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T RI-COUNTY H EALTH D EPARTMENT An Ounce of Prevention...

What Is It Really Worth? A NNUAL R EPORT 2004 14862 6/9/05 3:19 PM Page 2

An Ounce of The Times, They Are a Changing

An Apple A Day ublic health’s prevention efforts have had 50¢ Prevention Is Worth a dramatic influence on health in the a Pound of Cure PUnited States. During the early 1900s, infectious diseases were the main causes of death and disability throughout the world. In t’s an old, familiar saying … but what is it the first half of the 20th really worth? Just what does prevention century, most Americans cost and how much does it save – both in died from pneumonia, 2004 Per-Capita I County Contribution to terms of money and lives? influenza, tuberculosis or Tri-County Health Dept. diarrheal diseases. $5.74 Dollars and Sense As a result of the wide use of immunizations and ri-County Health Department seeks to better sanitation and improve everyone’s health, and do it in housing conditions, we have controlled many economically responsible ways. deadly infections and eradicated others by T preventing them. We promote good health at a reasonable cost. Aspirin for Cardiovascular Health Since public health resources are limited, we Today, the leading causes of death are chronic 1¢ often focus on prevention strategies that yield diseases such as heart disease, stroke, cancer the most benefit for the investment. and diabetes – yet these are often preventable. Fully 70 percent of all Americans who die each Preventive health is based on the belief that it year die of a chronic disease … and cancers is better to avoid having a disease or disability and cardiovascular diseases together account than to treat one. Spending money to prevent for half of all these deaths. Cost of Auto Safety disease and promote healthy lifestyles makes Equipment Per New Car good economic sense. $839 Tragically, many of these illnesses could have been prevented, or at least have been treated For example, the with early screening and intervention. They measles-mumps-rubella include lung cancer and stroke caused by vaccine saves up to tobacco and high blood pressure, heart disease $16.34 in direct and diabetes from obesity. Though heart medical costs for each attacks and strokes seem like sudden events, Water Purification and dollar spent. It’s Fluoridation they may actually have been years in the making. .00001¢ estimated that every dollar spent on Unfortunately, infectious diseases still remain influenza shots for a threat. Forty thousand people die of older adults saves up to pneumoccal pneumonia in the United States $60 in hospitalization each year, making it the leading cause of death costs. And for each among vaccine-preventable diseases. Yet only dollar spent on drinking water fluoridation, Yearly Influenza Shot 46 percent of Americans over the age of 65 $15 up to $80 is saved in dental treatment costs receive the pneumoccal vaccine. for children. In addition, emerging infections such as Prevention is one of the most important yet Severe Acute Respiratory Syndrome (SARS) most neglected topics in modern health care. and West Nile virus are constantly appearing. We can save millions of lives and billions of Others, such as malaria, tuberculosis and dollars by helping people change unhealthy bacterial pneumonias, are now appearing in Penicillin and Subsequent Antibiotics – behaviors. But how do you get people to forms that are resistant to drug treatments. Priceless change old habits? We must remain vigilant and responsive. 1 14862 6/9/05 3:19 PM Page 3

Good, but Not Good Enough There’s Strength in Numbers

ore Americans are living longer, ri-County Health Department is the Disposable Latex Gloves healthier lives than at any time in largest local health department in 9¢/pair Mour history, but we can do better. TColorado, serving the 1,030,000 residents of Adams, Arapahoe and Douglas Counties. Some of our programs are supported by federal and state funds or by grants, but just how much does all of this cost the Individual local taxpayer? Sterile Germ Barrier 4¢ $5.74. That is how much each of our three counties contributes to our budget per Despite impressive gains, Americans live resident. Talk about a good investment! shorter, less healthy lives than people in most Chicken Soup other industrialized countries. As you will read in this report, our 49¢ accomplishments in 2004 are impressive. Part of the problem is that the United States We are committed to developing innovative needs to think differently about the prevention programs that reduce the health and economic of diseases. Most people only see a doctor consequences of disease and injury, ensuring a when they are sick or hurt. long, healthy life for all people. Folic Acid to If You Have Your Health, You Have Prevent Birth Defects Medical care is primarily curative. Public 1.5¢ health is primarily preventive. We need Everything medical care some of the time, but we need public health all of the time. Sadly, only about Throughout this annual report we highlight 1% of health care expenditures are devoted to many public health products and services. Disposable Syringe public health prevention efforts. Most are very low-cost or completely free to 41¢ consumers, and all are a terrific value.

