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This web page contains sample material excerpted from the Orleans County Health Report Card, 1996-1997.


Is Your County Healthy?

 

Orleans County Department of Health

1996/1997


Forward

The Orleans County Community Health Assessment for 1996 - 1997 is an update of the assessment previously conducted and distributed in 1992. The County Health Department develops the assessment in keeping with its responsibility to do so under state and local law. The overall goal of the assessment is to stimulate participation in, and/or development of, programs addressing key local needs.

We hope to accomplish this by:

Issuing a report card on health and health care in Orleans County

Developing public awareness of key health issues facing the community

Advising Orleans County residents of services provided through Orleans County government

Furnishing the public, community organizations, health care practitioners and organizations and health care benefits insurance companies with a ready reference for health care needs and health- and health care-related statistical data for Orleans County.

Good health is a challenge to the entire community - not just government, doctors, clinics, hospitals and insurance companies, but schools, landlords, parents, local businesses, teenagers, and senior citizens.

 

Orleans County Legislature
1996-97

Marcia B. Touhey, Chairman
Ronald R. Radzinski, Vice-Chairman
John W. Beedon
Lyndon D. Billings
Richard Bennett
George R. Bower
David B. Callard
 

Orleans County Public Health Board
1996/97

Eric Brown, President
Carol Heiligenthaler, Vice-President
Thomas Madejski, MD
Eileen Kosieracki, DO
Alfred Daniels, MD
George Bower
Allen Lofthouse
 

Orleans County Health Department
1996/97

Andrew Lucyszyn, Public Health Director
Jeanette Welsh, Budget Director
Beverly Parmele, Director of Patient Services
Mary Jane Sahukar, Supervisor - Home Care Division
Wayne Dickinson, Supervising Sanitarian - Environmental Division
Nola Goodrich, Public Health Educator
Christine Covell, Coordinator for Children with Special Needs

Your comments on the assessment or any health related matters are requested and welcome.


Contents

Foreword

Accomplishments

Health Report Card - Orleans County

Programs

I. Family Planning, Maternal and Infant Health

II. Child Health

III. Dental Health

IV. Lead Poisoning Prevention

V. Nutrition

VI. Injury and Suicide Prevention

VII. Sexually Transmitted Disease

VIII. Tuberculosis

IX. Communicable Disease

X. Immunizations

XI. Chronic Diseases

XII. Human Immunodeficiency Virus (HIV/AIDS)

XIII. Local Health Care Services

Data and Analyses

I. General Demographics - Orleans County and its Ten Townships

II. Pregnancy Related

III. Mortality Related

IV. Outpatient Care Needs

V. General Trends

 This assessment was prepared by
HMS Associates, Getzville, NY.


Accomplishments

The Orleans County Health Department has two major functions: protect the public health and promote health programs vitally needed by the community. The County Health Department and the County Public Health Board are the County's first line of defense against the spread of disease throughout the community. A broad scope of programs, some operated by the County and others by local health care providers, is overseen by the County and designed to accomplish those broad goals. Programs range from educational classes to administration of vaccines, to monitoring health-related environmental conditions throughout the county. Program accomplishments of the past several years, listed below, will convey the depth of service provided, the extensive relationships with local health care providers, and the importance and complexity of the public health mission.

Child Health

The health and well-being of young County residents is a prime concern of the County Health Department and the Public Health Board. Numerous programs target children and adolescents because of age-related vulnerabilities and the importance of the development of healthy life-styles and behaviors at early ages. Many childhood diseases are prevented with immunization; many health problems of infants and mothers are averted through active prenatal care and the development of parenting skills and nutritional programs supply the building blocks of healthy young bodies. The County Health Department directly operates or oversees local program addressing these needs. Specific information on County and local health care providers' efforts concerning the health of Orleans County children are described in subsequent program summaries.

New Challenges

Like many other Medicaid-eligible people in New York State, the County's Medicaid-eligible population will be enrolled in managed care programs in 1997. The Health Department will assume additional responsibility for assuring that insurance companies' Medicaid managed care plans are meeting the needs of these individuals.

The challenge to the County Health Department and Public Health Board of protecting and ensuring public health is expanding, and yet fundamental to the overall well-being of the community.

