Public HealthJe�erson County

Every so oft en, big things happen in public health that eff ect everyone in perhaps subtle but signifi cant ways for years to come. In 2011, a big thing happened when our federal public health partners, the Centers for Disease Control and Preventi on (CDC) and the U. S. Department of Health and Human Services, adopted 10 “Winnable Batt les” as priority public health issues for the United States. The State of Colorado and Jeff erson County Public Health in turn have adapted the 10 Winnable Batt les to bett er align them with the unique aspects of the public health issues we are facing. This is something BIG, as are the 10 Winnable Batt les:

1. Clean Air 6. Obesity2. Clean Water 7. Oral Health3. Infecti ous Disease Preventi on 8. Safe Food4. Injury Preventi on 9. Tobacco5. Mental Health & Substance Abuse 10. Unintended Pregnancy

These winnable batt les have large-scale impact on health, and there are known, eff ecti ve strategies to address them. They were chosen based on the magnitude of the health problems and our ability to make signifi cant progress in improving

outcomes. We believe that by identi fying priority strategies and clear targets, and by working closely with our public health partners, we can make signifi cant progress in reducing health dispariti es and the overall health burden from these diseases and conditi ons.

Jeff erson County Public Health is willing to take up this challenge, and is committ ed to winning these batt les, but as many famous historical military geniuses could tell us, “winnable batt les” are not always won. Our success lies only in our strong partnerships with the many citi zens and stakeholders who have overlapping interests in protecti ng the health and environment of Jeff erson County, Colorado. To truly win these “winnable batt les,” all of us - residents, employees, visitors, young and old - must join together to make Jeff erson County a healthier place.

For complete background and informati on on the 10 Winnable Batt les, please visit the JCPH web site at www.jeff co.us/health.

Dr. Mark B. JohnsonExecuti ve Director, Jeff erson County Public Health

Public Health - Every day, Everywhere, Everyone

Letter from Dr. Mark B. Johnson, MD, MPH, Executive Director

10 Winnable Battles2011 ANNUAL REPORT

Clean Air

Air Quality is not just an environmental issue, it’s a health

issue!

1. Conquer with Clean Air Clean air is essential for healthy living. The air we breathe directly affects our health status and quality of life. It also plays a major role in health disparities. Poor air quality is associated with long-term damage to respiratory and cardiovascular systems, cancer, and premature death. The World Health Organization estimates that nearly 25% of the world’s total disease burden and deaths can be attributed to environmental factors, including poor air and water quality. (Prüss-Üstün A, Corvalán C. Preventing Disease through

Healthy Environments. Geneva, Switzerland: World Health Organization; 2006.)

Of most concern to air quality in Colorado and in Jefferson County are the nitrogen oxides (NOx), carbon dioxide (CO2), and mercury emissions. All of us can help clear the air. Driving less, carpooling or biking, as well as not smoking cigarettes and avoiding the use of aerosol cans can greatly improve air quality and decrease NOx emissions. Reducing the presence of mercury in our air is also important in the battle for clean air. Mercury is a heavy metal that does not break down or gradually go away. Its presence can decrease our ability to perform basic human functions. It affects our vision, our hearing, and our ability to talk and walk. Coal fi red power plants are the primary source of mercury air emissions in the U.S. The mercury is carried by the wind and eventually settles on our land

and in our rivers, lakes and oceans. Eating fi sh contaminated with mercury is the most common way people are exposed to mercury. Among other statewide efforts to decrease mercury emissions, the Mercury-free Colorado Campaign has undertaken efforts to increase the recycling of compact fl uorescent lights, mercury-containing thermostats and automotive mercury switches.

This annual report provides a brief introduction to each of the winnable battles. More information, including access to pertinent public health data can be found on our web site at www.jeffco.us/health. More information on the upcoming community health assessment and opportunities to get involved can also be accessed on our web site.

Vaccinations continue to be the primary public health weapons in the battle against infectious diseases. The JCPH Communicable Disease Program and the Immunization Program work to track disease outbreaks and to increase the number of persons who are up to date on their immunization schedules. In addition to working with schools, daycare providers, correctional facilities, and other large groups in the community, JCPH holds regular immunization clinics for individuals and families. Because of the presence of whooping cough (pertussis) in the community, this public health battle focuses in particular on the need for children to be fully immunized against diphtheria, tetanus and pertussis (DTaP) before entering school, and on the immunization of adults who are in contact with children with a similar

immunization (TDaP). Another important infectious disease prevention priority is the reduction of sexually transmitted infections (STIs). Gonorrhea, chlamydia, and other STIs continue to affect our population despite known and effective prevention methods and treatments. JCPH offers STI counseling, testing and treatment services at its clinics in Arvada and Lakewood. JCPH also works with schools and other partners to educate our community about the prevention of STIs.

