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of Contents
 Goals
and Objectives
1998 Highlights
Statistical Tables
User's
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1998
Goals and Objectives
Mission Statement:
The mission of the Department of Health is to promote health,
prevent disease and prolong meaningful life for Westchester residents. The Commissioner of
Health is vested with all of the powers and duties necessary under the mandates of the New
York State Public Health Law to monitor and control the spread of communicable disease,
monitor and regulate air and water quality, enforce the state and local sanitary code,
promote and ensure local public health activities and assure the availability of community
health services.
Principal Services:
 Communicable Disease Control
Environmental Health Services
Community Health Services
Health
Education and Information
Administration
Services
for Children with Disabilities
Department Goals:
Communicable Disease Control
To control the spread of communicable diseases, including vaccine
preventable diseases, enteric infections, food and waterborne infections, tuberculosis,
sexually transmitted diseases, HIV, vector-borne diseases, rabies, and central nervous
system infections in Westchester County by:
Appropriate surveillance programs;
Epidemiological analysis;
Case and outbreak investigations; and
Development and implementation of measures to reduce the
risk of disease.
To assure care for those infected with tuberculosis and sexually
transmitted diseases and identification, notification, evaluation, and treatment of
relevant contacts.
To provide physician consultation/case management for
rabies exposures, tuberculosis and other communicable diseases, 24 hours a day, 7 days a
week.
To provide immunizations for influenza and pneumococcus.
To provide education and outreach for the entire community,
targeted populations at high risk for particular infections, and physicians and health
care providers, to reduce the risk of communicable diseases.
Environmental Health Services
To ensure environmental quality by responding rapidly to
environmental emergencies~ inspecting, monitoring and regulating public water systems,
sewage treatment plants, sewage disposal systems, solid waste facilities, and radiological
equipment; monitoring and regulating air and water quality; reviewing and approving realty
subdivision plans and construction; and providing environmental risk assessment and
control.
To protect the public's health by monitoring and regulating food
service establishments, hotels and motels, day camps, swimming pools, housing and
community sanitation, migrant labor camps, bathing beaches, mobile home parks, rabies
control, public health functions, mass gatherings, animal facilities, camp grounds, lead
poisoning, injury control, and clean indoor air.
To respond to emergency spills and regulate petroleum bulk storage facilities.
To implement and enforce New York State and Westchester County
Sanitary Code requirements and applicable laws and administrative rules and regulations to
assure compliance with environmental quality and public health protection objectives.
Community Health Services
To assure access for residents of Westchester County to community
health services including breast cancer screening, cervical cancer screening, adult
immunizations against influenza and pneumococcal disease, child health services, family
planning, nutrition services, and pediatric dental services.
To prevent lead poisoning in children six months to six years of
age , including the need for routine screening; to assure case management and the removal
of lead hazards from the environments of children identified as lead poisoned.
To provide health care services to patients in
their homes through the Westchester County Department of Health Certified Home Health
Agency.
To reduce the incidence of vaccine-preventable
childhood diseases by assuring complete immunizations and through surveillance and
tracking of hepatitis B infected women and education of health professionals.
To reduce infant mortality by assuring access to
perinatal care for pregnant women and by in-home assessment and follow-up by community
health workers.
To identify children at risk for developmental delays and provide home visits, health
education, developmental screening tests and referral o the Early Intervention
Program and to other programs or community agencies as needed
Health Education and Information
To improve community awareness of public health issues by
providing health education and information programs to Westchester County residents.
To support public health programs through public
outreach and education, media coverage, education of medical providers, and coordination
of policies and information among local departments of health and other health and human
service agencies.
To provide 24 hours/day access to the public for response to
public health complaints and emergencies through our Complaint & Information Bureau.
To provide support to Community Partnerships Initiatives of the
Department of Health.
Administration
To obtain and administer grant funding, state aid and third party
reimbursement in order to maximize the delivery of health services to Westchester
residents while minimizing the use of tax levy dollars.
To manage resource allocation and utilization to help ensure the
continued provision of essential services for the protection of the public's health.
To collect, interpret and provide data for community health status and public health
services assessment for Westchester County.
To coordinate managed care activities within the
Department, with state and local departments of health and social services, and with
private providers in order to ensure the provision of preventive and primary health
services to Medicaid recipients.
To administer Ryan White Title I Comprehensive AIDS
Resources Emergency Act funding to develop and operate primary health, dental care, mental
health, and social support services for persons with HIV/AIDS in Westchester, Rockland and
Putnam counties.
To develop and expand programs that will help improve health
status, services, and access for residents of Westchester County.
Services for Children with Disabilities
To identify infants and toddlers with known or suspected
disabilities and/or delays and to ensure that they and their families receive appropriate
evaluations, service coordination, and, if eligible, services specified in the
individualized family service plan in accordance with Article 25, Title 2-A of the New
York State Public Health Law.
To work with school districts, providers, and families to
ensure access for preschool-aged children three to five years old with disabilities and/or
developmental delays, to appropriate services in their natural, least restrictive
environment in a cost-effective manner in accordance with Section 4410 of the New York
State Education Law of 1989.
To act as the fiscal agent for handicapped school-aged children placed in residential
programs by their respective school districts.
To determine eligibility of and provide financial assistance to
children aged birth to 21 years old under the Physically Handicapped Children's Program in
accordance with Article 25, Title 5, of the New York State Public Health Law.
