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CHNA‐South Suburban Chicago

Franciscan St. James Health‐Olympia Fields & Chicago Heights Spring 2016

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Community Health Needs Assessment CONTENTS

Community Health Needs Assessment 2

Executive Summary 4

Franciscan St. James Health‐Olympia Fields & Chicago Heights 5

Approach and Methodology 7

Communities We Serve 9

Special Populations 9

Social Determinants of Health 10

General Health 11

Overall Physical Health 14

Overall Mental Health 15

Chronic Disease, Mortality, Morbidity 15

Leading Causes of Death 15

Accidents, Injuries, and Homicide 16

Cancer 16

Cardiovascular 18

Diabetes 19

Infectious Disease 20

Neurological 20

Respiratory 20

Rheumatic/Joint Related 21

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Behavioral Health 21

Substance Abuse 22

Suicide 22

Pre‐Natal through 18 Years of Age 23

Pre‐Natal Care 24

Birth Outcomes 24

Youth Indicators 24

Modifiable Health Risks 25

Weight 25

Physical Activity 25

Nutrition 26

Substance Abuse 26

Tobacco Use 27

Oral Health 27

Access to Health Care Challenges 28

Health Professions Shortage Areas 28

Insurance/Payment 28

Transportation 28

Summary 28

Data Gaps and Challenges 29

Response to Findings 29

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Executive Summary

The Community Health Needs Assessment (CHNA) is designed to provide an understanding of the current health status and needs of the residents in the communities served by Franciscan St. James Health (FSJH‐Olympia Fields and Chicago Heights). This report meets the current Internal Revenue Service’s requirement for tax‐exempt hospitals, which is based on the Patient Protection and Affordable Care Act of 2010. More importantly, this document assists FSJH in providing essential services to those most in need. Based on the findings in this report, FSJH will develop a three year strategic plan on meeting community health needs as capacity and resources allow.

FSJH‐Olympia Fields and FSJH‐Chicago Heights are less than five miles apart and operate under one Tax ID number. The Illinois Health Facilities and Services Review Board recently approved the closure of the inpatient services in Chicago Heights in 2016. Inpatient services will be consolidated at FSJH‐Olympia Fields, and FSJH will be developed as an outpatient facility to better minister to the ongoing health needs of the community. Because of this arrangement, both locations are addressed in this CHNA.

This report focuses on South Cook County and Will County, the location of most of FSJH patient residences. Both counties face several challenges due to its socioeconomic factors, built environment, industry types, and geographical location. Using mixed methods to evaluate the primary and secondary data, the following health‐related issues are top concerns:

1. Physical Activity and Nutrition: Obesity, diabetes management, arthritis, and cardiovascular conditions all score highly in incident rates and perception of need. A common theme amongst all of these clinical issues is the lack of physical activity and proper nutrition. Concerns about public safety, lack of built environment, and access to healthy food also contribute to this issue. Food insecurity is also an issue.

2. Behavioral Health: Substance abuse rates are also quite high, especially with alcohol and opiates. Stress, depression, and poor mental health rates also contribute to poor chronic disease management, obesity, and self‐ satisfaction.

3. Access to Health Care: Cost of co‐pays, deductibles, medications, and durable medical equipment are reported most frequently as barriers to clinical care. Areas of Cook County are a federally designated Health Professions Shortage Area (HPSA). There is a shortage of providers and long waits to see a primary care provider.

4. Breast, Prostate, and Colorectal Cancers: While the mammogram rates are fairly good in the county, the incidence of breast cancer remains high. Colorectal and prostate cancer screening rates are low and incident rates are high.

5. Prenatal Care: Smoking during pregnancy, low clinical care visits, and high infant mortality rates show the need for improved access and services for pregnant women and their families.

6. Asthma: Perhaps linked to the poor air quality,, asthma rates are high and management is poor, especially in children.

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Census Data: Social Determinants of Health

Will and Cook County vs. Illinois: Social Determinants of Health

Characteristic Will County Cook County Illinois

Veteran Population 21.1% 25.6% 18.4%

Race/Ethnicity: Caucasian 56.3% Origin 76.0% 77.5%

Under 18 Population 26.7% 28.7% 23.2%

High School Graduation Rates 90.5% 84.8% 87.6%

Employment 69.6% 63.5% 65.9%

Unemployment 5.2% 7.8% 6.6%

Uninsured 11% 11% 15%

Poverty 8.1% 17.2% 14.4%

Franciscan St. James Health

A trusted leader in providing faith‐based, integrated health care, FSJH‐Olympia Fields & Chicago Heights is a full‐ service, acute‐care medical center. Franciscan St. James Health's Heart and Vascular Institute, ranked one of the Solucient Top 100 cardiovascular hospitals two years in a row, offers patients comprehensive cardiovascular services including prevention, treatment and rehabilitation. And, the Patricia A. Joyce Comprehensive Cancer Institute provides a multi‐disciplinary team of specialists for the continuum of patient care, from pre‐treatment evaluation to post‐treatment follow‐up.

