E S S EX C O U NT Y
C OMMUNITY H EALTH
I MPROVEMENT P LAN
DECEMBER 2006
ESSEX COUNTY, NEW JERSEY
T ABLE
OF
C ONTENTS
Overview and Vision Statement…………………………….……………………….1
Community Profile: The Healthy of Essex County………….………………………3
Community Input………………………………………………………………........7
Forces of Change……………………………………………………..………….....16
Public Health Priority Issues
Issue #1: Cardiovascular Disease…………………………………..………..19
Issue #2: Diabetes……………………………………………………..…......24
Issue #3: Mental Health……………………………………………………...28
Issue #4: Childhood Lead Exposure…………………………………………36
Issue #5: Obesity…………………………………………………………….40
Summary and Recommendations……………………………………..………........44
Data Sources……………………………………………………………………......47
OVERVIEW
AND
VISION
Essex County’s municipal
health officers have worked
over the past year and a half to
conduct and complete this
Community Health
Improvement Plan (CHIP). The
process included in depth
discussions among the local
health officers about their
observations of health needs
based on their day to day work
in communities, interviews with
key policy makers in the
municipalities and surveying
Essex County residents to find
out about their health needs and
concerns. This report presents
the findings from each of the
CHIP components as well as
recommendations for
addressing unmet and growing
health needs in the county.
Trends That Impact
Essex County
Nationally, access to healthcare
and rising rates of obesity,
disparities in health among
ethnic and economic groups,
and the rising cost of healthcare
are significant concerns. Fortysix million Americans have no
insurance and employers are
balking at the rising costs of
providing insurance to their
employees. An aging
population that will have
increasing health problems and
healthcare needs is another
critical issue that has led policy
makers, healthcare providers,
public health advocates and the
general public to a historic level
of worry about how to meet the
health needs of the population.
Growing Medicare and
Medicaid costs are one of the
major economic concerns both
nationally and at the State level
and as fewer employers
continue to provide insurance to
retirees or to provide insurance
at all, these public insurance
programs will have to absorb
higher numbers of people.
States like New Jersey, which is
facing a significant deficit, must
come up with both short and
long-term strategies for meeting
the health needs of the
population effectively and
efficiently.
Most of the major causes of
death in the United States and in
Essex County can be prevented
or alleviated by individual
behavior change. Much is
known about the best ways to
help people to adopt and
maintain a healthy lifestyle and
there are significant
opportunities to implement best
practice interventions in Essex
County. For example, ensuring
that the food provided in
schools is healthy and low-fat,
requiring physical education
classes throughout the week,
and ensuring adequate recess
time can alleviate childhood
obesity. In addition, all
communities must have access
to fresh fruits and vegetables at
a reasonable cost in order to
compete with the significant
marketing dollars and
sophistication of the fast food
industry. In addition, television
watching has an independent
effect on obesity (e.g. separate
1
CHIP
from the snacking and lack of
exercise that TV watching
implies) and TV turnoff
programs sponsored by schools,
faith communities and
government and social service
could also make a contribution
to preventing/reducing obesity
among children.
Shared Concerns Among
Stakeholders
The health issues identified by
health officers, residents and
policy makers overlapped
considerably and suggest that
support exists for focusing
resources and attention on the
major causes of mortality in
Essex County—heart disease,
cancer and stroke. Given the
preventable nature of the main
health problems, health
education campaigns based on
validated theories of behavior
change coupled with
environmental changes such as
ensuring access to parks and
opportunities for community
exercise should help to improve
health and well-being in Essex
County.
Many community based
organizations and governmental
entities seek to improve health
in Essex County and these
alliances ought to be mined for
opportunities to leverage and
improve health-related
programs and services.
Vision Statement
The vision of the Essex County
Governmental Public Health
Partnership is to: improve,
protect and promote physical
and mental health of Essex
County. Through a
collaboration of local health
departments, community-based
partners, community
stakeholders and other
committed entities we are
dedicated to prevent disease,
injury and disability as well as
eliminate health disparities for
residents of ethnically diverse
Essex County. Through a
strengthened public health
infrastructure via these
partnerships as well as through
resource sharing, we endeavor
to ultimately create communityhealth ownership for all,
through implementation of our
Community Health
Improvement Plan (CHIP).
2
COMMUNITY
PROFILE
THE HEALTH OF ESSEX COUNTY
Number of people living in Essex County in 2005:
791, 057
Essex
County
New
Jersey
Children (017 years)
27%
25%
Adults (1864 years)
62%
62%
Older adults
(65 years and
above)
11%
13%
Age
People in Essex County are
slightly younger than the New
Jersey average
1
1
3
CHIP
Race/Ethnicity Compared to New Jersey as a whole, more people in
Essex County are of African American race/ethnicity
New Jersey
Major
Causes Of
Death
Essex County
Heart disease, cancer, stroke, diabetes, and chronic lower
respiratory disease (CLRD) caused the most deaths. The
death rates for most causes were higher in Essex County
than in New Jersey
All Causes
Heart disease
Cancer
Stroke
Diabetes
CLRD
Essex County
New Jersey
No. of Death
deaths rate (per
100,00
people)*
6.885
883.6
1.853
238.1
1.536
200.2
339
43.4
292
37.9
219
28.6
Death rate
(per 100,00
people)*
791.7
232.2
191.2
41.6
26.7
31.2
Essex County
compared to
New Jersey as
a whole
Higher Lower
by
by
12%
3%
5%
4%
42%
8%
* Age-adjusted
4
CHIP
Municipality
Deaths due to
the Major
Causes
Municipalities within Essex County are similar in causes
of death and larger municipalities, as expected, have
higher numbers of deaths from each cause.
Number of Deaths
Municipality
Name
Belleville Twp
Bloomfield Twp
Caldwell Boro Twp
Fairfield Twp
Cedar Grove Twp
East Orange City
Essex Fells Twp
Glen Ridge Boro
Twp
Irvington Twp
Livingston Twp
Maplewood Twp
Milburn Twp
Montclair Twp
North Caldwell
Boro
Nutley
Orange City
Roseland Boro
South Orange
Village Twp
Verona Twp
West Caldwell Twp
West Orange Twp
Balance of county
Heart
Disease
96
141
17
11
49
205
4
44
Cancer Stroke Diabetes CLRD
81
95
19
13
37
157
3
19
17
18
3
2
7
30
1
7
11
10
1
3
6
29
0
6
7
18
2
2
8
26
0
4
102
54
50
30
69
7
99
45
40
36
83
12
24
14
9
6
13
0
23
1
6
2
11
1
5
5
5
5
7
0
75
77
3
25
77
60
11
23
12
16
3
2
6
22
0
1
13
8
0
3
53
39
188
9
31
32
105
7
10
8
39
1
4
6
17
2
7
6
20
1
5
CHIP
Highest
Mortality
Rates
Out of all the New Jersey counties, Essex County has the
highest death rate (247.8) for residents aged 25-44 years
Out of all the New Jersey counties, Essex county has the
highest death rate (17.3) due to resident homicide, which
is more than three times the statewide rate.
Of the eight counties with data sufficient to calculate
reliable age-adjusted firearm-related death rates, Essex
County has the highest rate (14.2), which is nearly three
times the statewide rate.
6
COMMUNITY
INPUT
HOW RESIDENTS PERCEIVE HEALTH IN ESSEX COUNTY
Introduction
The Essex County Health
Commission conducted a
written and online survey to
find out about the perceived
health needs and concerns
of Essex County residents.
The survey inquired about
residents’ perceptions of
community health
problems, solicited opinions
on factors that contribute to
the health of the
community, and collected
information on individuals’
personal health needs.
