2011 Orange County C ommunity H ealth A ssessment

1. 2011Orange CountyCommunity Health Assessment Healthy Carolinians of orange county

2. Healthy Carolinians of Orange County Partnering for a Healthy Community 2011 Community Health Assessment Healthy Carolinians of orange county

3. Healthy Carolinians of Orange County • A network of community members and service providers partnering to promote health and wellness in Orange County • Members are representatives from schools, human service agencies, churches, civic groups, businesses, local government, UNC Chapel Hill, health care organizations including UNC Healthcare, and concerned citizens. 2011 Community Health Assessment Healthy Carolinians of orange county

4. Healthy Carolinians of Orange County • Missionis to advocate, guide and assist Orange County in planning and implementing health care strategies to promote healthy lifestyles, improve health status and prevent premature death and injury for ALL residents in the county regardless of age, race, income, or educational level. • Overall goalof the partnership is to reduce health disparities 2011 Community Health Assessment Healthy Carolinians of orange county

5. Healthy Carolinians of Orange County • What We Do • Build and promote collaborative partnerships • Guide local planning efforts to improve health • Support innovative health programs • Advocate for health-promoting policies • Identify critical health needs in the community 2011 Community Health Assessment Healthy Carolinians of orange county

6. 2011Orange CountyCommunity Health Assessment 2011 Community Health Assessment Healthy Carolinians of orange county

7. Acknowledgments • Thanksto the residents of Orange County, Community Health Assessment Team members, and all Healthy Carolinians partners and member agencies who helped to guide and make the assessment a truecommunity process. 2011 Community Health Assessment Healthy Carolinians of orange county

8. Community Health Assessment: Overview • Required of all NC Health Departments every 4 years • Collaborative process with multiple stages • Over 50 Leadership Team members • Nearly 150 community survey volunteers • 30+ document writers • Close to 200 forum participants 2011 Community Health Assessment Healthy Carolinians of orange county

9. Community Health Assessment: Goals • Enable local public health officials/community groups to • Monitor trends in health status • Identify priorities among health issues • Determine the availability of resources • Document • Useful, relevant, actionable, reflective, forward-looking • Information gathered lays the foundation for effective, strategic community health planning 2011 Community Health Assessment Healthy Carolinians of orange county

10. Phase 1: Establish Community Assessment Team Phase 2: Collect Community Data Phase 3: Collect and Analyze Community Health Statistics Phase 4: Combine County Statistics and Community Data Phase 5: Solicit Community Input to Select Health Priorities Phase 6: Create Community Health Assessment Document Phase 7: Disseminate CHA Document to the Community Phase 8: Develop the Community Health Action Plans Health Assessment Process: Phases 2011 Community Health Assessment Healthy Carolinians of orange county

11. Data Sources and Community Involvement • Both primary and secondary data sources • Community Involvement • Various roles • Involvement at every stage • Planning • Data collection • Identification of health issues, community strengths • Development of strategies to address problems 2011 Community Health Assessment Healthy Carolinians of orange county

12. Quantitative: Health opinion Survey • Community Health Opinion Survey • Survey households sampled from census blocks with high poverty percentage • Administered in multiple languages • Covered various topics 2011 Community Health Assessment Healthy Carolinians of orange county

13. Qualitative: Focus Groups and forums • Nine focus groups • Gain well-rounded understanding of health concerns • Nearly 70 community voices • Five community forums • Almost 200 participants • Presented and discussed main data findings • Selected initial priorities 2011 Community Health Assessment Healthy Carolinians of orange county

14. Community Health Assessment: Full Report • Available online www.orangecountync.gov/healthycarolinians 2011 Community Health Assessment Healthy Carolinians of orange county

15. Orange County Community Profile 2011 Community Health Assessment Healthy Carolinians of orange county

16. Community Profile: Demographics • Population has more than doubled in past four decades • Total: 57,567 (1970) to 133,801 (2010) • About a 5.8% rate of increase every ten years • Age • Median:33 years old 2011 Community Health Assessment Healthy Carolinians of orange county

17. Community Profile: Demographics • Gender • 52.2% female / 47.8% male • Rural/Urban • 57% of residents live in southern “urban” areas of Chapel Hill and Carrboro • 43% live throughout rural areas • Diversity • Race and ethnicity • Country of origin • Languages 2011 Community Health Assessment Healthy Carolinians of orange county

