2011 State of the County Health Report

10 JCPH Johnston County 2011 State of the County Health Report Johnston County Public This annual report provides an overview of the health Health Department and wellbeing of Johnston County residents It 517 N Bright Leaf Blvd highlights the most current data which includes Smithfield , NC 27577 demographics , leading causes of death and the Phone 919 989 - 5200 county’s top health priorities In addition to educating the community of the current health status of its citizens , this report serves as a resource for grant applications , policy development , financial planning and program implementation Marilyn Pearson , MD Priority Health Issues Identified from the 2010 Health Director Community Health Assessment Table of Contents v Obesity v Diabetes Overview 2 v Access to Healthcare Demographics 2 v Cancer Health Professionals 3 Population Estimates 3 v Injury Prevention Leading Cause of Death 4 Teen Motor Vehicular Deaths Review of Data 5 Priority Health Issues 5 Obesity 5 Diabetes 8 Access to Healthcare 10 Cancer 12 Injury Prevention 13 Emerging Issues 14 Electronic copies of this document and other Johnston County health reports are available on our website wwwjohnstonnccom 2011 Johnston State of the County Health ReportPageOverview Every four years the state of North Carolina requires each local county health department and Healthy Carolinians Partnership to conduct a community health assessment CHA Completion of the CHA is a process that allows the community members and stakeholders to gain a better understanding of the health needs and concerns of the community During the three interim years , the health department is responsible for submitting the state of the county health SOTCH report to the North Carolina Division of Public Health and Office of Healthy Carolinians Johnston County Public Health Department JCPHD completed the last CHA in 2010 To access the 2010 CHA visit wwwjohnstonnccom The submission of the 2011 SOTCH addresses the most current data related to each priority health issue along with a summary of the progress to date Although this report is a reflection of years 2010 – 2011 , there are some categories where the most current data available is from years 2008 or 2009 Johnston’s Demographic & 1 Economic Summary 2010 Johnston County Demographics 2015 Projected Population 203,426 2010 Economic Glimpse 2010 Estimated Population 174,426 2010 Median Age 36 • 7,598 individuals , 98 of the 2010 Population aged 0 - 19 50,495 workforce , reported being 2010 Population aged 20 - 29 20,001 unemployed – a slight decrease 2010 Population aged 30 - 39 27,706 from 109 in 2009 2010 Population aged 40 - 49 28,017 • A total of 22,350 individuals 2010 Population aged 50 - 59 21,788 received SNAP benefits food 2010 Population aged 60 + 26,419 stamps in 2010 2010 Total Households 65,322 • Approximately 124 of the population benefited from 2010 Median Family Income 62,775 Medicaid in 2010 Growth rate from 2009 - 2010 36 2009 Uninsured aged 0 - 18 yrs 5,857 121 2009 Uninsured aged 19 - 64 24,617 237 Below Poverty Level 125 Page | 2PageWho provides medical care in Johnston County 2 2010 Johnston County Active Health Professionals 2010 Total Number of Physicians 129 2010 Physicians 10,000 population 76 2010 RNs 10,000 population 407 2010 Dentists 10,000 population 22 2010 Pharmacists 10,000 population 67 2010 Nurse Practitioners 10,000 population 13 2010 Physician Assistants 10,000 18 Who lives in Johnston County 3 2009 Johnston County Population Estimates The 2009 estimated population of Johnston County is 168,525 SEX ESTIMATE Male 83,925 Female 84,599 RACE non - Hispanic ESTIMATE White or Caucasian 138,527 Black or African American 26,290 American Indian 2,190 Asian 3,370 More than one race 2,190 ETHNICITY ESTIMATE Hispanic any race 19,717 Page | 3PageWhat are the leading causes of death for Johnston County residents 4 Johnston County 2009 Leading Causes of Death Rank Cause Total 1 Heart Disease 332 284 2 Cancer 267 229 3 Chronic lower respiratory diseases 58 50 4 All other unintentional injuries 57 49 5 Cerebrovascular diseases 54 46 6 Nephritis , nephrotic syndrome and nephrosis 31 27 7 Motor vehicle injuries 28 24 8 Diabetes mellitus 27 23 9 Septicemia 23 20 10 Alzheimers disease 20 17 2009 Johnston County Top Five Causes of Death by 4 Compared to state 30 25 20 15 10 5 0 Heart Disease Cancer Resp Disease Unintentional Stroke Injuries Johnston County North Carolina Page | 4PagePage pageNumber5Review of Data The rate for the two leading causes of death in 2009 , heart disease and cancer , were higher than North Carolina’s rates Johnston County’s rate was 284 for heart disease while