Rutherford County, TN
Community Health Needs Assessment
2016
Welcome
Health Is:
• A state of complete physical, mental and social
well-being and not merely the absence of
disease or infirmity
Source: World Health Organization
Why are we here?
• Assessments done separately in 2013 as
requirement for STH and VUMC as non-profit
hospitals
– ACA related requirement
• For new cycle, came together in overlapping
counties
• Review findings of most recent RCHD, VUMC
and STH health assessment
• Collectively identify needs for Rutherford
County
Approach
• Reviewed publically available community
health data
• Interviewed key stakeholders
• Conducted listening sessions
• Convened today’s summit to identify needs
• Special attention to underserved, low-income,
minority populations
• Post-summit: Review needs for development
of Implementation Strategies
Agenda
• Health Department Update
• Review Findings
– Secondary Data
– Interviews
– Listening Sessions
• Exercise 1 : Identification of Health Needs
• Exercise 2 : Visioning, Goals and Resources
• Summary
Rutherford County – Health Priorities
Dana Garrett, RN, BSN
Findings from Secondary Data Review
Rutherford County, TN
2016 Community Health Assessment
Rutherford
Determinants of Health
Introduction and
Methods
Tobacco Use
Diet & Exercise
Alcohol & Drugs
Sexual Activity
Access to Care
Quality of Care
Education
Employment
Income
Social Support
Safety
Air & Water
Housing & Transit
Methods: Secondary Data
• Used publically available data
• Indicators, considered
– Recommendations of
• Centers for Disease Control and Prevention
• Catholic Health Association
– Review of RCHD, STH and VUMC 2013 CHNA
Indicator Topics
– Demographics and Socioeconomic Status
– Social & Natural Environment
– Access to Health Care
– Health Status
•
•
•
•
•
Morbidity/Mortality
Birth Outcomes
Preventive Care/Risk Factor Behaviors
Infectious Diseases
Mental & Emotional Health
– Other Community Assessments
Rutherford
Demographics: Rutherford
Demographic /
Socioeconomic
2014 Population estimate: 288,906
Rutherford
TN
USA
10.0%
3.2%
3.3%
25.3%
23.0% 23.3%
Persons 65 years and over
9.3%
14.7% 14.1%
Female persons, percent
Language other than English
spoken at home
Persons below poverty level
50.7%
51.2% 50.8%
9.9%
6.6% 20.7%
13.0%
17.6% 15.4%
Population, % change from
2010-2014
Persons under 18 years
Persons per square mile
424
153
87
Source: US Census Bureau (2015). State and County QuickFacts: Davidson Co., TN. Retrieved on 6/30/15, from: http://quickfacts.census.gov/qfd/states/47000.html
Projected Population and Job Growth
(2015, 2025, 2035)
Rutherford
Demographic /
Socioeconomic
From 2010-2014, Rutherford County Grew 10%
This is more than three times faster than the state as a whole
409,986
450,000
349,083
400,000
350,000
288,734
300,000
250,000
226,453
200,000
187,195
150,000
Population
Jobs
155,284
100,000
50,000
4.6% Unemployment*
0
2015
2025
Source: Nashville Metro Planning Organization, US Census Bureau Quickfacts. Retrieved 8/21/15 *Data for May 2015
2035
Population Below the Poverty Level
ACS 2009-13
Rutherford Co. 13.1%
Tennessee
17.7%
United States
15.4%
Percent in Poverty
20% +
15.1-20%
10.1-15%
<10.1%
Source: : Map of Population Below Poverty Level, Rutherford Co. TN. Community Commons (2015). Retrieved: July 15, 2015, from
www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract
Rutherford
Demographic /
Socioeconomic
Population Below the Poverty Level
By Race, ACS 2009-13
Source: Population Below Poverty Level, Rutherford Co. TN. Community Commons (2015). Retrieved: July 15, 2015, from
www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract
Rutherford
Demographic /
Socioeconomic
Children in Poverty
Trends, County, State and National
