Community Health Assessment
Report & Action Plan
2011-2012
Community Health Assessment Report
Contents
I.
Executive Summary
2
II.
Focus Areas
- Health Service Actions
- Demographics
- Income and Employment
- Insurance Status
- Vital Statistics
- Health Statistics
- Child-related issues
- Aging Population
- Healthcare Access
- Health Behaviors and Risk
- Social, Economic, and Environmental Factors
4
7
9
13
15
17
27
37
43
46
48
III.
Community Health Council Stakeholder Survey Results
52
IV.
Community Health Council Action Plan
55
V.
Memorial Health System Action Plan
57
VI.
Reference List/Data Sources
59
Note: All years in report represent year of data collection.
2
Executive Summary
Purpose
The purpose of this report was to collect and analyze relevant data to prioritize
community needs so that the Community Health Council, and its members, can develop
and implement action plans to meet those needs and improve current programs and
systems.
Data Sources
Multiple data sources were used to construct this report with varied data collection time
periods and methodologies. All were chosen based on data integrity, sponsoring agency,
and repetition of study. The one source that differs somewhat is the Local Public Health
System Performance Assessment from the National Public Health Performance Standards
Program. The results are based on local health experts’ completion of the assessment.
Every effort was made to cross reference data points and integrate findings in the present
report. All sources are listed in the reference list on page 59.
Focus Areas
Within the 11 focus areas the following trends, or notable findings, emerged:

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Monitoring Health Status and Evaluating Services presented the greatest
opportunities for community health service actions
Washington County population is declining and aging
Per capita income in Washington County has increased although a segment of the
population lives below the poverty level with the poorest group being children under
the age of 5 and a larger percentage of those under age 18 living in poverty than at the
state and federal levels
OWF and TANF assistance to children increased while it has decreased to adults in
Washington County
Food assistance has trended upward
The number of uninsured adults and children has increased
Washington County has a higher infant mortality rate than the state
Leading causes of death in Washington County include cancer and heart disease with
the highest cancer site incidents and mortality rates being lung, breast, and prostate;
Washington County residents lag the state in PAP tests, mammography and
colonoscopies (but not PSA testing)
Washington County residents are more likely to have had a heart attack, heart
diseases or a stroke than the state average and less than 50% recognize symptoms of
heart attack and stroke
There has been an increase in maternal smoking during pregnancy
Child custody rates have risen and reunification with parents has simultaneously
decreased somewhat
Washington County has higher rates of abuse and neglect of children of all ages than
the state
Our population is aging and the incidence and severity of their disabilities is
increasing with the largest area being physical disability
3
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Due to the lower educational attainment by Washington County’s older population
they may be more economically vulnerable
Preventable hospitalizations are higher for residents with uncontrolled diabetes
pneumonia and COPD than the state
Washington County’s ratio of physicians to population is higher than the state (more
residents per physician)
Washington County health risk behaviors include a higher incidence of smoking and
less exercise than the state
Washington County ranks 82nd out of 88 counties in Ohio for physical environmental
(quality and built environment).
Washington County ranks 72nd out of 88 counties in Ohio for clinical care (quality
and access).
Washington County ranks 62nd out of 88 counties in Ohio for health behaviors
(tobacco use, diet/exercise, alcohol use, unsafe sex).
Washington County ranks 22nd out of 88 counties in Ohio for social/economic factors
(education, employment, income, family/social support, community safety).
4
Focus Areas
Health Service Actions1
Purpose of National Public Health Performance Standards Program (NPHPSP):


To improve the practice of public health and performance of public health
systems
Guide state and local jurisdictions in evaluating current performance against
optimal standards
Essential Public Health Services (EPHS) – include 2-4 model standards
Model Standards – describe key aspects of optimally performing health system
Ten EPHS and the respective model standards:
1. Monitor Health Status to Identify Community Health Problems

Population-Based Community Health Profile (CHP)

Access to and Utilization of Current Technology

Maintenance of Population Health Registries
2. Diagnose and Investigate Health Problems and Health Hazards

Identification and Surveillance of Health Threats

Investigation and Response to Public Health Threats and Emergencies

Laboratory Support for Investigation of Health Threats
3. Inform, Educate and Empower People about Health Issues

Health Education and Promotion

Health Communication

Risk Communication
4. Mobilize Community Partnerships to Identify and Solve Health Problems

Constituency Development

Community Partnerships
5. Develop Policies and Plans that Support Individual and Community Health
Efforts

Government Presence at Local Level

Public Health Policy Development

Community Health Improvement Process

Plan for Public Health Emergencies
5
6. Enforce Laws and Regulations that Protect Health and Ensure Safety

Review and Evaluate Laws, Regulations, and Ordinances

Involvement in the Improvement of Laws, Regulations, and Ordinances

Enforce Laws, Regulations, and Ordinances
7. Link People to Needed Personal Health Services and Assure the Provision of
Health Care when Otherwise Unavailable

Identification of Populations with Barriers to Personal Health Services

Assuring the Linkage of People to Personal Health Services
8. Assure a Competent Public and Personal Health Care Workforce

Workforce Assessment Planning, and Development

Public Health Workforce Standards

Life-Long Learning Through Continuing Education, Training, and Mentoring

Public Health Leadership Development
9. Evaluate Effectiveness, Accessibility, and Quality of Personal and PopulationBased Health Services

Evaluation of Population-Based Health Services

Evaluation of Personal Health Care Services

Evaluation of the Local Public Health System
10. Research for New Insights and Innovative Solutions to Health Problems

