How Healthy Are We?

COBB COUNTY 2014 ANNUAL REPORT CARD Introduction

Established in 1920, Cobb and Douglas Public Health (CDPH) is a health district (District 3-1) serving two metropolitan counties in Georgia and a population of nearly 900,000. The core functions of public health are to inform, prevent and protect in order to assure the well-being of our community and our residents.

With more than 30 distinct programs, we remain committed to our mission, which is:

Cobb & Douglas Public Health, with our partners, promotes and protects the health and safety of the residents of Cobb and Douglas counties.

We work to achieve healthy people in healthy communities by: Preventing epidemics and spread of disease Protecting against environmental hazards Preventing injuries Promoting and encouraging healthy behaviors Responding to disasters and assisting in community recovery Assuring the quality and accessibility of health care

By excelling at our core responsibilities, we will achieve healthier lives and a healthier community.

By 2020, Cobb & Douglas Public Health will be an acknowledged leader among health departments in the United States. In order to continuously improve our effectiveness and the health of our people and communities, we will work internally and with our community partners to: In order to continuously improve our effectiveness and the health of our people and communities, we will work internally and with our community partners to:

• Demonstrate significant improvement on key health and safety indicators • Achieve operational excellence by exceeding local public health system performance expectations • Champion workforce enhancement

To achieve these ambitious goals, we will engage, respect and value our staff and partners, thereby creating healthier lives and a healthier community. Cobb and Douglas Public Health (CDPH) staff designed the How Healthy Are We? Annual Report Card, Cobb County 2014 as a brief update to several more thorough Cobb County Highlights Community Health Assessments completed from 2010-2012. Please visit www.cobb2020. com for more information.

This health report card outlines the leading causes of death and infectious diseases. It presents trend and comparison data for Cobb County residents, including leading causes of death, children’s health issues, infectious and chronic diseases, and access to quality healthcare. The contents of this report represent information we use to assess our community’s current and future health needs. We hope it provides you with valuable information regarding the health of the community in which we live, work and play.

Below are highlights from the report: POPULATION LEADING CAUSES The population of Cobb County continues to These are the specific leading causes of illness, hospitalization and death in moderately grow (4.5% from 2009-2013) and has the county: a large percentage of youth. Heart and vascular disease is the leading cause of death in Cobb County, Sixty-two percent of the population is followed by other mental and behavioral disorders and lung cancers. under the age of 45. Infant Mortality is decreasing in Cobb County reflecting a national trend and ACCESS TO CARE due to the work of many. Georgia has moved from 44th highest in the nation Residents must have access to healthcare to 34th reflecting important improvements. There is a disparity in infant (facilities and providers) in order to be healthy. mortality, however. Among the black population infant mortality is triple that of the white population. It is estimated that 18.6% of residents in Cobb County lack health insurance. This is higher than Obesity due to poor nutritional habits and lack of physical activity are a major the U.S. rates. factor in the leading causes of illness and death in Cobb County. In 2012, 58% of Cobb County adults reported being either overweight or obese. It is Cobb County has approximately 181 physicians a significant public health concern for our community. per 100,000 residents. This is lower than the Georgia rate, creating an access to health care Georgia, like the rest of the Southeast, has some of the highest rates of issue in the county. Sexually Transmitted Diseases (STDs) in the country. According to the CDC, in 2012 Georgia was ranked 8th in the U.S. for Chlamydia, 5th in the U.S. for Gonorrhea, and 1st in the U.S. for Primary and Secondary Syphilis. This is also an issue that needs critical attention and solutions.

This document contains the most current verifiable information available from federal, state and local sources. The data is prior to 2014 due to collection and verification processes. This document contains the most current verifiable information available and verification processes. Population, by Race and Ethnicity, Cobb County, 2009 and 2013

RACE 2009 2013 The total population of Cobb County has grown since 2009. WHITE 462,821 469,626 Cobb County’s population increased by 4.5% between 2009 and 2013. The racial and ethnic makeup of Cobb BLACK/AFRICAN AMERICAN 173,317 191,823 County has remained the same since 2008.

