Cape Girardeau County - Saint Francis Medical Center

Transcription

2016CommunityHealth
NeedsAssessment
CapeGirardeauCounty,Missouri ThisassessmentwillidentifythehealthneedsoftheresidentsofCapeGirardeauCounty,Missouri
andthoseneedswillbeprioritizedandrecommendationswillbemadeforprogramstobe
implementedtomeetthoseneeds.
TableofContents
ListofFigures...............................................................................................................................................5
ListofTables.................................................................................................................................................6
ExecutiveSummary......................................................................................................................................8
CommunityHealthNeedsAssessmentProcessandRequirements.........................................................8
CommunityProfile...................................................................................................................................8
HealthOutcomes......................................................................................................................................8
HealthBehaviors......................................................................................................................................9
HealthMeasures......................................................................................................................................9
PrimaryResearch.....................................................................................................................................9
SummaryofFindings................................................................................................................................9
KeyFindings................................................................................................................................................10
HealthNeeds..........................................................................................................................................10
BehavioralNeeds....................................................................................................................................10
CommunityNeeds..................................................................................................................................10
PriorityNeeds.............................................................................................................................................11
PrioritizationProcess..............................................................................................................................11
Top5PriorityHealthNeeds(andAssociatedBehavioralNeeds)...........................................................12
Chapter1:CommunityHealthNeedsAssessmentIntroductionandMethods.........................................13
CommunityHealthNeedsAssessmentDescription...............................................................................13
CommunityHealthNeedsAssessmentRequirements...........................................................................13
ImplementationStrategyRequirements................................................................................................14
CommunityHealthNeedsAssessmentProcess.....................................................................................15
Defining“Community”.......................................................................................................................15
IdentifyingPartnersandIndividualsRepresentingtheBroadInterestsoftheCommunity...............15
GatherAvailableDataandCurrentAssessments...............................................................................16
DevelopandConductPrimaryResearch............................................................................................16
AggregatePrimaryandSecondaryResearch......................................................................................17
IdentifyandPrioritizetheHealthNeedsintheCommunity..............................................................17
DevelopandImplementaStrategytoAddresstheIdentifiedPriorityHealthIssues........................17
WidelyDisseminatetheCHNA...........................................................................................................17
Chapter2:CommunityProfile....................................................................................................................18
BackgroundInformationforCapeGirardeauCounty............................................................................18
CityofCapeGirardeau.......................................................................................................................18
CityofJackson....................................................................................................................................19
SmallerCitiesandTownsinCapeGirardeauCounty.........................................................................19
DemographicCharacteristics..................................................................................................................19
PopulationGrowth.............................................................................................................................19
Race....................................................................................................................................................19
Ethnicity..............................................................................................................................................20
AgeDistribution..................................................................................................................................20
Gender................................................................................................................................................21
Household/FamilyConfiguration.......................................................................................................21
Religion...............................................................................................................................................22
SocialCharacteristics..............................................................................................................................23
Education............................................................................................................................................23
2016CommunityHealthNeedsAssessment
1|P a g e Language............................................................................................................................................23
Literacy...............................................................................................................................................24
MaritalStatus.....................................................................................................................................24
EconomicCharacteristics.......................................................................................................................24
Income................................................................................................................................................24
Unemployment..................................................................................................................................25
Poverty...............................................................................................................................................25
Medicaid/MOHealthNet....................................................................................................................26
Free/Reduced-PriceLunches..............................................................................................................26
HungerandFoodUncertainty............................................................................................................27
Women,InfantsandChildren(WIC)Participation.............................................................................27
Housing...............................................................................................................................................27
Transportation....................................................................................................................................27
HealthPromotion...................................................................................................................................28
HealthcareSystem..................................................................................................................................28
AccesstoHealthcare..........................................................................................................................28
UninsuredPopulation.........................................................................................................................29
HealthcareProviders..........................................................................................................................29
Hospitals.............................................................................................................................................29
CommunityHealthResources/Services.............................................................................................33
EmergencyServices............................................................................................................................33
Long-TermCareFacilities...................................................................................................................35
Chapter3:HealthOutcomes......................................................................................................................36
Mortality.................................................................................................................................................36
LeadingCausesofDeath....................................................................................................................36
Cancer.................................................................................................................................................36
ChronicDisease..................................................................................................................................38
YearsofPotentialLifeLost.................................................................................................................39
InfantMortality..................................................................................................................................39
Morbidity................................................................................................................................................40
ObesityandOverweight.....................................................................................................................40
InfectiousDisease...............................................................................................................................41
HIV/AIDS.............................................................................................................................................42
OtherSexuallyTransmittedDiseases.................................................................................................43
HealthStatusatBirth.............................................................................................................................44
HealthStatus..........................................................................................................................................45
MentalHealth........................................................................................................................................45
PreventableHospitalizations..................................................................................................................45
Chapter4:HealthBehaviors......................................................................................................................47
DietandExercise....................................................................................................................................47
TobaccoUse...........................................................................................................................................47
SubstanceAbuse....................................................................................................................................47
MaternalHealth.....................................................................................................................................47
PrenatalCare......................................................................................................................................47
SmokingDuringPregnancy.................................................................................................................48
Breast-feeding....................................................................................................................................48
PreventionandScreening......................................................................................................................49
PreventativePractices........................................................................................................................49
2|P a g e Diabetes..............................................................................................................................................50
Chapter5:HealthMeasures.......................................................................................................................51
ChildandAdolescentHealth..................................................................................................................51
CausesofDeath–Children................................................................................................................51
CausesofDeath–Adolescents..........................................................................................................51
TeenSubstanceAbuseandSmoking..................................................................................................51
TeenPregnancy..................................................................................................................................52
SeniorHealth..........................................................................................................................................53
MissouriSeniorReport.......................................................................................................................53
CostBurdenedbyHousing.................................................................................................................53
Transportation....................................................................................................................................53
Safety..................................................................................................................................................53
HealthcareAccess..............................................................................................................................54
QualityofLife.....................................................................................................................................54
HealthandWellness...........................................................................................................................54
Chapter6:PrimaryResearch......................................................................................................................55
FocusGroups..........................................................................................................................................55
Methodology......................................................................................................................................55
Question1:Whatdoyouthinkofasyourcommunity?....................................................................55
Question2:Whatdopeopledointhecommunitytostayhealthy?.................................................56
Question3:Wheredopeoplegotogethealthinformationfrom?...................................................56
Question4:Whatdoyoufeelabouthowthechecklistexerciseprioritizedthehealthissues?........56
Question5:Whatarethetopissuesyoufeelneedtobeaddressedinthecommunity?.................57
OtherNotes:.......................................................................................................................................57
ChecklistExercise...............................................................................................................................58
Surveys...................................................................................................................................................58
SurveyLayoutandDesign..................................................................................................................58
Methodology......................................................................................................................................58
Participants.............................................................................................................................................59
Chapter7:SummaryofNeeds...................................................................................................................74
UsingtheDatatoDetermineNeeds......................................................................................................74
SecondaryData......................................................................................................................................74
PrimaryData...........................................................................................................................................76
Conclusion..............................................................................................................................................77
AppendixA:2016CHNACommunityHealthneedsAssessmentSurvey....................................................78
AppendixB:FocusGroupQuestions..........................................................................................................91
AppendixC:FocusGroupParticipantInformation.....................................................................................92
AppendixD:DataComparison...................................................................................................................93
Top5PriorityNeeds(andAssociatedBehavioralNeeds)..................................................................93
ImportantIssuestoAddressfromLastAssessment’sFocusGroup...................................................93
HealthyLifestyles...............................................................................................................................93
Obesity...............................................................................................................................................94
AccesstoHealthcareServices............................................................................................................94
Dentists..............................................................................................................................................94
MentalHealthProviders....................................................................................................................94
PrimaryCarePhysicians.....................................................................................................................94
DepressionandMentalHealth...........................................................................................................94
TobaccoUse.......................................................................................................................................94
3|P a g e Medicaid.............................................................................................................................................95
ChronicDiseaseRates........................................................................................................................95
LeadingCausesofDeath....................................................................................................................97
Cancer.................................................................................................................................................98
PrimaryData...........................................................................................................................................99
AppendixE:SourcesofInformation.........................................................................................................100
4|P a g e ListofFigures
Figure1:CapeGirardeauCountyPopulation.............................................................................................19
Figure2:RaceDistribution-CapeGirardeauCounty.................................................................................20
Figure3:HispanicPopulationinCapeGirardeauCountyvs.Missouri-2014...........................................20
Figure4:AgeDistributionforCapeGirardeauCountyvs.Missouri–2014...............................................21
Figure5:PercentofPopulation,Malevs.FemaleforCapeGirardeauCountyvs.Missouri-2014...........21
Figure6:HouseholdsbyType-CapeGirardeauCountyvs.Missouri-2014.............................................22
Figure7:MembershipbyReligiousCongregation-2010-CapeGirardeauCounty..................................22
Figure8:EducationalAttainment(Population25+Years)-CapeGirardeauCountyvs.Missouri-2014..23
Figure9:LanguageSpokenatHomeinCapeGirardeauCountyandMissouri..........................................23
Figure10:MaritalStatus(15+years)-CapeGirardeauCountyvs.Missouri-2014..................................24
Figure11:ChangeinPerCapitaIncomefrom2013to2014-CapeGirardeauCountyvs.Missouri.........24
Figure12:UnemploymentRatesforCapeGirardeauCountyvs.Missouri................................................25
Figure13:RateofInfantDeaths-CapeGirardeauCountyvs.Missouri..................................................39
Figure14:ObesityPrevalenceMap,2014..................................................................................................40
Figure15:PreventableHospitalizations2013-CapeGirardeauCountyvs.Missouri...............................46
Figure16:RateofMotherswhoSmokeDuringPregnancyinCapeGirardeauCountyvs.Missouri.........48
Figure17:RateofMotherswhoBreast-fedTheirBabiesSometimeDuringInfancy-CapeGirardeau
Countyvs.Missouri....................................................................................................................................49
Figure18:NumberofTeenBirthsinCapeGirardeauCounty,2009-2013.................................................53
5|P a g e ListofTables
Table1:ZIPCodesinCapeGirardeauCounty............................................................................................18
Table2:PercentBelowPovertyLevelbyCategoryin2014.......................................................................25
Table3:NumberofCapeGirardeauCountyResidentsEligibleforMOHealthNet...................................26
Table4:StudentsEnrolledinFree/Reduced-PriceLunchinCapeGirardeauCounty................................27
Table5:DentistsinCapeGirardeauCountyThatAcceptMOHealthNet(Medicaid)................................32
Table6:OptometristsinCapeGirardeauCountythatAcceptMOHealthNet(Medicaid)........................33
Table7:FireDepartmentsinCapeGirardeauCounty,MissouriandEmergencyMedicalResponse
Agencies.....................................................................................................................................................34
Table8:Long-termCareFacilitiesinCapeGirardeauCounty,Missouri....................................................35
Table9:LeadingCausesofDeathinCapeGirardeauCounty,2003-2013.................................................36
Table10:CapeGirardeauCounty,TopTenCancerIncidenceSites,2007-2011........................................37
Table11:ChronicDiseases-CapeGirardeauCountyvs.Missouri............................................................38
Table12:2011PrevalenceofHealth&PreventativePractices-CapeGirardeauCountyvs.Missouri.....50
Table13:CausesofDeathinChildrenAges1-14,2002-2012....................................................................51
Table14:CausesofDeathinAdolescentsAges15-19,2002-2012............................................................51
Table15:PercentofStudentswhousedSubstancesinthePast30Days–CapeGirardeauCounty&
Missouri......................................................................................................................................................52
Table16:QualityofLife.............................................................................................................................54
Table17:HealthandWellness...................................................................................................................54
Table18:CapeGirardeauCountyChecklistExercise.................................................................................58
Table19:Gender........................................................................................................................................59
Table20:MaritalStatus.............................................................................................................................59
Table21:Race/Ethnicity.............................................................................................................................59
Table22:Race/EthnicityofChildreninHome............................................................................................60
Table23:Howmanypeoplecurrentlyliveinyourhousehold?.................................................................60
Table24:Howmanyadultsage65oroldercurrentlyliveinyourhousehold?.........................................60
Table25:Howmanychildrenunder18yearsofagecurrentlyliveinyourhousehold?...........................60
Table26:HealthandLifestyleFactors.......................................................................................................61
Table27:EducationLevel...........................................................................................................................61
Table28:EmploymentStatus.....................................................................................................................61
Table29:AnnualHouseholdIncome.........................................................................................................63
Table30:HealthInformationSources........................................................................................................63
Table31:AdultHealthBehaviors...............................................................................................................63
Table32:ChildHealthBehaviors................................................................................................................64
Table33:Insurance....................................................................................................................................64
Table34:HealthInsuranceType................................................................................................................65
Table35:InsuranceCoverage....................................................................................................................65
Table36:HealthStatus..............................................................................................................................65
6|P a g e Table37:RoutineDoctor'sVisit.................................................................................................................66
Table38:Howmanydayshaveyoubeentoosicktoworkorcarryoutyourusualactivitiesduringthe
past30days?..............................................................................................................................................66
Table39:Haveyoueverhadhealthissuesduetoanyofthefollowing?..................................................66
Table40:Ifeverpregnant,didyoureceiveprenatalcare?........................................................................66
Table41:WheredoyougoforRoutineHealthcare?.................................................................................67
Table42:Howoftenareyouabletovisitadoctorwhennecessary?........................................................67
Table43:Ifyouansweredseldomornevertothepreviousquestion,pleasechoosewhyyouwerenot
alwaysabletovisitadoctorwhennecessary:...........................................................................................67
Table44:Whatarethetopthreechallengesforyouandyourhouseholdwhenreceivinghealthcare?..68
Table45:Selectanyofthefollowingpreventativemeasuresyouhavehadinthelastyear....................68
Table46:Arebothyouandanychildrenlivinginyourhouseholdup-to-dateonyourimmunizations?..69
Table47:Wheredothechildrencurrentlylivinginyourhomegoforroutinehealthcare?.....................69
Table48:HealthProblems/DiseaseDiagnoses..........................................................................................69
Table49:Ifyouhavebeendiagnosedbyadoctorwithcancer,pleaseprovidethetypeofcancer(s)?....70
Table50:Ifyouhavebeendiagnosedbyadoctorwithcancerorareacancersurvivor,pleaserateyour
satisfactionwiththebelowstatements.....................................................................................................71
Table51:Howoftendoyoutraveloutsideofyourcountyformedicalcare?...........................................71
Table52:Ifyoutraveloutsideofyourcountyformedicalcare,whatservicesdoyouseek?...................72
Table53:Ifyoutraveloutsideofyourcountyformedicalcare,why?......................................................72
Table54:CommunityHealthProblems......................................................................................................72
Table55:KeyCharacteristicsfromSurveyParticipants.............................................................................93
Table56:ObesityComparison...................................................................................................................94
Table57:SmokingComparison..................................................................................................................95
Table58:MedicaidComparison.................................................................................................................95
Table59:ChronicDiseaseRateComparison..............................................................................................95
Table60:CausesofDeathComparison......................................................................................................97
Table61:CancerComparison.....................................................................................................................98
Table62:PrimaryDataProblemComparison............................................................................................99
Table63:Sources.....................................................................................................................................100
7|P a g e ExecutiveSummary
SaintFrancisHealthcareSystem,anot-for-profithospital,conductedthisCommunityHealthNeeds
Assessment(CHNA).
CommunityHealthNeedsAssessmentProcessandRequirements
ACHNAmustbeconductedeverythreeyearsbynot-for-profithospitalsinordertocomplywithfederal
tax-exemptionrequirementsundertheAffordableCareAct.FollowingtheCHNA,thehospitalmust
adoptanimplementationstrategytomeetthecommunityhealthneedsidentifiedthroughthe
assessment.ItmustreporthowitisaddressingtheneedsidentifiedintheCHNAandprovidea
descriptionofneedsthatarenotbeingaddressedwiththereasonswhysuchneedsarenotbeing
addressed.TheultimatepurposeoftheCHNAistoimprovecommunityhealth.
TheCommunityHealthNeedsAssessmentprocessconsistsofthefollowingsteps:
1. Definethecommunityservedbythehospitalfacility
2. Identifythepartnersandindividualsrepresentingthebroadinterestsofthecommunity
3. Gatheravailabledataandcurrentassessments
4. Developandconductprimaryresearch
5. Aggregateprimaryandsecondaryresearch
6. Identifyandprioritizethehealthneedsinyourcommunity
7. Developandimplementastrategytoaddresstheidentifiedpriorityhealthissues
8. WidelydisseminatetheCHNA
CommunityProfile
CapeGirardeauCountyislocatedinsoutheastMissouriwithapopulationof78,043.Whitescomprise
88%ofthetotalpopulationandthecountyhasahigherpercentageoftheyoungerpopulationages15
to24,dueinparttothefactthatSoutheastMissouriStateUniversityislocatedinCapeGirardeau.88%
ofCapeGirardeauCountyresidents25yearsandoverhavegraduatedfromhighschool,with33%going
ontoreceiveapost-secondarydegree.Theunemploymentratewas4.3%in2015,whichislowerthan
Missouri’s5%.CapeGirardeauCountyhas17.3%ofresidentsinpovertywithabout17%ofthe
populationuninsured.CapeGirardeauCountyhastwomajorhospitals,acountyhealthdepartment,
severalfamilypracticesandfederallyqualifiedhealthcenters,emergencyservices,acommunity
counselingcenterandlong-termcarefacilities.Thecommunityprofilechapteralsoincludessocial,
economicandcommunityhealthprograms.
HealthOutcomes
TheHealthOutcomeschaptercontainsinformationonmortality,includingleadingcausesofdeath,
cancerincidence,chronicdiseaseandinfantmortality;andonmorbidity,includingobesity,diabetes,
infectiousdiseaseandhealthstatusatbirth.Thechapteralsocontainsinformationonmentalhealth
andpreventablehospitalizations.TheleadingcausesofdeathinCapeGirardeauCountyare:
• HeartDisease
• AllCancers(MalignantNeoplasms)
• Smoking-Attributable
• LungCancer
• AllInjuriesandPoisonings
8|P a g e HealthBehaviors
ThechapteronHealthBehaviorsiscomprisedofinformationondietandexercise,tobaccouse,
substanceabuse,maternalhealthandpreventionandscreening.InCapeGirardeauCounty,27%of
residentsarephysicallyinactive,20%smokecigarettesandthefoodenvironmentindexis7.0outof10.
HealthMeasures
ThechapteronHealthMeasuresincludesdataregardingcausesofdeathforchildrenandadolescents,
teensubstanceabuse,teenpregnancyandthehealthofseniorcitizens.Themaincausesofdeathfor
childrenandadolescentsareunintentionalinjuries,motorvehicleaccidentsandallcancers.However,as
acauseofdeathforadolescents,theratesforunintentionalinjuries,motorvehicleaccidents,homicide,
suicideandallcancersinCapeGirardeauCountyareallhigherthanthestaterate.Teencigaretteuse
andchewingtobaccouseisalsoanareaforconcernasthecountyrankismuchhigherthanthestate
rank.Alcohol,inhalant,prescriptionmedicationabuseandover-the-countermedicationabusewereall
higherthanthestateratesaswell.
PrimaryResearch
OnefocusgroupwasheldinCapeGirardeauCounty.Alistofthetentativequestionsaskedcanbefound
below.AsummaryofthisfocusgroupisincludedinChapter6.
1. Whatdopeopleinthiscommunitydotostayhealthy?Howdopeoplegetinformation
abouthealth?
2. Inthisgroup’sopinion,whataretheserioushealthproblemsinyourcommunity?Whatare
someofthecausesoftheseproblems?
3. Whatkeepspeopleinyourcommunityfrombeinghealthy?
4. Whatcouldbedonetosolvetheseproblems?
5. Isthereanygroupnotreceivingenoughhealthcare?Ifso,why?
6. Ofalltheissueswehavetalkedabouttoday,whatissuesdoyouthinkarethemost
importantforyourcommunitytoaddress?
38surveysbyCapeGirardeauCountyresidentswerecompleted.Thesurveywasveryextensiveand
consistedoffourdifferentsections.ThesurveydemographicswererepresentativeofCapeGirardeau
County’spopulation.
1. Demographics:Multiple-choicequestionstocollectinformationaboutthepopulationofthe
county.
2. SocialandEconomicFactors:Multiplechoicequestionstocollectinformationregardingthe
population’seducation,employmentandincomestatus.
3. HealthBehaviors:Questionstocollectinformationonthebehaviorscorrelatedtohealthof
adultsandchildreninthecounty.
4. MedicalCareandServices:Multiplechoice,shortanswerandrankedquestionstocollect
informationregardinghealthcareaccess,healthstatus,insurancecoverageandopinionson
healthissues.
SummaryofFindings
TheSummaryofFindingschaptersimplysummarizestheneedsdeterminedbytheassessmentandhow
thoseneedsweredetermined.
9|P a g e KeyFindings
ThefollowinglistsrepresentthekeyfindingsofthisCommunityHealthNeedsAssessmentbytypeof
need:
HealthNeeds
•
•
•
•
•
•
•
•
•
AdultObesity
ChildObesity
Cancer
o Colorectal,ColonandRectum,ProstateandCervical
MentalIllness
KidneyDisease
Alzheimer’sDisease
InfantHealthandMortality
Stress
HighBloodPressure/Strokes
BehavioralNeeds
•
•
•
•
•
Alcohol/DrugAbuse
SmokingandSmokelessTobacco
o SmokingDuringPregnancy
TeenPregnancy
Health&PreventivePractices
o Receivingannualmedicalcare,overweight,highbloodpressure,highcholesterol,no
mammogram,nopapsmear,nobloodstooltestandnosigmoidoscopyorcolonoscopy
StudentHealthBehaviors
o Alcoholuse,cigarettes,chewingtobacco,inhalants,prescriptiondrugabuseandoverthe-counterdrugabuse
CommunityNeeds
•
•
•
•
•
•
•
•
•
•
•
•
•
HealthcareAffordability
Transportation/AffordableTransportation
AbilitytoAffordPrescribedMedications
AffordableHealthcare
JobAvailability
Unemployment
Allergies
JobSecurity
SecondhandSmoke
ChildHealth
o Unintentionalinjury,motorvehicledeathsandallcancers
AdolescentHealth
o Unintentionalinjuryandmotorvehicledeaths
HealthcareKnowledge/Education
ConnectionstoHealthResources
10|P a g e PriorityNeeds
PrioritizationProcess
TheprioritiesMICAuseddifferentcriteriameasurementstorankthediseases,whicharelistedand
brieflyexplainedbelow.AdditionalinformationcanbefoundontheMissouriDepartmentofHealthand
SeniorServicesPriorityMICA.
•
•
•
•
•
•
•
•
•
•
•
AmenabilitytoChange:thescientificknowledgeofknowncommunityinterventionsthathave
beenshowntopreventorreduceagivendisease.
CommunitySupport:determinedbytheuserofthecurrentlevelofsupportinthecommunityto
addressthedisease(communityopposition,nointerest,someinterestororganizedsupport)
DeathTrendStatisticallySignificant:measurestheurgencyofthediseasedependingonwhether
thedeathrateisincreasingordecreasingovertime.
DisabilityBurden:thenumberofyearslivedwithdisabilitytakenfromtheRevisedGlobal
BurdenofDisease2002Estimates.
HospitalDaysofCare:measurestheseverityofadiseaseanditspotentialimpactonfinancial
resourcesfromthecostofhospitalcareandtimeunavailablefromnormalduties.
NumberofDeaths:measurestheseverityofadisease.
NumberofDeathsUnderAge65:measurestheseverityofadisease.
NumberofHospitalizationsandERVisits:measuresthemagnitudeofthedisease.
RacialDisparityforERVisits:measurestherateofracialdisparityfromERvisitsbecausebarriers
forcareduetolackofinsurancedoesnotaffectemergencyroomsasmuch(usestheprimary
minoritypopulationinMissouri,African-Americans).
RacialDisparityforDeaths:theratiooftheAfrican-Americanage-adjusteddeathratefora
specificdiseasedividedbythewhiteage-adjusteddeathrateforthesamedisease.
Prevalence/Incidence:Prevalenceisthenumberofpeoplewhohavethediseaseataspecific
pointintime.Incidenceisthenumberofnewpeoplewhogettheconditionduringaspecific
timeperiod.
Usingalloftheabovecriteria,thePrioritiesMICArankedselecteddiseasesandconditions.Usingjust
the“AmenabilitytoChange,”“CommunitySupport,”“Prevalence/Incidence”and
“Prevalence/Incidence”criteria,thePrioritiesMICArankedselectedriskfactors.Theserankingswere
alsoconsideredindeterminingthepriorityneedsdiscoveredfromresearchinthisassessment.
ThetopfiverankeddiseasesandconditionsfromthePrioritiesMICAforCapeGirardeauCounty
included:
1. Diabetes
2. HeartDisease
3. InfantHealthProblems
4. Arthritis/Lupus
5. ChronicObstructivePulmonaryDisease(COPD)
11|P a g e Thetopfiverankedriskfactorsincluded:
1. Mothersbeingoverweight
2. Obesity(>30BMI)
3. Noexercise/sedentarylifestyle
4. Smoking
5. NoCervicalCancerScreeningage18andolder
MembersoftheCHNATeamanalyzedsurveydata,focusgroupdataandsecondarydatainthereportto
prioritizethecommunityhealthneedsforeachcounty.Thepriorityneedswerefirstidentifiedbythe
primaryresearchorwhatthecommunityfindsmostimportant.Thesehigh-priorityneedswerethen
validatedbythesecondaryresearch–lookingatthecommunity’sstatisticsandtrendsagainstthe
state’sstatisticsandtrends.
Top5PriorityHealthNeeds(andAssociatedBehavioralNeeds)
1.
2.
3.
4.
5.
