The Health of Becker, Clay,
Wilkin and Otter Tail Counties
August 19, 2014
Prepared for Becker, Clay, Otter Tail and Wilkin Counties
Prepared by the Center for Small Towns
University of Minnesota, Morris
Rachel Bohling & Emily Irey – Report
Rebecca Erickson – Staff Lead
1|Page
Table of Contents
Introduction .......................................................................................................................... 3
A Framework for Assessing Health ..................................................................................................5
General Health Status.....................................................................................................................6
Health Disparities and Health Equity ...............................................................................................7
People and Place ................................................................................................................... 7
Population Change .........................................................................................................................7
Special Populations ........................................................................................................................8
Environment ................................................................................................................................ 15
Opportunity for Health ........................................................................................................ 18
Access to Health Care ................................................................................................................... 27
Healthy Living in Minnesota ................................................................................................ 32
Child, Infant, and Maternal Health ................................................................................................ 32
Community Activity and Involvement ........................................................................................... 36
Physical Activity ........................................................................................................................... 38
Community Health Opportunities ................................................................................................. 41
Nutrition ...................................................................................................................................... 42
Preventative Care......................................................................................................................... 48
Car Safety .................................................................................................................................... 53
Tobacco Use ................................................................................................................................. 57
Alcohol Use and Substance Abuse................................................................................................. 59
Violence ....................................................................................................................................... 64
Mental Health in Students ............................................................................................................ 69
High-Risk Sexual Behavior ............................................................................................................ 79
Mortality, Morbidity, & Disease Outcomes .......................................................................... 83
Injury & Violence.......................................................................................................................... 83
Self-harm & Suicide ...................................................................................................................... 87
Chronic Disease ............................................................................................................................ 91
Infectious Diseases ..................................................................................................................... 101
Conclusion......................................................................................................................... 108
Meeting Challenges with Strengths ............................................................................................. 108
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Introduction
Minnesota is a wonderful place to live. Not only does it provide a great landscape and many thriving
communities, but also, Minnesotans are on average among the healthiest people in the nation.
Businesses and industries thrive here and the lakes, fields, forests and rivers in the state provide many
opportunities that encourage people to be active. Many individuals and organizations throughout the
state share the mission of protecting, maintaining and improving these conditions which in turn benefits
the health of Minnesotans
This document presents an assessment of health in the counties of Becker, Clay, Wilkin, and Otter Tail
by looking at a combination of health factors and health outcomes. Health, as defined by the World
Health Organization, is “a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity.”1 This kind of health includes not only individuals, but families and
communities as well. This kind of health is an outcome of a combination of multiple conditions or
factors. It begins not when someone becomes ill, but in homes and schools, in jobs, and workplaces, and
in communities. It begins in the places where opportunity for health is provided and knowledge of how
to be healthy is first learned.
To reflect this understanding of health, The Health of Becker, Clay, Wilkin, and Otter Tail discusses a
wide array of indicators and information about the conditions and factors affecting health, as well as
indicators of health status. This report first provides information about physical, social, and behavioral
factors for health in Becker, Clay, Wilkin and Otter Tail. This was divided into four major sections that
reflect many aspects of health: People and Place; Opportunity for Health; Healthy Living; and Mortality,
Morbidity and Disease. These sections cover physical, social, and behavioral factors as well as health
outcomes.
The Center for Small Towns in partnership with the Becker, Clay-Wilkin, and Otter Tail
Community Health Boards
This assessment was prepared by the Center for Small Towns at the University of Minnesota, Morris, in
collaboration with the Becker County Community Health Board, the Clay-Wilkin Community Health
Board, and the Otter Tail Community Health Board. It will enhance and facilitate public health planning
efforts in preparation for the merging of the three community health boards into the Partnership 4
Health Community Health Board, effective January 1, 2015. This forthcoming merger is the result of a
three-year planning initiative that explored:








The discipline of public health
The state and local partnership
The areas of public health responsibility
Similarities and differences in programs and services
Current challenges and realities facing public health and local government
Health and economic data
State and national trends
The pros and cons of a merger
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During that time, a number of initiatives were implemented that demonstrated the benefits of working
together: sharing of staff to cover vacancies, the development of new programs that shared staff across
county lines and the sharing of staff expertise such as in finance and highly specialized but low volume
services such as Tb follow-up.
Each county collaborated with hospitals within their jurisdiction to complete local community health
assessments and health improvement plans. In addition to the local assessments, the counties
collaborated with each other to compile this four county community health assessment for the
Partnership4Health Community Health Board. Compiling information into one community health
assessment versus three separate assessments is an example of an efficiency to be gained from this
merger. Additionally, it will lay the foundation for increased collaboration in working across county lines
in the identification of priority issues and delivery of public health services that would be mutually
beneficial to residents.
Limitations
While this health assessment presents many important issues and topics, it does not present every
possible health-related issue. The issues and indicators chosen are intended to reveal the scope and
complexity of population health, but space does not allow for each of them to be thoroughly
documented. Therefore, the assessment should not be considered a formal study or research document
investigating the causes of each issue raised or providing a detailed analysis of the data. Volumes have
been written on many of these issues, and references are provided throughout to enable access to
additional information in each of these areas for those who desire it.
In some cases, the kinds of information that could greatly inform a statewide health assessment are
simply not available. This may be because data is not available at the state level, or data is not stratified
by race/ethnicity, income, sexual orientation, etc. When race/ethnicity data are gathered, analysis may
be further limited due to a lack of data stratification by more specific racial categories, such as U.S.-born
vs. African-born for the African-American population, or the many ethnicities and cultures represented
in the category of Asian-Pacific Islander.2
Further, data on small communities is often compromised with margins of error because certain
sampling and data gathering techniques are not robust or reliable. For example, data from the US
Census Bureau on small towns lacks a sufficient number of observations, and often contains a very large
percentage of error. This means that the data can vary greatly, often times resulting in unusable data.
This makes it difficult to conduct robust statistical analysis of data. Furthermore, because the data focus
for this report was on small communities, there are limitations to how data can be presented accurately.
For example, if the amount of deaths by category in each county is so low that a percentage would
provide too small of a number, no proper comparison may be able to be made between the counties.
The assessment also does not include the many programs, services, and strategies that are or have been
implemented in Becker, Clay, Otter Tail, and Wilkin Counties. It also does not present non-quantitative
health factors that cannot be statistically examined. The goal of this report is to present demographic
and socio-economic data and trends, and major health factors in lifestyle and opportunity, and then to
demonstrate various noticeable health outcomes.
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A Framework for Assessing Health
Health is the result of innumerable variables. With
greater access to data, there is a rapidly expanding
interest in researching how living conditions and
socioeconomic opportunity determine health
outcomes. 3 It is very difficult to comprehend the
broad factors that shape health outcomes. Dahlgren
and Whitehead 4 propose the model to the right, in
which the unique biological characteristics of an
individual are surrounded by community, place, and
system-based conditions and factors. In addition to this model, there is also the ecological or social
ecology model. This similar model is used in different academic areas as well as a variety of practice
fields for the purpose of better understanding the major forces that impact individuals. 5
The recent health movement has shifted focus from the individual to the community as a whole. This
change was presented in the debut of Healthy People, the national health agenda drafted by the U.S.
Department of Health and Human Services.
Healthy People 2020 Overarching Goals 6




Attain high-quality, longer lives free of preventable disease, disability, injury, and
premature death
Achieve health equity, eliminate disparities, and improve the health of all groups
Create social and physical environments that promote good health for all
Promote quality of life, healthy development and healthy behaviors for all life stages
The U.S. Department of Health and Human Services further describes similar factors that influence the
development of a healthy community7:
“[A healthy community is] one that continuously creates and improves both its physical
and social environments, helping people to support one another in aspects of daily life
and to develop to their fullest potential. Healthy places are those designed and built to
improve the quality of life for all people who live, work, worship, learn, and play within
their borders—where every person is free to make choices amid a variety of healthy,
available, accessible, and affordable options.”
Childhood experiences seem to particularly influence a person’s health in the immediate and distant
future. Beneficial and harmful events in those early years, such as the relationship with adults or
parents, community engagement, and familial health behaviors and habits shape how children will live
the rest of their lives. 8
Better health opportunities at an early age influence a healthier life, and therefore a better overall
lifetime health. To properly assess the health of a community or an entire county, we must examine not
only multiple factors, but also the relationship among those factors. The understanding of these
relationships and the effects a string of factors have on a specific health outcome is essential to shaping
policy or making improvements to the community that will have a positive impact on health.
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How early experiences get into the body: A bio-developmental framework
Source: Harvard University, Center on the Developing Child9
General Health Status
Minnesota is one of the healthiest states in the country. The United Health Foundation has ranked
states’ health status since 1990 by taking into account many different aspects of overall health for
evaluation; for the first 18 years, Minnesota ranked in the top five. From 2009 to 2011, Minnesota fell to
a ranking of sixth, before reclaiming a top-five ranking in 2012.
Minnesota Ranking
Among U.S states
Minnesota’s overall health ranking in the United States: 1990-2011
1990
1995
2000
2005
2010
1
2
3
4
5
6
Source: United Health Foundation
According to the 2012 America’s Health Rankings10 report, Minnesota’s strengths include:




Low rate of premature death and deaths from cardiovascular disease (Rank: 1)
Low prevalence of sedentary lifestyle (Rank: 8)
Low prevalence of diabetes (Rank: 3)
High rate of high school graduation (Rank: 3)
Challenges identified by the report include:



Low rate of public health funding per capita (Rank: 48)
High prevalence of binge drinking (Rank: 44)
High incidence of infectious disease (Rank: 50)
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The report discovered that Minnesota has made improvements on health factors, such as immunization
coverage and cardiovascular death rate, which could contribute to its raised health ranking. However, it
still continues to rank lower on certain health factors as the increasing number of children in poverty
and decreasing amount of public health funding become major concerns for the overall health of the
state.
Health Disparities and Health Equity11
Concerning health, Minnesotan counties are far from equal. Minority groups such as African Americans
and American Indians are far more likely to experience chronic disease, infectious disease, and
premature death, and thus, counties with a greater minority population will experience worse overall
health.
Health is not just a lack of disease. Rather, it is the state of “well-being.” Health covers all aspects of
life—home, school, workplace, place of worship, and social relationships. In respect to these overall
aspects of life, minority groups are highly disadvantaged and will therefore experience a state of lower
“well-being”. Data clearly reveal how historic and institutional oppression have contributed immensely
to health inequalities.
People and Place
Population Change
Minnesota is rapidly changing. Over time, Minnesota’s racial and ethnic diversity has grown. Residents
all over the state are re-examining what it means to be “Minnesotan”. As new immigrants enter the
state, and as the base population ages, Minnesota will face new challenges, and also encounter unique
opportunities.
Population change in Minnesota by county: 1990-2010
20%
% Change 1990-2000
% Change 2000-2010
15%
10%
5%
0%
-5%
-10%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: US Census Bureau 1990, 2000, 2010
Minnesota’s population grew by 7.8 percent between 2000 and 2010 (at about the same rate as South
Dakota, as but faster than North Dakota, Wisconsin, or Iowa). Urban areas continue to grow rapidly in
Minnesota, while rural areas experience steady population loss.
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Becker, Clay, and Otter Tail counties have all experienced a positive percent population change since
1990. Clay has experienced more population change from 2000-2010 compared to the growth from
1990-2000. Otter Tail has experienced close to 0 percent population change from 2000-2010. Wilkin has
experienced a steady decrease in population since 1990, decreasing by 5 percent from 1990-2000 and
then again by 8 percent from 2000-2010.
Population Density: 2010
Number of people per square mile
100
80
60
40
20
0
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: US Census Bureau, 2010
In 2010, Minnesota experienced a population density of 66.6 people per square mile. When compared
to surrounding states, this population density is similar to that of Iowa, higher than South Dakota and
North Dakota, and lower than Wisconsin. Of the four counties, Wilkin has the lowest population density
with 8.8 people per square mile. Becker and Otter Tail are in the middle with 24.7 and 29.1 people per
square mile respectively. Clay has the greatest population density and is close in numbers to the overall
population density of the state with 56.4 people per square mile.
Special Populations
While Minnesota is still far from the most diverse state in the U.S., this is gradually changing. In 1990,
populations of color and American Indians in Minnesota represented just over 6 percent of the total
population. In 2010, that number had grown to 15 percent. The Hispanic population grew by 364
percent during that time, and the African-American population grew by 189 percent.
Change in the distribution of people
of color in Minnesota: 1990-2010
Source: Center for Rural Policy and Development
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The above graph shows the percent increase in the colored population in Becker, Clay, Otter Tail, and
Wilkin from 1990 to 2010. Becker and Clay increased between 0 and 149.9 percent, Otter Tail increased
between 300 and 499.9 percent, and Wilkin increased between 150 and 199.9 percent.
From 1990-2010, Becker and Clay experienced the smallest percent increase in color populations. During
this time, Otter Tail experienced the greatest percent increase in color populations.
Populations of color as a proportion of Minnesota's total population: 2010
10%
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
Black or African American Indian or
American
Alaska Native
Minnesota
Becker
Asian
Clay
Native Hawaiian or
Pacific Islander
Otter Tail
Other
Wilkin
Source: US Census Bureau, 2010
Even though there has been a significant percent increase in color populations in these counties, color
populations still make up a relatively low percent of the overall population in Minnesota. In Minnesota,
the lead non-white population contributors are African Americans, who make up 5.17 percent of the
overall population, and Asians, who make up 4.04 percent. In Becker, the majority of the non-white
population is American Indian or Alaska Native, who makes up 7.55 percent of the overall population.
However, in Clay and Otter Tail Counties the majority of the non-white population is evenly spread over
African-American and Asian ethnicities as well as other unspecified populations. Wilkin County
experiences the lowest percentage of non-white population, totaling 2.11 percent among all non-white
populations. Wilkin also experiences the lowest population density, which could affect the amount of
non-whites living within the county.
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Percentage of total population of Hispanic or Latino origin: 1990-2010
5%
4%
3%
2%
1%
0%
1990
Minnesota
Becker
2000
Clay
2010
Wilkin
Otter Tail
Source: US Census Bureau 1990, 2000, 2010
Becker, Otter Tail, and Wilkin counties have all shown steady increases in the percent of Hispanic or
Latino residents since 2000. Clay County, however, has shown a slight but steady decrease in the
percent of Hispanic or Latino residents since 2000. Clay County, despite its decreasing trend, still has 1.5
to 2.0 percent more Latino residents than Becker, Otter Tail, or Wilkin Counties. Compared to the state
of Minnesota, all these counties have a lower percentage of Hispanic or Latino residents ranging from 1
to 5 percent.
Students with limited English proficiency: 2003-2012
10%
8%
6%
4%
2%
0%
2003
2004
2005
Minnesota
2006
Becker
2007
2008
Clay
2009
Otter Tail
2010
2011
2012
Wilkin
Source: Kids Count Data Center
Becker, Clay, Otter Tail, and Wilkin are all below the state average for the percentage of students with
limited English proficiency. Of these counties, Becker has remained at a consistently low percent, with
roughly 0.3 percent of students with limited English proficiency. Recently, Clay has shown a slight
decrease. Otter Tail and Wilkin have both possessed increases and decreases, but both have possessed
consistently lower percentages than Clay and consistently higher percentages than Becker.
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Percent of students living in single parent households: 2010
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
Both adults and children in households with a single parent are at greater risk for adverse health
outcomes and unhealthy behaviors. These households are especially susceptible to chronic stress, often
due to economic factors, social isolation, and stigma related to being part of a single-parent family.12
When looking at the state of Minnesota it can be seen that, on average, there are about 24.9 percent of
students living in single parent households as of 2010. When used as a baseline state average, the four
counties being examined are split. Becker and Clay are both slightly above the state average, while Otter
Tail and Wilkin are slightly below. It should also be understood that standard error In the US Census
sampling could be very high for small communities; thus this standard error could provide results that
are partially inaccurate for all of these small counties.
Percent population ages 65 and over: 2010
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Projected population ages 65 and over: 2030
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Source: US Census Bureau, 2010
Source: Minnesota State Demographic Center,
Minnesota Population Projections, 2015-2040
From the 2010 US Census data, Minnesota has a fairly low percentage of the population over the age of
65, with this age group only making up 12.9 percent. Clay has a slightly lower proportion of the
population over the age of 65 compared to the state of Minnesota, and is the only county below the
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state average. Becker and Wilkin possess similar percentages, but Becker is instead slightly higher than
the state average. Otter Tail is noticeably higher in the percentage of population over the age of 65
compared to the state of Minnesota.
In 2035, the individuals 65 years and older are expected to comprise an even greater percent of the total
population in Becker, Clay, Otter Tail, and Wilkin counties, as well as the state of Minnesota. This will
put considerable stress on the resources of the area. It should be noted that the projected number
might also be inaccurate, as many families may choose to bring their older relatives to live nearby in
long-term care facilities in these counties.
As our population ages, these small counties can expect new challenges; not only concerning health
related issues, but economic effects as well. As these individuals age, go into retirement, and pass on,
who will replace them? Will they remain in their small communities, or move to larger metropolitan
centers with better health amenities? These are questions that should be considered by all
communities, especially small towns where baby boomers or the future senior citizens are quite
prevalent, when trying to improve their overall health.
As displayed above, the senior citizen population (defined as those age 65 and older) is expected to
compose 22.5 percent of the Minnesota population in the year 2030. This will be about a 10 percent
increase from the percent reported for this population by the US Census in 2010. Becker is expected to
have 25.3 percent of the total projected population be composed of age 65+ in 2030. This will be about
a 7 percent increase from 2010. Clay is expected to have an increase of about 8 percent with a projected
19.7 percent of the population being composed of ages 65 and older. Otter Tail and Wilkin have very
similar projections for 2030; around 33 percent of the projected population is expected to be ages 65
and older.
As stated earlier, the biggest reason for this projected increase is the increase in the amount of baby
boomers in the older population. This increase will put considerable stress on community and familial
resources. An increase in the senior population means an increase in the demand for care, mainly in the
form of health care. There will be new challenges with the increasingly aging population. Baby boomers
are a large component of small town communities throughout west central Minnesota. As they age,
their roles in these communities will become void and need to be filled. The increase in demand for care
will force these communities to accommodate or risk losing a major portion of their population to more
suburban and better accommodated areas.
For more information on the methodologies used to generate these population projections, see the
references section below.
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Population by gender
Minnesota 2000
Minnesota 2010
80-84
80-84
70-74
70-74
60-64
60-64
50-54
50-54
40-44
40-44
30-34
30-34
20-24
20-24
10-14
10-14
0-4
0-4
6%
4%
2%
0%
2%
4%
Percent of Total Population
6%
6%
4%
Becker 2000
80-84
70-74
70-74
60-64
60-64
50-54
50-54
40-44
40-44
30-34
30-34
20-24
20-24
10-14
10-14
0-4
0-4
4%
2%
0%
2%
4%
Percent of Total Population
6%
6%
4%
Clay 2000
80-84
70-74
70-74
60-64
60-64
50-54
50-54
40-44
40-44
30-34
30-34
20-24
20-24
10-14
10-14
0-4
0-4
4%
2%
0%
2%
4%
Percent of Total Population
2%
0%
2%
4%
Percent of Total Population
6%
Clay 2010
80-84
6%
6%
Becker 2010
80-84
6%
2%
0%
2%
4%
Percent of Total Population
6%
6%
4%
2%
0%
2%
4%
Percent of Total Population
6%
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Otter Tail 2000
Otter Tail 2010
80-84
80-84
70-74
70-74
60-64
60-64
50-54
50-54
40-44
40-44
30-34
30-34
20-24
20-24
10-14
10-14
0-4
0-4
6%
4%
2%
0%
2%
4%
Percent of Total Population
6%
6%
4%
Wilkin 2000
2%
0%
2%
4%
Percent of Total Population
6%
Wilkin 2010
80-84
80-84
70-74
70-74
60-64
60-64
50-54
50-54
40-44
40-44
30-34
30-34
20-24
20-24
10-14
10-14
0-4
0-4
6%
4%
2%
0%
2%
4%
Percent of Total Population
6%
6%
4%
2%
0%
2%
4%
Percent of Total Population
6%
Source: US Census Bureau 2000, 2010
In 2000, the distribution of ages in each county shows a similar trend with a higher percent of 10-20 year
olds, a lower percent of 20-35 year olds, and a higher percent of 35-50 year olds (representing the babyboomer generation). However there are variations unique to each location. For example, nearly 15
percent of Clay’s population is between 15 and 25, possibly because of the presence of colleges in that
county. Otter Tail has only 8 percent of their population in the 20-30 age range, compared to 10 to 15
percent of the population in this age range for the other counties.
In 2010, the age distributions shift up as we’d expect since each of the citizens is now ten years older.