Sometimes, Cheaper Is Better So when it comes to an ounce of prevention, what is it really worth? ... Priceless. overty and lack of education are at the root of many health issues. However, Sharps Container for many health problems can be prevented Bloodborne Hazards P $4 through amazingly simple and extremely inexpensive methods: protection from environmental hazards; handwashing to stop the spread of germs; immunizations to prevent disease; birth control to prevent unplanned

pregnancies; prenatal care to improve birth Child-Resistant outcomes; and good nutrition throughout all Safety Caps stages of life. 9¢

Some of the most effective tools to prevent and fight disease – vaccinations, mammograms, colon cancer screening, Pap tests, tobacco cessation, cholesterol tests and blood pressure checks – are inexpensive but Tri-County Health Department – massively underused. Priceless 2 14862 6/9/05 3:19 PM Page 4

hantavirus, plague, rabies and West Nile virus; and other Germ Warfare dangerous diseases and conditions such as encephalitis, meningitis, toxic shock syndrome, SARS and tuberculosis. Control of Communicable ri-County Health Department helps prevent Diseases manual infectious diseases that can be spread by person- In 2004, Tri-County Health Department conducted $21 to-person contact, by animals or through food T 880 notifiable disease investigations including a record and water. These include such serious diseases as E. coli, number of reported pertussis cases – 273 cases in the hepatitis A, meningitis and pertussis (whooping cough). Tri-County area out of 1,214 in Colorado. This outbreak also occurred nationally. Improvements In an outbreak, the Tri-County Health Department in vaccination rates could help reduce the burden disease control staff trace the cause of an illness to its of disease. source, determine who else is at risk, and put control measures into Mosquito Larvacide $6 We utilize our Health Alert place … such as Insect Repellent Network (explained on page with DEET $4 immunizing the 6) to distribute the Public at-risk population, Health Update, a newsletter issuing glove containing timely public orders for health warnings and restaurant workers information for health or establishing care providers. quarantines. A combined system of surveillance, reporting and FightTheBiteColorado.com In 2004, we published 6 West Nile Virus control is very effective in preventing widespread editions of the Update. Prevention Education outbreaks, and is practiced by virtually all health Topics included pertussis, Campaign – $0 departments across the nation. West Nile virus, influenza surveillance, foodborne Health care providers and laboratories are required by illness outbreaks and adult obesity. You may view past law to report a total of 65 different diseases to us, Updates and other disease prevention and control whether suspect or confirmed. materials at www.tchd.org/disease.html. These include 11 vaccine-preventable diseases such as measles, mumps, whooping cough, poliomyelitis and Rub-A-Dub-Dub tetanus; 16 different foodborne illnesses including Various Immunizations botulism, E. coli and hepatitis A; five sexually- urprisingly, the most important thing that you can $15 - $75 transmitted diseases including HIV/AIDS, gonorrhea do to keep from getting sick is to wash your hands. Free to Qualifying Clients and syphilis; 13 animal-borne illnesses such as SWith frequent handwashing, people wash away germs that they may have picked up off of contaminated surfaces, from E.coli O157:H7 Select Notifiable Diseases: other people, or from animals and 11 2004 vs. 5-Year Median animal waste. In addition to colds, 19 some potentially serious diseases – Mousetrap Giardiasis like influenza, hepatitis A, meningitis 49¢ 130 and E. coli – easily can be prevented 129 if people make a habit of washing their hands. Hepatitis A 9 Handwashing also prevents those 21 infected from transmitting their Hepatitis B, Chronic infection to others through food Handwashing with Soap 211 preparation or close contact. 1¢ 192 Meningococcal Disease Simple handwashing can save a lot on 5 medical bills. Since an application of 7 soap costs less than 1¢, a single penny’s worth of prevention can avert Pertussis (Whooping Cough) a $50 visit to the doctor’s office … 264 or thousands of dollars in hospital 112 bills. So rub-a-dub-dub, don’t forget Healthy Citizens – Three County Totals, 2004 5-Year Median, 1999-2003 to scrub! Priceless 3 14862 6/9/05 3:19 PM Page 5

