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STRATEGIC_PLANNING_FOR_THE_VANDERBURGH_COUNTY_HEALTH_DEPARTMENT

  1. 1. STRATEGIC PLANNING FOR THE VANDERBURGH COUNTYHEAL Decision Making in Health Care Emily Kays Todd Duckworth Abeer Alfarat Nicolette Fonseca Christina Miller Spring 2015
  2. 2. Table of Contents I. Executive Summary ..........................................................................................1 II. Background ......................................................................................................3 III. Mission, Vision, Values ..................................................................................7 IV. Organizational Structure ...............................................................................9 V. Ten Essential Services....................................................................................11 VI. SWOT Analysis.............................................................................................13 VII. Adult Smoking.............................................................................................16 VIII. Obesity and Diabetes .................................................................................18 IX. Sexually Transmitted Diseases and HIV/AIDS...........................................25 X. Methamphetamines and Other Drugs ..........................................................40 XI. Lead Poisoning..............................................................................................44 XII. Recommendations .......................................................................................47
  3. 3. 1 | P a g e I. Executive Summary The Vanderburgh County Health Department exists to serve the clients and community. The VCHD shall work with the community partners to: develop and provide quality health care services; promote healthy lifestyles; protect against and prevent the spread of disease; and, assure preparedness to achieve and maintain the best public health for the community. The Vanderburgh County Health Department appointed its first board, which consisted of seven members, in 1948 and that remains the same today. Each member serves a four-year term and is responsible for health promotion, disease prevention, and public protection. The health department has eight divisions that include: Health Promotion; Communicable Disease; Laboratory; Vital Records; WIC Clinic; Environmental; Nursing Programs. The VCHD serves 180, 858 individuals with 85% of the population being Non-Hispanic White. Most organizations either have a centralized or decentralized structure. A centralized organization relies on one person to make most of the major business decisions, whereas a decentralized organization typically has multiple individuals who make business decisions for the organization. The Vanderburgh County Health Department has a combination of both. At the executive level of the organization, the VCHD follows a decentralized method with multiple individuals making business decisions for the organization. Further down the organization chart, a more centralized structure is utilized. There is a single director over each division and a line of employees who report to the appropriate director. The 2014 County Health Rankings report, which ranks counties according to their summary measures of health outcomes and health factors, ranked Vanderburgh County 51st out of 92 for summary health factors and 73rd out of 92 for summary health outcomes. Health factor rankings are based on weighted scores in four categories, which include environmental,
  4. 4. 2 | P a g e behavioral, social and economic, and clinical. Health outcomes are measures that describe the current health status of a county. Of the Ten Essential Public Health Services, the VCHD needs improvement in three areas, which are: monitoring health status to identify the community health problems; informing, educating, and empowering people about health issues; and, evaluating effectiveness, accessibility, and quality of personal and population-based health services. Some of the Vanderburgh County Health Department's strengths include implementation of electronic health records, information technology, the personality (staff) of the organization, and internal communications. Some of their weaknesses include limited digital media utilization, budget, no external evaluation (benchmarking) of other organizations, and personality (management) of the organization. Some opportunities for the VCHD include the use of social media, improvement of departmental goals, and social opportunities. Some threats that the VCHD face include politics, the environment, economics, and the five strategic issues. Five strategic issues were identified after analyzing the 2013 VCHD annual report. Meth and other drugs, adult smoking, lead poisoning, sexually transmitted diseases, and obesity and diabetes are major issues in the community that the VCHD needs to better address. Attention to these particular issues is limited due to budget, lack of educational programs, and lifestyle habits. Adding more long-term educational programs in schools, creating new targeted programs, and more funding can help address the challenges associated with the strategic issues. The VCHD would also benefit by hiring a Digital Media Coordinator and a Public Relations Specialist.
  5. 5. 3 | P a g e II. Background According to Indiana Code 16-20-2-2, the executive of each county shall by ordinance establish and maintain a local health department. Indiana Code 16-20-2-3 states a local board of health shall manage each local health department established. The Vanderburgh County Board of Health was appointed in 1948. Today, the Vanderburgh County Board of Health is comprised of seven (7) members; all of which have been appointed for terms of four years. Members of the Vanderburgh County Board of Health include: Catherine Engel (Chair); Mark Wohlford, DDS, PhD (Vice-Chair); Michelle Galen, MD; Timothy J. Hubert; Fred Mulfinger; John D. Pulcini, MD; and Maria Del Rio, MD. The Vanderburgh County Board of Health is in charge of addressing health promotion, disease prevention, and public protection. In order to ensure Vanderburgh's county community health, the Board of Health provides essential guidance to the Health Department's eight divisions. Each branch executes an area or function within public health. Division areas include: Vital Records (Birth/Death Certificates); Food Safety and Protection; Immunizations; Environmental Health Services; Public Health Nursing; WIC (Women, Infants, and Children) Program; Lead Poisoning Protection; Pandemic Influenza; HIV/AIDS and STD Intervention. The Vanderburgh County Health Department serves 180,858 individuals; 85% of which is Non- Hispanic White. A detailed look at the 2014 Vanderburgh County demographics is listed below.
  6. 6. 4 | P a g e 2014 Demographics Vanderburgh County Indiana Population 180,858 6,537,334 % Below 18 Years Of Age 22% 24% % 65 And Older 15% 14% % Non-Hispanic African American 9% 9% % American Indian And Alaskan Native 0% 0% % Asian 1% 2% % Native Hawaiian/Other Pacific Islander 0% 0% % Hispanic 2% 6% % Non-Hispanic White 85% 81% % Not Proficient In English 1% 2% % Females 52% 51% % Rural 9% 28% Source: Vanderburgh (VA) County Demographics http://www.countyhealthrankings.org/app/indiana/2014/rankings/vanderburgh/county/outcomes/overall/additional The 2014 County Health Rankings report ranks Indiana counties according to their summary measures of health outcomes and health factors. The structure of the County Health Rankings Model is provided below. In this model, health outcomes are measures that describe the current health status of a county. In order to improve health outcomes, a county must address all health factors with effective, evidence‐informed policies and programs. The summary health outcome rankings are based on an equal weight of mortality and morbidity measures. The summary health factor rankings are based on weighted scores of four types of factors: behavioral, clinical, social and economic, and environmental. The weights for each health factor (shown below) are based on a review of the literature by the County Health Rankings & Roadmaps program and expert input.
  7. 7. 5 | P a g e County Health Rankings Model For the 2014 County Health Rankings, Vanderburgh County ranked 51st out of 92 counties for summary health factors and received the ranking of 73rd for summary health outcomes. The table below compares the 2014 Vanderburgh County data to the Indiana State average.