Fostering Innovation

Linkage with Institutions of Higher Learning and/or Research

Capacity to Initiate or Participate in Research
6
Ranked Summary of EPHS Performance Scores, 2009*
1. Monitor Health Status
9. Evaluate Services
4. Mobilize Partnerships
5. Develop Policies/Plans
8. Assure Workforce
10. Research/Innovations
7. Link to Health Services
3. Educate/Empower
6. Enforce Laws
2. Diagnose/Investigate
Overall
0
10
20
30
40
50
60
70
80
90
*Bar graph represents overall performance scores for each EPHS on 100-point scale.
Evaluation of EPHS Activity
NO ACTIVITY
MINIMAL
ACTIVITY
MODERATE
ACTIVITY
SIGNIFICANT
ACTIVITY
OPTIMAL
ACTIVITY
0% or absolutely no activity.
Greater than zero, but no more than 25% of the activity
described within the question is met.
Greater than 25%, but no more than 50% of the activity
described within the question is met.
Greater than 50%, but no more than 75% of the activity
described within the question is met.
Greater than 75% of the activity described within the
question is met.
7
100
Demographics
Population2,3,4,5
-
Washington County is the 39th most populous of the 88 counties in
Ohio. The residents of Washington County account for 0.6% of
Ohio’s total population.
Washington County Population
Total population
2000
63,251
2002
62,561
2009
61,048
Gender2
Gender by Age Group in Washington County, 2000*
<19 years
20-39 years
40-59 years
60-79 years
80+ years
All ages
*Estimates
Male
8,623
7,690
8,968
4,664
786
30,731
Female
8,068
8,041
9,226
5,475
1,646
32,456
Age2,3,5
Population by Age in Washington County
Under 6 years
6-17 years
18-24 years
25-44 years
45-64 years
65+ years
Total population
Number
4,570
10,301
5,610
17,498
15,831
9,441
63,251
Population by Age in Washington County
2000
Percent
7.2%
16.3%
8.9%
27.7%
25.0%
14.9%
100.0%
2000
Number Percent
14,871 23.5%
9,441
14.9%
Under 17 years
65+ years
2009
Number
Percent
12,792
21.0%
11,859
19.4%
Median Age in Washington County
2000
2006-2008**
Median age
39.1
41.1
**Between 2006-2008, the median age in Ohio was 37.9.
Race/Ethnicity2,4,5,6
8
Population of Washington County by Race
2000
Number Percent
97.1%
61,403
481
0.8%
159
0.3%
256
0.4%
13
0.0002%
263
0.4%
805
1.3%
2,028
3.2%
White
African-American
American Indian/Alaska Native
Asian
Native Hawaiian/Pacific Islander
Hispanic (any race)
Two or more races
Total Minority Population
2002-2005
Number Percent
60,747
97.1%
563
0.9%
125
0.2%
313
0.5%
19
0.03%
319
0.05%
438
0.7%
1814
2.9%
Education5,7
Education Attainment, 2000*
Washington Co
Ohio
U.S.
No high school diploma
15.5%
17.0%
19.6%
High school diploma or GED
43.0%
36.1%
28.6%
Some college, no degree
19.4%
19.9%
21.1%
Associate’s degree
7.1%
5.9%
6.3%
Bachelor’s degree
9.4%
13.7%
15.5%
Master’s/professional degree or higher 5.6%
7.5%
8.9%
*Percent of residents ages 25+ attaining indicated level of education.
9
Income and Employment
Income2,3,5
-
The per capita income of a region provides a good barometer of its
economic health. Over the last decade, per capita income growth in
Ohio has been highly correlated with employment growth.
Per Capita Income Comparisons Washington Co
Per capita income, 2000
$22,733
Per capita income, 2008
$32,225
Ohio
$28,206
$35,889
U.S.
$29,845
$40,166
Per Capita Personal Income
$35,000
$30,000
$25,000
Washington County
$20,000
$15,000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Household Income, 2000
Washington County
Number
Percent
Total households
25,162
100.0%
Less than $10,000
2,502
9.9%
$10,000 - $19,999
4,184
16.6%
$20,000 - $29,999
4,192
16.7%
$30,000 - $39,999
3,518
14.0%
$40,000 - $49,999
2,748
10.9%
$50,000 - $59,000
2,273
9.0%
$60,000 - $74,999
2,384
9.5%
$75,000 - $99,999
1,891
7.5%
$100,000 - $149,999
981
3.9%
$150,000 - $199,999
215
0.9%
$200,000 or more
274
1.1%
Median Household Income* $34,275
*In 2000, the median household income for residents of Ohio was $40,956 and
the median household income for all U.S. residents was $41,994.
Poverty2,3,4,5,6
10
Percent of Residents in Poverty, 2002-2005* Washington Co
Ohio
Population <100% federal poverty level
11.4%
10.6%
Population <200% federal poverty level
33.1%
26.4%
*Federal Poverty Level as issued by the U.S. Department of Health and Human
Services, and published in the Federal Register.
Percentage of Washington County Residents Living in
Poverty
30%
25%
20%
All Ages
15%
Children
10%
5%
0%
2000
2005
2008**
**In 2008, a family of 3 was considered at or below 100% of poverty with an
annual household income of $16,600.
Residents Living Below Federal
Poverty Level, 2008*
<18 Years of age in poverty
All ages in poverty
Washington Co.
24.3%
16.9%
Ohio
18.5%
13.3%
U.S.
18.2%
13.2%
- The poorest group of Ohioans is young children under the age of five living in
single headed households, followed by single female-headed families and African
Americans.
11
Labor Force/Employment3,5,6
Major Employers in Washington County, 2008
American Electric Power Co
Americas Styrenics
Energizer Battery
Eramet Marietta Inc
Evonik Degussa
Globe Metallurgical
KRATON Polymers LLC
Marietta City Schools
Marietta College
Marietta Memorial Health System
Pioneer Pipe
RJF International Corp
Solvay Advanced Polymers
Tata Enterprises
Thermo Fisher Scientific Inc
Type
Utility
Mfg
Mfg
Mfg
Mfg
Mfg
Mfg
Govt
Serv
Serv
Mfg
Mfg
Mfg
Serv
Mfg
The size of a county’s labor force is an indication of economic health. It is influenced
both by the economy and the size and composition of the population.
Civilian Labor Force
in Washington County
2005
Civilian labor force
32,500
Employed
30,600
Unemployed
1,900
Unemployment rate
5.9%
2006
33,000
31,300
1,700
5.2%
2007
33,100
31,400
1,700
5.1%
2008
33,100
31,300
1,800
5.5%
2009
33,500
30,400
3,100
9.4%
Ohio Works First (OWF)3,6
Ohio Works First (OWF) is the financial-assistance portion of the state’s
Temporary Assistance to Needy Families (TANF) program, which provides cash
benefits to needy families for up to 36 months.
Cash Assistance (CA)
CY 2008
Washington Ohio
County
Average monthly adult recipients 5
44,998
Average monthly child recipients 202
132,601
Total number of recipients
349
368,211
Percent of population
0.6%
3.0%
Net expenditures
$458,780
$328,588,993
Average annual CA payment per $1,315
$892
recipient
12
CY 2009
Washington Ohio
County
7
59,600
201
154,499
343
429,404
0.6%
3.7%
$471,258
$410,769,562
$1,374
$957
6 out of every 1,000 residents in Washington County received cash benefits
through OWF during CY 2009.
Trend in OWF/TANF in Washington County Jan. 2000 Jan. 2005 Jan. 2008 Jan. 2010
Total number of OWF/TANF recipients
252
251
193
204
Number of children receiving “Child Only”
171
213
188
192
TANF
- The total number of Washington County recipients of OWF/TANF
decreased by 19% between January 2000 and January 2010.
- The number of children living with relative caregivers and receiving
“Child Only” TANF increased by 12% between January 2000 and
January 2010.
Food Assistance (FA)3,6
-
-
The Food Assistance program is designed to raise nutritional levels, to
expand buying power, and to safeguard the health and well-being of
individuals and families whose gross monthly income is within 130
percent of the federal poverty guideline.
Half of all recipients are children.
Food Assistance (FA)
Average monthly adult
residents
Average monthly child
residents
Total number of recipients
Percent of population
Net expenditures
Average annual FA
payment per recipient
CY 2008
Washington Ohio
County
3,624
672,065
CY 2009
Washington Ohio
County
4,318
843,420
2,634
587,273
3,116
691,148
9,362
15.3%
$7,172,969
$766
1,825,865
15.8%
$1,603,760,076
$878
10,726
17.6%
$10,734,239
$1,001
2,142,502
18.6%
$2,367,566,809
$1,105
Ohio Direction Card*
Jan. 2000 Jan. 2005 Jan. 2008 Jan. 2010
Total number of Ohio Direction Card
3,555
5,590
5,513
7,959
recipients in Washington County
*Formerly food stamps
- The number of county residents who received Ohio Direction Cards increased
by 224% between January 2000 and January 2010.
- The average card value in Washington County was $101 per month in 2008 and
$120 in 2009.
13
Insurance
Insurance Status2,5,7
Employer-Based Insurance in Washington County
Percent of adults with employer-based insurance
Percent of children with employer-based insurance
Uninsured Residents
Percent children
uninsured (<17 years)
Percent adults
uninsured (18+ years)
2000
59.0%
59.2%
2004
Washington Co. Ohio
0.4%
5.4%
2007
Washington Co.
2.7%
17.1%
18.2%
12.5%
Medicaid Enrollment3,4,6,7
Medicaid is the state and federally funded program that pays for health care
services for eligible low-income people of all ages, including children, pregnant
women, families, older adults, and Ohioans with disabilities. Medicaid services
are delivered via contracted health care providers, ensuring that Medicaid
consumers get access to needed services, such as physician visits, hospital
inpatient care, prescription drugs, and home health services.
Medicaid Enrollment and Expenditures
SFY 2009*
Washington Co.
Ohio
Residents enrolled in Medicaid
13,057
2,407,572
Average members per year**
9.991
1,883,288
Percent of members enrolled***
21.2%
21.0%
Residents enrolled in Medicaid (Ages 0-17) 6,059
1,218,390
Average members per years (Ages 0-17)
4,796
982,283
Percent of members enrolled (Ages 0-17)
46.8%
44.6%
+
Annual Medicaid expenditures
$64,812,420
$13,162,469,167
Total cost of coverage per member per year $6,487
$6,989
* SFY stands for State Fiscal Year (July 1st to June 30th)
