of Public Health in Orange County
Regina Chinsio-Kwong, DO County Health Officer
Family members with ownership of stocks: AbbVie, Bristol Myers Squibb, Johnson and Johnson, Merck, Pfizer, United Health, CVS Health, Walt Disney, Intuitive Surgical, Idexx Lab, Crispr Therapeutics, Apple, Dell, Microsoft, Meta, Oracle, Palantir, Salesforce, CrowdStrike, Verizon, VMware, Nvidia, LIT, Tesla
Presenter Notes
May 28, 2025
The purpose of this webinar is to educate community providers and leaders on health trends, local challenges, local initiatives and opportunities to advance health in Orange County.
For clinicians seeking continuing medical education credit, I am going to review key drivers of mortality and morbidity in Orange County (OC), review public health challenges, community response efforts and local health initiatives, and review where to gain access to some of the data that is shared. Continuing medical education (CME) credits are available.
To get the CME, clinicians need to be signed in for the entirety of the training and will also need to complete the online registration survey that will be sent via email following the webinar.
During this webinar, I will review what my role entails as the County Health Officer, data relevant to our community, readiness and response efforts and current Public Health challenges as well as opportunities and local initiatives.
Veronica Kelley, DSW, LCSW
Agency Director Lorraine Daniel, MPA
Assistant Agency Director
Compliance Officer
Office of Compliance
Staff: 6
State & Federal Compliance
Code of Conduct
Training & Education
Director of
Behavioral Health Services
Staff: 1,373
Adult and Older Adult Services
Behavioral Health Services Act
Children and Youth Services
Crisis and Acute Care Services
Data Analytics
Forensics
Substance Use Disorder Services
County Health Officer & Deputy Health Officers
Duty of protecting & promoting
public health across Orange County and cities, guardian of Public Health
Has authority to control communicable diseases and respond to emergencies
Deputy Director of
Government Affairs & Communications
Staff: 9
Communications
Custodian of Records
Grants & Funding
Legislation & Policy
Director of
Public Health and Nursing Services
Staff: 712
Clinical Services (Tb/HIV/STD)
Community Nursing Services
Health Promotions & Community Planning
Communicable Disease Control Division
Environmental Health
Public Health Lab
Director of Specialized Medical Services
Staff: 350
Emergency Medical Services
California Children Services
Office of the Public Guardian
Medical Safety Net
Employee Health Services
Director Of Correctional Health Services
Staff: 513
Adult Correctional Health Services
Juvenile Health Services
OC Cares
Orangewood Children and Family
Center Medical Services
Regina Chinsio-Kwong, DO
“Dr. CK”
County Health Officer
Matthew Zahn, MD Deputy Health Officer
Almaas Shaikh, MD MPH FACS Deputy Health Officer
Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025 --------------------------------------------
The Health Officer is a position grounded in both medical expertise and legal authority- entrusted with safeguarding the health and safety of our community. Under California law, the Health Officer has broad authority to prevent and control the spread of disease, respond to public health emergencies, and enforce health regulations that protect the public’s well-being. This role is not only clinical and regulatory, but also deeply collaborative, working across sectors to build a healthier, more resilient county.
By law, each county must have a Health Officer- much of the public health related programs delivered are under the authority of the Health Officer. Deputy Health Officers assist the Health Officer and can be delegated the role of the Health Officer in the Health Officer’s absence.
Dr. Matthew Zahn, a pediatric infectious disease specialist, oversees the Communicable Disease Control Division while Dr. Almaas Shaikh, a board-certified trauma surgeon, oversees the OC Health Care Agency’s (HCA) Community Health Assessment and Improvement Plan (OC CHIP) development and implementation and additionally partners with the community for preparedness work and improved partnerships.
Presenter Notes
May 28, 2025
Orange County has a rich history.
Reflecting on our county’s rich history, it is clear that many who preceded us –including the indigenous peoples, Spanish missionaries, rancheros and early settlers during the gold rush dreamed and saw the potential making Orange County a desired destination. It attracted settlers, health professionals, and visionaries alike. Their struggles and innovations laid the foundation upon which we build today. I learned that Orange County’s name was inspired not by its orange groves but by the promise of a semi-tropical paradise.
Image from: figure-1-2-public-health-achievements-of-the-twentieth-c-entury-l.jpg (1024×768)
Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025
During the 20th Century- the average life expectancy was quite low- as noted here. Infectious diseases afflicted many. Early public health efforts were primarily focused on the control of communicable disease and sanitation- as recurrent outbreaks of diphtheria (a disease that can cause severe sore throat, and strangled children with the bullneck that was formed), typhoid epidemic of 1924 which resulted in 28 deaths from waterborne outbreaks and 17 deaths from a milk-borne outbreak and hundreds of affected individuals (county population at the time was 91,00096,000), and smallpox cases were common. There were many viruses afflicting people- whether from exposure to others, or exposure from ingesting infected foods (raw milk, improperly cooked foods, or contamination of food or water sources). Additionally, there were infectious diseases that were spread person to person- such as influenza, measles, polio, or tuberculosis. In 1927 Orange County had a TB rate of 73.8/100,000- and at the time entire wards at the hospital were dedicated to those with tuberculosis.
