County of Marin Health and Human Services

Public Health Newsletter

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Public Health Newsletter, March 2018
Marin County Public Health Newsletter Volume 6 - Issue 3 - March 2018
In this Issue: Pain | Lyme | Gun | Rankings | Older | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Healthy Pain Management

Marin County has seen significant reductions in opioid prescribing due to evidence-based concerns about addiction and to opioids' lack of efficacy for many pain conditions.  Providers and patients alike are seeking healthier alternatives.  This will be the focus of the "Healthy Pain Management" Forum, hosted by RxSafe Marin and Marin HHS, April 12, from 11-1, at the Marin County Office of Education.  Pain experts from Marin General Hospital and Kaiser will describe emerging non-opioid pain modalities and local resources.   Clinicians can post this flyer for colleagues and patients.

Ticks and Lyme Disease Prevalence

Marin County clinicians regularly field questions and concerns regarding Lyme disease.  The following figures may help inform these conversations.  During 2013-2017, the regional Napa-Solano-Yolo-Marin Public Health Lab tested 2,950 ticks, 47 (1.7%) of which carried Borrelia burgdorferi, the organism that causes Lyme disease.  One human case acquired in Marin was confirmed in 2016 and none were confirmed in 2017.  Marin County Public Health accepts ticks from clinicians and members of the public for testing.  Instructions for packaging and drop-off of ticks as well as tips for preventing bites can be found here.

Marin Physicians and Gun Violence

Marin physicians in the San Francisco Marin Medical Society featured prominently in recent demonstrations against gun violence.  Framed as a public health crisis, society members joined other physicians to call for major reforms in gun control policies, including removing barriers to studying gun violence.  The voice of these Marin physicians echoes that of major physician organizations, including the American Medical Association and the California Medical Association.  Clinicians who want to join the movement against gun violence can connect to colleagues in the San Francisco Marin Medical Society.

County Health Rankings

Marin has been ranked the healthiest county in the state again by the Robert Wood Johnson County Health Rankings for the eighth time in nine years.  The rankings select multiple indicators of health and well-being, including life expectancy, to compare counties across the state.   This year's results are consistent with prior years', with high overall performance and notable exceptions in excessive substance use and  health disparities between affluent and low-income communities.

Year of the Older Adult

Marin County's Aging Action Initiative's Spring Convening is scheduled for Tuesday, April 3, from 9am to 4pm.  Topics will include reframing aging, falls, and aging equity.  This is a free event, for public sector agencies, non-profit organizations and health sector providers.  You can register for this event here.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotMarin County was again ranked the healthiest county in the state in the annual County Health Rankings.  What lessons can we offer other jurisdictions seeking to improve community health?  Our ranking is partly attributable to known associations between wealth and health.  By addressing health disparities in Marin County, ensuring universal access to health care, and advancing social policies that address inequities, we can better serve as an even stronger model of health for the nation.
Warm Regards,
Matt Willis
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Officer Newsletter, February 2018
Marin County Public Health Newsletter Volume 6 - Issue 2 - February 2018
In this Issue: Fentanyl | Vaccinate Cat | Zika | Salmonella | Food Now | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Fentanyl Overdoses

Last week in San Francisco, three men were found dead of suspected fentanyl poisoning.  Fentanyl has been increasingly present in street-purchased drugs in the Bay Area, and can lead to clusters of overdoses over a short period of time.  Alert physicians can offer early notice by reporting fentanyl overdoses directly to the Health Officer at 415-473-4163.  Fentanyl overdoses also may require multiple doses of naloxone, the opioid reversal agent.  We recommend you prescribe naloxone to patients at risk for overdose.  Patients can call (888) 818-1115, 24/7, to access substance use recovery services in Marin County.

Vaccinate Your Cat!

February is National Cat Health Month.  Marin Health & Human Services is partnering with the Marin Humane Society to urge residents to vaccinate their cats for rabies.  Rabies in domestic dogs and cats can serve as a bridge for transmission from wildlife to humans.  California law requires that domestic dogs be licensed and vaccinated against rabies.  In Marin County, a local ordinance also requires that domestic cats be vaccinated.   However, many pet owners are not aware or are non-compliant with vaccinating their cats. Visit our Rabies Information page for more information.

  Don't Bring Zika Home

After two years of active Zika surveillance, there have been more than 600 travel-associated Zika infections in California.  With spring approaching, more Marin County residents will be traveling to Zika-endemic areas.   The most frequented countries of Zika exposure include Mexico, Nicaragua and Guatemala.  Encourage your patients to stay informed and protected by visiting the Marin County HHS Zika website

Backyard Poultry Flocks and Salmonella

Marin County residents are becoming modern farmers and adding chicken coops to their yards.  The Centers for Disease Control and Prevention (CDC) has reported a major increase in illnesses associated with backyard poultry flocks, especially in California.  For families with backyard flocks, the CDC recommends (1) Thoroughly wash hands with soap and water after touching birds or the areas where they reside, (2) Do not let live poultry into your house, and (3) Supervise children while handling birds and assist with hand-washing.  Salmonella cases should be reported to Marin County Public Health.

Food Now Marin

One in five Marin County residents suffers from food insecurity.  Clinicians can help solve this problem by using the following screening:  "Please let me know if either of these statements is true for your family:  (1) Within the last 12 months, we worried whether our food would run out before we got money to buy more; (2) Within the last 12 months, the food we bought just did not last and we did not have money to get more."  For patients with a positive response to either question, you can offer the new Food Now Marin, a free, bilingual mobile application that helps people find low-cost food sites near them..

