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September 29, 2021Nursing- evidence based
October 6, 2021Community Health Assessment for Pitt County, North Carolina
Community health assessment is key to understanding the health problems and priorities of a population. This Application Assignment outlines a process by which you can complete a health assessment of a community using indicator-based methods. You will construct a set of health indicators from a variety of domains, evaluate problems, and report on the health priorities for a community.
Sections A–C ask questions about assessment in general. Section D involves assessment of a particular county in North Carolina, information on which is provided in that section and in the Appendix.
Instructions: Save this document to your computer and complete all questions in Sections A–D below. Submit by the end of Week 5 following the submission instructions in the Week 5 Application section.
Section A: Community Health Assessment
The goal of public health is to improve the health of a population. Public health interventions such as safe water sources, immunization programs, and improved motor vehicle safety regulations account for the majority of years of life expectancy gained in the United States over the last 100 years.
A community health assessment involves obtaining and interpreting information to determine the health status of a specific community. Once community health needs are identified, public health interventions can be developed and their effectiveness evaluated using a similar approach. Information necessary for performing a community health assessment, for example data on mortality rates or behavioral risk factors such as smoking, is available from various sources.
Questions:
1. How do you define community?
2. What stakeholders (groups/organizations) would you want to consult with for a community assessment?
3. What types and sources of data would you use for a community assessment?
Section B: Healthy People 2010
The Healthy People 2020 initiative is a national approach that identifies high priority health issues and establishes objectives to reduce the impact of these public health threats. To understand the significance of data on your own community, you have to be able to compare it to another standard. The questions in this section ask you about other standards that can be used.
Questions:
1. How are Healthy People 2020 standards used? What are advantages and disadvantages to applying them at a local community level? (Note: you may use the Healthy People 2010 standards if the 2020 standards are not reported.)
2. What other standards (national, state, or local) can be used?
Section C: Health Indicators
For this exercise, you will use an indicator approach to develop a community health assessment. A community health assessment involves three-step feedback loop.
The first step in such an assessment involves identifying important health indicators. The second step involves matching those indicators with available data. In the third step, standards such as those explored in Section B are applied to the data gathered in the first two steps to transform it into useful information about health needs of the population.
Health indicators are measurable health outcomes, such as death rate, insurance coverage measures, immunization rates, or other data items that are relevant to the health of a community. Indicators are thoughtfully selected data points that provide useful information about the health of a community.
Note that each indicator should be:
1. An important health problem.
2. Prevalent or common in the community of interest.
3. Measurable on a community or population basis. There should be population data on a local level that is easily available—this cannot be collected from health facilities or providers because these data sources do not apply to the entire community.
4. Ideally, because we want to use a limited number of indicators, the indicator should not be redundant—not measure the same thing—as another chosen indicator.
To organize indicators, it is helpful to identify major areas of focus. For this case, we will refer to these broad categories of public health concerns as domains. Please refer to Table 1 below for examples of domains. For each domain, an example of an indicator is provided.
Table 1: List of Domains to Assist Developing a Community Health Assessment
Domain: Example of an Indicator:
Communicable Diseases
(including Sexually Transmitted Diseases) Incidence of Gonorrhea
Chronic Diseases (including Cancer) Incidence of Diabetes
Injury and Violence Homicide rate
Maternal and Child Health Childhood immunization rate
Environmental Health Rates of Lead Poisoning
Access to Health Care Rates of Uninsured
Question:
1. How you would obtain data for these indicators. What sources might you use? Select 2 of the indicators above and provide specific sources of information on them (including URLs) for your own community or state.
Section D: Performing a Community Health Assessment
As a consultant to Pitt County Health Department, you are asked to perform a community health assessment for the county. Below is information about the county:
Pitt County is located in eastern North Carolina and has a population of 138,690 residents (2005 Census). Pitt County has been classified as urban for the first time in 2006. It and the surrounding counties are largely rural with a history of dependence on tobacco farming. Caucasians make up about 62.8% of the population, African Americans 33.6%, Hispanics 3.2%, Asians 1.1% and American Indians 0.3%. There are an estimated 6,606 migrant and seasonal workers or 5.4% of the population. About 18% or 26,000 adults in Pitt County adults have household incomes below the federal poverty level with a median per capita income of $18,243 (2000). The child poverty rate is estimated to be 21.8%. Approximately 20% of adult lack health insurance.