However, there are some discrepancies. For example, 10-14 year olds made up more than 8 percent of
Becker’s population in 2000, but in 2010 20-24 year olds (the same group of people) composed less than
5 percent of the population, which would indicate people of this age group leaving Becker County. In
Clay, 10-14 year olds made up about 7.5 percent of the population in 2000; this percentage nearly
doubled by 2010, reaching more than 12 percent. This would indicate that Clay has a higher percentage
of younger people than the other counties.
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Environment
The environment in which people live plays a major role in their health. It starts with the basic water
quality because water intake is a part of everyone’s health. Safe drinking water means the widespread
intake of water will have a positive effect on health. Unsafe drinking water, on the other hand, will do
the opposite. Furthermore, the quality of air and the amount of unsafe pollutants can show if a
particular area is at a high risk for certain adverse health effects. The built environment even has an
impact on the health of a county. Homes built before 1940 have a high chance of having mold and
asbestos. The limited housing choices in small communities compared to the amount of these old
homes can lead to a good amount of the population living in unhealthy environments, therefore further
impacting the health outcomes. 13
The environment of Becker, Clay, Otter Tail, and Wilkin was examined to give some background
information on possible effects on later health outcomes. These results provide information on the
health risks that could be present within the communities.
Water Quality
Percent population exposed to water exceeding a violation limit: 2012
10%
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: County Health Rankings, EPA Safe Drinking Water Information System
Water quality is a health factor that is often overlooked. Water is an essential element of health and
commonly used by the community as a whole, but if the drinking water is unsafe, this could impact
many different health outcomes. This measure represents the percentage of the population getting
water from public water systems with at least one health-based violation during the reporting period.
These violations can include maximum contaminant level, maximum residual disinfectant level, and
treatment technique violations. The only county that stands out is Clay, which reported 7 percent of the
population being exposed to unsafe drinking water. Otter Tail, Becker, and Wilkin all report numbers
near 0 percent.
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Air Quality
Average daily ambient ozone concentration (parts per billion): 2008
38
37.5
37
36.5
36
35.5
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Community Health Needs Assessment Community Commons, Center for Disease Control &
Prevention, National Environmental Public Health Tracking Network (2008)
Like water quality, air quality is another element that is often overlooked with regards to health.
Average daily ambient ozone concentration is one way to measure this. The emission standard for
average daily ambient ozone concentration is 75 parts per billion.14 All counties as well as the state of
Minnesota are below this standard. Further comparisons can be made between these areas, though, as
to who has the lowest ambient ozone concentration or the least amount of air pollution. The state of
Minnesota has an average of 36.19 parts per billion, lower than all four counties. Becker and Otter Tail
have the greatest ambient ozone concentration (around 37.5 parts per billion). Clay experienced the
lowest average daily ambient ozone concentration.
Daily fine particulate matter: 2008
Average daily measure of fine particulate matter in micrograms per cubic meter (PM 2.5)
10.2
10
9.8
9.6
9.4
9.2
9
8.8
8.6
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: County Health Rankings, CDC Wonder
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Daily fine particulate matter measures the daily amount of air pollutants with an aerodynamic diameter,
the diameter of a sphere of unit density that has aerodynamic behavior identical to that of the particle
in question, less than 2.5 micrometers. These particles can be made up of acids such as nitrates or
sulfates; organic chemicals, metals, and soil or dust particles. Smaller particles are more dangerous
because those generally enter the lungs. When these are inhaled they can cause serious health effects
on the heart and lungs.15 When comparing these areas, Otter Tail has the greatest amount of fine
particulate matter, just slightly above the state average. Becker and Wilkin are fairly close and about 0.4
micrograms per cubic meter lower. Clay has the lowest amount of fine particulate matter.
Built Environment
In some communities, the built environment can be overtly hazardous, such as living near a toxic waste
dump. Because income affects housing choice and more polluted areas are less desirable, families with
lower income often live in housing with hazards such as foundation cracks allowing radon seepage, lead
paint, and asbestos in the building materials. Outdoor hazards can include dilapidated sidewalks or no
sidewalks at all, which is often the case in rural areas and older towns, making it difficult for residents to
walk or children to ride bikes. The lower opportunity for physical activity is often viewed as a factor for
less physical activity within a community. Many areas also have a lack of parks and playgrounds, which
will prevent children from playing safely and instead, encourage sedentary activities indoors.16
A good measure of the quality of indoor environments is a low percentage of houses built before 1940.
The older a home is, the more likely it is to contain lead-based paint and other hazardous materials,
since paints containing up to 50 percent lead were used on the inside and outside of homes through the
1950s17. These homes are also at a higher risk for mold18 and asbestos19, which can cause respiratory
problems, exacerbate asthma, and increase the risk of lung cancer, mesothelioma, and nonmalignant
lung and pleural disorders.
Percent of homes built before 1940: 2010
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: US Census Bureau, 2010
The state of Minnesota had 18.1 percent of homes built before 1940 as of 2010. Otter Tail and Wilkin,
are both above the state average with 19.8 percent and 18.8 percent respectively, putting them at an
even higher risk within their counties for adverse health effects. Becker and Clay, on the other hand, are
17 | P a g e
about 4 percent lower than the state of Minnesota, meaning these counties have a healthier and safer
housing environment. Looking more in depth, the population living in these homes is most likely the
population with a lower income. These households already experience financial strain and a decrease in
opportunity for health due to income. Now, the affordability of an unsafe and unhealthy home could
also be negatively impacting the health of these individuals.
Number of fast food restaurants per county: 2010
35
30
25
20
15
10
5
0
Becker
Clay
Otter Tail
Wilkin
Source: County Health Rankings, County Business Patterns
The amount of fast food restaurants within a county can even have affects, by providing a negative
opportunity for health and a negative convenience with easy and quick food access. An environment
that not only promotes and provides great opportunity for health, and does not detract from the
wellbeing of residents plays a major role in the overall health of a community.20
Fast-food restaurants within a county provide negative effects on the health of the community by
presenting convenient, unhealthy options. Communities with less fast-food restaurants have less
opportunity or temptation for unhealthy choices. A factor not shown in this data, however, is the
accessibility of fast-food restaurants in neighboring counties. This can be especially true for residents
that live on or near county borders. Despite this, Clay still possesses the greatest number of fast- food
restaurants with 30; Otter Tail is fairly close as well with 28. Wilkin has the lowest number with 2, but
this is to be expected due to the small population in Wilkin. Becker is in the middle with a fair number of
fast-food restaurants at about 20.
Opportunity for Health
A number of the factors that shape the demographics in Minnesota—education, employment, and
transportation—also affect access to health care. One of the most basic factors is the cost and
availability of insurance. Without insurance, it is difficult for individuals to seek out proper health care
and monitor their health. In addition to this, the health care workforce and the amount of access to
18 | P a g e
physicians, nursing homes, or hospitals can have a significant impact on the health of an area. Greater
access to health care means more opportunity for health care. These results examine the ability of the
people within the four counties to not only access health care, but to afford it as well.
Socio-Economic Determinants
Education
Health and learning are closely connected. Education is an important predictor of health because it both
shapes and reflects multiple factors that affect people’s life chances. Investing in education can be “the
single most effective intervention we can make to improve health outcomes and tackle inequities.”21
Health affects learning at all ages, from early childhood through adolescence, to adulthood. Early
reading and literacy stimulate brain development in young learners, help develop their analytical and
communication skills, and influence their intellect and behavioral patterns. These in turn, shape future
opportunities and achievement.
Certain health behaviors are also strongly associated with education. For example, the percentage of
Minnesotans who smoke decreases with increased education: 33 percent of those who do not have a
high school degree, 25 percent of high school graduates, 21 percent of those with some post-secondary
education, and 9 percent of college graduates.22 To understand these possible correlations in the four
counties of interest, we next look at the four-year on-time graduation rate as described in the National
Center for Education Statistics Exclusion-Adjusted Cohort Graduation Indicator and reiterated in the
USDE guidance No Child Left Behind – High School Graduation Rate.23
Percent of high school students graduating on time: 2008-2012
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
2008-2009
Minnesota
2009-2010
Becker
Clay
2010-2011
Otter Tail
2011-2012
Wilkin
Source: Minnesota Department of Health, Vital Statistics Trend Report, 1992-2011
Over the past four years, the percent of students graduating on time has slightly increased in Becker,
Wilkin, Clay, and the State of Minnesota. Otter Tail has experienced a slight decrease since 2008.
However, all of these areas have remained fairly consistent with the percent of students graduating on
time only fluctuating in a 10 percent range.
19 | P a g e
As of 2011-2012, Wilkin possessed the highest percentage of students graduating on time of the four
counties with 88.1 percent Becker had a fairly close percentage with 84.9 percent of their students
graduating on time. Both of these counties are above state average. Otter Tail is in line with the state of
Minnesota with 77.1 percent of students graduating on time. Finally, Clay is slightly below the state
average with only 74.4 percent of students graduating on time.
Percent of students receiving special education: 2007-2011
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
2007-2008
Minnesota
2008-2009
Becker
Clay
2009-2010
Otter Tail
2010-2011
Wilkin
Source: Minnesota Department of Health, Vital Statistics Trend Report, 1992-2011
When looking at trends in the percent of students receiving special education between 2007 and 2011,
each area either remained constant or experienced a slight increase. Since 2007-2008, Wilkin has
experienced the greatest increase and is now even with Becker, at about 20 percent. In the 2010-2011
school years, Becker and Wilkin both had 20.6 percent of students receive special education about 5.5
percent greater than the state of Minnesota. Clay and Otter Tail are more consistent with the state of
Minnesota and have been since 2007. In the 2010-2011 school years, Clay and Otter Tail both had
around 15 percent of students receiving special education. It is important to note that there are other
possible variables to this data, such as different district policies, standards, or funding for special
education, all of which can significantly impact the percentage of students receiving special education
across different areas.
Unemployment
Employment is a major factor in the health of an individual and a community. Stable and secure
employment influences health not only by providing a source of income, but also by providing access to
health insurance, a necessity in today’s world.24
20 | P a g e
Unemployment Rates: 2000-2013
25.00%
20.00%
15.00%
10.00%
5.00%
Minnesota
Becker
Clay
Otter Tail
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
0.00%
Wilkin
Source: US Bureau of Labor Statistics
Unemployment Rates: 2013
10.00%
9.00%
8.00%
7.00%
6.00%
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: US Bureau of Labor Statistics
Since 1990, Becker has had the greatest unemployment rate, but has decreased from its peak of 13.6
percent in 1992. Clay, Otter Tail, Wilkin, and Minnesota have all followed a similar trend since 1990. One
exception would be from 2008-2011, when Minnesota and Otter Tail experienced more of an increase in
unemployment. The peak percentages in 2009 were all the same for Otter Tail, Becker, and Minnesota
at 7.6 percent unemployment. This peak can be attributed to the economic recession of the time. From
the time graph, it can be seen that Clay and Wilkin possess the lowest percent unemployment, while
Becker and Otter Tail possess the greatest percent unemployment.
In 2013, Becker experienced almost the exact same percent unemployment as Minnesota with 5.1
percent. Otter Tail was also very similar, with 4.9 percent. Clay and Wilkin again experienced percent
unemployment below the state average, with Clay being the lowest at 3.6 percent unemployment.
21 | P a g e
Income
While employment is important, income involves more than the money earned from a job. It also
includes assets (like a bank account or equity in an owned home) and access to a variety of economic
resources. Income influences the opportunity people have to choose where to live, to purchase
nutritious food, to participate in a wide variety of physical activities, especially those that require fees or
special equipment, and to have leisure time. Jobs and job-related income, however, remain steady
markers of aspects of a household’s wealth.
For example, in Minnesota as a whole there are significant disparities in employment opportunities for
different racial groups, with African-American and American Indian household incomes being almost
half that of Asian and white populations.25 These differences in employment and income opportunities
result in increases in poverty in these populations. Of Minneapolis-St. Paul residents, nearly two-thirds
of African-American live in ‘asset poverty,’ meaning they do not have enough assets to live above the
poverty level for three months if they lose their main source of income.26
Per Capita Income: 1990-2011
$50,000.00
$45,000.00
$40,000.00
$35,000.00
$30,000.00
$25,000.00
$20,000.00
$15,000.00
Minnesota
Becker
Clay
Otter Tail
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
$10,000.00
Wilkin
Source: Us Department of Commerce, Bureau of Economic Analysis
Incomes have increased at about the same rate in Becker, Clay, Wilkin and Otter Tail counties compared
to the state of Minnesota, with each showing a noticeable drop in 2008 corresponding with the
economic downturn in that year. Aside from this drop, there is a general trend of increasing income.
The per capita incomes in the counties are consistently about $5,000 below the state average. A major
factor behind this is that metro incomes skew the overall state averages; in this way, it is common for
rural counties to be below the state average in terms of mean or per capita income.
22 | P a g e
Household Income: 2007-2011
Percent of families with household income greater than $75,000
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: US Census Bureau, American Community Survey 2007-2011
Household income is another way to look at the economic status and opportunity for health in many
communities. In the state of Minnesota, 48.4 percent of families have a household income greater than
$75,000, higher than any of the four counties. Like per capita income, this can be attributed to the high
and skewing income of suburban areas. Among the four counties, Clay has the highest percent of
families with a household income above $75,000. Becker, Otter Tail, and Wilkin are all fairly even, but
about 9 percent below Clay and 14 percent below the state. This shows that these four counties have
very similar incomes. While the opportunity for health, based strictly on income, may be lower in these
rural areas than more populated and suburban parts of Minnesota, these four counties have a similar
opportunity for health based on income.
These data show the percent of households within each population that spend more than 30 percent of
their income on housing, either due to high housing costs or low incomes. These households experience
less opportunity for health from an economic perspective, due to the likelihood of a stricter budget and
inability to pay for many recreational activities or nutritious foods.
Housing Costs: 2007-2011
Percent of households that spend 30% or more of household income on housing costs
50%
40%
30%
20%
10%
0%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: County Health Rankings, American Consumer Survey, 2007-2011
23 | P a g e
All four counties have a lower percent of households than the state of Minnesota, with Becker, Clay, and
Otter Tail around 30 percent and Wilkin around 20 percent. Overall, the counties have fewer people
than the state of MN spending more than 30 percent of their income on housing; this may suggest that
they have better economic opportunities for health, since a higher percentage of their income can be
used for health costs.
Poverty
Poverty, often resulting from limited income or a lack of income, is linked to health in many ways.
Poverty limits choices: in education, in employment, and in living conditions, among others. Poverty
limits access to safe places to live, work, and play, and places to buy healthy food. Poverty can foster
obesity by forcing people and families to rely on cheap sources of food, which tend to be plentiful but
high in calories and low in nutritional value.27
Percent of population living in poverty: 2000-2011
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
2000
2001
2002
Minnesota
2003
2004
Becker
2005
2006
Clay
2007
2008
Otter Tail
2009
2010
2011
Wilkin
Source: US Department of Commerce, Bureau of Economic Analysis and Minnesota Department of
Health, Center for Health Statistics
Poverty in rural Minnesota is a complex issue. The recent recession and financial crisis have certainly
affected rural Minnesota, including Becker, Clay and Wilkin, where poverty rates have increased since
2008. In Wilkin and Clay, this has been a fairly steady but slight increase. Becker’s rates, on the other
hand, began to decrease in 2010, though its poverty rates are still higher than they were in 2008. Like
Becker, Otter Tail is also a bit of a surprise as its poverty rates increased at a normal rate after 2008, but
suddenly decreased beginning in 2010 to the point that they are lower than they were in 2008. These
counties seem to be contradicting not only the trend of the state of Minnesota, but also the expected
trend of rural Minnesota, which was hit hard by the economic challenges of the nation.
A growing body of research also demonstrates that children who are raised in families experiencing
chronic stress created by long-term poverty (<100% of the Federal Poverty Level) are at much greater
risk of long-term deficits in health.28 Children living in poverty can impact the opportunity for future
health of a county.
24 | P a g e
Percent of population under 18 living in poverty: 2000-2011
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
2000
2001
2002
Minnesota
2003
2004
Becker
2005
2006
Clay
2007
2008
Otter Tail
2009
2010
2011
Wilkin
Source: US Department of Commerce, Bureau of Economic Analysis and Minnesota Department of
Health, Center for Health Statistics
Poverty among Minnesota’s children is not evenly distributed. Even though Wilkin is at or below the
state average for child poverty rates, Becker, Clay, and Otter Tail all have child poverty rates that are
consistently above the state average. This is concerning since children who grow up in poverty are far
more likely to remain in poverty and have fewer opportunities for health as adults, impacting the future
opportunity for health in these counties.
Insurance
All of the following data were collected from time periods before the American Care Act was in place, so
many changes could already be underway to these data, especially concerning insurance coverage.
Percent of adults (18-64) without medical insurance: 2011
15.00%
10.00%
5.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Community Health Needs Assessment Community Commons, US Census Bureau: Small Area
Health Insurance Estimates, 2011
In 2011, 11.7 percent of adults in Minnesota and in Otter Tail County didn’t have medical insurance.
Becker was above the state average, with 14.4 percent. Clay and Wilkin were slightly below the state
average, reporting 10.3 percent and 10.9 percent, respectively. There is a very small difference (only
about 1 percent) between Minnesota, Clay, Otter Tail, and Wilkin.
25 | P a g e
Percent of children (18 & under) without medical insurance: 2011
15.00%
10.00%
5.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: US Census Bureau: Small Area Health Insurance Estimates, 2011
The percent of children without medical insurance in 2011 was again highest in Becker with 9.9 percent.
The state of Minnesota reported 6.4 percent. Clay and Otter Tail were slightly above the state average
with 6.6 percent and 7.0 percent respectively. Wilkin was slightly lower with 6.3 percent.
The data for the percent of children without medical insurance strongly follows the same trend as the
percent of adults without medical insurance. This gives reason to conclude that the two are strongly
correlated. From this, it is also reasonable to assume that the majority of adults without medical
insurance are part of a family that collectively does not have health insurance. This would provide the
same trend in the children data as shown. Therefore, it is possible that families face the largest issue or
struggle in affording health insurance in these areas.
Medicaid
To take a different look at health insurance, we can look at the percent of the population receiving
Medicaid. Medicaid is a federally and state-funded insurance for those with low income or resources.29
Counties with a larger low-income, uninsured population are likely to have more receiving Medicaid.
Percent of population receiving Medicaid: 2009-2011
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Minnesota
Becker
Clay
No data available for Wilkin County
Otter Tail
Source: Community Health Needs Assessment Community Commons, US Census Bureau: American
Community Survey (2009-2011)
26 | P a g e
For the percent of the population receiving Medicaid from 2009-2011, data for Wilkin was unavailable
due to the small numbers reported. Becker had the greatest percent of population receiving Medicaid,
reporting 20.1 percent; this county also had the largest percent of its population without medical
insurance. The state of Minnesota reported 14 percent; this is 6 percent lower than Becker. Clay was
slightly below the state average with 13.2 percent, and Otter Tail was slightly above with 16.4 percent.
Cost of health care: 2010
Price-adjusted Medicare spending per enrollee
$7,700
$7,600
$7,500
$7,400
$7,300
$7,200
$7,100
$7,000
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: County Health Rankings, Dartmouth Atlas Health Cares
The cost of health care can greatly impact the ability for individuals to receive proper health care due to
the issue of affordability. To estimate this across the examined areas, the price-adjusted Medicare
spending per enrollee within the area was used. It is hard to know what the “ideal” health care cost is,
but the results can still be compared across counties and to the state (county health rankings).
All four counties have health care costs below the state of Minnesota. Otter Tail has the highest, with
$7,604. Becker and Clay are about $100 lower, and Wilkin is about $400 lower, at $7,232.
Access to Health Care
Health Care Providers
The health care workforce in Minnesota that carries out most routine and preventive care primarily
consists of nurse practitioners, primary care physicians, and dentists. Access to primary care varies
regionally. For example, southeast Minnesota (where the Mayo Health System largely resides) employs
a relatively high proportion of providers for its population compared with the rest of the state;
northwest Minnesota has access to a relatively smaller pool of providers.30
Similarly, the access to dentists plays a vital role in oral health. Dentist visits are also essential health
checkups, which can be made more difficult by decreased availability of dentists.
27 | P a g e
Physicians in Minnesota: 2011-2012
Ratio of population to 1 primary care physician
7000
6574
6000
5000
4550
4000
3000
2000
1000
1909
1140
1251
Minnesota
Becker
0
Clay
Otter Tail
Wilkin
Source: County Health Rankings, HRSAA Area Resource File
The state of Minnesota as a whole has 1140 residents to 1 primary care physician. This number is lower
than all four counties, meaning the four counties have a smaller proportion of physicians to the
population than the state of Minnesota. Wilkin has the greatest proportion of population to physicians
with 6574 to 1. Clay is also fairly large with 4550 people to 1 physician. Becker and Otter Tail are slightly
above the state average, with 1250 people to 1 physician and 1909 people to 1 physician respectively.
