older adults disabilities walking trails heart disease access to specialists physical activity hypertension mental health food insecurity healthy living interagency poverty uninsured health education homelessness collaborationpreventive health care disconnect employment issues education chronic illness awareness primary care transportation daycare disease unemployment breast feeding expanded hours of service prevention affordable housing obesity underinsured nutrition bike paths community chronic disease health disparities active living public health Medicarehealth healthy foods communication substance abuse diabetes access to care insurance costs programs smoking available services Medicaid coverage school oral health fresh foods MIDDLESEX COUNTY COALITION ON COMMUNITY WELLNESS Community Health Needs Assessment JULY 2013 MIDDLESEX COUNTY, CONNECTICUT Acknowledgements Middlesex County Coalition on Community Wellness This community health needs assessment was prepared by Chatham Health District, who wishes to thank the Middlesex County Coalition on Community Wellness members, community partners, Connecticut Department of Public Health, Connecticut Association of Directors of Health, Middlesex Hospital, and policy and program key informants who contributed their time, expertise and involvement to the development of this assessment. The Middlesex County Coalition on Community Wellness and this assessment are supported by a Community Transformation Grant from the Centers for Disease Control and Prevention. This document has been produced for the benefit of the community. Chatham Health District community health needs assessment partners encourage the use of this report for planning purposes and are interested in learning of its utilization. When referenced, please use the citation provided. We would appreciate your comments and questions, which may be directed to Wendy Mis, (860) 365-0884, [email protected]. Citation: Middlesex County Coalition on Community Wellness Community Health Needs Assessment; Chatham Health District, East Hampton Connecticut; July 2013 This assessment was funded by a Centers for Disease Control and Prevention Community Transformation Grant. This study is available for download at: www.chathamhealth.org Special thanks to Wendy Mis, MPH, CHES, Director of Community Health at Chatham Health District, for coordination, collection and assembly of this assessment. The cover design is a word cloud consisting of words and phrases captured through community conversation while collecting data for this assessment. Words more frequently reported are presented in larger font. At the center of the word cloud is the Middlesex County Coalition on Community Wellness (CoCW) logo, designed by Michael M. Malicki, of Michael Malicki Design/Illustration ([email protected]). The buildings in the logo represent the various sectors of the community. The linked O and C concept symbolize collaboration and inclusiveness. The O represents the strength of the coalition, and the open C signifies the opportunity to join our effort to improve community wellness. i Contents List of Tables iv List of Figures v List of Maps vi Executive Introduction 1 Middlesex County Population and Demographic Overview 3 County and Town Designations and Governance 4 Middlesex County Municipality Population and Demographic Highlights 5 2000-2010 Population Comparisons, Growth Projections, and Ethnic/Racial 5 Composition Age Distribution 7 Educational Attainment 10 Economic Stability- Income, Poverty, and Unemployment 12 Health Insurance Coverage 15 Housing and Homelessness 16 Community Safety 17 Community Health-Related and Environmental Assets 19 Community Health-Related Assets 19 Environmental Assets 20 Special Populations 21 Health Status of County Residents 22 State and County Health Rankings 22 Lifestyle Behaviors and Risk Factors 24 Behavioral Risk Factor Surveillance 25 The Burden of Chronic Disease 29 Mortality and Leading Causes of Death 33 Healthy People 2020 Leading Health Indicators 36 Overview of Health Disparities and Inequities in Middlesex County 38 Accidents and Violence 39 Cardiovascular Disease 40 Diabetes 40 Health Care Access 41 Life Expectancy 41 Liver Disease 42 Mental Health 42 Renal Disease 43 Respiratory Illness 43 Description of Local Health-Related Programs and Services 44 Geographical Asset Maps 45 ii Healthy Eating 45 Active Living 46 Tobacco-Free Living 47 Social and Emotional Wellness 48 High Impact Quality Clinical and Other Preventive Services 48 Thematic Asset Map 50 CTG Coalition Overview and Coalition Activities 51 Middlesex County Policy, Systems and Environmental Scan 52 Data Tools 53 Policy Overviews 55 CHANGE Tool Implementation 58 Key Coalition Findings 59 Public and Political Will for Change