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ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 20102013 Edward A. Diana County Executive Jean M. Hudson, M.D., M.P.H. Commissioner of Health ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 TABLE OF CONTENTS Acknowledgements Executive Summary and Key Findings Exhibit Listing Guide to Statistical Terms Community Health Assessment (CHA) Index Section 1 – Populations at Risk Page A. Demographic and Health Status Information 1-23 1. The Population of Orange County 1-5 a. Population Growth Rates and Density b. Population Demographics c. Employment and Housing Characteristics d. Projected Demographic Changes e. Regional Perspective 2. Causes of Mortality in Orange County 5-7 a. Overall Mortality b. Mortality Rates of Demographic Subpopulations c. Leading Causes of Death 3. Health Status of County Residents 7-15 a. Family Health  Child and Adolescent Health  Maternal and Infant Health, Reproductive Health & Family Planning  Intentional and Unintentional Injuries b. Disease Control 15-23  Sexually Transmitted Diseases  HIV/AIDS  Tuberculosis  Other Communicable Diseases  Vaccine Preventable Diseases  Chronic Diseases B. Access to Care 24-28 1. Availability and Utilization of Health Care Services 24-26 2. Barriers to Health Care Access 26-28 a. Financial b. Structural c. Personal C. Behavioral Risk Factors 1. Core Behavioral Risk Factors 30-37 2. Optional Behavioral Risk Factors 37-39 3. Selected Youth Behavioral Risk Factors 39-40 D. The Local Health Care Environment 1. History 41 2. Physical and Social Factors 41-42 3. Economic Factors 43-44 E. Section One Exhibits 46-263 Section 2 – Local Health Unit Capacity Profile Page A. Organizational Structure and Program Description 1-9 B. Current Trends and Workload 10-17 C. New Initiatives and Significant Accomplishments 18-20 D. Staff Qualifications and Skill Levels 21-22 E. Expertise and Technical Capacity for Community Health Assessments 23 Section 3 – Problems and Issues in the Community Page A. Profile of Community Resources 1-31 B. Profile of Unmet Need for Health Services 1-3 Section 4 – Local Health Priorities Page A. Priority Local Needs 1-16  Priority Health Needs  Accomplishments Related to Priority Areas Section 5 – Opportunities for Action Page A. Opportunities and Potential Action Steps 1-4 Section 6 – Community Report Card Page  Introduction 1  County Health Indicator Profiles 2-3  Orange County Indicators for Tracking Public Health Priority Areas 4-7 Orange County Community Health Assessment 2010-2013 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 ACKNOWLEDGMENTS Many thanks to all who worked to bring this document together: Prevention Agenda Workgroup (see listing) Orange County Department of Health Division Directors: Chris Dunleavy, Deputy Commissioner of Health Robert Deitrich, Director, Community Health Outreach Marilyn Ejercito, R.N., M.S., Director, Public Health Nursing Christopher Ericson, M.P.A., Director, Public Health Response Matthias Schleifer, P.E., Assistant Commissioner, Environmental Health Anne Vradenburgh, Director, Fiscal Sheila Warren, R.N., M.Ed., Director, Intervention Services Charles A. Catanese, M.D., Chief Medical Examiner Robert Hastings, Health IT Consultant Colleen Larsen, R.N., M.P.A., OCDOH Nurse Epidemiologist Jacqueline Lawler, M.P.H., OCDOH Epidemiology Fellow Chris Saccone, Executive Secretary/Administrative Assistant Ed Waltz, Ph.D., Director, and Susan Wymer, B.S.N, R.N., Graduate Research Assistant, Prevention Research Center, SUNY Albany School of Public Health Mary Bevan, M.P.H., Project Director (Consultant) Jean M. Hudson, M.D., M.P.H. Commissioner of Health Orange County Community Health Assessment 2010-2013 1 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 EXECUTIVE SUMMARY The 2010-2013 Community Health Assessment (CHA) represents the ongoing efforts of representatives from community-based health, social service, mental health, and education agencies, health care providers, Advisory Board of Health and Health Department representatives to identify health needs and to collectively determine strategies to improve the health of County residents. Submission of the CHA is a requirement of the Municipal Public Health Services Plan. A complete assessment is conducted every four years. New York State regulations designate the county health department as the lead agency in the preparation and submission of the CHA. As stated in the 2010-2013 NYSDOH CHA Guidance document, “Community health assessment is a core function of public health agencies and a fundamental tool of public health practice. Its aim is to describe the health of the community, by presenting information on health status, community health needs, resources, and epidemiologic and other studies of current local health problems. It seeks to identify target populations that may be at increased risk of poor health outcomes and to gain a better understanding of their needs, as well as assess the larger community environment and how it relates to the health of individuals. It also identifies those areas where better information is needed, especially information on health disparities among different subpopulations, quality of health care, and the occurrence and severity of