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Sumter County Community Health AssessmentSUMTER COUNTY COMMUNITY HEALTHASSESSMENTApril 2013Sumter County Community HealthAssessment
Sumter County Community Health AssessmentTABLE OF CONTENTSINTRODUCTION . .3PARTICIPATING AGENCIES . . . .5MAPP STEERING COMMITTEE MEMBERS .6EXECUTIVE SUMMARY.7KEY ISSUES . . 8SUMTER COUNTY PROFILE.9METHODOLOGY.11LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT .14COMMUNITY HEALTH STATUS ASSESSMENT .17COMMUNITY THEMES AND STRENGTHS ASSESSMENT .21FORCES OF CHANGE ASSESSMENT . .24IDENTIFY STRATEGIC ISSUES .27CONTRIBUTING CAUSES . .30NEXT STEPS . . .34REFERENCES . . .35APPENDIX 1 - COMMUNITY HEALTH ASSESSMENT SURVEY . .36APPENDIX 2 - KEY ISSUES SIDE BY SIDE . .422
Sumter County Community Health AssessmentSumter County CommunityHealth AssessmentINTRODUCTIONCommunity Health Assessment has been defined as: A processto systematically collect, assemble, analyze, and make availableinformation on the health of the community, including statistics on healthstatus, community health needs, and epidemiologic and other studies ofhealth problems. (Adapted from Institute of Medicine1).There is a well understood and defined link between social and economicstatus and the health of a community and its members. This link is very wellillustrated in the video “Unnatural Causes”2; a must-see for those seeking tobetter understand this relationship. Some of the factors affecting acommunity’s health are; education and jobs, access to and quality ofhealthcare, the environment, and individual behaviors. By implementingpolicies and programs targeting these health factors, we can improve thehealth of the community. This, however, requires broad communitycollaboration not only of healthcare providers and public health officials, butmany others in the community who contribute to the well-being of individualsand populations.This assessment is the product of an ongoing comprehensive strategicapproach to community health improvement. The Mobilizing for Actionthrough Planning and Partnerships (MAPP) process has been the tool3
Sumter County Community Health Assessmentutilized throughout this process. This strategic planning tool is a communitywide strategy for improving community health developed by the NationalAssociation of County and City Health Officials (NACCHO) and the Centersfor Disease Control and Prevention (CDC). The Sumter County MAPPSteering Committee was formed in October of 2011. The MAPP SteeringCommittee continues to meet on a quarterly basis to facilitate the project.The committee consists of a broad array of community participants who havebeen working collaboratively. These organizations and participants arelisted on the following pages.4
Sumter County Community Health AssessmentPARTICIPATING AGENCIESNature Coast Early Learning CoalitionSumter County Fire ServicesPristine Cleaning Services, LLCHope CenterRural Metro Ambulance Corp5
Sumter County Community Health AssessmentMAPP STEERING COMMITTEE MEMBERSJoelle AboytesChristine HillFlorida Department of Children andRural Metro AmbulanceFamiliesJean HolsteinBradley ArnoldSumter County School BoardSumter Board of County CommissionersMichelle MorleyTim CampSumter County Circuit JudgeLifeStream Behavioral CenterNathan OverstreetLee CerovacLangley Health CenterSumter County ResidentPhillip ScarpelliWilliam CousinsFlorida Department of ChildrenTobacco Prevention Advocateand FamiliesAndrew CrippsBrenda ShrewsburySumter Chamber of CommerceWildwood RotarySarah DoyleRandall Thornton, Esq.Hope Center, First Baptist Church ofAttorneyBushnellBarbara WheelerAccreditation Task ForceMid Florida Homeless CoalitionSumter County Health DeptSandra WoodardLeland GreekNature Coast Early LearningSumter County Fire ServicesCoalitionJulian GreenPristine Cleaning Services/Wildwood CityCouncilSpecial thanks to Cassie Lewis for her work on the Community Health StatusAssessment and also to Junwei Jiang (“JJ”) for his expert analysis of theCommunity Themes and Strengths Assessment.6
Sumter County Community Health AssessmentEXECUTIVE SUMMARYThe purpose for this community health improvement planning initiative hasbeen to identify and prioritize community public health issues, theircontributing causes and describe the resources that may be used inaddressing them. This Community Health Assessment (CHA) report is acomprehensive analysis of the four MAPP assessments conducted over theprevious two years. The CHA and its associated assessments identifyprioritized health issues, outline specific goals to be used to address them,and describe the resources that may be used in realizing these goals. Thisdocument will help to inform the Sumter County Community HealthImprovement Plan (CHIP). The CHIP will have very specific, measurableaction steps focused on the issues identified that will ultimately lead toimproved health and quality of life of the Sumter County community. Thefollowing page briefly describes the three key public health issues that wereidentified along with targeted goals.7
