Travis County Commissioners Court

July 24, 2012 - Item 4
Agenda

4 receive update from Austin-Travis County Health and Human Services Department on
A, 2012 critical health indicators report, and
B, city/county interlocal for Public Health and Animal Services.

>> Good morning, judge Biscoe, Commissioners, sherri fleming, health and human services and veterans service.
We have today our partners from the city of Austin, from the Austin-Travis County health and human services department to present to you their report on the critical health indicators for Austin and Travis County, so we welcome them and we'll have each of them introduce themselves; however, I do want to reacquaint you with my colleague carlos rivera, who is moving toward his first anniversary with the city of Austin, and so we are pleased to have him and his staff here today and please introduce yourselves.

>> Kimberly maddux, chief administrative officer.

>> Abigale smith, chief animal services.

>> Carlos rivera, health and human services.

>> Fill wong, medical director and health authority.

>> Welcome to all of you.

>> Thank you.
I want to thank you for the opportunity to come before you, but before we get into our presentation, I want to thank sherri for her partnership and we've been collaborating a lot, you know, meeting the health and wellness needs of our population is extremely difficult especially with a million residents.
With public health so complex there's no one thing that makes a healthy person and there's no one thing that creates and you healthy person.
With that in mind, we have to do a lot of strategic planning and get a sense what it is at its baseline that is creating illness and disability in our community.
That's why we created the critical health document which is a partner document, a complimentary document to the

>> [inaudible] you will be hearing about soon.
It's basically a report card regarding Austin -- the residents of Austin-Travis County's health.
It's really speaks to the issues that are making our population sick and ending their lives prematurely.
Those are going to go a long way in terms of helping to us address the needs of our population and given that resources are scarce it's going to help us really focus those resources in the most appropriate of places.
I'm just going to give you a little bit of information, some background regarding what the health indicators contain.
It's a secondary data draw essentially so we gathered data from a variety of sources and really too a look at the date to the residents and employees see what the population's health is like.
The health indicators include demographic characteristics, leading causes of death, reportable conditions, maternal and child health, cancer, stds, chronic disease conditions, chronic risk factors and suicide data.
If you are a public health geek, you are going to love this document.
It's a little on the heavy side but it's formative in terms of what our population is experiencing and I'm going to turn it over to dr. Wong.

>> Sort of a high level overview of some of the key findings.
This first slide shows the leading causes of death by disease category in Travis County in 2008.
By far cancer and heart disease are the two leading causes of death among Travis County residents.
Cancer is over 1,000 deaths and the leading cause of death in Travis County.
That's -- historically heart disease has been the number one killer but we've already now flipped where cancer is the leading cause of death in Travis County.
And if you look at the cancers and I'll show you that in a little bit.
Lung cancer is the most common form of cancer followed by colorectal and then breast cancer.
About 20% of deaths were caused by heart disease.
Motor vick accidents were the leading cause of death for persons age 15 to 24 in Travis County and that's the same as for the rest of Texas.
Chronic lung disease, tobacco related disease was the fifth leading cause of death.
Diabetes is the seventh leading cause of dealt in the county and remains a significant cause of death for hispanics and blacks.
And there's a similar trend in the rest of the state.
If you look at the age adjusted mortality rates for the three leading causes of death by race and ethnicity in Travis County, you can see that people of different races and ethnicities have different fortlet experience for cancer, heart disease and stroke.
African-americans have the highest rates of cancer and heart disease, significantly higher.
Hispanics have the highest rate --

>> Hold on one second.
Can you tell me why that is, though, because when I started looking at that, I was looking at the causation and -- because I looked at this and I referred someone yesterday and this person asked me why, per se, and I hear, but I'm going to ask questions later on, but I just basically need to get why of a lot of these things and why is that number so significant among african-americans, heart disease and also cancer.

>> For these particular causes of death, there are multiple factors.
Part of it is access to care.
Part of it is risk factors.
There are higher rates of obesity in african-americans.
Also tobacco use and tobacco use rates are associated with all three of those three leading causes of death.
And again, access to care and socioeconomic status is some of the other aspects that all contribute to this burden.

