 SES.46 among Adults age 18 - 64 % Adults with Regular Health Care Provider % Cost Prevented Visit to Doctor within the Past Year among Adults % Visited a Doctor for Routine Checkup within the Past Year among Adults % Visited a Doctor for Routine Checkup within the Past 2 Years among Adults Children and Youth Living Below Poverty (%) Children and Youth Receiving Food Stamps (%) Children and Youth Receiving Public Assistance (%) Children and Youth Receiving Supplemental Security Income (%) Children Receiving Free or Reduced-price School Lunch - Public Schools (%) Annual Dropouts - Public Schools (%) High School Graduates Intending to Enroll in College - Public Schools (%) High School Graduates Receiving Regents Diplomas - Public Schools (%) % Medicaid or Self-pay births 2008 84.8 82.8 96.0 2008 11.0 12.6 N/A 2008 66.9 75.4 N/A 2008 80.2 86.6 N/A 2005 13.8 19.7 N/A 2007 13.6 17.1 N/A 2007 1.4 6.4 N/A 2007 1.2 1.7 N/A 2006/07 34.4 48.9 N/A 2006/07 2.2 3.1 N/A 2006/07 85.3 83.0 N/A 2006/07 89.7 80.0 N/A 2001-03 36.8 41.5 N/A SES.1 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.2 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.3 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.4 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.5 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.6 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.7 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.8 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.9 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.10 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.11 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.12 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov 122 Madison County 2010 – 2013 Community Health Assessment Report SES.13 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.14 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.15 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.16 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.17 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.18 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.19 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.20 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.21 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.22 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.23 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.24 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.25 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.26 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.27 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.28 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.29 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.30 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.31 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.32 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.33 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.34 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.35 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.36 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.37 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.38 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.39 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.40 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.41 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.42 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.43 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.44 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov SES.45 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov BR.1 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.2(April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. 123 Madison County 2010 – 2013 Community Health Assessment Report BR.3(April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.4(April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.5(April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.6(April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.7(April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.8(April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. Kwic.1 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.2 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.3 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.4 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.5 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.6 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.7 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.8 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 SES.46 Medicaid/Self-pay Births - Percentage Per 100 Live Births. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/medslf.htm Indicators of Health Status: Geographic Characteristics G.1 G.2 G.3 G.4 G.5 Social Geographic Characteristics Population Size Land Area (sq. mile) Population Density (sq. mile) % Population Change % Land in Farms Year 2005-07 2000 2000 2000-08 2007 Madison County 69,719 655.86 105.9 0.5 44.9 New York State 19,280,753 47,213.79 401.9 2.7 23.7 Healthy People 2010 N/A N/A N/A N/A N/A G.1 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov G.2 State & County QuickFacts Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://quickfacts.census.gov/qfd/states/36/36053.html G.3 State & County QuickFacts Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://quickfacts.census.gov/qfd/states/36/36053.html G.4 State & County QuickFacts Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://quickfacts.census.gov/qfd/states/36/36053.html G.5 Madison, New York. Retrieved June 2, 2009, from 2007 Census of Agriculture Web site: http://www.agcensus.usda.gov/Publications/2007/Online_Highlights/County_Profiles/New_York/cp36053.pdf Indicators of Health Status: Mortality M.1 M.2 M.3 M.4 M.5 M.6 M.7 Mortality by Cause Year Malignant Neoplasm*** Lung and Bronchus*** Breast (Female)*** Uterine Cervix*** Prostate*** Colorectal*** Melanoma of the Skin*** 2004 2002-06 2002-06 2002-06 2001-05 2002-06 2001-05 Madison County 199.8 54.2 29.1 3.0 26.7 25.1 2.7 124 New York State 172.3 46.1 24.5 2.6 25.7 18.3 2.2 Healthy People 2010 159.9 44.9 22.3 2.0 28.8 13.9 2.5 Madison County 2010 – 2013 Community Health Assessment Report M.8 M.9 M.10 M.11 M.12 M.13 M.14 M.15 M.16 M.17 M.18 M.19 M.20 M.21 M.22 Kwic.9 M.23 Oral Cavity and Pharynx*** Ovary*** Diseases of the Heart*** Coronary Heart Disease*** Congestive Heart Failure*** Cerebrovascular Disease*** Chronic Obstructive Pulmonary Disease*** Cirrhosis*** Diabetes Mellitus*** Lip, Oral Cavity, and Pharynx Cancer*** Cardiovascular Disease*** Chronic Lower Respiratory Disease*** Asthma**** 2001-05 2001-05 2004-06 2004-06 2004-06 2004-06 2004-06 1.4 12.0 180.9 136.0 13.8 43.6 64.8 2.4 8.8 237.2 198.3 12.7 30.5 31.3 2.7 N/A N/A 166.0 N/A 48.0 60.0 2004-06 2004-06 2004-06 5.7 11.6 2.1 6.0 18.7 2.3 3.0 45.0 N/A 2004-06 2004-06 251.5 64.8 285.0 31.3 N/A N/A 2004-06 13.1 13.4 Pneumonia*** Unintentional Injury Mortality: Total*** Unintentional Injuries Mortality 0-19 years (ThreeYear Average)*** Unintentional Injury Mortality: Motor Vehicle*** 2004 2004-06 27.3 29.2 25.8 20.8 1.0, 2.0, 9.0, 60.0 N/A 17.5 2004-06 12.2 7.5 N/A 2004-06 15.6 7.7 9.2 M.1 Table 40: Age-Sex Adjusted Death Rates and Selected Causes of Death by Resident County. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/nysdoh/vital_statistics/2004/table40.htm M.2 Lung & Bronchus Cancer - Deaths And Death Rates Per 100,000 Residents. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/cancer/ca_lun.htm M.3 Female Breast Cancer - Deaths And Death Rates Per 100,000 Female Residents. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/cancer/ca_bre.htm M.4 Uterine Cervical Cancer - Deaths And Death Rates Per 100,000 Female Residents. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/cancer/ca_utc.htm M.5 Cancer Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm M.6 Colorectal Cancer - Deaths And Death Rates Per 100,000 Residents. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/cancer/ca_col.htm M.7 Cancer Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm M.8 Cancer Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm M.9 Cancer Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm M.10 Diseases of The Heart Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/dishrt.htm M.11 Heart Disease and Stroke Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/chr_madison.htm M.12 Heart Disease and Stroke Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/chr_madison.htm M.13 Cerebrovascular Disease(Stroke) Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/cerebr.htm M.14 Respiratory Diseases Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/res_madison.htm M.15 Cirrhosis Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/cirrho.htm M.16 Diabetes Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/diabet.htm M.17 Lip, Oral Cavity, & Pharynx Cancer - Deaths And Death Rates Per 100,000 Residents. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/cancer/ca_ora.htm M.18 Cardiovascular Disease Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/cardio.htm 125 Madison County 2010 – 2013 Community Health Assessment Report M.19 Chronic Lower Respiratory Disease Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/clrd.htm M.20 Asthma Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/ast0.htm M.21 Table 40: Age-Sex Adjusted Death Rates and Selected Causes of Death by Resident County. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/nysdoh/vital_statistics/2004/table40.htm M.22 Unintentional Injury Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/totacc.htm Kwic.9 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 M.24 Motor Vehicle Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/mvacc.htm Indicators of Health Status: Sentinel Events S.1 S.2 S.3 S.4 S.5 S.6 S.7 S.8 S.9 Sentinel Events Year 2002-06 Madison County 16.9 New York State 18.0 Healthy People 2010 N/A Child Cancer Incidence, 0-19 yrs*** 0-4 yrs*** 5-9 yrs*** 10-14 yrs*** 15-19 yrs*** Breast (Female) Cancer Incidence Rate*** % Early Stage Diagnosis Cervix Uteri Cancer Incidence*** % Diagnosed at Early Stage 2002-06 2002-06 2002-06 2002-06 2001-05 0.8 0.2 1.0 1.4 129.6 271.2 152.4 190.2 312.6 124.8 N/A N/A N/A N/A N/A 2001-05 2001-05 67 5.8 63 8.9 N/A N/A 2001-05 Total suppressed for confidentiality 51% N/A S.1 Childhood Cancer Incidence by County, 2002-2006. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/cancer/registry/table7/countykids.htm S.2 Childhood Cancer Incidence by County, 2002-2006. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/cancer/registry/table7/countykids.htm S.3 Childhood Cancer Incidence by County, 2002-2006. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/cancer/registry/table7/countykids.htm S.4 Childhood Cancer Incidence by County, 2002-2006. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/cancer/registry/table7/countykids.htm S.5 Childhood Cancer Incidence by County, 2002-2006. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/cancer/registry/table7/countykids.htm S.6 Cancer Indicators - Madison County. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm S.7 Cancer Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm S.8 Cancer Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm S.9 Cancer Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm Indicators of Health Status: Maternal and Child Health MCH.1 MCH.2 MCH.3 MCH.4 Maternal and Child Health Infant Mortality Rate (per 1,000 live births) Neonatal Mortality Rate (per 1,000 live births) Post Neonatal Mortality Rate (per 1,000 live births) Fetal Death* Year 2004-06 Madison County 4.6 New York State 5.8 Healthy People 2010 4.5 2004-06 3.2 4.0 2.9 2004-06 1.4 1.8 1.5 2004-06 4.6 6.9 4.1 126 Madison County 2010 – 2013 Community Health Assessment Report MCH.5 MCH.6 MCH.7 MCH.8 MCH.9 MCH.10 MCH.11 MCH.12 MCH.13 MCH.14 MCH.15 MCH.16 MCH.17 MCH.18 MCH.19 MCH.20 MCH.21 MCH.22 MCH.23 MCH.24 MCH.25 MCH.26 MCH.27 MCH.28 MCH.29 MCH.30 MCH.31 MCH.32 MCH.33 Perinatal Mortality Rate (20 weeks gest - 28 days of life)* Perinatal Mortality Rate (28 weeks gest - 7 days of life)* Spontaneous Fetal Deaths 20+ Weeks (per 1,000 live births) Short Gestation (<37 Weeks) (%) Early Childhood Mortality (1-4)*** Childhood/Adolescent Mortality (5-14)*** Adolescent/Young Adult Mortality (15-19)*** Ambulatory Sensitive Conditions (0-4): Asthma** Pneumonia** Otitis Media** Gastroenteritis** Ambulatory Sensitive Conditions (5-14): Asthma** % Low Birth Weight Births (<2500 gms) % low birthweight singleton births % Very Low Birthweight (<1500 Grams) % very low birthweight singleton births Premature Births: <32 weeks gestation (%) 32 - <37 weeks gestation (%) <37 weeks gestation (%) Age-Specific Birth Rates (Teen Pregnancy Rate): 15-19 Years* 10-14 Years* 15-17 years* 18-19 years* % births with 5 minute APGAR < 6 % Teenage Birth Percentage (15-17) % Births with Early Prenatal Care % Births with Late or no Prenatal Care % adequate prenatal care (Kotelchuck) % Pregnant Women in 2004-06 7.8 10.9 4.1 2004-06 5.5 6.0 4.5 2004-06 4.1 6.9 N/A 2004-06 11.5 12.3 N/A 2004-06 22.9 21.5 18.6 2004-06 7.7 12.5 12.3, 16.8 2004-06 34.3 44.5 39.8 2004-06 30.3 61.7 25.0 2004-06 2004-06 2004-06 2004-06 62.5 0.9 20.2 5.8 44.8 4.0 32.5 23.4 N/A N/A N/A 7.7 2004-06 7.0 8.3 5.0 2004-06 5.3 6.1 N/A 2004-06 1.0 1.6 0.9 2004-06 0.6 1.1 N/A 2004-06 1.3 2.1 1.0 2004-06 10.2 10.2 6.4 2004-06 2004-06 11.5 26.1 12.3 61.3 7.6 N/A 2004-06 2004-06 2004-06 2004-06 0.3 14.2 35.5 0.4 1.5 36.7 99.5 0.5 N/A 43.0 N/A N/A 2004-06 1.8 2.1 N/A 2004-06 79.4 74.9 90.0 2004-06 4.5 5.0 10.0 2004-06 78.8 63.0 90.0 2005-07 80.0 84.0 N/A 127 Madison County 2010 – 2013 Community Health Assessment Report MCH.34 MCH.35 MCH.36 MCH.37 MCH.38 MCH.39 MCH.40 MCH.41 MCH.42 MCH.43 MCH.44 MCH.45 MCH.46 MCH.47 MCH.48 MCH.49 MCH.50 MCH.51 MCH.52 MCH.53 MCH.54 MCH.55 MCH.56 WIC with Early (1st Trimester) Prenatal Care, Low SES % Cesarian section Newborn Drug-Related Discharges** Maternal Mortality*** WIC Children who are Underweight (0-4) (%) WIC Children who are Overweight (2-4) (%) WIC Children who are Anemic (6 Months-4 Years) (%) Pregnancy Rate* Abortion Ratio: All ages^ 15-19 years Out-of-wedlock Births (%) % of births within 24 months of previous pregnancy % of births to teens (10-17 years) % of births to women 35+ years Fertility rate per 1,000 (all births/population 15-44) Teen birth rate per 1,000 (births 10-17/population 10-17) Pregnancy Rate per 1,000 (all pregnancies/population 15-44 years) % Pregnant Women in WIC with Anemia, Low SES % Pregnant Women in WIC Who Were Prepregnancy Underweight (BMI Under 19.8), Low SES % Pregnant Women in WIC Who Were Prepregnancy Overweight (BMI 26 - 29), Low SES % Pregnant Women in WIC Who Were Prepregnancy Very Overweight (BMI Over 29), Low SES % of births to women 25+ years w/out H.S. education % first births % of births that were multiple births 2004-06 2004-06 29.5 59.4 31.5 57.9 N/A N/A 2004-06 2004-06 46.0 1.2 18.3 4.8 3.3 N/A 2004-06 13.9 15.2 N/A 2004-06 9.0 11.5 N/A 2004-06 2004-06 55.0 12.8 94.4 48.4 N/A N/A 2004-06 2004-06 2004-06 41.8 39.3 22.2 123.7 39.2 16.5 N/A N/A 6.0 2004-06 1.9 2.2 N/A 2004-06 16.0 20.l N/A 2004-06 47.5 60.7 N/A 2004-06 3.6 5.4 N/A 2004-06 55.0 94.4 N/A 2005-07 13.2 11.4 N/A 2005-07 10.2 11.3 N/A 2005-07 14.1 15.4 N/A 2005-07 33.1 26.1 N/A 2004-06 0.7 7.6 N/A 2004-06 2004-06 41.6 3.3 42.9 3.8 N/A N/A 128 Madison County 2010 – 2013 Community Health Assessment Report MCH.1 Infant Mortality - Rate Per 1,000 Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/infmort.htm MCH.2 Neonatal Mortality - Rate Per 1,000 Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/neomort.htm MCH.3 Postneonatal Mortality - Rate Per 1,000 Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/postmort.htm MCH.4 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.5 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.6 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.7 Spontaneous Fetal Deaths (20+ Weeks Gestation) - Rate Per 1,000 Live Births+Spont Fetal Deaths 20+ WKS. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/sfd20.htm MCH.8 Short Gestation (<37 Weeks) - Percent of Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/shtges.htm MCH.9 Early Childhood (Age 1-4) Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/chd04.htm MCH.10 Childhood/Adolescent (Age 5-14) Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/chd14.htm MCH.11 Adolescent/Young Adult (Age 15-19) Deaths and Death Rates. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/chd19.htm MCH.12 Asthma (Age 0-4) - Discharge Rate Per 10,000 Population Age 0-4. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/hospital/asthma0.htm MCH.13 Pneumonia (Age 0-4) - Discharge Rate Per 10,000 Population Age 0-4. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/hospital/pneumo0.htm MCH.14 Otitis Media (Age 0-4) - Discharge Rate Per 10,000 Population Age 0-4. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/hospital/otitis0.htm MCH.15 Gastroenteritis (Age 0-4) - Discharge Rate Per 10,000 Population Age 0-4. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/hospital/gastro0.htm MCH.16 Asthma (Age 5-14) - Discharge Rate Per 10,000 Population Age 5-14. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/hospital/asthma1.htm MCH.17 Low Birthweight Births (<2500 Grams) - Percent of Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/lowbwt.htm MCH.18 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.19 Very Low Birthweight Births (<1500 Grams) - Percent of Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/vlowbwt.htm MCH.20 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.21 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.22 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.23 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.24 Teenage Pregnancies (Age 15-19) - Rate Per 1,000 Females Age 15-19. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/tp1519.htm MCH.25 Teenage Pregnancies (Age 10-14) - Rate Per 1,000 Females Age 10-14. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/tp1014.htm MCH.26 Teenage Pregnancies (Age 15-17) - Rate Per 1,000 Females Age 15-17. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/tp1517.htm MCH.27 Teenage Pregnancies (Age 18-19) - Rate Per 1,000 Females Age 18-19. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/tp1819.htm MCH.28 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.29 Teenage Births (Age 15-17) - Percent of Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/pct1517.htm MCH.30 Early Prenatal Care - Percent of Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/pnce.htm MCH.31 Late/No Prenatal Care - Percent of Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/pncl.htm MCH 32 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH 33 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH 34 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm 129 Madison County 2010 – 2013 Community Health Assessment Report MCH.35 Newborn Drug-Related - Discharge Rate Per 10,000 Newborn Discharges. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/hospital/v3drug.htm MCH.36 Maternal Mortality - Rate Per 100,000 Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/matmort.htm MCH.37 WIC Children (AGE 0-4) Who are Underweight - Per Children Tested. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/underwt.htm MCH.38 WIC Children (Age 2-4) Who are Overweight - Per Children Tested. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/overwt.htm MCH.39 WIC Children (6 Months-4 Years) Who are Anemic - Per Children Tested. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/anemia.htm MCH.40 Pregnancies - Rate Per 1,000 Females Age 15-44. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/tpreg.htm MCH.41 Induced Abortions - Ratio Per 100 Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/aborts.htm MCH.42 Family Planning/Natality Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/fp_madison.htm MCH.43 Out-Of-Wedlock - Percent of Live Births. Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/outwed.htm MCH.44 Family Planning/Natality Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/fp_madison.htm MCH.45 Family Planning/Natality Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/fp_madison.htm MCH.46 Family Planning/Natality Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/fp_madison.htm MCH.47 Family Planning/Natality Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/fp_madison.htm MCH.48 Family Planning/Natality Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/fp_madison.htm MCH.49 Family Planning/Natality Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/fp_madison.htm MCH.50 Health Risks and Behaviors Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/beh_madison.htm MCH.51 Health Risks and Behaviors Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/beh_madison.htm MCH.52 Health Risks and Behaviors Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/beh_madison.htm MCH.53 Health Risks and Behaviors Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/beh_madison.htm MCH.54 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.55 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm MCH.56 Maternal and Infant Health Indicators - Madison County . Retrieved June 2, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/mih_madison.htm Indicators of Health Status: Infectious Disease I.1 I.2 I.3 I.4 I.5 I.6 I.7 I.8 I.9 I.10 I.11 Kwic.1 0 Infectious Disease Year 2004-06 2004-06 2004-06 2004-06 2001-03 Madison County 0.0 2.4 3.3 0.0 0.0 New York State 8.0 23.8 24.0 8.6 16.0 Healthy People 2010 0.7 1.0 N/A N/A 1.0 AIDS Mortality Rate*** AIDS Case Rate*** HIV Case Rate*** Early Syphilis*** Congenital Syphilis Rate per 100,000 births Gonorrhea Rate*** Pelvic Inflammatory Disease Hospitalization** Hepatitis A Rate*** Hepatitis B Rate*** Hepatitis C Acute Rate*** Male Chlamydia (All Ages)*** STD – Reported Cases of Chlamydia, Males 15-19 yrs*** 2004-06 2004-06 12.3 3.5 93.4 4.8 19.0 5.0% 2004-06 2004-06 2004 2004-06 2004-06 1.9 0.5 0.0 80.9 354.7 1.9 1.2 0.2 189.3 576.2 4.5 2.4-5.1 2.4 3.0% 3.0% 130 Madison County 2010 – 2013 Community Health Assessment Report I.12 Kwic.1 1 I.13 I.14 I.15 I.16 I.17 I.18 I.19 I.20 I.21 I.22 I.23 I.24 BR.9 BR.10 BR.11 BR.12 BR.13 BR.14 BR.15 BR.16 BR.17 BR.18 BR.19 BR.20 BR.21 BR.22 Female Chlamydia (All Ages)*** STD – Reported Cases of Chlamydia, Females 15-19 yrs*** Tuberculosis Rate*** Lyme Disease*** Pneumonia/flu hospitalizations in adults 65+ years** Pertussis incidence*** Immunization: Pertussis*** Salmonella incidence*** Shigella incidence*** Giardiasis*** Hemolytic Uremic Syndrome*** Legionellosis*** Listeriosis*** Haemophilus Influenza (HIB)*** % Flu Shot within the Past 12 Months % Flu Shot or Flu Vaccine Sprayed in Nose within the Past 12 Months % Flu Shot among Adults age 65 and Older % Pneumonia Shot or Pneumococcal Vaccine % Pneumonia Shot or Pneumococcal Vaccine among Adults age 65 and older % Ever had a Mammogram among Women age 40 and Older % Had Mammogram within the Past 2 Years among Women age 40 and Older % Had Mammogram within the Past 2 Years among Women age 50 and Older % Ever Had a Pap Test among Women % Had a Pap Test within the Past 3 Years among Women % Ever Had a Digital Rectal Exam among Men age 40 and Older % Had Digital Rectal Exam within the Past 2 Years among Men age 40 and Older % Ever Had a Prostate Specific Antigen Test among Men age 40 and Older % Had Prostate Specific Antigen Test within the Past 2004-06 174.6 466.9 3.0% 2004-06 808.4 2601.6 3.0% 2004-06 2004-06 2004-06 0.0 3.3 204.6 6.9 26.2 172.8 1.0 9.7 N/A 2004-06 2004-06 2004-06 2004-06 2004 2004 23.7 23.7 18.0 0.9 17.1 0.0 7.1 7.1 13.6 3.7 13.6 0.1 N/A N/A 6.8 N/A N/A N/A 2004 2004 2004-06 0.0 1.4 1.4 1.0 0.4 1.2 N/A N/A N/A 2008 41.9 41.7 60.0 2008 42.1 41.9 60.0 2008 64.1 74.4 90.0 2008 30.0 25.8 60.0 2008 71.3 64.2 90.0 2008 96.2 89.8 N/A 2008 89.0 77.9 N/A 2008 91.9 82.9 N/A 2008 94.8 92.5 N/A 2008 79.5 83.8 N/A 2008 80.8 75.9 N/A 2008 62.1 54.9 N/A 2008 65.0 68.5 N/A 2008 54.6 58.7 N/A 131 Madison County 2010 – 2013 Community Health Assessment Report BR.23 BR.24 BR.25 BR.26 BR.27 BR.28 BR.29 BR.30 BR.31 BR.32 BR.33 BR.34 2 Years among Men age 40 and Older % Never or Rarely Been Asked About Sexual History During Routine Check-up Among Adults % Believed Hardly Any or a Few People their Age in their Community have had a Sexually Transmitted Disease (STD) among Adults % Believed it was At Least Somewhat Acceptable to See and Hear Discussions about STD Risks in Public Forums in their Community among Adults % Overweight among Adults % Obesity among Adults % Overweight or Obesity among Adults % Received Advice about Weight by a Health Professional among Adults % Received Advice to Lose Weight by a Health Professional among Adults Provided Weight Advice % No Leisure-Time Physical Activity among Adults % Consumption of 5 or More Servings of Fruits and Vegetables per day among Adults % Had a Fall within the Past 3 Months among Adults % Had a Fall that Caused Injury within the Past 3 Months among Adults 2008 73.3 65.9 N/A 2008 85.6 79.9 N/A 2008 87.0 88.8 N/A 2008 2008 2008 32.7 23.9 56.6 34.6 23.6 58.2 N/A N/A N/A 2008 20.1 28.2 N/A 2008 81.2 88.4 N/A 2008 24.0 22.7 N/A 2008 20.3 26.7 75.0, 50.0 2008 16.5 13.9 N/A 2008 6.5 4.2 N/A I.1 AIDS Deaths and Death Rates. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/aids.htm I.2 AIDS Cases Per 100,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/aids.htm I.3 HIV Cases Per 100,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/hiv.htm I.4 Early Syphilis Per 100,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/esyphilisall.htm I.5 Congenital Syphilis - Cases Per 100,000 Births. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/congsyphilis.htm I.6 Gonorrhea Per 100,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/gonorrheaall.htm I.7 Pelvic Inflammatory Disease - Discharge Rate Per 10,000 Females Age 15-44. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/hospital/pidp.htm I.8 Hepatitis A Per 100,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/hepa.htm I.9 Hepatitis B Per 100,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/hepb.htm 132 Madison County 2010 – 2013 Community Health Assessment Report I.10 Rate per 100,000 Population - Communicable Disease in New York State - 2004. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/nysdoh/cdc/2004/rates2.htm I.11 Male Chlamydia per 100,000 Males. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/malechlamydia.htm Kwic.10 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 I.12 Female Chlamydia per 100,000 Females. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/femalechlamydia.htm Kwic.11 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 I.13 Tuberculosis Per 100,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/tb.htm I.14 Lyme Disease Per 100,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/lyme.htm I.15 Immunization and Infectious Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/imm_madison.htm I.16 Immunization and Infectious Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/imm_madison.htm I.17 Immunization and Infectious Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/imm_madison.htm I.18 Immunization and Infectious Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/imm_madison.htm I.19 Immunization and Infectious Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/imm_madison.htm I.20 Rate per 100,000 Population - Communicable Disease in New York State - 2004. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/nysdoh/cdc/2004/rates2.htm I.21 Rate per 100,000 Population - Communicable Disease in New York State - 2004. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/nysdoh/cdc/2004/rates2.htm I.22 Rate per 100,000 Population - Communicable Disease in New York State - 2004. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/nysdoh/cdc/2004/rates2.htm I.23 Rate per 100,000 Population - Communicable Disease in New York State - 2004. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/nysdoh/cdc/2004/rates2.htm I.24 Haemophilus Influenza Per 100,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/general/hib.htm BR.9(April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.10 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.11 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.12 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.13 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.14 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.15 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.16 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.17 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.18 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.19 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.20 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.21 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.22 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.23 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.24 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.25 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.26 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. 133 Madison County 2010 – 2013 Community Health Assessment Report BR.27 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from Behavioral Risk Factor Surveillance System. BR.28 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from Behavioral Risk Factor Surveillance System. BR.29 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from Behavioral Risk Factor Surveillance System. BR.30 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from Behavioral Risk Factor Surveillance System. BR.31 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from Behavioral Risk Factor Surveillance System. BR.32 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from Behavioral Risk Factor Surveillance System. BR.33 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from Behavioral Risk Factor Surveillance System. BR.34 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from Behavioral Risk Factor Surveillance System. New York State Expanded New York State Expanded New York State Expanded New York State Expanded New York State Expanded New York State Expanded New York State Expanded New York State Expanded Indicators of Health Status: Environmental Health E.1 E.2 E.3 E.4 E.5 E.6 E.7 E.8 E.9 E.10 E.11 E.12 Kwic.1 2 E.13 E.14 E.15 E.16 E.17 2003-05 Madison County 7.7 New York State 8.6 Healthy People 2010 N/A 2003-05 2003-05 2003-05 2004 2.8 0.0 10.5 80.8 2.7 2.0 13.3 82.8 N/A N/A N/A N/A 2004-06 2.9 6.0 0.0 2004 34.4 19.4 17.5 2006 2004-06 2004-06 2004-06 15.7 1.6 9.3 0.0 7.9 4.7 6.4 4.4 9.2 3.0 5.0 N/A 2004-06 18.0 13.6 6.8 2004-06 136.5 130.8 933.0 2004-06 52.3 64.7 N/A 2004-06 26.3 35.0 N/A 2004-06 6.2 9.6 N/A 2004-06 13.7 13.2 20.8 2004-06 7.3 8.6 N/A Environmental Health Year Incidence Rate of Elevated Blood Lead Levels Among Children Under Age Six Years: 10 – 14 mcg/dL* 15 – 19 mcg/dL* = 20 mcg/dL* = 10 mcg/dL* % of children with at least one lead screening by age 36 months Elevated Blood Lead Levels (>=25 µg/dL) per 100,000 Employed Persons Age 16+ Accident Death Rate (Total)*** Motor Vehicle Death Rate*** Homicide Death Rate*** Suicide Death Rate*** Adolescent/Young Adult Suicide Mortality (15-19)*** Infectious Rate for Foodborne Pathogens: Salmonella*** Motor Vehicle Crashes – Hospitalizations (Three-Year Average)*** Unintentional Injury Hospitalization Rate per 10,000 Falls Hospitalization Rate per 10,000 Poisoning Hospitalization Rate per 10,000 Non-Motor Vehicle Mortality Rate per 100,000 Traumatic Brain Injury Hospitalization Rate per 134 Madison County 2010 – 2013 Community Health Assessment Report E.18 Kwic.1 3 Kwic.1 4 E.19 E.20 E.21 E.22 E.23 E.24 E.25 E.26 E.27 E.28 E.29 E.30 E.31 E.32 E.33 E.34 BR.35 BR.36 BR.37 BR.38 10,000 Asthma Hospitalization Total** Asthma – Hospitalizations 04 years** Asthma – Hospitalizations 514 years** Asthma – Hospitalizations 017 years** Asthma – Hospitalizations 564 years** Asthma – Hospitalizations 65+ years** Cerebrovascular Disease (Stroke) Hospitalization Rate per 10,000 Diabetes Hospitalization Rate per 10,000 % Adults Overweight or Obese (BMI 25+) % Adults Who Participated in Leisure Time Physical Activity in Last 30 Days % Adults Eating 5 or More Fruits or Vegetables per Day % Adults with Physician Diagnosed Diabetes % Adults with Physician Diagnosed Angina, Heart Attack or Stroke % Adults with Physician Diagnosed Arthritis Incidence of Malignant Mesothelioma per 1,000,000 Persons Age 15+ HOSPITALIZATION RATES for Persons Age 15+: Pneumoconiosis*** Asbestosis*** Work Related Hospitalizations per 10,000 Employed Persons Age 16+ Fatal Work-related Injuries per 100,000 Employed Persons Age 16+ % Prostate Cancer among Men age 40 and Older % Home Blood Stool Test Ever Used among Adults age 50 and Older % Home Blood Stool Test Used within the Past Year among Adults age 50 and Older % Home Blood Stool Test Used within the Past 2 Years among Adults age 50 and 2004-06 10.1 21.0 25.0, 7.7, 11.0 2004-06 30.3 61.7 25.0 2004-06 5.8 23.4 7.7 2004-06 10.6 31.5 N/A 2004-06 6.6 16.2 7.7 2004-06 21.6 30.0 11.0 2004-06 23.8 26.7 N/A 2004-06 8.2 19.7 N/A 2003 62.0 56.7 15.0 2003 72.4 74.6 N/A 2003 20.6 25.8 75.0, 50.0 2003 5.3 7.2 N/A 2003 8.8 6.9 N/A 2003 30.1 25.7 N/A 2001-05 13.8 13.3 N/A 2004-06 6.3 14.8 N/A 2004-06 2004-06 5.7 18.6 13.1 16.0 N/A N/A 2004-06 5.8 2.7 3.2 2008 6.0 3.7 N/A 2008 48.3 34.9 N/A 2008 21.0 11.5 N/A 2008 27.7 18.2 N/A 135 Madison County 2010 – 2013 Community Health Assessment Report BR.39 BR.40 BR.41 BR.42 BR.43 BR.44 BR.45 BR.46 BR.47 BR.48 BR.49 BR.50 BR.51 BR.52 BR.53 BR.54 BR.55 BR.56 BR.57 BR.58 BR.59 BR.60 Older % Ever had Sigmoidoscopy or Colonoscopy among Adults age 50 and Older % Sigmoidoscopy or Colonoscopy within the Past 10 Years among Adults age 50 and Older % Home Blood Stool Test within the Past Year or Sigmoidoscopy or Colonoscopy within the % Past 10 Years among Adults age 50 and Older % High Blood Pressure among Adults % Blood