Because Becker and Otter Tail are fairly close to the state average, it can be said that these counties
have reasonable access to physicians. On the other hand, Wilkin and Clay have less access to health care
than MN; these high ratios may correlate with increased distances traveled when seeking primary care.
Dentists in Minnesota: 2011-2012
Ratio of population to 1 dentist
7000
6000
5000
4000
3000
2000
1000
1660
1941
2329
1948
2242
0
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: County Health Rankings, HRSAA Area Resource File
Minnesota again reported the lowest ratio of people to dentists, at 1660 to 1. Unlike physicians though,
there is less discrepancy between the state of Minnesota and the four counties. Clay and Wilkin
reported the highest ratio and therefore the lowest access to dentists. Becker and Otter Tail provided
very similar ratios slightly lower than Clay and Wilkin.
28 | P a g e
Mental health providers in Minnesota: 2011-2012
Ratio of population to 1 mental health provider
7000
6000
5000
4000
3000
3479
2000
1000
1732
3579
2191
2169
0
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: County Health Rankings, HRSAA Area Resource File
As expected, Minnesota reported the lowest ratio in this category with 1732 people to 1 mental health
provider. Clay reported 3479 to 1 while Wilkin reported 3579 to 1; this is about 1750 more people to 1
mental health provider than the state of Minnesota. Becker and Wilkin reported lower and more similar
numbers. Becker reported 2169 people to 1 and Wilkin reported 2191 people to 1. Becker and Wilkin
have better access to mental health providers than Clay and Otter Tail.
Community Care Centers
The availability and access to community care centers have a large impact on the health and opportunity
for health of older populations or populations with many health problems. Counties with more
community care centers provide greater access to health care for these populations.
Nursing home bed capacity: 2013
Total Minnesota licensed bed capacity among all licensed nursing homes
700
600
500
400
300
200
100
0
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health
Nursing home bed capacity provides the total number of licensed nursing home beds among all state
licensed nursing homes within each county. This provides data on the access to nursing home care
within each county. Otter Tail reported the greatest access to nursing home care with 664 beds in 2013.
Wilkin reported the lowest access to nursing home care with 120 beds. Becker and Clay were fairly
similar and in the middle of the data, with 335 and 362 beds respectively.
29 | P a g e
Number of licensed assisted living units: 2013
40
35
30
25
20
15
10
5
0
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health
The number of licensed assisted living units provides data similar to that of nursing home bed capacity.
This access to health care is more useful for senior populations with mild health conditions. Otter Tail
again reported the greatest access to assisted living units with 36 in 2013. Wilkin also reported the
lowest access with 3 assisted living units. Becker and Clay were in the middle again. Clay was slightly
higher with 20 assisted living units compared to 12.
Number of licensed home care and home health agencies: 2013
40
35
30
25
20
15
10
5
0
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health
The number of licensed home care and home health agencies provides data on the access that adults or
seniors have to extra help at home for certain medical conditions or after medical procedures. Otter Tail
again reported the greatest access, with 35 home care and home health agencies in 2013. Wilkin also
reported the lowest access, with 4 home care and home health agencies. Clay has slightly higher access
than Becker, with 14 licensed home care or health agencies, compared to 10 in Becker.
In these three graphs, there are consistent trends. Otter Tail reported the highest nursing home bed
capacity, as well as the greatest number of licensed assisted living units and home care agencies. Wilkin,
on the other hand, reported the lowest number of all three things. Becker and Clay were consistently in
the middle, with Clay reporting slightly more than Becker. From this, it can be seen that Otter Tail has
the greatest access to specialized health care that is commonly utilized by seniors. Wilkin has the lowest
access and is at greater risk for an unhealthy adult or senior population.
30 | P a g e
Access to Childcare
Number of licensed childcare centers: 2013
20
15
10
5
0
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Human Services
Clay reported the greatest number of licensed childcare centers in 2013, with 19, and therefore has the
greatest access to childcare. Otter Tail reported the second highest number of licensed childcare
centers, with 12, and Becker was slightly lower, with 7. Wilkin had the lowest number of childcare
centers, with only 1. However, it is important to note that there may be a number of other childcare
options in each of the counties, such as after-school programs and unlicensed options.
Hospitals
Hospital bed capacity: 2013
Total licensed bed capacity in all hospitals
140
120
100
80
60
40
20
0
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health
Hospital bed capacity provides data on the total number of licensed hospital beds within a county. This
provides data on access to urgent or critical medical care within each county. Otter Tail had the greatest
hospital bed capacity in 2013, with 133. Becker was slightly lower, with 87. Both of these counties have
reasonable access to hospital care, especially when the small rural area is taken into account. Wilkin
reported a low hospital bed capacity of 25, while Clay reported the lowest, at 0. This data shows that
Becker and Otter Tail have the greatest access to hospital care among the four counties.
31 | P a g e
Preventable hospital stays: 2010
Hospitalization rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees
70
60
50
40
30
20
10
0
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: County Health Rankings, Dartmouth Atlas of Health Care
Among the four counties and Minnesota, though, there is not much discrepancy, only ranging from 44 to
59 in hospitalization rate for ambulatory-care sensitive conditions. Clay and Otter Tail had the lowest
rate of preventable hospitalizations, with 44 and 47 respectively. The state of Minnesota was slightly
above both of these counties, with a rate of 51. Becker and Wilkin were both greater than the state,
with rates of 55 and 59 respectively.
Healthy Living in Minnesota
Child, Infant, and Maternal Health
Prenatal Care and Healthy Pregnancies31
Women who access prenatal care aim to assure a healthy pregnancy, and prevent prematurity or low
birth weight, both of which are major contributors to infant mortality and high costs of care. Prenatal
care encompasses a multitude of measures: discussing a mother’s healthy choices and body changes;
prenatal testing and counseling; treating medical complications like gestational hypertension, diabetes,
and anemia; promoting optimal weight gain; testing for sexually transmitted infections; oral health
assessment and treatment; and maternal mental health and substance abuse screening. Low rates of
prenatal care can be correlated with disparities in infant mortality rates.
Minnesota consistently ranks among the states with the lowest infant mortality rates. In fact, infant
mortality rates have declined for all racial and ethnic populations in Minnesota over the last 20 years.
Nonetheless, disparities persist in the mortality rates of African-American and American-Indian infants,
compared to all other population groups.32
The causes of infant mortality vary by population. Sleep-related causes, such as SIDS (sudden infant
death syndrome), are a primary source of infant deaths in the American Indian community, while
prematurity is the leading cause of death among African-Americans. Birth defects are the main source of
infant deaths in the Asian, Hispanic, and white populations. Chronic stress, poverty, substance abuse,
lack of prenatal care, and lack of access to health care all contribute to infant mortality.33
32 | P a g e
Prenatal care: 2011
Percent of mothers receiving prenatal care during the first trimester
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics, US Census Bureau
In 2011, 84.7 percent of all mothers in Minnesota received prenatal care during the first trimester. Clay
reported 48.1 percent of mothers receiving prenatal care. This was the lowest percentage of all the
areas, and was about 30 percent below the state average. Otter Tail and Becker were both very close to
the state average, with 77.4 percent and 85.5 percent respectively. Wilkin was about 10 percent higher,
providing the most prenatal care in mothers in 2011 at 94.5 percent.
Percent of mothers smoking during pregnancy: 2005-2011
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
2005
2006
Minnesota
2007
Becker
2008
Clay
2009
2010
2011
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
Smoking during pregnancy is well known to be very hazardous to infant health.34-35 Since 2005, Otter Tail
is the only area that has experienced an overall decrease in the percent of mothers smoking during
pregnancy. All numbers fluctuated in the 6-year period shown, but Becker was consistently higher than
all other areas. From 2010-2011, Wilkin went from having the lowest percentage to having the second
highest percentage, just below Becker. Another overall trend is that Clay and Otter Tail tended to stay
close to the state average, while Wilkin fluctuated around it.
33 | P a g e
Birth Rates and Complications
Overall fertility rates vs. Overall pregnancy rates (2011)
Rates per 1,000 women ages 15-44
80
70
60
50
40
30
20
10
0
Minnesota
Becker
Clay
Otter Tail
Dark bars indicate fertility rate. Light bars indicate pregnancy rate.
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
The fertility rate above is defined as the number of live births per 1,000 women in the population of age
15-44 years; the pregnancy rate is defined as the number of pregnancies per 1,000 women in the same
population. In all four counties the fertility and pregnancy rates are fairly close, which again means there
are few infant deaths and few abortions. Also, all four counties have a smaller difference between
fertility and pregnancy rates than the state of Minnesota. Furthermore, Becker, Otter Tail, and Wilkin all
reported similar fertility and pregnancy rates that were slightly above the state average. Clay reported
rates just below the state average.
Teenage birth rates vs. Teenage pregnancy rates (2011)
Rates per 1,000 15-19 year old females
40
30
20
10
0
Minnesota
Becker
Clay
Otter Tail
Dark bars indicate birth rate. Light bars indicate pregnancy rate.
Source: Minnesota Department of Health, Center for Health Statistics
34 | P a g e
This data compares the birth and pregnancy rates for teenagers only, though data for Wilkin was
unavailable due to the small numbers reported. In each location, the birth and pregnancy rates are
fairly close; there are fewer infant deaths and abortions. In the case of Clay, the birth rate is slightly
greater than the pregnancy rate. This was likely due to teenagers from other areas to give birth in a
different county, but not technically contribute to the pregnancy rate. When looking at these
differences, Becker, Clay, and Otter Tail all have a smaller difference between teen birth and pregnancy
rates than the state of Minnesota. Among the counties, Becker has the highest teenage pregnancy and
birth rates, well above the state average. There is a noticeable difference between the rates for Becker
and those for Clay and Otter Tail, which each fall below the state average.
Percent of births that were premature: 2011
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics, US Census
A premature birth - defined as a live birth less than 37 weeks old - puts the infant at a greater risk for
health complications. All four counties were below the state of Minnesota in 2011 with the percent of
births that were premature. Wilkin had the highest percent of births that were premature among the
four counties, with 5.7 percent, and Clay had the lowest, with 0.1 percent. Becker and Otter Tail were
fairly even, with 4.0 percent and 3.7 percent respectively.
Percent of births with low birth weight: 2011
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics, US Census
35 | P a g e
A low birth weight birth is defined as a live birth weighing less than 2500 grams. Similar to premature
births, low birth weight births also increase the chance for health complications in the infant. Becker
and Wilkin reported the highest percent of low birth weight births in 2011, and were only slightly below
the state average. Clay and Otter Tail reported the lowest percent of low birth weight births, about 1.5
percent below the state average.
Infant Deaths
Minnesota consistently ranks among the states with the lowest infant mortality rates. In fact, infant
mortality rates have declined for all racial and ethnic populations in Minnesota over the last 20 years.
Despite these improvements, infant mortality still occurs and can be a result of chronic stress, poverty,
substance abuse, a lack of prenatal care, and lack of access to health care.36
Number of infant deaths by birth year: 1991-2010
35
30
25
20
15
10
5
0
1991-1995
1996-2000
Becker
Clay
2001-2005
Otter Tail
2006-2010
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics, US Census
Wilkin had the least amount of infant deaths for all birth year ranges; the low population within the
county compared to the other three counties can explain this. Otter Tail experienced a lot of infant
deaths for those born between 1991 and 1995, but has decreased since then. On the other hand, Clay
has experienced the greatest number of infant deaths, and Becker has increased from infants born
between 1991 and 1995 to be fairly close in numbers to Clay.
Community Activity and Involvement
Civic Engagement and community involvement are important for individual, family, and community
health. Research on adolescent brain development supports the need for youth to learn how to become
part of the broader community and to explore their unique contributions within the community. Positive
experiences in the community, under the guidance of caring adults, provide youth with social learning
experiences and help them develop a healthy social identity. Volunteer work is one way that students
can be involved in the community.37
36 | P a g e
Volunteer work in male students: 2010
Volunteer work in female students: 2010
Percent of male students who spend 3-5 hours per
week doing volunteer work
Percent of female students who spend 3-5 hours
per week doing volunteer work
20%
20%
15%
15%
10%
10%
5%
5%
0%
0%
6th Grade
9th Grade
12th Grade
Minnesota
Becker
Clay
Otter Tail
Wilkin
6th Grade
9th Grade
12th Grade
Minnesota
Becker Clay Otter Tail Wilkin
Source: Minnesota Student Survey, 2010
When comparing the volunteer work between male and female students, there are distinct differences.
In Clay, a minimum of 6 percent of female students participate in volunteer work, while only about 4
percent of male students do. When comparing different areas, Becker presents very similar numbers to
the state of Minnesota. For females, the percent participating in volunteer work substantially increases
with age, while male students do not experience this increase.
Religious activity in students: 2010
Percent of students who participated in religious activities one or more times per week
60%
50%
40%
30%
20%
10%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
Religious participation is an indicator of community experience for Minnesota adolescents.38 From 6th to
12th grade, religious participation goes down. In the case of these four counties, there is a peak in
religious activity in 9th grade. All areas are fairly similar in numbers and in trends, and the percent of
students involved in religious activities ranges from 30 to 50 percent.
37 | P a g e
Physical Activity
Regular physical activity helps improve overall health and wellness, reduces risk for obesity, and lessens
the likelihood of developing many chronic diseases like cancer and heart disease. The national physical
activity guidelines recommend that children engage in at least 60 minutes of physical activity each day,
including aerobic, muscle strengthening, and bone strengthening activity. Adults need at least two hours
of moderate to vigorous-level activity every week and muscle-strengthening activities on two or more
days a week.39
For the following graphs, “physical activity” is defined as being engaged in at least 30 minutes of physical
activity 5 days per week, as denoted in the Minnesota Student Survey.40
Physical activity in students: 1995-2010
Percent of students engaged in at least 30 minutes of physical activity 5 days per week
6th Grade
In 6th graders, Becker, Clay, and Wilkin
are all above the state of Minnesota for
physical activity, while Otter Tail is below
the state average and has gradually
decreased in physical activity in 6th grade
students since 2004.
70%
60%
50%
40%
30%
20%
10%
0%
1998
2001
2004
2007
2010
2007
2010
9th Grade
70%
60%
50%
40%
30%
20%
10%
0%
1998
2001
2004
12th Grade
Since 1998, there has only been a slight
increase in the physical activity of 12th
graders, with percentages only ranging
from 40-50 percent. All areas have very
similar numbers and trends for this group
of students.
70%
60%
50%
40%
30%
20%
10%
0%
1998
Minnesota
2001
Becker
2004
Clay
Since 1998, the physical activity of 6th, 9th,
and 12th graders has all increased, though
the most noticeable increase can be seen
in 9th grade students over time. This has
resulted in the greatest amount of
physical activity in 9th graders with 55-65
percent of 9th graders engaging in
physical activity as of 2010. Otter Tail and
Becker have the greatest amount of
physical activity in 9th graders.
2007
Otter Tail
2010
Source: Minnesota Student Survey, 2010
Wilkin
38 | P a g e
Physical activity in students: 2010
Percent of students engaged in at least 30 minutes of physical activity 5 days per week
70%
60%
50%
40%
30%
20%
10%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
The physical activity in students can be looked at more closely by focusing on the year 2010, shown
here. In all areas, physical activity seems to peak in 9th grade. Becker, Clay, and Wilkin are above the
state average for all grades, but not by any significant margin. Otter Tail is slightly below the state
average for physical activity in 6th graders, but is above the state average for physical activity in 9th and
12th graders.
Percent of adults (ages 20+) with no leisure time physical activity: 2010
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Community Health Needs Assessment Community Commons, Centers for Disease Control and
Prevention, National Center for Chronic Disease Prevention and Health Promotion, Diabetes Atlas, 2010
Physical activity in adults was measured through the survey question: “During the past month, other
than your regular job, did you participate in any physical activities or exercises such as running,
calisthenics, golf, gardening, or walking for exercise?”
Becker, Clay, Otter Tail, and Wilkin all reported physical inactivity levels above state average. Becker and
Otter Tail both reported about 23.5 percent of adults with no leisure time physical activity. Clay
reported 24.6 percent and Wilkin reported the highest percent of physical inactivity, with 26.9 percent.
39 | P a g e
70%
Students who watch 6 or more hours of television per week: 1995-2010
6th Grade
Another measure of physical activity
is looking at the amount of physical
inactivity, such as watching 6 or
more hours of television per week.
60%
50%
40%
30%
20%
10%
0%
1998
2001
2004
2007
2010
9th Grade
70%
60%
50%
40%
30%
20%
10%
0%
1998
2001
2004
2007
2010
th
12 Grade
70%
60%
50%
40%
30%
20%
10%
0%
1998
Minnesota
2001
Becker
2004
Clay
2007
Otter Tail
2010
Wilkin
For 6th grade the amount of
students watching television over
time has been fairly consistent.
Wilkin has the greatest percent and
is above the state average, Clay and
Otter Tail are fairly even with the
state average, and Becker is below
the state average for television
watching in 6th grade students.
For 9th grade students in Wilkin, the
percent of students watching
television has increased dramatically
in recent years and is now higher
than the other areas. The
percentages for Becker and Clay
have both steadily increased
recently and are now greater than
the state average. Otter Tail has
decreased since 2004 to below the
state average.
In 12th grade students, Wilkin has
had an increasing percent that
watch television since 1998. Becker,
Clay, and Otter Tail all have steadily
increased in similar fashion since
1998. Becker experienced a sharp
increase since 2007 that resulted in
it being above the state average.
Source: Minnesota Student Survey, 2010
40 | P a g e
Percent of students who watch 6 or more hours of television per week: 2010
70%
60%
50%
40%
30%
20%
10%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
The percentages of 6th, 9th, and 12th grade students across the areas can also be compared in 2010. The
percent of students who watch 6 or more hours of television per week shows an increase from 6th grade
to 12th grade, with a slight peak in 9th grade. Among all areas, Wilkin has the largest percent of students
watching television across all grades and is above the state average for all three grades. Becker has the
lowest percentage in 6th grade students, while Otter Tail has the lowest percentage in 9th and 12th grade
students. Clay is fairly consistent with the state average, with the exception of having a slightly higher
percentage than Minnesota in 9th grade students.
Community Health Opportunities
Community environment plays an important role in the health of the individuals that live there. The
presence of recreational facilities and parks provide opportunities for a healthy lifestyle as well as
encourage locals to exercise or engage in physical activity more often. By looking at recreational
facilities and parks, the opportunity each county provides for a healthy lifestyle can be seen.
Rate of recreational facilities per 100,000 people: 2010
14
12
10
8
6
4
2
0
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: County Health Rankings, County Business Patterns
41 | P a g e
Recreational facilities are defined as “establishments primarily engaged in operating fitness and
recreational sports facilities, featuring exercise and other active physical fitness conditioning or
recreational sports activities such as swimming, skating, or racquet sports”.41
The State of Minnesota reported a rate of 11.6. Becker and Clay reported rates slightly less the state
average with 9.2 and 8.5 respectively. Otter Tail reported a rate higher than the state average with 12.2.
Wilkin reported zero recreational facilities. Otter Tail, therefore, has the best access to recreational
facilities, while Becker and Clay have slightly lower than average access to recreational facilities.
Percent of population within 1/2 mile of a park: 2010
70%
60%
50%
40%
30%
20%
10%
0%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: County Health Rankings, CDC’s National Environmental Public Health Tracking Network
Similar to access to recreational facilities, park access also provides a measurement of the opportunity
for physical activity within an area. Minnesota reported 60.5 percent. Clay was slightly higher than the
state, with 62 percent. Becker reported the lowest percentage with 12 percent. Otter Tail and Wilkin
were fairly even, with 25 percent and 23 percent respectively.
The data on park and recreation facility access do not follow the same trend. Otter Tail reported the
greatest recreational facility access, while Clay reported the greatest park access. A county that was high
in one category was lower in the other category, almost balancing out. This means that the counties all
experience similar opportunity for physical activity in the community. However, the opportunities are
still below that of the state of Minnesota, and could be improved for better health outcomes.
Nutrition
Food and diet have a very direct effect on health, growth, and well-being. A balanced diet is essential to
living a healthy life. Despite a common knowledge of the importance of a balanced diet, about threefourths of Minnesotans do not eat the recommended amounts of fruits and vegetables. 42
Poor eating habits at any stage of life, especially those that result in too many calories, too much
saturated fat and sodium, and too few nutrients (e.g., sugary drinks and a lack of whole grains) increase
the risk for disease and disability. 43 Some mal-effects of poor nutrition include obesity, diabetes, heart
disease, stroke, tooth decay, and some cancers.
