Collier County Florida Health Assessment

Transcription

1 Florida Health Assessment Prepared by: The Health Planning Council of Southwest Florida, Inc.

2 Table of Contents Introduction... 4 Demographic and Socioeconomic Characteristics... 5 Population Demographics... 5 Population Growth... 6 Age... 7 Gender... 7 Race and Ethnicity... 8 Socioeconomic Indicators... 9 Health Status Health Ranking Healthy People 2020 Objectives Death Rate Death Rates by Race Leading Causes of Death Deaths from All Causes Chronic Diseases Cancer Heart Disease Diabetes Weight, Exercise and Nutrition Communicable Diseases Sexually Transmitted Diseases Vaccine Preventable Diseases AIDS and Other Diseases Maternal and Child Health Mothers Who Smoked During Pregnancy Teen Births Infant Deaths Senior Citizen Health Alzheimer s Disease Oral Health Accessibility for Low-Income Residents

3 Social and Mental Health Crime and Domestic Violence Alcohol-related Motor Vehicle Crashes Florida Youth Substance Abuse Survey Suicides Baker Act Hospitalizations Emergency Room Visits Health Resources Medicaid Florida KidCare Uninsured Physicians and Facilities Healthcare Network Patient Origin by Zip Code Federal Health Professional Shortage Designations Community Input Survey on Health and Healthcare Interviews with Community Leaders Appendices: Appendix A: County Health Rankings Appendix B: Behavioral Risk Factor Surveillance Survey Appendix C: Survey on Health and Healthcare Appendix D: Key Informant Interview Guide Appendix E: Community Leaders Interviewed Appendix F: Definitions of Prevention Quality Indicators Appendix G: Florida Youth Substance Abuse Survey Appendix H: Guide to Emergency and Health Services Appendix I: Selected Data Sources

4 Introduction In an effort to improve the health of the residents of, a collaborative partnership was formed between the Healthcare Network of Southwest Florida and the Health Planning Council of Southwest Florida, Inc. (HPC) for the purpose of conducting a needs assessment for use by the Healthcare Network of Southwest Florida and other community partners. HPC reviewed numerous data sources and received feedback from the Healthcare Network of Southwest Florida as well as from members of the community through surveys and interviews. The assessment group reviewed the preliminary data that was collected, and provided feedback to the Health Planning Council. This needs assessment consists of demographic, socioeconomic and health status information that will be used to identify areas where targeted interventions and policy changes may have the greatest impact. Once community needs are identified through quantitative data analysis of demographic, socioeconomic and health status information, and qualitative interviews, the strategic planning process can begin. 4

5 Demographic and Socioeconomic Characteristics The demographic, social and economic characteristics of a community can strongly influence the community s health status and related service needs. These indicators should be a primary consideration when designing and developing any system of care within the region. This section provides a brief overview of some of the characteristics and trends that make unique in comparison to the state of Florida. Population Demographics The sheer number of people in a community is the leading determinant of the demand for healthcare services., which has a population of just over 340,000, is located in southwest Florida (Fig. 1). The county also shares borders with the following counties: Hendry to the north; Broward to the east; Miami-Dade to the southeast; Monroe to the south; and Lee to the northwest. As seen in Figure 2, Collier is one of seven counties in southwest Florida that comprise the Local Health Planning District 8 as designated by the Florida Agency for Health Care Administration (AHCA). Naples is the county seat and largest city. is 2, square miles in area; about 12 percent of that area is covered by water. It is the second largest county in the state of Florida, after Palm Beach County. According to the 2010 census figures, the county has a population density of about 161 persons per square mile compared to a state average of 351 persons per square mile. Figure 1: Figure 2: 5

6 Population Growth The illustration below represents the total population of from The estimate for 2014 places the population of at 340,146. This represents an eleven percent increase since Chart 1: Total Population Source: The Florida Legislature, Office of Economic and Demographic Research Population growth in a community is the result of natural increase (more births than deaths) and also the migration of people moving into the area at a higher rate than those who are leaving. According to the Office of Economic and Demographic Research, the population of is expected to continue to grow in the coming years. In 2019, it is estimated that the population of will be 371,412; that is an increase of nine percent from the same number for Chart 2: Estimated Population Source: The Florida Legislature, Office of Economic and Demographic Research 6

7 Age The largest proportion of the population of the county is between the ages of 45 and 64 which is the same for the state. However, has a larger elder population, aged 65 and older, than the state as a whole (27.1% Collier vs. 18.4% State). The median age for residents is higher than that for the state as a whole (47.6 Collier vs State in 2013). The median age has also been rising in ; it was 44.1 in 2000 and 45.2 in Chart 3: Population Percentage by Age Group Collier and State, 2014 Gender Source: The Florida Legislature, Office of Economic and Demographic Research There are more women than men in. This is not surprising since women make up a larger proportion of the United States population as a whole and tend to live longer than men. In fact, a study based on 2009 data shows women have the highest life expectancy in the nation, living an average of 85.8 years percent of the residents of are female while 49.1 percent are male; statewide the percentages are 51.1 percent female and 48.9 percent male. Chart 4: Collier Population by Sex Percent of Total Population, 2014 Source: The Florida Legislature, Office of Economic and Demographic Research 7

8 Race and Ethnicity percent of the population of is non-white. Approximately 7.06 percent of the population is considered Black. Another 3.00 percent of the population is listed as Other non-white. This category includes American Indian, Alaskan Native, Asian, Native Hawaiian, and other Pacific Islanders, and those of mixed race who chose not to select white or black. Chart 5: Collier Population by Race Percent of Total Population, 2014 Source: The Florida Legislature, Office of Economic and Demographic Research Ethnicity in Florida is broken out separately from race. For ethnicity, a person must designate themselves as Hispanic or Non-Hispanic; people in both of those groups can identify as white, black or other non-white. About 26.4 percent of the residents of identify as Hispanic; this is higher than the state average of 21.9%. The vast majority of the people in who identify as Hispanic identify as white. Table 2: Race and Ethnicity, 2014 Collier State Hispanic Non-Hispanic Hispanic Non-Hispanic White 26.4% 63.6% White 21.9% 56.3% Black 0.6% 6.4% Black 1.2% 15.5% Other 0.8% 2.2% Other 0.8% 4.3% Total 27.8% 72.2% Total 23.9% 76.1% Source: The Florida Legislature, Office of Economic and Demographic Research 8

9 Socioeconomic Indicators The figures shown below summarize some of the primary indicators of economic health for the county and state. Like the rest of Florida, was affected by the economic downturn. The unemployment rate jumped from 3.7 percent in 2000 to 8.4 percent in It has since reduced to 5.7 percent; that is slightly lower than the state rate of 6.1 percent. Some strong socioeconomic numbers in partially disguise a mixed economic story. The median income in is significantly higher than the state average; however the average annual wage in is slightly lower than the state average. The percent of people living under the poverty level in is lower than the state as a whole. Unfortunately, the percent of children 0-17 years of age who are under the poverty level is higher in ; that rate is 27.9 percent for compared to 23.8 percent for the state. Table 3: Socioeconomic Indicators and State County 2012 County 2014 State 2014 Labor Force as a % of Pop. Aged % 47.4% 49.2% Personal Bankruptcy Filing Rate per 1, Unemployment Rate 8.4% 5.7% 6.1% Average Annual Wage $40,975 $43,939 $44,803 Per Capita Personal Income $59,264 $73,869 $41,737 % Living Below Poverty Level 16.2% 14.4% 16.7% % ages 0-17 living below Poverty 30.7% 27.9% 23.8% Source: The Florida Legislature, Office of Economic and Demographic Research One and a half percent fewer residents of who are aged 25 and older have received a high school diploma than the state average. However, a larger percentage of people in have received a Bachelor s degree than the percentage of residents of Florida who have done the same. Table 4: Educational Attainment Persons aged 25 and older, Collier and State, 2014 Collier State % High School graduate or higher 85.7% 87.2% % Bachelor's degree or higher 32.3% 27.3% Source: The Florida Legislature, Office of Economic and Demographic Research 9

10 The percentage of families with children under 18 who are below the poverty level has been rising in. The current rate of 25.4 percent is above the State rate of 23.8 percent. Table 5: Percentage of Families with Related Children Under 18 Years Below Poverty Level, Single Year Rates Collier Florida Year Rate (%) Rate (%) Source: The Florida Legislature, Office of Economic and Demographic Research The National Center for Farmworker Health (NCFH) provides estimates of the number of migratory and seasonal farmworkers by county. The population threshold shown below is based in the 2012 Census of Agriculture and the figures are for Crop and Animal production agricultural workers only and do not include their family members. The NCFH estimates that in 2016, there are 10,048 migratory and seasonal farmworkers in. The vast majority of those workers are involved in crop production. Migratory and Seasonal Farmworkers 2014 COLLIER COUNTY FLORIDA WORKERS ONLY COUNTY CROP PRODUCTION ANIMAL PRODUCTION Collier 9, Disclaimer: This is a threshold estimate of the number of horticulture and livestock workers only. In order to derive a validated and complete estimate, the data referenced here must undergo an established research and review process, which is designed to be conducted on a county by county basis. The numbers contained herein have not been adjusted to reflect the following factors which could increase the total estimate of potential migratory and seasonal farmworker in the state: 1. Non- working dependents of agricultural workers. 2. Aged and Disabled Former Farmworkers. 3. Under-reporting by agricultural employers. 4. Unemployed and underemployed agricultural workers in the county. 5. Unique weather conditions in 2012 that may have skewed the Census of Agriculture data. 6. Changes in agricultural practices that have occurred since 2012 that would drive the numbers up or down accordingly. 7. Data that has been suppressed by USDA (usually due to fewer than three respondents in the county). Source: National Center for Farmworker Health 10

11 As seen in Chart 6, among working adults in the most common sectors of employment are: educational and health services, hospitality and service industry, professional and management services, and retail trade. Chart 6: Average Employment by Category Collier and State, 2014 Source: Florida Legislature, Office of Economic and Demographic Research 11