ASIAN/PACIFIC ISLANDER 30,956 35,255

AMERICAN INDIAN/ALASKA NATIVE 3,256 3,575 ETHNICITY 2009 2013

NATIVE HAWAIIAN OR PACIFIC ISLANDER 538 471 HISPANIC 82,116 90,668

MULTIRACIAL 13,888 16,440 NON-HISPANIC 602,660 626,522

TOTAL 684,776 717,190 TOTAL 684,776 717,190

The largest age group in Cobb County is between 25 and 44 years old, with a population of 210,105 persons.

Approximately 62% of Cobb County’s population is under the age of 45 years.

10% 24% Population by Age Cobb County, 2012 0-17 YEARS OF AGE 26% 18-24 YEARS OF AGE 9% 25-44 YEARS OF AGE 45-64 YEARS OF AGE 65+ YEARS OF AGE 29%

*Source: Georgia Department of Public Health, Online Analytical Statistical Information System (OASIS)

Douglas County’s population has increased by 3.4% between 2008 and 2012. Within the same time period there was an 11% increase in black/African Americans and an 18% Leading Causes of Death, Cobb County, 2008-2012:

Diseases of the Heart: The Number One Leading Cause of Death in Cobb County, 2008 - 2012 Heart and Vascular Disease continues to be the number one leading cause of death in adults in Cobb County, the state of Georgia and the United States. All other mental and behavioral disor- ders (including Dementia, Schizophrenia and Bipolar disorder) was the second leading cause of death in Cobb County between 2008 and 2012, followed by lung and related cancers, cerebro- vascular disease and Chronic Obstructive Pulmonary Disease (COPD).

GA GA GA GA GA

Ischemic Heart and All Other Mental Malignant Neoplasms Cerebrovascular All COPD Vascular Disease and Behavioral Disorders of the Trachea, Disease Except Asthma (1,556) (1,184) Bronchus and Lung (876) (820) (1,089)

The dashboard arrow indicates where Cobb County ranks compared to the State of Georgia.

*Source: Georgia Department of Public Health: Online Analytical Statistical Information System (OASIS) Children’s Health Issues: Infant Mortality Rates, 2007-2011 CHILDREN’S HEALTH ISSUES

Infant Mortality

Cobb County Infant Mortality Rate Continues to Decline, 2008-2012 2008 2009 2010 2011 2012

UNITED STATES** 6.6 6.4 6.2 6.1 No data

WHITE 5.6 5.3 5.2 5.1 No data

BLACK 12.7 12.6 11.6 11.5 No data

GEORGIA*** 8.0 7.5 6.3 6.8 6.8

WHITE 7.3 6.5 5.7 5.8 5.3

BLACK 13.8 13.1 10.0 11.4 10.5

COBB COUNTY*** 6.7 6.9 5.6 5.4 4.9

WHITE 6.9 6.6 5.2 5.3 3.6

BLACK 12.7 14.2 9.4 10.3 9.2

Infant mortality rates for both blacks and whites are lower for Cobb County than for the state of Georgia. The infant mortality rate in Cobb County is 28% lower than the state as a whole. The rate of infant mortality among blacks in Cobb is nearly triple that of whites and efforts should be directed towards lowering the rate among this population in the county, as well as the state and nation.

Rate = Infant (<1 year) deaths per 1,000 live births *Source: National Center for Health Statistics, 2011 Data: http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_03.pdf **Source: Georgia Department of Public Health, Online Analytical Statistical Information System (OASIS) CHILDREN’S HEALTH ISSUES

Percent of Children 2 Years of Age Fully Immunized, 2010-2013 Cobb and Douglas counties have a lower percentage of fully immunized children 2 years of age than Georgia.

