ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 – 2013 Edward A Diana County Executive Jean M Hudson, M.D., M.P.H Commissioner of Health ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 TABLE OF CONTENTS Acknowledgements Executive Summary and Key Findings Exhibit Listing Guide to Statistical Terms Community Health Assessment (CHA) Index Section – Populations at Risk A Demographic and Health Status Information The Population of Orange County a b c d e Page 1-23 1-5 Population Growth Rates and Density Population Demographics Employment and Housing Characteristics Projected Demographic Changes Regional Perspective Causes of Mortality in Orange County 5-7 a Overall Mortality b Mortality Rates of Demographic Subpopulations c Leading Causes of Death Health Status of County Residents 7-15 a Family Health Child and Adolescent Health Maternal and Infant Health, Reproductive Health & Family Planning Intentional and Unintentional Injuries b Disease Control 15-23 Sexually Transmitted Diseases HIV/AIDS Tuberculosis Other Communicable Diseases Vaccine Preventable Diseases Chronic Diseases B Access to Care Availability and Utilization of Health Care Services Barriers to Health Care Access 24-28 24-26 26-28 a Financial b Structural c Personal C Behavioral Risk Factors Core Behavioral Risk Factors Optional Behavioral Risk Factors Selected Youth Behavioral Risk Factors 30-37 37-39 39-40 D The 41 41-42 43-44 Local Health Care Environment History Physical and Social Factors Economic Factors E Section One Exhibits Section – Local Health Unit Capacity Profile A B C D E Organizational Structure and Program Description Current Trends and Workload New Initiatives and Significant Accomplishments Staff Qualifications and Skill Levels Expertise and Technical Capacity for Community Health Assessments Section – Problems and Issues in the Community A B Profile of Community Resources Profile of Unmet Need for Health Services Section – Local Health Priorities A Priority Local Needs 46-263 Page 1-9 10-17 18-20 21-22 23 Page 1-31 1-3 Page 1-16 Priority Health Needs Accomplishments Related to Priority Areas Section – Opportunities for Action A Opportunities and Potential Action Steps Section – Community Report Card Page 1-4 Page Introduction County Health Indicator Profiles Orange County Indicators for Tracking Public Health Priority Areas 2-3 4-7 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 ACKNOWLEDGMENTS Many thanks to all who worked to bring this document together: Prevention Agenda Workgroup (see listing) Orange County Department of Health Division Directors: Chris Dunleavy, Deputy Commissioner of Health Robert Deitrich, Director, Community Health Outreach Marilyn Ejercito, R.N., M.S., Director, Public Health Nursing Christopher Ericson, M.P.A., Director, Public Health Response Matthias Schleifer, P.E., Assistant Commissioner, Environmental Health Anne Vradenburgh, Director, Fiscal Sheila Warren, R.N., M.Ed., Director, Intervention Services Charles A Catanese, M.D., Chief Medical Examiner Robert Hastings, Health IT Consultant Colleen Larsen, R.N., M.P.A., OCDOH Nurse Epidemiologist Jacqueline Lawler, M.P.H., OCDOH Epidemiology Fellow Chris Saccone, Executive Secretary/Administrative Assistant Ed Waltz, Ph.D., Director, and Susan Wymer, B.S.N, R.N., Graduate Research Assistant, Prevention Research Center, SUNY Albany School of Public Health Mary Bevan, M.P.H., Project Director (Consultant) Jean M Hudson, M.D., M.P.H Commissioner of Health Orange County Community Health Assessment 2010-2013 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 EXECUTIVE SUMMARY The 2010-2013 Community Health Assessment (CHA) represents the ongoing efforts of representatives from community-based health, social service, mental health, and education agencies, health care providers, Advisory Board of Health and Health Department representatives to identify health needs and to collectively determine strategies to improve the health of County residents Submission of the CHA is a requirement of the Municipal Public Health Services Plan A complete assessment is conducted every four years New York State regulations designate the county health department as the lead agency in the preparation and submission of the CHA As stated in the 2010-2013 NYSDOH CHA Guidance document, “Community health assessment is a core function of public health agencies and a fundamental tool of public health practice Its aim is to describe the health of the community, by presenting information on health status, community health needs, resources, and epidemiologic and other studies of current local health problems It seeks to identify target populations that may be at increased risk of poor health outcomes and to gain a better understanding of their needs, as well as assess the larger community environment and how it relates to the health of individuals It also identifies those areas where better information is needed, especially information on health disparities among different subpopulations, quality of health care, and the occurrence and severity of disabilities in the population.” The CHA is the basis for all local public health planning, giving the local health unit the opportunity to identify and interact with key community leaders, organizations and interested residents about health priorities and concerns New York’s Prevention Agenda toward the Healthiest State initiative was launched in April 2008, to promote collaborative community health planning focused in locally-selected health priority areas The Prevention Agenda designates local health departments and hospitals as the lead partners in this process Involving key community stakeholders, 2-3 priority areas are selected based on consideration of demographic and health status data, health service delivery data, local and regional surveys and studies Opportunities for action are identified to focus improvement efforts and maximize outcomes through coordination and collaboration National and state benchmarks, such as Healthy People 2010 and Prevention Agenda 2013 targets are used to monitor and evaluate progress Several strategies were used to encourage community input in establishing community health priorities The primary strategy is ongoing community collaboration In addition, two versions of a local health needs survey were developed to solicit input on local health needs from health providers, community agencies, and residents More than 160 provider/community agency and 760 resident surveys were completed Representatives from community agencies throughout the county also participated in “Health Town Meetings” held in distinct geographic areas of the county These meetings were hosted by the primary hospital/medical center in each region and the discussions were facilitated by representatives from each Community Health Center serving county residents The surveys and Health Town meetings attempted to capture as broad participation as possible and reflect the priority health issues in the communities in each area Despite slight differences in geographic emphasis, the primary concerns raised were highly consistent