2020 Big Bend Community Health Assessments and Priorities

BIG BEND COMMUNITY HEALTH ASSESSMENTS AND PRIORITIES BAY, CALHOUN, FRANKLIN, GADSDEN, GULF, HOLMES, JACKSON, JEFFERSON, LEON, LIBERTY, MADISON, TAYLOR, WAKULLA, WASHINGTON COUNTIES

Apalachicola Bluffs & Ravines Preserve Liberty County

SEPTEMBER 2020 BIG BEND HEALTH COUNCIL 403 E 11TH STREET PANAMA CITY, FL 32401 (850) 872-4128 HTTP://HEALTHCOUNCILS.NET/

Prepared by Big Bend Health Council 403 E 11th Street Panama City, FL 32401 (850) 872-4128 http://healthcouncils.net/ September 10, 2020

We hope that this summary of the Community Health Assessments conducted by Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, Washington Counties will be helpful in developing Community Health Improvement Plans throughout Big Bend Florida

Questions? Errors or Omissions? Please Contact Barbara Feeney [email protected] 561-891-6395

Page 2 of 97

TABLE OF CONTENTS

I. INTRODUCTION/ 5

II. OVERVIEW OF THE COMMUNITY HEALTH ASSESSMENT & PLANNING PROCESS/ 6

III. METHODOLOGY/ 11

IV. COMMUNITY HEALTH ASSESSMENT PARTNERS/ 12

V. PRIORITY HEALTH ISSUES IN FLORIDA AND THE BIG BEND/ 29

VI. ADDITIONAL DATA RESOURCES/ 44

DEMOGRAPHIC & SOCIOECONOMIC FACTORS/ 43 Total Population/ 44 Population by Age Range/ 46 Population by Gender/ 48 Population by Race/ 49 Population by Hispanic Ethnicity/ 50 Socioeconomic Indicators/ 51

HEALTH STATUS & HEALTH CARE FACTORS/ 52 Health-Related Quality of Life/ 52 Maternal and Infant Well-Being/ 53 Body Weight, Overweight, and Obesity/ 55 Leading Causes of Death/ 56 Appropriate and Timely Access to Quality Healthcare/ 59 Unnecessary Hospitalizations/ 59 Health Professional Shortage Areas/ 61 Healthcare Access and Coverage of Adults/ 68 Non-Elderly Uninsured/ 70

COMMUNITY AND ENVIRONMENTAL FACTORS & PERSONAL CHOICES AND BEHAVIORS / 72 Influenza Vaccination/ 73 Pneumonia Vaccination/ 75 Prevention of Unintentional Injuries/ 77 Pre-Diabetes and Diabetes/ 78 Fruit and Vegetable Consumption/ 79 Physical Activity/ 80 Tobacco Use and Exposure/ 82 Alcohol and Other Drug Abuse/ 85

(continued)

Page 3 of 97

(continued)

Data from the Florida Department of Health Opioid Dashboard/ 86 Overdose Deaths/ 87 Suspected Non-Fatal Overdoses/ 88 Annual Drug Arrests /Page 88 Case Definitions/ Page 89 Violent Crimes/ 91 Reported Domestic Violence Offenses/ 90 Aggravated Assault/ 90 Forcible Sex Offenses/ 91 Homicide and Murder/ 93 Suicide/ 94

VII. SUMMARY/ 95

Carrabelle, Franklin County

Page 4 of 97

I. INTRODUCTION

The Florida Department of Health (FDOH) requires local health Community Health departments to complete periodic community health assessments Assessments (CHAs) are (CHAs) in their respective counties. In order to do so, each county sometimes referred to as “Community Health Needs health department elicits support and input from a broad range of Assessments” or “CHNAs”. public and private community sectors including government, business, For consistency, this report health, education, social services. This report is a summary of the will generally use the terms “Community Health findings of the most recent community health assessments for Bay, Assessment” or “CHA”. Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington counties (“Big Bend”).

Between 2016 and 2019 numerous CHAs were conducted by the fourteen local health departments in Florida’s Big Bend.

Download original reports at http://www.floridahealth.gov/provider-and-partner- resources/community-partnerships/floridamapp/state-and-community-reports/index.html

While the FDOH commissioned their individual county health departments to conduct assessments to guide state and local health planning, a broad range of public and private organizations also participated in the assessment process. See section “II. Overview of the Assessment and Planning Process - Why complete a Community Health Assessment and Improvement Plan?” for more information regarding the purposes for which a CHA is useful, and section “IV. Community Health Assessment Partners” for an extensive list of CHA participants.

While each county and therefore each community health assessment is unique, they all shared common purposes and methods. The shared purpose was to identify the healthcare needs and priorities of the residents of each area. Shared methods included variations of a process referred to as “Mobilizing for Action through Planning and Partnerships” (MAPP). A more detailed description of MAPP is included in section “III. Methodology”. Additional information about community health planning and links to online resources are available in the next section of this report.

Page 5 of 97

II. OVERVIEW OF THE COMMUNITY HEALTH ASSESSMENT & PLANNING PROCESS What Is a Community Health Assessment?

The three following descriptions of Community Health Assessments express the purpose, scope, methodology inherent in virtually all Community Health Assessments.

1. A community health assessment (sometimes called a CHA), also known as community health assessment, refers to a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis. All community health assessments reflect a commitment to achieve all or most of the following standards:

• Multisector collaborations that support shared ownership of all phases of community health improvement, including assessment, planning, investment, implementation, and evaluation

• Proactive, broad, and diverse community engagement to improve results

• A definition of community that encompasses both a significant enough area to allow for population-wide interventions and measurable results, and includes a targeted focus to address disparities among subpopulations

• Maximum transparency to improve community engagement and accountability

• Use of evidence-based interventions and encouragement of innovative practices with thorough evaluation

• Evaluation to inform a continuous improvement process

• Use of the highest quality data pooled from, and shared among, diverse public and private sources Source: Principles to Consider for the Implementation of a Community Health Needs Assessment Process Cdc-pdf[PDF – 457KB]External (June 2013), Sara Rosenbaum, JD, The George Washington University School of Public Health and Health Services, Department of Health Policy.

2. The Public Health Accreditation board defines community health assessment as a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. The ultimate goal of a community health assessment is to develop strategies to address the community’s health needs and identified issues. A variety of tools and processes may be used to

Page 6 of 97

conduct a community health assessment; the essential ingredients are community engagement and collaborative participation. Source: Turnock B. Public Health: What It Is and How It Works. Jones and Bartlett, 2009, as adapted in Public Health Accreditation Board Acronyms and Glossary of Terms Version 1.0 Cdc- pdf[PDF – 536KB]External, July 2011.

3. The Catholic Health Association defines a community health needs assessment as a systematic process involving the community to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon unmet community health needs.” Source: (Catholic Health Association, Guide to Assessing and Addressing Community Health Needs Cdc-pdf[PDF-1.5MB]External, June 2013.)

What is a Community Health Improvement Plan?

A community health improvement plan (or CHIP) is a long-term, systematic effort to address public health problems based on the results of community health assessment activities and the community health improvement process. A plan is typically updated every three to five years. The Public Health Accreditation Board defines a community health improvement plan as a long- term, systematic effort to address public health problems on the basis of the results of community health assessment activities and the community health improvement process. This plan is used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities and coordinate and target resources. A community health improvement plan is critical for developing policies and defining actions to target efforts that promote health. It should define the vision for the health of the community through a collaborative process and should address the gamut of strengths, weaknesses, challenges, and opportunities that exist in the community to improve the health status of that community. One of the first steps in developing a CHIP is conducting a Community Health Assessment. Source: CDC (Public Health Professionals Gateway, Community Health https://www.cdc.gov/publichealthgateway/cha/index.html )

Page 7 of 97

Why complete a Community Health Assessment and Improvement Plan?

A community health assessment gives organizations comprehensive information about the community’s current health status, needs, and issues. This information can help develop a community health improvement plan by justifying how and where resources should be allocated to best meet community needs. Benefits include the following:

• Improved organizational and community coordination and collaboration

• Increased knowledge about public health and the interconnectedness of activities

• Strengthened partnerships within state and local public health systems

• Identified strengths and weaknesses to address in quality improvement efforts

• Baselines on performance to use in preparing for accreditation

• Benchmarks for public health practice improvements

Drivers of Health Assessment and Improvement Planning Numerous drivers have led health agencies and organizations to institutionalize community health assessment and community health improvement planning in recent years. Among those drivers, described below, are national voluntary accreditation requirements, CDC grant requirements, state specific mandates or requirements, and IRS Requirements for Tax-Exempt Healthcare Facilities. National Voluntary Accreditation Requirements In 2011, the Public Health Accreditation Board (PHAB), in partnership with key public health organizations, launched a new national voluntary accreditation program for state, tribal, local, and territorial health departments.

The standards and measures encompass 12 domains of performance and include a comprehensive community health assessment (Domain 1, Standard 1.1) and a community health improvement plan (Domain 5, Standard 5.2).

A documented community health assessment and improvement plan are two of the three prerequisites for applying to PHAB. PHAB requires that these processes be conducted collaboratively and that the documents be dated within the last five years. More information is available from PHABExternal and CDC.

Page 8 of 97

CDC Grant Requirements CDC grants often require or encourage completing a community health assessment or improvement plan. In some cases, these plans provide valuable information for identifying priority health issues or needs. Click on the following links for examples:

• National Public Health Improvement Initiative (NPHII)

• Community Transformation Grants

• REACH Core

State-Specific Requirements or Mandates A number of states, including Florida, require and support their local health departments in conducting community health assessments and/or improvement plan.

IRS Requirements for Tax-Exempt Healthcare Facilities The Patient Protection and Affordable Care Act of 2010 (ACA) revised the federal tax- exempt status requirements for nonprofit hospitals. To claim tax-exempt status, community benefit work must be transparent, concrete, measurable, and both responsive and accountable to identified community need. Therefore, at least once every three years, hospitals must conduct a community health assessment and adopt an implementation strategy—often called community benefit, Schedule H, or Form 990, which refer to the required tax forms.

An implementation strategy for a hospital facility is a written plan that addresses each of the significant community health needs identified through a community health needs assessment. A hospital organization must adopt a separate implementation strategy for each hospital facility it operates.

Collaboration between facilities on community health needs assessment and implementation strategy development is encouraged, and implementation strategies submitted by separate facilities may be substantively similar.

The community health needs assessment and the implementation strategy must take into account input from the following:

Page 9 of 97

• At least one state, local, tribal, or regional governmental public health department.

• Members of medically underserved, low-income, and minority populations in the community.

• Written comments received on the facility’s most recent community health needs assessment and implementation strategy.

See the Federal RegisterExternal, the Federal Register, Volume 78, No. 66 Cdc-pdf[PDF – 320KB]External or this IRS websiteExternal for more information concerning specific requirements.

Source: The CDC Office of Associate Director for Policy’s Resources for Implementing the Community Health Needs Assessment Process lists resources related to community benefit requirements and partnership opportunities.

Museum of Florida History, Tallahassee

Page 10 of 97

III. METHODOLOGY OF COMMUNITY HEALTH ASSESSMENTS

Each community health assessment reviewed for this report examined the health of community residents and attempted to ascertain the following: • What are the major causes of illness, injury, and death in the community? • What health issues and behaviors are most concerning to local citizens and community leaders? • What barriers and resources exist for residents to achieve better health?

The methodologies of all the community health assessments were variations of a process referred to as “Mobilizing for Action through Planning and Partnerships” (MAPP). Developed and promulgated by the National Association of County and City Health Officials (NACCHO), MAPP is a community-driven strategic planning process for improving community health. An important aspect of this approach is helping local health departments strategically align their community health assessment efforts with other assessment initiatives. See Section IV. Community Health Assessment Partners for an extensive list of community partners from each of Big Bend’s fourteen counties.

Facilitated by public health leaders, the MAPP framework helps communities apply strategic thinking to prioritize public health issues and to identify resources to address them. Rather than being an agency- focused assessment process, MAPP is an interactive process that can improve the efficiency, effectiveness, and ultimately the performance of local public health systems.

This report summarizes some of the key findings across the reports of fourteen counties and some of the data relevant to those findings.

For more information about Mobilizing for Action through Planning and Partnerships (MAPP) go to https://www.naccho.org/programs/public-health-infrastructure/performance- improvement/community-health-assessment/mapp.

As shown in the next section, representatives of a wide range of community partners and stakeholders participated in the Community Health Assessment process in each county of the Big Bend.

Page 11 of 97

IV. COMMUNITY HEALTH ASSESSMENT PARTNERS

BAY COUNTY

Bay County Community Health Task Force Steve Sumner, Chair Rebecca Curti, Operations Management Consultant Florida Department of Health in Bay County Kay Mulligan-Judah, Sr. Public Health Nutrition Douglas Kent, Administrator Supervisor Victor Walsh, Chief Financial Officer Claire Henninger, WIC Director Julie Tindall, Healthy Bay Director Don Rich, Emergency Preparedness Marsha Sumner, Senior Community Health Lisa Rahn, Healthiest Weight Coordinator Nurse Tyndall Health Promotion Heather Kretzer, Public Information Office April Wisdom, PhD, MPH, CHES Natasha Coleman, Senior Health Educator Life Management Center Brandy Hughes, Quality Assurance Tricia Pearce, Community Relations Specialist Administrator Bekah Taylor, Chief Human Resources Officer Tammy Stewart, Freedom 180 Program Julie Kitzerow, Chief Operating Officer for Manager Children’s Services Peggy Caldwell, Tobacco Free Partnership of Ned Ailes, President and CEO Bay County Program Manager Bay Medical Sacred Heart Jo Collville, Diabetes Services Program Tammy Newton, Vice President, Strategic Consultant Planning/Marketing Sandy McCroan, Breastfeeding Coordinator, Debbie Ward, Marketing Director IBCLC Julie Traugott Tanya Sharp Sacred Heart Health Systems Ralph Miller, Environmental Health Director Becky Washler, Sr. Planner Nancy Tipps, Clinic Director Carter Ross

Acknowledgements

90 Works, Shelley Berry Bay District Schools, Joe Wayne Walker AARP, Barbara Day Basic of Northwest Florida ADA, Pam Dorwarth Bay County Breastfeeding Connection Anchorage Children’s Home Jessica Greene Brooke Bullard Camille Smith Joel Booth Big Bend AHEC, James Lewis and Preston Matthews Ascendant Healthcare Partners, JoAnn Vanfletese Big Bend Community Based Care, Ann Wing Page 12 of 97

Big Bend Health Council, Mike Hill Shari Guiliford Kik Career Source Gulf Coast, Bryan Russell Nations Best Healthcare Catholic Charities, Betsie Kummer James Thompson (JT) Covenant Cares, Alisha Townsend News Herald Department of Children and Families Katie Landeck Mylisa Lee PanCare, Inc., Mike Hill Department of Environmental Protection Medical Reserve Corps, Andrew Miller Early Education and Care, Inc. Renew with Beverly, Beverly Brown Grace Aiyegbokiki St. Andrew Bay Center Emerald Coast Behavioral Hospital, Craig Segrest St. Andrews Community Medical Center Florida Blue, Carol Benson Curtis Williams Glenwood Working Partnership, Bill Swift Carol Summey Goodwill St. Andrews Towers, Shari Kik Gulf Coast Children’s Advocacy Center Second Chance of Northwest Florida Christi Bazemore Student Advocacy Center of Bay County Gulf Coast Medical Center Gregory Dossie Gulf Coast State College Titus 2 Partnership, Cathy Byrd Carol Miller Twelve Oaks Recovery, Joanne Devine Randy Chitwood Veterans Affairs, Matthew Standish Healthy Start, Sharon Owens Victory Temple Journey Pure Amanda Alexander Beverly Lewis Erica Lester Benjamin Nelson Youth Enrichment Services, Tim Lewis LEAD Coalition WestRock Paper Mill Janie Lucas Raphael Graham Sonya Lowery Suzanne Clark National Church Residences Catherine McClellan

Page 13 of 97

CALHOUN AND LIBERTY COUNTIES

April Landrum, Apalachee Center Virginia Baker, PHD FHEE WICL Inc. James Lewis, Big Bend AHEC Heather Ellerbee, Florida DOH – Calhoun Dr. Rob Thomas, Big Bend AHEC Susan Chafin, Florida DOH – Calhoun & Liberty Alexandria Washington, Big Bend AHEC Counties Emily Kohler, Big Bend AHEC Kelly King, Florida DOH – Calhoun & Liberty Kristy Terry, Calhoun County Chamber Counties Carla Hand, Calhoun County Clerk of Court Rachel Bryant, Florida DOH – Calhoun & Liberty Whitney Cherry, Calhoun County Extension 4H Counties Judy Ludlow, Calhoun County Extension Director Melissa L’Heureux, Florida DOH – Liberty Rita Maupin, Calhoun County Public Library Amy Johnson, Florida DOH – Liberty Bryanne White, Calhoun County Public Library Cathy Brown, Liberty County Clerk of Court Vickie Davis, Calhoun County School Board Cathia Schmarge, Liberty County Extension 4H Glen Kimbrel, Calhoun County Sheriff Department Monica Brinkley, Liberty County Extension Director Kim Tanner, Calhoun County Sheriff Department Johnette Wahlquist, Liberty County Schools Shelly King, Calhoun/Liberty County Extension Bryan Langston, Liberty County Sheriff’s Office Department Clara Leonard, Calhoun/Liberty Extension Food and Donnie Read, Liberty Just Nutrition Program Rhonda Hall, Life Management Center Nathan Ebersole, Calhoun-Liberty Hospital Chesnee McCaskill, North Florida Child David Taylor, Chemical Addiction Recovery Effort (CARE) Development Carolyn Harper, Department of Corrections Curtis Green, North Florida Child Development, Inc. Dr. Moses Izuegbu, Department of Corrections Mary McKenzie, Oglesby Plant Nursery Sally S. Mayo, Sr., RN Supervisor Department of Dan Yoder, Retired/Rivertown Community Church Corrections Logan Kever, Rex Lumber Diann Smith, Senior Health Svc, Admin. Renee Crawford, Ruth Attaway CPA Department of Corrections Nicole Gonzalez, Twin Oaks Juvenile Development Inc.