disabilities in the population.” The CHA is the basis for all local public health planning, giving the local health unit the opportunity to identify and interact with key community leaders, organizations and interested residents about health priorities and concerns. New York’s Prevention Agenda toward the Healthiest State initiative was launched in April 2008, to promote collaborative community health planning focused in locally-selected health priority areas. The Prevention Agenda designates local health departments and hospitals as the lead partners in this process. Involving key community stakeholders, 2-3 priority areas are selected based on consideration of demographic and health status data, health service delivery data, local and regional surveys and studies. Opportunities for action are identified to focus improvement efforts and maximize outcomes through coordination and collaboration. National and state benchmarks, such as Healthy People 2010 and Prevention Agenda 2013 targets are used to monitor and evaluate progress. Several strategies were used to encourage community input in establishing community health priorities. The primary strategy is ongoing community collaboration. In addition, two versions of a local health needs survey were developed to solicit input on local health needs from health providers, community agencies, and residents. More than 160 provider/community agency and 760 resident surveys were completed. Representatives from community agencies throughout the county also participated in “Health Town Meetings” held in 4 distinct geographic areas of the county. These meetings were hosted by the primary hospital/medical center in each region and the discussions were facilitated by representatives from each Community Health Center serving county residents. The surveys and Health Town meetings attempted to capture as broad participation as possible and reflect the priority health issues in the communities in each area. Despite slight differences in geographic emphasis, the primary concerns raised were highly consistent. This information, as well as analysis of the demographic, mortality, morbidity, and behavioral risk indicators discussed in Section I – Populations at Risk informed the selection of local health priorities aligned with the NYS Prevention Agenda. A Prevention Agenda Workgroup was convened to finalize the determination of unmet health and service needs, local health priorities, and opportunities for action. Workgroup representatives have extensive experience in public health and health services delivery, including service to high risk populations throughout the county. Working with a public health consultant, researchers from the SUNY Albany School of Public Health, the OCDOH epidemiologist, and Division Directors formed our CHA development team. The determination of local health priorities was guided by the 10 priority areas for public health action specified in The Prevention Agenda for the Healthiest State. Orange County Community Health Assessment 2010-2013 2 The majority of residents in Orange County enjoy favorable health. Preliminary results from the most recent NYSDOH Expanded Behavioral Risk Surveillance Survey found that 86% of Orange County adults ages 18 and over surveyed reported their health status to be good to excellent. Access to quality primary health care services is essential to maintain and improve health in the community. Access to primary care promotes a consistent source of care to receive preventive health education and health screenings, early detection and treatment of disease, and timely referrals for specialty care and other needed services. Ongoing contact with a primary health care provider is essential to prevent complications and improve health outcomes. Orange County is relatively well supplied with primary care providers, however all residents do not have adequate access. The leading health issues in Orange County, as in the state and the nation, result from a number of factors, many of which can be controlled or modified. Harmful personal behaviors such as smoking, overeating, poor nutrition, lack of physical activity, substance abuse, and unsafe sexual practices have major impacts on individual health. Economic and language/cultural factors present barriers to access and utilization of medical care and preventive health services. Income, unemployment, educational attainment, inadequate housing, and lack of transportation are social factors which impact health or limit access to care. Uncontrollable factors, including inherited health conditions or increased susceptibility to disease, also significantly influence health. In spite of the favorable health status enjoyed by most Orange County residents, health disparities persist and are concentrated in the county’s uninsured and low income population groups. Lack of health insurance and inadequate insurance coverage are increasing concerns in the current economic recession. Even individuals and families with health insurance can find navigating the health care system difficult especially when faced with personal or family illness. Persons who live in poverty or are uninsured are more likely to have poor health status. Poverty underlies many of the social factors that contribute to poor