Community Health Needs Assessment

Touchette Regional Hospital
Community Health Needs Assessment
Introduc)on
Community Served by the Hospital
Demographics of the Community
Health Status of the Community
Health Sta7s7cs in the Service Area
Process and Methods Used to Develop the CHNA
Data Background
Community Input
Priority Health Needs
Mental Health
Cancer
Diabetes
STIs
Violence
Language Barriers
Community Resources
Addi)onal Health Data
Birth Data
Food Dessert
Physical Environment
1
Introduction
ToucheGe Regional Hospital is located in Centreville, IL and provides services throughout Southwestern Illinois, centered around the impoverished greater East St. Louis area. ToucheGe Regional Hospital opened in 1957 as Centreville Township Hospital to provide care to low income, underserved persons and others who were not welcomed in surrounding hospitals. In 1993 it was converted from a township tax supported hospital to a private, not‐for‐profit en7ty. ToucheGe Regional Hospital maintains its community roots and remains the community’s safety net hospital. The hospital offers Cardiopulmonary with Stress, Pulmonary Func7on and ECHO Cardio Tes7ng, Laboratory, Radiology including Digital Mammography, CT, MRI, US guided Biopsy, Physical Therapy, Obstetrical Services, 24 hour Emergency Department, Intensive Care, Inpa7ent Medical, Medical Alcohol and Opiate Detox, Dialysis; Obstetrical with Level 2 Nursery; Surgical with General, Orthopedic, Urological, Gynecological, Obstetrical, Ophthalmologic; Outpa7ent Pediatric Dental, General, Orthopedic, Gastroenterological, Podiatric, and Otolaryngology; Behavioral Health Inpa7ent and Intensive Outpa7ent programs. Because of the poverty and hazards in the community it provides free transporta7on services (not ambulance) to and from the hospital and community health center physician offices within the primary service area. The hospital also provides Southern Illinois Home Care Services including nursing, aide and physical/occupa7onal therapy services; and Archview Medical Specialists, a mul7‐specialty group of physicians. ToucheGe Regional Hospital also offers community based programs such as Start Now Breast Cancer Awareness and Seniors IQ.
2
Community Served by the Hospital
The hospital’s Primary Service Area is composed of the communi7es surrounding East Saint Louis, Illinois and iden7fied in the specific zip codes below. These are the same communi7es served by East Side Health District. This is a predominantly low income African American community. Residents in the Primary Service Area make up 69% of the inpa7ent admissions; while 31% come from the Secondary Service Area. A larger propor7on of the Emergency Department visits (83%) come from the Primary Service Area and the remainder from the Secondary Service Area. East Saint Louis, Illinois and surrounding communi7es were once communi7es of prosperous steel, chemical, meat packing and other large manufacturing industries. As these plants moved south and abandoned the area in the 1950s & 60s rapid economic changes resulted in communi7es with high concentra7ons of families with mul7ple genera7ons of poverty and associated inner city problems. Today, these communi7es are s7ll struggling to overcome the grip of poverty. They stand in stark contrast to the prosperity displayed by the St. Louis Gateway Arch immediately on the other side of the Mississippi River in Missouri. The en7re community is a designated a Health Professional Shortage Area. Many challenges confront the community. The general medical / surgical service area in its en7rety consists of the following zip codes and communi7es:
Primary Service Area (PSA)
62201 East Saint Louis
62203 East Saint Louis
62204 East Saint Louis
62205 East Saint Louis
62206 East Saint Louis
62207 East Saint Louis
Secondary Service Area (SSA)
62040 Granite City
62060 Madison
62208 Fairview Heights
62220 Belleville
62221 Belleville
62223 Belleville
62226 Belleville
62232 Caseyville
62234 Collinsville
62239 Dupo
62269 O’ Fallon
3
Demographic Analysis of the Service Area
There are significant demographic differences between the Primary and Secondary Service Areas for TRH. However, those from the Secondary Service Area who seek services at TRH tend to more closely resemble the residents of the Primary Service Area than those of the communi7es included in the Secondary Service Area as a whole. The following charts detail the demographic make‐up of the Primary and Secondary Service Areas.
Primary Service Area
Secondary Service Area
58,994
236,129
Race*
% African American
% Caucasian
% Other
82%
16%
2%
16%
79%
5%
Ethnicity*
Hispanic
Not Hispanic
3%
95%
5%
95%
Income*
Below Poverty
100‐200% of Poverty
Over 200% of Poverty
39%
28%
34%
12%
17%
71%
Educa)on*
Below High School
High School Graduate
College Graduate
25%
75%
8%
10%
90%
25%
Age* Below 18
18‐64
65+
12%
59%
29%
26%
61%
13%
Unemployment**
2013 (June)
2010
2000
14.4%
18.2%
9.0%
9.4%
11.1%
6.1%
Total Popula)on*
*Data taken from Census 2010 **Data taken from Bureau of Labor Sta7s7cs official data.
4
Health Status of the Community
One of the most valid compara7ve analysis tools for measuring health status is the University of Wisconsin Popula7on Health Ins7tute and the Robert Wood Johnson Founda7on report, County Health Rankings Mobilizing Ac7on toward Community Health 2011. It provides a ranking for the 102 coun7es in the State of Illinois using measures of health outcomes and health factors (higher ranking = poorer health). Health outcomes are characterized by mortality and morbidity while the health factors are characterized by health behaviors, clinical care, social and economic factors, and physical environment. ToucheWe Regional Hospital’s service area is coterminous with East Side Health District’s service area. Much of the informa7on in this report is from the recently completed East Side Health District Local Health Needs Assessment. Although the popula7on of East Side Health District’s service area is 24% of the total popula7on in St. Clair County, the County Health Rankings for St. Clair County is the most comprehensive measure of health outcomes and factors available that are applicable to the hospital’s service area. St. Clair County is ranked
•94th out of 102 coun7es in Illinois for Health Outcomes
•100th out of 102 coun7es in Illinois for Health Factors
Health related data specific to the various communi7es that comprise the service area is delayed and fragmented. The most recent available vital sta7s7cs data on births, par7cularly maternal/child health is 2009, while the most recent death data available from the Illinois Department of Public Health is 2008. Sexually transmiGed disease data is generally available by county; however, a specific request was made to the Illinois Department of Public Health for East Side Health District service area data for their plan. HIV/AIDS was only available for St. Clair County. Health Measure
Health Outcomes
Descrip)on
Mortality and Morbidity
St. Clair County, IL Rank
94 out of 102 coun7es in IL
Mortality
Premature Death or the years of poten7al life lost prior to age 75
96 out of 102 coun7es in IL
Morbidity
Self‐reported fair or poor health, Poor physical health days, Poor mental days, and Low birth weight
93 out of 102 coun7es in IL
Health Factors
100 out of 102 coun7es in IL
Health Behaviors
Health Behaviors, Clinical Care, Social and Economic Factors, Physical Environment
Smoking, Diet and Exercise, Alcohol use, High risk sexual behavior
Clinical Care
Social and Economic Factors
Physical Environment
Access to care and Quality of Care
Educa7on, Employment, Income, Family and Social Support, and Community Safety
Air Quality and Built Environment
25 out of 102 coun7es in IL
99 out of 102 coun7es in IL
101 out of 102 coun7es in IL
64 out of 102 coun7es in IL
Source: University of Wisconsin Popula7on Health Ins7tute. County Health Rankings 2011.
5
Health Statistics Data in the Service Area
This low income service area suffers from a vast number of health dispari7es. The hospital’s Primary Service Area specific data displays that the burden of health outcomes and factors in St. Clair County are largely situated in the hospital’s primary service area.
