Loading...
HomeMy WebLinkAboutBOH agenda 042416 ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: April 27, 2016 TIME: 7:00 P.M. PLACE: Whitted Building, 3rd Floor Meeting Rooms 300 West Tryon Street Hillsborough, NC 27278 TIME ITEM 7:00 p.m. I. Welcome New Employees 7:00 – 8:00 II. Public Hearing: Board of Health Rule on E-Cigarette Use in Restaurants and Bars (Please sign up on the sheet near the entrance to the room) Limit comments to 3 minutes 8:00 – 8:10 III. Break 8:10 – 8:15 IV. Approval of April 27, 2016 Agenda A. Minutes of March 23, 2016 8:15 – 8:20 V. Public Comment for Items NOT on Printed Agenda (Please sign up on sheet near the entrance to room.) Please limit your comments to 3 minutes. 8:20 – 8:25 VI. Action Items (Consent) A. Approval of March 23, 2016 Minutes 8:25 – 8:50 VII. Action Items (Non-Consent) A. BOH Rule on E-Cigarette Use in Coby Austin Restaurants and Bars a. Results of survey/public comment b. Deliberation and Vote B. Board Reappointments Liska Lackey 8:50 – 8:55 VIII. Reports and Discussion with Possible Action A. Health Director Report Colleen Bridger B. Media Items 8:55 – 9:00 IX. Board Comments 9:00 X. Adjournment BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to lstrange@orangecountync.gov advising her of your attendance at this meeting OR CALL 919-245-2411. Compliance with the “Americans with Disabilities Act” and Title VI - Interpreter services and/or special sound equipment are available on request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter or other accommodation. Conforme a la “Ley sobre Estadounidenses con Discapacidades” (ADA) y el Título VI – los servicios de intérprete y/o equipo de sonido especial están disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes y Refugiados al 919-245-2387 para solicitar un intérprete u otros arreglos o adaptaciones. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH March 23, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ March Page 1 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality of life, promote the health, and preserve the environment for all people in the Orange County community. THE ORANGE COUNTY BOARD OF HEALTH MET ON March 23, 2016, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey, Chair, Nick Galvez, Vice Chair, Commissioner Mia Burroughs, Barbara Chavious, Paul Chelminski, Dan Dewitya, Jessica Frega, Sam Lasris, Reena Mehta and Timothy Smith. BOARD OF HEALTH MEMBERS ABSENT: Susan Elmore. STAFF PRESENT: Dr. Colleen Bridger, Health Director; Coby Austin, Senior Public Health Educator; Ashley Choate, Temporary FSA Facilitator; Alan Clapp, Environmental Health Director; Kathleen Goodhand, Home Visiting Services Supervisor; Donna King, Health Promotion & Education Services Director; Pam McCall, Public Health Nursing Director; Ashley Mercer, Healthy Carolinians Coordinator; Andrea Mulholland, Family Nurse Practitioner II; Stacy Shelp, Communications Manager; Meredith Stewart, Public Health Program Manager; La Toya Strange, Administrative Assistant II; and Hannah Welch, Temporary Clinical Social Worker Intern. GUESTS PRESENT: Katrice Perry (Student). I. Welcome New Employees Dr. Bridger introduced new staff member: Ashley Choate, Temporary Family Success Alliance Facilitator. II. Public Comment for Items NOT on Printed Agenda: Sherwin Mena and Benjamin Stevens. Both spoke against the proposed e-cigarette rule. III. Approval of the March 23, 2016 Agenda Motion was made by Mia Burroughs to approve the agenda, seconded by Dan Dewitya and carried without dissent. IV. Action Items (Consent) A. Minutes Approval of February 24, 2016 Meeting Motion to approve Consent Agenda without correction to the February 24, 2016 minutes was made by Jessica Frega, seconded by Nick Galvez and carried without dissent. V. Educational Sessions A. CHA Review Ashley Mercer, Healthy Carolinians Coordinator, gave an update on the 2015 Community Health Assessment (CHA) which enables public health officials to address health disparities and identify needs of populations who are most disadvantaged. There were 799 survey household randomly MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH March 23, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ March Page 2 selected from census blocks, 279 addresses were attempted with 166 door-to-door surveys completed. A new health opinion online survey was completed by 1,548 community residents. There were a total of 1,714 health opinion surveys answered, 5 focus groups conducted and 4 community listening sessions held. The 3 health priorities chosen as a result of the prioritization that occurred at the Healthy Carolinians of Orange County’s Annual Meeting were 1) Social Determinants of Health with priority around Access and Poverty, 2) Mental Health & Substance Abuse, and 3) Physical Activity & Nutrition. As the Board had previously received a copy of the nearly 150 page CHA full report (50 pages before the attachments), Ms. Mercer spoke on the design of the CHA Executive Summary. She also extensively discussed important and pertinent information in regards to each of the 3 focus areas displayed in the CHA Overview document that the Board had also received prior to the BOH meeting. Ms. Mercer addressed questions from the board that pertained to the data represented in the Executive Summary. Jessica asked – regarding the Mental Health and Substance Abuse portion - What’s the denominator (percentage of suicides)? How