health. Differences for many health indicators are also apparent by gender, race/ethnicity, age, and geographic area of residence. This information can be used to determine subgroups in the population in need of further assessment, as well as to guide the development of programs and services to meet identified health needs. Recent trends in health indicators for County residents show improvement in overall mortality rates from the leading causes of death – most notably heart disease and cancer. Key indicators of maternal and infant health, such as births and pregnancies in teens, infant mortality and low birthweight births, have also improved for county residents overall. There are indications of improvement in personal health habits such as smoking rates and accessing screening services for early detection of certain diseases. However, disparities in health care access and health status in high risk populations persist. The 2010-2013 CHA also indicates areas in need of improvement in county residents such as unintentional injuries, ambulatory care sensitive conditions, Prevention Quality Indicators for chronic diseases, receipt of early prenatal care, prevalence of smoking and obesity, asthma-associated illness, cancer incidence, and disparities in mortality from chronic diseases. Expanded joint planning and coordination of programs and services among health care partners in the community focused in the health priority areas can reduce health disparities and improve the health of all county residents. The intent is for the Community Health Assessment to have significant value for the community, and to be used to advance health-related service planning by a multitude of agencies. We welcome your comments and reactions to this report, and invite you to participate in the assessment process going forward. Jean M. Hudson, M.D., M.P.H. Commissioner of Health Orange County, New York September 2009 Orange County Community Health Assessment 2010-2013 1 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 KEY FINDINGS Demographic Trends  According to the U.S. Census population estimates published by the New York State Data Center, Orange County is the fastest-growing county in New York State; from April 1, 2000 to July 1, 2007, the county’s population increased by an estimated 10.5%. Trends in population growth vary greatly by municipality - communities with estimated population growth rates of twenty percent or more from 2000-2007 include the towns of Minisink and Monroe, and the villages of Kiryas Joel, Maybrook, and Montgomery.  Based on 2007 U.S. Census population estimates, the median age in the county has remained relatively constant (34.6 years); the greatest number of residents fall in age range 25-54. The number of residents ages 65-69 is forecasted to more than double from 2000-2020 primarily due to the entry of ‘baby boomers’ into these age ranges.  According to 2007 U.S. Census population estimates, the county’s single race composition is: 84.8% White, 10.6% Black/African American, 2.4% Asian with the remaining 2.2% classified as other. Hispanic/Latino, which is not a racial category, represents 15.9% of the county population. Since the 2000 Census, the greatest estimated rate of growth is in the Asian/Pacific Islander population which increased by 75%. The second highest increase was in the Hispanic/Latino population, which grew by 50%. During this time, the Black/African American population is estimated to have increased by 44% and the White population increased the least at 12%.  According to the U.S. Census, over nine thousand (9,082) foreign born persons entered Orange County from 1990-2000, up from 6,964 from 1980 to 1990. The majority (45.2%) were born in Latin America, 34.1% were born in Europe, and 16.4% were born in Asian countries. Kids’ Well-Being Clearinghouse data report that the number of Orange County students K-12 with limited English proficiency increased by 35% from 2000 to 2007, from 9.3% to 12.6%.  Recent educational attainment indicators for Orange County youth indicate improvement in educational performance and in the intent to pursue higher education. The percent of high school graduates receiving Regents Diplomas in Orange County’s Public Schools increased substantially from 1999-2000 to 2006-2007 (49.9% to 81.6%), in part due to the phase-in of Regent only diplomas statewide. The number of high school graduates intending to enroll in college also increased during this same period, from 81% to 83.7%.  Poverty rates vary greatly throughout the county based on municipality. Poverty rates exceeding 25% for families with related children under 18 are found in Orange County’s three cities (Middletown, Newburgh, and Port Jervis), as well as in the town of Monroe, largely due to the impact of the village of Kiryas Joel, where the poverty rate is more than 4 times the county average. Levels of poverty in the county also vary depending on race, ethnicity and family composition. Married couple families have the lowest overall poverty rates; the highest rates are seen in single mother families, and this rate exceeds 50% in single mother families with children under the age of five.  