Annual Health Report
The Florida Department of Health in Seminole County
COMPILED BY
EDITED BY
LAYOUT AND DESIGN
Zeenat Rahman, MBBS, MPH Epidemiologist, Public Health Planning and Policy Research, Florida Department of Health in Seminole County
Donna J. Walsh, MPA, BSN, RN Acting Health Officer, Florida Department of Health in Seminole County
Susan Tolksdorf Former Graphic Designer and Administrative Assistant II, Florida Department of Health in Seminole County
Juley Cetoute, BS CDC Public Health Associate Program (2015-2017), Florida Department of Health in Seminole County Tania Slade, MPH Epidemiology Program Manager, Florida Department of Health in Seminole County
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Tiffani McDaniel, MS Former Public Information Officer and Communications Manager, Florida Department of Health in Seminole County Dr. Swannie Jett, DrPH, MSc Former Health Officer, Florida Department of Health in Seminole County Pranav Mehta Operations and Management Consultant Florida Department of Health in Seminole County
PRINTING AlphaGraphics 1061 S. Sun Drive, Suite 1033 Lake Mary, Florida 32746
COVER PHOTO 2015 1st Annual Live, Work, Move Seminole 5k, Sanford, Florida
In This Report
Financial Highlights | Page 5 Healthiest Weight | Page 6 Mobile Health | Page 8 This is Public Health | Page 10 Boots on the Ground | Page 12 Health of the County | Page 14 Programs and Services | Page 22 2016 Goals | Page 30
Florida Health Cleans Up! We give back to the community, adopting a one mile stretch of Airport Boulevard.
www.seminolecohealth.com
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A Message from the Health Officer I am proud to present you with the 2015 Annual Health Report for the Florida Department of Health in Seminole County (DOH-Seminole). This report also provides you a glimpse into the health of the county and opportunities to work collectively to move health indicators in a positive direction.
to provide services through the support of the county. Our collaboration with community partners from unconventional health-related sectors including transportation, business and government will shift the approach to how we build a healthy community for the future.
We continue to invest in our workforce, quality improvement, technology and communities to ensure that we are on the cutting edge of progress. In 2015, the Florida Department of Health as a state agency was awarded Accreditation by the Public Health Accreditation Board. This award holds us accountable to our stakeholders, gives us leverage for funding opportunities and provides communication to the governing entity (Public Health Accreditation Board, 2013).
Thank you to Seminole County Government, Central Florida Regional Hospital, Florida Hospital, Orlando Health, True Health, the Health Council of East Central Florida and many more community partners and leaders who have come together to improve the health of Seminole County. It is with your continued support, I am certain the next year will be healthier than the last!
In the last decade, research has found a person’s overall health and longevity is impacted by more than seeing a doctor every year. External factors such as income, education, and neighborhood, otherwise known as social determinants of health, are shaping how we approach health. We have forged important relationships to address disparities in these areas. The mobile health unit, launched in 2015 to reach our most vulnerable populations, continues
Thank you for allowing us to serve. Sincerely,
Donna J. Walsh, MPH, BSN, RN Acting Health Officer
The Executive Leadership Team The Executive Leadership Team are highly skilled and educated leaders who move the mission of DOH-Seminole. Their various backgrounds and experiences are an asset to the evolving public health system. They are dedicated to forming relationships in the community, motivating staff and creating best practices and high standards.
Meena Joseph, MD Sarah A. Wright, Medical Director MPH, BSN, RN Executive Community Health Nursing Director
John Meyers, BS Administrative Services Director
Our Mission, Vision and Values MISSION To protect, promote and improve the health of all people in Florida through integrated state, county and community efforts. VISION VALUES
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To be the Healthiest State in the Nation. Innovation We search for creative solutions and manage resources wisely. Collaboration We use teamwork to achieve common goals and solve problems. Accountability We perform with integrity and respect. Responsiveness We achieve our mission by serving our customers and engaging our partners. Excellence We promote quality outcomes through learning and continuous performance improvement.
In 2015, operations for DOH-Seminole totaled $9.89 million. Revenue totaled $10 million of which 75% was for salaries; $1.2 million in awarded grants and contracts. DOH-Seminole receives revenue from federal, state and county entities in addition to grants, fees for services provided and insurance reimbursements. We saw a reduction in Medicaid earnings over the past year and are predicting continuing reduction for the coming year, which will play a role in how we do business. Reduced revenue simply means we have to be innovative in how we continue to meet the healthcare needs of our community. Process improvements and organizational restructuring have been implemented to reduce expenses and will continue to be monitored and assessed in the coming year. Additionally, we are seeking other revenue opportunities such as federal and state grants. We are held accountable to our taxpayers for the use of our funds according to Florida Statutes. The federal and state appropriated revenue is for required programs and services which include Women, Infants and Children (WIC), Healthy Start, Family Planning and Public Health Preparedness. *Fiscal year runs July 1 through June 30.
2014
$1.2M Grants and Contracts
$2.7M Federal Revenue
$347,802 Expenses
2015
INCOME County Revenue
$
General Revenue
807,970
$
807,970
3,369,660
2,793,808
Clinic Fees
476,117
491,909
Vital Statistic Fees
251,000
210,000
Environmental Health Fees
455,304
643,076
Medicaid
1,332,362
801,410
Medicare
6,200
9,000
2,501,792
2,660,674
Federal Revenue State Revenue Local Grants And Contracts Other Revenue Total Income
$
258,860
216,528
-
1,085,199
494,316
205,426
9,953,581
$
10,000,000
EXPENSES Salaries Temporary Employees Expenses Fixed Assets
7,468,472
7,367,495
670,062
823,025
1,047,224
835,028
68,825
71,665
Acquisition Contract Services
94,440 710,760
620,016
Risk Management
102,772
97,141
Lease/Purchase/Equipment
29,753
28,915
Statewide Contract
45,973
47,194
Less Total Expenses
$
10,238,281
$
9,890,479
TOTAL BUDGET
$
(284,700)
$
109,521
Financial Highlights
Financial Highlights
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Healthiest Weight 6
Healthiest Weight Florida is a public-private collaboration bringing together state agencies, not for profit organizations, businesses and communities to help Florida's children and adults make healthier choices. Healthiest Weight Florida employs five strategies to address behavior and environmental change. Strategy 1 - Increase opportunities for physical activity Regular physical activity can produce long-term health benefits. People of all ages, shapes, sizes and abilities can benefit from being physically active. The more physical activity you do, the greater the health benefits. Being physically active can help: •Control weight •Reduce the risk of cardiovascular disease •Reduce the risk of type 2 diabetes •Reduce the risk of some cancers •Strengthen bones and muscles •Improve mental health and mood •Improve ability to do daily activities and prevent falls in older adults •Increase the chances of living longer
Healthiest Weight Florida in Seminole County We are working with various community partners on the strategies outlined in Healthiest Weight Florida. Each year the State Surgeon General announces the Community Champion Recognition Program, which recognizes municipalities and counties who have implemented “best practice” policies to create healthier communities.
Strategy 2 - Make healthy food available everywhere A number of factors determine what people eat, but access to healthy food and beverages has a major influence. Finding healthy food is not always convenient. Studies have found people buy food that is readily available. Strategy 3 - Promote health in the worksite Staying with a healthy lifestyle while at work can be difficult. Now that many people are spending most of their day sitting at a desk or inside an office, implementing health programs inside the workplace has become a vital part of the healthy lifestyle puzzle. Strategy 4 - Strengthen schools as the heart of health Schools are uniquely positioned to be a national focal point for healthy weight promotion because children spend up to half of their waking hours in school and consume between one-third and one-half of their daily calories in the school setting. Strategy 5 - Market what matters for a healthy life When the messages around us focus on health, it becomes easier to think about making healthy choices. Healthiest Weight Florida seeks to make useful health information and advice available through campaigns, social media and other resources.
Stephanie Fyock, Healthiest Weight Coordinator, DOH-Seminole
Goldsboro Garden Project: Seeds for Change in a Food Desert In 2015, we collaborated with several community partners to implement the Goldsboro Garden Project which provided residents of a designated food desert with resources and education for individual and community vegetable gardening. The initiative is part of the Florida Department of Health’s Healthiest Weight public-private collaboration to help communities make better choices about healthy eating and active living.