  I. Family Planning and Maternal and Infant Health

"Partnership" was the watchword in the County's efforts to disseminate family planning information. The Public Health Educator organized a Health Educators Network, encouraging input from all community health educators in an effort to strengthen existing family planning programs. Links were strengthened with Family Life Education teachers in all five school districts. The Health Department maintained a close working relationship and formal linkage agreement with Planned Parenthood, referring patients to the agency as well to private providers. Department representatives sit on the Planned Parenthood Board and on its education subcommittee. The Health Department was also active in ACT (Alternative Choices for Teens). This group, comprised of the Health Department, the Department of Social Services, Planned Parenthood, Mental Health, Cooperative Extension, and Special Friends, allows for strong connections and collective input into programs for teens at high risk for pregnancy.

County Health Department nurses increased their efforts to identify, track and screen infants and toddlers at risk of physical and developmental disabilities. Early Intervention Service Coordination (EISC) was initiated to provide case management to developmentally delayed children. The Health Department also continued its Infant Health Assessment Program (IHAP), visiting and linking all referred clients as needed. Also of note:

   II. Dental Health

The Health Department's efforts to promote dental health have a dual focus: to teach preventive tooth care, primarily to children, and to compensate for the lack of fluoridation in sixty percent of the County water supply. Preventive efforts included visits to Head Start Day Care, migrant day care centers and private nursery schools to teach brushing and flossing; showing a "Snoopy" cartoon teaching these skills at a wide variety of sites; and providing dental care education during home visits by nursing staff and to parents of developmentally delayed children. The Department also provided technical assistance to, and approved completion of, six projects expanding the four water districts in the County that provide fluoridated water. In addition, the Department sponsored Oak Orchard Health Care's successful effort to fund a dental sealant program for the children of migrant workers - one hundred of whom received dental sealant treatment.

   III. Lead

The Health Department vigorously promoted lead screening for children under 5, and received lead blood test results for 1,001 children from primary care providers. Twenty-seven children with potentially problematic blood lead levels (above 9 micro grams per deciliter) were identified. For these children, County Public Health Nurses conducted 24 case conferences and 37 home visits. Also of note:

   IV. Nutrition

The Department undertook a broad range of nutrition-education efforts:

   V. Injury Prevention and Control

The Public Health Educator continued to maintain a working coalition of agencies to provide a variety of safety and injury prevention programs. Educational material on highway safety and drunk driving was provided to the five county school districts for use in driver education courses. Information on infant and child car seats was distributed to families with new babies by Public Health nurses. The County cosponsored Bicycle Safety Rodeos promoted by Medina Memorial Hospital's Industrial Health Program. Selected in 1993 as a bicycle helmet distribution site by the NYS Department of Health, the County Health Department has distributed approximately 200 bicycle helmets to income-eligible children.

   VI. Sexually Transmitted Diseases
The Health Department handed out information and provided direct instruction concerning sexually transmitted diseases in a wide variety of settings in an effort to reach at-risk groups at every opportunity. Information was provided at sites throughout the County, including the Pregnancy Counseling Center and the BOCES youth conference; to all men and women at immunization clinics; and to teen parents at immunization and blood lead testing clinics. Educational materials and presentations were made available to all school districts for use in health classes. Classes were provided to paroled inmates at the Orleans Correctional Facility, to the Association of Retarded Children's Community Living clients, and to several other groups.

   VII. Tuberculosis
Health Department efforts to control Tuberculosis focused on testing at-risk populations, particularly those in institutions, and vigilantly monitoring and treating all those infected with the disease. Approximately 150 people were treated for this disease in the County from 1992 through 1995. Many of these patients were monitored through a formalized Tuberculosis Clinic every Thursday morning. Also of note:

   VIII. Communicable Disease

Communicable disease investigations continued to be conducted in a timely manner. Most investigations were completed within a week of receiving the case report.

Follow-up investigations of each reported case entailed contacting the medical provider and patient to confirm the diagnosis and institute programs concerning other people who may have been infected or susceptible to infection.

Cooperative relationships with a wide range of health and social service providers were strengthened. Joint ventures were undertaken with other county health departments, the State Health Department, hospital infection control nurses, laboratories, physicians, school nurses from the 5 local school districts, correctional facilities including the County Jail, Iroquois Job Corps, the Migrant Day Care Center, Head Start, and Association for Retarded Children.