Pressure Medication among Adults with High Blood Pressure % Ever Had Blood Cholesterol Checked among Adults % Blood Cholesterol Checked within the Past 5 Years among Adults % Cardiovascular Disease among Adults % Coronary Heart Disease among Adults % Ever Diagnosed with Diabetes among Adults % Ever Diagnosed with Asthma (Lifetime) among Adults % Current Asthma among Adults % Chronic Joint Symptoms among Adults % Arthritis among Adults % Activity Limitations Because of Physical, Mental or Emotional Problems among Adults % Have Health Problem that Requires the Use of Special Equipment among Adults % Disability among Adults % Current Smoking among Adults % Everyday Smoking among Adults % Adults Living in Homes in Which Smoking is Prohibited % Binge Drinking within the Past Month among Adults % Heavy Drinking within the Past Month among Adults 2008 71.9 66.0 N/A 2008 71.6 64.3 N/A 2008 75.8 67.5 N/A 2008 29.1 25.8 16.0 2008 80.6 80.4 N/A 2008 74.5 81.0 N/A 2008 72.4 78.4 80.0 2008 9.9 7.8 N/A 2008 8.0 6.2 N/A 2008 6.2 9.7 N/A 2008 18.1 16.5 N/A 2008 15.4 9.9 N/A 2008 47.3 42.5 N/A 2008 2008 27.7 21.9 27.9 22.3 N/A N/A 2008 4.6 7.8 N/A 2008 2008 23.5 25.8 24.6 16.5 N/A 12.0 2008 22.1 11.5 N/A 2008 76.8 81.1 N/A 2008 19.5 19.6 6.0 2008 7.8 5.4 N/A 136 Madison County 2010 – 2013 Community Health Assessment Report E.35 E.36 E.37 E.38 E.39 E.40 E.41 E.42 E.43 E.44 E.45 E.46 E.47 E.48 E.49 E.50 E.51 Cancer Incidence: Oral Cavity and Pharynx*** Colon and Rectum*** Lung and Bronchus*** Female Breast*** Cervix Uteri*** Ovary*** Prostate*** Cancer Early Stage: Oral Cavity and Pharynx (%) Colon and Rectum (%) Lung and Bronchus (%) Melanoma of the Skin (%) Female Breast (%) Cervix Uteri (%)(%) 2001-05 9.2 9.8 N/A 2001-05 2001-05 2001-05 2001-05 2001-05 2001-05 2001-05 64.8 79.1 129.6 5.8 17.2 161.9 56.0 54.1 64.8 124.8 8.9 14.4 166.3 36.0 N/A N/A N/A N/A N/A N/A 50.0 2001-05 2001-05 2001-05 2001-05 2001-05 41.0 21.0 83.0 63.0 51.0 50.0 N/A 90.0 75.0 65.0 Ovary (%) Prostate (%) Cirrhosis: Hospitalization rate** Chronic Obstructive Pulmonary Disease Hospitalization Rate** 2001-05 2001-05 2004-06 50.0 25.0 84.0 67.0 Suppressed for confidentiality 16.0 88.0 2.4 19.0 87.0 3.3 N/A 95.0 N/A 2004-06 28.6 36.7 N/A E.1 Table 2b: Incidence Rate of Elevated Blood Lead Levels Among Children Under Age Six Years by Blood Lead Level Category and County of Residence; Three Year Average, 2003 - 20051, New York State Excluding New York City.. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/environmental/lead/exposure/childhood/surveillance_report/20042005/section_2/table_2b.htm E.2 Table 2b: Incidence Rate of Elevated Blood Lead Levels Among Children Under Age Six Years by Blood Lead Level Category and County of Residence; Three Year Average, 2003 - 20051, New York State Excluding New York City.. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/environmental/lead/exposure/childhood/surveillance_report/20042005/section_2/table_2b.htm E.3 Table 2b: Incidence Rate of Elevated Blood Lead Levels Among Children Under Age Six Years by Blood Lead Level Category and County of Residence; Three Year Average, 2003 - 20051, New York State Excluding New York City.. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/environmental/lead/exposure/childhood/surveillance_report/20042005/section_2/table_2b.htm E.4 Table 2b: Incidence Rate of Elevated Blood Lead Levels Among Children Under Age Six Years by Blood Lead Level Category and County of Residence; Three Year Average, 2003 - 20051, New York State Excluding New York City.. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/environmental/lead/exposure/childhood/surveillance_report/20042005/section_2/table_2b.htm E.5 Madison County Indicators For Tracking Public Health Priority Areas. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/prevention/prevention_agenda/county/indicators_matrix_madison.htm E.6 Occupational Health Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/occ_madison.htm E.7 Table 40: Age-Sex Adjusted Death Rates and Selected Causes of Death by Resident County. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/nysdoh/vital_statistics/2004/table40.htm E.8 County Health Indicator Profiles (2002 - 2006) . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chip/madison.htm E.9 Injury Mortality and Morbidity Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/inj_madison.htm E.10 Suicide Deaths and Death Rates. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/suicid.htm E.11 Adolescent/Young Adult Suicide (Age 15-19) Deaths and Death Rates. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/suicad.htm E.12 Immunization and Infectious Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/imm_madison.htm Kwic.12 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 137 Madison County 2010 – 2013 Community Health Assessment Report E.13 Injury Mortality and Morbidity Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/inj_madison.htm E.14 Injury Mortality and Morbidity Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/inj_madison.htm E.15 Injury Mortality and Morbidity Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/inj_madison.htm E.16 Injury Mortality and Morbidity Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/inj_madison.htm E.17 Injury Mortality and Morbidity Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/inj_madison.htm E.18 Respiratory Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/res_madison.htm Kwic.13 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.14 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 E.19 Respiratory Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/res_madison.htm E.20 Respiratory Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/res_madison.htm E.21 Respiratory Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/res_madison.htm E.22 Heart Disease and Stroke Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/chr_madison.htm E.23 Cirrhosis/Diabetes Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/dia_madison.htm E.24 Obesity Statistics and Prevention Activities in Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/prevention/obesity/county/madison.htm E.25 Obesity Statistics and Prevention Activities in Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/prevention/obesity/county/madison.htm E.26 Obesity Statistics and Prevention Activities in Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/prevention/obesity/county/madison.htm E.27 Obesity Statistics and Prevention Activities in Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/prevention/obesity/county/madison.htm E.28 Obesity Statistics and Prevention Activities in Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/prevention/obesity/county/madison.htm E.29 Obesity Statistics and Prevention Activities in Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/prevention/obesity/county/madison.htm E.30 Occupational Health Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/occ_madison.htm E.31 Occupational Health Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/occ_madison.htm E.32 Occupational Health Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/occ_madison.htm E.33 Occupational Health Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/occ_madison.htm E.34 Ocupational Health Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/occ_madison.htm BR.35 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.36 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.37 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.38 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.39 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.40 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.41 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.42 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.43 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.44 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.45 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. 138 Madison County 2010 – 2013 Community Health Assessment Report BR.46 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.47 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.48 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.49 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.50 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.51 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.52 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.53 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.54 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.55 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.56 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.57 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.58 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.59 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.60 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. E.35 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.36 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.37 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.38 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.39 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.40 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.41 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.42 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.43 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.44 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.45 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.46 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.47 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.48 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.49 Cancer Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/can_madison.htm E.50 Cirrhosis/Diabetes Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/dia_madison.htm E.51 Respiratory Diseases Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/res_madison.htm 139 Madison County 2010 – 2013 Community Health Assessment Report Cancer Incidence (per 100,000) Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 All Invasive Malignant Tumors Males Females Oral Cavity and Pharynx Males Females Esophagus Males Females Stomach Males Females Colorectal Males Females Colon excluding Rectum Males Females Rectum and Rectosigmoid Males Females Liver/ Intrahepatic bile duct Males Females Pancreas Males Females Larynx Males Females Lung and Bronchus Males Females Melanoma of the Skin Males Females Female Breast Females Cervix Uteri Females Corpus Uterus and NOS Females Ovary Females Prostate Males Testis Year Madison County New York State excl. NYC 2002-06 Healthy People 2010 N/A 619.2 452.4 610.4 464.4 13.3 4.7 14.9 6.1 9.1 1.4 9.7 2.3 8.3 4.2 11.1 5.3 73.1 54.0 61.8 46.8 50.1 44.3 43.6 35.2 23.0 9.7 18.2 11.7 5.7 3.0 8.5 2.8 11.3 8.3 14.8 11.8 7.3 1.5 7.2 1.7 99.6 68.2 86.9 63.3 26.0 16.0 22.0 13.7 124.3 134.2 4.8 7.5 31.7 29.4 14.9 14.8 178.9 173.7 140 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Madison County 2010 – 2013 Community Health Assessment Report Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Can.1 Males Urinary Bladder (including in situ) Males Females Kidney and Renal Pelvis Males Females Brain and other Nervous System Males Females Thyroid Males Females Hodgkin Lymphoma Males Females Non-Hodgkin Lymphomas Males Females Multiple Myeloma Males Females Leukemias Males Females 9.5 6.3 N/A N/A 53.5 13.1 49.3 