is it defined? Ms. Mercer expressed that she was not 100% positive of the explanation but would get the answer and would follow-up with Jessica after the meeting. Nick asked – What’s the process of dissemination? Ms. Mercer responded by stating the CHA will be placed on both the Health Dept. and Healthy Carolinians websites, emailed to various list servs, shared with the community thorough press releases and social media, shared with County Commissioners, and sent to community partners. Ms. Mercer thoroughly reviewed and discussed with the Board each of the BOH Requirements for Accreditation including explaining how most of the requirements have been satisfied and the procedures needed to satisfy the remaining benchmark activities. She also went through the dissemination requirements and how they will be satisfied after the Board approves the CHA document. Ms. Mercer explained that there are 8 phases in the CHA process. Currently, it is on schedule and at phase 6 which is to create the CHA document. Upon Board approval, the next phase involves disseminating the CHA document to the community which will include sending to community partners/stakeholders and uploading to different websites. The BOH members had questions that were addressed by Ms. Mercer and Dr. Bridger. VI. Action Items (Non-Consent) A. Integrated Behavioral Health Proposal Kathleen Goodhand, Home Visiting Services Supervisor, began with an introduction of herself, Hannah Welch, MSW Intern, and Andrea Mulholland, Family Nurse Practitioner II. Ms. Goodhand gave an overview of the results of the integrated behavioral health pilot as well as the need for funding a behavioral health position. First, she explained why integrating behavioral health is important. Some of those reasons included: • Behavioral and social factors contribute to nearly every cause of death, illness and disability. • 50% of patients with a mental health diagnosis are seen by their primary care provider. • 85% of physician visits are for problems that have a significant psychological component. • 45% of individuals who die by suicide have visited their primary care provider within a month of their death and over 75% had contact within one year. Next, she spoke on the impact of integrated behavioral health and how it increased patient, family and provider satisfaction. Ms. Goodhand also expressed that mental health should be viewed as a part of physical health. Ms. Welch talked about the population that the Health Department's integrated behavioral health pilot has served. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH March 23, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ March Page 3 • Total number of patient encounters: more than 300 • Total number of patients referred: 90 • Total number of patients served: 58 • Total number of integrated visits: more than 30 • Total number of ongoing psychotherapy appointments: 71 She continued by noting the two ways behavioral health services were provided. One way was as requested by clinicians during a clinic visit which would involve the provider asking Ms. Welch to see a patient during a primary care visit after patient issues were identified. The second way was via follow up interventions for issues that required longer term intervention. Dependent on the patient’s needs, the services were provided either by phone and/or through in person counseling sessions. Passive suicidality, interpersonal violence, active PTSD (current or from the past), anxiety, depression and stress management were just a few of the patient conditions/issues that the integrated behavioral health pilot have addressed. Ms. Mulholland provided patient examples and provider feedback which supported the need for the funding of a behavioral health position. She also spoke on the client and provider benefits. The benefits are: • Patients – having immediate, open access to mental health services; safety net; less stigma; client comfort and safety; improved health outcomes. • Providers – on-site, accessible specialty care; support for clinic staff; better control of chronic conditions; lower no-show rates; improved clinic efficiency; indispensable service; lifeline for patients and providers. Lastly, Ms. Goodhand gave the Board details on the projected costs for funding the behavioral health position and posed the staff’s recommendation to the Board. Motion to approve the request for one additional FTE for a Social Work Clinical Specialist to provide integrated behavioral health services and forward to the Board of County Commissioners for action was made by Paul Chelminski, seconded by Barbara Chavious and carried without dissent. The BOH members had questions that were addressed by Ms. Welch, Ms. Goodhand and Dr. Bridger. B. Strategic Planning Process Pt. 1 The Board embarked on its first step in the 2016-2018 Strategic Planning process. The priorities that resulted from the 2015 Community Health Assessment are Social Determinants of Health, Mental Health/Substance Abuse and Physical Activity/Nutrition. Keeping with the precedent from previous Board of Health Strategic Plans, the Chair and Vice-Chair of the Board of Health decided to adopt the same priorities that resulted from the CHA. Dr. Bridger presided over the process which required the Board to narrow down the priorities to focus areas, discuss those focus areas and the vote for the focus areas that will become the priority for each subcommittee. The