ChildandAdultObesity
HealthcareAvailability
MentalIllness
Alcohol/DrugAbuse
12|P a g e Chapter1:CommunityHealthNeedsAssessmentIntroductionand
Methods
CommunityHealthNeedsAssessmentDescription
Acommunityhealthneedsassessment(CHNA)isasystematicprocessinvolvingthecommunity,to
identifyandanalyzecommunityhealthneedsandassetsinordertoprioritizetheseneedsandtoplan
andactuponunmetcommunityhealthneeds.
ValueofaCommunityHealthNeedsAssessmenttotheCommunity
ü Tosharetheassessmentprocessandfindingswiththecountyresidentsandtoeducatelocalresidents,healthcare
ü
ü
ü
ü
ü
ü
ü
providersandstudentsregardingpressinghealthproblems
Toempowercommunitymemberstoactonissuesofconcern
Toidentifyemergingissues,toprovidedatafordecidingprogrammatic/organizationaldecisionsandtoplaneffective,
collaborativeinterventionstopromotebetterhealth
Toadvocateforcommunitychangewithpoliticiansandotherlocaldecision-makers
Topromotecollaborationandpartnershipamongcommunitymembersandgroups
Tofurnishabaselinebywhichtomonitorchanges
Toserveasareferencepointandahistoricalperspectiveforfutureassessments
Toprovidearesourceforactivitiessuchaswritinggrantapplications
ü Toserveasamodelforothercountieswhoareplanninganassessment
Source:NorthCarolinaPublicHealthCommunityHealthAssessmentGuideBook
CommunityHealthNeedsAssessmentRequirements
ACHNAmustbeconductedeverythreeyearsbynot-for-profithospitalsinordertocomplywithfederal
tax-exemptionrequirementsundertheAffordableCareAct.TheCHNAforSaintFrancisMedicalCenter
mustbecompletedbyJune30,2016.TheCHNAmusttakeintoaccountinputfrompersonswho
representthebroadinterestsofthecommunityservedbythehospitalfacility,includingthosewith
specialknowledgeoforexpertiseinpublichealthanditmustbemadewidelyavailabletothepublic.
FollowingtheCHNA,thehospitalmustadoptanimplementationstrategytomeetthecommunityhealth
needsidentifiedthroughtheassessmentanditmustreporthowitisaddressingtheneedsidentifiedin
theCHNA,andprovideadescriptionofneedsthatarenotbeingaddressedwiththereasonswhysuch
needsarenotbeingaddressed.TheultimatepurposeoftheCHNAistoimprovecommunityhealth.
ThedocumentationoftheCHNAmustincludethefollowinginformation:
1. Adescriptionofthecommunityservedbythehospitalfacilityandhowitwasdetermined.
2. Adescriptionoftheprocessandmethodsusedtoconducttheassessment,including:
a. Adescriptionofthesourcesanddatesofthedataandotherinformationusedinthe
assessment,includingprimaryandsecondarysources
b. Theanalyticalmethodsappliedtoidentifycommunityhealthneeds
c. Informationgapsthataffectthehospital’sabilitytoassessthecommunity’shealth
needs
d. IfahospitalcollaborateswithotherorganizationsinconductingaCHNA,thereport
shouldthenidentifyallofthecommunityorganizationsthatcollaboratedwiththe
hospital
13|P a g e e. IfahospitalcontractswithoneormorethirdpartiestoassistinconductingaCHNA,the
reportshouldalsodisclosetheidentityandqualificationsofthethirdparties.
3. Adescriptionoftheapproachusedtoplan,developandconducttheassessment,andhowthe
hospitalorganizationtookintoaccountinputfromindividualswhorepresentthebroadinterests
ofthecommunityservedbythehospitalfacility,including:
a. Adescriptionofwhenandhowtheorganizationconsultedwiththeseindividuals
(whetherthroughmeetings,focusgroups,interviews,surveys,writtencorrespondence,
etc.)
b. Communityleaderswhowereconsultedand/orcollaboratedintheplanningand
implementationprocess
c. Justificationofwhydatasourceswereusedandselected
d. Justificationoftheapproachforprimarydatacollection
e. Explanationofsuccessfulandunsuccessfulapproachestoseekbroad-basedcommunity
input,especiallyunderservedorhigh-riskgroupswithinthecommunity
f. Ifthehospitaltakesintoaccountinputfromanorganization,thewrittenreportshould
identifytheorganizationandprovidethenameandtitleofatleastoneindividualinthat
organizationwhoconsultedwiththehospital
g. Identificationofanyindividualprovidinginputwhohasspecialknowledgeofor
expertiseinpublichealthandthereportshouldlistthosepeoplebyname,title,
affiliationandincludeabriefdescriptionoftheindividual’sspecialknowledgeor
expertise
4. AprioritizeddescriptionofallthecommunityhealthneedsidentifiedthroughtheCHNA,aswell
asadescriptionoftheprocessandcriteriausedinprioritizingsuchhealthneeds.
a. Prioritiesidentifiedthroughprimaryandsecondarydata
b. Otherprocessesusedtorankpriorities
5. Adescriptionoftheexistinghealthcarefacilitiesandotherresourceswithinthecommunity
availabletomeetthecommunityhealthneedsidentifiedthroughtheCHNA.
ImplementationStrategyRequirements
TheIRSguidancespecifiesthattheCHNAresultsmustbeusedtodevelopanimplementationstrategy
thatmustbeadoptedbythehospital.Theimplementationstrategyisdefinedasawrittenplanthat
addresseseachofthecommunityhealthneedsthatwereidentifiedthroughtheassessment.Each
hospitalorganizationmustmeettherequirementtoadoptanimplementationstrategyseparatelywith
respecttoeachhospitalfacilityitoperates.TheTreasuryandIRSexpecttheimplementationstrategyto:
1. Describehowthehospitalfacilityplanstomeetthehealthneed;or
2. Identifythehealthneedasonethehospitalfacilitydoesnotintendtomeetandexplainswhy
thehospitalfacilitydoesnotintendtomeetthehealthneed
IndescribinghowahospitalfacilityplanstomeetahealthneedidentifiedthroughaCHNA,the
implementationstrategymusttailorthedescriptiontotheparticularhospitalfacility,takinginto
accountitsspecificprograms,resourcesandpriorities.Theimplementationstrategyshouldalso
describeanyplannedcollaborationwithgovernmental,non-profitorotherhealthcareorganizations,
includingrelatedorganizations,inmeetingthehealthneed.
TheIRSwillallowhospitalorganizationstodevelopimplementationstrategiesfortheirhospitalfacilities
incollaborationwithotherorganizations,includingrelatedorganizations,otherhospitalorganizations,
for-profitandgovernmenthospitalsandstateandlocalagenciessuchaslocalhealthdepartments.Ifa
14|P a g e hospitaldoescollaboratewithotherorganizationsindevelopinganimplementationstrategy,the
strategyshouldidentifyalltheorganizationswithwhichthehospitalcollaborated.
Theimplementationstrategyisconsideredtobeadoptedonthedatetheimplementationstrategyis
approvedbyanauthorizedgoverningbodyofthehospitalorganization.Theauthorizedgoverningbody
means:
1. Thegoverningbodyofthehospitalorganization(e.g.,boardofdirectors,boardoftrusteesor
equivalentcontrollingbody)
2. Acommitteeofthegoverningbody,whichmaybecomprisedofanyindividualspermitted
understatelawtoserveonsuchcommittee,totheextentthecommitteeispermittedbystate
lawtoactonbehalfofthegoverningbody;or
3. Totheextentpermittedunderstatelaw,otherpartiesauthorizedbythegoverningbodyofthe
hospitalorganizationtoactonitsbehalfbyfollowingproceduresspecifiedbythegoverning
bodyinapprovinganimplementationstrategy
Thehospitalorganizationmustadoptanimplementationstrategytomeetthecommunityhealthneeds
identifiedinaCHNAbytheendofthesametaxableyearinwhichitconductsthatCHNA.
CommunityHealthNeedsAssessmentProcess
TheCommunityHealthNeedsAssessmentprocessshouldconsistofthefollowingsteps:
1. Definethecommunityservedbythehospitalfacility
2. Identifythepartnersandindividualsrepresentingthebroadinterestsofthecommunity
a. Individualswithspecialknowledgeorexpertiseinpublichealth
b. Federal,tribal,regional,state,localhealthorotherdepartmentsoragencies,with
currentdataorotherinformationrelevanttothehealthneedsofthecommunityserved
bythehospitalfacility
c. Leaders,representativesormembersofmedicallyunderservedlow-incomeand
minoritypopulations,aswellaspopulationswithchronicdiseaseneeds
3. Gatheravailabledataandcurrentassessments
4. Developandconductprimaryresearch
5. Aggregateprimaryandsecondaryresearch
6. Identifyandprioritizethehealthneedsinyourcommunity
7. Developandimplementastrategytoaddresstheidentifiedpriorityhealthissues
8. WidelydisseminatetheCHNA
Defining“Community”
SaintFrancisMedicalCentermadethedecisiontodefine“community”asitsprimaryservicearea,which
consistsoffourcounties:CapeGirardeau,Bollinger,ScottandStoddard.Theprimaryserviceareais
basedonthenumberofinpatientdischargesfromeachofthesefourcounties.SaintFrancisMedical
Centerhas58.15%ofitspatientscomefromthesefourcountiesand29.29%comefromCapeGirardeau
County.ThisinformationisprovidedbytheHospitalIndustryDataInstitute(HIDI),whichisfoundedby
theMissouriHospitalAssociation.Sinceeachcountydiffersgreatlyfromoneanotherintermsof
demographics,healthcareproviders,educationandetc.Fourseparate,writtenassessmentreportswill
becreatedandmadeavailabletothepublicidentifyingspecificneedspercounty.
IdentifyingPartnersandIndividualsRepresentingtheBroadInterestsoftheCommunity
TheindividualsrepresentingthebroadinterestsofCapeGirardeauCountyincludedinvolvingpeople
fromthefollowingorganizationswhentheprimaryresearchwasconducted:
15|P a g e •
•
•
•
•
•
•
•
•
CapeGirardeauCountyPublicHealthCenter
CapeGirardeauHealthandWellnessExpo
CapePrimaryCare
CapeCareforWomen
CommunityCaringCounsel
CrossTrailsMedicalCenter
JacksonFamilyCare
St.MaryCathedral/CatholicSocialMinistries
UnitedWayofSoutheastMissouri
Effortsweremadetoincludeat-risk,targetedpopulationsandprinciplespecialtyareasthatareserved
bythehospitalandpresentwithinthecommunity,suchasthemedicallyunderserved,lowincome
persons,minoritygroupsandthosewithchronicdiseaseneedsontheirwillingnesstoparticipate.
GatherAvailableDataandCurrentAssessments
Secondarydataareexistingdatathatarecollectedbysomeoneelseforapurposeotherthantheone
beingpursued.Secondaryresearchwasobtainedfromvariouscrediblesourcesandisincludedinthis
writtenassessmentreport.Someareasthatwereresearchedincludedemographics,thephysical
environment,socialfactors,theeconomy,thetransportationsystem,theeducationsystemandthe
healthcaresystem.Theassessmentalsoincludesexistinghealthstatusandpublichealthdata.Examples
ofthedatasourcesusedareasfollows:
• U.S.CensusBureau
• MissouriDepartmentofHealthandSeniorServices
• MissouriDepartmentofElementaryandSecondaryEducation
• MissouriEconomicResearchandInformationCenter(MERIC)
• U.S.BureauofLaborStatistics
• CentersforDiseaseControlandPrevention
• UniversityofWisconsin’sCountyHealthRankings
• MissouriDepartmentofMentalHealth
• AnnieE.CaseyFoundationKIDSCOUNTdatacenter
• Otherlocalwebsites
MorespecificinformationonwhatdatasourceswereusedforcanbefoundinAppendixE.
DevelopandConductPrimaryResearch
Primarydataaredatacollectedspecificallyforthepurposeofansweringproject-specificquestions.
Primarydatashouldbecollectedafterthegatheringandinitialreviewofsecondarydataandshouldadd
breadth,depthandqualitativeinformationtothesecondarydata.Primaryresearchwasobtainedinthe
countythroughindividualpublicsurveysandfocusgroups.
PublicSurveys
Surveysprovideaflexiblemeansofassessingarepresentativesampleofthepopulationtogather
informationaboutattitudesandopinions,aswellasmeasurebehaviorsandpopulationcharacteristics.
TheindividualsurveythatwasusedwascreatedbytheCommunityHealthNeedsAssessment
ResearcherandcanbefoundinAppendixA.Advantagesofsurveyingforindividualresponsesinclude:
• Obtainingdirectfeedbackfromclients,keyinformantsandtargetpopulationsaboutspecific
issues
• Developingpublicawarenessproblems
• Buildingaconsensusforsolutionsoractions
16|P a g e •
•
•
Comparingtheself-reportedincidenceandprevalencewithmoreobjectivedatasources
Improvingperceptionofqualityoflocalhealthcareservices
Improvingperceptionontheneedofspecificserviceseitherinexistenceorunderconsideration
FocusGroups
Groupsurveysintheformoffocusgroupswerealsoconducted.Afocusgroupisdefinedaspeoplewho
possesscertainsimilarcharacteristicsthatareassembledasagrouptoparticipateinafocused
discussiontohelpunderstandthetopicofinterest.Thequestionsaskedineachfocusgroupcanbe
foundinAppendixB,andalistofallfocusgroupparticipantinformationcanbefoundinAppendixC.
Datawerecollectedfromthefocusgroupsprimarilythroughnote-taking.Awritingexercisewasalso
handedoutandcompletedregardingeachparticipant’stopfiveseriousissues.
AggregatePrimaryandSecondaryResearch
ThesurveywascreatedthroughSurveyMonkey.Mostparticipantschosetofilloutthesurveyonpaper,
sotheCommunityHealthNeedsAssessmentResearcheratSaintFrancisHealthcareSystemthen
enteredeachsurveyintotheSurveyMonkeydatabase,whichwasaverytediousandtime-consuming
processduetotheamountofquestionsaskedanddatacollectedbythesurvey.Followingtheentryof
allsurveys,thedatawerethenanalyzedthroughSurveyMonkey’sanalyzingtools.Thesurveydatawill
bepresentedanddiscussedinChapter6ofthisreport.Theinformationthatwascollectedfromthe
focusgroupswillalsobepresentedanddiscussedinChapter6–PrimaryResearchofthisreport.
IdentifyandPrioritizetheHealthNeedsintheCommunity
Fromtheanalysisofthisresearch,communityneedsweredeterminedbasedonwhatthecommunity
findsmostimportantandbywhatthecommunityismostlackingthatcouldhaveanimpactonthe
healthofitscitizens.Theseneedswerepredominantlydeterminedbytheprimaryresearch–whatthe
communityfindsmostimportant–alongwithtyingthatinformationintowhatthesecondaryresearch
confirms–lookingatthecommunity’sstatisticsandtrendsagainstthestate’sstatisticsandtrends.
DevelopandImplementaStrategytoAddresstheIdentifiedPriorityHealthIssues
SaintFrancisHealthcareSystemwilldecidewhatneedswillbeaddressedandhowthoseneedswillbe
addressed.Fromthis,animplementationplanwillbecreatedandexecuted.
WidelyDisseminatetheCHNA
TheCHNAisnotconsidered“conducted”untilthewrittenreportismadewidelyavailabletothepublic.
Fulfillingthe“widelyavailable”requirementrequiresthefollowing:
1. PostingtheCHNAonawebsitethatclearlyinformsusersthatthedocumentisavailableand
providesinstructionsfordownloading.
2. Thedocumentispostedinaformatthatexactlyreproducestheimageofthereportwhen
accessed,downloaded,viewedandprinted.
3. AllowsindividualswithInternetaccesstoaccess,download,viewandprintthereport
withouttheuseofspecialhardwareorsoftware.
4. Thehospitalorotherorganizationdistributingthereportwillprovidethedirectwebsite
addresstoindividualswhorequestacopyofthereport.
5. TheCHNAmustremainwidelyavailabletothepublicuntilthenextCHNAforthathospitalis
conductedandmadewidelyavailable.
17|P a g e Chapter2:CommunityProfile
BackgroundInformationforCapeGirardeauCounty
CapeGirardeauCountywasofficiallyformedin1812andislocatedinsoutheastMissouri.Thecounty
wasnamedafterEnsignSieurJeanBaptisteGirardot,aFrenchofficerwhodevelopedatradingposton
thesiteofpresentdayCapeGirardeauaround1733.The“cape”inthecountynamewasafterarock
bluffoverlookingtheMississippiRiverandistheworld’sonlyinlandcape.Partoftheactualcapewas
destroyedinthe1800stomakewayfortherailroads,yetamemorial“CapeRock”sitsatthetopofthe
bluffthatwasusedasthetradingpost.
ThecountyisborderedbytheMississippiRiverandthestateofIllinoistotheeast,PerryCountytothe
north,ScottCountyandaportionofStoddardCountytothesouthandBollingerCountytothewest.The
landareaofCapeGirardeauCountyis579squaremiles,andthewatersurfaceareais7.7squaremiles.
Interstate55isthemajorrouterunningnorthandsouththroughthecounty.Statehighwaysalsorun
throughthecountyconnectingthesmallercitiesandtowns,suchashighways72,34,25and61.
ThecitiesofCapeGirardeauandJacksonarethelargestcitiesinthecounty,butothersmallercitiesin
thecountyinclude:Delta,Gordonville,OakRidge,Pocahontas,Whitewater,Allenville,Dutchtownand
OldAppleton.Approximately70%ofresidentsliveintheareasofurbandevelopment,includingthe
citiesofCapeGirardeauandJacksonalongwithafewothersmallertownsandvillages.CapeGirardeau
Countyhasapopulationof78,403.
TherearefifteenZIPcodesinCapeGirardeauCounty,whicharelistedbelow:
Table1:ZIPCodesinCapeGirardeauCounty
ZIPCode
63701
63702
63703
63739
63743
63744
63745
63747
City
CapeGirardeau
CapeGirardeau
CapeGirardeau
Burfordville
Daisy
Delta
Dutchtown
Friedheim
ZipCode
63752
63755
63766
63769
63770
63779
63785
City
Gordonville
Jackson
Millersville
OakRidge
OldAppleton
Pocahontas
Whitewater
CityofCapeGirardeau
ThelargestcityinthecountyisCapeGirardeau.However,thecountyseatisactuallyheldbythe
cityofJackson.CapeGirardeauislocatedalongtheMississippiRiverinthesoutheasternpartofthe
county.CapeGirardeaubecameariverboomtownwhenthesteamboatarrivedin1835andwas
thebusiestportbetweenSt.LouisandMemphis.AfterbeingoccupiedbyUnionforcesduringthe
CivilWar,CapeGirardeausawcontinuedgrowthwiththeestablishmentofpubliceducationin
1867,theintroductionofrailservicesandwithadvancesinagricultureandindustry.In1873,
SoutheastMissouriStateUniversitywasfoundedasateachinguniversity.ThecityofCape
Girardeauhasevolvedfromatinytradingposttoathriving,culturallyrichcommunity,servingasa
regionalhubforeducation,commerceandmedicalcare:
18|P a g e •
•
•
Educationincludesapublicandprivatehighschool,manyelementaryschools,auniversity,
acollegeofnursingandhealthservicesandseveralsmallertradeschools/colleges.
Commerceisavailablethroughoutwithavarietyofgrocerystores,restaurants,
conveniencestores,retailstoresandalargeshoppingmall.
Medicalcareservicesrangefromtwomedium-sizedhospitalstolong-termcarefacilitiesto
publichealthservicestoanabundanceofspecialists.
CityofJackson
ThesecondlargestcityinthecountyisJackson,whichisalsothecountyseat.Jacksonwasincorporated
in1814andthefirstcommunityinthenationtobearthenameofPresidentAndrewJackson.Jacksonis
locatedinthecenterofCapeGirardeauCounty.ThecityofJacksonhasthelargestschooldistrictin
CapeGirardeauCounty,andoffersasuitableamountofeducation,commerceandmedicalcareaswell.
SmallerCitiesandTownsinCapeGirardeauCounty
ThetownsofDeltaandOakRidgeeachhosttheothertwoschooldistrictsfoundinCapeGirardeau
County.Neitherofthesetownsoffersmuchinregardstocommerce,buteachhasafewsmall
businesses.Medicalcareisnotavailableandmustbesoughtoutinoneofthelargercitiescloseby.
Gordonvillehasoneofthehigherpopulationsofthesmallervillages,butdoesnothavemany
businessessinceitisrelativelyclosetobothJacksonandCapeGirardeau.
DemographicCharacteristics
PopulationGrowth
AccordingtotheU.S.CensusBureau,in2014,CapeGirardeauCountyhadanestimatedpopulationof
78,043.ThepopulationestimatesinCapeGirardeauCountyshowasteady,increasingpopulation.
Figure1:CapeGirardeauCountyPopulation
CapeGirardeauCountyPopulaJon
70,622 71,141
69,231 69,514 69,813
73,957
72,149 72,643 73,217
77,080 77,530 78,043
75,67476,630
Year Year Year Year Year Year Year Year Year Year Year Year Year Year
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Source:U.S.CensusBureau,PopulationEstimates
Race
TheracedistributionofCapeGirardeauCountyisnotasdiverseasMissouri.Themajorityofthe
populationinCapeGirardeauCountyiswhiteorCaucasianat88%ofthepopulation,whereasonly
83.5%ofMissouri’spopulationiswhiteorCaucasian.
19|P a g e Figure2:RaceDistribution-CapeGirardeauCounty
RaceDistribuJon-CapeGirardeauCounty
0%
2%
0%
WhiteorCaucasian
2%
8%
BlackorAfricanAmerican
Asian
88%
AmericanIndianandAlaska
Narve
NarveHawaiianandOther
PaciﬁcIslander
Source:U.S.CensusBureau,QuickFacts
Ethnicity
TheHispanicpopulationpercentage(2.22%)inCapeGirardeauCountyisbelowthatofthestateof
Missouri(3.96%).
Figure3:HispanicPopulationinCapeGirardeauCountyvs.Missouri-2014
HispanicPopulaJon-CapeGirardeauCountyvs.
Missouri-2014
3.96%
2.22%
CapeGirardeauCounty
Missouri
AgeDistribution
Figure4showsCapeGirardeauCountyhasagreaterpopulationofages15to24yearsthanMissouri.
Thereis21.9%ofCapeGirardeauCounty’spopulation18yearsoryounger,whereas14.3%ofCape
GirardeauCounty’spopulationis65yearsorolder.ThemedianageofCapeGirardeauCounty’s
populationis36.4years,youngerthanthemedianageof38.3inMissouri.
20|P a g e Figure4:AgeDistributionforCapeGirardeauCountyvs.Missouri–2014
AgeDistribuJon-CapeGirardeauCountyvs.Missouri-2014
CapeGirardeauCounty
12.9%
12.6%
12.0%
Missouri
13.8% 13.5%
13.2%
12.1%
11.6%
13.0%
11.8%
9.8%
7.9%
6.2%
6.2%
8.7%
7.3%
7.2%
6.5%
4.9% 4.6%
2.3% 2.1%
<5
5-14
15-19
20-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Gender
ThepercentageofmalesinCapeGirardeauCountyisslightlylowerthanthatofMissouri,meaningthe
percentoffemalesisslightlyhigher.However,theyremainrelativelycloseto50%.
Figure5:PercentofPopulation,Malevs.FemaleforCapeGirardeauCountyvs.Missouri-2014
PercentofPopulaJon,Malevs.Female,for
CapeGirardeauCountyvs.Missouri-2014
CapeGirardeauCounty
Missouri
51.63%
48.37%
50.78%
49.22%
Male
Female
Source:U.S.CensusBureau,PopulationEstimates
Household/FamilyConfiguration
TheU.S.CensusBureaudescribesthetypesofhouseholdsinCapeGirardeauCountyandMissouri.Cape
GirardeauCountysitsjustbelowMissouriforthepercentofmalehouseholdersandfemale
householders.Thepercentageofhusband-wifefamiliesinCapeGirardeauCountyisslightlyhigherat
50.1%comparedto48.5%inthestateofMissouri.CapeGirardeauCountyalsohas0.6%more
nonfamilyhouseholdsthanthestatedoes.
21|P a g e Figure6:HouseholdsbyType-CapeGirardeauCountyvs.Missouri-2014
ScottCounty
Missouri
50.1%48.5%
35.1%
31.0%
14.1%12.1%
4.3%
4.8%
HouseholdsbyType- ScottCounty
vs.Missouri- 2014
Husband-wife
Male
Female
Family
Householder;no
householder,no
wifepresent
husbandpresent
Source:U.S.CensusBureau,AmericanFactFinder
Nonfamily
households
Religion
ThefollowingfigureshowsthemembershipbyreligiouscongregationinCapeGirardeauCounty.
Membershipiscountedascongregationaladherentswhichincludeallfullmembers,theirchildrenand
otherswhoregularlyattendservices.Nearly77%ofCapeGirardeauCounty’spopulationbelongstoa
religiouscongregation.
Figure7:MembershipbyReligiousCongregation-2010-CapeGirardeauCounty
MembershipbyReligiousCongregaJon-2010
CapeGirardeauCounty
11545 11,162 10,823
17,494
9,952
6,989
4,178
1,717
787
636
150
113
101
27
Source:AssociationofReligionDataArchives
22|P a g e SocialCharacteristics
Education
AccordingtotheU.SCensusBureau,therearejustfewerthan11.9%ofCapeGirardeauCounty
residentsdidnotgraduatehighschool,slightlylowerthanthestateaverageof12%.Theremaining88%
graduatedhighschoolwith33%receivingapost-secondarydegree.
Figure8:EducationalAttainment(Population25+Years)-CapeGirardeauCountyvs.Missouri-2014
EducaJonalA\ainment(PopulaJon25+years)-CapeGirardeau
Countyvs.Missouri-2014
33.1%
22.7%
7.5% 8.1%
4.4% 3.9%
9thto12thgrade,
nodiploma
Missouri
31.4%
21.9%
Lessthan9th
grade
CapeGirardeauCounty
18.4%
4.9%
Highschool
graduate
(includes
equivalency)
Somecollege,no
degree
16.7%
9.7%
7.2%
Associate's
degree
Bachelor'sdegree
10.0%
Graduateor
professional
degree
Language
Figure9showsthatCapeGirardeauCountyhasahigherpercentofitspopulationthatspeaksonly
EnglishathomethanMissouriby4%.
