Board of Health Transition Pro.CITY OF DUBUQUE, IOWA
MEMORANDUM
April 13, 2000
TO:
Board of Health
FROM:
Michael C. Van Milligen, City Manager
SUBJECT:
City Board of Health Transition Process
Public Health Specialist Mary Rose Corrigan has submitted an update on the City
Board of Health dissolution transition process and recommends that the City Board
of Health vote on dissolution at their July, 2000 quarterly meeting.
Michael C. Van Milligen
MCVM/dd
Attachment
cc:
Barry Lindahl, Corporation Counsel
Tim Moerman, Assistant City Manager
Mary Rose Corrigan, Public Health Specialist
CITY OF DUBUQUE, IOWA
MEMORANDUM
April 10,2000
'JO: Michael C. V.nM~~~r
FROM: Mary Rose Corrigan,' RN, Public Health Specialist
SUBJECT:
City Board of Health Transition Process
INTRODUCTION
This memo provides information regarding the City Board of Health dissolution transition process and
recommends when the City Board of Health should dissolve.
BACKGROUND
At its December 6, 1999 meeting, the City Board of Health directed me to work on a transition task
. force formed by the County Board of Health in order to assure a smooth transition from having
separate City and County Boards of Health to one County Board of Health. The task force members
included Dr. John Viner, County Board of Health Chair, County Health Department Director Paul Buss,
Mary Pat Breitfelder of Hillcrest Family Services, Barb Moran, Executive Director of the Visiting Nurse
Association, Art Roche, Mercy Medical Center Planning, and Rod Tokheim of Mercy Medical Center
who facilitated the process.
DISCUSSION
The transition task force has assisted the County Board of Health in completing the Community Health
Needs Assessment and Health Improvement Plan (see attached.) The task force is now in the process
of making recommendations for the single county contract from the Iowa Department of Public Health
for budgeting those dollars according to the identified public health needs of the county. This will be
finalized at the April 19, 2000 Board of Health meeting. Following submission of the single county
contract by the Board of Supervisors, which includes funding for senior health, public health nursing,
public health infrastructure, and the home care aide program, the transition task force will continue to
work with the Board of Health on a mission and goals statement and job description for the county
director of public health. That remaining portion of the process is projected to be complete at the end
of June, 2000.
RECOMMENDATION
Because the process will not be complete until the end of June, it is my recommendation that the City
Board of Health wait to dissolve until their July, 2000 quarterly meeting.
. BOARD OF HEALTH ACTION
No action is required at this time.
I will be present at the meeting to answer any questions.
MRC/cj
.
.
.
Community Health Needs Assessment
and Health Improvement Plan Reporting Form
Dubuque County
Section I: Review of Health Status Indicators
April 5, 2000
Table of Contents
A.
B.
C.
D.
E.
F.
G.
Demographic and Socioeconomic Characteristics........................
General Health and Access to Care Indicators............................
Maternal and Child Health Indicators......................................
Chronic Disease ..Indicators..................................................
Infectious Disease Indicators..................................................
Environmental Control Indicator............................................
Injury Control, Occupational Safety and Health and Domestic
Violence and Sexual
Assault...................................................
G(l) Injury Control............................................................
G(2) Occupational Safety and Health.......................................
G(3) Domestic Violence and Sexual Assault...............................
Substance Abuse, Tobacco Use and Problem Gambling
Behaviors..........................................................................
Page 2
Page 5
Page 9
Page 13
Page 16
Page 19
Page 23
Page 23
Page 25
Page 27
Pal!e 30
H.
TJte subcategories are coded as to where the iøformation may be found:
0 ealih Indiotor Traeking System)
Ota
* the Iowa Department of Publie Health
.
.
.
A. Demographit and Socioeconomic Characteristics
Understanding a populationDs age distribution, race and ethnic composition, and income
characteristics is essential to identifying health needs and planning health programs. The
demographic and socio-economic indicators represent important population characteristics
that can have related health attributes.
Demographic and Socio-economic Characteristics:
D Population by age & gender D Median household income
D Dependency indicators D Poverty
D Race/Ethnicity distribution D % children in poverty
D Educational attainment under age 6
D High school drop-outs D % families with children
0 Divorce rate headed by single parent
- Additional community data
Dependency indicators by age:
0 % of persons over 65
in nursing homes 65
D Percent of persons 55 and
over discharged to skilled
nursing facility
10.3%
11.7%
16.0%
State onowa
8.8%
19.1%
2.0%
340.5
$33,436
11.5%
13.7%
17.5%
.
.
.
1. Age Analysis: Compare the county and state percentage of age distribution and describe how
the county age distribution is different from the state. (Note especially the females 15-44 and
the 65 and over age groups as well as the 0 - 5 age group.)
Dubuque County
State of Iowa
Population
Thousands
Population
Thousands
0
0-5
6-13
14-17
Q, 18-24
ë 25-34
C) 35-44
& 45-54
<C 55-64
65-74
75-84
85+
2
4
6
8
0
50 100 150 200 250
fðoX'
:.d~
5'.¡¡Q%'
0-5
6-13 '
14-17
Q, 18-24
S 25-34
0 35-44
& 45-54
<C 55-64
61~'
?a~
t~%'
44t~:
e.~
:5~
fH'o/.
4¡~%/,
51'3%
"3.4%
't9%
i~,%
663~"
:p~/,
~.1'o/,
441%8;.
3.('1%
65-74
75-84
,
3.4%
"1.9%
85+
Percentages refer to percent oltotal.
1998 Estimates. Source: Claritas, Inc.
Percentages refer to percent of total.
1998 Estimates. Source: Claritas, Inc.
. In Dubuque County, 8.2% of the population is age 0-5, compared to 8.1% for Iowa. 41.6%
of women in Dubuque County are age 15-44, compared to 41.4% for Iowa. Retirement age
(65+) residents in Dubuque County comprise 15.1% of the population, compared to 15.9%
for Iowa.
2.
Race/Ethnicity Analysis: Compare the county and state distributions and describe how
the county distribution is different from the state. Looking at your county in comparison
with the state, do you have any racial/ethnic group needing special consideration?
Racial or Ethnic Group Dubuque County State oflowa
Asian and Pacific Islanders 0.7% 1.3%
Black 0.4% 2.0%
Native American and Other 0.1% 0.3%
White 98.8% 96.5%
Total 100.0% 100.0%
Hispanic 0.7% 1.8%
.
I Non-Hispanic
I Total
I Source: /HITS /997 Data
1 99.3%
1100.0%
198.2%
1100.0%
3. Socio-Cultural Demographic Features: Identify any unique features of your county that
may increase risks of a health problem for members of your community (examples:
poverty, high unemployment)
. Recent immigrants to the Dubuque area, particularly those from Bosnia, Marshall Islands,
Mexico, and other Hispanic people have demonstrated a higher than average incidence of
tuberculosis, hepatitis B, and problems with oral health.
. However, these groups also lack basic health coverage when thev arrive. This means that
they do not have access to medical care, both preventative care and acute care, when they
arrive. This increases their risk of health problems. The VNA often spends a lot of Child
Health Program diagnosis and treatment funding and/or VNA client assistance funding to
cover the costs of immediate medical care for these families, until they receive some type of
insurance coverage.
. In addition to the groups that are listed, there is also a small number of Wartburg
Seminary/Divine WordlEmmauslUniversity of Dubuque theological student families
living within our community deriving from a variety of cultures. These families often
have inadequate insurance coverage.
. Is there data on the percentage of the population receiving Medicaid? Food Stamps? FIP?
.
4. Environmental Indicators: Identify the major industries/employers and occupations,
housing conditions, and transportation facilities.
.
Major employers include a manufacturer of large agricultural and construction equipment, a
meat processing plant, and a furniture manufacturer, as well as a number of large medical
and educational facilities, and several large white collar businesses such as insurance
companies.
Housing in downtown Dubuque includes many old homes, many with lead paint hazards.
The City of Dubuque has launched a very aggressive lead hazard reduction program.
.
.
B. General Health and Access to Care Indicators
.
This section provides an overview of health status using general measures of mortality,
years of potential life lost, and life expectancy. The indicators in this section could be
used, for example, to analyze the problem of premature death in conjunction with a
detailed analysis of specific causes. General measures of health care access included in
this category also attempt to quantify the availability and use of basic health services
and the presence of barriers to health access.
General Health and Access to Care Indicators:
0 Mortality rates
0 Leading causes of mortality
0 Health insurance coverage (adults)
0 Population to primary care physician ratio
0 Cause-specific Years of Potential Life Lost
- Additional community data
0 Advance life support emergency care services
* Oral Health (use % of children on Free or Reduced
Lunch Program & population below the poverty
level)
* Health Professional Shortage Designations
(Map Attached)
.