Presenter Notes
May 28, 2025
Stray animals prior to the 1960’s also commonly had rabies and caused rabies infection in people. Health officers were tasked with doing their best to provide care for those who were imprisoned as well as controlling disease despite not having a formal public health office or support staff to carry out these responsibilities.
In 1922, with a county population growing to more than 60K, at the advisement of Health Officer Dr. Arthur Domann, the County of Orange (County) was able to find funds to establish a Public Health Department with full time staff. The Public Health Department’s humble beginnings started in the basement of the Old Courthouse in Santa Ana with a small team of dedicated professionals – including a Full-time Physician/Health Officer, a public health nurse who doubled as a dairy inspector, a sanitary inspector, a bacteriologist, and a stenographer. From there, it grew as the county grew.
One of our longest-serving Health Officers, Dr. Edward Lee Russell (who served the county for well over 30 years) regularly provided an annual report in the Physician’s Bulletin and also gave a lecture that was recorded in the latter portion of his service. He reflected on this progress. He recalled the days when diphtheria claimed many lives and how vaccines transformed public health, virtually eliminating diseases like polio. Dr. Russell foresaw future breakthroughs in understanding malignancies, cardiovascular diseases, genetics, environmental health, and more—many of which continue to shape modern medicine.
Presenter Notes
May 28, 2025
Stats:
1918- Spanish Flu
1922- death rate from contagious diseases: 469
1924- Typhoid outbreaks (water-borne and milk borne) 45 deaths
1927- Tb- 69 new cases reported
1928- Death rate: 8,94/1000 - Infant mortality: 73.48/1000 - Rabies- 109 people bitten by rabid dogs
1930- Death rate: 10.40/1,000. Recognized back then that emphasis had to be placed in improving services to the underserved to reduce the overall death rate in the county.
Leading causes of death: #1: cardiovascular followed by infectious disease.
Presenter Notes
May 28, 2025
The OC Health Care Agency (HCA) thrives with experts in medicine, science, academia, biotechnology, engineering, and more—continuing the pioneering spirit of our founders. We owe much to past leaders such as Dr. John Wehrly, who helped plan Orange County Hospital and fought tuberculosis, and Dr. Mark Horton, who served as Health Officer and later became California’s State Public Health Officer and many others. This year marks our Agency’s 103-year anniversary- and we’ve grown significantly from a team of 6 in the first year of the Agency’s establishment to a team of 3 thousand employees. Today, the HCA provides Behavioral Health Services, Correctional Health Services, Specialized Medical Services (includes California Children’s Services which was originally created by the state to address the growing polio epidemic), Emergency Medical Services (coordinates and regulates Emergency care in OC), Office of Public Guardian, our Public Health Services includes the Public Health Lab, TB control, STD/HIV care, Communicable Disease Control Division, Community Nursing, vaccination services, and the Environmental Health Division.
State of Public Health Report
Statewide mortality data trends can be found at: https://www.cdph.ca.gov/Programs/CHSI/Pages/County-HealthStatus-Profiles---Statewide-Mortality-Trends-Visualizations.aspx
Orange County Health Officer State of Health Address May 28, 2025
County Health Rankings & Roadmaps
Presenter Notes
May 28, 2025
Where does Orange County rank?
The California Department of Public Health typically releases the County Health Status Profile in March. This report takes into consideration selected data including mortality and morbidity as well as public health related categories. This year, its release will occur around May 30, 2025. Reviewing 2024’s County Health Status Profiles – revealed that Orange County overall fared well compared to the state.
On the national level, according to the 2025 County Health Rankings and Roadmaps (CHR&R) – an annual report published by the University of Wisconsin Population Health Institute and is supported by the Robert Wood Johnson Foundation, utilizes community conditions or social determinants of health to help with County Health Rankings, we are also faring well- as you see on the table we live in one of the healthiest counties in the country. Our strengths include a high flu vaccination rate compared to the state and the nation. However, note that these reports present aggregated data- representing the county as a whole. We know that as a whole, we might be doing well, we also know that there are different groups and segments that are more disadvantaged than others and have poorer health outcomes.
Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025
Reference: Details on data collected for the report:
-Average number of years people are expected to live. The 2025 Annual Data Release used data from 2020-2022 for this measure.
-Life Expectancy is a familiar and important population health outcome measure and can be easier to interpret than other mortality measures. Data Source National Center for Health Statistics - Natality and Mortality Files; Census Population Estimates Program.
-The National Center for Health Statistics (NCHS) provides birth and death data drawn from the National Vital Statistics System (NVSS).
-While most calculations of mortality rates can be downloaded from the Centers for Disease Control (CDC) WONDER, calculation of the Premature Death and Life Expectancy measures requires raw data files.
-The Census Bureau’s Population Estimates Program (PEP) uses data on births, deaths, and migration to estimate population changes occurring since the most recent decennial census and produce a vintage, or annual time series of estimates.
Presenter Notes
May 28, 2025
Earlier this year, Dr. Erica Pan - Director and State Public Health Officer - provided an update of the State of Health to the legislature, noting that in the years leading up to the COVID-19 pandemic, public health funding and support was restricted to very specific diseases and activities. COVID-19 brought on unprecedented challenges and highlighted the need for a stronger workforce and modernization.
The COVID-19 pandemic led to a drop in life expectancy for the first time in two decades from 81 years in 2019 to 78.4 years in 2021. This dip was also noted in Orange County. As you can see on the graphs, life expectancy has been improving since 2021, and is returning to pre-pandemic levels.
