Community Health Assessment June 2011

Transcription

1 County Community Health Assessment June 2011

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3 Overview... 1 Real Causes of Death... 1 Determinants of Health vs. Health Spending... 2 Public Health Approach... 3 Levels of Intervention... 4 Sources of Data... 5 How to Read our Charts... 6 The Social Context of Health... 7 Indicators of Overall Health Status... 9 Themes Education & Economics Themes Youth & Families in Crisis Themes Mental health Themes Health Behaviors and Health Outcomes Drugs & Alcohol Themes Injuries Themes Tobacco Nutrition & Physical Activity Themes Health Care Access & Utilization Themes

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5 What are we dying from? Causes of death Heart disease Cancer Stroke Injury Chronic lung disease Pneumonia/flu Diabetes Suicide Liver disease HIV infection REAL causes of death Tobacco use Improper diet Lack of physical activity Alcohol misuse Microbial/toxic agents Firearm misuse Unsafe sexual behavior Motor vehicle crashes Use of illicit drugs

6 What Determines Health vs. Health Spending Determinants of Health Health Spending in the U.S. Genetics Behavior 5 Environment Medical Care 88% Medical Care Other 8% Behavior 4%

7 Public Health Approach: What Changes Health Status? Mission Key Values How Protect and promote the health of people Policy and Regulation Prevention = upstream Population-based = greater impacts Science-based = data-driven Programs and Education Individual Services

8 Individual Services Smoking cessation support Diabetic education Walking program Community Practices/Policies Mall walking School nutrition policies Tobacco taxes Worksite wellness Family/Culture/Norms Adverse childhood experiences Family/community norms Education/income Built Environment Complete streets Healthy corner stores Smoke-free parks

9 Primary Sources of Data County Health Rankings Behavioral Risk Factor Surveillance Survey Healthy Youth Survey 2010 Washington State CHARS (hospital system) Data Data are accessible through our website: HealthyGH.org Online users can click on the source at the bottom of each slide to navigate to the source of the data

10 How to Read our Charts Gold generally represents data Blue generally represents the Washington State average Error bars are shown when possible (95% confidence intervals) These error bars don t overlap - there is a space between the cap of one error bar and the base of the other Error bars that don t overlap mean that the difference between Grays Harbor and the State is very unlikely to be due to chance i.e. it is a real difference If error bars overlap the difference between Grays Harbor and the State could be real, or could be due to chance a difference cannot be proven statistically, often because of small numbers These error bars overlap

11 The Social Context of Health Indicators of Overall Health Status... 9 Themes Education & Economics Themes Youth & Families in Crisis Themes Mental health Themes... 57

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13 INDICATORS OF OVERALL HEALTH

14 Years of life Life Expectancy at Birth, The average life expectancy of residents has increased by more than 2 years since 2000, but we still live almost 3 years less than other Washington residents years Washington State 2.87 years Source: Washington State Department of Health, Center for Health Statistics.

15 Years of healthy life Years of Healthy Life Expected at Age 20, Washington State Counties State Average 50 This measure factors in both early death and years of living in poor health. has the lowest years of expected healthy life in the state Source: Washington State Department of Health Local Public Health Indicators. Retrieved March 2011 from

16 Adults: Self-Reported Health Status, % very good or excellent Excellent Very Good Good 57% very good or excellent 4 3 Fair Poor Washington Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

17 Compared to other counties in Washington, County ranks as one of the least healthy for all factors. County Health Rankings 2011 Source: University of Wisconsin Population Health Institute, County Health Rankings. Retrieved May 2011 from

18 T H E M E S We are sick more and die younger than people in other parts of Washington. Science tells us that our behavior is strongly linked to our level of health meaning that much of what makes us sick can be prevented. We spend most of our health care dollars on taking care of people who are already sick. So what? Increasing prevention resources will decrease poor health outcomes and thus decrease the need for costly health care in the future.

