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Healthy Environments COMMUNITY HEALTH ASSESSMENT

Prepared by: HealtheConnectionsHealthPlanning November 2013 CHA Environmental Health |

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Healthy Environments TABLE OF CONTENTS Introduction ....................................................................................................................... 1 Key Findings....................................................................................................................... 2 Environmental Related Diseases ......................................................................................... 4 Food– and Water-Borne Diseases ...................................................................................... 4 Vector Borne Diseases .......................................................................................................... 5 Rabies ....................................................................................................................................... 7 Water Quality.......................................................................................................................... 9 Recreational Water Quality ............................................................................................... 11 Air Quality .............................................................................................................................. 13 Radon..................................................................................................................................... 16 Tobacco Smoke ................................................................................................................... 18 Climate Change .................................................................................................................. 21 Exposure to Lead ................................................................................................................. 22 Healthy Community Design ............................................................................................... 24 Walkable Communities ...................................................................................................... 27 Transportation ....................................................................................................................... 28 Data Tables ...................................................................................................................... 29 References ....................................................................................................................... 31

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INTRODUCTION Healthy Environments is concerned with all aspects of the natural and built environments that may affect human health including; preventing or controlling the spread of disease, exposure to harmful agents, and injury and disability related to the interactions between people and their environment. The physical spaces, or environments, where we live, work, learn and play serve a critical role in influencing health. Our interactions with the environment affect quality of life and years of healthy life lived, and can exacerbate, or assuage health disparities.1 The CHA Steering Committee agreed that “Healthy Environment” is appropriate as a stand-alone chapter. Although the specific “environments” one may find themself in at a given stage of life (e.g., school, worksite, institution) may be diverse, many of the same factors and issues are commonly found in these environments and cut across all life stages. A “Healthy Environment” encompasses the assessment and control of environmental factors that can potentially affect health. It targets the prevention of injury and illness by creating health-supportive environments. Creating health-promoting environments is complex and relies on continued research to understand more fully the effects our environments have on people’s health. Madison County understands the importance of collecting quality data at the local level in order to act on issues that are affecting, or could potentially affect, the health of residents. Potential partnerships with academic institutions such as Colgate University’s Upstate Institute offer opportunity for ongoing research and securing data that will further enhance our understanding of environmental conditions that could lead to health improvements and better health outcomes.

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KEY FINDINGS Madison County had no human cases of Shigella, Legionellosis, West Nile Virus or Eastern Equine Encephalitis in 2011 - 2012 Over the past 5 years (2008 – 2012) Madison County demonstrated higher rates of Campylobacter, on average than the state (23 vs. 15 per 100,000) but did have a lower rate than NY State in 2012 (17.7 vs. 18.2 per 100,000). Over the past 5 years (2008 – 2012) Madison County demonstrated higher rates of Giardia, on average than the state (13.6 vs. 11 per 100,000). Historically, Madison County demonstrates a significantly higher rate of Cryptosporidiosis when compared to the state . In 2012 the rate for Madison County was 23.2 per 100,000 compared to 1.8 per 100,000 for NYS. Over the past 5 years (2008 – 2012) Madison County demonstrated lower rates of Salmonella, on average than the state (12.9 vs. 13.6 per 100,000). The Annual Mean Particulate Matter as measured from the closest NYSDEC air monitoring station located in East Syracuse, NY is slightly less than the State (9.8 vs. 10.3 um/m3). Outdoor Air quality monitoring is minimal in Madison County, limited to the NYSDEC Region 7 monitoring site operated in a remote location at the former Camp Georgetown. Carbon Dioxide & Inhalable Particulate Matter data is limited to monitoring sites in Syracuse NY which are not representative of Madison County’s rural environment. 68% of Madison County is served by Community water systems that are tested and regularly monitored for water quality . This compares to 48% for NYS (excluding NYC). 32% of County residents are served by individual water supplies that are not tested regularly for water quality. Based on sampling conducted of 40 individuals wells tested from 2009- 2012, 25% were found to be subject to bacteriological contamination. Only 32% of county residents are served by municipal water systems that are optimally fluoridated compared to 47.2% in NY State excluding NYC. Including NYC, 71.4% of all NYS residents served by public water systems receive optimally fluoridated water. There is a high percentage of households built before 1950 in Madison County (39.2% as of 2011 US Census) and deemed a risk factor for childhood lead poisoning (42.8% in NYS ) and the communities with the highest percentage of older homes is Hamilton (63%) and Oneida (56%). Incidence of children less than six years old with confirmed blood lead levels greater or equal to 10 μg/dL decreased from 10.7 per 1,000 in 2009 to 1.0 per 1000 in 2011. New York State excluding New York City decreased from 7.4 per 1,000 in 2009 to 7.2 per 1,000 in 2011. The percent of children with elevated blood lead levels among children tested before age 6 in Madison County for the period 2004-2007 was 0.7%, which is lower than that of NYS excluding NYC for the same period (1.1%).

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The average radon concentration for total homes screened in Madison County ranges from 3.52 pCi/L to 8.71 pCi/l. The percent of homes screened for basement short term concentrations in Madison County that exceed the EPA recommended action level of 4 pCi/l is 34%, significantly higher than the NYS average of 18%. Madison County is categorized as a Zone 1/High Risk area for elevated radon levels by both the EPA and the NYSDOH. The percentage of cigarette smoking among adults in Madison County for the data years of 2008 – 2009 is significantly higher (25.2%) than the NY State average (16.8%). All chronic diseases commonly associated with smoking (asthma, respiratory disease, and lung cancer) are similarly higher in Madison County than NY State averages. As of 2011, Madison County had smoking bans in most village and town parks and a select number of vendors choosing to implement point of sale polices that will reduce purchasing. The County has implemented a smoke free campus policy at the County Office Complex and both Highway Garages. The County adopted the Climate Smart Communities pledge satisfying a NY State public health priority objective. Current trends indicate that most residential development is occurring at the peripheral of villages and the City of Oneida, as well as along the south shore of Oneida Lake in the Town of Sullivan. Commercial development in the City of Oneida is mostly occurring outside of the City center. The Madison County Transit System capacity to provide public transportation was reduced due to a reduction in funding.

Key Indicates a favorable status compared to New York State and/or when compared to Madison County’s previous data. Indicates an unfavorable but similar status compared to New York State and/or when compared to Madison County’s previous data (difference within 10%). Indicates an unfavorable and worse status compared to New York State and/or when compared to Madison County’s previous data (difference greater than 10%).

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Environmental-Related Diseases The environments in which we live host a diverse and potentially dangerous assortment of organisms (viruses, bacteria, fungi, parasites, etc.) that given the right conditions could negatively impact people directly, or indirectly through animals, food, water, air, and soils that become vehicles for diseases that may infect and harm people. These infectious diseases can be further spread from human to human, hence the surveillance and control of these diseases is an important part of protecting the public’s health.

Food- and Water-Borne Diseases Table #1 below illustrates a number of select environmentally-related diseases for Madison County. In 2012, Madison County demonstrated lower rates for Campylobacter, Salmonella, and Giardia than NYS for all three diseases. However, particularly for Campylobacter, the County rate was significantly higher for three out of the last five years. A possible reason may be the proximity of a high number of dairy farms and greater exposure to cattle (the main reservoir of the Campylobacter bacteria is cattle and poultry). Similarly for Salmonella, animals and poultry are a significant reservoir.

TABLE 1 Rates (per 100,000 population) of Select Food/Water Borne Diseases 2008-2012 Campylobacter

2012

2011

2010

2009

2008

5 yr Ave.

Madison County

17.7

32.7

31.4

11.5

21.5

23

NY State

18.2

17

14.7

12.6

12.4

15

NY State excl. NYC

17.9

18.3

15.2

13.3

13.4

15.6

Salmonella

2012

2011

2010

2009

2008

5 yr Ave.

Madison County

10.9

9.5

20

5.7

18.6

12.4

NY State

13.2

13.2

14.1

13.4

14.3

13.6

NY State excl. NYC

12.4

12.7

12

12.3

13.5

12.3

Giardia

2012

2011

2010

2009

2008

5 yr Ave.

Madison County

1.4

13.6

14.3

27.2

11.5

13.6

NY State

10.6

10.6

11

11.6

11

11

NY State excl. NYC

10.2

10.2

11

12.8

11.6

11.2

Cryptosporidiosis

2012

2011

2010

2009

2008

5 yr Ave.

Madison County

23.2

9.5

17.2

21.5

14.3

17.1

NY State NY State excl. NYC

1.8 2

1.7 2.1

1.7 2

1.5 2

1.9 2.4

1.7 2.1

Source: 2008-2012 New York State Department of Health, Communicable Disease Annual Reports, http://www.health.ny.gov/statistics/diseases/communicable/. Accessed 8/20/2013.