YEAR COBB AND DOUGLAS GEORGIA 2013 79% 85% 2012 83% 85% 2011 86% 82% 2010 78% 76%

The results of the 2013 Georgia Immunization Study indicate that the District 3-1 immunization coverage estimates for the 4:3:1:3:3:1:4* vaccination series is 85%. As of 2013, Cobb and Douglas counties have a 6% lower vaccination rate among 2 year olds compared to the state of Georgia. The importance of immunizations does not stop at 2 years old. Cobb & Douglas Public Health continues to stress the importance of childhood and adult vaccinations. Please visit http://www.cdc.gov/vaccines/acip/ for further information.

*4:3:1:3:3:1:4 Immunizations coverage considered fully immunized (a child has received 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hepatitis B, 1 Varicella, and 4 PCV vaccine doses), were based on the childhood immunization and catch-up schedules recommended by the Advisory Committee on Immunization Practices. Source: Georgia Department of Public Health, Georgia.

Childhood Obesity We are Facing a Youth Obesity Epidemic in Cobb County

Currently in America, one in three children is overweight or obese. These numbers have tripled over the last 30 years, and if this trend continues, one third of all children born in the year 2000 or later will suffer from a chronic obesity-related health problem.

The Georgia Student Health and Physical Education (S.H.A.P.E.) Act was passed in 2009. Beginning in the 2011-2012 school year, the law required each local school district to conduct an annual fitness assessment program (FitGrams) for all students in grades 1-12 enrolled in classes taught by certified physical education teachers.

Students who fell within the healthy fitness zone scored higher in math and reading, had fewer discipline referrals and had better attendance.

*Source: Cobb2020 FitGrams data, 2012 CHILDREN’S HEALTH ISSUES

Leading Causes of Death in Youth

Motor Vehicle Crashes were the Number One Leading Cause of Death among Youth in Cobb County, 2008-2012

Rank 1-4 years 5-9 Years 10-14 Years 15-19 Years

1 Congenital Septicemia Leukemia Motor Vehicle Crashes Malformations, Deformations and Chromosomal Abnormalities

2 Motor Vehicle Crashes Accidental All Other Diseases Intentional Self-Harm Drowning and of the Nervous System (Suicide) Submersion

3 Leukemia All Other Diseases Congenital Malformations, Assault (Homicide) of the Nervous System Deformations and Chromosomal Abnormalities

4 All Other Diseases Motor Vehicle Crashes Intentional Self-Harm Accidental Poisoning of the Nervous System (Suicide) and Exposure to Noxious Substances

5 Accidental Malignant Neoplasms of Diabetes Mellitus All Other Diseases Drowning and Meninges, Brain and of the Nervous System Submersion Other Parts of the Cenral Nervous System

Motor vehicle crashes continue to be the leading cause of death among youth in Cobb County and the state of Georgia. Between 2008 and 2012 motor vehicle crashes accounted for 28% of deaths among youth in Cobb County. Suicide was the second leading cause of death in youth in Cobb County followed by homicide.

*Source: Georgia Department of Public Health, Online Analytical Statistical Information System (OASIS) Community Health Needs Assessment Dashboard CHRONIC DISEASES

Body Mass Index* of Adults, Cobb County, 2012 Obesity 0.1%

Underweight Normal Weight Overweight Obese

In 2012, 58% of adults in Cobb County reported being either overweight or obese. The highest percentage of obesity in Cobb and Douglas counties is among the 28.5% black population at 45.8%. 22% of Cobb County adults reported being obese, 6% 35.1% less than the 2011 average for the state of Georgia..

