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2 Table of Contents INTRODUCTION... 2 METHODOLOGY... 4 Appendix 1 Comparison of... 6 Appendix 2 Key Findings from the MAPP Assessments... 7 BARRIERS TO HEALTHCARE ACCESS... 7 HEALTH STATUS... 9 DEATH INDICATORS COMMUNICABLE DISEASES MATERNAL AND CHILD HEALTH Appendix 3 Data for Additional Priority Areas Identified HEALTH STATUS Florida Department of Health Broward County, June, 2013 Page 1

3 INTRODUCTION The Mission of the Florida Department of Health in Broward County (FDOHBC) is to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts. Given this mission, in 2012, the Florida Department of Health in Broward County (FDOHBC) engaged the community in the Mobilizing for Action through Planning and Partnerships (MAPP). MAPP is a strategic approach to community health improvement and assists communities improve health and quality of life through community-wide strategic planning. MAPP includes four separate assessments: Community Health Status Assessment, Community Themes and Strengths Assessment, Local Public Health System Assessment, and the Forces of Change Assessment. Broward County has a long history of collaboratively planning across multiple state, county, and local entities from the public and private sectors to ensure the highest quality of care that also reduce redundancies and duplication within the system of care. The FDOHBC utilized this existing community-based planning structure to assist in the development of the Community Health Assessment. The following agencies participated in this process: Florida Department of Health Broward County, June, 2013 Page 2

4 Agency Name Coodinating Council of Broward (CCB) Health Care Access Committee Quality of Life Committee Steering Committee (CCB) 211 Broward AT&T Aging and Disability Resource Center of Broward County Agency for Health Care Administration Audacious Inquiry Broward Behavioral Health Coalition Broward College Broward County Government Broward County Medical Association Broward County Public Schools Broward County Sheriff s Office Broward Health Broward Healthy Start Coalition Broward Regional Health Planning Council, Inc. Children s Services Council of Broward Community Action Center Community Health Action Information Network Cooperative Feeding Program Coordinating Council of Broward CCB Million Meals Committee Family Central Florida Department of Children and Families Florida Department of Health in Broward County Florida Introduces Physical Activity and Nutrition to Youth Health Choice Network Henderson Behavioral Health Hispanic Unity of Florida Holy Cross Hospital Legal Aid Service of Broward County Light of the World Clinic Memorial Healthcare System Minority Development and Empowerment, Inc. Nova Southeastern University South Florida Regional Planning Council United Way of Broward County Urban Health Solutions Urban League of Broward County US Social Security Administration Volunteer Broward WorkForce One YMCA of Broward Florida Department of Health Broward County, June, 2013 Page 3

5 METHODOLOGY The Local Public Health System Assessment was conducted in the fall of 2011 using The National Public Health Performance Standards Program (NPHPSP). These assessments are intended to help users answer questions such as "What are the activities and capacities of our public health system?" and "How well are we providing the Essential Public Health Services in our jurisdiction?" The dialogue that occurs in answering these questions can help to identify strengths and weaknesses and determine opportunities for improvement. Based on the results of the assessment conducted for Broward County, it was determined that an in-depth population-based community health assessment should be conducted. Populations with barriers to care as well as linkages to care should be identified. In addition, the development of a community health improvement process was needed to assure the evaluation of the effectiveness and efficiency of the services provided occurs. The complete Assessment Report may be found in Attachment 1. The Forces of Change Assessment consisted of key informant interviews conducted with senior executive and administrative staff from 17 distinct organizations. Major findings include the need for continued and expanded collaboration among partners and simplifying the navigational system and linkages to care. The majority of the respondents agreed something needed to happen to address the rising cost and inaccessibility of healthcare. The complete Assessment Report may be found in Attachment 2. The Community Themes and Strengths Assessment utilized the 2011 Quality of Life Assessment developed by Professional Research Consultants, Inc. The 2011 Broward County Quality of Life Assessment represents the eighth such research effort conducted in Broward County since the baseline assessment in A random sample of 1,000 Broward County residents participated in the 2011 assessment of quality of life including a health assessment. The complete Assessment Report may be found in Attachment 3. The Community Health Status Assessment was prepared in The assessment presented data on Population and Socio-Economic Characteristics, Quality of Life, Health Care Resources, Health Status, Risk Youth Behavior Survey findings, Death Indicators, Communicable Diseases, Maternal and Child Health, Vaccine-Preventable Disease and Environmental Health. The complete Assessment Report may be found in Attachment 4. An analysis of the assessments identified nineteen health related challenges in Broward County. These challenges were then categorized into five broad categories each containing two or more of the nineteen identified health challenges. A peer comparison group was selected based on the closeness of the match between these counties and socio-demographic indicators for Broward County. Broward County s peer group was composed of Duval, Miami-Dade, Orange and Palm Beach counties (Appendix 1). Florida Department of Health Broward County, June, 2013 Page 4