Other environmentally related food and water borne disease commonly observed in NYS include; Listeriosis, Shigellosis, Hepatitis A, EHEC*, Legionellosis, and E. coli O157. However, the number of cases reported in Madison County is extremely low and occurs infrequently. *E.Coli non-0157 and producing non-sero-grouped Shigatoxin producing infection

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Each year foodborne disease makes one out of six Americans ill and kills 3,000 people. The CDC reports that reducing foodborne illness by just 10% would keep 5 million Americans from getting sick each year.2 Number of Food Service Violations in Madison County for Years 2011 and 2012 Number of Establishments Inspected

TABLE 2

Number Inspected with no public health hazards

Number of public health hazards found (Total)

Number of establishments with Critical Violations

Number of Critical Violations not Corrected

Madison County, 2011

430

373

83

14

1

Madison County, 2012

415

358

69

15

4

Source: New York State Department of Health, Food Service Establishment https://health.data.ny.gov/Health/Food-Service-Establishment-Map-Last-Inspection/qd6f-nmcs. Accessed 8/20/2013

Madison County Department of Health works to protect public health by assuring food establishments operate in a manner that eliminates hazards in order to decrease the risk of foodborne illnesses. Among facilities surveyed, the percentage of food service establishments with no violations decreased from 86.7% to 86.2% between 2011 and 2012. The number of establishments with critical violations however increased from 3.2% to 3.6%. A critical violation is more likely than other violations to contribute to food contamination, illness, or environmental degradation. According to NYSDOH, public health hazards can be mild to moderate offenses such as having unclean floors, storing cleaning cloths improperly or not having accessible hand washing sinks. Examples of “critical violations” include having food from an unapproved source on the premises and/or storing hot food below regulated temperatures. 3

Vector Borne Diseases "Vector-borne disease" is the term commonly used to describe an illness that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include viral encephalitis, Lyme disease, and West Nile Virus. Although the Central New York region represents the State’s “hot spot” for mosquito borne West Nile Virus and Eastern Equine Encephalitis, no cases of either virus were reported in either humans or equines (horses) from 2010 to 2012 in Madison County. Number of Human Cases of Select Vector Borne Diseases, 2008-2012 TABLE 3

2012 Madison NYS

2011 Madison NYS

2010 Madison NYS

2009 Madison NYS

2008 Madison NYS

Babesiosis

0

254

1

418

1

269

0

303

0

261

Lyme Disease

6

5,887

14

8,007

8

6,316

6

9,279

11

9,152

West Nile Virus

0

65

0

30

0

93

0

7

0

32

Encephalitis (Non-WNV)

0

242

0

123

0

212

1

233

0

304

Source: 2008-2012 New York State Department of Health, Communicable Disease Annual Reports, http://www.health.ny.gov/statistics/diseases/communicable . Accessed 8/20/2013.

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Lyme disease however, is increasingly found infecting both humans and canines throughout Madison County. The number of confirmed human cases of Lyme disease has steadily increased since 1992 (Figure 1). The increase in Lyme can be attributed to two factors. First, there is an increase in the incidence of disease in the entire region as shown by the graph below. All counties in the Central New York area have seen an uptick in the incidence of Lyme. Second, there is increased awareness and testing of Lyme by healthcare providers. This is reflected in an increase in the total number of cases investigated by health department from 2012 to 2013 (Figure 2).

Figure 1

Source: http://www.cdc.gov/lyme/stats/index.html. Accessed 9/16/2013.

In 2013, Madison County is seeing an increase in the total number of cases investigated (as a result of testing ordered by healthcare providers) and confirmed cases of Lyme disease when compared to reported numbers in 2012.

Figure 2

Source: Madison County Department of Health, Human and Animal Disease Surveillance Report. August 2013.

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Mosquito surveillance activities are conducted annually in Madison County to identify the degree of risk to public health from mosquito-borne disease, specifically West Nile virus and Eastern Equine Encephalitis. Over 100,000 mosquitos have been tested for the presence of viruses since 2010, and while the number of positive mosquito pools has declined since 2010, the threat of WNV & EEE remains high in the CNY area. Madison County - Number of Positive Mosquito Pools by Virus Type, 2010-2013 TABLE 4 West Nile virus EEE virus Cache Valley virus Flanders virus Highlands J virus Trivittatus virus Jamestown Canyon CAL

2010 1 2 12 1 3 1

2011 2

2012

6 10

1

2013 3 1

1 1

2

Source: Madison County Department of Health, Environmental. Update to end of season, 9/20/13

Rabies Rabies is a preventable viral disease that afflicts mammals. It is most often transmitted through the bite of a rabid animal such as raccoons, skunks, bats, and foxes. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The early symptoms of rabies in people include fever, headache, and general weakness or discomfort. As the disease progresses, symptoms such as insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, increased saliva, difficulty swallowing, and fear of water can appear. Death usually occurs within days of the onset of symptoms.5 Madison County annually submits animal specimens for rabies testing. The number of specimens testing positive for rabies is relatively consistent over the past three years (Table 5). Animal specimens testing positive for rabies are further delineated in Table 6.

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Number of Animals Tested for Rabies and Number found Positive, 2010-2012 2012

TABLE 5 Examinations in Animals

2011

2010

Madison

NYS

Madison

NYS

Madison

NYS

57

6,654

58

6,430

61

6,642

8

425

6

370

6

499

Number Found to be Positive

Source: New York State Department of Health, Rabies Annual Summaries. http://www.wadsworth.org/rabies/annualsum.htm. Accessed 8/20/2013

Animals Testing Positive for Rabies by Type, 2010-2012 TABLE 6

2011

2010

Cats

1

2

Skunks

1

Cattle

2012 1

Fox

2

1

Bats

1

1

1

Raccoons

3

2

3

Other Domestic 1 Source: New York State Department of Health, Rabies Annual Summaries http://www.wadsworth.org/rabies/annualsum.htm Accessed 8/20/2013.

One of the best ways to protect humans and pets from contracting rabies is to have domestic pets routinely vaccinated for rabies. Each year Madison County holds on average 12 rabies vaccination clinics. Over 15,000 cats, dogs, goats, and ferrets have been vaccinated at clinics held by Madison County in the past 10 years. TABLE 7 Animals Vaccinated at Madison County Health Department Rabies Vaccination Clinics 2009-2012 2012 2011 2010 2009 Dogs 1350 1293 1170 907 Cat 499 487 582 445 Ferrets/other 2 10 3 7 Total 1851 1790 1755 1359 Madison County Department of Health 2013

For situations where a reasonable probability of exposure to rabies cannot be ruled out Rabies PostExposure Prophylaxis (RPEP) is available. The program, jointly funded by New York State and Madison County provides RPEP to those uninsured or underinsured. Each exposure scenario is carefully vetted by Madison County staff and patients are advised accordingly. Over the past 5 years, Madison County demonstrated an increase in uninsured/underinsured individuals receiving RPEP. This increase can be attributed to a change in State protocol regarding potential exposure to bats. TABLE 8 Human Rabies Post Exposure Prophylaxis Administered 2008-2012 2012 2011 2010 2009 2008 39 21 30 15 10 Madison County Department of Health 2013

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Water Quality Improvements in water treatment over the decades have dramatically improved the public’s health. Access to healthy water can be affected by environmental pollutants in local water sources, drought and aquifer depletion, flooding that overwhelms local treatment capacity, local weather changes associated with climate change, new and more stringent regulations, or failures in water-related infrastructure.6 Residential water service in Madison County varies by location. In 2012, 68% of the county’s population was served by community water supplies that are regularly inspected and where the water quality is tested frequently. The remaining 32 % of the population is served by individual/private water sources (wells) that are tested infrequently, if at all, and for which there are no regulations in place to monitor water quality. Individual water supplies in Madison County, especially those consisting of shallow dug wells, springs or surface water sources are more likely vulnerable to contamination, especially from E. Coli and Cryptosporidium, which may be attributed to agricultural runoff in the rural areas of the County.

Figure 3 Madison County Residents Served By Municipal Water Supply Individual Water Supply 32%

Municipal Water Supply 68% Madison County Department of Health 2013

Figure 4

Residents Served by Municipal Water Sources and Receiving Optimally Fluoridated Water

Percent of NYS residents served by Municipal Water Sources…

48

Percent of County residents served by Municipal Water Sources

68

Percent of NYS population receiving optimally fluoridated water…

71.4

Percent of NYS population receiving optimally fluoridated water…

47.2 47.1

0

20

40

60

80

Madison County Department of Health 2013

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Approximately 48% of the county’s population is served by municipal water systems with optimally fluoridated water, with the remaining 52% of the population served by municipal water systems are not provided with fluoridated water. (NYS % of population served by PWS’s that receive fluoridated water is 71.4%, without NYC 47.2%). Many people in the United States receive their water from private ground water wells or other unregulated sources. EPA regulations that protect public drinking water systems do not apply to privately owned wells. As a result, owners of private wells are responsible for ensuring that their water is safe from contaminants. Various national studies have found unsafe levels of harmful agents in private wells including: radon, arsenic, uranium, manganese, fluoride, nitrates/nitrites, and bacteria. Areas of Madison County have been identified as exhibiting elevated levels of nitrates and arsenic, mainly in those Towns in the southeast area of the County along the NYS Route 20 corridor. Between 2009 and 2012, forty (40) private wells in Madison County were tested by the Health Department for bacteriological contamination. Most of these wells were in areas already known to have poor water quality and where the extension of public water service was desired by the local community. More data on private wells in Madison County is necessary to address public health impacts on residents, particularly as residents served by such private water supplies rarely or very infrequently test their water for contamination. Although only a limited number of private wells have been tested, the test results indicate that the water quality in a significant number of wells would not meet drinking water standards. Establishing baseline water quality for private wells is particularly important prior to expanding agricultural activity or industrial development such as natural gas extraction. Bacterial Tests Taken from Individual Wells- Madison County, 2009 - 2012