REVENUES:
Departmental Revenues
The Department of Health collects direct revenue from three major
activities: home health nursing visits, clinical encounters, and the issuance of
environmental health permits. Home health and clinic revenues are generated by billing to
Medicaid, Medicare and private insurance companies, under fee-for-service and capitated
payment plans. Patients without insurance are charged a fee based upon family income.
Environmental permit fees are established by determining the cost of issuing the permits.
State Aid
State aid reimbursement is based on a percentage of the total
eligible expenditures determined by the New York State Department of Health and the New
York State Department of Education.
Bad Debt and Charity
Proportional, retroactive reimbursement is provided based on the
share of clinical services provided to uninsured patients.
Grants
Categorical federal, state, and private grants are competitively
awarded to support discrete activities of the Department.
(Return to Table of Contents: Statistical Tables)
1998
Highlights
The Westchester County Department of Health has the broad mandate
to "promote health, prevent disease and prolong meaningful life" for the
residents of Westchester County. The functions of the Westchester County Department of
Health range from programs and services in family health, disease control, and health
education, to community health assessment and environmental health services.
The Department of Health provides clinical and environmental
services through five District Offices in New Rochelle, Rye/Port Chester, Mt. Kisco, White
Plains, and Yonkers. In 1998, the Westchester County Department of Health operated the New
Rochelle and Rye/Port Chester Pediatric Treatment Centers. The Department's Certified Home
Health Agency brings a variety of health services into the home to prevent illness and
maintain and improve the patient's health.
Health Education and Information
Health educators develop methods and programs which seek to
heighten community awareness of the need for sound health practices and preventive health
care. Through extensive publicity in the media and publications developed by the
Westchester County Department of Health, residents are encouraged to avail themselves of
public health services and clinics. Through multiple community partnerships with
community-based organizations and health care facilities, Department of Health messages
are carried to residents.
During 1998, the Department distributed thousands of bilingual
leaflets and brochures to County residents, public and private schools and community
agencies in a continuous campaign to publicize information about public health issues. The
Department continues to develop literature and portable exhibits in culturally relevant
formats for display at health fairs, conferences, seminars, and libraries.
Video stores participate in a "free overnight loan"
program for residents to borrow videos on important public health problems. Public
libraries are valuable allies in assisting the Department to publicize various Westchester
County Department of Health videos, special events and publications. The effective use of
the media in health education continues to expand through the use of feature articles,
stories and publication of press releases on potential public health emergencies and
health information.
The Department maintains a Speakers' Bureau to respond to
requests from schools and community agencies for educational programs. The Department
continues to provide consultation, education, and information to community agencies,
institutions, organizations and the public.
Complaints and Information
The computerized Complaint Bureau has heightened accessibility to
the Department by acting as a receiving and referral center for 24 hour response to public
concerns. The Department of Health maintains round-the-clock response capability to public
health emergencies such as oil and chemical spills; contact with rabid animals; lack of
heat; and medical problems for patients of its home health agency.
During 1998, staff responded to complaints relating to lack of
heat, animal bites, rabies and animal control, housing, rodents and insects, food service
establishments, smoking code violations, foodborne illness, oil and chemical spills,
sewage overflows, and other violations of the New York State and Westchester County
Sanitary Codes.
Tickborne Disease Prevention and Education
Tickborne Disease prevention, early identification and treatment
in early stages remain major priorities of the Department.
Westchester County remains a leader in developing and supporting
public education and information about these potentially serious illnesses. Portable
table-top exhibits were used as educational displays at health fairs, seminars and other
sites throughout the county. A video on Lyme Disease targeted to sports people, gardeners,
and outdoor professionals was distributed throughout the year. The Department continued to
work cooperatively with video stores throughout the County to stock Lyme Disease videos
for free loan to the public.
In 1998, the County Executive declared the week of May 11-17 to
be Tickborne Disease Awareness Week. Westchester County continued to be the driving force
behind the annual Lower Hudson Valley Tickborne Disease Awareness Week. Activities
during the week included seminars for health professionals, raining sessions for camp
personnel, and public forums.
Perinatal Outreach and Education Program
In 1995, the Department was awarded funding through the New York
State Department of Health (NYSDOH) to conduct a regional perinatal education outreach
campaign for low income pregnant women. The program uses culturally sensitive health
education materials designed to encourage underserved pregnant women to access early and
continuous prenatal care. The women and their families are also encouraged to utilize free
preventive and primary care services available in their communities to secure
immunizations, lead screenings, and well-child check-ups for their newborns.
County-wide outreach efforts include placement of cable, radio,
and print ads in English and Spanish publicizing a toll-free Healthy Baby Hotline,
development of relationships with local community leaders and residents to inform the
public of available services, and collaboration with service provider task forces to
improve access to care.
Westchester County AIDS Council
The Westchester AIDS Council was formally established in 1992 to
address pertinent issues involving the prevention and spread of AIDS, as well as the
compassionate care of individuals with AIDS and HIV infection.
In 1998, the AIDS Council accomplished the following:
- Sponsored the "Westchester County Youth AIDS Speak Out!"
that initiated a survey (to be completed in 1999) of high school aged students, both in
and out of school, to address their knowledge of HIV infection and AIDS, the sources of
their information, and the information source with which they are most comfortable.
- Provided ongoing education to persons living with HIV infection
and AIDS through the "Living with AIDS" series;
- Developed outreach for HIV risk-reduction education on select
college campuses in Westchester County; and,
- Continued the successful Westchester County Youth AIDS Council
that brings together high school students from across the county to discuss HIV./AIDS
issues.
