Community Health Assessment

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Community Health Assessment

• Macon County, NC
• 2000

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There is no better way to build support for
public health interventions than to engage
community residents
--State Center for Health Statistics
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Macon Countys 2000 Health Assessment

• Engaged community members and health
  professionals in
• Studying Macon Countys health statistics
• Gathering opinions of community members
• Identifying health priorities
• Planning steps of action to address those
  priorities

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The Team

• Macon County Public Health Center
• Anne Hyder Kathy McGaha Stan Polanski, PA
  Karen Oldham,
• Macon County Physicians
• Carlos Vargas Ronnie Massey
• Macon County Dept. of Social Services
• Dianne Holbrook
• Smoky Mountain Counseling Center
• Todd DuBose
• Hospital Representatives
• Martin Wadewitz, AMC Jim Graham, HCH
• Community Representatives
• Buck Trott, Mayor, Highlands Barbara McRae,
  NPL Rita deMaintenon, MCCF Ted Guenther,
  Kiwanis Club

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Demographic Economic Trends with Health Impacts
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Macon County Is Growing

• Young adults leave for greater opportunities
• Natural rate of increase is negative
• More deaths than births recorded for county
• Growth is due to in-migration
• 6th highest rate in the state, highest in WNC
• Many of those moving in are retired people

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Macon County is Aging
Fastest growing populations Seniors
Total pop. 9.8
Projected rate of increase 1999 - 2005.
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Part-time Population Large Growing

• Macon County homeowners
• 31 live elsewhere
• Highlands area homeowners
• 50 live elsewhere
• Part-time group growing faster than the permanent
  population

Source NPL Residential Customer Count, June 2000
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Minority PopulationSmall but Growing

• Influx of Hispanic residents
• no documentation exists on current numbers
• Hispanic population fluctuates
• reflects seasonal nature of jobs in agriculture
  and tourism

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Macon County ResidentsLagging the State in Wealth

• Full employment
• Unemployment rate 3.1 (1998)
• Chronic underemployment
• Average weekly wage rate 74 NC average
• 37 of Macon County wage earners made 7,890 or
  less (1997)

Poverty remains a problem.
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Health Consequences of the Demographics

• Growing elderly population requiring services
• Shortage of young workers to provide services
• Seasonal demand for medical services
• Need to be responsive to growing Hispanic
  presence

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Health StatisticsWhat Did the Health Numbers
Say?
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Source of Statistical Data
County Health Data Book State Center for Health
Statistics Office of Healthy Carolinians
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Limitations of State Data

• No hard data on part-time residents
• Some data are obsolete
• Statistical bias/ small number effect
• Especially true for minority population
• May need several years of data for validity
• Inadequate data on communicable diseases
• Human papilloma virus and Hepatitis C seem to be
  particular troublesome in Macon County

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Criteria Used in Evaluating Data

• Absolute numbers of people affected
• Leading causes of death
• Hospital admissions
• Residents without health insurance
• Macon County rates relative to state
• Age-adjusted age-specific rates
• Age of persons affected
• Elderly, all adults, all ages, the young

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Leading Causes of Death
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Age-Adjusted Rates Leading Causes of Death,
1994-1998

• Equal to or higher than the state rate
• Pneumonia and Influenza
• Injuries
• Diabetes
• Lower than the state rate
• Heart Disease
• Cancer
• Stroke
• Chronic Obstructive Lung Disease

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Age-Specific Death Ratesfor 1994 - 1998

• Macon County Death Rate is significantly above
  the state rate in these three areas
• Suicides in persons ages 20-39
• Injuries, other than motor vehicle accidents,
  ages 40-64
• Pneumonia and Influenza in persons 85

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Hospital AdmissionsPrimary Diagnoses Only, 1997
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Mental Disorders Alcohol/ Drug-Related
Admissions

• Primary or underlying diagnosis for more than
  1,400 hospital admissions in 1997.
• The five diagnoses listed as leading causes of
  admissions were primary diagnoses only.
• Cannot fully evaluate this finding, but it
  suggests a significant health concern.