The survey was completed
by 111 residents. Despite
the study’s small sample
size and low
generalizability, the results
present useful information
about community health
concerns. Furthermore, the
health concerns identified
by the residents
complement what the
county- and municipalitylevel mortality data show
are the major causes of
death.
About the Residents
The survey includes
respondants from 19 out of
21 municipalities, but the
majority of respondents
reside in Livingston,
Irvington, and Maplewood.
More women than men
responded to the survey.
Most of the respondents’
households include only one
or two people.
7
CHIP
Community in which the Respondents Reside
Belleville
Bloomfield
Cedar Grove
East Orange
Essex Falls
Fairfield
Irvington
Livingston
Maplewood
Millburn
Montclair
North Caldwell
Nutley
Orange
Roseland
South Orange
Verona
West Caldwell
West Orange
Number of respondents Percentage
1
1
3
3
1
1
7
6
1
1
5
5
18
16
22
20
13
12
1
1
4
4
2
2
9
8
3
3
3
3
3
3
7
6
4
4
4
4
Gender
Number of Respondents Percentage
Male
Female
No Response
35
56
20
31
51
18
8
CHIP
Number of People in Household
Number of Respondents Percentage
1
2
3
4
5
6
No response
15
23
4
9
9
1
50
14
21
4
8
8
1
45
The annual household income is distributed across the five income quintiles,
and the majority of respondents have obtained a college degree. Most
respondents are employed full-time; the main reason for not working among
unemployed residents was retirement. Neither the majority of respondents
nor their family members need social services benefits.
Annual Household Income
Less than $25,999
$26,000 to $49,999
$50,000 to $75,999
$76,000 to $99,999
Over $100,000
No response
Number of Respondents Percentage
16
14
26
23
24
22
14
13
19
17
12
11
Highest Educational Level Completed
Number of Respondents Percentage
Less than High School graduate
High School Diploma or GED
College Degree
Masters Degree or Higher
Other
No Response
7
6
22
20
45
31
2
4
41
28
2
4
9
CHIP
Employment Status
Not employed
Self-employed
Employed Part-time
Employed full time
No response
Number of Respondents Percentage
38
34
5
5
20
18
43
39
5
5
Main Reason for Unemployment
Number of Respondents
Percentage
2
2
Sick or disabled
Unable to find work
1
1
33
30
Taking care of family
2
2
Need job/vocational training
1
1
Retired
Other
No response
8
7
64
58
Within the past year, what type of social services benefits did you or
anyone in your family need?
None
Food stamps
NJ FamilyCare
General Assistance
Housing Assistance
Subsidized child care
Medicaid
Adult Protective Services
DYFS
Other
Number of people
79
4
6
2
2
1
3
1
1
3
10
CHIP
For fun, recreation, and/or physical activity, most respondents frequently go
to parks, shopping malls, and churches. This information will be helpful
when planning community health interventions and identifying venues that
might be effective in delivering health education materials and improving
access to and screening by health professionals.
In your community, where do you most often go for fun, recreation,
and/or physical activity?
Parks
Shopping Malls
Church
Movie theaters
Senior Center
Library
Swimming pools
Health/fitness clubs
Live theaters/dance performances/concerts
Sports fields
Social club/service club
Dance halls
Place for Yoga, Pilates, Tai Chi, etc.
Number of people
51
43
36
34
28
26
21
21
12
12
11
4
4
Opinions on Community Health
Most residents identified the follow factors as important for a health community: (1)
Access to health care, (2) Low crime and a safe neighborhood, and (3) Good place to
raise children. The majority also believes that the most important health problems in the
community are obesity/nutrition, cancer, and hypertension. This understanding of the
burden of heart disease and cancer mirrors two of the major causes of death according to
mortality data. When rating their community’s health, most residents believe that their
community is healthy in general as well as a healthy, safe place to grow up or raise
children.
11
CHIP
What do you think are the three most important “health problems” in
your community?
Obesity/Nutrition
Cancer
Hypertension
Gang-related activity/violence
Diabetes
Cardiovascular (heart disease)
Mental Health issues
STDs
Tobacco use
Lack of access to healthcare
Motor vehicle accidents/injuries
Respiratory issues
Homelessness
Childhood lead/lead prevention
Domestic violence
Indoor air quality (mold/asbestos)
Child abuse
Teenage pregnancy
Homicide
Suicide
Number of people
61
35
23
22
22
20
16
16
16
13
13
9
6
5
5
4
4
4
4
2
How would you rate your community as a health community to live in?
Very unhealthy
Unhealthy
Somewhat Healthy
Healthy
Very health
No response
Number of Respondents Percentage
2
2
11
10
34
31
45
41
14
13
5
5
12
CHIP
How would you rate your community as a safe place to grow up or raise
children?
Very unhealthy
Unhealthy
Somewhat Healthy
Healthy
Very health
No response
Number of Respondents Percentage
2
2
14
13
31
28
38
34
20
18
6
5
Opinions on Personal Health and Health Needs
When rating their own health, most residents believe that they are healthy. However, a
significant proportion of residents or family members of the residents are struggling with
high blood pressure/hypertension, arthritis or other joint diseases, and diabetes. As for
mental health, most residents or family members of the residents did not report needing
any mental health services in the past year.
How would you rate your own personal health?
Very unhealthy
Unhealthy
Somewhat Healthy
Healthy
Very health
No response
Number of Respondents Percentage
1
1
3
3
37
33
53
48
14
13
3
3
13
CHIP
What chronic illnesses have you or anyone in your immediate family
been living with?
High blood pressure/hypertension
Diabetes
Arthritis or other joint disease
Vision/hearing impairments
Cancer
Heart Disease
Respiratory/Lung
Mental/behavioral health issues
Hepatitis
Substance abuse
HIV/AIDS
Number of people
54
31
35
29
27
26
15
8
1
1
1
Within the past year, what type of mental health services did you or
anyone in your family need?
None
Emergency/Crisis Care
Hospitalization
Counseling/Therapy
Day Program
Number of people
69
10
10
10
2
14
CHIP
Access to Health
A great majority of the respondents are able to get health care and pay for health care
through health insurance.
Within the past year, were you able to get needed health care?
No
Yes
Not needed
No response
Number of Respondents Percentage
3
3
80
72
9
8
19
17
How do you pay for your healthcare?
Health Insurance
Medicare
Medicare Supplemental Insurance
No Insurance (self-pay, cash)
NJ KidCare or FamilyCare
Medicaid
Charity Care
Veteran’s benefits (VA)
Number of people
83
31
13
6
3
3
2
2
15
FORCES
OF
CHANGE
Essex County’s health status
will be affected by many larger
trends over the next few
years—shifting population
demographics, economic and
employment upturns or
downturns, and policy decisions
at the federal, state and local
level that impact public
insurance and healthcare.
While Essex County is ranked
as the 148th wealthiest county in
the United States with a median
household income of $44,944,
this average masks significant
differences in socio-economic
well-being between
municipalities and between
various demographic groups.
Local leaders are particularly
concerned about specific,
concrete challenges to the
health of Essex Community
municipalities such as the cost
of insuring municipal
employees, providing
transportation services to health
appointments and increasing
rates of uninsured residents.
program for those age 65 and
over, and Medicaid, the public
insurance program for those that
are low-income or disabled,
place significant strains on
federal and state budgets. New
Jersey has a lower percentage of
the population on Medicaid than
the US overall: 8.2% of New
Jersey residents receive
Medicaid compared to 14.1% of
US residents. However,
Medicaid spending per enrollee
is higher in New Jersey than the
US average meaning that any
increase in the number of
people receiving Medicaid costs
New Jersey more than other
States. See Table 1 below.