18. Community Profile: Demographics 2011 Community Health Assessment Healthy Carolinians of orange county

19. Profile: Leading Causes of Death 2011 Community Health Assessment Healthy Carolinians of orange county

20. Profile: Death Rates, Age adjusted 2011 Community Health Assessment Healthy Carolinians of orange county

21. Profile: Leading Causes of death 2011 Community Health Assessment Healthy Carolinians of orange county

22. Profile: leading Causes of Hospitalization 2011 Community Health Assessment Healthy Carolinians of orange county

23. Social, Economic, and environmental determinants of health Health Disparities 2011 Community Health Assessment Healthy Carolinians of orange county

24. Health Disparities • Health depends largely on • Economic status, income • Race/ethnicity • Where someone lives (Place, geography) • Rates of disease and health outcomes significantly worse among economically disadvantaged, particular racial and ethnic minorities, and rural populations. 2011 Community Health Assessment Healthy Carolinians of orange county

25. Determinants of Health • Built Environment • Child Care • Crime and Safety • Education • Housing and Homelessness • Hunger and Food Insecurity • Income and Poverty* • Labor and Employment* • Parks and Recreation • Transportation 2011 Community Health Assessment Healthy Carolinians of orange county

26. Determinants of Health: Income, Poverty • Median household income: $51,944 (2009) 2011 Community Health Assessment Healthy Carolinians of orange county

27. Determinants of health: Poverty 2011 Community Health Assessment Healthy Carolinians of orange county

28. Determinants of Health: labor, employment 2011 Community Health Assessment Healthy Carolinians of orange county

29. Top 10 Issue Areas (alphabetical) 2011 Community Health Assessment Healthy Carolinians of orange county

30. Access to Health Care, Insurance, and Information • Includes the availability and affordability of health care services and insurance, ability to navigate and understand the health system, access and transportation to services, and information about health care. 2011 Community Health Assessment Healthy Carolinians of orange county

31. Built Environment • Includes human-made structures such as sidewalks, streets, housing, businesses, schools, parks, and, more broadly, land use patterns. The built environment impacts safety and the ability to get exercise, to access good nutrition, and  health care services.  2011 Community Health Assessment Healthy Carolinians of orange county

32. Cancer • The leading cause of death in Orange County in 2010 and has been ranked as #1 in 9 of the past 10 years. It is estimated that nearly 80% of cancers are due to factors that can be prevented: tobacco use, poor nutrition, lack of physical activity, and exposure to radiation. Many cancers are highly treatable with advanced screening. 2011 Community Health Assessment Healthy Carolinians of orange county

33. Chronic Disease: Exercise & Nutrition • Regular exercise and proper nutrition significantly contribute to physical and mental health; and can help prevent chronic diseases like diabetes, heart disease, stroke and cancer. Physical activity and good nutrition are important in maintaining a healthy body weight. 2011 Community Health Assessment Healthy Carolinians of orange county

34. Environmental Health • Includes air quality; drinking, and ground water quality; and lead hazards. Environmental health issues local to neighborhoods may exist in addition to these key factors. 2011 Community Health Assessment Healthy Carolinians of orange county

35. Injury • Addresses unintentional injuries like motor vehicle crashes, falls, poisonings, drowning, etc., and intentional injuries, or violence, which includes sexual assault, child abuse, domestic violence, homicide, and suicide. 2011 Community Health Assessment Healthy Carolinians of orange county

36. Mental Health • Refers to a wide range of conditions that affect one’s mood, thinking and behavior. Broad classes of illness include mood disorders (depression, bipolar disorder), anxiety disorders, psychotic disorders (schizophrenia), eating disorders, personality adaptations or disorders, and addictive behaviors/substance abuse disorders. Many factors contribute to its onset, including genetics, biological factors, life experiences, and brain chemistry, though everyday stress. 2011 Community Health Assessment Healthy Carolinians of orange county

37. Oral Health • Not only includes tooth and gum health, but also has overall health impacts (gum disease contributes to heart disease; tobacco use contributes to tooth decay). Issues in oral health include availability of affordable dental insurance, access to regular and preventative care, and population specific issues. 2011 Community Health Assessment Healthy Carolinians of orange county

