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Ghristopher Spitters, MDfiPH Tel€phone: (206) 3834474 For (Ea8) 675 4845 Email: dtrisbph€[EMAIL REDACTED] November 14,2017 TO: t ori Koch Acting Adrnnistrator Klickitat County Health D€parhent Klickitat County Board of Hcalth RE: Restgnadon from Hedtl Oflicer position Dear Ms. Koch and of thc Board of Hcaltb, I a'o writing to cxpress lo you my intent to resign fion thc Health officcr positiol efrectivc on or about 0l January 2018. It has.been-a pteasure and a privilege to in this caaclty,in"e 2002; howcver, il an att€mpt to simpli! my life and consolidate my worHoa4 it is tioc i,or tris good ruo to end I 8m most gratEfur for the opportunity you havc given me aod for fire hsrd work and suppon the KCHD staf has providcd medwing mytime of Jnice. sincc communicating my irtentions to staff vertany in Septembcr, I bave discusscd tle position with two poteotial candidates, but have directcd ttrem to las. Koch and tlc oc goard iir€li roi furter inform.tion sbout the process for dcsignating my successor. rr oe seroctioa-paJ extends beyond my target date of January l, 201g, t am willing to extend my service on a'shoi term basis to permit that process to come to compietion. In yo:ur setection o1" you to corsider interest in proximity and local with comp"."* -J *pl"i*il sewing in the health ofrcer role. If I can be of further assistancc to )ou in this tansition, please feel ftee to contacr me. Wift r€spect and gatitude, (VV,rQta-,,'\ Cbris Spifrers, MD ---PAGE BREAK--- 1z14tnfl sDoH Png Figure 2 Social Determinants of Health Health Care System Health coverage Provider availability Provider linguistic and cultural com petencY Quality of care hdps /nEil .g le-cdn'rrail/ui0ffi r*rod 16O561 1r4sfdloer')projeclcr='1 ---PAGE BREAK--- COLUMBIA GORGE REGIONAL COM M U NITY HEALTH ASSESSM ENT: SUMMARY-20L6 Collaborating for Optimum Health and Optimized Healthcare Community Clinics Hospitals Public Health FIrblicHeaftlr l.r{rr F- rr.r.dr Nonh Central Public Health Department Community Partners q= a - t ,a ZF-- HEATTH COUNCIL *4 K'!Pa, COMMUNITY HEALTH PROVIDENCE Health & Services M@h/TC r\1tt).t-{I rr.!t8l1\ \11!lt< Al (JN1It1 SKYLINE Hc)sPtTAL PacificSource Communitv Solutions surrmarv ol'thc lbr itnlr,rrcd hcaltlt lbr tltc of rlrc Cblunrbia Corgc Rcgirrn including Hood Rivcl, Wasco, (iillianr. reuntics in C)rcg0n aud Sklnunia and Kli!'kilat qotIlltics in \\iisl)i0g1on Fall l0l(r ffi KTIIilIAIIIALLIY }IEATI1I ---PAGE BREAK--- The 2nd Columbia Gorge Regional Community Health Assessment This document represents the second version of our regional approach to the Columbia Gorge Community Health Assessment. Building on the partnerships started with the first iteration in 2013, this re8ional assessment now includes 7 ad.jacent counties in the Columbia Gorge Region. The cohort listed on the cover page represents the primary supporting organi2ations in this effort. Actnowledgement to Key Community Contribwors conducting a thorough health assessment was postible by the tireless support of these groups. DHt Mid-Columbia Housing Authority, Hood River County Health Department Hood River County Senior Center, Revell Coy Insurance, Oregon Child Development Coalition, Meals on wheels: Th€ Dalles, Mid-columbia center For Living, North central Public Health Oistrict, One Community Health, Wings, The Next Door Ing Providence, Aging in the Gorge Alliance, Xlickitat Valley Health, Skyline Hospital. Skamania County Heahh Department, Klickitat county Heahh Departtnent Acknowledgment to the C.ommunity Advisory Council (cACl The community Advisory Council. or CAC, is comprised of oHP consumers, community members, and local organizations. Their mission is to give the community a voice so