WPCp Uz)7>_X*R:ȢJnnSr, AbzlM]"@`X- y-c$WHed a\֍'fwC[[L6dZF:PEa<-K͕~\`pgw)e‰ގŃ L}d2*WWDB7 I:l1/؀t:bs[xSJ;9[[;iB Dy`5\_WT"r$a-T֤ibuw>~o9f*oBl>|TJ?Kkgq(Gk?<nrrɔ)44YZ[Hn*.m/\H-j Tq-J%av'Y%2QЬ]YHQpyOx'Afk`w 0(# Bm 0P 1 0"[a a 1u U1 %I 0 cO 0D A ou @>RUHUFfgw 0"E D5\ +#7^ Z]fkj0f4]]q!`! >!^!n' ~/!/!7 72$8! V8Nv< mx<f<!<! E %I]9IgIUJI^GJ^J]KT`K 72K  K 4L <:L )vLTLTL]2M MTEOTObO]OP"PTzUmUT;VgV 0V 0W 0XY^Y^Z 0{Z 0`[ 0B\ 0!] 0] 0^ 0_ 0`laagal4bgb^c 0ec 0;d 0e 0e 0f 0ug 0E^2AEd2MMd2A25dddddddddd66aŁxMb|t~V5VddfkWnY?aq;>k;qdnlUUCo[_YWdddd2ddddddd !dddddddn>fffffWYYYYM;M;M;M;qddddooooYfoddYe|nfffWWWWnYYYYaaaaaaqqM;M;M;M;wb>k;];mE^'(\ bBABA..'B6Q554<<M M1M k>M \B\R\B\BaAaAj\.\.\.B.B.B.B.O8O'O'bBbBbBbBbBbBvQ\5U4U4U4aBM \B\.B.O'\5\5rRaAbBT;.!!aA/<<<GGGLxECGO94E\;DQAO7\M\E4E\2EEEEEEEEEEEEEEEEEEEEEE4444444EEEEEEEEEEEEEEEEEEEEEE.`U IPLANWIC"Breastfeeding"breastfeed"*,Zh^2;Cd2MMd2B27dddddddddd66[yILxm}zU7UddeeYiU;Uk53e3lheeBI7lXSPOdddd2ddddddddddddddj3eeeeeYUUUUI5I5I5I5lhhhhllllzPeihhzPjwdeeeYYYYiUUUUUUUUUUkkI5I5I5I5hL3e3R3e3lllhhBBBmImImImI}W}7}7llllllzPOOOi3lBmI}7zPzPhlUI55h/dddd/Nudd;[RRd}dLNdBQmmyB2YYd11ddpom2YBjvdh!ddddxxxxAnAAdhwwwsow_Wsbrm\sWsSssssssssssssssssssssssWWWWWWWssssssssssssssssssssss."u'>E^2;Ed2OOd2A27dddddddddd66b}zJY~ymxwqhwO7Oddd_RcP9Yj95`3j^b_MK7jT}YSMdddd2ddddddd dddddddb5}d}d}d}d}dRPPPPJ9J9J9J9j^^^^jjjjhS}dd^^hS_wb}d}d}dRRRRcPPPPYYYYYYjjJ9J9J9J9nY5`~3~T~3e5jjj^^ɉMMMmKmKmKmKxWx7x7jjjjjj}hSwMwMwMc~3jMmKx7hShS^jPJ99^/dddd/Nudd;bkkdxdKFdBOmmyB2__dAAddqoo2_Bjvdh!ddddxxxxAnAAdsȟ~wweYwbuug~YwY~~~~~~~~~~~~~~~~~~~~~~YYYYYYYwwwwwwwwwwwwwwwwwwwwww. tobacco S %  9  .  _  Ibid. ] %  10  .  _  Ibid.,p.142.(R\w  p`2Dutch 801ItalicSpeedo T %  11  .  _  Ibid. T %  12  .  _  Ibid. S %  13  .  _ԀIbid.,p.512. J %  14  .  _ԀIbid.1. Immunizations Occupant Restraint  Statistical Characteristics %&'(*+-12 J %  15  .  _ԀIbid. J %  16  .  _ԀIbid. S %  17  .  _ԀIbid.,p.513.<6X9`+Courier+ * p.Dutch 801BoldSpeedo*4\L  p`0Dutch 801RomanSpeedoGr Ap`>WP TypographicSymbolsType 1(R\w  p`2Dutch 801ItalicSpeedo(X w  p<Dutch 801Bold ItalicSpeedo J %  18  .  _ԀIbid. J %  19  .  _ԀIbid. X %  20  .  _ԀIbid.,pp.513514. S %  21  .  _ԀIbid.,p.514.=?xxx,,Xx3Q5UCU,,/XU Pd,,/(Rd,,v7UCU,,vXU]{g #CXG~W!3(3,,vh36QCQ,,XQ }TE6OCO,,aXOletterisprovidedinAppendixA.ThecommunitymeetingsfollowedtheagendashownintheAppendixB.Themeetingsbe J %  22  .  _ԀIbid. c ,' &  %  23  .  _ԀIbid. J %  24  .  _ԀIbid. ] %  26  .  _0  Ibid.,p.275.2G+J 0_level1  X /%4 4 <DL/23  ..  2( 4 <DL2  2D+J 0_level2   ," <DL,23  ..  2( 4 <DL2  2A+J 0_level3   ) <DL)23  ..  2( 4 <DL2    T %  27  .  _0  Ibid. T %  28  .  _0  Ibid.2>+J 0_level4  ` &<<DL&23  ..  2( 4 <DL2  2;+J 0_level5   #DL#23  ..  2( 4 <DL2  28+J 0_level6    DL 23  ..  2( 4 <DL2  25+J 0_level7  h DDL23  ..  2( 4 <DL2  22+J 0_level8   L23  ..  2( 4 <DL2  2/+J 0_level9    L23  ..  2( 4 <DL2  2GJ 0_levsl1  X /%4 4 <DL/23  Ԁ  2( 4 <DL2  2DJ 0_levsl2   ," <DL,23  Ԁ  2( 4 <DL2   b %  29  .  _0  Ibid.,pp.275276. ] %  30  .  _0  Ibid.,p.276. b %  31  .  _0  Ibid.,pp.282283. ] %  32  .  _0  Ibid.,p.283. T %  33  .  _0  Ibid.2AJ 0_levsl3   ) <DL)23  Ԁ  2( 4 <DL2  2>J 0_levsl4  ` &<<DL&23  Ԁ  2( 4 <DL2  2;J 0_levsl5   #DL#23  Ԁ  2( 4 <DL2  28J 0_levsl6    DL 23  Ԁ  2( 4 <DL2  25J 0_levsl7  h DDL23  Ԁ  2( 4 <DL2  22J 0_levsl8   L23  Ԁ  2( 4 <DL2  2/J 0_levsl9    L23  Ԁ  2( 4 <DL2  2GJ 0_levnl1  X /%4 4 <DL/23   2( 4 <DL2  2DJ 0_levnl2   ," <DL,23   2( 4 <DL2  2AJ 0_levnl3   ) <DL)23   2( 4 <DL2  2>J 0_levnl4  ` &<<DL&23   2( 4 <DL2  2;J 0_levnl5   #DL#23   2( 4 <DL2  28J 0_levnl6    DL 23   2( 4 <DL2  25J 0_levnl7  h DDL23   2( 4 <DL2  22J 0_levnl8   L23   2( 4 <DL2  2/J 0_levnl9    L23   2( 4 <DL2  dd)Hairline d\  `timesroman !  _XEXX Xm[XXE @ 0MonroeandRandolphCounties  @ 4CommunityHealthPlan h @bb:20002005      `     h      p      x  m[X̸X@9Preparedby @  @  +ThomasG.Smith,M.P.A.,Administrator   XX̸@)MonroeRandolphBiCountyHealthDepartment : @44=for B X̸X@ ,IllinoisDepartmentofPublicHealth  @4Springfield,Illinois   @8March1,2000 :#    ` Priorities:  TobaccoUsePreventionandCessation j*%"    `    Immunizations P+&#    `    OccupantRestraint 6,'$   -l(% 8XXdd8  @hh4StatementofPurpose  TheMonroeRandolphBiCountyHealthDepartment,incooperationwiththeIllinois | DepartmentofPublicHealth,onceagain,hasendeavoredtoincludemembersofthe b communitiesweserveinthehealthassessmentandplanningprocess.Weenvisionthis H processasamultifacetedbenefittoboththecommunitiesandthehealthdepartment.First, . ~ theprocess,becauseofitsinclusiveness,encompassesmorecompletelypotentialhealth  d priorities.Second,theprocessgivesthehealthdepartmentvisibilitywiththepublic.Third,  J theprocesscontributescredibilitytothechoicesmadeintheselectionofprioritiessincethe  0 stakeholdersareinvolvedintheselectionprocess.    Thiscurrentplanningprocessistheresultofapproximatelytenyearsofcollaborativeeffort   betweentheIllinoisDepartmentofPublicHealthandtheIllinoisAssociationofLocal x  EnvironmentalHealthAdministrators.Bothgroupsrecognizedtheinadequaciesofthe ^  ProgramStandardswhichwererequiredbytheIllinoisDepartmentofPublicHealthtobe D  implementedbylocalhealthdepartmentsinordertobecertified.Thetenrequired *z  programshaveevolvedtothepresentsystemoffourrequiredprogramsandthreehigh ` priorityprogramstobeselectedbythecommunityplanningprocess.Theprocesstermed F IPLANhasbeenformalizedasadministrativerulesoftheStateofIllinois,Title77:Public , Health,ChapterI:DepartmentofPublicHealth,Subchapterh:LocalHealthDepartments,  Parts600through615.  ЀTheprioritieswereselectedbythecommunitymembersandwillbetargetedfor t interventionbythehealthdepartment,afterapprovalbytheMonroeRandolphBiCounty Z BoardofHealth.Othersuggestionswhicharenotselectedasoneofthethreepriorities, @ willbereservedaspotentialprogramneedspendingavailablefinancialsupport. &v   B @ .TheCommunityHealthPlanProcess  TheMonroeRandolphBiCountyHealthDepartmentheldsixcommunitymeetings | throughoutthetwocountyareaandmeetingsscheduledwithselectedmanagementstaffat b allthreehospitals.BothMonroeandRandolphCountieshaveadispersedpopulation. H NeithercountyhasatypicalIllinoispopulationdistribution,thatis,alargepopulationcenter . ~ 25%50%ofthecountypopulation.Instead,thepopulationoffourcitiesareapproximately  d 5,000,andthepopulationoftwoadditionalcitiesare2,000to3,000.Localcommunity  J membersthatwereinvitedincluded:lawenforcementofficials,healthprofessionals,  0 mayors,citycouncilmembers,politicians,churchleaders,boardofhealthmembers,EMS    personnel,seniorcitizens,andotherconcernedmembersofthecommunity.    