6 Data for each of the nineteen identified health challenges were then compared to a peer group average and a state average value. In addition, the Healthy People 2020 Goal and Indicator were included for each identified challenge (Appendix 2). At the May 20, 2013 joint meeting of the Coordinating Council of Broward s Steering and Quality of Life Committees, the nineteen challenges were reviewed. The following six priority areas were identified (in no particular order): 1. Barriers to Health Care Access to include Lack of Health Insurance 2. Cervical Cancer 3. HIV/AIDS 4. Sexually Transmitted Diseases (including Infectious and Congenital Syphilis) 5. Black Infant Mortality 6. Immunization for Kindergarten and 7 th Grade Students In addition, while not identified within the nineteen challenges, the Committee also felt that the following issues were of concern, and therefore, priorities for Broward County (in no particular order): 1. Obesity 2. Food Security/Hunger/Nutrition Data for the 2 additional challenges is located in Appendix 3. The eight priority areas were presented to the Coordinating Council of Broward Board of Director s on Thursday, June 6, 2013 for a final vetting and approval of the priority areas. Florida Department of Health Broward County, June, 2013 Page 5

7 Appendix 1 Comparison of Broward County and the State of Florida to the Community Themes and Strengths survey population Population and Sample Characteristics Men Women TOTAL PRC Survey 48.1% 51.9% Broward 852, % 902, % 1,753,678 Duval 419, % 445, % 864,726 Miami Dade 1,225, % 1,295, % 2,521,194 Orange 571, % 588, % 1,160,468 Palm Beach 642, % 684, % 1,327,313 State 9,261, % 9,673, % 18,934, PRC Survey 20.3% Broward 316, % 687, % 489, % 260, % Duval 168, % 366, % 228, % 101, % Miami Dade 449, % 1,051, % 651, % 369, % Orange 224, % 535, % 282, % 118, % Palm Beach 219, % 462, % 353, % 292, % State 5,374, % 7,145, % 5,139, % 3,375, % White Black Hispanic <200% FPL PRC Survey 54.0% 20.9% 19.6% 27.9% Broward 1,169, % 480, % 452, % 31.0% Duval 543, % 257, % 68, % 32.2% Miami Dade 1,953, % 487, % 1,626, % 40.7% Orange 812, % 251, % 318, % 34.6% Palm Beach 1,026, % 236, % 259, % 30.1% State 14,866, % 4,067, % 4,312, % 33.7% Source: Florida CHARTS, 2011 Florida Department of Health Broward County, June, 2013 Page 6

8 Appendix 2 Key Findings from the MAPP Assessments (19 challenges across five broad categories) with supporting data BARRIERS TO HEALTHCARE ACCESS The Local Public Health System Assessment indicates the following: An in-depth population-based community health assessment should be conducted. Populations with barriers to care as well as linkages to care should be identified. A community health improvement process is needed to assure the evaluation of the effectiveness and efficiency of the services provided occurs. The Forces of Change Assessment indicates the following: Access to health care may be limited by poverty, poor health literacy and lack of health insurance. There is an increased need to simplify the navigational system of obtaining healthcare and provide linkages to services. Public health efforts to develop culturally competent and age appropriate materials for the minority, disabled and elder community is needed to increase health literacy and promote access to care. Lack of Health Insurance In the 2010 BRFSS, 80.3% of the population of adults in Broward County reported that they had any type of health insurance which was lower than the state rate of 83%. LACK of Healthcare Insurance Coverage, 2011 Healthy People 2020 Goal: Increase the proportion of people with medical insurance Average Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Florida U.S. 0.0% (100% coverage) Source: Behavioral Risk Factor Surveillance System (BRFSS), 2010 Florida Department of Health Broward County, June, 2013 Page 7

9 Health Care Resources The rate of licensed physicians per 100,000 population in Broward is lower than the state. Broward County (Duval; Orange and Palm Beach peer counties) has/have been federally designated as a health professional shortage area Licensed Health Care Providers, 2011 HRSA Goal = target and in high need areas (3,500:1 or 3,000:1) HRSA Goal Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S Source: US Department of Health and Human Services Goal information Florida Department of Health Broward County, June, 2013 Page 8

10 HEALTH STATUS SUBSTANCE ABUSE The Community Themes and Strengths Assessment presented these findings: Less than 1% of survey respondents reported that members of their household were unable to obtain substance abuse services when needed in the past year (2011) The percentage of adults in 2010 who reported engaging in heavy or binge drinking in Broward was 16.1% as compared to 15% for Florida. The percentage of Hispanic adults in 2010 who reported engaging in heavy or binge drinking in Broward was higher than the overall rate (25.1) and higher than the Hispanic rate for Florida (15.3%) Adults Reporting Heavy or Binge Drinking, 2010 Healthy People 2020 Goal: Reduce the proportion of adults age 18 years and older engaging in binge drinking of alcoholic beverages during the past 30 days Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S. 24.4% Hispanic Source: Behavioral Risk Factor Surveillance System (BRFSS), 2010 Florida Department of Health Broward County, June, 2013 Page 9