**Average members per year = Member months/12
**8Percent of members enrolled = Members/population enrolled
+Expenditures reflect payments made directly to providers as well as capitation
payments to HMOs.
Medicaid Eligibility
Number of persons eligible for Medicaid
Percent of persons eligible for Medicaid
2002-2005
Washington Co. Ohio
11,665
1,786,440
18.4%
15.7%
14
15
Medicaid and Children in Washington County
Percent of all births paid by Medicaid
Percent of mothers receiving Medicaid who had
two or more risk factors for poor birth outcomes
Percent of children enrolled in Medicaid
Children Insured by Medicaid in
Washington County
# of Children Insured by Medicaid
-
SFY 2005
6,187
2007
42.9%
48.0%
36.6%
SFY 2007
6,029
SFY 2009
6,056
The number of children insured by Medicaid in Washington County
decreased by 2% between 2005 and 2009.
16
Vital Statistics
Vital Statistics3,5
Births and Deaths, 2008
Washington County
Number
Rate*
658
10.8
Number
148,592
Ohio
Rate
12.9
All births
Teen births
<15 years of age
1
0.6
201
0.5
15-17 years of age
17
14.4
4,717
19.7
18-19 years of age
52
59.3
11,467
73.7
Deaths
645
1,047.5
--------------- --------------*Birth rates per 1,000 population and death rate per 100,000 population.
Marriages/Divorces, 2007
Washington County
Ohio
Number
Rate**
Number
Rate
Marriages
459
7.4
70,704
6.2
Divorces
251
4.1
39,305
3.4
**Marriage and divorces rates per 1,000 population.
Mortality2,4,8,9
One main component:
-
Premature death (National Center for Health Statistics, 2004-2006)
Rank of Washington County in Mortality among 88 counties in Ohio (2010): 47
Infant Mortality:
Infant Mortality***
12
10
8
10.6
10.1
9.3
7.8
7.7
7.7
Washington County
6
Ohio
4
2
0
2006
2007
2008
***Infant mortality reported as a rate per 1,000 live births. Infant mortality =
(Infant deaths/Live births) x 1,000.
Adult Mortality:
17
Mortality Rates per 100,000 Age-adjusted
Population
Coronary heart disease
Cancer
Stroke
Unintentional injury
Suicide
2002-2005
Washington County Ohio
211.3
210.2
196.4
212.7
50.7
62.4
46.8
30.7
7.7
10.1
Leading Causes of Death:
Leading causes of death may differ in a population depending on the age,
sex, race, and socioeconomic status of individuals within a population.
Causes of Death*
Washington Co.
Number Rate
660
849.5
164
210.0
155
194.7
41
51.3
Ohio
Number Rate
107,217 855.0
24,825 198.8
28,617 225.3
6,170
49.2
U.S.
Number
Rank
2,447,910 798.8
559,300
183.8
649,399
210.3
130,957
43.2
All deaths
Cancer
Diseases of the heart
Chronic lower respiratory
disease
Diabetes mellitus
35
44.6
3,717
29.7
74,817
24.5
Stroke
31
38.9
6,183
48.6
143,497
46.6
Unintentional injury
26
38.9
4,473
37.6
114,876
38.1
Influenza and pneumonia
15
18.9
2,191
17.2
62,804
20.3
Nephritis, nephritic
14
17.9
1,834
14.5
43,679
14.3
syndrome, and nephrosis
Alzheimer’s disease
10
12.9
3,321
25.6
71,696
22.9
Septicemia
10
12.6
1,388
11.2
34,142
11.2
*Average annual number of deaths and average annual age-adjusted mortality
rates (per 100,000 population) among Washington County Residents with
comparison to Ohio, 2004-2006, and to the United States, 2005.
Morbidity8
Four main components:
1. Poor or fair health (Behavioral Risk Factor Surveillance System, 2002-2008)
2. Poor physical health days (Behavioral Risk Factor Surveillance System, 20022008)
3. Poor mental health days (Behavioral Risk Factor Surveillance System, 20022008)
4. Low birth weight (National Center for Health Statistics, 2002-2006)
Rank of Washington County in Morbidity among 88 counties in Ohio (2010): 44
18
Health Statistics
Cancer Rates2,7
Cancer Screening Behaviors, 20042007*
Washington County
Male
Female All
Ohio
Female
Male
N/A
79.9%
N/A
N/A
88.8%
PAP test in past 3 years (Age 18+,
Intact Cervix)
71.8%
N/A
N/A
79.1%
Mammography in past 2 years (Age N/A
40+)
34.7% 47.4%
41.6% 59.2%
52.6%
Colonoscopy/Sigmoidoscopy in
past 5 years (Age 50+)
N/A
57.5%
N/A
Prostate-specific antigen (PSA) test 57.4% N/A
in past year (Age 50+)
49.8% N/A
N/A
57.5%
N/A
DRE in past year (Age 50+)
*Estimated prevalence (percent) of selected cancer screening behaviors
among adult residents in Washington County and Ohio
Cancer Site/Type,
2001-2005**
Incidence
Mortality
Washington
Ohio
Washington
Ohio
County
County
Cases Rate Rate
Cases
Rate Rate
All Sites
381
509.3 465.1
157
207.4 203.3
Breast (Female)
44
112.1 121.9
13
33.7 27.5
Cervix
3
8.3
7.9
1
2.9
2.4
Colon and Rectum
43
57.3 52.9
16
20.9 20.6
Lung and Bronchus
63
81.9 75.0
47
60.5 60.3
Melanoma of the Skin 16
22.9 17.0
3
4.0
2.6
Prostate
58
168.3 145.7
9
29.9 27.8
**Average annual number and age-adjusted rates (per 100,000 population) of
invasive cancer cases and cancer deaths among Washington County and Ohio
residents
19
All
N/A
N/A
55.7%
N/A
N/A
Cancer Incidence,
2001-2005*
Washington County
Male
Female
Total
Case
Rate
Cases Rate
Cases Rate
All Sites
203
606.0 178
442.4 381
509.3
Breast
1
2.9
44
112.1 45
N/A
Cervix
N/A
N/A
3
8.3
3
N/A
Colon and Rectum
24
73.1
19
44.5
43
57.3
Lung and Bronchus
36
105.9 27
65.0
63
81.9
Melanoma of the Skin 9
25.6
7
21.4
16
22.9
Prostate
58
168.3 N/A
N/A
58
N/A
*Average annual number and age-adjusted rates (per 100,000 population)
Cancer Rate Incidence**
2000
Washington Co. Ohio
Breast
117.7
117.7
Cervical
------------------- 7.5
Lung and Bronchus
91.9
71.0
**Rates per 100,000 population
Cancer Mortality,
2001-2005*
All Sites
Breast
Cervix
Colon and Rectum
Lung and Bronchus
Melanoma of the Skin
Prostate
Male
Case
81
<1
N/A
9
26
2
9
Washington County
Female
Rate
Cases Rate
251.5 77
180.8
-------- 13
33.7
N/A
1
2.9
27.1
7
16.4
76.7
21
48.9
4.5
1
2.8
29.9
N/A
N/A
STD Rates/HIV/AIDS4,7
Communicable Diseases**
Persons living with HIV/AIDS
Chlamydia
Gonorrhea
Syphilis
2002-2005
Washington Co. Ohio
53.8
121.5
114.9
315.1
13.7
184.2
0.0
2.8
20
2001-2005
Washington Co. Ohio
112.1
121.9
8.3
7.9
81.9
75.0
Total
Cases
157
14
1
16
47
3
9
Rate
207.4
N/A
N/A
20.9
60.5
4.0
N/A
Heart Disease/Stroke2
- In both the United States and Ohio, heart disease and stroke are the first- and
third- leading causes of death respectively (CDC, 2007).
Cholesterol and Blood Pressure Awareness:
- High cholesterol and high blood pressure are modifiable risk factors for
heart disease and stroke.
Cholesterol and Blood Pressure
Awareness*
Washington County/
Southeast Region
Ohio
Male Female All
Male Female All
Cholesterol checked within last 5 years 46.2% 37.6% 41.7% 71.0% 75.3% 73.2%
Ever told cholesterol was high
69.6% 73.5% 71.6% 39.9% 36.2% 37.9%
Ever told blood pressure was high
37.6% 31.6% 34.6% 27.9% 27.4% 27.6%
*Estimated prevalence (percentage) among adult Washington County residents
with comparison to Ohio, 2004, 2006, 2007.
Prevalence of Heart Disease and Stroke:
-
-
Males have a higher risk of having a heart attack than females and
these heart attacks typically occur earlier in life (American Heart
Association, 2008).
Stroke is more common in males; however, at all ages, more women
die as a result of a stroke than men (American Heart Association,
2007).
Heart Attack, Coronary Heart
Disease or Stroke*
Ever told had a heart attack
Ever told had angina or coronary
heart disease
Ever told had a stroke
Washington County/
Southeast Region
White Black All
8.5% 5.1% 6.8%
7.6% 6.3% 7.0%
3.8%
3.1%
3.4%
White
6.0%
5.5%
Ohio
Black
3.6%
4.2%
All
4.7%
4.8%
2.6%
3.0%
2.8%
Heart Attack and Stroke Symptom Awareness and Response:
-
Recognition of the warning signs of a heart attack or stroke and the
need to call 911 are critical to improving outcomes of heart attacks and
strokes.
21
Heart Attack and Stroke Symptom
Recognition and Response*
Washington County/
Southeast Region
Male Female All
30.2% 42.2% 36.4%
46.7% 45.3% 46.0%
83.9% 85.4% 84.7%
Male
31.0%
41.1%
88.4%
Ohio
Female
42.6%
48.2%
91.2%
Recognize all 5 symptoms of heart attacks
Recognized all 5 symptoms of strokes
Know to call 911 in response to someone
having a heart attack or stroke
*Estimated prevalence (percentage) among adult Washington County
residents with comparison to Ohio, 2004, 2006, 2007.
- Five heart attack warning signs:
1. Pain or discomfort in areas of the upper body such as the shoulder,
back, neck, jaw, stomach, or in one or both arms.
2. Chest discomfort that may or may not be accompanied by
lightheadedness or shortness of breath.
3. Cold sweats
4. Nausea
5. Pressure or pain in the center of the chest that lasts more than a few
minutes
- Five stroke warning signs:
1. Sudden weakness or numbness in the face, arm, leg or on one side of
the body.
2. Sudden trouble seeing in one or both eyes, dimness or loss of vision,
particularly in one eye.
3. Sudden confusion, trouble speaking or understanding, and loss of
speech.
4. Sudden, sever headache with no apparent cause.
5. Sudden dizziness, trouble walking, loss of balance or coordination or
sudden falls, especially along with any of the previous symptoms.
Heart Disease and Stroke Mortality:
Heart Disease Mortality**
Washington County
Ohio
# of Deaths Rates
# of Deaths Rates
Age-adjusted
Males
75
236.3
14,029
282.4
Females
80
163.4
14,588
182.6
All
155
194.7
28,617
225.3
Age-specific (years)
<24
0
0.0
72
1.9
25-49
4
20.9
1,399
34.9
50-64
21
172.8
3,829
188.8
65+
130
1,307.9
23,317
1,526.4
**Average annual number of death and age-adjusted and agespecific mortality rates (per 100,000 population), 2004-2006.
22
All
37.0%
44.6%
89.9%
Stroke Mortality*
Washington County
# of Deaths Rates
Ohio
# of Deaths Rates
Age-adjusted
Males
14
42.8
2,350
48.8
Females
18
35.1
3,833
47.8
All
31
38.9
6,183
48.6
Age-specific (years)
<24
0
0.0
21
