The Health of Olmsted County 2004 H R COMMUNITY EALTH EPORT CARD Table Of Contents Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Table of Contents, Introduction, Demographics, Terms and Indicators Health Status Indicators Leading Causes of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 All Ages, Due to Unintended Injury Lifestyle Choices Contributing to Premature Illness & Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Overweight, Tobacco Use, Alcohol Use Pregnancy and Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Low Birth Weight, Infant Mortality, Early Prenatal Care, Smoking during Pregnancy Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Youth Self Esteem, Suicide Poverty and Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Children and Adults 65+ living in Poverty, Child Maltreatment Teen Sexual Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Sexually Active, Sexually Active and Use Birth Control Teen Pregnancy and Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Preschool Immunizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Gastrointestinal Illnesses, HIV Infection, Sexually Transmitted Diseases, Tuberculosis Environmental Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Air Quality, Drinking and Surface Water Quality, Foodborne Disease Outbreaks Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Introduction Dear Citizens of Olmsted County: Olmsted County Public Health Services is pleased to release the 2004 Community Health Report Card, providing a picture of the health and well-being of Olmsted County residents. This second edition of the report card is designed to follow the national Healthy People 2010 Report, which is grounded in science, built through consensus, and designed to measure progress on health indicators. The purpose of the report card is to: Inform people about the current health status of our residents using key health indicators; Provide information for policy development; and Provide a benchmark to measure progress and improvement in health status. Public health issues cover a broad scope - pregnancy and birth, immunizations, mental health, environmental conditions, and health care access, to name a few. We hope these local health indicators enhance your understanding of Olmsted County's overall health status. This report used the most current data available at the time of printing. Not all indicators of the community's health are measured locally, thus certain key information is not indicated in this report. Lack of consistent reliable data about the local community should not minimize the importance of an issue and its impact on health and quality of life. Sincerely, Mary Wellik, Director Olmsted County Public Health Page 2 County Demographics According to the 2000 U.S. Census, the resident population of Olmsted County was 124,277, making it the 8th largest county in the state of Minnesota. Sixty-nine percent of the population lives in the city of Rochester. The median age of Olmsted County residents was 35 years in 2000. Residents under age 18 made up 27% of the population, while those aged 65 years and older made up 11% of the population. The population is 51% female. Rochester and Olmsted County have seen significant increases in populations of ethnic minorities in recent years. Minorities (races other than White and/or Hispanic-Latino persons) now make up almost 11% of Olmsted County's total population. Despite a relatively high median household income, inequalities in income and education still exist. Generally, population groups that suffer the worst health status also have the highest poverty rates and the least education. Disparities are associated with higher amounts of illness and death, including heart disease, diabetes, obesity, elevated blood lead levels, and low birth weights. Higher incomes permit increased access to medical care, enable people to afford better housing and live in safer neighborhoods, and increase the opportunities to engage in healthy behaviors. Terms and Indicators Olmsted County Public Health Services used the national consensus indicators as a basis for selecting community level indicators for this Report. Priority in selecting the final indicators was given to measures for which data are readily available and that are commonly