Rutherford
Demographic /
Socioeconomic
Source: : University of Wisconsin Population Health Institute. County Health Rankings 2015. Data Source: US Census Bureau, Small Area Income and
Poverty Estimates, American Community Survey. Retrieved on August 16, 2015 from: http://www.countyhealthrankings.org/
Population with No High School Diploma
(25yrs and older)
Rutherford Co. 10.3%
Tennessee
15.6%
United States
14.0%
Percent without HS Diploma
>21%
16.1-21%
11.1-16%
<11.1%
Source: Map of Population with No High School Diploma, Rutherford County, TN. Community
Commons (2015). Retrieved: July 15, 2015, from www.communitycommons.org Data Source:
US Census Bureau, American Community Survey. 2009-13. Source geography: Tract
Rutherford
Demographic /
Socioeconomic
Rutherford
Graduation Rates
Demographic /
Socioeconomic
2014
81%
(2013)
USA
87%
(2014)
TN
93%
(2014)
Rutherford
County ranks in
the middle of
TN Counties
Rutherford
Source: County and State : The Annie E. Casey Foundation. 2015 KIDS COUNT Data Books, Retrieved from : http://www.datacenter.aecf.org
US rate source: National Center for Education Statistics - http://nces.ed.gov/ccd/tables/ACGR_2010-11_to_2012-13.asp
Summary
Rutherford
Demographic /
Socioeconomic
• County is experiencing rapid growth
• 90% with high school education
• 13% live in poverty; 16.5% of children live in
poverty (40% below 200%)
• Poverty and Education vary by place and race
Social & Natural Environment
• Housing
• Neighborhood Safety
• Transportation
• Access to Healthy Food
• Air
Rutherford
Affordable Housing
Social & Natural
Environment
2013
Homeownership rate
Median household income
Median value of owneroccupied housing
House value / Income
Cost Burdened Households
Cost Burdened Renters
Poverty
Rutherford
67.6%
$55,401
Tennessee
67.8%
$44,298
US
64.9%
$53,046
$159,100
$139,200
$176,700
2.9 / 1
3.1 / 1
3.3 / 1
31.4%
47.2%
13.0%
31.0%
45.9%
17.6%
35.5%
48.3%
15.4%
Source: US Census Bureau (2015). State and County QuickFacts: Davidson Co., TN. Retrieved on 6/30/15, from: http://quickfacts.census.gov/qfd/states/47000.html
Homelessness
2015
1,675
Individuals
Experiencing
Homelessness
846 Adults
829 Children
Source: City of Murfreesboro Consolidated Plan 2015-20: http://www.murfreesborotn.gov/DocumentCenter/View/2278
Rutherford
Social & Natural
Environment
Rutherford
Violent Crime Rate
Social & Natural
Environment
Per 100,000 population
199
USA
621
TN
431
Rutherford
County
Source: University of Wisconsin Population Health Institute. County Health Rankings 2015 Retrieved on July 31, 2015 from: http://www.countyhealthrankings.org/
Domestic Violence
Number of Victims
Rutherford
Social & Natural
Environment
2014 Rate per 1,000
Rutherford 12.7
Tennessee 11.6
Source: Tennessee Bureau of Investigation. Tennessee Crime On-Line. Retrieved on 8/12/15, From: http://tennesseecrimeonline.com/public/Browse/browsetables.aspx
Transportation
Households with No Vehicle
Rutherford Co. 3.5%
Tennessee
6.3%
United States
9.1%
Percent without Vehicle
>8%
6.1 - 8%
4.1 - 6%
<4.1%
Source: : Map of Households with No Vehicle, Rutherford Co., TN. Community Commons (2015). Retrieved: July 14, 2015, from
www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract
Rutherford
Social & Natural
Environment
Rutherford
Population with Limited Food Access
Social & Natural
Environment
Rutherford Co. 28.6%
Tennessee
27.4%
United States 23.6%
>50%
20.1 - 50%
5.1-20%
<5.1%
No Low Food
Access
Source: Map of Population with Limited Food Access, Nashville TN. Community Commons (2015). Retrieved: July 14, 2015, from
www.communitycommons.org Data Source: US Department of Agriculture, Economic Research Service, USDA - Food Access Research Atlas. 2010.
