COMPREHENSIVE REGIONAL COMMUNITY HEALTH ASSESSMENT REPORT
Florida Panhandle: May 1, 2013 Escambia, Santa Rosa, Walton, Okaloosa and Bay
Acknowledgements
We would like to thank our partners at North Florida Educational Development Corp., Alliance Institute, the Florida Department of Health, including the five Florida Panhandle County health offices, and Partnership for a Health Community for their assistance and support during this assessment process.
We would also like to extend a special thank you to Jayne Nussbaum, MPAff and Michelle Lackovic for their assistance in editing the final document for publication.
This work was overseen and informed by the Gulf Region Health Outreach Program Coordinating Committee.
This report was prepared by the Louisiana Public Health Institute Primary Care Capacity Project Assessment Team. We would like to acknowledge the following staff members for their contribution to this publication:
Samantha Francois, PhD Lauren Czaplicki, MPH Alex Priebe, MPH Heather Farb, MPH Michelle Duncan, MS Karen Mason, MSPH Megan Tulikangas, MPP Michelle Lackovic, MPH Elisabeth Gentry, LMSW, MPH Lisanne Brown, PhD, MPH Tiffany Netters, MPA Eric Baumgartner, MD, MPH
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Table of Contents
CHAPTER 1: INTRODUCTION
5 Background
5 Overview of Year 1 Assessment Activities 6 7 Comprehensive Regional Community Health Assessment Methodology
CHAPTER 2: COMPREHENSIVE REGIONAL COMMUNITY HEALTH ASSESSMENT YEAR 1
11 Who Lives in Your County?
17 What Can Influence the Health of Your County?
52 What is the Current Health Status of Your County?
CHAPTER 3: SUMMARY & ONGOING ASSESSMENT SUPPORT YEARS 2-5
67 Summary
67 Ongoing Community Assessment Support Conclusion 69 LPHI CHA/CHIP Technical Assistance Offerings Conclusion APPENDICES
70 Appendix A: Sources
74 Appendix B: Data Factor List & Supplemental Data
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CHAPTER 1
INTRODUCTION
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Comprehensive Regional Community Health Assessment Report: Florida Panhandle Background The Gulf Region Health Outreach Program (GRHOP) is a series of four integrated, five-year projects designed to expand capacity for and access to high quality, sustainable, community-based healthcare services, including primary care, behavioral health and mental health care, and environmental medicine in Gulf Coast communities in Louisiana, Mississippi, Alabama and the Florida Panhandle. GRHOP was developed jointly by BP and counsel representing certain plaintiffs in the Deepwater Horizon litigation in the U.S. District Court for the Eastern District of Louisiana in New Orleans. The program is supervised by the Court and is funded with $105 million from the BP Deepwater Horizon Medical Benefits Class Action Settlement Agreement. The target beneficiaries of GRHOP are residents, especially the uninsured and medically underserved, of 17 coastal counties and parishes in Alabama (Mobile, Baldwin), Florida (Escambia, Santa Rosa, Walton, Okaloosa, Bay), Louisiana (Orleans, Jefferson, St. Bernard, Plaquemines, Lafourche, Terrebonne, Cameron) and Mississippi (Hancock, Harrison, Jackson).
The four projects below that comprise GRHOP are described in detail in Exhibits 13-16 of the medical benefits settlement documents1:
1. Primary Care Capacity Project 2. Mental and Behavioral Health Capacity Project 3. Environmental Health Capacity and Literacy Project 4. Community Health Workers Training Project The Louisiana Public Health Institute (LPHI) administers the Primary Care Capacity Project (PCCP). The purpose of the PCCP is to expand access to integrated high quality, sustainable, community-based primary care with linkages to specialty mental and behavioral health, and environmental and occupational health services in coastal Alabama, the Florida Panhandle, Louisiana, and Mississippi. To achieve this purpose, the PCCP will establish a regional health partnership across coastal counties in these four states that aims to improve the capacity and infrastructure for delivering quality health care to the residents of this region. The five-year investment will result in greater prospect for sustainable community health centers with expanded capacity and a regional health information infrastructure to support them into the future.
Overview of Year 1 Assessment Activities One objective of PCCP is to conduct a comprehensive regional community health assessment. The Settlement states that: LPHI will coordinate with state public health and community-based organizations across all four states to conduct a comprehensive community health assessment during the first program year. Working closely with these groups, LPHI will bring together residents, local community leaders and health professionals and the coordinators of the Outreach Program (GRHOP) projects to understand the health needs and existing capacities of communities across the region.
1 Documents can be accessed online at http://www.deepwaterhorizonsettlements.com/Medical/SettlementAgreement.aspx
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This assessment is essential to targeting the highest need communities and informing subsequent funding of healthcare organizations and community-based organizations in the region. The specific goals of the [Community Health Assessment] include identifying:
Community health assets, needs, and challenges across the region; Current capacity and gaps of the region’s health care delivery system; and Key community health issues and concerns of residents regarding health and well-being.
To meet these goals LPHI initiated and engaged in three major assessment activities during Year 1: 1) a series of primary care clinic capacity assessments; 2) a rapid community health needs assessment process in the coastal counties of Mississippi, Alabama, and Florida only; and 3) a comprehensive regional community health assessment for each of the four states in the GRHOP footprint.
Primary Care Clinic Capacity Assessment The Primary Care Clinic Capacity Assessments were conducted to gather information regarding health delivery system characteristics of clinics, such as number and location of primary care and behavioral health clinics, type of health care professionals at each location, inventory of available health services, hours of operation, linkages to other social services, and information technology capacity of Federally Qualified Health Centers (FQHCs) and FQHC Look-alike clinics in the 17 coastal counties/parishes. The assessment tool used was informed by Patient Centered Medical Home and clinic transformation tools currently being used in a primary care practice learning collaborative in the Greater New Orleans area as part of the Crescent City Beacon Community, as well as feedback from other GRHOP partners after several rounds of review.
To date, clinic assessments were completed with all FQHC and FQHC Look-alike sites in Mississippi, Alabama, and Florida. Clinic assessments were completed with two clinic operators in Louisiana; however the remaining Louisiana clinic assessments will be completed during Year 2. Data collected was validated by clinic staff and will be summarized in the form of a clinic profile to send to clinic staff in Year 2. Important to note: Due to the terms of the confidentiality agreement entered into with clinics, no clinic data was included in this report. Rapid Community Health Needs Assessment In total, three Rapid Community Health Needs Assessments were conducted during Year 1: one completed for the three coastal counties of Mississippi, one for the two coastal counties in Alabama, and one for the five coastal counties in Florida. The purpose of the Rapid Community Health Needs Assessment was to work with state partner organizations to further define and verify community health needs and gaps in health care services in order to inform specific funding priorities in those communities related to building primary care capacity. The two major components of the rapid assessment process were: 1) a review of existing data sources related to a subset of health and quality of life factors and 2) a facilitated key informant Community Prioritization Meeting per state to gather information from community members to validate, inform and prioritize findings from the data review. The findings from the Rapid Community Health Needs Assessments conducted in Mississippi, Alabama, and Florida provided insight into the health priorities of the coastal counties of those states and subsequently informed decisions on Year 1 funding and technical assistance provided to eligible clinics in those regions. Because two regions in Louisiana – New Orleans East in Orleans Parish and the area of Jean Lafitte in Jefferson Parish – were pre- determined to receive Year 1 funding in the Settlement, a Rapid Community Health Needs Assessment was not conducted in Louisiana.
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The Florida Panhandle Rapid Community Health Needs Assessment Report2 can be found online: http://lphi.org/CMSuploads/Florida-Panhandle-Rapid-Assessment-Report-42427.pdf. Comprehensive Regional Community Health Assessment The Comprehensive Regional Community Health Assessment is an extension of the Rapid Community Health Needs Assessments because it incorporates both the information derived from the initial data review and community stakeholders in Mississippi, Alabama, and Florida alongside a comprehensive review of existing data sources related to population and demographic trends, existing health outcomes and disparities data, community health care needs, environmental and occupational health issues, etc. Based on the priorities identified during the three Community Prioritization Meetings, additional health and quality of life factors were included in the Comprehensive Regional Community Health Assessment reports, such as data related to veteran and military communities and data related to health disparities by ethnicity when available. Because two Louisiana communities were predetermined in the settlement to receive Year 1 funding, the Comprehensive Regional Community Health Assessment for the seven GRHOP parishes does not include data from key informants and only includes the review of existing data. However additional assessment components for Louisiana will be conducted during Year 2.
Comprehensive Regional Community Health Assessment Methodology This report presents data and findings from the comprehensive quantitative data analysis and the qualitative data collection from key informants at the regional and community levels to supplement and validate the quantitative analysis. The following sections outline in detail the rationale and methodology behind the Comprehensive Regional Community Health Assessment.
Community Health Assessment Best Practices Community health assessments (CHAs) involve a process of collecting, analyzing and using data to educate and mobilize communities, develop priorities, garner resources, and plan actions to improve the public's health. It involves the systematic collection and analysis of data in order to provide health departments and the communities they serve with a sound basis for decision-making.3
A CHA should be part of ongoing broader community health improvement at a population level involving multi-sector stakeholders that can work collectively to improve community health. A community health improvement process uses CHA data to identify priority issues, develop and implement strategies for action, and establish accountability to ensure measurable health improvement, which are often outlined in the form of a community health improvement plan (CHIP).4 CHAs and CHIPs provide an opportunity to establish a baseline for setting community health objectives and measuring change over time as well as cataloguing community assets and barriers to improving health. Additionally, CHAs, CHIPs along with an agency strategic plan are the three prerequisites for voluntary accreditation of state and local health departments by the Public Health Accreditation Board.
Nationally recognized frameworks for comprehensive CHAs include but are not limited to the National Association of County and City Health Officials’ Mobilizing for Action through Planning and Partnership model (MAPP)5, the Catholic Health Association’s assessment and community benefit planning6, and the
2 Suggested citation for this report: Louisiana Public Health Institute PCCP Assessment. (2013). Florida Panhandle Rapid Assessment Report (Report # FL-1a). New Orleans, LA: LPHI. 3 Public Health Accreditation Board. Viewed April 25, 2013 at http://archive.constantcontact.com/fs030/1102084465533/archive/1103695445388.html#LETTER.BLOCK21 4 Durch J.S., Bailey L.A., & Stoto M.A. (1997). Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: National Academy Press available on http://www.naccho.org/topics/infrastructure/CHAIP/index.cfm 5 NACCHO, Mobilizing for Action through Planning and Partnerships. Viewed April 25, 2013 at http://www.naccho.org/topics/infrastructure/mapp/.
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Association for Community Health Improvement’s CHA Toolkit7. All frameworks include collecting and analyzing data and convening community stakeholders to identify priorities, resources, and develop action plans. The PCCP adapted best practices from these national frameworks to conduct comprehensive regional CHAs for the 17 named GRHOP parishes and counties.
Quantitative Data Analysis: Community Health Status The comprehensive review of existing data sources in this report included an analysis of state, county and sub-county level data (where available) to characterize demographic, health and quality of life factors. For the existing data review, the PCCP assessment team gathered and analyzed data for each of the 17 parishes and counties and for each state as a whole in order to obtain a baseline assessment of demographics, health status, health care access and barriers to care in each of the parishes/counties and relative to the state.
Factors for which data were gathered and analyzed were chosen based on best practices of the Catholic Health Association and MAPP processes for selecting measurements that summarize the state of health and quality of life in a community. These factors then went through several rounds of review by GRHOP partners and community stakeholders to arrive at the final list of factors. See Appendix A for a list of the data sources that were included in Chapter 2 of this report. See Appendix B for the complete list of factors, as well as a supplemental data table for those data points not included in Chapter 2.
