2016 0 Florida Health Assessment Prepared by: The Health Planning Council of Southwest Florida, Inc. www.hpcswf.com
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... 12 Health Ranking... 12 Healthy People 2020 Objectives... 13 Death Rate... 15 Death Rates by Race... 15 Leading Causes of Death... 17 Deaths from All Causes... 20 Chronic Diseases... 24 Cancer... 24 Heart Disease... 30 Diabetes... 32 Weight, Exercise and Nutrition... 35 Communicable Diseases... 37 Sexually Transmitted Diseases... 38 Vaccine Preventable Diseases... 39 AIDS and Other Diseases... 40 Maternal and Child Health... 42 Mothers Who Smoked During Pregnancy... 43 Teen Births... 44 Infant Deaths... 44 Senior Citizen Health... 45 Alzheimer s Disease... 46 Oral Health... 48 Accessibility for Low-Income Residents... 51 2
Social and Mental Health... 52 Crime and Domestic Violence... 55 Alcohol-related Motor Vehicle Crashes... 57 Florida Youth Substance Abuse Survey... 59 Suicides... 62 Baker Act... 63 Hospitalizations... 64 Emergency Room Visits... 66 Health Resources... 67 Medicaid... 71 Florida KidCare... 72 Uninsured... 73 Physicians and Facilities... 76 Healthcare Network Patient Origin by Zip Code... 77 Federal Health Professional Shortage Designations... 80 Community Input... 82 Survey on Health and Healthcare... 82 Interviews with Community Leaders... 90 Appendices: Appendix A: County Health Rankings... 97 Appendix B: Behavioral Risk Factor Surveillance Survey... 100 Appendix C: Survey on Health and Healthcare... 103 Appendix D: Key Informant Interview Guide... 107 Appendix E: Community Leaders Interviewed... 109 Appendix F: Definitions of Prevention Quality Indicators... 110 Appendix G: Florida Youth Substance Abuse Survey... 111 Appendix H: Guide to Emergency and Health Services... 113 Appendix I: Selected Data Sources... 119 3
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
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 2,304.93 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
Population Growth The illustration below represents the total population of from 2005-2014. The estimate for 2014 places the population of at 340,146. This represents an eleven percent increase since 2005. Chart 1: Total Population 2005-2014 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 2014. Chart 2: Estimated Population 2014-2019 Source: The Florida Legislature, Office of Economic and Demographic Research 6
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. 41.0 State in 2013). The median age has also been rising in ; it was 44.1 in 2000 and 45.2 in 2009. 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. 50.8 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
Race and Ethnicity 10.06 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
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 2012. 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 25+ 57.4% 47.4% 49.2% Personal Bankruptcy Filing Rate per 1,000 4.10 4.30 3.39 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
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 (%) 2014 25.4 23.8 2013 23.5 23.3 2012 23.1 22.2 2011 22 20.5 2010 16.1 15.8 2000 13.1 14.2 1990 13.8 14.7 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 9,849 199 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
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
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 2013. 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
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 2010 2013 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. 54.10% 57.10% 56.30% 56.00% 69.30% 64.60% 64.80% 57.10% Needs Improvement Needs Improvement Needs Improvement Needs Improvement 13
Objective Measure 2010 2013 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-12.7. 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-13.1. 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). 62.40% 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. 22.40% 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. 19.20% 18.10% 49.80% 36.30% Source: U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/pdfs/hp2020objectives.pdf. Accessed February 27, 2013. 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
