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NORTON COMMUNITY HOSPITAL NORTON/WISE COUNTY, VIRGINIA

2011 COMMUNITY HEALTH

NEEDS ASSESSMENT

Published June 29, 2012

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Table of Contents

I. Introduction II. Executive Summary III. Community Interview Summary

a. Collecting Community Input b. Health Status Rating c. Top Health Priorities d. Identifying Available Resources e. Improving Health Priorities

IV. Global Perspective (America’s Health Rankings overview) a. Introduction b. Findings c. State Summary

V. Regional Perspective a. Norton/Wise County Snapshot

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Introduction

ountain States Health Alliance (MSHA) is an integrated health care delivery system providing a comprehensive continuum of care to people in 29 counties in Tennessee, Virginia, Kentucky, and North Carolina. MSHA was formed after Johnson City Medical Center Hospital, Inc. acquired six

Columbia/HCA hospitals in Northeast Tennessee on September 1, 1998; and was later renamed Mountain States Health Alliance in January 1999. Today, MSHA is the largest regional health care system with 13 hospitals operating at approximately $1.0 billion in net revenues. The hospitals are:

Johnson City Medical Center

Niswonger Children’s Hospital

Woodridge Psychiatric Hospital

James H. and Cecile C. Quillen Rehabilitation Hospital

Franklin Woods Community Hospital

Indian Path Medical Center

Johnson County Community Hospital

Sycamore Shoals Hospital

Dickenson Community Hospital

Johnston Memorial Hospital

Norton Community Hospital

Russell County Medical Center

Smyth County Community Hospital In addition to 13 hospitals, MSHA’s integrated health care delivery system includes primary/preventive care centers and numerous outpatient care sites, including First Assist Urgent Care, MedWorks, Same Day Surgery, and Mountain States Rehabilitation.

Executive Summary Regional and national rankings for health factors continue to be disappointing as cancer, heart disease, and diabetes rates continue to increase each year. Obesity continues to be a major problem in the United States, leading to additional diseases. From a global perspective, the United States falls behind other developing nations in health outcomes. Clearly, there are many needs that exist and need attention. Mountain States Health Alliance (MSHA) exists to “identify and respond to the health care needs of individuals and communities in our region and to assist them in attaining their highest possible level of health.” In order for MSHA to serve its region most effectively, it is essential to understand each community’s individual needs. MSHA has conducted a Community Health Needs Assessment to profile the health of the residents within the local region. The assessment focuses on MSHA’s 13 core counties, nine of which have MSHA facilities – Carter, TN; Dickenson, VA; Johnson, TN; Norton/Wise, VA; Russell, VA; Smyth, VA; Sullivan, TN; Washington, TN; and Bristol City/Washington, VA. The other four counties in which MSHA does not have a facility include Greene, TN; Hawkins, TN; Scott, VA; and Unicoi, TN. See map on page 5. Activities associated with the development of this assessment have taken place during the winter of 2011 and spring of 2012, including state, regional and county-specific secondary data collection and primary data obtained through 67 surveys with individuals from the local communities.

M

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Community Health Needs Assessment Interview Summary

Represents county in which MSHA owns a facility. MSHA has part-ownership in other hospitals but they are not included in this assessment.

*Service Area is defined by approximately 80% of inpatient population. Throughout the assessment, high priority was given to determining the health status and available resources within each community. Community members from each county met with MSHA to discuss current health priorities and identify potential solutions. The information gathered from a local perspective, paired with regional, state and national data, helps to communicate the region’s health situation in order to begin formulating solutions for improvement. After compiling the various sources of information, four top health priorities were identified by all nine counties within MSHA’s core service area. These priorities include: cancer, obesity, diabetes, and heart disease. In 2011, Tennessee ranked 39th and Virginia ranked 20th out of 50 states, for overall health outcomes. Both states had high rates of adult obesity, cancer deaths, infant mortality, and diabetes. Though Virginia’s overall ranking is moderately low, the health outcomes in Southwest Virginia, where MSHA’s facilities are located, resembles those of Tennessee. By examining national data, MSHA is able to identify successful measures that have been used in other states to solve similar issues. Vermont, for instance, ranked 1st in 2011 after being ranked 17th in 1998. Though obesity and diabetes rates are still increasing in Vermont, the percentage of affected adults is much lower than other states.

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According to American’s Health Rankings 2011 Edition, Norton/Wise County is ranked 126th in Virginia for health outcomes and 112th for health factors out of 134 counties. The leading causes of death are heart disease, cancer, and respiratory. Wise County also ranked very poorly for health behaviors (128th) due to high rates of injury-related mortality, low consumption of fruits and vegetables, and high rate of cigarette smoking. Norton/Wise County ranked 92nd in social & economic factors and 29th in physical environment with lower physical inactivity rates and lower rates of violent crime. By utilizing effective measures, available resources and community member involvement, county-specific plans have been developed and implemented which focus on preventing the growth of the four identified health outcomes. However, it is apparent that it takes more than just resources and an implementation plan to challenge these health priorities. MSHA is nevertheless, committed to seeing change take place within each community it serves. The following information has been collected and reviewed by the representatives from the Strategic Planning Department and Government Relations. Following presentation to the MSHA Social Responsibility Committee, future initiatives will be identified, prioritized, implemented, and monitored to ensure health status progress occurs. Community Interview Summary Throughout January and February of 2012, the MSHA Strategic Planning Department hosted four separate luncheons in order to connect with community members of each county in which MSHA owns a facility. MSHA hospital administration teams were contacted in order to obtain names of individuals in the community who were considered public health officials or community leaders. The 67 interviewees in attendance were local physicians, school board members, non-profit directors, health department officials, school nurses, minority group leaders, and others all from the nine counties in which MSHA has facilities: Carter, Johnson, Sullivan, and Washington counties in Tennessee and Dickenson, Norton City/Wise, Russell, Smyth, and Bristol City/Washington counties in Virginia. These individuals were invited to discuss and determine the health priorities and resources available in each area. Collecting Community Input In order to complete the community health needs assessment for Norton Community Hospital, MSHA met with seven individuals from Norton/Wise County. The organizations that were represented are listed in Table 1.1. Table 1.1 – Summary Organizations Participating in MSHA’s CHNA

Reported Organizations Providing Input for Assessment

Wise County Health Department

Norton Community Hospital

Mountain Empire Older Citizens

Wise County Emergency Medical Providers

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To begin the community health needs assessment, MSHA’s strategic planning staff presented data that had been collected in-house in order to illustrate past and current health trends for Tennessee and Virginia. The presentation depicted the current national health rankings, in addition to providing a snapshot of each county in MSHA’s service area. Following the presentation, each participant was given a survey to determine the individual’s personal assessment of their county’s health priorities. Secondly, the individuals were asked to submit ideas and suggestions as to how MSHA could use the available resources in order to improve the health priorities determined. After the surveys had been completed, each group discussed the questions and continued brainstorming ways to address obstacles and utilize resources. All of the information collected from the surveys and open discussion was evaluated and prioritized based on health needs.

In surveys obtained from seven community representatives, several community health needs and resources were identified. Table 1.2 lists the survey questions given to each participant in the assessment.

Table 1.2 – Community Survey Questions

Survey Questions

1 How would you rate the general health status of the patient population in this community on a scale of 1 to 10 (with 1 being the poorest and 10 being the best)?

2 Keeping in mind resources are not unlimited, are there other health priorities you feel should be addressed as well?

3 What existing resources, such as organized groups or public health initiatives have been developed and are in place to address these health priorities?

4 What ideas do you have that may serve to improve these health priorities?

Health Status Rating Overall, the general health status of Norton/Wise County was rated as 3.57 on a scale of 1 – 10, with 1 being the poorest and 10 being the best). Individual responses ranged from 1 to 5. The health ranking for each county, determined by participants, can be found below in Table 1.3. Table 1.3 – Average Health Status Ranking by Hospital and County

MSHA Facility/County Number of Attendants

Average of Health Status Rating

Norton Community Hospital/Dickenson Community Hospital, Norton/Dickenson, VA 7 3.57

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Top Health Priorities All seven interviewees agreed that the most prevalent health priorities in all counties were obesity, diabetes, cancer and heart disease. All of these could be positively impacted by addressing the obesity issue as it is a health risk factor for each of these diseases. In addition to these four, community members identified several other health priorities that need to be addressed. Tables 1.4 and 1.5 list the top health priorities identified by community participants. Table 1.4 – Top Identified Health Priorities

Top Health Priorities Responses % of Total Responses

Obesity 7 100%

Cancer 7 100%

Diabetes 7 100%

Heart Disease 7 100%

Table 1.5 – Additional Identified Health Priorities

Norton Community Hospital/Dickenson Community Hospital Wise County, VA Responses Percentage

Substance Abuse/Rx Abuse 6 50.0%

Mental Health 5 41.7%

Childhood Obesity 1 8.3%

TOTAL Responses 12 100.0%

*Individuals submitted multiple response regarding health priorities. Identifying Available Resources MSHA realizes that there are numerous resources in all of the counties it serves that can provide care for individuals. Our goal, in order to reduce costs and provide the best care possible for patients, is to identify these resources to prevent duplication of services. The interviewees were asked to list all of the services and resources within their community. The interviewees acknowledged that many resources currently exist to help meet health needs. Table 1.6 lists the current organizations within each county that offer health services to the community.