Health Disparity Chart:
Disparity
Rate in United States
Infant Mortality Rates per 1,000 4.5
live births*
Low Birth Weights *
5.0%
(<2,500 grams)
Gonorrhea rates per100,000*
98.1
Chlamydia rates per 100,000
367.5
Cancer Incidence Rates per 459.0
100,000**
Deaths from Heart Disease per 254.1
100,000**
Death due to Diabetes mellitus 22.4
per 100,000**
Serious Psychological Distress 3.3%
within the last year***
Rate in State of Illinois
Rate in TRH Service Area
Es)mated number in service area affected each year
7.4
10.8
25
8.4%
10.9%
204
163.5
381.3
349.1
691.9
202
400
484.9
502.9
291
252.9
267.7
155
23.1
40.3
23
3.2%
5.1%
2,925
*Most recent 5‐year averages from the Illinois Project for Local Assessment of Needs (IPLAN) Data System – TRH Service Area East Side Health District
** Taken from 2011 Centers for Disease Control (CDC) data most recent 10 year averages – TRH Service Area St. Clair County
*** Extrapolated by poverty status from 2011 Centers for Disease Control (CDC) data – TRH Service Area defined by Zip Codes 62201‐62207
6
Process and Methods Used to Develop the Community
Health Needs Assessment (CHNA)
Data Background
This Community Health Needs Assessment uses both quan7ta7ve data and informa7on collected from community residents. The sta7s7cal data used mul7ple data sources from the most recently available sources. The following sources (specific cita7ons are included with the specific tables) were used. •Illinois Project for Local Assessment of Needs (IPLAN) developed by the Illinois Department of Public Health
•Centers for Disease Control & Preven7on •East Side Health District’s Local Health Needs Assessment
•Healthy People 2020
•Na7onal Center for Health Sta7s7cs
•US Census Bureau
•US Department of Health and Human Services
•SIHF Community Healthcare Needs Data Survey
7
Community Input
Together, the sta7s7cal data and community input was used to inform decisions and select priority community health and wellness issues. A key component in this process was the local health department’s needs assessment and addi7onal data analysis provided by the local Federally Qualified Health Center (FQHC). The Federally Qualified Health Center’s (FQHC) planning and development staff assisted the hospital in conduc7ng the CHNA and development of this document. In regards to the qualifica7ons and exper7se of this staff in needs assessment, they have conducted needs assessments in this community over 20 years and have several notable accomplishments in u7lizing needs assessments to secure grant funding. Needs assessments are significant factors in the scoring of many compe77ve grants that have been awarded to the FQHC and hospital. Every five years the local public health department conducts an extensive needs analysis and strategic plan to guide its public health efforts for the next five years. This IPLAN document became available to the public in December 2012. The public health department’s needs assessment process relied heavily upon a series of five community mee7ngs involving 52 community members represen7ng a variety of business/civic organiza7ons and neighborhoods and a community survey which obtained 870 responses. The area covered is coterminous with the primary service area of the hospital. Addi7onally, SIHF conducts periodic surveys of health needs within the communi7es served by TRH and this assessment u7lized the most recent survey to determine that 48% rely on visi7ng the Emergency Room for care, and a third either have or know family members with unmet health needs.
A group of key informants who represent agencies that provide health and social services in the greater East St. Louis community was convened by the hospital to review data and priori7ze community issues for the hospital to address. The assistant administrator of the local public health department gave an extensive presenta7on of the informa7on and process that the local health department had just completed. The local health department’s priority areas to address by 2017 included sexually transmiGed diseases, HIV/AIDS, obesity, cancer, and environment. The local FQHC iden7fied infant mortality, chlamydia, gonorrhea, low birth weights, cancer incidence, heart disease mortality, diabetes mortality, and serious psychological distress within the last years significant community health needs. 8
Stakeholders
Stakeholders in the community include a variety of healthcare and social service providers as well as the residents of the community. For the purposes of this Needs Assessment, stakeholder input was solicited through in‐person mee7ngs, including a group mee7ng featuring representa7ves of local physician groups, the local health department and mul7ple social service agencies. Stakeholders were able to confirm the results of demographic and health data sta7s7cal analysis and offer ideas of addi7onal health priori7es in the community and discuss ways in which organiza7ons can work together to address the health problems of the TRH service area. The stakeholders consulted for this project include:
•East Side Health District
•Hoyleton Ministries and Puentes de Esperanza
•Windsor Health Center
•Southern Illinois Healthcare Founda7on (SIHF) – Community Programs
•Catholic Urban Programs
•Lessie Bates Davis Neighborhood House
•Opal’s House (Domes7c Violence Shelter)
•Griffin Center (unable to make the mee7ng but was consulted personally and her input was also u7lized.)
9
A focus group mee7ng was held at TRH on July 10, 2013 with the following individuals present: Agency Name Posi)on
Role in the agency/community
East Side Health District
Hardy Ware
Assistant administrator
Staff person responsible for the local health department’s recently completed community needs assessment. The health department provides WIC services, STD services, and healthy food ini7a7ve, dental sealant, environmental health and other public health services.
Opal's House
Essie Calhoun
Puentes de Esperanza Chris Cox
and Hoyleton Ministries
Proprietor/director Domes7c violence shelter in East St. Louis
President and Chief Puentes is a social service outreach to the Hispanic community. Opera7ng Officer
Hoyleton has contracts with the state to recruit and manage the area foster care programs; violence preven7on programs; residen7al care for abused and low IQ wards of the state; transi7onal and independent living facili7es for clients who age out of the state sponsored residen7al care.
Senior Opera7ons Responsible for the community programs including healthy start, Director
Ryan White HIV AIDS programs, fatherhood ini7a7ves, family planning, vic7ms of violence; and community health center special popula7on programs‐healthcare for the homeless, public housing primary care, and migrant and seasonal farmworkers program.
Southern Illinois Healthcare Founda)on
Paula Brodie
Southern Illinois Healthcare Founda)on
Leslie Bates Davis Neighborhood House
Carla Gibson
Windsor Health Center manager
East St. Louis primary medical and behavioral health care clinic
Cheryl Anthony
Providing A Sure Start Manager
Catholic Urban Programs
Gerry Director
Hasenstab
Paren7ng and developmental program for at risk teenage parents. Agency also provides numerous social services including day care, homemaker services, aperschool programs, community development, u7lity assistance, etc.
Social service mission helping those who fall between the cracks in the social service safety net including food pantry, clothing, thrip shop, soup kitchen, homeless shelter, immediate rent assistance, etc.
Aperschool program in six public housing complexes in East St. Louis
Griffin Center
Sister Julia Director
(Did not make the Huskamp
mee7ng; but input was obtained by phone July 11, 2013 )
10
Priority Health Needs
The members of the group were provided with informa7on about the modified Hanlon priori7za7on method and asked to help hospital develop priori7es. Aper extensive discussion and debate by community representa7ves the following community priori7es were selected:
•Mental Health
•Cancer
•STIs
•Diabetes
•Violence
•Language Barriers
11
Mental Health
Mental health is a state of successful performance of mental func7on, resul7ng in produc7ve ac7vi7es, fulfilling rela7onships with other people, and the ability to adapt to change and to cope with challenges. Mental health is essen7al to personal well‐being, family and interpersonal rela7onships, and the ability to contribute to community or society.
Mental disorders are health condi7ons that are characterized by altera7ons in thinking, mood, and/or behavior that are associated with distress and/or impaired func7oning. Mental disorders contribute to a host of problems that may include disability, pain, or death. Mental illness is the term that refers collec7vely to all diagnosable mental disorders.
Why Is Mental Health Important?
Mental disorders are among the most common causes of disability. The resul7ng disease burden of mental illness is among the highest of all diseases. According to the Na7onal Ins7tute of Mental Health (NIMH), in any given year, an es7mated 13 million American adults (approximately 1 in 17) have a seriously debilita7ng mental illness. Mental health disorders are the leading cause of disability in the United States and Canada, accoun7ng for 25 percent of all years of life lost to disability and premature mortality. Moreover, suicide is the 11th leading cause of death in the United States, accoun7ng for the deaths of approximately 30,000 Americans each year. Mental health and physical health are closely connected. Mental health plays a major role in people’s ability to maintain good physical health. Mental illnesses, such as depression and anxiety, affect people’s ability to par7cipate in health‐promo7ng behaviors. In turn, problems with physical health, such as chronic diseases, can have a serious impact on mental health and decrease a person’s ability to par7cipate in treatment and recovery. Understanding Mental Health and Mental Disorders
The exis7ng model for understanding mental health and mental disorders emphasizes the interac7on of social, environmental, and gene7c factors throughout the lifespan. In behavioral health, researchers iden7fy:
· Risk factors, which predispose individuals to mental illness
· Protec7ve factors, which protect them from developing mental disorders
Researchers now know that the preven7on of mental, emo7onal, and behavioral (MEB) disorders is inherently interdisciplinary and draws on a variety of different strategies. Over the past 20 years, research on the preven7on of mental disorders has progressed. The understanding of how the brain func7ons under normal condi7ons and in response to stressors, combined with knowledge of how the brain develops over 7me, has been essen7al to that progress. The major areas of progress include evidence that:
12
•
•
•
•
•
•
•
•
•
•
•
MEB disorders are common and begin early in life.
