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SETTING HEALTH PRIORITIES

This Application Assignment asks you to consider the kinds of data you would use, and how you would obtain the data, for a community health assessment.

Read through the case exercise on Community Health Assessment, linked below, and complete all the questions. All the information you will need to complete this assessment exercise is provided in the Appendix at the end of the document. Save this Word document to your computer before you begin to fill out the form.

Community Health Assessment Exercise

Note: Assessment is a very involved process, and you could easily spend many hours exploring this case exercise alone. However, for the purposes of this assignment, you should limit yourself to spending no more than two hours to complete this Application.

Your name:
Date:

Week 4 Application: Community Health Assessment for Pitt County, North Carolina[*]
Community health assessment is key to understanding the health problems and priorities of a population. This Application Assignment outlines a process by which you can complete a health assessment of a community using indicator-based methods. You will construct a set of health indicators from a variety of domains, evaluate problems, and report on the health priorities for a community.

 

Sections A–C ask questions about assessment in general. Section D involves assessment of a particular county in North Carolina, information on which is provided in that section and in the Appendix.

 Instructions: Save this document to your computer and complete all questions in Sections A–D below. Submit by the end of Week 4 following the submission instructions in the Week 4 Application section.

Section A: Community Health Assessment

The goal of public health is to improve the health of a population. Public health interventions such as safe water sources, immunization programs, and improved motor vehicle safety regulations account for the majority of years of life expectancy gained in the United States over the last 100 years.

 

A community health assessment involves obtaining and interpreting information to determine the health status of a specific community. Once community health needs are identified, public health interventions can be developed and their effectiveness evaluated using a similar approach.  Information necessary for performing a community health assessment, for example data on mortality rates or behavioral risk factors such as smoking, is available from various sources.

 

Questions:

  1. How do you define community?
  2. What stakeholders (groups/organizations) would you want to consult with for a community assessment?
  3. What types and sources of data would you use for a community assessment?

 

Section B: Healthy People 2010

 

The Healthy People 2020 initiative is a national approach that identifies high priority health issues and establishes objectives to reduce the impact of these public health threats. To understand the significance of data on your own community, you have to be able to compare it to another standard. The questions in this section ask you about other standards that can be used.

Questions:

  1. How are Healthy People 2020 standards used? What are advantages and disadvantages to applying them at a local community level? (Note: you may use the Healthy People 2010 standards if the 2020 standards are not reported.)

 

  1. What other standards (national, state, or local) can be used?

Section C: Health Indicators

 

For this exercise, you will use an indicator approach to develop a community health assessment. A community health assessment involves three-step feedback loop.

 

The first step in such an assessment involves identifying important health indicators. The second step involves matching those indicators with available data. In the third step, standards such as those explored in Section B are applied to the data gathered in the first two steps to transform it into useful information about health needs of the population.

 

Health indicators are measurable health outcomes, such as death rate, insurance coverage measures, immunization rates, or other data items that are relevant to the health of a community. Indicators are thoughtfully selected data points that provide useful information about the health of a community.

 

Note that each indicator should be:

  1. An important health problem.
  2. Prevalent or common in the community of interest.
  3. Measurable on a community or population basis. There should be population data on a local level that is easily available—this cannot be collected from health facilities or providers because these data sources do not apply to the entire community.
  4. Ideally, because we want to use a limited number of indicators, the indicator should not be redundant—not measure the same thing—as another chosen indicator.

 

To organize indicators, it is helpful to identify major areas of focus. For this case, we will refer to these broad categories of public health concerns as domains. Please refer to Table 1 below for examples of domains. For each domain, an example of an indicator is provided.