Figure9:LanguageSpokenatHomeinCapeGirardeauCountyandMissouri LanguageSpokenatHomein
CapeGirardeauCounty
LanguageSpokenatHomein
Missouri
SpeakEnglishonly
SpeakEnglishonly
SpeakLanguageotherthanEnglish
SpeakLanguageotherthanEnglish
4%
6%
96%
94%
23|P a g e Literacy
AccordingtotheNationalCenterforEducationStatistics’2003AssessmentofAdultLiteracy,the
estimatedpercentageofthose16andolderconsideredtobelackingbasicproseliteracyskillsinCape
GirardeauCountyis6%,comparedwith7%forMissouri.
MaritalStatus
InCapeGirardeauCounty,49.3%ofthepopulationage15yearsorolderarenowmarried(except
separated),lessthantheaverageforMissouriof49.9%.Also,32.2%ofCapeGirardeauCounty’s
populationhasneverbeenmarried,whichisabout2.5%higherthanthestateofMissouri’saverage.
Figure10:MaritalStatus(15+years)-CapeGirardeauCountyvs.Missouri-2014
MaritalStatus(15+years)-CapeGirardeauCountyvs.
Missouri-2014
CapeGirardeauCounty
Missouri
49.3%49.9%
12.1%
6.3%6.4% 10.4%
1.8%1.9%
Nowmarried
(except
separated)
Widowed
Divorced
Separated
32.2%29.7%
Never
Married
EconomicCharacteristics
Income
AccordingtotheU.S.CensusBureau,themedianhouseholdincomeinCapeGirardeauCountyin2011
was$41,755,comparedwith$45,231forthestateofMissouri.Below,Figure11showsthepercapita
income.From2013to2014,thepercapitaincomeroseinboththecountyandstate.However,the
overallpercapitaincomeinCapeGirardeauCountyisjustover$2,000lessthanthatinMissouri.
Figure11:ChangeinPerCapitaIncomefrom2013to2014-CapeGirardeauCountyvs.Missouri
ChangeinPerCapitaIncomefrom2013to
2014-CapeGirardeauCountyvs.Missouri
CapeGirardeauCounty
38,59239,547
2013
Missouri
39,54741,639
2014
Source:MERIC
24|P a g e Unemployment
TheunemploymentrateinCapeGirardeauCountyhasbeendecliningthelastfiveyears.Since2011,the
unemploymentratehasdecreasedby2.0%.CapeGirardeauCountyhasaratethatis0.4%lowerthan
theunemploymentrateinMissouri.
Figure12:UnemploymentRatesforCapeGirardeauCountyvs.Missouri
UnemploymentRates-Cape
GirardeauCountyvs.Missouri
Missouri
9.60%
8.50%
7.00%
7.30%
2010
CapeGirardeauCounty
6.80%
5.60%
2011
6.70%
6.10%
5.80%
2012
5.50%
2013
2014
Source:MERIC
5.00%
4.30%
2015
Poverty
AccordingtotheU.S.CensusBureau,thepercentofpeoplelivingbelowthepovertylevelinCape
GirardeauCountywas17.3%comparedto15.6%intheentirestateofMissouriin2014.
• CapeGirardeauCountyhadagreaternumberofpeopleinpovertyineachcategorybesides
thosewhohavenotgraduatedhighschool.
• ThegreatestdifferenceinpovertybetweenCapeGirardeauCountyandMissouriwasinblackor
African-Americans.CapeGirardeauCountyhadapovertylevelof55.5%,farabovethatof29.3%
forthestate.
Table2:PercentBelowPovertyLevelbyCategoryin2014
Category
Allpeople
Under18years
18-64years
65+years
White
BlackorAfrican-American
HispanicorLatinoOrigin
Lessthanhighschoolgraduate
Unemployed
CapeGirardeauCounty
17.3%
23.0%
17.2%
9.30%
13.1%
55.5%
31.2%
21.1%
35.5%
Missouri
15.6%
21.5%
14.9%
9.0%
12.9%
29.3%
26.5%
27.8%
34.7%
Source:U.S.CensusBureau,SmallAreaIncomeandPovertyEstimates(SAIPE)andAmericanFactFinder
25|P a g e Medicaid/MOHealthNet
AccordingtotheMissouriDepartmentofHealthandHumanServices,in2015,Missourihad1,056,204
residentseligibleforMOHealthNet.CapeGirardeauCountyhad12,893eligibleresidents.Population
estimatesfor2015havenotbeendetermined.However,thepopulationofCapeGirardeauCountya
yearpriorwasestimatedtobe78,043.Usingthisestimate,thepercentofCapeGirardeauCounty
residentseligibleforMOHealthNetwasapproximately17%.
Table3:NumberofCapeGirardeauCountyResidentsEligibleforMOHealthNet
Under1
1to4
5to14
15to17
18to19
20to24
25to44
45to64
65andover
Allages
White
Number
189
1,149
2,656
593
287
425
1,623
1,120
852
8,894
Black/AfricanAmerican
Number
64
396
970
243
105
186
482
277
82
2,805
AllRaces
Number
487
1,836
3,913
873
411
668
2,245
1,459
1,001
12,893
Source:DepartmentofHealthandHumanServices,MICA2015
TheMissouriDepartmentofSocialServicesprovidesalistofHealthNetprovidersinCapeGirardeau
County,showingthatthereare1,274providers.
Free/Reduced-PriceLunches
TheMissouriDepartmentofElementary&SecondaryEducationprovidesinformationregardingmeal
patternsoftheNationalSchoolLunchProgram.Thisliststheminimumcredibleservingforeachfood
categoryandtheamountsservedateachgradelevel.Forthelunchmealpattern,thereisacalorie
rangefrom550-650caloriesforgradesK-5,600-700forgrades6-8and750-850forgrades9-12.
Offeringsforstudentsparticipatinginathleticsarealsoavailableincludingafter-schoolsnacksofferedby
theNationalSchoolLunchProgramandafter-schoolsnacksandmealsofferedbytheChildandAdult
CareFoodProgram.Schoolslocatedinlow-incomeareasofferthefoodforfree,whereasothersmaybe
requiredtopaythereducedpriceorfullamountbasedonincomelevel.
AccordingtotheCountyHealthRankings,38%ofchildrenenrolledinCapeGirardeauCountypublic
schoolswereeligibleforfreelunchin2015.AccordingtotheMissouriHungerAtlas,thePercentEligible
andParticipatingintheNationalSchoolLunchProgramis82.5%forthecountyand82.5%forthestate
foraperformanceindicator,and25.3%inthecountyand52.1%inthestateforaneedindicator.Table4
showstheenrollmentintheFree/Reduced-PriceLunchPrograminCapeGirardeauCounty.
26|P a g e Table4:StudentsEnrolledinFree/Reduced-PriceLunchinCapeGirardeauCounty
StudentsEnrolledinFree/ReducedPriceLunchinCapeGirardeauCounty
Year
Number
CountyPercent
MissouriPercent
2013
4,490
48.2%
49.8%
2012
4,470
47.9%
49.4%
2011
4,261
45.9%
47.7%
2010
4,111
45.4%
46.8%
2009
3,842
42.1%
43.6%
2008
3,757
10.8%
42.0%
Source:KIDSCOUNTdatacenter,TheAnnieE.CaseyFoundation
SeeFederalRegisterPagesaboutchangesoccurringwithNewMealPatternsandRegulations.
HungerandFoodUncertainty
TheMissouriHungerAtlasfrom2013usesthreeNeedIndicatorstoestablishfooduncertaintylevels.
CapeGirardeauCountyhas13.4%,comparedwith13.9%for“PercentHouseholdsFoodUncertain,”
leadingtoanaveragerank.For“PercentHouseholdwithChildrenFoodUncertain,”CapeGirardeau
Countyhas22.5%withMissouriat23%,puttingthecountyintoanaverageranking.Additionally,Cape
GirardeauCountyhas5.3%,whereasMissourihas5.7%for“PercentHouseholdsFoodUncertainwith
Hunger,”leadingtoalowrankingforthecounty.
Women,InfantsandChildren(WIC)Participation
AccordingtotheMissouriHungerAtlasfrom2013,therewere1,607monthlyWICparticipants;1,157of
participantsbeinginfants/children(5yearsandyounger).Therewere52.5%infants/childrenunderthe
ageof5whowereeligibleandparticipatingintheWICprograminCapeGirardeauCounty,wellbelow
the68.5%eligibleforMissouri.
Housing
AccordingtotheU.S.CensusBureau'sAmericanCommunitySurvey,itisestimatedthatin2014there
were2,723,417housingunitsinMissouri,with86.7%beingoccupied.ThemedianvalueofMissouri
housingunitswasestimatedtobe$136,700.Just0.5%ofhouseholdslackedplumbingfacilities,0.8%
lackedkitchenfacilitiesand2.8%lackedtelephoneservicesinMissouri.
In2014,itwasestimatedthatCapeGirardeauCountyhad32,771housingunits,with90.5%ofthese
unitsbeingoccupied.About68.8%oftheseunitesweresingle-detached.Themedianvalueofhousing
unitsinCapeGirardeauCountywas$138,000.InCapeGirardeauCounty,86homeslackedplumbing
facilities,158homeslackedcompletekitchenfacilitiesand973homeshadnotelephoneservices.
Transportation
SeveraltypesoftransportationservicesareavailableinCapeGirardeauCounty.TheCapeGirardeau
RegionalAirportislocatedapproximatelyfivemilesfromdowntownCapeGirardeauandiseasily
accessiblefromInterstate55.Theairportisafull-serviceairportandcurrentlyoffersfourdailyflightsto
LambertInternationalAirportinSt.Louisforaround$50.Theseshort,one-hourflightsoffer
convenienceforpassengersincludingparking,baggageclaimandsecuritylinesthatarehassle-free.
Bustransportationisalsoavailablefromlocaltonationallevels.TheCapeGirardeauCountyTransit
AuthorityoffersbustransportationaroundthecityofCapeGirardeauonfixedroutes.Southeast
MissouriStateUniversityalsooffersshuttleservicesonfixedroutesaroundcampus,aswellasaWINGS
shuttlebusthattakesstudentsoffcampusandtocertainareasofthecity.BARTTransportationis
27|P a g e basedinJackson,MissouriandofferstransportationtotheSt.LouisAirportfromtheCapeGirardeau
andJacksonareaalongwithotherareasinIllinois.TheGreyhoundBusLinehasastoplocatedinthecity
ofCapeGirardeauandoffersbustransportationonanationallevel.TheCapeGirardeauCountyTransit
AuthorityalsoofferstaxiservicesaroundthecityofCapeGirardeauinwhichindividualpassengerscan
requesttransportationfromanylocationinCapeGirardeauatanytimeforafare.
HealthPromotion
ThetwocommunityhospitalsinCapeGirardeauCountyoffermanyhealthprograms,classesand
screeningopportunitiesthatareavailabletothepublic,withmanybeingfreeofcharge.Someofthose
areasfollows:
• Supportgroupsforbreast-feeding,bariatricsurgery,heartpatients,cancerpatients,ostomy
patients,diabetesself-managementandgriefsupport
• Classesforparentingandchildbirthincludingbreast-feeding,infantcare,infantmassage,car
seatinstallation,pregnancyandchildbirthbasics,infantandchildCPRandasiblingclassto
preparesiblingsforthearrivalofanewbaby
• Screeningopportunitiesfordiabetes,colorectalcancer,bloodpressure,metabolic
syndrome,abdominalaorticaneurysm,heartandoverallhealth
• Fitnessprogramsforadultsandchildren
• Smokingcessationprograms
• Campsforboysandgirlsthatareinterestedinahealthcareprofession
• Asthmaeducation
• FirstaidandCPR
Otherprogramsavailableinthecommunityprovidedbyothercommunityorganizationsinclude:
• AlcoholicsAnonymous
• Parentingclasses
• Familyskillsclasses
• Grandparentsupportgroupsforgrandparentsactingasparents
• Parentswithoutpartners
• Buildingstrongfamilies
• Postponingsexualinvolvement
• Pubertyclasses
• Nutritionclassesforhowtoeathealthy
• YouthSubstanceAbusePrevention
HealthcareSystem
AccesstoHealthcare
Accesstohealthcareisabroadconceptthattriestocaptureaccessibilitytoneededprimarycare,
healthcarespecialistsandemergencytreatment.Whilehavinghealthinsuranceisacrucialsteptoward
accessingthedifferentaspectsofthehealthcaresystem,healthinsurancebyitselfdoesnotensure
access.Itisalsonecessarytohavecomprehensivecoverage,providersthataccepttheindividual’s
healthinsurance,relativelycloseproximityofproviderstopatientsandprimarycareprovidersinthe
community.Thereareadditionalbarrierstoaccessinsomepopulationsduetolackoftransportationto
providers’offices,lackofknowledgeaboutpreventivecare,longwaitstogetanappointment,low
healthliteracyandinabilitytopaythehighdeductibleofmanyinsuranceplansand/orco-paysfor
receivingtreatment.
28|P a g e AccordingtotheHealthResourcesandServicesAdministration,CapeGirardeauCountyisconsideredto
beaHealthProfessionalShortageArea(HPSA)inmentalhealth,primarycareanddentalhealth.Each
areamaybeclassifiedasgeographic,populationorfacilities.Geographicmeanstheydonothave
enoughprovidersinacountyorservicearea.Populationmeanstherearenotenoughprovidersthatare
lowincomeorMedicaideligible.Facilitiesmeanstherearenotenoughprovidersthatarefederally
qualifiedhealthcentersorstateorfederalprisons.CapeGirardeauCountyisaHPSAGeographicfor
mentalhealth,lastupdatedin2011.ThecountyisaHPSAPopulationinprimarycareanddentalhealth,
lastupdatedin2013.
UninsuredPopulation
AccordingtotheCountyHealthRankingsforMissouri,in2015,17%ofCapeGirardeauCounty’s
populationwasuninsured,justbelowthe16%ofMissouri.Thispercentagemeasurestheestimated
percentofpopulationbelowtheageof65withnohealthinsurance.
HealthcareProviders
Hospitals
SaintFrancisHealthcareSystemisalsolocatedinthecityofCapeGirardeau,Missouriandhasbecome
aprogressive,innovativeregionaltertiarycarereferralcenterinthelast16yearsthathasnearlytripled
insize.Itisa284-bedfacilitythatservesmorethan203,000peoplethroughoutMissouri,Illinois,
Kentucky,TennesseeandArkansas.Thehospitalstaffsmorethan224physiciansandmorethan2,700
employees.SomeofSaintFrancis’majorservicelinesincludeNeurosciencesorthopedics,Family
BirthPlace,Cardiovascular,Oncology,RehabilitationandTrauma.SaintFrancisHealthcareSystemhas
theregion’sfirstLevelIIINeonatalIntensiveCareUnit.Thehospitalalsooffersurgentcarecentersanda
fitnessfacility.SaintFrancisHealthcareSystem’s284bedsaredividedoutintoMed/Surgbeds,Pediatric
beds,Rehabilitationbeds,NeonatalIntensiveCareUnitbeds,IntensiveCareUnitbedsandObstetrics
beds.
SaintFrancisHealthcareSystemjoinedtheHealthNetworkofMissouriinSeptember2014andhelps
worktoimprovehealthcareaccessandcoordinatedcareforpatientswithfiveothermembers.
SoutheastHospitalislocatedinthecityofCapeGirardeau,Missouri.Itisa266-bedmedicalcenterthat
servesmorethan640,000peoplein25countiesinsoutheastMissouriandsouthernIllinois.Thehospital
staffsmorethan200physiciansandover2,200employeesandoffersafullcontinuumofhealthcareand
wellnessservicesdesignedtomeettheneedsofindividuals,familiesandbusinesses.Someofthemajor
servicelinesfoundatSoutheastincludeOncology,Cardiovascular,Neurosciences,Women’sand
Children’sorthopedicsandEmergencyServices.The266bedsatSoutheastHospitalaredividedamong
158Med/Surgbeds,10Pediatricbeds,13Rehabilitationbeds,15NeonatalIntensiveCareUnitbeds,26
IntensiveCareUnitbeds,29Obstetricsbedsand15PsychiatricUnitbeds.
LandmarkHospitalofCapeGirardeauisthepremierLongTermAcuteCare(LTAC)hospitalofthefourstatearea.Thishospitalhasbuiltasolidreputationforprovidingtheverybestpatientcareandexcellent
customerservice.Thehospitaloperatesasajoint-venturebetweenLandmarkHoldingofMissouri,LLC
andSaintFrancisHealthcareSysteminCapeGirardeau.Thefacilityhas30single-occupancyrooms,
providingamoreprivate,comfortableexperienceduringthepatient’sstay.Apatient’saveragelengthof
stayisabout27days,dependingonthepatient’slevelofacuity.Primarydiagnosesinclude:ventilator
weaning,complexmedicalandwoundcare.MostpatientscometoLandmarkfromashort-termacute
carehospitalandaredischargedtohome,skillednursingorrehab.LandmarkHospitalhasdeveloped
strongrelationshipsinthemedicalcommunityandworksinpartnershipwithotherhospitalsand
29|P a g e doctors.Thecarethehospitalprovideswillcontinuetomakeapositivedifferenceforcriticallyill
patientsandtheirfamilies.
FamilyPractices
AccordingtotheUniversityofWisconsinPopulationHealthInstituteandRobertWoodJohnson
Foundation’sCountyHealthRankings,CapeGirardeauCountyhasaprimarycarephysicianratioof
1,084:1,whereasthestateofMissourihasaratioof1,439:1.
CapeGirardeauCountyhasmanyfamilypracticesthatofferprimarycare.Someofthepracticeslocated
inCapeGirardeauandJackson,Missouri,arelistedbelow.
InCapeGirardeau,Missouri:
• SoutheastPrimaryCare
• CapePrimaryCare
• RegionalPrimaryCare
• RiversideFamilyPractice
• CapePhysicianAssociates
• CapeFamilyMedicalClinic&WeightLossCenter
• CapeMedicalGroup
• PremierFamilyPhysicians
• MidwestFamilyCare
• UrgentCare
• DoctorsExpress
• ImmediateConvenientCare
InJackson,Missouri:
• JacksonPrimaryCare
• HeartlandFamilyPhysicians
• JacksonFamilyCare
• JacksonMedicalCenter
CrossTrailsMedicalCenterisaFederallyQualifiedHealthCenter(FQHC)andChronicCare
ImprovementProvider(CCIP)inCapeGirardeauCountyandislocatedinthecityofCapeGirardeau.This
facilityhasbeenprovidingpatientswithaffordablehealthcareanddentalservicesforover14years.
Someoftheservicesofferedinclude:
• Primarymedicalcare,dentalcare,preventivehealthscreeningsandadultimmunizations
• Acutecareforminorillnessorinjury–children’scare,includingimmunizationsandwell
childchecks
• Adolescenthealth(pediatrics),women’shealthcare,includingfamilyplanningandannual
gynecologyexams,geriatrics
• ParticipationinShowMeHealthyWomenprogramtoassistwomeninobtainingnecessary
exams
• Fulldiabetesprogram,includingeducationwithacertifieddiabeteseducator;onsite
laboratoryservicesandX-rayservices(on-site)
• Mentalhealthcounselingreferrals,patientmedicationassistanceprogram,telehealth
(currentdermatology–contractpharmacyprogram)
• Emergencycasesarereferredtothenearestemergencyroom
30|P a g e ARuralHealthCliniccanbefoundattheCapeGirardeauCountyHealthDepartmentlocatedinthecity
ofCapeGirardeau.Theclinicprovideswellandsickcarebyappointment,includingchildhood
immunizationsandphysicalexamsforchildrentwoweeksto18yearsofage.Noemergencycareis
given,butminorillnessescanbetreated.
RiverCityClinicisanotheravailablecliniclocatedindowntownCapeGirardeau.
SamaritanRegionalHealthClinicisafreecliniclocatedinCapeGirardeau,Missouri,thatjustopenedin
2012andservesindividualswhodonothavemedicalinsuranceandwhoarenoteligibleforMedicareor
Medicaid.Thisclinicisfundedthroughdonationsandvolunteers,andiscurrentlyopenWednesdays
from2to7pmandFridaysfrom9amto2pm.Servicesprovidedincludenon-emergencyclinical
treatments.Moreinformationcanbefoundonwww.samaritanregional.org.
MentalHealth
Foundation’sCountyHealthRankings,CapeGirardeauCountyhasmentalhealthproviderratioof413:1,
whereasthestateofMissourihasaratioof632:1.
TheCommunityCounselingCenterinCapeGirardeauCountyisanot-for-profitbehavioralhealth
organizationthatoffersafullarrayofcomprehensivementalhealthservicesforseveralcountiesin
southeastMissouri.Theyarededicatedtothetreatment,supportandultimaterecoveryofthose
afflictedwithmentalillness.TheCommunityCounselingCenterhasbeenaccreditedbytheCommission
onAccreditationofRehabilitationFacilities(CARF)andiscertifiedbytheMissouriDepartmentofMental
Health.Someoftheprogramsofferedincludethefollowing:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
AccesstoCareProgram
ApartmentLivingPrograms
CommunityPsychiatricRehabilitation
Center
IntensiveLevelCommunityPsychiatric
Rehabilitation
TargetedCaseManagement
CompulsiveGamblingInterventionand
Treatment
ConsumerAdvisoryBoard
ConsumerEmployment
DiseaseManagement
DiversionDayProgram
DiversionEmergencyBeds–
LouE.Masterman
FamilyReunificationServices
GalleryofInspiration-Consumer
Artwork
HavenHealthClinic
HealthcareHome
24-HourCrisisIntervention
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Housing
IndividualPlacementSupport
IntegratedDualDiagnosis
IntensiveIn-HomeServices
IntensiveResidentialTreatment
MentalHealthFirstAid
OutpatientCounselingServices
OutpatientSubstanceAbuseand
Co/Occurring
PhoneSupportServices-Talk,Listen,
CareLine
PeerSpecialist
PeerSupportGroup-ChronicMental
Illness
Physician/PsychiatricServices
PsychosocialRehabilitationPrograms
SupportiveCommunityLiving
Placement
Transportation
ChildrenandYouthServices
31|P a g e SoutheastHospitalalsooffersa15-bedpsychiatricunitthatisalockedunitandservesclientswitha
mentalillness.Commondiagnosestreatedonthepsychiatricunitincludedisorderssuchasdepression,
bipolardisorder,anxietydisordersandpsychosis.Theunitisavoluntaryunitservingadultsonan
inpatientbasis.Theunitisstaffedwithamultidisciplinaryteamcomprisedofamedicaldirector,
licensedclinicalsocialworkers,recreationaltherapistsandanursingstaffofRNs,LPNsandNurse
Assistants.Theprimarymissionofthepsychiatricunitistoprovideasafebehavioralhealthcare
environmentandtreatmenttoindividualsinneedofinpatientmentalhealthservices.
Dentists
Foundation’sCountyHealthRankings,CapeGirardeauCountyhasadentistratioof1,406:1whereasthe
stateofMissourihasaratioof1,920:1.
Table5showswhichdentistsinthecountyacceptMOHealthNet(Medicaid).Thereare16general
dentists,twodentistsspecializinginchildren’steethandtwooralsurgeons.Sixofthegeneraldentists
areemployedatCrossTrailsMedicalCenterinthecityofCapeGirardeau,whichisafederallyqualified
healthcenter.
Table5:DentistsinCapeGirardeauCountyThatAcceptMOHealthNet(Medicaid)
NameofProvider
ADEN,BYRONL.,DDS
BEGLEY,RANDALL.,DDS
COTNER,DANNAP.,DDS
DUROSEAU,DANIEL
EDWARDS,JONATHANWADE,DDS
ETHERTON,ROBERTC.,DMD
FOX,JAMESL.,DDS
FOX,ROBERTG.,DDS
JONES,ALANDAVID
LEWIS,T.WAYNE,DDS
MERKLEY,PATRICIAJ.,DMD
ROHLFS,LOUISH.,DDS
RUOPP,JANETB.,DDS
RUOPP,PATRICKR.,DDS
SCHERRMAN,JAYNEF.,DDS
SCHOOLMAN,STEVENRONALD,DDS
SHEETS,SUSANH.,DDS
SPENCE,BRIANPAUL
WILSON,LEIGHGARLAND,DDS
Specialty
DENTIST-GENERAL
ORALSURGEON
DENTIST-GENERAL
DENTIST-GENERAL
DENTIST-GENERAL
DENTIST-GENERAL
DENTIST-GENERAL
DENTIST-GENERAL
DENTIST-GENERAL
DENTIST-GENERAL
DENTIST-GENERAL
DENTIST-GENERAL
DENTIST-GENERAL
DENTIST-GENERAL
PEDODONTIST
DENTIST–GENERAL/ORALSURGEON
PEDODONTIST
DENTIST–GENERAL
DENTIST-GENERAL
Source:MissouriDepartmentofSocialServices,MOHealthNetProviderSearch
32|P a g e OptometryServices
Table6showswhichoptometristsinthecountyacceptMOHealthNet.Thereare23
opticians/optometrists.
Table6:OptometristsinCapeGirardeauCountythatAcceptMOHealthNet(Medicaid)
ProviderName
BERRY,MORGAN,A
BILLINGS,MICHAELK.,OD
BLANKENSHIP,TIMOTHYJ.,OD
BLIESE,DAVIDR.,OD
DETRING,KENNETHC.,OD
DOHOGNE,JEREMEYCAPEGIRARDEAU
EVANS,LAURAR.,OD
FOSTER,AMYM.,OD
FOWLER,CHRISTYM.,OD
HAGER,LISAA.,OD
HALL,JAMEST.,OD
KIPPENBROCK,ROBERTL.,OD
LEET,GREGORYS.,OD
MCDONALD,JR,EUGENEF.,OD
MCDOUGAL,CAPEGIRARDEAUA.,OD
NORMAN,BRIANK.