   IX. Immunization

The Health Department vigorously pursued all available avenues to provide immunization and immunization information to all County children and other at-risk groups. Immunization services included the following:

   X. Chronic Disease

Diet, exercise, and the dangers of smoking were the focal points of broad-based Health Department efforts to promote lifestyle choices that prevent such chronic diseases as heart disease and lung cancer. A new function was to monitor compliance on the part of merchants, vendors and the general public with the Adolescent Tobacco Use Prevention Act (ATUPA). The Department distributed detailed information on the Act, while environmental personnel maintained a compliance log and investigated all alleged violations. Also of note:

   XI. H.I.V.

The Health Department maintained an all-out effort to inform at-risk groups of high-risk behaviors and HIV preventive measures. The Department distributed HIV/AIDS material to local Chemical Dependency Treatment Centers, Department of Social Services waiting rooms, employment offices and libraries, BOCES Health Education classes, Retarded Citizens Medina apartments, and many other sites. HIV material was made available to all participants in the Hepatitis B immunization clinics, tuberculosis and SAD programs. The Department also provided information to soon-to-be paroled inmates of the Orleans Correctional Facility, women residents of the Iroquois Job Corps, the Orleans Cooperative Extension parenting class, and a range of other groups. Five staff nurses and the public Health Educator completed the three-level HIV/AIDS counseling certification course. The Health Department also continued to take a lead role in interpreting the confidentiality law for the community.

   XII. Health Care Services

Throughout the past several years, the County's Certified Home Health Agency program treated over 100 County residents each year. The program required expansion at times due to demand for home care for acutely ill county residents.

Through its involvement with the Lake Ontario Rural Health Network (LORHN) - a State-supported rural health network - the County determined that the closure of Arnold Gregory Hospital in Albion, NY in 1989, had not reduced access to inpatient care for that community. In 1993, residents of the Albion area were admitted to hospitals more frequently than people residing in Brockport or Medina. In addition, no major unmet needs for hospital services were identified for that the Albion community. Also of note:


Health Report Card - Orleans County

Is Orleans County a healthy place to live?

As people become increasingly conscious of the dependence good health upon environmental and lifestyle factors, they seek information about the health of their community and its health care system. This Report Card is the County's response to growing interest in health, the environment, life-styles and local health care systems. The Report Card is intended to recognize local strengths - and perhaps more importantly, to galvanize health care practitioners, providers and the community to address key problems and augment their services accordingly.

The County's overall grade is B.

Orleans County is a healthy place to live in that it has low rates of major health care problems. At the same time, the County is among the five lowest ranked counties in New York State in several areas. In some cases, programs have already been started or expanded to deal with key health care concerns.

The Report Card integrates two types of information:

  1. Data on County residents from statistical reports on death, pregnancy, birth, hospital use, or other factors.
  2. Assessments of local health care practitioners and agencies of health status problems previously referenced.

The combination of these two elements produced a letter grade.

It must be noted that the data in some instances is not current enough to reflect any changes in health that would result from new programs offered since 1994. Consequently the positive impact of recent local advances in prevention programs for chronic disease, accidental deaths, or problems associated with teen pregnancies are not reflected in the data. Yet, the data available thus far strongly support the maintenance of those programs and close monitoring of new information as it becomes available.

A comment section follows each area and grade. These comments help to explain the rationale for the grade and in some instances point toward specific areas which require attention and remediation. Please refer to the corresponding section of the assessment for more detailed information.


PROGRAMS:

Family Planning, Maternal and Infant Health

Infant health is shaped largely by prenatal factors, including the health care a woman receives when she is pregnant, her environment, and her nutrition. The life-style of a pregnant woman also has a direct impact on the health of her baby. Proper diet, exercise, and the avoidance of illegal substances and alcohol, are crucial to the health of the 625 babies born to Orleans County mothers each year. Family planning and preparation for parenthood, especially among young parents, also play a decisive role in the well-being of infants and children.

Target Groups

Approximately one out of every four Orleans County residents is female and of child bearing age. In 1999, there are projected to be 12,271 women and girls between the ages of 10 and 40 in the County:

1,818 females from age of 10 to 14

1,013 females from age of 15 to 17

2,063 females from age of 18 to 24

3,429 females from age of 25 to 34

3,948 females from age of 35 to 40

The Towns of Albion and Clarendon have higher than average proportions of females of child bearing age, whereas the Town of Yates has a very low proportion of females of child bearing age. Poverty is more prevalent in most western and central towns and villages, whereas the towns located on the eastern corridor of the County are more affluent.

With the exception of infant deaths, family "characteristics" of the County are relatively stable. During the 1989-1993 period, the County's live birth level fluctuated from a low of 578 births or 13.9 live births per 1,000 people in 1989 to a high of 652 births or 15.6 live births per 1,000 people in 1990.

