district 8-1: valdosta addressing community health disparities by meryl abrams, david berndt, molly...
TRANSCRIPT
District 8-1: Valdosta Addressing Community Health DisparitiesBY MERYL ABRAMS, DAVID BERNDT, MOLLY CINDERELLA, ASHLEY DAVIS, TRACE DEIGHAN, JADA FAMBROUGH, STEPHEN HAMMETT, SARAH JANSEN, NEIL PATEL, TAYLOR PHELPS, JOHN SHAPIRO, PAT SIMMONS, BENJAMIN SOOKHOO, AND ALLESYN YOUNG
Counties of District 8-1County Ranking
Echols (EC) 60
Lowndes (LW) 72
Berrien (BI) 76
Brooks (BO) 82
Tift (TI) 89
Lanier (LN) 100
Cook (CO) 108
Irwin (IR) 132
Ben Hill (BH) 147
Turner (TU) 153
EC
LW
TI
BO
BI
LN
CO
IR BH TU
Health District Popu-lation by County
Criteria for Ranking
Two components
• Health Outcomes
• Morbidity
• Mortality
• Health Factors
• Behaviors
• Clinical Care
• Social and Economic
• Physical Environment
• Changing health factors can shape health outomes
Health Behaviors• Diet and exercise• Sexual activity and teen
birth rates
Clinical Care• Access to care
• Golden Hour• Quality of care
Social Factors• Education• Employment• Income
Areas of Concern for District 8-1
Health Behaviors: Diet and Exercise
Problems
• Obesity
• Lack of physical activity
Potential Solutions
•Physically active classrooms
•Social support in community settings
• Buddy system walking groups
EC TU IR LN BO CO BH BI TI LW10%
15%
20%
25%
30%
35%
24%
33%31%
29%26%
29%31%30%29%
27%
Physical Inactivity
Georgia Avg. 24%
EC TU IR LN BO CO BH BI TI LW10%
15%
20%
25%
30%
35%
40%
29%
34%31% 31% 33%33%31%
30%34%
Adult Obesity
Georgia Avg. 28%
Health Behaviors: Sexual Activity
Problems• Teen Birth Rate
Potential Solutions
• Condom availability program
• Mass media campaigns
• Sexual education addressing pregnancy
and STDs
EC TU IR LN BO CO BH BI TI LW1.00%
3.00%
5.00%
7.00%
9.00%
11.00%
6.70%
10.10%
8.30%
5.70%
9.30%
7.80%
9.30%
6.30%
6.80%5.00%
Teen Birth Rate
Georgia Avg. 5.0%
Clinical Care: Access to and Quality of Care
Problems• Uninsured
• Primary care physicians
• Doctor: Patient ratio
• Golden Hour
Potential Solutions
EC TU IR LN BO CO BH BI TI LW18%
23%
28%
33%
38% 36%
25%25%26%26%
24%24%25%
22%
Uninsured
Georgia Avg. 22%
EC TU IR LN BO CO BH BI TI LW800
18002800380048005800680078008800
1604
64435296
1917
8000
3205
33701925
10102238
Pop. per primary care physician
Georgia Avg. 1611
Clinical Care: Access to and Quality of Care
Problems• Uninsured
• Primary care physicians
• Doctor: Patient ratio
• Golden Hour
Potential Solutions• Telemedicine
• Extended privileges of nurse practitioners
• Expand rural training tracts
1 2 3 4 5 6 7 8 9 1018%20%22%24%26%28%30%32%34%36%38%36%
25%25%26%26%
24%24%25%
22%
Uninsured
EC TU IR LN BO CO BH BI TI LW18%
23%
28%
33%
38% 36%
25%25%26%26%
24%24%25%
22%
Uninsured
Georgia Avg. 22%
EC TU IR LN BO CO BH BI TI LW800
18002800380048005800680078008800
1604
64435296
1917
8000
3205
33701925
10102238
Pop. per primary care physician
Georgia Avg. 1611
Social Behaviors: Education, Income EmploymentProblems• High unemployment
• Low median household income
Potential Solutions• Summer work experience
programs
• Career pathway and bridge programs for adults
• Drop-out prevention programs
• Early Head Start
EC TU IR LN BO CO BH BI TI LW5.00%
7.00%
9.00%
11.00%
13.00%
15.00%
7.3%
11.6%
13.2%
8.5%
9.4%
12.7%13.8%
12.0%
11.5%
9.3%
Unemployment
Georgia Avg. 9.8%
EC TU IR LN BO CO BH BI TI LW15000
20000
25000
30000
35000
40000
45000
50000Georgia: $45,886
Median Income
Health Disparities Amongst the Counties Counties differ by
Demographics
Geography
Access to care
Education
Economics
Disparities were identified based on African-American constitution
Hypothesized explanations
Disparity in health education
Community ties
Program efficacy
50 60 70 80 90 100 110 120 130 140 150 1600%
10%
20%
30%
40%
50%
County Health Ranking by African American Pop.%
5% 6% 7% 8% 9% 10% 11%0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
County Teen Birth Rate by African American Pop. %
Disparities in Morbidity and Mortality Rural districts are more
prone to specific health outcomes
Urban settings provide: Better access to health
facilities
Improved capacity for health education of population
Broader range of programs tailored to community
Greater opportunities for social support
0
50
100
150
200
250
Disparities in Mortality by County Size
Lung Cancer Stroke Heart Disease
**Lines represent Georgia Avgs**
Risk Factors
Modifiable
1) Self risk behaviors
2) Access to primary care
3) Health education curriculum
Limited Modifiability
4) Number of facilities and hospitals
5) Homicide/MVA rate
6) Income/Economics of counties
Criteria for recommendations:• Fiscally feasible
• Geographically accessible
• Relevant to the community
• Culturally appropriate
How can we, as physicians, help?
