ASTHO Phase II Tracking Fellowship Program Cincinnati Health Department Environmental Public Health Tracking ASTHO Phase II Fellowship Report Submitted by Denisha G. Porter Public Health Educator/Creating Healthy Communities Program Director 3101 Burnet Ave. Cincinnati, Ohio 45229 Submitted to Association of State and Territorial Health Officials Environmental Public Health Tracking: State to State Peer Fellowship Program 2231 Crystal Drive, Suite 450 Arlington, VA 22202 Draft 3/19/2013 I. Introduction and Background The Cincinnati Health Department (CHD) is an organization dedicated to improving the health of the Cincinnati community and is responsible for the promotion, protection, and maintenance of public health in the City of Cincinnati. Environmental health, public health and clinical care services are integrated in the Cincinnati Health Department, employing methods that include surveillance, assessment, disease prevention, health education and assuring access to public health services. The CHD is governed by a nine member Board appointed by the Mayor and meets on a monthly basis; day to day functions are under the leadership of the Health Commissioner, who has expressed strong support for submission the grant application. II. Proposed Tracking Activities Small Project: Overview The Centers for Disease Control and Prevention National Environmental Public Health Tracking Program was established in 2003. The goal of the tracking program is to collect environmental, human exposure and health data such as asthma, air pollution, and childhood lead poisoning for the purposes of integration, analysis, interpretation, and dissemination. Participating sites include California, Colorado, Connecticut, Florida, Maine, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey, New Mexico, New York, New York City, Oregon, Pennsylvania, South Carolina, Utah, Washington, and Wisconsin. Although, Cincinnati, Ohio was not funded in the last round we were very thrilled to be selected as an Association of State and Territorial Health Officials (ASTHO) fellow. As an ASTHO fellow, the Cincinnati Health Department completed a pilot project by developing a data portal that displays vital statistics data. Summary and Specific Aims In Phase I of the ASTHO Fellowship, the purpose of the CHD pilot project was to encourage data sharing between the CHD Vital Records Department, City of Cincinnati Information Technology Centers, and the Ohio Department of Health by working with internal programs as well as external database managers to reformat the data for presentation through the NEPHT portals. In Phase II of the Fellowship we continued these efforts and expanded the portal by adding additional data sets. Special emphasis will be placed on developing the IT infrastructure, the design/look for the portal front page, orienting and training advisory committee members, and forging strong relationships with state and local agencies. Benefits and significance to his or her state and EPHTN The long term goal of the project is to compare maternal, child health, vital statistics and chronic disease data between neighborhoods or neighborhood groupings, and identify patterns ascribed to infant mortality, cancer, asthma and other chronic diseases. This project may form the basis for linking geographic data on exposures to environmental hazards to maternal, child health, and chronic disease data and for encouraging data sharing among data stewards by working with internal programs as well as external database managers to reformat 2 Draft 3/19/2013 the data for presentation through the NEPHT portals. The project aims to ensure equity in health service delivery and equitable protection of the Cincinnati population. Research design and Methods The pilot tracking project activities in Phase I of the Fellowship which was completed included: 1. Evaluating the CHD database 2. Assessing Data Building, Sharing and Confidentiality 3. Researching Legal Aspects including Statutes and/or Rules 4. Analyzing Compatibility of Data with the National Environmental Public Health Tracking website In addition to completing the tracking activities of Phase I, members of the EPHT committee visited the host site in New York City and attended the National Environmental Public Health Tracking Conference in New York City. The Committee developed the following next steps for the Phase II of the Fellowship: 1. Enrich current portal by adding birth defects and explore adding population data and mortality data sets. 2. Create an implementation plan including consultant needs and developing and implementing a technical advisory committee (TAG) orientation program. 