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Table 1.6 – Identified Available Resources by County

Resources Available

Norton/Wise County, Virginia

Health Wagon

Healthy Appalachia

Wellness @ UVA Wise

UVA Mammogram

Upward Bound *MSHA understands that there are other resources available in each county that are not listed in this table. This table represents only the resources listed by participants in community health needs assessment. MSHA will continue to identify resources.

Improving Health Priorities The community members who were surveyed provided helpful ideas as to how to begin formulating a plan to improve the health priorities throughout the region. To enhance existing resources, the participants stressed the significance of increasing public awareness of both addressing one’s health needs and the availability of health care options within each community. Additional suggestions as to how MSHA can improve the previously identified health priorities are listed in Table 1.7. Table 1.7 – Ideas to Improve Health Priorities

Responses

1 Focus on school children by providing education to promote healthy habits. Counter obesity, drug use, and teen pregnancy

2 Require physical education activity as part of school curriculum

3 Incentivize employers or community to improve overall health status and address specific health issues.

4 Network to avoid duplicating services

5 Improve natural trails and parks to encourage physical activity

6 Increase community support for smoke-free areas.

7 Provide early screening for underinsured or uninsured

8 Advertise health fairs and other educational programs

9 Develop site for end-of-life care

10 Partner with local farmers markets

11 Extend partnerships with private business

12 Share health information between pharmacies

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Community Health Needs Assessment Global Overview

Global Perspective (Provided by America’s Health Rankings)* The focus on development of a community needs assessment for Mountain States Health Alliance is to determine the needs for the local communities and the service area in which we operate. However, it is also helpful to understand from a more global perspective the health status of the nation as a whole, since many issues MSHA’s service area experiences are not limited to just this region. Compiled on an annual basis, the America’s Health Rankings publication developed by the United Health Foundation, the American Public Health Association and Partnership for Prevention provides one of the most comprehensive assessments regarding the status of the nation’s health. The following information in the national and regional overview is from the 2011 edition. Introduction Health is a result of behavior, individual genetic predisposition to disease, the environment and the community in which we live, the clinical care received and the policies and practices of our health care and prevention systems. Each of us, individually, as a community, and as a society, strives to optimize these health determinants, so that all of us can have a long, disease-free and robust life regardless of race, gender or socio-economic status. This report looks at the four groups of health determinants that can be affected: 1. Behaviors include the everyday activities that affect personal health. It includes habits and practices developed by individuals and families that have an effect on personal health and on utilization of health resources. These behaviors are modifiable with effort by the individual supported by community, policy and clinical interventions. 2. Community and environment reflects the reality that daily conditions have a great effect on achieving optimal individual health. 3. Public and health policies are indicative of the availability of resources to encourage and maintain health and the extent that public and health programs reach into the general population. 4. Clinical care reflects the quality, appropriateness and cost of the care received at doctors' offices, clinics and hospitals. All health determinants are intertwined and must work together to be optimally effective. For example, an initiative that addresses tobacco cessation requires not only efforts on the part of the individual but also support from the community in the form of public and health policies that promote non-smoking and the availability of effective counseling and care at clinics. Similarly, sound prenatal care requires individual effort, access to and availability of prenatal care coupled with high-quality health care services. Addressing obesity, which is a health epidemic now facing this country, requires coordination among almost all sectors of the economy including food producers, distributors, restaurants, grocery and convenience stores, exercise facilities, parks, urban and transportation design, building design, educational institutions, community organizations, social groups, health care delivery and insurance to complement and augment individual actions. *America’s Health Rankings 2011 Report can be found online at http://www.americashealthrankings.org/. It is a product of United Health

Foundation.

http://www.americashealthrankings.org/

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America's Health Rankings® combines individual measures of each of these determinants with the resultant health outcomes into one, comprehensive view of the health of a state. Additionally, it discusses health determinants separately from health outcomes and provides related health, economic and social information to present a comprehensive profile of the overall health of each state. America's Health Rankings® employs a unique methodology, developed and periodically reviewed by a panel of leading public health scholars, which balances the contributions of various factors, such as smoking, obesity, binge drinking, high school graduation rates, children in poverty, access to care and incidence of preventable disease, to a state's health. The report is based on data from the U.S. Departments of Health and Human Services, Commerce, Education and Labor; U.S. Environmental Protection Agency; the American Medical Association; the Dartmouth Atlas Project; the Trust for America's Health; the World Health Organization; and the Organization for Economic Co-operation and Development (OECD). Findings Comparison to Other Nations When health in the United States is compared to health in other countries, the picture is disappointing. The World Health Organization, in its annual World Health Statistics 2011, compares the United States to the nations of the world on a large variety of measures. While the U.S. does exceed many countries, it is far from the best in many of the common measures used to gauge healthiness, and it lags behind its peers in other developed countries. Life expectancy is a measure that indicates the number of years that a newborn can expect to live. Japan is the perennial leader in this measure, with a life expectancy of 86 years on average for females and 80 years for males (San Marino men have a longer life expectancy at 82 years). With a life expectancy of 81 years for women, the United States is 32nd among the 193 reporting nations of the World Health Organization and at 76 years for men, the United States is 34th among nations. Table 7 lists a few other countries for comparison purposes. U.S. male life expectancy rates are on par with Chile, Cuba and Slovenia, and U.S. female life expectancy rates are on par with Costa Rica and Denmark. *America’s Health Rankings 2011 Report can be found online at http://www.americashealthrankings.org/. It is a product of United Health

Foundation.


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One of the underlying causes for these differences is the gap in infant mortality rates between the United States and many other countries (Table 7). The infant mortality rate for the U.S. in 2009 was seven deaths per 1,000 live births, ranking the United States 43rd among WHO nations. Rates for Sweden, Spain, Italy, Germany, France, Czech Republic, Slovenia and Iceland are all half of the United States rate. These countries also have considerably lower infant mortality rates than those of non-Hispanic whites in the United States, the ethnic/racial group with the lowest rates in the United States. In the United States, the infant mortality rate is also a health equity issue. Infant mortality among non-Hispanic whites is 4.8 deaths per 1,000 live births - still higher than 28 other countries. Infant mortality in the United States among non-Hispanic blacks, however, is 11.1 deaths per 1,000 live births; 2.3 times that of non-Hispanic whites and 60th among countries1. The life expectancy in the United States of a 65-year-old woman is 19.8 years, lower than 22 other OECD countries including France at 22.3 years, Spain at 22.2 years, Canada at 21.3 years and United Kingdom at 20.2 years. For 65-year-old men, the difference in life expectancy in the United States compared to other nations is less pronounced. Life expectancy for 65-year-old males is 17.1 years in the United States, 18.1 years in Canada, 17.6 in the United Kingdom, 18.0 years in France and 17.8 years in Spain2. Differences in life expectancy are also impacted by the effectiveness of treating disease, especially diseases that are amenable to care, including bacterial infections, treatable cancers, diabetes, cardiovascular and cerebrovascular disease, some ischemic heart disease and complications from common surgical procedures. The age-adjusted amenable mortality rate before age 75 for the United States was 95.5 deaths per 100,000 population in 2006 to 2007. This is a considerable improvement from 120.2 deaths per 100,000 population in 1997 to 1998, but the rate of improvement was much slower than in other Organization for Economic Co-operation and Development (OECD) nations studied. The rate in the U.S. remains 50 percent higher than the rate in Australia, France, Japan and Italy. This study estimated that if the United States achieved rates on par with comparative countries, between 59,500 and 84,300 deaths before age 75 would have been saved. Additionally, the study indicated that despite spending more than any other country on health care, the United States continues to slip further behind other countries. In 1997, the U.S. ranked 15th in this mortality rate. Since then, Finland, Portugal, the United Kingdom and Ireland have reduced their mortality rate from disease amenable to care more rapidly than the United States. All now have better rates than the U.S3. The homicide rate also distinguishes the United States from other OECD countries, as the United States ranks 29th among the 31 countries and its rate is more than double that of most other countries. France, Germany, Canada, Spain and the United Kingdom have homicide rates under 2 deaths per 100,000 population, and the United States has 5.2 deaths per 100,000 population. The homicide rate in the United States disproportionately affects young black adults, where homicide rates are seven times those of young white adults. (The homicide rate for blacks age 15 to 24 is 48.9 deaths per 100,000 population, whereas the homicide rate for whites age 15 to 24 is 6.7 deaths per 100,000 population.) The results of these studies should be a wake-up call to everyone in the United States to strive to improve all aspects of the health system however possible, including education, safety, prevention and clinical care. Other countries have improved their overall health, indicating that the United States too can do the same. *America’s Health Rankings 2011 Report can be found online at http://www.americashealthrankings.org/. It is a product of United Health

Foundation.