Indicator Dubuque County State of Iowa
Mortality rate (age-
adjusted, per 100,000)- 407.3 422.4
1997
Leading causes of Cause Deaths Cause Deaths
mortality (1997)
Heart Disease 254 Heart Disease 9,109
All Other Causes 100 All Other Causes 4,368
Other Cancer 93 Other Cancer 3,043
Cerebrovascular 61 Cerebrovascular 2,153
Disease Disease
Lung Cancer 53 Lung Cancer 1,776
Pneumonia or Flu 51 Bronchitis, 1,292
Emphysema, etc.
Bronchitis, 42 Pneumonia or Flu 1,209
Emphysema, etc.
Diabetes Mellitus 24 Cancer of Genital 738
Organs
Cancer of Genital 20 Diabetes Mellitus 679
Organs
Arteriosclerosis 16 All Other Accidents 581
Health insurance coverage 90.0% 90.3%
(adults) (1997)
Population to primary care 1,420.8 1,728.8
physician ratio (1997)
Cause-specific Years of Cause Years Cause Years
Potential Life Lost To Age
65 (1997)
Heart Disease 489 Heart Disease 15,68
.
I
Suicide 426 All Other Causes 14,80
2
Other Cancer 410 Motor Vehicle 12,46
Accidents 0
All Other Causes 326 Other Cancer 10,93
6
Motor Vehicle 220 Suicide 7,425
Accidents
Congenital 110 Condo In Perinatal 6,483
Anomalies Period
Diabetes Mellitus 104 All Other Accidents 5,228
Lung Cancer 84 Lung Cancer 5,217
Cerebrovascular 72 Congenital 4,407
Disease Anomalies
Condo In Perinatal 64 Breast Cancer 2,539
Period
Active emergency medical
services certificates per 561.9 480.7
100,000 population (1997)
Source for above indicators: ¡HITS 1997
.
1. Are there any special problems your community faces that restrict access to care?
.
.
.
The only Dubuque County population that is not adequately addressed by
conventional approaches to health care access is Hispanic residents who are not US
citizens. Although there are government programs in place to provide health care
services to this population, they are not served with the same levels of convenience
and hometown access available to the rest of the population. Young women, for
example, must receive prenatal care and obstetrical services in Iowa City, ninety miles
from Dubuque, because they are not Title XIX clients.
In Dubuque County, the only officially designated health services shortage is within the city
of Dubuque, in census tracts 1,2, and 10. Census tracts I and 2 together comprise what is
thought of as the downtown area (the area bounded by Dodge Street, Bluff Street, 17th
Street, Rhomberg Avenue, and the river). In each of these two census tracts, 49% of the
households have income less than $15,000. Census tract 10, which is roughly bounded by
Asbury Road, Carter Road, Kaufmann A venue and Grandview A venue, has 30% of its
households with income less than $15,000, although most of the land there is occupied by
religious and public institutions. These three census tracts are designated as a Medically
Underserved Area (MUA). The Federal government designates a rational service area as
medically underserved depending on its Index of Medical Underservice. This index is
calculated by detennining the values for population to primary care physician ratio; infant
mortality rate; percent of population over the age 65; and, percent of the population in
poverty. More than 35 federal grants and assistance programs are available to areas with
this MUA designation.
Tri-State Occupational Health, Medical Associates, and Mercy Medical Center are not
being
.
.
.
reimbursed for their services, yet they manage a large nwnber of people.
There are estimates available from HA WK-I about how many children are suspected
to be without health insurance. In 1999,42% (312) of the children seen for well child
.
.
exams in the VNA's Child Health Program had no health insurance for their children.
Also, 31 % (228) of the children seen for well child exams had health insurance with a
deductible greater than $200. This is a combined total of73% of the VNA children
without access to health care. (Note that the families served by the VNA are at or
below 185% of the poverty level, and the VNA targets this group of people). VNA
is constantly referring families to Title XIX and HAWK-I. The point is that there are
still kids out there without access to acre, despite HA WK-I's efforts.
. Both well child screening rates and dental screening rates are very important to the
overall health of children in the community. The VNA has several programs that
focus
on insuring that children aged 0-20 years receive regular well child physicals and
dental exams. Although immunization rates need to be maintained, well child exams
and routine dental exams are also very important. VNA feels strongly that
both well child screening rates and dental screening rates should be indicators.
. Many who owe money to their "usual" medical/dental provides (their "medical or
dental home") from previous office visits are not allowed to be seen until thev pav
their past-due bills. This is often the case even if they have insurance to cover the
cost
of the visit for the current illness/problem. The VNA receives many calls from
parents
who cannot take their children to their usual pediatrician, even though they have
insurance for the day's visit. The practices will not allow them back in to see their
usual doctor until they pay their past-due bills. Sometimes these parents schedule
their
children at a different office, but this is not an optimal solution.
. In the discussion of the Medically Underserved Areas (MUA's), is there any way to
report how many children live in these areas, maybe by percentages, or by age
groups?
How about how many elderly live in these areas by percentages, or by age groups?
What about minorities? It would be interesting to note how many of Dubuque's
children, elderly, minorities live in the MUA's.
2. What percentage of your population lacks health insurance coverage? Are there any
special population groups without health insurance?
.
90% of Dubuque County's adult population has health insurance, not quite as high as Iowa
overall, which is 92.3%.
Free or affordable HA WK-I health insurance is available for children age 0-17, but sign-up
has been slow.
Non-citizens (Hispanic, Bosnian, and Marshallese) mayor may not have health coverage.
.
.
.
3. What specialty services are needed but not available in your community? (Examples:
dental health, mental health services)
~
.
.
All but the most specialized medical services are available locally. However, these services
are not available to all because not all providers participate in Title XIX. Dental care and
mental health are the two best examples of this. At present, less than a dozen dentists in
Dubuque accept Title XIX patients. Psychiatric services provided by the large local clinic
are not available to Title XIX patients.
Other specialty services identified include:
. Transportation (especially disabled, elderly)
. Elderly CMI in need of nursing care
. Competitive jobs or supported employment for the disabled
. Housing (ADA) for the disabled.
.
4. Are there any populations not served by language-specific "r culturally knowledgeable
service providers?
.
There are insufficient translation/interpretation services available for Hispanic and Bosnian
residents for essential community services.
5. Is there a choice of primary care providers in your community?
.
Dubullue Countv Primarv Care Physicians
Family Practice Internal OB/Gyn Pediatrics Total
Medicine
Cascade 2 2
DubuQue II 27 12 14 64
Dversville 3 3
Total 16 27 12 14 69
Source: Mercv Medical Center - Dubuaue Planniní!. Department Database
Although 35 of these primary care physicians are associated with Medical Associates Clinic,
there are a total of 9 separate group practices offering primary care services in Dubuque
County, with an additional 8 physicians in solo practice.
6. What are your communityDs disability services? (Examples: assistive technology, sight
and hearing impaired services)
.
.
A few service clubs offer assistance with vision, hearing, and other disabilities.
The Dubuque County Special Needs Society offers financial assistance for special needs
children and adults.
Additional services are available through the school system, Keystone AEA, Goodwill,
Children at Home Program, Hillcrest Family Services Community Supported Living
Program, EPSDT Home Health Services, Child Health Specialty Clinics, Gannon Center,
And Tri-State Blind Society.
.
.
~
C. Maternal and Child Health Indicators
.
The purpose of the Maternal and Child Health Indicators is to provide an overview of the
key components of maternal, infant, and child health and the risk factors that contribute
to ill health and poor outcomes. In addition to the infant mortality rate, these indicators
include important measures of increased risk of death and disability, such as incidence of
low birth weight and receipt of prenatal care. Early childhood mortality and child abuse
indicators are also included.
Maternal and Child Health Indicators:
0 Live Births 0 Child AbuselNeglect 0 Leading Causes of Mortality (Children 1-4)
0 Infant Mortality 0 Domestic Abuse 0 Mothers Who Smoked During Pregnancy
0 Low Birthweight 0 Medicaid Deliveries 0 Mothers Began Prenatal Care in I st Trimester
0 Kessner Index of >'< Child death rate (6 & under) >'< Rate and number of teen deaths by accident,
Prenatal Care - School Attendance homicide, and suicide (10-14); (l5-19)
0 Teen Birth Rate >'< Perinatal Mortality >'< % of Births to Mothers under 20
0 Out-of-wedlock births (Vital Stats ofIowa) (Vital Statistics ofIowa)
- Additional Community Data
.