TABLE 9 Total Brookfield Cazenovia DeRuyter Eaton Lenox Lincoln Madison Oneida Smithfield

Total # tested 40 1 1 2 3 13 17 1 1 1

Total Coliform Positive 10 0 0 1 1 6 1 1 0 0

E. Coli Positive 2 0 0 0 1 0 0 1 0 0

Madison County Department of Health 2013

Results of Bacteriological Tests from Individual Well, 2009-2012

TABLE 10 Total Coliform Negative Total Coliform Positive E. Coli Negative E. Coli Positive

Percent Tested 75% 25% 95% 5%

Madison County Department of Health 2013

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Recreational Water Quality Madison County has abundant recreational water opportunities among the many lakes, ponds, reservoirs, streams and canals bordering or otherwise dispersed throughout the County. Many of these water bodies have been the impetus of extensive residential shorefront development, most acting as the center of a lake community and having associations whose purpose is to monitor and ensure these water sources are protected from degradation and retained as an important natural resource. Madison County works closely with these lake associations through its Planning and Health Departments. The Health Department: reviews and provides recommendations on wastewater treatment systems that will serve new or replacement shorefront dwellings; works with the NYS Department of Environmental Conservation on reviews and permitting of applications intended to address aquatic vegetation problems; and provides regulatory oversight of bathing beaches, campgrounds, new realty developments and other shorefront facilities permitted to operate under State Sanitary Codes. Bathing beaches are monitored for water quality during seasonal use to ensure the beach water’s do not present a risk to recreational users, in addition to assuring the operations are conducted in accordance with sanitary code requirements related to supervision and safety. Advisories are issued to lake associations when water quality conditions have been adversely impacted, including the presence of algae blooms that can be harmful to swimmers and shoreline property owner’s pets. Beach operators and effected residents are further advised of restrictions necessary to protect public health from potentially harmful chemical applications related to treatments intended to eliminate aquatic vegetation problems. Recreational Water Regulatory Activities 2010-2013 TABLE 11

2010

2011

2012

2013

# Bathing Beaches Permitted

12

13

11

11

# Beach Closures

1

0

2

3

# BG Algae Bloom Advisories Issued

1

0

1

2

# Aquatic Vegetation Permits Reviewed

0

2

2

2

# Shoreline OWTS Plans Approved

4

6

7

12

Madison County Department of Health 2013

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Madison County’s abundant fresh water Lakes, streams and reservoirs offer plentiful opportunities for sport fishing. Consuming fish is an important part of a healthy diet, however some fish contain chemicals at levels that may be harmful to health. Residents can get the benefits of fish and reduce their exposure to such chemicals by following the Advisories provided by the NYSDOH. The table below offers guidance on fish consumption specific to water bodies located in Madison County. Anglers, along with others who eat fish caught by friends or family, often eat fish from a limited set of waters as they tend to return to favorite fishing locations. It is important that such persons limit the consumption of fish taken from those locations noted in the table, to minimize their exposure to contaminants such as mercury. TABLE 12

Waterbody1 (County)

Fish

Men Over 15 & Women Over 50

Women Under 50 & Children Under 15

All waters NOT listed (Leatherstocking/Central Region)

All fish

Up to 4 meals/month

Chenango River (Broome, Chenango, Madison)

Walleye

Greater than 22", up to 1 DON'T EAT meal/month; Less than 22", up to 4 meals/month

All other fish

Up to 4 meals/month

Walleye

Greater than 22", up to 1 DON'T EAT meal/month; Less than 22", up to 4 meals/month

All other fish

Up to 4 meals/month

Unadilla River (Herkimer, Chenango, Oneida, Madison, Otsego)

Up to 4 meals/month

DON'T EAT

DON'T EAT

Source: New York State DOH Fish Advisories (2013) http://www.health.ny.gov/environmental/outdoors/fish/health_advisories/ regional/leatherstocking_and_central.htm

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Air Quality Indoor and outdoor air pollution is a major environmental health problem affecting everyone. Even relatively low concentrations of air pollution are associated with adverse health effects. Poor air quality is linked to increase rates of respiratory infections, asthma, chronic obstructive pulmonary disease, heart disease, and lung cancer. Exposure to air pollutants is largely beyond the control of individuals and requires action by public authorities at the regional, national, and even international levels.8

Respiratory Disease Indicators in Madison County 2008-2010 County Rate

NYS Rate

NYS Rate minus NYC

CLRD hospitalization rate per 10,000

31

37.5

31.7

CLRD mortality rate per 100,000

56

31.1

38.5

9.6

20.3

12.3

Ages 0-4 years

23.8

56.8

-

Ages 5-14 years

8.4

20.8

-

Ages 0-17 years

11.2

28.3

-

Ages 25-44 years

6.8

10.8

8.1

Ages 45-64 years

8.5

21.8

12.6

17.5

32.2

19.2

Asthma mortality rate per 100,000

0.0*

1.2

0.7

Age-adjusted % of adults with current asthma

13.8

9.7

10.1

TABLE 13 Chronic Lower Respiratory Disease

Asthma Asthma hospitalization rate per 10,000

Ages 65 years or older

Ever diagnosed with Asthma lifetime (adults)

17.8

15.2

15.3

Chronic Obstructive Pulmonary Disease (COPD) COPD hospitalizations among adults (per 10,000)

39.1

41.3

-

Male

96.0

75.8

-

Female

77.2

53.9

-

Lung Cancer Incidence (per 100,000)

Source: New York State Department of Health. https://www.health.ny.gov/statistics/chac/indicators/res.htm. Accessed 8/20/2013.

Air quality in Madison County was previously tracked from an air quality monitor located at Camp Georgetown, which closed recently, in the southern end of the county.

Air Quality Standards TABLE 14

New York and Federal Air Quality Standards

Sulfur Dioxide

30 ppb 12 month average

Ozone

0.0075 ppm over last 3 years

Carbon Monoxide

35 ppm one hour average max

PM 2.5 15 ug/m3 average of last three years Source: Department of Environmental Conservation, 2011 Region 7 Air Quality Data http://www.dec.ny.gov/chemical/29317.html. Accessed 8/20/2013.

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Madison County has lower rates of Annual Mean Particulate Matter (7.8 vs. 12.0 Âľm/m3) compared to the State. The County also demonstrates declining annual averages in ozone, carbon monoxide, and sulfur dioxide levels that are well below New York and Federal Air Quality Standards. Air Quality Data for Region 7, 2001-2011 TABLE 15

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Sulfur Dioxide - Continuous Pulsed Fluorescence Annual Averages (ppb) Camp Georgetown

2.46

2.18

248

2.3

2.39

2.06

1.85

1.79

1.17

1.09

0.52

East Syracuse

2.97

2.82

3.32

2.62

2.35

2.23

2.11

2.06

1.23

0.92

0.88

Ozone-Continuous UV Light Absorptions Annual Mean (ppm) Camp Georgetown

0.033

0.034

0.033

0.03

0.033

0.031

0.033

0.03

0.03

0.032

0.03

East Syracuse

0.027

0.028

0.025

0.023

0.028

0.026

0.028

0.027

0.025

0.027

0.026

Carbon Monoxide - Continuous Non-Dispersive Infrared Annual Arithmetic Mean (ppm) Syracuse COMS

0.5

0.5

0.6

0.5

0.5

0.5

0.5

0.4

0.4

0.5

0.3

-

-

-

-

-

-

7.6

7.6

8.1

Inhalable Particulates (PM2.5) (Âľg/m3) East Syracuse

-

-

Department of Environmental Conservation, 2011 Region 7 Air Quality Data http://www.dec.ny.gov/chemical/29317.html. Accessed 8/20/2013

Carbon monoxide is considered an indicator of sustainable outdoor air quality. It is a colorless, odorless gas with chemical formula CO that is considered a primary pollutant and is often a by-product of the incomplete burning of fossil fuels. It is primarily emitted into the air from automobile emissions, and to a smaller extent from industrial processes.9 Carbon monoxide levels have been decreasing since 1990 in the Syracuse area, which is the closest geographic area where data is available. A community with sustainable air quality should have concentrations of carbon monoxide not exceeding 9 parts per million over an 8 hour daily average.9

Figure 5

Source: http://www.epa.gov/airtrends/carbon.html. Accessed 10/23/2013.