This information, as well as analysis of the demographic, mortality, morbidity, and behavioral risk indicators discussed in Section I – Populations at Risk informed the selection of local health priorities aligned with the NYS Prevention Agenda A Prevention Agenda Workgroup was convened to finalize the determination of unmet health and service needs, local health priorities, and opportunities for action Workgroup representatives have extensive experience in public health and health services delivery, including service to high risk populations throughout the county Working with a public health consultant, researchers from the SUNY Albany School of Public Health, the OCDOH epidemiologist, and Division Directors formed our CHA development team The determination of local health priorities was guided by the 10 priority areas for public health action specified in The Prevention Agenda for the Healthiest State Orange County Community Health Assessment 2010-2013 The majority of residents in Orange County enjoy favorable health Preliminary results from the most recent NYSDOH Expanded Behavioral Risk Surveillance Survey found that 86% of Orange County adults ages 18 and over surveyed reported their health status to be good to excellent Access to quality primary health care services is essential to maintain and improve health in the community Access to primary care promotes a consistent source of care to receive preventive health education and health screenings, early detection and treatment of disease, and timely referrals for specialty care and other needed services Ongoing contact with a primary health care provider is essential to prevent complications and improve health outcomes Orange County is relatively well supplied with primary care providers, however all residents not have adequate access The leading health issues in Orange County, as in the state and the nation, result from a number of factors, many of which can be controlled or modified Harmful personal behaviors such as smoking, overeating, poor nutrition, lack of physical activity, substance abuse, and unsafe sexual practices have major impacts on individual health Economic and language/cultural factors present barriers to access and utilization of medical care and preventive health services Income, unemployment, educational attainment, inadequate housing, and lack of transportation are social factors which impact health or limit access to care Uncontrollable factors, including inherited health conditions or increased susceptibility to disease, also significantly influence health In spite of the favorable health status enjoyed by most Orange County residents, health disparities persist and are concentrated in the county’s uninsured and low income population groups Lack of health insurance and inadequate insurance coverage are increasing concerns in the current economic recession Even individuals and families with health insurance can find navigating the health care system difficult especially when faced with personal or family illness Persons who live in poverty or are uninsured are more likely to have poor health status Poverty underlies many of the social factors that contribute to poor health Differences for many health indicators are also apparent by gender, race/ethnicity, age, and geographic area of residence This information can be used to determine subgroups in the population in need of further assessment, as well as to guide the development of programs and services to meet identified health needs Recent trends in health indicators for County residents show improvement in overall mortality rates from the leading causes of death – most notably heart disease and cancer Key indicators of maternal and infant health, such as births and pregnancies in teens, infant mortality and low birthweight births, have also improved for county residents overall There are indications of improvement in personal health habits such as smoking rates and accessing screening services for early detection of certain diseases However, disparities in health care access and health status in high risk populations persist The 2010-2013 CHA also indicates areas in need of improvement in county residents such as unintentional injuries, ambulatory care sensitive conditions, Prevention Quality Indicators for chronic diseases, receipt of early prenatal care, prevalence of smoking and obesity, asthma-associated illness, cancer incidence, and disparities in mortality from chronic diseases Expanded joint planning and coordination of programs and services among health care partners in the community focused in the health priority areas can reduce health disparities and improve the health of all county residents The intent is for the Community Health Assessment to have significant value for the community, and to be used to advance health-related service planning by a multitude of agencies We welcome your comments and reactions to this report, and invite you to participate in the assessment process going forward Jean M Hudson, M.D., M.P.H Commissioner of Health Orange County, New York September 2009 Orange County Community Health Assessment 2010-2013 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 KEY FINDINGS Demographic Trends According to the U.S Census population estimates published by the New York State Data Center, Orange County is the fastest-growing county in New York State; from April 1, 2000 to July 1, 2007, the county’s population increased by an estimated 10.5% Trends in population growth vary greatly by municipality communities with estimated population growth rates of twenty percent or more from 2000-2007 include the towns of Minisink and Monroe, and the villages of Kiryas Joel, Maybrook, and Montgomery Based on 2007 U.S Census population estimates, the median age in the county has remained relatively constant (34.6 years); the greatest number of residents fall in age range 25-54 The number of residents ages 65-69 is forecasted to more than double from 2000-2020 primarily due to the entry of ‘baby boomers’ into these age ranges According to 2007 U.S Census population estimates, the county’s single race composition is: 84.8% White, 10.6% Black/African American, 2.4% Asian with the remaining 2.2% classified as other Hispanic/Latino, which is not a racial category, represents 15.9% of the county population Since the 2000 Census, the greatest estimated rate of growth is in the Asian/Pacific Islander population which increased by 75% The second highest increase was in the Hispanic/Latino population, which grew by 50% During this time, the Black/African American population is estimated to have increased by 44% and the White population increased the least at 12% According to the U.S Census, over nine thousand (9,082) foreign born persons entered Orange County from 1990-2000, up from 6,964 from 1980 to 1990 The majority (45.2%) were born in Latin America, 34.1% were born in Europe, and 16.4% were born in Asian countries Kids’ Well-Being Clearinghouse data report that the number of Orange County students K-12 with limited English proficiency increased by 35% from 2000 to 2007, from 