Table 1: List of Domains to Assist Developing a Community Health Assessment

 

Domain:Example of an Indicator:
Communicable Diseases(including Sexually Transmitted Diseases)Incidence of Gonorrhea
Chronic Diseases (including Cancer)Incidence of Diabetes
Injury and ViolenceHomicide rate
Maternal and Child HealthChildhood immunization rate
Environmental HealthRates of Lead Poisoning
Access to Health CareRates of Uninsured

 

Question:

 

  1. How you would obtain data for these indicators. What sources might you use? Select 2 of the indicators above and provide specific sources of information on them (including URLs) for your own community or state.

 Section D: Performing a Community Health Assessment

 

As a consultant to Pitt County Health Department, you are asked to perform a community health assessment for the county. Below is information about the county:

 

Pitt County is located in eastern North Carolina and has a population of 138,690 residents (2005 Census).  Pitt County has been classified as urban for the first time in 2006. It and the surrounding counties are largely rural with a history of dependence on tobacco farming. Caucasians make up about 62.8% of the population, African Americans 33.6%, Hispanics 3.2%, Asians 1.1% and American Indians 0.3%. There are an estimated 6,606 migrant and seasonal workers or 5.4% of the population. About 18% or 26,000 adults in Pitt County adults have household incomes below the federal poverty level with a median per capita income of $18,243 (2000). The child poverty rate is estimated to be 21.8%. Approximately 20% of adult lack health insurance.

 

Pitt County contains Greenville, the largest city in eastern North Carolina with a population of 67,525 (2005). Greenville is considered the hub of eastern North Carolina. The major employers are Pitt County Memorial Hospital (PCMH), Brody School of Medicine and East Carolina University. If a state was created of all the land in North Carolina east of Interstate 95, it would be the poorest of all 50 states. In addition, it would rate 48th in terms of premature mortality. Consider these factors when evaluating populations at risk and targeting resources for public health activities.

 

You now embark on the steps needed to perform your assessment.

 

 

 

·   STEP ONE:  IDENTIFYING HEALTH INDICATORS

 

As noted earlier, the first step in a community health assessment is identifying health indicators.   Develop a list of 18-20 indicators you would want to use in your assessment, identifying 3-4 indicators per domain.

 

Complete the column on the right in this table:

 

 

Domain:Indicator: (provide 3-4 per domain
Communicable Diseases

(including Sexually Transmitted Diseases)

Chronic Diseases (including Cancer)
Injury and Violence
Maternal and Child Health
Environmental Health
Access to Health Care

 

 

  • STEP TWO: MATCHING THE INDICATORS

 

Now that you have chosen indicators to use for a community health assessment, use the information provided in the tables below (Appendix) to match available data to your chosen indicators. In this example, residents of Pitt County constitute the community. If the Appendix does not give you the data for your indicator, you should choose another indicator (alternatively, you may seek out the data elsewhere that you need for your proposed indicator).

 

Question:

 

  1. Have you matched each of your indicators to the data available in the Appendix? If not, explain how and where you got the data needed for your proposed indicator.

 

·   STEP THREE:  SETTING HEALTH PRIORITIES

Using the information gathered in the first two steps, please answer the following questions.

Note: Keep in mind that in order to plan an effective intervention program in real life, you must communicate with other constituents and stakeholders and see what they perceive to be priority health issues. Collaboration with community stakeholders in program design is critical to the success of an intervention plan. For this purposes of this assignment, however, you are reviewing the data on your own, without the input from other stakeholders.

Questions:

 

  1. Looking at this data only, what would you conclude are three priority health issues for this population? (Can be picked by how the indicator compares)

 

  1. Choose three of your indicators. Compare them to the Healthy People 2020 Standards (or 2010 if appropriate) and provide URL(s) for the relevant Web page from Healthy People to the specific indicator.

 

  1. How do you explain the health disparities of these indicators? (i.e., as shown by this comparison with HP?]

 

You have completed this Application on assessment. Submit this completed form in the Dropbox following the submission instructions in the Week 5 Application area.