12 Health Status Health Ranking County Health Rankings & Roadmaps, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, has currently ranked the 2 nd healthiest out of 67 counties in Florida for Health Outcomes, and 5 th healthiest for Health Factors. This is a rise from 3 rd and 10 th respectively in These rankings are based on a variety of factors that affect the health of the county s residents such as unemployment, levels of physical inactivity, and rates of smoking, obesity, and children living in poverty. The Health Outcomes portion of the rankings includes data on Length of Life and Quality of Life. Collier County was ranked 3 rd healthiest of the Florida counties for Length of Life, which is based on the years of potential life lost before the age of 75. Quality of Life includes overall quality of health (poor or fair health, poor physical health days, and poor mental health days) as well as the percent of live births with low birth weight. In this category, ranked 8 th healthiest of all of the Florida counties. The Health Factors portion of the rankings includes data on health behaviors, clinical care, social & economic factors, and physical environment. was ranked as the 2 nd healthiest county in Florida for health behaviors, which includes rates of adult smoking, adult obesity, physical inactivity, excessive drinking, motor vehicle crash deaths, sexually transmitted infections, and teen births. For clinical care, was ranked as the 18 th healthiest county. Clinical care includes data on the number of uninsured, primary care physicians, dentists, preventable hospital stays, diabetic screening, and mammography screening. The percent of population under age 65 without health insurance in (30%) was higher than that of the state average (24%) and considerably higher than the national benchmark (11%). Social & economic factors, where ranked 21 st healthiest out of 67 counties in Florida, includes rates of high school graduation, some college, unemployment, children in poverty, inadequate social support, children in single-parent households, and violent crime. In, the percent of the population age 16 and older who are unemployed but seeking work was 5.9 percent. This rate is slightly lower than that of the state (6.3%), but more than the national benchmark (3.5%). The percent of children under age 18 in poverty was 26 percent, which is higher than the state average (24%) and significantly higher than the national benchmark (13%). Physical environment includes rates of daily fine particulate matter, drinking water violations, severe housing problems, driving alone to work and long commutes. In this category, ranked 5 th healthiest. A detailed breakdown of the rankings and full definitions for each health measure are available in Appendix A. 12

13 Healthy People 2020 Objectives Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. Healthy People 2020 is managed by the Office of Disease Prevention and Health Promotion within the US Department of Health and Human Services. Below is s data with relation to selected objectives (comparing 2010 Behavioral Risk Factor Surveillance Survey data with 2013 data, available in Appendix B). Mission Healthy People 2020 strives to: Identify nationwide health improvement priorities. Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress. Provide measurable objectives and goals that are applicable at the national, State, & local levels. Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge. Identify critical research, evaluation, and data collection needs. Overarching Goals Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Table 6: Healthy People 2020 Objectives 2013 Objective Measure Progress C-15. Increases the proportion of women who receive a cervical cancer screening based on the most recent guidelines. C-16. Increase the proportion of adults who receive a colorectal cancer screening based on the most recent guidelines. C-17. Increase the proportion of women who receive a breast cancer screening based on the most recent guidelines. Percentage of women 18 years of age and older who received a Pap test in the past year. Percentage of adults 50 years of age and older who received a sigmoidoscopy or colonoscopy in the past five years. Percentage of women 40 years of age and older who received a mammogram in the past year. Percentage of women 18 years of age and older who had a clinical breast exam in the past year % 57.10% 56.30% 56.00% 69.30% 64.60% 64.80% 57.10% Needs Improvement Needs Improvement Needs Improvement Needs Improvement 13

14 Objective Measure Progress D-9. Increase the proportion of adults with Percentage of adults with diabetes who Progress diabetes who have at least an annual foot 57.50% 75.20% had an annual foot exam. Shown examination. D-10. Increase the proportion of adults with diabetes who have an annual dilated eye examination. D-11. Increase the proportion of adults with diabetes who have a glycosylated hemoglobin (A1C) measurement at least twice a year. D-13. Increase the proportion of adults with diabetes who perform self-blood glucosemonitoring at least once daily. D-14. Increase the proportion of persons with diagnosed diabetes who receive formal diabetes education. HDS-5. Reduce the proportion of persons in the population with hypertension. HIV-14. Increase the proportion of adolescents and adults who have been tested for HIV in the past 12 months. IID Increase the percentage of noninstitutionalized adults aged 65 years and older who are vaccinated against seasonal influenza. IID-13. Increase the percentage of adults who are vaccinated against pneumococcal disease. IID Increase the percentage of noninstitutionalized adults aged 65 years and older who are vaccinated against pneumococcal disease. NWS-8. Increase the proportion of adults who are at a healthy weight. NWS-9. Reduce the proportion of adults who are obese. SA-14. Reduce the proportion of persons engaging in binge drinking of alcoholic beverages. TU-4. Increase smoking cessation attempts by adult smokers. Percentage of adults with diabetes who had an annual eye exam. Percentage of adults with diabetes who had two A1C tests in the past year. Percentage of adults with diabetes who self-monitor blood glucose at least once a day on average. Percentage of adults with diabetes who ever had diabetes self-management education. Percentage of adults with diagnosed hypertension. Percentage of adults less than 65 years of age who have ever been tested for HIV. Percentage of adults age 65 and over who received a flu shot in the past year. Percentage of adults who have ever received a pneumonia vaccination. Percentage of adults age 65 and over who have ever received a pneumonia vaccination. Percentage of adults who have a healthy weight (BMI from 18.5 to 24.9) % 57.80% 71.00% 76.00% 60.90% 64.80% 58.20% 59.80% 30.90% 34.60% 34.00% 40.70% 74.80% 59.70% 41.60% 43.20% 80.70% 67.20% 39.30% 43.30% Percentage of adults who are obese % 20.80% Percentage of adults who engage in heavy or binge drinking. Percentage of adult current smokers who tried to quit smoking at least once in the past year % 18.10% 49.80% 36.30% Source: U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People Washington, DC. Available at Accessed February 27, Data source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. Needs Improvement Progress Shown Progress Shown Progress Shown Progress Shown Progress Shown Needs Improvement Progress Shown Needs Improvement Progress Shown Progress Shown Progress Shown Needs Improvement 14

15 Death Rate The death rate for residents has been consistently lower than the state average. For 2014, s death rate was more than twenty-five percent lower than the state s rate (487.2 per 100,000 vs State). The death rate for has been on the decline for the past twenty years, and has leveled off since Chart 7: Collier Death Rate over 20 Years Compared to State Age-Adjusted All Causes 3-Year Death Rate Source: Florida Department of Health, Office of Vital Statistics Age-adjusted death rates are computed using the year 2000 standard population. Death Rates by Race The overall death rate for blacks in is very similar to that of whites (485.4 white population vs black population). From , the black population in had considerably higher rates of death due to heart disease, and stroke than the white population. The white population had considerably higher rates of death due to cancer, Alzheimer s disease, chronic lower respiratory disease and cirrhosis than the black population. 15

16 Cancer and heart disease were the leading causes of death for both whites and blacks. Table 7: Major Causes of Death and Race, and State 3-Year Age-Adjusted Death Rates by Cause, County State All All White Black Other White Black Other Races Races Cancer Heart Disease Unintentional Injury Alzheimer s Disease CLRD* Stroke Cirrhosis Suicide Diabetes Source: Florida Department of Health, Office of Vital Statistics *Chronic Lower Respiratory Disease Please note that due to the small size of the black population, a small number of deaths in one category can cause a large variance in the death rate for that category. Chart 8: Major Causes of Death and Race, 3-Year Age-Adjusted Death Rates by Cause Source: Florida Department of Health, Office of Vital Statistics 16

17 Leading Causes of Death Mortality rates can be key indicators of the state of health of a community. A significant number of s deaths are premature and preventable. Behavior modification and risk reduction can reduce the mortality rates of many of the leading causes of death, especially those attributed to heart disease, stroke, diabetes, lung cancer and motor vehicle accidents. Individuals may improve both the length and the quality of their lives by simply following a healthy lifestyle and receiving regular medical care. Table 8 gives detailed information on the leading causes of death for residents of in The Deaths column is a simple count of the number of people who died by the listed cause during Percent of Total deaths lets you know what percent of the people who died in 2014 died from that cause. Crude Rate per 100,000 gives a sense of how likely a person is to die of that cause in any given year. For example, out of every 100,000 people in, 49.1 of them died of a stroke in Using the rate per 100,000 allows comparison between areas with different populations such as comparing a small county to a large county or a county to the state. The next column lists the Age-Adjusted Death Rate per 100,000. Age-adjusting a rate is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population merely because the elderly are more likely to die or be hospitalized. The same distortion can happen when we compare races, genders, or time periods. Age adjustment can make the different groups more comparable. The 3-Year Age-Adjusted Death Rate per 100,000 gives an average of the three years ending in 2014 (2012, 2013, and 2014). A small increase or decrease in the number of deaths in a given year can make a big difference in the rate so averages are used to flatten out large fluctuations. The last column is Years of Potential Life Lost. This is an estimate of the number of years a person would have lived had they not died prematurely. In this case that number is given for all people who died under the age of 75 assuming that they would have lived to the age of 75. When the numbers are particularly low, such as they are for Alzheimer s disease, it is generally because that cause of death largely impacts the elderly. Conversely, a particularly high number such as for unintentional injuries suggests that the average age of the people who died due to that cause was fairly low. 17

18 Table 8: Major Causes of Death For Year Age- Adjusted Death Rate YPLL < 75 Per 100,000 Under 75 Cause of Death Deaths Percent of Total Deaths Crude Rate Per 100,000 Age-Adjusted Death Rate Per 100,000 Per 100,000 ALL CAUSES 3, , CANCER , HEART DISEASE ALZHEIMER'S DISEASE UNINTENTIONAL INJURIES CHRONIC LOWER RESPIRATORY DISEASE STROKE DIABETES MELLITUS CHRONIC LIVER DISEASE AND CIRRHOSIS PARKINSON'S DISEASE SUICIDE PNEUMONIA/INFLUENZA KIDNEY DISEASE SEPTICEMIA HOMICIDE AIDS/HIV Source: Florida Department of Health, Office of Health Statistics and Assessment Age-adjusted death rates are computed using the year 2010 standard population. YPLL = Years of Potential Life Lost 18

