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Date Week 4 Application Community Health Assessment for Pitt County, North Carolina Community health assessment is key to understanding the health problems and priorities of a population. This Application Assignment outlines a process by which you can complete a health assessment of a community using indicator-based methods. You will construct a set of health indicators from a variety of domains, evaluate problems, and report on the health priorities for a community. Sections AC ask questions about assessment in general. Section D involves assessment of a particular county in North Carolina, information on which is provided in that section and in the Appendix. Instructions Save this document to your computer and complete all questions in Sections AD below. Submit by the end of Week 4 following the submission instructions in the Week 4 Application section. Section A Community Health Assessment The goal of public health is to improve the health of a population. Public health interventions such as safe water sources, immunization programs, and improved motor vehicle safety regulations account for the majority of years of life expectancy gained in the United States over the last 100 years. A community health assessment involves obtaining and interpreting information to determine the health status of a specific community. Once community health needs are identified, public health interventions can be developed and their effectiveness evaluated using a similar approach. Information necessary for performing a community health assessment, for example data on mortality rates or behavioral risk factors such as smoking, is available from various sources. Questions How do you define community What stakeholders (groups/organizations) would you want to consult with for a community assessment What types and sources of data would you use for a community assessment Section B Healthy People 2010 The Healthy People 2020 initiative is a national approach that identifies high priority health issues and establishes objectives to reduce the impact of these public health threats. To understand the significance of data on your own community, you have to be able to compare it to another standard. The questions in this section ask you about other standards that can be used. Questions How are Healthy People 2020 standards used What are advantages and disadvantages to applying them at a local community level (Note you may use the Healthy People 2010 standards if the 2020 standards are not reported.) What other standards (national, state, or local) can be used Section C Health Indicators For this exercise, you will use an indicator approach to develop a community health assessment. A community health assessment involves three-step feedback loop. The first step in such an assessment involves identifying important health indicators. The second step involves matching those indicators with available data. In the third step, standards such as those explored in Section B are applied to the data gathered in the first two steps to transform it into useful information about health needs of the population. Health indicators are measurable health outcomes, such as death rate, insurance coverage measures, immunization rates, or other data items that are relevant to the health of a community. Indicators are thoughtfully selected data points that provide useful information about the health of a community. Note that each indicator should be An important health problem. Prevalent or common in the community of interest. Measurable on a community or population basis. There should be population data on a local level that is easily availablethis cannot be collected from health facilities or providers because these data sources do not apply to the entire community. Ideally, because we want to use a limited number of indicators, the indicator should not be redundantnot measure the same thingas another chosen indicator. To organize indicators, it is helpful to identify major areas of focus. For this case, we will refer to these broad categories of public health concerns as domains. Please refer to Table 1 below for examples of domains. For each domain, an example of an indicator is provided. Table 1 List of Domains to Assist Developing a Community Health