4. Putting the Brakes on Falls, Motor Vehicle Crashes and Other Preventable Injuries

Hundreds of Coloradans, including too many Jefferson County residents, die each year from preventable automobile crashes. Thousands more are hospitalized from injuries caused by preventable falls. Injury prevention is a broad fi eld, including such tools and modalities as seatbelt use, helmets, and the correct way to lay a child down to rest or sleep (on his back). JCPH works with partners at the state and local levels on a variety of injury prevention initiatives. Decreasing the rate of hospitalizations due to falls among older adults, decreasing the number of teens killed in automobile crashes and increasing the number of persons using seatbelts regularly are goals we believe everyone can support.

5. Substance Abuse and Mental HealthSubstance abuse and mental health issues affect the health of many of our residents. Substance abuse refers to excessive alcohol consumption, including binge and heavy drinking, as well as the use of illicit drugs or abuse of prescription drugs, and is a completely preventable health issue. It is estimated that about one in 15 Americans is a substance abuser. Substance abuse negatively impacts not only the individual using drugs or alcohol, but also their family and community. It has been linked to numerous negative health outcomes including increased rates of HIV/AIDS and other sexually transmitted infections, domestic violence and child abuse, automobile crashes, crime, and suicide. Many JCPH programs work to connect clients with community resources around both substance abuse and mental health issues. JCPH also partners with the Jefferson Center for Mental Health, a nonprofi t community mental health center serving Jefferson, Clear Creek, and Gilpin counties.

2. Champions for Clean WaterWater, like air, is also vital for healthy living. The immediate and long-term health effects of contaminated water are serious and can be life threatening. JCPH’s water quality program works in conjunction with the State health department to assure both manmade and naturally occurring contaminants stay out of our drinking water. In Jefferson County, many homes use well water, and while most well water is of good quality, there are several contaminants which may affect the suitability of the water supply. The department recommends that well water be tested for contaminants such as radiation, nitrates and others.Regulation of onsite wastewater (septic) systems is a primary focus of the JCPH water quality team’s assurance of water quality in Jefferson County. Owners with onsite wastewater systems should have a good working knowledge of their function, and all Jefferson County homes with these systems must have them inspected before the sale of the home.

3. Infectious Disease Prevention

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Food S afety

Ex

cellence in

Colorado Sexual Health & Pregnancy Prevention Program www.beforeplay.org

Jefferson County’s citizens are putting on the pounds, along with the rest of Colorado. Even though Colorado is the leanest state in the nation, with an adult obesity rate of 19.8%, obesity has increased by more than 80 percent over the past 15 years. (“F as in Fat: How Obesity Threatens America’s Future 2011,” Robert Wood Johnson Foundation) Nationally, one in three children is obese according to the CDC. Excess weight contributes to many of the

leading causes of death in Jefferson County, including heart disease, stroke, diabetes, and some types of cancer.

The good news is that Jefferson County still has one of the leanest populations in the country, and with the continued focus of public health and its many community partners, the battle against obesity can be won. Creating healthier environments is a good starting place. When children have safe places to walk, bike and play in their neighborhoods, they’re more likely to be active and less likely to become obese. When communities have access to healthy and affordable foods, families eat better and are healthier.

The JCPH LiveWell Wheat Ridge (LWWR) program is one of many community programs funded by LiveWell Colorado working to stem the tide of obesity in our state. LWWR focuses on changes to the physical environment and policy frameworks to ensure residents have access to safe environments and healthy food where they live, work, play and learn.

JCPH Nutrition Services is another program working with community partners to reduce obesity in the County. JCPH dietitians provide education and nutrition services for individuals and groups at risk of coronary heart disease, cancer, stroke, diabetes mellitus, and obesity. Nutrition education and the WIC (Women, Infants and Children) program are available to help residents improve their nutritional knowledge while also accessing healthy and affordable foods. JCPH also promotes and encourages breastfeeding as an important strategy in the fi ght against obesity. Breastfeeding has been shown to be an important tool in increasing child brain development and parent/child bonding as well as an effi cient weapon against early childhood dental disease.

7. Oral Health Poor oral health affects many of our residents and is preventable. It is estimated that nationwide, tooth decay affects 1 in 4 children ages 2-5 and as many as 1 in 2 adolescents are also affected. In U.S. adults age 65 or older, 1 in 4 has lost all of his/her teeth. With appropriate dental care, tooth decay, cancers of the mouth and gum disease can be prevented. The ability to access oral health care is associated with gender, age, education level, income, race and ethnicity, access to medical insurance, and geographic location.