Thefollowingindividualsparticipatedinthecommunityprocess: x  SpartaNewsPlaindealer0  6Gaslite,Sparta,IL622869D (#(# InterestedCitizen0 0 (# (#PattiBirchler,9515DeerRunLane,Sparta,IL62286*z (#(# ChesterMemorialHospital0  GwendyGarner,217Opdyke,Chester,IL62233`(#(# ChesterMemorialHospital0  KarenWolf,234Young,Chester,IL62233F(#(# ChesterMemorialHospital0  MarlaCushman,P.O.Box609,Chester,IL62233,(#(# ChesterMemorialHospital0  RandyDudenbostel,103Riverview,Chester,IL62233(#(# CountyCoroner0   NeilBirchler,214EstateDr.,Chester,IL62233 (# (# MonroeCountyBoard0  DonaldDietz,20Dwight,Waterloo,IL62298(#(# BoardofHealth   LyleHoffman,1254GallRoad,Waterloo.IL62298 t InterestedCitizen0 0 (# (#JoannDietz,20Dwight,Waterloo,IL62298Z(#(# InterestedCitizen0 0 (# (#JackNorman,906N.Metter,Columbia,IL62236@(#(# St.Clement'sHospital  BarbaraWagner,5804LemenRd.,Waterloo,IL62298 &v St.Clement'sHospital  SuzanneBeattie  \ St.Clement'sHospital  MikeMcManus B St.Clement'sHospital  ChristyBrinkman ( SpartaHospital0 0 (# (#DenaBaker(#(# SpartaHospital0 0 (# (#DebWalls(#(# SpartaHospital0 0 (# (#RuthHolloway (#(# SpartaHospital0 0 (# (#SusanDitchp! (#(# SpartaHospital0 0 (# (#DaleWoethyl,JrV"!(#(# SpartaHospital0 0 (# (#CherylAdams<#"(#(# SpartaHospital0 0 (# (#BrianTaylor"$r#(#(# SpartaHospital0 0 (# (#AllenPritchett%X $(#(# SpartaHospital0 0 (# (#DarlaWelty%>!%(#(# SpartaHospital0 0 (# (#SusanGutjahn&$"&(#(# SpartaHospital0 0 (# (#Tom' #'(#(# SpartaHospital0 0 (# (#JoannEmge(#((#(#    `     h      p     `     h  R+&+ Thedatesofthepublicmeetingswerepublishedininformationreleasesincounty   newspapersandthehospitalswerecontactedbytelephoneorinperson.Acopyofthe  invitationletterisprovidedinAppendixA. | ThecommunitymeetingsfollowedtheagendashownintheAppendixB.Themeetings H beganwithashortdiscussionoftheMonroeRandolphBiCountyHealthDepartment's . ~ missionstatement,followedbyadescriptionoftheIPLANplanningprocess.  d Thestatisticaldatawasthenpresentedanddiscussed.Fourpagesofsummarydataincluded  0 acomparisonoftheMortalityRatesforMonroeandRandolphCountieswiththeStateof    IllinoisandacomparisonoftheYearsofPotentialLifeLosttoAge65forMonroeand    RandolphCountieswiththeStateofIllinois.Bothtablesarelistedinorderofthepercent   differenceoftheratesbetweenthetwocountiesandIllinois.Thesignificanceofrates x  greaterthantwentypercentofthestateratewasdiscussed.Inaddition,sincetobacco ^  controlwasaselectedpriorityinthe1994IPLAN,thepercentageofmotherswhosmoke D  duringpregnancywaspresentedalongwiththepercentofbirthstoteens.Thetablesare *z  showninAppendixC,byyearandalsoseparatelybycountyinAppendixD. ` TheexistingprogramsoftheMonroeRandolphBiCountyHealthDepartmentwerethen , brieflypresented.Thediscussionincludedthepublichealthpurposeofeachprogramanda  shorthistoricalperspective.TheIPLANprioritiesfromthe1994IPLANwerethen  discussed,asweretheconcernsidentifiedbythepreviouscommunitymeetings.  Theparticipantswerethenrequestedtoidentifypublichealthconcernsofthecommunity Z includingthehealthproblemsidentifiedbythedataandthoseperceivedproblems @ unsubstantiatedbyavailabledata. &v Thecommunitymemberswerethenrequestedtoselectthethreemostimportantorserious B healthproblemsbasedonthediscussionofthedataandthepresentationofunsubstantiated ( concernsofthecommunity.Thepriorityprogramareaswereselectedbyvotingduring  eachcommunitymeeting.Eachmemberwasallowedtoselectthreeprogramareasashigh  priority.Inseveralofthecommunitymeetingsthetopthreeprioritieswereselectedby   consensus.Thetopthreeprioritiesfromeachcommunitymeetingwerethencounted,each p!  priorityreceivingonevoteifselectedatacommunitymeeting.Theprioritieswereeach V"! giventhesameweightregardlessofthenumberofparticipantsattendingaparticular <#" meeting.Theparticipantsselectedexistingprogramsasthetopthreeprioritieswithafew "$r# exceptions.Thefollowingisalistingoftheprioritieswiththenumberofmeetingseach %X $ wasselectedasapriority: %>!%   Program    h      p Meetings ' #'    `     h      p Selected (#(   TobaccoUsePreventionandCessation0  0p(#(#0p(#p(#4l*%*(#(#   Immunizations   h      p   3 R+&+   OccupantRestraint0  0h(#(#0h(#h(#0(#(#0p(#(#0p(#p(#28,',(#(# Ї  Program(continued)   h      p Meetings     `     h      p Selected(continued) |   ArrangingforMedicalSpecialiststoprovide_screenings_0  1. ~(#(#   TransportationforMedicalvisits0  0(#(#0p(#(#0p(#p(#1 d(#(#   EnvironmentalHealthServices0  0(#(#0p(#(#0p(#p(#1 J(#(#   MaternalandChildHealthEducation0  0p(#(#0p(#p(#1 0(#(#   FoodSanitation0  0h(#(#0h(#h(#0(#(#0p(#(#0p(#p(#1  (#(#   STDClinics0 0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#0p(#p(#1  (#(#   SchoolNursing0  0h(#(#0h(#h(#0(#(#0p(#(#0p(#p(#1 (#(#   PreventionHealthEducation x     ` (Diet,exercise,handwashing,esp.inschools)  1 ^    CPRandFirstAidclasses0 h 0h(#h(#0(#(#0p(#(#0p(#p(#1D (#(#   Teenagepregnancyprevention0  0(#(#0p(#(#0p(#p(#1*z (#(#   PublicityofHealthandSocialServiceagencies `    ` andSupportGroupsavailable0  0p(#(#0p(#p(#1F(#(#   SewageAerationUnitAnnualSurveillance0 p 0p(#p(#1,(#(#   GroundwaterProtection h      p   1  ThetopthreeprioritiesselectedareTobaccoUsePreventionandCessation,Immunizations,  andOccupantRestraint. t Theinformationgatheredatthecommunitymeetingswascombinedandaformalneeds @ assessmentwrittenfortheMonroeRandolphBiCountyBoardofHealthapproval,and &v submittedtotheIllinoisDepartmentofPublicHealthasthenextfiveyearhealthplanfor  \ MonroeandRandolphCounties. B TheroleofcommunitymembersindevelopingtheCommunityHealthPlanwastoclarify  theintentoftheirselections.TheplanwaswrittenbystaffoftheMonroeRandolphBi  CountyHealthDepartment,reviewedbytheProfessionalAdvisoryCommitteeand   approvedbytheMonroeRandolphBiCountyBoardofHealth.Alistofthemembersof p!  theMonroeRandolphBiCountyBoardofHealthisattachedinAppendixEandthe V"! ProfessionalAdvisoryCommitteeisattachedinAppendixF. <#"    `     h      p    &$"&   % > StatisticalCharacteristics     ThediscussionofthecharacteristicsofthestatisticaldatainrelationtotheStateofIllinois  Dataisprovidedinthefollowingsixgroupings.ThedataisfromtheCensusof1990, l unlessotherwisenoted: R 0  SocialandDemographicCharacteristics n(#(# 0  GeneralHealthandAccesstoCare T(#(# 0  MaternalandChildHealth :(#(# 0  ChronicandInfectiousDiseases  (#(# 0  Environmental,OccupationalandInjuryControl  (#(# 0  SentinelEvents (#(#  SocialandDemographicCharacteristics h   IncomparisontotheStateofIllinoisstatistics,thestatisticsoftheareadefinedbyMonroe H  andRandolphCountiescombinedindicatethatMonroeandRandolphcountiesare .~ substantiallymorerural(StandardizedRiskRatio[_SRR_]3.45);fewerresidentsaged25 d yearsorlessgraduatefromhighschool(_SRR_Ԁ1.31).StandardizedRiskRatioslessthan J 0.80orgreaterthan1.20indicatessubstantivedifferenceinratesinaccordancewiththe 0 NorthCarolinaRule.TheareaofMonroeandRandolphcountiesisslightlymoreracially  homogeneouslywhite(SRR1.15);older(SRRforresidentsolderthan65is1.16);fewer  individualsusefoodstamps(SRR0.54);fewerareMedicaidenrollees(SRR0.55);and  fewerarehighschooldropoutsthantheStateofIllinois(SRR0.51).Thestudyareaisnot x aspooraswouldbeexpectedforaruralpopulation.Poverty,definedasincomeslessthan ^ 200%oftheFederalPovertyLevel,was25.0%inMonroeandRandolphcountiesand27.1 D %inIllinois(SRR0.88).Povertyseemstobetemperedbythesuburbanaffluenceof *z centralandnorthwesternMonroeCounty,mostnotablytheareasincludingandsurrounding ` ColumbiaandWaterloo.ColumbiaisvirtuallyadjacenttoSouthSt.LouisCounty,avital F areaofcommerce. , Ifconditionsrelateddirectlyandindirectlyataffluenceandpovertyareobserved   anecdotallyinthebicountyarea,acontinuumisdetectedwhichbeginsinColumbiawith !  