Assessment DomainExample of an IndicatorCommunicable Diseases (including Sexually Transmitted Diseases)Incidence of Gonorrhea Chronic Diseases (including Cancer)Incidence of Diabetes Injury and ViolenceHomicide rateMaternal and Child HealthChildhood immunization rateEnvironmental Health Rates of Lead PoisoningAccess to Health CareRates of Uninsured Question How you would obtain data for these indicators. What sources might you use Select 2 of the indicators above and provide specific sources of information on them (including URLs) for your own community or state. Section D Performing a Community Health Assessment As a consultant to Pitt County Health Department, you are asked to perform a community health assessment for the county. Below is information about the county Pitt County is located in eastern North Carolina and has a population of 138,690 residents (2005 Census). Pitt County has been classified as urban for the first time in 2006. It and the surrounding counties are largely rural with a history of dependence on tobacco farming. Caucasians make up about 62.8 of the population, African Americans 33.6, Hispanics 3.2, Asians 1.1 and American Indians 0.3. There are an estimated 6,606 migrant and seasonal workers or 5.4 of the population. About 18 or 26,000 adults in Pitt County adults have household incomes below the federal poverty level with a median per capita income of 18,243 (2000). The child poverty rate is estimated to be 21.8. Approximately 20 of adult lack health insurance. Pitt County contains Greenville, the largest city in eastern North Carolina with a population of 67,525 (2005). Greenville is considered the hub of eastern North Carolina. The major employers are Pitt County Memorial Hospital (PCMH), Brody School of Medicine and East Carolina University. If a state was created of all the land in North Carolina east of Interstate 95, it would be the poorest of all 50 states. In addition, it would rate 48th in terms of premature mortality. Consider these factors when evaluating populations at risk and targeting resources for public health activities. You now embark on the steps needed to perform your assessment. STEP ONE IDENTIFYING HEALTH INDICATORS As noted earlier, the first step in a community health assessment is identifying health indicators. Develop a list of 18-20 indicators you would want to use in your assessment, identifying 3-4 indicators per domain. Complete the column on the right in this table DomainIndicator (provide 3-4 per domainCommunicable Diseases (including Sexually Transmitted Diseases)Chronic Diseases (including Cancer)Injury and ViolenceMaternal and Child HealthEnvironmental Health Access to Health Care STEP TWO MATCHING THE INDICATORS Now that you have chosen indicators to use for a community health assessment, use the information provided in the tables below (Appendix) to match available data to your chosen indicators. In this example, residents of Pitt County constitute the community. If the Appendix does not give you the data for your indicator, you should choose another indicator (alternatively, you may seek out the data elsewhere that you need for your proposed indicator). Question Have you matched each of your indicators to the data available in the Appendix If not, explain how and where you got the data needed for your proposed indicator. STEP THREE SETTING HEALTH PRIORITIES Using the information gathered in the first two steps, please answer the following questions. Note Keep in mind that in order to plan an effective intervention program in real life, you must communicate with other constituents and stakeholders and see what they perceive to be priority health issues. Collaboration with community stakeholders in program design is critical to the success of an intervention plan. For this purposes of this assignment, however, you are reviewing the data on your own, without the input from other stakeholders. Questions Looking at this data only, what would you conclude are three priority health issues for this population (Can be picked by how the indicator compares) Choose three of your indicators. Compare them to the Healthy People 2020 Standards (or 2010 if appropriate) and provide URL(s) for the relevant Web page from Healthy People to the specific indicator. How do you explain the health disparities of these