1. Public Health: Prevent-Promote-Protect Frederick County’s Health
Barbara Brookmyer, MD, MPH
Frederick County Health Officer
Frederick County Health Department
February 22, 2012

2. 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 

3. 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:

4. Demographics of Frederick County
Demographics Frederick Maryland
Total Population* 233,385 5,773,552
Age*, %
Under 5 Years 6.4% 6.3%
Under 18 Years % 23.4%
65 Years and Older % 12.3%
Race/Ethnicity*, %
White % 58.2%
Black % 29.4%
Native American 0.3% 0.4%
Asian % 5.5%
Hispanic or Latino origin 7.3% 8.2%
Median Household Income**$81,436 $70,017
Households in Poverty**, % 5.5% 8.6%
Pop. 25+ W/O H.S. Diploma** 8.4% 12.1%
Pop. 25+ With Bachelor's
Degree or Above**, % 36.2% 35.6%
Sources: *U.S. Census (2010), **American Community Survey ( )

5. County Health Rankings
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:

6. 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

7. 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)
The leading causes of death in Frederick County and the State of Maryland are very similar. It is public health’s role to work to prevent many chronic diseases. Many of these deaths are preventable through lifestyle changes such as healthy diet and increased physical activity and/ or screening
Reference:

8. Incidence Rates for All Cancers 1997-2007: Frederick County, Maryland, and U.S.
All Rates are per 100, 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

10. African American vs. Caucasian Mortality Data for the Top 15 Causes of Death, Maryland 2009
Ratio Disparity Rank
Excess Rate of Disparity Rank
Frederick Cause of Death
Statewide Cause of Death
Disease
Age-Adjusted Mortality per 100,000 Black White
Ratio
Age-Adjusted Difference per 100,000 7 1 2
Heart Disease
238.3
184.3
1.29 54 9 4
Cancer
193
176.6
1.09
16.4 8 3
Stroke
48.3
38.3
1.26 10
Chronic Lung Disease
27.8
40.4
0.69
-12.6 5
Diabetes
34.4
17.1
2.01
17.3 6
Accidents
22.9
24.7
0.93
-1.8
Flu and Pneumonia
17.5
17.2
1.02
0.3
Septicemia
25.2
16.5
1.53
8.7 11
Alzheimer's Disease
15.6
17.6
0.89 -2 19
HIV
1.2
14.58
16.3
Nephritis, Nephrotic Syndrome, and Nephrosis
22.1
11.8
1.87
10.3 15 12
Homicide
19.1
2.4
7.96
16.7 13
Chronic Liver Disease
6.2
7.2
0.86 -1 14
Suicide
5.2
11.4
0.46
-6.2 18
Certain conditions originating in the perinatal period
2.6
4.38
8.8
Source: Maryland Vital Statistics Annual Report 2009

11. Frederick County Data: Heart Disease and Related Risk Factors
Heart disease and cancer are the leading causes of death in Frederick County followed by stroke (Maryland VSA , 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 for Blacks vs 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).

12. Based on expanded coverage though employer-sponsored health plans
# 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: eServices/ib.shtml accessed February 21, 2012

13. BMI-For-Age 2 to 18: >=95th Percentile Frederick County / Maryland vs. Healthy People 2020 Target
HP Objective NWS-10: Reduce the proportion of children and adolescents who are
considered obese (target for ages 2-19).
Note: BRFSS data & HP objective- similar but not exact.
Maryland Behavioral Risk Factor Surveillance System, BRFSS , Retrieved from:

14. Adults ever told they had high cholesterol
HP Objective HDS-7: Reduce the proportion of adults with high total blood cholesterol levels
Maryland Behavioral Risk Factor Surveillance System, BRFSS , Retrieved from:

15. Ever Had Sigmoidoscopy or Colonscopy Exam - Age 50+ Frederick County / Maryland vs. Healthy People 2020 Target
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 , Retrieved from:

16. Last Mammogram Less than 2 years ago - Women 40+ Frederick County / Maryland vs. Healthy People 2020 Target
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 , Retrieved from:

17. Pap Smear Within Past Two Years - Women 18+ Frederick County / Maryland vs. Healthy People 2020 Target
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 , Retrieved from:

18. Tobacco Use in Frederick County
Cigar use among youth is more than twice the State average.

19. Frederick County Drunk Driving Fatalities
Maryland State Health Improvement Plan: Frederick County
MD SHIP Objective: Decrease the rate of alcohol impaired driving fatalities.
Objective Description: Rate of deaths associated with fatal crashes where driver had alcohol involvement (SHA 2009).
National baseline: per 100,000 vehicle miles traveled
Maryland baseline: per 100,000 vehicle miles traveled
HP 2020 Goal: per 100,000 vehicle miles traveled
MD 2014 Target: per100,000 vehicle miles traveled

20. Coverage Source for Overall Mental Health Related ER Visits
While percent of emergency department patients are admitted, almost one-third of all
psychiatric patients seen in the emergency department are subsequently hospitalized. Although
the number of emergency department visits for patients with diagnoses of mental health disorders
has increased in recent years, there have been declines in the number of inpatient beds for
psychiatric patients across all settings—acute care hospitals, private psychiatric hospitals, and
State psychiatric hospitals.

21. 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

22. Frederick County Health Department Is Your Health Department
Thank You!
Frederick County Health Department Is
Your Health Department