13.0 24.1 7.4 21.6 10.8 N/A N/A N/A N/A N/A N/A 10.8 6.7 9.0 6.2 8.5 12.4 6.3 17.6 2.7 4.4 3.9 3.1 12.3 20.2 25.8 18.4 7.5 4.9 7.9 4.8 17.0 9.7 18.8 11.3 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A (January 2009). Cancer Incidence and Mortality by County, New York State 2002-2006. Retrieved June 4, 2009, from NYSDOH New York State Cancer Registry. Cancer Mortality (per 100,000) Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 All Invasive Malignant Tumors Males Females Oral Cavity and Pharynx Males Females Esophagus Males Females Stomach Males Females Colorectal Males Females Colon excluding Rectum Males Year Madison County New York State excl. NYC 2002-06 Healthy People 2010 N/A 240.1 176.3 222.8 163.3 3.0 1.3 3.4 1.3 11.0 1.5 8.7 1.9 5.4 3.4 5.6 2.8 27.3 25.0 22.0 15.8 23.3 18.0 141 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Madison County 2010 – 2013 Community Health Assessment Report Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Females Rectum and Rectosigmoid Males Females Liver/ Intrahepatic bile duct Males Females Pancreas Males Females Larynx Males Females Lung and Bronchus Males Females Melanoma of the Skin Males Females Female Breast Females Cervix Uteri Females Corpus Uterus and NOS Females Ovary Females Prostate Males Testis Males Urinary Bladder (including in situ) Males Females Kidney and Renal Pelvis Males Females Brain and other Nervous System Males Females Thyroid Males Females Hodgkin Lymphoma Males Females Non-Hodgkin Lymphomas Males Females 19.1 13.4 4.0 5.9 4.0 2.4 2.5 3.7 6.4 2.7 8.4 6.5 13.0 10.2 2.8 1.4 2.2 0.6 68.0 44.6 65.5 43.6 4.9 2.0 3.7 1.9 29.7 24.5 3.0 2.2 4.5 4.7 10.7 9.5 27.3 24.0 0.0 0.3 11.8 1.3 8.4 2.6 9.9 1.4 5.7 2.6 4.1 3.5 5.3 3.4 0.9 1.0 0.4 0.4 0.7 0.7 0.5 0.4 10.5 4.3 8.7 5.7 142 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Madison County 2010 – 2013 Community Health Assessment Report Can.2 Can.2 Can.2 Can.2 Can.2 Can.2 Multiple Myeloma Males Females Leukemias Males Females 7.1 3.3 4.4 2.6 7.9 6.3 10.2 5.6 N/A N/A N/A N/A N/A N/A (January 2009). Cancer Incidence and Mortality by County, New York State 2002-2006. Retrieved June 4, 2009, from NYSDOH New York State Cancer Registry. Indicators of Health Status: Social and Mental Health SMH.1 Kwic.1 5 Kwic.1 6 Kwic.1 7 Kwic.1 8 Kwic.1 9 Kwic.2 0 Kwic.2 1 SMH.2 SMH.3 SMH.4 SMH.5 SMH.6 SMH.7 SMH.8 BR.61 BR.62 BR.63 BR.64 Social and Mental Health Alcohol Related Motor Vehicle Injuries and Deaths per 100,000 Young Adults - Driving While Intoxicated** Young Adults Arrests - Drug Use/Possession/Sale** Child Abuse/Maltreatment Children/Youth in Indicated Reports of Abuse/Maltreatment* Child Abuse/Maltreatment Indicated Reports of Child Abuse and Maltreatment (%) Crimes Known to the Police Firearm Related Index Crimes - General Population** Crimes Known to the Police Property Index Crimes General Population** Crimes Known to the Police Violent Index Crimes General Population** Self-inflicted Injury Hospitalization Total** Self-Inflicted Injury Hospitalization (15-19)** Assault Hospitalization Rate per 10,000 Homicide*** Suicide Total*** Suicide (15-19) Drug-related Hospitalizations** % Fair or Poor General Health among Adults % Poor Physical Health 14 or More Days within the Past Month among Adults % Poor Mental Health 14 or More Days within the Past Month among Adults % Poor Physical or Mental 2004-06 Madison County 5.8 New York State 4.2 Healthy People 2010 4.0, 65.0 2007 66.7 43.7 N/A 2007 27.6 215.4 N/A 2007 27.5 16.2 10.3 2007 29.6 32.4 10.3 2007 0.4 5.6 N/A 2007 186.3 196.8 N/A 2007 9.6 41.3 N/A 2004-06 4.3 5.0 N/A 2004-06 7.4 9.7 N/A 2004-06 1.2 5.0 N/A 2004-06 2004-06 2004-06 2004-06 1.6 9.3 0.0 7.6 4.7 6.4 4.4 34.0 3.0 5.0 N/A N/A 2008 17.7 16.2 N/A 2008 9.4 10.4 N/A 2008 11.0 10.0 N/A 2008 18.6 17.5 N/A Year 143 Madison County 2010 – 2013 Community Health Assessment Report Health 14 or More Days within the Past Month among Adults SMH.1 Injury Mortality and Morbidity Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/inj_madison.htm Kwic.15 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.16 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.17 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.18 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.19 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.20 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.21 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 SMH.2 Self-inflicted Injury - Discharge Rate Per 10,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/hospital/selfall.htm SMH.3 Self-inflicted Injury (Age 15-19) - Discharge Rate Per 10,000 Population Age 15-19. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/hospital/self1519.htm SMH.4 Injury Mortality and Morbidity Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/inj_madison.htm SMH.5 Injury Mortality and Morbidity Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/inj_madison.htm SMH.6 Suicide Deaths and Death Rates. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/mortality/suicid.htm SMH.7 Injury Mortality and Morbidity Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/inj_madison.htm SMH.8 Drug-Related - Discharge Rate Per 10,000 Population. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/hospital/drug.htm BR.61 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.62 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.63 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.64 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. Indicators of Health Status: Resource Availability HR.1 HR.2 HR.3 HR.4 HR.5 HR.6 HR.7 HR.8 HR.9 HR.10 HR.11 Health Resource Availability Licensed Beds (per 10,000): Hospital Beds Nursing Home Beds Licensed Professionals (per 10,000): Physicians Physician Assistants Dentists Podiatrists Optometrists Pharmacists Licensed Practical Nurses Licensed Registered Nurses Licensed Advanced Registered Year 2009, 2007 2009, 2007 2008 2008 2008 2009 2007 2009 2009 2009 2009 Madison County 20.2 New York State 32.0 Healthy People 2010 N/A 57.4 61.2 N/A 13.8 34.0 N/A 5.3 4.4 0.1 0.9 7.5 135.0 74.3 9.5 3.9 7.9 1.1 1.3 8.7 106.5 33.5 6.5 N/A N/A N/A N/A N/A N/A N/A N/A 144 Madison County 2010 – 2013 Community Health Assessment Report HR.12 HR.13 Occupational Therapists Physical Therapists 2008 2008 3.4 8.5 4.4 7.5 N/A N/A HR.1 Madison County Hospitals. Retrieved June 3, 2009, from NYSDOH Web site: http://hospitals.nyhealth.gov/browse_search.php?form=COUNTY&rt=madison New York: Hospital Beds per 1,000 Population, 2007 . Retrieved June 3, 2009, from Kaiser Family Foundation Web site: http://www.statehealthfacts.org/profileind.jsp?ind=384&cat=8&rgn=34 HR.2 Madison County Nursing Homes . Retrieved June 3, 2009, from NYSDOH Web site: http://nursinghomes.nyhealth.gov/browse_search.php?form=COUNTY&rt=madison&PHPSESSID=2793d3d97b2c732f388304e6a46 2cfb3 New York: Certified Nursing Facility Beds, 2007. Retrieved June 3, 2009, from Kaiser Family Foundation Web site: http://www.statehealthfacts.org/profileind.jsp?cat=8&rgn=34&ind=413 HR.3 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site: http://www.op.nysed.gov/medcounts.htm HR.4 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site: http://www.op.nysed.gov/medcounts.htm HR.5 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site: http://www.op.nysed.gov/dentcounts.htm HR.6 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site: http://www.op.nysed.gov/podcounts.htm HR.7 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site: http://www.op.nysed.gov/optomcounts.htm HR.8 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site: http://www.op.nysed.gov/pharmcounts.htm HR.9 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site: http://www.op.nysed.gov/nursecounts.htm HR.10 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site:http://www.op.nysed.gov/nursecounts.htm HR.11 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site:http://www.op.nysed.gov/nursecounts.htm HR.12 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site: http://www.op.nysed.gov/otcounts.htm HR.13 License Statistics. Retrieved June 3, 2009, from NYSED OP Web site: http://www.op.nysed.gov/ptcounts.htm Indicators of Health Status: Social Demographic Characteristics Demographic Characteristics D.1 D.2 D.3 D.4 D.5 D.6 D.7 D.8 % Female % Male % by Age: < 5 years 5-9 years 10-14 years 15-19 years 20-24 years 25-34 years 35-44 years 45-54 years 55-59 years 60-64 years 65-74 years 75-84 years 85 years and older Median Age (years) % White % Nonwhite % in Labor Force Birth Rate* Year 2005-07 2005-07 2005-07 2005-07 2005-07 2005-07 2005-07 2004-06 Madison County New York State 51.0 49.0 51.5 48.5 5.0 6.1 6.0 10.5 9.1 10.8 13.3 15.1 6.8 4.4 6.8 4.9 1.3 37.0 96.2 3.8 63.6 47.5 6.2 6.1 6.6 7.2 7.1 13.1 15.0 14.7 6.1 4.7 6.6 4.7 1.8 37.4 67.8 32.2 62.7 60.7 Healthy People 2010 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A D.1 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov D.2 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov D.3 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov D.4 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov 145 Madison County 2010 – 2013 Community Health Assessment Report D.5 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov D.6 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov D.7 Fact Sheet Madison County, New York. Retrieved June 2, 2009, from U.S. Census Bureau Web site: http://factfinder.census.gov D.8 Births - Rate Per 1,000 Females Age 15-44. Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/birth/births.htm O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 O.1 BR.65 BR.66 BR.67 BR.68 Madison County New York State Healthy People 2010 2002-04 2002-04 2002-04 2002-04 2002-04 2002-04 2002-04 2002-04 2002-04 2002-04 2002-04 2002-04 2002-04 2002-04 46.0 43.3 65.7 10.5 7.8 29.3 38.4 41.5 15.9 80.0 81.2 78.0 86.0 54.1 48.0 59.6 33.1 23.1 40.8 27.0 41.1 17.8 80.1 76.2 84.1 73.4 42.0 42.0 42.0 21.0 21.0 21.0 50.0 50.0 50.0 N/A N/A N/A N/A 2002-04 2002-04 2002-04 91.1 57.1 48.4 86.9 60.9 19.1 N/A 57.0 N/A 2002-04 2002-04 46.8 59.5 29.6 10.4 N/A N/A 2005-06 97.4 57.5 N/A 2008 64.6 70.5 56.0 2008 67.9 71.7 N/A 2008 51.1 50.1 58.0 2008 30.8 18.4 20.0 Oral Health Year % OF 3rd GRADE CHILDREN... With caries experience (all) High Socio-economic status Low Socio-economic status With untreated caries (all) High Socio-economic status Low Socio-economic status With dental sealants (all) High Socio-economic status Low Socio-economic status With dental insurance (all) High Socio-economic status Low Socio-economic status With at least one dental visit in last year (all) High Socio-economic status Low Socio-economic status Reported taking fluoride tablets on a regular basis (all) High Socio-economic status Low Socio-economic status Caries Outpatient Visit Rate per 10,000 Age 3-5 Years % Dentist Visit within the Past Year among Adults % Had Teeth Cleaned within the Past Year among Adults % Permanent Teeth Extracted Due to Decay or Gum Disease among Adults % Had All Permanent Teeth Extracted Due to Decay or Gum Disease among Adults age 65 and Older O.1 Oral Health Indicators - Madison County . Retrieved June 3, 2009, from NYSDOH Web site: http://www.health.state.ny.us/statistics/chac/chai/docs/ora_madison.htm BR.65 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.66 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.67 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. BR.68 (April 2009). Expanded BRFSS Interim Report Madison County. Retrieved June 4, 2009, from New York State Expanded Behavioral Risk Factor Surveillance System. 