Community Partnerships
In keeping with its commitment to develop and operate local
coalitions to improve the health of residents, the Westchester County Department of Health
initiated Community Partnerships to identify health issues of local importance, recommend
strategies to address those issues, and strengthen the community's long term capacity to
manage and improve health care. In 1997, the Health Department established a countywide
Community Partnerships Advisory Council to oversee the process as Westchester County
develops community health priorities.
In 1998, the Community Partnerships Initiative accomplished the
following:
- Sponsored a major conference that brought together 350 community
leaders from across Westchester to discuss key emerging public health issues;
- Established the Health Priorities Task Force and the Child Health
Task Force as bodies through which priorities identified at the conference will be
explored and addresses; and,
- Secured funding from the Westchester Health Foundation and
participating hospitals in the Northern Metropolitan Hospital Association (NORMET) to
support Partnership activities.
Community Health Services
District Office Services
District offices serve County residents of all
ages - from infants to senior citizens - through the delivery of health care and education
in the district offices and in residents' homes. Services continue to be provided at White
Plains, New Rochelle, Rye/Port Chester and Yonkers District Offices and are offered on a
sliding fee scale.
District Offices provide clinical services to
include pediatric and adolescent care, childhood immunizations, influenza and pneumococcal
immunizations, tuberculosis treatment, sexually transmitted diseases treatment, dental
care, lead screening, family planning, and nutritional services including WIC to county
residents.
Child Health Services
In 1998, the New Rochelle and Rye/Port Chester
Pediatric Treatment Centers provided comprehensive preventive and primary care for
well and sick children.
Childhood is the critical period for the identification,
prevention, and correction of many health problems. The Westchester County Department of
Health provides well child services, including health appraisals and free immunizations
for communicable diseases. Parents are counseled on a broad range of health and nutrition
matters. The Department works in close cooperation with Westchester's schools to provide
immunizations to children during health emergencies.
In recognition of the unique preventive and developmental needs
of adolescents, TeenCare is in operation in the Rye/Port Chester and New Rochelle District
Offices. Separate clinical sessions for this age group are conducted with an emphasis on
preventive counseling and early intervention when risk-taking behavior is identified.
Childhood Lead Poisoning Prevention Program (CLPPP)
Effective and comprehensive case management of children with
elevated lead levels on the Department's Lead Medical registry continued in 1998.
The Childhood Lead Poisoning Prevention Program closely
monitors the impact of New York State Department of Health lead legislation as private
providers across the county comply with the mandate to screen patients for lead poisoning.
As Medicaid Managed Care plays a larger role in the county, the Program continues to
expand surveillance.
The Westchester County Department of Health
receives lead lab reports for children under six years of age residing in Westchester
County via modem from the New York State Department of Health. The data are reviewed by
staff and entered into an electronic monitoring and surveillance system.
Educational endeavors are being developed to expand the
"Lead Head the Clown" high-risk targeted areas in Westchester
County. Performances were given at the Department's New Rochelle and RyeBrook/Port
Chester District Offices and Yonkers WIC site and the Greenburgh Health Center.
Immunization Action Plan (IAP)
The goal of the Immunization Action Plan is to improve the rates
of immunization of all children in Westchester County, especially those who are under
three years of age. This group of children often does not receive the protection of full
immunization, in part because parents do not realize the importance of receiving all
scheduled immunizations at this young age.
Intensive efforts were undertaken in District Offices to review
child health records and to conduct follow-up activities to ensure that children receiving
services in district offices are fully immunized.
The Provider-Based Immunization Initiative of the Immunization
Action Plan assesses physician practices that immunize children and reports on
immunization levels of their one and two year old patients. The program makes
recommendations/suggestions to aid providers in improving and sustaining immunization
coverage levels and incorporating follow up procedures to ensure that changes have been
implemented and improvements have been sustained.The Immunization Action P lan continues
to include the provision of information about the Vaccines for Children Program to private
providers to ensure that their patients have access to vaccines. The Program is a
State and federally-funded program that provides vaccines at no cost for use in immunizing
children up to 19 years of age. Effective October 15, 1998, private physicians and
college health services were required to order vaccines directly from the New York State
Department of Health. While no longer a vaccine distributor, the Westchester County
Department of Health continues to order vaccines for its own use.
Dental Health
The Westchester County Department of Health provides preventive
and restorative dental care for children and adolescents who are unable to obtain or
afford dental care.
Patients are provided with periodic examinations, home care
instruction, cleanings, preventive sealant applications, restorative care, endodontic
treatment, and basic oral surgical care. Early intervention for the prevention of
potential oral health problems is stressed so that the more costly replacement of teeth
lost due to caries/periodontal disease is avoided. Children from the ages of five to nine
years are the primary users of these services.
Home Health Services
The Certified Home Health Agency brings health services into the
home to prevent illness and maintain and improve the patient's health. Services are
provided to county residents by nurses, physical therapists, speech/language pathologists,
medical social workers, occupational therapists and home health aides.
Preventive home visits include nursing care
provided to expectant and new mothers. These visits offer information on how to prepare
and care for the newborn and on the importance of regular medical supervision, including
the need for immunizations.
In 1998, the Certified Home Health Agency continued to provide
Directly Observed Therapy (DOT) and Directly Observed Preventive Therapy (DOPT) to
patients diagnosed with tuberculosis in the County. DOT and DOPT assure completion of the
prescribed tuberculosis treatment and reduces the risk of tuberculosis transmission.
