Grays Harbor County:Health Assessment and Interventions

Uconj. 501 – Interdisciplinary Rural Health Issues

Rural Health County Project: Summer 2010

Rural Health County Project: Grays Harbor County

Evidence-based approach to improve Grays Harbor County’s socio-economic health through interventions.

August 19, 2010

Philip Sanchez

University of Washington

Overview

The basics: What is “rural”? Demographics Telehealth (surgical telementoring) 10 leading Health Indicators (good vs bad) Uninsured

The Economy and Environment: Social determinants to health Environmental Health

What can we do? Health interventions

Lung cancer and Premature death

What is “rural”?

The term “rural” are areas that comprise open country and settlements with fewer than 2,500 residents.

In pertinence to health policy and research:

areas that are predominantly agricultural, isolated, and have unique health and

environmental issues

Demographics and Geographic features

•Land area: 1,916.89 sq. mi.•Density: 37.1 Pop./Sq. Mi•Individuals living below poverty level: 15.9%

•Population: 2000: 67,194 2009: 71,200Largest city: Aberdeen (16,440) Average household income: $40,896

•Rank 35 of 39: social and economic factors

6.9% increase

GH WA

unemployed 8% 5%

own a college degree 13% 30%

children in poverty 22% 15%

inadequate social support 22% 17%•There are 400 farms in the countyThere are 400 farms in the county•4% of the county’s territory4% of the county’s territory is utilized for farming•RUCA code: mixed rural

Health Snapshots

Primary Care individual to practitioner ratio: 2000:1 Mental Health individual to practitioner ratio: 10000:1 Medically Underserved Areas (MUA):

Quinault Service Area: 50.10 Southeastern Grays Harbor Service Area: 61.40

Hospitals and Clinics: 5 Community Health and Rural Health Clinics 1 Indian Health Center and Tribal Clinic 1 Critical Access Hospital

Mental and Physical Health expenditure: $11,638,362 Health ranking to Washington County’s (of 39):

Health Outcomes: 33

Mortality: 34

Morbidity: 31

Health Factors: 38

Health Behavior: 39

Clinical Care: 32

Uninsured

Uninsured individuals (age under 65): 8,957 (13% of population)

Medicare beneficiaries Elderly (Age 65+): 10,959 (15% of population)

Disabled: 2,792 (4% of population)

Medicaid beneficiaries: 17,987 (25% of population)

Primary care physicians per 100,000 population: 39.2 Dentists per 100,000 population: 43.5 Community/Migrant Health Centers: Yes Health Professional Shortage Area: No

Trauma Centers and OB care

Only two hospitals that provides acute care, one of which provides OB care.

Majority of the areas are more than a 30 minute drive to a hospital for both acute and OB care.

Northern area need more time to reach these facilities in comparison to areas in the south.

Grays Harbor Community

Hospital

(Level V G)

Mark Reed Hospital

(Level III G)

Telehealth majority of the county’s area can

have wireless technology. However, wireless download speeds is only greater than or equal 3 mbps and less than 6 mbps. *The NTIA definition of Broadband is greater than or equal to 768 kbps download speed, 200 kbps upload speed

An approach:“Surgical Telementoring Initiation of

a Regional Telemedicine Network: Projection of Surgical Expertise in the WWAMI Region”

“Surgical telementoring represents an advanced form of telemedicine, whereby an experienced surgeon can guide and teach practicing surgeons new operative techniques utilizing current enabling video, robotics, and telecommunications technology”.

Health Indicators: Better than or the same as state

Health Indicator Grays Harbor

Washington

Physical activity:

% adults age 18 or older

% teen physical activity

66

52

62

44

Immunization:

% children 19-35 months with complete vaccination

56 42

Substance Abuse:

% teen alcohol use 32 32

Health Indicators: Worse than State

Health Indicator Grays Harbor Washington

Overweight and Obesity:

% adults overweight

% teens overweight

64

29

61

25

Tobacco Use:

% adults cigarette smoking

% teen cigarette smoking

24

18

16

14

Substance Abuse:

% adults binge drinking 23 16

Mental Health:

% adult poor mental health 12 10

Access to Health Care:

% adults age 18 or older who report having a personal doctor or health care provider

74 79

A bigger problem…

Grays Harbor Error Margin Target Value Washington Rank (of 39)

8,421 7,694-9,148 5,245 5,979 34

Health Indicator Grays Harbor Washington

Substance Abuse:

% adults binge drinking 23 16

Worse than state Health Indicators lead to: Premature Deaths

Lung CancerData type Site Year AA population AA rate per

100,000

Grays Harbor Washington

incidence Lung/bronchus 2005-2007 97.8 65.6

Social Determinants of Health

Premature death: High Blood Pressure

smoking*, alcohol, obesity Poor childhood nutrition Bad sanitation and hygiene Unsafe sex

*also a determinant of Lung Cancer

Environmental Factors

Nearly 33% of Grays Harbor citizens live in homes built before the 1950s.

