Rutherford County, TN Community Health Needs · PDF fileRutherford County, TN Community Health...

Rutherford County, TN Community Health Needs Assessment

2016

Health Is:

• A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

Source: World Health Organization

Welcome

• Assessments done separately in 2013 as requirement for STH and VUMC as non-profit hospitals

– ACA related requirement

• For new cycle, came together in overlapping counties

• Review findings of most recent RCHD, VUMC and STH health assessment

• Collectively identify needs for Rutherford County

Why are we here?

• Reviewed publically available community health data

• Interviewed key stakeholders

• Conducted listening sessions

• Convened today’s summit to identify needs

• Special attention to underserved, low-income, minority populations

• Post-summit: Review needs for development of Implementation Strategies

Approach

• Health Department Update

• Review Findings

– Secondary Data

– Interviews

– Listening Sessions

• Exercise 1 : Identification of Health Needs

• Exercise 2 : Visioning, Goals and Resources

• Summary

Agenda

Rutherford County – Health Priorities

Dana Garrett, RN, BSN

Findings from Secondary Data Review Rutherford County, TN

2016 Community Health Assessment

Determinants of Health Introduction and Methods

Rutherford

Tobacco Use Diet & Exercise Alcohol & Drugs Sexual Activity

Access to Care Quality of Care

Education Employment Income Social Support Safety

Air & Water Housing & Transit

• Used publically available data

• Indicators, considered

– Recommendations of

• Centers for Disease Control and Prevention

• Catholic Health Association

– Review of RCHD, STH and VUMC 2013 CHNA

Methods: Secondary Data

– Demographics and Socioeconomic Status

– Social & Natural Environment

– Access to Health Care

– Health Status

• Morbidity/Mortality

• Birth Outcomes

• Preventive Care/Risk Factor Behaviors

• Infectious Diseases

• Mental & Emotional Health

– Other Community Assessments

Indicator Topics

Demographics: Rutherford Demographic / Socioeconomic

Rutherford

Source: US Census Bureau (2015). State and County QuickFacts: Davidson Co., TN. Retrieved on 6/30/15, from: http://quickfacts.census.gov/qfd/states/47000.html

Rutherford TN USA

Population, % change from 2010-2014

10.0% 3.2% 3.3%

Persons under 18 years 25.3% 23.0% 23.3%

Persons 65 years and over 9.3% 14.7% 14.1%

Female persons, percent 50.7% 51.2% 50.8%

Language other than English spoken at home

9.9% 6.6% 20.7%

Persons below poverty level 13.0% 17.6% 15.4%

Persons per square mile 424 153 87

2014 Population estimate: 288,906

288,734

349,083

409,986

155,284

187,195

226,453

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

2015 2025 2035

From 2010-2014, Rutherford County Grew 10% This is more than three times faster than the state as a whole

Population

Jobs

Demographic / Socioeconomic

Rutherford Projected Population and Job Growth (2015, 2025, 2035)

Source: Nashville Metro Planning Organization, US Census Bureau Quickfacts. Retrieved 8/21/15 *Data for May 2015

4.6% Unemployment*

Population Below the Poverty Level ACS 2009-13


Rutherford

Source: : Map of Population Below Poverty Level, Rutherford Co. TN. Community Commons (2015). Retrieved: July 15, 2015, from www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract

Rutherford Co. 13.1%

Tennessee 17.7%

United States 15.4%

20% +

15.1-20%

10.1-15%

<10.1%

Percent in Poverty

http://www.communitycommons.org/

Population Below the Poverty Level By Race, ACS 2009-13


Rutherford

Source: Population Below Poverty Level, Rutherford Co. TN. Community Commons (2015). Retrieved: July 15, 2015, from www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract


Children in Poverty Trends, County, State and National


Rutherford

Source: : University of Wisconsin Population Health Institute. County Health Rankings 2015. Data Source: US Census Bureau, Small Area Income and Poverty Estimates, American Community Survey. Retrieved on August 16, 2015 from: http://www.countyhealthrankings.org/

http://www.countyhealthrankings.org/

Population with No High School Diploma (25yrs and older)


Rutherford

Source: Map of Population with No High School Diploma, Rutherford County, TN. Community Commons (2015). Retrieved: July 15, 2015, from www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract


Tennessee 15.6%

United States 14.0%

>21%

16.1-21%

11.1-16%

<11.1%

Percent without HS Diploma


Rutherford County ranks in the middle of TN Counties

87% (2014)


Rutherford

81% (2013)

93% (2014)

USA

TN

Graduation Rates 2014

Rutherford

Source: County and State : The Annie E. Casey Foundation. 2015 KIDS COUNT Data Books, Retrieved from : http://www.datacenter.aecf.org US rate source: National Center for Education Statistics - http://nces.ed.gov/ccd/tables/ACGR_2010-11_to_2012-13.asp

http://nces.ed.gov/ccd/tables/ACGR_2010-11_to_2012-13.asp






Summary


Rutherford

• County is experiencing rapid growth

• 90% with high school education

• 13% live in poverty; 16.5% of children live in

poverty (40% below 200%)

• Poverty and Education vary by place and race

• Housing

• Neighborhood Safety

• Transportation

• Access to Healthy Food

• Air

Social & Natural Environment

Affordable Housing 2013


Rutherford

Source: US Census Bureau (2015). State and County QuickFacts: Davidson Co., TN. Retrieved on 6/30/15, from: http://quickfacts.census.gov/qfd/states/47000.html

Rutherford Tennessee US

Homeownership rate 67.6% 67.8% 64.9%

Median household income $55,401 $44,298 $53,046

Median value of owner-occupied housing

$159,100 $139,200 $176,700

House value / Income 2.9 / 1 3.1 / 1 3.3 / 1

Cost Burdened Households 31.4% 31.0% 35.5%

Cost Burdened Renters 47.2% 45.9% 48.3%

Poverty 13.0% 17.6% 15.4%


Rutherford Homelessness 2015

1,675 Individuals

Experiencing Homelessness

846 Adults 829 Children

Source: City of Murfreesboro Consolidated Plan 2015-20: http://www.murfreesborotn.gov/DocumentCenter/View/2278

621


Rutherford

431

USA

TN

Rutherford County

Violent Crime Rate Per 100,000 population

199

Source: University of Wisconsin Population Health Institute. County Health Rankings 2015 Retrieved on July 31, 2015 from: http://www.countyhealthrankings.org/




Rutherford

Source: Tennessee Bureau of Investigation. Tennessee Crime On-Line. Retrieved on 8/12/15, From: http://tennesseecrimeonline.com/public/Browse/browsetables.aspx

Domestic Violence Number of Victims

2014 Rate per 1,000

Rutherford 12.7 Tennessee 11.6

Transportation Households with No Vehicle


Rutherford

Source: : Map of Households with No Vehicle, Rutherford Co., TN. Community Commons (2015). Retrieved: July 14, 2015, from www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract

Rutherford Co. 3.5%

Tennessee 6.3%

United States 9.1%

>8%

6.1 - 8%

4.1 - 6%

<4.1%

Percent without Vehicle


Population with Limited Food Access Social & Natural Environment

Rutherford

Source: Map of Population with Limited Food Access, Nashville TN. Community Commons (2015). Retrieved: July 14, 2015, from www.communitycommons.org Data Source: US Department of Agriculture, Economic Research Service, USDA - Food Access Research Atlas. 2010. Source geography: Tract


Tennessee 27.4%

United States 23.6%

>50%

20.1 - 50%

5.1-20%

<5.1%

No Low Food Access


Fast Food Restaurants Rate per 100,000 population


Rutherford

Source: Community Commons . Fast Food Restaurants, Rate per 100,000 population by year, 2008-2013. Data Source: US Census Bureau, County Business Patterns. Additional data analysis by CARES. 2013. Source geography: County Retrieved 7/14/15, Retrieved from: communitycommons.org


Rutherford

Source: Family & Children’s Services. Data Source: United Way of Metropolitan Nashville., 2-1-1

2-1-1 Calls, Top 10 Categories FY2014


Rutherford

Source: 2015 County Health Rankings, American Lung Association – Estimated Prevalence and Incidence of Lung Disease

Air Pollution and Lung Disease

14.3 13.8

11.9

0

2

4

6

8

10

12

14

Particulate Air Pollution (Daily PM2.5)

