Marquette County Health Department 2016 Annual Report

Transcription

1 Marquette County Health Department 2016 Annual Report Photo by: Zoe Rudisill

2 Marquette County Health Department MCHD Mission: Enriching lives in our community by preventing disease, promoting healthy lifestyles, and protecting the environment. MCHD Vision: A community where people achieve the highest quality of life through healthy living by caring for themselves, one another, and the environment Board of Health: The Marquette County Board of Health meets each month. Meeting information is available on our website at: The 2016 Board Members were: Kim Alanko, Jim Alderson (Chair), Robert Kulisheck, PhD (Vice-Chair), William Nordeen, JD, Karlyn Rapport, Arthur Saari, MD, and Harvey Wallace, PhD. 1.

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4 A Message from the Health Officer On behalf of the Marquette County Board of Health, the Board of Commissioners, and staff, I am pleased and honored to present the Marquette County Health Department (MCHD) 2016 Annual Report. MCHD is your unit of county government required by law to prevent disease, protect against environmental hazards, promote healthy behavior, and to prolong life. This report summarizes activities which were provided in 2016 and is intended to give an update on the activities of the Health Department as well as the health status of our community. We are fortunate to have a highly skilled, industrious, and passionate workforce dedicated to the value and benefit of the services we bring you. Likewise, our success would not be possible without the support and collaboration of so many community partners, state agencies, and local individuals. The Most Notable Highlights of 2016 A Bit of History: The year 2016 marks the 50 th year of operation for the Marquette County Health Department. Originally organized in July 1966, the newly formed Board of Health held its first meeting the following month and Marquette became the last Michigan County to comply with the State requirement to form a health department or be part of a district health department (Sedlacek, 2008). Prior to the formation of the Marquette County Health Department, limited public health services were provided by the cities and townships and included, primarily, monitoring and controlling the spread of infectious disease. Operations began in what is now known as the Old City Hall Building in Marquette and was staffed with a director and one Licensed Practical Nurse. Initially home visiting services were provided and by 1967 a sanitary code was adopted and staff was providing hearing/vision screening in schools, immunizations, and services for crippled children. Over the past 50 years, the Marquette County Health Department has added and eliminated a variety of programs and services, and at times employed more than 100 people. At different points in time, the Health Department provided private duty and home health services and also operated two dental clinics. As funding levels and reimbursement has changed over the years, so too has the mix of programs and services provided by the Health Department. Within the last four years, the Health Department has had a number of long-standing, experienced individuals retire, including five individuals from administration with more than 125 years of combined experience and four staff members with more than 100 years of combined experience. This is a significant loss of institutional knowledge. However, the Health Department is fortunate that these individuals and their predecessors have left behind a foundation of policies, procedures and culture that will allow the current and future employees of the Health Department to provide quality public health services to residents of Marquette County well into the future. 3.

5 Ordinance Amended: According to the Center for Disease Control and Prevention (CDC), tobacco use is the leading preventable cause of death in the United States. Diseases related to smoking include cancer, vascular disease and respiratory disease. The CDC estimates that mortality from these diseases among smokers is associated with 20% of all deaths in the United States annually. In the early 90s, the Marquette County Health Department secured State funding and began an aggressive tobacco prevention and cessation campaign that included education in schools, cessation programs for adults, and media outreach regarding the dangers of smoking. This program yielded excellent results; it reduced the smoking rate in youth and adults and produced an enforcement policy for the retail sale of cigarettes in Marquette County. State funding to support tobacco programs at the local level has since been drastically reduced. As a result, the Health Department lost its resources to continue the program. Consequently, smoking rates have climbed dramatically and remain significantly higher than when the program was running at full steam. Regardless of the reduction in funding, tobacco prevention remains a priority for the Health Department. The original smoking ordinance that was passed in 1992 remains in effect, despite subsequent preemptive laws preventing local regulation, particularly in regard to retail sales. In fact, there are only three counties in the State (Marquette, Ingham, and Genesee) currently allowed to license retail sales of tobacco. In 2016, the Board of Health amended the ordinance to include Electronic Nicotine Delivery Systems (ENDS), commonly known as e-cigarettes or vaping. These devices are known to be a method to help people quit smoking. Although that may be true, they also commonly contain nicotine and are available to purchase by youth in numerous places with no age restrictions. Teens and young adults are vulnerable to the addictive properties of nicotine, a dangerous chemical that can cause serious adverse health complications. Restricting access to nicotine for this population can reduce the number of people having long-term exposure to nicotine, which can lead to a reduction in chronic illness. Thank You: I want to thank the Board of Health, all employees past and present, and members of the community that have shown commitment to our mission and have displayed efforts to protect the health of the citizens of Marquette County. In addition, on behalf of the Marquette County Health Department, I want to express my appreciation for the continued support of the Marquette County Board of Commissioners and Administration along with the countless number of organizations and agencies who share a common vision with the Health Department. As I move into my fourth year as a public health professional, I continue to be amazed at the devotion, compassion, and resilience of those individuals who chose public health as a career; it is truly a rewarding profession. Respectfully submitted, Gerald A. Messana, MPA Health Officer/Director 4.