Orange County - Pediatric Population
Conditions of Children Report released December 2024
Presenter Notes
May 28, 2025
The Annual Report on the Conditions of Children in Orange County is published each December and provides a comprehensive portrait of the health, economic well-being, education, and safety of Orange County's children. The report includes data for indicators to assess improving or worsening trends over 10 years. For the most recently published report, two new indicators were added- child care and perinatal behavioral health.
We know that consistent childcare is important to child development and family financial stability. In 2023-2024, the number of early childcare spaces in OC declined, while the cost of childcare increaseddemonstrating lack of accessible childcare.
Presenter Notes
May 28, 2025
- Perinatal behavioral health, there was a 55.9% increase in referrals for substance-exposed infants to the OC Social Services Agency. Unborn babies exposed to substance use face long-term challenges, including premature birth, low birth weight, and higher risk for congenital anomalies and developmental and behavioral concerns.
- Mental health also continues to be a challenge during pregnancy; indicators show a modest recent rise in depression, with 15.1% experiencing depression during pregnancy and 11.2% postpartum. Mental health issues such as depression, anxiety and postpartum psychosis can inhibit parent's ability to care for themselves and bond with their newborn.
Talking about these concerns and creating an understanding social environment may encourage more parents and families to seek mental health treatment and support. The following areas have shown improvement in the lives of local youth:
Good Health: The percentage of uninsured children continues to drop to 3% as access to regular care improves. Rates for 2-5-year-olds enrolling in licensed childcare are at a 10-year high, and 95.6% of children enrolling in school are adequately immunized by kindergarten.
Presenter Notes
May 28, 2025 --------------------------------------------
Education: Orange County high school graduates have consistently higher rates of college readiness compared to the state average. The percent of college ready students increased for the 11th straight year and is now at 57.3%.
Economic Well-being: The number of children receiving CalWORKs in Orange County stabilized after eight years of decline. In 2022-2023, 3.3% of children received CalWORKs assistance, a 47% decrease from 6% of children from 2013-2014.
Safe Homes and Communities: The rate of foster care placements in permanent homes within 12 months improved, exceeding the national standard. Juvenile crime rates also decreased with the number of arrest rates per 100,000 youth down to 458 arrests in 2022.
While much progress has been made, continued areas for focus include behavioral health, chronic absenteeism, racial and ethnic disparities and insecure housing, among others. Reports of depressed-related feelings, sadness and hopelessness continue to rise in students. Chronic absenteeism is at a slight decline from the previous year; however, the numbers remain elevated, with the highest rates among students enrolled in Foster Youth and Homeless Youth. Post-pandemic family stability continues to waver across Orange County, seriously affecting the health and growth of the children in our community.
Total Number of Death for Infants under 1 in Orange County (2017-2023)
Total Number of Death for Ages 1 to 17 in Orange County (2017-2023)
Certain conditions originating in the perinatal period
Congenital malformations, deformations and chromosomal abnormalities
Orange County Health Officer State of Health Address May 28, 2025
*Note that missing data represent suppressed counts of fewer than 11 deaths
Source: California Comprehensive Death File (AKA CCDF)
Presenter Notes
May 28, 2025
When you look at infant mortality- you can see the differences in mortality between ethnicities. There were 153 total accidental deaths for children ages 1-17 between 2017 and 2023.
Of these 153 accidental deaths, most were due to transport-related accidents (70 deaths, or 46% of accidental deaths) followed by overdose deaths (48 deaths, 31%) and drowning deaths (27 deaths, 18%).
Among the 70 transport-related deaths, 39% were children as passengers in motor vehicles, 36% were children as pedestrians, and the remaining were children as cyclists, water/air vehicle passengers (boat, etc.), motorcycle passenger, etc.
(Note that graphs with missing data represent suppressed counts of fewer than 11 deaths.)
Every Parent OC is a resource for anyone who is thinking of becoming pregnant, is pregnant, or has a new baby. Our goal is to provide you with information and resources necessary to experience pregnancy and parenting in a safe and healthy way.
Presenter Notes
May 28, 2025
The has different programs and staff who provide services to the community to address maternal, child and adolescent health related challenges. The HCA partners with many different organizations- including the OC Perinatal Council which has members from different organizations who are focused on delivering care to this community. Information is provided to the community and providers on everyparentoc.org. Examples of the work that has been performed include Family Wellness Plans- or Plans of Safe Care. Several training sessions were provided in the past two years and a provider toolkit has been created and is available on the Every Parent OC website for clinicians to utilize. The HCA has a Maternal Child and Adolescent Program that performs a regular assessment every 5 years
The recent 2024 assessment noted the following: The rate of early prenatal care in Orange County, when excluding self-pay deliveries, was 90.1% in 2022. This is a slight increase from the previous year’s rate of 89.3%.
Racial/ethnic, geographic, and socioeconomic disparities affect early prenatal care with non-White birthing persons in Orange County experiencing lower rates than Whites. Native Hawaiian and Other Pacific Islander (NHOPI) and Black birthing persons experienced the lowest rates of early prenatal care in 2022 at 72.2% and 81.2%, respectively.
