Improving the Health of Our Communities

Transcription

2 01 5 CO M M U N IT Y H E A LTH N E E DS A S S E S S M E NT
Improving the Health
of Our Communities
Crawford, Oscoda, and Roscommon Counties
Community Health
Needs Assessment
Munson Healthcare Grayling Hospital:
Improving the Health of our Community
June 2015
Acknowledgments
Alice Snyder, Director, Crawford County Commission on Aging
Andrew Brookes, Executive Director, AuSable Free Clinic
Bonnie Gaiser, Administrative Assistant, AuSable Free Clinic
Carla Gardner, Director of Nursing Services, Munson Healthcare Grayling Hospital
Central Michigan District Health Department
Cheryl Melroy, Community Outreach Coordinator, Munson Healthcare Grayling Hospital
Cindy Pushman, Director, Department of Human Services - Crawford, Oscoda, Otsego County
Crawford County Collaborative
David Beck, Executive Director, AuSable Valley Community Mental Health
Deb Looney, Roscommon County Commission on Aging
Deb Nurse, Case Manager, AuSable Valley Community Mental Health
Denise Bryan, Health Officer, District Health Department #2
Holli Fehrenbach, Manager, Maternal and Newborn, Munson Healthcare Grayling Hospital
Jan Wiltse, PhD, Health Planner/QI Coordinator, District Health Department #10
Kevin Hughes, MA, Deputy Health Officer, District Health Department #10
Kevin Leavesley, Manager Marketing and Communications, Munson Healthcare Grayling Hospital
Kim Chandler, Health Education Supervisor, District Health Department #10
Kim Morley, Munson Healthcare Grayling Hospital Board Member
Leilani Kitler, Prevention and Community Coordinator, Northern Lakes Community Mental Health
Liz Monk, Director of Care Coordination, Munson Healthcare Grayling Hospital
Lori Weedon, Director Patient Accounts and Customer Access, Munson Healthcare Grayling Hospital
Marianne Tappan, Oscoda County Commission on Aging
Mark Dibbet, MD, Munson Healthcare Grayling Physician Network
Oscoda County Human Services Coordinating Council
Paul Lerg, Munson Healthcare Grayling Hospital Board Member
Project Hope Prudenville Michigan
Ralph Opperman, DDS, Munson Healthcare Grayling Hospital Board Member
Roscommon County Human Service Collaborative Body
Rosemary Nelson, Crawford County Baby and Toddler Closet
Stephanie Riemer, President, Munson Healthcare Grayling Hospital
Tammy Klein, Oscoda County Human Services Coordinating Council Coordinator
Tammy MacDonald, OB Nurse Care Coordinator, Munson Healthcare Grayling Hospital
Vince Schultz, MD, CMO, Munson Healthcare Grayling Physician Network
2015 COMMUNITY HEALTH NEEDS ASSESSMENT
Table of Contents
Introduction and Mission Review.............................................................2
Retrospective Review of the 2012 CHNA.................................................3
Summary Observations from the Current Needs Assessment..................6
Community Description............................................................................7
Profile of Service Area
Service Area Map
Data Collection Approaches.....................................................................9
Methodology
Community Participation Strategies
Findings from the Community and Health Data.....................................10
Demographics
Key Social and Economic Factors
Key Community Health Data
Key Environmental Health Factors
Findings from the Community Input Process.........................................22
Consumer Health Survey
Health Provider Survey
Public Forums and Focus Groups
Ranking and Prioritizing the Findings....................................................28
Reflections on the Health Needs Assessment........................................28
The Process: Lessons Learned
Conclusion
Appendices.............................................................................................29
I. Community Data Worksheet
II. Health Indicator Worksheet
III. County Health Rankings Data
IV.MiPHY Data Grid
V.Environmental Health Data
VI. 2-1-1 Data
VII. Community Survey
VIII.Roscommon County Survey
IX.Provider Survey
X. Health Profile Chart Book 2014
2015 COMMUNITY HEALTH NEEDS ASSESSMENT | 1
1
Introduction and Mission Review
Munson Healthcare Vision:
From October 2014 through March 2015, a
comprehensive Community Health Needs Assessment
was conducted by Munson Healthcare Grayling
Hospital in collaboration with District Health
Department #10, the AuSable Free Clinic, the
Roscommon County Human Services Collaborative
Body, Oscoda County Human Services Coordinating
Council, the Crawford County Collaborative, and other
community agencies, to identify significant health
issues in Crawford, Roscommon and Oscoda counties.
This 2015 Community Health Needs Assessment
(CHNA), which was adopted by the Board of Trustees
on June 2, 2015, incorporates requirements of the
Patient Protection and Affordable Care Act of 2010.
This assessment process is an extension of the previous
CHNA that was published in 2012. Special attention
was given to the poor and underserved in our service
area, in keeping with the heritage of Grayling Hospital,
and the Mission of Munson Healthcare:
We will become northern Michigan’s
indispensable system of health
care by driving collaboration and
coordination that results in care that
is of the highest quality, easy to use,
and close to home.
Munson Healthcare and its partners work
together to provide superior quality care and
promote community health.
The CHNA includes collection and review of the
most recent secondary data from local, state and
federal sources, as well as stakeholder, provider and
community input. The Community Health Needs
Assessment is a valuable tool for planning, and will
be used to help Grayling Hospital, as well as its
community partners, to identify and prioritize health
issues, and work to develop and implement action
plans, and pursue funding opportunities. With limited
resources and significant community needs, we are
challenged to steward our resources as we work
together to improve the health of our communities,
improve access to care and reduce health disparities,
so that we provide the greatest benefit to all residents
in the most cost effective manner possible.
Following the completion of the CHNA, the health
issues and priorities identified will be reviewed and a
new implementation plan that will be used by Grayling
Hospital and others will be developed for the next
three years.
Munson Healthcare and Grayling Hospital’s vision is
central to the commitment to our community. As stated
in 2012, the Community Health Needs Assessment
is not a static document, it is a dynamic document
and will provide data we can to use to measure our
progress and its implementation plan will serve as a
foundation to improve the health and wellness of our
communities. This is a long-term commitment. New
data will be available and we will continue to learn
more about our community. In compliance with the
Federal Patient Protection and Affordable Care Act, we
will repeat this process again in FY 2016 as we have
become an owned entity of the Munson Healthcare
system, effective February 1, 2015. We express our
gratitude to all who participated in this process, and
we invite you to get involved in community health
improvement initiatives.
Retrospective Review of the
2012 Community Health Needs
Assessment
The following is a listing of the needs identified in the
2012 Community Health Needs Assessment:
• Programs and advocacy for the uninsured
• Access to primary care
• Maternal and Child Health
• Obesity Prevention
• Chronic Disease Management and Prevention/
Education
• Advocacy re: Substance Abuse Services and
Mental Health Services
Mercy Hospital Grayling, now Munson Healthcare
Grayling Hospital, focused on developing or supporting
initiatives to address access to primary care and
programs and advocacy for the uninsured, maternal
and child health, and nutrition, physical activity and
weight status. Munson Healthcare Grayling Hospital’s
focus on providing senior services and chronic disease
management is part of our daily commitment to
providing the most compassionate and highest quality
health care possible.
Access to Primary Care and Programs
and Advocacy for the Uninsured
In 2012 the percentage of persons below the poverty
level was higher than the Michigan rate of 14.8%,
in all three counties, with Roscommon County the
highest at 22.0%. The poverty rates remain higher
than the Michigan rate with increases in Crawford and
Oscoda counties and a slight decrease in Roscommon
County. Median incomes continue to be below the
Michigan average of $48,471 in all three counties,
with Crawford at $39,982, Oscoda at $33,942, and
Roscommon at $34,765. The numbers of uninsured
have improved through the expansion of Medicaid in
2014 with the Healthy Michigan Plan, which offers
access to health insurance for adults age 19-64 whose
incomes are up to 133% of the Federal Poverty Level.
As of February 2015, 3442 people in the 3 county area
have enrolled in the Healthy Michigan Plan. Enrollment
for Crawford County was 946, for Oscoda County was
566, and for Roscommon County was 1930. Another
1389 adults age 18-64, whose incomes are 138-400%
of the Federal Poverty Level, were able to enroll for
Health Insurance through the Federal Health Insurance
Marketplace, 351 for Crawford County, 201 for Oscoda
County and 837 for Roscommon County. The hospital
continues to have dedicated staff and participates in
outreach efforts, in collaboration with the AuSable Free
Clinic, the local health departments and staff at MidMichigan Health to assist individuals with insurance
enrollment. Many patients have shared stories of how
insurance coverage has provided them with care that
had been delayed due to lack of resources.
As noted in 2012, the County Health Rankings and
other information on social determinants of health
help us to better understand health status as directly
reflective of the ability of a household to provide health
insurance coverage, pay for healthy foods and health
care, and the opportunity to gain access to a healthier
lifestyle. With an increased number of individuals
who are insured, access to Primary Care providers and
medical specialty providers continues to be a challenge
for our communities. All three counties are designated
as medically underserved areas and Health Professional
Shortage Areas. In both Roscommon and Oscoda
counties, the population to primary care physician
ratios continue to be higher than the Michigan ratio
of 1268:1. Oscoda County is served by two nurse
practitioners who provide primary care. Crawford
County is lower than the Michigan population to
primary care physician ratio at 1,168:1. Since 2012,
Munson Healthcare Grayling Physician Network added
1 pediatrician, 1 Family Practice physician (Grayling),
.5 Family Practice physician (Roscommon), 1 Adult
Nurse Practitioner (Prudenville), .5 Physicians Assistant
(Roscommon), and 1 Internal Medicine physician
(Prudenville) to its staff. Travel to see a provider also
can be problematic in a rural community. High levels of
poverty and limited public transportation that covers
large geographic areas make it difficult for some to
access care.
The AuSable Free Clinic, located in Grayling, is
financially supported through Grayling Hospital
community benefit funding and continues to provide
medical care and case management, as well as
the Medication Access program, for those who are
uninsured or underinsured. The Clinic has been
very active in providing health insurance enrollment
assistance for the Free Clinic patients and over time
has decreased the number of patients who rely on
the Clinic to receive care because they now have
insurance and a primary care provider. The Clinic is
looking for ways to reach out to patients in the three
county service area, knowing that in remote rural
areas recruitment of providers and transportation are
barriers.
Maternal and Child Health
In 2012, the trend of single parent households had
risen to the surface as a significant issue impacting
community health. This continues to be a concern,
while the Michigan average is 33%, both Crawford
at 36% and Roscommon at 49% are higher than the
Michigan average and Oscoda County is below the
average at 26%. The percentage of Medicaid births
continues to be significantly higher than Michigan
(44%) in all three counties, Crawford 70.9%, Oscoda
49.5% and Roscommon 71.9%. The Teen pregnancy
rate, age 15-19/1,000, has decreased in all three
counties. The percentage of women who smoke while
pregnant has decreased from the rates noted in the
2012 CHNA in Oscoda and Roscommon counties,
unfortunately the rate rose from 45.5% to 51.5% in
Crawford County. Births with adequate prenatal care
improved in all counties, but remain a concern as
Oscoda county is only at 58.1%. The percentage of
low birth weight babies improved in both Oscoda and
Roscommon Counties, and is lower than the Michigan
rate of 8.4%, but in Crawford County is slightly higher
at 10.4%. Excessive weight gain while pregnant
also exceeds the Michigan rate of 46.3% in all three
counties. Munson Healthcare Grayling Hospital is
a member of both the 21 county regional Perinatal
Initiative and Maternal Smoking Coalition, which are
working to address barriers and improve the health of
pregnant women and their children. Grayling Hospital
offers prenatal nutrition, child birth preparation and
breast feeding classes and support free of charge.
Outreach at community health fairs and Neighborhood
and Project Connect events continues, and work
with our colleagues at the public health departments
continues to try to improve self-care during pregnancy
and improve breastfeeding rates. Grayling Hospital
continues our commitment to provide obstetric care to
our three county area as one of nine birthing hospitals
in the northern 21 county region of Michigan after
hospitals in West Branch, Cheboygan, and Clare closed
their OB units. Munson Healthcare Grayling Physician
Network recently added an OB nurse navigator who
serves as a case manager for high risk OB patients,
facilitating appropriate referrals to other health care
providers and connections to needed community
resources, as well as coaching women through health
related challenges during their pregnancy. In response
to the unmet need for mental health services for this
population, Munson Healthcare Grayling Physician
Network is providing behavioral health services to
women and children through the Michigan Child
Collaborative Care (MC3) program in collaboration
with Northern Lakes Community Mental Health. A
grant from Blue Cross Blue Shield is currently funding
this work. In addition, a MSW prepared Social Worker
has also been added to the Munson Healthcare
Grayling Physician Network staff, specifically to address
the psychological needs of these women and children.
This is an initial step in expanding access to behavioral
health services in our service area. Currently a second
social worker and a Psychiatric Mental Health Nurse
Practitioner are actively being recruited.
Nutrition, Physical Activity and Weight
Status: Chronic Disease and Related
Risk Factors