Message from the Deputy Public Health Officer

Effective public health practice requires constant vigilance at all levels of our community.  While the health department has many tools to protect the health of our community  and ensure public safety, the best tool is always prevention.  Health care providers in Marin can practice harm reduction by prescribing naloxone.  Pet owners can keep their pets' vaccinations up-to-date.  Travelers can stay informed and prevent mosquito bites.  And, we can all wash our hands more often.  But, one of the most critical forms of prevention is addressing the social determinants of health.  Regardless of the disease or condition, health outcomes are worse when people are poor, hungry and have unstable housing.  Food Now Marin is a great example of our community working together to address one of the key social determinants of health by ending hunger in Marin.
Stay healthy,
Lisa Santora, MD, MPH
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Officer Newsletter - January 2018
Marin County Public Health Newsletter Volume 6 - Issue 1 - January 2018
In this Issue: Flu | Naloxone | MMRC | Cannabis | Integration | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Flu Surge:  Stemming the Tide 

Emergency Departments (ED) in Marin County and across the state are continuing to experience surges related to respiratory illness.  As of January 27th, 470 out of 2,217 tests performed in all three Marin hospitals were positive for influenza, with one reported death under age 65.  Clinicians can help protect ED resources for patients who require emergency response by managing lower risk illness on an outpatient basis.  The vast majority of patients evaluated for flu-like illness in EDs are sent home.  Refer to these guidelines to triage flu-like symptoms and visit www.marinflu.org for local resources and information on latest flu activity in Marin.

Opioid Overdose Reversals in the Community

Opioid overdose remains the leading cause of accidental death in Marin County.  The RxSafe Marin coalition and the Department of Health & Human Services (Marin HHS) are promoting naloxone (Narcan) availability at the community level.   We began training first responders last year.  Police officers in Novato, Fairfax and Mill Valley have revived victims of opioid overdose.  Marin Emergency Medical Services (911) data show increases in bystander administration of naloxone prior to ambulance arrival.  Clinicians should consider prescribing naloxone for patients prescribed opioids, particularly with opioid doses above 90 mg morphine equivalents per day.

Marin Medical Reserve Corps (MMRC) Answers the Call

The North Bay fires deeply impacted our families, friends, and colleagues.  A regional medical surge required the deployment of health care volunteers across the region.  The Marin Medical Reserve Corps (MMRC) and other medical volunteers stepped forward to provide medical care at the Marin Center shelter.  Our response to future emergencies depends on a roster of active, licensed and credentialed health care providers.   The MMRC is recruiting Marin County doctors, nurses, behavioral health professionals, social workers, EMTs and clerical/administrative people.  Join our team and be part of our next response.   Learn more and register here.

Let's Talk Cannabis 

On January 1, 2018, California's new recreational marijuana laws went into effect.  The California Department of Public Health (CDPH) has launched a health information and education campaign about what's legal in California and potential health impacts of cannabis use.  On CDPH's website, you can find information about legal, safe and responsible use, and health information for youth, pregnant and breast-feeding women, parents and mentors.


Public Health Clinic Integration

For decades, Marin HHS offered clinical services in communicable diseases and dental care for low income and uninsured clients.  Expanded access through the Affordable Care Act (ACA) has created opportunities for this care to be fully integrated into Marin's primary care community health centers.  Our community health centers provide comprehensive primary and specialty care, dental and behavioral health care plus support services to meet the needs of our most vulnerable residents.  Following the unanimous vote of the Marin County Board of Supervisors, in January, HHS will be completing the closure of the HHS medical clinics and the transfer of care to Marin Community Clinics.  Visit our clinics integration website for more information.

Message from the Public Health Officer

Matthew Willis Marin County PHO Headshot2017 was a remarkable year in public health in Marin County.  The response of the Marin County medical community to the North Bay wild fires was inspiring and reassuring.  Our health care providers accommodated surges of patients displaced by the fires into our hospitals and clinics, and staffed shelters for evacuees.  This event also highlighted the value of preparedness and planning for future events, which is work for 2018. In 2017, we also moved closer to an integrated care system for Marin's most vulnerable residents, with HHS transferring safety net clinical services to Marin Community Clinics.  This newsletter is resuming its monthly schedule and your suggestions for topics is always welcome. 
Warm Regards,
Matt Willis
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
County of Marin Logo

Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901

Influenza activity has increased significantly in California and in Marin County over the last few weeks, and influenza A (H3N2) is currently predominating this season. In general, H3N2 is associated with more deaths and hospitalizations in persons 65 years and older and in children under 2 years old. Marin County Emergency Departments (EDs) are managing a high volume of influenza patients. Most patients evaluated for influenza-like illness (ILI)1 in EDs are sent home. Clinicians can help protect ED resources for patients who require emergency response by managing lower risk ILI on an outpatient basis. While vaccine effectiveness this season is lower than most years, the recommendations for immunization with seasonal influenza vaccine remain the same. Even when vaccine effectiveness is limited, immunization prevents illnesses and hospitalizations, decreases severity of disease, and offers protection against other strains of influenza that are circulating.  

 