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. 683.5 State). The death rate for has been on the decline for the past twenty years, and has leveled off since 2008. 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. 484.2 black population). From 2012-2014, 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
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, 2012-2014 County State All All White Black Other White Black Other Races Races Cancer 123.6 94.7 71.5 122.6 159.4 146.0 109.4 158.1 Heart Disease 97.2 114.6 85.7 98.0 152.6 156.5 105.9 154.5 Unintentional Injury 39.8 39.3 61.6 39.7 42.7 28.2 24.1 39.9 Alzheimer s Disease 26.7 11.3 17.0 26.4 17.9 13.5 11.1 16.4 CLRD* 26.1 16.8 23.7 25.7 41.8 14.1 18.6 39.8 Stroke 23.6 39.1 23.5 24.4 30.2 47.2 32.8 32.1 Cirrhosis 12.9 8.9 16.8 12.6 12.4 5.1 5.5 11.2 Suicide 11.7 6.1 10.9 11.2 15.9 5.0 8.9 14.0 Diabetes 9.1 21.8 10.5 9.8 17.5 39.1 18.5 19.6 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 2012-2014 Source: Florida Department of Health, Office of Vital Statistics 16
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 2014. The Deaths column is a simple count of the number of people who died by the listed cause during 2014. 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 2014. 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
Table 8: Major Causes of Death For 2014 3-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 3,062 100 900.2 487.2 489 5,133.40 CANCER 782 25.5 229.9 120.8 122.6 1,209.40 HEART DISEASE 654 21.4 192.3 94.8 98 539 ALZHEIMER'S DISEASE 186 6.1 54.7 25.1 26.4 19.2 UNINTENTIONAL 5.8 52.6 38.8 39.7 803.7 179 INJURIES CHRONIC LOWER 5.8 52 25.3 25.7 139.6 177 RESPIRATORY DISEASE STROKE 167 5.5 49.1 23.9 24.4 113.3 DIABETES MELLITUS 66 2.2 19.4 10.7 9.8 141.7 CHRONIC LIVER DISEASE 1.9 16.8 12.1 12.6 277.2 57 AND CIRRHOSIS PARKINSON'S DISEASE 45 1.5 13.2 6.1 5.8 1.7 SUICIDE 36 1.2 10.6 9.5 11.2 287.7 PNEUMONIA/INFLUENZA 29 0.9 8.5 4.6 3.8 39.5 KIDNEY DISEASE 18 0.6 5.3 2.7 3.3 16.2 SEPTICEMIA 17 0.6 5 3.3 3.2 67.3 HOMICIDE 8 0.3 2.4 3.2 4 122.4 AIDS/HIV 3 0.1 0.9 0.9 1.3 21.6 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
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 2014. 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 2012-2014 Age-Adjusted Rate/100,000 Florida 2012-2014 Age-Adjusted Rate/100,000 Cause of Death ALL CAUSES 489 681.2 CANCER 122.6 158.1 HEART DISEASE 98 154.5 UNINTENTIONAL INJURIES 39.7 39.9 ALZHEIMER'S DISEASE 26.4 17.5 CHRONIC LOWER RESPIRATORY DISEASE 25.7 39.8 STROKE 24.4 32.1 CHRONIC LIVER DISEASE AND 12.6 11.2 CIRRHOSIS SUICIDE 11.2 14 DIABETES MELLITUS 9.8 19.6 PARKINSON'S DISEASE 5.8 6.9 HOMICIDE 4 6.3 PNEUMONIA/INFLUENZA 3.8 9.4 KIDNEY DISEASE 3.3 SEPTICEMIA 3.2 7.8 AIDS/HIV 1.3 4.4 Source: Florida Department of Health, Office of Health Statistics and Assessment Age-adjusted death rates are computed using the year 2010 standard population. 19
Deaths from All Causes Table 8 lists the cause of death noted for all deaths in from 2005-2014. The total number of deaths has fluctuated within a fairly narrow range during this period, with the lowest total in 2006. 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 2005-2014 Cause of Death 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 All Causes 2,618 2,586 2,581 2,707 2,693 2,861 2,871 2,917 2,909 3,062 Infectious Diseases 31 50 61 58 64 57 56 34 55 44 Certain other Intestinal Infections 7 9 10 7 11 6 4 3 8 3 Human Immunodeficiency Virus 0 0 0 0 0 1 0 0 0 0 (HIV) Disease Meningococcal Infection 9 8 6 3 7 6 6 7 7 4 Other & Unspecified 0 0 2 0 0 1 0 0 0 0 Infectious/Parasitic Disease & Sequelae Other Tuberculosis 1 1 1 1 1 1 0 0 0 0 Respiratory Tuberculosis 0 1 0 0 0 0 0 0 0 0 Salmonella Infections 8 18 22 31 29 25 18 11 24 17 Septicemia 5 7 9 4 2 5 7 4 9 7 Viral Hepatitis 7 3 5 7 9 4 2 5 7 4 Malignant Neoplasm (Cancer) 745 714 653 739 693 707 730 779 734 782...All Other & Unspecified Cancer 74 74 73 90 74 88 100 92 88 81...Bladder Cancer 23 15 17 16 16 24 19 13 33 20...Breast Cancer 46 42 42 35 