weld county public health improvement plan priorities meeting may 10, 2011
TRANSCRIPT
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Weld County Public Health Weld County Public Health Improvement Plan Improvement Plan Priorities MeetingPriorities MeetingMay 10, 2011May 10, 2011
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Today’s PlanToday’s PlanReview identified important issues
◦Brief summaries of data and possible broad strategies
Facilitated group discussion◦Everyone will vote on overall importance,
ability, and capacity to impactResults tallied and presentedDiscuss findings and make group
decision on priority issues based on score results (i.e., “cut points”)
Reflect on the priorities and next steps
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What is the point of choosing What is the point of choosing priorities?priorities?
With limited resources, intensive focus on a few areas, beyond the maintenance of effort, can make a difference
No single agency can not do it alone so we need to garner the resources and energy from other multiple sectors
Identifying a few key areas to collectively focus on results in improvement plans that are doable
Communications and talking points need to be direct and focused
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Where We Want To Go –Where We Want To Go –All residents living, working, and
playing in Weld County will benefit from physically, socially, emotionally, and spiritually enriched environments enhanced by the intentional, collaborative efforts among public & environmental health, health care, social service, education, community organizations and citizens-at-large.
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Weld County Winnable Weld County Winnable PrioritiesPriorities
Infant healthTeen motor vehicle injury
Mental health & substance abuse
Nutrition, physical activity, obesity
Tobacco useTeen pregnancy
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As you review the data …
How important is this health issue? • How many people are currently impacted,
rates of mortality, morbidity? • How many people are at risk, what does
the trend data tell us?• What is the degree of health disparities
inherent in this area?• Does this issue have a severe impact on
the quality of life?• As we consider health care costs, what is
the economic burden of this health issue?
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What is our ability to impact this area? • Do evidence-based strategies or best
practices exist that can make a difference? • Is it likely, that with collective effort, we
can make a difference? • Is there community level readiness and
support for change?
As you review the data…
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What is our capacity to impact this area? • Is there political will and champions to
support the issue?• Are there organizations prepared to take
the lead to move it forward?• Is there an adequate number of staff
available ?• Is there funding available or obtainable?
As you review the data …
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Populations of interest total Populations of interest total reach countsreach counts
Total Population: 252, 000◦ 28% Hispanic/Latino
Children 0 – 18 yrs : 73,000
Teens 15-19 yrs: 20,000◦ Teen females 15-17 yrs: 5,250
Teen mothers (15-17 yrs): 155/yr
Adults 18 – 64 yrs: 165,000Adults 65 and older: 22,000
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Populations of interest total reach Populations of interest total reach countscounts
38,000 (15%) of Weld residents live below the federal poverty level
14,000 (19%) of Weld children live below the federal poverty level
58,000 (25%) of Weld residents under 65 yrs live below 200% of the federal poverty level
Sources: 2009 FPL data from Colorado Health Institute, 2007 US Census SAHIE data compiled by WCDPHE
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Coun
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Q29. What assets can your organization possibly offer to help improve our community's health around any of the priority health issues?
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Using your keypad is easy… but don’t push any buttons yet!
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Your answer will be displayed
Let’s say you press 2/B
The check mark indicates the answer was received properly
Polling OpenPolling Open
Note: after your selection is
displayed the screen will go
blank
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Changing Your Answer
As long as Polling is Open, you can change your answer by pressing any other key.
Polling OpenPolling Open
Note: If you have a problem, let the screen go blank
and then try again
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Practice: Who is your public health hero?
Sara
Jose
phine...
Louis
Pasteur
Jonas S
alk
Albert Sa
bin
Mark W
allace
Oth
er
0% 0% 0%0%0%0%
1. C. Everett Koop
2. Louis Pasteur
3. Jonas Salk
4. Erin Brockovich
5. Mark Wallace
6. Other
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SOME SOME DEMOGRAPHICSDEMOGRAPHICS
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Prior to today, how many of these meetings have you attended?
This is
my fir...
One or t
wo
Three or m
ore
0% 0%0%
1. This is my first
2. One or two
3. Three or more
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What sector of the public health system do you represent?