19 Poverty and Education: The greatest social determinants of health EDUCATION & ECONOMICS

20 Educational Attainment of Adults, % with college or technical degree Graduate or Professional Degree Bachelor's Degree Associate's Degree 4 with college or technical degree 5 Some college, no degree 4 3 H.S. diploma or G.E.D. 9th-12th grade, no diploma Less than 9th grade Washington Source: U.S. Census Bureau American Community Survey. Retrieved March 2011 from

21 Median Income, 2009 $60,000 $50,000 $40,000 $30,000 For every $1 earned by Washington residents, residents earn 64. $36,345 $56,548 $20,000 $10,000 $- Washington State Source: U.S. Census Bureau American Community Survey. Retrieved March 2011 from

22 Unemployment, % 15% State U.S. Unemployment in mirrors state and national trends, but at a much higher rate. 5% Source: Washington Employment Security Department. County Profile. Retrieved April 2011 from

23 Poverty, 2009 Federal Poverty Threshold an annual income of $11,000 for 1 person $22,000 for a family of Washington 3 1 in 4 children 1 in 8 families 1 in 12 seniors Children Families Elders Source: U.S. Census Bureau American Community Survey. Retrieved March 2011 from

24 Food Stamp Recipients, This peak in early 2008 represents increased enrollment due to expansion of eligibility for those affected by the December 2007 windstorm. Counties Like Us Washington Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention in County. Retrieved March 2011 from

25 Students Qualified for Free or Reduced Lunch Prices at School, Eligibility ranges from 35% in our most affluent communities to 84% in the lowest income areas. Washington Source: Washington State Office of Superintendent of Public Instruction. Retrieved April 2011 from

26 Housing Distress, 2000 & Households Where Housing Costs are More Than 3 of Income 4 3 Washington Housing distress is less common in than elsewhere in the state but has increased 5% in the past decade Source: Washington Employment Security Department. County Profile. Retrieved April 2011 from

27 DSHS Service Use Rates, 2007 Overall use rates County: 43% Washington: 33% Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Client counts and service costs. Retrieved March 2011 from

28 Number of People DSHS Client Counts, 2009* 70,000 71,200 60,000 50,000 40,000 37% of people receive economic services, 29% receive medical assistance 30,000 20,000 20,312 26,313 10, * 1,114 1,175 2,167 4,160* *2008 client counts used for Developmental Disabilities and Children s Services; 2009 data for these categories not available at time of publication. Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Client counts and service costs. Retrieved May 2011 from

29 T H E M E The traditional resource-based economy which provided family-wage jobs has eroded Population has less formal education than the state average Housing and other costs of living are lower than in other areas, but many are still struggling We are more dependent on public assistance programs S So what? Science shows that these factors are all associated with poorer health status, and this effect on our communities is apparent in the information that follows.

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31 YOUTH & FAMILIES IN CRISIS

32 Begin at the Beginning: Fertility Most births Result from unintended pregnancy (54% statewide) Occur among women aged Premature birth and low birth weight rates are comparable to state average Our mothers are younger (11% under age 20 in 2009) and less educated than the state average Sources: Washington State Department of Health, Center for Health Statistics. Washington State Department of Health, Community and Family Health. Maternal and Child Health Data Report.

33 Student Sexual Behavior, 2010 Youth Condom Use Students Who Have Had Intercourse 12 th Graders Reporting Selected Behaviors in th graders report that they first experienced sexual intercourse at age 12 or younger th Grade 12th Grade Sex Before Age 13 4 or more partners Washington State Source: Washington State Department of Health Healthy Youth Survey.

34 Condom Use, 2010 Youth Condom Use (Among students who ve had intercourse) Condom use is inconsistent, especially among our youngest teens. 8th Grade 10th Grade 12th Grade Washington Source: Washington State Department of Health Healthy Youth Survey.

35 Teen Pregnancy & the Poverty Cycle, Early childbearing is associated with a cycle of generational poverty. 100 Washington Live Births Per 1,000 Women Aged & Ages Ages Source: Washington State Department of Health, Center for Health Statistics.

36 Students Living With Poor Family Management, 2010 Youth: Physically Smokeless Active Tobacco 60 min per Day Calculated based on responses to questions like, My parents ask if I ve gotten my homework done and When I am not at home, one of my parents knows where I am and who I am with. 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

37 Youth With a Supportive Adult, Washington State About half of students say yes when asked: When you feel sad or hopeless, is there an adult you can turn to for help? 8th Grade 10th Grade 12th Grade Source: Washington State Department of Health Healthy Youth Survey.