Pitt County contains Greenville, the largest city in eastern North Carolina with a population of 67,525 (2005). Greenville is considered the hub of eastern North Carolina. The major employers are Pitt County Memorial Hospital (PCMH), Brody School of Medicine and East Carolina University. If a state was created of all the land in North Carolina east of Interstate 95, it would be the poorest of all 50 states. In aIDition, it would rate 48th in terms of premature mortality. Consider these factors when evaluating populations at risk and targeting resources for public health activities.
You now embark on the steps needed to perform your assessment.
• STEP ONE: IDENTIFYING HEALTH INDICATORS
As noted earlier, the first step in a community health assessment is identifying health indicators. Develop a list of 18-20 indicators you would want to use in your assessment, identifying 3-4 indicators per domain.
Complete the column on the right in this table:
Domain: Indicator: (provide 3-4 per domain
Communicable Diseases
(including Sexually Transmitted Diseases)
Chronic Diseases (including Cancer)
Injury and Violence
Maternal and Child Health
Environmental Health
Access to Health Care
• STEP TWO: MATCHING THE INDICATORS
Now that you have chosen indicators to use for a community health assessment, use the information provided in the tables below (Appendix) to match available data to your chosen indicators. In this example, residents of Pitt County constitute the community. If the Appendix does not give you the data for your indicator, you should choose another indicator (alternatively, you may seek out the data elsewhere that you need for your proposed indicator).
Question:
1. Have you matched each of your indicators to the data available in the Appendix? If not, explain how and where you got the data needed for your proposed indicator.
• STEP THREE: SETTING HEALTH PRIORITIES
Using the information gathered in the first two steps, please answer the following questions.
Note: Keep in mind that in order to plan an effective intervention program in real life, you must communicate with other constituents and stakeholders and see what they perceive to be priority health issues. Collaboration with community stakeholders in program design is critical to the success of an intervention plan. For this purposes of this assignment, however, you are reviewing the data on your own, without the input from other stakeholders.
Questions:
1. Looking at this data only, what would you conclude are three priority health issues for this population? (Can be picked by how the indicator compares)
2. Choose three of your indicators. Compare them to the Healthy People 2020 Standards (or 2010 if appropriate) and provide URL(s) for the relevant Web page from Healthy People to the specific indicator.
3. How do you explain the health disparities of these indicators? (i.e., as shown by this comparison with HP?]
You have completed this Application on assessment. Submit this completed form in the Dropbox following the submission instructions in the Week 5 Application area.
APPENDIX 1: DATA TABLES
Community Health Assessment Indicators Pitt County (NC),
North Carolina, and the United States
Domain: Maternal and Child Health (2004)
Indicator Pitt County North Carolina United States
Infant mortality rate per 12,000 live births
(2004) 7.1
8.8 6.9
Black infant mortality per 12,000 live births 8.1 15.6 14.1
White infant mortality per 12,000 live births 7.0 6.2 5.8
Neonatal infant mortality rate per 12,000 live births(<28 days of age) (2000-2004)
5.7
6.0
4.6
Black neonatal infant mortality rate 8.9 11.2 7.3
White neonatal infant mortality rate 3.3 4.1 3.8
Low birth weight (<2,500 g) per 100 births
(2004) 11.6
9.1 7.9
Minority births <2500 g 15.9 13.4 13.0
White births <2500 g 8.3 7.4 6.5
Very low birth weight (<1500 g) per 100 births
(2000-2004)
2.8
1.9
1.4
Minority births <1500 g 3.3 3.6 3.0
White births <1500 g 2.4 1.0
Teen pregnancy rate per 12,000 teens
(ages 15-19)(2000-2004) 39.8 64.1
(11.9%) 83.6
Minority pregnancies 54.5 87.3 153.3
White pregnancies 27.0 53.6 71.4
Smoked during pregnancy 8.9 12.5 11.4
Postneonatal infant mortality per 12,000 live births (>28 days <1 year) (2000-2004)
1.4
2.8
2.3
Black postneonatal rate 1.1 4.5 4.8
White postneonatal rate 1.7 2.1 1.9
Immunization status at 2 years of age NA 82%
Immunization status at school entry NA 99%
BRFSS for 2004
Age adjusted rates Pitt County North Carolina