The greatest opportunity for preven7on is among young people.
There are mul7year effects of mul7ple preven7ve interven7ons on reducing substance abuse, conduct disorder, an7social behavior, aggression, and child maltreatment.
The incidence of depression among pregnant women and adolescents can be reduced.
School‐based violence preven7on can reduce the base rate of aggressive problems in an average school by 25 to 33 percent.
There are poten7al indicated preven7ve interven7ons for schizophrenia.
Improving family func7oning and posi7ve paren7ng can have posi7ve outcomes on mental health and can reduce poverty‐related risk.
School‐based preven7ve interven7ons aimed at improving social and emo7onal outcomes can also improve academic outcomes.
Interven7ons targe7ng families dealing with adversi7es, such as parental depression or divorce, can be effec7ve in reducing risk for depression among children and increasing effec7ve paren7ng.
Some preven7ve interven7ons have benefits that exceed costs, with the available evidence strongest for early childhood interven7ons.
Implementa7on is complex, and it is important that interven7ons be relevant to the target audiences.
The progress iden7fied above has led to a stronger understanding of the importance of protec7ve factors. A 2009 Ins7tute of Medicine (IOM) report advocates for mul7disciplinary preven7on strategies at the community level that support the development of children in healthy social environments. In addi7on to advancements in the preven7on of mental disorders, there con7nues to be steady progress in trea7ng mental disorders as new drugs and stronger evidence‐based outcomes become available.
Emerging Issues in Mental Health and Mental Disorders
New mental health issues have emerged among some special popula7ons, such as:
•
•
•
Veterans who have experienced physical and mental trauma
People in communi7es with large‐scale psychological trauma caused by natural disasters
Older adults, as the understanding and treatment of demen7a and mood disorders con7nues to improve
As the Federal Government begins to implement the health reform legisla7on, it will give aGen7on to providing services for individuals with mental illness and substance use disorders, including new opportuni7es for access to and coverage for treatment and preven7on services.
From Healthy People 2020
13
How is the Local Service Area Affected?
Extrapolated by poverty status from 2011 Centers for Disease Control (CDC) data – TRH Service Area defined by Zip Codes 62201‐62207
14
Cancer
Con7nued advances in cancer research, detec7on, and treatment have resulted in a decline in both incidence and death rates for all cancers. Among people who develop cancer, more than half will be alive in 5 years. Yet, cancer remains a leading cause of death in the United States, second only to heart disease. The cancer objec7ves for Healthy People 2020 support monitoring trends in cancer incidence, mortality, and survival to beGer assess the progress made toward decreasing the burden of cancer in the United States. The objec7ves reflect the importance of promo7ng evidence‐based screening for cervical, colorectal, and breast cancer by measuring the use of screening tests iden7fied in the U.S. Preven7ve Services Task Force (USPSTF) recommenda7ons. The objec7ves for 2020 also highlight the importance of monitoring the incidence of invasive cancer (cervical and colorectal) and late‐stage breast cancer, which are intermediate markers of cancer screening success.
In the coming decade, as the number of cancer survivors approaches 12 million, understanding survivors’ health status and behaviors will become increasingly important.
Why Is Cancer Important?
Many cancers are preventable by reducing risk factors such as:
• Use of tobacco products
• Physical inac7vity and poor nutri7on
• Obesity
• Ultraviolet light exposure
Screening is effec7ve in iden7fying some types of cancers, including:
• Breast cancer (using mammography)
• Cervical cancer (using Pap tests)
• Colorectal cancer (using fecal occult blood tes7ng, sigmoidoscopy, or colonoscopy)
In an era of pa7ent‐centered care, it is cri7cal to assess whether people understand and remember the informa7on they receive about cancer screening. Research shows that a recommenda7on from a health care provider is the most important reason pa7ents cite for having cancer screening tests.
For cancers with evidence‐based screening tools, early detec7on must include the con7nuum of care from screening to appropriate follow‐up of abnormal test results and referral to cancer treatment. 15
Understanding Cancer
Complex and interrelated factors contribute to the risk of developing cancer. These same factors contribute to the observed dispari7es in cancer incidence and death among racial, ethnic, and underserved groups. The most obvious factors are associated with a lack of health care coverage and low socioeconomic status (SES). SES is most open based on a person’s:
• Income
• Educa7on level
• Occupa7on
• Social status in the community
• Geographic loca7on (where the person lives)
Studies have found that SES, more than race or ethnicity, predicts the likelihood of an individual’s or group’s access to:
• Educa7on
• Health insurance
• Safe and healthy living and working condi7ons, including places free from exposure to environmental toxins
All of these factors are associated with the risk of developing and surviving cancer.
SES also appears to play a major role in:
• Prevalence of behavioral risk factors for cancer (like tobacco smoking, physical inac7vity, obesity, and excessive alcohol use)
• Rates of cancer screenings, with those with lower SES having fewer cancer screenings
Emerging Issues in Cancer
In the past decade, overweight and obesity have emerged as new risk factors for developing certain cancers, including colorectal, breast, uterine corpus (endometrial), and kidney cancers. The impact of the current weight trends on cancer incidence will not be fully known for several decades. Con7nued focus on preven7ng weight gain will lead to lower rates of cancer and many chronic diseases.
From Healthy People 2020
16
How is the Local Service Area Affected?
According to the Centers for Disease Control and Preven7on, chronic diseases such as cancer and diabetes are the leading causes of death and disability. The number and rate per 100,000 of deaths for cancer, cardiovascular diseases, and diabetes for 2007 and 2008 are displayed in the tables below. Data for specific types of cancers were available for 2007. There were a total of 154 cancer deaths (236 cancer deaths per 100,000) in 2007. The rate of bronchus and lung cancer was the highest among the types of cancers at 83 deaths per 100,000 popula7on in the East Side Health District service area followed by the rate of colorectal cancer, 34 deaths per 100,000. The rate of cancer deaths was 246 per 100,000 in 2008. Malignant Neoplasms – Cancer Deaths ESHD service area, 2007
Residence Area
Lip, Oral Colorectal
Cavity and Pharynx Alorton
Cahokia
Skin
Female Breast
Cervical
Prostate Leukemia Other Total
Malignant Neoplasms
1
2
1
13
37
4
16
1
26
81
1
1
7
2
5
Centreville
2
5
1
1
3
East St. Louis 2
14
29
3
1
5
3
1
1
1
Canteen Township
1
2
Centreville Township
5
2
11
Fairmont City
1
1
4
Washington 1
Park
Bronchus and Lung
1
1
3
2
3
Total
5
22
54
2
11
2
9
2
47
154
Rate per 100,000
8 34 83 3
17
3
14
3
72
236
*Total popula7on 65,349
17
Taken from 2011 Centers for Disease Control (CDC) data most recent 10 year averages – TRH Service Area St. Clair County
Malignant Neoplasms – Cancer Deaths ESHD service area, 2008
Residence Area
Total
Alorton
3
Brooklyn
2
Cahokia
42
Centreville
East St. Louis
Washington Park
Fairmont City
Total
13
90
3
8
161
Rate per 100,000
246
18
Sexual Transmitted Infections
An es7mated 19 million new cases of sexually transmiGed diseases (STDs) are diagnosed each year in the United States—almost half of them among young people age 15 to 24. An es7mated 1.1 million Americans are living with the human immunodeficiency virus (HIV), and 1 out of 5 people with HIV do not know they have it. Untreated STDs can lead to serious long‐term health consequences, especially for adolescent girls and young women, including reproduc7ve health problems and infer7lity, fetal and perinatal health problems, cancer, and further sexual transmission of HIV.