11 DEATH INDICATORS CANCER Colorectal Cancer Screenings The US Preventive Services Task Force recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults beginning at age 50 years and continuing until age 75 years. Other organizations (e.g. American Cancer Society, American Academy of Family Physicians, American College of Physicians, Nation Cancer Institute) may have slightly different screening guidelines. The Community Themes and Strengths Assessment presented these findings: Among adults age 50 and older, 71.0% have had a sigmoidoscopy or colonscopy at some point in their lives Although the Broward County age adjusted death rate due to colorectal cancer has decreased by 31.5% since 1990, Broward County does not meet the goal set by Healthy People 2020 of 14.5 deaths per 100,000 from colon cancer. Colorectal Cancer Age Adjusted Death Rates, 2012 Healthy People 2020 = Reduce Colorectal Cancer Death Rate 2010 Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S Prostate Cancer The Broward County rolling 3-year Black and other age adjusted death rate due to prostate cancer was 2.3 times the White rate. Prostate Cancer Age-Adjusted Death Rates, 3-Year Rolling Rates, Healthy People 2020 = Reduce the Prostate Cancer Death Rate 2010 Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S Black White Florida Department of Health Broward County, June, 2013 Page 10

12 Breast Cancer Mammograms The Community Themes and Strengths Assessment presented these findings Among women aged 40 and older, 79.3% have had a mammogram within the past two years o Similar to statewide and national findings o Satisfies the Healthy People 2020 target among women (81.1% or higher) o Statistically unchanged since 1994 Broward County does not meet the Healthy People 2020 objective of less than 20.6 per 100,000 deaths due to breast cancer. Breast Cancer Age-Adjusted Death Rates, 3-Year Rolling Rates, Healthy People 2020 Goal = Reduce the Female Breast Cancer death rate 2010 Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S Cervical Cancer Cervical Cancer Screenings The Community Themes and Strengths Assessment presented these findings Among women 18+, 82.9% self-reported that they have had a Pap smear in the past three years (Fails to satisfy Healthy People 2020 target for women age (93% or higher)) Women aged 18+ Who Have Had a Pap Smear in the Past 3 Years, 2011 Healthy People 2020 Goal: Increase the Proportion of Women Who receive cervical cancer screening based on the most recent guidelines Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S. 93% Florida Department of Health Broward County, June, 2013 Page 11

13 STROKE Broward County did not meet the Healthy People 2020 goal of age adjusted death rate due to stroke of less than 33.8 per 100,000 population in 2011 (34.6) The 2012 rate of 32.6 for Broward County is below the goal range as is the peer average rate (31.9) and the Florida rate (31.2). Stroke Age Adjusted Death Rate, 2012 Healthy People 2020 Goal: Reduce Stroke Deaths Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S. Florida Department of Health Broward County, June, 2013 Page 12

14 COMMUNICABLE DISEASES HEPATITIS B In 2011, Broward County had 14.7% of the State s reported chronic Hepatitis B cases as compared to 9.2% of the population. Hepatitis B, Rate per 100,000 for New Infections 2011 Healthy People 2020 Goal: Reduce New Hepatitis B Infections Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S Number of Cases ,350 HEPATITIS C In 2011, Broward County had the 21st highest rate of reported chronic Hepatitis C cases of the 67 Florida counties. Hepatitis C New Infections and Rates per 100,000, 2010 Healthy People 2020 Goal: Reduce New Hepatitis C Infections Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S Number of Cases SOURCE FOR BOTH TABLES: Florida Department of Health Broward County, June, 2013 Page 13

15 HIV/AIDS The Community Themes and Strengths Assessment presented these findings: A total of 1.1% of survey respondents indicates that they or a member of their household has HIV/AIDS Broward County has approximately 9% of the State s population and 17% of persons living with HIV and/or AIDS. New HIV Infections and Rates per 100,000, 2011 Healthy People 2020 Goal: Reduce the rate of HIV Transmission among Adolescents and Adults Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S. Healthy People , ,100 47, new infections SEUALLY TRANSMITTED DISEASES (STDS) The rate of Gonorrhea, Chlamydia and infectious Syphilis since 2002 has increased by 44.9% in Broward County and in the state by 33.7% per 100,000 population CHLAMYDIA In 2011 Broward County Chlamydia rates, 404.1, were slightly higher than that of Florida 401.3, but lower than the peer average. Chlamydia Rate per 100,000, 2011 Healthy People 2020 Goal: Reduce the Chlamydia trachomatis infection rate 2011 Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S. In development Florida Department of Health Broward County, June, 2013 Page 14