0.5
25-49
1
4.8
208
5.2
50-64
3
25.1
552
27.2
65+
27
275.0
5,403
353.7
*Average annual number of death and age-adjusted and agespecific mortality rates (per 100,000 population), 2004-2006.
Diabetes2
-
Diabetes was the sixth-leading cause of death in Ohio and in the
United States in 2004-2006.
- Two types of diabetes:
1. Type 1 diabetes typically strikes children and young adults. It
accounts for 5 to 10 percent of all diagnosed cases of diabetes. Risk
factors for type 1 diabetes include autoimmune, environmental, and
genetic factors.
2. Type 2 diabetes usually strikes adults and accounts to 90 to 95 percent
of all diagnosed diabetes cases. Risk factors for type 2 diabetes
include older age, obesity, family history of diabetes, impaired glucose
metabolism or pre-diabetes, history of gestational diabetes, and
physical inactivity.
Diabetes Prevalence:
Estimated Prevalence (Percent) of Diabetes by Gender,
2004-2007
9.50%
9.00%
8.50%
Washington County
8.00%
Ohio
7.50%
7.00%
6.50%
Male
Female
All
23
Estimated Prevalence (Percent) of Diabetes by Age, 20042007
20.00%
18.00%
16.00%
14.00%
12.00%
10.00%
8.00%
6.00%
4.00%
2.00%
0.00%
Washington County
Ohio
18-34
35-44
45-54
55-64
Diabetes Management Practices:
Diabetes Management Behaviors, 2004-2007
Annual dilated-eye exam
Daily self-monitoring of blood glucose
Annual foot exam
Annual doctor visit
Daily self-exam of feet
2+ A1c tests past year
Attended diabetes self-management class
Annual influenza vaccine
Ever had pneumonia vaccine
Diabetes Mortality:
Diabetes Mortality, 2004-2006*
65+
Washington Co.
51.5%
63.6%
51.3%
88.5%
67.4%
63.9%
47.6%
44.7%
40.6%
Washington County
# of Deaths Rates
Ohio
70.3%
63.0%
67.4%
89.4%
66.0%
72.9%
55.0%
57.5%
52.0%
U.S.
69.4%
63.0%
68.7%
88.9%
67.9%
68.7%
53.1%
49.8%
49.0%
Ohio
# of Deaths Rates
Age-adjusted
Males
14
43.9
1,812
35.3
Females
20
45.2
1,905
25.6
All
35
44.6
3,717
29.7
Age-specific (years)
<24
<1
1.7
9
0.2
25-49
2
8.0
222
5.5
50-64
7
55.7
687
33.9
65+
26
261.6
2,799
183.2
*Average annual number of deaths and average annual age-adjusted agespecific diabetes mortality rates (per 100,000 population).
24
Arthritis2
-
Arthritis is the nation’s most common cause of disability (CDC, 2008).
Arthritis is not just one disease, but more than 100 different diseases
and conditions. The most frequently occurring is osteoarthritis. Other
common forms include rheumatoid arthritis, lupus, fibromyalgia, and
gout (CDC, 2008).
Estimated Prevalence (Percent) of Arthritis among Adult
Residents, 2004-2007
40.00%
35.00%
30.00%
25.00%
20.00%
Washington County
15.00%
Ohio
10.00%
5.00%
0.00%
Male
Female
All
Estimated Prevalence (Percent) of Arthritis among Ohio
Residents by Age, 2004-2007
70.00%
60.00%
50.00%
40.00%
Male
30.00%
Female
All
20.00%
10.00%
0.00%
18-34
35-44
45-54
55-64
65+
Unintentional and Intentional Injuries2
-
For Ohioans of all ages, the leading causes of injury-related death
include unintentional motor vehicle traffic crashes, suicide,
unintentional poisonings, unintentional falls, and homicides.
25
All Fatal Unintentional Injuries:
- Unintentional injury is the leading cause of death for Ohioans aged 1-34,
and the fifth-leading cause of death for all age groups in Ohio.
Unintentional Fatal Injury: All*
Washington County
Ohio
# of Deaths Rates
# of Deaths Rates
Age-adjusted
Males
16
52.1
2,775
51.3
Females
10
27.5
1,698
25.2
All
26
38.9
4,473
37.6
Age-specific (years)
<24
5
25.6
714
18.3
25-49
9
43.4
1,524
38.0
50-64
5
39.0
711
35.0
65+
7
70.4
1,524
99.8
*Rates per 100,000 population, 2004-2006.
Unintentional Fatal Falls:
- Fatal falls among older adults are expected to rise as Ohio’s population
continues to age.
Unintentional Injury Mortality: Falls*
Washington County
Ohio
# of Deaths Rates
# of Deaths Rates
Age-adjusted
Males
2
6.5
421
8.6
Females
<1
0.8
400
5.0
All
2
3.1
821
6.5
Age-specific (years)
<24
0
0.0
11
0.3
25-49
<1
1.6
51
1.3
50-64
1
5.6
99
4.9
65+
1
13.4
661
43.3
Unintentional Fatal Poisonings:
-Rates of unintentional fatal poisonings have been increasing at alarming
rates in Ohio due largely to unintentional drug overdoses and medication
errors.
26
Unintentional Injury Mortality:
Poisonings*
Washington County
# of Deaths Rates
Age-adjusted
Males
4
13.8
Females
1
3.3
All
5
8.4
Age-specific (years)
<24
1
6.8
25-49
3
16.1
50-64
<1
2.8
65+
0
0.0
*Rates per 100,000 population, 2004-2006.
Ohio
# of Deaths Rates
733
379
1,112
13.0
6.5
9.7
115
735
221
41
3.0
18.3
10.9
2.7
Unintentional Motor Vehicle Traffic Crashes:
- Motor vehicle traffic crashes among older adults will continue to be a
growing concern as Ohio’s population ages.
Unintentional Injury Mortality:
Motor Vehicle Traffic Crashes*
Washington County
Ohio
# of Deaths Rates
# of Deaths Rates
Age-adjusted
Males
6
18.2
904
16.2
Females
6
17.6
416
6.8
All
11
17.7
1,321
11.4
Age-specific (years)
<24
3
13.6
370
9.5
25-49
5
22.5
506
12.6
50-64
3
25.1
217
10.7
65+
1
10.1
228
14.9
Homicide:
- Homicide is the leading cause of death for young, black Ohioans.
Intentional Fatal Injury:
Homicide*
Age-adjusted
Males
Females
All
Age-specific (years)
<24
25-49
50-64
65+
Washington County
# of Deaths Rates
Ohio
# of Deaths Rates
0
1
1
0.0
2.0
1.0
----------------------------150
5.5
8.4
2.6
0
<1
<1
0
0.0
1.6
2.8
0.0
211
315
63
31
5.4
7.8
3.1
2.0
27
Suicide:
- Although females attempt suicide at higher rates, males take their lives
four times more often than females (CDC, 2007) and white adults males
are at the greatest risk of committing suicide in Ohio.
Intentional Fatal Injury: Suicide*
Washington County
# of Deaths Rates
Age-adjusted
Males
5
151.6
Females
1
2.4
All
6
8.9
Age-specific (years)
<24
<1
1.7
25-49
4
17.7
50-64
1
11.1
65+
<1
3.4
*Rates per 100,000 population, 2004-2006.
28
Ohio
# of Deaths Rates
1,053
266
1,319
18.8
4.4
11.3
192
616
312
200
4.9
15.3
15.4
13.1
Child-Related Issues
Child Health2,4,7
Vital Statistics, 2008
Total Births
% Low Birth Weight
% Very Low Birth Weight
% Preterm
% Very Preterm
% Late Prenatal Care
% Unmarried
Teen Birth Rate (15-17)
Vital Statistics
Comparison
% Low Birth
Weight
% Maternal
Smoking
% Infant
Mortality
Washington County
658
7.0%
2.3%(15)
14.0%
3.2%
14.5%
36.9%
14.4(17)
Ohio
148,592
8.6%
1.6%
12.3%
2.1%
27.3%
43.2%
19.7
2002-2005
Washington Ohio
County
7.8%
8.0%
2004-2006
Washington Ohio
County
8.4%
8.6%
2008
Washington Ohio
County
7.0%
8.6%
19.3%
18.9%
23%
18.1%
28.3%
19.2%
0.0057%
0.0078% 0.0064%
-------
0.011%
-------
Lead Testing, 2008
# Children Lead Screened
% Elevated Blood Lead Level
Overweight, 3rd Grade
% Children Overweight
Overweight, 2-5 Years
% Children Overweight
Washington County
Ohio
629
159,239
0.6%
1.6%
2004-2006
Washington Co. Ohio
19.6%
18.9%
2008
Washington Co. Ohio
26.6%
28.0%
29
Child Support3,6
The Washington County Child Support Enforcement Agency
establishes paternities and obtains, enforces, and collects child
support funds for children.
Child Support Cases
FFY 2008
FFY 2009
Wash. Co. Ohio
Wash. Co. Ohio
Number of Cases
4,049
978,385 4,212
985,863
Paternity Establishment Rate*
105.0%
91.6%
106.4%
93.6%
Cases with Support Orders
3,516
739,995 3,637
754,903
% of Cases with Support Orders
86.8%
75.6%
86.4%
76.6%
Collection Rate on Current Support Due 74.1%
68.8%
72.8%
67.4%
Rate of Cases Paying on Arrears
74.3%
68.2%
73.1%
66.5%
*Paternity Establishment Rate is the total number of children born out-ofwedlock who had active child support cases, for whom paternity was
established or acknowledged as of the end of the reporting period, divided
by the total number of children born out-of-wedlock who had active child
support cases, as reported 12 months prior to the reporting period. Rate
can exceed 100%.
Child Support Collections in Washington County FFY 2005 FFY 2007 FFY 2009
Total amount of child support collections
$9.4 mil
$9.3 mil
$9.7 mil
- Child support collections in Washington County increased by 3%
between FFY 2005 and FFY 2007.
- The number of paternities established for non-marital births in
Washington County increased by 28% between FFY 2005 and FFY
2007.
Child Safety and Care Placement3,6
Of Ohio’s 88 children services agencies, Washington County’s is one of 25
agencies accreditd by the Council on Accrediation (2011).
The Washington County Public Children Services Agency administers
local adoption assistance, foster care services, and child welfare
intervention programs.
30
Custody Issues
Children Entering Custody
Children Reentering Custody
# of Children Reunified
# of Children Reunified within 12 mo.
% of Child Reunifications <12 mo.
FFY 2008
Wash. Co. Ohio
7
8,279
1
1,261
14
4,678
13
3,206
92.9%
68.5%
Tracking Children in Custody in Washington County
Total number of children reunified with parents or
legal guardian
Total awards of legal custody to relatives
Total number of adoptions finalized
Total number of children waiting to be adopted
Total number of youth who aged out of care
Total number of children placed out of county
Average number of days a child stays in placement
FFY 2009
Wash. Co. Ohio
19
7,743
6
952
17
5,847
16
4,008
94.1%
68.5%
2005
22
2007
15
2009
17
9
0
11
2
11
160
7
3
2
1
10
244
-------3
2
4
6
291
Total Number of Children in Custody During the Year
70
60
61
55
51
50
50
40
Washington County
30
20
10
0
2001
2003
2005
31
2007
Child and Custody Profiles in
Washington County
Temporary
Custody
Children in custody 1/1/10
Age
0-5 years
6-11 years
12-18 years
Race
White
Af/Am
Other
Total years in custody
0-2 years
2-4 years
4+ years
Court Rationale for Placement

