(upbeat music) - Hello, I'm Steve Kendall.

And welcome to The Journal.

One of the things that county health departments are responsible for is assessing the health of their residents.

And we have with us today, the Wood County health commissioner, Ben Robinson, to talk about the Wood County health assessment and what that means for the people that live in the county.

It, of course, gets into both physical and mental health areas, but I wanna welcome you The Journal.

Talk about the health assessment, why it's done, and how it's done.

And then we'll kind of delve into some of the numbers, 'cause obviously there's a lot of data here.

- Yeah, thank you.

And it's good to be here and to be here in person for the first time, which is really exciting.

- Yeah, we've talked a lot, but we've never actually met face to face, so it's good to have you here, and yeah, we can have the conversation the way we always used to do it.

So yeah, so again, thanks for being here.

- Thank you.

- Yeah, yeah.

- So a community health assessment is something that's done on a regular interval.

In Ohio, it's done every three to five years.

Here in Wood County, we do it every three years to align with the schedule that our hospital partners utilize.

And so we took this on and actually did a lot of our data gathering last year as we were coming out of the last winter wave of COVID.

And the goal of a community health assessment is to just take a benchmark measure of how your community is doing across a number of health indicators.

This will help you to understand if you are improving or if you are having bigger challenges and things like physical health, mental health, it helps to understand how connected communities are feeling.

And it also looks at certain demographic characteristics like a person's income to see if that might be influencing what their health status actually looks like.

- Right, and I know when I was looking through the report, and it's an extensive report, as we talked, you know, a lot of data, a lot of information there, but it also, I guess, allows you then to see if there have been any changes, obviously, compared to previous reports, and if something new has shown up, something that wasn't showing up three years ago, now suddenly becomes an issue.

And you're trying to align these with state health initiatives as well, I understand.

- That's correct.

And what was unique about the time that we did our assessment is that we did it during this COVID-19 pandemic.

So all of our reference data is from a time, about three years earlier when that was not happening.

So we expected to see some impacts from the pandemic, and we did, particularly in the area of mental health.

In fact, what we found was that almost half of adults experienced four or more unhealthy days when it comes to mental health, and almost 30% of youth had the same experience.

- [Steve] Yeah.

Now, was that significantly different than what you'd seen in your previous assessment, or those numbers increased, obviously, then?

- [Ben] Those numbers increased, and we believe that it certainly was related to not only the pandemic itself, but also the indirect impacts the pandemic on behavioral and social health.

- Yeah, and it's interesting because when we think of health, we usually think of physical health, but I've heard someone say that mental health is health.

Even though we tend to look at it somewhat differently, that's one of the biases we have as a culture, I guess.

But that was the thing that concerned a lot of people that because of the change in lifestyle, you know, that COVID brought on, that that impact, as you said, demographically, especially children, talk a little about what you found there, because there were some really serious ramifications in terms of people thinking about taking their own lives, which is always with us, but this seemed to ramp that up a little bit more even.

- Yeah, what we found was that youth in particular reported, about three in 10 youth reported that they felt sad or hopeless every day for two weeks in a row.

- [Steve] Oh, my.

- And about one in five youth seriously considered, or actually attempted suicide.

And so these impacts are not something that we can just take lightly.

We recognize that they have real implications for lifelong health, both in the immediate term and the long-term, and finding opportunities to support our youth and our adults as well is critical.

- [Steve] Yeah.

Was there any particular area, and I know that we, when you looked at that demographic, we mentioned of course, children with regard to, yeah, feeling less than enthused, I guess, about what was going on with their lives.

Were there other mental health areas that stuck out too, for other demographics?

- Well, what we also found was that people who had lower incomes compared to the general population had worse health outcomes, pretty much across most measures.

They were 60% more likely to rate mental health as not good.

Five times more likely to rate their general health as poor.

And they were about twice as likely to have diabetes.

Each of these things tells us that having resources is related to having long-term health.

So when we think about public health, it's not just about what's happening in your doctor's office or what's happening at your local health department, it's also about what's happening in your economy and in your schools and all the organizations that make us our community.

- Yeah, and basically every moment of your life outside of those specific areas you mentioned do contribute both positively and negatively.

And you mentioned diabetes, which is interesting, 'cause we were gearing up, and PBS as a unit, was gearing up to talk about, there was a blood sugar show that was gonna come out a whole series of things, but then COVID hit.