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The popularity and increased number of outdoor wood boiler (OWB’s) installations has prompted a rise in complaints from persons adversely effected by such OWB’s. Many installations are noted as not being in compliance with NYSDEC regulations, including the burning of garbage, plastics and unseasoned wood that produces airborne pollutants known to be harmful. While some communities have attempted to address this issue through local zoning ordinances, many OWB’s are being installed in the absence of such local ordinances or permitting and oversight by local codes officials. A 2008 report prepared by the NYS Attorney Generals Environmental Protection Bureau noted that OWB’s emit fine particulate matter in quantities greater than any other heating source, and that such emissions have both short term and long term health effects on respiratory and cardiac health. The report further recommended strict emission limitations be implemented as well as regulations enacted to mitigate environmental and health problems associated with OWB’s. The NYSDEC subsequently developed Part 247 regulations that apply to OWB installations, but such regulations are not being enforced uniformly in Madison County. Greater awareness of the Part 247 regulations and enactment of local ordinances requiring permitting and compliance is needed to reduce or otherwise address health complaints related to OWB’s. Data on the number of OWB installations now present in the County as well as means to measure or otherwise detect harmful emissions from such devices is needed to further address this issue.

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Radon Elevated radon levels are a concern in Madison County and have been identified in recently built homes and older homes that have undergone energy conservation improvements. Elevated levels are a result of the emission of radon gas linked to shallow depths of shale layers below the building foundations. Major radon entry routes include: cracks in concrete floors, older stone foundations, pores and cracks in concrete blocks and slab-footing joints, exposed soil, sump pump wells, loose fitting pipes; and water wells. Higher than average levels of radon may be linked to the higher rates of lung cancer experienced in the County. Prolonged exposure to radon poses serious health implications and is cited as the number one cause of lung cancer in non-smokers. The risk of lung cancer increases proportionally with rising radon exposure. The percentage of lung cancers attributable to radon is estimated to range from 3 to 14%, and is more likely to contribute to higher rates of lung cancer in people who smoke. Radon-induced lung cancers are mainly caused by low and moderate exposure. The concentration of radon in a home depends on: the amount of uranium in the underlying rocks and soils, the routes available for the passage of radon into the home, the rate of exchange between indoor and outdoor air, ventilation habits, and the sealing of windows.10 TABLE 16 Radon Level If 1,000 people who smoked were exposed If 1,000 people who never smoked were exposed (picocuries per litre) to this level over a lifetime… to this level over a lifetime… 20 pCi/L

About 260 people could get lung cancer

About 36 people could get lung cancer

4 pCi/L

About 62 people could get lung cancer

About 7 people could get lung cancer

0.4 pCi/L

About 3 people could get lung cancer

Less than 1 person could get lung cancer

Source: http://www.health.ny.gov/environmental/radiological/radon/radonrx.htm Accessed 8/20/2013.

Measured Basement Screening Radon Levels by Town - October 2012 TABLE 17 Average Town/Village/City BROOKFIELD CAZENOVIA DERUYTER EATON FENNER GEORGETOWN HAMILTON LEBANON LENOX LINCOLN MADISON NELSON ONEIDA SMITHFIELD STOCKBRIDGE SULLIVAN

Homes Screened 35 219 23 59 11 16 166 12 166 7 24 21 168 7 14 168

Radon Level 8.03 4.99 5.48 8.71 3.8 6.33 8.37 3.52 4.26 5.27 3.34 5.64 6.2 5.76 4.44 7.12

<4 42.9% 60.7% 60.9% 47.5% 63.6% 37.5% 37.3% 58.3% 68.7% 42.9% 70.8% 57.1% 72.6% 57.1% 57.1% 59.5%

≥4 & <20 pCi/L 54.3% 37.4% 34.8% 42.4% 36.4% 62.5% 52.4% 41.7% 27.7% 57.1% 29.2% 38.1% 23.8% 42.9% 42.9% 31.0%

>20 pCi/L 2.9% 1.8% 4.3% 10.2% 0.0% 0.0% 10.2% 0.0% 3.6% 0.0% 0.0% 4.8% 3.6% 0.0% 0.0% 9.5%

Source: http://www.health.ny.gov/environmental/radiological/radon/towns.htm. Accessed 8/20/2013.

Radon levels have increased or remained stable in most towns, villages and cities in Madison County from 2008 to 2010.11

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2008 Radon Levels in Madison County

TABLE 18 2008-2012 Radon Test Results Brookfield Cazenovia DeRuyter Eaton Fenner Georgetown Hamilton Lebanon Lenox Lincoln Madison Nelson Oneida Smithfield Stockbridge Sullivan

Figure 6

39 166 24 64 14 16 122 5 210 12 21 12 192 20 22 121

29 262 26 83 12 14 156 16 206 5 38 23 214 9 18 182

15 98 10 33 4 8 104 5 52 3 11 8 32 2 4 49

12 23 4 22 0 4 71 2 16 1 2 7 25 1 0 37

Measurement (pCi/L) 0 0.1-3.9 4.0-9.9 10.0+

Madison County Department of Health 2013

Madison County Department of Health 2013

2012 Radon Levels in Madison County Figure 7

Madison County Department of Health 2013

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Tobacco Smoke Smoking harms nearly every organ of the body causing diseases such as coronary heart disease, cancer, and lung diseases. An estimated 90% of all lung cancer deaths in men are attributable to smoking compared to 80% of all lung cancer deaths in women. Approximately 90% of all deaths from chronic obstructive lung disease are caused by smoking. CDC reports that if no one smoked, one out of three cancer deaths in the US would not occur.12 According to the 2010 Behavioral Risk Factor Surveillance System (BRFSS), the percentage of smokers in Madison County is significantly higher than NYS as a whole (25.2% vs. 16.8 %). The county correspondingly experiences higher rates of asthma, respiratory diseases, lung cancer and stroke than the state and upstate averages.

Disease Associated with Smoking in Madison County, 2008-2009 TABLE 19 Chronic Lower Respiratory Disease mortality rate per 100,000

County Rate

NYS Rate

NYS minus NYC

56

31.1

38.5

Age-adjusted % of adults with current asthma

13.8

9.7

10.1

Ever diagnosed with Asthma lifetime (adults)

17.8

15.2

15.3

Lung Cancer Incidence per 100,000 Males

96.0

75.8

-

Lung Cancer Incidence per 100,000 Females

77.2

53.9

-

New York State Department of Health-BRFSS, 2008-2009, Community Health Indicator Reports, 2011. Accessed 8/20/2013

In an effort to lower the percentage of county residents exposed to tobacco smoke, a number of outdoor air and point of sale polices were adopted throughout the County. As of November 2011, the following policies were in place: Outdoor Air Policies Restricting Public Smoking Madison County Fair Town of Brookfield parks and playgrounds Town of Madison, Madison Lake Town of DeRuyter parks and playgrounds Town of Cazenovia parks and playgrounds Town of Nelson parks and playgrounds Town of Stockbridge parks and playgrounds City of Oneida parks and playgrounds Town of Lenox skateboard park Town of Sullivan parks and playgrounds Village of Chittenango parks and playgrounds All County government worksites Recent NYS regulations have further limited smoking in key areas of our community. The regulations include: measures to prohibit smoking within 100 feet of the entrances or exits of any public or private school or outdoor areas of public and private school (Public Health Law Article 13-E), as well as prohibit the sale of electronic cigarettes to individuals under the age of 18 (PHL Article 13-F). On August 1, 2013, New York State legislation was passed that prohibits smoking on or around hospital and nursing home grounds. Smoking will be prohibited within 15 feet of hospitals; however, they may elect to have company policies that would extend the radius further.

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The Adolescent Tobacco Use Prevention Act (ATUPA) empowers Madison County Department of Health to: educate all tobacco retail vendors of their responsibilities under ATUPA, perform compliance checks for tobacco sales to minors at all non-Native American facilities, restrict locations of tobacco vending machines, and administer fines to non-compliant businesses if they are found in violation of the act. Between 2009 and October 2013, there have been three violations of sales to minors and one store without proper ATUPA signage.14 2012 marked the 10 year anniversary of the Clean Indoor Air Act (Public Health Law, Article 13-E), which prohibits smoking in workplaces and all restaurants and bars, warrants the disclosure that Madison County has not issued any waivers from any of the provisions of the CIAA to any owner / operator of such establishments, and that all such facilities will continue to be required to remain smoke free. The majority of respondents to the 2012 Community Tobacco Survey support restricting or completely eliminating cigarette smoking in outdoor spaces. The percentage is lower among current smokers. 13

Percentage of Residents that Support either Restricting or Completely Eliminating Cigarette Smoking Madison County (2012)

Regional Average (2012)

77.7 81.1 85.4 77.9 87.3 60.8

78.8 80.8 85.4 75.1 91.3 68.7

TABLE 20 Public outdoor community events Public outdoor recreational areas (parks, pools, and beaches) Public building entryways Public outdoor recreational area Public playgrounds Areas outdoor in public (i.e. sidewalks)

Among Current Smokers (2012) 42.0 61.9 70.0 46.5 63.3 35.3

Madison County (2010) 81.7 86.0 81.1 -

Source: Madison County 2012 Community Tobacco Survey

Nearly half of respondents to the 2012 Community Tobacco Survey report that smoking is prohibited on the entire grounds of their workplace. Nearly one-third (30%) of current smokers favor such a policy.13 Percentage of Residents that Have or Favor Workplace Policies that Prohibit Smoking on Entire Ground Madison County (2012)

Regional Average (2012)

Among Current Smokers (2012)

Madison County (2010)