For many, reproduc7ve and sexual health services are the entry point into the medical care system. These services improve health and reduce costs by not only covering pregnancy preven7on, HIV and STD tes7ng and treatment, and prenatal care, but also by screening for in7mate partner violence and reproduc7ve cancers, providing substance abuse treatment referrals, and counseling on nutri7on and physical ac7vity. Each year, publicly funded family planning services help prevent 1.94 million unintended pregnancies, including 400,000 teen pregnancies. For every $1 spent on these services, nearly $4 in Medicaid expenditures for pregnancy‐related care is saved. Improving reproduc7ve and sexual health is crucial to elimina7ng health dispari7es, reducing rates of infec7ous diseases and infer7lity, and increasing educa7onal aGainment, career opportuni7es, and financial stability.
Health Impact of Reproduc7ve and Sexual Health
Reproduc7ve and sexual health is a key component to the overall health and quality of life for both men and women. Reproduc7ve and sexual health services can:
• Prevent unintended pregnancies. Nearly half of all pregnancies are unintended. Risks associated with unintended pregnancy include low birth weight, postpartum depression, delays in receiving prenatal care, and family stress.
• Prevent adolescent pregnancies. More than 400,000 teen girls age 15 to 19 give birth each year in the United States. • Detect health condi7ons early. Prenatal care can detect gesta7onal diabetes or preeclampsia before it causes problems, and taking prenatal vitamins can prevent birth defects of the brain and spinal cord.
• Increase the detec7on and treatment of STDs. Untreated STDs can lead to serious long‐term health consequences, especially for adolescent girls and young women.
• Decrease rates of infer7lity. The Centers for Disease Control and Preven7on (CDC) es7mates that undiagnosed and untreated STDs cause at least 24,000 women in the United States each year to become infer7le.
• Slow the transmission of HIV through tes7ng and treatment.5 People living with HIV who receive an7retroviral therapy are 92% less likely to transmit HIV to others.
From Healthy People 2020
19
How is the Local Service Area Affected?
The 5 year (2007‐2011) average of Gonorrhea Cases in the East Side Health District service area is 529 cases. This is a rate of 809.5 cases per 100,000 people in the area. African Americans were 97.5% (2,265 cases) of the Gonorrhea cases with known race in ESHD over The 5 year average of ra7o of Gonorrhea is 1.3:1 between women and men. The greatest ra7o was in 2011 – 1.5:1. Year
Female
Male
Ra)o
2007
404
310
1.3:1
2008
348
291
1.2:1
2009
245
186
1.3:1
2010
227
187
1.2:1
2011
269
179
1.5:1
5 year (2007‐2011) average
298.6
230.6
1.3:1
20
Age group 15‐19 had an average of 192.6 cases (36.4%) of Chlamydia during the 5 year period. Age Group
5 year (2007‐2011) Average
0‐4
0.6 (.1%)
5‐9
0.8 (.2%)
10‐14
9 (1.7%)
15‐19
192.6 (36.4%)
20‐24
184.8 (34.9%)
25‐29
73 (13.8%)
30‐34
30.8 (5.8%)
35‐39
16.2 (3.1%)
40‐44
9 (1.7%)
45‐49
6.8 (1.3%)
50+
5.6 (1.0%)
Unknown
0 (0%)
Total
529.2
21
National and State Comparisons
Data from most recent 5‐year averages from the Illinois Project for Local Assessment of Needs (IPLAN) Data System – TRH Service Area=East Side Health District.
Data from most recent 5‐year averages from the Illinois Project for Local Assessment of Needs (IPLAN) Data System – TRH Service Area=East Side Health District.
22
Diabetes Mellitus
DM occurs when the body cannot produce or respond appropriately to insulin. Insulin is a hormone that the body needs to absorb and use glucose (sugar) as fuel for the body’s cells. Without a properly func7oning insulin signaling system, blood glucose levels become elevated and other metabolic abnormali7es occur, leading to the development of serious, disabling complica7ons.
Many forms of diabetes exist. The 3 common types of DM are:
• Type 2 diabetes, which results from a combina7on of resistance to the ac7on of insulin and insufficient insulin produc7on.
• Type 1 diabetes, which results when the body loses its ability to produce insulin.
• Gesta7onal diabetes, a common complica7on of pregnancy. Gesta7onal diabetes can lead to perinatal complica7ons in mother and child and substan7ally increases the likelihood of cesarean sec7on. Gesta7onal diabetes is also a risk factor for subsequent development of type 2 diabetes aper pregnancy.
Effec7ve therapy can prevent or delay diabe7c complica7ons. However, almost 25 percent of Americans with DM are undiagnosed, and another 57 million Americans have blood glucose levels that greatly increase their risk of developing DM in the next several years. Few people receive effec7ve preventa7ve care, which makes DM an immense and complex public health challenge.
Why Is Diabetes Important?
DM affects an es7mated 23.6 million people in the United States and is the 7th leading cause of death.
•
•
•
Lowers life expectancy by up to 15 years.
Increases the risk of heart disease by 2 to 4 7mes.
Is the leading cause of kidney failure, lower limb amputa7ons, and adult‐onset blindness. In addi7on to these human costs, the es7mated total financial cost of DM in the United States in 2007 was $174 billion, which includes the costs of medical care, disability, and premature death. The rate of DM con7nues to increase both in the United States and throughout the world. Due to the steady rise in the number of persons with DM, and possibly earlier onset of type 2 DM, there is growing concern about:
•
•
•
•
The possibility of substan7al increases in diabetes‐related complica7ons
The possibility that the increase in the number of persons with DM and the complexity of their care might overwhelm exis7ng health care systems
The need to take advantage of recent discoveries on the individual and societal benefits of improved diabetes management and preven7on by bringing life‐saving discoveries into wider prac7ce
The clear need to complement improved diabetes management strategies with efforts in primary preven7on among those at risk for developing DM
23
Understanding Diabetes
Four “transi7on points” in the natural history of diabetes health care provide opportuni7es to reduce the health and economic burden of DM:
•
•
•
•
Primary preven7on: movement from no diabetes to diabetes
Tes7ng and early diagnosis: movement from unrecognized to recognized diabetes
Access to care for all persons with diabetes: movement from no diabetes care to access to appropriate diabetes care
Improved quality of care: movement from inadequate to adequate care
Dispari7es in diabetes risk:
•
•
•
People from minority popula7ons are more frequently affected by type 2 diabetes. Minority groups cons7tute 25 percent of all adult pa7ents with diabetes in the United States and represent the majority of children and adolescents with type 2 diabetes.
African Americans, Hispanic/La7no Americans, American Indians, and some Asian Americans and Na7ve Hawaiians and other Pacific Islanders are at par7cularly high risk for the development of type 2 diabetes.
Diabetes prevalence rates among American Indians are 2 to 5 7mes those of whites. On average, African American adults are 1.7 7mes as likely and Mexican Americans and Puerto Ricans are twice as likely to have the disease as non‐Hispanic whites of similar age.
Barriers to progress in diabetes care include:
•
•
Systems problems (challenges due to the design of health care systems)
The troubling increase in the number of people with diabetes, which may result in a decrease in the aGen7on and resources available per person to treat DM
Emerging Issues in Diabetes
Evidence is emerging that diabetes is associated with addi7onal comorbidi7es including:
•
•
•
•
Cogni7ve impairment
Incon7nence
Fracture risk
Cancer risk and prognosis
The importance of both diabetes and these comorbidi7es will con7nue to increase as the popula7on ages. Therapies that have proven to reduce microvascular and macrovascular complica7ons will need to be assessed in light of the newly iden7fied comorbidi7es.
24
Lifestyle change has been proven effec7ve in preven7ng or delaying the onset of type 2 diabetes in high‐
risk individuals. Based on this, new public health approaches are emerging that may deserve monitoring at the na7onal level. For example, the Diabetes Preven7on Program demonstrated that lifestyle interven7on had its greatest impact in older adults and was effec7ve in all racial and ethnic groups.