The City of Oviedo was 1 of 36 communities in Florida recognized as a Healthy Weight Community Champion. The City of Oviedo has a number of policies in place supporting the objectives of the Healthy Weight Community Champion Recognition Program. Initiatives range from establishing mixed-use zoning districts, requiring bike facilities to be placed in new developments and making sure sidewalks are landscaped properly, among others. The City is proud to receive the recognition and will continue to endorse and enforce policies that promote a healthy environment and a healthy community.
Over 25%
of the Hispanic population in Seminole County eats five or more servings of fruits or vegetables per day! Compared to 6.9% Non-Hispanic Black and 17.3% NonHispanic White.
The City of Sanford through the Healthy Weight Community Champion Recognition Program is proud to announce the City's designation as a 2015 Community Champion. The City has a positive impact on the health in Sanford by providing access to over 38 parks and the RiverWalk fresh fruits/ vegetables every week at the Farmer’s Market held Saturdays in downtown Sanford’s Magnolia Square 10 a.m. to 3 p.m.
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Mobile Health
20% of Seminole County residents DO NOT have health insurance In 2015, DOH-Seminole purchased a mobile health unit to extend services to impoverished communities in Seminole County. The Healthy Seminole Mobile Health Unit became fully operational in part by the gracious contributions of the Seminole County Government and partners. The mobile health unit travels to various locations throughout Seminole County and participates in community events to improve access to healthcare. The homeless, uninsured and underinsured populations are able to obtain health services, screenings and referrals. Services are not limited to specified populations. Services are provided on a walk-in, first come, first served basis including:
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Family Planning – Annual physical, birth control and rechecks, pregnancy testing, vasectomy referrals and free condoms.
Immunizations – Child and adult, flu and pneumonia. Screenings – Diabetes, hypertension, cholesterol, heart disease, Body Mass Index (BMI) and blood pressure. STD, HIV/AIDS, Hepatitis – Testing, screening and education. Referrals – Follow-up care, smoking cessation and more. WIC—Nutrition and breastfeeding counseling and WIC EBT eligibility. The Mobile Health Unit has agreements to visit various locations throughout Seminole County including Remington Inn, Grace & Grits, Rescue Outreach Mission in Sanford, Goodwill Industries in Sanford and other locations and events as requested.
The Mobile Health Unit is graciously funded by community partners: Seminole County Government Orlando Health South Seminole Hospital True Health Healthy Start Coalition of Seminole County WIC Program, Florida Department of Health in Seminole County
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This is Public Health 10
DOH-Seminole collaborated with Florida Hospital for Children, the Jordan Smelski Foundation for Amoeba Awareness and the Florida Department of Health in Orange County to host the Amoeba Summit 2015 on Friday, September 11. The Amoeba Summit joined together public health professionals, clinicians and specialists in a national conversation to spread awareness about risks, treatment and research associated with Naegleria fowleri amoeba. The summit was a live-streamed event which drew viewers from the U.S., Canada, Pakistan, and Germany. In 2014, the Jordan Smelski Foundation for Amoeba Awareness was established in memory of Jordan Cole Smelski who passed away from Primary Amebic Meningoencephalitis (PAM) on July 2, 2014. Naegleria fowleri is an amoeba found around the world, often in unchlorinated pools and warm or hot freshwater such as lakes, rivers and hot springs. If contracted through the nose it can lead to PAM. The foundation’s primary goal is to increase awareness about the risks associated with amoebas and to inform the public of best practices for the prevention of PAM.
On January 20, 2015, the Florida Department of Health kicked off the Healthy Promise campaign. It was a state-wide campaign encouraging citizens and employees to make a ‘Healthy Promise” for 2015. Our Department made over 50 promises!
DOH-Seminole hosted the first annual Men’s Health Challenge to empower men to take charge of their health. Did you know? Men of all ages are 5 times more at risk of dying due to suicide than women (2014). The rate of suicide was 5 times higher in men than women in 2014 in Seminole County, mostly due to gunshot.
National Public Health Week 2015 Each year, DOH-Seminole celebrates National Public Health Week. The purpose of the week is to celebrate our work in the community and educate residents about public health services in Seminole County. We hosted the first annual Live, Work, Move Seminole 5k in downtown Sanford, along with a Health and Wellness Fair.
Veteran’s Stand Down DOH-Seminole hosted the 3rd Annual Veteran’s Stand Down with the Seminole County Government Community Services Division. The stand down provides veteran’s with free haircuts, resources and medical exams. We partner with IDignity to provide birth certificates so veteran’s are able to obtain IDs.
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Boots on the Ground 12
We achieve our mission by being involved in community events, educating people about health and healthy options, surveying the county for disease and celebrating achievements related to the various factors that can affect the health of our population—income, education, ethnicity and access to care. In 2015, the agency participated in 75 events throughout Seminole County.
The Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), ministries of health of Guinea, Liberia, Nigeria, Sierra Leone and other international organizations collaborated in response to an outbreak of Ebola Virus Disease (EVD) in West Africa, which was first reported in late March 2014. EVD continued through most of 2015. EVD is characterized by a sudden onset of fever and malaise, accompanied by other nonspecific signs and symptoms, such as myalgia, headache, vomiting and diarrhea. The magnitude of the outbreak caused widespread concern about the possibility of introduction of the virus in the U.S.
We Responded It is our job to monitor disease threats and keep the public informed and prepared. Our preparedness activities included:
partners in Seminole County through the DOHSeminole Epi Gazette newsletters. Further, communication was provided through Everbridge faxes to over 300 medical providers. In order to prepare our staff and the Region 5 Epidemiology and Environmental Health Strike Teams, members were trained on donning and doffing personal protective equipment (PPE) including wearing N-95 respirators, goggles and gloves. Additional training included cleaning and decontamination of Ebola on surfaces per Occupational Safety and Health Administration (OSHA) guidelines (FS-3756). Our epidemiology and preparedness staff ensured hospital care PPE inventories were readily available and stocked and the Region 5 Epi-strike team members were ready for deployment.
DOH-Seminole conducted two meetings with Seminole County Emergency Management team members to keep them abreast on Ebola • Distributing Ebola guidance documents to preparedness. We met with representatives at the hospitals, healthcare providers and Orlando Sanford International Airport, Seminole emergency management contacts. County partners and the CDC Miami Quarantine • Meeting with Orlando Sanford International Station to review their communicable disease plan. Airport and Miami Quarantine Station Ebola twice daily Incident Management Team experts. (IMT) conference calls were held during the start • Participating on twice daily conference calls of the Ebola outbreak. In addition to daily with the State Incident Management Team. conference calls, a daily meeting occurred with our • Participating in regional response planning Ebola Virus Readiness Team (EVRT). Active monitoring of all travelers returning from Ebola through a Central Florida Disaster Medical affected countries was mandated per Executive Coalition webinar. Order of Governor Rick Scott on October 25, 2014. • Educating our staff on how to be prepared in Twice daily in-person temperature checks were the event of a surge of needs. conducted for all travelers. Twenty-one travelers In addition to these activities, we communicated to were monitored from 2014 to 2015 in Seminole over 100 healthcare providers and community County.
Dr. Swannie Jett, former Health Officer, is also a Major in the Air Force National Guard. He assisted in Senegal, Africa in late 2014 and spent the beginning of 2015 educating community partners and organizations about the virus and what we can do to protect our health in America.
Boots on the Ground Spotlight Story Connor Bridge, our CDC Public Health Apprenticeship Program (PHAP) fellow, was part of the CDC Ebola response. He traveled to Sierra Leone in 2014 to help track Ebola patients.
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Population Growth
Race & Ethnicity
Overall, Seminole County has experienced a slow but steady population growth over the past decade. As of Census 2010, the population for Seminole County increased to 422,718 or 15.57% from 365,207 in 2000. While the white population has increased by 9.9%, between the 2000 and 2010 census, the black population grew by 35.5% and other racial and ethnic groups have also shown significant increase over the same time period. The Hispanic population in the same time period grew by 77.9%. According to population estimates for 2014 the population grew to 432,135.
Following national trends, the proportion of non -White residents in Seminole County continues to increase since 1990. According to the 2010 U.S. Census, Seminole County has a non-White population of 31%, with the smallest portion being non-Hispanic Blacks (12%), and 19% of Seminole County residents are of Hispanic or Latino origin.