19 The most frequent causes of death for people in are cancer and heart disease. Together they accounted for 46.9 percent of the deaths in Table 9, which compares the three-year ageadjusted rates for with those for all of Florida, shows that the death rates in Collier County for cancer, heart disease, chronic lower respiratory disease and diabetes are significantly lower than the state average. The death rates for are slightly higher than the state average for Alzheimer s disease, and chronic liver disease & cirrhosis. Table 9: Major Causes of Death Collier and State County Age-Adjusted Rate/100,000 Florida Age-Adjusted Rate/100,000 Cause of Death ALL CAUSES CANCER HEART DISEASE UNINTENTIONAL INJURIES ALZHEIMER'S DISEASE CHRONIC LOWER RESPIRATORY DISEASE STROKE CHRONIC LIVER DISEASE AND CIRRHOSIS SUICIDE DIABETES MELLITUS PARKINSON'S DISEASE HOMICIDE PNEUMONIA/INFLUENZA KIDNEY DISEASE 3.3 SEPTICEMIA AIDS/HIV Source: Florida Department of Health, Office of Health Statistics and Assessment Age-adjusted death rates are computed using the year 2010 standard population. 19

20 Deaths from All Causes Table 8 lists the cause of death noted for all deaths in from The total number of deaths has fluctuated within a fairly narrow range during this period, with the lowest total in The death rate has fallen considerably during this same period, in part because the population of has increased. Table 10: Deaths From All Causes All Races, All Sexes, All Ethnicities, All Ages Cause of Death All Causes 2,618 2,586 2,581 2,707 2,693 2,861 2,871 2,917 2,909 3,062 Infectious Diseases Certain other Intestinal Infections Human Immunodeficiency Virus (HIV) Disease Meningococcal Infection Other & Unspecified Infectious/Parasitic Disease & Sequelae Other Tuberculosis Respiratory Tuberculosis Salmonella Infections Septicemia Viral Hepatitis Malignant Neoplasm (Cancer) All Other & Unspecified Cancer Bladder Cancer Breast Cancer Cervical Cancer Colon, Rectum, & Anus Cancer Corpus Uteri & Uterus, Part Unspec Cancer...Esophagus Cancer Hodgkins Disease Kidney and Renal Pelvis Cancer Larynx Cancer Leukemia Lip, Oral Cavity, Pharynx Liver & Intrahepatic Bile Ducts Cancer...Meninges, Brain, & Other Part Cen Nerv Sys Cancer...Multiple Myeloma & Immunoprolifera Neoplas...Non-Hodgkins Lymphona Ovarian Cancer

21 Cause of Death Pancreatic Cancer Prostate Cancer Skin Cancer Stomach Cancer Trachea, Bronchus, Lung Cancer In Situ, Benign, Uncert/Unk Behavior Neoplasms Anemias Nutritional and Metabolic Diseases Diabetes Mellitus Malnutrition Other Malnutritional Deficiencies Nervous System Diseases Alzheimer s Disease Meningitis Parkinsons Disease Cardiovascular Diseases Acute & Subacute Endocarditis Acute Myocardial Infarction Acute Rheum Fever & Chronic Rheum Heart Dis. All Other Chronic Ischemic Heart Dis. Aortic Aneurysm & Dissection Atherosclerosis Atherosclerotic Cardiovascular Disease Cerebrovascular Diseases Essen Hypertension & Hypertensive Renal Dis. Heart Failure Hypertensive Heart & Renal Disease Hypertensive Heart Disease Other Acute Ischemic Heart Disease Other Arteries, Arterioles, Capillaries Other Forms Heart Dis Pericardium Diseases & Acute Myocarditis...Other Circulatory System Disorders Respiratory Diseases Asthma Bronchitis, Chronic & Unspecified Emphysema

22 Cause of Death Other Chronic Lower Respiratory Diseases Influenza Pneumonia Other Respiratory System Dis Pneumoconiosis & Chemical Effects...Pneumonitis Due To Solids & Liquids Digestive Diseases Appendix Diseases Cholelithiasis & Other Gallbladder Disorders Alcoholic Liver Disease Other Chronic Liver Disease & Cirrhosis Hernia Peptic Ulcer Urinary Tract Diseases Hyperplasia of Prostate Kidney Infections Acute/Progressive Nephritic/Nephrotic Synd Glomeruloneph, Nephri/Nephro, Renal Sclerosis Other Kidney Disorders Renal Failure Pregnancy, Childbirth, Puerperium Complications Perinatal Period Conditions Congenital & Chromosomal Anomalies Symptoms, Signs & Abnormal Findings Other Causes (Residual) External Causes 2,618 2,586 2,581 2,707 2,693 2,861 2,871 2,917 2,909 3,062 Drowning & Submersion Falls Firearms Discharge Homicide by Firearms Discharge Homicide By Other & Unspecified Means & Sequelae Medical & Surgical Care Complications Motor Vehicle Crashes Other & Unspecified Event & Sequelae

23 Cause of Death Other & Unspecified Nontransport & Sequelae Other Land Transport Accidents Poisoning & Noxious Substance Exposure...Smoke, Fire, Flames Exposure Suicide By Firearms Discharge Suicide By Other & Unspecified Means & Sequelae War Operations & Sequelae Water/Air/Space/Oth-Unsp Transport & seq Source: Florida Department of Health, Office of Vital Statistics 23

24 Chronic Diseases Chronic diseases are those conditions defined as having a long duration and typically a slow progression. These diseases have a major impact on the health and wellbeing of people in the United States. According to the Centers for Disease Control and Prevention, eighty-six percent of all health care spending in 2010 was for people with one or more chronic medical conditions. They also state that as of 2012, about half of all adults 117 million people had one or more chronic health conditions and seven of the top 10 causes of death nationwide in 2010 were chronic diseases. Chronic diseases are also having an impact in. Cancer Cancer is the leading cause of death in. Chart 9 gives a detailed look at the decline in deaths from all cancers across the last twenty years. The decline in is not as dramatic as the decline at the state level, although it has been consistently significantly lower in Collier than for the state as a whole. The trend line has flattened a bit, but tends to remain positive. In fact, had the lowest three-year rate of deaths from all cancers of all 67 counties in Florida for Chart 9: Deaths from All Cancers Age-adjusted rate per 100,000, 3-Year Rates Source: Florida Department of Health, Bureau of Vital Statistics 24

25 has a significantly lower incidence rate for cancer than the state as a whole. Both Collier County and the State of Florida have seen a decline in the cancer incidence rate across the last few years. Chart 10: Cancer Incidence Age-adjusted rate per 100,000, 3-Year Rates Source: Florida Department of Health, Bureau of Vital Statistics Among the types of cancer, lung cancer causes the highest number of deaths in. It also has the highest incidence rate followed by breast cancer. Skin cancer is also relatively prevalent, but not nearly as deadly. Table 11: Common Types of Cancer Death Rate and Incidence, 3 yr. Age-Adjusted Death Rate, Avg. Annual Number of Events (Incidence), 2012* Lung Cancer Breast Cancer Prostate Cancer Colorectal Cancer Pancreatic Cancer 8.0 Cervical Cancer Skin Cancer Source: Deaths - Florida Department of Health, Office of Vital Statistics; Incidence - University of Miami (FL) Medical School, Florida Cancer Data System *2012 is the most recent data available for annual number of cancer incidence. 25

26 An annual pap test is used to detect changes in the cells of the cervix, which can lead to cervical cancer. Detecting these abnormal cells early increases the chances of curing cervical cancer. According to the Behavioral Risk Factor Surveillance System 2013 Data Report (available in Appendix B), women over 18 years of age in were slightly less likely than women across the state as a whole to report that they had received a Pap test in the last year (54.1% Collier vs. 57.1% State). This rate is significantly lower than the rate in 2007 (62.9%). The rate is lowest for those women who make under $25,000 annually. Chart 11: Women 18 Years of Age or Older Who Received a Pap Test in the Past Year Percentage By Income, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. 26

27 Women ages 40 years and older are recommended to annually receive a mammogram, an x-ray of the breast, annually to detect and/or diagnose breast cancer. A higher percentage of women 40 years or older in reported that they had received a mammogram than the state average (69.3% Collier vs. 61.9% State). Chart 12: Women 40 Years of Age and Older Who Received a Mammogram in the Past Year Percentage By Income, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. NA=Not available due to respondent counts of less than

28 Residents of over the age of 50 who make $50,000 per year or more are more likely to indicate that they have received a sigmoidoscopy or colonoscopy than their counterparts who have lower income levels. Residents of over the age of 50 report having these screenings at a similar rate to the state average (56.0% Collier, 55.3% State). Chart 13: Percentage of Adults 50 Years of Age and Older Who Received a Sigmoidoscopy or Colonoscopy in the Past Five Years Percentage By Income, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. 28

29 The rate of residents over 50 who have received a blood stool sample in the past year is also similar to the rate across the state (14.1% Collier, 13.9% State). Adults with incomes below $25,000 annually had the lowest rates across (11.2%) compared to those with incomes $25,000 to $49,999 (20.4%) or $50,000 and more (14.8%). Chart 14: Percentage of Adults 50 Years of Age and Older Who Received a Blood Stool Test in the Past Year Percentage By Income, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. 29

30 Heart Disease Heart disease is the second most common cause of death in, and the leading cause of death in the United States. As seen in Chart 15, age-adjusted death rates from heart disease have been on the decline for both and the state of Florida as a whole during the last twenty years although they have leveled off some in recent years. Rates for are considerably lower than the state average. Chart 15: Deaths from Heart Disease Age-adjusted rate per 100,000, 3-Year Rates Source: Florida Department of Health, Bureau of Vital Statistics 30

