MARION-POLK 2019 COMMUNITY HEALTH ASSESSMENT 2021 UPDATE (This page intentionally left blank) 2 Marion-Polk Community Health Assessment 2021 Update Contents Contents ................................................................................................ 3 Executive Summary ............................................................................... 7 2021 Update ........................................................................................................................................................ 8 Introduction & Methods ...................................................................... 11 Health Equity and the Social Determinants of Health ...................................................................................... 12 Organizing for Success & Visioning ................................................................................................................... 14 Four MAPP Assessments ................................................................................................................................... 16 Strategic Issue Identification & Selection ......................................................................................................... 18 Next Steps ......................................................................................................................................................... 19 Data Limitations ................................................................................................................................................ 20 Supporting Assessments ...................................................................... 21 Community Themes & Strengths Assessment .................................................................................................. 22 Community Health System Assessment ............................................................................................................ 24 Forces of Change Assessment ........................................................................................................................... 28 Demographics ...................................................................................... 30 Population ......................................................................................................................................................... 31 Language ........................................................................................................................................................... 36 People Living with Disabilities ........................................................................................................................... 38 Population Projections ...................................................................................................................................... 40 Social Determinants of Health ............................................................. 43 Socioeconomics ................................................................................................................................................. 44 Education ........................................................................................................................................................... 47 Food Insecurity .................................................................................................................................................. 51 Housing & Homelessness .................................................................................................................................. 54 Safety & Violence .............................................................................................................................................. 57 Quality of Life ...................................................................................... 60 3 Marion-Polk Community Health Assessment 2021 Update Mortality ............................................................................................. 65 Chronic Disease ................................................................................... 73 Cancer ................................................................................................................................................................ 81 Cardiovascular Disease ...................................................................................................................................... 92 Diabetes ............................................................................................................................................................. 98 Respiratory Diseases ....................................................................................................................................... 101 Risk Factors for Chronic Disease ..................................................................................................................... 107 Health Screening and Disease Monitoring ...................................................................................................... 111 Communicable Disease Control .......................................................... 115 Adult Immunizations ....................................................................................................................................... 116 Hepatitis .......................................................................................................................................................... 118 Diarrheal Diseases ........................................................................................................................................... 119 Healthcare Associated Infections (HAIs) ......................................................................................................... 120 Tuberculosis .................................................................................................................................................... 124 Sexually Transmitted Infections ...................................................................................................................... 125 Vector-Borne Diseases .................................................................................................................................... 134 Vaccine Preventable Diseases ......................................................................................................................... 135 Maternal Health and Pregnancy ......................................................... 139 Births ............................................................................................................................................................... 140 Risk Factors for Pregnancy .............................................................................................................................. 143 Prenatal Care ................................................................................................................................................... 149 Infant, Child, and Adolescent Health .................................................. 153 Immunizations ................................................................................................................................................. 156 Breastfeeding .................................................................................................................................................. 160 Support for Children and Families .................................................................................................................. 161 Childhood Education ....................................................................................................................................... 166 Risk Factors for Children and Adolescents ...................................................................................................... 170 Adverse Childhood Experiences (ACEs) ........................................................................................................... 182 4 Marion-Polk Community Health Assessment 2021 Update Behavioral Health .............................................................................. 186 Mental Health ................................................................................................................................................. 187 Youth ............................................................................................................................................................ 187 Adults ........................................................................................................................................................... 190 Suicide .......................................................................................................................................................... 193 Alcohol, Tobacco, and Drug Use ..................................................................................................................... 196 Alcohol ......................................................................................................................................................... 196 Tobacco ........................................................................................................................................................ 199 Marijuana ..................................................................................................................................................... 203 Prescription and Illicit Drugs