PRY,DONNA
SHEWMAKE,RACHELA.,OD
SMITH,JANETH.,OD
THOMA,KORY,OD
TYHURST,KEITHN.,OD
WILLIAMSE,BROOKEWHITSITT
WOOD,RYNECHRISTOPHER,OD
Source:MissouriDepartmentofSocialServices,MOHealthNetProviderSearch
Specialty
OPTICIAN/OPTOMETRIST
CommunityHealthResources/Services
TheCapeGirardeauCountyHealthDepartmentisalsoagreatresourceforpublichealth,
environmentalhealth,disasterandemergencymanagementinformationandotherresources.
TheAmenCenterinDeltaisaChristianbasedinterdenominationalcrisisandrestorationcenterthat
assistsfamiliesandindividualsinrecoveringfromasetback,crisisortragedythatrequiresaplaceof
refugeforatransitionalperiod.
EmergencyServices
CapeCountyPrivateAmbulanceService,Inc.(CCPA)hasbeenprovidingEmergencyAmbulanceService
toCapeGirardeauCounty,Missouri,since1968.Asaleaderinthefieldofemergencymedicalservices,
emergencycallsarehandledbyfull-timecertifiedEmergencyMedicalDispatchers(EMD)usingMedical
Priority'sEMDprotocols.Thisprovidesthecallerwithlife-savingandinjury-preventingpre-arrival
instructions,includingphoneinstructionsoncriticallife-savingmaneuverssuchasCPR,choking,serious
bleedingandothers.Eachemergencyambulanceisequippedwithcutting-edgetechnology,including
33|P a g e 12-leadEKGandtelemetrycapabilityandleadingemergencydrugs.Ambulancesarestaffedwith
MissouriLicensedandNationalRegistrycertifiedparamedicsandemergencymedicaltechnicians.CCPA
alsoprovidesNon-EmergencyMedicalTransportationwithintheMidwestregion.Non-emergency
transportationmaybeprovidedusingAdvancedLifeSupportvehiclesandcrewsifspecialoradvanced
servicesarerequiredormaybeprovidedbyBasicLifeSupportcrewsifappropriate.
SevenfiredepartmentscanbefoundinCapeGirardeauCounty.Thefollowingtableshowsthose
locationsalongwithdetails.Firefightershavemanyresponsibilitiesbesidesjustputtingoutfires.Oneof
thoseresponsibilitiesmaybetoprovideemergencycareforpeopleinvolvedinaccidentsand
oftentimes,firefightersarethefirstemergencypersonnelonthescene.
Table7:FireDepartmentsinCapeGirardeauCounty,MissouriandEmergencyMedicalResponseAgencies
No.of
No.of
No.of
No.ofPaid
NonTypeofFire
FireDepartment
Fire
Career
Volunteer
perCall
Firefighting
Department:
Stations: Firefighters: Firefighters: Firefighters:
Employees:
CapeGirardeauFire
Department*
Career
4
57
0
0
3
CapeGirardeau,MO63703
FruitlandAreaFire
Department
Volunteer
2
0
27
0
0
Fruitland,MO63755
MillersvilleFireRescue
Department*
Volunteer
3
0
20
0
0
Millersville,MO63766
WhitewaterFireProtection
District
Volunteer
2
0
16
0
0
NonFirefighting
Volunteers:
0
3
0
2
Whitewater,MO63785
EastCountyFireProtection
District*
CapeGirardeau,MO637020691
JacksonFire&Rescue*
Jackson,MO63755
NorthCapeCountyFire
District
Volunteer
3
0
42
0
0
42
Mostly
Volunteer
1
11
1
18
0
0
Volunteer
1
0
19
0
0
0
OakRidge,MO63769
*LicensedasanEmergencyMedicalResponseAgency
Source:MissouriDepartmentofHealth&SeniorServices,EmergencyMedicalServices,Directories,FireDepartmentsNetwork,Fire
DepartmentListingsbyCounty
AirEvacLifeteamisrunthroughAirEvacEMC,Inc.whichisthelargestindependentlyownedand
operatedmembership-supportedairmedicalserviceintheUnitedStates.Amembershipfeeisrequired,
coveringasmallfractionofthecostofflightandentitlesmemberstobetransportedtotheclosest
medicalfacilityformedicalconditionsthatarelife-orlimb-threateningorcouldleadtopermanent
disability.TheAirEvacLifeteamwilltransportnonmembers,butthecostismuchgreater.
SaintFrancisHealthcareSystemoffersemergencyservicesandistheregion’sonlystate-designated
LevelIIITraumaCenter.Inearly2011,SaintFrancisHealthcareSystemcompletedatwo-phase
expansionandrenovationprojectandaddedalmost30,000squarefeettotheoriginalfacility’s11,600
squarefeet.Thenewstate-of-the-artfacilityoffers26privatetreatmentrooms,threetraumarooms,
twotriageroomsandaspecialproceduresroomforatotalof32patientrooms.TheEmergencyand
TraumaCenterfeatureshospital-based,board-certifiedemergencymedicinephysiciansandtrauma
surgeonswhoprovidecriticalcare24hoursaday,sevendaysaweek.
34|P a g e SoutheastHospitaloffersEmergencyServicesinits17,800squarefootemergencydepartment.The
EmergencyDepartmentincludesanAcuteCareFacilitythatisopenandstaffed24/7,designatedtocare
forpatientswithawiderangeofmedicalproblemsarisingfromillnessorinjuryandincludes22
treatmentroomswithonemajortreatmentroomwithcompleteX-raycapabilities.Italsoincludesa
ChestPainCenterwiththebackupofanationallyrecognizedHeartCenter,anationallyaccredited
StrokeCenterandERexpress.
Long-termCareFacilities
ThefollowingdescribesthreetypesofLong-termCareFacilities:
•
Residentialcarefacilities(RCFs)refertofacilitiesthatprovidelong-termcaretoadultsorchildreninaresidential
settingratherthanthepatient'shome.Peoplewithdisabilities,mentalhealthproblemsorlearningdifficultiesare
oftencaredforathomebypaidorvoluntarycaregivers,suchasfamilyandfriends,withadditionalsupportfrom
homecareagencies.
•
Assistedlivingresidencesorassistedlivingfacilities(ALFs)providesupervisionorassistancewithactivitiesofdaily
living(ADLs);coordinationofservicesbyoutsidehealthcareproviders;andmonitoringofresidentactivitiestohelpto
ensuretheirhealth,safetyandwell-being.
•
Skillednursingfacilities(SNFs),nursinghomesorconvalescenthomesprovideaplaceofresidenceforpeoplewho
requireconstantnursingcareandhavesignificantdeficiencieswithactivitiesofdailyliving.Residentsincludethe
elderlyandyoungeradultswithphysicalormentaldisabilities.Residentsinaskillednursingfacilitymayalsoreceive
physical,occupationalandotherrehabilitativetherapiesfollowinganaccidentorillness.
Table8:Long-termCareFacilitiesinCapeGirardeauCounty,Missouri
FACILITYNAME
AUBURNCREEK-ASSISTEDLIVINGBYAMERICARE
BARNABASACRES
CAPETOWNASSISTEDLIVING
CHATEAUGIRARDEAU
CHATEAUGIRARDEAUASSISTEDLIVINGCENTER
FOUNTAINBLEAULODGE
FOUNTAINBLEAULODGE
FREDERICKSTREETMANOR
HEARTLANDCAREANDREHABILITATIONCENTER
JACKSONMANORNURSINGHOME
JEFFERSONMANOR
LIFECARECENTEROFCAPEGIRARDEAU
LUTHERANHOMEASSISTEDLIVING
LUTHERANHOME,THE
MAPPLECRESTMANOR
MONTICELLOHOUSE
MONTICELLOHOUSE
PARKWOODMANOR
PARKWOODMANOR
RATLIFFCARECENTER
SPRIGGSTREETMANOR
LEVELOFLICENSURE
CITY
ASSISTEDLIVINGFACILITYOPTION1
SKILLEDNURSINGFACILITY
RESIDENTIALCAREFACILITYII
RESIDENTIALCAREFACILITYI
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
JACKSON
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
JACKSON
JACKSON
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
CAPEGIRARDEAU
Source:MissouriDepartmentofHealth&SeniorServices,ShowMeLongTermCareinMissouri
35|P a g e Chapter3:HealthOutcomes
Mortality
LeadingCausesofDeath
AccordingtotheMissouriDepartmentofHealth&SeniorServices,CapeGirardeauCountyhasalower
rateofdeathfrommostofthecauseslistedinthetablebelowthanMissouri.CapeGirardeauCounty
onlyhasahigherrateofdeathcausedbyAlzheimer’sdiseaseandkidneydiseasesthanMissouri.
Table9:LeadingCausesofDeathinCapeGirardeauCounty,2003-2013
LeadingCausesofDeath
AllCauses
HeartDisease
AllCancers(MalignantNeoplasms)
LungCancer
BreastCancer
ChronicLowerRespiratoryDisease
Stroke/OtherCerebrovascularDisease
TotalUnintentionalInjuries
MotorVehicleAccidents
Alzheimer'sDisease
DiabetesMellitus
PneumoniaandInfluenza
KidneyDisease(NephritisandNephrosis)
Suicide
Septicemia
ChronicLiverDiseaseandCirrhosis
Homicide
HIV/AIDS
Smoking-Attributable(estimated)
Alcohol/Drug-Induced
AllInjuriesandPoisonings
Firearm
InjuryatWork
County
Events
7,812
2,069
1,658
519
124
437
476
242
91
429
184
168
216
98
82
54
24
9
1,316
111
431
81
13
Rate
808.3
208.3
177.7
56.1
13.1
45.4
47.5
27.4
10.5
41.6
19.7
16.4
21.6
12.1
8.8
6.2
3.1
1.2*
137.7
14.5
51.2
9.9
1.6*
Missouri
Comparedto
MissouriRate
Lower
Lower
Lower
Lower
Lower
Lower
Lower
Lower
Lower
Higher
Lower
Lower
Higher
Lower
Lower
Lower
Lower
Lower
Lower
Lower
Lower
Lower
Lower
Rate
837.3
216.7
188.9
58.7
13.6
50.3
47.8
47.5
16.4
25.8
22
20.3
18.1
13.7
11.5
7.5
7.2
1.9
145.2
20.2
70.5
13.2
1.7
Source:MissouriDepartmentofHealth&SeniorServices,CommunityDataProfiles
Mortalityratesareperyearper100,000populationandareage-adjustedtotheU.S.2000standardpopulation.
Cancer
AccordingtotheMissouriCancerRegistryandResearchCenter,CapeGirardeauCountyhad341
incidencesofcancer,leadingtoanage-adjustedinvasivecancerincidentrateforallsitesof393.7in
2011.Missourihad30,179casesforarateof436.6in2011.Table10showsthetoptencancerincidence
sites.Combined,malesandfemaleshadthehighestpercentoflungandbronchuscancer.However,split
up,females’highestincidenceoccurredthroughbreastcancerandmalesthroughprostatecancer.
36|P a g e Femalebreastcancerincidencedidresultinthesecondhighestincidencerateforbothsexescombined
aswell,justbelowlungandbronchuscancer.
Table10:CapeGirardeauCounty,TopTenCancerIncidenceSites,2007-2011
AllSexes
Females
Males
CancerIncidenceRates(TopTen)
CancerSite
LungandBronchus
FemaleBreast
Prostate
ColonandRectum
KidneyandRenalPelvis
Non-Hodgkin’sLymphoma
Thyroid
UrinaryBladder
OralCavityandPharynx
CorpusandUterus,NOS
CancerSite
FemaleBreast
LungandBronchus
ColonandRectum
Thyroid
CorpusandUterus,NOS
Ovary
Pancreas
MelanomaoftheSkin
CancerSite
Prostate
LungandBronchus
ColonandRectum
UrinaryBladder
MelanomaoftheSkin
Pancreas
LiverandIntrahepaticBileDuct
Percent
16.25
15.90
13.44
9.73
4.92
4.00
3.72
3.09
2.92
2.92
Percent
31.38
14.9
9.93
6.09
5.76
3.95
2.93
2.48
2.26
2.03
Percent
27.26
17.63
9.51
6.96
5.22
4.06
3.94
3.25
2.55
2.44
Source:MissouriCancerRegistryandResearchCenter,TopTenCancerIncidenceSites,Missouri;County-levelData
37|P a g e ChronicDisease
Table11showsacomparisonofchronicdiseasesforCapeGirardeauCountyandMissouri.Itshowsthe
deaths,hospitalizationsandERvisitscausedbyeachofthechronicdiseases.
Table11:ChronicDiseases-CapeGirardeauCountyvs.Missouri
ChronicDisease
HeartDisease
Deaths
Hospitalizations
ERVisits
IschemicHeartDisease
Deaths
Hospitalizations
ERVisits
Deaths
Hospitalizations
ERVisits
Deaths
Hospitalizations
ColorectalCancer
Deaths
Hospitalizations
ColonandRectumCancer(SEER)
Deaths
LungCancer
Deaths
Hospitalizations
BreastCancer
Deaths
Hospitalizations
CervicalCancer
Deaths
Hospitalizations
ProstateCancer
Deaths
Hospitalizations
DiabetesMellitus
Deaths
Hospitalizations
ERVisits
No.ofEventsin
CapeGirardeau
CapeGirardeau
Rate
2002-2012
2008-2012
2008-2012
2158
4469
4491
221
104.1
11.8
223.6
129.8
14.3
2002-2012
2008-2012
2008-2012
1577
1282
59
162
29.9
0.1
151.2
41.6
0.7
2002-2012
2008-2012
2008-2012
495
1321
187
50.2
27.9
0.4
49.8
29.3
0.8
2002-2012
2008-2012
1628
1321
177.9
31.1
191.1
34.6
2002-2012
2008-2012
174
171
18.7
4
18.1
4.4
2002-2012
174
18.7
17.9
2002-2012
2008-2012
485
179
53.4
4.2
59.4
4.6
2002-2012
2008-2012
127
58
13.7
1.4
13.9
1.7
2002-2012
2008-2012
18
11
2.0*
0.3*
1.4
0.6
2002-2012
2008-2012
79
158
8.3
3.6
8.4
2.5
2002-2012
2008-2012
2008-2012
182
553
19.8
13.8
22.5
17.8
635
1.7
1.8
DataYears
Missouri
Rate
38|P a g e ChronicObstructivePulmonaryDiseaseExcludingAsthma
Deaths
2002-2012
Hospitalizations 2008-2012
ERVisits
2008-2012
Asthma
Deaths
2002-2012
ERVisits
2008-2012
Smoking-Attributable(Estimated)
Deaths
2002-2012
Arthritis/Lupus
Deaths
2002-2012
ERVisits
2008-2012
404
912
1045
42.8
21
2.7
48.5
23.6
5.7
8
233
878
0.9*
6.4
2.5
1.2
13.1
5.3
1283
136.9
146.9
22
1799
5922
2.4
42.5
15.8
3.3
41.7
9.9
Deathratesareperyearper100,000populationandareage-adjustedtotheU.S.2000standardpopulation.
Hospitalizationratesareperyearper10,000populationandareage-adjustedtotheU.S.2000standardpopulation.
ERvisitsareperyearper1,000populationandareage-adjustedtotheU.S.2000standardpopulation.
*Fewerthan20eventsinnumerator;rateisunstable.
Source:MissouriDepartmentofHealthandSeniorServices
YearsofPotentialLifeLost
TheMissouriDepartmentofHealth&SeniorServicesdescribestheyearsofpotentiallifelost(YPLL)
statisticasanestimateofthenumberofliveslostduetoprematuredeath(beforeage75).Ayounger
deathcorrespondstomoreyearsofpotentiallifelost.
AccordingtotheMissouriDepartmentofHealth&SeniorServices,in2013,Missourihadacombined
459,648yearsofpotentiallifelost.Alone,CapeGirardeauCountyhad5,281yearsofpotentiallifelost.
TheMissouriDepartmentofHealth&SeniorServicesalsoreported8,145yearsofpotentiallifelostper
100,000populationinMissouriand7,360yearsofpotentiallifelostper100,000populationinCape
GirardeauCounty.
InfantMortality
Therateofinfantdeathsincreaseddrasticallyfrom2012to2013andiswellabovetherateofMissouri.
Figure13:RateofInfantDeaths-CapeGirardeauCountyvs.Missouri
RateofInfantDeaths-CapeGirardeauCountyvs.Missouri
8
7.5
7
7.3
7.8
Missouri
7
7.1
7.1
6.5
7.5
7.4
6.9
6.8
6.6
CapeGirardeau
County
6
2009
2010
2011
2012
2013
Source:AnnieE.CaseyFoundationKIDSCOUNTDataCenter
39|P a g e Morbidity
ObesityandOverweight
AccordingtotheCentersforDiseaseControlandPrevention,morethanone-thirdoftheadultsinthe
UnitedStatesareobese,whichcanleadtoseveralotherchronicconditionsincludingheartdisease,
stroke,type2diabetesandcertaintypesofcancer.In2011,theBehavioralRiskFactorSurveillance
SystemfromCDCpresentedtheprevalenceestimatesforobesityinthepicturebelow.Thisshowsthat
Missourihadanobesityprevalencefrom30%to<35%.Obesityismeasuredwhenapersonhasabody
massindex(BMI)greaterthanorequalto30kg/m2.ThishasshowntobeaconcernacrosstheUnited
States.
Figure14:ObesityPrevalenceMap,2014
Source:CentersforDiseaseControlandPrevention–Data,TrendsandMaps
AccordingtotheCountyHealthRankingsdevelopedbytheRobertWoodJohnsonFoundationandthe
UniversityofWisconsinPopulationHealthInstitute,CapeGirardeauCountyhasa29%prevalenceof
obesitycomparedwith30.2%inMissouri.CapeGirardeauCountyhasahighprevalenceofobesity,
whichmaybecausedbyalackofexerciseandphysicalactivityalongwithapoordiet.
Diabetes
AccordingtotheCentersforDiseaseControlandPrevention,diabetesistheleadingcauseofkidney
failure,non-traumaticlower-limbamputationsandnewcasesofblindnessamongadultsintheUnited
States.Itisalsoamajorcauseofheartdiseaseandstroke.Othercomplicationsthatcanbecausedby
diabetesinclude:hypertension,eyeproblems,kidneydisease,nervoussystemdisease,amputations,
dentaldiseaseandcomplicationsofpregnancy.
Diabetesisagroupofdiseasesmarkedbyhighlevelsofbloodglucoseresultingfromdefectsininsulin
production,insulinactionorboth.Diabetescanleadtoseriouscomplicationsandprematuredeath,but
peoplewithdiabetes,workingtogetherwiththeirsupportnetworkandtheirhealthcareproviders,can
takestepstocontrolthediseaseandlowertheriskofcomplications.Thereismorethanonetypeof
diabetes:
40|P a g e •
•
•
•
Type1diabeteswaspreviouslycalledinsulin-dependentdiabetesmellitus(IDDM)orjuvenileonsetdiabetes.Type1diabetesdevelopswhenthebody’simmunesystemdestroyspancreatic
betacells,theonlycellsinthebodythatmakethehormoneinsulinthatregulatesbloodglucose.
Tosurvive,peoplewithType1diabetesmusthaveinsulindeliveredbyinjectionorapump.This
formofdiabetesusuallystrikeschildrenandyoungadults,althoughdiseaseonsetcanoccurat
anyage.Inadults,Type1diabetesaccountsforapproximately5%ofalldiagnosedcasesof
diabetes.RiskfactorsforType1diabetesmaybeautoimmune,geneticorenvironmental.There
isnoknownwaytopreventType1diabetes.SeveralclinicaltrialsforpreventingType1diabetes
arecurrentlyinprogressorarebeingplanned.
Type2diabeteswaspreviouslycallednon-insulin-dependentdiabetesmellitus(NIDDM)or
adult-onsetdiabetes.Inadults,Type2diabetesaccountsforabout90%to95%ofalldiagnosed
casesofdiabetes.Itusuallybeginsasinsulinresistance,adisorderinwhichthecellsdonotuse
insulinproperly.Astheneedforinsulinrises,thepancreasgraduallylosesitsabilitytoproduce
it.Type2diabetesisassociatedwitholderage,obesity,familyhistoryofdiabetes,historyof
gestationaldiabetes,impairedglucosemetabolism,physicalinactivityandrace/ethnicity.
African-Americans,Hispanic/LatinoAmericans,AmericanIndiansandsomeAsianAmericansand
NativeHawaiiansorotherPacificIslandersareatparticularlyhighriskforType2diabetesand
itscomplications.Type2diabetesinchildrenandadolescents,althoughstillrare,isbeing
diagnosedmorefrequentlyamongAmericanIndians,African-Americans,Hispanic/Latino
AmericansandAsians/PacificIslanders.
Gestationaldiabetesisaformofglucoseintolerancediagnosedduringpregnancy.Gestational
diabetesoccursmorefrequentlyamongAfrican-Americans,Hispanic/LatinoAmericansand
AmericanIndians.Itisalsomorecommonamongobesewomenandwomenwithafamily
historyofdiabetes.Duringpregnancy,gestationaldiabetesrequirestreatmenttooptimize
maternalbloodglucoselevelstolessentheriskofcomplicationsintheinfant.
Othertypesofdiabetesresultfromspecificgeneticconditions(suchasmaturity-onsetdiabetes
ofyouth),surgery,medications,infections,pancreaticdiseaseandotherillnesses.Suchtypesof
diabetesaccountfor1%to5%ofalldiagnosedcases.
AccordingtotheCountyHealthRankingsdevelopedbytheRobertWoodJohnsonFoundationandthe
UniversityofWisconsinPopulationHealthInstitute,CapeGirardeauCountyhasadiabetesprevalenceof
12%,justabovetheMissouriprevalenceof11%.
InfectiousDisease
TheMissouriDepartmentofHealthandSeniorServices’BureauofCommunicableDiseaseControland
PreventionputoutanAnnualCommunicableDiseaseSurveillanceReportsummarizingthedifferent
communicablediseasesreportedacrossMissouriin2012.ThediseasesthatwerereportedinCape
GirardeauCountyaredescribedbelow.
HepatitisCisacontagiousliverdiseasethatresultsfrominfectionwiththeHepatitisCvirus.Itcanrange
inseverityfromamildillnesslastingafewweekstoaserious,lifelongillness.HepatitisCisusually
spreadwhenbloodfromapersoninfectedwiththeHepatitisCvirusentersthebodyofsomeonewhois
notinfected.Today,mostpeoplebecomeinfectedwiththeHepatitisCvirusbysharingneedlesorother
equipmenttoinjectdrugs.Before1992,whenwidespreadscreeningofthebloodsupplybeganinthe
UnitedStates,HepatitisCwasalsocommonlyspreadthroughbloodtransfusionsandorgantransplants.
HepatitisCcanbeeither“acute”or“chronic.”AcuteHepatitisCvirusinfectionisashort-termillness
thatoccurswithinthefirstsixmonthsaftersomeoneisexposedtotheHepatitisCvirus.Formost
people,acuteinfectionleadstochronicinfection.ChronicHepatitisCisaseriousdiseasethatcanresult
41|P a g e inlong-termhealthproblemsorevendeath.ThereisnovaccineforHepatitisC.Thebestwaytoprevent
HepatitisCisbyavoidingbehaviorsthatcanspreadthedisease,especiallyinjectiondruguse.Cape
GirardeauCountyhad47casesofHepatitisC,ChronicInfectionreportedin2012.
Tuberculosis(TB)isadiseasecausedbythebacteriumcalledMycobacteriumtuberculosis.Thebacteria
canattackanypartofyourbody,butitusuallyattacksthelungs.TBisspreadthroughtheairfromone
persontoanother.ThebacteriaareexpelledintotheairwhenapersonwithTBdiseaseofthelungsor
throatcoughs,sneezes,speaksorsings.Thesebacteriacanstayintheairforseveralhours,depending
ontheenvironment.PeoplewhobecomeinfectedwithTBbacteriausuallyhavehadveryclose,day-todaycontactwithsomeonewhohasTBdisease(e.g.afamilymember,friendorcloseco-worker).Inmost
peoplewhobecomeinfected,thebodyisabletofightthebacteriatostopthemfromgrowing.The
bacteriabecomeinactive,buttheyremainaliveinthebodyandcanbecomeactivelater.Thisiscalled
latentTBinfection(LTBI).ThesepeopledonothavesymptomsofTBdiseaseandtheycannotspreadTB
toothers.AccordingtotheBureauofCommunicableDiseaseControlandPrevention’sCommunicable
DiseaseSurveillance2012AnnualReport,CapeGirardeauCountyhadnocasesoftuberculosisin2012.
OthercommunicablediseasesthatwerereportedinCapeGirardeauCountyin2012include:
• AnimalBites:5cases
• Campylobacteriosis(oftenfoodborneillness):26cases
• Cryptosporidiosis:8cases
• DengueFever:1case
• E.ColiShigaToxinPositive:8cases
• E.Coli(All):14cases
• EColi0157H7:6cases
• Ehrlichiosis&Anaplasmosis:4cases
• HemolyticUremicSyndrome:1case
• HepatitisAAcute:1case
• HepatitisBChronicInfection:6cases
• HepatitisCAcute:1case
• Legionellosis:1case
• MeningococcalDisease:1case
• Pertussis:3cases
• RabiesPostExposureProphylaxis:3cases
• RockyMountainSpottedFever:3cases
• Salmonellosis:22cases
• Shigellosis:1case
• StrepDisease,GroupAInvasive:1case
• StrepPneumoniae,Drug-Resistant:6cases
• Tetanus:1case
• Tick-borneDisease:7cases
• Varicella(Chickenpox):1case
HIV/AIDS
HIVisthehumanimmunodeficiencyvirusthatcanleadtoacquiredimmunedeficiencysyndrome(AIDS).