In 2012 smoking, overweight, obesity, and physical
inactivity, all risk factors for chronic disease, were noted
as significant concerns and mirrored what was being
seen in all of the state of Michigan. Adult smoking
continues to be a significant concern, with all three
counties exceeding the Michigan percentage of 20%.
Overweight and obesity exceed state percentages as
well as Healthy People 2020 goals. Physical inactivity
rates improved in Oscoda and Roscommon Counties,
while the rate declined in Crawford, all were at or
above the Michigan rate of 24%. Grayling Hospital
initiated Cardiac Rehab Nutrition Classes with poor
response initially. Prenatal nutrition classes are now
offered at no charge to address healthy weight gains
during pregnancy. The hospital joined the MHA
Michigan Healthy Foods Hospital Campaign and
removed its fryers and is offering more health conscious
choices. The Community Outreach Department makes
healthy nutrition choices and physical activity a part of
its message at all community events.
Fitness opportunities can be a challenge with the cold
Northern Michigan winter, especially for those who
cannot get outside. There are limited opportunities for
free or low cost indoor activity. The Hospital supports
two weekly Senior Exercise Programs at the Crawford
County Council on Aging. The Hospital Employee
Wellness Committee has encouraged participation in
the District Health Departments Fitness Challenges.
The Collaborative Bodies in each of the counties have
increased awareness of these risk factors as they relate
to chronic disease. The 2014 County Health Rankings
data was used as a call to action in each county to
initiate the discussion of establishing or re-establishing
health coalitions to work together, using the collective
impact model improve to the health of the residents of
Crawford, Oscoda and Roscommon Counties.
Summary Observations from the
Current Community Health Needs
Assessment
Executive Summary
The 2015 Community Health Needs Assessment has
identified the following health problems and issues as the
highest priority needs, through a comprehensive process
of data collection and analysis, and gathering input from
community members with a focus on at risk populations,
as well as healthcare and human service providers from
Crawford, Roscommon and Oscoda counties. Economic
factors (poverty), transportation issues, and an aging
population present significant challenges to our rural
communities.
Access to Dental Care
Access to dental care continues to be an issue facing our
three county area. Provider shortages as well as limited
access to dental care for adults without dental insurance
and those adults who have obtained dental coverage
through the Healthy Michigan Plan continue to be barriers
to access. Travel to clinics located outside of the three
county area can also be problematic.
Chronic Disease
The percentage of the population of our three county
area 65 years and older is significantly larger than that of
Michigan. The risks of many chronic diseases increase as
people grow older. Cardiovascular disease, cancer, diabetes
and chronic lower respiratory disease rates are higher than
Michigan rates. Also of interest was the percentage of the
population with any disability, which is significantly higher
than the state average in all three counties.
Advanced Directives
When survey participants were asked, “Do you have an
advanced directive?” 35% responded no, while another
almost 37% reported that “they didn’t know what an
advanced directive was”. These responses identify an
opportunity to educate our community members about
advanced directives and advance care planning.
Access to Primary Care
Access to primary care continues to be an issue facing
our three county area. Although many more residents in
our area have obtained health care insurance through
the Healthy Michigan Plan and the Health Insurance
Marketplace, barriers to access remain. Provider shortages,
transportation, lack of knowledge on where to access care,
as well as difficulties individuals have paying for co-pays,
deductibles, and medications continue to provide on-going
challenges in our area. Continued work is needed to reach
those who still do not have health insurance and assist with
education regarding enrollment options.
Education on Health Issues
and Health Resources
Increased public education regarding health issues and where
to obtain health related services is also a significant need. As
more people obtain health insurance coverage, education is
necessary regarding responsibilities and benefits.
Physical Inactivity, Obesity, and
Access to Affordable Healthy Foods
Physical inactivity and obesity, which are modifiable risk
factors for chronic disease, remain a concern. Access to
affordable healthy foods was a concern not only of the
community members, but also the Health and Human
Service Providers. Increased opportunities for physical
activity is an area that was identified to help make residents
healthier.
Maternal and Infant Health – Access
and Coordination of Prenatal and
Maternal Infant Services
The percentage of Medicaid paid birth exceeds Michigan
in all three counties, the highest being Roscommon County
at 75.2%. Teen pregnancy, smoking while pregnant and
excessive weight gain during pregnancy continue to be
areas of concern.
Child and Adolescent Health
The number of children living in poverty, living in single
parent households and who are eligible for free and
reduced price school lunch, significantly exceeds state rates
in all three counties, with Roscommon county being of
most concern. Rates of child abuse and neglect are also
higher in the three county area than in Michigan. Physical
inactivity, increased electronic device screen time and
poor nutritional habits of middle school and high school
age students, as self-reported in the Michigan Profile for
Healthy Youth, are also of concern.
Mental Health and Substance Abuse
Mental health issues and alcohol and substance abuse
were identified by community members and health care
providers among the most important health problems in our
counties. Additionally, adult smoking rates continue to be a
concern. A lack of mental health providers is a significant
barrier to obtaining mental health services.
The final approved version of the Munson Healthcare
Grayling Hospital 2015 CHNA and Implementation Strategy
will be available to the public at munsonhealthcare.org/
graylinghospital in the Community Benefit section. Printed
copies will also be available at the hospital (1100 E.
Michigan Avenue, Grayling MI 49738) in the Community
Outreach Department, or by calling (989) 348-0924.
Community Description
Profile of Service Area
Grayling Hospital is located in the heart of Michigan,
serving Crawford, Roscommon and Oscoda counties.
As shown on the following map of the service area, the
hospital is located in Grayling, which is the County seat of
Crawford County. Community Health Centers are located in
Grayling, Roscommon and Prudenville.
Crawford County
Crawford County is located in the north central area of
Michigan’s lower peninsula. The county is composed of six
townships: Grayling Township, Frederic Township, Maple
Forest Township, Lovells Township, South Branch Township,
and Beaver Creek Township. Also located in Crawford
County is the City of Grayling, which is the county seat.
Crawford County has a land area of 556 square miles and
an estimated population of 13,745 in 2014. Its population
density is 25.3 people per square mile, and is designated
as 73% rural by the US Census Bureau. Crawford County is
designated a Health Professional Shortage Area (HPSA) and
Medically Underserved Population Area (MUA).
Oscoda County
Oscoda County is located east of Crawford County. Mio
is the county seat. Oscoda County has 6 townships. Mio,
Fairview, Luzerne and Comins are communities located
within Oscoda County. Oscoda County has a land area of
566 square miles and an estimated population of 8,371 in
2014. Its population density is 15.3 people per square mile,
and is designated as 100 % rural by the US Census Bureau.
The AuSable River runs throughout the entire County. There
are over 2,000,000 plus acres of State and Federal land,
which is more than any other county in Michigan. Oscoda
County is the smallest county in Michigan. Oscoda County
is designated a Health Professional Shortage Area and
Medically Underserved Population Area.
Roscommon County
Roscommon County is located south of Crawford County.
The village of Roscommon is the county seat. Roscommon
County has 11 townships. The largest communities are
Roscommon, Houghton Lake, Prudenville and St. Helen.
Roscommon County has a land area of 520 square miles
and an estimated population of 23,955 in 2014. Its
population density is 47.1 people per square mile, and
is designated as 66% rural by the US Census Bureau.
Houghton Lake, the largest inland lake in Michigan is
located in Roscommon County. Higgins Lake and Lake
St. Helen are also located in Roscommon County making
tourism one of the county’s largest industries. Roscommon
County is designated a Health Professional Shortage Area
(HPSA) and Medically Underserved Population Area (MUA).
The number of persons per square mile in these counties
is much less than in Michigan. Crawford, Roscommon and
Oscoda Counties have long been areas of high poverty, low
income, and unemployment. This problem is due largely to
the lack of high paying, year-round employment for local
residents. The counties in the Grayling Hospital’s service
area are known as recreation and retirement destinations.
The counties’ high quality of life, including an abundance
of unspoiled rivers, streams, lakes and vast forest area, has
helped sustain the local economy.
Zip Codes Included in the Hospital’s
Primary Service Area Covered in the CHNA
Munson Healthcare
Grayling Hospital Facility
Primary Service Area
Secondary Service Area
Fairview
48621
Frederic
49733
Grayling
49738
Higgins Lake
48629
Houghton Lake Heights
48630
Houghton Lake
48629
Luzerne
48636
Mio
48647
Prudenville
48651
Roscommon
48653
St. Helen
48656
Data Collection Approaches
Methodology
The process of completing the Community Health
Needs Assessment requires gathering data from both
primary and secondary sources. Health specific data,
as well as data that outline the social determinants of
health have been included. Sources of secondary data
include:
as staff of the human service agencies they represent.
A total of 95 providers participated in the survey: 34
from Crawford County, 24 from Roscommon County,
18 from Oscoda County, and 19 from outside the 3
county area. See Appendix IX for Survey Questions.
• U.S. Census Bureau
• American Community Survey
• Michigan Department of Community Health
• Behavior Risk Factor Surveillance System
• County Health Rankings
• Michigan Profile for Healthy Youth (MiPHY)
• District Health Department #10
• District Health Department #2
• Central Michigan District Health Department
• Small Area Income and Poverty Estimates (SAIPE)
2012
• Michigan League for Public Policy
• 2-1-1 Northeast Michigan
Community Participation Strategies –
Primary Data Collection
Community Provider Survey
The Community Provider Survey was developed with
the help of District Health Department #10 staff. The
Survey was distributed to area physicians and mid-level
providers, and Case Management and Nursing staff at
Munson Healthcare Grayling Hospital, members of the
Crawford County Collaborative Body, the Roscommon
County Human Service Collaborative Body, the Oscoda
County Human Services Coordinating Council, as well
Community Survey
The Community Survey was distributed with emphasis
on the poor and underserved populations of our
counties. Surveys were distributed at the AuSable Free
Clinic, the Baby and Toddler Closet in Grayling, the
Crawford County Commission on Aging and Senior
Center, the Roscommon County Senior Center in
Houghton Lake, the Oscoda County Senior Center, to
first OB patients, District Health Department #10 and
at the Project Connect event in Prudenville. A total
of 252 residents completed the surveys: 135 from
Crawford County, 94 from Roscommon County, and
20 from Oscoda County, and 3 from counties outside
the 3 county area. See Appendix VII and VIII for Survey
Questions. Community Survey data for Oscoda County
from District Health Department #2’s Community
Health Needs Assessment was also shared for inclusion
in this CHNA.
Input from the County Collaborative Bodies
Once the preliminary data was collected, it was
presented to the Collaborative Bodies in Crawford,
Roscommon and Oscoda County. The question again
was asked: “What is the most important Health Need
or Issue in our Community?” Results will be discussed
in “Findings from the Community Input Process”.
Michigan Profile for Healthy Youth (MiPHY)
2013-2014
The MiPHY is an online student health survey offered
by the Michigan Departments of Education and
Community Health to support local and regional
needs assessment. The MiPHY provides student results
on health risk behaviors including substance use,
violence, physical activity, nutrition, sexual behavior,
and emotional health in grades 7, 9, and 11. The
survey also measures risk and protective factors
most predictive of alcohol, tobacco, and other drug
use and violence. A limitation of the data is that the
survey covered only 3 of 10 districts in the Crawford,
Roscommon, Oscoda and Ogemaw county region.
Findings from the Community and
Health Data: Appendix I
Demographics
The population of all three counties continues to
decrease, with the largest change in Oscoda County.
The percentage of persons 65 years and older
continues to increase, and is higher than the Michigan
average, while the percentage of persons under 5
years and under 18 years continues to see a small
decrease and is lower than the Michigan average. Our
population is growing older.
Crawford
Oscoda
Roscommon
Michigan
Source
Population
13,904
8,379
24,014
9,895,622
US Census Bureau, 2013 est.
Population, % change
-1.2%
-3.0%
-1.8%
0.1%
US Census Bureau, 4/1/10-7/1/13
Persons under 5 years
4.2%
4.8%
3.9%
5.8%
US Census Bureau, 2013
18.8%
19.2%
15.4%
22.7%
Persons 65 years and over
23.2%
25.6%
29.5%
15.0%
Female persons
49.6%
49.2%
50.2%
50.9%
Crawford
Oscoda
Roscommon
Michigan
Source
97.0%
97.3%
96.9%
80.1%
0.7%
0.2%
0.6%
14.3%
0.7%
0.8%
0.7%
0.7%
Race: Asian
0.4%
0.1%
0.5%
2.7%
Two or more races
1.2%
1.6%
1.3%
2.2%
Hispanic or Latino
1.6%
1.1%
1.5%
4.7%
Race: White
Race: Black or African
American
Race: American Indian and
Alaska Native
All three counties are predominantly White, with very
low census counts of African Americans, American
Indian, Asian and Hispanic or Latino populations.
Key Social & Economic Factors
According to the US Census Bureau median household
incomes are lower than the Michigan average in
all three counties, and the unemployment is higher
than the Michigan average in all three counties. The
median income in Crawford County is approximately
17.5% lower than the state average, Oscoda County
30%, and Roscommon County 28.25% lower.