3. Members of the EPHT committee will revisit New York City, our previous ASTHO fellowship mentor city, and propose that the Mayor of Cincinnati also visit New York City to be educated on EPHT as well to show the power of a well developed tracking system. 4. The CHD EPHT Committee will also communicate with and visit with the Ohio Health Department. 5. We will investigate additional partnerships with the University of Cincinnati’s Institute for Policy Research, the Health Foundation of Greater Cincinnati, the US Environmental Protection Agency, The Ohio Public Health Informatics Committee (TOPHIC), and the Cincinnati Health Department’s Emergency Preparedness Program. Key Personnel The Environmental Public Health Tracking Committee consists of the following: Dr. Camille Jones, MD, MPH, Cincinnati Health Department, Assistant Health Commissioner Tunu Kinebrew, MPA, Cincinnati Health Department, Vital Statistics Coordinator Sean Ware, Enterprise Technology Solutions, Computer Systems Analyst LiAnne Howard, MCP, MEd, Cincinnati Health Department, Senior Administrative Specialist - Community Planning and Evaluation Denisha Porter, MPH, HHS, RS, Cincinnati Health Department, Public Health Educator/Creating Healthy Communities Program Director 3 Draft 3/19/2013 III. Statement of Need According to 2010 census data Cincinnati’s population was 296,943 people, occupying over 77.2 square miles. Cincinnati’s median household income was $33,855 compared to $47,144 statewide. Poverty still plagues a large portion of Cincinnati’s population. In 2005-2009 25.3% of people of all ages were living below the poverty line compared to 13.6% statewide. In 2008, the American Community Survey ranked Cincinnati the seventh poorest city out of 75 cities surveyed with 25.1% of the residents living in poverty. Some of the adverse health impacts of living in poverty include: increased likelihood of living in a geographic area that is exposed to environmental toxins, as well as poor nutrition, inadequate access to preventive health and pre-natal care, housing that is infested with rodents and insects, housing without smoke detectors, and housing with lead hazards. Cincinnati has one of the lowest home ownership rates of comparably sized cities in the country with a rate of 34%. The housing stock is old with 93% of the housing built prior to 1980. Lead hazards from lead-based paint can be presumed to be present in the majority of the housing units. Based solely on the age of the housing, 37,972 occupied rental units and 39,090 owner-occupied dwelling units have a high potential for lead based paint hazards. The City of Cincinnati’s infant mortality rate (IMR) at 15.5 deaths per 1000 live births in 2009, is as high as some developing nations. The IMR is widely thought to reflect the overall health of a community as an indicator of a lack of education, poor hygiene, poor nutrition, lack of access to healthcare and other underlying health and social issues. Table 1 – Infant 2002 2003 2004 2005 2006 2007 2008 2009 2010 Mortality Rate Cincinnati Health * * * * 5.6 7.1 Department 18.6 6.4 13.8 City of Cincinnati * 11.0 16.7 17.9 11.3 13.5 13.6 15.5d 12.6 Hamilton County, * * 9.8 9.6 11.0 13.9 9.7 10.9 11.1 Ohio * * Ohio 7.9 7.8 7.7 8.3 7.8 7.7 7.7 * * U.S. 7.0 6.8 6.8 6.8 7.0 6.8 * In 2008, Cincinnati was ranked by the American Lung Association as the 8th most polluted city in the United States for Year-Round Particle Pollution. This coincides with resident perceptions that Cincinnati has poor air quality which results in a high prevalence of asthma. Results from the 2010 Greater Cincinnati Community Health Status Survey (GCCHSS) show that the average adult in Greater Cincinnati experienced 7.7 days – over one week – of poor mental or physical health per month. This is compared to just under a week (6.2 days) nationally. Both the national and regional rates have stayed relatively consistent since 2005. About 6 in 10 Greater Cincinnati adults report having been told by a doctor or other health care provider that they have a chronic condition such as high blood pressure, high cholesterol, depression, severe allergies, asthma or another condition. Although rates of many 4 Draft 3/19/2013 chronic conditions have stayed relatively consistent since 1999, the percent of Greater Cincinnati adults who have been told they have high blood pressure or hypertension, high cholesterol or triglycerides, and depression increased. High blood pressure rose from 25% to 34%; high cholesterol rose from 20% to 28%; and depression rose from 15% to 21%. Recent analyses done by the CHD in conjunction with Xavier University show that Cincinnati residents have higher mortality rates than Hamilton County as a whole, than all large metropolitan areas in Ohio as a whole, and than the average mortality rates for the US. Mortality rates are higher in Cincinnati consistently across