146 Madison County 2010 – 2013 Community Health Assessment Report Tobacco (%) T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 2008 72.6 New York State 68.1 2008 34.4 33.7 N/A 2008 25.1 32.7 N/A 2008 22.1 15.2 N/A 2008 67.9 70.3 N/A 2008 20.1 18.5 N/A 2008 32.7 37.9 N/A 2008 51.9 53.2 N/A 2008 11.1 13.5 N/A 2008 12.7 10.9 N/A 2008 15.9 10.3 N/A 2008 86.5 85.1 N/A 2008 67.7 67.2 N/A 2008 36.7 33.5 N/A 2008 80.1 73.3 N/A 2008 75.7 76.4 N/A 2008 91.5 93.8 N/A Year In the past 30 days, people who have noticed advertising or information about the dangers of tobacco or quitting smoking on television In the past 30 days, people who have noticed advertising or information about the dangers of tobacco or quitting smoking on the radio In the past 30 days, people who have noticed advertising or information about the dangers of tobacco or quitting smoking in newspapers In the past 30 days, people who have noticed advertising or information about the dangers of tobacco or quitting smoking on the Internet During the past twelve months had any doctor, nurse, or healthcare professional ask if you smoke In the past 30 days, noticed cigarettes or tobacco products being advertised or promoted in newspapers In the past 30 days, noticed cigarettes or tobacco products being advertised or promoted in magazines In the past 30 days, noticed cigarettes or tobacco products being advertised or promoted on posters/signs on shop windows or inside shops where tobacco is sold In the past 30 days, noticed cigarettes or tobacco products being advertised or promoted at sports events In the past 30 days, noticed cigarettes or tobacco products being advertised or promoted at festivals/fairs In the past 30 days, noticed cigarettes or tobacco products being advertised or promoted on the Internet When you go to a convenience store, supermarket, or gas station, you see ads for cigarettes and other tobacco products or items that have tobacco names or pictures on them Think advertising of tobacco products on the outside of stores or on the inside of windows facing outside should be restricted to certain areas or not allowed at all Of the magazines/periodicals you subscribe to, if these magazines/periodicals were available free of tobacco advertising, you would request the tobacco-ad-free version Agree or strongly agree that movies rated G, PG, and PG-13 should not show actors smoking In the past 30 days, saw adults smoking on screen when you watched movies in a movie theatre or on video, DVD, cable, or satellite Think breathing smoke from someone else’s 147 Madison County Healthy People 2010 N/A Madison County 2010 – 2013 Community Health Assessment Report T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 cigarettes is very or somewhat harmful As a rule, smoking is not allowed in the home As a rule, smoking is not allowed in family vehicle There is a policy that prohibits smoking on the entire grounds of your workplace In favor or would be in favor of a/the policy that prohibits smoking on the entire grounds of your workplace Employer has offered a stop-smoking program or any other help to employees who want to quit smoking Among renters, there is a policy that restricts indoor smoking in your building Among renters, do not think smoking in your building should be allowed Among renters, during the last 12 months of living in the unit, secondhand smoke has entered into your living space from somewhere else in or around your building Agree or strongly agree that exposure to secondhand smoke in your living area is causing you to consider moving In the past seven days, have seen anyone smoking in your community inside public places In the past year in your county, you visited a public outdoor event such as an auto show, musical festival, or concert and were exposed to secondhand smoke while there At a public outdoor event such as an auto show, musical festival, or concert in your county, you think smoking should be restricted to certain areas or not allowed at all In the past year in your county, you visited a public beach and were exposed to secondhand smoke while there At a public beach in your county, you think smoking should be restricted to certain areas or not allowed at all In the past year in your county, you visited a public park and were exposed to second hand smoke while there At a public park in your county, you think smoking should be restricted to certain areas or not allowed at all In the past year in your county, you visited a public playground and were exposed to secondhand smoke while there At a public playground in your county, you think smoking should be restricted to certain areas or not allowed at all In the past year in your county, you visited areas around public building entryways and were exposed to secondhand smoke while there At areas around public building entryways in your county, you think smoking should be restricted to certain areas or not allowed at all 148 2008 2008 2008 79.7 76.6 45.3 83.0 80.9 49.3 N/A N/A N/A 2008 55.0 62.2 N/A 2008 32.2 34.7 N/A 2008 14.0 18.0 N/A 2008 37.2 42,7 N/A 2008 29.1 30.2 N/A 2008 15.0 14.5 N/A 2008 5.1 5.9 N/A 2008 55.8 63.1 N/A 2008 80.6 81.8 N/A 2008 34.8 34.4 N/A 2008 80.5 81.0 N/A 2008 37.7 46.2 N/A 2008 78.8 81.4 N/A 2008 26.2 29.4 N/A 2008 90.0 90.0 N/A 2008 73.9 74.7 N/A 2008 87.2 87.5 N/A Madison County 2010 – 2013 Community Health Assessment Report T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 T.1 In the past year in your county, you visited the grounds of a hospital or medical facility and were exposed to secondhand smoke while there On the grounds of a hospital or medical facility in your county, you think smoking should be restricted to certain areas or not allowed at all You would favor or strongly favor a policy in your county that prohibits tobacco use on the grounds of a hospital or medical facility. Status among adult residents is current smoker Among current smokers, mean number of cigarettes smoked on days you smoke Currently use smokeless tobacco Currently use cigars, cigarillos, or little cigars Currently use pipe tobacco Currently use Bidis (flavored cigarettes from India) Currently use Kreteks or clove cigarettes Use of Some (at least one) Type of Non-cigarette Tobacco Product Among adult residents, use at least one type of tobacco product Among current smokers, in the past 12 months, you or a friend or relative purchased cigarettes for your own use at an Indian reservation or through an Indian enterprise Among current smokers, in the past 12 months, you or a friend or relative purchased cigarettes for your own use from a website or on the Internet Among current smokers, in the past twelve months a doctor, nurse, or healthcare professional advised you to quit smoking Among current smokers, during the past twelve months you stopped smoking for one day or longer because you were trying to quit smoking Among current smokers, if yes, you have quit at least one day in the past year, you remain tobacco free less than one month Among current smokers, you attempted to quit smoking in the past three years at least one time Among current smokers, you would like to quit smoking now Among current smokers, you have used or switched to a low tar or nicotine cigarette to reduce your health risk at some time Among current smokers, you are aware of cessation services in your county Among current smokers, you would be interested in learning more about available cessation services Among current smokers, the NYS law prohibiting smoking in all workplaces, including bars and restaurants, had at least one positive impact on your tobacco use Among current smokers, the price increase of tobacco caused some positive effect Among former smokers, you quit less than 3 years 149 2008 37.3 40.4 N/A 2008 89.3 90.1 N/A 2008 75.7 78.4 N/A 2008 2008 18.7 16.4 16.3 14.1 N/A N/A 2008 2008 2008 2008 2008 2008 0.6 4.4 0.5 1.2 1.2 6.6 1.2 2.9 0.5 0.2 1.0 4.9 N/A N/A N/A N/A N/A N/A 2008 22.4 19.2 N/A 2008 84.2 57.8 N/A 2008 12.5 7.0 N/A 2008 55.4 58.4 N/A 2008 49.1 52.6 N/A 2008 74.2 61.3 N/A 2008 70.1 70.4 N/A 2008 42.8 49.7 N/A 2008 48.3 37.2 N/A 2008 51.5 64.0 N/A 2008 34.3 26.0 N/A 2008 36.0 34.7 N/A 2008 35.4 51.4 N/A 2008 10.8 12.9 N/A Madison County 2010 – 2013 Community Health Assessment Report T.1 T.1 ago Among recent former smokers, the NYS law prohibiting smoking in all workplaces, including bars and restaurants, had at least one positive impact on your tobacco use Among recent former smokers, the increased price of tobacco caused some positive effect on your tobacco use 2008 18.5 17.8 N/A 2008 51.5 42.0 N/A (December 2008). Community Tobacco Survey of Adult Residents of Madison County (New York). Retrieved June 4, 2009, from Tobacco Free Madison County. ^-per 100 *- per 1,000 **- per 10,000 ***- per 100,000 ****-1,000,000 Kwic.22 Kwic.23 Kwic.24 Kwic.25 Kwic.26 Kwic.27 Kwic.28 Kwic.29 Kwic.30 Kwic.31 Kwic.32 Kwic.33 Kwic.34 2006/07 Madison County 70.1 New York State 67.3 Healthy People 2010 N/A 2006/07 72.3 68.1 N/A 2006/07 76.6 68.3 N/A 2006/07 72.1 63.4 N/A 2006/07 65.5 58.0 N/A 2006/07 67.3 57.2 N/A 2006/07 86.2 85.3 N/A 2006/07 78.6 80.0 N/A 2006/07 75.1 76.2 N/A 2006/07 73.2 71.4 N/A 2006/07 83.1 66.6 N/A 2006/07 65.9 59.0 N/A 2006/07 92.1 85.3 N/A KWIC Year Student Performance in English Language Arts Public Schools - Grade 3 (%) Student Performance in English Language Arts Public Schools - Grade 4 (%) Student Performance in English Language Arts Public Schools - Grade 5 (%) Student Performance in English Language Arts Public Schools - Grade 6 (%) Student Performance in English Language Arts Public Schools - Grade 7 (%) Student Performance in English Language Arts Public Schools - Grade 8 (%) Student Performance in Mathematics - Public Schools - Grade 3 (%) Student Performance in Mathematics - Public Schools - Grade 4 (%) Student Performance in Mathematics - Public Schools - Grade 5 (%) Student Performance in Mathematics - Public Schools - Grade 6 (%) Student Performance in Mathematics - Public Schools - Grade 7 (%) Student Performance in Mathematics - Public Schools - Grade 8 (%) Student Performance in Science -Public Schools Grade 4 (%) 150 Madison County 2010 – 2013 Community Health Assessment Report Kwic.35 Kwic.36 Kwic.37 Kwic.38 Kwic.39 Kwic.40 Kwic.41 Kwic.42 Kwic.43 Kwic.44 Kwic.45 Kwic.46 Kwic.47 Kwic.48 Kwic.49 Kwic.50 Kwic.51 Kwic.52 Kwic.53 Kwic.54 Kwic.55 Student Performance in Science -Public Schools Grade 8 (%) Student Performance in Social Studies -Public Schools - Grade 5 (%) Student Performance in Social Studies -Public Schools - Grade 8 (%) Students with Limited English Proficiency - Public and NonPublic Schools (%) Referral to Court - JD Intakes* Referral to Court - JD Intakes by Outcomes – Adjusted (%) Referral to Court - JD Intakes by Outcomes - Referred for Court Petition After Diversion Attempt (%) Referral to Court - JD Intakes by Outcomes - Referred for Court Petition Immediately (%) Referral to Court - JD Offenses Designated as Felonies (%) Young Adult Arrests Property Crimes - 16-21 years** Young Adult Arrests - Violent Crimes - 16-21 years** Foster Care Admissions Children/Youth Admitted to Foster Care* Foster Care Adoption Milestone - Children/Youth Discharged to Adoption (%) Foster Care Adoption Milestone - Children/Youth