Another emerging issue is the effect on public health of new diagnos7c criteria, such as introducing the use of HbA1c for diagnosis of diabetes and high risk for diabetes, and lower thresholds for gesta7onal diabetes. These changes may impact the number of individuals with undiagnosed diabetes and facilitate the introduc7on of diabetes preven7on at a public health level.
Several studies have suggested that process indicators such as foot exams, eye exams, and measurement of HbA1c may not be sensi7ve enough to capture all aspects of quality of care that ul7mately result in reduced morbidity. New diabetes quality‐of‐care indicators are currently under development and may help determine whether appropriate, 7mely, evidence‐based care is linked to risk factor reduc7on. In addi7on, the scien7fic evidence that type 2 diabetes can be prevented or delayed has s7mulated new research into the best markers and approaches for iden7fying high‐risk individuals and the most effec7ve ways to implement preven7on programs in community sexngs.
Finally, it may be possible to achieve addi7onal reduc7on in the risk of diabetes or its complica7ons by influencing various behavioral risk factors, such as specific dietary choices, which have not been tested in large randomized controlled trials.
From Healthy People 2020
25
How is the Local Service Area Affected?
Area
Diabetes Diabetes
2007
2008
Alorton
0
2
Brooklyn
NA
0
Cahokia
9
5
Centreville
3
4
East St. Louis
32
23
Washington Park
4
2
Fairmont City
0
3
Canteen Township
0
NA
Centreville Township (Centreville) 1
4
Sauget
NA
0
Total
49
43
Rate per 100,000
75
66
Sources: Illinois Department of Health, Vital Sta7s7cs 2007 and 2008
26
Violence
Homicide, domes7c and school violence, child abuse and neglect, suicide, and uninten7onal drug overdoses are important public health concerns in the United States. In addi7on to their immediate health impact, the effects of injuries and violence extend well beyond the injured person or vic7m of violence, affec7ng family members, friends, coworkers, employers, and communi7es. Witnessing or being a vic7m of violence is linked to lifelong nega7ve physical, emo7onal, and social consequences.
Both uninten7onal injuries and those caused by acts of violence are among the top 15 killers of Americans of all ages. Injuries are the leading cause of death for Americans age 1 to 44, and a leading cause of disability for all ages, regardless of sex, race and ethnicity, or socioeconomic status. Each year, more than 29 million people suffer an injury severe enough that emergency department treatment is needed. More than 180,000 people each year die from these injuries, with approximately 51,000 of these deaths resul7ng from a violent event. Many inten7onal and uninten7onal injuries are preventable.
From Healthy People 2020
27
Crime and Violence in the Community
The annual uniform crime reports (2006‐2009) from the Illinois State Police were used to describe crime in the East Side Health District service area. The data for the reports were obtained from Illinois Uniform Crime Repor7ng (I‐UCR) Program that highlights more than 900 agencies. Agencies in the East Side Health District service area repor7ng crime data include: Alorton, Cahokia, Caseyville, Centreville, East St. Louis, Washington Park, Brooklyn, Fairmont City, and Sauget. Offenses and arrests, both reported and rates per 100,000 popula7on are displayed in the annual reports. From 2006 to 2009, the total reported index crime offenses in the ESHD were 25,550. East St. Louis had the greatest number of total reported crime index offenses, 16,840 during the 7me period. The highest number of total index crimes reported was 4,492 in East St. Louis, 2007. Sauget had a total index crime rate of 59,832.6 per 100,000 popula7on in 2008. The 2008 total reported crime index rate per 100,000 in Sauget was the highest among all the ESHD areas between 2006 and 2009. Total Index Crime Rates per 100,000 Popula)on (Total Index Crimes Reported)
Agency
2006 Rates
2006 Reported
2007
Rates
2007
Reported
2008
Rates
2008
Reported
2009
Rates
2009
Reported
Alorton
9,160.3
240
7,137.3
184
10,788.5
275
9,699.1
245
Cahokia
Caseyville
Centreville
4,337.8
2,559.9
6,475.9
677
110
378
3,739.5
2,771.9
9,596.4
577
118
554
4,052.8
2,941.9
10,320.5
617
127
586
4,979.1
2,219.6
10,452.5
752
95
589
East St. Louis
15,035.4
4,487
15,254.0
4,492
14,550.3
4,219
12,657.7
3,642
Washington Park
Brooklyn
8,310.1
477
9,480.2
538
8,696.4
487
521.8
29
6,220.8
40
12,755.9
81
19,808.3
124
11,451.6
71
Fairmont City 2,661.4
61
2,606.0
59
1,658.4
37
3,030.3
67
Sauget
126
55,371.9
134
59,832.6
143
47,257.4
112
Total
51,851.9
6,596
6,737
6,615
5,602
Washington Park had 29 index crimes reported in 2009, the lowest number during the 7me period as well as lowest rate of 521.8 per 100,000 popula7on in the same year. Source: Illinois State Police. Illinois Uniform Crime Repor7ng (I‐UCR) 2006‐2009. 2009/2008 Crime Index Offense & Arrest Database hGp://
www.isp.state.il.us/crime/cii2009.cfm, 2008/2007 Crime Index Offense & Arrest Database hGp://www.isp.state.il.us/crime/cii2008.cfm, 2007/2006 Crime Index Offense & Arrest Database hGp://www.isp.state.il.us/crime/cii2007.cfm. The numbers and rates of total index crime arrests are listed below in the table below by area within the East Side Health District, from 2006 to 2009. The total index crime arrests reported in the ESHD service area were 4,070. East St. Louis had the greatest number of total index crime arrests, 1,214 among those agencies in the service area. The highest number of total index crime arrests reported was 462 in East St. Louis, 2009. Moreover, Sauget had the highest total index crime arrests per 100,000 popula7on in 2007, at 26,859.5 arrests per 100,000 popula7on. Washington Park had the lowest total index crime arrests reported and rater per 100,000 in 2009, 5 and 90.0 total index crime arrests per 100,000 popula7on, respec7vely. 28
Total Index Crime Arrests per 100,000 Popula)on (Total Index Crime Arrests Reported)
Agency
Alorton
2006 2006 Arrests Rates Arrests
Reported
5,648.9
148
2007
Arrests
Rates
2,366.2
2007
Arrests
Reported
61
2008
Arrests
Rates
3,295.4
2008
Arrests
Reported
84
2009
Arrests
Rates
2,454.5
2009
Arrests
Reported
62
Cahokia
Caseyville
Centreville
1,172.5
768.0
3,255.1
183
33
190
1,399.9
422.8
4,555.7
216
18
263
1,701.3
509.6
4,385.3
259
22
249
1,774.5
607.5
4,241.3
268
26
239
East St. Louis
847.8
253
961.0
283
744.9
216
1,605.7
462
Washington Park 1,411.1
81
1,409.7
80
946.4
53
90.0
5
Brooklyn
2,332.8
15
3,464.6
22
2,076.7
13
2,903.2
18
Fairmont City
479.9
11
750.9
17
672.3
15
904.6
20
Sauget
18,518.5
45
26,859.5
65
17,573.2
42
13,924.1
33
Total 959
1,025
953
1,133
Rates of inten7onal homicide and robbery per 100,000 people have been used as a proxy for the incidence of violent crime; for the occurrence of homicide is related to the occurrence of other crimes of violence and robbery has a dual trauma, physical and psychological. Robberies are also related to property and associated with violence (Fajnzylber, P. et al. 2002). The numbers and arrests of murders in the ESHD service area between 2006‐2009 are displayed in a graph and table below. Among all the areas, East St. Louis had the greatest number of murders, 95 with approximately 20% of all the murders resul7ng in arrests between 2006‐2009. Caseyville was the only area to have zero murders while Alorton, Centreville, and Brooklyn each had 2 numbers during the 7me period.
