davidson county, tn community health needs assessment 2016 · 2015. 10. 8. · language other than...

Davidson County, TN Community Health Needs Assessment

2016

STH Logo VUMC logo

Health Is:

• A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

• Source: World Health Organization

Welcome

• Assessments done separately in 2013 as requirement for STH and VUMC as non-profit hospitals

– ACA related requirement

• For new cycle, STH and VUMC came together in overlapping counties

• Review findings of most recent VUMC and STH health assessment

• Collectively identify needs for Davidson County

Why are we here?

• Reviewed publically available community health data

• Interviewed key stakeholders

• Conducted listening sessions

• Convened today’s summit to identify needs

• Special attention to underserved, low-income, minority populations

• Hospitals post-summit: Review needs for development of Implementation Strategies

Approach

• Opening remarks

• Review Findings

– Secondary Data

– Interviews

– Listening Sessions

• Exercise 1 : Identification of Health Needs

• Exercise 2 : Visioning, Goals and Resources

• Summary

Agenda

Davidson County – Health Priorities

Dr. Bill Paul, MD, MPH

Findings from Secondary Data Review Davidson County, TN

2016 Community Health Assessment

Determinants of Health Introduction and Methods

Davidson

Tobacco Use Diet & Exercise Alcohol & Drugs Sexual Activity

Access to Care Quality of Care

Education Employment Income Social Support Safety

Air & Water Housing & Transit

• Used publically available data

• Indicators, considered

– Recommendations of

• Centers for Disease Control and Prevention

• Catholic Health Association

– Review of STH and VUMC 2013 CHNA

Methods: Secondary Data

– Demographics and Socioeconomic Status

– Social & Natural Environment

– Access to Health Care

– Health Status

• Morbidity/Mortality

• Birth Outcomes

• Preventive Care/Risk Factor Behaviors

• Infectious Diseases

• Mental & Emotional Health

– Other Community Assessments

Indicator Topics

Demographics: Davidson County Demographic / Socioeconomic

Davidson

Source: US Census Bureau (2015). State and County QuickFacts: Davidson Co., TN. Retrieved on 6/30/15, from: http://quickfacts.census.gov/qfd/states/47000.html

Davidson TN USA

Population, % change from 2010-2014

6.7% 3.2% 3.3%

Persons under 18 years 21.6% 23.0% 23.3%

Persons 65 years and over 10.9% 14.7% 14.1%

Female persons, percent 51.7% 51.2% 50.8%

Language other than English spoken at home

15.5% 6.6% 20.7%

Persons below poverty level 18.5% 17.6% 15.4%

Persons per square mile 1,243 153 87

2014 Population estimate: 668,347

White White 66%

Black 28%

Asian 3% More than one race

3%

654,879

702,871

752,326

618,891

687,059

755,684

600,000

620,000

640,000

660,000

680,000

700,000

720,000

740,000

760,000

780,000

2015 2025 2035

PopulationJobs

Demographic / Socioeconomic

Davidson Projected Population and Job Growth (2015, 2025, 2035)

Source: Nashville Metro Planning Organization

People in Poverty By Census Tract


Davidson

Source: US Census Bureau, 2009-2013, American Community Survey Shapefiles from Metropolitan Planning Department Map by Metropolitan Social Services-Planning & Coordination

Davidson Co. 18.5%

Tennessee 17.6%

United States 15.4%

Percent in Poverty

People Living Below Poverty Level By Race / Ethnicity


Davidson

Source: : People Living Below Poverty Level by Race/Ethnicity, Nashville TN. HealthyNashville.org (2015). Retrieved: July 29, 2015, from www.healthynashville.org Data Source: US Census Bureau, American Community Survey. 2009-13.

http://www.healthynashville.org/

Children in Poverty Trends, County, State and National


Davidson

Source: : University of Wisconsin Population Health Institute. County Health Rankings 2015. Data Source: US Census Bureau, Small Area Income and Poverty Estimates, American Community Survey. Retrieved on August 3, 2015 from: http://www.countyhealthrankings.org/

http://www.countyhealthrankings.org/

Population with No High School Diploma By Metro Council District (25yrs and older)


Davidson

Source: US Census Bureau, 2009-2013, American Community Survey Shapefiles from Metropolitan Planning Department Map by Metropolitan Social Services-Planning & Coordination

Davidson Co. 13.6%

Tennessee 15.6%

United States 14.0%

Percent without HS Diploma

87% (2014)


Davidson

81% (2013)

79% (2014)

Graduation Rates

Davidson County ranks

94th of 95 TN Counties

Source: County and State : The Annie E. Casey Foundation. 2015 KIDS COUNT Data Books, Retrieved from : http://www.datacenter.aecf.org US rate source: National Center for Education Statistics - http://nces.ed.gov/ccd/tables/ACGR_2010-11_to_2012-13.asp