Nationwide, 46 million people
have no health insurance. As
New Jersey Governor John
Corzine observed: “At the
compounded rate we’re going
at, the country would spend
about a quarter of its resources
on health care in a decade.”
(New York Times, December 19,
2006,B5) Medicare, the public
insurance
TABLE 1: New Jersey and US Per Enrolee Medicaid Expenditures, FY 2005
New Jersey
US
Adults
$1,749
$1,467
Children
$2,345
$1,872
Blind
$16,456
$12,265
Elderly
$14,893
$10,799
Other
Source: Kaiser Family Foundation, available at www.kff.org
16
CHIP
Private insurance is generally
linked to employment and
instability in particular sectors
or downturns in the overall
economy can lead to layoffs
that jeopardize people’s
healthcare coverage. In New
Jersey, 62.5% of residents
receive insurance via their
employer compared to an
average of 53.4% nationwide.
Essex County includes a
number of families supported
through TANF (Temporary
Assistance to Needy Families),
the federal program that
replaced traditional welfare a
decade ago, and some families
that have reached the 5-year
limit for TANF benefits may
not apply separate for
healthcare, erroneously
believing that their eligibility
for Medicaid ended with their
TANF assistance. Essex
County is also home to a large
number of undocumented
workers that may not be eligible
for any type of private or public
health insurance coverage and
therefore end up having to use
emergency rooms for health
problems as they have no ability
to pay for ongoing healthcare
and may even overlook health
issues initially because of an
inability to pay for care.
The cost of private insurance
outpaces inflation annually and
municipalities with significant
numbers of public employees
face the challenge of trying to
balance budgets while
continuing to pay for healthcare
for their employees. In New
Jersey, several teacher contracts
are currently in dispute over
differences in what teachers’
unions and municipalities are
willing and able to pay toward
healthcare coverage.
Some Communities Face
Greater Challenges
Essex County is made up of
municipalities with extremely
variable socio-economic
statuses. Communities such as
Irvington and East Orange
(median household income
$32,346), with greater
percentages of low income
residents, face different
challenges that wealthy
communities such as Millburn
(median household income
$130,848) or Livingston
(median household income
$98,869)—although, ultimately,
all communities, and the State
as a whole, will pay for health
problems either through higher
taxes for public services for
people that are ill or disabled or
through loss of revenue from
people that are unable to work
and contribute to the tax base.
CHIP
Irvington, NJ, illustrates some
of the challenges faced by
lower-income communities in
Essex County. Irvington has
the highest per capita public
transportation utilization in the
State (buses) indicating a low
proportion of residents that own
private automobiles Irvington
General Hospital closed a year
ago due to financial insolvency,
and along with that obvious
reduction in service, the
associated ambulance service
was terminated (the township
acquired another ambulance
service). Residents now face
greater challenges in getting to
hospitals and even to routine
medical appointments that are
hospital-based. Mayor Wayne
Smith comments: “The fact is
that Medicaid and Medicare
don’t pay the full rate for
ambulance service as it is, never
mind people that need
ambulance services that are
uninsured. The State
Department of Health is
beginning to look at this issue
state-wide but communities like
Irvington are already having
trouble making sure that people
have both healthcare and
transportation to and from that
healthcare.”
Providing recreational
opportunities to ensure physical
activity and ensuring supervised
after-school and Summer care
for children and teens is another
area that is more challenging for
municipalities whose residents
may not be able to pay for
expensive childcare and camp.
Approximately 10 years ago,
the State provided a grant
that enables to Township to
open the pool to residents at low
cost. In neighboring
Maplewood, where the per
capital income is higher,
residents pay about $200 per
family for use of the pool in the 15
17
CHIP
summer which actually
generates income for the
Township.
Mayor Wayne Smith summed
up the broader challenge of
helping residents that face
disproportionate challenges:
“We need to find a way to help
families weave together a social
fabric that can support them
effectively through a variety of
life challenges.”
Other healthcare related
challenges facing New Jersey
include:
In 2007, New Jersey will be one
of 17 States that faces reduced
federal financing for, the public
insurance program for lowincome children. A new
analysis by the Center for
Budget and Policy Priorities
notes that New Jersey will face
a $174,079,000 shortfall under
the new federal guidelines for
disbursing SCHIP funds. States
facing reduced contributions
from the federal government
will either need to reduce the
number of children in the
program, reduces the services
made available to those
children, or raise taxes/shift
funding from other programs to
cover the gap.
An aging population has both a
need for additional healthcare
and social support services and
contributes less to the tax base.
The State of New Jersey
currently faces a $4 billion
deficit and some policymakers
want to examine healthcare for
all public employees as one
potential place to save money
for the State.
16
18
P
U B L I C
H
E A L T H
P
R I O R I T Y
I
S S U E S
ISSUE ONE:
C ARDIOVASCULAR D ISEASE
Introduction
In Essex County, the Health
Officers responsible for public
health in 22 municipalities came
together in August 2004 and
created the Essex Governmental
Public Health Partnership
(GPHP). The GPHP will assist
local public health efforts by
building upon and enhancing
existing public health capacity,
and act as a resource to local
public health in their efforts to
meet the objectives of the
Public Health Practice
Standards.
Caldwell, and West Orange.
At the June 2005 GPHP
meeting, the Health Officers,
together with other public
health staff, identified their top
five health-related priorities.
Cardiovascular disease was
identified as a top priority by
ten municipalities, including:
Bloomfield, Essex Fells,
Irvington, Livingston,
Maplewood, Millburn, North
Caldwell, Orange, West
Figure 1: Leading causes of death in
New Jersey, 2002
Cardiovascular disease (CVD)
is the leading cause of death in
the United States (U.S.) for both
men and women among all
racial and ethnic subgroups.1
Cardiovascular disease is also
the number one killer in New
Jersey and Essex County
accounting for approximately
30% of all deaths in 2002
(Figure 1 & 2).
Figure 2: Leading causes of death in
in Essex County, 2002
19
CARDIOVASCULAR DISEASE
A Problem for the
Elderly, Men, and
Specific Ethnic
Groups
As one ages, the incidence of
developing CVD dramatically
increases. Thus, the aging of
the population will certainly
result in an increased incidence
of coronary heart disease, heart
failure, and stroke.6
Additionally, there is
significantly higher prevalence
of CVD risk factors in minority
populations. For example, the
rate of hypertension (41%) in
African Americans and
Hispanics (independent of
gender or educational status)
and obesity (47%) in African
American women make these
groups particularly vulnerable
to CVD. These risk factor
profiles translate into
significantly higher rates of
stroke in African Americans
and heart failure in African
Americans and Hispanics
compared with Caucasians.
In Essex County, the trend
toward an aging and a more
ethnically diverse population
places a greater percentage of
Essex County’s residents at risk
for CVD.
A Problem for
Middle-Aged Adults
The impact of CVD, while
affecting the elderly the most, is
also a growing problem for
middle-aged adults. Coronary
heart disease, as a result of
myocardial infarctions (heart
attack) and angina pectoris
(chest pain), is the leading cause
of premature, permanent
disability among working
adults.7 Approximately 54.8%
of Essex County residents aged
18-64 years do not meet
moderate physical activity
recommendations. The relative
risk of CVD associated with
physical inactivity ranges from
1.5-2.4, comparable to high
cholesterol, hypertension or
cigarette smoking.
