Winona County
Community Health
Improvement Plan
A plan for improving health, well being, and
quality of life in our community.
2014
TABLE OF CONTENTS
Completed: 12/11/2014 Updated: 12/14/2014
Table of Contents
Core Team Members
1
Demographics
2
Introduction
4
Community Prioritization Process
5
Community Health Priorities
13
Priority #1
13
Priority #2
14
Priority #3
15
Sustainability
17
Contact Information:
18
Completed: 12/11/2014 Updated: 12/14/2014
CORE TEAM MEMBERS
Core Team Members
Core Team members serve as a resource and asset that will be utilized throughout Community
Health Improvement Plan. These members will provide knowledge and expertise that will assist
in the improvement of our community’s health.
Winona County Public Health
Winona Health
Winona Area Chamber of Commerce
Minnesota Department of Health
Winona Community Foundation










Project FINE
Minnesota Center for Health Statistics
Winona County United Way
Live Well Winona
HIA Advisory Committee
Community Health Improvement Plan process included:






Engaging a broad group of partners and stakeholders that represent the community
and public health system in Winona County
Establishing a vision and mission
Developing workgroups
Gathering community input
Reviewing data to identify key strategic issues
Identifying priority health issues through a democratic process
Our Vision
To provide a high quality of life, health, and well-being for all people in Winona County.
Our Mission
To empower the people of Winona County to achieve lifelong physical, mental and social
well-being through:



Page 1
Equal access to high quality, affordable healthcare.
A coordinated system of care that is local, preventive, holistic, and patient centered.
An environment that supports healthy living for all.
DEMOGRAPHICS
Demographics
Winona County encompasses 626 square miles and includes 19 townships. It is home to
over 50,000 residents with the majority (65%) living in urban areas. Throughout the 19
townships lakes, rivers, and streams comprise approximately 15 square miles of the
county.
Winona County has a population of 51,461. According to the U.S. Census Bureau, from
2000-2010, Winona County experienced a population increase of 1.02%. The population is
spread through twelve cities including Altura, Dakota, Elba, Goodview, Lewiston,
Minneiska, Minnesota City, Rollingstone, St. Charles, Stockton, Utica, and Winona. The
largest town in Winona County is Winona, which has a population of approximately
27,592. The breakdown of population by incorporated areas is in the Population by City
table below.
Winona County has seen significant demographic growth in some of its townships, in
particular those closest to its population centers of Winona and St. Charles.
Some population growth in the county can be attributed to higher enrollments at Winona
State University, Saint Mary’s University of Minnesota, and Minnesota College Southeast
Technical. The expanding metropolitan areas of Rochester and La Crosse, in close
proximity to Winona County’s borders, are also a factor.
Population by City
Page | 2
DEMOGRAPHICS
WINONA COUNTY
Southeast Region, Minnesota
DEMOGRAPHICS
2000
MOST RECENT DATA
Total population
49,985
51,232 (2013)
Percent of Color
4.90%
7.8% (2013)
Median age
32.8
Veterans
33.8 (2013)
2,989 (2009-2013)
AGING
Percent age 65+
Median household income, 65+ head of household
13.10%
$34,382
16.1% (2015)
$32,838 (2008-2012)
CHILDREN AND YOUTH
Percent of Population under 5
N/A
4.5% (2013)
Percent of Population under 18
N/A
18.3% (2013)
63.20%
38.3% (2014)
CIVIC ENGAGEMENT
Voter turnout
EARLY CHILDHOOD
Percent low birth weight among single births
3.00%
3.1% (2013)
Percent of children screened who were under age 5
N/A
82.1% (2013)
Number of children screened who were under age 5
N/A
343 (2013)
ECONOMY
Median household income
Percent of individuals below the poverty level
$53,007
$49,753 (2012)
8.50%
14.4% (2013)
Percent meeting or exceeding standards in 3rd grade reading
N/A
63.1% (2014)
Percent meeting or exceeding standards in 8th grade math
N/A
54.1% (2014)
Graduation rate (on time)
N/A
81.6% (2013)
High School Graduate or higher (age 25+)
N/A
89.9%(2009-2013)
23.20%
26.8% (2009-2013)
EDUCATION
Bachelor's Degree or higher (age 25+)
HEALTH
Percent of adults (20+) with diagnosed diabetes
N/A
7.1% (2011)
Percent of adults (20+) who are obese
N/A
26.6% (2011)
Percent uninsured, under age 65
N/A
10.1% (2012)
Rate of psychiatric hospital admissions per 1,000 residents
5.7
7.3 (2012)
Share of all households paying 30% or more of income for monthly
housing costs
20.70%
31.3% (2009-2013)
Homeownership rate
HOUSING
70.80%
71.6% (2009-2013)
Median value of owner-occupied housing units
N/A
$158,000 (2009-2013)
Housing units
N/A
20,834 (2013)
Persons per household
N/A
2.48 (2009-2013)
2.70%
3.6% (2009-2013)
IMMIGRATION
Percent foreign born
NOTES: *Figures for percent in poverty and median household income were collected from the 2000 decennial census, which asked about
income during 1999. Elsewhere on the Compass site these are reported as 1999 data, but they are listed here in the 2000 column for comparison
purposes. Income data have been inflation-adjusted and are shown in most recent year dollars.
Page | 3
INTRODUCTION
Introduction
The purpose of the Community Health Improvement Plan is to identify how to
strategically and collaboratively address community priority areas to improve the health
and well-being of the community. Community members used the assessment process to
formulate a community health improvement plan aimed at striving to provide effective,
quality health services and an environment that enables community members to reach
their full health potential through assessment, leadership and partnerships.
During 2013 and 2014, Winona Community partners organized a thoughtful and
strategic approach to facilitating a community health needs assessment that would
identify current and unmet needs in Winona County. The process examined community
demographics, socio-economic factors and health service utilization trends. This
assessment incorporates components of primary data collection and secondary data
analysis that focus on the health and social needs of Winona County using the zip code
55987.
The intent of the Community Health Needs Assessment process is to ensure that people
of Winona County are empowered to achieve lifelong physical, mental and social
wellbeing through 1) equal access to high quality affordable healthcare; 2) a coordinated
system of care that is local, preventative, holistic, and patient centered; and 3) and
environment that supports healthy living for all.
Page | 4
COMMUNITY PRIORITIZATION PROCESS
Community Prioritization Process
In order to achieve the prioritization process; population data and community input was
collected. Additional indicators of health were identified utilizing existing local, state,
and national secondary data sources. A comprehensive overview of the health status
across populations within Winona County was undertaken. At that point the Core Team
members were polled to identify their primary health issues. Collectively, the group
narrowed the scope of the long-term goals.
Goals were intended to be challenging, yet achievable over a 5-year term. With this in
mind the core team identified several key steps.