>> Thank you.

>> Some of the most frequently reportable -- reported, notifiable conditions in Travis County are pertussis, salmonella, shigella, strep toe cock Tuesday pneumonia, meningitis, strep group b, strep group a and hepatitis b.
We have actually a more detailed table in the report, but these are just some of the highlights from the report.
Infant mortality rates are one of the key indicators as we look at potential health disparities and this charge shows spy race and ethnicity.
Nationally and for the state of Texas infant mortality is two times higher among african-americans than whites.
Similar disparity in race ethnicity in Travis County.
The three-year average infant mortality rate for african-americans in 2008 was 15 per 1,000 live births, quite and hispanic 5 opinion 1 and ..2 for 1,000 live births respectively.
Some of the reasons for the difference relate to socioeconomic status, access to health care, but there's still a lot that is unknown in terms of specific reasons for these disparities.
These are Travis County maternal and child health indicators also by race, ethnicity.
Two in five births occur with mothers receiving late or no prenatal care.
Through 2006 to 2008 the percentage of mothers identified as black and hispanic with late or no prenatal care was over twice that.
It's often related to access to medical care and low birth weight.
Higher percentages of instant born to black mothers are premature or low birth rate which is seen nationwide.
These same disparities that we see throughout.
As I mentioned, cancer, you know cancer mortality rates overall have been declining the past two decades.
It still is now the leading cause of death in Travis County surpassing the historic leading cause this is heart disease.
In 2008 over 1,000 people died of cancer in Travis County.
And few look at by the specific types of cancer, lung cancer is by far the leading cause of cancer deaths.
Followed by prostate, colon, colorectal and breast are the next most common diagnosed cancer sites.
Deaths from these four cancer account for approximately 50% of all cancer deaths.
If you look at cancer affects men and women at different rates.
In Travis County males typically have higher cancer mortality rates after you adjust for age and there is difference, blacks have the higher age adjusted rates than whites while hispanics have the lows he cancer mortality rates.
Another key indicator in our community is hiv/aids and this is the number of persons living with hiv/aids in Travis County from 2222 to 2010.
What good news due to medical advancements and treatment taken standardization of routine testing more people are becoming more aware of status, monitoring help and seeking treatment.
This graph shows that increase in people living with h.i.v.
And aids over the past decade n 2010 there were 3791 reported persons living with hiv/aids in Travis County.
An increase from 2009 which had 3649.
Again, some successes in treatment but certainly prevention is another area this we need to keep working on.
If we look at number reported primary and secondary syphilis in Travis County by gender, in Travis County the rates are higher than either the state or national rates.
For the state and nation, 201 represented the first overall decrease, however, in primary and secondary syphilis we've seen in ten years.
Travis County ranked 13th among Texas counties for primary and secondary syphilis rates and primary and secondary syphilis rates are significantly more reported among males.
In 2010, 86% of reported case were males, as you can see in this graph.
If we look at heart disease and diabetes, one in 15 adults in Travis County has diabetes.
One in 19 adults has heart disease.
This is pretty similar to adults in Texas and the united states.
As people age, these chronic diseases become even more common in our community and over 65 years of age, one in four older adults has heart disease and one in six older adults has diabetes.
When we look at the preventable causes of death and for many the conditions that we've seen before, tobacco, again, remains the number one preventable cause of death in Austin and Travis County.
In 2008 almost 600 deaths in Travis County were caused by cigarettes and other tobacco products and as we keep saying that's more than aids, crack, heroin, cocaine, alcohol, car accidents, fire and murder and suicide combined and it's entirely preventable t use of tobacco including, diseases such as cardiovascular and cancer of the lung, throat, kidney and pancreas.
More than one in six Travis County adults uses tobacco products such as cigarettes, snuff, chewing tobacco according to our latest surveys.
Another significant risk factor for some of these chronic conditions is obesity.
And obesity and overweight again is a growing problem in the midwest, Texas and Travis County for all ages.
In Travis County one in four adults is obese.
Meaning over 118,000 persons are clinically obese.
Two in five black adults are obese and one in three hispanic adults are obese.
When you look at some of the breakdown of those, adults with lower education and lower income are also more likely to be overweight, obese and the lack of health care coverage associated with a higher prevalence of overweight and obesity.
Adults who report being diagnosed with chronic asthma, diabetes and heart disease have higher prevalence than those without those co-morbid decisions and we see that specifically with diabetes where you can see being overweight and/or obese can be related especially to having diabetes.
And 65% of Travis County adults with diabetes also report being obese.
So the healthier the weight, the less likely you are to have diabetes.
Now, another indicator we've been looking at is suicide deaths.
This is by rate and ethnicity.
Most suicides occurring in city of Austin regardless of gender were among whites.
This is one the disparity goes the opposite way.
Most suicides occur in city of Austin were committed among males.
Among males most were white.
Suicide among females were less common than among males and among females most occurred among whites.
Percentage of asian females committing suicide was higher than asian females.
These disparities are one for suicide that are reversed.
Suicides occur much more commonly among the higher socioeconomic groups than the lower socioeconomic groups.
In summary, the 2012 critical health indicator report is a document to really promote awareness of some of these health indicators internally and externally, guiding efforts to address the needs of the community and fits in with weather's of the community health assessment, and demonstrates the value of public health.
And the document is available on our website.
And so really I want to acknowledge all the work that went into this and carlos' leadership in getting this document done and all the staff that put this together.