The existing data review for the Florida counties also included a review of available County Health Department CHAs for each of the five Florida Panhandle counties along with national, state, county and sub-county level data to characterize demographic, health and quality of life factors. The data review also included findings and information from County Health Department Community Health Improvement Plans (CHIPs) for Bay, Escambia and Walton Counties8. It should be noted that the Comprehensive Regional Community Health Assessment adds findings beyond what was included in the Rapid Community Health Needs Assessment from several data factors and sources including Center for Disease Control and Prevention’s (CDC) Gulf States Population Survey and Oxfam America’s Social Vulnerability Index Project. Added data factors includes indicators disaggregated by race and ethnicity when available, oil spill exposure and impact, mental health care coverage, veteran status, as well as a host of other data factors related to health risk behaviors and social environment.
Qualitative Data Collection and Analysis: Community Prioritization Meeting Community priority setting meetings were held with key informants representing eligible counties in Alabama to collect information from community members to validate and prioritize findings from the Rapid Community Health Needs Assessment data review. The Florida Community Prioritization Meeting (also called Key Informant Meeting) was held in Okaloosa County, Florida on December 19th, 2012. Key informants were comprised of representatives from state, regional and local community organizations and nonprofits, as well as local leaders from the health and education sectors. During the meetings, key informants were split into breakout groups by county for a facilitated discussion on community health needs and barriers to care. The top ten community health needs and barriers to care were identified by
6 Catholic Health Association of the United States, Assessing and Addressing Community Health Needs. Viewed April 25, 2013 at http://www.chausa.org/Pages/Our_Work/Community_Benefit/Assessing_and_Addressing_Community_Health_Needs/. 7 Association for Community Health Improvement, ACHI Community Health Assessment Toolkit. Viewed April 25, 2013 at http://www.assesstoolkit.org/. 8 CHIPs for Santa Rosa and Okaloosa counties were not available at the time of this report. However, the PCCP team has met with health officials and CHIP leads in both counties to identify and support health improvement priorities and planning.
Page 8 Comprehensive Regional Community Health Assessment Florida Panhandle each group. The last part of the meeting was a community prioritization process and a description of next steps. Using electronic audience response system polling, key informants prioritized community needs by voting first for their top five needs, and then from the top five, they voted for their top three needs. Key informants then voted on their top five barriers to care. The priority community health needs and barriers identified by key informants are included throughout this report.
Organization of Findings The following Comprehensive Regional Community Health Assessment findings are organized according to three basic principles:
Who lives in your county? What influences health in your county? What is the health status of your county?
Quantitative data is primarily presented in pie charts, bar graphs, tables, and maps. Qualitative data derived from the Community Prioritization Meeting is highlighted in outlined text boxes throughout the report.
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CHAPTER 2
COMPREHENSIVE REGIONAL COMMUNITY HEALTH ASSESSMENT YEAR 1
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Who Lives in your County?
Bay County is home to 168,852 residents.
% of Residents by Race White Residents 82.2% Black Residents 10.8% Asian Residents 2.0%
American Indian & Alaskan Native 0.7% 2 or more races 3.1%
Other 1.2%
% of Residents by Ethnicity
Hispanic Residents 4.8%
Military Community In Bay County, 15.8% of residents are veterans. Among the county’s veteran population, 8.3% of veterans in the civilian labor force are unemployed; 8.4% were living in poverty in the past year; and 24.7% are currently disabled.
Additionally, approximately 0.4% of Bay County residents are currently employed in the Armed Forces
65 and older Age of Population 14.5% 18 and under Overall, Bay County’s population is relatively 23.3% young. More than half of the residents are adults of working age. Slightly less than a quarter of all residents are 19 - 64 children and adolescents. years 62.2%
Household Income The median household income in Bay County is $44,310.
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Escambia County is home to 297,619 residents.
% of Residents by Race White Residents 68.9% Black Residents 22.9% Asian Residents 2.8%
American Indian & Alaskan Native 0.9% 2 or more races 3.2%
Other 1.3%
% of Residents by Ethnicity
Hispanic Residents 4.7%
Military Community In Escambia County, 13.7% of residents are veterans. Among the county’s veteran population, 5.0% of veterans in the civilian labor force are unemployed; 6.4% were living in poverty in the past year; and 26.2% are currently disabled.
Additionally, approximately 3.7% of Escambia County residents are currently employed in the Armed Forces.
65 and older Age of Population 14.4% 18 and under 23.4% Similarly, more than half Escambia County’s residents are adults of working age. Slightly less than a quarter of all residents are children 19 - 64 and adolescents. years 62.2%
Household Income The median household income in Escambia County is $40,917.
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Okaloosa County is home to 180,822 residents.
% of Residents by Race White Residents 81.1% Black Residents 9.3%
Asian Residents 3.0% American Indian & Alaskan Native 0.6% 2 or more races 3.9% Other 2.0%
% of Residents by Ethnicity Hispanic Residents 6.8%
Military Community In Okaloosa County, 20.4% of residents are veterans. Among the county’s veteran population, 4.6% of veterans in the civilian labor force are unemployed; 5.0% were living in poverty in the past year; and 20.8% are currently disabled.
Additionally, approximately 4.4% of Okaloosa County residents are currently employed in the Armed Forces.
65 and older Age of Population 13.9% 18 and under More than half of Okaloosa County’s 23.6% residents are also adults of working age. Slightly less than a quarter of all residents are children and adolescents. 19 - 64 years 62.4%
Household Income The median household income in Okaloosa County is $49,158.
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Santa Rosa County is home to 267,619 residents.
% of Residents by Race White Residents 87.8% Black Residents 5.4% Asian Residents 1.8% American Indian & Alaskan Native 0.9% 2 or more races 3.0% Other 1.0%
% of Residents by Ethnicity
Hispanic Residents 4.3%
Military Community In Santa Rosa, 18.0% of residents are veterans. Among the county’s veteran population, 7.2% of veterans in the civilian labor force are unemployed; 4.8% were living in poverty in the past year; and 21.9% are currently disabled.
Additionally, approximately 2.9% of Santa Rosa residents are currently employed in the Armed Forces.
65 and older Age of Population 12.9% 18 and under Similarly, more than half Santa Rosa’s residents 25.3% are adults of working age. A quarter of all residents are children and adolescents.
19 - 64 years 61.8%
Household Income The median household income in Santa Rosa County is $53,103.
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Walton County is home to 55,043 residents.
% of Residents by Race White Residents 87.8% Black Residents 5.8% Asian Residents 0.9% American Indian & Alaskan Native 0.9%
2 or more races 2.4%
Other 2.1% % of Residents by Ethnicity Hispanic Residents 5.3%
Military Community In Walton County, 14.2% of residents are veterans. Among the county’s veteran population, 8.5% of veterans in the civilian labor force are unemployed; 9.0% were living in poverty in the past year; and 39.5% are currently disabled.
Additionally, 0.0% of Walton County residents are currently employed in the Armed Forces.
65 and Age of Population older 16.2% 18 and under More than half of Walton County’s residents 21.7% are also adults of working age. Less than a quarter of all residents are children and adolescents. 19 - 64 years 62.1%
Household Income The median household income in Walton is $47,150.
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Population Density Where residents live in a county can play a contributing role to the type of health care and related services available to communities. The following map shows the distribution of White, Black, Hispanic, Asian and Other race residents in the Florida Panhandle by census block.
*Other includes residents who identify as American Indian & Alaskan Native, 2 or more races, and Other race.
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What can Influence the Health of your County? SOCIOECONOMIC FACTORS Socioeconomic factors such as low socioeconomic status, unemployment, and level of education impact a variety of health behaviors, lifestyle choices, and access to health care and health information among individuals. Santa Escambia Rosa Okaloosa Walton = Low Socioeconomic Status Bay Low SES reflects individuals below the poverty threshold based on income and family size.
In Bay County, 13% of all residents in All residents the county are considered low SES. n=808,049 In Escambia County, 18% of all residents in the county are considered low SES. White n=647,424 In Okaloosa County, 15% of all residents in the county are considered low SES.
In Santa Rosa County, 10% of all residents in the county are considered low SES. Black In Walton County, 15% of all residents n=100,921 in the county are considered low SES.
Low SES by Race Geographically, the distribution of low SES residents in the five counties varies Asian considerably by race, with over 30% of Black and Asian n=19,925 residents considered low SES in certain census tracts in each Panhandle county.
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Low SES by Ethnicity Geographically, the distribution of low SES residents also varies by ethnicity. In certain census tracts of the across the Panhandle, at least 29.5% of Hispanic residents are considered low SES. In areas of Bay, Okaloosa, Santa Rosa and Escambia Counties, 51.3% or more of Hispanic residents are considered low SES.
Hispanic Residents (n=37,559)
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Low SES by Age Santa Escambia Rosa Okaloosa Walton Low SES reflects individuals below the = poverty threshold based on income and family size. Bay In Bay County, 19% of children and adolescents are considered low SES. In Escambia County, 27% of children and adolescents are considered low SES. All residents n=808,049 In Okaloosa County, 26% of children and adolescents are considered low SES. In Santa Rosa County, 13% of children and adolescents are considered low SES. In Walton County, 22% of children and adolescents are considered low SES. Under 18 n=186,332 Geographically, the distribution of low SES residents in the five counties varies by age. In certain census tracts in all five counties, over 30% of residents 18 years and younger are considered low SES.
Generally, less than 10% of residents who are 65 years Age 18-64 and older are consider low SES across the five n=508,105 Panhandle counties.
65 and older n=113,612
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Santa Unemployment Escambia Rosa Okaloosa Walton 10% of Bay County residents 16 years and = older in the labor force are unemployed.
11% of Escambia County residents 16 years Bay and older in the labor force are unemployed.
9% of Okaloosa County residents 16 years and older in the labor force are unemployed. Total Population ≥ 16 & in labor force n=681,140 9% of Santa Rosa County residents 16 years and older in the labor force are unemployed.
11% of Walton County residents 16 years and older in the labor force are unemployed.
Unemployment by Race White n=553,335 (among residents ≥16 years in the labor force)
Geographically, the distribution of unemployed residents in the five counties also varies considerably by race, with over 15% of White residents 16 years and older in the labor force unemployed in certain areas of Walton County. Black n=82,613 Across the five counties, over15% of Black residents 16 years and older in the labor force are unemployed in certain census tracts.
In Santa Rosa and Okaloosa County, unemployment among Asian residents 16 years old and older in the labor force exceeds 15% in certain census tracts. Asian n=17,588
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Unemployment by Ethnicity (among residents ≥ 16 years in the labor force) Geographically, the distribution of unemployed residents also varies by ethnicity. In the majority of census tracts in the Panhandle, less than 5.7% of Hispanic residents are unemployed. In Walton County no more than 22.2% of Hispanic residents are unemployed. In the remaining counties, there are certain census tracts where a larger proportion of Hispanic residents are unemployed.
Hispanic Residents (n=10,965)
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Santa Education Escambia Rosa Okaloosa Walton = 10% of Bay County residents over age 25 do not have a high school diploma. Bay 13% of Escambia County residents over age 25 do not have a high school diploma.
8% of Okaloosa County residents over age 25 do not have a high school diploma. Total Population ≥ 25 years old n=567,044 9% of Santa Rosa County residents over age 25 do not have a high school diploma.
13% of Walton County residents over age 25 do not have a high school diploma.
Education by Race White n=467,279 (among residents 25 years and older) Geographically, the distribution of residents without a high school diploma in the five counties also varies considerably by race.
In certain census tracts of Walton County, over 30% of White, Black, and Asian residents who are 25 years Black and older do not have a high school degree. n=64,743
In certain census tracts of Okaloosa and Bay Counties, over 30% of Black and Asian residents who are 25 years and older do not have a high school education, as well.
