Preview: Community Health Assessment Findings for the Community Transformation Grant Sharon Hutchins, Ph.D., MPH Health Services Agency November 26, 2012 Made possible with funding from the Centers for Disease Control and Prevention.
Community Transformation Grant: Capacity Building Mobilize the community Assess community health status and needs through a Community Health Assessment (CHA) Tell your story Develop an implementation plan
CTG Core Principles Use & Expand Evidence Base Utility of Proven Strategies Enhance Community Efforts Fill Gaps Maximize Health Impact Jurisdiction-wide Policy & Environmental Change Strategies Advance Health Equity Community Impact All Members of the C it
CTG Priority Areas Tobacco-Free Living Smoke-free multi-unit housing (apartments) Exterior advertising on corner stores Parks and other outdoor public spaces Healthy Eating / Active Living Exterior advertising on corner stores / point of sale strategies School wellness policies and implementation Sodium consumption Expanding joint use agreements High Impact Clinical Preventive Services Control high blood pressure, high cholesterol, diabetes Expand use of community health workers as health extenders
Community Health Assessment Components Health data Policy scans Key informant interviews Focus groups Asset inventories i Combined assessment of clinical preventive services area
Community Health Assessment Health data Policy scans Tobacco, (HEAL in progress) Key informant interviews (in progress) Focus Groups (in progress) Asset Inventories HEAL, Tobacco
Health Data Demographic context Risk and protective factors Chronic disease prevalence ER visits Hospitalizations Compliance and clinical quality measures Mortality Health disparities focus Gender, age, race/ethnicity, poverty/income, geographic area
Stanislaus County Regions Southwest North East Northeast Southeast West South South Note: Stanislaus county regions roughly Note: Stanislaus county regions roughly correspond to areas served by Family Resource Centers.
Life Expectancy at Birth Stanislaus County, 2006-2010 Southwest North East Northeast Southeast West South South Legend 75.4 Southwest 75.5 East 77.4 South 78.2 78.3 Southeast 79.4 North 79.6 Northeast 79.8 South 80.6 West
Unequal Distribution of Risk and Protective ti Factors Group # Adequate Fruit/Veggie Consumption At least Weekly Fast Food Consumption Adequate Physical Activity Overweight /Obesity Tobacco Use Poor 26.4% 72.1% 41.6% 37.0% 22.8% Not Poor 46.8% 68.4% 32.9% 33.1% 15.1% Adults living above the poverty level are more likely to eat 5+ fruits & veggies per day than those living in poverty. Poor adults get marginally more physical activity, while poor children get marginally less (34.0 vs. 46.6% of kids aged 5-11 physically active at least 1 hour 5 times per week). A slightly higher percentage of poor adults are overweight or obese. Adults in poverty are significantly more likely to be current smokers. Personal lifestyle choices are influenced by social and environmental factors.
Poverty/Income and Racial/Ethnic Differences in Diet Percenta age of Resid dents 80% 70% 60% 50% At Least Weekly Fast Food Consumption in Past Week by Poverty Status 72.1% 69.3% 68.1% 68.0% 100% FPL 101-200% 201-300% 301+% FPL FPL FPL Poverty Status (% of Federal Poverty Level) Perce entage of Re esidents At Least Weekly Fast Food Consumption in Past Week by Race/Ethnicity it 80% 74.7% 60% 65.8% 40% 46.5% 20% 0% Latino White Black Race/Ethnic Group
RFEI 6 5 4 3 2 1 Obesity Prevalence and the Retail Food Environment, by Jurisdiction 31.5% 29.4% 5.5 4.9 35% 28.8% 30% 25% 45 4.5 20% 11.4% 2.1 15% 10% 5% s Perce ent of Obe ese Adult 0 Stanislaus Tulare San Joaquin Marin Jurisdiction Designed for Disease: The Link Between Local Food Environments and Obesity and Designed for Disease: The Link Between Local Food Environments and Obesity and Diabetes. California Center for Public Health Advocacy, PolicyLink, and the UCLA Center for Health Policy Research. April 2008. 0%
Heart Disease: Gender Disparities Hyper Heart ER Hospital Group tension Disease Visits izations Mortality YPLL Male 35.0% 5.4% 64.6 663.6 201.6 7.0 Female 27.8% 4.8% 43.1 360.0 187.5 3.3 There are slight, but not statistically significant differences, in hypertension and heart disease diagnoses (ie (i.e. women have essentially caught up with men). Males are at statistically significantly higher risk of ER visits and hospitalization i due to heart disease ( ischemic i heart disease ). While mortality rates (due to disease of the heart ) are not statistically significantly different, males lose significantly more YPLL than females due to these causes.
Gender Differences in Compliance Pe ercentage of Diagnosed Res spondents Confidence in Managing Heart Disease by Gender 100% 75% 50% 25% 0% 93.9% 87.0% Male Female 6.1% 13.0% Very / Somewhat Not too / Not at all Self-Reported Level of Confidence Diagnosed Re espondents Percentage of 100% 75% 50% 25% 0% Taking Medication for High Blood Pressure 67.0% 73.3% Male Female 33.0% 26.7% Tk Takes medicine dii Doesn't take medicine i Self-Reported Behavior Source: UCLA s California Health interview Survey, 2009
Diabetes: Racial & Ethnic Disparities Overweight/ Hospital Group Obesity Diabetes ER Visits izations Mortality YPLL Latino 64.2% 8.3% 229.9 173.8 31.9 8.2 Non Latino 66.2% 7.3% 347.1 182.5 22.1 6.8 Black 80.2% NA 510.5 377.0 69.1 6.8 Asian/PI 55.0% 6.1% 104.7 54.1 13.0 12.2 White 66.5% 72% 7.2% 267.4 175.77 25.8 71 7.1 Non-Latinos have significantly higher age-adjusted rates of ER visitation, but Latinos have higher age-adjusted mortality due to diabetes. Age-adjusted ER visitation, hospitalization and mortality rates for diabetes are statistically significantly higher for Blacks than for Whites and for Whites than for Asians. However, Asians lose significantly more YPLL due to diabetes than either Blacks or Whites.
100% Working Age Adults with Health Insurance by Ethnicity tage Ins sured Percen 90% 80% 70% 60% 86.5% 91.9% 50% Latino Eh Ethnicity i Non-Latino
Diabetes Mortality Rates, Stanislaus County, 2006-2010 Southwest North East Northeast Southeast West South South Legend 17.4 Southeast 20.5 20.6 North 20.9 South 22.2 West 24.0 East 24.3 South 26.7 Northeast 35.3 Southwest
Average Years of Potential Life Lost, Stanislaus County, 2006-20102010 North Southwest East Northeast Southeast West South South Legend 7.9 8.0 South 8.1 North 8.5 Northeast 9.5 Southeast 11.2 West 11.5 South 12.2 East 13.9 Southwest
Health Disparity Summary Many significantly health disparities are related to Gender Race and ethnicity Poverty Geographic area Personal lifestyle choices and the social, physical and policy environments all play a role. The areas of the county most burdened by CTGrelated risk factors and conditions are: Southwest t (West Md Modesto and South Md Modesto) t) East (Airport Neighborhood and La Loma area)
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