Upper Peninsula Community Health Needs Assessment 2018 Reporting on the Health Status of Michigan’s Upper Peninsula Residents Second Edition 2 2018 Upper Peninsula Community Health Needs Assessment Western U.P. Health Department Upper Peninsula Community Health Needs Assessment 2018 Second Edition Downloadable at www.wupdhd.org/upchna Western U.P. Health Department 2018 Upper Peninsula Community Health Needs Assessment 3 "Si Quaeris Peninsulam Amoenam Circumspice" (Michigan’s Motto: If you seek a pleasant peninsula, look about you) Published in Auguest 2018 by: Western Upper Peninsula Health Department 540 Depot Street, Hancock, MI 49930 906-482-7382, www.westernuphealth.org The data and analyses in this report may be excerpted and used for the public good with appropriate attribution, e.g. “…from the 2018 Upper Peninsula Community Health Needs Assessment.” 4 2018 Upper Peninsula Community Health Needs Assessment Western U.P. Health Department Partner Acknowledgements This report brings together data and analysis from a regional community health needs assessment led by Western U.P. Health Department in conjunction with all other U.P. local public health departments and 26 additional partners who care deeply about the health of the Upper Peninsula’s more than 300,000 residents. All partners, including the project’s largest funder, the Michigan Health Endowment Fund, have contributed their energy, ideas and dollars to make this regional health needs assessment possible on an unprecedented scale – across 15 counties. The partners are listed alphabetically below: Aspirus Iron River Hospital Munising Memorial Hospital Aspirus Ironwood Hospital Northcare Network Aspirus Keweenaw Hospital Northpointe Behavioral Health Systems Aspirus Ontonagon Hospital OSF St. Francis Hospital Central U.P. Planning & Development Pathways Community Mental Health Regional Commission Public Health of Delta & Menominee Counties Chippewa County Health Department Schoolcraft Memorial Hospital Copper Country Community Mental Health Superior Health Foundation Dickinson County Healthcare System Upper Great Lakes Family Health Center Dickinson-Iron District Health Department Upper Peninsula Health Care Solutions Gogebic County Community Mental Health Upper Peninsula Health Group Helen Newberry Joy Hospital Upper Peninsula Health Plan Luce-Mackinac-Alger-Schoolcraft District U.P. Health System-Bell Health Department U.P. Health System-Marquette Marquette County Health Department U.P. Health System-Portage Michigan Health Endowment Fund War Memorial Hospital Michigan Technological University Western U.P. Health Department This report is intended to inform health practitioners, planners, policymakers, and the public. It can be read as a snapshot of the region’s health status and used to identify priorities for community health improvement. If knowledge is power, it is hoped that this report will empower citizens and health care professionals alike to work effectively for improved health and wellbeing in the Upper Peninsula. Western U.P. Health Department 2018 Upper Peninsula Community Health Needs Assessment 5 6 2018 Upper Peninsula Community Health Needs Assessment Western U.P. Health Department TABLE OF CONTENTS Partner Acknowledgements 5 Table of Contents 7 Executive Summary 9 Introduction 13 Demographics 17 Access to Care 29 Maternal and Child Health 39 Adolescent Risk Factors 67 Immunization 101 Infectious Disease 121 Chronic Disease and Mortality 145 Mental Health 167 Substance Abuse 177 Regional Adult Health Survey 195 Community Health Issues and Priorities 285 County Health Data Dashboards 319 Western U.P. Health Department 2018 Upper Peninsula Community Health Needs Assessment 7 8 2018 Upper Peninsula Community Health Needs Assessment Western U.P. Health Department EXECUTIVE SUMMARY Introduction The 2018 Upper Peninsula Community Health Needs Assessment (CHNA) is a bold new initiative led by the six local health departments serving the 310,000 residents of Michigan’s Upper Peninsula region and their 26 community partners. For the first time, all U.P. counties will not only have a robust assessment in hand, they will also have the ability to look at similarities and differences across the region. The CHNA will provide U.P. policy makers, stakeholders and residents with a vast pool of data which can serve as a springboard for a thoughtful, data-driven Community Health Improvement Plan (CHIP). Not only does the current data tell us where we are on a number of community health issues; it can also serve as a baseline against which to measure the progress made as communities implement program and policy changes. On-going CHNA, done every three years, will inform regional efforts for decades to come. Social Determinants of Health Historically, when