Community Health Assessment Report & Action Plan

Community Health Assessment Report & Action Plan 2011-2012 Community Health Assessment ReportContentsI. Executive Summary 2II. Focus Areas - Health Service Actions 4 - Demographics 7 - Income and Employment 9 - Insurance Status 13 - Vital Statistics 15 - Health Statistics 17 - Child-related issues 27 - Aging Population 37 - Healthcare Access 43 - Health Behaviors and Risk 46 - Social, Economic, and Environmental Factors 48III. Community Health Council Stakeholder Survey Results 52IV. Community Health Council Action Plan 55V. Memorial Health System Action Plan 57VI. Reference List/Data Sources 592 Note: All years in report represent year of data collection.3 Executive SummaryPurpose The purpose of this report was to collect and analyze relevant data to prioritize community needs so that the Community Health Council, and its members, can develop and implement action plans to meet those needs and improve current programs and systems.Data Sources Multiple data sources were used to construct this report with varied data collection time periods and methodologies. All were chosen based on data integrity, sponsoring agency, and repetition of study. The one source that differs somewhat is the Local Public Health System Performance Assessment from the National Public Health Performance Standards Program. The results are based on local health experts’ completion of the assessment. Every effort was made to cross reference data points and integrate findings in the present report. All sources are listed in the reference list on page 59.Focus Areas Within the 11 focus areas the following trends, or notable findings, emerged: Monitoring Health Status and Evaluating Services presented the greatest opportunities for community health service actions  Washington County population is declining and aging  Per capita income in Washington County has increased although a segment of the population lives below the poverty level with the poorest group being children under the age of 5 and a larger percentage of those under age 18 living in poverty than at the state and federal levels  OWF and TANF assistance to children increased while it has decreased to adults in Washington County  Food assistance has trended upward  The number of uninsured adults and children has increased  Washington County has a higher infant mortality rate than the state  Leading causes of death in Washington County include cancer and heart disease with the highest cancer site incidents and mortality rates being lung, breast, and prostate; Washington County residents lag the state in PAP tests, mammography and colonoscopies (but not PSA testing)  Washington County residents are more likely to have had a heart attack, heart diseases or a stroke than the state average and less than 50% recognize symptoms of heart attack and stroke  There has been an increase in maternal smoking during pregnancy  Child custody rates have risen and reunification with parents has simultaneously decreased somewhat  Washington County has higher rates of abuse and neglect of children of all ages than the state4  Our population is aging and the incidence and severity of their disabilities is increasing with the largest area being physical disability  Due to the lower educational attainment by Washington County’s older population they may be more economically vulnerable  Preventable hospitalizations are higher for residents with uncontrolled diabetes pneumonia and COPD than the state  Washington County’s ratio of physicians to population is higher than the state (more residents per physician)  Washington County health risk behaviors include a higher incidence of smoking and less exercise than the state  Washington County ranks 82nd out of 88 counties in Ohio for physical environmental (quality and built environment).  Washington County ranks 72nd out of 88 counties in Ohio for clinical care (quality and access).  Washington County ranks 62nd out of 88 counties in Ohio for health behaviors (tobacco use, diet/exercise, alcohol use, unsafe sex).  Washington County ranks 22nd out of 88 counties in Ohio for social/economic factors (education, employment, income, family/social support, community safety).5 Focus AreasHealth Service Actions1Purpose of National Public Health Performance Standards Program (NPHPSP): To improve the practice of public health and performance of public health systems Guide state and local jurisdictions in evaluating current performance against optimal standards Essential Public Health Services (EPHS) – include 2-4 model standards Model Standards – describe key aspects of optimally performing health systemTen EPHS and the respective model standards:1. Monitor Health Status to Identify Community Health Problems Population-Based Community Health Profile (CHP) Access to and Utilization of Current Technology Maintenance of Population Health Registries2. Diagnose and Investigate Health Problems and Health Hazards Identification and Surveillance of Health Threats Investigation and Response to Public Health Threats and Emergencies Laboratory Support for Investigation of Health Threats3. Inform, Educate and Empower People about Health Issues Health Education and Promotion Health Communication Risk Communication6 4. Mobilize Community Partnerships to Identify and Solve Health Problems Constituency Development Community Partnerships5. Develop Policies and Plans that Support Individual and Community Health Efforts Government Presence at Local Level Public Health Policy Development Community Health Improvement Process Plan for Public Health Emergencies6. Enforce Laws and Regulations that Protect Health and Ensure Safety Review and Evaluate Laws, Regulations, and Ordinances Involvement in the Improvement of Laws, Regulations, and Ordinances Enforce Laws, Regulations, and Ordinances7. Link People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable Identification of Populations with Barriers to Personal Health Services Assuring the Linkage of People to Personal Health Services8. Assure a Competent Public and Personal Health Care Workforce Workforce Assessment Planning, and Development Public Health Workforce Standards Life-Long Learning Through Continuing Education, Training, and Mentoring Public Health Leadership Development7 9. Evaluate Effectiveness, Accessibility, and Quality of Personal and Population- Based Health Services Evaluation of Population-Based Health Services Evaluation of Personal Health Care Services Evaluation of the Local Public Health System10. Research for New Insights and Innovative Solutions to Health Problems Fostering Innovation Linkage with Institutions of Higher Learning and/or Research Capacity to Initiate or Participate in Research*Bar graph represents overall performance scores for each EPHS on 100-point scale. Evaluation of EPHS Activity NO ACTIVITY 0% or absolutely no activity. MINIMAL Greater than zero, but no more than 25% of the activity ACTIVITY described within the question is met. MODERATE Greater than 25%, but no more than 50% of the activity ACTIVITY described within the question is met. SIGNIFICANT Greater than 50%, but no more than 75% of the activity ACTIVITY described within the question is met. OPTIMAL Greater than 75% of the activity described within the ACTIVITY question is met.8 9 DemographicsPopulation2,3,4,5 - Washington County is the 39th most populous of the 88 counties in Ohio. The residents of Washington County account for 0.6% of Ohio’s total population.Washington County Population 2000 2002 2009 Total population 63,251 62,561 61,048Gender2Gender