Source geography: Tract
Fast Food Restaurants
Rate per 100,000 population
Source: Community Commons . Fast Food Restaurants, Rate per 100,000 population by year, 2008-2013. Data Source: US
Census Bureau, County Business Patterns. Additional data analysis by CARES. 2013. Source geography: County Retrieved
7/14/15, Retrieved from: communitycommons.org
Rutherford
Social & Natural
Environment
2-1-1 Calls, Top 10 Categories
FY2014
Source: Family & Children’s Services. Data Source: United Way of Metropolitan Nashville., 2-1-1
Rutherford
Social & Natural
Environment
Rutherford
Air Pollution and Lung Disease
Social & Natural
Environment
Particulate Air Pollution
(Daily PM2.5)
14.3
14
13.8
Estimated Number Suffering from Lung Disease
Rutherford County
11.9
12
Pediatric Asthma
5,757
Adult Asthma
15,538
COPD
17,271
Lung Cancer
217
10
8
6
4
2
0
Rutherford Co
TN
USA
Source: 2015 County Health Rankings, American Lung Association – Estimated Prevalence and Incidence of Lung Disease
Rutherford
Summary
Social & Natural
Environment
• Many are burdened by housing costs
• Violent crime rate is high
• Areas of limited healthy food access are present
• Rates of fast food establishments are rising
• Particulate air pollution presents a regional
challenge
Access to Health Care
• Provider availability
• Health staffing shortages by HPSAs
• Insurance coverage
Rutherford
Provider Rates
Access to Health
Care
County
Heath
Rankings
Rutherford
Rutherford
Top 10%
10% of
US
Best
USCounti
Counties
es
Primary Care
2231:1
1045:1
Dental
2036:1
1377:1
Mental Health
1358:1
386:1
Source: 2015 County Health Rankings
Access to Providers
Behavioral Risk Factor Surveillance Survey
Rutherford
Access to Health
Care
Source: Tennessee Department of Health (2013/2012) Behavioral Risk Factor Surveillance System: Tennessee State and Regional Data, retrieved from: on July 17, 2015
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data
[online]. 2015. [accessed Aug 05, 2015].
Rutherford
Preventable Hospital Stays
# of Hospital Stays for ambulatory-care sensitive conditions / 1,000 Medicare Enrollees
Access to Health
Care
65
USA
73
TN
85
Rutherford
Source: University of Wisconsin Population Health Institute. County Health Rankings, 2015. Preventable Hospital Stays, 2012.. Data CDC, National Center for Health
Statistics and Division of Behavioral Surveillance Dartmouth Institute for Health Policy & Clinical Practice. Retrieved on 7/17/15, From:
http://www.countyhealthrankings.org
Chronic Disease Hospitalization Rate
(age-adjusted per 100,000)
Source: TN DOH, Chronic Disease Health Profile, December 2011, Retrieved 8/15/15, from: http://hit.state.tn.us/CDProfiles.shtml
Rutherford
Access to Health
Care
Health Insurance
Tennessee Coverage of Total Population 2013
Rutherford
Access to Health
Care
Source: : Kaiser Family Foundation 2015. State Health Facts. Health Insurance Coverage of the Total Population. Retrieved: August 28, 2015,
from www.kff.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract
Health Insurance
Uninsured Population 2009-2013
Rutherford Co. 13.6%
Tennessee
14.1%
United States 14.9%
Percent Uninsured
20% +
15.1-20%
10.1-15%
<10.1%
No Data
Source: : Map of Insurance-Uninsured Population, Rutherford Co., TN. Community Commons (2015). Retrieved: July 14, 2015, from
www.communitycommons.org Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract
Rutherford
Access to Health
Care
Rutherford
Summary
Access to Health
Care
• Fewer providers relative to nation and state
– 11% did not see MD due to cost
– 28% did not visit a dental professional in the past
year
• HPSA facilities within county
• Remain less than 100% coverage, 100% access
Health Status
• Morbidity/Mortality
– Causes of Death
– Premature Death (Years of Potential Life Lost)
•
•
•
•
Birth Outcomes
Preventive Care/Risk Factor Behaviors
Infectious Disease
Mental & Emotional Health
Causes of Death: USA, 1900-2013
Age adjusted Death Rates for Selected Major Causes of Death
Mortality Rate per 100,000, Standard Population
600
Rutherford
Morbidity /
Mortality
Influenza,
Pneumonia
Heart Disease
500
400
300
Cancers
200
Stroke
100
Accidents
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010
Year
Source: National Center for Health Statistics http://blogs.cdc.gov/nchs-data-visualization/2015/06/01/deaths-in-the-us/
Percentage of Deaths
Rutherford County (2011-2013)
Cancer
23
Heart Disease
22
Lung Disease
6
Accidents
5
Stroke
5
Alzheimer's
4
Diabetes
3
Flu / Pneumonia
3
Suicide
2
Liver Disease
2
Rutherford
Morbidity /
Mortality
Other [25]
Rutherford
Premature Death
Morbidity /
Mortality
Rate
per of
100,000
population
(2013)
Rate of Potential
Years
Life Lost
per 100,000
population - 2013
6592
Rutherford County
8636
Tennessee
6605
United States
0
2000
Source: National Vital Statistics System-Mortality (NVSS-M) (2011-2013)
4000
6000
8000
10000
Rutherford
Premature
Death
Premature Death
Morbidity /
Mortality
Rutherford County (2009) vs. Tennessee (2013) vs. United States (2013)
Percentage of Years of Potential Life Lost, by Leading Cause
25
Percentage of YPLL <age 75 years
22.2 21.6
Rutherford County
20
TN
15.3
15
USA
14.9
15.1
12.8
10
6.3
5.7
5
2.2
3.2
3.3
4.4
0
Cancer
Heart Disease Unintentional
Injury
Suicide
Homicide
Source: State and National data - National Vital Statistics System-Mortality (NVSS-M) (2013),
Rutherford County Data - Tennessee Department of Health, Office of Policy, Planning and Assessment, Division of Health Statistics (2009)
Perinatal
Period
Rutherford
Premature Death in TN
Morbidity /
Mortality
Percentage of Years of Potential Life Lost (<75)
Racial Disparity in % of YPLL by Cause
25
21.4
20
17.6
TN - White
17.6
16.8
TN - Black
16.2
15
10.6
10
8.6
6.7
6.1
5
2.1
1.4
2.1
0
Cancer
Heart Disease Unintentional
Injury
Suicide
Homicide
Source: State and National data - National Vital Statistics System-Mortality (NVSS-M) (2013),
Rutherford County Data - Tennessee Department of Health, Office of Policy, Planning and Assessment, Division of Health Statistics (2009)
Perinatal
Period
Rutherford
Cancer Death Rates in Tennessee
Morbidity /
Mortality
Disparities by Race, Gender (2012)
The cancer death rate is higher for men than women.