55 51 45 49 34 47...Cervical Cancer 4 6 1 1 8 4 7 6 2 2...Colon, Rectum, & Anus Cancer 58 60 56 67 50 65 51 56 59 71...Corpus Uteri & Uterus, Part 7 9 10 8 4 13 7 5 10 11 Unspec Cancer...Esophagus Cancer 23 21 13 21 19 25 20 20 17 17...Hodgkins Disease 0 2 1 1 3 0 2 2 1 0...Kidney and Renal Pelvis Cancer 15 19 20 13 18 10 16 14 16 18...Larynx Cancer 5 10 3 2 2 4 6 5 3 6...Leukemia 29 25 21 30 42 27 29 40 32 40...Lip, Oral Cavity, Pharynx 7 13 12 7 6 9 15 13 20 16...Liver & Intrahepatic Bile Ducts 25 20 23 31 26 16 25 37 32 30 Cancer...Meninges, Brain, & Other Part Cen 20 26 9 18 19 16 20 21 24 27 Nerv Sys Cancer...Multiple Myeloma & 13 13 18 17 16 13 19 20 12 19 Immunoprolifera Neoplas...Non-Hodgkins Lymphona 28 33 32 23 29 32 26 28 25 30...Ovarian Cancer 22 20 16 23 17 21 17 24 26 16 20
Cause of Death 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014...Pancreatic Cancer 46 38 45 48 44 49 43 53 38 66...Prostate Cancer 54 39 39 58 39 43 34 39 40 47...Skin Cancer 11 20 11 23 11 15 18 31 21 17...Stomach Cancer 17 11 13 13 7 10 13 14 19 9...Trachea, Bronchus, Lung Cancer 218 198 178 194 188 172 198 197 182 192 In Situ, Benign, Uncert/Unk 19 19 22 11 38 33 21 25 20 20 Behavior Neoplasms Anemias 5 3 5 4 5 6 2 1 4 6 Nutritional and Metabolic Diseases 45 63 55 69 59 46 60 61 55 67 Diabetes Mellitus 45 61 50 67 56 43 57 59 54 66 Malnutrition 0 1 5 2 3 3 3 2 0 1 Other Malnutritional Deficiencies 0 1 0 0 0 0 0 0 1 0 Nervous System Diseases 90 93 131 130 186 198 174 208 249 231 Alzheimer s Disease 66 70 97 105 149 153 136 166 212 186 Meningitis 1 1 2 0 0 1 2 0 0 0 Parkinsons Disease 23 22 32 25 37 44 36 42 37 45 Cardiovascular Diseases 842 788 820 804 752 892 861 906 848 884 Acute & Subacute Endocarditis 4 2 1 2 2 1 1 4 0 3 Acute Myocardial Infarction 101 111 120 114 88 108 118 112 116 104 Acute Rheum Fever & Chronic 5 10 8 2 3 4 8 5 3 6 Rheum Heart Dis. All Other Chronic Ischemic Heart 294 279 250 250 221 205 169 177 307 347 Dis. Aortic Aneurysm & Dissection 11 15 27 13 12 14 12 10 10 12 Atherosclerosis 16 6 8 8 4 6 7 5 6 7 Atherosclerotic Cardiovascular 50 64 77 74 91 172 182 226 62 40 Disease Cerebrovascular Diseases 140 113 148 145 143 177 164 168 150 167 Essen Hypertension & 27 21 13 15 22 25 29 28 35 30 Hypertensive Renal Dis. Heart Failure 35 25 26 25 26 21 20 18 14 18 Hypertensive Heart & Renal 1 1 0 1 0 3 7 5 3 3 Disease Hypertensive Heart Disease 18 24 25 27 26 31 36 30 29 27 Other Acute Ischemic Heart 2 0 1 2 0 5 2 3 1 1 Disease Other Arteries, Arterioles, 19 10 4 11 19 17 11 20 16 10 Capillaries Other Forms Heart Dis. 112 101 109 112 94 102 91 93 95 104 Pericardium Diseases & Acute 0 1 0 1 0 0 0 0 1 1 Myocarditis...Other Circulatory System Disorders 7 5 3 2 1 1 4 2 0 4 Respiratory Diseases 218 200 211 226 232 266 271 223 256 263 Asthma 0 2 3 2 3 1 2 2 2 2 Bronchitis, Chronic & Unspecified 1 0 1 0 1 0 0 1 0 1 Emphysema 12 13 13 15 22 14 16 16 12 3 21
Cause of Death 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Other Chronic Lower Respiratory 117 114 115 127 127 175 180 155 161 171 Diseases Influenza 2 1 0 1 2 0 0 1 7 6 Pneumonia 32 27 31 30 21 19 23 10 22 23 Other Respiratory System Dis. 41 39 35 38 38 41 38 25 33 39...Pneumoconiosis & Chemical 5 0 1 3 2 2 0 0 2 1 Effects...Pneumonitis Due To Solids & 8 4 12 10 16 14 12 13 17 17 Liquids Digestive Diseases 55 63 48 54 41 55 60 60 73 66 Appendix Diseases 1 0 2 1 1 0 0 0 0 0 Cholelithiasis & Other Gallbladder 8 6 4 3 0 4 4 7 5 2 Disorders Alcoholic Liver Disease 17 33 28 30 22 27 37 39 46 35 Other Chronic Liver Disease & Cirrhosis 21 16 14 16 15 21 16 10 16 22 Hernia 0 0 0 2 0 2 2 2 4 4 Peptic Ulcer 8 8 0 2 3 1 1 2 2 3 Urinary Tract Diseases 28 29 46 49 49 32 37 21 25 19 Hyperplasia of Prostate 0 0 0 2 1 1 0 0 0 1 Kidney Infections 0 0 2 1 1 0 1 0 0 0 Acute/Progressive 0 0 0 0 0 0 0 1 0 0 Nephritic/Nephrotic Synd Glomeruloneph, Nephri/Nephro, 0 1 1 4 4 4 4 0 0 0 Renal Sclerosis Other Kidney Disorders 0 0 0 0 0 0 0 0 0 0 Renal Failure 28 28 43 42 43 27 32 20 25 18 Pregnancy, Childbirth, Puerperium 0 0 0 2 1 0 1 3 0 0 Complications Perinatal Period Conditions 7 10 10 14 12 11 9 4 11 9 Congenital & Chromosomal 11 11 9 9 