by Age Group in Washington County, 2000* Male Female <19 years 8,623 8,068 20-39 years 7,690 8,041 40-59 years 8,968 9,226 60-79 years 4,664 5,475 80+ years 786 1,646 All ages 30,731 32,456 *EstimatesAge2,3,5Population by Age in Washington County 2000 Number Percent Under 6 years 4,570 7.2% 6-17 years 10,301 16.3% 18-24 years 5,610 8.9% 25-44 years 17,498 27.7% 45-64 years 15,831 25.0% 65+ years 9,441 14.9% Total population 63,251 100.0%Population by Age in Washington County 2000 2009 Number Percent Number Percent Under 17 years 14,871 23.5% 12,792 21.0%10 65+ years 9,441 14.9% 11,859 19.4%Median Age in Washington County 2000 2006- 2008** Median age 39.1 41.1 **Between 2006-2008, the median age in Ohio was 37.9.Race/Ethnicity2,4,5,6Population of Washington County by Race 2000 2002-2005 Number Percent Number Percent White 61,403 97.1% 60,747 97.1% African-American 481 0.8% 563 0.9% American Indian/Alaska Native 159 0.3% 125 0.2% Asian 256 0.4% 313 0.5% Native Hawaiian/Pacific Islander 13 0.0002 19 0.03% % Hispanic (any race) 263 0.4% 319 0.05% Two or more races 805 1.3% 438 0.7% Total Minority Population 2,028 3.2% 1814 2.9%Education5,7Education Attainment, 2000* Washington Co U.S. Ohio No high school diploma 15.5% 17.0% 19.6% High school diploma or GED 43.0% 36.1% 28.6% Some college, no degree 19.4% 19.9% 21.1% Associate’s degree 7.1% 5.9% 6.3% Bachelor’s degree 9.4% 13.7% 15.5% Master’s/professional degree or higher 5.6% 7.5% 8.9% *Percent of residents ages 25+ attaining indicated level of education.11 12 Income and EmploymentIncome2,3,5 - The per capita income of a region provides a good barometer of its economic health. Over the last decade, per capita income growth in Ohio has been highly correlated with employment growth.Per Capita Income Comparisons Washington Co U.S. Ohio Per capita income, 2000 $22,733 $28,206 $29,845 Per capita income, 2008 $32,225 $35,889 $40,166Household Income, 2000 Washington County Number Percent Total households 25,162 100.0% Less than $10,000 2,502 9.9% $10,000 - $19,999 4,184 16.6% $20,000 - $29,999 4,192 16.7% $30,000 - $39,999 3,518 14.0% $40,000 - $49,999 2,748 10.9% $50,000 - $59,000 2,273 9.0% $60,000 - $74,999 2,384 9.5% $75,000 - $99,999 1,891 7.5% $100,000 - $149,999 981 3.9% $150,000 - $199,999 215 0.9% $200,000 or more 274 1.1% Median Household Income* $34,275 *In 2000, the median household income for residents of Ohio was $40,956 and the median household income for all U.S. residents was $41,994.Poverty2,3,4,5,6Percent of Residents in Poverty, 2002-2005* Washington Co Ohio Population <100% federal poverty level 11.4% 10.6%13 Population <200% federal poverty level 33.1% 26.4% *Federal Poverty Level as issued by the U.S. Department of Health and Human Services, and published in the Federal Register.**In 2008, a family of 3 was considered at or below 100% of poverty with an annual household income of $16,600.Residents Living Below Federal Poverty Level, 2008* Washington Co. Ohio U.S. <18 Years of age in poverty 24.3% 18.5% 18.2% All ages in poverty 16.9% 13.3% 13.2%- The poorest group of Ohioans is young children under the age of five living in single headed households, followed by single female-headed families and African Americans.14 Labor Force/Employment3,5,6 Major Employers in Washington County, 2008 Type American Electric Power Co Utility Americas Styrenics Mfg Energizer Battery Mfg Eramet Marietta Inc Mfg Evonik Degussa Mfg Globe Metallurgical Mfg KRATON Polymers LLC Mfg Marietta City Schools Govt Marietta College Serv Marietta Memorial Health System Serv Pioneer Pipe Mfg RJF International Corp Mfg Solvay Advanced Polymers Mfg Tata Enterprises Serv Thermo Fisher Scientific Inc MfgThe size of a county’s labor force is an indication of economic health. It is influenced both by the economy and the size and composition of the population.Civilian Labor Force in Washington County 2005 2006 2007 2008 2009 Civilian labor force 32,500 33,000 33,100 33,100 33,500 Employed Unemployed 30,600 31,300 31,400 31,300 30,4001,900 1,700 1,700 1,800 3,100 Unemployment rate 5.9% 5.2% 5.1% 5.5% 9.4%Ohio Works First (OWF)3,6Ohio Works First (OWF) is the financial-assistance portion of the state’s Temporary Assistance to Needy Families (TANF) program, which provides cash benefits to needy families for up to 36 months.15 Cash Assistance (CA) CY 2008 CY 2009 Washington Ohio Washington Ohio County County Average monthly adult recipients 5 44,998 7 59,600 Average monthly child recipients 202 132,601 201 154,499 Total number of recipients 349 368,211 343 429,404 Percent of population 0.6% 3.0% 0.6% 3.7% Net expenditures $458,780 $328,588,993 $471,258 $410,769,562 Average annual CA payment per $1,315 $892 $1,374 $957 recipient 6 out of every 1,000 residents in Washington County received cash benefits through OWF during CY 2009.Trend in OWF/TANF in Washington County Jan. 2000 Jan. 2005 Jan. 2008 Jan. 2010 Total number of OWF/TANF recipients 252 251 193 204 Number of children receiving “Child Only” 171 213 188 192 TANF - The total number of Washington County recipients of OWF/TANF decreased by 19% between January 2000 and January 2010. - The number of children living with relative caregivers and receiving “Child Only” TANF increased by 12% between January 2000 and January 2010. Food Assistance (FA)3,6 - The Food Assistance program is designed to raise nutritional levels, to expand buying power, and to safeguard the health and well-being of individuals and families whose gross monthly income is within 130 percent of the federal poverty guideline. - Half of all recipients are children.Food Assistance (FA) CY CY 2009 2008 Washington Ohio Washington Ohio County County Average monthly adult 3,624 672,065 4,318 843,420 residents Average monthly child 2,634 587,273 3,116 691,148 residents Total number of recipients 9,362 1,825,865 10,726 2,142,502 Percent of population 15.3% 15.8% 17.6% 18.6% Net expenditures $7,172,969 $1,603,760,07 $10,734,239 $2,367,566,80916 6 Average annual FA $766 $878 $1,001 $1,105 payment per recipientOhio Direction Card* Jan. 2000 Jan. 2005 Jan. 2008 Jan. 2010 Total number of Ohio Direction Card 3,555 5,590 5,513 7,959 recipients in Washington County *Formerly food stamps - The number of county residents who received Ohio Direction Cards increased by 224% between January 2000 and January 2010. - The average card value in Washington County was $101 per month in 2008 and $120 in 2009.17 InsuranceInsurance Status2,5,7Employer-Based Insurance in Washington County 2000 Percent of adults with employer-based insurance 59.0% Percent of children with employer-based insurance 59.2%Uninsured Residents 2007 2004 Washington Co. Ohio Washington Co. Percent children 0.4% 5.4% 2.7% uninsured (<17 years) Percent adults 17.1% 12.5% 18.2% uninsured (18+ years)Medicaid Enrollment3,4,6,7Medicaid is the state and federally funded program that pays for health care services for eligible low-income people of all ages, including children, pregnant women, families, older adults, and Ohioans with disabilities. Medicaid services are delivered via contracted health care providers, ensuring that Medicaid consumers get access to needed services, such as physician visits, hospital inpatient care, prescription drugs, and home health services.Medicaid Enrollment and Expenditures SFY 2009* Washington Co. Ohio Residents enrolled in Medicaid 13,057 2,407,572 Average members per year** 9.991 1,883,288 Percent of members enrolled*** 21.2% 21.0% Residents enrolled in Medicaid (Ages 0-17) 6,059 1,218,390 Average members per years (Ages 0-17) 4,796 982,283 Percent of members