350
Death Rate from Cancer, per 100,000 population
311.6
300
Particularly black men, who die of cancer at more
than twice the rate of white women
250
200
150
151.7
94.8
100
90.9
45.1
50
32
45.5
37.3
14.7
13.3
32.4
21.4
0
All Cancer
Lung
Black Male
Digestive
System
White Male
Genital
Black Female
Source: CDC Wonder, US Cancer Statistics, Data is age-adjusted statewide rate for Tennessee in 2012
Colorectal
White Female
Breast
Cancer
Heart Disease Death Rates in Tennessee
Death Rate from Heart Disease, per 100,000 population
Disparities by Race, Gender
Morbidity/
Mortality
Rates of Heart Disease Death are Falling, particularly for
women and non-white men
290
270
Rutherford
266.5
265.7
White Male
251.4
250
236.8
230
Female (all)
208
210
195.1
Black Male
190
170
2004
2005
2006
2007
2008
2009
Source: 2013 Tennessee Women’s Health Report Card, 2013 Tennessee Men’s Health Report Card
2010
2011
2012
2013
Rutherford
Injury Death Rate by Age and Type
Morbidity /
Mortality
Tennessee Males, per 100,000 Population [2013]
120
Injury Death Rate, by type
100
Males (84 per 100k) are more
than twice as likely as females
(35 per 100k) to die from
unintentional injuries
80
Falls
60
Poisoning / Exposure
40
20
0
15-24
Transport Accidents
25-34
35-44
Age
45-54
55-64
Source: IVP-1.1: National Vital Statistics System-Mortality (NVSS-M), CDC/NCHS; Population Estimates, Census.
65-74
75-84
Rutherford
Summary
Morbidity /
Mortality
• Cancer and heart disease are leading causes of
death
• Causes of death vary by race and gender
• Combined accidents, assaults and suicide
represent 12% of deaths and 21% of years of
potential life lost
Birth Outcomes
• Infant Mortality
• Low Birth Weight
• Prenatal Care
• Teen Pregnancy
Rutherford
Infant Mortality in the United States
Birth
Outcomes
Racial Disparities since 1915
3
Black
Infant Death Rate per 1000 Live Births
180
Relative Disparity in Black Rate
over White Rate
160
140
2.5
2
120
100
1.5
80
1
60
White
40
0.5
20
0
0
1915
1925
1935
1945
1955
1965
1975
Source: CDC/NCHS, National Vital Statistics System, Mortality Data ;1900–1967, CDC Wonder
1985
1995
2005
Disparity in Black Rate over White Rate
200
Rutherford
Infant Mortality: Rutherford Co
Birth
Outcomes
International Comparison - 2013
10
9
Rutherford
8
Tennessee
7
6.8
United States
6
6
5
4
3
2
Cuba (4.7)
US Ranks
55th
4.5
France (3.3)
Czech Republic (2.6)
Japan (2.1)
1
0
Infant Death Rate / 1000
births
Source: TN Dept of Health, Division of Policy, Planning and Assessment, Office of Health Stats; National Vital Statics Reports, Vol 64 No1 Jan 15, 2015; KIDS Count
Rutherford
Birth Outcomes
Birth
Outcomes
2013
10
9
8
7
6
Rutherford
8.7
9.1
8
Tennessee
6.8
6
United States
5
4.5
4
3
2
1.5
1.6
1.4
1
0
Very Low Birthweight
(%)
Low Birthweight (%) Infant Death Rate / 1000
births
Source: TN Dept of Health, Division of Policy, Planning and Assessment, Office of Health Stats; National Vital Statics Reports, Vol 64 No1 Jan 15, 2015; KIDS Count
Rutherford
Birth Outcomes
Birth
Outcomes
Racial Disparities In Rutherford County (2013)
16
14.2
Rutherford
14
12
White
10
Black
1.8x
8.7
7.7
8
7.7
6
2.1x
4.5
3.6
4
2
2.7
1.5
1.3
2.1x
0
Very Low Birthweight (%)
Low Birthweight (%)
Infant Death Rate / 1000 births
Source: TN Dept of Health, Division of Policy, Planning and Assessment, Office of Health Stats; National Vital Statics Reports, Vol 64 No1 Jan 15, 2015; KIDS Count
Rutherford
Teen Pregnancy Rates; Ages 15-17,
Trend: 2005-2014
Birth
Outcomes
Teen Pregnancy Rate, per 1000 15-17 yo Females