USA

TN

Davidson

http://nces.ed.gov/ccd/tables/ACGR_2010-11_to_2012-13.asp






Summary


Davidson

• The County is racially and ethnically diverse

• 18.5% live in poverty; 30% of children live in

poverty (54% below 200%)

• Graduation rates are lower than State and US

• Poverty and Education vary by place and race

• Housing

• Neighborhood Safety

• Transportation

• Access to Healthy Food

• Air

Social & Natural Environment

Affordable Housing 2013


Davidson

Source: US Census Bureau (2015). State and County QuickFacts: Davidson Co., TN. Retrieved on 6/30/15, from: http://quickfacts.census.gov/qfd/states/47000.html

Davidson Co. Tennessee US

Homeownership rate 54.7% 67.8% 64.9%

Median household income

$47,335 $44,298 $53,046

Median value of owner-occupied housing

$167,500 $139,200 $176,700

House value / Income 3.5 3.1 3.3

Cost Burdened Households

36.6% 31.0% 35.5%

Cost Burdened Renters 47.4% 45.9% 48.3%

Poverty 18.5% 17.6% 15.4%


Davidson

Source: Metro Nashville Social Services, Homelessness Commission. Nashville Point In Time Counts, January 2014. Retrieved on 8/5/15, from: http://www.nashville.gov/Social-Services/Homelessness-Commission/About-Homelessness/Homeless-Counts.asp

Homelessness January 2014

2,094 shelter count 207 outdoor count

2,301

Experiencing Homelessness

http://www.nashville.gov/Social-Services/Homelessness-Commission/About-Homelessness/Homeless-Counts.asp










621


Davidson

Source: University of Wisconsin Population Health Institute. County Health Rankings 2015 Retrieved on July 31, 2015 from: http://www.countyhealthrankings.org/

1153

199

Violent Crime Rate Per 100,000 population

Davidson County ranks

94th of 95 TN Counties

USA

TN

Davidson




Davidson

Source: Tennessee Bureau of Investigation. Tennessee Crime On-Line. Retrieved on 8/12/15, From: http://tennesseecrimeonline.com/public/Browse/browsetables.aspx

Domestic Violence 2014 Rate per 1,000

Davidson: 18.9 Tennessee: 11.6

Every year there are more than 12,000 victims of Domestic Violence

in Davidson County

Transportation Households with No Vehicle


Davidson

Source: : Map of Households with No Vehicle, Nashville TN. Community Commons (2015). Retrieved: July 14, 2015, from www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract

Davidson Co. 7.5%

Tennessee 6.3%

United States 9.1%

> 8%

6.1 - 8%

4.1 – 6%

< 4%

No Data

http://www.communitycommons.org/

Population with Limited Food Access Social & Natural Environment

Davidson

Source: Map of Population with Limited Food Access, Nashville TN. Community Commons (2015). Retrieved: July 14, 2015, from www.communitycommons.org Data Source: US Department of Agriculture, Economic Research Service, USDA - Food Access Research Atlas. 2010. Source geography: Tract

Davidson Co. 26.2%

Tennessee 27.4%

United States 23.6%

> 50%

20.1 – 50%

5.1 – 20%

< 5.1%

None


Fast Food Restaurants Rate per 100,000 population


Davidson

Source: Community Commons . Fast Food Restaurants, Rate per 100,000 population by year, 2008-2013. Data Source: US Census Bureau, County Business Patterns. Additional data analysis by CARES. 2013. Source geography: County Retrieved 7/14/15, Retrieved from: communitycommons.org


Davidson 2-1-1 Calls, Top 6 Categories FY2014

Source: Family & Children’s Services. Data Source: United Way of Metropolitan Nashville., 2-1-1


Davidson

Source: 2015 County Health Rankings, American Lung Association – Estimated Prevalence and Incidence of Lung Disease

Air Pollution and Lung Disease

14.5 13.8

11.9

0

2

4

6

8

10

12

14

16

18

Particulate Air Pollution (Daily PM2.5)

Davidson Co TN USA

Estimated Number Suffering from Lung Disease Davidson County

Pediatric Asthma 11,560

Adult Asthma 38,622

COPD 43,488

Lung Cancer 510

Summary Social & Natural Environment

Davidson

• Violent Crime rate is very high

• Many are burdened by housing costs

• It is difficult for many in our community to

access healthy food

• Rates of fast food establishments are rising

• Air quality impacts health

• Provider availability

• Health staffing shortages by HPSAs

• Insurance coverage

Access to Health Care

Davidson

Best 10% of

US Counties

Primary Care 1059:1 1045:1

Dental 1401:1 1377:1

Mental Health 395:1 386:1


Davidson

Source: 2015 County Health Rankings

Provider Rates

County Health

Rankings

Access to Providers Behavioral Risk Factor Surveillance Survey


Davidson

Source: Tennessee Department of Health (2013/2012) Behavioral Risk Factor Surveillance System: Tennessee State and Regional Data, retrieved on July 17, 2015 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. [accessed Aug 05, 2015.