Languages Spoken English remains the main language of 80.8% of the population five years and over in Seminole County according to the American Community Survey estimates in 2014. The percent of residents who speak a language other than English is 19.2%, and those who do not speak English well were estimated to be 6.3% in 2014. Of all the residents speaking a language other than English at home, the most common language was Spanish. The number of Seminole County residents that speak Indo-European languages combined is 14,163 and Asian/Pacific Islander languages combined is 7,922.
Age The largest group of residents in Seminole County by age in 2014 was 45 to 64 followed by the 25 to 44 age group, each comprising approximately 27% of the population. However, since 2000, the 25 to 44 age group decreased by 1%, while those in the age group 45 to 64 increased by 36%. The median age in Seminole County in 2014 was 38.9 years. Seminole County Population Estimates: 2010
Health Insurance Coverage According to the 2013 Behavioral Risk Surveillance System (BRFSS) survey, the percentage of adults having health care coverage in Seminole County was higher than the state. Hispanics had the lowest percentage of health coverage in Seminole County and Florida compared to whites and blacks. Health Insurance Coverage by Race & Ethnicity, 2013
Source: Population estimates are provided by DOH-Seminole, Office of Health Statistics and Assessment in consultation with the Florida Legislature's Office of Economic and Demographic Research (EDR).
Seminole County Population by Age (2000, 2010, 2014)
Population
Health of Seminole County 14
Demographic and Socioeconomic Status
Source: Bureau of Labor Statistics
Age in years
Unemployment Rates Source: Bureau of Labor Statistics
55%
of the Hispanic Population in Seminole County does not have health insurance.
Historically, the unemployment rate in Seminole County has been lower than the national rates. As the nation’s unemployment rate nearly doubled over the past ten years, so has the rate in Seminole County; the unemployment rate for Seminole County tripled from 2005 to 2013 (3.8 to 11.8) and remained slightly higher than the state rate in 2014.
To raise awareness of the importance of early childhood development, the health department co-sponsored with the Healthy Start Coalition of Central Florida the documentary “The Raising of America� which premiered at the Oviedo Regal Cinema.
Rate per 100,000
Annual Unemployment Rates, 2005-2014
Economic Status Source: Bureau of Labor Statistics
Education Educational attainment of Seminole County residents has little resemblance to that of the nation and the state. According to 2014 estimates, 24.5% of Seminole County residents have at least a high school diploma compared to the U.S. estimate of 28.4%. Approximately 5.1% of Seminole County residents, 25 years and older, did not earn a high school diploma, compared to 8.1% for the state. Seminole County had higher percentages of residents with some college education or degrees compared to the state and the nation. Whites (35.9%), Blacks (22.6%) and Hispanics (28.3%) attained bachelor degrees.
According to the 2014 American Community Survey estimates, the median household income in Seminole County was $57,875. This was 8% higher than the median income for the nation, which was $53,482. Approximately 19% of Seminole County households have annual incomes under $25,000. According to the 2014 American Community Survey estimates, Seminole County has lower percentages of households with income less than $50,000 compared to the nation. Seminole County Annual Family Income, By Race and Ethnicity, 2014
Seminole County Educational Attainment: 25 years and older, ACS 2014
Source: U.S. Census Bureau & 2014 American Community Survey
Seminole County Annual Household Income, 2014
Source: U.S. Census Bureau & 2014 American Community Survey
Seminole County Educational Attainment: 25 years and older by Race/Ethnicity, ACS 2014
Source: U.S. Census Bureau & 2014 American Community Survey
Source: U.S. Census Bureau & 2014 American Community Survey
Federal poverty thresholds are defined by the U.S. Department of Health and Human Services and vary by size and composition of the household. In 2014, 11.6% of the Seminole County population was living below poverty level (a family of four was considered living below poverty level if their household income was less than $23,850). A higher percentage of Black (33.6%) and Hispanic (21.8%) households had incomes below $25,000 than White (10%) households in Seminole County.
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The total number of deaths from all causes in Seminole County in 2014 was 3,197. The ageadjusted death rate from all causes was 672.9 per 100,000. This was lower than the rate for Florida (683.6). Seminole County death rates in 2014 for both genders were lower than the state statistics; the rate for male residents was 40% higher than the rate for females (800.5 compared to 571.6 per 100,000) in all races.
Rate per 100,000
Age Adjusted Death Rate (All Causes) by Gender, 2014
Rate per 100,000
Age-Adjusted Death Rate (All Causes) by Race, 2005-2014
Malignant neoplasm, commonly known as cancer, was the number one cause of death in Seminole County during 2014, accounting for 28% of all deaths. In addition to cancer, the other top causes of death were heart disease, chronic lower respiratory disease (including COPD), stroke/cerebrovascular disease and unintentional injuries. Seminole County males had higher death rates than females for each of the top ten causes of death during 2014. Malignant cancers were the leading cause of deaths across all races. Blacks had a higher death rate from cancer, stroke, diabetes, pneumonia and kidney diseases, while the age-adjusted death rates for heart diseases, chronic lower respiratory diseases (CLRD), suicide, unintentional injuries and Alzheimer’s disease were higher in Whites. White males had a higher rate of cancer, CLRD, and unintentional injuries; while Black men and women had a higher rate of heart disease, stroke, diabetes, kidney disease and hypertension compared to their white counterparts. The rate of deaths due to Alzheimer’s was highest in white females.
Age-Adjusted Death Rate (All Causes) by Race & Gender, 2005-2014
Age Adjusted Death Rate
Leading Cause of Death by Race and Gender, 2014
Rate per 100,000
Leading Cause of Death by Race, 2014
Percentage of Leading Causes of Death, 2014
Age Adjusted Death Rate
Health of Seminole County 16
Causes of Death
Cancer In 2014, the age-adjusted rate of death from all cancer deaths combined in Seminole County (154.6 per 100,000) was slightly lower than Florida’s rate of 155.5. This rate is also slightly lower than the Healthy People 2020 goal of 161.4 deaths per 100,000. However, when distributed by gender, the age adjusted death rate for males
in Seminole County and Florida, and Blacks in Seminole County were higher than the Healthy People 2020 target. Although there are more than 100 different types of known cancers, cancer of the lung/bronchus, prostate and breast are the most prevalent.
Lung Cancer
The age-adjusted death rate for lung cancer in Seminole County decreased from 51.1 per 100,000 in 2005 to 35.9 per 100,000 in 2014.
Female Breast Cancer
Rate per 100,000
All Cancers: Age Adjusted Death Rates Comparison, 2014
the White and Black females in Florida (19.2 and 25.0 respectively). The age-adjusted rate for breast cancer in Black females in Seminole County in 2014 was 40% higher than the rate in Black females in Florida (41.9 compared to 25). Age Adjusted Death Rate: Breast Cancer, 2014
Rate per 100,000
Breast cancer is the second leading cause of cancer death among women. In Seminole County, the age-adjusted death rate for female breast cancer in 2014 was 22.6 per 100,000 population, higher than the rate for Florida (20.1). The ageadjusted death rate for female breast cancer in Seminole County did not meet the Healthy People 2020 target of 20.7 per 100,000. Both White and Black females in Seminole County had a higher rate (20.0 and 41.9 respectively) than
Prostate Cancer
Rate per 100,000
All Cancers Age Adjusted Death Rate by Gender: Seminole County & Florida, 2005-2014
In 2014, the age-adjusted death rate for prostate cancer in Seminole County was 23.3 per 100,000 males, higher than the overall rate for the State (17.3), as well as above the Healthy People 2020 goal of 21.8. Consistent with the state rates for prostate cancer, the rate for Black males in Seminole County was approximately twice the rate for White males (23.4 compared to 14.6).