A Problem for the
Male Population
CVD disproportionately affects
males and racial or ethnic
subgroups. Although about half
of all heart disease deaths occur
among men and half among
women, over 70 percent of
premature (before age 65 years)
heart disease deaths occur
among men.
Behavioral Risks
Based on the New Jersey
Behavioral Risk Factor Survey
(BRFS) Survey for Essex
County (Appendix B), the
following behavioral risks for
Cardiovascular Disease were
identified:
Poor nutrition: Only 28.9
percent of the population had
fruit and vegetable intake of 5
or more times per day. Rates
were highest among Caucasians
and African Americans
(30.3%), and lowest among
Hispanics (21.4%).
Overweight/obesity: An
estimated 60.6 percent of the
population is either overweight
(36.1%) or obese (24.5%).
Hispanics were more likely to
be overweight in comparison to
other racial/ethnic subgroups,
while African Americans were
the most likely to be obese.
Males were more likely to be
overweight or obese in
comparison to females.
Physical inactivity: Almost onethird of the population (27.7%)
had no physical activity or
exercise in the past 30 days
(Table 4). Hispanics (38.9%),
African Americans (34.3%),
and Asians (32.4%) were more
likely than Caucasians (19.7%)
not to exercise. Additionally,
approximately 56.9% of
respondents did not meet
moderate physical activity
recommendations.
Cigarette smoking: About 17.1
percent of the population
currently smokes cigarettes,
which is roughly similar among
all racial/ethnic subgroups.
Cholesterol testing:
Approximately 80.3 percent of
the population has had a
20
CARDIOVASCULAR DISEASE
cholesterol screening in the
previous 5 years.
In addition to the above risk
factors, hypertension affects
one-fifth to one-third of the
adult population in Essex
County if national rates hold
true. Uncontrolled hypertension
is a major cause of stroke.
Stroke is the third leading cause
of death in the U.S., New
Jersey, and Essex County.
In sum, recent findings from the
New Jersey BRFS demonstrate
that a majority of Essex County
residents are either overweight
or obese, one-third engage in no
physical activity, two-thirds do
not eat a healthy diet, and about
20 percent either smoke or have
hypertension. The risk for
cardiovascular-related
morbidity and mortality is
greatly increased in the
presence of multiple risk
factors. With a growing elderly
population, the burden of CVD
will further increase unless
effective preventive measures
are developed.
Need for More
Physical Activity,
Medical Advice on
Weight Loss, and
Smoking Cessation
The burden of CVD is
tremendous, but the missed
opportunity is that it is often
preventable. Although the risk
of disease increases with
advancing age, poor health is
not an inevitable consequence
of aging. The epidemics of
diabetes, hypertension, and
obesity in the population are
contributing to the development
of CVD in all ages and racial or
ethnic subgroups. Adopting
healthier behaviors – regular
physical activity, a healthy diet,
and a smoke-free lifestyle – can
dramatically decrease an
individual’s risk for CVD.
21
CARDIOVASCULAR DISEASE
CARDIOVASCULAR DISEASE
Goal
Reduce the prevalence of Cardiovascular Disease in the community
Risk Factors
Advancing age
Cigarette smoking
Diabetes
Family history
Hypertension
High cholesterol
Male gender
Overweight and obesity
Physical inactivity
Poor nutrition
Suggested Intervention Strategies
Increase educational activities and focus the core program on critical risk factors for
CVD such as physical inactivity, nutrition, and tobacco use.
Integrate efforts into a community wellness and prevention program, expanding from
blood pressure screenings to a more cohesive approach focused on all the risk factors.
Educate local organizations to programs offered by the American Heart Association, such
as churches to the Search Your Heart Program and employers to the Heart at Work
Program.
Develop primary prevention clinics that focus on cardiac health, extend hours that make
access possible to the working population, and provide services free of charge to reach
the large immigrant population and those who are uninsured.
Increase assistance (financial and program-wise) from the state level to overcome
financial barriers and limited resources given to local health departments.
Develop, grow, and support a no or low cost “global” approach to controlling modifiable
risk factors – exercise program, weight reduction programs, smoking cessation programs,
healthy eating services by a nutritionist.
Initiate no or low cost preventative clinics at various locations.
Expand and promote hours of operations for the working-age population; develop and
expand bilingual services for the immigrant population.
Partner with local and national organizations.
22
CARDIOVASCULAR DISEASE
Resources Available
Blood pressure screenings
Health fairs where health professionals offer free screenings, educate patients about diet
and exercise, and conduct blood work to evaluate markers of CVD
A senior health clinic
A stroke risk assessment in a local retirement community
Barriers
The patients’ unwillingness or reluctance to change habits related to exercise, diet, and
smoking status
Large commuter population is difficult to reach. Three-fourths of families have parents
that both work. These individuals are typically not around during the times when
screenings and other services are offered.
Immigrant population is hard to contact due to lack of information and/or knowledge.
Limited resources and monetary support.
23
ISSUE TWO:
D IABETES
THREE
diabetes has on New Jersey.
Diabetes is controllable and
Diabetes is a serious chronic
disease-related complications
illness characterized by the
can either be delayed or
presence
too much
in H P prevented.
P U Bof LI
C H glucose
E A LT
R I O R Quality
IT Y I S SE S
the blood. Diabetes mellitus is
improvement programs, early
a disease in which the body
detection of diabetes, and
does not produce or properly
screening for complications at
use insulin. Diabetes is the sixth
recommended intervals are
leading cause of death in the
important factors to improve
United States and in New
diabetes care in Essex County.
Jersey. In 1994, Essex County
Numerous federal and
had the fourth highest mortality
organizational entities exist that
rate for diabetes among all state
provide educational materials
counties. It is estimated that
and programs for communities.
over 400,000 persons in New
Jersey have either been
A Problem for Ethnic
diagnosed with diabetes or have
the disease but are unaware of
Groups, Middle-Aged
it. The prevalence is closely
Adults, and
related to the age and
Overweight/Obese
racial/ethnic background of the
population. With a trend toward
Populations
an aging and a more diverse
population, a greater percentage
The risk of diabetes varies
of Essex County residents are at
across the population. Certain
risk for diabetes. In addition,
racial and ethnic subgroups,
the risk factors of poor diet,
such as African-Americans,
overweight and obesity, and
Hispanics, Asians, and
lack of physical activity place
American Indians, are more
an increasing burden on Essex
likely to have diabetes than
County.
Caucasians. People older than
45 years of age are more likely
***
to have diabetes than those who
are younger. In 2003, people
Many opportunities exist to
aged 65 years or older
modify the negative impact
Introduction
:
composed approximately 12.4
percent of the population.6 By
2030, the number of older
Americans is projected to reach
71 million, or 20 percent of the
population.7 The aging of the
population will certainly result
in an increased prevalence of
diabetes.
Overweight and obesity are
significantly associated with
diabetes. In 2001, the
prevalence of obesity (BMI >
30 kg/m2) was 20.9 percent
versus 19.8 percent in 2000, an
increase of 5.6 percent. The
prevalence of diabetes increased
to 7.9 percent compared to 7.3
percent in 2000, an increase of
8.2 percent. From 1991 to
2001, the increase in obesity
greatly contributed to the
growing diabetes epidemic.
The burden of diabetes in Essex
County is significant and
growing. With a rising
prevalence of overweight or
obese individuals, the morbidity
and mortality associated with
diabetes will escalate. The
trend towards an aging, more
ethically diverse population
places even a greater percentage
24
DIABETES
of Essex County’s residents at
risk for diabetes.
Opportunities exist within
Essex County to improve the
care of patients with diabetes.