Presenter Notes
May 28, 2025
Cities with the lowest percentage of women receiving early prenatal care in 2022 were Midway City (80.2%), Stanton (83.3%), Westminster (83.8%), and Santa Ana (85.2%). Additionally, when assessing by education, individuals with less than a high school diploma experienced the lowest rates of early prenatal care (82.1%). Severe complications from labor or delivery, such as potentially life-threatening hemorrhage, infection, and cardiac events, are increasing in Orange County and rates are highest in Black mothers. The rate of severe maternal morbidity is higher in Orange County (87.7 persons with severe complications per 10,000 delivery hospitalizations) than the Healthy People 2030 target (68.1).
There have been significant increases between 2008 and 2019 in mental health and substance use diagnoses among hospitalized pregnant individuals aged 15-44 years across all race/ethnicity categories. Disparities across race/ethnicity groups are evident. Blacks had the highest rate of mental health diagnoses (92.8 per 1,000 hospitalizations) and substance use diagnoses (52.5 per 1,000 hospitalizations) among hospitalized pregnant individuals aged 15-44. In 2017-2019. Hispanics had the largest percent increase (334.2%) in mental health diagnoses when comparing 3-year averages (2008-2010 vs. 2017-2019), and Asian and Pacific Islanders had the largest percent increase (302.7%) in substance use diagnoses during the same time period.
Presenter Notes
May 28, 2025
Multiple efforts across the county have been focused on prioritizing the health of children in Orange County. Examples include;
-Orange County was one of the first counties to establish a childhood death review team which is run by the Sheriff’s office.
-Perinatal Council- meets on a regular basis- includes local community based organizations, clinical and hospital partners to review all efforts focused on maternal/infant health.
-Walk to School Day- is a day of awareness in our cities and schools- where efforts are focused on pedestrian and bicycle safety efforts.
-May is Drowning prevention Month- Orange County has a Drowning Coalition that includes a variety of membersincluding community members, researchers, clinicians. Behavioral health Services runs fentanyl overdose awareness and prevention efforts.
-Electric Vehicles- which includes e-bikes and e-scooters are now contributing also to significant injuries across all ages. Local trauma centers have seen a significant rise in traumatic injuries related to e-vehicle usage across all ages- from 2 years old to older adults, with the majority of cases occurring in the children, adolescents and young adults. An e-bike collaborative started meeting earlier this year to share data as well as efforts to improve community awareness around safety and helmet use with e-vehicles.
Presenter Notes
May 28, 2025
As noted by the Orange County Business Council's Community Indicators report- the proportion of those > 65 is projected increase and surpass the 25–44 age group and the 45-65 age group.
For those of you who work with the aging population, or who may be age 65+, or have loved ones you are caring for who are 65+, there are unique needs for both the aging individual as well as the caregiver. According to the Report on Aging in Orange County, which was published in 2024, the top concerns are as listed- and include Alzheimer’s disease and dementia and memory loss.
Barriers to accessing medical/behavioral health services are already being faced by many todayincluding inconvenient appointment times, not knowing where to get help, high cost and lack of transportations.
Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025
Cause of death is from the Underlying Cause of Death definition: World Health Organization (WHO) as "the disease or injury which initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury.“ (Death Profiles by Leading Causes of Death - DatasetCalifornia Health and Human Services Open Data Portal).
The number and rate of deaths in Orange County remained relatively level between 2017 and 2019, but increased 16% in 2020, the first year of the global pandemic, and increased 6% in 2021 – for a 23% increase compared to pre-pandemic mortality. After reaching a high in 2021, there was a gradual decline through 2023.
Despite recent decreases, the total number and rate remain above pre-pandemic levels. Heart disease and cancer were consistently the two leading causes of death during 2017 to 2023. Their trends remained relatively stable, with slight increases over time. COVID-19 appeared in 2020, peaked sharply in 2021, and then declined dramatically in 2022 and 2023, falling below other causes.
Accidents (unintentional injuries) show a gradual increase, becoming more prominent in recent yearsapproaching or surpassing stroke.
Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025
Heart Disease and Cancer are the leading causes of death both in OC and CA. COVID-19 caused a significant temporary spike around 2020-2021, then decreased.
Even if the Heart Disease rate had previously declined in CA, a slight upward trend is observed in both CA and OC during 2017 to 2023.
Alzheimer's is a growing concern in OC, becoming the third cause of death, unlike in CA, where Alzheimer's deaths are not in the top 3 causes.
Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025
As you see on this chart, neonatal conditions and congenital anomalies affect infants and toddlers. For adolescents and young adults, drug overdose, road injury and suicide are leading causes of death. You then start to see stroke and cardiovascular disease enter the top 5 starting at the mid 30mid 40's, with ischemic heart disease leading as the top leading cause of death for those 55-84. Alzheimer's takes the lead for those 85+. County Health Status Profiles.
2024- Overall, when looking at trends- death rates have been downward trending pre-COVID. But you see Chronic Liver Disease and Cirrhosis trend upward in 2020 and 2021 and decline in 2022. When looking at deaths related to external and environmental forces, you see a rise in drug overdose deaths and accidents. And while this is representative of California, rates in deaths are similar in Orange County.