Additional Resources Marin County Public Health – www.marinflu.org

CDPH – www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Influenza.aspx

CDC – www.cdc.gov/flu

PUBLIC HEALTH ADVISORY: Facts About Mask Protection October 13, 2017 Northern California Fires Affecting Marin Air Quality: The fires in Northern California are impacting air quality across the region. The best way to protect yourself from health effects of wildfire smoke is to limit your exposure. Will a face mask protect me from wild fire smoke? The following do not protect your lungs from wildfire smoke: - Bandanas or towels (wet or dry) or tissue held over the mouth and nose: this may relieve dryness but won’t protect your lungs from wildfire smoke - One-strap paper dust mask or a surgical mask that hooks around your ears: these don’t protect against the fine particles in smoke For those who cannot avoid prolonged activities outdoors “Particulate respirator” masks (respirator masks) labeled N95 or N100 may provide some protection: they filter out fine particles but not hazardous gases - The respirator masks do not seal well on people with facial hair or beards -Individuals with respiratory conditions should consult their doctor before using a mask— masks may limit air flow and make it more difficult to breathe. - Respirator masks should not be used on young children: they don’t seal well enough to provide protection What can I do to protect myself? Limiting exposure to wildfire smoke by remaining indoors is the primary goal. Depending on your situation, a combination of the strategies below may work best and give you the most protection from wildfire smoke. Keep indoor air as clean as possible. Keep windows and doors closed. Use a high-efficiency particulate air (HEPA) filter to reduce indoor air pollution. Avoid smoking tobacco, using wood-burning stoves or fireplaces, burning candles, incenses or vacuuming. Minimize the amount of time spent outdoors as much as possible. Avoid vigorous outdoor activities. Drink plenty of water Listen to your body and contact your healthcare provider or call 911 if you experience difficulty breathing, chest pain, severe fatigue, dizziness, or worsening of asthma or chronic respiratory illness PG. 2 OF 2 For those who wish to use an N-95 mask, these may be available at hardware stores or from online retailers As always, if you or someone you know is experiencing an emergency, call 9-1-1. Follow @MarinHHS or MarinHHS.org for updates For up to date information about fires in California go to: http://www.calfire.ca.gov/ For up to date information about air quality in the Bay Area go to: http://www.baaqmd.gov/

 

AVISO DE SALUD PÚBLICA: Datos sobre la protección con máscara October 13, 2017 Incendios en el norte de California afectan la calidad del aire en Marin: Los incendios en el norte de California están afectando la calidad del aire en toda la región. La mejor manera de protegerse contra los efectos adversos para de la salud del humo de los incendios descontrolados es limitar su exposición. ¿Me protegerá una máscara facial contra el humo de los incendios? * Los siguientes no protegen sus pulmones del humo de los incendios: - Los pañuelos o toallas (húmedos o secos) o pañuelos desechables colocados sobre la boca y la nariz: estos podrían aliviar la sequedad pero no protegerán sus pulmones del humo de los incendios. - Una máscara antipolvo de papel de una sola cinta o una máscara quirúrgica con cintas que se pasan por atrás de las orejas: éstas no protegen contra las partículas finas en el humo * Para aquellos que no puedan evitar actividades prolongadas al aire libre las máscaras "respiradoras para partículas" (máscaras respiratorias) etiquetadas como N95 o N100 pueden brindar cierta protección: filtran las partículas finas pero no los gases peligrosos - Las máscaras respiratorias no sellan bien en personas con vello facial o barba - Las personas con afecciones respiratorias deben consultar a su médico antes de usar una máscara - las máscaras pueden limitar el flujo de aire y dificultar la respiración. - Las máscaras respiratorias no deben usarse en niños pequeños: no sellan lo suficientemente bien como para ofrecer protección ¿Qué puedo hacer para protegerme? Limitar la exposición al humo de incendios descontrolados permaneciendo en el interior es el objetivo principal. Dependiendo de su situación, una combinación de las siguientes estrategias puede funcionar mejor y darle la mejor protección contra el humo de los incendios. * Mantener el aire interior lo más limpio posible. Mantener cerradas las ventanas y las puertas. * Usar un filtro de aire de partículas de alta eficiencia (HEPA) para reducir la contaminación del aire en el interior. * Evitar fumar tabaco, usar chimeneas o estufas que queman leña, prender velas o incienso, o utilizar aspiradora. PÁG. 2 DE 2 * Minimizar la cantidad de tiempo que pasa al aire libre tanto como sea posible. Evitar actividades vigorosas al aire libre. * Beber abundante agua * Escuche a su cuerpo y comuníquese con su profesional de la salud o llame al 911 si tiene dificultad para respirar, dolor en el pecho, fatiga severa, mareos o empeoramiento del asma o enfermedad respiratoria crónica * Para aquellos que deseen usar una máscara N-95, éstas tal vez se puedan conseguir en ferreterías o en tiendas en línea Como siempre, si usted o alguien que usted conoce tiene una emergencia, llame al 9-1-1. Siga a @MarinHHS o MarinHHS.org para las últimas noticias Para obtener información actualizada sobre incendios en California, consulte: http://www.calfire.ca.gov/ Para obtener información actualizada sobre la calidad del aire en el Área de la Bahía, consulte: http://www.baaqmd.gov/

Northern California Fires Affecting Marin Air Quality: Health Tips for Marin Residents The multiple fires currently burning in Napa, Sonoma and other northern counties are affecting our air quality and have created a potential health hazard in Marin County. For General Public: Please be aware that with shifting winds and poor wildfire containment air quality can change drastically in a short period of time. Smoke from wildfires can affect health. The most common symptoms are eye and throat irritation, coughing, and difficulty breathing.

 

Follow these precautions to protect your health and those with health problems, especially heart or respiratory conditions, should take extra caution:  

  • Minimize outdoor activities Stay indoors with windows and doors closed as much as possible
  • Do not run fans that bring smoky outdoor air inside
  • Run your air-conditioner only if it does not bring smoke in from the outdoors
  • Consider leaving the area until smoke conditions improve if you experience symptoms related to smoke exposure

For Outdoor Workers:

  • Limit exertion
  • Take frequent breaks
  • If prolonged outdoor activity is unavoidable, proper masks (for example N95 masks) can protect against harmful exposure

Consult with your employer if you have specific concerns For Schools:

  • Outdoor activities should be limited
  • Windows and doors should be kept shut as much as possible
  • When air quality is unhealthy activities such as athletic events or practices should be cancelled or rescheduled
  • Watch for symptoms and take action as needed
  • Students with asthma should follow their asthma action plans and keep their quick-relief medicine close at hand

When to Seek Medical Attention:

  • Contact your health care provider if you experience the following symptoms that do not improve after moving indoors or into a safe air quality environment
  • Shortness of breath or difficulty breathing
  • Wheezing
  • Chest tightness or pain
  • Palpitations
  • Nausea or unusual fatigue
  • Lightheadedness and/or feeling faint
  • As always, if you or someone you know is experiencing an emergency, call 9-1-1.
  1. Follow @MarinHHS for updates
  2. For up to date information about fires in California go to: http://www.calfire.ca.gov/
  3. For up to date information about air quality in the Bay Area go to: http://ttp://www.baaqmd.gov/

AVISO DE SALUD PÚBLICA
12 de octubre de 2017
Incendios en el norte de California afectan la calidad del aire de Marin: Consejos de salud para los residentes de Marin
Los incendios múltiples que arden actualmente en los condados de Napa, Sonoma y otros del norte están afectando la calidad de nuestro aire y han creado un posible peligro para la salud en el condado de Marin.