  8. 8. 6 | P a g e 2014 County Comparison in Indiana Source: Vanderburgh County Comparison, County Health Rankings http://www.countyhealthrankings.org/app/indiana/2014/compare/snapshot?counties=163 Indiana Vanderburgh (VA) Health Outcomes 73 Length of Life 57 Premature death 7,520 8,010 Quality of Life 82 Poor or fair health 16% 20% Poor physical health days 3.6 4.7 Poor mental health days 3.7 4.2 Low birth weight 8.3% 9.2% Health Factors 51 Health Behaviors 63 Adult smoking 23% 25% Adult obesity 31% 32% Food environment index 7.5 7.7 Physical inactivity 28% 29% Access to exercise opportunities 64% 79% Excessive drinking 16% 15% Alcohol-impaired driving deaths 26% 26% Sexually transmitted infections 427 510 Teen births 40 42 Clinical Care 11 Uninsured 17% 15% Primary care physicians 1,539:1 1,048:1 Dentists 2,015:1 1,546:1 Mental health providers 890:1 690:1 Preventable hospital stays 76 79 Diabetic screening 84% 85% Mammography screening 61% 66% Social & Economic Factors 54 High school graduation 87% 82% Some college 60% 66% Unemployment 8.4% 7.6% Children in poverty 22% 21% Inadequate social support 20% 22% Children in single-parent households 33% 40% Violent crime 329 328 Injury deaths 61 74 Physical Environment 85 Air pollution - particulate matter 13.5 14.2 Drinking water violations 2% 0% Severe housing problems 14% 16% Driving alone to work 83% 83% Long commute - driving alone 30% 15%
  9. 9. 7 | P a g e III. Mission, Vision, Values A. Vision Statement The annual report misses the vision statement section, which is the initial step in strategic planning. However, it is merged and addressed implicitly in the mission statement. Having a clear vision facilitates the communication between the health department's participants and motivates them to work efficiently and productively through realizing the associated benefits with the future picture of the organization. B. Mission Statement Although it is mixed with the vision statement, it is clear, concise, realistic, and an action-oriented plan. Identifying the purpose (maintain the public health), the target population (community), and the process of achieving the goal (work with community partners) creates an appropriate tool, allows for better internal and external communication. Targeting the public population requires the concept of education to be included in the mission statement. C. Communicable Disease Division The mission is clear, realistic and emphasizes federal, state, and local collaborations to prevent transmission of communicable diseases in the community. The inclusion of patient education in the mission statement would strengthen its integrity. Patient awareness positively influences disease prevention, protection, and treatment. The division's goals are attainable and resemble the identified needs (prevent communicable diseases due to their high rates). The goals are related directly to the mission and range from the short-term to long-term. Nevertheless, involving plans for the arising issues in infectious diseases such as Ebola, contributes to preventing and protecting against the communicable diseases and could be
  10. 10. 8 | P a g e included to ensure the public safety. The responsibilities and the services provided support the mission and its goals. Because the number of STD cases is increasing continuously, more preventative services and protective programs need to be established. Therefore, the specialty clinic goal needs to be revised to accomplish the primary goal (preventing communicable diseases' transmission). The goal of TB's program states much information instead of focusing on a clear goal that contains an actionable plan. In addition, it mentions the CDC goal rather than the organization's purpose. D. Environmental Health Division The division's goals are integrated with the general mission. Most goals follow a SMART goal approach and focus on a measurable scope of practice. Since the division has different areas to operate, its mission supports each goal. E. Health Promotion Division & Laboratory Division The goals are well written, which correspond with the mission, based on the target population’s needs through educational programs. F. Nursing Division The mission statement is broad in that it includes all the individuals in the community. However, the goals are more specific to the WIC group. Thus, to get a powerful mission, its goals should match the same target (community). G. Vital Record Division The goal relates indirectly to the mission even though it assists the work-flow process through saving time, cost, and efforts.
  11. 11. 9 | P a g e IV. Organizational Structure There are two different types of organizational structure. One is centralized, and the other is decentralized. Each structure offers its advantages and disadvantages given the type of business and the work it does. A centralized organizational structure relies on a single individual for most decisions made by that company. Organizations with this type of structure are seen to be extremely efficient in business decision making because it is typically a single person making all executive decisions leading to quicker outcomes. However, since there is what seems to be a single decision maker for most operations, it may take longer to accomplish tasks because of an overwhelming amount of info being delivered to a single person. A decentralized organization differs from the centralized because there are typically several individuals in charge of making business decisions for the company. It is more of a team environment at multiple levels throughout the business. Positives for this type of structure is that it is possible to have individuals with different areas of expertise running different departments as well as bringing different perspectives to decision-making. However, individuals having different opinions on certain business decisions can bring conflict when opinions about what is better for the company clashes. It is here where trying to get the entire team on the same page could bring a disadvantage. The organizational structure for the Vanderburgh County Health Department looks like a combination of both centralized and decentralized structure. At the executive structure level of the department, there are multiple individuals making key decisions for the department. However, the rest of the organizational chart structure takes after a centralized pattern. There is
  12. 12. 10 | P a g e a single director for each department and a line of employees that report to that individual. This allows the department to have a team environment on key business decisions as well as bringing adverse ideas to the table. The centralized structure for the rest of the health department works well because once an executive decision is made, those individual departments have the opportunity to work swiftly to obtain desirable outcomes. In order to achieve maximum workforce activity output and community outreach, a digital media coordinator and a public relations specialist shall be added to the organizational structure of the Vanderburgh County Health Department. A Public Health Administrator is a fairly well-paying job. The median annual salary within the United States is just under $61,000. A questionnaire showed that a majority of positions for the job title are women and that they are very satisfied with their position. It comes with excellent benefits along with good pay. The Public Health Administrator's job requires them to do almost everything a healthcare administrator would be asked of: promote, develop, and supervise. They must support and maintain a healthier community by assisting in any means necessary while also developing plans and policies to imperative to achieving certain goals to obtain that. Then they must also supervise and help lead staff in any direction necessary as well as lead by example.
  13. 13. 11 | P a g e V. Ten Essential Services The ten essentials of Public Health help determine what is to be addressed in any type of Public Health report. In this case, the report being analyzed is the 2013 Vanderburgh Annual Report. There are a few places in the report that need improvement. The table below analyzes what is needed or what is not needed in each section and the reasons for the needed improvement. Ten Essential Public Health Service Yes or No Needs Improvement, Yes, No Reasons for needing improvement Monitor Health status to identify the community health problems NI This section is mostly complete with the exception of the periodic health assessments. Most of the health assessments were only done on an as needed basis. Health assessments done on an as needed basis can result in problems that go unnoticed in the community by the Health Department. The majority of health issues are not reported until the issue is to the point where it is out of control and a lot of time and money is spent on the issue. Data Collection Y Disease Reporting Y Conduct periodic health assessments N Diagnose and investigate health problems and health hazards in the community Y Routine outbreak investigations Y Take lead in emergencies that are public health in nature Y Alleviate health problems and adverse health events Y Inform, educate and empower people about health issues NI When reviewing this section, there was little or no media strategies that were used to help inform people of issues. If there were any media strategies implemented there was no evidence to support them. Develop and implement media strategies N Provide health information to individuals for behavior change Y Health promotion programs for behavior change Y Mobilize community partnerships to identify and solve health problems YCommunity planning Y Advocating for resources to implement priorities Y
  14. 14. 12 | P a g e Ten Essential Public Health Service Yes or No Needs Improvement, Yes, No Reasons for needing improvement Develop policies and plans that support individual and community health efforts Y Policy Advocacy Y Enforce laws and regulations that protect and ensure safety Y Review and update public health authority Y Community - oriented program learning Y Individual - focused linkages to needed care Y Link people to needed personal health services and assure the provision of health care when otherwise unavailable Y Community - oriented program learning Y Individual - focused linkages to needed care Y Assure a competent public health and personal healthcare workforce YDeveloping future workforce Y Overall human resources function/capacity Y Evaluate effectiveness, accessibility, and quality of personal and population - based health services NI Throughout the annual report, there were local health department programs that were evaluated, however, external evaluation of other programs were never mentioned. Evaluate local health department programs Y External evaluation of other's programs N Research for new insights and innovative solutions to health problems YParticipate in research activities Y Disseminate research findings Y Apply research results in local health department activities Y KEY Yes (Y): all information is found and is being addressed in the 2013 annual report the community No (N): information was not stated or not found in the 2013 annual report Needs Improvement (NI): some information was found in the 2013 annual report but not all in designated section.