From East Side Health District Local Health Needs Assessement
29
500
375
250
125
W
as
hi
et
Sa
ug
ity
tC
on
Fa
irm
B
ro
Pa
ng
to
n
.L
St
Ea
st
ok
ly
n
rk
is
ou
lle
ev
i
C
C
en
tr
as
ey
vi
ah
ok
C
lo
rt
A
lle
ia
on
0
2006
2007
2008
2009
Murders in ESHD service area, 2006-2009
Numbers of Murders and arrests in ESHD service area, 2006‐2009
Agency
2006
2006 Arrests
2007
2007
Arrests
2008
2008
Arrests
2009
2009
Arrests
Alorton
0
0 (0%)
1
0 (0%)
1
0 (0%)
0
0 (0%)
Cahokia
1
1(100%)
1
0 (0%)
2
2 (100%)
3
3 (100%)
Caseyville
0
0 (0%)
0
0 (0%)
0
0 (0%)
0
0 (0%)
Centreville
3
3(100%)
4
1 (25%)
2
2 (100%)
3
2 (67%)
East St. Louis
25
7 (28%)
30
0 (0%)
16
5 (31%)
24
8 (33%)
Washington Park 2
0 (0%)
3
0 (0%)
5
0 (0%)
0
0 (0%)
Brooklyn
0
0 (0%)
0
0 (0%)
1
0 (0%)
1
0 (0%)
Fairmont City
0
0 (0%)
0
0 (0%)
1
0 (0%)
1
1 (100%)
Sauget
1
1(100%)
0
0 (0%)
0
0 (0%)
0
0 (0%)
Total
32
12(38%)
39
1 (2%)
28
9 (32%)
32
14 (44%)
Source: Fajnzylber, P. et al. (2002). Inequality and Violent Crime. Journal of Law and Economics, vol. XLV. As one of two proxy’s for the incidences of violent of crimes, there were a total of 1,801 robberies and a total of 171 robbery arrests in the ESHD service area between 2006 and 2009. East St. Louis had the greatest number of robberies 1,369 while Fairmont City had the least number of robberies 7 during this 7me period.
30
Numbers of Robberies and arrests in ESHD service area, 2006-2009
Total Aggravated Assault/BaWery Offenses (Total aggravated assault/baWery arrests reported)
Agency
2006
Offenses
2006
Arrests
2007
Offenses
2007
Arrests
2008
Offenses
2008
Arrests
2009
Offenses
2009
Arrests
Alorton
79
53 (67%)
21
15 (71%)
97
58 (60%)
57
40 (70%)
Cahokia
27
18 (67%)
13
13 (100%)
17
17 (100%)
44
18 (41%)
Caseyville
6
6 (100%)
3
3 (100%)
6
4 (67%)
13
9 (69%)
Centreville
169
98 (58%)
209
114 (54%)
161
64 (40%)
195
72 (37%)
East St. Louis
1,745
138 (8%)
1,762
157 (9%)
1,584
92 (6%)
1,348
176 (13%)
Washington Park 157
50 (32%)
179
46 (26%)
130
36 (28%)
5
2 (40%)
Brooklyn
10
7 (70%)
35
20 (57%)
34
8 (24%)
14
10 (71%)
Fairmont City
1
1 (100%)
1
1 (100%)
1
1 (100%)
2
2 (100%)
Sauget
46
37 (80%)
61
51 (84%)
51
37 (72%)
31
25 (81%)
Total
2,240
408 (18%)
2,284
456(20%)
2,081
317 (15%)
1709
354(21%)
31
Total drug crime arrests reported (Total drug crime arrests per 100,000 popula)on)
Agency
2006 Rates
2006 Reported
2007
Rates
2007
Reported
2008
Rates
2008
Reported
2009
Rates
2009
Reported
Alorton
1,717.6
45
3,064.4
79
3,216.9
82
1,346.0
34
Cahokia
Caseyville
Centreville
333.2
2,583.2
531.1
52
111
31
356.4
1,432.9
675.6
55
61
39
394.1
1,413.0
757.3
60
61
43
331.1
1,799.1
443.7
50
77
25
East St. Louis
2,472.9
738
3,198.9
942
3,462.5
1,004
3,506.8
1,009
Washington Park 365.9
21
405.3
23
589.3
34
0.0
0
Brooklyn
5,754.3
37
8,346.5
53
4,153.4
26
4,032.3
25
Fairmont City
1,265.3
29
618.4
14
672.3
15
361.8
8
Sauget
18,107.0
44
10,743.8
26
8,368.2
20
4,641.4
11
Total
1,108
1,292
1,345
1,239
From East Side Health District Local Health Needs Assessement
32
Language Barriers
The popula7on of the United States is growing linguis7cally more diverse each year, with approximately 11 million people repor7ng they speak English “not well” or “not at all” in the 2000 U.S. census. Language barriers have been found to complicate many aspects of pa7ent care, including receipt of medical services, pa7ent sa7sfac7on, interpersonal processes of care, comprehension, adherence to prescribed medica7on regimens, and length of hospital stay. Advocates for pa7ents with limited English proficiency (LEP) have searched for ways to make interpreters available to pa7ents who need them and to make LEP pa7ents aware of their rights to an interpreter. To date, most pa7ents and providers do not have access to professional interpreters, yet a body of research suggests that interpreters may be underu7lized even when readily available. From the Journal of General Internal Medicine ‐ © Society of General Internal Medicine 2007
Hispanics of all races experience more age‐adjusted years of poten7al life lost before age 75 years per 100,000 popula7on than non‐Hispanic whites for the following causes of death: stroke (18% more), chronic liver disease and cirrhosis (62%), diabetes (41%), human immunodeficiency virus (HIV) disease (168%), and homicide (128%). Hispanics have higher age‐adjusted incidence for cancers of the cervix (152% higher) and stomach (63% higher for males and 150% higher for females). Mexican Americans aged 20‐‐74 years report higher rates of overweight (11% higher for males and 26% higher for females) and obesity (7% higher for males and 32% higher for females) than non‐Hispanic whites (3); Mexican‐
American youths aged 12‐‐19 years also report higher rates of overweight (112% higher for males and 59% higher for females).
Despite recent progress, ethnic dispari7es persist among the leading indicators of good health iden7fied in na7onal health objec7ves. Hispanics or Hispanic subpopula7ons trail non‐Hispanic whites in various measures, including 1) persons aged <65 years with health insurance (66% Hispanics versus 87% non‐
Hispanic whites) and persons with a regular source of ongoing health care (77% versus 90%); 2) children aged 19‐‐35 months who are fully vaccinated (73% versus 78%) and adults aged >65 years vaccinated against influenza (49% versus 69%) and pneumococcal disease (28% versus 60%) during the preceding 12 months; 3) women receiving prenatal care in the first trimester (77% versus 89%); 4) persons aged >18 years who par7cipated in regular moderate physical ac7vity (23% versus 35%); 5) persons who died from homicide (8.2 versus 4.0 per 100,000 popula7on); and 6) persons aged 6‐‐19 years who were obese (24% [Mexican Americans] versus 12%), and adults who were obese (34% [Mexican Americans] versus 29%).
In other health categories (e.g., tobacco use and exposure to secondhand smoke, infant mortality, and low birth weight), Hispanics lead non‐Hispanic whites. In addi7on, since the 1970s, ethnic dispari7es in measles‐vaccine coverage during childhood and in endemic measles have been all but eliminated; however, the vaccina7on‐coverage gap between non‐Hispanic white and Hispanic children has widened for children aged 19‐‐35 months who were up to date for the 4:3:1:3:3 series of vaccines recommended to prevent diphtheria, tetanus, and pertussis; polio; measles; Haemophilus influenzae type b disease; and hepa77s B. Reported by: Office of Minority Health, Office of the Director, CDC.
33
Community Resources
SIHF
Southern Illinois Healthcare Founda7on is a community‐based, Federally Qualified Health Center (FQHC) network, with over 30 health centers located in seven coun7es in Southern Illinois. As an FQHC, Southern Illinois Healthcare Founda7on serves predominately low income or medically underserved popula7ons throughout southern Illinois.
SIHF opened its doors in 1985 as a small healthcare facility on Bond Avenue in Centreville, IL with one doctor, one nurse, and a clinic director at a 7me when many physicians were leaving southern Illinois. Today, SIHF employs over 600 people, including over 140 medical providers as well as a controlled affiliate hospital in Centreville, Illinois.