FSJH‐Olympia Fields is located in Will County, 20201 South Crawford Avenue, Olympia Fields, IL 60461. FSJH‐ Chicago Heights is located in Cook County, 1423 Chicago Road, Chicago Heights, IL 60411. The President is Arnie Kimmel The FSJH statistics include:

FSJH Services Average Annual Inpatient Admissions 13,696 Annual Outpatient Visits 160,957 Annual Emergency Department Visits 74,328 Annual Surgical Procedures 10,175 Births 756 Average length of patient stay 3.70 Volunteers 225 Total Physicians (includes Franciscan Physician Network and affiliated doctors) 456

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FSJH‐Chicago Heights ‐ Services Include:

Emergency Medicine Joint & Spine Care Pediatrics Urgent Care Family Doctor Laboratory Services Primary Care Physicians Women’s Health/OBGYN Home Health Care Neurodiagnostics Rehabilitation Services Hospice OBGYN Respiratory Care Hospitalists Occupational Health Robotic Surgery Imaging Orthopedics Sleep Disorders Intensive Care Unit Palliative Medicine Surgical Services Interventional Radiology Pathology Therapy Services

FSJH‐ Olympia Fields – Services Include:

Bariatrics Gastrointestinal Services Neurodiagnostics Weight Loss/Bariatrics Behavioral Health Heart & Vascular Nuclear Medicine Cancer Care Home Health Care Pain Management Colon and Rectal Surgery Hospitalists Palliative Medicine Diabetes Care Imaging Pathology Electrophysiology Lab Infusion Services Primary Care Physicians Emergency Medicine Imaging Respiratory Care Endoscopy Surgery International Travel Clinic Therapy Services Center Family Doctor Laboratory Services Urgent Care

The FSJH mission is To Continue Christ’s Ministry in our Franciscan Tradition. Values include:

Respect for Life The gift of life is so valued that each person is cared for with such joy, respect, dignity, fairness and compassion that he or she is consciously aware of being loved.

Fidelity to Our Mission Loyalty to and pride in the health care facility are exemplified by members of the health care family through their joy and respect in empathetically ministering to patients, visitors and co‐workers.

Compassionate Concern In openness and concern for the welfare of the patients, especially the aged, the poor and the disabled, the staff works with select associations and organizations to provide a continuum of care commensurate with the individual's needs.

Joyful Service The witness of Franciscan presence throughout the institution encompasses, but is not limited to, joyful availability, compassionate, respectful care and dynamic stewardship in the service of the Church.

Christian Stewardship Christian stewardship is evidenced by just and fair allocation of human, spiritual, physical and financial resources in a manner respectful of the individual, responsive to the needs of society, and consistent with Church teachings.

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Approach and Methodology

FSJH partnered with MCHC, which is now the Illinois Health and Hospital Association. The partnership allowed for better data collection, reduced burden on residents to complete surveys, and a platform to combine efforts on various community health needs throughout the state.

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The Mobilizing for Action through Planning and Partnership (MAPP) model, developed by the National Association of County and City Health Officials (NACCHO), guided the assessment process in Cook County, as the county health department is working on accreditation through the Public Health Accreditation Board (PHAB). The MAPP model includes several components for community assessment. The PRECEDE‐PROCEDE method was also utilized. This assessment reflects Phases 1 through 5.

Community benefit professionals from each system worked together on data collected in three ways: 1. Community Health Survey: Questions based on perception of community and personal needs was created.

2. Secondary Data Collection: With the assistance of public health undergraduate and graduate students, data on health and wellness issues was collected. Sources include County Health Rankings, Census Bureau Data, various reports from the Illinois State Department of Health, and other national reports. Community Commons, and Healthy Communities Institute data management systems also contributed to the secondary data used. Sources of the secondary data are identified throughout this report.