higherhouseholdincomes,moreeducatedandemployedpopulace,decliningasthe t"! continuumisfollowedalongStateRoute3throughWaterloo,thentoRedBudandto Z#" ChesterandalsofromRedBudtoSpartaandontoCoulterville.Otherconditionsappears @$# toparallelthisparadigm.Forexample,single,sexuallyactiveteenagedwomenin &%v $ ColumbiaappeartousebirthcontrolmorefrequentlythantheirSpartaorChester  &\!% counterpartsandwhentheColumbiateensbecomepregnant,theyaremorelikelytoseek &B"& abortionsthanSpartaandChesterteens.Thissofterinformationhasnotbeensubstantiated '(#' withharddatabutaregeneralimpressions. ($( Thepopulationdiffersfrommostdownstatecountieswhichtendtohave2550%oftheir *%* populationsinonecommercialtradingcenter,usuallymoreorlessgeographicallycentered p+&+ inthecounty.Thepopulationdistributionofeithercountyisthusatypical;fourpopulation V,', centersofapproximately5,000;1ofapproximately3,000andoneofapproximately2,000  exist.Thesesixcitiescomprise42%ofthetotalcombinedcountiespopulation.  ThepopulationofChesterisofficially8,000butincludesresidents(inmates)ofMenard b CorrectionalCenterandChesterMentalHealthCenter.Theresidentsofthesefacilities H skewRandolphCountysblacknessandpoorness. . ~ Sparta(population4853)islocatedinthemideasternpartofRandolphCounty.Ithasa  J significantblackpopulation.Withinthelast1015years,blacksfromEastSt.Louishave  0 migratedtoSparta.Theviolence,racialtensionsanddrugsassociatedwithEastSt.Louis    havealsoappearedinSparta.TheareaaroundSpartawerethecoalminingregionsof    RandolphCounty.   Waterloo(population5,072)islocatedinthecenterofMonroeCounty.Verylittle ^  manufacturingislocatedinMonroeCounty.BothWaterlooandColumbia(population D  5,524),locatedalongthenorthwestsideofMonroeCountyarebecomingsuburbsofSt. *z  LouisandarerapidlygrowingduetopopulationpressurefromSouthSt.LouisCounty, ` whichisadjacenttonorthernMonroeCountyandtheMetroEastArea(Dupo,Cahokia, F etc).Inaddition,recentincreasesinpopulationarealsoduetotherelocationofresidents , formthe1993floodravagedValmeyerandsurroundingMississippiRiverbottomsarea.  RedBud(population2,918)islocatedinextremenorthwesternRandolphCounty,adjacent  onthenorthandwesttoMonroeCounty.BecauseofitsrelativeproximitytoWaterloo, t mostRedBudresidentsuseourclinicservicesatWaterlooratherthanatChesterorSparta. Z Steeleville(population2,059)islocatedmidwaybetweenChesterandSparta. &v ThedistancefromColumbiatoChesterisapproximately50miles;theareaofMonroeand B Randolphcountiesis1,059squaremileswithatotalpopulationof57,005. (  GeneralHealthandAccesstoCare   MostoftheGeneralHealthandAccesstoCareindicatorswerelabeled NotApplicablefor z!  GroupSelectionbytheIPLANDataSystem.The RatioofMedicaidEnrolleesto `"! MedicaidPhysicianVendorswasslightlylowerthantheStateofIllinoisratio(SRR0.96); F#" therateper100,000of AdvancedLifeSupportEmergencyCareVehicleswas ,$|# significantlyhigherthantheStateofIllinoisrate,dueprimarilytoMedstarAmbulance %b $ ServiceinRandolphCounty(SRR2.92). %H!% ThreehospitalsservetheareaandarelocatedinRedBud,SpartaandChester.Thereareno '#' readilyidentifiedpopulationslivinginafederallyrecognizedHealthProfessionalShortage (#( Area,althoughthepoorappeartobeunderservedbymedicalcareandthecase )$) managementstaffintheMonroeRandolphBiCountyHealthDepartmenthavecommented v*%*  thattherewerenotenoughphysicianstoserveallofthemedicalneed.TheMonroe \+&+ RandolphBiCountyBoardofHealthrecognizedthisgapandhaveexpandedfacilitiesin  ChesterandWaterloo.   MaternalandChildHealth b  In1990,MonroeandRandolphcountieshad715births,96.5%ofwhichwerewhite(680 B  births;96%whitein1997).MedicaiddeliverieswereslightlylessthantheStateofIllinois ( x rate.Infantmortalityratesweretoolowtoaccuratelycalculate,statistically.Lowbirth  ^ weightsweresignificantlylowerthantheStateofIllinoisrateandaresomewhatlowerthan  D theYear2000Objectiveof5.0%(StateSRR0.61;Year2000SRR0.92).  *  PrenatalindicatorsrevealthatprenatalcareissignificantlybetterthantheStateofIllinois   averages.Morewomenreceiveadequateprenatalcareinthefirsttrimesterandsignificantly   fewerteensbecomepregnant.Thetwohealthindicatorswhicharesignificantlygreater r  thantheStateofIllinois,asawholearethatsignificantlymoremothersmokeduring X  pregnancy(SRR1.20;1997SRR1.52)andsignificantlymorecongenitalanomaliesare >  detectatbirth(SRR1.58). $t  ChronicandInfectiousDiseases  @ InfectiousDiseaseIndicatorsaresignificantlyalllowerthantheStateofIllinoisforthe  MonroeandRandolphcounties,includingthefollowingdiseaseswhicharefollowedbythe  numberoftheiroccurrences:  Ѐ0  Syphilis(0),Gonorrhea(21),Vaccinepreventablediseases(2),Haemophilus x Influenza(2),HepatitisB(2),Tuberculosis(4),Salmonella(5),andCampylobacter ^ (2).D(#(# ChronicDiseaseIndicatorsforMonroeandRandolphcountiesaregenerallylowerthanthe ` StateofIllinois,exceptforCoronaryHeartDisease(SRR1.37).Thesignificantlyhigh F CoronaryHeartdiseaseisindicativeofsedentarylifestylesandpoordietaryhabitsofbi , countyresidents.OtherchronicdiseaseindicatorswereeitherlowerthantheStateof  Illinoisratesortooinfrequenttobestatisticallyevaluated.    Environmental,OccupationalandInjuryControl  t"! Environmental,Occupational,andInjuryControlIndicatorswhichweresignificantlyhigher J$# thantheStateofIllinoisrateswerehipfracturesforbicountyresidentssixtyfiveyearsand 0% $ older(SRR1.24),Suicide(SRR2.29),andMotorVehicleCrashes(SRR1.57).The &f!% significantrateofhipfracturesisindicativeoftheagingpopulationofthetwocounties. &L"& Indiscussions% ) ԀwithNeilBirchler,RandolphCountyCoronerandIPLANCommittee ($( Participant,thesuicidedataisundoubtedlyskewedduetothenatureofMenard )$) CorrectionalCenterandChesterMentalHealthCenter.AccordingtoMr.Birchler,suicide *%* isacommoncauseofdeathinthesetwoinstitutions. z+&+ ЇMotorvehiclemortalityisalsosignificantlyhigherthantheStateofIllinoisrate.Motor  vehicledeathswere14in1990(SRR1.57).ParticipantsandtheformerCoordinatorforthe  MonroeRandolphBiCountyHealthDepartmentssafetybeltprogramrecalledthatdeaths | inthemid1980'swereabout25forRandolphCountyalone.Apparently,theefforts b exhibitedbytheIllinoisDepartmentofTransportationandtheMonroeRandolphBiCounty H HealthDepartmenthavesubstantiallyreducedthedeathrate,however,asof1997,the . ~ mortalityrateduetotrafficcrasheswasstillsignificantlyhigherthantheStateofIllinois.  d Otherenvironmental,occupationalandinjurycontroldatawereeithertoosmalltobe  0 statisticallyvalid,orwerelessthantheStandardizedRiskRatioof1.20.    Inspiteoftheperceivedneedforindigenthealthcare,theoccurrenceofsentinelevents ^  werealllowerthantheStateofIllinois.Thismightindicatethatthelackofaccesstocareis D  nothavingasignificantimpactonselectedhealthcareevents.However,theeventsselected *z  assentinelevents ...shouldberareamongapopulationthathasreadyaccesstoprimary ` healthcare.TheoccurrenceofsuchcasesinIllinoisindicatessomeofourpopulationhave F notobtainedearlyprimarycare.Thegoalshouldbetohavenoeventsamongthesesentinel , indicators.  