Indicator Dubuoue Countv State oflowa
Live Births (per 1000 13.1 13.0
DoDulation)
Infant Mortality (per 1000 5.2 6.5
live births)
Out of Wedlock Births 230.9 272.4
I (Der 1000 live births)
Perinatal Mortality (per 10.4 10.4
1000 live births) Source for above: 19981owa Vital Statistics
Kessner Index of prenatal 91.4% 86.1%
care: % Adequate
Kessner Index of prenatal 7.3% 11.6%
care: % Intermediate
Kessner Index of prenatal 1.4% 2.3%
care: % Inadeauate
Teen Births, Age 10-17 6.9 8.7
Der 1000 females
% Births Out Of Wedlock 25.0% 26.2%
Infant Mortality (per 1000 <10 events 6.3
live births)
Neonatal Mortality (per <10 events 4.1
1000 live births)
Post Neonatal Mortality <10 events 2.2
(Der 1000 live births)
Birth Wei¡¡:ht <2500 ¡¡:rarns 6.4% 6.4%
Birth Wei¡¡:ht <1500 0.5% 1.3%
.
Mothers who smoked 16.1% 18.0%
during pregnancy
Mothers who drank during 1.2% 1.3%
. pregnancv
Prenatal Care in 1st 87.8% 86.3%
Trimester
Domestic Abuse (per 472.3 227.1
100,000)
Medicaid Deliveries 26.3% 34.2%
Source for above indicators: 1997 1HITS Data
.
1. Discuss how your county compares with the rest of the state on the maternal and child
health indicators. Identify and include information unique to races or special populations.
.
.
.
The areas that are greater risk than that of the state are infant deaths, low birth weight,
prenatal mortality, and domestic abuse rate.
WIC (Women, Infants and Children) data identifies specific areas of concern for these
populations:
Pregnancv: Young Age/high parity; diabetes, depression, pre-pregnancy underweight,
drinking during pregnancy, no medical care for some.
Breast-feeding Women: breast-feeding complications, congenital defects, dental
problems.
Postpartwn Women: history of neonatal loss.
Infants: underweight and overweight, dilution offormula, sanitation with bottles.
Children: improper use of bottles.
Although 1996 nwnbers show Dubuque County below the state in self-reported use of drugs
and alcohol, Hillcrest-Mercy Maternal Health Center statistics for the year 98-99 indicate
48% of their low income pre-natal patients using tobacco and 9.7% of the patients using
drugs or alcohol.
Dubuque County domestic abuse rate is twice that of the state.
The volwne for preventative protective services, parent education programs and PAT has
been increasing over the last few years. They have done 1,600+ visits. The grant
funding does cover all of these services.
The School District spends 13 million dollars for special needs children attending the
Dubuque Community School District. Many of these children are products of the
problems described under maternal child health; i.e., poor prenatal care and poor newborn
care.
Child Abuse and Neglect needs additional statistics. Nwnber of child abuse cases reported?
Of those cases that were "founded" cases, how many were "neglect" cases? How many
were "abuse"? For sexual abuse cases? Were any children murdered by
their caregivers?
Another thing that was looked at previously by the Healthy Dubuque group was 2nd
pregnancies in our teen population. Are they having second unwa'1ted pregnancies?
.
.
.
.
.
.
.
.
2. Are there any special populations with prenatal problems (Example: race, migrant
workers, illegal immigrants)? If yes, please list.
. The community is experiencing increased numbers of non-citizen immigrants. Over the
past year about a dozen patients were returned to Iowa City because they are not eligible for
Medicaid.
. IHITS 1997 data shows that the low birth weight «2500 grams) for blacks in Dubuque
County is 13.3 versus the state average of I 0.6 for this population.
. Young females who become pregnant while under the influence of alcohol and drugs and
continue to use these during pregnancy.
. Dubuque County has seen an increase in our immigrant and refugee population. There is an
enormous problem with lack of interpreters. Lack of insurance coverage and no means of
payment exist. Special populations are Bosnian and Hispanic. They have little or no
prenatal care, late entry into prenatal care and translation is difficult.
. Those without insurance (including non-citizen and some legal immigrants.)
. Teen parents.
. In addition, there are also some women from the Marshall Islands with problems with
access
to prenatal care.
3. Identify any underlying problems related to low birth weights and infant mortality.
.
. Maternal health clinic data shows (I 0/98 - 10/99) 48% smoking rate and 9.7% with drug or
alcohol use in pregnancy.
. Drug and alcohol use continues to rise.
. Education of pregnant teens on parenting needs to be provided.
. Smoking is also present.
. Accidental infant suffocation (rare but significant event): co-sleeping issue.
. Lack of pre-natal care.
. Lack of insurance.
4. Identify current programs and resources addressing maternal and child health issues.
.
. Hillcrest Mercy Maternal Health Center: pre-natal care
. Visiting Nurse Association (VNA): immunizations/home visits
. WIC (Women, Infants and Children): nutrition
. Department of Human Services: food stamps and Medicaid (Title XIX)
. Turning Point/SASC/Gannon Center: mental health
. Substance Abuse Services Center (SASC) has a women/children program that provides
intense case management services for women while in treatment at SASC.
. VNA: Parent Partnership Program and home visits for new "high risk" moms and infants.
Parents As Teachers (PAT): Cornerstone
. VNA: Child Health Clinics
. School aurses.
. Hillcrest Family Services Programs.
. Private physician offices.
. Dubuque Breastfeeding Coalition
.
. Mercy Healthy Beginnings
. Finley Suite Beginnings
. HIV testing and counseling
. Young Mom's Support Group
. EPSDT infonning and care coordination-education/assistance to Title XIX families to
teach them how to use their Medicaid benefits most appropriately
. Lead program, including the work with the Healthy Homes Initiative
. Well Being program-visits to those that no longer receive FIP benefits
. Parent Partnership Program-Nurse & Family Advocate home visits and assistance to
new parents/young moms to provide education and support
. Voluntary Parenting-provides in-home parenting instruction and support to families
. Access to Baby and Child Dentistry (ABCD) Program, as well as other Oral Health
programs
. Breast and Cervical Cancer Early Detection Program
5. Are there any gaps between needs and available resources?
.
. There is a lack of public awareness about many of these programs.
. Grant money is extremely limited.
. Title XIX reimbursement is significantly lower than the actual cost of providing services.
. Transportation to services is limited.
. Some agencies are insufficiently funded to provide evening hours.
. There is a need for "one stop shopping" for all services.
. There is a serious need for parenting programs for non-teen moms.
. Summertime parenting groups for teen moms are needed.
. Respite care funding is limited.
. Medical coverage for illegal immigrants is limited.
. There is a huge need for residential programs for women and children, and little funding to
develop such programs.
. Few physicians accept Title XIX patients.
. There is always the need for teen mothers and high risk intervention. This program is
out of money.
. Does plan reflect efforts to reduce service fragmentation?
. Does plan reflect duplication of service issues, especially between County & City services?
.
D. Chronic Disease Indicators
.
This section provides an overview of mortality, incidence, and hospitalization rates for
selected chronic diseases that reflect the influence of lifestyle-related risks. The chronic
disease indicators also illustrate the prevalence of several risk factors controllable by each
individual that can play an important role in the prevention and management of
cardiovascular diseases, cancers, stroke, diabetes, and mental health problems.
Chronic Disease Indicators:
Mortality Rate for
0 Coronary Heart Disease
'J Cerebrovascular Disease
0 Cirrhosis
Mortality Rate for
0 Breast Cancer
0 Lung Cancer
0 Colorectal Cancer
0 Cervical Cancer
0 Prostate Cancer
Hospitalization Rate for
0 Total Psychoses
0 Adult Onset Diabetes
0 Asthma (I7 and under)
* Hip Fractures (Females 65 and Over)
Percent population
0 Overweight
0 Smokers,
0 Binge drinking
*Sedentary Lifestyle
*Fruit & Vegetable Consumption
0 Incidence Rate for Cancers
- Additional Community Data
.
Age-Adjusted Mortality Rates per Dubuque County State of Iowa
100,000
Coronary Heart Disease (Mortality Rate) 72.3 80.8
Cerebrovascular Disease (Mortality 23.0 23.3
Rate)
Cirrhosis (Mortality Rate) <10 events 4.2
Breast Cancer (Mortality Rate) 15.8 17.7
Lung Cancer (Mortality Rate) 31.6 34.5
Colorectal Cancer (Mortality Rate) 12.4 13.8
Cervical Cancer (Mortality Rate) <11 events 1.5
Prostate Cancer (Mortality Rate) <10 events 12.6
Incidence Rates per 100,000 (5 year Dubuque County State oflowa
averal!e based on 1996 data)
Breast Cancer (Incidence Rate) 104.5 93.1
Lung Cancer (Incidence Rate)- Female 38.1 31.0
Lung Cancer (Incidence Rate)- Male 71.2 63.9
Colorectal Cancer (Incidence Rate)- 37.5 32.2
Female
Colorectal Cancer (Incidence Rate)- 51.9 44.0
Male
Cervical Cancers (Incidence Rate) 7.7 7.9
Prostate Cancer (Incidence Rate) 139.5 105.3
.