The percentage of population with any disability is
significantly higher than the state average of 13.5%
in all three counties with Crawford at 19.9%, Oscoda
21.8% and Roscommon at 24.2%. Addressing the
issues related to those with disabilities is a growing
concern.
Crawford County is 53.4%, Oscoda County is 52.9%
and Roscommon is 48.4%, compared to Michigan
at 49.0%. The percentages of widowed residents
in Crawford County is 3.7% males and 11.8%
females, in Oscoda County is 5.1% and 10.5%, and
in Roscommon is 3.9% and 15.8%, are all higher
compared to Michigan at 2.7% and 9.3%. The
percentage of households with children under 18 years
old is 25% in Crawford, 21.7% in Oscoda, and 19.6%
in Roscommon, all less than the Michigan average
of 31.6%. The percentage of households with one
or more people over 65 years and over exceeds the
Michigan average of 25.5% in all three counties with
Crawford at 34.0%, Oscoda 38.1% and Roscommon
at 40.5%.
Crawford
Oscoda
Roscommon
Michigan
$39,982
$33,942
$34,765
$48,471
Unemployed
16.3%
16.5%
15.5%
12.6%
Unemployment
(in labor force)
10.7%
14.6%
12.5%
8.8%
Population with any
disability
19.90%
21.80%
24.20%
13.50%
Crawford
Oscoda
Roscommon
Michigan
84.80%
81.90%
85.40%
88.70%
15.20%
9.60%
14.50%
25.50%
Median household income
High school graduate or
higher
Bachelor’s degree or
higher
Source
US Census Bureau 2008-2012
American Community Survey
Bureau of Labor Statistics, as
provided by Michigan League for
Public Policy, 2013
Source
Vehicle Access – No Vehicle Available
Education
In the three county service area, 5.4% of Crawford,
6.3% of Oscoda and 5.5% of Roscommon households
report having no vehicles. These large rural counties
also have limited public transportation options.
The rates of high school graduation for residents
Crawford, Oscoda and Roscommon are lower than
the state average of 88.7%. The rates of obtaining a
bachelor’s degree or higher is significantly lower than
the Michigan average of 25.5% in all three counties.
Lower educational level can adversely affect health
outcomes.
Family Structure
The percentage of married couple family households in
Poverty
Poverty statistics are higher in all three counties of the service area than the Michigan average. Medicaid paid
births are higher in all three counties than the state average, but significantly higher than the state average
in both Crawford and Roscommon counties. Participation in WIC, free and reduced price school lunch and the
SNAP program are significantly higher in all three counties to help meet the needs of those families who are
economically stressed.
Crawford
Oscoda
Roscommon
Michigan
Households below poverty
level
13.60%
13.90%
14.10%
11.70%
Poverty: all ages
19.70%
21.20%
18.80%
17.40%
Poverty: ages 0-17
32.6%
34%
36.7%
24.7%
Poverty: ages 5-17
29.90%
31.80%
33.60%
22.70%
Medicaid paid births
64.20%
55.40%
75.2%
44.80%
Children ages 0-18
insured by Medicaid
46.80%
49.80%
62.80%
40.80%
WIC*
70.5%
101.5%
98.6%
63.6%
58.90%
66.90%
72.20%
48.60%
19.70%
20.60%
21.90%
15.80%
Children eligible for school
free and reduced price
lunch
Food Stamp/SNAP
benefits in the past 12
months
Source
US Census Bureau and Small Area
Income and Poverty Estimates
(SAIPE), as provided by Michigan
League for Public Policy, 2012
Michigan Department of
Community Health, as provided
by Michigan League for Public
Policy, 2012
Michigan Department of Human
Services, as provided by Michigan
Community Health
Michigan Department of Education,
as provided by Michigan League for
Public Policy, 2013
* The number of children who received benefits under the Women, Infants and Children program. The percentage is based on the
population ages 1-4. Date for 2006-2009 reflect the county of service, but subsequent data is based on the county of residence.
Because of this, the percentage is greater than 100% in some counties for 2006-2009. In September 2014, rates were revised for
all prior years; the numerators reflected children ages 1-4, but the rates were calculated based on populations of 0-4.
Key Community Health Factors: Appendix: II, III, IV
Access to Care
The percentage of adults without insurance is estimated to be at or above the state average of 14% in all three
counties. Collaborative outreach efforts have resulted in reducing the number of uninsured persons age 19-64 at
133% of the Federal Poverty Level (FPL) through enrollment in the Healthy Michigan Plan and those from 138400% of the FPL in Marketplace Insurance plans. With shortage of primary care providers, dentists and mental
health providers in the service area, access to care remains a challenge.
Crawford
Oscoda
Roscommon
Michigan
Source
14%
17%
15%
14%
County Health Rankings 2014
Primary care physicians
1,168:1
n/a
3,488:1
1,268:1
Dentists
2,841:1
4,329:1
2,217:1
1,557:1
Mental health providers
1,578:1
2,164:1
1,355:1
676:1
946
566
1930
39,709
MI State Progress Report
351
201
837
24,399
MI State Progress Report
Uninsured adults
Healthy Michigan Plan
County Enrollment
February 9, 2015
Marketplace Enrolled
January 16, 2015
Cancer Incidence and Mortality
Cancer is the second leading cause of death in Crawford, Oscoda, and Roscommon counties, exceeding the
Michigan rate in all three counties. Lung cancer is the most prevalent cancer in all three counties. Smoking is a
significant risk factor for lung cancer. Rates of breast cancer are lower than the state average in all three counties.
Crawford
Oscoda
Roscommon
Mich.
Healthy People
2020 Goal
Source
Prostate*
60.0
47.7
75.8
73.7
21.1
2007-2011, MDCH
Lung*
92.6
72.0
87.4
70.7
45.5
2007-2011, MDCH
Breast*
39.5
54.5
60.1
65.1
20.6
2007-2011, MDCH
Colorectal*
41.1
55.2
48.6
44.3
14.5
2007-2011, MDCH
Cancer Mortality Rate*
180.7
192.2
211.9
178.1
160.0
2010-2012, MDCH
* Age adjusted rates per 100,000 population
Cardiovascular Disease
Hospital discharges for Heart Attack are higher in all three counties than the Michigan average, while hospital
discharges for stroke is lower than the state average rate in all three counties. Cardiovascular disease is the
leading cause of death in the three county area and in Michigan. Better management of risk factors and chronic
disease, coupled with early identification of stroke and heart attack symptoms and timely treatment can lead to
decreases in the mortality rate.
Hospital Discharges –
Acute Myocardial
Infarction
Congestive Heart Failure
Stroke
Mortality Rate
Cardiovascular Disease*
Crawford
Oscoda
Roscommon
Michigan
Source
344.9
298.3
269.0
209.0
2010-2012, MDCH
278.1
326.9
297.8
306.9
2010-2012, MDCH
225.7
206.8
200.1
233.6
2010-2012, MDCH
247.3
337.5
306.6
255.9
2010-2012, MDCH
Obesity and Physical Activity
Adult obesity rates remained relatively unchanged. The percentage of adult obesity reported in the 2011 County
Health Rankings data was 30% for Crawford, 31% for Oscoda and 32% for Roscommon County. MiPHY data
reports data on overweight and obesity for students in the 7th, 9th and11th grade. An increased percentage of
7th and 9th grade students are reported as overweight, while only 31.7% of the middle school students and
32.8% of the high school students were physically active more than an hour per day and a high percentage of the
students watched 3 or more hours of TV or used a computer for something that was not related to school work for
3 or more hours on an average school day. Poor nutritional habits were also reflected in the MiPHY data.
People who are at a healthy weight and have regular
physical activity are less likely to develop risk factors
for chronic disease such as high blood pressure and
dyslipidemia. They are also less likely to develop
chronic diseases, such as type 2 diabetes, heart
disease, osteoarthritis, and some cancers. Women
at a healthy weight are less likely to experience
complications during pregnancy. (Healthy People 2020)
Obesity and Physical Activity (continued)
Crawford
Oscoda
Roscommon
Michigan
Source
30%
30%
33%
32%
Adult Overweight
(BMI 25.0 – 29.9)
48.0%
-
42.1%
34.5%
MDCH, BRFSS data from
2011-2013 combined
Physical inactivity
24%
25%
30%
24%
Adult obesity (BMI > 30)
Percentage of students who are obese (at or above the 95th percentile for BMI by age
and sex)
Percentage of students who are overweight (at or above the 85th percentile and below
the 95th percentile for BMI by age and sex)
Percentage of students who were physically active for a total of at least 60 minutes per day on
five or more of the past seven days
Percentage of students who watched three or more hours per day of TV on an average
school day
Percentage of students who played video or computer games or use a computer for
something that is not school work three or more hours per day on an average school day
Percentage of students who ate five or more servings per day of fruits and vegetables
during the past seven days
Percentage of students who drank a can, bottle, or glass of soda or pop one or more
times per day during the past seven days
7th
16.4%
9th
16.6%
11th
13.5%
7th
20.0%
9th
17.1%
11th
14.6%
7th
31.7%
9th
35.9%
11th
29.3%
7th
31.4%
9th
18.1%
11th
27.3%
7th
35.4%
9th
34.3%
11th
32.1%
7th
34.3%
9th
30.4%
11th
31.1%
7th
26.5%
9th
21.3%
11th
27.7%
Diabetes
The percentage of the Medicare population diagnosed with Diabetes in Crawford, Oscoda, and Roscommon County
exceed the state of Michigan rate of 27.03%. The Diabetes Related Mortality rate of Crawford County at 84.8, and
Roscommon County at 77.8 exceed the state level of 76.1, while Oscoda County is just slightly lower at 75.4.
Diabetes (Medicare
Population)
Mortality Rate Diabetes
Related *
Crawford
Oscoda
Roscommon
Michigan
Source
31.1%
28.65%
29.81%
27.03%
CMS 2012 Community Commons
84.8
75.4
77.8
76.1
MDCH 2010 -2012
Chronic Lower Respiratory Disease and Smoking
The mortality rate for Chronic Lower Respiratory Disease (CLRD) is significantly higher in all three counties than the state
of Michigan average. In the United States, tobacco smoke is a key factor in the development and progression of COPD
as well as heart disease and heart attack, and cancer. With little change from the 2012 assessment, adult smoking rates
were higher in all three counties than the Michigan rate, with the rates in Crawford County being the highest. The rates
of women smoking while pregnant continue to be significantly higher than the Michigan rate in all three counties. In the
regional MiPHY data for Crawford, Ogemaw, Oscoda and Roscommon counties it was reported that 3% of the middle
school students and 10.7% of the high school students smoked cigarettes during the last 30 days..
Mortality Rate Chronic
Lower Respiratory Disease*
Adult smoking
Smoked While Pregnant
Crawford
Oscoda
Roscommon
Michigan
Source
66
61.4
77.7
45.8
2010-2012, MDCH
35%
22%
26%
20%
County Health Ranking 2014
51.5%
29.7%
42.7%
19.8%
MDCH 2012
Dental Health
A lack of dentists is a significant barrier to obtaining adequate dental care. It is more difficult for adult patients with
Medicaid to access dental care in the three county service area. Currently there are no Michigan Community Dental
Clinics in Crawford, Oscoda or Roscommon counties. Participants in the Community Survey listed no dental insurance
and cost of dental care as two of the biggest problems they are having in getting health care services. Residents must
travel outside of the county to receive care at one of these clinics.
In reviewing utilization data for Emergency Room visits at Grayling Hospital for calendar year 2014, 558 patients
sought care in the Emergency Department with dental-related diagnoses. There is a strong relationship between
dental health and overall health.
Dentists
Crawford
Oscoda
Roscommon
Michigan
Source
2,841:1
4,329:1
2,217:1
1,557:1
2015 COMMUNITY HEALTH2015
NEEDS
COMMUNITY
ASSESSMENT
HEALTH NEEDS ASSESSMENT | 16
Alcohol and Substance Abuse
Alcohol consumption continues to exceed the Michigan average in Crawford and Roscommon counties, as do
alcohol-impaired deaths. The excessive drinking measure increased by 12% in Crawford County since the last
assessment measured by the 2011 County Health Rankings. The 2013-2014 MiPHY data below lists the percentage
of students who reported use of alcohol, marijuana, and unprescribed pain medication. Alcohol and substance
abuse is also reported in both the Community and Provider Surveys as one of the most important health problems in
the community. Drug abuse is a major public health problem that impacts society on many different levels.
Crawford
Oscoda
Roscommon
Michigan
Source
Excessive drinking
30%
n/a
22%
18%
Alcohol-impaired driving
deaths
30%
29%
33%
31%
Percentage of students who drank alcohol during the past 30 days
Percentage of students who used marijuana during the past 30 days
Percentage of students who took painkillers such as OxyContin, Codeine, Vicodin or
Percocet without a doctor’s prescription during the past 30 days
7th
8.5%
9th
16.4%
11th
29.7%
7th
4.4%
9th
13.4%
11th
18.5%
7th
2.6%
9th
7.6%
11th
7.7%
Mental Health
A lack of mental health providers is a significant barrier to obtaining adequate mental health care. In the Community
Survey, approximately 40% of the respondents reported that they or an immediate family member had ever been
told by a doctor or another health professional that they had a mental health issue. Among these respondents,
depression (self 18.6%/family member 15.5%) was identified as the most predominant mental health issue,
followed by anxiety (self 18.6%/family member 11%) and attention deficit/hyperactivity disorder (self <1%/family
member 14.5%).
The MiPHY data reports a significant number of middle school and high school students who reported symptoms
of depression and making a plan about how they would commit suicide. 7.5% (29 students) of the high school
students completing the survey reported actually attempting suicide one or more time in the past 12 months.
Grayling Hospital in Collaboration with Northern Lakes Community Mental Health has initiated the Michigan Child
Collaborative Care (MC3) Program in the Munson Healthcare Grayling Physician Network offices to address the
mental health needs of women and children, and has recently hired a MSW, as work is being done to establish
behavior health services in the Munson Healthcare Grayling Physician Network.
Mental Health (continued)
Crawford
Oscoda
Roscommon
Michigan
Source
1,578:1
2,164:1
1,355:1
676:1
Percentage of students who felt so sad or hopeless almost every day for two weeks or
more in a row that they stopped doing some usual activities during the past 12 months
Percentage of students who ever made a plan about how they would attempt suicide
during the past 12 months
Percentage of students who actually attempted suicide one or more times during the
past 12 months
7th
24.6%
9th
29.7%
11th
36.8%
9th
13.4%
11th
15.9%
9th
7.9%
11th
7.1%
Sexually Transmitted Disease
The reported number of cases of Gonorrhea reported in 2013 was similar to the average number of cases reported
during 2008-2012. The number of reported cases of Chlamydia in 2013 was comparable to the average number
of cases 2008-2012 in Crawford and Oscoda counties, in Roscommon County the rate was up over 70% from an