Para el público en general:
Por favor tenga en cuenta que debido a los vientos cambiantes y la expansión descontrolada de los incendios, la calidad del aire de puede cambiar drásticamente en un corto período de tiempo.
El humo de los incendios puede afectar la salud. Los síntomas más comunes son irritación de los ojos y la garganta, tos y dificultad para respirar. Siga estas precauciones para proteger su salud, y las personas que tengan problemas de salud, sobretodo afecciones cardíacas o respiratorias, deben extremar precauciones:

  • Minimizar las actividades al aire libre
  • Permanecer en interiores con las ventanas y las puertas cerradas tanto como sea posible
  • No activar ventiladores que introduzcan el aire con humo del exterior
  • Usar su aire acondicionado sólo si no introduce humo del exterior
  • Considerar abandonar el área hasta que las condiciones de humo mejoren si tiene síntomas relacionados con la exposición al humo

Para trabajadores al aire libre:

  • Limitar el esfuerzo
  • Tomar descansos frecuentes
  • Si no se puede evitar la actividad al aire libre, las máscaras apropiadas (por ejemplo las máscaras N95) pueden proteger contra la exposición dañina.
  • Consultar con su empleador si tiene preocupaciones específicas
  • Para escuelas:
  • Se deben imitar las actividades al aire libre
  • Se deben mantener cerradas las ventanas y puertas tanto como sea posible
  • Cuando la calidad del aire es insalubre, las actividades como prácticas o eventos deportivos deben ser canceladas o reprogramadas
  • Estar alerta a los síntomas y tomar las medidas necesarias
  • Los estudiantes con asma deben seguir su plan de acción contra el asma y tener a la mano su medicina de alivio rápido

Cuándo buscar atención médica:
Comuníquese con su profesional de la salud si tiene los siguientes síntomas que no mejoran después de meterse bajo techo o moverse a un ambiente con buena calidad del aire.

  • Falta de aliento o problemas para respirar
  • Respiración ruidosa
  • Dolor o opresión en el pecho
  • Palpitaciones
  • Náusea o fatiga inusual
  • Mareo y/o sensación de desmayo

Como siempre, si usted o alguien que usted conoce tiene una emergencia, llame al 9-1-1.
Siga a @MarinHHS para las últimas noticias
Para obtener información actualizada sobre incendios en California, consulte: http://www.calfire.ca.gov/
Para obtener información actualizada sobre la calidad del aire en el Área de la Bahía, consulte: http://www.baaqmd.gov

PUBLIC HEALTH ADVISORY: October 09, 2017 
Northern California Fires- Smoke Advisory: Current Situation

Air quality in Marin County has been affected by multiple fires in Napa and Sonoma County. While concentrations of smoke vary depending upon location within Marin, all areas have been affected and all residents are being exposed. Smoke from wildfires is expected to continue as the wildfires are not yet contained. There are no fires in Marin County as of this afternoon. Smoke can cause eye and throat irritation, coughing, and difficulty breathing. People who are at greatest risk of experiencing symptoms are: Young children, older adults, pregnant women, or people with respiratory conditions (such as asthma or emphysema) or heart conditions: We are advising these sensitive populations to stay indoors, avoid prolonged activity, and seek medical help if respiratory symptoms worsen. When smoke levels are high, even healthy people may experience symptoms such as coughing, a scratchy throat, irritated sinuses, shortness of breath, headaches, stinging eyes, and a runny nose. All residents should limit outdoor physical activities and stay indoors if at all possible. As a precaution, Health and Human Services has recommended that all outdoor sporting activities for children be cancelled.

https://www.marinhhs.org/sites/default/files/files/public-health-updates/ph_advisory_wildfire_smoke_100917.pdf

For up to date information about fires in California go to: http://www.calfire.ca.gov/

For up to date information about air quality in the Bay Area go to: http://www.baaqmd.gov/

Public Health Newsletter July 2017
Marin County Public Health Newsletter Volume 4 - Issue 6 - July 2017
In this Issue: Hep A | Tdap | Foster Care | Syphilis | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Hepatitis A Outbreak 

Outbreaks of hepatitis A disease are currently ongoing in San Diego County and Santa Cruz County in persons who are homeless and/or using illicit drugs.  Transmission is presumed to occur person-to-person; no commercial product has been identified as being contaminated.  The California Department of Public Health recommends offering HAV vaccine to persons who are homeless or might be using illicit injection or non-injection drugs.

Tdap in Pregnancy 

Last year, there were 1,830 cases of pertussis.  108 cases were hospitalized; 47% of hospitalized patients were infants.  Prevention of severe disease and death among infants has become the top priority in pertussis control.  ACIP, ACOG and AAFP recommend Tdap vaccine during each pregnancy, preferably in the third trimester, between, 27 - 36 weeks gestation, regardless of the mother's Tdap vaccination history.   Please remember to stock and recommend pertussis vaccination to protect our most vulnerable patients.

Foster Community, Foster Hope, Foster Our Future 

Our community needs exceptional people who can provide loving, temporary homes to children in foster care.  Individuals with medical experience, those who can welcome siblings together, and those who are Spanish-speaking are especially needed.  Attend an orientation with a social worker and an experienced foster parent to learn more.  Visit www.FosterOurFutureMarin.org or call 415-473-2200 for more information.