6 Medical Director s Report Hepatitis C in the U.P. Hepatitis C, a virus which infects the liver, is an emerging threat in the U.P. Baby Boomers are known to be an at-risk group for Hepatitis C. Prior to 1992, blood tests were unable to detect the virus, so transmission of the infection often occurred through blood transfusions or organ transplants. Screening has been routinely recommended for individuals born between 1945 and 1965 for a number of years and blood banks now routinely test for Hepatitis C in donors. Then why is Hepatitis C an important topic today? Here are four important reasons: 1) Hepatitis C infection is often so mild that most people do not know that they are infected. Some people will clear the infection and recover completely, but about 8 out of 10 people infected will not clear the infection and become chronic carriers of the virus. Over a lifetime, about 20 out of 100 folks will develop chronic liver disease like cirrhosis and up to 5 out of 100 will die from liver failure or liver cancer. Hepatitis C is the leading reason for liver transplant and cause of liver cancer which is the most rapidly increasing cancer in the U.S. 2) The number of Hepatitis C cases is rising rapidly in the U.S. and the primary means of infection is now through drug use, i.e. IV drug users sharing needles and other drug equipment. 3) Hepatitis C can be treated with medication but the treatment is extremely expensive often $100,000 or more. 4) Finally, Hepatitis C is important because some of the same people who pick up Hepatitis C infection will also become infected with Human Immunodeficiency Virus (HIV) through similar exposures. In 2015, a small rural county in Indiana had an outbreak of HIV during which their typical number of cases per year exploded from less than 5 to 181, in a community of only 4,200 people. Nearly 90% of these people also had Hepatitis C infection. While U.S. deaths from other infectious illnesses have been declining over time, deaths due to Hepatitis C have been increasing. To put this in a local context, there were 66 newly diagnosed cases of chronic Hepatitis C in Marquette County (2015), with rates in young people years more than twice that of the State of Michigan s. This pattern is seen across the U.P. There is no current vaccine to prevent Hepatitis C and as noted, treatment is extraordinarily expensive and has potential risks. Because of this, PREVENTION IS KEY! 5. Medical Director s Report

7 So, how do we prevent Hep C infection? We begin by addressing the increasing problem of substance abuse in our communities. The abuse of non-prescription opioids leading to the use of heroin and other illegal narcotics has been well-documented. This impacts not only the young adults who become addicted but also their children. The U.P. s sole regional neonatal intensive care unit has the highest rate of infants in the state born with neonatal abstinence syndrome, which is to say, infants who are exposed in utero to narcotics and experience drug withdrawal after birth. Reducing substance abuse within our communities is a complicated process and will require looking long and hard at challenges facing many of our residents such as poverty, unemployment, low educational attainment, diminishing family supports, and the overprescribing of narcotics in the management of acute and chronic pain. It will not be a quick fix. In the meantime, reduction in the risk of Hepatitis C and HIV transmission can be accomplished more rapidly through evidence-based interventions such as needle-exchange programs, harm reduction strategies, and enhanced screening and detection of chronic carriers. Historically, needle exchange programs have been controversial and slow to gain acceptance, particularly in rural areas. But they are effective and successfully curtailed the epidemic in Indiana mentioned above. These programs accomplish at least two objectives: They help to decrease the spread of infection by providing drug users with clean needles/equipment to reduce sharing, and they bring individuals struggling with addiction to a setting where they can receive education about reducing their risk and are offered assistance in treating their addiction. Harm reduction strategies aim to reduce the stigma surrounding drug addiction, help those who elect to continue drug use to do so more safely, and offer assistance to those who wish to quit. Finally, enhanced screening will identify those infected, both in order to offer treatment and to provide education about reducing their risk of transmitting infection to others. It is important to at least begin a conversation about the increasing burden of drug addiction in our communities and ways in which each of us can contribute to solving the problem. Submitted by: Dr. Teresa Frankovich, MD, MPH, FAAP 6.