annual average of 27.4 cases during 2008-2012.
Oscoda
Roscommon
1
1
4
28
7
47
Michigan
Source
Michigan Sexually Transmitted
Disease Section, MDCH
Michigan Sexually Transmitted
Disease Section, MDCH
Teen Pregnancy
The teen pregnancy rate continues to be higher than the Michigan rate for all three counties, with Roscommon
County having the highest teen birth rate. The MiPHY data shows that 8.4% of the 7th grade, 25.1% of 9th grade,
and 54.6% of 11th grade students surveyed reported ever having sexual intercourse.
Teen Pregnancy
Age 15-19/1,000
Crawford
Oscoda
Roscommon
Michigan
Source
42.1
50.5
52.4
41.6
2011-2013, MDCH
Percentage of students who ever had sexual intercourse
Among students who had sexual intercourse during the past three months, the
percentage who used a condom during last sexual intercourse
7th
8.4%
9th
25.1%
11th
54.6%
7th
50.0%
9th
66.7%
11th
56.3%
MiPHY 7th grade n=235 , 9th grade n= 228, 11th grade n = 191
STD: Gonorrhea- Number
of cases reported in 2013
STD: Chlamydia – Number
of cases reported in 2013
Crawford
Maternal and Infant Health
The percentage of Medicaid paid births in each of the three counties is higher than the state average, with
Roscommon County being the highest at 75.2%. At 10.4%, the rate of low birth weight babies born in Crawford
County exceeds the Michigan rate of 8.4%. The percentage of women who smoked while pregnant continues to be
much higher than the Michigan rate in all three counties. Births with adequate prenatal care is below the Michigan
rate in Oscoda County with only 60.3% receiving adequate care. The percentage of women who had excessive
weight gain while pregnant exceeded the Michigan rate in all three counties.
Crawford
Oscoda
Roscommon
Michigan
Source
Medicaid Paid Births
64.2%
55.4%
75.2%
44.8%
MDCH, as provided by the Michigan
Low Birth weight
10.4%
7.3%
6.9%
8.4%
2011-2013, MDCH
Smoked While Pregnant
51.5%
29.7%
42.7%
19.8%
MDCH 2012
79.2%
60.3%
76.7%
68.2%
Community Health, 2011-2013
49.5%
51.5%
47.9%
46.3%
MDCH 2012
Births with adequate
prenatal care
Weight Gain While
Pregnant was excessive
Infant Mortality
Infant mortality is the rate at which babies born alive die before reaching their first birthday. There were 2 infant
deaths in Crawford, 2 in Oscoda and 1 in Roscommon County from 2011-2013. Because the number of deaths is
small, the infant death rate is too small to calculate. The average number of infant deaths has decreased from the
last assessment. The average number of live births in Crawford County shows a decrease in Crawford County of
approximately 18 percent.
Infant Death Rate
Average number of infant
deaths/Infant Deaths
Average number of live
births
Crawford
Oscoda
Roscommon
Michigan
Source
**
**
**
6.8
MDCH 2011-2013
.7/2
.7/2
.3/1
777
MDCH 2011-2013
109
82.3
179
113,533
MDCH 2011-2013
Immunizations
Crawford and Roscommon County’s immunization rates were higher than the Michigan rates. Oscoda County’s
immunization rates were lower than the state rate, and much lower than the Crawford and Roscommon rates for the
1323213 coverage (13-17 years).
Birth dose Hep B
43133142 coverage
(19-35 months)
1323213 coverage
(13-17 years)
1+ flu (6 months through
17 years)
1+ flu (18 years +)
Crawford
Oscoda
Roscommon
Michigan
79.9%
78.2%
84.5%
79.5%
55.7%
48.5%
50.9%
49.1%
36.0%
12.9%
29.9%
18.1%
35.2%
14.7%
31.8%
32.6%
25.8%
16.0%
33.9%
18.0%
Source
County Quarterly Immunization
Report Card, September 30, 2014
Vulnerable Populations
Children
Although the percentage of the population 18 years and under in all three counties is less than the Michigan
average of 22.7%, the number of those children living in poverty and those who are eligible for school free and
reduced price lunch, significantly exceeds that of the state rates. The number of children living in single parent
households exceeds the state rate of 33%, in both Crawford and Roscommon. Of particular concern is the
confirmed cases of child abuse and neglect, which exceeds the state rate in all three counties. With number of
children who are eligible for free and reduced price lunch, there is concern for the availability and access to healthy
foods at home.
Children in poverty
Children in single parent
households
lunch
Child Abuse/Neglect:
Number of Confirmed
Victims/Rate
Crawford
Oscoda
Roscommon
Michigan
Source
18.8%
19.2%
15.4%
22.7%
33%
34%
37%
25%
36%
26%
49%
33%
58.90%
66.90%
72.20%
48.60%
Michigan Department of Education,
as provided by Michigan League
for Public Policy, 2013
43/15.9
35/20.9
103/27.6
14.9
Kids Count in Michigan Data
Profile 2015
NEEDS
COMMUNITY
ASSESSMENT
Seniors
The population of persons over 65 in the three county area is significantly larger with Roscommon having the largest
number of seniors. Roscommon also has the highest median age at 53. Both Crawford and Oscoda County’s median
age is higher than Michigan’s median age of 40.4 years. An aging population generally has greater health needs, as
the risk of many chronic diseases increases as people grow older.
Median Age
Crawford
Oscoda
Roscommon
Michigan
Source
23.2%
25.6%
29.5%
15.0%
48
50
53
40.4
Michigan League for Public Policy,
2014 Fact Sheet
Key Environmental Factors: Appendix V
Homes built before 1950 are at high risk for lead, the number of lead - high risk homes represents the number of
homes in Roscommon County built before 1950. Children who live in these homes or visit them should be screened.
All three counties have an unintentional death rate that exceeds the Michigan rate of 36.7/100,000. Actual numbers
are provided.
Roscommon leads the three county area in suicide deaths. The three county area enjoys good air and drinking water
quality. Severe housing problems are above the state rate in Crawford and Roscommon Counties. Availability of safe
affordable housing is of concern in the three county area.
Crawford
Lead – High Risk Homes
Failed Septic Systems
Unintentional Injuries –
(deaths/100,000)
Fatal injuries: suicide
Motor vehicle accident
mortality
Fatal injuries: other
unintentional
Failed septic systems
Oscoda
Roscommon
Michigan
2052
5591*
1,197,040
36
463
4,130
86.0
89.5
51.1
36.7
2
4
6
1,296
6
0
3
1,047
4
4
12
3,147
463
4,130
36
Source
Michigan Department of Community
Health 2013
Department of Environmental
Quality
Community Health 2010-2012
Community Health, 2013
Air pollution - particulate
matter
11.3
11.3
11.4
11.5
Drinking water violations
0%
0%
6%
1%
Severe housing problems
18%
16%
18%
17%
*According to the 2009-2013 American Community Survey 5-Year Estimates, 5591 housing units in Roscommon County were built before 1950.
21
The respondents were 75.5% female and 24.3% male.
Dial 2-1-1 Northeast Michigan:
Appendix VI
Dial 2-1-1 is a free, easy-to-remember telephone number
that connects people in need with people who can
help - 24 hours a day, 7 days a week. Between January
2014 and December 2014 there were 617 requests from
Crawford County, 225 requests from Oscoda County and
1564 requests Roscommon County. Top service requests
included electric service payment assistance, heating fuel
payment assistance, rent payment assistance, gas service
payment assistance, and food pantries.
Findings from the Community Input
Process: Appendix VII and VIII
Community Participation and Input
In collaboration with District Health Department #10,
two surveys were developed to gain public input into
the Community Health Needs Assessment, a survey of
community members with emphasis on the at-risk and
underserved, and a Health Provider Survey. Additional
input was sought from the community when the county
health ranking data was released in 2014.
Community Survey
The Community Survey was distributed with an
emphasis on the poor and underserved populations of
our counties. 252 residents completed the surveys: 135
from Crawford County, 94 from Roscommon County,
and 20 from Oscoda County, and 3 from counties
outside the three county area. Surveys were distributed
at the AuSable Free Clinic, the Baby and Toddler
Closet in Grayling, the Crawford County Commission
on Aging and Senior Center, the Roscommon County
Senior Center in Houghton Lake, the Oscoda County
Senior Center, to first OB patients, at District Health
Department #10 and at the Project Connect event in
Prudenville. Additional survey information was obtained
for Oscoda County from District Health Department #2.
Here is a summary of the survey findings:
Response by Age
Age Range
Percent of
Surveys
18-24
9.00%
25-34
11.30%
35-44
9.40%
45-54
14.90%
55-64
15.80%
65-74
20.70%
75 and over
18.90%
Response by Household Size
Including yourself, how many
people live in your household?
Percent of
Surveys
1
23.90%
2
38.50%
3-4
27.70%
5-6
7.70%
more than 6
2.30%
Response by Employment Status
Employment Status
Percent of
Surveys
Employed full-time
18.50%
Employed part-time
15.50%
Unemployed
9.50%
Laid off
2.50%
Retired
41.00%
Military/Veteran
1.00%
Student
2.00%
Homemaker
7.50%
Disabled
2.50%
NEEDS
ASSESSMENT
COMMUNITY
What defines a healthy community?
Personal Health:
In the Community survey, the top five factors that
define a “healthy community” were identified as:
Approximately 82% of the respondents reported
having a doctor, care provider or medical home, and
73% reported having insurance for prescriptions. Only
65% of the respondents said their personal health was
good to very good.
• Access to Healthcare
• Safe Neighborhoods and Good Jobs and Healthy
Economy
• Good Schools and Community Involvement
• Healthy Lifestyles and Clean Environment
• Affordable Housing and Access to Affordable
Healthy Foods
What are the most Important Health Problems
in your county?
The respondents ranked the most important health
problems in the following order:
• Alcohol and drug issues
• Use of illegal drugs or medications that weren’t
prescribed
• Overweight and obesity
• Mental Health Issues
Do you leave the county to seek medical
services?
Just over 49% of the respondents report they leave
the county they live in to seek medical services.
Reasons for seeking services outside of the county
include: specialty services are not available, only Nurse
Practitioners are available, family doctor is in nearby
town, the Free Clinic is in Grayling.
Leading Health Problems:
Health problems were reported in the following order
when the respondents were asked: Have you or a
family member ever been told by a doctor or other
health professional that you have any of the following?
Health problems were reported in the following order:
1.Hypertension
6. Hearing Problems
2.Arthritis
7. Chronic Pain
Difficulties Experienced in Getting Healthcare:
3. Vision Problems
8. Dental Health Problems
61.9 % of the respondents reported trouble getting
health care services for themselves or their families.
4.Overweight
9.Diabetes
• Child Abuse and Neglect
The respondents ranked the biggest problems they are
experiencing getting healthcare as follows:
5. High Cholesterol
10. Cancer
How do you pay for your health care?
• Cost of Dental Care
• No Dental Insurance
Medicare
33.80%
• No Vision Insurance
Insurance through employer
21.00%
• No Health Insurance
Medicaid/Health MI Plan
18.30%
Pay cash, no insurance
14.20%
Health insurance bought privately or
purchased on Marketplace
9.60%
Veteran’s Administration
3.10%
• Cost of Health Care in General
• High Deductibles
• Can’t afford medications and existing medical debt
• Transportation Issues and Can’t Afford Visits to
doctor/clinic/hospital
23
Physical Activity
Approximately 27% of the respondents reported doing
moderate physical activity at least 30 minutes daily,
while 11% reported exercising more than three times
per week, 20% 2-3 times per week, and 33% reported
exercising only once a week or not at all.
What is needed in the Community to Help Make
Residents Healthier?
When asked to choose the top three areas that are
needed in the community to help make residents
healthy the respondents ranked the areas in this order:
• Improved access to affordable healthy foods
Obesity
• Increased opportunities for physical activity
Approximately 42% of the respondents considered
themselves or another family member seriously
overweight.
• Improved access to health care
Mental Health
• Increased public education regarding health issues
Of the approximately 40% of respondents who
reported that they or a family member had ever
been told by a doctor or another health professional
that they had any of a list of mental health issues,
depression (self 18.6%/family member 15.1%) was
identified as the most predominant mental health
issue, followed by anxiety (self 18.6%/ family member
11%) and attention deficit/hyperactivity disorder (self
<1%/family member 14.5%).
• Improved access to mental health care
• Improved nutrition and eating habits
• Improved access to dental care
Oscoda County Community Survey
As a part of the Community Health Needs Assessment
that was completed by District Health Department #2,
survey input was received from one hundred community
members in Oscoda County. Below are the responses:
The respondents were 71% female and 29% male.
Alcohol and Tobacco
Approximately 50% of the respondents reported never
using alcohol. While approximately 47% reported
using alcohol occasionally. Approximately 21% report
currently smoking cigarettes or using other tobacco
products.
Response by Age
Age Range
Percent of
Surveys
18-25
18%
26-39
25%
Advanced Directives
40-54
20%
When asked do you have an Advanced Directive,
approximately 28% said yes, while 35% said no, and
another almost 37% reported that they didn’t know
what an advanced directive was!
55-64
12%
65 and over
25%
Health Information
The respondents most frequently responded,
approximately 75%, that they get their health
information from their doctor or health clinic. The
internet and family and friends were other sources of
health information, at approximately 30%.
NEEDS
ASSESSMENT
COMMUNITY
In the last 12 months what difficulties have you
experienced obtaining health care?
• No insurance
• Cannot afford visits
• Lack of healthcare providers
Weight
When asked about ideal weight, 34% of the
respondents answered they needed to lose 11-30
pounds and another 24% answered they needed to
lose 31-50 pounds.
• Can’t afford medications
Smoking
• Difficult to get away from work, lack of convenient
times,
Forty nine percent of the respondents reported that
they are currently using tobacco products or had done
so in the past. The most common form of tobacco used
was cigarettes.
• Waiting list to be seen by doctor
• Transportation issues
• Difficult to set appointments
Alcohol Use
• Don’t know where to go
Thirty nine percent of the respondents reported no
alcohol use, while 54% reported occasional alcohol
use.
Eighty percent of the respondents leave the county to
seek medical services.
Physical Activity
Approximately 36% of the respondents reported
having an exercise routine of 30 minutes or more, most
days of the week, while 38% reported exercising a
minimum of 30 minutes a couple times per week, and
26% reported rarely exercising.
Illegal Drugs or Taking Medications That Aren’t
Prescribed
Sixteen percent of the respondents reported that they
currently or in the past used illegal drugs or had taken