.
Dubu State oflowa
840.1 807.3
669.2 688.2
984.3 1059.4
34.3% 34.5%
23.9% 23.6%
18.8% 18.4%
93.5 261.2
IHITS I997(All reflect 1997 data unless otherwise
1. Discuss how your county compares with the rest of the stat
; on chronic disease indicators.
Identify and include information unique to races or special populations.
. Overall, Dubuque County's mortality rates are lower than Iowa's in the five major cancer
types shown above. In the five-year cancer incidence rates, however, Dubuque County is
higher than the state in breast, lung, colorectal and prostate cancers.
.
2. Are there any special populations with chronic disease problems (Example: race, migrant
workers, illegal immigrants)?
Because of the extremely low numbers of non-white non-Hispanic residents in this county,
useful and reliable comparison rates are not available. Statewide, mortality rates are
significantly higher for blacks than whites in lung cancer, coronary heart disease, and
cerebrovascular disease. Cancer incidence rates are higher for blacks than for whites in
breast cancer, colorectal cancer for females, cervical cancer, lung cancer for males, and
prostate cancer.
.
3. Identify any underlying problems related to chronic disease.
.
The higher smoking rate, of course, translates into a higher five-year incidence rate for lung
cancer.
4. Identify current programs/resources addressing chronic disease.
Both hospitals and all physician groups offer a wide range of preventive and treatment
services. As a regional health care center, most services are available locally in Dubuque.
In addition, numerous associations and self-help groups are available to provide services
and assistance to individuals and families suffering from chronic diseases. Public screening
programs are occurring for blood pressure, colorectal cancer, skin cancer, and depression.
School nurses provide individual, family, and group health education on chronic disease
issues.
.
.
.
.
The VNA has a Breast and Cervical Cancer Early Detection grant that can pay for some
women to receive breast and cervical cancer screening services at local providers, if they
meet the program requirements.
S. Are there any gaps between needs and available resources?
.
.
.
Mercy and Finley hospitals jointly launched a diabetic education center several years ago
which has not been fully accepted by the medical community. Some physician groups in
the community offer counseling to their diabetic patients.
Screening clinics are not as available in other parts of the county as they are in the city of
Dubuque.
Home visit services outweighs the money available. There are 50 - 60 clients on a
waiting list. We have a growing elderly population. Many homemaker visits are being
done by Junior Board volunteers; i.e., grocery shopping, etc.
Improvement and increasing home care services, especially for housekeeping and
medication compliance/judgement are needed.
Does plan reflect efforts to reduce service fTagmentation?
Does plan reflect duplication of service issues, especially between County & City services?
.
.
.
.
.
E. Infectious Disease Indicators
.
The purpose of the Infectious Disease Indicators is to present an overview of available
information on the incidence of reportable infectious diseases in Iowa and to report the
immunization status of Iowa children. Reportable infectious diseases have various causative
agents, distribution patterns, modes of transmission, treatments, and methods of control.
According to the Centers for Disease Control and Prevention, the number of infectious
disease cases is seriously underreported. Even so, surveillance systems are important in
detecting both the causative agents and diseases, and these systems are essential components
of modern prevention and control strategies.
Infectious Disease Indicators;
0 Syphilis 0 Infections by key foodborne pathogens
0 Gonorrhea 0 Basic Series Vaccinations (age 2)
0 Chlamydia 0 Hepatitis A
[J AIDS 0 Tuberculosis
0 Vaccine Preventable Diseases;
- Pertussis - Mumps
- Measles - Rubella
Additional community data
.
Indicator Dubuoue Countv State of Iowa
Number of cases of
vaccine-preventable 4 cases (1997) 217 cases (1997)
diseases
Percent of children
receiving basic 83% (1999) 88% (1997)
immunization series by
age 2 including HepB
Percent ever immunized 20.4% (1994) NA
for pneumonia
Percent over aged 65 75% (1999) 44% (1994)
immunized for pneumonia
Rate of tuberculosis per 4 cases (1999) 2.6 (1997)
100,000
Case rates ofhib and
meningococcol meningitis I case (1997) 53 (1997)
per 100,000
Pneumonia death rate per 56.8 (1997) 42 (1997)
100,000
Percent receiving flu shot 24.7% (1994) NA
in the past year
Percent over age 65
receiving flu shot in the 73% (1994) 63% (1995)
Past vear
Source for above indicators: Healthv Dubuaue Database
Syphilis (reported
incidence, rate per <10 events 2.2
100,000)
Gonorrhea (reported 12.5 45.9
incidence, rate per
.
.
100,000)
Chlamydia (reported
incidence, rate per 135.1 171.9
100,000)
AIDS (reported incidence, <10 events 3.8
rate per 100,000) Infections bv key foodborne Dathol!ens (reDorted incidence. rate Der 100,000):
- Salmonella 20.4 10.4
- Campvlobacteria 48.8 14.9
- Shigella <10 events 3.2
-EColi 14.8 4.0
- Giardia 21.6 12.6
- Cryptosporidium 21.6 2.5
Hepatitis A (reported
incidence, rate per <10 events 17.2
100,000)
Tuberculosis (reported
incidence, rate per <10 events 2.6
100,000)
Vaccine Preventable 4 217
Diseases (total incidents)
Source for above indicators: IHITS 1997
.
1. Discuss how your county compares with the rest of the state on infectious disease indicators.
Identify and include information unique to races or special populations.
.
Some diseases are more prevalent in Dubuque County than in the state as a whole. Specific
areas of concern are childhood immunizations (the percentage of children who are properly
immunized is decreasing), deaths ITom pneumonia, and infections ITom foodborne pathogens.
Currently, TB is a disease of the poor in Dubuque. If those affected are not appropriately
treated, TB may indeed again become a disease affecting the well-to-do.
TB and funding to combat if one case could infect many.
In-home medication management for TB and/or medical management.
When one notes the drop in immunizations, one ought also note the number of families/
children who have no health insurance and either no or exceedingly difficult access to
health care.
While individual physicians may be willing to care for children without insurance, it is
very difficult to get past the appointment makers in the clinics where the physicians
practice.
Dollars to support County immunization rate.
Dollars for Pneumonia immunizations to decrease death. rate in County.
We need consensus for diagnosis, screening and treatment for tuberculosis and other
diseases among the medical community.
.
.
.
.
.
.
.
2. Are there any special populations with infectious disease problems? (Example: race,
migrant workers, illegal immigrants)
.
.
Some Bosnians and Hispanics working in the meat industry. Some have been deported.
.
3. Identify any underlying problems related to infectious disease.
. Improper/inadequate cooking, cooling and/or storage of milk, egg, and meat products,
particularly ground meat products, and other potentially hazardous foods.
. Lack of records for both children and adults.
. Communication and interpreters/translators.
. Tight knit families in living facilities not designed for extended families.
. Immunization rates are decreasing.
.
4. Identify current programs/resources addressing infectious disease.
. Local industry has provided finances for immigrant employees, but this is in danger of being
discontinued and referred to the County. County resources are not budgeted. VNA is
attempting to address these needs.
. County Health Department will be working with schools to educate on control offoodborne
diseases.
. County Health Department will be promoting water testing to assure safe water supplies.
. Pneumonia rate is too high. This will be examined during 2000. There could be some
relationship to outside activity and failure to seek medical attention earlier.
. VNA and physicians are discussing how to improve the immunization rates. May offer
additional clinics to help promote childhood immunization.
. The VNA has 1-4 funding from the Iowa Department of Public Health (IDPH) that is used
to fund the Immunization Clinics. The VNA, Dr. Krish, and Medical Associates are all
Vaccine For Children (VFC) providers. This means that they receive free FVC vaccine from
IDPH for children without health insurance or children on Title XIX.
. The VNA Well Child clinic screens all children for immunization status. If immunizations
are needed, they are given in the clinics.
. The VNA does confidential HIV testing and counseling.
. WIC screens all oftheir participants for immunization need as well.
. Men can be tested for STD's through Hillcrest Family Services, but there is no funding.
. Is there any data available on head lice? This continues to be a problem with our school aged
children.
.
5. Are there any gaps between needs and available resources?
. Financial concerns especially where there is not insurance.
. Heavy caseload for nursing followup.
