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A Message from the Health Officer & Director to the Florida Department of Health in Orange County, Dr. Kevin M. Sherin The focus of this 2015 Annual Report is to highlight the many ways we continue in our unwavering efforts to spread the public health message. While in the medical field, we as clinicians, may treat diseases and injuries one patient at a time, in public health we identify causes of disease and disability and implement largescale solutions or what is known today as population health. It is a field full of researchers, practitioners and educators working together for the wellbeing of our community. Our vision as the Florida Department of Health is to be the Healthiest State in the Nation. We will also work to make Orange the healthiest county in the state. Within our agency, we house different areas such as Kevin M. Sherin, M.D., M.P.H., M.B.A health protection, outbreak surveillance, emergency preparedness for natural & human-made disasters, health promotion, and disease prevention. Our dedicated staff work tirelessly to ensure we are able to provide exceptional service to our clients. Through community engagement and a collective impact approach, we are able to bring together community partners and resources to meet our community's unique needs. Orange County is a microcosm of our great nation. In 2014, Orange County had a population in which 29.7% were of Hispanic descent and 22.2% were Black or African American. In 34% of the homes, a language other than English was a primary language. As we continue to address and improve the well-being of our community, we also focus on health equity and its goal of attaining the highest level of health for all people. Through health equity, we work to eliminate avoidable health disparities by working to ensure that everyone has a fair opportunity to live a long, productive life regardless of race, ethnicity, gender, income, sexual orientation, neighborhood or social condition. Throughout the 2015 Annual Report, you will see many examples of how we work together as an agency to better serve our community. It is through partnerships, interventions, best practices, community assessments, communication, evaluations, and education that we succeed in meeting our public health mission. It is with gratitude and much appreciation that I thank the staff of the Florida Department of Health in Orange County for their continued dedication and commitment to ensuring the public’s health each and every day.

“Health cannot be a question of income; it is a fundamental human right.” —Nelson Mandela


Contents: From The Director Introduction


Our Health Department Mission/Vision & Our Values Ten Essential Public Health Services

4 5

Community Impact Potentially Preventable Deaths, U.S. Clinical/Behavioral Trials Dentistry in Motion Environmental Health 2015 Winnable Battles & Target Goals Epidemiology—Reportable Disease List Healthiest Weight Florida (HWF) HWF’s Small Steps, BIG Rewards School Health Program Volunteer Program World Heart Day OPQI—Road to Quality Preventing STDs Family Planning and Prenatal Health WIC Impact Client Services by Department Client Count by Race/Ethnicity Client Services by Age Group

6-7 10-11 11 12-13 14-15 16-17 18 19 20 20 20 21 22 23 24 25 26 27

Awards and Recognitions Prudential Productivity Awards National Public Health Week Minority Health Month/Bookhardt Award

28 29 29

Fiscal Responsibility Statement of Operations


Grant Awards New and Continued Grants


Other Public Health Accomplishments Feedback Locations

32-33 34 35


OUR MISSION: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

OUR VISION: To Be The Healthiest State In The Nation

OUR VALUES: I CARE I NNOVATION: We search for creative solutions and manage resources wisely. C OLLABORATION: We use teamwork to achieve common goals and solve problems. A CCOUNTABILITY: We perform with integrity and respect. R ESPONSIVENESS: We achieve our mission by serving our customers and engaging our partners. E XCELLENCE: We promote quality outcomes through learning and continuous performance improvement. 4


10 Essential Public Health Services 1. Monitor health status to identify community health problems. 2. Diagnose and the community.

investigate health problems and health hazards in

3. Inform,

educate, and empower people about health issues. 4. Mobilize community partnerships to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure a competent public health and personal healthcare workforce. 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

10. Research for new insights and innovative solutions to health problems. (Source: Public Health Foundation)



Each year, in the US., nearly


people die prematurely from the five leading causes of death, and yet 20% to 40% of the deaths from each cause could be prevented, according to the Centers for Disease Control and Prevention, (CDC). The five leading causes of death in the United States are heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries.



If all the states had the lowest death rate for each cause, it would be possible to prevent:  

 

21% of premature cancer deaths, prolonging about 84,500 lives. 34% of premature deaths from heart diseases, prolonging about 92,000 lives. 33% of premature stroke deaths, prolonging about 17,000 lives. 39% of premature deaths from unintentional injuries, prolonging about 37,000 lives. 39% of premature deaths from chronic lower respiratory diseases, prolonging about 29,000 lives.

include tobacco smoke, secondhand smoke exposure, other indoor air pollutants, outdoor air pollutants, allergens, and exposure to occupational agents.

There are modifiable risk factors largely responsible for each of the leading causes of death. These risk factors include: 



Heart disease risks include tobacco use, high blood pressure, high cholesterol, type 2 diabetes, poor diet, overweight, and lack of physical activity. Cancer risks include tobacco use, poor diet, lack of physical activity, overweight, sun exposure, certain hormones, alcohol, some viruses and bacteria, ionizing radiation, certain chemicals, and other substances. Chronic respiratory disease risks



Stroke risks include high blood pressure, high cholesterol, heart disease, diabetes, overweight, previous stroke, tobacco use, alcohol use, and lack of physical activity. Unintentional injury risks include lack of seatbelt use, lack of motorcycle helmet use, unsafe consumer products, drug and alcohol use (including prescription drug misuse), exposure to occupational hazards, and unsafe home and community environments.

Source: Centers for Disease Control and Prevention (CDC) 2015 7 7


Impact Engagement Support ...improving the health of all people in Florida through integrated state, county & community efforts. 8

Equity Better Health Quality Care 9

Clinical/Behavioral Trials?

To find out more on how to participate in one of our clinical trials or studies, please contact the Florida Department of Health in Orange County Research Unit at 407-858-1436.

Clinical trials are research studies that test how well new medical approaches work in people. Each study answers scientific questions and tries to find better ways to prevent, screen for, diagnose, or treat a disease. Clinical trials may also compare a new treatment to a treatment that is already available.

Behavioral trials on the other hand, address health issues in large groups of people or populations in natural settings. DOH-Orange continues to strive for research excellence by implementing clinical trials and research studies to increase access to services, improve service quality, contain cost, and sustainability of vital programs.

tobacco dependence, obesity, and asthma (Krishna et al., 2009). Similar antiretroviral medication adherence studies have been conducted using standalone short message service (SMS), but not mobile health (mHealth) applications (app) with a SMS text messaging feature (Puccio et al., 2006).The Florida Mobile Application ART Adherence Project (mAAAP) was designed to identify clinical, behavioral, and demographic variables that are associated with successful adoption of the Care4Today Mobile Health Manager (MHM) mobile phone application (app), for short term and long term use.

