Community pulse

Butte County residents aren’t faring so well when it comes to their well-being. At least, that’s the picture painted by the Department of Public Health’s latest Community Health Assessment (CHA) released last week.

“For all of the priority health needs identified in the CHA, the rates for people living in Butte County are higher than the state,” explained department spokeswoman Lisa Almaguer. “So, our mental health and substance use disorders are higher. Our adverse childhood experiences are higher. We’re ranking higher, but not in a good way.”

The CHA includes analysis of data culled from Adventist Health Feather River, Enloe Medical Center and Orchard Hospital (Oroville Hospital did not participate). It was begun in the summer of 2018, shortly before the Camp Fire. That could mean things are even worse than they look, Almaguer said.

“Before the Camp Fire, data were showing these things were already a concern, and of course now they’re all impacted,” she said. “Because the fire happened during data collection, the full impacts of the fire are not represented. It’ll take some time before we’re able to collect data from the fire—at least a year.”

A few things she says are known about the impacts of the disaster: Hundreds of health care offices were lost, including 24 percent of skilled nursing facility beds and 18 percent of acute care hospital beds (see “Patient overflow,” Healthlines, Nov. 7). This region already was experiencing a shortage of providers, however. Between 2012 and 2016, the ratio of Butte County residents to primary care physicians increased 10.9 percent (from 1,497:1 to 1,660:1). In California, that ratio was 1,270:1 in 2016, a 1.9 percent decrease over 2012.

Plus, it’s common for things like substance abuse and mental health problems to worsen after a traumatic event. In focus groups held after the fire, Almaguer said, 69 percent of participants ranked mental health as a very high priority for the region. And 27 percent said they’d been diagnosed with some sort of depressive disorder—much higher than the state average of 17 percent.

The purpose of the CHA, Almaguer explained, is to identify things that need improvement. It assesses four key priority areas—access to care, substance abuse and mental health, chronic diseases and adverse childhood experiences. Public health officials, in partnership with local health care providers, will now take that data and develop a Community Health Improvement Plan (CHIP).

This is only the second time the county has produced a formalized community health assessment, with the aim to create goals, implement them and then reassess.

“In the first CHA, in 2015, the opioid epidemic was identified. And overprescribing was identified,” she said. “From that, action items were developed in the improvement plan and the results of that are things like giving naloxone to first responders.”

While the drug-induced and opioid-induced death rates have dropped in Butte County since the last assessment, they’re still much higher than the state or national averages. In fact, from 2014 to 2016, Butte County ranked 54th out of 58 counties for drug-related deaths (the full effect of the 2015 improvement plan won’t be seen until more recent data becomes available). And it has the highest rate of both non-heroin opioid-related hospitalizations and heroin-related hospitalizations in California, with 40.3 per 100,000 population (vs. 7.8 statewide) for the former, and 10 per 100,000 (vs. 1.8) for the latter.

The CHA indicates that Butte County teens are starting drugs and alcohol early, too. The percentage of local teens who reported ever trying alcohol or illicit drugs—including misuse of prescription meds—“was greater for all grade levels for nearly every category than in California overall,” the report reads.

That’s not all: When it comes to chronic illnesses like cancer, Alzheimer’s disease and chronic liver disease, Butte County also is behind the curve. “Almost across the board, our rates of chronic conditions are higher than the state,” Almaguer confirmed.

Over the next couple months, the county will be delving into the reasons for Butte’s poor performance. Almaguer said she expects the improvement plan to be produced around January.

“We don’t really see the why here, but when the improvement plan comes along, they’ll be digging into that so they can look at solutions,” she said.