Page 14 of 97

FRANKLIN COUNTY

Lead Project Staff April Landrum, Apalachee Center Sarah Hinds DOH-Franklin County Administrator Jennifer Travieso, DISC Village DT Simmons DOH-Franklin Operations Manager Hunter Bailey, Big Bend AHEC Sean Golder, Performance Management and Emily Kohler, Big Bend AHEC Quality Improvement Coordinator Myrtis Wynn, Community Representative Burt Boyd, Franklin County Board of County CHIP Steering Committee Commissioners Chelsea Marshall-Hirvela, UF/IFAS Talitha Robinson, DOH-Franklin/Gulf Closing the Gap Clara Leonard, UF/IFAS Alma Pugh, DOH-Franklin/Gulf Closing the Gap John Griggs, My Gulf Care Marquita Thompkins, DOH-Franklin Tobacco Lori LaCivita, My Gulf Care Prevention Program Sean Golder, PanCare Nicole Sandoval, DOH-Franklin Preparedness Planner Mary Harrell, Sacred Heart Clinic Karey Lehnert, DOH-Franklin Environmental Health David Walker, Weems CEO Charles Addison, DOH-Franklin Environmental Health Suzie Buskirk, Weems Memorial Hospital Clinic Kyle Merritt, DOH-Franklin CHOICES Program Suzy Nadler, Healthy Start Coalition Megan Bennefield, DOH-Franklin CHOICES Program Patricia Richards, DOH-Franklin Healthy Start Jessie Pippin, DOH-Franklin/Gulf Heart Health Plus Erica Head, Holy Family Senior Center Program Ivy Nixon, Elder Care Services Vanessa Edenfield, Franklin County School Health Phil Carter, Connect Program Coordinator April Rester, Franklin County WIC Program Sarah Hinds, DOH-Franklin Administrator Stephanie Cash, Healthy Families Program DT Simmons, DOH-Franklin County CHIP Ivy Nixon, Elder Care Services Coordinator

Page 15 of 97

GADSDEN COUNTY

Data Collection Team Charles Mann Cynthia Seaborn, DrPH, MPA, Emanuel Joseph Manning, Jr. Consultation & Evaluation Vanessa Shaw Sandra Suther, Ph.D, Yellow Rose Consulting Bostick Temple Christian Center Tyra Dark, Ph.D, CEP Consulting Dogwood Manor Arrie Battle, CEO, Mother Care Network, Inc. New Direction Christian Center New Jerusalem Missionary Baptist Church Community Members Oak Ridge Church Lindsey Harris Rich Bay AME Church Beverly Mann

Special Acknowledgement Thank you to the Gadsden County Health Council for your review and contribution to development of the survey instrument.

Page 16 of 97

GULF COUNTY

Lead Project Staff Melanie Taylor, UF/IFAS Marsha Lindeman, ARNP, MSN, Florida MaryJim Montgomery, Sacred Heart Hospital on Department of Health in Gulf County (DOH- the Gulf Gulf) Administrator Pam Jones, Gulf Coast State College Sarah Hinds, MPH, DOH-Gulf Operations Manager Suzy Nadler, Bay, Franklin, Gulf Healthy Start and Management Consultant, Project Lead Coalition Facilitator and CHIP Plan Creator Amory Harris, Sacred Heart My Gulf Care Deanna Simmons, DOH-Gulf Government Jordan Miles, LCSW, Gulf County Schools Operations Consultant, Project Assistant and Shelby Richards, DOH-Gulf Healthy Start/Healthy Facilitator Families Amy Barnes, Gulf County School Coordinator CHIP Steering Committee Jason Flowers, North Florida Child Development Jessie Pippin, DOH-Gulf CHOICES Program Stephanie Cash, DOH-Gulf Coordinator Talitha Robinson, DOH-Gulf/Franklin Closing the Gap Ann Wing, Big Bend Community Based Care Deborah Mobley, Life Management Center Kari Williams, DOH-Gulf Tobacco Prevention Robert Thompson, PanCare of Florida, Inc. Program Mike Hill, PanCare of Florida, Inc. Meg Norwood, Sacred Heart Health System James Lewis, Big Bend Area Health Education Center David Walker, DOH-Franklin Operations Manager Samantha Jones, Department of Juvenile Justice and Management Consultant Valerie Murphy, Community Care Center – Gulf Shelton Ceasar, DOH-Gulf CHOICES Program Sandy McCroan, DOH-Bay/Gulf WIC Educator

Implementation Members Mental Health/Substance Abuse Subcommittee

Jake Richards, Port St. Joe Police Department Suzy Nadler Bay, Franklin, Gulf Healthy Start Anthony Croom Jr., Bureau of Alcohol, Tobacco Coalition and Firearms Valerie Murphy, Community Care Center Gulf Steven Brightwell, Mark4Ministries County DT Simmons, DOH-Gulf/Franklin Ann Wing, Big Bend Community Based Care (CBC) Matt Herring, Port St. Joe Policy Department Lisa Andencamp, Big Bend CBC/ME James Wiley, Oak Grove Church Page 17 of 97

Jordan Miles, Gulf County Schools James Lewis, Big Bend Area Health Education Sarah Hinds, DOH-Gulf Center Amy Driggers, DOH-Gulf School Health Samantha Jones, Department of Juvenile Justice Stephanie Cash, DOH-Gulf/Franklin, Healthy Jessie Pippin, DOH-Gulf/Franklin Choices Program Start/Healthy Families Pam Jones, Gulf Coast State College Kari Williams, DOH-Gulf Tobacco Prevention Martha Weimorts, Gulf County Schools Program Deborah Mobley, Life Management Center Access to Care Subcommittee

Mary Jim Montgomery, Sacred Heart on the Gulf Mike Hill, PanCare of Florida, Inc. James Lewis, Big Bend Area Health Education Robert Thompson, PanCare of Florida, Inc. Center Suzy Nadler, Bay, Franklin, Gulf Healthy Start Coalition Meg Norwood, Sacred Heart Katrina Saunders, Wewa Medical Center Holly Rish, NHC Home Health Care

Healthy Weight Subcommittee

Alma Pugh, FDOH Gulf/Franklin Closing the Gap Jordan Linton, Gulf County District Schools Amory Harris, Sacred Heart My Gulf Care Sarah Hinds, DOH-Gulf Amy Driggers, DOH-Gulf School Health Amy Driggers, DOH-Gulf School Health Amy Lee, DOH-Gulf/Franklin Health Educator Stephanie Cash, DOH-Gulf/Franklin; Healthy Antoinette Batson, Healthy Start Start/Healthy Families April Wisdom, Tyndall AFB Health Promotion Kari Williams, DOH-Gulf Tobacco Prevention Program Department Deborah Mobley, Life Management Center Betsy Wood, Outreach & workforce Pub Health FSU James Lewis, Big Bend Area Health Education Center Brittney Beauchamp, DOH Nurse- Lactation Consultant Samantha Jones, Dept of Juvenile Justice DT Simmons, Chip/Cha Healthy Babies Pam Jones, Gulf Coast State College Jason Flowers, North Florida Child Development Martha Weimorts, Gulf County Schools Center

Page 18 of 97

HOLMES COUNTY

The Health Planning Council of Northeast Florida Chipola Healthy Start (HPCNEF) Northwest Florida Cancer Collaborative Florida Department of Health in Holmes (DOH- University of Florida's Institute of Food and Holmes) Agricultural Sciences – Holmes County Holmes County Sheriff’s Department Extension Gulf Coast Sexual Assault Program Florida Department of Health Holmes Healthy Start Early Learning Coalition of Northwest Florida Harrison-Hathaway Publishing I-10 Beyond the Exits Holmes County Library PanCare Florida Department of Health- Holmes Magellan Complete Care Doctors Memorial Hospital Florida Department of Juvenile Justice Tri-County Community Council Headstart

Page 19 of 97

JACKSON COUNTY

Jackson Hospital Covenant Care PanCare Chipola Healthy Start Big Bend AHEC ELC of Northeast Florida JTrans (Jackson County Transportation, Inc. of FL) North Florida Inland Long Term Recovery Project Hope Life Management Center Big Bend Behavioral Big Bend Community-Based Healthcare Marianna District AME Churches CARE FEMA UF/IFAS Jackson County Extension Service Life Management Center Children’s Medical Services 90 Works/Veterans Assistance Jackson County Housing Department Panhandle Area Health Network Gulf Coast Sexual Assault Jackson County Community Development

Page 20 of 97

JEFFERSON COUNTY

Department of Health in Jefferson County Healthy Start Coalition of Jefferson, Madison & Kimberly Allbritton, Administrator Taylor Counties, Inc. Pam Beck, Operations Manager, document author Jefferson Chamber of Commerce Chelsey McCoy, CHA/CHIP Liaison Jefferson County Board of County Commissioners Participating Agencies Jefferson County Emergency Management Services Apalachee Center, Inc. Jefferson County School District Big Bend Area Health Education Coalition North Florida Community College Big Bend Community Based Care Saint Leo University Department of Children and Families Senior Citizens Council of Jefferson County, Inc. Department of Health in Jefferson County Sickle Cell Foundation DISC Village, Inc. Tri-County Electric Co-Op, Inc. Florida State University United Methodist Cooperative Ministry

Page 21 of 97

LEON COUNTY

Dr. Janet Bard-Hanson 2-1-1 Big Bend, Inc. Kathy Winn League of Women Voters Dr. Jay Reeve Apalachee Center, Inc. Felisa Barnes Leon County Office of Human Dr. Temple Robinson Bond Community Health Services & Community Partnerships Center Rayshell Holmes Tallahassee Housing Authority Susan Taylor Capital Area Breastfeeding Coalition Warren Jones Tallahassee Memorial HealthCare Tequila Hagan Capital Health Plan Melissa Dancer-Brown Tallahassee Memorial Pam Wilson Capital Medical Society HealthCare Mary Waller Capital Regional Medical Center Lauren Faison Tallahassee Memorial HealthCare Betsy Wood Community Member Ruth Nickens Tallahassee Parks & Recreation – Meade Grigg Community Member Senior Center Miaisha Mitchell Community Member Major Lonnie Scott Tallahassee Police Department Dr. Edward Holifield Community Member Ellen Piekalkiewicz United Partners for Human Services Dr. Sandra Suther Florida A & M University Katrina Rolle United Way of the Big Bend Claudia Blackburn Florida Department of Health in Rebecca Weaver United Way of the Big Bend Leon County R. Jai Gillum United Way of the Big Bend (former Dr. Les Beitsch Florida State University employee) Karen Geletko Florida State University Courtney Atkins Whole Child Leon

Page 22 of 97

LIBERTY COUNTY

Florida State University College of Social Sciences Calhoun-Liberty Hospital and Public Policy, Demography Department University of Florida Institute of Food and and Public Health Program, Angela Peralta, Agricultural Sciences Extension Office MPH second year student PanCare of Florida Vanessa Crowther, MPH, Department of Health Big Bend Health Council Division of Public Health Statistics and Calhoun County Senior Citizens Performance Management Liberty County Transit Florida Department of Health in Liberty and Apalachee Regional Planning Council Calhoun Counties (led by Rachel Bryant and Gulf Coast Sexual Assault Program Susan Chafin) CARE Chipola Healthy Start Liberty County Library Liberty County Emergency Management Twin Oaks Juvenile Development Center Big Bend Area Health Education Center,

Page 23 of 97

MADISON COUNTY

Madison County Memorial Hospital Saint Leo University Tammy Stevens, CEO North Florida Community College Department of Health in Madison County Madison County Government Kimberly Allbritton, Administrator Madison County School District Pam Beck, Operations Manager Tri-County Electric Chelsey McCoy, CHA Liaison Disc Village North Florida Community College Healthy Start Coalition of the Big Bend Denise Bell, Coordinator of Student Activities Lake Park of Madison and Student Center, Equity Coordinator Department of Children and Families Scott Hubert, Technical Director of Theater & Big Bend Area Health Education Coalition Macintosh Support, Information Technology Apalachee Center, Inc. Madison County Memorial Hospital City of Madison Department of Health in Madison County Senior Citizens Council of Madison Florida State University Sickle Cell Foundation Big Bend Community Based Care UM Cooperative Ministry Madison Chamber of Commerce Madison County Emergency Management Services

Madison County Courthouse

Page 24 of 97

TAYLOR COUNTY

Taylor County Health Council Chris Olson, Taylor County Schools Florida Department of Health in Taylor County Anthony Jones, Big Bend AHEC Eddie Cullaro, Big Bend AHEC Donna Hagan, Healthy Start Kristy Anderson, Taylor County Emergency Padraic Juarez, Florida Department of Health Management Wynton Geary, Big Bend AHEC Martine Young, Florida Department of Health Melissa Buelesa, Big Bend AHEC Tonya Bell, Healthy Start Tarre Stanley, Big Bend AHEC Ben Fairbrother, Florida Department of Health Kristie Lutz, Florida Department of Health

Steinhatchee Falls, Taylor County

Page 25 of 97

WAKULLA COUNTY

Sabrina Williams, Wakulla Refuge House Tonya Hobby FDOH-Wakulla, Assistant Emily Kohler, Big Bend AHEC Administrator Big Bend Rural Health Network Samantha Kennedy University of Florida, Institute Lori Lawhon, FDOH-Wakulla, School Health for Food and Agricultural Sciences Donna Clark, FDOH-Wakulla, SRA Grace Keith FDOH-Wakulla, Health Educator Clyde Preston, Grace Embraced Ministry Charlean Lanier, National Alliance on Mental Tanya English, Wakulla County School Board Health Marva Preston, Grace Embraced Ministry Judy Harris, St. Marks Powder Stacey Harvey, Wakulla County Pat Walker Wakulla Medical Center (Federally Sheriff Department Qualified Clinic) Dr. Alan Rowan, Florida State University, College of Public Health

St. Marks Lighthouse, Wakulla County

Page 26 of 97

WASHINGTON COUNTY

The Florida Department of Health in Washington Allison Blevins, FDOH- Preparedness County Susan Roberts, Washington County School Board Member CHA Planning Committee Melissa Medley, FDOH- Heart Health Plus Donna Carnley, Early Learning Coalition of NW Arely Sapp, FDOH- Green Dot Florida Suzan Gage, Early Learning Coalition of NW Florida Forces of Change Committee Traci Corbin, Florida Department of Health (FDOH) Traci Corbin, Chair, FDOH- Accreditation/Quality Susie Sewell, FDOH Improvement Coordinator Karen Johnson, FDOH Cecilia Spears, Co-Chair, Early Learning Coalition of NW Florida Community Survey Committee Valery Lawton, FDOH- Healthy Start Coordinator Susie Sewell, Chair, FDOH- Nursing Director Catherine Wynne, Big Bend Community Based Care Suzan Gage, Co-Chair, Early Learning Coalition of Board Member NW Florida Donna Carnley, Early Learning Coalition of NW Judy Corbus, UF/IFAS Extension Washington Florida County Rachael Conrad, CARE Amy Riley, Chipola Healthy Start Amanda Brannon, Washington County Sheriff’s Local Public Health System Committee Office Karen Johnson, Chair, FDOH- Health Officer Cecilia Spears, Early Learning Coalition of NW Kristin Martin, Co-Chair, Washington County Florida Sheriff’s Office Lindsay Holmes, Early Learning Coalition of NW Brenda Blitch, FDOH-Preparedness Florida Russ Thomas, FDOH- Environmental Health Sean Golder, PanCare of Florida Community Focus Group Committee Cecilia Spears, Early Learning Coalition of NW Sharron Hobbs, Chair, FDOH- Tobacco Prevention Florida Milton Brown, Co-Chair, FDOH- Green Dot Stephanie Green, FDOH- School Health Additional Key Partners Renae Rountree, Director Washington County Salem Avery, Northwest Florida Community Library Hospital (NFCH) Rachael Conrad, Chemical Addiction Recovery Connie Swearingen, NFCH Effort (CARE) Eileen Swindle, NFCH Page 27 of 97