Freed for Adoption (%) Foster Care Adoption Milestone - Children/Youth Placed for Adoption (%) Foster Care Adoption Milestone - Children/Youth with Adoption Goal Set (%) Foster Care Children In Care - Children/Youth 0-17 years (pre-2000)* Foster Care Children In Care - Children/Youth 0-21 years* Foster Care Discharges Children/Youth Discharged from Foster Care (%) Foster Care Surrendered Judgments - Surrendered Parental Rights (%) Foster Care TPR Judgments - Dismissed or Withdrawn 2006/07 83.5 64.7 N/A 2006/07 89.1 78.3 N/A 2006/07 65.4 56.9 N/A 2006/07 0.1 7.9 N/A 2006 14.5 16.2 N/A 2006 76.9 32.4 N/A 2006 5.1 7.4 N/A 2006 0.0 58.9 N/A 2006 0.0 0.1 N/A 2007 124.2 153.6 N/A 2007 9.2 93.3 N/A 2007 4.5 2.9 N/A 2007 22.2 40.2 N/A 2007 3.0 5.3 N/A 2004 43.5 21.6 N/A 2004 8.1 7.4 N/A 2000 6.3 8.5 N/A 2007 3.7 4.9 N/A 2007 38.4 33.7 N/A 2005 0.0 74.4 N/A 2007 0.0 30.7 N/A 151 Madison County 2010 – 2013 Community Health Assessment Report Kwic.56 Kwic.57 Kwic.58 Judgments (%) Foster Care TPR Judgments - Other Judgments (%) Foster Care TPR Judgments - Suspended Judgments (%) Foster Care TPR Judgments - Terminated Judgments (%) 2007 50.0 5.4 N/A 2007 0.0 7.2 N/A 2007 50.0 58.7 N/A All: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.22 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.23 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.24 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.25 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.26 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.27 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.28 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.29 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.30 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.31 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.32 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.33 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.34 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.35 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.36 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.37 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.38 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.39 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.40 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.41 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.42 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.43 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.44 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.45 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.46 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.47 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.48 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.49 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.50 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 152 Madison County 2010 – 2013 Community Health Assessment Report Kwic.51 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.52 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.53 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.54 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.55 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.56 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.57 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Kwic.58 KWIC Region Profile: Madison County. Retrieved June 4, 2009, from NYSKWIC Web site: http://www.nyskwic.org/access_data/region_profile.cfm?countyID=36053 Literacy LIT.1 LIT.2 LIT.3 Year Students in Private Schools in Grades 1 to 8 (%) Students in Private Schools in Grades 9 to 12 (%) Students in private undergraduate colleges (%) Madison County 4.6% New York State 14.0% Healthy People 2010 N/A 3.2% 13.2% N/A 54.2% 38.2% N/A Madison County Indicators for Tracking Public Health Priority Areas Indicator % of adults with health care 1 coverage % of adults with regular health care 1 provider % of adults who have seen a dentist in 1 the past year Breast Cervical Colorectal % cigarette smoking in adolescents (past month) 1 % cigarette smoking in adults 3 Indicator st 5 96%† 83%† 80% 65% 50% 12% 12%† COPD hospitalizations among adults 4 18 + years (per 10,000) Male Female % early prenatal care (1 trimester) Prevention Agenda 2013 Objective 100%† 5 % low birthweight births (<2500 grams) 6 Infant mortality (per 1,000 live births) 31.0 * 62.0 * 41.0 Prevention Agenda 2013 Objective 90%† 5%† 4.5† 153 US NYS 85.5% (2006) 80% (2006) 70.3% (2006) 63% 53% 40% (19962003) 23.0% (2005) 20.1% (2006) 23.0 (2004) * 85.3 * 54.2 (2004) US 86.5% (2006) 85.0% (2006) 71.8% (2006) 63% 51% 41% (2001-2005) 83.9% (2005) 8.2% (2005) 6.9 (2005) 74.9% (2004-2006) 8.3% (2004-2006) 5.8 (2004-2006) 16.3% (2006) 18.2% (2006) 39.7 (2004-2006) * 80.8 * 53.8 (2001-2005) NYS Madison County 86.2% (2003) NA 68.7% (2003) 67% s 50% (2001-2005) NA 29.3% (2003) 34.6 (2004-2006) * 98.1 * 64.7 (2001-2005) Madison County 79.4% (2004-2006) 7.0% (2004-2006) 4.6~ (2004-2006) Madison County 2010 – 2013 Community Health Assessment Report Increase % of 2 year old children who receive recommended vaccines (4 DTaP, 3 polio, 1 MMR, 3 Hib, 3 HepB) 90% 80.5% (2006) 82.4% (2006) NA % of children with at least one lead 8 screening by age 36 months 96% - 80.8% (2004 birth cohort) 42%† 53.0% (2004) 44.4 (2002) US 82.8% (NYS excl. NYC) (2004 birth cohort) 54.1% (2004) 36.7 (2004-2006) NYS 7 rd Prevalence of tooth decay in 3 grade 9 children Pregnancy rate among females aged 10 15-17 years (per 1,000) Indicator 2-4 Years (WIC) 11 (pre-school) 12 28.0 Prevention Agenda 2013 Objective 11.6% K 2 4 7 10 1 % of adults who are obese (BMI>30) 5%† 5%† 5%† 5%† 5%† 15%† % of adults engaged in some type of 1 leisure time physical activity % of adults eating 5 or more fruits or 1 vegetables per day % of WIC mothers breastfeeding at 6 11 months Unintentional Injury mortality (per 13 100,000) Unintentional Injury hospitalizations 14 (per 10,000) Motor vehicle related mortality (per 13 100,000) Pedestrian injury hospitalizations (per 15 10,000) Fall related hospitalizations age 65+ 15 years (per 10,000) Indicator 80%† Incidence of children <72 months with confirmed blood lead level >= 10 µg/dl 14 (per 100 children tested) 0.0† Total Ages 0-17 years Work related hospitalizations (per 10,000 employed persons aged 14 16+ years) Elevated blood lead levels (>25 µg/dl) per 100,000 employed 14 persons age 16+ years Indicator 33% 50%† 17.1† 44.5 5.8 * 1.5 * * * 14.8% (2004) 25.1% (2006) 77.4% (2006) 23.2% (2005) 24.3% (2005) * 39.1 (2005) 15.2 * (2005) - 155.0 - Prevention Agenda 2013 Objective US - * * 16.7 17.3† 11.5 16.6 22.6 (2003) - 0.0† - Prevention Agenda 2013 Objective 154 US 15.2% (2004-2006) 22.9% (2006) 74.0% (2006) 27.4% (2007) 38.6% (2004-2006) * 21.0 (2004-2006) * 64.7 (2004-2006) 7.7 * (2004-2006) * 1.9 (2004-2006) 196.0 (2004-2006) NYS 1.3 (2003-2005) (Rate for NYS Excluding NYC) * 21.0 31.5 (2004-2006) 16.0 (2004-2006) 46.0% (2004) 14.2 (2004-2006) Madison County 13.9% (2004-2006) NA NA NA NA NA 23.5% (2003) 72.4% (2003) 20.6% (2003) 21.9% (2004-2006) * 29.7 (2004-2006) * 52.3 (2004-2006) * 15.6 (2004-2006) * 0.5~ (2004-2006) 138.4 (2004-2006) Madison County 1.1 (2003-2005) * 10.1 10.6 (2004-2006) 18.6 (2004-2006) 6.0 (2004-2006) 2.9~ (2004-2006) NYS Madison County Madison County 2010 – 2013 Community Health Assessment Report Diabetes prevalence in adults 1 5.7% Age 6-17 years Age 18+ years 2.3 3.9 Coronary heart disease 14 hospitalizations (per 10,000) Congestive heart failure hospitalization 17 rate per 10,000 (ages 18+ years) Cerebrovascular (Stroke) disease 13 mortality (per 100,000) Breast (female) Cervical Colorectal 48.0 33.0 24.0 * * 21.3 † * 2.0 † * 13.7 † Indicator Prevention Agenda 2013 Objective Newly diagnosed HIV case rate (per 18 100,000) 19 Gonorrhea case rate (per 100,000) Tuberculosis case rate (per 100,000) 23.0 20 1.0† 90%† 90%† % population living within jurisdiction with state-approved emergency 21 preparedness plans Indicator 13 100% 4.8† * Prevention Agenda 2013 Objective % adults reporting 14 or more days 1 with poor mental health in last month 7.8% % binge drinking past 30 days 1 (5 + drinks in a row) in adults Drug-related hospitalizations (per 22 10,000) 13.4%† 48.9 (2004) * 46.6 (2005) * 24.4 * 2.4 * 18.0 (2004) US 18.5 (2006) 120.9 (2006) 4.4 (2007) 69.6% 66.9% (2006) - 19.0† flu shot past year ever pneumonia Suicide mortality rate (per 100,000) 7.5% (2006) 2.9 5.5 (2004) - 24.0 (2004-2006) 93.4 (2004-2006) 6.8 (2004-2006) 64.7% 61.0% (2006) 100% (2007) US * 10.9 (2005) 10.1% (20022006) 15.4% (2006) - 26.0 7.6% (2006) 3.0 5.3 (2004-2006) * 61.2 (2004-2006) 46.3 (2004-2006) * 30.5 (2004-2006) * 25.5 2.6* * 19.1 (2001-2005) NYS NYS 5.3% (2003) 1.2~ 3.3 (2004-2006) * 59.8 (2004-2006) 28.0 (2004-2006) * 43.6 (2004-2006) * 29.0 * 1.9 * 25.8 (2001-2005) Madison County 3.3~ (2004-2006) 12.3 (2004-2006) 0.0~ (2004-2006) 69.9% 76.9% (2003) 100% (2007) 6.4 (2004-2006) 10.4% (2003-2005) Madison County * 9.3 (2004-2006) 9.2% (2003) 15.8% (2006) * 34.0 (2004-2006) 15.8% (2003) * 7.6 (2004-2006) * † Healthy People 2010 Goal utilized * Rate age-adjusted to the 2000 US population ~ Fewer than 20 events in the numerator; rate is unstable s Suppressed (percent could not be calculated, fewer than 3 cases per year) DATA SOURCES NYS (statewide) and US Data Source: Centers for Disease Control, Behavioral Risk Factor Surveillance System, http://apps.nccd.cdc.gov/brfss/index.asp and http://www.cdc.gov/brfss/technical_infodata/surveydata/2006.htm, NYS (county level) Data Source: NYS Department of Health, Expanded Behavioral Risk Factor Surveillance System (Expanded BRFSS), http://www.health.state.ny.us/nysdoh/brfss/expanded/2003/index.htm. Note: the Expanded BRFSS survey 38 localities (including individual counties and county groupings. For a list of counties and county groupings, http://www.health.state.ny.us/nysdoh/brfss/expanded/2003/docs/rptstlocreg.pdf. NYS (statewide and county level) Data Source: NYS Cancer Registry, http://www.health.state.ny.us/statistics/cancer/registry/, US Data Source: National Cancer Institute, SEER Fast Stats, http://seer.cancer.gov/data/ NYS (statewide) Data Source: New York State Department of Health, Youth Tobacco Surveillance New York State 2006, http://www.health.state.ny.us/prevention/tobacco_control/youth_tobacco_survey.htm, US Data Source: Centers for Disease Control, Youth Risk Behavior Survey, http://www.cdc.gov/HealthyYouth/yrbs/ NYS (statewide and county level) Data Source: New York State Department of Health, Statewide Planning and Research System (SPARCS); US Data Source: AHRQ Quality Indicators, http://www.qualityindicators.ahrq.gov NYS (statewide and county level) Data Source: NYS Department of Health - Vital Statistics, NYS Community Health Data Set, http://www.health.state.ny.us/statistics/chac/chds.htm, US Data Source: Centers for Disease Control, National Vital Statistics Reports, Volume 56, Number 6 Births: Final Data for 2005 http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf 155 Madison County 2010 – 2013 Community Health Assessment Report NYS (statewide and county level) Data Source: NYS Department of Health - Vital Statistics, NYS Community Health Data Set, http://www.health.state.ny.us/statistics/chac/chds.htm, US Data Source: Centers for Disease Control, National Vital Statistics Reports, Volume 56, Number 10 Deaths: Final Data for 