3. Key Leader Survey: An online key informant survey was implemented. The survey was taken by 64 community leaders from multiple sectors, including government, health care, social services, and schools.

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Communities We Serve

FSJH serves Cook and Will County primarily with a majority of patients from these zip codes: 60411, 60443, 60466, 60478, 60484, 60428, 60438, 60473, and 60423.

The other zip codes include: 60417, 60422, 60425, 60430, 60449, 60461, 60471, 60475, 60409, 60419, 60426, 60429, 6448, 60452 and 6477.

Special Populations

Our primary populations served include, African American, and Hispanic. As seen below, the student’s eligible for the free lunch program is very high. This correlates to the children living below the poverty level.

Characteristics‐ Special Populations Will County Cook County Illinois

Single Parent Households 22.00% 37.90% 32.00%

Median Household Income 76,142 54,828 57,166

Households with Cash Public Assistance Income 1.70% 3.30% 2.50%

Renters Spending 30% or More of Household Income on Rent 52.30% 52.90% 45.40%

Children Living Below Poverty Level 11.80% 25.20% 21.60%

Families Living Below Poverty Level 6.50% 13.30% 33.00%

Students Eligible for the Free Lunch 62.60% 46.70% Program 30.20%

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Insurance and Demographic Will County Cook County Insured, Private Health Insurance 85.30% 76.20% Insured, Public Health Insurance 5.40% 7.00% Insured, Employed, Ages 18‐64 89.10% 81.70% Insured, Unemployed, Ages 18‐64 68.50% 66.40% Social Determinants of Health

Will and Cook County vs. Illinois Narrative

Cook County Illinois Characteristic Will County Percentage Percentage Total Percentage Population 677,560 5,194,675 12,830,632 Median Household Income $76,142 54,828 57,166 Veteran Population 32,514 21.10% 202,886 25.60% 699,522 18.40% Race/Ethnicity: Caucasian Origin 514,664 76.00% 2,877,212 56.30% 9,177,877 77.50% Over 18 Population 245,001 36.20% 2,075,426 40.00% 5,007,536 39.00% Homeowners: Occupied Units 225,256 94.80% 1,966,356 90.20% 4,836,972 91.30% High School Graduation Rates 90.5% 90.50% 87.60% Employment: Construction/Manufacturing 58,227 23.60% 366,497 15.10% 1,265,338 21.70% Employment: Educational, Health and Social Services 43,396 17.60% 556,802 22.90% 1,131,987 19.40% Unemployment 11,318 3.10% 322,732 7.80% 669,561 6.60% Not Insured 11.00% 15.90% 12.30% Poverty 8.10% 17.20% 14.40%

Poverty can be displayed through the amount of students receiving free or reduced lunch within the school system. In Will County, 30.20% of kids are eligible for free lunch. (Census, 2015). 8.10% of people live in poverty and 11.80% of children under 18 live in poverty (Census, 2015). The top five industries that employ residents are within these sectors (Census, 2015): 1. Manufacturing: 11.80% of the total working population 2. Educational services, and health care and social assistance: 22.30% of the total working population 3. Professional, scientific, and management, and administrative and waste management services: 11.00% of the total working population 4. Retail Trade: 12.20% of the total working population 5. Arts, entertainment, and recreation, and accommodation and food services: 8.50% of the total population

In Cook County, 62.80% of kids are eligible for free lunch. (Census, 2015). 17.20% of people live in poverty (Census, 2015). The top five industries that employ residents are within these sectors (Census, 2015): 1. Manufacturing: 10.50% of the total working population 2. Educational services, and health care and social assistance: 22.90% of the total working population 3. Professional, scientific, and management, and administrative and waste management services: 13.70% of the total working population 4. Retail Trade: 10.10% of the total working population 5. Arts, entertainment, and recreation, and accommodation and food services: 9.90% of the total population

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General Health

The survey asked the respondents, “How would you rate the overall healthcare services available to you?”

35.00%

30.00%

25.00% 20.00% 15.00%

10.00%

5.00% 0.00%

Excellent Very Good Good Fair Poor

The survey asked the respondents, “How long has it been since you last visited a doctor for a routine checkup?”

90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Within the past Within the past 2 Within the past 5 5 or More Years Never year years years Ago

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The survey asked the respondents, “How difficult is it for you to access safe and affordable places to get physical activity or exercise?”