9.3% to 12.6% Recent educational attainment indicators for Orange County youth indicate improvement in educational performance and in the intent to pursue higher education The percent of high school graduates receiving Regents Diplomas in Orange County’s Public Schools increased substantially from 1999-2000 to 2006-2007 (49.9% to 81.6%), in part due to the phase-in of Regent only diplomas statewide The number of high school graduates intending to enroll in college also increased during this same period, from 81% to 83.7% Poverty rates vary greatly throughout the county based on municipality Poverty rates exceeding 25% for families with related children under 18 are found in Orange County’s three cities (Middletown, Newburgh, and Port Jervis), as well as in the town of Monroe, largely due to the impact of the village of Kiryas Joel, where the poverty rate is more than times the county average Levels of poverty in the county also vary depending on race, ethnicity and family composition Married couple families have the lowest overall poverty rates; the highest rates are seen in single mother families, and this rate exceeds 50% in single mother families with children under the age of five Housing units within the county increased an estimated 9.2% from 2000 to 2007 The majority of housing units in the county are owner occupied; however this also varies by municipality Communities with 50% or more of their housing units consisting of pre-1950 construction include Cornwall, Highlands, and the county’s three cities of Middletown, Newburgh, and Port Jervis Among the seven counties in the Hudson Valley Region (HVR), Orange County is the second most populated county, and ranks second in the rate of population growth from 1990-2000 and in the number of Hispanic/Latino residents Orange County Community Health Assessment 2010-2013 Health Status and Risk Indicators Overall Mortality and Leading Causes of Death: Since 1998 - 2000, there has been a steady decline in the 3-year average age-sex adjusted mortality rate in the county The 2004-2006 age-sex adjusted mortality rate for county residents was below the Upstate rate In 2004-2006, the mortality rate for Black/African American residents in the county is highest, followed by that for White residents Hispanic/Latinos have the lowest overall mortality rate in the county, which may be due in part to underreporting of ethnicity on death certificates The leading causes of death in the county, as well as in the state and nation, vary by age In 2005-2007, heart disease and cancer together accounted for over half (53%) of all county resident deaths, and are the leading causes of death in adults ages 45 and over The leading cause of death in children, adolescents, and young adults is accidents, in adults ages 25-44 the leading causes are cancer followed closely by accidents Child Health: In general, the health of Orange County children is relatively good; however, there are vulnerable groups within the population who lack consistent access to primary and preventive health care such as children living in low income families without health care insurance Analysis of the most recent comparative data (2004-2006) shows improvement in hospitalization rates for children ages 0-4 for the following ambulatory care sensitive (ACS) conditions: asthma, pneumonia, and otitis media Improvements in hospitalization rates for otitis media are dramatic, and in 2004-2006 were below those of the state, upstate, and HVR Three-year hospitalization rates for Orange County infants and children ages 0-4 remain consistently above those for the HVR for the other ACS conditions The screening rate for lead poisoning in children under years of age remains in need of improvement In addition, findings of the 2003 NYSDOH Oral Health Survey were suggestive of a lack of access to or utilization of preventive oral health services in third grade children Adolescent Health: Adolescents in Orange County generally enjoy favorable health Health risks in teens most often include risky behaviors related to sexuality, alcohol, tobacco, and drugs, and accidents Pregnancy and birth rates in teens ages 15-19 have declined in Orange County from 1997-2006 Nonetheless, in 2004-2006, pregnancy and birth rates were the second highest in the HVR; the highest rates in the county are found in minority teens and in the county’s cities Indicators of youth risk behaviors related to drug and alcohol use and for certain sexually-transmitted diseases indicate the need for enhanced and affordable prevention, treatment and screening services for county youth Maternal and Infant Health: The pregnancy rate for females ages 15-44 increased from 2004-2006; Orange County’s rate remains above that for the HVR and Upstate The percentage of women who are receiving early prenatal care is well below HP2010 targets, and is lowest in teens, minority females, and geographically, in the cities of Middletown and Newburgh Birth rates were relatively constant from 2004-2006, and are, like pregnancy rates, higher than the average for the HVR and Upstate Birth rates are highest in Hispanic females The city of Middletown has the highest birth rate in the county; the city of Newburgh has the highest percentage of births to teens (ages 17 and under) and Medicaid/Self Pay births Infant mortality rates in the county have declined substantially since 2004, and the 2006 rate met the HP 2010 target for the first time Infant mortality (as a percentage of total births) is highest in Black/African American infants, which is consistent with state and national findings Orange County has the second lowest rate of LBW in the HVR; within the county rates are highest in teens and in Black/African Americans Injuries: Overall mortality from unintentional injury or accidents in the County is higher than the HVR and NYS This is in part due to death rates from motor vehicle accidents (MVAs) which are higher than the HVR, Upstate, and NYS Rates of alcohol-related MVAs exceeded average rates for the region and for NYS in 2004-2006 Disease Control: The number of cases of certain sexually transmitted diseases (STDs), in particular Gonorrhea and Chlamydia has recently increased; a significant proportion of these cases are in adolescents and demonstrate the need for enhanced prevention services, screening and treatment in high risk groups The case rate for HIV/AIDS is below that for Upstate and NYS Advances in HIV treatment have dramatically reduced AIDS mortality, and advances in testing, such as highly accurate oral testing, will hopefully increase testing acceptance and frequency in high risk groups Enhancements to disease surveillance systems instituted by OCDOH permit closer monitoring for all reportable communicable diseases, including TB and vaccine preventable diseases The recent resurgence in Pertussis cases in the county in children and adolescents is testimony of the need to achieve full protection from vaccine preventable diseases through timely and complete immunization Full protection of county residents at highest risk from serious illness from influenza and pneumonia remains a priority; efforts have been intensified with the arrival of pandemic H1N1 influenza The rate of Lyme disease is Orange County Community Health Assessment 2010-2013 Exhibit 4.1b ORANGE COUNTY DEPARTMENT OF HEALTH Edward A Diana County Executive Jean M Hudson, MD, MPH Commissioner of Health Hudson Valley Regional Provider Survey 1a.) Please check the category that best describes your agency (Check all that apply): Medical Practice Community Health Center Diagnostic and Treatment Center Dental Practice Other (Please Specify): Mental Health Center Community-Based Organization Correctional Health Services Hospital/Clinic 1b.) How many service sites/locations does your agency have? In what counties are they located? 