medications that weren’t prescribed for them.
How do you pay for your health care?
Insurance through employer
45%
Medicare
30%
Medicaid
16%
No insurance
14%
Self Pay
9%
Other
6%
Veteran’s Administration
4%
Health insurance
purchased on Marketplace
3%
25
Health Provider Survey:
Appendix IX
A survey was distributed to local physicians, midlevel providers, the case management and nursing
staff at Munson Healthcare Grayling Hospital and
members of the Crawford County Collaborative Body,
the Roscommon County Human Service Collaborative
Body, the Oscoda County Human Services Coordinating
Council, as well as staff of the human service agencies
they represent. The survey was made available on paper
as well as through a Survey Monkey link. A total of 95
providers participated in the survey: 34 from Crawford
County, 24 from Roscommon County, 18 from Oscoda
County, and 19 respondents from outside the 3 county
area.
In the Provider Survey, the top five factors that define a
“healthy community” were identified as:
When asked about the top barriers to their patients
experience obtaining care the following reasons were
cited as:
• Household budget/financial constraints (65.22%)
• Lack of transportation (64.13%)
• Lack of access to mental health services (53.26%)
• Medications are not affordable (43.48%)
• Lack of parenting skills (30.43%)
The resources that the Providers routinely referred their
patients to were as follows:
• Department of Human Services (59.34%)
• Community Mental Health Services (51.65%)
• Community Free Clinic (50.55%)
• Food pantries (42.86%)
• Home care and/or hospice services (37.36%)
• Access to healthcare (56.84%)
• WIC (31.87%)
• Good jobs and Healthy economy (50.53%)
• Dental services (28.57%)
• Healthy lifestyles (41.05%)
• Substance abuse treatment (19.78%)
• Good schools and Strong families (33.68%)
• Pregnancy/prenatal resources (18.68%)
• Community Involvement (25.26%)
• Domestic violence shelter (18.68%)
The Health Providers ranked the most important health
problems in the community as follows:
• Mental health issues (51.06%)
• Alcohol and drug issues (44.68%)
• Use of illegal drugs (37.23%)
• Overweight and obesity (36.17%)
• Chronic diseases (heart disease, cancer, diabetes,
COPD, stroke (28.72%)
• Lack of physical activity (18.09%)
• Chronic pain (18.09%)
• Parenting (15.38%)
Input from the County
Collaborative Bodies
Once the preliminary data was collected, it was
presented to the Collaborative Bodies in Crawford,
Roscommon and Oscoda County. The question again
was asked: “What is the most important Health Need or
Issue in our Community?” Below are the responses from
each of the county collaborative bodies.
Crawford County
Transportation:
• What options are currently available?
• Transportation Summit in September
NEEDS
COMMUNITY
ASSESSMENT
Basic Needs – Focus on Poverty:
• Breathe life into Continuum of Care – shortage of
available affordable housing
• Use United Way ALICE data, KIDS Count data, and
PIT Count
Fitness at any age and in any season::
• Inventory of what is available
• Disability challenges and challenges of older
residents
• For Fall 2015 find a place for residents to walk indoors
Other Community Input
At several community events in Crawford County where
the County Health Rankings data were available for the
community to view, there also was an opportunity for
community members to answer the following questions:
• What is the most important health need in our
community?
• Where do you get your health information?
The responses gathered were similar to those in the
community survey. Top health needs included:
• Access to indoor exercise opportunities in the cold
weather
Oscoda County
• Drug, alcohol and tobacco issues
• Access to dentist for Adults with Medicaid
• Transportation • Teen births
• Mental Health
•Obesity
• Access to Care/ Cost of Care/ Dental Services/ No
Urgent Care/Awareness of Services Available
•Smoking
• Poverty – breaking through the cycle of poverty,
healthy relationships, education, employment
opportunities
• Excessive drinking
• More options for access to healthy foods and
forms of activity for winter months
Roscommon County
• Domestic, sexual and emotional abuse
• Substance abuse
• Teenage pregnancy
• ALICE: Asset Limited, Income Constrained,
Employed – those who are working yet struggling
to make ends meet
Personal Needs:
• Access to healthy foods
•Activity
• Something for kids to do
• Under aged smoking, drinking and drug use
• Fruits and vegetables more convenient and
affordable
• Need information on where to obtain service most
effectively
Domestic Needs:
•Transportation
•Inactivity
• Knowing what is covered by your insurance and
who to contact to get answers
Most people responded that they get health information
from their doctor or health clinic, and the internet.
Michigan Profile for Healthy Youth
(MiPHY) 2013-2014
Key information from the MiPHY was included in:
Findings from the Community and Health Data.
•Education
27
Ranking and Prioritizing the
Findings
A list of health needs was developed by analyzing
survey data, secondary data, and feedback from the
county collaborative bodies. An initial ranking session
was held. The group of key stakeholders, including
hospital board members, medical staff, AuSable Free
Clinic leadership, and representatives from the health
system were given the list of health issues and asked
to rank the issues on a scale of 1 to 5, with 5 being
high. There were four criteria for scoring: severity –
the magnitude and urgency of the issue, feasibility
– are human resources available, infrastructure in
place, financial resources available, and barrier issues
surmountable, potential impact – on the greatest
number of people, and outcomes within three years
– are achievable, measurable outcomes possible in three
years. Health issues were ranked in the following order:
1. Access to Dental Care
2. Chronic Disease: Cardiovascular Disease, Cancer,
Diabetes, Chronic Lower Respiratory Disease
3. Advanced Directives: Not having an Advanced
Director or lack of knowledge of Advanced
Directives
4. Access to Primary Care
5. Education on Health Insurance and Health
Resources
6. Obesity, Physical Activity, Access to Healthy Foods
7. Maternal Infant Health: Access and Coordination
of Prenatal Care and Maternal Infant Services
8. Child and Adolescent Health
Mental Health and Substance Abuse Services
Transportation
9. Senior Services
10. Child Abuse and Neglect
The health issues and priorities identified will be
reviewed by the Community Health Improvement
Committee and an implementation plan that will be
used by the Grayling Hospital will be developed for the
next three years.
Reflections on the Community
Health Needs Assessment
The Process: Lessons Learned and
Recommendations for Future CHNA
The 2015 Community Health Needs Assessment Process
requires collection of a large amount of data and
community input. A rural three county area provided
many challenges in collecting both data and community
input. With small population of the rural counties,
data is sometimes reported as too small to calculate
or not available. Using the community survey data
that was collected by District Health Department #2
helped to strengthen the amount of community data
from Oscoda County. The initial Community Survey was
too long. In order to get input at community events it
was streamlined. Review of the survey questionnaire
is necessary prior to distribution so that questions are
easily understood, meaningful for data collection, yet
minimized in number. Work will continue to find the
best strategies and practices to collect broad community
input, using the available resources.
Data available from secondary sources has some
limitations. Some data was not available for our
counties due to small sample sizes. Mental health data
was limited. MiPHY data was based on 3 of 10 total
districts in Region.
Sharing County Health Rankings data and information
from the CHNA community survey, as well as enlisting
focus group participation of the county collaborative
bodies has led to discussion regarding the use of the
collective impact model to coordinate efforts and work
together to improve the health of the communities we
serve. Continued collaboration with our partners will
be key in the work that will need to be done moving
forward. Coordination of resources and sharing of
NEEDS
COMMUNITY
ASSESSMENT
expertise will be necessary to steward limited resources
while working together to address complex issues and
improve outcomes. The rural nature of our counties will
continue to present us with many challenges.
Conclusion
Munson Healthcare Grayling Hospital will develop
an implementation strategy, or plan, to address the
priority health needs identified in this assessment. This
is a separate document, and will be available on the
hospital website, munsonhealthcare.org/graylinghospital
in the Community Benefit section. Printed copies will
also be available at the hospital (1100 E. Michigan
Avenue, Grayling MI 49738) in the Community Outreach
Department, or by calling (989) 348-0924.
If you have questions, comments or feedback regarding
this CHNA or the implementation strategy, please call
Cheryl Melroy, Community Outreach Coordinator, at
(989) 348-0924, or email at [email protected].
Appendices
I.
Community Data Worksheet
II.
Health Indicator Worksheet
III.
County Health Rankings Data
IV.
MiPHY Data Grid
V.
Environmental Health Data
VI. 2-1-1 Data
VII.
Community Survey
VIII.
Roscommon County Survey
IX.
Provider Survey
X. Health Profile Chart Book 2014
29
Appendix I: Community Data
Data Set
Crawford
Oscoda
Roscommon
Michigan
US
Source
Population
13,904
8,379
24,014
9,895,622
316,128,839
US Census Bureau, 2013 estimate
Population, % change
-1.20%
-3.00%
-1.80%
0.10%
2.40%
US Census Bureau, April 1, 2010 to July 1, 2013
4.20%
4.80%
3.90%
5.80%
6.30%
18.80%
19.20%
15.40%
22.70%
23.30%
23.20%
25.60%
29.50%
15.00%
14.10%
Female persons
49.60%
49.20%
50.20%
50.90%
50.80%
Race: White
97.00%
97.30%
96.90%
80.10%
77.70%
Race: Black or African
American
0.70%
0.20%
0.60%
14.30%
13.20%
Race: American Indian and
Alaska Native
0.70%
0.80%
0.70%
0.70%
1.20%
Race: Asian
0.40%
0.10%
0.50%
2.70%
5.30%
Two or more races
1.20%
1.60%
1.30%
2.20%
2.40%
Hispanic or Latino
1.60%
1.10%
1.50%
4.70%
17.10%
Male marital status: Never
married
24.60%
22.90%
24.50%
34.90%
35.10%
US Census Bureau 2008-2012 American Community
Survey
Male marital status: Now
married, except separated
54.80%
56.80%
56.20%
51.00%
51.10%
Survey
3.00%
1.60%
1.50%
1.20%
1.80%
3.70%
5.10%
3.90%
2.70%
2.50%
13.90%
13.70%
13.90%
10.30%
9.50%
19.80%
20.00%
16.20%
28.80%
28.70%
55.10%
59.20%
52.20%
47.60%
47.40%
0.60%
0.60%
1.10%
1.60%
2.50%
11.80%
10.50%
15.80%
9.60%
9.30%
12.60%
9.60%
14.70%
12.30%
12.00%
67.60%
64.70%
62.00%
66.00%
66.50%
53.40%
52.90%
48.40%
49.00%
49.00%
Survey
5.20%
4.00%
3.50%
4.30%
4.60%
Survey
Male marital status:
Separated
Widowed
Divorced
Female marital status:
Never married
Now married, except
separated
Separated
Widowed
Divorced
Household type: Family
households
Household type: Married
couple family
Household type:
Male householder, no wife
present, family
1
Survey
Survey
Survey
Survey
Survey
Survey
Survey
Survey
Survey
Data Set
Crawford
Oscoda
Roscommon
Michigan
US
Source
Household type: Female
householder, no husband
present, family
9.00%
7.80%
10.10%
12.70%
12.90%
Survey
Household type:
Nonfamily households
32.40%
35.30%
38.00%
34.00%
33.50%
Survey
Household type:
Householder living alone
27.60%
29.40%
32.00%
28.60%
27.50%
Survey
25.00%
21.70%
19.60%
31.60%
33.30%
Survey
34.00%
38.10%
40.50%
25.50%
24.90%
Survey
Persons per household
2.31
2.25
2.11
2.53
2.61
$39,982
$33,942
$34,765
$48,471
$53,046
Households below poverty
level
13.60%
13.90%
14.10%
11.70%
10.90%
Poverty: all ages
19.70%
21.20%
18.80%
17.40%
Not included
Poverty: ages 0-17
32.60%
34.00%
36.70%
24.70%
Not included
Poverty: ages 5-17
29.90%
31.80%
33.60%
22.70%
Not included
Children ages 0-18 insured
by Medicaid
46.80%
49.80%
62.80%
40.80%
Not included
Michigan Department of Human Services, as provided
by Michigan League for Public Policy, 2013
Medicaid paid births
64.20%
55.40%
75.20%
44.80%
Not included
Michigan Department of Community Health, as
provided by Michigan League for Public Policy, 2012
In labor force and
unemployed
8.50%
7.70%
6.60%
7.80%
6.00%
Unemployed
16.30%
16.50%
15.50%
12.60%
9.30%
10.70%
14.60%
12.50%
8.80%
Not included
58.90%
66.90%
72.20%
48.60%
Not included
Michigan Department of Education, as provided by
Michigan League for Public Policy, 2013
n/a
n/a
Health Resources and Services Administration, US
Department of Health and Human Services, 2014
7.5
n/a
County Health Rankings, 2014
Households with one or
more people under 18
years old
Households with one or
more people 65 years and
over
Unemployment (in labor
force)
lunch
Health Professional
Shortage Area
Food deserts/retail food
index score
2 Primary 2 Primary 5 Primary Care
Care HPSAs Care HPSAs
HPSAs
7.7
7.6
7.1
Food environment index
Food Stamps (SNAP)
Disparity Index
2
Survey
Survey
Survey
US Census Bureau and Small Area Income and
Poverty Estimates (SAIPE), as provided by Michigan
Survey
Survey
Bureau of Labor Statistics, as provided by Michigan
Data Set
Crawford
Oscoda
Roscommon
Michigan
US
Source
Food Stamp/SNAP benefits
in the past 12 months
19.70%
20.60%
21.90%
15.80%
11.40%
Survey
5.40%
6.30%
5.50%
7.70%
9.00%
Survey
1,168:1
Not
available
3,488:1
1,268:1
n/a
Violent crime
320
323
188
478
n/a
Occupation: Management,
business, science, arts
27.90%
24.30%
22.50%
34.20%
35.90%
Survey
Service occupations
24.40%
23.40%
22.90%
18.60%
17.80%
Sales and office
occupations
22.10%
25.80%
31.40%
24.80%
24.90%
Natural resources,
construction, maintenance
occupations
9.30%
10.70%
8.60%
7.90%
9.30%
Survey
Production,
transportation, material
moving occupations
16.30%
15.80%
14.50%
14.60%
12.10%
Survey
19.90%
21.80%
24.20%
13.50%
12.00%
37.80%
41.90%
37.50%
30.70%
28.20%
8.40%
5.70%
8.50%
8.40%
7.70%
10.10%
6.90%
9.60%
15.70%
17.90%
5.20%
2.70%
4.90%
9.80%
10.60%
84.80%
81.90%
85.40%
88.70%
85.70%
15.20%
9.60%
14.50%
25.50%
28.50%
98.30%
92.60%
97.50%
91.00%
79.50%
55.60%
74.30%
33.90%
40.90%
39.80%
Vehicle Access: no vehicles
available
Access to primary care:
ratio of primary care
physicians
Homeless census
Population with any
disability
Population with high
school diploma
Population with
associate’s degree
Population with bachelor’s
degree
Population with graduate
or professional degree
High school graduate or
higher
Bachelor’s degree or
higher
Language spoken at home:
English only
Grandparents living with
and responsible for
grandchildren under age
18
3
Survey
Survey
Survey
Survey
Survey
Survey
Survey
Survey
Survey
Survey
Survey
**
**
20.83%
13.8%
Population with any disability
Percent of births to teens under
age 20
60.2
**
50.9
51.71%
**
29.65%
247.3
**
84.8
31.1%
Crawford
Asthma:
Ever told
Current
CLRD (deaths/100,000) 3 year
age adjusted rate
Stroke:
Ever told
Stroke(deaths/100,000) 3 year
age adjusted rate
High Blood Pressure (Medicare
Population)
Cardiovascular disease:
Ever told
Heart Disease (Medicare
Population)
Cardiovascular disease
mortality, age adjusted per
100,000
Diabetes:
Ever told
Diabetes Related Mortality
Diabetes (Medicare Population)
Data Set
Appendix II. Health Indicator Worksheet
11.9%
22.02%
**
**
54.1
**
**
50.11%
**
34.63%
337.5
**
75.4
28.65%
Oscoda
12.3%
24.53%
24.9%
**
81.8
**
38.8
58.97%
19.5%
34.81%
306.6
23.8%
77.8
29.81%
Roscommon
8.7%
13.73%
15.6%
10.6%
45.6
3.4%
38.4
57.28%
9.8%
34.35%
255.9
10.3%
65.8
27.03%
Michigan
12.13%
55.49%
US
1
Michigan Department of Community Health, as
provided by Michigan League for Public Policy,
2012
ACS 2009-2013 Community Commons
Michigan Behavioral Risk Factor Survey, 20112013
Michigan Department of Community Health,
2010-2012
2010-2012
2010-2012
2010-2012
Source
51.5%
45.41%
**
High Cholesterol (Medicare
Population)
Cholesterol ever checked
**
38.04%
45
80
84
49.5%
Weight gain while pregnant was
excessive
29.7%
21
1
17
51.5%
Smoked while pregnant
**/2deaths
78.2%
48.5%
12.9%
14.7%
16.0%
**/2 deaths
Infant Deaths
13
60.3%
7.3%
50.5
Oscoda
79.9%
55.7%
36.0%
35.2%
25.8%
79.2%
Births with adequate prenatal
care
Immunizations:
Birth dose Hep B
43133142 coverage (19-35 mos)
1323213 coverage (13-17 years)
1+ flu (6 mos through 17 years)
1+ flu (18 years +)
Immunizations: County Rank in
Michigan n=84
43133142 coverage (19-35 mos)
1323213 coverage (13-17 years)
Flu coverage (6 mos-17 years)
10.4%
Low birth weight babies
26
42.1
Teen pregnancy rate
ages 15-19/1,000
Estimated number of Teen
Pregnancies ages 15-19
Crawford
Data Set
31
**
53.38%
38
9
36
84.5%
50.9%
29.9%
31.8%
33.9%
47.9%
42.7%
**/1 death
76.7%
6.9%
52.4
Roscommon
82.1%
45.33%
79.5%
49.1%
18.1%
32.6%
18.0%
46.3%
19.8%
6.9
68.2%
8.4%
41.6
Michigan
44.75%
74.2%
56.6%
41.5%
US
2
County Quarterly Immunization Report Card,
September 30, 2014
County Quarterly Immunization Report Card,
September 30, 2014
2012
2012
2011-2013
2011-2013
2011-2013
MDCH-Live Births and Estimated Pregnancies
by Age of Woman, Crawford County Residents,
2013
2011-2013
Source
32.0%
Tobacco use: current smoker
0
STD: Syphilis/100,000
180.7
Cancer deaths/100,000
7,191
**
Premature deaths
Alcohol use (heavy drinking)
Prostate
Lung and bronchus
Breast
Colon and rectum
All other sites
Total
60.0
92.6
39.5
41.1
252.5
485.6
19
Hepatitis C
Cancer incidence/age adjusted
per 100,000
28
STD: Chlamydia – Number of
cases reported in 2013
STD: Chlamydia/100,000
1
STD: Gonorrhea-Number of
cases reported in 2013
STD: Gonorrhea/100,000
Crawford
Data Set
**
10,183
47.7
72.0
54.5
55.2
202.6
431.9
192.2
7
0
1
**
Oscoda
**
8,525
75.8
87.4
60.1
48.6
246.0
517.9
211.9
47
**
4
21.5%
Roscommon
6.4%
7,254
73.7
70.7
65.1
44.3
234.3
488.1
178.1
455.7
10.9
106.6
22.7%
Michigan
US
3
County Health Rankings 2014 – National Center
for Health Statistics 2008-2010 (Years of
potential life lost before age 75 per 100,000
population (age-adjusted))
2007-2011
2012
DHD County Specific Communicable Disease
Reporting 2013-2014
Michigan Sexually Transmitted Disease Section,
MDCH
2013
2013
Michigan Sexually Transmitted Disease Section,
MDCH
2013
Source
Crawford
48.0%
20.0%
17.1%
14.6%
30%
16.4%
16.6%
13.5%
Data Set
Overweight adults (BMI 25-30)
Overweight youth (at or above
th
the 85 percentile and below
th
the 95 percentile for BMI by
age and sex)
th
7 grade
th
9 grade
th
11 grade
Obesity: adult BMI >30
Obesity: youth (at or above the
th
95 percentile for BMI by age
and sex)
th
7 grade
th
9 grade
th
11 grade
30%
**
Oscoda
33%
42.1%
Roscommon
32%
34.5%
Michigan
US
4
Crawford, Ogemaw, Oscoda and Roscommon
counties, 2013-2014
CDC Diabetes Interactive Atlas, County Health
Rankings 2014
Crawford, Ogemaw, Oscoda and Roscommon
counties, 2013-2014
Source
Appendix III.
1
Appendix III.
Michigan
Crawford (CR)
Oscoda (OC)
Roscommon (RO)
Health Outcomes
7,254
14%
3.6
3.7
8.4%
20%
32%
7.5
24%
78%
18%
31%
502
32
14%
1,268:1
1,522:1
661:1
70
85%
65.4%
76%
65.0%
9.1%
25%
20%
33%
478
59
11.5
1%
17%
83%
32%
58
49
7,191
66
8.7%
71
80
35%
30%
7.7
24%
91%
30%
30%
171
44
25
14%
1,168:1
2,802:1
1,557:1
55
87%
68.2%
69
73%
51.4%
10.1%
33%
36%
320
63
32
11.3
0%
18%
78%
26%
77
80
10,183
25
7.7
4.5%
66
23
22%
30%
7.6
25%
85%
29%
70
31
61
17%
4,296:1
2,148:1
69
89%
67.0%
79
50.8%
15.1%
34%
13%
26%
323
97
16
11.3
0%
16%
75%
26%
71
74
8,525
64
24%
4.4
4.2
6.8%
77
65
26%
33%
7.1
30%
92%
22%
33%
98
38
50
15%
3,488:1
2,191:1
1,339:1
73
90%
69.7%
80
64%
55.2%
11.5%
37%
17%
49%
188
77
39
11.4
6%
18%
77%
31%
Length of Life
Premature death
Quality of Life
Poor or fair health
Poor physical health days
Poor mental health days
Low birthweight
Health Factors
Health Behaviors
Adult smoking
Adult obesity
Food environment index
Physical inactivity
Access to exercise opportunities
Excessive drinking
Alcoholimpaired driving deaths
Sexually transmitted infections
Teen births
Clinical Care
Uninsured
Primary care physicians
Dentists
Preventable hospital stays
Diabetic monitoring
Mammography screening
Social & Economic Factors
High school graduation
Some college
Unemployment
Children in poverty
Inadequate social support
Children in singleparent households
Violent crime
Injury deaths
Physical Environment
Air pollution particulate matter
Drinking water violations
Severe housing problems
Driving alone to work
Long commute driving alone
2
Appendix III.
Michigan
Crawford (CR)
Oscoda (OC)
Roscommon (RO)
9,883,360
22.9%
14.6%
14.0%
0.7%
2.5%
0.0%
4.5%
76.4%
1.5%
50.9%
25.4%
14,009
19.3%
22.2%
0.4%
0.6%
0.4%
0.0%
1.5%
96.1%
0.2%
49.8%
72.6%
8,592
19.5%
24.6%
0.2%
0.7%
0.1%
0.0%
1.1%
96.7%
0.5%
49.6%
100.0%
24,106
15.5%
28.9%
0.4%
0.6%
0.4%
0.0%
1.2%
96.4%
0.2%
50.2%
66.1%
11%
169
362.2
7.8
58.0
11%
369.0
14%
474.0
16%
49
400.0
84.9
18%
6%
11
12
14%
7%
20
18%
0%
25
19
16%
9%
14
21
17%
4%
13%
1,605:1
17%
5%
$10,273
1,274:1
21%
7%
$9,830
4,296:1
18%
5%
$9,995
19%
1,148:1
Children eligible for free lunch
$46,793
41%
$37,169
53%
$33,046
55%
$34,536
57%
Homicides
7
Demographics
Population
% below 18 years of age
% 65 and older
% NonHispanic African American
% American Indian and Alaskan Native
% Asian
% Native Hawaiian/Other Pacific Islander
% Hispanic
% NonHispanic white
% not proficient in English
% Females
% Rural
Health Outcomes
Diabetes
HIV prevalence
Premature ageadjusted mortality
Infant mortality
Child mortality
Health Behaviors
Food insecurity
Limited access to healthy foods
Motor vehicle crash deaths
Drug poisoning deaths
Health Care
Uninsured adults
Uninsured children
Health care costs
Could not see doctor due to cost
Other primary care providers
Social & Economic Factors
3
Appendix IV.
MiPHY Crawford, Roscommon, Oscoda, and Ogemaw Counties, 2013-2014
th
th
th
3 of 10 districts participating /3 of 14 buildings/ 7 grade: n= 235, 9 grade: n=228 , 11 grade: n=191
Alcohol Use
7th
9th
11th
7th
9th
11th
7th
9th
11th
Percentage of students who ever drank alcohol
*Percentage of students who drank alcohol during the past 30 days
Percentage of students who have ever been drunk
38.5%
68.5%
8.5%
16.4%
29.7%
21.7%
52.5%
Drinking and Driving/Riding
Percentage of students who ever rode in a car driven by someone who had been drinking alcohol
Percentage of students who rode in a car or other vehicle driven by someone who had been drinking
alcohol one or more times during the past 30 days
Percentage of students who rode in a car or other vehicle driven by someone who had been drinking
alcohol one or more times during the past 30 days
7th
9th
11th
7th
9th
11th
7th
9th
11th
21.0%
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
28.3%
48.1%
70.2%
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
11.8%
40.8%
66.8%
14.1%
13.9%
2.6%
4.8%
Smoking
Percentage of students who reported sort of easy or very easy to get cigarettes
Percentage of students who ever smoked a whole cigarette
*Percentage of students who smoked cigarettes during the past 30 days
Among Students who are current smokers, the percentage who tried to quit smoking during the
past 12 months
The percentage of students who used chewing tobacco, snuff or dip during the past 30 days.
24.1%
39.7%
3.0%
7.8%
14.1%
56.3%
50.0%
2.1%
3.2%
8.7%
Other Drugs
Percentage of students who reported sort of easy or very easy to get marijuana
Percentage of students who ever tried marijuana
Percentage of students who used marijuana during the past 30 days
Percentage of students who took painkillers such as OxyContin, Codeine, Vicodin or Percocet without
a doctor’s prescription during the past 30 days
Percentage of students who were offered, sold, or given an illegal drug on school property by
someone during the past 12 months
24.3%
42.5%
4.4%
13.4%
18.5%
2.6%
7.6%
7.7%
2.7%
12.6%
15.6%
1
Appendix IV.
th
th
th
Physical Health
Percentage of students who saw a doctor or health care provider for a check-up or physical exam
when they were not sick or injured during the past 12 months
Percentage of students who were exposed to second hand smoke during the past 7 days
Percentage of students who were exposed to second hand smoke daily during the past 7 days
Percentage of students who had ever been told by a doctor or nurse that they had asthma
Percentage of students who had ever been told by a doctor or nurse that they had asthma and still
have asthma
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
62.0%
70.7%
55.7%
54.7%
61.9%
23.7%
23.4%
26.5%
17.6%
18.5%
22.1%
12.2%
10.7%
14.9%
7th
9th
11th
9th
11th
9th
11th
8.4%
25.1%
54.6%
11.8%
40.7%
20.0%
21.8%
7th
6.7%
9th
11th
8.3%
19.4%
7th
50.0%
9th
11th
9th
11th
9th
11th
66.7%
56.3%
4.1%
7.0%
2.4%
5.1%
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
15.8%
Sexual Behavior
Percentage of students who ever had sexual intercourse
Percentage of students who had sexual intercourse during the past 3 months
Of students who ever had sexual intercourse, the percentage whose first partner was 3 or more
years older
Among students who had sexual intercourse, the percentage who drank alcohol or used drugs
before last sexual intercourse
Among students who had sexual intercourse during the past three months, the percentage who
drank alcohol or used drugs before last sexual intercourse
Among students who had sexual intercourse during the past three months, the percentage who used
a condom during last sexual intercourse
Among students who had sexual intercourse during the past three months, the percentage who used
a condom during last sexual intercourse
Percentage of students who have ever been physically forced to have sexual intercourse when they
did not want to
Percentage of students who had ever been pregnant or gotten someone else pregnant
Suicide
Percentage of students who ever seriously considered attempting suicide
Percentage of students who ever made a plan about how they would attempt suicide
Percentage of students who ever tried to kill themselves
Percentage of students who felt so sad or hopeless almost every day for two weeks or more in a row
that they stopped doing some usual activities during the past 12 months
Percentage of students who ever seriously considered attempting suicide during the past 12 months
Percentage of students who ever made a plan about how they would attempt suicide during the past
12 months
Percentage of students who actually attempted suicide one or more times during the past 12 months
12.5%
5.9%
24.6%
29.7%
36.8%
20.1%
16.9%
13.4%
15.9%
7.9%
7.1%
2
Appendix IV.
th
th
th
Weight
Percentage of students who are obese (at or above the 95th percentile for BMI by age and sex)
Percentage of students who are overweight (at or above the 85th percentile and below the 95th
percentile for BMI by age and sex)
Percentage of students who were trying to lose weight
7th
9th
11th
7th
9th
11th
7th
9th
11th
16.4%
16.6%
13.5%
20.0%
17.1%
14.6%
56.0%
43.6%
43.9%
7th
9th
11th
7th
9th
11th
7th
9th
11th
31.7%
35.9%
29.3%
31.4%
18.1%
27.3%
35.4%
34.3%
32.1%
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
7th
9th
11th
34.3%
30.4%
31.1%
24.4%
18.7%
15.4%
26.5%
21.3%
27.7%
45.2%
47.1%
35.4%
10.5%
9.5%
8.5%
Physical Activity
Percentage of students who were physically active for a total of at least 60 minutes per day on five
or more of the past seven days
Percentage of students who watched three or more hours per day of TV on an average school day
Percentage of students who played video or computer games or use a computer for something that
is not school work three or more hours per day on an average school day
Nutrition
Percentage of students who ate five or more servings per day of fruits and vegetables during the
past seven days
Percentage of students who drank three or more glasses per day of milk during the past seven days
Percentage of students who drank a can, bottle, or glass of soda or pop one or more times per day
during the past seven days
Percentage of students who had breakfast every day in the past seven days
Percentage of students who did not eat breakfast in the past seven days
3
12
44
0
2
1
2,052
2
1,300
2
6
4
36
Food/water/vector-borne
diseases diagnosed
Animal bites/exposures
Animals positive-rabies
w/exposure occurring
Toxic chemical releases
Lead poison cases/levels
Lead-high risk homes
Radon poison cases
Radon at-risk homes
Fatal injuries: suicide
Motor vehicle accident
mortality
Fatal injuries: other
unintentional
Failed septic systems
4
0
4
Oscoda
463
12
3
6
0
0
5591*
0
0
4
63
4,130
3,147
1,047
1,296
545,000
Unknown
1,197,040
2,031
3,056
41
3,800
Unknown
Unknown
33,561
40,600
Unknown
Unknown
Unknown
535,000
54,050
6,154
800,000
900,000
2 Food
2 Water
0 vector
2,541
US
Roscommon Michigan
Appendix V.
Department of Environmental Quality
2013
2013
2013
Environmental Protection Agency
Department of Environmental Quality
Michigan Department of Community Health
Centers for Disease Control
Environmental Protection Agency
Centers for Disease Control
District Health Department #10, Michigan
Veterinary Association
1
District Health Department #10, Michigan
Disease Surveillance System, Centers for Disease
Control
Source
*The best measure I have of homes at high-risk for lead is the number of homes built before 1950. According to the 2009-2013 American
Community Survey 5-Year Estimates, 5591 housing units in Roscommon County were built before 1950.
Crawford
Data Set
Environmental Health Data Grid
Appendix VI.
2014 Top 10 Needs 2-1-1
Crawford
Roscommon
Oscoda
327
91
33
17
13
10
9
9
9
9
Electric Service Payment Assistance
Heating Fuel Payment Assistance
Rent Payment Assistance
Home Rehabilitation Grants
Gas Service Payment Assistance
Undesignated Temporary Financial Assistance
Community Shelters
Food Pantries
Home Rental Listings
Specialized Information and Referral
810
136
124
94
68
22
17
15
13
13
Gas Service Payment Assistance
Food Pantries
General Legal Aid
Property Tax Payment Assistance
Veteran Benefits Assistance
88
34
11
9
7
6
5
4
4
3
Home Rehabilitation Grants
Mortgage Payment Assistance
Veteran Benefits Assistance
Food Pantries
Community Shelters
1
Appendix VII.
1
Appendix VII.
2
Appendix VII.
3
Appendix VIII.
CHNA Roscommon FY2015
1. How do you pay for your health care?
2. What are the biggest problems you or your family are having in getting health care
services? Check all that apply.
 Pay cash, no insurance