Stephanie Gustuson, NFCH Missie Finch, NHC Homecare Janet Kinney, CFO, NFCH Kevin Crews, Washington County Sheriff Michael Kozar, CEO, NFCH Landrea Garrett, Kindred at Home Melissa Collins, Gulf Coast Sexual Assault Candice Hudson, FDOH Kathy Green, FDOH Rick Kerr, Washington County Fire/Rescue Amanda Baker, FDOH Heather Lopez, Washington County Tourist Shelia Paul, FDOH Development Council Sunshine Speers, Emerald Coast Hospice George Parsons, PanCare Joe Taylor, Washington County Superintendent of Joel Paul, Tri County Community Council Schools Troy Peoples, Washington County School District Anita Clarke, Washington County Council on Aging Stephanie Sweeting, Washington County Jail James Lewis, FDOH Natalie Parker, Rivertown Community Church Martha Compton, Florida Panhandle Technical Philip Horvath, Rivertown Community Church College Hannah Gainey, Gulf Coast State College Student Lynne Abel, Washington County Emergency Jeanna Olson, Department of Children & Families Management Kayleigh Cosson, CARE Deborah Anderson, Community Home Health Joshua Skipper, Washington County Sheriff’s Office Lisa Autdencamp, Big Bend Community Based Care Angela Klopf, United Way of NW Florida Nicole Barefield, Washington County News

Seacrest Wolf Preserve, Chipley, Washington County

Page 28 of 97

V. PRIORITY HEALTH ISSUES IN FLORIDA AND THE BIG BEND

Factors that Generally Influence Community Health and Wellbeing In general, as shown in the following Venn Diagram and table, the most important factors and issues which influence the health of any community are complex and inextricably interdependent. The priorities identified as health priorities in the counties of Big Bend are likewise inextricably interdependent. Although the data in this report may be most closely associated with one group of factors or another, they usually reflect multiple factors that shape overall community health and wellbeing.

Factors that Generally Influence Community Health and Wellbeing

Demographic & Socio- Economic Factors

Community Health & Personal Health Choices & Wellbeing Status & Behavior Health Care

Community & Environmental Factors

Page 29 of 97

Florida’s 2017–2021 State Health Improvement Plan

Each of the fourteen counties designed and implemented their assessments and plans to be compatible and coordinated with the State Health Implement Plan which is described below: “Under the leadership of the State Surgeon General, the Department of Health tasked a diverse group of partners with creating a blueprint for action, culminating in Florida’s State Health Improvement Plan (SHIP). The five-year SHIP sets out goals for Florida’s public health system which includes a range of stakeholders, such as state and local government agencies, healthcare providers, employers, community groups, universities and schools, non-profit organizations and advocacy groups. The Department used a collaborative planning process to foster shared ownership and responsibility for the plan’s implementation, with the goal of efficient and targeted collective action to improve the health of Floridians.” Florida State Health Improvement Plan (SHIP) 2017-2021 Executive Summary December 2017 Revised June 2019 http://www.floridahealth.gov/about/state-and-community-health-assessment/ship- process/SHIP-exec-summary.7.pdf#:~:text=The%20five- year%20SHIP%20sets%20out%20goals%20for%20Florida%E2%80%99s,as%20state%20a nd%20local%20government%20agencies%2C%20health%20care

Florida’s SHIP articulated and defined the nine health priorities summarized in the table on the following page. These priorities helped to guide the Community Health Assessments in each of the counties as described in the counties’ priorities as described in this section.

After extensive discussions, data collection, and data analysis, each county’s assessment workgroup identified priority health issues in their respective areas. As you can see from the table starting after the following table, Big Bend’s priority issues can be best considered as interrelated factors that influence community health and wellbeing and are confluent with Florida’s State Health Improvement Plan.

Each priority (except for Priority 3 [Immunizations and Influenza] and Priority 9 [Alzheimer’s Disease and Related Dementias]) that was articulated in the State Health Improvement Plan was also described as a priority in one or more Community Needs Assessment in the counties of the Big Bend.

Page 30 of 97

Florida’s State Health Improvement Plan’s (SHIP) Priority Areas Priority 1 Health Equity Health equity is the attainment of the highest level of health for all people and requires focusing on avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. It provides the foundation for success in all the other health-issue priorities. Priority 2 Maternal & Child Health The well-being of women, infants, children and families determines the health of the next generation. Events over the life course influence maternal and child health risks and outcomes. Differences in health outcomes such as infant mortality, by race and ethnicity, can predict future public health challenges for families, communities and the health care system. Priority 3 Immunizations & Influenza Immunizations protect adults and children from serious disease. Being immunized reduces the risk of complications from certain diseases, especially among those with compromised immune systems, and reduces the chance of passing on a serious disease to others. Priority 4 Injury, Safety & Violence Unintentional injuries such as falls and motor vehicle crashes, and intentional injuries such as intimate partner violence are a major cause of death for people ages 1 to 44; however, most events are predictable and preventable. Priority 5 Healthy Weight, Nutrition & Physical Activity Overweight and obesity are increasingly common conditions in the United States and in Florida. The accumulation of excess fat is a serious medical condition that can cause complications such as metabolic syndrome, high blood pressure, atherosclerosis, heart disease, type 2 diabetes, high blood cholesterol, cancers and sleep disorders. Priority 6 Behavioral Health - Includes Mental Illness & Substance Abuse Mental and emotional well-being enables individuals to realize their own abilities, cope with the normal stresses of life, work productively and contribute to his or her community. Priority 7 Sexually Transmitted Disease STDs) - Includes Other Infectious Diseases Infectious organisms that are primarily acquired and transmitted through sexual activity cause many harmful, often irreversible and costly clinical complications in reproductive, fetal and perinatal health. Other emerging infectious agents pose the threat of disease outbreaks. Prevention, treatment and diagnostic strategies are essential. Priority 8 Chronic Diseases & Conditions - Includes Tobacco-Related Illnesses & Cancer Heart disease, stroke, type 2 diabetes, cancer and illnesses related to tobacco use are among the most common health problems affecting people of all ages, socioeconomic statuses and ethnicities. Risk factors —lack of physical activity, poor nutrition, tobacco use, excessive alcohol use, the environment, and social and economic factors—cause much of the illness, suffering and early death related to chronic diseases and conditions. Priority 9 Alzheimer's Disease & Related Dementias Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. It is the most common cause of dementia among adults 65 years and older. Previous studies have shown that African Americans are about twice as likely, and Hispanics are about one and half times as likely to develop Alzheimer’s disease or other dementias compared to older White Americans. Women are also at a higher risk of developing Alzheimer’s than men. Currently, two-thirds of Americans with Alzheimer’s disease are women. There is no known cure for Alzheimer’s disease; however, innovative research may provide hope for prevention and effective treatment for the disease.

Page 31 of 97

Florida’s SHIP Priorities and the Most Recently Identified Community Health Priorities in the Big Bend Florida’s Florida’s Florida’s Florida’s Florida’s Florida’s Florida’s Priority 1 Priority 2 Priority 4 Priority 5 Priority 6 Priority 7 Priority 8 Health Equity Maternal & Injury, Healthy Behavioral Sexually Chronic Child Health Safety & Weight, Health - Transmitted Diseases & Violence Nutrition & Includes Disease Conditions - Physical Mental Illness (STDs) - Includes Activity & Substance Includes Tobacco- Abuse Other Related Infectious Illnesses & Diseases Cancer Bay County physical treatment; heart activity, fruit & mental health disease; vegetable first aid melanoma; intake; obesity training; diabetes, recidivism at including ------Bay County --- diabetes Jail of those related with mental maternal and health/ infant substance outcomes abuse issues Calhoun County access to obesity; focus focus on healthcare; on youth, youth, primary care nutrition, awareness & ------physical education ------activity regarding issues & resources Franklin County access to substance care abuse, reduce ------alcohol and ------substance abuse mental health, increase ------awareness and services (continued)

Page 32 of 97

(continued) Florida’s SHIP Priorities and the Most Recently Identified Community Health Priorities in the Big Bend Florida’s Priority Florida’s Florida’s Florida’s Florida’s Florida’s Florida’s 1 Priority 2 Priority 4 Priority 5 Priority 6 Priority 7 Priority 8 Health Equity Maternal Injury, Healthy Behavioral Sexually Chronic & Child Safety & Weight, Health - Transmitted Diseases & Health Violence Nutrition & Includes Mental Disease (STDs) Conditions - Physical Illness & - Includes Includes Activity Substance Other Tobacco- Abuse Infectious Related Diseases Illnesses & Cancer Gadsden County (These key findings from the Executive Summary of the 2018-2022 Community Health Assessment will be used to establish and articulate Gadsden County’s community health priorities.) lack of adequate physical lack of mental transportation inactivity health providers ------unemployment overweight/ ------obesity ------children in shortage of poverty recreation ------facilities for youth lack of homeless shelter and transitional ------housing lack of awareness of ------services provider shortages (primary care, mental health, ------fully operational hospital)

Gulf County access to care, healthy awareness of primary care, weight, mental health certified diabetes ------youth and services, reduce ------programs adults alcohol among youth (continued)

Page 33 of 97

Holmes County domestic healthy behavioral chronic violence lifestyle/ health disease prevention including prevention (including substance (including ------obesity, poor abuse/ --- diabetes, nutrition/ mental high blood unhealthy health/ pressure, and eating, and domestic heart tobacco use) violence disease) ------tobacco use Jackson County healthcare chronic mental chronic access disease and health and disease and lifestyle substance lifestyle behaviors, abuse, behaviors, physical suicide, tobacco use, activity, services and cancer ------obesity, resources, in- --- screenings, nutrition and patient beds, the food licensed environment mental (fruits and health vegetables) professionals

(continued)

Page 34 of 97

Jefferson County shared reduce late healthy food social and diabetes understanding entry into options in at mental prevention & across all care, increase least 2 food health, education; sectors breastfeeding establishments consistent breast, regarding info initiation. presence of prostate, and and issues providers; colon cancer concerning linkage and screenings ------health equity, referral cultural system competency/ sensitivity, and social determinants of health. (continued)

Page 35 of 97

(continued) Florida’s SHIP Priorities and the Most Recently Identified Community Health Priorities in the Big Bend Florida’s Florida’s Florida’s Florida’s Florida’s Florida’s Florida’s Priority 1 Priority 2 Priority 4 Priority 5 Priority 6 Priority 7 Priority 8 Health Equity Maternal & Injury, Safety Healthy Behavioral Sexually Chronic Child Health & Violence Weight, Health - Transmitted Diseases & Nutrition & Includes Disease Conditions - Physical Mental (STDs) - Includes Activity Illness & Includes Tobacco- Substance Other Related Abuse Infectious Illnesses & Diseases Cancer Leon County availability of infant physical mental HIV/AIDS, safe and mortality rate activity health STDs sanitary (cross-sector outcomes (reduce new --- affordable community infections) housing walking) remove enrollment in nutrition barriers to early (reduce sustainable childhood consumption employment education of sugar- --- sweetened ------beverages in Title 1 schools) parental engagement and empowerment in early childhood education Liberty County education risky youth obesity, fruit (increase high behavior, and vegetable school specifically intake, high graduation teen school rates) pregnancy --- nutrition ------education; community fitness program (continued)

Page 36 of 97

Madison County shared reduce late healthy food social and diabetes understanding entry into options in at mental prevention & across all care, increase least 2 food health, education; sectors breastfeeding establishments consistent breast, regarding info initiation. presence of prostate, and and issues providers; colon cancer concerning linkage and screenings health equity, --- referral --- cultural system competency/ sensitivity, and social determinants of health

Taylor County

improve birth healthy infectious outcomes, lifestyles disease reduce teen --- (worksite --- (STDs) --- pregnancy wellness programs) (continued)

Page 37 of 97

Wakulla County living healthy – healthy living - health literacy & food insecurity promotion, an informed community about ------the impact of health on quality of life and life expectancy living health – building capacity for health promotion, an informed ------community on the economic and social impacts of wellness (continued)

Page 38 of 97

Washington County

obesity and substance obesity and chronic abuse (drug chronic diseases diseases abuse) mental health (availability and resources) Communicatio inform the implement the n (resources, public on National dissemination, physical Diabetes keeping public activity and Prevention informed nutritional Program (NDPP) resources in Washington available County within the county; increase the use of recreational trail, parks and kayak/canoe launches; implement programs/ projects aimed at reducing weight Sources: See the original reports for additional details regarding how these priority issues affect specific communities. http://www.floridahealth.gov/provider-and-partner-resources/community- partnerships/floridamapp/state-and-community-reports/index.html • Bay County, 2019-2020 Community Health Improvement Plan Annual Report, revised and reviewed February 2020.

Page 39 of 97

• Calhoun County, 2019-2021 Community Health Improvement Plan. • Franklin County, 2020-2023 Community Health Improvement Plan. • Gadsden County, 2018 Gadsden County 2018-2022 Community Health Assessment, Executive Summary, Key Findings. • Gulf County, 2018-2019 Community Health Improvement Plan Progress Report, March 2018-March 2019. • Holmes County, 2016 (revised 2020) Community Health Assessment. • Jackson County, 2019 Community Health Improvement Plan. • Jefferson County, 2019 Community Health Improvement Plan Annual Report. • Leon County, 2020 Community Health Improvement Plan 2017-2022, Annual Report, March 2020. • Liberty County, 2018 Community Health Improvement Plan. • Madison County, 2019 Community Health Improvement Plan Annual Report, March 2019. • Taylor County, 2019 Community Health Improvement Plan Annual Report March 2019. • Wakulla County, 2020 Community Health Improvement Plan (aka Community Wellness Improvement Plan) Update and Report of Progress, October 2018 – December 2019, January 2020. • Washington County, 2020 Community Health Improvement Plan Annual Report 2019.

Ponce de Leon Springs State Park, Holmes County

Page 40 of 97

Highlights of Health Priorities Identified by the Counties of the Big Bend

Priority 1: Health Equity Issues related to health equity were identified by eleven counties (Calhoun, Franklin, Gadsden, Gulf, Jackson, Jefferson, Leon, Liberty, Madison, Wakulla, Washington). Specific factors mentioned included access the healthcare; lack of homeless shelter; lack of awareness of services; provider shortages in primary and mental health; sustainable employment and other economic and social determinants of health.

Priority 2: Maternal and Child Health Issues related to maternal and child health were identified by five counties (Jefferson, Leon, Liberty, Madison, and Taylor). Specific priorities included reducing late entry into prenatal care; increasing breastfeeding initiation; reducing infant mortality; early childhood education; and reducing risky youth behavior (specifically teen pregnancy).

Priority 3: Immunizations and Influenza No counties prioritized issues specifically related to immunizations and influenza.

Priority 4: Injury, Safety and Violence Holmes was the only county in which Priority 4, specifically, domestic violence, was identified as a priority.

Priority 5: Healthy Weight, Nutrition, and Physical Activity Except for Franklin, all thirteen counties (Bay, Calhoun, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, Washington) identified some aspect of healthy weight, nutrition, and physical activity. Among the specific issues mentioned were physical activity; fruit and vegetable intake; obesity; obesity and chronic diseases (also listed under Priority 8 below) especially regarding nutrition for youth; shortages of recreation facilities for youth; healthy lifestyle/prevention; healthy food options in at least two food establishments; a community walking program; high school nutrition education;

Page 41 of 97

food insecurity; inform the public on physical activity and nutritional resources available within the county and increase the use of these resources.

Priority 6: Behavioral Health – Includes Mental Illness and Substance Abuse Eleven counties (Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Madison, and Washington) mentioned some aspect of behavioral health as a priority. Specific topics included treatment; mental health first aid training; forensic recidivism of those with behavioral health issues; focus on youth, awareness, resources, and issues; reduce alcohol and substance abuse; increase mental health awareness and services; lack of mental health providers; reduce alcohol among youth; substance abuse/mental health/domestic violence; behavioral health, suicide services and resources; mental health professionals; the need for a consistent presence of providers; linkage and referral system.