indicators (i.e., as shown by this comparison with HP You have completed this Application on assessment. Submit this completed form in the Dropbox following the submission instructions in the Week 5 Application area. APPENDIX 1 DATA TABLES Community Health Assessment Indicators Pitt County (NC), North Carolina, and the United States Domain Maternal and Child Health (2004) IndicatorPitt CountyNorth CarolinaUnited StatesInfant mortality rate per 1,000 live births (2004) 7.1 8.8 6.9 Black infant mortality per 1,000 live births 8.1 15.6 14.1 White infant mortality per 1,000 live births 7.0 6.2 5.8Neonatal infant mortality rate per 1,000 live births(28 days of age) (2000-2004) 5.7 6.0 4.6 Black neonatal infant mortality rate 8.911.2 7.3 White neonatal infant mortality rate 3.3 4.1 3.8Low birth weight (2,500 g) per 100 births (2004)11.6 9.1 7.9 Minority births 2500 g15.913.4 13.0 White births 2500 g 8.3 7.4 6.5Very low birth weight (1500 g) per 100 births (2000-2004) 2.8 1.9 1.4 Minority births 1500 g 3.3 3.6 3.0 White births 1500 g 2.4 1.0Teen pregnancy rate per 1,000 teens (ages 15-19)(2000-2004)39.864.1 (11.9) 83.6 Minority pregnancies54.587.3153.3 White pregnancies27.053.6 71.4Smoked during pregnancy 8.9 12.5 11.4Postneonatal infant mortality per 1,000 live births (28 days 1 year) (2000-2004) 1.4 2.8 2.3 Black postneonatal rate 1.1 4.5 4.8 White postneonatal rate 1.7 2.1 1.9Immunization status at 2 years of ageNA82Immunization status at school entryNA99 BRFSS for 2004 Age adjusted ratesPitt CountyNorth CarolinaAdult disability 28.3 25.0Current asthma 7.1 6.4Smoking women of childbearing age 30.4 24.4Smoking everyday men 32.9 37.6Obesity 26.1 22.7Binge drinking (childbearing age) 9.5 6.8Binge Drinking (all) 12.0 8.4 Men 19.8 Women 3.1No leisure time physical activity 26.4 26.3Are any firearms kept in your home 39.6 40.9 Domain Access to CareIndicatorPitt CountyNorth CarolinaUnited States No medical insurance 20.8 17.5 16.5 Children with no health insurance 14.3 12.5 9.8 Children enrolled in Medicaid 36.7 32.6 26.0 Children enrolled in NC Health Choice 5.2 5.9 NAPrimary Care Physicians/100,000 population 149 83.5Dentists/100,000 population 37.8 40.5 58.4Kindergarten Tooth Decay Rates 27.7 22 26 whites 36 A-A 43 HispanicBRFSS 2001Eastern NCNorth CarolinaCost as barrier to health insurance 16.5 11.5No usual place of care 24.0 22.1No dental insurance 52.7 45.3 Domain Communicable DiseasesIndicatorPitt CountyNorth CarolinaUnited StatesTB rate per 100,000 population (2004) 5.0 4.5 4.9Hepatitis A rate per 100,000 population 2004 17 cases 12.1 (2004) 3.65 (2003) 2.6 (2003)Hepatitis B rate per 100,000 population 2004 11 cases 7.0 (2004) 1.9 2.6Hepatitis C rate per 100,000 population 2004 4 cases 2.9 0.2 0.4 DomainSexually Transmitted Diseases IndicatorPitt County North CarolinaUnited StatesGonorrhea rate per 100,000 population 347.8181.3 113.5 Black rate 848.3673.8 629.6 White rate 52.6 38.4 33.3Chlamydia rate per 100,000 population 645.9313.3 319.6 Black rate1206.4929.71209.4 White rate 216.2116.3 143.6Syphilis rate per 100,000 population 3.2 8.9 2.7 Black rate 8.0 15.3 9.0 White rate 1.3 1.1 1.6HIV rate per 100,000 population 18.0 25.2 20.7 Black rate 38.8 76.6 76.3 White rate 7.2 9.6 9.0 Domain Cancer (2000)IndicatorPitt CountyNorth CarolinaUnited StatesLung Cancer Mortality rate per 100,000 population 68.7 61.6 54.2 Incidence rate per 100,000 78.8 69.7 67.5Breast Cancer (Female) Mortality rate per 100,000 females 27.7 26.5 14.4 Female incidence per 100,000 females167.5149.5 132.2Colon/Rectum Cancer Mortality rate per 100,000 population 22.7 20.0 19.1 Incidence rate per 100,000 males 64.7 48.4 52.0Prostate Cancer Mortality rate per 100,000 males 36.7 36.9 31.5 Incidence rate per 100,000 males 154.5152.5 166.7Incidence All Cancer 494.3445.3 Domain Chronic Diseases IndicatorPitt CountyN.C. (1999-2002)United States (2003)Heart disease Mortality rate per 100,000 population248.5 246.6235.4Stroke Mortality rate per 100,000 population 82.1 72.0 54.3Diabetes Mortality rate per 100,000 population 34.3 27.4 25.4COPD Mortality rate per 100,000 population 38.4 46.5 43.4Youth death rates (Ages 0-17)/100,000 100.6 79.9 Domain Environmental HealthIndicatorPitt CountyNorth CarolinaUnited StatesLead (2004) 2.81.3 1100 infants 56 testedHave you had an illness in the past 12 months that you