38 Low Commitment to School, 2010 Youth: Physically Smokeless Active Tobacco 60 min per Day Many students dislike being in school and find it dull or not important. 6th Grade 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

39 At Risk of Academic Failure, 2010 Youth: Physically Smokeless Active Tobacco 60 min per Day About half of students report getting mostly low grades (C s D s or F s). 6th Grade 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

40 School Protective Factors, 2010 Youth: Physically Smokeless Active Tobacco 60 min per Day 10 Opportunities for Pro-Social Involvement 10 Rewards for Pro-Social Involvement Many students feel they have opportunities to be involved in clubs or special projects at their school Many students feel like their hard work gets noticed by teachers and parents Source: Washington State Department of Health Healthy Youth Survey. Washington State

41 Community Opportunities for Pro-Social Involvement, 2010 Youth: Physically Smokeless Active Tobacco 60 min per Day Most of our older students feel they have opportunities for positive involvement in their communities. Source: Washington State Department of Health Healthy Youth Survey.

42 Children in Accepted CPS Referrals, % Counties Like Us Washington 15% 1 in 20 children 5% Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention in County. Retrieved March 2011 from

43 Students Reporting Family Violence, Ever Been Physically Abused By an Adult 1 in 5 students Ever Witnessed Adult-to-Adult Violence 1 in 3 students Source: Washington State Department of Health Healthy Youth Survey. Washington State

44 Domestic Violence Offenses, 2009 Arrests per 1,000 population Washington Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention in County. Retrieved March 2011 from

45 Youth Dating Violence, % These students reported that their boyfriend or girlfriend limited their activities, threatened them or made them feel unsafe in other ways. 15% 5% 8th Grade 10th Grade 12th Grade Source: Washington State Department of Health Healthy Youth Survey. Washington State

46 Students Reporting Being Bullied Once a Week or More, % 15% 5% 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

47 Bullying and Gender, 2010 Girls 5 More girls report bullying than boys. 5 Boys th Grade 10th Grade 12th Grade 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

48 Students Reporting Gang Membership In the Last 12 Months, % The decline in gang membership in the older grades may be because these highrisk students drop out of school. 15% 5% 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

49 Adolescent Arrests, Arrests per 1,000 population age Washington Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention in County. Retrieved March 2011 from

50 Adult Violent Crime Arrests, Arrests per 1,000 population age Washington Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention in County. Retrieved March 2011 from

51 Prisoners in State Correctional System, Offenders per 100,000 population age Counties Like Us Washington 0 Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention in County. Retrieved March 2011 from

52 T H E M E S Many families are in a cycle of poverty perpetuated by early childbearing Many parents lack good role models; there is too much child abuse and neglect Young people report a lack of adult mentorship and engagement in their lives Family violence is a problem and can be seen perpetuating itself in youth violence and emotional distress Our community and schools offer some opportunities but many young people lack the skills or support to benefit from them. So what? Without active intervention, the cycle of poverty, family disorganization, will repeat itself. Committed action over time is required to change this picture.

53 MENTAL HEALTH

54 Adults: Mental or Emotional Problems Past 30 Days, % 1 in 10 adults reported that they could not do their usual activities for at least one day in the past month because of mental or emotional problems. 15% 5% Washington State Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

55 Adults: Inadequate Social Support, % 1 in 5 adults report getting the social support they need never rarely or sometimes 15% 5% Washington State Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

56 Youth Depression, in 3 students reported that they felt so sad or hopeless everyday for two weeks or more that they stopped doing their usual activities. 3 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

57 Youth Depression and Gender, 2010 Girls 5 More girls report depression than boys. 5 Boys th Grade 10th Grade 12th Grade 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

58 Serious Suicidal Thoughts in the Past 12 Months Among Youth, % 15% 5% 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

59 Age-Specific Hospitalization Rates, Self-Inflicted Injury, Hospitalizations per 100,000 Population Age Group Washington State Source: Washington State Department of Health, Center for Health Statistics.