Particular efforts should be
focused on the following highrisk groups:
•
Racial and ethnic
subgroups: AfricanAmericans, American
Indians, Asians, and
Hispanics
•
Middle-aged adults and
the elderly
•
Individuals with poor
behavioral health –
inadequate nutrition,
overweight and obese,
lack of physical exercise
Hispanics were more likely to
be overweight in comparison to
other racial/ethnic subgroups,
while African Americans were
the most likely to be obese.
Males were more likely to be
overweight or obese in
comparison to females.
Physical inactivity: Almost onethird of the population (27.7%)
participated in no physical
activity or exercise in the past
30 days (Table 4). Hispanics
(38.9%), African Americans
(34.3%), and Asians (32.4%)
were more likely than
Caucasians (19.7%) not to
exercise. Additionally,
approximately 56.9 percent of
respondents did not meet
moderate physical activity
recommendations.
Need for More Testing
It is estimated that only 35.8
percent of Americans achieved
glycemic control in 1999-2000,
defined as hemoglobin A1c
level less than 7 percent. The
American Diabetes Association
recommends annual A1c testing
for all patients with diabetes, in
part to improve glycemic
control rates. Uncontrolled
diabetes is associated with a
higher rate of mortality and
complications including foot
ulcers, lower-extremity
amputations, kidney disease,
neurological problems, and
blindness. Only 73.1 percent of
county residents with diabetes
reported an A1c test within the
past year, far short of the 90
percent target established by
Healthy New Jersey 2010.
Behavioral Trends
Based on the New Jersey
Behavioral Risk Factor Survey
(BRFS) Survey for Essex
County, the following trends
were identified:
Poor nutrition: Only 28.9
percent of the population had
fruit and vegetable intake of 5
or more times per day. Rates
were highest among Caucasians
and African-Americans
(30.3%), and lowest among
Hispanics (21.4%).
Overweight/obesity: An
estimated 60.6 percent of the
population is either overweight
(36.1%) or obese (24.5%).
25
DIABETES
Goal
Reduce the prevalence of Diabetes Mellitus in the community
Risk Factors
Advancing age
Overweight and obesity
Physical inactivity
Poor nutrition
Suggested Intervention Strategies
Implement New Jersey Diabetes Care Quality Improvement programs.
Utilize federal and organizational programs and resources and communicate this
information to local residents.
Increase focus on the aging, ethnically diverse populations, and those with modifiable
risk factors (obesity, poor nutrition, and physical inactivity).
Partner with local and national organizations.
26
DIABETES
Potential Partnerships
American Diabetes Association
Garden State Association of Diabetes Educators
Atlantic Health System
Saint Barnabas Health Care System
Camp Nejeda
New Jersey Diabetes Control and Prevention Program
Juvenile Diabetes Foundation International
National Diabetes Education Program
National Diabetes Information Clearinghouse
Barriers
The patients’ unwillingness or reluctance to change behavioral habits related to diet and
exercise
Large commuter population is difficult to reach when educational and screening
programs may be offered.
Limited resources and monetary support
27
ISSUE THREE:
M ENTAL H EALTH
THREE
Caldwell, Cedar Grove, Glen
Ridge, Livingston, Millburn,
Montclair, Nutley, Roseland,
and Verona. In discussions
At the June 2005 GPHP
with local public health staff in
meeting, the Health Officers,
P U Bwith
LI other
C H
E A LT H P these
R I jurisdictions,
O R IT Y itI was
S SE S
together
public
revealed that they all shared
health staff, identified their top
concerns about two specific
three health-related priorities.
groups of people: adolescents
Mental Health was identified as
and older adults. Bloomfield
a top priority by 11
identified homeless individuals
municipalities, including:
as a third concern.
Belleville, Bloomfield,
Introduction: The
Need
:
Essex County
Belleville
Bloomfield
Caldwell
Cedar Grove
Glen Ridge
Livingston
Milburn
Montclair
Nutley
Roseland
Verona
Social Isolation and
Depression among
Older Adults
All of the municipalities that
outline older adults as at risk for
mental health issues have a
population of residents age 65
and older either at or above the
county average.
Percentage of population
age 65 yrs +
12.0%
13.3%
14.3%
17.9%
22.5%
10.4%
15.3%
13.1%
11.9%
16.0%
19.7%
19.3%
28
MENTAL HEALTH
Bloomfield
The Township of Bloomfield
Health Assessment (2005)
reports that in a survey of key
informants mental health issues
among constituents came up
most frequently, representing
14% of all responses. In this
community, older adults suffer
from dementia and depression
which often goes undetected.
The elderly here are also
isolated and lack contact with
other individuals.
Livingston & Millburn
The communities of Livingston
and Milburn, municipalities
with comparable demographics
and socioeconomic status,
identified older adult mental
health as a priority issue. There
is a growing population of
senior citizens. Residents 65
years of age make up for 15.3%
and 13.1% of the population in
Livingston and Millburn,
respectively. Many of them live
alone and are not able to leave
their home often. Some suffer
from loneliness and anxiety
about the challenges of
everyday life activities.
Montclair
Many older residents of
Montclair face the challenges of
living alone. Seniors are not
necessarily suffering from
mental illness but rather a poor
state of overall mental
wellbeing. Isolation and
loneliness leads to increased
anxiety. The transportation
provided by the town is mainly
functional, taking residents food
shopping, to church services, or
on medical appointments and
does not address social needs.
Some individuals see their
aging neighbors as a
“nuisance.” The Montclair
health department receives
phone calls from neighbors,
seeking assistance. In the event
that such a call is placed, the
health department will send out
an inspector or social worker to
the home of a senior who has
been reported as a concern or
“nuisance” by neighbors. An
assessment is done in the home
and referrals are made.
Verona
As residents are living longer,
the senior population in Verona
is growing. Almost one fifth
(19.3%) of the town’s residents
are 65 years of age or older.
Older adults face depression
and loneliness from living alone
and feeling isolated from the
community.
find acceptance by peer groups,
family and the community, and
competitive pressure to “be the
best” and to “fit in.”
Competition to excel in school
can become overwhelming to
young people. There is
tremendous pressure associated
with the process of seeking
admission to colleges and
universities. It is not acceptable
for students to perform at an
average level, but rather a
standard of excellence is
demanded. Added pressure
from parents can leave young
people with feelings of
inadequacy. Furthermore,
adolescents are reluctant to seek
help for anxiety or stress
because they are under pressure
to remain composed and appear
able to cope. Sometimes, this
ongoing pressure ends in
tragedy. In 2003, Livingston
reported two teenage suicides
and twenty more suicide
attempts inside a year.
MENTAL HEALTH
Drug and Alcohol
Abuse, Depression,
and Behavior
Problems among
Young People
Livingston
The Report of the Livingston
committee for healthy
community culture identifies
social and academic pressures
as challenges detrimental to the
health of its adolescents. These
challenges consist of pressures
to conform to social norms, to
Teenagers also experience
stress and anxiety from
problems outside the classroom.
Children of parents with
substance abuse or other mental
health programs may be under
stress to keep problems at home
confidential which prevents
them from seeking support for
their own needs. Break ups in
marriages and divorce create
emotional stresses and pressures
with which young people may
not be adequately prepared to
cope.
29
MENTAL HEALTH
Disposable income and lack of
parental supervision were
identified as potential
contributing factors for
substance abuse among high
school students in Livingston.
Many of them also have cars to
travel to neighborhoods to
purchase drugs. They are also
in a position to be left alone and
unsupervised when parents take
vacations or business trips. The
Livingston Municipal alliance
committee website reports that
approximately one of every
three eighth grade students
(36%) and nine of every ten
twelfth grade students (87%)
report use of alcohol at some
time in their lives.