31 According to the Centers for Disease Control and Prevention, coronary heart disease is the most common form of heart disease and can lead to a heart attack and/or angina (chest pain or discomfort). In, the percentage of adults who reported that they had ever had a heart attack, angina, or coronary heart disease was slightly higher than for the state as a whole in 2013 (11.6% Collier vs. 10.3% State). Chart 16: Adults Who Ever Had a Heart Attack, Angina, or Coronary Heart Disease Percentage by Income, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. * Indicates that the difference observed between the 2013 county and state measures is statistically significant. 31

32 Diabetes Deaths rates for diabetes in are much lower than those for cancer and heart disease, but are still a health concern. The age-adjusted three-year rates have fluctuated within a fairly narrow margin over the last twenty years; they do seem to have lowered somewhat in recent years. The rates are lower in than for the state as a whole. Chart 17: Deaths from Diabetes Age-adjusted rate per 100,000, 3-Year Rates Source: Florida Department of Health, Bureau of Vital Statistics 32

33 has a significantly lower rate of adults diagnosed with diabetes than the state (7.6% Collier vs. 11.2% State). The number of men reporting a diabetes diagnosis in has decreased from 2010 (12.5% 2010 vs. 7.9% 2013). The number of women reporting this chronic condition has increased (6.2% 2010 vs. 7.3% 2013). Chart 18: Adults with Diagnosed Diabetes Percentage by Sex, 2010 and 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. * Indicates that the difference observed between the 2013 county and state measures is statistically significant. 33

34 Residents with lower annual incomes reported much higher rates of diabetes than those with middle and higher incomes. Residents with incomes lower than $25,000 annually reported a 12.7% rate in 2013, while those with incomes $25,000-$ reported a rate of 4.8% and those who earned $50,000 or more reported a 6.5% rate of diagnosed diabetes. Chart 19: Percentage of Adults with Diagnosed Diabetes Percentage By Income, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. Of those adults who have been diagnosed with diabetes, more residents reported ever having participated in diabetes self-management education than the state as a whole (59.8% Collier vs. 49.6% State). 34

35 Weight, Exercise and Nutrition Weight, exercise and nutrition are all factors that can contribute to the overall health of an individual. In, women are less overweight and obese than the state average (39.1 Collier vs State). The rate among men is closer to the state average but still slightly lower; overall 67.9 percent of men in report that they are overweight or obese compared to a state average of Approximately one-quarter of residents are considered sedentary; this is slightly lower than the state average. In, 48.5 percent of the people earning less than $25,000 per year are considered sedentary; this is significantly higher than the 11.7 percent of people who earn over $50,000 per year. Table 12: Weight, Exercise and Nutrition by Gender, County and State 2013 County State Male Female Male Female Adults who are Overweight * Adults who are Obese Adults Overweight and Obese * Adults who are Sedentary Adults who consume 5 or more servings of fruit or vegetables Adults who meet muscle strengthening recommendations Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. * Indicates that the difference observed between the 2013 county and state measures is statistically significant. 35

36 Seventy-six percent of people in who earn less than $25,000 per year are considered inactive or insufficiently active; the rates improve as incomes rise. Thirty-two percent of people in earning more than $50,000 per year are considered inactive or insufficiently active. Slightly more people in than the state average eat five or more servings or fruit or vegetables per day. Chart 20: Percentage of adults who are inactive or insufficiently active by income 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. * Indicates that the difference observed between the 2013 county and state measures is statistically significant. 36

37 Communicable Diseases currently ranks below the state average rate for all sexually transmitted diseases and many vaccine preventable diseases. has slightly higher rates than the state for Perussis (Whopping Cough) and Tuberculosis. The most prevalent of the reportable communicable dieseases is Chlamydia with an average of 807 cases per year. Note: It is possible that a larger number of individuals are positive for these diseases, but have not been tested. Table 13: Communicable Diseases and State County County State Disease # of Cases 3 yr. Rate 3 yr. Rate Annual Avg. per 100,000 per 100,000 Sexually Transmitted Diseases Infectious Syphilis Gonorrhea Chlamydia Vaccine Preventable Diseases Hepatitis B Measles Mumps Rubella Pertussis Tetanus AIDS and Other Diseases AIDS Meningococcal Meningitis Hepatitis A Tuberculosis Source: Division of Disease Control, Florida Department of Health 37

38 Sexually Transmitted Diseases Chlamydia is the most prevalent sexually transmitted disease in with an average of 807 cases per year between 2012 and That works out to a rate per 100,000 of 241; much lower than the state average of The infection rate for chlamydia across the state of Florida has been on the rise for the last twenty years. The rates in have also seen an increase, but have remained well below the state rate over the past decade. Chart 21: Chlamydia Cases 3-Year Rate per 100, Source: Florida Department of Health, Bureau of STD Prevention & Control 38

39 Vaccine Preventable Diseases The overall rate of infection from vaccine preventable diseases is very low in. For most of these diseases there is an average of less than two case every three years. Pertussis, a highly contagious respiratory disease that is commonly known as whooping cough, is the most prevalent vaccine preventable disease in with an average of 16 cases per year between 2012 and The disease usually starts with cold-like symptoms and maybe a mild cough or fever. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. Whooping cough is most harmful to young babies. The Centers for Disease Control and Prevention (CDC) recommend pertussis vaccinations for children. The CDC further recommend that everyone who is around very young children be immunized as well. At a 3-year rate of 4.9 per 100,000, is seeing its highest rates in twenty years and the rate in is higher than the average for the state as a whole. Fortunately there has not been a death attributed to pertussis in since Chart 22: Pertussis Cases 3-Year Rate per 100, Source: Florida Department of Health, Bureau of Epidemiology 39

40 AIDS and Other Diseases An average of 26 people per year were diagnosed with AIDS in between 2012 and The rate per 100,000 in is 7.6 compared to a rate of 14.1 for the state as a whole. The largest number of those cases come from urban areas. These numbers have been declining over time and are significantly lower than they were in the 1990s, however the decline has slowed a bit in Collier County in recent years. Chart 23: AIDS Cases 3-Year Rate per 100, Source: Florida Department of Health, Bureau of HIV/AIDS 40

41 The rate of tuberculosis, an infectious bacterial disease, in is slightly higher than the state as a whole at 3.7 per 100,000 compared to 3.1 per 100,000. While these numbers are higher than the state average, they are considerably lower than in years past. had a 3-year high of 19.2 per 100,000 in , and has seen a fairly steady decline in the years since although due to the small number of cases a small increase can cause a spike such as in Chart 24: Tuberculosis Cases 3-Year Rate per 100, Source: Florida Department of Health, Bureau of TB and Refugee Health 41

42 Maternal and Child Health On average, 3,197.0 babies were born per year in between 2012 and The health of the babies, the care they received before birth and the age of the mothers are important factors in determining the state of maternal and child health which in turn is a large factor in the overall health of the county. Babies born to young mothers under the age of 19 are more likely to experience poor birth outcomes than those born to adult mothers and are more at risk for developmental complications later in life. The rates in for births to teenage mothers are a little lower than the state, and have been declining in recent years. Infant mortality rates are considered a primary indicator of the health of a community. These rates document the deaths of babies between birth and 364 days of life. The leading causes of infant deaths in Florida are perinatal conditions, congenital anomalies, low birth weight and sleep-related deaths. There has been a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics released its recommendation in 1992 that infants be placed down for sleep in a nonprone position. Infant mortality rates for this time period in are lower than the average for the state of Florida. Table 14: Maternal & Child Health Indicators, & State 3-Year Figures, Births County State Trend Quartile* Total Births (3-yr annual avg.) Births to Mothers ages 15-44, per 1, Births to Mothers ages 10-14, per 1, Positive 2 Births to Mothers ages 15-19, per 1, Positive 1 Percent of Births to Unwed Mothers Steady 2 Infant Deaths Infant Deaths (0-364 days) per 1,000 Births Steady 1 Neonatal Deaths (0-27 days) per 1,000 Births Steady 2 Post neonatal Deaths ( days) per 1,000 Births Steady 3 Low Birth Weight Percent of Births < 1500 Grams Steady 2 Percent of Births < 2500 Grams Steady 1 Prenatal Care Percent of Births with 1st Trimester Prenatal Care Positive 1 Percent of Births with Late or No Prenatal Care Steady 4 Source: Florida Department of Health *County compared to other Florida counties. The lowest Quartile equals the lowest number. That is not always the most desirable rate. For instance, it would be desirable to have a quartile of 4 for percent of births with 1 st trimester care; however it would be desirable to have a quartile of 1 for infant deaths. 42

43 Mothers Who Smoked During Pregnancy Mothers who smoke during pregnancy are putting their unborn child(ren) at a higher risk for low birth weight and Sudden Infant Death Syndrome (SIDS). Fortunately, mothers have low rates of smoking during pregnancy. s rates have been consistently lower than that of the state and that gap has become wider. For 2014, had a rate of 3.0 births per 1,000 to mothers who smoked during pregnancy, as compared to the state average of 6.5 births per 1,000. was ranked 5 th healthiest out of all 67 counties in Florida for this health indicator for This rate has seen a 78 percent decrease over the past twenty years, from a high of 12.8 births per 1,000 to mothers who smoked during pregnancy in 1994 to its lowest rate of 3.0 births per 1,000 in Chart 25: Births to Mothers who Smoked During Pregnancy Single Year Rate per 1,000 Source: Florida Department of Health, Bureau of Vital Statistics 43

