Community Health Needs Assessment
2012
Narrative Summary
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Community Health Needs Assessment
Escambia County Alabama
2012
In 2013, a comprehensive community health needs assessment (CHNA) was facilitated by Baptist
Health Care Corporation, on behalf of Atmore Community Hospital, and for the approximately 38,000
residents of Escambia County, Alabama.
Description of Community
Escambia County is located in south central Alabama, and lies on the northern
boundary of Florida. It encompasses 951 square miles; with the three most populous
communities are Brewton, in the eastern part of the County, Flomaton, closer to the
middle of the county, and Atmore, in the west.
Atmore Community Hospital (ACH) is a 49-bed facility, serving several rural communities in southern Alabama and northwest Florida, offering services for residents
who otherwise would have to travel further from their homes for medical care. Atmore
Community Hospital is owned by the Escambia County Health Authority, but has
been leased and operated by Baptist Health Care Corporation since 1995. Baptist
Health Care is a not-for-profit parent corporation for a locally- owned health system,
based in Pensacola, in adjoining Escambia County, Florida
Atmore is the largest incorporated township in Escambia County, with over 25% of the County’s
population. While the County is a largely rural area, with just over 40 persons per square mile
compared to the state average of nearly 95, it has a diversified economic base. The business sector
produces automotive parts, carpets, wood products, castings, and other goods. Forestry and
agriculture provide jobs for many residents. Potential tourism opportunities include canoeing,
camping, horseback-riding, hunting, golf courses, and a casino operated by the Poarch Band of Creek
Indians the only federally recognized tribe in Alabama.
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There are three other hospitals, all in rural areas, within a 20-mile radius of Atmore Community
Hospital. The area’s hospitals include:
Facility
D. W. McMillian Hospital
Atmore Community Hospital
North Baldwin Infirmary
Jay Hospital
County
Escambia AL
Escambia AL
Baldwin AL
Santa Rosa FL
Parent
Escambia County Health Authority
Baptist Health Care Corporation (Lease)
Infirmary Health
Baptist Health Care Corporation
Type
Government
501(c)(3)
501(c)(3)
501(c)(3)
Beds
91
49
70
55
Setting
Rural
Rural
Rural
Rural
79% of all of Atmore Community Hospital’s inpatients and outpatients are residents of Escambia
County Alabama, with 15% from adjoining Escambia County, Florida and Baldwin County, Alabama
This Summary of the needs assessment for Escambia County, Alabama provides documentation that
Atmore Community Hospital is in compliance with IRS requirements for conducting community health
assessments.
The percent of persons living below the poverty level in Escambia County is 23.7%, higher than the
rate of 17.6% for the State of Alabama. Median household income for Escambia County is $638, more
than $10,000 below the state median of $42,934. Lower results for socioeconomic indicators in
Escambia County are one social determinant of health. Additional demographic and socioeconomic
data for the two counties are provided in Attachment A.
Community Involvement in the CHNA Process
The CHNA process was facilitated by Baptist Health Care Corporation, and presented to and
reviewed by the Escambia County Alabama Community Hospitals (ECACH) Board of Directors.
ECACH is an Alabama not-for-profit corporation whose board members provide oversight and
guidance for the operation of Atmore Community Hospital, under its lease and management
arrangement with Baptist Health Care.
The results of the assessment were shared with, and comments were solicited from, the Coalition for
a Healthier Escambia County, and the Escambia County Health Department.
In 2012, the Coalition for a Healthier Escambia County received the Ira L. Myers Award for Excellence
in Public Health, awarded by the Alabama Public Health Association. The Coalition is comprised of
organizations and individual committed to creating healthier communities in Escambia County, and
will provide feedback to Atmore Community Hospital in the development of an implementation plans
to address identified priority health needs for the County. A list of the members of the Coalition for a
Healthier Escambia County is provided in Attachment D.
The data included in the assessment were also reported to Escambia County news media, including
the Atmore Advance, Brewton Standard and Escambia County News.
