OGLE COUNTY Health Department

OGLE COUNTY Health Department Illinois Project for Local Assessment of Needs (IPLAN) Community Health Needs Assessment Plan Prepared By: Brian Kennedy, BA Public Health Associate May 27, 2015

Table of Contents Executive Summary... 3 Purpose... 4 Data... 5 Demographic and Socioeconomic Characteristics... 6 Population... 6 Age... 7 Income... 8 Employment... 10 General Health and Access to Care... 11 Health Insurance... 11 Hospitalization... 12 Maternal Child Health... 13 Births... 13 Teen Pregnancy... 14 Pregnancy Risks... 15 Chronic Disease... 17 Causes of Death... 17 Obesity... 20 Infectious Disease... 21 STDs... 21 Environmental, Occupational, and Injury Control... 22 Motor Vehicles... 22 Drug Overdoses... 23 Drug Arrests... 24 Crime... 25 Sentinel Events... 26 Suicide... 26 Accidental Death... 26 Ogle County Health Department IPLAN 2015 1

Community Participation... 27 Process... 27 Convening the Community Health Committee... 29 Analysis of Community Health Problems... 29 Development of the Community Health Plan... 30 Purpose... 30 Community Health Plan... 31 Community Health Plan Worksheet - Cancer... 31 Community Health Plan Worksheet - Heart Disease... 33 Community Health Plan Worksheet - Obesity... 35 Community Health Plan Explanation - Cancer... 36 Community Health Plan Explanation - Heart Disease... 38 Community Health Plan Explanation - Obesity... 41 Appendix... 43 Attachment I: Illinois Project for the Local Assessment of Needs (IPLAN) Community Health Committee... 43 Attachment II: Ogle County IPLAN Community Health Committee Priority Selection Worksheet Hanlon Method... 45 Attachment III: List of Data Sources for Community Health Needs Assessment... 47 Attachment IV: Health Problem Analysis Worksheets... 48 Ogle County Health Department IPLAN 2015 2

Executive Summary Ogle County Health Department conducted a systematic process to assess the health needs and determine priority health problems for Ogle County. As part of the process for recertification, the Ogle County Health Department conducted an organizational capacity self-assessment, completed a Community Health Needs Assessment, and created a Community Health Plan by using the Assessment Protocol for Excellence in Public Health (APEXPH) process. This process, required for the Illinois Project for Local Assessment of Needs (IPLAN), resulted in three priority health problems: Heart Disease Cancer Obesity These identified health problems are largely consistent with health trends across the United States. Heart disease and cancer are the two leading causes of death in both Ogle County and United States. Obesity is a growing problem within Ogle County, and is a leading risk factor for both heart disease and cancer. Changing socioeconomic and demographic changes are also having an effect health in Ogle County. Consistent with the United States, the Ogle County population is growing increasingly older. In 2013, the median age of Ogle County residents was 41.0 years, compared to the U.S. median age of 37.6 years. This increase in age is due to a number of factors, most notably the exodus of young persons from Ogle County. Since 2000, the number of each age group under the age of 45 has declined. Over the previous ten years, Ogle County lost 20.6% of its 30-44 year old adults. On the other hand, the number of adults 45-64 and 65 years and older has increased 24.8% and 12.7% respectively. Declining economic opportunity within Ogle County has also exacerbated existing health problems. Since 2000, the unemployment rate in Ogle County has worsened relative to Illinois and the United States. Over the previous 15 years, the number of residents working in the manufacturing industry has declined by 39.4%. However, manufacturing remains Ogle County s second largest industry, employing 17.5% of all working residents. Only 18.9% of Ogle County residents have a bachelor s or graduate degree, compared to 31.6% of Illinoisans. Ogle County Health Department IPLAN 2015 3

Despite these challenges, Ogle County remains a healthy place to live. According to County Health Rankings, Ogle County ranks 24 th out of 102 counties in Illinois. However, worsening demographic and social indicators are troubling precursors for the future health of Ogle County. Without community-wide efforts to improve the health and well-being of Ogle County, the health of our community will continue to worsen. The Community Health Committee has chosen to address these challenging issues by emphasizing the prevention of prevalent chronic diseases: heart disease, cancer, and obesity. The harmful effects of these chronic diseases can only be reduced over the long-term through concerted effort and collaboration from many community organizations working together. Purpose The Illinois Project for Local Assessment of Needs (IPLAN) is a community health assessment and planning model designed to identify and propose solutions through a comprehensive process in which the community directs decision-making under the guidance and leadership of the local health department. IPLAN is grounded in core functions of public health and addresses public health practice standards. The process results in a five-year plan that addresses a minimum of three community health problems with specific, measurable, attainable, and timebound intervention strategies and outcome objectives. Completion of the IPLAN process fulfills one of the requirements for local health department certification. Ogle County Health Department used the Assessment Protocol for Excellence in Public Health (APEXPH) to assess the organizational capacity of the health department and provide a framework for working with community members to assess the health status of the community. With guidance from the health department the APEXPH process leads the Community Health Committee through data and information that impacts health status. The Committee uses this information to prioritize community health problems and establish a plan to address the top three priority health problems. After identifying three priority problems, the Committee identifies risk factors and contributing factors for each priority problem, which results in strategies and objectives for subsequent community intervention. In addition to meeting the requirements for local health department recertification, IPLAN facilitates partnerships between community organizations that have a stake in the overall health and well-being of Ogle County. Through this process, the Committee hopes this IPLAN spurs greater resource-sharing and collaboration to address the needs of our community. Ogle County Health Department IPLAN 2015 4