enrolled (Ages 0-17) 46.8% 44.6% Annual Medicaid expenditures+ $64,812,420 $13,162,469,167 Total cost of coverage per member per year $6,487 $6,989 * SFY stands for State Fiscal Year (July 1st to June 30th) **Average members per year = Member months/1218 **8Percent of members enrolled = Members/population enrolled +Expenditures reflect payments made directly to providers as well as capitation payments to HMOs.Medicaid Eligibility 2002-2005 Washington Co. Ohio Number of persons eligible for Medicaid 11,665 1,786,440 Percent of persons eligible for Medicaid 18.4% 15.7%19 Medicaid and Children in Washington County 2007 Percent of all births paid by Medicaid 42.9% Percent of mothers receiving Medicaid who had 48.0% two or more risk factors for poor birth outcomes Percent of children enrolled in Medicaid 36.6%Children Insured by Medicaid in Washington County SFY 2005 SFY 2007 SFY 2009 # of Children Insured by Medicaid 6,187 6,029 6,056- The number of children insured by Medicaid in Washington County decreased by 2% between 2005 and 2009.20 21 Vital StatisticsVital Statistics3,5Births and Deaths, 2008 Washington County Ohio Number Rate* Number Rate All births 658 10.8 148,592 12.9 Teen births <15 years of age 1 0.6 201 0.5 15-17 years of 17 age 52 14.4 4,717 19.718-19 years of 59.3 11,467 73.7 age Deaths 645 1,047.5 ------*Birth rates per 1,000 population and death rate per 100,000 population.Marriages/Divorces, 2007 Washington County Ohio Number Rate** Number Rate Marriages 459 7.4 70,704 6.2 Divorces 251 4.1 39,305 3.4 **Marriage and divorces rates per 1,000 population.Mortality2,4,8,9 One main component: - Premature death (National Center for Health Statistics, 2004-2006) Rank of Washington County in Mortality among 88 counties in Ohio (2010): 47Infant Mortality:***Infant mortality reported as a rate per 1,000 live births. Infant mortality = (Infant deaths/Live births) x 1,000. Adult Mortality: Mortality Rates per 100,000 Age-adjusted 22 Population 2002-2005 Washington County Ohio Coronary heart disease 211.3 210.2 Cancer 196.4 212.7 Stroke 50.7 62.4 Unintentional injury 46.8 30.7 Suicide 7.7 10.1Leading Causes of Death:Leading causes of death may differ in a population depending on the age, sex, race, and socioeconomic status of individuals within a population.Causes of Death* Washington Ohio Co. U.S. Numbe Rate Number Rate Number Rank r All deaths 660 849.5 107,217 855.0 2,447,91 798.8 0 Cancer 164 210.0 24,825 198.8 559,300 183.8 Diseases of the heart 155 194.7 28,617 225.3 649,399 210.3 Chronic lower respiratory 41 51.3 6,170 49.2 130,957 43.2 disease Diabetes mellitus 35 44.6 3,717 29.7 74,817 24.5 Stroke 31 38.9 6,183 48.6 143,497 46.6 Unintentional injury 26 38.9 4,473 37.6 114,876 38.1 Influenza and pneumonia 15 18.9 2,191 17.2 62,804 20.3 Nephritis, nephritic 14 17.9 1,834 14.5 43,679 14.3 syndrome, and nephrosis Alzheimer’s disease 10 12.9 3,321 25.6 71,696 22.9 Septicemia 10 12.6 1,388 11.2 34,142 11.2 *Average annual number of deaths and average annual age-adjusted mortality rates (per 100,000 population) among Washington County Residents with comparison to Ohio, 2004-2006, and to the United States, 2005.Morbidity8 Four main components:1. Poor or fair health (Behavioral Risk Factor Surveillance System, 2002-2008)23 2. Poor physical health days (Behavioral Risk Factor Surveillance System, 2002- 2008)3. Poor mental health days (Behavioral Risk Factor Surveillance System, 2002- 2008)4. Low birth weight (National Center for Health Statistics, 2002-2006) Rank of Washington County in Morbidity among 88 counties in Ohio (2010): 4424 Health StatisticsCancer Rates2,7Cancer Screening Behaviors, 2004- 2007* Washington County Ohio Male Female All Male Female All PAP test in past 3 years (Age 18+, N/A 79.9% N/A N/A 88.8% N/A Intact Cervix) Mammography in past 2 years (Age N/A 71.8% N/A N/A 79.1% N/A 40+) Colonoscopy/Sigmoidoscopy in 34.7% 47.4% 41.6% 59.2% 52.6% 55.7% past 5 years (Age 50+) Prostate-specific antigen (PSA) test 57.4% N/A N/A 57.5% N/A N/A in past year (Age 50+) DRE in past year (Age 50+) 49.8% N/A N/A 57.5% N/A N/A *Estimated prevalence (percent) of selected cancer screening behaviors among adult residents in Washington County and OhioCancer Site/Type, 2001-2005** Incidence Mortality Washington Ohio Washington Ohio County County Cases Rate Rate Cases Rate Rate All Sites 381 509.3 465.1 157 207.4 203.3 Breast (Female) 44 112.1 121.9 13 33.7 27.5 Cervix 3 8.3 7.9 1 2.9 2.4 Colon and Rectum 43 57.3 52.9 16 20.9 20.6 Lung and Bronchus 63 81.9 75.0 47 60.5 60.3 Melanoma of the Skin 16 22.9 17.0 3 4.0 2.6 Prostate 58 168.3 145.7 9 29.9 27.8 **Average annual number and age-adjusted rates (per 100,000 population) of invasive cancer cases and cancer deaths among Washington County and Ohio residents25 Cancer Incidence, 2001-2005* Washington County Male Female Total Case Rate Cases Rate Cases Rate All Sites 203 606.0 178 442.4 381 509.3 Breast 1 2.9 44 112.1 45 N/A Cervix N/A N/A 3 8.3 3 N/A Colon and Rectum 24 73.1 19 44.5 43 57.3 Lung and Bronchus 36 105.9 27 65.0 63 81.9 Melanoma of the Skin 9 25.6 7 21.4 16 22.9 Prostate 58 168.3 N/A N/A 58 N/A *Average annual number and age-adjusted rates (per 100,000 population)Cancer Rate Incidence** 2001- 2000 2005 Washington Co. Ohio Washington Co. Ohio Breast 117.7 117.7 112.1 121.9 Cervical ------7.5 8.3 7.9 Lung and Bronchus 91.9 71.0 81.9 75.0 **Rates per 100,000 populationCancer Mortality, 2001-2005* Washington County Male Female Total Case Rate Cases Rate Cases Rate All Sites 81 251.5 77 180.8 157 207.4 Breast <1 ------13 33.7 14 N/A Cervix N/A N/A 1 2.9 1 N/A Colon and Rectum 9 27.1 7 16.4 16 20.926 Lung and Bronchus 26 76.7 21 48.9 47 60.5 Melanoma of the Skin 2 4.5 1 2.8 3 4.0 Prostate 9 29.9 N/A N/A 9 N/ASTD Rates/HIV/AIDS4,7Communicable Diseases** 2002-2005 Washington Co. Ohio Persons living with HIV/AIDS 53.8 121.5 Chlamydia 114.9 315.1 Gonorrhea 13.7 184.2 Syphilis 0.0 2.8Heart Disease/Stroke2- In both the United States and Ohio, heart disease and stroke are the first- and third- leading causes of death respectively (CDC, 2007). Cholesterol and Blood Pressure Awareness: - High cholesterol and high blood pressure are modifiable risk factors for heart disease and stroke.Cholesterol and Blood Pressure Washington County/ Awareness* Southeast Region Ohio Male Female All Male Femal All e Cholesterol checked within last 5 years 46.2% 37.6% 41.7% 71.0% 75.3% 73.2% Ever told cholesterol was high 69.6% 73.5% 71.6% 39.9% 36.2% 37.9% Ever told blood pressure was high 37.6% 31.6% 34.6% 27.9% 27.4% 27.6% *Estimated prevalence (percentage) among adult Washington County residents with comparison to Ohio, 2004, 2006, 2007.Prevalence of Heart Disease and Stroke:27 - Males have a higher risk of having a heart attack than females and these heart attacks typically occur earlier in life (American Heart Association, 2008). - Stroke is more common in males; however, at all ages, more women die as a result of a stroke than men (American Heart Association, 2007). Heart Attack, Coronary Heart Washington County/ Disease or Stroke* Southeast Region Ohio Whit Black All White Black All e Ever told had a heart attack 8.5% 5.1% 6.8% 6.0% 3.6% 4.7% Ever told had angina or coronary 7.6% 6.3% 7.0% 5.5% 4.2% 4.8% heart disease Ever told had a stroke 3.8% 3.1% 3.4% 2.6% 3.0% 2.8%Heart Attack and Stroke Symptom Awareness and Response: - Recognition of the warning signs of a heart attack or stroke and the need to call 911 are critical to improving outcomes of heart attacks and - strokes.Heart Attack and Stroke Symptom Washington County/ Recognition and