Sumter County Community Health AssessmentKEY ISSUESAs a result of this comprehensive Community Health Assessment, thefollowing three key issues were identified. These are: Tobacco/Drug Use,Obesity and Poor Cardiovascular Health, and Access to Healthcare.Specific goals were identified targeting these health issues.HEALTH ISSUE A: TOBACCO/DRUG USEGOAL A1: Reduce high rate of tobacco use among middle and highschool students.GOAL A2: Address increasing rates of alcohol and substance abuse.HEALTH ISSUE B: OBESITY AND POOR CARDIOVASCULARHEALTHGOAL B1: Reduce rates of obesity and associated healthconsequences.GOAL B2: Raise awareness of obesity as a risk factor for poorcardiovascular health and associated morbidity and mortality.HEALTH ISSUE C: ACCESS TO HEALTHCAREGOAL C1: Address need for specialized education/training fordevelopment of the public health and medical workforce.GOAL C2: Decrease barriers to healthcare for residents of SumterCounty.8
Sumter County Community Health AssessmentSUMTER COUNTY PROFILESumter County is located in Central Florida, and is surrounded by thecounties of Lake, Marion, Citrus, Hernando, Pasco, and Polk. The estimatedpopulation for Sumter County in 2010 was reported as 93,420 from the 2010official U.S. Census. Sumter County has five incorporated cities includingBushnell, Center Hill, Coleman, Webster, and Wildwood. In addition, thecounty includes one of the largest self-contained retirement communities inthe United States; The Villages.Sumter County has a predominately Caucasian population. According todata from the 2010 U.S. Census about 87% of the Sumter county populationis Caucasian while around 11% is African American, Asian, American Indian,Native Alaskan, Native Hawaiian, or Pacific Islander. The Hispanicpopulation of Sumter County is reported from the 2010 U.S. Census as5,605 (6%) and Non-Hispanic is reported as 87,815 (94%) for 2010.According to the 2010 U.S. Census, the population in Sumter County has anolder median age than Florida as a whole. Sixty-three percent (63%) of the9
Sumter County Community Health Assessmentresidents are age 55 or older as compared to thirty percent (30%) for thestate. The median age is 63.5 years. Approximately 48% of the population isfemale and 52% is male.Sumter County Population Overview100%87%80%CaucasianHispanicNon-Hispanic Minority *MaleFemale 55 Yrs Old 55 Yrs Old63%60%52%48%37%40%20%6.0%7.0%0%Population categories10
Sumter County Community Health AssessmentMETHODOLOGYThe Mobilizing for Action through Planning and Partnerships (MAPP) modelcan be expressed graphically as follows.11
Sumter County Community Health AssessmentThis process involves organizations and individuals who partner together towork toward a shared vision of improved public health in their community.To identify strategic issues that need to be targeted to achieve that vision, aseries of assessments are conducted. These assessments, shown on theoutside of the model, largely drive the process. The four MAPPassessments are; Local Public Health SystemAssessment Community Health StatusAssessment Community Themes andStrengths Assessment Forces of Change AssessmentThe first phase of the MAPP process involves organizing for success andpartnership development. The Sumter County Health Department initiatedthis phase in April, 2011 with the formation of the Accreditation Task Force(ATF). The committee’s membership represents the various fields of thehealth department including public health administration, medical, nursing,epidemiology, health education, emergency preparedness, andenvironmental health. The ATF held (and continues to hold) weekly meetingsto discuss the way forward and to keep up the momentum.12
Sumter County Community Health AssessmentThe ATF invited community partners to become part of a public healthplanning committee. In October, 2011, the MAPP Steering Committee wasformed and met for the first time. The Steering Committee continues toinform the process with participation from a variety of community partners.The MAPP Steering Committee began by developing a vision statement forthe future of public health in Sumter County. Part of the Visioning processinvolves identifying other visioning efforts that the community is engaged in.This effort revealed the Sumter 20303 visioning process conducted by theSumter County Planning Department in 2008. The following vision statementwas agreed upon by the committee.A partnership-centered community focused on a safe and healthyfamily environment where citizens have access to a public healthsystem that meets their needs.In the next phase of the MAPP process the four assessments are conducted.On the following pages, the procedures and results for each of theassessments can be found. The full versions can be found 3