 

 APPENDIX 1: DATA TABLES

Community Health Assessment Indicators Pitt County (NC),

North Carolina, and the United States

 

 

 

Domain: Maternal and Child Health (2004) 
IndicatorPitt CountyNorth CarolinaUnited States
Infant mortality rate per 1,000 live births(2004)  7.1    8.8    6.9
      Black infant mortality per 1,000 live births  8.1 15.6  14.1
      White infant mortality per 1,000 live births  7.0   6.2  5.8
Neonatal infant mortality rate per 1,000 live births(<28 days of age) (2000-2004)5.76.04.6
      Black neonatal infant mortality rate  8.911.2  7.3
      White neonatal infant mortality rate  3.3  4.1  3.8
Low birth weight (<2,500 g) per 100 births(2004)11.6    9.1  7.9
      Minority births <2500 g15.913.4 13.0
      White births <2500 g  8.3  7.4  6.5
Very low birth weight (<1500 g) per 100 births(2000-2004)2.81.91.4
      Minority births <1500 g  3.3  3.6  3.0
      White births <1500 g  2.4  1.0
Teen pregnancy rate per 1,000 teens(ages 15-19)(2000-2004)39.864.1(11.9%) 83.6
      Minority pregnancies54.587.3153.3
      White pregnancies27.053.6 71.4
Smoked during pregnancy  8.9 12.5 11.4
Postneonatal infant mortality per 1,000 live births (>28 days <1 year) (2000-2004)1.42.82.3
      Black postneonatal rate  1.1  4.5  4.8
      White postneonatal rate  1.7  2.1  1.9
Immunization status at 2 years of ageNA82%
Immunization status at school entryNA99%

 

BRFSS for 2004Age adjusted ratesPitt CountyNorth Carolina
Adult disability  28.3  25.0
Current asthma   7.1    6.4
Smoking: women of childbearing age   30.4  24.4
Smoking everyday: men   32.9  37.6
Obesity   26.1  22.7
Binge drinking (childbearing age)     9.5   6.8
Binge Drinking (all)   12.0   8.4
       Men   19.8
       Women     3.1
No leisure time physical activity   26.4  26.3
Are any firearms kept in your home   39.6  40.9

 

Domain: Access to Care
IndicatorPitt CountyNorth CarolinaUnited States
% No medical insurance  20.8  17.5  16.5
% Children with no health insurance  14.3  12.5    9.8
% Children enrolled in  Medicaid  36.7  32.6  26.0
% Children enrolled in NC Health Choice    5.2    5.9  NA
Primary Care Physicians/100,000 population 149  83.5
Dentists/100,000 population  37.8  40.5  58.4
Kindergarten Tooth Decay Rates  27.7%   22%  26% whites36% A-A

43% Hispanic

BRFSS 2001Eastern NCNorth Carolina
Cost as barrier to health insurance  16.5  11.5
No usual place of care  24.0  22.1
No dental insurance  52.7  45.3
Domain: Communicable Diseases
IndicatorPitt CountyNorth CarolinaUnited States
TB rate per 100,000 population (2004) 5.0 4.5 4.9
Hepatitis A rate per 100,000 population2004: 17 cases12.1(2004) 3.65(2003) 2.6(2003)
Hepatitis B rate per 100,000 population2004: 11 cases  7.0(2004) 1.9 2.6
Hepatitis C rate per 100,000 population2004: 4 cases 2.9 0.2 0.4

 

Domain:Sexually Transmitted Diseases
IndicatorPitt County North CarolinaUnited States
Gonorrhea rate per 100,000 population  347.8181.3  113.5
      Black rate  848.3673.8  629.6
      White rate    52.6  38.4    33.3
Chlamydia rate per 100,000 population  645.9313.3  319.6
      Black rate1206.4929.71209.4
      White rate  216.2116.3  143.6
Syphilis rate per 100,000 population      3.2   8.9      2.7
      Black rate      8.0 15.3      9.0
      White rate      1.3   1.1      1.6
HIV rate per 100,000 population    18.0 25.2     20.7
      Black  rate    38.8 76.6     76.3
      White rate      7.2   9.6       9.0