Response* Southeast Region Ohio Male Female All Male Femal All e Recognize all 5 symptoms of heart attacks 30.2 42.2% 36.4 31.0% 42.6% 37.0% % % Recognized all 5 symptoms of strokes 46.7 45.3% 46.0 41.1% 48.2% 44.6% % % Know to call 911 in response to someone 83.9 85.4% 84.7 88.4% 91.2% 89.9% having a heart attack or stroke % % *Estimated prevalence (percentage) among adult Washington County residents with comparison to Ohio, 2004, 2006, 2007. - Five heart attack warning signs:28 1. Pain or discomfort in areas of the upper body such as the shoulder, back, neck, jaw, stomach, or in one or both arms.2. Chest discomfort that may or may not be accompanied by lightheadedness or shortness of breath.3. Cold sweats4. Nausea 5. Pressure or pain in the center of the chest that lasts more than a few minutes- Five stroke warning signs:1. Sudden weakness or numbness in the face, arm, leg or on one side of the body.2. Sudden trouble seeing in one or both eyes, dimness or loss of vision, particularly in one eye.3. Sudden confusion, trouble speaking or understanding, and loss of speech.4. Sudden, sever headache with no apparent cause.5. Sudden dizziness, trouble walking, loss of balance or coordination or sudden falls, especially along with any of the previous symptoms. Heart Disease and Stroke Mortality:Heart Disease Mortality** Washington Ohio County # of Deaths Rates # of Deaths Rates Age-adjusted Males 75 236.3 14,029 282.4 80 163.4 14,588 182.6 Females 155 194.7 28,617 225.3 All Age-specific (years) <24 0 0.0 72 1.9 4 20.9 1,399 34.9 25-49 21 172.8 3,829 188.8 50-64 130 1,307.9 23,317 1,526.4 65+ **Average annual number of death and age-adjusted and age- specific mortality rates (per 100,000 population), 2004-2006.29 Stroke Mortality* Washington County Ohio # of Deaths Rates # of Deaths Rates Age-adjusted Males 14 42.8 2,350 48.8 18 35.1 3,833 47.8 Females 31 38.9 6,183 48.6 All Age-specific (years) <24 0 0.0 21 0.5 1 4.8 208 5.2 25-49 3 25.1 552 27.2 50-64 27 275.0 5,403 353.7 65+ *Average annual number of death and age-adjusted and age- specific mortality rates (per 100,000 population), 2004-2006.Diabetes2 - Diabetes was the sixth-leading cause of death in Ohio and in the United States in 2004-2006. - Two types of diabetes:1. Type 1 diabetes typically strikes children and young adults. It accounts for 5 to 10 percent of all diagnosed cases of diabetes. Risk factors for type 1 diabetes include autoimmune, environmental, and genetic factors.2. Type 2 diabetes usually strikes adults and accounts to 90 to 95 percent of all diagnosed diabetes cases. Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, impaired glucose metabolism or pre-diabetes, history of gestational diabetes, and physical inactivity.Diabetes Prevalence:Diabetes Management Practices:Diabetes Management Behaviors, 2004-2007 Washington Co. Ohio U.S. Annual dilated-eye exam 51.5% 70.3% 69.4% Daily self-monitoring of blood glucose 63.6% 63.0% 63.0%30 Annual foot exam 51.3% 67.4% 68.7% Annual doctor visit 88.5% 89.4% 88.9% Daily self-exam of feet 67.4% 66.0% 67.9% 2+ A1c tests past year 63.9% 72.9% 68.7% Attended diabetes self-management class 47.6% 55.0% 53.1% Annual influenza vaccine 44.7% 57.5% 49.8% Ever had pneumonia vaccine 40.6% 52.0% 49.0%Diabetes Mortality:Diabetes Mortality, 2004-2006* Washington Ohio County # of Deaths Rates # of Deaths Rates Age-adjusted Males 14 43.9 1,812 35.3 20 45.2 1,905 25.6 Females 35 44.6 3,717 29.7 All Age-specific (years) <24 <1 1.7 9 0.2 2 8.0 222 5.5 25-49 7 55.7 687 33.9 50-64 26 261.6 2,799 183.2 65+ *Average annual number of deaths and average annual age-adjusted age- specific diabetes mortality rates (per 100,000 population).Arthritis2 - Arthritis is the nation’s most common cause of disability (CDC, 2008). - Arthritis is not just one disease, but more than 100 different diseases and conditions. The most frequently occurring is osteoarthritis. Other common forms include rheumatoid arthritis, lupus, fibromyalgia, and gout (CDC, 2008).31 Unintentional and Intentional Injuries2 - For Ohioans of all ages, the leading causes of injury-related death include unintentional motor vehicle traffic crashes, suicide, unintentional poisonings, unintentional falls, and homicides.All Fatal Unintentional Injuries:- Unintentional injury is the leading cause of death for Ohioans aged 1-34, and the fifth-leading cause of death for all age groups in Ohio.Unintentional Fatal Injury: All* Washington County Ohio # of Deaths Rates # of Deaths Rates Age-adjusted Males 16 52.1 2,775 51.3 10 27.5 1,698 25.2 Females 26 38.9 4,473 37.6 All Age-specific (years) <24 5 25.6 714 18.3 9 43.4 1,524 38.0 25-49 5 39.0 711 35.0 50-64 7 70.4 1,524 99.8 65+ *Rates per 100,000 population, 2004-2006.Unintentional Fatal Falls: - Fatal falls among older adults are expected to rise as Ohio’s population continues to age.Unintentional Injury Mortality: Falls* Washington County Ohio # of Deaths Rates # of Deaths Rates Age-adjusted Males 2 6.5 421 8.6 <1 0.8 400 5.0 Females 2 3.1 821 6.5 All Age-specific (years) <24 0 0.0 11 0.3 <1 1.6 51 1.3 25-49 1 5.6 99 4.9 50-64 1 13.4 661 43.3 65+32 Unintentional Fatal Poisonings:-Rates of unintentional fatal poisonings have been increasing at alarming rates in Ohio due largely to unintentional drug overdoses and medication errors.Unintentional Injury Mortality: Poisonings* Washington County Ohio # of Deaths Rates # of Deaths Rates Age-adjusted Males 4 13.8 733 13.0 1 3.3 379 6.5 Females 5 8.4 1,112 9.7 All Age-specific (years) <24 1 6.8 115 3.0 3 16.1 735 18.3 25-49 <1 2.8 221 10.9 50-64 0 0.0 41 2.7 65+ *Rates per 100,000 population, 2004-2006.Unintentional Motor Vehicle Traffic Crashes: - Motor vehicle traffic crashes among older adults will continue to be a growing concern as Ohio’s population ages. Unintentional Injury Mortality: Motor Vehicle Traffic Crashes* Washington County Ohio # of Deaths Rates # of Deaths Rates33 Age-adjusted Males 6 18.2 904 16.2 6 17.6 416 6.8 Females 11 17.7 1,321 11.4 All Age-specific (years) <24 3 13.6 370 9.5 5 22.5 506 12.6 25-49 3 25.1 217 10.7 50-64 1 10.1 228 14.9 65+Homicide: - Homicide is the leading cause of death for young, black Ohioans.Intentional Fatal Injury: Homicide* Washington County Ohio # of Deaths Rates # of Deaths Rates Age-adjusted Males 0 0.0 ------5.5 Females 1 2.0 ------8.4 All 1 1.0 150 2.6 Age-specific (years) <24 0 0.0 211 5.4 25-49 <1 1.6 315 7.8 50-64 <1 2.8 63 3.1 0 0.0 31 2.0 65+Suicide: - Although females attempt suicide at higher rates, males take their lives four times more often than females (CDC, 2007) and white adults males are at the greatest risk of committing suicide in Ohio.Intentional Fatal Injury: Suicide* Washington County Ohio # of Deaths Rates # of Deaths Rates Age-adjusted Males 5 151.6 1,053 18.8 1 2.4 266 4.4 Females 6 8.9 1,319 11.3 All34 Age-specific (years) <24 <1 1.7 192 4.9 4 17.7 616 15.3 25-49 1 11.1 312 15.4 50-64 <1 3.4 200 13.1 65+ *Rates per 100,000 population, 2004-2006.35 Child-Related IssuesChild Health2,4,7Vital Statistics, 2008 Washington County Ohio Total Births 658 148,592 % Low Birth Weight 7.0% 8.6% % Very Low Birth Weight 2.3%(15) 1.6% % Preterm 14.0% 12.3% % Very Preterm 3.2% 2.1% % Late Prenatal Care 14.5% 27.3% % Unmarried 36.9% 43.2% Teen Birth Rate (15-17) 14.4(17) 19.7Vital Statistics Comparison 2002- 2004- 2005 2006 2008 Washington Ohio Washington Ohio Washington Ohio County County County % Low Birth 7.8% 8.0% 8.4% 8.6% 7.0% 8.6% Weight % Maternal 19.3% 18.9% 23% 18.1% 28.3% 19.2% Smoking % Infant 0.0057% 0.0078% 0.0064% ------0.011% ------MortalityLead Testing, 2008 Washington County