Community Health Assessment

Introduction

The health status of a community plays a huge role in that community’s social and economic prosperity. It is, therefore, important that every community strives to persistently improve and maintain its health. The first step in improving the health status of any community is to complete a community health assessment and share the findings with the community. A community health assessment is a methodical gathering and examination of information about the health of the community (Clark & Clark, 2008). Community Assessment as a tool can be used to make program decisions especially in the determination of the types of services that are needed the most by families and children in a location. The assessment can subsequently be used to locate the resources available in such a way as to meet those needs, and to set long and short-term program objectives. By using the findings of the assessment, societies can initiate plans to begin improving the healthiness of their residents.

General Service Area Data

The community health assessment carried out for Orange County, Florida with the aim of looking at the information available about the state of healthcare in the county. Orange County is located in central Florida, midway between Jacksonville and Miami. Orange County encompasses an area of over 1000 square miles and includes thirteen municipalities, these being: Apopka, Bay Lake, Belle Isle, Eatonville, Edgewood, Lake Buena Vista, Maitland, Oakland, Ocoee, Orlando, Windermere, Winter Garden and Winter Park, with Orlando being the largest from among these. The county is bordered on the south by Osceola County, the north by Seminole County, east by Brevard County and west by Lake County. As at 2014, just over one million of the 18 million Florida residents live in Orange County, with 28.7% of the population being Hispanics.

Population Economic Status Assessment

Economic status has a significant bearing on the ability of a population to access healthcare (Minkler & Wallerstein, 2011). There is an identifiable correlation between being poor and being unhealthy. Orange County has almost 220,000 people living in poverty (18.2% of the population) with almost 72,000 of them being children under the age of 18 (26.0% of the population). The impact of poverty, particularly in children, is huge. A child’s experience with poverty has the potential to not only affect him at the present moment but also affect him in future (Minkler & Wallerstein, 2011). Infant Mortality Rates, the best indicator of the healthiness of a population, is significantly higher in populations living in poverty. Families living in poverty are also more likely to have children with low birth weights, a condition that is associated with more child deaths in the first year of life and an increased risk of cardiovascular diseases later in life. Also, low-income families are increasingly likely to be unable to access health-insurance which would impact the quality of care they can afford. Orange County figures of those without insurance stand at 22.2% of the population. Children from impoverished backgrounds are also more likely to overweight and obese, a fact that places them at an increased risk of type II diabetes, hypertension, asthma, and heart diseases later in life.

Religion and Cultural Assessment Tool

The Association of Religious Data Archives (ARDA) identified the number of strict adherents to religion including their children, seen in regular attendance of religious services at 482,253. This figure accounted for a total of 42.1 % of the population. Of these, 216980 were Evangelical Protestants with 145,082 being Catholics. Religious beliefs play a role in healthcare, as some religions advocate against birth control and even immunization. The population of Orange County has undergone a huge change in the last decade that has resulted in its diversification. Presently, a quarter of the residents of the county speak a language other than English at home. The American Community Survey (2009) of the US Census Bureau gives the community breakdown as 71.7% White, of whom 48.9% are non-Hispanic, 20.9% Black, and 0.5% Native American and Alaskan Natives. An estimated 4.7% of the population are Asian, with 0.2% being from Hawaii or some other Pacific Island, with 2% identifying with two or more races. Culture affects beliefs about causes of disease, perceptions of health, illness and death. Culture also influences how illness and pain is perceived and, therefore, can affect approaches to health promotion and the forms of treatment patients prefer. Culture, much like religion, shapes the beliefs regarding health and wellness. Another area of concern with regard to culture is on how decisions are made. For example, among most of the cultural groups in Orange County including the Hispanic, Native Americans and to some degree the Black population, decision making is exhibits a greater collectivism trend. The implication on healthcare is that decisions regarding health are often subject to collective decisions.