priority subcommittees are: 1) Social Determinants of Health – focus on FSA, Cultural & Language Barriers and Access 2) Mental Health/Substance Abuse – focus on Integrated Care focus, Service Delivery and Access MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH March 23, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ March Page 4 3) Physical Activity & Nutrition – focus on Preschool & School Nutrition & Physical Activity and Healthy Food Access/Policy & Access to Safe Places The priority subcommittees will meet to discuss and prioritize action steps for their focus areas and report their recommended action steps to the Board at the May Board of Health meeting. The BOH members had questions that were addressed by Dr. Bridger. VII. Reports and Discussion with Possible Action A. Health Director Report There were no questions from the Board regarding the Health Director’s Report included in the packet. Dr. Bridger presented the Board with a get well card for Dr. Robert Blackburn, former Director of NALBOH and the NCALHD, and asked them to sign. She also reminded the Board of the public comment/public hearing that will take place at next month’s BOH meeting and its process. She also expressed that the public hearing isn’t the only avenue for the public to share their opinions. The other methods are via email, the online survey link on the Health Department’s website, the telephone message line and postal mail. Lastly, Dr. Bridger informed the Board that she was invited to the WCHL Community Leaders’ Luncheon where concerns about life/issues in the community were discussed such as the challenge of covering the Syringe Exchange Program. The BOH members had questions that were addressed by Dr. Bridger. B. Media Items Media items were in the packet which focused on Orange County’s events and our involvement in various efforts. VIII. Board Comments Barbara Chavious commended the OCHD staff for all that they do. IX. Adjournment A motion was made by Nick Galvez to adjourn the meeting at 8:50 p.m., was seconded by Reena Mehta and carried without dissent. The next Board of Health Meeting will be held April 27, 2016 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, Colleen Bridger, MPH, PhD Orange County Health Director Secretary to the Board Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: April 27, 2016 Agenda Item Subject: Proposed BOH Rule on E-Cigarette Use in Restaurants and Bars Attachment(s): 1) Draft Board of Health Rule; 2) Summary of Public Comments (will be available on April 27, 2016) Staff or Board Member Reporting: Coby Jansen Austin Purpose: ____ Action ____ Information only _X__ Information with possible action Summary Information: At its January 2016 Board of Health meeting, the Board voted to develop a rule to prohibit the use of electronic cigarettes in enclosed areas of restaurants and bars based on the emerging public health research. During February and March, staff worked with a Board subcommittee and the county attorney to develop a draft rule, which was made available for public comment in early April. Staff will continue to collect public comments submitted via an online survey, a dedicated email account, a telephone message line, and mail through Sunday, April 24 and will present a summary of the comments to the Board at the April 27 meeting. After hearing a summary presentation of the public comments submitted, the Board will deliberate and vote on whether to adopt the proposed rule. Because the public comment period is ongoing, staff will make their recommendation to the Board at the April 27 meeting, once they have had the opportunity to thoroughly review of all available evidence submitted. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ___________________________ ___Accept as information ___Revise & schedule for future action _X_Other (detail): Staff will make its recommendation at the April 27 meeting. Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: April 27, 2016 Agenda Item Subject: Reappointment Recommendation Attachment(s): None Staff or Board Member Reporting: Liska Lackey Purpose: __X_ Action ____ Information only ____ Information with possible action Summary Information: The Board of Health will vote to recommend Paul Chelminski to his 3rd term, Dan Dewitya to his first full term and Sam Lasris to his 2nd term. Background: None. Recommended Action: ___Approve _X_Approve & forward to Board of Commissioners for action ___Approve & forward to ___________________________ ___Accept as information ___Revise & schedule for future action ___Other (detail): Health Director’s Report April, 2016 • I attended an “invitation only” summit, hosted by the State Health Director, on improving perinatal health in North Carolina. There is a lot of energy and enthusiasm in Raleigh around improving our infant mortality statistics in the state. Unfortunately, one approach they’re using is to take money from counties with low infant mortality rates (like Orange) and redistributing it to counties with high rates. They also excluded counties with low infant mortality rates (like Orange) from being able to apply for competitive funding allocated by the General Assembly to address infant and child health. • A group of Human Service Department Directors attended a meeting with Weaver Street management to discuss their vision of eliminating hunger in Orange County. They have an awesome plan and we have pledged out help and support. For