48.7

49.0

34.8

-

57.1

58.6

30.0

56.7

TABLE 21 Percentage of adults who report that there is a policy that prohibits smoking on the entire grounds of their workplace Percentage of Madison County employed adults who strongly favor a policy that prohibits smoking on the entire grounds of their workplace Source: Madison County 2012 Community Tobacco Survey

More than half (55%) of respondents to the 2012 Community Tobacco Survey report that they tend to agree that if tobacco retailers removed tobacco ads it would decrease the number of youth who begin smoking. Half of respondents also feel that tobacco products sold in stores near schools is somewhat unacceptable or totally unacceptable (51.2%) and they favor a policy that would restrict the sale of tobacco products in stores close to schools (49.7%).13

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Percent of Residents that Favor the Removal of Tobacco Ads and Restriction of Tobacco Sales Near Schools

Madison County

Regional Average

Among Current Smokers

2010

55.0

56.0

27.0

59.8

51.2

51.2

14.9

-

49.7

53.8

14.0

-

TABLE 22 Percent of adults that tend to agree that if tobacco retailers removed tobacco ads it would decrease the number of youth who begin smoking Percentage of adults who feel tobacco products being sold in stores near schools is somewhat unacceptable or totally unacceptable Percentage of adults who are in favor of a policy that would restrict the sale of tobacco products in stores that are located near schools in Madison County Source: Madison County 2012 Community Tobacco Survey

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Climate Change

Climate change affects clean air, safe drinking water, sufficient food and secure shelter. Climatesensitive diseases are expected to worsen as the climatic conditions strongly affect water-borne diseases and zoonotic-diseases by lengthening the transmission seasons and geographic range of vector -borne diseases. 15 Based on data from Cornell Universityâ&#x20AC;&#x2122;s Northeast Regional Climate Center the average monthly temperature has been increasing over the past 30 years. This is reflected in the maximum, minimum and average temperatures. The information is for the Syracuse area, which is the closest geographic area to Madison County for which data is available.16

Annual Average Temperatures for the Syracuse Area (degrees F), 1980-2012

TABLE 23 2012 1981-2010

Jan 39 32

Maximum Temperature (degrees F) for Syracuse Area Feb Mar Apr May Jun Jul Aug Sep Oct 40 57 57 76 79 88 85 75 63 34 43 57 69 78 82 80 72 60

Nov 47 48

Dec 42 37

Annual 62 58

Oct 46 41

Nov 32 33

Dec 29 22

Annual 43 39

Oct 54 51

Nov 39 41

Dec 35 29

Annual 53 48

Source: http://www.nrcc.cornell.edu/page_nowdata.html. Accessed: 10/29/2013

TABLE 24 2012 1981-2010

Jan 23 16

Feb 25 18

Minimum Temperature (degrees F) Mar Apr May Jun Jul Aug Sep 36 35 53 58 65 61 53 25 37 46 56 61 60 52

Source: http://www.nrcc.cornell.edu/page_nowdata.html. Accessed: 10/29/2013

TABLE 25 2012 1981-2010

Jan 31 24

Feb 32 26

Average Temperature (degrees F) Mar Apr May Jun Jul Aug Sep 47 46 64 69 76 73 64 34 47 58 67 71 70 62

Source: http://www.nrcc.cornell.edu/page_nowdata.html. Accessed: 10/29/2013

Climate experts are confident that climate change will bring increasingly frequent and severe heat waves and extreme weather events, e.g., floods. In addition to the hazards of drowning and physical injury associated with a flood event, floods contaminate freshwater supplies, heighten the risk of water-borne disease, and create breeding grounds for disease-carrying insects such as mosquitoes.15 Conversely, droughts can result in shortages of clean water which strains agricultural productivity and could lead to food shortages. Heat exposure can cause mild heat rashes, deadly heat stroke, and aggravates cardiovascular and respiratory disease such as asthma and chronic obstructive pulmonary disease. Potential indirect effects include the exacerbation of chronic diseases due to interruptions in health care service, mental health concerns both from interrupted care and geographic displacement, and socioeconomic disruption resulting from population displacement and infrastructure loss.15

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Exposure to Lead Lead affects multiple body systems including the brain, liver, kidney and bones. There is no blood lead level that is considered safe; however, as lead exposure increases, the range and severity of symptoms and effects also increase. It is particularly harmful to young children, specifically affecting the development of the brain and nervous system. Even blood lead concentrations as low as 5 micrograms per deciliter of blood (μg/dL), may result in decreased intelligence in children, behavioral difficulties and learning problems. Undernourished children are more susceptible to lead because their bodies absorb more lead if other nutrients, such as calcium, are lacking. Exposure of pregnant women to high levels of lead can cause miscarriage, stillbirth, premature birth and low birth weight, as well as minor malformations. Lead also causes long-term harm in adults, including increased risk of high blood pressure and kidney damage.18 New York Code of Rules and Regulations (NYCRR) was amended in 2009 to require comprehensive follow-up services that include: lead exposure assessment, developmental screening, nutritional assessment, medical management as necessary and referral to the state or local health departments for environmental management for children with a blood lead level of 15 μg/dL or greater. This expanded previous criteria, which required these services for children with blood lead levels greater than 20 μg/dL. Incidence of children less than six years old with confirmed blood lead levels greater or equal to 10 μg/dL decreased from 10.7 per 1,000 in 2009 to 1.0 per 1000 in 2011. New York State excluding New York City decreased from 7.4 per 1,000 in 2009 to 7.2 per 1,000 in 2011.19

Figure 8

Source: Vital Statistics Data, NYSDOH, http://www.health.ny.gov/statistics/chac/indicators/cah.htm. Accessed 12/03/2013 .

State law and regulations require health care providers to test all children’s blood lead levels at one and two years of age and to assess all children six months to six years of age for risk of lead exposure at least annually as part of routine care, with blood lead testing for children at risk for lead exposure based on those assessments.

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Figure 9

Source: Vital Statistics Data, NYSDOH, http://www.health.ny.gov/statistics/chac/indicators/cah.htm. Accessed 12/03/2013

Many of the homes in Madison County are older which could contribute to an increased risk of lead poisoning in children. Exposure to elevated levels of lead affects all socioeconomic levels, but children living in poverty are at the greatest risk.19 Lower income families are more likely to live in older housing which is most likely to have lead paint and hazards.18

Percent of Homes Built Before 1950, Madison County, 2011 Percent Homes Built Before 1950

Total housing units

Homes built before 1950

New York State

8,081,303

3,457,812

42.8%

Madison County

31,539

12,352

39.2%

TABLE 26

Brookfield

1,238

509

41.1%

Cazenovia

2,894

1159

40.0%

793

339

42.7%

1,835

845

46.0%

Fenner

690

174

25.2%

Georgetown

287

131

45.6%

1,999

1260

63.0%

DeRuyter Eaton

Hamilton Lebanon

752

307

40.8%

4,179

1500

35.9%

845

283

33.5%

Madison

1,633

506

31.0%

Nelson

1,131

404

35.7%

Oneida

5,099

2851

55.9%

Smithfield

421

141

33.5%

Stockbridge

947

458

48.4%

Sullivan 6,796 1485 Source: U.S. Census Bureau, 2007-2011 American Community Survey

21.9%

Lenox Lincoln

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Healthy Community Design The design of communities can directly impact the publicâ&#x20AC;&#x2122;s health. Many factors in our built environments contribute to or exacerbate diseases such as cancer, heart disease, asthma, birth defects, behavioral disorders, infertility, and obesity. For example, much of the design in communities has the unintentional consequence of creating places that promote sedentary rather than active lifestyles. When home, work, shopping, and schools are isolated from each other, people are dependent on the automobile to get to each place they need to go and will be less likely to walk or bike. The increase dependency on driving contributes to increases in air pollutants, which in turn can affect human health. As part of the 2009 Community Health Improvement Planning process, Madison County Department of Health and Madison County Department of Planning joined forces to create a strategy for the integration of Smart growth principles into county development initiatives. The 10 Smart Growth Principles were developed by the Smart Growth Institute to help communities create physical environments that protect natural resources while fostering healthy living, and economic and technological advancement. One of the key principles of Smart Growth is strengthening and developing within existing community centers. Contrary to this principle, new development trends in Madison County indicate that growth is occurring away from the community centers. Growth patterns suggest that communities are sprawling outwards which can drain the vitality of downtowns; increase dependence on automobiles; increase the costs of local utilities (e.g., water, sewer); decrease opportunities to incorporate fitness into daily routines; and compete with the protection of open space, farmland, and important environmental areas. Evidence of this trend comes from population growth patterns and residential and commercial development patterns.20 Smart Growth Principles Mix Land Uses Take Advantage of Compact Design Create a Range of Housing Opportunities and Choices Create Walkable Communities Foster Distinctive, Attractive Communities with a Strong Sense of Place Preserve Open Space, Farmland, Natural Beauty, and Critical Environmental Areas Strengthen and Direct Development Toward Existing Communities Provide a Variety of Transportation Options Make Development Decisions Predictable, Fair, and Cost Effective Encourage Community and Stakeholder Collaboration

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Population Growth Patterns The population of towns in Madison County increased at a higher rate than villages and cities. From 1980 to 2010, towns saw a net gain of 7,211 people while the City of Oneida and villages, the community centers of these towns, only gained 1,081 people. The percentage of people living in towns is now 55.1% compared to 51% in 1980 and the percentage living in the city or villages is 44.9% compared to 49% in 1980.