 Health insurance through employer




 Transportation issues




 Health insurance bought privately or purchased on Marketplace




 Finding a doctor




 Medicaid/Healthy Michigan Plan




 Too busy to get to doctor




 Medicare




 No health insurance




 Veteran's Administration




 High deductibles




 High co-pays for office visits




Other (please specify)
 No vision insurance




 No dental insurance




 Finding a dentist




 Cost of dental care




 Insurance limited in coverage




 Difficult to set appointments




 Do not know where to go




 Cannot afford medications




 I can't find a doctor to accept me as a patient




 My doctor dropped me as a patient for missing appointments




 Cannot afford visits to doctor/clinic/hospital




 Existing medical debt




 Getting specialist care




 Getting pregnancy care




 Racial or ethnic prejudice




 Medications not covered by insurance




 ER waiting time




 Cost of health care in general




 Lack of access to urgent care




 Lack of access to mental health services




Page 1
8. How often do you do moderate physical activity for 30 minutes (running, walking,
bicycling, golf, working out in a gym, etc.)?
3. Do you have...
a doctor, health care
Page 2
Yes
No










insurance for prescriptions?










 Once a week




difficulty filling out medical










 2-3 times a week




 Every day




provider, or medical home?
or insurance forms and
 More than 3 times a week




other paperwork?
 Not at all




4. Does your spouse have...
Yes
No
I don't have a spouse






























provider, or medical
home?
 No




 Myself




5. Do your children under the age of 18 have...
I don't have children under the age of
Yes
No






























annual medical checkups















9. Do you consider yourself or a member of your family seriously overweight? Check all
that apply.
18
 My spouse




 A child




 Other family member




provider, or medical
home?
10. How often do you use alcohol?
 Never




even if they are not sick?
 Occasionally




6. How would you rate health care in your community?
 Daily




Very poor
Poor
Fair
Good
Very good
Ability to get appointments

























Quality of care

























Information about options

























Cost

























 Binge drinking (five or more drinks)




11. Do you currently smoke cigarettes or use other tobacco products?
 Yes




 No




7. In general, how would you say your personal health is?
12. Does your home have safe drinking water and working plumbing?
 Very good




Yes
No
 Good




Safe drinking water










 Fair




Working plumbing










 Poor




 Very poor




Page 3
Page 4
1
Appendix VIII.
13. In the following list, what do you think are the most important factors that define a
"healthy community"? Please check THREE.
15. In the following list, what do you think are the most important health problems in your
county? Please check THREE.
 Community involvement




 Motor vehicle crashes




 Safe neighborhoods




 Rape/sexual assault




 Low levels of child abuse




 Mental health issues




 Good schools




 Homicides




 Access to health care




 Child abuse and neglect




 Parks and recreation




 Lack of access to dental care




 Clean environment




 Use of illegal drugs or medications that weren't prescribed




 Affordable housing




 Suicide




 Tolerance for diversity




 Teenage pregnancy




 Good jobs and healthy economy




 Domestic violence




 Strong family life




 Firearm-related injuries




 Healthy lifestyles




 Sexually transmitted diseases




 Low death rate and disease rates




 Infectious disease (TB, Hepatitis)




 Religious or spiritual values




 Lack of physical activity




 Arts and cultural events




 Chronic pain




 Access to affordable healthy foods




 Alcohol and drug issues




 Lack of access to health care




 Chronic diseases (heart disease, cancer, diabetes, COPD, stroke)




14. Do you have an advanced directive?
 Aging problems (arthritis, hearing/vision loss, etc.)




 Yes




 Tobacco use




 No




 Homelessness




 I don't know what an advanced directive is




 Overweight and obesity




 Lack of access to affordable healthy food




16. Do you leave the county to seek medical services?
 Yes




 No




If yes, why?
Page 5
Page 6
17. Please check the top THREE areas that you think are needed in the community to help
make residents healthier.
20. What is your current employment status?
 Employed full time




 Increased public education regarding health issues




 Employed part time




 Improved nutrition and eating habits




 Unemployed




 Improved access to affordable healthy foods




 Laid off




 Increased opportunities for physical activity in the community




 Retired




 Improved community environmental quality, including clean air and water




 Military/Veteran




 Improved access to health care




 Student




 Homemaker




 Improved access to mental health care




 Improved access to dental care




 Reduction in crime




18. What is your gender?
 Female




 Male




19. What is your age?
 18-24




 25-34




 35-44




 45-54




 55-64




 65-74




 75 or over




Page 7
Page 8
2
Appendix IX.
Health Provider - Community Health Needs Assessment FY2015
3. In the following list, what do you think are the most important factors that define a
"healthy community"? Please check THREE.
1. Where do you live?
 Community involvement




 Crawford County




 Safe neighborhoods




 Oscoda County




 Low levels of child abuse




 Roscommon County




 Good schools




If you don't live in one of the counties listed above, please list your county.
 Access to health care




 Parks and recreation




2. Which hospital are you primarily affiliated with?
 Tawas St. Joseph




 West Branch Regional Medical Center




 Mercy Hospital Grayling




 Mid-Michigan Medical Center




 McLaren Bay Region




 Clean environment




 Affordable housing




 Tolerance for diversity




 Good jobs and healthy economy




 Strong family life




 Healthy lifestyles




 Low death rate and disease rates




 Religious or spiritual values




 Arts and cultural events




 Access to affordable healthy foods




4. In the following list, what do you think are the most important health problems in your
community? Please check THREE.
5. What do you think are the top barriers your patients experience in obtaining care?
Please check THREE.
 Motor vehicle crashes




 Medications are not affordable




 Rape/sexual assault




 Lack of access to mental health services




 Mental health issues




 Household budget/financial constraints




 Homicides




 Lack of parenting skills




 Lack of access to dental care/dental issues




 Lack of self confidence




 Child abuse and neglect




 Struggles with grief and loss




 Use of illegal drugs




 Medical debt




 Suicide




 Lack of transportation




 Teenage pregnancy




 Communication barriers




 Domestic violence




 Lack of senior services




 Firearm-related injuries




 Sexually transmitted diseases




 Lack of access to adult day care




 Infectious disease (TB, Hepatitis)




 Lack of physical activity




6. What community resources do you routinely refer patients to?
 Chronic pain




 Community Free Clinic




 Alcohol and drug issues




 Community Mental Health Services




 Lack of access to health care




 Department of Human Services




 Chronic diseases (heart disease, cancer, diabetes, COPD, stroke)




 Home care and/or hospice services




 Aging problems (arthritis, hearing/vision loss, etc.)