Rutherford Co TN USA

Estimated Number Suffering from Lung Disease Rutherford County

Pediatric Asthma 5,757

Adult Asthma 15,538

COPD 17,271

Lung Cancer 217

Summary Social & Natural Environment

Rutherford

• Many are burdened by housing costs

• Violent crime rate is high

• Areas of limited healthy food access are present

• Rates of fast food establishments are rising

• Particulate air pollution presents a regional

challenge

• Provider availability

• Health staffing shortages by HPSAs

• Insurance coverage

Access to Health Care


Rutherford

Source: 2015 County Health Rankings

Provider Rates

RutherfordTop 10% US

Counties

Primary Care 2231:1 1045:1

Dental 2036:1 1377:1

Mental Health 1358:1 386:1

County Heath

Rankings

Rutherford Best 10% of US Counties

Access to Providers Behavioral Risk Factor Surveillance Survey


Rutherford

Source: Tennessee Department of Health (2013/2012) Behavioral Risk Factor Surveillance System: Tennessee State and Regional Data, retrieved from: on July 17, 2015 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. [accessed Aug 05, 2015].

73


Rutherford

65

85

Preventable Hospital Stays # of Hospital Stays for ambulatory-care sensitive conditions / 1,000 Medicare Enrollees

Source: University of Wisconsin Population Health Institute. County Health Rankings, 2015. Preventable Hospital Stays, 2012.. Data CDC, National Center for Health Statistics and Division of Behavioral Surveillance Dartmouth Institute for Health Policy & Clinical Practice. Retrieved on 7/17/15, From: http://www.countyhealthrankings.org

USA

TN

Rutherford



Chronic Disease Hospitalization Rate (age-adjusted per 100,000)


Rutherford

Source: TN DOH, Chronic Disease Health Profile, December 2011, Retrieved 8/15/15, from: http://hit.state.tn.us/CDProfiles.shtml

Health Insurance Tennessee Coverage of Total Population 2013


Rutherford

Source: : Kaiser Family Foundation 2015. State Health Facts. Health Insurance Coverage of the Total Population. Retrieved: August 28, 2015, from www.kff.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract

http://www.kff.org/

Health Insurance Uninsured Population 2009-2013


Rutherford

Source: : Map of Insurance-Uninsured Population, Rutherford Co., TN. Community Commons (2015). Retrieved: July 14, 2015, from www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract


Tennessee 14.1%

United States 14.9%

20% +

15.1-20%

10.1-15%

<10.1%

No Data

Percent Uninsured


Summary Access to Health Care

Rutherford

• Fewer providers relative to nation and state

– 11% did not see MD due to cost

– 28% did not visit a dental professional in the past year

• HPSA facilities within county

• Remain less than 100% coverage, 100% access

• Morbidity/Mortality

– Causes of Death

– Premature Death (Years of Potential Life Lost)

• Birth Outcomes

• Preventive Care/Risk Factor Behaviors

• Infectious Disease

• Mental & Emotional Health

Health Status

Morbidity / Mortality

Rutherford

Source: National Center for Health Statistics http://blogs.cdc.gov/nchs-data-visualization/2015/06/01/deaths-in-the-us/

Causes of Death: USA, 1900-2013 Age adjusted Death Rates for Selected Major Causes of Death

0

100

200

300

400

500

600

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010

Mo

rtal

ity

Rat

e p

er 1

00

,00

0,

Stan

dar

d P

op

ula

tio

n

Year

Heart Disease

Influenza, Pneumonia

Cancers

Accidents

Stroke


Rutherford

Cancer

23

Heart Disease 22

Lung Disease 6

Accidents 5

Stroke 5

Alzheimer's 4

Diabetes 3

Flu / Pneumonia 3

Suicide 2

Liver Disease 2

Other [25]

Percentage of Deaths Rutherford County (2011-2013)


Rutherford

6605

8636

6592

0 2000 4000 6000 8000 10000

United States

Tennessee

Rutherford County

Premature Death Rate per 100,000 population (2013)

Source: National Vital Statistics System-Mortality (NVSS-M) (2011-2013)

Premature Death Rate of Potential Years of Life Lost per 100,000 population - 2013

22.2

15.3

12.8

6.3

2.2 3.3

21.6

15.1 14.9

5.7

3.2 4.4

0

5

10

15

20

25

Cancer Heart Disease UnintentionalInjury

Suicide Homicide PerinatalPeriod

Pe

rce

nta

ge o

f Y

PLL

<ag

e 7

5 y

ear

s

Rutherford County

TN

USA

Premature Death Rutherford County (2009) vs. Tennessee (2013) vs. United States (2013)