medication, visiting a physician more often and being Through Thick and hospitalized more often. Regular physical activity substantially reduces the risk of dying of coronary heart Five-A-Day disease (the nation’s leading cause of death) and Fruits and Vegetables Through Thin 72¢ - $1.68 decreases the risk for colon cancer, diabetes and high blood pressure. The direct and indirect costs of obesity ri-County Health Department provides in America are more than $117 billion per year. community outreach to educate adults about the The direct and indirect costs of diabetes are nearly $132 Timportance of good nutrition, and partners with billion a year. local Food Stamp offices, childcare providers, grocery stores and fitness centers to reinforce key obesity Women and Children First prevention messages. We help prevent obesity and other Got Milk? Non-fat Milk $1.49 chronic diseases by addressing two closely related he Special Supplemental Nutrition Program for factors – poor nutrition and inadequate physical activity. Women, Infants and Children (WIC) provides We also stress the importance of good nutrition for a nutrition counseling and vouchers for nutritious healthy lifestyle and the health benefits of breastfeeding. T foods to income-eligible women who are pregnant, postpartum or breastfeeding, and children from birth A Step in the Right Direction through age five. WIC contributes to healthier Whole Grain Bread pregnancies and healthier children, resulting in better $2.79 uring the past 20 years, obesity among adults health and dramatic savings in medical care costs. Every has risen significantly in the United States and dollar invested in WIC saves up to $3.13 in health care Dnow has reached epidemic proportions. Sixty costs within the first 60 days after birth. percent of U.S. adults are considered overweight and 23 percent of U.S. adults – over 60 million people – are Tri-County Health Department has the largest network obese. Although Colorado is ranked lowest in U.S. of WIC clinics in Colorado, serving an average caseload Portion Control obesity rates, and though we are the leanest state in the of 23,963 clients in 2004. This federal program $4.29 nation, the Colorado numbers have increased to 51.4% provided $15,623,281 in direct assistance to local of the population considered overweight and 16% Tri-County families with a monthly average of $54 classified as obese. The state spent an estimated $192 worth of food per person. Only specific nutritious foods per person in 2003 on medical costs related to obesity. are available, including milk, cheese, eggs, cereal, peanut butter, beans, fruit juices and infant formula. In 2004, our proportion of overweight WIC clients between the $54 Worth of Monthly ages of two and five remained at 9.6%, far below the Groceries for WIC Clients national average of 14.3%. Free to Qualifying Clients

Through our WIC clinics, we also screen for anemia, provide West Nile virus prevention tips, provide smoking cessation and prevention education, offer childhood immunizations and counsel on the benefits of breastfeeding. Exercise Video $15 Mother’s Milk Step Counter $8 Walking $0 ri-County Health Department’s nutrition division promotes breastfeeding because Tmother’s milk has just the right amount of fat, sugar, water and protein that is needed for a baby’s This increase is not limited to adults. The percentage growth and of young people who are overweight has more than development. tripled since 1980. Among children and teens aged Formula $885/year 6-19 years, 16 percent (over 9 million young people) Breastfeeding Most babies find $0 are considered overweight. it easier to digest breast milk than Americans’ expanding waistlines are leading to escalating they do formula. disease rates and costs. People who are overweight or Breast milk has obese increase their risk for cardiovascular disease, antibodies that diabetes, high blood pressure, arthritis-related help protect disabilities and some cancers. Not getting an adequate infants from bacteria and viruses and help them fight Healthy Nutrition and amount of exercise is associated with needing more off infection and disease. Healthy Weight – Priceless 4 14862 6/9/05 3:19 PM Page 6

In 2004, Tri-County Health Department performed Like a Breath 315 plan reviews and 6,790 restaurant and foodservice Proper Handwashing facility inspections for 3,803 establishments. You can Handsoap 1¢ view an inspection report for any restaurant in our Disposable Towel 2.1¢ of Fresh Air three-county region with our new online database of restaurant inspections at www.tchd.org/restaurants.html. ri-County Health Department’s Environmental Health programs focus on preventing exposure Tto diseases and environmental conditions that This Land Is Your Land, could be harmful to your health. We protect the This Land Is My Land Disinfectant population from environmental hazards and protect $1.79 the environment from human carelessness. and use decisions can have widespread public health and environmental impact. The way our We help to prevent or control disease, injury or deaths communities grow and develop can directly that result from interactions between people and their L impact the health of current and future generations. environment. This can include exposure to hazards from Sanitary Packaging air, water, animals, chemicals and natural substances. Well-planned 1.2¢ development can Tri-County Health Department performs over 6,300 encourage exercise, yearly inspections of restaurants, child care facilities, promote safety, public swimming pools and home septic systems. We utilize natural inspect 655 individual child care centers serving about resources sensibly 55,000 children. This includes consultations on food and enhance the Food Safety preparation, sanitation, diapering, handwashing, disease quality of life. Refrigerator Thermometer prevention and safety. $4.79 In 2004, Eat, Drink and Be Wary Tri-County Health Department reventing foodborne illness and death remains a worked with the planning departments of the major public health challenge. Contaminated food municipalities in our jurisdiction to provide 276 land Pcan be very dangerous, especially to young use plan reviews containing recommendations to Online Restaurant children, older adults, pregnant women and people with enhance positive health impacts and reduce negative Inspection Results weakened immune systems. health impacts of land use decisions. www.tchd.org $0 While the food supply in the United States is one of the safest in the world, the Centers for Disease Control and Come On In, the Water’s Fine Prevention (CDC) estimates that 76 million people get sick, more than 300,000 are hospitalized, and 5,000 ri-County Health Department regulates public Hybrid Car Americans die each year from foodborne illness. swimming pools, hot tubs and spas to help $25,000 Tprevent gastrointestinal, respiratory and skin diseases. We also offer classes to certify pool operators.