38. Substance Abuse • Includes alcohol abuse and illegal drug use, but also includes underage drinking, traffic accidents, prescription drug abuse/misuse, and injury related to alcohol and drugs. It often connects with mental health needs. 2011 Community Health Assessment Healthy Carolinians of orange county

39. Transportation • Transportation systems impact quality of life and health. Expanding active transportation (walking and biking) options and safety can prevent disease, reduce and prevent motor-vehicle-related injury and deaths, improve environmental health, stimulate the economy and improve equal access to resources. Accessible and affordable transportation is particularly an issue in rural areas, for those with disabilities, older citizens and lower-income people. 2011 Community Health Assessment Healthy Carolinians of orange county

40. Community Priorities Identified in the Community Health Assessment 2011 Community Health Assessment Healthy Carolinians of orange county

41. Ranked Top 10 Orange County Priorities • Access to Health Care, Insurance, and Information • Chronic Disease: Exercise, and Nutrition • Mental Health • Transportation • Built Environment • Cancer • Substance Abuse • Environmental Health • Oral Health • Injury • Write-ins: Teen Pregnancy/Youth Health, Sexual health, Socio-economic Development 2011 Community Health Assessment Healthy Carolinians of orange county

42. Top 5 Healthy Carolinians Priorities • Access to Health Care, Insurance, and Information • Chronic Disease: Exercise and Nutrition • Mental Health • Substance Abuse • Injury • Current Healthy Carolinians of Orange County Focus Areas 2011 Community Health Assessment Healthy Carolinians of orange county

43. Current Focus areas and findings Healthy Carolinians of Orange County, 2012-2015 2011 Community Health Assessment Healthy Carolinians of orange county

44. Access to Health Care • Orange County has highest per capita number of physicians and dentists in NC • 88.9 physicians, 10.4 dentists per 10,000 population • 18.3% of Orange County residents do not have one or more persons that they considered a doctor or health care provider • Close to 28% of residents did not visit a doctor for a routine (general physical exam) checkup within the past year • 14.8% of county residents could not see a doctor due to cost 2011 Community Health Assessment Healthy Carolinians of orange county

45. Access to Health Care • In addition to medical insurance, factors contributing to a resident’s inability to access health care services include • Concentration of health care resources in the southern part of county • Inadequate transportation systems in the central and northern parts of Orange County • Language barriers; Recent relocation to the county from another country • Perceived disparities (or racism) within health care facilities 2011 Community Health Assessment Healthy Carolinians of orange county

46. Access: Orange County Medical Facilities • Medical facilities (hospitals, urgent care facilities, and health departments) in the county are all within city limits of Chapel Hill, Carrboro, or Hillsborough. • This map does not include private physician or dentist offices. 2011 Community Health Assessment Healthy Carolinians of orange county

47. Access to Health Insurance • 2008-2009 county-level estimates of uninsured • 18.9% (21,854) of Orange County residents, 0-64 years of age • Due to economic recession, rise in unemployment rates consistent with rise in uninsured residents 2011 Community Health Assessment Healthy Carolinians of orange county

48. Access to Health Information • Health Literacy • “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” • Extends beyond a person’s reading and writing skills • Ability to comprehend spoken words • Use numeracy and math skills for calculations • Navigate the health care system • Transcends income and education levels 2011 Community Health Assessment Healthy Carolinians of orange county

49. Chronic Disease: Cancer • Cancer • Leading cause of death in Orange County (2010) • Ranked as leading cause of death in 9 of past 10 years • Among all cancers, death rate per 100,000 population was 163.3 (2008) • Lower cancer death rates than NC (2008) • Responsible for 859 deaths (2005-2009) • Total number of cancer deaths decreased slightly in comparison with previous time periods • Difference in cancer deaths between racial groups is dramatic • For all common cancers, African Americans had higher death rate than whites 2011 Community Health Assessment Healthy Carolinians of orange county

50. Chronic Disease: Diabetes • Diabetes • 2001-2005, age-adjusted diabetes death rates for Orange County was 17.8 per 100,000 (NC rate was 27.6 per 100,000) • Percentage county residents with diabetes varied in recent years 2011 Community Health Assessment Healthy Carolinians of orange county