Local Health Improvement Coalition Annual Meeting, October 26, 2017 Russell Moy, MD, MPH Acting Health Officer

Local Health Improvement Coalition (LHIC) Today’s Update Reviewing the data Discussion Selecting the priorities

Harford County Local Health Improvement Coalition (LHIC) Organized in 2011 Selected 3 Health Priorities Community Efforts Organized Around These Priorities Obesity Prevention / Healthy Eating & Active Living Tobacco Use Prevention / Tobacco-Free Living Behavioral Health / Substance Use & Mental Health

Let’s Review The Good News! Harford County ranks better than the State average in 23 of 39 Maryland SHIP measures in 2017 . . . Let’s Review The Good News! Infant mortality Low birth weight rates Teen birth rates Early prenatal care Uninsured E.D. visits E.D. visit rates for diabetes, hypertension, asthma, dental and mental health care Hospitalization rate for Alzheimer’s Disease Heart disease mortality Annual seasonal flu vaccines Persons with a usual primary care provider HIV incidence rate Chlamydia incidence rate Pedestrian injury rate on public roads And many other conditions Source: ship.md.networkofcare.org/ph/ Note: Data reflects SHIP year, not year data collected

Challenging Health Problems Persist Harford County still ranks worse than the State average in 16 of 39 2017 SHIP measures . . . Challenging Health Problems Persist Measure 2017 Goal MD 2016 MD 2017 Harford 2016 Harford 2017 Drug-induced death rate (per 100,000) 12.6 15.2 17.7 19.2 20.2 E.D. visit rate for addictions (per 100K) 1400.9 1474.6 1591.3 1462.1 1673.6 Adults who currently smoke (%) 15.5 14.6 15.1 18.9 20.7 Fall-related death rate (per 100,000) 7.7 8.5 8.8 10.1 11.8 Domestic violence*(per 100,000 crimes) 445.0 455.8 510.9 384.6 512.6 Sudden Unexpected Infant Death* (SUID per 1,000 lives births) 0.86 0.82 1.03 1.55 Adults at a healthy weight* (%) 36.6 35.1 35.0 40.6 27.7 Source: ship.md.networkofcare.org/ph/ Note: Data reflects SHIP year, not year data collected

Challenging Health Problems Persist Harford County still ranks worse than the State average in 16 of 39 2017 SHIP measures (continued) Challenging Health Problems Persist Measure 2017 Goal MD 2016 MD 2017 Harford 2016 Harford 2017 Suicide death rate (per 100,000) 9.0 9.2 9.1 11.6 11.4 Cancer death rate (per 100,000) 147.4 162.0 159.3 170.9 165.6 Adolescents use tobacco products (%) 15.2 16.9 16.4 20.2 19.2 Child maltreatment (per 1,000 < age 18) 8.3 9.9 7.3 14.1 11.7 Increased physical activity (% 150 min/wk) 50.4 48.0 52.9 46.4 51.2 Adolescent wellness checkups (% 12 mo) 57.4 54.7 56.0 50.3 52.0 Children’s dental care (% 12 mo) 64.6 63.2 64.3 58.3 60.2 Children blood lead screening(%12-15mo) 69.5 62.0 62.6 51.4 52.7 Affordable housing 54.4 46.1 48.2 40.3 41.0 Source: ship.md.networkofcare.org/ph/ Note: Data reflects SHIP year, not year data collected

Impact of the opioid overdose crisis

Drug-Induced Mortality Rates Harford County & Maryland, 2008-2015 Harford County rates worse than the State, up 35% over past 6 yrs. * Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Emergency Dept Visits for Addictions Conditions Harford County & Maryland, 2008-2015 Harford County rates worse than the State, up 44% over past 6 yrs. * Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Drug & Alcohol Intoxication Deaths By place of occurrence, Harford County, 2008-2016 Harford County had a 68% increase in overdose deaths from 2015-2016. Preliminary data for 2017 indicate a possible 100% increase from 2016-2017. Source: Maryland Vital Statistics: Drug- and Alcohol-Related Intoxication Deaths in Maryland, 2016

The Leading Causes of Death Harford County, 2015 At the current rate, overdose deaths may become the 3rd leading cause of death in 2017. Potential 100% increase in overdose deaths by 2017 Source: Maryland Vital Statistics, 2015