How the Assessment Was Conducted
In performing the comprehensive health needs assessment for Escambia County, Baptist Health Care
gathered data from sources with records and data for key health indicators, including:
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Alabama Department of Public Health, Center for Health Statistics, Statistical Analysis Division.
BRFSS Data – U.S. Department of Health and Human Services, Centers for Disease Control.
Robert Wood Johnson Foundation County Health Rankings and Roadmaps.
United Health Foundation America’s Health Rankings 2012
Gallup Healthways Well-Being Index for States 2012.
Results were compared to those for the State of Alabama overall, and also used to establish
comparative rankings among Alabama’s 67 counties. A summary of the results of the assessment are
provided in Attachment B.
In addition, a document entitled Selected Health Status Indicators: Escambia County, which was
published by the Office of Primary Care and Rural Health of the Alabama Department of Public Health
and the Alabama Rural Health Association, in April 2013, was studied and incorporated as part of the
assessment process. This document is provided as Attachment C.
To identify the highest priority health issues for Escambia County, health status indicators that
compared unfavorably to Peers and the State were combined for the two counties. There were a total
of 10 indicators that were identified as most unfavorable. Priorities were then identified by applying
four criteria, three of which were objective, and one that was subjective.
Objective Criteria
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Magnitude of difference between Escambia County and the State of Alabama
Magnitude of difference between Escambia County and 66 other Alabama counties
Overall number of people affected
Subjective Criterion
#
Potential community support and availability of resources to permit effective intervention.
In order to synthesize the results from application of the objective criteria, those indicators with results
most unfavorable by comparison were the indicators were viewed in terms of established social
determinants of health – identifying influencers, precursor behaviors, and other societal factors which
could have affected results. Subsequently, input was solicited from the Coalition for a Healthier
Escambia County regarding programs and resources available, both in Escambia County and at the
state level, to support effective intervention strategies.
Input from members of the Coalition included a discussion relating to indicators for which there were
proven evidence-based interventions, and indicators which were directly correlated to many of the
poor health outcomes. The Coalition’s input also focused priorities that the community had previously
succeeded in achieving positive results for, through collaborative efforts.
Health Needs Identified
Based on the analysis of health indicators for residents of Escambia County, Alabama and input from
the Coalition for a Healthier Escambia County, priority should be given to health improvement
initiatives focused on:
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

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Diabetes
Tobacco Use
Healthy Weight
Premature Deaths - Homicides/Suicides/Substance Abuse
Atmore Community Hospital will work collaboratively with other health providers and organizations in
the community to support initiatives designed to address these four priorities.
Community Assets Identified
Escambia County has community assets that can help address the priority health needs identified
through the assessment, including two acute care hospitals, a federally-qualified health center, dental
clinic, the Alabama Department of Public Health for Escambia County, and other community-based
organizations and programs. Community assets are identified in Attachment E. Atmore Community
Hospital will work collaboratively with the organizations in the two-county area to address the
identified priority health problems.
Next Steps
Atmore Community Hospital will develop a Community Health Implementation Plan to address the
priority health needs of Escambia County residents and the populations served by the Hospital.
Although pursuing measures to address the four primary health issues is a place to start, the overall
health status for the area is unfavorable to an extent that that the efforts of health providers alone
cannot assure substantive progress will be made. Government, educators, business leaders, civic
groups, and individuals residing in Escambia County must recognize that improving health must be a
collective priority. Substantial improvement in community health, however, cannot be achieved and
sustained without policy, system, and environmental changes that are community-wide.
Substantial costs associated with poor health status are already shouldered by government,
employers, and residents. These same stakeholders must become involved in charting a course for
improvement. Health insurers set rates actuarially for geographic areas and charge higher premiums
in areas where resident health status results in a higher number of actual or expected claims. Poor
health status among employees results in higher absenteeism, lower productivity, and higher health
plan expenditures for employers. Emergency rooms rank among the costliest setting for health care
delivery. Populations with chronic conditions that experience barriers to access to care develop
problems which must typically be dealt with in longer episodes of care in costlier settings.