 

Domain: Cancer (2000)
IndicatorPitt CountyNorth CarolinaUnited States
Lung Cancer
      Mortality rate per 100,000 population  68.7  61.6   54.2
      Incidence rate per 100,000  78.8  69.7   67.5
Breast Cancer (Female)
      Mortality rate per 100,000 females  27.7  26.5  14.4
      Female incidence per 100,000 females167.5149.5 132.2
Colon/Rectum Cancer
       Mortality rate per 100,000 population  22.7  20.0  19.1
        Incidence rate per 100,000 males  64.7  48.4  52.0
Prostate Cancer
      Mortality rate per 100,000 males  36.7  36.9   31.5
      Incidence rate per 100,000 males 154.5152.5 166.7
Incidence All Cancer 494.3445.3

 

Domain: Chronic Diseases
IndicatorPitt CountyN.C.(1999-2002)United States(2003)
Heart disease
      Mortality rate per 100,000 population248.5 246.6235.4
Stroke
      Mortality rate per 100,000 population  82.1  72.0 54.3
Diabetes
      Mortality rate per 100,000 population  34.3  27.4 25.4
COPD
      Mortality rate per 100,000 population  38.4  46.5 43.4
Youth death rates (Ages 0-17)/100,000 100.6  79.9

 

Domain: Environmental Health
IndicatorPitt CountyNorth CarolinaUnited States
Lead (2004)    2.81.3 >1100 infants56% tested
Have you had an illness in the past 12 months that you think was caused by outdoor air pollutants?    9.1     12.0
Have you had an illness in the past 12 months that you think was caused by poor indoor air quality?   15.0     16.4
Domain: Injury and Violence
IndicatorPitt CountyNorth Carolina1999–2002United States2003
Motor vehicle accidents
      Mortality rate per 100,000 population 19.6 19.2 15.2
Mortality
      Homicide rate per 100,000 population 11.2  7.6  5.9
      Suicide rate per 100,000 population(10-24 yr)10.8211.36 10.5
Violent Crime rate per 100,000 population (2004)617.2446.9
Accidents Unintentional injuries
      Mortality rate per 100,000 population  40.0 42.7 36.3
Child Maltreatment substantiated  18.1 14.512.3
Admissions to Juvenile Justice 38.6 34.1

 

Domain: Economic and Education
IndicatorPitt CountyNorth CarolinaUnited States
Premature mortality rate per 100,000 populationunder 75956 years903 years799 years
Percent below poverty level  17.5   15.2   12.4
Percent of children below poverty level  21.8   21.9   16.9
Unemployment rate    5.2     5.0     4.7
Percent children receiving food stamps  24.9   18.210.6 million(14%)
Percent children receiving free or reduced lunch  48.4   44.3   41.9
Public school dropout rate (9-12thgrade)2004-5     6.95       4.86   10.3%
High School completion (%)   56     86.1   85%
Percent >25 years of age with <9th grade education     7.6     7.8    7.5
Median Household income $33,73446,33550,046
Median per capita income $18,24326,88232,937
Migrant and seasonal workers number6,606 (5.4%)155,888(2.1%)13 million(4.4%)

APPENDIX 2: Healthy People 2020

What Is Healthy People?

Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans.. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:

  • Encourage collaborations across communities and sectors.
  • Empower individuals toward making informed health decisions.
  • Measure the impact of prevention activities

It can be used by many different people, states, communities, professional organizations, and others to help them develop programs to improve health.

Healthy People 2020 continues in this tradition with the launch on December 2, 2010 of its ambitious, yet achievable, 10-year agenda for improving the Nation’s health. Healthy People 2020 is the result of a multiyear process that reflects input from a diverse group of individuals and organizations.