Population Trends in Madison County, 1980-2010 TABLE 27 Total Population Eastern Madison Fenner Lenox Lincoln Oneida Smithfield Stockbridge Western Madison Cazenovia DeRuyter Georgetown Sullivan Southern Madison Brookfield Eaton Hamilton Lebanon Madison Nelson

1980

1990

2000

2010

% Change 1980-1990

% Change 1990-2000

% Change 20002010

65,150 25,597 1,661 8,539 1,629 10,810 1,030 1,928 21,399 5,882 1,269 877 13,371 18,154 2,037 5,310 5,895 1,099 2,446 1,367

69,120 25,855 1,694 8,621 1,669 10,850 1,053 1,968 23,526 6,514 1,458 932 14,622 19,739 2,225 5,362 6,221 1,265 2,774 1,892

69,441 26,435 1,680 8,665 1,818 10,987 1,205 2,080 23,950 6,481 1,532 946 14,991 19,056 2,403 4,826 5,733 1,329 2,801 1,964

73,442 27,644 1,726 9,122 2,012 11,393 1,288 2,103 24,988 7,086 1,589 974 15,339 20,810 2,545 5,255 6,690 1,332 3,008 1,980

6.1% 1.0% 2.0% 1.0% 2.5% 0.4% 2.2% 2.1% 9.9% 10.7% 14.9% 6.3% 9.4% 8.7% 9.2% 1.0% 5.5% 15.1% 13.4% 38.4%

0.5% 2.2% -0.8% 0.5% 8.9% 1.3% 14.4% 5.7% 1.8% -0.5% 5.1% 1.5% 2.5% -3.5% 8.0% -10.0% -7.8% 5.1% 1.0% 3.8%

5.8% 4.6% 2.7% 5.3% 10.7% 3.7% 6.9% 1.1% 4.3% 9.3% 3.7% 3.0% 2.3% 9.2% 5.9% 8.9% 16.7% 0.2% 7.4% 0.8%

Population growth in towns indicate implications for the community to preserve the rural landscape, sustain vibrant main streets, and maintain village centers that are social, healthy places for people of all ages. This trend can also be costly as it leaves a mismatch between the population and existing infrastructure as more sewers, roads, and services are demanded on the fringes while at the same time existing infrastructure is underutilized. Residential and Commercial Development From 2004-2010 there have been 428 new residential properties developed. Villages and the inner district of Oneida received only 7.7% (or 33 of 428) of new residential development; out of the 33 residential developments to occur inside community centers: Chittenango received 22 new residential developments Hamilton received 5 new residential developments Inner city of Oneida only saw 2 new residential developments during this time period. Towns received 92.3% (or 395 of 428) of the new growth; the top three included: Sullivan with 134 new residential developments, 22 of which occurred in a the Village of Chittenango, Lenox with 37 new residential developments, 2 of which occurred in the Village of Canastota Brookfield with 37 new residential developments.

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Three towns (Madison, DeRuyter and Eaton) grew, but the villages did not increase at all. In the Town of Madison there were 27 new residential developments, but none occurred in the village. Nearly 22% (or 94 of 428) of all new development occurred on property in an Agricultural District. The vast majority of the new development was single family housing, while there were some apartments and duplexes constructed they were as add-ons or concentrated to specific areas. From 2004-2010 there have been 26 new commercial developments: Only 34.6% (or 9 of 26) of new commercial developments occurred within the villages/city inner district while the remaining 17 (65.4%) was built in towns. Implications for the Elderly According to an AARP survey, 89% of older people want to stay in their homes as long as possible. To do this, communities have to be designed to allow for people to â&#x20AC;&#x153;age in place.â&#x20AC;? Aging in place can mean a senior is able to stay in his or her own home or in their native community. Rather than watching seniors move to warmer climates or more age friendly places, communities are realizing there are things they can do to keep these vital members in place by providing affordable and appropriate housing options, supportive community features and services, and adequate mobility options. Identified barriers to aging in place include a lack of diverse housing options, automobile dominance, lack of walking options, and development patterns that favor expansion (sprawl) thereby making it harder for older adults to get around. Agricultural Districts According to the most recent 2007 USDA Census of Agriculture the number of farms continues to rise in Madison County; similarly, the number of acres of farmland has risen over the last decade but is still below 1992 levels. Keeping working lands profitable is one of the best ways to preserve rural land and combat sprawl. As Madison County continues to grow and develop, targeted growth is crucial to maintain large tracts of working lands and to preserve prime agricultural soils.

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Walkable Communities In the Fall of 2011, a group of representatives from the Oneida Planning Department, the Madison County Department of Health and Community Economic Development Team conducted a walkability survey in the city of Oneida. The goals of this project were to assess safety and appeal of walking routes that connect popular destinations in the city and to provide recommendations regarding needed repairs and revitalization efforts. The survey in Oneida focused on six conditions including crossing the street (intersections), sidewalks, driver behavior, safety, comfort, and appeal. The survey assessed the downtown area along four routes ranging from a half a mile to under two miles. Routes selected included destinations to medical facilities, restaurants, businesses, shopping areas, farmersâ&#x20AC;&#x2122; markets, senior housing, libraries, parks and schools. The results of the study indicated that few intersections provided signals for pedestrians to cross safely, many street crossings in the city were not marked, were poorly marked or had poor curb cuts. Surveyors also reported many sidewalks required repair and that it was common to see a lack of sidewalks in blacktopped areas doubling as parking lots. Areas of high vehicle traffic were perceived to be less safe due to driver behavior. Surveyors also noted that a majority of places along routes did not provide benches, trash receptacles, green space, restrooms, shade trees or landscaping. The report generated from this study provided recommendations to city planners regarding possible improvements for specific problem areas. The benefits of walkable communities mainly include easy accessibility to goods and services for community residents and employees, expanded transportation options for both residents and visitors and numerous health benefits as a result of increased physical activity.21

TABLE 28 Madison County Walkability Scores Location Canastota Cazenovia Chittenango DeRuyter Earlville Hamilton Madison Morrisville Munnsville Oneida Wampsville

Score 67 75 41 46 46 89 23 45 21 73 26

Street Smart Desription Somewhat Walkable Very Walkable Car-Dependent Car-Dependent Car-Dependent Very Walkable Car-Dependent Car-Dependent Car-Dependent Very Walkable Car-Dependent

www.walkscore.com

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Transportation For many of the residents that live in rural parts of the county getting to the village and community centers, where the majority of services and resources are located, can be challenging, especially if one does not have transportation. Some of the specific issues cited through community outreach efforts included access to care issues (missed appointments or delay in care) are a result of the personâ&#x20AC;&#x2122;s inability to get to a physicianâ&#x20AC;&#x2122;s office. Furthermore, a lack of transportation affects a personâ&#x20AC;&#x2122;s ability to access other basic necessities such as food, medicine, clothing, socialization and employment. In May 31, 2013, county funding for the public transportation system (Madison Transit) was eliminated. The elimination of these funds placed additional stress on an already vulnerable public transportation system. However, as a result of collaboration with Birnie Bus, Madison County, Heritage Farms and the New York State Department of Transportation the Madison Transit System has been able to continue limited service to select areas of Madison County. Though limited in scope and frequency, this service does provide an option for some of the most heavily traveled areas of the county. The transportation plan for Madison County still needs further refinement and more options for county residents.

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DATA TABLES Data Year

Madison County

New York State

2011

9.5

4.3

2011

0.0

0.1

2011

0.0

4.3

2011

13.6

10.6

2011

32.7

17.8

2011

0.0

3.2

2011

1.4

0.4

2011

1.4

2.0

2011

0

123

2011

0

30

2011

14

8,007

Communicable Diseases Salmonella case rate per 100,000

24

Hemolytic Uremic Syndrome case rate per 100,000 Shigella case rate per 100,000

26

Rate of giardiasis per 100,000

27

25

Campylobacteriosis case rate per 100,000 population 29

Legionellosis case rate per 100,000 30

Listeriosis case rate per 100,000

Haemophilus Influenza (HIB) case rate per 100,000 Annual cases of encephalitis

28

31

32

Annual cases of West Nile Virus Annual cases of Lyme disease

33

34

Air Quality Ambient Particulate Matter (PM2.5) Levels*

35

Annual Mean Particulate Matter (PM2.5) Levels (ug/m3)*

36

Average Annual 98th Percentile Values for PM 2.5 (ug/m3)*

37

Average Sulfur Dioxide Levels (ppm) (Continuous Pulsed 38 Florescence) Average Carbon Monoxide Levels (ppm)*

39

Number of Days with Eight Hour Ozone Averages Greater than .075 40 ppm Average Ozone Levels (ppm)

41

Number of days labeled unhealthy for sensitive groups* Number of days labeled unhealthy*