2.) What types of services does your site provide? (Check all that apply): Dental Care for Adults Dental Care for Children/Adolescents Primary/Preventive Health Care for Adults Primary/Preventive Care for Children/Adolescents Family Planning Prenatal Care/PCAP WIC Other (Please Specify): 3.) What are the most significant barriers impacting your ability to provide care to your patients? (Please select no more than and rank them on a scale of 1-5 with being the most significant and the least significant.) Limited staffing resources Limited bi-lingual staff Inadequate insurance reimbursement Patient lack of trust Limited or lack of access to specialists High patient no-show rate Patient non-adherence to treatment Cultural competency issues Limited space and/or equipment Patient inability to afford prescription medications Other (Please Specify): 4.) What are the most significant barriers your patients face in accessing health care from you? (Please select no more than and rank them on a scale of 1-5 with being the most significant and the least significant.) Inability to pay for services or medications Too far to travel Limited availability of specialists Afraid to go Lack the time to go to appointments Lack childcare Limited availability of bi-lingual clinicians Lack of transportation Hours of operation not convenient Other (Please Specify): _ 5.) Please select the top chronic health problems/issues facing the patients you serve (Please select no more than and rank them on a scale of 1-5 with being the most significant and the least significant.) Diabetes Cancer Other (Please Specify): Heart Disease Asthma Obesity Orange County Community Health Assessment 2010-2013 Section IV COPD 13 6a.) What are the health-related priorities in your service area? (Check all that apply): Improving access for the uninsured/underinsured to: Medical Care Dental Care Substance Abuse/Mental Health Services Expanding services: Prenatal Care Family Planning/Reproductive Health Dental Services Adding additional services: Primary Care Please specify type(s) (e.g pediatric, adolescent, adult, family): Medical/Dental Specialty (e.g cardiologists, oncologists, gerontologists, periodontists) Please specify type(s): _ Substance Abuse/Mental Health Please specify type(s): _ _ Home health care services Increasing health care providers that are: Representative of racial or ethnic minorities Please specify which minorities: Fluent in Spanish / other languages prevalent in the area Please specify which languages: For special needs population (e.g immigrants, persons with disabilities, migrant farm workers) Please specify populations in highest need: Committed to eliminating health care disparities Improving availability of: Medical/Dental providers participating in Medicaid Managed Care/Child Health Plus Health-related outreach, engagement and support services Please specify which services: _ Health education/risk reduction services Please specify type(s): (e.g adolescent pregnancy/substance abuse prevention/pediatric asthma): _ Screening and early detection services for disease (e.g breast and cervical cancer screening, HIV testing) Please specify type(s): Public transportation services to improve access to health care appointments Other (Please Specify): 6b.) Of all the priorities listed in 6a, what are the top health related priorities in your service area? _ _ _ What are your facility/agency’s plans for future expansion? Expand services Scale down services No plans Don’t know/Not sure Thank you for completing this survey Orange County Community Health Assessment 2010-2013 Section IV 14 Exhibit 4.2 Community Health Assessment Regions For Health Town Meetings Crawford Town of Newburgh Montgomery City of Newburgh Wallkill Deerpark Mount Hope New Windsor Middletown Hamptonburgh Wawayanda Port Jervis Blooming Grove Goshen Cornwall Highlands Greenville Chester Minisink Woodbury Monroe Warwick Population in all Four Regions: 377,169 Based on 2007 Census Population Estimates Orange County Community Health Assessment 2010-2013 Section IV Tuxedo 15 Exhibit 4.3 Orange County Prevention Agenda Workgroup Roster NAME AGENCY/ORGANIZATION TITLE Alan Bernstein, M.D Greater Hudson Valley Family Health Care Chief Medical Officer Mary Bevan OCDOH OCDOH CHA Consultant Clare Brady Bon Secours Charity Health System Robert Dietrich OCDOH Karen Dietz Bon Secours Charity Health System VP of Mission/OC Facilities Director of Community Health Outreach VP of Business Development & Planning Jocelyn Dummett, M.D Middletown Community Health Center Medical Director Barbara Demundo Bon Secours Charity Health System Outreach Director Christopher Dunleavy OCDOH Deputy Commissioner of Health Marilyn Ejercito OCDOH Christopher Ericson OCDOH Barry Hawkins OC Department of Mental Health Director of Patient Services Director of PH Emergency Response Chemical Dependency Services Director Jean Hudson, M.D OCDOH Rob Lee Orange Regional Medical Center Commissioner of Health Executive Director Public Relations/Marketing Lucia Lee St Luke’s/Cornwall Hospital Community Outreach Specialist Eileen McManus Hudson River Health Care Uma B Mishra, M.D OC Advisory Board of Health Practice Management Specialist Orange County Radiation Oncology Danielle Nordlund Greater Hudson Valley Family Health Care Grants Coordinator Matt Schleiffer OCDOH Director of Environmental Health Jean-Paul Vallet Orange Regional Medical Center Sheila Warren OCDOH Senior Planning Analyst Director of Early Intervention Services Mirta Zapata-Popoca Hudson River Health Care Unit Manager Orange County Community Health Assessment 2010-2013 Section IV 16 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 SECTION FIVE: OPPORTUNITIES FOR ACTION Introduction In defining opportunities for action, the intent is to focus and mobilize cohesive community action in the health priority areas selected to improve health and reduce health disparities among Orange County residents Improving community health requires coordinated and systemic efforts among all stakeholders: health care providers; community, state, local, and federal health and human service agencies; community and faith-based organizations and groups; policy makers; schools; businesses and the residents they serve The leading health concerns in Orange County, as in the state and the nation, result from a number of interconnected factors, many of which can