And that sort of, like a lot of health issues, both mental and physical, everything else was pushed to the side.

And one of the things that I know people talked about, I'm sure, that probably it showed up data wise as well, that people quit doing their normal medical treatments.

They quit going to the doctor they normally would.

Maybe they didn't handle their medication the same way.

They quit doing the things they had been used to doing because of COVID.

Does that represent itself somehow here as well?

- I think that what we need to dig into is to really understand how much that impact was short-term versus long-term.

As we're coming out of the COVID pandemic, we certainly have seen the immediate impacts of that on all kinds of health factors.

But I think that you're right.

I mean, things like failure to seek care was something that we saw throughout the pandemic.

It's largely recovered, which is really good.

- [Steve] Ah, okay, good.

- But the implications of not doing the ongoing preventative care can have lifelong health impacts if you delayed so much that it led to complications or other impacts on your health.

- Yeah, because something as simple as a routine physical, you know, if you're able to do that once or twice a year, that's where you catch things before they become significantly difficult medically.

And people were, well, because, let's face it, it was difficult to maybe get procedures at hospitals, get procedures in doctors' offices because of the COVID situation.

So yeah, I see what you mean that you're gonna have to, that'll be something you'll track over the next few years to see, yeah, what were the long-term impacts of people not just doing their routine medical activities.

When you look at this too, and I know one of the things, well, we have just a moment here.

We'll pick this up in the next segment too.

Now the goal then is to look at all of this data and develop approaches to address the issues that have now shown up.

So how do you go about doing that?

What's the plan for that right now?

- Yeah so, there are two terms that are worth sharing.

One is what we call our community health assessment around the office.

We call it the cha, the CHA.

What that does is it gives us the foundation of data that we need to move forward.

And we're just one source of data.

There are a number of other community organizations that also collect survey information and measure impacts of their program.

So we're using all of that to try to inform what is in our community health improvement plan or our CHIP.

And so we have the CHA and the CHIP and those two things work together to help us understand our health needs and also to set priorities to address them and improve them over time.

- [Steve] Okay, when we come back, we'll talk more about CHIP then, because obviously that's the next phase of this and it is important because those are the things now you can apply this information and start to address the issues that have shown up.

Back in just a moment with Wood County health commissioner, Ben Robinson, here on The Journal.

Thanks for staying with us on The Journal.

Our guest is the Wood County health commissioner, Ben Robinson.

We're talking about the assessment that was done of Wood County residents called the community health assessment.

But there's another piece of that, and you talked about that as we were leaving that last segment that now there's taking that data and data from other sources and developing a plan to address what you've seen in this report.

And that's called the CHIP.

So talk about, and we touched that a little bit, where do we go with this now, and how does that unfold?

And what's sort of the timeframe for that?

It's not something you can just take care of in a week or two, there's obviously, this is an extensive process.

- Yeah, that's right.

So now that we have our data from our CHA, our community health assessment, then we begin to gather partners together to look at that data and digest that collectively.

We recognize that we are not the only public health agency in Wood County.

We're just one of the whole system.

And so we want to bring together everyone across all industries that help us to be healthy.

So once we do that, we have a chance then to look at what our opportunities are.

And the way we begin is by looking at the state health improvement plan, or the SHIP.

So depending on which level you are, you're either using a CH or an SH to identify your opportunities.

The state health improvement plan has a vision of first and foremost addressing community conditions.

If you address those factors that inform what happens, then that gives you an opportunity to improve your outcomes.

If you improve your outcomes, you improve better health.

And then you improve a long-term vision of having a healthy Ohio.

So in the same way, we have to look at those factors to say, what can we take on that the state wants to do?

We have to have a have alignment across at least one factor and one outcome.

But these are factors that are pretty common, as you might imagine, across communities.

So when we looked at the data, we actually chose to align with all of the community or the factors that the state health improvement plan shows.

So these were community conditions, things like housing, adverse childhood experiences, those are things that you experience as a young person that can have life lifelong impacts on your health.

Health behaviors, like how physical we are or physically active we are, or how much we avoid unhealthy foods and avoid things like tobacco.

And then finally access to care.

These things will help you to engage the support that you need.

On the outcome side, there were three that the state health improvement plan had: mental health and addiction, chronic disease, and then maternal child health.