During this year in review, the Clinical Trial and Research Unit at DOH-Orange added several new research projects stemming across the agency. The studies continue to advance the body of knowledge needed to address infectious disease issues (particularly in population health) and the  RealTalk Study: In partnership with Sociometric Inc., social determinants of health. this proposed project was designed to address health Highlighted below are a few studies that impacted our vision to make Florida the healthiest state in the nation. 


Florida Cohort Study: The Florida Cohort is a new, longitudinal cohort study to identify factors that influence health outcomes in persons with HIV infection and intend to study how individual, clinic, and community level factors influence (1) accessibility and use of healthcare, and (2) HIV clinical outcomes, such as CD4 count and viral load. Specifically, the study interest will look at whether substance use and mental health treatment influence the HIV clinical outcomes. The study is in partnership with the University of Florida and several Florida Department of Health County  Health Departments. Florida mAAAP: Delivery of health information or educational intervention using a cell phone or text messaging has been shown to enhance medication adherence for chronic diseases such as diabetes,

disparities within the population of Black men who have Sex with men (MSM). Black MSM have been disproportionately affected by the HIV/AIDS epidemic in Central Florida and throughout the US. Yet, very few effective interventions have been developed or adapted specifically for Black MSM. The study addressed this gap by producing (1) an Afrocentric, modular intervention package that can be easily tailored to fit different sub-populations of Black MSM; (2) an interactive, multimedia version of the program for men that may prefer a computer-delivered intervention; and (3) an online practitioner forum to support implementing the two versions of the program. Fifty-one (51) Black MSM receiving services at DOH-Orange and the surrounding community were recruited and participated in the multimedia arm. Integrating to Improve (i2i): Funded through the Robert Wood Johnson Foundation, this study was designed to (1) examine how public health, primary care, and community organizations work as a system to identify, link to care, and provide continuous care for HIV patients, (2) determine the organizational and

10 Continued on next page

system characteristics associated with delivery of continuous care for persons with HIV, and (3) develop resources to improve HIV systems of care based on the study findings. The study was conducted by DOH-Orange Area-7 personnel and the community served by Area-7 Office. 

Angels in Action: This study was in partnership with the University of Florida, PACE Center for Girls and DOH-Orange STD Clinic, and was designed to assess the feasibility of conducting a nine-week sexual health promotion program within an alternative school for girls (16-18 year olds) from PACE Center for Girls, Orange County. Primarily, the goals were to help girls and their best friend assist each other in potentially risky situations and learn about the importance of knowing your STD status. They were provided vouchers to get free STD testing and treatment for chlamydia and gonorrhea. DOH-Orange Research Team

Dentistry In Motion

The DOH-Orange Dental Program was awarded a grant from the Agency of Health Care Administration to provide oral health prevention, intervention, education, and outreach activities to low-income under and uninsured children 7-11 years of age through the School Based Sealant Program at Title I schools in five target zip codes (32805, 32808, 32811, 32822, and 32839) as well as provide prevention and treatment oral health services to children 5-11 years of age at the Hoffner Dental Clinic site. These zip codes have the highest percentages of poverty, uninsured and underinsured and low-income populations most of which are minorities. The Hoffner Dental Clinic is in the

32822 zip code, an area with a large uninsured Hispanic population and a large undocumented population who by their status do not have insurance, yet these children need oral health services as well. A total of 300 unduplicated children were served as follows: 150 children 7-11 years of age (approximately 2nd and 3rd graders) as a part of the mobile School Based Sealant Program at Title I schools and 150 children 5-11 years of age at the Hoffner Dental Clinic. This was done to reduce emergency room visits and preventable hospitalizations due to oral health disease in 11 children in Orange County. 11


Regulatory Activities The Environmental Health Program is responsible for monitoring conditions within the community that could present a threat to the health and safety of the public. Environmental Health Specialists work in the community to ensure the public’s health and monitor potential problems. Staff responsibilities include: inspecting tanning facilities, investigating sanitary nuisances, and licensing tattoo establishments and artists, among others.

Community Environmental Health Food Permits Group Care Mobile Home Parks Pools Biomedical Waste Biomedical Waste Exempt Body Piercing Tanning Water Wells Tattoo Migrant Labor Camps Animal Bites Nuisances Early Learning Coalition of Orange County

888 830 128 2320 2285 730 32 52 262 1003 501 4 830 433 62

Onsite Treatment Disposable Systems New








Aerobic Treatment Unit


Pump Trucks


Industrial Manufacturing Permits


Performance Based

51 12

ironmental Health The Environmental Health Community Health Initiatives (CHI) for 2015/2016 fiscal year have accomplished all of their objectives and made a positive impact on the community.  The River Clean Up/Metra CHI team has partnered with

Department of Environmental Protection and Environmental Protection Division to clean up local rivers and has labeled 142 storms drains in various communities in Orange County. The team continues to work with the City of Orlando to distribute door hangers in efforts to educate the communities and neighborhoods that have storm drains located in them.  The EVH Strike Team has been busy attending trainings

both locally and out of state that will prepare the team against Radiation, Bio-Terrorism, Active Shooters and Lead Poising. The team has also participated in community presentation opportunities to educate the community on environmental emergency and disaster preparedness.  The Tobacco CHI team has established smoke free

policies in some public swimming pools and apartment complexes throughout Orange County. The team has also shared many DOH-Orange employee success stories of those that have quit smoking with the community. The team continues to attend community events to share cessation opportunities with the public who are looking to quit smoking.  The Healthy Weight CHI team has sponsored a salad bar

is working closely with the American Lung Association in efforts to educate the public through a variety of upcoming health fairs, symposiums for health workers and asthma awareness summits.  The Sanitary Nuisance Abatement Initiative using No

Transaction (SAINT) Permit CHI team has developed a criteria to help Orange County residents financially with an active sanitary nuisance issues. The team has developed partnerships with professionals in the plumbing and septic industry in assisting with these issues. The team is working to establish funding from community partners to help sustain the program long term.  The Injury Prevention CHI team has provided all EVH

county assigned cars with First Aid Kits. The team has also established a partnership with the local YMCA to provide swimming lessons to interested staff members and those that will be inspecting public pools.  The Homeless CHI team has established community

partners which together are working to ensure that the homeless population is aware of the services DOHOrange offers and to educate them on how to obtain other needed services. The team is working to have a supply drive to assist the local homeless shelters obtain the needed items for the homeless population.  The Health Promotion CHI team reads to local

elementary schools on a monthly basis. The team has also participated in local health fairs to educate the community on what EVH does to promote and protect public health.