Rate per 100,000
Age-Adjusted Death Rate: Lung Cancer, 2005-2014
Rate per 100,000
Age-Adjusted Death Rate: Prostate Cancer, 2014
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The BRFSS survey asked participants for their height and weight to compute a Body Mass Index (BMI). The BMI is a calculated index that attempts to normalize weight for height as an indirect measurement of body fat. A BMI of 25 to 29 is classified as overweight and a BMI of 30 or more indicates obesity. In 2007, 61.5% of Seminole County adults indicated they were overweight or obese. This increased to 64.8% in 2010. Twenty-six percent of Seminole County adults are obese. Although this was below the goal (30.5%) of Healthy People 2020, county health officials and the Healthy Seminole Collaboration chose obesity as one of their top five target areas for intervention.
males had higher death rates when compared to females (42.2 compared to 37.5); however, the rate for females in Seminole County was consistent with Florida females. The rate for Blacks in Seminole County was also higher compared to Blacks in Florida (28.2 compared to 25.7).
Heart Disease In 2014, the age-adjusted rate of death for heart disease in Seminole County (147.1 per 100,000) was lower than Florida’s rate of 167.0, and U.S. (167.0), but higher than the Healthy People 2020 goal (110.8 deaths per 100,000). The ageadjusted death rate for heart disease among Seminole County Blacks (122.5. per 100,000) continues to be lower than Whites (151.1 per 100,000), since 2012. Age-Adjusted Death Rates: Heart Diseases, 2014
Age-Adjusted Rate per 100,000
Age-Adjusted Rate per 100,000
Percentage of Overweight or Obese Adults in Seminole County
Chronic Lower Respiratory Disease The age-adjusted death rate for chronic lower respiratory disease (CLRD) in Seminole County in 2014 was 42.4 deaths per 100,000, higher than the rate in Florida (39.3 per 100,000). Seminole County Whites had a higher rate (44.6) than Blacks (28.2). Seminole County Age-Adjusted Rate per 100,000
Health of Seminole County 18
Obesity and Overweight
Age-Adjusted Death Rate: Chronic Lower Respiratory Disease (CLRD), 2014
Healthy People 2020 Goal = 110.8
Age-Adjusted Death Rate: Heart Diseases by Race and Gender, 2005-2014
Source: http://www.floridacharts.com
Asthma In 2013, 8.4% of Seminole County adults participating in the BRFSS survey reported currently having asthma. This was slightly higher compared to the state percentage. The percentage of adults reporting having asthma currently (at the time of survey) shows an upward trend over the years. If managed timely and appropriately, hospitalization due to asthma and associated complications could be reduced. In Seminole County, the rate of hospitalizations in individuals less than 65 years old has shown an increase over time from 68.9 per 100,000 in 2005 to 92.1 per 100,000.
Rate per 100,000
Preventable Hospitalizations Under 65 from Asthma, Seminole County, 2005-2014
Stroke/Cerebrovascular Disease The age-adjusted death rate for stroke, or cerebrovascular disease, in 2014 was 33.5 deaths per 100,000. This rate is slightly below the Healthy People 2020 goal and the state rate of 36.7 deaths per 100,000. Seminole County Blacks had a higher age-adjusted death rate from stroke (55.2 per 100,000) than Whites (35.2 per 100,000).
Seminole County Blacks continue to have the highest age adjusted death rates due to diabetes over the years while the rates have remained steady for Whites in Seminole County and Florida. Percentage of Adults Reporting Diabetes: BRFSS
Age Adjusted Death Rate for Stroke by Race, 2014 Age-Adjusted Rate per 100,000
Healthy People 2020 Goal = 33.8
Age Adjusted Death Rate Trend: Diabetes 2005-2014 Healthy People 2020 Goal = 66.6
Age-Adjusted Rate per 100,000
Age-Adjusted Death Rates from Stroke, 2005-2014
Age Adjusted Death Rate for Diabetes, 2014
Diabetes The age-adjusted diabetes mortality rate was 21.0 deaths per 100,000 for Seminole County in 2014. This rate was slightly higher than the state rate of 19.8. Seminole County Blacks had the highest age-adjusted death rate from diabetes (47.5 per 100,000), which was more than twice the overall rate for Seminole County.
Healthy People 2020 Goal = 66.6
Rate per 100,000
The age-adjusted death rate from stroke in Seminole County has varied from 2005 to 2014, with an overall steady decrease, except in the last two years when there has been an upward trend.
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Birth Rate There were 4,515 live births in Seminole County in 2014. Most of these births (77%) occurred to White women, followed by Black women (15%). Twenty-two percent of these births were of Hispanic ethnicity. Birth rate is calculated as the number of births per 1,000 people. The birth rate was 10.4 live births per 1,000 population in 2014, with the highest birth rate occurring among Black women (13.1) followed by other women (12.3). Almost two-thirds of the live births in 2014 (59%) were born to women 25 to 34 years of age, women age 20 to 24 accounted for 19% of births while women age 35 to 44 accounted for 18% of births. Teenage females (age 15 to 19) accounted for 4% of the live births. Teen births (ages 15 to 19) have decreased nearly 53% over the past 10 years from 368 births in 2004 to 173 in 2014. Approximately 91% of mothers that gave birth in 2014 were high school graduates.
low birth weight, developmental problems and death. Teen births can have adverse long-term social and economic impacts on teen parents, their children and the community. The teen birth rate in Seminole County in the past decade has shown a decline. In 2014, the overall teen birth rate was 11.8, which was lower than the state (21.9) and the national rate (24.2 in 2014). Birth Rates for Teenage Females 15-19 Years of Age Florida and Seminole County: 2004-2014
Rate per 100,000
Health of Seminole County 20
Maternal and Child Health
Prenatal Care Approximately 15.5% of Seminole County and 20.6% of Florida women who gave birth in 2014 did not receive prenatal care during the first trimester. Seminole County and Florida fell short of meeting the Healthy People 2020 goal of not more than 10% of pregnant women failing to receive prenatal care in the first trimester. Black women were less likely to receive prenatal care in their first trimester. In 2014, Blacks had the highest number of mothers (26.2%) that did not receive prenatal care in the first trimester compared to Whites (13%). Women 15-19 years of age were the least likely to receive prenatal care during the first trimester, with 26.2% not receiving such care in the first trimester. Women, 35 years of age and older, were most likely to receive prenatal care, with only 10.5% not receiving care during the first trimester. Teenage mothers (age 15 to 19) were Women without Prenatal Care in 1st Trimester: 2014
Teen Birth Rates in Seminole County The teen birth rate is defined as the number of live births per 1,000 women 15 to 19 years of age. It is important to note the teen pregnancy rates differ from teen birth rates. Teen pregnancy rates represent the number of live births, induced abortions and fetal deaths combined. High teen birth rates are an important concern for a community because teen mothers and their babies face increased health risks and diminished opportunities to build a healthy future. Teenage mothers face a higher risk for premature birth,
more prone to not receiving prenatal care in their first trimester (30.2%).
Our Healthy Start and WIC programs work diligently to educate and ensure access to quality healthcare for pregnant women to improve health outcomes for infants in Seminole County.
Seminole County Percentage of Mothers Not Receiving Prenatal Care in First Trimester by Age:
Infant Mortality Infant mortality is the death of an infant before a child’s first birthday. The infant mortality rate (IMR) is calculated by dividing the number of newborns who die before a year of age by the number of live births during the year. The IMR is reported as the number of live newborns dying under a year of age per 1,000 live births. Infant mortality is an important indicator of the health of a community and its reproductive female population.
Age of Mother
Low Birth Weight In 2014, 339 of the 4,515 live births in Seminole County were classified as low birth weight (LBW) and of these, 62 (or 1.4%) were very low birth weight (VLBW). The rate of low birth weight infants in Seminole County (7.5) was lower than the state (8.7) or national rate of 8.0. The overall county rate was below the Healthy People 2020 goal of 7.8 per 1,000 population; however, in Blacks, the LBW for 2014 was 11.0 compared to 6.8 for Whites.
