2011 orange county community health assessment december 2011 healthy carolinians of orange county

2011

ORANGE COUNTY

COMMUNITY

HEALTH

ASSESSMENT

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HEALTHY CAROLINIANS OF ORANGE COUNTY

HEALTHY

CAROLINIA

NS

OF ORANGE C

OUNTY

P AR

TN

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I NG

FO

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AL T

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CO

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UN

I TY

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2 0 1 1 C O M M U N I T Y H E A LT H A S S E S S M E N TH E A LT H Y C A R O L I N I A N S O F O R A N G E C O U N T Y 2

HEALTHY CAROLINIANS OF ORANGE COUNTY• A network of community members and service

providers partnering to promote health and wellness in Orange County

• Members are representatives from schools, human service agencies, churches, civic groups, businesses, local government, UNC Chapel Hill, health care organizations including UNC Healthcare, and concerned citizens.

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• Mission is to advocate, guide and assist Orange County in planning and implementing health care strategies to promote healthy lifestyles, improve health status and prevent premature death and injury for ALL residents in the county regardless of age, race, income, or educational level.

• Overall goal of the partnership is to reduce health disparities

2 0 1 1 C O M M U N I T Y H E A LT H A S S E S S M E N TH E A LT H Y C A R O L I N I A N S O F O R A N G E C O U N T Y

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4


• What We Do Build and promote collaborative partnerships Guide local planning efforts to improve health Support innovative health programs Advocate for health-promoting policies Identify critical health needs in the

community

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2011

ORANGE COUNTY

COMMUNITY

HEALTH

ASSESSMENT

ACKNOWLEDGMENTS

• Thanks to the residents of Orange County, Community Health Assessment Team members, and all Healthy Carolinians partners and member agencies who helped to guide and make the assessment a true community process.

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COMMUNITY HEALTH ASSESSMENT: OVERVIEW• Required of all NC Health Departments every 4

years

• Collaborative process with multiple stages Over 50 Leadership Team members Nearly 150 community survey volunteers 30+ document writers Close to 200 forum participants

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COMMUNITY HEALTH ASSESSMENT: GOALS• Enable local public health officials/community groups

to Monitor trends in health status Identify priorities among health issues Determine the availability of resources

• Document Useful, relevant, actionable, reflective, forward-

looking

• Information gathered lays the foundation for effective, strategic community health planning

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HEALTH ASSESSMENT PROCESS: PHASES

Phase 1: Establish Community Assessment Team

Phase 2: Collect Community Data

Phase 3: Collect and Analyze Community Health Statistics Phase 4: Combine County Statistics and Community Data Phase 5: Solicit Community Input to Select Health PrioritiesPhase 6: Create Community Health Assessment DocumentPhase 7: Disseminate CHA Document to the CommunityPhase 8: Develop the Community Health Action Plans

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DATA SOURCES AND COMMUNITY INVOLVEMENT• Both primary and secondary data sources

• Community Involvement Various roles Involvement at every stage

Planning Data collection Identification of health issues, community

strengths Development of strategies to address problems

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• Community Health Opinion Survey

• Survey households sampled from census blocks with high poverty percentage

• Administered in multiple languages

• Covered various topics

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QUANTITATIVE: HEALTH OPINION SURVEY

QUALITATIVE: FOCUS GROUPS AND FORUMS• Nine focus groups

Gain well-rounded understanding of health concerns

Nearly 70 community voices

• Five community forums Almost 200 participants Presented and discussed main data findings Selected initial priorities

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• Available online www.orangecountync.gov/healthycarolinians

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COMMUNITY HEALTH ASSESSMENT: FULL REPORT

ORANGE COUNTY

COMMUNITY

PROFIL

E

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COMMUNITY PROFILE: DEMOGRAPHICS

• Population has more than doubled in past four decades Total: 57,567 (1970) to 133,801 (2010)

About a 5.8% rate of increase every ten years

• Age Median: 33 years old

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Age and Percent of Total Population (2010)

Age Group Percent

Under 5 years 5.1%

Under 18 years 20.9%

Under 25 years 39.1%

Between 25-65 years

51.3%

65 years or older 9.6%


• Gender 52.2% female / 47.8% male

• Rural/Urban 57% of residents live in southern “urban” areas of

Chapel Hill and Carrboro 43% live throughout rural areas

• Diversity Race and ethnicity Country of origin Languages

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Race and Ethnicity Demographics, Percent of Total Population

NCOrange County

Carrboro

Chapel Hill

Hillsborough

White68.