70.00%

60.00%

50.00%

40.00%

30.00%

20.00%

10.00%

0.00% Very difficult Somewhat difficult Not too difficult Not at all difficult

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Overall Physical Health

Physical health is based on physical activity, air and water quality, and access to recreational parks and centers. In Will County, 23% of adults are physically inactive. The average number of physically unhealthy days is 3.2 days during the last 30 days (County Health Rankings). Other indicators include:

Air and Water Quality Linked to Health Disparities: Will County, Indiana Recognized Carcinogens Released into the Air 87,678 lbs. Air Quality Index 2 Drinking Water Violations 2% Physical Environment Ranking 97 Age‐Adjusted ER Rate due to Urinary Tract Infection 70.3 per 10,000 Age‐Adjusted Hospitalization Rate due to Urinary Tract Infection 23.1 per 10,000 Age‐Adjusted ER Rate due to Dehydration 15.6 per 10,000 Age‐Adjusted Hospitalization Rate due to Dehydration 17.8 per 10,000 Asthma: Medicare Population 4.50% Age‐Adjusted ER Rate due to Asthma 45.3 per 10,000 Age‐Adjusted Hospitalization Rate due to Asthma 12.2 per 10,000 Age‐Adjusted ER Rate due to Pediatric Asthma 73.6 per 10,000 Age‐Adjusted Hospitalization Rate due to Pediatric Asthma 11.7 per 10,000 Age‐Adjusted ER Rate due to Adult Asthma 35.5 per 10,000 Age‐Adjusted Hospitalization Rate due to Adult Asthma 12.3 per 10,000 Age‐Adjusted ER Rate due to COPD 8.8 per 10,000 Age‐Adjusted Hospitalization Rate due to COPD 31.0 per 10,000 HCI, 2015

In Cook County, 21% of adults are physically inactive. The average number of physically unhealthy days is 3.5 days during the last 30 days (County Health Rankings). Other indicators include:

Air and Water Quality Linked to Health Disparities: Cook County, Indiana Recognized Carcinogens Released into the Air 330,396 lbs. Air Quality Index 5 Drinking Water Violations 1% Physical Environment Ranking 44 Age‐Adjusted ER Rate due to Urinary Tract Infection 60.1 per 10,000 Age‐Adjusted Hospitalization Rate due to Urinary Tract Infection 18.4 per 10,000 Age‐Adjusted ER Rate due to Dehydration 10.9 per 10,000 Age‐Adjusted Hospitalization Rate due to Dehydration 15.2 per 10,000 Asthma: Medicare Population 5.70% Age‐Adjusted ER Rate due to Asthma 67.7 per 10,000 Age‐Adjusted Hospitalization Rate due to Asthma 18.1 per 10,000 Age‐Adjusted ER Rate due to Pediatric Asthma 105.7 per 10,000 Age‐Adjusted Hospitalization Rate due to Pediatric Asthma 17.1 per 10,000 Age‐Adjusted ER Rate due to Adult Asthma 54.5 per 10,000 Age‐Adjusted Hospitalization Rate due to Adult Asthma 18.4 per 10,000 Age‐Adjusted ER Rate due to COPD 7.8 per 10,000 Age‐Adjusted Hospitalization Rate due to COPD 21.5 per 10,000 HCI, 2015

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Overall Mental Health

Mental health is a combination of all factors, especially social and emotional support and drug and alcohol‐related behaviors. The rank is out of 102.

Will and Cook County State Rankings (Out of 102 Counties) Characteristic Will County Rank Cook County Rank Health Outcomes 21 64 Health Factors 19 70 Clinical Care 34 81 Health Behaviors 13 12 Physical Environment 97 44 Socioeconomic Factors 21 85 Quality of Life 39 87 County Health Rankings 2015

A lack of social and emotional support can be the cause of several health disparities. Factors that can be attributed to this statistic are listed below:

Indicator Characteristic Will County Cook County Excessive Drinking 24.00% 21.00% Alcohol impaired driving deaths 46.00% 39.00% ER Rate due to alcohol abuse per 10,000 29.30% 41.80% Violent Crime rate per 100,000 167.2 630.6

Chronic Disease, Mortality, Morbidity

Leading Causes of Death

According to the CDC National Health Report, the leading causes of death in 2011 in the United States were heart disease, cancer, stroke, Alzheimer’s disease, diabetes mellitus, pneumonia and influenza, kidney disease and suicide.