In certain census tracts of Escambia and Santa Rosa Counties, over 30% of Black and Asian residents who are 25 years and older do not have a high school Asian education. n=14,717
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Education by Ethnicity (among residents 25 years and older) Geographically, the distribution of residents 25 years and older who do not have a high school education also varies considerably by ethnicity. Within certain census tracts, over 28.5% of Hispanic residents 25 years and older lack a high school education. Additionally across the Panhandle, there are census tracts where over 53.3% of Hispanic residents 25 years and older do not have a high school education.
Hispanic residents (n=21,582)
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SOCIAL VULNERABILITY Oxfam America’s Social Vulnerability Index (SoVI) project is the first of its kind to examine the underlying social and demographic characteristics in a county and the possible impact of environmental hazards on the most vulnerable. Oxfam America’s SoVI project seeks to demonstrates the potential impact of climate change on the most vulnerable communities, where those who are most socially vulnerable may experience more difficulty coping with and bouncing back from an environmental hazard like a flood. Social Vulnerability Identification The SoVI itself is constructed of 32 variables that take into consideration the wealth, age, race, gender, ethnicity, rural farm populations, special needs population, and employment status of the community. 9
Based on the factors above, residents throughout Escambia Escambia County, Santa Rosa County, Santa Rosa Okaloosa Walton Okaloosa County, Walton County and Bay County are considered “Low” in their social vulnerability level based on the Social Vulnerability Index. Bay
9 For more information visit http://adapt.oxfamamerica.org/resources/Exposed_Report.pdf
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Social Vulnerability and Multiple Environmental Hazards
The climate change related environmental hazards examined by the SoVI project were drought, flooding, hurricane force winds, and sea level rise – all of which strongly impact the health of the environment in the Gulf Coast region. The map below shows both level of social vulnerability within a county and the impact of all four environmental hazards on the area. For example, some counties may have a “Low” level of social vulnerability but are at “High” risk for multiple environmental hazards. On the map this county would appear as a medium shade of blue.
Data to calculate the risk of environmental hazards are derived from national data sources like the Federal Emergency Management Agency, particularly for events such as drought, hurricane force winds, and floods occurring in the county. Sea level rises were predicted using based on future climate change projections.
Based on the both the Social Escambia Santa Rosa Vulnerability Index and the risk for Okaloosa multiple environmental hazards on the county, residents throughout the Florida Panhandle are considered Walton “Low” in social vulnerability but at “High” risk for environmental hazards. Bay
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NATURAL ENVIRONMENT Natural factors, such as trends in air quality, excessive heat days, and the likelihood of flooding, all affect the health of a community. The very young, ill, and elderly may be at increased risk of poor health outcomes as a result of these factors. Flood Plain Distribution The majority of residents in the coastal areas of Bay County, Escambia County, Okaloosa, Santa Rosa and Walton County live in or near a FEMA designated flood zone. Low-income residents, especially those with chronic health conditions, can be disparately affected by storms or seasonal flooding.
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Fish Consumption Advisories Fish consumption advisories are recommendations issued by state and federal agencies to limit or avoid eating certain species of fish due to chemical contamination. An advisory may be issued for the general public or it may be issued specifically for sensitive populations, such as pregnant women, nursing mothers, and children. Advisories vary in the extent of water body that they cover. Mercury Contamination: In 2012, there were fish consumption advisories due to mercury for the following: Bay Escambia Okaloosa Santa Rosa Walton Deerpoint Hurricane Bear Lake Fish Crescent Lake Basin Bayou Reservoir Lake Management Area Escambia River Karick Lake Escambia River Choctawhatchee River Perdido River Shoal River Shoal River Juniper Lake Yellow River Yellow River Woodbine Lake Jackson Spring Lake Yellow River Lake Juniper
Other Chemical Contamination: In 2012, consumption advisories were issued for polychlorinated biphenyls (PCBs) contamination for the following: Bay Escambia Okaloosa Santa Rosa Walton Escambia Bay Escambia Bay Escambia River Escambia River
Safe water was identified as an environmental health priority by Beach Water Quality Key Informants.
Beach water monitoring is conducted to detect bacteria that indicate the possible presence of disease- causing microbes. When monitoring results show levels of concern, the state or local government issues a beach advisory closure notice until further sampling shows that the water quality meets EPA standards. There are a total of 13 monitored beaches in Bay County. In 2010, 7 of these monitored beaches were affected by a notification action. There are a total of 12 monitored beaches in Escambia County. In 2010, 6 of the monitored beaches were affected by notification actions. There are a total of 12 monitored beaches in Okaloosa County. In 2010, 8 of the monitored beaches were affected by notification actions. There are a total of 7 monitored beaches in Santa Rosa County. In 2010, 2 of the monitored beaches were affected by notification actions. There are a total of 9 monitored beaches in Walton County. In 2010, 0 of the monitored beaches were affected by notification actions.
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Unhealthy Air Quality 5 The number of days that air Santa Rosa quality was rated air quality 4 was rated unhealthy, very
unhealthy, hazardous, and Escambia unhealthy for sensitive 3 groups like the elderly, children, and those with lung Okaloosa disease in Okaloosa and 2
SensitiveGroups Florida Bay County remained below 2 days and declined
to 0 days in 2011. 1 DaysQuality Air Unhealthy Rated for Overall, the number of days Bay air quality was rated 0 unhealthy in Santa Rosa and 2009 2010 2011 Escambia County in 2010 and 2011 was higher than the state average and increased between 2010 and 2011 in Santa Rosa County. Air quality was an identified environmental health priority by Key *Data for Walton County not reported. Informants, especially air quality related to air pollution from
chemical and paper companies.
80 Excessive Heat Days Florida Walton Between 2008 and 2010, there 70 was an increase in the number of
Santa Rosa days from May through
° 60 September with a heat index of Escambia 50 Bay greater than 100° across the five counties. 40 Okaloosa In 2010, the number of days 30 over 100° was the same or nearly the same as the state Number ofr Days over 100 20 average in Walton County and Bay County. 10
0 Extreme heat and sun 2008 2009 2010 exposure were identified environmental health priorities by Key Informants, particularly for the young, elderly, and low income populations.
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Extreme Weather Events Climate scientists predict many changes in climate over the next 50 years. These changes will have many impacts – direct and indirect – on human health. Populations that are highly exposed, sensitive, and least prepared or able to respond to climate changes
are the most vulnerable. 8
Over the past decade, the 7 incidence of extreme 6 weather events such as hurricanes, flooding, and 5 severe storms resulting in a Escambia 4 minimum of $50,000 in Santa Rosa property damage have 3 fluctuated above and 2 below the state average in Florida all five Panhandle counties, Number Number Extremeof Weather Events 1 with peak number of Okaloosa Walton Bay extreme events for all 0 counties in 2005. 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
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SOCIAL ENVIRONMENT Health is determined in part by the social and economic opportunities available in a community. For example, proximity to grocery stores and recreational facilities are often related to improved health outcomes. Homicide, a leading cause of premature death among young Black males, and violent crime however are often related to a general lack of social and economic opportunities. Grocery Stores
In Bay County, there are Florida 0.2 about the same number of grocery stores per capita Walton 0.16 compared to the state. In Walton, Santa Rosa, Santa Rosa Okaloosa, and Escambia 0.099 Counties, there are fewer grocery stores per capita Okaloosa 0.16 compared to the state. Escambia 0.15
Bay 0.19 Food security was identified as priority 0.00 0.05 0.10 0.15 0.20 0.25 issue in Bay County. Grocery Stores per 1,000 Residents
Recreational Facilities
Florida 0.09 In Okaloosa County, there are more recreational facilities per Walton 0.073 capita compared to the state. Santa Rosa In Santa Rosa County, there are 0.099 about the same number of Okaloosa 0.12 recreational facilities per capita compared to the state. Escambia 0.073 In Walton, Okaloosa and Bay 0.079 Escambia Counties, there are fewer recreational facilities per 0.00 0.02 0.04 0.06 0.08 0.10 0.12 0.14 0.16 0.18 capita compared to the state.
Recreational Facilities per 1,000 Residents
Page 30 Comprehensive Regional Community Health Assessment Florida Panhandle
Homicide Rate The homicide rate in Florida 6.3 Escambia County and Bay County is higher than the Walton 4.5 overall homicide rate for
the state, and both are Santa Rosa 2.5 People2020 higher than the Healthy Okaloosa 2.4
People 2020 target. Healthy Escambia 8.1
Bay 7.7
0 2 4 6 8 10 Homocide Rate per 100,000 individuals
Homicide Rate (per 100,000) by Race and Ethnicity
However, like the state the homicide rate among Non-Whites10 in both Escambia and Bay County is significantly higher than the rate among whites, and is twice as large as the Healthy People 2020 objective. The rate of homicide among Non-Whites in Santa Rosa and Walton Counties is zero.
White Non White Hispanic Non-Hispanic 14 9 *Indicates that the total number is less than 5 and therefore considered too small to report as an accurate rate. 8 12 7 10 6
8 5 Healthy People 2020
6 4
Healthy People 2020 3 4 2 2 1 * 0.0 0.0 * * * * * 0 0 Bay EscambiaOkaloosa Santa Walton Florida Bay EscambiaOkaloosa Santa Walton Florida Rosa Rosa
10 “Non-whites” includes Blacks, Asians, and Other race.
Page 31 Comprehensive Regional Community Health Assessment Florida Panhandle
Violent Crime Rate Violent crime includes homicide, Florida 614 forcible rape, robbery, and aggravated assault.
Walton 436 The rate of violent crime in Walton, Santa Rosa, and Santa Rosa Okaloosa County is lower than 172 the state average. The rate of violent crime in Bay Okaloosa 348 County is similar to the state. The rate of violent crime in Escambia 866 Escambia County is higher than the state. Bay 590 Domestic violence was 0 200 400 600 800 1,000 identified as priority issue by Key Informants in Escambia, Violent Crime Rate per 100,000 Residents Santa Rosa, and Walton Counties.
Page 32 Comprehensive Regional Community Health Assessment Florida Panhandle
OCCUPATIONAL SAFETY AND HEALTH Loss of income and employment due to the oil spill can impact both the health and access to health care services among those most affected. Additionally, people in high-risk occupations may be more likely to require health care for work-related injuries. Lost Income & Employment Due to Oil Spill The Gulf State Population Survey conducted in 2010 and 2011 asked residents in the Gulf Coast region whether they had lost income due to the oil spill, as well as whether someone in their household had lost a job as a result of the Deepwater Horizon disaster. In Okaloosa County, a similar Bay County not included in the Gulf State Population Survey. percentage of residents experienced a loss in income Florida 24.5% and employment compared to the state. Walton 15.6%
In Walton and Santa Rosa Santa Rosa Counties, a lower percentage 15.5% of residents were economically Okaloosa impacted by the disaster 23.9% compared to the state. Escambia 34.8% In Escambia County, almost 35% of residents were 0% 10% 20% 30% 40% economically impacted by the Percent of Residents who Lost Income & Employment Due to Oil Spill spill. Lost Income and Employment Due to Oil Spill by Race and Ethnicity With the exception of Walton County, the economic impact of the oil spill was highest among Non-White residents in the remaining counties included in the survey. In Okaloosa County a higher percentage of Hispanic residents were economically impacted by the oil spill, while in Escambia, Santa Rosa, and Walton Counties a higher proportion of Non-Hispanic residents were economically impacted.
Page 33 Comprehensive Regional Community Health Assessment Florida Panhandle
Occupational at Risk for Injury
44% of Bay County residents in the civilian labor force work in occupations with a high risk for injury (shown in pink and dark red below).
16% of Bay County residents in the civilian labor force work in occupations with a high risk for fatal injury* (shown in dark red below).
