HomeMy WebLinkAboutMINUTES - 09131988 - T.1 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Order on September 13 , 1988 , by the following vote:
AYES: Supervisors Powers, Fanden, McPeak, Torlakson, Schroder
NOES: None
ABSENT: None
ABSTAIN: None
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SUBJECT: Public Health Issues
Joseph Hafey, Chair, Public and Environmental Health
Advisory Board, presented the attached report to the Board relative
to health issues which are of importance. to Contra Costa County
residents.
IT IS BY THE BOARD ORDERED that receipt of the attached
report is ACKNOWLEDGED.
IT IS FURTHER ORDERED that the report is REFERRED to the
cities for information.
B hereby certify that this is a true anti correct com �f
an action takers and entered on Z')r- m1mites Lai s;a
Bard of Supervisors on the date sho— rn.
ATTESTED: 01
cc. Public Health Director PH!L BATCEt_OR, Clemk of the Board
Health Services Director of Supervisors and Courty Administrator
County Administrator
Cities By
Deputy
Health Services Department
»:� ,• Public Health Division
r J �.•
OFFICE OF THE DIRECTOR
Administrative Offices
20 Allen Street
a a Martinez,California 94553
(415)646-4416
osrA,coin`
To: Members •of the Board of Supervisors September 13, 1988
From: Public and Environmental Health REPORT ON ACTIVITIES TO DATE
Advisory Board RECOMMENDATIONS FOR ACTION
by Joseph Hafey, Chair
The Public and Environmental Health Advisory Board (PEHAB) is a 12 member board
appointed by the Board of Supervisors in 1986. It advises the Public and
Environmental Health Divisions of the Health Services Department on community
health needs and priorities. ' It is a community oriented board with diverse
representation from West, Central , and East County- and key constituents of the
Contra Costa community: older adults, consumers, children services,
business/industry, environmental organizations, and labor. Health professionals
from the American Cancer Society, the Alameda-Contra Costa Medical Association,
the State Department of Health Services, the School of Public Health and the
Western Consortium for Public Health join the constituent members to provide a
board that has both broad community knowledge and health expertise.
PEHAB ' s mission is to:
* Anticipate emerging health needs to initiate prevention programs
* Focus public health interventions in communities, with the greatest needs
* Balance available resources with growing needs, and
* Advocate for increased county action to improve community health
Emerging Health Issues
PEHAB has identified the emerging health issues which are of growing importance
to Contra Costa County residents. This identification is the result of a year
long investigation which included: a community needs survey, data collection on
morbidity and mortality rates from various causes of death and disability, a
_ comparison of Contra Costa' s health indices with state and national statistics,
presentations from experts on health planning and disease prevention, and input
from County staff who are involved in the day-to-day operations of the Health
Services Department. The results of the Blue Ribbon Committee (1983) which eva-
luated the viability of the Health Services Department to meet community health
needs in the midst of a fiscal crisis were also considered. This report outli-
nes the emergence of health issues which are of increasing importance to Contra
Costa County.
A372 (4/88)
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Priority Health Areas. Six areas or "constellations of issues" were identified
as emerging health priorities for Contra Costa. In selecting these issues the
advisory board acknowledged the tremendous difficulty and frustration inherent
in making choices between very pressing needs. Many critical issues are not
included which should in no way deflect from their need for more resources or
public attention.
For example, it is important to note that toxics and hazardous materials has 'not
been identified as an emerging issue. Advisory board members noted that much
work has been done by the Health Services Department, advisory board members,
and others on these issues, and many programs are in place or being developed
including the Occupational Health Clinic, Emergency Response, 2185 Inspections,
and the Hazardous Materials Commission. The advisory board feels that the
Health Services Department is making an effective response to the issues of
toxics which allows the advisory board to focus much of its attention to other
public and environmental issues.
As a backdrop to considering the emerging issues, it is important to outline the
advisory board' s concerns about gaps in income equity in Contra Costa County.