60 Suicide, Age-Specific Rates, Deaths From Self- Inflicted Injury per 100,000 Population Washington State Source: Washington State Department of Health, Center for Health Statistics.

61 T H E M E Many adults and youth have experienced trauma and many report poor mental health. Many adults report feeling isolated and unsupported. Hospitalization rates indicate that serious self-harm is more common among local adolescents and adults through age 64, and suicide rates for older males is significantly higher than the state average. S So what? Research increasingly suggests that traumatic events, especially in childhood, impact not only mental health and substance abuse risk but also the risk for other chronic diseases.

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63 Health Behaviors The Real Causes of Disease and Death Drugs & Alcohol Themes Injuries Themes Tobacco Nutrition & Physical Activity Themes

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65 DRUGS AND ALCOHOL

66 Adults: Binge Drinking Past 30 Days, 2007 Binge Drinking Defined: For men 5 or more drinks on a single occasion For women 4 or more drinks on a single occasion 5 4 Washington State 3 Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

67 Use Rates for State-Funded Alcohol or Drug Services, Clients in Services per 1,000 population Washington ages 18+ ages Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention in County. Retrieved March 2011 from

68 Adult Drug- and Alcohol-Related Arrests, Arrests per 1,000 population age 18 + Washington Alcohol-related arrests Drug-related arrests Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention in County. Retrieved March 2011 from

69 Property Crime Arrests By Age, Property crimes are often related to addiction. 20 Arrests per 1,000 population in age group Washington Age Group Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Risk and Protection Profile for Substance Abuse Prevention in County. Retrieved March 2011 from

70 Student Perceptions 2010: How big a deal is youth alcohol and drug use? Youth: Physically Smokeless Active Tobacco 60 min per Day Permissive Laws/Norms Low Perception of Risk About 1 in 3 students report that the adults in their neighborhood don t think it s wrong to use drugs and that, if someone did use drugs, they wouldn t be caught by police Almost half of our students believe using drugs and alcohol is NOT risky th Grade 8th Grade 10th Grade 12th Grade 6th Grade 8th Grade 10th Grade 12th Grade Source: Washington State Department of Health Healthy Youth Survey.

71 Current Alcohol Use Among Students, in 4 10 th graders has drunk alcohol at least once in the last 30 days 4 3 Age at Initiation, 12th Grade Alcohol Users or more Before age Before age 14 6th Grade 8th Grade 10th Grade 12th Grade 35% 10 or less Washington 36% Washington State Source: Washington State Department of Health Healthy Youth Survey.

72 Current Marijuana Use Among Students, in 5 10 th graders has used marijuana at least once in the last 30 days Age at Initiation, 12th Grade Marijuana Users Before age 14 28% 17 or more Washington Before age 14 6th Grade 8th Grade 10th Grade 12th Grade 10 or less 26% Washington State Source: Washington State Department of Health Healthy Youth Survey.

73 Current Use of Any Illegal Drug Among Students, in 3 12 th graders has used an illegal drug at least once in the past 30 days. 3 6th Grade 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

74 Current Use of Painkillers To Get High Among Students, in 20 8 th graders and 1 in th graders has used painkillers to get high at least once in the last 30 days. 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

75 Alcohol-Related Deaths, Deaths per 100, year olds Includes diseases known to be 10 attributable to alcohol use as well as a proportion of diseases and injuries known to be partially attributable to alcohol use, as shown by epidemiological studies (for example, some cancers, liver disease, and injuries) Washington State Source: Washington State Department of Health, Center for Health Statistics.

76 Drug-Related Deaths, Deaths per 100, year olds Includes all diseases known to be 10 attributable to drug use as well as a proportion of diseases and injuries known to be partially attributable to drug use, as shown by epidemiological studies, for example, viral hepatitis, AIDS, and endocarditis. Washington State Source: Washington State Department of Health, Center for Health Statistics.

