1. Sustaining Healthy Communities - A Challenge Maria Torroella Carney, MD, FACP March 23, 2010 Long Island Center for Health Policy

4. Assessment Monitor Health Diagnose &Investigate Policy Development Inform & Educate Mobilize Community Develop Policy Assurance Enforce Law Link to Provide Care Assure Competent Workforce Evaluation Public Health Core Functions

5. County Health Ranking Health Outcomes – 6th Health Outcomes – 6th Mortality – 1stMortality – 1st Morbidity – 17 thMorbidity – 17 th Health Factors – 1st Health Factors – 1st Healthy Behaviors – 7 th (tobacco, diet, exercise, alcohol use, high risk sexual behavior)Healthy Behaviors – 7 th (tobacco, diet, exercise, alcohol use, high risk sexual behavior) Clinical Care – 3rdClinical Care – 3rd Social and Economic Factors – 2ndSocial and Economic Factors – 2nd Physical Environment – 32 ndPhysical Environment – 32 nd Environmental Quality Environmental Quality Built Environment Built Environment Source: Robert Wood Johnson Foundation in partnership with University of Wisconsin Population Health Institute County Healthy Rankings 2010

6. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

7. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

8. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

9. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

10. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

11. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

12. Community Health Assessment Nassau County Department of Health report to NY State Department of Health created every 5 years - contains: Population Report Population Report Health Data Health Data Local Health Unit Description Local Health Unit Description Problems and Issues in the Community Problems and Issues in the Community Local Health Priorities Local Health Priorities Opportunities for Action Opportunities for Action

18. 0 50 100 150 200 250 300 350 400 450 500 1976- 1980 1981- 1985 1986- 1990 1991- 1995 1996- 2000 2001- 2005 Nassau County NYS NYS excl. NYC Source: NYS Cancer Registry 1976-2005 Cancer Incidence Rates among Females (All Invasive Malignant Tumors) 5 Year Trends (1976-2005) Age-adjusted Rate per 100,000 Population

36. HIV in Communities

39. Asthma Prevalence by Community Nassau County Behavioral Risk Surveillance Survey 2006

40. Tobacco Use (%) Source: Nassau County Behavioral Risk Factor Surveillance Survey 2006

41. Overweight (%) Source: Nassau County Behavioral Risk Factor Surveillance Survey 2006

42. Obesity (%) Source: Nassau County Behavioral Risk Factor Surveillance Survey 2006

43. Local Health Priorities  Cardiovascular Disease Prevention  Diabetes, Obesity, Nutrition Education  Tobacco Use Cessation  Fall Injury Prevention  Cancer Screening Promotion  Teenage Pregnancy Prevention

44. Access to Health Care Built Environment Community Economic Development Health Literacy Health Marketing Natural Environment Public Policy Public Well Being Social Capital Individual & Family Community

45. Nassau’s Access to Health Care 12 Hospitals 12 Hospitals 34 Nursing Home/Rehabilitation Centers 34 Nursing Home/Rehabilitation Centers 6 Hospices 6 Hospices 21 Home Health Care Agencies 21 Home Health Care Agencies 12 Long Term Care Agencies 12 Long Term Care Agencies 8 Prenatal Care Assistance Programs 8 Prenatal Care Assistance Programs 4 Community Health Centers 4 Community Health Centers 12 HIV Testing Sites 12 HIV Testing Sites Urgent Care Centers expanding Urgent Care Centers expanding

46. Nassau’s Access to Health Care CHC Hospices PCAP Hospitals LTC HIV HHA Nursing Homes/Rehabilitation Centers 0 5 10 15 20 25 30 35 Urgent Care Centers 7,411 beds 4,397 beds

47. Health Care Providers in Nassau Over 8,000 Physicians Over 8,000 Physicians 2666 Primary care2666 Primary care 5368 Specialists5368 Specialists 1057 Physician Assistants 1057 Physician Assistants 1,218 Nurse Practitioners 1,218 Nurse Practitioners 2,019 Dentists 2,019 Dentists

48. Health Care Providers in Nassau

49. Health Determinants Behaviors Intermediate Outcomes Environmental and Community Factors Health Outcomes Mortality/ Morbidity aka Longevity/Quality of Life Steps to Sustain Healthy Communities

50. Nassau County Legislation Mandating Nutritional Information Artificial Trans Fats Banned From Restaurants On September 18, 2007, the NCBOH voted to restrict the use of artificial trans fats from all permitted food service establishments in the county. On April 1, 2008, the trans fat restrictions took effect for trans fats used for frying or in spreads and on April 1, 2011, the ban will go into effect for oils or shortening used for baking. On September 18, 2007, the NCBOH voted to restrict the use of artificial trans fats from all permitted food service establishments in the county. On April 1, 2008, the trans fat restrictions took effect for trans fats used for frying or in spreads and on April 1, 2011, the ban will go into effect for oils or shortening used for baking. Calorie Menu Labeling On September 10, 2009, the NC Legislature voted into law Calorie Menu Labeling legislation. On September 10, 2009, the NC Legislature voted into law Calorie Menu Labeling legislation.

51. NCDOH Recommendations for Action 1. Promote activity, lessen sedentary behavior (30 minutes a day/5-7 days a week) 2. Create safe walking environments 3. Create safe biking paths 4. Create a Nassau Walking Trail throughout the county connecting communities 5. Encourage access to grocery stores and markets/fresh fruits and vegetables

52. Recommendations for Action (Continued) 5. Grab bars in every new or renovated bathroom 6. Promote use of handrails to prevent injury 7. Senior-friendly housing needed within neighborhoods with close access to public transportation, shopping and health care 8. Expand on Delivery of Health care needs in home

53. Sidewalks

54. Walking and Bike Path

55. BeforeAfter

58. Parks and Seating – Universal Use

62. Grab bars

64. Handrails

67. Next Steps for Long Island Center for Health Policy?

68. Of Possible Interest… Aging Aging Study falls etiology and risks in regionStudy falls etiology and risks in region Evaluate quality of care in nursing homesEvaluate quality of care in nursing homes Educate public and physicians re Advance Directives – poorly utilized tool and not diversely utilizedEducate public and physicians re Advance Directives – poorly utilized tool and not diversely utilized Expand home care deliveryExpand home care delivery Health Disparities Health Disparities Prevent Teenage PregnancyPrevent Teenage Pregnancy Promote concept and use of Medical HomePromote concept and use of Medical Home Health Promotion Health Promotion Evaluate School WellnessEvaluate School Wellness Improve quality of care and access to quality careImprove quality of care and access to quality care Eg Falls and Coumadin use Eg Falls and Coumadin use Promote wellness across the age spectrumPromote wellness across the age spectrum

69. Resources www.countyhealthrankings.org www.countyhealthrankings.org www.countyhealthrankings.org www.cdc.gov www.cdc.gov www.cdc.gov www.nassaucountyny.gov/agencies/Health/ www.nassaucountyny.gov/agencies/Health/ www.nassaucountyny.gov/agencies/Health/ index.html www.thecommunityguide.org www.thecommunityguide.org www.thecommunityguide.org www.healthymadisoncounty.org www.healthymadisoncounty.org www.healthymadisoncounty.org www.HumanCenteredDesign.org/pedestrian www.HumanCenteredDesign.org/pedestrian www.HumanCenteredDesign.org/pedestrian