be controlled or modified Harmful behaviors such as smoking, overeating, poor nutrition, lack of physical activity, substance abuse, and unsafe sexual practices have major impacts on individual health Economic and language/cultural differences present barriers to access and utilization of medical care and preventive health services Income, unemployment, educational attainment, inadequate housing, and lack of transportation are social factors which impact health or limit access to care Uncontrollable factors, including inherited health conditions or increased susceptibility to disease, also significantly influence health In spite of the favorable health status enjoyed by most Orange County residents, health disparities persist and are concentrated in the county’s uninsured and low income population groups Families and individuals who live in poverty or are uninsured are more likely to have poor health status Poverty underlies many of the social factors that contribute to poor health Differences for many health indicators are also apparent by gender, race/ethnicity, age, and geographic area of residence This information can be used to determine subgroups in the population in need of further assessment, as well as guide the development of programs and services to meet identified health needs Expanded joint planning and coordination of programs and services among health partners in the community can reduce health disparities and improve the health of all county residents Effective strategies to improve community health involve collaboration between providers, health agencies, educators, and community-based organizations and groups, and the public they serve In determining opportunities for action, creative coordination and sharing of expertise and resources among agencies and organizations results in the most cost-effective approach The following listing of Opportunities for Action and Potential Action Steps by priority health area was established by the Prevention Agenda Workgroup, with input from Regional Health Town Meetings and Provider/Agency and Resident Surveys This provides the framework for future development of a community health action plan, integrating evidence-based interventions, to build and sustain community capacity focused in the selected priority areas The Prevention Agenda Workgroup will join together with the Healthy Orange Team, to accomplish the following: Coordinate and leverage resources for new initiatives; Develop innovative approaches and advance strategic health planning; Disseminate best practices and lessons learned; and Monitor and evaluate progress based on Prevention Agenda targets Orange County Community Health Assessment 2010-2013 Section V ACCESS TO CARE OPPORTUNITIES FOR ACTION POTENTIAL ACTION STEPS IDENTIFIED How community health partners accomplish through existing programs/services, collaboration, and new initiatives? Promote medical home/gatekeeper for all residents Expand outreach & facilitated enrollment services for public insurance programs at all points of care Collaborate with MISN to increase opportunities for enrollment in Medicaid Managed Care (MMC), Child Health Plus (CHP), and Family Health Plus (FHP) through eligibility screening onsite in hospital, health care and community sites Encourage development of low literacy level print materials in multiple languages with key information on FQHC services for distribution at diverse locations (e.g., hospitals, ERs, CHCs, group practices, CBOs, FBOs, OCDOH clinics, unemployment & DSS offices) Expand outreach to faith-based organizations and strengthen linkages with established Interfaith and Ecumenical Councils in high need communities Encourage/support record systems electronic medical Promote universal access to service & program information Promote efforts by hospitals and group medical practices to implement Electronic Medical Records Systems and secure funding support Research and leverage funding support for a regional call center (e.g., Infoline 211) Intensify outreach to community leaders/CBOs/FBOs working with medically underserved populations regarding available programs & services, public insurance programs, and social services Continue efforts to recruit outreach & engagement workers representative of communities of need Explore partnerships to increase outreach capacity in high need areas, e.g., RSVP programs, college student health and social work internship programs Recruit /retain specialty health/mental health providers in critical shortage areas/survey existing providers Continue participation in Children’s Services County Systems of Care Explore needs assessment to better mental/behavioral health services shortages define Partner with Orange County Medical Society to develop recruitment plan for specialty providers Advocate for restructuring of Medicaid reimbursement rates and reimbursement formulas Support OCDSS efforts to inform state policy makers/elected officials of need to restructure reimbursement Improve transportation services hours, frequency, and routes within and outside county Explore expansion of Orange County DSS Health Bus service to other areas Recruit/retain primary care providers and support staff who are representative of underserved populations at highest risk for health disparities Develop linkages with Medical and Nursing Professional Societies; Medical, Nursing, and Allied Health Professional Colleges and Universities; and technical training programs Improve availability Prescription services Partner with Orange County Office for Aging of discounted Orange County Community Health Assessment 2010-2013 Section V CHRONIC DISEASE OPPORTUNITIES FOR ACTION POTENTIAL ACTION STEPS IDENTIFIED How community health partners accomplish through existing programs/services, collaboration, and new initiatives? Research, pilot, and implement surveillance systems to better assess needs and target interventions (e.g., sentinel schools, health providers, Head Start/large Child Care Centers) Explore development of asthma surveillance system with school nurses in sentinel elementary schools and schoolbased health centers in high need districts Develop linkages to recruit MPH and nursing interns to extend personnel resource capacity Utilize School BMI surveillance data to target prevention and intervention programs Assess the determinants of increased hospitalizations for asthma in children and adults and PQI chronic disease composites Partner regionally through HVRHON/HEAL Consortium to maximize outcomes and funding support Research, pilot, and replicate evidence-based models for prevention, early detection & treatment in chronic diseases of highest concern (Regional approach) Collaborate with community partners to expand availability of evidence-based programs and services (in school, college, work and community settings) to reduce the prevalence of obesity in children, adolescents, and adults, emphasizing improvements in nutrition and activity patterns to achieve and maintain healthy weight throughout life Work with food industry representatives to expand healthy food choices in school and work