for the EVH employees. The team has also established a walk, run crawl nights on Tuesdays and Thursdays at the Caddy Way Trail located near the EVH office. The team  The Institutional Biosafety Committees (IBC) CHI team is continues to work with Leu Gardens in efforts to learn tips working to approve experimental protocols, improve and and tricks to assist existing community gardens and update standards and forms to continue to streamline those looking to start a garden. EVH processes. The team continues to develop training as well as train new staff.  The Asthma CHI team has recruited several schools in Orange County to promote asthma friendliness. The team

During 2015, we also worked with the Winter Park Housing Authority to implement a smoke-free policy at all 5 of their properties and worked with EOS Apartments, Dwell Nona Apartments, and Watercrest Senior Living to implement smoke-free policies. These policies will impact the lives of about 1700 people in Orange County. 13 13

2015 Winnable Batt Nutrition, Physical Activity, Obesity & Food Safety

Tobacco 

Track tobacco use and prevention policies Reduce exposure to secondhand smoke

Offer help to quit tobacco use

Use effective media to warn about the dangers of tobacco

Reduce exposure to tobacco advertising, promotion and sponsorship

Make tobacco use less attractive and affordable

Cigarette smoking is responsible for

480,000 deaths per year.

1,300 deaths every day. 14

Monitor the quality of breastfeeding related maternity care practices Reduce artificial trans fat in the food supply Reduce sodium in the food supply Improve the food environments of child care centers, schools, hospitals, workplaces, and food retail outlets Reduce consumption of calories from added sugars Improve the environments/policies of child care centers, schools, workplaces, and communities to support increased physical activity


of U.S. adults are obese...that is

78.6 million

Healthcare-Associated Infections (HAI) 

Promote and track use of proven HAI prevention practices Increase use of National Healthcare Safety Network (NHSN) to intervene, track and report HAIs

1 in 25

hospital patients has at least one healthcareassociated infection.

In 2011, there were an estimated 722,000 HAIs in U.S. acute care hospitals.



tles & Target Goals

Source: Centers for Disease Control and Prevention (CDC)

Motor Vehicle Safety 

Reduce injuries and deaths in motor vehicle crashes by increasing child safety seat and seat belt use Protect teens drivers with comprehensive Graduated Driver Licensing (GDL) systems and parental monitoring Reduce alcohol-impaired driving with evidencebased prevention strategies, such as ignition interlock programs

In 2013, 2,163 in the U.S. ages 16-19 were killed & 243,243 were treated in emergency departments for injuries suffered in motor vehicle crashes.

Teen Pregnancy 

Monitor teen pregnancy/birth rates and prevention policies


Promote the delay of sexual initiation through evidence-based programs and social norm changes

Expand the reach of Medical family planning services Promote the use of effective contraceptive methods, including longacting reversible contraception, by sexually active teens

In 2014, almost 250,000 babies were born to women aged 15 to 19 years, for a birth rate of

24.2 per 1,000 women in this age group.

Reduce HIV incidence in the United States Maximize the proportion of people with HIV who have suppressed viral load by improving diagnosis, linkage and retention in care, and antiretroviral provision and adherence Implement data monitoring, dissemination, and feedback Reduce HIV-related disparities




people in the United States were living with HIV at the end of 2012. 1 in 8, did not know they were infected. 15 15

Epidemiology The Epidemiology Department conducts disease surveillance, investigates suspected occurrences of infectious disease and conditions and monitors identifies and mitigates transmission of emerging pathogen as required by Florida Statutes 381, Rule 64D3. In 2015, the department identified and investigated 36 outbreaks caused by parasitic, viral and bacterial pathogens and investigated over 3600 reportable diseases and conditions. The department monitored 123 travelers returning from Ebola affected countries, which ranked 2nd in 67 counties for the most number of initial monitoring sessions (1,962) and total number of monitoring sessions completed. The department houses the Perinatal Hepatitis B Prevention Program which in 2015 serviced 57 surface antigen pregnant females to ensure that their babies and household contacts would be case managed to prevent Hepatitis B transmission from occurring. In addition, the

Hepatitis Prevention Program also housed within the Epi Department tested 1400 individuals and provided Hepatitis A (80) and Hepatitis B (470) vaccines in collaboration with partner agencies. Each year there is over 1400 animal exposures in Orange County that require additional follow up from the Rabies Prevention Program. In 2015, the Epidemiology Program identified and managed 88 exposures requiring rabies post exposure prophylaxis. The Department provides disease statistics and important health topics on a monthly basis via it’s Surveillance Report. Current and past editions may be found on DOHOrange’s website here programs-and-services/infectious-disease-services/ epidemiology/epi-surveillance-reports.html. The Department also has successfully contributed to public health its’s publications which can be located here http://

Reportable Disease

Orange County 2015

Amebic Encephalitis Anthrax Arsenic Poisoning Botulism: Infant Botulism: Other Brucellosis California Serogroup Virus Neuroinvasive Disease Campylobacteriosis Carbon Monoxide Poisoning Chikungunya Fever Cholera (Vibrio cholerae Type O1) Ciguatera Fish Poisoning Creutzfeldt-Jakob Disease (CJD) Cryptosporidiosis Cyclosporiasis Dengue Fever Ehrlichiosis/Anaplasmosis: HGA (Anaplasma phagocytophilum) Ehrlichiosis/Anaplasmosis: HME (Ehrlichia chaffeensis) Ehrlichiosis/Anaplasmosis: Undetermined Encephalitis (Other: Non-Arboviral) - Expired 6/4/2014 Escherichia coli: Shiga Toxin-Producing (STEC) Infection Giardiasis: Acute Haemophilus influenzae Invasive Disease Hansen's Disease (Leprosy) Hemolytic Uremic Syndrome (HUS) Hepatitis A Hepatitis B: Acute Hepatitis B: Chronic Hepatitis B: Perinatal Hepatitis B: Surface Antigen in Pregnant Women Hepatitis C: Acute

Mean (2010 - 2014)

Florida 2015

Mean (2010 - 2014)

0 0 2 0 0 1 0 137 13 3 2 2 1 50 2 2 0 0 0 0 22 74 15 3 1 3 18 499 0 60

0 0 0 0 0 0.6 0 115.6 7.8 11.8 0.4 1.6 0.8 37.4 3 11.8 0.2 0.6 0 0.2 16.4 73 14.2 0.4 0.6 7.2 12.4 395.6 0.2 60.4

1 0 16 0 1 11 1 3720 270 126 4 59 26 874 33 88 7 21 1 0 464 1055 249 32 5 136 528 5471 0 460

0.8 0.2 8.2 0.6 0 9.6 0.4 2400 152.2 96.8 6.4 45.6 20.6 730.4 45.8 138.4 5.8 20 0.2 11.6 413.8 1360.4 241.2 10.6 6.8 132.8 328.2 4418.6 1 469.2