TherearetwotypesofHIV:HIV-1andHIV-2.Unlessotherwisenoted,whenreferringtoHIVinthe
UnitedStates,HIV-1isthetypebeingreferredto.Bothtypesdamageaperson’sbodybydestroying
CD4+Tcells,whicharecrucialtohelpingthebodyfightdiseases.AccordingtotheMayoClinic,potential
42|P a g e signsandsymptomsvarydependingonthestageofHIV.Withinamonthortwo,infectedpeopleusually
developflu-likesymptoms,whichmaylastforafewweeks.Signsandsymptomsofthismayinclude
fever,headache,muscleachesandjointpain,rashes,sorethroatandswollenlymphglands.Duringthis
primaryHIVinfection,theamountofthevirusinthebloodstreamishigh,causingmoreefficient
spreadingofthevirus.Thisisparticularlydangerousbecausethevirusoftengoesunnoticedinthis
stage.ThroughoutstagesofHIVinfection,manyothersignsandsymptomsmayoccurincludingfever,
fatigue,swollenlymphnodes,diarrhea,weightlossoralyeastinfectionandshingles.
EveryonewhohasbeeninfectedwithHIVshouldseeahealthcareproviderexperiencedwithtreating
HIVinfectiononaregularbasis.Medicationsreceivedcanslowdowndestructionoftheimmune
system,improveoverallhealthandmayevendecreasechancesofspreadingthevirus.Ifthevirusgoes
unnoticedanduntreated,theHIVinfectioncanleadtoassociationwithmanydiseasessuchas
cardiovasculardisease,kidneydisease,liverdiseaseandcancer.MayoClinicalsostatedthatwithout
treatmentforHIVinfection,thediseaseusuallydevelopsintoAIDSinabout10yearsandleadingto
manyotherwiserarediseases.Signsandsymptomsofthisstagemayincludesoakingnightsweats,
recurringfever,chronicdiarrhea,persistentwhitespotsorunusuallesionsonthetongue/mouth,
persistentandunexplainedfatigue,weightlossandskinrashesorbumps.
AccordingtoAIDSVu,withinformationfromtheU.S.CentersforDiseaseControlandPrevention’s(CDC)
nationalHIVsurveillancedatabase,Missourihad11,737peoplelivingwithHIV/AIDS,with222deaths.In
2013,therewere482newdiagnosesofthevirus.TheCountyHealthRankingsreportthatthereare74
peoplelivingwithHIVper100,000peopleinCapeGirardeauCounty,comparedwith223per100,000
peopleinMissouri.Morespecificcountydataislacking.
OtherSexuallyTransmittedDiseases
Sexuallytransmitteddiseases(STDs)isatermusedtodescribemorethan20differentinfectionsthat
aretransmittedthroughexchangeofsemen,bloodandotherbodyfluids;orbydirectcontactwiththe
affectedbodyareasofpeoplewithSTDs.Sexuallytransmitteddiseasesarealsocalledvenerealdiseases.
STDscanhaveverypainfullong-termconsequencesaswellasimmediatehealthproblems.Theycan
cause:
• birthdefects
• blindness
• bonedeformities
• braindamage
• cancer
• heartdisease
• infertilityandotherabnormalitiesofthereproductivesystem
• mentalretardation
• death
SomeofthemostcommonsexuallytransmitteddiseasesaredescribedbelowasdefinedbytheCenters
forDiseaseControlandPreventionalongwiththenumberofcasesreportedinCapeGirardeauCounty
bytheMissouriDepartmentforHealthandSeniorServices.
SyphilisisasexuallytransmitteddiseasecausedbythebacteriumTreponemapallidum.Ithasoften
beencalled"thegreatimitator"becausesomanyofthesignsandsymptomsareindistinguishablefrom
thoseofotherdiseases.In2015,CapeGirardeauCountyhadzerocasesofsyphilisreported.
43|P a g e GonorrheaisasexuallytransmitteddiseasecausedbyNeisseriagonorrhoeae,abacteriumthatcan
growandmultiplyeasilyinthewarm,moistareasofthereproductivetract,includingthecervix
(openingtothewomb),uterus(womb)andfallopiantubes(eggcanals)inwomenandintheurethra
(urinecanal)inwomenandmen.Thebacteriumcanalsogrowinthemouth,throat,eyesandanus.
Gonorrheaisaverycommoninfectiousdisease.In2015,CapeGirardeauCountyhad125casesof
gonorrheareported.
ChlamydiaisacommonsexuallytransmitteddiseasecausedbythebacteriumChlamydiatrachomatis,
whichcandamageawoman'sreproductiveorgans.Eventhoughsymptomsofchlamydiaareusually
mildorabsent,seriouscomplicationsthatcauseirreversibledamage,includinginfertility,canoccur
"silently"beforeawomaneverrecognizesaproblem.Chlamydiaalsocancausedischargefromthe
penisofaninfectedman.Chlamydiaisthemostfrequentlyreportedbacterialsexuallytransmitted
diseaseintheUnitedStates.Under-reportingissubstantialbecausemostpeoplewithchlamydiaarenot
awareoftheirinfectionsanddonotseektesting.Also,testingisnotoftendoneifpatientsaretreated
fortheirsymptoms.In2015,CapeGirardeauCountyhad353casesofchlamydiareported.
HealthStatusatBirth
Thehealthstatusatbirthcanbeindicatedbyoutcomesincludinglowbirthweight,verylowbirthweight
andgestationalage.Theconceptiscalled“healthystart”accordingtotheUniversityofWisconsin’s
RobertWoodJohnsonFoundation.
LowBirthWeight
TheRobertWoodJohnsonFoundation’sCountyHealthRankingsuseslowbirthweight,whichisless
than2,500grams.Havingalowbirthrateisusedbecauseitaffectsthematernalexposuretohealth
risksandtheinfant’scurrentandfuturemorbidity.Italsoaffectstheprematuremortalityrisk.Lowbirth
weighthasshowntoincreasechancesofdevelopmentalandgrowthproblems,cardiovasculardisease
risklaterinlifeandrespiratoryconditions.Cognitiveproblemshavealsobeenaffectedbylowbirth
weights,suchascerebralpalsy,aswellasvisual,auditoryandintellectualimpairments.TheCounty
HealthRankinsshowthat8.2%ofCapeGirardeauCounty’sbirthshadlowbirthweightsin2015.Thisis
slightlygreaterthanthe8.0%oflowbirthweightsinMissouri.
PretermDeliveries
AccordingtoCDC,pretermbirthisthebirthofaninfantbefore37weeksofpregnancy.Beingthe
greatestcontributortoinfantdeath,itisalsocommon,havingaffected1in10birthsintheUnited
Statesin2014.
TheAnnieE.CaseyFoundation’sKIDSCOUNTdatacenteronlyshowedthat12%ofbirthswerepreterm
in2009through2012and11%werepretermin2013inMissouri.TheMissouriDepartmentofHealth
andHumanServicesreportedfrom2008to2012,therewere47,443pretermbirthsinMissouri.Of
these,562occurredinCapeGirardeauCounty.
BirthDefects
AccordingtotheCDCandtheNationalBirthDefectsPreventionNetwork,birthdefectsoccurinabout
3%oflivebirths.TheMissouriDepartmentofHealthandHumanServicesreported375birthdefectsin
CapeGirardeauCountyfrom2007to2011.Thiswasarateof798.2inCapeGirardeauCounty,higher
thanthe643.6rateinMissouri.
44|P a g e HealthStatus
TheRobertWoodJohnsonFoundation’sCountyHealthRankingsliststhreefactorstoaperson’shealth
status:
1. Poororfairhealth–Aself-reportedhealthstatusthatisageneralmeasureofhealth-related
qualityoflifeinapopulation.
2. Poorphysicalhealthdays–Ameasuretakenfromhowmanydaysduringthepast30daysa
person’shealthwasnotgood.
3. Poormentalhealthdays–Ameasuretakenfromhowmanydaysduringthepast30daysa
person’smentalhealthwasnotgood.
Poororfairhealthwas15%inCapeGirardeauCountycomparedwith16%inMissouriin2015.Boththe
countyandthestatehavethesamepercentageofreportedpoororfairhealthsince2010.
In2015,theaverageamountofpoorphysicalhealthdaysinCapeGirardeauCountywas3.8daysandin
Missouriitwas3.7days.Thisexplainsresponsestohowmanydaysinthepast30dayspeople
consideredtheirhealthtobepoor.
Poormentaldaysincludesthenumberofdayspeoplefelttheyhadpoormentalhealthinthepast30
days.Poormentalhealthmayincludestress,depression,emotionalproblems,etc.In2015,theaverage
numberofpoormentalhealthdayswas4.6daysinCapeGirardeauCountyandasimilar3.8daysin
Missouri.
MentalHealth
TheMissouriDepartmentofMentalHealthcompletedCommunityEpidemiologicalProfilesforeach
countyinJune2015.Theprofilesshowthatpeoplewhostrugglewithmentalillnesshaveanincreased
riskforhomicide,suicideandaccidents.Theyalsohaveahigherriskforchronicconditionssuchas
cardiovascularandrespiratorydiseasesandsubstanceabusedisorders.AccordingtoCapeGirardeau
County’sCommunityEpidemiologicalProfile,therewere2,085residentswhoreceivedtreatmentfor
seriousmentalillnessatpubliclyfundedfacilitiesin2014.Amongthose,therewere204ofthose
residentswithadjustmentdisorder,310withanxietydisorder,229withimpulsecontroldisorder,1,185
withmooddisorderand205withpsychoticdisorder.Itwasalsoreportedthatofstudentsin6ththrough
12thgradeinCapeGirardeauCounty,9.7%hadconsideredsuicide,6.9%hadaplanand1.4%actually
attemptedtheplanandresultedininjury.Therewere10suicidesbyCapeGirardeauCountyresidentsin
2013.Morespecificdataonmentalhealthislimitedatthelocallevel.
PreventableHospitalizations
AccordingtotheCountyHealthRankingsbytheRobertWoodJohnsonFoundation,CapeGirardeau
Countyhad52preventablehospitalstayscomparedtoMissouri’s65preventablehospitalstaysin2015.
Preventablehospitalstaysisdefinedasthenumberofhospitalstaysforambulatorycare-sensitive
conditionsper1,000Medicareenrollees.
TheMissouriDepartmentofHealth&SeniorServices(MICA)indicatedthatCapeGirardeauCountyhas
ahigherratethanMissouriinpreventablehospitalizationsfrombacterialpneumonia,congenital
syphilis,failuretothrive,immunization-preventable,kidney/urinaryinfectionandpelvicinflammatory
disease.
45|P a g e Figure15:PreventableHospitalizations2013-CapeGirardeauCountyvs.Missouri
Diagnosis
CapeGirardeauCounty
Missouri
Number
Rate
Number
Rate
Angina
0
*
199
0.3
Asthma
30
5.1
5,390
10.5
Bacterialpneumonia
127
18.5
8,960
16.0
Cellulitis
80
12.7
7,221
13.6
Chronicobstructivepulmonary
65
8.2
6,359
10.1
Congenitalsyphilis
2
0.3*
4
0.0
Congestiveheartfailure
44
6.6
5,620
9.0
Convulsions
16
2.3*
1,497
2.9
Dehydration-volumedepletion
187
26.9
16,236
29.3
Dentalconditions
3
0.4*
539
1.1
Diabetes
68
9.3
7,095
13.4
Epilepsy
25
3.8
3,037
5.9
Failuretothrive
5
0.8*
234
0.5
Gastroenteritis
19
3.2*
1,775
3.3
Hypertension
12
1.8*
1,455
2.6
Hypoglycemia
1
0.1*
69
0.1
Immunization-preventable
1
0.2*
55
0.1
Kidney/Urinaryinfection
56
8.4
3,845
7.1
Nutritionaldeficiencies
13
1.7*
2,090
3.5
Pelvicinflammatorydisease
9
1.3*
393
0.8
SevereENTinfections
9
1.5*
737
1.5
Tuberculosis
0
*
38
0.1
772
113.2
72,848
131.5
TotalforSelection
Source:MissouriDepartmentofHealth&SeniorServices,MICA
Ratesper10,000AgeAdjustmentUsesYear2000StandardPopulation
AreasmarkedwithredshowahigherrateinCapeGirardeauCountythanMissouri.
*Rateconsideredunstable;numeratorlessthan20
46|P a g e Chapter4:HealthBehaviors
DietandExercise
AccordingtotheUniversityofWisconsin’sPopulationHealthInstituteandtheRobertWoodJohnson
Foundation’sCountyHealthRankings,thereare27%ofCapeGirardeauCountyresidentswhoare
physicallyinactive,comparedwith26%inMissouri.Physicallyinactivewasdeterminedintherankings
bythepercentofpeople20yearsorolderwhoreportednoleisuretimeactivity.Therewas71%ofCape
GirardeauCountythathadadequateaccesstoexerciseopportunitieswhichisbelowthe77%ofthe
populationinMissourithathasaccess.TheCountyHealthRankingsalsogaveCapeGirardeauCountya
foodenvironmentindexof7.0,with0beingtheworstand10beingthebest.ThisisequaltoMissouri’s
foodenvironmentindex.
TobaccoUse
Adultsmokingprevalenceistheestimatedpercentoftheadultpopulationthatcurrentlysmokesevery
dayor“mostdays”andhassmokedatleast100cigarettesintheirlifetime.The20%percentofadults
whowerecurrentsmokersinCapeGirardeauCountywasjustbelowthe23%ofsmokersinMissouri,
accordingtotheCountyHealthRankings.However,thisstillnotonlycausesconcernfordisease
developmentinsmokers,butalsofornon-smokersthroughsecond-handsmoke.
SubstanceAbuse
Substanceabuseincludesexcessiveuseofanydrugsuchasalcohol,narcotics,illicitdrugs,prescription
drugs,etc.TheMissouriDepartmentofMentalHealthcreatedabehavioralhealthprofileforCape
GirardeauCountyin2015.Usingdatafrom2010through2012,itwasdeterminedthatintheSoutheast
Region,32.1%usedcigarettesinthelast30days;47.9%hadalcohol,with23.7%havingfiveormore
drivesonasingleoccasioninthelast30days;and4.1%usedmarijuana.Another4.8%abusedpain
relievers,and2.8%usedotherillicitdrugsinthelast30days.Bothrateswerehigherthanthestate
abusepercentage.
Accordingtothebehavioralhealthprofile,CapeGirardeauCountyhad72alcohol-relatedand43drug-
relatedhospitalizationsin2012,withanother144alcoholrelatedand84drug-relatedERvisits.In2013,
therewere57crashesrelatedtoalcoholuseresultingin19injuries.Therewerealso474DWIarrests,
109liquorlawviolationsand347drug-relatedarrestsinthecountyin2013.
MethamphetaminehasbeenproblematicforMissouri,yetthenumberoflabseizuresinthestatehas
decreasedfrom2,788in2004to1,045in2014.Comparatively,CapeGirardeauCountyhad42
methamphetaminelabseizuresin2004,butthishasdeclinedtojustfourlabseizuresin2014.Alsoin
2014,547CapeGirardeauCountyresidentswereadmittedintosubstanceabusetreatmentprograms;
211oftheseadmissionswereduetoalcoholand162wereduetomarijuana.
MaternalHealth
PrenatalCare
In2015,theMissouriDepartmentofHealthandHumanServicescreatedCapeGirardeauCounty
PrenatalProfile.Accordingtothisprofile,in2013,therewereeightCapeGirardeauCountyresidents
whodidnothaveprenatalcare.Therewasalso29.3%whoreceivedlatecareinthe2ndor3rdtrimester
ofpregnancy.ThiswashigherthanMissouri’s24.3%.Additionally,69.8%receivedcarebeginninginthe
firsttrimester,justaboveMissouri’s74.5%.Therewere14.6%forthosewhoreceivedinadequatecare
47|P a g e (fewerthan5visitsfora37weekpregnancyorfewerthan8visitsforapregnancylastinglongerthan37
weeks),15.6%forMissouri.
SmokingDuringPregnancy
Womenwhosmokeduringpregnancyputthemselvesandtheirunbornbabiesatriskforotherhealth
problems.Dangersofsmokingduringpregnancyinclude:
• Higherriskformiscarriage
• Prematurebirthorlowbirthweight
• Birthdefects,suchascleftliporcleftpalate
• Infantdeath
• Problemswiththeplacenta,whichisthesourceofthebaby’sfoodandoxygenduringpregnancy
• HigherriskforSuddenInfantDeathSyndrome
AccordingtotheMissouriDepartmentofHealthandHumanServicestherewere192accountsrecorded
ofmotherssmokingduringpregnancy,arateof19.8%,whichwaswellabovetherateof17.8%for
Missouri.Thefigurebelowshowstherateofmother’swhosmokeduringpregnancyinCapeGirardeau
CountycomparedtoMissourifrom2001to2013.ThisshowsthattherateisconsistentlyhigherinCape
GirardeauCounty.
Figure16:RateofMotherswhoSmokeDuringPregnancyinCapeGirardeauCountyvs.Missouri
RateofMotherswhoSmokeDuringPreganancy
CapeGirardeauCountyvs.Missouri
CapeGirardeauCounty
19.3
19.2
20.1
18.1
18.1
18.1
Missouri
21.9
21
19.9
19.2
20.8
20.5
20.9
19.8
18.2
18.1
17.9
17.4
17.7
17.9
18.3
17.8
Source:MissouriDepartmentofHealthandSeniorServices,CommunityDataProfiles
Breast-feeding
AccordingtotheCentersforDiseaseControlandPrevention,bothbabiesandmothersgainseveral
benefitsfrombreast-feeding.Breastmilkiseasyforinfantstodigestandhasantibodiesthatcanprotect
themfrombacterialandviralinfections.Aninfant’sriskofbecominganoverweightchilddecreaseswith
eachmonthofbreast-feeding.Also,womenwhobreast-feedmayhavelowerratesofcertainbreastand
ovariancancers.Breast-feedingcanalsosavemother’smoneybecausetheymayspendlessmoneyon
formulasfortheirbabies.
48|P a g e InareportcompletedbytheRobertWoodJohnsonFoundationandTrustforAmerica’sHealth,research
foundmanyotherbenefitsofbreast-feedingforthechildandthemother.Forthechild:reducedriskof
ear,skin,stomachandrespiratoryinfections;diarrhea;suddeninfantdeathsyndrome;necrotizing
enterocolitisandotherbacterialandviralinfections.Inthelongerterm,thereisareducedriskof
obesity,Type1and2diabetes,asthma,celiacdisease,inflammatoryboweldiseaseandchildhood
leukemia.Forthemother:quickerlossofpregnancyweight;preventionofpostpartumbleeding;anda
reducedriskofbreastcancer,ovariancancer,Type2diabetesandpostpartumdepression.
ThefollowingfigureshowstherateofmotherswithinfantsontheWomen,InfantsandChildren(WIC)
programwhobreast-fedtheirbabiessometimeduringinfancy.Informationhasnotbeenupdatedfrom
2008,butthroughout2000-2008,CapeGirardeauCountyhadanoveralllowerrateofmotherswho
breast-fedduringinfancythanMissouridid.
Figure17:RateofMotherswhoBreast-fedTheirBabiesSometimeDuringInfancy-CapeGirardeauCountyvs.Missouri
RateofMotherswhoBreast-fedTheirBabiesSomeJmeDuring
Infancy-CapeGirardeauCountyvs.Missouri
CapeGirardeauCounty
46.8
48.4
48.5
47.4
37.8
40.6
42.5
44
2000
2001
2002
2003
49.2
49.1
2004
Source:MissouriDepartmentofHealthandSeniorServices,MICA,WICInfant
Missouri
52.1
52.4
54.5
43.4
46.4
49.5
2005
2006
2007
56
56.2
2008
PreventionandScreening
Healthscreeningsareanimportantpartofmaintaininggoodhealth,especiallyasyougetolder.Many
deathscouldbepreventedifpeoplegotsimple,regularhealthscreeningsasrecommendedbytheir
doctors.Healthscreeningscandetectproblemsearlyon,whenchancesforsuccessfultreatmentare
greatest.Forexample,heartdiseaseistheleadingcauseofdeathinMissouri,butpeoplewhoroutinely
havetheirbloodpressureandcholesterolcheckedandtreatedifnecessary,mayimprovetheirchances
ofpreventingandcontrollingconditionsthatcouldcauseaheartattack.Whenapersongetsthehealth
screeningsrecommended,theyaretakingsimplebutveryimportantstepstowardabetterqualityoflife
andquitepossibly,alongerlife.
PreventativePractices
ThetablebelowshowsthatCapeGirardeauCountyhadfewerresidentsseekinghealthandpreventive
practicesthanMissouriinseveralofthecategories.However,thecountywasalsobetterthanthestate
inseveralcategories.Comparisonscanbeseenbelow:
49|P a g e Table12:2011PrevalenceofHealth&PreventativePractices-CapeGirardeauCountyvs.Missouri
Indicator
Didnotgetmedicalcareinpast12months
Currentcigarettesmoking
Noleisure-timephysicalactivity
Lessthan5fruitsandvegetablesperday
Overweight(25.0-29.9BMI)
Obese(>=30BMI)
Everhadhighbloodpressure-amongthosewhohavehadit
checked
Everhadbloodcholesterolchecked-age35andolder
Evertoldhadhighcholesterol–among35+whohavehadit
checked
Evertoldhaddiabetes
Neverhadamammogram-womenage40andolder
Nomammogramorclinicalbreastexaminlastyear-women
age40andolder
Neverhadapapsmear-womenage18andolder
Nopapsmearinlast3years-womenage18andolder
Neverhadabloodstooltest-menandwomenage50and
older
Nobloodstooltestinlastyear-menandwomenage50and
older
Neverhadasigmoidoscopyorcolonoscopy-menand
womenage50andolder
Nosigmoidoscopyorcolonoscopyinpast10years-menand
women50andolder
CapeGirardeau
County
Prevalence%*
9.5
21.1
20.6
86.4
39.0
25.9
Comparedto
Missouri%
Missouri
Prevalence%*
Worse
Better
Better
Better
Worse
Better
9.0
23.1
23.7
87.5
34.5
30.1
36.0
Worse
34.4
90.0
Worse
89.5
47.0
Worse
44.8
9.9
12.2
Better
Worse
10.7
9.9
34.7
Worse
30.5
7.3
29.6
Better
Worse
7.5
26.4
65.0
Better
66.1
91.7
Worse
90.4
35.7
Worse
33.8
39.2
Worse
38.0
Source:MissouriDepartmentofHealthandSeniorServices,CommunityHealthProfiles,HealthandPreventativePractices
WeightedPercent:Theproportion(usuallyapercentage)ofapopulationthathasadefinedriskfactor,diseaseorconditionataparticular
pointintime.Percentsarenotavailableforindicatorswithlessthan50respondents.
Diabetes
AccordingtotheDiabetesFactSheet,Missouri,2015fromtheMissouriDepartmentofHealthand
SeniorServices,diabetesmellitusisachronicdiseasethatoccurswhenthepancreasdoesnotproduce
insulinorwhenthebodycannotusetheinsulineffectively.Sinceinsulinhelpsregulatebloodsugar
levels,uncontrolleddiabetesresultsinelevatedbloodsugar,causingseriousdamagetomanybody
organs.Diabetescanbepreventedthroughreducingtheamountoffatinfoodsandeatingmorefiberrichfoods,increasingphysicalactivity,keepingyourbodyweightnormal(BMIbetween15.5and24.9)
andbyfollowingyourdoctor’sindicationsonmedicationusageifnecessary.Havingscreeningsthrough
aninexpensivebloodtestanddetectingdiabetes(orpre-diabetes)earlyallowstheretobetimeto
preventanyfurthercomplications.Itisimportanttomanageanddelayeffectsofdiabetes.
AccordingtotheCountyHealthRankings,in2015,12%ofCapeGirardeauCountyresidentswere
diagnosedwithdiabetescomparedto11%ofMissouri’sresidents.
50|P a g e Chapter5:HealthMeasures
ChildandAdolescentHealth
CausesofDeath–Children
Table13:CausesofDeathinChildrenAges1-14,2002-2012
CapeGirardeauCountyRate
Allcauses
21.7
8.7*
MotorVehicleDeaths
5.8*
5.1*
BirthDefects
0.7*
Homicide
0.7*
HeartDisease
0.0*
Source:MissouriDepartmentofHealthandSeniorServices,ChildHealth
*Fewerthan20eventsinnumerator,rateisunstable
MissouriRate
21.2
7.6
3.6
2.2
1.7
2.0
0.9
CausesofDeath–Adolescents
Table14:CausesofDeathinAdolescentsAges15-19,2002-2012
CapeGirardeauCountyRate
Allcauses
45.5
21.2*
MotorVehicleDeaths
15.2*
Homicide
3.0*
Suicide
7.6*
4.6*
HeartDisease
0.0*
Source:MissouriDepartmentofHealthandSeniorServices,ChildHealth
*Fewerthan20eventsinnumerator;rateisunstable
MissouriRate
73.5
38.6
30.0
12.3
8.50
2.90
1.70
TeenSubstanceAbuseandSmoking
The2015StatusReportonMissouri’sSubstanceUseandMentalHealthcompletesaMissouriStudent
Surveythrough12thgrade.InCapeGirardeauCounty:
• 55.3%ofyouthbelieveditwaseasytoobtainalcoholand53.6%hadfriendswhodrankalcohol
inthepast12months.
• 50.7%ofyouthbelieveditwaseasytoobtaincigarettesand41.0%hadfriendswhosmokedin
thelast12months.
• 22.7%ofyouthbelieveditwaseasytoobtainmarijuanaand18.5%hadfriendswhoused
marijuanainthelast12months.
• 11.5%ofyouthbelieveditwaseasytoobtainotherillicitdrugsincludingcocaine,LSD,
methamphetamine,clubdrug,etc.and6.5%whohadfriendsusethesetypesofdrugsinthelast
12months.