used in public health. The indicators are intended to ensure data comparability and provide a broad indication of the general health status of our community at a point in time. Throughout the report, we have tried to use rates and percentages as much as possible to describe our community, and then compare those findings with the state. No matter how accurate the data seems to be, the level of health, disease, or health perceptions present in Olmsted County can never be entirely known. It is also important to keep in mind demographics and socioeconomic factors as they can significantly impact one's health. The following rating key is used periodically in this report card, and provides a quick reference as to the health status of our community for each of the indicators selected. The ratings were assigned based on positive or negative trends over time and/or increases or decreases in risk exposures. When available, national or state goals are included as a reference point to show the gap between where we are and where we would like to get. Please note: not all indicators have a corresponding state or national goal, and some of the selected indicators have not been assigned a rating because the data represents a point in time and not a trend over time. Movement in wrong direction No movement or significant change Movement in right direction Page 3 Leading Causes of Death Leading Causes of Death, all ages, Olmsted County1 2000 Leading Causes of Death Due to Unintended Injuries, Olmsted County1 2000 12% 25% 5% 22% 38% 9% 6% 5% 6% 36% 36% Heart Disease Stroke Chronic Resp. Disease Falls Poisoning Cancer Unintended Injury Other Motor Vehicle Other Suffocation The leading causes of death are now associated with chronic diseases and not infectious diseases. Cancer and heart disease now account for nearly 47% of all deaths in Olmsted County, and are associated with lifestyle and individual behaviors. Promoting good nutritional habits and adequate physical activity will help decrease chronic diseases. Unintentional injuries account for 5% of the total deaths and falls are now the leading cause of death due to injuries. Falls disproportionately affect young children and older adults. Increased awareness of potential hazards, improved motor skills and balance, along with continued safety precautions can reduce injuries and death due to falls. Lifestyle Choices Contributing to Premature Illness & Death Overweight Adults2 70 60 55 56 55 55 58 58 50 percent 40 40% 30 20 10 0 1999 Color Key Page 4 2000 2002 The prevalence of overweight is defined as a Body Mass Index (BMI) greater than or equal to 25 for men and women. Overweight for all ages has increased dramatically all across the country over the past decade. Behaviors established in childhood such as poor eating patterns and lack of physical activity, become more difficult to change with age. A 1999 CardioVision 2020 survey provided local data regarding adult nutritional and daily physical activity habits, however it has not been repeated. There are no other data available at the local level to assess these behaviors. Addressing the issue of overweight will take a comprehensive and aggressive approach from schools, businesses, medical professionals and environmental planners. Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota Goal Tobacco Use & Exposure Weekly Cigarette Use by 12th Graders3 40 40 30 30 20 17 17 percent percent Weekly Cigarette Use by 9th Graders3 20 16 13 10 10 10% 20 31 28 26 28 24 21 15% 10 0 0 1995 1998 2001 1995 1998 2001 Tobacco use among youth has decreased or stayed level for the past several years, due in large part to the targeted funds for tobacco prevention initiatives across the state following the tobacco settlement in 1998. The optimal strategy is a comprehensive approach involving smoke-free environments, evidence-based prevention curriculum, reduced youth access and youth led - adult guided activities. Targeted tobacco prevention funding has been substantially reduced, and youth smoking rates may rise again in the future as a result. Current Adult Cigarette Use2 Percent of Smoke Free Food and Beverage Establishments4 35 100 23 23 20 20 20 22 75 22 15 15% 10 percent percent 25 85 84 30 80% 67 50 33 25 16 15 5 0 0 1992 1998 2002 1999 2002 Smoke-Free 2003 Not