574.4 70.9 72.8 62.9

Black21.

511.9 10.1 9.7 29.5

Hispanic or Latino of any race

8.4 8.2 13.8 6.4 6.6

Asian 2.2 6.7 8.2 11.9 1.7American Indian and Alaska Native

1.3 0.4 0.4 0.3 0.6

Native Hawaiian and Other Pacific Islander

0.1 0.0 0.0 0.0 0.0

Some other race

4.3 4.0 7.5 2.7 3.3

Two or more races

2.2 2.5 2.9 2.7 2.1

PROFILE: LEADING CAUSES OF DEATH

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Leading Causes of Death in Orange County,

% and Number, 2005-2009OC

Rank Cause of Death OC %

NC %

OC # NC #

1 Cancer 24.6 22.8 859 86,246

2 Diseases of heart 21.2 23.0 742 86,920

3 Cerebrovascular diseases 5.5 6.0 191 22,600

4 Chronic lower respiratory diseases 4.4 5.6 155 21,22

8

5 All other unintentional injuries 2.9 3.4 100 12,89

66 Influenza and pneumonia 2.7 2.3 96 8,632

7 Alzheimer's disease 2.2 3.3 78 12,386

8 Motor vehicle injuries 2.1 2.1 74 8,027

9 Diabetes mellitus 2.0 2.9 69 10,906

10 Intentional self-harm (suicide) 1.5 NA 51 NA

PROFILE: DEATH RATES, AGE ADJUSTED

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Age-adjusted death rates (per 100,000 population)

Orange County and NC, 2005-2009OC

Rank Cause of Death OC Rate

NC Rate

1 Cancer 158.4 185.6

2 Diseases of Heart 141.8 191.7

3 Cerebrovascular Disease 37.2 50.5

4 Chronic Lower Respiratory Diseases 30.7 47.0

5 Pneumonia and Influenza 18.6 19.4

6 Alzheimer's disease 17.5 28.3

7 All Other Unintentional Injuries 17.2 28.6

8 Diabetes Mellitus 14.5 23.6

9 Suicide 12.8 12.0

10 Nephritis, Nephrotic Syndrome, and Nephrosis 12.1 18.7

PROFILE: LEADING CAUSES OF DEATH

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2005 2006 2007 2008 20090

5

10

15

20

25

30

Top-5 Leading Causes of DeathOrange County, %, by Year, 2005-2009

CancerDiseases of heartCerebrovascular diseasesChronic lower respiratory dis-easesAll other uninten-tional injuries

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PROFILE: LEADING CAUSES OF HOSPITALIZATION

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Leading Causes of HospitalizationOrange County and North Carolina, 2009

Cause OC % NC %

Other diagnoses (incl. mental disorders) 16.6 10.1

Cardio-vascular and circulatory diseases 16.4 19.3

Pregnancy and childbirth 16.1 15.7Digestive system diseases 11.3 11Injuries and poisoning 10.7 9.4Respiratory diseases 8.2 11.8Musculo-skeletal system diseases 7.7 6.9Genito-urinary diseases 4.6 5.4Endocrine, metabolic and nutritional diseases 4.2 4.7

Malignant neoplasms 4.2 NA Symptoms, signs and ill-defined conditions NA 5.7

SOCIAL,

ECONOMIC,

AND ENVIR

ONMENTAL

DETERMIN

ANTS O

F

HEALTH

HE

ALT

H D

I SP A

RI T

I ES

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HEALTH DISPARITIES

• Health depends largely on Economic status, income Race/ethnicity Where someone lives (Place, geography)

• Rates of disease and health outcomes significantly worse among economically disadvantaged, particular racial and ethnic minorities, and rural populations.