The IMR for Seminole County in 2014 was 4.9 deaths per 1,000 live births. This rate was lower than the reported rate for Florida and United States (6.0). It also exceeded the Healthy People 2020 goal of no more than 6.0 deaths per 1,000 live births. IMR among Whites was lower than the rate for Blacks (4.1 per 1,000 live births compared to 11.5). Hispanics had the lowest IMR for 2014 (3.1). IMR for Blacks decreased from 2013 to 2014 (from 14.0 to 11.5). Seminole County Infant Mortality Rate (IMR) Time Series 2004-2014
Birth Rates for Females Between Ages 15-19 for Seminole County, Florida & U.S.: 2014
Rate per 1,000
Rate per 1,000
Healthy People 2010 Goal: 4.5 Healthy People 2020 Goal: 6.0
Seminole County Infant Mortality Rate by Race/Ethnicity: 2014
Rate per 1,000
Healthy People 2020 Goal: 7.8
Smoking During Pregnancy and Low Birth Weight Approximately 9% percent of the women who gave birth to a low birth weight infant in Seminole County in 2014 reported smoking during pregnancy. This exceeded the Healthy People 2020 goal of 99% of females abstaining from cigarette smoking while pregnant. Our Tobacco Prevention Program is working closely with the Healthy Start and prenatal programs to ensure every pregnant mother is educated on the effects of smoking during pregnancy.
Rate per 1,000
Seminole County Low Birth Weight: 2014
Healthy People 2020 Goal: 6.0
Seminole County Smoking Status of Mother with Low Birth Weight Infants: 2014
Tobacco Free Florida’s Mission is to protect the people of Florida from the dangers of Tobacco.
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Programs & Services 22
Programs and Services Clinical and Nutritional Health Services Dental Care Offers free pap smears and mammograms to eligible women ages 50-64.
Dental Care for children and adults including exams, x-rays, cleanings, sealants, fillings, extractions and more. Limited urgent services.
Family Planning
Environmental Health
Pregnancy planning and prevention including birth control for men and women, teen health, free condoms and sterilization (tubal ligation and vasectomy), in coordination with local physicians.
County-wide services designed to educate, regulate and inspect facilities and operations for cleanliness, safe food handling and disease control.
Epidemiology
Flu and Pneumonia Shots Flu vaccines are available seasonally; pneumonia vaccines are available year round.
Monitors diseases and investigates outbreaks. Provides disease control education and consultation for the public, physicians and institutions in the community.
Healthy Start
Hepatitis Program
Individualized social services and health care coordination for pregnant women and infants up to age three. Services include risk assessments, case management, childbirth classes, parenting education, smoking cessation support, and referrals for nutrition, counseling and community resources.
Provides counseling, education and testing for Hepatitis A, B, and C. Vaccines for A and B are available for those at risk or who qualify.
Breast and Cervical Cancer Screening
HIV/AIDS Provides HIV/AIDS testing, prevention and treatment including education, medical and case management services. A drug assistance program is available for qualified individuals.
Immunizations/Vaccines Child and adult immunizations such as Hepatitis A and B, Tdap, Polio, HIB, HPV, chickenpox, measles, meningitis and shot records.
Men’s Health Men are able to receive birth certificates, dental care, immunizations, family planning, STD and HIV/AIDS testing, prevention, education and treatment, and chronic disease screenings.
Refugee Health Program Refugee health assessments, immunizations and any necessary follow-up or referrals are provided within 90 days to eligible clients.
School Health Services Serving public and private schools. Services include screening and monitoring, growth and development, dental, scoliosis, hearing and vision. Health education presentations and Teen Outreach Program provided.
Tobacco Prevention Program Provides a comprehensive approach to prevent and reduce tobacco use and exposure to secondhand smoke. Services include education and training. Also oversees a county-wide Students Working Against Tobacco (SWAT) Program.
Tuberculosis (TB) Program
Pregnancy Testing
Testing, diagnostic evaluations, treatment and followup for active TB disease and latent TB infection.
By appointment and same-day appointments.
Office of Health Promotion and Education
School and College Physicals
Partnership development, capacity building and community engagement to coordinate health observances, health education and programs in the community, and employee wellness.
Physical exams to meet the requirement for students enrolling in school.
STD
Provides confidential or anonymous HIV/AIDS testing, Our Locations Sexually Transmitted Disease (STD) testing, prevention, SANFORD | 400 West Airport Blvd. education, treatment, free condoms and teen health. Clinical and Nutritional Services, Birth and Death Travel Vaccines Certificates, Dental Care, STD, HIV/AIDS, Breast and Provides vaccines required and recommended for Cervical Cancer Screening, Epidemiology, Men’s Health, foreign travel as well as information about food and Family Planning, WIC, Healthy Start, Hepatitis, water conditions for the business and pleasure traveler. Immunizations, Refugee Health, School Health, Also offered at Casselberry Office. Tobacco Prevention, Tuberculosis (TB), Health Promotion and Education, Minority Health, and WIC Planning and Policy Research. Provides services for pregnant and nursing women, infants and children up to age five. Provides WIC EBT Card to purchase specific foods to supplement one’s diet. Individual and group nutrition education, counseling and breastfeeding support services available. Also offered at Casselberry Office.
DOWNTOWN SANFORD | 1101 East First St.
Other Services
WIC, birth and death certificates and travel vaccines.
Birth and Death Certificates
MOBILE HEALTH UNIT
Birth Certificates issued after 1930 for the State of Florida. Death Certificates can be issued for a specific time period. Also offered at Casselberry Office.
Environmental Health conveniently located by the County Building Department.
CASSELBERRY | 132 Sausalito Blvd.
Traveling health clinic with various locations throughout Seminole County.
Breast and Cervical Cancer Detection
Employee Wellness Program
The Breast and Cervical Cancer Early Detection Program (BCCEDP) started in Seminole County in 2003 serving approximately 250 women. The program serves women 50 to 64 years of age who are uninsured Florida residents in Seminole, Orange, Lake and Osceola counties. These women are at 200% of the poverty level. Services provided by the BCCEDP are clinical breast exams, screening and diagnostic mammograms, sonograms, biopsies, surgical consults and pap smears. BCCEDP provided 905 breast screening and diagnostic services to women during the 2014-15 calendar year. Seven women were diagnosed with breast cancer and none with cervical cancer or related pre-cancerous conditions. The BCCEDP staff coordinated and presented to the community a Breast & Cervical Cancer Awareness and Survivor’s Celebration Brunch in October 2015. Ruth Garcia, Senior Clerk for the program received the Employee of the Quarter Award for April thru June 2015.
The Employee Wellness Program was established to promote a culture of wellness among the employees of DOHSeminole. In order to promote health in our community, the committee encourages employees to be examples to the clients they serve by promoting healthy lifestyle choices. Members of the Employee Wellness Committee coordinate monthly Encouraging Wellness Lunch and Learns, weekly Wednesday Walks to Wawa, Healthy Happy Hours, physical activity challenges and newsletters to promote employee wellness. The program also coordinated the 1st annual Live, Work, Move Seminole 5K during National Public Health week with nearly 300 race participants.
Our goal for 2016 is to provide 450 screening services to qualifying clients. Community education will be ongoing. We will also continue to build strong partnerships and community liaisons.
Dental Care Program Our Dental Care Program provides services to children with Medicaid. Adults over the age of 20 with Medicaid may be eligible for emergency dental care. The program also sees self-paying patients. Services offered by the dental clinic include exams, x-rays, cleanings, sealants, fillings and simple extractions. In 2015 the Dental Care Program implemented Electronic Oral Health Records and Digital X-Rays. By going digital, we have cut costs in processing liquids, repairs and maintenance of the processor and x-ray developing time. Digital x-rays give off less radiation and are therefore better for our patients and staff. In 2015, the Dental Care Office provided 4,652 services - 1,716 cleanings, 1,704 fluoride treatments and 1,232 sealants. Did You Know? Dental Care partners with Seminole County Government’s Community Services Office who provides free dental services to those who qualify.
Environmental Health Program Our Environmental Health Program works to prevent diseases of environmental origin. Environmental health activities focus on prevention, preparedness and education, and are implemented through routine inspections, monitoring and surveillance of conditions that may contribute to the occurrence or transmission of disease. 2015 Accomplishments • Completed 100% of mandatory inspections. • Scored 90% on water programs State Evaluation. • Expanded Arbovirus Surveillance from 3 Locations to 11 locations. • Permitted One of First Isolation Float Tanks in the State of Florida. In 2015, the Environmental Health staff provided 4,416 permits and/or inspections—110 sanitary nuisance complaints, 560 biomedical waste, 9 body piercing, 629 food hygiene, 501 group care, 60 limited use wells, 36 mobile home parks, 1,309 onsite sewage and disposal, 1,121 public swimming pools, 52 tanning salons and 29 tattoo parlors.