51|P a g e ThetablebelowshowstheuseofsubstancesinCapeGirardeauCountyandMissouribystudentsinthe
last30daysfromtheMissouriStudentSurvey.Therateofcigaretteuseincreasedfrom12.2in2012to
15.2in2014.Therateofchewingtobaccousegreatlyincreasedfrom5.6in2012to13.1in2014.The
rateofprescriptionmedicationsnotprescribedforthestudentrosefrom2.7in2012to4.8in2014.
Alcoholusedeclinedfrom15.0to14.0andmarijuanausedeclinedfrom4.8to2.4from2012to2014.
Table15:PercentofStudentswhousedSubstancesinthePast30Days–CapeGirardeauCounty&Missouri
Substance
Alcohol
Alcohol,Binge(5+drinksinone
occasion)
Cigarettes
ChewingTobacco
Marijuana
Inhalants
PrescriptionMedicationsnot
prescribedforthestudent
Over-the-countermedications
fornon-medicaluse
CapeGirardeauCounty
14.0
Missouri
13.9
8.0(2012data)
9.7(2012data)
15.2
13.1
2.4
1.8
8.1
5.0
7.6
1.1
4.8
3.7
2.4
1.6
Source:2015StatusReportonMissouri’sSubstanceUseandMentalHealth,MissouriStudentSurvey
TeenPregnancy
Teenpregnancycanbeassociatedwithpoorprenatalcareandpretermdelivery.Pregnantteensare
morelikelythanolderwomentoreceivelateornoprenatalcare,havegestationalhypertensionand
anemiaandachievepoormaternalweightgain.Theyarealsomorelikelytohaveapretermdeliveryand
lowbirthweightofthechild,whichincreasestheriskofchilddevelopmentaldelay,illnessandmortality.
AccordingtotheCentersforDiseaseControlandPrevention,teenpregnancyandbirthscause
considerablesocialandeconomiccoststhroughbothimmediateandlong-termimpactsontheteens
andtheirparents.TheCentersforDiseaseControlandPreventionlistedthefollowingimpactsteen
birthshaveoncostsandeducation:
• In2013,therewere273,105babiesborntowomenbetweentheagesof15and19accounting
forarateof26.5per1,000womenaged15to19.Althoughthiswasarecordlowrateforteen
births,itisstillhigh.In2010,teenpregnancyandbirthaccountedforover$9.4billionincosts
forU.S.taxpayers.Inadditiontocosts,just50%ofteenmothersreceivetheirhighschool
diplomabythetimetheyare22yearsofagecomparedwith90%onwomenwhodonotgive
birthintheirteenageyears.
• Pregnancyandbirtharesignificantcontributorstohighschooldropoutratesamonggirls.Only
about50%ofteenmothersreceiveahighschooldiplomaby22yearsofage,versus
approximately90%ofwomenwhohadnotgivenbirthduringadolescence.
• Thechildrenofteenagemothersaremorelikelytohavelowerschoolachievementanddropout
ofhighschool,havemorehealthproblems,beincarceratedatsometimeduringadolescence,
givebirthasateenagerandfaceunemploymentasayoungadult.
ThefollowinggraphshowsthenumberofbirthstoteenagersinCapeGirardeauCounty.Thenumberof
teenagebirthsremainedhighuntil2013,whenthenumberofteenagebirthsinCapeGirardeaudropped
tojust7.
52|P a g e Figure18:NumberofTeenBirthsinCapeGirardeauCounty,2009-2013
NumberofTeenageBirths(Ages15-19)in
CapeGirardeauCounty
94
87
100
80
7
2009
2010
2011
2012
2013
Source:AnnieE.CaseyFoundationKidsCountDataCenter,FamilyandCommunityTrust
SeniorHealth
MissouriSeniorReport
TheMissouriDepartmentofHealthandSeniorServicesandtheUniversityofMissouriOfficeofSocial
andEconomicDataAnalysis(OSEDA)generatedaMissouriSeniorReportin2013toinformstateand
localaudiencesaboutthecontributionsandneedsofseniorsinMissouri.Someofthefindingsfromthat
reportarefoundbelow:
CostBurdenedbyHousing
TheU.S.DepartmentofHousingandUrbanDevelopmentconsidersfamilieswhopaymorethan30
percentoftheirincomeforhousingas“costburdened”.Often,thesefamiliesmaystrugglepayingfor
necessitiessuchasfood,clothing,transportationandmedicalcare.Manyseniorsliveoffoffixed
incomes,makingthemsusceptibletobeingcostburdenedbyhousing.
InCapeGirardeauCounty,thepercentofseniorsthatarecostburdenedbyhousingwas27.1%in2011,
upfrom24.7%in2008.Thispercentislowerthanthestatepercentat29.4%
Transportation
Transportationneedsaremeasuredthroughwhetheraseniorcitizenhasavaliddriver’slicense,
obtainedthroughtheMissouriDepartmentofRevenue.Itisimportanttorememberthattheavailability
andaccesstopublictransitsystemsmayplayaroleaswell.
InCapeGirardeauCounty,87.9%ofseniorshadaMissouridriver’slicensein2011,upfrom82.9%in
2008.Thestatehad88.6%ofseniorswithadriver’slicensein2011.
Safety
Seniorsareatriskofbecomingvictimsofpropertyandviolentcrimes;theyarealsoatanincreasedrisk
ofsufferingfinancialexploitation,accidentsandabuseiftheyarephysicallyorpsychologically
vulnerable.
CapeGirardeauCountyhad29.7%ofseniorsthatfacedcrimeandabuseper1,000personsin2011.This
decreasedfrom37.6%in2008,butisabove27.4%forthestate.
53|P a g e HealthcareAccess
Havingreliableandconvenientaccesstoprimarycareincreasestheabilityofseniorstolive
independently.Dataregardingtheamountofprimarycarephysiciansper1,000seniorsarelimitedfor
recentyearsandwaslastreportedin2008.Backthen,CapeGirardeauCountyhadarateof13.9primary
carephysiciansper1,000seniors.Thisincreasedfrom9.1in2004andissimilartothestate’srateof
13.1.
QualityofLife
Qualityoflifeisimportantinhelpingseniorsbeproductiveandliveineconomicsecurity.TheMissouri
SeniorReportusedtheU.S.CensusBureau,OSEDAACSEstimatesandSocialServicestocollectdatato
determineseniorqualityoflife.Thetablebelowidentifiesseveralquality-of-lifefactors.
Whencomparedtothestate,therewasaslightlylowerpercentageofseniorslivinginpovertyinCape
GirardeauCounty.Thestatehad8.2%ofseniorsinpovertywiththeaverageincomeofsenior
householdsbeing$46,767.CapeGirardeauCountyhad8.1%oftheirseniorsinpovertywiththeaverage
incomeofseniorhouseholdsbeing$44,799.Inaddition,17.2%ofseniorsinthecountyhadacollege
education,whereas18.2%ofseniorsinMissourihadacollegeeducation.
Table16:QualityofLife
QualityofLife
SeniorOwner-OccupiedHousing,2011
SeniorsLivinginFamilies,2011
MedianValueofAllOwnedHousing,2011
SeniorsinPoverty,2011
PercentAge60+ReceivingSNAP,2011
AverageIncomeofSeniorHouseholds,2011
SeniorswithaCollegeEducation,2011
Measure
77.3%
67.6%
$135,800
8.1%
4.1%
$44,799
17.2%
Source:MissouriSeniorReport,2013
HealthandWellness
TheMissouriSeniorReportlooksatsevenindicatorsforlong-termhealthandwellnessthatcanbe
influencedbypreventivepracticesandpublichealthinterventions.Thetablebelowshowstheseven
indicatorsforhealthandwellness.
Table17:HealthandWellness
HealthandWellness
NoExercise,2011
NoSigmoidoscopyorColonoscopy,2011
HighBloodPressure,2011
Obesity,2011
Smoking,2011
NoMammography,2011
HighCholesterol,2011
Measure
27.9%
31.8%
67.5%
30.7%
8.5%
60.6%
52.8%
Source:MissouriSeniorReport,2013
54|P a g e Chapter6:PrimaryResearch
FocusGroups
Methodology
AfocusgroupforCapeGirardeauCountywasheldonFebruary11,2016,atCrossTrailsMedicalCenter
inCapeGirardeau,Missouri.Elevenparticipantswerepresentfromvariousorganizationsthroughout
CapeGirardeauCounty.
ThefocusgroupprocessbeganwiththeCommunityHealthNeedsAssessmentTeamand/orsome
communitymemberscompilingalistofpotentialparticipantsandtheninvitingthoseparticipantstothe
focusgroupviaemail,letter,phonecallorinperson.Theeventtookapproximatelyanhourandwas
heldoverlunch.MembersoftheCommunityHealthNeedsAssessmentTeamhostedtheevent,with
onememberservingasmoderatorandanothermemberastheprimarynote-taker/recorderofthe
entireevent.
Materialsthatwereprovidedtothegroupincludedaparticipantconsentform,aparticipant
informationform,achecklistexerciseandalistoftentativequestionsasked.Theparticipant
informationformaskedforeachparticipant’sname,company/organization,jobtitle,credentials,
education,affiliationsandexperience.Notallformswerefilledoutcompletely,butsomeofthe
informationcollectedcanbefoundinAppendixC.Thechecklistexerciseaskedtheparticipantsto
choosetheirtopfiveconcernsfromalisttheCommunityHealthNeedsAssessmentTeamcreated;the
resultsofthatexerciseareprovidedintheChecklistExercisesectionfollowingthequestionsummaries
ahead.
Thetentativequestionsaskedbythemoderatorarelistedbelow.Promptswerealsousedtogetmore
detailedanswersfromthegroupsandtohelpthegroupalongiftheywerenotprovidingmuch
information.Themoderatordidhisorherbesttoaskallquestionsandtostayontrackwiththetopics,
butinsomecasesthegroupwanderedofftrackandnotallquestionswereansweredcompletely.
1. Whatdopeopleinthiscommunitydotostayhealthy?Howdopeoplegetinformationabout
health?
6. Ofalltheissueswehavetalkedabouttoday,whatissuesdoyouthinkarethemostimportant
foryourcommunitytoaddress?
Thetentativequestionswereusedasaguideline,butwerenotfollowedstrictly.Questionswereasked
basedonthediscussionofthefocusgroup.Thefollowingquestionsarethequestionsthatwereactually
askedandasummaryofalltheresponsestothosequestions:
Question1:Whatdoyouthinkofasyourcommunity?
Almostalltheparticipantsinthefocusgroupagreedthatthecommunityisoftenthoughtofasa
geographicregionandcanbehardtocapturewhoexactlyispartofthecommunity,although
governmentagenciesdooutlinethecommunity.AlargepartoftheCapeGirardeauCountycommunity
alsodeliberatedthecommunitytobethesupportofmanyfaithbasedgroupsandchurches.However,
55|P a g e whilethesegroupssupportandassistthecommunity,greatportionsofpeopleareunawareofthis
supportanddonotutilizethesupport.Itwasalsoagreedthatwithinthecommunity,therearegapsin
servicefromthelowereconomicpopulationsthroughthehighereconomicpopulations-anareaof
considerationwhenlookingathealthneeds.
Question2:Whatdopeopledointhecommunitytostayhealthy?
Likemostareas,CapeGirardeauCountyhassomepeoplewhoexerciseandeathealthy.Thereisalarge
populationofrunnersandcyclists.However,thereisalsothegapwherepeoplearesedentaryandeat
verypoorly.Someofthepoornutritioncomesfromaffordability.Thehealthyfoodisalwaysmuchmore
expensivethantheunhealthyfoodsuchasthatfoundatfastfoodchains.Therefore,nourishmentis
lackinginmanypopulations,especiallytheunderprivileged.Thisalsorelatestothehealthcareofthe
community.Manypeoplefocusontheirday-to-daycare,accordingtoparticipantsinthefocusgroup.
Peopletendtotakecareoftheirhealthandwellnessbasedonwhatisimportantonthatspecificday,
withoutplanningforthefuture.Theywaituntilahealthneedisanabsolutenecessityandthentake
careofit.InCapeGirardeauCounty,thefocusgroupparticipantsemphasizedhowtheunder-privileged
andpoverty-strickenpopulationstendtostrugglemaintainingalifestyletostayhealthy.
Question3:Wheredopeoplegotogethealthinformationfrom?
Manyparticipantsstatedthatpeopleusuallyobtainhealthinformationfromtheirfamilyandfriends,
neighbors,anorganization’soutreachefforts,theInternetandphysiciansandprovidersinpractice.
Morespecificallydiscussedwashowthisinformationwashelpful.Mostpeoplewhoreceivehealth
informationtendtoliveinagrouphousingstructure,asneighborhoodrelationshipshavedeclinedin
recentyearsitseems.Theyalsoquestionwheretheinformationtheirneighborsgivethemiscoming
from;howaccurateisthisinformation?Peopleinthecommunityseemtobelievewhatistoldthemno
matterwhereitcomesfrom.Inthatdiscussion,theInternetwasimmediatelybroughtup.Somany
peopleusetheInternettogetinformationanditcanbeagreatsource.However,peoplemisuseit.The
statement,“IftheInternetsaysit,ithastoberight”seemedfitting.PeoplewillusetheInternetto
eitherfalselygetinformationattimesortodiagnosethemselves,oftenincorrectlybasedonwhatthe
Internetsays.ProperuseoftheInternetforhealthinformationisnotalwaysthecasewithinthe
community.
Question4:Whatdoyoufeelabouthowthechecklistexerciseprioritizedthehealthissues?
Themostcommonlymarkedhealthissuewashealthaffordability.Participantsreflectedonthisby
statingthatthecostsandpaymentsofhealthcarearesetupforthosewithinsurance;thereisan
inflatedrateforpeoplewithoutinsurancewhichcausesmanyoftheaffordabilityissues.TheHealth
InsuranceExchangewasalsodebated.Inconclusion,itwasdecidedthattheHealthInsuranceExchanges
issimplytooexpensive,witharetiredcouplepotentiallypaying$800,andmanybasichealthcareneeds
suchasdentalcare,mentalcareandmedicationsnotbeingcovered.
Thesecondmostcommonlymarkedhealthissuewasoverweightadults.Thetiebetweenobesityand
povertycameupduringthispartofthediscussion.Thosewhoareinpovertycannotaffordtospend
moneyonfood.Insteadofbuyinghealthyfoodforahigherprice,theybuycheapfood,whichcanoften
beunhealthy.Ontopofthehealthyfoodissueisthefactthatthoseinpovertyareunabletoaffordgym
membershipstoincreasetheirphysicalhealth.Whilesomeofthoseinpovertystruggletomaintaina
healthylifestyle,someoftheworkingpopulationalsostrugglewithobesityduetounhealthylifestyles.
Peoplelifefastlives,meaningtheymayskipoutonexerciseandusedrive-throughfastfoodchains
whiletheyareconsistentlyontimeconstraints.Obesityingeneralwasanissuebecauseofitshigh
prevalenceinthecommunityandtheotherhealthconcernsthatcomewithit.
56|P a g e Thethirdcommonlymarkedhealthissuediscussedwasmentalillness.Participantsmentionedthat
mentalillnessisexceedinglygrowingfromchildrentoadultpopulationsandhasmanyotherissuesthat
stemfromitincludingdruguseandabuse,employmentlossanddown-streamingintoseveralotherlife
factors.Whilementalillnessisserious,itmaintainsastigmathatleadspeopleintodenialuntilthe
illnessisfartoosevere.Thisalsopushesmentalillnessonthebackburnerbehindotherhealthneeds,
especiallyforthosewhodonothaveinsuranceandhavetodecidewhathealthcaretospendtheir
moneyon.Additionally,mentalillnessisprevalentinyoungerpopulations,butschoolresourcesforthis
arelacking.Parentsandeducatorsmaybeunawareorsimplydonotwanttodealwithit.Educatorsface
severallegalitiestogothroughiftheymakenoteofamentalillness,whichiswhymanymaybe
overlookingsignsinchildren.Thisinturnleadstomentalillnessesincreasingtheirprevalenceinthe
community.
Thefourthcommonlymarkedhealthissuediscussedwassexuallytransmittedinfections.Thisissuewas
asurprisetomany.However,itwasnotedthatCrossTrailsMedicalCenterseesahighamountof
patientswithsexuallytransmittedinfections,bothintheteenagepopulationsandadultagesaround30
to40years.Manybelievedmostsexuallytransmittedinfections,likeHPV,wererelatedtopoverty.
Thelastcommonlymarkedhealthissuediscussedwastransportation.Participantswidelydebated
factorsoftheCapeTransitSystem.Threefactorswerebroughtup:atime,costandintimidationfactor.
Thetransitsystemtakestime.Whileusingit,youmayneedtositthroughtheentireroutetogettoyour
destinationsoyoumustbeawareofthisandplanyourtimeaccordinglytoarriveatappointmentsand
destinationsontime.Outdoorsheltersarealsolackingforthestops,sopeoplemustbewillingto
sustainpoorweather.Italsocostsmoney,butitwasnotedthatMedicaidwillpayfortransportation.
ThosewantingMedicaidtopaymustcallthenumbermorethanfivedaysinadvance,whichis
sometimeschallengingasitwasnotedthatmostpeopleliveday-to-daywiththeirhealthcareneedsand
appointments.Finally,participantsbroughtupthefactthatpeoplemaysimplybeintimidatedofthe
transitsystembecausetheyareunawareofhowtouseit.
Question5:Whatarethetopissuesyoufeelneedtobeaddressedinthecommunity?
Astimewasrunningout,participantsmentionedissuesthatshouldbeaddressedwithinthecommunity.
Someofthosementionedincludedpreventivecareandeducation,especiallyonMedicaiduse;changing
themindsetofthecommunitytomakehealthapriority;connectingpeopletotheplentifulhealth
resourcesinthecommunity;andaddressinghealthcareaffordability.
OtherNotes:
Throughoutthefocusgroupdiscussion,someothernoteswerementioned.First,theCatholicService
Ministryannouncedtheyareworkingonreceivingandbuildinganew,biggerbuildingandworkingto
alternatedaysbetweentheirfoodbankandtheadditionofclinicswithintheneighborhoods.Dental
healthwasalsoanissuebroughtupbecausethereseemstobeapatternofcaringforchildrenwiththe
samecavitiestimeaftertime,withnotreatmentsprovidedtothem.Finally,emergencyroomusewas
noted.PeopleinthecommunityusetheEmergencyRoominsteadofhealthcenters,suchasCrossTrails
MedicalCenter,becausetheyknowtheywillbeserved,whereastheymayneedtopayelsewhere.
Overall,thefocusgroupdecidedthattherewasaneedtoconnectpeopletohealthresourcesthrough
educationandmakinghealthcaremoreaffordabletothecommunity.
57|P a g e ChecklistExercise
ThetablebelowsummarizestheChecklistExercisethatwashandedoutinthefocusgroupheldinCape
GirardeauCounty.Theconcernsarerankedfromthehighestconcerntothelowest.
Table18:CapeGirardeauCountyChecklistExercise
Issue
1.HealthAffordability
2.OverweightAdults
3.HealthAvailability
3.MentalIllness
3.AlcoholandDrugUse
4.STI's
5.Smoking
5.Transportation
5.ChildAbuse
5.Cancer
Occurrence
8
5
4
4
4
3
2
2
2
2
Surveys
SurveyLayoutandDesign
TheCommunityHealthNeedsAssessmentSurveywasaquestionnaire-style,self-administeredsurvey,
availableonlytovoluntaryparticipantsatcertainlocations.SurveyMonkeywasusedtoadministerthe
surveys;howevermostparticipantschosetotakethesurveyonpaper.
Thesurveywasdesignedtocollectdataonhealthbeliefs,healthbehaviors,accesstoandutilizationof
healthcareservicesandconcernsaboutcommunityhealthissues.Thesurveyconsistsoffourdifferent
sections:
1. Demographics
2. SocialandEconomicFactors
3. HealthBehaviors
4. MedicalCareandServices
Methodology
Atotalof42surveyswerecompletedbyCapeGirardeauCountyresidents,withafewsurveyshaving
someunansweredquestions.SurveyMonkeyanalysistakesintoconsiderationthenumberofactual
responsesforeachquestion.Thesurveysamplewasnotarandomsample,butmoreofatargeted
sampletoensurethatcertainpopulationsweresurveyed.Also,someofthequestionsaskedinthe
surveyhadanoptionofchoosingmultipleanswers,whichmeansthatnotallofthequestionshave
answersthataremutually-exclusive,sosomeofthetotalpercentageswillnotaddupto100percent.
Theprocessforconductingthesesurveysinvolvedtravelingtothecounty’shealthcarefacilitiesand
communitybusinessesandaskingparticipantsface-to-facetocompletethesurveyorallowingthe
facilitytohandoutsurveysontheirownbasis.
58|P a g e Participants
KeyCharacteristics
• 73.8%arefemale,26.2%aremale
• 66.7%aremarried
• 78.6%arewhite/Caucasian
• 61.9%have3to5peoplelivingintheirhousehold
• 33.3%haveahighschooldiploma,butnosecondarydegree
• 33.3%haveatwo-yearorfour-yearcollegedegree
• 57.1%areemployedfull-time
• 23.8%haveanannualincomebetween$25,000and$49,999
Demographics
ThetablesbelowshowcertaindemographiccharacteristicsofthesurveyparticipantsinCapeGirardeau
County,includingthesurveyrespondents’gender,maritalstatus,age,educationlevel,race/ethnicity,
employmentstatusandlifestylehealthfactors.
Table19:Gender
Gender?
Answer Options
Male
Female
Response Percent
34.2%
65.8%
answered question
skipped question
Response Count
13
25
38
0
Table20:MaritalStatus
Marital Status?
Answer Options
Single/Not Married
Married
Divorced
Widowed
Living with Partner
Other
Response Percent
39.5%
36.8%
13.2%
2.6%
5.3%
2.6%
answered question
skipped question
Response Count
15
14
5
1
2
1
38
0
Table21:Race/Ethnicity
What is your race/ethnicity?
Answer Options
Response Percent
Asian or Pacific Islander
0.0%
Black or African-American
21.6%
Hispanic or Latino
2.7%
Native American
2.7%
White or Caucasian
67.6%
Other
5.4%
answered question
skipped question
Response Count
0
8
1
1
25
2
37
1
59|P a g e Table22:Race/EthnicityofChildreninHome
What is the race/ethnicity of any children currently living in your home?
Answer Options
Response Percent Response Count
Asian or Pacific Islander
0.0%
0
Black or African-American
16.7%
6
Hispanic or Latino
0.0%
0
Native American
0.0%
0
White or Caucasian
41.7%
15
Other
0.0%
0
I have no children living in my home currently
41.7%
15
answered question
36
skipped question
2
Table23:Howmanypeoplecurrentlyliveinyourhousehold?
How many people currently live in your household?
Answer Options Response Percent Response Count
1-2
47.4%
18
3-5
36.8%
14
6 or more
15.8%
6
answered question
38
skipped question
0
Table24:Howmanyadultsage65oroldercurrentlyliveinyourhousehold?
How many adults age 65 or older currently live in your household?
Answer Options
Response Percent
Response Count
0
77.1%
27
1-2
20.0%
7
3-5
2.9%
1
6 or more
0.0%
0
answered question
35
skipped question
3
Table25:Howmanychildrenunder18yearsofagecurrentlyliveinyourhousehold?
How many children under 18 years of age currently live in your household?
Answer Options
Response Percent
Response Count
0-1
69.4%
25
2-3
19.4%
7
3-5
8.3%
3
6 or more
2.8%
1
answered question
36
skipped question
2
60|P a g e Table26:HealthandLifestyleFactors
Select all of the following that describe your home or household:
Answer Options
Response
Percent
More than one working smoke detector
100.0%
Carbon monoxide detector
51.4%
Food is put back into the refrigerator within two hours after a
86.5%
meal
Septic Tank
40.5%
Pets (dog, cat, reptiles, etc.)
48.6%
Family fire safety plan/evacuation plan
37.8%
Children know how to dial 911 in case of emergency
35.1%
Children know their phone number and address
32.4%
Have one or more types of aerobic (cardiovascular) exercise
27.0%
equipment
Internet access
86.5%
Provide care for an older adult
10.8%
Children under 13 are supervised in non-school hours
27.0%
answered question
skipped question
Response
Count
37
19
32
15
18
14
13
12
10
32
4
10
37
1
SocialandEconomicFactors
ThetablesbelowshowcertainsocialandeconomicfactorsinCapeGirardeauCounty,includingthe
surveyrespondents’educationlevel,employmentstatusandannualhouseholdincome.
Table27:EducationLevel
What is your highest level of education?
Answer Options
Response Percent
Never graduated high school
5.4%
High school diploma
27.0%
GED
0.0%
Currently attending or have some college
29.7%
Two-year college degree
16.2%
Four-year college degree
13.5%
Graduate-level degree or higher
8.1%
answered question
skipped question
Response Count
2
10
0
11
6
5
3
37
1
Table28:EmploymentStatus
What is your employment status? (check all that apply)
Answer Options
Employed full-time
44.7%
17
Employed part-time
21.1%
8
Full-time student
10.5%
4
Part-time student
0.0%
0
Full-time homemaker
0.0%
0
Retired
15.8%
6
Unemployed more than one year
5.3%
2
Unemployed less than one year
2.6%
1
Unemployed due to disability or illness
10.5%
4
answered question
38
skipped question
0
61|P a g e 2016CommunityHealthNeedsAssessment
62|P a g e Table29:AnnualHouseholdIncome
What is your annual household income?
Answer Options Response Percent Response Count
Less than $5,000
13.9%
5
$5,000-$14,999
5.6%
2
$15,000-$24,999
16.7%
6
$25,000-$49,999
19.4%
7
$50,000-$74,999
19.4%
7
$75,000-$99,999
11.1%
4
$100,000 or higher
8.3%
3
Does not apply
5.6%
2
answered question
36
skipped question
2
Table30:HealthInformationSources
What sources do you use to obtain most of your health-related information? (check all
that apply)
Answer Options
Response Percent
Response Count
Family
39.5%
15
Friends
34.2%
13
Doctor/Nurse/Pharmacist
81.6%
31
Newspaper/Magazines/Television
5.3%
2
Health Department
2.6%
1
Church
7.9%
3
School
2.6%
1
Internet
42.1%
16
Other
2.6%
1
answered question
38
skipped question
0
HealthBehaviors
ThetablesbelowshowinformationregardingthehealthbehaviorsofadultsandtheirchildreninCape
GirardeauCounty.
