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Grays Harbor County:Health Assessment and Interventions
Uconj. 501 – Interdisciplinary Rural Health Issues
Rural Health County Project: Summer 2010
Rural Health County Project: Grays Harbor County
Evidence-based approach to improve Grays Harbor County’s socio-economic health through interventions.
August 19, 2010
Philip Sanchez
University of Washington
Overview
The basics: What is “rural”? Demographics Telehealth (surgical telementoring) 10 leading Health Indicators (good vs bad) Uninsured
The Economy and Environment: Social determinants to health Environmental Health
What can we do? Health interventions
Lung cancer and Premature death
What is “rural”?
The term “rural” are areas that comprise open country and settlements with fewer than 2,500 residents.
In pertinence to health policy and research:
areas that are predominantly agricultural, isolated, and have unique health and
environmental issues
Demographics and Geographic features
•Land area: 1,916.89 sq. mi.•Density: 37.1 Pop./Sq. Mi•Individuals living below poverty level: 15.9%
•Population: 2000: 67,194 2009: 71,200Largest city: Aberdeen (16,440) Average household income: $40,896
•Rank 35 of 39: social and economic factors
6.9% increase
GH WA
unemployed 8% 5%
own a college degree 13% 30%
children in poverty 22% 15%
inadequate social support 22% 17%•There are 400 farms in the countyThere are 400 farms in the county•4% of the county’s territory4% of the county’s territory is utilized for farming•RUCA code: mixed rural
Health Snapshots
Primary Care individual to practitioner ratio: 2000:1 Mental Health individual to practitioner ratio: 10000:1 Medically Underserved Areas (MUA):
Quinault Service Area: 50.10 Southeastern Grays Harbor Service Area: 61.40
Hospitals and Clinics: 5 Community Health and Rural Health Clinics 1 Indian Health Center and Tribal Clinic 1 Critical Access Hospital
Mental and Physical Health expenditure: $11,638,362 Health ranking to Washington County’s (of 39):
Health Outcomes: 33
Mortality: 34
Morbidity: 31
Health Factors: 38
Health Behavior: 39
Clinical Care: 32
Uninsured
Uninsured individuals (age under 65): 8,957 (13% of population)
Medicare beneficiaries Elderly (Age 65+): 10,959 (15% of population)
Disabled: 2,792 (4% of population)
Medicaid beneficiaries: 17,987 (25% of population)
Primary care physicians per 100,000 population: 39.2 Dentists per 100,000 population: 43.5 Community/Migrant Health Centers: Yes Health Professional Shortage Area: No
Trauma Centers and OB care
Only two hospitals that provides acute care, one of which provides OB care.
Majority of the areas are more than a 30 minute drive to a hospital for both acute and OB care.
Northern area need more time to reach these facilities in comparison to areas in the south.
Grays Harbor Community
Hospital
(Level V G)
Mark Reed Hospital
(Level III G)
Telehealth majority of the county’s area can
have wireless technology. However, wireless download speeds is only greater than or equal 3 mbps and less than 6 mbps. *The NTIA definition of Broadband is greater than or equal to 768 kbps download speed, 200 kbps upload speed
An approach:“Surgical Telementoring Initiation of
a Regional Telemedicine Network: Projection of Surgical Expertise in the WWAMI Region”
“Surgical telementoring represents an advanced form of telemedicine, whereby an experienced surgeon can guide and teach practicing surgeons new operative techniques utilizing current enabling video, robotics, and telecommunications technology”.
Health Indicators: Better than or the same as state
Health Indicator Grays Harbor
Washington
Physical activity:
% adults age 18 or older
% teen physical activity
66
52
62
44
Immunization:
% children 19-35 months with complete vaccination
56 42
Substance Abuse:
% teen alcohol use 32 32
Health Indicators: Worse than State
Health Indicator Grays Harbor Washington
Overweight and Obesity:
% adults overweight
% teens overweight
64
29
61
25
Tobacco Use:
% adults cigarette smoking
% teen cigarette smoking
24
18
16
14
Substance Abuse:
% adults binge drinking 23 16
Mental Health:
% adult poor mental health 12 10
Access to Health Care:
% adults age 18 or older who report having a personal doctor or health care provider
74 79
A bigger problem…
Grays Harbor Error Margin Target Value Washington Rank (of 39)
8,421 7,694-9,148 5,245 5,979 34
Health Indicator Grays Harbor Washington
Substance Abuse:
% adults binge drinking 23 16
Worse than state Health Indicators lead to: Premature Deaths
Lung CancerData type Site Year AA population AA rate per
100,000
Grays Harbor Washington
incidence Lung/bronchus 2005-2007 97.8 65.6
Social Determinants of Health
Premature death: High Blood Pressure
smoking*, alcohol, obesity Poor childhood nutrition Bad sanitation and hygiene Unsafe sex
*also a determinant of Lung Cancer
Environmental Factors
Nearly 33% of Grays Harbor citizens live in homes built before the 1950s.
Associated in these homes are the tear of asbestos microfibers. Risk of having lung cancer, mesothelioma, and asbestosis for
people inhaling asbestos microfibers in their home. (risk increases as more are inhaled, Greatest risk for smoker).
According the National Cancer Institute, Grays Harbor County has an Annual Incidence Rate of 103.6 for individuals in the county with lung cancer.