In Will County, the violent crime rate is 167.2 per 100,000. According to the CDC (2014), Will County was ranked in ten of the top fifteen leading causes of death in the United States last year. In order, here are the causes and rates per 100,000: o Heart Disease: 99.5 o Lung Cancer: 50.6 o Stroke: 37.7 o Chronic Lower Respiratory Diseases: 36.1 o Unintentional Injuries: 29.2 o Prostate Cancer: 21.5 o Alzheimer’s Disease: 18.0 o Kidney Disease: 18.0 o Diabetes: 17.2 o Suicide: 9.3

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In Cook County, the violent crime rate is 630.6 per 100,000. Cook County was ranked in ten of the top fifteen leading causes of death in the United States last year. In order, here are the causes and rates per 100,000:

o Heart Disease: 103.9 o Lung Cancer: 46.1 o Stroke: 37.0 o Chronic Lower Respiratory Diseases: 30.8 o Unintentional Injuries: 27.3 o Prostate Cancer: 26.0 o Diabetes: 20.3 o Alzheimer’s Disease: 17.3 o Kidney Disease: 17.2 o Suicide: 8.2

Accidents, Injuries, and Homicide

Unintentional injury and accidents continue to rank in the top ten (sometimes top five) leading causes of injury or death, statewide and locally. County and state data are compared below: Will County has an unintentional injury mortality rate of 29.2 per 100,000 and Cook County has 27.3 per 100,000.

Will and Cook County vs. Illinois Description Will County Data Cook County Data Illinois Data Unintentional Injury Mortality Rate 29.2 per 100,000 27.3 per 100,000 27.60 per 100,000 Traffic Injury Mortality Rate 7.8 per 100,000 5.6 per 100,000 7.22 per 100,000 Homicide in 2012 3.5 per 100,000 11.97 per 100,000 7.40 per 100,000

Cancer

Cancer greatly affects these county mortality rates as well. The top four causes of cancer mortality are listed below and the rate are per 100,000 (National Cancer Institute): Will County

 Lung Cancer: 50.6  Female Breast Cancer: 22.8  Colorectal Cancer: 15.7  Prostate Cancer: 21.5

Cook County

 Lung Cancer: 46.1  Female Breast Cancer: 24.5  Colorectal Cancer: 17.7  Prostate Cancer: 26.0

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The top three cancers that affect the state of Illinois are lung cancer, colorectal cancer, and prostate cancer. The National Cancer Institute projected the estimated number of incidents and deaths for selected cancers in each Illinois County. Will and Cook’s County’s projections were:

Estimated Number of Incidents and Deaths for Selected Cancers per 100,000: Illinois 2014 Prostate Female Breast Colorectal Lung/Bronchus

Incident Mortality Incident Mortality Incident Mortality Incident Mortality Illinois 142.1 21.5 128.8 22.8 46.5 15.7 73.1 50.6 Will Cook 147.5 26.0 127.5 24.5 48.4 17.7 65.1 46.1 INdicators, 2015

Smoking can be attributed to several health disparities, including cancer. Adult smoking is defined as the percentage of the adult population that currently smokes every day or most days and has smoked at least 100 cigarettes in their lifetime (County Health Rankings, 2015). In Will and Cook County, the adult smoking rate is 18%, which is below the state percentage of 23%.

The survey asked the respondents, “Have you stopped smoking for one day or longer because you were trying to quit?”

3.20%

Yes No 32.90%

The survey asked the respondents, “In the past 30 days, has anyone including yourself smoked cigarettes, cigars or pipes anywhere in your home?

10%

Yes No

90%

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Cardiovascular

Illinois ranks 27th in the nation for heart disease (USA Life Expectancy, 2015). Last year, 137.2 deaths per 100,000 were cardiovascular related. Other statistics include age‐adjusted rates in the table below:

Will and Cook County vs. Illinois

Description Will County Cook County Illinois Data Age‐Adjusted Death Rate due to Stroke (per 100,000) 37.7 37.0 74.8 Age‐Adjusted Death Rate due to Coronary Heart Disease (per 100,000) 99.5 103.9 351

Data: (CDC, 2015)

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Diabetes

Obesity is a contributing factor to diabetes; both factors relate to poverty, physical environment, and food insecurity. Approximately 8.7% of adults ages 18 and older have been medically diagnosed with diabetes in Will County and 8.5% in Cook County. The diabetes mortality rate for Will County is 17.2 per 100,000 and in Cook County it is 20.3 per 100,000 (Centers for Disease Control and Prevention).

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Infectious Disease

Infectious disease is inevitable, but rates can be reduced through preventative care (vaccines) or lifestyle changes/choices.