Smoke-free The adult smoking rate has been relatively stable for the past several years. Young adults represent the largest percentage of smokers, and increased emphasis will be needed to reach out to this group to prevent them from starting, and/or to help stop the addiction cycle quickly. Exposure to tobacco smoke is limited because of state restrictions and the passage of a county Smoke Free Restaurant ordinance in 2001. The ordinance does not restrict smoking in bars, defined as 50% or more of net sales from the sale of liquor. Color Key Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal Page 5 Alcohol Use Acute/Binge Alcohol Use by 9th Graders3 Acute/Binge Alcohol Use by 12th Graders3 40 40 30 30 17 percent 32 32 34 32 33 20 13 16 13 percent 20 20 29 10 20 10 5% 0 0 1995 1998 1995 2001 1998 2001 Alcohol is the most commonly used drug by youth as well as adults. In fact, nearly 63% of our 12th grade students report having drank alcohol in the last twelve months. Alcohol use, especially binge drinking (five or more alcoholic drinks on one or more occasions), affects nearly every part of the body and is directly related to lower academic performance, dropping out of college, high-risk and early sexual activity, violent behavior, and death and injury from alcohol-related car crashes. Acute/Binge Alcohol Use by Adults (18 Yrs. +)2 25 21 20 17 16 18 21 18 percent 15 10 6% 5 0 1999 Color Key Page 6 2000 2002 Minnesota has one of the highest rates of adult alcohol use in the nation. Olmsted County ranks 7th in the state for alcohol-related motor vehicle injuries and fatalities. Binge drinking continues to increase, as does the percentage of adults who chronically use alcohol. Binge drinking seriously impairs physical, motor and coordination skills necessary to function safely, and longterm drinking contributes to several chronic diseases. Strategies to reduce alcohol use must include changing the social acceptance and tolerance of excessive alcohol use. Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal Pregnancy & Birth 5-Year Infant Death Rate (per 1,000 births)1 10 10 8 8 6 4 3.9 4.4 5.2 4.9 4.6 4.6 3.5% 2 rate per 1,000 percent Percent of Low Birth Weight (single births only)1 0 6.8 7.4 6.6 6.4 5.4 6 5.7 5.0 4 2 0 2000 2001 2002 88-92 87-92 93-97 98-02 Infants born at low birth weights weigh less than 2500 grams (5 lbs 8 oz). They have higher rates of health problems, developmental delays, and risk of death than babies born at higher weights. To increase the chances of a normal weight infant women need early and ongoing prenatal care, good nutrition, and must refrain from smoking and drinking. The Minnesota 2004 Goal for infant death is a rate of 5.0 per 1,000 live births or fewer. Since the early 1970's, the infant death rates have decreased by over 50% for both Olmsted County and the state. Percent of Prenatal Care Received In 1st Trimester1 100 80 80 84 87 86 100 90% 92 88 91 89 92 89 99% 80 60 percent percent 88 88 Percent of Women Who Did Not Smoke During Pregnancy1 40 20 60 40 20 0 0 1998 2001 2002 1999 2000 2001 Prenatal heath care received in the first 3 months of pregnancy for assessments, risk screening, health education, and referrals to community resources help prevent problems in the unborn baby and mother. The percent of women who access prenatal care is nearing the Minnesota 2004 Goal of 90%. Cigarette smoking is a leading cause of low birth weight and has been linked to prematurity and infant death. Smoking prevention and cessation education is critical to the health of baby and mom. Color Key Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal Page 7 Mental Health 9th Grade Females Who Usually Feel Good About Themselves3 100 100% 78 78 79 80 78 100 87 78 89 90 90 100% 87 87 80 60 60 percent percent 80 9th Grade Males Who Usually Feel Good About Themselves3 40 20 40 20 0 0 1995 1998 2001 1995 1998 2001 Mental health is critical to a person's well being and self-esteem is a key factor in adolescent health. Along with everything else they deal with, adolescents face issues about how they see themselves and how their peers see them. In Olmsted County, 9th grade females report feeling good about themselves less often compared to males. Adolescents who have low self-esteem or who feel that their lives are meaningless