that the consumer and community health needs are heard. They were instrumental in reviewing and adjusting the survey itself to ensure our local needs were m€t. A resuft that is rewarding In a rural community, working together is paramount for success. The formation of the Columbia corge Coordinated Care Organization with Pacificsource Community Solutions aided us to turn an ordinary requirement from Oregon lawmakers into an extraordinary opportunity to improve the health and wellness of all residents. We are proud of our accomplishments and delighted that the Robert Wood Johnson Foundation recognized our work. We invite the community to use this material in the pursuit of better health for all. ,z '*'For the full document look on th€ Columbia Gorge Health Council website at cghealthcouncil.org ---PAGE BREAK--- Columbia Gorge Regional Gommunity Health Assessment 2o-13 US 2o-16 Mail = 457 Hand-fielded = 691 Non-HisPanic White=827 H ispanic/Lati no/other= 29o Low Income= 668 6 Counties: 4 oregon + 2 Washington 65 Questions including Food' Housing and Tra nsPortatioh 4 hosPitals; 4 Health DeParts; One CommunitY Health; County Mental Health Columbia Gorge cCO Housing & Food; Transportation; f,obs Adult Dental Access; Physical and Mental health together; Mental Health access for children & Youth Coordination with healthcare & social lseniices; Health insurance re-€nrollment; supporting Developmental and Healthy Mail = 674' statisti€al significance Hand-fielded = 694 Non-Hispenic \^r'hite= lO43 H ispanic/Latino/Other= 30l Low lncome=631 7 Counties, 5 oregon + 2 washington 72 Questions including Tr€uma and Support for caregivers 2Ol3 cohort + United Way; Four Rivers Early Learning Hub Employment rate better; other areas remain a conceln Dental Access remains #l gap; Progless on Mental Health Access; PcP Access harder Coordination with primary car€ and mental'health=good; More people are insured: Families with children o-5 more likelv to oo without basic needs 'sURVEYS DEMOCRAPHICS COUNTY @ QUESTIONS +O COHORT @R soclAL DETERMINANTS e€t HEALTHCARE rl.r llLr-, CONNECTED Growth in the Early Yeel! ?E$xxlr"m"t tn partnershiP with: Hosptlals: Providence Hood River, Mid-cotumbia Medical center. Klickilal valley Heallh, skyline ' Public Health: Hood River County, Klickitat Valley, North Central, Skamania one communily Hcalth, Mid'columbia Cenler for Living, Pacificsource community solutions Uniled Way of the Columbia Gorge,4 Rivers Early Hub ---PAGE BREAK--- Columbia Gorge Regional Health Assessment-201 6 General Pooulation 6^H Sasic Needs 1 in 4 had to go.wilhout a basic. need AND 1 in 4 had illiiirjiiip torgo withoul a healthcare need I ri ti. lFt+'ig: I in 3 hadtroublepaying forbasicneeds il!iE! pg 18 p(l 18 at) co ^ 'l in 3 are worried about runninq out of food* more than 1 in 10 had to go without food 25% are worried about their ho!sing situation 7% had lo go wilhout stable housing 13% had to go wilhout ps 18 ps l9 ps 20 ps 20 .QD. r.g 8% are uninsured of the uninsured. 21% live in Wash and 69% llve in 21% do not have someone to make them feel loved or wanted 22% do no have someone to give them good advice 23% dq ns ha a aomeone to relax with : ' 26% do not have som?one to lalk to aboul problems 29% do not have someone lo help if they were confined to a bed 25% leel they can nol trusl people in their community 20% can not count on aduhs in their community 13% lhink people in their community are unwilling to help 10?o ds n91 1aaI safe in their communitv 1 in 5 are caregivers ps 37 ps a'l oo n-i-l UrJ Suppon for Caraglvers EE() (J cohosion ps 37 rcorge Wide Food Survey 6 out of l0 cBregivers don't feel that they ---PAGE BREAK--- Columbia Gorge Regional Health Assessment-201 6 Pooul race/'eth parities by or