the state rate was 223 For all cancer deaths , the rate for Johnston County was 229 and the NC rate was 227 Many of these deaths are related to risky behaviors which include tobacco use , alcohol consumption , lack of physical activity , poor nutrition and substance abuse Not only are these chronic diseases preventable , they are the most costly of all medical services in the 5 United States Priority Health Issues As identified in the 2010 Community Health Assessment , five focus areas with the largest impact on quality of life will be the priority over the next several years 1 Obesity 2 Diabetes 3 Access to Healthcare 4 Cancer of the breast 5 Injury Prevention – motor vehicular deaths , persons 15 - 19 years of age Obesity Obesity , the leading cause of chronic disease , is the primary public health concern in Johnston County Not only is obesity a problem in Johnston County , it is affecting the entire state of North Carolina at an alarming rate In 2009 over 38 of Johnston County residents were documented as obese while a 301 obesity rate was reported for the state According to the Centers for Disease Control and Prevention CDC , 57 of all North Carolinians are either overweight or obese A large price tag is associated with the obesity epidemic in Johnston County In 2007 , 6,753,361 of Johnston County Medicaid funds were directly related to overweight and obesity medical care Based on a January 2004 research study conducted by Research Triangle Institute RTI , North Carolina taxpayers paid an estimate of 21 billion annually for medical and healthcare costs due to obesity There are many factors contributing to obesity , most of which are preventable The most common causes are correlated with poor eating habits high fat and low fiber diets , high sugar food and beverage consumption , eating more meals away from home , larger portions , and eating few fruits and vegetables A sedentary lifestyle is also to blame for the high obesity rates Many Johnston County residents are not getting enough exercise and spending too much time in front of the television or computer Page | 5PagePage pageNumber62009 Weight , Nutrition , and Physical Activity Percentage County and State Comparison 100 832 794 72 80 654 559 536 60 Percentage North Carolina 40 Johnston 20 0 Overweight or Less than five Not getting Obese Fruits and recommended Vegetables exercise 6 Source for charts above and below 7 th According to the 2011 County Health Rankings , Johnston County ranked 78 for diet and exercise in the Health Behaviors category Our County Health Ranking for Health th Behaviors in 2010 was 67 Below is a table comparing obesity rates to peer counties in North Carolina 2009 Body Mass Index gt; 30 Obese 386 40 321 32 32 30 259 BMI Rate 20 10 0 Johnston Wayne Union Harnett Wilson County Interventions to reduce Obesity The Healthy North Carolina 2020 objective is to increase the percentage of individuals getting the recommended amount of physical activity Johnston County action plan to increase physical activity Increase opportunities for exercise in the community by fostering environments conducive to physical activity • The Town of Smithfield Planning and Zoning Department have initiated the development of a walking trail Page | 6PagePage pageNumber7• Clayton Property and Maintenance has implemented construction to increase the safe conditions of paved sidewalks Progress to Date • Since the greenway has been developed in Smithfield , you will often see many people outside participating in physical activity The three mile greenway trail entrance is located at the back of Smithfield Community Park and runs along the Spring Branch to the Neuse River Walk at Smithfield Town Commons to Sea Trail The ten foot wide path accommodates hikers , runners and bikers • The Town of Clayton has just completed a sidewalk and curb reconditioning project on nine town streets , using a new process that brings them up to current safety standards at less than a quarter of the cost of replacing them The town intends to begin modifying other community streets with sidewalks in need of repair in the next year • In 2007 , 58 of Johnston county residents reported not participating in the recommended amount of physical activity In 2009 , that rate decreased to 55 Although slight , this is a turn in the right direction to increase physical activity The Healthy North Carolina 2020 goal related to nutrition is to increase the percentage of individuals who consume five or more servings of fruits and vegetables per day Johnston County’s action plan to increase fruit and vegetable consumption 1 Increase availability of Farmer’s Markets and access to healthy foods in communities