The Certified Home Health Agency, in partnership with the
Westchester County Department of Social Services Personal Care Program, provides personal
care aides to patients who require assistance with activities of daily living, nutrition
and health-related tasks. This service is essential to maintain the patient's health and
safety within the home. The Department of Health assures the provision of nursing
assessment, establishes a plan of care, and provides professional nursing supervision to
the personal care aides.
Adult Health Services
This preventive program provides clinical and educational
activities for adults and adolescents. In 1998, a Chronic Disease Prevention
Workgroup was organized to identify and promote programs addressing the prevention of
chronic diseases including cancer and asthma. Efforts included the development of a
Tobacco Use Prevention Workplan, the initiation of a community-based asthma program and
the promotion of better nutrition and exercise habits.
The Breast Health Program offers examinations,
mammography and self-exam teaching to women with limited access to these services. The
program has successfully focused its outreach efforts to targeted minority populations,
with increased mammography availability in 1998. Cervical cancer screening was expanded to
four district offices in 1998.
The Community Health Worker Program (Healthy Beginnings) is a
case management program that targets high risk pregnant women and parents of infants. Case
managers offer assistance with referrals to health care and social service providers,
transportation for clients as needed to access these services, and peer counseling
parenting groups. In 1998, Healthy Beginnings continued to target the communities of
Yonkers, White Plains/Greenburgh and Port Chester.
Family Planning Services in District Offices are confidential.
They include HIV counseling and, if the patient consents, HIV testing.
In December of 1998, the New York State Department of Health
awarded the Department a Colorectal Cancer Screening and Prostate Cancer Education grant.
Activities include the use of comedians to present at a wide variety of community
and business organizations, professional and trade associations, church groups and others
with the goal of improving participation in colorectal cancer screening and prostate
cancer education activities.
Community Nutrition Services
The Bureau of Community Nutrition Services continues as a
resource for the public and community agencies. Nutrition information, education and
guidance are provided to promote health and reduce the risk of chronic diseases such as
diabetes, cancer and cardiovascular disease.. Technical assistance and consultation on
nutrition education program development are available to community agencies and
organizations. The Bureau works cooperatively with community agencies and groups to
reach nutritionally vulnerable groups.
The goal of the Special Supplemental Nutrition Program for Women,
Infants, and Children, more commonly known as the WIC Program, is to improve pregnancy
outcomes and promote optimal growth and development in infants and preschool children.
In order to meet these goals, the WIC Program provides nutritious foods, nutrition
education and counseling, breastfeeding guidance, and referrals for health and human
services. WIC Offices are located in Department of Health District Offices in
Yonkers, White Plains, and Rye Brook/Port Chester. The Program generated revenues of
$5.6 million into the local economy through the use of WIC checks by program participants
to purchase authorized foods in local food markets, many of which are located in
low-income areas.
The Farmers Market Nutrition Program (FMNP) is
sponsored jointly by the New York State Departments of Health and Agriculture and Markets,
the New York State Office for Aging, and the United States Department of Agriculture's
Food & Consumer Services. Families enrolled in the WIC Program are issued coupon
booklets to purchase fresh fruits and vegetables at local authorized Farmers Markets to
help low-income WIC families increase their consumption of fresh fruits and vegetables.
In addition, it assists New York State farmers by increasing direct retail sale of
their produce.
Communicable Disease Control
The Division of Communicable Disease Control is responsible for
the development and administration of programs to effectively control and prevent the
spread of communicable diseases in Westchester County. Communicable disease control is
accomplished through active and passive surveillance programs, epidemiologic analysis,
case and outbreak investigations, and the development and implementation of measures to
reduce the risk of a particular disease.
Tuberculosis Tuberculosis (TB)
TB control is accomplished through early identification and
treatment of active cases. Contacts of active cases are also identified,
administered a tuberculin skin test, and provided with preventive therapy when indicated.
Tuberculin testing of contacts is performed in households, chest clinics, work
sites, community organizations, and schools. Directly Observed Therapy (DOT) assures
adequate treatment and reduces the emergence of drug-resistant strains of TB.
Comprehensive medical management and supervision for TB is available through the Health
Department's TB/Chest Clinics. Clinic sessions, including evening hours, are held in
Yonkers, Rye/Port Chester, New Rochelle, and White Plains district offices. Consultation
to private physicians and Medicaid Managed Care providers for management of individual
cases is provided.
Sexually Transmitted Diseases (STD)
The screening of high risk populations for sexually transmitted
diseases is performed and Sexually Transmitted Disease Clinics are conducted to diagnose
and treat syphilis, gonorrhea, chlamydia, and other sexually transmitted diseases. Clinics
located in the New Rochelle, White Plains, and Yonkers district offices are free and
confidential. Sexually transmitted disease/HIV services at the Westchester County
Correctional Facility continues to promote early identification and treatment of sexually
transmitted diseases. Partner identification, notification, and treatment are provided for
identified cases of sexually transmitted disease. Education and counseling for prevention
of sexually transmitted diseases are provided by outreach staff at community-based
and health care settings.
Rabies
The Westchester County Department of Health continues to provide
education and medical consultation to individuals exposed to rabid or potentially rabid
animals. Consultation is provided to physicians in Westchester County managing such
exposures. Services include facilitating the testing of suspect animals and the
surveillance of biting pets and quarantined pets. Preventive treatment is provided
to county residents when indicated. Ongoing rabies education has resulted in increased
public awareness of bat rabies and measures to reduce the likelihood of exposure to rabid
animals and bat entry into dwellings.