To that end, the community must choose to look for leadership, like that provided by the Coalition
for a Healthier Escambia County, and recognize the need to participate, collaboratively, in the
development of plans to effectively improve the health status of residents of Escambia County. In the
absence of broad recognition of the need to improve health status, and of willingness on the part of many
community leaders and organizations to participate in health improvement initiatives, little progress can be
made.
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Atmore Community Hospital is committed to providing leadership and working collaboratively with the
Coalition for a Healthier Escambia County and other community health and social services providers to
develop and support community-wide health improvement initiatives addressing the four priorities, and
seek broad community engagement in these efforts.
Atmore Community Hospital will also pursue completion of another comprehensive needs assessment
in 2016, to assess progress in improving community health.
This summary CHNA is available at www.ebaptisthealthcare.org, or by contacting Atmore Community
Hospital at 251-368-2500.
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment A
Escambia County Profile
Demographic & Socioeconomic Data
Escambia County
Florida
Population 2012 Estimate
Population 2010 Census
% Change April 2010 – July 2011
Persons Under 5 Years – 2011
Persons Under 18 Years – 2011
Persons 65 and Over – 2011
% Males
% Females
% White Population
% Black Population
% American Indian & Alaskan Native Population
% Asian Population
% Hispanic/Latino Origin Population
% White not Hispanic Population
% Foreign Born Population
38,095
38,319
-0.5%
6.2%
22.7%
15.3%
51.9%
48.1%
62.6%
32.1%
3.4%
0.3%
2.0%
61.0%
1.1%
4,779,745
4,779,736
--6.3%
23.5%
14.0%
48.5%
51.5%
70.1%
26.5%
0.7%
1.2%
3,0%
66.8%
3.4%
Veterans
% Living in Same House 1 Year +
% High School Graduates – Population 25+
% Bachelor’s Degree of Higher – Population 25+
3,117
89.8%
73.7%
11.8%
403,982
84.5%
81.9%
22.0%
Housing Units – 2011
Households – 2007-2011
Persons Per Household – 2007-2011
% Home Ownership – 2007-2011
Median Value Owner-Occupied Housing – 2007-2011
16.406
13,860
2.53
72.0%
$84,500
2.182,088
1,831,269
2.53
70.7%
$120,800
Per Capita Income – 2007-2011
Median Household Income – 2007-2011
% Population Below Poverty Level
$16,509
$31,638
23.7
$23,483
$42,934
17.6
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment B
Summary of Results - Assessment 2013
Overview
Atmore Community Hospital has sponsored an assessment of the health status of residents of
Escambia County, Alabama. The study was conducted by Baptist Health Care Corporation, which
operates Atmore Community Hospital under a lease arrangement with the Escambia County Health
Authority. Not-for-profit hospitals like Atmore Community are required to conduct such assessments
every three years, under new provisions of the Patient Protection and Affordable Care Act.
The study found that the overall health status of the community isn’t good. The County places 46 th out
of 67 Alabama counties in a national health ranking compiled by the Robert Wood Johnson
Foundation. The State of Alabama ranks 45th among the 50 states in two key indexes of health and
well-being for 2012.
Escambia’s total population of 38,095 ranks it 33rd out of Alabama’s 67 counties.
Positive results from the study include death rates for heart disease, and for pneumonia and influenza
that are below the state average. The same is true for the overall incidence of diabetes among
residents.
Among key problems identified in the assessment, the death rate for females in Escambia County is
much higher than the state average and ranks 56th out of Alabama’s 67 counties.
There are also high death rates for several types of cancer, including:



Cancers of the brain and nervous system (Escambia ranks 65th out of 67 Alabama counties);
Breast cancer (Escambia’s rate ranks 64th); and
Lung and respiratory system cancers (Escambia’s rate ranks 56th).
Escambia also has high rates for diabetes (51st out of 67 counties).
The County has substantially higher rates for violent crimes than the State of Alabama, and the
number of homicides rank the County 54th among the state’s 67 counties. Suicides, drug-induced, and
alcohol-induced deaths for Escambia County are also substantially higher than state rates.
