Sustaining Healthy Communities - A Challenge

Sustaining Healthy Sustaining Healthy Communities - A Communities - A

ChallengeChallenge

Maria Torroella Carney, MD, Maria Torroella Carney, MD, FACPFACP

March 23, 2010March 23, 2010

Long Island Center for Health Long Island Center for Health PolicyPolicy

AssessmentMonitor Health

Diagnose &Investigate

Policy DevelopmentInform & Educate

Mobilize CommunityDevelop Policy

AssuranceEnforce Law

Link to Provide CareAssure Competent Workforce

Evaluation

Public Health Core Functions

County Health RankingCounty Health Ranking

Health OutcomesHealth Outcomes – 6th– 6th• Mortality – 1stMortality – 1st• Morbidity – 17Morbidity – 17thth

Health Factors – 1stHealth Factors – 1st• Healthy Behaviors – 7Healthy Behaviors – 7thth (tobacco, diet, exercise, alcohol (tobacco, diet, exercise, alcohol

use, high risk sexual behavior)use, high risk sexual behavior)• Clinical Care – 3rdClinical Care – 3rd• Social and Economic Factors – 2ndSocial and Economic Factors – 2nd• Physical Environment – 32Physical Environment – 32ndnd

Environmental Quality Environmental Quality Built Environment Built Environment

Source: Robert Wood Johnson Foundation in partnership with University of Wisconsin Population Source: Robert Wood Johnson Foundation in partnership with University of Wisconsin Population Health Institute County Healthy Rankings 2010Health Institute County Healthy Rankings 2010

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 1985BRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Community Health Community Health AssessmentAssessment

Nassau County Department of Health Nassau County Department of Health report to NY State Department of report to NY State Department of Health created every 5 years - contains:Health created every 5 years - contains:

Population ReportPopulation Report Health DataHealth Data Local Health Unit DescriptionLocal Health Unit Description Problems and Issues in the CommunityProblems and Issues in the Community Local Health PrioritiesLocal Health Priorities Opportunities for ActionOpportunities for Action

Average Age-Sex-Adjusted Death Rates from Selected Diseases*

(2005-2007)

0

100

200

300

400

500

600

700

800

New York State New York State(excluding NYC)

Nassau County

Region

Rat

e (p

er 1

00,0

00)

Total Death

Diseases of the Heart

Malignant Neoplasms

CerebrovascularDiseaseAIDS

Chronic LowerRespiratory DiseaseTotal Accidents

Diabetes

Homicide and LegalInterventionCirrhosis of the Liver

Suicide

Series12

NYS Vital Stats: Rates are directly standardized using Census 2000*Suicide w as included in 2007, only

Average Rates of Cardiovascular Disease Mortality 2005-2007

290

300

310

320

330

340

350

360

Rate

per

100

,000

pop

ulat

ion

New York State

NYS excluding NYC

Nassau County

Source: NYSDOH Vital Statitics 2005-2007

Average Rate of Cardiovascular Disease Mortality by Sex, Nassau & NYS, 2005-2007

0

50100

150

200

250300

350

400

Nassau County New York State

Rate

per

100

,000

pop

ulat

ion Female

Male

Source: NYSDOH Vital Statistics 2005-2007

Average Rate of Cardiovascular Disease Hospitalizations, 2004-2006

18501900195020002050210021502200225023002350

Rat

e pe

r 100

,000

pop

ulat

ion

New York State

NYS excluding NYC

Nassau County

Source: NYSDOH SPARCS 2004-2006

0

50

100

150

200

250

300

350

400

450

500

1976-

1980

1981-

1985

1986-

1990

1991-

1995

1996-

2000

2001-

2005

Nassau County

NYS

NYS excl. NYC

Source: NYS Cancer Registry 1976-2005

Cancer Incidence Rates among Females (All Invasive Malignant Tumors) 5 Year Trends

(1976-2005)Age-adjusted Rate per 100,000 Population

Cancer Incidence Rates among Males (All Invasive Malignant Tumors) 5 Year Trends (1976-2005)

0

50

100

150

200

250

300

350

400

450

500

1976-1980 1981-1985 1986-1990 1991-1995 1996-2000 2001-2005

Age-

Adju

sted

Rat

e pe

r 100

,000

pop

ulat

ion

Nassau County

NYS

NYS excluding NYC

Source: New York State Cancer Registry 1976-2005

Average Mortality Rate Among Females by Type of Cancer, 2001-2005

25.5

16.4

37.5

3 1.6

25.5

16.6

43.8

2.5

1.9

26.2

15.6

37.7

2.2

2.1

05

101520253035404550

Fem

ale

Brea

st

Col

orec

tal

Lung

and

Bron

chus

Live

r/int

rahe

patic

bile

duc

t

Mel

anom

a of

the

skin

Age

-adj

uste

d ra

te

per 1

00,0

00 p

opul

atio

n

NYS

NYS excluding NYC

Nassau County

Source: New York State Cancer Registry

Average Incidence Rate Among Malesby Type of Cancer, 2001-2005

63.5

166.