44 Teen Births Teen birth rates in have fallen significantly in the last twenty years. In 1994 the rate of teen births was more than three times what it was in 2014 (38.2 vs. 11). The decrease since 2006 has been the most significant; the rate fell from 27.4 to 11 in less than ten years. had rates of teen births consistently higher than the rates for the state of Florida until 2010 and has rates have since been lower than the state rate; although they are now very similar. Chart 26: Births to Mothers ages Single Year Rate per 1,000 Source: Florida Department of Health, Bureau of Vital Statistics Infant Deaths Infant deaths in have declined consistently since the most recent peak in 2009 (7.4 per 1,000 births). There were fifteen infant deaths in 2014 (4.6 per 1,000 births). Please note that a small number of deaths can have a big impact on the rates. Chart 27: Infant Deaths (0-364 days) Single Year Rate per 1,000 births Source: Florida Department of Health, Bureau of Vital Statistics 44

45 Senior Citizen Health Over the past twenty years, the elderly population (those 65 and older) in has seen an increase of 82%. The overall population of has only increased 71% during that same time. The number of residents who are 85 and older has increased 209% during that time. As this unique population continues to grow in, their unique health concerns continue to grow as well. The population in age 65 and over tends to have a higher median income than residents of the same age across the state of Florida as well as throughout the United States. While higher income does not necessarily equate to better health, it does play a role in an individual s health. Table 15: Median Household Income by Age 2014 Collier Florida United States less than 25 $26,517 $26,315 $27, to 44 $52,891 $50,523 $58, to 64 $69,564 $55,546 $65, and over $57,191 $38,425 $39,186 Source: U.S. Census American Community Survey For residents age 65 and over, the leading causes of death most recently have been cancer, heart disease, chronic lower respiratory disease, Cerebrovascular Diseases, Alzheimer s disease and unintentional injuries. Alzheimer s disease in particular has seen a large rise in the total number of deaths over the past ten years by those age 65 and over in. Please note when comparing death counts over time that the population has increased. Table 16: Leading Causes of Death, Residents 65 and over Total Number of Deaths*, Total Cancer ,598 Heart Diseases ,447 CLRD** ,869 Cerebrovascular Diseases ,787 Alzheimer s Disease ,469 Unintentional Injury ,038 Source: Florida Department of Health, Office of Vital Statistics *Please note these are raw counts. Some fluctuations in counts may be due to changes in the population. **Chronic Lower Respiratory Disease 45

46 Alzheimer s Disease has seen a dramatic increase in recent years in the rate of deaths attributed to Alzheimer s disease, the most common form of dementia. The three-year age-adjusted rate for Collier County for (25.1 per 100,000) is nearly four times the lowest rate for the county over the past twenty years (6.2 per 100,000 for ). This rate is also higher than the state average for (25.1 Collier vs State). Chart 28: Deaths from Alzheimer s Disease Age-adjusted rate per 100,000, 3-Year Rates Source: Florida Department of Health, Bureau of Vital Statistics 46

47 As stated previously, women in tend to have a longer than average life-expectancy. The largest risk factor for acquiring Alzheimer s disease is an increase in age, which can explain why more women than men in have had Alzheimer s listed as their cause of death in recent years. Chart 29: Deaths from Alzheimer s Disease, by Sex Age-adjusted rate per 100,000, 3-Year Rates Source: Florida Department of Health, Bureau of Vital Statistics has ten nursing homes (skilled nursing facilites), with a total of 908 beds. This is a rate of beds per 100,000 population, which is much lower than the state average of per 100,000 even though the percent of persons over 65 is higher than the state average. Of those 908 beds, 65 are in secured units that are designated for those who are cognitively impaired (such as residents with dementia and Alzheimer s disease). These are needed units, with an overall occupancy rate of 94.3 percent for January 2015 through December 2015, with several months at 100% occupancy. 47

48 Oral Health Oral health is felt to be central to a person s overall health and well-being. In 2000, Surgeon General David Satcher released the first-ever report on oral health, in which he found that there were significant disparities between racial and socioeconomic groups with regards to oral health, and the the medical complications that can result from minimal oral care and treatment. According to the Behavioral Risk Factor Surveillance System 2010 Data Report (these questions were not asked in 2013), a larger percentage of adults in reported that they had visited a dentist or dental clinic in the past year than the same for the state (73.3% Collier vs. 64.7% State). Women were more likely than men to have reported a visit to a dentist of dental clinic (68.5% men vs. 78.2% women). Persons with higher annual incomes reported significantly higher rates of dental visits percent of persons with annual incomes of $50,000 or more reported visiting a dentist or dental clinic in the past year while only 40.6 percent of those with incomes under $25,000 annually only reported having visited a dentist of dental clinic. Chart 30: Adults Who Visited a Dentist or Dental Clinic in the Past Year Percentage By Income, 2010 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2010]. 48

49 residents reported lower rates of having a permanent tooth removed because of tooth decay or gum disease than adults across the state (48.4% Collier vs. 53.0% State). Income levels, again, played a role in the percentage of these procedures amongst residents. Chart 31: Adults Who Had a Permanent Tooth Removed Because of Tooth Decay or Gum Disease Percentage By Income, 2010 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2010]. 49

50 The same holds true for the percentage of adults who had their teeth cleaned in the past year. Overall 69.2 percent of adult residents had their teeth cleaned compared to 60.9 percent of adults across the state of Florida. Those with higher income levels were significantly more likely to have had a cleaning. Chart 32: Adults Who Had Their Teeth Cleaned in the Past Year Percentage By Income, 2010 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2010]. 50

51 Accessibility for Low-Income Residents According to data from the Florida Department of Health Public Health Dental Program, residents who are living below the poverty level have seen a decrease in their access to dental care over recent years. As of 2012 (the latest year of available data), 22.6 percent of low income persons in had access to dental care. That is below the state average of 24.9 percent. Chart 33: Percentage of Low-Income Persons* with Access to Dental Care Single Year Rate Source: Florida Department of Health, Public Health Dental Program *Low-Income Persons are defined as those living below the poverty level. Figure 3: Source: Florida Department of Health, Public Health Dental Program 51

52 Dental Emergencies Preventable hospitalizations for residents under 65 years of age have steadily risen over the last several years across the state. However residents have shown a decline every year since Chart 34: Preventable Hospitalizations Under 65 from Dental Conditions Single Year Rate per 100, Source: Florida Agency for Health Care Administration (AHCA) 52

53 Social and Mental Health The status of the social and mental health of a community plays a large role in that community s overall health. Rates of criminal activity, substance abuse, and suicides all contribute to the well-being of a community. The rates of people who have ever been told that they have a depressive disorder are a little lower in than the average for the state (13.7 percent Collier vs percent State). Those who earn below $25,000 per year were the most likely residents to have ever been told that they have a depressive disorder. It should be noted that not everyone who has a depressive disorder has ever been diagnosed as such. Chart 35: Adults who have ever been told they had a depressive disorder by income 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. * Indicates that the difference observed between the 2013 county and state measures is statistically significant. 53

54 Similarly, fewer people in than in the State report that they have had fourteen or more days of poor mental health in the past thirty days (7.3 Collier vs State). However, there is a sizable difference in the rates of poor mental health reported amongst those earning less than $25,000 per year compared to those earning $50,000 per year or more (11.4 vs. 4.7). Chart 36: Percentage of adults who had poor mental health on 14 or more of the past 30 days by income 2014 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. * Indicates that the difference observed between the 2013 county and state measures is statistically significant. 54

55 Crime and Domestic Violence In several categories ranks amongst the best quartile for crime in the state of Florida. ranks below the state average for all categories of crime and domestic violence, and ranks in the 1 st Quartile for burglary, aggravated assault and forcible sex offenses. Table 17: Crime and Domestic Violence 3-Year Rate per 100,000, County State Quartile* Larceny 1, , Total Domestic Violence Offenses Burglary Aggravated Assault Motor Vehicle Theft Robbery Forcible Sex Offenses Murder Sources: Florida Department of Law Enforcement *County compared to other Florida Counties. The lowest Quartile equals the lowest number. Larceny, which is a common law crime involving theft, had the highest rates of all of the crime and domestic violence indicators in. These rates, although high, have seen a steady decline from a high in of per 100,000 people and are consistently lower than the state average. Chart 37: Larceny in 3-Year Rate Per 100,000 Population Source: Florida Department of Law Enforcement 55

56 Domestic violence offenses in have been on the decline in recent years, and are currently lower than the state rate. For the three year period from , had a rate of domestic violence offenses per 100,000 population, compared to the state average of Since 1994, s rate of domestic violence offenses has decreased by more than one-third. Chart 38: Total Domestic Violence Offenses Rate per 100,000, 3-Year Rates Source: Florida Department of Law Enforcement The most reported domestic violence offense in is simple assault. Simple assaults account for over seventy-seven percent of all domestic violence offenses in. Please note that these figures are for offenses that were reported to law enforcement. Instances of these offenses often take place but are not reported. Table 18: Reported Domestic Violence Offenses, Murder Manslaughter Forcible Rape Forcible Sodomy Forcible Fondling Aggravated Assault Aggravated Stalking Simple Assault 1,411 1,398 1,265 1,318 1,114 1,258 1,198 Threat/Intimidation Stalking Total 1,784 1,764 1,655 1,613 1,427 1,539 1,536 Source: Florida Department of Law Enforcement 56

57 Alcohol-related Motor Vehicle Crashes Rates of Alcohol-related motor vehicle crashes in have fallen from the late 1990s and early 2000s. They tend to be fairly similar to the state rates. Chart 39: Alcohol Related Motor Vehicle Crashes in Source: Florida Department of Health, Bureau of Vital Statistics, and Florida Department of Highway Safety and Motor Vehicles When compared to the state average, had slightly lower rates for all of the alcoholrelated motor vehicle crash indicators for the three year period from 2012 to ranked in the 1 st Quartile for each indicator. Table 19: Alcohol-related Motor Vehicle Crashes 3-Year Rate per 100,000, County State Quartile* Alcohol-related Motor Vehicle Crashes Alcohol-related Motor Vehicle Crash Injuries Alcohol-related Motor Vehicle Crash Deaths Sources: FDLE Uniform Crime Report, DHSMV Traffic Crash Facts, Florida Office of Vital Statistics *County compared to other Florida Counties. The lowest Quartile equals the lowest number. 57