42 | P a g e
Overall Population
Percent of the population with inadequate fruit & vegetable consumption: 2005-2009
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Minnesota
Becker
Clay
Otter Tail
Data for Wilkin not available
Source: Community Health Needs Assessment Community Commons, Centers for Disease Control and
Prevention, Behavioral Risk Factor Surveillance System, 2005-2009
Inadequate fruit and vegetable consumption is defined as having less than 5 servings of fruit and
vegetables each day. The data on fruit and vegetable consumption was averaged from 2005-2009 on the
percentage of the population age 18 and over with inadequate consumption. Data for Wilkin was
unavailable due to low numbers in relevance to the population.
The state of Minnesota reported 78.1 percent with inadequate consumption. Clay was slightly less than
this, with 75.9 percent. Becker and Otter Tail reported the highest percentage, with 91.3 percent and
87.9 percent respectively. All areas reported high percentages, which means the adequate or proper
fruit and vegetable consumption is an issue across the board in adults.
Students
Fruit & vegetable intake in students: 1995-2010
Percent of students who ate 5 or more servings of fruits, fruit juices, or vegetables the previous day
6th Grade
Fruit and vegetable intake in 6th graders
has slightly increased over the years in
Clay and Becker. Wilkin peaked in 2007,
but has since decreased and followed an
inconsistent trend. Becker reported
similar percentages to the state from
1998-2010.
25%
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
Fruit and vegetable intake in 9th graders
had increased since 1998 in all areas,
43 | P a g e
9th Grade
despite a slight decrease from 20072010. Since 1998, Becker has increased
by a margin of 7 percent, Clay has
increased by a margin of 4 percent, Otter
Tail and Wilkin have increased by margins
of 7 percent, and the state of Minnesota
has increased by a margin of 3 percent.
25%
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
2007
2010
th
12 Grade
25%
20%
15%
10%
5%
0%
1998
Minnesota
2001
Becker
2004
Clay
Otter Tail
Source: Minnesota Student Survey, 2010
Fruit and vegetable intake in 12th graders
has increased from 1998 to 2010 in all
areas. Becker and Clay both decreased
from 2001 to 2004, followed by a steep
increase. Otter Tail increased the most by
a margin of 11 percent. Becker increased
by a margin of 7 percent, Clay increased
by a margin of 5 percent, and Wilkin
increased by a margin of 1 percent. From
1998 to 2010, the state of Minnesota
increased by a margin of 6 percent.
Overall, fruit and vegetable intake has
increased in 9th and 12th graders, while
Wilkin remaining steady at a high percentage in
6th grade.
Fruit & vegetable intake in students: 2010
Percent of students who ate 5 or more serving of fruits, fruit juices, or vegetables the previous day
25%
20%
15%
10%
5%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
By comparing fruit and vegetable intake across 6th, 9th, and 12th grade students specifically in 2010, a
different trend can be looked at. Becker reported the highest percent of fruit and vegetable intake in
students in 6th, 9th, and 12th grade and was also above the state average. Otter Tail reported percentages
44 | P a g e
above the state average for 9th and 12th grade. Clay and Wilkin were both below the state average for all
grades, and Wilkin reported the lowest percentage among all grades. Minnesota and Clay reported the
most fruit and vegetable intake in 6th graders. Becker reported the most fruit and vegetable intake in 6th
and 9th graders, with 22 percent in each. Otter Tail reported the most fruit and vegetable intake in 9th
and 12th graders. Wilkin reported the most fruit and vegetable intake in 9th graders. From this, there is
no clear trend as to which grade has the most fruit and vegetable intake; especially since the differences
between the grades is a fairly small percentage.
Soda consumption in students: 1995-2010
Results measure percent of students who drank one or more glasses of pop/soda the previous day
6th Grade
Unlike with fruit and vegetable intake,
a decrease in soda consumptions yields
better nutritional results. 6th grade soda
consumption decreased in all areas
from 2001 to 2010. Becker increased
slightly from 2004 to 2007. All areas
reported about 65 percent in 2001 and
decreased to about 50 percent in 2010.
80%
60%
40%
20%
0%
2001
2004
9th Grade
80%
60%
40%
20%
0%
80%
60%
40%
20%
0%
2007
2010
Soda consumption decreased in 9th
grade students from 2001 to 2010. All
areas reported about 70 percent in
2001 and decreased to about 50
percent in 2007. Clay decreased by the
largest margin of 25 percent, Becker
decreased by a margin of 16 percent,
Otter Tail decreased by a margin of 17
percent, Wilkin decreased by a margin
of 3 percent, and Minnesota decreased
by a margin of 19 percent.
Soda consumption in 12th graders
decreased inconsistently in all four
counties from 2001 to 2010. The state
2001
2004
2007
2010
of Minnesota decreased steadily by a
th
12 Grade
margin of 18 percent. Soda
consumption decreased by a greater
margin in 12th grade students than in
6th or 9th grade students. Becker and
Clay reported percentages above the
state mark and decreased by a margin
of about 15 percent. Otter Tail
decreased by a margin of 17 percent
Wilkin decreased by the largest margin
of 34 percent, with a noticeable
2001
2004
2007
2010
Minnesota
Becker
Clay
Otter Tail
Wilkin decrease from 2007 to 2010.
Source: Minnesota Student Survey, 2010
45 | P a g e
Soda consumption in students: 2010
Percent of students who drank one or more glasses of pop/soda the previous day
70%
60%
50%
40%
30%
20%
10%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
Soda consumption can be more closely examined by comparing the soda consumption of 6 th, 9th, and
12th graders in 2010. Soda consumption in 6th graders is about 50 percent and consistent in all areas.
Wilkin has the most soda consumption in 9th graders, with 64 percent. Becker is consistently above the
state average in soda consumption across all grades. Clay and Otter Tail stay fairly close to the state
average, but tend towards a greater percentage across the grades. There was not much difference in
soda consumption between 6th, 9th, and 12th graders in Minnesota. Becker reported the highest
percentage of soda consumption in 9th and 12th grade. Otter Tail and Clay reported the highest
percentage of soda consumption in 12th grade. Wilkin was again greatest in 9th grade.
Community
Grocery store establishment rate per 100,000 population: 2010
20
18
16
14
12
10
8
6
4
2
0
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Community Health Needs Assessment Community Commons, US Census Bureau,
County Business Patterns, 2011
46 | P a g e
Grocery stores are defined as “supermarkets and smaller grocery stores primarily engaged in retailing a
general line of food, such as canned and frozen foods; fresh fruits and vegetables; and fresh and
prepared meats, fish, and poultry”.44 Included are delicatessen-type establishments, though
convenience stores and large general merchandise stores that also retail food, such as supercenters and
warehouse club stores, are not included in defined grocery store establishments in this data set. This
variable provides a measure of healthy food access and environmental influences on dietary behaviors.
The state of Minnesota reported a rate of 17.6 and Otter Tail was close with a rate of 17.5. Becker and
Clay reported rates below the state average, with 15.4 and 10.1 respectively. Wilkin reported 0 grocery
stores. Low grocery store access in Clay and Wilkin can be a factor into the nutrition. Becker and Otter
Tail are both fairly close to the state average.
Percent population with low food access: 2010
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Community Health Needs Assessment Community Commons, US Department of Agriculture,
Economic Research Service, USDA-Food Access Research Atlas, 2010
This indicator reports the percentage of the population living in census tracts that are designated as
“food deserts,” which are defined as “a low-income census tract where a substantial number or share of
residents has low access to a supermarket or large grocery store”.45 This indicator highlights populations
and geographies facing food insecurity. Counties with a higher percentage of the population living in
food deserts are likely to have more negative nutritional outcomes.
In 2010, Minnesota reported 30.1 percent of the population on average live in a food desert. Becker and
Wilkin both reported percentages above the state average, with 36.5 percent and 30.8 percent
respectively. Clay and Otter Tail both reported a lower percentage of the population living in food
deserts than the state average, with 23.6 percent and 21.7 percent respectively. Therefore, Becker and
Wilkin are at a greater risk for having negative nutritional outcomes than Clay and Otter Tail. One thing
to keep in mind is rural communities are more likely to have a high percent population living in food
deserts.
47 | P a g e
Percent of children eligible for free/reduced price lunches: 2000-2011
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Community Health Needs Assessment Community Commons, National Center for Education
Statistics
This data assesses vulnerable populations, which are more likely to have multiple health access, health
status, and social support needs. Children eligible for free or reduced price lunches often receive their
only meal or only substantial meal at school. This data can be looked at as a strong factor into the
nutritional and health outcomes of children.
The state of Minnesota reported that, on average, 35 percent of children were eligible for free or
reduced price lunches from 2000-2011. Clay is the only county that reported a percentage below the
state average, with 32.3 percent. Becker reported the greatest percentage, with 44.5 percent. Nearly
half of the children in Becker are eligible for free or reduced price lunches and therefore at risk for
negative nutritional outcomes. Otter Tail and Wilkin both reported 40 percent, which is still above the
state average.
Preventative Care
Immunizations and Vaccinations
Immunizations and vaccinations protect the health of entire communities. Immunizations are important
in not only preventing individuals from contracting disease, but in containing the disease and preventing
it from becoming widespread. This is especially important in protecting those who cannot be
immunized, such as children too young to be vaccinated, children and adults who cannot be vaccinated
for medical reasons, and those who cannot make an adequate response to vaccination.46 Those not
receiving vaccinations are not only at a higher risk for contracting potentially preventable diseases, but
are less likely to have healthy behaviors such as visiting a physician annually.
It is important to vaccinate children and adults alike. In about 50% of Minnesotan counties, less than
60% of children are up-to-date. Statewide, about 58% of children have received the entire
recommended series of vaccines.47
48 | P a g e
Percent of populations with two or more non-Influenza immunizations: 2013
4-month to 5-year population
19- to 64-year population
65-year or older population
Source: Minnesota Department of Health, MIIC Saturation
Non-influenza (non-flu) immunizations are most prevalent statewide in the 4-month to 5-year age
group. Fewer adults receive multiple non-flu immunizations than children, though more senior citizens
(age 65+) report receiving these immunizations.
These trends hold true in Becker, Clay, Wilkin, and Otter Tail County as well. Each county reported
between 90 and 100 percent of children, between 40 and 80 percent of adults, and between 60 and 95
percent of senior citizens receiving multiple non-influenza immunizations. Otter Tail consistently
reported the lowest non-flu immunizations percentages among the four counties.
Influenza Vaccinations: 2012-2013
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: 2012/2013 Seasonal Influenza Doses Administered Report
The state of Minnesota reported 36 percent of people received an influenza vaccination from 2012 to
2013. All counties reported percentages below the state average. Becker was fairly close to the state of
Minnesota, with 33.1 percent receiving an influenza vaccination. Otter Tail reported 29.3 percent and
Wilkin reported 28.5 percent. Clay was the lowest with 14.9 percent.
49 | P a g e
Chronic Health and Cancer Screenings
Diabetes management: 2010
Percent of Medicare enrollees with diabetes who receive an annual examor hemoglobin A1C test
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Community Health Needs Assessment, Dartmouth Atlas of Health Care, 2010
Chronic health conditions, like diabetes and heart disease, are not necessarily preventable, but they can
be more easily treated when caught earlier on.
All areas reported high percentages, meaning diabetes is well maintained across the board. Minnesota
reported 87.8 percent. Becker, Clay, and Wilkin were all below the state average, with 86.8 percent,
84.6 percent, and 85.5 percent, respectively. Otter Tail was above the state average, with 90.5 percent
of diabetic Medicare patients receiving a hemoglobin A1C test. However, all areas are fairly close,
differing by only about 5 percent.
Colon cancer screenings in males (age 50+): 2004-2010
Percent of men (ages 50+) who self-report ever having a sigmoidoscopy or colonoscopy
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
Minnesota
Clay
Otter Tail
Data unavailable for Becker and Wilkin counties
Source: Community Health Needs Assessment, Centers for Disease Control and Prevention,
Behavioral Risk Factor Surveillance System (2004-2010)
With cancers, those who are regularly screened are more likely to survive a diagnosis. For example
sigmoidoscopies or colonoscopies are screenings that may help men catch colon cancer early.
Becker and Wilkin had insufficient data, so neither is presented here. Minnesota reported 66.2 percent
of men who had been screened, while Clay reported 74.3 percent and Otter Tail reported 54.1 percent.
50 | P a g e
Breast cancer screenings in female Medicare enrollees: 2010
Percent of female Medicare enrollees who received a mammogram in the past 2 years
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Community Health Needs Assessment, Dartmouth Atlas of Health Care, 2010
Receiving a mammogram annually or every 2 years is not only a positive practice of preventative
behavior, but it increases the risk of breast cancer survival by detecting a tumor before it spreads.
All areas reported very similar percent of female Medicare enrollees receiving a mammogram in the
past 2 years. Minnesota reported an average of 72.6 percent. Becker was very close to this with 72.7
percent. Clay was slightly higher than the state average, with 76.9 percent, and Otter Tail reported the
greatest percentage, with 78.8 percent. Wilkin reported the lowest percentage, with 64.2 percent.
Cervical cancer screenings in women (age 18+): 2004-2010
Percent of women (ages18+) who self-report having had a Pap smear in the past 3 years
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
Minnesota
Becker
Otter Tail
Data unavailable for Clay and Wilkin counties
Source: Community Health Needs Assessment, Centers for Disease Control and Prevention, Behavioral
Risk Factor Surveillance System (2004-2010)
Each year in the United States about 12,000 women get cervical cancer.48 Most cervical cancers can be
detected early if a woman has routine Pap smears49 which can lead to better treatment options and
outcomes for these women.
In Minnesota, 81.9 percent of women reported receiving a Pap smear in the past three years. Becker
reported 84 percent, and Otter Tail reported 77 percent. Results were unavailable for Clay and Wilkin
due to insufficient data.
51 | P a g e
Percent of Minnesota teen girls (ages 13-17) receiving 3-dose HPV vaccination
50
40
30
20
10
0
2008
2009
2010
Source: Center for Disease Control and Prevention [19], Minnesota Student Survey
Almost all of cervical cancer cases are associated with the genital human papillomavirus (also called
HPV), the most common sexually transmitted infection. Approximately 20 million Americans are
currently infected with HPV, with another 6 million people becoming infected each year.50 Two vaccines
are available to protect females against the types of HPV that cause most cervical cancers and most genital
warts, while one vaccine is available for boys and men to protect against most genital warts and anal
cancers.51 Here we see that the number of 13- to 17-year-old girls vaccinated against HPV increased each
year, suggesting that more girls are protecting themselves against this virus.
Oral Health
Annual dental check-ups are necessary for the proper maintenance of oral health. Those who engage in
preventative behaviors, such as an annual dental exam, are more likely to have positive health
outcomes and face less health complications later on. Low percentages of adults receiving dental exams
can possibly highlight other issues within the community, such as a lack of access to dental care, a lack
of health knowledge, insufficient provider outreach, and social barriers preventing utilization of services.
Percent adults without a dental exam in the last year: 2006-2010
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Minnesota
Becker
Clay
Data for Wilkin unavailable
Otter Tail
Source: Community Health Needs Assessment Community Commons, Centers for Disease Control and
Prevention, Behavioral Risk Factor Surveillance System (2006-2010)
Data for Wilkin was unavailable, due to small numbers. Minnesota reported only 22.4 percent of the
population on average received a dental exam within the past year from 2006-2010. Becker reported a
noticeably higher percentage, with 42.2 percent. Clay and Otter Tail were fairly similar to the state
average, with 20.5 percent and 22.8 percent respectively.
52 | P a g e
Car Safety
Booster seats are also required by law in Minnesota, for children who have outgrown a forward-facing
harnessed restrain but who are still too small to correctly fit into an adult safety belt (usually those
around age four and those who weigh between 40 and 60 pounds). In a 2011 survey,52




Two-thirds of children were found to be properly restrained in a booster seat
Female caregivers were more likely to put children in boosters than males
Only half of young caregivers (between age 16 and 29) used booster seats
If the driver wasn’t wearing a seatbelt, only 27 percent of the children were in a booster seat
Both booster seats and safety belts (also called seatbelts) are highly effective in reducing injury and
death from motor vehicle crashes. Minnesota reached a statewide seatbelt use rate of 93 percent in
2011, the highest in the state’s history. Rates of use had been steadily increasing since 2003, and
increased even more with passage of the state’s Primary Seat Belt Law in 2009.53 The lowest rates of
safety belt use are found among young people, particularly male pickup truck drivers.54
Students who always wear a seatbelt 1998-2010
Percent of students who always wear a seatbelt when riding in a car
6th Grade
100%
80%
60%
40%
20%
0%
1998
2001
2004
2007
2010
th
9 Grade
100%
80%
60%
40%
20%
0%
1998
2001
2004
2007
2010
Seatbelt use in 6th grade students has
increased from 1998 to 2010 in all areas.
Overall, Minnesota has increased its
seatbelt use in 6th grade students by a
margin of 11 percent. Wilkin has
increased by a margin of 10 percent.
Otter Tail and Clay have both increased
by a margin of 22 percent. Becker has
increased by largest margin of 34
percent. There are not major differences
among the areas for 6th grade students.
Seatbelt use in 9th grade students has
increased by an even greater margin from
1998 to 2010. All counties reported
similar increases and percentages. Becker
increased by the largest margin of 37
percent and Wilkin increased by a
noticeable margin of 30 percent. There is
more variation in the percentages than
with the 6th grade data. Otter Tail and
Wilkin consistently reported the lowest
percentages.
53 | P a g e
12th Grade
There were similar percentages reported
in 9th and 12th grade students. Becker
reported largest margin of increase of 40
percent. Clay increased by a noticeable
margin of 34 percent. Otter Tail and
Wilkin consistently reported the lowest
percentages.
100%
80%
60%
40%
20%
0%
1998
2001
2004
Minnesota
Becker
Clay
2007
Otter Tail
2010
Wilkin
Overall, the consistent percentage of
seatbelt use above 40 percent reflects
improvements of car safety awareness
and action across all counties and the
state of Minnesota since 1998.
Source: Minnesota Student Survey, 2010
Students who always wear a seatbelt: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
6th Grade
Minnesota
9th Grade
Becker
Clay
12th Grade
Otter Tail
Wilkin
Source: Minnesota Student Survey, 2010
Further comparisons can be made, by looking at the data on seatbelt use in students in the year 2010. In
6th grade, Becker reported about 10 percent more students wearing seatbelts than Minnesota, Clay, and
Otter Tail and about 20 percent more than Wilkin. In 9th and 12th grade, Becker, Clay, and Minnesota
reported very similar percentages. Otter Tail was around 10 to 15 percent lower and Wilkin was around
20 percent lower. Across the board, Wilkin reported the least amount of seatbelt use and Becker
reported the most. There were both increases and decreases between the grades so no trend on
seatbelt use between the grades can really be seen.
54 | P a g e
Alcohol-related accidents 2005-2012
Percent of the total alcohol-related accidents in the state of Minnesota in each county
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
2005
2006
2007
Becker
2008
Clay
2009
Otter Tail
2010
2011
2012
Willkin
Source: Minnesota Department of Public Safety, Office of Traffic Safety
Out of all the alcohol-related accidents in the state of Minnesota, none of the four counties contributed
more than about 2 percent. Clay consistently reported the highest percentage of alcohol-related
accidents, ranging from 1.5 percent to 2.2 percent of Minnesota’s alcohol-related accidents (meaning
1.5 to 2.2 percent of the accidents in Minnesota occurred in Clay County). Becker and Otter Tail
reported similar percentages in the middle of the data, ranging from 0.8 percent to 1.1 percent. Wilkin
contributed the lowest percent of alcohol-related accidents, with only between 0.1 and 0.2 percent.
One reason for Wilkin’s lower percentages is that they have a noticeably lower population than the
other three counties, so it is expected that there would be fewer accidents, and consequently, fewer
alcohol-related accident. Becker and Otter Tail have the greatest population sizes, which could help
explain their higher percentage. However, Clay has a smaller population than Becker and Otter Tail, so it
is interesting that they contributed a higher percentage of alcohol-related accidents.
Students who have driven after drinking alcohol: 1998-2010
Percent of students who drove a motor vehicle after using alcohol or other drugs in the last 12 months
9th Grade
No data was given for 6th grade students.
60%
50%
40%
30%
20%
10%
0%
1998
2001
2004
2007
2010
The percent of 9th grade students who
have driven a motor vehicle after using
alcohol or other drugs has decreased since
1998. Wilkin county showed a large drop
from 1998 to 2001 and the overall greatest
margin of decrease at 18 percent. Clay
county, Otter Tail county and the state of
Minnesota were consistently low in percent
of students driving after alcohol/drug use,
remaining in the single digits over the span
of 12 years. Becker county had a spike in
2004 but has dropped to below 5 percent.