Housing units within the county increased an estimated 9.2% from 2000 to 2007. The majority of housing units in the county are owner occupied; however this also varies by municipality. Communities with 50% or more of their housing units consisting of pre-1950 construction include Cornwall, Highlands, and the county’s three cities of Middletown, Newburgh, and Port Jervis.  Among the seven counties in the Hudson Valley Region (HVR), Orange County is the second most populated county, and ranks second in the rate of population growth from 1990-2000 and in the number of Hispanic/Latino residents. Orange County Community Health Assessment 2010-2013 2 Health Status and Risk Indicators  Overall Mortality and Leading Causes of Death: Since 1998 - 2000, there has been a steady decline in the 3-year average age-sex adjusted mortality rate in the county. The 2004-2006 age-sex adjusted mortality rate for county residents was below the Upstate rate. In 2004-2006, the mortality rate for Black/African American residents in the county is highest, followed by that for White residents. Hispanic/Latinos have the lowest overall mortality rate in the county, which may be due in part to underreporting of ethnicity on death certificates. The leading causes of death in the county, as well as in the state and nation, vary by age. In 2005-2007, heart disease and cancer together accounted for over half (53%) of all county resident deaths, and are the leading causes of death in adults ages 45 and over. The leading cause of death in children, adolescents, and young adults is accidents, in adults ages 25-44 the leading causes are cancer followed closely by accidents.  Child Health: In general, the health of Orange County children is relatively good; however, there are vulnerable groups within the population who lack consistent access to primary and preventive health care such as children living in low income families without health care insurance. Analysis of the most recent comparative data (2004-2006) shows improvement in hospitalization rates for children ages 0-4 for the following ambulatory care sensitive (ACS) conditions: asthma, pneumonia, and otitis media. Improvements in hospitalization rates for otitis media are dramatic, and in 2004-2006 were below those of the state, upstate, and HVR. Three-year hospitalization rates for Orange County infants and children ages 0-4 remain consistently above those for the HVR for the other ACS conditions. The screening rate for lead poisoning in children under 6 years of age remains in need of improvement. In addition, findings of the 2003 NYSDOH Oral Health Survey were suggestive of a lack of access to or utilization of preventive oral health services in third grade children.  Adolescent Health: Adolescents in Orange County generally enjoy favorable health. Health risks in teens most often include risky behaviors related to sexuality, alcohol, tobacco, and drugs, and accidents. Pregnancy and birth rates in teens ages 15-19 have declined in Orange County from 1997-2006. Nonetheless, in 2004-2006, pregnancy and birth rates were the second highest in the HVR; the highest rates in the county are found in minority teens and in the county’s 3 cities. Indicators of youth risk behaviors related to drug and alcohol use and for certain sexually-transmitted diseases indicate the need for enhanced and affordable prevention, treatment and screening services for county youth.  Maternal and Infant Health: The pregnancy rate for females ages 15-44 increased from 2004-2006; Orange County’s rate remains above that for the HVR and Upstate. The percentage of women who are receiving early prenatal care is well below HP2010 targets, and is lowest in teens, minority females, and geographically, in the cities of Middletown and Newburgh. Birth rates were relatively constant from 2004-2006, and are, like pregnancy rates, higher than the average for the HVR and Upstate. Birth rates are highest in Hispanic females. The city of Middletown has the highest birth rate in the county; the city of Newburgh has the highest percentage of births to teens (ages 17 and under) and Medicaid/Self Pay births. Infant mortality rates in the county have declined substantially since 2004, and the 2006 rate met the HP 2010 target for the first time. Infant mortality (as a percentage of total births) is highest in Black/African American infants, which is consistent with state and national findings. Orange County has the second lowest rate of LBW in the HVR; within the county rates are highest in teens and in Black/African Americans.  Injuries: Overall mortality from unintentional injury or accidents in the County is higher than the HVR and NYS. This is in part due to death rates from motor vehicle accidents (MVAs) which are higher than the HVR, Upstate, and NYS. Rates of alcohol-related MVAs exceeded average rates for the region and for NYS in 2004-2006.  