*Body Mass Index is a number calculated from a person’s weight and height. A BMI greater than 18.5 and less than 25 is considered healthy. 36.2%

*Source: Douglas County MAPP Survey Report, A.L. Burruss Institute of Public Service and Research, 2011-2012; The Georgia Behavioral Risk Factor Surveillance Survey Report, 2012

Smoking in Adults, Cobb County, 2012 1.10% Tobacco

Yes No Don’t Know/Refused

11.80% Approximately 12% of adults in Cobb County smoke, 9% below the 2011 state average for Georgia. Those that reported tobacco use in Cobb County tended to be male, have less education and have less income. 0.208

87.10%

*Source: Cobb County MAPP Survey Report, A.L. Burress Institute of Public Service and Research, 2011-2012; The Geor- gia Behavioral Risk Factor Surveillance Report, 2012. CHRONIC DISEASES

Heart Disease

Percent of Adults Who Have Had a Heart Attack, 2011

TOTAL MALE FEMALE WHITE BLACK 18-44 45-64 65+

COBB & 4.1% 3.2% 4.8% 4.7% 6.0% 3.2% 2.6% 12.2% DOUGLAS

GEORGIA 4.4% 5.2% 3.6% 5.2% 3.1% 0.9% 5.8% 13.8%

In 2011, approximately 4.1% of adults suffered a heart attack in Cobb and Douglas counties. This rate is lower than the Georgia average; however, heart attacks are still a major concern in Cobb County. In Cobb and Douglas counties a higher percentage of the black population and 18-44 year old population reported having a heart attack compared to the Georgia average.

*Source: Georgia Department of Public Health, Online Analytical Statistical Information System (OASIS) Behavioral Risk Factor Surveillance System

Age–Adjusted Death Rates* Due to Cardiovascular Disease, 2008-2012

Georgia Cobb 270 County 267.8 262.6 252.1 202.5 242.5 214.8 211.7 207.1 233.3 194.8 135 176.8

67.5

0 2008 2009 2010 2011 2012

After adjusting for age in order to make Cobb County comparable to the state of Georgia, Cobb County had a lower death rate for cardiovascular disease. Cardiovascular disease, however, is the leading cause of death in Cobb County.

Source: Georgia Department of Public Health, Online Analytical Statistical Information System (OASIS) Morbidity/Mortality Web Query Tool

*Rate = the number of cases per 100,000 population. Age adjusting rates is a way to make fairer comparisons between populations with different age distributions. CHRONIC DISEASES

Diabetes Adults Living with Diabetes, 2011

TOTAL MALE FEMALE WHITE BLACK 18-44 45-64 65+

COBB & 8.2% 7.8% 8.6% 8.6% 10.4% 3.9% 9.1% 23.5% DOUGLAS

GEORGIA 10.2% 9.8% 10.5% 10.1% 11.8% 2.8% 14.8% 25.9%

In 2011, 10.2% of adults in Georgia had ever been diagnosed with diabetes. This is slightly higher than the U.S. prevalence* of 9.5%. Cobb and Douglas counties have a combined prevalence slightly lower than the state prevalence.

*Prevalence = the number of cases of a disease/ condition in a population at a given time. *Source: Georgia Department of Public Health, Online Analytical Statistical Information System (OASIS) Behavioral Risk Factor Surveillance System, The Georgia Behavioral Risk factor Surveillance System Report, 2012

Prevalence of Adults Living with Asthma, 2011 Asthma

TOTAL MALE FEMALE WHITE BLACK 18-44 45-64 65+

COBB & 6.6% 2.6% 9.7% 7.1% 7.8% 7.7% 4.6% 7.4% DOUGLAS

GEORGIA 9.6% 7.5% 11.6% 9.8% 10.9% 10% 9.2% 9.3%

Cobb and Douglas counties have a lower prevalence of asthma compared to the state of Georgia, which has a prevalence of 9.6%.

