Opioid abuse identified as key issue
If Sonoma County were a single patient it would score a pretty clean bill of health. Seven hospitals and numerous community clinics provide primary and specialized health care to more residents than ever in history. Wellness, prevention and patient-centered medical initiatives have been expanded and the county just ranked sixth among all California counties for healthy outcomes, a clean environment and reduced premature deaths.
But Sonoma County is not just one patient and thousands of individuals suffer poor health outcomes, mostly due to poverty, lack of education and rashes of substance abuse, opioid addiction and untreated mental illnesses.
The portrait of Sonoma County’s population health today is defined by U.S. Census tracts, separated by income levels and access to housing, education and social services. Life expectancies can vary by more than 10 years between side-by-side rich and poor neighborhoods.
“We have worked hard to improve the health of our community, and recognize that there is more work to do in order to achieve our goal of being the healthiest county in California,” said county supervisor Shirlee Zane earlier this year when the statewide health rankings were announced.
Although Sonoma County is a healthy and affluent county, “substantial disparities” exist in many places, concluded the annual Community Health Needs Assessment completed as a partnership with the region’s hospitals, community clinics and the county’s public health department.
“We’ve moved the needle on many of our targets but there are still a few we didn’t,” said Lisa Wittke Schaffner, co-chair of the countywide Health Action coalition.
“We’ve found that the biggest factor to a healthy life is economic wellness,” said Schaffner, a former Healdsburg mayor and current executive director of the John Jordan Foundation.
“Our goal is to keep moving the needle forward, do more community engagement and help people understand they can change their own lives by just believing in themselves.”
Job number one said Schaffner is “upstream investments” to improve access to education from “cradle to career.”
Health Action, a 20-year plan launched by the county in 2007 also has set specific targets to reduce opioid addiction, childhood and adult obesity and diabetes, lack of affordable housing and tobacco smoking.
A shortage of mental health services also was called a “high concern” as was the general population’s use of alcohol.
The county’s Health Action involves 47 various community, nonprofit and government agencies. Core values include fostering ongoing collaborations as well as “bold action.”
These include past efforts such as iWalk and iGarden promoting physical exercise and growing healthy vegetables in schools and neighborhoods. Almost all communities have recently launched health action chapterss such as Windsor Wellness Partnership, Russian River Area Resources and Advocates, Sebastopol Area Community Alliance and Corazon Healdsburg, as well as a Health Action city council liaison group.
At the beginning of this year, Health Action produced new guidelines to counter opioid abuses with safe pain management directed at both prescribing physicians and patients. Opioid overdoses increased by 73 percent in recent years, based on local emergency room reports. In 2014, 25 percent of the county’s population filled a prescription for an opioid. “This high number is contributing to an epidemic,” said Dr. Karen Milman, the county’s public health officer.
“This is something we can attack right now,” said Schaffner, noting that opioid abuse was not on the radar of Health Action in 2007. “We are hearing about this problem from the primary doctors, the emergency rooms and from families.”
As with the more recent opioid issue, Health Action this year revamped its original goals and targets, said Schaffner. Instead of aiming at a single set of healthy outcomes to become California’s healthiest county by 2020, the consortium’s new approach is to do more community outreach, individual empowerment and increased focus on the underlying economic factors that inhibit wellness and lifestyle changes.
For example, 22 percent of county children “suffer adverse incidents” such as neglect, witnessing domestic violence or substance abuse and homelessness.
Kindergarten-readiness and availability of preschool programs were ranked low and insufficient across the entire county, according to all of the annual reports cited herein.
Prior to the federal Affordable Care Act’s expansion of Medicaid, 18 percent of the county’s population already was enrolled in the poverty program that mostly serves children and mothers.
“We need to stay nimble and keep listening to our communities,” said Schaffner, adding, “of course that could all change depending on what happens in Washington, D.C.” where the political debate to repeal and replace Obamacare is taking place.
“That would start a whole other discussion and I’m not sure what that would be. We would be talking about impacts on a whole lot of people,” said Schaffner.
Meanwhile, Health Action last year also launched a Sustainable Financing Catalyst Team to work with government agencies and others to create longer term support for Health Action’s wellness programs and investments in future healthy outcomes.
“We don’t have anything solved but we have gathered some great resources and we’ve improved access and awareness,” said Schaffner. “We want to keep helping people to believe in themselves.”