example, Environmental Health put together a document showing them the regulatory ramifications of various scenarios we had discussed so they can design their process with that in mind. • I facilitated a meeting to discuss health and safety issues at the Gateway Apartments here in Hillsborough. This complex has a long history of resident complaints about mold, sewage backups, etc. This meeting was to bring together residents and service providers such as Justice United and Legal Aid, Environmental Health and building inspections to prioritize issues to be addressed and develop a plan/timeline for addressing them. We’ll meet again to check progress but all agreed it was a great start. Coby and Alan represented our Healthy Homes Asthma project and were a great help to have in attendance. • This month has seen a lot of budget meetings/discussions. I don’t yet know what the Manager’s recommended budget for the Health Department will be, so I’ll probably send out an email once I know. • We did receive final approval from the BOCC for the Behavioral Health Clinician position you recommended at the last meeting. This position is currently posted and we’ll start interviews in the next couple weeks. The Manager’s Office was extremely helpful in finding an alternate funding source for this position. We will be using the mental health maintenance of effort funds for this project for its duration. • In an effort to improve relationships between DPH staff in Raleigh and local public health staff, we are participating in a pilot to have DPH staff shadow local health directors for a day. Dr. Lou Turner will be with me all day on the 27th and will also attend our Board meeting. March 18, 2016 5:20 PM Wake County health officials say social networking apps are partly to blame for a sharp increase in syphillis cases. By Chris Cioffi ccioffi@newsobserver.com RALEIGH - The number of reported syphilis cases is on the rise in North Carolina, and Wake County health officials say social networking websites are partly to blame. Across the state, 1,113 early syphilis infections were diagnosed in 2014 – a 62 percent increase from the prior year, when 688 cases were reported, according to the state Department of Health and Human Services. Wake saw 233 reported cases of syphilis last year, marking a 15-year high. In 2014, the county saw 171 cases, according to county data. When patients who contracted syphilis were interviewed in Wake County, many said they met their partner online, said Sue Lynn Ledford, Wake’s public health division director. “People are hooking up with strangers they have most often met through social media, and that is really increasing the rate of transmission,” she said. Other Triangle counties have also seen increases in syphilis cases. In Durham County, there were 121 reported cases in 2015, up from 46 in 2013. Orange County had 13 reported cases in 2015, compared to five in 2013. Johnston County had 19 reported cases in 2015 and one case in 2013. Syphilis is a sexually transmitted disease that causes skin rashes and sores most commonly in the genital area. The disease can also be passed from mother to child during pregnancy. The most common treatment is penicillin, but if the bacteria goes untreated, patients can eventually go blind, become paralyzed, develop dementia or die. Most of the recent syphilis cases occurred in men who said they had been engaging in sexual activity with other men, said Arlene Sena, medical director for the Durham County Department of Public Health and an associate professor at the UNC School of Medicine. Patients who have an STD, including syphilis, are at a higher risk of testing positive for HIV in the future, health officials say. More than 40 percent of males with early syphilis statewide also have HIV, Sena said. In Wake County, the number is higher – 52 percent, according to Ledford. “What we’re concerned about in public health is an increase of early stage syphilis and the co-infection of HIV,” Sena said. In Wake and Durham counties, health officials are trying to combat the rise in syphilis cases through awareness, outreach and education, both on social media and at facilities. Ledford said anyone who meets people online should practice safe sex and avoid anonymous hookups. “And if you have had unprotected sex, you need to be tested,” she said. Read more here: http://www.newsobserver.com/news/local/counties/wake- county/article66940787.html#storylink=cpy Opinion: Consumers and businesses should set vaping rules | March 21, 2016 Read more: http://www.dailytarheel.com/article/2016/03/opinion-consumers-and-businesses-should-set- vaping-rules Soon, Orange County bar and restaurant patrons might no longer be using electronic vaporizers indoors — not because of personal choice or the house rules of bar owners, but because a board of unelected bureaucrats has decided it knows best about which products should be allowed in businesses. The Orange County Health Department might be well-intentioned in its efforts to discourage the use of nicotine products, but a ban on electronic cigarettes in private establishments curtails both freedom of choice and property rights, and might actually induce nicotine users to use more unhealthy traditional cigarettes instead of less-harmful e-cigs. While the case for a public health department to ban traditional cigarettes is stronger, it is well- established that nicotine vaporizers are dramatically less