Public Health:
Prevent-Promote-Protect
Frederick County’s Health
Barbara Brookmyer, MD, MPH
Frederick County Health Officer
Frederick County Health Department
February 22, 2012
Objectives

Review Key Indicators of Health Status
and later …
Describe State Health Improvement Process
 Describe FC’s Local Health Improvement Process
 Identify opportunities for you to become engaged 

What is Public Health?
Definition:
 Protect and improve health of communities and populations
through education, promoting healthy lifestyles, and research
for disease and injury prevention

How:
◦ Population or community level focus
◦ Surveillance and data gathering
◦ Develop plans, programs, and policies
◦ Implement plans, programs, and policies
◦ Evaluate performance and outcomes
Reference:http://www.whatispublichealth.org/what/index.html
Demographics of Frederick County
Demographics
Frederick
Total Population*
Age*, %
 Under 5 Years
 Under 18 Years
 65 Years and Older
233,385
5,773,552
6.4%
25.3%
11.1%
6.3%
23.4%
12.3%
81.5%
8.6%
0.3%
3.8%
7.3%
58.2%
29.4%
0.4%
5.5%
8.2%

Race/Ethnicity*, %
 White
 Black
 Native American
 Asian
 Hispanic or Latino origin
Maryland
Median Household Income**$81,436
Households in Poverty**, %
5.5%
$70,017
8.6%
Pop. 25+ W/O H.S. Diploma** 8.4%
Pop. 25+ With Bachelor's
Degree or Above**, %
36.2%
12.1%
35.6%
Sources: *U.S. Census (2010), **American Community Survey (2008-2010)
County Health Rankings

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

All counties in the US
3rd year in a row rankings to be released April
Frederick County ranked 3rd overall in health outcomes 2
years in a row!
Frederick County Health Factors rank was 4th
Frederick’s physical environment ranked 16th
Reference:http://www.whatispublichealth.org/what/index.html
2007 Community Health Assessment Areas
of Opportunity


Access to Healthcare Services
◦ Routine Medical Care
◦ Availability (Inconvenient Office
Hours)
◦ Health Disparities (Low-Income,
Minorities)
Death, Disease & Disability
◦ Heart Disease & Stroke
◦ Cancer
 Colorectal Cancer (Deaths)
 Prostate Cancer (Screening)
◦ Respiratory Disease
 Asthma
 Chronic Lower Respiratory
Disease

Maternal & Infant Health
◦ Prenatal Care

Mental & Emotional Health
◦ Alzheimer’s Disease
◦ Emotional Wellness
 Stress
 Suicide

Modifiable Health Risks
◦ Overweight & Obesity
◦ Alcohol Abuse
◦ Tobacco Use
10 Leading Causes of Death in
Frederick County, 2010
Malignant Neoplasms (332 down from 385)
 Diseases of the Heart (316 down from 380)
 Chronic Lower Respiratory Diseases (92 up from 69)
 Cerebrovascular Diseases (88 up from 71)
 Accidents (62 up from 50)
 Influenza and Pneumonia (46 up from 39)
 Alzheimer’s (37 up from 23)
 Kidney Disease (31 up from 30)
 Diabetes Mellitus (23 down from 27)
 Septicemia (23 down from 33)
 Intentional Self-Harm (Suicide) (21 down from 32)

Reference: http://dhmh.maryland.gov/vsa/Documents/deaths/Frederick.pdf
Incidence Rates for All Cancers 1997-2007:
Frederick County, Maryland, and U.S.
700
Incidence Rate per 100,000
600
500
400
FC Total
MD Total
300
US Total
200
100
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
All Rates are per 100,000. 1997 and 1998 rates are age-adjusted to the 1970 U.S. population, all other
years are age-adjusted to the 2000 U.S. standard population
Source: Maryland Department of Health and Mental Hygiene CRF Annual Reports 2000-2010.
2007
Years of Potential Life Lost (YPLL) Before
Age 75, Frederick County, 2009, Selected
Causes of YPLL
3500
3000
2500
Years
2000
1500
1000
500
0
Source of Data: Divsion of Health Statistics, DHMH
African American vs. Caucasian Mortality Data for the Top 15 Causes of Death,
Maryland 2009
Ratio Disparity Excess Rate of Frederick Cause Statewide Cause of
Rank
Disparity Rank
of Death
Death
Disease
Age-Adjusted Mortality per
100,000 Black
White
Ratio
Age-Adjusted
Difference per
100,000
7
1
2
1
Heart Disease
238.3
184.3
1.29
54
9
4
1
2
Cancer
193
176.6
1.09
16.4
8
7
3
3
Stroke
48.3
38.3
1.26
10
4
4
Chronic Lung Disease
27.8
40.4
0.69
-12.6
10
5
Diabetes
34.4
17.1
2.01
17.3
5
6
Accidents
22.9
24.7
0.93
-1.8
4
2
10
10
6
7
Flu and Pneumonia
17.5
17.2
1.02
0.3
6
9
7
8
Septicemia
25.2
16.5
1.53
8.7
11
9
Alzheimer's Disease
15.6
17.6
0.89
-2
19
10
HIV
17.5
1.2
14.58
16.3
22.1
11.8
1.87
10.3
1
5
5
6
9
11
Nephritis, Nephrotic
Syndrome, and
Nephrosis
2
3
15
12
Homicide
19.1
2.4
7.96
16.7
12
13
Chronic Liver Disease
6.2
7.2
0.86
-1
8
14
Suicide
5.2
11.4
0.46
-6.2
15
Certain conditions
originating in the
perinatal period
11.4
2.6
4.38
8.8
3
8
18
Source: Maryland Vital Statistics Annual Report 2009
Frederick County Data: Heart Disease and
Related Risk Factors
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
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Heart disease and cancer are the leading causes of death in Frederick
County followed by stroke (Maryland VSA 2007-2009, Table 50).
Among chronic disease risk factors, 15% of adults smoke, 25% report
having high blood pressure and well over a third report having high
cholesterol (Maryland BRFSS, 2009).
25% of adults are classified as obese; 40% are classified as overweight,
which is 5th worst in the State (Maryland BRFSS, 2010).
72% of adults, 4th highest in the State, describe their activity level at work
as “mostly sitting/standing” (Maryland BRFSS, 2010).
With regards to chronic disease disparities, the rate (per 100,000) of
diabetes-related ED visits is 536 for Blacks vs. 197 for Whites (2.7 times
greater), and hypertension-related ED visits is 426.8 for Blacks vs. 142.9
for Whites (3 times greater) (HSCRC, 2010).
Age-adjusted mortality data for Frederick County also shows that Blacks,
when compared to Whites, suffer a higher rate of death from stroke (1.26
times greater), heart disease (1.29 times greater), and diabetes (2
times greater) (Maryland Vital Statistics Annual Report 2009).
# Marylanders Estimated to be Receiving
Expanded Preventive Services Under the ACA