157.6 16

Hepatitis C: Chronic Hepatitis D Hepatitis E Hepatitis G Herpes B Virus: Possible Exposure Influenza A: Novel or Pandemic Strains Influenza-Associated Pediatric Mortality Lead Poisoning Legionellosis Leptospirosis Listeriosis Lyme Disease Malaria Measles (Rubeola) Melioidosis (Burkholderia pseudomallei) Meningitis: Bacterial or Mycotic Meningococcal Disease Mercury Poisoning Middle East Respiratory Syndrome (MERS) Mumps Pertussis Pesticide-Related Illness and Injury: Acute Psittacosis (Ornithosis) Q Fever: Acute (Coxiella burnetii) Rabies: Human Rabies: Possible Exposure Ricin Toxin Poisoning Rocky Mountain Spotted Fever - Expired 7/15/2014 Rocky Mountain Spotted Fever and Spotted Fever Rickettsiosis Rubella Salmonellosis Saxitoxin Poisoning (Paralytic Shellfish Poisoning) Shigellosis St. Louis Encephalitis Neuroinvasive Disease Staphylococcal Enterotoxin B Poisoning Staphylococcus aureus Infection: Intermediate Resistance to Vancomycin Staphylococcus aureus: Community-Associated Mortality - Expired 6/4/2014 Strep pneumoniae Invasive Disease: Drug-Resistant Strep pneumoniae Invasive Disease: Drug-Susceptible Streptococcal Invasive Disease (Group A) - Expired 6/4/2014 Tetanus Toxoplasmosis - Expired 6/4/2014 Tularemia (Francisella tularensis) Typhoid Fever (Salmonella Serotype Typhi) Typhus Fever: Endemic (Rickettsia typhi) - Expired 6/4/2014 Vaccinia Disease Varicella (Chickenpox) Vibriosis (Grimontia hollisae) Vibriosis (Other Vibrio Species) Vibriosis (Vibrio alginolyticus) Vibriosis (Vibrio cholerae Type Non-O1) Vibriosis (Vibrio fluvialis) Vibriosis (Vibrio mimicus) Vibriosis (Vibrio parahaemolyticus) Vibriosis (Vibrio vulnificus) West Nile Virus Neuroinvasive Disease West Nile Virus Non-Neuroinvasive Disease


2042 0 1 0 0 0 0 31 19 0 3 5 6 0 0 0 0 0 0 0 13 0 0 0 0 89 1 0 2 0 339 0 79 0 0 0 0 18 26 0 0 0 0 0 0 0 18 0 0 2 0 0 0 0 0 0 0


1663.8 0 0.2 0.2 0 2.4 0.2 26 21 0.6 3 4 9.4 1.4 0.2 9.2 1.2 0.2 0.2 0.8 30.8 3.6 0 0 0 90.6 0 0.2 0.4 0 328.8 0 140.2 0 0 0 0 33.4 23 12.8 0 0.6 0 1.2 0 0 28.6 0 0.2 1.4 0.4 0 0 0.6 0.4 0.8 0.2


36779 1 6 0 5 0 2 988 351 5 45 310 56 11 0 126 26 28 0 19 349 54 1 2 0 3397 4 0 47 1 6513 0 2034 0 0 4 0 177 289 0 4 0 0 6 0 1 758 1 19 56 9 15 11 48 48 13 0


27795.4 0.4 2.8 0.4 6.2 30.6 4.2 879.8 241.4 1.6 43.4 142.6 87.8 3.8 0.2 172 57.2 10.6 0.2 17 536.4 45.2 0.2 2.2 0.2 2547 0.2 16.6 7.2 0 6367 0.6 1871.4 0.4 0.2 4.4 10.6 573.2 582.2 252.4 4 9 0.4 13.4 0.4 0.2 781.4 1.8 8.8 53 12.4 7.6 5.2 40.4 35.2 20.2 7.6



The NUMBER 1 public health threat to Florida’s future is unhealthy weight.

The costs of care for 1 out of 3 kids are 65% of adults in Florida chronic diseases from obesity alone are are at an unhealthy now considered to be weight. overweight or obese. estimated to be $34B over the next 17 years.

Currently, only 36% of Floridians are at a healthy weight. On our current trend, by 2030, almost 60 percent will be obese. Additionally, six out of ten children born today will be obese by the time they graduate high school. Over the next 20 years in Florida, obesity is expected to contribute to millions of cases of preventable chronic diseases such as type 2 diabetes, heart disease and cancer, costing an estimated $34 billion. To address this important public health issue, the Department of Health launched the Healthiest Weight Initiative in January 2013.

Healthiest Weight Florida is a public-private collaboration bringing together state agencies, not for profit organizations, businesses, and entire communities to help Florida’s children and adults make consistent, informed choices about healthy eating and active living.

Strategies to Address Healthy Weight in Florida Strategy One—Increase opportunities for physical activity Strategy Two—Make healthy food available everywhere Strategy Three—Promote health in the worksite Strategy Four—Strengthen schools as the heart of health Strategy Five—Market what matters for a healthy life

18 18

SMALL steps, BIG rewards How do we spread the message?

AND MUCH MORE! Spreading the Healthiest Weight message can be as easy as referring those you know to

Follow us on social media! #HealthiestWeightFL


with Orange County Public Schools, and other community partners, to provide schoolrequired immunizations during two special events, 1) the Spring Break Event and 2) the Back-toSchool Event for families. A total of 580 students who attended the events received 799 vaccinations. For the past three consecutive years the School Health Program has been targeting the Orange County student population by engaging in a strategy to attain and sustain high levels of immunization for all children who will be entering the school system. The School Health Program continues to collaborate

A total of 67 volunteers worked within DOH-Orange in 2015. They included regular volunteers performing as staff as well as interns, nursing/medical students, and medical residents. Volunteers are able to gain valuable skills and training along with an exceptional public health experience. Additionally, our volunteers can enhance their existing knowledge while developing personal pride and satisfaction in knowing they have “made a difference.”

certified documents were issued during the event. In addition a total of school health mandatory vision, hearing, scoliosis, growth and development screening referrals were conducted throughout the school year.