Data The Community Health Needs Assessment process presents a comprehensive overview of Ogle County by describing characteristics of the population through secondary sources of information. The purpose of collecting this data is to provide a meaningful comparison of community health indicators defined in terms of disease, disability, death, or other adverse outcomes. At minimum, the IPLAN process requires the following seven categories: 1. Demographic and Socioeconomic Characteristics 2. General Health and Access to Care 3. Maternal and Child Health 4. Chronic Diseases 5. Infectious Diseases 6. Environmental, Occupational and Injury Control 7. Sentinel Events The Community Health Committee relied on the data presented to address the following three objectives: 1. Provide a demographic description of Ogle County. 2. Establish critical health issues and overarching critical issues that may have an indirect impact on health. 3. Describe the health of the county population and establish a basis of comparison using measures of morbidity, mortality, natality, or adverse health outcomes Ogle County Health Department IPLAN 2015 5

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2013 29,129 27,864 26,830 28,118 29,869 33,429 38,106 42,867 46,338 45,937 51,032 53,497 52,385 Demographic and Social Characteristics Population 80,000 Ogle County Population According to the U.S. Census Bureau, the population of Ogle County was approximately 52,385 residents in 2013. Since 2010, Ogle County has slowly been losing residents due to low birth rates and outmigration. The declining population is reflective of the overall economic health of Ogle County, which was harmed by the loss of manufacturing jobs in the early 2000s. 60,000 40,000 20,000 0 The majority of Ogle County residents are Non-Hispanic whites. Hispanics are the fastest growing population group in Ogle County, due to higher than average county birth rates and in-migration, particularly from Mexico. Since 2000, the percentage of Hispanic residents in Ogle County has increased by 48.3% Hispanic 9.0% Non- Hispanic Black, 0.9% Two+ races NH, 1.5% Asian NH, 0.6% Non- Hispanic White, 88.4% 2013 Ogle County Health Department IPLAN 2015 6

Median Age (years) Median Age (years) 37.2 35.3 37.2 37.6 40.7 41.0 Age 50.0 Ogle County Median Age Similarly to the rest of the United States, the median age of Ogle County has been steadily increasing. However, the median age of Ogle County is increasing at a faster rate than elsewhere in the United States. Older populations are often associated with higher prevalence of disease and disability, as well as higher medical costs. In Ogle County, the fastest growing age groups are 45-64, and 65+ years of age. Since 2000, the relative percentage of all age groups under 45 has decreased. 40.0 30.0 20.0 10.0 0.0 2000 2010 2013 Ogle County U.S. Ogle County Median Age by Race2010 There are noticeable differences by race and ethic group in median age. Non-Hispanic whites have the highest median age in Ogle County, 42.0, in 2010. Hispanics have the youngest median age at 22.8 years. This median age gap is consistent with trends throughout the United States. This phenomenon can be partly explained by Hispanic inmigration to Ogle County, as well as higher total fertility rate, which is the number of children the average woman is predicted to have in her life time, based on current agespecific age rates. For Hispanics, the U.S. total fertility rate is 2.4. For Non- Hispanic whites, the fertility rate is 50.0 40.0 30.0 20.0 10.0 0.0 42.0 Non-Hispanic White 23.5 Black 22.8 Hispanic Ogle County Health Department IPLAN 2015 7

Per Capita Personal Income $17,105 $20,833 $26,843 $29,690 $34,244 Percent of U.S. $41,695 Median Household Income $31,805 $31,846 $28,906 $40,696 $44,995 $45,214 $51,334 $52,250 $56,212 Income $60,000 Median Household Income In 1989, Ogle County had a higher median household income than Illinois and the United States. Since 2000, however, Ogle County has experienced lower income growth than Illinois and the U.S. In 2013, the median household income in the U.S. surpassed Ogle County for the first time. The relative decline Ogle County s is a confluence of factors, but the most likely culprit is the exodus of well-paying blue collar and manufacturing jobs around the year 2000. $40,000 $20,000 $0 Ogle County Illinois U.S. 1989 1999 2013 Ogle County has always had a lower per capita income than the U.S., even though median household income was higher than the U.S. average in the past. Residents in Ogle County are more likely to be married, and children are more likely to live in two-parent households compared to the U.S., which partly explains this difference. $50,000 $40,000 $30,000 $20,000 Per Capita Income 93% 100% 80% 60% 40% $10,000 20% $0 1990 1995 2000 2005 2010 2013 Ogle Percent of U.S. 0% Ogle County Health Department IPLAN 2015 8

Educ., Health, Soc. Asst. Manufacturing Retail trade Transp., Warehouse, Util. Prof., Scient., Mgmt., Admin. Arts, Ent., Rec., Accom., Food Serv. Construction Finance, Insur., Real estate Public admin.2 Ag., Forestry, Fish., Hunt., Mining Wholesale trade Information 9.5% 4.9% 12.2% 11.6% 7.5% 10.9% 6.6% 9.5% 6.3% 6.1% 4.0% 6.6% 3.7% 4.9% 2.6% 2.0% Percent Employed Ages 16+ 10.5% 2.8% 2.7% 1.7% 2.1% 17.5% 21.2% 23.2% 10.5% 8.5% 7.5% 5.9% 12.5% 7.9% 13.7% 13.0% 12.0% 10.9% Percent Population 25+ 21.2% 21.2% 19.6% 18.2% 27.2% 28.0% 26.1% 34.4% 50% Highest Educational Level, 2013 40% Ogle County Illinois 30% U.S. 20% 10% 0% Less than high school High school degree Some college, no degree Associate degree Bachelor's degree Graduate or professional degree Ogle County residents are significantly less likely to have earned a bachelor s or advanced degree compared to Illinois and the U.S. There are no colleges or universities located within Ogle County, which certainly contributes to the low percentage of adult residents without a degree. However, Ogle County residents are more likely to work in an industry that does not require additional education. Approximately 17.5% of Ogle County residents work in the manufacturing industry, compared to the U.S. average of 10.5%. 30% Ogle County Employment by Industry, 2013 25% 20% Ogle County U.S. 15% 10% 5% 0% Ogle County Health Department IPLAN 2015 9