77 T H E M E S Substance abuse is prevalent and often co-occurs with mental health problems. Local youth start using alcohol and drugs of abuse earlier than their peers statewide. The misuse of prescription drugs is an emerging problem and often results in opiate addiction. Disease and death due to alcohol and drug use is significantly more common than the state average. Substance abuse and mental health issues are inextricably linked to poor family management, adverse childhood events, and chronic disease. So what? Direct and purposeful action is required to change family and cultural norms around the use of alcohol and drugs of abuse in order to change this picture.

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79 INJURIES

80 Youth Bike Helmet Use, Less than 1 in 3 students report wearing a bike helmet most of the time or always when they ride a bike. Washington State 8th Grade 10th Grade 12th Grade Source: Washington State Department of Health Healthy Youth Survey.

81 Youth Riding in a Car with a Drinking Driver, % More than 1 in 10 students report that they rode with a driver who had been drinking alcohol more than one time during the past 30 days. 15% Washington State 5% 8th Grade 10th Grade 12th Grade Source: Washington State Department of Health Healthy Youth Survey.

82 Use of Seat Belts, 2010* These people report wearing seat belts most of the time or always. Washington State 8th Grade 10th Grade 12th Grade Adults * * Adult rate is for 2006 Sources: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from Washington State Department of Health Healthy Youth Survey.

83 Firearms in the Home, 2004 Have Firearm In Home Keep Firearm Loaded & Unlocked In Home Washington State Washington State Sources: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

84 Age-Adjusted Death Rates, Injury By Major Cause, We experience significantly more deaths due to motor vehicle accidents, firearm injuries, and drowning. 15 Deaths per 100,000 population Washington State 10 5 Source: Washington State Department of Health, Center for Health Statistics. 0 Motor Vehicle Accident Firearm Fall Drowning

85 Age-Specific Hospitalization Rates, Unintentional Injury, Hospitalizations per 100,000 population We have higher rates of hospitalization from unintentional injury at every age group < 1 years Age Group Washington State Source: Washington State Department of Health, Center for Health Statistics.

86 Age-Specific Hospitalization Rates, Assault, Hospitalizations due to assault are higher than Washington State among year olds Hospitalizations per 100,000 population Age Group Source: Washington State Department of Health, Center for Health Statistics. Washington State

87 T H E M E S Bike helmet and seat belt use appears less consistent than for youth statewide. Firearms are more prevalent in our homes. Injuries serious enough to require hospitalization are more common at every age group. Most injuries are unintentional, but hospitalization for assault is more common here than statewide. Family violence, as previously discussed, plays a role. Drowning deaths are higher here; we have many lakes and rivers in which they can occur. Injuries are often associated with the use of drugs and alcohol. So what? Motor vehicle injuries and drowning are a particular concern, and intervention here could save lives. Interventions that reduce family disorganization, violence, and drug and alcohol use could also have an impact.

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89 TOBACCO

90 Current Smoking Among Youth, Our kids start smoking earlier and smoke more at every grade level Age at Initiation, 12 th Graders 17 or more 6th Grade 8th Grade 10th Grade 12th Grade Washington Source: Washington State Department of Health Healthy Youth Survey Before age or less Washington Before age 14 41%

91 Adult Smoking, More than 1 in 5 adults, including pregnant women, smoke Pregnant Women All Adults Washington State Sources: Washington State Department of Health, Tobacco Prevention and Control Program.

92 Exposure to Tobacco Smoke, 12 th Graders, Over half of 12 th graders report exposure to secondhand smoke Exposed to ETS Smoker at Home Smoker in Car Washington Source: Washington State Department of Health Healthy Youth Survey.

93 Smokeless Tobacco, % 15% of 12 th graders, almost exclusively boys 15% 5% 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

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95 NUTRITION & PHYSICAL ACTIVITY

96 Students Reporting Food Insecurity, in 5 students report that their family cuts meal size or skips meals because there isn t enough money for food 3 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

97 Youth Consuming 2 or More Youth: Consumed Sugary Beverages 2 or More Yesterday, Sugary 2010 Sodas/Day in 5 8 th and 10 th graders drank at least two sugary beverages yesterday 3 Washington State Source: Washington State Department of Health Healthy Youth Survey.

