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Monitoring The Human Condition

Study - 2009** TRENDS **

Presented By:

Warren Smith, Data Analyst

Barnstable County Dept. of Human Services

June 25, 2009

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Background• Monitoring The Human Condition on

Cape Cod Study:– Health & Human Services Needs Assessment– Annual – Cape Cod Community Survey Findings – Five Years of Data (2004-2008)– Latest US Census Statistics– Findings Report in April – Findings Presented at May HHSAC Meeting– TRENDS Report in June

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Today’s Presentation• Demographic Trends• Affordability Trends:

– Trade-Offs– Central Issues

• Trends in Eleven Key Areas:– Statistically-significant changes

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Trends in Eleven Key Areas1. Food/Nutrition2. Housing3. Leisure Time/Recreation4. Medical/Dental5. Mental Health6. Overweight/Obesity7. Childcare8. Legal Assistance9. Transportation10. Discrimination11. Work/Employment

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Key Demographic Trends

** Changes in the Population **

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Population Changes

• Births• Public School Enrollment• Child Poverty• Median Income• Age Distributions• Median Age• Future Projections (Seniors/Elders)

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1,850

1,950

2,050

2,150

2,250

2,350

2,450

2,550

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

2,470

1,987

Total Births To Barnstable County Mothers1989 - 2007

2,049

YEAR

1,905

Trendline

2005200019951990

Data Source: MA DPH MassCHIP @6/18/09

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Total Public School Enrollment - Barnstable County, MA

30,744

29,909

29,179

28,445

27,594

26,000

26,500

27,000

27,500

28,000

28,500

29,000

29,500

30,000

30,500

31,000

2004-2005 2005-2006 2006-2007 2007-2008 2008-2009

School Year(Total PK - 12 plus SPED Enrollments as of October 1st)

Trendline

Change:-10% in past 4

years

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17%

19%

21%

18%

16%

0%

5%

10%

15%

20%

25%

2004-2005 2005-2006 2006-2007 2007-2008 2008-2009

Low Income Students* as Percentage of Total EnrollmentBarnstable County, MA Public Schools

School Year(Enrollments as of October 1st)

Trendline

* "Low Income" as defined by Mass. Dept. of Education

Average # of Low Income Students = 5,269

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$60,015

$56,974

$54,439

$68,290

$70,955$71,570

50,000

55,000

60,000

65,000

70,000

75,000

1 2 3

Median Income in Barnstable County, MA: 2005-2007Median Household Income and Median Family Income: (50%:50%)

YEAR

200720062005

Median Household Income

Median Family Income

Data Source: U.S. Census Bureau, Sel. Econ. Char's

(= 83% of Family Income)

(= 80% of Family Income)

( Growth: +5% in 2 Years)

( Growth: +10% in 2 Years)

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Barnstable County Population Trends: Selected Age Groups

15,000

25,000

35,000

45,000

55,000

65,000

75,000

1 2 3

Year

Age 60+

Age 20-34

Ages 10-19

Ages 0-9

2005 2006 2007

Ages 35-59: Steady at about 78,000

Data Source:US Census Bureau (ACS)

(66,018)

(34,000)

(24,412)

(19,437)

NOTE:Cape's Population Under

Age 35 is Shrinking!(-3.5% in One Year)

(64,625)

(33,205)

(24,390)

(20,747)

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Median Age in Barnstable County, MA (in years)

Age 46.5

Age 45.7

Age 45.6

45.0

45.2

45.4

45.6

45.8

46.0

46.2

46.4

46.6

1 2 3

YEAR

2006 20072005

+2%(in one year)

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Notes:

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Trends in Human Needon Cape Cod

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Maslow's Hierarchy of Needs

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2nd and 1st Levels of Need

1. Air, Water, Food, Sleep, Clothing, Shelter

2. Health and Well-Being

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AffordabilityKey to Overcoming Unmet Health and

Human Services Needs

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Affordability Trends(2nd and 1st Level Items)

• Healthcare Affordability: (2nd level)– Health and Well-Being

• Basic Needs Affordability: (1st level)– Food– Clothing– Shelter

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Notes:

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62%

74%

86%*

81%*

76%*

65%*

56%*

45%*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

“Paying for a mental health counselor”

“Not able to afford nutritious food”

“Paying for or getting dental (insurance)care”

“Not being able to afford legal help”

“Not having enough money to pay thedoctor, the dentist, or buy presc. med's

“Not always having enough money for food”

“Not having enough money to pay forhousing”

“Not being able to afford recreationalactivities”

Percentage of Most Needy Households Reporting Problem as Minor-to-Major

Affordability Problems in Most Needy Households: Barnstable County, MA for Years 2004 - 2007

(2007)

(2007)

(2007)

(2007)

(2007)

(2007)

(2007)

(2007)

* Statistically Significant increase over 4-years

(2006)(2005)

(2004)

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Affordability Barriers Reported in Most Needy Households:Barnstable County, MA for Years 2004-2007

57%

75%*

0% 10% 20% 30% 40% 50% 60% 70% 80%

“Could not afford fees or costs forservices”

“Paying insurance deductible/co-payments”

Percentage of Most Needy Households Reporting Barrier as Serious

(2007)

(2007)

(2004)

(2004)

* Statistically Significant increase over 4-years

(2005)

(2006)

(2005)

(2006)

(“The” Central Issue!)

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“The” Central Issue• “Paying insurance deductible/co-payment”

– Strongly related to key affordability problems

– Correlated with “Could not afford fees or costs for services” (combined with it?)

– 58% of Most Needy households report this as a barrier to accessing needed services

– Statistical analysis (correlation) confirms strong links to affordability of nutritious food, dental care, and leisure time/recreation.

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Trade-Offs

** Affordability **

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Historical Trade-Offs(Time Period: 2004-2007)

• Historically Inter-Related Affordability Cluster:– “Not able to afford nutritious food”– “Not always having enough money for food”– “Not being able to afford recreational activities”– “Not having enough money to pay for housing”– “Paying for a mental health counselor”– “Paying for or getting dental [insurance] care”– “Could not afford fees or costs for services”– “Paying insurance deductible/co-payments”

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Today’s Trade-Offs(Latest 3-Years: 2006-2007-2008)

• Current Affordability Cluster:– “Not able to afford nutritious food”– “Not being able to afford recreational activities”– “Paying for or getting dental [insurance] care”– “Could not afford fees or costs for services”– “Paying insurance deductible/co-payments”

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Trade-Offs Shown By Survey Cost of Living

Responses(Most Needy Households in 2008)

• To Afford Food: Trading Off

– Telephone service– Clothing store items

(all)

– Rent or lease payments

– Car/truck insurance– Transit services

• To Afford Nutritious Food:

Trading Off– Telephone service– Out-of-home fun

activities – Clothing store items– In-home fun

activities– Transit services

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Trade-Offs (continued)

• To Afford Housing: Trading Off

– Telephone service– Electric service– Clothing store

items (school cloths)

• To Afford Medical/Dental Care:

Trading Off– Telephone service– Clothing store items

(casual cloths)

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Trade-Offs (continued)

• To Afford Leisure Time and Recreation:

Trading Off– Nutritious foods– Clothing store items

(casual and dress cloths)

• To Afford Mental Health Care:

Trading Off– House or condo

payments

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Trends in Unmet NeedAmong Our

Most Needy Households(2004 – 2007)

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Definitions• Prevalence:

– How widespread is the problem/barrier?• Proportion of households reporting a problem

• Seriousness:– How detrimental is the problem/barrier?