Percent Change in Number of Employees All Industries Manufacturing Health Care and Social Services Retail Trade Educational Services 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 (Nov) Percent of Labor Force Unemployed Employment Since 2000, employment opportunities in Ogle County have become steadily worse than elsewhere in Illinois and the United States. 14% 12% 10% 8% Unemployment 6% 4% 2% 0% Ogle County Illinois U.S. According to Illinois Department of Employment Security, Ogle County has 6.3% fewer jobs in 2014 than in 2000. This drop in employment is largely driven by losses in the manufacturing sector, which has lost roughly 40% of its jobs since 2000. Ogle County Employment Change All and Top Industries: 2000 to 2014 Q1 30% 15% 0% 15.7% 16.8% 9.6% -15% -30% -6.3% -45% -39.1% Ogle County Health Department IPLAN 2015 10

Percent of Ogle Population Enrolled 2006 2007 2008 2009 2010 2011 2012 2013 General Health and Access to Care Health Insurance PERCENT UNINSURED: 2012 Group Ogle County Illinois Ogle County s residents are less likely to be uninsured than the state. However, the number of Ogle County residents uninsured or reliant on Medicaid has increased dramatically. Since 2006, enrollment in Medicaid has increased by 57.2% for all ages, and 67.3% among children. Age < 65 All income levels 12.0% 14.6% < 138% poverty 21.6% 26.1% < 200% poverty 23.1% 25.9% < 400% poverty 16.6% 20.6% Age 18-64 All income levels 15.3% 18.8% < 138% poverty 35.4% 38.5% < 200% poverty 33.2% 37.4% < 400% poverty 22.7% 28.3% Since 2011, more than half of all children in Ogle County have been enrolled in AllKids/Medicaid. These numbers do not include the adult Medicaid expansion due to the Affordable Care Act, which expands eligibility to adults who earn less than 138% of the federal poverty line. 60% 40% 20% 32.1% 13.8% Medicaid Enrollment 53.7% 21.7% All Ages 0% Children <18 Ogle County Health Department IPLAN 2015 11

Hospitalization Ogle County residents are admitted to the hospital at a similar rate to the rest of Illinois. The number one cause of hospitalization, heart disease, is the second leading cause of death in Ogle County. Ogle County has fewer medical providers per resident than Illinois on average. However, the majority of Ogle County residents receive care from neighboring Winnebago and Lee counties. Based on Hospital COMPData for 2013-2014 the hospitals that admitted the greatest share of Ogle County residents are: 1. SwedishAmerican, 27% 2. Katherine Shaw Berea, 17% 3. OSF Saint Anthony, 16% 4. Rockford Memorial, 13% 5. Rochelle Community Hospital, 7% 6. FHN Memorial Hospital, 4% 7. CGH Medical Center, 3% 8. Other, 13% Top Causes of Hospitalization Ogle County 2012 Number Rate Per 10,000 Illinois 2012 Heart Disease 614 116.2 100.0 Mental Disorders 369 69.8 101.3 Injury 222 42.0 39.8 Pneumonia/Influenza 174 32.9 32.4 Cancer 164 31.0 34.9 Stroke 144 27.2 27.7 Urinary Disorders 137 25.9 26.2 Septicemia 127 24.0 32.4 Spinal Disease 109 20.6 18.1 Rehabilitation 90 12.9 18.0 Gallstones 63 11.9 10.1 Diabetes 61 11.5 16.5 Health Professional Supply per population, 2013 Ogle County Illinois Primary Care Physicians 1 : 1,897 1 : 1,270 Mental Health Providers 1 : 1,391 1 : 844 Dentists 1 : 2,781 1 : 1,496 Ogle County Health Department IPLAN 2015 12

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Births Per 1,000 Population 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 600 589 589 571 569 608 643 606 608 557 566 547 520 499 Births Maternal and Child Health Births 1,000 800 Ogle County Births 600 400 200 0 20.0 Birth Rate 15.0 10.0 5.0 Ogle County Illinois 0.0 U.S. Similar to the rest of the United States, Ogle County has been experiencing a falling birth rate. The number of births peaked in 2006, but has declined to a record low in 2013. The lower birth rate in Ogle County is likely a function of population characteristics. 88.4% of Ogle County residents are Non-Hispanic White, which generally have lower fertility rates than Hispanics or blacks. Ogle County Health Department IPLAN 2015 13

Rate Per 1,000 Women Ages 15-19 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent of Births to Women <20 Teen Pregnancy 25% Teen Births Teen birth rates have steadily declined over the previous decades. Teen pregnancy has a direct impact on the socioeconomic outcomes of the mother and child. Teen mothers are more likely to live in poverty, and have lower levels of academic achievement. 20% 15% 10% 11.5% 9.3% 9.1% Teenage mothers are much less likely than older women to receive prenatal care, are more likely to smoke, and less likely to gain the recommended weight during their pregnancy all of which contribute to low birth weights and infant death. 5% 0% Teen Birth Rate, 2010 Ogle County Illinois U.S. 60.0 The teen birth rate in Ogle County is similar to elsewhere in the United States. Ogle County has approximately 60-70 teen births a year. 40.0 20.0 34.5 33.0 34.2 0.0 Ogle County Illinois U.S. Ogle County Health Department IPLAN 2015 14

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent of Births Weighing Under 2,500 Grams 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Percent of Births to Mothers Who Used Tobacco During Pregnancy Pregnancy Risks 30% Tobacco Use During Pregnancy Tobacco use during pregnancy remains a contributor to low birth weight and preterm births. 25% 20% Women who are pregnant are in Ogle County are significantly more likely to continue smoking during pregnancy compared to the rest of Illinois. Based on BRFSS data, approximately 18.4% of Ogle County adults smoke. 15% 10% 5% 0% Ogle County Illinois Linear (Ogle County) 10.0% Low Birthweight 9.2% Since 1995, Ogle County has seen a steady increase in the percentage of low birthweight infants 8.0% 8.3% 8.1% 6.0% 4.0% 2.0% Ogle County Illinois U.S. Linear (Ogle County) 0.0% Ogle County Health Department IPLAN 2015 15