Emerging Pathogens
The Department provides surveillance, treatment recommendations,
and educational information to residents on emerging pathogens. During the past few years
there has been increased surveillance and investigation for newly recognized diseases
including E. Coli 0157, vibrio parahaemolyticus, and cyclosporidiosis. Investigations of
potential water-borne pathogens such as cryptosporidium and giardia have intensified.
Acquired Immunodeficiency Syndrome (AIDS)
The Division of Communicable Disease Control provides
community-based prevention,, works with state and local education committees to
incorporate appropriate educational efforts into curriculum, conducts outreach to
populations at high risk for infection with HIV, and facilitates access to health care.
Public health staff provide HIV counseling and
testing to detect infection with HIV and the AIDS virus and make health and human service
referrals for those who are HIV-infected.
Collaboratively with the Sexually Transmitted Diseases Program,
staff provide partner identification and notification of HIV-infected persons for private
physicians and for cases identified through Department of Health counseling and testing
programs.
The Department provides leadership on HIV/AIDS related issues
through participation in the Westchester County AIDS Council; the Ryan White Network; the
Mount Vernon AIDS Task Force; the Yonkers Community Planning Council's AIDS Committee; the
People of Color HIV Coalition; and other community-based committees and task forces.
Vector-borne Disease
The Department conducts active and passive surveillance for Lyme
Disease and together with New York State Department of Health initiated active
surveillance for human ehrlichiosis which was newly recognized in Westchester County in
1994. Both diseases are transmitted by the deer tick Ixodes Scapularis. Educational
efforts are directed towards physicians and health care providers to recognize, diagnose,
and manage tick-borne diseases and in schools, for high risk persons, such as outdoor
workers and senior citizens.
Communicable Diseases
The Department conducts immediate investigations of situations
which represent significant health risks to the public, such as meningococcal meningitis
and hepatitis in food handlers. Public health staff implement appropriate control measures
through contact identification, and provide recommendations for treatment, prophylaxis,
and immunization.
Physician Education
Infectious Disease Updates give current information and
recommendations for a wide range of infectious diseases to physicians and other health
care practitioners in Westchester County several times per year. Physician Grand Rounds,
to educate physicians about issues of public health significance and up-to-date diagnostic
and management recommendations for particular diseases, are provided throughout the year.
ENVIRONMENTAL HEALTH SERVICES
Environmental Quality
Increased technology, urbanization, and a population shift have
created the potential for adverse effects on natural resources. The Westchester County
Department of Health is the lead regulatory agency charged with monitoring the
environmental quality of land, air, and waters. As in the last several years, 1998
demanded vigilant implementation of the regulatory controls designed to protect these
natural resources.
The Department of Health responds to public concerns and
inquiries regarding sewage, septic waste, water supply and drinking water quality, refuse
disposal, medical and hazardous waste, air quality, water pollution, realty subdivisions,
individual sewage disposal systems, and individual water supplies.
The monitoring of sewage treatment plants in Westchester County
is conducted to prevent and control water pollution and for the improvement and
maintenance of water quality. The Department is responsible for plan reviews and approval
of public sewer extensions and new or modified wastewater treatment plants. Staff respond
to complaints of sewage discharges onto the ground surface or to the waters of the County.
The Department performs inspections and surveillance sampling of
water treatment plants to assure that a high quality of drinking water, which meets all
State and County codes, is provided to the residents of Westchester County. The Department
maintains oversight responsibility for 91 community and 173 non-community public water
supplies. Staff work closely with the northern and mid-county supplies to encourage the
best regional solutions for mandatory filtration of surface water users.
The Department seeks to protect ambient air
quality through plan reviews and approvals of commercial and industrial sources, and
inspections and response to complaints from County residents regarding ambient air quality
and point source emissions.
Engineers make inspections of construction sites and provide
construction certifications. They review realty subdivision plans for compliance
with State and County Sanitary Codes and design standards to assure safe and adequate
water supplies and adequate sanitary sewer systems. The approval of the Westchester County
Department of Health is required before the filing of a subdivision map with the County
Clerk.
Department engineers review and approve plans and specifications
for new public swimming pools as well as modifications to existing public swimming pools.
Inspections are conducted and permits are issued to regulate the
management, transportation and disposal of solid waste in accordance with State and County
laws and regulations.
In November 1997, the New York City Watershed Agreement was
implemented. This has resulted in a cooperative partnership to develop and implement a
watershed protection program to maintain and enhance the quality of the New York City
drinking water supply system and the economic vitality and social character of the
watershed communities. The New York City watershed negotiations involved delegation of
plan approval for septic systems on the New York City watershed (more appropriately called
subsurface sewage treatment systems) to the Westchester County Department of Health.
This serves to avoid duplication of regulatory effort by utilizing the services
already performed by the Department.
Public Health Protection
Public health sanitarians enforce the laws, rules, and
regulations necessary to maintain and promote community hygiene. They perform routine
inspections, investigate complaints from county residents, and strive to educate the
public concerning the necessary safeguards to maintain a healthy, safe environment. The
appropriate enforcement authority is exercised when violations are discovered to protect
the public from actual or potential health hazards.