Associated in these homes are the tear of asbestos microfibers. Risk of having lung cancer, mesothelioma, and asbestosis for

people inhaling asbestos microfibers in their home. (risk increases as more are inhaled, Greatest risk for smoker).

According the National Cancer Institute, Grays Harbor County has an Annual Incidence Rate of 103.6 for individuals in the county with lung cancer.

Tobacco use Grays Harbor Washington

% adults cigarette smoking

% teen cigarette smoking

24

18

16

14

Environmental Factors

A study provided the strongest evidence after controlling external factors that can affect the experiment such as cigarette smoking, diet, occupational exposures, and other risk factors.

Results: Risk to exposure to fine particulate matter over a long period of

time, lead to lung cancer and increase cardiopulmonary mortality.

County’s years daily average resulted to be 0.6 as opposed to its neighboring county, such as Jefferson County which showed a years daily average of 0.2.

Interventions to Premature Deaths

Preventing Excessive Alcohol Use: Enhanced Enforcement of Laws Prohibiting Sales to Minors

Enhanced enforcement programs used as part of a community wide, multicomponent system to reduce underage drinking

Creating strategies to increase detection of unlawful actions advertising the increased enforcement and cautioning

proprietors against selling alcohol to minors. mass media letters to all local alcohol retailers

Having retailer compliance checks coordinated with local law enforcement or alcohol beverage control (ABC) agencies

Having violators receive legal or administrative sanctions

Interventions Results

Effective in reducing retail sales of alcohol to minors Sales to decoys: median decrease of 42% Modest decreases in underage alcohol consumption Effective in both rural and urban communities in on-

premises and off-premises establishments and various diverse ethnicities and socioeconomic groups.

Decrease not only the number of premature deaths in the county, but also the percentage of underage drinking.

Intervention to Lung Cancer

Increasing Tobacco Cessation Multicomponent interventions that include client

telephone support. Provide counseling and assistance for those who

want to stay tobacco-free. Individuals assisting are health care and drug

counseling professionals who will abide protocols in providing advice needed to help tobacco-users quit.

Increase motivation and help prevent relapse by educating, using nicotine-replacement therapies, and counseling.

In clinical settings, the curriculum can be used to follow up on other clinical cessation programs.

Intervention Results

Number of smokers that quit from this program resulted in 3 people per 100.

Program is it is applicable to many people. 2.6 percentage point increase of the median

difference during follow-up periods of 5 weeks to 34 months

Program showed similar increases in comparison to client education

For those living in house’s prior to 1950: significantly decreases chance of having lung cancer

Questions for health advocates and leaders

Premature deaths: What are other approaches to decreasing the number

of premature deaths? How can we improve our Emergency Medical

Services such that it is accessible to everyone? How can we encourage to improve everyone’s quality

of life? How can we educate people of the risk of premature

death once they are pregnant? What are ways health professionals can ensure that

the carrier (mother) does not make wrong decisions while she is pregnant? Or a way for health professionals to keep track of the carrier’s nutrition?

Questions for health advocates and leaders

Lung Cancer: What are other approaches to decreasing the number

of smokers in Grays Harbor? What incentives can we give to smokers to stop

smoking and have them do more healthier activities? How can we convince people who live in houses prior

to 1950 to refurbish them? Should we replace old houses with new ones? What are ways we can educate the community about

lung cancer?

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www.doh.wa.gov/hsqa/ocrh/RHC/Fed_DesignRHCs.pdf Remington, P. (2010). Snapshot 2010: grays harbor wa. Retrieved from

http://www.countyhealthrankings.org/washington/grays-harbor Meldrum, B. (2009). Mark reed health care district. Retrieved from http://www.markreed.org/ Robinson, D. (2009, October 23). Emergency Medical Services and Trauma System. Retrieved June 24, 2010, from Washington

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from http://www.thecommunityguide.org/alcohol/lawsprohibitingsales.html

Pictures: http://crawford.tardigrade.net/journal/album6832b.html http://www.movoto.com/wa/224-l-st-hoquiam/501_48979.htm http://www.fcschools.net/ http://www.homes.com/Real_Estate/WA/County/GRAYS%20HARBOR/ http://www.house.gov/dicks/grayshar.shtml