F  1           @u u , TobaccoUsePreventionandCessation   Thecommunitygroupsidentifiedtobaccousepreventiveeducationandsmokingcessation  oneofthesignificanthealthissuesfacingbicountyresidents.Theparticipantssawvaluein l thecurrenteducationaleffortsconductedbytheMonroeRandolphBiCountyHealth R Department.ThefollowingHealthStatusObjectiveadaptedfromHealthyPeople2000 8  selectedtodemonstrateoneofthehealthproblemsdiscussedisasfollows:  n 1.1% 3 0  ReducecoronaryheartdiseasedeathsinMonroeandRandolphcountiestonomore  : than345per100,000peopleby2010.(Baseline:358.4per100,000in1997)  (#(# ThecoronaryheartmortalityrateforMonroeandRandolphCountiesfor1997was358.4   per100,000whichisconsiderablymorethantheYear2000Objectiveof100per100,000   andmorethantheStateofIllinoisrateof225.3per100,000. h   Nationaltrendsandinformation  4  0  TobaccouseisresponsibleformorethanoneofeverysixdeathsintheUnitedStates  Z andisthemostimportantsinglepreventablecauseofdeathanddiseasein@(#(# 0  oursociety.Tobaccouseisamajorriskfactorfordiseasesoftheheartandblood & vessels;chronicbronchitisandemphysema;cancersofthelung,larynx,pharynx,   oralcavity,esophagus,pancreas,andbladder;andotherproblemssuchasrespiratory  infectionsandstomachulcers.Cigarettesmokingaccountsforabout390,000deaths  yearlyincluding21percentofallcoronaryheartdiseasedeaths,87percentoflung n cancerdeaths,and30percentofallcancerdeaths. F  2      T(#(# 0  Manysmokingrelateddeathsoccurbeforeage65,strikingpeopleintheprimeof  p theirlife.Smokingcontributessubstantiallytochronicmorbidityanddisabilityas V well.Forexample,in19831985,chronicbronchitis,emphysema,andlungcancer < werethemaincauseofactivitylimitation(_ie_.,disability)fornearly4per1000 " peopleintheUnitedStatesandaccountedforalmost3percentofallactivity  limitation. F  3       (#(# 0  Cigarettesmokersareatincreasedriskforfatalandnonfatalheartattacksandfor j"! suddendeath.Smokershavea70percentgreatercoronaryheartdiseasedeathrate, P#" atwofoldtofourfoldgreaterincidenceofcoronaryheartdisease,andatwofoldto 6$# fourfoldgreaterriskforsuddendeaththannonsmokers.In1985,smokingwas %l $ estimatedtoaccountfor21percentofallcoronaryheartdisease,and40percentof &R!% coronaryheartdiseasedeathsinpeopleyoungerthanage65.Prospective &8"& epidemiologicstudieshavedocumentedasubstantialreductionincoronaryheart '#' diseaseratesfollowingsmokingcessation.Whilesomestudieshaveshownabenefit ($( within2yearsafterquitting,otherstudieshavesuggestedthatcoronaryheartdisease )$) riskgraduallydecreasesoveraperiodofseveralyears.Reducingtheproportionof *%*  youthwhostarttosmokeandencouragingsmokingcessationamongcurrent f+&+ smokersareimportantpreventivemeasuresforreducingcoronaryheartdisease  incidenceandmortality. F  4      (#(#  0  Amongpeopleaged20andolder,cigarettesmokingprevalencehasbeendeclining b steadilyatarateof0.5percentagepointsperyearsince1965.Thedeclinehasbeen H substantiallysloweramongwomen.Bythelate1990s,smokingratesforwomen . ~ willprobablyexceedtheratesformen.In1987,smokingprevalencefortheentire  d populationaged20andolderwas29percent.Projectionofthe1974through1985  J trendsuggeststhatsmokingprevalencewillbe22percentintheyear2000.The  0 targetof15percent,althoughchallenging,isbelievedattainablewithintensified    efforts,giventhechangingsocialattitudesregardingtobaccouse.  F  5        (#(# 0  The1987prevalenceofcigarettesmokingamongpeoplewithahighschool x  educationorlesswas34percent.Therateofdeclineinsmokingprevalencesince ^  1965forthisgrouphasbeenapproximately0.2percentagepointsperyear.Ifthe D  currenttrendcontinues,smokingprevalenceamongpeoplewithahighschool *z  educationorlesswillbeapproximately31percentintheyear2000.Acceleratingthe ` rateofchangeforthispopulationpresentsamajorchallengetothepublichealth F professionals,andthetargetof20percentreflectsthischallenge.  F  6      ,(#(# 0  Smokingprevalencevariesbyoccupationalcategory.Smokingprevalenceis  consistentlyhigheramongbluecollarandserviceworkersthanamongwhitecollar  professionals,In1987,26.1percentofwhitecollarmalessmokedcigarettesasdid t 26.6percentofwhitecollarfemales.Amongbluecollarworkers,36.1percentof Z malesand36.6percentoffemalessmoked.Theunusualsimilarityofthedata @ betweenmenandwomenwithintheblueandwhitecollarworkingcategories &v suggestthattheworkenvironmentisanimportantinfluenceonsmokingstatus. " F  7       \(#(# 0  Theprevalenceofcigarettesmokinghasbeenmuchhigheramongmilitarypersonnel ( thanamongtheoverallpopulation.Smokingisinverselyassociatedwithmilitary  rank,andisatleasttwiceashighamongenlistedpersonnelamongcommissioned  officers.Accordingtoworldwidesurveysofsubstanceabuseamongmilitary   personnelconductedbytheDepartmentofDefense,smokingprevalencehasfallen p!  from52percentin1980to42percentin1988.Ifthe1980through1988trend V"! continues,smokingprevalenceamongmilitarypersonnelwillberoughly26percent <#" intheyear2000.Thetargetof20percentisbelievedattainablegivenincreased "$r# _antismoking_ԀactivitieswithintheDepartmentofDefense. # F  8      %X $(#(# ̀0  Thirtyfourpercentofblackssmokedin1987:41percentofmenand29percentof &$"& women.Smokingprevalencedeclinedmorerapidlyamongblacksthanamong ' #' youngwhitesfrom1974through1985,indicatingthatthegapisclosing,albeit (#( slowly.Settingatargetof20percentforblackswouldrepresentanequivalent )$) achievementforwhitesandblacksbytheyear2000.Therefore,thetargetforthe l*%* blacksissettwopercentagepointslowerat18percent. 4 F  9      R+&+(#(#  8,', 0  Womenofreproductiveagearetargetedasprimarypreventionstrategytoreducethe  prevalenceofsmokingduringpregnancy.Approximately29percentofwomenaged  18through44smokedcigarettesin1987. 5 F  10      ׀|(#(# 0  Nationaldataonsmokingduringpregnancyarescarceandestimatesvary.The1980 H NationalNatalitySurveyreportedthat29percentofallmarriedwomensmoked . ~ duringpregnancy.In1982,theNationalSurveyofFamilyGrowthfoundthat32  d percentofwomenaged15through44smokedduringtheirmostrecentpregnancy.  J Inthe1985NationalHealthInterviewSurvey,25percentofwomenaged18through  0 44whohadgivenbirthwithinthepast5yearssmokedduringpregnancy.Limited    datasuggestthattheprevalenceofsmokingduringpregnancyhasbeendecreasing    forsomebutnotallgroups.Between1967and1980,smokingratesduring   pregnancyamongteenagersremainedfairlyconstantat38percentforwhitesand27 x  percentforblacks.Amongwomenovertheageof20,smokingduringpregnancy ^  declinedfrom34to11percentamongblackwomenanddeclinedfrom40to25 D  percentamongwhitewomen.Amongwhitesmokerswithlessthan12yearsof *z  education,theprevalenceofsmokingduringpregnancydeclinedfrom48percentto ` 43percent,comparedtoadeclinefrom34to11percentforwomenwith16ormore F yearsofeducation.Ingeneral,womeninthelowestageandsocioeconomic , categorieshavethehighestlikelihoodofsmokingduringpregnancy.TheNational  MaternalandInfantHealthSurvey,begunin1988,willprovidereliableestimatesof  smokingduringpregnancyforthelate1980s.Inaddition,maternalsmokingdata  frombirthcertificateswillbeavailableforanalysisoftheeffectofsmokingon t certainpediatricconditions. 