These services and events are the School Health Programs, public health effort that proactively Before attending schools in Florida, every child must provide a offers an opportunity for no missed opportunities, when it certified document establishing comes to providing health that they have received full services to our children. vaccinations and are up-to-date on their immunizations, and can enter school. A total of 705

Volunteers extend our areas of influence as well as contribute to a greater awareness of the numerous services public health provides in the community. A total of 7,907 volunteer hours in 2015 resulted in a dollar value equal to $874,841.25 Volunteers are needed for many programs and services at various health department locations throughout Orange County. For more information, please call



In celebration of World Heart Day, Sept. 29, the Florida Department of Health in Orange County promoted heart health by hosting Hands-Only™ CPR training. World Heart Day is an annual event created by the World Heart Foundation to remind everyone that heart disease and stroke are the world’s leading causes of death. The theme for 2015 was creating heart healthy environments. In Florida, 23.4 percent of adults age 65 and older reported in 2013 that they had been told by a healthcare provider that they had a heart attack, coronary heart disease or stroke. Heart disease was the leading cause of death in Florida in 2014 and is the number one killer of women, taking more lives than all forms of cancer combined. Hands-Only™ CPR is CPR without mouth-to-mouth breaths. It is recommended for use by people who see a teen or adult suddenly collapse in an “out-of-hospital” setting (such as at home, at work or in a park). It consists of two easy steps: 1. Call 9-1-1 (or send someone to do that); and 2. Push hard and fast in the center of the chest. Hands-Only™ CPR performed by a bystander has been shown to be as effective as conventional CPR with mouth-to-mouth breaths in the first few minutes of sudden cardiac arrest.

“World Heart Day has given us yet another opportunity to collaborate with other community organizations to teach the community how to help save lives through hands only CPR. Everyone can benefit by learning HandsOnly™ CPR,” said Dr. Kevin Sherin, director and health officer for the Florida Department of Health in Orange County. 20


All Roads Lead to


In 2015, as a continued effort to achieve a higher level of quality within the organization, the Florida Department of Health in Orange County (DOH-Orange) created the Office of Performance and Quality Improvement (OPQI) What is OPQI?

The Office of Performance and Quality Improvement (OPQI) was developed to lead the quality improvement and accreditation efforts. The main focus of OPQI is to provide the human capital to assist the department in attaining a “Culture of Quality.” Inherent in a culture of quality improvement is the concept of “organizational culture” or “the essence of how work is accomplished.” According to NACHHO, an organizational culture “matures over several years, during which norms are passed on from one generation of staff to the next.” The primary goal is to be able to fully understand our organizational culture so that we can replicate its strengths and reduce or eliminate its weaknesses.


What is an STD? How to prevent them!

Testing in your county?

Preventing STDs Sexually Transmitted Diseases (STDs), or sexually transmitted infections (STIs), are generally acquired by sexual contact. The organisms that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids. Sometimes these infections can be transmitted non-sexually, such as from mother to infant during pregnancy or childbirth, or though blood transfusions or shared needles. It’s possible to contract sexually transmitted diseases from people who seem perfectly healthy, and who may not even be aware of the infection. STDs don’t always cause symptoms, which is one of the reasons experts prefer the term “sexually transmitted infections” to “sexually transmitted diseases.” Source: Mayo Clinic

20 MILLION new STD infections in the Unites States every year. Anyone who is sexually active can get an STD. STDs are preventable...Here’s How:

1. Practice Abstinence—The surest way to avoid STDs is not to have sex. This means not having vaginal, oral, or anal sex. 2. Use Condoms—Using a condom correctly every time you have sex can help you avoid STDs. Condoms lessen the risk of infection for all STDs. 3. Have Fewer Partners—Agree to only have sex with one person who agrees to only have sex with you. Make sure you both get tested to know for sure that neither of you has an STD. 4. Get Vaccinated—The most common STD can be prevented by a vaccine. The HPV vaccine is safe, effective, and can help you avoid HPV-related health problems. 5. Talk With Your Partner—Talk with your sex partner (s) about STDs and staying safe before having sex. It might be uncomfortable, but protecting your health is your responsibility. 6. Get Tested—Many STDs don’t have symptoms, but they can still cause health problems.

If you test positive, it is not the end! Many STDs are curable and all are treatable.

Evaluation, treatment and counseling of sex partners of persons with a Sexually Transmitted Disease (STD).

Orange County CHLAMYDIA 

Reported cases increased 12.6% from 7,121 cases in 2014 to 8,022 cases in 2015.

The ratio of female to male infections was 2.3 to1

696 re-infections within 12 months

1.5% (119 cases) were HIV+ in 2015


Reported cases increased by 18.95% from 1,852 cases in 2014 to 2,203 in 2015

The ratio of male to female infections was 1.5 to 1

The Sexually Transmitted Disease (STD) Program at DOH-Orange works to control transmission through four major avenues:

7.4% (164 cases) were HIV+ in 2015


Source: CDC

 

Education of at risk persons on the modes of disease transmission and the means for reducing the risk of transmission by changing sexual behaviors Detection of infection in persons without symptoms, and those who are unlikely to seek diagnostic and treatment services. Diagnosis and treatment of persons who are infected.

Reported cases increased by 39.52% from 291 cases in 2014 to 406 cases in 2015

The ratio of male to female infections was 15.7 to 1

22 53 % (216) of 406 cases were also HIV+ MSM (men who have sex with men) risk

Family Planning & Prenatal Health 2015 Transitions and Improvements


The Family Planning and Prenatal Health program transitioned into new areas of practice in 2015. A major shift was to offer family planning care to men. Traditionally, our care focused on females only. Male health care includes a physical annually, a reproductive life plan, STD screening and treatment, sterilization counseling and condoms.

The second transition was shifting all prenatal care to the west side of the county and family planning care to the east side of the county. This increased access to Long Acting Reversible Contraception including Nexplanon and Mirena IUDs.



The third transition was the addition of our Family Planning Nurse Practitioner. She is responsible for the well-baby/well woman group care for families in need of enhanced family development and well-being services. This is the final component for the 3.5 million dollar HRSA grant Bellies, Babies and Beyond which is evidence based group health care to improve birth outcomes and decrease infant mortality to families at risk.



Women, Infant and Children WIC is a federally funded nutrition program for Women, Infants, and Children. WIC provides the following at no cost: healthy foods, nutrition education and counseling, breastfeeding support, and referrals for health care and community services. The WIC Program in Orange County served an average of 34,006 clients monthly in 2015 and scheduled appointments for nearly 1,000 clients each day in the 8 permanent WIC sites.

WIC 2015 — By the Numbers 216,213 Nutrition education and breastfeeding contacts were provided to 57,097 unduplicated clients in 2015.

The WIC Program conducted 187

breastfeeding classes: 118 in English, 41 in Spanish, and 28 in Creole.

Breastfeeding Peer Counselors provided an additional 5,435 individual and group contacts.

The value of food purchased by the Orange County WIC program participants each month totaled 955,733 transactions at a value of $26,131,827.11 in food purchases to the local economy. This averaged 79,644 transactions monthly for a total of $2,177,652.26 24 monthly in 2015.