As one of the most affluent counties in one of the richest states in the
country, equity is a glaring problem that cannot be ignored. Its direct effect
on health status makes it an issue under the purview of the advisory board. The
Association of Bay Area Governments (ABAG) recently reported that the greatest
growth in the prosperity gap -- the difference betweeen the average and median
income -- between the rich and poor has been in Contra Costa County, where the
difference in income has nearly tripled since 1978. In 1978, the two income
levels were 16.3 percent apart. In 1985, the average income was 42.1 percent
higher than the median income. This means that a few people are substantially
increasing their wealth, while the working poor and the poor are growing in
number. The ABAG report considers this overall Bay Area experience "alarming",
and the Public Environmental Health Advisory Board agrees. The priority areas
for immediate action should address the needs of all Contra Costans, but with
particular emphasis on the needs of the poor and low income residents who often
exclusively depend on public health services for their health promotion and
disease prevention needs.
The six priority issues which have been identified are described below.
1. Chronic Disease Prevention. Cancer, heart disease and hypertension continue
as the primary causes .of death and disability in Contra Costa. Chronic
diseases will become a growing health problem as Contra Costa's population
ages over the next decades. In 1985 10.7% of Contra Costa' s population was
65 years or older, and by the year 2020, 18.5% of Contra Costans will be
more than 65 years old representing a 58% increase.
As Figure A shows, chronic diseases accounted for over 70% of deaths in
Contra Costa in 1986. Smoking is linked to most of these deaths. Special
studies of nearby California communities indicate that smoking contribues to
between 206 - 276 years of potential life lost (YPLL) annually per 10,000
people. YPLL means the number of years between the age at which a person
dies and his/her actuarial life expectancy. An extrapolation of this data
to Contra Costa indicates that approximately 14,000 - 19,000 years of poten-
tial life lost can annually be attributed to smoking.
-3-
Many avenues for prevention of chronic disease have not yet been explored
in Contra Costa County. Smoking control ordinances and other tobacco
control policies are assisting the decrease and prevention of smoking in.
our community. Since smoking causes 35% of all cancers, these public poli-
cies are essential tools in improving the health of county residents. In
addition, the American Lung Association estimates that over $560 million is
spent annually in the Bay Area to cover smoking related health care costs.
these costs can be dramatically reduced through prevention and cessation.
Preventive public policies and organizationa°1 practices can also be deve-
loped
eveloped for improved nutrition in our community. Recent studies estimate
that up to 30°i of all cancers are due to the poor nutrition of the U.S.
population. There is a growing awareness that public policy is urgently
needed to address our nutritional status. For example, public agencies
(hospitals, jails, etc. ) can be required to improve the nutritional quality
of the food served; school lunch programs can meet nutritional guidelines;
fast food restaurants can be required to label the nutritional contents of
their products and farm land must be protected for the growing of fresh
fruits and vegetables to decrease reliance on packaged and processed food
which are often high in fat and low in fiber content.
Because there is little current activity within the Health Services
Department on chronic disease prevention, the Public and Environmental
Health Advisory Board has identified this issue as a top priority for
action. Chronic diseases are largely preventable, and proactive public
policy facilitates preventive behavior among individuals, and organiza-
tions. The advisory board would therefore like to issue a broad challenge
to the Contra Costa community to cooperatively develop policies and
programs targeted at chronic disease prevention.
2. Substance Abuse, Including Drugs, Alcohol and Tobacco. Substance abuse has
traditionally been a mental healthand law enforce issue in Contra Costa
County, yet it has a growing negative impact on all major public health
issues: AIDS, perinatal care, injuries, cancer, heart disease, hunger,
homelessness, as well as many other causes of death and disability. Drug
addicted mothers can permanently disable their offspring, the majority of
vehicular accidents with teens are associated with alcohol use and diseases
related to tobacco use kill more Contra Costar's each year than any other
single cause of death.
The breadth and depth of substance abuse in our community often makes the
issue seem insurmountable. The Drug and Alcohol Advisory Boards to the
Mental- Health Division -and many community agencies have played a leadership
role in addressing the problems. There is a need, however, to more
thoroughly address these issues from a public health perspective to better
understand the underlying social conditions _related to substance abuse.
Chronic disease prevention, injury control , health-care for the homeless and
improved perinatal car can give us increased opportunities for intervention.
The Public and Environmental Health Advisory Board would like to offer its
support to the ongoing efforts addressing substance abuse problems in Contra
Costa County.
