The Onondaga County Health Department (OCHD) is a large academic local health department with a mission to protect and improve the health of all Onondaga County residents. With a 2014 budget of approximately $76 million (including over $10 million in grants) and approximately 300 employees, the OCHD is a full service health department providing a wide range of public health services to the community since 1965. For a description of all the programs and services offered by the OCHD, please see the Annual Report at
www.ongov.net/health. The OCHD core values are: Respect, Excellence, Accountability, Collaboration, and Health Equity. The OCHD envisions a community of partners working together for the physical, social, and emotional well‐being of all. With a proud history of quality improvement, OCHD is currently pursuing accreditation through the Public Health Accreditation Board in order to best meet the community’s needs. Please see Appendix 3 for an organizational chart of the OCHD.
According to the latest census data, Onondaga County has over 467,000 residents. One third of people living in the county seat, Syracuse, are living below the poverty level. Many of the key health indicators
disproportionately impact racial and ethnic minorities, and women and children. Because health equity is a core department value, every OCHD program is expected to address racial, ethnic, and economic disparities in program development, implementation and evaluation.
The OCHD is fortunate to have a strong network of partners working together to improve the health of the community. As an example, in the 2008‐2012 CHIP, Refugee Health was identified as a community priority. Since then, community collaborations to support the needs of this vulnerable population have been greatly strengthened. In 2012, the Onondaga Citizen’s League did a year‐long study of the challenges facing, and assets and resources available for, the refugee population. (Report is available at
http://onondagacitizensleague.org/) As described in this CHIP, a large number of agencies and individuals are contributing assets and resources toward the selected priority areas: Preventing Chronic Disease and
Preventing Substance Abuse/Promoting Healthy Women, Infants and Children. In addition to the support detailed in the CHIP, Onondaga County has a variety of resources devoted to improving health, some of which are outlined below. For a broader profile of selected assets and resources in Onondaga County, please see Appendix 4.
Environmental assets and resources
A number of resources are available in Onondaga County to promote an environment conducive to physical activity and good nutrition. The Onondaga County Parks system covers nearly 6,500 acres and includes a nature center, beaches, forested areas, recreational facilities, athletic fields and other historic features. Many county parks are accessible by public transportation. According to the Onondaga County Parks Annual Report, nearly 3 million people enjoy the parks each year. Onondaga County is also home to a number of fitness facilities, athletic clubs, and sporting groups.
Since 2011, the OCHD has been working to educate and encourage local municipalities to adopt Complete Streets policies. Improving access for bicyclists and pedestrians can increase physical activity in a community. As described earlier, the first such policy in Onondaga County was passed by the Village of Fayetteville in 2012.
In the last several years, the City of Syracuse has also made progress toward expanding opportunities for alternate modes of transportation. Recent completion of the Connective Corridor has linked the Syracuse University community with downtown Syracuse through a stretch of road that was modified to facilitate safe access for bicyclists, pedestrians, motorists and bus passengers. Additional projects are under consideration in other parts of the city.
During the growing season there are 12 farmers markets operating in Onondaga County, including a large, central Farmers Market open year round, and many mobile markets that operate throughout the City of Syracuse. In addition, at least 14 community gardens are tended in Syracuse. Each of these efforts increases the accessibility of healthy, safe and affordable foods, and many have incorporated educational components to provide culturally appropriate information on health and nutrition.
Food insecurity can be a major barrier to healthful eating. The Food Bank of Central New York serves 11 counties including Onondaga, providing food, nutrition education, and technical assistance to food programs, including emergency food shelters. Over 75 food pantries/soup kitchens operate in Onondaga County to help ensure that residents do not go hungry.
Healthcare assets and resources
According to the Annual New York Physician Workforce Profile, there are 1,555 physicians practicing in Onondaga County, and 321 FTE physicians per 100,000 population (2010) including 82‐92 primary care FTEs per 100,000 population. While Onondaga County appears to compare favorably to NYS and CNY with respect to the number of physicians per population, the data do not address the geographic distribution of physicians within the county or whether the physicians accept Medicaid as payment. These factors contribute to overall healthcare access, and should be further explored.