throughout the county • Smithfield Parks and Recreation Farmer’s Market • Clayton Farmer’s Market 2 Increase the amount of fruits and vegetables consumed on a daily basis • Eat Smart , Move More , Weigh Less • Families Eating Smart & Moving More • Be Active Kids • Color Me Healthy Trainings • Community Gardens Progress to Date • The Town of Smithfield opened the Smithfield Farmers Market in the Spring of 2011 This provides the opportunity for fresh fruits and vegetables without having to go to a grocery store • The Clayton Farm & Community Market is open from April – October The number of vendors participating continues to increase each year • The Cooperative Extension is growing a community garden with the help of citizens They are learning not only how to grow vegetables , but ways to prepare them so they are more enjoyable • Two elementary schools began community gardens during the 2010 - 2011 school year It was a great opportunity for the students to be exposed to a variety of fruits Page | 7PagePage pageNumber8and vegetables At the end of the growing season , the students had a vegetable party Two more schools will begin a community garden in the 2011 - 2012 school year Diabetes Diabetes is a serious chronic disease that affects many people in Johnston County and across the state It is the eighth leading cause of death in Johnston County North Carolina spent 36 billion in 2007 on medical care related to diabetes Approximately one - tenth of all health care expenses are attributed to diabetes Below are two tables comparing diabetes related deaths and incidence to peer counties in North Carolina 2008 Diabetes Deaths Per 100,000 Population 344 324 35 30 252 254 238 25 20 15 10 5 0 Johnston Wayne Union Harnett Wilson County 6 Source for diabetes chart 2009 Diabetes Incidence in 13 14 127 127 12 Rate 10 81 71 Diabetes8 6 4 2 0 Johnston Wayne Union Harnett Wilson County 8 Source for diabetes chart Page | 8PagePage pageNumber9Interventions to reduce Diabetes The Healthy North Carolina 2020 objective is to reduce the percentage of adults with type II diabetes from 96 in 2009 to a rate of 86 by 2020 Our rate of 81 in 2009 is below the state rate of 96 Our action plan in Johnston County is to improve diabetes self management for those currently suffering from diabetes Interventions currently implemented are focused on improving the health of diabetics in Johnston County using the following • Diabetes Education Recognition Program DERP • Johnston Health Diabetes Education Program • Marketing Awareness • Screenings Progress to Date • The Diabetes Education Recognition Program DERP is a self - management class for diabetics offered by the health department This initiative provides education by teaching diabetes self - management As of July 5 , 2011 a total of 111 patients have participated in this program since 2009 On average the clients that have completed the DERP Program have a decrease in their Hgb A1C by at least one point , weight reduction and are independently monitoring their blood glucose level on a regular basis • Johnston Health , the local hospital , offers an educational program for diabetics provided by nurse educators This has been an ongoing program and proven to be effective in teaching diabetics to control and maintain normal A1C levels • The Living Well Partnership continues to involve community partners – Cooperative Extension , the health department , Johnston Health , Project Access , CommWell Health and Benson Area Medical Center – by increasing awareness to programs offered to diabetics in Johnston County • Free glucose screenings continue to be offered at on - site health fairs and community events Access to Healthcare Approximately 20 of Johnston County Adults report having no health insurance , slightly higher than the state rate of 197 The rate of health insurance is correlated with the economy and employment since many health insurance plans are employer provided In 2009 Johnston County had an unemployment rate of 101 compared to the state rate of 106 With the rate of unemployment remaining around 10 since 2009 , we continue to have a large number of individuals who are not able to receive regular medical care without an income or any type of health insurance because they cannot afford it or they th don’t qualify for Medicaid or Medicare Johnston County ranks at 85 for access to clinical care according the 2011 County Health Rankings This is an improvements as we Page | 9Page0th ranked 96 in 2010 Below are tables comparing Johnston County to peer county data related to employment , poverty level and health insurance 2009 Estimate of Uninsured Aged 0 - 64 by 25 22 20 20 20 18 20 15 10 5 0 Johnston