1993-1995 1996-1998 1999-2001 2002-2004 2005-2007 2008-2010 Average Annual Infant Death Rate Per 1,000 Live Births 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent of Births Born Before 37 Weeks Gestation 20.0% Preterm Births 15.0% 12.1% Related to low birthweights, the number of preterm births in Ogle County has been steadily increasing since 1995. 10.0% 12.0% 5.0% Ogle County Illinois U.S. Linear (Ogle County) 0.0% 15.0 Infant Deaths The infant death rate in Ogle County is similar to elsewhere in Illinois and the United States. Approximately 1-5 infants die each year in Ogle County. 12.0 9.0 6.0 3.0 Ogle County Illinois 0.0 U.S. Ogle County Health Department IPLAN 2015 16

Chronic Disease Causes of Death Chronic diseases and conditions are among the most common, costly, and preventable of all health problems. Seven of the top 10 causes of death in Ogle County are chronic diseases. Cancer and heart disease, the two leading causes of death, account for 47% of all deaths in Ogle County. Rank Cause of Death Ogle County Number Rate 1 Illinois Rate 1 U.S. Rate 1 1 Cancer 116.3 223.3 189.1 185.2 2 Heart Disease 110.3 204.4 192.9 191.9 3 Chronic lower respiratory diseases 2 32.7 61.9 42.0 46.3 4 Stroke 27.3 51.8 41.4 41.0 5 Accidents 23.0 43.6 34.1 40.9 5 Alzheimer s disease 22.7 42.9 22.5 26.9 7 Nephritis 11.0 20.8 18.7 14.7 8 Hypertension/Renal Disease 9.3 17.7 7.7 9.3 9 Self-Harm 9.0 17.1 9.9 12.9 10 Parkinson s Disease 8.7 16.4 7.9 7.7 1 Per 100,000 population. Not age-adjusted 2 Previously known as chronic obstructive pulmonary disease (COPD) Source:Centers for Disease Control and Prevention, National Center for Health Statistics, CDC WONDER Ogle County Health Department IPLAN 2015 17

Chronic liver dis. & cirrh. 1% Parkinson's 2% Septicemia 1% Influen. & pneum. 1% Nephritis 2% Diabetes 2% Alzheimer's 5% Suicide 2% Cause of Death, Ogle County 2010-2012 Other 20% Heart disease 23% Cancer 24% Accidents 5% Stroke 5% Chronic lower resp. 7% Cancer and heart disease are the leading cause of death in Ogle County. The most common form of cancer in Ogle County is lung cancer, which accounts for 27% of all cancer deaths. Smoking is directly responsible for approximately 90 percent of lung cancer deaths and approximately 80-90% of chronic lower respiratory disease deaths. Cancer Mortality by Type, Ogle County 2009-2013 Other 26.7% Lung, bronchus 27.2% Mult. Myeloma 2.0% Esophagus 1.8% Prostate 4.4% Colon, rectum 9.6% Ovary 3.7% Non-Hodgkins lymphoma 3.7% Liver 2.5% Leukemia 5.2% Breast 7.3% Pancreas 5.9% Ogle County Health Department IPLAN 2015 18

ALL CAUSES Suicide Accidents Chr. liver, cirrhosis Cancer Diabetes Heart Chr. lower resp. dis Stroke Percent Deaths Before Age 65 22.4% 18.0% 16.6% 10.1% 11.1% 29.4% 50.0% 67.2% 89.5% Deaths Per 100,000 Standard Population 53.9 43.7 47.1 45.4 42.5 41.7 42.1 34.3 41.0 37.4 22.8 27.3 14.1 22.0 21.2 184.1 197.9 194.9 196.1 197.1 188.4 200.0 Age-Adjusted Death Rates, Ogle County 2011-2013 150.0 Ogle County Illinois U.S. 100.0 50.0 0.0 Heart Disease Cancer Chronic Lower Resp. Stroke Accidents Alzheimer's Diabetes Ogle County has a higher prevalence of all diseases in the top ten causes of death compared to Illinois. However, this difference largely disappears when comparing age-adjusted death rates. Higher crude death rates are largely a function of Ogle County s older population. 22.3% of Ogle County residents die before the age of 65, compared to 27.3% of U.S. residents. Suicide, accidents, and cirrhosis are the three causes of death that disproportionately affect residents under the age of 65. Cancer, however, is still the most common cause of death for residents under the age of 65. 100.0% Ogle County Deaths before age 65: 2009-2013 80.0% 60.0% 40.0% 20.0% 0.0% Ogle County Health Department IPLAN 2015 19

Obesity Overweight and obesity are both labels for ranges of weight which are generally considered unhealthy for a given height. Body Mass Index (BMI) is a common standard for calculating whether an adult is overweight or obese. For most people, a person s BMI correlates with their amount of body fat. An adult with a BMI 25 or greater is overweight, and an adult with a BMI of 30 or greater is considered obese. According to 2007 BRFSS data, approximately 64.1% of Ogle County residents are obese, compared to 62.1% of Illinoisans. Based on 2013 Illinois Youth Survey data, Ogle County high school students are less likely to be obese than their Illinois counterparts. Weight, 2007 BRFSS 16% 14% 12% 10% 8% 6% 4% 2% 0% Status PERCENT OF ADULTS 18+ Ogle County Illinois Overweight 35.7% 37.6% Obese 28.4% 24.4% Percent Obese According to BMI by School Grade 6th 8th 10th 12th Ogle County Illinois Ogle County Health Department IPLAN 2015 20