Rutherford

Source: State and National data - National Vital Statistics System-Mortality (NVSS-M) (2013), Rutherford County Data - Tennessee Department of Health, Office of Policy, Planning and Assessment, Division of Health Statistics (2009)

Premature Death Percentage of Years of Potential Life Lost, by Leading Cause


Rutherford Premature Death in TN Racial Disparity in % of YPLL by Cause

21.4

17.6 16.2

6.1

1.4 2.1

17.6 16.8

10.6

2.1

8.6

6.7

0

5

10

15

20

25

Cancer Heart Disease UnintentionalInjury

Suicide Homicide PerinatalPeriod

Pe

rce

nta

ge o

f Ye

ars

of

Po

ten

tial

Lif

e L

ost

(<7

5)

TN - White

TN - Black

Source: State and National data - National Vital Statistics System-Mortality (NVSS-M) (2013), Rutherford County Data - Tennessee Department of Health, Office of Policy, Planning and Assessment, Division of Health Statistics (2009)


Rutherford Cancer Death Rates in Tennessee Disparities by Race, Gender (2012)

311.6

94.8 90.9

45.5 37.3 32.4

151.7

45.1 32

14.7 13.3 21.4

0

50

100

150

200

250

300

350

All Cancer Lung DigestiveSystem

Genital Colorectal BreastCancer

Dea

th R

ate

fro

m C

ance

r, p

er 1

00

,00

0 p

op

ula

tio

n

Black Male White Male Black Female White Female

The cancer death rate is higher for men than women.

Particularly black men, who die of cancer at more than twice the rate of white women

Source: CDC Wonder, US Cancer Statistics, Data is age-adjusted statewide rate for Tennessee in 2012

Morbidity/ Mortality

Rutherford Heart Disease Death Rates in Tennessee Disparities by Race, Gender

251.4

208

236.8

195.1

265.7 266.5

170

190

210

230

250

270

290

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Dea

th R

ate

fro

m H

eart

Dis

eas

e, p

er 1

00

,00

0 p

op

ula

tio

n

Rates of Heart Disease Death are Falling, particularly for women and non-white men

Source: 2013 Tennessee Women’s Health Report Card, 2013 Tennessee Men’s Health Report Card

White Male

Female (all)

Black Male


Rutherford

Source: IVP-1.1: National Vital Statistics System-Mortality (NVSS-M), CDC/NCHS; Population Estimates, Census.

Injury Death Rate by Age and Type Tennessee Males, per 100,000 Population [2013]

0

20

40

60

80

100

120

15-24 25-34 35-44 45-54 55-64 65-74 75-84

Inju

ry D

eath

Rat

e, b

y ty

pe

Age

Transport Accidents

Poisoning / Exposure

Falls

Males (84 per 100k) are more than twice as likely as females

(35 per 100k) to die from unintentional injuries

Summary Morbidity / Mortality

Rutherford

• Cancer and heart disease are leading causes of death

• Causes of death vary by race and gender

• Combined accidents, assaults and suicide represent 12% of deaths and 21% of years of potential life lost

• Infant Mortality

• Low Birth Weight

• Prenatal Care

• Teen Pregnancy

Birth Outcomes

0

0.5

1

1.5

2

2.5

3

0

20

40

60

80

100

120

140

160

180

200

1915 1925 1935 1945 1955 1965 1975 1985 1995 2005

Dis

par

ity

in B

lack

Rat

e o

ver

Wh

ite

Rat

e

Infa

nt

Dea

th R

ate

pe

r 1

00

0 L

ive

Bir

ths

Black

White

Relative Disparity in Black Rate over White Rate

Birth Outcomes

Rutherford Infant Mortality in the United States

Racial Disparities since 1915

Source: CDC/NCHS, National Vital Statistics System, Mortality Data ;1900–1967, CDC Wonder

Birth Outcomes

Rutherford

Source: TN Dept of Health, Division of Policy, Planning and Assessment, Office of Health Stats; National Vital Statics Reports, Vol 64 No1 Jan 15, 2015; KIDS Count

4.5

6.8

6

0

1

2

3

4

5

6

7

8

9

10

Infant Death Rate / 1000births

Rutherford

Tennessee

United States

US Ranks 55th

Infant Mortality: Rutherford Co International Comparison - 2013

Cuba (4.7)