Household sewage that is improperly disposed of can contaminate the groundwater, which could put the Public Transportation public at serious risk for exposure to cryptosporidium, $1.25 E. coli, giardiasis or hepatitis A. Tri-County Health Department reviews plans for new home septic systems, inspects malfunctioning systems and issued 630 new septic system permits in 2004.

Walking $0 Reduce, Re-Use, Recycle

ollution prevention programs help prevent Diseases can be transmitted in meat or on produce and hazardous chemical damage to the environment also through improper food handling, preparation and Pand injuries to individuals. In 2004, our six storage. Consumer food safety education is vitally Household Chemical Roundups collected nearly important since the majority of foodborne illnesses can Clean Air, Land 150 tons of house and garden chemicals, auto fluids, and Water – be traced to improper food handling procedures in batteries, paint products and tires from 3,360 Priceless home kitchens, not restaurants. households for proper disposal and recycling. 5 14862 6/9/05 3:19 PM Page 7

A Clean Bill of Health people of risk, describe symptoms and identify locations to seek medications. Clear communication can also keep a bad situation from becoming worse by reducing public ri-County Health provides oversight in the Battery-Operated Radio cleanup of clandestine methamphetamine labs. anxiety and preventing unnecessary panic. $10 TWe work closely with other local agencies, landlords and qualified cleanup contractors to ensure that the affected residence is properly cleaned prior to allowing re-occupancy. Flashlight $3 An environmental health specialist and a public health nurse work as a team to inspect all 20 known body art establishments in our region. Body art includes tattoos and piercing, with public health concerns of sanitation, sterilization of instruments and prevention of 911 Emergency System – Priceless communicable diseases. Detailed information on all these services is available on our website at www.tchd.org/environmentalhealth.html. Tri-County Health Department is one of the lead local agencies for dispensing medication from the Strategic Survival Necessity National Stockpile, a national repository of 0.4¢ pharmaceuticals and medical supplies that can be deployed anywhere in the country within 12 hours after Hope for the Best, a natural disaster or act of terrorism.

But Plan for the Tri-County Health Department’s all-hazards plans and preparedness efforts work to assure the community that N-95 Particle Mask $1 Worst our staff have the ability to respond to a variety of challenging public health situations, from chemical spills or an influenza epidemic to a large foodborne illness cross the nation, public health agencies are outbreak or a natural disaster. increasingly active in all levels of emergency preparedness planning, training and exercises, A Duct Tape and Tri-County Health Department staff members are Be Prepared $4 on-call 24 hours a day to respond to emergencies. here are six basic categories of Tsupplies people should stock in their own emergency preparedness Car Safety Kit kit: water, food, first aid $20 supplies, clothing and bedding, tools and emergency supplies, and special items for medical conditions. Keep the items that you would most likely need during an evacuation in an easy-to-carry container. The American Red Cross offers Smoke Alarm a ready-made emergency preparedness kit or individuals $5 can compile one for their family from everyday household items. More information is available on our Although the threat of bioterrorism may be remote, website at www.tchd.org/emergency.html. in 2004, we conducted or participated in 5 state and local emergency preparedness exercises in order to We are part of the nationwide Health Alert Network Emergency Locator practice responding to a variety of situations, (HAN), a high-speed communication system that $1 mobilizing health professionals on short notice and connects the CDC with every state and local health under difficult conditions. department in the county. The HAN enables us to transmit urgent information to a network of emergency We continue to improve our communication systems to agencies, hospitals, schools and physicians. Through the assure coordination between local and state public health HAN, we can deliver information simultaneously to the agencies and first responders. Clear communication and 2,608 contacts in our network. In 2004, we sent 18 notification systems are crucial in every emergency health advisories. Topics included pertussis, West Nile Peace of Mind – situation, providing vital information that would advise virus and foodborne illness alerts. Priceless 6 14862 6/9/05 3:19 PM Page 8

