Weld County Public Health
Improvement Plan
Priorities Meeting
May 10, 2011
Today’s Plan

Review identified important issues
◦ Brief summaries of data and possible broad
strategies

Facilitated group discussion
◦ Everyone will vote on overall importance, ability,
and capacity to impact



Results tallied and presented
Discuss findings and make group decision on
priority issues based on score results (i.e.,
“cut points”)
Reflect on the priorities and next steps
What is the point of choosing
priorities?

With limited resources, intensive focus on a few areas,
beyond the maintenance of effort, can make a difference

No single agency can not do it alone so we need to
garner the resources and energy from other multiple
sectors

Identifying a few key areas to collectively focus on results
in improvement plans that are doable

Communications and talking points need to be direct and
focused
Where We Want To Go –

All residents living, working, and playing in
Weld County will benefit from physically,
socially, emotionally, and spiritually
enriched environments enhanced by the
intentional, collaborative efforts among
public & environmental health, health care,
social service, education, community
organizations and citizens-at-large.
Weld County Winnable Priorities
 Infant
health
 Teen motor
vehicle injury
 Mental health &
substance
abuse
 Nutrition, physical
activity, obesity
 Tobacco use
 Teen pregnancy
As you review the data …
How important is this health issue?
• How many people are currently impacted,
rates of mortality, morbidity?
• How many people are at risk, what does
the trend data tell us?
• What is the degree of health disparities
inherent in this area?
• Does this issue have a severe impact on
the quality of life?
• As we consider health care costs, what is
the economic burden of this health issue?
As you review the data…
What is our ability to impact this area?
• Do evidence-based strategies or best
practices exist that can make a difference?
• Is it likely, that with collective effort, we
can make a difference?
• Is there community level readiness and
support for change?
As you review the data …
What is our capacity to impact this area?
• Is there political will and champions to
support the issue?
• Are there organizations prepared to take
the lead to move it forward?
• Is there an adequate number of staff
available ?
• Is there funding available or obtainable?
Populations of interest total reach counts

Total Population: 252, 000
◦ 28% Hispanic/Latino

Children 0 – 18 yrs : 73,000

Teens 15-19 yrs: 20,000
◦ Teen females 15-17 yrs: 5,250
 Teen mothers (15-17 yrs): 155/yr
Adults 18 – 64 yrs: 165,000
 Adults 65 and older: 22,000

Populations of interest total reach counts

38,000 (15%) of Weld residents live below the
federal poverty level

14,000 (19%) of Weld children live below the
federal poverty level

58,000 (25%) of Weld residents under 65 yrs
live below 200% of the federal poverty level
Sources: 2009 FPL data from Colorado Health Institute, 2007 US Census SAHIE data compiled by WCDPHE
Count
Q29. What assets can your organization possibly offer
to help improve our community's health
around any of the priority health issues?
20
18
16
14
12
10
8
6
4
2
0
18
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5
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5
3
Using your keypad is easy…
but don’t push any buttons yet!
Polling Open
Let’s say you
press 2/B
Your answer will
be displayed
The check mark
indicates the
answer was
received properly
Note: after your
selection is
displayed the
screen will go
blank
Changing Your Answer
Polling Open
As long as Polling
is Open, you can
change your
answer by
pressing any other
key.
Note: If you have
a problem, let the
screen go blank
and then try again
Practice: Who is your public health
hero?
C. Everett Koop
Louis Pasteur
Jonas Salk
Erin Brockovich
Mark Wallace
Other
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SOME DEMOGRAPHICS
Prior to today, how many of these
meetings have you attended?
1. This is my first
2. One or two
3. Three or more
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What sector of the public health
system do you represent?
1.
2.
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7.
8.
Public Health
Environmental Health
Health Care
Social Service
Education
Community Organization
Citizen-at-large
Other county or municipal
government
9. Media
10. Other
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Do you work directly with one or
more of the target populations?
1. Yes
2. No
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A LITTLE MORE DEPTH
ON EACH OF ISSUE
Infant Health