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3. Acquired Immune Deficiency Syndrome. AIDS has emerged as a life threaten-
ing health issue that will continue to be a top priority by the Health
Services Department throughout the foreseeable future. In Contra Costa
County the cumulative number of cases has doubled during each of the years
1984, 1985, 1986 (See Chart B) . Based on health department projections,
there will be between 400-700 cumulative cases of AIDS diagnosed in Contra
Costa County by 1990.
The AIDS epidemic is especially threatening to drug users, minorities, and
poor people whose socio-economic status contributes to a higher risk for
most diseases. The future cost of AIDS may especially tax the county health
system as these high risk populations turn to the public sector for medical
care. The AIDS Task Force has provided tremendous community support to the
Health Department to effectively develop community education, test sites,
case management, long term care, and death and dying protocols.
4. Perinatal Care. Early access to perinatal care is the major determinant to
a positive pregnancy and healthy baby. Improved nutrition, elimination of
tobacco, alcohol and drug use and psycho-social preparation for parenthood
are important complements to medical monitoring and clinic care.
The advisory board identified perinatal health indices (low birthweight,
infant mortality) as direct reflections of many economic inequalities ende-
mic in our society. While Contra Costa has excellent perinatal outcome
measurements countywide, certain populations have perinatal outcomes that
are unacceptably high. For example:
o In 1984, 554 babies, or 5.4% of Contra Costa babies were born at health
risk because of their low weight at birth (estimated at below 2,500 grams
or 51� lbs. ) . The percent increased to 6.3% in 1985 and 1986. Infant
mortality is also on the rise in Contra Costa County. In 1985 the rate
was 7.1 infant deaths per 1,000 live births for a total of 90 infant
deaths. Twenty-three of the 38 counties which could be ranked had a
better record on low birthweight than Contra Costa County.
o The rate of low birthweight births to black mothers is approximately
2-1/2 times that to white mothers. This racial differential mirrors the
state and national experience.
o Increase in low birthweight births occur in' all parts of the county (west,
central and east) , however, West County continues to have a significantly
higher proportion of low birthweights births. Thirty-one percent of
Contra Costa County's are born to West County residents, while 40% of low
birthweight births are to these mothers.
o Kaiser, Walnut Creek reported that 25% of_women enrolled in prenatal care
admitted to using drugs and/or alcohol during pregnancy. The county run
prenatal clinics report that 14-18% of pregnant women admitted to using
drugs or alcohol , or were strongly suspected for using drugs and/or
alcohol .
-5-
The advisory board would like to address perinatal health issues in con-
junction with substance abuse prevention and nutrition interventions
which have direct impact on pregnancy outcome. Improved access to care,
substance abuse treatment facilities, and employment and educational,
opportunies are pressing needs for low income pregnant women. The Health
Start Program and the Alcohol , Drug Abuse and Pregnancy Task Force
(ADAPT) are tremendous efforts on the part of the entire Health Services
Department and many community agencies to address these issues. These
programs are providing a critical and vital service to all county resi-
dents and deserve continued strong support of all of us who are committed
to public health.
5. Trauma. Injuries, both unintentional and intentional , are the leading cause
of death and disability among children, teens, and young adults. As with
chronic disease and substance abuse, injuries are preventable. Uninten-
tional injuries which include vehicular accidents, drownings, and poisonings
account for 19.6%, and suicides and homicides account for 10.6% of potential
years of life lost before age 65 (Figure C) . While trauma affects people of
all ages and from every background, young children and frail elders are the
two highest risk groups for most injuries. Additionally, the incidence of
most injuries, including motor vehicle injuries, burns, poisoning, falls,
homicides, and assaults, occur with greater frequency in communities that
lack economic resources. For example, in 1986 242 children were injured or
died when they were hit by a car in the county. Over one-third of these
incidents occurred in Richmond.
6. Family/Adolescent Issues. The needs of families and youth are touched by
every conceivable public health issue and cut across boundaries of race,
religion, and socio-econmic status. Unemployment, homelessness, hunger,
mental health, and family planning, are all issues that affect family well
being, yet have not been addressed. Families are as diverse as their needs
and require the support and services that respects this diversity.