  15. 15. 13 | P a g e VI. SWOT Analysis Strengths ·Implementation of Electronic Health Records ·Each department has a goal in line with the organization’s mission ·Programs available to the community ·Personality of the organization- Staff ·Information Technology ·Internal Communications Opportunities ·Use of social media and website in all departments (Technological) ·Improve effectiveness of departmental goals by creating SMART goals ·Room for more educational programs/ promotion ·Economic ·Social ·Scientific Weaknesses ·Low overall county ranking ·Limited utilization of website and social media (digital media) amongst departments ·No external evaluation of other programs (no benchmarking) ·No periodic health assessments ·Personality of the organization- Management ·Budget Threats ·Number of meth labs/usage ·STDs (especially gonorrhea and chlamydia) ·Adult smoking ·Obesity and diabetes ·Lead poisoning in children ·Severe housing problems ·Political ·Economic ·Environmental A. Strengths It is important that each department’s goals align with the organization’s mission statement to ensure that the organization is in agreement with its core purpose. The Vanderburgh County Health Department (VCHD) also has a number of programs available to the community such as Homeless Connect, NACo Prescription Drug Discount Card, and various counseling services. Community programs are essential to have in order to build a strong relationship
  16. 16. 14 | P a g e between the health department and the community. Based off of a staff survey, the employees see its strengths of the organization as the personality of the organization (staff), its information technology, and its internal communications. These aspects are vital to sustaining an active work environment that allows employees to perform to the best of their abilities. B. Weaknesses One of the biggest weaknesses facing the VCHD is the low overall county ranking compared to other counties in Indiana. While the actual number is out of the VCHD's control, how they combat those issues that contributed to a low county ranking is in their control. Based off of the 2013 annual report, there was no evidence to indicate that the VCHD externally evaluates (or benchmarks) other health departments to see how they compare to them. This could provide the VCHD with more insight and what may strategically work better for them. Another weakness is the lack of periodic health assessments of the community. Health assessments were done on as need basis by the patient. If periodic health assessments were offered on a regular basis, such as quarterly wellness exams, they could help provided better treatment, promotion, and education for the community, which could allow for better prevention of certain medical conditions. The final two weaknesses come from the staff survey. They are the budget and the personality of the organization (management). The budget plays a big role in what programs and educational tools are offered to the community to promote better health. If the budget is not sufficient or distributed inadequately, this can lead to disconnects between funding for programs offered and areas that receive too many budgetary dollars. Finally, if staff members perceive that their leadership is not strong, they will not be motivated to do their best job in fulfilling the mission of the organization.
  17. 17. 15 | P a g e C. Opportunities There are three significant opportunities for the VCHD. One of them is the use of social media and the website (technological opportunities) in all of the departments, not just a couple of them. Our society is becoming more and more engaged with social media and the Internet, so this would be a great way to communicate externally, promote programs offered by the VCHD, and to educate the community. Another opportunity is offering more educational programs and doing more promotion of those programs for particular issues that are prominent in the community such as obesity, diabetes, adult smoking, meth labs, and adult smoking. A third opportunity is improving the effectiveness of the departments by creating SMART (specific, measurable, achievable, realistic and relevant, time-bound) goals. The VCHD employee survey identified three areas of perceived opportunities, which are: economic, social, and scientific. D. Threats Based off of the 2013 Annual Report, we identified five major problems that are affecting the community. Those problems, which are meth labs/usage, STDs (especially chlamydia and gonorrhea), adult smoking, obesity and diabetes, severe housing problems and lead poisoning in children due to a majority of houses being built before 1950. These issues contribute to a poor overall county health ranking and may create a poor image for the VCHD. Due to the staff survey, political, environmental, and economic factors are perceived as threats.
  18. 18. 16 | P a g e VII. Adult Smoking Strategic Issue: How can the Vanderburgh County Health Department reduce or maintain the rate of adult smoking? It appears that the major challenge for creating a smoke-free environment in Vanderburgh County is the casino, Tropicana Evansville. The city of Evansville explicitly tried to implement a city-wide smoking ban, which in turn, was overruled by the State Supreme Court. It was deemed unconstitutional and unfair to ban smoking in all private and public institutions except the casino. There is also fear of the loss of financial contribution to the city if smoking were completely banned in the casino. Tropicana is also a major attraction for Evansville, drawing in crowds from much of the Tristate area. Small, privately owned businesses also complained about fear of losing a majority of their business if smoking were banned. They complained to city and state officials that it was unfair to ban smoking in all private and public establishments except for the casino. They also spoke of how much it would affect their businesses negatively from a financial standpoint. It seems that options for overcoming challenges brought up by smoking in the city of Evansville is limited. It is limited because as long as the casino remains in Evansville and has a financially large impact then they will not pass a bill preventing smoking inside of it. Therefore, it would be more beneficial to refocus attention towards the younger population. By raising awareness and educating the youth even more than before, we can strike down smoking before it even begins. New staffing positions to travel to schools for informative sessions and teachings may be required. The Health Department still needs to continue with their offerings of smoking cessation classes to those who are in need. The department and city of Evansville could also try
  19. 19. 17 | P a g e and strike a deal with Tropicana with signs reminding their visitors on the harmful effects of tobacco use. The financial contributions of Tropicana might just be too much ever to enforce a citywide smoking ban. If this is true, then the most recommended action is to prevent and cut out smoking where it starts which is with the youth. Smoking cessation is possible with the right focus and attention towards specific age groups where smoking is most likely to begin. Most counties and states have a staff that goes into schools and warns students about the adverse effects of smoking. However, this special staff speaks to all grades every year to always remind students of the harmful habit. Most programs talk to a single class one time, and that is it. This specific group of staff will speak to students and revisit them every year. It is also imperative to get the parents involved and onboard with smoking prevention. We learn most of our beliefs, values, and morals from our parents at an early age. If the parents are on board, reminding their kids, and setting examples for the negative aspects of smoking then a difference can be made. If parents are already smokers, make sure they are offered smoking cessation classes and if still refused, encourage them to instill healthy habits of non-smoking in their children. This type of prevention method has far more long-term effects than short-term. Statistical data may not show immediate results, but positive outcomes lie within the long-term time frame.
  20. 20. 18 | P a g e VIII. Obesity and Diabetes Strategic Issue: How can the Vanderburgh County Health Department reduce or maintain the rate of obesity and Diabetes? The obesity rate in Vanderburgh County has consistently increased the previous three years and now estimated to 33.2%. Around (44,699) people is having equal or more than 30 in the BMI. Several behavioral, clinical, and socioeconomic factors participate in increasing the percentage. Physical inactivity and diet are two major behavioral factors that strongly associated with the obesity rate in Vanderburgh. Sedentary lifestyle in the county (29%) is exceeding the Indiana average rate (28%) that leads directly to increasing weight. Another crucial issue is the food environment including the availability of fast food restaurants in the area, healthy food consumption, and groceries continence. An approximate number of 145 restaurants are located in Vanderburgh County (236 sq) miles, which means that unhealthy choices are reachable every 1.6 miles. Moreover, healthy food consumption is fluctuated and insufficient. For instance, on the state level, there are 41.6% of the censuses consume less than one fruits daily, and there are 27.3% consume less than one vegetable daily. Both percentages are under the recommended healthy meals. Although there are 17.2 stores for 1000 residents in Vanderburgh, there is 19.80% of the community has low access to them due to socioeconomic factors. A 15.9% are under the poverty level, a 14.42% of the senior group has access difficulties due to aging, and 2.85% are facing transportation struggles.