Public Hea
lth
Envir
onmental
...
Health Care
Socia
l Servi
ce
Educa
tion
Community O
rga...
Citizen-at-l
ar...
Other c
ounty o...
Media
Other
0% 0% 0% 0% 0%0%0%0%0%0%
1. Public Health
2. Environmental Health
3. Health Care
4. Social Service
5. Education
6. Community Organization
7. Citizen-at-large
8. Other county or municipal government
9. Media
10. Other
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Do you work directly with one or more of the target populations?
Yes N
o
0%0%
1. Yes
2. No
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A LITTLE MORE A LITTLE MORE DEPTH ON EACH OF DEPTH ON EACH OF ISSUEISSUE
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Infant HealthInfant Health
Why is this important?◦ Infant mortality is associated with maternal health, quality
and access to care, socioeconomic conditions, and public health practices.
◦ Weld County’s infant mortality rate: 6.3 deaths per 1,000 live births; this translates to about 20–30 infants/yr or about 1 death every other week among 4,000 mothers annually
◦ 2009 CDPHE analysis: Weld’s rate has not changed in the long-term and is far from the goal of 4.5/1,000
◦ A 2003 statewide analysis found that 30% of Weld County’s fetal and infant deaths were preventable.
◦ VLBW infant NICU costs > $3,500 per infant; can exceed $1 million for an prolonged stay
◦ Family financial and emotional costs can also be significant
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Infant HealthInfant HealthWhat can we do?
◦ American College of Obstetrician and Gynecologists Fetal and Infant Mortality Review (FIMR) program is well evaluated/evidence informed
What is our capacity? ◦ Medical, public health, and human service community have
champions and are ready. Health department is prepared to take the lead. Staffing to be determined.
Start-up and long-term funding needs to be identified.
◦ $17 million is dedicated to child health issues by 11 organizations; 112 primary staff, 112 support staff, 28 volunteer staff
◦ Several strong coalitions and/or networks focused on maternal and child health issues – Promises for Children, Early Childhood Council
◦ There are no programs addressing this directly
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Infant healthInfant health
0
1
2
3
4
5
6
7
8
9
10
Ra
te p
er
1,0
00
Liv
e B
irth
s
3 Year Interval
Infant Mortality Rates, Weld, Larimer, El Paso & Colorado,1990-1992 to 2007-2009, 3 Year Averages
Weld ColoradoLarimer El Paso
Weld Trendline
6.3
8.2
6.4
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Preventable deathsPreventable deaths
Table 1. Weld County Infant Deaths, 1997 – 2002Birthweight Fetal Neonatal Postneonatal Total
500 – 1,499 grams
Maternal Health / Prematurity63 deaths
63
≥ 1,500 grams
Maternal Care
38 deaths
Newborn Care
20 deaths
Infant Health40 deaths
98
Total 57 62 42 161
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Infant health is a priority for Weld County.
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
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Teen Motor Vehicle SafetyTeen Motor Vehicle Safety
Why is this important? Motor vehicle crashes are the leading cause of death for U.S.
teens In 2009, about 3,000 teens in the United States aged 15–19
were killed and more than 350,000 were treated in emergency departments for injuries suffered in motor-vehicle crashes.
Young people ages 15-24 represent only 14% of the U.S. population. However, they account for 30% ($19 billion) of the total costs of motor vehicle injuries among males and 28% ($7 billion) of the total costs of motor vehicle injuries among females.
1 out of 6 drivers involved in a crash in Weld county are teens◦ The most cited violation was “inattention to driving”◦ 10% of teens involved in a crash in Weld County were not wearing a
seatbelt.