Ohio # Children Lead Screened 629 159,239 % Elevated Blood Lead Level 0.6% 1.6%36 Overweight, 3rd Grade 2004- 2006 Washington Co. Ohio % Children Overweight 19.6% 18.9%Overweight, 2-5 Years 2008 Washington Co. Ohio % Children Overweight 26.6% 28.0%Child Support3,6The Washington County Child Support Enforcement Agency establishes paternities and obtains, enforces, and collects child support funds for children.Child Support Cases FFY 2008 FFY 2009 Wash. Co. Ohio Wash. Co. Ohio Number of Cases 4,049 978,385 4,212 985,863 Paternity Establishment Rate* 105.0% 91.6% 106.4% 93.6% Cases with Support Orders 3,516 739,995 3,637 754,903 % of Cases with Support Orders 86.8% 75.6% 86.4% 76.6% Collection Rate on Current Support Due 74.1% 68.8% 72.8% 67.4% Rate of Cases Paying on Arrears 74.3% 68.2% 73.1% 66.5% *Paternity Establishment Rate is the total number of children born out-of- wedlock who had active child support cases, for whom paternity was established or acknowledged as of the end of the reporting period, divided by the total number of children born out-of-wedlock who had active child support cases, as reported 12 months prior to the reporting period. Rate can exceed 100%.37 Child Support Collections in Washington County FFY 2005 FFY 2007 FFY 2009 Total amount of child support collections $9.4 mil $9.3 mil $9.7 mil - Child support collections in Washington County increased by 3% between FFY 2005 and FFY 2007. - The number of paternities established for non-marital births in Washington County increased by 28% between FFY 2005 and FFY 2007. Child Safety and Care Placement3,6 Of Ohio’s 88 children services agencies, Washington County’s is one of 25 agencies accreditd by the Council on Accrediation (2011).The Washington County Public Children Services Agency administers local adoption assistance, foster care services, and child welfare intervention programs.Custody Issues FFY FFY 2008 2009 Wash. Co. Ohio Wash. Co. Ohio Children Entering Custody 7 8,279 19 7,743 Children Reentering Custody 1 1,261 6 952 # of Children Reunified 14 4,678 17 5,847 # of Children Reunified within 12 mo. 13 3,206 16 4,008 % of Child Reunifications <12 mo. 92.9% 68.5% 94.1% 68.5%Tracking Children in Custody in Washington County 2005 2007 2009 Total number of children reunified with parents or 22 15 17 legal guardian Total awards of legal custody to relatives 9 7 ------Total number of adoptions finalized 0 3 3 Total number of children waiting to be adopted 11 2 238 Total number of youth who aged out of care 2 1 4 Total number of children placed out of county 11 10 6 Average number of days a child stays in placement 160 244 291Planned Child and Custody Profiles in Temporary Permanent Permanent Total Washington County Custody Custody Living Arrangement Children in custody 1/1/10 31 5 6 42 Age 0-5 years 29% ------21% 26% 80% ------29% 6-11 years 45% 20% 100% 50% 12-18 years Race White 71% 100% 83% 76% ------Af/Am 29% ------17% 24% Other Total years in custody 0-2 years 94% 40% 67% 83% 6% 40% 33% 14% 2-4 years ------20% ------3% 4+ years Court Rationale for Placement  Neglect 6% 20% ------7%  Dependency 19% 20% 17% 20% ------17% 2%  Physical abuse ------ Sexual abuse39  Delinquency/unruly 10% ------7%  Multiple safety issues 65% 60% 66% 64% Placement Type  Licensed foster home 94% 40% 66% 83%  Approved relative/kinship ------home 6% 20% 17% 10%  Group/residential care ------40% ------5%  Adoptive placement ------17% 2%  Independent living placement/otherFoster Care/Custody 2008 (Snapshot 9/30/2008) 2009 (Snapshot 9/30/2009) Washington Ohio Washington Ohio County County Children in 31 9,057 39 8,161 Licensed/Certified Foster Homes Children in Permanent 9 5,200 10 4,907 CustodyChild Deaths FFY FFY 2009 2008 Wash. Co. Ohio Wash. Co. Ohio # of Child Deaths 0 74 0 91 # of Child Deaths in Substitute Care 0 22 0 14Public Expenditures on Child Services:Federal $1,233,209 43%State $419,542 15%Local* $1,192,548 42%40 ------Total 2,845,299 100%*Of Ohio’s 88 counties, Washington County was not among the 45 that maintained a children services levy in 2009.Adoption3Ohio counties provide comprehensive services to birth parents, adoptive parents, and adoptive children, particularly those involved in foster care.Adoption FFY 2008 FFY 2009 Wash. Co. Ohio Wash. Co. Ohio # of Children Adopted 1 1,390 4 1,452 # of Adoptions Completed within 24 1 426 2 497 mo.Kinship Permanency Incentive (KIP)3 KIP provides time-limited incentive payments to relatives caring for minors who would be at risk of harm if they remained in their own homes.KIP (Unduplicated Counts) CY 2008 CY 2009 Wash. Co. Ohio Wash. Co. Ohio Children Approved for Initial KPI Funding 5 3,074 7 2,586 Children Receiving KPI Payment Redeterminations ------3,705 4 5,366 Total # of Children Receiving KPI Payments 5 6,779 11 7,952Child Care3,6Through state and federal funding, families whose income is at or below 150% of the federal poverty guideline can receive payment for all or part of their monthly childcare expenses while parents work or attend job training/educational activities. A family may remain eligible until income increase to 200% of the federal poverty guideline.41 Children Served and Providers of Child Care CY 2008 CY 2009 Wash. Co. Ohio Wash. Co. Ohio # of Children Using 785 198,244 693 192,697 Publicly Funded Child Care Public Funds Used for Child $986,605 $558,762,58 $904,852 $569,657,458 Care Expenditures 7 Annual Average $1,257 $2,819 $1,306 $2,956 Expenditure per Child # of Licensed Child Care 31 3,683 32 4,483 Centers* *Includes licensed full-time, part-time, Head Start, school-based and combination centers with 7 or more children. Subsidized Child Care in Washington County Jan. 2000 Jan. 2005 Jan. 2008 Jan. 2010 # of children whose families received 292 309 376 278 subsidized child care - The number of children whose families received subsidized child care decreased by 5% between January 2000 and January 2010. Step Up to Quality3 The Step Up to Quality Program (SUTQ) is Ohio’s voluntary quality rating system for childcare programs. SUTQ is designed to increase the number of high-quality programs, recognize and support programs that achieve higher quality standards, and provide parents with an easy-to-use tool to assist them in making more informed choices on behalf of their children. Programs with the highest ratings qualify for monetary awards. Number of Licensed Child Care Centers in Washington County Earning Quality Ratings as of June 30, 2010: 9Child Abuse and Neglect3,6,9*The Ohio Department of Job and Family Services (ODJFS) defines the following statistics as the rate of infants/children with substantiated abuse or neglect. The statistics are expressed as the rate per 1,000 infants/children.Infant Child Abuse and Neglect: Infants are children ages zero to one year old.42 Toddler Child Abuse and Neglect: Toddlers are children ages one to three years old. Preschool Child Abuse and Neglect: Preschoolers are children ages four to five years old.School-Age Child Abuse and Neglect: School-aged children are children ages 6 to 12 years old.Adolescent Child Abuse and Neglect: Adolescents are children ages 13 to 18 years old.Local Trends on Abuse and Neglect:- In 2007 and 2009, new allegations of child abuse and neglect totaled 650 and 638, respectively. The percentage of total reports the new allegations represent fall within the following five categories:Types of Child Abuse and Neglect 2007 2009 Numbe Percent Number Percent r Physical abuse 156 24% 145 23% Neglect 296 46% 204 32% Sexual abuse 80 12% 66 10% Emotional maltreatment 7 1% 0 0% Family in need of services, dependency & others 111 17% 223 35% Total 650 100% 638 100%43 Local and State Comparison of Child Abuse:Maltreatment/Child Abuse FFY 2009 Washington Co. Ohio Reports/Investigations – Allegations 522 79,906 of Child Abuse and Neglect Cases Number of Maltreatment Cases 112 15,358 Percentage of Children with No 88.4% 92.7% Recurrence of MaltreatmentPrenatal Care7,9 The Ohio Department of Health uses the Kotelchuck Index in the definition of adequate prenatal care.  