*Source: Georgia Department of Public Health, Online Analytical Statistical Information System (OASIS) Behavioral Risk Factor Sur- veillance System, The Georgia Behavioral Risk Factor Surveillance Report, 2012 CHRONIC DISEASES

Stroke Percent of Adults Who have had a Stroke, 2011

WHITE 4 4 MALE FEMALE WHITE TOTAL FEMALE 3.9% 3.5% 3.3% 3.3% 3.4% 3 3 3.3% BLACK TOTAL BLACK 2.8% 2.5% 2 2.3% 2 MALE 1.6% 1 1

0 0

COBB AND DOUGLAS GEORGIA

The occurrence of stroke within Cobb and Douglas counties was less than Georgia in 2011. Females and Whites, however, were more likely to have a stroke within Cobb and Douglas counties compared to other populations.

*Source: Georgia Department of Public Health, Online Analytical Statistical Information System (OASIS) Behavioral Risk Factor Surveillance System, The Georgia Behavioral Risk Factor Surveillance Report, 2012 INFECTIOUS DISEASES STD RANKINGS PERTUSSIS Georgia, like the rest of the Southeast, has some of the highest rates of Sexually Transmitted Diseases (STDs) in the country. According to the CDC, in 2012 Georgia was ranked: Reported Pertussis Cases in Cobb County and Georgia, 2008-2012 8th Highest in the U.S. for chlamydia with a rate of 534 per 100,000 2008 2009 2010 2011 2012

COBB 20 42 22 25 65 5th Highest COUNTY in the U.S. for gonorrhea with a rate of 156.1 per 100,000 GEORGIA 116 230 247 180 330 1st in the U.S. for primary and secondary syphilis with a rate of 9.5 per 100,000 Incidence Rates* of Pertussis are Increasing in Cobb County Pertussis rates have increased significantly in Cobb County in recent years; nearly triple the rate for the state of Georgia in 2012. Pertussis is a vaccine preventable disease. Cobb & Douglas Public Health recommends vaccinations to all age groups. SYPHILLIS

COBB 10 DOUGLAS Sexually Transmitted Diseases GEORGIA Primary and Secondary Syphilis, 2008-2012 7.5 COBB GEORGIA COBB GEORGIA CASES CASES RATES RATES 5 2008 74 912 10.9 9.6 2009 68 954 9.9 9.9 2.5 2010 50 778 7.2 8 2 0 1 1 53 860 7.6 8.8 0 2008 2009 2010 2011 2012 2012 57 935 8.1 9.4

*Rate = the number of cases per 100,000 population. **Source: Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance 2011, Atlanta: U.S. Department of Health and Human Services, 2012

Cobb County has averaged about 60 cases of primary and *Rate = the number of cases per 100,000 population. secondary syphilis per year since 2008. Source: Georgia Department of Public Health, Acute Disease Epidemiology Section ACCESS TO HEALTH SERVICES

Insurance Coverage In the 2011-2012 Cobb County MAPP Survey Report, 15% Cobb County has approximately the same percentage of of participants reported having to forgo a doctor’s visit in uninsured individuals compared to the state of Georgia, but the past year due to cost. Those who reported having a higher percentage of uninsured individuals compared to to delay care tended to be female, non-White, Hispanic, the U.S. as a whole. have less income and less education. The opposite was true for people who were 65 years old or older. Percent of the Population without Insurance Coverage, 2013 Cobb County 18.6% Georgia 18.8% United States 14.6%

*Source: Cobb County MAPP Survey Report, A.L. Burruss Institute of Public Service and Research, 2011-2012 Source: American Community Survey, 2013

Physicians to Population Ratio Emergency Room Visits, Cobb County 2008-2012 In Cobb County, the ratio of residents to Unintentional injuries, not including falls, were the number one reason for emer- physicians was 551 to 1, 13% worse than the gency room visits in Cobb County between 2008 and 2012, with 95,084 cases Georgia ratio (489 to 1).This contributes to the total. The rate of emergency room visits for all other unintentional injuries in access to health care issue in the county. Cobb County falls below the rate for the state of Georgia.. Unintentional Injuries: Number One Reason for Emergency Room Visits, 2008 – 2012