• Assist in modification of risky behaviors
• Facilitate access to primary care
• Enlist help of teachers and counselors
• Identify and communicate health
disparities
Special thanks to…
Dr. William Grow, Health District Director; South District
Patrina Bowles, Health District Administrator Assistant
Erin Mundy, Director of Community Based Training Programs
Anne Hinton; Information Technology Support and Services
Bibliography• Alford S. Science and success, 3rd edition: Sex education and other programs that work to prevent teen
pregnancy, HIV and sexually transmitted infections. Washington, DC: Advocates for Youth; 2012.
• Barr-Anderson DJ, AuYoung M, Whitt-Glover MC, Glenn BA, Yancey AK. Integration of short bouts of physical activity into organizational routine: A systematic review of the literature. American Journal of Preventive Medicine. 2011;40(1):76-93.
• Bartfeld J, Kim M, Ryu JH, Ahn H-M. The School Breakfast Program: Participation and impacts. Madison: University of Wisconsin-Madison; 2009.
• Bashshur RL, Shannon GW. National telemedicine initiatives: Essential to healthcare reform. Telemedicine Journal and e-Health. 2009;15(6):600-10
• Blake SM, Ledsky R, Goodenow C, et al. Condom availability programs in Massachusetts high schools: Relationships with condom use and sexual behavior. American Journal of Public Health. 2003;93(6):955-62.
• Christenson SL, Thurlow ML. School dropouts: Prevention considerations, interventions, and challenges. Current Directions in Psychological Science. 2004;13(1):36-9.
• Daniels ZM, Vanleit BJ, Skipper BJ, Sanders ML, Rhyne RL. Factors in recruiting and retaining health professionals for rural practice. Journal of Rural Health. 2007;23(1):62–71
• Georgia Department of Health. Online Analytical Statistical Information System. Available at http://oasis.state.ga.us/oasis/. Accessed on October 27, 2013.
• Georgia Department of Public Health. South Health District Programs and Services. Available at http://www.southhealthdistrict.com/default.asp. Access on October 27, 2013
• Havnes T, Mogstad M. No child left behind: Subsidized child care and children’s long-run outcomes. American Economic Journal. 2011;3(2):97-129.
Bibliography cont.• Keller SN, Brown JD. Media interventions to promote responsible sexual behavior. Journal of Sex Research.
2002;39(1):67-72.
• Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: An evidence-based review. Obesity. 2008;16(5):1009-18.
• Laurant M, Reeves D, Hermens R, et al. Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Review. 2004;(4):CD001271.
• McCombs JS, Augustine CH, Schwartz HL, et al. Making summer count: How summer programs can boost children's learning. Santa Monica: RAND Corporation; 2011: Monograph Report 1120.
• National Center for Health Statistics. Vital Statistical Data: 1996-2005. Available at http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm. Accessed on October 27, 2013 Smith E, Green A. How workplace experiences while at school affect career pathways. Adelaide: National Centre for Vocational Education Research (NCVER); 2005.
• Social Security Administration. National Average Wage Index. Available at http://www.ssa.gov/oact/cola/AWI.html. Accessed on October 27, 2013.
• Sum A, McLaughlin J. Out with the young and in with the old: US labor markets 2000-2008 and the case for an immediate jobs creation program for teens and young adults. Boston: Center for Labor Market Studies Publications, Northeastern University; 2008.
• Tucker, Cherri, Colette Caldwell, Carla Graves, Kelly McNamara, and Allen Dever. "Fact Sheet on Georgia's Trauma Physicians." Gpbw.georgia.gov. Georgia Board for Physician Workforce, Apr. 2011. Web. 27 Oct. 2013.
• United Health Foundation. America’s Health Rankings, 2013 ed. Available at http://www.americashealthrankings.org/GA/2012-2012. Accessed on October 27, 2013.
Group member roles: Meryl Abrams – County Researcher, PowerPoint Contributor
David Berndt – County Researcher
Molly Cinderella – Communications Officer
Ashley Davis – County Researcher
Trace Deighan – County Researcher
Jada Fambrough – County Researcher
Stephen Hammett – Podcast Producer
Sarah Jansen – County Researcher, PowerPoint Contributor, Podcast Voice
Neil Patel – Podcast Producer
Taylor Phelps – County Researcher
John Shapiro – Data Analyzer, PowerPoint Contributor, Podcast Voice
Pat Simmons – Data Analyzer, PowerPoint Contributor
Benjamin Sookhoo – County Researcher, Meeting Coordinator
Allesyn Young – County Researcher