12% of District 6 students say they rarely/never wear a seatbelt when riding in a car (2007 YRBS)
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Teen Motor Vehicle SafetyTeen Motor Vehicle Safety
What can we do? Programs, policies, and social norms related to
increasing awareness of high-risk driving, creating positive attitudes toward seat belt use, developing safer driving-related skills and decision-making abilities
What is our capacity?◦ DRIVE SMART Weld County is a strong nonprofit community
coalition made up of members of law enforcement, business, insurance, media, concerned citizens, schools, fire departments, and health professionals working to reduce injuries and death from traffic crashes
◦ Current funds < $100,000 / yr plus in-kind resources from coalition Funding sources: MCH, CDOT, Banner, State Farm, All State Staffing <.5 FTE plus 5.0 FTE volunteer hours
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*Rates are per 100,000 teens ages 15-19Source: Health Statistics Section, Colorado Department of Public Health and Environment
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* Rates are hospitalizations to teens age 15-19 per 100,000 population age 15-19 in each regionSource: Health Statistics Section, Colorado Department of Public Health and Environment
Motor vehicle crash hospitalization rates* to teens 15-19, 2007-2009 by Health Statistics Regions
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Disparities in (teen) motor vehicle crashes/deaths
• Males (61% of teen crashes)
• Geography -most crashes happen in southwest but origin of teen drivers is:
• 25% Greeley/Eaton/Ft. Lupton• 34% other cities in Weld • 26% Denver and other cities outside Weld• 15% neighboring cites (Ft. Collins/
Brighton/Longmont)
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Teen motor safety is a priority for Weld County.
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
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Mental HealthMental Health
Why is this important? Mental health disorders are the leading cause of disability in
the US, accounting for 25% of all years of life lost due to disability and premature mortality
Depression and anxiety affect people’s ability to participate in health-promoting behaviors which, in turn, affects physical health
Suicide is the 8th leading cause of death in the Weld County 27% of adults in Weld said their mental health was not good
1 – 7 of the previous 30 days and 14% said their mental health was not good for 1 week or more (Weld 2010 CHS)
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Mental HealthMental Health
What can we do? Ensure supply and access to effective & appropriate mental health &
suicide prevention services Shift norms & address stigma associated with seeking mental health
services Fill community gaps with effective & appropriate program interventions
What is our ability/capacity?◦ Northern Colorado Health Alliance and North Range
Behavior Health are champions in this area NOCOHA has a newly launched initiative called Project Launch -
promotes maternal mental health and early social-emotional health in underserved children (from birth to age 8) who are experiencing or at risk for significant social stressors
◦ About $16 million is dedicated to this area from 7 agencies; with 203 primary staff, 65 support staff, and 31 volunteer staff
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Source: WCSD6 Youth Risk Behavior Survey, WCDPHE
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*Rates are per 100,000 teens ages 15-19Source: Health Statistics Section, Colorado Department of Public Health and Environment
Teen suicideTeen suicide
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21%15%
24%
15%
27%
18%12%
17% 17%13%
18%14%
0%
10%
20%
30%
40%
50% Do you currently have depression, anxiety, or other mental health problem? (YES)
2010 Weld CHS
Disparities in mental health
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Substance AbuseSubstance AbuseWhy is this important? Excessive alcohol consumption is the third leading
cause of preventable death in the US; 5% of US pop. drinks heavily & 15% binge drink
17% of adult Weld residents binge drink; 5% exceeded guidelines for low-risk drinking; 3% drove after having too much to drink (2007-2008 BRFSS, COHID)
28% of WCSD6 high school students binge drink (2007, YRBS)
6% of Weld pregnant moms drank during pregnancy (PRAMS)
2% of households had someone who needed and used alcohol or drug treatment services; another 3% said it was needed by someone but not used
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Substance AbuseSubstance Abuse
What can we do?◦ Shift norms associated with substance use/abuse◦ Reduce youth access (raise prices, promote alternatives)◦ Decrease the appeal of substance products (examining,
publicizing, reducing advertising/marketing and by doing counter-advertising & programming)
What is our capacity?◦ Weld County Prevention Partners is a champion in this area◦ WCPP has a large multiyear federal grant focusing on underage
binge drinking especially among Latinos. In depth readiness assessments have been done in four regions/school districts – Ault RE-9, Fort Lupton RE-8, Johnstown-Milliken RE-5J, and LaSalle, Gilcrest, Platteville RE-1 – to see if underage drinking interventions could be implemented
◦ Over 80% of residents are concerned about alcohol or drug abuse
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Disparities in Substance Abuse (binge drinking)
• Males (higher)• Age (younger higher)• Race (Whites and Hispanics higher)• Income (higher income higher)
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Mental health and substance abuse is a priority for Weld County.