>> > I think one of the most telling points is the fact we need to reconsider the way we look at public health.
Generally when public health departments such as counties or Austin's do their jobs well, no one notices because we're in the field of prevention.
However, if you take all the preventable chronic disease related deaths they easily outnumber firearm related deaths, fire related deaths, all other deaths combined are pale in comparison so the almost 3,000 preventable deaths that occurred in Travis County in 2008 which was is last time we have the data.
So we just have to take a real concerted look at what we're faced with and come up with programming that makes sense given our resource.
I want to thank you for the opportunity to come before you and I definitely want to thank sherri fleming, without here this job would be a lot more difficult.
We look forward to working with the court and doing what we can to improve the health and wellness of the population.

>> Let me ask a couple of questions.
And this is a real great report and also some of the indicators of where we are in Travis County.
But also with that I guess what are we doing to educate the public of these particular indicators but not only that the preventable, because a lot of these things are preventable.
And my point is what are we doing aggressively to let the public know, okay, this is where we are today in h.i.v., this is where we are today in heart disease, this is where we are in cancer, this is where we are for syphilis and all these other things that you've mentioned in such a great report.
But what's missing to me is how aggressively we are alerting the public because of our significant average compared to other places in the state in a lot of these particular regards.
What are we doing aggressively to notify the public that this is actually what's going on in our health well-being, health situation here in Travis County?
What are we doing?

>> Well, I think that the most important step that we've taken to date is really aligning our respective departments and making sure that we're working together so that there's no redundancy and, you know, the right hand doesn't know what the left hand is doing.
But equally important is using every source of media, using public programs like the child chip process.
Talks about the population about what health priorities should be.
And we're also talking of leadership across the city and today regarding the fact we need to create better environments to live in, make sure we're addressing food desserts, making our neighborhoods bikable, that we have good school simms. It's a very complicated issue, but it starts, as you said, Commissioner, basic education with the population.
Making the information that we have at our disposal available to them for their everyday use and making it available to them in a format they can readily understand.
That was one of the goals of this report.
Additionally we've -- in my department we've redesigned the department to better focus with the needs of the population.
One of our most vulnerable populations are women and children.
We did not have a division dedicated to that population, now we do and we're going to begin working with sherri to really address that population, particularly infant more facility among african-american women, reaching feels in their homes as opposed to waiting for them to come to us.
We have a enough strategies meant to address that issue.