Health Professional Shortage Areas Primary Care


Davidson

Source: Map of Population Below Poverty Level, Children (Age 0-17), Nashville TN. Community Commons (2015). Retrieved: July 14, 2015, from www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract


Number of Visits


Davidson

Source: Vick, J., Thomas-Trudo, S., Cole, M., and Samuels, A.D. (Eds.). (2015). Health equity in Nashville. Metro Nashville Public Health Department Division of Epidemiology and Research and RWJF Center for Health Policy at Meharry Medical College.

Hospital Visits for Ambulatory Sensitive Conditions, By Zip Code - 2012

2 – 126

127-296

1131-1992

297-619

620-1130

Chronic Disease Hospitalization Rate (age-adjusted rate per 100,000)


Davidson

Source: TN DOH, Chronic Disease Health Profile, December 2011, Retrieved 8/15/15, from: http://hit.state.tn.us/CDProfiles.shtml

Health Insurance Tennessee Coverage of Total Population 2013


Davidson

Source: : Kaiser Family Foundation 2015. State Health Facts. Health Insurance Coverage of the Total Population. Retrieved: August 28, 2015, from www.kff.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract

http://www.kff.org/

Insurance Uninsured Population


Davidson

Source: : Map of Insurance-Uninsured Population, Nashville TN. Community Commons (2015). Retrieved: July 14, 2015, from www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract

Davidson Co. 16.8%

Tennessee 14.1%

United States 14.9%

20% +

15.1-20%

10.1-15%

<10.1%

No Data


Insurance: Davidson County Adults with Health Insurance By Race/Ethnicity


Davidson

Source: : Adults with Health Insurance by Race/Ethnicity, Nashville TN. HealthyNashville.org (2015). Retrieved: July 30, 2015, from www.healthynashville.org Data Source: US Census Bureau, American Community Survey. 2009-13.


Summary Access to Health Care

Davidson

• Provider levels similar to nation, however, – 17% did not see MD due to cost

– 34% did not visit a dental professional in the past year

• Health Professions Shortage Areas areas are present within county

• Remain less than 100% access, 100% coverage

• Morbidity/Mortality

– Causes of Death

– Premature Death (Years of Potential Life Lost)

• Birth Outcomes

• Preventive Care/Risk Factor Behaviors

• Infectious Disease

• Mental & Emotional Health

Health Status

Morbidity / Mortality

Davidson

Source: National Center for Health Statistics http://blogs.cdc.gov/nchs-data-visualization/2015/06/01/deaths-in-the-us/

Causes of Death: USA, 1900-2013 Age adjusted Death Rates for Selected Major Causes of Death

0

100

200

300

400

500

600

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010

Mo

rtal

ity

Rat

e p

er 1

00

,00

0,

Stan

dar

d P

op

ula

tio

n

Year

Heart Disease

Influenza, Pneumonia

Cancers

Accidents

Stroke

Heart Disease

23

Cancer

22

Accidents 8

Lung Disease 5

Stroke 5

Alzheimer's 4

Diabetes 3

Influenza / Pneumonia 2

Suicide 2 Liver Disease and Cirrhosis 1

Other [25]

Source: CDC Wonder, Leading Causes of Death


Davidson Percentage of Deaths, Davidson County 2013


Davidson

6605

8636

7681

5000 5500 6000 6500 7000 7500 8000 8500 9000

United States

Tennessee

Davidson County

Premature Death Rate of Years of Potential Life Lost, per 100,000 population - 2013

Source: National Vital Statistics System-Mortality (NVSS-M) (2011-2013)


Davidson

18.7

14.1

12.4

11

4.9

0

5

10

15

20

25

Cancer Heart Disease Accidents Suicide /Homicide

Perinatal Period

Pe

rce

nta

ge o

f Y

PLL

, >7

5 y

ear

s o

f A

ge Davidson County

Tennessee

USA

Premature Death Percentage of Years of Potential Life Lost, by leading cause

Source: National Vital Statistics System-Mortality (NVSS-M) (2013), Tennessee Department of Health, Office of Policy, Planning and Assessment, Division of Health Statistics (2009)