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Community Health Needs Assessment National Overview

National Changes from 1990 The 22-year perspective provides a view of health over time. During the past 22 years, this report has tracked the nation’s 21.2 percent improvement in overall health (Graph 1). National success stems from improvements in the reduction of infant mortality, infectious disease, prevalence of smoking, cardiovascular deaths and violent crime, among others (Table 3). Graph 1 illustrates that the rate of improvement experienced in the health of the United States’ population occurred in two phases. During the 1990s, improvement in national health averaged 1.6 percent per year. During this decade, the annual improvement in health has averaged 0.5 percent per year. The annual rate of growth this decade is less than one-third of the annual rate of growth during the 1990s. Special concern surrounds the decline in health determinants, as those measures point to the future health of the population. Graph 1: Improvements Since 1990

*America’s Health Rankings 2011 Report can be found online at http://www.americashealthrankings.org/. It is a product of United Health

Foundation.


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Table 1 - National Measures of Successes and Challenges: 2011 Edition

MEASURE CHANGES

SUCCESSES

Smoking The prevalence of smoking decreased 41 percent from 29.5 percent in the 1990 Edition to 17.3 percent of the adult population in the current edition. Smoking dropped from 17.9 percent to 17.3 percent in the last year, continuing a gradual decline over the past eight years.

Violent Crime The violent crime rate declined 34 percent from 609 offenses in the 1990 Edition to 404 offenses per 100,000 population in the 2011 Edition. Violent crime dropped by 25 offenses per 100,000 population in the last year.

Preventable Hospitalizations

Preventable hospitalizations continue a 10-year decline. In the 2001 Edition, there were 82.5 discharges; in this edition, there were 68.2 discharges per 1,000 Medicare enrollees.

Occupational Fatalities Occupational fatalities have declined slightly in the last five years from 5.3 deaths in the 2007 Edition to 4.0 deaths per 100,000 workers in the 2011 Edition. Rates are the lowest in 22 years.

Air Pollution

The average amount of fine particulate in the air continues to decline from 13.2 micrograms in the 2003 Edition to 10.8 micrograms per cubic meter in 2011.

Infectious Disease Infectious disease has dropped from 19.7 cases in the 1998 Edition to 10.3 cases per 100,000 population in the 2011 Edition. However, the incidence is above the rate of 9.0 cases achieved in 2009 and 2010.

Infant Mortality The infant mortality rate decreased 33 percent from 10.2 deaths in the 1990 Edition to 6.7 deaths per 1,000 live births in 2011. Improvements have slowed dramatically in the last 10 years as compared to the 1990s.

Premature Death Years of potential life lost before age 75 per 100,000 population declined 16 percent from 8,716 in the 1990 Edition to 7,279 years of potential life lost before age 75 per 100,000 population in 2011. Premature deaths, like several other metrics, have leveled off in the last decade compared to gains in the 1990s.

CHALLENGES

Obesity The prevalence of obesity increased 137 percent from 11.6 percent in the 1990 Edition to 27.5 percent of the population in the 2011 Edition.

Diabetes Diabetes has almost doubled in prevalence since the 1996 Edition, rising from 4.4 percent to 8.7 percent of the adult population. This continued 0.3 percent annual increase does not show signs of abating in the near term.

Children in Poverty The percentage of children in poverty has increased for the last four editions and, at 21.5 percent of persons under age 18, is approaching the 22-year historical high of 22.7 percent in the 1994 Edition. This is far above the 22-year low of 15.8 percent in the 2002 Edition.

Lack of Health Insurance The rate of uninsured population has increased 17 percent from 13.9 percent in the 2001 Edition to 16.2 percent in 2011. The rate of uninsured population has slowly but steadily increased during the last 10 years.

Binge Drinking The percent of adults who report binge drinking remains above 15 percent of the population.

High School Graduation Rate

Over the last seven years, the high school graduation rate remains locked in the range of 73 percent to 75 percent of incoming ninth graders who graduate in four years.

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The United States has the potential to return to the rates of improvement typical in the 1990s. However, to do so, it must address the drivers of health directly by focusing on reducing important risk factors. For example, the prevalence of smoking was stagnant for many years and now is showing improvement, declining from 23.2 percent in the 2003 Edition to 17.3 percent in the 2011 Edition, the lowest level in 22 years (Graph 2). Utah has reduced its smoking rate to less than 10 percent, lower than the 12 percent goal for the nation set forth in Healthy People 2020. Seven other states (California, Connecticut, Arizona, Massachusetts, New Jersey, Hawaii and Minnesota) have driven their smoking rates to less than 15 percent, approaching the Healthy People 2020 goal.

Graph 2 - Prevalence of Smoking Since 1990

Unprecedented and still unchecked growth in the prevalence of obesity dramatically affects the overall health of the United States. The prevalence of obesity has increased 137 percent, from 11.6 percent of the population in the 1990 Edition to 27.5 percent of the population in the 2011 Edition. Now, more than one in four people in the U.S. is considered obese — a category that the CDC reserves for those who are significantly over the suggested body weight given their height. This alarming rate of increase shows little evidence of slowing or abating (Graph 3). Because this data relies on self-reported height and weight, actual obesity rates, as measured by health professionals, may be up to 10 percent higher, meaning that more than one-third of the population is likely to be obese. Obesity is known to contribute to a variety of diseases, including heart disease, diabetes and general poor health. Graph 3 - Prevalence of Obesity Since 1990


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The current economic climate also increases the challenge of maintaining a healthy population. Graph 4 shows the recent increase in the percentage of children in poverty in the last few years, increasing from 17.4 percent of children in the 2007 Edition to 20.7 percent of children in the 2010 Edition. In the 2002 Edition, the child poverty rate was at a historic low of 15.8 percent of persons under age 18. Poverty is an indication of the lack of access to health care, including preventive care, by this vulnerable population. Graph 4–Children in Poverty Since 2001

Lack of health insurance coverage increased from 13.9 percent in the 2001 Edition to 16.2 percent of the population in the 2011 Edition (Graph 5). Lack of health insurance not only inhibits people from getting the proper care when needed but also reduces access to necessary preventive care to curtail or minimize future illnesses. Massachusetts, with lack of health insurance at 5.0 percent of the population, is substantially better than all other states and less than one third of the national average. Texas has a rate five times that of Massachusetts. Changes in national health care laws have the potential to dramatically affect this metric over the next few years. Graph 5: Lack of Health Insurance Since 2001


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Since the 2009 Edition, overall health in the United States has increased slightly from 20.3 percent to 21.3 percent above the 1990 baseline. This increase is primarily due to declines in preventable hospitalizations, infectious disease, prevalence of smoking and violent crime. 2011 State Results