Rates for children born with low birth weights (49th) and number of births to teen mothers are also
disproportionately high.
Finally, rates for number of Escambia residents overweight and obese and residents leading inactive
and sedentary lifestyles also exceed state averages.
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Many of Escambia Counties bigger health problems can be linked back to root causes – too many
area residents use tobacco products and too many are overweight and physically inactive.
The results of the report should be cause for concern for everyone living in the County, and it’s
important to realize that everyone, from government officials to business, church and civic leaders,
must be committed to make health improvement a priority, if any progress is to be made.
Attachment B (Continued)
Community Health Needs Assessment Summary
Total Population:
Escambia AL
All Ages
38,095
% 45-64
27.0
% 65-84
13.7
% 85+
1.6
Health Indicator
Escambia AL Rate
Death Rate Per 1,000:
Total Death Rate
12.0
Male Death Rate
11.3
Female Death Rate
12.8
Death Rate Per 100,000 by Cause:
Alzheimer’s Disease
44.6
Cancer:
All Cancers
262.5
Brain/Nervous System
15.8
Breast
28.9
Colorectal
13.1
Pancreas
21.0
Prostate
15.8
Trachea/Bronchus/Lung
91.9
Chronic Lung/Respiratory Disease
73.5
Diabetes
39.4
Heart Disease
246.8
Homicide
15.8
Suicide
23.6
Drug-Induced Deaths
37.5
Alcohol-Induced Deaths
39.4
Influenza/Pneumonia
13.1
Stroke
65.6
Natality and Infants:
Infant Deaths Per 1,000 Births
6.4
% Births to Unmarried Women
50.2
% Low Birth Weights
11.4
% Medicaid Births
74.8
BRFSS Morbidity Data:
% Diabetes Rate
12.3
Robert Wood Johnson County Health Rankings:
Teen Births Per 1,000 Females
71
Violent Crimes Per 100,000
516
% Adults Who Smoke
21
% Obesity Rate
36
% Physical Inactivity
38
Alabama
4,802,740
27.0
12.4
1.6
Alabama Rate
Ranking – 67 Alabama Counties
33
---Ranking – 67 Alabama Counties
10.1
10.5
9.7
39
27
56
30.6
48
211.4
5.4
13.5
18.3
13.3
11.3
65.3
60.2
36.1
247.4
7.9
13.8
12.6
5.2
19.6
52.8
46
65
64
14
54
49
56
38
51
17
54
16
43
8.1
42.1
10.0
53.1
30
46
49
56
13.1
25
49
427
23
33
31
------
9
% Uninsured
20
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-Key Challenges:

High Prevalence of Smoking

High Prevalence of Obesity and Sedentary Lifestyles

High Prevalence of Premature Deaths – Homicide/Suicide/Substance Abuse
Robert Wood Johnson County Health Rankings: Overall Escambia Ranks 46 th Among 67 Alabama Counties
United Health Foundation 2012 America’s Health Rankings: Alabama Ranked 45 th Among 50 States
Gallup Healthways 2012 Well-Being Index: Alabama Ranked 45th Among 50 States
Sources: Alabama Department of Public Health, Center for Health Statistics, Statistical Analysis Division, February 2013.
BRFSS Data – U.S. Department of Health and Human Services, Centers for Disease Control, 2008.
Robert Wood Johnson Foundation County Health Rankings and Roadmaps, 2012.
United Health Foundation America’s Health Rankings, 2012.
Gallup Healthways Well-Being Index for States, 2012.