In 2004, Tri-County Health Department tobacco Don’t Let Your Future prevention staff worked with healthcare providers to offer trainings on secondhand smoke and cessation to their medical staff and provided educational materials Money to Burn? Go up in Smoke for distribution to patients and families. In addition, our Pack of Cigarettes $3.75 Cost to Society $7.18 tobacco experts promoted the statewide QuitLine and obacco use is the leading preventable cause of QuitNet in all venues, worked with schools and death in the United States. Each year, over community organizations to implement youth tobacco T440,000 people die of diseases caused by activities, and educated our communities on the risks of smoking – that’s about 20% of all deaths. Tobacco secondhand smoke through group presentations, claims more lives than drugs, alcohol, firearms and community events and the media. motor vehicle accidents combined, resulting in an annual cost of more than It Will Take Your Breath Away Lung Cancer, Stroke, $75 billion in direct medical costs, or Coronary Heart Disease – about $3,391 per smoker per year. Each Cough up Big Bucks obacco hazards are not limited to pack of cigarettes sold in the U.S. costs smokers. Restaurant and bar taxpayers and employers an estimated workers are the occupational $7.18 in direct medical care costs and T group most heavily exposed to lost productivity. secondhand smoke. During a shift in a smoke-filled restaurant or bar, workers Lung cancer is the leading cause of breathe in the equivalent of actively cancer death in men and women, and smoking 1.5 to 2 packs of cigarettes. smoking is a primary cause in 87% of all Low-Birthweight or Secondhand smoke contains more than Premature Baby Care lung cancers. It makes more sense to 4,000 chemicals, 43 of which are known $59,700 encourage people to quit smoking now to cause cancer, including arsenic, rather than to have to treat them for lung cancer in 20 formaldehyde, hydrogen cyanide and radioactive years. Smoking is directly responsible for most cases of elements. The U.S. Environmental Protection Agency lung cancer, chronic bronchitis and emphysema, and it (EPA) classifies secondhand smoke as a Group-A is a major factor in coronary heart disease and stroke. Carcinogen. Currently 22 percent of Americans and 18.6 percent of Coloradans smoke. Many of them live and suffer with Secondhand smoke is so toxic it causes more deaths each some form of smoking-related illnesses. Nicotine Patch $2.86 year than all of the EPA’s regulated chemical work Nicotine Gum 45¢ hazards combined. Every year, Pregnant women who smoke are more likely to have an estimated 3,000 lung Current Smokers babies who have an increased risk of death from sudden cancer deaths and 35,000 infant death syndrome and respiratory distress, or low deaths from coronary heart Adams County 22.2% birth weight babies with many health disorders. disease are attributed to Arapahoe County 17.5% Programs that reduce smoking during pregnancy can secondhand smoke ... Douglas County 11.9% save more than $6 for each dollar spent by decreasing in non-smokers. Colorado 18.6% the number of babies born with low birth weight or Quitting “Cold Turkey” Source: Behavioral Risk Factor Surveillance developmental delays. System Estimates 2003 $0 Children who are frequently exposed to secondhand smoke The good news is that tobacco prevention programs work. also suffer unnecessary illnesses, with higher long-term rates of lung cancer and increased susceptibility to Smoking cessation interventions respiratory infections, and an increase in occurrence and have often been called the gold severity of asthma attacks. standard of cost-effective interventions. U.S. adult If at First You Don’t Succeed, Try, Try Again QuitLine and QuitNet smoking rates have been cut Cessation Counseling nearly in half in the last 40 years, nd then keep trying again! Unless a person is $0 from 42.2 percent to 22.8 able to quit immediately, it takes an average of percent. Unfortunately, every day seven to nine attempts to become completely nearly 4,000 young people try their first cigarette. A smoke-free. It is worth it, since many of the effects of smoking are reversible over time once a person has quit. Tri-County Health Department supports coalitions in In 2004, 2,244 Tri-County residents initiated tobacco each of our three counties that are tailored to each quit attempts through the statewide toll-free QuitLine individual community. They share three common goals: (1-800-639-QUIT) or www.co.quitnet.com. Though preventing youth initiation of tobacco use; increasing it might seem to be easier said than done, many Smoke-Free Public cessation of tobacco use; and reducing exposure to former smokers now brag that you can teach an old dog Places and Workplaces – secondhand smoke. Priceless new tricks! 7 14862 6/9/05 3:19 PM Page 9

Numbers Don’t Lie Of Vital Importance

ne of Tri-County Health Department’s many onitoring birth outcomes and causes of death Certified Birth and roles is to monitor the health of the has been the basis for keeping track of the Death Certificates $15 Ocommunity through public health data. Mhealth of a population for centuries. We compare this information to baseline numbers and The Tri-County Health Department Vital Records other data so that we can get an accurate snapshot of department issues legal, certified copies of birth current health challenges. certificates. A hospital birth Tri-County Health Department examines birth certificate with a certificate data to understand trends in access to baby footprint is Blood Pressure prenatal care, pre-term births and low birth-weight suitable for Gauge $22 births. We also use death certificate data to monitor framing … trends in deaths from a variety of causes such as heart but not a legal disease, cancer, stroke, respiratory illnesses and document. unintentional injury. Certified birth certificates protect against identity theft and are legal documentation for proof of employment, Cholesterol Level school enrollment and extracurricular activities, travel to Screening $45 Top Five Causes of Death Canada and Mexico, passport applications, and to apply for a Social Security card. (Age-adjusted rate per 100,000 people, 2003) Adams Arapahoe Douglas Colo. Birth certificates are available for people born any year Heart Disease 215.9 153.2 163.0 179.3 in Adams, Arapahoe and Douglas Counties and since All Cancers 177.4 161.0 129.6 167.3 Injury Prevention 1905 anywhere in Colorado. Death certificates are Is No Accident! Chronic Lower issued for deaths that occurred any year only in Adams, Bike Helmet $20 Respiratory Disease 69.2 41.7 41.1 53.4 Arapahoe and Douglas Counties. Stroke 45.5 47.4 47.6 51.3 Unintentional Injuries 40.2 34.2 28.7 41.5 In 2004, we issued 20,981 birth certificates and 48,306 death certificates. You can order certificates in person at Source: Colorado Health Information Dataset, Colorado Department of Public Health and Environment the administration office or online at www.tchd.org.