America’s Health Rankings® — 2011 Edition shows Vermont at the top of the list of healthiest states again this year. The state has steadily risen in the rankings for the last 13 years from a ranking of 17th in 1997 and 1998. New Hampshire is ranked second this year, an improvement from ranking third last year. New Hampshire has ranked in the top 10 states every year of the index. Connecticut is number three, followed by Hawaii and Massachusetts. Mississippi is 50th and the least healthy state, while Louisiana is 49th. Oklahoma, Arkansas and Alabama complete the bottom five states. Vermont ascended from 20th in 1990 and 1991 to the top position with sustained improvement in the last decade. Vermont’s strengths include its number one position for all health determinants combined, which includes ranking in the top 10 states for a high rate of high school graduation, a low violent crime rate, a low rate of infectious disease, a high usage of early prenatal care, high per capita public health funding, a low rate of uninsured population and ready availability of primary care physicians. Vermont’s challenges are low immunization coverage with 91.2 percent of children ages 19 to 35 months receiving recommended immunizations, relatively high occupational fatalities at 4.3 deaths per 100,000 workers and a high prevalence of binge drinking at 17.1 percent of the population. Mississippi remains 50th this year, the same as the last 10 years. It has been in the bottom three states since the 1990 Edition. The state ranks well for a low prevalence of binge drinking, a low violent crime rate and a high rate of immunization coverage. Mississippi’s infectious disease rate improved from 11.9 to 10.5 cases per 100,000 population in the last year. It ranks in the bottom five states on 12 of the 23 measures including a high prevalence of obesity, a low high school graduation rate, a high percentage of children in poverty, limited availability of primary care physicians and a high rate of preventable hospitalizations. Mississippi ranks 48th for all health determinants combined, so its overall ranking is unlikely to change significantly in the near future. Scores presented in the table indicate the weighted number of standard deviation units a state is above or below the national norm. For example, Vermont, with a score of 1.197, is slightly more than one standard deviation unit above the national norm and Mississippi, with a score of -0.822, is more than three-quarters of a standard deviation unit below the national average. When comparing states from year to year, differences in score are more important than changes in ranking. Table –Overall Rankings 2011

ALPHABETICAL BY STATE

RANK ORDER

RANK State Score

RANK State Score

46 Alabama -0.607

1 Vermont 1.197

35 Alaska -0.168

2 New Hampshire 1.027

29 Arizona 0.050

3 Connecticut 1.010

47 Arkansas -0.622

4 Hawaii 0.940

24 California 0.265

5 Massachusetts 0.906 9 Colorado 0.555

6 Minnesota 0.755

3 Connecticut 1.010

7 Utah 0.723

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30 Delaware -0.032

8 Maine 0.575

33 Florida -0.119

9 Colorado 0.555 37 Georgia -0.275

10 Rhode Island 0.549

4 Hawaii 0.940

11 New Jersey 0.495 19 Idaho 0.344

12 North Dakota 0.494

28 Illinois 0.098

13 Wisconsin 0.476 38 Indiana -0.290

14 Oregon 0.475

17 Iowa 0.401

15 Washington 0.443

26 Kansas 0.128

16 Nebraska 0.414 43 Kentucky -0.478

17 Iowa 0.401

49 Louisiana -0.817

18 New York 0.392 8 Maine 0.575

19 Idaho 0.344

22 Maryland 0.269

20 Virginia 0.343

5 Massachusetts 0.906

21 Wyoming 0.311 30 Michigan -0.032

22 Maryland 0.269

6 Minnesota 0.755

23 South Dakota 0.267

50 Mississippi -0.822

24 California 0.265 40 Missouri -0.342

25 Montana 0.139

25 Montana 0.139

26 Kansas 0.128

16 Nebraska 0.414

26 Pennsylvania 0.128 42 Nevada -0.471

28 Illinois 0.098

2 New Hampshire 1.027

29 Arizona 0.050 11 New Jersey 0.495

30 Delaware -0.032

34 New Mexico -0.141

30 Michigan -0.032

18 New York 0.392

32 North Carolina -0.068 32 North Carolina -0.068

33 Florida -0.119

12 North Dakota 0.494

34 New Mexico -0.141 36 Ohio -0.233

35 Alaska -0.168

48 Oklahoma -0.669

36 Ohio -0.233 14 Oregon 0.475

37 Georgia -0.275

26 Pennsylvania 0.128

38 Indiana -0.290

10 Rhode Island 0.549

39 Tennessee -0.314 45 South Carolina -0.521

40 Missouri -0.342

23 South Dakota 0.267

41 West Virginia -0.413 39 Tennessee -0.314

42 Nevada -0.471

44 Texas -0.508

43 Kentucky -0.478

7 Utah 0.723

44 Texas -0.508 1 Vermont 1.197

45 South Carolina -0.521

20 Virginia 0.343

46 Alabama -0.607 15 Washington 0.443

47 Arkansas -0.622

41 West Virginia -0.413

48 Oklahoma -0.669

13 Wisconsin 0.476

49 Louisiana -0.817 21 Wyoming 0.311

50 Mississippi -0.822


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Community Health Needs Assessment Regional Overview

Tennessee and Virginia Summary In 2011, Tennessee ranked 39th out of 50 states in overall health outcomes, having improved from 42nd place in 2010. Since 1990, this is the first time Tennessee has ranked below 40th. Despite the improved rating, Tennessee still ranks very high in several measurements. For instance, Tennessee currently ranks 46th for prevalence of diabetes, 46th for cancer-related deaths, 46th for preventable hospitalizations, 42nd for obesity, and 45th for infant mortality. In addition, Tennessee ranked 47th for violent crime. One positive outcome is a decrease from 26.7 percent to 20.1 percent in adult smoking over the past five years. Virginia also improved in ranking, having been in 22nd place in 2010, and currently ranking 20th in 2011. Just like Tennessee, Virginia has seen an increase in obesity, as well as diabetes. Virginia also has a high prevalence of smoking and high levels of air pollution, which will continue to be challenges. As for health outcomes, Virginia’s highest rankings were in infant mortality (31st), and cancer deaths (31st). Below is a timeline from 1990 to 2011 illustrating the rankings of each state over the past two decades. Clearly, Tennessee has seen a definite improvement within the past four years, falling from 48th to 39th. Virginia on the other hand has remained somewhat consistent. *America’s Health Rankings 2011 Report can be found online at http://www.americashealthrankings.org/. It is a product of United Health

Foundation.


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Community Health Needs Assessment Regional Summary

Regional Overview In this assessment MSHA provides a broad overview of the current health status for MSHA’s core service area. MSHA’s core service area consists of 13 counties: Carter, TN; Greene, TN; Hawkins, TN; Johnson, TN; Sullivan, TN; Unicoi, TN; Washington, TN; Dickenson, VA; Russell, VA; Scott, VA; Smyth, VA; Washington/Bristol City, VA; and Wise/Norton City, VA. The following statistics for MSHA’s core service area include:

I. Demographic Characteristics II. Population Distribution

III. Household Income Distribution IV. Education Level V. Race/Ethnicity

DEMOGRAPHIC CHARACTERISTICS

Core Service

Area USA

684,310 281,421,906

718,922 310,650,750

729,638 323,031,618

1.5% 4.0%

Average Household Income $46,747 $67,529

2000 Total Population



% Change 2011 - 2016

2011 2016 % Change

Total Male Population 351,749 356,997 1.5%

Total Female Population 367,173 372,641 1.5%

Females, Child Bearing Age (15-44) 131,722 127,919 -2.9%

Page - 23 -

POPULATION DISTRIBUTION

Age Group 2011 % of Total 2016 % of Total

USA 2011 %

of Total

0-14 119,858 16.7% 119,909 16.4% 20.2%

15-17 25,668 3.6% 25,271 3.5% 4.2%

18-24 60,706 8.4% 62,231 8.5% 9.7%

25-34 88,388 12.3% 84,738 11.6% 13.3%

35-54 199,249 27.7% 190,388 26.1% 27.6%

55-64 97,817 13.6% 102,528 14.1% 11.7%

65+ 127,236 17.7% 144,573 19.8% 13.3%

Total 718,922 100.0% 729,638 100.0% 100.0%

Age Distribution

HOUSEHOLD INCOME DISTRIBUTION

HH Count % of Total

USA %

of Total

<$15K 61,482 20.1% 12.9%

$15-25K 47,284 15.4% 10.8%

$25-50K 97,956 32.0% 26.6%

$50-75K 52,193 17.0% 19.5%

$75-100K 23,181 7.6% 11.9%

Over $100K 24,109 7.9% 18.3%

Total 306,205 100.0% 100.0%

2011 Household Income

Income Distribution

EDUCATION LEVEL

2011 Adult Education Level Pop Age 25+ % of Total

USA %

of Total

Less than High School 48,562 9.5% 6.3%

Some High School 61,597 12.0% 8.8%

High School Degree 183,229 35.7% 28.9%

Some College/Assoc. Degree 132,823 25.9% 28.3%

Bachelor's Degree or Greater 86,479 16.9% 27.7%

Total 512,690 100.0% 100.0%

Education Level Distribution


Page - 24 -

RACE/ETHNICITY

2011 Pop % of Total

USA %

of Total

White Non-Hispanic 676,865 94.1% 64.2%

Black Non-Hispanic 18,685 2.6% 12.1%

Hispanic 11,686 1.6% 16.1%

Asian & Pacific Is. Non-Hispanic 3,371 0.5% 4.6%

All Others 8,315 1.2% 3.0%

Total 718,922 100.0% 100.0%

Race/Ethnicity Distribution

Race/Ethnicity


© 2011, Claritas Inc., © 2011 Thomson Reuters. All Rights Reserved

Page - 25 -


NCH Snapshots The NCH Snapshot consists of demographics, key indicators of health status, interview highlights, and local resources. The model for the key indicators of health status analysis was based on the 2010 County Health Rankings, a key component of the Mobilizing Action Toward Community Health (MATCH). MATCH is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Indicators are organized into two broad categories: Health Outcomes and Health Factors. The Health Factors have multiple components, including Clinical Care, Health Behaviors, Social and Economic Factors, and Physical Environment. A number of additional key indicators of health status were included in this analysis from other sources (they are noted in blue font in the snapshot section). For each indicator, the state and county score is provided as well as a ranking comparing the county’s performance to that of the other counties/localities in the state if available (134 counties and cities for Virginia). The rankings are based on ascending order (with 1 being the desired rank).