France (3.3)

Czech Republic (2.6)

Japan (2.1)

Birth Outcomes

Rutherford


1.5

8.7

4.5

1.6

9.1

6.8

1.4

8

6

0

1

2

3

4

5

6

7

8

9

10

Very Low Birthweight(%)

Low Birthweight (%) Infant Death Rate / 1000births

Rutherford

Tennessee

United States

Birth Outcomes 2013

1.5

8.7

4.5

1.3

7.7

3.6 2.7

14.2

7.7

0

2

4

6

8

10

12

14

16

Very Low Birthweight (%) Low Birthweight (%) Infant Death Rate / 1000 births

Rutherford

White

Black

2.1x

Birth Outcomes

Rutherford Birth Outcomes Racial Disparities In Rutherford County (2013)

2.1x

1.8x


Teen Pregnancy Rates; Ages 15-17, Trend: 2005-2014

Birth Outcomes

Rutherford

33.8

16.1

28.8

10.7

0

5

10

15

20

25

30

35

40

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Tee

n P

regn

ancy

Rat

e, p

er

10

00

15

-17

yo

Fe

mal

es

Teen Pregnancies are In Decline Across the County and State

Tennessee (-52%)

Rutherford(-63%)

Source: KIDScount, Tennessee Department of Health, Office of Policy Planning and Assessment, Division of Health Statistics.

Summary Birth Outcomes

Rutherford

• Infant mortality and low birth weight rates are high

– Vary by race

• Mothers receiving early prenatal care is steady, but remains below HP2020 goal

• Teen pregnancy and birth rates continue to decline

– Vary by race

• Well-being

• Tobacco & Substance Use

• Obesity & Nutrition

• Physical Activity

• Youth Risk Behavior Survey

• Vaccinations

Preventive Care / Risk Factor Behaviors

23%

Preventive Risk Factors

Rutherford

Source: 2015 County Health Rankings, BFRSS, 2006-2012

15%

17%

Adults Reporting “Poor” or “Fair” Health 2006-2012

USA

TN

Rutherford

23%


Rutherford

Source: 2015 County Health Rankings, : Tennessee Department of Health, Division of Policy, Planning and Assessment, Behavioral Risk Factor Surveillence System., HealthyPeople2020.gov

21%

12%

Adult Smokers 2013

17%

Tobacco use is the most preventable

cause of premature mortality and

morbidity - TN Dept of Health

Healthy People 2020 Target

USA

TN

Rutherford


Rutherford Substance Abuse

TDMHSAS Funded Treatment Admissions, by Cause (FY 2014)

5.6

36.9

51.5

39.9

11.6

40.2 44.2

38.6

0

10

20

30

40

50

60

70

Methamphetamines Opiods Alcohol Other Illicit Drugs

Pe

rce

nt

of

Tota

l Ad

mis

sio

ns,

by

Sub

stan

ce

Substance of Abuse for TDMHSAS funded treatment admissions

Rutherford County

TN

Source: 2014 Tennessee Behavioral Health County Data Book

More than 1 in 12 People in Rutherford County have Abused Substances in the Past Year

34% Obese


Rutherford

Source: Mid-Cumberland and State: Source: Tennessee Department of Health . 2013 BRFSS. US, Source: ,Kaiser Family Foundation

31% Obese

Adults Obese and Overweight 2013

69% Overweight and Obese



34% Obese

Mid-Cumberland Region

TN

USA

77%

70%

Social Environment

Rutherford

Source: 2015 County Health Rankings

65%

Access to Exercise Opportunities 2013

USA

TN

Rutherford

63%


Rutherford

Source: Tennessee Department of Health 2013 . Behavioral Risk Factor Surveillance Survey

75%

71% Mid-Cumberland

Region

Adults Participating in Physical Activity (Past Month) 2013

USA

TN


Rutherford

Source: BRFSS: TN DoH (2013). Behavioral Risk Factor Surveillance System: Tennessee State and Regional Data. Retrieved 8/14/15 from: http://tn.gov/health/topic/statistics-brfss

Influenza & Pneumococcal Vaccination Adults and Seniors 2013

http://tn.gov/health/topic/statistics-brfss



73%


Rutherford

Source: TN DoH (2014). Behavioral Rtor Surveillance System: Tennessee State and Regional Data.. *Data is for Mid-Cumberland Region