 Intermediate School District or Educational Services District




 Tobacco use




 Substance abuse treatment




 Homelessness




 Dental services




 Overweight and obesity




 Food pantries




 Lack of access to affordable healthy foods




 Pregnancy/prenatal resources




 WIC




 Parenting




 Domestic violence shelter




1
4.2%
18.8%
23.2%
Persons under 5
years
Persons under
18 years
Persons 65 years
and over
15.2%
16.8%
Bachelor’s
degree or higher
Persons below
poverty
High school
graduates
85.4%
13,904
Total population
Education:
Crawford
Population:
20.2%
10.4%
82.6%
25.6%
19.2%
4.8%
8,379
Oscoda
Demographics
22.2%
12.9%
85.1%
29.5%
15.4%
3.9%
24,014
Roscommon
9,895,622
Michigan
16.8%
25.9%
88.9%
15.0%
22.7%
5.8%
Population is 2013 estimate.
Age and race, 2013.
Education based on persons over age 25, 2009-2013.
Income and poverty data, 2009-2013.
Jobless rate
Median
household
income
Income:
Hispanic
8.6
$40,295
1.6%
0.4%
0.7%
American
Indian/Alaska
Native
Asian
0.7%
97.0%
Crawford
Black
White
Race and
Ethnicity:
11.1
$33,329
1.1%
0.1%
0.8%
0.2%
97.3%
Oscoda
10.0
$33,334
1.5%
0.5%
0.7%
0.6%
96.9
Roscommon
7.2
$48,441
4.7%
2.7%
0.7%
14.3%
80.1%
Michigan
Source: US Census Bureau
Source for jobless rate: Michigan Department of Technology,
Management and Budget; Local Area Unemployment Statistics, 2014.
•
•
•
•
3
2004
87
143
207
2005
76
132
196
Births
2006
97
154 154
Crawford
2007
78
131
202
While the information collected is very helpful in
determining health status of a community, there are
limitations to the data. The main considerations are:
• Differences in results are found among various data
sources, even when reporting on the same variable.
• Small sample size may be of concern in rural areas and
data may not be available at the county level.
Using similar indicators, this Chartbook looks at available
data in Crawford, Oscoda, and Roscommon counties.
Comparisons are made to Michigan. In addition,
comparisons are made to the Healthy People 2020 targets,
when available.
This Chartbook is based on the Michigan Health Profile
Chartbook, compiled by the Michigan Department of
Community Health.
Introduction
9
10
11
12
Mortality Rates:
Cancer, Cardiovascular Disease, and Diabetes
CVD Hospital Discharges
Cancer Incidence
Fatal Injuries
173
2009
82
136
17
16
2011
80
114
Roscommon
2010
72
133
163
195
2012
103
101
171
2013
66
110
171
Source: Michigan Department of Community Health
Number of births by year
Immunizations
Health Behavior Risk Factors:
Obesity, Overweight, Smoking, Physical Activity and Binge Drinking
Oscoda
2008
85
133
177
8
Leading Causes of Death
14-15
7
Access to Health Care
Birth Related
5-6
Poverty
13
3-4
Demographics
Sexually Transmitted Diseases:
Gonorrhea and Chlamydia
Page
Table of Contents
4
2
Poverty
ages 0-17
24.7%
WIC
63.6%
48.6%
2,802:1
1,557:1
Dentists
Mental health
providers
2,148:1
4,296:1
n/a
Oscoda
1,339:1
2,191:1
3,488:1
Roscommon
661:1
1,522:1
1,268:1
Michigan
February 9, 2015
Crawford – 946
Oscoda – 566
Roscommon – 1930
Mental health providers include psychiatrists, clinical psychologists, clinical social workers, psychiatric nurse
specialists, and marriage and family therapists who meet certain qualifications and certifications. Source: County
Health Rankings, 2014.
1,168:1
Primary care
physicians
Crawford
10.7%
14.6%
12.5%
8.8%
7
Medicaid paid Unemployment
births
5
44.8%
75.2%
64.2%
55.4%
Healthy Michigan Plan
County Enrollment :
Free/reduced
lunch
66.9%
58.9%
72.2%
Number of people per health care provider
Poverty
ages 5-17
22.7%
70.5%
101.5%
98.6%
Source: Michigan League for Public Policy provided data from the US Census Bureau and
Small Area Income and Poverty Estimates (SAIPE); Michigan Department of Education;
Michigan Department of Community Health; and Bureau of Labor Statistics.
33.6%
31.8%
29.9%
Access to
Health Care
Poverty all ages
21.2%
19.7% 18.8%
17.4%
36.7%
34.0%
32.6%
Michigan
Roscommon
Oscoda
Crawford
Poverty
• Poverty status is based on those living below the poverty threshold in 2012.
• WIC (Women, Infants, and Children) is determined by the number of children age 0-4
who received benefits in Crawford County in 2013. Data reflect the county of service.
• School children eligible for free and reduced price lunch is based on family income
below 185 percent of poverty in 2013.
• Percent of births paid by Medicaid in 2012, based on a three year average.
• Unemployment is based on the number of unemployed compared to the number in
the labor force in 2013.
30.6%
35.1%
Oscoda - children 0-17
Roscommon - children 0-17
*
*
Pneumonia/Influenza
Suicide
*
Diabetes
*
*
Alzheimer’s
Kidney disease
86.0
50.9
Accidents
Stroke
60.2
183.1
Cancer
Chronic lower
respiratory disease
188.2
Crawford
Heart disease
Causes of Death
Leading Causes of Death
29.9%
Crawford - children 0-17
2008
19.3%
Michigan - children 0-17
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Poverty Trend Data:
Children Age 0-17
*
*
*
*
*
89.5
*
54.1
210.9
314.3
2010
2011
35.8%
33.2%
29.6%
26.4%
2012
36.7%
34.0%
32.6%
24.7%
* too small to calculate
Leading causes of death are rates per 100,000 population,
Three year average Age-Adjusted Mortality Rates 20102012.
39.4%
36.0%
27.8%
23.4%
*
*
*
*
18.8
51.1
38.8
81.8
203.3
247.1
Roscommon
12.4
14.0
14.3
23.7
24.7
36.7
38.4
45.6
178.1
201.0
Michigan
Source: Michigan Department of Community Health.
Oscoda
42.1%
32.9%
31.2%
22.2%
2009
Source: US Census Bureau and Small Area Income and
Poverty Estimates (SAIPE) website, provided by Michigan
League for Public Policy.
8
6
60.0
Cancer
160.0
Crawford
178.1
211.9
Prostate
47.7
21.1
Crawford
75.8 73.7
72.0
Lung
45.5
Roscommon
70.7
Roscommon
Healthy People 2020
431.9
485.6
517.9
Roscommon
Breast
Michigan
39.5
54.5
60.1
20.6
41.1
48.6
44.3
488.1
Michigan
Colorectal
55.2
Healthy People 2020
65.1
Rates are age adjusted, per 100,000.
Oscoda
Crawford
11
14.5
9
65.8
Diabetes Related
75.4 77.8 76.1
Cancer Incidence, 2009-2011
Michigan
Diabetes
18.8 23.7
84.8
Source: Michigan Department of Community Health,
2010-2012.
• Mortality rates are age adjusted and per 100,000
population.
• Healthy People 2020 objectives are included for cancer
mortality and diabetes related mortality rates.
• Diabetes data too small to calculate for Crawford
county and Oscoda county.
Age adjusted rates per 100,000 population, 2007-2011, MDCH
Oscoda
92.6
CVD
255.9
306.6
87.4
Oscoda
Cancer Incidence
180.7
192.2
247.3
337.5
Mortality Rates:
Cancer, Cardiovascular Disease,
and Diabetes
298.3
269.0
209.0
Roscommon
Oscoda
Crawford
297.8
306.9
Roscommon
Michigan
225.7
Stroke
206.8 200.1
233.6
10
0
0
Assault/homicide
Other
3
1
1
Assault/homicide
Other
5
Unintentional (other)
Self-inflicted/suicide
2
Unintentional (transport)
2
Assault/homicide
0
3
Other
2
2
4
5
3
2009
1
0
4
13
2
0
0
1
5
3
0
0
2
6
2
2010
0
0
5
8
1
1
0
0
6
2
1
0
1
10
4
2011
1
0
5
7
4
0
0
1
6
1
1
1
0
6
6
2012
2
1
6
12
3
0
0
4
4
0
0
1
2
4
6
2013
12
The Healthy People 2020 targets for fatal injuries per 100,000 are as follows:
Suicide: 10.2
Poisoning: 13.1
Falls: 7.0
Drowning: 1.1
Burn/fire/flame: 0.86
Firearm related: 9.8
Motor vehicle traffic crash related: 12.4
Source: Michigan Resident Death files, Data Development Section, Michigan
Department of Community Health.
Oscoda
326.9
Source, Michigan Department of Community
Health, 2010-2012.
• Rates are age adjusted, per 100,000 population.
Congestive heart failure
278.1
Crawford
Number of fatal injuries by year
Fatal Injuries
Acute myocardial infarction
344.9
Cardiovascular Disease
Hospital Discharges
2.8
Roscommon
34.5%
Overweight
42.1%
48.0%
Obese
25.7%
31.3%
Crawford
31.6%
47
7
28
Number of cases
reported in 2013
4
1
1
13
32.0%
Michigan
Smoking
12.0%
22.7%
21.5%
22.2% 23.8%
Healthy People 2020
No physical activity
26.9%
15
Binge drinking
19.2%
22.5%
24.3%
Source: Michigan Department of Community Health, Michigan Behavioral Risk
Factor Surveillance System; data from 2011-2013, combined.
• Overweight is having a body mass index (BMI) between 25.0 and 29.9.
Obesity is a BMI of 30 or greater.
• Overweight and obesity are calculated by self reported height and weight.
Healthy People 2020 target for obesity is 30.6%.
• The Healthy People 2020 target for cigarette smoking is 12%.
• Physical activity is measured as the percent of adults who reported not
participating in any leisure-time physical activities or exercises such as
running, calisthenics, golf, gardening, or walking during the past month.
• Binge drinking is defined as the consumption of five or more drinks per
occasion for men or four or more drinks per occasion for women at least
once a month in the previous month.
• Data not available for Oscoda county. Data on binge drinking unavailable
for Crawford County.
Roscommon
30.6%
Health Behavior Risk
Factors:
Obesity, Overweight,
Smoking, Physical Activity,
and Binge Drinking
5.8
4.2
16.8
Oscoda
Roscommon
27.4
27.0
Annual average
number of cases
2008-2012
Chlamydia
3.6
1.2
0.6
15.0
Crawford
1.2
Oscoda
Annual average
number of cases
2003-2007
1.0
Crawford
Annual average
number of cases
2008-2012
Number of cases
reported in 2013
Source: Michigan Sexually Transmitted Disease Section, Michigan
Department of Community Health.
• Gonorrhea: The Healthy People 2020 target for females is no more than
257 incident cases and males no more than 198 incident cases per
100,000 population aged 15-44 years be reported per year.
• Chlamydia: The Healthy People 2020 target for females aged 15-24
attending family planning clinics with the past 12 months and testing
positive for chlamydia will be less than 6.7%.
Gonorrhea
Annual average
number of cases
2003-2007
Sexually Transmitted
Diseases:
Gonorrhea and
Chlamydia
29.7%
42.7%
19.8%
Smoked while pregnant
1.4%
72%
74%
4:3:1:3:3:1:4 (19-35 months)
71%
41.6
Michigan
Crawford
75.2%
Roscommon
44.8%
Michigan
7.3%
10.4%
6.9%
Roscommon
8.4%
Michigan
60%
Too small to
calculate
Too small to
calculate
Roscommon
6.9
Michigan
77%
65%
Oscoda
Roscommon
19%
40%
27%
Michigan
3 HPV (Female 13-17)
46%
16
Source: MCIR (Michigan Care Improvement Registry) data, 2014.
• 4:3:1:3:3:1:4 includes 4 doses of DTaP, 3 polio, 1 MMR, 3Hib,
3 Hepatitis B, 1 varicella, and 4 PCV7/13. This is the percent
of 19-35 month old children who have received these
immunizations.
• 1:3:2:3:2:1 includes 1 Tdap, 3 IPV, 2 MMR, 3 HepB, 2 Varicella,
and 1 Meningococcal. This is the percent of 13-17 year olds
who have received these immunizations.
• This is the percent of females age 13-17 years who have
received 3 HPV.
14
Infant deaths: Deaths occurring to individuals less than 1 year of age.
Infant mortality rate is calculated as the number of deaths per 1,000 live births,
using a three year average from 2010-2012.
Oscoda
Too small to
calculate
Crawford
Infant Mortality
Low weight births are less than 2,500 grams (approximately 5 pounds, 8 ounces).
Source: Michigan Department of Community Health, 2011-2013
Oscoda
Crawford
Low Weight Births
Michigan Department of Community Health, as provided by Michigan League of Public
Policy, 2012.
55.4%
64.2%
Medicaid Births
Oscoda
Crawford
1:3:2:3:2:1 (13-17 years)
73%
Childhood Immunizations
80%
52.4
Roscommon
Teen pregnancy rates are per 1,000 females ages 15-19 and include live births, abortions, and
estimated miscarriages, 2011-2013 average. Source: Michigan Department of Community Health.
Healthy People 2020 target for teen pregnancies among 15-17 year olds is 36.2 per 1,000 females.
The HP 2020 target for teen pregnancies among 18-19 year olds is 105.9 per 1,000 females.
50.5
42.1
Teen Pregnancy
Oscoda
Crawford
Smoked while pregnant were those who had a history of smoking, but never
quit, plus those who quit at some point between estimated conception and
birth data.
Source: Michigan Department of Community Health, 2012
51.5%
Birth Related
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Improving the Health of Our Communities

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