. There is no free or reduced-fee clinic for males to get tested and treated for sexually transmitted
diseases. The only available resource for women is through Hillcrest Family Planning.
. Followup for TB infection and also for active cases is fragmented between the Dubuque City
Health Department and VNA. Physician offices and the Occupational Health Clinics also assist
in case management. Many services for TB followup not "billable" or covered by insurance.
. Closer look at food borne pathogens in Dubuque County.
. Funding for immunization clinics for children continues to decrease every year. The
immunizatio'1 rates in Dubuque County have decreased as well. This r.1ay be due in part to
the decrease in funding.
Does plan reflect efforts to reduce service fragmentation?
. Does plan reflect duplication of service issues, especially between County & City services?
F. Environmental Control Indicators
.
This category includes a set of indicators related to health factors in the areas of
environmental health.
Environmental indicators available at this time.:
I:l % Children with Elevated Blood Lead Levels
I:l Number of children tested for Lead Poisoning
I:l % of children screened for Lead Poisoning
- Additional community data
I:l Housing Units Built Before 1950
- Number of carbon monoxide poisonings
- Drinking water contaminations
'" Toxic sites
.
State of Iowa
1,239
25,814
11.1%
11.1%
42.8%
1.57 pounds
NA
1. What is your county's percentage oflead poisoned children? How are you addressing the
problem?
. County wide, 11.1 % of screened children (those thought to be in high risk situations) were
found to have >= 10 mcgldllead in 1997. City levels have been even higher:
Lead Poisoning Prevalence
in the City of Dubuque
(percentage of tested children found to
have >= 10 mcf!/dllead
1994 8.3%
1995 11.55%
1996 13.98%
1997 13.55%
1998 13.4%
1999 11.42%
Source: City of Dubuque Health
Devartment
.
Number of Unsafe Nitrate & Total Coliform Bacteria (Dubuque County)
.
... -
Year Unsafe Total Unsafe Total
1998 32 155 63 169
1999 18 177 90 237
Source: University oflowa Hygienic Laboratory
. The nwnber of children tested each year has generally decreased, while the percentage of
lead poisoned children has increased. One possible conclusion from this scenario is that
physicians are screening children with higher risks of becoming lead poisoned. The City of
Dubuque Health Department still recommends that all children receive lead screening at
one year of age.
. There are very aggressive programs in the City of Dubuque for lead inspections of homes
and financial assistance available to homeowners for abatement. The program has been
very visible in the community.
. Lead poisoned children are case managed through the City's IDPH Grant. Case
Management also occurs for County children.
. Need to look at the environment in tenus of cancer rates.
2. What percent of the children in your county are being tested for lead poisoning? What
are you doing to increase the number of children being tested?
.
Approximately 18% of Dubuque County children less than 6 years of age were screened in
1997. This nwnber has decreased in recent years. The City of Dubuque has a Childhood
Lead Poisoning Prevention Program which aims to educate on childhood lead poisoning,
promote screening to parents and physicians, and provide assistance to repair and remove
lead hazards.
.
3. What percent of the housing in your county was built before 1950? What are yon doing
to improve the condition of pre-1950 housing in your community to reduce the risk of
lead poisoning in children?
.
43% of the housing in the county was built before 1950. Approximately 60% of the
housing in the City of Dubuque was built before 1950. The City of Dubuque's Childhood
Lead Poisoning Prevention Program offers financial assistance to income qualifying
property owners to make homes and apartments lead safe. Education is ongoing in the City
for safe lead removal and treatment.
4. Identify the contaminants affecting the environmental quality of homes, day cares,
schools and other public buildings in your community (Examples: carbon monoxide
poisoning, water contamination, radon, asbestos)? List the occurrence rates where
possible. How are you addressing the problem?
.
Radon: Dubuque has a significant amount of homes with Radon measurements above 4
pCi/L which is the EPA action level. In the early 90's the City Health Services Department
conducted a sample study which indicated 60% of the homes sampled had levels> 4 pCi/L.
The City Health Services Department promotes Radon screening and general radon
.
.
awareness. Little has been done in the county outside of Dubuque to check for radon.
. Carbon monoxide poisonings are not too common, but they do occur in homes with gas
heating, etc. Gas company responds to approximately \00 calls per year in Dubuque
County, about 25 of which result in detection of carbon monoxide. The public has received
education regarding the use of carbon monoxide detectors. There is no requirement for CO
detectors.
. Water suDDlies (both public and semi-public) are safe ITom bacteria. Occasional samples
have found E coli and total coliforms. Of concern is the nitrate in rural/fann wells. Some
shallower wells have levels above 45 ppm as nitrate. In the last 10 years 190+ wells have
been abandoned. Some supplies are filtered to reduce the nitrates. Water at all schools is
tested regularly for the common contaminants, bacteria and nitrates. There have been no
outbreaks of disease specifically associated with drinking water.
. Asbestos: During the 1980s and early 1990s, all schools and public buildings were
inspected for asbestos. At the present time, none present a public health hazard. Numerous
buildings had ceilings and heat pipe insulations which contained asbestos. In most cases,
the asbestos was removed. In some, the pipe coatings were encased in new coatings to
prevent possible release.
.
5. Identify the environmental risks impacting the health of your community. (Example:
industrial and farm waste, hazardous waste sites, open sewers, private wells and air
(indoor and work) and outdoor air pollution). How are you addressing the problems?
. A major concern is hog factories and/or larger confinement operations.
. Hazardous waste sites are under DNR supervision. Several have been cleaned and others
are awaiting funding.
. During 1999 there were four chemical releases reported in Dubuque County. These resulted
in one injury. There are numerous sites being monitored for past petroleum leaks or spills.
. Failing sewage disposal systems are always a concern as they pose a potential health hazard
to the local residents and also the neighborhood and groundwater. When problems are
identified, the responsible property owner is notified immediately to abate the nuisance.
. Water supply systems: It is estimated that there are between 4,800 and 4,900 private and
fann wells in Dubuque County. About \00 oftheé~ are tested annually. There are between
120 and 150 public and semi-public wells. Many, but not all of these, are tested for bacteria
and nitrates. In general, the quality of water is good. There are ongoing concerns with iron
and sulphur. Wells with these two concerns frequently have filters and/or use disinfection
to improve the palatability of the water. Outbreaks from contaminated water are rare. More
often, illness is from recreational use of rivers, streams, or lakes.
. Air pollution: no good statistics are available. City building department does evaluate air
ventilation, exhaust fans for bathrooms, kitchens, etc. In the rural area there are no
inspections to check this.
. What is available for treatment oflead poisoning and what percent of poisoned are
treated adequately.
Need to look at housing developments in the County and use of septic tank systems with
regard to safe water issues.
Dollars for County well testing to continue so we can anticipate problem areas in
groundwater.
.
.
.
.
ANNUAL RADON STATS
Note: This test data is based on contract testing by interested clients in the Cities of Dubuque and
Asbury. Testing conducted by an Iowa Department of Public Health/EP A-RMINEHA
Accredited Testing Specialist. Test set up was implemented using EP A protocol for short
term activated charcoal 2 to 5 day test.
Year, House I Building I School I Total # Test Highest I lowest I Post
Screen Screen Screen Screen Percentage Screen Screen Mitigation
Test Test Test Test > 4 DCI/L Test Test Test
1992 I 25 I 3 I 12 I 40 65% 120 pCi/l I 1 pCi/l I 3
1993 I 22 I 0 I 0 I 22 55% 16.4 pCi/l I .6 pCi/l I 1
1994 I 16 I 0 I 0 I 16 31% 6.4 pCi/l I .5 pCi/l I 0
1995 I 15 I 0 I 0 I 0 40% 14.3 pCi/l I .8 pCi/l I 0
1996 I 25 I 2 I 0 I 27 48% 30.6 pCi/l I 1.2 pCi/l I 1
1997 I 43 I 0 I 0 I 43 72% 18 pCi/l I .5 pCi/l I 7
1998 I 50 I 2 I 0 I 52 44% 25 pCi/l I .3 pCi/l I 5
*1999 I 27 I 0 I 3 I 30 53% 49.7 pCi/l I .8 pCi/l I 8
* = Data from January to October
Post Mitigation Test was conducted after a mitigation system was installed to correct radon levels> 4 pCi/L by an
Iowa Department of Public Health Licensed Mitigator.
TABLE I. Screen indoor radon data from the EP AIState Residential Radon Survey ofIowa conducted during 1988-
89. Data represents 2-7 day charcoal canister measurements from the lowest level of each home tested.
No. of Geom. Std.
County Meas. Mean Mean Median Dev. Maximum %>4 DCi/l %>20 DCi/l
Dubuque 38 5.6 4 5 4.7 24 58 3
"
G. Injury Control, Occupational Safety and Health and Domestic Violence and Sexual Assault.
.
