The Health of Harford County Presentation to UM Upper Chesapeake Health Russell Moy, MD, MPH, Health Officer September 19, 2018
• Protecting the public’s health: Emergency Preparedness • The impact of cancer on the health of Harford County residents • What are the other contributory factors affecting the County’s health? 2
How far is the Peach Bottom nuclear power plant from Bel Air, Maryland? Distance between Peach Bottom plant in Delta, PA and downtown Bel Air, MD is: (A) 21 miles (B) 31 miles (C) 41 miles (D) 51 miles
Peach Bottom Nuclear Power Station Delta, PA (21 miles from Bel Air, MD)
Peach Bottom Nuclear Plant 10-mile Plume Exposure Emergency Planning Zone (EPZ)
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Susquehanna Center Interior Layout Harford Tennis Courts Community College Back Driveway with Parking Shelter Buses Chesapeake Center Stadium and parking and parking ICS-Report Side Driveway Women’s Locker Rm Side Driveway Auxiliary Gym Dirty Reception EMS R Men’s Locker Rm Area Greeter P R Thyroid Clean traffic Check Mini Map Front of Building – Main Parking Lot on Thomas Run Road
50-mile Ingestion Exposure Pathway Emergency Planning Zone (EPZ)
How healthy are Harford County residents? Of Maryland’s 24 jurisdictions, what is Harford County’s health ranking? (A) # 1 (most healthy) (B) # 8 (C) # 12 (D) # 16 (E) # 24 (least healthy)
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Health is not just medical care
80 % of what influences your health and life expectancy happens outside of the healthcare system From Tony Iton, MD, “Is Your Zip Code More Important Than Your Zip Code,” 2015 lecture
Health Outcomes Rankings By Maryland Jurisdiction, 2018 8th Healthiest for Health Outcomes: Birth outcomes Death rates Quality of life Montgomery Howard Carroll Calvert Frederick St. Mary's Anne Arundel Harford Queen Anne's Talbot Charles Worcester Baltimore Prince George's Garrett Kent Cecil Washington Wicomico Allegany Dorchester Caroline Somerset Baltimore City Source: County Health Rankings, RWJF, 2018 13
Health Factors Rankings By Maryland Jurisdiction, 2018 8th Healthiest for Health Factors: Health behaviors Access to care Socio-economics Environment Prince… Howard Montgomery Carroll Frederick Calvert Queen Anne's Talbot Harford Anne Arundel St. Mary's Baltimore Charles Kent Garrett Worcester Washington Allegany Wicomico Cecil Caroline Dorchester Somerset Baltimore City Source: County Health Rankings, RWJF, 2017 14
Harford County ranks 185 th healthiest among the 3,000 counties nationwide
What are the leading causes of mortality in Harford County? What is the leading cause of death in Harford County in 2016? (A) Heart Disease (B) Cancer (C) Stroke (D) Chronic Obstructive Pulmonary Disease (E) Accidents
What are the leading causes of mortality in Harford County? What is the leading cause of death in Harford County in 2016? (A) Heart Disease (B) Cancer (C) Stroke (D) Chronic Obstructive Pulmonary Disease (E) Accidents
Top 10 Causes of Death Harford County, 2016 600 526 475 500 400 # of Deaths 300 200 111 108 93 84 56 55 100 41 31 0 Source: Maryland Vital Statistics, 2016 Source: * Maryland Drug and Alcohol-Related Intoxication Deaths, 2016 18
Cancer Mortality Rates By Maryland Jurisdiction, 2011-2015 250 Harford County has the 223 14 th highest mortality rate. 201 200 200 190 188 184 181 180 175 172 170 169 168 168 165 165 164 163 162 162 153 153 152 148 150 128 118 100 50 0 Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/ 19
Cancer Mortality Rates Harford County & Maryland, 2012-2016 180 Harford County rates worse than the State. 172 Per 100,000 Population 171 169 170 168 166 Harford 167 Maryland 164 160 162 159 157 150 2010-12 2011-13 2012-14 2013-15 2014-16 * Age-Adjusted Rates Source: Maryland Vital Statistics Reports 20
Cancer Mortality Rates, By Site Harford County & Maryland, 2011-2015 Harford County rates worse for most cancers than the State. 39.0 Lung 35.4 22.8 Breast 22.4 Harford 17.8 Prostate Maryland 20.1 13.2 Colorectal 11.9 0 10 20 30 40 Per 100,000 Population Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/ 21