2015 Annual Breast Cancer Survivor’s Luncheon. Florida Department of Health in Seminole County.
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Programs & Services 24
inter-conception care and nutrition education are available to all participating families to ensure the very best start for their babies. Additional Healthy Start services include: • Breastfeeding Support • Family Planning Counseling • Personal Health Care Coordination • MomCare Program • Childbirth Classes • Text4Baby Message Service • Infant Care Education
Epidemiology Disease Reporting and Surveillance Epidemiology is the study of health in populations to understand the causes and patterns of illness. It is also a core public health function. Physicians and other health professionals are required by Florida Statute to report any disease of public health significance to the Florida Department of Health (FDOH). Our Epidemiology Program monitors reportable diseases other than sexually transmitted diseases and HIV/AIDS. Also, program staff members investigate disease outbreaks in order to identify their source, intervene to protect others who may be at risk and identify ways to prevent additional cases. Epidemiology staff also provide disease control education and consultation for the public, physicians, veterinarians, hospitals, schools, daycare centers, nursing homes, animal services and other institutions in the community. In 2015, the Epidemiology Program was published in the Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) for its “Notes from the Field Publication: Primary Amebic Meningoencephalitis Associated with Hot Spring Exposure During International Travel — Seminole County, Florida,” July 2014.
Healthy Start Program The Healthy Start Program is available to all pregnant women and infants in Seminole County. The program is voluntary and eligibility is not based on financial factors. The Healthy Start Program’s core goals are to prevent infant death, decrease the number of low birth weight babies born within the county and improve health and developmental outcomes. The Healthy Start Program care coordination staff coordinate services in the comfort of the client’s home. Services such as psychosocial assessment and counseling, childbirth education, breastfeeding assistance, parenting instruction,
• Health Referrals • WIC Referrals • Mental Health Referrals • Community Referrals
Hepatitis Prevention Program Viral hepatitis is an inflammation of the liver caused by a virus. In Florida, 305,000 residents are infected with Hepatitis C and nationwide, over 4 million people are infected with the Hepatitis C virus. People are at risk of contracting Hepatitis A, B or C from various risk factors such as eating contaminated food prepared by an infected person who did not wash their hands properly (Hepatitis A), to having unprotected sexual contact with an infected person (Hepatitis B) to sharing injection drug equipment (Hepatitis C). As a core function of public health, our Hepatitis Prevention Program offers a variety of preventative services including counseling, testing, access to support groups and more. In 2015 the Hepatitis Program provided 1,466 services including vaccines and outreach participation.
Award Winner! In 2015, the Hepatitis Prevention Program received a Prudential Productivity Award. This award is a testament to the collaborative efforts with community partners such as Orange and Osceola Counties, Hope and Help of Central Florida, Miracle of Love and Vitas Healthcare in working toward the common goal of health equity and prevention of chronic diseases such as hepatitis and HIV/AIDS.
HIV/AIDS Testing, Surveillance and Treatment The HIV/AIDS Program has been providing HIV Outpatient Ambulatory Medical Care with Ryan White Part A funding for over 20 years. Our in-house services consist of acute care office visits, physical exams, follow-up exams, immunizations and laboratory services. We have also contracted with local community specialists to provide specialty care services for those patients who qualify for our Ryan White Part A medical program. These services consist of diagnostic testing, consultations and outpatient surgical procedures in many different specialties. DOH–Seminole also provides HIV/AIDS medication to eligible clients free of charge through the AIDS Drug Assistance Program (ADAP). In 2015, the Program’s Contract Monitoring and Evaluation staff successfully completed its annual program monitoring of the Ryan White Part A Funded Service for Outpatient Ambulatory Medical Care. Plans for 2016 are to continue to provide excellent service to all HIV/AIDS clients within Seminole County and the Orlando Eligible Metropolitan Area (EMA).
Immunizations and Travel Vaccine Program The Immunizations and Travel Vaccine Program clinic provides childhood immunization services through the Vaccines for Children (VFC) program. We also provide routine adult vaccines and travel services. In 2015, the immunization coverage rate was 98% for two-year-old patients. This rate is above the overall state rate of 93% and the state goal of 95%. The one-year-old child coverage rate for 2015 was 98%. This rate is above the overall state rate of 85% and above the state goal of 90%. The Immunization Program also conducted a flu vaccine clinic at the Remington College of Nursing. Clinic Services in 2015 included: • Childhood vaccines and daycare or school entry forms (DH 680, DH 681) • Routine adult immunizations • Travel consult • Travel immunizations and prescriptions for malaria prophylaxis • Lab titers for immunity status • College form completion Did you know? In 2015, DOH-Seminole served over 700 students in a two week period in preparation for back to school.
Office of Health Planning and Policy Research The Office of Health Planning and Policy Research (OHPPR) is a new program added to DOH-Seminole in 2014, with the mission to improve the health of Seminole County through collection and analyses of information on health disparities. The OHPPR administers community health assessments to various targeted communities within Seminole County to collect health information at the subcounty level, and publishes findings in the Seminole Matters newsletter. In 2015, the OHPPR assessed and compiled the
Seminole Matters newsletter with a spotlight on Sanford neighborhoods. The OHPPR is also involved in the Goldsboro Community Garden Project located in the city of Sanford. The goal of this project is to increase access to fresh healthy foods in Goldsboro by growing seasonal vegetables in self-watering garden containers distributed by DOHSeminole through the Healthiest Weight Florida initiative. The OHHPR also partners with community leaders to collaborate on events and activities throughout the county and perform health assessment surveys in targeted communities. One major task of OHPPR is to set up a chronic disease surveillance system in Seminole County.
Office of Health Promotion and Education The Office of Health Promotion and Education (OHPE) was developed in May 2015 to promote and coordinate health observance events and provide chronic disease prevention education and screenings. The OHPE manages the following programs and services to meet the needs of our employees and community: • Employee Wellness Program and Committee • Grants Administration and Grants Committee • Health Education and Community Outreach • Healthiest Weight Florida Initiative • Reach and Connect Outreach for Breast and Cervical Cancer Screening The OHPE engaged community partners and hosted events such as the Evergreen Cemetery Veterans Day Event, Greater Winwood Health and Resource Fair and the first annual Men’s Health Challenge in 2015. The OHPE increasingly directs its focus to outreach and preventative care. The OHPE staff continually seek partnerships with non-profit organizations, faith-based organizations, youth groups, schools, health providers and other community and private sectors to positively impact social determinants of health. Did you know? The Reach and Connect Program received grant funding to provide breast and cervical cancer education and referral services for screenings to eligible women residing in Seminole, Orange and Lake Counties.
Office of Men’s Health The Office of Men’s Health (OMH) is a new endeavor for Seminole County’s public health agenda. The office was developed because today’s men in Seminole County face barriers to good health. A report provided by the Office of Health Planning and Policy Research summarized: • Disease of the heart is 49% higher for Seminole County men than women • Stroke is 16% higher among Seminole County men than women • Men’s life expectancy is approximately 7 years less than women • Cancer death rate is 26% higher for men than women • Suicide rate for men is 4 times higher than women
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Programs & Services 26
The mission of the OMH is to serve Seminole County males ages 12 and older to provide healthcare education, screenings and support services to promote healthy lifestyles and emotional wellness. This will lead to disease prevention and improved quality of life. The goal of the Office of Men’s Health is to develop a forum for men to voice their concerns regarding their health care needs. These focus groups will be convened to understand the male perspective on preventive care.
Office of Minority Health The Office of Minority Health was established in July 2013 as the Minority Health Task Force and reestablished in 2015 as the Office of Minority Health. Its primary goals are to coordinate specific events and projects which focus on the health of minority populations in Seminole County disproportionately affected by infant mortality and chronic health conditions such as diabetes, obesity, heart disease and cancer, as well as to reduce and eliminate racial and ethnic health disparities. The Office of Minority Health supports the mission of the Florida Department of Health to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts. These efforts aim to ensure all community members are equally respected, treated fairly, valued and have equal access to grow and reach their optimal potential. Membership is voluntary consisting of individuals from DOH-Seminole and the local community. Did you know? No Limit Health and Education in association with DOH-Seminole’s Office of Minority Health hosted the Third Annual Seminole County Day of Unity and Take a Loved One to the Doctor Day event in October 2015. Our Mobile Health Unit had its debut at the event, providing screening services to 25 residents. Information was provided to 371 registered participants.