>> Okay, well, that's really good to know and I guess how we do that, I guess is what we need to focus on.
Some of these sexually transmitted diseases, for example, is something -- these are preventable, most all these things you scud here are preventable things that we can kind of reduce our averages as far as where we are today is where we were years back.
I mean, it's definitely increasing.

>> Yes.

>> So that's what my concern is, to put some kind of controls, educationswise or what we can do, what can the community as a whole do.
Because I think this is a communitywide, it should be a communitywide initiative, in my opinion.
That's just me talking, to make sure that we can wrestle this thing down and get control of it.
Otherwise it may get where it's out of control more so.

>> We have had some successes, I think that the tobacco free project is an example of a successful project, and dr. Wong can speak a little to it, but what we're trying to do is not take incremental steps.
Sometimes you have to take incremental steps, but to take some transformational steps towards really improving the health of the community.
Tobacco cessation -- tobacco use cessation is one of those examples, and dr. Wong can perhaps tell us about that.
It resulted in a two to three percentage point decrease in the use of tobacco which goes a long way in terms of not only improving the quality of life of our residents but also prolonging their lives.

>> All the data that we presented

>> [inaudible] four of the top five chronic disease are directly related to tobacco use.
On that particular behavior has one of the most significant impacts we can on chronic disease and the health burden in our community.
I think the principles, we're to do a lot --

>> [inaudible].

>> So a lot of the principles on that, we did have some federal dollars for doing media campaigns and using -- trying to get the messages out through all the media and also social media, internet types of things, but also principle has really changed the environment.
We talked about making the healthy choice the easy choice.
Some of those same principles as we're moving to physical activity and nutrition to make that healthy choice.
We talked about the work site policies for tobacco free campuses and things like.
That those have such an impact on behavior compared to any other just education and type of efforts that we do.
So all the things that we can do to really make that healthy choice the easy choice will have, I think, great impact on these indicators as anything we can do.

>> Once again I would add one of the more important things is stop working in silos and ignoring one another's efforts.
The closer sherri and I work together the better off we'll be.
The more we expect out of our respective staff to reach out and establish new partnerships to build that better framework for health and wellness in the community the better off we'll be.
We have a limited number of resources when compared to the amount of work that we have before us so, again, it's just about aligning initially and really reaching out to the population in a concerted effort.

>> How do we define obesity?

>> Obesity, there's a body mass index which looks at weight and height of a person and so, like over 30 is considered obese.
When the figure comes out over 30.

>> And that's how it done nationwide?

>> Yes.
These reports.

>> Okay.
Thank you very much.

>> Thank you all.

>> Judge,

>> [inaudible].

>> Is it relevant to this item?

>> Very much so.

>> That microphone is not working.

>> Thank you so much.
I was so impressed by Ron Davis and his hard-hitting questions and there's three of them I've got an answer for.
The first one is why.
Why is this happening.
And it's also related to directly why is this increasing.
And it wasn't covered by any of you all, I'm sorry to say, but it has to do with something that I spoke to and many people speak to here and a lot of people address city council about week after week after month after year and that is why is this increase -- specifically about blacks.
You ask why is this increasing among the black population and I think part of it is because less black families happen to have r.o.
Units meaning reverse osmosis, meaning taking the fluoride out of water.
Fluoride, dr. Wong here, he's sitting right here telling you all lies and not only here but at city hall about fluoride.
It's a horrific death wish that they are inflicting on everybody around the country and for many, many decades now.
So if we face the truth and read the facts about fluoride and not take the hog wash, we would be a whole lot better off, all of our health.
And so that's one of the reasons.
There's less r.o.
Systems among the black population.
You mentioned suicides.
He did mention suicides are out of the -- are exploding with our service personnel.
And it's through the roof.
And, of course, one way I know to stop the killing -- stop that is bring awful our troops home now.
The other thing --

>> Is it relevant to this item?