Teen Pregnancies are In Decline Across the County and State
40
35
33.8
30
25
28.8
Tennessee (-52%)
20
16.1
15
Rutherford(-63%)
10
10.7
5
0
2005
2006
2007
2008
2009
2010
2011
2012
Source: KIDScount, Tennessee Department of Health, Office of Policy Planning and Assessment, Division of Health Statistics.
2013
2014
Rutherford
Summary
Birth
Outcomes
• Infant mortality and low birth weight rates are
high
– Vary by race
• Mothers receiving early prenatal care is
steady, but remains below HP2020 goal
• Teen pregnancy and birth rates continue to
decline
– Vary by race
Preventive Care / Risk Factor Behaviors
• Well-being
• Tobacco & Substance Use
• Obesity & Nutrition
• Physical Activity
• Youth Risk Behavior Survey
• Vaccinations
Rutherford
Adults Reporting “Poor” or “Fair” Health
Preventive
Risk Factors
2006-2012
17%
USA
23%
TN
15%
Rutherford
Source: 2015 County Health Rankings, BFRSS, 2006-2012
Adult Smokers
2013
21%
USA
23%
TN
Rutherford
Preventive
Risk Factors
Tobacco use is the
most preventable
cause of premature
mortality and
morbidity
- TN Dept of Health
Healthy People
2020 Target
17%
Rutherford
12%
Source: 2015 County Health Rankings, : Tennessee Department of Health, Division of Policy, Planning and Assessment, Behavioral Risk Factor Surveillence System., HealthyPeople2020.gov
Rutherford
Substance Abuse
Percent of Total Admissions, by Substance
TDMHSAS Funded Treatment Admissions, by Cause (FY 2014)
70
Preventive
Risk Factors
More than 1 in 12 People in Rutherford County have
Abused Substances in the Past Year
60
50
40
Rutherford County
TN
36.9
51.5
44.2
40.2
39.9
38.6
30
20
11.6
10
5.6
0
Methamphetamines
Opiods
Alcohol
Other Illicit Drugs
Substance of Abuse for TDMHSAS funded treatment admissions
Source: 2014 Tennessee Behavioral Health County Data Book
Rutherford
Adults Obese and Overweight
Preventive
Risk Factors
2013
64%
31%
Obese
Overweight
and Obese
USA
34%
Obese
TN
Mid-Cumberland
Region
34%
Obese
Source: Mid-Cumberland and State: Source: Tennessee Department of Health . 2013 BRFSS. US, Source: ,Kaiser Family Foundation
68%
Overweight
and Obese
69%
Overweight
and Obese
Rutherford
Access to Exercise Opportunities
Social
Environment
2013
65%
USA
70%
TN
77%
Rutherford
Source: 2015 County Health Rankings
Rutherford
Adults Participating in Physical Activity (Past Month)
Preventive
Risk Factors
2013
75%
USA
63%
TN
Mid-Cumberland
Region
Source: Tennessee Department of Health 2013 . Behavioral Risk Factor Surveillance Survey
71%
Influenza & Pneumococcal Vaccination
Adults and Seniors 2013
Source: BRFSS: TN DoH (2013). Behavioral Risk Factor Surveillance System: Tennessee State and Regional Data. Retrieved 8/14/15 from:
http://tn.gov/health/topic/statistics-brfss
Rutherford
Preventive
Risk Factors
Rutherford
24-Month Vaccinations
Preventive
Risk Factors
2014
73%
Mid-Cumberland
Region
100
98
96
94
92
90
88
86
84
82
80
24 Month Olds,
Fully Vaccinated
77%
(4:3:1:3*:3:1:4 Series)
The Mid-Cumberland Region Exceeds Healthy People 2020 Targets in
6 of 7 Leading Recommended Vaccinations at 24 months of age
97.1
96.2
97.1
96.2
HP 2020
Target
(90%)
92.4
93.3
83.8
DTaP
Poliomyelitis
MMR
Hepatitis B
Hib
Varicella
Source: TN DoH (2014). Behavioral Rtor Surveillance System: Tennessee State and Regional Data.. *Data is for Mid-Cumberland Region
Pneumococcus
Youth Risk Behavior Survey
2013 – Tennessee High School Youth (US)
Rutherford
Preventive
Risk Factors
• Tobacco Use
– 15.4% smoked cigarettes within 30 days (US: 15.7%)
– 12% smoked a whole cigarette before age 13 (US:
9.3%)
• Nutrition & Obesity
– 16.9% are obese (US: 13.7%)
– 15.4% are overweight (US: 16.6%)
• Physical Activity
– 19.6% were not physically active at least 60 min on
at least 1 day during the past week (US: 15.2%)
Rutherford
Summary
Preventative
Risk Factors
• Smoking rate remains higher than HP2020 target
• Many are overweight and obese
• High School Youths
– 15.4% smoked cigarettes within 30 days
– 16.9% are obese
• 30% seniors (age 65 years and older) are not
vaccinated for influenza and pneumococcal
Infectious Disease
• STD incidence rates
– chlamydia
– gonorrhea
– syphilis
• HIV incidence rate
Chlamydia
Trends 2003 – 2012
Rutherford
Infectious
Disease
State 2012
White 251.5
Black 1,629.9
Source: Community Commons (2015). Data Source: US Department of Health Human Services, Health Indicators Warehouse. Centers for Disease Control and Prevention,
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. 2012. Source geography: County. Retrieved on 7/14/15, From: www.communitycommons.org
Source: Centers for Disease Control and Prevention . NCHHSTP Atlas. Chlamydia by County. Retrieved on 8/12/15, From:
http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html
Rutherford
Gonorrhea
Infectious
Disease
Trends 2003 – 2012
State 2012
White 36.5
Black 627.2
Source: Community Commons (2015). Data Source: US Department of Health Human Services, Health Indicators Warehouse.
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. 2012. Source
geography: County. Retrieved on 7/14/15, From: www.communitycommons.org
Rutherford
HIV Prevalence
Infectious
Disease
Trends 2008-2010
State 2010
White 145.6
Black 1,093.6
Source: Community Commons (2015). Data Source: US Department of Health Human Services, Health Indicators Warehouse.
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. 2010. Source
geography: County. Retrieved on 7/14/15, From: www.communitycommons.org
Rutherford
Summary
Infectious
Disease
• Chlamydia rates are rising
• Gonorrhea rate is increasing locally
• STD prevalence rates vary
– By Race/Ethnicity (higher among minorities)
Mental & Emotional Health
• ACE
• Well-being
• Mental Illness
• Serious mental illness
Rutherford
Adverse Childhood Events (ACEs)
Source: “Adverse Childhood Experiences in Tennessee,” Tennessee Department of Health
Mental and
Emotional Health
# ACEs
% (TN)
0
48%
1
20%
2
11%
3
7%
4(or more)
14%
Poor Mental Health Days (last 30 days)
2013
3.5
USA
3.4
TN
2.7
Rutherford
Source: Source: 2015 County Health Rankings
Rutherford
Mental and
Emotional Health
Rutherford
Mental Illness in the past Year (18+)
Mental and
Emotional Health
2013
19%
USA
21%
TN
20%
Rutherford
Source: 2015 County Health Rankings,
Serious Mental Illness (SMI)
in the past Year (18+), 2013
Rutherford
Mental and
Emotional Health
Serious Mental Illness (SMI)
Schizophrenia
Bipolar Disorder
~8,000
Experience
Serious Mental Illness
Each Year
Schizoaffective Disorder
Major Depressive Disorder
Source: Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: Tennessee, 2014. HHS Publication No. SMA–15–4895TN. Rockville,
MD: Substance Abuse and Mental Health Services Administration, 2015.
Rutherford
Mental Illness
Mental and
Emotional Health
“Evidence has shown that
mental disorders
are strongly related to the occurrence of many chronic diseases,
including
diabetes, cancer, cardiovascular disease,
asthma, and obesity
and many risk behaviors for chronic disease; such as,
physical inactivity, smoking, excessive drinking, and
insufficient sleep.”