Public Health Preparedness Program Our Public Health Preparedness Program has dual responsibilities in preparedness and response. Our primary mission is to protect the
employees, facilities, records, and assets, development of local emergency operations plans and to prevent or reduce employee loss through pre-incident planning, training and exercising. In addition, our main objective is to provide support to core public health services through the coordination of public health and medical system preparedness, response and recovery activities. DOH-Seminole ensures public health services continue to serve the community during natural or man-made emergencies through an efficient and effective coordinated response and allocation of resources through coordination with other community agencies and stakeholders. In Florida, preparedness is operationalized through three overlapping structures: public health and medical, emergency management and domestic security.
Refugee Health Program The Refugee Health Program serves Refugees, Political Asylees and Parolees who have recently immigrated to the United States. Refugee Services in the state of Florida are coordinated by the Florida Department of Children and Families (DCF). Clients are typically referred by our community partners at Catholic Charities and Lutheran Services who work with DCF to resettle refugees in the U.S. The Refugee Health Program provides an initial health history, mental health and physical assessments, conducts a comprehensive laboratory screening for communicable and chronic diseases, provides routine immunizations and immigration form validation for those clients seeking to adjust their immigration status. The Refugee Health Program is highly regarded for providing high quality service, facilitating quick appointments and for its warm and caring staff. In 2015, the program provided 1,351 services including assessments,
Take a Loved One to the Doctor Event, October 2015, Florida Department of Health in Seminole County
appointments and I-693 forms.
STD Testing, Surveillance, Treatment Program The STD Program provides services including exams, testing and treatment for sexually transmitted disease (STD’s) such as HIV, syphilis, gonorrhea and chlamydia. Herpes culture and typing along with wart removals are also conducted for patients needing those services. We have highly trained medical staff including Disease Intervention Specialists (DIS) who counsel, educate and provide clients with methods to reduce their risk of reinfection. Annually, the STD Program provides free testing for HIV and syphilis in April for STD Awareness Month, National HIV Testing Day on June 27th and World AIDS Day on December 1st. Our DIS participate in outreach events and conduct presentations at schools, churches, community centers, jails and colleges. In the past year Seminole County has seen an increase in morbidity for all sexually transmitted infections. Did you know? Our STD Program is now conducting
Year 2014
2014-2015 Year Comparison New Cases of Sexually Transmitted Infections Chlamydia Gonorrhea Syphilis HIV 1,449 297 54 62
2015
1,656
394
89
85
%Increase
+14.3%
+32.7 %
+64.8 %
+37%
Rapid HIV and syphilis testing for you to get your results in minutes instead of weeks. Did you know? Chlamydia affects young adults between the ages of 15 to 24 more than any other age group.
Tuberculosis Program Our Tuberculosis (TB) Program provides TB skin testing, chest x-ray referrals, medications, investigation of active cases, Directly Observed Therapy (DOT), nurse case management and expert medical management for cases and suspects of active TB disease and latent TB infection. Seminole County had five active TB cases in 2015 and all cases of active tuberculosis were treated to completion or are currently being treated. Our TB program continues to perform TB testing on high risk populations. These populations include homeless, substance abusers, HIV infected and previously incarcerated individuals. Use of the new Interferon Gamma Release Assay (IGRA) in our foreign born population has led to greater specificity and compliance in these patients as well. This test has led to greater compliance with medication and completing treatment. The TB program is working with area providers and Civil Surgeons to educate utilizing CDC guidelines.
Did you know? In 2015, the TB Program staff provided 477 total services - 365 TB tests (290 skin tests and 75 blood tests) and conducted 112 TB assessments.
Volunteer and Internship Program DOH-Seminole provides a rewarding experience for volunteers in a state government organization addressing public health needs in coordination with Federal, State and County programs. DOH-Seminole further reflects its commitment to assisting in instruction of effective professionals, developing and promulgating public health knowledge and providing leadership to students as a means of achieving its mission in the community as an academic health department.
Vital Statistics Office: Birth and Death Certificates The Vital Statistics Office provides official records of birth, death, fetal death, marriage and dissolution of marriage. These records are essential for just administration of our law and for the protection of individual rights. In addition, the statistical data from these records are of great value to public health and other agencies. Various agencies such as the Florida Division of Driver’s License, Vital Statistics, Veterans Affairs, Social Security Administration and others, work together symbiotically to provide such services. In 2015, Vital Statistics issued 53 birth certificates to the homeless at IDignity Outreach Events. 2015 Vital Statistic Facts for Seminole County
3,021 Births and 3,491 Deaths.
The peak months of birth in 2015 were January with 285 births, followed by September with 281 births.
The peak months for deaths in 2015 were March with 327 deaths and December with 328 deaths.
Vital Statistics serviced 9,700 clients issuing 28,919 certificates of birth and death. This included 909 electronic requests from funeral homes, 688 requests by mail, 62 online clients via Vitalchek, and 8,041 walk-in customers.
Did you know? On November 23, 2015, we partnered with Vitalchek. Clients can request official birth and death certificates via Vitalchek.com.
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Programs & Services 28
Tobacco Prevention Program Tobacco use is the most preventable cause of death and disease in our society. Tobacco is recognized as a cause of multiple cancers, heart disease, stroke, complications of pregnancy and chronic obstructive pulmonary disease (COPD), and is responsible for over 438,000 deaths in the U.S. each year. We are an active member of the Tobacco Free Seminole Partnership (TFSP), a group of local individuals and community agencies who are committed to a tobacco-free Seminole County. The TFSP mission is to form partnerships with individuals and organizations to educate and serve the citizens of Seminole regarding prevention of tobacco use, intervention and cessation. In 2015, the Tobacco Prevention Program accomplished:
City of Oviedo was the first to ban smoking in Seminole on October 5, 2015 Produced one Point of Sales billboard and 1 Students Working Against Tobacco (SWAT) billboard Achieved 2 voluntary policy adoptions on multiunit housing properties in Seminole County Weston Park in Longwood Heritage Village Created one Tobacco Free Worksite policy Access on Time
The Tobacco Prevention Program creates sustainable infrastructure through: SWAT Sponsored 5K with DOH-Seminole Produced SWAT marketing video
Adopted Midway Park 1st Annual SWAT Bowling Recruitment Event Victoria Galvan was selected as the Statewide Youth Advocacy Board Chair
School Health Services Program The goal of the School Health Program is to minimize health barriers to learning for students in pre-kindergarten through 12th grade. We partner with Seminole County Public Schools
(SCPS) to provide basic health services to students in 66 public schools, as mandated by Florida Statute section 381.0056. The program includes a combined staff of 22 registered nurses, 46 school health aids, 3 licensed practical nurses, 46 health aids, and 5 administrative staff. Seminole County Public School’s vision and hearing screening teams collaborate with DOH-Seminole to ensure the delivery of required services. Basic health services are also available to private schools. Over the past school year, the School Health Program team provided over 750,000 services to more than 66,000 students in Seminole County. In 2014-2015 the program partnered with MicheLee Puppets Inc. and SCPS to offer the EXTREME Health Challenge interactive puppet presentations, which focus on promoting healthier behaviors among youth, at various elementary schools. In partnership with SCPS and Healthy Schools LLC, we were able to make flu mist available in school clinics to help reduce the impact of flu within the population. 66 PUBLIC SCHOOLS SERVED 66,121 Total Students Enrolled K-12 18,552 Vision Screenings1 1,220 referred for follow-up
13,712 Hearing Screenings2 170 referred for follow-up
4,981 Scoliosis Screenings3 134 referred for follow-up
14,129 Growth & Development/BMI Screenings4 2,149 referred for at-risk of obesity 573 referred for underweight
13,403 Oral Health Screenings4 339 referred for dental caries
64 PRIVATE SCHOOLS SERVED 9,329 Total Students Enrolled K-12* 19 School Health Screening Events 1,383 Immunization Records Reviewed for Grades KG and 7th
933 Vision, Hearing and Scoliosis Screenings PUBLIC SCHOOL DATA: 1. Screening data for grades KG, 1, 3 and 6 as mandated by Florida Statute (F.S.). 2.Screening data for grades KG, 1, and 6 as mandates by F.S. 3. Screening data for grad 6 as mandated by F.S., 4. Screening data for grades 1, 3, and 6 as mandated by F.S. Number of unduplicated services provided. *Enrollment data for private schools obtained from the Florida Department of Education Annual Report.