The reason this epidemic is so deadly

Rate of Opioid Prescriptions Per Capita By Maryland Jurisdiction, 2010 & 2015 Harford County ranks 8th worst in the State. Source: Dinsmore, “How Maryland measured up in opioid prescribing,” Baltimore Sun, 7/8/17 – citing CDC data

Rate of Hospital Encounters for Newborns Born with Maternal Drug/Alcohol Exposure in Harford County and Maryland, 2000-2016 NOTE: ICD Codes used 760.70, 760.71. 760.72, 760.73, 760.75, 760.77, 779.5 Source: HSCRC Hospital Data, 2000-16,Maryland resident births only, does not include Maryland resident births born out of state.

Overdose Deaths In Maryland by Selected Substances, 2007-2016 Heroin increased by 62% Fentanyl increased by 229% From 2015 to 2016. Source: “Drug and Alcohol Related Intoxication Deaths in Maryland, 2016,” Maryland Vital Statistics

Overdose Deaths In Maryland by Age Group, 2007-2016 45-54 yr olds impacted most. 25-34 yr olds impacted next most. Source: “Drug and Alcohol Related Intoxication Deaths in Maryland, 2016,” Maryland Vital Statistics

“Young adult (25-34 yrs) Whites in suburban areas and middle-aged (45-64 yrs) Whites in rural areas had the most marked increase in premature death relative to other sub-populations in each respective age group… “The marked increases in accidental poisonings and suicide death rates, together with unfavorable chronic disease trends, are driving increased premature mortality in Whites. A large portion of these deaths are caused by underlying behavioral risk factors and behavioral health. Case and Deaton coined such deaths as ‘despair deaths’… as they enter the labor market and are met with bleaker prospects and lower paying jobs… “Despair manifests in health, including ending life intentionally or soothing through opiates, food, tobacco or alcohol use … having the highest increases in poisonings, suicide… CVD and respiratory disease. Stein et al, AJPH, October 2017

Adult Binge Drinking Rates* Harford County & Maryland, 2012-2017 Harford County rates have worsened by 13% over the past 5 years. * Consumed ≥ 5 drinks (male) or 4 drinks (female) on a single occasion in past 30 days Source: www.countyhealthrankings.org

Youth Binge Drinking Rates* Harford County & Maryland, 2005-2014 Harford County rates are 44% worse than the State average. No new data * Students Grades 9-12 consumed ≥ 5 drinks on a single occasion in past 30 days Source: Maryland YRBS, 2014

Youth Marijuana Use Rates* Harford County & Maryland, 2005-2014 Harford County rates are 13% worse than the State average. No new data * Students Grades 9-12 who used marijuana ≥1 time during past 30 days Source: Maryland YRBSS, 2014

Suicide Mortality Rates Harford County & Maryland, 2008-2015 Harford County rates 27% worse than the State. * Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Impact of tobacco and obesity

The Leading Actual Underlying Causes of Death Smoking, obesity and alcohol are the leading actual causes of death. Source: Mokdad et al, “Actual Causes of Death in the U.S., 2000” JAMA, 3/19/2004

Adult Smoking Rates Harford County & Maryland, 2011-2015 Harford County adult use rates increased by 10% over the past 5 years. Source: phpa.health.maryland.gov MD BRFSS, 2011-15

Adolescent Tobacco Use Rates Harford County & Maryland, 2013-2014 Harford County youth use rates are 17% higher than the State average. Note: Students Grades 9-12 who used any tobacco products in the past 30 days Source: Maryland YRBSS, 2013 and 2014:

Youth E-Cigarette Smoking Rates* Harford County & Maryland, 2014 Plus Harford County youth e-cig use rate is 10% higher than the State average. * Students Grades 9-12 who have ever used electronic vapor products (e.g., e-cigarettes, e-pipes, e-hookahs) Source: Maryland YRBSS, 2014

55% of all cancers in women and 24% of cancers in men are associated with obesity.