Client Count 9,391

Communicable Disease Services


Dental Family Planning & Prenatal Health Immunizations







Personal Health Services by

Department Data Source: DOH-Orange Health Management System 25

DOH-Orange Client Count for Personal Health Services By Race & Ethnicity Total Clients: 40,197 | Total Visits: 128, 155


Hispanic/Latino (12,623 clients)


Black/African American (12,622 clients)


White/Caucasian (7,777 clients)


Other or Unknown (7,175 clients)

Data Source: DOH-Orange Health Management System 26 26

DOH-Orange Client Count For Personal Health Services

by Age Group

<5 years old


5-18 years old

9,929 19-64 years old

19,058 65 or older


Other or Unknown

4,879 Data Source: DOH-Orange Health Management System

27 27

2015 Prudential Productivity Award Recipients The Prudential Productivity Awards are made possible through the generosity of Prudential, as Anchor Sponsor, and the vision of the late J.E. Davis and A.D. Davis, co-founders of the Winn-Dixie Stores Inc. and co-founders of Florida TaxWatch. Since 1989, the Awards program has publicly recognized and rewarded state employees and work units whose work significantly and measurably increases productivity and promotes innovation to improve the delivery of state services and save money for Florida taxpayers and businesses. Over the 27-year program, more than 15,000 nominations have been received, and awards have been given to state employees for saving or maximizing state dollars to the tune of $9 billion.

sidewalks installed so that clients would have a safe and more convenient access to the facility. After a proposal and quotes, it was a surprise when Orange County announced they would cover all cost associated with the sidewalk, therefore not only ensuring the safety of pedestrians, but improving the walkability of our facility and saving DOH-Orange $10,500.00.

To reduce the cost and increase patient compliance with treatment protocol DOH-Orange Information Technology and TB programs collaborated with the state IT and TB programs to implement the Tuberculosis (TB) Video Direct Observation Therapy (VDOT) resulting in a team award. Monitoring of active TB cases requires time and commitment from the department and the patient. DOH-Orange staff utilizes In 2015 DOH-Orange was recognized for the following 5 Polycom client software loaded on their computers to video conference with TB patients to observe medication compliance key initiatives: through the client’s smartphone device. This system has saved the agency $655.35 per patient in a period of 5 months. Team The Interdisciplinary TB case review allows staff to identify members include: Chris Collinge, LaDawn Pierre, Van and refer patients to appropriate community resources thus Nguyen, MD, Mary Green, Willie Carter, MPH, Tami Hodges, saving additional cost and ensuring that our patients are not Sherrie Osorio, Saadia Stephan, MHA, LHRM, RN-BSN. wasting community resources by using hospital emergency rooms to manage conditions that require special care. The daily patient case review offers early intervention with non-compliance The DOH-Orange Environmental Health team won an award on on the local level, which helps keep the patient from being sent Revamping and Energizing the Sanitary Nuisance Program. The to a specialized treatment facility and translates into a savings of efficiency of these program changes has caused an overall approximately $77,550.00 per patient. Team members increase in the compliance rate for the abatement of sanitary included: Van Nguyen, MD, Saadia Stephan, MHA, LHRM, nuisances which ultimately resulted in fewer site visits. In RN-BSN, Kathy Walker, Richard A. Stevens, Dr.PH, MPH, addition there has been an increase in septic system permits and MSHSA, MS, Yvette Miranda-Venzen. repairs applications and the corresponding revenues associated Susannah Bowersox, received an award for her development and implementation of the NARF System. An innovative idea was set in motion, using Microsoft InfoPath, an electronic fillable Network Access Request Form (NARF) in response to the growing difficulties encountered through the use of cumbersome and outdated paper copies. The implementation of NARF has resulted in a more effective use of resources, such as the need for less staff time required to track, monitor, and process forms. As a result DOH-Orange has seen a cost savings of $18,000 per year.

with them. By improving the investigation process, there has been a saving of over $10,800 in staff time and more importantly, problematic sanitary nuisances have been closed in a third of the time it took before the implementation of the team approach. Team members include: Kari Murabito, Virgia Stephens, Bryce Edwards, Keila Flores-Burgos, Maciej Lewandowski, Wanda Back, Jessica Maldonado, Jared Sweat.

DOH-Orange staff in collaboration with DOH-Seminole also received a Café Latino of Central Florida Team Award for their innovative collaboration with Café Latino Coalition of Central Increasing Client Accessibility to Services and Promoting Florida in reaching the Central Florida Area for HIV/AIDS, STD Safety is an individual award received by Karen Johnson. Safety and Hepatitis Program Services. Team members include: Tai concerns and issues of access to care for numerous DOHJohnson, Luz Reyes, and Mirna Chamorro. Orange clients made one individual undertake the task of getting


Public Health Heroes

...personifying the spirit of public Health through a commitment to building a healthier community and improving the lives of people we serve.

DOH-Orange Celebrates National Public Health Week On April 7, 2015 DOH-Orange held a special event in celebration of National Public Health Week (NPHW). This week was established in 1995 as a way to recognize the many contributions of public health and prevention services to America’s well-being. The weeklong event serves to focus public attention on state, community and individual efforts aimed at preventing public health problems such as teenage pregnancy, food-borne illness, injuries in the home, and chronic disease. A ceremony was held on April 7, 2015 to publicly recognize the 2015 Public Health Heroes. The Public Health Hero Award serves as a mechanism to honor and recognize those very special individuals who work every day to improve the lives of Orange County residents and visitors. Several communication channels were utilized in order to expand our public health messages to the public. For example, information

on a variety of health topics as well as the many services provided at DOH-Orange were included in a newsletter and published on our webpage. In addition, there were links to several sites one could visit to see videos on the role of public health. We worked closely with the Orlando Sentinel to place mobile “ads” on their website. The ads were brief health messages on measles, Ebola, and the dangers of candy flavored cigarettes. The ads received over 1000 viewer clicks. Pictured above from left to right: Diana Mejia (Nuevo Sendero Inc.), Sarah Matthews (DOH-Orange, Epidemiology), Dr. Tim Hendrix (Florida Hospital Centra Care), John Zerega (Orange County Public Schools), Luz Calderon (DOH-Orange, Immunology), Dr. Michael Deichen (University of Central Florida, Health Services), Jackie Mendez (Pan American Medical Association), Dr. Michael Ham-Ying (Community Health Centers), Monica May (Star 94.5), Penny Smith (DOH-Orange, Healthy Start), & Dean Hutchins (DOH-Orange, Immunology).

National Minority Health Month/ Dr. Alfred L. Bookhardt Award long term care facility in Orlando for African Americans.