rnsurance dis me. with inco ons ati nir ps 18 ps 18 p9 '19 ct) ft .QD. r.g @frH Baslc Nceds Incomc Sccurltt soclal cohesion 4 in 10 in the Hispanic/Latino/Other, Low Uninsured, and Medicaid populalions had to go without a basic need and healthcare need lfl ffi Morethan half of the Hispanic/Latino/Other, Low income, Uninsured, pg ll i: and Medicaid populations had trouble paying lor basic needs tg 1 in 4 in the,tlispanic/Latino/0lher, Uninssred, and Medicaid populations had to go without food Aboul 40% in Hispanic/Latino/0ther, Uninsured, and Medicaid populations are worried about theif housing situation 1 6% of these populations had to go without stable housing . About 1 in 4 in the H ispanic/Lalino/0ther, Low income, If,,; j uninsured, and Medicaid populations had to go without ll transportation Hispanic/Latino/0ther and Low income populations are about twice as likely to be uninsured than the general population Lorv income was less likelyto feel likelhey had these social supports than highel incomes Uninsuled and Medicaid populations were less likely to feel like they had these socisl supports than the Private and Medicare populations. 3590 of Low income, Uninsured, and Medicaid populations feel they can nol lrust people in lhei. community 25% of Hispanic/Latino/other, Low income, Uninsured, and Medicaid populations can not counl on adults in their community 25% of the Uninsured think people in lheir community are unwilling lo help 2070 of the Uninsured do nol feel safe in their community 6 out of 10 caregivers do not feel like they have adequale support ai::1-:,6 nj;i i.jr:',Ei ij ll a: =l rr pg 20 pg 20 IFEI. Hadth hsur.nce p9 ps 37 EFo (J oo G+:l UU Suppon for Car€givers ---PAGE BREAK--- Columbia Gorge Regional Health Assessment-2016 Adults (aoes 1B-98 High blood pressur€ is the most common chronic condition More than half have a chronic medical condition aa', lf ll t lJ'ffi. ps 22 Mefl tal lledth Conditlons ,1 , Deprassion is the most diagnosed mental health condilion t in a n.u" I mental health condition pg 22 pg 23 3 oul of 4 experienced one or more traumatic ,il,{Itil{'1f About 4 out of 10 had someone do something harmful to them 21% have lhree or more drinks on the days they drink 1 5% use mariiuana 19% use tobacco 7 % use other drugs 'I in 5 do not have a ptirnary care provider and are going wilhout needed care pg 24 ps 26 Q llealthcarc Grertest unnet led: 314 people are going without care alf ' t't' 1 in 4 ate going without needed care ll . G' c) E(f'o) - IT\ Q/ !t"6gNl H?ilut-c_tf 9 ! Substance Use f Access greatlY lmproved from 2013 46% got care ftom primary care provider 39% got _9ar9 Jr9n 9,o!l!I m9!llCl-!te-?l!t' 7% needed substance use care, of those 68% are receiving lreatment tfeutotogy, substance use t,eaiment, and cancer treatment had highest unmet need Most people use local services pg 28 pg 29 c a - .i :l flt-irii::'F-iiffli+iL.flif;-'riiiri'Ff I in 10 cannot get ail rheir medications ll ji, i! :1 lr :jl il i,i pg 29 ---PAGE BREAK--- o cene.al Health Assessment-2016 race/ethnicitv, aoes 1B-98) ' 35% of Low income and Medicaid populations raled lheir health as fair or poor 3 out of 4 on Medicare have a chronic medical condition t ps 22 Columbia Gorge Regional Health chronic Medieal , / \ \ r) t/ Mem.l He.lth Conditiong (o OJ the most diagnosed mental condition tor low income and Medicaid 2 of 5 of the Low inc6me population have Half of the Medicaid population has experienced I or fi1* more lraumatic events U ig 1 in 4 oflhe Uninsured and Medicaid populalions are going without needed care rtrl&; ll Il More than half of the Uninsured do not have a primary care provider About 37% of the Low income, Unlnsured, and Medicaid populations are going without needed care ps 22 Trauma ard