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DETERMINANTS OF HEALTH

• Built Environment• Child Care• Crime and Safety• Education• Housing and Homelessness• Hunger and Food Insecurity• Income and Poverty*• Labor and Employment*• Parks and Recreation • Transportation

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DETERMINANTS OF HEALTH: INCOME, POVERTY• Median household income: $51,944 (2009)

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Percentage below the Poverty Level by Age and Gender % Below Poverty

Level NC Orange

CountyPopulation for whom poverty status is determined 17.5 20.1

Age Under 18 years 24.9 22.218 to 64 years 16.2 20.865 years and over 9.9 11.3

Gender Male 16.2 18.4Female 18.7 21.6

DETERMINANTS OF HEALTH: POVERTY

Percentage below the Poverty Levelby Race and Hispanic or Latino Origin

% Below Poverty Level

NC Orange County

One Race 17.3 NA White 13.2 20.2Black or African American 27.7 23.0American Indian and Alaska

Native 31.2 NA

Asian 14.1 14.1Native Hawaiian and Other

Pacific 26.8 NA

Some other race 36.7 NA Two or other races 24.3

Hispanic or Latino origin (of any race) 33.9 49.8

White alone, not Hispanic or Latino 11.8 16.8Dec

embe

r 2011


DETERMINANTS OF HEALTH: LABOR, EMPLOYMENT

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Unemployment Rate (%) by Gender, Poverty Status, and Disability

Status Unemployment

Rate (%) NC Orange

CountyGenderMale 12.3 10.1Female 11.4 9With own children under 6

years 14.7 6.7

Poverty status in the past 12 monthsBelow poverty level 36.2 22

Disability statusWith any disability 23.2 41.1

TOP

10 ISSUE A

REAS

(ALP

HABETICAL)

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ACCESS TO H

EALT

H CARE,

INSURANCE, A

ND

INFO

RMATIO

N• Includes the availability

and affordability of health care services and insurance, ability to navigate and understand the health system, access and transportation to services, and information about health care.

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BUILT E

NVIRONMEN

T

• Includes human-made structures such as sidewalks, streets, housing, businesses, schools, parks, and, more broadly, land use patterns. The built environment impacts safety and the ability to get exercise, to access good nutrition, and health care services.

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CANCER

• The leading cause of death in Orange County in 2010 and has been ranked as #1 in 9 of the past 10 years. It is estimated that nearly 80% of cancers are due to factors that can be prevented: tobacco use, poor nutrition, lack of physical activity, and exposure to radiation. Many cancers are highly treatable with advanced screening.

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CHRONIC D

ISEASE:

EXERCIS

E & N

UTRIT

ION

• Regular exercise and proper nutrition significantly contribute to physical and mental health; and can help prevent chronic diseases like diabetes, heart disease, stroke and cancer. Physical activity and good nutrition are important in maintaining a healthy body weight.

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ENVIR

ONMENTAL H

EALTH

• Includes air quality; drinking, and ground water quality; and lead hazards. Environmental health issues local to neighborhoods may exist in addition to these key factors.

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INJU

RY

• Addresses unintentional injuries like motor vehicle crashes, falls, poisonings, drowning, etc., and intentional injuries, or violence, which includes sexual assault, child abuse, domestic violence, homicide, and suicide.

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MENTAL H

EALTH • Refers to a wide range of

conditions that affect one’s mood, thinking and behavior. Broad classes of illness include mood disorders (depression, bipolar disorder), anxiety disorders, psychotic disorders (schizophrenia), eating disorders, personality adaptations or disorders, and addictive behaviors/substance abuse disorders. Many factors contribute to its onset, including genetics, biological factors, life experiences, and brain chemistry, though everyday stress.

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ORAL HEALT

H• Not only includes tooth and

gum health, but also has overall health impacts (gum disease contributes to heart disease; tobacco use contributes to tooth decay). Issues in oral health include availability of affordable dental insurance, access to regular and preventative care, and population specific issues.

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SUBSTANCE A

BUSE• Includes alcohol abuse

and illegal drug use, but also includes underage drinking, traffic accidents, prescription drug abuse/misuse, and injury related to alcohol and drugs. It often connects with mental health needs.