Page - 26 -

NORTON COMMUNITY HOSPITAL

Service Area Counties:

Dickenson, VA

Wise, VA

Primary Service Area Map:

Facility Profiles:

Norton Community Hospital (NCH), located in Norton, Virginia, in

the heart of Southwest Virginia and the Appalachian Mountains, is

a not-for-profit, 129-bed, acute-care facility that has been serving

Southwest Virginia and Southeastern Kentucky cince 1949. It is the

largest healthcare facility in the coalfield region. NCH was the first

AOA (American Osteopathic Association) accredited teaching

facility in the state of Virginia, and hosts residents in Internal

Medicine. The hospital operates several primary care clinics

throughout the region.

A 5-page profile of each county is provided. The profile includes demographic highlights, key

indicators of health status, utilization projections, and survey results specific to the county. A detailed

demographic analysis by county is provided in the appendix which follows the collection of county

snapshots.

Carter

Unicoi

Washington

Washington

Johnson

Letcher

Sullivan

Hawkins

Scott

Harlan

Greene

Smyth

Russell

Dickenson

Lee

Wise

Buchanan

AveryMitchell

Hamblen

Tazewell

Watauga

MadisonYancey

Dickenson CountyCommunity Hospital

Norton CommunityHospital

Cocke

Ashe

Hancock

Grayson

Wythe

Page - 27 -

DICKENSON COUNTY, VA 2010 COUNTY SNAPSHOT

Demographic Highlights:

Overall population decline

expected

Large elderly population

compared to VA and US

Median age of 41.8

(compared to 37.2

nationally and 37.6

statewide)

Large declining rate of

females of child-bearing

age compared to minimal

loss nationally

Unemployment rate well

above national and state

rates

Low average household

income level (25% of

households make less than

$15,000)

Lower level of educational

attainment compared to

state and country (19%

without any high school

education compared to

6.4% nationally)

Low level of diversity

compared to state and

national

Service Area Map:

Age Distribution and Population Projections:

Key Statistics:

Letcher, KY

Yancey , NC

Hamblen, TN

Harlan, KY

Lee, VA

Madison, NC

Avery , NC

Russell, VA

Buchanan, VA

Tazewell, VA

Mitchell, NC

Hawkins, TN

Greene, TN

Unicoi, TN

Cocke, TN

Hancock, TN

Ashe, NC

Gray son, VA

Wythe, VA

Washington, VA

North Carolina

Virginia

Kentucky

Tennessee

Watauga, NC

Scott, VA

0-17 18-34 35-64 65+

2010 2,983 3,446 6,385 2,865

2015 2,929 3,192 6,251 3,168

0

2,000

4,000

6,000

8,000

Population by Age Cohort

Dickenson County Virginia USA

2010 Total Population 15,679 7,884,744 281,421,906

% Change 2010 - 2015 -0.9% 4.3% 4.1%

2010 Females, Child Bearing Age 15 - 44 2,859 1,604,748 62,026,739

% Change 2010 - 2015 -5.2% -1.5% -0.7%

% of Population 65+ (2010) 18.3% 12.6% 13.2%

% Unemployment (2010) 8.5% 4.9% 6.4%

Average Household Income (2010) 38,488$ 83,388$ 71,071$

% Minority (2010)* 2.7% 33.8% 35.3%

HS Degree and Above (2010) 66.4% 85.9% 84.7%

Page - 28 -


Local Health Highlights:

STRENGTHS:

High rankings for stroke-

related deaths and

mortality

Highest ranked in state for

air quality and percent of

lead-poisoned children

WEAKNESSES:

Among poorest in state

regarding reported

general health status and

percent to uninsured

High rates of death due

to cancer and diabetes

Key Indicators of Health Status:

Leading Causes of Death (all

ages):

VA Dickenson Rank Desired

Health Outcomes 127 ↓

Low Birth Weight (%) 8.0% 11.0% 103 ↓

General Health Status (% fair/poor health) 13.0% 34.0% 133 ↓

Poor Physical Health Days 3.2 7.9 117 ↓

Poor M ental Health Days 3.2 6 113 ↓

Very Low Birth Weight (%) 1.8% 3.2% 120 ↓

Infant M ortality (per 100,000) 716.0 2.0 53 ↓

M ortality Rate (per 100,000) 758.0 774.4 41 ↓

Cardiovascular Deaths (per 100,000) 176.5 174.5 47 ↓

Cancer Deaths (5-yr avg rate per 100,000) 186.0 198.7 72 ↓

Diabetes M ellitus Deaths (Age Adjusted Rate per 100,000) 19.5 31.3 107 ↓

Cerebrovascular Deaths (Age Adjusted Rate per 100,000) 42.0 17.9 7 ↓

Suicide Deaths (Age Adjusted Rate per 100,000) 11.8 15.4 78 ↓

M ortality rate for ages 1 - 14 yrs (per 100,000) 60.4 74.9 n/a ↓

M ortality rate for ages 15 - 21 yrs (per 100,000) 63.3 103.4 86 ↓

M ortality rates for ages 65+ (per 1,000) 45.1 37.6 19 ↓

Lung Cancer Deaths (5-yr avg rate per 100,000)* 54.8 66.6 28/35 ↓

Female Breast Cancer Deaths (5-yr avg rate per 100,000)* 25.4 66.6 15/35 ↓

Percent o f Adults with Asthma* 8.4% 10.8% 30/35 ↓

Prevalence of Diabetes (% of adults)* 17.4% 12.4% 33/35 ↓

Psychosis Discharges (per 100,000) 539.8 523.2 68 ↓

Health Factors 124 ↓

Clinical Care 130 ↓

No Health Insurance (%) 15.8% 26.6% 133 ↓

M edicaid/Tenncare Enro llees (%) 14.3% 27.6% 128 ↓

M edical Doctors Per Capita (per 100,000) 335.3 65.5 n/a ↑

No Biennial M ammography (%)* 24.5% 35.3% 35/35 ↓

PSA Testing Past 2 Years (%)* 37.0% 47.4% 35/35 ↑

Pap Test Past 3 Years (%)* 13.4% 24.9% 34/35 ↑

Sigmoidoscopy/Colonoscopy (%)* 39.9% 50.5% 35/35 ↑

HbA1c Screening (%) 84.0% 83.0% 48 ↑

Inadequate or No Prenatal Care (%) 15.0% 18.0% 76 ↓

First Trimester Prenatal Care (%) 82.8% 67.1% 119 ↑

Hospital Staffed Beds (per 1,000) 2.3 0.1 n/a ↑

Licensed Nursing Beds (per 1,000 65+) 35.4 38.7 n/a ↑

Preventable Hospital Stays (ACSC Rate) 63.0 186.0 129 ↓

# of Primary Care M Ds Per Capita (per 100,000) 115.9 25.1 n/a ↑

# of Psychiatric Specialists, Population per Professional 6,720 0 n/a ↓

State M ental Health Facility Beds (per 100,000)* 18.4 13.9 11/40 ↑

Inpatient Discharge Rate (per 1,000) - Total 92.9 143.3 n/a ↓

Inpatient Discharge Rate (per 1,000) - Women's 31.8 21.4 n/a ↓

Inpatient Discharge Rate (per 1,000) - Cardiac 16.0 26.9 n/a ↓

Inpatient Discharge Rate (per 1,000) - Oncology 3.7 5.3 n/a ↓

Inpatient Discharge Rate (per 1,000) - Ortho/Neuro 13.7 17.8 n/a ↓

Could Not See Doctor Due to Cost (%) 13.0% 11.0% 2 ↓

Cause of Death Rate Rank

Heart Disease 174.5 1

Malignant Neoplasms 134.8 2

Unintentional Injury 129.4 3

Chronic Lower Respiratory Disease 85.6 4

Diabetes Mellitus 31.3 5

Chronic Liver Disease 19.8 6

Nephritis & Nephrosis 19.6 7

Influenza & Pneumonia 18.5 8

Cerebrovascular Disease 17.9 9

Suicide 15.4 10

Page - 29 -


Cancer Incidence:

Key Indicators of Health Status:

Birth Rate Trend:

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

Prostate Lung & Bronchus

Breast Colon

Age-Adjusted Cancer Incidence Rates(per 100,000)

Virginia Dickenson

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

Lung & Bronchus

Breast Colon Cervical

Age-Adjusted Cancer Mortality Rates

(per 100,000 Females)

Virginia Dickenson

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Lung & Bronchus Prostate Colon


(per 100,000 Males)

Virginia Dickenson

VA Dickenson Rank Desired

Health Behaviors 119 ↓

Cigarette Smoking (%) 18.1% 24.9% 29/35 ↓

Physical Inactivity (%) 23.0% 21.0% 6 ↓

Overweight/Obesity (% BM I > 30) 58.0% 57.0% 15 ↓

Low Fruit and Vegetable Consumption (% <5 a day) 77.0% 77.0% 52 ↓

Binge Drinking (%) 15.0% 16.0% 101 ↓

Teen Birth Rate (per 1,000) 17.7 25 89 ↓

Sexually Transmitted Diseases (per 100,000) 578.9 115.8 7/119 ↓

Vio lent Crime (per 100,000) 278.0 161.0 62 ↓

M otor Vehicle Crash Deaths (per 100,000) 13.0 30.0 116 ↓

Unmarried M other B irth Rate (%) 36.0% 28.0% 14 ↓

Injury-related M ortality (Age Adjusted Rate per 100,000) 35.4 129.4 134 ↓

Homicides (per 100,000) 4.8 5.3 21/35 ↓

Social & Economic Factors 107 ↓

High School Graduation Rate (%) 85.5% 86.6% 79 ↑

Level o f Education (%) 86.0% 61.0% 133 ↑

Some College (%) 65.0% 37.4% 19 ↑

Unemployment (%) 6.7% 9.0% 99 ↓

Children (age 0 to 17) in poverty ratio (%) 14.0% 27.0% 115 ↓

Food Stamp Eligible Recipients (% of individuals) 10.7% 19.5% 108 ↓

Poverty Rate (% of all ages) 10.6% 20.5% 116 ↓

Temporary Assistance for Needy Families 1.0% 1.0% 76/128 ↓

Inadequate Social Support (%) 19.0% n/a n/a ↓

Single Parent Households (%) 29.0% 33.0% 82 ↓

High School Dropout Rate 1.8% 1.9% 87 ↓

Physical Environment 88 ↓

Pre-1950 Housing (%) 15.6% 19.7% n/a ↓

Lead Poisoned Children (%) 0.5% 0.0% 1 ↓

Child Abuse and Neglect (rate per 1,000) 3.2 6.3 106 ↓

Access to Healthy Foods (%) 52% 43% 88 ↑

Recreational Facility Rate 11.0 0.0 134 ↑

# Days air quality poor 1 0 1 ↓

Communicable Diseases

Hepatitis A (per 100,000) 0.7 0.0 1/119 ↓

Campylobacter Infection (per 100,000) 8.7 6.2 53/119 ↓

Salmonellosis (per 100,000) 15.1 0.0 1/119 ↓

Shigellosis (per 100,000) 4.0 12.4 114/119 ↓

AIDS/HIV cases (per 100,000) 299.1 0.0 1 ↓

Early Stage Syphilis (per 100,000) 6.5 0.0 1/119 ↓

Tuberculosis (per 100,000) 3.8 0.0 1/119 ↓

Chlamydia (per 100,000) 404.6 111.3 11/119 ↓

Gonorrhea (per 100,000) 134.0 0.0 1/119 ↓

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1995 2000 2005

Crude Birth Rate(per 1,000)

Virginia Dickenson

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

1995 2000 2005

Teen Birth Rate(per 1,000)

Virginia Dickenson

Page - 30 -


Inpatient Projections

Outpatient Projections

2010 2015 # Growth % Growth

Behavioral Health SSU 82 80 -2 -2.2%

Cardiovascular SSU 396 419 23 5.7%

Oncology SSU 89 93 4 4.0%

Ortho-Neuro SSU 354 370 16 4.5%

Women's SSU 262 246 -16 -6.0%

All Others 981 1,015 33 3.4%

GRAND TOTAL 2,165 2,223 58 2.7%


Endocrinology 61 63 2 3.5%

ENT Surgery 6 6 0 -0.3%

Gastroenterology 192 199 7 3.4%

General Medicine 141 145 4 2.9%

General Surgery 131 134 3 1.9%

Neonatology 60 59 -1 -1.0%

Nephrology 75 79 4 5.5%

Ophthalmic Medicine 2 2 0 1.5%

Ophthalmic Surgery 1 1 0 1.5%

Oral Surgery 1 1 0 -0.7%

Otolaryngology 16 16 0 3.0%

Plastic Surgery 7 7 0 1.6%

Pulmonary 219 230 11 5.1%

Rheumatology 11 11 0 3.6%

Thoracic Surgery 15 16 1 5.0%

Trauma Medical 7 8 0 3.0%

Unspecified 0 0 0 -6.9%

Urology Medicine 8 8 0 1.6%

Urology Surgery 27 29 1 5.0%

SSU

Inpatients

All Other Product Lines

Inpatients


Hospital-Based 35,681 36,133 452 1.3%

Physician Office 125,078 127,699 2,620 2.1%

Other Sites 11,226 11,220 -6 -0.1%

Total Market 171,985 175,052 3,067 1.8%

Setting

Inpatients

Page - 31 -


Interview Highlights:

INTERVIEWEES:

Seven individuals

KEY FINDINGS:

Average rating of health status is 3.5, with a range in responses of 1 to 5

Top health issues are:

o Obesity

o Diabetes

o Cancer

o Heart Disease

o Substance Abuse/Rx Abuse

o Mental Health

Ideas to improve these conditions include:

o Set goals to exercise o Get kids out - programs in schools o Program to involve parents o Educate on healthy eating and living o Make young kids aware of what using drugs does to their health o Programs for diabetics, maybe at community center

Sources:

Medstat

VA Department of

Health

US Department of

Labor

US Census Bureau

Virginia Atlas of

Community Health

KIDS COUNT

VA Office of Social

Services

Local Resources:

Cumberland Plateau Health District

The Health Wagon (mobile outreach clinic)

Regional Area Medical – RAM (outreach fair to provide free

medical, dental & and vision care)

Free clinics (Stone Mountain Health Clinic)

Social services

Upward Bound

Health Wagon

Page - 32 -

WISE COUNTY, VA & NORTON CITY 2010 COUNTY SNAPSHOT

Demographic Highlights

(Norton & Wise):

Overall population decline

expected

Large elderly population

compared to VA and US

Median age of 37.7

(compared to 37.2

nationally and 37.6

statewide)

Declining rate of females

of child-bearing age

compared to minimal loss

nationally

Unemployment rate well

above state rates but close

to national

Low average household

income level (21% of

households make less than

$15,000)

Lower level of educational

attainment compared to

state and country (12%

without any high school

education compared to

6.4% nationally)

Low level of diversity

compared to state and

national

Service Area Map (Norton & Wise):

Age Distribution and Population Projections

(Norton & Wise):

Key Statistics (Norton & Wise):

Letcher, KY

Yancey , NC

Hamblen, TN

Harlan, KY

Lee, VA

Madison, NC

Avery , NC

Russell, VA

Buchanan, VA

Tazewell, VA

Mitchell, NC

Hawkins, TN

Greene, TN

Unicoi, TN

Cocke, TN

Hancock, TN

Ashe, NC

Gray son, VA

Wythe, VA

Washington, VA

North Carolina

Virginia

Kentucky

Tennessee

Watauga, NC

Scott, VA

0-17 18-34 35-64 65+

2010 9,792 13,057 18,982 7,252

2015 9,435 12,286 18,757 7,983

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Population by Age Cohort

Norton & Wise Virginia USA

2010 Total Population 49,083 7,884,744 281,421,906

% Change 2010 - 2015 -1.3% 4.3% 4.1%

2010 Females, Child Bearing Age 15 - 44 9,338 1,604,748 62,026,739

% Change 2010 - 2015 -4.8% -1.5% -0.7%

% of Population 65+ (2010) 14.8% 12.6% 13.2%

% Unemployment (2010) 6.5% 4.9% 6.4%

Average Household Income (2010) 45,835$ 83,388$ 71,071$

% Minority (2010)* 4.7% 33.8% 35.3%

HS Degree and Above (2010) 69.7% 85.9% 84.7%

Page - 33 -


Local Health Highlights

(Norton):