  21. 21. 19 | P a g e Obesity correlates with the socio-economic status and educational level. The overweight rate among people under the poverty level is higher than others. The poverty level in the county is 15.90% that might participate in growing the obesity rate in the area. Furthermore, there is 11.2-13.5 % of the population has less than high school education, which is a fair percentage. However, it adds to the probability of increasing the obesity rate in the county. Obesity rate should be manageable to reduce the associated health care issues. It increases the incidence and the prevalence of the physical chronic condition including heart diseases, stroke, diabetes (12.7%), hypertension as well as psychological problems such as depression. Overall, it elevates the mortality and morbidity rate. Vanderburgh County adults exceed the national averages for those affected by type 2- diabetes. While the national average is 9.3%, the county average is 13.4% because several risk factors exist in the county. The first category is related to behavioral factors including high obesity rate, high physical inactivity rate, high fatty food (restaurant), and unhealthy diet. The second category is related to the low-income status of the residents that prevents them from having health care insurance. The uninsured rate in Vanderburgh is high (15%) resulting in inadequate access to health care. In addition, there is a correlation between diabetes rate and socioeconomic level. In Vanderburgh, the DM prevalence among high-income people is below 7% while it is 15% among the low-income people. A. Challenges and Options to Overcome Them The Vanderburgh County is facing several challenges in addressing obesity and DM to the public. Reaching health disparities is one of obstacle that decreases the overall public health status. According to the Agency for Healthcare Research and Quality, racial and ethnic minorities have a significantly lower percentage of receiving ongoing care. Achieving the
  22. 22. 20 | P a g e maximum healthcare for despaired racial and ethnic groups is difficult since it relates directly to socioeconomic factors such as lacking of housing, food insecurity, and transportation. Thus, implementing a medical-social program will continue to be hard since it needs huge funds and fairness. Another challenge is the lacking of coverage funds for the uninsured people that minimizes the care services among low-income people. With 15% (23,176) of uninsured citizens in the county, the chance of getting associated problems such as high rate of obesity and unmanaged DM is 5 to 6 percentage more than insured people. Several steps and actions could be initiated to improve the quality of care among disparities. The proper identification is the first step toward successful improvement in the public wellness. Risk evaluation programs are a useful tool that helps Vanderburgh County to have the essential information about the most people in need. Therefore, a comprehensive plan is developed not to cover all funds, but to manage their conditions or at least to direct them to the right organizations of seeking help. Some governmental, local, and charity assistance programs (such as Latino Community Liaison, two dental clinics) are available. Indiana Black Barbershop Health Initiative program is a good step that took place three years ago, but it needs to expansion and including of the other minorities in the community. Another step targets the public health funds. Comparing to the national average of public health for each person ($94), the State of Indiana is notably falling below ($39). Because the public health funding supports diabetic prevention program, increasing the public health funds will participate in diabetic services' elaboration. Integrating the Healthy People 2020 objectives facilitates the efforts of not only reducing health disparities among the Vanderburgh County’s citizens, but also to accomplish health
  23. 23. 21 | P a g e fairness in term of accessing the diabetic screening, managing, and improving the quality of care equally among the county population. Limited wellness programs regarding obesity issue in the area is another challenge in the county. The Evansville & Vanderburgh County offers a free weight loss program located in the health department building. Although it is free of charge, the enrollees must need to lose at least 20 pounds. Therefore, there are limitations regarding the location, programs' quantity, and participants group. In addition, such beneficial programs should be announced to the public to attract as many overweight people to help them managing their health behaviors. Because obesity is high among the low-income people, who have transportation trouble, the program is not accessible to them. In order to overcome this challenge, several programs should be established in several locations. Collaboration with local fitness centers might be a good idea to reach them as well as minorities with such problem. In addition, hospitals such as Deaconess and St. Mary's could have a great contribution to weight loss programs. Another overcome method is the early interventions of weight loss programs in most recent overweight people. Identifying and targeting them with an attractive (dancing classes especially for children and teenagers) and a low-cost program will drop the future efforts on managing the associated diseases. Moreover, announcing these programs by TV advertising or Intern-based ways to the public is crucial since it helps them to find and utilize the available health resources in the community. The Vanderburgh County has little health educational programs. Regarding diabetes management, the county participates in public events by providing presentations related to the diet, exercise, and diseases' complications. Presentations method works well with older adults and people with limited access to the Internet. In addition, screening is available in their office.
  24. 24. 22 | P a g e Although it has a social media involving such as Facebook and Twitter, the page is not active, and no interaction is embodied. It would be a powerful tool to post the educational material and encourage discussion. Moreover, linking some schools' assignments to diabetes educational information. B. Recommendations 1.Physical inactivity The physical activity of the community could be enhanced through encouraging and engaging more people in outdoor exercise. Creating fitness groups and adopting cost-effective methods will help in increasing the training time that reduces the body weight. In the Evansville area, the Ohio River creates an excellent opportunity to start a community-based activity (similar to In Shape Indiana program) by gathering people and set an initial goal such as achieving 700 thousands steps for day 1 and increasing the levels gradually. All Vanderburgh County residents have an equal chance to join without age or particular needs restriction. Moreover, people within the normal weight range are welcomed to be part of the program especially for families that have overweight members. It motivates the target population and creates an opportunity to adopt healthy habitual actions. In addition, creating several exercise programs that fit people with limited range of motion such as elderly and people with disabilities is attainable through the community resource. To illustrate, there are 65 parks in Vanderburgh County. Some of them encompass basketball courts, baseball fields, or tennis courts, where people could engage in the department arrangements. Games might be initiated, and adjustment could be applied if needed such as playing volleyball in chairs for old people, or adjust the game rules for disabled people if required.
  25. 25. 23 | P a g e Another recommendation is increasing the partnership with the fitness centers inside the county. Therefore, the opportunity to enroll in the free offered program is not limited to one place. It will be connivance for all residents including the 13,144 people who have no transportation access (CDC). 2.Healthy food Increasing the opportunity of receiving a healthy food for the County residents who are under the poverty level through the effective implementation of the existing governmental program such as Supplemental Nutrition Assistance Program (SNAP). According to the Food Research and Action Center, there were 19,820 participants got SNAP benefits while there were 32,789 residents under the poverty level (page 9). The difference between the 12,969 non-signed participants indicates that the county needs to put more efforts in order to reach and help them to obtain the available resource. A local TV advertisement, providing brochures on the main groceries, or online blogs might be an attainable way to inform people of need about the available sources. Furthermore, regulatory rules should be initiated regarding the availability of fast food restaurants in the County area. Reducing the unhealthy choices will decrease the fatty food option that links directly to obesity and type 2-diabetes. 3.Diabetes Vanderburgh County shall improve the access of the uninsured population by expanding the Medicaid program and providing healthcare insurance coverage for the low and moderate- income population in addition to individuals under the poverty level. Collaboration between federal efforts from Affordable Care Act and state or local level will impact the targeted population with limited access to care. Several southern states launched a health insurance marketplace to enroll individuals who were not previously eligible for Medicaid services.
  26. 26. 24 | P a g e Improving access will eventually help diabetic patients in obtaining the maximum benefits from government assisted programs. Furthermore, the National Diabetes Prevention Program Lifestyle Change Intervention is an organization that aims to enhance diabetes prevention. This organization provides funds that support related activities in term of preventing, managing, and delaying the associated complications. The county needs to utilize available federal resources and programs in order to reach optimal outcomes.