8 Marquette County Health Department 2016 Finances Total Revenues $4,295,608 Total Expenditures $4,277,775 7.

9 Marquette County Communicable Disease Summary 2012 Case Count 2013 Case Count 2014 Case Count 2015 Case Count 2016 Case Count Chlamydia (Genital) Hepatitis C, Chronic Pertussis Campylobacter Chickenpox (Varicella) Giardiasis HIV (New Cases) Salmonellosis Meningitis Aseptic Shiga toxin-producing Escherichia coli--(stec) Streptococcus pneumonia, Inv Blastomycosis Cryptosporidiosis Gonorrhea Guillain-Barre Syndrome Hepatitis B, Chronic Lyme Disease Streptococcal Dis, Inv, Grp A Medical Director s Report 8.

10 Community Health Report CSHCS: Children s Special Health Care Services (CSHCS) helps families who have a child with special health care needs receive the medical care and treatment for their qualifying diagnosis. Enrollment in the program averaged 180 children in 2016, including children enrolled in Medicaid, MIChild and private insurances. MCHD assisted families with enrollment, renewal of services, transportation to medical appointments, and care coordination by public health nurses to make sure that families have the supports needed in place. Family night at the Marquette Children s Museum is held monthly and is facilitated by a parent of a child enrolled in CSHCS. 180 CSHCS children served in 2016 MIHP: The Maternal Infant Health Program (MIHP) continues to provide nursing and social work services to pregnant women and infants under one year of age that are enrolled in Medicaid. MIHP recipients receive monthly home visits to provide education on pregnancy health, prenatal and infant nutrition, importance of regular check-ups, immunizations, and community resources. In addition, all MIHP recipients are encouraged to attend the Marquette County Community Baby Shower. MIHP continues to demonstrate specific benefits in improving the health of the maternal child health population. 306 Family Planning clients were seen in 2016 Family Planning: MCHD s Family Planning Clinic is clearly serving the community, meeting 129% of our contracted caseload. Low income, uninsured clients, and teens are priority target populations of Family Planning/Title X programs and MCHD continues to serve those groups well. A breakdown of clientele shows that 82% of clients reported income < 100% of the Federal Poverty Level (program aim was 63%) while 93% of clients reported income < 150% of the Federal Poverty Level. The program aim is to maintain at least a 20% teen client caseload. MCHD s teen client caseload was at 31% for While the Affordable Care Act and Medicaid expansion offer increased insurance opportunities for women and for capturing revenue for local health departments, one-third of women seen at MCHD still report they are uninsured. Maintaining these services is critically important to ensure continued access to quality reproductive health care. During 2016, MCHD also participated in a joint Family Planning/STD chlamydia project to increase screening of clients under age 25 resulting in a 67% screening rate of that age group. Immunizations: In 2016, MCHD provided 685 vaccines to the community (not including the flu shot). Although MCHD continues to provide routine childhood/adult immunizations, the role of local health departments has changed with the addition of immunizations as a covered preventative benefit of most health insurances. Medical Director s Report 685 vaccines were given FY