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Other Group Specific Rates

• Macon County had significantly higher rates than
  the state in several areas
• Teen pregnancy, white females
• Maternal smoking
• Lack of health insurance
• Reports of child abuse/ neglect/ dependency
• Shortage of dentists, nurses and primary care
  physicians

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White Female Pregnancy Rates ages 15-19
Pregnancies per 1000 females, 15-19.
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Macon County Residents without Private or Public
Health Insurance

• In 1995, 3,673 residents were uninsured
• 1,375 of these had incomes below the poverty
  level
• The childrens health insurance program, NC
  Health Choice has helped
• 560 Macon County children were enrolled by
  September 2000.
• Rate of uninsured adults remains high

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Shortage of DentistsMost serious shortage in
health-care professions
Population served by each dentist, NC vs Macon
County
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Problems Affecting Mostly the Elderly

• Leading causes of hospitalizations and death
  among the elderly
• Heart Disease
• Cancer
• Stroke
• Chronic Obstructive Lung Disease
• Pneumonia and Influenza

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Problems Affecting AllAdult Age Groups

• Diabetes
• Drug/ alcohol-related hospitalizations
• Mental health hospitalizations
• Workplace accidents
• Suicide

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Problems Affecting All Ages

• Injuries, including motor vehicle accidents
• Lack of health insurance
• Lack of dentists, nurses and primary care
  physicians
• Lack of health care services for lower income
  people without insurance

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Problems Affecting the Young

• Teen pregnancy
• Maternal smoking
• Child abuse and neglect

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Conclusions fromHealth Statistics
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Most Statistically Significant Problems

• Smoking-related problems
• Lack of health insurance
• Shortage of dentists, nurses, and primary care
  physicians
• Hospital admissions for mental health drug/
  alcohol related disorders
• High teen pregnancy rates
• Injuries (motor vehicle other)
• Diabetes mortality
• Pneumonia and Influenza deaths in the elderly

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Community DataWhat Did Macon County Residents
Say?
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Sources of Community Data

• Youth health issues focus groups
• Adult health issues focus group
• Vision 2025 Report
• School Health Services Survey

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Youth saidThese are most common risky
behaviors in Macon County

• Sexual Behavior
• Substance Abuse
• Driving Behavior

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Youth SaidThis would discourage risky behavior

• Getting Accurate and Age Appropriate Information
• Private, Non-judgmental Environment
• Ex Friends, Video, Book, Internet, TV
• Parents they trust, but not if bad examples
• School System
• Organized Activities
• Parental/Guardian Guidance

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Adults who work with youth saidThese are
common threads inteen pregnancy in Macon County

• Under 18 years of age
• No more than an 8th grade education
• Claim to be home-schooled
• Boyfriends at least 4 years older
• Recurring pattern of teenage pregnancy in family
• Smoke
• Use drugs

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Adults who work with youth saidThese are
successful programs foryouth at risk

• Outward Bound
• Project Soar
• Project Pursuit/FRIENDS Program
• Baby Think It Over
• New Century Scholars
• Dollar a Day Program
• Support Our Students

Programs existing in Macon County
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Adults saidThese are needs related to youth

• Sex education
• Substance abuse education
• Parenting training
• Earlier childhood programs
• Participation in community organizations
• Mentoring programs
• Nurses in schools

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Adults SaidThese are the adult health
issuesin Macon County

• More accessible mental health counseling and
  information
• Health services and activities in Nantahala and
  other remote sections of the county
• Getting more adults to exercise

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Vision 2025 Report

• Important trends
• Macon Countys population is rapidly aging
• More people who used to be part-time residents
  are becoming full-time residents
• Growth aging put tremendous stress on Macon
  Countys health care system
• More attention should be paid to special needs of
  the aging

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School Health ServicesSurvey Report
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Teachers as Nurses?Elementary Teachers who
Encountered Sick/Injured Children in a One Month
Period
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Elementary Students withChronic Health Conditions
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Elementary Students Administered Medication Daily
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Elementary Students Administered Medications in a
One Month Period
Nebulizers
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Average Number ofSchool Nurses
Macon County is 1 of 8 counties without a school
nurse
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Community Health Action Plan
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Macon County Health Priorities, 2000

• Access to Dental Care
• Influenza/Pneumonia
• Injuries
• Mental Health/Suicide
• School Nurse
• Senior Health Assisted Living In-Home Care
• Senior Health - Diabetes Type 2
• Teen Pregnancy
• Teenage Tobacco Use