Farming, Fishing & Forestry Production Occupations* Occupations 0.3 5.0 Construction & Transportation & Extraction Material Moving Occupations* Occupations* 6.2 5.1 Installation, Maintenance & Repair Occupations* Management, 4.5 Business & Financial Occupations 13.8
Service Occupations 22.9
Professional and related Occupations 18.4
Sales and related Office & Occupations Administrative 13.3 Support 10.5
Page 34 Comprehensive Regional Community Health Assessment Florida Panhandle
41% of Escambia County residents in the civilian labor force work in occupations with a high risk for injury (shown in pink and dark red below).
15% of Escambia County residents in the civilian labor force work in occupations with a high risk for fatal injury* (shown in dark red below).
Farming, Fishing & Forestry Occupations* 0.6 Production Occupations Construction & Transportation & 3.7 Extraction Material Moving Occupations* Occupations* 4.7 6.0 Installation, Maintenance & Repair Occupations* Management, 3.4 Business & Financial Occupations 11.6
Service Occupations 22.4
Professional and related Occupations 20.5 Sales and related Occupations 11.8 Office & Administrative Support 15.4
Page 35 Comprehensive Regional Community Health Assessment Florida Panhandle
38% of Okaloosa County residents in the civilian labor force work in occupations with a high risk for injury (shown in pink and dark red below).
15% of Okaloosa County residents in the civilian labor force work in occupations with a high risk for fatal injury* (shown in dark red below).
Farming, Fishing & Forestry Occupations* 0.5 Production Occupations Transportation & 3.1 Construction & Material Moving Extraction Occupations* Occupations* 5.9 5.0
Installation, Maintenance & Repair Occupations* Management, 3.2 Business & Financial Occupations 13.1 Service Occupations 20.0
Sales and related Occupations 11.6 Professional and related Occupations 24.2 Office & Administrative Support 13.5
Page 36 Comprehensive Regional Community Health Assessment Florida Panhandle
38% of Santa Rosa County residents in the civilian labor force work in occupations with a high risk for injury (shown in pink and dark red below).
18% of Santa Rosa residents in the civilian labor force work in occupations with a high risk for fatal injury* (shown in dark red below).f
Farming, Fishing & Forestry Production Occupations* Occupations 3.9 0.7 Construction & Transportation & Extraction Material Moving Occupations* Occupations* 8.5 5.2 Installation, Maintenance & Repair Occupations* Management, 3.7 Business & Financial Occupations 13.5
Service Occupations 15.8
Professional and Sales and related related Occupations Occupations 18.6 14.8
Office & Administrative Support 15.4
Page 37 Comprehensive Regional Community Health Assessment Florida Panhandle
42% of Walton County residents in the civilian labor force work in occupations with a high risk for injury (shown in pink and dark red below).
18% of Walton County residents in the civilian labor force work in occupations with a high risk for fatal injury* (shown in dark red below).
Farming, Fishing & Forestry Occupations* Production .5 Transportation & Occupations Construction & 2.9 Extraction Material Moving Occupations* Occupations* 7.3 5.4 Installation, Maintenance & Repair Occupations* 4.3 Management, Business & Financial Occupations 17.2
Service Occupations 21.5
Professional and related Occupations 14.2 Sales and related Occupations 14.6 Office & Administrative Support 12.2
Page 38 Comprehensive Regional Community Health Assessment Florida Panhandle
Work-Related Hospitalization Employees in occupations at high risk for injury may require hospitalization if injured on the job. Individuals hospitalized with work-related injuries and illnesses have some of the most serious and costly work-related health outcomes. The rate work-related Florida 11.0 hospitalizations can be calculated based on the Walton 10.9 number of hospital visits covered by Workmen’s’ Santa Rosa 9.5 Compensation. Okaloosa 10.9 The rate of work-related hospitalizations among Escambia 10.5
employed residents in Bay
County is higher than the Bay 15.7 state rate. The rate of work-related 0 5 10 15 20 hospitalizations in the Rate of Work-Related Hospitalization per 10,000 Workers remaining counties is similar or slightly lower than the state rate.
Key Informants identified high rates of occupational injuries in Bay, Okaloosa, and Walton Counties among residents employed in the service, shipbuilding, fishing, agriculture, and construction industries.
A lack of occupational health education to prevent workplace hazards/injuries was identified as a health care gap by Key Informants.
Page 39 Comprehensive Regional Community Health Assessment Florida Panhandle
RISK BEHAVIORS Risk behaviors such as smoking cigarettes, drinking alcohol, prescription drug use, and physical inactivity contribute to chronic illnesses and the leading causes of death among adults in the United States.
Smoking Prevalence Florida 17.1 The percentage of residents who smoke in Walton, Santa Rosa, Walton 24.3
Okaloosa, and Escambia Santa Rosa Counties is higher than the state 22.0 average and the Healthy People
2020 target. Okaloosa 19.2 People2020 The percentage of residents who smoke in Bay County is less than Escambia 22.6 the state average, but exceeds the Healthy Healthy People 2020 target. Bay 15.8
0 5 10 15 20 25 30 Percentage of Residents who Currently Smoke
Drug abuse was identified as a priority health outcome by Key Informants. Key Informants recommended 211 referrals for tobacco cessation programs.
Binge and Heavy Drinking
Binge drinking is defined as 4 or more alcoholic drinks in one sitting for females and 5 or more drinks in one sitting for males. Heavy drinking is defined as having 1 drink per day on average for women and 2 or more drinks per day on a verage for men. The prevalence of binge and heavy drinking in Santa Rosa and Bay County is higher than Florida 15.0 the state average but below the Healthy People 2020 target. Walton 13.5
The prevalence of binge and Santa Rosa heavy drinking in Walton, 16.4 Okaloosa, and Santa Rosa Counties is lower or similar to the Okaloosa 12.0 state average and the Healthy People 2020 objective. Escambia 14.8
Bay 15.6 Alcohol abuse was identified as priority health 0 5 10 15 20 25 outcomes by Key Informants. Percentage of Residents who Binge Drank or Drank Heavily in the Past 30 Days
Page 40 Comprehensive Regional Community Health Assessment Florida Panhandle
Prescription Drug Use The Gulf State Population Survey also asked Gulf Coast residents if they had increased their prescription drug use without a doctor’s order Bay County not included in the Gulf State Population Survey. in the past 30 days. Compared to the state, a higher Florida 2.8% percentage of residents in Walton
County increased prescription Walton 5.4% drug use without a doctor’s order.
A similar or lower percentage of Santa Rosa residents in Santa Rosa, 1.3% Okaloosa, and Escambia Counties increased prescription Okaloosa 2.9% drug use compared to the state. Escambia 2.2%
0% 1% 2% 3% 4% 5% 6% Percent of Residents who Used Prescription Drugs in the Last 30 Days without a Doctors Order
Prescription Drug Use by Race and Ethnicity In Escambia County and Okaloosa County, unauthorized increased use of prescription drugs is higher among Non-White and Non-Hispanic residents. In Santa Rosa County the percentage of White and Non- White residents who increased prescription drug use is the same. In Walton County, increased use of prescription drugs wihthout a doctor’s order is highest among White and Non-Hispanic residents.
White Non-White Hispanic Non-Hispanic 7% 7%
6% 6%
5% 5%
4% 4%
3% 3%
2% 2%
1% 1%
0.0% 0.0% 0.0% 0.0% 0% 0% Escambia Okaloosa Santa Walton Florida Escambia Okaloosa Santa Walton Florida Rosa Rosa
Page 41 Comprehensive Regional Community Health Assessment Florida Panhandle
Bay County not included in the Gulf State Population Survey. Physical Activity
Compared to the state, a slightly 2020HealthyPeople lower or similar percentage of Florida 73.5% Walton County and Escambia County residents participate in Walton 69.8% non-work related physical activity Santa Rosa in the past 30 days. 76.3% A slightly higher percentage of Okaloosa residents in Santa Rosa County 78.7% and Okaloosa County Escambia participate in non-work related 73.2% physical activity compared to the 0% 20% 40% 60% 80% 100% state. Percent of Residents who were Participated in Non-Work Related Healthy lifestyle Phsycial Activity in the Past 30 Days education was identified as a priority issue by Key Informants, especially in Bay County.
Physical Activity by Race and Ethnicity In all four counties, the rate of non-work related physical activity is higher among White residents compared to Non-White residents, particularly in Walton County. In Escambia County and Santa Rosa County, phsycial activity rates are higher among Hispanic residents, but in Okaloosa County and Walton County physical acitvity rate is higher among Non-Hispanic residents.
Healthy People 2020
Healthy People 2020
Page 42 Comprehensive Regional Community Health Assessment Florida Panhandle
ACCESS TO HEALTH CARE Availability of health care is an important factor in a community’s health. Components include health insurance coverage, number of health care professionals in the area, and proximity to health care resources. Uninsured Children Florida 11.9% Compared to the state, a higher percentage of children Walton 9.8% in Bay County are uninsured. Santa Rosa The percentage of uninsured 9.1% children in Walton, Santa Okaloosa 7.5% Rosa, Okaloosa, and Escambia Counties is lower PeopleHealthy 2020 Escambia 6.7% than the state average.
Bay 13.9%
0% 2% 4% 6% 8% 10% 12% 14% 16% Lack of health insurance was identified Percent of Residents ≤ 19 years old who are Uninsured as a major barrier to care by Key Informants. Access to medication was identified by Key Informants as a priority issue among the uninsured in Bay and Escambia Counties.
Uninsured Adults Florida 29.5% Each of the five Florida
Panhandle counties has a lower Walton 18.0%
rate of uninsured adults Santa Rosa between 18 to 64 years old 15.1% compared to the entire state Okaloosa of Florida.
19.9% Healthy PeopleHealthy 2020 Escambia Healthy PeopleHealthy 2020 21.7%
Bay 21.4% 0% 5% 10% 15% 20% 25% 30% 35% Percent of Adult Residents (18-64 years) who are Uninsured
Page 43 Comprehensive Regional Community Health Assessment Florida Panhandle
Medicaid Recipients Florida 16.5% The percentage of Medicaid recipients in Santa Rosa, Okaloosa, and Bay Walton 19.2% Counties is lower than the state average. Santa Rosa The percentage of Medicaid 14.4% recipients in Walton County Okaloosa and Escambia County is 13.3% slightly higher than the state average. Escambia 17.5% Key Informants identified policies and regulations Bay 14.3% around Medicaid reimbursements and 0% 5% 10% 15% 20% 25% eligibility as major Percentage of Medicaid Recipients barriers to care, particularly in Walton County. Single point eligibility for entitlements was identified by Key Informants as a priority issue.
Medicare Florida 96.3% Beneficiaries Over 95% of residents 65 Walton 96.5% year olds and older in all five counties are currently Santa Rosa receiving Medicare benefits. 95.6%
Okaloosa 97.3% Escambia 97.8%
Bay 98.0%
0% 20% 40% 60% 80% 100% Percentage of Medicare Beneficiaries
Page 44 Comprehensive Regional Community Health Assessment Florida Panhandle
Mental Health Coverage The Gulf State Population Survey asks Gulf Coast residents whether or not their health care plan includes mental health coverage. Bay County not included in the Gulf State Population Survey. A similar percentage of residents in Santa Rosa Florida 63.8% County have mental health coverage compared to the Walton 50.9% state. Santa Rosa A lower percentage of 63.3% residents in Walton County have mental health coverage Okaloosa 65.5% compared to the state. Escambia A slightly higher percentage of 68.6% residents in Okaloosa County and Escambia County have 0% 10% 20% 30% 40% 50% 60% 70% 80% mental health coverage Percent of Residents with Mental Health Insurance Coverage compared to the state.