Award Winning! In 2015, the School Health Program received various recognitions including the 2015 Model Practice Award from the National Association of County and City Health Officials (NACCHO) both for program efficiencies.
LEFT TO RIGHT: 2014 Celebrate Literacy Week at Goldsboro Elementary; 2015 Families in Transition Day of Magical Connections at Winter Springs High School.
WIC Proudly Celebrates World Breastfeeding Week
Women, Infants and Children Program Women, Infants and Children (WIC) is a federallyfunded special supplemental nutrition program for lowmoderate income women, infants, and children under 5 years of age. WIC’s purpose is to improve the client’s health by providing nutritional and breastfeeding support during critical periods of growth and development. This occurs through the provision of nutritious foods, nutrition education and counseling, breastfeeding promotion and support and referrals to health and social services. WIC employs two Nutrition Educators and nine Licensed Dietitians /Nutritionists (LD/Ns). The WIC Program in Seminole County is provided at two locations - Sanford and Casselberry. Each location serves 50% of the participants. Florida WIC clients now enjoy the convenience of using a WIC EBT card to purchase WIC approved foods at any of the 45 authorized WIC grocery stores throughout Seminole County.
WIC promotes and supports breastfeeding as the best choice for infant feeding. We maintain high breastfeeding rates through frequent contact with nursing mothers. During the prenatal period, moms-to-be are provided with the education necessary to make an informed decision on how to nourish their babies. After delivery, mothers receive ongoing individual counseling – to ensure every woman has the support she needs to successfully reach her personal breastfeeding goals. WIC employs three International Board Certified Lactation Consultants (IBCLCs), five Certified Lactation Counselors (CLCs) and three breastfeeding peer counselors. WIC also provides breastfeeding support by offering the electric pump loan program for clients that are separated from their babies due to hospitalizations, employment or school.
20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0%
Some of WIC’s 2015 Accomplishments include: WIC participated in 55 outreach events in Seminole County. 155,064 services were provided to WIC clients by our WIC staff. WIC provided services to approximately 7,695 WIC clients per month. Of these 7,695 clients, 23% were women; 25% were infants; and 52% were children.
Did you know? One out of 3 kids in Florida is now considered overweight or obese and 65% of adults are at an unhealthy weight. WIC provides young families the nutrition education to help everyone reach and maintain their healthiest weight!
34% 33% 32% 31% 30% 29% 28% 27% 26%
LEFT TO RIGHT: Seminole Cross Country Event at Seminole State College 2015; Lawton Chiles Middle School Student Health Fair 2015; MicheLee Puppet EXTREME Health Challenge presentations 2014.
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2016 Goals
Priorities, Strategies and Objectives The Strategic Plan provides a guide to help the community extend its reach in conjunction with the direction of the Florida Department of Health. Consistent with previous year’s plans, the Strategic Plan is designed as a roadmap for improving population health. The plan includes a vision of what we aspire to be, as well as a mission statement and values which guide our organization’s behavior and culture. Goals and specific objectives are included so progress can be conceptualized, measured and reported to all stakeholders.
PRIORITY 1. PROMOTE AND IMPROVE POPULATION HEALTH
STRATEGY
Reduce the number of new HIV infections from 72 per year to 65 per year.
Reduce the bacterial STD cases from 1413 per 100,000 to 1300 per 100,000.
Reduce the TB case rate from 2.4 per 100,000 (2010) to 1.0 per 100,000.
Increase the percentage of adults age 65 and older who have had a flu shot in the last year from 47% to 50%.
Reduce the infant mortality rate for “Black & Others” from 7.6 to 6.0.
Reduce the rate of deaths from all causes of unintentional injuries among children ages 0-14 from 7.3 per 100,000 to 5.0 per 100,000..
1.3 Promote Access to Safe, Affordable Housing
Develop a model program for improving housing conditions for vulnerable populations through partnerships with Housing and Urban Development and other local, regional and federally funded agencies.
2.1 Increase the Proportion of Adults and Children Who are at a Healthy Weight.
Increase the percentage of adults who have a healthy weight (BMI of 18.5 to 24.9) from 39.6% (2013) to 43%.
Decrease the percentage of WIC children aged 2 and above who are overweight and obese from 27.9% (2014) to 26.5%.
Decrease the percentage of children screened in elementary and middle school who are overweight and obese from 29.7% to 26%.
Decrease diabetes in the non-Hispanic black population from 10.4% to 9 %.
Decrease hypertension in the nonHispanic black population from 52% to 49%.
Decrease heart disease in the white population from 7.6% to 6.0%.
Decrease the death rate for nonHispanic black females due to breast cancer from 36.1 to 33.
Decrease the rate of prostate cancer in black males from 155.9/100,000 (2010) to 153/100,000.
Develop a chronic diseases surveillance program.
1.1 Prevent and Control Infectious Diseases by Providing Education, Intervention and Community Outreach Activities.
1.2 Reduce the Infant/Child Death Rate
2. REDUCE CHRONIC DISEASE MORBIDITY AND MORTALITY
2.2 Reduce Health Inequity and Health Disparities
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OBJECTIVE - by 12/31/2016
The 2016 Strategic Plan is a revision of the 2013-2015 plan due to the necessary step toward completing national accreditation. The year 2016 will see the completion of a new Community Health Assessment (CHA) and the development of a new Community Health Improvement Plan (CHIP), which will have a strong influence on future plans for DOH-Seminole. The goals of strategic planning at DOH-Seminole are: Ensure the organization continues to accurately identify its strengths, weaknesses, opportunities and threats. Appropriately set challenging goals and objectives. Effectively acquire and allocate adequate resources for achieving our vision and mission.
PRIORITY (2. Continued)
REDUCE CHRONIC DISEASE MORBIDITY AND MORTALITY
3. PROMOTE AND IMPROVE ACCESS TO CARE
STRATEGY 2.3 Reduce the Amount
Reduce percentage of adults engaging in heavy or binge drinking from 13.3% to 12%.
Reduce the percentage of middle school youth who engaged in binge drinking of alcohol from 3.3% to 2.5%.
Make available to staff a minimum of 12 opportunities for physical, mental or nutritional health-related activity.
Reduce the amount of uninsured from 20% to 15%.
Increase mammography screenings for females age 50 to 64 from 67% to 85%. (by 6/30/16)
Increase percentage of adults who have had diabetic screenings from 86% to 89%.
Achieve 100% Implementation of electronic health records in clinical departments and programs.
3.3 Promote and Improve Customer Service and Satisfaction
Provide mandatory training for 90% of staff in customer service culture, skills and practice standards.
Decrease the average wait time for customers to reach the intended recipient via the DOH-Seminole appointment line from 16 minutes to 5 minutes.
4.1 Promote Cross Training
Develop a CHD-wide plan for workforce cross training.
4.2 Improve Internal Agency Communications and Training
Develop and implement a new staff orientation and onboarding process for staff, interns and volunteers.
Provide training to 95% of full time staff on quality improvement theory and processes.
Implement quality improvement infrastructure and processes aligned with state guidelines.
At a minimum, conduct one quality improvement project related to the statewide Healthiest Weight Initiative and one related to Business Administration.
Participate in at least one Lean Six Sigma Green Belt training and project resulting in Green Belt Certification.
Implement an Action plan for at least two items from the 2015 Employee Satisfaction Survey with less than 74% satisfaction rating.
of Excessive Alcohol Consumption 2.4 Provide a Positive, Health-Promoting Work Environment 3.1 Reduce Barriers to Access to Clinical Services
3.2 Implement Electronic ealth Records
4. DEVELOP AN ENGAGED AND SATISFIED WORKFORCE
OBJECTIVE - by 12/31/2016
4.3 Promote a Culture of Quality Improvement and Implement Quality Improvement Infrastructure and Processes 4.4 Address Identified Employee Satisfaction Issues
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A Publication of the Florida Department of Health in Seminole County 400 West Airport Boulevard, Sanford, Florida 32773 Phone | 407-665-3000 | www.SeminoleCoHealth.com