58 The percent of adults who reported on the Behavioral Risk Factor Surveillance System survey that they engage in heavy or binge drinking in increased been variable from 16.1 percent in 2007 to 19.2 percent in 2010 to 18.1 percent in The latest percentage is higher than the state average of 17.6 percent. The rate of heavy and binge drinking is higher for men than for women in (22.2 men vs women). The highest rate is among people between 18 and 44 (24.1) and lowest among people over the age of 65 (9.8). Persons with lower income levels reported drinking at higher rates than those with higher annual incomes. However, the reverse was true in Singles were more likely to drink heavily than persons who are married. Chart 40: Percentage of Adults who Engage in Heavy or Binge Drinking Percentage By Income, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. 58

59 Florida Youth Substance Abuse Survey The Florida Youth Substance Abuse Survey (FYSAS) is a collaborative effort between the Florida departments of Health, Education, Children and Families, Juvenile Justice, and the Governor's Office of Drug Control. It is based on the "Communities That Care" survey, which measures the prevalence and frequency of drug use, the prevalence and frequency of other antisocial behaviors, and the degree to which risk and protective factors exist that can predict alcohol, tobacco, and other drug use, delinquency, gang involvement and other problem behaviors in adolescents. The FYSAS was administered to 65,917 students in grades 6 through 12 in Spring of Across Florida, 407 middle schools and 343 high schools administered the surveys. In, 1264 students completed the survey (708 middle school, 556 high school). The survey has been administered annually since 2000, making the 2014 FYSAS the fifteenth set of data. Alcohol use in the past 30 days was 20.2 percent for students in 2012, which was similar to the state average of 20.5 percent had the lowest percentage of students reporting that they had used alcohol in the past 30 days in the years surveyed, with a peak of 35.5 percent in 2004 and a decline every year since then. Chart 41: Past-30-Day Alcohol Use and Florida Statewide 2014 Source: Florida Youth Substance Abuse Survey (2014), Florida Department of Children and Families 59

60 Similarly, the percentage of students reporting cigarette use over the past 30 days in in 2014 was similar to the Florida average (4.7% Collier vs. 4.9% State). This is lower for than past years, with a high of 13.7 percent in Males are slightly more likely to report cigarette use than females (4.8% males vs. 4.5% females). Chart 42: Past-30-Day Cigarette Use and Florida Statewide 2014 Source: Florida Youth Substance Abuse Survey (2014), Florida Department of Children and Families Past-30-day marijuana use for students in 2014 was lower than students across the state as a whole (11.0% Collier vs. 12.4% State). The overall percentage of students who have reported marijuana use has remained fairly consistent since 2002, from a low of 10.5 percent in 2010 to a high of 12.2 percent in High school students surveyed were more than four times as likely to have used marijuana as middle school students (16.4% high school students vs. 3.7% middle school students). Chart 43: Past-30-Day Marijuana Use and Florida Statewide 2014 Source: Florida Youth Substance Abuse Survey (2014), Florida Department of Children and Families 60

61 The FYSAS asks youth if they have ever used various drugs. Table 18 below illustrates the percentage of middle and high school students in who have ever tried various drugs and a comparison to the state averages. Most percentages in are similar to the state average. Twenty-nine percent of students in report that they have used at least one illicit drug in their lifetime; that includes fifteen percent of middle school students and thirty-nine percent of high school students. The reported substances most often used by Collier teens are alcohol, marijauana or hashish and cigarettes. Table 20: Percentages of Youth Who Reported Having Used Various Drugs in their Lifetimes 2014 Florida Statewide Middle School High School Total Middle School High School Total Alcohol Blacking Out Cigarettes Marijuana or Hashish Synthetic Marijuana Inhalants Club Drugs LSD, PCP or Mushrooms Methamphetamine Cocaine or Crack Cocaine Heroin Depressants Prescription Pain Relievers Prescription Amphetamines Steroids (without a doctor s order) Over-the-Counter Drugs Any illicit drug Any illicit drug other than marijuana Alcohol only Alcohol or any illicit drug Any illicit drug, but no alcohol Source: Florida Youth Substance Abuse Survey (2012), Florida Department of Children and Families The symbol indicates that data are not available. Additional tables from the Florida Youth Substance Abuse Survey are available in Appendix G. 61

62 Suicides Suicides can be considered as a strong indicator of the overall mental health of a community. The most common underlying causes of suicide are depression, anxiety, damaged relationships and loss of employment. Suicide is a major, preventable public health problem. The suicide rate for is consistently a little lower than the state average but is variable year-to-year. It should be noted that a small change in the number of suicides can have a large impact on the rate. The three-year age adjusted rate for for is 11.2 percent compared to a state-rate of 14.0 percent. The rate represents an average of 39.7 suicides per year for that time period. Chart 44: Age-Adjusted Suicide 3-Year Death Rate 3-Year Age-Adjusted Death Rate Per 100,000 Population Source: Florida Department of Health, Bureau of Vital Statistics. 62

63 Baker Act The Florida Mental Health Act of 1971 (commonly known as the "Baker Act") is a statute allowing for involuntary examination of an individual. It was originally enacted, at least in part, because of widespread instances of elder abuse in which one or more family members would have another family member committed in order to gain control over their estate prior to their death. Once committed, it was difficult for many of the patients to obtain representation, and they became warehoused until their death. The Baker Act allows for involuntary examination (what some call emergency or involuntary commitment). It can be initiated by judges, law enforcement officials, physicians or mental health professionals. There must be evidence that the person has a mental illness (as defined in the Baker Act) and is a harm to self, harm to others, or self-neglectful (as defined in the Baker Act). Examinations may last up to 72 hours and occur in over 100 facilities statewide. There are many possible outcomes following examination of the patient. This includes the release of the individual to the community (or other community placement), a petition for involuntary inpatient placement (what some call civil commitment), involuntary outpatient placement (what some call outpatient commitment or assisted treatment orders), or voluntary treatment (if the person is competent to consent to voluntary treatment and consents to voluntary treatment). The rate of involuntary examinations has been consistently higher in than across the state. The rates have also been rising in recent years. It should be noted though that rates tend to be influenced by whether or not a Baker Act-receiving facility in is the vicinity. Chart 45: Involuntary Examinations* Single Year Rate Per 100,000 Population Source: 2008, 2009, 2010, 2011, 2012, 2013, 2014 Florida Mental Health Act (The Baker Act) Reports / Baker Act Reporting Center at FMHI/USF. *Involuntary examination forms for people who never reach a receiving facility are not received by the Baker Act Reporting Center, so are not included in the data. 63

64 Hospitalizations The Prevention Quality Indicators (PQIs) are a set of measures that can be used with hospital inpatient discharge data to identify quality of care for "ambulatory care-sensitive conditions." These are conditions for which good outpatient or preventative care can potentially eliminate the need for hospitalization or for which early intervention can prevent complications or more severe disease. Even though these indicators are based on hospital inpatient data, they provide insight into the community health care system or services outside the hospital setting. For instance, patients with diabetes may be hospitalized for diabetic complications if their conditions are not adequately monitored or if they do not receive the patient education needed for appropriate self-management. Full definitions for each of the PQIs are available in Appendix F. Congestive heart failure, bacterial pneumonia, urinary infections, and chronic obstructive pulmonary disease (this category includes chronic bronchitis and emphysema) are the most common preventable causes of hospitalizations for residents. Table 21: Prevention Quality Indicators Annual Rate per 100, , PQI Diabetes/short-term Diabetes/long-term Chronic obstructive PD Hypertension Congestive HF Dehydration Bacterial pneumonia Urinary infections Angina w/o procedure Uncontrolled diabetes Adult asthma Diabetes/LE amputations Source: AHCA via Broward Regional Health Planning Council Hospital Inpatient and Emergency Department Analytical System Includes hospitalizations of residents in any hospital in Florida. 64

65 The Chronic Condition Indicator tool is another method to look at the health of a community through hospitalizations. This tool stratifies chronic diseases based on ICD-9-CM diagnosis codes. A chronic condition is a condition lasting 12 months or longer and meeting one or both of the following tests: (a) the condition places limitations on self-care, independent living and social interactions; (b) the condition results in the need for ongoing intervention with medical products, services and special equipment. The identification of chronic conditions is based on all five-digit ICD-9-CM diagnosis codes, excluding external cause of injury codes (E codes). The data from this tool tells a similar story as the PQI data. Hypertension is the number one cause of hospitalization for a chronic condition; the number of hypertension-related hospitalizations was rising but seems to be falling again. Table 22: Hospitalizations for Chronic Conditions Annual Figures, , Residents Disease Diabetes 5,876 6,413 6,838 6,434 6,398 Asthma 1,976 2,021 2,056 1,973 1,816 Congestive Heart Failure 4,031 4,129 3,908 3,912 4,174 Hypertension 12,163 13,346 14,031 13,038 12,626 AIDS Sickle Cell Source: AHCA via Broward Regional Health Planning Council Hospital Inpatient and Emergency Department Analytical System Includes hospitalizations of residents in any hospital in Florida. 65

66 Emergency Room Visits Residents made 93,411 visits to hospitals in 2014 that did not result in an inpatient admission. The largest number of visits was made to Naples Community Hospital. The next largest numbers of visits were made to Physicians Regional Medical Center Collier Blvd., and Physicians Regional Medical Center Pine Ridge and Lehigh Regional Medical Center. Table 23: Emergency Room Visits by Residents by Payer Source 2014 No charge/ Private, incl. HMO Medicaid Medicare Other Charity Naples Community Hospital 3,224 8, , 1,714 4,238 2,668 21,524 Physicians Regional Medical Center - Col 7,236 3, ,178 2,610 16,908 Physicians Regional Medical Center - Pin 3,918 4, ,029 2,351 15,144 Lehigh Regional Medical Center 1, ,162 Healthpark Medical Center 1, ,609 Southwest Florida Regional Medical Center Lee Memorial Hospital Cape Coral Hospital Florida Hospital Celebration Health Tallahassee Memorial Hospital Miami Children's Hospital Baptist Hospital Of Miami Memorial Regional Hospital Shands Hospital At The Univ. Of Florida Dr P Phillips Hospital Cleveland Clinic Hospital Kendall Regional Medical Center University Community Hospital Sarasota Memorial Hospital Hendry Regional Medical Center Memorial Hospital West Total Self- Pay* Source: AHCA via Broward Regional Health Planning Council Hospital Inpatient and Emergency Department Analytical System The AHCA ED data contains records for all ED visits for which the severity of the visit did not result in an inpatient admission. Includes visits by residents to the ED of any hospital in Florida. *Charges billed as self-pay often end up as no charge/charity if the patient is unable to pay the bill. Only hospitals with at least 35 visits are included in the table above. There are an additional 1,501 visits divided amongst 177 hospitals that have not been included in the table, but are included in the total. Grand Total 66