13 12 9 11 3 10 Anomalies Symptoms, Signs & Abnormal 31 39 34 31 20 51 65 38 52 135 Findings Other Causes (Residual) 270 277 264 278 257 252 301 317 270 301 External Causes 2,618 2,586 2,581 2,707 2,693 2,861 2,871 2,917 2,909 3,062 Drowning & Submersion 6 7 16 6 6 6 12 6 3 2 Falls 49 55 39 66 87 85 76 90 100 101 Firearms Discharge 2 0 0 0 0 0 0 1 1 0 Homicide by Firearms Discharge 4 4 4 4 14 8 7 3 10 4...Homicide By Other & Unspecified 3 4 13 5 4 5 5 5 4 4 Means & Sequelae Medical & Surgical Care 4 2 1 2 5 3 5 5 3 1 Complications Motor Vehicle Crashes 54 51 49 33 35 43 31 37 36 36 Other & Unspecified Event & Sequelae 2 2 0 0 1 0 1 0 0 0 22
Cause of Death 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014...Other & Unspecified Nontransport 21 10 11 9 17 5 10 5 21 11 & Sequelae Other Land Transport Accidents 0 1 1 0 1 0 1 0 0 0...Poisoning & Noxious Substance 41 44 36 55 44 35 29 25 26 26 Exposure...Smoke, Fire, Flames Exposure 0 1 0 1 1 0 0 1 3 1...Suicide By Firearms Discharge 21 16 21 15 26 25 14 23 17 18...Suicide By Other & Unspecified 11 23 15 27 25 22 18 23 20 18 Means & Sequelae War Operations & Sequelae 0 0 0 0 0 0 0 1 1 0...Water/Air/Space/Oth-Unsp Transport & seq 0 2 5 2 1 3 3 1 2 2 Source: Florida Department of Health, Office of Vital Statistics 23
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 2012-2014. Chart 9: Deaths from All Cancers Age-adjusted rate per 100,000, 3-Year Rates 1993-2014 Source: Florida Department of Health, Bureau of Vital Statistics 24
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 1998-2012 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, 2012-2014 Avg. Annual Number of Events (Incidence), 2012* Lung Cancer 29.8 220 Breast Cancer 13.8 201 Prostate Cancer 13.0 122 Colorectal Cancer 10.1 119 Pancreatic Cancer 8.0 Cervical Cancer 1.4 14 Skin Cancer 4.0 137 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
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
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 30. 27
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
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
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 1994-2014 Source: Florida Department of Health, Bureau of Vital Statistics 30
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
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 1994-2014 Source: Florida Department of Health, Bureau of Vital Statistics 32
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
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-$49.999 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
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. 55.3 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 70.4. 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 44.8 20.7* 42.9 30.0 Adults who are Obese 23.1 18.4 27.5 25.3 Adults Overweight and Obese 67.9 39.1* 70.4 55.3 Adults who are Sedentary 22.3 28.0 25.3 30.0 Adults who consume 5 or more servings of fruit or vegetables 20.1 21.4 16.1 20.4 Adults who meet muscle strengthening recommendations 37.3 30.1 36.0 23.6 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
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
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 2012-2014 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 13 3.9 8 Gonorrhea 71 21.3 105.7 Chlamydia 807 241 417.8 Vaccine Preventable Diseases Hepatitis B 2 0.7 1.9 Measles 0.0 0.0 0.0 Mumps 0.0 0.0 0.0 Rubella 0.0 0.0 0.0 Pertussis 16 4.9 3.5 Tetanus 0.0 0.0 0.0 AIDS and Other Diseases AIDS 26 7.7 14.8 Meningococcal Meningitis 0.0 0.0 0.0 Hepatitis A 2 0.5 0.6 Tuberculosis 14 4.2 3.3 Source: Division of Disease Control, Florida Department of Health 37
Sexually Transmitted Diseases Chlamydia is the most prevalent sexually transmitted disease in with an average of 807 cases per year between 2012 and 2014. That works out to a rate per 100,000 of 241; much lower than the state average of 417.8. 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 100,000 1995-2014 Source: Florida Department of Health, Bureau of STD Prevention & Control 38