The Florida Department of Health in Orange County (DOHOrange) celebrates National Minority Health Month with the award presentation of the Dr. Alfred L. Bookhardt Health Equity Award. This award honors Dr. Alfred L. Bookhardt (1928-2014) who began his medical practice in Orlando during the Civil Rights movement. He treated African American patients who were refused care by white physicians. He also cofounded the Central Florida Medical Society and Guardian Care, the first

Health Sciences in California and became a Diplomat of the American Board of Family Medicine. He later became a Fellow of the The annual Health Equity Award was created by the Florida Department of Health in American Academy of Family Physicians. Dr. Ham-Ying is an active member of the Orange Orange County as a way to recognize Orange County Medical Society, the American County physicians for their dedication and Academy of Family Physicians and the commitment to increasing access to healthcare American Medical Association. He completed with a goal of achieving health equity in Central the Physicians in Management Series I, II, and Florida. II through the American College of Physician Executives. Dr. Ham-Ying brings over 25 years It was an honor to present our 2015 Health Equity Award to Dr. Michael Ham-Ying. of experience and with his work towards advancing Health Equity as a leader to an With a medical degree from Meharry Medical organization that is medical home to nearly College, Dr. Ham-Ying is the Vice President/Chief Medical Officer of Community 60,000 patients, he is most deserving of this Health Centers, Inc. (CHC) a private, nonprofit year’s Dr. Alfred L. Bookhardt Health Equity Award. organization that provides primary and preventative medical, dental and pharmaceutical services to insured, uninsured, underinsured, and underserved children and adults throughout Orange and Lake county. He completed his Family Medicine residency and Geriatric Fellowship at Drew University of 2929

Fiscal Responsibility Consolidated Statement of Operations FY 2014/2015 REVENUES General Revenue


Other State Funds


Federal Funds


Local Revenue






Other Personnel Services




Other Capital Outlays




*Certified Forward Expenditures Total

1,059,618.00 35,735,869.00

*Expenses paid in 2014-2015 from prior year

Grant Awards New & Continued Multiyear Projects Each year, the Grants Administrator works with several departments in the Department of Health in Orange County (DOH-Orange) to develop grant applications that seek to maintain the level of funding received and/or pursue additional funding to address emerging needs in communities we serve. Once a year, your Grants Administrator answers the following question - “what have you done for me lately?” In 2015 the Grants Administrator worked under the direction of the Assistant Director for Administration. Here’s our response to the question above. DOHOrange grant seeking activities have successfully acquired funding to support direct patient care, community education, and community engagement activities to address multiple health issues including: HIV/AIDS, infant mortality, low-birth weight, prevention of tobacco related illnesses (i.e. heart disease, emphysema, stroke and several types of

cancer), and prevention and treatment of oral disease in children. In 2015, DOH-Orange was awarded $5,062,401 in grant funds to provide services that include: medical and non-medical case management services, nutrition therapy, nutrition education, linkage to prenatal care, outpatient ambulatory medical care including access to specialty care providers and laboratory services, tobacco use prevention and cessation, applying dental sealants and providing oral health treatment to children. In total 4,293 unduplicated consumers were served. In addition 100,135 units of service were provided. This would not have been possible without grant funds. Our DOH-Orange grant development activities directly support achieving our mission to protect, promote, and improve the health of all people in Florida through integrated state, county and community efforts. 30

2015 New & Competitive Renewal Grant Awards Grant

AHCA Oral Health Project


$100,000 [6 months to be utilized in 2016]


Project seeks to prevent oral disease in low-income under and uninsured children 5 – 11 years of age in target Orange County zip codes by providing preventive oral health services to the target population through the School Based Sealant Program at Title I schools; and both preventive and treatment oral health services at the Hoffner Dental Clinic site.


Ryan White Part A Outpatient Ambulatory Medical Care (OAMC)


$625,974 [Year 1 of 3]


Project provides HIV/AIDS patient care including access to specialty care providers and laboratory services for HIV infected adults in Orange County.


Ryan White Part A OAMC-Minority AIDS Initiative


$584,710 [Year 1 of 3]


Project provides HIV/AIDS patient care including access to specialty care providers for HIV infected minority adults in Orange County.


Ryan White Part A – Medical Case Management


$586,324 [Year 1 of 3]


Provide medical case management services to HIV/AIDS clients


Ryan White Part C Sunshine Care Center competitive proposal


$1,111,183 [Year 1 of 2]


Project supports comprehensive HIV/AIDS EIS services provided


Ryan White Part D Sunshine Care Center competitive proposal


$868,073 [Year 1 of 2]


Project supports comprehensive HIV/AIDS treatment services specific to women, infants, children and families


State Tobacco Partnership competitive proposal


$309,192 [Year 1 of 3]


Project supports comprehensive tobacco use prevention and cessation efforts targeting youth in Orange County

2015 Continued Multiyear Grant Projects Grant

Ryan White Part B Non-Medical Case Management


$37,500 [Year 2 of 2] *(Part B funding cycle was modified)


Project provides HIV/AIDS non-medical case management to HIV infected adults in Orange County.


Ryan White Part B Medical Nutrition Therapy


$61,375 [Year 2 of 2] *(Part B funding cycle was modified)


Project provides HIV/AIDS medical nutrition therapy to HIV infected adults in Orange County.


Ryan White Part A – Non Medical Case Management


$71,000 [Year 2 of 2] *(Part A funding cycle was modified for this service)


Provide medical case management services to HIV/AIDS clients


Healthy Start initiative Eliminating Racial/Ethnic Disparities – Bellies Babies and Beyond


$707,070 [Year 2 of 5]


Address the high infant mortality rate, high percentages of low birth weight and preterm births; and low percentages of mothers entering prenatal care in the first trimester experienced by Black and Hispanic women in the target Orange County zip codes


Achie Public Health Vaccine-preventable Diseases The past decade has seen substantial declines in cases, hospitalizations, deaths, and health-care costs associated with vaccine-preventable diseases. New vaccines were introduced, bringing to 17 the number of diseases targeted by U.S. immunization policy. A recent economic analysis indicated that vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs.