Why is this important?
◦ Infant mortality is associated with maternal health, quality
and access to care, socioeconomic conditions, and public
health practices.
◦ Weld County’s infant mortality rate: 6.3 deaths per 1,000
live births; this translates to about 20–30 infants/yr or about
1 death every other week among 4,000 mothers annually
◦ 2009 CDPHE analysis: Weld’s rate has not changed in the
long-term and is far from the goal of 4.5/1,000
◦ A 2003 statewide analysis found that 30% of Weld County’s
fetal and infant deaths were preventable.
◦ VLBW infant NICU costs > $3,500 per infant; can exceed $1
million for an prolonged stay
◦ Family financial and emotional costs can also be significant
Infant Health

What can we do?
◦ American College of Obstetrician and Gynecologists Fetal and Infant
Mortality Review (FIMR) program is well evaluated/evidence
informed

What is our capacity?
◦ Medical, public health, and human service community have
champions and are ready.
 Health department is prepared to take the lead. Staffing to be determined.
Start-up and long-term funding needs to be identified.
◦ $17 million is dedicated to child health issues by 11
organizations; 112 primary staff, 112 support staff, 28
volunteer staff
◦ Several strong coalitions and/or networks focused on
maternal and child health issues – Promises for Children,
Early Childhood Council
◦ There are no programs addressing this directly
Infant health
Infant Mortality Rates, Weld, Larimer, El Paso & Colorado,
1990-1992 to 2007-2009, 3 Year Averages
Weld
Larimer
10
Colorado
El Paso
9
8.2
Rate per 1,000 Live Births
8
7
6.4
6.3
6
5
4
3
Weld Trendline
2
1
0
3 Year Interval
Preventable deaths
Table 1. Weld County Infant Deaths, 1997 – 2002
Birthweight
500 – 1,499
grams
≥ 1,500
grams
Total
Fetal
Neonatal
Postneonatal
Maternal Health / Prematurity
63 deaths
Maternal Newborn
Care
Care
38 deaths 20 deaths
57
62
Total
63
Infant Health
40 deaths
98
42
161
Infant health is a priority for
Weld County.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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Teen Motor Vehicle Safety
Why is this important?




Motor vehicle crashes are the leading cause of death for U.S.
teens
In 2009, about 3,000 teens in the United States aged 15–19
were killed and more than 350,000 were treated in emergency
departments for injuries suffered in motor-vehicle crashes.
Young people ages 15-24 represent only 14% of the U.S.
population. However, they account for 30% ($19 billion) of the
total costs of motor vehicle injuries among males and 28% ($7
billion) of the total costs of motor vehicle injuries among
females.
1 out of 6 drivers involved in a crash in Weld county are teens
◦ The most cited violation was “inattention to driving”
◦ 10% of teens involved in a crash in Weld County were not wearing a
seatbelt.

12% of District 6 students say they rarely/never wear a seatbelt
when riding in a car (2007 YRBS)
Teen Motor Vehicle Safety
What can we do?
 Programs, policies, and social norms related to
increasing awareness of high-risk driving, creating
positive attitudes toward seat belt use, developing safer
driving-related skills and decision-making abilities

What is our capacity?
◦ DRIVE SMART Weld County is a strong nonprofit community
coalition made up of members of law enforcement, business,
insurance, media, concerned citizens, schools, fire
departments, and health professionals working to reduce
injuries and death from traffic crashes
◦ Current funds < $100,000 / yr plus in-kind resources from
coalition
 Funding sources: MCH, CDOT, Banner, State Farm, All State
 Staffing <.5 FTE plus 5.0 FTE volunteer hours
*Rates are per 100,000 teens ages 15-19
Source: Health Statistics Section, Colorado Department of Public Health and Environment
Motor vehicle crash hospitalization rates* to teens
15-19, 2007-2009 by Health Statistics Regions
* Rates are hospitalizations to teens age 15-19 per 100,000 population age 15-19 in each region
Source: Health Statistics Section, Colorado Department of Public Health and Environment
Disparities in (teen) motor
vehicle crashes/deaths
• Males (61% of teen crashes)
• Geography -most crashes happen in
southwest but origin of teen drivers is:
•
•
•
•
25% Greeley/Eaton/Ft. Lupton
34% other cities in Weld
26% Denver and other cities outside Weld
15% neighboring cites (Ft. Collins/
Brighton/Longmont)
Teen motor safety is a priority
for Weld County.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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Mental Health
Why is this important?