In Wood County, we actually do really well in maternal and child health.

And so for us, we were able to set that aside.

And given everything we've had from COVID, we actually selected another category called social wellness.

And so our third outcome along with the other two is social wellness.

And it's an opportunity for us to begin to reinvest and reknit the fabric of society that has been frayed over these last couple of years.

- Right, yeah, because we know that it wasn't business as usual in terms of how we conducted our lives, whether it was at work, school, any other aspect of our lives.

Now, you touched on adverse childhood experiences and how that weighs in this, so talk a little bit more about that because obviously early impacts, as you said, lead to long-term issues and impacts too.

So kind of run through those, what things lead into bad mental and physical health based on things you experience when you're very young.

- Yeah so, adverse childhood experiences are very strong, traumatic events that a child might indicate things that really are disruptive to their environment or disruptive to their emotional health.

These could be things like experiencing abuse or neglect, witnessing violence, having someone in the home who is either struggling with mental illness or has been incarcerated.

It could also be instability that comes from divorce, where families have to separate.

So the more of these that a child experiences, the more likely they are to have impacts.

And what we found is when we look at other factors like smoking, for instance, low rates of smoking in Wood County, but 83% of current smokers who are youth have had three or more adverse childhood experiences.

We call these sentinel behaviors, things that indicate something else is going on.

So when we encounter these sentinel behaviors, it's not just an opportunity to address something like tobacco cessation, it's also an opportunity to say to ourselves, there's likely a mental health need that's going on too.

- What's behind that particular behavior, it's more than just the actual behavior.

There's a reason why that behavior's being practiced.

- That's correct.

- Yeah.

And you mentioned that we do really, Wood County's in better shape with regard to the number of people that smoke.

Were there other areas in Wood County that we were better than maybe the median or the mean, and other areas where, well, we need to do better than we're doing?

- Well, when we looked at things like how Wood County felt connected to their community, we had really strong ratings on connectedness, which was great.

We as a community really do have a strong sense of belonging and I think that that has been important for us.

And those numbers were actually pretty durable even with the pandemic.

And so everything that was pandemic impacted definitely took a hit, but there were a number of things that were durable that we can be really proud of, and that is one of them.

- Yeah, and that probably helped us through that, that community, yeah, feeling and everything.

When you look at now, as you go to develop plans to address these things, what are some of the first ones you'll look at in terms of this is our priority area?

We talked about 'em in general things, but are there specific ones that say, this is where we need to concentrate our efforts and bring all our partners in and try and put together a comprehensive approach?

- I think in terms of outcome, I think mental health and addiction is probably the thing that rises to the surface.

I think we recognize the need for it.

We feel an opportunity to address it, not only individually, but at the community level, and in the professional way.

What we found was that about half of adults who had experienced four more unhealthy mental health days didn't seek care at all.

So there was something going on there with just seeking care.

We also are in an area that is identified by the federal government as having not enough mental health professionals.

And so there are a number of, at both the pediatric level and the adult level, it can take a long time to get access to care, even if you do seek it.

- [Steve] Ah, okay.

- [Ben] And then finally, I think at the community level, we just need to be thinking about how we support one another holistically.

We are whole persons.

We're not just physical health, we're not just mental health, but we are the people who are connected to each other, relationally, occupationally, at a community level.

And when we think about that together, not only can we address mental health, we also have a chance then to address social wellness and to begin to say to ourselves, where do we want to go after this pandemic?

And what are the things we've that we've lost, we wanna regain?

And what are the things we've never done before that we wanna do for the first time?

- [Steve] And that's a good point because everybody talks about, well, we're gonna get back to normal, we're gonna get back to normal.

And then of course the flip side of that is, well, this is the new normal, but as you've indicated, we have recovered a lot of what we believe we lost during the pandemic.

When you talk to your peers around the state, are they seeing the same sort of things, similar reactions, similar issues that they're now having to approach as we are?

- We have asked that question and people certainly have had the impacts from COVID across the board and we were looking at our numbers recently from our community survey that we did, and I asked the question, how do our numbers compare to other counties?

'Cause our numbers were pretty stable from the last time that we did it to now.

And the moderator said yes, when I look at other counties, ours have been pretty good.

Other counties took some bigger hits recently because of COVID.

So I think it speaks to the resilience of Wood County.

I think it speaks to how we really support one another and, really, community health isn't something we can do on our own.