55 | P a g e
12th Grade
60%
50%
40%
30%
20%
10%
0%
1998
Minnesota
2001
Becker
2004
Clay
2007
Otter Tail
2010
Wilkin
Since 1998, the percentage of 12th grade
students who have driven after using
alcohol or other drugs has consistently
dropped. The state of Minnesota has stayed
fairly constant from 1998 to 2010, with a
range starting from 33 percent to the most
recent 29 percent. Becker has the lowest
reported percentage in 2010 at 9 percent.
Wilkin county has the largest margin of
overall decrease at around 40 percent.
Otter Tail county has decreased to 20
percent from 50 percent and Clay has also
decreased to 20 percent, but starting from
40 percent in 1998.
Source: Minnesota Student Survey, 2010
Students who have driven after drinking alcohol: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
25%
20%
15%
10%
5%
0%
9th Grade
Minnesota
Becker
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
Looking at the data for 2010, there is a clear difference between 9th and 12th grade students in this
behavior. This can most likely be attributed to the fact that the average 9th grade student is not at the
appropriate age to drive in the first place, and therefore is less likely to operate a motor vehicle after
using alcohol or other drugs. Becker County shows the lowest percent of 12th grade students driving
after consuming alcohol or using drugs, where all other counties and Minnesota show similar
percentages surrounding 20 percent. Wilkin has the most 9th grade students participating in this
dangerous behavior.
56 | P a g e
Tobacco Use
Students who smoke cigarettes: 1998-2010
Percent of students who smoked cigarettes in the last 30 days
6th Grade
Tobacco use in 6th grade students has
slightly decreased since 2001. The margin
of decrease is not noticeable, however.
Otter Tail reported the most tobacco use
in 6th grade students with 6 percent in
2001 and 4 percent in 2010. Tobacco use
in 6th grade students is fairly minimal so
the percentages among the counties are
similar.
60%
50%
40%
30%
20%
10%
0%
2001
2004
2007
2010
th
9 Grade
60%
50%
40%
30%
20%
10%
0%
2001
2004
2007
2010
12th Grade
60%
50%
40%
30%
20%
10%
0%
2001
Minnesota
2004
Becker
2007
Clay
Otter Tail
2010
Tobacco use in 9th grade students has also
decreased since 2001, but by a greater
margin. Becker reported the greatest
margin of decrease from 2001 to 2010,
with 13 percent. Minnesota and Clay both
decreased by a margin of 10 percent,
Wilkin decreased by a margin of 8
percent, and Otter Tail decreased by a
margin of 7 percent.
Tobacco use in 12th grade students
decreased by a greater margin, but
reported greater percentages as well. In
2001, Wilkin reported a noticeably higher
percentage of tobacco use than the other
areas with 56 percent. It also decreased
by the greatest margin, 31 percent. Otter
Tail decreased by the smallest margin, 9
percent. Minnesota decreased by a
margin of 15 percent, Becker decreased
by a margin of 19 percent, and Clay
decreased by a margin of 23 percent.
Overall, tobacco use has decreased from
2001 to 2010 but increases from 6th grade
to 9th grade to 12th grade.
Wilkin Source: Minnesota Student Survey, 2010
57 | P a g e
Students who smoke cigarettes in the last 30 days: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
30%
25%
20%
15%
10%
5%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
As suspected from the time series graphs, tobacco use is greatest in 12th grade students and lowest in 6th
grade students as of 2010. Also, the range of percentages across the areas shortens from 12th grade to
6th grade. The percent of 12th grade students that smoke cigarettes ranges from 18 to 26 percent. In 9th
grade students, it ranges from 8 to 11 percent. In 6th grade students, it ranges from 1 to 4 percent. In all
grades, Otter Tail reported the greatest percentage of tobacco usage and Clay reported the lowest.
Percent of Adult Smokers in Minnesota 1995-2010
30%
25%
20%
15%
10%
5%
0%
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Source: Center for Disease Control and Prevention, Behavioral Risk Factor Surveillance System
Fewer Minnesotan adults smoke now than in the last 15 years, and the remaining smokers consume
fewer cigarettes per day.55 In addition, fewer Minnesotans report being exposed to secondhand
smoke.56 The percent of adult smokers in the state of Minnesota has decreased inconsistently since
1995, with the most noticeable increases between 1998 and 2001. Overall, the percent of adult smokers
went from 20.5 percent in 1995 to 14.9 percent in 2010.
58 | P a g e
Alcohol Use and Substance Abuse
Alcohol is consumed by more people than any other drug, including tobacco. The younger a person
begins drinking regularly, the greater the chance that person will develop a clinically defined alcohol
disorder like alcoholism. Youth who start drinking before age 15, compared to those who start at 21, are
far more likely to be injured while under the influence of alcohol, to be in a motor vehicle crash after
drinking, or to become involved in a physical fight after drinking. 57 Binge drinking – consuming a great
deal of alcohol in a short period of time - is associated with the same serious long-term health problems
as other forms of alcohol abuse58 and the additional higher risk of alcohol poisoning.
Students who used drugs/alcohol before/during school: 1998-2010
Percent of students who used drugs or alcohol before OR during school
6th Grade
From 1998 to 2010, the percent of 6th
grade students using drugs or alcohol
before or during school has been
constant and low. The percentages
ranged from 0 to 3 percent, most likely
due to low exposure in 6th grade.
25%
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
th
9 Grade
25%
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
th
12 Grade
25%
20%
9th grade students have shown an overall
decrease since 1998. The largest margin
of decrease was from 1998 to 2007. Otter
Tail has decreased by the largest margin,
14 percent. In 1998 and 2010, Wilkin
reported the highest percent of students.
The overall percent of 12th grade students
has steadily decreased from 1998 to
2010. Wilkin decreased by the greatest
margin, 17 percent. Becker, Clay, Otter
Tail, and Minnesota decreased following
similar trends. Beside Wilkin, the counties
and Minnesota average around 10
percent in 2010, compared to the initial
average around 19 percent in 1998.
Overall, there is a decrease in the
percentage of 9th and 12th grade students
using drugs or alcohol from 1998 to 2010.
The percentage of 6th grade students has
remained fairly constant and low due to
percentages reported below 3 percent.
15%
10%
5%
0%
1998
Minnesota
2001
Becker
2004
Clay
2007
Otter Tail
2010
Wilkin
Source: Minnesota Student Survey, 2010
59 | P a g e
Students who used drugs or alcohol before or during school: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
14%
12%
10%
8%
6%
4%
2%
0%
6th Grade
9th Grade
Minnesota
Becker
Clay
12th Grade
Otter Tail
Wilkin
Source: Minnesota Student Survey, 2010
In 2010, 12th grade reported the greatest percentage of students who used drugs or alcohol before or
during school, and 6th grade reported the lowest percentage. From this it can be seen that more
students use drugs or alcohol as age increases. The greatest difference can be seen between 6th grade
and 9th grade students. This can be due to a greater exposure to these substances in high schools. All
counties reported a lower percentage for 12th grade students than the state of Minnesota. Wilkin had
interesting data with relatively high percentages reported for 6th and 9th grade students, but reported a
very low percentage of 12th grade students. Excluding the unexpected Wilkin difference, percentages
for each grade only differed by about 3 percent between the areas. The major trend here is the
increasing percent of students using drugs or alcohol before or during school from 6th grade to 12th
grade.
Students who engaged in binge drinking: 1998-2010
Percent of students who engaged in binge drinking in the last two weeks
9th Grade
Data for 6th grade students was not
available.
60%
50%
40%
30%
20%
10%
0%
1998
2001
2004
2007
2010
Binge drinking in 9th grade students has
decreased from 1998 to 2010. Wilkin
experienced the greatest decrease of 27
percent. Otter Tail decreased by 15
percent. Becker decreased by 13 percent.
Clay decreased by 8 percent and
Minnesota decreased by 10 percent. In
2010, all areas reported similar
percentages around 10 percent.
60 | P a g e
12th Grade
Binge drinking in 12th grade students has
decreased from 1998 to 2010 as well.
Wilkin and Clay experienced the greatest
decreases of about 30 percent. Becker
decreased by 20 percent and Otter Tail by
13 percent. All counties experienced a
greater decrease than Minnesota, which
only decreased by 10 percent.
60%
50%
40%
30%
20%
10%
0%
1998
2001
Minnesota
Becker
2004
Clay
2007
Otter Tail
2010
Wilkin
Overall, binge drinking has decreased in
both 9th and 12th grade students from
1998-2010 by about 15 to 30 percent.
Source: Minnesota Student Survey, 2010
Students who engaged in binge drinking in the last two weeks: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
30%
25%
20%
15%
10%
5%
0%
9th Grade
Minnesota
Becker
Clay
12th Grade
Otter Tail
Wilkin
Source: Minnesota Student Survey, 2010
As expected from the data shown in the previous time series graphs, there are an overall higher
percentage of 12th grade students who engaged in binge drinking in 2010. Each area reported similar
percentages of 9th grade students engaging in binge drinking, around 10 percent.
However, 12th grade students show a high binge drinking average when compared to 9th grade. Becker
and Clay counties have the lowest reported percentage and comparable populations. Otter Tail has a
similar population size to Becker and Clay, as well, but displays the highest percent of 12th grade
students engaged in binge drinking, at 26 percent.
61 | P a g e
Students who used marijuana: 1998-2010
Percent of students who used marijuana one or more days in the last 30 days
6th Grade
35%
From 1998 to 2010, the percentage of 6th
grade students who reported using
marijuana remained fairly constant and
low. The percentages ranged from 0 to 2
percent. This is most likely due to the low
exposure to marijuana in 6th grade
students.
30%
25%
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
th
9 Grade
35%
30%
25%
20%
15%
10%
5%
0%
1998
2001
2004
12th Grade
35%
30%
25%
20%
15%
10%
5%
0%
2007
2010
In 9th grade students, higher percentages
were reported and a noticeable decrease
was shown over time. Wilkin reported the
greatest margin of decrease with 20
percent. Becker reported the smallest
margin of decrease of only 2 percent and
reported increase from 1998 to 2001 and
2007 to 2010. The percentages had a
range of 11 percent in 1998, but only
differed by 7 percent in 2010.
In 12th grade students, there were both
increases and decreases between 1998
and 2010 that resulted in fairly similar
percentages reported in 1998 and 2010 in
all areas. Clay was the only area that
reported a noticeable decrease of 13
percent. Minnesota decreased steadily
by a margin of 1 percent. Wilkin
decreased by a margin of 2 percent
Becker decreased slightly in 2001 and
2004, but experienced no overall change.
Otter Tail decreased by an overall margin
of 1 percent.
Overall, marijuana use was consistently
low in 6th grade students, varied in 12th
1998
2001
2004
2007
2010
th
Minnesota
Becker
Clay
Otter Tail
Wilkin grade students, and decreased in 9
grade students from 1998 to 2010.
Source: Minnesota Student Survey, 2010
62 | P a g e
Students who used marijuana one or more days in last 30 days: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
25%
20%
15%
10%
5%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
In 2010, marijuana use was lowest in 6th grade students and highest in 12th grade students All counties
reported a lower percent of 12th grade students who use marijuana than Minnesota. This is a positive
sign of health in these communities.
In 9th grade students Becker, Clay, and Minnesota reported higher percentages than Otter Tail and
Wilkin by about 5 percent. Furthermore, the percent of 9th grade students using marijuana in Otter Tail
and Wilkin is only slightly higher than the percent of 6th grade students. This suggests that Otter Tail and
Wilkin have relatively low exposure to marijuana for both 6th grade and 9th grade students. Overall, the
major trend is increasing use of marijuana with age.
Students who used prescription drugs to get high: 1998-2010
Percent of students who used prescription drugs to get high one or more times in the last 12 months
From 1998 to 2010, the percent of 6th grade
6th Grade
14%
students who reported using prescription
drugs was constant and low. All areas
12%
averaged 1 percent from 1998 to 2010.
10%
8%
6%
4%
2%
0%
1998
2001
2004
2007
2010
The percent of 9th grade students using
prescription drugs has decreased noticeably
from 1998 to 2010. All areas reported 0
percent in 2007 and 2010. This sudden drop
could be due to some error in surveying. For
the exception of Clay, all areas decreased
from 1998 to 2001 and increased from 2001
63 | P a g e
9th Grade
to 2004. Even though the decrease to 0
percent in 2007 and 2010 is suspect, it does
strongly suggest that there was an overall
decrease in prescription drug use in 9th grade
students from 1998 to 2010.
14%
12%
10%
8%
6%
4%
2%
0%
1998
2001
2004
2007
2010
th
12 Grade
14%
12%
10%
8%
6%
4%
2%
0%
1998
Minnesota
2001
Becker
2004
Clay
2007
Otter Tail
2010
Wilkin
Prescription drug use in 12th grade students
increased and decreased from 1998 to 2010.
Wilkin and Otter Tail both increased
noticeably from 1998 to 2001. Becker and
Minnesota increased from 1998 to 2004.
These increases were followed by a
noticeable decrease. All areas again
reported 0 percent in 2007 and 2010. This
may be suspect, but an overall decrease
from 1998 to 2010 in prescription drug use
in 12th grade students is reasonable to
assume.
Overall prescription drug use in students has
followed no clear trend. The data suggests
an overall decrease from 1998 to 2010 in
students.
Source: Minnesota Student Survey, 2010
Violence
The same factors that influence the lifestyle people live and their resulting level of health—physical
activity, preventative care, nutrition—also are linked to the experience of violence. Violence and crime
affect health in multiple ways. High-crime neighborhoods keep people isolated from one another by
keeping them indoors and limiting opportunities both for interaction with neighbors and for physical
activity. Individuals who experience crime as well as those who witness or hear about it experience a
range of effects from a delay in cognitive development (for children) to poor mental health.
There are two aspects of violence that make it both a health factor and a health outcome. When
examined as a factor, violence statistics depict an environment or the kind of lifestyle that would
influence the health of the community. When looked at as an outcome, specific outcomes of violent
events are examined. These can include motor vehicle deaths and injuries as well as suicides. Violence
factors do impact violence outcomes, however violence factors also impact other aspects of health as
described above.
Violence is not randomly distributed; some groups of Minnesotans are more likely to be affected by
violence than others, resulting in different effects on health being felt in different areas, depending on
the difference in violent environment.
64 | P a g e
Violence Rates
Violent Crime Rate: 2008-2012
The violent crime rate is defined as the number of “violent crimes” per 1,000 inhabitants.
3
2
1
0
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Uniform Crime Reporting, FBI
Violent crimes include “murder, rape and sexual assault, robbery, and assault”. All counties reported less
than half of the violent crime rate of the state of Minnesota. This is to be expected since the state
average is heavily influenced by high crime rates in urban areas. Among the four counties, Becker and
Clay reported rates of 1.04 and 0.98 violent crimes per 1,000 inhabitants respectively. Otter Tail was
slightly lower, with a rate of 0.71, and Wilkin was the lowest, with 0.42. The rates within the counties
were not very different, differing by less than a percent.
Children’s Serious Crime Rate: 2007-2009
Rate of children ages 10-17 years arrested for “serious crimes” per 1,000
25
20
15
10
5
0
2007
Minnesota
Becker
2008
Clay
Otter Tail
Wilkin
2009
Source: Minnesota Department of health, Center for Health Statistics
Here we define serious crimes as “murder, rape, robbery, aggravated assault, burglary, larceny, vehicle
theft and arson,” and the rate per 1,000 is calculated by dividing the number of juvenile arrests by the
number of children ages 10-17. 59 The children’s serious crime rate is lower in all counties than the
state of Minnesota by a rate margin of about 5-10. Wilkin consistently reported a serious crime rate of
around 115 from 2007 to 2009; this was the greatest rate of all the counties. It is possible, however, that
Wilkin could experience the same number or fewer serious crimes in children, since their population is
so small compared to the other counties, which would make it look like they have a higher “crime rate.”
65 | P a g e
Relationship and Sexual Violence
Students who report relationship violence: 2007 &2010
th
Percent of 9 and 12th grade students who report someone they are going out with has ever hurt,
threatened, or forced them to have sex compared from 2007 to 2010
9th Grade
12th Grade
20%
20%
15%
15%
10%
10%
5%
5%
0%
0%
Dark indicates 2007 and light indicates 2010
Dark indicates 2007 and light indicates 2010
Source: Minnesota Student Survey, 2010
Data was unavailable for 6th grade students because the survey did not choose to survey 6th grade
students on this topic. Among 9th grade and 12th grade students in 2007 and 2010, there are not drastic
differences between percentages of students reporting sexual or relationship violence.
In Minnesota, 5 percent more 12th grade students reported relationship violence than 9th grade students
for both 2007 and 2010. Becker reported more relationship violence in 12th grade students than 9th
grade students, with a more noticeable difference in 2010. Wilkin reported an increase of 8 percent of
9th grade students who reported relationship violence from 2007 to 2010, but a decrease in violence of 7
percent for 12th grade students. Otter Tail also reported a 5 percent decrease in relationship violence for
9th grade students.
Overall, reported relationship violence in 12th grade students was slightly higher than 9th grade students.
This could indicate either more relationship violence in 12th grade students or a greater ability to report
relationship violence in 12th grade students.
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Students who report inappropriate sexual touching: 1998-2010
Percent of students who reported that someone inside or outside the family has touched them sexually
6th Grade
The percent of 6th grade students who
reported being touched inappropriately
were low and varied over the time
period. Wilkin reported the highest
percentage of 8 percent in 2010. Over the
time period, Minnesota and Otter Tail
reported an average of 5 percent and
Becker, Clay, and Wilkin reported an
average of 4 percent.
14%
12%
10%
8%
6%
4%
2%
0%
1998
2001
2004
2007
2010
9th Grade
14%
12%
10%
8%
6%
4%
2%
0%
1998
2001
2004
2007
2010
12th Grade
14%
12%
10%
The percentages reported in 9th grade
students decreased from 1998 to 2010.
Becker and Otter Tail decreased by the
greatest margin of 4 percent. Wilkin
decreased by a margin of 3 percent.
Minnesota and Clay decreased by a
margin of 2 percent.
The percent of 12th grade students who
reported being touched varied from 1998
to 2010, but all areas decreased overall.
Becker, Otter Tail, and Wilkin reported
the greatest margin of decrease, with 6
percent. On average, from 1998 to 2010,
Becker reported 8 percent, Minnesota,
Clay, and Otter Tail reported 7 percent,
and Wilkin reported 6 percent.
Overall, there has been no consistent
trend in the percent of 6th, 9th, and 12th
grade students reporting being touched
inappropriately from 1998 to 2010. The
percentages have varied over time,
ranging on average from 6 to 12 percent.
8%
6%
4%
2%
Source: Minnesota Student Survey, 2010
0%
1998
Minnesota
2001
Becker
2004
Clay
2007
Otter Tail
2010
Wilkin
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Students who report household abuse: 1998-2010
Percent of students who reported that an adult in their household has ever hit them so hard or so often
that they had marks or were afraid of that person
6th Grade
All areas followed similar, inconsistent
trends for the percent of 6th grade
students that reported household abuse.
Becker consistently decreased by a
margin of 5 percent. On average, from
1998 to 2010, 10 to 12 percent of 6th
students within these areas reported
household abuse.
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
th
9 Grade
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
12th Grade
20%
15%
10%
5%
0%
1998
Minnesota
2001
2004
Becker
Clay
2007
Otter Tail
2010
The percent of 9th grade students who
reported household abuse varied from
1998 to 2010. Wilkin was the only area to
increase by a margin of 2 percent from
1998 to 2010. Over the time period, Otter
Tail and Clay reported percentages below
those of the state of Minnesota. Wilkin
reported lower percentages than
Minnesota until 2010. Becker has
experienced sharp increases and
decreases in data, resulting in a
fluctuation around the state average.
The percentages for 12th grade students
who reported household abuse were
much more consistent across the areas,
ranging from 7 to 9 percent. Minnesota
ranged from 8 to 9 percent. Becker
reported a peak of 11 percent in 2004,
but experienced no overall change. Wilkin
and Otter Tail both decreased from 1998
to 2010. Clay increased by a margin of 4
percent.
The percent of students who reported
household abuse showed no noticeable
trend, ranging on average from 5 to 15
percent.
Wilkin Source: Minnesota Student Survey, 2010
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Students who report household abuse: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
16%
14%
12%
10%
8%
6%
4%
2%
0%
6th Grade
9th Grade
Minnesota
Becker
Clay
12th Grade
Otter Tail
Wilkin
Source: Minnesota Student Survey, 2010
When comparing the percent of students who report household abuse in the state of Minnesota, 6th
grade has the highest percentage of students and 12th grade has the lowest percentage of students. Clay
and Otter Tail follow this same trend. In Becker and Wilkin, 12th grade still had the lowest percent of
students who reported household abuse. However, in these counties, 9th grade had the greatest percent
of students who reported household abuse, rather than 6th grade students. There is no clear overall
trend in students who report household abuse, but on average, 10 percent of students reported
household abuse.