East Side Health District
The East Side Health District is devoted to improving public health and the environment of the residents of Canteen Township, Centreville Township, East St. Louis Township and S7tes Township by providing the appropriate preven7ve health care throughout our community. The District works closely with both the East St. Louis and Cahokia School Districts to provide programs that posi7vely impact the health of children. Furthermore the District collaborates with local community social service and health care organiza7ons to include: Lessie Bates Davis Neighborhood House, Comprehensive Mental Health, Southern Illinois Regional Wellness Center, Southern Illinois Healthcare Founda7on and various local Churches. Annually, the District provides preven7ve health services to thousands of clients throughout our community.
Comprehensive Behavioral Health Center
Comprehensive Behavioral Health Center has been in opera7on since 1957, providing quality individualized essen7al services for people in need of emo7onal, rehabilita7ve and social support, on a twenty‐four (24) hour basis, in the least restric7ve environment.
Comprehensive Behavioral Health Center strives to be the top ranking Community Behavioral Healthcare Center within its size, popula7on and category within the State of Illinois, offering quality services designed to meet the needs of children, adolescents and adults. Services may include but are not limited to therapeu7c counseling, psychosocial tes7ng, individual and group therapy, crisis interven7on, consulta7on, community interven7on, psychiatric evalua7on, case management services, referrals, and outreach services.
Social Service Agencies That Address Issues Related to the Social Determinants of Health
Several social services organiza7ons operate in East St. Louis including Lessie Bates Davis Neighborhood House, Catholic Urban Programs, The Urban League, Hoyleton Ministries, Puentes de Esperanza, and Chris7an Ac7vity Center. These agencies strive to improve life outcomes for local residents through a host of programming designed to improve the social determinants of health through direct ac7on.
34
Additional Health Issues and Information
Maternal Health and Birth Outcomes
The well‐being of mothers, infants, and children determines the health of the next genera7on and can help predict future public health challenges for families, communi7es, and the medical care system. Moreover, healthy birth outcomes and early iden7fica7on and treatment of health condi7ons among infants can prevent death or disability and enable children to reach their full poten7al.
Despite major advances in medical care, cri7cal threats to maternal, infant, and child health exist in the United States. Among the Na7on’s most pressing challenges are reducing the rate of preterm births, which has risen by more than 20% from 1990 to 2006, and reducing the infant death rate, which in 2011 remained higher than the infant death rate in 46 other countries. Health Impact of Maternal, Infant, and Child Health
More than 80% of women in the United States will become pregnant and give birth to one or more children. 31% of these women suffer pregnancy complica7ons, ranging from depression to the need for a cesarean delivery. Many of these complica7ons are associated with obesity during pregnancy. Although rare, the risk of death during pregnancy has declined liGle over the last 20 years.
Each year, 12% of infants are born preterm and 8.2% of infants are born with low birth weight. In addi7on to increasing the infant’s risk of death in its first few days of life, preterm birth and low birth weight can lead to devasta7ng and lifelong disabili7es for the child. Primary among these are visual and hearing impairments, developmental delays, and behavioral and emo7onal problems that range from mild to severe.
Preconcep7on (before pregnancy) and interconcep7on (between pregnancies) care provide an opportunity to iden7fy exis7ng health risks and to prevent future health problems for women and their children. These problems include heart disease, diabetes, gene7c condi7ons, sexually transmiGed diseases, and unhealthy weight.
From Healthy People 2020
35
How is the Local Service Area Affected?
Births in service area
Data between 2007‐2009 documented 3,272 births, respec7vely 1,091, 1,133, and 1,048. The number of births decreased by 43 between 2007 and 2009. The most recent data available is 2009. Below are characteris7cs of the 2009 births in the service area. In 2009, there were a total of 267 teenage births (<19) or 25.5% of all births in the ESHD service area. Women ages 20‐24 had the greatest number of births in 2009, 404 total or 38.5%. Of the 1,048 births in 2009, 85.7% (898) were to unmarried couples. Data from most recent 5‐year averages from the Illinois Project for Local Assessment of Needs (IPLAN) Data System – TRH Service Area=East Side Health District.
36
Heart Disease
Heart disease is the leading cause of death in the United States. Stroke is the third leading cause of death in the United States. Together, heart disease and stroke are among the most widespread and costly health problems facing the Na7on today, accoun7ng for more than $500 billion in health care expenditures and related expenses in 2010 alone. Fortunately, they are also among the most preventable.
The leading modifiable (controllable) risk factors for heart disease and stroke are:
• High blood pressure
• High cholesterol
• CigareGe smoking
• Diabetes
• Poor diet and physical inac7vity
• Overweight and obesity
Over 7me, these risk factors cause changes in the heart and blood vessels that can lead to heart aGacks, heart failure, and strokes. It is cri7cal to address risk factors early in life to prevent the poten7ally devasta7ng complica7ons of chronic cardiovascular disease.
Controlling risk factors for heart disease and stroke remains a challenge. High blood pressure and cholesterol are s7ll major contributors to the na7onal epidemic of cardiovascular disease. High blood pressure affects approximately 1 in 3 adults in the United States, and more than half of Americans with high blood pressure do not have it under control. High sodium intake is a known risk factor for high blood pressure and heart disease, yet about 90 percent of American adults exceed their recommenda7on for sodium intake. The risk of Americans developing and dying from cardiovascular disease would be substan7ally reduced if major improvements were made across the U.S. popula7on in diet and physical ac7vity, control of high blood pressure and cholesterol, smoking cessa7on, and appropriate aspirin use. Why Are Heart Disease and Stroke Important?
Currently more than 1 in 3 adults (81.1 million) live with 1 or more types of cardiovascular disease. In addi7on to being the first and third leading causes of death, heart disease and stroke result in serious illness and disability, decreased quality of life, and hundreds of billions of dollars in economic loss every year.
37
The burden of cardiovascular disease is dispropor7onately distributed across the popula7on. There are significant dispari7es in the following based on gender, age, race/ethnicity, geographic area, and socioeconomic status: • Prevalence of risk factors
• Access to treatment
• Appropriate and 7mely treatment
• Treatment outcomes
• Mortality
Understanding Heart Disease and Stroke
Disease does not occur in isola7on, and cardiovascular disease is no excep7on. Cardiovascular health is significantly influenced by the physical, social, and poli7cal environment, including:
• Maternal and child health
• Access to educa7onal opportuni7es
• Availability of healthy foods, physical educa7on, and extracurricular ac7vi7es in schools
• Opportuni7es for physical ac7vity, including access to safe and walkable communi7es
• Access to healthy foods
• Quality of working condi7ons and worksite health
• Availability of community support and resources
• Access to affordable, quality health care
Emerging Issues in Heart Disease and Stroke
No na7onal system exists to collect data on how open cardiovascular events occur or recur, or how open they result in death. Similarly, there is inadequate tracking of quality indicators across the con7nuum of care, from risk factor preven7on through treatment of acute events to post hospitaliza7on and rehabilita7on. New measures and tools are needed to monitor improvement in cardiovascular health over the next decade.
From Healthy People 2020
38
How is the Local Service Area Affected?