There are five hospitals located within Onondaga County: Upstate University Hospital Community Campus, Crouse Hospital, St. Joseph’s Hospital Health Center, Upstate University Hospital (including Golisano Children’s Hospital) and Syracuse VA Medical Center.
Upstate University Hospital Community Campus maintains 306 acute‐care beds. The Hospital offers emergency services, medical and surgical care, intensive care, maternity services, acute physical rehabilitation, inpatient psychiatric care, and outpatient testing. In addition, the hospital operates an inpatient physical medicine and rehabilitation program as well as an outpatient physical & occupational therapy service. They also are part of the Upstate Midwifery Program which offers gynecological care, family planning, perimenopause and
menopause management.
Crouse Hospital operates 506 acute‐care beds and 57 neonatal intensive care bassinets. Crouse Hospital’s inpatient services include comprehensive maternity, labor and delivery care, including high‐risk
maternity/obstetrics (with Central New York’s only Level 4 neonatal intensive care unit); coronary, intensive and progressive care; adult and pediatric cardiac catherization; chemical dependency treatment services ; emergency care; surgical services; oncology; pharmacy; radiology; and laser services. Together with SUNY Upstate Medical University, Crouse Hospital provides the services of the Central New York Regional Perinatal Program.
Upstate University Hospital is a facility with 409 licensed inpatient beds and 10 observation beds. University Hospital has a Level 1 Trauma Center. The hospital provides services including stroke care, AIDS care, trauma care, epilepsy care, a diabetes program, a burn unit and Poison Control, as well as 77 unique specialty clinics. A recent addition to the hospital is Golisano Children’s Hospital which offers general pediatrics, pediatric surgery, hematology/oncology, pediatric intensive care and a pediatric emergency department.
St. Joseph’s Hospital Health Center has 431 beds, and offers several specialty services, including aesthetic surgery, The Birth Place, wound care and hyperbaric medicine, dental services, diabetes self‐management, emergency and intensive care services, hemodialysis, maternity and outpatient pediatric services,
neurosurgery, orthopedic diagnostics, surgery and rehabilitation, outpatient surgery centers, rehabilitation services , a sleep lab, and certified home health care. St. Joseph’s also offers behavioral health services for adults and children, including a Comprehensive Psychiatric Emergency Program (CPEP) with a licensed Psychiatric Emergency room fully staffed 24/7.
The Syracuse VA Medical Center has 106 beds and provides primary care, mental health care, tertiary care, long‐term care, physical medicine, rehabilitation, neurology, oncology, dentistry and geriatric services to veterans in the central New York area.
In addition to the local hospitals, there are seven urgent care facilities in Onondaga County. Residents of each quadrant in the County have access to an urgent care facility, with additional facilities available in Syracuse. Upstate Golisano Children’s hospital provides after hours care for children birth to age 21 years at the Community Campus.
Syracuse is home to the Syracuse Community Health Center, a Federally Qualified Health Center that offers comprehensive care for children and adults, and operates six school‐based health centers in the Syracuse City School District. Two hospital‐based outpatient clinics also provide medical services to un‐ or underinsured individuals, or those who cannot pay. Five additional community‐based clinics are also available to meet this need. The OCHD provides testing and treatment for STDs and tuberculosis, and testing for HIV in a clinic setting. Family planning care is available through Family Planning Service and Planned Parenthood, with several sites throughout the County.
Employer and business assets and resources:
Onondaga County is fortunate to have a cadre of employers and businesses that are engaged in promoting health throughout the community. This is most evident in preparedness efforts and in worksite wellness efforts. With respect to the former, in 2013 the OCHD held a public health preparedness exercise in
partnership with the Texas Engineering Extension Service. Participants included Syracuse University, LeMoyne College, Onondaga Community College, and the Long Term Care Council as major local employers in the area. Several of these employers have agreed to provide support for closed point of distribution sites in the event of an emergency. With respect to the latter, one of the initiatives described in the Community Health
Improvement Plan, Healthy Syracuse, has been successful in engaging numerous businesses to begin to adopt worksite wellness policies. In 2013, the conference was attended by over 300 individuals. In 2014, the conference was able to secure former Surgeon General Dr. Regina Benjamin as the keynote speaker.