>> Again what Ron Davis said about why is it happening, why are there so many heavy casualties among blacks and why is this increasing.
They are forced to consume, again, this poisonous toxic sludge which was promoted by others and their kids, pets, gardens, restaurants, and we can all thank dr. Wong for his sociopathic promotion of this toxic sludge, toxic water.
It's in everything.
Tobacco is overrated.

>> Thank you very much.

>> My mother died, my grandmother died --

>> Thank you very much mr. Reeferseed.

>> Not everything is from tobacco.
It has nothing to do with tobacco.

>> Thank you very much.
Interlocal for public health and animal services.

>> Good morning, judge Biscoe, Commissioners, kimberly maddux, chief administrator officer for the Austin-Travis County health and human services and I'll be presenting to you the annual report on the progress of the public health and animal services interlocal agreement.
The first slide is just a recap of the level of services that are included in the interlocal agreement.
Chronic disease, control and other public health related items. Also in the near future you are going to see an amendment to the fiscal year 12 interlocal agreement and that amendment is for the purpose of adding the community health assessment and community health improvement plan to the work statement of the interlocal.
So the community help assessment will become a part of the interlocal agreement as well.
Our expense data is through the end of may.
The total program budget for all the programs that we're listed on the previous slide for fiscal year 12 is $17.9 million.
The county share is 3 million.
As of the end of may our year to date expenditures are 11.7 million and the county share 1.8 million.
At this time the city is projected a 5.7% savings, however our expenses in several programs over the summer do increase.
And so that is just a projection at this point and could be lower than that.
We have 78 performance measures we report to you on missouri's programs. Through March is our latest performance data.
49 of our measures meet and exceed the midyear targets.
Several of our measures have a lot of seasonal activity.
So while they may not have met their midyear target, they are anticipated to meet their target by the indicators of the year when their seasonal activity is complete.
And we do have a couple of measures that we do not anticipate meeting the measures by the end of the year.
One of those is our flu clinics and there are a couple things related to.
That we did a lot of flu clinics towards the end of fiscal year 11.
And due to some location availability, the later season flu clinics may be pushed into fiscal year 13.
So it's not there's going to be an overall less of veil bit, it's a matter of the time line of when those clinics will actually consider.
Also the other item we do not anticipate meeting the goal is our tuberculosis elimination.
They are experiencing a decrease in the false positive and this is a good thing because it means testing methods are more accurate.
With less false positives, that means fewer visits for false positive followups.
That is actually a good indicator that we're not meeting that target.
So for fiscal year 13, the animal services component is separated from the public health interlocal.
The proposed changes fiscally are for the public health side would be increase of $596,000 and for the animal services side increase of $195,000.
Which is a total proposed budget includes $791,000 increase.
The cost drivers that are -- that are driving that increase are the population increases, so the county on the public health side, the county share is based on population.
And the county share of the total population went from 27.37% in fiscal year 12 to 28.21% in fiscal year 13.
And that results in a $71,000 increase in the county's share for the interlocal.
Also fiscal year 13 is changing the way revenue is calculated.
In the past the county has been given 100% credit for all the revenue in our three programs, vital records, std and tb elimination and that is change to go give the county credit for their proportion at population share of that revenue credit.
And then also the largest cost driver as in many years in the past are employee benefit costs.
Health insurance is increasing 3% this year for the city.
The city budget is also including a 3% cost of -- wage adjustment increase for city staff.
And the city is making a change in how they budget for retirement benefits.
In the past a large portion of retirement benefits were budgeted at the fund level which means each department did not have it in their budget to pay the full amount of the retirement.
In fiscal year 13 the city is changing and put the entirety of the retirement, 18%, into the departmental budgets so that's a 10 percent increase on retirement expenses for the department which feeds into the expenses the department pays out and programs list understand the ilat cost methodology includes change five year rate to three year average intake rate resulting in increase of $73,000 to the interlocal.xd I'll be happy to entertain any questions.ni

>> [one moment, please, for change in captioners]

The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.

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