11 Immunizations (Continued): MCHD oversees and provides technical and educational assistance to our 15 Marquette County providers who participate in the federal Vaccines for Children (VFC) program. Annual influenza clinics are offered throughout Marquette County each fall. In October alone, 1358 flu vaccines were given, with 550 of those given in the schools. Michigan Department of Health and Human Services reports show Marquette County ranks consistently in the top 5 of 84 Michigan counties for flu vaccine coverage for children 6 months to 18 years of age. Pregnant and Parenting Teens: For the year 2016, we assisted, or offered assistance to 15 young adults. Six Pregnant and Parenting Teens (PPT) exited the program due to graduation, aging out, or lack of response/interest. PPTs were given assistance in enrolling in the GED program, enrolling in on-line classes, getting their driver s license, and transportation to/from school (bus pass). In the year 2016, two PPTs obtained their high school diplomas, one PPT began her freshman year at Northern Michigan University, and one PPT obtained her driver s license. Ryan White/Continuum of Care Services: There were 88 HIV+ clients living in the Upper Peninsula that were provided services through the Continuum of Care Program in Because of the efforts of COC staff to keep clients engaged in HIV medical care and on their HIV medications, 92% of clients have a suppressed HIV viral load (<200 copies). Also, 100% of our clients have been prescribed HIV medication and have continued access to medications. The majority of the issues clients have had over the last year revolve around keeping insurance and other HIV benefit programs up-to-date, transportation, financial, and housing issues. Housing Opportunities for Persons with AIDS (HOPWA) has been able to provide 26 households, U.P.-wide, with housing assistance to pay for rent or utilities. HIV Prevention: MCHD received funding in 2016 to provide an increase in HIV testing by using the Alere HIV Rapid Test device. The rapid test can detect HIV within two weeks of exposure and a client can get results in 20 minutes. A total of 122 HIV tests were performed in 2016; 86 were rapid tests. 122 HIV tests were performed in

12 Community Health Report (Continued) Women, Infants, & Children Program (WIC) The WIC Program can service women who are pregnant/postpartum, infants and children up to the age of five. Each participant is given a food package accustomed to their age and need and given an electronic benefits transfer (EBT) card with a list of foods they can purchase. An average of 1,186 clients participated in WIC in FY2016 The WIC Program received an update on the food package, effective July 11, Several changes were made with more variety in the brands of food offered and two new food items were added. Pasta and yogurt are now options for participants to purchase using their WIC benefits. The last time the WIC Food Guide was updated was October Each year, our WIC agency participates in the Project Fresh Program. Project Fresh is a program that runs from June 1 to October 31. The program provides a $20 voucher booklet for use at any participating Farmer s Market in the State of Michigan. Eligible WIC participants can receive 1-2 booklets each. The vouchers are to be used for Michigan grown produce only. This year, Marquette County was provided with 421 vouchers, 348 vouchers were utilized by our WIC participants. This year our agency was involved in the 2016 Management Evaluation (ME). This evaluation takes place biennially and is conducted by a State Evaluator. The evaluator provided our agency with 12 special recognitions, paying special attention to our breastfeeding program. The special recognitions were acknowledged by the Michigan State Director of WIC. In 2016, the Breastfeeding Peer Counselors met with 430 WIC clients WIC Peers The WIC Peer Counselors had a very busy year supporting and encouraging breastfeeding in our community. The Peers held breastfeeding classes called A Healthy Start twice a month, and had 65 clients attend. Thirty-six Breastfeeding Moms groups were held and facilitated by the WIC Peers. The Peers are very active in the community and attend many events catered to pregnant/breastfeeding women. Jolene Spencer is an MCHD Public Health Nurse in the WIC program. She is out in the community at the Big Latch On event spreading the news about WIC and breastfeeding. 11.

13 Community Health 2016 Statistics Vaccines Given (Not Including Flu) 685 Flu Shots Given 1,753 Pregnancy Tests Given 146 Positive Pregnancy Tests 13 Total STD Visits 659 Total Units of HIV Services 2,531 Family Planning Initial Visits Completed 101 Family Planning Annuals Completed 143 Maternal/Infant Visits 727 Children s Special Health Care Annual Updates 176 Average Monthly Caseload of Healthy Families U.P. Clients 7 Hearing Screens 2,795 Hearing Referrals Made 91 Vision Screens 4,105 Vision Referrals Made 301 New Family Health Education Referrals Received 61 Family Health Education Visits 1,170 Statistics 12.