Neighborhood/Community Safety Inventory

OrangeCounty’s main environmental concern is ozone pollution, with some level of carbon monoxide and nitrogen dioxide pollution experienced as well. Measures taken to address this include adding pollution control equipment to the over 400 buses that serve public district schools and 93 heavy-duty construction trucks. The aim is to reduce tailpipe emissions by up to 50%. Through the use of cleaner burning biodiesel, E85 (85% ethanol) and electricity as transportation fuels the County has successfully reduced petroleum fuel consumption levels by over 20%. Pollutants have been known to cause a number of health related complications, therefore, it serves to ensure the exposure levels are kept at minimum levels through legislation.

Disaster Assessment and Planning Guide

Hurricane season in Florida begins from June 1^st to November 30^th, and while Orange County is in Central Florida, the area is not insulated from the effects of storms. As such, a good disaster preparedness strategy is important. Hurricanes cause severe weather and can cause floods. To alleviate this, the residents are encourage to pick sandbags at predefined points. Even more concerning, Orange County and the general Florida area experiences tornadoes as well, and these threaten destruction of life and property as well as floods. To protect against the effects, citizens are encouraged to build safe rooms and are given the necessary emergency contacts.

Windshield Survey

Windshield surveys offer a good way to gain objective feedback about the community. Knowledge on the nature of street life, the community’s relationship to the environment, traffic, or with any other element of community life or functioning can be gleaned through a windshield survey (Clark & Clark, 2008). In addition, the poverty levels and neighborhood safety assessments can be done by simply looking at the environments. The principal reasons for such an undertaking would be to gain a fair idea on the nature of resources available in a given locality, and the relative distribution of service amenities in the area (Minkler, 2012). Topics of relevance include the status of education, housing, culture and religion as well as entertainment and recreation. The results of the assessment in Orange County revealed critical details relevant for planning including the age, gender and as well as the relative length of their stay as members of the community. More importantly, the survey gave indications about the level of information available to the general public on healthcare, and on the HeadStart centers designed for community relations.

Population Health Scavenger Hunt

Like the windshield surveys, health scavenger hunts are meant to identify issues with the health care delivery system. These involve conducting spot on tests on the ability of the community to meet the demands of its population. The health scavenger aims at reconciling the data that is available to the situation on the ground (Allender, Rector, & Warner, 2013). Some of the key metrics identified by a scavenger hunt include the nutrition, the poverty levels for the different populations, access to healthcare, and the relative implementation rates for community-based health laws.

The health scavenger hunt in Florida reveals the establishment of initiatives such as the use of only certified nurse midwives in the delivery process, the establishment of sensitization workshops on the spread of waterborne diseases, and informative program on proper feeding and nutrition. In addition, due to the high prevalence rates of smokers ( 135 among adults, 11% among high school students), there is a drive in collaboration with CDC to stem out the practice especially in communal areas like schools and recreational facilities.

Problems Identified and their Solutions

Orange county morbidity rates indicate high prevalence of high blood pressure (34% to 26.9% Healthy People 2020 targets), high cholesterol (34.2% to 13.5% targets) and overweight (35%). The number of persons who are overweight and obese stands at 27.8% to the Healthy People 2020 target of 30.5%, but the figure raises concern since it has been climbing consistently for the last three years. The relative incidence of diabetes is also high, standing at 9.9% to the target 7.2%. From this figure, the age-adjusted death rate for diabetes stands at 24.7, which translates to about 68% of the diabetic population. The three highest health contributors to the number of years lost in Orange County are cancer, heart diseases and perinatal conditions. Of even greater concern is the problem of access to healthcare. While the target of Healthy People 2020 is the assurance that all people have medical insurance cover (by 2020), only 78.6% of the population in Orange County has any form of insurance cover. On the issue of infant mortality, fetal mortality rates were at 7.3 deaths/ 1000 live births against Healthy People 2020’s 5.6 deaths/ 1000 live births, neonatal mortality rates at 5.1 deaths/ 1000, post-neonatal mortality rates of 2.2 deaths/ 1000 live births against 2.0 deaths/ 1000 live births, and Sudden Infant Death Syndrome (SIDS) at 1 death in the county.