The CDC’s Behavioral Risk Factor Surveillance Child Car Seat $45 System (BRFSS) provides information on the existence of health behaviors and preventive The Top Ten Things You Can Do health practices associated with the leading to Improve Your Health Now causes of disease, disability and premature death such as alcohol use, drug use, seatbelt non-use 1. Wash your hands. Handwashing with soap is the single most and the neglect of recommended health effective means to stop the spread of communicable disease. Toothbrush, screenings such as blood pressure and Toothpaste and 2. Quit smoking. Tobacco is associated with heart disease, lung Dental Floss $6.19 cholesterol. The Pregnancy Risk Assessment disease, cancer and stroke. Monitoring System (PRAMS) helps us 3. Eat less animal fat. It clogs the arteries, raises cholesterol, and understand maternal attitudes and can lead to heart attacks, stroke, diabetes and numerous problems experiences prior to, during and immediately affected by overweight and obesity. following pregnancy. 4. Eat more healthy foods. Increase your intake of fruits, vegetables and fiber. 5. Exercise. Get on your feet! Exercise adds to both your physical There’s a Method to Our Madness and emotional well being. It also helps to alleviate stress, which can lead to other problems. First Aid Kit $14 e use this information to help plan 6. Listen to your body. Headache, fever, vomiting or diarrhea Sunscreen $6 services at Tri-County Health can be possible signs of underlying problems, including Multivitamin 7.5¢ Department, and also share it with foodborne illnesses. W 7. Visit your doctor and dentist. Get checkups and cleanings and other health care providers and policy makers to know your family health history. guide their service provision and decision- 8. Avoid overexposure to the sun. Skin cancer is the #1 form of making. A snapshot of key health indicators for cancer in the U.S. and it is preventable. each county along with an extensive community 9. Get enough sleep. It gives your body a chance to repair itself health profile is available at every night. www.tchd.org/communityhealth.htm. 10. Drink lots of water. It hydrates the body and clears out toxins. Improved Longevity and Quality of Life – Priceless 8 14862 6/9/05 3:19 PM Page 10

Each premature or low-weight birth costs an average of Better Safe Than Sorry $59,700 more in the first year of care. Tri-County Health Department nurses visit with a woman ten times espite education and contraception, half of all Oral Contraceptive during her pregnancy to help address issues such as pregnancies in the United States are unintended “The Pill” $30 smoking, alcohol abuse and lack of medical care. In and more than 75 percent of teen pregnancies Sliding Fee Scale and D 2004, we served 314 high-risk Prenatal Plus clients. Free to Qualifying Clients are unplanned. The United States has the highest teenage childbearing rate among all industrialized The Nurse-Family Partnership is a home-based prenatal nations. In addition, the infant mortality rate for program that follows mothers and children through children born to teen moms is about 50% higher than pregnancy and for two years after the child’s birth. for those born to mothers over 20 years of age, and Families receive prenatal support and education, more than 75 percent of teen mothers eventually go postpartum and newborn physical exams, parenting on welfare. Condom - HIV/STD and and child development education, and referrals to Pregnancy Protection community services that can address the health and Tri-County Health Department provides confidential 66¢ social needs of the family. family planning services which help prevent unintended pregnancies and sexually transmitted diseases. In 2004, we provided 8,193 clients (1,184 of them teens) with annual health examinations, birth control counseling, contraceptive supplies, and testing for pregnancy, STDs and HIV/AIDS. And let’s not forget that the birth control burden is not only for females since it takes Low-Birthweight or Premature Baby Care two to tango. $59,700 Off to a Good Start

nfant mortality is an important measure of a Sex Education and community’s health. A newborn in the U.S. has one Planned Pregnancies – of the world’s highest healthy life expectancy Priceless I Similar programs around the country have existed for rankings, averaging 77.4 years. Infant mortality in the U.S. is currently at a rate of 7.0 deaths per 1,000 births. over two decades, and have demonstrated that programs Colorado is at a rate of 6.0 deaths per 1,000 births, and like this improve family life and reduce child abuse. our three-county infant mortality rates include Adams at They reduce mothers’ problems with drugs and alcohol, 6.5, Arapahoe at 5.5 and Douglas at 4.8. Comprehensive as well as reduce children’s alcohol, drug, cigarette and data from our community health profiles are available crime statistics once they grow to be teens. online at www.tchd.org/communityhealth.htm. The Nurse-Family Partnership returns $4 to society for Mammogram $200 every dollar invested and approximately $38,000 over Pap Test $65 Sliding Fee Scale and the child’s lifetime. The program is fully funded by Free to Qualifying Clients funds from the national master tobacco settlement. In 2004, our nurses provided 2,486 home visits to 358 clients.