(Source: HCA Suicide Data Dashboard, https://www.ochealthinfo.com/services-programs/mental-healthcrisis-recovery/wellness-promotion-prevention/suicide-prevention-3; CA Department of Finance Population Projections, P-3, July 2022 Vintage. https://dof.ca.gov/forecasting/demographics/projections/)
Presenter Notes
May 28, 2025
Suicides- intentional self harm and suicide, continue to be a public health concern in Orange County. The HCA has a Suicide Data Dashboard that pulls data from the California Comprehensive Death File.
https://www.ochealthinfo.com/services-programs/mental-health-crisis-recovery/wellness-promotion-prevention/sui cide-prevention-3
From 2001 to 2023 suicide death rates increased by 32%.
2001 to 2023 approximately 300 lives lost to suicide each year, on average 6,889 deaths/23(yrs) = 300 average per year (299.5).
2018 saw an all-time high of 369 lives lost to suicide.
- Those greater than 65 years continue to die by suicide in the greatest numbers in Orange County, 23% of all suicide deaths in 2021-2023 were among this age group.
- BUT when comparing based on the overall population size of each age group, 55–64-year-olds had the highest rate of death, at 15.7 per 100,000, followed by 25- to 34-year-olds at 14.4 per 100,000.
Presenter Notes
May 28, 2025
Youths 10-17 years and young adults
19-24 years had the lowest rates of suicide death (2.5 and 7.8 per 100,000). The number of deaths among these two age groups have been relatively stable between 2021 and 2023
Between 2021 and 2023, older adults 65 years and older have the highest number of suicide deaths, at 223 deaths over that 3-year period. Their rate of suicide death, at 13.4 per 100,000, was the third highest among the age groups. (Source: California Community Burden of Disease Engine, accessed 3/20/2025. https://skylab.cdph.ca.gov/communityBurden/)
• The highest rates of suicide death are still among White residents in Orange County, at 15.9 suicide deaths per 100,000, in the period between 2021-2023.
• Black residents have the second highest rate at 11.6 suicide deaths per 100,000.
• Unlike other race and ethnicity groups, the rate of suicide deaths among Asian residents has been increasing from 6.3 per 100,000 in the period between 2012 and 2014 to 9.6 per 100,000 in 2021 to 2023.
Presenter Notes
May 28, 2025
• Males continue to have the highest rates of suicide death, at 16.1 per 100,000, compared to females at approximately one-third that rate at 5.2 per 100,000 in the period between 2021 and 2023.
• For those younger than 54 years, strangulation and asphyxia was the most common means in completing suicide death, followed by firearms.
• For those older than 55 years, firearms was the most common means in completing suicide death, followed by strangulation and asphyxia.
• For all age groups 25 and older, death by overdose (drugs) was the third most common means, and for those younger than 25, jumping from a high place was the third most common.
In March 2019, at the direction of the Orange County Board of Supervisors, the HCA established an Office of Suicide Prevention and a Countywide Suicide Prevention Coalition (CSPC). The priority populations based on Suicide Death Data trends identified were:
-Men in their middle years (with focus on vets, construction workers, first responders)
-Older adults
-Youth and young adults
-Diverse
Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025
In 2023 (the most recent year with confirmed data), 1,213 people in Orange County died of a drug or alcohol related cause. Data updated 7/24/2024
Note: One death can be counted more than once on this figure, if more than one substance was present on decedent at time of death. Also, this figure looks at all substances listed as an underlying cause on the death certificate even if it was not determined as the primary substance leading to death. For the category listed as stimulants, approximately 92% to 98% of these cases involved methamphetamines in any given year. Estimates for those who die from drug and alcoholrelated causes who have taken multiple substances (aka polydrug – including drugs and alcohol at once) are between 35% and up to about 50% of the drug and alcohol-related deaths in a given year (peak reached in 2021).
Orange County Health Officer State of Health Address May 28, 2025
Orange County Fentanyl-Related Overdose Deaths
Youth & Young Adults 2018 - 2023
May 28, 2025
In 2023 (the most recent year with confirmed data), 1,213 people in Orange County died of a drug or alcohol related cause. Opioid related deaths accounted for 576 of those deaths, which is a rate of 18.3 per 100,000 people. The largest age group for overdose deaths in Orange County are 25–44-year old’s, followed by 45–64-year-olds.
Black residents have experienced the highest overdose death rate among all race/ethnicity groups, with Asian/Pacific Islanders having the lowest overdose death rate. Although, Black residents experienced the highest overdose death rate, White residents were the majority of overdose deaths (52% in 2023). Males continue to comprise most of the overdose deaths in Orange County.
Fentanyl overdose death rates have dropped 7.4% in 2023 from the prior year. Fentanyl has become the most frequent type of opioid (91% in 2023) involved in opioid deaths. Santa Ana, Anaheim, and Huntington Beach had the highest number of opioid overdose deaths between 2021 and 2023; however, the highest 3-year average rates within that same period were in Huntington Beach, Santa Ana, and San Juan Capistrano.
Presenter Notes
May 28, 2025
The HCA launched the Fentanyl is Forever Campaign in Orange County in October 2023 through a multimedia campaign and accompanying customized websites (www.fentanylisforeveroc.org and www.FentaniloOC.com) with local resources.
The campaign and websites educate about the dangers of illicit fentanyl and overdose prevention, including where individuals can receive free Naloxone and training on how to administer this life-saving medication that can reverse an overdose. Since the inception of the campaign, there have been over 436,500 unique visitors to the websites.