Cardiovascular diseases or diseases of the heart were among the greatest causes of deaths in the East Side Health District service area. The rate of cardiovascular disease deaths were 311 and 234 per 100,000 popula7on in 2007 and 2008, respec7vely. Moreover, the rate of diabetes deaths was 75 and 66 per 100,000, respec7vely in 2007 and 2008. Rate per 100,000
75
66
Sources: Illinois Department of Health, Vital Sta7s7cs 2007 and 2008
Taken from 2011 Centers for Disease Control (CDC) data most recent 10 year averages – TRH Service Area St. Clair County
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Nutrition Environment
The East Side Health District’s Local Needs Assessment iden7fied the the nutri7onal environment as a factor in local health status. The nutri7on environment is a complex set of environmental variables that influence ea7ng paGerns. The Na7onal Preven7on Strategy documents, “over 23 million people, including 6.5 million children, live in “food deserts” – neighborhoods that lack access to stores where affordable, healthy food is readily available.” According the USDA Food Desert Locator, several census tracts in the East Side Health District Service Area are iden7fied as “food deserts” or “a low‐income census tract where a substan7al number or share of residents has low access to a supermarket or large grocery store,” (ERS, 2011). There are a total of 21 census tracts in the service area of which nearly half (10) of the census tracts are food deserts (East St Louis ‐5004, 5009, 5013, 5042.01, 5045, Alorton‐ 5025, Centreville ‐ 5026.03, 5027, 5028, 5029). East St Louis with a popula7on of 25,222 or 38.6% of the service area has 5 of its 10 census tracts iden7fied as food deserts. Moreover, Centreville Township with a popula7on of 26,805 or 41% in the service area has 7 census tracts and 4 of those tracts are food deserts. Source: Na7onal Preven7on Council, Na7onal Preven7on Strategy, Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General, 2011
Retrieved March 12, 2012 hGp://www.ers.usda.gov/Data/FoodDesert/fooddesert.html
40
A list of food outlets that serve as grocery stores was obtained from the Environmental Health Sec7on of the East Side Health District. These food outlets are rou7nely inspected by the Environmental Health Sec7on. The IPLAN Team, ESHD Director, and Administrators reviewed the list and iden7fied outlets that serve as grocery stores for residents. Of the 18 stores iden7fied, 6 were excluded from the list, 7 were classified as grocery stores, 4 as specialty stores, and 1 as a butcher shop. The specialty stores largely sell ethnic foods. The store loca7ons were geocoded using GIS.
Food Outlet
Aldi Foods
Schnucks Grocery Co
Shop & Save Grocery
Schnuck Markets, Inc
Save A Lot
Gateway Market
Cahokia More Food For Less
Mi Tiera El Cerrito Meat Market
Tienda El Ranchito Grocery
Tienda El Maguey
East Side Meat Company
Address
1233 Camp Jackson Cahokia, IL 62206
1615 Camp Jackson Cahokia, IL 62206
1028 Camp Jackson Cahokia, IL 62206
2511 State St East St Louis, IL 62205
2600 State St East St Louis, IL 62205
7600 State St. East St Louis, IL 62203
800 Upper Cahokia Cahokia, IL 62206
3121 Collinsville Rd Fairmont City, IL 62201
5370 Collinsville Rd Fairmont City, IL 62201
2565 N 32nd St Fairmont City, Il 62201
8402 Collinsville Rd Collinsville, IL 62234
514 M L King Dr. East St Louis, IL 62201
Type of Store
Grocery Store
Grocery Store
Grocery Store
Grocery Store
Grocery Store
Grocery Store
Grocery Store
Specialty Store
Specialty Store
Specialty Store
Specialty Store
Butcher Shop
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Built Environment and Physical Activity
The Built Environment is another contribu7ng factor to poor health status iden7fied in East Side Health District’s Local Needs Assessment. The Metro East Park and Recrea7on District (MEPRD) has the duty to develop trails and trail facili7es in Madison and St. Clair County, Illinois providing support to local governments and jurisdic7ons. The districts mission is to, “have as its primary duty the development, opera7on, and maintenance of a public system of interconnec7on trails and parks through the coun7es compromising the district.” The Metro East Park and Recrea7on District has iden7fied 2,700 park ameni7es in the coun7es of Madison and St Clair. Some of these park ameni7es are located in the East Side Health District service area. hGp://www.meprd.org/index.html
MEPRD is con7nuously compiling a map of every park amenity and structure in Madison and St. Clair that currently boasts over 2,700 ameni7es. A far of the ameni7es iden7fied on this interac7ve map include: restrooms, pavilions, sport ac7vity fields, and playgrounds. hGp://www.meprd.org/mapping‐
project.html Malcolm W. Mar7n Memorial Na7onal Park
The Malcolm W. Mar7n Memorial Na7onal Park opened to the public in the spring of 2009. It is located on the East St. Louis Riverfront and features the Mississippi River Overlook and the Gateway Geyser. The Mississippi River Overlook provides picturesque views of the Mississippi and Skylines in St. Louis. Moreover, the Gateway Geyser is encapsulated by a small lake and four fountains. The geyser reaches heights of 630 feet, releasing 7,500 gallons of water per minute four 7mes a day in the spring and summer. hGp://www.meprd.org/mmmp.html
The MEPRD has funded projects within the East Side Health District Service Area. In 2007, park ligh7ng improvements were made in Cahokia, IL at the Cahokia Community Park around the asphalt walking park. There was also the installa7on of park benches at this same park. In 2010, upgrades were made to Lincoln Park in East St. Louis. These improvements included various renova7ons to the pool‐house and the improvement/construc7on of various structures within the park. hGp://
www.meprd.org/projects.html The parks and recrea7on facili7es in East St. Louis could benefit from con7nued funding from the MEPRD to improve ameni7es as there are a number of opportuni7es for recrea7on and physical ac7vity in the East St. Louis area. These parks and the ameni7es have been iden7fied below:
• Frank Holten Park is a State of Illinois recrea7on area and is approximately 1,080 acres with an 18‐hole golf course (Grand Marais Golf Course), football‐soccer field, cross country track, basketball, and baseball diamonds, fishing, and launch ramps for boast at Whispering Willow and Grand Marais Lakes, and picnic facili7es. hGp://www.dnr.state.il.us/lands/landmgt/parks/r4/frank.htm
• Jones Park is located in Census Tract 5004 and is approximately 130.5 acres. It is the largest park in the East St. Louis. The park has such ameni7es as 8 tennis courts, 6 baseball fields, 1 fountain, 1 waterpark, 2 playgrounds, 1 lagoon/lake, 3 pairs of restrooms, and a recrea7on center that is only open in the summer, 2 basketball courts, and a garden.
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Area
•
•
•
•
•
•
•
•
Major Cardiovascular Diseases
2007
Diseases of the heart
2008
Alorton
4
3
Brooklyn
‐
2
Cahokia
48
23
Centreville
19
12
East St. Louis
113
85
Washington Park
9
8
Fairmont City
7
7
Canteen Township
2
NA
Centreville 1
12
Sauget
NA
1
Total
203
153
Rate per 100,000
311
234
Lincoln Park is located is located in Census Tract 5009 and is approximately 14.2 acres. This park has 1 basketball court, 4 tennis courts, 3 baseball/sopball fields, a concession center, a swimming pool for children and adults, 2 playgrounds, and a picnic area.
Virginia Park is located in Census Tract 5011 and is approximately 8 acres. This park has 1 tennis court, .5 of a basketball area, a picnic table with cover, a flower bed area, 2 playground areas, several park benches, and a baseball area.
Carver Park is located in Census Tract 5042.01 and is approximately 3 acres. There is playground equipment, 1 baseball/sopball field, a field house with restrooms, a basketball court, and a picnic area.
Cannady Park is located in Census Tract 5024.01 and is approximately 3 acres. It has 2 playgrounds and a basketball court.
77th & State Street Park is located in Census Tract 5014 and is approximately 4 acres. This park has a picnic area and pavilion, 1 playground, 2 baseball fields, 1 basketball court, and 1 free play area.
Williams Park is located in Census Tract 5012 and is .8 acres. It has a sopball field, a playground, and a free play area.
McBride Park is located in Census Tract 5011 and is 3.5 acres. This park has 2 swing sets, a baseball field, and an open play area.
Sunken Garden Park is located in Census Tract 5006 and is 1.9 acres. It has a slide and 5 swings.
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•
•
Joyner Park is another park in East St. Louis which has 1 baseball/sopball field, 1 basketball court, 1 tennis court, 1 picnic pavilion and a swing set.
Sportsman Park is located in Washington Park and houses a playground and a baseball/sopball field.
Cita7on: hGp://www.eslarp.uiuc.edu/ntac/resources/ParkReport01/pdf/appE.pdf
In addi7on to the parks in the East St. Louis, football and track fields provide opportuni7es for physical ac7vity such as: Clyde C. Jordan Center football and track, the Cahokia High School football and track fields, and the Cahokia Area YMCA. The Jackie Joyner Kersee Center provides opportuni7es to serve youth and encourage physical ac7vity through its facili7es. Skate City Roller Ska7ng Rink located in East St. Louis is a venue that can promote physical ac7vity. 44