An Introduction to the Community Health Needs Assessment Milwaukee County | 2018-2019
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An Introduction to the Community Health Needs Assessment Milwaukee County | 2018-2019 SPONSORED BY Health System members of the Advocate Aurora Health Ascension Wisconsin Children's Hospital of Wisconsin Froedtert & Medical College of Wisconsin PREPARED BY Center for Urban Population Health Background Every three years the health system members of MHCP con- Top Health Issues Identified by Source duct a collaborative Community Health Needs Assessment (CHNA) in six counties in southeast Wisconsin. The CHNAs SURVEY RESPONDENTS KEY INFORMANTS serve as the foundation from which hospitals and local health Chronic Disease 34% 18% departments develop their respective community health improvement strategies. The findings are also intended to Substance Use 27% 3% inform a broader audience about the top health issues facing Mental Health 15% 79% their communities. Access to Health Care 20% 62% The Milwaukee County CHNA relies on three sources of information: Violence 16% 46% • Milwaukee County Community Health Survey (Survey), a phone survey of 1,312 County residents; The top health issues are described in the following pages to • Key Informant Report (KIR), with input from 80 individuals include: representing 40 key informants and 4 focus groups; and • the burden the issue has on Milwaukee County through • Health Compass Milwaukee, a compilation of numerous data like mortality, years of potential life lost, costs where publicly reported data and other sources on one website. available and other relevant information, This introduction highlights the top health issues identi- • disparities or inequities that exist within the issue by fied by survey respondents and key informants, along with income, race or other demographics, supporting data from a variety of sources. The full reports of • factors or determinants that contribute to the issue, and the Community Health Survey and Key Informant Interviews contain far more extensive information, including trended • relevant children's related data or information. data since 2006. We encourage you to see all the 2018-2019 Milwaukee County CHNA reports at healthcompassmilwau- Health Factors / Determinants of Health kee.org/local reports It is estimated that clinical care contributes to about 20% of an individual’s overall health. Where one lives, learns, works Milwaukee County CHNA reports are developed in collaboration and plays is increasingly recognized as having a much great- with the Center for Urban Population Health. cuph.org er impact on an individual’s length and quality of life. These The authors and sponsors of this report recognize that it relies factors, also known as determinants of health, include the on a limited number of key informants and available external physical environment, socioeconomic conditions, and individ- data sources, and focuses broadly on Milwaukee County. While ual behaviors — along with clinical care. They reflect a growing every effort was made to conduct a comprehensive and current area of interest, research and investment in community health community health needs assessment, issues of high concern improvement. To learn more about this population health to specific individuals or communities within Milwaukee may framework, visit healthcompassmilwaukee.org/resources not be represented. DISPARITY VS INEQUITY Though sometimes used interchangeably, disparity and inequity have different definitions. According toHuman Impact Partners: health disparities are differences in health status and mortality rates across population groups, which can sometimes be expected, such as cancer rates in the elderly versus children; health inequities are differences in health status and mortality rates across population groups that are systemic, avoidable, unfair, and unjust, such as breast cancer mortality for black women versus white women. Understanding the difference provides greater context for the determinants of health and serves as a means to prioritize health issues, develop health policy and shape effective health programs. 2 Milwaukee County Community Health Needs Assessment Summary 2018-2019 Chronic Disease The Centers for Disease Control and Prevention define chronic diseases broadly as conditions that last one year or more and require ongoing medical attention or limit Determinants activities of daily living or both. Chronic diseases such as heart disease, cancer, and There are many factors that contribute diabetes are the leading causes of death and disability in the United States. The lead- to chronic disease including: high blood ing cause of death in Milwaukee County is heart disease. pressure, high cholesterol, obesity, poor nu- trition, lack of physical activity, and tobacco Burden and alcohol use. Age-Adjusted Death Rate due to Heart Disease ■ 2012-2014 BEHAVIOR per 100,000 population ■ 2013-2015 37% of adults in Milwaukee County report 224 220.6 219.6 ■ 2014-2016 consuming at