Mental health disorders are the leading cause of disability in
the US, accounting for 25% of all years of life lost due to
disability and premature mortality
Depression and anxiety affect people’s ability to participate in
health-promoting behaviors which, in turn, affects physical
health
Suicide is the 8th leading cause of death in the Weld County
27% of adults in Weld said their mental health was not good
1 – 7 of the previous 30 days and 14% said their mental
health was not good for 1 week or more (Weld 2010 CHS)
Mental Health
What can we do?

Ensure supply and access to effective & appropriate mental health &
suicide prevention services

Shift norms & address stigma associated with seeking mental health
services

Fill community gaps with effective & appropriate program interventions

What is our ability/capacity?
◦ Northern Colorado Health Alliance and North Range
Behavior Health are champions in this area
 NOCOHA has a newly launched initiative called Project Launch promotes maternal mental health and early social-emotional health in
underserved children (from birth to age 8) who are experiencing or at risk for
significant social stressors
◦ About $16 million is dedicated to this area from 7 agencies;
with 203 primary staff, 65 support staff, and 31 volunteer staff
Source: WCSD6 Youth Risk Behavior Survey, WCDPHE
Teen suicide
*Rates are per 100,000 teens ages 15-19
Source: Health Statistics Section, Colorado Department of Public Health and Environment
Disparities in mental health
Do you currently have depression, anxiety, or
other mental health problem? (YES)
2010 Weld CHS
50%
40%
30%
21%
20%
10%
0%
27%
24%
15%
15%
18%
17% 17%
12%
18%
13%
14%
Substance Abuse
Why is this important?
 Excessive alcohol consumption is the third leading
cause of preventable death in the US; 5% of US pop.
drinks heavily & 15% binge drink
 17% of adult Weld residents binge drink; 5%
exceeded guidelines for low-risk drinking; 3% drove
after having too much to drink (2007-2008 BRFSS,
COHID)
 28% of WCSD6 high school students binge drink
(2007, YRBS)
 6% of Weld pregnant moms drank during pregnancy
(PRAMS)
 2% of households had someone who needed and
used alcohol or drug treatment services; another 3%
said it was needed by someone but not used
Substance Abuse
What can we do?
◦ Shift norms associated with substance use/abuse
◦ Reduce youth access (raise prices, promote alternatives)
◦ Decrease the appeal of substance products (examining,
publicizing, reducing advertising/marketing and by doing
counter-advertising & programming)

What is our capacity?
◦ Weld County Prevention Partners is a champion in this area
◦ WCPP has a large multiyear federal grant focusing on underage
binge drinking especially among Latinos. In depth readiness
assessments have been done in four regions/school districts –
Ault RE-9, Fort Lupton RE-8, Johnstown-Milliken RE-5J, and
LaSalle, Gilcrest, Platteville RE-1 – to see if underage drinking
interventions could be implemented
◦ Over 80% of residents are concerned about alcohol or drug
abuse
Disparities in Substance Abuse
(binge drinking)
•
•
•
•
Males (higher)
Age (younger higher)
Race (Whites and Hispanics higher)
Income (higher income higher)
Mental health and substance abuse
is a priority for Weld County.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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Nutrition, Physical Activity, & Obesity

