2013 State of Health: Ashe County Promoting safe & healthy living, preventing disease,& protecting the environment 2013 State of Health Report [December 2, 2013] 0 12/2/2013 Contents Executive Summary……………………………………………………………………………………………………2 County Demographics………………………………………………………………………………………….3 Unemployment, Median Household Income…………………………………………………………………4 Education………………………………………………………………………………………………………...5 Poverty & the Uninsured……………………………………………………………………………………….6 Leading Causes of Death…………………………………………………………………………………………….7 Cancer Incidence………………………………………………………………………………………………..9 Cancer Projections……………………………………………………………………………………………..10 Pregnancy & Birthweight……………………………………………………………………………………….11 Teen Pregnancy……………………………………………………………………………………….12 Infants and Children…………………………………………………………………………………..13 Leading Risk Factors…………………………………………………………………………………………………14 Housing & Food Security……………………………………………………………………………………………..16 Emerging Issues……………………………………………………………………………………………………….17 The Affordable Care Act…………………………………………………………………………………………17 Triple AIM and the Quest for Quality……………………………………………………………………………18 Carbon Monoxide Detection Required by NC Law……………………………………………………….…..19 Tobacco Innovations or Deceptions……………………………………………………………………..…….20 Health Priorities Priority Update: Obesity Prevention…………………………………………………………………………..21 Priority Update: Access & Affordability of Healthcare Services……………………………………………22 Priority Update: Substance Abuse Prevention………………………………………………………………23 Spotlight Updates Triple P: Positive Parenting Program & Innovative Approaches…………………………………………….23 Quality Healthcare Services…………………………………………………………………………………….24 State and National Perspectives………………………………………………………………………………….....25 Contact Information……………………………………………………………………………………………………..26 2013 State of Health Report [December 2, 2013] 1 Executive Summary The state of health in Ashe County is somewhat similar to many other communities across North Carolina and the nation. In the past year, the county population has decreased slightly, with population totals coming in at 27,361 people. Like so many other communities, the county has faced challenges in unemployment, uninsured adults and children, and people living in poverty. Although this has been a challenge since the economic troubles that began in 2008, there are some points worth celebrating including a downward trend in unemployment over the past few years, but concerns do remain in the county unemployment, the number of people living in poverty and food insecurity, and the many who remain uninsured. Our health challenges include chronic diseases that have increased across the state and nation. Unlike NC, heart disease remains the leading cause of death for the county, with cancer deaths following a close second. The good news is that these chronic diseases are linked back to three primary behaviors that can help prevent them: tobacco use, poor nutrition, and lack of physical activity. These chronic diseases not only contribute to the leading causes of death, but also cost us greatly in quality of life and healthcare expenditures. Using evidence- based strategies while innovating to link them to county context will be ever important in the year ahead in continuing to promote more people achieving and maintaining a healthy weight and more people choosing not to smoke or having access to services to get help quitting. 2014 brings new opportunities and challenges ahead as many of the major health behaviors and those that impact health such as housing, income, and access to healthcare services are complex and involve partnerships across sectors to bring improvements. Emerging trends and issues to watch this next year include the Affordable Care Act enrollment and continued efforts by safety net organizations to serve those who will not be able to afford insurance or qualify for Medicaid and food security and services that support it may impact health outcomes if changes are made in funding or legislative actions. In addition, monitoring implications of new legislation in NC such as the carbon monoxide detection will be important as well as that of prior legislation that has supported public health protection such as the smoke free restaurants and bars law from 2010. Finally, 2014 brings an opportunity to take a closer look at local community health needs with the community health assessment process. Learn more and get involved by contacting us. Sharing the State of Health Copies of this report may be found at www.apphealth.com The report will be presented to community leaders and groups during scheduled events through February, 2014. To learn more, follow us on Facebook at Appalachian District Health Department, log on to our website, and check your local radio and newspapers. To request additional information or to schedule a presentation of this information for your group, call our Watauga County office at 828.264.4995 or email at County Demographics Ashe County’s population has steadily increased since 2008 to 27,361 though it decreased slightly between 2011 and 2012 (NC DHHS, 2013). According to population estimates July, 2013, racial and ethnic demographics of the county are primarily White Non-Hispanic with the second largest racial/ethnic group being Hispanic. The median age in Ashe County is 46 years compared to 37.2 in that of NC overall, which indicates generally an older population in the county. Source: NC Office of State Budget and Management, updated estimates as of July, 2013 Race/Ethnicity by Percent of Total Population Race/Ethnicity Percent of total population White Non-Hispanic 93.6% Hispanic or Latino 4.8% African American Non- 0.9% Hispanic Other Non-Hispanic 0.7% Source: NC State Center for Health Statistics 2014 data book 2013 State of Health Report [December 2, 2013] 3 Community Statistics Ashe County unemployment percentage was 8.1% and NC 7% as of November, 2013 (NC Department of Commerce, 2014). This data does not reflect a seasonal adjustment and has not accounted for many layoffs from the closing of the Gates Rubber Company facility in the county so this rate may increase with the next report from the NC Department of Commerce. Though the current data indicates that the unemployment rates have not recovered from that of 2008 with the economic downturn, this data trend indicates a trend in the right direction. This data will continue to be a top trend to monitor over the course of the next year. The table below shows the trend of median household income in Ashe County and NC. As of 2011, the Ashe County annual median household income is $34,333 compared to $44,028 for NC (US Census Bureau, 2013). 