Davidson Premature Death in TN Racial Disparity in % of YPLL by Cause

21.4

17.6 16.2

6.1

1.4 2.1

17.6 16.8

10.6

2.1

8.6

6.7

0

5

10

15

20

25

Cancer Heart Disease Accidents Suicide Homicide PerinatalPeriod

Pe

rce

nta

ge o

f Ye

ars

of

Po

ten

tial

Lif

e L

ost

(<7

5)

TN - White

TN - Black

Source: State and National data - National Vital Statistics System-Mortality (NVSS-M) (2013),


Davidson Leading Causes of Death, Ages 1-49

Davidson County, by Gender and Race (1999-2013)

Source: CDC Wonder, Davidson County (1999-2013)

0

20

40

60

80

100

120

140

160

Black Male White Male Black Female White Female

Mo

rtal

ity

Ris

k, p

er

10

0,0

00

Accidents

Accidents

Accidents

Accidents

Assault

Heart Disease Heart

Disease

Heart Disease

Cancer

Cancer

Suicide

Heart Disease


Davidson Cancer Death Rates in Davidson County Disparities by Race, Gender (2004-2013)

311

93

32 53

19

155

47

14 22

0

50

100

150

200

250

300

350

All Cancer Lung Colorectal Prostate Breast

De

ath

Rat

e f

rom

Can

cer,

pe

r 1

00

,00

0 p

op

ula

tio

n

Black Male White Male Black Female White Female

The cancer death rate is higher for men than women.

Particularly black men, who die of cancer at roughly twice the rate of white women.

Source: CDC Wonder, US Cancer Statistics, Data is age-adjusted rate for Davidson County


Davidson Heart Disease Deaths, Davidson County Age Adjusted Rate, by Year, 2004-2013

Source: CDC Wonder, Davidson County, Deaths by Major Cardiovascular Diseases (I00-I78)

473

332 363

282

390

299

249

195

100

150

200

250

300

350

400

450

500

550

600

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Mo

rtal

ity

Rat

e f

or

He

art

Dis

eas

e, p

er

10

0k

Black Male (-30%)

Rates of Heart Disease Deaths Are Falling Across Gender and Racial Lines

White Female (-22%)

Black Female (-23%) White Male (-21%)


Davidson

Source: IVP-1.1: National Vital Statistics System-Mortality (NVSS-M), CDC/NCHS; Population Estimates, Census.

Injury Death Rate, Davidson County Davidson County, by Age, Leading Cause [2013]

0

10

20

30

40

50

60

70

80

15-24 25-34 35-44 45-54 55-64 65-74 75-84

Inju

ry D

eath

Rat

e, b

y ty

pe

Age

Transport Accidents

Poisoning / Exposure

Falls

Males (84 per 100k) are more than twice as likely as females

(35 per 100k) to die from unintentional injuries


Davidson

Source: CDC Wonder, Data for Davidson County, 1999-2013

Cumulative Death Rate: Suicide/Homicide Davidson County Males, by Race, Age (1999-2013)

0

20

40

60

80

100

120

140

160

180

15-24 25-34 35-44 45-54 55-64

Mo

rtal

ity

Rat

e, S

uic

ide

/Ho

mic

ide

Age

Black - Homicide

Black - Suicide

White - Suicide

Summary Morbidity / Mortality

Davidson

• Heart disease and cancer are top leading causes of death

• Leading causes of death vary by race and gender

• Combined accidents, assaults and suicide represent 11% of deaths and 23% of years of potential life lost

• Infant Mortality

• Low Birth Weight

• Prenatal Care

• Teen Pregnancy

Birth Outcomes

0

0.5

1

1.5

2

2.5

3

0

20

40

60

80

100

120

140

160

180

200

1915 1925 1935 1945 1955 1965 1975 1985 1995 2005

Dis

par

ity

in B

lack

Rat

e o

ver

Wh

ite

Rat

e

Infa

nt

Dea

th R

ate

pe

r 1

00

0 L

ive

Bir

ths

Black

White

Relative Disparity in Black Rate over White Rate

Birth Outcomes

Davidson Infant Mortality in the United States

Racial Disparities since 1915

Source: CDC/NCHS, National Vital Statistics System, Mortality Data

Birth Outcomes

Davidson

Source: TN Dept of Health, Division of Policy, Planning and Assessment, Office of Health Stats; National Vital Statics Reports, Vol 64 No1 Jan 15, 2015; KIDS Count

7.7

6.8

6

0

1

2

3

4

5

6

7

8

9

10

Infant Death Rate / 1000 births

Davidson

Tennessee

United States

Birth Outcomes 2013

Kuwait (7.5)

Qatar (6.4)

Russia (7.0)

US Ranks 55th

Ireland (3.7)