we talked about health in a community, we examined rates of diabetes or cancer, heart disease or stroke. We also looked at personal health behaviors such as tobacco use, physical activity and healthy eating, and their impact on overall health. It is becoming increasingly clear, however, that as important as these factors are to health outcomes, focusing on specific disease prevention and management alone will not be enough to create the healthy communities we desire. Disease and health do not develop in a vacuum. To a large extent, the conditions of the environments in which we live and work, go to school and age, determine our quality of life and health outcomes. These conditions are called Social Determinants of Health (SDOH), and they explain why some people face a more difficult challenge in achieving and maintaining good health. The diagram below, from the Centers for Disease Control and Prevention (CDC), outlines the five key areas of SDOH. Western U.P. Health Department 2018 Upper Peninsula Community Health Needs Assessment 9 Per the CDC, each of these five determinant areas reflects a number of key issues that are underlying risk or protective factors in the arena of SDOH. Economic Stability: . Employment . Food Insecurity . Housing Instability . Poverty Education: . Early Childhood Education and Development . Enrollment in Higher Education . High School Graduation . Language and Literacy Social and Community Context: . Civic Participation . Discrimination . Incarceration . Social Cohesion Health and Health Care: . Access to Health Care . Access to Primary Care . Health Literacy Neighborhood and Built Environment: . Access to Foods that Support Healthy Eating Patterns . Crime and Violence . Environmental Conditions . Quality of Housing Another way to think about this is that the neighborhood you live in, whether you experience racism or other discrimination, have access to a decent job or quality education, are safe walking down your sidewalk or even have a sidewalk upon which to travel, may be as important or even more important to your lifelong health than whether you have a doctor to call when you are sick. Differences in SDOH lead to health disparities not only between individuals but also between large groups. One example is the markedly higher infant mortality rate for African American babies compared to non-Hispanic Caucasian babies. Another is the poorer long-term health for those who experience multiple adverse childhood experiences (discussed in the Maternal and Child Health chapter). Health equity for all will require understanding and addressing Social Determinants of Health. This is why, in this first iteration of our U.P. wide health needs assessment, you will find data on areas like poverty, education, employment and childhood abuse and neglect as well as access to health care, health insurance, chronic disease rates and tobacco use. 10 2018 Upper Peninsula Community Health Needs Assessment Western U.P. Health Department Key Themes Although this assessment provides a wealth of information on many varied issues related to health, a few key themes are seen throughout the data and emerge as a focus for our region: 1. The impact of an aging population: In the Upper Peninsula, nearly 20 percent of the non- incarcerated population is age 65 or older, compared with 15 percent statewide. In Keweenaw and Ontonagon Counties, greater than 30 percent of the population is 65 years or older. Since the chronic disease burden is higher in older adults, and aging adults have greater needs for home health services, assisted living and nursing home care, the shifting of a community’s age distribution toward older cohorts has profound implications on the needs for health care and elder services. 2. The importance of prevention: Chronic diseases such as cancer, heart disease, diabetes and stroke are the leading causes of death in the U.P. and across much of the globe. Cancer and heart disease alone account for about half of all U.P. deaths. They are also largely preventable. Curtailing tobacco use, obesity and the abuse of alcohol and other drugs alone would dramatically reduce morbidity and mortality among U.P. residents. As noted elsewhere in this document, tobacco is still the leading preventable cause of death in the U.S., but the emerging opioid epidemic is taking its toll in the region through its broad impact on maternal and child health, child abuse and neglect, neonatal drug addiction/withdrawal, incarceration and employment. 3. The powerful correlation between socio-economic status and health: Although the U.P. spans over 16,000 square miles and comprises approximately one third of Michigan’s land mass, its residents are more alike than they are different. In fact, the reader will note that income