environments Collaborate with community health providers to expand access to comprehensive CVD, cancer, asthma, and diabetes evidence-based prevention and intervention programs, including smoking cessation and nutrition counseling, especially for high risk minority and low income residents Partner with Orange County/regional chapters of voluntary health agencies (e.g., American Lung Association, American Diabetes Association, American Heart Association, American Cancer Society) in planning and delivery of school and community-based prevention programs (i.e., asthma, diabetes, smoking prevention) Work with community partners to develop health messages that are responsive to the interests and needs of target groups, and provide messages in culturally, language, and media appropriate formats – i.e., social media to reach adolescents with health messages Improve availability of low literacy, language appropriate health promotion materials in community and provider settings Enhance availability of communitybased screening/early detection programs & primary care and treatment services in high need areas Investigate grant opportunities to expand access to breast, cervical, prostate, and colorectal screening, especially for high risk minority and low income residents Convene countywide task force focused on priority health needs Expand membership in Healthy Orange Team to coordinate, sustain and monitor initiatives targeted to priority health needs Orange County Community Health Assessment 2010-2013 Section V MATERNAL, INFANT, CHILD & FAMILY HEALTH OPPORTUNITIES FOR ACTION POTENTIAL ACTION STEPS IDENTIFIED How community health partners accomplish through existing programs/services, collaboration, and new initiatives? Intensify & focus community outreach & engagement services related to importance of early prenatal care in areas of high prevalence; investigate determinants of not accessing early care Collaborate with and support MISN, WIC, and CHWP initiatives, strengthen partnerships with community and faith-based leaders Intensify efforts with schools and Parent Organizations in high risk communities Continue participation in the Orange County Perinatal Consortium to improve access to early prenatal care Expand WIC, CHC & Hospital breastfeeding promotion and support initiatives Collaborate Consortium Support & expand community and schoolbased pregnancy prevention education Focus efforts in high risk areas Partner with BOCES and community-based pregnancy prevention programs with MISN/Regional Lactation Explore opportunities for parents to develop skills in discussing sexuality issues with their children Collaborate with community health partners to expand family planning education and services for adolescents and adults at high risk of HIV/STD infection and substance abuse Support and collaborate with Lead Safe Orange to reduce incidence of EBLL in children < years of age Disseminate outreach and risk reduction materials widely in communities of need; strengthen outreach to medical providers Improvements in techniques for safe and less costly housing remediation are needed, as well as grant funds/loans for low income home owners Explore expansion of programs to educate and to certify trained lead remediation specialists with community partners Intensify health professional and public education to promote universal lead testing, especially in areas of high incidence/prevalence for elevated blood lead levels Support/expand injury prevention initiatives using evidence-based models Explore options for comprehensive assessment of injury data to assist in the identification of areas needing intervention Collaborate with community partners to expand injury prevention and education activities and media campaigns for the elderly, particularly regarding fall prevention and home safety, and for adolescents and adults to prevent MVA injuries Expand OCDOH Healthy Neighborhoods Program to other high risk areas in the county; use social media to reach adolescents with prevention messages Orange County Community Health Assessment 2010-2013 Section V ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 SECTION SIX: COMMUNITY REPORT CARD Introduction The County Health Indicator Profile and County Indicators for Tracking Public Health Priority Areas compiled by NYSDOH were determined to contain the most comprehensive and authoritative listing of the leading health indicators for the county As such, we have adopted these two reports as the Community Report Card for Orange County The most recent edition of the County Health Indicator Profile is for the years 2003-2007; Orange County Indicators for Tracking Public Health Priority Areas data include years 2001-2006 Updates to the County Health Profile will be available through the NYSDOH website at http://www.health.state.ny.us/statistics/chip/orange.htm Updates to the County Indicators for Tracking Public Health Priority Areas will be available at: http://www.ny.health.gov/prevention/prevention_agenda/indicators/county/orange.htm The Orange County Community Health Assessment was developed to be readily accessible to official, voluntary, and community agencies; health care facilities; health care providers; community groups; and the general public to assist in and facilitate local and countywide health-related planning This document is being distributed in print form to a variety of agencies, and is available to the public on request In addition, an electronic version of the 2010-2013 Orange County CHA will be posted on the county and health department websites, and its availability will be promoted through county newsletters and the local media Orange County Community Health Assessment 2010-2013 Section VI County Health Indicator Profiles (2003 - 2007) Profile of: Orange County 2007 # 2006 Rate # 2005 Rate # 2004 Rate # 2003 Rate # Rate SOCIO-DEMOGRAPHIC(1) Population Unemployment 377,169 7,824 376,392 4.3 7,667 372,893 4.3 7,568 370,352 4.3 8,236 363,153 4.7 8,167 4.7 Percent in Poverty 38,184 10.5 41,257 11.3 37,594 10.5 37,244 10.2 38,027 10.5 Median Household Income (in dollars) 64,799 63,551 61,773 54,771 53,139 PERINATAL HEALTH(2) Pregnancies (All ages) - Age 10-14 - Age 15-19 Births Low Birthweight (Less than 2500 grams) Prenatal Care (1st Trimester) 7,156 90.6 0.6 7,203 89.8 12 6,829 87.1 0.8 10 0.7 6,880 87.6 17 1.2 6,744 86.9 0.4 727 50.3 639 45.3 626 46.4 597 45.0 588 46.4 5,333 14.1 5,433 14.4 5,165 13.9 5,206 14.1 5,133 14.1 362 6.8 2,923 64.4 365 6.7 3,125 68.5 396 7.7 3,072 68.7 366 7.0 3,399 71.5 331 6.4 3,230 67.7 Infant Deaths 38 7.1 20 3.7 31 6.0 34 6.5 32 6.2 Neonatal Deaths 23 4.3 13 2.4 21 4.1 28 5.4 18 3.5 Postneonatal Deaths 15 2.8 1.3 10 1.9 1.2 14 2.7 Spontaneous Fetal Deaths (20+ wks) 18 3.4 17 3.1 10 1.9 19 3.6 26 5.0 MORTALITY (Rates per 100,000 Population) Total Deaths 2,498 662.3 2,399 637.4 2,465 661.0 2,499 674.8 2,505 689.8 Lung Cancer (Total) 184 48.8 165 43.8 176 47.2 186 50.2 159 43.8 Lung Cancer (Male) 98 51.7 89 47.1 92 49.0 99 53.1 88 48.3 Lung Cancer (Female) 86 45.8 76 40.6 84 45.4 87 47.3 71 39.2 Breast Cancer (Female) 55 29.3 37 19.8 49 26.5 