Page | 5
Winona County Health Educator will continue to work with the Statewide Health
Improvement Plan (SHIP) to improve the overall health of Winona County
residents.
“I Can Prevent Diabetes” program will be implemented in cooperation with
University of Minnesota Health Educator. This program will run over 16-weeks
and is designed to work with at risk persons who are displaying pre-diabetes
symptoms. This course will equip clients with long-term knowledge and tools to
live out a healthier lifestyle.
Working collaboratively with Live Well Winona to educate citizens on healthy
living actives in the community.
Continue work to with the Community Gardens group to enhance natural food
options.
Winona County will work with the Farmers Market (in Winona and St. Charles) to
maximize healthy food options for citizens at an affordable price.
Working with Project FINE to reach newcomer and immigrant populations in
Winona County.
Working on Drug Free Communities and Winona County Alliance for Substance
Abuse Prevention (ASAP) to reduce youth involvement in substance abuse.
Collaborate with local post-secondary institutions to establish and implement
alcohol prevention policies and find ways to implement.
Work to enact a social host ordinance for Winona County; require alcohol retailer
training; and re-establish alcohol compliance checks in an effort to reduce alcohol
issues.
Partner with Winona Health, and other local mental health providers, to improve
community access to mental health resources.
Work with Live Well Winona and Winona Health to create a user-friendly database
that will allow residents to quickly identify resources.
COMMUNITY PRIORITIZATION PROCESS
Two surveys were conducted and are identified as Survey A and Survey B:
Survey A:
Six thousand surveys were mailed to the general population residing in
zip code 55987. Respondents returned their completed survey in a
postage-paid envelope to an independent tabulation site located in
Minneapolis, MN. Nearly 2000 surveys were returned and the response
rate was 28%. Key finding were:









Survey B:
Two hundred surveys were distributed to the immigrant population
through a variety of methods including distribution to targeted
households, hosting focus groups at central locations and one-on one
surveying. The surveys were either completed privately or by assistance
from representatives and/ or translators of Project FINE. 30% of the
immigrant population completed the survey. Key finding were:



Page | 6
21.9% said they have been told by their doctor they have/had
depression
27.7% said they have been told by their doctor they have/had high
cholesterol
14.1% said they have been told by their doctor they have/had obesity;
however, 61.1% are classified as overweight or obese according to
their BMI
56% thought their general health was good to excellent
50.9% said they are trying to lose weight
32.7% said in the past 12 months there was a time when they thought
they needed to seek medical but did not get it or delayed getting it
12.9% said in the past 12 months there was a time when they wanted
to talk with or seek help from a health professional about emotional
problems such as stress, depression, excess worrying, troubling
thoughts or emotional problems, but did not or delayed talking to
someone
34.4% said in the past 12 months there was a time when they
delayed getting dental work done
9.7% said they have been binge drinking in the past 30 days
46.1% thought their general health was good
22.2% said they have been told by their doctor they are or were
overweight while only 8.9% were told they are or were obese
43.3% are currently trying to lose weight; however, 69.4% are
classified as overweight or obese according to their BMI
COMMUNITY PRIORITIZATION PROCESS






22.8% said they have been told by their doctor they have/had
depression
12.8% said they have been told by their doctor they have/had anxiety
16.7% said they have been told by their doctor they have/had high
blood pressure
29.4% said in the past 12 months there was a time when they thought
they needed to seek medical but did not get it or delayed getting it
15.6% said in the past 12 months there was a time when they thought
they wanted to talk with or seek help from a health professional about
emotional problems such as stress, depression, excess worrying,
troubling thoughts or emotional problems, but did not or delayed
talking with someone
32.7% said in the past 12 months there was a time when they delayed
getting dental work done
The top three needs identified from Survey A were:



Overweight/Obesity
Mental Health Access
Binge Drinking
The top four needs identified from Survey B were:




Overweight/Obesity
Access to Healthcare due to lack of Transportation
Healthcare costing too much or lack of Health Insurance
Running out of food before had money to buy more
Additional needs identified through the focus group process were:


Need for preventative care and education of access and benefits of
preventative care
Lack of adequate dental care for the underprivileged population
After review of the survey findings, six different issues were initially identified as major
priorities through a careful review of the survey data and rankings. Using a
prioritization process three strategic priorities were chosen. These will be addressed
throughout this Community Health Improvement Plan and shared with our partners.
Page | 7
COMMUNITY PRIORITIZATION PROCESS
The prioritization process began with a review of the community health assessment key
findings. Core Team members reviewed a master list of health indicators (based on
County Health Rankings Health Factors).
Figure 1: County Health Rankings Model
Health Outcomes and Health Factors are affected by underlying causes. Figure 2 below from
“The Wisconsin Guidebook on Improving the Health of Local Communities” identifies
potential underlying causes related to Health Outcomes and Health Factors. Health
disparities are the differences between groups in their health status. Examples of health
disparities are race/ethnicity, gender, income groups and age.
Page | 8
COMMUNITY PRIORITIZATION PROCESS
Figure 2: Wisconsin Guidebook on Improving the Health of Local Communities
What Makes a Community Healthy
Page | 9
COMMUNITY PRIORITIZATION PROCESS
Community Health Needs
By far, the issue of greatest concern to the interview participants was access to medical,
mental and dental health services due to lack of available services, low-cost services, or
transportation.
• A number of people commented on trends in health care that people with or
without insurance are experiencing. These include:
o Many people go out of the area for specialty care which is very difficult
for patients without resources.
o It has become difficult to find dentists who take Medicaid or self pay
who are greatly in need of dental services.
o Lack of transportation to and from appointments is a problem as well
as finding funds for people that have no resources.
Trends in Community Health Status:
The most frequently reported trend was the increase in childhood and adult obesity which
was identified as a major problem in all focus groups. Other negative trends in community
health status included increases in:
• People without health insurance
• Fewer people accessing preventive care or screenings due to lack of insurance,
higher deductibles, or lack of income
• Lack of mental health access
• Stress and depression
• Alcohol use and drug abuse
Some positive trends in community health status include:
• People are eating healthier and exercising more, becoming more health
conscious and aware, and making more thoughtful lifestyle choices
• Healthy lifestyle options in the Winona region
Page | 10
COMMUNITY PRIORITIZATION PROCESS
Problems or Barriers to Obtaining Health Care
 The most frequent problem related to obtaining health care is lack of health
insurance or ability to pay for care and/or medications.
 Young adults often cannot afford health insurance so they go without.
 People do not get preventive care or they wait to obtain health care until their
problems are very serious. This sometimes results in needing emergency care
 There is a lack of information and communication about available, free/lowcost services
 Transportation to medical services was also identified as a barrier by several
participants.
 Barriers for seniors include transportation issues and also the difficulty in
accessing care due to cost and lack of assistance for coordinating care and
helping to manage medications.
 Cuts in funding and services were also identified as barriers, including:
 Huge cuts in county mental health services
 Overall funding for nonprofit organizations is stagnant or decreased
It was noted that some people do not know where to go when they need help. However,
the most frequently identified places where people go include:
 The Emergency Room
o The ER is often the place people go for mental health crises.
o The ED is getting more dangerous for staff, more difficult patients.
 Urgent Care Clinic
 Personal doctor (for those with insurance)
Services that are Lacking to Meet Community Need
A mobile medical unit with nurses and physician assistants that can provide exams and
can write prescriptions when needed.
 Mental health. Every focus group mentioned this need.
 Dental care.
 Vision care
 Provide lab work for patients for free and medications for free in conjunction
with a local pharmacy
 Demonstrate healthy cooking and healthy snacks for youth
 Provide screenings for youth
Page | 11
COMMUNITY PRIORITIZATION PROCESS
Recommendations for Improving Health Care Access and Community Health Status
 Institute 24-hour “Ask a Doctor/Nurse” line to help determine who needs ER
services
 Embark on a healthy lifestyles, healthy living, self-care program
 Educate kids in the schools so they learn about health issues while they are
young
 Educate adults about chronic disease prevention (all languages needed)
 Promote vaccines. Educate people on how they protect the public’s health and
that they are safe
 Provide community outreach and services in the community (e.g., immunization
 clinics, medical screenings, preventive services)
 Develop an information/education campaign to help people find services that
are relevant for their needs.
Page | 12
COMMUNITY HEALTH PRIORITIES
Community Health Priorities
The following top three community health priorities will be the focus for Winona County
over the next three years:
Priority #1: Mental Health Services
Priority Rationale: Our community needs ongoing education regarding mental
health issues and how those issues can impact an individual’s day-to-day
functioning. There is a need for mental health evaluation and service access. This
priority is intended to assist individuals who have not sought mental health
support and/or lack natural support.
Objective 1: by Aug. 2017 - Responsible parties: Winona County Community
Services and Winona Mental Health Services. Develop collaborative approach
with area organizations to focus attention and resources on behavioral health
issues in Winona County.
Objective 2: by April 2016 - Responsible parties: Winona County Community
Services and Winona Mental Health Services. Identify strategies to eliminate
fragmentation of behavioral health services to Winona County residents.
Objective 3: by Dec. 2015 - Responsible parties: Winona County Community
Services, Winona Mental Health Services, and Live Well Winona. Increase