Mental Health Coverage by Race and Ethnicity In Escambia, Santa Rosa, and Okaloosa Counties, a higher percentage of Non-White and Hispanic residents have mental health coverage. In Walton County a higher proportion of White and Non- Hispanic residents have mental health coverage.
Page 45 Comprehensive Regional Community Health Assessment Florida Panhandle
Health Care Providers and Facilities
Bay Escambia Okaloosa Santa Walton Rosa A shortage Licensed Family Practice Physicians 89 267 157 132 23 of health care Licensed Internists 191 375 163 97 15 providers Licensed Obstetrics/Gynecologists 49 91 53 34 8 was identified as Licensed Pediatricians 42 192 62 71 6 a top Federally Qualified Health Center11 Sites 3 5 2 1 4 priority barrier to Hospitals/Emergency Rooms 7 8 8 4 1 care by Key Informants. Licensed Mental & Behavioral Health Care Providers (includes adult and child psychologists, psychiatrists, and 91 198 72 76 24 LCHWs)
Health Professional Shortage Areas (HPSA) For many living in inner city or rural areas, obtaining health care is difficult because health care providers are often in short supply. The federal government relies on HPSA designations of geographic areas, population groups, or health care facilities to identify areas facing these types of critical shortages. There are three categories of HPSAs: primary medical care, dental care, and mental health care. Bay Primary Medical Care HPSA Low income Bay County: 10 full-time providers needed to remove HPSA designation for the low income population Dental Care HPSA Low income Bay County: 11 full time providers needed to remove HPSA designation for the low income population Mental Health Care HPSA Mental Health Catchment Area 2A: 1 full time provider needed to remove HPSA designation for the area
11 Federally Qualified Health Centers (FQHC) are “safety net” providers such as community health centers, public housing centers, and programs serving migrants and the homeless. The main purpose of the FQHC Program is to enhance the provision of primary care services in underserved urban and rural communities.
Page 46 Comprehensive Regional Community Health Assessment Florida Panhandle
Escambia Primary Medical Care HPSA Low income Pensacola/ Cantonment: 16 full-time providers needed to remove HPSA designation for the low income population Atmore (AL/FL): 2 full time providers needed to remove HPSA designation for the area Century Correctional Institution: 1 full time provider needed to remove HPSA designation for the facility Dental Care HPSA Low income Escambia: 19 full time providers needed to remove HPSA designation for the low income population Century Correctional Institution: 1 full time provider needed to remove HPSA designation for the facility Mental Health Care HPSA Low income Escambia: 1 full time provider needed to remove HPSA designation for the low income population Hamilton Correctional Institution is designated a mental health HPSA in Escambia County Okaloosa Primary Medical Care HPSA Low income Northern Okaloosa: 4 full-time providers needed to remove HPSA designation for the low income population Low income Fort Walton: 2 full-time providers needed to remove HPSA designation for the low income population Okaloosa Correctional Institution: 1 full time provider needed to remove HPSA designation for the facility Dental Care HPSA Low income North Okaloosa: 2 full time providers needed to remove HPSA designation for the low income population Okaloosa Correctional Institution: 1 full time provider needed to remove HPSA designation for the facility Mental Health Care HPSA Okaloosa Correctional Institution is designated a mental health HPSA in Okaloosa County Santa Rosa Primary Medical Care HPSA Low income North Santa Rosa: 2 full-time providers needed to remove HPSA designation for the low income population Santa Rosa Correctional Institution: 2 full time providers needed to remove HPSA designation for the area Dental Care HPSA Low income North Santa Rosa: 7 full time providers needed to remove HPSA designation for the low income population Santa Rosa Correctional Institution: 2 full time providers needed to remove HPSA designation for the area Mental Health Care HPSA Santa Rosa Correctional Institution is designated a mental health HPSA in Santa Rosa County
Page 47 Comprehensive Regional Community Health Assessment Florida Panhandle
Walton Primary Medical Care HPSA Low income Walton: 2 full-time providers needed to remove HPSA designation for the low income population Walton Correctional Institution: 1 full time provider needed to remove HPSA designation for the area Dental Care HPSA Low income Walton: 4 full-time providers needed to remove HPSA designation for the low income population Walton Correctional Institution: 1 full time provider needed to remove HPSA designation for the area Mental Health Care HPSA Walton County: 1 full time provider needed to remove HPSA designation for the area
Limited primary care capacity, limited mental health services, and a lack of specialty care service providers were identified as major barriers to care by Key Informants. Overutilization of emergency rooms for health care was identified as priority issue, especially in Escambia County.
Recruitment and retention of providers, particularly in Okaloosa County was identified as a reason for the provider shortage in the Panhandle region. The expansion of the 211 System was identified as a priority health outreach issue to improve access to care and services.
Page 48 Comprehensive Regional Community Health Assessment Florida Panhandle
Proximity to Care Federally Qualified Health Centers are certified by the Center for Medicare and Medicaid Services (CMS) and provide primary care services to all age groups and typically serve a large number of low-income patients. FQHCs provide services on a sliding fee scale based on income and family size.
Low SES residents in the most heavily populated areas of Escambia, Santa Rosa, Walton, and Bay Counties are generally within a 15-minute drive to a FQHC. Low SES residents in Walton and Okaloosa Counties and those in the outlying areas of the other counties may require a 30-minute drive or more for a primary care visit at a FQHC.
Transportation was identified as a major barrier to care by Key Informants. Limited and expensive public transportation in the counties was reported by Key Informants, particularly for minorities, uninsured, underinsured, and low income residents.
Page 49 Comprehensive Regional Community Health Assessment Florida Panhandle
HEALTH CARE SEEKING BEHAVIOR People who have difficulty obtaining medical care due to lack of health insurance or low income are less likely to receive appropriate preventive care.
Unable to See Doctor when Florida 17.3% Needed Due to Walton 19.3% Cost Santa Rosa Compared to the state 15.3% average, a higher percentage Okaloosa of adult residents in Walton 10.5% County and Escambia County Escambia were unable to see a doctor 17.8% when needed due to cost. Bay 14.1%
Adult residents in Bay, Santa 0% 5% 10% 15% 20% 25% Rosa, and Okaloosa Percentage of Residents Unable to See a Doctor due to Cost Counties were unable to see a doctor when needed due to cost at a lower rate compared to the state average.
Affordability of care was identified as a major barrier to care, especially in Bay and Walton Counties. A lack of discounted medical care was also identified as a major barrier to care.
Adults without Healthcare Florida 18.3% Provider
Walton 19.0% Like the Florida state average, less than 20% of Santa Rosa adult residents in Walton, 41.5% Okaloosa, Escambia, and Bay Counties do not have Okaloosa 19.1% a personal healthcare provider. Escambia 19.0% Over 40% of residents in Santa Rosa County do not Bay 19.6% have a healthcare provider, a much higher rate 0% 10% 20% 30% 40% 50% compared to the state Percentage of Residents without a Healthcare Provider average.
Page 50 Comprehensive Regional Community Health Assessment Florida Panhandle
Adults Receiving Medical Checkup Florida 69.7% in Past Year Walton 63.8%
The percentage of adults in Santa Rosa all five Panhandle Counties 68.7% who had a medical checkup Okaloosa in the past year is similar to 69.5% the state average. Escambia 66.3%
Bay 62.6% A lack of preventative care was identified as a 0% 10% 20% 30% 40% 50% 60% 70% 80% priority health issue by Percentage of Residents who Had a Medical Checkup in the Past Year Key Informants. Key Informants also identified a lack of health literacy as a barrier to care.
Page 51 Comprehensive Regional Community Health Assessment Florida Panhandle
What is the Current Health Status of your County?
Cancer 161.1 LEADING CAUSES OF Heart Disease 154.3 Resp. Disease 41.6 DEATH
Florida Accidents 38.6 Stroke 31.4 Like the state of Florida, the top two leading causes Cancer 166.9 of death in Walton, Santa Rosa, Okaloosa, Heart Disease 166 Escambia and Bay Counties are heart disease and Resp. Disease 51.7 cancer.
Walton Accidents 42.7 Diabetes 35.8 Cancer 189.0 One notable difference is that the one of the five Heart Disease 173.8 leading causes of death in Walton County is Resp. Disease 63.0 Diabetes. Accidents 43.6
Santa Rosa Stroke 39.9 Cancer 189.6 Heart Disease 167.0 Heart Disease and Cancer were identified as Resp. Disease 59.4 priority health outcomes by Key Informants, Accidents 37.1 Okaloosa Stroke 35.3 especially in Escambia, Santa Rosa, and Cancer 187.3 Walton Counties. Heart Disease 184.2 Resp. Disease 54.9 Respiratory Conditions were identified as a Stroke 49.9 Escambia Accidents 37.4 priority issue in Walton County by Key Cancer 193.8 Informants. Heart Disease 183.7 Resp. Disease 62.2
Bay Accidents 41 Stroke 32.1 0 50 100 150 200 250 Death Rate per 100,000 individuals
Page 52 Comprehensive Regional Community Health Assessment Florida Panhandle
Leading Causes of Death by Race When separated by race the top two leading causes of death among Non-Whites and Whites in Walton, Santa Rosa, Okaloosa, Escambia and Bay Counties remain heart disease and cancer. One notable difference is that Diabetes is reported as a leading cause of death among Non- Whites in both the state and Panhandle region.
Cancer 161.6 Heart Disease 162.3 Heart Disease 151.9 Cancer 155.0 Resp. Disease 45.1 Stroke 44.5
Accidents 40.5 Diabetes 34.9 Florida Stroke 29.4 Florida Accidents 26.9 Cancer 171.8 Heart Disease 117.6 Heart Disease 169.2 Cancer 93.7 Accidents55.3 Diabetes 55.3
Resp. Disease 44.5 * Walton Walton Stroke 32.1 * Cancer 191.5 Cancer160.5 Heart Disease 175.0 Heart Disease148.4 Resp. Disease 64.8 Diabetes 41.3 Accidents 45.0 Accidents 31.3 Stroke 34.1
Stroke 40.0 Rosa Santa Santa Rosa Santa Cancer 194.0 Cancer144.2 Heart Disease 168.6 Heart Disease 140.2 Resp. Disease 62.4 Diabetes 50.3
Accidents 38.7 Stroke 43.4 Okaloosa Okaloosa Stroke 34.7 Accidents 30.8 Cancer 187.6 Heart Disease 207.7 Heart Disease 177.0 Cancer 184.7 Resp. Disease 60.5 Stroke 72.8
Stroke 49.9 Diabetes 42.5 Escambia Escambia Accidents 40.6 Accidents 40.6 Cancer 196.7 Heart Disease 189.7 Heart Disease 182.8 Cancer 168.6
Resp. Disease 65.0 Stroke 47.6 Bay Bay Accidents 44.7 Resp. Disease 36.9 Alzheimer's 32.1 Diabetes 32.1 0 50 100 150 200 250 0 50 100 150 200 250 Death Rate per 100,000 White residents Death Rate per 100,000 Non-White residents
*Indicates that the total number is less than 5 individuals and therefore considered too small to report as an accurate rate.