Adult disability 28.3 25.0
Current asthma 7.1 6.4
Smoking: women of childbearing age 30.4 24.4
Smoking everyday: men 32.9 37.6
Obesity 26.1 22.7
Binge drinking (childbearing age) 9.5 6.8
Binge Drinking (all) 12.0 8.4
Men 19.8
Women 3.1
No leisure time physical activity 26.4 26.3
Are any firearms kept in your home 39.6 40.9
Domain: Access to Care
Indicator Pitt County North Carolina United States
% No medical insurance 20.8 17.5 16.5
% Children with no health insurance 14.3 12.5 9.8
% Children enrolled in Medicaid 36.7 32.6 26.0
% Children enrolled in NC Health Choice 5.2 5.9 NA
Primary Care Physicians/100,000 population 149 83.5
Dentists/100,000 population 37.8 40.5 58.4
Kindergarten Tooth Decay Rates 27.7% 22% 26% whites
36% A-A
43% Hispanic
BRFSS 2001 Eastern NC North Carolina
Cost as barrier to health insurance 16.5 11.5
No usual place of care 24.0 22.1
No dental insurance 52.7 45.3
Domain: Communicable Diseases
Indicator Pitt County North Carolina United States
TB rate per 100,000 population (2004) 5.0 4.5 4.9
Hepatitis A rate per 100,000 population
2004: 17 cases 12.1
(2004) 3.65
(2003) 2.6
(2003)
Hepatitis B rate per 100,000 population
2004: 11 cases 7.0
(2004) 1.9 2.6
Hepatitis C rate per 100,000 population
2004: 4 cases 2.9 0.2 0.4
Domain:Sexually Transmitted Diseases
Indicator Pitt County
North Carolina United States
Gonorrhea rate per 100,000 population 347.8 181.3 113.5
Black rate 848.3 673.8 629.6
White rate 52.6 38.4 33.3
Chlamydia rate per 100,000 population 645.9 313.3 319.6
Black rate 1206.4 929.7 1209.4
White rate 216.2 116.3 143.6
Syphilis rate per 100,000 population 3.2 8.9 2.7
Black rate 8.0 15.3 9.0
White rate 1.3 1.1 1.6
HIV rate per 100,000 population 18.0 25.2 20.7
Black rate 38.8 76.6 76.3
White rate 7.2 9.6 9.0
Domain: Cancer (2000)
Indicator Pitt County North Carolina United States
Lung Cancer
Mortality rate per 100,000 population 68.7 61.6 54.2
Incidence rate per 100,000 78.8 69.7 67.5
Breast Cancer (Female)
Mortality rate per 100,000 females 27.7 26.5 14.4
Female incidence per 100,000 females 167.5 149.5 132.2
Colon/Rectum Cancer
Mortality rate per 100,000 population 22.7 20.0 19.1
Incidence rate per 100,000 males 64.7 48.4 52.0
Prostate Cancer
Mortality rate per 100,000 males 36.7 36.9 31.5
Incidence rate per 100,000 males 154.5 152.5 166.7
Incidence All Cancer 494.3 445.3
Domain: Chronic Diseases
Indicator Pitt County N.C.
(1999-2002) United States
(2003)
Heart disease
Mortality rate per 100,000 population 248.5
246.6 235.4
Stroke
Mortality rate per 100,000 population 82.1 72.0 54.3
Diabetes
Mortality rate per 100,000 population 34.3 27.4 25.4
COPD
Mortality rate per 100,000 population 38.4 46.5 43.4
Youth death rates (Ages 0-17)/100,000 100.6 79.9
Domain: Environmental Health
Indicator Pitt County North Carolina United States
Lead (2004) 2.8 1.3 >1100 infants
56% tested
Have you had an illness in the past 12 months that you think was caused by outdoor air pollutants? 9.1 12.0
Have you had an illness in the past 12 months that you think was caused by poor indoor air quality? 15.0 16.4
Domain: Injury and Violence
Indicator Pitt County North Carolina
1999–2002 United States
2003
Motor vehicle accidents
Mortality rate per 100,000 population 19.6 19.2 15.2
Mortality
Homicide rate per 100,000 population 11.2 7.6 5.9
Suicide rate per 100,000 population(10-24 yr) 10.82 11.36 10.5
Violent Crime rate per 100,000 population (2004) 617.2 446.9
Accidents Unintentional injuries
Mortality rate per 100,000 population 40.0 42.7 36.3
Child Maltreatment substantiated 18.1 14.5 12.3
Admissions to Juvenile Justice 38.6 34.1
Domain: Economic and Education
Indicator Pitt County North Carolina United States
Premature mortality rate per 100,000 population
under 75 956 years 903 years 799 years
Percent below poverty level 17.5 15.2 12.4
Percent of children below poverty level 21.8 21.9 16.9
Unemployment rate 5.2 5.0 4.7
Percent children receiving food stamps 24.9 18.2 10.6 million
(14%)
Percent children receiving free or reduced lunch 48.4 44.3 41.9
Public school dropout rate (9-12th grade)2004-5 6.95 4.86 10.3%
High School completion (%) 56 86.1 85%
Percent >25 years of age with <9th grade education 7.6 7.8 7.5
Median Household income $ 33,734 46,335 50,046
Median per capita income $ 18,243 26,882 32,937
Migrant and seasonal workers number 6,606 (5.4%) 155,888
(2.1%) 13 million
(4.4%)
APPENDIX 2: Healthy People 2020
What Is Healthy People?
Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans.. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:
• Encourage collaborations across communities and sectors.
• Empower individuals toward making informed health decisions.
• Measure the impact of prevention activities
It can be used by many different people, states, communities, professional organizations, and others to help them develop programs to improve health.
Healthy People 2020 continues in this tradition with the launch on December 2, 2010 of its ambitious, yet achievable, 10-year agenda for improving the Nation’s health. Healthy People 2020 is the result of a multiyear process that reflects input from a diverse group of individuals and organizations.
What Are the Leading Health Indicators?
Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans. Healthy People 2020 contains 42 topic areas with nearly 600 objectives (with others still evolving), which encompass 12,200 measures. A smaller set of Healthy People 2020 objectives, called Leading Health Indicators, has been selected to communicate high-priority health issues and actions that can be taken to aIDress them
. The Leading Health Indicators are composed of 26 indicators organized under 12 topics. The Healthy People 2020 Leading Health Indicators are:
1. Access to Health Services 7. Nutrition, Physical Activity, and Obesity
2. Clinical Preventive Services 8. Oral Health
3. Environmental Quality 9. Reproductive and Sexual Health
4. Injury and Violence 10. Social Determinants
5. Maternal, Infant, and Child Health 11. Substance Abuse
6. Mental Health . 12. Tobacco
http://www.healthypeople.gov/2020/about/default.aspx
Pitt County Municipalities Data:
Municipality Child
<5 yrs Pop. Persons/
square mile White
Non-Hispanic% African-
America% Amer.
Indian% Hispanic (#) % Asian%
Ayden 282 4,622 1992 47.6 49.5 0.2 (102) 2.2 0.2
Bethel 116 12,681 1618 40.2 58.1 0.0 (13) 0.8 0.1
Falkland 11 112 <112 68.8 30.4 0.0 (11) 9.8 0.0
Farmville 252 4,302 1431 47.4 50.1 0.1 (91) 2.1 0.2
Fountain 38 533 515 49.0 50.5 0.2 (3) 0.6 0.0
Greenville 3,361 60,476 2298 61.4 34.1 (181) 0.3 (1,244) 2.1 (1,098)1.8
Grifton 122 2,073 1188 63.2 33.2 0.0 (98) 4.7 0.2
Grimesland 19 440 850 62 29.1 0.0 (39) 8.9 0.2
Simpson 32 464 1125 56 42.5 0.0 (13) 2.8 0.0
Winterville 399 4,791 1877 58.7 38.4 0.5 (49) 1.0 0.1
Total 4,603 75,624 (1573)
Pitt County 8,653 133,798 216 62.1 33.6 (357)0.3 (4,216) 3.2 (1,443)1.1
North Carolina 72.1 21.6 1.2 4.7 1.4
U.S. 75.1 12.3 0.9 12.5 3.6
Municipalities
County/State Median
Family
Income % < HS
Education Families below poverty In labor force
>16 years of age Median travel to work
(min) % now
married
(>15 yrs of age)
Ayden 34,808 30% 21% 53.1% X 45%
Bethel 35,278 40% 18.5% 49.2% 25 42.5%
Falkland 43,750 40% 5.0 57.4% 18 36%
Farmville 38,918 27.4% 14.6 57.5% 18.7 44.6%
Fountain 26,042 41% 35.6 51.6% 20.4 48%
Greenville 44,491 14% 9.0 66.3% 17.9 35.9%
Grifton 40,875 27% 12.2 55.9% 23.4 58.3%
Grimesland 36,250 40% 12.3 58.3% 22.9 53.5%
Simpson 47,500 23.6% 14.2 63.6% 17 56.6%
Winterville 47,167 16.6% 10.3 71.2% 25.5 56.7%
Pitt County 43,971 20% 13.5 65.8% X 47%
North Carolina 46,335 22% 9.0 65.7% X 56.3
U.S. 50,046 19.6% 9.2 63.9% 25.5 54.4
http://factfinder.census.gov http://www.city-data.com/city
Disclaimer regarding interpretation of data in this Community Assessment:
Various sources of data have been used in the development of this teaching case including but not limited to vital statistics, the 2004 BRFSS survey, N.C. Communicable Disease Control Branch reports, N.C. County Health Data Book, U.S. Census American Fact Finder, N.C. Child Advocacy Institute, N.C. Child Fatality Task Force.