Mental Health in Students
When a person experiences mental or emotional health issues, it undoubtedly affects their everyday
functioning. Mental and emotional health struggles can strain relationships, affect the ability to and
quality of work, and potentially lead to self-harm. Depression and anxiety can also affect a person’s
ability to participate in healthy activities and can disrupt connections to helpful social supports.60
Physical or medical conditions can also lead to mental health struggles. Physical pain and depression are
strongly associated: More than 65 percent of adults with a mental disorder reported also having at least
one general medical disorder. The connections between mental and physical health are complex and
move in both directions. Socioeconomic factors, such as low income and poor educational attainment,
are associated with both mental disorders and medical conditions.61
Furthermore, individuals with serious mental illness die an average of 25 years earlier than those
without.62 This holds true in Minnesota, as well: a study of Minnesotans receiving services through
Minnesota Health Care Programs found that Minnesotans with serious mental illness do not live past an
average age of 58, while those without mental illness live to an average age of 82.63
69 | P a g e
When adolescents experience emotional distress, it can affect their ability to develop, to learn, and to
make sound decisions about their behavior. This distress can also lead to immediate physical dangers in
adolescents, like cutting and other forms of self-harm, as well as suicide and attempts at suicide.
However, protective factors like the involvement of caring friends and adults moderate the effects of
negative life experiences, and improve the opportunity for positive health outcomes and overall wellbeing in adolescents.64
Students who felt nervous, worried, or upset: 1998-2010
Percent of students who felt nervous, worried, or upset all or most of the time in the last 30 days
6th Grade
The percent of 6th grade students who have
felt nervous, worried, or upset all or most of
the time was fairly constant, ranging
between 10 and 15 percent. Wilkin reported
the greatest difference in percentages across
the years examined with a range of 7
percent. The state of Minnesota varied the
least, with a range of only 1 percent.
30%
25%
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
th
9 Grade
30%
25%
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
th
12 Grade
30%
25%
20%
15%
10%
5%
0%
1998
Minnesota
2001
Becker
2004
Clay
2007
Otter Tail
2010
Wilkin
The percent of 9th grade students varied
greatly over time. All areas except Becker
show a decreasing trend from 1998 to 2010.
Otter Tail and Wilkin decreased by the
greatest margin of 9 percent. Clay decreased
by a margin of 5 percent. Minnesota
decreased by a margin of 3 percent. Becker
reported the only increase by a margin of 3
percent. Wilkin reported the greatest range
of data, from 11 to 27 percent.
The percentages reported in 12th grade
students varied less than those of 9th grade
students. All regions averaged between 10
and 17 percent, similar to the average in 6th
grade students. Wilkin decreased by the
greatest margin of 11 percent. Otter Tail
decreased by a margin of 8 percent. Becker
and Minnesota decreased by a margin of 1
percent. Clay reported no overall change.
The percentages reported in 6th and 12th
grade students were fairly consistent over
time, ranging from 7 to 16 percent. The
percent of 9th grade students reported a
noticeable decrease from 1998 to 2010.
Source: Minnesota Student Survey, 2010
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Students who have felt nervous, worried, or upset: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
Wilkin
12th Grade
Source: Minnesota Student Survey, 2010
This graph looks at the students who have felt nervous, worried, or upset in 2010 with a comparison
across all grades. Less than 20 percent of students report feeling nervous, worried, or upset all or most
of the time in the last 30 days. Most of the time, the counties reflect the state average in both 6 th and 9th
grade students.
The counties consistently report lower than the state average in 12th grade students, with the exception
of Clay County, which remains at the state average. These percentages do not seem to draw any
attention for concern besides possibly Wilkin County 9th grade students after other factors such as
population size are considered. The mental health of 6th, 9th, and 12th grade students for Becker, Clay,
Otter Tail, and Wilkin all seem to fall within the state norms.
Students who felt stressed/pressured: 1998-2010
Percent of students who felt under great stress or pressure in the last 30 days
6th Grade
The percent of 6th grade students that felt
under great stress or pressure averaged
about 15-20 percent from 1998 to 2010.
There is a slight decreasing trend from
1998 to 2010 in all regions. Wilkin County
reported the lowest percentage in 2007
at 10 percent, but spiked back up again in
2010 to 20 percent.
50%
40%
30%
20%
10%
0%
1998
2001
2004
2007
2010
9th grade students reported a higher
average than 6th grade students, at about
30 percent. Wilkin reported the greatest
71 | P a g e
9th Grade
range of 22 to 39 percent. Clay reported
the greatest margin of decrease of 11
percent. Otter Tail decreased by a margin
of 6 percent. Minnesota decreased by a
margin of 4 percent. Becker and Wilkin
increased by a margin of 1 percent.
50%
40%
30%
20%
10%
0%
1998
2001
2004
2007
2010
th
12 Grade
50%
40%
30%
20%
10%
0%
1998
Minnesota
2001
2004
Becker
Clay
2007
Otter Tail
2010
Wilkin
The percent of 12th grade students that
reported feeling great stress or pressure
is noticeably higher, averaging about 40
percent. Becker reported a similarly high
average compared to Minnesota. Otter
Tail, Clay, and Wilkin reported averages
less than Minnesota. Still, less than half of
the 12th grade students in these counties
and the state of Minnesota are reporting
great stress or pressure.
Overall, the percent of students feeling
stressed or pressured is consistent over
time, but increases on average by 10
percent from 6th to 9th grade students and
by 10 percent from 9th to 12th grade
students.
Source: Minnesota Student Survey, 2010
Students who have felt stressed/pressured: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
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Comparing the grades and each county in the year 2010 shows that 12th grade students overall
experience the most feelings of great stress and pressure. This is to be expected, as there is greater
pressure in general at this age, such as applying to colleges or working jobs outside of school. There are
similar percentages in 6th grade students experiencing stress and pressure in all areas. The 9th grade
students report stress and pressure levels, on average lower or the same as the 12th grade students,
which is also to be expected since responsibilities tend to increase at this age.
Students who felt sad all or most of the time: 1998-2010
Percent of students who felt sad all or most of the time in the last 30 days
6th Grade
On average, about 10 percent of 6th grade
students from 1998 to 2010 reported feeling
sad all or most of the time. Across the counties
and the state of Minnesota, the percent of
students reporting feelings of sadness has
remained fairly constant, with the exception of
Wilkin. Wilkin reported a noticeable margin of
increase, 5 percent.
25%
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
th
9 Grade
25%
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
12th Grade
25%
20%
15%
10%
5%
0%
1998
Minnesota
2001
Becker
2004
Clay
2007
Otter Tail
2010
Wilkin
9th grade students report a greater average at
about 15 percent. Minnesota consistently
reported 13 to 14 percent. Becker reported the
greatest range of data from 10 percent in 2001
to 22 percent in 2007. Other counties like
Wilkin and Otter Tail show variability over the
years but averaging out to less than 15 percent
of students reporting feelings of great sadness.
Across all counties and the state of Minnesota,
an average of 10 percent of 12th grade students
report feeling sad all or most of the time in the
last 30 day, with little variability over the time
period. Wilkin reported the lowest average
percentage from 1998 to 2010 with 8 percent.
Minnesota and Becker reported the greatest
average percentage over the time period, 11
percent. Clay reported an average of 9 percent
and Otter Tail reported an average of 10.
Overall, 6th and 12th grade students reported
little variation and average about 10 percent.
9th grade students reported more variation and
averaged about 15 percent.
Source: Minnesota Student Survey, 2010
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Students who felt sad all or most of the time: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
In 2010, the data show that 9th grade students have slightly higher percentages of students reporting
sadness all or most of the time than both 6th and 12th grade students. It is difficult to tell what these data
really say about the presence of sadness in the students of Minnesota. Generally, each county has fairly
low percentages of sad students with the highest being 18 percent of Becker County 9th grade students.
Students who report that they have carried a weapon on school property: 1998-2010
Percent of students who report that they have carried a weapon on school property one or more times in
the last 30 days
th
For 6th grade students, the percent of
6 Grade
14%
students carrying weapons on school
12%
property was low. There is no clear trend
10%
from 1998 to 2010 and averages over
time ranged from 1 to 6 percent, with the
8%
exception of Becker in 1998. Although
6%
there is not a great margin of decrease,
4%
the percentages were consistently below
2%
10 percent.
0%
1998
2001
2004
2007
2010
74 | P a g e
9th Grade
9th grade students in the Minnesota,
Becker, Otter Tail, and Wilkin decreased
slightly from 1998 to 2010. Clay county
reported an increase from 6 percent in
1998 to 9 percent in 2004 and then back
down to 7 percent in 2010. All areas
peaked in 2004. The percentages over
time differed by 1 to 4 percent.
14%
12%
10%
8%
6%
4%
2%
0%
1998
2001
2004
2007
2010
th
12 Grade
14%
12%
10%
8%
6%
4%
2%
0%
1998
Minnesota
2001
Becker
2004
Clay
2007
Otter Tail
2010
Wilkin
The percent of 12th grade students that
reported having carried a weapon on
school property does not show a clear
trend. Becker reported a noticeable
increase of 6 percent from 1998 to 2007
followed by a sharp decrease of 4 percent
in 2010. Otter Tail decreased by a margin
of 6 percent. Minnesota, Clay, and Wilkin
share a similar pattern, ranging from 6 to
10 percent across all years. Overall, 12th
grade students overall have a slightly
higher average than the 6th and 9th grade
students.
Source: Minnesota Student Survey, 2010
Students who report that they have carried a weapon on school property: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
14%
12%
10%
8%
6%
4%
2%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
75 | P a g e
The data from 2010 give a good summary of the percent of students carrying weapons onto school
property. Even with the 6th grade students appearing to have the lowest percent of students displaying
this behavior, it seems that there is no stark difference across the age groups because the percentages
are so low with the highest being only 10 percent from Wilkin’s 9th grade students. This is rather telling
of the student community in these areas and the overall trend in Minnesota, as not many students will
bring weapons to school, improving safety and the overall well-being of the Minnesota school systems.
Students who feel that parents care: 1998-2010
Percent of students who feel that their parents care about them very much
6th Grade
The percent of 6th grade students who feel that
their parents care has slightly increased from
1998 to 2010. In 1998, about 85 percent was
reported and in 2010 about 90 percent was
reported. All areas reported similar percentages
and increases over the time period.
100%
90%
80%
70%
60%
50%
1998
2001
2004
2007
2010
th
9 Grade
100%
90%
80%
70%
60%
50%
1998
2001
2004
2007
2010
th
12 Grade
100%
90%
80%
70%
60%
50%
1998
2001
2004
Minnesota
Becker
Clay
2007
Otter Tail
2010
Wilkin
The percent of 9th grade students also increased
in all areas from 1998 to 2010. All counties, for
the exception of Wilkin, demonstrated similar
trends, increasing by a margin of about 10
percent. These areas increased from about 70
percent to about 80 percent. Otter Tail
decreased in 2007. Wilkin increased by a margin
of 23 percent from 1998 to 2007, but decreased
by a margin of 16 percent from 2007 to 2010.
All areas reported slight increases in the percent
of 12th grade students from 1998 to 2010. Of the
areas, Wilkin reported the greatest percentages,
but a small margin of increase of 3 percent. Clay
increased by an even smaller margin, 1 percent.
Otter Tail and Minnesota both increased from 73
percent to 78 percent from 1998 to 2010. Becker
reported the lowest percentages in 12th grade
students, increasing from 71 to 75 percent.
Among all grades, there were only noticeable
increases in 9th grade students from 1998 to
2010. The percentages reported were greatest in
6th grade students at around 90 percent and
lowest in 9th and 12th grade students, which
ranged from 70 to 85 percent.
Source: Minnesota Student Survey, 2010
76 | P a g e
Students who feel that parents care: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
100%
95%
90%
85%
80%
75%
70%
65%
60%
55%
50%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
The graph above compares the percentage of 6th, 9th, and 12th grade students who have felt stressed or
pressured in 2010. The greatest percentages were reported in 6th grade students, about 90 percent, with
little variation among the areas. 9th and 12th grade students reported similar percentages on average,
ranging from 70 to 85 percent. In 9th grade students Becker, Clay, Otter Tail, and Minnesota all reported
similar percentages near 80 percent; Wilkin, however, differed with a reported percentage of 71
percent. In 12th grade students, there was little variation in the reported percentages near 80 percent.
Students who feel friends care: 1998-2010
Percent of students who feel that friends care about them very much or quite a bit
6th Grade
100%
There is a lot of variation between 1998 and
2010 in the percent of 6th grade students who
reported that they feel their friends care about
them. Becker increased by the greatest margin
of 13 percent. Clay increased by a margin of 2
percent. Wilkin increased by a margin of 5
percent. Otter Tail reported the only decrease,
4 percent. Minnesota had the least variation
and increased by a margin of 2 percent.
80%
60%
40%
20%
0%
1998
2001
2004
2007
2010
77 | P a g e
9th Grade
100%
80%
60%
40%
20%
0%
1998
2001
2004
2007
2010
th
12 Grade
The percentages reported in 12th grade students
either decreased or did not change from 1998
to 2010. Over the time period, Becker
experienced no change in percentage. Clay
decreased by a margin of 3 percent. Otter Tail
decreased by 4 percent. Wilkin decreased by
the greatest margin of 8 percent. Minnesota
decreased by a margin of 3 percent.
100%
80%
60%
40%
20%
0%
1998
2001
2004
Minnesota
Becker
Clay
There was noticeably less variation from 1998
to 2010 for 9th grade students. Clay and
Minnesota followed similar trends with little
variation and no overall increase. Becker
reported a small overall increase of 1 percent,
due to a steep decrease from 2004 to 2007.
Otter Tail decreased slightly from 1998 to
2004, and increased steadily from 2004 to
2010 for an overall increase of 6 percent.
Wilkin increased by the largest margin: 9
percent.
2007
Otter Tail
2010
Wilkin
Overall, there was no clear trend in the percent
of 6th, 9th and 12th grade students who feel their
friends care about them.
Source: Minnesota Student Survey, 2010
Students who feel that friends care: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
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The percent of students who feel their friends care can be looked at in 2010 to compare across 6th, 9th,
and 12th grade students. All grades reported similar percentages between 70 and 80 percent. 6th grade
percentages had the most variation among the areas. Otter Tail reported the lowest percentage of 6th
grade students and Becker reported the greatest percentage. Because of the similarity between 6th, 9th
and 12th grade students it can be suggested that the percent of students who feel their friends care
about them does not depend on grade.
High-Risk Sexual Behavior
The most effective way to prevent the transmission of sexually transmitted infections (STIs), and
consequently the development of sexually-transmitted diseases, is to delay the onset of sexual activity.65
While delaying the onset of sexual activity is helpful, it is not long-term. Sexual education is also very
important for young students and is effective in decreasing or preventing the transmission of STIs.
Consistent condom use is also an effective means of preventing STIs and pregnancies.66
Students who have ever had sexual intercourse: 1998-2010
Becker peaked in 2001 at 27 percent. Otter Tail
9th Grade
and Wilkin both reported 40 percent of 9th
grade students had ever had sexual intercourse
in 1998, the highest percentage across all the
years. Both of these counties then reported
substantial decreases in 2001; all areas
averaged about 20 percent from 2001 to 2010.
100%
80%
60%
40%
20%
0%
1998
2001
2004
th
12 Grade
100%
80%
60%
40%
20%
0%
2007
2010
The percent of 12th grade students who had
ever had sexual intercourse was fairly constant
over time, averaging around 50 percent. Wilkin
was the exception to this, as it reported 60
percent in 1998, peaked at 74 percent in 2001,
and decreased to 45 percent in 2007 before it
leveled out at 51 percent in 2010. These large
number changes could be due to the small
population, which makes it very easy to have a
large percentage jump for a small increase.
Becker decreased by a margin of 13 percent,
while Clay and Otter Tail both increased and
reported the highest percentages in 2010.
Overall, the percent of students who ever had
sexual intercourse was fairly consistent from
1998
2001
2004
2007
2010
1998 to 2010; 9th grade students averaged
Minnesota
Becker
Clay
Otter Tail
Wilkin about 20 percent, while 12th grade percentages
averaged around 50 percent.
Source: Minnesota Student Survey, 2010
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Students who have had sexual intercourse: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
9th Grade
Minnesota
12th Grade
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Student Survey, 2010
The 9th grade population had a rate of sexual intercourse about 30 percent lower than that of the 12th
grade population, as could be expected. The percentages reported for 9th grade students were very
similar across all areas in 2010. In 12th grade students, Becker reported the lowest percentage, with 42
percent. Clay and Otter Tail reported the highest percentage, with 57 and 56 percent respectively.
Minnesota and Wilkin were around 50 percent.
Overall, a noticeably greater percentage of 12th grade students have had sexual intercourse when
compared to 9th grade students. The percent of 9th grade students, however, is still a fair number and
poses an area where the onset of sexual activity could be reasonably decreased.
Students who use condoms: 1998-2010
Among sexually active students: Percent who always use condoms
9th Grade
Condom use in sexually active 9th grade
students has decreased in recent years.
Becker has decreased by a margin of 12
percent since its peak at 62 percent in 2001.
Clay decreased by a margin of 27 percent
since 2004. Otter Tail peaked at 65 percent in
2007 and decreased by a margin of 15
percent through 2010. Minnesota increased
slightly, by only 2 percent. Wilkin reported a
noticeable increase of 11 percent from 1998
to 2010.
100%
80%
60%
40%
20%
0%
1998
2001
2004
2007
2010
80 | P a g e
12th Grade
Reported condom use in sexually active 12th
grade students followed the same trend as in
9th graders increasing slightly in all areas
except Wilkin. Becker increased by 5 percent,
Otter Tail increased by a margin of 11 percent,
Clay increased by 4 percent, and Minnesota
saw a 5 percent increase. Wilkin decreased
from 1998 to 2001, but increased noticeably
by 21 percent to reach 63 percent in 2010.
100%
80%
60%
40%
20%
0%
1998
Minnesota
2001
2004
Becker
Clay
2007
Otter Tail
2010
Wilkin
In both 9th and 12th grade students there have
been recent decreases in condom use. This
decrease is the most noticeable in 9th grade
students. Despite this recent decline, condom
use has still increased in students since 1998.
Source: Minnesota Student Survey, 2010
Students who use condoms: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
9th Grade
Minnesota
Becker
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
When looking at the percentage of sexually active 9th and 12th grade students who use condoms in 2010
it can be seen that in Minnesota, Becker, and Otter Tail have a greater percentage of 9th grade students
use condoms than 12th grade students. There is no difference in Clay, and in Wilkin a greater percentage
was reported in 12th grade students. Condom use in 9th grade students averages about 50 percent, while
condom use in 12th grade students averages closer to 45 percent. This data shows that in general
condom use does not increase with age, but this could be due to use of other birth control methods at
older ages.
81 | P a g e
Students use some birth control method: 1998-2010
Among sexually active students: Percent who always use some birth control method
9th Grade
100%
80%
60%
40%
20%
0%
1998
2001
2004
2007
2010
th
12 Grade
100%
80%
60%
40%
20%
0%
1998
2001
2004
Minnesota
Becker
Clay
2007
Otter Tail
2010
Wilkin
Among sexually active 9th grade students,
birth control use had no clear trend with
increases and decreases from 1998 to 2010.
Clay peaked at 47 percent in 2004, but
decreased from then, resulting in an overall
decrease of 10 percent. Otter Tail increased
by a margin of 20 percent from 1998 to 2001
and decreased by a margin of 13 percent from
2001 to 2010. Wilkin increased by a margin of
25 percent from 1998 to 2007 and then
decreased by 24 percent from 2007 to 2010.
Minnesota reported consistent percentages
around 40 percent over the time period.
All areas followed similar trends for birth
control use in sexually active 12th grade
students with a mix of increases and
decreases from 1998 to 2010. Becker
decreased by an overall margin of 14 percent.
Clay, Otter Tail and Wilkin increased by a
margin of 1 percent, 3 percent and 5 percent
respectively. Minnesota remained constant
over time.
Source: Minnesota Student Survey, 2010
Students who use some birth control method: 2010
Comparison across the counties and the state of Minnesota and each grade in one year
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
9th Grade
Minnesota
Becker
Clay
12th Grade
Otter Tail
Wilkin
Source: Minnesota Student Survey, 2010
The percent of sexually active 9th grade and 12th grade students that always use a form of birth control
can be compared with the data from the 2010 student survey. It is noticeable that about 20 percent
82 | P a g e
more 12th grade students report this than 9th grade students. In 9th grade students, Becker reported the
highest percentage and Wilkin reported the lowest percentage. Furthermore, Becker reported a greater
percentage of their 9th grade students use birth control than the average for Minnesota. There was less
variation in 12th grade students. Wilkin and Otter Tail reported greater percentages than Minnesota.