Wayne Union Harnett Wilson County 9 Source for charts above & below 2009 Estimate of Persons Below Poverty Level by 30 25 20 174 20 165 135 15 109 10 5 0 Johnston Wayne Union Harnett Wilson County Annual Average Unemployment Rate by 14 129127 12 112 113 113 12 101 102 99 98 9 89 89 93 9 10 2009 8 2010 6 2011 4 2 0 Johnston Wayne Union Harnett Wilson 10 Source Page | 10Page1Interventions to improve Access to Healthcare The Healthy North Carolina 2020 objective is to reduce the percentage of non - elderly aged less than 65 uninsured individuals While we are not able to impact the number of uninsured individuals , our goal is to provide medical care to the uninsured Johnston County is taking the following action steps to meet this goal • Project Access • HealthNet Group for Access to Healthcare • Primary Care on sliding fee scale Progress to Date • Project Access is a physician - volunteer initiative that gives low - income , uninsured county residents access to comprehensive medical care Through Project Access , physicians and community partners like Johnston Medical Center and the health department , donate their time and medical services without receiving reimbursement or compensation Project Access is not health insurance It is however , an innovative program designed to help community residents stabilize their health in a time of need when health insurance is not available In the last four years , 986 patients have received services through Project Access In 2010 , Johnston County Project Access was awarded a 554,446 grant by The Duke Endowment • The HealthNet committee meets on a monthly basis with several partners – Project Access , Community Care of Wake & Johnston County , Benson Area Medical Center , Rural Health , Johnston County Health Dept , Johnston County DSS , Johnston Health Hospital , CommWell Health , Cooperative Extension and Mental Health – to address the issues of providing care to the uninsured • In Primary Care , patients are able to pay a nominal fee based upon their income Cancer Johnston County is focusing on increasing the number of women who are getting screened for early detection of breast cancer Many women are not getting screened or receiving follow - up care for breast cancer Early detection is an important factor in breast cancer since there are so many treatment options available Without annual screening or follow - up care , cancer can go undetected In 2008 588 of women reported receiving a mammogram in their lifetime in Johnston County and the state rate is 785 for the same year Below is a table comparing Johnston County to peer county data related to breast cancer deaths Page | 11Page22009 Breast Cancer Deaths Per 100,000 Population 50 456 367 40 278 30 203 202 20 10 0 Johnston Wayne Union Harnett Wilson County 11 Source Interventions to increase breast cancer screening Johnston County is increasing awareness of and the number of women receiving breast cancer screening through the following • NC Breast & Cervical Cancer Control Program BCCCP • Encore Plus YWCA of Wake County • Susan G Komen for the Cure , NC Triangle Affiliate • Project Access Progress to Date • Johnston County has partnered with the NC BCCCP and the Susan G Komen for the Cure programs to provide screenings for 225 women in the past 12 months • Through the lead agency , the YWCA Encore Plus Program , 75 women have been screened in the past 12 months • Project Access clinic makes referrals to the NC BCCCP for uninsured women Injury Prevention Unintentional injuries have been one of the leading causes of death in Johnston County over the last several years In 2009 , they ranked fourth Teen motor vehicular death is a large concern for Johnston County According to Johnston County Teen Crash Data from nd 2005 - 2009 , Johnston County ranked 2 in the state for teen driving fatalities In 2009 , vehicular accidents resulted in the death of 10 teenagers Below is a table comparing Johnston County data to peer county data related to teen motor vehicular deaths Page | 12Page3Motor Vehicle Deaths Involving Drivers Aged 15 - 19 10 10 9 8 6 Number of 4 4 4 Deaths 4 3 2009 3 2 1 1 2010 0 0 Johnston Wayne Union Harnett Wilson County 12 Source Interventions to decrease teen motor vehicular deaths The Healthy North Carolina 2020 objective is to reduce motor vehicle crash - related deaths from 138 per 100,000 to 124 ; by 10 This applies to all age groups , but the incidence of teen deaths from motor vehicular accidents is significant enough to develop interventions for this population Johnston County has implemented the following interventions • Teen Driving Safety Committee • Safekids Coalition of Johnston County • Johnston County Schools