harmful than smoked tobacco products. Any evidence of harm to bystanders from secondhand mist from smokeless, tar-free vaporizers is poorly established or nonexistent. In its zeal to stamp out anything resembling tobacco usage in the name of public health, the health department ignores a basic lesson of economics: the importance of incentives. Currently, because regular cigarettes are banned from being smoked indoors, it is more convenient for people who use both vaporizers and traditional tobacco products to substitute vaporizers for regular cigarettes when in bars and restaurants, as users can stay seated to vape and avoid the trouble of getting up to go outside to smoke. A main motivating factor for tobacco smokers to switch to less harmful vaporizer products is that vapes can be used in far more places. With the proposed ban on indoor e-cig use at bars and restaurants, the department could unintentionally nudge users away from less harmful e-cigs and toward smoked cigarettes if using both were to become equally inconvenient. The proposed rule also tramples the property rights of business owners, who invested significant amounts of their time and money to develop their business, and who should thus be able to set their own house rules. Restaurant owners are already free to ban e-cigs if their customers complain or if it is the owner’s desire, but setting arbitrary rules like a vaporizer ban places the burden of enforcement on entrepreneurs while reducing their ability to craft a unique atmosphere for their establishment. Further, the proposed ban will likely hit certain establishments particularly hard: more bohemian and hipster-oriented bars, where patrons are more likely to vape, could see a drop in business. If the Orange County government absolutely must impose its will regarding nicotine products on business owners, it should at least do so through the legislative process, not through an unelected bureaucracy. If legislators vote on such an e-cigarette ordinance, Orange County residents who oppose the ban could vote out legislators who voted for it. When unelected bureaucrats make such choices, voters have no recourse. Education and social pressure have been much more effective in lowering tobacco usage in recent decades than heavy-handed bans. In a free society, adults can choose to make decisions that might be harmful to themselves. The ever-creeping nanny state should keep its hands off e-cigarettes. Read more: http://www.dailytarheel.com/article/2016/03/opinion-consumers-and-businesses-should- set-vaping-rules Quoted from The Daily Tar Heel Orange County commissioners discuss goals for county Lauren Miller Published 03/30/16 4:11pm The Orange County Board Commissioners reviewed and discussed the county’s aims in capital development and its human resources goals for county employees at a Tuesday meeting. Bonnie Hammersley, county manager, opened the meeting by detailing the county’s prospective capital investment plan that establishes budget projections related to capital needs of the county. Approval of the plan commits the county to first year funding while all other yearly plans are used as tools to guide the county’s future financial decisions, Hammersley said. Brenda Bartholomew, Orange County human resource director, presented information about 2016-2017 county employee benefits and salaries. Bartholomew said the county pays 100 percent of individual premiums and roughly 65 percent of family premiums — on average in North Carolina, employers cover 82 percent of individual premiums and 53 percent of family premiums. The board was less enthusiastic about the progress of resolving the issue of pay compression among Orange County employees. Compression in the workplace is caused when newly hired employees are brought in at equal or better salaries than employees with more years at the same position. “This did not happen overnight, but it is,” Bartholomew said. Commissioner Barry Jacobs said the county should be recruiting well-seasoned local government employees and paying them accordingly to remain competitive. “Orange County does not need to become a training ground,” Jacobs said. Commissioner Earl McKee said he has faith that the human resource department will be able to resolve the issue in due time so Orange County does not lose out on job recruiting prospects, as well as veteran employees. Bartholomew’s presentation also prompted a discussion about diversifying the Orange County government staff, particularly seeking out Hispanic or Latino influence, as well as Asian. The board discussed wanting to incentivize being bilingual in terms of salary and also provide better resources so that employees can learn the Spanish language. Notable: Commissioner Bernadette Pelissier thanked the Department of Human Resources, Department of Health and UNC Health Care for collaborating on providing Orange County government employees with free mammograms earlier this year, emphasizing the importance of women’s health care coverage as a employee benefit. Quotable: “It may say that this person has a Ph.D. in solid waste collection or whatever you call it,” said Jacobs in reference to recruiting experienced employees to fill positions. Health rankings not perfect, but have value First Posted: 7:43 am - March 30th, 2016 You have to give the the University of Wisconsin and the Robert J. Wood Foundation a healthy round of applause for the ambitiousness of their