within Middlesex County 64 Prioritized Strategies for Implementation 67 CTG Strategic Direction: Tobacco Free Living 67 CTG Strategic Direction: Healthy Eating 68 CTG Strategic Direction: Active Living 68 CTG Strategic Direction: Clinical Preventive Services 69 Future Strategic Directions: Social and Emotional Wellness, Healthy and Safe 70 Physical Environment Appendices 1 Data Sources 71 2a ICD-10 Coding for Selected Causes of Death 73 2b ICD-19 Coding for Selected Causes of Hospitalization 73 3 Glossary of Statistical Terms 74 4 Data Sources 78 5a Connecticut Association of Directors of Health Technical Appendix for the 1/82 Health Equity Index March 2013 5b Connecticut Association of Directors of Health Health Equity Index Data 106 Tables 6a Middlesex County Assets that Support Healthy Eating 113 6b Middlesex County Assets that Support Active Living 117 6c Middlesex County Assets that Support Tobacco Free Living 121 6d Middlesex County Assets that Support Social and Emotional Wellness 122 6e Middlesex County Assets that Support Quality Clinical Preventive Services 127 7 Description of Focus Area Assets 129 8 Key Informant Survey/Interview 139 9a Focus Group Questions - Community-at-Large & Community 141 Industry/Organization Sectors iii 9b Focus Group Questions- Healthcare Sector 143 9c Focus Group Questions- Worksite Sector 144 9d Qualitative Analysis – Key Informant Surveys 145 9e Qualitative Analysis – Focus Groups 156 10a Middlesex County Coalition on Community Wellness Steering Committee 163 10b Middlesex County Coalition on Community Wellness Members 164 10c Middlesex County Coalition on Community Wellness Workgroup Members 167 10d Community Agencies and Partners That Participated With Key Informant 169 Interviews, Focus Groups, and CHANGE Tool Surveys 11 Photo Journal Pictures from CoCW Members 173 Tables 1 2010 University of Connecticut Population and Projections for Middlesex 5 County Municipalities, 2015 - 2030 2 Middlesex County Municipality Census 2000 and 2010 Population Counts by 6 Race/Ethnicity 3 Middlesex County Municipality Census 2000 and 2010 Numeric and Percent 7 Population Change 4 Educational Attainment in Middlesex County Residents Ages 25 and Over, 2000 10 and 2010 5 High School Graduation Rates and Dropout Rates, School Districts in Middlesex 11 County, 2008 6 Percent of Minority and ELL Students Enrolled by School District, Middlesex 12 County 2008 - 2010 7 Economic Characteristics of Middlesex County Municipalities, 2006 - 2010 13 8 Students Eligible for Free/Reduced Price School Meals, 2010 -2011 14 9 2010 Crime Index Totals for Middlesex County Municipalities, Rank Ordered by 18 Rate 10 Percent Select Arrests for Middletown, Middlesex County, and Connecticut, 18 2010 11 Hospitals Utilized by Middlesex County Residents, 2010 20 12a Middlesex County Health Indicators, 2012 23 12b County Health Rankings 24 13 Percentage of K – 12 Students Passing All Four Physical Fitness Test 28 Components, 2010 - 2011 14 State and County Age-Adjusted ED Visit Rates per 100,000 Residents by 32 Gender, Race, and Ethnicity, 2005 - 2009 15 State and County Age-Adjusted Hospitalization Rates per 100,000 Residents by 33 Gender and Race/Ethnicity, 2005 - 2009 iv 16a State and County Age-Adjusted Mortality Rates per 100,000 Residents by 35 Gender and Race/Ethnicity, 2005 - 2009 16b State and County Age-Adjusted Years of Potential Life Lost to Age 75 by 36 Gender and Race/Ethnicity, 2005 - 2009 17 Healthy People 2020 Indicator 37 18a Community Conditions Related to Accidents and Safety in Middletown 39 Connecticut 18b Community Conditions Related to Cardiovascular Disease in Killingworth CT 40 18c Community Conditions Related to Diabetes in Cromwell CT 40 18d Community Conditions Related to Health Care Access in Westbrook CT 41 18e Community Conditions Related to Life Expectancy in Middletown CT 41 18f Community Conditions Related to Liver Disease in Middlefield CT 42 18g Community Conditions Related to Mental Health in Clinton CT 42 18h Community Conditions Related to Renal Disease in Chester CT 43 18i Community Conditions Related to Respiratory Illness in Old Saybrook CT 43 19a Policy, Systems and Environmental Change Strategies: Needs 60 19b Policy, Systems and Environmental Change Strategies: Assets 60 20 CHANGE Tool Scale 61 21 Middlesex County CHANGE Tool Results 62 Figures 1 Population of Middlesex County 2000 – 2010, by Age Group 8 2 Middlesex County Population 2010, by Age and Municipality 8 3 Middlesex County Median Age Projections 2000 to 2030 9 4 Middlesex County Municipalities Population Under Age 18, 2010 9 5 Middlesex County Municipalities Population Age 65 and Over, 2010 9 6 CT and U.S. Percent Uninsured Population, 1999 -2009 15 7 Persons with Health Insurance Children 0 – 18 Yrs of