Driver Education Course • Enhanced Safety Check Points in School Zones Progress to Date • The Safekids Coalition of Johnston County promotes seat belt use among siblings , parents , and teens as they educate on car seat use They now have a permanent car seat checking station at the Partnership for Children ; provides seat check events and encourages use of seatbelts by siblings parents ; over 200 families educated on proper use of car seats seatbelts • Teen Driving Safety Committee provides an avenue for all groups to work together and collaborate , including peers advocating for safe driving Effective December 1 , 2010 , anyone up to aged 21 receiving a moving violation ticket must attend “ Alive at 25 ” course ; Planning for Mass Media Campaign to promote safe driving • Johnston County Schools Driver Education Course requires all students obtaining permits to park at school to attend “ Alive at 25 ” Driving course • Law Enforcement has increased patrols around high school campuses at the beginning and end of the school day and during events to discourage speeding and unsafe driving habits • The number of teens killed by motor vehicle crashes was reduced from 10 in 2009 to three in 2010 Page | 13Page4Emerging Issues Chlamydia Chlamydia cases are increasing The rise may be due to a reporting process update in the North Carolina Electronic Disease Surveillance Systems NCEDSS • In 2007 Johnston County reported 254 Chlamydia cases ; this number increased to 524 cases in 2008 • They have remained well above the 2007 numbers with 407 being reported in 2009 and 441 in 2010 We are well on our way to exceeding the number of cases 13 as 346 were reported by the end of September this year Respiratory Cancer Cancer continues to be a health concern but respiratory cancers are on the rise From 2005 - 2009 Johnston County had a total of 419 deaths due to respiratory cancer , with a 14 rate of 629 Mental Health As the Mental Health Landscape continues to change , there have been increasing numbers of behavioral health concerns reported by residents of Johnston County In the North Carolina BFRSS 2009 survey , about one - third of adults reported that there were one or more days in the past month when their mental health was not good The Johnston County Local Management Entity LME , responsible for managing , coordinating , facilitating , and monitoring the provision of mental health , developmental disabilities , and substance abuse services , has entered into an inter - local agreement with two other counties The LME is also working with the Health Department and Community Care of Wake and Johnston Counties through integrated care programs to better provide Behavioral Health care at the time of primary care visits Community Involvement Members of the community are welcome to particpate on any committee with a focus on improving the health of the citizens of Johnston County If anyone is interested they can visit the website with meeting dates and locations for the different coalitions Interested parties may contact the Health Education Department at 919 - 989 - 5200 This entire report will be accessible on our website wwwjohnstonnccom Page | 14Page51 http accessnccommercestatencus docs countyProfile NC 37101 pdf ; http eslmi40 escstatencus ThematicLAUS clfasp CLFAASYasp ; Health Resources and Services Administration , http arfhrsagov arfwebtool Counties_searchasp ; Phone communication with Geneva Ray at Dept of Social Services , Nutrition Services 2 NC Health Professions Database , http wwwshepscenteruncedu hp 2010 2010_10000pop_allpdf 3 2010 Community Health Assessment for Johnston County 4 State Center for Health Statistics , http wwwepistatencus SCHS data lcd getleadcausescfm 5 Centers for Disease Control and Prevention , http wwwcdcgov chronicdisease overview indexhtm 6 North Carolina State Center for Health Statistics , http wwwncpublichealthcatchcom ReportPortal design viewaspx 7 County Health Rankings , http wwwcountyhealthrankingsorg north - carolina johnston 8 http wwwncdiabetesorg , http wwwncdiabetesorg library _pdf Burden 20of 20Diabetes 20in 20NC 20201 0pptpdf , http wwwncdiabetesorg library _pdf Diabetes 20burden 20in 20North 20Carolina 202010 20Fact 20Sheet 20WEBpdf 9 NC CATCH http wwwncpublichealthcatchcom ReportPortal design viewaspx 10 Civilian Labor Force estimates for NC Counties http eslmi40 escstatencus ThematicLAUS clfasp CLFaasyasp 11 http wwwncpublichealthcatchcom ReportPortal design viewaspx 12 UNC Highway Safety Research Center , phone and email communication with Eric Rodgman , MPH on November 3 , 2011 13 http epipublichealthncgov hiv statshtml 14 http wwwschsstatencus SCHS CCR mort0509cntypdf Page | 15Page