Cancer Mortality Rates, By Race Harford County & Maryland, 2011-2015 190 Age-Adjusted Rate Per 100,000 182.8 181.2 180 Population 169.1 Harford 170 Maryland 160.0 160 150 White Black Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/ 22
Cancer Incidence Rates By Maryland Jurisdiction, 2011-2015 550 Harford County has the 530 3rd highest incidence rate. 505 500 491 489 487 486 480 479 477 476 471 465 462 462 457 446 442 442 441 441 436 435 450 409 406 402 400 350 300 Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/ 23
Cancer Incidence Rates, By Site Harford County & Maryland, 2011-2015 Harford County rates worse for than the State. 137.0 Breast 131.7 131.0 Prostate 125.7 Harford 70.4 Lung Maryland 52.4 39.6 Colorectal 37.0 0 50 100 150 Per 100,000 Population Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/ 24
Cancer Incidence Rates, By Race Harford County & Maryland, 2011-2015 550 Age-Adjusted Rate Per 100,000 500.5 494.5 500 Population Harford 453.1 Maryland 444.5 450 400 White Black Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/ 25
TERTIARY PREVENTION Limiting the progression of disease 26
SECONDARY PREVENTION Screening and Early Detection Colorectal Cancer Screening Rates, Harford & Maryland, 2008-2014 Percent Screened 27
PRIMARY PREVENTION Preventing disease before it occurs 28
The Leading Actual Underlying Causes of Death Source: Mokdad et al, “Actual Causes of Death in the 29 U.S., 2000” JAMA, 3/19/2004
The Rise and Decline of Cigarette Smoking Source: AHRQ.gov
Community Norms Have Changed Over the Past 50 Years 31
There was a time when it seemed OK for babies … 32
… and OK for kids… 33
OK for future presidents … 34
OK for doctors who preferred the toasted taste … 35
OK for the Flintstones to light up in front of the kids … 36
37 … but finally a culture change
1950s-1970s Anti-Smoking Ads: Moralistic, Logical
1980s-1990s Anti-Smoking Ads: Sharper Tone, More Emotional
1990s-Present Anti-Smoking Ads: Shock value to “break through the fog” of denial
Maryland ranks 7 th in adult smoking rates, 22 nd in adolescent tobacco use rates Source: CDC BRFSS Website 2016
Adult Smoking Rates Harford County & Maryland, 2012-2016 30 Harford County rates worse than the State. 21.7 20.7 18.9 20 16.9 16.7 Percent Harford 16.4 16.2 15.1 14.6 Maryland 13.7 10 0 2010-12 2011-13 2012-14 2013-15 2014-16 Source: CDC Maryland Behavioral Risk Factor Surveillance System (BRFSS) 42
Adolescent Tobacco Use Rates* Harford County & Maryland, 2010-2016 30 Harford County rates 26.8 better than the State. 23.0 24.8 20.2 19.2 20 Percent Harford 16.9 16.4 14.9 Maryland 10 0 Source: Maryland Youth Risk Behavior Survey (YRBS) 2010 2013 2014 2016 Note: Students, Gr 9-12 who smoked at least 1 cigarette in the past 30 days * Data gap between 2010-2013 and 2014-2016 43
Teen smoking may be replaced with teen vaping one day From Varvel, G, Indianapolis Star, 9.14.18
Adolescent E-Vaping Rates Harford County & Maryland, 2016 15 14.3 13.3 10 Percent 5 Harford Maryland Source: Maryland Youth Risk Behavior Survey (YRBS), 2016 Note: Students, Gr 9-12 who drank at least 1 drink of alcohol in the past 30 days 46
Dangers of Synthetic Cannabinoids Source: NPR.org, 9/15/18 and 4/18/14
Synthetic Cannabinoid is Not Marijuana
Since 1999, all of the following population groups in Harford County have reduced their death rates, EXCEPT: (a) White (a) te men (b)White (b) te women en (c) (c) Black ck men (d) (d)Black ck women en
Since 1999, all of the following population groups in Harford County have reduced their death rates, EXCEPT: (a) White men: 12% decrease (b) (b)White te women: en: 9% increa rease se (c) Black men: 55% decrease (d)Black women: 34% decrease
8/31/16
Death Rate Change for White Women Ages 45-54, Since 1999, By Maryland Jurisdiction 100 90 80 Percent Rate Change 60 40 33 40 23 21 21 18 18 15 15 20 10 9 9 3 0 0 -1 -3 -3 -3 -4 -22 -17 -13 -9 -20 -40 Montgomery Garrett Caroline Charles Queen Anne's Dorchester Talbot Kent Anne Arundel Wicomico Calvert Harford Baltimore City Worcester Frederick Baltimore County Cecil Carroll Somerset Howard Prince George's St Mary's Washington Allegany Source: Keating, Elliott & Shapiro, “White women are dying faster all over America – but what about where your live?” Washington Post, 8/31/16 54
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