think was caused by outdoor air pollutants 9.1 12.0Have you had an illness in the past 12 months that you think was caused by poor indoor air quality 15.0 16.4 Domain Injury and ViolenceIndicatorPitt CountyNorth Carolina 19992002United States 2003Motor vehicle accidents Mortality rate per 100,000 population 19.6 19.2 15.2Mortality Homicide rate per 100,000 population 11.2 7.6 5.9 Suicide rate per 100,000 population(10-24 yr)10.8211.36 10.5Violent Crime rate per 100,000 population (2004)617.2446.9Accidents Unintentional injuries Mortality rate per 100,000 population 40.0 42.7 36.3Child Maltreatment substantiated 18.1 14.512.3Admissions to Juvenile Justice 38.6 34.1 Domain Economic and EducationIndicatorPitt CountyNorth CarolinaUnited StatesPremature mortality rate per 100,000 population under 75956 years903 years799 yearsPercent below poverty level 17.5 15.2 12.4Percent of children below poverty level 21.8 21.9 16.9Unemployment rate 5.2 5.0 4.7Percent children receiving food stamps 24.9 18.210.6 million (14)Percent children receiving free or reduced lunch 48.4 44.3 41.9Public school dropout rate (9-12th grade)2004-5 6.95 4.86 10.3High School completion () 56 86.1 85Percent 25 years of age with 9th grade education 7.6 7.8 7.5Median Household income 33,73446,33550,046Median per capita income 18,24326,88232,937Migrant and seasonal workers number6,606 (5.4)155,888 (2.1)13 million (4.4) APPENDIX 2 Healthy People 2020 What Is Healthy People Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans.. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to Encourage collaborations across communities and sectors. Empower individuals toward making informed health decisions. Measure the impact of prevention activities It can be used by many different people, states, communities, professional organizations, and others to help them develop programs to improve health. Healthy People 2020 continues in this tradition with the launch on December 2, 2010 of its ambitious, yet achievable, 10-year agenda for improving the Nations health. Healthy People 2020 is the result of a multiyear process that reflects input from a diverse group of individuals and organizations. What Are the Leading Health Indicators Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans. Healthy People 2020 contains 42 topic areas with nearly 600 objectives (with others still evolving), which encompass 1,200 measures. A smaller set of Healthy People 2020 objectives, called Leading Health Indicators, has been selected to communicate high-priority health issues and actions that can be taken to address them . The Leading Health Indicators are composed of 26 indicators organized under 12 topics. The Healthy People 2020 Leading Health Indicators are Access to Health Services 7. Nutrition, Physical Activity, and Obesity Clinical Preventive Services 8. Oral Health Environmental Quality 9. Reproductive and Sexual Health Injury and Violence 10. Social Determinants Maternal, Infant, and Child Health 11. Substance Abuse Mental Health . 12. Tobacco http//www.healthypeople.gov/2020/about/default.aspx Pitt County Municipalities Data MunicipalityChild 5 yrs Pop.Persons/ square mileWhite Non-HispanicAfrican- AmericaAmer. IndianHispanic () AsianAyden 282 4,622 199247.649.50.2 (102) 2.20.2Bethel 116 1,681 161840.258.10.0 (13) 0.80.1Falkland 11 112 11268.830.40.0 (11) 9.80.0Farmville 252 4,302 1431 47.450.10.1 (91) 2.10.2Fountain 38 533 51549.050.50.2 (3) 0.60.0Greenville3,36160,476 229861.434.1(181) 0.3(1,244) 2.1(1,098)1.8Grifton 122 2,073 118863.233.20.0 (98) 4.70.2Grimesland 19 440 8506229.10.0 (39) 8.90.2Simpson 32 464 11255642.50.0 (13) 2.80.0Winterville 399 4,791 187758.738.40.5 (49) 1.00.1Total 4,603 75,624(1573)Pitt County8,653133,798 21662.133.6(357)0.3(4,216) 3.2(1,443)1.1North Carolina72.121.61.2 4.71.4U.S.75.112.30.912.53.6 Municipalities County/StateMedian Family Income HS EducationFamilies below povertyIn labor force 16 years of ageMedian travel to work (min) now married (15 yrs of age)Ayden34,808302153.1X45Bethel35,2784018.549.22542.5Falkland43,75040 5.057.41836Farmville38,91827.414.657.518.744.6Fountain26,0424135.651.620.448Greenville44,49114 9.066.317.935.9Grifton40,8752712.255.923.458.3Grimesland36,2504012.358.322.953.5Simpson47,50023.614.263.61756.6Winterville47,16716.610.371.225.556.7Pitt County43,9712013.565.8X47North