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TRANSPO

RTAT

ION • Transportation systems impact

quality of life and health. Expanding active transportation (walking and biking) options and safety can prevent disease, reduce and prevent motor-vehicle-related injury and deaths, improve environmental health, stimulate the economy and improve equal access to resources. Accessible and affordable transportation is particularly an issue in rural areas, for those with disabilities, older citizens and lower-income people.

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COMMUNITY

PRIO

RITIE

S

I DE

NT

I FI E

D I N

TH

E C

OM

MU

NI T

Y H

EA

L TH

AS

SE

SS

ME

NT

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RANKED TOP 10 ORANGE COUNTY PRIORITIES1. Access to Health Care, Insurance, and Information2. Chronic Disease: Exercise, and Nutrition 3. Mental Health4. Transportation5. Built Environment6. Cancer7. Substance Abuse8. Environmental Health9. Oral Health10.Injury

Write-ins: Teen Pregnancy/Youth Health, Sexual health, Socio-economic Development

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TOP 5 HEALTHY CAROLINIANS PRIORITIES1. Access to Health Care, Insurance, and Information

2. Chronic Disease: Exercise and Nutrition

3. Mental Health

4. Substance Abuse

5. Injury

Current Healthy Carolinians of Orange County Focus Areas

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CURRENT FO

CUS AREAS

AND FIN

DINGS

HE

AL T

HY

CA

RO

LI N

I AN

S O

F O

RA

NG

E C

OU

NT

Y, 2

01

2- 2

01

5

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ACCESS TO HEALTH CARE

• Orange County has highest per capita number of physicians and dentists in NC

88.9 physicians, 10.4 dentists per 10,000 population

• 18.3% of Orange County residents do not have one or more persons that they considered a doctor or health care provider

• Close to 28% of residents did not visit a doctor for a routine (general physical exam) checkup within the past year

• 14.8% of county residents could not see a doctor due to cost

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ACCESS TO HEALTH CARE

• In addition to medical insurance, factors contributing to a resident’s inability to access health care services include Concentration of health care resources in the southern

part of county Inadequate transportation systems in the central and

northern parts of Orange County Language barriers; Recent relocation to the county

from another country Perceived disparities (or racism) within health care

facilities

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• Medical facilities (hospitals, urgent care facilities, and health departments) in the county are all within city limits of Chapel Hill, Carrboro, or Hillsborough.

• This map does not include private physician or dentist offices.

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ACCESS: ORANGE COUNTY MEDICAL FACILITIES

ACCESS TO HEALTH INSURANCE

• 2008-2009 county-level estimates of uninsured 18.9% (21,854) of Orange County residents,

0-64 years of age

• Due to economic recession, rise in unemployment rates consistent with rise in uninsured residents

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ACCESS TO HEALTH INFORMATION

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• Health Literacy “The degree to which individuals have the

capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

Extends beyond a person’s reading and writing skills

Ability to comprehend spoken words Use numeracy and math skills for calculations Navigate the health care system

Transcends income and education levels

CHRONIC DISEASE: CANCER

• Cancer Leading cause of death in Orange County (2010)

Ranked as leading cause of death in 9 of past 10 years Among all cancers, death rate per 100,000 population was

163.3 (2008) Lower cancer death rates than NC (2008) Responsible for 859 deaths (2005-2009)

Total number of cancer deaths decreased slightly in comparison with previous time periods

Difference in cancer deaths between racial groups is dramatic For all common cancers, African Americans had higher

death rate than whites

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CHRONIC DISEASE: DIABETES

• Diabetes 2001-2005, age-adjusted diabetes death rates for

Orange County was 17.8 per 100,000 (NC rate was 27.6 per 100,000)

Percentage county residents with diabetes varied in recent years

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Disparities in Diabetes Orange County NC Residents