For prenatal care to be adequate according to the Kotelchuck Index, care must begin in the first trimester and the total number of visits must equal or exceed that which would be expected for the infants’ gestational age at birth. *Adequate prenatal care is expressed as a percent.Late Prenatal Care, 2008 Washington Co. Ohio % Late Prenatal Care 14.5% 27.3%Aging Population Demographics10 Population Projections by Age Group:*Year 2000 data are actual population counts44 Population Change among Residents Age 60+ Washington County 2000 Population Projected 2020 Percent Population Population Increase Total 60+ population 12,544 18,542 47.8% 60-69 years 5,699 9,275 62.7% 70-79 years 4,441 5,883 32.5% 80-89 years 2,031 2,719 33.9% 90+ years 373 665 78.3%Rank of Washington County in total 60+ population among 88 counties in Ohio (2000): 36Rank of Washington County in proportion of 60+ population to total county population among 88 counties in Ohio (2000): 11Marital Status:**The Southeast region of Ohio includes Monroe, Morgan, and Noble counties.Since older single adults are more likely than married couples to need outside help or institutional care, the population in Washington County and Southeast Ohio that is potentially in need of such assistance is largely female.45 Education:*The Southeast region of Ohio includes Monroe, Morgan, and Noble counties. The majority of Washington County residents age 60+ (76.1%), have completed 12 or fewer years of school. This suggests that a significant proportion of the older population may be economically vulnerable.Housing/Residence:*The Southeast region of Ohio includes Monroe, Morgan, and Noble counties.Health Issues10 Projections of Disability Among 60+ Population, 2000**-2020 Washington County Total No Moderate Severe Year Population Disability Disability Disability 2000 12,544 9,439 2,066 1,039 2005 13,350 10,026 2,199 1,125 2010 14,784 11,140 2,409 1,235 2015 16,533 12,514 2,670 1,349 2020 18,542 14,077 2,975 1,490 **Year 2000 data are actual disability counts.In the Scripps Gerontology Center’s Profile and Projections of the 60+ Population, disability is defined as a measure of impairment in Activities of Daily living (ADLs) and Instrumental Activities of Daily Living (IADLs).46 - Moderate disability: At least one of the following ADLs: eating, transferring into or out of bed or chair, getting to the toilet, dressing, bathing, or remaining continent, or At least one of the following IADLs; walking, shopping, meal preparation, housekeeping, or using transportation or the telephone - Severe disability: At least two of the following ADLs: eating, bathing, transferring into or out of bed or chair, dressing, getting to the toilet, remaining continent, or having cognitive impairment.*Year 2000 data are actual disability counts.Disability rates by age and sex are projected to remain the same between 2000 and 2020. Any fluctuations in the number of persons with disabilities across time are attributed to projected changes in the number of people in each age-gender group.*The Southeast region of Ohio includes Monroe, Morgan, and Noble counties.Characteristics of disabilities: - Sensory disabilities Blindness Deafness Severe or long-lasting vision or hearing impairment - Physical disabilities Long-lasting condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying - Mental disabilities47  Difficulty learning, remembering, or concentrating because of a physical, mental, or emotional condition that lasts 6 months or more - Self-care disabilities Difficulty dressing, bathing, or getting around the house as a result of a condition that lasts 6 months or more. Note: These categories of disabilities are not mutually exclusive. Respondents could have multiple impairments, which may span more than one disability category.In 2000, 38.5% of the 60+ population in Washington County and Southeast Ohio (Monroe, Morgan, and Noble counties) had at least one disability.Adult Protective Services3 County Departments of Job and Family Services provide Adult Protective Services to the elderly who are in danger of harm, unable to protect themselves, and/or have no one to assist them.Adult Protective Services (APS) CY 2008 CY 2009 Washington Co. Ohio Washington Co. Ohio Adult Cases 144 17,351 175 16,208 Cases Deemed Emergencies 38 1,215 49 802 Cases in Need of Protective Services 45 7,469 61 6,967 Cases Where Protective Services 0 68 0 84 Not AvailableAllocation of APS Funds SFY SFY 2008 2009 Washington Co. Ohio Washington Co. Ohio Expenditures* $33,044 $21,095,720 $38,676 $21,435,882 *APS funds are allocated at the beginning of the SFY (State Fiscal Year), July 1st to June 30th.48 Healthcare Access Access to Health Care2,4,5Health Care 2000 2006 Washington Co. Washington Co. Ohio Physicians (MDs & DOs) 107 108 28,853 Physicians per 10,000 Population 17.5 17.1 25.4 Registered Hospitals 2 1 207 Number of Beds 250 225 45,505 Number of Beds per 10,000 40.1 4.0 40.0 PopulationInsurance/Medicaid 2002-2005 Washington Co. Ohio Population Uninsured 13.9% 11.2% # of Persons Eligible for Medicaid 11,665 1,786,440 % Persons Eligible for Medicaid 18.4% 15.7%Primary Care Physicians (PCP) 2002-2005 Washington Co. Ohio # of Primary Care Physicians 54 13,400 Ratio of Population to Primary Care Physicians 1,159:1 852:1Family/General Practice Physicians & Medicaid 2002-2005 Washington Co. Ohio # of Family/General Practice Physicians Serving 2 1,13649 Medicaid Recipients: 1-50 patients # of Family/General Practice Physicians Serving 16 1,783 Medicaid Recipients: 51-250 patients # of Family/General Practice Physicians Serving 14 901 Medicaid Recipients: 251-1,000 patients # of Family/General Practice Physicians Serving 1 103 Medicaid Recipients: >1,000 patientsPediatricians & Medicaid 2002-2005 Washington Co. Ohio # of Pediatricians Serving Medicaid Recipients: 1- 0 292 50 patients # of Pediatricians Serving Medicaid Recipients: 51- 0 502 250 patients # of Pediatricians Serving Medicaid Recipients: 251- 2 605 1,000 patients # of Pediatricians Serving Medicaid Recipients: 1 138 >1,000 patientsDentists 2002-2005 Washington Co. Ohio # of Primary Care Dentists 21 5123 Ratio of Population to Primary Care Dentists 2,979:1 2,229:1Nursing Facilities and Residential Care3,5 Nursing Facilities/ Residential Care CY 2008 CY 2009 Washington Co. Ohio Washington Co. Ohio # of Nursing Homes* 5 961 5 959 # of Residential Care 3 583 3 593 Facilities # of Medicaid Eligibles 328 51,917 316 49,088 Living in Nursing Facilities Total Expenditures $16,174,108 $3,090,753 $15,966,386 $2,946,913,50 ,003 921 *Includes state-licensed and Medicaid-certified facilities.Clinical Care8 Two main components:1. Access to Care Uninsured Adults (Small Area Health Insurance Estimates, U.S. Census, 2005) Primary Care Provider (Health Resources & Services Administration, 2006)2. Quality of Care Preventable Hospital Stays (Medicare/Dartmouth Institute, 2005-2006) Diabetic Screening (Medicare/Dartmouth Institute, 2003- 2006) Hospice Use (Medicare/Dartmouth Institute, 2001-2005) Rank of Washington County in Clinical Care Among 88 Counties in Ohio (2010): 