7 F  11      Z(#(# 0  Womenwhousedoralcontraceptivesandsmokecigaretteshaveanincreasedriskof &v heartattackandstroke.In197680,40percentofwomenusingoralcontraceptives  \ smokedcigarettes.In1983,theBehavioralRiskFactorSurveillanceSystemfound B that36percentoforalcontraceptiveuseraged18through44smokedcigarettes.The ( year2000targetof10percentisbelievedattainablegiventheapparentdownward  trend. 8 F  12      ׀(#(#  MonroeRandolphtrendsandinformation  p!  Thepercentageofwomenwhosmokedduringpregnancyinthetwocountieshave F#" decreasedfrom19.7%in1990to18.7%in1997whichisstillhigherthantheStateof ,$|# Illinois'12.3%andmorethantheNationalYear2000Objectiveof15%.Percentagesof %b $ womenwhosmokeduringpregnancywere9.8%forMonroeCountyand25.9%for %H!% RandolphCountyfor1997. &."& TheImpactObjectivechosenfortheHealthStatusObjectiveisasfollows: (#( 1.20  Reducecigarettesmokingtoaprevalenceofnomorethan20percentamongpeople v*%* aged18andolderby2005.\+&+(#(#  B,', TheimpactobjectiveselectedfortheMonroeRandolphBiCountyHealthDepartmentisto  reducetheprevalenceofsmokingfrom1997levelof24.9%to20%.Thiswillbe  accomplishedthroughtheHealthPromotionGrantin"SmokeFreeThat'sMe"smoking | preventionpresentationstoschoolchildren,"IllinoisRestaurantRecognitionProgram", b designedtoencouragesmokefreerestaurants,"FreedomFromSmoking"asmoking H cessationprogrampresentedincooperationwithMemorialHospital,andgeneral . ~ informationreleasestothemedia.TheseprogramshavebeenprescribedbytheIllinois  d DepartmentofPublicHealthaseffectiveinreducingsmokingprevalence.Inaddition,to  J theabovementionedprograms,WICclientsarecounseledontheadverseeffectsof  0 smokingwhilepregnant.     SmokeFreeThatsMeisasmokingpreventionandawarenessprogramtargetedto   second,fourth,andsixthgradeschoolchildren.Thepresentationsareageappropriate, x  includeclassroomactivitiesanddiscussion,andaudiovisualmedia. SmokeFreeThats ^  MewasdesignedandisdistributedbytheAmericanLungAssociation.The SmokeFree D  ThatsMeactivitiesindirectlyaffecttheImpactObjectivestatedaboveinthattheyare *z  designedtoencouragestudentstoresisttheinitiationofsmokingandtheinformation ` presentedalsoequipstheparticipantstoencourageparentsandoldersiblingstoquit F smoking.Thehypothesisexiststhatthesechildrenwillalsobelesslikelytosmokeas , adults,directlyaffectingtheImpactObjectivestrategically.  The"IllinoisRestaurantRecognitionProgram"acknowledgesrestaurantswhichare,or  becomesmokefreewithacertificatefromtheIllinoisDepartmentofPublicHealthsuitable t forframing.TheIllinoisDepartmentofPublicHealthwillalsopublishabookletlisting Z smokefreerestaurantsbycountyandwilllistsmokefreerestaurantsintheirwebsite.The @ MonroeRandolphBiCountyHealthDepartmentispromotingtheprojectandwillidentify &v restaurantstoberecognizedbytheIllinoisDepartmentofPublicHealth.The"Illinois  \ RestaurantRecognitionProgram"indirectlyaffectstheImpactObjectivebydiscouraging B andmakingpublicsmokingmoredifficult.Evaluationofthisprogramwillbethenumber ( ofrestaurantswhicharesmokefree.  The"FreedomFromSmoking"cessationprogramisbeingjointlymoderatedbytheHealth   EducatorfromtheMonroeRandolphBiCountyHealthDepartmentandtheRespiratory p!  TherapistfromMemorialHospital,Chester.Theprogramisdesignedanddistributedbythe V"! AmericanLungAssociationandtargetsfourgroupsofindividuals: <#"  (5h83 " "     Ī25h  1  .3  0 `   Smokerswhoarereadytoquit Ī݌%X $` (#` (# Ќ  " "     󿶫25h  2  .3  0 `   Smokerswhoarenotreadytoquit 󿶫݌%>!%` (#` (# Ќ  " "     󿬬25h  3  .3  0 `   Mediatorspeoplewhoareincontactwithsmokers,suchasphysicians, &$"& nurses,humanresourcesdirectors,etc 󿬬݌' #'` (#` (# Ќ  " "     25h  4  .3  0 `   Highriskindividualsforstartinganddevelopingsmokingaddictions,suchas, (#( youth,AfricanAmericans,Hispanicsandlowliteracyindividuals <݌)$)` (#` (#    l*%* Theprogramispresentedinaclinicformat,consistingofeightsessionsinapproximately  eightweeks.Smokersquitcompletelyatthefourthsession.Thenextsessionsinclude  followuptothecessation. |  TheWICprogramaddressesasubsetofthetargetpopulation,individually.Printed H informationandverbalcounselingisprovidedtopregnantwomenintheWICprogram . ~ regardingthedangersofsmokingduringthepregnancyforthefetusandregardingthe  d dangersofsecondhandsmokefortheinfantafterdelivery.Thesetwoactivitiesare  J intendedtoreducethecigarettesmokingamongpregnantlowincomewomen.This  0 componentwasselectedasanIPLANpriorityin1994.    Theeffectivenessoftheprogramswillbeevaluatedbythereductionintheincidenceof   smoking.Thepercentageof24.9%smokingprevalenceisstratifieddataforruralcounties x  throughouttheStateofIllinois.Theactualprevalenceofsmokersovertheageof18will ^  undoubtedlyvaryastherateof"MotherswhoSmokeDuringPregnancy"variesbycounty D  (Monroe9.8%;Randolph25.9%,1997).Thesedataaresubsetsofthepeoplewhosmokein *z  eachcounty.Theactualsmokingprevalencewillbereviewedwhenthedatafromthe ` BehaviorRiskFactorSurveys(BRFS)fromMonroeandRandolphcountiesbecome F available.Untilthattime,thestratifieddatafromthestatewideBehaviorRiskFactor , SurveillanceSurvey(BRFSS)andthepercentageof"MothersWhoSmokeDuring  Pregnancy"willbeusedasmeasurementsoftheimpactofthetobaccocontrolprograms.     @uu8% < Immunizations  Thecommunitygroupschoseimmunizationsasthesecondmostimportanthealth | componentfortheMonroeRandolphBiCountyHealthDepartment'sconsideration. b TheHealthStatusObjectiveselectedfromHealthyPeople2000whichbestcharacterizes . ~ thechoiceofthecommunitygroupsisasfollows:  d 2.10  ReducethefiveyearoccurrenceofvaccinepreventablediseasesinMonroeand  0 Randolphcountiesfrom6to0bytheyear2010.Baseline:6casesofthefollowing    vaccinepreventablediseaseswerereportedfrom1993to1997:  (#(# 0  6X XXX̸ (#(# #X̸X X6X=#0  Diphtheriaamongpeopleaged25andyounger (#(# 0  Tetanusamongpeopleaged25andyounger0p(#(#0p(#p(#h (#(# 0  Polio(wildtypevirus)0h(#(#0h(#h(#0(#(#0p(#(#0p(#p(#N (#(# 0  Measles0 (#(#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#4 p(#p(# 0  Rubella0 (#(#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#jp(#p(# 0  CongenitalRubellaSyndrome0(#(#P(#(# 0  Mumps0 (#(#0 (# (#0h(#(#0h(#h(#6(#(# 0  Pertussis(#(#  NationalDataandInformation   0  Thereductioninincidenceofinfectiousdiseasesisthemostsignificantpublichealth n achievementofthepast100years.Thissuccessbestillustratedbytheglobal T eradicationofsmallpox,achievedin1977.Othergainsincontrolofinfectious : diseasesarenearlyasstriking,includingthevirtualeliminationofdiphtheriaand  p poliomyelitisintheUnitedStates.Muchofthisprogressisaresultofimprovements V inbasichygiene,foodproductionandhandling,andwatertreatment.The < developmentanduseofantimicrobialdrugshavereducedillnessanddeathfroma " numberofinfectiousdiseases.Theothermajorfactoristhedevelopmentand  widespreaduseofvaccines,whichareamongthesafestandmosteffective   preventivemeasures.9 F  13      ! (#(# 0  Notwithstandingtheprogressthathasbeenmade,infectiousdiseasesremain P#" importantcausesofillnessanddeathintheUnitedStates.Specificmeansfor 6$# combatingmanyofthesediseasesexistandcouldfurtherreducethetolltakenby %l $ theseconditionsifusedappropriately.: F  14      &R!