Why is this important?
◦ Increased the risk for:
 Coronary heart disease, type 2 diabetes, cancers
(endometrial, breast, and colon), hypertension,
dyslipidemia , stroke, liver and gallbladder disease,
sleep apnea and respiratory problems, osteoarthritis,
gynecological problems (abnormal menses, infertility)
◦ US medical expenses alone attributed to both
overweight and obesity may have reached as high as
$78.5 billion
◦ Weld County resident fruit and vegetable consumption
and physical activity levels are below state averages
◦ Weld County’s obesity rate is 25% which is significantly
higher than the state rate of 19%
Nutrition, Physical Activity, & Obesity

What can we do?
◦ Help change individual’s knowledge and skills
◦ Reduce exposure to foods low in nutritional value and high in
calories
◦ Increase opportunities for physical activity

What is our capacity?
◦ Healthy Weld 2020, WCDPHE, Banner/NCMC are champions
in this area
◦ $6.2 million is dedicated to chronic disease risk factor reduction by 11
organizations; 40 primary staff, 44 support staff and 1.4 volunteer staff are
dedicated to this area
Percent of children aged 2-14 overweight or obese
HP 2020
Obj: 5%
Source: Colorado Child Health Survey, CDPHE
Percent
Percent of WCSD6 9-12 graders who are overweight or
obese, 2005-2007
HP 2020
Obj: < 5%
Sources: Weld County School District Six Youth Risk Behavior Survey (YRBS), WCDPHE
& Colorado YRBS, CDPHE
Overweight & obesity trend
Overweight and obesity (BMI):
Weld County, 2005 - 2010
50%
Percent
40%
HP 2020
Obj: 15%
Neither overweight
or obese (BMI <25)
Overweight (BMI =
25-<29)
Obese (BMI 30+)
30%
20%
10%
0%
2005
2006
2007
Year
2010
Disparities in Obesity
•
•
•
•
Race (Hispanics higher)
Income (lower income higher)
Education (lower education higher)
Geography (Greeley/Evans and Southeast
are higher)
Nutrition, physical activity and
obesity are priorities for Weld
County.
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Tobacco

Why is this important?
◦ Tobacco use is the single most preventable cause of
death and disease in the United States
◦ Each year, approximately 443,000 Americans die from
tobacco-related illnesses
◦ Tobacco use costs the U.S. $193 billion annually in
direct medical expenses and lost productivity
◦ Adult cigarette use in Weld County is decreasing but
adolescent cigarette use has not
◦ Chew tobacco rates are higher in Weld County
compared to Colorado
Tobacco

What can we do?
◦
◦
◦
◦
◦

Increase price of tobacco products
Promote comprehensive smoke-free policies
Reduce tobacco advertising and promotion
Implement anti-tobacco education or media campaigns
Encourage / assist tobacco users to quit
What is our capacity?
◦ Tobacco Free Weld County Coalition is a strong champion
◦ 80% of county residents are concerned about youth tobacco
use
Source: Weld Behavioral Risk Factor Surveillance Survey, WCDPHE
Weld County Community Health Survey
Youth tobacco use

Generally, WCSD6 smoking rates are lower
than Colorado’s
◦ In 2007, 15.9% of WCSD6 9-12 grade students
smoked cigarettes.

However, smoking rates significantly
increased among white, non-Hispanic youth
◦ increasing from 12% to 18% from 2005 to 2007
◦ In 2009-2010 HKCS for WCSD6, about 19%
smoked cigarettes.
Disparities in tobacco
•
•
•
•
•
Age (18-34 year olds higher)
Gender (males higher)
Income (lower income higher)
Education (lower education higher)
Geography (Greely/Evans & Southeast
higher)
Tobacco use is a priority for
Weld County.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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Teen Pregnancy