undertaking, even if some critics doubt the relevance of their findings. We refer to the annual County Health Rankings pieced together each year by the university and the foundation that attempt to rank by health more than 3,000 counties across the United States within their own state. A variety of metrics are used for the report, which was released recently and — disappointingly but unsurprisingly — determined that Robeson County was the unhealthiest of all of North Carolina’s 100 counties. Our own test, which is done with the eye, gives us confidence that the report, if not a bulls’eye, is pretty darn accurate with regard to this county. North Carolina’s health directors, including our own, Bill Smith, aren’t convinced of the report’s worthiness. Colleen Bridger, president of the association and Orange County’s health director, sent a letter to the co-director of the annual County Health Rankings that read in part: “… While we appreciate your intention to bring attention to the social determinants of health and the role they play in the community’s health, we believe the ranking of counties must stop. The methodology is seriously flawed.” Smith also protested, but his letter was to this newspaper. He pointed out that it would be unlikely for five counties to pass Robeson, which was 95th last year in the state, in a single year, tooted his department’s own horn and added perspective. He wrote: “The Healthy Robeson Task Force has been addressing issues such as infant mortality, substance use, obesity, exercise, smoking, nutrition, etc. for years and the Community Health Assessment has identified these areas as well. Let’s face it, whether we are 100 or 95 or 90, it is still a largely unhealthy population in Robeson County. But even those ranked at the top in this state must temper their enthusiasm with the knowledge that North Carolina is the 34th healthiest state, so there is a lot of room to grow.” Bridger, Smith and other health directors question the validity of the report largely because of how information is collected, and work-arounds when there is no information. Dr. Bridget Catlin, co-director of the County Health Rankings, suggested that the lens be pulled back, and that the report provides a bigger picture that can be useful. “In a state like North Carolina where there are 100 counties, if you moved by five ranks that’s a 5 percent change. Don’t worry about that too much, look at what’s happening over time … . Smaller changes are just the nature of fluctuations in data that are really hard to control for,” she said. We understand Smith’s objections as he surely feels as if a finger has been pointed toward him and his staff. But we believe a local Health Department’s ability to move the needle of a county’s collective health in the short term is right next to nil. In the end health is an individual’s responsibility, and if the report inspires one person to put down the potato chips, get off the couch, grab an apple and take a walk, then we submit it has value. Laurinburg Exchange Report: Scotland County health ranking at 99th By Scott Witten 3/29/16 LAURINBURG — Scotland County has ranked near the bottom in the state in terms of overall health outcomes, according to the County Health Rankings and Roadmaps. The report, which was released earlier this month, listed Scotland 99th out of North Carolina’s 100 counties. In 2015, Scotland ranked 98th in overall health outcomes. The report is compiled by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute and looked at 30 measures, including premature death, respondents’ own views of their health, sick days taken and birth weight. The group releases the study each year. The rankings suggested that rural counties have higher rates of smoking, obesity, child poverty, teen births and higher numbers of uninsured adults than their urban counterparts. Wake County topped the list as the healthiest county followed by Orange County. Union, Camden and Mecklenburg counties rounded out the top five healthiest counties. “We have known for some time that our county faces challenges,” said Wayne Raynor, interim Scotland County health director. “In the 2016 County Health Rankings, Scotland County ranked low on overall health ranking, compared with other counties in the state.” Raynor said the rankings indicated Scotland County is at-risk for poor health when it comes to health behaviors such as adult smoking, obesity, sexually transmitted infections and teen pregnancy and social and economic factors such as unemployment and violent crime. About 25 percent of county adults are smokers and 37 percent are obese — figures that have changed little since the previous report. For 2016, 66 percent of county resident said they had “adequate access to locations for physical activity,” the same as the previous year’s report. Twenty-seven percent of Scotland adults over 20 report no leisure-time physical activities. According to the report, rates of teen births did see a slight decrease. There were 68 teen births per 1,000 women aged 15 to 19, down from 72 in the previous year. But sexually transmitted infections rose from 718 to 825. The rate of diabetes, 82 percent, dropped a percentage point from last year. The study said that 18 percent are without health insurance in Scotland County — about the same as last year — and 42 percent of children are living in poverty. Although that’s a slight decrease from 44 percent in the previous report, it’s