Table31:AdultHealthBehaviors
In the following section, respond with how often YOU do the following (N/A = does not
apply to you):
Answer Options
Almost Sometimes Never Response
Always
Count
Exercise at a moderate pace at least 30 minutes per
21
10
7
38
day, 5 days per week
Consume more than 3 alcoholic beverages per day
2
12
24
38
(female) or more than 5 per day (male)
Smoke cigarettes
7
5
25
37
Are exposed to secondhand smoke at home or at the
7
11
21
38
workplace
Chew tobacco
0
1
36
37
Use illegal drugs (marijuana, cocaine,
2
2
32
36
methamphetamine, etc.)
Get a flu shot each year
22
12
4
37
Practice safe sex (use of condom or other barrier
20
4
9
33
method)
Get enough sleep every night (7-9 hours)
11
23
5
38
answered question
38
skipped question
0
63|P a g e •
•
MostsurveyrespondentsinCapeGirardeauCountyreportedthattheyalwaysexercisethe
recommendedamountand18%reportedthattheyneverexercisetherecommendedamount.
Closeto67%reportedthattheyneversmoke,withmostreportingtheyarenotexposedto
secondhandsmokeathomeorattheworkplaceeither.
Table32:ChildHealthBehaviors
In the following section, how often do any children CURRENTLY living in your home do
the following?*(N/A = does not apply to them)
Answer Options
Almost
Sometimes
Never N/A*
Response
Always
Count
Participate in at least 1 hour of
8
7
2
21
38
physical activity every day
Are exposed to secondhand smoke
4
3
10
20
37
in the home
Get a flu shot each year
8
6
0
23
37
Practice safe sex (condom or other
4
1
2
30
37
barrier methods)
Get enough sleep each night (7-9
9
6
1
21
37
hours)
answered question
38
skipped question
0
•
Respondentsofthesurveyreportedthatmostoftheirchildrenalmostalwaysgetonehourof
physicalactivityeveryday,arenotexposedtosecondhandsmokeinthehome,getaflushot
annuallyandgetenoughsleepeverynight.
MedicalCareandServices
ThetablesbelowshowinformationregardingthemedicalcareandservicesreceivedinCapeGirardeau
County,includingthesurveyrespondents’insurancetype,insurancecoverage,doctor’svisits,accessto
careandhealthproblemswithinthecommunity.
Table33:Insurance
What kinds of insurance do you (and/or your family) have currently? (check all that apply)
Answer Options
Response Percent
Response Count
Health
97.3%
36
Dental
78.4%
29
Vision
67.6%
25
Do not have insurance
2.7%
1
answered question
37
skipped question
1
•
Themajorityofsurveyrespondentshadhealth,dentalandvisioninsurance.
64|P a g e Table34:HealthInsuranceType
What type of health insurance do you (and/or your family) have currently?
Answer Options
Response Percent
Response Count
Self-insured
0.0%
0
Employer-provided
62.2%
23
Medicare
13.5%
5
Medicaid or MC+
10.8%
4
VA/CHAMPUS
0.0%
0
Other ___________________
8.1%
3
Do not know
2.7%
1
Do not have health insurance
2.7%
1
answered question
37
skipped question
1
•
•
Themajorityhademployer-providedinsurance,with13.5%havingMedicareand10.8%having
MedicaidorMC+.
Another5.4%reportednothavinghealthinsuranceornotknowingwhattypeofinsurancethey
had.Thisisskewedfromthepreviousquestionduetohumanerrorwhiletakingthesurveyor
differencesincoveragefordifferentfamilymembers.
Table35:InsuranceCoverage
If anyone living in your household does not have insurance, who is NOT currently
covered?
Answer Options
Response Percent
Response Count
Entire family
5.7%
2
At least one adult
11.4%
4
All adults
5.7%
2
Child(ren) age 6 or older
0.0%
0
Child(ren) younger than age 6
0.0%
0
Does not apply
77.1%
27
answered question
35
skipped question
3
•
•
Therewere11.4%thatsaidatleastoneadultintheirfamilywasnotcoveredandanother5.7%
thatsaidnoadultswerecoveredbyinsurance.
5.4%ofrespondentsalsoreportedthattheentirefamilyhadnoinsurance.
Table36:HealthStatus
What is your current health status?
Answer Options Response Percent
Poor
5.3%
Fair
18.4%
Good
42.1%
Very Good
21.1%
Excellent
13.2%
answered question
skipped question
Response Count
2
7
16
8
5
38
0
•
76.4%reportedthattheirhealthwasgood,verygoodorexcellent.
65|P a g e Table37:RoutineDoctor'sVisit
When was your last routine doctor's visit?
Answer Options
Response Percent
Within the last 12 months
83.8%
Within the last 13-18 months
2.7%
Within the last 19-24 months
0.0%
Between 2 and 5 years
8.1%
Over 5 years ago
2.7%
Never had a routine visit
2.7%
answered question
skipped question
•
Response Count
31
1
0
3
1
1
37
1
Mostrespondentshadaroutinedoctor’svisitwithinthelastyear.However,2.7%reported
neverhavingaroutinedoctor’svisit.
Table38:Howmanydayshaveyoubeentoosicktoworkorcarryoutyourusualactivitiesduringthepast30days?
How many days have you been too sick to work or carry out you r usual activities during
the past 30 days?
Answer Options
Response Percent
Response Count
None
63.2%
24
1-2 days
26.3%
10
3-5 days
5.3%
2
6-10 days
0.0%
0
More than 10 days
5.3%
2
answered question
38
skipped question
0
•
Mostrespondentsstatedthattheyhavenotmissedanydaysofworkorusualdailyactivitiesin
thelastmonth.Themajorityofpeoplewhodidmissworkmissedjust1-2days.
Table39:Haveyoueverhadhealthissuesduetoanyofthefollowing?
Have you ever had health issues due to any of the following? (check all that apply)
Answer Options
Response Percent
Response Count
Alcohol abuse
2.6%
1
Lack of pregnancy care
0.0%
0
Stress
31.6%
12
Drug abuse/addiction
5.3%
2
None of the above
68.4%
26
answered question
38
skipped question
0
•
Respondentsprimarilyhadhealthissuesduetostressintheirlives.
Table40:Ifeverpregnant,didyoureceiveprenatalcare?
If ever pregnant, did you receive prenatal care?
Answer
Response
Response
Options
Percent
Count
Yes
35.1%
13
No
2.7%
1
Not sure
0.0%
0
Does not apply
62.2%
23
answered question
37
skipped question
1
66|P a g e Table41:WheredoyougoforRoutineHealthcare?
Where do you go for routine healthcare? (check all that apply)
Answer Options
Physician's Office
86.5%
32
Hospital Emergency Room
13.5%
5
Health Department Clinic
8.1%
3
Urgent Care Center
16.2%
6
Chiropractor
0.0%
0
Community Clinic
5.4%
2
Eye Doctor
35.1%
13
Dentist
35.1%
13
Other
2.7%
1
Do not seek healthcare
2.7%
1
answered question
37
skipped question
1
Table42:Howoftenareyouabletovisitadoctorwhennecessary?
How often are you able to visit a doctor when necessary?
Answer Options
Response Percent
Response Count
Always
81.1%
30
Sometimes
13.5%
5
Seldom
5.4%
2
Never
0.0%
0
answered question
37
skipped question
1
Table43:Ifyouansweredseldomornevertothepreviousquestion,pleasechoosewhyyouwerenotalwaysabletovisita
doctorwhennecessary:
If you answered seldom or never to the previous question, please choose why you were
not always able to visit a doctor when necessary:
Answer Options
Response Percent
Response Count
No insurance
33.3%
2
Too expensive/unaffordable
16.7%
1
Could not get an appointment
0.0%
0
Lack of transportation
0.0%
0
Doctor is too far away/inconvenient location
0.0%
0
Other
50.0%
3
answered question
6
skipped question
32
•
Peoplewhowereabletovisitadoctorwhennecessaryweretoldtoskipthequestionfrom
Table43.Ofthepeoplewhoresponded,havingnoinsuranceanditbeingtooexpensivewere
theconcerns.
67|P a g e Table44:Whatarethetopthreechallengesforyouandyourhouseholdwhenreceivinghealthcare?
What are the top three challenges for you and your household when receiving
healthcare?
Answer Options
Response Percent
Response Count
Top Challenge
100.0%
20
Second Challenge
80.0%
16
Third Challenge
60.0%
12
answered question
skipped question
20
18
•
Manypeoplechosenottoanswerthisquestion.However,ofthosewhoresponded,thetop
challengesforreceivinghealthcareincluded:
o Cost/Affordability
o Time/Scheduling
o InsuranceCoverage
o CommunicationwithDoctors
o Transportation
o Convenience
Table45:Selectanyofthefollowingpreventativemeasuresyouhavehadinthelastyear.
Select any of the following preventative measures you have had in the last year (check
all that apply):
Answer Options
Response Percent
Response Count
Mammogram
19.4%
7
Pap smear
25.0%
9
Glaucoma test
5.6%
2
Flu shot
66.7%
24
Colon/rectal examination
16.7%
6
Blood pressure check
69.4%
25
Skin cancer reading
8.3%
3
Prostate cancer digital screen
11.1%
4
Prostate cancer PSA blood screen
11.1%
4
Cholesterol screen
47.2%
17
STD (Sexually Transmitted Disease) screening
13.9%
5
Vision screening
41.7%
15
Hearing screening
16.7%
6
Cardiovascular screening
11.1%
4
Bone density test
0.0%
0
Dental exam
52.8%
19
Diabetes
19.4%
7
answered question
36
skipped question
2
•
Inthisquestion,respondentsrecountedpreventivescreeningsandteststheyhavehaddonein
thelastyear.Notableresultsincludethatjust19.4%receivedmammograms,66.7%receiveda
flushot,69.4%receivedabloodpressurecheck,8.3%receivedaskincancerreading,47.2%
receivedacholesterolscreen,52.8%receivedadentalexamand19.4%receivedadiabetes
screening.
68|P a g e Table46:Arebothyouandanychildrenlivinginyourhouseholdup-to-dateonyourimmunizations?
Are both you and any children living in your household up -to-date on your
immunizations?
Answer Options
Response Percent
Response Count
Yes
88.6%
31
No
0.0%
0
I am up-to-date, but my children are not
0.0%
0
I am not up-to-date, but my children are
5.7%
2
Do not know
5.7%
2
answered question
35
skipped question
3
•
•
•
Mostrespondentsreportedthatboththeyandtheirchildrenwereup-to-dateon
immunizations.
5.7%respondedthattheirchildrenwereup-to-datebuttheywerenotnot.
Another5.7%werenotsureiftheyortheirchildrenwereup-to-dateontheirimmunizations.
Table47:Wheredothechildrencurrentlylivinginyourhomegoforroutinehealthcare?
Where do the children currently living in your home go for routine healthcare? (check all
that apply)
Answer Options
Response Percent
Response Count
Physician's Office
38.9%
14
Hospital Emergency Room
0.0%
0
Health Department Clinic
0.0%
0
Urgent Care
2.8%
1
Chiropractor
0.0%
0
Community Clinic
8.3%
3
Eye Doctor
5.6%
2
Dentist
5.6%
2
Other
0.0%
0
Does not apply
55.6%
20
answered question
36
skipped question
2
•
Mostpeoplereportedthattheirchildrengotothephysician’sofficeandcommunityclinics.
Table48:HealthProblems/DiseaseDiagnoses
Have you been diagnosed by a doctor with any of the following health problems or
diseases? If you have NOT been diagnosed by a doctor with any of these health
problems or diseases, please check the "No" box. If you have, please check any boxes
that apply to your health problem or disease.
Answer
No
Yes, but I am not
Yes, I
Yes, I am
Yes, I
Response
Options
taking any additional
see a
taking
feel the
Count
precautions or
doctor. medications
disease
treatments regarding
or getting
is
it.
treatment.
managed
well.
Diabetes
34
0
2
3
0
38
Stroke
36
2
0
0
0
38
Heart Disease
34
3
0
0
0
37
High Blood
25
2
5
8
1
38
Pressure
Coronary Heart
35
3
0
0
0
38
69|P a g e Failure
High Cholesterol
Cancer
Asthma
COPD (Chronic
Obstructive
Pulmonary
Disease)
Kidney Disease
Obesity
Liver Disease
Arthritis
Migraine
Headaches
Depression
Bipolar Disorder
Sleep Disorders
Hepatitis
Tuberculosis
Epilepsy/Seizure
Disorder
Lupus
Sickle Cell
Anemia
Glaucoma
Gonorrhea
HIV/AIDS
Dental Health
Problems
Hearing
Disorders
Eye/Vision
Problems
Sinus Problems
Memory Loss
33
37
34
35
1
0
1
2
0
1
3
1
3
0
1
1
1
0
0
0
38
38
38
38
36
29
38
32
35
2
6
0
1
0
0
1
0
1
1
0
0
0
2
1
0
0
0
2
2
38
36
38
37
38
26
37
32
37
38
38
1
0
1
1
0
0
6
1
3
0
0
0
7
0
0
0
0
0
3
0
0
0
0
0
38
38
36
38
38
38
37
38
0
0
1
0
0
0
0
0
38
38
37
38
36
33
0
0
2
0
1
0
0
5
0
0
0
0
0
0
0
0
38
38
38
38
34
1
2
1
0
38
24
0
5
2
7
38
29
34
3
1
2
1
3
3
0
0
answered question
skipped question
38
36
38
0
•
•
•
About34.2%reportedhavinghighbloodpressure.
31.6%reportedbeingdiagnosedwithdepression.
13%werediagnosedwithdentalhealthproblemsand24%diagnosedwitheye/visionproblems.
Table49:Ifyouhavebeendiagnosedbyadoctorwithcancer,pleaseprovidethetypeofcancer(s)?
If you have been diagnosed by a doctor with cancer, please provide the type of
cancer(s)? *Write N/A if you have not been diagnosed with cancer.
Answer Options
Response Count
35
answered question
skipped question
35
3
•
Therewerenocasesofcancerintherespondentsofthissurvey.
70|P a g e Table50:Ifyouhavebeendiagnosedbyadoctorwithcancerorareacancersurvivor,pleaserateyoursatisfactionwiththe
belowstatements.
If you have been diagnosed by a doctor with cancer or are a cancer survivor, please rate
your satisfaction with the below statements.*Select N/A if you have not been diagnosed
with or survived cancer.
Answer Options
Very
Dissatisfied Satisfied
Very
*N/A
Response
Dissatisfied
Satisfied
Count
Waiting time for
0
0
0
2
32
34
treatment
Communication with
0
0
1
1
32
34
doctors and
healthcare
professionals
Education on
0
0
2
0
32
34
diagnosis
Fair access to
0
0
1
1
32
34
health services
Insurance coverage
0
0
0
2
32
34
Waiting time for
0
0
1
1
32
34
treatment
Travel time/time off
0
0
1
1
32
34
work
answered question
34
skipped question
4
•
•
Thereweretworesponsestothisquestion,aspeoplemayhaveansweredbasedonafriend’sor
relative’scancerexperience.
Allresultsshowedtheywere“satisfied”or“verysatisfied.”
Table51:Howoftendoyoutraveloutsideofyourcountyformedicalcare?
How often do you travel outside of your county for medical care?
Answer Options
Response Percent
Response Count
Always
5.4%
2
Sometimes
13.5%
5
Seldom
2.7%
1
Never
78.4%
29
answered question
37
skipped question
1
•
•
Aboutthree-quartersoftherespondentsreportednevertravelingoutsideofthecountyfor
medicalcare.
Table52belowshowsthatofthepeoplewhodotraveloutsidethecountyforcare,mostpeople
travelformedicalanddoctorappointments,dentalappointmentsorthopedicappointmentsand
visionappointments.
71|P a g e Table52:Ifyoutraveloutsideofyourcountyformedicalcare,whatservicesdoyouseek?
If you travel outside of your county for medical care, what services do you seek? (check
all that apply)
Answer Options
Response Percent
Response Count
Medical/doctor appointments
16.2%
6
Outpatient treatment
2.7%
1
Hospitalization
5.4%
2
Dental appointments
10.8%
4
Laboratory or other tests
2.7%
1
Orthopedic appointments
8.1%
3
X-rays, MRIs, etc.
8.1%
3
Vision appointments
8.1%
3
Other
2.7%
1
Do not travel outside of the county for medical care
78.4%
29
answered question
37
skipped question
1
Table53:Ifyoutraveloutsideofyourcountyformedicalcare,why?
If you travel outside of your county for medical care, why? (check all that apply)
Answer Options
Services not available in my county
3.0%
1
Better quality elsewhere
15.2%
5
Recently moved to this county
3.0%
1
Local doctors are not covered by insurance
3.0%
1
Closer to work/home
9.1%
3
Too hard to get an appointment with a local doctor
0.0%
0
Do not travel outside of the county for medical care
78.8%
26
Less expensive healthcare services offered elsewhere
6.1%
2
answered question
33
skipped question
5
•
Majorreasonspeopletraveledoutsideofthecountyformedicalcarewerethatserviceswere
betterquality,closertowork/homeorlessexpensiveelsewhere.
Table54:CommunityHealthProblems
In this final section, please choose how much of a problem you think each item listed is
for the county where you live. Do you think it is a serious problem, a moderate problem,
not a problem at all or are you not sure about this issue in your county?
Answer Options
Serious
Moderate
Not a
Not
Response
Problem
Problem
Problem
Sure
Count
Ability to Afford Prescribed
14
11
7
4
36
Medications
Affordable Healthcare
14
9
8
5
36
Available Healthcare
4
8
17
4
33
Alcohol/Drug Use
15
9
7
5
36
Allergies
11
8
8
9
36
Ambulance Services
1
4
20
11
36
Asthma/Respiratory
4
5
10
17
36
Disorders
Eating Disorders
5
7
8
16
36
Cancer
16
11
4
5
36
Emergency Preparedness
5
3
14
14
36
Fire Protection
1
3
19
12
35
72|P a g e Firearms
Fitness Levels
Healthcare Quality
Heart Disease
High Blood
Pressure/Strokes
HIV/AIDS
Infant Health
Infectious Diseases
(meningitis, hepatitis, etc.)
Job Availability
Job Security
Mental Illness
Overweight Adults
Overweight Children
Prenatal Health
Recreation Opportunities
Secondhand Smoke
Services for Disabled
Smokeless Tobacco
Smoking
Stress
Teen Pregnancy
Unemployment
1
9
6
8
8
2
7
8
9
12
20
9
12
4
4
11
9
9
14
11
34
34
35
35
35
3
0
2
7
5
4
5
8
9
20
21
19
35
34
34
8
9
6
18
16
3
5
15
6
9
15
15
9
14
17
12
8
7
8
3
8
9
4
5
7
10
6
9
3
6
3
10
4
17
2
7
2
8
9
19
13
8
3
8
5
18
3
15
3
10
2
8
2
17
2
9
answered question
skipped question
34
34
35
34
34
34
34
35
33
32
35
35
34
34
36
2
•
•
Thetableaboveshowshowsurveyrespondentsweighedhealthproblemsinthecommunity.
Theseresponseswereopinionsofthepeople,notfactual.
Thetoptenhealthproblemsdescribedaseitheraseriousproblemoramoderateproblem
included(thenumberinparenthesesrepresentsthetotalnumberofpeoplewhostateditwasa
seriousormoderateproblem):
1. Cancer(27)with16peoplesayingitwasaseriousproblem.
2. OverweightAdults(25)with18peoplesayingitwasaseriousproblem.
3. Stress(25)with15peoplesayingitwasaseriousproblem.
4. AbilitytoAffordPrescribedMedications(25)with14peoplesayingitwasaserious
problem.
5. JobAvailability(25)with8peoplesayingitwasaseriousproblem.
6. OverweightChildren(24)with16peoplesayingitwasaseriousproblem.
7. Alcohol/DrugUse(24)with15peoplesayingitwasaseriousproblem.
8. SecondhandSmoke(24)with15peoplesayingitwasaseriousproblem.
9. AffordableHealthcare(23)with14peoplesayingitwasaserioushealthproblem.
10. Unemployment(23)with14peoplesayingitwasaseriousproblem.
11. Smoking(22)with15peoplesayingitwasaserioushealthproblem.
73|P a g e Chapter7:SummaryofNeeds
UsingtheDatatoDetermineNeeds
ThesecondarydataareusedtocompareCapeGirardeauCountytoMissouribyexaminingquantitative
datasuchaspercentages,ratesandtrends.IfCapeGirardeauCountyranksworsethanthestateora
negativetrendisoccurring,thenaneedispresented.Theprimarydataarequalitativeandtakein
considerationthethoughtsandopinionsofpeopleinthecommunity.Ifaconsensusarisesabouta
concern,thenaneedisestablished.
SecondaryData
Afterareviewofthesecondaryresearchfoundinchapters2-5,itcanbedeterminedthatCape
GirardeauCountydoesnotdoverywellcomparedwiththestateofMissouriinmanyareas,sothereare
manyareasofconcern.Thefollowingdescribesthefindingsfromthesecondarydata.
Education:CapeGirardeauCountyhasahigherpercentageofpeoplewhohavelessthana9thgrade
educationorhaveahighschooldiplomawithnoadditionalsecondaryeducationthanMissouri.In
addition,thecountyhasalowerpercentageofresidentswithsomecollegebutnodegreeoran
associate’sdegree.However,intotal,thecountydoeshaveahigherpercentageofpeoplewhohavea
bachelor’sdegreeoragraduateorprofessionaldegree(28.1%)comparedwiththestate(26.7%).
Income:CapeGirardeauCountyhasapercapitaincomeof$39,547whichwasabout$2,000lessthan
thestate.
Employment:Theunemploymentrateof3.9%inCapeGirardeauCountyis0.4%higherthantheratein
Missouri.
Poverty:CapeGirardeauCountyhasapovertyrateof17.3%,abovethe15.6%povertyrateofMissouri.
HealthcareProviders:
• CapeGirardeauCountyhasaprimarycarephysicianratioof1,084:1,whereasMissourihasa
ratioof1,439:1.
• CapeGirardeauCountyhasamentalhealthproviderratioof413:1,whereasMissourihasa
ratioof632:1.
• CapeGirardeauCountyhasadentistratioof1,406:1:1,whereasMissourihasaratioof1,920:1.
LeadingCausesofDeath:CapeGirardeauCountyhasalowerrateofallcausescombinedthanthestate.
Separately,thecountyhasahigherrateofdeathduetoAlzheimer’sdiseaseandkidneydisease.
ChronicDisease:CapeGirardeauCountyhashigherratesformanyofthechronicdiseasecategoriesof
death,hospitalizationsandERvisitsthanthestate,including:
• Deathsfromischemicheartdisease,stroke/othercerebrovasculardisease,colorectalcancer,
colonandrectumcancerandcervicalcancer.
• Hospitalizationsfromprostatecancerandarthritis/lupus.
• ERvisitsfromarthritis/lupus.
InfantDeaths:CapeGirardeauCounty’srateofinfantdeathsincreasedfrom2011to2013.Thecounty
rateis7.8comparedto6.5forMissouri.
74|P a g e Diabetes:CapeGirardeauCountyhasa12%prevalenceofdiabetes,justoverthe11%forthestate.
HealthStatusatBirth:TheCountyHealthRankingsshowthat8.2%ofCapeGirardeauCounty’sbirths
hadlowbirthweightsin2015.Thisisgreaterthanthe8.0%oflowbirthweightsinMissouri.Thecounty
alsohadahigherrateofbirthdefectsthanthestate.
HealthStatus: • Poororfairhealthwas15%inCapeGirardeauCountycomparedwith16%inMissouriin2015.
• TheaveragenumberofpoorphysicalhealthdaysinCapeGirardeauCountywas3.8daysandin
Missouriitwas3.7days.
• TheaveragenumberofpoormentaldaysinCapeGirardeauCountywas4.6daysandin
Missouriitwas3.8days.
PreventableHospitalizations:
• CapeGirardeauCountyhad52preventablehospitalstayscomparedtoMissouri’s65
preventablehospitalstaysin2015.Preventablehospitalstaysisdefinedasthenumberof
hospitalstaysforambulatorycare-sensitiveconditionsper1,000Medicareenrollees.
• CapeGirardeauCountyhadahigherratethanMissouriinthefollowingdiagnosticcategories:
bacterialpneumonia,congenitalsyphilis,failuretothrive,immunization-preventable,
kidney/urinaryinfectionandpelvicinflammatorydisease.Theyhadequalratesofhypoglycemia
andsevereENTinfections.
DietandExercise:
• 1%moreCapeGirardeauCountyresidents(27%)thanMissouriresidents(26%)arephysically
inactive.
• Therewas71%ofCapeGirardeauCountythathadadequateaccesstoexerciseopportunities,
whichisbelowthe77%ofthepopulationinMissourithathasaccess.
• TheCountyHealthRankingsalsogavethesamefoodenvironmentindexof7.0tobothCape
GirardeauCountyandMissouri.
MaternalHealth:
• CapeGirardeauCountyhadarateof19.8formotherswhosmokedduringpregnancy,above
the17.8rateforMissouri.
• CapeGirardeauCountyhasarateof56.2formotherswhobreast-fedsometimeduring
pregnancyin2008,whichwasnarrowlyabovetherateofMissouriat56.0.
PreventivePractices:Severalindicatorswereusedtotestpreventivepracticesusedbypeopleinthe
community.CapeGirardeauCountyhadworseaprevalencethanthestateforthefollowingindicators:
didnotgetmedicalcareinthepastyear,overweight,everhadhighbloodpressure–amongthosewho
havehaditchecked,everhadbloodcholesterolcheckedinthoseages35andolder,evertoldtheyhad
highcholesterolamongthoseages35andolderwhohavehaditchecked,neverhadamammogram
amongwomenages40andolder,nomammogramorclinicalbreastexaminthelastyearamong
womenages40andolder,nopapsmearinthelastthreeyearsamongwomenages18andolder,no
bloodstoodtestinthelastyearamongmenandwomenages50andolderandneverhada
sigmoidoscopyorcolonoscopyamongmenandwomenages50andolder.