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Rate Per 100,000 Population 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Rate Per 100,000 Population Infectious Disease STDs Sexually transmitted diseases remain a significant health challenge in the United States. Each infection poses a risk to an individual s immediate and long-term health and well-being. In addition to increasing a person s risk for HIV infection, STDs can lead to severe reproductive health complications, such as infertility. Half of all new STD infections occur among young people aged 15-24. Men who have sex with men are disproportionately at risk for contracting an STD. 72% of all new syphilis cases are among MSM. The rise in Chlamydia rates is most likely explained by increased screening, the expanded use of more sensitive tests, and more accurate reporting. 600.0 500.0 400.0 300.0 200.0 100.0 0.0 350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 Chlamydia Ogle County Illinois Illinois except Chicago Gonorrhea Ogle County Illinois Illinois except Chicago Ogle County Health Department IPLAN 2015 21

2007 2008 2009 2010 2011 2012 2007 2008 2009 2010 2011 2012 Environmental, Occupational, and Injury Control Motor Vehicles Motor vehicle deaths remain the single largest cause of accidental death in Ogle County, accounting for 38.8% of all accidental deaths from 2009-2013. 2,000 1,600 1,200 800 Ogle County Motor Vehicle Crashes Motor vehicle crashes and injuries have declined significantly since 2007. 400 0 300 Ogle County Motor Vehicle Persons Injured 200 188 100 0 Ogle County Health Department IPLAN 2015 22

Deaths Per 100,000 Deaths Per 100,000 Population 3.2 6.4 7.3 7.6 11.7 13.7 Drug Overdoses 15.0 Drug Overdose Deaths Fatal drug overdoses have increased consistently across the United States, including Ogle County, for the past 15 years. Fatal prescription drug overdoses over the last decade outnumber deaths from heroin and cocaine combined 12.0 9.0 6.0 According to the National Center for Health Statistics, approximately 60% of all overdoses in the United States involved known prescription drugs. Nearly 75% of all prescription drug deaths are accidental. Only 17% of overdoses are suicide. 12.1% of accidental deaths from 2009-2013 in Ogle County were poisonings, which includes drug overdose deaths. 3.0 0.0 15.0 Ogle County Illinois U.S. 1999-2004 2009-2013 Ogle County Drug Overdose Death Rates by Age Group,1999-2011 Drug overdose deaths are consistent across age groups. 12.0 11.7 11.3 9.0 6.0 3.0 0.0 15-34 35-54 Ogle County Health Department IPLAN 2015 23

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Number 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Drug Arrest Rate Per 100,000 Population Drug Arrests Drug arrests have been consistently on the decline over the previous decade, even as drug overdose deaths have continued to increase. Most drug overdose deaths are due to an increase in prescription drug overdose deaths, which are not well-reflected in arrest statistics. 800.0 600.0 400.0 Ogle County Total Drug Arrests The decline in drug arrests is largely a decline in the number of cannabis/marijuana arrests and drug paraphernalia arrests, which are often related to cannabis arrests. 200.0 0.0 Total Drug Arrests Ogle County Linear (Total Drug Arrests Ogle County) 200 Ogle CountySpecific Drug Offenses 175 150 125 100 75 50 25 0 Drug Paraphernalia Controlled Substances Cannabis Hypodermic Syringe Ogle County Health Department IPLAN 2015 24

Rate Per 100,000 Population Crime 3,500.0 Crime Rates, 2013 3,000.0 Crime remains significantly lower in Ogle County than elsewhere in Illinois 2,500.0 2,262.8 2,000.0 Three-quarters (75.3%) of Ogle County s 2013 reported crimes were theft, which is consistent with crime throughout Illinois. 1,500.0 1,000.0 500.0 0.0 608.9 47.6 Ogle County Violent 387.7 Illinois Property Violent Offense Type: 2013 Assault/battery 30.5 215.0 Forcible rape 7.6 30.1 Robbery 3.8 137.0 Criminal homicide 5.6 5.7 Illinois Ogle County 0.0 50.0 100.0 150.0 200.0 250.0 300.0 Rate Per 100,000 Population Ogle County Health Department IPLAN 2015 25

Sentinel Events Suicide and Accidental Death Ogle County residents are significantly more likely to commit death by suicide than Illinois residents. 89 Ogle County residents died by suicide from 1999-2013. 49.4% of suicides committed by firearms and 36.0% committed by suffocation or hanging. 2011-2013 Deaths by Suicide Annual Rate Per 100,000 Ogle County Total 17.1 8.7 Illinois Ogle County residents more likely to commit suicide by firearm than rest of U.S. The leading cause of accidental death is motor vehicle accidents Accidental poisoning deaths from drug overdoses have more than doubled over the previous decade (see pg. 23). Ogle County Accidental Deaths by Injury Mechanism: 2009-2013 Other 19.8% Unspecified 8.6% Motor vehicle 38.8% Fall 20.7% Poisoning 12.1% Ogle County Health Department IPLAN 2015 26

Community Participation A 20-member Community Health Committee was formed to conduct a community needs assessment. Members of the Committee volunteered their time and expertise to help Ogle County Health Department identify health problems within our community. Committee members were asked to: Identify and prioritize health problems based on presented data and their experience working in the community. Use their expertise to present their perspective on community health problems. Participate in developing and recommending a Community Health Plan for the county. Four staff members of Ogle County Health Department guided the discussion and development of a Community Health Plan, including Lucinda Bauling, Ogle County Health Department Administrator; Joanie Padilla, Director, Health Education and Emergency Preparedness; Brian Kennedy, Public Health Associate; and Ednice Wagnac, AmeriCorps Fellow. See Attachment I for a full listing of committee members. Process Convening the Community Health Committee The Committee met three times to discuss data presented for the Community Health Assessment and determine health priorities: February 11, 2015: Introduction of IPLAN process, priority issues from last IPLAN, presentation and review of data. March 4, 2015: Overview of Ogle County Health Department programs and funding, identification of community health problems, health problem priority setting. March 30, 2015: Identify community resources, barriers to success, and identify indirect contributing factors for heart disease, cancer, and obesity. Ogle County Health Department 27