still about double the statewide rate. There was a slight improvement in premature deaths for the county. The measure is defined as the number of years of potential life lost before age 75 per 100,000 people. For example, if someone dies at the age of 65, that adds 10 years to the total. Premature death decreased from 11,011 years in 2015 to 11,000 years in 2016. Scotland County adults engage in excessive drinking less — at 12 percent — compared to their counterparts statewide, at 15 percent. Doctor-to-patient ratios have improved, especially in mental health. For 2016, the ratio was 620 patients per mental health provider, down from 680 patients per provider last year. In addition, many Scotland County residents can’t afford to visit those medical professionals, instead waiting until their condition is unbearable and they have no choice but to visit the costly Emergency Department. Those living below the poverty line also may not have the money for nutritious foods and often don’t have time for exercise because of work. It’s no coincidence that the counties that continually fall near the bottom of the rankings have high poverty rates, health officials said. Raynor said the report helps local health officials identify factors that are making it difficult for residents to maintain a healthy lifestyle. “The good news is that the County Health Rankings are an important springboard for conversations on how to expand opportunities for all of our citizens to be healthy and have become an important tool for local communities working to build a better culture of health,” Raynor said. “We know from the Rankings, Scotland County needs to do more to reduce the infant mortality rate, reduce teen pregnancy and reduce obesity and diabetes among children and adults.” Scotland County Health Department is currently working on a plan to reduce infant mortality and improve birth outcomes. The county recently received $60,000 in state funding for that purpose. “We anticipate this funding will be ongoing in coming years. The Health Department’s Child Health and Maternity Clinics which began nearly a year ago should have a positive impact on the reduction of infant mortality and improved birth outcomes over the next few years.” Scotland County Health Department is also taking part in an effort called Active, Healthy Living Partnership that will focus on obesity and heart disease. “With these new initiatives, I am convinced that we can, in conjunction with our community partners, have a very positive impact on our health rankings here in Scotland County,” Raynor said. Full results can be found at countyhealthrankings.org. Orange is Second Healthiest County in State According to Study By Chris Grunert SHARE THIS: Posted March 17, 2016 at 3:40 pm Ranking of Health Outcomes. Photo via countyhealthrankings.org Orange County is the second healthiest county in North Carolina, according to a new study. The study, done by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute looked at factors such as life expectancy, po verty rates, health behaviors and environmental factors among others to determine the rankings. The study looked at almost every county in all 50 states. Maisha Simmons is a senior program officer with the Robert Wood Johnson Foundation. “The rankings show us that where we live matters to our health and that good health is about more than medical care, it’s also about factors like access to healthy food and reliable transportation, as well as safe and healthy schools and neighborhoods,” said Simmons. Orange County was ranked as having the best clinical care and longest length of life in North Carolina. But there are some areas where Orange County could improve such as quality of life where Orange County was ranked 7th and physical environment, which consider ed factors like air quality, housing and commute to work, Orange County was ranked 4th. But in last year’s study, Orange County was ranked as the healthiest county in North Carolina. This year, Wake County came out on top. “Look at the data and compare from last year’s ranking to this year but this is only part of the story,” said Simmons, “recognize that there were improvements made as well, even if there was a slip in the rankings.” The rate of uninsured people and violent crime has gone down in Orange County over the past year. The study illuminates some inequalities that exist in Orange County too. Income inequality in Orange County is higher than most other counties in the state and the rate of children living in poverty has risen to 13%. “These are all things that communities can do something about but it also shows us that not everyone has the same opportunity to be healthy,” said Simmons. Simmons said probably the most disturbing new trend nationwide is a rise in drug overdose deaths due to heroin and opiate use. “We’ve been hearing about this in the community but the rankings also show us that this is an epidemic for us,” said Simmons, “but we know that there are things that communities can do around this factor and in particular it’s really paying attention to the rates that we are prescribing prescription drugs and thinking about training for our first responders, in terms of responding to these incidents.” Orange County emergency services have begun using the drug Naloxone, which can reverse an opiate overdose. So far, Orange County Emergency Services have successfully reversed four overdoses with the drug.