%(#(# 0  Theveryyoung.olderadults,andmembersofminoritygroupsareatanincreased '#' riskformanyinfectiousdiseases.Eachofthecausativeagentsofinfectious ($( diseases,eventhosethatarecurrentlyrare,posesapotentialthreatofrecurrenceor )$) developmentofresistancetocurrenttreatment.Inaddition,anumberofnewly *%* recognizeddiseaseshaveemerged.RecentexamplesincludeLegionnaires'disease, f+&+ toxicshocksyndrome,Lymedisease,andthewidespectrumofdiseaseassociated L,', withhumanImmunodeficiencyvirus(HIV)infection.Thus,surveillancesystemsto  detectboththeagentsanddiseasesareessentialcomponentsofmodernprevention  andcontrolstrategies.@ F  15      |(#(# 0  Inadditiontoapplicationofspecificmeasures,suchasimmunizationandregulation H offood,water,andsewagedisposal,thereisaneedforcontinuedpubliceducation . ~ aboutbasichygienicpractices,inhome,school,andoccupationalsettings;for  d continuededucationofhealthcarestudentsandworkersabouttheepidemiologyand  J preventionofthesediseases;andforresearchtoimproveimmunizations,diagnostic  0 methods,andtherapeuticmodalities.A F  16        (#(#  0   DiphtheriaandTetanus:Withtheavailabilityofhighlyeffectivetoxoidsandschool   entrylaws,nooneattendingschoolsincetheearly1980sshoulddeveloptetanusor   diphtheria.Themajorbarriertotheachievementofcompleteeradicationofthese   diseasesisfailuretoimmunizeasappropriatefortheirageallchildren,adolescents, f  andadults.B F  17      ׀ L (#(# 0  Polio(wildtypevirus),IndigenousMeasles,Rubella,andCongenitalRubellaSyndrome: "r TheWorldHealthOrganizationhasadoptedaresolutionforeradicationofparalytic b poliomyelitisfromtheworldbytheyear2000.Nocasesofindigenouspoliocaused H bywildtypevirushavebeenreportedintheUnitedStatessince1979.D F  18      .(#(# 0  Since1978,theUnitedStateshashadasagoaltheeliminationofindigenous  measles;however,importationswithlimitedspreadwillcontinuetooccur,and  approximately500casesofmeaslesareexpectedeachyear,evenaftereliminationof v indigenouscases.Casesofmeaslesdecreasedfrom26,871in1978toapproximately \ 3,000casesannuallyfrom1981through1988.In1989,therewasaresurgenceof B measleswithaprovisionaltotalof16,236casesreported.E F  19      (x(#(# 0  Currentillnesscanbedividedintotwomajorpatternspreschooloutbreaks.The D formerarepredominantlyinunvaccinatedchildrenandrequirebetterimmunization * coverageatrecommendedages.Thelatteroccurprimarilyinvaccinatedchildren   andrequiremoreaggressiverevaccinationstrategiesduringoutbreakcontrolefforts. !  Otherrequirementsincludecontinuedhighvaccinecoverageatschoolentry, "! implementationofatwodoseschedule,identificationandvaccinationofatrisk r#" groups,anduseofeveryhealthcarecontacttoprovideallneededvaccines, X$# includingmeaslesvaccine.Becausemeaslesvaccineisusuallyadministeredwith >% $ mumpsandrubellavaccine(MMR)andbecausethelatterdiseasesareless $&t!% communicablethanmeasles,highcoveragewithatwodoseMMRscheduleshould  'Z"& leadtoeliminationofrubellaandcongenitalrubellasyndromeandtomarked '@#' decreasesinmumpscases.F F  20      (&$((#(# 0  Mumps:Reportedmumpscasesdecreaseddramaticallyfrom152,209casesin *%* 1968theyearaftermumpsvaccinelicensureto2,982casesin1985.In1986and +&+ 1987,however,thereweremarkedincreases,peakingat12,848casesin1987.  Followingtheepidemicin1987,mumpscasesdecreasedto4,866in1988anda  provisionaltotalof5,611in1989.Theseincreaseswereduetocasesoccurringin | unvaccinatedchildren,predominatelyinStateswithoutimmunizationrequirements b formumps.IncreaseduseofMMR,particularlyinatwodoseschedule,should H permitattainmentofthetargetforreductionofmumps.Currently,11Statesdonot . ~ navemumpsimmunizationrequirements.G F  21       d(#(# 0  Pertussis:Themajorityofreportedcasesofpertussisoccurinchildrenuptoage5.  0 Themostsignificantmorbidityandincidentsofdeathoccurin  .  infantspredominatelyininfantslessthan6monthsofage.Pertussisvaccine,which    isgivenwithdiphtheriaandtetanusasDTP,isrecommendedinafourdoseprimary   schedulecommencingat6to8weeksofageandendingwiththefourthdoseat15to   18monthsofage.Inaddition,aboosterdoseisneededbeforeschoolentry. v  Becauseatleastthreedosesareconsiderednecessaryforprotectionagainstthe \  disease,infantsarenotadequatelyprotectedagainstpertussispriorto6monthsof B  age.I F  22      (x(#(# 0  Besidesreducingillnessanddeathintheagegroupmostatriskforpertussisandits D complications,increasedvaccinationagainstpertussiscanreduceitsoverall * transmission.Highlevelsofageappropriatevaccinationofinfantsandyoung  childrenneedtobeachieved,requiringtheidentificationandvaccinationofhigh  riskgroupsandtheassurancethateveryhealthcareencounterbecomesan  opportunityforvaccination.Effortsarecontinuingtodevelopasaferpertussis r vaccinethatisatleastaseffectiveascurrentwholecellvaccines.Theavailabilityof X suchavaccinemayleadtodecreasedtransmissionofpertussisamongolderpeople > andfromolderpeopletoinfantsandyoungchildren.J F  23      $t(#(# 0  Thereductionofindigenouscasesofvaccinepreventablediseaseswillrequire @ sensitivesurveillancetodetectandreportcasesasearlyaspossible.Itwillalso & requirebroadeningthedefinitionoftheatriskpopulationtoincludeadultsaswellas   childreninsomeinstances.K F  24       (#(#  MonroeRandolphtrendsandinformation  x"! Duringthefiveyearsfrom1993to1997thefollowingvaccinepreventableillnesswere N$# reportedinMonroeandRandolphcountiescomparedwiththesameperiodfortheStateof 4% $ Illinois: &j!%    `     h      p   Disease    h      p MonroeRandolph x Illinois '6#'   Diphtheriaamongpeopleaged25andyounger p   0   x 0 (&$( 0  Tetanusamongpeopleaged25andyounger0p(#(#0p(#p(#1   x 9) %)(#(# 0  Polio(wildtypevirus)0h(#(#0h(#h(#0(#(#0p(#(#0p(#p(#0   x 0*%*(#(# 0  Measles0 (#(#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#  0   x 82+&+p(#p(# 0  Rubella0 (#(#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#  0   x 5p(#p(# 0  Mumps0 (#(#0 (# (#0h(#(#0h(#h(#   p   4   x 273(#(# 0  Pertussis    h      p   1   x 1044|(#(# Nocasesofvaccinepreventablediseaseswerereportedin1996or1997inMonroeand b Randolphcounties.Duetothelowincidenceofsuchreportedillnesses,afiveyear H reportingisusedtobuffervariabilityofdata. . ~ The1994rateofimmunizationsfortwoyearoldswas68%inMonroeandRandolph  J countiesand51%intheStateofIllinois,excludingChicago.Thefiveyearoldpopulation  0 wasover97%immunized,areflectiononthethoroughnessoftheschoolsystemensuring    thatchildrenareproperlyimmunizedpriortoentryintoschools.Increasingthetwoyear    oldimmunizationrate,whichwasbelowtheYear2000Objectivewasoneofthepriorities   ofthe1994IPLAN.Sincetheresourceswerepresenttoprovideadequateimmunizationsat x  thefiveyearcohort,therelativelylowimmunizationratein2yearoldsreflectedproblems ^  withaccesstocare,motivationissuesoreducationalneeds. D  TheaccesstocareissueswereaddressedbyMonroeRandolphBiCountyHealth ` DepartmentstaffandtheMonroeRandolphBiCountyBoardofHealth.First,theclinic F programexpandedthenumberofclinicsiteswhereserviceswereprovidedtoincludeasite , inRedBud.TheclinicexpansionbeganasanexperimentattheinvitationofSt.Clement  HomeHealthAgency.TheRedBudclinicserviceswereheldbeginninginFebruary1995  atRedBudHospital,RedBud.Thiscontinuestobeanopportunitytoexpandourclinical  servicestoclients,includingacloserworkingrelationshipwiththehealthcareinstitution t whichissignificantforMonroeandRandolphbirths. Z TheMonroeRandolphBiCountyBoardofHealthrecognizedinFebruary1994,theneed &v forexpandingthescopeofclinicalservicesprovidedtothepublic.TheMonroeRandolph  \ BiCountyBoardofHealth,inconjunctionwiththeMonroeCountyBoardof B CommissionersandtheRandolphCountyBoardofCommissionershaveprovidednew, ( largerfacilitiesinSparta,ChesterandWaterloo.TheSpartaclinicislocatedat123West  CollegeStreetintheformerLincolnSchoolBuilding.TheWaterloobuilding,completedin  Septemberof1996,includestheMonroeCountyCooperativeExtension,MonroeCounty   AmbulanceServiceandtheMonroeRandolphBiCountyHealthDepartment.Thebuilding p!  inChesterwasagrocerystore,remodeledforthehealthdepartment'susebyadeveloperin V"! Novemberof1996,whosoldthebuildingandimprovementstotheRandolphCountyBoard <#" ofCommissioners. "$r# TheImpactObjectivechosenfortheHealthStatusObjectiveisasfollows: &$"& 2.20  Improvethecurrentimmunizationrateforagetwofromthe1997rateof95%age (#( appropriaterateto97%by2005.)$)(#(# Motivatingtheparentsofinfantsandchildrenlessthantwoyearsold,isoneofthebarriers R+&+ toageappropriatevaccination.Partofthemotivationcontinuestobeencouragedby 8,', MonroeRandolphBiCountyHealthDepartmentstaffinFamilyCaseManagement,WIC  andFamilyPlanningprograms.CaseManagementremainsthemosteffectivein  encouragingparentstofullyimmunizetheirchildrenbyagetwo,sinceoneoftheirprimary | goalsistoassistlowincomefamiliestoaccessmedicalandsocialservices. b TheannualjointimmunizationdayinconjunctionwithMemorialHospital,willbe . ~ continuedasapublicrelationsandeducationtool.Similarly,schoolbasedandHeadStart  d basedimmunizationswillcontinuetobeemployedassuccessfultoolstoincreasethe  J immunizationrate.Thelastidentifiedinterventionstrategyistoprovideeducationto  0 parentsinsuchsettingsasprenatalclasses,throughthemediaandevenperhapsasprinted    informationaspartofapackageof"gifts"toparentsofnewborns.       % = OccupantRestraint  @  @`  @  @  @h     ThefollowingHealthStatusObjectiveadaptedfromHealthyPeople2000selectedto  illustratethethirdprioritychosenbythecommunitygroups: v 3.10  ReducedeathscausedbymotorvehiclecrashesinMonroeandRandolphcountiesto B  nomorethan20per100,000peopleby2010.(Baseline:32.0per100,000in1997)( x(#(#  NationalDataandInformation   D  0  Motorvehiclerelatedfatalitiesaccountforabouthalfofallunintentionalinjury  $  deathsandaretheleadingcauseofworkrelatedinjurydeaths.Approximately   46,000peopledieeachyearandmorethan3.5millionareinjured.Societyloses$75   billionannuallyastheresultofmotorvehiclecrashes.  F  25       (#(# 0  Theyear2000targetrateswereestablishedafterconsideringrecenttrendsinthe R  deathrate,theimpactofthefutureautomaticoccupantprotectionsystems,and 8 anticipateddemographicchanges.Reductionoftheoveralldeathratewilldependon n severalfactors,includinguseofmasstransit,continuedreductionindrunkdriving, T andimprovementofpedestrian,motorcycle,andbicyclesafety. L F  26      :(#(# 0  Motorcycle,pedestrian,andbicyclecasualtiesaccountforalmost30percentof  motorvehicledeathsperyear.Motorcyclecrashescauseapproximately11percent  ofallmotorvehicledeaths.Manymotorcyclecrashinjuriesareduetolackof  operationskill,intoxicationoftheoperator,andabsenceofprotectiveheadgear. h Countermeasures,includingmotorcyclehelmets,arestronglyassociatedwith N decreaseddeathandinjury.Anincreaseinalcohol/drugusepreventionand 4 deterrenceactivitiesisalsoassociatedwiththedecreaseddeathanddisability. Q F  27      j(#(# 0  Motorvehiclecrashesinvolvingpedestrianshavesteadilydeclinedoverthepast50 6 yearstoalowof6,746deathsin1987.Nonetheless,pedestriansaccountfor14.5  percentofallmotorvehiclerelatedfatalities,andalcoholisassociatedwithcloseto   50percentofallpedestriandeaths.Safetyprogramsdirectedatyouthfulpedestrians !  havebeenshowntobeeffectiveandmaybepartiallyresponsibleforthe24percent ~"! declineofchildrenlessthan15yearsoldbetween1980and1986. R F  28      d#"(#(# 0  Asolderadults(aged70andolder)becomealargerpercentageofthepopulation, 0% $ theyrepresentanincreasingproportionofthelicensedanddrivingpopulation.They &f!% alsoaccountforalargeshareofthemotorvehicleinjuryproblemeachyear.Older &L"& peoplehaveagreaterriskofcrashpermiledriventhanyoungeradults,andonceina '2#' crash,theyaremuchmorevulnerabletoinjuryanddeath.Fatalinjuriesamongthis ($( groupfrequentlydonotresultinimmediatedeath,butratheroccuronlyafterlengthy )$) andcostlytreatment.Itis,however,extremelyimportanttotheoverallhealthand *%* welfareofthisagegroupthattheybeabletomaintaintheirmobility.Prevention z+&+ effortsamongthisgroupcanincludeimprovementinvehicleandhighwaydesign,  appropriatelicensingprograms,pedestrianwalkwaysforolderusers,adequatetime  onpedestriancrossingsignals,andoccupantrestraintsystemsdesignedforfrailolder | adults. [ F  29      b(#(# 0  Speedisafundamentalfactorinthephysicalforcesinvolvedincrashes.Highway . ~ speedenforcementeffortshavegeneratedsignificantyearlyincreaseinspeeding  d citations,yetspeedcontinuestorise.Lawenforcementagencieshavenotbeenable  J tokeeppacewiththeincreasedemandsoftraffic.Inthefuture,lawenforcement  0 needsacomprehensiveapproach,includingimprovedinformationandeducation    efforts,expandedpublicandprivatesupport,andnewstrategiessuchasthelegal    prohibitionofradardetectors,aswellascarefullymonitoredspeedlimits.Improved   motorvehicletechnology,suchasantilockbrakingsystems,sideimpactprotection, x  andmodificationofthehighwayenvironmentbytheeliminationofroadsidehazards ^  alsooffersimportantpreventionmeasures. \ F  30      D (#(#  0  Achievementofthe85percentusegoalwilldependonanumberoffactors, j includingthedesignofoccupantprotectionsystemsprovidedbyautomakersin P comingyearsandthenumberofStateswithmandatorysafetybeltuselaws. 6 Beginningwiththe1990models,automobilemanufacturersarerequiredtoequipall  oftheirpassengercarswithautomaticcrashprotection.Mostofthemanufactures  areprovidingautomaticsafetybeltsandsomeareofferingairbagsystemstomeet  thenewFederalrequirement.Therestraintsystemsthemselveswillneedtobe ~ constantlyimprovedtokeepabreastofadvancingtechnologyandtomakethem d convenientandcomfortabletouse.Basedoncurrentusageratesforautomaticand J manualbeltsystems,achievementofthisobjectiveisnotunreasonable.However, 0 the17Stateswithoutmandatorybeltuselawsin1989willneedtoenactsuchlaws, f andseveralStateswithweaklawswillneedtostrengthenthem.Thelaw L enforcementcommunityandthepublicatlargemustbeconvincedthattheselaws 2 areimportantenoughtowarrantvigorousenforcementandpublicacceptanceofthat  enforcement.Inaddition,thecorrectuseofbeltsforallautomobileoccupants,  includingoccupantsofheavytrucks,shouldbepromoted. ] F  31       (#(# 0  Basedoncurrentusageratesforautomaticandmanualbeltsystems,achievementof `"! thisobjectiveisnotunreasonable.However,the17Stateswithoutmandatorybelt F#" uselawsin1989willneedtoenactsuchlaws,andseveralStateswithweaklawswill ,$|# needtostrengthenthem.Thelawenforcementcommunityandthepublicatlarge %b $ mustbeconvincedthattheselawsareimportantenoughtowarrantvigorous %H!