62 33.7 39 21.6 Cervical Cancer 4.3 1.6 4.3 2.2 3.9 Cerebrovasular Disease 107 28.4 116 30.8 123 33.0 127 34.3 121 33.3 Diseases of the Heart 725 192.2 676 179.6 675 181.0 706 190.6 759 209.0 Homicides Suicides Unintentional Injury 2.4 35 9.3 1.9 1.9 12 3.2 1.9 17 4.5 23 6.2 28 7.6 14 3.9 100 26.5 105 27.9 98 26.3 91 24.6 83 22.9 Motor Vehicle 39 10.3 39 10.4 48 12.9 44 11.9 43 11.8 Non-Motor Vehicle 61 16.2 66 17.5 50 13.4 47 12.7 40 11.0 AIDS Cirrhosis (Liver) 2.1 11 2.9 12 3.2 11 3.0 17 4.7 32 8.5 26 6.9 25 6.7 29 7.8 29 8.0 HOSPITALIZATIONS (Rates Per 10,000 Population) Pediatric (0-4) - Asthma 76 29.0 120 46.7 116 45.5 136 53.6 158 65.3 - Gastroenteritis 98 37.4 139 54.0 124 48.7 102 40.2 128 52.9 - Otitis Media Drug Related Head Injury (5) 2.7 1,045 27.7 264 7.0 1.6 1,155 30.7 295 0.8 1,135 30.4 7.8 Orange County Community Health Assessment 2010-2013 Section VI 246 6.6 3.5 1,008 27.2 267 7.2 17 7.0 980 27.0 243 6.7 2007 # 2006 Rate # 2005 Rate # 2004 Rate # 2003 Rate # Rate DISEASE MORBIDITY (3) AIDS Cases (4) 33 8.7 32 8.5 Early Syphilis 10 2.7 0.8 Chlamydia Incidence 716 189.8 605 160.7 43 11.5 0.3 683 183.2 42 11.3 10 2.7 580 156.6 52 14.3 0.6 495 136.3 TB Incidence 1.9 1.1 0.8 2.4 14 3.9 Ecoli O157 Incidence 1.6 0.3 0.0 1.1 1.1 0.5 0.0 0.5 0.5 0.3 19 5.0 69 18.3 30 8.0 115 31.1 38 10.5 510 135.2 467 124.1 536 143.7 518 139.9 587 161.6 Meningococcal Incidence Pertussis Incidence Lyme Disease Incidence N/A - Not Available (1) Census population estimates were used for all years Unemployment data from U.S Bureau of Labor and Statistics Unemployment Rate is per 100 persons in the labor force Percent of population in poverty and median household income are estimates from the U.S Census Bureau (2) Total Pregnancy Rate is per 1,000 women 15-44; 10-14 and 15-19 rates are per 1,000 women in these age groups The Birth Rate is live births per 1,000 population The Low Birthweight and Early Prenatal Care Rates are per 100 births Infant, Neonatal and Postneonatal Death Rates are per 1,000 births (3) Rates in this section are per 100,000 population (4) AIDS Cases include ICD-9 diagnosis (5) Head Injury Cases are presented by ICD-9 codes 800-801.9, 803-804.9, 850-854.1, 925 Source: New York State Department of Health Orange County Community Health Assessment 2010-2013 Section VI Orange County Indicators For Tracking Public Health Priority Areas Prevention Agenda 2013 Objective Indicator US Orange County NYS ACCESS TO QUALITY HEALTH CARE % of adults with health care coverage 100%† 85.5% (2006) 86.5% (2006) 83.5% (2003) 96%† 80% (2006) 85.0% (2006) NA 83%† 70.3% (2006) 71.8% (2006) 73.7% (2003) Breast 80% 63% 63% 60% Cervical 65% 53% 51% 53% Colorectal 50% 40% (19962003) 41% (2001-2005) 40% (2001-2005) 12% 23.0% (2005) 16.3% (2006) NA 12%† 20.1% (2006) 18.2% (2006) 24.3% (2003) 31.0 23.0 (2004) 39.7 (2004-2006) 38.3 (2004-2006) Male 62.0* 85.3* 80.8* 91.9 Female 41.0* 54.2* (2004) 53.8* (2001-2005) 63.0 * (2001-2005) % of adults with regular health care provider % of adults who have seen a dentist in the past year Early stage cancer diagnosis 2: TOBACCO USE % cigarette smoking in adolescents % cigarette smoking in adults (past month) COPD hospitalizations among adults 18 + years Lung cancer incidence (per 10,000) (per 100,000) * HEALTHY MOTHERS/ HEALTHY BABIES/HEALTHY CHILDREN % early prenatal care (1st trimester) 90%† 83.9% (2005) 74.9% (2004-2006) 69.6% (2004-2006) 5%† 8.2% (2005) 8.3% (2004-2006) 7.1% (2004-2006) 4.5† 6.9 (2005) 5.8 (2004-2006) 5.4 (2004-2006) 90% 80.5% (2006) 82.4% (2006) NA % of children with at least one lead screening by age 36 months8 96% - 82.8% (NYS excl NYC) (2004 birth cohort) 86.7% (2004 birth cohort) Prevalence of tooth decay in 3rd grade children 42%† 53.0% (2004) 54.1% (2004) 56.6% (2004) 28.0 44.4 (2002) 36.7 (2004-2006) 25.6 (2004-2006) 11.6% 14.8% (2004) 15.2% (2004-2006) 13.9% (2004-2006) K12 5%† - - NA 5%† - - NA 5%† - - NA 5%† - - NA 10 5%† - NA % low birthweight births (95th percentile) Years (WIC)11 (pre-school) Indicator Prevention Orange County Community Health Assessment 2010-2013 Section VI US NYS Orange Agenda 2013 Objective % of adults who are obese (BMI>30) County 25.1% (2006) 22.9% (2006) 21.4% (2003) 77.4% (2006) 74.0% (2006) 73.5% (2003) 23.2% (2005) 27.4% (2007) 25.2% (2003) 24.3% (2005) 38.6% (2004-2006) 48.9% (2004-2006) 17.1†* 39.1* (2005) 21.0* (2004-2006) 27.4 * (2004-2006) 44.5* - 64.7 * (2004-2006) 71.9 * (2004-2006) 5.8* 15.2 * (2005) 7.7 * (2004-2006) 12.0 * (2004-2006) 1.5* - 1.9* (2004-2006) 0.9 * (2004-2006) 155.0 - 196.0 (2004-2006) 221.8 (2004-2006) 0.0† - 2.0 1.3 (2003-2005) (2003-2005) (Rate for NYS Excluding NYC) Total 16.7* 16.6* 21.0* 16.0 Ages 0-17 years 17.3† 22.6 (2003) 31.5 (2004-2006) 21.8 (2004-2006) 11.5 - 16.0 (2004-2006) 31.4 (2004-2006) 0.0† - 6.0 (2004-2006) 37.6 (2004-2006) 7.5% (2006) 7.6% (2006) 6.1% (2003) 15%† % of adults engaged in some type of leisure time physical activity 80%† % of adults eating or more fruits or vegetables per day % of WIC mothers breastfeeding at months 33% 11 50%† UNINTENTIONAL INJURY Unintentional Injury mortality (per 100,000) 13 Unintentional Injury hospitalizations (per 10,000) Motor vehicle related mortality (per 100,000) 14 13 Pedestrian injury hospitalizations (per 10,000) 15 Fall related hospitalizations age 65+ years (per 10,000) 15 HEALTHY ENVIRONMENT Incidence of children = 10 µg/dl (per 100 children tested)14 Asthma related hospitalizations (per 10,000) 16 Work related hospitalizations (per 10,000 employed persons aged 16+ years) 14 Elevated blood lead levels (>25 µg/dl) per 100,000 employed persons age 16+ years 14 * CHRONIC DISEASE Diabetes prevalence in adults 5.7% Diabetes short-term complication hospitalization rate (per 10,000) 17 Age 6-17 years 2.3 2.9 3.0 3.3 Age 18+ years 3.9 5.5 (2004) 5.3 (2004-2006) 4.5 (2004-2006) 48.0 - 61.2 * (2004-2006) 70.6 * (2004-2006) 48.9 (2004) 46.3 (2004-2006) 40.8 (2004-2006) 24.0* 46.6 * (2005) 30.5 * (2004-2006) 38.4 * (2004-2006) Breast (female) 21.3* † 24.4* 25.5* 26.6 Cervical 2.0* † 2.4* 2.6* 2.9 13.7* † 18.0* (2004) 19.1* (2001-2005) 23.5 * (2001-2005) Coronary heart disease hospitalizations (per 10,000) 14 Congestive heart failure hospitalization rate per 10,000 (ages 18+ 33.0 years) 17 Cerebrovascular (Stroke) disease mortality (per 100,000) Reduce cancer mortality (per 100,000) 13 Colorectal Indicator Prevention Agenda 2013 Objective Orange County Community Health Assessment 2010-2013 Section VI US NYS * * Orange County INFECTIOUS DISEASE Newly diagnosed HIV case rate (per 100,000)18 23.0 18.5 (2006) 24.0 (2004-2006) 11.0 (2004-2006) 19.0† 120.9 (2006) 93.4 (2004-2006) 38.5 (2004-2006) 1.0† 4.4 (2007) 6.8 (2004-2006) 1.4~ (2004-2006) flu shot past year 90%† 69.6% 64.7% 66.9% ever pneumonia 90%† 66.9% (2006) 61.0% (2006) 60.4% (2003) - 100% (2007) 100% (2007) 4.8†* 10.9* (2005) 6.4 * (2004-2006) 6.1 * (2004-2006) 7.8% 10.1% (20022006) 10.4% (2003-2005) 10.7% (2003) 13.4%† 15.4% (2006) 15.8% (2006) 12.8% (2003) 26.0 - 34.0 * (2004-2006) 29.3 * (2004-2006) Gonorrhea case rate (per 100,000)19 Tuberculosis case rate (per 100,000)20 % of adults 65+ years