Verona
High school students in Verona
are also at risk for mental health
problems due to a number of
stressors. A rigid schedule of
academics and extra curricular
activities leaves little time for
recreation and relaxation. The
demands of excelling in school
and preparing for college can be
overwhelming for some
teenagers, many of whom are
also enrolled in sports, church
groups, and other clubs.
They also suffer from body
image concerns and pressure
from peers to be accepted
socially. Often times pressures
to look as good and perform as
well as other classmates leads to
eating disorders and drug and
alcohol use. Rather than seek
guidance for stress and anxiety,
some choose to self medicate
and substance abuse and
addiction problems develop.
Therefore, drug and alcohol use
is indicative of a deeper
problem; they are symptoms or
consequences of other mental
health issues, rather than the
problem itself.
Many Verona teens also suffer
from a stressful home
environment. Parents are often
preoccupied with their own
stress from divorce or caring for
their own parents. Some
teenagers who come from single
parent households also have
responsibilities to contribute
financially.
Mental Health of the
Homeless
The homeless population in
Bloomfield is a priority in this
community because many of
these individuals are in crisis as
a result of mental illness.
Mental health problems put
these residents at risk for losing
their jobs and subsequently,
their homes. Mental health
screenings are routine
procedure in addressing a case
of a homeless individual and
often underlying conditions are
revealed. Dual diagnosis of
substance addiction and mental
health are also common in
homeless individuals. Therefore
the homeless in Bloomfield are
in as much need of mental
health assistance as they are of
housing and economic aid.
Access to Care, Parent
Involvement, and
Stigma Remain
Problems
While The Mental Health
Association has been successful
in serving the residents of Essex
County, the organization
identifies two major challenges:
restrictions imposed by
managed care and the move by
government to close down state
run facilities. Many residents of
Essex County are either
uninsured or Medicaid
recipients. It is difficult to find
facilities and programs that
participate in Medicaid due to
the program’s poor
reimbursement rate.
Sometimes there is lack of
parent follow up for adolescents
at risk. Some parents feel that
the school should be responsible
for coordinating these services
for their child and do not see the
need for their own participation.
Others are reluctant to seek
professional help for their child
because they do not want to
bring in a third party to help
with family issues. Shame and
stigma associated with mental
health makes the subject taboo
for parents who prefer to keep a
mental health crisis private.
Schools do not have the
capabilities to provide young
people with the help they need
as they await permission from
parents to carry out the next
step, intervention from social
workers at The Mental Health
30
MENTAL HEALTH
Association is delayed. Certain
school districts are not as open
as others to seek guidance from
other service providers in the
county and instead choose to
handle issues locally. While
some fear lack of
confidentiality, others are in
denial about the extent of the
problem in their community,
and take a “not in my backyard”
approach to mental health
issues.
Stereotypes about normal aging
also can make diagnosis and
assessment of mental disorders
in late life challenging. For
example, many people believe
that “senility” is normal and
therefore may delay seeking
care for relatives with
dementing illnesses. Similarly,
patients and their families may
believe that depression and
hopelessness are natural
conditions of older age,
especially with prolonged
bereavement.
Duplication and
Adequacy of Mental
Health Services
Duplication of services also
prevents individuals in Essex
County from receiving proper
treatment. There are several
community organizations and
social service agencies that
provide service for the mentally
ill. There is competition of
services for partial care and
while many agencies are
available to contact for an initial
mental health crisis, not many
are equipped to carry out long
term care.
31
MENTAL HEALTH
Goal
Promote Mental Health in the community
Risk Factors
Family history
Lack of access to care
Contributing Factors
Direct contributing factors
Aging
Lack of insurance coverage
Cost of treatment/medications
Unavailability of treatment resources
Stigma
Poverty
Indirect contributing factors
Substance abuse
Social attitudes
32
MENTAL HEALTH
Suggested Intervention Strategies
Enhance partnerships between local public health and other community agencies that
provide mental service to create a strong referral system
A comprehensive, clear, easy-to-navigate guide to mental heath resources and services in
Essex County, made available to local public health departments, community agencies,
hospitals, health professionals and county residents
Explore CARE (Citizens Assessment Regarding Elders) model for formation of
committees in other Essex County municipalities.
Empower people through education to be responsible for their own mental well being as
well as the health of their neighbors.
Expand mental health component in curriculum of local health educators.
Assistance with employment and housing to prevent the stresses of economic strain and
potential homelessness from precipitation serious mental health problems.
Further outreach to homebound elderly of Essex County to improve quality of life
challenges that put seniors at risk for developing mental illness
Further assess the prevalence of mental health conditions as well as the need for
additional services.
Parent support hotline to provide anonymous, confidential information and answer
questions about mental health and available services
Training in anger management, self esteem, body image, and coping with stress for high
school students
33
MENTAL
MENTALHEALTH
HEALTH
Resources Available
County supported mental health systems
Comprehensive senior services program in Bloomfield
Mobile Crisis, a 24 hour mobile unit, responds to psychiatric emergencies in Essex
county to assess level of risk.
The Livingston Municipal alliance committee (LMAC) works to prevent substance
abuse.
The Citizens Assessment Regarding Elders (C.A.R.E.) Committee addresses the needs of
senior citizens in the township of Nutley and Montclair.
Local public health in Verona: works in partnership with high school guidance counselors
and social workers to identity and prevents mental heath problems in teenagers; sponsors
parenting workshops to educate families about the stress and challenges their adolescents
are coping with; creates commercials and public service announcements which air on
local television.
The Center for Prevention and Youth Development (CPYD) at The Mental
Health Association of Essex County provides interventions and counseling services for
at-risk children and adolescents through partnerships with local schools, parents
advocacy groups and community organization.
The Lewis H. Loeser Center for low-cost Psychotherapy (CLCP) provides affordable
counseling services for residents of Essex County with limited resources.
The Mental Health Resource Center (MHRC) located in Montclair, provides outpatient
treatment for children and adults with mental, emotional and behavioral problems.
Only4teens.org is a website created and maintained by the professional therapists,
counselors and doctors affiliated with the Mental Health Resource Center. Its purpose is
to be an educational tool and resource for teenagers seeking guidance dealing with
emotional and mental health issues.
Cope Center Inc (Counseling, Outreach, Prevention and Education) provides behavioral
healthcare services in Essex County, operating out of offices in Montclair and Verona.
34
MENTAL HEALTH
Barriers
Insufficient availability and affordability of services
Lack of funding to support programs and personnel
Poor referral systems for those who call for help
Low parental support and follow up
Limitations of insurance
Deinstitutionalization laws forcing patients to seek outpatient services which may not be
adequate for certain conditions
HIPPA rules and regulations are too strict and crippling partnerships between local public
health and mental health service providers.
Service competition and duplication
Many residents cannot afford prescriptions
Benefit restrictions imposed by Medicaid and Medicare
Lack of Internet access for some residents, including elderly is limiting
Stigma
35
ISSUE FOUR:
C HILDHOOD L EAD E XPOSURE
THREE
Introduction: The
Need
urban areas with a high
percentage of housing built
before 1978, particularly those
in rental housing and living
The adverse health
below the poverty level, face a
consequences of lead exposure
much greater likelihood of lead
include
Pmay
U B
LI Cdamage
H E toA LT H P R exposure
I O R IT Y I S SE S
than their wealthier
children’s central nervous
peers. In addition, lead
systems, kidneys, and
poisoning is another area that
reproductive systems. At
disproportionately affects
higher levels, lead exposure can
African-American children.
cause coma, convulsions, and
death. intelligence, impaired
Essex County has several
neurobehavioral development,
municipalities that include the
decreased growth, and impaired
high-risk groups for lead
hearing. Research has shown
poisoning and, indeed, sees the
an association between lead
largest number of lead
exposure and antisocial/criminal
poisoning cases of any New
behavior.