67 Health Resources Access to health care is the key to achieving a healthy community and is a primary goal of health policy in Florida. This section will review health coverage of residents including the rate of uninsured residents, licensed providers and facilities, and federal health professional shortage designations percent of adults in reported on the Behavioral Risk Factor Surveillance System survey that they were unable to see a doctor at least once in the previous year due to cost. This is better than the state average of 20.8 percent, but it is an increase from 14.5 percent in The rates in are similar for men and women. Chart 46: Percentage of Adults who Could Not See a Doctor at Least Once in the Past Year Due to Cost Percentage by Sex, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. 67

68 Annual income and age had the greatest effect in residents ability to see a doctor. Residents with annual incomes $50,000 or more only reported not being able to see a doctor due to cost at a rate of 6.8 percent, while those with annual incomes below $25,000 reported a rate of 45.4 percent. The rate among those earning below $25,000 has increased from 35.6 percent in Chart 47: Percentage of Adults who Could Not See a Doctor at Least Once in the Past Year Due to Cost Percentage by Income, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. * Indicates that the difference observed between the 2013 county and state measures is statistically significant 68

69 Older residents had more difficulty seeing a doctor than their younger counterparts. residents have reported that there has been an increase in the county in concierge doctors who do not accept Medicare, Medicaid or any private insurance. Local residents believe this is negatively impacting their ability to find certain types of providers. More information on this can be found in the Community Input section. Chart 48: Percentage of Adults who Could Not See a Doctor at Least Once in the Past Year Due to Cost Percentage by Age, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. 69

70 71.7 percent of adults in reported that they had a medical checkup in the past year; this is slightly better than the state average of 70.3 percent. Annual income played a role in how likely residents were to have had a medical checkup percent of those with annual incomes below $25,000 reported than they had a medical check-up in the past year compared to 82.2 percent of those with incomes of $50,000 or more. Chart 49: Percentage of Adults who had a Medical Checkup in the Past Year Percentage by Income, 2013 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013]. 70

71 Medicaid Medicaid provides medical coverage to low-income individuals and families. The state and federal government share the costs of the Medicaid program. Medicaid services in Florida are administered by the Agency for Health Care Administration (AHCA). About half of the recipients are children or adolescents under the age of 21. While children are the largest category of beneficiaries, most of the costs arise from providing services to seniors, especially nursing home care, as well as to people with disabilities who have significant medical costs. There are four categories of Medicaid eligibility for adults in Florida, which include low-income families, pregnant women, emergency medical assistance for non-citizens, and Medicaid for the elderly and disabled. Eligibility for each of those programs is based on specific income criteria. Medicaid enrollment rates in are lower than the State rates. Rates in and across the State have been climbing in recent years even though the eligibility rules have not changed. Chart 50: Median Monthly Medicaid Enrollment Single-Year Rate Per 100,000 Population Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis 71

72 Florida KidCare Florida KidCare is the state-funded children s health insurance program for those who are uninsured from birth to age 19 and meet income and eligibility requirements. Three state agencies and the Florida Healthy Kids Corporation work together to form KidCare. The four components of Florida KidCare are: Medicaid for Children from birth to 19 (see previous section on Medicaid) Florida Healthy Kids for children ages 5 to 18 who are ineligible for Medicaid or Children s Medical Services Network (families pay a monthly premium, based on their income) MediKids for children ages 1 to 4 (families pay a monthly premium, based on their income) Children s Medical Services (CMS) Network for children with special health care needs up to 200% of the Federal Poverty Level Table 24: Monthly Children s Health Insurance Enrollment Florida Healthy Kids MediKids CMS Total Active Children August, , ,542 September, , ,484 October, , ,103 November, , ,056 December, , ,011 January, , ,954 February, , ,968 March, , ,071 April, , ,216 May, , ,311 June, , ,427 July , ,485 Source: Florida Healthy Kids Corporation Chart 51: Total Monthly Children s Health Insurance Enrollment Source: Florida Healthy Kids Corporation 72

73 Uninsured Lack of health insurance coverage is a significant barrier to accessing needed health care. Those who are uninsured are less likely to receive preventive care, and more likely to delay needed medical treatments which, often leads to costly visits to the local Emergency Department. The Small Area Health Insurance Estimates from the U.S. Census Bureau provide annual estimates of the population without health insurance coverage for all U.S. states and their counties. The most recent year for which reliable county-level estimates are available is The rate of uninsured adults represents the estimated percent of the adult population under age 65 that has no health insurance coverage. People over the age of 65 are generally eligible for Medicare from the federal government. As of 2014, was estimated as having approximately 30 percent of adults without health insurance. This is higher than the State average. The rate of uninsured adults in has been decreasing since Chart 52: Uninsured Adults (Age 18 64) Source: The Census Bureau s Small Area Health Insurance Estimates (SAHIE) 73

74 People in with incomes below 138% of the Federal Poverty Level (FPL) are the most likely to be uninsured at 55.9 percent compared to 30.9 percent of those at all incomes. Chart 53: Uninsured Adults (Age 18 64) Percentage by Income (based on Federal Poverty Level), 2014 Source: The Census Bureau s Small Area Health Insurance Estimates (SAHIE) 74

75 The data on the rates of youth under 18 who are uninsured have been variable in recent years; on average however the rates are declining. That decline is consistent with what is being seen across the state. Chart 54: Uninsured Youth (Under 18 Years) Source: The Census Bureau s Small Area Health Insurance Estimates (SAHIE) Children who are below 400% of the poverty level are more likely to be uninsured than those of all incomes, however the variation is not as large as seen in the adult population. Chart 55: Uninsured Youth (Under 19 Years) Percentage by Income (based on Federal Poverty Level) 2014 Source: The Census Bureau s Small Area Health Insurance Estimates (SAHIE) 75

76 Physicians and Facilities As of 2014, there were 884 licensed physicians in. That works out to doctors for every 100,000 residents. That is a very similar to the state average of doctors for every 100,000 residents. The county has a lower rate per 100,000 than the state for licensed pediatricians (14.1 Collier vs State). There are a significantly lower number of skilled nursing home beds per 100,000 residents in than across the state (266.9 Collier vs State) despite the fact that residents are older on average than residents across the state. The number of Health Department employees per every 100,000 residents is lower than the state average. The Health Department spent $11,744,029 dollars in 2014; that places the rate of expenditure per 100,000 residents at a little lower than the state average. Providers* Table 25: Health Resources Availability & State 2014 County Number Rate per 100,000 Quartile** State Rate per 100,000 Total Licensed Dentists Total Licensed Physicians Total Licensed Family Private Practice Physicians Total Licensed Internists Total Licensed OB/GYN Total Licensed Pediatricians Facilities Total Hospital Beds Total Acute Care Beds Total Specialty Beds Total Skilled Nursing Home Beds County Health Department County Health Department Full-Time Employees County Health Department Expenditures $11,744, $ $37.21 Source: Division of Medical Quality Assurance and Office of Planning, Evaluation and Data Analysis, Florida Department of Health; Florida Agency for Health Care Administration *Data for Providers are for a fiscal year, not a calendar year Number of licensed providers does not necessarily equal the number of practicing providers. These numbers may include providers who work in another county, only work part time, or are retired. **County compared to other Florida counties. The lowest Quartiles equal the lowest number. For resource availability the lowest number is generally considered the worst ranking. 76

77 Healthcare Network Patient Origin by Zip Code The largest percentage of patients of the Healthcare Network of Southwest Florida live in the zip code (Immokalee); percent of patients list as their place of residence. ZIP Code None/ Uninsured Table 26: Healthcare Network of Southwest Florida Patient origin by zip code 2015 Medicaid/ CHIP/Other Public Medicare Private 77 Total Patients Percent of Patients HCN Services at this Location % Children, Women, Family, Dental % Children % % Dental % Children % Women, Family, Dental % % % % Children, Women % % % Children % % Children, Family % Children % % % % % % % % % % % % % %

78 ZIP Code None/ Uninsured Medicaid/ CHIP/Other Public Medicare Private Total Patients Percent of Patients % % % % % % % % % % % % % % % % % % % % % % % % % Other ZIP Codes Unknown Residence % 0.00% Total % Source: Healthcare Network of Southwest Florida HCN Services at this Location 78