Neglect

Dependency

Physical abuse

Sexual abuse

Delinquency/unruly

Multiple safety issues
Placement Type

Licensed foster home

Approved relative/kinship
home

Group/residential care

Adoptive placement

Independent living
placement/other
31
Planned
Permanent Permanent
Custody
Living
Arrangement
5
6
29%
26%
45%
-------80%
20%
--------------100%
21%
29%
50%
71%
-------29%
100%
---------------
83%
-------17%
76%
-------24%
94%
6%
--------
40%
40%
20%
67%
33%
--------
83%
14%
3%
6%
19%
--------------10%
65%
20%
20%
---------------------60%
-------17%
17%
--------------66%
7%
20%
2%
-------7%
64%
94%
--------
40%
--------
66%
--------
83%
--------
6%
---------------
20%
40%
--------
17%
-------17%
10%
5%
2%
Foster Care/Custody
Children in
Licensed/Certified Foster
Homes
Children in Permanent
Custody
Total
42
2008 (Snapshot 9/30/2008)
Washington
Ohio
County
31
9,057
2009 (Snapshot 9/30/2009)
Washington Ohio
County
39
8,161
9
10
5,200
32
4,907
Child Deaths
FFY 2008
Wash. Co. Ohio
# of Child Deaths
0
74
# of Child Deaths in Substitute Care 0
22
FFY 2009
Wash. Co. Ohio
0
91
0
14
Public Expenditures on Child Services:
Public Expenditures on Child Services in Washington
County, 2009
Federal
State
Local
Federal
$1,233,209
43%
State
$419,542
15%
Local*
$1,192,548
42%
---------------------------------------------------Total
2,845,299
100%
*Of Ohio’s 88 counties, Washington County was not among the 45 that
maintained a children services levy in 2009.
Adoption3
Ohio counties provide comprehensive services to birth parents, adoptive
parents, and adoptive children, particularly those involved in foster care.
Adoption
FFY 2008
FFY 2009
Wash. Co. Ohio
Wash. Co. Ohio
# of Children Adopted
1
1,390
4
1,452
# of Adoptions Completed within 24
1
426
2
497
mo.
Kinship Permanency Incentive (KIP)3
KIP provides time-limited incentive payments to relatives caring for
minors who would be at risk of harm if they remained in their own homes.
33
KIP (Unduplicated Counts)
Children Approved for Initial KPI Funding
Children Receiving KPI Payment Redeterminations
Total # of Children Receiving KPI Payments
CY 2008
Wash. Co. Ohio
5
3,074
-------3,705
5
6,779
CY 2009
Wash. Co.
Ohio
7
2,586
4
5,366
11
7,952
Child Care3,6
Through state and federal funding, families whose income is at or below
150% of the federal poverty guideline can receive payment for all or part
of their monthly childcare expenses while parents work or attend job
training/educational activities. A family may remain eligible until income
increase to 200% of the federal poverty guideline.
Children Served and
Providers of Child Care
CY 2008
Wash. Co.
Ohio
785
198,244
CY 2009
Wash. Co.
Ohio
693
192,697
# of Children Using
Publicly Funded Child Care
Public Funds Used for Child $986,605
$558,762,587 $904,852
$569,657,458
Care Expenditures
Annual Average
$1,257
$2,819
$1,306
$2,956
Expenditure per Child
# of Licensed Child Care
31
3,683
32
4,483
Centers*
*Includes licensed full-time, part-time, Head Start, school-based and
combination centers with 7 or more children.
Subsidized Child Care in Washington County Jan. 2000 Jan. 2005 Jan. 2008 Jan. 2010
# of children whose families received
292
309
376
278
subsidized child care
- The number of children whose families received subsidized child care
decreased by 5% between January 2000 and January 2010.
Step Up to Quality3
The Step Up to Quality Program (SUTQ) is Ohio’s voluntary quality
rating system for childcare programs. SUTQ is designed to increase the
number of high-quality programs, recognize and support programs that
achieve higher quality standards, and provide parents with an easy-to-use
tool to assist them in making more informed choices on behalf of their
children. Programs with the highest ratings qualify for monetary awards.
Number of Licensed Child Care Centers in Washington County
Earning Quality Ratings as of June 30, 2010: 9
34
Child Abuse and Neglect3,6,9
*The Ohio Department of Job and Family Services (ODJFS)
defines the following statistics as the rate of infants/children
with substantiated abuse or neglect.
The statistics are expressed as the rate per 1,000
infants/children.
Infant Child Abuse and Neglect: Infants are children ages zero to
one year old.
Infant Child Abuse and Neglect
50
45
40
35
30
25
20
15
10
5
0
38.28
36.75
24.5
18.72
2007
19.96
16.1
2008
Washington County
Ohio
2009
Toddler Child Abuse and Neglect: Toddlers are children ages one
to three years old.
Toddler Child Abuse and Neglect
50
45
40
35
30
25
20
15
10
5
0
33.81
25.97
22.54
Washington County
Ohio
9.33
2007
10.57
8.13
2008
2009
35
Preschool Child Abuse and Neglect: Preschoolers are children
ages four to five years old.
Preschool Child Abuse and Neglect
50
45
40
35
30
25
20
15
10
5
0
21.8
8.3
2007
Washington County
20.35
18.9
Ohio
8.51
6.98
2008
2009
School-Age Child Abuse and Neglect: School-aged children are
children ages 6 to 12 years old.
School-Age Child Abuse and Neglect
50
45
40
35
30
25
20
15
10
5
0
Washington County
20.29
13.14
Ohio
13.14
6.52
2007
6.3
5.55
2008
2009
Adolescent Child Abuse and Neglect: Adolescents are children
ages 13 to 18 years old.
36
Adolescent Child Abuse and Neglect
50
45
40
35
30
25
Washington County
20
Ohio
15
11.12
8.46
10
4.56
5
9.67
4.4
3.86
0
2007
2008
2009
Local Trends on Abuse and Neglect:
Unduplicated Number of New Allegations of Child
Abuse (All Ages)
2009
2007
2005
Washington County
2003
2001
0
100
-
200
300
400
500
600
700
In 2007 and 2009, new allegations of child abuse and neglect totaled
650 and 638, respectively. The percentage of total reports the new
allegations represent fall within the following five categories:
Types of Child Abuse and Neglect
Physical abuse
Neglect
Sexual abuse
Emotional maltreatment
Family in need of services, dependency & others
Total
37
2007
Number Percent
156
24%
296
46%
80
12%
7
1%
111
17%
650
100%
2009
Number Percent
145
23%
204
32%
66
10%
0
0%
223
35%
638
100%
Local and State Comparison of Child Abuse:
Maltreatment/Child Abuse
FFY 2009
Washington Co. Ohio
522
79,906
Reports/Investigations – Allegations
of Child Abuse and Neglect Cases
Number of Maltreatment Cases
Percentage of Children with No
Recurrence of Maltreatment
112
88.4%
15,358
92.7%
Prenatal Care7,9