Syphilis 2016:  Return of the Great Masquerader

The California Prevention Training Center (CAPTC) is offering a valuable one-hour online course on syphilis.  Syphilis is a growing public health concern as manifest by the 19% increase in cases nationally from 2014 to 2015.  Many people with syphilis go undiagnosed and untreated for years, putting others at risk.   This course offers an easy and inexpensive opportunity to learn the latest information regarding syphilis epidemiology, screening, diagnosis, and treatment.   You can find out more about this course here.

Message from the Deputy Public Health Officer

The Marin County Board of Supervisors is recognizing National Health Center Week, August 13 - 19.  Coastal Health Alliance, Marin City Health and Wellness Center, Marin Community Clinics and Ritter Center provide high quality, cost effective primary care to tens of thousands of Marin County residents.  Our community health center partners' mission is to provide healthcare to Marin County residents, regardless of ability to pay.  Amidst the ongoing healthcare debate, I am thankful for their ongoing commitment and service to our community.
Warm Regards,
Lisa Santora
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Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter June 2017
Marin County Public Health Newsletter Volume 4 - Issue 5 - June 2017
In this Issue: Fair | CPR | Shigella | Fentanyl | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

A Healthy County Fair

County fairs are not known for healthy food and drink.  The Marin County Fair is an exception.  Visit June 30 - July 4 to see why ours was named the healthiest fair by the Western Fairs Association in 2015.  Reflecting local values in health, the fair is smoke-free, all food vendors offer at least one healthy option, alcohol use is controlled, and there are regular healthy activities for all ages.  The Marin team shared their healthy fair model in this Growing Healthy Events Guide.

Staying Alive 

On June 10, over 1,600 people were trained in life-saving skills in Sidewalk CPR and Stop the Bleed at 19 venues throughout Marin County.  Bystander response is a key determinant of survival in life-threatening emergencies, and these annual trainings ensure our Marin residents are better prepared every year.  Congratulations to our EMS staff and EMTs / paramedics, nurses, doctors and Marin Medical Reserve Corps volunteers who stepped up again to save lives.  Clinicians interested in volunteering at future events can contact Karrie Groves at kgroves@marincounty.org.  Patients can be directed to visit heart.org/handsonlycpr to watch the Hands-Only CPR instructional video.

Cipro Resistance - Shigella

Shigella isolates across the U.S. are showing new resistance to quinolones.  The CDC is now recommending clinicians order a stool culture and antimicrobial susceptibility testing when Shigella is suspected; reserve antibiotic therapy for patients for whom it is clinically indicated or when treatment is advised in an outbreak setting.   Marin County Public Health will communicate relevant local incidence and resistance patterns to you, our clinicians.  Quinolone-resistant strains are commonly resistant to other standard agents, including azithromycin, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate and ampicillin.  For more information, visit the CDC's Health Alert Network.

Occupational Fentanyl Exposure

Very high potency opioids, such as fentanyl and carfentanil, may pose a contact hazard to medical personnel and first responders who may handle these compounds.  Recently in California, fentanyl and its analogs have been found in other drugs, including heroin, methamphetamine, cocaine, and counterfeit pills made to look like prescription medications, such as alprazolam (Xanax).  To address this concern, Marin County Public Health issued this communication last week to Emergency Medical Services providers.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotAs health care providers, we are facing uncertainty about the systems in which we provide care.  Pending federal decisions may significantly impact our capacity to care for all residents.  When access is threatened, the value of disease prevention is even more clear.  Regardless of the outcome in Washington, as stewards of health for our community, we will remain engaged and responsive to the needs of all in Marin.  Thank you for your excellent standards of care.
Warm Regards,
Matt Willis
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Twitter
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HHS Youtube
Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
County of Marin Logo

Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901

The California Department of Public Health (CDPH) is urging all Californians, in an effort to prevent Zika and  West Nile Virus infections and eliminate mosquito populations, to remove standing water around their homes and businesses.  There is also updated guidance from the Centers for Disease Control and Prevention (CDC) for Zika testing in pregnant women.  Visit Marin HHS' Zika web page for more information. 

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Public Health Newsletter May 2017
Marin County Public Health Newsletter Volume 5 - Issue 5 - May 2017
In this Issue: Carfentanil | End of Life Option | Norovirus | Zika | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Elephant Tranquilizer New Threat 

Marin County's Emergency Medical Services Agency (EMS) is monitoring drug overdoses and use of naloxone (Narcan) to prevent deaths.  This month, we received the first report of an overdose from Carfentanil.  Carfentanil is 10,000 times more powerful than morphine and 100 times more potent than fentanyl.  It can cause overdose in accidental exposures to particles through skin or inhaled.  This is a reminder to take a substance use and overdose history and to prescribe naloxone for patients at risk for overdose.

 End of Life Option

On Monday, June 12, 2017, the Health Council of Marin (HCM) will hold its Annual Community Education Forum.  The Council is advisory to the Board of Supervisors and the Marin County Department of Health & Human Services on public health and environmental health issues.   Lonny Shavelson, MD, will be the speaker on this year's topic:  California's End of Life Option Act:  A First Year Bedside Report.    The event will be held in the Library of Marin General Hospital, 250 Bon Air Road, Greenbrae, at 7:00 pm.

Norovirus

This month, the Bay Area experienced a surge in gastro-intestinal illness among students and staff in the school setting, which was most likely caused by the highly contagious Noroviruses. While symptoms may only last for one day, people are highly infectious for 48 hours after symptoms resolve.  The most important steps to prevent the spread of Norovirus in schools are:  1) stay home while sick and for another 48 hours after symptoms go away, 2) wash hands after using the bathroom and before eating, and 3) regularly clean with appropriate disinfectant all contaminated and high-touch surfaces.