Birth Outcomes

Davidson


1.8

8.8

7.7

1.6

9.1

6.8

1.4

8

6

0

1

2

3

4

5

6

7

8

9

10

Very Low Birthweight (%) Low Birthweight (%) Infant Death Rate / 1000 births

Davidson

Tennessee

United States

Birth Outcomes 2013

1.8

8.8

7.7

1.4

6.9

5.9

2.9

12.9

11.5

0

2

4

6

8

10

12

14

Very Low Birthweight (%) Low Birthweight (%) Infant Death Rate / 1000 births

Davidson (Total)

White

Black

2.1x

Birth Outcomes

Davidson Birth Outcomes Racial Disparities In Davidson County (2013)

1.9x

1.9x


7.7

5.9

11.5

0

2

4

6

8

10

12

14

Infant Death Rate / 1000 births

Davidson (Total)

White

Black

Birth Outcomes

Davidson Birth Outcomes Racial Disparities In Davidson County (2013)

1.9x


Libya (11.9) Palau (11.5)

Teen Pregnancy Rates; Ages 15-17, Trend: 2007-2014

Birth Outcomes

Davidson

27.8

14

42.9

12.8

0

5

10

15

20

25

30

35

40

45

50

2007 2008 2009 2010 2011 2012 2013 2014

Tee

n P

regn

ancy

Rat

e, p

er

10

00

15

-17

yo

Fe

mal

es

Teen Pregnancies are In Decline Across the County and State

Tennessee (-50%)

Davidson (-70%)

Source: KIDScount, Tennessee Department of Health, Office of Policy Planning and Assessment, Division of Health Statistics.

Summary Birth Outcomes

Davidson

• Infant mortality and low birthweight rates are high

– Vary by race

• Teen birth rates continue to decline

– Vary by race

• Well-being

• Tobacco & Substance Use

• Obesity & Nutrition

• Youth Risk Behavior Survey

• Vaccinations

Preventive Care / Risk Factor Behaviors

23%

Preventive Risk Factors

Davidson

Source: 2015 County Health Rankings, BFRSS, 2006-2012

14%

17%

Adults Reporting “Poor” or “Fair” Health 2006-2012

USA

TN

Davidson

24%


Davidson

Source: 2015 County Health Rankings, : Tennessee Department of Health, Division of Policy, Planning and Assessment, Behavioral Risk Factor Surveillance System., HealthyPeople2020.gov

17%

21%

12%

Tobacco use is the most preventable

cause of premature mortality and

morbidity - TN Dept of Health

Adult Smokers 2013

Healthy People 2020 Target

USA

TN

Davidson


Davidson Substance Abuse

TDMHSAS Funded Treatment Admissions, by Cause (FY 2014)

5.6 3.2

21.6

42.9

49.5

4.2

9.7

40.2 44.2

38.6

0

10

20

30

40

50

60

70

Heroin Methamphetamines Opiod Alcohol Other Illicit Drugs

Pe

rce

nt

of

Tota

l Ad

mis

sio

ns

Davidson County

TN

Heroin admissions more than doubled

from 2012-2014

Source: 2014 Tennessee Behavioral Health County Data Book

~1 in 10 People in Davidson County have Abused Substances in the past year

34% Obese


Davidson

Source: Tennessee Department of Health . 2013 BRFSS. US, Source: ,Kaiser Family Foundation

31% Obese

31% Obese

Adults Obese and Overweight 2013

58% Overweight and Obese



TN

USA


Davidson

Source: Vick, J. & Thomas-Trudo, S. (2014). Community Health Profile 2014 . Metro Nashville Public Health Department, Division of Epidemiology and Research

Access to Parks (½ mile distance from parks, population, by 2012 Census Block Groups)

40%

Live within ½ mile of a park

63%


Davidson

Source: TN DoH (2013). Behavioral Risk Factor Surveillance System: Tennessee State and Regional Data.. Retrieved on: 8/14/15, From: http://tn.gov/health/topic/statistics-brfss

75%

67%

Adults Participating in Physical Activity (Past Month) 2013

TN

USA

Davidson


Davidson

Source: BRFSS: TN DoH (2013). Behavioral Risk Factor Surveillance System: Tennessee State and Regional Data. Retrieved 8/14/15 from: http://tn.gov/health/topic/statistics-brfss

Influenza & Pneumococcal Vaccination Adults and Seniors 2013

http://tn.gov/health/topic/statistics-brfss




73%


Davidson

Source: TN DoH (2014), Results of the 2014 Immunization Status Survey of 24-Month-Old Children in Tennessee