Customized campaign materials into the several languages have been developed for amplifying culturally appropriate awareness messaging.
Presenter Notes
May 28, 2025
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Currently 14 community Naloxone distribution sites have been stood up in 10 cities across OC; in addition the HCA continues to participate in numerous community event to increase awareness of overdose prevention and to distribute Naloxone.
To further address opioid overdoses, the HCA has used Opioid Abatement Settlement funding to expand Substance Use Disorder treatment services and supports, including the expansion of residential treatment and withdrawal management beds, expansion of recovery residence beds and used funding to provide MAT (Medically Assisted Treatment) in the custody setting.
Recreational Use of Nitrous Oxide (N2O) is on the Rise!
Here are some tips of what to do with Nitrous Oxide canisters:
1. Do not puncture, incinerate or store N2O canisters near flammable materials
2. Do NOT dispose N2O canisters in the regular trash
3. Contact OC Waste & Recycling for further instructions on where you can turn these items in
4. Follow the center’s recommendations
Presenter Notes
May 28, 2025
Unfortunately, Nitrous Oxide, also known as Laughing Gas is increasingly being used recreationally across the globe as it is being popularized on social media and is easily accessible.
On March 14, 2205, the Food and Drug Administration (FDA) issued a Consumer Advisory – advising consumers not to inhale nitrous oxide products from any size canisters, tanks, or chargers as inhaling nitrous oxide recreationally can lead to serious health effects (B12 deficiency and neurologic effects), including death.
Earlier this year, the Orange County Board of Supervisors approved an ordinance which bans the sale or distribution of Nitrous Oxide for recreational use.
Orange County Health Officer State of Health Address May 28, 2025
May 28, 2025
From the OC CHIP plan which is available on our website at https://www.ochealthinfo.com/page/oc-health-improvement-plan.
• 2024-2025 Winter Respiratory Season
• COVID-19
• Respiratory Syncytial Virus (RSV)
• Influenza Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025
The good news is that COVID-19 remained low this recent winter season, while seasonal influenza dominated over other respiratory viruses. This was also seen locally. As you can see the percent of positivity for flu (yellow) was much higher than COVID-19 and Respiratory Syncytial Virus (RSV) test positivity. Additionally on the mortality table on the upper right, you see that pediatric deaths were higher over the past season compared to the previous 4 years.
According to the CDC Preliminary Estimated Flu Disease Burden for 2024-2025 Season, flu-related hospitalizations estimates were higher than previous years- ranging from 610,000-1.3 million. This past flu season resulted in a total of 226 deaths according to the CDC’s FluView as of May 9, 2025, which is the most the nation has encountered since 2009-10 when 288 pediatric deaths were recorded. For comparison, nationwide pediatric deaths related to flu for 2021-2022 season was 49, 22-23 season: 187, 2324 season: 207, 24-25 season: 226.
Earlier this month, Riverside County public health officials reported the first pediatric flu-associated death of the season. The CDC stated that, “Among children who were eligible for influenza vaccination and with known vaccine status, 90% of reported pediatric deaths have occurred in children who were not fully vaccinated against influenza."
Hesitancy and lower flu vaccination rates may have contributed to the increased flu burden experienced during the past winter season, highlighting the importance of implementing strategies for improved use of preventive measures to help protect against severe flu illness in the 2025-26 season.
https://ochealthinfo.com/services-programs/hivstd-and-tb-clinics/pulmonary-disease-services
Presenter Notes
May 28, 2025
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Historically- Orange County has been a county with the highest cases of Tuberculosis across the state since the year it was founded- hitting a death rate of 173 per 100,000 in initial decades of the county’s foundation.
With establishment of the Public Health Department, and the detection and control efforts in both human and cattle, rates then went down to 74.61 per 100,000 in 1928 which was lower than the national rate of 86.15 in 1927. As you can see on the tables that are available on our website- last year, we had a rate of 5.3- which although higher than the United States, has improved from the prior year and is now at a rate lower than the state.
- Chlamydia cases were down by 26% from a peak in 2019 (14,260 to 10,482 cases)
- Gonorrhea cases were down by 27% from a peak in 2021 (5,341 to 3,871 cases)
- Contagious syphilis cases were down by 47% in 2021 (944 to 501 cases)
- Congenital syphilis cases were down by 53% in 2022 (32 to 15 cases)
- Mpox cases were down from 294 in 2022 to 30 in 2024
- Newly diagnosed with HIV: 230
- Persons living with HIV (PLWH) who are aware of their HIV status 6,955
- Estimated # of persons unaware of their HIV status: 1,706
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• 747 new cases (age-adjusted rate 22.4 cases/100,000) of chronic hepatitis C infection were identified in OC in 2024.
• This is a 19% decrease compared to 2023.
• Changing Epidemiology
• < 40 yo - Primary risk factor was injection drug use
• > 65 yo - Variety of risk factors identified
May 28, 2025
Hepatitis Awareness Month
You’ve likely seen on the news of recent Hepatitis A outbreaks in another southern California county. The good news is that we are not seeing a Hepatitis A outbreak locally. While there is a Hepatitis B vaccine to prevent the illness, for those who have been identified as having Hepatitis B, they are advised to be monitored by their primary care providers, while those identified to have Hepatitis C should speak to their provider to talk about the highly effective treatment that exist and can cure the disease.