Will County had 27 cases of HIV in 2014 and Cook County had 984 (County Health Rankings, 2015). (County Health Rankings, 2015).

Neurological

Most neurological illness occurrence is not reported by county, but Alzheimer’s disease mortality rates are reported. The Alzheimer’s disease mortality rate for Will County is 18.0 per 100,000 and for Cook County it is 17.3 per 100,000 (Illinois Hospital Association).

Respiratory

Respiratory issues continue to fill the Emergency Department and hospital rooms (Illinois Hospital Association):

Will County

o Asthma ED Visits: 45.3 per 10,000 o Pediatric Asthma ED Visits: 73.6 per 10,000 o Asthma Hospitalization: 12.2 per 10,000 o Pediatric Asthma Hospitalization: 11.7 per 10,000 o Chronic Lower Respiratory Disease Mortality: 36.1 per 100,000

Cook County o Asthma ED Visits: 67.7 per 10,000 o Pediatric Asthma ED Visits: 105.7 per 10,000 o Asthma Hospitalization: 18.1 per 10,000 o Pediatric Asthma Hospitalization: 17.1 per 10,000 o Chronic Lower Respiratory Disease Mortality: 30.8 per 100,000

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The survey asked the respondents, “Have you ever been told by a doctor, nurse, or other health professional that you had asthma?

18.40%

Yes No

81.60%

Rheumatic/Joint Related

Arthritis and hip fractures continue to fill the Emergency Department and hospital rooms:

Occurrence Will Cook Illinois Rheumatoid Arthritis: Medicare Population 32.3% 33.9% 31.50% Osteoporosis: Medicare Population 6.5% 6.6% 6.40%

(Centers for Medicare & Medicaid Services)

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Behavioral Health

Substance Abuse

Substance abuse is an issue statewide and locally; task forces have been tackling the ever‐growing issue. Will County had 52 heroin deaths in 2012 and accidental overdoses accounted for 28.2% of unnatural deaths. Cook County had 29% of teens who use marijuana and the death rate due to drug poisoning was 10.9 per 100,000.

Suicide

Suicide is one of the most preventable causes of death, but it still has a major impact in the state of Illinois. The suicide mortality rate was 8.2 per 100,000 (Illinois Life Expectancy). Illinois on an average has about 16.7 suicide attempts daily.

According to the 2013 National Youth Risk Behavior Survey, 18.9% of students in grades 9th through 12th seriously considered attempting suicide during the 12 months before the survey. 16.9% of the students made a plan about how they would attempt suicide and 12.4% of the students attempted one or more times during the 12 months before the survey (CDC, 2013).

The survey asked the respondents, “During the past 30 days, have you used an illegal drug or taken a prescription drug that was not prescribed to you?”

12000.00%

10000.00%

8000.00%

6000.00%

4000.00%

2000.00%

0.00% Yes No

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The survey asked the respondents, “In the past 30 days, did you have 5 or more drinks on an occasion?”

80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 12456710None

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Pre‐Natal through 18 Years of Age

Pre‐Natal Care

Prenatal care seems to be declining, causing other issues to arise. Although 61.7% of pregnant women sought prenatal care during the first trimester in Will County, 5.2% of women smoked throughout their pregnancy. In Cook County, 80.5% of pregnant women sought prenatal care during the first trimester and 3.65 of women smoked during their pregnancy (Illinois Department of Public Health). Healthy People 2020’s objective for the state’s breastfeeding rate is to be 81.9%.

Birth Outcomes

The state average for low birth weight is 8.2%; Will County’s low birth weight percentage is 7.5%. The county’s infant mortality rate is 5.1 per 1,000 live births. The premature death in Will County in 2012 was 5,271. Cook County’s low birth weight percentage is 9.1%. The county’s infant mortality rate is 6 per 1,000 live births and the premature death was 6,794(County Health Rankings, 2015).