TN

24-Month Vaccinations 2014

90.7 91.7

95.4

90.7

80.6

94.4

87

75

80

85

90

95

100

DTaP Poliomyelitis MMR Hepatitis B Hib Varicella Pneumococcus

Davidson County Exceeds Healthy People 2020 Targets in 5 of 7 Leading Recommended Vaccinations at 24 months of age

24 Month Olds, Fully Vaccinated

(4:3:1:3*:3:1:4 Series)

HP 2020 Target (90%)

74% Davidson

Youth Risk Behavior Survey 2013 – Tennessee High School Youth (US)


Davidson

• Tobacco Use – 15.4% smoked cigarettes within 30 days (US: 15.7%)

– 12% smoked a whole cigarette before age 13 (US: 9.3%)

• Nutrition & Obesity – 16.9% are obese (US: 13.7%)

– 15.4% are overweight (US: 16.6%)

• Physical Activity – 19.6% were not physically active at least 60 min on

at least 1 day during the past week (US: 15.2%)

Summary Preventive Risk Factors

Davidson

• Smoking rate remains higher than HP2020 goal

• Many are overweight and obese

• High School Youth – 15.4% smoked cigarettes within 30 days

– 16.9% are obese

• 20% of seniors (age 65 years and older) are not vaccinated for influenza and pneumococcal

• STD incidence rates

– chlamydia

– gonorrhea

– syphilis

• HIV incidence rate

• Tuberculosis incidence rate

Infectious Disease

Chlamydia Trends 2003 – 2012

Infectious Disease

Davidson

Source: Community Commons (2015). Data Source: US Department of Health Human Services, Health Indicators Warehouse. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. 2012. Source geography: County. Retrieved on 7/14/15, From: www.communitycommons.org Source: Centers for Disease Control and Prevention . NCHHSTP Atlas. Chlamydia by County. Retrieved on 8/12/15, From: http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html

State 2012 White 251.5 Black 1,629.9


http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html

http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html

Gonorrhea Trends 2003 – 2012

Infectious Disease

Davidson

Source: Community Commons (2015). Data Source: US Department of Health Human Services, Health Indicators Warehouse. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. 2012. Source geography: County. Retrieved on 7/14/15, From: www.communitycommons.org

State 2012 White 36.5 Black 627.2


HIV Prevalence Trends 2008-2010

Infectious Disease

Davidson

Source: Community Commons (2015). Data Source: US Department of Health Human Services, Health Indicators Warehouse. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. 2010. Source geography: County. Retrieved on 7/14/15, From: www.communitycommons.org

State 2010 White 145.6 Black 1,093.6


2.3

Infectious Disease

Davidson

Source: Tennessee Department of Health, Tuberculosis Elimination Program (2015) 2014 Regional Tuberculosis Cases and Rates. Retrieved on :8/6/15, From: http://tn.gov/assets/entities/health/attachments/2014_Regional_TB_Cases_and_Rates_by_County.pdf

5.6

3.0

Davidson

Tuberculosis 2014 per 100,000 population

1.0

Healthy People 2020 Goal

USA

TN

Summary Infectious Disease

Davidson

• Chlamydia rates are rising

• Gonorrhea rate is increasing locally

• STD incidence rates vary

– By Race/Ethnicity (higher among minorities)

– By Age group (higher among 15-29 yo)

• HIV rates more than twice as high as State and Nation

• ACEs

• Well-being

• Mental Illness

• Serious mental illness

Mental & Emotional Health

Mental and Emotional Health

Davidson

Adverse Childhood Experiences (ACEs)

# ACEs % (TN)

0 48%

1 20%

2 11%

3 7%

4 (or more) 14%

Source: “Adverse Childhood Experiences in Tennessee,” Tennessee Department of Health

3.4


Davidson

Source: 2015 County Health Rankings

2.7

3.5

USA

TN

Davidson

Poor Mental Health Days last 30 days 2013

20.6%


Davidson

Source: 2015 County Health Rankings,

21.2%

18.6%

USA

TN

Davidson

Mental Illness in the past Year (18+) 2013


Davidson

Source: Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: Tennessee, 2014. HHS Publication No. SMA–15–4895TN. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.

Serious Mental Illness (SMI) in the past Year (18+), 2013

Serious Mental Illness (SMI)

Schizophrenia

Bipolar Disorder

Schizoaffective Disorder

Major Depressive Disorder

~20,100

in Davidson Co. Experience

Serious Mental Illness


Davidson

Summary

“Evidence has shown that

mental disorders

are strongly related to the occurrence of many chronic diseases, including

diabetes, cancer, cardiovascular disease, asthma, and obesity

and many risk behaviors for chronic disease; such as,

physical inactivity, smoking, excessive drinking, and insufficient sleep.”