75|P a g e ChildandAdolescentHealth:
• CapeGirardeauCountyhadagreaternumberofchildrenages1through14diefromallcauses
includingtotalunintentionalinjuries,motorvehicledeathsandallcancers.
• CapeGirardeauCountyhadagreaternumberofadolescents(ages15through19)diefromall
causesincludingtotalunintentionalinjuries,motorvehicledeaths,homicide,suicideandall
cancers.
SeniorHealth:
InCapeGirardeauCounty,
• 27.1%ofseniorswerecostburdenedbyhousingin2011,upfrom24.7%in2008.However,this
islowerthanthestatepercentof29.4%.
• 87.9%ofseniorshaveaMissouridriver’slicense,upfrom82.9%in2008.Thestatehad88.6%
ofseniorswithadriver’slicensein2011.
• 29.7%ofseniorsthatcrimeandabuseper1,000persons.Thisdecreasedfrom37.6%in2008,
butisabove27.4%forthestate.
• Therewasarateof13.9primarycarephysiciansper1,000seniors.Thisincreasedfrom9.1in
2004andisnowabovethestaterateof13.1.
• 8.1%ofseniorslivedinpoverty,comparedwith8.2%ofseniorslivinginpovertyinthestate.
• Theaverageincomeofseniorhouseholdswas$44,799,whichwasbelowtheMissouriaverage
of$46,767.
• 17.2%ofseniorshadacollegeeducation,comparedwiththe18.2%ofseniorsinMissouriwitha
collegeeducation.
PrimaryData
AfterareviewoftheprimaryresearchresultsfoundinChapter6,itcanbedeterminedthatCape
GirardeauCountyhasmanyareasofconcern.Thefollowingliststhefindingsfromtheprimarydata,
includingthecommunitysurveys,focusgroupsandchecklistexercisecompletedatthefocusgroup.The
issuesweredeterminedasaconcernifthefocusgroupparticipantswereinagreementabouttheissue
and/orifmorethan50%ofsurveyparticipantsclassifiedtheissueasamoderatetoseriousproblem.
HealthProblemsdeterminedbyprimaryresearchinclude:
• AdultObesity
• ChildObesity
• Cancer
• MentalIllness
• Stress
• HighBloodPressure/Strokes
• Stress
BehavioralProblemsdeterminedbyprimaryresearchinclude:
• AlcoholAbuse
• DrugAbuse
• Smoking
• SexuallyTransmittedInfections
• PreventiveCare
76|P a g e CommunityProblemsdeterminedbyprimaryresearchinclude:
• HealthcareAffordability
• Transportation
• JobAvailability
• JobSecurity
• Unemployment
• SecondhandSmoke
• AbilitytoAffordPrescribedMedications
• Allergies
• HealthcareKnowledge/Education
• ConnectionstoHealthResources
Conclusion
ThisCommunityHealthNeedsAssessmentistheproductofacompletedprocessoffindingsecondary
data,performingprimaryresearchandpresentingthosefindings.Thiscompiledinformationwillallow
SaintFrancisHealthcareSystemtocreateanimplementationstrategydesignedtomeetsomeparticular
needsthatarespecifictotheCapeGirardeauCountycommunity.
77|P a g e AppendixA:2016CHNACommunityHealthneedsAssessmentSurvey
90|P a g e AppendixB:FocusGroupQuestions
CommunityHealthNeedsAssessmentFocusGroupQuestions
1. Whatdopeopleinthiscommunitydotostayhealthy?Howdopeoplegetinformationabout
health?
6. Ofalltheissueswehavetalkedabouttoday,whatissuesdoyouthinkarethemostimportant
foryourcommunitytoaddress?
91|P a g e AppendixC:FocusGroupParticipantInformation
CapeGirardeauCountyPublicHealthCenter
•
AssistantDirector,RN,15yearsasanRNinlong-termcareand8yearsinpublichealth
CommunityCaringCouncil
•
CommunityCoordinator,BA,15yearswiththeCommunityCaringCouncil
CrossTrailsMedicalCenter
•
•
•
•
FamilyNursePractitioner,MSN
DiabetesEducator,RN,BSN,CDE,15+yearsworkingincommunityhealth
ClinicalDirector,19yearsworkingincommunityhealth
CaseManager,4yearsRTC,5yearswithdomesticviolence,childadvocate,education
coordinatorandcrisiscounselorand8yearswithmedicalsocialworkandchronicdisease
management
St.MaryCathedral/CatholicSocialMinistries
•
•
PastoralMinister
President/Coordinator
UnitedWayofSoutheastMissouri
•
•
ExecutiveDirector,BA,MA
DirectorofOperationsandCommunityImpact,MPA,PhD
92|P a g e AppendixD:DataComparison
Someofthesignificantsecondaryinformationstatisticswerepulledandusedasacomparisonbetween
thelastCommunityHealthNeedsAssessmentandthecurrentassessmentdonebySaintFrancis
HealthcareSystem.
Table55:KeyCharacteristicsfromSurveyParticipants
2013Assessment
69%werewomen
7%werearaceotherthanWhiteorBlack
64.35%hadatleastsomecollege,while9.57%did
notfinishhighschool
Almost62%hadahouseholdincomelessthan
$25,000
72%wereemployedatleastpart-time
10%wereatleastpart-timestudents
11%wereconsideredunemployed
51%livedinhouseholdswiththreeormore
members
2016Assessment
65.79%werewomen
10.81%werearaceotherthanWhiteorBlack
67.57%hadatleastsomecollege,while5.41%did
notfinishhighschool
About36%haveahouseholdincomelessthan
$25,000
65.79%areemployedatleastpart-time
10.53%arefull-timestudents
18.42%wereconsideredunemployed
52.63%liveinhouseholdswiththreeormore
members
Top5PriorityNeeds(andAssociatedBehavioralNeeds)
• Cancer(Smoking)
• Obesity(DietandExercise)
• ChronicDisease
o Stroke(HealthyLifestyle)
o HeartDisease(Smoking)
o Diabetes(DietandExercise)
o ChronicRespiratoryDisease(Smoking)
• SubstanceAbuse/MentalHealth(DrugandAlcohol,AnxietyandDepression)
• HealthcareAffordability(Uninsured)
ImportantIssuestoAddressfromLastAssessment’sFocusGroup
1. Healthylifestyles
2. Obesity
3. Makingsurepeoplehaveaprimarycarephysicianorregularwalk-inclinictovisitasneeded
4. Healthcareaffordability
5. Educationandawareness
HealthyLifestyles
In2015,accordingtotheCountyHealthRankings,thepercentageofresidentsinCapeGirardeauCounty
withadequateaccesstolocationsforphysicalactivityisat71%.In2013,thispercentagewasnot
measured.However,in2014,itwasalsoat71%.
Thepercentofresidentsages20andolderthatreportnoleisuretimephysicalactivityisat27%.In
2013,thispercentagewasat28%,soithasdecreasedslightlyandisatthesamepercentageasthe
state.
93|P a g e Thefoodenvironmentindex,whichtakesintoconsiderationfactorsthatcontributetoahealthyfood
environment,ranks7outof10.In2013,thispercentagewasnotmeasured.However,in2014,itwasat
7.4outof10.
Obesity
Fromthe2013Assessment:AccordingtotheCountyHealthRankingsdevelopedbytheRobertWood
JohnsonFoundationandtheUniversityofWisconsinPopulationHealthInstitute,28%ofCapeGirardeau
Countyresidentswereobesecomparedwithcloseto31%ofMissouriresidents.In2015,29%ofadults
inCapeGirardeauCountywereconsideredobeseandabout31%ofadultsinMissouriwereconsidered
obese.
Table56:ObesityComparison
PercentofObesityinCapeGirardeauCountyResidents
2013
2015
28%
29%
AccesstoHealthcareServices
Using2013datafromtheCountyHealthRankings,15%ofCapeGirardeauCountywentwithnohealth
insurance.In2015,theCountyHealthRankingsshowthat15%ofCapeGirardeauCountyresidents
under65yearsofagewerestilluninsured.
Dentists
In2013,CapeGirardeauCountyhasdentistratioof1,686:1.In2015,CapeGirardeauCountyhada
dentistratioof1,406:1.
MentalHealthProviders
In2015,accordingtotheCountyHealthrankings,CapeGirardeauCountyhadamentalhealthprovider
ratioof413:1.Informationwasnotavailablefortheratioofmentalhealthprovidersin2013.
PrimaryCarePhysicians
In2013,CapeGirardeauCountyhadaprimarycarephysicianratioof1,150:1.In2015,CapeGirardeau
Countyhadaratioof1,084:1.
DepressionandMentalHealth
The“poormentalhealthdays”measureisbasedonresponsestothequestion:“Thinkingaboutyour
mentalhealth,whichincludesstress,depressionandproblemswithemotions,forhowmanydays
duringthepast30dayswasyourmentalhealthnotgood?”ForCapeGirardeauCounty,theaverage
numberofdaysthatmentalhealthwasnotgoodwas4.6days,whichishigherthanthestateaverageof
3.7days.In2015,the“poormentalhealthdays”remainedat4.6daysandthestateaverageremained
at3.8days.
TobaccoUse
Adultsmokingprevalenceistheestimatedpercentoftheadultpopulationthatcurrentlysmokesevery
dayor“mostdays”andhassmokedatleast100cigarettesintheirlifetime.AccordingtotheCounty
HealthRankingsdevelopedbytheRobertWoodJohnsonFoundationandtheUniversityofWisconsin
PopulationHealthInstitute,20%ofCapeGirardeauCountyresidentssmokecigarettescomparedwith
23%ofMissouriresidents.
The20%ofadultswhowerecurrentsmokersinCapeGirardeauCountywasjustbelowthe23%of
smokersinMissouri.AccordingtotheCountyHealthRankings,bothpercentagesremainedthesameas
94|P a g e in2013.However,thisstillnotonlycausesconcernfordiseasedevelopmentinsmokers,butalsofor
nonsmokersthroughsecondhandsmoke.
Table57:SmokingComparison
PercentofSmokersinCapeGirardeauCountyResidents
2013
2015
20%
20%
Medicaid
Medicaidpercentagesincreasedbyjustoveronepercentforboththecountyandstate.
Table58:MedicaidComparison
2008
CapeGirardeauCounty
13.72%
Missouri
14.5%
2015
CapeGirardeauCounty
14.83%
Missouri
15.92%
Source:DepartmentofHealthandSeniorServices,MOHealthNetMICA
Poverty
ThepovertystatusofCapeGirardeauCountyin2010was14.2%comparedwiththestateat14%.
AccordingtotheU.S.CensusBureau,thepovertyrateinCapeGirardeauCountyreached15.8%
comparedwith15.5%forMissouriin2013,bothincreasingfromthelastassessment.
ChronicDiseaseRates
Note:HighlightedmeansanincreasedrateforCapeGirardeauCountyfromthelastassessment.
Table59:ChronicDiseaseRateComparison
Deaths
Hospitalizations
ERVisits
Deaths
Hospitalizations
ERVisits
Deaths
Hospitalizations
ERVisits
Deaths
Hospitalizations
Deaths
Cape
Girardeau Missouri
Data
DataYears
Rate
Rate
Years
HeartDisease
1999-2009
260.7
245.6
2002-2012
2005-2009
121.7
152.38 2008-2012
2005-2009
11.6
12.95
2008-2012
IschemicHeartDisease
1999-2009
189
170.32 2002-2012
2005-2009
38.4
55.25
2008-2012
2005-2009
0.2
0.82
2008-2012
1999-2009
59
54.92
2002-2012
2005-2009
30.7
30.37
2008-2012
2005-2009
0.5
0.79
2008-2012
1999-2009
183.9
197.7
2002-2012
2005-2009
36.7
39.07
2008-2012
ColorectalCancer
1999-2009
21.8
19.39
2002-2012
Cape
Girardeau
Rate
Missouri
Rate
221
104.1
11.8
223.6
129.8
14.3
162
29.9
0.1
151.2
41.6
0.7
50.2
27.9
0.4
49.8
29.3
0.8
177.9
31.1
191.1
34.6
18.7
18.1
95|P a g e Hospitalizations
Deaths
Deaths
Hospitalizations
Deaths
Hospitalizations
Deaths
Hospitalizations
Deaths
Hospitalizations
Deaths
Hospitalizations
ERVisits
Deaths
Hospitalizations
ERVisits
Deaths
Hospitalizations
ERVisits
Deaths
Deaths
Hospitalizations
ERVisits
2005-2009
4.7
4.89
2008-2012
4
ColonandRectumCancer(SEER)
1999-2009
21.8
19.25
2002-2012
18.7
LungCancer
1999-2009
54.2
61.41
2002-2012
53.4
2005-2009
4.6
5.18
2008-2012
4.2
BreastCancer
1999-2009
13.3
14.55
2002-2012
13.7
2005-2009
1.9
2.2
2008-2012
1.4
CervicalCancer
1999-2009
1.7*
1.41
2002-2012
2.0*
2005-2009
0.5*
0.79
2008-2012
0.3*
ProstateCancer
1999-2009
10.6
9.1
2002-2012
8.3
2005-2009
4.2
7.78
2008-2012
3.6
DiabetesMellitus
1999-2009
20.8
23.78
2002-2012
19.8
2005-2009
13.8
17.32
2008-2012
13.8
2005-2009
1.5
1.7
2008-2012
1.7
ChronicObstructivePulmonaryDiseaseExcludingAsthma
1999-2009
41.2
47.38
2002-2012
42.8
2005-2009
19.3
23.22
2008-2012
21
2005-2009
4.6
5.41
2008-2012
2.7
Asthma
1999-2009
1.1*
1.3
2002-2012
0.9*
2005-2009
7.2
13.41
2008-2012
6.4
2005-2009
2.3
5.12
2008-2012
2.5
Smoking-Attributable(Estimated)
1999-2009
144.3
152.23 2002-2012
136.9
Arthritis/Lupus
1999-2009
2.8
3.55
2002-2012
2.4
2005-2009
39.8
41.01
2008-2012
42.5
2005-2009
14.9
8.67
2008-2012
15.8
4.4
17.9
59.4
4.6
13.9
1.7
1.4
0.6
8.4
2.5
22.5
17.8
1.8
48.5
23.6
5.7
1.2
13.1
5.3
146.9
3.3
41.7
9.9
Deathratesareperyearper100,000populationandareage-adjustedtotheU.S.2000standardpopulation.
Hospitalizationratesareperyearper10,000populationandareage-adjustedtotheU.S.2000standardpopulation.
ERvisitsareperyearper1,000populationandareage-adjustedtotheU.S.2000standardpopulation.
*Fewerthan20eventsinnumerator;rateisunstable.
Source:MissouriDepartmentofHealthandSeniorServices
96|P a g e LeadingCausesofDeath
2013Assessment:LeadingCausesofdeathwere:
• HeartDisease:32%
• AllCancers(MalignantNeoplasms):21%
• Stoke/OtherCerebrovascularDisease:7%
• AllInjuriesandPoisonings:5%
• ChronicLowerRespiratoryDisease:5%
2016Assessment:LeadingCausesofdeathare:
• HeartDisease:26%
• AllCancers(MalignantNeoplasms):22%
• SmokingAttributable(estimated):17%
• LungCancer:7%
• AllInjuriesandPoisonings:6%
Table60:CausesofDeathComparison
AllCauses
HeartDisease
Smoking-Attributable(estimated)
LungCancer
AllInjuriesandPoisonings
ChronicLowerRespiratoryDisease
Alzheimer'sDisease
KidneyDisease(NephritisandNephrosis)
DiabetesMellitus
PneumoniaandInfluenza
Alcohol/Drug-Induced
BreastCancer
Suicide
MotorVehicleAccidents
Firearm
Septicemia
ChronicLiverDiseaseandCirrhosis
Homicide
InjuryatWork
HIV/AIDS
Cape
Girardeau
Co.Rate
Missouri
Rate
1999-2009
843.8
871.5
260.7
245.6
183.9
197.7
144.2
152.2
54.2
61.4
47.4
67
59
54.9
42.3
48.7
33.6
21.9
28.9
45
17.7
17.2
20.8
23.8
21.1
23.1
10.2
16.4
13.3
14.6
10.1
12.8
12.1
18.6
8.8
12.7
8.4
11.5
4.8
7.3
2.4
7.1
2
2
0.9
2.3
Cape
Girardeau
Co.Rate
Missouri
Rate
2003-2013
808.3
837.3
208.3
216.7
177.7
188.9
137.7
145.2
56
58.7
51.2
70.5
47.5
47.8
45.4
50.3
41.6
25.8
27.4
47.5
21.6
18.1
19.7
22
16.4
20.3
14.5
20.2
13.1
13.6
12.1
13.7
10.5
16.4
9.9
13.2
8.8
11.5
6.2
7.5
3.1
7.2
1.6
1.7
1.2
1.9
Source:MissouriDepartmentofHealthandHumanServices
*HighlightedrepresentratesofCapeGirardeauCountythathaveincreasedsincethelastassessmentandMissouriRates
thathaveincreasedfromthelastassessment.
97|P a g e Cancer
Table61:CancerComparison
CapeGirardeauCounty,TopTenCancerIncidenceSites
Percent
Percent
CancerSite
(2004-2008)
(2007-2011)
LungandBronchus
16.95
16.25
FemaleBreast
13.91
15.9
Prostate
13.5
13.44
ColonandRectum
10.87
9.73
All
Thyroid
3.92
3.72
Sexes
UrinaryBladder
3.92
3.09
3.74
4.92
3.74
4
MelanomaoftheSkin
2.69
-
2.57
2.92
CorpusandUterus,NOS
-
2.92
Percent
Percent
CancerSite
(2004-2008)
(2007-2011)
FemaleBreast
27.9
31.38
LungandBronchus
15.83
14.9
ColonandRectum
10.79
9.93
Thyroid
6.68
6.09
Females CorpusandUterus,NOS
4.57
5.76
3.75
3.95
Ovary
2.7
2.48
Pancreas
2.88
2.26
CervixUteri
2.34
-
MelanomaoftheSkin
2.23
2.03
-
2.93
Percent
Percent
CancerSite
(2004-2008)
(2007-2011)
Prostate
26.92
27.26
LungandBronchus
18.07
17.63
ColonandRectum
10.96
9.51
UrinaryBladder
5.83
5.22
5.71
6.96
Males KidneyandRenalPelvis
3.73
4.06
3.38
3.94
MelanomaoftheSkin
3.15
3.25
Leukemia
2.68
-
LiverandIntrahepaticBileDuct
2.333
2.44
Pancreas
-
2.55
Source:MissouriCancerRegistryandResearchCenter,TopTenCancerIncidenceSites,Missouri
County-levelData
98|P a g e PrimaryData
Thefollowingliststhefindingsfromtheprimarydata,includingthecommunitysurveys,focusgroups
andchecklistexercisecompletedatthefocusgroupsfromboththe2013assessmentandthecurrent
2016assessment.Theissuesweredeterminedasaconcernifthefocusgroupparticipantswerein
agreementabouttheissueand/orifmorethan50%ofsurveyparticipantsclassifiedtheissueasa
moderatetoseriousproblem.
Table62:PrimaryDataProblemComparison
HealthProblems
2013
•
•
•
•
•
•
•
•
•
•
•
•
•
•
BehavioralProblems
•
•
•
•
•
•
Allergies(especiallyfoodallergiesin
children)
Smoking
Alcohol/DrugUse
PoorDiet&NoExercise
PoorLifestyle
High-RiskPregnancies–becauseofno
prenatalcare,livinganunhealthylifestyle
anddruguse
DrugUsewithAdolescents
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
EatingDisorders
EMScalledoutfornon-emergenciesor
repeatpatients
ChildAbuse
DomesticViolence
HealthcareAffordabilityandAvailability
HealthFacilities
TeenPregnancy
Transportation(public)
Unemployment
Mosquitos
JobAvailability
JobSecurity
Crime
HousingAffordability
Racism
ChildCare/DayCare
MurderorIntentionalInjury
SecondhandSmoke
•
LackofCommunicationandResources
•
•
CommunityProblems
2016
Diabetes&Pre-Diabetes
HeartDisease
OverweightAdults
OverweightChildren
Cancer
HighCholesterol
DentalHealth
Autism
ChronicPain
MentalHealth–AnxietyandDepression
Asthma/RespiratoryDisorders(especially
inchildren)
SexuallyTransmittedInfections
(especiallyinadolescents)
•
•
•
•
•
•
AdultObesity
ChildObesity
Cancer
MentalIllness
Stress
•
•
•
•
AlcoholAbuse
DrugAbuse
Smoking
SexuallyTransmitted
Infections
PreventativeCare
•
•
•
•
•
•
•
•
•
•
•
Transportation
JobAvailability
JobSecurity
Unemployment
SecondhandSmoke
AbilitytoAffordPrescribed
Medications
Allergies
Healthcare
Knowledge/Education
ConnectionstoHealth
Resources
99|P a g e AppendixE:SourcesofInformation
Table63:Sources
Measure
Source
Population
U.S.CensusBureau(PopulationEstimates)
U.S.CensusBureau(QuickFacts,AmericanCommunity
Survey5-YearEstimates)
U.S.CensusBureau(QuickFacts,AmericanCommunity
U.S.CensusBureau(QuickFacts,AmercicanCommunity
U.S.CensusBureau(QuickFacts)
Race
Ethnicity
HispanicPopulation
AgeDistribution
PercentofPopulation,Male
vs.Female
Household/Family
Configuration
Religion
EducationAttainment
Year
U.S.CensusBureau(PopulationEstimates)
AssociationofReligionDataArchives
U.S.CensusBureau(AmericanFactFinder)
U.S.CensusBureau(AmericanFactFinder,American
LanguageSpokenatHome
CommunitySurvey5-YearEstimates)
Literacy
NationalCenterforEducationStatistics
MaritalStatus
U.S.CensusBureau(AmericanFactfinder)
Income
MERIC(missourieconomy.org)
Unemployment
MERIC
U.S.CensusBureau,SmallAreaIncomeandPoverty
Poverty
Estimates
Medicaid/MOHealthNet
MissouriDepartmentofHealthandHumanServices,MICA
MissouriDepartmentofHealthandHumanServics,
HealthNetProviders
MissouriHealthNetProviderSearch
TheAnnieE.CaseyFoundation,KIDSCOUNTdatacenter,
Free/ReducedLunches
FamilyandCommunityTrust
HungerandFoodUncertainty MissouriHungerAtlas
WICParticipation
MissouriHungerAtlas
Housing
CountyHealthRankings(UniversityofWisconsin’s
HealthcareProviders
PopulationHealthInstitute,TheRobertWoodJohnson
Foundation)
Mortality
MissouriDepartmentofHealth&SeniorServices
Cancer
MissouriCancerRegistryandResearchCenter
ChronicDisease
YearsofPotentialLifeLost
InfantMortality
ObesityandOverweight
Foundation)
2014
2010-2014
2014
2014
2014
2014
2014
2010
2014
2014
2003
2014
2013-2014
2010-2015
2010-2014
2015
Current
2013
2013
2013
2014
2015
2003-2013
2008-2012
2002-2012
2013
2009-2013
2015
100|P a g e Diabetes
InfectiousDisease
HIV/AIDS
OtherSexuallyTransmitted
Diseases
LowBirthWeight
PretermDeliveries
BirthDefects
HealthStatus
MentalHealth
PreventableHospitalizations
DietandExercise
TobaccoUse
SubstanceAbuse
PrenatalCare
SmokingDuringPregnancy
Breast-feeding
PreventativePractices
ChildandAdolescentHealth:
CausesofDeathforChildren
andAdolescents
TeenSubstanceAbuseand
Foundation)
MissouriDepartmentofHealth&SeniorServicesBureau
ofCommunicableDiseaseControlandPrevention,Annual
CommunicableDiseaseSurveillanceReport
CDC,NationalHIVSurveillanceDatabase
MissouriDepartmentforHealth&SeniorServices’
HIV/AIDSSurveillanceSystemSTDbyCountyReport
Foundation)
MissouriDepartmentofHealth&HumanServices
NationalBirthDefectsPreventionNetwork
Foundation)
MissouriDepartmentofMentalHealth,Community
EpidemiologicalProfiles
Foundation)
MissouriDepartmentofHealth&SeniorServices(MICA)
Foundation)
Foundation)
MissouriDepartmentofMentalHealth,BehavioralHealth
Profile2015
MissouriDepartmentofHealth&SeniorServices,2015
PrenatalProfile
MissouriDepartmentofHealth&SeniorServices,
CommunityDataProfiles
MissouriDepartmentofHealth&SeniorServices(MICA),
WICInfant
MissouriDepartmentofHealth&SeniorServices,
CommunityHealthProfiles,HealthandPreventative
Practices
MissouriDepartmentofHealth&SeniorServices,Child
Health
MissouriStudentSurvey,StatusReportonMissouri’s
2015
2012
2013
2015
2015
20019-2012
2008-2012
2008-2012
2015
June2015
2015
2013
2015
2015
2015
2013
2001-2013
2000-2008
2011
2002-2012
2015
101|P a g e Smoking
TeenPregnancy
SeniorHealth
SubstanceUseandMentalHealth
MissouriSeniorReport(MissouriDepartmentofHealth&
SeniorServices,UniversityofMissouriOfficeofSocialand
EconomicDataAnalysis(OSEDA))
2009-2012
2013
Someothersourcesforgeneralinformationinclude:
• CentersforDiseaseControlandPrevention(CDC)
• MayoClinic
• AIDSvu
• TrustforAmerica’sHealth
• Otherlocalwebsites
o CapeGirardeauCountyPublicHealthCenter
o TheAmenCenter
102|P a g e

Cape Girardeau County - Saint Francis Medical Center

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