-Since the introduction of effective Hepatitis C treatments which became available in 2014, the local case counts of Hepatitis C have gradually decreased. However, despite treatment availabilities, over the past 5 years we have averaged above 700 cases annually. While identified annual cases have decreased as a result of changing epidemiology, cases in the those > 65 were a result of different exposures- including exposure from receipt of infected transfusions.
Hepatitis C cases has increased in those under 40, primarily amongst those who inject drugs. People need to be screened and when identified offered treatment.
Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025
Leading Causes of Cancer deaths in Orange County have been Lung, Breast, Prostate, Colon, and Pancreatic. This is consistent with the top cancer deaths in the state. There has been a small and steady increase, overall, in the total number of cancer deaths since 2010 (gray bars) in Orange County.
The rate of lung cancer deaths, which has been the leading cause of cancer death since 2010 for both the state and Orange County, has been on a prominent declining trend (about 33 deaths per 100k population in 2010 to 24 deaths per 100k in 2024). In fact, preliminary findings for 2024 show that lung cancer deaths fell below the rate of breast cancer deaths for Orange County in 2024.
(Note that breast cancer rate of death is among population of females only, and prostate cancer rate is among male population only. Other rates are among the total population of OC.)
Orange County Health Officer State of Health Address May 28, 2025
May 28, 2025
Generally, since 2010 the cancer mortality rate among White residents in OC has decreased, but among Asian and Hispanic residents the mortality rate has increased. (Black residents also appear to have a generally increasing cancer mortality trend, but their smaller numbers make the trend less stable.) Asian residents have seen increases in their lung cancer mortality rates, whereas White residents have seen their lung cancer mortality rates fall.
Orange County Health Officer State of Health Address May 28, 2025
May 28, 2025
While Lung Cancer still ranks as a leading cause of cancer related deaths, we have seen a significant decline as a result of all the efforts to reduce tobacco use.
Coccidiomycosis/ Valley Fever
County Health Officer State of Health Address May 28, 2025
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Orange County Health Officer State of Health Address May 28, 2025
May 28, 2025
Bird flu- if you haven’t already heard of it, you probably were affected when the price of eggs significantly increased the last few months. Over the past two years, Bird flu- H5N1 has been circulating- primarily affecting birds and other animals. So far, 70 human cases (all of whom had contact with infected animals either from working on an affected dairy or poultry farm, or from exposure to an ill wild bird) have been identified, and 1 death has been associated with the H5N1 Outbreak. Preventive measures are recommended for those in direct contact with sick animals are at highest risk of exposure and development of symptoms. Efforts across the country have been taking place and across our county to help control the spread. The state and the nation is continuing to monitor this situation.
Dairy milk is now being tested for H5N1, while poultry farms are also being monitored for H5N1. A significant number of farms have been affected- resulting in significant efforts to protect the food supply from H5N1- this has resulted in the culling of millions of birds, and preventive measures such as quarantine/isolation of affected dairy cattle, and disposal of infected milk supplies. H5N1 has also affected felines disproportionately – causing severe illness and neurologic disease in felines (wild as well as domesticated felines) that are exposed to the virus either through contaminated milk (raw milk) or food (raw pet food).
In the meanwhile, the public is urged to choose pasteurized milk, avoid consuming unpasteurized milk- (several batches have been identified to have H5N1).
Presenter Notes
May 28, 2025
As you are likely seeing on the news- more cases of measles is being identified and unfortunately earlier this year, three deaths have occurred as a result of measles. As of May 23rd, 1,046 measles cases have been identified from 31 jurisdictions across the nation- 92% of cases are part of outbreaks, 12% of cases have required hospitalization. We are likely going to surpass 2019 levels (1,274).
So far, the outbreaks have primarily been affecting communities and people who do not have adequate immunity. 96% percent of those infected were unvaccinated or have unknown vaccination status.
The vaccination requirements in schools have saved California from experiencing outbreaks in 2014-2015 when measles was identified and is likely also continuing to protect the pediatric population today.
Orange County Health Officer State of Health Address May 28, 2025
May 28, 2025
Diseases that impacted many lives in Orange County in the 20th Century have nearly been eliminated with widespread vaccination efforts. The widespread use of safe, effective childhood vaccinations has been one of the most successful and cost-effective public health interventions in the US and globally. Many serious and oncecommon childhood infections have been dramatically reduced through routine immunizations.
The success of immunization programs depends upon appropriate timing and on a high rate of vaccine acceptance, particularly among parents of young children. Over the past decade, increasing numbers of children with delayed or refused vaccinations have led to reduced levels of vaccine coverage.
Studies have found that children whose parents delay or refuse vaccines are more likely to be White and reside in well-educated, higher income areas. On the population level, success depends on a community achieving a threshold level of immunity, and many communities are below the protective level needed to prevent the spread of disease. With many of the children who attend local schools protected, an outbreak is less likely to occur in childcare centers and schools – however individuals and communities who are unprotected are still at risk.
June- Silicosis Awareness
Month
• Orange County has well over 100 fabricated stone businesses.
• To date, 60 cases of silicosis have been diagnosed in Orange County since 2019!