Media assets and resources
Onondaga County is home to a major daily newspaper, the Post‐Standard, which frequently features stories on health‐related issues. There are several weekly/monthly newspapers, as well as 20 local AM and FM radio stations. One radio station and one monthly newspaper target the Spanish‐speaking community. Residents have access to four standard commercial television stations, one public broadcasting station, and one station with 24 hour local news broadcasting. The OCHD routinely works with media partners to promote health‐ related messages. In 2012, nine print media sources and one radio channel committed to support the OCHD media series, and nearly 80% of submissions were published or aired. High speed internet service is available to most county residents. The OCHD maintains a website, as well as a social media presence on Facebook and Twitter to provide information to the community on services and health conditions. Each of these media platforms will be utilized to publicize and distribute the Community Health Assessment and Community Health Improvement Plan.
Academic assets and resources
Onondaga County is home to a number of academic institutions with health‐related programs whose students are ready and willing to assist in addressing community health needs. Upstate Medical University graduates approximately 150 physicians each year, the majority of whom have experienced two site visits at the OCHD as part of their pediatric rotation. Additionally, every year approximately 10‐15 fourth year students do a month long rotation at the OCHD. Upstate also houses a joint Central New York Master of Public Health program with Syracuse University. Since the program’s inception, over 15 students have completed field placement or capstone projects with the OCHD. Syracuse University is home to the Lerner Center for Public Health Promotion, and offers a variety of health‐related programs including a Bachelor’s degree in public health. In addition, St. Joseph’s Hospital Health Center, Crouse Hospital and Upstate Medical University offer various nursing degree programs.
Community‐based health and human service agency assets and resources
Central New York, including Onondaga County, has more than seventy community based health and human service agencies. The Human Services Leadership Council is a membership organization of the chief executive officers of these agencies and was established as a collaborative to facilitate information sharing and increase cooperation among the agencies. More information about each of these community based service agencies is available at www.hslccny.org.
Other governmental agency assets and resources
With respect to protecting the public’s health, the OCHD has close working relationships with the New York State Departments of Health, Education, Environmental Conservation, and Agriculture and Markets. In addition to these state resources, the OCHD works closely with other departments within Onondaga County, particularly the Departments of Children and Family Services, Emergency Management, Parks and Recreation, and Social Services: Economic Security. The OCHD works closely with all town and village governments both proactively (e.g., Complete Streets initiatives) and reactively as needed (e.g., mosquito control, sewer issues).
Part F: Community Engagement Process and the Methodology of
the Community Health Assessment
The Onondaga County Health Department (OCHD) partnered with the hospitals in Onondaga County to conduct a community health assessment (CHA) process that engaged health improvement efforts already underway and drew on local resources. The process was designed to result in a clear picture of the health of the community and to identify meaningful and realistic community health improvement initiatives that are supported by key constituencies. The Onondaga County CHA process was also structured to meet the requirements of the New York State Prevention Agenda and Title IX of the Patient Protection and Affordable Care Act of 2010.
The initial CHA process began in the fall of 2011 with graduate students in the Central New York Master of Public Health program (CNYMPH), a graduate program in public health sponsored by Syracuse University and SUNY Upstate Medical University. The graduate students began their work by convening and facilitating five community forums in October and November 2011. The purpose of the forums was to identify the health issues that are perceived to be of importance in the community. The Lerner Center for Public Health Promotion at the Maxwell School for Citizenship and Public Affairs at Syracuse University provided logistical support and assistance with recruiting forum participants in collaboration with the Onondaga County Advisory Board of Health, the Syracuse City Schools, and Say Yes to Education. The forums were held at the Central New York Community Foundation Philanthropy Center; the school‐focused forum was held at the Say Yes to
Education offices. Altogether, 92 people, including local residents and individuals representing a wide range of community organizations, participated in the forums. Two photos from one of the community forums are seen in Figures 42 and 43.