The Ohio Department of Health uses the Kotelchuck Index in the
definition of adequate prenatal care.
For prenatal care to be adequate according to the Kotelchuck Index, care
must begin in the first trimester and the total number of visits must equal
or exceed that which would be expected for the infants’ gestational age at
birth.
*Adequate prenatal care is expressed as a percent.
Adequate Prenatal Care
100
80
89.5
88.6
71.5
86.2
69.5
68.5
60
Washington County
40
Ohio
20
0
2006
Late Prenatal Care, 2008
% Late Prenatal Care
2007
2008
Washington Co.
14.5%
38
Ohio
27.3%
Aging Population
Demographics10
Population Projections by Age Group:
Projections of Population Age 60+ by Year and Age
Group,Washington County*
10,000
9,000
8,000
7,000
6,000
60-69 Years
5,000
70-79 Years
4,000
80-89 Years
3,000
90+ Years
2,000
1,000
0
2000
2005
2010
2015
2020
*Year 2000 data are actual population counts
Population Change among
Residents Age 60+
Total 60+ population
60-69 years
70-79 years
80-89 years
90+ years
Washington County
2000 Population Projected 2020
Population
12,544
18,542
5,699
9,275
4,441
5,883
2,031
2,719
373
665
Percent Population
Increase
47.8%
62.7%
32.5%
33.9%
78.3%
Rank of Washington County in total 60+ population among 88 counties in
Ohio (2000): 36
Rank of Washington County in proportion of 60+ population to total
county population among 88 counties in Ohio (2000): 11
39
Marital Status:
Percent ofMarital Staus Among Total Population Age 60+,
by Gender, Washington County and Southeast Ohio**,
2000
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Men
Women
Married
Divorced/ Separated/
Widowed
Never Married
**The Southeast region of Ohio includes Monroe, Morgan, and Noble
counties.
Since older single adults are more likely than married couples to need
outside help or institutional care, the population in Washington County
and Southeast Ohio that is potentially in need of such assistance is largely
female.
Education:
Highest Level of Educational Attainment Among Total
Population Age 60+, 2000
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Washington County/Southeast
Ohio*
Ohio
6th Grade
or Less
7th-12th
(No
Diploma)
High
School
Graduate
Some
College
Bachelor's Graduate
Degree
Degree
*The Southeast region of Ohio includes Monroe, Morgan, and Noble
counties.
40
The majority of Washington County residents age 60+ (76.1%), have
completed 12 or fewer years of school. This suggests that a significant
proportion of the older population may be economically vulnerable.
Housing/Residence:
Percent of Population Age 60+ Living Alone, by Gender
and Age Group, Washington County and Southeast Ohio*,
2000
60.00%
50.00%
40.00%
30.00%
Men Living Alone
20.00%
Women Living Alone
10.00%
0.00%
60-64
Years
65-69
Years
70-74
Years
75-79
Years
80-84
Years
85-89
Years
90+
Years
*The Southeast region of Ohio includes Monroe, Morgan, and Noble
counties.
Health Issues10
Projections of Disability Among
60+ Population, 2000**-2020
Year
2000
2005
2010
2015
2020
Washington County
Total
No
Moderate
Population Disability Disability
12,544
9,439
2,066
13,350
10,026
2,199
14,784
11,140
2,409
16,533
12,514
2,670
18,542
14,077
2,975
**Year 2000 data are actual disability counts.
Severe
Disability
1,039
1,125
1,235
1,349
1,490
In the Scripps Gerontology Center’s Profile and Projections of the 60+
Population, disability is defined as a measure of impairment in Activities
of Daily living (ADLs) and Instrumental Activities of Daily Living
(IADLs).
41
-
Moderate disability:
At least one of the following ADLs: eating, transferring into or out
of bed or chair, getting to the toilet, dressing, bathing, or remaining
continent, or

At least one of the following IADLs; walking, shopping, meal
preparation, housekeeping, or using transportation or the telephone
- Severe disability:

At least two of the following ADLs: eating, bathing, transferring
into or out of bed or chair, dressing, getting to the toilet, remaining
continent, or having cognitive impairment.

Projections of the Number of Women Age 60+ with
Severe Disability, by Age Group, Washington County,
2000*-2020
400
350
300
250
60-69 Years
200
70-79 Years
150
80-89 Years
100
90+ Years
50
0
2000
2005
2010
2015
2020
*Year 2000 data are actual disability counts.
Projections of the Number of Men Age 60+ with Severe
Disability, by Age Group, Washington County, 2000*-2020
180
160
140
120
60-69 Years
100
70-79 Years
80
80-89 Years
60
90+ Years
40
20
0
2000
2005
2010
2015
42
2020
Disability rates by age and sex are projected to remain the same between
2000 and 2020. Any fluctuations in the number of persons with
disabilities across time are attributed to projected changes in the number
of people in each age-gender group.
Percent of Total Population Age 60+ with Sensory,
Physical, Mental, and Self-Care Disabilities, 2000
35.00%
30.00%
25.00%
Washington
County/Southeast Ohio*
20.00%
15.00%
Ohio
10.00%
5.00%
0.00%
Sensory
Physical
Mental
Self Care
*The Southeast region of Ohio includes Monroe, Morgan, and Noble
counties.
Characteristics of disabilities:
-
Sensory disabilities

Blindness

Deafness

Severe or long-lasting vision or hearing impairment
- Physical disabilities

Long-lasting condition that substantially limits one or more basic
physical activities such as walking, climbing stairs, reaching,
lifting, or carrying
- Mental disabilities

Difficulty learning, remembering, or concentrating because of a
physical, mental, or emotional condition that lasts 6 months or
more
- Self-care disabilities

