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Examination of Health and Public Health Service Delivery in Delaware County, Pennsylvania

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Examination of Health and Public Health Service Delivery in Delaware County, Pennsylvania Final Report Examination of Health and Public Health Service Delivery in Delaware County, Pennsylvania July 20, 2020 Prepared by the Johns Hopkins Bloomberg School of Public Health, under contract with the Delaware County Council Principle Investigators Paulani Mui, MPH Beth Resnick, DrPH, MPH Aruna Chandran, MD, MPH Contributors: George Zhang, MPH Katherine Zellner, MPH 1 TABLE OF CONTENTS EXECUTIVE SUMMARY................................................................................................................3 Background ................................................................................................................................9 Project Origins .................................................................................................................................... 9 Contextual Background ...................................................................................................................... 9 Approach and Methods .................................................................................................................... 10 Study Framework: The Core Public Health Functions & 10 Essential Public Health Services ......... 11 Methods ....................................................................................................................................... 13 Results ......................................................................................................................................19 Aim 1: Inventory of existing health and public health service structure............................................ 19 Aim 2: Identify key health and public health strengths and needs.................................................... 24 Public Health Community Survey Findings .................................................................................... 24 Findings from Focus Groups, Community Forums, and In-depth Interviews ................................. 35 Discussion of Key Community Health Needs in Delaware County ................................................. 41 Aims 3 & 4: Gather Relevant Data and Compile Community Health Status Indicators ..................... 43 Emergency Department Visits ...................................................................................................... 43 Mortality Data from the Delaware County Medical Examiner’s Office ......................................... 48 Community Health Status Profile: Delaware County & Comparable Jurisdictions ........................ 53 Recommendations ....................................................................................................................58 Appendix ..................................................................................................................................60 Appendix A: Public Health Community Survey Questions ................................................................ 61 Appendix B: Methodology and Figures for Data from the Delaware County Medical Examiner’s Office ................................................................................................................................................ 68 Appendix C: Comparison County and Indicator Selection, Community Health Status Profile: Delaware County & Comparable Jurisdictions .................................................................................. 77 Appendix D: Community Health Status Profile: Delaware County & Comparable Jurisdictions – Full Report............................................................................................................................................... 79 2 EXECUTIVE SUMMARY To ensure the best possible health services and practices for its residents, the Delaware County Council hired the Johns Hopkins Bloomberg School of Public Health in 2019-2020 to conduct an assessment of the delivery of health and public health services in Delaware County. This work builds on the Johns Hopkins 2010 Profile of Health and Public Health Services in Delaware County. This 2020 study includes an overview of the current health and public health infrastructure in the County; compilation and analysis of community health status indicators; evaluation of existing and projected health and public health needs of Delaware County residents; and recommendations to enhance health and public health service quality and efficiency in Delaware County. The underlying principles at the outset of this study were two-fold: 1) explore the need for the establishment of a local governmental public health presence in Delaware County; and 2) assure conditions that are conducive to health and quality of life for all Delaware County residents. However, given leadership changes in the Delaware County Council as a result of the November 2019 election, an effort was launched in January 2020 to establish a Delaware County Health Department by 2021. Given this change, our study was adapted to align with and inform the establishment of a Delaware County Health Department. As a result, our analysis and recommendations are framed by the core public health functions developed by the Institute of Medicine to describe public health practice1 and the ten essential public health services2 that offer local public health departments a blueprint for activities that should be provided to local communities to protect and promote the health of all residents. Input from Delaware County Residents Information on how well Delaware County is meeting the existing and projected health and public health needs of its residents was collected via a variety of mechanisms including a community survey, focus groups, community forums, and in-depth interviews. The community survey focused on respondents’ individual health whereas the focus groups, community forums, and in-depth interviews explored population level health and public health services. While the individuals and organizations that provided input to this study have varying perspectives and backgrounds, there was widespread agreement and consensus on Delaware County’s key issues and health needs. Contributors were forthcoming about their public health concerns and shared a common goal of improved health and public health for all Delaware County residents. Community survey: A total of 1,795 surveys were completed. Survey respondents were more likely to be white, female, older, educated, homeowners, employed full-time, and have health 1 Institute of Medicine (US) Committee for the Study of the Future of Public Health. The Future of Public Health. Washington, D.C: National Academy Press; 1988. pp. 7-8 2 Centers for Disease Control and Prevention. The Public Health System & the 10 Essential Public Health Services Updated May 21, 2020. Accessed July 1, 2020 from https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html 3 insurance, suggesting that respondents were not completely representative of the overall Delaware County population. However, as the vast majority of survey respondents (84%) reported having lived in the County for over 10 years, their input provides helpful insight from the perspective of long-term County residents. Focus groups and community forums: Researchers facilitated four one-hour focus groups for County residents and health professionals serving the County, averaging 16-18 participants per session. Additionally, researchers partnered with Multicultural Community Family Services to host a ‘Palava Hut’3 community convening, with a diverse group of approximately 50 community members in attendance. In-depth interviews: The JHSPH research team conducted 23 in-depth interviews with representatives from multiple sectors to obtain insight into Delaware County’s existing public health infrastructure and identify gaps. Collectively the study outreach efforts revealed consensus from stakeholders around a number of key needs to improve public health systems and services for all Delaware County residents. First and foremost, was the need for a formal public health entity for Delaware County that offers identifiable leadership and vision for public health as well as a centralized entity to coordinate public health efforts and communications across county agencies and community- based organizations. In particular, a cohesive and strengthened system for communication of information and improved access to services was emphasized, particularly for underserved communities. Health disparities and inequities were cited as major concerns that require approaches tailored to meet the needs of targeted populations, as well as data systems to track and report outcomes at the neighborhood level. It was emphasized that to sustain such efforts the County will need access to resources and a well-trained public health workforce. In sum, study outreach findings suggested a keen interest in and support for establishing a local Delaware County entity charged with promoting health and advancing health equity for all Delaware County residents. COVID-19 Implications All qualitative data collection was completed prior to March 2020 when the COVID-19 outbreak began in Delaware County. It is likely that responses to questions about public health overall and specifically related to interactions with public health agencies or sources for public health information would have been different following widespread knowledge and awareness of COVID-19. Thus, it is important to note that the findings in this report represent the views of Delaware County residents and leadership in the pre-pandemic period. Comparisons
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