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 2014. 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 1989. Chart 22: Pertussis Cases 3-Year Rate per 100,000 1994-2014 Source: Florida Department of Health, Bureau of Epidemiology 39
AIDS and Other Diseases An average of 26 people per year were diagnosed with AIDS in between 2012 and 2014. 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 100,000 1994-2014 Source: Florida Department of Health, Bureau of HIV/AIDS 40
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 1993-1995, 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 2008-2010. Chart 24: Tuberculosis Cases 3-Year Rate per 100,000 1995-2014 Source: Florida Department of Health, Bureau of TB and Refugee Health 41
Maternal and Child Health On average, 3,197.0 babies were born per year in between 2012 and 2014. 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, 2012-2014 Births County State Trend Quartile* Total Births (3-yr annual avg.) 3197.0 Births to Mothers ages 15-44, per 1,000 63.7 59.9 Births to Mothers ages 10-14, per 1,000 0.2 0.3 Positive 2 Births to Mothers ages 15-19, per 1,000 22.3 24.3 Positive 1 Percent of Births to Unwed Mothers 45.8 47.9 Steady 2 Infant Deaths Infant Deaths (0-364 days) per 1,000 Births 4.9 6.1 Steady 1 Neonatal Deaths (0-27 days) per 1,000 Births 3.4 4.0 Steady 2 Post neonatal Deaths (28-364 days) per 1,000 Births 1.4 2.1 Steady 3 Low Birth Weight Percent of Births < 1500 Grams 1.3 1.6 Steady 2 Percent of Births < 2500 Grams 7 8.6 Steady 1 Prenatal Care Percent of Births with 1st Trimester Prenatal Care 67.5 79.8 Positive 1 Percent of Births with Late or No Prenatal Care 7.8 5.0 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
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 2014. 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 2014. 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
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 10-19 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
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 $27,047 25 to 44 $52,891 $50,523 $58,970 45 to 64 $69,564 $55,546 $65,018 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*, 2005-2014 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total Cancer 745 714 653 739 693 707 730 779 734 782 8,598 Heart Diseases 622 618 617 610 551 652 634 673 631 654 7,447 CLRD** 130 129 132 144 153 190 198 174 175 177 1,869 Cerebrovascular Diseases 140 113 148 145 143 177 164 168 150 167 1,787 Alzheimer s Disease 66 70 97 105 149 153 136 166 212 186 1,469 Unintentional Injury 174 172 158 174 194 177 163 166 194 179 2,038 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
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 2012-2014 (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 1996-1998). This rate is also higher than the state average for 2012-2014 (25.1 Collier vs. 19.1 State). Chart 28: Deaths from Alzheimer s Disease Age-adjusted rate per 100,000, 3-Year Rates 1995-2014 Source: Florida Department of Health, Bureau of Vital Statistics 46
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 1994-2014 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 266.9 beds per 100,000 population, which is much lower than the state average of 426.7 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
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. 90.2 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
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
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
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 2002-2012 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
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 2011. Chart 34: Preventable Hospitalizations Under 65 from Dental Conditions Single Year Rate per 100,000 1998-2014 Source: Florida Agency for Health Care Administration (AHCA) 52
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. 16.8 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
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. 12.7 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