14 Community Outreach Report Marquette County Cares MC 2 The Marquette County Health Department, through funding from the NorthCare Network, has managed the Marquette County Substance Abuse Prevention Coalition (MC 2 ) for almost 25 years. The MC 2 Coalition recently adopted an evidence based community model called Communities That Care or CTC. With an emphasis on reducing risk factors, communities that have adopted the model have seen measured improvements. As an example, middle and high school children in CTC communities were less likely to have initiated delinquent behavior, less likely to have initiated the use of alcohol, and less likely to have initiated cigarette use than in other control communities. The CTC model helps guide our community through a proven five-phase change process. This process will take, at the minimum, three to five years to fully implement and go through each of the five phases. Using prevention science at its base, the MC 2 coalition, newly named Marquette County Cares, will promote healthy youth development, improve our youth outcomes, and reduce problem behavior in Marquette County. The formula to achieve this: Prevention Science + Digital Tools + Community Support = Successful Kids. Suicide Prevention As a sub-grantee of the State of Michigan s Injury and Violence Prevention Division, the Health Department is continuing progress on a four year federal Garrett Lee Smith Suicide Prevention grant. Currently in year two, the grant titled Communities Uniting for Suicide Prevention (CUSP), the Health Department was funded for an additional part-time health educator to work on the project. In 2016, we were able to work collaboratively with the Ishpeming School District to implement and enhance a comprehensive suicide prevention and postvention policy covering the district. Staff from MCHD, the Hematite Health Clinic, and the Marquette Alger Regional Educational Service Agency worked together to review current systems in regards to youth who may be at risk of suicide and created supporting documents and a flow chart to ensure students experience a seamless system of care. The Health Department also assisted in training Ishpeming School staff in a gatekeeper training titled Question, Persuade, Refer (QPR), as well as supporting a health teacher to become a QPR trainer. Two community specific suicide prevention action teams were formed in Ishpeming and Gwinn in These teams will be targeted to promote connectedness both with the school as well as their communities at large. A variety of training was offered to many groups including medical offices, university students, high school students, youth-serving organizations, Health Department staff, and mental health professionals. Future goals for the Health Department will be to begin to work with other school districts on their suicide/crisis response policies. 13. Medical Director s Report

15 Dental Outreach The Blue Cross Blue Shield of Michigan Foundation (BCBSMF) awarded MCHD with $50,000 to fund the next phase of the Oral Health Grant. Beginning in June 2016, this project will be funded for a two-year period. The Central Upper Peninsula Planning and Development Regional Commission (CUPPAD) also awarded MCHD with an additional $5,000 in matching funds for the project. Phase II of the Oral Health Grant will continue the dental prevention outreach work that has already been started across the U.P. The components include: Assisting additional U.P. elementary schools in establishing and sustaining school fluoride rinse programs. Training additional primary care physician (PCP) offices in providing oral screenings and the fluoride varnish applications to high risk children ages 6 months to 3 years of age since PCP offices typically see babies, toddlers, and very young children before the dentist does. Assisting eligible families in linking with state insurance programs such as MIChild and Healthy Kids to make dental services affordable. Evaluating the impact of the U.P. Wide Smiles Initiative on the oral health of children. Pictured is 1 year old Nick Ham, son of Scott and Erica Ham, having fluoride varnish applied to his baby teeth by a nurse. Fluoride varnish adheres directly to the teeth so young children can t swallow the fluoride. It sticks to the tooth s enamel surface, making the teeth more resistant to acids from bacteria in the mouth that can cause tooth decay. For more information, please visit our website at: MCHD s Dental Hygienist, Becca Maino, received this note from a child after visiting their classroom and teaching the children about dental hygiene. 14.

16 Environmental Health Report The Marquette County Health Department (MCHD) Environmental Health (EH) Division works under the authority of several State and local regulations to provide environmental health services in a variety of program areas. Program areas include: food service, commercial and residential on-site waste water disposal, private water supplies, non-community public water supplies, public swimming pools and spas, body art, campgrounds, Michigan Department of Health and Human Services (MDHHS) environmental facility inspections, and general environmental health response. Some highlights of Environmental Health Division efforts in 2016 are listed below. New Low Risk Temporary Food Service Licensing Options The State of Michigan amended the Michigan Food Law to provide for a new licensing category of temporary food service establishment for those serving only low risk foods. This law change went into effect in the 2016 licensing year. What constitutes a Low Risk Temporary Food Service Establishment and the type of foods that would be allowable are defined in law. The intent of this regulation is to reduce the amount of manpower expended to venues having low potential public health impact. This allows resources to be redirected to food service operations that have higher potential for public health impact based upon risk factors known to cause food borne illness. Low risk temporary food service establishments continue to be licensed. However, the operation is evaluated by an office consultation with the person responsible for the event. The office consultation involves a review of the menu, set-up, procedures to be employed at the operation, and Public Health compliance education. On-site inspections are no longer required for low risk temporary food establishments. This programmatic change has reduced the overall man-hours and overtime expended to the licensing of temporary food service establishments in Marquette County. Low risk temporary food service licenses accounted for 44% of all temporary food service licenses issued in In 2016 there were: 97 Temporary Food Licenses were issued in Food Service Inspections (Fixed & Follow-Up) 10 Plan reviews for new food establishments 39 Food complaints investigated 5 Food Enforcement Actions A Mes- sage From 15.