% with

Diabetes% without Diabetes

% Borderline Diabetes

2005 2010 2005 2010 2005 2010Gender

Male 4.1 4.2 94.5 95.4 1.4 0.4Female 7.1 6.1 90.0 91.7 1.6 1.1

Race

White 3.8 3.5 95.0 95.2 0.8 1.0Other 11.6 10.5 82.8 87.9 3.9 0.0

Age

18-44 1.5 2.3 96.4 96.9 0.9 0.045+ 10.8 8.1 87.0 90.0 2.2 1.6

Education

High school or less

6.5 8.0 90.4 91.3 1.7 0.7

Some college 5.3 4.5 92.9 94.0 1.4 0.8

CHRONIC DISEASE: HEART DISEASE AND STROKE• Heart Disease and Stroke

Second leading cause of death 137 deaths due to heart disease; 29 due to cerebrovascular

disease (2009) Heart disease and cerebrovascular disease leading causes of

hospitalizations, hospital expenses Heart disease: $31,730,269 Cerebrovascular disease: $7,290,187

Age-adjusted death rate for heart disease decreasing 2001-2005: 165.3 per 100,000 2009: 148.4 per 100,000

Age-adjusted death rate for cerebrovascular disease is 39.0 per 100,000 (2009)

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CHRONIC DISEASE: OBESITY, OVERWEIGHT• Obesity and Overweight

Contributes to the burden of cancer, heart disease, stroke

Rate of overweight or obese among residents 18 and older

Overall rate dropped from 56% to 48.1% (2007-2009)

However, recent increase to 53.2% (2010) Rate of overweight among 2-4 year olds has

decreased

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CHRONIC DISEASE: EXERCISE AND NUTRITION• Physical activity and proper nutrition

Important to reach a healthy body weight Meeting recommendations can help prevent

cardio-metabolic conditions Healthy eating in childhood and adolescence

important for proper growth and development

• 31.1% of residents consume five or more servings of fruits or vegetables per day (2009)

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MENTAL HEALTH AND SUBSTANCE ABUSE• Suicide

Among top 10 leading causes of death Rates fluctuated (2000-2009), ranging from a low

of 5.8/100,000 to a high of 18.5/100,000

• High stress/Poor mental health

• Substance abuse Increasing prevalence of prescription drug

abuse/misuse Underage drinking Driving under the influence

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MENTAL HEALTH AND SUBSTANCE ABUSE• Contributing factors

System instability Family and community violence Barriers to access

Stigma Lack of knowledge about existing services Lack of adequate insurance or co-pays Lack of specific service/needing more

options

552 0 1 1 C O M M U N I T Y H E A LT H A S S E S S M E N T

H E A LT H Y C A R O L I N I A N S O F O R A N G E C O U N T Y

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TOBACCO

• Tobacco use remains leading preventable cause of death• 11.5% of county residents report smoking some days or

every day, compared to 20.3% in NC (2009)• 14.5% of high school students report using tobacco

(cigarettes, cigars, smokeless tobacco) in the past 30 days (2011)

• 8.1% of people exposed to secondhand smoke in workplace (2008)

• Educational attainment, employment correlated with secondhand smoke exposure

• Percentage of mothers who smoked during pregnancy has been decreasing since 1994

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INJURY AND VIOLENCE

• Broad topic: Injury-related health issues including Unintentional injuries: Motor vehicle crashes, falls,

poisonings, drowning, etc. Intentional injuries/violence: Sexual assault, child abuse,

domestic violence, suicide, human trafficking, etc.

• Unintentional injuries a leading cause of death for ages 1-44

• Intentional injuries (or violence) likewise pervasive and a leading cause of death/hospitalization, especially for ages 15-35

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TAKING ACTION, TOGETHER

• Many efforts underway to address priority areas; new initiatives needed to respond to identified gaps

• Progress requires total community involvement to improve the quality of life for people living in Orange County

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TAKING ACTION, TOGETHER

• Join the more than 125 other individuals and 80 county agencies and organizations who are partnering with Healthy Carolinians of Orange County to find creative solutions so that all Orange County residents can choose health as their first priority

• To find out how to become involved with work groups addressing the top health concerns in the county, please contact the Healthy Carolinians Coordinator

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CONTACT INFORMATION

Nidhi Sachdeva MPH, CHES• Healthy Carolinians Coordinator• Orange County Health Department• 300 West Tryon Street | Hillsborough, NC 27278• Phone: 919.245.2440 • Email: [email protected] • Website, Full Report, Membership Information:

http://www.co.orange.nc.us/healthycarolinians

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2011 orange county community health assessment december 2011 healthy carolinians of orange county

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