Figures 42, 43: Images from one of the community forums, Onondaga County, Fall 2011
After the community forums were held, the data collection and analysis phase began. Data from a number of sources were utilized, including the New York State Department of Health, the U.S. Census, internal
information from the OCHD and hospitals, the 2013 Community Needs Assessment Report developed by the United Way of CNY as well as many other local sources of data as identified Parts A‐E of this CHA. The
qualitative findings identified in the community forums provided a backdrop against which data were collected and analyzed to better understand the concerns raised by community members. The results of the forum, summarized in a report issued in January of 2012, are included in Appendix 5.
In early 2013, meetings between the leadership of the Onondaga County Health Department (Commissioner of Health and Chair of the Advisory Board of Health) with the chief executive officers of the three civilian
hospitals in the community (St. Joseph’s Hospital Health Center, Crouse Hospital and Upstate University Hospital (including the Golisano Children’s Hospital and Upstate at Community General)) were held to discuss both the CHA and the Community Health Improvement Plan(CHIP)/Community Service Plans (CSP) processes and to gain support of the leadership. The outcome of the meeting was an agreement that all processes would be collaborative and would focus on building on existing partnerships to ensure that the outcome would incorporate initiatives that already had a strong base of support. Over the course of 2012/2013, a task force composed of representatives from the LHD and the hospitals met regularly to review the data and explore areas for collaboration. Appendix 6 includes a list of some of the meeting dates for the CHA/CHIP, excluding the community forums.
In the spring of 2013, another group of students from the CNYMPH program were engaged to support the CHA/CHIP/CSP effort. Teams of students were paired with the hospitals and with the OCHD to support further data collection and analysis. The teams, at the direction of the hospital and LHD, collected and organized data that was used by the leadership of the organizations to understand the health needs of the community. The students provided formal reports to each of the organizations in the spring of 2013.
In addition, in the spring and fall of 2013, all first year medical students at Upstate Medical University were required to participate in a modified CHA process for a class assignment. Students overwhelmingly selected indicators in the chronic disease domain (obesity, cardiovascular disease, cancer and diabetes all ranking the highest within the domain). Their second priority was communicable disease with an emphasis on STDs. Indicators in the domains of maternal and child health, environmental health, and mental health were much less commonly selected.
During the course of the community health assessment, an issue related to neonatal abstinence syndrome, drug withdrawal in a baby, surfaced. The issue was identified concurrently by the NYSDOH and by local physicians and hospital staff. It was also raised at an Onondaga County Advisory Board of Health meeting by a neonatologist on the Board. A review of the data revealed that Onondaga County has the highest rate of hospital discharges for newborns with drug‐related issues in NYS. A community solution is one of the priority/focus areas chosen by local hospitals and the OCHD in Onondaga County.
The findings of the community forum as well as further data collection and analysis revealed that the other priority issue should address chronic disease and more specifically, physical activity and nutrition as they relate to chronic disease.
In summary, through discussions with the task force and the leadership of the OCHD and the local hospitals, two priority areas were chosen:
Preventing Chronic Disease
Promoting Mental Health and Substance Abuse/ Promoting Healthy Women, Infants and Children
o Neonatal Abstinence Syndrome
At a meeting on May 1, 2013 of the Thursday Morning Roundtable (a community forum sponsored by Syracuse University) the Commissioner of Health and Chair of the Advisory Board of Health presented “The State of Our County’s Health: An Assessment of Onondaga County’s Health”. This was the first of several presentations on the CHA in Onondaga County. The original presentation is included as Appendix 7.
Community Health
Improvement Plan
Background
The two shared priority areas were identified by the community, and by health and public health professionals over a two year process. In 2011, community forums were held to identify the community’s areas of concern with respect to health. (The process is described in Section F of the Community Health Assessment and in greater detail in Appendices 8.a and 8.b.) The summary of the input gathered from these forums concluded