Committee members were selected to provide a diverse representation of organizations within Ogle County. Members were informed of their role and responsibility in the Community Health Assessment process through an introductory letter prior to the first meeting. At the first meeting, data were presented covering the following topics: population, race, housing, ethnicity, gender, marriage and divorce, education, employment, crime, births (natality), morbidity, mortality (deaths), health status and behaviors, and utilization of available resources. A total of twenty potential priorities were identified for potential inclusion in the Community Health Improvement Plan. Ten of the potential priorities were determined by a measure of premature mortality, years of potential life lost. The remaining ten priorities were determined qualitatively through discussion by the Community Health Committee. The following potential priorities were identified and discussed: 1. Access to Care 2. Accidents 3. Asthma 4. Cancer 5. Chronic Lower Respiratory Disease 6. Diabetes 7. Elder Abuse 8. Health Wellness/Fitness 9. Heart Disease 10. Hypertension/Renal Diseases 11. Mental Health 12. Obesity 13. Perinatal Deaths 14. Pneumonia/Influenza 15. Prenatal Care 16. Smoking 17. Stroke 18. Suicide 19. Worsening Economic Conditions 20. Youth Substance Abuse After discussing these priorities, the Community Health Committee individually scored these health problems using a Hanlon tool. Each health problem was evaluated and scored using the following: 1. Size of the problem based on the percentage of the population affected. 2. Seriousness of the problem determined by morbidity, mortality, economic loss, public demand, or impact on quality of life. 3. Effectiveness of interventions, including the ability of the Health Department to implement and effect change. Ogle County Health Department IPLAN 2015 28

Using the Hanlon Method, the identified health problems were given the following scores. Higher scores indicate higher priority: 1. Heart Disease 2. Cancer 3. Obesity 4. Health Wellness/Fitness 5. Pneumonia/Influenza 6. Diabetes 7. Mental Health 8. Youth Substance Abuse 9. Hypertension/Renal Disease 10. Smoking 11. Prenatal Care 12. Asthma 13. Access to Care 14. Stroke 15. Suicide 16. Elder Abuse 17. Chronic Lower Respiratory Disease 18. Worsening Economic Conditions 19. Perinatal Deaths 20. Accidents 2422 2162 1949 1925 1863 1857 1834 1811 1801 1759 1750 1582 1577 1550 1424 1367 1345 1306 1271 1046 Heart disease, cancer, and obesity were identified as the top three focus areas for Ogle County Health Department. However, many of these health priorities bear a direct relationship with each other as risk factors or direct contributing factors for another health priority. Diabetes, for example, is a risk factor for heart disease. Reducing the prevalence of diabetes within our community will also affect the prevalence of heart disease. Analysis of Community Health Problems At the third and final meeting of the committee, members discussed the factors that cause or may contribute to the priority health problems in our community. The Health Problem Analysis Worksheets detail the identified causes for heart disease, cancer, and obesity. (See Attachment IV). Ogle County Health Department IPLAN 2015 29

Risk Factor: Scientifically established factors (determinants) that relate directly to the level of the health problem. Direct Contributing Factor: Scientifically established factors that directly affect the level of a risk factor. Indirect Contributing Factor: Community-specific factors that directly affect the level of the direct contributing factors. After identifying indirect community-specific factors that contribute to the priority health problems, the Community Health Committee discussed community health resources and potential barriers that might mitigate or prevent effective intervention. Development of a Community Health Plan After the final meeting of the Community Health Committee, Ogle County Health Department began development of a Community Health Plan to determine how to best address the identified health priorities. The Community Health Plan is detailed in the following worksheets and accompanying explanation section for each health problem. The Community Health Plan describes each priority health problem (including risk, direct, and indirect contributing factors), corrective actions, community partnerships, and an evaluation plan to track progress towards impact objectives. Each identified health problem has at least one outcome objective, impact objective, and proven intervention strategy. The selected objectives are aligned with CDC s Healthy People 2020 objectives, which were designed to provide measurable objectives, and goals that are applicable at the national, State, and local levels. All of the selected outcome and impact objectives are specific objectives outlined in CDC s Healthy People 2020. Community resources and potential barriers to the identified objectives are also outlined within the plan. Purpose The Community Health Plan was developed collaboratively with community partners to create a shared action plan for improving the health of Ogle County. The purpose of the Community Health Plan is to outline strategies and partnerships for addressing the leading health priorities identified in the Community Health Needs Assessment. The Community Health Improvement Plan establishes long-term objectives and measures for determining progress made towards reducing the harm of leading health problems in the community. Ogle County Health Department IPLAN 2015 30

Community Health Plan Worksheet Health Problem: Cancer Risk Factor(s): 1. Tobacco/Smoking 2. Dietary Behaviors 3. Environmental Causes 4. Genetics Contributing Factors: 1. Addiction to nicotine, lack of quit knowledge, tobacco marketing/peer influence. 2. Lack of dietary knowledge, overweight/obese, social/community Outcome Objective(s): 1. By 2020, increase the proportion of adults who were counseled about cancer screening consistent with current guidelines. 2. By 2020, increase the proportion of persons who participate in behaviors that reduce their exposure to harmful ultraviolet (UV) irradiation and avoid sunburn. 3. By 2020, reduce the initiation of tobacco use among children, adolescents, and young adults from 35.0% to 31.0%. 4. By 2020,, reduce tobacco use by adolescents from 22.4% baseline to 20.0% past month use. 5. By 2020, reduce tobacco use by adults from 18.4% to 17.0%. 6. By 2020, increase smoking cessation attempts by adult smokers. Impact Objective(s): 1. By 2019, reduce the overall cancer death rate from 223.3to 200.0/100,000. 2. By 2019, reduce the lung cancer death rate from 65.0to 58.0/100,000. 3. By 2019, reduce the proportion of youth that experiment with tobacco products from 35.0% to 31.0%. 4. By 2019, increase the proportion of adults who received screenings at USPSTF recommended intervals by 10% above baseline. Proven Intervention Strategies: 1. Increasing tobacco use cessation: Quitline interventions. 2. Reducing tobacco use and secondhand smoke exposure. 3. Preventing tobacco use among youth Ogle County Health Department IPLAN 2015 31

norms. 3. Exposure to toxins, sun/uv exposure, air quality. 4. Lack of screening, family history. and young adults. Resources Available: 1. All About Me program through Rochelle Community Hospital. 2. Breast cancer awareness programs. 3. Cancer screenings available through health insurance policies with no cost sharing. 4. Funding for comprehensive tobacco control program available through IDPH. 5. Tanning salon inspection grant. Barriers: 1. Tobacco control funding cut due to state budget concerns. 2. Marketing/outreach of programs in rural area. 3. Access/cost of healthcare Ogle County Health Department IPLAN 2015 32