Youth Indicators

According to the CDC (2015), the Youth Risk Behavior Surveillance System “monitors six types of health‐risk behaviors that contribute to the leading causes of death and disability among youth and adults including: behaviors that contribute to unintentional injuries and violence, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection, alcohol and other drug use, tobacco use, unhealthy dietary behaviors, and inadequate physical activity. In 2013, the YRBSS report was released, and all of these behaviors were assessed. For example, in Illinois, 44.0% of students tried cigarette smoking, even one or two puffs. The survey revealed that 14.1% of students smoked cigarettes on one or more of the past 30 days, and 51.2% of students who reported current cigarette use have tried to quit in the past 30 days. Alcohol usage is prevalent in Illinois high schools as well. The survey showed that 67.7% of students had at least one drink of alcohol in their life. The survey also showed that 21.0% of students had five or more drinks of alcohol in a row, that is, within a couple of hours, on one or more of the past 30 days; 32.9% of students who reported current alcohol use usually got the alcohol they drank from someone who gave it to them during the past 30 days. Besides smoking and alcohol, sexual activity is another prevalent health‐risk behavior. According to the survey, 44.5% of students have had sexual intercourse, and 33.1% of students have had sexual intercourse with one or more people during the past three months.

“DCS Ombudsman responded to 660 Information and Referral inquiries, conducted 78 assists, opened 256 cases and closed 236 cases with 19 pending closure in the first quarter of 2015, provided 24 case specific recommendations, and 10 systematic recommendations” (Department of Child Services and Ombudsman Bureau 2014 Annual Report). Child abuse and neglect cases are reported by county and labeled as sexual, physical, or neglect. The cases are then categorized as substantiated and unsubstantiated. “Substantiated means an investigation by Child Protective Services determined there is a reasonable cause to believe that the child has been abused or neglected. Unsubstantiated means an investigation determined no maltreatment occurred or there was insufficient evidence under state law or agency policy to conclude that the child was maltreated. Some states require the coworker to determine not only whether the incident of abuse or neglect occurred, but also whether the child is at risk for future maltreatment” (Child Welfare Information Gateway, 2003).

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Another program available for at‐risk children is Head Start. Head Start’s mission is to “provide health, education, and promote self‐sufficiency for children and families facing adversity” (Head Start, 2015). In Cook County, there are 19,787 Head Start enrollment slots and in Will County there are 753 slots (Kids Count, 2015).

Modifiable Health Risks

Weight

Weight can be attributed to several health disparities, and it seems to be an issue in Will County. Approximately 29% of adults in Will County are obese. Obesity can be a cause of diabetes. In Will County, the diabetes prevalence rate is 9.0%, with a mortality rate of 17.2 per 100,000. This is also a problem in Cook County. The adult obesity rate is 25%, which contributes to diabetes. 8.5% of adults have diabetes and the mortality rate in Cook County is 20.3 per 100,000 (Centers for Disease Control and Prevention).

The survey asked the respondents, “How would you describe your own personal weight?”

2.90%

13.50%

Somewhat underweight 38.10% Above the right weight Somewhat overweight Very overweight 45.50%

Physical Activity

Physical activity is defined as “any body movement produced by the skeletal muscles that results in substantial increase over resting energy expenditure” (Bouchard & Shepard, 1994). Physical inactivity is defined as participating in an insufficient amount of moderate‐to‐vigorous physical activity according to the age specific physical activity guidelines. Sedentary behavior is defined as any walking activity characterized by an energy expenditure less than or equal to 1.5 METS and in a sitting or reclined posture (Sedentary Behavior Research Network, 2012). MET is an acronym that stands for metabolic equivalent; it represents the intensity of an exercise. MET refers to the amount of oxygen a person consumes and the number of calories a person burns at rest (Fitness for Weight Loss, 2015).

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Although access to exercise is at 96% in Will County (County Health Rankings and Roadmaps, 2015), 23% of adults are physically inactive. This could be linked to the violent crime if residents believe that it is unsafe to exercise outside. The county’s violent crime rate is 167.2 per 100,000. 99% of Cook County’s residents have access to exercise opportunities. 21% of adults are physically inactive (County Health Rankings and Roadmaps, 2015).

The survey asked the respondents, “How many days per week or month do you do vigorous activities for at least 20 minutes?”

1.20%

11.60% 1 23.40% 2 9.80% 3 4 5 7.70% 18.40% 6 7 10.00% Less than once a week 12.90% No activity 1.10% Unable to do any activity 4.00%

Nutrition

Nutrition can be analyzed by several societal factors such as food insecurity, limited access to healthy foods, food environment index, etc. Data for Will County is listed below:

Nutrition Factors Occurrence Will County Cook County Food Insecurity 9.9% 16.6% Households with no Car and Low Access to a Grocery Store 1.3% 0.5% Food Environment Index* 8.4% 7.6% People 65+ with Low Access to a Grocery Store 3.1% 1.1% Children with Low‐Access to a Grocery Store 10.5% 2.0% Low‐Income and Low Access to a Grocery Store 5.8% 1.8% *on a scale of 1‐10 with 10 being the best County Health Rankings and Roadmaps, 2015; HCI, 2015

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Substance Abuse

In Will County, 24% of adults drink excessively and 46% of car accident deaths are alcohol‐impaired driving deaths (County Health Rankings, 2015). In Cook County, 21% of adults drink excessively and 39% of car accidents deaths are alcohol impaired driving deaths.