are at a greater risk for depression, alcohol and drug use, and suicidal thoughts and/or behaviors. Suicide Rates (per 100,000) Aggregated Data, 1998-20021 Olmsted County Age group # Rate Minnesota # Rate 10 -- 14 2 4.2 30 1.6 15 -- 19 2 4.5 170 9.8 20 -- 24 5 13.7 237 14.8 25 -- 34 4 4.4 383 11.6 35 -- 44 19 17.8 530 13 45 -- 54 9 10.8 437 13.3 55 -- 64 3 6 196 9.6 over 65 9 13.6 328 11.1 Totals 53 8.6 2311 9.7 In 2000, suicide was the tenth leading cause of death in Olmsted County and in Minnesota. Suicidal behavior is complex. Some risk factors vary with age, gender and ethnic group. Although suicide first emerges as a health threat in the teen years, rates of completed suicide are higher among adults 20 years and older. Data from 19982002, indicates the 35-44 age group had the highest rate in Olmsted County and was considerably higher than the state. MN 2004 Goal = 8.3 Color Key Page 8 Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal Poverty & Violence Percent of Children (0-18 years) Living In Poverty 5 14 Percent of Adults (65 years +) Living In Poverty 6 14 12.4 12 12 10 7.9 8 9.5 10 6.7 percent percent 9.2 12.1 10.7 6 8.2 8 6 4 4 2 2 0 0 1990 1990 2000 2000 Poverty contributes to health problems. The young and the old are especially vulnerable to poverty. The percentage of the over 65 population living in poverty in Olmsted County exceeds the state level. Poverty often results in poor nutrition, compromised child development, inadequate housing, lack of transportation, and a lack of basic health care. Maltreatment Rate (per 1,000) For Children 0-18 years7,8 12 10 9.6 8.4 8 rate per 100,000 9.2 6.7 7.6 5.9 6 6.2 4 2 0 1998 Color Key 2000 2002 Despite a slight rise in the maltreatment rate between 2000 and 2002, there has been a significant drop since 1998. Abused children are at greater risk for injury, poor health, and emotional-behavioral problems. Society suffers an economic burden, whether it is from increased health care costs, mental health services, additional educational services, social services, or correctional services. Providing family-centered support services to parents as they begin their families helps provide the parenting education and support needed to alleviate family stress. Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal Page 9 Teen Sexual Behaviors 12th Grade Males Ever Sexually Active 3 Sexually Active 12th Grade Males Who Always Use Birth Control 3 100 100 80 61 56 60 46 49 46 48 50% 40 20 percent percent 80 60 57 61 65% 60 40 0 1992 1998 2001 1992 12th Grade Females Ever Sexually Active3 1998 2001 Sexually Active 12th Grade Females Who Always Use Birth Control 3 100 100 80 80 52 60 48 51 48 50 50% 40 percent percent 55 20 0 60 62 60 20 67 63 69 65 68 69 65% 60 40 20 0 0 1992 1998 2001 1992 1998 2001 The percentage of adolescents reporting that they have had sexual intercourse continues to decline. These percentages have been declining for both 9th and 12th graders since 1989, and are very encouraging. Communication between partners about sexually transmitted disease protection has increased considerably since 1992. Females report always using birth control more than males, however the percentages are still much lower than desired. Young women who are at greatest risk need a greater concentration of effort and resources to prevent unintended pregnancies. Pregnancy prevention efforts must include increased education and include young men, as well as reducing risk taking behaviors and promotion of self-esteem, good decision-making, and family support. Color Key Page 10 Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal Teen Pregnancy & Birth 3-Year Pregnancy Rates (per 1,000) 15-19 years1 50 40 50 44 37 3-Year Birth Rates (per 1,000) 15-19 years1 41 35 40 37 40 30 Rate Rate 30 20 29 24 29 24 25 28 20 10 10 0 0 97-99 99-01 97-99 00-02 99-01 00-02 Teen mothers and their children face many difficulties such as poverty, less education, and unstable employment. Children have increased risk of abuse and neglect, health and social problems. Teens are less likely to become pregnant when they have success in school and connection with caring adults. Pregnancy prevention efforts should be early and focused on young men and women at risk for sexual behaviors leading to pregnancy. Preschool Immunizations