Certainly I have to take steps, each of us do.

- [Steve] But we all have to be a part of it, literally individually as well.

- [Ben] That's correct.

- When we come back, I wanna talk a little bit about, access is one of the big questions and of course we're a county that's near a major metropolitan city, Toledo, but we're also very rural and the area around us is very rural.

So as you mentioned, access can be a little bit of a challenge in some cases.

So we can touch on that and then a couple of other things back in just a moment with Wood County health commissioner, Ben Robinson, here on The Journal You're with us here on The Journal, our guest is Wood County health commissioner, Ben Robinson.

We've been talking about the Wood County health assessment.

And one of the things you mentioned, Commissioner Robinson, was that access, of course, is dependent on a lot of factors as well.

But so, what kind of things do you see when we talk about access to mental and physical healthcare and all of these aspects that we've talked about?

- Well, one of the things that we found in our community health assessment was that people who have incomes under $25,000 a year are about half as likely to seek the normal care that we'd recommend that they get over the course of a year.

So when we look at those challenges, we often think of things like, well, let's provide telehealth, which is certainly helpful, but telehealth may not be available to you or accessible to you if your connectivity is not very good.

Or if the technology is unfamiliar.

So that can certainly help to address the problem, but may but may not be the silver bullet we want it to be.

Transportation in Wood County is something that we've identified.

Particularly if you have limited resources, that can be particularly challenging.

And we, in our own agency, have a federally qualified health center under our roof.

So a health clinic.

And that is based on a sliding fee scale.

But what we know is that people like to seek care within a few miles of where they live.

And so these outlying areas just don't have the same ability to come in and be served as someone who lives in Bowling Green might have.

And that's what our numbers show.

- [Steve] Yeah.

And how do you go about addressing that?

Because you obviously want people to seek care that they need and that's probably part of this is a way, okay, how do we make sure that we can improve accessibility within the areas that are within the health department's control?

'Cause obviously you can't necessarily control connectivity on the internet and you can't control transportation to the degree that might be necessary.

So is that where you bring in other partners and you talk to people, say, hey, look, we do have a transportation issue, who do we talk to in Wood County about that?

How do we make that better for people so they can get to your location here near Bowling Green?

- Well, that's exactly right.

And we know that these problems are bigger than just the health department or Wood County Hospital, who's our primary partner in this effort.

We really need the entire community to work together.

And so as we look at these things, we really begin to think, what is the right solution to get at this?

What would address this need?

Some of it is doing everything that we can do quickly, taking the most feasible approach, and seeing how much of the problem is left.

And unfortunately, it is unlikely that our very first attempt to solve it... - [Steve] Will capture it all, yeah, will bring it all to life.

And, you know, you talked about, we've talked about the processes here, as you start to now look at your strategic plan for this, because obviously you've had this health assessment done, it's been done just within the last few months, you've got the results and everything.

What are the next steps you now take to start to address those needs, and how does that unfold in a timeline for people?

Obviously as you said, you're gonna do what you can do immediately, you're gonna jump on that, but it isn't something you're gonna tackle and everything's sewed up by the end of May.

Let's face it, not gonna happen.

So how do you move forward now with this information?

- Right so, the first thing, we wanna choose goals that are both relevant and feasible, right?

They will actually impact health across Wood County and something we can actually accomplish.

The second thing though, is we want to choose strategies that involve all of our partners.

Because if we only choose strategies that are affecting just public health or agencies like Wood County Health Department or hospitals, we're gonna leave out of that engagement most of the community that doesn't doesn't work there or doesn't see themselves as part of that direct impact.

So we want to have broad strategies that begin to chip away at these challenges across all the various facets that inform them.

And then finally, what we want to do is we want to lay groundwork, not just to make improvements between now and three years from now, but to begin to lay groundwork that we know can be built upon in each successive year.

- And that's grooved so where you get to the point where you like the numbers you're seeing.

And not that, again, we've done okay, generally speaking, but in some ways, you'd like to get all of those numbers down to areas, like, that's not a problem for us anymore, and that's a perfect world, and probably never will happen, but that's the goal, is to maximize the strategies there.

And as you said too, early addressing, whether it's, as you said, the adverse childhood impacts and just access, obviously, are very important.

We've talked a little bit.

Is there anything else you'd like to add at this moment?