2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment C
Selected Health Status Indicators Report - April 2013
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment C
Selected Health Status Indicators Report - April 2013 (Continued)
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment C
Selected Health Status Indicators Report - April 2013 (Continued)
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment C
Selected Health Status Indicators Report - April 2013 (Continued)
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment C
Selected Health Status Indicators Report - April 2013 (Continued)
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment C
Selected Health Status Indicators Report - April 2013 (Continued)
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment C
Selected Health Status Indicators Report - April 2013 (Continued)
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment C
Selected Health Status Indicators Report - April 2013 (Continued)
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment C
Selected Health Status Indicators Report - April 2013 (Continued)
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment D
Members of the Coalition for a Healthier Escambia County
Dr. Daniel Bain, President
Jefferson Davis Community
College
Brewton, AL 36427
Ms. Joan Hackman
East Escambia County Red Cross
P.O. Box 252
Brewton, AL 36427
Ms. Carolyn Bivins
1107 Fairview Circle
Brewton, AL 36426
Ms. Ruth Harrell
P.O. Box 626
Flomaton, AL 36441
Ms. Claudia Brown
901 Douglas Ave.
Brewton, AL 36426
Ms. Arelene Mack
Health Planner
Poarch Band of Creek Indians
5811 Jack Springs Road
Atmore, AL 36502-5025
Mayor Terry Clark
P.O. Box 2010
East Brewton, AL 36427
Ms. Amy Cooley
Escambia County RSVP Office
P.O. Box
Brewton, AL 36427
Ms. Sara Davis
291 Robinsonville Road
Atmore, AL 36502
Ms. Marcia De Graaf
c/o D. W. McMillan Memorial
Hospital
P.O. Drawer 908
Brewton, AL 36427
Mr. Ricky Elliott
1115 Azeala Place
Brewton, AL 36426
Ms. Vicki Fussell
Hope Place
Brewton, AL 36426
Mr. Chris Griffin
DW McMillan Hospital
Brewton, AL
Ms. Jamie Manning
Brewton, AL 36426
Mr. Mark Manning
c/o Westgate Village
P.O. Box 49
Brewton, AL 36427
Ms. Gerrie McMillan
416 Agriculture Dr.
Monroeville, AL 36460
Ms. Emilie Mims
1100 Fridge Ave.
Atmore, AL 36502
Mr. Phillip Parker
P.O. Box 908
Brewton, AL 3642
Mr. Bill Perkins - Administrator
Atmore Community Hospital
Atmore, AL
Marsha Raulerson, M.D.
1205 Belleville Ave.
Brewton, AL 36426
Ms. Mary Jane Schrock
c/o Atmore Community Hospital
401 Medical Park Drive
Atmore, AL 36502
Sheriff Grover Smith
316 Court Street
Brewton, AL 36426
Mr. Lynn Smith
Brewton City Board of Education
811 Belleville Avenue
Brewton, AL 36426
Mr. David Stokes
P.O. Box 1375
Brewton, AL 36427
Ms. Lisa Tindall
The Brewton Standard
Brewton, AL 36427
James Walker, M.D.
57 Brentwood Lane
Brewton, AL 36426
Ms. Stephanie Walker
57 Brentwood Lane
Brewton, AL 36426
Mr. Larry W. White
P.O. Drawer C
Flomaton, AL 36441
Dan Raulerson, M.D.
1205 Belleville Ave.
Brewton, AL 36426
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2012 Comprehensive Health Status Assessment
Escambia County Alabama
Attachment E
Community Assets
The following are organizations are direct providers of health care services and provide community
benefit to support interventions related to the four health priorities identified in the CHNA.
Health Care Assets – Escambia County
Facility
D. W. McMillian Hospital
Atmore Community Hospital
Parent
Escambia County Health Authority
Baptist Health Care Corporation (Lease)
Type
Government
501(c)(3)
Beds
91
49
Setting
Rural
Rural
Community Mental Health
Southwest Alabama Mental Health
Federally-Qualified Health Center
Tri-County Medical Center (Atmore)
Health Departments
Alabama Department of Public Health - Escambia County (Atmore and Brewton)
Poarch Band of Creek Indians Health Department
Oral Health
Tri-County Dental Clinic (Brewton)
The Coalition for a Healthier Escambia County is a collaborative organization focused on health promotion
and improvement initiatives, which participated in the conduct of the needs assessment described in this
document, and in the identification of health improvement priorities for Escambia County, Diabetes, Tobacco
Use, Healthy Weight and Premature Deaths from Homicides, Suicides, and Substance Abuse.
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