Establishment of an Osage County Health Department Proposal
Background
The Osage County Public Health Citizen Committee is comprised of the following members: Martha Ray, Central Missouri Community Action; Alan Stevens, Community Health Center of Central Missouri; Patrick Steele, Osage County Clerk’s Office; Wanda Rehagen, Osage County RIII School Nurse; Victoria Sallin, St. Joseph’s School Nurse; Jennie Ames, Osage County Special Services; Russell Scheulen, Presiding Commission; Vincent A. Samson, District Two Commissioner; Kathy Dothage, MU Extension; Mark Schaefer, Osage Ambulance; Andrea Rice, 911/EMD; Lucy Brenner, Parish Nurse; Susan Gyaben, MPH; Margie Lange, Osage County Faith Community Nursing; and Marie Helton, LPN. The members of the Citizens Committee represent various regions of the county and all feel strongly that public health services are critical to the citizens of the county. They have been meeting over the last three months to assess the feasibility of the reestablishment of a local public health department. The county has had public health service since September of 1965. In April of 2010, the Osage County Commission was advised that Gasconade County would no longer contract for public health services in Osage County, a practice which was established in 1999.
Need
Osage County health data indicates poor to average health status. The leading cause of death in 2008 for Osage County residents was heart disease followed by cancer1. Heart disease occurred at a rate of 267 per 100,000 compared to a state average of 213 per 100,000 cases. Risk factors for heart disease include those related to lifestyle behaviors such as smoking, obesity, stress, exercise, and diet. Cancer is a group of diseases caused by both internal and external factors. Lung cancer was the most common cause of cancer deaths; 90% of all lung cancer is caused by cigarette smoking.2 WIC data demonstrated a rate of 36.7 per 100,000 of the prenatal participants in Osage County had a pre-pregnancy body mass index greater than 29 (obese) as compared to 31.5 for the state. In addition, prenatal participants in Osage County had a rate of 53.8 per 100,000 that had smoked three months prior to the pregnancy as compared to the state rate of 41.1. This is important data when considering the impact that it has on healthy outcomes for Osage County infants and the overall health of young adults. From January thru June, 2010, 1296 individuals participated in the Women, Infants and Children program in Osage County.
Motor vehicle accidents occurred at a rate of 26.1 per 100,000 for Osage County as compared to a state average of 16.2/100,000. When motor vehicle accident deaths are reviewed for children under 15 years old (2004-2008) there is a significant difference between the Osage County rate of 7.4 and the state rate of 3.7 (MODHSS, Death MICA).
Indicators for a five year period 2004-2008 demonstrated that there is an increasing trend in the rate of death of Osage County residents related to pneumonia and influenza from a low of 15.9 (2004) to a high of 27.5 (2008) which exceed the state rate of 21. In Osage County in the past 2 1/2 years the health department administered approximately 5,000 vaccinations to adults and children for vaccine preventable diseases such as measles, mumps, tetanus, influenza, pneumonia, and many others. In addition over the past five years 346 cases encompassing diseases such as rabies, syphilis, pertussis, and tuberculosis have been identified, treated, and monitored through public health.
Proposed Health Department Structure and Services
The Citizens Committee has met with other public health departments in the region, the Missouri Department of Health and Senior Services staff, and other health providers. Upon completion of gathering information, the committee reviewed, prioritized and recommends the following programs/services initially be provided:
Women, Infants, and Children Federal Program (WIC)
Restaurant Inspections
Immunizations
Flu Shots
Maternal Child Health
Health Education
Emergency Management and Planning
Child Care Provider Consultations and Inspections
Communicable Disease Monitoring and Investigations
Lodging Inspections
Sewage Complaints
Birth and Death Certificates
It is estimated that to provide the above mentioned programs/services and to adhere to budgetary constraints, local, state and federal, the following personnel are needed:
· Registered Nurse Administrator: full time: responsible for health department, administration, WIC coordination, Communicable Disease Monitoring and Investigations, coordination of Maternal Child Health , Emergency Management and Planning, and Child Care Provider Consultations contracts.
· Environmental Sanitarian: Contract staff on an as needed basis: Responsible for restaurant and lodging inspections, sewage complaints, and child care sanitation inspections and reinspections.
· Receptionist/Clerical: full time: responsible for maintaining office hours, phone coverage, providing WIC reports, public information dissemination, filing, scheduling and receptionist duties.
· Public Health Nurse: Part time: Responsible for public health clinics, (i.e. immunizations), communicable disease investigations, assist with WIC, child care provider and community education.
· Nutritionist: Part time: Responsible for WIC client consultations.
Budget Proposal
The Osage County Health Department could be funded thru the Missouri Department of Health and Senior Services’ contracts and provider agreements, grants, donations and county commission appropriations. The budget for the proposed Osage County Health department provides staffing to meet the public health needs of citizens in Osage County and fulfill the contractual obligations of funding. Attachment A provides a detailed budget for the establishment and first year of operation for the Osage County Health Department.
Support and Partners
Support has been offered by the Central Missouri, local public health administrator group, Missouri Department of Health and Senior Services, and the Community Health Center of Central Missouri. Also, the Osage County Public Health Citizen Committee is willing to continue their service and function as an advisory committee for the establishment and ongoing operation of the Osage County Health Department.
Timeline Recommendations
July, 2010:
· Osage County Health Department Proposal Presentation to County Commission by the committee.
· Commission Approval
August, 2010:
· Designate The Osage County Public Health Citizen Committee as the advisory board for the Osage County Health Department.
· Newly appointed advisory board to appoint a personnel committee from their membership. Recruitment, interview and a recommendation for an administrator will be submitted to the commission.
· Promote the opening of the Osage County Health Department.
September, 2010:
· Administrator hired and begins their employment. Administrator would proceed with initiating contract and provider agreements, recruitment of remaining personnel, function as a liaison to the advisory committee.
· Promote the opening of the Osage County Health Department.
October 1, 2010:
· Osage County Health Department opens the doors to the Citizens of Osage County.
Sources:
1. Missouri Department of Health and Senior Services MICA, 2010
2. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 2004.