3

80.8

10.9 17

.1

64.5

172.

6

87.7

8.2 20

.5

64.5

163.

8

75.5

8.6 26

.1

020406080

100120140160180200

Color

ecta

l

Pros

tate

Lung

and

Bron

chus

Liver

/intra

hepa

ticbil

e du

ct

Mela

nom

a of

the

skin

Age-

adju

ted

Rate

per

100

,000

Po

pula

tion

NYS

NYS excluding NYC

Nassau County

Source: New York State Cancer Registry

Cancer Mortality among White and Black Females Nassau County, 2001-2005

05

1015202530354045

Fem

ale

Bre

ast

Col

orec

tal

Lung

&B

ronc

hus

Live

r/int

rahe

patic

bile

duc

t**

Mel

anom

a of

the

skin

**

Rat

e pe

r 10

0,00

0 po

pula

tion

White

Black

Source: NYS Cancer Registry 2001-2005** Rates for Blacks are based on fewer than deaths per year therefore are unstable.

Cancer Mortality among White and Black Males Nassau County, 2001-2005

010203040506070

Colo

rect

al

Pros

tate

Lung

&Br

onch

us

Live

r/int

rahe

pati

c bi

le d

uct**

Mel

anom

a of

the

skin

**Rat

e pe

r 100

,000

pop

ulat

ion

White

Black

Source: NYS Cancer Registry 2001-2005** Rates for Blacks are based on fewer than 5 deaths per year therefore are unstable.

Proportion of Average Injury Hospitalization Rate by Type within Age GroupNassau County, 2004-2006

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Age (years)

Perc

ent

Struck by Object/Person

Self Inf licted

Poisonings

Pedestrian

Motor Vehicle Crash

Falls

Assault

Source: NYSDOH SPARCS 2004-2006Age-adjusted to the US Projected Population

The Rate of Hospitalizations due to Falls 2005-2007

32

33

34

35

36

37

38

39

40

41

42

43

1

Age

-Adj

uste

d R

ate

per

10,0

00 P

opul

atio

n

Nassau County New York State New York State Excluding New York City

Rate difference is statistically significant between both Nassau County and NYS and NYS excluding NYCSource: NYSDOH County Health Assesment Indicators

Average Teenage (15-19 years) Pregnancy Rate 2005-2007

0

10

20

30

40

50

60

70

NYS NYS excluding NYC Nassau County

Rate

per

1,0

00 fe

mal

e po

pula

tion

aged

15-

19 y

ears

Source: NYS DOH Vital Statistics, 2005-2007 New York State

Communities with Highest Teen Pregnancy Rates Nassau County, 2005-2007

Nassau County, 24.2

0

20

40

60

80

100

120

140

Communities (Zipcode)

Rat

e pe

r 1,0

00 fe

mal

e po

pula

tion

aged

15-

19

*Average of Nassau CountySource: NYS DOH Vital Statistics, 2005-2007

% All Pregnances Vs. Teenage Pregnancies by TypeNassau County, 2005-2007

01020304050607080

Live Births InducedAbortion

Spon. FetalDeaths

Perc

ent

All Pregnancy

Teenage Pregnancy

Source: NYS DOH Vital Statistics, 2005-2007

Average Rate of Induced Abortion 2005-2007

0

100

200

300

400

500

600

NYS NYS excluding NYC Nassau County

*Rat

e

Source: Vital Statistics of New York State*Number of induced abortions per 1000 live births

Average Infant Death Rate 2005-2007

0

1

2

3

4

5

6

7

New York State NYS excluding NYC Nassau County

Rate

per

1,0

00 li

ve b

irths

Source: NYS DOH Vital Statistics

Communities with Highest Average Infant Death Rates, Nassau County 2005-2007

Average, 4.3

0

2

4

6

8

10

EASTMEADOW

UNIONDALE BALDWIN* BELLMORE* ROOSEVELT*

Deat

hs u

nder

1 y

ear o

f age

per

1,0

00

live

birth

s

Source: Vital Statistics of New York State* Frequency of Less than 5/yr Average: Average rate for Nassau County