This category includes a set of indicators related to factors around injury and violence.
G(I) Injury Control. Injuries are a leading cause of years of potential life lost in Iowa. Injury
control indicators displayed in this category are intended to bring into sharper focus the
major causes of intentional and unintentional injury.
0 Mortality Due to Motor Vehicle Crashes
0 Alcohol-Related Motor Vehicle Deaths
0 Hospitalizations for non-fatal head and spinal cord injuries
- Additional community data
0 Mortality Due to Homicide
0 Mortality Due to Suicide
* Hospitalization for gunshot injury
* Seat belt usage
Indicator Dubuque Countv State ofIowa
Mortalitv Due to Motor Vehicle Crashes
Alcohol-Related Motor Vehicle Deaths < 10 events 4.4
Hospitalizations for non-fatal head injuries
Hospitalizations for non-fatal spinal cord
injuries
Mortality Due to Homicide (age adjusted, per < 10 events 2.6
100,000)
Mortality Due to Suicide (age adjusted, per 15.4 11.6
100,000)
Source for above indicators: 1HITS 1997
.
1. Identify the major types of injuries in your county, the causes, and how your county is
addressing the problems. Include any information from local sources about non-work-
related injuries and special populations with injury problems (Examples: race, migrant
workers, illegal immigrants).
. Many injuries occur in the home from falls.
. Major types of injuries due to motor vehicle crashes.
. Both City and County Law Enforcement have special traffic enforcement programs.
2. Identify the circumstances of mortality due to homicide. (Identify special populations,
age, geography, education, income, ethnicity).
.
Dubuque Police Department reports circumstances are unpredictable. The past two
homicides in the county have been small children who died ITom shaken baby syndrome.
3. Identify the circumstances of mortality due to suicide. (Identify special populations, age,
geography, education, income, and ethnicity).
.
Dubuque Police Department reports that the majority is in the mid-teens to mid-twenty age
group. Also, there are some elderly. Alcoholics and those with family problems that see
"no way out" are often seen. There were 10 successful suicides in Dubuque County during
1999. Six occurred in the city of Dubuque, the remainder elsewhere in the county. Nine
died from gunshot wounds, and one by drowning.
.
.
Dollars to educate public that domestic abuse is a learned behavior.
The suicide rate could be due to the isolated rural populations and/or substance abuse
and/or problem gambling. Managed care holds the purse strings for how long
hospital stays are for mental illness patients.
.
.
4. Identify current programs/resources addressing injury. Include EMS dispatching and
transportation. (For more information, contact the EMS Bureau)
5. Are there any gaps between needs and available resources?
.
Does plan reflect efforts to reduce service fragmentation?
Does plan reflect duplication of service issues, especially between County & City services?
.
.
.
24
.
.
.
G(2) Occupational Safety and Health.
0 Mortality Due to Work-related Injuries
- Additional community data
0 Hospitalizations for agricultural injuries
Duhu ue Coun
<10 events
State of Iowa
2.3
<10 events
9.9
<10 events
(17 Not Hospitalized
7 Hos italized
No mortality
during year
1. Identify work-related mortalities and injuries and the sources.
.
Construction industries - fall protection standards.
Farm injuries:
Tractor rollover
Machinery
Crushing injuries (heavy equipment and large animal)
Impaling injuries
Electrical contact
Chemical-related
Water-related (drowning.)
.
2. Identify agricultural injuries in your county.
.
Most seen in emergency departments rather than at occupational health clinic. Worker
Compensation information is not available due to family run businesses.
Tractor rollover, machinery entanglements, large animal-related, drowning.
.
3. Discuss how your county compares with the rest of the state on occupational injuries.
.
Repetitive motion - high in meat packing industry. With low unemployment - high
turnover on entry level jobs often results in more safety concerns, secondary to education
and experience.
High injury rate - top II. number of machine and tra~tor-related injuries- some related to
land topography.
.
25
4. Are there any special populations with occupational injury problems? (Examples: race,
migrant workers, illegal immigrants)
.
.
Smaller employers not educated on Federal and OSHA standards.
Family farm operators.
Youth working on farms/older adults continue to do farm labor.
Small agri businesses that do not have safety programs or safety managers on site (seasonal
workers with chemical exposures are quite minimal.)
.
.
.
5. Identify any underlying problems related to occupational injury.
.
Foreign-born language barriers.
Transportation for the entire family.
Education and safety equipment for decreased blood exposure.
Safety training for personal protective equipment.
Youth and older adults operating farm equipment and working with large animals.
.
.
.
.
6. Are there any gaps between needs and available resources?
.
.
.
. .
.
.
.
.
For economic growth, we need labor force but there are no services or funds to manage
health problems that come with it. Similar to the times of the Industrial Revolution.
Follow-up and compliance with TB prophylactic medication.
Education resources for small/agri businesses.
Affordable and accessible education and prevention resources for families in farming
communities.
Accurate injury reporting (ag-related illness reporting.)
Does plan reflect efforts to reduce service fragmentation?
Does plan reflect duplication of service issues, especially between County & City services?
G(3) Domestic Violence and Sexual Assault. Victims of domestic violenœ and sexual assault
may be young or old, male or female. No one is immune to this health threat.
.
- Police Department Reports (Unifonn Crime Report - Internet: www.state.ia.us/gov/dps)
- Victim Service Report Ü'om Local Domestic Violence/Sexual Assault Program (check county records also)
- Additional community data
State ofIowa
227.1
Dubuque Police reports 105 referrals to the sexual assault program for 1999
1. Discuss how your county compares with the rest ofthe state.
.
. Sexual assaults are increased all over and domestic abuse remains about the same.
. Regarding domestic violence, county comparisons would serve no useful purpose. The
nature and amount of outreach by domestic violence programs, along with law enforcement
view of domestic violence affects reporting, service use, and charges filed. This county has
a great deal of outreach and a very good working relationship between law enforcement and
the YWCA Domestic Violence Program. Local law enforcement statistics report .85 cases
per day, while the "Y" reports 1.3 new cases per day. (Source: YWCA.)
. We are the only county in northeastern Iowa with a shelter for victims of domestic violence.
Outreach serves Dubuque, Delaware, and Clayton counties, as well as out-of-state persons.
We provide one-on-one group counseling, legal/medical advocacy, child advocacy skill
training and victim empowerment. We have 24-hour coverage.
. New emerging problem of school violence.
2. Are there any special populations with problem with domestic violence and sexual
assault?
.
.
Predominant population is white with no special patterns. More incidents occur with lower
socio-economic groups, but this may be because these women have fewer options.
Alcohol control issues.
Domestic violence occurs among all ages (adolescent and adult) and social classes.
Pregnancy places a woman in greater risk of domestic violence. Women are more likely to
be victimized than men.
Crimes are not predictable. Several shaken baby.
More often reported among lower class income persons, but is a problem across whole
spectrum of economic classes. Often victims have either a physical or medical disability.
Children whose mothers are battered women.
Home where there is a substance abuse or gambling issues.
Parents with history of sexual abuse.
.
.
.
.
.
.
.
.
.
Home where there is a financial difficulty.
3. Identify underlying problems related to domestk violence and sexual assault.
. Substance abuse, financial problems, and mental health problems are usually involved,
either separately or together.
. Experts view domestic violence as a learned behavior. The incidence of domestic violence
and child abuse occurring in same family is not yet fully explored. Beginning data on
violence in dating relationships suggests a high percentage. While there may be other
problems in a family other than domestic violence, these would be contributing rather than
causal.
. More education - services available at all age/sex/economic levels.
. More cohesion with law enforcement (this is improving with our Domestic Violence
Response Team (DiVert) with the DLEC and County Attorney's Office.
. Excessive anger
. Excessive jealousy
. Excessive control
. Low self esteem
. Difficulty expressing feelings
. Drinks heavily, uses drugs, gambles
. Fear
. Men/women wanting power control
.
4. Identify programs/resources addressing domestic violence and sexual assault?
.
There are programs addressing both domestic violence and sexual assault:
.
Riverview Center provides sexual assault victim assistance.
YWCA Domestic Violence Program provides assistance and emergency sheltef.
There is a program within the County for batterers.
Mercy Medical Center asks a screening question of patients to identify if domestic violence
is occurring, provides information on resources, and makes referrals.
Victim/Witness Assistance Programs.
Police & Sheriff's Departments' Domestic Crime Unit.
Individual/group counseling/safety planning/legal assistance/financial assistance/child
advocacy.
YWCA Battered Women's Program.
Iowa Domestic Abuse Hotline.