16 GONORRHEA The 2011 Broward County Gonorrhea rate at per 100,000 population is greater than the state rate at The 2011 Broward County Gonorrhea rate for males at per 100,000 population is greater than the peer average rate (132.5) and state rate (105.3) Gonorrhea Rate per 100,000, 2011 Healthy People 2020 Goal: Reduce the Gonorrhea infection rate 2011 Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S Females: Males: SYPHILIS INFECTIOUS SYPHILIS Broward County is second highest rate in the State for Syphilis per 100,000 at Broward County does not meet the Healthy People Goal of 1.3 new cases for Females (2.3) nor 6.7 new cases for Males (25.1) Broward County s Infectious Syphilis Rates per 100,000 are higher than the peer average, the state and the US. Infectious Syphilis Rate per 100,000, 2011 Healthy People 2020 Goal: Reduce sustained domestic transmission of primary and secondary syphilis 2011 Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S Famales:1.3 new cases Males: 6.7 new cases Florida Department of Health Broward County, June, 2013 Page 15

17 CONGENITAL SYPHILIS In 2011 Broward County had 10 of the state s 32 cases of Congenital Syphilis cases. In 2011 Broward County s Congenital Syphilis case rate per 1,00 live births (47.4) is higher than the peer average (16.3), state (15.0) and US (8.5) Congenital Syphilis Rate per 1,000 Live Births, 2011 Healthy People 2020 Goal: Reduce Congenital Syphilis Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S. 9.6 cases per 1,000 live births Florida Department of Health Broward County, June, 2013 Page 16

18 MATERNAL AND CHILD HEALTH TEENAGE SEUAL ACTIVITY In 2011, 8.3% of teenagers in Broward County had had sex before the age of the 13 years, compared to the state and U.S. at 7.6 % and 6.2% respectively. Teenagers Engaging in Sexual Activity Before Age 13 Years, 2011 Healthy People 2020 Goal: Increase the proportion of adolescents aged 15 years and under who have never had sexual intercourse Average Florida U.S. Broward Duval Miami-Dade Orange Palm Beach Healthy People Females: Males: INFANT MORTALITY Broward County Black infant mortality rate was more than two and a half times the White rate in Infant Deaths per 1,000 Live Births, 2011 Healthy People 2020 Goal: Reduce the Rate of Infant Deaths 2011 Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S Black White Florida Department of Health Broward County, June, 2013 Page 17

19 IMMUNIZATIONS In 2011 Broward County did not meet the state goal for immunization of 95% for Kindergarten and seventh grade students. Children in Kindergarten Immunization Rate per 100,000 Population, 2011 Healthy People 2020 Goal: Maintain Vaccination Coverage Levels for Children in Kindergarten State Immunization Goal = 95% Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S. 95% Florida Department of Health Broward County, June, 2013 Page 18

20 Appendix 3 Data for Additional Priority Areas Identified HEALTH STATUS OBESITY AND OVERWEIGHT The Community Themes and Strengths Assessment presented these findings: More than 6 in 10 Broward County adults (61.8%) are overweight. Further, 22.3% of Broward County adults are obese. According to the 2010 BRFSS, 37% of the population of Broward County reported being overweight and 28% reported being obese. The percentage of obese adults has increased nearly 8% from 20.4% in 2007 to 28% in 2010 (BRFSS) The percentage of obese Black adults in Broward County is higher than the peer average and Florida and does not meet the Healthy People 2020 goal. (2010 BRFSS) Percentage of Adults Who Are Obese, 2010 Healthy People 2020 Goal = Reduce the proportion of Adults Who Are Obese Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S. 30.5% White Black Hispanic Source: Behavioral Risk Factor Surveillance System (BRFSS), 2010 Percentage of Adults Who Are Overweight, 2010 Healthy People 2020 Goal Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S White Black Hispanic Source: Behavioral Risk Factor Surveillance System (BRFSS), 2010 Florida Department of Health Broward County, June, 2013 Page 19

21 NUTRITION The Community Themes and Strengths Assessment presented these findings: Over 27% of adults reported eating five or more servings of fruit and vegetables per day in 2007, as compared to the state rate of 26.2% There is no significant difference between race percentages. Percentage of Adults Who Consume At Least Five Servings of Fruits and Vegetables A Day, Overall, 2007 Healthy People 2020 Goal = Increase Consumption of Fruit 2 to 75% and Vegetables 3 to 50% for the Population Aged 2 Years and Older Healthy People 2020 Broward Duval Miami-Dade Orange Palm Beach Average Florida U.S White Black Hispanic Source: Behavioral Risk Factor Surveillance System (BRFSS), 2007 Florida Department of Health Broward County, June, 2013 Page 20

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