2013 Community Health Improvement Process and Plan (CHIPP)

Meeting minutes March 19, 2013

Present: April Konitzer, Bernie Faith, Dave Bertrand, Joey Sieber, Lynn Stymiest, Rhonda Stuart, Carol Kopp, David Honish, Rose O’Hara, Elaine Kluth, Laura Cormier, Sara Applebee, Carol Luebeck, Debra Konitzer, Kim Wolfmeyer, Dr. Keith Elkins, Julie Yonker, Jane Schneider, Irene Drake, Mary Lemmen, Jan Stranz, Ali Carlson

1. Welcome/ Introductions/ Lunch

2. Follow-up from March 5th meeting: Sara briefly presented data on prescription drug use in grades 9-12, and provided the formula for measuring Body Mass Index. Childhood Obesity topic will be covered in another meeting.

3. Sara Applebee: Data Presentation/Discussion

Health Focus Area—Environmental and Occupational Health

Human health is affected in countless ways by the physical environments where we live, work, learn and play. We take the quality of air, soil, water and food for granted, but numerous hazards could be present that can cause both temporary and permanent health issues, and death. Radon and lead are examples of natural environmental hazards that are currently being addressed. Increasing attention is being paid to the “built environment” also, which may determine access to physical activity and food resources in a community.

In Wisconsin, local health departments have a shared but limited role in the area of environmental and occupational health. State and federal agencies such as the DNR, EPA, OSHA and US Dept of Ag and Trade have a larger scope of responsibility in setting and enforcing regulations.

Data being presented today will be about environmental factors that can be impacted by local communities.

Radon is a naturally-occurring, odorless radioactive gas that causes lung cancer. It is the #1 cause of lung cancer in NON –smokers and causes thousands of preventable lung cancer deaths every year. In Wisconsin, radon comes from the breakdown of Uranium in rock and soil beneath houses, and is at unacceptable levels in about 5-10% of WI homes. Radon levels vary from one home to another and the only way to know your Radon level is to test. The data collected is from Oconto County testing results.

Lymes Disease is an illness caused by bacteria transmitted by deer ticks. It is the highest reported tick borne disease in Wisconsin, with more than 23,000 cases reported between 1980 and 2010 (DHS). In 2011, 96% of Lyme disease cases were reported from 13 states, including WI. (CDC) Left untreated, infection can spread to joints, the heart, and the nervous system. Efforts thus far have focused on Lymes awareness, prevention, prompt diagnosis and treatment, as well as reducing tick habitat.

From current data which compares our confirmed Lymes cases with that in neighboring counties, it appears that we have significantly fewer cases. It is unclear whether or not we may have more undiagnosed cases.

Clean Drinking Water has been one of the success stories of public health. 29% of WI residents drink water from private wells. However, 72% (almost ¾) of Oconto Co. residents drink well water. Unlike public water systems, protection and maintenance of a private well is largely the responsibility of homeowners. Wells should be tested annually, after flooding, and if changes in taste, odor or appearance of the water occur.

All drinking water, including bottled water, can reasonably be expected to contain at least small amounts of some contaminants, both natural and manmade. The presence of contaminants does not indicate that drinking the water poses adverse health effects. In Oconto Co. municipalities that provide a public water supply, testing is conducted at least annually, and Consumer Confidence Reports indicate NO contaminants found above EPA safe levels.

Municipalities providing public water supply: Oconto, Oconto Falls, Gillett, Suring, Lena, and Pulaski.

Lead poisoning in our children can cause problems with learning, growth, and behavior. Many homes and buildings in Oconto County built before 1978 have lead paint on interior/exterior walls, woodwork, windows and floors. Even small amounts of lead can be harmful. The lead dust makes its way into the body through normal hand -to -mouth activities of young children. As of October 2012, the Oconto County WIC program has been testing children’s lead levels.

Health Focus Area: Injury and Violence Prevention

Injuries are the leading cause of death in Wisconsin residents ages 1-44. The majority of these deaths are preventable.