 

Marriages have fluctuated from a low of 304 or 6.9 per 1,000 people in 1993 to a high of 348 or 8.3 per 1,0000 people in 1990. Divorce rates varied from a low of 106 per 1,000 people in 1990 to a high of 144 in 1991.

Infant death rates, however, changed by more than 100%, having ranged from a low of 3 or 5.2 per 1000 live births in 1989 to a high of 7 or 10.9 per 1,000 live births in 1992. This level of variation - may be explained largely by the small numbers involved. An increase or decrease of two deaths which can occur by chance alone can result in an extremely high rate.

County teen birth rates warrant attention. In 1993, teen birth rates were almost 50% higher than the Upstate New York Average. During that year, seven out of every 100 teenage females in the County became pregnant; teens gave birth to 72 babies. New pregnancies declined from 113 in 1992 to 98 in 1993. The decline occurred in younger teenagers, females 15 to 17 years of age, dropping from 54 to 39. The rate among "older" teens remained unchanged, 59 in both 1992 and 1993.

Fertility ratios - the number of births compared to the number of women of a given childbearing age range - also indicate that teenagers are a major target group for family related services. The County's fertility ratio in 1993 was 66 births per 1,000 women of child bearing age, a rate slightly higher than the Upstate norm. Yet, fertility ratios for 15 to 17 year-old females and 18 to 19 year-old females from Orleans County are more than 50% higher than the Upstate County "norm".

One out of every three babies were born out of wedlock and/or received Medicaid public assistance. These rates were also significantly above those of other Upstate counties.

Lack of prenatal care also warrants attention. A high percentage of women did not receive prenatal care at appropriate times. Twenty-seven pregnant women had no record of medical care or had their first medical care just before they gave birth.

In 1993, 61 babies, or one out of every ten, weighed less than 2500 grams - the standard for healthy birth weight. This rate is almost 50% higher than the Upstate norm. Seven of 31 babies borne by teens 15 to 17, or approximately one out of every four, weighed less than 2500 grams. Low birthweight levels have been increased steadily between 1991 and 1993, rising from 36 in 1991, to 50 in 1992, to 61 in 1993.

Pregnancy-related information by age and minor civil division over the years 1990 - 1992 demonstrated that the Town of Albion has a high concentration of pregnancy-related problems for the 15-to-17 year-old of age population. This apparent concentration may be exaggerated by the small numbers involved, yet a pattern was apparent. The Village of Medina was also high in this area.

 

Many participants in the interview process conducted by the Lake Ontario Rural Healthcare Network noted significant concern over the teen pregnancy problem in the area. These individuals basically felt teen pregnancy is a cultural phenomenon, fostered in part by a change in family values in which children borne out of wedlock are no longer ostracized or stigmatized, by a social service network which has aided single moms in taking care of their children rather than causing them to become "outcasts". The availability of "public assistance" to financially support unwed mothers was viewed by some individuals as a major contributor to the growth in this life style. Some individuals talked about the need for the development of parenting classes to help young people deal with the trials of childbearing.

No babies have been born with HIV in Orleans County.

A variety of nutritional programs are available to women, infants, and children. These are listed in the Nutrition section of this report.

 

Existing Services

The Oak Orchard Health Center, which has offices in Albion and Brockport, provides prenatal care for women with low incomes who are not eligible for Medicaid. This Prenatal Care Assistance Program (PCAP) focuses on the special needs of women during pregnancy. The Oak Orchard Health Center provides prenatal care as part of its range of services. It also operates the Womens, Infants, and Children Program which provides services to pregnant women, nursing mothers, infants and children.

Planned Parenthood provides pregnancy testing and referral to appropriate sources for prenatal care.

The Orleans County Health Department makes home visits to pregnant women identified as in need of such services. Health Department nurses work with families to anticipate the future needs of the infants and mothers. They assess the mother's preparedness for, and provide her with instructions on, labor and delivery. They also evaluate how ready the home and family are to care for that child, and help to prepare for the child's arrival at home.

Prenatal care services are also available at Medina Memorial Hospital and intensive care services for newborns are available in Erie and Monroe Counties.