The responsibility for the surveillance and protection of food
prepared and served to the public rests with this program. In 1998, public health
sanitarians and environmental health technicians regularly inspected all food service
establishments in Westchester County, based upon a risk assessment model. These
inspections focus on violations likely to result in foodborne illness. Depending on the
type and number of violations found, a food service establishment could be immediately
closed, referred for legal action, or reinspected to ensure non-recurrence of the
violations. The way food is prepared, stored, and marketed is ever changing, as is the
microbial environment of food. In the last decade, we have discovered a host of new
foodborne pathogens - L. monocytogenes, E. Coli 0157:H7, S. enteriditis, and Norwalk
viruses, among others. Both the changes in food preparation and food pathogens require us
to investigate all outbreaks of foodborne illness to learn the causes of the outbreak.
Only after discovering the causes, can measures be put into place to prevent further
outbreaks.
All motels, hotels, and institutions are inspected annually with
special emphasis on fire safety. During the summer months, sanitarians inspect children's
day and overnight camps. Inspections are conducted at migrant labor camps, mobile home
parks, and campgrounds from Spring through the fall.
Beginning in the spring, outdoor swimming pools
and bathing beaches are inspected, sampled and then permitted. During the Fall, indoor
swimming pools and spa pools are checked.
Animals implicated in possible disease outbreaks, including
rabies, are monitored by sanitarians. All animal bites should be reported to the Health
Department immediately. Westchester County continues to be threatened by a major public
health emergency, rabies, which reached the borders of Westchester County as raccoon
rabies on April 4, 1991. Documented, confirmed cases of animal rabies have been reported
Countywide and the problem has spread through the more rural northern part of the County
into the more populous, southern regions of Westchester. The Department of
Health offers low-cost rabies vaccination clinics for household pets. The Department
vigorously enforces the dog and cat immunization law; owners who have not had their
cats and dogs immunized risk serious penalties, including a potential $1000 fine if the
animal is involved in a biting incident.
Complaints from the public concerning lack of heat, insects and
rodents, nuisance and service requests are responded to by sanitarians who ensure that
County and State Sanitary Codes are enforced. Staff work closely with municipal and
State agencies to resolve many types of housing problems encountered. Staff perform
inspection s in response to complaints concerning smoking in public places and enforce the
County's Sanitary Code. Initiatives continue under the Department's Healthy
Neighborhoods Program in the City of Yonkers via door-to-door outreach, home safety
inspections, distribution of safety products, and referrals for community health services
when indicated.
The Department continues to respond to a variety of environmental
incidents including the transportation of hazardous materials, newly listed hazardous
waste sites, industrial/commercial accidents, spills, and various other hazardous
materials related releases. This can be attributed to the higher level of
environmental awareness of county residents and the chemical industry community, and to
the implementation of local legislation.
The Department's chemical emergency response van continues to
enable the Westchester County Department of Health to respond on a 24-hour basis to
chemical emergencies and hazardous spills with efficiency and a high level of technology.
The Department continues to take a lead role in advising the Hazardous
Materials Local Emergency Planning Committee as mandated by the Federal Superfund
Amendments and Reauthorization Act (SARA) Title III. This Act requires the listing
of sites containing quantities of potentially hazardous chemicals. The chemical
industry community formed a Community Awareness and Emergency Response Group to further
assist the Local Emergency Planning Committee in accomplishing its mandated tasks. A
number of new SARA-subject facilities have been identified and the Department of Health
responded to an increased number of petroleum-related spills and complaints in 1998.
Protection of the public from needless radiation exposure is
achieved through State-mandated inspections of medical and dental X-ray facilities,
surveillance around the Indian Point nuclear power reactors and other facilities utilizing
or discharging radioactive materials, and surveys of other sources of potential exposures.
Radiological training for public health staff continued in preparation for a
federally observed Indian Point Emergency Response Drill. Environmental staff spent more
than 700 personnel hours on training, dose assessment, field monitoring, and emergency
operating center procedures.
The Westchester County Department of Health continues to conduct
special investigations in conjunction with the Westchester County District Attorney's
office, the Westchester County Fire Coordinator's Hazardous Materials Unit, the
Westchester County Bomb squad, the New York Sate Department of Environmental Conservation
and the New York State Department of Health regarding criminal prosecution of individuals
and companies involved in environmental criminal acts that jeopardize the health of the
community as well as the environment.
Westchester is one of five Petroleum Bulk Storage delegated
counties in New York State with the authority to enforce petroleum bulk storage
regulations from the New York State Department of Environmental Conservation. The
Westchester County Board of Health added Article XXV, Petroleum Bulk Storage Code, to the
Westchester County Sanitary Code in December of 1996. Department of Health staff issue
permits for all petroleum bulk storage tanks greater than 1,1000 gallons capacity in
conjunction with monitoring and inspections. Staff also provide training and
information to owners and operators of petroleum bulk storage facilities that include
gasoline stations, fuel oil companies, apartment building complexes, schools, office
buildings and private residences.
In the continuing effort to stop the sale of tobacco products to
minors, the Westchester County Department of Health performed enforcement checks for
compliance with the Adolescent Tobacco Use Prevention Act (ATUPA) at establishments
throughout the County. Compliance teams, consisting of two full-time staff members from
the Health Department and a minor 17 years of age. Third-time offenders are referred
to the New York State Department of Taxation and Finance for suspension of their license
to sell tobacco products. The Department of Health is committed to aggressive
enforcement of the ATUPA law. Each year, tobacco kills more New Yorkers than
alcohol, drugs, car accidents, fires, homicide, suicide and AIDS combined.