MVC (motor vehicle crash) occupant deaths are all unintentional. Majority of falls deaths are unintentional. About 2/3 of firearms and suffocation deaths are self-inflicted. 1/3 of firearms are homicide, other 1/3 of suffocation are unintentional. (in bed caused by bedding, pillow or mother’s body; choking or the respiratory tract being blocked somehow) About half of the poisonings are unintentional and the other half self-inflicted During the years 2002-2011, the Oconto County rate of deaths in MVC per 100,000 population (compared to surrounding counties) was significantly higher in the 25-34 age group, while surrounding counties are significantly higher in the 65-74 age group. A large majority of fall-related deaths (87%) and inpatient hospitalizations (70%) involve people age 65 or older. Hospitalizations and emergency department visits (all ages) due to falls result in $800 million in hospital charges each year in Wisconsin. The average charge per injury-related inpatient hospitalization in Oconto County during 2007-09 was $26,307.48.

The Oconto County Injury hospitalization rate is lower than the NE region and Wisconsin overall in the areas of falls, poisoning and cutting/piercing. The majority of poisonings are accidental, from improper use of analgesics, antipyretics, and antirheumatics, specifically other opiates and related narcotics such as Codeine, Meperidine (Demerol), Morphine, Opium. Cutting/piercing injuries are from objects such as arrows or darts.

4. Laura Cormier led discussion on the “master” Oconto County Resource List, from what has been compiled thus far. Clarification on some items obtained. 5. Sara Applebee: Data Presentation/Discussion continued

Reproductive and Sexual Health

High risk sexual behavior is behavior that increases one’s susceptibility to infectious diseases, such as sexually transmitted diseases, HIV/AIDS, and/or results in unplanned pregnancies. It can have a significant impact on infant mortality rates. Many of these behaviors are deeply rooted cultural norms.

During the years 2003-2010, between 27-38 births have been to women 15-19 years old. Around 2% of all Oconto County births are to mothers between 15-17 years old and 6% to mothers between 18-19 years old. Births to teens can result in increased risk for poorer outcomes and social/economic issues.

It appears that Oconto Co. has a much lower rate of sexually transmitted diseases than the state overall. However, there are differences in access to care in rural areas vs. urban areas, and also the fact that some of these infections have no symptoms, so may continue to spread while going undetected/untreated/unreported. In general, sexually transmitted infections can result in infertility, increased likelihood for HIV transmission and compromised ability to have healthy babies.

Having multiple partners is considered a high-risk sexual behavior, as it increases the risk for acquiring sexually transmitted diseases.

Tobacco Use and Exposure Tobacco use and exposure is defined as: the active or passive introduction of toxins found in tobacco products into the human body. Out of all modifiable risk factors, tobacco use and exposure is linked to more health conditions and more health care costs than any other. It is the single most preventable cause of disease and death in Wisconsin and the U.S. Tobacco use and exposure is a complex issue involving social and cultural influences, physiological addiction, and the marketing/promotion of tobacco products. The smoke free air law in Wisconsin workplaces has helped to prevent exposure to second-hand smoke, but is only one facet of the challenge to this health focus area.

Oconto Co. does stand out as having the lowest % of adult smokers when compared to surrounding counties, but 17% is still too high. Research has demonstrated a relationship between youth tobacco use and access to tobacco products. Counties with 10% or lower illegal tobacco sales are more likely to have an impact on reduced tobacco use and addiction by WI youth. Oconto was showing a steady and dramatic decline in illegal tobacco sales until the funding was discontinued for Oconto Co. to monitor the illegal sales. Over the past 9 years an average of 21% or more than 1 in 5 Oconto Co. women smoked during pregnancy, while the average is 13% for WI women overall. The state percentage appears to be trending down, while Oconto Co. is not. An even greater percentage of pregnant WIC participants smoke during their pregnancies than in the general population.

6. Areas of concern voiced by members included; motor vehicle & ATV crashes, pregnant women smoking, and current economic situation & culture of poverty,

7. Debra Konitzer concluded the meeting. In preparation for April 2nd meeting, members are requested to continue entering known resources into the emailed grids, in relation to the 4 Health Focus Areas presented today (Environmental/Occupational Health, Injury/Violence Prevention, Reproductive/Sexual Health, and Tobacco Use/Exposure). Any questions can be directed to Laura Cormier, Nancy Williquette, Debra Konitzer, or Sara Applebee.

8. Next Meeting: Tuesday, April 2, 2013 at Bellin Health Oconto Hospital from 12noon—1:30 p.m. Lunch will be provided. Please bring any remaining public opinion surveys you may have.