  27. 27. 25 | P a g e IX. Sexually Transmitted Diseases and HIV/AIDs Strategic Issue: How can the Vanderburgh County Health Department reduce or maintain the rate of HIV/AIDs and Sexually Transmitted Diseases? The Communicable Disease Division consists of four program areas that address the utilization of preventative health services to minimize the morbidity and mortality caused by communicable diseases. Services are provided to the community through the following programs: Adult Hepatitis A/B, HPV (human papillomavirus) and Tdap (Tetanus, Diphtheria and Pertussis) Immunization Program; Communicable Disease Control/Investigations; Human Immunodeficiency Virus Partner Counseling and Referral Services (HIV PCRS); Sexually Transmitted Disease (STD) Accelerated Prevention Campaign and Infertility Program; and the Specialty Clinic. Indiana is divided into 10 districts for the STD control program. Each district is assigned a Disease Intervention Specialist/Program Coordinator (DIS/PC) to manage the screening program and assist in the operation of STD control programs. The Disease Intervention Specialist/Program Coordinator (DIS/PC) operates the gonorrhea (GC) and chlamydia (CT) screening program, utilizes epidemiological (disease intervention) techniques, and assists in the operation of STD control programs in eleven (11) southwestern counties of Indiana, including: Daviess, Dubois, Gibson, Knox, Martin, Perry, Pike, Posey, Spencer, Vanderburgh and Warrick. These counties are known as District 8. The STD Morbidity for District 8, Vanderburgh County, is listed below for the years 2011, 2012, and 2013.
  28. 28. 26 | P a g e Source: State of Indiana Morbidity by District for Years 2011 -2012 - 2013 http://www.in.gov/isdh/files/District_8_chart.pdf Chlamydia is the most commonly reported STD in the United States. Chlamydia prevalence among sexually-active young individuals aged 14-24 years is nearly three times the prevalence among persons aged 25-39 years. It is estimated that 1 in 15 sexually active females aged 14-19 years has chlamydia. Most people who have chlamydia have no symptoms; however, even with no symptoms chlamydia can cause severe, permanent damage to a woman's reproductive system if left untreated. In 2013, Chlamydia was the most prevalent STD in Vanderburgh County with nine hundred and thirty-one (931) cases reported. Throughout the years, Vanderburgh County has continued to have the highest rate of Chlamydia cases reported among the featured Tri-State counties below.
  29. 29. 27 | P a g e Source: County Health Rankings; National Center for Hepatitis, HIV, STD, and TB Prevention (NCHHSTP) www.countyhealthrankings.org Preventive and medical care continues to improve for those diagnosed and at risk for contracting HIV/AIDS. AIDS diagnoses have decreased over the years for the states and the nation due in part to the ability to prolong the development of the disease. In 2013, Vanderburgh County had 319 total persons living with HIV/AIDS and had six new HIV/AIDS cases reported. In 2013, the number of persons that were diagnosed with HIV/AIDS and died in Vanderburgh County was 201. CDC estimates that of the 1.2 million people living with HIV in the United States, nearly one in seven (more than 168,000 individuals) do not know they are infected. According to the CDC, more than 90 percent of new HIV infections in the United States could be averted by diagnosing people living with HIV and ensuring they receive prompt, ongoing care and treatment. With more people than ever before living with HIV, it has also become increasingly important for Vanderburgh County to provide prevention programs tailored to the
  30. 30. 28 | P a g e needs of HIV-positive individuals and their partners, as well as for those who are HIV-negative and at high risk for infection. Indiana Persons Living with HIV Disease as of December 31, 2013 Source: 2013 Indiana Semi-Annual Report http://www.in.gov/isdh/files/living_wwith_hiv_disease.pdf Indiana HIV Disease Case Deaths Reported as of December 31, 2013 Source: 2013 Indiana Semi-Annual Report http://www.in.gov/isdh/files/mapdeathsreported_by_county.pdf
  31. 31. 29 | P a g e Meth Strategic Issue: How can the Vanderburgh County Health Department reduce or maintain the rate of drug usage, especially Meth? Meth and other drugs are some of the biggest issues in Vanderburgh County. A study was done in 2013 that named Indiana the meth capital of the United States. The graph below shows the total methamphetamine lab seizures for each county from 2001 to 2013. Bartholomew County is the number one county for lab seizures whereas Vanderburgh County is in the top five. In the same year, there were 115 clandestine lab seizures in Vanderburgh County. The 2013 graph compared to the 2014 graph shows that clandestine lab seizures were reduced; however, Source: Indiana State Department of Health, HIV/AIDS Epidemiological Profiles www.in.gov/isdh Of the featured Indiana counties, Vanderburgh County, IN, also the population center, reports the highest rates of people diagnosed with HIV/AIDS. Though rates of people diagnosed with HIV/AIDS are lower, an upward trend is shown in all three counties. The goal of Vanderburgh County’s Communicable Disease Division is to encourage and assist people to utilize preventive health services to minimize the morbidity and mortality caused by communicable diseases. As such, early detection of HIV and other STDs is vital to Vanderburgh’s County overall health. However, an individual requesting HIV testing cannot just walk into Vanderburgh County Health Department and receive testing. It should be noted that individuals who are seeking HIV testing that have not been identified through partner notification activities are referred to healthcare providers, AIDS Resource Group, or other community-based agencies. As for Sexually Transmitted Diseases, the Specialty Clinic of the
  32. 32. 30 | P a g e Vanderburgh County Health Department provides confidential testing and treatment for gonorrhea, chlamydia, and syphilis. Individuals with private health insurance or Medicaid should not be tested at the Vanderburgh County Health Department Specialty Clinic. The cost associated with the Specialty Clinic include a $20.00 office visit fee and a $10.00 medication administration fee. It becomes apparent that the issue at hand is providing testing and treatment for individuals with healthcare coverage, individuals who lack healthcare coverage or individuals with health care coverage but are unable to afford additional costs. According to the 2015 Tri-State Health Survey, seventy-eight percent (78%) of adults surveyed in Vanderburgh County have had a routine checkup in the past year. However, according to the 2013 Vanderburgh County Community Needs Assessment, twenty-one percent (21%) of respondents aged 18-44 had been tested for HIV in the past year. While chlamydia and gonorrhea disproportionately affect women over men, women are more likely to have had a routine checkup over men. According to the 2015 Tri-State Health Survey, eighty-two percent (82%) of women have had a routine checkup in the past year, compared to seventy-three percent (73%) of men. Fifty-eight percent (58%) of gonorrhea, and sixty-nine percent (69%) of chlamydia cases reported were among women in Vanderburgh County. The issues to be addressed is if officials of the Vanderburgh County Health Department should promote HIV and STD testing during routine checkups with healthcare providers; changing twenty-one percent (21%) of individuals tested closer to seventy-eight percent (78%). According to the 2015 Tri-State Health Survey, the 18-19-year-old age category has the highest percentage of persons without health care coverage at some point in the last year, forty- four percent (44%). The 18-19-year-old age group was also most likely to report needing to see a doctor, but couldn't because of cost. Sixty-four (64%) percent of gonorrhea and seventy-four
  33. 33. 31 | P a g e (74%) percent of chlamydia cases reported in Vanderburgh County were among people 14-24 years of age. It seems to be ironic that the age category with the most gonorrhea and chlamydia cases reported includes the age group with the highest percentage of uninsured. African Americans accounted for fifty-six percent (56%) of gonorrhea and thirty-seven percent (37%) of chlamydia cases reported in Vanderburgh County. According to the 2015 Tri- State Health Survey, thirty-eight percent (38%) of Black residents needed to see a doctor over the past year but couldn’t because of cost, and thirty-nine percent (39%) of Black adults went without health care coverage at some point in the last year. While gonorrhea and chlamydia continue to disproportionately affect African Americans, this category of race lacks access to health care and barriers due to cost. The $30 cost associated with receive testing and treatment at the Vanderburgh County Health Department Specialty Clinic may be not financially feasible or economically prioritized for those seeking testing and treatment. Race, age, and gender disproportionately affect the prevalence of HIV and STDs in Vanderburgh County. Other special populations, such as intravenous drug users, are disproportionately affected by HIV. Vanderburgh County was among the highest in the state for meth lab busts in 2013. Awareness of HIV status for injection drug users and their needle- sharing partners are obstructed by a number of competing needs, such as financial resources. Public health professionals have a difficult time identifying individuals at risk due to the stigma and legality of drug use. The Vanderburgh County Health Department Communicable Disease Division has not made youth HIV/STD prevention a high priority. In Indiana, the majority of people are first diagnosed with HIV at the ages of 20 to 24 years of age. As previously stated, Sixty-four (64%) percent of gonorrhea and seventy-four (74%) percent of chlamydia cases reported in