Healthcare pg 23 The Uninsured and Medicaid population were more likely to have three or mofe drinks, use tobacc!, and use othe. drugs than general population Tobacco, LoW'lncome was more likely to use tobacco than the general population ps 24 tlealthc.le Access q, U' (u C' (J o) a- (o c) :f Nearly twice as many Medicaid tecipienls are going without needed care than the general population 15% of Medlcaid recipienls needed substance use cafe High income, Uninsured, and Private insurance populalions were Low incorne had more unmet orthopedic needs than the general population Private insurance had more unmet cardiology needs than the general population Medicaid had more unmel skin condition needs than the general population ps 27 ps z6 Substance Use Treatmenl twice as likeiy to go without needed care than lhe general , 19_99 ylh ry9_q9q -c!19" 1tr1,u9. s e! T!e9q9l1t''1 _ No signif icant disparities - M€dicatims ps p9 29 specialists ---PAGE BREAK--- Columbia Gorge Regional Health Assessment-201 6 Youth aqes 0-17 i' a, I ll ps 31 a (t'a (u - Asthma is the most common chronic medical condition Aruiely is the most diagnosed mental health condition ll€allh Conditions ps 31 Trauma and R6illence Alcohol, Tobacco, ps 31 ps 32 ct) U' o) CJ C) (u I . . - I in l0parentssaid I in 5youthfeel il!. i:';i'i'iitteitctritorenarenot vs lheyarenotgettinofE.'f,ff'f I] ' geftinq all needed care all needed care f, r t, :r ; * n :l,ffi"T:";"^l u, Hf ,f :ili ff 1,$r {1 11 getting all neoiiJ the past .12 monih. ll = Ii ii 34 VY Healthcates Heal0rcarc c Medications 8% oarents said their children are not gelting VS all needed care 15% youth feel they are not getting all needed care* x Substanca Use Treatment 1in 20 teens have used prescription drugs withoul a doctor's orders* *This Information is trom the oregon and washinglon Healthy Teen survey ^ This information came for the OHA Behavioral Profiles All other Information is from the 2016 CHA survev ---PAGE BREAK--- Klickitat County Percent 18-39 years 4G64 vears Are- 65-80 years 80+ vears 81 23.8% 134 39.4% 97 28.5% 20 5.9% ' Worried about housing Pays less than 750 Pavs 750-1500 Pays more than 1500 Basic l{eeds Went without SDH Went without healthcare Went without food Went without transporta 62 L8.2o/o 173 50.9% v) 27.9% 37 to.9% 59 17.4% 80 23.5% 25 7 .4o/o ro.6% Went without lo 4.77o Health Status General health'fair or 66 79.4o/" ht 95 27 .9To Obese t20 35.3%o Chronic Disease 202 59.4Yo Mental Health Condition 722 35.9Yo Mental and 87 25_6% Traumatic Event 278 8L.8o/o 3 oI. more traumatic events 742 41.8% Has 3 or more drinks a day 5t 75.O% ---PAGE BREAK--- Tobacco Use Marijuana Us€ : other drus use 63 IA.5% l_L 75.O% 24 7 . , Doesn't have usual place of Need Unmet Dental Need .r,1 Chro-nic Disease 11 14.7% roufft tt€atfJl r;:r.r Mental Health Condition 18 24.O% Mental and 8 10.7Yo , Unmet Mental Need Pcoplc in my community are wiliing to hclp : People in my comrnunity can Social and be trusted 4I 72.1% 83 24.4% Community I feel safe in my comnlunitY Environment Caregivers do no feel like they disagree) have ddequate support ilas to love them and make them feel wanted H.]s someone to confide in J-L 9.r% 40 f70 are cs) 57 .lo/s bz 18.2o/o 72 21.ZYo *cg=caregiver ---PAGE BREAK--- e : j t^ lL) ;i : di 3 lL: 3l F@ o o I,I3I, : : . : F: o oF gF 6,q s t: :EO : iE ,dF : , : li4Pz :o1 ^*K33 1-r N ;{E5g9 =ioo 6dd;; E,+t!t:6 FT llE cn H o E2 R fr R t:E ? ? fi 9E E E ; bo o o 9 IlV Y Y F gF zE zE F Ei gi gt 33 33 33 i- TEE ig5: 3 3 "oz 3 R 3 \o 10 i:ev E /i -Zdn' # o Su ! 7i uJ sz:\^ E ^ff 3-5iE A ; O= o q < 3F- CN to .i Et .i N .lr 8f, i 1 I ,io : : 5 ; :i:ooo!: .F ol Ei t0 > l z2t: fi o gi: - 9rt E Ig 6 V 9E e €F i:x: -uZ do UF Fcl ;3 ao Ee q; a; o A E o ; E o E ql :E c, :02 :A