Prevention & Control of Infectious Disease

Improvements in state and local public health infrastructure along with innovative and targeted prevention efforts yielded significant progress in controlling infectious diseases. Examples include a 30% reduction in reported U.S. tuberculosis cases and a 58% decline in central line--associated blood stream infections. Multiple efforts to extend HIV testing, including recommendations for expanded screening of persons aged 13--64 years, increased the number of persons diagnosed with HIV/AIDS and reduced the proportion with late diagnoses, enabling earlier access to life-saving treatment and care and giving infectious persons the information necessary to protect their partners

Tobacco Control

Since publication of the first Surgeon General's Report on tobacco in 1964, implementation of evidence-based policies and interventions by federal, state, and local public health authorities has reduced tobacco use significantly. By 2009, 20.6% of adults and 19.5% of youths were current smokers, compared with 23.5% of adults and 34.8% of youths 10 years earlier. By 2010, FDA had banned flavored cigarettes, established restrictions on youth access, and proposed larger, more effective graphic warning labels that are expected to lead to a significant increase in quit attempts.

Maternal & Infant Health

Mandatory folic acid fortification of cereal grain products labeled as enriched in the United States beginning in 1998 contributed to a 36% reduction in neutral tube defects (NTDs) from 1996 to 2006 and prevented an estimated 10,000 NTD-affected pregnancies in the past decade, resulting in a savings of $4.7 billion in direct costs. Improvements in technology and endorsement of a uniform newborn-screening panel of diseases have led to earlier life-saving treatment and intervention for at least 3,400 additional newborns each year with selected genetic and endocrine disorders. In 2003, all but four states were screening for only six of these disorders.

Motor Vehicle Safety

Motor vehicle crashes are among the top 10 causes of death for U.S. residents of all ages and the leading cause of death for persons aged 5--34 years. In terms of years of potential life lost before age 65, motor vehicle crashes ranked third in 2007, behind only cancer and heart disease, and account for an estimated $99 billion in medical and lost work costs annually. Crash-related deaths and injuries largely are preventable. While the number of vehicle miles traveled on the nation's roads increased by 8.5%, the death rate related to motor vehicle travel declined from 14.9 per 100,000 population to 11.0, and the injury rate declined from 1,130 to 722. 32 32

evements of the 21st Century Source: Centers for Disease Control and Prevention (CDC)

Cardiovascular Disease Prevention

Heart disease and stroke have been the first and third leading causes of death in the United States since 1921 and 1938, respectively. Age-adjusted coronary heart disease and stroke death rates have declined from 195 to 126 per 100,000 population and from 61.6 to 42.2 per 100,000 population, respectively, continuing a trend that started in the 1900s for stroke and in the 1960s for coronary heart disease. Factors contributing to these reductions include declines in the prevalence of cardiovascular risk factors such as uncontrolled hypertension, elevated cholesterol, and smoking, and improvements in treatments, medications, and quality of care.

Occupational Safety

Significant progress was made in improving working conditions and reducing the risk for workplace-associated injuries. For example, patient lifting has been a substantial cause of low back injuries among the 1.8 million U.S. health-care workers in nursing care and residential facilities. In the late 1990s, an evaluation of a best practices patient-handling program that included the use of mechanical patient-lifting equipment demonstrated reductions of 66% in the rates of workers' compensation injury claims and lost workdays. Following widespread dissemination and adoption of these best practices by the nursing home industry, Bureau of Labor Statistics data showed a 35% decline in low back injuries in residential and nursing care employees.

Cancer Prevention

Evidence-based screening recommendations have been established to reduce mortality from colorectal cancer and female breast and cervical cancer. Several interventions inspired by these recommendations have improved cancer screening rates. Through the collaborative efforts of federal, state, and local health agencies, professional clinician societies, not-for-profit organizations, and patient advocates, standards were developed that have significantly improved cancer screening test quality and use. The National Breast and Cervical Cancer Early Detection Program has reduced disparities by providing breast and cervical cancer screening services for uninsured women. The program's success has resulted from similar collaborative relationships.

Childhood Lead Poisoning Prevention

In 2000, childhood lead poisoning remained a major environmental public health problem in the United States, affecting children from all geographic areas and social and economic levels. By 2010, 23 states had comprehensive lead poisoning prevention laws. Enforcement of these statutes as well as federal laws that reduce hazards in the housing with the greatest risks has significantly reduced the prevalence of lead poisoning. Findings of the National Health and Nutrition Examination Surveys from 1976--1980 to 2003--2008 reveal a steep decline, from 88.2% to 0.9%, in the percentage of children aged 1--5 years with elevated blood lead levels.

Public Health Preparedness and Response

During the N1H1 pandemic, the improvements in the ability to develop and implement a coordinated public health response in an emergency facilitated the rapid detection and characterization of the outbreak, deployment of laboratory tests, distribution of personal protective equipment from the Strategic National Stockpile, development of a candidate vaccine virus, and widespread administration of the resulting vaccine. These public health interventions prevented an estimated 5--10 million cases, 30,000 hospitalizations, and 1,500 deaths (CDC, unpublished data, 2011).


34 34

Locations Administration Offices 6101 Lake Ellenor Drive Orlando, Florida 32809 407-858-1400 Apopka Health Center 1111 North Rock Springs Road Apopka , Florida 32712 WIC Program 407-858-1494 Central Health Center 832 W. Central Boulevard Orlando, Florida 32805 407-836-2600 WIC Program 407-858-1494 Church Street Vital Statistics Office 807 West Church Street Orlando, Florida 32805 407-836-7128 Eastside Health Center 12050 East Colonial Drive Orlando, Florida 32829 WIC Program 407-858-1494 Family Planning/ Prenatal Health 407-858-1487

Hoffner Health Center 5449 South Semoran Boulevard Orlando, Florida 32826 Dental (Suite 19B) 407-254-1925 WIC Program 407-858-1494

Lake Underhill Health Center 5730 Lake Underhill Road Orlando, Florida 32807 WIC Program 407-858-1494 Family Planning/ 407-858-1487 Prenatal Health Lila Mitchell Health Center 5151 Raleigh Street Orlando, Florida 32811 Family Planning/ 407-858-1487 Prenatal Health Ocoee Health Center 475 Story Road Ocoee, Florida 34761 Healthy Start 407-254-6822 Orlando Health Campus 44 Lake Beauty Drive Orlando, Florida 32806 Vital Statistics Office 407-245-0047 Southside Health Center 6101 Lake Ellenor Drive Orlando, Florida 32809 WIC Program 407-858-1494 407-858-1487 Family Planning/ Prenatal Health Colonial Office 1001 Executive Center Drive Orlando, Florida 32808 Environmental Health 407-858-1497 Winter Garden Health Center 13275 W. Colonial Drive Winter Garden, Florida 34787 WIC Program 407-858-1494 35 35

Mission To protect, promote and improve the health of all people in Florida through integrated state, county and community efforts. Vision To be the Healthiest State in the Nation



Florida Department of Health in Orange County 6101 Lake Ellenor Drive Orlando, FL 32809



407-858-1400 36

Florida Health - Orange County Impact Report 2015  
Florida Health - Orange County Impact Report 2015