2013 State of Health Report [December 2, 2013] 4 Education Education is a critical component for many reasons. Those who graduate from high school have a better potential of achieving or maintaining a better health status over time. According to the NC Department of Public Instruction, the Ashe County 4 year cohort graduation rate is 80.1% compared to the 80.2% for NC for the 2011-2012 year. This shows a slight decrease below the graduation rate of 80.6% in 2010-2011(NC DPI, 2013). Since 2007, Ashe County has had better outcomes as compared to the state, but also have remained relatively constant. This data does not include charter school data. Free and reduced meals are subsidized for families at or below 130% of the Federal Poverty Guidelines. Ashe County children participating in the free or reduced meal program has increased steadily since the 2007-2008 school year to nearly ¾ of students in 2011-2012. This does not include charter school data. (NC DPI, 2012). Year % Children participating in Free & Reduced Meals 2007-2008 53.7% 2008-2009 55.2% 2009-2010 59.5% 2010-2011 62% 2011-2012 75.6% 2013 State of Health Report [December 2, 2013] 5 Community needs: Poverty & Uninsured Poverty continues to be a critical need in the county. The trend below indicates a steady increase in children who are living in poverty in Ashe County, with current percent of children in poverty at 31.3% as of 2011 and up steadily from the rate of 23% in 2007 (US Census Bureau, 2011). According to the US Census Bureau, 19.3% of people in Ashe County live below the federal poverty level compared to 16.8% in NC. The NC Median Household Income is $46,291 while Ashe County Median Household Income is $34,333 (US Census Bureau, 2011). The number of individuals without health insurance is detailed in the table below (NCIOM, 2011). The Patient Protection and Affordable Care Act (ACA) will expand health insurance coverage for many Americans in the U.S., but not nearly as many as originally anticipated in NC since the NC Legislature did not choose to expand Medicaid coverage. Read more about this in the emerging issues section of this report. County Ag e Category Data Type 2011 Number <500 Children (0-18) Percent 7.60% 2013 State ofN Huemabltehr Report [3D,0e0c0ember 2, 2013] 6 Ash e Adults (19-64) Percent 19.70% Number 4,000 Total (0-64) Percent 16.70% Health statistics: Causes of death This report includes a brief overview of health statistics for the county. Every year Appalachian District Health Department provides relevant updates to health statistics in this report. Every three years, the report is a comprehensive community health needs assessment report. The 2011 community health assessment is available at www.apphealth.com. In December, 2014, the community health assessment report will be published. Leading causes of death in Ashe County and NC 2008-2012 Age adjusted death rates per 100,000 (NC DHHS, 2013) Cause Ashe County NC Heart disease 174.7 174.4 Cancer 171.1 175.9 Chronic lower respiratory 52.7 46.6 disease Cerebrovascular disease 41.2 45.1 Unintentional Non-motor 36.6 29.4 vehicle injuries Unintentional Motor Vehicle 20.6 14.3 injuries* Suicide* 20.6 12.2 Pneumonia & Influenza 11.6 18 Alzheimer’s Disease 19.4 29.3 Diabetes 18.7 21.8 Chronic liver disease & 12.2 9.3 Cirrhosis The table above reflects the age-adjusted death rates in Ashe County with NC rates per 100,000 from the 2014 Databook (NC DHHS, 2013). This data reflects the current national and statewide trend of leading causes of death from chronic diseases. *Death rates from unintentional motor vehicle injuries and suicide were the same for this time period. 2013 State of Health Report [December 2, 2013] 7 Health statistics: Death rates The leading causes of death for Ashe County are chronic diseases. Though heart disease has a higher death rate at 174.7/100,000, cancer is only slightly below at 171.7/100,000. Following these, chronic lower respiratory disease follows. Overall, chronic diseases represent over 60% of the deaths in Ashe County. We draw attention to the areas where the county rate (noted in blue) is either better or worse than the state rate (noted in red). In categories where the actual number of deaths is too small to be a reliable rate, no blue is shown. Ashe County has a higher rate of unintentional non-motor vehicle injuries and suicide than NC, as well higher rates of chronic lower respiratory disease and chronic liver disease/cirrhosis when compared to NC. 2013 State of Health Report [December 2, 2013] 8 Health statistics: Cancer Incidence Cancer is the second leading cause of death in Ashe County, though only slightly less than heart disease. This graph demonstrates the types of cancer by incidence rate per 100,000 for the county and NC. Ashe County total cancer incidence rate of 466.1 is below the NC rate of 498.1 (NC DHHS, 2013). Source: NC State Center for Health Statistics, NC Central Cancer Registry (2011). 2013 State of Health Report [December 2, 2013] 9