Sumter County Community Health AssessmentLOCAL PUBLIC HEALTH SYSTEM ASSESSMENTThe Local Public Health System Assessment (LPHSA) was conducted firstfrom April – July 2011. This assessment was accomplished with input froma wide variety of health and medical partners. The LPHSA seeks feedbackabout the ten Essential Public Health Services4.These are:1. Monitor health status to identify and solve community healthproblems.2. Diagnose and investigate health problems and health hazards in thecommunity.3. Inform, educate, and empower people about health issues.4. Mobilize community partnerships and action to identify and solvehealth problems.5. Develop policies and plans that support individual and communityhealth efforts.6. Enforce laws and regulations that protect health and ensure safety.7. Link people to needed personal health services and assure theprovision of health care when otherwise unavailable.8. Assure competent public and personal health care workforce.9. Evaluate effectiveness, accessibility, and quality of personal andpopulation-based health services.10. Research for new insights and innovative solutions to healthproblems.These ten essential services are linked to the three core functions of a publichealth agency; Assessment, Assurance, and Policy Development. Thefollowing figure illustrates this concept.14
Sumter County Community Health AssessmentOsaki, Ten Essential Public Health ServicesFeedback was solicited through e-mailed communication with partners aswell as through telephone calls. Partners were asked to answer specificquestions from the assessment tool. The survey responses were thensubmitted to the CDC and a LPHSA results report was returned. Thefollowing come directly from this report.15
Sumter County Community Health Assessment16
Sumter County Community Health AssessmentCOMMUNITY HEALTH STATUS ASSESSMENTThe Community Health Status Assessment was completed in December2011. This assessment takes a snapshot in time of the local public healthsystem. Information for the assessment was gathered from a variety of datasources including the U.S. Census Bureau5,the Florida Community Health AssessmentResource Tool Set (CHARTS6), theBehavioral Risk Factor Surveillance Survey(BRFSS7), the Florida Department of HealthCounty Performance Snapshot and others.Additionally, county-level results from the 2012 County Health Rankings8published by the University of Wisconsin Population Health Institute and theRobert Wood Johnson Foundation were considered. The resulting analysisindicated four overarching health related concerns. These are; 1) Lowenrollment in higher education, 2) A high percentage of smoking in middleand high school students, 3) A high percentage of overweight residents, and4) Poor cardiovascular health among Sumter County residents. Thefollowing figures are taken from the Community Health Status Assessment.17
Sumter County Community Health Assessment% 18-44 Yrs Old Enrolled in College or Graduate eYouth Smoking (past 30 .9%4%2%0%18Middle SchoolHigh School
Sumter County Community Health AssessmentSumterOverweight(BMI 25-29.9) Obese(BMI 30 tObeseStroke (2008-2010)600SumterState538(per 100,000 talizations
Sumter County Community Health Assessment500Coronary Heart Disease (2008-2010)489.9(per 100,000 1104.5100500DeathsHospitalizationsCongestive Heart Failure (2008-2010)180(per 100,000 er7Hospitalizations7.6Deaths
Sumter County Community Health AssessmentCOMMUNITY THEMES AND STRENGTHS ASSESSMENTThe Community Themes and Strengths Assessment was completed inAugust, 2012 and resulted in a comprehensive report detailing the issuesthat residents of Sumter County feel are most important. The CommunityThemes and Strengths Assessment answers the following questions. “Whatis important to our community?”, “How is quality of life perceived in ourcommunity?”, and “What assets do we have that can be used to improvecommunity health?” The method for data collection was a CommunityHealth Assessment Survey (Appendix 1). This 24 question telephone-basedsurvey used a simple stratified sample design for data collection. As SumterCounty consists of two distinct demographics; an affluent urban north (TheVillages) and a rural central and southern part, the survey results comparethe two. A total of 2734 phone calls were made resulting in 271 surveyresponses, approximately a 10% response rate. The assessment revealed anumber of issues residents feel are very important. Among these are HeartDisease and Stroke, Obesity, Respiratory/Lung Disease, and DrugUse/Abuse as indicated in the following charts.21