Health Problem: Heart Disease Risk Factor(s): 1. Tobacco/Smoking 2. Diabetes 3. High Cholesterol 4. Hypertension Outcome Objective(s): 1. By 2020, increase the proportion from 64.4% to 70.0% of adults who have had their blood pressure within the preceding 1 year and can state whether their blood pressure was normal or high. 2. By 2020, increase the proportion from 92.1% to 96.0% of adults who have had their blood cholesterol checked within the preceding 5 years. 3. By 2020, reduce the initiation of tobacco use among children, adolescents, and young adults. 4. By 2020, reduce tobacco use by adolescents from 22.4% to 20.0%. 5. By 2020, reduce tobacco use by adults from 18.4% to 17.0%. 6. By 2020, increase the number of smoking cessation attempts by adult smokers to the Illinois Quitline by 15% over current baseline. Impact Objective(s): 1. By 2019, reduce the coronary heart disease death rate from 204.4to 190.0/100,000. 2. By 2019, reduce the proportion of youth and adults that use tobacco products from 35% to 31%. 3. By 2019, reduce the proportion of adults classified as overweight or obese from 64.1% to 60.0%. 4. By 2019, reduce the proportion of obese Ogle County 6 th graders from 14.0% to 12.0%. Ogle County Health Department IPLAN 2015 33

Contributing Factors: 1. Addiction to nicotine, lack of quit knowledge, tobacco marketing/peer influence 2. Overweight/obese, lack of physical activity, genetics. 3. Overweight/obese, lack of physical activity, lack of healthcare. 4. Overweight/Obese, lack of physical activity, stress. Resources Available: 1. Pre-diabetes awareness program through Rochelle Community Hospital. 2. Tri-County Youth Enrichment Services 3. Master gardeners and free education/programs through University of Illinois-Extension. 4. Community gardens 5. Free space/kitchens available through community partners Proven Intervention Strategies: 1. Increasing tobacco use cessation: Quitline interventions. 2. Reducing tobacco use and secondhand smoke exposure. 3. Preventing tobacco use among youth and young adults. 4. USPSTF recommended blood pressure and cholesterol screenings. Barriers: 1. Not enough demand for current programs. 2. Marketing/outreach is difficult in rural county. 3. Funding/Categorical Funding 4. Health behavior resistance to change. 5. Low staffing levels. Ogle County Health Department IPLAN 2015 34

Health Problem: Obesity Risk Factor(s): 1. Dietary Behaviors 2. Lack of Physical Activity Contributing Factors: 1. Lack of dietary knowledge, poor nutrition, social/community norms. 2. Depression, built environment, stress. Resources Available: 1. Community gardens 2. Free education and training available through community organizations 3. Some organizations have worksite wellness programs. Outcome Objective(s): 1. By 2020, increase the variety and contribution of vegetables to the diets of the population aged 2 years and older. 2. By 2020, reduce the consumption of calories from solid fats and added sugars in the population aged 2 years and older. 3. By 2020, increase the proportion of worksites or employers with worksite wellness programs. Impact Objective(s): 5. By 2019, reduce the proportion of adults classified as overweight or obese from 64.1% to 60.0%. 6. By 2019, reduce the proportion of obese Ogle County 6 th graders from 14.0% to 12.0%. Proven Intervention Strategies: 1. Worksite-based interventions and policies to improve employee health. 2. Improve weight status through worksite health promotion programs that target nutrition, physical activity, or both. Barriers: 1. Lost funding- no worksite wellness through We Choose Health 2. Not enough demand for produce from community gardens 3. Marketing/outreach for programs in rural area. 4. Access to healthcare/cost. 5. Built environment, reliance on cars. Ogle County Health Department IPLAN 2015 35

Community Health Plan Explanation Cancer Description of the Health Problem, Risk Factors and Contributing Factors (including high risk populations, and current and projected statistical trends): Cancer is the leading cause of death in Ogle County 2011-2013, and the second leading cause of death in the United States. Residents of Ogle County are more likely to die from cancer (220.4 deaths per 100,000 population) than the United States as a whole (185.2). However, differences in death rate are largely a function of Ogle County s population, which is significantly older than the United States as a whole. The age-adjusted cancer death rate for Ogle County (171.1) is similar to the adjusted death-rate for the United States (166.2). Lung cancer is the leading form of cancer in Ogle County, and responsible for roughly 29% of all cancer-related deaths. In the United States, roughly 90% of lung cancers are linked to cigarette smoking. Individuals who smoke are 15 to 30 times more likely to develop or die from lung cancer than people who do not smoke. Currently, 18.4% of adults in Ogle County smoke cigarettes, compared to the U.S. average of 18.1%. Healthy People 2020 The cancer objectives for Healthy People 2020 support monitoring trends in cancer incidence, mortality and survival to better assess the progress made toward reducing the burden of cancer in the United States. Many forms of cancer are preventable by reducing risk factors such as: Use of tobacco products Physical inactivity and poor nutrition Obesity Ultraviolet light exposure. Some cancers can be prevented by vaccinations, such as forms of cervical or liver cancer. In some cases, screening is effective at identifying some types of cancer, including breast, cervical, and colorectal cancer. Selected objectives and interventions are aimed at the following Healthy People 2020 objectives: C-1: Reduce the overall cancer death rate C-2: Reduce the lung cancer death rate Ogle County Health Department IPLAN 2015 36