Mosquitos and Zika

The California Department of Public Health (CDPH) is urging all Californians, in an effort to prevent Zika and  West Nile Virus infections and eliminate mosquito populations, to remove standing water around their homes and businesses.  There is also updated guidance from the Centers for Disease Control and Prevention (CDC) for Zika testing in pregnant women.  Visit Marin HHS' Zika web page for more information.

Message from the Deputy Public Health Officer

Summer time and pool parties are upon us.  As the weather warms up, so does the risk of drowning.  (Drowning is a leading cause of injury death for children ages 1 to 4.)  As providers, we can encourage parents to prevent unintentional drownings by taking precautions.  One of our friends recently hired a high school student with a lifeguard certificate to supervise their child's birthday pool party.  It was reassuring to have an extra pair of eyes when 15 kids of varying ages and swim abilities were screaming "Marco Polo."  Stay safe and have a fun summer.
Warm Regards,
Lisa Santora
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Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter April 2017
Marin County Public Health Newsletter Volume 5 - Issue 2 - April 2017
In this Issue: Vaccination | Take-Back | Concussion | Rankings | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Record High Vaccination Rates 

Kindergarten immunization rates in Marin County are the highest they have been since 2000.  This school year, 93.2 percent of Marin kindergarten students have received all of the immunizations required for school, increasing nearly 20% from the 2011/12 school year, when local immunization rates were at their lowest point, or 77.9 percent of kindergarten students.  Providers and parents can visit the Shots for School website to see if their child's school is well vaccinated.

Medicine Cabinet Spring Cleaning

Medications kept in our home cabinets can be targets for misuse and abuse.   In a recent survey, 60% of Marin County residents report holding on to unused medicines.  Clinicians should remind patients to safely dispose of medications.  Take Back Day April 29 is an ideal opportunity, when sites throughout Marin County will be taking back medications including controlled substances.
 

Marin Concussion Symposium

There is increasing interest and concern among parents and medical professionals about childhood concussions.  On May 6, the Buck Institute will host a symposium for clinicians to advance local standards in the prevention, diagnosis and management of concussions.  Organized by ConcussionSmart Marin -- a coalition of medical professionals, education leaders, athletic experts and brain injury advocates -- the event will offer free CME's to physicians.  Interested clinicians can registered for this symposium here.

   

County Health Rankings

The Robert Wood Johnson Foundation released its annual rankings of California's 58 counties, and Marin came in at No. 2 this year behind San Mateo County.  Marin had been ranked No. 1 in statewide health for seven consecutive years.  Marin retained the top spot statewide in overall health factors, such as education, employment, family and social support, and community safety.  Marin experienced a spike in accidental drug overdoses from 2012 to 2014, the time period reflected in the latest rankings.  In response, the County helped create a grassroots initiative called RxSafe Marin in 2014 to tackle prescription drug abuse.

 

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotThis week, I had the surreal experience of sitting near Newt Gingrich and Patrick Kennedy while they strongly agreed on something of national importance.   The event was the National RxDrug Abuse and Heroin Summit in Atlanta where we had been invited to share our RxSafe Marin coalition model.  While I was encouraged to see that the opioid crisis is a bipartisan priority and proud to share the progress we've made in Marin, it was clear that the epidemic is worsening nationally.  Now more than ever, we need to demonstrate the effectiveness of robust local response.   Thank you for your partnership and the excellent care you offer every day.
Warm Regards,
Matt Willis
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Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
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Our mailing address is:
3240 Kerner Boulevard
San Rafael, CA 94901

Marin County’s track record of being one of the healthiest counties in California is intact, according to new statistics, but several significant issues remain for those who deliver health care and other wellness services.

Dr. Matthew Willis, the County's Public Health Officer, says known problems with substance use were one contributor to Marin receiving the No. 2 ranking rather than No. 1.
The Robert Wood Johnson Foundation released its annual rankings of California’s 58 counties, and Marin came in at No. 2 this year behind San Mateo County. Marin had been ranked No. 1 in statewide health for seven consecutive years.  The County Health Rankings data give a glimpse of a community’s health and provide a starting point for investigating and prioritizing ways to improve health.

“As the safety net for our community, our goal is to create a safe and healthy community for all our residents,” said Board of Supervisors President Judy Arnold. “We have a lot to be proud of, but major challenges remain in the areas of income inequality, affordable housing, binge drinking, and prescription drug abuse.”

Marin retained the top spot statewide in overall health factors such as education, employment, family and social support, and community safety.

Dr. Matthew Willis, the County’s Public Health Officer, said one contributor to the change in ranking is known problems with substance use.

“Compared to other counties, we lose points for having higher rates of adult binge drinking, drunk driving deaths, and drug overdose rates,” Willis said. “This is another sign that these are issues we need to take seriously.” 

Marin experienced a spike in accidental drug overdoses from 2012 to 2014, the time period reflected in the latest rankings for that category. In response, the County helped create a grassroots initiative called RxSafe Marin in 2014 to tackle prescription drug abuse. The Marin County Department of Health and Human Services and several other County departments are involved and shepherding positive change.

“We've made some progress since 2014, and we’re losing fewer people to overdoses, but we have long way to go,” Willis said.

Marin was worse than the state average in income inequality and still experiences a large division between the top and bottom ends of the income spectrum. Marin consistently shows a low rate of children in poverty (9 percent), but social inequity came to light as the foundation broke down the statistics by race for the first time. Thirty percent of African-American children and 24 percent of Hispanic children experience poverty compared with 4 percent of white children.

As a countermeasure, the County has made steady progress on many fronts with social equity, and the Board of Supervisors made equity a priority in its 2016 State of the County message. It is working to preserve existing affordable housing, helping underserved residents visit and enjoy parks and open spaces, and making its annual County Fair one of the healthiest of its kind in the country, and improving access for disabled visitors at County-maintained pathways, park trails and buildings.