Difficulty dressing, bathing, or getting around the house as a result
of a condition that lasts 6 months or more.
Note: These categories of disabilities are not mutually exclusive.
Respondents could have multiple impairments, which may span more than
one disability category.
43
In 2000, 38.5% of the 60+ population in Washington County and
Southeast Ohio (Monroe, Morgan, and Noble counties) had at least one
disability.
Adult Protective Services3
County Departments of Job and Family Services provide Adult Protective
Services to the elderly who are in danger of harm, unable to protect themselves,
and/or have no one to assist them.
Adult Protective Services (APS)
Adult Cases
Cases Deemed Emergencies
Cases in Need of Protective Services
Cases Where Protective Services
Not Available
Allocation of APS Funds
Expenditures*
CY 2008
Washington Co.
144
38
45
0
Ohio
17,351
1,215
7,469
68
SFY 2008
Washington Co. Ohio
$33,044
$21,095,720
CY 2009
Washington Co.
175
49
61
0
Ohio
16,208
802
6,967
84
SFY 2009
Washington Co. Ohio
$38,676
$21,435,882
*APS funds are allocated at the beginning of the SFY (State Fiscal Year), July 1st
to June 30th.
44
Healthcare Access
Access to Health Care2,4,5
Health Care
2000
Washington Co.
Physicians (MDs & DOs)
107
Physicians per 10,000 Population 17.5
Registered Hospitals
2
Number of Beds
250
Number of Beds per 10,000
40.1
Population
Insurance/Medicaid
Population Uninsured
# of Persons Eligible for Medicaid
% Persons Eligible for Medicaid
2006
Washington Co. Ohio
108
28,853
17.1
25.4
1
207
225
45,505
4.0
40.0
2002-2005
Washington Co. Ohio
13.9%
11.2%
11,665
1,786,440
18.4%
15.7%
Primary Care Physicians (PCP)
2002-2005
Washington Co. Ohio
# of Primary Care Physicians
54
13,400
Ratio of Population to Primary Care Physicians 1,159:1
852:1
Family/General Practice Physicians & Medicaid
# of Family/General Practice Physicians Serving
Medicaid Recipients: 1-50 patients
# of Family/General Practice Physicians Serving
Medicaid Recipients: 51-250 patients
# of Family/General Practice Physicians Serving
Medicaid Recipients: 251-1,000 patients
# of Family/General Practice Physicians Serving
Medicaid Recipients: >1,000 patients
45
2002-2005
Washington Co. Ohio
2
1,136
16
1,783
14
901
1
103
Pediatricians & Medicaid
2002-2005
Washington Co. Ohio
0
292
# of Pediatricians Serving Medicaid Recipients:
1-50 patients
# of Pediatricians Serving Medicaid Recipients:
51-250 patients
# of Pediatricians Serving Medicaid Recipients:
251-1,000 patients
# of Pediatricians Serving Medicaid Recipients:
>1,000 patients
Dentists
0
502
2
605
1
138
2002-2005
Washington Co. Ohio
21
5123
2,979:1
2,229:1
# of Primary Care Dentists
Ratio of Population to Primary Care Dentists
Nursing Facilities and Residential Care3,5
Nursing Facilities/
Residential Care
# of Nursing Homes*
# of Residential Care
Facilities
# of Medicaid Eligibles
Living in Nursing
Facilities
Total Expenditures
CY 2008
Washington Co. Ohio
5
961
3
583
CY 2009
Washington Co. Ohio
5
959
3
593
328
316
49,088
$15,966,386
$2,946,913,
921
51,917
$16,174,108
$3,090,753
,003
*Includes state-licensed and Medicaid-certified facilities.
Clinical Care8
Two main components:
1. Access to Care

Uninsured Adults (Small Area Health Insurance Estimates,
U.S. Census, 2005)

Primary Care Provider (Health Resources & Services
Administration, 2006)
2. Quality of Care

Preventable Hospital Stays (Medicare/Dartmouth Institute,
2005-2006)

Diabetic Screening (Medicare/Dartmouth Institute, 20032006)

Hospice Use (Medicare/Dartmouth Institute, 2001-2005)
46
Rank of Washington County in Clinical Care Among 88 Counties in Ohio
(2010): 72
Preventable Hospitalizations4
Preventable Hospitalizations*
Pediatric Asthma, under age 18
Adult Asthma, age 18 and older
Bacterial Pneumonia, all ages
Congestive Heart Failure, age 18 and older
Chronic Obstructive Pulmonary Disease, age 18 and older
Uncontrolled Diabetes and Diabetes Short-term
Complications, age 18 and older
Hypertension, age 18 and older
*Inpatient admissions rate per 1,000 population
47
2002-2005
Washington Co. Ohio
1.44
1.89
0.56
1.20
4.72
4.15
4.40
6.00
3.96
3.53
1.01
0.76
0.44
0.43
Health Behaviors and Risk
Health Behaviors2,8
Four main components:
1. Alcohol Use

Binge drinking

Motor vehicle crash death rate
2. Tobacco

Adult smoking
3. Diet and Exercise

Adult Obesity
4. High Risk Sexual Behavior

Chlamydia rate

Teen birth rate
Rank of Washington County in Health Behaviors Among 88 Counties in
Ohio (2010): 67
Health Behaviors,
2004-2007
Washington County
Male
Female All
Residents
9.9%
2.7%
6.1%
30.0% 29.2% 29.6%
Male
Ohio
Female
All
Residents
5.4%
23.6%
Heavy Drinking*
4.0%
7.6%
Current Cigarette
22.6% 30.0%
Smoking
Current Use of
5.3%
0.2%
2.7%
3.4%
0.2%
2.7%
Smokeless Tobacco
Consuming <5
86.6% 74.2% 80.1%
73.9% 81.4%
78.4%
Fruits/Vegetables
Per Day
Lack of Physical
26.2% 31.3% 28.9%
26.8% 26.7%
24.2%
Activity**
Overweight***
35.8% 26.8
31.1%
29.4% 30.3%
35.9%
+
32.9% 32.1% 32.5%
25.6% 32.6%
26.3%
Obese
*Men having more than 2 drinks/day, women having more than 1
drink/day.
**Persons who failed to participate in moderate physical activity for 30 or
more minutes per day on five or more days per week; or vigorous activity
for 20 or more minutes per day on three or more days per week.
***Body Mass Index (BMI) of 25-29.9.
+
BMI of 30.0 or greater.
48
Health Risk4
Behavioral Risk Factor Surveillance System
Indicators
2002-2005
Washington Co. Ohio
Adults age 18 and older with Diabetes
6.1%
6.5%
Adults age 18 and older with Asthma
10.3%
7.9%
Adults age 18 and older with High Blood Pressure 31.4%
26.3%
Adults age 18 and older with High Cholesterol
39.7%
32.4%
Adults age 20 and older that are Obese
22.0%
22.0%
Adults age 65 and older that have had a
23.5%
27.3%
Pneumonia Vaccination
Mental Health and Substance Abuse4
Mental Health and Substance Abuse**
2002-2005
Washington Co. Ohio
23
16
Treatment rate per 1,000 children under age 18 for
Serious Emotional Disturbance (SED)
Treatment rate per 1,000 adults age 18 and older for
9
Serious Mental Disease (SMD)
# of days in past 30 days that adults age 18 and older
3.5
felt sad/depressed
Adults age 18 and older who drank <5 drinks on one
12.0%
or more occasions in past month
**Insufficient numbers or sample size for meaningful analysis
49
8
3.2
14.9%
Social, Economic, and Environmental Factors
Social/Economic Factors2,4,7,8
Five main components:
1. Education

High school graduation (National Center for Education Statistics,
2005-2006)

College degrees (Health Resources & Services Administration,
2006)
2. Employment

Unemployment (Bureau of Labor Statistics, 2008)
3. Income

Children in poverty (Small Area Income and Poverty Estimates,
U.S. Census, 2007)

Income inequality (U.S. Census/American Community Survey,
2000/2005-2007)
4. Family and social support

Inadequate social support (Behavioral Risk Factor Surveillance
System, 2005-2008)

Single-parent households (U.S. Census/American Community
Survey, 2000/2005-2007)
5. Community safety

Violent crime (Uniform Crime Reporting, Federal Bureau of
Investigation, 2005-2007)
Rank of Washington County in Socioeconomic Factors among 88 counties in
Ohio (2010); 22
Female-headed Households, 2000
Female-headed households with children <18
Language, 2002-2005
Population >5 years who speak a
language other than English at home
Households linguistically isolated
Washington Co.
5.3%
Ohio
7.3%
Washington County
2.5%
6.1%
0.3%
1.2%
50
U.S.
7.2%
Ohio
Physical Environment8
Two main components:
1. Air Quality

Air pollution - particulate matter days (U.S. Environmental
Protection Agency/Centers for Disease Control and
Prevention, 2005)

Air pollution - ozone days (U.S. Environmental Protection
Agency/Centers for Disease Control and Protection, 2005)
2. Built Environment

Access to healthy foods (Census zip Code Business
Patterns 2006)