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
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Nutrition, Physical Activity, & Nutrition, Physical Activity, & ObesityObesity
Why is this important?◦ Increased the risk for:
Coronary heart disease, type 2 diabetes, cancers (endometrial, breast, and colon), hypertension, dyslipidemia , stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, gynecological problems (abnormal menses, infertility)
◦ US medical expenses alone attributed to both overweight and obesity may have reached as high as $78.5 billion
◦ Weld County resident fruit and vegetable consumption and physical activity levels are below state averages
◦ Weld County’s obesity rate is 25% which is significantly higher than the state rate of 19%
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Nutrition, Physical Activity, & Nutrition, Physical Activity, & ObesityObesity
What can we do?◦ Help change individual’s knowledge and skills
◦ Reduce exposure to foods low in nutritional value and high in calories
◦ Increase opportunities for physical activity
What is our capacity?◦ Healthy Weld 2020, WCDPHE, Banner/NCMC are
champions in this area◦ $6.2 million is dedicated to chronic disease risk factor reduction by 11
organizations; 40 primary staff, 44 support staff and 1.4 volunteer staff are dedicated to this area
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Percent of children aged 2-14 overweight Percent of children aged 2-14 overweight or obeseor obese
Source: Colorado Child Health Survey, CDPHE
HP 2020 Obj: 5%
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Sources: Weld County School District Six Youth Risk Behavior Survey (YRBS), WCDPHE & Colorado YRBS, CDPHE
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Overweight & obesity Overweight & obesity trendtrend
HP 2020 Obj: 15%
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Disparities in Obesity
• Race (Hispanics higher)• Income (lower income higher)• Education (lower education higher)• Geography (Greeley/Evans and
Southeast are higher)
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Nutrition, physical activity and obesity are priorities for Weld County.1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
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TobaccoTobaccoWhy is this important?
◦ Tobacco use is the single most preventable cause of death and disease in the United States
◦ Each year, approximately 443,000 Americans die from tobacco-related illnesses
◦ Tobacco use costs the U.S. $193 billion annually in direct medical expenses and lost productivity
◦ Adult cigarette use in Weld County is decreasing but adolescent cigarette use has not
◦ Chew tobacco rates are higher in Weld County compared to Colorado
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TobaccoTobacco
What can we do?◦ Increase price of tobacco products ◦ Promote comprehensive smoke-free policies ◦ Reduce tobacco advertising and promotion ◦ Implement anti-tobacco education or media
campaigns ◦ Encourage / assist tobacco users to quit
What is our capacity?◦ Tobacco Free Weld County Coalition is a strong
champion◦ 80% of county residents are concerned about
youth tobacco use
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Source: Weld Behavioral Risk Factor Surveillance Survey, WCDPHE Weld County Community Health Survey
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Youth tobacco useYouth tobacco useGenerally, WCSD6 smoking rates are
lower than Colorado’s ◦ In 2007, 15.9% of WCSD6 9-12 grade
students smoked cigarettes.However, smoking rates significantly
increased among white, non-Hispanic youth◦ increasing from 12% to 18% from 2005
to 2007◦ In 2009-2010 HKCS for WCSD6, about
19% smoked cigarettes.
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Disparities in tobacco
• Age (18-34 year olds higher)• Gender (males higher)• Income (lower income higher)• Education (lower education
higher)• Geography (Greely/Evans &
Southeast higher)
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Tobacco use is a priority for Weld County.
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
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Teen PregnancyTeen PregnancyWhy is this important?