JCPH has focused most of its efforts to improve oral health of children. Dental disease is the number one disease of childhood, yet it is 100% preventable. JCPH is in its fourth year of implementing a unique statewide oral disease prevention program, Cavity Free at Three. The JCPH program works with volunteer dental hygienists to provide free cavity prevention services to over 1,000 low-income WIC and Head Start children each year. Dental health is very important in a child’s physical and mental well being. Too many of Jefferson County’s children are entering school with signifi cant dental issues that can seriously contribute to learning problems as well as decreased self-esteem. Providing early intervention helps with these issues as well as other potential health problems caused by dental disease.

8. Safe FoodThe JCPH Food Protection and Safety Program works to prevent foodborne illness outbreaks and to assure that Jefferson County citizens and visitors are served safe food. Staff routinely inspects food service operations, such as restaurants, delicatessens, school cafeterias and retail markets to ensure compliance with Colorado State regulations. According to the CDC, foodborne illnesses cause over 3,000 deaths in the U.S. each year and more than 48 million illnesses per year. Everyone has a role in food safety.In 2011, JCPH convened its fi rst, “Food Safety Forum.” Food service operators, consumers and the JCPH Food Safety Program met to collaborate and develop innovative strategies to reduce the risk factors associated with foodborne illness.

Additional goals of the forum included promoting food safety education, discussing current food

safety issues and concerns, and fostering communication between industry, the public and JCPH’s food safety program staff. The forum was a result of the Food Safety Program’s participation in the U.S. Food & Drug Administration’s Voluntary

National Retail Food Regulatory Program Standards. The program standards serve as a guide to enhance and improve food safety programs nationwide.

9. TobaccoTobacco use is a major preventable cause of premature death and disease worldwide. In the United States, an estimated 46.6 million people – about one in fi ve adults – currently smoke, and an estimated 443,000 people die prematurely from diseases caused by smoking or second-hand smoke exposure. Reducing tobacco use has been identifi ed as a public health winnable battle at the federal, state and local level.Preventing the harms of tobacco use is a primary focus of the JCPH Tobacco Prevention Initiative and its State and Federal counterparts. Studies show that the use of and the addiction to tobacco often begins in adolescence. Among adults in the U.S. who have ever smoked, nearly 90 percent tried their fi rst cigarette before age 18, and 53 percent became daily smokers before age 18. Tobacco use and the exposure to secondhand smoke is one of Jefferson County’s most serious public health problems. Community coalitions are working in Lakewood, Golden, Unincorporated Jefferson County and Wheat Ridge to better protect everyone from the harms of tobacco. Program goals include decreasing the percentage of youth who use tobacco, decreasing the percentage of minors who are able to purchase tobacco, and decreasing exposure to secondhand smoke. To learn more about coalition efforts in Jefferson County visit www.smokefreejeffco.com.

10. Unintended PregnancyUnintended pregnancy is a statewide problem in Colorado. Nearly 40 percent of pregnancies in Colorado are unintended, and the rate is even higher among those aged 20 to 29. The health risks associated with unintended pregnancies include lack of early prenatal care, increased risks of low birth weight and preterm births, all of which can impact immediate and long-term health. Studies show that unintended pregnancy also can limit the education and employment opportunities for both parents. JCPH works to educate residents about effective contraception, assists families with fi nding affordable health care and provides pregnancy testing at its clinics. The JCPH Family Planning Program is committed to working with its partners to reduce the number of teens who give birth and increase the percentage of sexually active high school students and adults who use an effective method of birth control.

6. Out Front of Obesity

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Total 2011 Revenue = $14,951,038

Total 2011 Expenditures = $14,951,038

CHS23%

HPLM16%

EHS6%

ADMIN55%

HPLM20%

CHS37%

ADMIN28%

EHS15%

JCPH Budget 2011

Where to Find Us:

Arvada: 6303 Wadsworth Bypass, Arvada, CO 80003 303-275-7500

Edgewater WIC: 1711 A & B Sheridan Blvd., Edgewater, CO 80214 303-239-9580

Lakewood: 260 S. Kipling Street, Lakewood, CO 80226 303-232-6301

Administrative & Environmental Health Offi ces: 1801 19th Street, Golden, CO 80401 303-271-5700

Vital Records: 800 Jefferson Cnty Pkwy, Suite 1300, Golden, CO 80401 303-271-6450

Emergency Preparedness: 800 Jefferson Cnty Pkwy, Golden, CO 80401 303-271-8391

Jefferson County Board of HealthBonnie McNulty - PresidentMaureen Sullivan - Vice PresidentBeverley Dahan - SecretaryGreg Deranleau - MemberLinda Reiner - MemberJefferson County Board of CommissionersDonald Rosier – Chair, District 3John Odom – Chair Pro Tem, District 2Faye Griffi n – District 1

Jefferson County Public Health (JCPH) is committed to promoting health and preventing injury and disease for the residents of Jefferson County, Colorado. Public Health is what we as a society do collectively to prevent illness and premature death and promote health in our neighborhoods and communities. Public health professionals monitor and diagnose the health concerns of communities and promote policies, practices and behaviors to assure our populations stay healthy. It is the collaborations and efforts of everyone that ultimately determine the County’s health. With the support, policy oversight and mandates of the Jefferson County Board of Health, our programs work to prevent and control contagious diseases and epidemics; investigate health and safety hazards; protect our environment; prevent foodborne illness; link people to health care services; promote active living and healthy eating; and, advocate and enforce laws that protect the health and safety of everyone.

2011 Achievements and Health OutcomesPage 4

www.jeffco.us/health

Environmental Health Services (EHS) works to prevent, investigate and respond to health threats in the County from environmental sources such as our air, water, land, the food we eat and the domestic and wild animals and insects we encounter. EHS inspects facilities including schools, daycares, restaurants for adherence to public health safety and disease control measures. • 4,876 food-service establishment inspections were

performed and 187 food handlers were educated to protect citizens from common foodborne illnesses such as E. coli, Salmonella and hepatitis A. The JCPH Retail Food Inspection web page was visited 42,298 times by persons seeking information on food-safety records of various eateries.

• 586 inspections of childcare centers, pools and camps were performed protecting children and adults from disease and safety hazards.

• 524 onsite wastewater system inspections were performed and 129 permits were issued to protect residents from water-borne illnesses and protect the county’s groundwater from contaminants. 523 time-of-sale wastewater permits were approved and 215 additional properties were added to the septic system computer database, providing easier access for public queries.

• The Zoonosis (animal-borne disease) Program investigated potential disease threats such as hantavirus pulmonary syndrome, bubonic plague, tularemia, West Nile virus, and rabies. 122 specimens were submitted for testing resulting in 9 positives, all rabies.

Community Health Services (CHS) programs and services work to improve health and quality of life through communicable disease surveillance, prevention, control, education and treatment. Diverse programs provide essential preventive health screenings, health education, public health nursing interventions, resource referral as well as access to healthcare for the County’s uninsured or underinsured residents. • 9,389 immunizations were given protecting

the County’s children and adults from vaccine preventable diseases.

• 6,370 disease surveillance contacts were made to investigate and follow-up in response to potential communicable disease threats.

• 5,145 nurse home visitations were made to improve health outcomes for infants and mothers.

• 1,614 individuals were assisted with access to health care via screenings for eligibility for Medicaid and/or Child Health Insurance Plan; 11,270 enrolled in Medicaid and CHP+ received follow-up in the Healthy Communities Program to assure that they accessed health care benefi ts and community resources.

• 11,879 clinic visits were made by individuals seeking dental, reproductive health and chronic disease prevention screenings and consultation.

Health Promotion and Lifestyle Management (HPLM)works to improve health through programs and activities enabling people to increase control over their health. Programs and services promote healthy eating and active living, tobacco free environments and access to health communications and public information. Policy work involves working with elected offi cials and our communities to adopt policies that promote nutrition, tobacco free public places and built environments that support safe walking, biking and multimodal transportation.• 13,785 women and children were provided with

nutrition education and counseling and food prescription vouchers to be used for healthy foods at local grocery stores.

• The JCPH web site had 106,354 views and 1,831 followers of our social media pages for diverse public information and health education materials. 46,000 educational materials were distributed via library and educational displays in the community increasing citizen knowledge of prevention initiatives.

• Tobacco control policy campaigns in four communities are helping to advance local laws which will increase smoke-free workplaces and public places as well as reduce youth access to tobacco products. 2,660,670 potential media reach via print, television, radio and social media venues to address tobacco-related issues.

Administrative Services provides department administration and fi nancial management as well as the Emergency Preparedness and Response Program and Vital Records Program.• 6,469 birth and 4,661 death certifi cates

(fi rst copy) were issued providing residents with essential identifi cation documents as well as providing a snapshot of the number and causes of death in the county throughout the year.

• JCPH Emergency Preparedness and Response Program updated or wrote 30 plans; provided 24 trainings for staff, other agencies, and the community; and participated in 5 regional exercises. Coordinated or responded to 30 outbreaks.