98 Youth: Consumed Sugary Beverages 2 or More and Sugary School Sodas/Day 10 Consumes Soda at School 10 Buys Soda at School Most students who drink soda at school are bringing it from home or buying it off-campus th Grade 10th Grade 12th Grade 8th Grade 10th Grade 12th Grade Washington State Source: Washington State Department of Health Healthy Youth Survey.

99 Adults Consuming Nutrition 5 or More Servings of Fruits and Vegetables Per Day, Only 1 in 5 adults report adequate fruit and vegetable consumption 3 Washington State Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

100 Youth Who Are Physically Active at Least 60 Minutes Every Day, 2010 Youth: Physically Smokeless Active Tobacco 60 min per Day A higher percentage of our kids report adequate physical activity, but this edge is lost by 12 th grade Good News! Washington State 6th Grade 8th Grade 10th Grade 12th Grade Source: Washington State Department of Health Healthy Youth Survey.

101 Adults Meeting Physical Physical Activity Activity Recommendations, 2007 Smokeless Tobacco Recommendation: 30 minutes or more of moderate physical activity for 5 or more days per week or 20 minutes or more of vigorous physical activity for 3 or more days per week Washington State Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

102 Youth: Overweight and Obesity, 2010 Percent of Students Who Are Overweight or Obese Percent of Students Who Are Trying to Lose Weight Obese includes students who are in the top 5% for body mass index by age and gender based on growth charts developed by the Centers for Disease Control and Prevention (2000). Overweight includes students who are in the top 15% but not the top 5% A higher percentage of students are trying to lose weight than are identified as being obese or overweight. Washington State 5 4 Washington State th Grade 10th Grade 12th Grade 8th Grade 10th Grade 12th Grade Source: Washington State Department of Health Healthy Youth Survey.

103 Obesity Adult Overweight & Obesity, A body mass index of is considered overweight ; a body mass index of 30 or greater is considered obese. Body mass index is determined by a person s height and weight. For example, a 5 5 person weighing 150 lbs. is overweight; a 5 5 person weighing 180 lbs. is obese. Washington State Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

104 Age-Adjusted Hospitalization Rates, Diabetes with Complications, Diabetes Hospitalizations per 100,000 Population Washington State Source: Washington State Department of Health, Center for Health Statistics.

105 Age-Adjusted Death Rates, Deaths per 100,000 population Washington Lung Cancer Heart Disease Chronic Lower Respiratory Disease Diabetes Source: Washington State Department of Health, Center for Health Statistics.

106 Leading Causes of Death, 2009 Chronic Lower Respiratory Disease Accidents 7% Diabetes 4% Cancer Colon/Rectum Liver/Bile Ducts Pancreas Other 24% Heart disease 31% Cancer 25% Lung, Trachea, Larynx All Other Breast Prostate Bladder Leukemia/ Lymphoma Source: Washington State Department of Health, Center for Health Statistics.

107 Deaths per 100,000 population Deaths per 100,000 (heart disease) Chronic Disease Mortality Trends (Age-Adjusted Death Rates, ) Lung Cancer Chronic Lower Respiratory Disease Heart Disease Diabetes Source: Washington State Department of Health, Center for Health Statistics.

108 T H E M E S More of our kids start using tobacco when they are very young and their use persists into adulthood and during pregnancy Poor diet and food insecurity are real problems Our 6 th and 8 th graders are more active than their peers statewide, but this edge is lost by 12 th grade. Local adults are more sedentary than the state average We are sick longer and die younger from chronic diseases related to Tobacco use Poor diet Physical inactivity Diabetes is increasing rapidly So what? The heavy burden of chronic disease in our communities is not surprising in the context of information about our health behaviors, and changed behavior is the key to reducing this burden.

109 Health Care Access and Utilization

110 Hospitalization Rates, All Causes* by Age Group, *except childbirth We are hospitalized at higher rates in every age group except ages Ages Birth through 12 Months Ages 1-14, 15-24, & Ages & Washington State Source: Washington State Department of Health, Center for Health Statistics.