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, 2012-2014 County State Quartile* Larceny 1,166.8 2,244.4 2 Total Domestic Violence Offenses 456.0 557.7 2 Burglary 336.7 713.1 1 Aggravated Assault 173.3 302.1 1 Motor Vehicle Theft 75.1 186.9 2 Robbery 42.7 118.5 2 Forcible Sex Offenses 32.1 52.2 1 Murder 2.3 5.1 2 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 1995-1997 of 3087.4 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
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 2012-2014, had a rate of 456.0 domestic violence offenses per 100,000 population, compared to the state average of 557.7. 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 1994-2015 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, 2009-2015 2009 2010 2011 2012 2013 2014 2015 Murder 10 7 1 2 3 2 0 Manslaughter 0 0 0 0 0 0 0 Forcible Rape 19 20 15 15 34 16 25 Forcible Sodomy 5 1 7 3 - - - Forcible Fondling 25 26 20 29 11 6 11 Aggravated Assault 273 265 286 221 241 236 269 Aggravated Stalking 1 2 2 0 4 0 0 Simple Assault 1,411 1,398 1,265 1,318 1,114 1,258 1,198 Threat/Intimidation 37 44 54 24 18 20 33 Stalking 3 1 5 1 2 1 0 Total 1,784 1,764 1,655 1,613 1,427 1,539 1,536 Source: Florida Department of Law Enforcement 56
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 1997-2014 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 2014. ranked in the 1 st Quartile for each indicator. Table 19: Alcohol-related Motor Vehicle Crashes 3-Year Rate per 100,000, 2012-2014 County State Quartile* Alcohol-related Motor Vehicle Crashes 86.0 87.6 1 Alcohol-related Motor Vehicle Crash Injuries 52.5 59.2 1 Alcohol-related Motor Vehicle Crash Deaths 3.3 4.3 1 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
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 2013. 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. 14.5 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 2010. 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
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 2014. 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. 2014 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 2004 2014 and Florida Statewide 2014 Source: Florida Youth Substance Abuse Survey (2014), Florida Department of Children and Families 59
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 2004. 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 2004 2014 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 2012. 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 2004 2014 and Florida Statewide 2014 Source: Florida Youth Substance Abuse Survey (2014), Florida Department of Children and Families 60
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 21.9 56.2 41.7 25.0 56.0 42.6 Blacking Out -- 20.3 20.3 -- 18.9 18.9 Cigarettes 7.3 24.5 17.2 9.8 23.6 17.6 Marijuana or Hashish 6.1 32.8 21.6 8.4 33.4 22.6 Synthetic Marijuana -- 8.7 8.7 -- 8.8 8.8 Inhalants 7.6 4.6 5.8 8.6 4.9 6.5 Club Drugs 0.8 4.6 3.0 1.1 4.5 3.0 LSD, PCP or Mushrooms 0.6 5.5 3.4 1.3 5.3 3.6 Methamphetamine 0.2 2.4 1.5 0.9 1.1 1.0 Cocaine or Crack Cocaine 0.7 4.9 3.2 0.9 2.5 1.9 Heroin 0.2 1.3 0.8 0.6 0.7 0.6 Depressants 1.4 5.6 3.8 1.9 6.2 4.3 Prescription Pain Relievers 2.9 6.6 5.1 3.0 7.3 5.5 Prescription Amphetamines 1.5 5.6 3.9 1.0 5.1 3.3 Steroids (without a doctor s order) 0.3 1.0 0.7 0.5 0.8 0.7 Over-the-Counter Drugs 2.5 6.6 4.9 3.4 6.1 5.0 Any illicit drug 15.0 39.3 29.0 17.9 39.3 30.0 Any illicit drug other than marijuana 11.4 21.3 17.1 13.7 19.7 17.1 Alcohol only 12.9 22.8 18.7 14.0 22.2 18.6 Alcohol or any illicit drug 27.5 61.8 47.3 31.7 61.4 48.5 Any illicit drug, but no alcohol 5.9 5.7 5.8 6.9 5.5 6.1 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
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 2012-2014 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
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