Priority 7: Sexually Transmitted Disease (STDs) – Includes Other Infectious Diseases Leon and Taylor were the only counties that mentioned STDs or HIV/AIDS as priority health issues.

Priority 8: Chronic Diseases & Conditions – Includes Tobacco-Related Illnesses and Cancer Bay, Holmes, Jackson, Jefferson, Madison, and Washington identified chronic diseases & conditions as health priorities in their counties. Examples identified included heart disease; melanoma; diabetes- related maternal and infant outcomes; chronic disease prevention (including diabetes, high blood pressure, and heart disease); tobacco use; chronic disease and lifestyle behaviors; cancer screenings; diabetes prevention and education; breast, prostate, and colon cancer screenings; obesity and chronic diseases (also mentioned under Priority 5 above); implement the National Diabetes Prevention Program.

Priority 9: Alzheimer’s Disease & Related Dementias Although no counties identified priorities that directly relate to this Florida State Health Plan priority, current research suggests that Alzheimer’s Disease and related dementias may be exacerbated or mitigated by other priority health issues including, but not limited to healthy weight, nutrition, physical activity, behavioral health, chronic diseases and conditions.

The next section will include recent demographic, socio-economic, health, and related data regarding the counties in Big Bend Florida, individually and aggregated when available (“n/a” will indicate that aggregated data was not available). Although each assessment may have used different data sources, elements, and time frames, the data used in this report were chosen to provide, as much as possible, consistency with and support of the priority issues identified in all the Community Health Assessments summarized in this report. Page 42 of 97

VI. ADDITIONAL DATA RESOURCES

DEMOGRAPHIC AND SOCIOECONOMIC FACTORS

This section includes recent demographic and socioeconomic data regarding the counties in Big Bend – individually, aggregated for Big Bend when available (“n/a” will be used to indicate that aggregated data were not available for that particular data point), and statewide. Overall, these data are consistent with and supportive of the data used to identify priority issues in community health assessments.

Data were drawn from a wide range of sources including: • Florida Department of Health Community Health Assessment Resource Toolset (CHARTS) • Florida Department of Health Behavioral Risk Factor Surveillance System • Florida Department of Health Opioid Use Dashboard • Florida Department of Economic Opportunity • Florida Department of Education • US Census Bureau Quickfacts • US Census Small Area Health Insurance Estimates • US Department of Health and Human Services Health Services and Resources Administration

Jackson County Courthouse, Marianna

Page 43 of 97

Total Population

In 2018, the total population of Big Bend was 754,190, which was 3.5% of Florida’s total population of 21,299,325. Across Big Bend, the counties’ populations range from Liberty with 8,457 to Leon with 292,502. Most of the counties have populations of less than 25,000. Bay with 185,287 and Leon with 292, 502 have the largest populations in the area; together they account for nearly two-thirds, 63.4% of the area’s total population.

Population as a Percentage of the Total Population of Florida 2018 Percent of Area Count Florida’s Population Bay 185,287 0.9% Calhoun 14,587 0.1% Franklin 11,736 0.1% Gadsden 45,894 0.2% Gulf 16,164 0.1% Holmes 19,477 0.1% Jackson 48,305 0.2% Jefferson 14,288 0.1% Leon 292,502 1.4% Liberty 8,457 0.0% Madison 18,529 0.1% Taylor 21,623 0.1% Wakulla 32,461 0.2% Washington 24,880 0.1% Big Bend 754,190 3.5% Florida 21,299,325 100.0% Source: US Census Bureau; downloaded November 5, 2019 from http//ww.census/quickfacts/.

Page 44 of 97

Population as a Percentage of the Total Population of Florida’s Big Bend, 2018 Percent of Area Count Big Bend's Population Bay 185,287 24.6% Calhoun 14,587 1.9% Franklin 11,736 1.6% Gadsden 45,894 6.1% Gulf 16,164 2.1% Holmes 19,477 2.6% Jackson 48,305 6.4% Jefferson 14,288 1.9% Leon 292,502 38.8% Liberty 8,457 1.1% Madison 18,529 2.5% Taylor 21,623 2.9% Wakulla 32,461 4.3% Washington 24,880 3.3% Big Bend 754,190 100.0% Source: US Census Bureau; downloaded November 5, 2019 from http//ww.census/quickfacts/.

Population of Each County as a Percentage of the Total Population of Big Bend, 2018

Wakulla Madison Taylor 4% Washington, 3% Bay 3% 3% 25% Liberty, 1%

Calhoun, 2%

Franklin, 2%

Gadsden, 6%

Gulf, 2% Leon Holmes, 3% 39% Jackson Jefferson 7% 2%

Page 45 of 97

Population by Age Range

The proportional distributions of age ranges in each county and Big Bend as a whole are similar to those of Florida as a whole. Like the state, the area’s largest age range is 18-24 (482,382, 64%) followed by 0- 17 (148,240, 19.7%) and 65+ (123,567, 16.4%).

Population by Age Range, 2018 All Ages Ages 0-17 Ages 18-64 Ages 65+ Area Count Percent Count Percent Count Percent Count Percent

Bay 185,287 100% 39,837 21.5% 113,766 61.4% 31,684 17.1% Calhoun 14,587 100% 2,917 20.0% 9,044 62.0% 2,626 18.0% Franklin 11,736 100% 1,889 16.1% 7,030 59.9% 2,817 24.0% Gadsden 45,894 100% 10,097 22.0% 27,582 60.1% 8,215 17.9% Gulf 16,164 100% 2,505 15.5% 10,167 62.9% 3,491 21.6% Holmes 19,477 100% 3,934 20.2% 11,667 59.9% 3,876 19.9% Jackson 48,305 100% 8,985 18.6% 29,901 61.9% 9,419 19.5% Jefferson 14,288 100% 2,429 17.0% 8,501 59.5% 3,358 23.5% Leon 292,502 100% 54,405 18.6% 198,901 68.0% 39,195 13.4% Liberty 8,457 100% 1,514 17.9% 5,717 67.6% 1,226 14.5% Madison 18,529 100% 3,483 18.8% 11,247 60.7% 3,798 20.5% Taylor 21,623 100% 4,346 20.1% 12,866 59.5% 4,411 20.4% Wakulla 32,461 100% 6,947 21.4% 20,418 62.9% 5,096 15.7% Washington 24,880 100% 4,951 19.9% 15,575 62.6% 4,354 17.5% Big Bend 754,190 100% 148,240 19.7% 482,382 64.0% 123,567 16.4% Florida 21,299,325 100% 4,238,566 19.9% 12,694,398 59.6% 4,366,362 20.5% Source: US Census Bureau; downloaded November 5, 2019 from http//ww.census/quickfacts/ .

Page 46 of 97

Population by Age Range 2018

0-17 18-64 65+

Bay 21.5% 61.4% 17.1%

Calhoun 20.0% 62.0% 18.0%

Franklin 16.1% 59.9% 24.0%

Gadsden 22.0% 60.1% 17.9%

Gulf 15.5% 62.9% 21.6%

Holmes 20.2% 59.9% 19.9%

Jackson 18.6% 61.9% 19.5%

Jefferson 17.0% 59.5% 23.5%

Leon 18.6% 68.0% 13.4%

Liberty 17.9% 67.6% 14.5%

Madison 18.8% 60.7% 20.5%

Taylor 20.1% 59.5% 20.4%

Wakulla 21.4% 62.9% 15.7%

Washington 19.9% 62.6% 17.5%

Big Bend 19.7% 64.0% 16.4%

Florida 59.6% 20.5%

0% 20% 40% 60% 80% 100%

Page 47 of 97

Population by Gender

Population by Gender, 2018 Female Male The gender distribution Area Population Count Percent Count Percent of the population of Big Bay 185,287 93,385 50.4% 91,902 49.6% Bend, its counties, and Calhoun 14,587 6,622 45.4% 7,965 54.6% Franklin 11,736 5,187 44.2% 6,549 55.8% the state are similarly Gadsden 45,894 24,094 52.5% 21,800 47.5% divided between Gulf 16,164 6,708 41.5% 9,456 58.5% females and males Holmes 19,477 9,135 46.9% 10,342 53.1% except for Calhoun, Jackson 48,305 21,689 44.9% 26,616 55.1% Jefferson 14,288 6,801 47.6% 7,487 52.4% Franklin, Gulf, Jackson, Leon 292,502 153,856 52.6% 138,646 47.4% Liberty, and Taylor Liberty 8,457 3,239 38.3% 5,218 61.7% which have significantly Madison 18,529 8,727 47.1% 9,802 52.9% Taylor 21,623 9,817 45.4% 11,806 54.6% higher rates of males Wakulla 32,461 15,127 46.6% 17,334 53.4% (55% or more).

Washington 24,880 11,519 46.3% 13,361 53.7% Big Bend 754,190 375,906 49.8% 378,284 50.2%

Florida 21,299,325 11,395,139 53.5% 9,904,186 46.5% Source: US Census Bureau; Quickfacts, downloaded November 5, 2019.

Population by Gender, 2018 Female Male Bay 50.4% 49.6% Calhoun 45.4% 54.6% Franklin 44.2% 55.8% Gadsden 52.5% 47.5% Gulf 41.5% 58.5% Holmes 46.9% 53.1% Jackson 44.9% 55.1% Jefferson 47.6% 52.4% Leon 52.6% 47.4% Liberty 38.3% 61.7% Madison 47.1% 52.9% Taylor 45.4% 54.6% Wakulla 46.6% 53.4% Washington 46.3% 53.7% Big Bend 49.8% 50.2% Florida 53.5% 46.5%

0% 20% 40% 60% 80% 100%

Page 48 of 97

Population by Race

All the counties in Big Bend have predominantly white populations except for Gadsden County whose population is 41.7% white. Overall, Big Bend has a larger minority population than Florida as a whole (30.1% minority in Big Bend compared to 22.7% statewide). Population by Race, 2018 Total Asian Black White Other Area Count Count % Count % Count % Count % Bay 185,287 4,262 2.3% 21,679 11.7% 151,379 81.7% 7,967 4.3% Calhoun 14,587 117 0.8% 1,925 13.2% 11,991 82.2% 554 3.8% Franklin 11,736 59 0.5% 1,455 12.4% 9,870 84.1% 352 3.0% Gadsden 45,894 321 0.7% 25,609 55.8% 19,138 41.7% 826 1.8% Gulf 16,164 81 0.5% 2,748 17.0% 12,899 79.8% 436 2.7% Holmes 19,477 136 0.7% 1,305 6.7% 17,335 89.0% 701 3.6% Jackson 48,305 386 0.8% 12,994 26.9% 33,427 69.2% 1,497 3.1% Jefferson 14,288 86 0.6% 4,901 34.3% 9,016 63.1% 286 2.0% Leon 292,502 11,115 3.8% 92,723 31.7% 181,059 61.9% 7,605 2.6% Liberty 8,457 34 0.4% 1,658 19.6% 6,512 77.0% 254 3.0% Madison 18,529 93 0.5% 7,004 37.8% 11,025 59.5% 408 2.2% Taylor 21,623 173 0.8% 4,238 19.6% 16,520 76.4% 692 3.2% Wakulla 32,461 227 0.7% 4,252 13.1% 27,008 83.2% 974 3.0% Washington 24,880 149 0.6% 3,707 14.9% 20,004 80.4% 1,020 4.1% Big Bend 754,190 17,239 2.3% 186,198 24.7% 527,180 69.9% 23,573 3.1% Florida 21,299,325 638,980 3.0% 3,599,586 16.9% 16,464,378 77.3% 596,381 2.8% Source: US Census Bureau; downloaded November 5, 2019 from http//ww.census/quickfacts/.

Population by Race, 2018

Asian Black White Other

Bay Calhoun Franklin Gadsden Gulf Holmes Jackson Jefferson Leon Liberty Madison Taylor Wakulla Washington Big Bend Florida 0% 20% 40% 60% 80% 100%

Page 49 of 97

Population by Hispanic Ethnicity

Population by Hispanic Ethnicity, 2018 Total Hispanic Area Count Count Percent In 2018, the percentage of Florida’s Hispanic Bay 185,287 12,414 6.7% population (26.1%) was nearly four times the Calhoun 14,587 831 5.7% Franklin 11,736 657 5.6% rate of Big Bend’s (6.2%). Gadsden, whose Gadsden 45,894 4,819 10.5% Hispanic population accounted for 10.5% of its Gulf 16,164 744 4.6% total population, had the highest rate in Big Holmes 19,477 584 3.0% Bend and Holmes had the lowest (3.0%). The Jackson 48,305 2,415 5.0% Jefferson 14,288 557 3.9% Hispanic population in Big Bend’s other Leon 292,502 19,305 6.6% counties ranged from 3.7% in Washington to 8,457 609 7.2% Liberty 7.2% in Liberty. Madison 18,529 1,038 5.6%

Taylor 21,623 973 4.5%

Wakulla 32,461 1,234 3.8% Washington 24,880 921 3.7%

Big Bend 754,190 47,101 6.2%

Florida 21,299,325 5,559,124 26.1% Source: US Census Bureau; downloaded November 5, 2019 from http//ww.census/quickfacts/.

Population by Hispanic Ethnicity, 2018

Bay 6.7% Calhoun 5.7% Franklin 5.6% Gadsden 10.5% Gulf 4.6% Holmes 3.0% Jackson 5.0% Jefferson 3.9% Leon 6.6% Liberty 7.2% Madison 5.6% Taylor 4.5% Wakulla 3.8% Washington 3.7% Big Bend 6.2% Florida 26.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Page 50 of 97

Socioeconomic Indicators

• Florida had a higher per capita income ($28,774) than any of Big Bend’s counties; Leon’s was almost as high ($28,548) as the state’s; and Calhoun had the lowest rate ($15,927) in Big Bend . • Florida had a higher median household income ($50,883) than any of Big Bend’s counties except for Wakulla ($57,866). Madison had the lowest ($31,816). • Except for Wakulla County, Florida had a lower % of persons <100% of the Federal Poverty Level than any of Big Bend’s counties (Wakulla 12.9%; Florida 13.6%). Ten counties had rates >20%. • In October 2019, the unemployment rate in Florida was 2.9% and rates throughout Big Bend were similar. • Leon had a higher percentage of residents who graduated from high school (93.2%) or college (45,5%) than other Big Bend counties and the state as a whole (87.6%, 28.5%). • Leon was Big Bend’s only county with a lower rate, than the state, of students who were eligible of free/reduced lunch (Leon, 63.5%; Florida, 66%).

Selected Socioeconomic Indicators % of PK-12 Median % Students Per Persons % high House- Unemploy- bachelor's Eligible for Area Capita in school hold ment Rate2 degree or Free/ Income1 Poverty1 grad or >1 Income1 >1 Reduced Lunch3 Bay $26,742 $50,283 14.9% 2.9% 89.1% 22.4% 67.8% Calhoun $15,927 $36,237 21.1% 3.4% 77.4% 9.6% 99.9% Franklin $23,524 $41,267 21.3% 2.7% 81.4% 18.4% 99.5% Gadsden $19,252 $39,830 23.1% 3.8% 79.7% 16.3% 99.6% Gulf $21,085 $44,647 20.3% 3.5% 84.3% 18.5% 69.7% Holmes $18,402 $37,474 23.9% 3.2% 76.1% 11.5% 94.8% Jackson $18,126 $36,944 23.5% 3.0% 79.7% 14.0% 95.0% Jefferson $22,452 $47,599 17.9% 2.9% 80.9% 21.2% 79.9% Leon $28,548 $49,941 18.0% 2.8% 93.2% 45.5% 63.5% Liberty $16,937 $36,741 23.0% 3.0% 79.8% 11.1% 93.3% Madison $17,192 $31,816 28.3% 3.4% 82.2% 12.5% 79.0% Taylor $16,979 $37,188 23.8% 3.1% 79.5% 8.6% 100.0% Wakulla $22,846 $57,866 12.9% 2.6% 87.5% 17.8% 69.7% Washington $18,718 $36,989 21.1% 2.9% 80.5% 11.3% 66.7% Florida $28,774 $50,883 13.6% 2.9% 87.6% 28.5% 66.0% Sources: 1Per Capita income in past 12 months (in 2017 dollars) 2013-2017 and Median Household income (in 2017 dollars), 2013-2017; high school grad and bachelor's degree percent of persons age 25 years+ 2013-2017; US Census Bureau, Florida QuickFacts. 2U.S. Department of Labor, Bureau of Labor Statistics, Local Area Unemployment Statistics Program, in cooperation with the Florida Department of Economic Opportunity, Bureau of Labor Market Statistics. Published November 15, 2019, October 2019 (not seasonally adjusted). 3Florida Department of Education, Fldoe.org, Lunch Status by District (for Federal Funding) 2018-19 Final Survey 3.