111 Age-Adjusted Hospitalization Rates, Major Causes, We are hospitalized at higher rates for every major cause group Injury and poisoning Certain conditions originating in the perinatal period Diseases of the musculoskeletal system and connective tissue Diseases of the skin and subcutaneous tissue Complications of pregnancy; childbirth; and the puerperium Diseases of the genitourinary system Diseases of the digestive system Diseases of the respiratory system Diseases of the circulatory system Diseases of the nervous system and sense organs Mental Illness Diseases of the blood and blood-forming organs Endocrine; nutritional; and metabolic diseases and immunity disorders Washington State Neoplasms Infectious and parasitic diseases *age-adjusted to the 2000 standard population Source: Washington State Department of Health, Center for Health Statistics Hospitalizations per 100,000 Population*

112 Primary Care Physician Coverage Rate, We have a shortage of primary care physicians 50 Number of Primary Care Physician FTEs per 100,000 population "Goldsmith Standard" Source: Washington State Department of Health, Office of Community Health Systems.

113 Adults Who Report Not Seeking Health Care When Needed Due to Cost, % More than 1 in 6 adults report not seeking health care when needed because they could not afford it. 15% 5% Washington Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

114 Health Insurance Coverage in 8 children and 1 in 5 adults aged are uninsured Washington Children, 2009 Adults 18-64, 2007 Sources: Washington State Department of Health Local Public Health Indicators. Retrieved March 2011 from Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

115 Medicaid Eligibility, Washington Source: Washington State Department of Social and Health Services, Research and Data Analysis Division. Client counts and service costs. Retrieved March 2011 from

116 Payor Mix, Community Hospital, % 3% L & I/Workers Comp 24% 23% Commercial* 5% 13% 12% Self Pay 12% 13% Healthy Options** 16% Less than 3 of services are paid by a private insurance company 3 45% Medicaid Medicare 32% Admissions By Payor ED Charges By Payor * Commercial refers to payment by Champus or Regence, Blue Cross, or other private health plans **Healthy Options is a state-subsidized managed care insurance plan. Source: Community Hospital

117 Prenatal Care Initiation Trends, County, % - 3 rd trimester - 2nd trimester In % - 1 st trimester None 3rd Trimester 2nd Trimester 1st Trimester Source: Washington State Department of Health, Center for Health Statistics.

118 Preschool Immunization Coverage, Complete coverage = 4 DTaP, 3 polio, 1 MMR, 3 HiB, 3 hepatitis B, 1 varicella, 4 pneumococcal by 36 months Washington United States Sources: County Public Health Department. Available at National Center for Health Statistics. Retrieved September 2010 from

119 Flu Shot in the Past 12 Months, Persons Age 65+, /3 of elder adults did not receive a flu shot Washington Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

120 Well Child Care in the Past 12 Months, Washington 8th Grade 10th Grade 12th Grade Source: Washington State Department of Health Healthy Youth Survey.

121 Adults Receiving Recommended Cancer Screenings, 2006* More than 2/3 of adults are not getting recommended screening for oral cancer Washington Pap Colon Prostate Oral *Oral cancer screening data from 2007 Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

122 Dental Care in the Past 12 Months, Youth in 3 students report inadequate preventive dental care Washington 8th Grade 10th Grade 12th Grade Source: Washington State Department of Health Healthy Youth Survey.

123 School dental screenings, 2010 Preschool, Kindergarten, 3 rd Grade In Need Of Restorative Care History of Rampant Decay K & 3 rd Grade 28% Yes 26% Yes 71% No 74% No Rampant decay = evidence of cavities on 7 or more teeth Source: County Public Health Department.

124 Adult dental care: Percent of adults who did NOT see a dentist in the past 12 months, in 3 of adults report inadequate preventive care 3 Washington Source: Washington State Department of Health, Center for Health Statistics. Behavioral Risk Factor Surveillance System. Retrieved March 2011 from

125 T H E M E S We use a lot of hospital care at every age We have significant populations of people without access to routine health care Access to dental care is a serious problem for people on Medicaid and without insurance Preschool immunization coverage is better than the state average Early prenatal care has been a concern but access appears to be improving in the past few years So what? This heavy use of the most expensive health services could be reduced by more resources and attention paid to supporting behavior changes through specific action at all levels - individual, family, systems, and community.