STRENGTHS:

Ranks highest in state for

reported general health

status

Very low rate of mortality

for 15 – 21 yrs of age

Ranks highest in state for

AIDS/HIV cases

WEAKNESSES:

Very high rate of very low

birth weight

Among highest in percent

of Medicaid eligibles and

Temporary Assistance for

Needy Families

Very high rate of

inadequate or no

prenatal care

High rates of death due to

cancer, diabetes,

cerebrovascular, and

suicide

Key Indicators of Health Status (Norton):

Leading Causes of

Death (all ages; Norton):

VA Norton Rank Desired

Health Outcomes 80

Low Birth Weight (%) 8.0% 10.0% 86 ↓


Poor Physical Health Days 3.2 n/a n/a ↓

Poor M ental Health Days 3.2 n/a n/a ↓



M ortality Rate (per 100,000) 758.0 854.2 77 ↓













Psychosis Discharges (per 100,000) 539.8 1,261.9 122 ↓

Health Factors 56

Clinical Care 21


M edicaid Eligibles (%) 14.3% 30.0% 131 ↓






HbA1c Screening (%) 84.0% 80.0% 27 ↑







# of Psychiatric Specialists, Population per Professional 6,720 4,649 n/a ↓















Suicide 18.0 7


Alzheimer's Disease 17.6 8

Page - 34 -


Cancer Incidence

(Norton):

Key Indicators of Health Status (Norton):

Birth Rate Trend (Norton):

0

20

40

60

80

100

120

140

160

180


Breast Colon


Virginia Norton

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Lung & Bronchus



(per 100,000 Females)

Virginia Norton

0.0

20.0

40.0

60.0

80.0

100.0

120.0



(per 100,000 Males)

Virginia Norton

VA Norton Rank Desired

Health Behaviors 46





Binge Drinking (%) 15.0% 15.0% 26 ↓

Teen Birth Rate (per 1,000) 17.7 16.5 44 ↓






Homicides (per 100,000) 4.5 3.3 10/35 ↓

Social and Economic Factors 91



Some College (%) 65.0% 53.3% 80 ↑

Unemployment (%) 6.7% 6.6% 40 ↓





Inadequate Social Support (%) 19.0% n/a n/a ↓

Single Parent Households 29.0% 44.0% 114 ↓


Physical Environment 3

Pre-1950 Housing (%) 15.6% 26.6% n/a ↓




Recreational Facility Rate 11.0 27 10 ↑


Communicable Diseases n/r

Hepatitis A (per 100,000) 0.7 0.0 1/119 ↓



Shigellosis (per 100,000) 4.0 0.0 1/119 ↓




Chlamydia (per 100,000) 404.6 242.3 52/119 ↓

Gonorrhea (per 100,000) 134.0 11.0 13/119 ↓

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

1995 2000 2005


Virginia Norton

0.0

10.0

20.0

30.0

40.0

50.0

60.0

1995 2000 2005


Virginia Norton

Page - 35 -


Local Health Highlights

(Wise):

STRENGTHS:

Very low rate of mortality for

15 – 21 yrs of age

Low rates of poor air quality

Low rates of psychosis

discharges

WEAKNESSES:

Ranks among lowest in state

for reported general health

status

Very high mortality rate

Very high rate of uninsured

High rates of death due to

cardiovascular, cancer,

diabetes, cerebrovascular,

and lung cancer

Key Indicators of Health Status (Wise):

Leading Causes of Death

(all ages; Wise):

Health Outcomes 126 ↓

Low Birth Weight (%) 8.0% 8.0% 49 ↓


Poor Physical Health Days 3.2 6.5 114 ↓

Poor M ental Health Days 3.2 6 115 ↓



M ortality Rate (per 100,000) 758.0 1,095.0 130 ↓













Psychosis Discharges (per 100,000) 539.8 183.8 11 ↓

Health Factors 112 ↓

Clinical Care 112 ↓


M edicaid Eligibles (%) 14.3% 23.3% 103 ↓






HbA1c Screening (%) 84.0% 88.0% 109 ↑







# of Psychiatric Specialists, Population per Professional 6,720 4,649 n/a ↓
















Septicemia 33.2 8

Influenza & Pneumonia 31.2 9

Hypertension & Renal Disease 19.7 10

Page - 36 -


Cancer Incidence

(Wise):

Key Indicators of Health Status (Wise):

Birth Rate Trend (Wise):

0

20

40

60

80

100

120

140

160

180


Breast Colon


Virginia Wise

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Lung & Bronchus


Age-Adjusted Cancer Mortality Rates(per 100,000 Females)

Virginia Wise

0.0

20.0

40.0

60.0

80.0

100.0

120.0


Age-Adjusted Cancer Mortality Rates(per 100,000 Males)

Virginia Wise

VA Wise Rank Desired

Health Behaviors 128 ↓





Binge Drinking (%) 15.0% 10.0% 55 ↓

Teen Birth Rate (per 1,000) 17.7 32.7 115 ↓






Homicides (per 100,000) 4.8 3.3 13/35 ↓

Social and Economic Factors 92 ↓



Some College (%) 65.0% 41.0% 26 ↑

Unemployment (%) 6.7% 7.0% 51 ↓





Inadequate Social Support (%) 19.0% 28.0% 73 ↓

Single Parent Households (%) 29.0% 27.0% 50 ↓


Physical Environment 29 ↓

Pre-1950 Housing (%) 15.6% 21.6% n/a ↓




Recreational Facility Rate 11.0 0 134 ↑


Communicable Diseases n/a

Hepatitis A (per 100,000) 0.7 0.0 1/119 ↓



Shigellosis (per 100,000) 4.0 0.0 1/119 ↓




Chlamydia (per 100,000) 404.6 242.3 52/119 ↓

Gonorrhea (per 100,000) 134.0 11.0 13/119 ↓

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1995 2000 2005


Virginia Wise

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

1995 2000 2005


Virginia Wise

Page - 37 -


Inpatient Projections

Outpatient Projections


Behavioral Health SSU 259 254 -5 -2.1%

Cardiovascular SSU 1,070 1,133 63 5.9%

Oncology SSU 250 259 9 3.6%

Ortho-Neuro SSU 990 1,031 41 4.2%

Women's SSU 855 818 -36 -4.3%

All Others 2,802 2,891 89 3.2%

GRAND TOTAL 6,226 6,386 160 2.6%


Endocrinology 176 182 5 3.1%

ENT Surgery 20 20 0 -0.9%

Gastroenterology 544 561 18 3.2%

General Medicine 406 417 11 2.7%

General Surgery 379 385 6 1.6%

Neonatology 189 187 -1 -0.6%

Nephrology 209 220 11 5.3%

Ophthalmic Medicine 7 7 0 1.0%

Ophthalmic Surgery 3 3 0 1.0%

Oral Surgery 4 4 0 -1.2%

Otolaryngology 46 47 1 2.6%

Plastic Surgery 20 20 0 1.4%

Pulmonary 608 638 29 4.8%

Rheumatology 30 31 1 3.3%

Thoracic Surgery 41 43 2 4.8%

Trauma Medical 22 23 1 2.4%

Unspecified 0 0 0 -4.5%

Urology Medicine 24 24 0 1.8%

Urology Surgery 74 78 4 5.3%

SSU

Inpatients

All Other Product Lines

Inpatients


Hospital-Based 105,715 106,581 866 0.8%

Physician Office 363,246 368,968 5,722 1.6%

Other Sites 34,374 34,190 -184 -0.5%

Total Market 503,335 509,739 6,404 1.3%

Setting

Inpatients

Page - 38 -


Interview Highlights (Norton & Wise):

INTERVIEWEES:

Seven individuals

KEY FINDINGS:

Average rating of health status is 3.5, with a range in responses of 1 to 5

Top health issues are:

o Obesity

o Diabetes

o Cancer

o Heart Disease

o Substance Abuse/ Rx Abuse

o Mental Health

Ideas to improve these conditions include:

o Develop a cardiovascular/metabolic education center

o Make physical education classes available

o Additional providers

o Local smoking cessation program

o More ATV trails, bike/walking trails

o Diabetes consulting/dietary assistance available to community

o Use Channel 19 (Wise Co Govt channel) to educate

Sources (Norton &

Wise):