mental health awareness and education by sponsoring at least three (3)
educational forums by December 2015.
Alignments:
Healthy People 2020: Improve mental health through prevention and by ensuring
access to appropriate, quality mental health services (Mental Health and Mental
Disorders, Goal). Increase the proportion of primary care facilities that provide mental
health treatment onsite or by paid referral (MHMD-5), Increase the proportion of
persons with co-occurring substance abuse and mental disorders who receive treatment
for both disorders (MHMD-10), and Increase depression screening by primary care
providers (MHMD-11).
Healthy Minnesota 2020:
 Capitalize on the opportunity to influence health in early childhood.
 Assure that the opportunity to be healthy is available everywhere and for everyone.
 Strengthen communities to create their own healthy futures.
Page | 13
COMMUNITY HEALTH PRIORITIES
Priority #2: Preventive Care Services
Priority Rationale: Community lacks education on available preventative care
services and how to efficiently access them in our community. This priority is
aimed at assisting individuals who are in need of provider reference and service
access.
Objective 1: Dec. 2017 - Responsible parties: Winona County Community
Services, Winona Health, and Live Well Winona. Reduce the disparity of
preventive screenings in the minority or disadvantaged populations, supporting
cultural factors and promoting healthy living for all county residents.
Objective 2: July 2016 - Responsible parties: Winona County Community
Services Winona Health, and Live Well Winona. Work with Winona providers
to create a universal preventative screening tool.
Objective 3: Dec. 2015 - Responsible parties: Winona County Community
Services Winona Health, and Live Well Winona. Increase educational efforts on
the value of preventive care.
Objective 4: June 2016 - Responsible parties: Winona County Community
Services, Winona Health, Live Well Winona, and City of Winona
Transportation. Investigate transportation solutions to enhance care to
underserved populations.
Objective 5: Aug. 2017 - Responsible parties: Winona County Community
Services and Winona County Dental Group. Explore opportunities to provide
preventive dental care to the underserved population.
Alignments:
Healthy People 2020: Improve access to comprehensive, quality health care
services.(Access to Health Services, Goal). Increase the proportion of persons with
medical insurance (AHS-1), Increase the proportion of persons with a usual primary
care provider (AHS-3), and Reduce the proportion of persons who are unable to obtain
or delay in obtaining necessary medical care, dental care, or prescription medicines
(AHS-6).
Healthy Minnesota 2020:
 Capitalize on the opportunity to influence health in early childhood.
 Assure that the opportunity to be healthy is available everywhere and for everyone.
 Strengthen communities to create their own healthy futures.
Page | 14
COMMUNITY HEALTH PRIORITIES
Priority #3: Obesity/Overweight:
Priority Rationale: Educate our community on the risk and negative impact of
obesity. Ensure any social determinants surrounding obesity are addressed. This
priority is aimed at assisting individuals with unhealthy eating habits and have
other health concerns related to obesity.
Objective 1: Nov. 2015 - Responsible parties: Winona County Community
Services, Winona County School Districts, and Live Well Winona. Identify
opportunities to promote healthy lifestyles, recreational opportunities, healthy
eating and wellness behaviors by partnering with area organizations, schools,
businesses and Live Well Winona.
Objective 2: June 2016 - Responsible parties: Winona County Community
Services and Live Well Winona. Educate community on ‘what is obesity’, the
impact of overweight on health and well-being, understanding important ‘health
numbers’, and offering viable solutions through at least three (3) educational
forums by June 2016.
Objective 3: Dec. 2018 - Responsible parties: Winona County Community
Services, Project FINE, Community Gardens, and Farmers Market. Ensure that
all income levels have access to healthy foods which then will reduce the risk for
obesity in our community.
Outcomes: Increased attendance at Winona County Farmer’s Markets and
participants in I Can Prevent Diabetes will decrease their body mass index.
Alignments:
Healthy People 2020: Promote health and reduce chronic disease risk through the
consumption of healthful diets and achievement and maintenance of healthy body
weights. (Nutrition and Weight Status, Goal). Increase the proportion of physician
office visits that include counseling or education related to nutrition or weight (NWS6), Increase the proportion of adults who are at a healthy weight (NWS-8), Reduce the
proportion of adults who are obese (NWS-9), Reduce the proportion of children and
adolescents who are considered obese (NWS-10), and Prevent inappropriate weight
gain in youth and adults (NWS-11).
Healthy Minnesota 2020:
 Capitalize on the opportunity to influence health in early childhood.
 Assure that the opportunity to be healthy is available everywhere and for everyone.
 Strengthen communities to create their own healthy futures.
Page | 15
COMMUNITY HEALTH PRIORITIES
Figure 3: Behavior Change Framework
What influences behavior changes?
6 components necessary for behavior to occur
Behavior = Environment/Person
Engage community stakeholders with a shared interest in improving community health
needs. Need to engage a neutral partner to facilitate the group process. Participants in this
group need to represent the private and public health system in Winona County. Develop
workgroups based on the health priorities, gather community input/data collection, and
review data to identify key strategic issues. Establish a work plan through a democratic
process. Individual organizations may need to revise existing policies and procedures to
address practice changes. Community engagement and collaborative participation are vital
to the community health improvement process.
Page | 16
SUSTAINABILITY
Sustainability
The Winona County Community Health Improvement Plan was created by a core team of
community members to broaden and build upon successful local initiatives. This health
improvement plan identifies specific evidence-based components based on community
health needs.
Page | 17
CONTACT INFORMATION
Contact Information:
Beth Wilms, Director
Community Services
202 West Third Street
Winona, MN 55987
Tel: 507-457-6205
Fax: 507-454-9381
www.co.winona.mn.us
Page | 18