Despite continuous efforts towards of healthier communities, the goal has not been attained. While a lot has been done, a lot still requires to be done. The most pressing issues based on the community assessment are many, but these three are the most prominent. First, Diabetes and coronary heart disease are the leading causes of morbidity and mortality for Orange County residents (Orange County, 2015). These statistics are even concerning because despite a slight decrease in the number of cases dying of diabetes and diabetes related complications nationwide, the figures are still quite high. Consequently, the community health improvement plan should factor in how to address this with specific regard on how to effect the changes necessary to ensure that the diseases are eliminated in the community. Similarly, the high rate of preterm births is the leading cause of infant mortality (Orange County, 2015). The community health improvement plans should therefore find ways to address the issues related to infant and maternal health. One of the key goals of the Healthy People initiative is the elimination of cancer. Tobacco use, and the resultant cases of cancer, account for a large percentage of deaths in the county. Through sourcing funding from CDC, Orange County has initiated programs to educate on the effects of smoking tobacco, and to combat the vice. Similar programs have been implemented to aid in the spreading of information that would prevent the increases in cases of obesity. The last major issue emerges in the access to healthcare (Healthy People, 2015). Access to healthcare presents one of the most far reaching goals of the Healthy People 2020 program. Social determinants of health like poverty, lack of housing, domestic violence, child abuse, and perceived neighborhood safety make it difficult for some people to access community health, and the goal of the program is to mitigate against this.

The primary prevention method discussed will be on how to ensure children are carried to term, and in this way eliminating the cases of infant mortality. The key ways of achieving this would include the assurance of quality care during pregnancy and safe delivery by a skilled birth attendant. Good neonatal care, with particular emphasis on paying immediate attention to breathing and warmth and early initiation of exclusive breastfeeding will ensure maternal health, and that of the baby. Other common ways of preventing this would include educating the general public on the causes of infant strangulation, and advice mothers on how to avoid this (CDC, 2015). The reduction of prenatal smoking is also key to improving infant health. Community outreach programs will also help in the dissemination of information necessary to aid in this effort.

The prevention of these diseases and health concerns can be mitigated through the use of resources available in the community. These resources include the Orange County Health System that develops community health directives for the county. Aside from the County Health, the Center for Change helps with informing the general public on health considerations and concerns. The American Lung Association, The American Heart Association offer support to those suffering or recovering from lung cancer and heart diseases respectively. Similar community based resources that have proven to be very instrumental in the fight for healthy lifestyle and wellness include Debbie Turner Cancer Care and Resource Center, Hispanic Health Initiatives, Center for Multicultural Wellness and Prevention, and the American Cancer Society.

Conclusion

Community health assessments serve to collect information on the state healthcare in a given locality with a view towards the elimination of common causes of poor health in the community. Community health assessments are, therefore, and integral part in the formulation of a community health improvement plan. It follows that a thorough and objective needs assessment program should be adopted to ensure that such an improvement plan benefits from the most accurate and relevant information. The community health need assessment for Orange County in Florida identifies three vital issues that should be addresses for the continued well-being of the community. If these are addressed, then the community of Orange County will benefit from improved health.

References

Allender, J., Rector, C., & Warner, K. (2013). Community & public health nursing: promoting the public’s health (8th ed.). Lippincott Williams & Wilkins.

CDC,. (2015). CDC grand rounds: Public health approaches to reducing U.S. infant mortality. cdc.gov. Retrieved 26 November 2015, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6231a3.htm

Clark, M., & Clark, M. (2008). Community assessment reference guide for community health nursing. Upper Saddle River, N.J.: Pearson Education.

Healthy People,. (2015). 2020 topics and objectives: Objectives A-Z. Healthy People 2020. Retrieved 26 November 2015, from http://www.healthypeople.gov/2020/topics-objectives

Minkler, M. (Ed.). (2012). Community organizing and community building for health and welfare. Rutgers University Press.

Minkler, M., & Wallerstein, N. (Eds.). (2011). Community-based participatory research for health: From process to outcomes. John Wiley & Sons.

Orange County,. (2015). 2012-2015 Orange County community health improvement plan (1st ed.). Orlando, Florida: Florida Department of Health. Retrieved from http://www.orangecountygov.com/filestorage/124/1334/CHA_2014_2017_Final_PDF.pdf