“Our scores did not change dramatically from last year,” Willis said. “San Mateo has made substantial progress and that’s good news. No one is backsliding here: San Mateo is raising the bar and it’s up to us to meet the challenge.”

Public Health Newsletter March 2017
Marin County Public Health Newsletter Volume 5 - Issue 1 - March 2017
In this Issue: Disaster Triage | Antibiotic of Last Resort | Drug Overdose | Pertussis | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Disaster Triage and Treatment - Free CME 

Hosted by the Marin Medical Reserve Corps (MMRC) Foundation

Saturday, April 29, 2017
9:00 am - 12:00 pm
Marin General Hospital, 250 Bon Air Road, Greenbrae, CA
West Wing, 1st Floor Conference Center

This free CME presentation (3.0 AMA PRA Category 1 Credit(tm)) presentation is designed to provide new information to physicians and nurses who will choose to or may be expected to respond to disasters in neighborhoods or designated alternative treatment sites.  This program will provide you with key skills for emergent medical triage in your own office practice or as part of a County disaster event or even a personal emergency.

Keynote Speaker:  Jan Horn, MD

Please register today at https://www.surveymonkey.com/r/MMRC429 

Antibiotic of Last Resort

In 2015, scientists reported the emergence of the plasmid-encoded mcr-1 gene, conferring bacterial resistance to the antibiotic colistin, signaling potential emergence of a pandrug-resistant bacterium.  The mcr-1 gene makes bacteria resistant to the antibiotic, colistin.  Colistin is one of the few "last resort" antibiotics available to treat bacteria that are resistant to many other antibiotics, such as carbapenem-resistant Enterobacteriaceae (CRE).  The Centers for Disease Control and Prevention (CDC) Get Smart program offers resources for Marin County heath care providers, including evidence-based adult and pediatric treatment guidelines, to promote antibiotic stewardship.

95 Drug Overdose Deaths in Marin County Between 2012 and 2014

Patients on high doses of opioids are at increased risk of overdose and diminishing function.  Tapering a patient, weaning them from higher opioid doses, can be an important first step to reducing overdose risk and improving function.  It is also helpful to maintain on-going communication with your patient about your concern for their well-being and your commitment to safe prescribing.  The California Department of Public Health (CDPH) is promoting a variety of tools on the prescriber resource sheet, including a tapering pocket guide, telephone consultation services, and an opioid overdose toolkit.   

Vaccine-Preventable Deaths - Pertussis

In 2016, California reported two pertussis infant deaths.  One of these deaths was in a healthy, full-term Hispanic baby; Hispanic infants are 40% more likely to be reported with pertussis in comparison to non-Hispanic, white infants in California.  These deaths are a devastating reminder that all prenatal care providers should ensure that all pregnant women are immunized with Tdap at the earliest opportunity, between 27-36 weeks gestation of every pregnancy regardless of the mother's Tdap history.  Postpartum Tdap vaccination and cocooning do not provide direct protection to the infant.   

Message from the Deputy Public Health Officer

The American Health Care Act ("AHCA"), the legislation intended to "repeal and replace" the Affordable Care Act ("ACA"), was shelved on Friday, March 24, 2017.  The ACA is working in Marin County and in California.  The uninsured rate in Marin County fell from 12% in 2013 to a historic low of 8% in 2016.  Covered California, the state's health insurance marketplace, provides a competitive health insurance marketplace for approximately 12,000 Marin County residents.  By remaining vigilant, informed and engaged, we can improve the ACA, not dismantle or neglect it. 
Warm Regards,
Lisa Santora
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Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
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(415) 473-4163
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Our mailing address is:
3240 Kerner Boulevard
San Rafael, CA 94901

This communication is for those who have been contacted by the Public Health Department by phone the week of January 9-13, 2017

For contacts of Bacterial Meningitis case:

The purpose of this letter is to inform you that you may have had contact with a person who had meningococcal meningitis. For that reason, we encourage you to contact your health care provider or go to Urgent Care to discuss possible preventive treatment with antibiotics (post-exposure prophylaxis).

Close contact includes:

  • household members
  • persons who frequently eat or sleep in the same house
  • persons who spent 4-6 hours per day together
  • persons who have come in close contact with the saliva or respiratory secretions of an infected person.

Preventive antibiotic treatment is recommended for individuals who are close contacts of someone who had meningococcal disease. Ciprofloxacin 500mg one tablet effectively prevents disease.

Symptoms of meningococcal disease include, but are not limited to:

  • Fever
  • Headache
  • Stiff neck
  • Confusion
  • Rash

If you experience any of these signs or symptoms, contact your health care provider immediately for evaluation. 

 

Flu Is Here! On December 1st, the California Department of Public Health (CDPH) announced the first influenza-associated fatality in a person under the age of 65 for the 2016-2017 flu season.  It is mandatory to report laboratory-confirmed influenza cases who require admission to an intensive care unit (ICU) and/or who die at any location (i.e. home, hospital, ER).  Visit www.marinflu.org for the most up-to-date information about current influenza activity in Marin. 

Public Health Newsletter December 2016
Marin County Public Health Newsletter Volume 4 - Issue 10 - December 2016
In this Issue: Flu | RxSafe Marin | Norovirus | TB | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Flu Is Here 

On December 1st, the California Department of Public Health (CDPH) announced the first influenza-associated fatality in a person under the age of 65 for the 2016-2017 flu season.  It is mandatory to report laboratory-confirmed influenza cases who require admission to an intensive care unit (ICU) and/or who die at any location (i.e. home, hospital, ER).  Visit www.marinflu.org for the most up-to-date information about current influenza activity in Marin. 