Knowledge Is Power

ammograms and Pap tests provide early Prenatal Plus detection and early treatment of breast and Free to Qualifying Clients Mcervical cancers. These procedures are crucial, since early detection increases a woman’s chance of survival. If discovered in the early stages, breast cancer Tri-County Health Department’s Prenatal Plus program can often be effectively treated. is a case management program for high-risk pregnant women who are eligible for Medicaid. Nurses, Tri-County Health Department provides uninsured nutritionists and mental health professionals work in women with free breast and cervical cancer screenings collaboration with medical care providers toward a and with referrals to additional care, if needed. In 2004, common goal of improving birth outcomes – specifically we provided cancer screenings to 374 women. Cancer to improve the chances of a healthy mother and child, screening clinics are held in various locations across the Healthy Women and Babies – and to decrease the incidence of low birth weight and metro area. A limited number of screenings are available. Priceless premature babies. Appointments are required. Call 303-783-7150. 9 14862 6/9/05 3:19 PM Page 11

A Helping Hand, Not a Handout Measles is so infectious that more than 90 ccess to health care can be difficult even under percent of people the best of circumstances, and can be an CHP+, HCP and who are not Medicaid Enrollment enormous challenge to our uninsured and A immune will get Free to Qualifying Clients under-insured populations. Tri-County Health it if they are Department provides a variety of services to help these exposed to the individuals obtain health insurance and health care. virus. And about 128,000 people We help families enroll in the federally-funded Child still get infected Health Plan Plus Program (CHP+), a low-cost health with hepatitis B insurance program for children. Currently 6,879 virus each year. There is no cure for hepatitis B, but children are enrolled in CHP+ in our three-county area. simple immunizations can prevent it. Nurse-Family Partnership Parenting Education Complications from these and other diseases can cause Free to Qualifying Clients time lost at work or school, expensive doctor visits or hospitalizations, disabling physical and mental problems, and even death. Truly, a shot in the arm is a shot at success, so protect the ones you love with vaccinations.

Getting immunized is an easy way to prevent getting sick, and many infant and toddler immunizations Children’s Immunizations – protect children for the rest of their lives. In 2004, Priceless Tri-County Health gave a total of 52,298 shots, and 44,246 of these were children’s immunizations. Prices are very reasonable and no one is ever turned away because of inability to pay. Weekly immunization clinics are held at our offices and other community locations. Call 303-451-0123 for more information.

Tri-County Health Travel Clinic In 2004, Tri-County’s Health Care Program for Travel Immunizations Children with Special Needs (HCP), linked a variety of $20 - $150 community services with 1,597 families who have children with challenges ranging from asthma to severe physical or mental disabilities.

The Early Periodic Screening, Diagnosis and Treatment program helps Medicaid-eligible clients access medical care and benefits for their children. Adult Booster Shots $20 - $60 A Shot at Success

mmunizations are one of the greatest public health Adults need immunizations and booster shots too. achievements in history. Immunizations have Each year thousands of adults die unnecessarily from virtually eliminated the spread of many childhood I influenza, pneumonia and hepatitis B, or from common Yearly Influenza Shot diseases, including measles, mumps, rubella, pertussis diseases that travelers are exposed to in foreign countries. $15 (whooping cough), diphtheria and polio. However, the In 2004, Tri-County Health Department administered viruses and bacteria that cause disease and death still 8,052 adult and travel immunizations. Getting travel exist and can be passed on to people who are not immunizations will help assure that souvenirs are the protected by vaccines. only thing you bring back from overseas.

For example, chickenpox is often present in the Adult and travel vaccinations are available at the community and is highly contagious to those not Tri-County Health Department International Travel immunized. Measles is one of the most infectious Clinics in Aurora, Northglenn and Lone Tree. Elimination of diseases in the world and can be imported into the U.S. Smallpox and Polio – Call 303-784-7866 for more information. Priceless 10 14862 6/9/05 3:19 PM Page 12