Also, Wilkin reported the greatest percentage and Becker reported the lowest percentage in 12th grade
students. The opposite trend was seen in 9th grade students between Becker and Wilkin.
Mortality, Morbidity, & Disease Outcomes
Injury & Violence
In order to have a greater understanding of why certain mortality and morbidity statistics are the way
they are, we can look at the leading causes of death in Minnesota in each of many age groups. For all
ages, cancer and heart disease are the leading causes of death in Minnesota by a wide margin. Stroke,
unintentional injury, and chronic lower respiratory disease reported the next highest number of deaths.
The leading cause of death for those over 65 was heart disease, and for those ages 25 to 64 it was
cancer; Unintentional injuries were the leading cause of death in Minnesota for those ages 5 to 24.
Leading causes of death in Minnesota, 2010
Cause
AIDS/HIV
Alzheimer's Disease
Atherosclerosis
Cancer
Cirrhosis
Congenital Anomalies
Chronic Lower Respiratory Disease
Diabetes
Heart Disease
Homicide
Hypertension
Nephritis
Perinatal Conditions
Pneumonia and Influenza
Septicemia
SIDS
Stroke
Suicide
Unintentional Injury
Other
Total
0-4
1
0
0
3
0
96
2
0
3
8
0
1
133
9
3
28
2
0
34
53
376
5-14
0
0
0
13
0
5
5
0
0
4
0
3
3
1
0
0
2
6
30
24
96
15-24
0
0
0
29
1
8
2
1
9
32
0
0
2
1
0
0
3
87
164
58
397
Age Group
25-44 45-64
11
29
0
23
0
2
220
2,386
38
244
23
35
14
217
23
218
138
1,000
46
16
8
62
5
81
1
0
14
45
9
65
0
0
23
193
202
235
331
486
221
1,095
1,327 6,432
65-74
6
54
5
2,307
66
6
395
194
863
4
73
115
0
47
48
0
223
33
151
1,004
5,594
75+
0
1,373
31
4,641
63
17
1,377
600
5,131
1
296
690
1
474
212
0
1,708
36
891
7,092
24,634
Total
47
1450
38
9,599
412
190
2,012
1,036
7,144
111
439
895
140
591
337
28
2,154
599
2,087
9,547
38,857
Source: Minnesota Department of Health, Center for Health Statistics
83 | P a g e
Percent of total deaths by age group: 2010
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
0-4
5-14
15-24
Minnesota
25-44
Becker
Clay
45-64
Otter Tail
65-74
75+
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
As expected, the general trend is death increases with older age. Both the 45 to 64 year age group and
the 65 to 74 year age group contribute 10 to 15 percent to the total death count. One thing to notice is
that ages 0 to 4 do contribute a higher percentage of deaths in some areas than the 5 to 14 age group.
This can be attributed to infant mortality and the numerous health complications that can occur in this
age group compared to the 5 to 14 year-olds.
Total number of fatal unintentional injuries: 2000-2011
35
30
25
20
15
10
5
0
2000
2001
2002
2003
Becker
2004
2005
Clay
2006
2007
Otter Tail
2008
2009
2010
2011
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
The Minnesota Department of Health states, “Deaths are a small proportion of the impact of injury. For
every one fatal injury, there are three severe traumas (including brain and spinal cord injuries), ten
other hospitalized injuries, and 100 injuries that result in emergency department treatment only.”67
84 | P a g e
Over time, the fatal unintentional injury counts of Clay and Becker follow similar trends and reported
similar numbers. On average over the 11 years, Becker has reported 17 deaths in this category, Clay has
reported 21, Otter Tail has reported 26, and Wilkin has reported 3. The large difference between Wilkin
and the other counties can be attributed to the noticeably lower population.
Motor Vehicle Fatalities & Injuries
In Minnesota, motor vehicle-related injuries are the leading cause of injury-related death for individuals
up to the age of 44, and for adults between 55 and 64.68 Those at greatest risk of injury from traffic
crashes are 20- to 24-year-old drivers, elderly drivers, male drivers, unbelted occupants, and
unrestrained children. Pedestrian injuries are among the most expensive in terms of hospital charges,
and elderly Minnesotans are particularly vulnerable.69
Total number of motor vehicle deaths: 2003-2010
14
12
10
8
6
4
2
0
2003
2004
Becker
2005
2006
Clay
2007
2008
2009
Otter Tail
2010
Wilkin
Source: Minnesota Department of Public Safety
Total number of motor vehicle deaths: 2011
14
From the years 2003 to 2010, there was
no clear trend in any county regarding the
total number of motor vehicle deaths.
The scattered data can be attributed to
the low number of deaths reported; a
small increase or decrease can look like a
major change on this scale. Wilkin
consistently reported the lowest number
of motor vehicle deaths, but this is most
likely due to its small population. Otter
Tail reported a higher number of motor
vehicle deaths than Becker and Clay,
which share a similar size population.
There were fewer motor vehicle deaths in
2005 than any other year studied.
In 2011, Otter Tail reported 11 motor
vehicle deaths, a noticeably higher
number than the other counties. Becker
and Clay reported similar numbers with 4
and 2 respectively. Wilkin reported 0
motor vehicle deaths in 2011.
12
10
8
6
4
2
0
Becker
Clay
Otter Tail
Source: Minnesota Department of Health,
Center for Health Statistics
Wilkin
Overall, Otter Tail appears to have the
most motor vehicle deaths of all the
counties, but not by a noticeable margin,
especially considering that it has a higher
population than the other counties.
85 | P a g e
Unbelted motor vehicle deaths & injuries: 2012
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Percent of motor vehicle deaths with
unbelted occupant
Minnesota
Becker
Percent of severe motor vehicle injuries with
unbelted occupant
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Public Safety, Office of Traffic Safety
Many motor vehicle deaths and injuries result from vehicle occupants not wearing a seatbelt. From the
graph on the left, we see that Becker, Clay, and Otter Tail all reported a greater percentage of motor
vehicle deaths with an unbelted occupant than the state of Minnesota in 2012. Clay reported exactly
half of all deaths were a result of an unbelted occupant. Becker and Otter Tail both reported more than
50 percent. 0 percent of unbelted motor vehicle deaths in 2011 for Wilkin because there were 0 motor
vehicle deaths reported in that year.
As for the percent of severe motor vehicle injuries in which there was an unbelted occupant (see the
graph on the right), Becker, Clay, and Otter Tail all reported similar percentages of injuries to the state of
Minnesota, about 25 to 30 percent. Wilkin reported 100 percent, since there were only 2 severe motor
vehicle injuries were reported in 2012 and both contained an unbelted occupant.
Percent of motor vehicle deaths that were alcohol related: 2011
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Public Safety
86 | P a g e
Alcohol-related motor vehicle accidents are becoming increasingly more common and are a major
reason behind large amounts of motor vehicle deaths. In Becker and Clay, 50 percent of motor vehicle
deaths were alcohol-related in 2011. This is more than the state average of 37 percent. Otter Tail
reported 27 percent of motor vehicle accidents were alcohol-related, less than the state average. Again,
Wilkin reported 0 motor vehicle deaths in 2011, so none could be alcohol-related. These percentages
suggest that one reasonable way to decrease motor vehicle deaths in Becker and Clay would be to
decrease the amount of drunk-driving or alcohol-related accidents.
Self-harm & Suicide
In 2010, the number of people who died by suicide, 599, in Minnesota in 2010 was more than five times
higher than the number of homicide victims, at 111. Additionally, Minnesota’s suicide rate has been
steadily climbing in the last ten years, from a low of 8.9 deaths by suicide per 100,000 in 2000 to 11.1
per 100,000 in 2010. While many people assume that suicide rates are highest among teenagers, males
over the age of 35 actually have the highest rates of suicide.
Death by suicide: 2000-2011
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
2000
2001
2002
2003
Becker
2004
Clay
2005
2006
2007
Otter Tail
2008
2009
2010
2011
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
Here we examine the percent of deaths in each county that were ruled suicides. From 2000 to 2011,
there was high variation in the percent of deaths due to suicide in the four counties, which is largely due
to the low number of deaths by suicide reported in each county.
No clear trend can be observed from this data, but average percentages can be compared. Clay reported
the highest average over the time period with 1.67 percent. Becker reported an average of 1.40 percent
and Otter Tail reported an average of 1.29 percent. Wilkin reported the lowest time average of 1.09
percent. This is to be expected since they have the lowest population and death counts. Plus they
reported 0 suicides in the 2005 and from 2008 through 2011.
87 | P a g e
Death by suicide in Minnesota by Sex: 2011
120
Male
Female
100
80
60
40
20
0
15-24
25-34
35-44
45-54
55-64
Source: Minnesota Department of Health, Center for Health Statistics
In 2011, there were a noticeably greater number of suicide deaths in males than in females of all age
groups. The number of suicide deaths between the age groups was fairly similar, with ages 45-54
reporting a slightly higher count than the other age groups. Again, there are more suicides in the older
age groups than there are among teenagers. It is important to point out that while more males die by
suicide, more females have thought about killing themselves, especially among adolescents.70
Suicide in Students
Students who have hurt themselves: 2010
Percent of students who have hurt themselves on purpose in the last year
25%
20%
15%
10%
5%
0%
6th Grade
Minnesota
Becker
9th Grade
Clay
Otter Tail
12th Grade
Wilkin
Source: Minnesota Student Survey, 2010
The percentage of students who have hurt themselves in the past year as reported in 2010 was greatest
in 9th grade students and lowest in 12th grade students. Wilkin reported the greatest percentage in 9th
and 12th grade students and Becker and Otter Tail reported the greatest percentage in 6th grade
students. These data suggest that younger students struggle more with self-harm and suicide than highschool seniors.
88 | P a g e
Percent of students who have had suicidal thoughts in the past year
6th Grade
th
The percent of 6 grade students who
had suicidal thoughts in the previous year
has decreased from 1998 to 2010. Becker
decreased by a margin of 7 percent. Clay
decreased by the greatest margin of 14
percent. Otter Tail decreased by a margin
of 3 percent. Minnesota decreased by a
margin of 5 percent. Wilkin, however,
increased by a margin of 6 percent.
30%
25%
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
2007
2010
th
9 Grade
30%
25%
20%
15%
10%
5%
0%
1998
2001
2004
th
12 Grade
The percent of 12th grade students who
had suicidal thoughts in the previous year
decreased steadily and by a smaller
margin than 6th and 9th grade data from
1998 to 2010. Becker decreased by a
margin of 7 percent. Clay decreased by a
margin of 9 percent. Otter Tail decreased
by a margin of 7 percent. Minnesota
decreased by a margin of 5 percent.
Wilkin experienced no overall change.
30%
25%
20%
15%
10%
5%
0%
1998
Minnesota
2001
Becker
2004
Clay
The percent of 9th grade students who
had suicidal thoughts in the previous year
has decreased inconsistently from 1998
to 2010. Becker decreased from 1998 to
2001 by a margin of 9 percent and then
increased by a margin of 5 percent from
2001 to 2010 resulting in an overall
decrease of 4 percent. Clay decreased by
a margin of 20 percent. Otter Tail
decreased by a margin of 10 percent.
Wilkin decreased by a margin of 12
percent from 1998 to 2007 and then
increased by 10 percent from 2007 to
2010, resulting in an overall decrease of 2
percent. Minnesota decreased by a
margin of 7 percent.
2007
Otter Tail
Source: Minnesota Student Survey, 2010
2010
Overall, there have been decreases in the
Wilkin suicidal thoughts of students from 1998
to 2010.
89 | P a g e
Percent of students who attempted suicide in the past year
6th Grade
20%
15%
10%
5%
0%
1998
2001
2004
2007
2010
th
9 Grade
20%
The percent 6th grade students who
attempted suicide in the previous year
has decreased from 1998 to 2010. In
2010, all areas reported percentages
less than 5 percent. Becker decreased
by a margin of 3 percent. Clay
decreased by a margin of 6 percent.
Otter Tail decreased by a margin of 2
percent. Minnesota decreased by a
margin of 3 percent. Wilkin decreased
by 3 percent from 1998 to 2007 and
then increased by 4 percent from 2007
to 2010.
The percent of 9th grade students who
attempted suicide in the previous year
has decreased with variation from 1998
to 2010. All areas reported sharp
increases from 2001 to 2004. Becker
decreased by a margin of 4 percent.
Clay and Otter Tail decreased by a
margin of 5 percent. Wilkin decreased
by a margin of 2 percent.
15%
10%
5%
0%
1998
2001
2004
2007
12th Grade
20%
15%
10%
5%
0%
1998
Minnesota
2001
Becker
2004
Clay
2007
Otter Tail
Source: Minnesota Student Survey, 2010
2010
The percent of 12th grade students who
attempted suicide in the previous year
remained fairly constant and below 5
percent from 1998 to 2010. The already
low numbers results in a less noticeable
change over time. Becker and Clay
decreased by a margin of 1 percent.
Wilkin decreased by a margin of 2
percent. Minnesota and Otter Tail
decreased by a margin of 3 percent.
Overall the percent of students who
have attempted suicide has decreased
from 1998 to 2010. The greatest
2010
percent of students who have
th
Wilkin attempted suicide is reported in 9
grade students over time.
90 | P a g e
Chronic Disease
Chronic diseases and chronic conditions are those which persist over a long period of time, from months
to years. These diseases are among the leading causes of death and years of potential life lost in
Minnesota and also contribute significantly to long-term disability and poor quality of life.71 Examples of
common chronic disease and conditions include: Alzheimer's disease, arthritis, obesity, asthma, chronic
obstructive pulmonary disease, heart disease and stroke, diabetes, mental illnesses, and cancer.72 Some
of these will be examined in more detail below.
Obesity
Obesity is not only a chronic disease itself, but it places people with it at a higher risk for multiple other
chronic diseases and severe health conditions. The Minnesota Department of Health lists hypertension,
dyslipidemia, Type II diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep
apnea, and even some cancers (such as endometrial, breast, and colon) as a few of the chronic disease
health conditions that can result from being overweight or obese.73 In addition to the long list of health
effects from obesity are the social and emotional effects that it can have. Obesity in children and teens
is a major factor of bullying and obese adults can be discriminated against in the work place.74
The percent of Minnesotans who are overweight (have a BMI of 25.0-29.9) or obese (have a BMI >30.0)
has increased over the years consistent with increasing obesity in America as a whole. In 1995, 50.6
percent of the Minnesota population was overweight or obese and by 2010, this number rose to 63.1
percent. This translates to 662,000 additional overweight or obese individuals in those 15 years. 75
Weight Status in Children ages 2-5: 2012
20.00%
18.00%
16.00%
14.00%
12.00%
10.00%
8.00%
6.00%
4.00%
2.00%
0.00%
Underweight
Overweight
Minnesota
Becker
Clay
Obese
Otter Tail
Very Obese
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
Using the 2000 CDC growth chart percentiles, underweight is defined here as having a BMI for their age
below the 5th percentile, overweight is defined as having a BMI for their age between the 85th and 95th
percentile, obese is defined as having a BMI for their age between the 95th and 97th percentile, and very
obese is defined as having a BMI for their age greater than or equal to the 97th percentile.
91 | P a g e
When looking at the data, Wilkin reported a slightly greater percent of children who were underweight
compared to the other areas. Across all areas, the lowest percent of children are underweight. The
largest percent of children are overweight, with percentages reported ranging from 12 to 18 percent. In
this category, Wilkin reported a noticeably lower number, 12.4 percent, compared to the other areas.
Another noticeable aspect of this graph is that there is a noticeably lower percent of children that are
obese or very obese compared to those that are overweight.
Percent of students who report feeling overweight: 2010
35%
30%
25%
20%
15%
10%
5%
0%
9th Grade
Minnesota
Becker
Clay
12th Grade
Otter Tail
Wilkin
Source: Minnesota Student Survey, 2010
In 2010, all four counties reported a similar percentage of 9th grade students who felt overweight
compared to the state of Minnesota, ranging from 20 to 25 percent. Clay reported the greatest
percentage of 12th grade students, 31 percent; this is 8 percent greater than the state of Minnesota and
5 to 10 percent greater than the other counties. Becker and Wilkin both reported numbers below the
state of Minnesota, with 21 percent and 20 percent respectively.
Percent of students who are “overweight” by BMI: 2010
“Overweight”: BMI in the 85th to 95th percentile
35%
30%
25%
20%
15%
10%
5%
0%
9th Grade
Minnesota
Becker
Clay
12th Grade
Otter Tail
Wilkin
Source: Minnesota Student Survey, 2010
Wilkin reported the greatest percentage of overweight 9th grade with 22 percent. Otter Tail, Clay,
Becker, and Minnesota reported similar percentages ranging from 12 to 15 percent, about 7 percent
below that of Wilkin. All counties reported percentages slightly above the state average for 12th graders.
92 | P a g e
Percent of students who are “obese” by BMI: 2010
“Obese”: BMI in the 95th percentile or higher
35%
30%
25%
20%
15%
10%
5%
0%
9th Grade
Minnesota
Becker
Clay
12th Grade
Otter Tail
Wilkin
Source: Minnesota Student Survey, 2010
Wilkin reported the greatest percentage of obese 9th grade students, with 16 percent. This is 7 percent
greater than Becker, Clay, and Minnesota and 5 percent greater than Otter Tail. Wilkin also reported the
greatest percentage of 12th grade students, but by a less noticeable margin. Becker reported a
percentage in 12th grade students below the state average.
Percent of adults (age 20+) who are obese (BMI≥30): 2005-2009
40%
35%
30%
25%
20%
15%
10%
5%
0%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
All four counties reported lower percentages of obese adults than the state. All four counties also
reported similar percentages around 30 percent.
Diabetes, Heart Disease, & Stroke
Obesity and being overweight are primary risk factors for diabetes, heart disease and stroke.76 Diabetes
limits daily activities, contributes to depression and also increases the incidence of heart disease and
stroke.77 Those with diabetes are twice as likely to get heart disease, and two out of three people with
diabetes die due to heart disease and stroke. Additionally, diabetes is a leading cause of death in
Minnesota and is on the rise. It is the leading cause of blindness in adult Minnesotans, and the leading
complication among mothers giving birth in the state.78
93 | P a g e
Heart disease currently is the second leading cause of death in Minnesota. Minnesota consistently has
one of the lowest rates of heart disease mortality in the nation—about 30 percent lower than the
national average.79 Stroke is another major cause of death in Minnesota. In 2010, approximately 1.9
percent of adults in the state reported ever having had a stroke in their lifetime—a total of over 75,000
people.80 Stroke kills more women than men and is disproportionately fatal those over the age of 75.81
Diabetes Prevalence: 2009
Percent of population(age 20 and older) that have been told by their doctor that they have diabetes
10.00%
8.00%
6.00%
4.00%
2.00%
0.00%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
The percent of population over the age of 20 that had been diagnosed with diabetes was greater in all
four counties than the state of Minnesota which was 6.4 percent in 2009. All four counties had little
variation with a range of 1 percent. Clay reported the lowest percentage of all four counties, 8.1
percent. Becker reported the greatest percentage, 9.1 percent.
Number of diabetic deaths: 1995- 2011
50
40
30
20
10
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
The number of diabetic deaths from 1995 to 2011 varied greatly among all four counties. The low death
counts provide reason for small changes to look like large variations. Since there is no clear trend in the
number of diabetic deaths within a county over time, the average number of diabetic deaths from 1995
to 2011 for each county can be compared. Otter Tail reported a noticeably greater number of diabetic
deaths over time with an average of 19.2. Becker and Clay reported the same time average of diabetic
deaths, 10.2. Wilkin reported the lowest average number of diabetic deaths over time, with 2.2. Since
this data was presented as counts, the differences in population should be taken into account.
94 | P a g e
Heart disease age-adjusted mortality rate: 1995-2011
400
350
300
250
200
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
The age-adjusted mortality rate for heart disease is the number of deaths per 100,000 people with
adjustments made for the effects of age group. A mortality rate provides a way to compare deaths
among the different populations of the counties. Becker, Clay, Otter Tail, and Minnesota all followed
similar decreasing trends in the heart disease mortality rate from 1995 to 2011. Wilkin, due to the small
population and fluctuating numbers, did not show any clear or comparable trend in mortality rate. The
decreasing trend in mortality rate is likely attributed to improvements in the quality of health care and
the ability to treat heart disease.
Stroke age-adjusted mortality rate: 1995-2011
90
80
Data for Wilkin County not available
70
60
50
40
30
20
10
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Minnesota
Becker
Clay
Otter Tail
Source: Minnesota Department of Health, Center for Health Statistics
Stroke age-adjusted mortality rates were not reported for Wilkin due to low counts and privacy issues.
Becker reported a lot of variation in the mortality rates over time, but overall did experience a decrease
from 1995 to 2009. Clay, Otter Tail, and Minnesota’s stroke mortality rates all decreased by a similar
steady trend from 1995 to 2009. Again, this decrease can most likely be attributed to an increase in the
quality of healthcare rather than a decrease in the number of strokes.