Items starred are currently being addressed by
Macon Partners.
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Access to Dental CareGoal for 2005

• Increase dental services to Macon County
• Under-insured populations
• Under-served populations

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Access to Dental Care - Strategies

• Public Health Mobile Dental Unit
• For under-insured under-served children
  adults
• Access Dental Care program
• Special needs patients
• e.g. nursing home patients developmentally
  disabled
• Seven WNC counties
• Recruit dentists
• Mobile Unit
• Access Dental Care Program
• Private Practice in Macon County

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Access to Dental CareStrategy

• Legislative Strategy
• Advocate for legislation changes
• Reciprocity/ licensing on credentials
• Increase in Medicaid reimbursement rates for
  dental services
• Simplify Medicaid claim filing process

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Influenza/PneumoniaGoal for 2005

• Achieve 20 increase in vaccination rate
• For Influenza and Pneumococcal Disease
• For adults 65 and older
• During senior vaccination season

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Influenza/PneumoniaStrategies

• Form local agency partnership to conduct public
  awareness campaign
• Hold Senior Vaccination Events
• Weekends
• Voting Day
• Increase partnering agencies awareness of
  vaccine importance availability
• Promote Pneumonia vaccination year-round

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InjuriesGoal for 2005

• Increase motor vehicle injury prevention
  awareness among Macon County residents

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InjuriesStrategies

• Inventory existing vehicle safety programs
• Coordinate a public awareness campaign for
  vehicle operation safety
• Increase utilization of the Health Centers
  carseat safety program

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Mental Health/SuicideGoal for 2005

• Increase public education on risk factors of
  Stress Related Disorders and Suicide
• Depression
• Substance abuse
• Isolation

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Mental Health/SuicideStrategies

• Establish a partnership to review mental disorder
  and substance abuse treatment
• Mental health professionals
• Local physicians
• Local hospital professionals
• Help initiate promote support groups in Macon
  County

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Mental Health/SuicideStrategies - continued

• Increase awareness of Smoky Mountain Counseling
  Center hotline and phone numbers
• Coordinate mental health education events for
  Macon County churches
• Coordinate mental health education events within
  private industry

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School NursesGoal for 2005

• Ensure the coordination of fluent policies and
  procedures for a School Health Nurse Program

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School NursesStrategies

• Hire 1.5 school nurses for county schools
• Maintain the School Health Task Force as advisory
  committee
• Research identify funding to meet minimum
  state recommendation
• 1 nurse per 750 students
• Macon County, 4000 students 5 1/3 Nurses
• Train all county teachers in first aid CPR

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Senior Assisted Living In-Home Care Goal for
2005

• Increase efficiency of case management for
• county residents
• 60 years old or older
• requiring community-based care

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Senior Assisted Living In-Home Care Strategies

• Establish a Senior Health Partnership
• Agencies organizations serving seniors
• Increase access to affordable in-home assisted
  living care
• Increase awareness of available respite care
• Alzheimers population
• Families of residents (60) who need
  community-based care

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Senior Health - Diabetes Type 2Goal for 2005

• Increase Diabetes educational and resource
  awareness in Macon County

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Senior Health - Diabetes Type 2Strategies

• Coordinate a public awareness campaign on the
  importance of Diabetes Screening

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Teen PregnancyGoal for 2005

• Develop a countywide education program
• Educate students ages 10-17 on risk factors for
  teen pregnancy

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Teen PregnancyStrategies

• Coordinate a public awareness campaign
• Extent of Teen Pregnancy problem in Macon County
• Develop and implement strategies
• Address the risk factors for teen pregnancy in
  Macon County
• Bring community members into the process (e.g.
  ministers, teachers, parents)

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Teenage Tobacco UseGoal for 2005

• Increase the average age of first use of tobacco
  products by adolescents to 14

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Teen Tobacco UseStrategies

• Youth Health Assessment Program
• 5th Grade Tar Wars Program
• Local physicians provide tobacco use education
• Media Literacy Presentation
• Middle school and high school age students
• Expand tobacco-free schools policy
• Ban tobacco use by adults at after-school events
• Increase merchants We Card compliance

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Questions?

• Want to get involved?