01/02/09 — Prevention tops goals for health department chief as 2009 dawns

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Prevention tops goals for health department chief as 2009 dawns

By Phyllis Moore
Published in News on January 2, 2009 1:46 PM

Wayne County Health Director James Roosen says his department will do more this year in the way of preventive medicine, hoping to help drive down the costs of health care -- and to battle concerns like teenage pregnancy and obesity.

"Some of the problems that we're trying to address, well, most of the time are entirely preventable. Usually the problems that we're trying to mitigate are about a behavior change," Roosen said.

That includes chronic disease, which Roosen said can sometimes be regulated simply by changing eating and exercise habits. About 6 percent of those -- particularly obesity and heart-related ailments fall into that category.

"We have seen decreases in heart diseases mainly because people are eating better, eating less fat," he said.

According to the Health Department's latest community health assessment, heart disease death rates in Wayne County have gone down 31 percent since 1990.

In North Carolina, which ranks fifth in the nation in childhood obesity rates, funding is one of the biggest obstacles.

"We realize it's a problem but there's not a lot of money in prevention," Roosen said. "So we wait until people have heart attacks and end up in the hospital, paying for a stint or rehab therapy. We're not doing enough with prevention."

The best way to start is with young people, Roosen said. There is a desperate need to convince children to make better health-related choices, he said.

"The problem that we see is it's going to be like a tidal wave," he said. "Not only are we seeing a lot of complications in children that we used to see in adults -- diabetes, high blood pressure, early onset of heart disease -- but the prediction is that they're not going to live as long as their parents unless something's done."

The coming year offers an opportunity to tackle that problem, Roosen said. Other goals the health director has set include working to lower teenage pregnancy and infant mortality rates, to monitor HIV patients better and to get county officials to seriously consider a new building for the health department.

More than 300 people in Wayne County are HIV-positive, Roosen said, but there might be others who are unchecked, untreated or undocumented.

It's difficult to get to everyone who needs assistance, and yet it's the reason behind public health, Roosen said.

"We're a safety net, and we're here for all those folks who need attention and follow-up," he said.

The Health Department received grant money earlier in the year to address this, knocking on doors and locating those who had been diagnosed to set them up with proper care.

But more is needed. One of Roosen's goals is to hire an HIV case manager to continue in that vein of linking people with services.

"I don't want to be stereotypical of folks with HIV, but a lot of them may not practice the best behaviors in taking care of their health," he said. "This manager will make sure they're seeing a doctor, taking their medications."

Cases of sexually transmitted diseases, particularly syphilis, have also been on the rise.

"Ten years ago, we were talking about syphilis elimination, that we thought it would be gone by now, but it's not," Roosen said. "We had 15 cases of syphilis in 2006 and then 17 in 2007."

Roosen said he was pleased with advances made by his department in 2008. Among them was growth in the family planning program, with an average of 300-350 patients seen in its clinic each month. In 2008, about 390 of the visits were by women age 17 and younger.

"We're seeing about 45 percent of the pregnant women in this county. I'm proud of the fact that we have got the staff that can see as many patients and that do it in such a kind and professional manner. I rarely get complaints from our patients that come here," he said.

Another improvement was in reducing the amount of time patients had to wait to be seen. A new open access system of scheduling resulted in an estimated 30 percent reduction in wait time.

"The key thing is listening to the patients who come through your doors," Roosen said.

One area of concern remains, he said, regarding teen pregnancies, which increased about 12 percent in 2006-07.

"One of our goals next year is to better address (that). It's one of the biggest problems that we have, not only with health but socioeconomics," he said. "Wayne County is really no different than any other county. We have got the same issues. We have seen a decrease in teen pregnancy rates (before) and now we have got an 11 percent increase."

A by-product is the increasing number of abortions reported.

"In 2007, we had 77 abortions done to kids 15 to 19 years of age," Roosen said.

Pregnancy rates among Latinos is another growing area. To contrast the issue, he said, consider that in Spain, birth rates among teens is eight per thousand. In Japan, it's about three per thousand. In the U.S., it's 53 per thousand.

"The pregnancy rate among Hispanic teens is high," Roosen said. "For one thing, they're used to starting a family at a younger age. I will go out on a limb here and say that a lot of these pregnancies are young girls who are undocumented, may not have any chance of going on to college or getting a job."

It's not all bad news, though. Wayne County has a great system, Roosen said, with some organizations that are leaders in the state -- WISH school-based health centers, WATCH that does primary care for the uninsured, and the diabetes program WADEC that Wayne Memorial Hospital offers among the most noted.

Another advancement Roosen noted, is Wayne's serving over the past year as a test for a new statewide information system.

"We were a pilot county for our new health information system, the new statewide computer system for community health," he said, noting that the existing system has been in place for 25 years.

"It's an archaic system and we're hoping that this new system will be a lot easier to use and help us to become more efficient."

The system will be operational in 2009, providing electronic information on all cases at the Health Department.

"In addition to seeing thousands every month, right now they're 11 percent over their WIC (Women, Infant and Children program) caseload, which means that we're funded for one amount but we're seeing 11 percent more than we're funded for," Roosen said.

Roosen also noted the hiring of Dr. Ashton Griffin as the Health Department's medical director as another improvement made during the past year.

"He's a great guy and he's got a lot of great ideas," Roosen said.

If pressed, Roosen acknowledges there is an ongoing need that most everyone in the Health Department is keenly aware of -- the need for a new home.

"We need a new Health Department for a lot of reasons. The building was not designed for a public health department and we're trying to modify an existing building to meet our needs," Roosen said.

Citing constant maintenance as just one issue -- the former county hospital building is more than 100 years old -- he said an updated location could be streamlined to offer patient accessibility.

For now, though, Roosen is focusing on immediate strategies. A strategic plan has been developed and the public is invited to sit in on the discussion -- to be held at its next regular Board of Health meeting Jan. 21 at noon at the Wayne Center.

"We looked internally into the Health Department in terms of competencies, what we can improve on, (we) did this health assessment community survey, and have put together some goals. We will talk about our goals and strategies on how we're going to get there," Roosen said.

"I will be the first to admit that not everything is going to mesh with the whole community, but we have got a lot of good ideas."

One suggestion being mentioned is having a satellite family planning clinic in the southern end of the county.

There are common problems within all health care agencies, Roosen said. From dealing with chronic disease to producing sufficient nurses, pharmacists and nurse practitioners, there is also a "tremendous shortage" of dentists that must be addressed, he said.

The bottom line, however, is to communicate and educate as much as possible.

"We want everybody out there to be aware of what's going on in Wayne County," Roosen said. "There shouldn't be any secrets. People need to know -- they're the ones being affected. Awareness goes a long way."