with immunizations COMMUNITY PREPAREDNESS % population living within jurisdiction with state-approved emergency preparedness plans 21 100% MENTAL HEALTH/SUBSTANCE ABUSE Suicide mortality rate (per 100,000) 13 % adults reporting 14 or more days with poor mental health in last month % binge drinking past 30 days (5 + drinks in a row) in adults Drug-related hospitalizations (per 10,000) 22 † Healthy People 2010 Goal utilized * Rate age-adjusted to the 2000 US population ~ Fewer than 20 events in the numerator; rate is unstable s Suppressed (percent could not be calculated, fewer than cases per year) DATA SOURCES NYS (statewide) and US Data Source: Centers for Disease Control, Behavioral Risk Factor Surveillance System, http://apps.nccd.cdc.gov/brfss/index.asp and http://www.cdc.gov/brfss/technical_infodata/surveydata/2006.htm, NYS (county level) Data Source: NYS Department of Health, Expanded Behavioral Risk Factor Surveillance System (Expanded BRFSS), http://www.health.state.ny.us/nysdoh/brfss/expanded/2003/index.htm Note: the Expanded BRFSS survey 38 localities (including individual counties and county groupings For a list of counties and county groupings, http://www.health.state.ny.us/nysdoh/brfss/expanded/2003/docs/rptstlocreg.pdf NYS (statewide and county level) Data Source: NYS Cancer Registry, http://www.health.state.ny.us/statistics/cancer/registry/, US Data Source: National Cancer Institute, SEER Fast Stats, http://seer.cancer.gov/data/ NYS (statewide) Data Source: New York State Department of Health, Youth Tobacco Surveillance New York State 2006, http://www.health.state.ny.us/prevention/tobacco_control/youth_tobacco_survey.htm, US Data Source: Centers for Disease Control, Youth Risk Behavior Survey, http://www.cdc.gov/HealthyYouth/yrbs/ NYS (statewide and county level) Data Source: New York State Department of Health, Statewide Planning and Research System (SPARCS); US Data Source: AHRQ Quality Indicators, http://www.qualityindicators.ahrq.gov NYS (statewide and county level) Data Source: NYS Department of Health - Vital Statistics, NYS Community Health Data Set, http://www.health.state.ny.us/statistics/chac/chds.htm, US Data Source: Centers for Disease Control, National Vital Statistics Reports, Volume 56, Number Births: Final Data for 2005 http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf NYS (statewide and county level) Data Source: NYS Department of Health - Vital Statistics, NYS Community Health Data Set, http://www.health.state.ny.us/statistics/chac/chds.htm, US Data Source: Centers for Disease Control, National Vital Statistics Reports, Volume 56, Number 10 Deaths: Final Data for 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf NYS (statewide) and US Data Source: Centers for Disease Control, National Immunization Survey (NIS), http://www.cdc.gov/vaccines/stats-surv/nis/data/tables_2006.htm NYS (statewide and county level) Data Source: NYS Department of Health, NYS Childhood Lead Program NYS (statewide and county level) Data Source: NY State Oral Health Surveillance System, http://www.health.state.ny.us/prevention/dental/docs/child_oral_health_surveillance.pdf, US Data Source: Healthy People Data 2010, Oral Health, http://wonder.cdc.gov/data2010/focus.htm 10 NYS (statewide and county level) Data Source: NYS Department of Health - Vital Statistics, NYS Community Health Data Set, http://www.health.state.ny.us/statistics/chac/chds.htm, US Data Source: Centers for Disease Control, National Center for Health Statistics, Recent Trends in Teenage Pregnancy in the US, 1990 – 2002, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/teenpr eg1990-2002/teenpreg1990-2002.htm Orange County Community Health Assessment 2010-2013 Section VI 11 NYS (statewide and county level) and US Data Source: NYS Department of Health, The Pediatric Nutrition Surveillance System, http://www.health.state.ny.us/statistics/prevention/nutrition/cacfp/pednss/index.htm 12 NYS (statewide and county level) Data Source: NYS Department of Health, Division of Chronic Disease Prevention and Adult Health, Program Data 13 NYS (statewide and county level) Data Source: NYS Department of Health - Vital Statistics, NYS County Health Assessment Indicators, http://www.health.state.ny.us/statistics/chac/chai/, US Data Source: Centers for Disease Control, National Vital Statistics Reports, Volume 56, Number 10 Deaths: Final Data for 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf 14 NYS (statewide and county level) Data Source: NYS Department of Health, NYS County Health Assessment Indicators, http://www.health.state.ny.us/statistics/chac/chai/ 15 NYS (statewide and county level) Data Source: New York State Department of Health, Statewide Planning and Research System (SPARCS) 16 NYS (statewide and county level) Data Source: NYS Department of Health, NYS Asthma Surveillance Summary Report, http://www.health.state.ny.us/statistics/ny_asthma, US Data Source: National Hospital Discharge Survey 2005, http://www.cdc.gov/nchs/data/series/sr_13/sr13_165.pdf 17 NYS (statewide and county level) Data Source: New York Department of Health, State Planning and Research System (SPARCS); US Data Source: AHRQ Quality Indicators, http://www.qualityindicators.ahrq.gov 18 NYS (statewide and county level) Data Source: NYS Department of Health, NYS County Health Assessment Indicators, http://www.health.state.ny.us/statistics/chac/chai/, US Data Source: Centers for Disease Control, HIV/AIDS Surveillance, http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/us_media.pdf 19 NYS (statewide and county level) Data Source: New York Department of Health, Communicable Disease Annual Reports, http://www.health.state.ny.us/statistics/diseases/communicable/2006/, US Data Source: Centers for Disease Control, STD Surveillance, http://www.cdc.gov/STD/stats/tables/table1.htm 20 NYS (statewide and county level) Data Source: NYS Department of Health, NYS County Health Assessment Indicators, http://www.health.state.ny.us/statistics/chac/chai/, US Data Source: Centers for Disease Control, MMWR Weekly, March 21, 2008, Trends in Tuberculosis – United States 2007, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2 21 NYS (statewide and county level) Data Source: NYS Department of Health, Emergency Preparedness Program data 22 NYS (statewide and county level) Data Source: NYS Department of Health, NYS Community Health Data Set, http://www.health.state.ny.us/statistics/chac/chds.htm Orange County Community Health Assessment 2010-2013 Section VI ... M.P.H Commissioner of Health Orange County, New York September 2009 Orange County Community Health Assessment 201 0- 2013 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 KEY FINDINGS Demographic... are per 10,000 births Orange County Community Health Assessment 201 0- 2013 Guide to Statistical Terms 201 0- 13 Community Health Assessment COVER PAGE County: Orange Local Health Department Address:... Health Mary Bevan, M.P.H., Project Director (Consultant) Jean M Hudson, M.D., M.P.H Commissioner of Health Orange County Community Health Assessment 201 0- 2013 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT