Waushara County. Community Health Needs Assessment. and. Community Health Improvement Plan

Transcription

1 Waushara County Community Health Needs Assessment and Community Health Improvement Plan Prepared by Waushara County Health and Wellness Coalition i

2 An Invitation to the Community... 1 Waushara County Wellness Coalition and Workgroup Members... 2 Part I: Introduction... 4 Part II: Process... 7 Part III: Demographic and Economic Profile Waushara County Demographic Profile...12 Population Characteristics...12 Age Profile...12 Race Profile...13 Housing...13 Household Characteristics...13 Population Density...14 Birth Characteristics...14 Education...15 Waushara County Economic Profile...16 Employers, Industry, and Wages...16 Unemployment...17 Income...17 Labor force participation...18 Poverty...18 Homeownership...18 Education...19 Part IV: Review of Past Assessment Part V: Health Priorities Based on Healthiest Wisconsin 2020 Health Focus Areas23 Adequate, Appropriate, and Safe Food and Nutrition...25 Alcohol and Other Drug Use...29 Chronic Disease Prevention and Management...33 Communicable Disease Prevention and Control...38 Injury and Violence...50 Physical Activity...59 Definition...59 Tobacco Use and Exposure...67 Definition...67 Part VI: 2012 Community Health Survey Part VII: Community Health Improvement Plan Chronic Disease...79 Access to Health Care...84 Mental Health & Alcohol and Other Drug Use...89 Physical Activity and Nutrition...93 Part VIII: Reference List ii

3 Dear Waushara County Residents and Friends, Thank you for taking time to read the Community Health Assessment and Community Health Improvement Plan. This process has taken almost two years to gather data, listen to the residents of the community and determine the top health priorities of the community and a plan of action. We are excited about presenting this information to you. I extend my sincere appreciation to all of those who contributed in putting this plan together. A special thanks to the Health and Wellness Committee, to Dawn Shuman from Wild Rose Community Memorial Hospital, and to Ted Kay, Family Health/ La Clinica in their support of our community improvement efforts. The partnerships that help us build a healthier environment for the residents and visitors to Waushara County are critical to the success of the plan. The plan should be used as a guide by residents and community agencies interested in improving the health of Waushara County. Each priority has a list of goals and strategies suggested to reach the next level of improvement. Over time we will evaluate our progress and post this on our website. We invite anyone to join in making Waushara County a healthier place to live, work and play. Ask for a copy of the plan, join one of our workgroups or make a comment on the plan. Contact us at publichealth.parkstreet@co.waushara.wi.us or call me at Sincerely, Patti Wohlfeil Health Officer Waushara County Health Department 1

4 The Waushara County Wellness Coalition has been working for many years to improve the health of the residents of Waushara County. As part of the Community Health Improvement Planning Process, and to address the three health priority areas, three workgroups were formed. The following individuals have been instrumental in the development of this Community Health Improvement Plan. Thank you for your time, dedication, and commitment to health and wellness in Waushara County! Pam Alf Community Health Network Mary Babler Network Health Pat Bero Waushara County Human Services Pa Chang AmeriCorps Member Bridget Daly AmeriCorps Member Everett Eckstein County Board/Board of Health Nancy Gimenez Community Health Network Lafe Hendrickson Waushara County Sheriff s Department Brigette Henschel Community Member Michael Henschel Community Member Ted Kay Family Health/La Clinica Valerie Ladwig Waushara County Department of Aging Kevin Meighan Waushara County Health Department Lorna Miller Wild Rose Community Memorial Hospital Jody Moesch Ebeling Wisconsin Department of Public Health Shannon Myers Aging and Disability Resource Center Patrick Nehring UW-Extension Jan Novak Waushara County Human Services 2

5 Claude Olson Wild Rose School District Brian Pothier Waushara County EMS Richelle Rooney Wild Rose Community Memorial Hospital Dawn Shuman Wild Rose Community Memorial Hospital Chris Sluke Wautoma Area School District Cheryl Sorenson Waushara County Health Department Paul Theyel Waushara County Human Services Patti Wohlfeil Waushara County Health Department Cheryl Wuyts Wautoma Area School District Kay Zelienka Community Member 3

6 Waushara County Community Health Needs Assessment Part I: Introduction 4

7 Part I: Introduction This Community Health Assessment was designed to regularly and systematically collect, assemble, analyze, and make available information on the health status of Waushara County. Findings will be utilized to assist the local health department and community partners as they plan collaborative efforts designed to improve the health of our community. The assessment is divided into eight sections: Part I: Introduction Part II: Process Part III: Demographic and Economic Profiles Part IV: Review of Past Assessment Part V: Health Priorities Based on Healthiest Wisconsin 2020 Part VI: Community Health Survey Part VII: Community Health Improvement Plan Part VIII: Reference List Part II: Process provides a summary of the steps taken in order to complete the Community Health Assessment and Community Health Improvement Plan. Part III: Demographic and Economic Profiles was completed using secondary data analysis. Part II relies heavily on data from the 2010 US Census, Wisconsin Department of Health Services, and data provided by stakeholders. While the Demographic and Economic Profiles are designed as general overviews of the County, there is a focus on data that are directly relevant to the health of County residents. Part IV: Review of Recent Assessment provides a context for this report, showing whether current health concerns are related to previously identified issues and activities. Inclusion of a previous assessment ensures that past work can be integrated into present planning and actions. This section includes the summary of a community assessment that was completed in the past four years in Waushara County. The assessment was obtained through Waushara County Public Health. Part V: Health Priorities Healthiest Wisconsin 2020 provides secondary data analysis of the eleven health priorities/risk factors that were identified in the Healthiest Wisconsin 2020: Everyone Living Better, Longer, the Wisconsin Health Plan. The twelve health priorities are: 1) Adequate, Appropriate, and Safe Food and Nutrition 2) Chronic Disease Prevention and Management 3) Communicable Disease Prevention and Control 4) Environmental and Occupational Health 5) Healthy Growth and Development 6) Mental Health 7) Oral Health 8) Physical Activity 9) Reproductive and Sexual Health 10) Tobacco Use and Exposure 11) Unhealthy Alcohol and Drug Use 12) Violence and Injury Prevention 5

8 Each chapter contains a definition of the health priority and morbidity data and mortality data on resulting health conditions. Part VI: Health Survey includes results from a community health survey. The survey was planned and conducted by the Waushara County Health and Wellness Coalition. This data collection method was intended for a better understanding of the health concerns of Waushara County residents as a whole. Part VII: Community Health Improvement Plan addresses the top three health issues that the community felt was prevalent in Waushara County. The top three health issues are: 1) Chronic Disease and access to health care 2) Mental Health and Alcohol and Other Drug Use 3) Physical Activity and Nutrition Part VIII: Reference List provides a comprehensive list of the sources of secondary data used in this report. Because data are updated on a regular basis, and resources change, this list can be useful for those who wish to verify data or check for updates. Geographical Regions Compared in the Secondary Data Analyses in Parts II and IV correspond to the geographical areas used for collecting the data. In most cases, county-level data are compared to regional, state, or national data. Raw numbers, however, cannot be used to compare populations of varying sizes. Rates are reported in many sections in order to appropriately compare areas with varying population sizes. The major type of comparison is described below. County vs. regional vs. state comparison. The State of Wisconsin collects health data at the regional level, in addition to the county and state levels. The state is divided into five regions for this purpose: the northern, northeastern, southeastern, southern and western regions. Because Waushara County is part of the Northeastern Region, northeastern data are included in this report for the purpose of comparison. The counties in the Northeastern Region are listed here. Northeastern Region Brown, Calumet, Door, Fond du Lac, Green Lake, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Oconto, Outagamie, Shawano, Sheboygan, Waupaca, Waushara, and Winnebago. 6

9 Waushara County Community Health Needs Assessment Part II: Process 7

10 Part II: Process Waushara County was selected as one of ten sites to pilot new Community Health Improvement Plans and Processes resources and tools. Waushara County partnered with Wild Rose Community Memorial Hospital and other stakeholders to complete a Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP) in 2013 using the process as outlined in the Wisconsin Guidebook on Improving the Health of Local Communities. The plan includes goals, objectives, outcomes and strategies to target the top health issues in Waushara County. CHIP is done once every five years for health departments and once every three years for hospitals. Throughout the process, evidence-based practice was used to engage the community. The map on the right summarizes the process. Collaborate with Stakeholders and Community Members Throughout Community members from different organizations were included throughout the whole process Stakeholders were actively involved in the coalition and workgroup meetings Assess Needs and Resources Completed Community Health Assessment to identify the needs of the community Identified community assets and resources by partnering with different organizations Prioritize Strategic Issues Identified the top three focus areas based on a set of criteria Aligned CHIP with state and national priorities Summarized and disseminated results to the community through the Community Needs Assessment and Community Health Improvement Plan Action Plan for Impact Engaged partners to plan and implement strategies Choose strategies Detailed action plan Implement Strategies Workplan to track progress Keep the community updated Evaluate Efforts Evaluate and monitor progress and outcome Revise action plan Wisconsin Guidebook v 1.2; 5/2013 [Final Version Due Spring 2014] Wisconsin CHIPP Infrastructure Improvement Project 8

11 Over the course of the summer of 2012, extensive primary and secondary data was collected and compiled. Within the data was a Community Health Survey. The survey was available online and distributed by stakeholders. Over 300 surveys were completed. In order to represent the Waushara Community, a diverse demographic population was surveyed. The population surveyed includes: Amish Hispanics Elderly Youth All income levels Business people Stakeholders Civil groups This survey allowed residents to provide input on the top health issues they felt were prevalent in Waushara County. The survey questions focused on: Factors for a healthy Community Most important health problems Risky behaviors Resources Key people and organizations Demographics The following are the top health issues identified by residents in the Community Health Survey: Risky behaviors in our community: Alcohol abuse Drug abuse/tobacco use Being Overweight/obesity Poor eating habits Health problems in our community: Heart disease and stroke/high blood pressure Diabetes Cancers Aging problems (arthritis, hearing/vision loss) Mental Health/ Suicides Factors for a healthy community: Low crime/safe neighborhoods Good schools Access to healthcare Good jobs/healthy economy 9

12 The Waushara County Health and Wellness Coalition reviewed the Community Health Needs Assessment data and issues identified by residents from the community health survey and then chose the top three focus areas to be addressed in the Community Health Improvement Plan. The focus areas were selected based on the following criteria: Healthiest Wisconsin 2020 plan objectives Community Health Survey Morbidity and mortality data In addition, the coalition considered: What was achievable What assets were available What other organizations/coalitions were already addressing Based on the criteria, the Waushara County Health and Wellness Coalition decided that the three focus areas would be: Chronic Disease and Access to Health Care Mental Health and Alcohol and Other Drug Use Physical Activity and Nutrition Community assets were evaluated. Community partners were also brought to the table to form three workgroups, one for each focus area, to develop their piece of the plan. One of the workgroups, Physical Activity and Nutrition, was formed due to a CDC CHANGE grant so this workgroup plan consists of additional focus areas such as chronic disease and leadership. The Wellness Coalition and the three workgroups met routinely to go over goals, objectives, strategies, and previous implementation efforts for the different focus areas. After the initial draft of the Community Health Improvement Plan was written, the plan was revised and access to health care was added into the chronic diseases focus area. Data was gathered and analyzed to identify the availability of health care services in Waushara County. Meetings were set up to develop goals, objectives and activities to address access to health care. Throughout the whole process, the plan was continuously evaluated, monitored and revised. The next steps will be to implement the plan and to track its progress. The community will be kept up to date on progress. 10

13 Waushara County Community Health Needs Assessment Part III: Demographic and Economic Profile 11

14 Part III: Demographic and Economic Profile Population Characteristics According to the US Census, Waushara County had a population of 24,496 in 2010 and an estimated population of 24,461 in The county grew by 5.80% since 2000 making it the 28 th fastest growing county in the state (Saint Croix was the fastest at a rate of 33.55%). The population growth rate is slightly lower than state average rate of 6.03% and is lower than the national average rate of 9.71%. (US Census, 2010b). Age Profile Of the 24,496 people in Waushara County in 2010, 4,883 were 65 years or older. The percentage of adults age 65 and over (20%) is significantly higher than the state (14%) and the nation (13%). Examining those 85 years and older in 2010, there were 567 persons or 2.31% of the total population in Waushara County. Waushara County ranked 36 th of all counties in the state in terms of percentage of population age 85 and older. In addition, the percentage of children and young adults under the age of 19 (22%) is somewhat less than the state (26%) and the nation (27%). Waushara County s median age (46.2) is also much older than the state and nation as shown in the following table (US Census, 2010a). Age Profile 2010 Waushara County Wisconsin US Age Number % Of Total % Of Total % Of Total ,351 22% 26% 27% ,415 26% 32% 34% ,847 32% 28% 26% 65+ 4,883 20% 14% 13% Total 24, % 5,686, ,745,538 Median Age Source: (US Census, 2010a) 12

15 Race Profile According to 2010 US Census Bureau estimates, Waushara County is predominantly white, non- Hispanic (93.9%). This compares to 86.2% white, non-hispanic in Wisconsin, and 72.4% for the nation. American Indian/Alaskan Natives make up.5% of the population (131 individuals), in large part due to the presence of the Oklevueha Band Indian Community in Waushara County. Persons of Hispanic or Latino origin make up 5.4% of the population (1,329 individuals). Asian residents, combined with Native Hawaiians and Pacific Islanders, total.5% (108 individuals) of the county s population. Black or African American residents also account for 1.9% of the population (454 individuals). The remaining 2.1% of the population (509 individuals) identified themselves as multiracial or some other race (US Census, 2010a). Housing In 2010 there were 14,843 housing units in Waushara County (US Census Bureau). The County s 2010 Census homeownership rate (81.3%) was significantly higher than that of the state (69.1%) as well as the nation (66.1%). While a quarter (25.4%) of the state s housing units were multi-unit structures, there were significantly fewer (5.5%) multi-unit structures in Waushara County. Household Characteristics According to Census data, Waushara County has 10,143 households with an average of 2.28 persons per household. This can be compared to the state where there is an average of 2.42 persons per household. Selected household characteristics are listed in the following table. Waushara County has a significantly higher percentage of households without children than the state and the nation, reflecting the low proportion of youth and high proportion of elderly in the County s population (US Census, 2010c). Household Characteristics for 2000 Waushara County WI US Household containing married couple with children 16.1% 19.4% 29.8% Household containing single female parent with children 4% 6.4% 7.2% Household with no children 75.3% 69.4% 66.6% Householder living alone 27.5% 28.2% 26.7% Source: (US Census, 2010a) 13

16 Population Density Waushara County, with 626 square miles, is much less densely populated than the state overall. In 2010, Waushara County had 39 people per square mile and the state of Wisconsin (54,157 square miles) had 105 people per square mile (US Census). There are no metropolitan areas in Waushara County. Birth Characteristics The number of births in Waushara County decreased by 1% from 2005 (241 births) to 2010 (232 births), averaging 237 births per year during this period. As noted in the table below, the decrease in births is not represented by a steady decrease. Waushara County Total Births Total Births Source: (Wisconsin Department of Health Services, WISH). The following table summarizes selected birth characteristics for Waushara County, the Northeastern Region, and the State. Birth Characteristics Waushara North Eastern County Region Wisconsin Average birth rate per 1, Average general fertility rate per 1,000 for women age Average teen birth rate per 1, Source: (Wisconsin Department of Health Services, WISH) The average teen (15 19 years) birth rate for Waushara County from 2005 to 2010 (36/1,000) was 24% higher than the Northeastern Region average (29) and 12.5% higher than the state average (32) (Wisconsin Department of Health Services). From 2005 to 2010 general fertility rates were fairly equal amongst Waushara County, the Northeastern Region and Wisconsin. (Wisconsin Department of Health Services). 14

17 Education There are three school districts in Waushara County: Tri-county, Wautoma, and Wild Rose. Eleven Pre-K-12 public schools are in Waushara County, including those identified in the following Table, as well as 3 private schools and 5 Amish schools. Waushara County also has a branch of Fox Valley Technical College located in Wautoma. Public and Private Schools in Waushara County School Name City Public/Private Students Student/ Teacher Ratio Cottonville School Wautoma Private Coloma Elementary Coloma Public Faith Christian Academy Wautoma Private Mecan Springs Amish School Coloma Private Parkside School Wautoma Public Pleasant View Elementary Pine River Public Redgranite Elementary Redgranite Public Riverview Elementary Wautoma Public Shady Pine Amish School Wautoma Private St. John Lutheran School Fremont Private Tri-County Elementary Plainfield Public Tri-County High School Plainfield Public Wautoma High School Wautoma Public Wild Rose Elementary Wild Rose Public Wild Rose High School Wild Rose Public Tri-County Middle Plainfield Public Christ Lutheran School Weyauwega Private Valleyview Amish School Coloma Private Country Curve Amish School Wautoma Private Total N/A N/A Source: (US Department of Education, and Public Health Staff) Key Findings: The county grew by 5.80% since 2000 making it the 28 th fastest growing county in the state. The median age of Waushara County residents is more than seven years greater than that of the median age in Wisconsin and nationally. The average teen birth rate in Waushara County is significantly higher than that of the Northeastern Region as a whole and the state of Wisconsin. 15

18 Employers, Industry, and Wages Five of the top 10 employers in Waushara County are involved in government and education. The top ten employers in 2012 are listed in the table below. Public and Private Employers in Waushara County Top 10 Public and Private Employers 2012 Company Product or Service Size County of Waushara Executive and general government Department of Corrections Correctional Institution Magnum Power Products Lighting Equipment Manufacturing Wautoma Public Schools Education Wild Rose Community Memorial General medical and surgical hospital Tri-County Area School Education Wild Rose Public School Education Nordic Mountain Skiing Mayville Engineering Co. Fabricated Metal Product Heartland House/Preston Place Homes for the Elderly Source: (Wisconsin Department of Workforce Development) The annual wage for Waushara County workers in 2012 was $28,778. This was 69% of the state average, $41,985 (Wisconsin Department of Workforce Development). The 2011 top paying hourly occupations in Waushara County are reflected in 0 below. Table 1 Average Annual Wage Average Annual Wage Wisconsin $41,012 $41,985 Waushara County $28,481 $28,778 Table 2 Top Paying Hourly Occupations Position Hourly Wage Family and General Practitioners $86.78 General and Operations Managers $45.27 Medical and Health Services Managers $43.26 First-Line Supervisors of Mechanics, Installers $39.06 Healthcare Practitioners and Technical Occupations $33.22 Source: (Wisconsin Department of Workforce Development) 16

19 Unemployment Waushara County s unemployment rate has been consistently higher than that of the state as shown in the graph below, however, it was similar to the nation in 2011 and In 2012, Waushara County s unemployment rate was 8.1% compared to 6.9% statewide and 8.1% nationally. This can be compared to the 2011 unemployment rate which was 8.9% in Waushara County and 7.5% in Wisconsin and 8.9% nationally. Below is a graph depicting the annual unemployment rate for Waushara County, the state and the nation from Annual Unemployment Rate Percent United States Wisconsin Waushara County Source: (Wisconsin Department of Workforce Development) Income Waushara County s per capita income ($22,363) was lower than the state ($27,192) and nation ($27,915) from Waushara County s median household income ($43,544) is also lower than the state and nation as shown in the graph below (US Census, 2010c) Per Capita and Household Income $60,000 $50,000 $40,000 Dollars $30,000 $20,000 $10,000 $0 $22,363 $27,192 $27,915 Per Capita Income $52,762 $43,544 $52,374 Median Household Income Waushara County Wisconsin US Source: (US Census, 2010c) 17

20 Labor force participation Labor force is defined as the number of residents age 16 and older who are either working or looking for work. People who are not in the labor force choose not to work for a variety of reasons: retirement, school attendance, inability to perform available work, physical incapacity, and the belief that no work for them is available. Waushara County s labor force participation rate was 58%, which was lower than the state (68.7%) and the nation (64.8%) (US Census, 2010c). This participation rate in Waushara County is related to the high percentage of elderly, many of whom are retired. Therefore, as the population ages, the labor force participation rate will decline. Poverty Waushara County had a larger percentage of people living in poverty (13.3%) as compared to the state, but lower than the nation as shown in the graph below. Additionally, Waushara County had a higher percentage of children living in poverty (21.4%) as compared to the state (16.4%) and higher than the nation (20%) and (US Census, 2010c). Poverty ( Rates) 25.0% 20.0% 15.0% 10.0% 13.3% 12% 14.3% 21.4% 16.4% 20% Waushara County Wisconsin USA 5.0% 0.0% Total Living in Poverty Children Living in Poverty Source: (US Census 2010c) Homeownership In % of Waushara County residents owned homes. This is a higher percentage than the state of Wisconsin or the nation as shown in the following chart (US Census, 2010b). Homeownership Rate % 80.0% 60.0% 40.0% 20.0% 0.0% 81.3% 69.1% Homeownership rate 66.1% Waushara County Wisconsin USA Source: (US Census, 2010b) 18

21 Education The percentage of people 25 years and over with a high school diploma or higher in Waushara County was 85.9% in This is lower than the state but slightly higher than the nation, as shown in the following graph. The percentage of people 25 years and older with a bachelors degree or higher is also lower than the state and the nation (US Census, 2010c). Educational Levels % 80.0% 60.0% 40.0% 20.0% 85.9% 89.8% 85.4% 13.4% 26.0% 28.2% Waushara County Wisconsin USA 0.0% High School or Higher Bachelors Degree or Higher Source: (US Census, 2010b) Key Findings: In 2012, the average annual wage in Waushara County was 69% of that of the state. Waushara County consistently has a higher unemployment rate when compared to the state. Waushara County had a higher percentage of its population living in poverty as compared to the state but a lower percentage as compared to the nation. However, Waushara County has a higher percentage of children living in poverty compared to the state and nation. A larger percentage of Waushara County residents own their home when compared to the state and nation. A smaller percentage of people in Waushara County have obtained a bachelors degree or higher when compared to the state and nation. 19

22 Waushara County Community Health Needs Assessment Part IV: Review of Past Assessment 20

23 Part IV: Review of Past Assessment The most recent Community Health Needs Assessment was completed in 2009 and is summarized in this section. The 2009 Community Health Needs Assessment was compiled by Rebecca Hovarter, Nurse Consultant, Northeastern Regional Office and was organized by the 2010 Wisconsin Health Priorities. The assessment was obtained through the Waushara County Health Department. Waushara County Community Health Needs Assessment Summary 2009 Lack of Access to Primary and Preventative Care: Lack of access to oral health care, especially for Medical Assistance patients; only 22% of MA eligible clients receive services Lack of access to prenatal care in the first trimester, high rate of low birth babies Lack of access to mental health care, with lack of treatment leading to other health issues such as drug abuse and domestic/child abuse, and lack of mental health providers, plus high rate of chronic disease hospitalization for age was for mental health Poor nutrition and lack of exercise, among all community populations often resulting in obesity and diabetes Unhealthy behaviors, including smoking, alcohol abuse, other drug abuse (especially methamphetamine and marijuana) and unsafe sex Highest years of life lost, were for malignancy, heart disease, accidents, suicide and chronic respiratory disease Tobacco Use and Exposure: Increased number of women smoking during pregnancy, increased rates of low birth weight Increased health care costs Increased cancer (lung) and respiratory disease Overweight, Obesity, and Lack of Physical Activity: Increased mortality rate of residents caused by Ischemic /Coronary Heart Disease, listed as primary cause of death. Heart Disease is the leading cause of death for all Americans, tobacco use, poor nutrition (high in fat, high calorie, and low fiber), and lack of physical exercise all contribute to the development of heart disease. Increased Breast Cancer rate, in comparison to other counties in Wisconsin. Being overweight can be attributed to 20% of cancers. Increased costs both directly and indirectly, according to the 2008 Burden of Diabetes the direct cost in 2007 to Waushara County for diabetes were estimated at $20.4 million and indirect costs at $10.2 million. In Waushara County it is estimated that 4,990 people age 20 years and older have prediabetes. 21

24 Mental Health: Increased Suicides and suicide hospital related emergency room visits according to the 2004 Wisconsin Violent Death Report Higher rate of non- firearm suicides than Winnebago County which is 6 times the size of Waushara County; in the Burden of Suicide 2008 publication, the aggregate rate of suicide for Waushara County for at 12.3 was greater than Waupaca County which is twice the population and similar to Winnebago (12.2) which once again is six times the population. Alcohol and Other Substance Use and Addiction: Rate of binge drinking is higher than National goal, although lower than the State of Wisconsin Alcohol related crashes, similar to state at %, the highest rates that resulted in death were 15 year and less than 1 year of age Increased rate of OWI compared to other counties Increased number of child deaths in Wisconsin due to no car seats or seat belts Intentional and Unintentional Injuries: High range of mortality rate for motor vehicle accidents in comparison to other Wisconsin Counties Falls are number one reason for cause of injury hospitalizations in Waushara County for age 45 and older, falls are one of the leading causes of several, disabling and costly injuries in Wisconsin. High Risk Sexual Behavior: Waushara County s older teen birth (18-19 years) rate is in the high range compared to other counties, 67.3 compared to Wisconsin at 53.6 Waushara County s younger teen birth (15-17) rate is in the high range compared to other counties, 17.2 to 18.2 for the state of Wisconsin While the percent of births to teens under 20 has slowly declined in the NE region and in Wisconsin from , the percentage in Waushara County has fluctuated more. Waushara County s percent of low birth weight births is in the high range as compared to other counties, 7.4% compared to 6.9% in Wisconsin According to the Wisconsin Youth Risk Behavior Survey Summary from , youth in Wisconsin are abstaining longer before first sexual intercourse experience and increasing use of condoms, fewer ever had sex, fewer sex partners, but they were fewer who discussed HIV/ AIDS with parents. In comparing Wisconsin to the United States in youth sexual behavior, Wisconsin youth are lower in percent of youth having sex before age 13, having 4 or more partners and who have ever had sexual intercourse. 22

25 Waushara County Community Health Needs Assessment Part V: Health Priorities Based on Healthiest Wisconsin 2020 Health Focus Areas 23

26 Part V: Health Priorities Based on Healthiest Wisconsin 2020 Health Focus Areas Part IV of this report provides information on the health focus areas that were identified in Healthiest Wisconsin 2020: Everyone Living Better, Longer. The state public health plan was prepared by the Wisconsin Department of Health Services, in collaboration with public health system partners. It complies with state statute through the development of a state public health agenda once every 10 years. A significant piece of the process was to identify health focus areas, which affect health conditions and diseases for all Wisconsin residents. Each health condition is influenced by more than one overlapping risk factor (i.e., lung cancer may be caused by tobacco use and exposure as well as environmental and occupational exposures). And, each risk factor may affect several diseases (i.e., tobacco use and exposure influences the onset of lung cancer, asthma, and cardiovascular disease). The twelve health priorities are: 1. Adequate, Appropriate, and Safe Food and Nutrition 2. Alcohol and Other Drug Use 3. Chronic Disease Prevention and Management 4. Communicable Disease Prevention and Control 5. Environmental and Occupational Health 6. Healthy Growth and Development 7. Injury and Violence 8. Mental Health 9. Oral Health 10. Physical Activity 11. Reproductive and Sexual Health 12. Tobacco Use and Exposure The twelve sections in Part IV provide information on each of the health priorities listed above. Each chapter contains a definition of the health priority and other data that are commonly linked to the health priority are included in some chapters. Data reported here were collected in a variety of ways and are compared in a variety of ways. In most cases, county-level data are compared to regional, state, or national data. Raw numbers, however, cannot be used to compare populations of varying sizes. Rates, which have been calculated using common denominators, are reported instead in many sections in order to compare areas with varying population sizes appropriately. The State of Wisconsin collects health data at the regional level, in addition to the county and state levels. The state is divided into five regions for this purpose: the northern, northeastern, southeastern, southern and western regions. Because Waushara County is part of the Northeastern Region, Northeastern Region data are included in this report for the purpose of comparison. The counties in this region are listed here. Northeastern Region Brown, Calumet, Door, Fond du Lac, Green Lake, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Oconto, Outagamie, Shawano, Sheboygan, Waupaca, Waushara, and Winnebago. 24

27 Adequate, Appropriate, and Safe Food and Nutrition Definition Adequate, appropriate and safe food and nutrition means the regular and sufficient consumption of nutritious foods across the life span, including breastfeeding, to support normal growth and development of children and promote physical, emotional, and social well-being for all people. Good nutritional practices can also reduce the risk for a number of chronic diseases that are major public health problems, including chronic conditions such as obesity, type 2 diabetes, cancer, heart disease and stroke. As established in the U.S. Dietary Guidelines (2005), good nutrition includes meeting nutrient recommendations yet keeping calories under control. It includes safe handling, preparation, serving, and storage of foods and beverages. It also includes ready and appropriate access to nutritious foods throughout the year for all individuals and families in Wisconsin communities. Health Indicator Data - Healthiest Wisconsin 2020 Adequate, Appropriate, and Safe Food and Nutrition Profile Adequate and appropriate nutrition is linked to breast cancer, cerebrovascular disease (stroke), diabetes, heart disease, infant mortality, and pneumococcal infections. The following indicators are examined in this section: 1. Fruit and vegetable intake 2. WIC services 3. Cholesterol Screenings 4. Free and reduced lunch 5. FoodShare Program Participation 6. Food security Fruit and vegetable intake In 2013 Oshkosh nursing students conducted a survey at the Blue Ribbon Kid s Day regarding fruit and vegetable intake. 8% of respondents do not eat any fruit, 26% eat ½ a cup of fruit a day, 32% eat 1 cup a day and 34% eat more than a cup of fruit a day. 5% do not eat any vegetables, 33% eat ½ a cup of vegetables a day, 10% eat 1 cup a day and 52% eat more than a cup of vegetables a day. Women, Infants, Children (WIC) Services Waushara County had an annual average of 847 participants in the WIC program from 2005 to The number of pregnant/postpartum women who received WIC Services has decreased from , infants who received WIC Services has also decreased. Children, age 1-4 years old who receive WIC Services has increased from as can be seen in the chart below (Wisconsin Department of Health Services, Public Health Profiles). 25

28 Number of Participants WIC Services Year Women, Pregnant/Postpartum Infants Children, age 1-4 Source: (Wisconsin Department of Health Services, Public Health Profiles) Cholesterol Screenings The most recent measure from the combined years of shows that the age-adjusted percent of Waushara County residents 18 and older who had their blood cholesterol levels checked was 87%. Of those tested, 27% were told that their cholesterol levels were high. (Wisconsin Department of Health Services, WISH) Free and reduced lunch Below is a graph showing the percentage of students who received free and reduced price lunch for Waushara County and the State. From , 2009 was the only year that Waushara County had a lower percentage of students receiving free and reduced price lunch compared to the State Children Eligible for Free/Reduced Lunch (% enrolled) Percentage 70% 60% 50% 40% 30% 20% 10% 0% 49% 33% 54% 34% 34% 37% 59% 39% Year 59% 40% Waushara County Wisconsin Source: (Wisconsin Department of Public Instruction, Program Statistics) 26

29 FoodShare Program Participation From 2005 to 2012 there was a staggering 47% increase in FoodShare recipients in Waushara County. The increase overtime can be seen in the graph below. Number of Waushara County FoodShare Recipients Year Wisconsin also had a dramatic FoodShare recipient increase of 51% from and can be seen below. Number of Wisconsin FoodShare Recipients Year Source: (Wisconsin Department of Health Services, FoodShare Wisconsin Data) 27

30 Food security - A household is considered food secure if, during the course of a year, all members of that household had ready access to foods that were safe and sufficient to satisfy their nutritional requirements and were able to obtain these foods in socially acceptable ways (i.e. without using food pantries, stealing, or depleting emergency household food reserves). A household is considered food insecure if access to safe, nutritious foods was limited or uncertain for at least one person at some point during the year. In addition, a subset of these households are also classified as having very low food security if one or more individuals in that household reduced their food intake or changed their normal eating patterns during that year, due to a lack of money or other resources. Food Insecurity in the Wisconsin WIC Population, January The Wisconsin WIC Program has conducted a survey every five years to gather information about the level of food insecurity and very low food security in WIC-participating households across the state. Scores for overall food insecurity and very low food insecurity were calculated in a standard manner. Households with two or more (of six possible) affirmative responses were categorized as having Food Insecurity, and the households with either five or six affirmative responses were categorized as having Very Low Food Security. 60% 50% 57% 51% Food Insecurity in 2007 and % 54% Waushara County Wisconsin 40% 30% 20% 22% 20% 25% 21% 10% 0% 2007 Food Insecurity 2007 Very Low Food Security 2012 Food Insecurity 2012 Very Low Food Security (Source: Wisconsin Department of Health Services, WIC and Nutrition Data) Key Findings: Fluctuating numbers of WIC participants from , children have increased, while women and infants has decreased. The percentage of students eligible for free and reduced price lunch has been higher than the State percentage in 2010, 2011 and 2012 FoodShare recipients have nearly doubled from 2005 to 2012 Food insecurity has gone down for Waushara County, however, very low food security has gone up 28

31 Alcohol and Other Drug Use Definition Alcohol and other drug use - any use of a substance, or uses of substances, that results in negative consequences. This includes a broad array of mood-altering substances that include, but are not limited to, alcohol, prescription substances, and illegal mood-altering substances. Negative consequences or unhealthy uses include, but are not limited to, operating a motor vehicle while intoxicated, drinking while pregnant, alcohol dependence, fetal alcohol spectrum disorder, alcohol-related hospitalizations, heavy drinking, alcohol-related liver cirrhosis deaths, motor vehicle injury or death, liquor law violations, other alcohol-attributable deaths, underage drinking, non-medical or illicit drug use, drug-related deaths, drug-related hospitalizations, arrests for drug law violations, and alcohol- or drug-related crimes (e.g., property crimes, violent crimes). - Healthiest Wisconsin 2020 Alcohol and Other Drug Use Profile Health Indicator Data Alcohol and other substance use and addiction are linked to AIDS/HIV, Cerebrovascular Disease (Stroke), Heart Disease, Homicide, Infant Mortality, Motor Vehicle Crashes, and Suicide. The following indicators are examined in this section: 1. Alcohol Consumption 2. AODA (Alcohol and Other Drug Abuse) Hospitalizations 3. AODA as the Underlying Cause of Death 4. Liver Disease 5. Operating While Intoxicated (OWI) 6. Motor Vehicle Accidents 7. Drug and Other Law Violations Alcohol Consumption The percentage of adults 18 and older who reported consuming 5 or more alcoholic drinks in a row can be seen in the chart below. Prevalence of Binge Drinking Among Adults (Aged 18 and Older) Percentage 30% 25% 20% 15% 10% 5% 0% 23% 23% 24% 17% 21% 12% Waushara County Wisconsin Source: (Wisconsin Department of Health Services, Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012) 29

32 From the 2012 Youth Risk Behavior Survey, 35.4% of Waushara County students in grades 10 th - 12 th reported drinking alcohol during the last 30 days. In addition, 21.6% of students reported having had 5 or more drinks of alcohol in a row (binge drinking) during the last 30 days before the survey. The most recent County Health Rankings show that Waushara County remains at 21% for excessive drinking (binge plus heavy drinking). Source: (2012 Waushara County Youth Risk Behavior Survey, County Health Rankings) AODA (Alcohol and Other Drug Abuse) Hospitalizations The number of alcohol-related hospitalizations in Wisconsin increased approximately 9% between 2002 and 2010, from 44,733 to 48,718. However, when comparing more recent years and the rate per 100,000 population, Wisconsin saw a decrease. From there was a rate of 870 and in there was a slight decrease at a rate of 856 per 100,000. Waushara County had 202 alcohol-related hospitalizations in The rate per 100,000 population for Waushara County was 735 for and this increased to 779 per 100,000 for Source: (Wisconsin Department of Health Services, Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012) Drug-related hospitalizations for Wisconsin were 15,135 in 2010 which is an increase of 38% since In 2010, Waushara County had 51 drug-related hospitalizations. Both Waushara County and Wisconsin saw an increase in drug-related hospitalizations per 100,000 population. Wisconsin had a rate of 259 for and a rate of 262 for Waushara County had a rate of 192 hospitalizations for and a rate of 217 for (Wisconsin Department of Health Services, Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012) AODA as the Underlying Cause of Death From , there was an average of 4 deaths each year in which alcohol was the underlying cause (other than from cirrhosis or motor vehicle accidents) in Waushara County. This is a rate of 16.1 per 100,000 population. For Wisconsin, the average annual number of alcohol-related deaths was 1,083 at a rate of 19.4 per 100,000. In 2010, Wisconsin had 512 drug-related deaths which is a rate of 9 deaths per 100,000 population. This is a huge increase compared to 2002, when there were 287 drug-related deaths and a rate of 5.2 per 100,000 population. Source: (Wisconsin Department of Health Services, Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012) Liver Disease Mortality There was 1 death due to chronic liver disease from 2002 to 2010 in Waushara County, which means a death rate of 5.8 per 100,000 population. This was higher than the State rate at 4.4 per 100,000 population. (Wisconsin Department of Health Services, Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012) 30

33 Operating While Intoxicated From 2009 to 2010 there was an increase in arrests for operating while intoxicated (OWI) in Waushara County. In 2009 there were 504 arrests per 100,000 population and 621 per 100,000 for In comparison, in 2009 Wisconsin had 712 per 100,000 population OWI arrests and a decrease in 2010 with 626 OWI arrests per 100,000. Liquor law violation (LLV) arrests follow the same pattern; Waushara County had an increase from 2009 to 2010 going from 353 to 433 arrests per 100,000 population. Wisconsin had a decrease in that same period with 666 LLV arrests per 100,000 to 559 per 100,000. Source: (Wisconsin Department of Health Services, Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012) Alcohol-related Motor Vehicle Accident (MVA) Deaths and Injuries (by location of crash) The following chart compares alcohol-related motor vehicle injuries at the County and State levels. Alcohol-Related Motor Vehicle Accident Injury Rate Per 100,000 Population Waushara County Wisconsin Source: (Wisconsin Department of Health Services, Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012) From 2007 to 2010, Wisconsin saw consistent rates per 100,000 population for motor vehicle accidents that were alcohol related and resulted in death. Waushara County saw varying rates per 100,000 population and not a consistent pattern during that same time period. (See chart below) (Wisconsin Department of Health Services, Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012). Per 100,000 population Alcohol-Related Motor Vehicle Accident Death Rate Waushara County Wisconsin Source: (Wisconsin Department of Health Services, Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012)

34 Drug and Other Law Violations There were 25,750 arrests in Wisconsin for drug law violations in 2010, a number that has not changed by much since 2002 (25,774 arrests). In 2010 Waushara County had 282 arrests per 100,000 population for drug law violations which is much lower compared to the state rate of 453 per 100,000 population. The county and state rates are both lower than the national rate of 531. Waushara County saw a decrease in the rate per 100,000 population of drug law arrests from 2009 (393) to 2010 (282). In 2010, Waushara County reported 440 property crimes at a rate of 1,796 per 100,000 population. Compared to 2009, this is a slight decrease with 443 reported property crimes and a rate of 1,758 per 100,000 population. Source: (Wisconsin Department of Health Services, Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012) Key Findings: High prevalence of binge drinking among juveniles and adults Increasing number of adults operating a vehicle while intoxicated Increase in both alcohol and drug related hospitalizations From , there was an average of 4 deaths/year in which alcohol was the underlying cause of death (other than from cirrhosis or motor vehicle accidents) 32

35 Chronic Disease Prevention and Management Definition Chronic Disease Prevention and Management - In general terms, chronic diseases are defined as illnesses that last a long time, do not go away on their own, are rarely cured, and often result in disability later in life (adapted from McKenna and Collins, 2010). The goals of chronic disease prevention and management are to prevent disease occurrence, delay the onset of disease and disability, lessen the severity of disease, and improve the healthrelated quality and duration of the individual's life (adapted from Doll, 1985). The line between what constitutes prevention and management is somewhat blurred. However, prevention efforts traditionally involve interventions performed before the clinical onset of disease or early in the course of disease, while management efforts may occur later in the disease course and are often focused on reducing the undesired consequences of diseases (adapted from McKenna and Collins, 2010). Chronic diseases include heart disease, stroke, cancer, diabetes, asthma and arthritis. Four modifiable health risk behaviors unhealthy diet, insufficient physical activity, tobacco use and secondhand smoke exposure, and excessive alcohol use are responsible for much of the illness, suffering, and early death related to chronic disease. - Healthiest Wisconsin 2020 Chronic Disease Prevention and Management Profile The following indicators are examined in this section: 1. Coronary Heart Disease 2. Stroke (Cerebrovascular Disease) 3. Cancer 4. Diabetes 5. Asthma The chart below shows underlying cause of death related to chronic illness for Waushara County. Number of Deaths Underlying Cause of Death Heart Disease Cancer Cerebrovascular Disease Diabetes Lower Respiratory Disease Pneumonia/Influenz a Infection/Parasitic Disease Source: (Wisconsin Department of Health Services, Public Health Profiles, 2010) 33

36 Coronary Heart Disease In 2010 there were 94 hospitalizations in Waushara County due to coronary heart disease. Per 1,000 population that is 3.8 hospitalizations which is slightly higher than the Northeastern Region (3.4) and the State (3.3). The average hospital stay in days for Waushara County was 3.8 which is comparable to the Northeastern Region (3.6) and the State (3.8). The chart below shows the trends from Coronary Heart Disease Hospitalization Rates for Waushara County, Northeastern Region and Wisconsin Waushara County Coronary Heart Disease Hospitalizations Waushara County Coronary Heart Disease Hospitalizations (per 1,000 population) Northeastern Region Coronary Heart Disease Hospitalizations (per 1,000 population) Wisconsin Coronary Heart Disease Hospitalizations (per 1,000 population) Source: (Wisconsin Department of Health Services, Public Health Profiles) Stroke (Cerebrovascular Disease) From 2005 to 2011 there were a total of 78 deaths due to stroke which represents 4.4% of all deaths for that period. The Waushara County death rate due to stroke was 44.7 per 100,000 population from which was lower than the Northeastern Region rate of 49.7 per 100,000 population. Number of Deaths per Year Due to Stroke (Cerebrovascular Disease) in Waushara County Number of Deaths Source: (Wisconsin Department of Health Services, WISH) 34

37 Cancer The Wisconsin Cancer Reporting System (WCRS) collects reports of all newly diagnosed Wisconsin resident cancer cases from hospitals, clinics, physician offices, and out-ofstate central cancer registries. The report, Wisconsin Cancer Incidence and Mortality, summarizes cancer incidence (new cancer cases) and mortality (deaths due to cancer) that occurred from 2002 through Cancer Incidence Age-Adjusted Rates per 100,000 Population Cancer Site Waushara County Cases Waushara County Age-Adjusted Rate Wisconsin Age- Adjusted Rate All Cancer Sites Breast Cancer (Female) Cervical Colon and Rectum Uterine Esophageal Kidney/Renal Pelvis Leukemia Lung and Bronchus Continued - Cancer Site Waushara County Cases Waushara County Age-Adjusted Rate Wisconsin Age- Adjusted Rate Melanoma of the Skin Non-Hodgkin Lymphoma Ovary Pancreas Prostate Urinary Bladder Source: (Wisconsin Department of Health Services, Wisconsin Cancer Incidence and Mortality Report, 2009) In 2011, the Wisconsin Cancer Reporting System (WCRS) joined with the American Cancer Society to provide similar, more recent data for a few of the cancers listed above for

38 There were 333 deaths caused by cancer in Waushara County from with a death rate of deaths per 100,000 population which is higher than the State which had 182 deaths per 100,000 population during that same period Cancer Incidence Age-Adjusted Rates per 100,000 Population Cancer Site Waushara County Cases Waushara County Age-Adjusted Rate Wisconsin Age- Adjusted Rate All Cancer Sites Colon and Rectum Lung and Bronchus Breast Cancer (Female) Prostate Source: (American Cancer Society: Wisconsin Cancer Facts and Figures, 2011) Diabetes According to the County Health Rankings, 10% Waushara County residents age 20 and above have diabetes compared to 8% for the state of Wisconsin Source: (County Health Rankings). Morbidity There were 24 hospitalizations due to diabetes in Waushara County in The rate of hospitalizations due to diabetes in 2010 was 1.0 per 100,000 population, which is similar to the Northeastern Region at a rate of 1.0 and the State which had a rate of 1.2 hospitalizations per 100,000 population. Source: (Wisconsin Department of Health Services, Public Health Profiles) Mortality There were 5 deaths due to diabetes in Waushara County for This is an increase of 2 deaths since 2005; however, the graph below shows that it was not a steady increase. Number of Deaths per Year Due to Diabetes in Waushara County Number of Deaths Source: (Wisconsin Department of Health Services, Public Health Profiles) 36

39 Asthma In 2010, 12 people in Waushara County had asthma, 2 of which were younger than 18 years old, 5 were between the ages of 18-44, 2 were between the ages of and 3 were 65 or older (Wisconsin Department of Health Services, Public Health Profiles). Below is a graph of age-adjusted asthma hospitalization rates per 100,000 population comparing Waushara County to the State from Source: (Wisconsin Department of Health Services, County Environmental Health Profile) From Waushara County had an emergency department visit rate for asthma of per 10,000 population which was lower than the State rate of per 10,000. This ranks the county as the 19 th highest for asthma-related emergency department visits throughout Wisconsin. Hospitalization rates for asthma in Waushara County was 3.21 per 10,000, a rate much lower than the State, (9.13) and this ranks Waushara County at 66 th throughout Wisconsin (Wisconsin Department of Health Services, Burden of Asthma in Wisconsin, 2010). Key Findings Waushara County has seen a decrease in coronary hearth disease hospitalizations over the years, however, the hospitalization rate per 1,000 population is higher than the Northeastern Region and the State. Waushara County saw a sharp increase in stroke deaths from 2010 (6) to 2011 (18). Age-adjusted cancer incidence rates remain lower for the County compared to the State. Waushara County has higher rates of ER visits for asthma compared to the State, but lower hospitalization rates. 37

40 Communicable Disease Prevention and Control Definition Communicable Disease Prevention and Control - (infectious diseases) are illnesses caused by bacteria, viruses, fungi or parasites. Organisms that are communicable may be transmitted from one infected person to another or from an animal to a human, directly or by modes such as airborne, waterborne, foodborne, or vectorborne transmission, or by contact with an inanimate object, such as a contaminated doorknob. Communicable disease prevention and control involves the surveillance for and protection from communicable diseases that may result from changes in or evolution of infectious agents (bacteria, viruses, fungi or parasites), spread of infectious agents to new geographic areas or among new populations, persistence of infectious agents in geographic areas and populations, newly emerging infectious agents, or acts of bioterrorism. Communicable disease prevention and control involves isolation and quarantine, immunization, prophylactic (preventive) measures, early interventions including antimicrobial treatment, public health education and other measures. - Healthiest Wisconsin 2020 Communicable Disease Prevention and Control Profile The following indicators are examined in this section: 1. HIV/AIDS infection 2. Sexually Transmitted Diseases 3. Food and Water Borne Illnesses 4. Respiratory Illnesses: Pneumonia, Influenza, and Tuberculosis HIV/AIDS infection There was one case of AIDS/HIV infection in Waushara County in 2012, a rate of 4.1 per 100,000 population. This is lower than the state s rate of 4.2 per 100,000 population. The chart below shows the reported cases of HIV infection for Waushara County from There were 5 cases diagnosed before 2003, 1 case identified in each of the following years, 2003, 2004, 2007, 2010, 2012 and 4 were identified in number of cases Percent of cases Total Cases % Disease Category HIV 7 50% AIDS % Missing 1 7.1% 38

41 Continued number of cases Percent of cases Sex Male % Female % Race/Ethnicity White % African American % Hispanic % American Indian 0 0% Asian/Pacific Islander 0 0% Multi-racial 0 0% Age <5 0 0% % % % % % % % % % % % Source: (Wisconsin Department of Health Services, Wisconsin AIDS/HIV Program) 39

42 Sexually Transmitted Diseases (STD) In 2005 and 2006 there were less than 5 cases of Syphilis and from there were zero cases. There were zero cases of Gonorrhea in 2005 and Waushara County had 5 cases of Gonorrhea in 2006 and 8 cases in 2011, and less than 5 cases for the years 2007, 2008 and Below is a chart showing the most recent data comparing the rate of Sexually Transmitted Disease per 100,000 population to the Northeastern Region. This chart shows that Waushara County has lower rates for each STD. Source: (Wisconsin Department of Health Services, Waushara County Public Health Profile) 2011 STD Rate Per 100,000 Population STD Chlamydia Gonorrhea Syphilis Waushara County Northeastern Region Source: (Wisconsin Department of Health Services, STD Summary Data) Chlamydia trachomatis has been the most prevalent sexually transmitted disease in Waushara County for many years now. From there were 205 confirmed cases which have ranged from 21 to 55 cases a year. There was a huge jump of cases from 2010 to 2011 as can be seen below. Chlamydia Cases Number of Cases Source: (Wisconsin Department of Health Services, Waushara County Public Health Profile) Food and Water Borne Illnesses The incidence of Campylobacter Enteritis, Salmonella, and Shigella from can be seen in the chart below Campylobacter Enteritis < Salmonella <5 <5 <5 Shigella <5 7 0 Source: (Wisconsin Department of Health Services, Waushara County Public Health Profile) 40

43 Respiratory Illnesses: Pneumonia, Influenza, and Tuberculosis There were 21 deaths due to pneumonia or influenza from 2005 to 2010 in Waushara County (with no data in 2006) which can be seen broken down by year in the chart below Pneumonia/Influenza Deaths 6 No data Waushara County had a pneumonia/influenza hospitalization rate of 3.9 per 1,000 population which was higher than the Northeastern Region (2.6) and the State (3.0). The chart below shows number of hospitalizations broken down by age groups and totals for Pneumonia/Influenza Hospitalizations Less than 18 years old years old and older Total Source: (Wisconsin Department of Health Services, Waushara County Public Health Profile) There were very few cases of Tuberculosis in Waushara County from the time period. There were zero cases in 2006, 2008 and 2009 and less than five cases in 2005 and Key Findings: Low number of reported cases of AIDS/HIV Increasing prevalence of Chlamydia trachomatis Annual variability in the pneumonia and influenza mortality rate Consistent number of pneumonia/influenza hospitalizations 41

44 Environmental and Occupational Health Definition Environmental and Occupational Health - includes the broad and diverse suite of interrelated regulatory and educational programs and services needed in every Wisconsin community to prevent, identify, and mitigate illnesses and injuries resulting from hazards in the natural, built, and work environments. Environmental and occupational health practice requires close collaboration with environmental and public health system partners to achieve and maintain the healthy places required for healthy living. Environmental and occupational health activities include but are not limited to the following: Identifying, evaluating and controlling chemical, radiological, and biological hazards in the air, water, soil, food, and built environment. Assuring a safe and healthy food supply that considers the farm to fork concept. Assuring basic sanitation and safety in hotels, pools, campgrounds, and other public places and workplaces. Monitoring the safe use and handling of radioactive materials in health care and industry. Ensuring that Wisconsin s workers are adequately protected from the range of physical, chemical, biological and psychosocial hazards associated with work. Preparing for and responding to natural and manmade disasters, including those potentially exacerbated by global climate change. Conducting surveillance of occupational and environmental hazards and relevant health outcomes to provide evidence needed to take action in local, regional, and statewide communities. -Healthiest Wisconsin 2020: Environmental and Occupational Health Profile The following indicators are examined in this section: 1. Air Quality 2. Nitrate in Water 3. Lead Poisoned Children 4. Radon Risk 5. Infectious Diseases Air Quality According to the County Health Rankings, Waushara County ranked 4 out of 72 counties for physical environment which includes Daily Fine Particulate Matter. Daily fine particulate matter consists of the average daily measure of fine particulate matter in micrograms per cubic meter (PM2.5) in a county. Waushara County has 9.9 micrograms per cubic meter compared to the state at The national benchmark for daily fine particulate matter is 8.8 so the County and State are both below the benchmark. Source: (County Health Rankings, 2013) 42

45 Nitrate in Water The following is from the County Environmental Health Profile: Public water supplies are monitored to ensure public health protection. While there are many regulations in place to make sure new wells are constructed to protect drinking water quality, there are no regulations for ongoing monitoring of private wells unless properties are being sold. Individual well owners are responsible for monitoring and testing private wells. The public water use index estimates how many people are served by public water supplies. A number greater than 50 means more people are served by public water versus private wells. The map below is the Wisconsin Public Water Use Index,

46 The chart below shows Waushara County community water supply characteristics such as, ground water population which is an estimate of population served by public water systems that have ground water sources and surface water population which is public water systems that have surface water sources and the population served. Ground Water Population Surface Water Population Population Served County Population Public Water Use Index Waushara 6, ,141 24, Below is a chart that shows the mean nitrate levels (annual average level of milligrams per liter of nitrate in the water levels) in community water systems (a public water system which serves at least 15 service connections used by year-round residents or regularly serves at least 25 year-round residents) from Waushara County Mean Nitrate Levels Year Number of Community Water Systems Population Served Number of Community Water Systems Population Served Number of Community Water Systems Population Served Nitrate Mean (Mg/L) (missing) 8 6, < , , < , < Source: (Wisconsin Department of Health Services, County Environmental Health Profile) 44

47 Lead Poisoned Children From there were hundreds of children tested for lead poisoning each year. 7 children were lead poisoned during this time period, 2 each in 2006, 2007 and 2009, and 1 in This can be seen in the graphs below. Source: (Wisconsin Department of Health Services, County Environmental Health Profile) 45

48 Radon Risk In 2009, 1,260 radon measurements were conducted in houses throughout Waushara County and of those 484 were greater than 4 pci/l. The measurements were conducted in basements, up to a week in duration, while windows are kept close. This was done because there is less radon upstairs and even less when windows are open. The picture below shows the Northeastern Region estimated percent of homes with greater than 4 picocuries (pci/l) of Radon per liter year average on the main floor of the home. Most of Waushara County has 1-10%, the western part has 0-1% and a small portion of northern Waushara County has 10-20% of >4 pci/l. Source: (Wisconsin Department of Health Services, Radon Information) In 2012, the Waushara County Health Department distributed 51 radon test kits to Waushara County residents. Approximately 18 of those tests were completed and 4 resulted in elevated radon concentrations at or above 4 picocuries per liter (pci/l). Radon test results for the South Central Radon Information Region are shown below. Number of Tests Radon Test Results South Central Radon Information Center (Waushara, Green Lake, Marquette and Portage Counties) Year 18 Tests Completed Radon >= 4 pci/l Source: (Waushara County Health Department Annual Report, 2012) 46

49 Infectious Diseases The number and types of infectious disease cases in Waushara County varied each year from 2006 to For most infectious diseases, 5 or fewer cases were identified each year as indicated in the following table. Campylobacter, Lyme Disease, Hepatitis C, and Salmonellosis had identified cases each of the five years. Disease Campylobacter Enteritis Giardiasis < 5 6 < 5 < 5 0 Hepatitis A < Hepatitis B < < 5 < 5 Hepatitis C 10 7 < 5 < 5 15 Legionnaire s Lyme Measles Meningitis, Aseptic < 5 < Meningitis, Bacterial < Mumps Pertussis 0 0 < 5 < 5 0 Salmonellosis 5 6 < 5 < 5 < 5 Shigellosis 0 0 < Tuberculosis 0 < < 5 Source: (Wisconsin Department of Health Services, Waushara County Public Health Profile) Key Findings: From there were 7 children who were lead poisoned in Waushara County. In 2012, 51 radon test kits were distributed to Waushara County residents. Approximately 18 of those tests were completed and 4 resulted in elevated radon concentrations at or above 4 picocuries per liter (pci/l). Campylobacter, Lyme Disease, Hepatitis C, and Salmonellosis were the only infectious diseases that had identified cases each year from

50 Healthy Growth and Development Definition Healthy Growth and Development - requires family-centered, community-based, culturally competent, coordinated care and support throughout the life course during preconception and prenatal periods, infancy, childhood, adolescence, and adulthood. Components include: Addressing factors that affect biologic, psychological, social and emotional growth and development. Conducting prevention, screening, assessment, and intervention to promote healthy growth and development across the life span. Promoting healthy social, emotional, behavioral, cognitive, linguistic, sensory, and motor development. - Healthiest Wisconsin 2020: Healthy Growth and Development Profile The following indicators are examined in this section: 1. Prenatal Care in First Trimester 2. Access to Health Care Prenatal Care in First Trimester In 2010, there were 232 births in Waushara County and 76.7% received prenatal care in their first trimester, which is significantly lower than the Northeastern Region and the State, and can be seen in the graph below. Percent of Women who Received First Trimester Prenatal Care 100.0% 80.0% 60.0% 70.7% 78.2% 76.7% 40.0% 20.0% 0.0% Waushara County 70.7% 78.2% 76.7% Northeastern Region 84.5% 85.3% 86.4% Wisconsin 82.2% 83.4% 84.2% 48

51 The graph below shows the trimester prenatal care began in 2010 for Waushara County, the Northeastern Region and Wisconsin. Waushara County has a higher percentage compared to the Northeastern Region and Wisconsin for receiving prenatal care in the second trimester which is most likely due to the lower percentage of women receiving care in their first trimester. Percent of Women who Received First Trimester Prenatal Care 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 76.7% First Trimester 19.8% Second Trimester 2.2% Third Trimester No Care Waushara County 76.7% 19.8% 2.2% 0.43% Northeastern Region 86.4% 10.4% 1.6% 0.34% Wisconsin 82.2% 11.6% 2.2% 0.64% 0.43% Source: (Wisconsin Department of Health Services, Wisconsin Births and Infant Deaths, 2010) Access to Health Care According to the County Health Rankings for 2012, 14% of the population of Waushara County under the age of 65 are uninsured. The state of Wisconsin has 11% under the age of 65 uninsured and the benchmark set by the County Health Rankings is 11%. The ratio of the population of Waushara County to primary care physicians is 1 to 3,062. For the state of Wisconsin the ratio of the population to primary care physicians is 1 to 1,247 and the national benchmark is 1 to 1,067. Source: (County Health Rankings) Key Findings: Prenatal care in the first trimester is significantly lower in Waushara County compared to the Northeastern Region and the State. More women receive second trimester prenatal care in Waushara County compared to the Northeastern Region and the State. 14% of the population under age 65 are uninsured There are 3,062 residents to every primary care physician 49

52 Injury and Violence Definition Injury and Violence encompasses a broad array of topics. Unintentional injuries are often referred to as accidents despite being highly preventable. Examples include falls, drowning, motor vehicle crashes, suffocation and poisoning. Intentional injuries include those that were purposely inflicted, with the intent to injure or kill someone (including self). Intentional injuries often involve a violent act. Examples include homicide, child maltreatment, sexual assault, bullying and suicide. While not all violence results in physical injury, the use, and threat of use, of force or power may result in injury, death, psychological harm, maldevelopment, or deprivation eroding communities by reducing productivity, decreasing property values, and disrupting social services, to name a few (Dahlberg and Krug 2002, Centers for Disease Control 2008). Common prevention strategies exist across all causes and manners of injury that include but are not limited to environmental changes, education, and enforcement of policies, laws and standards. The burden of injury differs across the life span. The effects of unintentional and intentional injury include costs related to care and treatment of injuries, but also loss of productivity (economic loss to the individual, family and workforce), years of potential life lost due to injury mortality, and the influence of injury and violence on chronic disease, physical and mental health. - Healthiest Wisconsin 2020 Injury and Violence Profile The following indicators are examined in this section: 1. Suicide 2. Homicide 3. Child Abuse and Neglect 4. Domestic Abuse 5. Motor Vehicle Accidents 6. Motor Vehicle Accident Related Deaths 7. Falls The Wisconsin Department of Health Services produced a report called, Wisconsin Deaths, which came out in January of 2013 with data pertaining to Waushara County, Wisconsin and the Northeastern Region regarding suicides and homicides. Suicide According to the Wisconsin Deaths report, in 2011 there were 4 suicides in Waushara County. There were a total of 272 deaths* in 2011 for Waushara County, so 1.5% of the deaths were due to suicide. In 2011 for Wisconsin, 1.5% of deaths were also due to suicide, with 48,101 deaths* and 736 due to suicide. The graph shows the number of suicides from *The number of deaths refers to residents, regardless of where the person died. Source: (Wisconsin Department of Health Services, Wisconsin Deaths, 2011) 50

53 Number of Suicides Number of Suicides in Waushara County Source: (Wisconsin Department of Health Services, Wisconsin Deaths, 2011, Wisconsin Department of Health Services, Public Health Profile) Homicide In 2011, Waushara County had zero homicides, while Wisconsin had 145 homicides or.3% of all deaths. Source: (Wisconsin Department of Health Services, Wisconsin Deaths, 2011) Child Abuse and Neglect In 2011, there were 207 reports alleging child maltreatment in Waushara County. Broken down by type, there were 71 allegations of physical abuse; 40 were for sexual abuse; 185 for neglect; and 6 was for emotional abuse (Wisconsin Department of Children and Families). Note that the total of the types of abuse allegations is greater than the total number of reports, because multiple types of abuse (e.g. physical and emotional abuse) are sometimes alleged in a single report. A comparison of child abuse and neglect reports shows that the county rate had a steady increase from 2005 to 2008, and then it fluctuated. Overall, there was an increase from 32.9 reports per 1,000 children in 2005 to 43.2 in The county rate has remained higher than the state rate for all years, as displayed in the following chart. Source: (Wisconsin Department of Children and Families). Child Abuse and Neglect Reports Per 1,000 Children Per 1,000 Children Year Source: (Wisconsin Department of Children and Families) Waushara County Wisconsin 51

54 Domestic Abuse There were 58 domestic abuse incidents in Waushara County in A comparison shows that the number of domestic abuse incidents declined dramatically from 2006 to 2007 then stayed between 55 and 68 incidents from Number of Domestic Abuse Incidents and Arrests Year Incidents Arrests Source: (Wisconsin Department of Justice, Domestic Abuse Incident Reports) Motor Vehicle Accidents An annual average of 200 persons were injured in motor vehicle accidents from in Waushara County. Twelve percent of injuries in motor vehicle accidents during the six-year period were alcohol-related (data are reported by location of accident not residence). Persons Injured Due to Motor Vehicle Accidents (MVA) Number of Injuries Year Alcohol-related MVA Injuries Total MVA injuries Source: (Wisconsin Department of Health Services, Public Health Profile) 52

55 Motor Vehicle Accident Related Deaths In 2011, Wisconsin had 604 motor vehicle accident related deaths and that same year Waushara County had 8. From 2005 to 2011, 39 Waushara County residents were killed as a result of a motor vehicle traffic crash and the data for each year can be seen below. Waushara County Deaths Due to Motor Vehicle Traffic Crash Number of Deaths Source: (Wisconsin Department of Health Services, Wisconsin Deaths, 2011) Falls In 2011, Waushara County had 93 hospitalizations due to falls, the Northeastern Region had 4,236 and the State had 24,410. Hospitalizations due to falls has ranged from in Waushara County during and the number of falls for each year can be seen below. Number of Hospitalizations Due to Falls Number of Hospitalizations Source: (Wisconsin Department of Health Services, WISH) Key Findings: Variable number of suicides Consistently higher rate of reported child abuse and neglect than the state 12% of injuries in motor vehicle accidents from were alcoholrelated Variable number of deaths due to motor vehicle crashes from

56 Mental Health Definition Mental health Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community (World Health Organization, 2001). "Mental health is the foundation for well-being and effective functioning for an individual and community. It is more than the absence of mental illness; it is a resource vital to individuals, families and societies" (British Columbia, Ministry of Health, 2007). - Healthiest Wisconsin 2020 Mental Health Profile The following indicators are examined in this section: 1. Psychiatric Hospitalizations 2. Suicide 3. Access to Mental Health Services Psychiatric Hospitalizations From Waushara County had a total of 624 psychiatric hospitalizations. The chart below shows the number of hospitalizations each year for the County and the rate of hospitalizations per 1,000 population for Waushara County, the Northeastern Region and the State. Waushara County has always had a lower rate than the State, and 2006 was the only year the Northeastern Region had a lower rate than the County. Waushara County Northeastern Region Wisconsin Year Number of Hospitalizations Rate per 1,000 population Rate per 1,000 Population Rate per 1,000 Population Source: (Wisconsin Department of Health Services, Public Health Profiles) 54

57 Suicide The graph below shows suicides in Waushara County from 2005 to There was a steady increase from 2005 to 2007, then a drop in There was a jump in 2009 and a steady decrease in 2010 and Suicides in Waushara County Number of Suicides Source: (Wisconsin Department of Health Services, Waushara County Public Health Profile) The 2012 Waushara County Youth Risk Behavior Survey is administered every two years and the results are representative of some of the 10 th, 11 th and 12 th grade students. The results for the suicide portion can be seen below. Males Females Percentage of students who felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities. Percentage of students who seriously considered attempting suicide in the last 12 months. Percentage of students who made a plan about how they would attempt suicide in the last 12 months Percentage of students who attempted suicide at least once in the past 12 months. Percentage of students that had an injury, poisoning, or overdose from a suicide attempt that had to be treated by a doctor or nurse in the past 12 months. 15.5% 25.4% 7.4% 14.6% 6.8% 10.3% 6.8% 7.6% 1.4% 2.2% Source: (2012 Waushara County Youth Risk Behavior Survey) 55

58 Access to Mental Health Services According to the 2013 County Health Rankings, the ratio of the population to mental health providers is 3,499:1 while the state of Wisconsin has a ratio of 2,714:1. Source: (County Health Rankings) Key Findings: Low rate of psychiatric hospitalizations Variable number of suicides Female students have a higher percentage of suicide attempts, thoughts and plans for suicide, and feelings of sadness or hopelessness compared to males High ratio of the population to mental health providers compared to the State Oral Health Definition Oral health is basic to general overall health throughout the life span. It means being free of mouth pain, tooth decay, tooth loss, oral and throat cancer, oral sores, birth defects, gum (periodontal) disease, and other diseases that affect the mouth and surrounding structures. Achieving good oral health requires access to a dental home, which is not a building, but rather a team approach to providing comprehensive oral health care services in a high quality and cost-effective manner. Early intervention with primary preventive measures (tooth brushing, flossing, good nutritional and infant feeding practices) begins during preconception and prenatal periods. It includes care provided from both primary health care providers and oral health providers and continues through the life span. Early intervention with preventive measures, such as fluoride varnish and dental sealants, includes children and adults with developmental disabilities who experience significant problems of access to dental services. Older adults with poor oral health are at risk for malnutrition. - Healthiest Wisconsin 2020: Oral Health Profile The following indicators and related data are described in this section: 1. Youth Oral Health 2. Fluoridation 3. Access to Oral Care Youth Oral Health - Family Health/La Clinica is the Federally Qualified Community Health Center in the county and it offers dental services. From October 1 st 2011 to November 30 th 2012 there were a total of 21,099 visits for dental care. Of those visits, 4,917 were for 0-18 year olds, which is 23% of dental visits for that timeframe at Family Health/La Clinica. Source: (Family Health/La Clinica) 56

59 Fluoridation Fluoride use has been a major factor in the decline in the prevalence and severity of dental caries in the United States. It has been used throughout the world, in the form of tablets, lozenges and liquids, since the 1940 s. Dietary fluoride supplements are intended for use with children between the ages of 6 months and 16 years and are available by prescription. Because fluoride supplements are intended to compensate for fluoride deficient drinking water, the dosage schedule requires knowledge of the child s primary drinking water. Therefore, the water for the residence must be tested for fluoride prior to receiving supplements. Test kits are available from the Health Department and the cost of processing at the State Lab of Hygiene is dependent upon the family income. When families have completed the requirements to be in the program, they are able to receive a 4 month supply of Fluoride and request refills as needed. In 2012, 35 children in various non-fluoridated areas of Waushara County received prescribed fluoride supplements in Source: (Waushara County Annual Report, 2012) In 2011, 24.6% of the population was on a public water supply. 40.6% of the population on a public water supply had access to optimally fluoridated water. Of the total population, 10% had access to optimally fluoridated water. Source: (Wisconsin Department of Health Services, County Oral Health Wisconsin Surveillance System) It is recommended for communities with non-fluoridated water supplies to provide fluoride mouth rinse to students because it reduces tooth decay. Currently Waushara County schools in Wild Rose and Plainfield are supplied with fluoride mouth rinse through a grant. 547 children ages 5 through 12 in the Wild Rose and Tri County schools have been served by the grant from the school year. Waushara County has a free dental sealant program that can be found in all 7 public schools and many private schools in Waushara County. The program offers fluoride varnish and sealants to eligible children in several grades. In 2012, 45% of students were on MA, and 18% were uninsured that received services. Additional data can be seen below. Total Screened 375 Special needs 46 Sealants 297 Varnish 354 Educated children with untreated caries observed, 30 with urgent needs, and 235 with previous experience of dental need or carie. Source: (Waushara County Annual Report, 2012) 57

60 Access to Oral Health - There were 10 licensed dentists in Waushara County in 2011 and 10 licensed dental hygienists. For every 1 dentist or dental hygienist, there were 2,450 people. In comparison, the state of Wisconsin has 1,662 people for every dentist. Of the 10 licensed dentists in Waushara County, 4 are able to take patients with Medicaid or BadgerCare+. Wisconsin has 1,487 dentists who take patients with Medicaid or BadgerCare+. The ratio of Medicaid/BadgerCare+ population (continuously enrolled) to dentists for Wisconsin is 219, while the ratio for Waushara County is 334. In Waushara County, there were 86 patient visits to a hospital emergency department for nontraumatic dental complaints in 2010 with a mean charge per hospital visit of $320. Wisconsin had 27,867 visits to a hospital emergency department for non-traumatic dental complaints and a mean charge of $420 per visit. Source: (Wisconsin Department of Health Services, County Oral Health Wisconsin Surveillance System) Key Findings 23% of dental visits at Family Health/La Clinica, Federally Qualified Community Health Center in Waushara County, were for 0-18 year olds. In 2011, 10% of the population of Waushara County had access to optimally fluoridated water. Waushara County has 1 dentist for every 2,450 people, while the state of Wisconsin has 1 dentist for every 1,662 people. 58

61 Physical Activity Definition Physical Activity means any bodily activity that enhances or maintains physical fitness and overall health. Public health strategies focus on environmental and policy changes (e.g., active community environment initiatives, urban planning, safety enforcement, trails and sidewalks) to reach large sections of the population. Physical activity includes specific time set aside for exercise as well as activity that is part of a person s daily routine (lifestyle activity). Regular physical activity has been shown to reduce the risk of certain chronic diseases, including high blood pressure, stroke, coronary artery disease, type 2 diabetes, obesity, colon cancer, and osteoporosis. Physical activity recommendations include strategies to make physical activity the easy choice. This can be accomplished by creating opportunities for children, adults, and older adults to be active where they live, play, work and learn. Adults need 150 minutes of moderate aerobic activity or 75 minutes of intense aerobic activity per week, preferably spread throughout the week. Adults should also do strengthening activities two or more days per week. Children 6-17 years of age need 60 minutes of aerobic activity per day. This includes vigorous activity and strengthening activities three days per week each. Older adults need guided physical exercise to improve strength, prevent falls, improve cardiovascular performance, and restore resilience and social connection. The built environment and overall environment should promote and support people being active. -Healthiest Wisconsin 2020: Physical Activity Profile The following indicators are examined in this section: 1. Overweight/Obesity (Based on Body Mass) 2. Physical Activity 59

62 Overweight/Obesity Over the years, the percentage of overweight and obesity has been changing across the nation. In particular, the obese population has continued to rise. The graph below shows trends in Waushara County for overweight, obese or neither from , , and % 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Percentage Overweight, Obese, or Neither in Waushara County 42.5% 41.1% 42.9% 32.1% 32.9% 27.4% 29.7% 25.4% 26.0% Neither Overweight Obesity Source: (Wisconsin Department of Health Services, WISH) According to the County Health Rankings, over the past few years, Waushara County adults are becoming more obese and at a percentage higher than the State. However, the State is also seeing an increase in obese adults over the years, which can be seen in the graph below. Adult Obesity (Percent of Adults That Report a Body Mass Index, BMI, Greater Than 30) 33% 35% 28% 29% 28% 29% 30% 25% Waushara 25% County 20% 15% Wisconsin 10% 5% 0% Source: (County Health Rankings)

63 Physical Activity Physical activity greatly impacts an individual s health and also their weight. The time periods in the graph below show that over the years, physical activity has been declining and days spent being inactive has increased for Waushara County residents. Percent of Adults Who Have Exercised in the Last 30 Days 100% 80% 60% 40% 20% 0% 79.4% 76.6% 74.8% 20.6% 23.4% 25.2% Exercised in the last 30 days Have not exercised in the last 30 days Source: (Wisconsin Department of Health Services, WISH) Recent data from the County Health Rankings shows that the percent of adults aged 20 and over reporting no leisure time activity has gone up for Waushara County from 23% in 2011 to 25% in The percent in Wisconsin of adults reporting no leisure time activity has remained 23% in 2011 and Source: (County Health Rankings) Waushara County residents were surveyed at the Waushara County Fair in 2011 and 2012 regarding time spent being physically active, activities they engaged in and programs relating to physical activity they would like to have in their community. The results and responses can be seen below. 25% 20% Time Spent Being Physically Active Per Week 22% 22% 18% % 10% 5% 3% 3% 8% 10% 13% 4% 11% 11% 6% 13% 6% 11% 9% 11% 10% 0% None 30 min or less/day 30 min or more/day 30 min/week 30 min 3x/week 30 min more than 3x/week 60 min/week 60 min 3x/week 60 min more than 3x/week 61

64 Survey respondents were asked what activities they participate in and were able to check all that apply to them and write-in additional activities. In 2011, walking/hiking was the most popular form of activity, with swimming, fishing and biking also among the most popular. For 2012, the results were the same with walking/hiking being the most popular and swimming, fishing and biking ranking high as well. For both years, the activity that was the least popular was tennis. The rest of the results can be seen below. Horseback riding Basketball Skiing/snowboarding Baseball/softball Soccer Water skiing/tubing Swimming Tennis Golfing Bowling Fishing Biking Weightlifting Running/jogging Walking/hiking Activities Residents Participate In Some of the write-in activities that residents participate in include snowmobiling, hunting, gardening/yard work, camping, volleyball, yoga, canoeing/kayaking, cooking, farming, and dancing. Additional Data In 2012, a Discover Waushara County, Get Active guide was printed and distributed throughout the County. As a follow-up, an evaluation of the guide was distributed. According to the results of the evaluation, 66.7% said they used the guide to find activities in Waushara County, 35.7% made a plan for themselves or their family to increase physical activity since receiving the guide, 28.6% increased physical activity since receiving the guide, and 53.3% plan to use the guide again. Key Findings: The percent of the population that is obese continues to rise in Waushara County (33%) and Wisconsin (29%). Adults aged 20 and older reporting no leisure time activity has gone up from 23% in 2011 to 25% in Survey results show that residents prefer activities such as walking/hiking, swimming, fishing and biking. 62

65 Reproductive and Sexual Health Definition Reproductive and Sexual Health includes the factors that affect the physical, emotional, mental, and social well-being related to reproduction and sexuality across the life span, including engaging in same-sex and/or heterosexual behaviors. Reproductive and sexual health is a core component of individual and community public health. To maintain reproductive and sexual health, individuals must have access to reproductive and sexual health education, and medical services from a health care provider of their choice. Medical services include biomedical interventions and supplies that help prevent unwanted pregnancies and sexually transmitted diseases, including HIV; screening for and treatment of sexually transmitted diseases, testing for HIV, and linkage to care; and pregnancy-related services that include care before and during pregnancy and from the end of one pregnancy to the next. Services must be culturally competent in addressing the health needs of diverse populations, including people marginalized because of race/ethnicity or socioeconomic status; young women and men; older adults; people engaging in same-sex sexual contact and/or identifying as lesbian, gay, bisexual or transgender; people who are deaf and hard-of-hearing; and people with disabilities. Health outcomes are not driven by individual behavior alone. Supportive community attitudes toward healthy sexuality, positive social and economic environments, and constructive public policies are as important as access to education and services in fostering reproductive and sexual health. Supportive community attitudes recognize that sexuality is normal. Constructive public policies must support individuals and communities. - Healthiest Wisconsin 2020: Reproductive and Sexual Health Profile The following indicators are examined in this section: 1. Teen Births/Pregnancies 2. Infant Mortality 3. Birth Characteristics (Data relating to STD s and HIV/AIDS can be found in the Communicable Disease Prevention and Control section.) 63

66 Teen Births/Pregnancies For 2010, Waushara County had 31 births to teenage women, while the Northeastern Region had 1,076 and the State had 5,147 births to teenage women. The graph shows the number of births to teenage women from 2005 to 2010 in Waushara County. Number of Teenage (15-19) Births in Waushara County The percent of teen births has been higher in Waushara County compared to the Northeastern Region and the State from Of the 232 total births in 2010 for Waushara County, 13.4% were to teenage women (age 15-19). This is much higher compared to the Northeastern Region with 8.3% of births to teenage women (1,076 births) and the State with 7.5% of births to teenage women (5,147 births). The percent for Waushara County went up from 10.3% in 2009 to 13.4% in Percent of Teen Births Percent Waushara County Northeastern Region Wisconsin Source: (Wisconsin Department of Health Services, Public Health Profile) 64

67 Infant Mortality In 2011, there were 2 infant deaths in Waushara County out of 427 in the State. Source: (Wisconsin Department of Health Services, Wisconsin Deaths, 2011). Local death files show that there were 0 deaths among infants (less than 1 year old) in 2009 and 2010 for Waushara County. The Northeastern Region had 74 infant deaths in Of the 74 infant deaths in the Northeastern Region, 63 were fetal deaths (gestation or up to 20 weeks old), 52 were neonatal deaths (less than 28 days) and 22 were postneonatal deaths (age 28 days to 1 year) Source: (Wisconsin Department of Health Services, Wisconsin Births and Infant Deaths, 2010). From Waushara County had an infant mortality rate of 2.2 per 1,000 live births, and Wisconsin had a rate of 6.2 per 1,000 live births Source: (Wisconsin Department of Health Services, WISH). Birth Characteristics Birth Characteristics for Waushara County, the Northeastern Region and the State can be seen in the tables below. Birth count and birth rate per 1,000 population for Waushara County, Northeastern Region and Wisconsin from Year Waushara County Northeastern Region Birth count Birth rate per 1,000 population Birth count 14,686 14,844 15,130 14,841 14,549 14,193 Birth rate per 1,000 population Wisconsin Birth count Birth rate per 1,000 population 70,934 72,302 72,757 72,002 70,824 68,

68 The table below shows the number of low birthweight births (<2,500 grams), and the percent of low birthweight for Waushara County, Northeastern Region and Wisconsin from Year Waushara County Northeastern Region Wisconsin Low birthweight birth Percent of low birthweight Low birthweight birth Percent of low birthweight Low birthweight birth Percent of low birthweight % 6.53% 6.46% 3.90% 7.26% 4.31% ,017 1, % 6.68% 6.72% 6.74% 6.78% 6.62% 4,992 4,994 5,089 5,051 5,040 4, % 6.91% 6.99% 7.02% 7.12% 7.04% Source: (Wisconsin Department of Health Services, WISH) Key Findings: Variable number of teen births in Waushara County from Waushara County had an infant mortality rate of 2.2 per 1,000 live births, Wisconsin had 6.2 per 1,000 live births Lower birth rate than the Northeastern Region and the State 66

69 Tobacco Use and Exposure Definition Tobacco use and exposure Eliminating tobacco use and exposure means improving health by preventing tobacco abuse, promoting tobacco dependence treatment, protecting all people from exposure to secondhand smoke, and identifying and eliminating tobacco-related disparities. This is accomplished by partnering with state and local leaders to implement a research-based comprehensive tobacco prevention and control plan. - Healthiest Wisconsin 2020 Tobacco Use and Exposure Profile The following indicators are examined in this section: 1. Smoking Rates 2. Deaths Directly Related to Smoking 3. Percentage of Women Who Smoke During Pregnancy Smoking Rates The 2013 County Health Rankings indicate that in Waushara County 17% of adults reported smoking 100 or more cigarettes and are currently smoking, Wisconsin is at 19% and the national benchmark is 13%. Current Cigarette Smokers (Adults 18 and Older) Percentage 20% 15% 10% 5% 17% 19% 13% Waushara County Wisconsin County Health Rankings benchmark 0% Source: (County Health Rankings) 67

70 The Youth Risk Behavior Survey conducted in Waushara County schools for some of the 10 th, 11 th and 12 th students asked questions regarding smoking and the results can be seen in the chart. Males Females Percentage of students who have tried cigarette smoking 43.9% 34.6% Percentage of students who smoked a whole cigarette for the first time before the age of % 4.3% Percentage of students who have smoked cigarettes, during the past 30 days Among students who reported current cigarette use, the percentage who smoked more than 10 cigarettes per day on the days they smoked. Percentage of students who have tried to quit smoking during the past 12 months Source: (2012 Waushara County Youth Risk Behavior Survey) 14.9% 12.4% 3.4% 0% 8.1% 8.1% Deaths Directly Related to Smoking According to the 2010 Burden of Tobacco in Wisconsin report, 79% of deaths from lung cancer in Waushara County were due to smoking, and 93% of deaths from respiratory disease were due to smoking. Additional data from the Burden of Tobacco in Wisconsin report for Waushara County can be seen below. Wisconsin Waushara County Cause of Death Average Annual Deaths Due to Smoking Average Annual Deaths Due to Smoking Lung Cancer 2,845 2, Other Smoking- Related Cancers Cardiovascular Disease Respiratory Disease Other Causes (not associated with smoking) 2, ,894 2, ,396 1, , Source: (Burden of Tobacco Report, 2010) 68

71 Women Who Smoked During Pregnancy Seventeen percent of pregnant women in Waushara County smoked in 2002 and over the years there has been some fluctuation. However, the percent has risen to 21% in The county percentage was consistently higher than the State and the Northeastern Region throughout from as shown in the following graph. 25% 20% Prevalence of Smoking During Pregnancy % 20% 22% 21% 21% 19% Percentage 15% 10% 5% 0% Year Waushara County Wisconsin Northeastern Region Source: (Wisconsin Department of Health Services, WISH) Key Findings: Lower percent of adults who are currently smoking compared to the State, but higher than the County Health Rankings benchmark 43.9% of surveyed 10 th, 11 th, and 12 th grade males have tried smoking and 34.6% of females High percentage of women who smoked during pregnancy 69

72 Waushara County Community Health Needs Assessment Part VI: 2012 Community Health Survey 70

73 Part VI: 2012 Community Health Survey A health survey was widely distributed throughout Waushara County with the intent to reach as many demographics as possible. The first five questions ask the respondent their view on the factors for a healthy community, health problems in the community, risky behaviors in the community, the assets and resources available, and how they view the health of Waushara County. The remainder of the questions asks about the respondent such as: zip code, age, gender, ethnicity, martial status, education, household income, how they pay for their healthcare, and where they received the survey. The results of the survey can be seen in the following pages. 1. In the following list, what do you think are the three most important factors for a healthy community? (Those factors which most improve the quality of life in a community.) Factors Which Most Improve the Quality of Life in a Community Low crime/safe neighborhoods Access to healthcare Affordable Housing Good jobs/healthy economy Healthy behaviors and lifestyles Low infant deaths/low levels of child abuse Good schools Clean environment, parks, recreation Excellent race/ethnic relations Strong family life Low adult death and disease rates Emergency preparedness Survey takers could also write-in a response under other. Below you can see the responses that were written in. 36 identified: Being able to stay in your community as you age 1 identified: Community pride/ownership 1 identified: Competent healthcare providers 71

74 2. In the following list, what do you think are the three most important health problems in our community? (Those problems which have the greatest impact on overall community health.) Health Problems Which Have the Greatest Impact on Overall Community Health Aging problems(i.e. arthritis hearing/vision loss) Child abuse/neglect/infant death Diabetes Mental health problems/suicide Domestic violence/rape/sexual assault Terrorist activities Cancers Dental problems Heart disease and stroke/high blood pressure Motor vehicle crash injuries Teenage pregnancy HIV/AIDS/STDs/infectious diseases Survey takers could also write-in a response under other. Below you can see the responses that were written in. 6 identified: drug use and sales 1 identified: alcohol accessibility 2 identified: access to healthcare 2 identified: obesity 15 identified: falls 1 identified: better education for raising kids i.e. how to give Tylenol 3. In the following list, what do you think are the three most important risky behaviors in our community? (Those behaviors which have the greatest impact on overall community health.) Risky Behaviors in Our Community That Have the Greatest Impact on Overall Community Health Alcohol abuse Being overweight/obesity Dropping out of school Drug abuse/tobacco use Lack of exercise Lack of maternity care Poor eating habits Not getting "shots" to prevent disease Racism Not using seat belts/child safety seats Unsafe sex/not using birth control Unsecured firearms 72

75 Survey takers could also write-in a response under other. Below you can see the responses that were written in. 1 identified: lack of respect 1 identified: stress on teens 1 identified: poor driving habits 1 identified: not using problem solving/reasoning skills before acting 4. Respondents were then asked what assets (resources, key people, organizations, etc.) they felt were available in Waushara County to address the issues they identified in the previous three questions. A wide variety of answers were given including: Kiwanis Rotary Better family communication Sealants Dietitians Hospitals Community groups Alcoholics Anonymous Churches Fitness organizations Department of Aging Schools Car Seat Program Free immunizations Water tests Free fluoride for kids Radon kits Community Health Improvement Plan UMOS Prevention Council Meal sites Family Health/La Clinica Good doctors/dentists Human Services All Area Counseling Aurora Health UW-Extension Waushara County Health Department Police Department Education campaigns Health education through clinics/organizations Substance abuse prevention efforts Get Active Guide Biking groups Yoga/Tai Kwon Do Club Team Boy/Girl Scouts/4H Extracurricular activities Church youth groups Bible study groups AODA classes Community leaders Dietetic counseling/education Exercise/aerobic classes Programs for elderly Pastors Van transportation through Dept. of Aging Health fairs News programs Weight Watchers Clinic and insurance company weight loss programs Medical Assistance Waushara Family Physicians Family nights Family planning Curves Parents & kids Sports for youth Support groups Ambulance services Ministers Neighborhoods Senior housing Employers 73

76 5. How would you rate the overall health of our community? How Resients View the Health of Our County Very Unhealthy Unhealthy Somewhat Healthy Healthy Very Healthy Zip code where you live: (Lodi) (Madison) (Madison) (Portage) (Adams) (Beaver Dam) (Columbus) (Dalton) (Endeavor) (Friendship) (Grand Marsh) (Markesan) (Montello) (Oxford) (Randolph) (Waupun) (Westfield) (Wisconsin Dells) (Combined Locks) (De Pere) (Little Chute) (Sobieski) (Wrightstown) (Green Bay) (Green Bay) (Amherst) (Plover) (Port Edwards) (Stevens Point) (Wisconsin Rapids) (Oshkosh) (Almond) (Appleton) (Appleton) (Bancroft) (Berlin) (Clintonville) (Coloma) (Fond Du Lac) (Fond Du Lac) (Fremont) (Green Lake) (Greenville) (Hancock) (Neshkoro) (New London) (Pine River) (Plainfield) (Poy Sippi) (Princeton) (Redgranite) (Ripon) (Saxeville) (Waupaca) (Wautoma) (Wild Rose) (Delavan, IL) 1 74

77 7. Age Number of Respondents Age of Survey Respondents and over 8. Gender: Male 176 Female Ethnic group you most identify with African American/Black 4 Asian/Pacific Islander 0 Hispanic/Latino 89 Native American 11 Caucasian/White Marital Status: Married 217 Not Married Education Educational Attainment of Respondents Number of Respondents Less than high school HS diploma or GED 2-year college degree (Associates) 4-year college degree (BA, BS) Master's degree Doctoral degree Professional degree (JD, MD) 75

78 12. Household income Number of Respondents Household Income of Respondents Less than $20,000 $20,000 - $29,999 $30,000-$49,999 Over $50, How do you pay for your health care? Type of Health Insurance Percent Pay Cash (no insurance) 17.57% Health Insurance 47.63% Medicaid 9.49% Medicare 20.56% Veteran's Administration 3.69% Indian Health Service 0.18% Other (Community Care Assistance) 0.88% 76

79 14. Where did you get this survey? Rotary 13 Wild Rose Community Memorial Hospital 48 Work 7 Waushara Family Physicians 1 Health Department 34 Meal site 40 Wild Rose clinic 4 Family Health/La Clinica 172 WRCMH clinic alumni luncheon 1 Senior Center 13 High School 92 Meals on Wheels 13 Department of Aging 13 Work/WRCMH 33 Work/Family Health 17 Plainfield Trucking 1 Key Findings The community identified low crime/safe neighborhoods, access to healthcare, good schools, and good jobs/healthy economy as top factors which most improve the quality of life in a community. Aging problems, cancers, heart disease and stroke/high blood pressure, and diabetes were seen as top problems which have the greatest impact on overall community health. Top risky behaviors identified by the community include, alcohol abuse, drug abuse/tobacco use, being overweight/obesity, and poor eating habits. Over 60 organizations/clubs/agencies/resources were identified as assets in our county to help combat the risky behaviors and health-related problems. 56% believe the health of our county is somewhat healthy while 26% view it as healthy. Majority of respondents had either a high school diploma or GED Majority of respondents have health insurance 77

80 Waushara County Community Health Improvement Plan Part VII: Community Health Improvement Plan Top Three Focus Areas 78

81 Definition of Chronic Disease Illnesses that last a long time, do not go away on their own, are rarely cured, and often result in disability later in life (Healthiest Wisconsin 2020: Chronic Disease profile, adapted from McKenna and Collins, 2010). Why is this Focus Area Important? The top underlying causes of death for Waushara County are heart disease and cancer. Number of Deaths 100 Underlying Cause of Death Heart Disease Cancer Cerebrovascular Disease Diabetes Lower Respiratory Disease Pneumonia/Influenza Infection/Parasitic Disease There were 94 hospitalizations due to coronary heart disease in 2010 and 77 deaths. In 2010, there were 24 hospitalizations and 5 deaths due to diabetes. Number of Deaths per Year Due to Diabetes in Waushara County Number of Deaths % of Waushara County residents age 20 and above have diabetes compared to 8% for Wisconsin. From 2005 to 2011, there were a total of 78 deaths due to stroke which represents 4.4% of all deaths for that period. 79

82 Number of Deaths per Year Due to Stroke (Cerebrovascular Disease) in Waushara County Number of Deaths Goal: Early Access to Emergency Care Measures of Success: By May 2014, reduce out of house times to 110 seconds By spring 2015, contact American Heart Association and seek assistance for early access to 911 campaign Objective 1: By the end of 2016, develop and implement one public awareness campaign related to 911 utilization when experiencing signs and symptoms of stroke Activities: 1. Research for 911 utilization when experiencing signs and symptoms of stroke public awareness campaign 2. Plan an awareness campaign for early recognition of Cerebrovascular Accident (CVA) and importance of calling 911 Objective 2: Increase number of businesses in the county that have an AED and staff trained in CPR by 2-3% within the calendar year of 2015 Activities: 1. Contact local businesses and churches that do not have AED Objective 3: Decreased EMS response times to have an ambulance on scene within 14:59 90% of the time county-wide within the calendar year of 2014 Activities: 1. Reduce out of house times to 90 seconds from time of dispatch 2. Build Hancock EMS Station 3. Monitor monthly response times 4. Work with Wild Rose Community Memorial Hospital (WRCMH) to determine number of self admitted patients 5. Review all 911 calls for response time standards. Evaluate location of EMS stations 80

83 Goal: Improve health quality of life through prevention and management of modifiable risk factors associated with chronic disease Measures of Success: The percent of increase for each measure of success below will be set after baseline data is collected Increase the proportion of women between the ages of years who receive cervical cancer screenings by 2% Increase the proportion of women between the ages of years who have received a mammogram screening by 2% Increase the proportion of adults between the ages of years who have received colorectal screenings by 2% Increase the proportion of adults with the diagnosis of diabetes or CAD who have had their blood cholesterol checked by 2% Objective 1: Identify baseline quality data measurements according to established evidence based on disease management strategies by 2014 Activities: Health Screenings 1. Run report of women ages years who have received cervical cancer screenings within the last 3 years 2. Run report of the proportion of women between the ages of years who have received mammogram screenings within the last 24 months 3. Run report of the proportion of adults between the ages of years who have received colorectal screenings within the last 10 years 4. Run report of the proportion of adults with the diagnosis of diabetes or Coronary Artery Disease (CAD) who have had their blood cholesterol checked in the preceding 12 months Wellness Programs 1. Educate physicians about community resources 2. Work with technology available to identify patients that would benefit from programs in order to increase referrals 81

84 Goal: Improve health related quality of life by mitigating the effects of chronic illness Measures of Success: Increased number of ADRC class referrals coming from medical staff to 25% by the year 2016 By 2015, number of average participants by 10% for classes offered through ADRC Increase completion rate for ADRC classes to 90% by 2015 (participants must complete 70% of the sessions or higher to be considered completely) By 2016, ADRC classes will be offered a minimum of two times per year (currently offered once a year) By 2016, the completion rate of Health Programs offered through ADRC will increase by 20% 4 public awareness campaigns promoting cardiac rehab benefits created within the calendar year of 2014 Objective 1: Improve completion rate of Stepping On classes offered through ADRC by one class by 2014 Activities: 1. Encourage medical staff to make referrals through educating at a medical staff meeting 2. Educate nurses on program through medical staff meeting 3. Increase public exposure through additional press releases Objective 2: Improve completion rate of Living Well classes offered through ADRC by one class by 2014 Activities: 1. Encourage medical staff to make referrals through educating at a medical staff meeting 2. Educate nurses on program through medical staff meeting 3. Increase public exposure through additional press releases Objective 3: Implementation of one Living Healthy with Diabetes class offered through the ADRC this fall Activities: 1. Work with the local Certified Diabetes Educator 2. Educate nurses and medical staff on program to increase referrals 3. Educate public on the new program through press releases 82

85 Objective 4: Increase the number of people attending the ADA recognized Diabetes Education program held at WRCMH by 50% (12 new patients seen in calendar year of 2014) Activities: 1. Educate medical staff to increase referrals at medical staff meeting 2. Provide public relations to people in the WRCMH service area with an ad or article in the local paper Objective 5: Increase public awareness of the benefits of cardiac rehabilitation program within the calendar year of 2014 (Revised 10/01/2013) Activities: 1. Develop 4 public awareness campaigns within the calendar year of

86 Definition of Access to Health Care: Access to high-quality health services means universal access to affordable high-quality health services for all people in Wisconsin to promote optimal physical and mental health and to prevent illness, disease, injury, disability, and premature death (Healthiest Wisconsin 2020: Infrastructure Focus Area Profiles, 2010). Why is this Focus Area Important? In the Community Health Survey, access to health care was in the top three factors that Waushara County residents felt most improved the quality of life in a community. Insurance: 14% of the population of Waushara County under the age of 65 is uninsured. As reported in the Community Health Survey (Self reported), 17.57% of the residents surveyed were uninsured. Type of Health Insurance in Waushara County Self Reported in Community Health Survey Pay Cash (no insurance) Health Insurance Medicaid Medicare Veteran's Administration 1 5 Indian Health Service Other (Community Care Assistance) 84

87 Wild Rose Community Memorial Hospital Payment for health care: 32.4% of patients pay for health care with Medicare/ Medicare advantage. 29% of patients pay for health care with Commercial/ Worker Compensation. 27.2% of patients pay for health care with Medical Assistance/ Medical Assistance HMO s. 11.4% of Wild Rose Community Memorial Hospital patients pay out of pocket for health care. Wild Rose Community Memorial Hospital: How Patients Paid for Health Care Self Pay 427 Medicare/ Medicare advantage 1,217 Medicare/ Medicare advantage 1,217 MA/MA HMO's 1,024 Commercial/Worker Compensation 1,092 Commercial/Worker Compensation 1,092 Self Pay 427 MA/MA HMO's 1,024 Shortage of health care providers: The ratio of the population of Waushara County to primary care physicians is 1 to 3,062. For the state of Wisconsin the ratio of the population to primary care physicians is 1 to 1,247 and the national benchmark is 1 to 1,067. According to the 2013 County Health Rankings, the ratio of the population to mental health providers is 3,499:1 while the state of Wisconsin has a ratio of 2,714:1. Source: (County Health Rankings) There were 10 licensed dentists in Waushara County in 2011 and 10 licensed dental hygienists. For every 1 dentist or dental hygienist, there were 2,450 people. In comparison, the state of Wisconsin has 1,662 people for every dentist. 85

88 Waushara County has a shortage of mental health professionals (Shaded region represents area with a shortage of mental health providers) Wisconsin Office of Rural Health Waushara County has a shortage of dental access (Shaded region represents area with a shortage of dental providers) Health care needs: Wisconsin Office of Rural Health 86

89 Health Care Needs: The top five emergency room diagnosis in 2011 at Wild Rose Community Memorial Hospital are: Urinary Tract Infection, otitis media (ear infection), open wounds, head injuries and COPD (chronic obstructive pulmonary diseases) Female Male UTI Otitis Media Open Wound Head Injury COPD Family Health/ La Clinica is a private non-profit Federally Qualified Health Center that provides affordable services to the under-served and vulnerable population (under 200% of federal poverty) who lack access to health services. The chart shows the top medical diagnosis at Family Health. The top three diagnosis are: unspecified essential hypertension, tobacco use disorder and diabetes mellitus not stated as uncontrolled Family Health/ La Clinica Top Medical Diagnosis 0.06% Unspecified Essential Hypertension 15.31% 12.71% 6.01% 6.39% 7.08% 8.10% 9.23% 15.31% 13.16% 11.83% 10.12% Tobacco Use Disorder 13.16% Obesity Unspecified 11.83% Issue of Repeat Prescriptions 10.12% Influenza vaccine 9.23% Other/unspecified hyperlipidemia 8.10% Chronic Pain Syndrome 7.08% Osteoarthrosis unspecified 6.39% Diabetes Mellitus uncontrolled 6.01% Diabetes Mellitus not stated as uncontrolled 12.71% Other Specified Counseling.06% 87