42

43

2011

8.05

12.0

2009-2011

7.8

12.0 um/m3

2009-2011

24.1 ug/m3

35 ug/m3

2011

0.52 ppb

-

20011

0.3 ppm

-

2011

1 day

22 days

2011

.030 ppm

-

2012

2

-

2012

0

-

2012

68 %

-

2008

/122

4601/9936

2008

12

1468

2004

32 %

-

Water Quality Percentage of the county served by municipal water sources Violations for public water systems

44

45

Violations issued for reasons other than "no monitoring and reporting" Percentage of the county served by private water sources Percentage of the county undeveloped/no water service

46

47

48

2004

?25%

-

Percentage of the county served by water which has no regular water 49 quality enforcements

2004

?49%

-

Percentage of residents served by community water systems with 50 optimally fluoridated water

2012

32%

71.4

2013

2

151

2008

0

-

Water bodies with fish consumption advisories (Chenango, Unadilla)

51

Beach closures or delays due to an elevated health risk such as contamination from human or animal fecal material or toxic chemicals

52

Radon Average radon level for buildings (pCi/L)

53

2012

6.16

5.48

Percentage of homes tested with radon levels higher than 4 pCi/L

54

2012

58.4

63.3

Percentage of homes tested with radon levels between 4-20 pCi/L

54

2012

36.3

30.4

Percentage of homes tested with radon levels higher than 20pCi/L

54

2012

6.0

6.3

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Data Year

Madison County

New York State

2010

32.40%

-

2007

4,741

131,796

2007

2.5

1.8

2007

3

3.3

2007-2011

88.3

61.3

2007-2011

34.1

46.5

2007-2011

23.3

31.4

2007-2011

6.7

34.1

2008

46.5

-

2008

70.6

-

2008

22.7

-

2008

40.05

-

2008

121.2

-

2007-2009

0

3

2007-2009

0

6

2008

19,773

1,016,000

2008

4.7

3.4

2008

0.35

0.05

2008

500

-

2012

0.3

(Upstate NY) 4.4

2012

175.5

190.0

2012

8.2

40.5

2010

4.8

2.5

2008-2011

NA

12.9

Priority sites in the New York State Department of Environmental 79 Conservation Site Remediation Database

2013

1

481

A Priority sites in the New York State Department of Environmental 80 Conservation Site Remediation Database

2013

4

755

Percentage of the state living within jurisdiction with state approved 81 emergency preparedness plans

2010

100

100

Percentage of population that lives in a jurisdiction that adopted the 82 Climate Smart Communities pledge

2012

100

26.7

Lead Indicators Percentage of households built before 1950

55

Agriculture Acres of total farmland according to USDA agricultural Census

56

Percentage of total farmland acres on property of USDA certified organic 57 farms Percent of total farms with organically produced crops and livestock Travel Patterns Percentage of workers that commute by car van or truck

59

Percentage of individuals traveling more than 30 minutes Average Commute to work in minutes

60

61

Percentage of workers that use public transportation or walk to work Weather Patterns Average annual temperature range

62

63

64

Yearly high temperature average

Monthly low average temperature range average annual total precipitation average annual snowfall value

58

65

66

67

Federally declared severe winter storms Federally declared natural disasters

68

69

Park Land Acres of open park land

70

Percent of land devoted to parks Acres of park land per person Miles of trails for public use

71

72

73

Safe Communities Crimes Known to the Police - Firearm Related Index Crimes - General 74 Population Crimes Known to the Police - Property Index Crimes - General 75 Population (per 10,000) population Crimes Known to the Police - Violent Index Crimes-General Population 76 (per 10,000) population Healthy Communities Percentage of population with low income and low access to a 77 supermarket or large grocery store Percentage of homes in healthy neighborhood program that have fewer 78 asthma triggers during home revisits Environmental Remediation Sites

Jurisdiction Plans

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REFERENCES 1 World Health Organization (WHO). Preventing disease through healthy environments. Geneva, Switzerland: WHO; 2006 2 CDC. CDC and Food Safety. March 2013. http://www.cdc.gov/foodsafety/cdc-and-food-safety.html. Accessed on 9/23/2013. 3 New York State Department of Health, Food Service Establishment Last Inspection. https:// health.data.ny.gov/Health/Food-Service-Establishment-Map-Last-Inspection/qd6f-nmcs 4 CDC. Vector-Borne Threats and What We Do About Them. October 2013 http://www.cdc.gov/ncezid/dvbd/ about.html. Accessed 11/1/2013. 5 CDC. Rabies. September 2013. http://www.cdc.gov/rabies/. Date Accessed: 11/1/2013 6 CDC. Promoting Clean Water for Health. January 2012. http://www.cdc.gov/nceh/hsb/cwh/default.htm. Date Accessed 10/23/2013. 7 Madison County 2010-2013 Community Health Assessment Report. 8 World Health Organization. Air quality and health. September 2011. http://www.who.int/mediacentre/ factsheets/fs313/en/index.html. Accessed 10/23/2013 9 http://www.epa.gov/airtrends/carbon.html. Accessed 10/23/2013. 10 World Health Organization. Radon and cancer. September 2009. http://www.who.int/mediacentre/ factsheets/fs291/en/index.html. Date Accessed on 10/23/2013. 11 Percentage of homes with radon levels higher than 4pCi/L Measured Basement Screening Radon Levels by County October 2012. http://www.health.ny.gov/environmental/radiological/radon/county.htm. Date accessed 10/22/2013. 12 CDC. Smoking and Tobacco Use. August 2013. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/ health_effects/effects_cig_smoking/index.htm 13 Madison County 2012 Community Tobacco Survey 14 Madison County Department of Health. ATUPA Violations/Point Report. Effective Dates Between 1/1/2009 to 10/16/2013. 15 CDC. Climate change and health. October 2012. http://www.who.int/mediacentre/factsheets/fs266/en/ index.html. Date Accessed 10/29/2013 16 Cornell University Northeast Regional Climate Center. http://www.nrcc.cornell.edu/page_nowdata.html. Date Accessed: 10/29/2013 17 CDC. Climate Change. May 2013. http://ephtracking.cdc.gov/showClimateChangeIndicators.action. Date Accessed 10/22/2013 18 World Health Organization. Lead poisoning and health. September 2013. http://www.who.int/mediacentre/ factsheets/fs379/en/index.html. Date Accessed: 9/16/2013. 19 Vital Statistics Data, NYSDOH, http://www.health.ny.gov/statistics/chac/indicators/cah.htm. Date Accessed: 9/16/2013 20 Madison County Planning Department. A Healthy Design for Madison County, A Primer for Smart Growth. https://www.madisoncounty.ny.gov/sites/default/files/Primer.pdf. Date Accessed: 8/20/2013

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21 Madison County Department of Health. City of Oneida Walkability Survey, Executive Report. http://www.healthymadisoncounty.org/linkeddocs/a-ztopics/econdev/walkabilityFINAL.pdf. Accessed 8/20/2013. 22 Madison County Department of Planning. Transportation website. https://www.madisoncounty.ny.gov/planning/transportation. Date accessed 10/22/2013. 23 Sustainable Communities Collective. Sustainable Communities Index. http://www.sustainablecommunitiesindex.org/webpages/view/39. Date accessed 10/22/2013. 24 Communicable Disease Indicators, Salmonella. NYSDOH, 2011 Communicable Disease Annual Reports: http:// www.health.ny.gov/statistics/diseases/communicable/2011/cases/5.htm. Date accessed: 8/20/2013. 25 Communicable Disease Indicators, Hemolytic Uremic Syndrome. NYSDOH, 2011 Communicable Disease Annual Reports: http://www.health.ny.gov/statistics/diseases/communicable/2011/cases/3.htm. Date accessed: 8/20/2013. 26 Communicable Disease Indicators, Shigella. NYSDOH, 2011 Communicable Disease Annual Reports: http:// www.health.ny.gov/statistics/diseases/communicable/2011/cases/5.htm. Date accessed: 8/20/2013. 27 Communicable Disease Indicators, Giardasis. NYSDOH, 2011 Communicable Disease Annual Reports: http:// www.health.ny.gov/statistics/diseases/communicable/2011/cases/2.htm. Date accessed: 8/20/2013. 28 Communicable Disease Indicators, Camplyobacteriosis. NYSDOH, 2011 Communicable Disease Annual Reports: http://www.health.ny.gov/statistics/diseases/communicable/2011/cases/1.htm. Date accessed: 8/20/2013. 29 Communicable Disease Indicators, Legionellosis. NYSDOH, 2011 Communicable Disease Annual Reports: http://www.health.ny.gov/statistics/diseases/communicable/2011/cases/4.htm. Date accessed: 8/20/2013. 30 Communicable Disease Indicators, Listeriosis. NYSDOH, 2011 Communicable Disease Annual Reports: http:// www.health.ny.gov/statistics/diseases/communicable/2011/cases/4.htm. Date accessed: 8/20/2013. 31 Communicable Disease Indicators, Haemophilus Influenza. NYSDOH, 2011 Communicable Disease Annual Reports: http://www.health.ny.gov/statistics/diseases/communicable/2011/cases/3.htm. Date accessed: 8/20/2013. 32 Communicable Disease Indicators, Encephalitis, NYSDOH, 2011 Communicable Disease Annual Reports: http:// www.health.ny.gov/statistics/diseases/communicable/2011/cases/2.htm. Date accessed: 8/20/2013. 33 Communicable Disease Indicators, West Nile Virus, NYSDOH, 2011 Communicable Disease Annual Reports: http://www.health.ny.gov/statistics/diseases/communicable/2011/cases/7.htm. Date accessed: 8/20/2013. 34 2008-2012 New York State Department of Health, Communicable Disease Annual Reports, http:// www.health.ny.gov/statistics/diseases/communicable . Accessed 8/20/2013. 35 Ambient Particulate Matter, Department of Environmental Conservation, 2011, pm2.5/pm 10 Monitoring Data: http://www.dec.ny.gov/docs/air_pdf/pm25summarythru4q11.pdf. Date accessed: 9/16/2013. 36 Annual Mean Particulate Matter, Department of Environmental Conservation, 2011, pm2.5/pm 10 Monitoring Data: http://www.dec.ny.gov/docs/air_pdf/pm25summarythru4q11.pdf. Date accessed: 9/16/2013. 37 Average Annual 98th Percentile Values for PM 2.5, Department of Environmental Conservation, 2011, pm2.5/ pm 10 Monitoring Data: http://www.dec.ny.gov/docs/air_pdf/pm25summarythru4q11.pdf. Date accessed: 9/16/2013.