Page 51 of 97

HEALTH STATUS & HEALTH CARE FACTORS

Health Related Quality of Life

Percentage of Adults (in 2006) … Overall, adult residents of Big Bend …who had poor …who had poor physical health on 14 mental health on 14 reported poor physical health on 14 Area or more of the past or more of the past 30 or more of the previous 30 days at 30 days days Bay 16.6% 12.8% higher rates than Florida as a whole. Calhoun 20.8% 12.0% Franklin 19.6% 12.3% Florida’s rates of 14 poor health days Gadsden 13.0% 8.8% Gulf 21.7% 12.7% were 12.9% for physical health and Holmes 24.2% 12.3% 11.4% for mental health. Only Leon Jackson 20.4% 14.2% County adults reported a lower rate Jefferson 15.3% 10.5% Leon 11.2% 11.7% of poor physical health on 14 of the Liberty 20.8% 15.9% previous 30 days (11.2%). Gadsden Madison 17.6% 12.6% Taylor 19.5% 14.8% and Jefferson had lower rates of poor Wakulla 15.2% 11.6% mental health days (8.8% and 10.5% Washington 18.4% 14.6% Florida 12.9% 11.4% respectively). Source: Florida Department of Health, Behavioral Risk Factor Surveillance System (BRFSS), 2016 County Level Reports. Downloaded from CHARTS, August 2020.

Percentage of Adults with Poor Health on 14 or More of the Past 30 Days, 2016 100% 90% 80% Percentage of adults who had poor physical health on 14 or more of the past 30 days 70% 60% Percentage of adults who had poor mental health on 14 or more of the past 30 days 50% 40% 30% 20% 10% 0%

Page 52 of 97

Maternal and Infant Well-Being Indicators

*Please keep in mind that rates and ratios are considered unstable if they are based on fewer than 5 cases or if the denominator (population at risk) is fewer than 20. This applies to many of these rates.

 In 2018, the birth rates in Big Bend’s counties ranged from 6.6 per 1,000 population in Franklin to 10.9 in Taylor. Florida’s birthrate was 10.6.  Florida’s teen birth rate (ages 15-19) was 16.7 per 1,000 population of females in that age range. The teen birth rates in Big Bend’s counties ranged from 9 in Jefferson to 51.6 in Taylor. Only Jefferson and Leon had rates lower than the state rate and lower than 20.  Florida’s repeat teen birth rate was 15%, lower than all but four counties in Big Bend. The rates in Big Bend ranged from 3.8% in Taylor, to 40% in Holmes.  The state rate of low birthweight babies (8.7%) was similar to the rates in many counties in Big Bend. The rates in Big Bend varied from 3.7% in Franklin to 13.6% in Madison.  Florida’s rate of 3rd trimester or no prenatal care was 7.1% while Big Bend’s rates varied from 4.0% in Madison to 12.5% in Franklin.  Florida’s infant death rate was 10.9. The rates in Big Bend ranged from 0 in Holmes, Liberty, and Washington to 27.8 in Gulf. Maternal and Infant Well-Being Indicators, 2018 Single Year Counts and Rates Total Birth Count Teen Birth and Rate Count & Repeat Birth Low 3rd Trimester Infant Death (Resident Live Rate (Ages Rate (to Ages Birthweight (% or No Prenatal Rate (per Area Birth Rate per 15-19) per 15-19) <2500 g) Care 1,000) 1,000 Pop.) 1,000 Count Rate Count Rate Count Rate Count Rate Count Rate Count Rate Bay 2,186 12 154 32.9 19 12.3% 177 8.1% 159 8.7% 25 11.4 Calhoun 140 9.1 12 28.8 3 25.0% 8 5.7% 13 10.1% 1 7.1 Franklin 81 6.6 7 32.4 1 14.3% 3 3.7% 9 12.5% 1 12.3 Gadsden 496 10.3 53 36.9 11 20.8% 53 10.7% 27 5.8% 7 14.1 Gulf 108 6.7 13 37.2 2 15.4% 8 7.4% 8 9.1% 3 27.8 Holmes 177 8.7 10 20.3 4 40.0% 9 5.1% 15 9.5% 0 0 Jackson 503 9.9 39 28.7 4 10.3% 50 9.9% 41 9.0% 6 11.9 Jefferson 111 7.5 3 9 1 33.3% 14 12.6% 6 5.6% 1 9 Leon 2,914 10 131 9.7 20 15.3% 293 10.1% 151 5.5% 25 8.6 Liberty 59 6.7 5 24 1 20.0% 3 5.1% 3 5.2% 0 0 Madison 184 9.5 11 24.9 1 9.1% 25 13.6% 7 4.0% 2 10.9 Taylor 242 10.9 26 51.6 1 3.8% 23 9.5% 15 6.7% 2 8.3 Wakulla 338 10.4 29 31.5 5 17.2% 36 10.7% 13 4.1% 5 14.8 Washington 251 9.9 21 32.3 4 19.0% 23 9.2% 24 10.8% 0 0 Big Bend 7,790 n/a1 514 n/a1 77 n/a1 725 n/a1 492 n/a1 78 n/a1 Florida 221,508 10.6 9,828 16.7 1,478 15.0% 19,271 8.7% 14,176 7.1% 1,334 6 1 n/a = not available Source: Florida Department of Health, CHARTS, 2018, downloaded September 24, 2019. Page 53 of 97

Total Birth Rate and Teen Birth Rates, 2018

Total Birth Rate (Resident Live Birth Rate per 1,000 population)

Teen Birth Rate (to ages 15-19 per 1,000 population of females ages 15-19) 60 51.6 50

40 36.9 37.2 32.9 32.4 31.5 32.3 28.8 28.7 30 24 24.9 20.3 20 16.7 12 10.3 9.9 9.8 9.7 10.9 10.4 9.9 10.6 9.1 8.7 7.5 9 9.5 10 6.6 6.7 6.7

Repeat Teen Birth, Low Birthweight, and 3rd Trimester or No Prenatal Care Rates, 2018

100%

90% Repeat Birth Rate (to Ages 15-19) Low Birthweight (% <2500 g) 80% 3rd Trimester or No Prenatal Care 70% 60% 50% 40% 30% 20% 10% 0%

Page 54 of 97

Body Weight, Overweight, and Obesity

Percentage of Adults who (in 2016) …

…had a …were In nearly every county in Big Bend healthy weight …were …were Area overweight (BMI between overweight obese and the state as a whole, the or obese 18.5 and 24.9) percentage of overweight or Bay 31.4% 35.7% 30.5% 66.3% obese adults was at least twice or Calhoun 30.8% 34.3% 32.8% 67.1% more than twice the rate of Franklin 29.9% 28.4% 37.8% 66.2% adults with a healthy BMI. Gadsden 19.0% 34.7% 45.5% 80.2% Florida’s rate of adults with a Gulf 29.9% 33.7% 34.9% 68.5% Holmes 28.7% 37.3% 32.4% 69.6% healthy BMI was 34.5%. The Jackson 32.0% 31.5% 33.8% 65.4% rates in Big Bend ranged from Jefferson 29.1% 33.2% 35.0% 68.1% 19% in Gadsden to 34.5% in Leon. Leon 34.5% 33.8% 30.4% 64.2% Florida’s rate of overweight Liberty 24.5% 31.7% 42.7% 74.4% among adults was 63.2%; the Madison 32.2% 30.3% 35.4% 65.7% rates in Big Bend ranged from Taylor 25.7% 36.3% 34.6% 70.9% Wakulla 25.4% 35.3% 38.1% 73.3% 64.2% in Leon to 80.2% in Washington 24.5% 35.3% 37.4% 72.7% Gadsden. Florida 34.5% 35.8% 27.4% 63.2%

Source: Florida Department of Health, Behavioral Risk Factor Surveillance System (BRFSS), 2016 County Level Reports. Downloaded from Florida Department of Health CHARTS, August 2020.

Percentage of Adults who were at a Healthy Weight, or were Overweight or Obese, 2016 Percentage who were overweight or obese Percentage of adults who had a healthy weight (BMI between 18.5 and 24.9) 100% 66% 67% 66% 80% 69% 70% 65% 68% 64% 74% 66% 71% 73% 73% 63% 80%

60%

40% 35% 35% 20% 31% 31% 30% 30% 32% 29% 32% 29% 25% 26% 25% 25% 19% 0%

Page 55 of 97

Leading Causes of Death

The graph below and tables below and on the next two pages summarize the five leading causes of death in Florida and the corresponding Age Adjusted Death Rates (AADR) per 100,000 Population in each of the fourteen counties in Big Bend and Florida as a whole. In 2018, all the counties had higher rates of death for all causes than the state. In each of the counties and statewide, heart disease and cancer were the leading causes of death. In most counties and the state, the next highest rates of death were attributed to stroke, unintentional injury, and chronic lower respiratory disease.

Age-Adjusted Death Rate Per 100,000 Population for All Causes of Death, 2018 1400 1153.7 1200 1023.4 988.6 971.6 959.6 939.4 946.7 1000 888.8 863.7 869.6 870.2 748 800 715.8 712.7 679.4 600 400 200 0

Age-Adjusted Death Rate Per 100,000 Population for All Causes and Florida’s Five Leading Causes of Death, 2018 Chronic Lower All Heart Unintentional Area Cancer Stroke Respiratory Causes Disease Injury Disease Bay 888.8 195.2 163.5 33.8 57.5 71.9 Calhoun 988.6 218.2 206.8 35.4 61.3 104 Franklin 748 152 149.7 19.5 54.9 53.3 Gadsden 863.7 176 180.7 45.2 48.7 34.1 Gulf 869.6 179 157.3 45 50.5 92.2 Holmes 1023.4 213.1 194.1 41.8 86 91.5 Jackson 971.6 175.3 185.4 45.9 66.5 66.1 Jefferson 715.8 148.2 129.6 28.9 83.5 24 Leon 712.7 144.8 137.7 45.9 38.1 35.4 Liberty 959.6 259.7 217.1 30.9 26.3 87.6 Madison 939.4 246.1 146.8 58.7 70 55.3 Taylor 946.7 215.6 164.7 54.8 58.5 81.1 Wakulla 870.2 182.7 140.7 41.3 80.3 70.5 Washington 1153.7 288.6 188.9 50.2 46.9 113.6 Florida 679.4 147.7 146.2 41 53.8 38.4 Source: Florida Department of Health, CHARTS, downloaded November 2019.

Page 56 of 97

Age Adjusted Death Rate (AADR) per 100,000 Population for Counties’ Five Leading Causes of Death, 2018 Bay Florida Calhoun Florida All Causes 888.8 679.4 All Causes 988.6 679.4 Heart Disease 195.2 147.7 Cancer 206.8 146.2 Cancer 163.5 146.2 Heart Disease 218.2 147.7 Chronic Lower Chronic Lower 71.9 38.4 104.0 38.4 Respiratory Disease Respiratory Disease Unintentional Injury 57.5 53.9 Unintentional Injury 61.3 53.8 Alzheimer’s Disease 47.6 20 Diabetes 41.3 20.4 Franklin Florida Gadsden Florida All Causes 748 679.4 All Causes 863.7 679.4 Cancer 149.7 146.2 Cancer 180.7 146.2 Heart Disease 152 147.7 Heart Disease 176 147.7 Chronic Lower 53.3 38.4 Unintentional Injury 48.7 53.8 Respiratory Disease Unintentional Injury 54.9 53.8 Stroke 45.2 41 Chronic Liver Disease Chronic Lower 33.2 12 34.1 38.4 and Cirrhosis Respiratory Disease Gulf Florida Holmes Florida All Causes 869.6 679.4 All Causes 1023.4 679.4 Heart Disease 179 147.7 Heart Disease 213.1 147.7 Cancer 157.3 146.2 Cancer 194.1 146.2 Chronic Lower Chronic Lower 92.2 38.4 91.5 38.4 Respiratory Disease Respiratory Disease Unintentional Injury 50.5 53.8 Unintentional Injury 86 53.8 Stroke 45 41 Alzheimer’s Disease 53.2 20 Jackson Florida Jefferson Florida All Causes 971.6 679.4 All Causes 715.8 679.4 Cancer 185.4 146.2 Heart Disease 148.2 147.7 Heart Disease 175.3 147.7 Cancer 129.6 146.2 Chronic Lower 66.1 38.4 Unintentional Injury 83.5 53.8 Respiratory Disease Unintentional Injury 66.5 53.8 Diabetes 30.2 20.4 Alzheimer’s Disease 50.5 20 Stroke 28.9 41 Leon Florida Liberty Florida All Causes 712.7 679.4 All Causes 959.6 679.4 Heart Disease 144.8 147.7 Heart Disease 259.7 147.7 Cancer 137.7 146.2 Cancer 217.1 146.2 Chronic Lower Stroke 45.9 41 87.6 38.4 Respiratory Disease Chronic Lower 35.4 38.4 Unintentional Injury 26.3 53.8 Respiratory Disease Unintentional Injury 38.1 53.8 Stroke 30.9 41 (continued)

Page 57 of 97

(continued)

Age Adjusted Death Rate (AADR) per 100,000 Population for Five Leading Causes of Death, 2018 Madison Florida Taylor Florida All Causes 939.4 679.4 All Causes 946.7 679.4 Heart Disease 246.1 147.7 Heart Disease 215.6 147.7 Cancer 146.8 146.2 Cancer 164.7 146.2 Chronic Lower Stroke 58.7 53.8 81.1 38.4 Respiratory Disease Chronic Lower 55.3 38.4 Diabetes 67.5 20.4 Respiratory Disease Unintentional Injury 70 41 Stroke 54.8 41 Wakulla Florida Washington Florida All Causes 870.2 679.4 All Causes 1153.7 679.4 Heart Disease 182.7 147.7 Heart Disease 288.6 147.7 Cancer 14.07 146.2 Cancer 188.9 146.2 Chronic Lower Unintentional Injury 80.3 53.8 113.6 38.4 Respiratory Disease Chronic Lower 70.5 38.4 Diabetes 50.1 20.4 Respiratory Disease Stroke 41.3 41 Unintentional Injury 46.9 53.8 Source: Florida Department of Health, CHARTS, downloaded November 2019.

Panama City, Bay County

Page 58 of 97

Appropriate and Timely Access to Quality Healthcare,

Unnecessary Hospitalizations

Ambulatory Care Sensitive (ACS) conditions are conditions where timely and effective ambulatory care can decrease hospitalizations by preventing the onset of an illness or condition, controlling an acute episode of an illness, or managing a chronic disease or condition.

High rates of Ambulatory Care Sensitive hospitalizations in a community may be an indicator of a lack of or failure of prevention efforts, a primary care resource shortage, poor performance of primary health care delivery systems, or other factors that create barriers to obtaining timely and effective care.

An extensive listing of avoidable, acute, and chronic Ambulatory Care Sensitive conditions (and associated ICD-9-CM Codes) is available on the Florida Department of Health website at http://www.flhealthcharts.com/charts/SearchResult.aspx http://www.flhealthcharts.com/ChartsReports/rdPage.aspx?rdReport=ChartsProfiles.ACSConditionsProf ile

The table and graph on the next page compare the counts and rates of preventable hospitalizations for residents under the age of 65 from all ACS conditions in Big Bend and the state as a whole. In 2018, Florida’s count and rate of ACS conditions were 161,107 and 961.2 respectively. Big Bend’s count totaled 5,576 and county rates ranged from 687.2 in Leon to 1,194.8 in Bay.

Chipola River, Altha, Calhoun County

Page 59 of 97

Preventable Hospitalizations Under Age 65 from All Conditions, 2018 Rate per Area Count 100,000 population

Bay 1,811 1,194.8 Calhoun 115 913.2 Franklin 75 786.3 Gadsden 443 1,110.1 Gulf 119 924.7 Holmes 143 872.8 Jackson 339 826.5 Jefferson 120 1,055.3 Leon 1,737 687.2 Liberty 65 865.3 Madison 131 843.0 Taylor 193 1,080.2 Wakulla 235 855.6 Washington 179 860.1 Big Bend 5,576 not available Florida 161,107 961.2 Source: Florida Department of Health, CHARTS, downloaded August 14, 2020.

Preventable Hospitalizations Under Age 65 from All Conditions, Rate per 100,000 Population, 2018

Bay 1,194.8 Calhoun 913.2 Franklin 786.3 Gadsden 1,110.1 Gulf 924.7 Holmes 872.8 Jackson 826.5 Jefferson 1,055.3 Leon 687.2 Liberty 865.3 Madison 843.0 Taylor 1,080.2 Wakulla 855.6 Washington 860.1 Florida 961.2 0 200 400 600 800 1,000 1,200 1,400

Page 60 of 97

Health Professional Shortage Areas, Medically Underserved Areas, and Medically Underserved Populations

U.S. Department of Health and Human Services, Health Services and Resources Administration (HRSA) develops shortage designation criteria and uses them to decide whether or not a geographic area, population group or facility is a Health Professional Shortage Area (HPSA), a Medically Underserved Area (MUA) or a Medically Underserved Population (MUP).

