Diverse stakeholders meet to determine county health priorities

Local officials and community members listen as Uinta County Public Health Nurse Manager Kim Proffit conducts a meeting concerning health issues in Wyoming. (HERALD PHOTO/Kayne Pyatt)

EVANSTON — Representatives from local law enforcement, public health, BOCES, Western Wyoming Community College, social service agencies, SAFV, Evanston Regional Hospital, Wyoming State Hospital and other public service organizations attended a meeting sponsored by the Wyoming Dept. of Health (DOH) on Tuesday, Oct. 22, at the Human Services Building.

Kim Proffit, local manager for the Uinta County Public Health office, conducted the meeting, which began with a video produced by the Wyoming DOH. On the video, Wyoming Public Health Senior Administrator Stephanie Pyle explained how a steering committee made up of 63 people from state and local levels of government, public safety offices, health departments, education, community services, businesses and from the University of Wyoming Extension Office met to identify health issue indicators for the state.

Felicia Turner from the Wyoming DOH worked with the steering committee to establish the process for determining the criteria. Their vision is for all people to have a fair and just opportunity to live healthy lives. They set criteria for 30 indicators and scored them by degree according to social and economic costs and the number of people who were affected. Health indicators that scored the highest were included as final potential priorities to be taken to each of Wyoming’s county public health departments, where representatives from the aforementioned entities would choose the top two indicators as their county’s priorities on which to focus local resources.

The steering committee used statistics from the FBI Uniform Crime Reporting Program (FBI-UCR), which is a nationwide, cooperative statistical effort by nearly 18,000 city, county, state, tribal, federal and collegiate law enforcement agencies voluntarily reporting data on crimes brought to their attention. They also used Behavioral Risk Factor Surveillance System (BRFSS) surveys, which are the nation’s premier system of health-related telephone surveys that collect data about U.S. residents regarding their health-related risk behaviors, chronic health conditions and use of preventive services. Other statistical data was gathered from Vital Records, the National Center for Health Statistics, the Wyoming Highway Safety Report and the Youth Risk Behavior Survey.

In order to facilitate an easy approach for judging the criteria, the steering committee developed a report based on Wyoming residents who first listed the health indicator followed by five criteria: 

• Comparison of the rate of incidence in Wyoming to the nation’s overall rate of incidence. 

• Causes and risk factors in Wyoming. 

• National standing — whether Wyoming was the same, better or worse than the nation as a whole.

• The trend for the indicator in Wyoming — stable, increasing, or decreasing. 

• Who is impacted the most.

Over video, Dr. Alexia Harrist with Wyoming DOH discussed the potential indicators and explained in detail the criteria for each. She paused after each set of health listings to let the local representatives vote for their top two indicators.

Under the category of youth and young adult deaths there were four indicators, including adolescent/young adult deaths (12 to 24 years); child deaths (0 to 18 years); infant deaths; and maternal deaths. The local group at the meeting voted and determined the number one priority was adolescent/young adult deaths followed by maternal deaths. 

The rate of incidence for adolescent/young adult deaths in Wyoming was 75.1 per 100,000. In the U.S. the rate is 62.0 according to Vital Records, 2016. Causes and risk factors in Wyoming are unintentional injuries followed by suicide. Wyoming is worse than the national average and at last report the trend is stable. Rates are higher among boys and among American Indian youth.

Maternal deaths in Wyoming are about the same as in the nation as a whole, but the trend for Wyoming is increasing due to suicide or drug overdoses as causes or risk factors. 

The second health issue given was injury, with suicide, unintentional injury deaths, firearm deaths, and violent crime listed as the four priorities. The number one priority for Evanston was suicide and number two was unintentional injury deaths. Both of these are impacted by drug overdose and both were shown to be increasing and worse in Wyoming than in the nation overall. People age 15 years and older, whites and American Indians and males are most impacted by suicide. Unintentional injury is the leading cause of death for people 1 to 44 years; rates are also high among those over 75 years and especially males.

Next, drugs and alcohol categories were alcohol-impaired driving deaths and drug overdose deaths. The Evanston representatives listed them in that order of priority. Alcohol-impaired driving deaths are statistically worse in Wyoming than in the nation and mostly affect male drivers between the ages of 21 to 34 years. In 2016, 47% of Wyoming adults reported having driven after drinking too much. Drug overdose deaths are decreasing and national standing is better in Wyoming. However, from 2012 to 2016, opioids, both illicit and prescription, were involved in nearly half of drug overdose deaths and prescription opioids were involved in 73% of opioid overdose deaths. Among those 20 to 64, American Indians and whites experienced higher rates of overdose deaths. 

The category of mental health listed youth depression, depressive disorder and frequent mental distress as indicators. Youth depression and depressive disorder were ranked equally important locally. Youth depression in Wyoming is currently about the same as in the nation but is showing an increase due to risk of suicide and substance abuse disorders. Female and LGBTQ students report higher rates of depression than male and heterosexual students. Depressive disorder is worse in Wyoming than in the nation but seems to be at a stable rate. Risk factors are family history, traumatic events, medical problems and substance use. Females report diagnosis more than males.

Four indicators under the next heading of chronic disease and conditions were adult obesity, heart disease deaths, diabetes prevalence and cancer deaths. Local voters listed adult obesity as the number one health issue, with heart disease deaths and cancer deaths following. Adult obesity in Wyoming is the same as nationally but has been increasing steadily for the past 30 years. Risk factors and causes are poor nutrition and lack of physical activity. 

Lower-income adults and adults aged 45 to 64 report higher rates of obesity. Heart disease deaths and cancer deaths have been decreasing in the past few years due to early detection and improved care.

Last, but not least, Evanston representatives all agreed that having no health insurance was the number one indicator related to access to care. Wyoming is worse than the national average for access to health insurance, and those residents aged 18 to 44, Hispanic individuals and people making less than $35,000 per year are more likely to report they do not have insurance of any kind.

The other indicator under access to care was having no personal doctor or provider. Wyoming is worse than the nation due to obstacles such as geographic barriers, language barriers and provider shortages. Those most impacted by not having a personal doctor are males, younger adults (18-44) and Hispanics. 

Proffit will compile the results of the local votes and will send the information to the Wyoming Public Health office. 

Proffit was asked how the information gathered at the meeting would be used. She said, “Information collected from communities will be used to help the steering committee finalize priorities for the state health improvement plan. Much of the information will be aggregated to help define priorities. The steering committee anticipates moving into strategy development using a collaborative process that will offer opportunities for involvement in deciding what will be done to address the priorities once they have been decided.” 


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