  34. 34. 32 | P a g e Vanderburgh County were among people 14-24 years of age. County public health officials must play a critical role in encouraging healthy behaviors in adolescents through clear, nonjudgmental, confidential guidance or communication. STDs result in significant costs to the U.S. Healthcare System. According to the CDC, the lifetime cost of treating eight of the most common STDs contracted in just one year is $15.6 billion. The annual cost of curable STIs is $742 million. It is necessary to prevent, diagnosis and provide prompt treatment for STDs in order to minimize the negative consequences and costs. In Vanderburgh County, the primary determinants of the spread and distribution of HIV/AIDS and STDs involve both the patterns of risk behavior and the effectiveness of prevention and control interventions. According to National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, "An individual's risk of acquiring these diseases is also dependent upon the risk of others (partners, household members, community contacts) as well as characteristics of the social and sexual networks, the communities within which these networks reside, and the society's characteristics including socioeconomic, cultural norms, and values (health determinants)”. A. Challenges and Options to Overcome Them Budget and financing constraints have caused local health departments, much like Vanderburgh County, to decrease services and public awareness for HIV and other sexually transmitted diseases. Funding cuts in Vanderburgh County have reduced the number of HIV tests performed. The VCHD Laboratory only performed 64 rapid HIV tests in 2013 as a result. As seen recently, inadequately funded public health efforts have resulted in the declaration of a public health emergency in Scott County, Indiana due to HIV outbreak reaching epidemic proportions of 89 cases. This crisis comes in light of April being STD Awareness Month, which has the goal of raising public awareness about the importance of preventing, testing for, and
  35. 35. 33 | P a g e treating STDs. Planned Parenthood of Indiana and Kentucky are showing their support for the Get Yourself Tested (GYT) campaign, and highlighting the need for regular STD testing by offering free HIV, gonorrhea and chlamydia testing the week of April 20-25th. Even with these public health initiatives, federal funding has an effect on how quickly Vanderburgh County residents receive their status and undergo treatment in order to avoid adverse health problems. Indiana State health officials have reported that all positive cases of HIV in Scott County have been linked to intravenous drug use, with some individuals also reporting sexual intercourse as a possible mode of transmission. Vanderburgh County isn’t a stranger to the prevalence of substance abuse individuals as discussed previously. Education, awareness, and people knowing what services are available may prevent the spread of this outbreak to the Evansville area, but current Indiana policy has created an obstacle. Needle and syringe programs provide clean needles and syringes to people who inject drugs intravenously in exchange for used instruments. Even though needle and syringe programs have been proven to reduce the transmission of HIV caused by the sharing of injecting equipment, Indiana State law dictates outright needle exchange programs are to be illegal. Opponents of needle exchange programs believe such measures encourage drug use in Indiana and transpose an image of acceptable drug usage. Nonprofit agencies in Vanderburgh County like the Aids Resource Group, are providing services that work around the law. The ARG is providing needle sterilization kits to intravenous drug users instead of clean syringes and needles in Evansville. Public health officials still believe, however, drug users are counting to use and share contaminated needles within southern counties. Most states today have a policy requiring HIV education, usually in conjunction with broader sex education. Many states have enacted specific content requirements concerning sex education in the wake of an emerging debate over the use of abstinence-only-until-marriage
  36. 36. 34 | P a g e versus the use of a more comprehensive approach. Indiana state law includes only an HIV/AIDS education mandate. When provided, local school boards decide what sex education subjects are covered and the grade level in which topics are introduced. Abstinence must be stressed as the only completely effective protection against unplanned pregnancy, sexually transmitted infections, and HIV/AIDS when transmitted sexually. While the Vanderburgh County Health Department offers health promotion programs, such as the Sexually Transmitted Disease Awareness Program, it is ultimately up to the Vanderburgh County School Corporation to decide what educational services and topics should be provided to adolescents. However, schools are not the only potential partner available to help the VCHD engage the youth in HIV/STD prevention activities. Identifying community stakeholders and partners for adolescent HIV and STD prevention is central to defining what might be the optimal role and unique contribution of the VCHD within the system. The VCHD does not have any national partners for adolescent HIV/STD prevention and education. Rather than using community resources, many young adults look for information on the web and are reached through the TV. It's Your (Sex) Life is MTV's public information campaign to support young people in making responsible decisions about their sexual health. The campaign focuses on reducing unintended pregnancy, preventing the spread of sexually transmitted diseases (STDs), including HIV/AIDS, and open communication with partners and healthcare providers. The campaign includes targeted public service ads (PSAs), entertainment and other special programming and promotions, news segments, talent engagement, sweepstakes, community partnerships, free informational materials, and extensive social media/web/mobile resources. IYSL has been credited with helping to decrease significantly teen pregnancies and
  37. 37. 35 | P a g e increase STD testing in the U.S. in recent years; the campaign has reached over 200 million young people on the sexual health issues since its inception. In Indiana, all minors have the legal ability to consent to testing and treatment for all sexually transmitted infections (STIs). Parental involvement in minors' health care decisions typically causes minors to avoid important sexual and reproductive health services in order to keep the information confidential. However, private health insurance processes inadvertently rescind patient confidentiality for individuals insured as dependents. Insurance companies send an explanation of benefits forms (EOBs) to a policyholder whenever care is provided under his or her policy. EOBs typically identify the individual who received care, the health care provider and the type of care obtained, which prevents minors to obtain confidential access to sexual and reproductive health care they need. Unable to receive confidential care through their insurance plans, minors and other dependents, including young adults, often turn to publicly funded providers, such as the Vanderburgh County Specialty Clinic, for care. The increased number of individuals in return places a significant burden on already-stretched health programs and departments. Several states have developed creative approaches to address confidentiality concerns. Indiana State legislators and the Vanderburgh County Health Department could collaborate to think of solutions that satisfy the needs of insurers, protect policyholders from unexpected financial exposure, and facilitate access to confidential care for all covered individuals. Vanderburgh County Health Department could start requesting that EOBs be sent to the individual who obtained the care rather than to the policyholder. VCHD could encourage state legislators to mandate insurers provide confidential communications upon written request of insured dependents or mandate that insurers may not disclose private health information,
  38. 38. 36 | P a g e including through an EOB, without minor's authorization. VCHD could also request insurance companies only to send EOBs when there is a balance due on the claim beyond whatever copayment was paid at the time of service. B. Recommendations Primary care and public health share the goal of promoting the health of all individuals. While there are some overlapping services and activities, these systems have largely functioned as parallel and independent entities. The primary care system has focused on facilitating improved health through the screening, diagnosis, and treatment of disease among individuals with public or private insurance. The public health system has directed its efforts toward prevention and health promotion at the community and population level through funding from governmental sources, often in the form of grants. More recently, opportunities have begun to increase the integration of these two systems. These opportunities are the result of recent developments including increased emphasis on controlling health care costs, growing recognition of the importance of the social and environmental determinants of health, the availability of health information technology to inform the connection between clinical and community-level health issues, and, perhaps most significantly, ACA’s passage and implementation. Some primary care settings also provide clinical STD services such as screening, diagnosis and treatment and bill for them as they do other services. The Affordable Care Act (ACA) has provided individuals with additional opportunities to receive preventive, screening and treatment services including those for STDs at sites other than the public health clinics. The increasing budgetary constraints for the Vanderburgh County Health Department may lead them to reconsider STD programs and services and make decisions about their priorities, roles, and services, while continuing to ensure access to services for individuals who are in need. The goal