- Centers for Disease Control
Other Community Assessments
• TN Dept. of Health – Drive Your County to
the Top Ten
http://tn.gov/health/topic/specialreports
• County Health Status Indicators
http://wwwn.cdc.gov/CommunityHealth/HomePage.aspx
Rutherford
Summary
Community Needs
Assessments
• 13% live in poverty
– 40% of children below 200% poverty level
• Health outcomes could be improved
• Place & Race matter
• Many resources in our community
Thank you / Questions
Findings From
Interviews with Community Leaders
Methods: Interviews
• Interviewed community representatives and
leaders with:
– Focus on the broad interests of the community
– Serving low-income, minority or underserved
populations
• Sectors represented include: public health,
government/public sector, health care,
education, faith community, private
foundations, academia
• Interviews conducted in pairs by STH, VUMC
and graduate students from MMC and VU
• Closed and open-ended questions
Rutherford
Methods: Interviews (cont.)
• Semi-structured interview protocol focused on
health concerns, determinants of health,
health systems issues, health assets
• Quantitative data (6 questions) :
– Entered in REDCap and analyzed using excel
– “Other” responses coded or analyzed separately
• Qualitative data (3 questions):
– Thematic analysis conducted using team of 3
reviewers for each question
Rutherford
“What are the Greatest Health and/or Health Care Concerns
in your Community?” (n=28)
Answers with zero responses excluded from chart
Respondents Could Select Up to Five Response Options
Health Concerns (Rutherford)
%
1. Mental/Emotional Health
50
2. Obesity
46
3. Affordability/Cost of Care
39
4. Access to Care
36
5. Alcohol & Drug Abuse
32
6. Oral/Dental Health
29
6. Housing/Homelessness
29
6. Health Education
29
9. Transportation
21
Rutherford
“What Socioeconomic and Demographic Factors have the
Biggest Impact on Community Health?”(n=28)
Leading Health Concerns
(Rutherford)
Respondents Could Select Up to Three Response Options
%
1. Health Insurance Coverage
54
2. Poverty/Working Poor
39
3. Education Attainment
32
4. Language Barriers
25
4. Wealth Dispersion
25
6. Cultural Competency
21
6. Housing/Homelessness
21
6. Food Insecurity
21
Rutherford
“What Environmental Factors have the Biggest Impact on
Community Health?”(n=28)
Respondents Could Select Up to Three Response Options
Conditions/Diseases (Rutherford)
%
1. Healthy Food Access
57
2. Transportation
54
2. Housing/Homelessness
54
4. Limited Sidewalks
29
5. Secondhand Smoke
25
Rutherford
“What Conditions and Diseases are Causing Illness and Death
in your Community?” (n=28)
Respondents Could Select Up to Three Response Options
Conditions / Diseases (Rutherford)
%
1. Alcohol & Drug Abuse/ Addiction
50
2. Emotional and Mental Health
46
3. Obesity
43
4. Diabetes
39
5. Cancer
29
6. Cardiovascular Disease
25
Rutherford
“What Are the Greatest Barriers within the Health System?”
(n=28)
Respondents Could Select Up to Three Response Options
Health System (Rutherford)
%
1. Affordability/Cost of Care
39
2. ER use for non-emergencies
32
3. Health Education
25
3. Coordination of Care
25
5. Transportation Barrier to
Care
21
5. Provider Availability
21
5. Health Navigation
21
5. Not Prevention Focused
21
5. Access: Overall
21
Rutherford
“What Behaviors have the most Negative Impact on Health in
your Community?” (n=28)
Respondents Could Select Up to Three Response Options
Behaviors (Rutherford)
%
1. Alcohol/Drug Abuse & Addiction
54
2. Nutrition/Healthy Eating
46
2. Physical Activity
46
4. Tobacco Use/Smoking
36
5. Health Education /Literacy
32
6. Preventive Care
25
7. Texting While Driving
21
7. Adherence to Medical Regimen
21
Rutherford
“What Reasons/Barriers exist that cause the use of ER for
non-emergencies?” (n=28)
• Lack of consistent source of medical care
▫ There are not enough primary care providers for people
to see when needed urgently or for prevention
• Convenience, hours of operation and transportation
▫ The ER provides immediate access to care during nonbusiness hours
▫ Lack of after hours availability to primary care
providers
• No Health Insurance
▫ Many without insurance aren’t familiar with the
financial impact of unnecessary ER use
• Health Navigation/Literacy
▫ Many homeless families are more concerned about
shelter than preventive healthcare
Rutherford
“What Community Health Assets work well to support health
and well-being?” (n=28)
• Safety net healthcare & service providers
▫ Local health department
▫ Mobile health unit & safety net clinics
▫ Basic service agencies
• Community cohesiveness
▫ We work well together
▫ Degree of perceived collaboration and engagement
within the county
• Hospitals & Healthcare availability in the county
• Greenways & Recreational opportunities
▫ Walking trails, farmers’ markets
▫ Local recreational facilities
Rutherford
“What Priority Actions should Rutherford County focus on?”