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Leading Causes of Death by Ethnicity Similar to the total causes of death and leading cause of death by race, when separated by ethnicity the top two leading causes of death among Hispanics and Non-Hispanics in Walton, Santa Rosa, Okaloosa, Escambia and Bay Counties remain heart disease and cancer. One notable difference is that Diabetes is reported as a leading cause of death among Hispanic residents in Escambia County
Heart Disease 130.4 Cancer 169.9 Cancer 113.6 Heart Disease 158.7 Accidents 25.9 Accidents 44.5
Stroke 25.3 Resp. Disease 41.3 Florida Florida Resp. Disease 22.9 Diabetes26.9 Heart Disease 111.0 Cancer 169.7 Accidents 93.2 Heart Disease 167.3 * Accidents 55.3
* Resp. Disease 43.6 Walton Walton * Diabetes 36.7 Heart Disease 94.0 Cancer160.5 Cancer 92.5 Heart Disease148.4 Accidents 42.0 Resp. Disease 64.3 * Accidents 43.8
* Stroke 40.9
Santa Rosa Santa Rosa Santa Cancer 61.4 Cancer144.2 Heart Disease 32.7 Heart Disease 140.2 * Resp. Disease 60.4
* Accidents 43.4 Okaloosa Okaloosa * Stroke 30.8 Cancer 91.7 Cancer 189.4 Heart Disease 64.7 Heart Disease 186.7 Accidents 28.7 Resp. Disease 72.8
Stroke 49.9 Stroke 42.5 Escambia Escambia Diabetes 40.6 Accidents 40.6 Heart Disease 86.7 Cancer 197.0 Cancer 58.5 Heart Disease 185.9
* Resp. Disease 47.6 Bay Bay * Accidents36.9 * Stroke32.1 0 20 40 60 80 100 120 140 0 50 100 150 200 250 Death Rate per 100,000 Hispanic iresidents Death Rate per 100,000 Non-Hispanic residents
*Indicates that the total number is less than 5 individuals and therefore considered too small to report as an accurate rate.
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PREVENTION QUALITY INDICATORS (PQI) PQIs measure adult hospital admissions for ambulatory care sensitive conditions (ACSC) across geographic areas. ACSCs represent conditions for which hospitalization could be avoided if the patient receives timely and adequate outpatient care. Many factors influence the quality of outpatient care, including access to care and adequately prescribed treatments, once care is obtained. In addition, patient compliance with those treatments and other patient factors may play a role. In total, there are 13 PQI measures for specific ACSCs and 3 composite measures based on multiple conditions, several of which are presented below
In general, areas with lower socio-economic status tend to have higher admission rates for ACSCs than areas with higher socio-economic status. As with utilization indicators, there are no “right rates” of admission for these conditions. Very low rates could signal inappropriate underutilization of healthcare resources while very high rates could indicate potential overuse of inpatient care. Therefore, hospital admission for ACSCs is not a measure of hospital quality but a potential indicator of outpatient and community healthcare need.12 Florida Bay Escambia Okaloosa Santa Walton PQI Rosa Data from all hospitals in the entire state of Overall PQI 1852 1989 1732 1703 1758 1874 Florida are provided as a reference point to contextualize how the PQI rates in each of Congestive Heart Failure 416 537 452 329 324 378 the Panhandle counties stand in relation to the state average. Hypertension 98 108 83 95 51 71
Cases where the county PQI rate is higher Respiratory Disease 604 593 521 724 686 582 than that of the state are bolded. Bay and (older adults) Walton Counties have a higher Overall PQI Uncontrolled Diabetes 32 22 19 13 20 37 rate than the state; the remaining three counties have lower Overall PQI rates Diabetic Complications 60 87 89 68 92 80 compared to the state. (short term)
Diabetic Complications While all five counties have a lower PQI rate 141 135 130 111 105 99 for long term Diabetic Complications, all five (long term) counties have a higher PQI rate for short term Diabetic Complications compared to the state
12 Source: AHRQ Quality Indicators Software Instructions, SASVersion 4.4., March 2012, p. 24
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CHRONIC HEALTH CONDITIONS Chronic health conditions generally persist for 3 months or longer. Common chronic health conditions in the United States include obesity and diabetes. Health behaviors such as poor diet or lack of physical activity can contribute to the leading chronic diseases. Obesity Prevalence A person is considered obese if Florida 27.2% they have a Body Mass Index (BMI) of 30 or greater. Walton 28.6%
In all five counties, the Santa Rosa
prevalence of obesity meets the 29.8% Healthy People 2020 target. Okaloosa However, close to 30% of 28.8%
residents in each county is still Escambia People2020 considered obese. 29.7%
Bay 28.2% Healthy A lack of chronic 0% 5% 10% 15% 20% 25% 30% 35% disease management Percentage of Residents Considered Obeses was identified as a priority health issue by Key Informants. “Diabesity” was identified as a priority health outcome by Key Informants, particularly among minority populations.
Diabetes In the CDC’s ongoing, monthly state-based telephone Behavioral Risk Factor Surveillance Survey, adult residents are asked, “Has a doctor ever told you that you have Florida 10.4% diabetes?”
Walton 10.0% In Okaloosa County and Bay County, a lower percentage of Santa Rosa adults reported that a doctor had 12.6% ever diagnosed them with Okaloosa diabetes compared to the state. 8.8% Escambia In Escambia and Santa Rosa 11.2% Counties, a larger percentage of adult residents self-reported they Bay 9.0% had been diagnosed with diabetes compared to the state, and in 0% 2% 4% 6% 8% 10% 12% 14% Walton County the percentage Percent of Adult Residents Ever Diagnosed with Diabetes was similar to the state average.
Page 56 Comprehensive Regional Community Health Assessment Florida Panhandle
MENTAL WELL-BEING Depression and anxiety are among the most commonly occurring mental health conditions in the United States of America – both often co-occur with physical health conditions. Suicide Rate Florida The suicide rate in Walton, Santa 13.8 Rosa, Okaloosa, and Bay Walton Counties is higher than the 20.3 suicide rate in Florida and higher Santa Rosa than the Healthy People 2020 15.6 target. Okaloosa 20.2
The suicide rate in Escambia Escambia People2020 County is lower than the state 12.3 rate but still exceeds the Health Bay 19.4
People 2020 target. Healthy 0 5 10 15 20 25
Suicide Rate per 100,000 individuals
Suicide Rate (per 100,000) by Race and Ethnicity
White residents in Okaloosa, Escambia and Bay County are committing suicide at higher rates than Non-Whites. The suicide rate among White residents in these counties is also higher than the Florida rate for White residents and the Healthy People 2020 target.
White Non-White Hispanic Non-Hispanic 25 25 *Indicates that the total number is less than 5 individuals and therefore considered too small to report as an accurate rate.
20 20
15 15
10 10 Healthy People 2020 Healthy People 2020 7.5
5 5
* * * * * 0.0 0 * 0 Bay EscambiaOkaloosa Santa Walton Florida Bay Escambia Okaloosa Santa Walton Florida Rosa Rosa
Page 57 Comprehensive Regional Community Health Assessment Florida Panhandle
Depression Bay County not included in the Gulf State Population Survey.
A higher percentage of residents Florida 15.0% in Walton County are currently depressed compared to the state Walton 16.2% A smaller percentage of residents in Santa Rosa, Okaloosa, and Santa Rosa Escambia Counties are currently 8.9% depressed compared to the state.
Depression was identified as Okaloosa 8.1% a priority health outcome by Key Informants. Escambia 14.3%
0% 5% 10% 15% 20%
Percent of Residents who are Currently Depressed
Depression by Race and Ethnicity
With the exception of Okaloosa County, a higher percentage of Non-White residents in the remaining counties are currently depressed compared to White residents. Across the four counties a higher proportion of Non-Hispanic residents are currently depressed compared to Hispanic residents.
Page 58 Comprehensive Regional Community Health Assessment Florida Panhandle
Anxiety Bay County not included in the Gulf State Population Survey. A higher percentage of residents in Escambia County and Walton County report anxiety symptoms Florida 13.7% compared to the state Walton 15.2% A smaller percentage of residents in Santa Rosa County and Santa Rosa Okaloosa County report anxiety 7.2% symptoms compared to the state. Okaloosa 8.5% Anxiety was identified as a priority health outcome Escambia 14.7% by Key Informants. 0% 2% 4% 6% 8% 10% 12% 14% 16%
Percent of Residents with a Current Anxiety Disorder
Anxiety by Race and Ethnicity
In all four counties a higher percentage of Non-White and Non-Hispanic residents report anxiety symptoms compared to White and Hispanic residents.
White Non-White Hispanic Non-Hispanic 30% 18%
16% 25% 14%
20% 12%
10% 15% 8%
10% 6%
4% 5% 2% 0.0% 0% 0% Escambia Okaloosa Santa Walton Florida Escambia Okaloosa Santa Walton Florida Rosa Rosa
Page 59 Comprehensive Regional Community Health Assessment Florida Panhandle
MATERNAL & CHILD HEALTH A focus on child health provides the opportunity to identify health risks and prevent future health problems in infant, child, and related vulnerable populations. Infant mortality has proven to be an accurate predictor of the state of health of a given area, population, or nation due to the number of contributing factors involved. Infant Mortality Rate Florida 6.6 The infant mortality rate Walton
in Santa Rosa is lower 6.8 than the state’s rate and Santa Rosa meets the Healthy People 4.8 2020 target. Okaloosa
6.5 People2020 Infant mortality in Escambia Escambia County is 9.2 higher than the state and Healthy Bay also higher than the 6.7 Healthy People 2020 target. Infant mortality in 0 2 4 6 8 10 Walton, Okaloosa, and Infant Mortality Rate per 1,000 live births Bay Counties is similar to the state and exceeds the Healthy People 2020 target.
Infant Mortality Rate (per 1,000 live births) by Race and Ethnicity
In Escambia County and Okaloosa County, the infant mortality rate of Non-White mothers is higher than the state’s rate. In Escamiba County, infant mortality among Hispanic mothers is higher than infant mortality among Non-Hispanic Mothers.
White Non-White Hispanic Non-Hispanic 16 12 *Indicates that the total number is less than 5 individuals and therefore considered too small to report as an accurate rate. 14 10 12 8 10 6 8 Healthy People 2020 6 4 Healthy People 2020 4 2
2 * * * 0.0 * * 0 0 Bay Escambia Okaloosa Santa Walton Florida Bay EscambiaOkaloosa Santa Walton Florida Rosa Rosa
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Teen Birth Rate Teen pregnancies are often at higher risk for pregnancy-induced hypertension and poor birth outcomes such as premature birth and low birth weight. Florida 13.4 The teen birth rate in Walton, Walton Escambia and Bay Counties is 17.6 higher than Florida’s overall Santa Rosa rate. 12.4 Okaloosa In Santa Rosa and Okaloosa 12.7 Counties, the rate of teens Escambia giving birth is slightly lower than 15.4 the state. Bay 17.4 0 5 10 15 20 Teen Birth Rate per 1,000 15-17 Year Olds
Teen Birth Rate (per 1,000 15-17 year olds) by Race and Ethnicity
In Escambia, Bay, and Okaloosa Counties the teen birth rate among Non-Whites is higher than among White teens. In Santa Rosa and Okaloosa Counties the teen pregnancy rate among Hispanic teens is higher than the teen birth rate among Non-Hispanic teens.
White Non-White Hispanic Non-Hispanic 40 40 *Indicates that the total number is less than 5 individuals and therefore considered too small to report as an accurate rate. 35 35
30 30
25 25
20 20
15 15
10 10
5 5 * * * * 0.0 0 0 Bay EscambiaOkaloosa Santa Walton Florida Bay EscambiaOkaloosa Santa Walton Florida Rosa Rosa
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Low Birth Weight Low birth weight is a major Florida determinant of mortality, 8.7 morbidity and disability in Walton infancy and childhood and 9.4 also has a long-term impact on health outcomes in adult life. Santa Rosa 7.6
In Santa Rosa and Okaloosa Okaloosa Counties, the rate of babies 7.8 born weighing less than 2,500 grams is lower than the state Escambia
People2020 10.3 average and meets the Healthy People 2020 target. Bay
Healthy 9.3 The percentage of low birth weight births in Walton, 0 2 4 6 8 10 12 Escambia, and Bay Counties Percent of Low Birth Weight Births is higher than both the state average and Healthy People 2020 target.