24-Month Vaccinations 2014

77%

92.4

97.1 96.2 96.2

83.8

97.1

93.3

80828486889092949698

100

DTaP Poliomyelitis MMR Hepatitis B Hib Varicella Pneumococcus

The Mid-Cumberland Region Exceeds Healthy People 2020 Targets in 6 of 7 Leading Recommended Vaccinations at 24 months of age

24 Month Olds, Fully Vaccinated

(4:3:1:3*:3:1:4 Series)

HP 2020 Target (90%)

Mid-Cumberland Region

Youth Risk Behavior Survey 2013 – Tennessee High School Youth (US)


Rutherford

• Tobacco Use – 15.4% smoked cigarettes within 30 days (US: 15.7%)

– 12% smoked a whole cigarette before age 13 (US: 9.3%)

• Nutrition & Obesity – 16.9% are obese (US: 13.7%)

– 15.4% are overweight (US: 16.6%)

• Physical Activity – 19.6% were not physically active at least 60 min on

at least 1 day during the past week (US: 15.2%)

Summary Preventative Risk Factors

Rutherford

• Smoking rate remains higher than HP2020 target

• Many are overweight and obese

• High School Youths – 15.4% smoked cigarettes within 30 days

– 16.9% are obese

• 30% seniors (age 65 years and older) are not vaccinated for influenza and pneumococcal

• STD incidence rates

– chlamydia

– gonorrhea

– syphilis

• HIV incidence rate

Infectious Disease

Chlamydia Trends 2003 – 2012

Infectious Disease

Rutherford

Source: Community Commons (2015). Data Source: US Department of Health Human Services, Health Indicators Warehouse. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. 2012. Source geography: County. Retrieved on 7/14/15, From: www.communitycommons.org Source: Centers for Disease Control and Prevention . NCHHSTP Atlas. Chlamydia by County. Retrieved on 8/12/15, From: http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html

State 2012 White 251.5 Black 1,629.9


http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html

http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html

Gonorrhea Trends 2003 – 2012

Infectious Disease

Rutherford

Source: Community Commons (2015). Data Source: US Department of Health Human Services, Health Indicators Warehouse. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. 2012. Source geography: County. Retrieved on 7/14/15, From: www.communitycommons.org

State 2012 White 36.5 Black 627.2


HIV Prevalence Trends 2008-2010

Infectious Disease

Rutherford

Source: Community Commons (2015). Data Source: US Department of Health Human Services, Health Indicators Warehouse. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. 2010. Source geography: County. Retrieved on 7/14/15, From: www.communitycommons.org

State 2010 White 145.6 Black 1,093.6


Summary Infectious Disease

Rutherford

• Chlamydia rates are rising

• Gonorrhea rate is increasing locally

• STD prevalence rates vary

– By Race/Ethnicity (higher among minorities)

• ACE

• Well-being

• Mental Illness

• Serious mental illness

Mental & Emotional Health

Mental and Emotional Health

Rutherford

Adverse Childhood Events (ACEs)

# ACEs % (TN)

0 48%

1 20%

2 11%

3 7%

4(or more) 14%

Source: “Adverse Childhood Experiences in Tennessee,” Tennessee Department of Health

3.4


Rutherford

Source: Source: 2015 County Health Rankings

2.7

3.5

USA

TN

Poor Mental Health Days (last 30 days) 2013

Rutherford

21%


Rutherford

Source: 2015 County Health Rankings,

20%

19%

USA

TN

Mental Illness in the past Year (18+) 2013

Rutherford


Rutherford

Source: Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: Tennessee, 2014. HHS Publication No. SMA–15–4895TN. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.

Serious Mental Illness (SMI) in the past Year (18+), 2013

Serious Mental Illness (SMI)

Schizophrenia

Bipolar Disorder

Schizoaffective Disorder

Major Depressive Disorder

~8,000 Experience

Serious Mental Illness Each Year


Rutherford

Mental Illness

“Evidence has shown that

mental disorders

are strongly related to the occurrence of many chronic diseases, including

diabetes, cancer, cardiovascular disease, asthma, and obesity

and many risk behaviors for chronic disease; such as,

physical inactivity, smoking, excessive drinking, and insufficient sleep.”