least five fruits and vegeta- bles per day. However, 69% of adults are 185.0 184.2 183.5 178.5 173.4 174.0 173.1 171.2 169.1 168.4 167.0 overweight or obese, a rate that is negatively 163.5 157.5 156.0 154.5 trending up. 104.8 97.1 100.0 23% of Milwaukee County adults report 93.8 95.8 71.1 being sedentary in the past month, a rate that is negatively trending up. 13% of adults currently report smoking, a African Latino American White Asian Milw. Cty Wisconsin United rate that is positively trending down. American Indian Overall States Source: Wisconsin Department of Health Services and Health Compass Milwaukee CLINICAL CARE The rate of heart disease in Milwaukee County is greater than both US and Wisconsin The rate of ER visits for uncontrolled rates, with it contributing to a premature death rate of 1,228 per 100,000 – higher diabetes in Milwaukee County is 21.6 per than the state of Wisconsin at 875 per 100,000 population. According to the Wis- 10,000 adults, but the rate increases to 85.2 consin Department of Health Services (DHS), heart disease costs an estimated $4.1 in zip code 53206. billion in direct medical costs for Wisconsin. SOCIAL AND ECONOMIC Although chronic disease is the highest ranked health issue in this assessment, Research continues to show that low levels and heart disease is the top cause of death in Milwaukee County, only 8% of survey of education, income and employment respondents reported having heart disease in the past three years, whereas 24% status are associated with increased risk reporting high blood pressure and 23% with high cholesterol, heart disease related for chronic disease. An individual’s employ- conditions. ment status or occupation can also have an impact on heart health, as higher status Local Context occupations may be associated with better Key informants noted a number of barriers and challenges for individuals with chronic health. illnesses, as well as the community’s ability to promote prevention. They suggested that individuals may lack the resources and motivation to manage their disease and Children may not know where to go for help, with their providers perceived as unable to provide 17% of children in Milwaukee County report adequate education. Informants also suggested that there is some duplication of currently having asthma, with 15.5 per prevention programs across the community and greater collaboration among service 10,000 children hospitalized due to asthma organizations and providers would be helpful. A number endorsed workplace health compared to 5.6 for Wisconsin. education programs and incentives as helpful prevention strategies. In 2018, survey respondents reported that 58% of children in the household as physi- cally active, down from 70% in 2015. 1 Milwaukee County Community Health Needs Assessment Summary 2018-2019 Substance Use When an individual uses a substance frequently and this impairs all or a portion of Determinants their life, this is known as a substance use disorder or substance abuse. Although Of the many factors that contribute to alcohol and tobacco are substances, they are not included in this section as those is- substance use, some prominent conditions sues are typically reported separately in state and local data sets. In 2018, substance include having a parent who uses sub- use in Milwaukee County was ranked as the 4th major health issue by key informants stances, living in a neighborhood high in and the 2nd highest rank health issue among survey respondents. violence or poverty, lack of job security, or experiencing racism. Burden BEHAVIOR Opioid-Related Overdose Deaths in Milwaukee County Of the overdose deaths in Milwaukee County 337 in 2016, 294 220 231 • 97% of individuals had previous treat- 181 ment or rehabilitation for 144 substance use disorder • 92% had a history of treatment for pain 2012 2013 2014 2015 2016 2017 management Source: Milwaukee County Medical Examiner and the Milwaukee County Opioid-Related Overdose Report 2012-2017 CLINICAL CARE Milwaukee County has a higher rate of hos- Based on opioid overdose rates in 2018, Milwaukee County has a higher rate of over- pitalizations for substance abuse than the doses at 83.3 compared to Wisconsin’s rate of 72.5 per 100,000. From the most re- state of Wisconsin at 17.2 per 10,000 adult cent data, in 2015 the overall overdose death rate per 100,000 in Wisconsin was 10.7. population versus 10.5 state-wide. In Milwaukee County, the rate was much higher at 23 deaths per 100,000 residents. ER visits for substance use among Milwau- Nationally, the cost of prescription opioid misuse is $78.5 billion per year. kee County adults in 2017 is 42.6 / 10,000. In 2017 the age-adjusted death rate for overdose involving any opioid was 36.6 per That rate rises to 171.7 in zip code 53205 100,000 for Whites, 26.2 for African Americans and 25.9 for Latinos. Children Local context Though the majority of individuals who died Key informants mentioned multiple opportunities to address substance use in of an opioid-related overdose in Milwaukee Milwaukee County.