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf NYS (statewide) and US Data Source: Centers for Disease Control, National Immunization Survey (NIS), http://www.cdc.gov/vaccines/stats-surv/nis/data/tables_2006.htm NYS (statewide and county level) Data Source: NYS Department of Health, NYS Childhood Lead Program NYS (statewide and county level) Data Source: NY State Oral Health Surveillance System, http://www.health.state.ny.us/prevention/dental/docs/child_oral_health_surveillance.pdf, US Data Source: Healthy People Data 2010, Oral Health, http://wonder.cdc.gov/data2010/focus.htm NYS (statewide and county level) Data Source: NYS Department of Health - Vital Statistics, NYS Community Health Data Set, http://www.health.state.ny.us/statistics/chac/chds.htm, US Data Source: Centers for Disease Control, National Center for Health Statistics, Recent Trends in Teenage Pregnancy in the US, 1990 – 2002, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/teenpr eg1990-2002/teenpreg1990-2002.htm NYS (statewide and county level) and US Data Source: NYS Department of Health, The Pediatric Nutrition Surveillance System, http://www.health.state.ny.us/statistics/prevention/nutrition/cacfp/pednss/index.htm NYS (statewide and county level) Data Source: NYS Department of Health, Division of Chronic Disease Prevention and Adult Health, Program Data. NYS (statewide and county level) Data Source: NYS Department of Health - Vital Statistics, NYS County Health Assessment Indicators, http://www.health.state.ny.us/statistics/chac/chai/, US Data Source: Centers for Disease Control, National Vital Statistics Reports, Volume 56, Number 10 Deaths: Final Data for 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf NYS (statewide and county level) Data Source: NYS Department of Health, NYS County Health Assessment Indicators, http://www.health.state.ny.us/statistics/chac/chai/ NYS (statewide and county level) Data Source: New York State Department of Health, Statewide Planning and Research System (SPARCS) NYS (statewide and county level) Data Source: NYS Department of Health, NYS Asthma Surveillance Summary Report, http://www.health.state.ny.us/statistics/ny_asthma, US Data Source: National Hospital Discharge Survey 2005, http://www.cdc.gov/nchs/data/series/sr_13/sr13_165.pdf NYS (statewide and county level) Data Source: New York Department of Health, State Planning and Research System (SPARCS); US Data Source: AHRQ Quality Indicators, http://www.qualityindicators.ahrq.gov NYS (statewide and county level) Data Source: NYS Department of Health, NYS County Health Assessment Indicators, http://www.health.state.ny.us/statistics/chac/chai/, US Data Source: Centers for Disease Control, HIV/AIDS Surveillance, http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/us_media.pdf NYS (statewide and county level) Data Source: New York Department of Health, Communicable Disease Annual Reports, http://www.health.state.ny.us/statistics/diseases/communicable/2006/, US Data Source: Centers for Disease Control, STD Surveillance, http://www.cdc.gov/STD/stats/tables/table1.htm NYS (statewide and county level) Data Source: NYS Department of Health, NYS County Health Assessment Indicators, http://www.health.state.ny.us/statistics/chac/chai/, US Data Source: Centers for Disease Control, MMWR Weekly, March 21, 2008, Trends in Tuberculosis – United States 2007, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2 NYS (statewide and county level) Data Source: NYS Department of Health, Emergency Preparedness Program data NYS (statewide and county level) Data Source: NYS Department of Health, NYS Community Health Data Set, http://www.health.state.ny.us/statistics/chac/chds.htm http://www.health.state.ny.us/prevention/prevention_agenda/county/indicators_matrix_madison.htm Participant Category Women Infants Children Total Estimated WIC Eligibles 1167 700 2075 3942 March 2009 Participation 423 439 1002 1864 % Eligible Served 36% 63% 48% 47% Source: Linda B. Whalen, RD, Public Health Nutritionist II Indicator Ind.1 Ind.2 Ind.3 Ind.4 % of adults with health care coverage % of adults with regular health care provider % of adults who have seen a dentist in the past year Early stage cancer diagnosis: 1998 2005 2009 84% (18-64) 86.2 Prevention Agenda 2013 Objective 100.0 N/A 96.0 68.7 83.0 67.0 80.0 60.7% 156 Madison County 2010 – 2013 Community Health Assessment Report Ind.5 Ind.6 Ind.7 Ind.8 Ind.9 Ind.10 Ind.11 Ind.12 Ind.13 Ind.14 Ind.15 Ind.16 Ind.17 Ind.18 Ind.19 Ind.20 Ind.21 Ind.22 Ind.23 Ind.24 Ind.25 Ind.26 Ind.27 Ind.28 Breast Cervical Colorectal % cigarette smoking in adolescents (past months) % cigarette smoking in adults COPD hospitalizations among adults 18 + years (per 10,000) Lung cancer incidence (per 100,000): Male Female % early prenatal care (1st trimester) % low birthweight births (<2500 grams) Infant mortality (per 1,000 live births) Increase % of 2 year old children who receive recommended vaccines (4 DTaP, 3 polio, 1 MMR, 3 Hib, 3 HepB) % of children with at least one lead screening by age 36 months Prevalence of tooth decay in 3rd grade children Pregnancy rate among females aged 15-17 years (per 1,000) % of obese children by grade level: (BMI for age>95th percentile): 2-4 Years (WIC) (preschool) % of adults who are obese (BMI>30) % of adults engaged in some type of leisure time physical activity % of adults eating 5 or more fruits or vegetables per day % of WIC mothers breastfeeding at 6 months Unintentional Injury mortality (per 100,000) Unintentional Injury hospitalizations (per 10,000) Motor vehicle related mortality (per 100,000) Pedestrian injury hospitalizations (per 10,000) Fall related hospitalizations 64.3% Suppressed 50.0 N/A 65.0 50.0 12.0 Mortality 54.2*** 29.3% Mortality 45+ age 137.9*** 29.3 34.6 12.0 31.0 Mortality m/f 49.1*** 66.5*** mortality 98.1 62.0 64.7 41.0 Mortality m/f 49.1*** 83.3% 81.7% 79.4 90.0 5.6% 7.2% 7.0 5.0 11.9* 7.1* 4.6 4.5 N/A 90.0 80.8 96.0 46.0 42.0 14.2 28.0 13.9 11.6 23.5% 23.5 15.0 72.4% 72.4 80.0 20.6 33.0 21.9 50.0 34.9*** 29.7 17.1 494.3*** 52.3 44.5 14.6*** 15.6 5.8 0.5 1.5 138.4 155.0 39.9* (1519) 30.9***acc ident 19.6*** 30.5* 157 Madison County 2010 – 2013 Community Health Assessment Report Ind.29 Ind.30 Ind.31 Ind.32 Ind.33 Ind.34 Ind.35 Ind.36 Ind.37 Ind.38 Ind.39 Ind.40 Ind.41 Ind.42 Ind.43 Ind.44 Ind.45 Ind.46 Ind.47 Ind.48 Ind.49 Ind.50 age 65+ years (per 10,000) Incidence of children <72 months with confirmed blood lead level >= 10 µg/dl (per 100 children tested) Asthma related hospitalizations (per 10,000): Total Ages 0-17 years Work related hospitalizations (per 10,000 employed persons aged 16+ years) Elevated blood lead levels (>25 µg/dl) per 100,000 employed persons age 16+ years Diabetes prevalence in adults Diabetes short-term complication hospitalization rate (per 10,000): Age 6-17 years Age 18+ years Coronary heart disease hospitalizations (per 10,000) Congestive heart failure hospitalization rate per 10,000 (ages 18+ years) Cerebrovascular (Stroke) disease mortality (per 100,000) Reduce cancer mortality (per 100,000): Breast (female) Cervical Colorectal Newly diagnosed HIV case rate (per 100,000) Gonorrhea case rate (per 100,000) Tuberculosis case rate (per 100,000) % of adults 65+ years with immunizations: flu shot past year ever pneumonia % population living within jurisdiction with stateapproved emergency preparedness plans Suicide mortality rate (per 100,000) % adults reporting 14 or more days with poor mental health in last month .2% 2.5% (1-5 age) 1.1 0.0 120.4*** discharge rate 10.1 16.7 10.6 18.6 17.3 11.5 2.9 0.0 5.3 5.7 1.2 2.3 3.3 59.8 3.9 48.0 28.0 33.0 43.6 24.0 Mortality 17.8*** 51.0*** 23.1*** 29.3*** 29.0 21.3 2.8*** 41.9*** .7*** incidence, 7.2*** prev. 12.6*** 2.1*** 24.9*** 0.0*** (13+. HIV/AIDS) 1.9 25.8 3.3 2.0 13.7 23.0 12.9***incidenc e .5*** 12.3 19.0 0.0 1.0 69.9 90.0 76.9 100.0 90.0 100.0 9.3 4.8 9.2 7.8 1.4*** 6.5*** 12.9*** 158 Madison County 2010 – 2013 Community Health Assessment Report Ind.51 Ind.52 % binge drinking past 30 days (5 + drinks in a row) in adults Drug-related hospitalizations (per 10,000) Issue Sulfur Dioxide OA.1 Carbon Monoxide Particulate Matter OA.2 Ozone OA.3 13.4 5.0** 7.6 26.0 2007 Madison County .002 ppm New York State .004 ppm 2008 .50 ppm .35 ppm + .15 ppm 20052007 9.8 um/m3 10.3 ug/m3 - .5 um/m3 Outdoor Air Quality Year Average Sulfur Dioxide Levels* (ppm) (Continuous Pulsed Florescence) Average Carbon Monoxide Levels* (ppm) Annual Mean Particulate Matter (PM2.5) Levels* (ug/m3) th Comparison - .002 ppm Average Annual 98 Percentile Values for PM2.5* (ug/m3) 20052007 28 ug/m3 29.7 ug/m3 - 1.7 ug/m3 OA.5 Number of Days with Eight Hour Ozone Averages Greater Than .075 ppm* Average Ozone Levels* (ppm) 2008 3 days 171 days 1.8% of total NYS days 2007 .031 ppm .030 ppm - .001 ppm OA.7 Asthma Hospital Discharge Rates per 10,000 Individuals 20052007 20.5 discharges - 11 discharges OA.8 Deaths from Asthma per 1,000,000 Individuals 20052007 9.5 discharge s 0 deaths 12.5 deaths - 12.5 deaths OA.9 Chronic Obstructive Pulmonary Disease (COPD) Discharge Rates per 10,000 Individuals Deaths From COPD Per 10,000 Individuals 20052007 39.11 discharges - 10.95 discharges 20052007 28.16 discharge s 6.36 deaths 3.49 deaths + 2.87 deaths Number of days with air quality labeled “unhealthy for sensitive groups” Number Of Days With Air Quality Labeled “Unhealthy” Percent of Workers Who Commute By Car, Truck, Or Van 2008 3 days 103 days 2.9% of total days 2008 0 days 3 days 2000 88.1% 65.5% 0% of total days + 22.6% Percent Of Population Who Utilize Public Transportation/Walks/Bikes Works From Home For Commute Average Commute Time For Workers Ages 16+ Percent Of Workers Who Commute 30+ Minutes To Work, Using Private Transportation 2000 11.2% 33.9% - 22.7% 2000 22.6 minutes 33.3% 31.7 minutes 9.1 minutes 33.9% - .6% OA.10 OA.11 OA.12 Vehicle Emissions 15.8 OA.4 OA.6 Health Impacts 15.8 OA.13 OA.14 OA.15 OA.16 2000 *Based on Air Quality Data from the Region 7 EPA Air Quality Monitoring Stations of Camp Georgetown and East Syracuse, where data was available. 159 Madison County 2010 – 2013 Community Health Assessment Report OA.1 NYSDEC Ambient Air Quality Monitoring Reports 2007, http://www.dec.ny.gov/chemical/8536.html OA.2 NYSDEC Ambient Air Quality Monitoring Reports 2008, http://www.dec.ny.gov/chemical/8536.html OA.3 NYSDEC Ambient Air Quality Monitoring Reports 2005-2007, http://www.dec.ny.gov/chemical/8536.html OA.4 NYSDEC Ambient Air Quality Monitoring Reports, http://www.dec.ny.gov/chemical/8536.html OA.5 NYSDEC Ambient Air Quality Monitoring Reports 2008, http://www.dec.ny.gov/chemical/38377.html OA.6 NYSDEC Ambient Air Quality Monitoring Reports 2007, http://www.dec.ny.gov/chemical/8536.html OA.7 NYS Department of Health Asthma Hospital Discharges 2005-2007, http://www.health.state.ny.us/statistics/ny_asthma/hosp/asthma6.htm OA.8 NYS Department of Health Asthma Deaths and Death Rates 2005-2007, http://www.health.state.ny.us/statistics/ny_asthma/mort/ast0.htm OA.9 SPARC Rate Profiles 2005-2007, http://www.nyhealth.gov/statistics/sparcs/ OA.10 SPARC Rate Profiles 2005-2007, http://www.nyhealth.gov/statistics/sparcs/ OA.11 US Environmental Protection Agency Air Quality Index 2008, http://www.epa.gov/air/data/reports.html OA.12 US Environmental Protection Agency Air Quality Index 2008, http://www.epa.gov/air/data/reports.html OA.13 – OA.16 US Census 2000, http://factfinder.census.gov/ 160
© Copyright 2024