72Preventable Hospitalizations4Preventable Hospitalizations* 2002-2005 Washington Co. Ohio Pediatric Asthma, under age 18 1.44 1.89 Adult Asthma, age 18 and older 0.56 1.20 Bacterial Pneumonia, all ages 4.72 4.15 Congestive Heart Failure, age 18 and older 4.40 6.00 Chronic Obstructive Pulmonary Disease, age 18 and older 3.96 3.53 Uncontrolled Diabetes and Diabetes Short-term 1.01 0.76 Complications, age 18 and older Hypertension, age 18 and older 0.44 0.43 *Inpatient admissions rate per 1,000 population51 Health Behaviors and Risk Health Behaviors2,8Four main components:1. Alcohol Use Binge drinking Motor vehicle crash death rate2. Tobacco Adult smoking3. Diet and Exercise Adult Obesity4. High Risk Sexual Behavior Chlamydia rate52  Teen birth rate Rank of Washington County in Health Behaviors Among 88 Counties in Ohio (2010): 67Health Behaviors, 2004-2007 Washington County Ohio Male Female All Male Female All Residents Residents Heavy Drinking* 9.9% 2.7% 6.1% 4.0% 7.6% 5.4% Current Cigarette 30.0% 29.2% 29.6% 22.6% 30.0% 23.6% Smoking Current Use of 5.3% 0.2% 2.7% 3.4% 0.2% 2.7% Smokeless Tobacco Consuming <5 86.6% 74.2% 80.1% 73.9% 81.4% 78.4% Fruits/Vegetables Per Day Lack of Physical 26.2% 31.3% 28.9% 26.8% 26.7% 24.2% Activity** Overweight*** 35.8% 26.8 31.1% 29.4% 30.3% 35.9% Obese+ 32.9% 32.1% 32.5% 25.6% 32.6% 26.3% *Men having more than 2 drinks/day, women having more than 1 drink/day. **Persons who failed to participate in moderate physical activity for 30 or more minutes per day on five or more days per week; or vigorous activity for 20 or more minutes per day on three or more days per week. ***Body Mass Index (BMI) of 25-29.9.+BMI of 30.0 or greater.Health Risk4 Behavioral Risk Factor Surveillance System Indicators 2002-2005 Washington Co. Ohio Adults age 18 and older with Diabetes 6.1% 6.5% Adults age 18 and older with Asthma 10.3% 7.9% Adults age 18 and older with High Blood Pressure 31.4% 26.3% Adults age 18 and older with High Cholesterol 39.7% 32.4%53 Adults age 20 and older that are Obese 22.0% 22.0% Adults age 65 and older that have had a 23.5% 27.3% Pneumonia VaccinationMental Health and Substance Abuse4Mental Health and Substance Abuse** 2002-2005 Washington Co. Ohio Treatment rate per 1,000 children under age 18 for 23 16 Serious Emotional Disturbance (SED) Treatment rate per 1,000 adults age 18 and older for 9 8 Serious Mental Disease (SMD) # of days in past 30 days that adults age 18 and older 3.5 3.2 felt sad/depressed Adults age 18 and older who drank <5 drinks on one or 12.0% 14.9% more occasions in past month **Insufficient numbers or sample size for meaningful analysisSocial, Economic, and Environmental Factors Social/Economic Factors2,4,7,8 Five main components:1. Education54  High school graduation (National Center for Education Statistics, 2005-2006) College degrees (Health Resources & Services Administration, 2006)2. Employment Unemployment (Bureau of Labor Statistics, 2008)3. Income Children in poverty (Small Area Income and Poverty Estimates, U.S. Census, 2007) Income inequality (U.S. Census/American Community Survey, 2000/2005-2007)4. Family and social support Inadequate social support (Behavioral Risk Factor Surveillance System, 2005-2008) Single-parent households (U.S. Census/American Community Survey, 2000/2005-2007)5. Community safety Violent crime (Uniform Crime Reporting, Federal Bureau of Investigation, 2005-2007) Rank of Washington County in Socioeconomic Factors among 88 counties in Ohio (2010); 22Female-headed Households, 2000 Washington Co. Ohio U.S. Female-headed households with children <18 5.3% 7.3% 7.2%Language, 2002-2005 Washington County Ohio Population >5 years who speak a language 2.5% 6.1% other than English at home Households linguistically isolated 0.3% 1.2%55 Physical Environment8Two main components:1. Air Quality Air pollution - particulate matter days (U.S. Environmental Protection Agency/Centers for Disease Control and Prevention, 2005) Air pollution - ozone days (U.S. Environmental Protection Agency/Centers for Disease Control and Protection, 2005)2. Built Environment Access to healthy foods (Census zip Code Business Patterns 2006) Liquor store density (Census County Business Patterns, 2006) Rank of Washington County in Physical Environment Among 88 Counties in Ohio (2010): 82 Family Type5Family Type by Employment Status, 2008 Washington County Number Percent Total Families 17,766 100.0% Married couple, husband and wife in labor force 7,387 41.6% Married couple, husband in labor force, wife not 3,265 18.4% Married couple, wife in labor force, husband not 955 5.4% Married couple, husband and wife not in labor force 2,942 16.6% Male householder, in labor force 613 3.5% Male householder, not in labor force 197 1.1% Female householder, in labor force 1,547 8.7% Female householder, not in labor force 860 4.8%Family Type by Presence of Own Children Under 18, 2008 Washington County Number Percent Total Families 17,766 100.0% Married-couple families with own children 5,826 32.8% Male householder, no wife present, with own children 459 2.6% Female householder, no husband present, with own children 1,478 8.3%56 Families with no own children 10,003 56.3%Housing5Housing Units, 2008 Washington County Number Percent Total housing units 27,760 100.0% Occupied housing units 25,137 90.6% Owner occupied 19,165 Renter occupied 5,972 69.0%21.5% Vacant housing units 2,623 9.4%Year Structure Built, 2008 Washington County Number Percent Total housing units 27,760 100.0% Built 1995-March 2000 2,172 7.8% Built 1990-1994 1,596 5.7% Built 1980-1989 3,875 14.0% Built 1970-1979 5,255 18.9% Built 1960-1969 3,401 12.3% Built 1950-1959 3,228 11.6% Built 1940-1949 1,549 5.6% Built 1939 or earlier 6,684 24.1% Median Year Built 1967 ------Crime5Total crimes in Washington County reported in Uniform Crime Report (2008): 1,32757 58 Community Health Council Stakeholder Survey Results The Community Health Council participated in a survey conducted by the Memorial Health System as part of our Community Health Assessment. Stakeholders of each participating agency were asked to complete the survey. The hospital then tallied the results and provided feedback to the Community Health Council. In addition, the hospital facilitated an action planning session based on the assessment report and the survey results. Participating Agencies The Right Path/Washington County Mental Health EVE Washington County Health Department Community Action Health Service Job and Family Services Washington County Community Health Council Memorial Health SystemHealth Care AccessN ot Not At Very Somewha Very Al Easy t Easy Easy l Ea sy 28 Is access to medical treatment and services in .6 Washington County….. 14.3% 42.9% 14.3% % 71 Is access to mental health treatment and services in .4 Washington County….. 28.6% % 14 .3 Is access to a physician in Washington County….. 