79 This map shows the location of the zip codes within. Figure 4. 79

80 Federal Health Professional Shortage Designations There are two types of health professional shortage designations: Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas or Populations (MUAs/MUPs). Both designations consider primary care physician-to-population ratios, other high-need indicators (poverty levels, percent of the population that is elderly, infant death rate and rate of low birth weight), and barriers to access care. Designations are required for placement of health professionals under the National Health Service Corps and waiver programs for foreign physicians. Designations are also necessary for the location of community and migrant health centers and rural health clinics, programs that provide health care to underserved populations. Medically Underserved Areas or Populations (MUAs/MUPs) are a measure of medical under service as defined by the U.S. Department of Health and Human Services. These designations determine the Index of Medical Under service (IMU) using the following variables: (1) percent of the population below 100 percent of the Federal Poverty Level, (2) percent of the population over age 65, (3) infant mortality rate (5 year average) and (4) population-to-physician ratio. The low income/migrant farmworker population in has been designated as Medically Underserved Population. Any population with a score of 62 or lower on the Index of Medical Underservice is considered medically underserved. The areas with the lowest numbers are those that are determined to have the most need. The low income/migrant farmworker population in Collier County scored a Health Professional Shortage Areas (HPSAs) are defined in Section 332 of the Public Health Service Act, 42 U.S.C. 254e to include: (1) urban and rural geographic areas, (2) population groups, and (3) facilities with shortages of health professionals. Federal designation as a HPSA documents a shortage of health care providers (primary care, dental or mental health) as well as the existence of barriers to accessing care including lack of public transportation, travel time and distance to the next source of undesignated care and high poverty. A geographic area will be designated as having a shortage of primary medical care professionals if the following three criteria are met: 1. The area is a rational area for the delivery of primary medical care services. 2. One of the following conditions prevails within the area: (a) The area has a population to full-time-equivalent primary care physician ratio of at least 3,500:1. (b) The area has a population to full-time-equivalent primary care physician ratio of less than 3,500:1 but greater than 3,000:1 and has unusually high needs for primary care services or insufficient capacity of existing primary care providers. 3. Primary medical care professionals in contiguous areas are over utilized, excessively distant, or inaccessible to the population of the area under consideration. 80

81 What a Designation Means A geographic designation for the whole county means there is a shortage of providers (primary care physicians, dentists, mental health professionals) for everyone living in the county, regardless of ability to pay for services through insurance or other means. A geographic area within the county means there is a shortage of health care providers for everyone living in that area of the county. A special population designation for the whole county (or parts of counties) means there is a shortage of providers to meet the needs of low income, migrant or other special populations because the existing providers do not serve these patients. The Immokalee/Everglades service area has been designated as a Health Professional Shortage Area (HPSA) for primary care. The HPSA designation scores counties between one and twenty-six, with the higher scores indicating higher levels of need. The Immokalee/Everglades service area scored a thirteen for primary care. also scored a seventeen for dental care for the low income and migrant farmworker population meaning it is designated as a shortage area. 81

82 Community Input Survey on Health and Healthcare in The Health Planning Council of Southwest Florida, with feedback from the HCN Community Health Assessment Group, developed a survey questionnaire to assess residents perceptions of healthcare and health issues for the county. The survey was conducted online and on paper, in both English and Spanish. Surveys were distributed by members of the HCN Community Health Assessment Group to those who live and/or work in. Links to the online version of the survey were distributed through flyers and blasts. The English version of the survey is included in Appendix C. Sixty-nine surveys were completed on paper and online over a two month period in the summer of Of the 61 respondents, 95 percent of were permanent residents and 5 percent were temporary residents. Fifty-eight percent reported living in a Naples zip code; 36 percent reported living in an Immokalee zip code; and one percent living on Marco Island. The survey garnered responses from a higher proportion of respondents ages 35 to 65 (58% of survey respondents). There were also more females who responded to the survey than males in Collier County (68% of survey respondents were female vs. 32% of males in ). Race was evenly distributed, with 92 percent of survey respondents being white (90% in the overall population in Collier County), 6 percent of respondents were black (7% in the overall population) and 3 percent were other (3% in the overall population). The surveys were completed by a higher proportion of Hispanic residents than in the overall population (57% of the survey respondents identified as Hispanic vs. 27% in the overall population in ). The same survey was administered in The 2013 responses are given to show a comparison with Please note that the samples are not scientific and changes should be considered anecdotal. Of those who responded to the survey, the majority (50.8%) reported having private health insurance, and 19.7 percent reported being uninsured. (Respondents were allowed to select multiple answers for the majority of the questions asked.) What type of insurance do you have?* 2013 Number of responses Number of responses private insurance (through employer) % % private insurance (self-pay) % 4 6.6% Medicare % 5 8.2% Medicaid % 6 9.8% Veteran 0 0.0% 0 0 other** 6 2.7% 3 4.9% none % % *totals to more than 100% as some respondents selected multiple options **share of cost, Molina, Florida Blue, United Healthcare 2016

83 The findings of the surveys were compiled by the Health Planning Council, and are as follows: (Please note that OTHER was listed as an option on most survey questions. Respondents filled in individual responses to specify what they meant by OTHER. The views expressed in these responses are those of the comment writers alone. They do not represent the views or opinions of the Health Planning Council of Southwest Florida, nor do they represent the views or opinions of the Healthcare Network of Southwest Florida.) When asked, How would you rate the general health of residents? 24 percent of survey respondents said Excellent, 53 percent said Good, 19 percent said Fair, and 4 percent said Poor. When asked, How would you rate the quality of healthcare in? 32 percent said Excellent, 51 percent said Good, 15 percent said Fair, and 2 percent said Poor. When asked where residents go to get health information, similar to responses in 2013, the majority of respondents noted that they go to their family doctor (46 responses). In 2013 friends and family was the second highest ranked of where residents receive their healthcare where as in 2016 the internet was second highest (39 responses). When asked where they go to receive healthcare services, the majority said they visit their family doctor (42 responses) or an area clinic (32 responses). Where do you think the residents of go to get health information? Where do you go to get healthcare? family doctor family doctor or health provider clinic friends or relatives health department 36 6 Internet hospital/emergency room television other* 17 1 newspaper 47 6 don't know 5 0 social media - 19 dental care - 15 magazines 41 3 *urgent care radio 39 8 books 35 5 other* 10 2 *insurance carrier, community events, seminars, wellness programs, emergency room, referrals (Please note that OTHER was listed as an option on most survey questions. Respondents filled in individual responses to specify what they meant by OTHER. The views expressed in these responses are those of the comment writers alone. They do not represent the views or opinions of the Health Planning Council of Southwest Florida, nor do they represent the views or opinions of the Healthcare Network of Southwest Florida.) 83

84 Respondents were asked their opinions on healthcare difficulties for specific populations in Collier County. Of the population groups listed, those who are uninsured and have low income levels were selected most often (38 responses). The next most frequently chosen options were migrants (26 responses) and non-english speaking residents (26 responses). With regards to specific areas of the county where residents are thought to have a particularly difficult time accessing healthcare services, 34 respondents said there are none. 24 respondents named multiple locations in the area as having difficulty accessing health services. The areas with the most responses listed were Immokalee (11 responses), Golden Gate (11 responses), and East Naples (6 responses). What types of residents of have more difficulty with healthcare than others? Are there areas/neighborhoods where residents have a particularly difficult time accessing health services? adults elderly/senior citizens 54 5 persons with disabilities 30 8 children 27 9 teens/adolescents 25 3 persons in dependency (foster care/no-relative care) 24 other* 9 1 veterans 8 0 none 7 3 *mentally ill uninsured/low-income no 34 migrants yes* 24 non-english speaking *Immokalee, Golden Gate, East Naples, lowincome areas, Everglades City, Marco Island, village area, Ave Maria, south county (Please note that OTHER was listed as an option on most survey questions. Respondents filled in individual responses to specify what they meant by OTHER. The views expressed in these responses are those of the comment writers alone. They do not represent the views or opinions of the Health Planning Council of Southwest Florida, nor do they represent the views or opinions of the Healthcare Network of Southwest Florida.) 84

85 The surveys also asked about difficulties in receiving specific types of health services. Nineteen respondents said, no, there are no services that individuals in have difficulty accessing. Of those who felt there were services that were difficult to access, mental and behavioral health for adults was number one, with 34 responses. Next highest on the list mental/behavioral health for children, with 32 responses and dental care for adults (24 responses). (Please note that OTHER was listed as an option on most survey questions. Respondents filled in individual responses to specify what they meant by OTHER. The views expressed in these responses are those of the comment writers alone. They do not represent the views or opinions of the Health Planning Council of Southwest Florida, nor do they represent the views or opinions of the Healthcare Network of Southwest Florida.) 85

86 Possible options for improving the health of area residents were given. Financial assistance for health care was chosen most often by survey respondents in both 2013 and 2016 (126 responses and 30 responses). The next highest options were substance abuse treatments, more doctors, counseling and support, and additional health services each with 19 responses. *other: medical equipment to detect cancer, eating disorder treatment (Please note that OTHER was listed as an option on most survey questions. Respondents filled in individual responses to specify what they meant by OTHER. The views expressed in these responses are those of the comment writers alone. They do not represent the views or opinions of the Health Planning Council of Southwest Florida, nor do they represent the views or opinions of the Healthcare Network of Southwest Florida.) 86

87 Respondents were asked to select what they felt to be the three most important health concerns for residents of. Access to primary care topped the list, with 23 responses. Second highest on the list was mental health problems, with 22 responses, followed by access to specialty care (19 responses) and obesity with 16 responses. *other: access and timeliness of access to specialty services, neurological testing, psychiatric services, psychological testing for Medicaid and individuals who lack healthcare, engaging the community in healthy living behaviors, Zika, low income health access including dental care, Autism Spectrum Disorders, Eating Disorders, Affordable Housing, Outside therapy, substance use disorders, and access to mental health providers (Please note that OTHER was listed as an option on most survey questions. Respondents filled in individual responses to specify what they meant by OTHER. The views expressed in these responses are those of the comment writers alone. They do not represent the views or opinions of the Health Planning Council of Southwest Florida, nor do they represent the views or opinions of the Healthcare Network of Southwest Florida.) 87

88 Respondents were then asked to select the three most important risky behaviors in. Substance abuse was listed most frequently, with 29 responses. Other risky behaviors identified included being overweight (28 responses), distracted driving (27 responses), discrimination (17 responses), and smoking/tobacco use and lack of health literacy, each with 16 responses. *other: UV protection (Please note that OTHER was listed as an option on most survey questions. Respondents filled in individual responses to specify what they meant by OTHER. The views expressed in these responses are those of the comment writers alone. They do not represent the views or opinions of the Health Planning Council of Southwest Florida, nor do they represent the views or opinions of the Healthcare Network of Southwest Florida.) 88