C-18 Increase the proportion of adults who were counseled about cancer screening consistent with current guidelines C-20: Increase the proportion of persons who participate in behaviors that reduce their exposure to harmful ultraviolet (UV) irradiation and avoid sunburn TU-1: Reduce tobacco use by adults TU-2: Reduce tobacco use by adolescents TU-3: Reduce the initiation of tobacco use among children, adolescents, and young adults TU-4: Increase smoking cessation attempts by adult smokers Corrective Actions Ogle County Health Department receives approximately $24,000 through Illinois Department of Public Health to implement a tobacco prevention and control program at the local level. Local and community-based tobacco programs are vital to mitigate morbidity and mortality associated with tobacco use in Ogle County. Ogle County Health Department s current tobacco control program is aligned with CDC s Best Practices for Comprehensive Tobacco Control Programs, The Guide to Community Preventive Services, and Designing and Implementing an Effective Tobacco Counter-Marketing Campaign. With these best practices in mind, Ogle County will focus efforts on the following goals: Prevent tobacco use among youth. Promote tobacco cessation and adults and youth. Eliminate exposure to secondhand smoke. Identify and eliminate tobacco-related health disparities among specific population groups. Ogle County Health Department receives $5,000 of funding through REALITY Illinois to promote youth anti-tobacco strategies. Ogle County Health Department will work with youth to promote tobacco-free messaging and anti-tobacco activities within Ogle County. Nearly 9 out of 10 smokers first tried cigarettes by age 18, and 99% first tried cigarettes by age 26. Preventing initiation among youth and young adults is an integral part of an effective tobacco control program. Ogle County will actively work with community partners to promote community policy changes that reduce the harm of smoking, such as retail tobacco licensing or strengthening public smoking restrictions. Ogle County Health Department IPLAN 2015 37

Anticipated Funding Needs OCHD receives approximately $30,000 for tobacco control activities, which supports the majority of activities listed in this section. State funding cuts to tobacco control, however, would severely diminish OCHD s ability to initiate meaningful changes in our community. Expanding current cancer-related activities and partnerships to include other activities, such as cancer screening outreach, would require additional funding. Total anticipated funding needs: $40,000. Current unfunded need: $10,000. Evaluation Ogle County Health Department will monitor and periodically review process measures (e.g. number of Illinois Quitline referrals, number of media messages) to determine progress towards anti-tobacco program goals. Progress towards outcome and impact objectives will be measured through routine surveillance systems, such as BRFSS and IYS data. Heart Disease Description of the Health Problem, Risk Factors and Contributing Factors (including high risk populations, and current and projected statistical trends): Heart disease is the second leading cause of death in Ogle County, and the leading cause of death for the United States. Residents are more likely to die from heart disease (209.0 deaths per 100,000 population) than the U.S. average (191.9). However, differences in death rate are largely a function of the Ogle County population, which is significantly older than the U.S. older as a whole. The age-adjusted heart disease death rate for Ogle County (160.3) remains lower than the U.S. average (171.3). According to 2009 BRFSS data, 25.7% of Ogle County adults suffer from high blood pressure. In the past year, 64.4% of Ogle County adults received a cholesterol check, whereas 7.9% of adults report never receiving a cholesterol check. Ogle County Health Department IPLAN 2015 38

Healthy People 2020 According to Healthy People 2020, heart disease and stroke are among the most preventable health problems facing the United States. The heart disease objectives outlined in Healthy People 2020 are aimed at improving cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attacks and stroke. Healthy People 2020 identifies the following risk factors that an individual can control to reduce the risk for heart attack and stroke: High blood pressure High cholesterol Cigarette smoking Diabetes Poor diet and physical inactivity Overweight and obesity These risk factors can cause changes to the heart and blood vessels, and eventually cause heart attacks, heart failure, or strokes. Selected interventions and objectives are aimed at the following Healthy People 2020 objectives: HDS-2: Reduce coronary heart disease deaths HDS-5: Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high HDS-6: Increase the proportion of adults who have had their blood pressure checked within the preceding 5 years HDS-7: Reduce the proportion of adults with high total blood cholesterol levels TU-1: Reduce tobacco use by adults TU-2: Reduce tobacco use by adolescents TU-3: Reduce the initiation of tobacco use among children, adolescents, and young adults TU-4: Increase smoking cessation attempts by adult smokers Ogle County Health Department IPLAN 2015 39

Corrective Actions Ogle County Health Department will provide worksite wellness materials and education as resources permit. Currently, OCHD does not receive dedicated funding to provide or promote wellness activities. OCHD will also work to coordinate and promote Ogle County Health Department will maintain its comprehensive tobacco control program, as described in the Cancer section. Ogle County will provide free or low-cost cholesterol checkups and wellness screenings at community events and wellness fairs. Rochelle Community Hospital will host a pre-diabetes awareness program to help individuals reduce their risk of developing diabetes and heart disease. Oregon Park District will offer discounted gym memberships to community businesses and provide fitness classes to Ogle County residents for a fee. University of Illinois Extension Office will provide educational classes and training to members of the community, including: Meals for A Healthy Heart, Living Well with Diabetes Support Group, I on Diabetes, Worksite Wellness, SNAP Ed, Agriculture in the Classroom, and general nutrition classes on a variety of topics. Anticipated Funding Needs Ogle County Health Department receives approximately $30,000 in funding for tobacco control, which targets a key risk factor for heart disease. Expanding activities to better address other risk factors would require additional funding. Current unfunded need: $5,000. Evaluation Plan Ogle County Health Department will periodically review process data, such as the number of individuals who receive a specific service or attend an educational seminar. Outcome and impact objectives will be monitored through routine surveillance systems like BRFSS. Ogle County Health Department IPLAN 2015 40