95 | P a g e
Cancer Prevalence
50 percent of men and more than one-third of all women in the United States will develop a potentially
serious form of cancer in their lifetime. Because life expectancy is slightly longer in Minnesota, the risk
of developing cancer is slightly higher.82
Cancer can develop in anyone, though smoking, sun exposure, low physical activity, and unhealthy
eating can increase cancer risk. The American Cancer Society has also found that risk of cancer is highly
influenced by poverty. People in poverty are more likely to smoke and to be obese, two major risk
factors for cancer. In addition, poverty may expose people to unhealthy environments, limit awareness
of health promotion messages and access to cancer screening, and lead to seeking medical care at a
later stage of illness, when treatment options are limited and the potential for death is much higher.83
Percent of diagnosed cancer cases in women:
2005-2009
Percent of diagnosed cancer cases in men:
2005-2009
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Breast
Minnesota
Colon and
Rectum
Becker
Clay
Lung
Otter Tail
Other
Wilkin
Prostate
Minnesota
Colon and
Lung
Other
Rectum
Becker
Clay Otter Tail Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
The most commonly diagnosed cancers in Minnesota include lung cancer, colon/rectal, breast and
prostate cancer84 so we examine the prevalence of each of these in men and women. In women, breast
cancer is the leading reported cancer case while in men prostate cancer is the leading cancer, each
making up about 30 percent of the total cancer cases in the respective sexes. Colon/rectal and lung
cancer each make up about 10 percent of reported cancer cases in all areas in both men and women.
A higher percentage of the cancer cases in Wilkin were colon and rectum cancers, compared to the
other areas. Otter Tail had the highest percentage of cancer cases being prostate cancer. There were no
clear trends among the areas for breast cancer or lung cancer prevalence. Other cancers also varied
greatly in the different areas.
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Incidence rate of breast cancer in women: 1995-2009
Age-adjusted incidence rates (per 100,000) for 5 year population
160
140
120
100
80
60
40
20
0
1995-1999
Minnesota
2000-2004
Becker
Clay
Otter Tail
2005-2009
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics, MN Public Health Data Access
There was little change from 1995 to 2009 in the age-adjusted incidence rates of breast cancer in
women for the three 5 year populations. All counties reported breast cancer incidence rates equal to or
below that of the state of Minnesota. There was no noticeable or clear trend in the breast cancer
incidence rates over time with all rates ranging between 100 and 140.
Incidence rate of colon/rectum cancer: 1995-2009
Age-adjusted incidence rates (per 100,000) for 5 year population
160
140
120
100
80
60
40
20
0
1995-1999
Minnesota
2000-2004
Becker
Clay
2005-2009
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics, MN Public Health Data Access
There was little change in the incidence rate of colon and rectum cancer from 1995 to 2009. All areas,
except for Wilkin, reported similar rates over time ranging from 40 to 60. Wilkin, however, reported a
spike in rate to 92.5 during the years 2000 to 2004.
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Incidence rate of lung/bronchus cancer: 1995-2009
Age Adjusted Incidence rates (per 100,000) for a 5 year population
160
140
120
100
80
60
40
20
0
1995-1999
Minnesota
Becker
2000-2004
Clay
Otter Tail
2005-2009
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics, MN Public Health Data Access
There was little change in the incidence rate of lung and bronchus cancer from 1995 to 2009. All areas
reported similar numbers and remained consistent over time with rates ranging from 45 to 70. From
1995 to 1999, Becker reported a noticeably higher incident rate than the other areas. From 2000 to
2004, Wilkin reported a noticeably higher incidence rate than the other areas. From 2005 to 2009,
Minnesota and Becker both reported the highest incidence rate.
Cancer Mortality
Cancer is currently the leading cause of death in Minnesota overall. The American Cancer Society
estimates that there were over 25,000 new cases of cancer in 2010 and 9,200 deaths.85
As mentioned above, different populations have different prevalence rates for different types of
cancers, but death by cancer also varies according to certain demographics. For example, In Minnesota,
overall cancer incidence and mortality are highest among American Indians and African-Americans and
lowest among Hispanic and Asian-Pacific Islander populations86 despite higher poverty rates among
Hispanics and Asian-Pacific Islanders. However, the risk for stomach and liver cancers - two of the most
deadly cancers - are considerably higher for Hispanic and Asian-Pacific Islanders.87
Death risk for many cancers will depend on when the cancer is diagnosed. For example, breast cancer is
the most common form of cancer and the second leading cause of cancer deaths among Minnesota
women; surviving breast cancer is directly related to the stage of the disease at the time of diagnosis.88
Breast cancer mortality among African-American women is 24 percent higher than white women,
despite the incidence of breast cancer among African-American women being 18 percent lower.89 This
population’s higher rate of mortality can clearly be partially attributed to later stage diagnosis.90
Cancer mortality rate: 1995-2011
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Mortality rates (per 100,000 people)
300
250
200
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
The cancer mortality rate of Wilkin County was not reported due to small numbers for most years. In
2001, a rate of 257 was reported, greater than the rates of all other areas. This may seem unreasonably
high, but since the population in Wilkin County is far below 100,000, this number is scaled up from a
smaller (and more reasonable) mortality count.
Becker, Clay, Otter Tail, and Minnesota all followed a similar steady cancer mortality rate over time,
ranging from 150 to 225 deaths per 100,000 people. Becker and Minnesota reported the greatest
average cancer mortality rate over time. Wilkin and Clay reported the lowest average cancer mortality
rate over time, with Wilkin being much lower due to the number of zeroes.
Breast cancer deaths in women: 2006-2008
Percent of female cancer deaths that resulted from breast cancer
40%
30%
20%
10%
0%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
From 2006 to 2008, Becker Otter Tail, and Wilkin all reported a lower percent of female cancer deaths
due to breast cancer than the state of Minnesota, with Becker having the lowest percentage, at 9
percent. Clay reported the greatest percentage, 15.3 percent. Overall, about 10 percent of female
cancer deaths result from breast cancer.
Prostate cancer deaths in men: 2006-2008
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Percent of male cancer deaths that resulted from prostate cancer
40%
30%
20%
10%
0%
Minnesota
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
The percent of prostate cancer deaths in men was higher in Wilkin than all the other areas, at 17.4
percent. Clay reported the lowest percentage of prostate cancer deaths in men, with 8 percent.
Minnesota reported 10.7 percent, Becker reported 11 percent, and Otter Tail reported 11.4 percent
of cancer deaths in men were a result of prostate cancer.
Lung cancer deaths: 2006-2008
Percent of female or male cancer deaths that resulted from lung cancer
40%
30%
20%
10%
0%
Men
Minnesota
Becker
Clay
Otter Tail
Women
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
For lung cancer deaths in men, Becker reported the lowest percentage, with 23.7 percent. For lung
cancer deaths in women, Wilkin reported a higher percentage than the other areas, at 37 percent. Otter
Tail reported the lowest overall percentage in women and was the only county to report a lower
percentage then the state of Minnesota for women.
In Minnesota and Otter Tail, there is a greater percent of lung cancer deaths in men than in women. In
Wilkin and Becker, there is a greater percent of lung cancer deaths in women than in men and in Clay
there is no difference between men and women.
Colon and rectum cancer deaths: 2006-2008
100 | P a g e
Percent of male and female cancer deaths that resulted from colon or rectum cancer
40%
30%
20%
10%
0%
Men
Minnesota
Becker
Clay
Women
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
There was only slight variation in the percent of colon and rectum cancer deaths in men, ranging from
8.7 to 10.2 percent. There was slightly more variation in the percent of colon and rectum cancer deaths
in women. Otter Tail reported the highest percent of female colon and rectum cancer deaths, with 14.5
percent. Clay reported the lowest percent in females, with 7.6 percent.
In Clay and Becker there was a slightly lower percent of colon and rectum cancer deaths in women than
in men. In Otter Tail, Wilkin, and Minnesota there was a lower percent of colon and rectum cancer
deaths in men than in women.
Infectious Diseases
Infectious diseases are a serious cause of illness, disability, and death in Minnesota. Infectious diseases
are illnesses caused by organisms such as bacteria, viruses, fungi, or parasites. Some infectious diseases
can be passed from person to person, some are transmitted via bites from insects or animals, and others
are acquired by ingesting contaminated food or water or other exposures in the environment.91
Diseases caused by bacteria, fungi and some parasites can be treated through a variety of treatment
types, antibiotics being the most common. The first antibiotic was introduced in the 1940s, and more
than 100 different antibiotics are available today to cure a variety of infections from skin infections to
life-threatening blood infections by inhibiting the growth and reproduction of bacteria. However, the
overuse and inappropriate use of antibiotics have led to antibiotic-resistant infections which may make
many infections untreatable.92 For this reason it is very important not to overuse antibiotics and too
many antibacterial agents.
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Vaccine-Preventable Diseases
Percent of population with vaccine preventable diseases: 2011
0.02%
0.02%
0.01%
0.01%
0.00%
Pertussis
Becker
Clay
Otter Tail
Hepatitis A
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
Pertussis and Hepatitis A are two vaccine preventable diseases whose incidence can indicate potential
health negligence in an area, since they are both preventable with a vaccine. For the sake of anonymity,
numbers were converted to percentages. Otter Tail was the only area to report any cases of Hepatitis A
in 2011. Wilkin reported the greatest percent of their population had had pertussis in 2011, though the
low population could have inflated this percent. The lowest percentage was reported in Clay County.
Foodborne & Waterborne Illnesses
Food contains natural chemicals from the original plant or animal sources, and may also come in contact
with many natural and artificial substances during production, processing, and preparation. Potential
food hazards include microorganisms, naturally present chemicals, chemicals produced by cooking,
environmental contaminants, additives, and pesticides. Foodborne illness is caused by consuming food
or beverages that are contaminated by disease-causing microbes or pathogens.93
In Minnesota, the annual number of confirmed foodborne illness outbreaks has gradually increased,
from a median of 40 between 1995 and 2005 to a median of 46.5 between 2001 and 2010. Some (but
not all) of this increase is due to more effective outbreak monitoring like the establishment of a toll-free
foodborne illness hotline in 1998. 94
Here we examine the most common waterborne and foodborne illnesses: Giardiasis and Salmonellosis.
These can me contracted as outcomes of poor water quality and eating food contaminated with animal
feces95 respectively.
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Number of Giardiasis cases: 2005-2010
7
6
5
4
3
2
1
0
2005
2006
Becker
2007
Clay
2008
Otter Tail
2009
Wilkin
2010
Source: Minnesota Department of Health, Center for Health Statistics
There was no clear trend in Giardiasis cases among the four counties from 2005 to 2010, though there
were more cases in 2008 and 2009 than 2005 and 2006, possibly indicating an increase. Otter Tail
increased over time, while Wilkin remained consistently low in the number of cases. Becker and Clay
increased in number of cases until 2008 and leveled off or decreased from there.
Otter Tail reported the highest average number of cases over the time period, with 3.5. Becker reported
an average of 2.2 cases and Clay reported an average of 1.7 cases over the time period. Wilkin reported
0 Giardiasis cases most years for the lowest average, 0.2 cases.
Number of Salmonellosis cases: 2005-2010
12
11
10
9
8
7
6
5
4
3
2
1
0
2005
2006
Becker
2007
Clay
2008
Otter Tail
2009
Wilkin
2010
Source: Minnesota Department of Health, Center for Health Statistics
With the exception of Wilkin, each of the counties decreased in the number of Salmonellosis cases from
2006 to 2010, though there was a lot of variation over time within each of the four counties. Wilkin
reported the lowest average number of cases over the time period and Becker reported the greatest
average number of cases. Becker and Clay reported similar averages. These averages are consistent with
the average number of Giardiasis cases and can likely be attributed to the differences in sizes of
populations within the four counties.
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Tick & Mosquito Transmitted Diseases
Many Minnesotans participate in outdoor activities that put them at risk for the diseases carried by
insects. Lyme disease, Human Anaplasmosis and Babesiosis are the three most common tick-transmitted
diseases, though several less common and emerging diseases also have been reported in recent years.
The blacklegged tick (formerly known as the deer tick) transmits the agents of all of these diseases. In
general, the risk of tick-borne disease is higher in eastern Minnesota counties, and most diagnosed cases
report blacklegged tick exposure in forested areas of east central, north central, and southeastern
Minnesota. In recent years, however, blacklegged ticks have emerged in forested regions of the state
where they had not previously been reported, particularly in west central and northern Minnesota.96
With all the water around the state, mosquitoes have also become another insect carrier of diseases. In
2002, mosquito-borne diseases like West Nile disease weren’t a concern for Minnesotans since they had
never been reported here. However from 2003 to 2007, the occurrence of these diseases rose at an
alarming rate.97
Here we report the prevalence of tick- and mosquito-transmitted diseases, including Lyme disease,
Babesiosis, Anaplasmosis, and West Nile disease in recent years.
Reported cases of tick-transmitted diseases in Minnesota: 2006-2010
1400
1300
1200
1100
1000
900
800
700
600
500
400
300
200
100
0
2006
2007
Lyme Disease
2008
2009
Human Anaplasmosis
2010
2011
Babesiosis
Source: Minnesota Department of Health, Center for Health Statistics
Minnesota tick-borne disease case numbers have increased substantially in recent years. Lyme disease
has the greatest number of cases and Babesiosis has the lowest number of cases. There has been a slight
increase in the number of cases of Babesiosis and a steep increase in the number of cases of Human
Anaplasmosis from 2006 to 2011.
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Reported total cases of tick-transmitted diseases by county: 2006-2011
40
35
30
25
20
15
10
5
0
2006
Total number of cases of Lyme Diseases and Human Anaplasmosis
From 2006 to 2011, the number of
cases of tick-transmitted diseases
increased in each county: Becker
increased by a margin of 27, Otter Tail
by a margin of 11, Clay by a margin of 5,
and Wilkin by a margin of 1. Becker
consistently reported the greatest
number of cases of tick-transmitted
diseases over time, and Wilkin reported
the lowest number of cases.
2007
2008
2009
2010
2011
Reported cases of Lyme Disease and Human Anaplasmosis by county: 2011
20
15
10
5
0
In 2011, Becker reported the greatest
number of cases of Lyme Disease and
Human Anaplasmosis and Wilkin
reported the lowest number of cases.
Clay and Wilkin reported 0 cases of
Human Anaplasmosis. Becker reported
17 cases and Otter Tail reported 6
cases. Wilkin reported only 1 case of
Lyme Disease, Clay reported 6 cases,
Otter Tailed reported 10 cases, and
Lyme Disease
Human Anaplasmosis
Becker reported 19 cases.
Becker
Clay
Otter Tail
Wilkin
Source: Minnesota Department of Health, Center for Health Statistics
Reported cases of West Nile Virus: 2007-2011
Reported Cases of West Nile Virus
2007
2008
2009
2010
Minnesota
101
10
4
8
Becker
5
1
0
0
Clay
11
0
0
0
Otter Tail
2
0
0
0
Wilkin
3
0
0
0
2011
2
0
0
0
0
Source: Minnesota Department of Health, Center for Health Statistics
The above table presents the reported cases of West Nile Virus from the years 2007 to. The greatest
number of cases was reported in 2007. In that year, Minnesota reported 101 cases. Of the counties, Clay
reported the most cases, with 11, and Otter Tail reported the lowest number of cases, with 2.
Clay, Otter Tail, and Wilkin each reported 0 cases from 2008 to 2011, while Becker reported 1 case in
2008 and 0 cases from 2009 to 2011. These noticeably lower numbers from 2008 to 2011 could be
connected to the noticeably lower number of cases in the state of Minnesota during this time.
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Sexually-Transmitted Infections
Sexually transmitted infections (STIs), also known as sexually transmitted diseases, are the most
commonly reported communicable diseases in Minnesota, and account for nearly 70 percent of all
notifiable diseases reported to the Minnesota Department of Health. In 2010, the number of reported
bacterial STIs increased to nearly 18,000 cases, a 5 percent increase from the previous year. The
majority of those (over 15,000) are cases of chlamydia. Since 1996, the rates of chlamydia in Minnesota
have more than doubled. Youth and young adults between 15 and 24 are much more likely to contract
chlamydia; they comprise 69 percent of all chlamydia cases.98
Number of reported cases of Chlamydia: 2001-2011
160
140
Data for Wilkin was ommitted due to low counts
120
100
80
60
40
20
0
2001
2002
2003
2004
2005
2006
Becker
Clay
2007
2008
Otter Tail
2009
2010
2011
Source: Minnesota Department of Health, Center for Health Statistics, Acute Disease Epidemiology
From 2001 to 2011, Clay reported the most cases of chlamydia and averaged 87 per year over the 10
year time period. Becker and Otter Tail reported a similar number of cases of chlamydia over the time
period. Becker averaged 34 cases and Otter Tail averaging 38 cases over those 10 years. The number of
cases of chlamydia for Wilkin was omitted for privacy due to counts less than 20.
Number of cases of Chlamydia: 2011
140
Data for Wilkin was omitted
120
100
80
60
40
20
0
Becker
Clay
Otter Tail
Source: Minnesota Department of Health, Center for Health Statistics, Acute Disease Epidemiology
In 2011, Clay reported 123 cases of chlamydia, noticeably higher than Otter Tail and Becker. Otter Tail
reported 73 cases and Becker reported 42 cases of chlamydia. Like in the time series, the number of
cases of chlamydia in 2011 for Wilkin was omitted because there were less than 20.
106 | P a g e
HIV and AIDS
The number of persons assumed to be living with HIV (human immunodeficiency virus) and AIDS
(acquired immune deficiency syndrome) in Minnesota has been steadily increasing during the past 30
years. As of 2010, almost 7,000 persons were known to be living with HIV/AIDS in Minnesota, a 4
percent increase from the year prior (see below). However, both the number of newly-diagnosed AIDS
cases and the number of deaths among AIDS cases declined between 1996 and 2000. These decreases
were primarily due to the success of new treatments introduced in 1995 and 1996. These treatments do
not cure AIDS, but can delay progression of the disease and improve survival.99-100
Number of people living with HIV/AIDS in Minnesota: 2003-2011
8000
7000
6000
5000
4000
3000
2000
1000
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
Source: Minnesota Department of Health
The number of people living with HIV or AIDS in Minnesota was collected additively over time. From
2003 to 2011 the number has increased steadily from about 5000 to a little over 7000.
New Cases of HIV and AIDS in Minnesota: 2003-2012
300
250
200
150
100
50
0
2003
2004
2005
2006
AIDS deaths
2007
2008
2009
2010
HIV (non-AIDS)
AIDS
2011
2012
Source: Minnesota Department of Health
The number of new cases of HIV and AIDS in Minnesota has varied from 2003 to 2012. The most new
AIDS cases were reported in 2004, with 247, and the most HIV cases were reported in 2009, with 281.
The number of AIDS deaths over time remained fairly consistent, averaging 63 over the 8 year period.
107 | P a g e
Total reported cases of HIV and AIDS: 2012
30
Data for Wilkin was omitted
25
20
15
10
5
0
Becker
Clay
Otter Tail
Source: Minnesota Department of Health, Center for Health Statistics, Acute Disease Epidemiology
In 2012, Clay reported a noticeably greater amount of cases of HIV and AIDS than the other counties,
with 28. Otter Tail and Becker reported a similar number of cases, with 14 and 13 respectively. The data
for reported number of cases of HIV and AIDS was omitted for Wilkin because counts were less than 10.
Conclusion
Meeting Challenges with Strengths
This assessment of Becker, Clay, Otter Tail, and Wilkin addresses many concerns for health and the
challenges posed to maintaining or improving that within each county. It also identifies the noticeable
disparities in health status among Minnesotans and between the counties. These issues reveal that
there are many areas where Becker, Clay, Otter Tail, and Wilkin could improve their health, but there
are also many components of health where these counties thrive.
In the context of a four-county health assessment, the “strengths and assets” include many types of
human, social, economic, and organizational resources that stakeholders can leverage to improve the
health of all, and ensure a healthy future for the state. Becker, Clay, Otter Tail, and Wilkin citizens can
make progress not by focusing on problems, but by harnessing resources for change.101-102
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Key References and Resources
Minnesota Center for Health Statistics (www.health.state.mn.us/divs/chs)
The Minnesota Center for Health Statistics coordinates, collects and analyses a wide range of
Minnesota health-related data, including data from the U.S. Census Bureau, the Centers for Disease
Control and Prevention (CDC), the Minnesota Student Survey, and other programs within the
Minnesota Department of Health.
Minnesota Student Survey (www.health.state.mn.us/divs/chs/mss)
The Minnesota Student Survey is the result of collaboration between Minnesota schools and the
Minnesota Departments of Education, Employment and Economic Development, Health, Human
Services and Public Safety. The survey is administered every three years to sixth, ninth, and 12thgrade students.
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