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

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

3. 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

4. Let’s Review The Good News!
Harford County ranks better than the State average in 23 of 39 Maryland SHIP measures in
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

5. Challenging Health Problems Persist
Harford County still ranks worse than the State average in 16 of 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

6. Challenging Health Problems Persist
Harford County still ranks worse than the State average in 16 of 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

7. Impact of the opioid overdose crisis

8. 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

9. 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

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

11. 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

12. The reason this epidemic is so deadly

13. 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

14. Rate of Hospital Encounters for Newborns Born with Maternal Drug/Alcohol Exposure in Harford County and Maryland,
NOTE: ICD Codes used , , , , , 779.5
Source: HSCRC Hospital Data, ,Maryland resident births only, does not include Maryland resident births born out of state.

15. 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

16. 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

17. “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

18. 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:

19. 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

20. 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

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

22. Impact of tobacco and obesity

23. 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

24. 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,

25. 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:

26. 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

28. 55% of all cancers in women and 24% of cancers in men are associated with obesity.

29. % 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
Source: Maryland BRFSS,

30. % 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,

31. 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:

32. 10% Improvement in Childhood Obesity Among WIC Participants, 2010-2014
Source: MMWR, 2016, CDC

33. 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

34. 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

35. Cancer Incidence Rates, By Race Harford County, 2010-2014
Racial disparity exists for screenable cancers in Harford County.
Source: CDC and NCI at

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

37. 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

38. Other public health issues in Harford County

39. 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

40. 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

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

42. 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

43. 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

44. Chlamydia Infection Rates Harford County & Maryland, 2008-2015
Although Harford County rate is better than the State average, it has increased by 57% between
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

45. Domestic Violence Rates Harford County & Maryland, 2010-2015
Harford County 2015 rate now exceeds the State average.
Source: Maryland Uniform Crime Reporting Program

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

47. 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

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

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

50. 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/

51. 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

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

53. 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.

54. Harford County Local Health Improvement Coalition (LHIC)