Immunizations Received On Schedule at 20 Months of Age9 100 percent 80 81 70 66 60 46 90% 75 55 40 20 0 92-93 Color Key 96-97 00-01 00-02 In school years 1992-93, 1996-97 and 2000-01, the immunization records of nearly every kindergarten student in Minnesota were reviewed to determine immunization levels at critical ages. Olmsted County kindergarteners have had the state's highest immunization levels at the critical age of 20 months in each of these surveys. Not coincidentally, the County has also had very low rates of vaccine-preventable diseases. Immunizations for children and adults are vital to protecting a community as mobile and diverse as ours and it is important to receive those vaccinations at the appropriate time for maximum effectiveness. New recommendations now include annual influenza vaccinations for all children aged 6-23 months. Adults aged > 65 years, women in their second or third trimester, and persons with chronic conditions should also consider having annual influenza vaccinations. Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal Page 11 Infectious Diseases Infectious Gastrointestinal Disease 3-Year Case Rates (per 100,000)1 50 46.6 40.5 37.9 40 36.9 31.8 28.1 30 6.8 ‘00-’02 30 22.4 ‘97-’99 Salmonellosis Salm onellosis 20.1 ‘94-’96 ‘00-’02 Campylobacteriosis Cam phylobacteriosis 13.1 ‘97-’99 ‘94-’96 13.4 0 12.3 15.1 20.3 21 10 19.2 28 19 20 20.2 rate per 100,000 34.1 ‘97-’99 ‘94-’96 ‘00-’02 Giardiasis 27.4 25 rate per 100,000 20 15 11.6 10 8.8 10 7.9 5 5 4.2 0 ‘94-’96 4.1 ‘97-’99 E-Coli 0157:H7 2.7 ‘00-’02 0.9 1.0 ‘94-’96 4.1 3.6 ‘97-’99 ‘00-’02 Cryptosporidiosis Olmsted County has had higher rates of infectious gastrointestinal diseases than most other counties in the state for many years, but there is evidence of decline in those rates. Salmonellosis and Campylobacteriosis are common diseases in cattle, poultry and some pets. E. coli 0157:H7 has been usually associated with eating undercooked ground beef. Humans get these diseases when they eat or drink something contaminated with stool from a sick animal or human. Most outbreaks of Giardiasis involve childcare settings. Several swimming pool outbreaks of Cryptosporidiosis in 1998 contributed to high rates in that 3 year period. Color Key Page 12 Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal HIV Infection and STD’S HIV and Selected STD 3-Year Case Rates (per 100,000) 180 8 150 6.1 ‘94-’96 ‘97-’99 rate per 100,000 rate per 100,00 0 ‘00-’02 14.6 14.9 ‘97-’99 ‘94-’96 Syphilis HIV Infection at first diagnosis 16 145.1 ‘00-’02 30 56.2 ‘97-’99 60 51.8 1.4 ‘94-’96 0.5 135.8 1.7 2 2.5 63.4 3.7 2.4 90 176.7 4.1 6.4 5.9 6.3 120 4 0 132.6 7 6 155.4 144.8 ‘00-’02 ‘94-’96 Gonorrhea ‘97-’99 ‘00-’02 Chlamydia HIV/AIDS, syphilis and gonorrhea rates have remained low compared to Minnesota rates for nearly a decade. Chlamydia is the most commonly reported sexually transmitted bacterial infection in Minnesota and the United States. Although the three-year case rates of Chlamydia in Olmsted County were lower than Minnesota from 1997 to 2002, the actual numbers of cases were still unacceptably high. Raising public awareness, improving prevention education, and increasing screenings and testings can reduce the number of STD's. Tuberculosis Active Tuberculosis 3-Year Case Rates (per 100,000)1 12 10.8 10 rate per 100,000 10 8 6 4 3.8 3.1 3.7 4.5 2 0 94-96 97-99 00-02 Olmsted County has higher rates (number of cases per 100,000 population) of active tuberculosis than most counties in Minnesota. More than 90% of these cases are in persons who recently lived or worked in countries where tuberculosis is very common. These cases have usually been diagnosed very early in the course of the disease and there is little evidence of community transmission. Color Key Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal Page 13 Environmental Conditions Air Quality Percent of 1 & 2 Family Homes Tested for Radon, Olmsted County 20034 Of the 7% of homes tested, 49% had elevated levels of radon. 