Administration: 2004 Revenues Richard L. Vogt, MD Public Health Services Executive Director January 1 - December 31, 2004 - Unaudited Provided in 2004 Anne Bennett, MS, RD Adams County $2,228,462 Director of Nutrition Arapahoe County 2,993,694 Robert Browning, MBA Douglas County 1,258,705 Child care center inspections 655 Director of Administration Total County Appropriations $6,480,861 and Finance (A per capita contribution of $5.74) Child Health Plan Plus clients (CHP+) 6,879 Mary Carol Ferrera, RN, MSN* Family planning program clients 8,193 Director of Nursing Total county appropriations $6,480,861 Hazardous materials investigations 44 Jeanne North, RN, MS Total grants and contracts 1,391,224 Interim Director of Nursing Total fees from service 2,865,880 Total immunizations given 52,298 Joy Ranum, MS, RD* Total federal funds 524,286 Children’s immunizations 44,246 Director of Nutrition Total state appropriations Stacy Weinberg, MA and grant funds 7,324,740 Adult and Travel Clinic immunizations 8,052 Director of Total Medicaid 355,329 Epidemiology, Planning In-kind contributions 1,309,041 New septic system permits issued 630 and Communication Total Revenues $20,251,361 Notifiable disease investigations 880 Bruce Wilson, MPA Director of Nurse/Family Partnership home visits 2,861 Environmental Health 2004 Expenditures Total salaries, wages Prenatal Plus program clients 314 Board of Health: and benefits $12,921,130 Restaurant/retail food establishment inspections 6,790 Joseph Anderson, MD Total operating costs 4,443,090 Adams County Capital 307,878 Vital Statistics, total certificates issued 69,287 Total contributed services 1,309,041 Steve Boand, MSES* Douglas County Contribution to reserve 1,270,222 Birth certificates 20,981 Total Expenditures $20,251,361 John Dawson, President** Death certificates 48,306 Arapahoe County Reba Drotar* 2004 Population Base WIC - Women, Infants and Children caseload 23,963 Adams County WIC supplemental food vouchers retail value $15,623,281 Thomas Fawell, MD Adams County 388,031 Douglas County Arapahoe County 521,077 Women’s cancer screening program clients 374 Douglas County 219,172 Ruth Fischhaber, RN, BSN, MA Estimated Total Population 1,128,480 Adams County Brenda Gallagher* Arapahoe County Kaia Gallagher, PhD Arapahoe County Office Locations and Services Available Kim Gordon, RPh, MSHA Administration 7000 E. Belleview Avenue, #301, Greenwood Village, CO 80111 (303) 220-9200 B D E EP N O TP Arapahoe County Aurora 15400 East 14th Place, #309, Aurora, CO 80011 (303) 341-9370 C E F H I M N P S T W Jim Miers, JD, MAS(EPM) Arapahoe County Brighton 1295 East Bridge Street, #102, Brighton, CO 80601 (303) 659-2335 NW Judy Robinson, PhD, RN Castle Rock 101 Third Street, Castle Rock, CO 80104 (303) 663-7650 E FHIM NTW Douglas County Commerce City 4201 East 72nd Avenue, Commerce City, CO 80022 (303) 288-6816 E EP N O R W Nick Robinson, BA Douglas County Englewood 4857 South Broadway, Englewood, CO 80110 (303) 761-1340 CE FHIMNPST W Lois Tochtrop, RN, BSN Havana 10330 East Colfax Avenue, Aurora, CO 80010 (303) 361-6010 N W Adams County Iliff 15559 East Iliff Avenue, Aurora, CO 80013 (303) 745-5858 NW *Retired 2004 ** Retired 2005 Lone Tree 9350 Heritage Hills Circle, Lone Tree, CO 80124 (303) 784-7866 IT Annual Report: Northglenn 10190 Bannock Street, Suite 100, Northglenn, CO 80260 (303) 452-9547 CFHIMNPTW Written and produced by Gary Sky, Public Information Pecos 7290 Samuel Drive, Suite 130, Denver, CO 80221 (303) 426-5232 NW Officer. B Birth and Death Certificates C Cancer Screenings for Women D Disease Control/Epidemiology Multiple copies of this E Environmental Health EP Emergency Preparedness F Family Planning/Women’s Health H HCP Health Care annual report are available Program for Children with Special Needs I Immunizations M Medicaid Outreach N Nutrition Services free of charge. Call 303-846-6245. O Occupational Health/Industrial Hygiene P Prenatal Case Management R Rocky Mountain Arsenal S Senior Dental T Travel Clinic TP Tobacco Prevention W WIC Nutrition Office www.tchd.org ©2005 Tri-County Health Department Printed on recycled paper. Tri-County services are provided without regard to race, color, gender, sexual orientation, age, religion, national origin or disability. Information sources: ABC News, American Medical Student Association, Centers for Disease Control and Prevention, CNN, Colorado Department of Public Health and Environment, The Denver Post, US Department of Health and Human Services, Healthy People 2010, Journal of the American Medical Association, New Dictionary of Cultural Literacy, Rocky Mountain News, Doug Shenson, MD, TIME Magazine, USDA, The Wall Street Journal and World Health Organization. Photos: Centers for Disease Control and Prevention, Comstock, Tri-County Health Department and World Health Organization. All rights reserved, used with permission. Prices quoted are estimates based on standard units of measure by package, serving size, individual portion size or single use. Prices are from national and store brands as well as internet searches. Zero dollars is the cost to a consumer, not what it cost an agency to produce the goods or services listed.