The data in this report is not to be relied on for actual assessment activities because of various limitations including: different time periods for data collections and a small number of events during the reported time period. These factors subject the results to chance variation. Longer time periods of data collection are required before inferences can be made. For a full discussion of the issues and up-to-date data, refer to the report of the North Carolina State Center of Health Statistics, http://www.schs.state.nc.us/SCHS/.
Resources for Community Assessment
Advocates for Youth
Cecil G. Sheps Center for Health Services Research – University of North Carolina, Chapel Hill
http://www.shepscenter.unc.edu/Data.html
http://www.shepscenter.unc.edu/hp/prof04.htm
Center for Disease Control and Prevention – STD Surveillance 2004
http://www.cdc.gov/std/stats/toc2004.htm
Center for Health Services Research and Development, East Carolina University
http://www.chsrd.med.ecu.edu
CLIKS: community-Level Information for Kids
http://www.aecf.org/cgi-bin/cliks.cgi
Employment Security commission of North Carolina – Labor & Wage Unit, Labor Market Information Division
http://eslmi23.esc.state.nc.us/ew/
Environmental Defense Fund
http://www.scorecard.org/
Geographic.org
http://www.geographic.org
Guttmacher Institute
http://www.guttmacher.org/pubs/fb_teens.html
Institute of Research in Social Science at University of North Carolina, Chapel Hill
http://unc.edu/depts/irss/
Log into North Carolina (LINK)
http://data.osbm.state.nc.us/pis/linc/dyn_linc_main.show
North Carolina Child Advocacy Institute
North Carolina Child Fatality Task Force
www.preventchildabusenc.org/publications/press_releases/cftf
North Carolina Communicable Disease Control
http://www.epi.state.nc.us/epi/gcdc.html
North Carolina Crime Statistics
http://sbi2.jus.state.nc.us/crp/public/default.htm
North Carolina Department of Agriculture
http://www.agr.state.nc.us/stats/
North Carolina Department of Commerce
http://www.commerce.state.nc.us
North Carolina Department of Health and Human Services – Division of Medical Assistance
http://www.dhhs.state.nc.us.dma/
North Carolina Department of Health and Human Services – HIV/STD Prevention & Care Branch
http://www.epi.state.nc.us.epi/hiv/surveillance.html
North Carolina Department of Public Instruction
http://www.dpi.state.nc.us
North Carolina Department of Transportation Public Transportation Division
http://www.dot.state.nc.us/transit/transitnet/
North Carolina Division of Public Health – Oral Health Section
http://www.communityhealth.dhhs.state.nc.us/dental/
North Carolina Division of Public Health – Women’s and Children’s Health Section
http://wch.dhhs.state.nc.us/
North Carolina Employment Security Commission
http://esc.state.nc.us
North Carolina Office of State Planning
http://www/ospi.state.nc.us
North Carolina State Bureau of Investigation
http://sbi.jus.state.nc.us
North Carolina State Center for Health Statistics (NC-SCHS)
http://www.schs.state.nc.us/SCHS/index.html
North Carolina Rural Data Bank (by county)
http://www.ncruralcenter.org/databank/profile
Public Schools of North Carolina
http://www.ncpublicschools.org/accountability/reporting/sat/2005
State of North Carolina
http://www.state.nc.us
University of North Carolina Highway Safety Research Center
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