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 100,000 2009-2014, PQI 2009 2010 2011 2012 2013 2014 01-Diabetes/short-term 26.7 28.1 27.2 41.5 29 44.2 03-Diabetes/long-term 80.6 82.7 72 92.4 91.3 79.8 05-Chronic obstructive PD 144.6 146.1 155 181.5 176.4 157.7 07-Hypertension 49.7 58.8 56.9 62 58.7 39.9 08-Congestive HF 316.2 361.1 345.8 278.5 300 297.7 10-Dehydration 80.6 56.1 64.1 60.9 55.7 46 11-Bacterial pneumonia 201 248.1 251.1 284.2 261.8 224.4 12-Urinary infections 149.8 149.1 187.4 204.3 192.3 180.9 13-Angina w/o procedure 8.7 7.6 7.2 6.5 4.8 4.7 14-Uncontrolled diabetes 24.1 23.5 24.1 28.2 20.1 15.6 15-Adult asthma 79.1 73.2 64.9 70.8 70.6 62.7 16-Diabetes/LE amputations 20.7 22.4 21.1 23.6 31.6 33 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
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, 2010-2014, Residents Disease 2010 2011 2012 2013 2014 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 70 108 112 77 66 Sickle Cell 86 87 91 115 109 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
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 8,206 1474, 1,714 4,238 2,668 21,524 Physicians Regional Medical Center - Col 7,236 3,236 1 647 3,178 2,610 16,908 Physicians Regional Medical Center - Pin 3,918 4,281 565 4,029 2,351 15,144 Lehigh Regional Medical Center 1,344 155 77 204 382 2,162 Healthpark Medical Center 1,119 58 64 61 195 112 1,609 Southwest Florida Regional Medical Center 263 67 38 59 162 131 720 Lee Memorial Hospital 66 38 28 59 44 61 296 Cape Coral Hospital 19 10 2 17 7 9 64 Florida Hospital Celebration Health 20 3 3 27 9 62 Tallahassee Memorial Hospital 1 1 1 5 39 15 62 Miami Children's Hospital 38 8 8 3 57 Baptist Hospital Of Miami 7 12 17 14 3 53 Memorial Regional Hospital 19 3 6 9 15 52 Shands Hospital At The Univ. Of Florida 8 4 3 22 10 47 Dr P Phillips Hospital 9 9 4 18 6 46 Cleveland Clinic Hospital 3 10 1 21 11 46 Kendall Regional Medical Center 10 4 2 5 12 8 41 University Community Hospital 7 2 1 4 13 13 40 Sarasota Memorial Hospital 5 8 4 14 9 40 Hendry Regional Medical Center 10 2 4 7 15 38 Memorial Hospital West 16 5 5 5 5 36 Total 30214 21255 2227 6395 19681 13639 93411 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
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. 17.3 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 2010. 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
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 2010. 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
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
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. 52.2 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
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
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, 2015 3,772 547 223 4,542 September, 2015 3,730 535 219 4,484 October, 2015 3,384 527 192 4,103 November, 2015 3,345 523 188 4,056 December, 2015 3,307 523 181 4,011 January, 2016 3,246 527 181 3,954 February, 2016 3,268 529 171 3,968 March, 2016 3,345 556 170 4,071 April, 2016 3,471 587 158 4,216 May, 2016 3,529 603 179 4,311 June, 2016 3,615 626 186 4,427 July 2016 3,658 630 197 4,485 Source: Florida Healthy Kids Corporation Chart 51: Total Monthly Children s Health Insurance Enrollment Source: Florida Healthy Kids Corporation 72
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 2014. 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 2011. Chart 52: Uninsured Adults (Age 18 64) 2010-2014 Source: The Census Bureau s Small Area Health Insurance Estimates (SAHIE) 73
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
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) 2010-2014 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
Physicians and Facilities As of 2014, there were 884 licensed physicians in. That works out to 259.9 doctors for every 100,000 residents. That is a very similar to the state average of 259.3 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. 18.7 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. 426.7 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 256 75.3 4 59.5 Total Licensed Physicians 884 259.9 4 259.3 Total Licensed Family Private Practice Physicians 57 16.8 3 19.1 Total Licensed Internists 187 55.0 4 49.6 Total Licensed OB/GYN 45 13.2 10.2 Total Licensed Pediatricians 48 14.1 4 18.7 Facilities Total Hospital Beds 977 287.2 3 317.3 Total Acute Care Beds 818 240.5 3 260.3 Total Specialty Beds 159 46.7 57.0 Total Skilled Nursing Home Beds 908 266.9 1 426.7 County Health Department County Health Department Full-Time Employees 164.0 48.2 1 51.1 County Health Department Expenditures $11,744,029.49 $34.53 2 $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