What Are the Leading Health Indicators?

Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans. Healthy People 2020 contains 42 topic areas with nearly 600 objectives (with others still evolving), which encompass 1,200 measures. A smaller set of Healthy People 2020 objectives, called Leading Health Indicators, has been selected to communicate high-priority health issues and actions that can be taken to address them

. The Leading Health Indicators are composed of 26 indicators organized under 12 topics. The Healthy People 2020 Leading Health Indicators are:

  1. Access to Health Services                                  7.  Nutrition, Physical Activity, and Obesity

 

  1. Clinical Preventive Services                                  8.  Oral Health

 

 

  1. Environmental Quality                                           9.  Reproductive and Sexual Health

 

  1. Injury and Violence                                                10.  Social Determinants

 

  1. Maternal, Infant, and Child Health                       11. Substance Abuse

 

  1. Mental Health                                             .      12. Tobacco

 

 http://www.healthypeople.gov/2020/about/default.aspx

 

 Pitt County Municipalities Data:

 

MunicipalityChild<5 yrsPop.Persons/square mileWhiteNon-Hispanic%African-America%Amer.Indian%Hispanic (#) %Asian%
Ayden  282  4,622  199247.649.50.2  (102)  2.20.2
Bethel  116  1,681  161840.258.10.0   (13)   0.80.1
Falkland    11     112 <11268.830.40.0   (11)   9.80.0
Farmville  252  4,302  143147.450.10.1   (91)   2.10.2
Fountain    38    533    51549.050.50.2     (3)   0.60.0
Greenville3,36160,476  229861.434.1(181) 0.3(1,244) 2.1(1,098)1.8
Grifton  122  2,073  118863.233.20.0    (98)  4.70.2
Grimesland    19     440    8506229.10.0   (39)  8.90.2
Simpson    32     464  11255642.50.0   (13)  2.80.0
Winterville   399  4,791  187758.738.40.5    (49) 1.00.1
Total4,603 75,624(1573)
Pitt County8,653133,798    21662.133.6(357)0.3(4,216) 3.2(1,443)1.1
North Carolina72.121.61.2  4.71.4
U.S.75.112.30.912.53.6

 

MunicipalitiesCounty/StateMedianFamily

Income

% < HSEducationFamilies below povertyIn labor force>16 years of ageMedian travel to work(min)%  nowmarried

(>15 yrs of age)

Ayden34,80830%21%53.1%X45%
Bethel35,27840%18.5%49.2%2542.5%
Falkland43,75040% 5.057.4%1836%
Farmville38,91827.4%14.657.5%18.744.6%
Fountain26,04241%35.651.6%20.448%
Greenville44,49114% 9.066.3%17.935.9%
Grifton40,87527%12.255.9%23.458.3%
Grimesland36,25040%12.358.3%22.953.5%
Simpson47,50023.6%14.263.6%1756.6%
Winterville47,16716.6%10.371.2%25.556.7%
Pitt County43,97120%13.565.8%X47%
North Carolina46,33522% 9.065.7%X56.3
U.S.50,04619.6% 9.263.9%25.554.4

 

http://factfinder.census.gov               http://www.city-data.com/city

 

Disclaimer regarding interpretation of data in this Community Assessment:

 

Various sources of data have been used in the development of this teaching case  including but not limited to vital statistics, the 2004 BRFSS survey, N.C. Communicable Disease Control Branch reports, N.C. County Health Data Book, U.S. Census  American Fact Finder, N.C. Child Advocacy Institute, N.C. Child Fatality Task Force.

The data in this report is not to be relied on for actual assessment activities because of various limitations including: different time periods for data collections and a small number of events during the reported time period. These factors subject the results to chance variation. Longer time periods of data collection are required before inferences can be made. For a full discussion of the issues and up-to-date data, refer to the report of the North Carolina State Center of Health Statistics, http://www.schs.state.nc.us/SCHS/.

 

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