0

20

40

60

80

100

Rat

e p

er 1

00,0

00

Po

pu

lati

on

Rates of Gonorrhea 2005-2007

Nassau County New York State

0

200

400

600

Rat

e pe

r 100

,000

Po

pula

tion

Males Females

Rates of Chlamydia by Sex, 2005-2007

Nassau County

New York State

Source: NYSDOH County Health Assessment Indicators

Average Chlamydia Rate Among Females by AgeNassau County, 2006-2008

29.85

1413.551315.01

148.6444.83 5.71

0200400600800

1000120014001600

14 andunder

15-19 20-29 30-39 40-49 50+Age Group (Years)

Rate

per

100

,000

po

pula

tion

Source: NYSDOH, Health Information Network, Communicable Disease Statistical Queries

Average Gonorrhea Rate Among Females By AgeNassau County, 2006-2008

130.04150.94

23.828.02 2.43

0.0020.0040.0060.0080.00

100.00120.00140.00160.00

15-19 20-29 30-39 40-49 50+Age Group (years)

Rat

e pe

r 100

,000

po

pula

tion

Source: NYSDOH, HIN, Communicable Disease Statistical Queries

HIV in CommunitiesHIV in Communities

3% 3% 4% 7%

21%

34%

21%

7%

0%

12 & under

13-19

20-24

25-29

30-39

40-49

50-59

60+

Unk

Living HIV and AIDS Cases by Age, Nassau County For Cases Diagnosed through December 2007

Source: New yrok State HIV/AIDS County Surveillance Report (Excludes State Prison Inmates), Bureau of HIV/AIDS Epidemiology, NYSDOH June 2009. Data as of April 2009

Asthma Prevalence by Community Asthma Prevalence by Community Nassau County Behavioral Risk Surveillance Survey 2006Nassau County Behavioral Risk Surveillance Survey 2006

0

5

10

15

20

25

Nassau New York US

Tobacco Use (%)

Source: Nassau County Behavioral Risk Factor Surveillance Survey 2006

35.5

36

36.5

37

37.5

38

38.5

39

Nassau New York US

Overweight (%)


0

5

10

15

20

25

Nassau New York US

Obesity (%)


Local Local HealthHealth Priorities Priorities

Cardiovascular Disease PreventionCardiovascular Disease Prevention Diabetes, Obesity, Nutrition Diabetes, Obesity, Nutrition

EducationEducation Tobacco Use CessationTobacco Use Cessation Fall Injury PreventionFall Injury Prevention Cancer Screening Promotion Cancer Screening Promotion Teenage Pregnancy PreventionTeenage Pregnancy Prevention

Access to Health Care

Built Environment

Community Economic Development

Health Literacy

Health MarketingNatural Environment

Public Policy

Public Well Being

Social Capital

Individual &

Family

Community

Nassau’s Access to Health Nassau’s Access to Health CareCare

12 Hospitals12 Hospitals 34 Nursing Home/Rehabilitation 34 Nursing Home/Rehabilitation

CentersCenters 6 Hospices 6 Hospices 21 Home Health Care Agencies21 Home Health Care Agencies 12 Long Term Care Agencies12 Long Term Care Agencies 8 Prenatal Care Assistance Programs8 Prenatal Care Assistance Programs 4 Community Health Centers4 Community Health Centers 12 HIV Testing Sites12 HIV Testing Sites Urgent Care Centers expandingUrgent Care Centers expanding

Nassau’s Access to Health CareNassau’s Access to Health Care

CHC HospicesPCAP

Hospitals

LTC

HIV

HHA

Nursing

Homes/Rehabilitation

Centers

0

5

10

15

20

25

30

35

Urgent Care Centers

7,411 beds

4,397 beds

Health Care Providers in Health Care Providers in NassauNassau

Over 8,000 PhysiciansOver 8,000 Physicians• 2666 Primary care2666 Primary care• 5368 Specialists5368 Specialists

1057 Physician Assistants1057 Physician Assistants 1,218 Nurse Practitioners1,218 Nurse Practitioners 2,019 Dentists2,019 Dentists