Coping with the pressures of every day life can be beyond the capabilities
of families and individuals. Since economic pressures weigh heavily
on thousands of county residents, Contra Costans are confronted daily with
the physical and emotional tolls of poverty or economic hardship. More than
10% of the county's population live in or near poverty. Twenty-eight
percent of the population in both east and west county live on incomes of
less than $10,000 (1980 Census) . Seventy percent of the county's homeless
are members of families with children. Two-thirds of these are single
parent families headed by women. Nearly 30% of emergency food recipients
have recently lost `their jobs. An additional 40°% have had other events that
cause financial crisis such as late paychecks, stolen money, and injuries
preventing work.
Single parents, youth and the elderly are at highest risk for economic
problems. Problems such as teen pregnancy, substance abuse groups) , child,
spouse and elder abuse are all directly influenced. by unemployment and eco-
nomic hardships. Family health and economic stability are often closely
related factors.
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Future Action Steps.
PEHAB is encouraged by the prevention-oriented approach of the Health Services
Department in addressing public health needs in the county. Many Health
Services Department programs are providing excellent services to address both
patient care needs and the social and public policy changes needed for long term
prevention of health problems. Energy and resources are directed at a broad
spectrum of health services, and are stretched to cover extremely pressing
health care needs for county residents. In addition, the department effectively
uses coalitions and advisory boards on a variety of critical health and human
service issues which extends and enhances the work of the county personnel .
They provide an intricate network of community-county relationships geared
towards health promotion and protection, and create an environment amenable to
developing new activities.
The advisory board will work with county staff to become a catalyst for action
in the coming year and has set two priority activities: ( 1) to develop media _
packages on health issues facing county residents; and (2) to initiate chronic
disease prevention activities. These efforts will highlight the efforts of
existing programs within county services, and other community based programs.
( 1) Media Packages on Health Issues : PEHAB , in its investigation of a com-
munity health status, has accumlated a considerable volume of important health
data. This information deserves to be shared as broadly as possible with the
Contra Costa community. Discussions have been initiated by PEHAB with local
media to help publish and disseminate this data. The goal is to generate media
attention on major health problems and community-based solutions that work in
other communities which can be adapted in Contra Costa. Foundation funding is
being sought to support the development of graphic representation of health sta-
tistics to accompany written text.
The advisory board plans to pursue further investigation into innovative solu-
tions to some of the health problems identified. Our investigations are
designed to trigger activity and gain support from organizations and institu-
tions beyond the traditional arenas of the Health Services Department. We will
focus on solutions that can be implemented by businesses, schools, community
agencies, governmental organizations, and others.
(2) Chronic Disease Prevention : The advisory board has identified chronic
disease prevention as an area of outstanding need in Contra Costa County.
Chronic diseases cause over 70°i of deaths in Contra Costa, and on a national
_ level account for more than 30% of years of life lost due to premature mor-
tality. Chronic diseases have traditionally been addressed through promoting
individual lifestyle changes like smoking cessation, and high fiber/low fat
diets. These individualized interventions are important, but have not been
effective in reducing the impact of chronic disease on the broad community.
PEHAB will join with programs within the Health Services Department and the com-
munity in expanding community-based activities for chronic disease prevention.
The smoking control initiative passed by the Board of Supervisors in 1985 is an
excellent example of the type of interventions PEHAB would like to pursue. The
advisory board will work with local institutions to address the social and
environmental structures (workplaces , schools, public places, etc. ) that
influence health.
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Conclusion :
The emerging health issues identified in this report all require aggressive
activity by the Health Services Department. Addressing these issues requires
building on the solid foundation of existing public health programs. The advi-
sort' board is fundamentally committed to maintaining and enhancing the current
effective work of the department.
Contra Costa County has excellent programs with positive results for public
health and safety. However, Contra Costa cannot be satisfied by merely main-
taining the status quo as maior health problems are currently causing undue suf-
fering in the community, or will develop into greatly exacerbated problems in
the future. The advisory board is encouraged by the history of the Board of
Supervisors and county staff in creatively tackling difficult health problems.
We look forward to working with you in making Contra Costa a model community for
health protection.
PEHAB 1
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