  39. 39. 37 | P a g e of the Vanderburgh County Health Department should be to bring together health care, public health and community resources to improve health and efficiencies of a fully functioning system that reduces and maintains the rate of HIV/AIDs and sexually transmitted diseases. On Aug. 15–16, 2013, the CDC/DSTDP National Partners Collaborative met in Atlanta to (1) bring together partners from public health and primary care to identify, discuss, and examine strategies for the integration of public health and primary care in the STD prevention and service provision setting(s); and (2) learn from health department and primary care leadership about how better to support and align STD prevention, care, and treatment within the changing health care and public health landscape. Listed below, participants of the meeting shared ideas for action steps with respect to moving forward along the integration continuum and the types of tools, resources, and technical assistance that would support these action steps. Partnerships  Identify stakeholders critical to integration efforts  Create directories of community resources  Work jointly to conduct community assessments, gap analyzes, improvement efforts, or strategic planning  Leverage one another’s services (e.g., communication platforms/strategies)  Place representatives on each other’s boards  Co-locate staff  Hold joint staff meetings  Conduct provider education in new ways and through new platforms  Engage with payers  Link similar professionals across systems (e.g., CFOs, nursing)
  40. 40. 38 | P a g e Service Models  Pilot integration within one service or one location  Cross train staff across public health and primary care  Engage DIS in work across systems  Use patient navigators Payment Reform and Health Insurance  Understand the impact of the ACA on States  Explore STD-specific reimbursement options (e.g., opportunities for billing)  Assess training and operational needs with respect to managing insured/uninsured clients  Look at alternate mechanisms to fund staff/services (e.g., Accountable Care Organizations, funding of DIS). Community/Provider Knowledge  Collaborate on a STD prevention campaign, other community education efforts, and the development of best practices  Have health departments lead STD education and training for primary care providers;  Use telemedicine and telephone consultation models;  Build discussion of sexual health into communities  Consider the possibility of different approaches for easy-to-treat STDs versus more complex STDs  Provide cultural and linguistic diversity training for providers  Conduct workforce development activities  Create patient-centric care settings  Transition to models of nurse-directed services for STDs. Financing  Aggregate funding for public health services  Build billing systems for STD clinics Data and Measurement  Create universal metrics  Share data.
  41. 41. 39 | P a g e Tools and Resources Needed to Support Integration  Develop guidance on data, assessments, and planning  Create sample partnership agreements and policy briefs  Gather and share information on pilot projects, case studies, and clinical care and other integration-related training  Develop a clearinghouse for successful models, policies, and technical assistance  Package and circulate provider training Policy and Society  Tackle stigma and discrimination  Address criminalization issues  Address confidentiality issues and concerns
  42. 42. 40 | P a g e X. Methamphetamines and Other Drugs Strategic Issue: How can the Vanderburgh County Health Department reduce or maintain the rate of drug usage, especially Meth? Meth and other drugs are some of the biggest issues in Vanderburgh County. A study was done in 2013 that named Indiana the meth capital of the United States. The graph below shows the total methamphetamine lab seizures for each county from 2001 to 2013. Bartholomew County is the number one county for lab seizures whereas Vanderburgh County is in the top five.
  43. 43. 41 | P a g e In the same year, there were 115 clandestine lab seizures in Vanderburgh County. The 2013 graph compared to the 2014 graph shows that clandestine lab seizures were reduced; however, Vanderburgh County is still in the top five counties that have these types of labs. It has been proven that there is a link between drug and sex addiction. Studies have found that both sex and drug addiction are driven by the same compulsion. Sex and drug addicts become addicted to the feeling they experience when a chemical reaction occurs in their brains. Some sex addicts turn to drugs to heighten their experience and chemical high. The high STD rate in Vanderburgh County could be attributed to the high number of drug users. "Behaviors associated with drug abuse are among the main factors in the spread of HIV infection in the United States" (NIH, 2015). Most people know that sharing needles can transmit HIV; however,
  44. 44. 42 | P a g e some drugs influence people to act in more risky behavior, such as having unprotected sex with an infected partner or trading sex for drugs and money. There is also a positive correlation between drugs and crime. Among 18-49-year-olds, 26.1% is related to alcohol and drug consumption. One study examined 350 meth users and found that 56% perceived that their use of meth contributed largely to their violent behaviors, and 59% reported specific violent crimes. "Users' perceptions that their methamphetamine use resulted in violence appears strongest for those with the most severe methamphetamine-related problems, particularly paranoia," (NCADD, 2015, p.1). According to the National Council on Alcoholism and Drug Dependence, 80% of incarcerated offenders are in jail due to drug and or alcohol abuse, and nearly 50% are clinically addicted. About 95% return to drugs or alcohol abuse after they get out of prison. When it comes to inmates who are in rehab programs not regularly supervised by a judge, 60 – 80% drop out of the program. The connection between alcohol, drugs and crime is clear. We need to break the chain that links drug addiction and crime. A. Challenges and Options to Overcome Them Some of the challenges presented by meth and other drugs in Vanderburgh County are due to limited people working on drug busts and unsuccessful recovery from drug addiction. Most people in Vanderburgh County have been turning a blind eye to the use of drugs. It is also hard to prevent the use of illegal drugs if there is no one to stop them. The Evansville Police Department cannot be everywhere at once and because of the limited resources, there are more people who get away with the use of illegal drugs. The Evansville Police Department is trying to crack down on illegal drug users but throwing them into jail or prison does not always work. This is due to the high amount of people who reuse after being released from prison. There is no designated official in the Vanderburgh County Health Department that oversees drug use in the
  45. 45. 43 | P a g e community; this could be one of the contributing factors to the downfall of the health department. One solution would be to install a supervised drug recovery program in all the prisons and jails that is continued after they are released. The program will incorporate sober friends and family for moral support and give people rewards for staying clean. We can also provide more information to Vanderburgh County schools that show kids the side effects of illegal drug use. Another opportunity would be to offer an after school program that gets kids involved in the community. The Vanderburgh Health Department can educate individuals in the community about the effects of drugs at health fairs or informational talks.
  46. 46. 44 | P a g e XI. Lead Poisoning Strategic Issue: How can the Vanderburgh County Health Department reduce or maintain the rate of childhood lead poisoning? According to the Vanderburgh County website, childhood lead poisoning is the most common environmental disease that affects children and is preventable. Lead poisoning occurs when too much lead is absorbed by the body either through inhalation or ingestion of a substance that contains lead. Lead can be found in food, dust, paint, or water and has a disastrous effect on the body if levels become too high. Lead can damage almost all organ systems in the body. In children, high levels of lead can permanently affect growth and development by slowing growth and affecting hearing, learning, and behavior. In adults, elevated levels of lead can cause high blood pressure, and can damage the stomach, kidneys, nervous system, and the brain. High levels of lead in the body may also cause convulsions, coma, or death. Any damage caused by lead poisoning is irreversible. According to the Vanderburgh County Health Department Annual Report from 2013, "lead poisoning in children continues to be a problem especially in Vanderburgh County since 41.5% of its housing units were built prior to 1950." The most common source of exposure is through lead-based paint. Homes that were built or painted prior to 1978 commonly used lead- based paint until it was outlawed in 1978. Several of the children who are exposed to lead live in homes that contain lead paint. As lead paint deteriorates, it creates lead dust that the child may inhale directly from room air, or they could accidently ingest it from items that the lead dust settled on such as clothing, window sills, toys, etc.