- Increased Education/Awareness
-Improved surveillance/detection of disease
-Improved Care Pathway navigation for affected individuals
Link: https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/OHB/Pages/essdashboard.aspx
Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025
We have a small and mighty Emergency Medical Services (EMS) team that serves to plan and coordinate pre-hospital and emergency care across our county. Over the past decade, our county has been challenged with coordination of care to respond to the COVID-19 pandemic, the surge of RSV that affected us in 2023, recent fires, and record setting trends in pre-hospital transport reached this year- even beyond what we experienced during the COVID emergency. In January alone, 18,108 transports occurred in Orange County.
Our system of care- through coordination between first responders, our EMS teams and our network of hospitals has been able to manage the rise and demand for hospital services- despite these record numbers- our county has been able to minimize offload times to < 20 minutes- so that patients can get care they need in a timely manner – this requires significant coordination and efficiency across multiple partners.
In March this year our Orange County Emergency Medical Services team received an award from the state for their groundbreaking Bi-directional Data Exchange project. Led by Laurent Repass, this project enhances emergency medical response and patient care coordination.
Every year our EMS team and local hospitals participate in a statewide health exercise simulation to better understand how to address crisis scenarios. Through engagement and continuous preparedness activities such as this, we hope that efforts will pay off with improving response during an actual crisis.
As a result of federal funding reductions (including Epidemiology and Lab Capacity Enhancing Detection and Immunization and Vaccines for Children grants), the HCA Public Health Services has had to evaluate mandated services and community capacity to absorb impacted care.
As a result of thorough discussions, the following Programs are impacted:
• Emergency Dental Services – effective May 6, 2025
• Pediatric Clinic/Family Planning Access, Care and Treatment Program (PACT)- effective June 30, 2025
Where will clients be referred to?
Clients will be connected to alternative providers through a coordinated transition plan- (Medi-Cal Managed Care and Medi-Cal
Dental Providers, Federally Qualified Health Centers, Community Clinics and Family PACT providers in the community)
Will HCA’s 17th Street Clinic continue to offer clinical services?
Yes. The following clinics remain operational: Immunization Clinic, Pulmonary Disease Services Clinic, Testing, Treatment and Care Clinic.
If Clients have questions about services, who can they contact?
The HCA Health Referral Line will remain available to the public for Public Health related questions and clinic services: (800)
564-8448 M-F 8am-5pm
Presenter Notes
May 28, 2025
1) Emergency Dental Services – effective May 6, 2025
Previously offered Emergency Dental Services at HCA’s 17th Street Campus will discontinue.
Average number of clients seen in 2024: 239
Free/low-cost emergency and comprehensive dental services are available at multiple clinics across the county.
Clients seeking dental services will be transitioned to network of providers across Orange County.
2) Child Health Clinic/Family PACT- effective June 30, 2025
Pediatric physicals and sick care previously provided by Family Health Services will be discontinued.
Calendar Year 2024 encounters: 2,037
Family PACT (Family Planning Access, Care and Treatment Program) family planning services will be discontinued. Calendar Year 2024 encounters: 450.
Orange County Health Officer State of Health Address May 28, 2025
Presenter Notes
May 28, 2025
Community Health Assessment (CHA)/Community Health Improvement Plan (CHIP) – workgroup and many different collaboratives working across Orange County to tackle different issues- from food insecurity to housing and care for the homeless.
Additionally, as Orange County, CalOptima and Kaiser are working on a unified CHA/CHIP and have also invited other hospital leaders in on the early planning of this.
Prevention, Promotion, Protection, Partnership
May 28, 2025
We have multiple challenges including the rise of communicable diseases, multidrug resistant organisms, the potential for re-emergence of preventable bacterial and viral illness that once was controlled with high vaccination rates, rise of chronic conditions related to lifestyle, diet, or environmental exposures. We also face a different set of injuries- with the rise of other modes of transportation, or emerging drug/substance use, and untreated mental health related conditions that may also be aggravated by today’s uncertainties, pressures and world-wide crisis.
We should be proud of how Orange County has grown, innovated, and thrived, fulfilling much of the promise envisioned by those early settlers—and yet we still have so much more opportunity ahead. The 20th Century brought revolutionary public health advances—from clean water systems to antibiotics and vaccines—that dramatically increased life expectancy and quality of life. These advances, along with a dedicated team laid the foundation for controlling infectious diseases.
For many years, we have benefited from the hard-earned lessons, challenges, and solutions developed by those who came before us. While many may not know this history firsthand, it’s important to remember the heartache and countless lives lost to infectious diseases and the devastating impacts of severe weather.
Orange County Health Officer State of Health Address May 28, 2025
Follow the OC Health Care Agency on Social Media
Orange County Health Officer State of Health Address May 28, 2025
Cancer cases are collected from physicians, pathologists, hospitals, and treatment facilities are reported to a statewide systemCalifornia Cancer Registry (CCR). The state also participates in the CDC’s National Program of Cancer Registries and in the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI).
The public can also access data through the Cal*Explorer Cancer Data by clicking on the tab “Data for Public” (https://www.ccrcal.org/retrieve-data/datafor-the-public/) then clicking on “Access Cal*Explorer-CA Cancer Data or access Health Maps on the right.
Locally, UCI Chao Family Comprehensive Cancer Center (CFCCC) has created a Cancer Burden Catchment Area Dashboard to help the community understand the cancer burden in Orange County.
This can be accessed by visiting https://cancer.uci.edu/about/catchment-area.
County Health Officer State of Health Address May 28, 2025