Sumter County Community Health AssessmentThe VillagesTop 3 health issues you think are a problemOutside The VillagesSumter County90%80%70%60%50%40%30%20%10%baccoUseesToeasD isuallyTransmittedngDiseasersLuealHntair atory/Sexesit yOtheP rolthObmsb lecarealthheMeRespLackofavail a bleusD iseasekeSt rondaseaInfectiouseHeartDiseUse/Abbet esDrugD iaCancer0%The top three health issues identified as a problem in The Villages were Heart Disease and Stroke,Obesity, and Respiratory/Lung Disease. Outside The Villages the top three identified were DrugUse/Abuse, Heart Disease and Stroke, and Obesity. Countywide, the top three health issuesresidents felt were most important were Heart Disease and Stroke, Obesity, and Respiratory/LungDisease. It’s noteworthy that Heart Disease and Stroke are considered extremely important withinThe Villages, while Drug Use/Abuse was identified as the top health issue outside The Villages.22
Sumter County Community Health AssessmentThe Villages3 Most Important Factors of a Healthy CommunityOutside The VillagesSumter County60%50%40%30%20%10%tionrsr eaheecdedranrksPaLowin fantor hhbe igOtsa thdsooa tefeNSae/rimwCLolt dduwaLoHea lthybeeahathvi oanrsddanis edlasifeserty lesso lshoScodGoi l drchsetocep laodsajo bodGoGondC leheana ltr aihyenv irecononmeomenynteovabA llAccesstoHealthcare0%Countywide, Low Crime/Safe Neighborhoods was considered the most important factor ofa healthy community. More than half of the residents of The Villages identified Access toHealthcare as an important factor. Over 50% of residents of other areas of Sumter Countyidentified a Good place to raise children and Good Schools as important components of a healthycommunity.23
Sumter County Community Health AssessmentFORCES OF CHANGE ASSESSMENTThe Forces of Change (FOC) Assessment was completed in September2012. The Forces of Change Assessment focuses on the identification offorces that affect the context in which the public health system operates.These forces can be Trends, Events, or Factors. Trends are patterns overtime such as a slow economy. Events are one-time occurrences such as theconstruction of a new hospital. Factors are discrete elements such as a ruralsetting. The FOC Assessment answers the questions “What is occurring ormight occur that affects the health of our community or the local public healthsystem?” and “What specific threats or opportunities are generated by theseoccurrences?” MAPP Steering Committee members participated in the FOCAssessment during two brainstorming sessions on August 2, 2012 andAugust 30, 2012; and also though an e-mail survey on August 21, 2012.The following is taken from the Forces of Change Assessment report.24
Sumter County Community Health AssessmentTRENDOpportunities Increased demand forHealthcare services due toaging populationAging healthcare workforce/Shortage of competent,skilled health professionalsGrowing internet useShrinking budgets andincreasing need for socialprograms25Fewer people able toaffordinsurance/healthcare Loss of jobs inconstruction/housingindustry Increased morbidity andmortalityIncreased incidence ofdiseasesIncreased cost of foodImpact to potable watersupplies Targeted programs Raise awareness ofdrought-related healthissues/concerns EmploymentPossible functional orstructural improvementsto healthcare systemEducational programs tofill these needs Lack of trained workersRising costs Insufficient workforce tohandle demandLoss of institutionalknowledgePatients self-evaluatingthrough internet researchIllegal/improper use ofprescription medicationsPrograms/servicesdiscontinuedIncreased populationbased morbidityBuild-out of The Villagesresidential housingSignificant drought acrosscountry Impetus to seek morecost efficient ways ofdelivering servicesOpportunity foremployment in supportand caregiver roles foraging populationSlow economyGrowth in chronic diseaseThreats Opportunities for youngtalent to join theworkforce Increased patientknowledge/awareness Opportunities forinnovation
Sumter County Community Health AssessmentFACTORSocio-economic differenceswithin Sumter CountyUndocumented workersDrug use/abuseOpportunities Lack of access to careTargeted programs EVENT26Disease transmission New hospital east ofWildwood Mobility of populationHealthcare reform(Medicaid/Medicare)Confidentiality concernsCostMisuse of aggregate dataTargeted programs Rural nature of SumterCounty outside The Villages Electronic Health Records ThreatsUnequal access to careDisparate needsUtilization/payment ofhealthcareDisease surveillancechallengesCrimeIncreased diseaseprevalenceSocial disruptionTargeted programsEasier access to patientinformation/betterhealthcareBetter/faster sharing ofinformation amongprovidersExpanded reach oftargeted healthinformationImprove access to careTargeted healtheducation programsPreserve open spaces Opportunities Expansion could lead toimproved access tohealthcareIncreased access to careEmploymentThreats Access to care Non-emergency ER visits