Low Birth Weight by Race and Ethnicity
The percentage of low birth weight births born to Non-white mothers is substantially higher than that of White mothers in the Panhandle counties. The rate of low birth weight babies born to Non-White mothers in all five counties exceeds the Healthy People 2020 target. In all five counties the percentage of low birth weight births is higher among Non-Hispanic mothers compare to Hispanic mothers.
White Non-White Hispanic Non-Hispanic 18% 12%
16% 10% 14%
12% 8%
10% Healthy People 2020 6% 8% Healthy People 2020 6% 4% 4% 2% 2% 0.0% 0% 0% Bay Escambia Okaloosa Santa Walton Florida Bay Escambia Okaloosa Santa Walton Florida Rosa Rosa
Page 62 Comprehensive Regional Community Health Assessment Florida Panhandle
CANCER Risk of developing cancers like lung and breast cancer can be reduced by taking actions to maintain a healthy diet, reduce tobacco and alcohol intake and receive regular medical care, including preventative screenings such as mammograms. Although there are services through the CDC that provide free or low cost screenings, more work is needed to increase the availability and accessibility of cancer screenings, information and referral services. Lung Cancer In Santa Rosa, Okaloosa, Florida 69.2 Escambia, and Bay Counties a higher number Walton 65.1 of new cases of lung cancer were diagnosed Santa Rosa compared to the state. 81.3
In Walton County, a Okaloosa 78.7 slightly lower number of new cases of lung cancer Escambia 79.6 were diagnosed compared to the state. Bay 85.4
0 20 40 60 80 100 Lung Cancer Incidence per 100,000 Residents
Breast Cancer Florida 114.9 In Santa Rosa County and Okaloosa County a slightly Walton 84.6 higher number of new cases of breast cancer were diagnosed Santa Rosa compared to the state. 123.1 In Escambia County and Bay Okaloosa 135.9 County a similar number of new cases of breast cancer were Escambia 115.0 diagnosed compared to the state.
Bay 111.7 In Walton County, a lower number of new cases of breast 0 20 40 60 80 100 120 140 160 cancer were diagnosed compared to the state. Breast Cancer Incidence per 100,000 Residents
Page 63 Comprehensive Regional Community Health Assessment Florida Panhandle
INFECTIOUS DISEASE Infectious disease has a significant impact on the overall health of a community. The number of people living with HIV in the United States is higher than ever and remains a significant cause of death for some populations.
Chlamydia Florida 396.0 In Okaloosa County and Escambia County, the rate of Walton 246.0 chlamydia is higher than the state rate. Santa Rosa 216.4 In Walton County, Santa Rosa County and Bay County, the Okaloosa 411.3 chlamydia rate is lower than the state rate. Escambia 571.2
Bay 389.1
0 100 200 300 400 500 600
Chlamydia Rate per 100,000 Residents
Florida 107.6 Gonorrhea In Escambia County, the Walton 21.8 gonorrhea rate is higher than the state rate. Santa Rosa 34.5 In Walton County, Santa Rosa County and Okaloosa 71.5 Okaloosa County, the gonorrhea rate is lower Escambia 199.6 than the state rate.
Bay 108.7 Bay County’s rate is similar to the state rate. 0 50 100 150 200 250 Gonnorhea Rate per 100,000 Residents
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Syphilis Escambia County is the only Florida 6.2 county with a syphilis rate greater than the state’s rate. *Indicates that the total number is less than 5 individuals and * therefore considered too small to report as an accurate rate.
*
*
Escambia 10.9
*
0 2 4 6 8 10 12 Syphilis Rate per 100,000 Residents
Rate of HIV Florida 27.7 Overall, the rate of HIV in the five Panhandle counties Walton 9.7 is lower than the state rate. Santa Rosa The HIV rate in Santa Rosa 5.0 County is substantially less than the state rate. Okaloosa 7.9 The HIV rate in Escambia Escambia 22.3 County is slightly lower than the state rate. Bay 13.4
0 5 10 15 20 25 30 HIV Rate per 100,000 Residents
Page 65 Comprehensive Regional Community Health Assessment Florida Panhandle
CHAPTER 3
SUMMARY AND ONGOING ASSESSMENT SUPPORT YEARS 2-5
Page 66 Comprehensive Regional Community Health Assessment Florida Panhandle
Summary Overall, the comprehensive assessment for the five Florida Panhandle Counties revealed several common health and health care needs. Data gathered from state and national sources and data gathered from Key Informants suggest that adult dental health, mental health and chronic illness, such as diabetes and obesity are health priorities in these communities. Increasing access to care, particularly related to lack of transportation and limited number of primary and mental health care providers and services, also emerged as a priority in this assessment. PCCP’s objective of conducting regional community health assessments was achieved by reviewing existing data at the state, county, and sub-county level, where available, and gathering information from key informants regarding heath and health care needs. Additionally, per the Settlement PCCP also completed the clinic assessments of all FQHC and FQHC Look-alikes in the five counties. The PCCP comprehensive assessment included and complemented data and information from each of the Florida Panhandle County’s CHAs and CHIPs, when available. These data were shared in a community prioritization focus group meeting with key informants from the five counties. The meeting also informed the inclusion of additional data into the comprehensive assessment. Importantly, this work was not meant to take the place of CHA activities in Florida, rather its aim was to inform funding to coastal county FQHCs and add value to local CHA and CHIP efforts. Ongoing Community Assessment Support In Years 2-5 of the GRHOP, PCCP’s approach to community assessment is to provide ongoing technical assistance (TA) and other support services to local and state partners in conducting CHAs and planning and implementing CHIPs as part of the state or parish/county’s public health accreditation process13. PCCP will support state and parish/county existing and ongoing CHA and CHIP processes to further collective impact, community benefit, engagement, and resiliency in those communities while also building their capacity for community health assessment and improvement.
PCCP program, assessment, and community health teams have met with partners in all four states to provide consultation and share a list of possible TA and support services that LPHI can provide to support their ongoing or planned CHAs and CHIPs (see p. 69). In Florida, all five counties named in the settlement have conducted CHAs and most have developed CHIPs for their counties, and the PCCP comprehensive assessment included data and information from each of the county CHAs and CHIPs, when available. In response to the current status of the Florida county CHAs and CHIPs, the PCCP assessment developed possible TA and support services offerings that would build on and contribute to ongoing efforts as led and defined by the Florida county officials. The PCCP TA offerings were shared by the Walton County Health Officer at the Emerald Coast County Health Officers meeting in March, a meeting of 10 FL county health officers, five of which are in the GRHOP footprint. From this meeting, plans are being made to provide group TA on three priority areas: 1) identifying, accessing, and optimizing use of data sources; 2) mapping data, and 3) evaluating programs. The PCCP assessment and community health teams are in the process of developing curricula for these TA priorities.
Additionally, the PCCP assessment and community health teams have partnered with the Partnership for a Healthy Community, who has sponsored CHAs for Escambia and Santa Rosa counties, to provide organizing, planning, funding, and logistical support for their Health Care Summit. The Summit aimed to
13 Public health department accreditation is defined as the development of a set of standards, a process to measure health department performance against those standards, and reward or recognition for those health departments who meet the standards. Citation: Public Health Accreditation Board, What is Accreditation? Viewed April 27, 2013 at http://www.phaboard.org/accreditation-overview/what-is-accreditation/.
Page 67 Comprehensive Regional Community Health Assessment Florida Panhandle involve and engage the key organizations and community leaders whose participation is essential to the development of plans to effectively improve the health status of residents of Escambia and Santa Rosa Counties.
If you would like further information regarding the methodology and data sources used in this assessment or have questions related to plans for ongoing community assessment support in Years 2-5, please contact Dr. Samantha Francois at [email protected] or 504-301-9800.
Page 68 Comprehensive Regional Community Health Assessment Florida Panhandle
LPHI CHA/CHIP Technical Assistance Offerings Through PCCP, LPHI can offer technical assistance and support services to some degree, at no cost, to state and county health officials and their partners, including public health institutes and key stakeholders, to advance community health assessment and improvement processes. This TA and support could include: Identifying, acquiring, and analyzing additional data sources needed to address identified health needs within the county Examples: o Food security o Transportation
Identifying, acquiring and analyzing data sources on environmental and occupational health Examples: o Air quality, water quality o Industry & occupation-specific hazards o Exposure to lead and other contaminants
Designing to collect data that may not currently be available Examples: o Survey design o Qualitative methods (e.g., focus groups, key informant interviews)
Advanced data analysis techniques including: o Sub-county hospital discharge data analysis Examples: . Admission rates by zip code . Prevention quality indicators by zip code o Multivariate analysis
Translating and disseminating data including: o GIS data mapping to visualize community health status and assets Examples: . Census tract and block level mapping . Drive time mapping . Multi-factor mapping (e.g. race and poverty by census block): o Data dashboard development
Assistance with development of evaluation plans to include: o Evaluation design o Data acquisition and/or collection o Analysis o Reporting and dissemination strategies
Community health planning and implementation o Identifying community health priorities and gaps in health resources o Identifying and adapting model public health best practices o Creating sustainable community action plans o Aligning community health improvement plans with the U.S. Department of Health and Human Services Healthy People 2020 goals and objectives
Community capacity/coalition building to promote collective impact o Coaching community coalitions o Partnership development and advocacy training o Health leadership training o Creating shared community health agendas o Community mobilization o Linking communities to resources Page 69 Comprehensive Regional Community Health Assessment Florida Panhandle
APPENDIX A Sources – Comprehensive Regional Community Health Assessment
Domain Measure Source Year
Who lives in your county?
Race US Census 2010 Ethnicity Age American Community Survey 2011 and 2009-2011 Income (Walton only) Veteran Status Military
What influences health in your county?