A HPSA is a geographic area, population group, or health care facility that has been designated by the Federal government as having a shortage of health professionals. There are three categories of HPSAs: primary care (shortage of primary care clinicians), dental (shortage of oral health professionals), and mental health (shortage of mental health professionals). HPSAs are designated using several criteria, including population-to-clinician ratios. This ratio is usually 3,500 to 1 for primary care, 5,000 to 1 for dental health care, and 30,000 to 1 for mental health care.

HRSA also establishes guidelines for use in applying the established Criteria for Designation of Medically Underserved Areas (MUAs) and Populations (MUPs).

Additional detailed information about HPSAs, MUAs, and MUPs, is available online at https://data.hrsa.gov/tools/shortage-area

The tables on the following six pages summarize the numerous HSPAs, MUAs, and MUPs in each of the counties in Big Bend.

Downtown Monticello, Jefferson County

Page 61 of 97

Health Professional Shortage Areas & Medically Underserved Areas and Populations (As of December 2, 2019) BAY COUNTY Primary Care HPSA Population: Low Income – Bay County Federally Qualified Health Center: PanCare of Florida, Inc. Dental Care HPSA Population: Low Income – Bay County Federally Qualified Health Center: PanCare of Florida, Inc. Mental Health High Needs Geographic HPSA: Mental Health Catchment Area 2A Federally Qualified Health Center: PanCare of Florida, Inc. Correctional Facility: CF- Bay Correctional Institute Correctional Facility: Bay Correctional Facility Medically Underserved Areas/Populations MUA: Panama City/Southport Service Area MUA: Cedar Grove Service Area CALHOUN COUNTY Primary Care Federally Qualified Health Center: PanCare of Florida, Inc. PanCare - Blountstown Low Income Population HPSA: Low Income – Calhoun County Correctional Facility: Calhoun Correctional Institution Dental Care Federally Qualified Health Center: PanCare of Florida, Inc. PanCare - Blountstown Low Income/Migrant Farmworker Population HPSA: Low Income/Migrant Farmworker - Calhoun Correctional Facility: Calhoun Correctional Institution Mental Health Federally Qualified Health Center: PanCare of Florida, Inc. PanCare - Blountstown High Needs Geographic HPSA: Mental Health Catchment Area 2A Correctional Facility: Calhoun Correctional Institution Medically Underserved Areas/Populations MUA: Low Income - Calhoun County FRANKLIN COUNTY Primary Care, Dental Care, and Mental Health Low Income Population HPSA Population: Low Income – Franklin (Primary Care and Dental Health only) Geographic HPSA: Franklin County (Mental Health only) Correctional Facility: Franklin Correctional Institution Federally Qualified Health Center: North Florida Medical Centers, Inc. Federally Qualified Health Center: PanCare of Florida, Inc. Rural Health Clinic: Weems Medical Center East Rural Health Clinic: Weems Medical Center West Medically Underserved Areas/Populations MUA: Low Income/ Migrant Farm Worker - Franklin County

(continued)

Page 62 of 97

(continued)

Health Professional Shortage Areas & Medically Underserved Areas and Populations (As of December 2, 2019) GADSDEN COUNTY Primary Care Geographic HPSA: Gadsden County Federally Qualified Health Center: Neighborhood Medical Center, Inc. Federally Qualified Health Center: North Florida Medical Centers, Inc. Rural Health Clinic: Quincy Medical Group Dental Care Low Income/Migrant Farmworker HPSA Population: Low Income/Migrant Farmworker Gadsden County Federally Qualified Health Center: Neighborhood Medical Center, Inc. Federally Qualified Health Center: North Florida Medical Centers, Inc. Rural Health Clinic: Quincy Medical Group Mental Health Geographic HPSA: Gadsden County Federally Qualified Health Center: Neighborhood Medical Center, Inc. Federally Qualified Health Center: North Florida Medical Centers, Inc. Rural Health Clinic: Quincy Medical Group Medically Underserved Areas/Populations MUA: Gadsden County GULF COUNTY Primary Care Low Income Population HPSA: Low Income - Wewahitchka Correctional Facility: Gulf Correctional Institution Federally Qualified Health Center: North Florida Medical Centers, Inc. Federally Qualified Health Center: PanCare of Florida, Inc. Rural Health Clinic: Shoreline Medical Group Dental Care Correctional Facility: Gulf Correctional Institution Comprehensive Health Center: Gulf County Health Department / St. Joseph Mental Health Comprehensive Health Center: Gulf County Health Department / St. Joseph HPSA Geographic: Mental Health Catchment Area 2A Single County: Gulf County Correctional Facility: Gulf Correctional Institution Medically Underserved Areas/Populations MUA: Low Income Population of Gulf County (continued)

Page 63 of 97

(continued)

Health Professional Shortage Areas & Medically Underserved Areas and Populations (As of December 2, 2019) HOLMES COUNTY Primary Care Low Income Population HPSA: Low Income - Holmes Correctional Facility: Holmes Correctional Institution Federally Qualified Health Center: PanCare of Florida, Inc. Rural Health Clinic: Ahmad Tariq Ismail Dental Care Low Income Population HPSA: Low Income - Holmes Correctional Facility: Holmes Correctional Institution Federally Qualified Health Center: PanCare of Florida, Inc. Rural Health Clinic: Ahmad Tariq Ismail Mental Health High Needs Geographic HPSA: Mental Health Catchment Area 2A Correctional Facility: Holmes Correctional Institution Federally Qualified Health Center: PanCare of Florida, Inc. Rural Health Clinic: Ahmad Tariq Ismail Medically Underserved Areas/Populations MUA: Low Income - Holmes County JACKSON COUNTY Primary Care Low Income Population HPSA: Low Income – Jackson County Correctional Facility: Apalachee Correctional Institution Correctional Facility: Jackson Correctional Institution Federally Qualified Health Center: PanCare of Florida, Inc. Rural Health Clinic: Internal Medicine Associates of Jackson Hospital Dental Care Low Income Population HPSA: Low Income – Jackson County Correctional Facility: Jackson Correctional Institution Federally Qualified Health Center: PanCare of Florida, Inc. Rural Health Clinic: Internal Medicine Associates of Jackson Hospital Mental Health High Needs Geographic HPSA: Mental Health Catchment Area 2A Correctional Facility: Apalachee Correctional Institution Correctional Facility: Jackson Correctional Institution Federally Qualified Health Center: PanCare of Florida, Inc. Medically Underserved Areas/Populations MUA: Low Income/ Migrant Farmworker - Jackson County

(continued)

Page 64 of 97

(continued)

Health Professional Shortage Areas & Medically Underserved Areas and Populations (As of December 2, 2019) JEFFERSON COUNTY Primary Care Geographic HPSA: Jefferson County Correctional Facility: Jefferson Correctional Institution Dental Care High Needs Geographic HPSA: Jefferson County Correctional Facility: Jefferson Correctional Institution Mental Health Low Income Population HPSA: Low Income – Jefferson County Correctional Facility: Jefferson Correctional Institution Medically Underserved Areas/Populations MUA: Low Income of Jefferson County LEON COUNTY Primary Care; Dental Health; Mental Health Low Income Population HPSA: Low Income - Leon County Federally Qualified Health Centers: Bond Community Health Center Neighborhood Medical Center, Inc. North FL Medical Centers, Inc. Medically Underserved Populations MUP: Low Income - Leon County LIBERTY COUNTY Primary Care Geographic HPSA: Liberty County Correctional Facility: Liberty Correctional Institution Federally Qualified Health Center: PanCare of Florida, Inc. Dental Care Low Income Population HPSA: Low Income - Liberty County Federally Qualified Health Center: PanCare of Florida, Inc. Mental Health Geographic HPSA: Liberty County Correctional Facility: Liberty Correctional Institution Federally Qualified Health Center: PanCare of Florida, Inc. Medically Underserved Areas/Populations Medically Underserved Area (MUA): Liberty County

(continued)

Page 65 of 97

(continued)

Health Professional Shortage Areas & Medically Underserved Areas and Populations (As of December 2, 2019) MADISON COUNTY Primary Care; Mental Health High Needs Geographic HPSA: Madison County Correctional Facility: Madison Correctional Institution Federally Qualified Health Center: North FL Medical Centers, Inc. Rural Health Clinic: Little Pines Pediatrics PLLC Dental Care Low Income Population HPSA: Low Income – Madison County Correctional Facility: Madison Correctional Institution Federally Qualified Health Center: North FL Medical Centers, Inc. Rural Health Clinic: Little Pines Pediatrics PLLC Medically Underserved Areas/Populations Medically Underserved Area (MUA): Madison Service Area TAYLOR COUNTY Primary Care; Dental Health Low Income Population HPSA: Low Income - Taylor County Correctional Facility: Taylor Correctional Institutions Federally Qualified Health Center: North FL Medical Centers, Inc Rural Health Clinic: Doctors Memorial Family Practice Rural Health Clinic: Little Pines Pediatrics PLLC Rural Health Clinic: Steinhatchee Family Medical Center Mental Health Geographic HPSA: Taylor County Correctional Facility: Taylor Correctional Institutions Federally Qualified Health Center: North FL Medical Centers, Inc Rural Health Clinic: Doctors Memorial Family Practice Rural Health Clinic: Little Pines Pediatrics PLLC Rural Health Clinic: Steinhatchee Family Medical Center Medically Underserved Areas/Populations Medically Underserved Area (MUA): Taylor County

(continued)

Page 66 of 97

(continued)

Health Professional Shortage Areas & Medically Underserved Areas and Populations (As of December 2, 2019) WAKULLA COUNTY Primary Care; Dental Health; Mental Health Geographic HPSA: Wakulla County Correctional Facility: Wakulla Correctional Institution Federally Qualified Health Center: North FL Medical Centers, Inc Rural Health Clinic: TMH Physician Partners Wakulla Medically Underserved Areas/Populations Medically Underserved Area (MUA): Wakulla County WASHINGTON COUNTY Primary Care High Needs Geographic HPSA: Washington County Correctional Facility: Northwest Florida Reception Center Federally Qualified Health Center: PanCare of Florida, Inc. Dental Care Low Income Population HPSA: Low Income - Washington County Correctional Facility: Northwest Florida Reception Center Federally Qualified Health Center: PanCare of Florida, Inc. Mental Health High Needs Geographic HPSA: Mental Health Catchment Area 2A Correctional Facility: Northwest Florida Reception Center Federally Qualified Health Center: PanCare of Florida, Inc. Medically Underserved Areas/Populations Medically Underserved Area: Washington County Source: Health Resources and Services Administration, Data Warehouse, downloaded December 2019.

Gadsden County Courthouse, Quincy

Page 67 of 97

Health Care Access and Coverage for Adults

In 2016… • …rates of adults with any type of health care insurance coverage ranged from 81.5% in Liberty, 81.7% in Holmes, 81.6% in Washington to 91.9% in Leon. Nine Big Bend counties had higher rates than Florida’s rate of 83.7%. • …rates of adults with a personal doctor exceeded 80% in all Big Bend counties except for Bay (71.2%), Jackson (77.5%), Taylor (76.7%), and Washington (75.7%). Florida’s rate was 72%. • …rates of those who could not see a doctor in the past year due to cost were highest in Washington (20.5%), Bay (18.7%), Jackson (18.1%), and Holmes (18%). Rates in the other counties ranged from 11% in Jefferson to 17.1% in Taylor and 17.2% in Liberty. Florida’s rate was 16.6%. • …more than three-fourths of adults had a medical checkup in the past year. Rates ranged from 76.3% in Washington to 82.1% in Calhoun and 82.9% in Jefferson. Florida’s rate was 76.5%.

Health Care Access and Coverage by Percentage of Adults (2016) … ...with any ...who could ...who had a type of ...who have not see a medical Area health care a personal doctor in the checkup in insurance doctor past year the past year coverage due to cost Bay 82.1% 71.2% 18.7% 79.7% Calhoun 84.3% 80.8% 15.3% 82.1% Franklin 87.9% 82.6% 14.6% 78.1% Gadsden 84.3% 85.7% 13.2% 81.5% Gulf 86.0% 83.6% 15.6% 78.9% Holmes 81.7% 83.5% 18.0% 79.0% Jackson 82.6% 77.5% 18.1% 81.2% Jefferson 87.1% 86.2% 11% 82.9% Leon 91.1% 82.3% 13.5% 80.4% Liberty 81.5% 82.9% 17.2% 78.1% Madison 88.7% 82.4% 12.7% 81.5% Taylor 86.7% 76.7% 17.1% 78.7% Wakulla 86.7% 86.1% 14.0% 80.9% Washington 81.6% 75.7% 20.5% 76.3% Florida 83.7% 72.0% 16.6% 76.5% Source: Florida Department of Health, Florida Behavioral Risk Factor Surveillance System (BRFSS) State and County Data Summary, 2016, downloaded August 2020.

Page 68 of 97

Percentage of adults with any type of health care insurance coverage, 2016 91.1%

88.7% 87.9% 87.1% 86.7% 86.7% 86.0% 84.3% 84.3% 83.7% 82.1% 82.6% 81.7% 81.5% 81.6%

Percentage of adults who could not see a doctor in the past year due to cost, 2016

20.5% 18.7% 18.0% 18.1% 17.2% 17.1% 16.6% 15.3% 15.6% 14.6% 13.5% 14.0% 13.2% 12.7% 11%

Page 69 of 97

Non-Elderly Uninsured

The data on the previous two pages summarize access and coverage data for all adults during 2016. The following table shows rates of all residents ages 0-64 who were uninsured during 2018. Holmes and Franklin had the highest rates (17.4% and 17.1% respectively). Leon had the lowest rate (11.7%) and Florida’s rate was 16.1%.

Non-Elderly Uninsured (Residents Ages 0-64), 2018 Uninsured Area Count Percent Bay 22534 15% Calhoun 1517 14.9% Franklin 1272 17.1% Gadsden 5353 15.4% Gulf 1243 12.7% Holmes 2416 17.4% Jackson 4630 14.8% Jefferson 1359 14% Leon 27929 11.7% Liberty 706 13.7% Madison 1936 15.3% Taylor 2094 14.2% Wakulla 3090 12.4% Washington 2825 15.7% Florida 2,673,659 16.1% Source: US Census Small Area Health Insurance Estimates, 2018 Estimates (for states and counties). Non-Elderly Residents (Ages 0-64) Uninsured, 2018

17.1% 17.4% 16.1% 15.0% 14.9% 15.4% 14.8% 15.3% 15.7% 14.0% 13.7% 14.2% 12.7% 11.7% 12.4%

Page 70 of 97

As shown in the graph below, nationwide, statewide, and in the counties of Big Bend, the rates of non- elderly residents uninsured trended downward between 2006 and 2015, leveled off and started to rise after 2016.

For details regarding annual rates for each area, interactive graphs and maps are available at https://www.census.gov/data- tools/demo/sahie/#/?s_statefips=12&s_stcou=12005,12013,12037,12039,12045,12059,12063,12065,12 073,12077,12079,12123,12129,12133&s_year=2018

Non-Elderly Residents (Ages 0-64) Uninsured

Source: US Census Small Area Health Insurance Estimates (for states and counties). Downloaded September 2020.

Page 71 of 97

COMMUNITY AND ENVIRONMENTAL FACTORS & PERSONAL CHOICES AND BEHAVIORS

The effects of “Community and Environmental Factors” and “Personal Choices and Behaviors” are inextricably linked and relevant to the health priorities identified in Big Bend’s community health assessments. Therefore, data collected during Florida’s 2016 Florida Behavioral Risk Factor Surveillance System (BRFSS) survey particularly relevant and are the focus of this section. Additional BRFSS data are cited earlier in this section, for example, in “Health-Related Quality of Life” and “Body Weight, Overweight and Obesity”.

What is the Florida Behavioral Risk Factor Surveillance System (BRFSS)? With the support of Florida’s County Health Departments (CHDs), the Florida Department of Health conducted the 2016 Florida BRFSS survey in each of Florida’s 67 counties. The Florida BRFSS is a statewide telephone survey that has been collecting and reporting health behavior data since 1986. This survey is the only source of state-specific, population-based estimates of the prevalence of various health conditions and related risk behaviors among Florida residents aged 18 and older. The purpose of this survey is to gather information regarding personal health and risk behaviors, selected medical conditions, and preventive health care practices among Florida adults.