% enforcementandpublicacceptanceoftheatenforcement.Inaddition,thecorrectuse &."& ofbeltsforallautomobileoccupants,includingoccupantsofheavytrucks,shouldbe '#' promoted. ^ F  32      (#((#(# 0  Thespecialpopulationtargetforpassengersunder5yearsoldrelatesespeciallyto v*%* thecorrectuseofsafetyseats.Ithasbeenobservedthatchildsafetyseatsareoften \+&+ attachedtothecarincorrectlyornotatall.Bothsafetymanufacturersand B,', automobilemakersneedtomakeproperinstallationanduseoftheseatseasierfor  parents.Also,parentsneedtobeawarethatuseoftheseatsisvitalforallchildren  under5,notjustinfants.Instructionontheproperuseofinfantsafetyseatsshould | begiventoallparentsofnewborninfants. _ F  33      ׀b(#(#  MonroeRandolphtrendsandinformation  8  MotorVehicleCrashMortalityRatesduringtheperiod19901997forMonroeand  ^ Randolphcountieshaverangedfrom18.6to36.3per100,000;mean26.8per100,000.In  D contrast,theStateofIllinoisratesforthesameperiodrangedfrom13.1to15.8per100,000;  *  mean14.2per100,000.SeeAppendixD.TheratesforMonroeandRandolphcountiesis    significantlyhigherthantheStateofIllinoisortheYear2000Objectives.TheStandardized   RiskRatiocomparedwiththeStateofIllinoisvariesfrom1.3to2.7.   TheMonroeRandolphBiCountyHealthDepartmentadministeredanOccupantRestraint X  programsponsoredbytheIllinoisDepartmentofTransportationfrom1988to1990and >  againfrom1994to1996.Theprogramhadtwomaincomponents,asafetybeltuse $t educationalprogramandacarseatrentalandsalesprogram.  Z Thesafetybelteducationalprogramconsistedofeducationalpresentationsmadetoschools, & drivers'educationclasses,andcommunitygroups,newsreleases,articlesandradio   interviews.Theprogramwascoupledwithalawenforcementincentiveprogram,which  providedmonetaryincentivesforpolicedepartmentswhichmettheirgoalsofsafetybelt  checksandsecondarytickets.Theprogramevaluationincludedperiodictrafficsurveysto n determinethepercentofsafetybeltuse. T Thecarseatrentalandsalesprogramincludedthesubsidizedsaleofnewinfantandtoddler  p carseats;therentalofinfantandtoddlercarseats,includingaweekendandmonthlong V rentals,ifneededorrequested.Boththesalesandrentalprogramsincludedinstructionin < theuseandproperinstallationofthecarseat.Healthdepartmentstaffinstalledthecar " safetyseatwiththeclientobserving.  TheImpactObjectivechosenfortheHealthStatusObjectiveisasfollows: !   3.20  Increaseuseofoccupantprotectionsystems,suchassafetybelts,andchildsafety P#" seats,toatleast75percentofmotorvehicleoccupants.(Baseline:51%in1995)@$#(#(#  AhealtheducationinternpresentlyinterningattheMonroeRandolphBiCountyHealth &f!% DepartmentisresearchingthepossibilityofobtainingagrantfromtheIllinoisDepartment &L"& ofTransportationtoreimplementoccupantsafetyactivities.Asabeginning,theMonroe '2#' RandolphBiCountyHealthDepartmentisseekingfundingtopayaparttimehealth ($( educatortoimplementasimilaroccupantrestraintprogramasthehealthdepartment )$) formerlyadministered.Theprogramwouldincludesafetybelttrafficsurveystodetermine *%* theextentofsafetybeltuse.  z+&+ @cc:Endnotes  !"0 | й  0 `  ` (#` (#    TR].'letterhdX3' Letter .'letterhd3'T o @9AppendixA   XXXX̸October1999  DearCommunityMember,   TheMonroeRandolphBiCountyHealthDepartmentisseekingyour F   input.Weareholdingcommunityforumsthroughoutthetwo  l  countiesinacontinuingefforttoberesponsibletothehealth  B  needsofthearea.Thehealthstatisticsofthetwocounties   willbepresentedanddiscussed,inadditiontothecurrent   programsoftheMonroeRandolphBiCountyHealthDepartment.You t  haveanopportunitytocontributeyourperspectiveofthehealth J  needsoftheareatohelpdirectthefuturedevelopmentofhealth  p  departmentprograms.Themeetingsareopentothepublic, F however,youhavebeenidentifiedasanindividualwhomayhavea  specialinterestinthehealthofthearea.  Thefollowingmeetingshavebeenscheduled: N ChesterCityHallThurs,Oct14,19997:00pm J ColumbiaCityHallFriday,Oct15,19990  7:00pm (#(# RedBudSt.ClementsWed,Oct13,19997:00pm  SpartaCityHallMon,Oct11,19997:00pm | SteelevilleCityHallThurs,Oct21,19997:00pm R WaterlooHealthDeptTues,Oct12,19997:00pm (x Ifyouhaveanyquestionsorcommentsregardingthecontentsof $ thisletter,pleasecontactme.  ̀Verytrulyyours, V ! ̀ThomasG.Smith Z% ' Ѐ_Administrator  0&!( #X̸XX X /#TRY03' Letter].'letterhd 3' Letter .'letterhdT9 i AppendixB@ /_IPLAN_ԀCommunityMeetingAgenda   XXXX̸@>XXIntroduction l 0  ThemissionoftheMonroeRandolphBiCountyHealthDepartmentisto B providepublichealthservicesdirectedtowardthepreventionof h disease,promotionofhealth,andimprovementofthequalityoflife > forthecitizensofMonroeandRandolphcounties. %% Descriptionoftheplanningprocess p    0  TheIllinoisDepartmentofPublicHealthistheagencywhichcertifies F   localhealthdepartments.Thecertificationprocesswhichincludessome  l  grantapplicationshaveincorporatedanassessmentofthecommunities'  B  needforspecificprograms.ThisyeartheIllinoisDepartmentofPublic   Healthrequiresthatweactivelyseekcommunityinputintheformulation   oftheneedsassessments.t %% Presentationofhealthstatisticaldata  p  0  Thedatatobepresentedissummarizedintheattachments.F%% Discussionofhealthdata  0  ThedatawillbediscussedincomparisonwiththeStateofIllinois x data.Thehealthrelateddataisprimarilymortality(death) N statistics,althoughsomemorbidity(illness)statisticsandhighrisk $t informationisprovided.J%% Discussionofexistinghealthdepartmentprograms  0  TheexistingprogramsoftheMonroeRandolphBiCountyHealthDepartment | willbebrieflypresented.Thediscussionwillincludethepublic R healthpurposeofeachprogram.(x%% Listingofpublichealthproblems $ 0  ThedataidentifiessomestatisticswhichexceedtheStateofIllinois  ratesand/orTheYear2000ObjectivessetbytheCentersforDisease   Control.Otherpublichealthconcernsofthecommunityneedtobe V ! proposedatthistime.Theseotherconcernsmaybeunsubstantiatedwith ,!|" availabledata,butnonetheless,maybestillbesignificantorserious."R#%% Selectionofthe3mostimportantpublichealthproblems #% 0  Thecommunityparticipantsneedtoselectthethreemostimportantor $& serioushealthproblemsbasedonthediscussionofthedataandthe Z% ' presentationofunsubstantiatedconcernsofthecommunity.0&!(%% Conclusion/Descriptionoftheremainingsteps ',#* 0  Theinformationgatheredatthecommunitymeetingswillbecombinedand ($+ aformalneedsassessmentwillbewrittenandreviewedbyour )$, ProfessionalAdvisoryCommittee,approvedbytheMonroeRandolphBi ^*%- CountyBoardofHealth,andsubmittedtotheIllinoisDepartmentof 4+&. PublicHealthasthefiveyearhealthplanforMonroeandRandolph  ,Z'/ Counties. #,0(0%% #vX5XX X#X̸XXvX58#