Jersey county every year. Three
:
Despite the fact that the dangers
of lead, particularly to very
young children, are wellestablished and the main
sources of lead poisoning in the
United States, leaded gasoline
and leaded residential paint,
were banned close to thirty
years ago, lead poisoning
remains a public heath threat.
While lead levels across the
United States continue to drop
and now stand at less than 2%,
there are particular segments of
the population that remain at
high risk and suffer the
consequences of lead exposure.
In particular, children living in
of the top four municipalities
with the highest rates of lead
exposure in the State are in
Essex County. The full extent
of the problem is not clear as
screening rates for lead
exposure, while higher in many
Essex County areas than in
other areas of the State, still do
not come close to universal
screening. However, some
municipalities, particularly
those that have focused on lead
as a health priority, have made
significant strides in improving
screening rates and creating
local policies that prevent lead
exposure.
At the June 2005 GPHP
meeting, the Health Officers,
together with other public
health staff, identified their top
three health-related priorities.
Childhood lead poisoning was
identified as a top priority by
three municipalities, including:
Maplewood, Orange, and South
Orange.
A Problem for Poor
Children and
Racial/Ethnic
Minorities
Children that are poor and are
racial/ethnic minorities are
disproportionately affected by
lead. In part, this disparity can
be traced to the greater
likelihood that low income and
African-American children will
be living in housing built prior
to 1978 and will be in rental
housing which are both markers
for the presence of lead paint
that has not been properly
covered, maintained or abated.
Keeping these risk factors in
mind, it is not surprising that
Essex County has the highest
rate of lead exposure in New
Jersey:
 Just over 90% of
36
CHILDHOOD LEAD EXPOSURE
housing in Essex County was
built prior to 1978 meaning
that the vast majority of units
in Essex County may contain
some lead paint. (See
Appendix B for tables
related to Essex County
Housing and Economic
Characteristics)
 Over half (54%) of
Essex County’s housing
units are renter occupied
compared to 35% that are
owner occupied.
 The poverty rate for
Essex County overall is
15.6%. However, select
municipalities have higher
rates of poverty and are the
same municipalities that
have the highest rates of lead
burdened children.
Need for More
Screening
Since the health effects of lead
are often not acute or noticeable
in the near term, the main way
that lead exposure is detected is
via a screening test. New
Jersey regulations require
physicians to test all one and
two year olds for lead.
However, only 40% of one and
two year olds in New Jersey are
currently screened. In addition,
the State Department of
Medical and Health Assistance
works with HMOs to ensure
that all physicians serving at
least 50 Medicaid patients
provide universal screening.
There is no system in place to
encourage private physicians to
meet the universal screening
requirement.
37
CHILDHOOD LEAD EXPOSURE
Goal
Eliminate childhood lead poisoning by 2010 (consistent with Healthy People 2010 Goals for
the United States)
Risk Factors
Poverty/Likelihood of living in housing with cracked/peeling leaded paint or attending
childcare or being cared for by relatives in such housing
Improper renovation techniques
Parents involved in industries that expose them to lead which may be brought into the home
Suggested Intervention Strategies
Increase awareness among do-it-yourself renovators.
Train and provide incentives to professional to utilize lead-safe work practices.
Develop a special designation for contractors that complete lead safe work practices training
and use marketing to encourage residents to hire trained companies.
Encourage additional abatement by modifying the New Jersey requirement that landlords be
up to date on property tax and sewer payments in order to access funds for interim controls
and loans for full-abatement.
Make screening more accessible by offering screening services on site at WIC clinics or
other well-utilized social service sites.
Enforce the New Jersey requirement that physicians screen all one and two year olds for
exposure to lead either via insurance companies or licensing bodies.
Increase parental awareness about the need to screen young children.
Repeat public service messages on busses or radio that have been developed by the State
Department of Health and Senior Services or private agencies.
Increase services for lead-burdened children, including building more lead-safe facilities.
Educate school boards and administrators further about lead poisoning and its effects.
Documenting cases of lead poisoning and bringing those to the attention of policy makers
and interested parties at all levels including town councils, State representatives and senators
and federal office holders.
38
CHILDHOOD LEAD EXPOSURE
Resources Available
New Jersey State’s lead elimination plan
Lead Hazard Control Assistance Act provides both loans and grants for interim
controls and lead abatement for qualifying landlords and properties.
NJ KidCare (New Jersey’s Medicaid program for children) is working to ensure
that all covered children are receiving lead screening.
“Mobile” lead analyzers for use in municipalities around the state
Wipe Out Lead environmental screening kits to pregnant women in 18 lower
income municipalities
Public Service Announcements
Barriers
Funding for interim controls and full abatement is in adequate and current sources
of funds are tied to conditions (e.g. requirement that all taxes be up to date) which
are difficult for some landlords to meet.
Absentee landlords are difficult to engage in New Jersey education and awareness
efforts.
No mechanism within WIC to charge for lead screening
Laboratory regulations in New Jersey prevent providing on site screening at
daycare centers and other places where young children and their parents could
easily be reached.
39
ISSUE FOUR:
O BESITY
THREE
Introduction
***
Obesity is a growing public
A major change in eating and
health concern that is defined as
activity patterns will help to
PanU excessive
B LI Caccumulation
H E A LTof H P R slow
I O down
R IT the
Y epidemic
I S SEofS
body fat. The adverse effects of
obesity as well as decrease the
obesity may include diabetes,
prevalence of chronic diseases
heart disease, high blood
that are associated with obesity.
pressure, gall bladder disease,
To alter obesity’s continuing
arthritis, breathing problems,
trend, public health leaders
and some forms of cancer.
must implement strategies and
programs for weight
There has been a dramatic
maintenance and reduction and
increase in this serious health
increasing the level of physical
threat during the past 20 years
activity across the population.
in the United States. A person
is characterized as obese if the
body mass index (BMI) is over
A Problem for Ethnic
30.0. A person is considered
Groups, the Middleoverweight if the BMI is
Aged, and Males
between 25.0 and 29.9. Fiftyeight million people, or one in
three Americans, are considered
The prevalence of obesity is
overweight or obese. In 2005,
significantly higher among
37% of New Jersey residents
African-Americans when
were overweight and 22% were
compared to all other races and
obese. Both dietary factors and
ethnicities. In 2005, 32% of
physical activity are
blacks in New Jersey were
contributors to obesity and
obese while 22% of whites and
being overweight although there
Hispanics were obese.
are genetic factors that may
Residents in New Jersey
play a role for some individuals
between the ages of 45 and 64
with obesity. Rates of obesity
are significantly more obese
vary greatly among racial and
than other age groups. The
ethnic groups in the US.
New Jersey Behavioral Risk
Factor Surveillance System
:
(BRFSS) had also found that
the overweight population is
disproportionately male. In
2000, 48% of males were
overweight while 27% of
females were overweight.
Significant opportunities exist
within Essex County to improve
obesity prevention efforts.
Particular efforts should be
focused on the following highrisk groups:
•
African-Americans
•
Middle-aged adults and
males
•
Individuals with poor
behavioral health –
inadequate nutrition,
overweight or obese,
lack of physical exercise
Behavioral Trends
Based on the New Jersey
Behavioral Risk Factor Survey
(BRFS) Survey for Essex
County (Appendix B), the
following trends were
identified:
40
OBESITY
Poor nutrition: Only 28.9
percent of the population had
fruit and vegetable intake of 5
or more servings a day. Rates
were highest among Caucasians
and African-Americans
(30.3%), and lowest among
Hispanics (21.4%).