'Cause I'd like to talk a little bit, we touched on COVID and how it changed some of the data here, but maybe not as much as you anticipated, where are we right now?

Because I think the general consensus is, eh, we're done with this and everything's fine again.

And you know, yeah, there's gonna be some people contract this are gonna be, but overall it's in our rear view mirror now and we're just gonna move forward.

Is that really the case?

Or how are things going as we sit here on, you know, in the middle of May compared to where we were and where we think we were going to be at this point?

- So, so first and foremost, I think we just can't give enough of a thank you to all of the partners who stepped up during this pandemic.

Part of the reason that we're in a place to say, let's put this behind us is because of the great work of public health agencies and others that have worked tirelessly to address people who are ill, to provide vaccinations, to provide support, so that we are well positioned because of that.

And here in Wood County, we've had strong vaccination rates, which has really helped to mitigate many of the impacts.

Over the last couple of months, it's been really great.

We have had some increasing cases recently, but low hospitalizations.

What we're starting to see right now is a resurgence of COVID particularly in southeast Michigan.

We tend to be impacted by things that are in our neighboring locations.

And so, our cases are actually going up too.

Last week, we had about 220 cases, which puts us at a community level of 168 cases per a hundred thousand.

So it's higher than we were previously at this point.

We're not necessarily overly concerned, but we are watching numbers because there could come enough impacts that it leads to some recommendations being changed, so individuals think differently about how they protect themselves.

- And we don't want to let down our guard completely because then we will find ourselves.

And obviously, as we've talked in previous times, vaccination is still the best approach to prevent, to protect yourself against this.

That's still the case, right?

- It is still the case, but it's not just vaccination at this point.

So if we go back a year ago where vaccines were finally becoming widely available, I think by May, most people who had wanted a vaccine had been able to get one, and completed their series.

But we've had other things too.

So now an individual can use a high quality mask, which was previously unavailable because of the supply issues.

We also have, for people who have immuno compromising conditions, you can get an antibody dose that's preexposure prophylaxis and provides up to six months of protection against COVID.

We have antivirals and monoclonal antibody treatments, which can be effectively applied to reduce the risk of hospitalization, depending on the study.

Some as much as 90% reduction of severe outcomes.

And then we have ample access to testing.

So the difference between now and a year ago is there's a lot more individuals can do to protect themselves.

So at this point, the best thing to say is if you have symptoms that could be from COVID, get tested.

Engage your physician.

If you are at risk for severe outcomes, take the time to talk to your provider and determine if a therapy will help you to recover and stay out of the hospital.

And if we do that, that gives us our best chance of not seeing us return to a place where those community level recommendations are needed to protect individuals.

- [Steve] Yeah, yeah.

And you make a good point too that we now have access to more resource than we had back when we were really, you know, fighting this thing in a big way.

There's testings available, vaccines readily available.

All of those things are now more available to us.

So we really shouldn't have an excuse for getting in a position that we don't wanna be in, again, if we keep our guard up and do the things that we need to do.

We've got just a moment, is there anything you'd like to add about the health department that people should know or how easy it is to get in touch with you and how they could, if they have a question in any regard, whether it's mental health, physical health, to talk with you?

- Yeah, absolutely.

All the information on our community health improvement plan or community health assessment is posted on our website, woodcountyhealth.org.

You can go to our reports and publications page on our website and that's how you'll find the information about our CHIP and our CHA.

We, like everyone else, are very excited to be seeing what's happening with COVID.

So we're pulling with everyone else to hope that we don't see high impacts on our medical system at large.

But more than anything else, we are excited about investing in our community, really thinking together about how we improve our health long-term.

And this is not just the work of the health department, it's all of our partners, but it's also the general public too, because they are the public and public health.

- [Steve] Yeah, we all have a role in this and it starts with the individual as well.

And then you can provide us all the assistance we need and the resources, but we have to be directly involved.

We have to take that first step and access those.

So, good, good.

Well, thank you, Commissioner Robinson, again, for being here.

We'll have you back again as time goes on, because there's always information that we need to get out to the public in regard to health.

So we appreciate you being here.

- [Ben] Thank you.

A privilege as always.

- Okay, thank you.

You can check us out at wbg.org and of course you can watch us every Thursday night at 8:00 PM on WBG PBS.

We will see you again next time.

Good night and good luck.

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