The 2016 BRFSS was the fifth county-level survey to be conducted in Florida. Previous surveys were conducted in 2002, 2007, 2010, and 2013. The 2016 county-level survey was developed in collaboration with state and local representatives and designed to meet the needs of CHD programs by offering options to add county developed questions and increase sample sizes. Almost 37,000 interviews were completed statewide during the 2016 calendar year, with a target sample size of 500 completed surveys in each county.

The 2016 BRFSS survey provides counties and the state with a reliable source of data to estimate the prevalence of personal health behaviors that contribute to morbidity and mortality among adults in Florida. Responses to survey questions provide data on a variety of issues including health status, health care access, lifestyle, chronic illnesses, and disease prevention practices.

The data tables and charts in this section summarize data which are particularly relevant to some of the key health priorities identified in the community health assessments. Additional detailed information about the 2016 Florida BRFSS and state and county Data is available on the Florida Department of Health’s website at http://www.floridahealth.gov/statistics-and-data/survey-data/behavioral-risk- factor-surveillance-system/index.html .

Page 72 of 97

Influenza Vaccine

As shown in the table below and the graph on the following page, adults 65 years of age and older received a flu shot in the past year at a significantly higher rate than all adults.

For example, the rate for all adults in Bay County was 34.6% and was 51.1% for adults 65 years of age and older. The rates for all adults ranged from 29.7% in Washington to 44.1% in Calhoun. Eleven counties had rates nearly equal to or higher than the state rate of 35%.

The rates for adults 65 years of age and older ranged from 50.1% in Franklin to 66.5% in Leon. Six counties had rates higher than the state rate of 57.6%.

Percentage of adults (in 2016) … ...65 years of age ...who received a and older who Area flu shot in the past received a flu shot year in the past year Bay 34.6% 51.1% Calhoun 44.1% 62.3% Franklin 35.9% 50.1% Gadsden 41.3% 55.2% Gulf 37.9% 54.9% Holmes 38.8% 54.7% Jackson 39.7% 59.8% Jefferson 40.2% 58.2% Leon 41.0% 66.5% Liberty 41.4% 64.6% Madison 33.2% 51.7% Taylor 34.8% 50.5% Wakulla 42.9% 64.2% Washington 29.7% 50.8% Florida 35.0% 57.6% Source: Florida Department of Health, 2016 Florida Behavioral Risk Factor Surveillance System Data Report. Downloaded from Florida Department of Health CHARTS, August 2020.

Page 73 of 97

Percentage of adults… (2016)

...who received a flu shot in the past year

...65 years of age and older who received a flu shot in the past year

66.5% 64.6% 64.2% 62.3% 59.8% 58.2% 57.6% 55.2% 54.9% 54.7% 51.7% 51.1% 50.1% 50.5% 50.8%

44.1% 42.9% 41.3% 41.4% 39.7% 40.2% 41.0% 37.9% 38.8% 34.6% 35.9% 34.8% 35.0% 33.2% 29.7%

Page 74 of 97

Pneumonia Vaccine

As shown in the table below and the graph on the following page, adults 65 years of age and older received a pneumonia vaccine at a significantly higher rate than all adults.

For example, the rate for all adults in Bay County was 35.1% and was 61.7% for adults 65 years of age and older. The rates for all adults ranged from 28.7% in Washington to 49.2% in Liberty. Except for Washington, all Big Bend counties had rates higher than the state rate of 34.6%.

The rates for adults 65 years of age and older ranged from 55.5% in Washington to 76.1% in Wakulla. Eight counties had rates nearly equal to or higher than the state rate of 65.6%.

Percentage of adults (in 2016) … ...65 years of age …who have ever and older who received a have ever Area pneumonia received a vaccination pneumonia vaccination Bay 35.1% 61.7% Calhoun 46.1% 70.3% Franklin 39.1% 61.8% Gadsden 37.3% 64.4% Gulf 45.3% 68.9% Holmes 37.6% 63.8% Jackson 38.9% 67.4% Jefferson 40.7% 70.5% Leon 38.1% 74.0% Liberty 49.2% 70.7% Madison 36.6% 60.3% Taylor 36.2% 61.6% Wakulla 43.7% 76.1% Washington 28.7% 55.5% Florida 34.6% 65.6% Source: Florida Department of Health, 2016 Florida Behavioral Risk Factor Surveillance System Data Report. Downloaded from Florida Department of Health CHARTS, August 2020.

Page 75 of 97

Percentage of Adults (in 2016) …

…who have ever received a pneumonia vaccination

...65 years of age and older who have ever received a pneumonia vaccination

76.1% 74.0% 70.5% 70.7% 70.3% 68.9% 67.4% 65.6% 64.4% 63.8% 61.8% 61.7% 60.3% 61.6% 55.5%

49.2% 46.1% 45.3% 43.7% 40.7% 39.1% 38.9% 38.1% 37.3% 37.6% 36.6% 36.2% 35.1% 34.6%

28.7%

Page 76 of 97

Prevention of Unintentional Injuries

Percentage of adults (in 2016) …

...who always or ...45 years of age The rates of seatbelt use exceeded 90% in nearly always use and older who had a Area a seatbelt when fall-related injury in every county (from 91.5% in Jackson to riding in a car the past 12 months 97% in Wakulla) and the state as a whole Bay 94.4% 10.4% (95%). Calhoun 92.0% 14.9% Franklin 92.9% 11.6% Gadsden 95.3% 5.8% The rates of fall-related injury among 92.6% 16.2% Gulf adults 45 years and older in the past 12 Holmes 93.2% 15.6% months ranged from 5.8% in Gadsden to Jackson 91.5% 17.0% Jefferson 95.3% 12.2% 17% in Jackson. The state rate was 9.9%. Leon 95.9% 12.1% Liberty 91.2% 12.0%

Leon 95.9% 12.1%

Madison 95.6% 11.2% Taylor 93.9% 12.3%

Wakulla 97.0% 10.3% Washington 92.5% 15.1%

Florida 95.0% 9.9% Source: Florida Department of Health, Behavioral Risk Factor Surveillance System (BRFSS), 2016 County Level Reports. Downloaded August 2020.

Percentage of adults (in 2016) …

...who always or nearly always use a seatbelt when riding in a car ...45 years of age and older who had a fall-related injury in the past 12 months 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Page 77 of 97

Pre-Diabetes and Diabetes

Percentage of adults who have ever been told

they had (as of 2016) …

...pre- Overall, 9.4% of adults in Florida reported having ...pre- Area …diabetes diabetes or diabetes been told they had pre-diabetes and 11.8% diabetes reported they had diabetes, a total of 21.2%.

Bay 7.5% 14.1% 21.6% Calhoun 8.3% 20.4% 28.7% The rates of those who were told they had pre- Franklin 9.8% 17.0% 26.8% Gadsden 13.3% 23.4% 36.7% diabetes ranged from 7.5% in Bay to 13.3% in Gulf 11.9% 18.8% 30.7% Gadsden. Holmes 11.1% 16.5% 27.6% Jackson 10.0% 19.6% 29.6% The range of rates those who were diagnosed Jefferson 10.4% 19.3% 29.7% with diabetes ranged from 10.5% in Leon to Leon 13.1% 10.5% 23.6% Liberty 8.4% 19.0% 27.4% 23.4% in Gadsden. Madison 11.4% 20.4% 31.8% Taylor 12.8% 17.0% 29.8% The percentage of adults who have ever been 11.0% 11.6% 22.6% Wakulla told they had pre-diabetes or diabetes ranged Washington 8.7% 15.3% 24.0% Florida 9.4% 11.8% 21.2% from 21.6% in Bay to 36.7% in Gadsden. Source: Florida Department of Health, Behavioral Risk Factor Surveillance System (BRFSS), 2016 County Level Reports. Downloaded August 2020.

Percentage of adults who have ever been told they had (as of 2016) … 100% 90% 80% ...pre-diabetes …diabetes 70% 60% 50% 40% 30% 20% 10% 0%

Page 78 of 97

Fruit and Vegetable Consumption

Percentage of adults who consumed (in 2016) … ...two or more ...five or more The percentage of adults who consumed two servings of fruits servings of fruits Area or more servings of fruits or vegetables per or vegetables per or vegetables per day day day was at least twice the rates of those who consumed five or more servings per day. Bay 39.6% 13.2% Calhoun 28.6% 7.9% Franklin 41.6% 13.2% The statewide rate of adults who consumed Gadsden 41.0% 16.5% two or more servings per day was 40.3%. 26.2% 7.9% Gulf Big Bend’s rates ranged from 26.2% in Gulf Holmes 31.9% 8.0% to 44.1% in Wakulla. Jackson 35.7% 15.1%

Jefferson 37.3% 19.3% The statewide rate of adults who consumed Leon 36.9% 16.2% Liberty 29.9% 10.2% five or more servings per day was 18.3%. Madison 42.8% 17.0% Big Bend’s rates ranged from 7.9% in Taylor 28.4% 12.4% Calhoun and Gulf to 19.3% in Jefferson and Wakulla 44.1% 15.3% 19.4% in Washington. Washington 38.8% 19.4% 40.3% 18.3% Florida Source: Florida Department of Health, Behavioral Risk Factor Surveillance System (BRFSS, survey. Downloaded August 2020.

Percentage of adults who consumed (in 2016) … 100% 90% ...two or more servings of fruits or vegetables per day 80% 70% ...five or more servings of fruits or vegetables per day 60% 50% 40% 30% 20% 10% 0%

Page 79 of 97

Physical Activity

As summarized in the table below and the graphs on the following page, 29.8% of Florida’s adults reported that they were sedentary. The rates in Big Bend ranged from 23.3% in Leon to 45.1% in Liberty.

Higher percentages of adults indicated they are inactive or insufficiently active. The rates in Big Bend ranged from 50.6% in Leon to 70.3% in Liberty. Florida’s rate was 56.7%.

Less than half of Florida’s adults reported meeting aerobic recommendations (44.8%). Rates in Big Bend ranged from 32.7% in Calhoun to 51.6% in Leon.

The rates of adults meeting muscle strengthening recommendations were lower. Florida’s rate was 38.2% and the rates in Big Bend ranged from 24.4% in Liberty to 38.8% in Leon.

Percentage of adults who (in 2016) ... …were inactive …met muscle …were …met aerobic Area or insufficiently strengthening sedentary recommendations active recommendations

Bay 37.0% 60.6% 41.0% 35.6% Calhoun 45.0% 70.0% 32.7% 34.1% Franklin 32.8% 56.2% 45.1% 27.1% Gadsden 35.8% 63.4% 38.7% 31.7% Gulf 38.9% 58.7% 42.5% 27.4% Holmes 41.0% 63.4% 38.2% 29.3% Jackson 42.6% 64.7% 37.6% 26.2% Jefferson 29.9% 54.0% 48.4% 31.4% Leon 23.3% 50.6% 51.6% 38.8% Liberty 45.1% 70.3% 30.9% 24.4% Madison 35.5% 57.8% 43.4% 27.6% Taylor 42.1% 62.0% 39.4% 35.4% Wakulla 32.5% 54.8% 47.9% 33.3% Washington 39.4% 57.8% 43.8% 27.5% Florida 29.8% 56.7% 44.8% 38.2% Source: Florida Department of Health, Behavioral Risk Factor Surveillance System (BRFSS), 2016 County Level Reports. Downloaded from Florida Department of Health CHARTS, August 2020.

Page 80 of 97

Percentage of adults who (in 2016) ...

100% 90% …were sedentary …were inactive or insufficiently active 80% 70% 60% 50% 40% 30% 20% 10% 0%

Percentage of adults who (in 2016) ... (2016) 100% 90% …met aerobic recommendations …met muscle strengthening recommendations 80% 70% 60% 50% 40% 30% 20% 10% 0%

Page 81 of 97

Tobacco Use and Exposure

In 2016, The rates of current adult smokers in Big Bend ranged from 11.5% in Jefferson to 24% in Jackson. Ten Big Bend counties had higher rates than the state’s rate of 15.5%.

The rates of former smokers in the Big Bend ranged from 20.1% in Gadsden to 38.4% in Franklin. Florida’s rate was 26.5%.

A majority of adults reported that they had never smoked, from 47.2% in Franklin and Taylor to 66.4% in Gadsden and 58% statewide.

Percentage of adults who (in 2016) …

...were current smokers who ...were ...were ...had tried to quit Area current former never smoking at least smokers smokers smoked once in the past year Bay 17.1% 28.9% 53.9% 52.6% Calhoun 20.3% 24.9% 54.8% 71.7% Franklin 14.4% 38.4% 47.2% 52.0% Gadsden 13.5% 20.1% 66.4% 51.4% Gulf 15.7% 32.4% 52.0% 60.0% Holmes 20.2% 26.0% 53.8% 61.1% Jackson 24.0% 26.5% 49.5% 63.5% Jefferson 11.5% 30.0% 58.5% 55.9% Leon 12.8% 26.7% 60.5% 56.5% Liberty 18.4% 25.6% 56.1% 50.1% Madison 16.2% 27.5% 56.2% 55.7% Taylor 21.6% 31.3% 47.2% 61.7% Wakulla 16.6% 32.7% 50.7% 62.7% Washington 20.5% 23.8% 55.7% 58.9% Florida 15.5% 26.5% 58.0% 62.1% Source: Florida Department of Health, Behavioral Risk Factor Surveillance System (BRFSS), 2016 County Level Reports. Downloaded from Florida Department of Health CHARTS, August 2020.

Page 82 of 97

Percentage of adults who (in 2016) were current smokers, former smokers, or had never smoked 100% …were current smokers ... were former smokers ...had never smoked 80%

60%

40%

20%

The majority of adults who were current smokers reported that they tried to quit smoking at least once in the past year. The highest percentage was in Calhoun (71.7%) and the lowest was Liberty (50.1%). Nearly two-thirds (62.1%) of current smokers in Florida reported that they tried to quit.

Percentage of adults who (in 2016) were current smokers who tried to quit smoking at least once in the past year 100%

90%

80% 71.7% 70% 63.5% 61.7%62.7% 62.1% 60.0% 61.1% 58.9% 60% 55.9% 56.5% 55.7% 52.6% 52.0% 51.4% 50.1% 50%

40%

30%

20%

10%

Page 83 of 97

Percentage of adults who (in 2016) …

...were ...were ...had 4.7% of Florida’s residents reported that current e- former e- never used Area cigarette cigarette e- they were current e-cigarette users. The users users cigarettes rates in Big Bend ranged from 2.6% in Bay 3.9% 16.6% 79.4% Gadsden to 6.9% in Taylor. Calhoun 4.0% 14.3% 81.7%

Franklin 3.8% 13.4% 82.8% Gadsden 2.6% 7.4% 90.0% 15.5% of Florida’s residents reported that Gulf 5.9% 12.6% 81.5% they were former e-cigarette users. Big Holmes 5.1% 15.4% 79.5% Bends’ rates ranged from 7% to 18.9%.

Jackson 6.6% 15.1% 78.3% Jefferson 2.0% 7.0% 91.0% The majority of residents in Florida and Big Leon 4.4% 14.1% 81.6% Bend have never used e-cigarettes. The Liberty 4.9% 11.3% 83.7% Madison 3.6% 11.6% 84.7% state rate was 79.8%. Jefferson had the Taylor 6.9% 14.4% 78.7% highest rate of 91% and Washington had the Wakulla 4.3% 10.6% 85.1% lowest (78.2%). Washington 2.9% 18.9% 78.2%

Florida 4.7% 15.5% 79.8%

Source: Florida Department of Health, Behavioral Risk Factor Surveillance System (BRFSS), 2016 County Level Reports. Downloaded August 2020.

Percentage of adults who (in 2016) were current or former e-cigarette smokers or who never used e-cigarettes

…were current e-cigarette users …were former e-cigarette users ...had never used e-cigarettes

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Page 84 of 97

Alcohol and Other Drug Abuse

Percentage of adults who (in 2016) …

...engaged in ...used marijuana or As shown in the table to the left and the Area heavy or binge hashish during the graph below, 17.5% of Florida’s adults drinking past 30 days reported that they engage in heavy or Bay 17.7% 6.3% Calhoun 9.3% 4.3% binge drinking. Rates in the Big Bend Franklin 22.8% 6.7% ranged from 8.4% in Liberty to 22.8% in Gadsden 12.6% 4.5% Franklin. Gulf 16.0% 8.2%

Holmes 10.6% 3.3% Jackson 11.8% 6.1% Rates of marijuana or hashish use during Jefferson 8.5% 3.5% the previous 30 days were significantly Leon 20.4% 8.3% lower, ranging from 3.3% in Holmes to Liberty 8.4% 5.4% 8.3% in Leon. Florida’s rate was 7.4%. Madison 11.6% 3.4% Taylor 12.9% 4.7% Wakulla 16.3% 5.1%

Washington 9.2% 4.4% Florida 17.5% 7.4% Source: Florida Department of Health, Behavioral Risk Factor Surveillance System (BRFSS), 2016 County Level Reports. Downloaded August 2020.