Sumter County Community Health AssessmentIDENTIFY STRATEGIC ISSUESFrom the four MAPP assessments, the highest priority issues were identifiedand a Key Issues Side by Side Document (Appendix 2) was createdsummarizing the main themes and issues from each assessment. Thepriority issues identified are not exclusive to Sumter County, but reflecthealth issues impacting the entire United States.The first common theme that emerged from the assessments wasTobacco/Drug Use. Data from the Community Health Status Assessmentindicates tobacco use among both youth and adults is higher compared tooverall rates in Florida. Results from comprehensive surveillance systemsshow an increasing trend among adult smokers in Sumter County. In theCommunity Health Status Assessment Survey, Sumter County residentsexpressed concern regarding drug use, including tobacco, alcohol, and illicitdrugs. The survey also identified drug use as a greater concern amongthose residing outside The Villages.The second issue identified as a high priority from the four MAPPassessments was Obesity/Overweight and associated poor cardiovascularhealth. The Community Health Status Assessment revealed more SumterCounty residents are overweight or obese compared to the state. This islikely associated with the higher hospitalization rate for conditions like,coronary heart disease and congestive heart failure in Sumter County. TheCommunity Health Status Assessment identified obesity and associatedconditions like heart disease, stroke, and diabetes as a top health issue27
Sumter County Community Health Assessmentthroughout Sumter County. By comparison, individuals residing in TheVillages identified poor cardiovascular health as a critical issue more oftenthan those living outside The Villages.The last issue highlighted as high priority was Access to Care. Access tocare is an overarching issue that impacts health outcomes and maycontribute to other health issues, such as those previously identified. Atheme that emerged from the Forces of Change Assessment was anincreased demand for health services. The Community Themes andStrengths Assessment identified a specific need for drug and alcohol abuseservices as a major issue to residents living outside of The Villages. Accessto counseling and treatment are critical in addressing the issue of drug andalcohol abuse.The distribution of these health issues is attributable to the contrast betweenthe populations living within and outside of The Villages. These differingcharacteristics are discussed in further detail in the next section,“Contributing Causes”.The following illustration summarizes the roles of the four MAPPassessments in the identification of the strategic issues.28
Sumter County Community Health AssessmentLocal Public Health System Monitor health status to identify and solvecommunity health problems Link people to personal health services;assure provision of care Assure a competent public & personalhealthcare workforceCommunity Health Status Low enrollment in higher education High Percentage of smoking inmiddle and high school students High percentage of overweightresidents Poor cardiovascular health incomparison to FloridaStrategic Issues1. Tobacco/drug use2. Obesity & poorcardiovascular health3. Access to HealthcareCommunity Themes & Strengths 29Heart disease & strokeObesityRespiratory/lung diseaseDrug use/abuseAccess to HealthcareAlcohol/drug abuse servicesForces of Change Increased demand for servicesAging workforceDrug use/abuseHealthcare reform
Sumter County Community Health AssessmentCONTRIBUTING CAUSESThere are a variety of contributing causes for these health issues. Amongthem are behavioral and socio-economic. For example, in Sumter Countytobacco use is, in many cases, a cultural phenomenon. Smoking andsmokeless tobacco use is a behavior that is normalized through generationalconsumption and lack of education on harmful effects. Obesity and poorcardiovascular health is often associated with behavioral and environmentalfactors. The availability of healthy food choices, nutritional education, aswell as access to recreational areas can all play an important part. Theissue of access to healthcare is related to the status of the public health andhealthcare workforce as well as to health disparities. Access to healthcare incentral and southern Sumter County is markedly different than in northernSumter County where The Villages retirement community is located. Thereare socio-economic differences between the regions and a much greaternumber of healthcare providers serving northern Sumter County. However,the continued expansion of The Villages has resulted in an ever increasingpercentage of elderly in the county’s population which has generated anincreased need for trained health professionals.30