• Degree of seriousness on a “scale” (moderate, very serious, so serious did not get needed help)

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Food/Nutrition(Changes 2004 – 2007)

• Prevalence: – “Not always having

enough money for food” [+41%]

– “Not able to afford nutritious food” [+58%]

• Seriousness:– “Not always having

enough money for food” [+50%]

– “Not able to afford nutritious food” [+73%]

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Housing(Changes 2004 – 2007)

• Prevalence: – “Not having enough

money to pay for housing” [+52%]

• Seriousness:– “Not having enough

money to pay for housing” [+66%]

– Overcrowding: “Not enough room in your house for all of the people who live there” [+43%]

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Leisure Time/Recreation(Changes 2004 – 2007)

• Prevalence: – “Not being able to

afford recreational activities” [+29%]

• Seriousness:– “Not being able to

afford recreational activities” [+40%]

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Medical/Dental(Changes 2004 – 2007)

• Prevalence: – Do any of the

house-hold insurances “provide for dental care?” [+39%]

– “Is any adult (age 18+) in Fair-to-Poor health” [+64%]

• Seriousness:– “Paying for or getting

dental (insurance) care”

[-10%]– “Not having enough

money to pay the doctor, dentist, or to buy prescription medications” [+21%]

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Mental Health(Changes 2004 – 2007)

• Prevalence: – “Paying for a

mental health counselor” [+49%]

• Seriousness:– “Paying for a

mental health counselor” [+56%]

– “Having a lot of anxiety or stress in the household” [+19%]

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Overweight/Obesity(Changes 2004 – 2007)

• Prevalence: – “Seriously

overweight person(s) in house-hold” [+1,749%]

• Seriousness:– “Seriously

overweight person(s) in house-hold” [+3,600%]

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Childcare(Changes 2004 – 2007)

• Prevalence: – Average number of

“children (age 17 or younger) living in your household?” [-22%]

• Seriousness:– “Not being able to

find or afford after-school child care” [+39%]

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Legal Assistance(Changes 2004 – 2007)

• Prevalence: – “Not being able to

afford legal help” [+27%]

• Seriousness:– “Not being able to

afford legal help” [+37%]

– “Immigration or Visa dispute” [+37%]

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Transportation(Changes 2004 – 2007)

• Prevalence: – “Lack of

transportation” [+76%]

• Seriousness:– “Lack of

transportation” [+79%]

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Discrimination(Changes 2004 – 2007)

• Prevalence: – “Feelings of

discrimination” [+47%]

• Seriousness:– “Feelings of

discrimination” [+69%]

– “Discrimination (due to race, age, language, sexual identity/orientation, etc.)” [+142%]

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Work/Employment(Changes 2004 – 2007)

• Prevalence: – “All adults (age

18+) in your household are employed” [-31%]

• Seriousness:– “Unable to take

time away from work to go to services” [+17%]

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Comment on 2008 Most Needy• Due to a much broader-based demographic profile of the

2008 Most Needy households:

– Household incomes are higher than usual:• Fewer affordability issues

– Education levels are higher

– Fewer children and child-related issues:• Fewer problems getting after-school child care

– Fewer housing issues and less overcrowding

– Fewer employed household members: • Fewer work-related access issues• Fewer leisure time/recreation issues• Fewer job training/skills upgrade issues• More retiree households

– More households have a working vehicle:• Fewer transportation issues

– Fewer feelings of discrimination

– Fewer system capacity complaints ("not accepting new clients”)

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Q & A

• What surprised you?• What made you happy?• What made you sad?• What is most positive?• What is most negative?• What additional info do you need?• What should be next? . . . . . .

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Notes:

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The “Most Needy”

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Who Are “Most Needy”

• Compared to Overall Cape Cod Sample:– Problems and Service Barriers:

• 2.5x to 3x Times More Households Report Problems/Barriers

also,• 2.5x to 3x Times More Seriousness Reported

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Historically

“Most Needy” Cape Cod Households

(Four Well-Defined Population “Groups”)

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Group #5: ALL Retired

Group #4: NOT All Retired

Group #3: Undefined Most Years

“Most Needy” Group #2

“Most Needy” Group #1

20%

80%

THEN

Working, Middle-Class Families/Individuals—”Doing OK, in General”

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What Happened?Where Were

These New Arrivals Last Year?

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Group #5: ALL Retired

Group #4: NOT All Retired

“Most Needy” Group #3

“Most Needy” Group #2 “Most Needy” Group #1

26%

74%

NOW

Working, Middle-Class Families/Individuals— “Many Not Doing So Well These Days”

Some

New Retirees