RxSafe Marin

On December 9th, David Mineta, former White House Deputy Director of Demand Reduction for the Office of National Drug Control Policy (INDCP), addressed attendees of the annual RxSafe Marin community meeting.  Marin's trend of increased co-prescription of opioids and benzodiazepines with age was highlighted.  About one in three Marin residents over age 65 who are prescribed opioids are also receiving benzodiazepines, increasing the risk of falls, cognitive impairment, and overdose.  The leading cause of accidental death in Marin is prescription opioid overdose, and most opioid-related deaths include other sedatives.  Adhering to Marin County safe opioid prescribing guidelines can decrease harmful polypharmacy.

Wash Your Hands!

Norovirus is now increasing in circulation throughout Marin County.  Remind patients of the importance of hand-washing, especially after using the toilet or changing diapers, and before preparing and handling food.  Also, please encourage patients to stay home from work or school for at least 24 hours (OSHA recommends 48-72 hours) after the symptoms have subsided.  Norovirus outbreaks rapidly grow due to contact with others while still contagious.

Tuberculosis Outbreak 

In September 2016, the County of Marin reached an important threshold -- more than 10 related TB cases over a 2 1/2 year period.  These cases (both US-born and foreign born) have close social and familial ties to each other as well as ties to a congregate community site and/or a local work site.  Review of TB genotype results revealed that they all shared the same rare genotype and thus were likely linked in the same local chain of TB transmission. It is critical for health care providers to think TB when evaluating patients.  Also, Marin County providers should enhance screening and treatment of latent tuberculosis infection.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotOn December 6th, the Board of Supervisors passed a resolution opposing any repeal of the Affordable Care Act (ACA).  The ACA, through Medi-Cal expansion, Covered California, consumer protections, and quality improvement initiatives, has increased access to affordable, high-quality health care for tens of thousands of Marin County residents.  Between 2013 and 2016, the number of Marin residents covered by Medi-Cal nearly doubled from 20,154 to 38,843.  Increased access has been matched by quality improvements in prevention and screening, chronic disease management, patient experience and advanced care planning.  HHS is committed to working with you, our healthcare partners, to protect access to high quality health care to achieve health equity for All in Marin.
Warm Regards,
Matt Willis
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Matthew Willis MD, MPH
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mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Boulevard
San Rafael, CA 94901

In the summer, pediatric patients visit their doctors for health examinations for school entry and pre-participation physical examinations. These are opportunities to discuss both required and recommended vaccinations (e.g., HPV, meningitis). With the introduction of SB277, parents may be seeking temporary and/or permanent medical exemptions for required vaccinations. Visit our Immunization Program website for forms and guidance on medical exemptions or call (415 473 3078) or email (dhiser@marincounty.org) Danielle Hiser, RN, PHN, Immunization Coordinator, with any questions.

Many college campuses are experiencing mumps outbreaks. Summer is around the corner, and students from colleges and universities will intermingle, increasing risk for mumps transmission.  Contact the Communicable Disease Prevention and Control unit at (415) 473-7805, if you have any questions. 

For the seventh straight year, Marin holds the title of the healthiest County in California, according to the Robert Wood Johnson Foundation. Despite the best overall rating, persistent health and social inequities remain a challenge for Marin health officials.

The annual County Health Rankings were released today, and Marin shines in many measures of health. The rankings consider two main health outcomes: premature death and quality of life, and multiple factors that affect health including behavior, clinical care, the physical environment, and social and economic factors.

For example, Marin ranks highest in life expectancy and lowest rates of adults reporting fair or poor health and teen births. Marin is No. 2 among counties with a high number of adults with a healthy body weight and low rate of unemployment and violent crime.

“Community investments such as reserving land for open space and social norms around healthy eating and staying active have helped Marin maintain our ranking,” said Dr. Grant Colfax, Director of Marin County Department of Health and Human Services (HHS). “However, the rankings also reflect major disparities across Marin and help us know where we need to prioritize our work. For example, we need to focus on increasing equity in health care coverage, access to health food, early childhood education, and job training so everyone has an opportunity to optimize his or her health.”  

Marin ranked poorly – No. 54 out of 57 counties reporting – in income inequality, a measure that focused on the ratio between those with the highest incomes (above 80 percent of the median) and the lowest incomes (below 20 percent of the median). The County also fared poorly in one of the foundation’s new additional measures: racial segregation between whites and non-whites. Marin came in No. 50 among the 56 counties reporting. Racial segregation can translate to disparities in income, educational opportunities and work opportunities – all three of which lead to poor health outcomes.

When it comes to opportunities to live a long and healthy life, a few miles can make an enormous difference in Marin. There is a 15-year gap between life expectancy in Ross (94) and Marin City (79), a disparity that correlates with the per capita income.

Marin HHS is working in communities to help improve life expectancy. The Nutrition Wellness Program works with schools that have high obesity rates, which is known to drive heart disease and other conditions that lead to premature death. In Marin City, for example, Marin HHS supports nutrition education, walk to school programs, school gardens, and marketing to attract health-conscious grocery stores.

“While there are signs of progress, we’re more vulnerable than these rankings suggest,” said Dr. Matt Willis, the County’s Public Health Officer. “There is much more to do to achieve health equity in Marin. We need to continue to bolster programs and policies that address poverty, jobs, housing, and education.”

The County has made steady progress on many fronts with social equity, and the Board of Supervisors has made equity a priority. For instance:

  • It has made a commitment to preserve existing affordable housing, explore ways to acquire more affordable housing and encourage landlords to adhere to voluntary rent guidelines.
  • Marin County Parks is in its third year of a program designed to help more Marin residents, especially the underserved, to visit and enjoy parks and open spaces.
  • The Marin County Fair and Play Fair Marin have partnered for 14 years to build and maintain a healthy and successful fair as well as create a resource guide for ongoing and future success.
  • The Department of Public Works is diligent in its efforts to improve disability access and safety at County-maintained facilities, such as widening a popular pathway in the lower Ross Valley.
  • The County has even launched a TV series to promote education on mental health.

Other community efforts working to alleviate poverty and promote success of Marin residents are Rise Together, Marin Promise, and Marin Strong Start.

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