- Centers for Disease Control, Mental Health Basics

• Healthy Nashville http://www.healthynashville.org/

• TN Dept. of Health – Drive your County to the Top Ten http://tn.gov/health/topic/specialreports

• County Health Status Indicators http://wwwn.cdc.gov/CommunityHealth/HomePage.aspx

• Metro Social Service http://www.nashville.gov/Social-Services/Planning-And-

Coordination/Community-Needs.aspx

• Nashville Area Chamber of Commerce http://www.nashvillechamber.com

Other Community Assessments



http://tn.gov/health/topic/specialreports

http://wwwn.cdc.gov/CommunityHealth/HomePage.aspx

http://www.nashville.gov/Social-Services/Planning-And-Coordination/Community-Needs.aspx










http://www.nashvillechamber.com/docs/default-source/pdfs/060315_fti_assessmentofnashville_final.pdf?sfvrsn=2

http://www.nashvillechamber.com/docs/default-source/pdfs/060315_fti_assessmentofnashville_final.pdf?sfvrsn=2

Community Needs Assessments

Davidson

Summary

• 18.5% live in poverty

– 54% of children below 200% poverty level

• Health outcomes could be improved

• Place & Race matter

• Many resources in our community

Thank you / Questions

Findings From Interviews with Community Leaders

Methods: Interviews

• Interviewed community representatives and leaders with: – Focus on the broad interests of the community

– Serving low-income, minority or underserved populations

• Sectors represented include: public health, government/public sector, health care, education, faith community, private foundations, academia

• Interviews conducted in pairs by STH, VUMC and graduate students from MMC and VU

• Closed and open-ended questions Davidson

Methods: Interviews (cont.)

• Semi-structured interview protocol focused on health concerns, determinants of health, health systems issues, health assets

• Quantitative data (6 questions) :

– Entered in REDCap and analyzed using excel

– “Other” responses recoded or analyzed separately

• Qualitative data (3 questions):

– Thematic analysis conducted using team of 3 reviewers for each question

Davidson

“What are the Greatest Health and/or Health Care Concerns in your Community?” (n=33)

Health Concerns (Davidson) %

1. Access to Care 48

2. Housing and Homelessness 42

3. Poverty 39

4. Mental and Emotional Health 33

5. Health Education 24

5. Obesity 24

5. Health Disparities 24

--Number of respondents-- Respondents Could Select Up to Five Response Options, Answers with Zero Responses Removed

Davidson

Socioeconomic / Demographic (Davidson)

%

1. Poverty / Working Poor 52

2. Educational Attainment 39

2. Health Insurance Coverage 39

4. Income / Wealth Dispersion 36


6. Changing Population 24

7. Language Barriers 21

“What Socioeconomic and Demographic Factors have the Biggest Impact on Community Health?”(n=33)

--Number of respondents--

Davidson Respondents Could Select Up to Three Response Options

Environmental Factors (Davidson)

%


2. Healthy Food Access 54

2. Transportation 54

4. Neighborhood Safety 48

5. Limited Sidewalks 24

“What Environmental Factors have the Biggest Impact on Community Health?”(n=33)



“What Conditions and Diseases are Causing Illness and Death in your Community?” (n=33)

Conditions / Diseases (Davidson) %

1. Emotional and Mental Health 42

2. Cardiovascular Disease 39

2. Chronic Disease 39

4. Obesity 36

5. Alcohol and Drugs 33

6. Diabetes 30

7.Cancer 24



Health System (Davidson) %

1. Access – Overall 42

2. Coordination of Care 36

3. Health Disparities 24

4. Affordability 21

4. Access – Mental Health 21

“What Are the Greatest Barriers within the Health System?” (n=33)



Behaviors (Davidson) %

1. Nutrition 48

1. Physical Activity 48

3. Alcohol and Drug Abuse 30

3. Preventive Care 30

5. Health Education / Health Literacy 21

“What Behaviors Have the most Negative Impact on Health in your Community?” (n=33)

--Number of respondents-- Davidson Respondents Could Select Up to Three Response Options

“What Reasons/Barriers exist that cause the use of ER for non-emergencies?” (n=33)

• Convenience, hours of operation and transportation

▫ Difficult to find a doctor at non-business hours

▫ Long wait times for appointments

• No Health Insurance

▫ Can’t be turned away for failure to pay

• Health Navigation/Literacy

▫ Not sure what constitutes an emergency

▫ Not knowing where or when to go for care

• Lack of consistent source of medical care

▫ Lack of affordable/timely alternatives

▫ Lack of preventive care

Davidson

“What Community Health Assets work well to support health and well-being?” (n=33)