Tobacco use Grays Harbor Washington
% adults cigarette smoking
% teen cigarette smoking
24
18
16
14
Environmental Factors
A study provided the strongest evidence after controlling external factors that can affect the experiment such as cigarette smoking, diet, occupational exposures, and other risk factors.
Results: Risk to exposure to fine particulate matter over a long period of
time, lead to lung cancer and increase cardiopulmonary mortality.
County’s years daily average resulted to be 0.6 as opposed to its neighboring county, such as Jefferson County which showed a years daily average of 0.2.
Interventions to Premature Deaths
Preventing Excessive Alcohol Use: Enhanced Enforcement of Laws Prohibiting Sales to Minors
Enhanced enforcement programs used as part of a community wide, multicomponent system to reduce underage drinking
Creating strategies to increase detection of unlawful actions advertising the increased enforcement and cautioning
proprietors against selling alcohol to minors. mass media letters to all local alcohol retailers
Having retailer compliance checks coordinated with local law enforcement or alcohol beverage control (ABC) agencies
Having violators receive legal or administrative sanctions
Interventions Results
Effective in reducing retail sales of alcohol to minors Sales to decoys: median decrease of 42% Modest decreases in underage alcohol consumption Effective in both rural and urban communities in on-
premises and off-premises establishments and various diverse ethnicities and socioeconomic groups.
Decrease not only the number of premature deaths in the county, but also the percentage of underage drinking.
Intervention to Lung Cancer
Increasing Tobacco Cessation Multicomponent interventions that include client
telephone support. Provide counseling and assistance for those who
want to stay tobacco-free. Individuals assisting are health care and drug
counseling professionals who will abide protocols in providing advice needed to help tobacco-users quit.
Increase motivation and help prevent relapse by educating, using nicotine-replacement therapies, and counseling.
In clinical settings, the curriculum can be used to follow up on other clinical cessation programs.
Intervention Results
Number of smokers that quit from this program resulted in 3 people per 100.
Program is it is applicable to many people. 2.6 percentage point increase of the median
difference during follow-up periods of 5 weeks to 34 months
Program showed similar increases in comparison to client education
For those living in house’s prior to 1950: significantly decreases chance of having lung cancer
Questions for health advocates and leaders
Premature deaths: What are other approaches to decreasing the number
of premature deaths? How can we improve our Emergency Medical
Services such that it is accessible to everyone? How can we encourage to improve everyone’s quality
of life? How can we educate people of the risk of premature
death once they are pregnant? What are ways health professionals can ensure that
the carrier (mother) does not make wrong decisions while she is pregnant? Or a way for health professionals to keep track of the carrier’s nutrition?
Questions for health advocates and leaders
Lung Cancer: What are other approaches to decreasing the number
of smokers in Grays Harbor? What incentives can we give to smokers to stop
smoking and have them do more healthier activities? How can we convince people who live in houses prior
to 1950 to refurbish them? Should we replace old houses with new ones? What are ways we can educate the community about
lung cancer?
References Brewster , J. (2006). How to Get mental health services. Retrieved from http://www.healthygh.org/ Cheteri, M. (2010). Washington State Cancer Registry. Wscr data online. Retrieved (2010, August 17) from
https://fortress.wa.gov/doh/wscr/WSCRQuery.aspx Olexa, L. (2009). Federally designated rural health clinics by county. Retrieved from http://
www.doh.wa.gov/hsqa/ocrh/RHC/Fed_DesignRHCs.pdf Remington, P. (2010). Snapshot 2010: grays harbor wa. Retrieved from
http://www.countyhealthrankings.org/washington/grays-harbor Meldrum, B. (2009). Mark reed health care district. Retrieved from http://www.markreed.org/ Robinson, D. (2009, October 23). Emergency Medical Services and Trauma System. Retrieved June 24, 2010, from Washington
State Department of Health: http://www.doh.wa.gov/hsqa/emstrauma/traumadesig.htm Samson, L. (2003). Quinalt indian nation. Retrieved from http://www.quinaultindiannation.com Wakefield, M. K. (2010, May 28). Shortage Designation: HPSAs, MUAs & MUPs. Retrieved June 24, 2010, from U.S. Department
of Health and Human Services: http://bhpr.hrsa.gov/shortage/index.htm Washington State Department of Health. (2009). Retrieved July 02, 2010 from Washington State Local Public Health Indicators:
http://www.doh.wa.gov/ phip/ khi/ lphi/ overview.htm. Who Identifies five major causes of premature death. (2009, October 29). Retrieved from
http://www.medicalnewstoday.com/articles/169132.php Wu, A. (2010). Washington state broadbands. Retrieved from http://wabroadbandmapping.org/MapGallery.aspx Yoon, Kim. (2008). Surgical telementoring initiation of a regional telemedicine network:. IEEE computer Society. Zaza, S. (2005). The Guide to community preventive services: what works to promote health? [pp. 44-46]. (Adobe), Retrieved
from http://www.thecommunityguide.org/tobacco/Tobacco.pdf Zaza, S. (2005). The Guide to community preventive services: what works to promote health? [pp. 44-46]. (Adobe), Retrieved
from http://www.thecommunityguide.org/alcohol/lawsprohibitingsales.html
Pictures: http://crawford.tardigrade.net/journal/album6832b.html http://www.movoto.com/wa/224-l-st-hoquiam/501_48979.htm http://www.fcschools.net/ http://www.homes.com/Real_Estate/WA/County/GRAYS%20HARBOR/ http://www.house.gov/dicks/grayshar.shtml