Health System: Public Health, Policy and Planning
(5550P and 6220P)

Program Outcome Statement

Improve the health of all San Mateo County residents by preventing, monitoring, screening and treating communicable and chronic diseases and injury and implementing place-based primary prevention strategies.

Program Services

  • Animal Control and Licensing
  • Birth and Death Record Registration
  • Communicable Disease Control
  • Epidemiological Investigation
  • Health Policy Development
  • Public Health Laboratory Services
  • Public Health Clinical Services
  • Whole Person Care


Overview

Public Health, Policy, and Planning protects the health of all San Mateo County residents by investigating and analyzing communicable diseases and other health issues, engaging in disease treatment and prevention measures, and creating conditions that enable all San Mateo County residents to live healthy lives. 
Diseases of focus include flu viruses, salmonella, HIV, sexually transmitted diseases (STDs), tuberculosis, rabies, and other communicable diseases. In order to achieve this goal, Public Health operates a public health laboratory; provides health care services to people with HIV, STDs and infectious disease at the Edison Clinic; brings healthcare to people who otherwise would not receive it through the Mobile Clinic; maintains an infrastructure and training for disaster response; investigates reportable diseases and engages in prevention measures; provides animal control and care; and registers all births and deaths in the county. Epidemiologists monitor disease in the population, watch for and solve infectious disease outbreaks and analyze health data to help pinpoint health problems.
Public Health intends to protect the health of all 750,000 San Mateo County residents by monitoring over 5000 disease cases, performing over 69,000 laboratory tests; serving 1,250 homeless clients; registering over 4,500 deaths and 5,500 births; providing clinical services to over 1,500 patients in the STD/HIV Edison Clinics; and providing 602 people with TB services annually.
Health Policy and Planning (HPP) focuses on making it easy for all residents to stay healthy. HPP planners partner with community-based organizations and other County agencies to find solutions. HPP’s long term strategies to lead the County’s efforts to improve the food and physical activity environments and to make the healthy choice the easy choice include: awarding 30 contracts to local school districts, community-based organizations and cities for the implementation of HPP’s initiative, Get Healthy San Mateo County, activities and communication strategies including eliminating sugary drinks from public property, increasing walking and bicycling safety, conducting corner store make-overs to include healthy foods, supporting cities and organizations to adopt wellness policies, and engaging parents in school wellness; developing and implementing the first Health and Wellness element for the North Fair Oaks Community Plan, drafting Complete Streets language for cities in Priority Development Areas, increasing participation in the local Safe Routes to School program; and piloting innovative prevention strategies such as the East Palo Alto Police Department Fit Zone project and the Redwood City Drink More Water Campaign.
Whole Person Care is a pilot courtesy of California's Medi-Cal 1115 waiver. The Health System is leveraging $16.5 million in local dollars, and $2 million Measure K investment to earn up to $16.5 million in federal funding annually to support transformations in the quality of care, access and efficiency for up to 2,000 complex, high-risk clients. The objective of the pilot is to engage clients with high mental health and substance abuse needs that have complicated medical conditions and homelessness that require substantial system coordination.  
The Bridges to Wellness (BWT) team within Whole Person Care uses a care navigation model to support the largely homeless highest utilizers with the ultimate goal of connecting clients with their primary care or behavioral health home. Data shows that following the engagement of a set of clients by care navigators from the BWT team, emergency room visits among the same group dropped by 35 percent. The pilot has also achieved success with diabetes control for 46 percent of eligible clients, and housing five clients who have struggled with homelessness or housing instability that has affected their health. 

Percent of HIV Patients with a Clinically Undetectable Viral Load Exceeding Target

Percent of San Mateo County Children Overweight or Obese Met Target at Last Measurement

Percent of San Mateo County Adults with Type II Diabetes Above Target

FY 2017-18 Year-End Story Behind Performance

Percent of HIV patients with Clinically Undetectable Viral Load

Public Health provides primary medical care and supportive services to people with HIV in order to maintain their health, increase their quality of life and life expectancy, and reduce the transmission of HIV. A significant measure in achieving these outcomes is maintaining an undetectable HIV viral load for the patient, which is defined as less than 200 copies per ml of blood. In fiscal year 2017-18, the target for the percent of HIV patients with a clinically undetectable viral load was surpassed.  This result is attributable to aggressive nursing, social work outreach to support patients to take antiretroviral medications, as well as provider expertise to prescibe and support safe, effective, well-tolerated regimens.

Percent of San Mateo Children Obese or Overweight

Childhood obesity and excess weight lead to a lifetime of preventable chronic diseases. While the rates of childhood obesity are increasing across the country, San Mateo County is one of a few counties that has successfully held the rate of increase flat - this in fact constitutes significant work and will be a success.

However, new data has not been available for this performance measure for several years. The data is obtained from the California Deparment of Education (DOE), and the DOE made a decision to no longer share this data. The California Department of Public Health is currently working with the DOE to try and obtain access to the data again. Updated results will be reported when the data becomes available.

Percent of San Mateo County Adults with Type II Diabetes

Type II diabetes is also a highly preventable chronic disease. The national rates of this disease have doubled in less than a decade indicating a growing health issue. In San Mateo County, the percentage of adults reported to have Type II diabetes increased this fiscal year compared to the prior fiscal year. Although it was a slight increase of only two percentage points, San Mateo County is currently not meeting the established target for this performance measure.  Please note, however, the two percentage point increase could be due to a fluctuation from small numbers, as the California Health Interview Survey (CHIS) used to capture the diabetes data only surveys approximately 300 county residents.  Unfortunately, we are limited in the sources of diabetes and other chronic disease data and currently this is the best data source available. In the future, we will evaluate using confidence limits due to the small sample size to determine if the estimate is stable and if not the data should be interpreted with extreme caution.
 
PHPP will:  1) continue to encourage residents to screen for pre-diabetes; 2) provide technical support to Cities to implement policies that reduce the consumption of sweetened sugar beverages and increase physical activity (e.g. recently passed Daily City beverage neutral policy); 3) sustain current nutrition efforts - including, but not limited to, the federally funded nutrition education and obesity prevention program (NEOP), the University Cooperative Extension which provides week long summer day nutrition education classes to select elementary schools, facilitates an after school program at Garden Village Elementary that promotes physical activity, administers the Healthy Living Ambassadors program which delivers an eight week garden-based nutrition curriculum to over 400 elementary school children, and the HEAL project which has also provided hands on farm and garden related education to more than 2,000 students; 4) implement park prescriptions to expand physical activity among at risk adults; and, 5) explore partnerships to develop mobile applications that encourage using trails and parks to walk, hike and bike.

Future Priorities

  • Strengthen communicable disease case investigation, animal bite reporting, laboratory outbreak response infrastructure and surveillance systems that protect the public's health from an increasing number of communicable diseases including Zika, Salmonella, Escherichia coli, Meningococcal disease, Measles, Ebola, and Influenza.
  • Continue to expand the public health mobile health clinic and street medicine program to deliver medical care to homeless and farmworker residents where they live and work. Work with partners to link homeless patients to housing and primary care and specialty clinics.
  • Focus on policy, systems, and environmental changes to modify the environment to make healthy choices practical and available to all community members. Use new and existing data sources to change laws and shape physical landscapes to help reduce obesity, diabetes, cancer, and other chronic diseases in communities. Disseminate data to internal programs and the community to prioritize health outcomes.

Author: Gina Wilson, Chief Financial Officer, Health System     Contact Email: gwilson@smcgov.org    
Last Updated: 08-21-2018