• Organizations & Groups Focused on Underserved

▫ Safety net providers, hospitals, and health systems

▫ Local health department

▫ Local non-profits, social service agencies

• Access to Recreational Activities

▫ Greenways, trails, sidewalks, bike paths

▫ Mayor’s health initiatives

▫ Neighborhood activities, including walks / runs

Davidson

“What Priority Actions should Davidson County focus on?” (n=33)

• Increase access to insurance for all ▫ Connecting to affordable, quality insurance

• Address the barriers to accessing health system ▫ Coordination of care ▫ Transportation ▫ Affordability

• Environment (built, social, natural) ▫ Healthy food access ▫ Walkability/physical activity

• Health Education and Promotion ▫ Navigation / literacy ▫ Multi-level perspective

Davidson

Davidson Co. Interview Summary

Basic Needs of Many are Unmet

Emotional and Mental Health

Access and Coordination of Care

Davidson

Findings From Community Listening Sessions

Listening Session Methodology

Davidson

• Six listening sessions held in five locations. Collaborated with United Way and community partners on recruitment

- McGruder Family Resource Center - Salvation Army Family Resource Center - Napier Elementary Family Resource Center - St Luke’s Family Resource Center - South Nashville Family Resource Center (2)

• Moderated and co-moderated by partners • Moderator’s guide topics included community

assets and issues, health and healthcare issues, preventable ER utilization, and priority actions

• Short survey to obtain participant demographic info • Qualitative data: thematic analysis conducted using

team of four reviewers

Demographic Information Listening Sessions

Demographics of Participants (n=58) - 79% Female

- 75% English Speakers

- 55% High School Diploma or less

- 18% Uninsured, 36% Medicare, 9% Medicaid, 30% Privately Insured

Davidson

“What Community Health Assets/Resources work well to support health and well-being?”

• Community resources

– 211

– Schools

– Family Resource Centers (FRCs)

– Non-profit organizations

– Faith community

Davidson

“What are the Top Community Issues?”

• Transportation • Chronic stress related to crime, lack of

opportunity, challenges meeting basic needs • Opportunities and safe spaces for youth • Housing • Cost of childcare • Family/parent support • Social breakdown of communities

– “The village has left us…It raised us.”

• Violence/crime • Resources available but community not using or

aware of them Davidson

“What are the Greatest Health and/or Health Care Issues in your community?”

• Access to care, cost of care – Insurance gap, lack of insurance

• Appointment wait times and access to health care providers

• Access to affordable, healthy food

• Emotional and mental health

• Substance use and abuse – Prescription drugs

• Fragmented, uncoordinated, unwelcoming health care delivery system – Not person-centered

Davidson

“What Reasons/Barriers exist that cause the Use of ER for non-emergencies?”

• Challenges of accessing primary care system and limitations of availability, for example: – Work hours

– Fear of job loss

– Transportation issues

• No co-pays or need for cash up front

• Care regardless of ability to pay or level of insurance

• Wait times for appointments in primary care system

Davidson

“If you had a Magic Wand, what Priority Actions should your community focus on?”

Davidson

• Broadening access to care and insurance for all

• Improve transportation

• Improve workforce development

• Affordable housing and child care

• Community safety and reduction of crime

• Expand opportunities for youth and teens

• Parent/family support and community building and connectedness

Davidson Co. Listening Session Summary

Challenge in Meeting Basic Needs

Health System Difficult to Access and

Challenging to Navigate

Information on Health and Social Services

can be Difficult to Access

Emotional and Mental Health

Davidson

Limitations: Primary and Secondary Data

• Interviews:

– Response categories on interview guide for some questions not mutually exclusive

– Variability in number of responses that respondents chose

• Listening sessions:

– Representativeness of listening session participants

– Potential language/cultural barriers

• Secondary data:

– Source variability

– Benchmarking not always available

Davidson

• Interviewees & Listening session participants

• Metro Health Department

• Family and Children’s Services

• United Way of Metropolitan Nashville

• Metro Social Services

• Student team members:

– Christopher Artis, Meharry Medical College

– Althea Robinson, Vanderbilt University

– Shellese Shemwell, Vanderbilt University

Acknowledgements

Questions/Discussion

Exercise 1: Identification of Health Needs

Identification of Health Needs

• Please write down 3 Health Needs

– 1 per sticky note

• Place sticky note on white paper

Davidson County Identified Community Health Needs

Access to Care/Care Coordination (72)

Social Determinants (53)

Mental and Emotional Health (46)

Wellness and Disease Prevention (18)

Davidson

Exercise 2: Visioning, Goals, Resources

• Work in groups

• Worksheets at tables

• Groups will need:

– Facilitator

– Recorder

– Reporter

Thank you to all!!

davidson county, tn community health needs assessment 2016 · 2015. 10. 8. · language other than...

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