Medstat

VA Department of

Health

US Department of

Labor

US Census Bureau

Virginia Atlas of

Community Health

KIDS COUNT

VA Office of Social

Services

Local Resources (Norton & Wise):

VA Department of Health Initiatives

Mountain Empire Older Citizens (pharmacy connect,

transportation, Kin Care, Fuel Fund)

The Health Wagon (mobile outreach clinic)

Regional Area Medical – RAM (outreach fair to provide free

medical, dental & and vision care)

CareSpark (Regional Healthcare Information Organization)

Appalachian Mountain Project Access – AMPA (specialty care for

uninsured)

Appalachian Substance Abuse Prevention Coalition (considering

future focus on prescription drug abuse)

Southwest VA Graduate Medical Education Commission

Southwest VA Health Authority

Medical Specialty Center of Excellence (in process)

SWVA Recreational Authority

One Care VA

Healthy Appalachia

Page - 39 -

APPENDIX

Table of Contents

1. NCH & DCH Primary Service Area Detailed Demographics

2. Dickenson, VA Detailed Demographics

3. Wise, VA Detailed Demographics (includes Norton City)

Page - 40 -

2010 Demographic Snapshot

Area: FY09 Service Area - NCH & DCH

Level of Geography: ZIP Code


Selected

Area USA 2010 2015 % Change

63,371 281,421,906 Total Male Population 32,844 32,488 -1.1%

64,762 309,038,974 Total Female Population 31,918 31,513 -1.3%

64,001 321,675,005 Females, Child Bearing Age (15-44) 12,197 11,599 -4.9%

-1.2% 4.1% % Unemployment 6.9%

Average Household Income $43,957 $71,071 % USA Unemployment 6.4%

POPULATION DISTRIBUTION HOUSEHOLD INCOME DISTRIBUTION


USA 2010

% of Total HH Count % of Total

USA

% of Total

0-14 10,310 15.9% 10,216 16.0% 20.1% <$15K 5,924 22.2% 12.1%

15-17 2,465 3.8% 2,148 3.4% 4.2% $15-25K 4,610 17.2% 10.2%

18-24 7,044 10.9% 6,622 10.3% 9.7% $25-50K 8,046 30.1% 25.5%

25-34 9,459 14.6% 8,856 13.8% 13.3% $50-75K 4,389 16.4% 19.5%

35-54 17,153 26.5% 16,311 25.5% 28.1% $75-100K 1,946 7.3% 12.5%

55-64 8,214 12.7% 8,697 13.6% 11.5% Over $100K 1,813 6.8% 20.1%

65+ 10,117 15.6% 11,151 17.4% 13.2%

Total 64,762 100.0% 64,001 100.0% 100.0% Total 26,728 100.0% 100.0%

EDUCATION LEVEL RACE/ETHNICITY

2010 Adult Education Level

Pop Age

25+ % of Total

USA

% of Total 2010 Pop % of Total

USA

% of Total

Less than High School 6,251 13.9% 6.4% White Non-Hispanic 62,031 95.8% 64.7%

Some High School 7,738 17.2% 8.9% Black Non-Hispanic 1,339 2.1% 12.1%

High School Degree 15,756 35.1% 29.0% Hispanic 508 0.8% 15.8%

Some College/Assoc. Degree 10,458 23.3% 28.2% Asian & Pacific Is. Non-Hispanic 266 0.4% 4.5%

Bachelor's Degree or Greater 4,740 10.5% 27.5% All Others 618 1.0% 2.9%

Total 44,943 100.0% 100.0% Total 64,762 100.0% 100.0%


Income Distribution

Race/Ethnicity DistributionEducation Level Distribution




% Change 2010 - 2015

Race/Ethnicity

Age Distribution


Page - 41 -

10,310 2,465

7,044

9,45917,153

8,214

10,117

Population Distribution by Age Group

0-14

15-17

18-24

25-34

35-54

55-64

65+

5,924

4,610

8,046

4,389

1,9461,813

Current Households by Income Group

<$15K

$15-25K

$25-50K

$50-75K

$75-100K

Over $100K

6,251

7,738

15,756

10,458

4,740

Population Age 25+ by Education Level Less than High School

Some High School

High School Degree

Some College/Assoc. Degree

Bachelor's Degree or Greater

62,031

1,339508266618

Population Distribution by Race/Ethnicity

White Non-

Hispanic

Black Non-Hispanic

Hispanic

Asian & Pacific Is. Non-Hispanic

All Others

Page - 42 -


Area: Dickenson County, VA



Selected









USA 2010


USA

% of Total

0-14 2,465 15.7% 2,464 15.9% 20.1% <$15K 1,676 24.5% 12.1%

15-17 518 3.3% 465 3.0% 4.2% $15-25K 1,241 18.2% 10.2%

18-24 1,250 8.0% 1,174 7.6% 9.7% $25-50K 2,226 32.6% 25.5%

25-34 2,196 14.0% 2,018 13.0% 13.3% $50-75K 998 14.6% 19.5%

35-54 4,182 26.7% 3,951 25.4% 28.1% $75-100K 384 5.6% 12.5%

55-64 2,203 14.1% 2,300 14.8% 11.5% Over $100K 306 4.5% 20.1%

65+ 2,865 18.3% 3,168 20.4% 13.2%

Total 15,679 100.0% 15,540 100.0% 100.0% Total 6,831 100.0% 100.0%



Pop Age

25+ % of Total

USA


USA

% of Total


Some High School 1,661 14.5% 8.9% Black Non-Hispanic 234 1.5% 12.1%



Bachelor's Degree or Greater 879 7.7% 27.5% All Others 98 0.6% 2.9%

Total 11,446 100.0% 100.0% Total 15,679 100.0% 100.0%


Income Distribution





% Change 2010 - 2015

Race/Ethnicity

Age Distribution


Page - 43 -

2,465 518

1,250

2,196

4,182

2,203

2,865


0-14

15-17

18-24

25-34

35-54

55-64

65+

1,676

1,2412,226

998

384 306


<$15K

$15-25K

$25-50K

$50-75K

$75-100K

Over $100K

2,189

1,661

4,350

2,367

879

Population Age 25+ by Education Level Less than High School

Some High School

High School Degree

Some College/Assoc. Degree

Bachelor's Degree or Greater

15,248

234891098


White Non-

Hispanic

Black Non-Hispanic

Hispanic


All Others

Page - 44 -


Area: Norton & Wise, VA



Selected









USA 2010


USA

% of Total

0-14 7,845 16.0% 7,752 16.0% 20.1% <$15K 4,248 21.3% 12.1%

15-17 1,947 4.0% 1,683 3.5% 4.2% $15-25K 3,369 16.9% 10.2%

18-24 5,794 11.8% 5,448 11.2% 9.7% $25-50K 5,820 29.3% 25.5%

25-34 7,263 14.8% 6,838 14.1% 13.3% $50-75K 3,391 17.0% 19.5%

35-54 12,971 26.4% 12,360 25.5% 28.1% $75-100K 1,562 7.9% 12.5%

55-64 6,011 12.2% 6,397 13.2% 11.5% Over $100K 1,507 7.6% 20.1%

65+ 7,252 14.8% 7,983 16.5% 13.2%

Total 49,083 100.0% 48,461 100.0% 100.0% Total 19,897 100.0% 100.0%



Pop Age

25+ % of Total

USA


USA

% of Total


Some High School 6,077 18.1% 8.9% Black Non-Hispanic 1,105 2.3% 12.1%



Bachelor's Degree or Greater 3,861 11.5% 27.5% All Others 520 1.1% 2.9%

Total 33,497 100.0% 100.0% Total 49,083 100.0% 100.0%


Income Distribution





% Change 2010 - 2015

Race/Ethnicity

Age Distribution


Page - 45 -

7,845 1,947

5,794

7,26312,971

6,011

7,252


0-14

15-17

18-24

25-34

35-54

55-64

65+

4,248

3,369

5,820

3,391

1,5621,507


<$15K

$15-25K

$25-50K

$50-75K

$75-100K

Over $100K

4,062

6,077

11,406

8,091

3,861

Population Age 25+ by Education Level Less than High

School

Some High School

High School Degree

Some College/Assoc. DegreeBachelor's Degree or Greater

46,783

1,105419256520


White Non-Hispanic

Black Non-Hispanic

Hispanic


All Others

Page - 46 -

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