Tobacco Use

Tobacco use continues to impact the health and wellness of county residents, and the health cost of tobacco continues to impact the communities’ wellness and healthcare costs.

Will Cook Adults (18+) that smoke 18% 18% Teens that smoke 12% 11% Pregnant women who smoke 5.2% 3.6% (Illinois Department of Public Health, 2015)

Oral Health

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Dental care opportunities are prevalent in Will and Cook County, because the patient to dentist ratio is 1,997:1 and in Cook County the patient to dentist ratio is 1,250:1 (County Health Rankings, 2015). Access to Health Care Challenges

Health Professions Shortage Areas

In Will County, the patient to mental health provider ratio is 1,173:1. Also, the ratio of population to primary care physicians is 2,060:1. The ratio for dentists is1,9972:1. In Cook County, the patient to mental health provider ratio is 505:1. The ratio for primary care physicians is 1,088:1 and the ratio for dentists is 1,250:1(County Health Rankings, 2015).

Insurance/Payment

Insurance affordability is a barrier that many residents encounter in Will and Cook County. According to County Health Rankings, 11% of the adults in Will County are uninsured. In Cook County, 18% of the adults are uninsured.

Transportation

Will & Cook County Transportation Option: Contact Information: Populations Served:

Dial‐a‐Ride 1‐800‐244‐4410 Disabled and Seniors http://www.willcountyillinois.com/County‐Offices/Special‐ Services/Public‐Transportation Will County ADA 1‐800‐244‐4410 Disabled Paratransit http://www.willcountyillinois.com/County‐Offices/Special‐ Services/Public‐Transportation PACE 815‐723‐3259 Anyone http://www.pacebus.com/sub/schedules/default.asp Franciscan St. James 708‐679‐2777 Anyone Health CareLinks Anyone can call to find out what transportation options exist in the Transportation community. Service

Summary

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Data Gaps and Challenges

As in every data collection and analysis processes, there are limits to the data collected. The survey was available electronically and on paper at special events. If a resident of the county did not receive the promotional messages or attend an event, they would not have an opportunity to offer input. However, the paper surveys were used to solicit information from the most underserved populations. Therefore, the total survey results are skewed to represent those in most need.

Public health data and infrastructure is severely lacking in the United States Much of the data used is from state and national collections that are only implemented every few years. Data may not reflect the current status of health. Zip code data rarely is available, except in national databases, such as the US Census Bureau.

It is the team’s hope that by using the available secondary data with the collected primary data, a relatively accurate picture of community health is presented.

Response to Findings

The information and results of this report were shared with internal and external audiences. Participants were asked if they felt the report accurately described their communities and if the information would be helpful in future strategic planning. All participants indicated that the report was accurate and representative.

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Community Health Needs Assessment Collaborative Team

Dr. Rupert Evan, Chairman, Health Administration Program, Governors State University Patty Zuccarello, Prairie State University, Dean, Health & Industrial Technology Carl Wolf, Respond Now, Executive Director Dr. Geraldine Palmer, PADS, Executive Director Dr. Sherrone Ward, Grand Prairie Services, Chief Executive Officer Michele Burgio, R.N., B.S.N, Speciality Physicians of Illinois, Operations Manager Catherine Grantner‐Colton, Franciscan St. James Home Health, Director Sister Petra Nielsen, Franciscan St. James Health, Vice President, Mission Integration Felicia Davis, Franciscan St. James Health, Manager, Comprehensive Cancer Institute Alice Collins, Cook County Health and Hospital System, Community Outreach Worker David Mekarski, AICP, Village of Olympia Fields, Village Administrator Elizabeth Murphy, Grand Prairie Services, Director of Corporate Communication Patty Zuccarello, Prairie State University, Dean, Health & Industrial Technology Jenise Ervin, Village of Park Forest, Director of Public Health Kate Hill‐Johnson, Community Benefit and Engagement, Franciscan St. Francis Health Vidhi Joshi, Indiana University School of Public Health Bloomington