- Centers for Disease Control

• TN Dept. of Health – Drive Your County to the Top Ten

http://tn.gov/health/topic/specialreports

• County Health Status Indicators http://wwwn.cdc.gov/CommunityHealth/HomePage.aspx

Other Community Assessments



http://wwwn.cdc.gov/CommunityHealth/HomePage.aspx

http://wwwn.cdc.gov/CommunityHealth/HomePage.aspx

Community Needs Assessments

Rutherford

Summary

• 13% live in poverty

– 40% of children below 200% poverty level

• Health outcomes could be improved

• Place & Race matter

• Many resources in our community

Thank you / Questions

Findings From Interviews with Community Leaders

Methods: Interviews

• Interviewed community representatives and leaders with: – Focus on the broad interests of the community

– Serving low-income, minority or underserved populations

• Sectors represented include: public health, government/public sector, health care, education, faith community, private foundations, academia

• Interviews conducted in pairs by STH, VUMC and graduate students from MMC and VU

• Closed and open-ended questions Rutherford

Methods: Interviews (cont.)

• Semi-structured interview protocol focused on health concerns, determinants of health, health systems issues, health assets

• Quantitative data (6 questions) :

– Entered in REDCap and analyzed using excel

– “Other” responses coded or analyzed separately

• Qualitative data (3 questions):

– Thematic analysis conducted using team of 3 reviewers for each question

Rutherford

“What are the Greatest Health and/or Health Care Concerns in your Community?” (n=28)

Health Concerns (Rutherford) %

1. Mental/Emotional Health 50

2. Obesity 46

3. Affordability/Cost of Care 39

4. Access to Care 36

5. Alcohol & Drug Abuse 32

6. Oral/Dental Health 29

6. Housing/Homelessness 29

6. Health Education 29

9. Transportation 21

Rutherford Respondents Could Select Up to Five Response Options Answers with zero responses excluded from chart

“What Socioeconomic and Demographic Factors have the Biggest Impact on Community Health?”(n=28)

Leading Health Concerns (Rutherford)

%

1. Health Insurance Coverage 54

2. Poverty/Working Poor 39

3. Education Attainment 32

4. Language Barriers 25

4. Wealth Dispersion 25

6. Cultural Competency 21


6. Food Insecurity 21

Rutherford Respondents Could Select Up to Three Response Options

“What Environmental Factors have the Biggest Impact on Community Health?”(n=28)

Conditions/Diseases (Rutherford) %

1. Healthy Food Access 57

2. Transportation 54


4. Limited Sidewalks 29

5. Secondhand Smoke 25


“What Conditions and Diseases are Causing Illness and Death in your Community?” (n=28)

Conditions / Diseases (Rutherford) %

1. Alcohol & Drug Abuse/ Addiction 50

2. Emotional and Mental Health 46

3. Obesity 43

4. Diabetes 39

5. Cancer 29

6. Cardiovascular Disease 25


Health System (Rutherford) %

1. Affordability/Cost of Care 39

2. ER use for non-emergencies 32

3. Health Education 25

3. Coordination of Care 25

5. Transportation Barrier to Care

21

5. Provider Availability 21

5. Health Navigation 21

5. Not Prevention Focused 21

5. Access: Overall 21

“What Are the Greatest Barriers within the Health System?” (n=28)


Behaviors (Rutherford) %

1. Alcohol/Drug Abuse & Addiction 54

2. Nutrition/Healthy Eating 46

2. Physical Activity 46

4. Tobacco Use/Smoking 36

5. Health Education /Literacy 32

6. Preventive Care 25

7. Texting While Driving 21

7. Adherence to Medical Regimen 21

“What Behaviors have the most Negative Impact on Health in your Community?” (n=28)


“What Reasons/Barriers exist that cause the use of ER for non-emergencies?” (n=28)

• Lack of consistent source of medical care ▫ There are not enough primary care providers for people

to see when needed urgently or for prevention

• Convenience, hours of operation and transportation ▫ The ER provides immediate access to care during non-

business hours ▫ Lack of after hours availability to primary care

providers

• No Health Insurance ▫ Many without insurance aren’t familiar with the

financial impact of unnecessary ER use

• Health Navigation/Literacy ▫ Many homeless families are more concerned about

shelter than preventive healthcare

Rutherford

“What Community Health Assets work well to support health and well-being?” (n=28)