Liquor store density (Census County Business Patterns,
2006)
Rank of Washington County in Physical Environment Among 88 Counties
in Ohio (2010): 82
Family Type5
Family Type by Employment Status, 2008
Washington County
Number
Percent
Total Families
17,766
100.0%
Married couple, husband and wife in labor force
7,387
41.6%
Married couple, husband in labor force, wife not
3,265
18.4%
Married couple, wife in labor force, husband not
955
5.4%
Married couple, husband and wife not in labor force 2,942
16.6%
Male householder, in labor force
613
3.5%
Male householder, not in labor force
197
1.1%
Female householder, in labor force
1,547
8.7%
Female householder, not in labor force
860
4.8%
Family Type by Presence of Own Children Under 18, 2008
Total Families
Married-couple families with own children
Male householder, no wife present, with own children
Female householder, no husband present, with own children
Families with no own children
51
Washington County
Number
Percent
17,766
100.0%
5,826
32.8%
459
2.6%
1,478
8.3%
10,003
56.3%
Housing5
Housing Units, 2008
Total housing units
Occupied housing units
Owner occupied
Renter occupied
Vacant housing units
Year Structure Built, 2008
Total housing units
Built 1995-March 2000
Built 1990-1994
Built 1980-1989
Built 1970-1979
Built 1960-1969
Built 1950-1959
Built 1940-1949
Built 1939 or earlier
Median Year Built
Washington County
Number
Percent
27,760
100.0%
25,137
90.6%
19,165
69.0%
5,972
21.5%
2,623
9.4%
Washington County
Number
Percent
27,760
100.0%
2,172
7.8%
1,596
5.7%
3,875
14.0%
5,255
18.9%
3,401
12.3%
3,228
11.6%
1,549
5.6%
6,684
24.1%
--------------1967
Crime5
Total crimes in Washington County reported in Uniform Crime Report
(2008): 1,327
52
Community Health Council Stakeholder Survey Results
The Community Health Council participated in a survey conducted by the Memorial
Health System as part of our Community Health Assessment. Stakeholders of each
participating agency were asked to complete the survey. The hospital then tallied the
results and provided feedback to the Community Health Council. In addition, the
hospital facilitated an action planning session based on the assessment report and the
survey results.
Participating Agencies
The Right Path/Washington County Mental
Health
EVE
Washington County Health Department
Community Action Health Service
Job and Family Services
Washington County Community Health
Council
Memorial Health System
Health Care Access
Very
Easy
Is access to medical treatment and services in
Washington County…..
Is access to mental health treatment and services in
Washington County…..
14.3%
Is access to a physician in Washington County…..
Somewhat
Easy
42.9%
Not
Very
Easy
14.3% 28.6%
28.6% 71.4%
57.1%
28.6% 14.3%
Services Sought Outside of Washington County
The services are presented in rank order with the most often cited service appearing first.
Services mentioned only once are not included.
Adults
Addiction services; detox
Psychiatric inpatient
Family planning
Mental health
Cardiac open heart surgery
Dental
Dentists who accept
Medicaid
Teenagers
Mental health
Psychiatric inpatient
Dental
Children
Specialized pediatric care
Dental
Mental health
53
Not
At All
Easy
Top Health Concerns
Adults
Weighted
Score
28
19
16
13
Rank
1
2
3
4
Mental health
Obesity
Physical health
Substance abuse
Children and Teenagers
Weighted
Score
30
20
15
11
Rank
1
2
3
4
Mental health
Substance abuse
Obesity
Lack of physical activity/exercise
Community
Concerns
Weighted
Score
25
18
16
Rank
1 Employment
2 Access to mental health services
3 Access to healthcare
54
Strengths
Local hospitals/health services
 2 local hospitals
 4 hospitals in mid-Ohio valley
 Cancer Center
 New facilities/expansion
 Wide variety of services
 Services accessible
Physicians
 Excellence
 Primary care physicians
 Specialists
 Good psychiatrists
Free Services
 Free Clinic
 Growth of dental clinic
Senior Center Day Care
Opportunities
Coordination and Cooperation
 Community health providers
 Health departments
Mental Health Services
Expansion of Clinics and Free Services
Caregiver Support
Weaknesses
Lack of substance abuse treatment
 No inpatient services
Lack mental health care/resources
 No inpatient care
 Community mental health is private/for
profit
Physician Issues
 Contracted physicians
 Dr. without hospital privileges
 Limited time spent with patients
Reproductive/Sexual Health Services
 Lack family planning
 Lack prenatal care
 Lack STD clinic
Community Health System/Services Relationship
 Lack trust in delivery system
 Lack trust in ED physicians
 Medical insurance accepted by physicians
controlled by one entity
 Quality decrease with expansion
Uninsured/underinsured/Medicare
 Low cost dental limited
 Limited services without 3rd party payer
 New services aimed at Medicare
population
Lack coordination of Health Departments
Threats
Financial
 Program funding
 Reduction in Medicare reimbursement
 Economy
 No mental health levy
 Loss of jobs with medical insurance benefit
Health Reform
Mental Health/Substance Abuse strain on
community businesses and resources
Lack of community collaboration
Environmental pollution
Infrastructure in rural parts of county
 Cell service
 High speed internet
 Emergency response
55
Community Health Council Action Plan
Action Planning Agenda
An action planning session was facilitated by the hospital to review the Community
Health Assessment report and the Stakeholder Survey Results in order to develop an
action plan based on the findings. Three brainstorming groups formed to develop
potential ideas for addressing the community health needs based on the two sources of
information.
Brainstorming Group#1 Summary:
o
o
o
o
o
o
Communication
Access—resource guide tool lit available to family
Resources
Understanding—meet regularly with medical staff
Stronger Attendance of Council
Education—partnering of council, voice of prevention
Brainstorming Group#2 Summary:
o Grass Roots—support for Mental Health Levy
o Potential of grant writing, funding
o Volunteer organizations
Brainstorming Group#3 Summary:
o Meeting mental health services—coming up
o Education-nutrition
o Levy issues
The larger group then developed a set of priorities based on the three brainstorming
groups lists.
Priorities:
1.
Communication/Education
a. Toolbox
b. Resource Guide
c. Social Media
d. Collaboration
e. All Resources Currently Available
2. Mental Health Levy—Develop levy support model
a. Grassroots
b. Access to Mental Health Initiative
c. Council support of levy—tell us what to do
56
3. Partnership Development
a. Physician
b. Employees
c. Volunteers
d. Education
e. Financial
f. Faith Based
Order of importance of priorities:
Later
Now
Communication/Education
Mental Health Levy
Mental Health Levy
Communication/Education
Partnership Development
Partnership Development
Next Steps to accomplish support model for levy support:





Letter of Support/Letter to Editor
Encourage Individual Council members to write letter to editor
Attend Kiwanis, Rotary, Women’s Club, Lions Club, etc., if you are a
member of secondary organization invite representative to attend to
speak of support for levy
Brochure distribution
Faith Based Organizations—Health Ministries
Next Steps to accomplish communication and education:






Establish Criteria (Mission)
Briefing upcoming levy; what materials using, testimonials
Sub-committee of council members
Education to local agencies/audiences
Commitment of group
Ad in local media
57
Memorial Health System Action Plan
The following actions will be undertaken by the Memorial Health System in response the
Community Health Assessment and Community Health Council Stakeholder report.
1. Create consistent data sets to understand the trends in our community health needs
and the impact of our actions over time.
a. Every three years we will update the current Community Health Assessment
report and conduct the same Community Health Council Stakeholder survey.
b. We will share both data sets with Community Health Council to assist them with
the broader community health planning.
2. Support the Community Health Council.
a. The Memorial Health System committed resources to assist with the development
of a communication toolbox for agencies, a community Resource Guide, and
Social Media tools to address community health needs and to connect community
members to available resources.
b. The Memorial Health System will provide opportunities for agencies of the
Community Health Council to educate our employees on levy issues and agency
needs. We will also lend marketing support to support health related levies and
public campaigns initiated by the agencies of the Community Health Council.
c. Continue participation as a Community health Council member.
3. Promote disease detection and prevention in the community.
a. Develop a mechanism to offer an all-inclusive colonoscopy screening package at
a lower combined cost.
b. Offer more prevention and wellness outreach services to local employers (e.g.
health screenings, health education, exercise and nutritional services).
c. Continue offering the grant funded Komen Foundation mammography screenings
for low income women. Increase community awareness of program availability.
4. Pursue and obtain Primary Stroke Center Certification through the Healthcare
Facilities Accreditation Program (HFAP).
5. Partner with Marietta College and People’s Bank on a long term, community wide
project to reduce hunger.
6. Support mental health needs in the community.
58
a. Recruit psychiatrist(s)
b. Add geripsych bed(s)
c. Support other mental health initiatives through the Community Health Council
such as levies and community awareness of resources.
59
Reference List/Data Sources
1. National Public Health Performance Standards Program. Local Public Health
System Performance Assessment; Report of Results: Washington County General
Health District. November 16, 2009.
2. Ohio Department of Health. Health Ohio Community Profiles. Office of Healthy
Ohio, Columbus, Ohio. December, 2008.
3. Ohio Department of Job and Family Services. 2009 Washington County Profile.
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