Physical inactivity: Almost onethird of the population (27.7%)
participated in no physical
activity or exercise in the past
30 days. Hispanics (38.9%),
African Americans (34.3%),
and Asians (32.4%) were more
likely than Caucasians (19.7%)
not to exercise. In addition,
approximately 56.9 percent of
respondents did not meet
moderate physical activity
recommendations.
41
OBESITY
Goal
Reduce the prevalence of Obesity in the community
Risk Factors
39
Physical inactivity
Poor nutrition
Genetic propensity
Suggested Intervention Strategies
Improve state and local capacity to address physical activity and healthy eating across the
lifespan. Engage key institutions such as schools, workplaces, and faith communities in
promoting healthy eating and providing opportunities for regular exercise.
Develop an intergenerational, culturally sensitive public awareness campaign on
preventing obesity through healthy choices and physical activity.
Partner with local organizations and neighborhoods to help families raise healthier
children and to motivate citizens to increase their physical activity and improve their
diets.
Mobilize schools to take local action steps to help families raise healthier children and
increase the number of schools that view obesity as a public health issue. New Jersey
state regulations to improve the quality of school breakfast and school lunch programs
and to remove unhealthy vending machine choices from school property by 2008 are a
step in the direction of reducing obesity.
Increase workplace awareness of the obesity issue and increase the number of worksites
that have environments that support weight management, healthy food choices, and
physical activity.
Decrease disparities in obesity and increase healthy eating and physical activity among
African-Americans, persons of low socioeconomic status, the middle-aged, and males.
Potential Partnerships
Schools
Faith organizations
Community based organizations
Parks and Recreation departments/programs
42
OBESITY
Barriers
Limited resources and monetary support.
Lack of availability and/or high cost for healthy foods such as fruits and vegetables and
non-fat milk in areas with particularly high rates of overweight and obesity
Confusion about nutrition advice and information provided in the media
43
SUMMARY
AND
RECOMMENDATIONS
The Essex County Community
Health Improvement Plan
process examined existing data
on the major causes of
morbidity and mortality
throughout the county and
within each municipality,
surveyed community members
about their major health
concerns, engaged the health
officers in a process of
identifying the main health
challenges they observe in their
day to day work in
communities, and elicited input
from policy makers about the
health trends and broader
challenges currently facing
Essex County. Based on a
thorough review of this data, the
following steps would be both
high leverage and responsive to
community concerns:
1) Advocate for State and
Federal programs that
benefit Essex County
residents.
Essex County health officers,
elected officials, and residents
ought to contribute to the
important national and state
policy conversation about the
need for new approaches to
health insurance coverage by
sharing their expertise and
experience and advocating for
programs that will ensure
preventive services and
healthcare access for Essex
County residents. In addition,
leadership must be enhanced on
a state and local level in order
to address the five public health
issues identified in this report.
In order to implement this
improvement plan, policy
makers must identify funding
through public and private
grants and appropriations to
support effective educational
programs and healthcare
services.
2) Encourage prevention
and use of primary
care.
Efforts to educate insurers and
policy makers on the etiology
and prevalence of mental health
illnesses, lead poisoning,
cardiovascular disease, diabetes,
and obesity will help them
understand the county’s health
priorities, the available
treatment, and the fact that
prevention will result in
significant cost savings. Most
Essex County residents have
insurance either publicly
(Medicaid and Medicare) or
privately (generally linked to
employment). Health education
campaigns and incentive
structures should encourage
regular medical check-ups and
discourage practices that
threaten overall public health
such as using antibiotics for
viral infections or taking
someone else’s medication,
eating regularly at fast food
establishments and sedentary
lifestyles that don’t include
regular exercise.
3) Implement a public
awareness campaign
designed to support
disease prevention
efforts.
Public awareness and social
marketing campaigns can
increase knowledge about
mental health illnesses, lead
poisoning, cardiovascular
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disease, diabetes, and obesity,
educate individuals at risk of
these diseases, and encourage
residents to change their health
behaviors. Effective campaigns
engage key stakeholders and
inspire social change by
developing messages
customized to the target
audience, working with
members of those groups to
develop culturally relevant,
understandable messages and
invest enough time and
resources to ensure that most of
the target audience hears the
important behavioral health
messages repeatedly through
different media. Engaging
professionals with expertise in
behavior change
communication would be useful
in designing and implementing
any Essex County health
promotion campaigns.
4) Mobilize municipalities
to partner with local
organizations.
Local organizations such as
schools, after-school programs,
colleges, community-based
clinics, faith-based
organizations, and senior citizen
centers, can help to encourage
community participation and
facilitate and promote public
health initiatives such as
educational campaigns and
physical activity and healthy
eating programs. Strong
partnerships with existing social
institutions will help to ensure
that most community residents
receive key health messages and
can help maximize the impact
of local public health resources.
5) Commit to reducing
health disparities
among Essex County
residents.
Essex County is extremely
diverse—it is home to people of
all races, ethnicities, and
income levels. Large disparities
exist in the county between
people of color and Whites and
among those with higher
incomes and lower incomes.
Each municipality and the
county overall ought to
redouble its efforts to eliminate
disparities by focusing
resources on communities with
particular health challenges and
replicating programs that might
benefit communities most in
need of health improvement.
Various state programs, such as
new regulations governing
school breakfast and lunch and
eliminating soda and candy
vending machines, are examples
of the kinds of efforts that can
reduce disparities. In addition,
challenges that may be
particular to certain
communities, such as
transportation to medical
appointments or healthcare
facilities, ought to be focused
on as challenges for the county
as a whole. For example,
volunteer programs might be set
up to allow more privileged
county residents to make a
contribution to their neighbors
that don’t own private
automobiles by offering to drive
people to doctor’s visits.
Health interventions must meet
the needs of individual
populations and be designed by
a culturally diverse work-group.
Essex County may want to
consider conducting an in depth
needs assessment in order to
better understand the challenges
to maintaining a healthy
lifestyle and the role of culture
in health behaviors among atrisk ethnic groups.
6) Meet the needs of an
aging population.
Because Essex County’s
population is aging, a work
group with expertise in the
needs of seniors must design
health interventions addressing
the five health priorities. Also,
as people get older, they
experience more health
problems and may also lose
some of their support structures
such as spouses or children that
are raising their own families or
have moved away. Connecting
the needs of different
populations within the county
might provide opportunities to
improve social connectivity and
health across the generations.
For example, municipalities
could link students that need
after school supervision and
homework tutoring to assisted
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living communities for the
mutual benefit of those two
generations.
7) Encourage healthy
eating and exercise
among Essex County
Residents.
Increasing health education,
developing low or no cost
activities to promote exercise
and engaging schools,
workplaces, faith communities
and civic organizations in
promoting healthy eating and
regular exercise is an important
way to help prevent significant
health problems for Essex
County residents. Further,
because fresh fruits and
vegetables and non-fat milk
may not be as widely available
in some areas of the county as
others, programs to develop
local farmer’s markets or reduce
the cost of healthy foods for low
income residents would make
an important contribution to
improving dietary habits in
Essex County. Finally,
decision-makers should be
aware of the high costs
associated with treating people
with obesity, heart disease and
diabetes and consider these
monetary costs when making
decisions about opening
additional fast food
establishments or other kinds of
businesses that may be
detrimental to health of the
residents.
46
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