Administration
Ryan White Comprehensive AIDS Resource Emergency
Act Funding
For the eighth year, the Westchester County Department of Health
administered Ryan White Title I CARE Act funding to develop services for persons with
HIV/AIDS in Westchester, Rockland, and Putnam Counties. In 1998, the Tri-County region
received a total of $4,003,664 in Title I funding. The funding provided for 45 HIV/AIDS
service contracts in primary health care, dental care, adult drop-in services, permanency
planning, meal delivery, respite care, advocacy assistance, case management, mental
health, housing emergency assistance, transportation and risk reduction/outreach. This
program operates the Title I Steering Committee, participates in the Care Network, and
continues to support Living Together, a coalition of persons infected and affected by
HIV/AIDS.
Major accomplishments in 1998 included the following: compiling a
Consumer Survey for People with HIV/AIDS and an HIV/AIDS Case Management as planning
tools to reassess service priorities; re-contracting with 13 case management and
supportive services programs to make them more"outcome-oriented" for clients;
conducting a training series for providers of services to persons with HIV/AIDS on
treatment education and back-to-work issues; implementing two new housing services
programs providing short-term assistance with rent and utility payments; and, maintaining
a continuum-of-care throughout 45 community-based contracts providing primary, dental, and
mental health care, meal delivery, transportation, legal advocacy, case management and
other supportive services.
Services for Children with Disabilities
Services for Children with Disabilities continues to expand
as families access services under the Early Intervention Act and as use of
itinerant-related services in home/community environments increases under the preschool
special education legislation.
During 1998, Westchester County continued to hold appointments to
the Governor's statewide Early Intervention Coordinating Council and the State Education
Municipal Advisory Committee on Services to Preschool-aged Children with Disabilities. The
Department continues to chair the Downstate Physically Handicapped Children's Program
Regional Group and hosts a workgroup of Downstate Early Intervention Officials.
Managed Care
The Westchester County Department of Health continued to
experience the impact of mandatory enrollment of Medicaid recipients in managed care plans
during 1998, the program's third year of full implementation. Children previously seen by
the Department's Pediatric Treatment Centers continued to be assigned to one of five
managed care plans serving Westchester County. During 1998, the loss of Medicaid-eligible
patients and reduction s in fee-for-service Medicaid revenues continued to be experienced.
The Department continues to work with the Westchester County
Department of Social Services and the New York State Department of Health on issues of
quality assurance, data reporting, delineation of responsibility for health services and
protection, and the public health impact of mandatory Medicaid Managed Care and of the
expanded Child Health Plus Program. In 1998, regular educational forums on a variety
of public health topics were held for managed care plan representatives.
Child Health Task Force
In 1998, the Department was awarded a grant from the
Westchester Health Foundation. The funding supports a contract with the Westchester
Children's Association to staff and organize education and training to broaden the base of
community outreach around Child Health Plus and Medicaid. This is accomplished
through the Westchester Child Health Task Force, co-chaired by the Westchester Children's
Association and the Westchester County Department of Health, under the umbrella of the
Community Partnerships for a Healthy Westchester.
Health Priorities Task Force
In 1998, the eighteen Westchester member hospitals of NORMET
funded a project of community health priority setting under the Health Priorities Task
Force, co-chaired by NORMET and the Westchester County Department of Health, under the
umbrella of the Community Partnerships for a Healthy Westchester. The Health
Priorities Task Force hired a nationally recognized consultant who began the process of
local priority setting through focus groups and public forums to identify local need and
concerns.
Grants and Contracts
With the reduction of third-party funding, state aid, and tax
levy funding, the Westchester County Department of Health continues to seek to maximize
the availability of non-county dollars to support public health activities and the
delivery of health care services through the administration of grants and contracts.
In 1998, the Division of Administration administered and managed 25 grants totaling
$10.5 million and approximately 375 contracts.
(Return to Table of Contents: Statistical Tables)
Statistical Tables
1. Demographic Data - 1997 & 1990
Table 1: Population, Surface Area and Population
Density Per Square Mile by Community Health Service Area and Municipality -
Westchester County: 1997
Table 2: Population Distribution by Age, by
Community Health Service Area and Muncipality - Westchester County: 1990
Table 3: Population Distribution by Race and
Ethnicity by Community Health Service Area and Muncipality - Westchester County: 1990
2. Vital Statistics - 1997
Table 4: Number and Rate of Live Births, Infant and
Total Deaths - Westchester County: 1900-1997
Table 5: Number and Rate of Infant Deaths by Race -
Westchester County, New York State, and Upstate New York: 1982-1997
Table 6: Live Births and Deaths by Community Health
Service Area and Municipality - Westchester County: 1997
Table 7: Number and Rate of Total Pregnancies, Live