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38 Average Sulfur Dioxide Levels, 2011 Region 7 Air Quality Data: http://www.dec.ny.gov/chemical/29317.html. Date accessed: 9/16/2013. 39 Average Carbon Monoxide Levels, 2011 Region 7 Air Quality Data: http://www.dec.ny.gov/ chemical/29317.html. Date accessed: 9/16/2013. 40 Number of Days with Eight Hour Ozone Averages Greater than 0.075, 2011 Ozone Exceedances in New York State: http://www.dec.ny.gov/docs/air_pdf/2011o3exc.pdf. Date accessed: 9/16/2013. 41 Average Ozone Levels, 2011 Region 7 Air Quality Data: http://www.dec.ny.gov/chemical/29317.html. Date accessed: 9/16/2013. 42 Number of days labeled unhealthy for sensitive groups http://www.epa.gov/airdata/ad_rep_aqi.html. Date accessed: 9/16/2013. 43 Number of days labeled unhealthy http://www.epa.gov/airdata/ad_rep_aqi.html. Date accessed: 9/16/2013. 44 Percentage of County served by municipal water sources, Madison County 2010-2013 Community Health Assessment Report, Page 39 45 Violations for public water systems, 2010 State of New York Water Supply Annual Compliance Report: http:// www.health.ny.gov/environmental/water/drinking/violations/2010/2010_compliance_report.htm. Accessed 8/21/2013. 46 Violations issued for reasons other than â&#x20AC;&#x153;no monitoring and reportingâ&#x20AC;? 2010 State of New York Water Supply Annual Compliance Report: http://www.health.ny.gov/environmental/water/drinking/ violations/2010/2010_compliance_report.htm. Date accessed: 8/20/2013. 47 Percentage of the county served by private water sources, Madison County 2010-2013 Community Health Assessment Report, Page 39 48 Percentage of the county undeveloped/no water service, Madison County 2010-2013 Community Health Assessment Report, Page 39 49 Percentage of the county served by water which has no regular water quality enforcements, Madison County 2010-2013 Community Health Assessment Report, Page 39 50 Percentage of residents served by community water systems with optimally fluoridated water, Madison County Indicators for Tracking Public Health Priority Areas 2013-2017: http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/madison.htm. Date accessed: 8/20/2013. 51 Water bodies with fish consumption advisories, New York State Department of Health Leatherstocking/ Central Region Fish Advisories: http://www.health.ny.gov/environmental/outdoors/fish/health_advisories/ regional/leatherstocking_and_central.htm. Date accessed 8/22/2013. 52 Beach closures or delays due to an elevated health risk, Madison County 2010-2013 Community Health Assessment Report, Page 40 53 Average Radon levels for buildings, Measured Basement Screening Radon Levels by County October 2012. http://www.health.ny.gov/environmental/radiological/radon/county.htm 54 Percentage of homes with radon levels higher than 4pCi/L Measured Basement Screening Radon Levels by County October 2012. http://www.health.ny.gov/environmental/radiological/radon/county.htm

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55 Percentage of households built before 1950, U.S. Census Bureau, 2007-2011 American Community Survey. 56 http://www.agcensus.usda.gov/Publications/2007/Online_Highlights/County_Profiles/New_York/ cp36053.pdf. Accessed 8/21/2013. 57 Percentage of total farmland acres on property of USDA certified organic farms, USDA Census of Agricultural 2007 Madison County Profile: http://www.agcensus.usda.gov/Publications/2007/Online_Highlights/ County_Profiles/New_York/cp36053.pdf. Accessed 8/21/2013. 58 Percent of total farms with organically produced crops and livestock, USDA Census of Agricultural 2007 Madison County Profile: http://www.agcensus.usda.gov/Publications/2007/Online_Highlights/County_Profiles/ New_York/cp36053.pdf. Accessed 8/21/2013. 59 Percent of workers that commute: U.S. Census Bureau, 2007-2011 American Community Survey, S0802 Means of Transportation to Work by Selected Characteristics. 60 Percent of individuals traveling more than 30 minutes: U.S. Census Bureau, 2007-2011 American Community Survey, S0802 Means of Transportation to Work by Selected Characteristics. 61 Average Commute to work: U.S. Census Bureau, 2007-2011 American Community Survey, S0802 Means of Transportation to Work by Selected Characteristics. 62 Percent of workers that commute by public transport or walk to work, 2007-2011 American Community Survey, DP03 Selected Economic Characteristics. 63 Average annual temperature range, Madison County 2010-2013 Community Health Assessment Report, Page 43 64 Yearly high temperature averages, Madison County 2010-2013 Community Health Assessment Report, Page 43 65 Monthly low average temperature range, Madison County 2010-2013 Community Health Assessment Report, Page 43 66 Average annual total precipitation, Madison County 2010-2013 Community Health Assessment Report, Page 43 67 Average annual snowfall value, Madison County 2010-2013 Community Health Assessment Report, Page 43 68 Federally declared severe winter storms, Madison County 2010-2013 Community Health Assessment Report, Page 43 69 Federally declared natural disasters, Madison County 2010-2013 Community Health Assessment Report, Page 43 70 Acres of Open Park land, Madison County 2010-2013 Community Health Assessment Report, Page 45 71 Percent of land devoted to parks, Madison County 2010-2013 Community Health Assessment Report, Page 45 72 Acres of park land per person, Madison County 2010-2013 Community Health Assessment Report, Page 45 73 Miles of trails for public use, Madison County 2010-2013 Community Health Assessment Report, Page 45 74 Crimes known to police â&#x20AC;&#x201C; Firearms, Kids Well-being indicators Clearinghouse, Firearm Related Crime Index: http://www.nyskwic.org/get_data/indicator_profile.cfm?subIndicatorID=48&go.x=16&go.y=18. Accessed 8/21/2013.

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75 Crimes known to the police – property, Kids Well-being indicators Clearinghouse, Violent Crime Index: http://www.nyskwic.org/get_data/indicator_profile.cfm?subIndicatorID=48&go.x=16&go.y=18. Accessed 8/21/2013. 76 Crimes known to police – Violent, Kids Well-being indicators Clearinghouse, Violent Crime Index: http://www.nyskwic.org/get_data/indicator_profile.cfm?subIndicatorID=49. Accessed 8/21/2013. 77 Grocery Store Access: http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/madison.htm.Date accessed 8/20/2013. 78 Fewer Asthma Triggers: http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/madison.htm. Date accessed 8/20/2013. 79 Priority sites in NYS Remediation Database, Environmental Site Database Search: http://www.dec.ny.gov/ chemical/8437.html. Date accessed 8/22/2013. 80 A priority sites in NYS Remediation Database, Environmental Site Database Search: http://www.dec.ny.gov/chemical/8437.html. Date accessed 9/9/2013. 81 Percent of state living within jurisdiction with state approved emergency preparedness plans, Madison County Indicators for Tracking Public Health Priority Areas: http://www.health.ny.gov/prevention/prevention_agenda/ indicators/county/madison.htm. Accessed 8/20/2013. 82 Percent of population that lives in a jurisdiction that adopted climate smart communities’ pledge, Madison County Indicators for Tracking Public Health Priority Areas 2013-2017: http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/madison.htm Accessed 9/9/2013.

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For Report Information please contact: Madison County Department of Health www.healthymadisoncounty.org © 2013 For Report Information please contact: Madison County Department of Health www.healthymadisoncounty.org © 2013 Madison County Department of Health Madison County Department of Health PO Box 605 • Wampsville, NY 13163 PO315‐366‐2361 Box 605 • Wampsville, NY 13163 Tel: • Fax: 315‐366‐2697 Tel:health@madisoncounty.ny.gov 315‐366‐2361 • Fax: 315‐366‐2697 health@madisoncounty.ny.gov

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7 - CHA Healthy Environments