GA GA Ratio of Persons to Physicians, 2010 GA

551

489 All Other Falls Diseases of the Unintentional Injury (57,900) Musculoskeletal System (95,084) and Connective Tissue (52,685) GA GA

Cobb County Georgia All Other Diseases of the Motor Vehicle Crashes Genitourinary System (28,770) (52,462)

*Source: UGA Georgia County Guide *Source: Georgia Department of Public Health, Online Analytical Statistical Information System (OASIS) Community Health Needs Assessment Dashboard Seeking a Solution

CDPH facilitated the 2011 launch of Cobb2020 - a partnership of community organizations and individuals dedicated to promoting healthy lifestyles and the delivery of essential health services in Cobb County. Together, through a strategic process called Mobilizing Action through Planning and Partnerships (MAPP), Cobb2020 has assessed the current health status of the County and is developing a Health Improvement Plan that will help create significant changes in building a healthier community.

The overall goal of Cobb2020 is to implement strategic changes throughout Cobb County over the next five years that build a foundation for reducing and preventing chronic disease such as diabetes, stroke, heart disease and cancer by promoting healthy lifestyles and better access to health and prevention services for the community.

Cobb 2020 has identified the following focus areas: • Improving Access to Primary Health Care • Improving Healthy Lifestyles – Through Proper Nutrition – Access to Physical Activity – Reducing the Use Of Alcohol and Other Drugs

Please visit Cobb2020.come or CobbandDouglasPublicHealth.org for more information on our health status, community improvement plan and current partnership activities. Cobb Public Health Board of Health Members Dr. Dan Stephens, Chairman Acworth Public Health Center South Cobb Public Health Center 4489 Acworth Industrial Drive 875 Six Flags Drive Dr. W. Wyman Pilcher, III, Vice-Chair Acworth, Ga. 30101 Austell, Ga. 30168 Dr. Emily Lembeck Phone: (770) 974-3330 Phone: (678) 385-1360 Fax (770) 966-9192 Fax: (678) 385-1376 Mr. Tim Lee

East Cobb Public Health Center Lake Park Public Health Center Mr. Chris Ragsdale 4938 Lower Roswell Road 1955 Lake Park Drive, Suite 300 Ms. Judi Snelson Marietta, Ga. 30068 Smyrna, GA 30080-8855 Phone: (678) 784-2180 Phone: (770) 514-2357 Dr. James M. Tallman Fax: (678) 784-2198 Fax: (770) 432-1774

Marietta Public Health Center Cobb County Environmental Health 1650 County Services Pkwy. 3830 South Cobb Drive, Suite 102 Marietta, Ga. 30008 Smyrna, Ga. 30080 Phone: (770) 514-2300 Phone: (770) 435-7815 Fax: (770) 514-2363 Fax: (770) 431-7410 Cobb Health Futures Foundation Smyrna Public Health Center 3830 South Cobb Drive, Suite 200 Smyrna, Ga. 30080 Phone: (770) 438-5105 The Cobb Health Futures Foundation is a 501(c)3 Fax: (770) 319-8245 philanthropic arm of public health in Cobb County. Incorporated in 1994, the foundation’s purpose is to Important Websites and Numbers support the mission it shares with Cobb & Douglas Cobb & Douglas Public Health: Public Health, which is, with our partners, to http://www.cobbanddouglaspublichealth.org/ promote and protect the health and safety of the Cobb 2020: residents of our county. Cobb Health Futures has http://cobb2020.com/ selected to focus its 2014 fundraising efforts on: Georgia Department of Public Health: http://dph.georgia.gov/ Babies Can’t Wait Centers for Disease Control & Prevention: Perinatal Case Management http://www.cdc.gov/ Children’s Medical Services Georgia Poison Center: 404-616-9000 (inside metro Atlanta) or 1-800-222-1222 (outside metro Atlanta)

For more information about the foundation or any of the programs it supports, call (770) 514-2325, email [email protected], or visit www.cobbhealthfutures.org. CDPH-CHR_121214