(n=28)
• Increase access to affordable primary care
▫ Address transportation barriers
▫ More providers for low income individuals
▫ Integration of services
• Substance abuse
• Mental health
• Lifestyle component
▫ Healthy food access/nutrition/obesity
▫ Walkability/physical activity
• Increase access to adult dental care
Rutherford
Rutherford Co. Interview Summary
Alcohol & Drug abuse/addition
Emotional and Mental Health
Nutrition/Physical Activity
Working together to address issues
Rutherford
Findings From
Community Listening Sessions
Listening Session Methodology
• Three listening sessions held. Collaborated with
health department and community partners on
recruitment
– Rutherford County Health Department (Smyrna)
– Primary Care & Hope Clinic
– First Baptist Church
• Moderated and co-moderated by partners
• Moderator’s guide topics included community
assets and issues, health and healthcare issues,
preventable ER utilization, and priority actions
• Short survey to obtain participant demographic info
• Qualitative data: thematic analysis conducted using
team of four reviewers
Rutherford
Demographic Information
Listening Sessions
Demographics of Participants (n=37)
– 76% Female
– 97% English speakers
– 25% High School Completion or less, 22% Some
College, 53% College Degree or more
– 19% Uninsured, 58% Insured, 15% Medicare, 3%
Medicaid
Rutherford
“What Community Health Assets/Resources
work well to support health and well-being?”
•
•
•
•
Parks, greenways
Centralized location and highways
Growth of businesses
Activities for kids and recreational
opportunities
– Many opportunities offered by faith
community
Rutherford
“What are the Top Community Issues?”
• Traffic
• Transportation and difficulty navigating different
areas of the county
• Walkability
• Cost of living
– Affordable child care
– Affordable housing
• Resources available but community not using or
aware of them
• Long wait for services/benefits (i.e. housing and
unemployment)
Rutherford
“What are the Greatest Health and/or Health
Care Issues in your community?”
• Access to care, cost of care
– Insurance gap, lack of insurance
– Cost of prescription drugs
• Culture of unhealthy eating
• Emotional/mental health
– Opportunities and youth development
• Substance use/abuse
– Addiction
– Prescription drugs
• Access to specialty care
– Mental and adult dental
Rutherford
“What Reasons/Barriers exist that cause the
Use of ER for non-emergencies?”
• No co-pays or need for cash upfront
• Care regardless of ability to pay or
comprehensiveness of insurance coverage
• Transportation barrier to local care providers
• Challenges of accessing primary care system
and limitations of available hours for primary
care visits
Rutherford
“If you had a Magic Wand, what Priority Actions
should your community focus on?”
• Transportation, transit, connectivity across the
county
• Coordination and collaboration across
community and health resources
• Access to care:
– Mental health
– Adult dental
• Expand affordable insurance options and
address insurance gap
Rutherford
Rutherford Co. Listening Session
Summary
Transportation and lack of connectivity
across the county
Emotional/Mental health
Health system difficult to navigate and not
easily accessible
Information on health and social services
can be difficult to access
Rutherford
Limitations: Primary and Secondary Data
• Interviews:
– Response categories on interview guide for some
questions not mutually exclusive
– Variability in number of responses that respondents chose
• Listening sessions:
– Representativeness of listening session participants
– Potential language/cultural barriers
• Secondary data:
– Source variability
– Benchmarking not always available
Rutherford
Acknowledgements
•
•
•
•
Interviewees & listening session participants
Primary Care and Hope Clinic
First Baptist Church
Lane Agri-Park Community Center/ Rutherford
County Agricultural Extension
• Student team members:
– Christopher Artis, Meharry Medical College
– Althea Robinson, Vanderbilt University
– Shellese Shemwell, Vanderbilt University
Questions/Discussion
Exercise 1:
Identification of Health Needs
Identification of Health Needs
• Please write down 3 Health Needs
– 1 per sticky note
• Place sticky note on white paper
Exercise 2:
Visioning, Goals, Resources
• Work in groups
• Worksheets at tables
• Groups will need:
– Facilitator
– Recorder
– Reporter
Thank you to all!!