7% 93% Homes tested for Radon Radon is the second leading cause of lung cancer deaths in the US, accounting for an estimated 15,000 lung cancer deaths each year. Olmsted County is in a region of Minnesota designated as a "High Radon Potential Zone." About half of the radon tests done in the county exceed the EPA's action level of 4pCi/L. Residents can test radon levels in their home with a simple low-cost test kit available from Public Health and take steps to reduce the long-term risk of exposure. Homes not tested Ambient Air Quality by Community, 200310 300 272 261 191 number of days 200 165 102 90 100 161 118 2 10 St. Cloud Rochester 3 13 0 Duluth Good Moderate Tw in Cities Unhealthy for sensitive groups Outdoor air quality is rated using an index developed by the U.S. EPA. Rochester's air is typically rated Good or Moderate, but there were 10 days during 2003 when it was rated Unhealthy for Sensitive Groups. These include the elderly, and those with respiratory diseases such as asthma and emphysema. Air quality is a regional problem because polluted air masses can travel long distances. Air pollution comes from multiple sources including motor exhaust, power plants, heating systems, and wind blown soils. Color Key Page 14 Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal Water Quality Stream Assessments Completed as of 200311 Drinking Water Supplies Tested in Olmsted County, 200311 100 100 100 78 80 80 percent percent 60 40 20 100 100 60 40 40 13 20 8 8 0 0 Private Wells Tested tested Olmsted Streams sampled Public Wells Meets standards standards meets Minnesota Impaired Public wells serve urban areas and are tested at least once each year for common contaminants. In 2003, all of the public water supplies in Olmsted County were found to meet state drinking water standards. About 8% of the 6,500 private wells in the County were tested in 2003. Of these, 78% met the state standards for nitrate and coliform bacteria (two contaminants that may be found in drinking water supplies). It is recommended that families with private wells have their water tested annually. As of 2003, 70 of the 500 miles of streams and rivers in Olmsted County have been assessed and compared to surface water quality standards. So far, all of the assessed waters fail to meet state standards. Consequently, the Minnesota Pollution Control Agency has categorized all of the assessed streams in the County as "Impaired Water" (those which pose risks to human health, aquatic life, and are not suited for water based recreation). Foodborne Disease Outbreaks 100 94 80 60 number Foodborne Disease Outbreaks Investigated by County, 1998-20024 48 40 21 21 20 17 15 11 7 0 in ep n n He y se m Ra a ok n A ed st m l O ta ko Da n to ng i h as W is ou L . St t ot Sc Counties Nationally, there is an estimated 76 million cases of foodborne disease, resulting in more than 325,000 hospitalizations and 5000 deaths each year. Olmsted County averages about 4 foodborne outbreaks each year (an outbreak is when 2 or more people become ill after eating a meal with no other common exposures that could explain their illness). While most foodborne disease is not reported, a higher proportion may be identified in Olmsted County due to the strong healthcare presence and active reporting by the public and restaurant managers. Color Key Movement in wrong direction No movement or significant change Movement in right direction Olmsted County Minnesota US or MN Goal Page 15 Data Sources 1. Minnesota Department of Health, Center for Health Statistics 2. Minnesota Behavioral Risk Factor Surveillance System 3. Minnesota Student Survey 4. Olmsted County Public Health Services Environmental Health Database 5. Minnesota Planning Department, 2002 Minnesota Children's Report Card 6. US Census Bureau 7. Minnesota Department of Human Services 8. Olmsted County Community Services 9. Minnesota Department of Health, Retrospective Kindergarten Survey 10. Minnesota Pollution Control Agency 11. Olmsted County Environmental Resource Services Database For More Information If you would like additional information, or to schedule a presentation for your group or organization about this report card, please contact: Kari Etrheim Olmsted County Public Health Services 2100 Campus Drive SE Rochester, MN 55904 507-285-8370 [email protected] To view an electronic copy of this and other documents, visit our web site: www.olmstedcounty.com/publichealth P U B L I C H E A LT H S E RV I C E S “Bringing people together to create a healthy future for Olmsted County”
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