17 Type II Non-Community Public Water Supplies The State of Michigan rules governing coliform bacteria water sampling requirements for non-community public water supplies were amended and new sampling requirements went into effect in These rules exist under the authority of the Michigan Safe Drinking Water Act, Act 399, P.A This specific rule change is referred to as the Revised Total Coliform Rule (RTCR). Generally the RTCR has significantly increased the number of coliform water samples required to be collected by non-community public water supply operators in Michigan. The RTCR has also created new requirements surrounding water supplies that are operated seasonally. These changes have resulted in an increase of effort for both the local health department and the non-community water supplies within the county. More 2016 Environmental Health Statistics Septic Permits Issued (Residential) 155 Septic Permits Issued (Commercial) 6 Total Complaints Investigated 24 Failed Systems Investigated 23 Septage Truck and Site Inspections 13 Well Permits Issued 126 Public Water System Inspections 9 Public Water Systems Requiring 52 Routine Monitoring Oversight Swimming Pool and Spa Inspections 39 Samples Collected from Pools/Spas 142 Campground Inspections 16 Temp Campground Licenses Issued 6 Body Art Facility Inspections 5 DHHS Facility Inspections

18 Gwinn Teen Clinic Report P.S. I Love You: The fourth annual "P.S. I Love You" walk took place in October, Gwinn Teen Clinic staff, Youth Advisory Committee (YAC) Members, students, families and friends joined together in a walk to raise suicide prevention awareness. Monthly, the Gwinn High and Middle Schools have a "P.S. I Love You day, when the YAC group distributes encouraging quotes to every student s locker (approximately 537) in the school. Gwinn Teen Clinic s Nurse Practitioner, Autumn Trudeau and Hematite Health Clinic s Public Health Nurse, Sarah Engstrom are showing their pride for the Gwinn Community at the P.S. I Love You walk held in October Top Five Overall Diagnosis: 1) Adjustment disorder with mixed anxiety and depressed mood 2) Immunizations 3) Adjustment disorder with anxiety 4) Well Child Visit 5) Oppositional Defiant Disorder A GWINN TEEN CLINIC S 2016 STATISTICS Total Unduplicated Clients 252 Total Immunizations Administered 352 Total Visits to Nurse Practitioner 476 Total Visits to Mental Health 459 Total Visits to Registered Nurse 132 Mes- 17.

19 Hematite Health Clinic Report Mental Health Policy: In 2016, the clinic Mental Health Provider drafted a Mental Health Policy for the Ishpeming School District which he presented to teachers and staff during a professional development day to assist them in helping students at risk for suicide. Site Review: In September 2016, the Hematite Health Clinic (HHC) had its first state site review. The clinic received an A or Full Accreditation, meaning the clinic is meeting or exceeding the requirements necessary to operate successfully. Logo: Our Logo was updated and signage was placed throughout the school. YAC: The HHC continues to have an active Youth Advisory Committee (YAC). This year the YAC students promoted health and wellness throughout the school using Respect as the platform. Each month they updated the YAC bulletin board (located just outside of the HHC) and held awareness campaigns. They also participated in the Great American Smoke Out, delivered candy canes to each high school student with positive messages attached, held an anti-drug campaign, offered healthy snacks during lunch, and numerous other activities throughout the year Top Five Overall Diagnosis: 1) Allergic Rhinitis 2) Immunizations 3) Generalized anxiety disorder 4) Dysthymic disorder 5) Post traumatic stress disorder A Mes- HEMATITE HEALTH CLINIC S 2016 STATISTICS Total Unduplicated Clients 191 Total Immunizations Administered 209 Total Visits to Nurse Practitioner 393 Total Visits to Mental Health 337 Total Visits to Registered Nurse 142 sage 18.

20 Marquette County Health Department 184 US 41 East Negaunee, MI