Healthcare Network Patient Origin by Zip Code The largest percentage of patients of the Healthcare Network of Southwest Florida live in the 34142 zip code (Immokalee); 28.68 percent of patients list 34142 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 34142 3755 7607 626 1968 13956 28.68% Children, Women, Family, Dental 34116 511 5904 91 828 7334 15.07% Children 34120 270 2610 70 802 3752 7.71% 34113 465 2147 43 386 3041 6.25% Dental 34104 242 2064 42 394 2742 5.64% Children 34112 204 1866 56 301 2427 4.99% Women, Family, Dental 34114 503 1076 27 234 1840 3.78% 34143 550 570 179 347 1646 3.38% 34117 392 845 38 359 1634 3.36% 34109 256 595 30 438 1319 2.71% Children, Women 34119 247 542 29 475 1293 2.66% 34105 124 305 18 271 718 1.48% 34145 120 322 2 173 617 1.27% Children 34110 106 251 11 237 605 1.24% 34108 125 268 15 153 561 1.15% Children, Family 34103 118 268 13 155 554 1.14% Children 34135 161 240 12 135 548 1.13% 34102 79 255 19 119 472 0.97% 33935 210 169 9 75 463 0.95% 33974 150 168 16 85 419 0.86% 33936 85 71 12 40 208 0.43% 33971 76 81 2 26 185 0.38% 33976 72 79 1 17 169 0.35% 33905 69 60 5 7 141 0.29% 39373 64 57 7 11 139 0.29% 33930 70 41 8 14 133 0.27% 33967 38 52 1 29 120 0.25% 34101 27 49 3 15 94 0.19% 33928 23 30 4 34 91 0.19% 34139 32 48 0 8 88 0.18%
ZIP Code None/ Uninsured Medicaid/ CHIP/Other Public Medicare Private Total Patients Percent of Patients 34134 9 34 5 33 81 0.17% 33972 28 29 1 19 77 0.16% 33440 39 31 0 5 75 0.15% 33916 38 25 1 5 69 0.14% 34138 19 38 5 5 67 0.14% 33913 21 17 3 20 61 0.13% 33907 23 22 0 8 53 0.11% 33909 26 24 0 2 52 0.11% 33975 23 12 4 10 49 0.10% 33908 22 16 0 9 47 0.10% 34141 16 5 0 26 47 0.10% 33901 14 24 3 5 46 0.09% 34137 8 24 2 4 38 0.08% 33917 12 17 1 4 34 0.07% 34266 15 10 1 1 27 0.06% 33993 11 12 0 1 24 0.05% 33990 12 7 0 3 22 0.05% 34133 10 7 0 4 21 0.04% 34140 4 13 0 3 20 0.04% 34106 4 11 0 4 19 0.04% 34146 2 9 0 7 18 0.04% 33914 4 7 0 3 14 0.03% 33903 1 10 0 0 11 0.02% 33912 2 7 0 1 10 0.02% 33919 2 6 0 2 10 0.02% Other ZIP Codes Unknown Residence 179 73 14 92 358 0.74% 0.00% Total 9688 29130 1429 8412 48659 100.00% Source: Healthcare Network of Southwest Florida HCN Services at this Location 78
This map shows the location of the zip codes within. Figure 4. 79
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 57.1. 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
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
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 email 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 2016. 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 2013. The 2013 responses are given to show a comparison with 2016. 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 82 2013 2016 Number of responses private insurance (through employer) 108 48.4% 31 50.8% private insurance (self-pay) 25 11.2% 4 6.6% Medicare 55 24.7% 5 8.2% Medicaid 48 21.5% 6 9.8% Veteran 0 0.0% 0 0 other** 6 2.7% 3 4.9% none 57 25.6% 12 19.7% *totals to more than 100% as some respondents selected multiple options **share of cost, Molina, Florida Blue, United Healthcare 2016
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? 2013 2016 2013 2016 family doctor 147 42 family doctor or health provider 193 46 clinic 132 32 friends or relatives 180 29 health department 36 6 Internet 140 39 hospital/emergency room 34 10 television 70 18 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
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 78 19 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 7 2013 2016 uninsured/low-income 160 38 no 34 migrants 120 26 yes* 24 non-english speaking 99 26 *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
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
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
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
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