Total 1,153,000
Children 297,000
Women 448,000
Men 408,000
Based on expanded coverage though
employer-sponsored health plans
Source = February 2012 ASPE Issue Brief
◦ available on the Internet at:
http://aspe.hhs.gov/health/reports/2012/Preventiv
eServices/ib.shtml accessed February 21, 2012
BMI-For-Age 2 to 18: >=95th Percentile
Frederick County / Maryland vs. Healthy People
2020 Target
30
25
20
15
10
5
0
Frederick County
Maryland
HP 2020 Target
2006
20.6
21.9
2007
14.2
22.3
2008
19.2
22.3
2009
23
23.1
2010
17.4
25.7
14.6
HP Objective NWS-10: Reduce the proportion of children and adolescents who are
considered obese (target for ages 2-19).
Maryland Behavioral Risk Factor
Note: BRFSS data & HP objective- similar but not exact.
Surveillance System, BRFSS-2006- 2010,
Retrieved from: www.marylandbrfss.org
Adults ever told they had high cholesterol
45
40
35
30
25
20
15
10
5
0
Frederick County
Maryland
HP 2020 Target
2001
30.8
31.1
2003
32.9
33.9
2005
30.6
33.2
2007
39.1
36.9
2009
35.5
37.4
13.5
HP Objective HDS-7: Reduce the proportion of adults with high total blood cholesterol levels
Maryland Behavioral Risk Factor
Surveillance System, BRFSS-2001- 2009,
Retrieved from: www.marylandbrfss.org
Ever Had Sigmoidoscopy or Colonscopy Exam Age 50+ Frederick County / Maryland vs. Healthy
People 2020 Target
80
70
60
50
40
30
20
10
0
Frederick County
Maryland
HP 2020 Target
2002
66.8
54.8
2004
48.2
61.1
2006
67.3
65.7
2008
73.8
71.3
2010
70
72.3
70.5
HP Objective C-16: Increase the proportion of adults who receive a colorectal cancer screening based
on the most recent guidelines
Maryland Behavioral Risk Factor
Surveillance System, BRFSS-2002- 2010,
Retrieved from: www.marylandbrfss.org
Last Mammogram Less than 2 years ago - Women
40+ Frederick County / Maryland vs. Healthy
People 2020 Target
84
82
80
78
76
74
72
70
68
Frederick County
Maryland
HP 2020 Target
2000
77.5
81.6
2002
81
82.1
2004
73.7
79
2006
80.1
79.8
2008
78.7
77
2010
80
80.8
81.1
HP Objective C-17: Increase the proportion of women who receive a breast cancer screening based on
the most recent guidelines
Maryland Behavioral Risk Factor
Surveillance System, BRFSS-2000- 2010,
Retrieved from: www.marylandbrfss.org
Pap Smear Within Past Two Years - Women 18+
Frederick County / Maryland vs. Healthy People
2020 Target
95
90
85
80
75
70
Frederick County
Maryland
HP 2020 Target
2000
86.8
87.1
2002
89.2
88.4
2004
84.2
84.1
2006
83.9
83.1
2008
85.9
78.2
2010
83.3
82
93
HP Objective C-15: Increase the proportion of women who receive a cervical cancer screening based
on the most recent guidelines
Maryland Behavioral Risk Factor
Surveillance System, BRFSS-2000- 2010,
Retrieved from: www.marylandbrfss.org
Tobacco Use in Frederick County
25
20
15
10
5
0
2008 State of
Maryland
Frederick County Drunk Driving
Fatalities
20
18
16
14
12
12
10
10
8
6
6
4
Number of Drunk
Driving Fatalities
3
2
0
2002
2003
2004
2005
Coverage Source for Overall Mental
Health Related ER Visits
45
40
35
30
25
Mental Health Visits
All Other ER Visits
20
15
10
5
0
Medicare
Medicaid
No
Insurance
Private
Dental Care - Adults


Calls seeking care received by FCHD >10/wk
Religious Coalition for Emergency Human Needs – #
served limited by funding for vouchers:
◦ 2010 = 122
◦ 2011 = 238
◦ 2012 = ?>350

Mission of Mercy free dental services
◦ 2011 = 338

Others
◦ Dentists – charity care in office
◦ Seton Center
◦ FCAA
Thank You!
Frederick County Health Department
Is
Your Health Department