Police station.
Hospitals.
Churches.
Treatment centers.
Schools.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5. Are there any gaps between need and available resources?
The agencies are dependent annually upon grants. There is no assurance ofre-funding. The
only women/children shelter is in Dubuque. Domestic Violence Program in Dubuque
recently secured an 800 phone number. Riverview Center in Dubuque also has an 800
number.
. Resources not always at hand - supplies easily depleted.
. Making people aware at a young age about all types of abuse.
. No co-dependent meetings here.
. Courts.
. Treatment centers.
. Halfway Houses.
. Correctional facilities making support group such as Alanon part of their aftercare.
. Does plan reflect efforts to reduce service fragmentation?
. Does plan reflect duplication of service issues, especially between County & City services?
.
.
29
.
.
H. Substance Abuse, Tobacco Use and Problem Gambling Behaviors
Substance abuse and tobacco use risk factors are presented because of the impact these
behaviors have on many aspects of health, family function, crime, and economic well-being.
The indicators selected include arrest data to provide some measure of incidence. They also
include factors that have been demonstrated to pose significant risk in the population.
Problem gambling behaviors also affect health, family function, crime and economic well
being.
The indicators in this category:
0 Juvenile arrests
0 Juvenile vandalism rates
1< Juvenile substance abuse
admissions
1< Adult substance abuse
admissions
0 Narcotics arrests
0 Drunkenness arrests
0 Hospitalization rates for
alcohol dependence syndrome
1< Adult gambling addiction
admissions
0 Rate of arrests for OWl
0 Per capita sales of Alcoholic Beverages
- Additional community data
.
Indicator Dubuque County State of Iowa
Juvenile arrests (per 100,000 population) 3226.1 3083.5
Juvenile vandalism arrests (per 100,000 97.8 171.3
population)
Narcotics arrests (per 100,000 population) 230.5 350.3
Drunkenness arrests (per 100,000 population) 648.2 251.1
Rate of arrests for OWl (per 100,000 population) 660.7 442.8
Source{or above indicators: IHITS I 997
Juvenile substance abuse hospital admissions 0.09 0.16
(per 1000 ooDulation)
Adult substance abuse hospital admissions (per 2.41 2.95
1000 population)
Sources/or above indicators: Association o/Iowa Hospitals and Healthcare Services
Patient Orif!in/Destination Database and Claritas, Inc.
1. Identify and discuss the risk factors for substance abuse, tobacco use and problem
gambling behaviors, which are unique to your community.
.
German and Irish culture support high alcohol use.
Community has high tolerance for alcohol use.
Healthy Dubuque 2000 survey demonstrated alcohol use patterns higher than State and
national norms.
Dubuque has both dog track and a casino boat.
High availability of alcohol and gaming.
Culture acceptance of alcohol use in this area.
Availability of casino gambling sites in the city and nearby cities.
Numerous bars.
Crimes of violence are often alcohol and narcotics-related.
.
.
.
.
.
.
.
.
2. Discuss how your county compares with the rest of the state.
. Juvenile arrests in Dubuque County are almost 5% higher than in the State of Iowa, while
Dubuque County juvenile vandalism arrests are 43% lower than the state rate. Drunkenness
arrests in Dubuque County are more than 2 Y, times more prevalent than in the State of
Iowa, while narcotics arrests occur at only 2/3 of the state rate. Substance abuse-related
inpatient hospitalizations occur at a lower rate in Dubuque County compared to the state for
both youth and adults.
.
3. Are there any special populations with a problem of substance abuse, tobacco use or
problem gambling behaviors?
.
.
Adolescents diagnosed with ADHD conduct disorder.
Dual diagnosis clients (mental health/substance abuse.)
Youth using alcohol.
Elderly with gambling issues.
.
.
4. Identify underlying problems related to substance abuse, tobacco use or problem
gambling behaviors.
.
.
Family relationship problems.
Parental substance abuse problems (multi-generational.)
Poverty is a major issue, as people addicted tend to have big money issues.
Eighty percent (80%) at SASC are involved in the criminal justice system.
.
.
.
5 Identify programs and resources addressing prevention and treatment for substance
abuse, tobacco use or problem gambling behaviors.
.
Alcoholics Anonymous.
Turning Point Treatment Center outpatient programs.
Mercy Medical Center (behavioral health) inpatient programs detox and outpatient partial
hospitalization program
SASC - substance abuse treatment and prevention services. Also, gambling prevention and
treatment.
Turning Point: substance abuse treatment services.
Helping Services for Northeast Iowa: substance abuse prevention services.
.
.
.
.
.
6. Are there any gaps between need and available resources?
.
. Need more outpatient service for adolescent populations.
. Need residential treatment for adults and adolescents.
. Need insurance providers to recognize and pay for needed treatment.
Residential substance abuse treatment is unavailable in Dubuque.
. Financial crimes linked to gambling.
. No resources available.
.
.
.
.
Detoxification services are not available unless client has private insurance or has been
hospitalized under the substance abuse criminal law.
Financial crimes linked to gambling.
Does plan reflect efforts to reduce service fragmentation?
Does plan reflect duplication of service issues, especially between County & City services?
.
.
.
.
.
.
Section: II: Health Improvement Plan
Section A. Demographic and Socio-economic Characteristics
Problem Community Assets Community Goals/Outcomes Action Stens Evaluation/
(Identified in Section AI And Resources BarrierslNeeds Measurement of
ProOfess
Immigrant Population Catholic Charities Language Barriers Promoting Integration in
Translator Capabilities Financial Barriers Community by 2005
AT&T Translation Line Cultural Barriers
Employer Involvement Lack of documented
Religious Outreach health records
Programs
Aging Population Scenic Valley Area Transportation Integrated System of
Agency on Aging Inadequate Staff for Care for the Elderly by
Hospitals/Medical Staff Home Care 2005
Physicians Inadequate Funding for
VNA Home Care
Senior Citizen Meal Sites
Lifeline
Meals on Wheels
Project Concern
JJ
.
.
.
Section B. General Health and Access to Care Indicators
Problem Community Assets Community Goals/Outcomes Action Stens Evaluation!
(Identified in Section B) And Resources BarrienlNeeds Measurement of
Prooress
Residence wbo are not HilicresllMercy Maternal Language Barrier Access to Healtb Care
U.s. Citizens lacking Health Cultural Barrien for all residences by 2005
Health Care VNA Child Health Transportation to Iowa
Clinics City
Free Medical Clinic at Not seeking care
the Mission
Hillcrest Family Planning
Clinic
WIC
Uninsured and Under- HAWK-I Unwillingness to enroll in Increase to 80% in
insured populations Free Medical Clinic HAWK-I HAWK-I the number of
VNA Child Health Oral Health Need eligible people by 2005
Clinics Inadequate supply of
D.H.S. Primary Care Physicians
HilicresllMercy Maternal Lack of dentists accepting
Health Title XIX Clients
Area Hospitals Cost of prescription
VNA Oral Health drugs
Services for Dental
Health
Physician Specialists
Hillcrest Family Planning
Clinic
Local Service
Organizations
Involvement
Keystone AEA
Service & Outreach
Organizations
.
.
.
Section C: Maternal and Child Health Indicators
Problem Community Assets Community GoalslOutcomes Action Stens Evaluation!
(Identified in Section C) And Resources BarrierlNeeds Measurement of
Pr02ress
Cbildhood I-KID Advisory Inadequate Funding Reach 90% or better
Immunizations Committee Inadequate Staffing Immunization Rate by
Community Awareness Documentation for 2005
VNA Childhood Immunization Records
Immunization Clinics Lack of a seemless
WIC referral and
documentation system
Prenatal Care Issues Suite Beginnings Immigrants Increase healthier
Hillcrest/Mercy Material Language Barriers pregnancy outcomes by
Health Cultural 2005
VNA Home Visitor Lack of desire to access
Program care
Area Hospitals Repeat Pregnancy
Medical Staff High use of alcohol and
Iowa City drugs
Midwife Services Abstinence - Only
Teen Family Information Inadequate Funding
Center Transportation
Teen Pregnancy Issues Teen Family Information Reference Previous Reduce teen pregnancy
Center Prenatal Care Issues rates by 2005
Hillcrest Family Planning Teen Attitudes
Teen Esteem Cannot access rederal
GAP pregnancy prevention
YWCA Domestic Abuse programs
Program Lack of funding for
Girl Scouts/Boy Scouts H.O.P.E.S. Project
ISU Girl Talk Services to teens in school
School Nurses setting
Baby Think It Over
Adoption Services
VNA Parent Partnership
Postpartum Issues for the Program Lack of Public A ware- 90% of households with
familv Communitv Assets ness about Pr02rams newborns would receive
.