Sumter County Community Health AssessmentIt is critical to note that there is a disparity in access to care for residentsliving outside of The Villages.Health DisparitiesThere is a persistent gap between the least and most vulnerable in oursociety in terms of illness, injury, risky behaviors, and premature death9.These health disparities exist across a broad spectrum of socio-economiccharacteristics including age, sex, race, ethnicity, income, and education.As seen in the following chart, the percentage of adults in Sumter Countywho are current smokers is also influenced by education and income level.31
Sumter County Community Health AssessmentThese disparities in education, income, and other socio-economic factors putpeople at increased risk of unhealthy behaviors. Additionally, theynegatively affect access to and quality of healthcare, morbidity and mortality.In Sumter County there is a big difference in death rates between blacks andwhites for major causes of death as shown below.32
Sumter County Community Health AssessmentAs stated previously, Sumter County consists of two major populations.Approximately 60% of the population is retired adults who live in TheVillages. The other 40% of the population resides outside The Villages.These two populations have very different characteristics. Residents of TheVillages are a group of affluent retirees of similar age (over 55 years). Thisgroup is generally more educated and has very similar demographiccharacteristics including a shared lifestyle. On the other hand, the populationin the rest of Sumter County has a more varied structure in terms of age,household income, education level and other demographic characteristics.Generally speaking, education levels and average incomes are lower for thisrural populace. Because of the contrasting nature of these two populations,they face different kinds of health issues. For this reason, a dual approach isrequired involving both universal interventions impacting everyone as well asapproaches targeted for specific populations.33
Sumter County Community Health AssessmentNEXT STEPSThis Community Health Assessment identified three overarching healthissues. These are; 1) Tobacco/Drug Use, 2) Obesity and PoorCardiovascular Health, and 3) Access to Healthcare. These issues wereidentified through a comprehensive MAPP process involving multiplecommunity partners. This Community Health Assessment and the fourMAPP Assessments were placed on the Sumter CHD internet site for thegeneral public to review and provide input. Additionally, these documentswere distributed by e-mail to Sumter County communityagencies/organizations. All MAPP Steering Committee meetings were opento the public and were announced on the Sumter CHD internet site as wellas in the Sumter CHD Newsletter.Over the next few months, a Community Health Improvement Plan will bedeveloped to address the identified health issues. There are resourcesavailable to us that provide information on evidence-based interventionssuch as, the Wisconsin Population Health Institute, County Health Rankings& Roadmaps, What Works for Health10, as well as the CDC Guide toCommunity Preventive Services11. Using these resources, in conjunctionwith broad community collaboration of healthcare providers, public healthofficials, and others in the community; goals, strategies and activities will beadded. In this way an action plan will be finalized. The Steering Committeewill then meet on an ongoing basis to monitor, update and evaluateimplementation of the Community Health Improvement Plan.34
Sumter County Community Health AssessmentREFERENCES1.2.3.4.5.6.7.8.9.10.11.35The Future of Public Health, 1988, Institute of MedicineUnnatural Causes is inequality making us sick? 2008 California /1469Ten Essential Public Health es.htmlThe United States Census Bureau, www.census.govFlorida Department of Health, Community Health Assessment Resource ToolSet, www.floridacharts.comBehavioral Risk Factor Surveillance System,www.doh.state.fl.us/Disease ctrl/epi/BRFSS Reports/2010/BRFSS 2010.htmWisconsin Population Health Institute, www.countyhealthrankings.orgCDC Health Disparities & Inequalities Report t.htmlCounty Health Rankings, What Works For rks-for-healthThe Guide to Community Preventive ml
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Sumter County Community Health Assessment 4 utilized throughout this process. This strategic planning tool is a community- . counties of Lake, Marion, Citrus, Hernando, Pasco, and Polk. The estimated . nursing, epidemiology, health education, emergency preparedness, and environmental health. The ATF held (and continues to hold) weekly meetings