  47. 47. 45 | P a g e A. Challenges and Options to Overcome Them They are a variety of challenges associated with trying to reduce the number of children with lead poisoning. Some parents may get their children screened and seek treatment for lead poisoning, but if the culprit of the problem is not addressed, then the numbers will remain high. For example, some owners or landlords may refuse to fix lead problems on their properties. This was seen in Evansville in 2009 when the landlords of a property where a child had elevated blood lead levels refused to fix the property despite a lawsuit against them. It is understandable why people may not want to fix their properties that have high levels of lead. Renovations and lead clean-ups are time-consuming and costly. According to USAToday, it can range from $200(for one new window to be replaced) to $20,000 or $30,000 to have a professional lead abatement done. Some people in Vanderburgh County may be able to afford an inspection, which usually costs between $150 and $300, but they may not be able to afford renovations or replacements of things that test positive for lead. The most important thing the Vanderburgh County Health Department can do to overcome challenges is to promote education of lead poisoning and screenings through multiple medias (social media, print sources, medical professional offices, TV and news stations, partnerships with local schools, universities, healthcare facilities, etc.). It is important that a majority of Vanderburgh County knows what lead poisoning is, who is affected, where to get screened, where to get treatment, and how to detect lead in their homes, offices, and daycares. This will allow citizens to make more educated decisions when purchasing their homes, selecting childcare services, and seeking treatment as soon as possible if lead poisoning is suspected. Other ways the VCHD can overcome these challenges is to have plans in place for when large contamination sites are found and educate the public on how they will be impacted and
  48. 48. 46 | P a g e how to handle the situation. It is also important to work with the city of Evansville and the historic district to preserve the historic buildings, but also to make them as lead-free as possible. Finally, continue searching for grants that help fund child lead screenings and promotion of childhood lead poisoning education.
  49. 49. 47 | P a g e XII. Recommendations In addition to the recommendations for the five strategic issues, it is also recommended that the Vanderburgh County Health Department add two positions: a digital media coordinator and a public relations specialist. Based off of the analysis of the 2013 VCHD Annual Report and a staff survey, external communications was a weakness. The website is lacking and not interactive, and the social media of the VCHD is poorly utilized. A digital media coordinator could take care of all of this. Better utilization of the web site would make education, promotion, and services more accessible to the community. Better utilization of social media accounts would allow the VCHD to communicate better and promote more with the community and younger generations in ways they prefer to be communicated with. The digital media coordinator could even look into designing an app since a majority of people nowadays have smart phones. Additionally, the digital media coordinator would work closely with the public relations specialist. The second recommendation for the organization is to add a public relations specialist. We feel that one of the major problems with the Health Department is that the community lacks awareness in what they are trying to accomplish. By adding a public relations specialist, we will be able to properly create and maintain a favorable image for not only the health department, but the community as a whole. We expect the public relations specialist to not only reshape the public perception of the health department, but to increase awareness of its work and goals. Our PR specialist will also work alongside the digital media coordinator on events such as our Bouncy Fun Castle Day. By doing this, we can take advantage of the free publicity through the news and social media to make sure the public is aware of such events. They can do this by writing press releases, prepare information for the media, draft speeches and arrange
  50. 50. 48 | P a g e interviews with top executives in the department, and evaluate advertising and promotional programs to determine whether they are compatible with their organization's public relations efforts. By making the public more aware of events held by the department, we can hopefully raise awareness of health related problems and positively impact them.
  51. 51. 49 | P a g e The promotional event Bouncy Fun Castle is intended to bring in people from all over the community. The overall target group is young adults and families from Vanderburgh County. Not only does this event help raise money for the Health Department by selling food, it also has informational booths that will allow individuals the opportunity to get more involved with their community. Some of the booths may consist of volunteer opportunities, donation slips, and information about what the health department is trying to do to improve the overall health of the community. This event will cost money to rent the bounce houses, but it will provide more profit rather than loss. Also, the bounce houses could be donated for the event if the Vanderburgh Health Department helps get some of the community businesses involved. For example, food venues may be provided by local restaurants. There will be free prizes donated by the local businesses involved in the event. Each person will get one raffle ticket where they put their phone number and email address and get a chance to win one of the free prizes. The prizes could include gift cards to local businesses, an iPad, tickets to a Ford Center event, and so forth. This is just one example of a promotional event to raise awareness in the community about the health department.
  52. 52. 50 | P a g e References Adult Communicable Disease | Tri-State Community Wellness. (2015). Retrieved from http://www.tristatecwi.org/health/adultcommunicabledisease Artiga, S., Stephens, J., Lyons, B., & Heiman, H. (2014, January 19). Advancing opportunities, assessing challenges: key themes from a roundtable discussion of health care and health equity in the south. Retrieved from http://kff.org/disparities-policy/issue-brief/advancing- opportunities-assessing-challenges-key-themes-from-a-roundtable-discussion-of-health- care-and-health-equity-in-the-south/ Benson Gold, R. (2013). A New Frontier in the Era of Health Reform: Protecting Confidentiality for Individuals Insured as Dependents. Retrieved from http://www.guttmacher.org/pubs/gpr/16/4/gpr160402.html Beyond needle exchange: Containing HIV outbreak. (2015, April 22). Retrieved from http://www.indystar.com/story/news/2015/04/21/beyond-needle-exchange-containing- hiv-outbreak/26145339/ Bradford Health Services, (2015). The link between drug addiction and sexual addiction. Retrieved from https://bradfordhealth.com/the-link-between-drug-addiction-and-sexual- addiction/ CDC - Diverse Populations - Challenges - HIV Prevention. (n.d.). Retrieved from http://www.cdc.gov/nchhstp/newsroom/HIVFactSheets/Challenges/DiversePopulations.h tm CDC - Too Few People with HIV Are Aware of Their Infection. (n.d.). Retrieved from http://www.cdc.gov/nchhstp/newsroom/HIVFactSheets/Challenges/TooFewPeople.htm CDC Fact Sheet | Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States. (2013, February). Retrieved from http://www.cdc.gov/std/stats/sti- estimates-fact-sheet-feb-2013.pdf CDC/DSTDP National Partners Collaborative on Public Health. (2013, December). Retrieved from https://www.nachc.com/client/National%20Partners%20Collaborative%20on%20Public%20Heal th%20and%20Primary%20Care%20Integration_August%202013.pdf Center for Diseases Control and Prevention. (2012). Diagnosed diabetes percentage 2012. Retrieved from http://www.cdc.gov/diabetes/atlas/countydata/atlas.html Center for Diseases Control and Prevention. (2012). State indicator report on fruits and vegetables 2013. Retrieved from http://www.cdc.gov/nutrition/downloads/State- Indicator-Report-Fruits-Vegetables-2013.pdf Chokshi, N. (2014). Congrats Missouri, your no longer the nation’s meth-bust capital. Retrieved from http://www.washingtonpost.com/blogs/govbeat/wp/2014/03/31/indiana-now-leads-the- nation-on-meth-busts/?Post+generic=%3Ftid%3Dsm_twitter_washingtonpost
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