• Safety net healthcare & service providers

▫ Local health department

▫ Mobile health unit & safety net clinics

▫ Basic service agencies

• Community cohesiveness

▫ We work well together

▫ Degree of perceived collaboration and engagement within the county

• Hospitals & Healthcare availability in the county

• Greenways & Recreational opportunities

▫ Walking trails, farmers’ markets

▫ Local recreational facilities

Rutherford

“What Priority Actions should Rutherford County focus on?” (n=28)

• Increase access to affordable primary care

▫ Address transportation barriers

▫ More providers for low income individuals

▫ Integration of services

• Substance abuse

• Mental health

• Lifestyle component

▫ Healthy food access/nutrition/obesity

▫ Walkability/physical activity

• Increase access to adult dental care

Rutherford

Rutherford Co. Interview Summary

Rutherford

Alcohol & Drug abuse/addition

Emotional and Mental Health

Nutrition/Physical Activity

Working together to address issues

Findings From Community Listening Sessions

Listening Session Methodology

Rutherford

• Three listening sessions held. Collaborated with health department and community partners on recruitment – Rutherford County Health Department (Smyrna) – Primary Care & Hope Clinic – First Baptist Church

• Moderated and co-moderated by partners • Moderator’s guide topics included community

assets and issues, health and healthcare issues, preventable ER utilization, and priority actions

• Short survey to obtain participant demographic info • Qualitative data: thematic analysis conducted using

team of four reviewers

Demographic Information Listening Sessions

Demographics of Participants (n=37)

– 76% Female

– 97% English speakers

– 25% High School Completion or less, 22% Some College, 53% College Degree or more

– 19% Uninsured, 58% Insured, 15% Medicare, 3% Medicaid

Rutherford

“What Community Health Assets/Resources work well to support health and well-being?”

• Parks, greenways

• Centralized location and highways

• Growth of businesses

• Activities for kids and recreational opportunities

–Many opportunities offered by faith community

Rutherford

“What are the Top Community Issues?”

• Traffic

• Transportation and difficulty navigating different areas of the county

• Walkability

• Cost of living – Affordable child care – Affordable housing

• Resources available but community not using or aware of them

• Long wait for services/benefits (i.e. housing and unemployment)

Rutherford

“What are the Greatest Health and/or Health Care Issues in your community?”

• Access to care, cost of care – Insurance gap, lack of insurance – Cost of prescription drugs

• Culture of unhealthy eating

• Emotional/mental health – Opportunities and youth development

• Substance use/abuse – Addiction – Prescription drugs

• Access to specialty care – Mental and adult dental

Rutherford

“What Reasons/Barriers exist that cause the Use of ER for non-emergencies?”

• No co-pays or need for cash upfront

• Care regardless of ability to pay or comprehensiveness of insurance coverage

• Transportation barrier to local care providers

• Challenges of accessing primary care system and limitations of available hours for primary care visits

Rutherford

“If you had a Magic Wand, what Priority Actions should your community focus on?”

• Transportation, transit, connectivity across the county

• Coordination and collaboration across community and health resources

• Access to care: – Mental health

– Adult dental

• Expand affordable insurance options and address insurance gap

Rutherford

Rutherford Co. Listening Session Summary

Rutherford

Transportation and lack of connectivity

across the county

Emotional/Mental health

Health system difficult to navigate and not

easily accessible

Information on health and social services

can be difficult to access

Limitations: Primary and Secondary Data

• Interviews:

– Response categories on interview guide for some questions not mutually exclusive

– Variability in number of responses that respondents chose

• Listening sessions:

– Representativeness of listening session participants

– Potential language/cultural barriers

• Secondary data:

– Source variability

– Benchmarking not always available

Rutherford

• Interviewees & listening session participants

• Primary Care and Hope Clinic

• First Baptist Church

• Lane Agri-Park Community Center/ Rutherford County Agricultural Extension

• Student team members:

– Christopher Artis, Meharry Medical College

– Althea Robinson, Vanderbilt University

– Shellese Shemwell, Vanderbilt University

Acknowledgements

Questions/Discussion

Exercise 1: Identification of Health Needs

Identification of Health Needs

• Please write down 3 Health Needs

– 1 per sticky note

• Place sticky note on white paper

Exercise 2: Visioning, Goals, Resources

• Work in groups

• Worksheets at tables

• Groups will need:

– Facilitator

– Recorder

– Reporter

Thank you to all!!

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