How is the health of our county residents?
Marin has been ranked the healthiest county
in California seven years in a row by the
Robert Wood Johnson Foundation, has the
longest life expectancy of any county in
the nation, and was named the country’s
healthiest county for children by U. S. News &
World Report. When I took this job, I wasn’t
interested in being the Maytag repairman of
public health, and when we dig deeper we see
that we have plenty of work to do to. We’re at
risk of outbreaks because of low vaccination
rates. We have huge disparities in health status between communities across the county,
with much higher rates of preventable illnesses like heart disease in some low-income
neighborhoods. And we stand out year after
year as having high rates of substance use and
have been deeply impacted by the national
epidemic of opioid painkiller abuse. These
problems are the focus of Hack4Health.
What are you hoping for with Hack4Health?
The County of Marin is committed to using
technology in innovative ways and this program was created by the Information Services
and Technology Department here. They have
important data, such as on the 15,000 calls
that came through 911 last year, as well as
community information on vaccinations,
childhood obesity and opioids. To make sense
of this information they have asked us here
at Health and Human Services to analyze it.
Think of it like CSI Marin. We brought in high
school and college students to come up with
innovative solutions to some of our biggest
[health] challenges here in the county. Ideally,
we will end up with important information
such as where bike crashes might occur most
often, or is there a city where seniors are having more issues. Our goal is to come out with
a few ideas such as an app for a patient with
pain. For instance, because of the opioid epidemic, doctors are prescribing fewer narcotics
for pain; we’d make even more progress if we
had an easy way to access healthy alternatives
like physical therapy, acupuncture or chiropractic. An app could help with that.
Can you describe your work with the vaccina-
tion issue and tell us what the current status
is here in the county? When I came on board
we had the lowest vaccination rate in the Bay
Area and were about four times lower than
the state average. The message that vaccines
were safe and effective just wasn’t penetrat-
ing, and our first step was to understand why.
We did a survey of parents to ask what their
beliefs were when they decided to not vaccinate. This was something that hadn’t really
been done at a community level before, and it
added nuance to the conversation. One of the
big factors, we learned, is that parents really
didn’t understand that vaccination is not
just a personal decision. When we vaccinate
our kids it protects their friends, neighbors
and classmates. When they see it as part of
community well-being, I think more people
opt in. A local measles outbreak, the understanding of the risks of non-vaccination and
changes in vaccine policy have all played a
role in improving our rates. Since 2012 our
rates have improved every year.
Can you talk about the crisis surrounding
opioid abuse? The leading cause of accidental
death in Marin is prescription drug overdose.
Opioid painkillers are driving most of this.
They’re highly addictive and even one too
many pills can end a life. In the years 2012
and 2013 one person overdosed accidentally
every t wo weeks in Marin, one in five high
school juniors reported they’d taken painkillers recreationally, and the problem was
getting worse. To me, this data was a real call
to action, and we convened a town hall–style
meeting in early 2014. One hundred or so people including doctors, police officers, elected
officials, educators and parents came, and we
spent five hours designing a game plan. Out of
that grew RxSafe Marin, our county wide prescription drug abuse coalition. This has been
one of the most rewarding projects, since I’ve
gotten to work with great people who share
responsibility for protecting our community
inside and outside of government. Now we’re
sharing our coalition model with other communities as people are looking for solutions to
the opioid epidemic nationally.
Our positive health scores are off the charts,
but we seem to be on the opposite side of
the scale when it comes to substance abuse.
High rates of substance use are really
inconsistent with the other health norms
in Marin and it’s a concern. In California,
the Healthy Kids Survey says 80 percent of
high school juniors report that alcohol and
marijuana are easy to access, and half that
number report using these in the past month.
With changing laws and the likely increased
availability of marijuana, we approach this a
lot like alcohol. Whatever our beliefs about
adult marijuana use, we should all agree that
it’s not safe for young people. In considering
dispensary locations and practices, we’re
working with the county to help ensure that
kids are protected. We’re also learning more
and more about adolescent brains, and it’s
clear that use at that age impairs development and increases risk of lifelong addiction.
I also see how hard Marin parents and kids
work to set themselves up for success. While
substance use threatens that goal of high
performance, we’re also hearing from kids
that stress is one reason they’re looking to
alcohol and other drugs. The county health
rankings are a stark reminder of our substance abuse problem. While we rank far
above most counties in almost all established
indicators of community health, we rate near
To make sense of this
information, they have asked us
here at Health and Human
Services to analyze it. Think
of it like CSI Marin.
Matt Willis at a recent
RxSafe Marin event.