The Orleans Parenting Council, a group of providers of parenting services in Orleans County, offers a variety of programs, some of which may be used as an adjunct to prenatal care. Some of the programs have fees, either sliding or fixed, or have eligibility criteria. Transportation issues are addressed by each group individually. These organizations include:

"Help Yourself" - Adult & Adolescent Basic Education, Albion

Albion Central School - "Project Open Door" (school age), Albion

Alternative Choices for Teens (ACT) (teens), Albion

Orleans Co. Assoc. for Retarded Citizens (develop. disabled), Albion/Medina

Community Free Library, Holley

Cornell Cooperative Extension in Orleans County, Albion

Daisy Marquis Jones Family Wellness (fee), Brockport

Orleans EPIC - Effective Parenting Information for Children (children), Albion based/countywide

Genesee-Orleans Ministry of Concern, Albion

Orleans County Action Committee Head Start (children, low income)

All Orleans Community Action Committee, Inc. (low income), Albion

Orleans County Department of Social Services (low income), Albion

Orleans County Health Department, Albion

Orleans County Mental Health, Albion

Monroe 2 - Orleans BOCES (education), Holley

Orleans-Niagara BOCES Single Parent Program, Medina

Rape Crisis Service of Planned Parenthood, Albion

Special Friends Program, Inc., Albion

Swan Library, Albion

WE-MO-CO Occupational & Technical Center, Holley/Spencerport

Yates Community Library, Lyndonville

Young Parent's Network, Albion

Orleans County "Youth At Risk", Albion

The Orleans County Department of Health public health nurses provide post partum and newborn care health guidance to most women and newborns (particularly first-born), especially when indicated by local hospitals. The OCDOH publicizes clinic schedules and lead screening programs.

 

 Community Priorities for 1997/98

Family Planning, Maternal and Infant Health

  • The extremely high teen birth and fertility rates coupled with excessive low birthweight babies born by teens should be a priority concern of the County Health Department and local providers. Causes should be examined. Particular attention pertaining to teen reproductive health to be directed at the Town of Albion.
  • The increase in low birth weight babies needs to be watched very closely and potentiality discussed with obstetricians/gynecologists.

 

 Programs:

Communicable Diseases

Communicable diseases are most commonly spread by contact with infected people, eating utensils, food, or water. The County Health Department routinely tracks the incidence of these diseases, since outbreaks can be prevented by targeting information and preventive measures at any disease that shows increased incidence.

 

Target Groups

Of the eleven major diseases that the County routinely monitors, seven, excluding gonorrhea, syphilis, and tuberculosis, have infected at least two County residents in one of the three years 1993-1995. (Please see separate sections of this Assessment for discussion of Sexually Transmitted Diseases, Tuberculosis, and AIDS.) Among these diseases, only Giardiasis has increased markedly and bears monitoring. Following a four year period averaging seven new reported cases per year, incidence increased to 13 in 1994 and 16 in 1995. Of the four infectious diseases for which data was compiled in the NYSDOH Preventive Health and Health Services Block Grant Needs Assessment of June, 1994, only the Pertussis rate was "above average" in Orleans County, ranking in the second highest quartile for the state. This rate has declined in 1993-95 Lyme Disease rates were lower than the Upstate average from 1991-93, with four new cases reported in 1992 but none in 1991 or 1993. Hepatitis B has been increasing in the population. 1995 levels exceeded previous highs which occurred in 1989/90. Rabies incidence was also below the Upstate rate. Raccoon rabies, which has been moving northward from the New York-Pennsylvania border for the past several years, did not hit Orleans County in force until 1994; one case among animals was confirmed in 1991, none in 1992 or 1993. In 1994 rabies in Orleans County peaked at 47 reported animal cases and 62 cases of human prophylaxis. In 1995, figures dropped to 30 confirmed animal cases and 15 human prophylaxes.

The 925 individuals who work in correctional facilities in Orleans County are at high risk of contracting communicable diseases. These workers pose a major target group for educational and preventive efforts because they can spread infections from the prisons to the general community.

Existing Services

Numerous institutions, health care practitioners, and the County Health Department offer a broad range of services for the prevention, identification and treatment of communicable diseases. Please see the sections "Sexually Transmitted Diseases" and "Tuberculosis" for a detailing of such services offered by the County and by other public and private agencies.

Physicians in Orleans County currently either treat or make referrals for treatment of communicable diseases.

 

Community Priorities for 1997/1998

Communicable Diseases


 

This web page contains sample material excerpted from the Orleans County Health Report Card, 1996-1997. A complete copy of the report (in either color hardcopy or electronic form) is available for $39.95 plus $4.45 for shipping and handling from HMS Associates, Getzville, NY.

To order, contact:

E-mail: Consulthms@aol.com

 

HMS Associates
Suite B, Box 374
2280 Millersport Highway,
Getzville, NY 14068
Tel. (716) 688 - 8448
Fax (716) 688 - 0395

E-mail: Consulthms@aol.com



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