Carolina46,33522 9.065.7X56.3U.S.50,04619.6 9.263.925.554.4 http//factfinder.census.gov http//www.city-data.com/city Disclaimer regarding interpretation of data in this Community Assessment Various sources of data have been used in the development of this teaching case including but not limited to vital statistics, the 2004 BRFSS survey, N.C. Communicable Disease Control Branch reports, N.C. County Health Data Book, U.S. Census American Fact Finder, N.C. Child Advocacy Institute, N.C. Child Fatality Task Force. The data in this report is not to be relied on for actual assessment activities because of various limitations including different time periods for data collections and a small number of events during the reported time period. These factors subject the results to chance variation. Longer time periods of data collection are required before inferences can be made. For a full discussion of the issues and up-to-date data, refer to the report of the North Carolina State Center of Health Statistics, http//www.schs.state.nc.us/SCHS/. Resources for Community Assessment Advocates for Youth http//www.advocatesforyouth.org Cecil G. Sheps Center for Health Services Research University of North Carolina, Chapel Hill http//www.shepscenter.unc.edu/Data.html http//www.shepscenter.unc.edu/hp/prof04.htm Center for Disease Control and Prevention STD Surveillance 2004 http//www.cdc.gov/std/stats/toc2004.htm Center for Health Services Research and Development, East Carolina University http//www.chsrd.med.ecu.edu CLIKS community-Level Information for Kids http//www.aecf.org/cgi-bin/cliks.cgi Employment Security commission of North Carolina Labor Wage Unit, Labor Market Information Division http//eslmi23.esc.state.nc.us/ew/ Environmental Defense Fund http//www.scorecard.org/ Geographic.org http//www.geographic.org Guttmacher Institute http//www.guttmacher.org/pubs/fb_teens.html Institute of Research in Social Science at University of North Carolina, Chapel Hill http//unc.edu/depts/irss/ Log into North Carolina (LINK) http//data.osbm.state.nc.us/pis/linc/dyn_linc_main.show North Carolina Child Advocacy Institute http//www.ncchild.org North Carolina Child Fatality Task Force www.preventchildabusenc.org/publications/press_releases/cftf North Carolina Communicable Disease Control http//www.epi.state.nc.us/epi/gcdc.html North Carolina Crime Statistics http//sbi2.jus.state.nc.us/crp/public/default.htm North Carolina Department of Agriculture http//www.agr.state.nc.us/stats/ North Carolina Department of Commerce http//www.commerce.state.nc.us North Carolina Department of Health and Human Services Division of Medical Assistance http//www.dhhs.state.nc.us.dma/ North Carolina Department of Health and Human Services HIV/STD Prevention Care Branch http//www.epi.state.nc.us.epi/hiv/surveillance.html North Carolina Department of Public Instruction http//www.dpi.state.nc.us North Carolina Department of Transportation Public Transportation Division http//www.dot.state.nc.us/transit/transitnet/ North Carolina Division of Public Health Oral Health Section http//www.communityhealth.dhhs.state.nc.us/dental/ North Carolina Division of Public Health Womens and Childrens Health Section http//wch.dhhs.state.nc.us/ North Carolina Employment Security Commission http//esc.state.nc.us North Carolina Office of State Planning http//www/ospi.state.nc.us North Carolina State Bureau of Investigation http//sbi.jus.state.nc.us North Carolina State Center for Health Statistics (NC-SCHS) http//www.schs.state.nc.us/SCHS/index.html North Carolina Rural Data Bank (by county) http//www.ncruralcenter.org/databank/profile Public Schools of North Carolina http//www.ncpublicschools.org/accountability/reporting/sat/2005 State of North Carolina http//www.state.nc.us University of North Carolina Highway Safety Research Center http//www.hsrc.unc.edu This case study exercise adapted by Lloyd F. Novick, MD, MPH and Jorg Westermann, PhD, from Cibula, D. A, Novick, L. F., Morrow, C. B., Sutphen, S. M. (2003). Community health assessment. American Journal of Preventive Medicine, 24(4S), 118123. PAGE PAGE 13 Y, dXiJ(x( I_TS 1EZBmU/xYy5g/GMGeD3Vqq8K)fw9
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Solution: healthcare policy
Solution: Case Exercise: Community Health Assessment for Pitt County, North Carolina