57.1% 28.6% %Services Sought Outside of Washington County The services are presented in rank order with the most often cited service appearing first. Services mentioned only once are not included.Adults Teenagers Addiction services; Mental health 59 detox Psychiatric inpatient Psychiatric inpatient Family planning Dental Mental health Cardiac open heart surgery Children Dental Specialized pediatric care Dentists who accept Dental Medicaid Mental health Top Health Concerns AdultsWeighted Score Rank 28 1 Mental health 19 2 Obesity 16 3 Physical health 13 4 Substance abuseChildren and TeenagersWeighted Score Rank 30 1 Mental health 20 2 Substance abuse 15 3 Obesity 11 4 Lack of physical activity/exerciseCommunity ConcernsWeighted Score Rank 25 1 Employment 18 2 Access to mental health services 16 3 Access to healthcare60 Strengths Weaknesses Local hospitals/health services Lack of substance abuse treatment  2 local hospitals  No inpatient services  4 hospitals in mid-Ohio valley Lack mental health care/resources  Cancer Center  No inpatient care  New facilities/expansion  Community mental health is private/for  Wide variety of services profit  Services accessible Physician Issues Physicians  Contracted physicians  Excellence  Dr. without hospital privileges  Primary care physicians  Limited time spent with patients  Specialists Reproductive/Sexual Health Services  Good psychiatrists  Lack family planning Free Services  Lack prenatal care  Free Clinic  Lack STD clinic  Growth of dental clinic Community Health System/Services Relationship Senior Center Day Care  Lack trust in delivery system  Lack trust in ED physicians  Medical insurance accepted by physicians controlled by one entity  Quality decrease with expansion Uninsured/underinsured/Medicare  Low cost dental limited  Limited services without 3rd party payer  New services aimed at Medicare population Lack coordination of Health Departments Opportunities Threats Coordination and Cooperation Financial  Community health providers  Program funding  Health departments  Reduction in Medicare reimbursement Mental Health Services  Economy Expansion of Clinics and Free Services  No mental health levy Caregiver Support  Loss of jobs with medical insurance benefit Health Reform Mental Health/Substance Abuse strain on community businesses and resources Lack of community collaboration Environmental pollution Infrastructure in rural parts of county  Cell service  High speed internet  Emergency response61 Community Health Council Action PlanAction Planning Agenda An action planning session was facilitated by the hospital to review the Community Health Assessment report and the Stakeholder Survey Results in order to develop an action plan based on the findings. Three brainstorming groups formed to develop potential ideas for addressing the community health needs based on the two sources of information. Brainstorming Group#1 Summary: o Communication o Access—resource guide tool lit available to family o Resources o Understanding—meet regularly with medical staff o Stronger Attendance of Council o Education—partnering of council, voice of preventionBrainstorming Group#2 Summary: o Grass Roots—support for Mental Health Levy o Potential of grant writing, funding o Volunteer organizationsBrainstorming Group#3 Summary: o Meeting mental health services—coming up o Education-nutrition o Levy issuesThe larger group then developed a set of priorities based on the three brainstorming groups lists. Priorities:1. Communication/Education a. Toolbox b. Resource Guide c. Social Media d. Collaboration e. All Resources Currently Available 2. Mental Health Levy—Develop levy support model a. Grassroots62 b. Access to Mental Health Initiative c. Council support of levy—tell us what to do 3. Partnership Development a. Physician b. Employees c. Volunteers d. Education e. Financial f. Faith BasedOrder of importance of priorities: Later Now Communication/Education Mental Health Levy Mental Health Levy Communication/Education Partnership Development Partnership DevelopmentNext Steps to accomplish support model for levy support: Letter of Support/Letter to Editor  Encourage Individual Council members to write letter to editor  Attend Kiwanis, Rotary, Women’s Club, Lions Club, etc., if you are a member of secondary organization invite representative to attend to speak of support for levy  Brochure distribution  Faith Based Organizations—Health MinistriesNext Steps to accomplish communication and education: Establish Criteria (Mission)  Briefing upcoming levy; what materials using, testimonials  Sub-committee of council members  Education to local agencies/audiences  Commitment of group  Ad in local media63 Memorial Health System Action PlanThe following actions will be undertaken by the Memorial Health System in response the Community Health Assessment and Community Health Council Stakeholder report.1. Create consistent data sets to understand the trends in our community health needs and the impact of our actions over time. a. Every three years we will update the current Community Health Assessment report and conduct the same Community Health Council Stakeholder survey. b. We will share both data sets with Community Health Council to assist them with the broader community health planning. 2. Support the Community Health Council. a. The Memorial Health System committed resources to assist with the development of a communication toolbox for agencies, a community Resource Guide, and Social Media tools to address community health needs and to connect community members to available resources. b. The Memorial Health System will provide opportunities for agencies of the Community Health Council to educate our employees on levy issues and agency needs. We will also lend marketing support to support health related levies and public campaigns initiated by the agencies of the Community Health Council. c. Continue participation as a Community health Council member.3. Promote disease detection and prevention in the community. a. Develop a mechanism to offer an all-inclusive colonoscopy screening package at a lower combined cost. b. Offer more prevention and wellness outreach services to local employers (e.g. health screenings, health education, exercise and nutritional services).64 c. Continue offering the grant funded Komen Foundation mammography screenings for low income women. Increase community awareness of program availability.4. Pursue and obtain Primary Stroke Center Certification through the Healthcare Facilities Accreditation Program (HFAP).5. Partner with Marietta College and People’s Bank on a long term, community wide project to reduce hunger.6. Support mental health needs in the community. a. Recruit psychiatrist(s) b. Add geripsych bed(s) c. Support other mental health initiatives through the Community Health Council such as levies and community awareness of resources.65 Reference List/Data Sources1. National Public Health Performance Standards Program. Local Public Health System Performance Assessment; Report of Results: Washington County General Health District. November 16, 2009.2. Ohio Department of Health. Health Ohio Community Profiles. Office of Healthy Ohio, Columbus, Ohio. December, 2008.3. Ohio Department of Job and Family Services. 2009 Washington County Profile. 2009.4. Ohio Department of Health. Primary Care County Profile: Washington County. 2006.5. Ohio Department of Development. Ohio County Profiles. Office of Policy, Research, and Strategic Planning, Columbus, Ohio. September, 2010.6. Public Children Services Association of Ohio. County Profiles: Washington County; The 2009-2010 PCSAO Factbook, 9th Edition. May 2009. The 2011- 2012 PCSAO Factbook, 10th Edition. May 2011.7. Ohio Department of Health. Child and Family Health Services; Health Status Profile: Washington County, Ohio. November, 2010.8. University of Wisconsin Population Health Institute. Robert Wood Johnson Foundation. County Health Rankings: 2010 Ohio. 2010.9. Ohio Department of Jobs and Family Services. Ohio Family Children First: Washington County. Ohio Secretary of State, Columbus, Ohio. 2008.10. Scripps Gerontolgy Center. Profile and Projections of the 60+ Population: Washington County, Ohio. University of Miami, Oxford Ohio. May 24, 2004.66

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