.
.
And Resources Community Goals/Outcomes
(CONTINUED) BarrierlNeeds (CONTINUED)
(CONTINUED)
Suite Beginnings
Hillcrest/Mercy Maternal Limited Funding service through at least
Health Care Transportation one agency upon
Catholic Charities Lack of integration of discharge from the
Adoption Services services hospital hy 2005
CornerstonelFADDS Parenting Programs for
Gannon Center Non-Teen Moms
YWCA Respite Care
Child Care Resource & Service fragmentation
Referral
Schools
Day Cares
WIC
D.H.S.
S.A.S.c.
VNA Health Clinics
Child Planning Program
Breast Feeding Coalition
Nutrition Coalition
I-KIDS Coalition
Teen Esteem
M.D. Offices
ABCD Program for Oral
Health
Breast & Cervical
Cancer Early Detection
Program
"
.
.
.
Section D: Chronic Disease Indicators
Problem Community Assets Community Goals/Outcomes Action Stens Evaluation!
(Identified in Section OJ And Resources BarrierlNeeds Measurement of
Proeress
Higber tban State American Cancer Society Lack of awareness of Decrease cancer
Averages for Incidence Medical Staff support groups incidence rates in the
Rates of Cancer Hospitals Nutrition County by 5% by 2005
Wendt Cancer Treatment Physical Activity
Center Risky Behaviors
VNA Senior Health Lack of rural County
VNA B.c.C.P. screening sites
Hospice Lackofmotivalion to
Area Agency on Aging adopt positive health
Education in Schools behaviors
Community Screening Radon testing for County
Programs
Support Groups
Diabetes Diabetes Center Reduce incidence rate for
Hospitals Lifestyle hospitalization of
Medical Staff Obesity diabetes by 10% by 2005
VNA Culture
N.I.D.D. Attitude
Project Concern Lack of Awareness
Lifeline
VNA Senior Health
Programs
37
.
.
.
Section E: Infectious Disease Indicators
Problem Community Access Community Goals/Outcomes Action SteDs Evaluation!
(Identified in Section E) And Resources BarrierlNeeds Measurement oC
Prosress
Higber tban State Physicians Fear oCimmunization Increase immunization oC
Average of Death Rate VNA Outreach to elderly elderly Cor both influenza
rrom Pneumonia Lack of Clinics in Rural and pneumonia to 90%
Areas by 2005
Lack of Funding if don't
have M"dicare, Part B
Transportation
Tuberculosis VNA Immigrant Populations
Lncal Employer Language Barriers
Physicians Culture Increase the compliance
Lack nfFunding in T.B. testing and
Lack of awareness and treatmeut Collow-up by
knowledge ofthe disease 2005
Potential for increase Hillcrest Community Attitude
incidences for STD's Free Medical Clinic Community Culture
Hospital Emergent Care Lack of Funding Keep STD's at current or
Programs Confidentiality Issues lower level by 2005
VNA - HIV Testing
Foodborne Illnesses City Health Department Lack of .dequate
State Surveillance surveillance Reduce Coodborne
Lack of education on illnesses in the
proper rood handling community by 25% by
and storage in Cood 2005
preparation throughout
the community
Cultural attitudes
Childhood Immunization Reference Section C -
Rates Problem I
.
.
.
Section F: Environmental Control Indicators
Problem Community Assets Community Goals/Outcomes Action Stens Evaluationl
(Identified in Section F) And Resources BarrierlNeeds Measurement of
Pro.ress
Childhood Lead Dubuque Lead Coalition Physician Screenings Increase all childhood
Poisoning City Health Department Old Housing lead screenings to 25%
VNA Child Health Lack of Awareness by 2005
Lead Case Management Lack of City and County
Program - VNA wide testing by Lead
HUD Program Abatement Program
I.D.P.H. through City
Safe Water & Sewage City & County Health Resistance to repair and Use more State Grant
Disposal System Issues Departments testing monies to increase water
State Grants tests to 150 per year by
DNR Services 2005
J9
.
.
.
Section G(I): Injury Control
Problem Community Assets Community Goals/Outcomes Action SteDs EvalDatioD/
(Identified in Section G-I) And Resources BarrierlNeeds MessuremeDt of
Proness
Lack of A wareDess Decrease suicide rate to
Higher than State GanDoD CeDter Stigma of accessing 10% by 2005
Average Suicide Rate Churcbes mental healtb services
Mercy HospitallnpatieDt Poor self-esteem
Meutal Healtb Alcohol/SubstaDce Abuse
Law EDforcemeDt Depression Untreated
Finley Geriatric Mental GambliDg
Health Lack of teen recreational
Hillcrest Residential activities
YWCA
Court System
Schools
DARE Program
Car Seat Availability Goal will be that tbis
Child Safety Issues Hillcrest/Mercy Maternal Lack of seat belt usage particular issne will be
Health researched fnrther
STOP Programs
Child Care Facilities
Drivers Ed Programs
40
.
.
.
Section G(2):Occupationa' Safety and Health
Problem: Community Assets Community Goals/Outcomes Action Stens Evaluation/
(Identified in Section G-21 And Resources BarrierlNeeds Measurement or
Pr02ress
Farm Injuries Mercy Hospital Long Hours Decrease the amount or
Schools - FFA Program Seasonal Stress rarm injuries by 50% by
N.I.c.c. Financial Conditions 2005
4-H Program Isolation
Extension Office Environmental Terrain
Old Equipment
Lack or Education
(OSHA)
Age or Macbinery
Onerators
.
.
.
Section G(3): Domestic Violence and Sexual Assault
Problem COI,uRunity Assets Community Goals/Outcomes Action SteDs Evaluation/
(ldent;fied in Section G-3). And Resources BarrierlNeeds Measurement of
Pr02ress
Domestie Abuse Two Gannon CeRter Substance Abuse Decrease domestic abuse
Times the State Rate YWCA Alcohol Abuse to no more than the State
Two deaths ofC'liid AI-Anon Lack of Funding for Rate by 2005
Abuse - Shaken Baby Riverview Education
Syndrco:;e Hillcrest Lack of effective
Mercy Mental Health programs dealing with
Law Enforcement domestic abuse
Court System Fear
VNA Parent Partnership Low self-esteem
D.H.S. Lack of Reporting Abuse
Iowa Domestic Hotline Only I Shelter in NE
Domestic Violence Center Iowa
HEAL THY DUBUQUE
Task Force
Section H: Substance Abuse, Tobacco Use and Problem Gambling Behaviors
.
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Section III: Health Problem Priorities
A: After discussing your responses to the assessment questions and identifying your local health
problems with your community partnerships, given your resources, what are your priority health
problems? Consider the magnitude of the problem, seriousness, and effectiveness of the interventions.
B. In addition to the priority health problems identified in part A of this section, what other problems
would you address if more resources were made available?
.
.
.
Section IV. Community Partnerships
A. What community partnerships and coalitions exist in your area?
Tri-State Health CARE. Coalition
Healthy Dubuque, Steering, Subcommittees & Task Force, Volunteers, and Interested Individuals
City of Dubuque Health Services
Dubuque County Board of Supervisors
Dubuque City Council
Dubuque County Board of Health
Dubuque Breastfeeding Coalition
Dubuque Regional AIDS Coalition (DRAC)
Consortium on Aging
Lead Coa1ition (City of Dubuque)
Nutrition Coalition (WIC)
Early Access (Keystone)
Domestic Abuse Council
Empowerment
Society of Special Needs
Healthy Mouths
Child Abuse Council
.
.
.
Section IV. Community Partnerships (Cont'd)
B. What organizations and groups were represented in making this assessment?
Birthright
Women, Infants, & Children (WIC)
Visiting Nurse Association
March of Dimes
Medical Associates Clinic -HMO & Foundation
Dubuque Area Labor Management Council
Northeast Iowa Dietetic Association
Dubuque Community School District
Scenic Valley Area Agency on Aging
Hillcrest Family Services
Finley Hospital
Mercy Medical Center
Dubuque County Medical Society
Substance Abuse Services Center
Emergency Medical Services (E.M.S.) - Dubuque Fire
Gannon Center
DE-CAT /Department of Human Services
Loras College
Retired Senior Volunteer Program (R.S.V.P.)
Hills & Dales
American Cancer Society
Smoking Cessation Providers
Area Businesses, Churches, Schools
Empowennent
Local Media - KDTH, KDUB, WDBQ, Telegraph Herald
Iowa Department of Public Health (IDPH)
Dubuque County Mental Health Association
Infonnation & Referral Services
Immunized KIDS in Dubuque (I-KID)
American Diabetes Association
American Lung Association
~