Why is this important?
◦ Delays in initiating prenatal care, reduced likelihood
of breastfeeding, poor maternal mental health
◦ 76% of teens pregnancies were unintended
◦ 46% of teens entered into prenatal care after 1st
trimester
◦ Children born as a result of an unintended
pregnancy are more likely to experience poor
mental and physical health and poor educational
and behavioral outcomes
◦ 8% of Weld teen infants were born at a low birth
weight
◦ Direct medical costs associated with unintended
pregnancies in 2002 were $5 billion, or an average
of $1,609 for each unintended pregnancy
Teen Pregnancy

What can we do?
• Develop multi-faceted programs that support prevention
• Reduce cost barriers to family planning services and
contraceptives
• Increase access to reproductive health services
• Provide comprehensive family planning services specifically
designed to meet cultural, age, and gender needs of clients
in a variety of settings
• Provide assessment, policy development and planning, and
assurance activities to reduce unintended pregnancy rates

What is our capacity?
◦ $6.5 million is dedicated to adolescent health issues by
12 organizations; 52 primary staff, 17 support staff, 38
volunteer staff
◦ Over 80% of residents are concerned about teen sexual
activity and pregnancy
Teen (15-17 yrs) Birth Rate
Disparities in unintended
pregnancy
•
•
•
•
Race (Hispanic higher)
Income (lower income higher)
Education (lower education higher)
Geography
Teen pregnancy is a priority for
Weld County.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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Health equity/disparities (in any area just
mentioned) is a priority for Weld County.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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Health care access & utilization
is a priority for Weld County.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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PRIORITIZING THE SIX
WINNABLE BATTLES
The three criteria
How important? Number of people,
mortality, morbidity, at risk, trend,
disparities, quality of life, economic
burden
 What is the ability to impact? Strategies
to make a difference, community
readiness
 What is the capacity to impact? Political
will, organizations to lead, staff, funding

The first three items…
Infant health
 Teen motor vehicle injury
 Mental health & substance abuse

Ability
Infant health
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Ability
Teen motor safety
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Ability
Mental health & substance
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Capacity
Infant health
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Capacity
Teen motor safety
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Capacity
Mental health & substance
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Important
Infant health
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Important
Teen motor safety
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Important
Mental health & substance
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Bubble size = Important
5
Capacity 2.5
0
0
2.5
Ability
5
The next three…
Nutrition, physical activity, obesity
 Tobacco use
 Teen pregnancy

Ability
Nutrition, activity, obesity
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Ability
Tobacco
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Ability
Teen pregnancy
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Capacity
Nutrition, activity, obesity
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Capacity
Tobacco
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Capacity
Teen pregnancy
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Important
Nutrition, activity, obesity
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Important
Tobacco
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Important
Teen pregnancy
0%
0%
...
0%
...
0%
...
0%
...
...
...
...
...
...
...
1.
2.
3.
4.
5.
Bubble size = Important
5
Capacity 2.5
0
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2.5
Ability
5
Based on your own personal sense of
what is important, pick your top two
public health priorities.
Select as many choices as you want, then
push “Enter” on keypad.
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1. Infant health
2. Teen motor vehicle injury
3. Mental health &
substance abuse
4. Nutrition, physical
activity, obesity
5. Tobacco use
6. Teen pregnancy
7. Other
Discussion
Based on the data and discussion, what
should be the public health priorities?
 If these are our priorities, what should we
be doing next?

QUICK EVALUATION
I learned a lot about Weld County’s six
winnable public health priorities.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
0%
0%
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ro
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ng
ly
Di
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gr
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gr
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sa
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Ag
re
e
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St
ro
1.
2.
3.
4.
5.
This was a good process to learn about and
prioritize public health issues.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
0%
0%
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ro
1.
2.
3.
4.
5.
I have a clear sense of what Weld county
public health priorities should be.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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0%
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ro
1.
2.
3.
4.
5.
I am confident that Weld County can make
significant progress over the next few years on its
priorities.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
0%
0%
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St
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1.
2.
3.
4.
5.
Please leave keypads at your place.
THANKS FOR
PARTICIPATING