Health Care Providers in NassauHealth Care Providers in Nassau Physicians

Primary Care

Specialists

Physician Assistants

Nurse Practitioners

Dentists

0

1000

2000

3000

4000

5000

6000

7000

8000

Health Determinant

sBehaviors

Intermediate Outcomes

Environmental and Community

Factors

Health Outcomes

Mortality/ Morbidity aka

Longevity/Quality of Life

Steps to Sustain Healthy Steps to Sustain Healthy CommunitiesCommunities

Nassau County Legislation Nassau County Legislation Mandating Nutritional Mandating Nutritional

InformationInformation

Artificial Trans Fats Banned From Artificial Trans Fats Banned From RestaurantsRestaurants

On September 18, 2007, the NCBOH voted On September 18, 2007, the NCBOH voted to restrict the use of artificial trans fats to restrict the use of artificial trans fats from all permitted food service from all permitted food service establishments in the county. On April 1, establishments in the county. On April 1, 2008, the trans fat restrictions took effect 2008, the trans fat restrictions took effect for trans fats used for frying or in spreads for trans fats used for frying or in spreads and on April 1, 2011, the ban will go into and on April 1, 2011, the ban will go into effect for oils or shortening used for baking.effect for oils or shortening used for baking.

Calorie Menu LabelingCalorie Menu Labeling On September 10, 2009, the NC Legislature On September 10, 2009, the NC Legislature

voted into law Calorie Menu Labeling voted into law Calorie Menu Labeling legislation. legislation.

NCDOH Recommendations NCDOH Recommendations for Actionfor Action

1.1. Promote activity, lessen sedentary Promote activity, lessen sedentary behavior (30 minutes a day/5-7 days behavior (30 minutes a day/5-7 days a week)a week)

2.2. Create safe walking environments Create safe walking environments

3.3. Create safe biking pathsCreate safe biking paths

4.4. Create a Nassau Walking Trail Create a Nassau Walking Trail throughout the county connecting throughout the county connecting communitiescommunities

5.5. Encourage access to grocery stores Encourage access to grocery stores and markets/fresh fruits and and markets/fresh fruits and vegetables vegetables

Recommendations for Action Recommendations for Action (Continued)(Continued)

5.5. Grab bars in every new or Grab bars in every new or renovated bathroomrenovated bathroom

6.6. Promote use of handrails to Promote use of handrails to prevent injury prevent injury

7.7. Senior-friendly housing needed Senior-friendly housing needed within neighborhoods with close within neighborhoods with close access to public transportation, access to public transportation, shopping and health care shopping and health care

8.8. Expand on Delivery of Health care Expand on Delivery of Health care needs in home needs in home

SidewalksSidewalks

Walking and Bike PathWalking and Bike Path

BeforeBefore AfterAfter



Parks and Seating – Parks and Seating – Universal UseUniversal Use

Grab barsGrab bars

HandrailsHandrails

Next Steps for Long Island Next Steps for Long Island Center for Health Policy?Center for Health Policy?

Of Possible Interest…Of Possible Interest… AgingAging

• Study falls etiology and risks in region Study falls etiology and risks in region • Evaluate quality of care in nursing homes Evaluate quality of care in nursing homes • Educate public and physicians re Advance Educate public and physicians re Advance

Directives – poorly utilized tool and not diversely Directives – poorly utilized tool and not diversely utilizedutilized

• Expand home care delivery Expand home care delivery Health DisparitiesHealth Disparities

• Prevent Teenage Pregnancy Prevent Teenage Pregnancy • Promote concept and use of Medical Home Promote concept and use of Medical Home

Health PromotionHealth Promotion• Evaluate School WellnessEvaluate School Wellness• Improve quality of care and access to quality careImprove quality of care and access to quality care

Eg Falls and Coumadin useEg Falls and Coumadin use• Promote wellness across the age spectrumPromote wellness across the age spectrum

ResourcesResources

www.countyhealthrankings.orgwww.countyhealthrankings.org www.cdc.govwww.cdc.gov www.nassaucountyny.govwww.nassaucountyny.gov

/agencies/Health//agencies/Health/index.htmlindex.html www.thecommunityguide.orgwww.thecommunityguide.org www.healthymadisoncounty.orgwww.healthymadisoncounty.org www.HumanCenteredDesign.orgwww.HumanCenteredDesign.org

/pedestrian/pedestrian

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Sustaining Healthy Communities - A Challenge