Births and Fetal Deaths (Spontaneous and Induced) by Maternal Age Group - Westchester
County: 1997
Table 8: Live Births by Number and Percent Low
Birthweight, Time Prenatal Care Began and Maternal Age Group - Westchester County: 1997
Table 9: Live Birth and Birth Rates - Women 15-19
Years of Age by Community Health Service Area and Municipality - Westchester County: 1997
Table 10: Deaths and Death Rates by Selected Causes
- Westchester County and New York State (Including and Excluding New York City): 1997
Table 11: Leading Causes of Death and Death Rates -
Westchester County, New York State, Upstate New York, New York City and the United States:
1997
Table 12: Number and Rate of Deaths Due To Malignant
Neoplasms by Site, Sex and Age Group - Westchester County: 1997 and 1987
3. Morbidity Data - 1998
Table 13: Cases and Rates of Reportable Diseases-
Westchester County: 1996-98,
Table 14: Newly Diagnosed Cases of Early Syphilis by
Age Group and Sex Westchester County: 1998
Table 15: Newly Diagnosed Cases of Gonorrhea by Age
Group and Sex Westchester County: 1998
Table 16: Selected Tuberculosis Statistics: New and
Continuing Active Cases, Contacts, Deaths and Rates of Incidence, Prevalence and Death
Westchester County: 1994-98
Table 17: Confirmed Cases of Tuberculosis, Single
and Multiple Drug Resistant Cases, by Year - Westchester County: 1989-1998
Table 18: Reported Cases of Acquired Immune
Deficiency Syndrome (AIDS), Deaths, and Case Fatality Rates by Year of Diagnosis -
Westchester County Residents Surveillance Report through December 31, 1998
Table 19: Reported Cases of Acquired Immune
Deficiency Syndrome (AIDS) by Sex and Risk Factor - Westchester County Residents
Surveillance Report through December 31, 1998
Table 20: Reported Cases of Acquired Immune
Deficiency Syndrome (AIDS) by Age Group - Westchester County Residents Surveillance Report
through December 31, 1998
Table 21: Confirmed Cases of
Lyme Disease and Ehrlichiosis - Westchester County by Community Health Service Area and
Municipality: 1998
Table 22: Confirmed Cases of
Lyme Disease Reported by Age and Sex Westchester County: 1998
Table 23: Confirmed cases of
Ehrlichiosis Reported by Age and Sex - Westchester County: 1998
4. Public Health Protection
Services Data - 1998
Table 24: Number of Selected
Program Activities: l998
Table 25: Food Sanitation and
General Environmental Permits Issued: 1998
Table 26: Number of Animals Confirmed Rabid by Community Health Service Area and
Municipality Westchester County: 1991-1998
Table 27: Number of Animals
Confirmed Rabid by Type of Animal Westchester County: 1991-1998
Table 28: Rabies Post-Exposure
Treatment Given: 1991-1998
5. Environmental Quality
Control Services Data - 1997
Table 29: Selected Activities by Program: 1998
6. Clinical Health Services
Data - 1998
A.
Clinics
Table 30: Clinic Sessions and Patient Visits by Community Health Service Area: 1998
Table 31: Clinical Services:
Pediatric, Dental, Family Planning - Patients and Visits by District Office and Patient
Age Group: 1998
Table 32: Clinical Services:
Tuberculosis, Sexually Transmitted Disease - Patients and Visits by District Office and
Patient Age Group - 1998
Table 33: Immunizations by Site Where Administered and Type : 1998
B. Home Health Agency
Program
Table 34: Patients Served by
District Office, Discipline and Diagnosis: 1998
Table 35: Patients Served by Patient Age Group, Discipline and Diagnosis: 1998
Table 36: Visits by District Office, Discipline and Diagnosis: 1998
Table 37: Visits by Patient Age
Group, Discipline and Diagnosis: 1998
Table 38: Directly Observed Therapy Visits and Directly Observed Preventive
Therapy Visits: 1994-1998
C. Childhood Lead Poisoning Prevention Program
Table 39: Number of Screening Tests Conducted by Site and Classification,
Westchester Country 1998
Table 40: Number of Screening
Tests Conducted, Children Confirmed Positive and Lead Registry Cases by Community Health
Service Area and Municipality - Westchester County: 1998
VI: Services for Children with Disabilities
Table 41: Services for Children with Disabilities - Number of Children Served:
1998
Table of figures and maps
Figure 1: Map - Westchester
County Department of Health - Community Health Service Areas
Figure 2: Infant Mortality Rate By Race, Westchester
County and Upstate New York - 1982-1997 (Source: Table 5)
Figure 3: Pregnancy Rate by Maternal Age Group,
Westchester County: 1997 (Source: Table 7)
Figure 4: Percent Low
Birthweight and Percent Delayed Prenatal Care by Maternal Age Group,
Westchester County: 1997 (Source: Table 8)
Figure 5: Cancer Mortality Rate, 5 Leading Sites,
Westchester County: 1997 and 1987
(Source: Table 12)
Figure 6: Distribution of
Site-Specific Cancer Mortality, Westchester County: 1997
(Source: Table 12)
Figure 7: AIDS Cases and
Deaths by Diagnosis Year, Westchester County: 1982-1998
(Source: Table 18)
Figure 8: Reported Cases of AIDS by Risk
Factor, Westchester County: 1982-1998
(Source: Table 19)
Figure 9: Maps - Confirmed Cases
of Lyme Disease and Ehrlichiosis - Westchester County, by Municipality, 1998 (Source:
Table 21)
Figure 10A: Maps - Confirmed Cases
of Animal Rabies: Westchester County by Municipality, by Year, 1991-1994 (Source: Table
26)
Figure 10B: Maps - Confirmed Cases of Animal Rabies: Westchester County by
Municipality , by Year: 1995-1998
Figure 11: Rabies Post-Exposure Treatment Administered, 1991-1998 (Source:
Table 28)
Figure 12: Directly Observed Therapy and Directly Observed Preventive Therapy
Visits, 1994-1998 (Source: Table 38)
Figure 13: Childhood Lead
Poisoning Prevention Program Number of Screening Tests and Children Confirmed Positive by
Community Health Service Area: 1998 (Source: Table 40)
(Return to Table of Contents:
Statistical Tables)
Technical
Notes :( under construction)
(Return to Table of Contents: Statistical Tables) |