% Adults at a Healthy Weight Harford County & Maryland, 2012-2015 Harford County rates have decreased by 3% over the past 4 years. Note: Adult BMI 18.5-24.9 Source: Maryland BRFSS, 2012-2015

% Adults Who Are Obese Harford County & Maryland, 2012-2015 Harford County rates have increased by 9% over the past 4 years. Note: Adult BMI 30 and above Source: Maryland BRFSS, 2011-2014

Adolescent Obesity Rates Harford County & Maryland, 2013-2014 Harford County youth use rates are 15% better than the State average. Note: High school students who self-report BMI ≥ 95th percentile for age and gender Source: Maryland YRBSS, 2013 and 2014:

10% Improvement in Childhood Obesity Among WIC Participants, 2010-2014 Source: MMWR, 2016, CDC

Cancer Mortality Rates Harford County & Maryland, 2008-2015 Harford County rates improving but worse than the State. * Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Cancer Incidence Rates, By Type Harford County, Maryland & US, 2010-2014 Harford County rates worse with each different type of cancer. Source: CDC and NCI at https://www.statecancerprofiles.cancer.gov/incidencerates/

Cancer Incidence Rates, By Race Harford County, 2010-2014 Racial disparity exists for screenable cancers in Harford County. Source: CDC and NCI at https://www.statecancerprofiles.cancer.gov/incidencerates/

COPD Mortality Rates Harford County & Maryland, 2008-2015 Harford County rates worse than the State. * Age-Adjusted Rates Source: Maryland Vital Statistics Reports

The Leading Causes of Death Harford County, 2015 Cancer and COPD are 2 of the 3 leading disease causes of death in Harford County. Age-Adjusted Rates Source: Maryland Vital Statistics, 2015

Other public health issues in Harford County

Heart Disease Mortality Rates Harford County & Maryland, 2008-2015 Harford County rates improving and comparable with the State. * Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Stroke Mortality Rates Harford County & Maryland, 2008-2015 Harford County rates improving and comparable with the State. * Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Teen Birth Rates Harford County & Maryland, 2010-2015 Harford County rates better than the State. Source: Maryland Vital Statistics Reports

Fall-Related Death Rates Harford County & Maryland, 2009-2015 Harford County rates worse than the State average. * Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Children Receiving Dental Care in Past Year Harford County & Maryland, 2009-2015 Harford County rates worse than the State and the gap is widening. Source: Maryland Medicaid Service Utilization

Chlamydia Infection Rates Harford County & Maryland, 2008-2015 Although Harford County rate is better than the State average, it has increased by 57% between 2012-15. So far in 2017, chlamydia cases have increased by 11.5%, gonorrhea cases increased by 17.9% in Harford County. * Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Domestic Violence Rates Harford County & Maryland, 2010-2015 Harford County 2015 rate now exceeds the State average. Source: Maryland Uniform Crime Reporting Program http://ship.md.networkofcare.org/ph/ship

Sudden Unexpected Infant Death Rates Harford County & Maryland, 2005-2015 Harford County rate now worse than the State average. Source: Maryland Vital Statistics Reports

Infant Mortality Rates Harford County & Maryland, 2010-2015 Harford County rates improving and better than the State. * Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Infant Mortality Rates By Race/Ethnicity, Maryland, 2015 Infant mortality racial disparities exist in Maryland Source: Maryland Vital Statistics, 2015

Teen Birth Rates By Race/Ethnicity, Maryland, 2015 Racial disparities exist in Maryland teen birth rates Source: Maryland Vital Statistics, 2015

Black : White Health Disparities Exist Black mortality rates exceed White mortality rates by: 13% for Cancer 15% for Heart Disease Black E.D. visit rates exceed White E.D. visit rates by: 35% for Addictions-Related 46% for Alzheimer’s/dementia 187% for Diabetes 267% for High Blood Pressure 306% for Asthma Source: ship.md.networkofcare.org/ph/

Persons With a Usual Primary Care Provider By Race/Ethnicity, Maryland, 2015 Primary care provider availability does not explain disparities. Source: Maryland Vital Statistics, 2015

Uninsured Emergency Dept Visits Harford County & Maryland, 2008-2015 Insurance coverage availability does not explain disparities. Source: phpa.health.maryland.gov MD BRFSS, 2011-15

Local Health Improvement Coalition (LHIC) In Summary Obesity, tobacco, and behavioral health are current LHIC priorities and continue to be problems in Harford County. High cancer, COPD, drug-related, and suicide mortality rates continue to be the result. Other health issues exist including access to care, health disparities, dental health, fall-related mortality, domestic violence and others, with limited resources for addressing.

Harford County Local Health Improvement Coalition (LHIC)