90 Transportation: In 2012, the Waushara County Department of Aging scheduled a total of 7,395 one-way trips to 293 individuals. o 228 riders were 60 years or older who received 5,101 rides o 65 riders were 59 years or younger who received 2,294 rides o Included in those numbers are 65 people who were non-ambulatory and they received 979 rides. Some trips are within Waushara County and others are out of the County. 53% of the trips provided by the Waushara County Department of Aging are for medical reasons. Goal: By 2018, assure all residents have affordable access to comprehensive, patient centered health services. Measures of Success: By 2014, information on the Affordable Care Act will be made available to the community By 2014, define public health s role with the new insurance policy and increase public health staff knowledge of the Affordable Care Act By 2018, strategies will be developed to assist the public in obtaining access to health care services Objective 1: By 2014, increase awareness of the Affordable Care Act Activities: 1. Distribute educational material on the new insurance policy and marketplace plus any relevant information to the community 2. Educate the public health staff on how to better serve the community as a resource and referral on the Affordable Care Act Objective 2: By 2018, develop strategies to increase health care access Activities: 1. Collaborate with community partners to develop strategies to assist the public in obtaining access to health care services 88

91 Definition of Mental Health Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community (World Health Organization, 2001). Definition of Alcohol and Other Drug Use Any use of a substance, or uses of substances, that result in negative consequences. This includes a broad array of mood-altering substances that include, but are not limited to, alcohol, prescription substances, and illegal mood-altering substances. (Healthiest Wisconsin 2020: Alcohol and Other Drug Use Profile). Why is this Focus Area Important? Alcohol and other drugs Alcohol and other substance use and addiction are linked to AIDS/HIV, Cerebrovascular Disease (Stroke), Heart Disease, Homicide, Infant Mortality, Motor Vehicle Crashes, and Suicide. Alcohol-Related Motor Vehicle Accident Injury Rate Per 100,000 Population Waushara County Wisconsin There is a high prevalence of binge drinking among juveniles and adults. Prevalence of Binge Drinking Among Adults (Aged 18 and Older) Percentage 30% 25% 20% 15% 10% 5% 0% 23% 23% 21% 24% 17% 12% Waushara County Wisconsin 89

92 there were 192 drug-related hospitalizations per 100,000 population. There was a slight increase in of 217 drug-related hospitalizations per 100,000 population. Suicide Female students have a higher percentage of suicide attempts, thoughts and plans for suicide, and feelings of sadness or hopelessness compared to male students According to the 2012 Youth Risk Behavior Survey, 7% of 8 th graders have attempted suicide 6.8% of males and 7.6% of females in 10 th and 12 th grade have attempted suicide at least once in the past 12 months Suicides in Waushara County Number of Suicides % of males and 25.4% of females in 10 th and 12 th grade have felt sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities Access to mental health services: According to the 2013 County Health Rankings, the ratio of the population to mental health providers is 3,499:1 while the state of Wisconsin has a ratio of 2,714: 1. Source (County Health Rankings) 90

93 Goal: Reduce unhealthy and risky alcohol and other drug use and promote early identification of mental health needs and access to resources Measures of Success: By 2015, 50% of municipalities will be on board with the Social Host Ordinance *Completed. Ordinance passed by county Sept 2013 making all municipalities 100% compliant (Revised 9/24/2013) By 2015, a brochure of available mental health care access services will be in Waushara County libraries and other locations By 2018, reduce the percentage of students who report having had 5 or more drinks of alcohol in a row (binge drinking) during the past 30 days before the survey from 21.6% to 20.6% By 2018, reduce percentage of students who reported drinking alcohol during the past 30 days from 35.4% to 34% By 2018, increase awareness, among the elderly, of mental health services, signs and symptoms of depression and suicide through an educational presentation and pre- and post-test Objective 1: By 2018, mass educational campaigns for residents of Waushara County on mental health, alcohol and other drugs, and bullying Activities: 1. Heroin presentation in all Waushara County High Schools to increase the knowledge of risks associated with heroin use 2. Create Public Service Announcements in Waushara County newspaper and church newsletters throughout the year and health displays on relevant topics for local libraries to increase awareness of health issues related to mental health, alcohol/drugs, and bullying 3. Put articles/statistics/information on social media sites (facebook, websites Health Department, Healthy Communities, Healthy Youth, School Districts) to update the community on mental health, alcohol and other drug use 4. Provide DARE program for additional grades to educate youth on resisting drug use 91

94 Objective 2: By 2018, implement and increase 2 community-based effective alcohols and other drug use prevention programs Activities: 1. Social Host Ordinance (AB 209) a. If Social Host Ordinance does not pass by September, present it to the County Board for the County i. (Social Host Ordinance was passed September 17, 2013 and will be in effect October 1, REVISED 9/18/2013) b. If the Social Host Ordinance is passed, municipalities will be contacted to make sure they are onboard 2. National Drug Take Back Day spread awareness program through multi-media outlets to increase proper disposal of prescription drugs that are expired or not needed 3. Increase the pounds of prescription drugs collected for Drug Take Back Days 4. Provide information on proper prescription drug use and drug disposal Objective 3: By 2018, increase dissemination and awareness of information available on Mental Health and accessible Mental Health services Activities: 1. Compile, create and distribute brochures of accessible mental health services plus any additional relevant information a. Provide information on what is available locally, what is available close by, how to access, current phone numbers, and websites 2. Promote use of screening tools for depression, anxiety, and suicide risk across all medical settings, community, and schools. a. Examples of tools include the Signs of Suicide (SOS), and Question-Persuade-Refer (QPR) 3. Work with directors/employees in daycare/childcare centers to identify mental health risk factors in children 4. Research what is currently being done with/for the elderly in regard to mental health and suicide risk factors 5. Train mealsite directors on Question-Persuade-Refer (QPR) and also provide them with brochures of accessible services 6. Increase awareness of mental health services, signs and symptoms of depression and suicide through an educational presentation and a pre/post test 7. Make sure schools have an updated suicide plan and review their plans Objective 4: By 2018, increase education of professionals in regards to drug trend leading to policy change Activities: 1. Presentation to professionals to increase knowledge on current drug trend 2. Create and facilitate a round table discussion with prescribers to change prescribing habits 92

95 Definition of Physical Activity Any bodily activity that enhances or maintains physical fitness and overall health. (Healthiest Wisconsin 2020: Physical Activity Profile). Definition of Adequate, Appropriate, and Safe Food and Nutrition Regular and sufficient consumption of nutritious foods across the life span, including breastfeeding, to support normal growth and development of children and promote physical, emotional, and social well-being for all people. (Healthiest Wisconsin 2020: Adequate, Appropriate, and Safe Food and Nutrition). Why is this Focus Area Important? Physical Activity The percentage of overweight and obesity in Waushara County has increased, while physical activity has decreased. 50% 40% 30% Percentage Overweight, Obese, or Neither in Waushara County 42.5% 41.1% 42.9% 32.1% 32.9% 25.4% 26.0% 27.4% 29.7% 20% 10% 0% Neither Overweight Obesity 35% 30% 25% 20% 15% 10% 5% 0% Adult Obesity (Percent of Adults That Report a Body Mass Index, BMI, Greater Than 30) 33% 28% 25% 29% 28% 29% Waushara County Wisconsin 93

96 Percent of Adults Who Have Exercised in the Last 30 Days 100% 80% 60% 40% 20% 0% 79.4% 76.6% 74.8% 20.6% 23.4% 25.2% Exercised in the last 30 days Have not exercised in the last 30 days 25% Time Spent Being Physically Active Per Week % 15% 10% 5% 0% None 30 min or less/day 30 min or more/day 30 min/week 30 min 3x/w eek 30 min more than 3x/w eek 60 min/week 60 min 3x/w eek 60 min more than 3x/w eek Nutrition The percentage of students eligible for free and reduced price lunch has been higher than the state in 2010, 2011 and 2012 Children Eligible for Free/Reduced Lunch (% enrolled) Percentage 70% 60% 50% 40% 30% 20% 10% 0% 34% 49% 33% 34% 54% 37% 59% 59% 39% Year 40% Waushara County Wisconsin 94

97 A survey for WIC participants showed that there was a 3% increase from for WIC participating households being categorized as having very low food security Food Insecurity in 2007 and % 50% 40% 30% 20% 10% 0% 57% 51% 22% 20% 54% 48% 25% 21% Waushara County Wisconsin 2007 Food Insecurity 2007 Very Low Food Security 2012 Food Insecurity 2012 Very Low Food Security From 2005 to 2012, there was a staggering 47% increase in FoodShare recipients in Waushara County. Number of Waushara County FoodShare Recipients Goal: Increase physical activity and improve access to adequate, appropriate, and safe food and nutrition in Waushara County Measures of Success: By 8/2014, the number of low-income residents eligible and enrolled in supplement food programs is identified in addition to the number of those that are eligible and not enrolled By 8/2014, 1 new safe, affordable and culturally appropriate physical activity opportunity will be provided by a community-based organization By 8/2014, the top 5 employers of Waushara County will be contacted to assess if they have a wellness plan and if so, what the motivation was to establish one By 8/2014, assess current chronic disease management plans in 75% of the Waushara County schools By 8/2014, increase the number of healthcare professionals by 2 that attend workgroup meetings Year 95

98 Objective 1: By 2018, increase by 1% the proportion of Waushara County low-income residents who have access to food outlets that offer a variety of foods that meet the Dietary Guidelines for Americans Activities: 1. Identify the number of low income residents enrolled in supplement food programs and those that are eligible but not enrolled 2. Provide a Fresh Food Atlas to residents a. A Fresh Food Atlas guide identifies fresh food outlets in Waushara County (i.e. farm stands, producers etc.) 3. Provide technical assistance to grocery stores to support present stores and to prevent food deserts. a. Food deserts are areas where there is a lack of good quality and affordable fresh foods. 4. Educate senior/wic clients on where to redeem farmer market vouchers and what kind of foods are in season 5. FoodShare outreach educate eligible residents through articles, presentations, and the program s benefits to increase the number of eligible residents receiving FoodShare Objective 2: By 2018, facilitate and support the development of a minimum of 5 new safe, affordable and culturally appropriate physical activity opportunities provided by community-based organizations Activities: 1. Multimedia campaigns to promote physical activity in Waushara County 2. Facilitate partnerships within community-based organizations to support and promote safe, affordable, and culturally appropriate physical activities 3. Distribute Get Active Guide and spread awareness of online link Objective 3: By 2018, 20% of worksites that employ 100+ employees in Waushara County will establish a Wellness plan with a strong focus on physical activity and nutrition Activities: 1. Contact the top 5 employers of Waushara county to assess if they have a wellness plan a. If employers have a wellness plan, find out what the motivation was to establish one 2. Wellness plan development educate employers on the benefit of having a worksite wellness plan 3. Encourage employers to educate their employees on insurance incentives 4. Education outreach on physical activity and nutrition 96

99 Additional objectives related to physical activity and nutrition Objective 4: By 2018, 50% of the Waushara County schools public, private, Amish and/or home school will develop a plan for managing children with chronic disease Activities: 1. Assess current chronic disease management plans in 75% of Waushara County schools 2. CPR training support Emergency Medical Services (EMS) in their goal of training school district staff in CPR 3. Educational media outreach education on chronic conditions and prevention through press releases, newsletters, websites, etc 4. School engagement partner with schools to assess chronic disease management plans Objective 5: By 2018, increase the number of healthcare professionals involved with the Waushara County Health and Wellness Coalition Activities: 1. Healthcare professional leadership recruitment 2. Build community partnerships collaborate, support, network and promote community health efforts in Waushara County 97

100 Waushara County Community Health Needs Assessment Part VIII: Reference List 98

101 Part VII: Reference List American Cancer Society, Wisconsin Cancer Facts and Figures, County Health Rankings and Roadmaps, Waushara County Rankings, Family Health/La Clinica, Top Diagnosis Codes US Census. American Factfinder. 2010a. US Census. State and County Quickfacts. 2010b. US Census. American Community Survey 5-year Estimates: 2010c. US Department of Education, Institute of Education Sciences, National Center for Education Statistics, , Voskuil KR, Palmersheim KA, Glysch RL, Jones NR. Burden of Tobacco in Wisconsin: 2010 Edition. University of Wisconsin Carbone Cancer Center. Madison, WI: March, Waushara County Public Health Department, Annual Report Waushara County Public Health Department, Community Health Needs Assessment Summary Waushara County Youth Risk Behavior Survey, Wild Rose Community Memorial Hospital, Top Emergency Department Diagnosis, Wisconsin Association of Local Health Departments and Boards (WALHDAB). Wisconsin. Wisconsin CHIPP Infrastructure Improvement Project Wisconsin Department of Children and Families, Wisconsin Child Abuse and Neglect Annual Reports Wisconsin Department of Health Services, Alcohol and Other Drug Use Statistics. Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, Wisconsin Department of Health Services, Division of Public Health, Bureau of Environmental and Occupational Health, Burden of Asthma in Wisconsin Wisconsin Department of Health Services, Division of Public Health, County Oral Health Wisconsin Surveillance System Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Births and Infant Deaths, (P ). January Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Cancer Incidence and Mortality, (P ). November

102 Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Deaths, Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH). Wisconsin Department of Health Services, Eligibility Management (Income Maintenance) FoodShare Wisconsin Data. Wisconsin Department of Health Services, Public Health Profiles, Waushara County, Northeastern Region, and Wisconsin Wisconsin Department of Health Services, Radon Information for Wisconsin Wisconsin Department of Health Services, Sexually Transmitted Diseases, Wisconsin County 2011 Profiles, Summary Data. Wisconsin Department of Health Services, WIC and Nutrition Data, Food Security in the Wisconsin WIC Population Wisconsin Department of Health Services, Wisconsin AIDS/HIV Program. Interactive Map of County HIV Case Surveillance Data Wisconsin Department of Health Services, Wisconsin Environmental Public Health Tracking. County Environmental Health Profile, Wisconsin Department of Justice, Office of Crime Victim Services. Domestic Abuse Incident Reports Wisconsin Department of Public Instruction, Program Statistics. Participation and Funding Data (P&FD) for Food and Nutrition Programs Operating in Wisconsin Schools and Institutions Wisconsin Department of Workforce Development, Office of Economic Advisors. Waushara County Workforce Profile Wisconsin Office of Rural Health. Data and Maps

103 Border Counties Portage, Waupaca, Winnebago, Green Lake, Marquette, and Adams 101