◦ Delays in initiating prenatal care, reduced likelihood of breastfeeding, poor maternal mental health
◦ 76% of teens pregnancies were unintended◦ 46% of teens entered into prenatal care after 1st
trimester ◦ Children born as a result of an unintended
pregnancy are more likely to experience poor mental and physical health and poor educational and behavioral outcomes
◦ 8% of Weld teen infants were born at a low birth weight
◦ Direct medical costs associated with unintended pregnancies in 2002 were $5 billion, or an average of $1,609 for each unintended pregnancy
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Teen PregnancyTeen Pregnancy
What can we do?• Develop multi-faceted programs that support prevention• Reduce cost barriers to family planning services and
contraceptives• Increase access to reproductive health services• Provide comprehensive family planning services specifically
designed to meet cultural, age, and gender needs of clients in a variety of settings
• Provide assessment, policy development and planning, and assurance activities to reduce unintended pregnancy rates
What is our capacity?◦ $6.5 million is dedicated to adolescent health issues by
12 organizations; 52 primary staff, 17 support staff, 38 volunteer staff
◦ Over 80% of residents are concerned about teen sexual activity and pregnancy
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Teen (15-17 yrs) Birth Teen (15-17 yrs) Birth RateRate
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Disparities in unintended pregnancy
• Race (Hispanic higher)
• Income (lower income higher)
• Education (lower education higher)
• Geography
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Teen pregnancy is a priority for Weld County.
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
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Health equity/disparities (in any area just mentioned) is a priority for Weld County.
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
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Health care access & utilizationis a priority for Weld County.
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
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PRIORITIZING THE PRIORITIZING THE SIX WINNABLE SIX WINNABLE BATTLESBATTLES
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The three criteriaThe three criteriaHow important? Number of people,
mortality, morbidity, at risk, trend, disparities, quality of life, economic burden
What is the ability to impact? Strategies to make a difference, community readiness
What is the capacity to impact? Political will, organizations to lead, staff, funding
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The first three items…The first three items…Infant healthTeen motor vehicle injuryMental health & substance abuse
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AbilityInfant health
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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AbilityTeen motor safety
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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AbilityMental health & substance
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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CapacityInfant health
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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CapacityTeen motor safety
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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CapacityMental health & substance
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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ImportantInfant health
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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ImportantTeen motor safety
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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ImportantMental health & substance
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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Bubble size = Important
0
2.5
5
0 2.5 5
Ability
Capacity
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The next three…The next three…Nutrition, physical activity,
obesityTobacco useTeen pregnancy
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AbilityNutrition, activity, obesity
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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AbilityTobacco
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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AbilityTeen pregnancy
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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CapacityNutrition, activity, obesity
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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CapacityTobacco
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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CapacityTeen pregnancy
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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ImportantNutrition, activity, obesity
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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ImportantTobacco
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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ImportantTeen pregnancy
1. ...
2. ...
3. ...
4. ...
5. ...
... ... ... ... ...
0% 0% 0%0%0%
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Bubble size = Important
0
2.5
5
0 2.5 5
Ability
Capacity
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Based on your own personal sense of what is important, pick your top two public health priorities.
Infan
t health
Teen moto
r vehicl
e injury
Menta
l health
& su
bsta...
Nutri
tion, physi
cal a
ctivit
..
Tobacco use
Teen pregnancy
Oth
er
0% 0% 0% 0%0%0%0%
1. Infant health
2. Teen motor vehicle injury
3. Mental health & substance abuse
4. Nutrition, physical activity, obesity
5. Tobacco use
6. Teen pregnancy
7. Other
Select as many choices as you want, then push “Enter” on keypad.
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DiscussionDiscussionBased on the data and
discussion, what should be the public health priorities?
If these are our priorities, what should we be doing next?
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QUICK EVALUATIONQUICK EVALUATION
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I learned a lot about Weld County’s six winnable public health priorities.
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
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This was a good process to learn about and prioritize public health issues.
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
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I have a clear sense of what Weld county public health priorities should be.
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
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I am confident that Weld County can make significant progress over the next few years on its priorities.
Stro
ngly Agree
Agree
Neutra
l
Disa
gree
Stro
ngly Disa
gree
0% 0% 0%0%0%
1. Strongly Agree
2. Agree
3. Neutral
4. Disagree
5. Strongly Disagree
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THANKS FOR THANKS FOR PARTICIPATINGPARTICIPATING
Please leave keypads at your place.