Percentage of adults who (in 2016) engaged in heavy or binge drinking or used marijuana or hashish during the past 30 days 100% 90% …engaged in heavy or binge drinking 80% 70% ...used marijuana or hashish during the past 30 days 60% 50% 40% 30% 20% 10% 0%

Page 85 of 97

Data from Florida Department of Health, Opioid Use Dashboard

The tables and graphs on the following pages summarize selected indicators regarding opioid and other drug use as compiled by the Florida Department of Health. Counts and rates vary significantly from one county to another and with the state as a whole.

In 2018, the annual age-adjusted death rate per 100,000 persons for opioid overdose was 18.7 in Florida. In Big Bend, the rates ranged from 0 in Franklin, Gadsden, Jackson, Liberty, and Taylor, to 12.2 in Madison, 12.5 in Bay, and 12.9 in Holmes.

1n 2018, the annual age-adjusted death rate per 100,000 persons for all drug overdose was 24.5 in Florida. In Big Bend, the rates ranged from 0 in Liberty to 43.4 in Holmes.

Keeping in mind that in 2018, the total population of the Big Bend was 754,190 (3.5% of Florida’s population of 21,299,325), Big Bend had… • …45 opioid overdose deaths, 1.2% of Florida’s 3,727 cases. Bay had the highest number of deaths (23), followed by Leon (12). • …111 drug overdose deaths, 2.2% of Florida’s 4,977 cases. Bay had the highest number (38), followed by Leon (26), Jackson (12), and Holmes (10). • …217 suspected non-fatal opioid-involved overdoses in Big Bend, 1.8% of the 11,820 cases in Florida. Bay had the highest number of cases (114), followed by Leon (48), Taylor (18), and Jackson (12). • …929 suspected non-fatal all drug overdoses in Big Bend, 2.6% of the 35,102 cases in Florida. Bay had the highest number of cases (268) followed by Leon (219), Taylor (56), and Gadsden (43). • …8,031 drug arrests, 6% of the 134,396 drug arrests in Florida. Bay had the highest number of arrests (3,144) followed by Leon (2,159). • …305 juvenile drug arrests, 5.6% of the 5,404 juvenile drug arrests in Florida. Bay and Leon had the highest number of arrests (117 and 102, respectively).

Page 86 of 97

Overdose Deaths Overdose Deaths, 2018 Opioid overdose Drug overdose Opioid Drug annual age- annual age- Area overdose overdose adjusted death rate adjusted death deaths1 deaths2 per 100,000 rate per 100,000 persons3 persons4 Bay 23 38 12.5 20.7 Calhoun 1 2 6.2 12.3 Franklin 0 1 0 4.9 Gadsden 0 1 0 2.1 Gulf 0 2 7.8 21.3 Holmes 3 10 12.9 43.4 Jackson 2 12 4 24.7 Jefferson 0 1 0 6.4 Leon 12 26 4.6 10.3 Liberty 0 0 0 0 Madison 2 4 12.2 22.3 Taylor 0 2 0 7 Wakulla 1 7 2.1 16.4 Washington 1 5 3.9 17.8 Big Bend 45 111 n/a n/a Florida 3,727 4,977 18.7 24.5 1, 2, 3, 4 See Case Definitions on Page 90. Source: Source: Florida Department of Health, Opioid Use Dashboard, 2018. Downloaded August 2020.

Overdose Death Rates, 2018

Opioid overdose annual age-adjusted death rate per 100,000 persons 50 Drug overdose annual age-adjusted death rate per 100,000 persons 45 40 35 30 25 20 15 10 5 0

Page 87 of 97

Suspected Non-Fatal Overdoses and Annual Drug Arrests

Suspected Non-Fatal Overdoses, 2018 Suspected non-fatal Suspected non-fatal all drug Area opioid-involved overdose5 overdose6 Bay 114 268 Calhoun 2 3 Franklin 0 0 Gadsden 6 43 Gulf 4 22 Holmes 0 9 Jackson 12 18 Jefferson 2 24 Leon 48 219 Liberty 0 0 Madison 2 17 Taylor 18 56 Wakulla 4 22 Washington 5 28 Big Bend 217 929 Florida 11,820 35,102 5,6 See Case Definitions on Page 90. Source: Source: Florida Department of Health, Opioid Use Dashboard, 2018. Downloaded August 2020.

Annual Drug Arrests, 2018 Area Drug arrests7 Adult drug arrests8 Juvenile drug arrests9 Bay 3,144 3,027 117 Calhoun 158 152 6 Franklin 160 155 5 Gadsden 306 304 2 Gulf 161 157 4 Holmes 299 288 11 Jackson 400 397 3 Jefferson 105 99 6 Leon 2,159 2,057 102 Liberty 69 68 1 Madison 119 114 5 Taylor 288 277 11 Wakulla 257 244 13 Washington 406 387 19 Big Bend 8,031 7,726 305 Florida 134,396 128,992 5,404 7,8,9 See Case Definitions on Page 90. Source: Source: Florida Department of Health, Opioid Use Dashboard, 2018. Downloaded August 2020. Page 88 of 97

Opioid Use Dashboard Case Definitions (see data in tables on Pages 88-89) Health Status and Quality of Life 1 Opioids identified as the cause of death by Florida Medical Examiners by county where death occurred, data supplied by Florida Department of Law Enforcement. 2 Drugs identified as the cause of death by Florida Medical Examiners by county where death occurred, data supplied by the Florida Department of Law Enforcement. 3 Opioids identified as the cause of death by Florida Medical Examiners by county where death occurred, data supplied by Florida Department of Law Enforcement. 4 Drugs identified as the cause of death by Florida Medical Examiners by county where death occurred, data supplied by the Florida Department of Law Enforcement. 5 Patients with an identified non-fatal opioid overdose during an emergency medical service transport, data from Florida’s EMSTARS database which includes 90% of Florida's prehospital emergency transports. These data come from the Florida Enhanced State Opioid Overdose Surveillance Program Dashboard County Report. 6 Patients with an identified non-fatal drug overdose during an emergency medical service transport, data from Florida's EMSTARS database which includes 90% of Florida's prehospital emergency transports. These data come from the Florida Enhanced State Opioid Overdose Surveillance Program Dashboard County Report. Drug-related Consequences 7 Arrests attributed to possession or sale of illegal drugs. Data are from the Florida Department of Law Enforcement. 8 Arrests of persons 18 and over attributed to possession or sale of illegal drugs. Data are from the Florida Department of Law Enforcement. 9 Arrests of persons under 18 attributed to possession or sale of illegal drugs. Data are from the Florida Department of Law Enforcement. Source: Florida Department of Health, Opioid Use Dashboard 2018, data downloaded May 6, 2020.

Port St. Joe, Gulf County

Page 89 of 97

Violent Crimes were reported on the Florida Department of Health CHARTS’ website

Domestic Violence

Reported Domestic Violence Offenses, 2018 Rate Per Area Count 100,000 In 2018, the rate of reported domestic violence Population Bay 1,342 740.6 offenses in Florida was 503.4 per 100,000 population Calhoun 39 258.4 lower than the overall rate of 548.7 in Big Bend. Franklin 76 632.9 Gadsden 159 332.4 Liberty and Wakulla had the lowest rates (134.6 and Gulf 73 442.5 Holmes 109 541.4 140.9 respectively). Taylor had the highest rate Jackson 174 345.0 (996.3) followed by Bay (740.6). Jefferson 70 475.1

Leon 1,610 550.7 Liberty 12 134.6 Madison 98 503.3 Taylor 222 996.3

Wakulla 45 140.9 Washington 109 433.8

Big Bend 4,138 548.7

Florida 104,914 503.4 Source: Florida Department of Health, CHARTS, Downloaded June 2020. Reported Domestic Violence Offenses Rate Per 100,000 Population, 2018 1100 996.3 1000 900 800 740.6 700 632.9 600 541.4 550.7 548.7 475.1 503.3 503.4 500 442.5 433.8 400 332.4 345.0 300 258.4 200 134.6 140.9 100 0

Page 90 of 97

Aggravated Assault

Aggravated Assault, 2018

Rate Per Area Count 100,000 In 2018, the rate of reported aggravated assault Population offenses in Florida was 264.8 per 100,000 population, Bay 583 319.9 lower than the overall rate of 322.9 in Big Bend. Calhoun 28 182.8

Franklin 52 420.7 Liberty, Washington, and Wakulla had the lowest Gadsden 165 342.5 Gulf 43 264.9 rates (68.3, 142.6, and 145.3, respectively) and Taylor Holmes 52 254.9 had the highest (992.9) followed by Madison (628.2), Jackson 139 274.2 and Jefferson (502.5)

Jefferson 74 502.5

Leon 1,167 402.1 Liberty 6 68.3 Madison 122 628.2

Taylor 221 992.9

Wakulla 47 145.3 Washington 36 142.6

Big Bend 2,735 322.9 Florida 55,491 264.8

Source: Florida Department of Health, CHARTS, Downloaded June 2020.

Aggravated Assault, Rates Per 100,000 Population, 2018

1200 992.9 1000

800 628.2 600 502.5 420.7 402.1 400 319.9 342.5 322.9 264.9 254.9 274.2 264.8 182.8 200 145.3 142.6 68.3 0

Page 91 of 97

Forcible Sex Offenses

Forcible Sex Offenses, 2018 In 2018, the overall rate of forcible sex offenses was Rate Per Area Count 100,000 higher in the Big Bend (83.1) than in Florida as a whole Population (56.8). Bay 122 11.9 Calhoun 1 6.5 Leon’s rate of 124.4 was, by far, the highest. Other Franklin 3 24.3 Gadsden 35 72.7 counties with rates higher than the state rate were Gulf 4 24.6 Taylor (89.9), Gadsden (72.7), Wakulla (68), and Holmes 3 14.7 Madison (66.9). Jackson 28 55.2 Jefferson 5 34.0 Leon 361 124.4 Big Bend had a total of 627 forcible sex offenses, 5.3% Liberty 4 45.6 of Florida’s 11,907 cases. Madison 13 66.9 Taylor 20 89.9

Wakulla 22 68.0

Washington 6 23.8 Big Bend 627 83.1

Florida 11,907 56.8 Source: Florida Department of Health, CHARTS, Downloaded June 2020.

Forcible Sex Offenses, 2018 140 124.4 120

100 89.9 83.1 80 72.7 66.9 68.0 56.8 60 55.2 45.6 40 34.0 24.3 24.6 23.8 20 11.9 14.7 6.5 0

Page 92 of 97

Homicide and Murder

Homicide and Murder, 2018 Homicide Murder In 2018, the rate of homicide in Florida was Rate Per Rate Per Area 6.6 per 100,000 population, slightly lower Count 100,000 Count 100,000 Population Population than Big Bend’s overall rate (6.9). Bay 11 5.3 7 3.8 Calhoun 2 11.4 2 13.1 Gulf, Jackson, Calhoun, and Liberty had the Franklin 0 0 1 8.1 highest rates (16.4, 12.8, 11.4, and 11.4, Gadsden 4 9.3 4 8.3 respectively). Franklin, Madison, Bay, and Gulf 2 16.4 0 0 Holmes 1 5.3 0 0 Holmes had the lowest rates (0,0, and 5.3, Jackson 6 12.8 4 7.9 and 5.3, respectively). Jefferson 1 9.7 2 13.6

Leon 18 5.5 20 6.9 The murder rate per 100,000 population in Liberty 1 11.4 0 0 Madison 0 0 0 0 Florida was 5.3, lower than Big Bend’s rate of Taylor 2 8.3 3 13.5 6.0. Big Bend’s highest rates were in Jefferson, Wakulla 2 6.0 1 3.1 Taylor, and Calhoun (13.6, 13.5, and 13.1, Washington 2 8.4 1 4.0 Big Bend 52 6.9 45 6.0 respectively). Four counties (Gulf, Holmes, Florida 1,311 6.6 1,107 5.3 Liberty, and Madison) had rates of 0. Source: Florida Department of Health, CHARTS, Downloaded August 2020. Homicide and Murder Rates Per 100,000 Population, 2018

20 Homicide Rate Per 100,000 Population Murder Rate Per 100,000 Population

18 16.4 16 13.6 13.5 14 13.1 12.8 12 11.4 11.4 9.3 9.7 10 8.3 8.4 8.1 8.3 7.9 8 6.9 6.9 6.6 6.0 6.0 6 5.3 5.3 5.5 5.3 3.8 4.0 4 3.1 2 0 0 0 0 0 0 0

Page 93 of 97

Suicide Suicide, 2018

Rate Per In 2018, Florida’s suicide rate was 15.3 per 100,000 Area Count 100,000 population, lower than the overall rate in Big Bend of Population 18.6.

Bay 51 23.9 Madison had the lowest rate of 5, Washington the highest Calhoun 2 14.3 (33.6).

Franklin 2 11.6 Six counties had rates lower than the state, eight had Gadsden 7 17.2 rates higher than the state. Gulf 3 15.8 Holmes 3 11.9 Overall, Big Bend had 140 suicides, 3.9% of the 3,552 Jackson 11 20.1 suicides in Florida. Jefferson 2 13.4 Leon 34 12.3

Liberty 2 22.0

Madison 1 5.0 Taylor 6 21.2 Wakulla 7 22.0 Washington 9 33.6 Big Bend 140 18.6

Florida 3,552 15.3

Source: Florida Department of Health,

CHARTS, Downloaded August 2020.

Suicide Rates Per 100,000 Population, 2018 40

35 33.6

30 23.9 25 22.0 22.0 20.1 21.2 18.6 20 17.2 15.8 15.3 14.3 13.4 15 11.6 11.9 12.3 10 5.0 5

Page 94 of 97

VII. SUMMARY

The following Venn Diagram, which was introduced in Section V, illustrates the over-lapping nature of the factors which influence Community Health & Wellbeing. As the data in this report suggests, these factors include complex and inextricably interdependent issues.

Determining Factors that Generally Affect Community Health and Wellbeing

Demographic & Socio- Economic Factors

Health Personal Community Status & Choices & Health & Health Behavior Wellbeing Care

Community & Environmental Factors

While the various community health assessments used different verbiage to describe the priority health issues in their communities, all assessments identified variations of these factors.

The extensive work documented in the fourteen community health assessments referenced in this report represents the kind of diligent and comprehensive effort needed to improve the health and wellbeing of all residents and all communities in Big Bend Florida. All the community health assessments recognized that many factors influence and contribute to all the dimensions of community health. Next steps include developing community health improvement plans and implementing those plans to mitigate the barriers to and promoting comprehensive community health and wellbeing.

We at Big Bend Health Council hope that this document will be used to help make those efforts more fruitful and effective.

The following highlights of Florida’s SHIP priorities and the corresponding health priorities identified in the community health assessments of the Big Bend were introduced in Section V and are repeated here.

Page 95 of 97

Highlights of Health Priorities Identified by the Counties of the Big Bend

Priority 3: Immunizations and Influenza No counties prioritized issues specifically related to immunizations and influenza.

Priority 4: Injury, Safety and Violence Holmes was the only county in which Priority 4, specifically, domestic violence, was identified as a priority.

Page 96 of 97

Priority 7: Sexually Transmitted Disease (STDs) – Includes Other Infectious Diseases Leon and Taylor were the only counties that mentioned STDs or HIV/AIDS as priority health issues.

Priority 8: Chronic Diseases & Conditions – Includes Tobacco-Related Illnesses and Cancer Bay, Holmes, Jackson, Jefferson, Madison, and Washington identified chronic diseases & conditions as health priorities in their counties. Examples identified included heart disease; melanoma; diabetes-related maternal and infant outcomes; chronic disease prevention (including diabetes, high blood pressure, and heart disease); tobacco use; chronic disease and lifestyle behaviors; cancer screenings; diabetes prevention and education; breast, prostate, and colon cancer screenings; obesity and chronic diseases (also mentioned under Priority 5 above); implement the National Diabetes Prevention Program.

The extensive work documented in the fourteen community health assessments referenced in this report represents the kind of diligent and comprehensive effort needed to improve the health and wellbeing of all residents and all communities in Big Bend Florida. All the assessments acknowledged that many factors influence and contribute to all the dimensions of community health. Next steps include developing and implementing community health improvement plans to mitigate barriers and promote comprehensive community health and wellbeing. We at Big Bend Health Council hope that this document will be used to help make those efforts more fruitful and effective.

Page 97 of 97