Socioeconomic Factors Low SES American Community Survey 2011 and 2009-2011 Unemployment (Walton only) Education Status Social Vulnerability Social Vulnerability Oxfam America 2009 Index Social Vulnerability by Environmental Hazard Natural Environment Flood Plain Distribution FEMA 2012
Fish Advisories Florida Department of Health 2012 Division of Disease Control and Prevention Unhealthy Air Quality Environmental Protection Agency 2009-2011
Extreme Heat Days CDC North American Land Data 2008-2010 Assimilation System
Beach Water Quality Environmental Protection Agency 2010-2011
Extreme Weather Events Spatial Hazard Events and Losses 2001-2012 Database
Social Environment Grocery Stores USDA Food Environment Atlas 2009 Recreational Facilities
Homicide Rate Florida CHARTS – Bureau of Vital 2009-2011 Statistics
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Domain Measure Source Year Social Environment Violent Crime Rate FBI Uniform Crime Reports via 2008-2010 County Health Rankings Occupational Health Lost Income and Gulf State Population Survey 2010-2011 Employment due to Oil Spill Occupation American Community Survey 2011 and 2009-2011 (Walton only) Risk for Injury Bureau of Labor Statistics 2008-2010
Census of Fatal Occupational Injuries Survey of Occupational Injuries and 2010 Illnesses
Work related Hospital Inpatient Data – Florida 2009-2011 hospitalizations Agency for Health Care Administration
Risk Behaviors Smoking Prevalence Florida CHARTS – Behavioral Risk 2010 Factor Surveillance System Binge Drinking
Prescription Drug Use Gulf State Population Survey 2010-2011 Physical Activity
Access to Health Care Uninsured Children Small Area Health Insurance 2010 Estimates Uninsured Adults American Community Survey 2011 and 2009-2011 Medicaid Recipients (Walton only)
Medicare Beneficiaries Mental Health Coverage Gulf State Population Survey 2010-2011
Health Care Providers Florida CHARTS – Division of 2009-2010 and Facilities Medical Quality Assurance
Health Resource and Services 2012 Administration (HRSA) Florida Chapter of the American 2012
Academy of Emergency Medicine ESRI Infogroup Point Data 2012 Florida Department of Health 2012 Division of Medical Quality Assurance Licensee Data Center
Page 71 Comprehensive Regional Community Health Assessment Florida Panhandle
Domain Measure Source Year Access to Health Care Health Professional Health Resource and Services 2013 Shortage Areas Administration
Proximity to Care HRSA 2012 American Community Survey 2006-2010
Health Care Seeking Unable to See Doctor Florida CHARTS – Behavioral Risk 2010 Behavior When Needed Due to Factor Surveillance System Cost Adults with Health Care Provider Adults Receiving Medical Checkup in Past Year What is the current health status of your county? Causes of Death Leading Causes of Florida CHARTS – Bureau of Vital 2009-2011 Death Statistics Prevention Quality PQI Rates Hospital Inpatient Data – Florida 2009-2011 Indicators (PQI) Agency for Health Care Administration Chronic Health Obesity Prevalence Florida CHARTS – Behavioral Risk 2010 Conditions Factor Surveillance System Diabetes
Mental Well-Being Suicide Rate Florida CHARTS – Bureau of Vital 2009-2011 Statistics Depression Gulf State Population Survey 2010-2011 Anxiety
Maternal & Child Health Infant Mortality Rate Florida CHARTS - Florida Vital 2011 Statistics Annual Report
Teen Birth Rate
Low Birth Weight
Cancer Lung Cancer National Cancer Institute 2005-2009
Breast Cancer
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Domain Measure Source Year Infectious Disease Chlamydia Rate Florida CHARTS – Bureau of STD 2009-2011 Prevention and Control Gonorrhea Rate
Syphilis Rate
Incidence of HIV
Page 73 Comprehensive Regional Community Health Assessment Florida Panhandle
APPENDIX B Data Factor List and Supplemental Data Factors for which data were gathered and analyzed were chosen based on best practices put forth by the Catholic Health Association and MAPP processes for selecting measurements that summarize the state of health and quality of life in a community. These factors then went through several rounds of review by GRHOP partners and stakeholders in each county to arrive at the final list of factors. Below is a complete list of indicators selected in the secondary data review.
Domain Sub-Domain Level of analysis
Demographics and socioeconomic status Basic demographic information Census tract (age, sex, race, ethnicity, income, marital status, education)
Poverty by age and Census tract racial/ethnic subgroups
Unemployment rate Census tract
% Employed population by County occupation & Industry
Access to health care Health care staffing shortages: County
-Primary care HPSA
-Dental care HPSA
-Mental health HPSA Primary care physicians (MDs County and DOs) per population
# Hospitals and # beds per County 10,000 population
% uninsured adults (age 18-64) County and children (≤ 19)
% Medicaid recipients County
% Medicare beneficiaries, County elderly (age 65+)
% has personal doctor or County someone they consider health care provider
% unable to see a doctor when County needed in past 12 months due to cost Length of time since last routine County check-up
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Health status Leading causes of death (age- County adjusted rates to year 2000 standard)
Rate of “preventable” County hospitalization stays
Risk factor behaviors % of adults that report they are County currently smoking
% of adults that report binge County drinking
Screening utilization rates: County
-Diabetes
-Mammography
-Prostate cancer
-Colorectal cancer %adults aged 20 and over County
reporting no leisure time physical activity
Child health Infant mortality rate County
Low birth weight rate County
Teen pregnancy rate County
Proportion of women receiving County no prenatal care in first trimester
% children felt nervous or afraid County in the past 30 days
% children had problems County sleeping in the past 30 days
% children had problems getting County along with other children in the past 30 days
Infectious disease STI incidence rates: County
-Chlamydia
-Gonorrhea
-Syphilis
HIV rate County
Tuberculosis incidence rate County
Page 75 Comprehensive Regional Community Health Assessment Florida Panhandle
Natural environment Air quality: County
-Annual average of PM 10
-Annual average of PM 2.5
-# of days PM 2.5 in AQI unhealthy range
-#of days Ozone in AQI unhealthy range
-# of days rated unhealthy for sensitive groups
Fish Advisories: Location of water body
-# Consumption advisories due to chemical contaminant(s)
Days with extreme heat County
Water quality: Location of water body
- Recreational
Floodplain distribution Location of floodplain
% population who had direct County contact with oil
Occupational & Environmental Health Work-related Hospitalizations County
Rate of Fatal Occupational County Injuries
Rate of Non-Fatal Occupational County Injuries
% of workers employed in County industries at high risk of occupational morbidity
Relative risk of Fatal County Occupational Injury
Chronic Health Conditions % Obese adult residents County
% residents ever diagnosed with County diabetes
% residents ever told they have County asthma
% residents ever told they have County coronary heart disease
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Social environment Total crime index County
Homicide rate County
% Renters Spending 30% or County More of Household Income on Rent Recreational facilities per 1,000 County population
% Households without a Car and County > 1 Mile from a Grocery Store
Fast food restaurants per 1,000 County population
% students free-lunch eligible County
% WIC participants County
Grocery stores per 1,000 County residents Liquor stores per 1,000 residents County
Mental and Behavioral health % Currently depressed - Patient County Health Questionnaire 8 (PHQ-8)
% Anxiety Disorder - County Generalized Anxiety Disorder 7
Suicide rate County
Average # Poor Mental Health County Days
% Ever Received Counseling for County emotional health issues
Average # times counseling County received % Ever prescribed medication County for emotional health issues
% residents prescribed County medication for emotional health issues in the past year Resources/assets # FQHCs or lookalikes County
# Mental health service County providers (public, private)
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Resources/assets (cont.) Occupational Safety & Health County Professionals:
-# board-certified occupational physicians
-# of members of ACOEM
-# board-certified occupational health nurses
-# members of AAOHN
-# board certified industrial hygienist
-# members of AIHA
-# board certified safety health professionals
-# members of ASSE
-# members of AOEC
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For those factors which were not presented in the report, the following table lists the available data for these factors for each Florida county. Also listed is the data source and year.
Santa Sub-Domain Source Year Bay Escambia Okaloosa Walton Rosa Marital Status
(of those 15 and older): % Married Census 2010 49.1% 42.4% 51.8% 53.1% 54.4%
Sex:
% Male Census 2010 49.5% 49.4% 50.2% 50.5% 51.2% Education
(for those 25 years and older): 2011 and 2009- 22.6% 23.4% 29.1% 25.9% 24.0% % College or graduate degree ACS 2011 (Walton only) 2011 and 2009- 99.0% 97.4% 98.1% 97.5% 96.9% % Citizens of USA ACS 2011 (Walton only)
Language spoken at home:
Demographics and socioeconomic status socioeconomic and Demographics % English only 2011 and 95.4% 89.5% 89.7% 93.3% 92.7% ACS 2009- 2011 1.9% 4.1% 6.1% 3.5% 4.8% % Spanish or Creole only (Walton only)
care
to to 39.6 43.4 27.0 16.3 20.1
# beds per 10,000 population ARF 2008 Access
Page 79 Comprehensive Regional Community Health Assessment Florida Panhandle
Santa Sub-Domain Source Year Bay Escambia Okaloosa Walton Rosa Cancer
National Cancer Breast cancer annual death rate (age Institute's 2005- 23.7 23.4 22.8 22 23.8 adjusted rates per 100,000) State 2009
Health Status Health Cancer Profiles Screening utilization rates:
Not collected Diabetes: tested in last 3 years
Percentage of women who 59% 62.8% 61.5% 60.6% 51.1% received a mammogram (40+) BRFSS 2010 Percentage men who 72.2% 63.8% 79.4% 69.4% 71.1%
received a PSA test (50+) Risk Risk Behaviors
Percentage of adults who received 62.9% 58.1% 63.9% 58.6% 60.7% sigmoidoscopy or colonoscopy (50+)
FL Bureau of Infectious Tuberculosis 2009-2011 5.1 3.3 2.4 1.1 3 Disease (incidence rate per 100,000) Vital Stats FL Bureau of % women receiving no prenatal 2011 29.5% 20.8% 26.3% 17.7% 17.8%
care in the first trimester Vital Stats
In the past 30 days:
Child felt nervous or afraid Not 14.1% 12.3% 12.5% 21.2% Gulf State 2010- collected
Child Child Health Population Child had problems sleeping 2011 18.9% 13.1% 11.8% 20.1% Survey Child had problems getting along 14.0% 15.5% 4.1% 17.3% with other children
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Santa Sub-Domain Source Year Bay Escambia Okaloosa Walton Rosa
% Ever told have coronary heart Not Gulf State 8.8% 7.2% 6.9% 10.5% disease 2010- collected Population
2011 Not Health Health
Chronic % Ever told have asthma Survey 16.9% 18.7% 13.9% 15.4% collected
Air quality-
Annual average of PM 2.5 2009- EPA No data 0 No data No data No data (3 year average) 2011 #of days Ozone in AQI unhealthy 2009- EPA 1.0 2.0 1.3 1.7 No data environment range (3 year average) 2011 Gulf State Not % population who had direct 2010- 19.0% 14.7% 20.1% 18.3% Population collected
Natural Natural contact with oil during the oil spill 2011 Survey Occup. 2008- Relative Risk of Fatal Injury CFIO/ACS 1.05 0.96 0.95 1.01 1.09 Health 2010 2011 and % Renters Spending 30% or More ACS 2009- 52% 56.6% 58% 57.7% 60.4% of Household Income on Rent 2011 (Walton only) USDA Food % Households without a Car and > 2.5% 2.9% 1.9% 2.2% 4.1% 2006 1 Mile from a Grocery Store Environment Atlas USDA Food Fast food restaurants per 1,000 Environment 2009 0.76 0.58 0.8 0.49 0.6 population Atlas USDA Food % students free-lunch eligible Environment 2009 40.1% 50.4% 26.3% 29.2% 40% Social Social environment Atlas US Census Liquor Store Density per 1,000 County 2010 1.18 0.74 1.11 0.59 1.64 population Business Patterns
Page 81 Comprehensive Regional Community Health Assessment Florida Panhandle
Santa Sub-Domain Source Year Bay Escambia Okaloosa Walton Rosa
Ever received counseling for Not 31.4% 23.6% 18.8% 24.8% emotional health issue collected Gulf State Among those 2010- Not Population 2011 collected 25.5% 19.2% 24.3% 35.4% currently depressed Survey Among those reporting Not 28.3% 18.2% 19.5% 30.5% anxiety symptoms collected Gulf State Average # time counseling received 2010- Not Population 14 16 19 17 last year 2011 collected Survey Ever prescribed medication for Not 75.1% 67.9% 65.4% 73.5% emotional health issues collected Gulf State 2010- Population Not 2011
Mental and Behavioral Health Behavioral and Mental % Prescribed medication Survey availabl 17.5% 11.2% 13.0% 15.2% in the past year e
Average # Poor Mental Health Days BRFSS 2010 3.5 4.5 3.5 4.4 4.8 in last 30 days Occupational Safety & Health Professionals: # board-certified occupational AOEC 2012 0 5 0 2 0
physicians
# of members of ACOEM ACOEM 2012 0 3 0 3 0 # board-certified occupational health 2012
/assets ABOHN Public directory not available nurses # members of AAOHN AAOHN 2012 Public directory not available # board certified His NBCHIS 2012 0 4 0 7 0
Resources # members of AIHA AIHA 2012 0 0 0 3 0 # board certified safety health BCSP 2012 0 26 21 21 6 professionals # members of ASSE ASSE 2012 Public directory not available # members of AOEC AOEC 2012 No AOEC clinics Page 82 Comprehensive Regional Community Health Assessment Florida Panhandle