Disease Control: The number of cases of certain sexually transmitted diseases (STDs), in particular Gonorrhea and Chlamydia has recently increased; a significant proportion of these cases are in adolescents and demonstrate the need for enhanced prevention services, screening and treatment in high risk groups. The case rate for HIV/AIDS is below that for Upstate and NYS. Advances in HIV treatment have dramatically reduced AIDS mortality, and advances in testing, such as highly accurate oral testing, will hopefully increase testing acceptance and frequency in high risk groups. Enhancements to disease surveillance systems instituted by OCDOH permit closer monitoring for all reportable communicable diseases, including TB and vaccine preventable diseases. The recent resurgence in Pertussis cases in the county in children and adolescents is testimony of the need to achieve full protection from vaccine preventable diseases through timely and complete immunization. Full protection of county residents at highest risk from serious illness from influenza and pneumonia remains a priority; efforts have been intensified with the arrival of pandemic H1N1 influenza. The rate of Lyme disease is [...]... births Orange County Community Health Assessment 201 0- 2013 Guide to Statistical Terms 2 201 0- 13 Community Health Assessment COVER PAGE County: Orange Local Health Department Address: 124 Main Street, Goshen, New York 10924 Telephone: 84 5-2 9 1-2 332 Fax: 84 5-2 9 1-2 341 Submitted by: Jean M Hudson, M.D., M.P.H E-MAIL: JMHudson@orangecountygov.com Prepared by: CHA Development Team GENERAL COUNTY INFORMATION Health. .. Gender, Orange County, 200 1-2 005 Exhibit 1A.87 Trends in Cancer Incidence and Mortality Rates by Gender, Orange County and NYS, 197 6-2 005 Orange County Community Health Assessment 201 0- 2013 4 Exhibit 1A.88a 1A.88b Exhibit 1A.89a-c Exhibit 1A.90 Exhibit 1A.91a-e Exhibit 1A.92 Exhibit 1A.93a-b Exhibit 1A.94* Exhibit 1A.95a-b Exhibit 1A.96 Age-Adjusted Cancer Incidence Rates by Site and Gender, Orange County, ... the county should be expanded, especially for those at highest risk for health disparities - the uninsured, recent immigrants, minorities, and low income groups Refer to Sections IV and V - Local Health Priorities and Opportunities for Action for a detailed summary of recommendations based on assessment findings Orange County Community Health Assessment 201 0- 2013 3 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT. .. Locations in Orange County New York, 2009 Certified Home Health Agencies and Long Term Home Health Care Programs in Orange County New York, 2009 Nursing Facilities in Orange County New York, 2009 Managed Care Plans in Orange County New York, 2009 Expanded BRFSS Access to Care Results, Orange County, Hudson Valley Region, and NYS, 2003 Orange County Community Health Assessment 201 0- 2013 5 C Behavioral... Below Poverty Level: Orange County, 2000 Exhibit 1A.21a-b Orange County Recipients of Financial and Medical Assistance by Type and Municipality, December 2008 Exhibit 1A.22 Orange County Department of Social Services Population Served, 200 5-2 008 Orange County Community Health Assessment 201 0- 2013 1 Exhibit 1A.23 Demographic Profile of Public School Districts in Orange County, 200 7-2 008 (Racial/Ethnic... Accidents, Total and Alcohol-Related, Orange County, Hudson Valley Region, and New York State, 200 4-2 006 Orange County Community Health Assessment 201 0- 2013 3 Exhibit 1A.69 Exhibit 1A.70 Mortality from Motor Vehicle Accidents, Orange County and Upstate New York, Ten Year Time Trends, 199 7-2 006 Discharge Rates for Traumatic Brain Injury, Orange County, Hudson Valley Region, and Upstate, 200 4-2 006 Disease Control... Upstate NY, Ten Year Time Trends 199 7-2 006 Orange County Community Health Assessment 201 0- 2013 2 Exhibit 1A.46a-d Births to Teen Mothers (17 years of age and younger) per 100 Live Births by Race, Ethnicity, Age and Zone, Orange County, 199 8-2 006 Exhibit 1A.47a-d Medicaid/Self-Pay Births Percentage per 100 Live Births, by Race, Ethnicity, Age and Zone, Orange County, 199 8-2 006 1A.47e Medicaid/Self Pay Births... Trends, 199 7-2 006 Teenage Pregnancy Rate by Age Group (Ages 1 0-1 4, 1 5-1 7, 1 8-1 9), and Induced Termination of Pregnancy (ITOPS) to Pregnancy Ratio (All Ages) Orange County, Hudson Valley Region, and NYS, 200 4-2 006 Teenage Birth Rates by Age Group (1 0-1 4), (1 5-1 7) (1 5-1 9), Orange County and Upstate NY, Ten Year Time Trends, 199 7-2 006 Teenage Births (Age 1 5-1 7) - Percentage per 100 Live Births, Orange County. .. 2009 Orange County Department of Health Intervention Services Schedule, 2009 Orange County Department of Health Clinic Services Schedule, 200 8-2 009 Orange County Department of Health FTEs by Division, 2009 PROBLEMS AND ISSUES IN THE COMMUNITY Resource Guide for Health and Related Services, Orange County, 2009 Listing of OCDOH Staff Community Affiliations, 2009 LOCAL HEALTH PRIORITIES Orange County Department... Kids’ Well-Being Indicators, Orange County and Rest of State, 200 3-2 007 Death Rates in Children and Adolescents, Orange County, Hudson Valley Region, and NYS, 200 4-2 006 Suicide and Self-Inflicted Injury Mortality and Hospital Discharge Rates (All Ages, Ages 1 5-1 9), Orange County, Hudson Valley Region, and NYS, 200 4-2 006 Teenage Pregnancy Rates by Age Group (1 0-1 4), (1 5-1 7), (1 5-1 9), Orange County and . Orange County Community Health Assessment 201 0- 2013 1 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 EXECUTIVE SUMMARY The 201 0- 2013. Health Priority Areas 4-7 Orange County Community Health Assessment 201 0- 2013 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT 2010 - 2013 ACKNOWLEDGMENTS
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