Grays Harbor County: Health Assessment and Interventions   Uconj. 501 – Interdisciplinary Rural Health Issues Rural Health...
Rural Health County Project: Grays Harbor County <ul><li>Evidence-based approach to improve Grays Harbor County’s socio-ec...
Overview <ul><li>The basics:   </li></ul><ul><li>What is “rural”?  </li></ul><ul><li>Demographics </li></ul><ul><li>Telehe...
What is “rural”? <ul><li>The term “rural” are areas that comprise open country and settlements with fewer than 2,500 resid...
Demographics and Geographic features <ul><li>Land area: 1,916.89 sq. mi. </li></ul><ul><li>Density :  37.1 Pop./Sq. Mi </l...
Health Snapshots <ul><li>Primary Care individual to practitioner ratio: 2000:1 </li></ul><ul><li>Mental Health individual ...
Uninsured  <ul><li>Uninsured individuals (age under 65): 8,957  (13% of population) </li></ul><ul><li>Medicare beneficiari...
Trauma Centers and OB care Only two hospitals that provides acute care, one of which provides OB care.  Majority of the ar...
Telehealth <ul><li>majority of the county’s area can have wireless technology. However, wireless download speeds is only g...
 
Health Indicators:   Better than or the same as state  32 32 Substance Abuse :  % teen alcohol use 42 56 Immunization:  % ...
Health Indicators:    Worse than State Washington  Grays Harbor Health Indicator 79 74 Access to Health Care: % adults age...
A bigger problem…  Worse than state Health Indicators lead to:    Premature Deaths Lung Cancer 16 23 Substance Abuse: % ad...
Social Determinants of Health <ul><li>Premature death:  </li></ul><ul><li>High Blood Pressure  </li></ul><ul><ul><li>smoki...
Environmental Factors  <ul><li>Nearly 33% of Grays Harbor citizens live in homes built before the 1950s.  </li></ul><ul><l...
Environmental Factors <ul><li>A study provided the strongest evidence after controlling external factors that can affect t...
Interventions to Premature Deaths  <ul><li>Preventing Excessive Alcohol Use: Enhanced Enforcement of Laws Prohibiting Sale...
Interventions Results <ul><li>Effective in reducing retail sales of alcohol to minors  </li></ul><ul><li>Sales to decoys: ...
Intervention to Lung Cancer <ul><li>Increasing Tobacco Cessation  </li></ul><ul><li>Multicomponent interventions that incl...
Intervention Results <ul><li>Number of smokers that quit from this program resulted in 3 people per 100.  </li></ul><ul><l...
Questions for health advocates and leaders <ul><li>Premature deaths:  </li></ul><ul><li>What are other approaches to decre...
Questions for health advocates and leaders <ul><li>Lung Cancer: </li></ul><ul><li>What are other approaches to decreasing ...
References  <ul><li>Brewster , J. (2006).  How to Get mental health services . Retrieved from  http:// www.healthygh.org /...
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Rural Health: Grays Harbor County

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Summer 2010: Uconj. 501
University of Washington

Rural Health County Project
Grays Harbor County

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  • Explain siginificance general desigantion of levels… Level V G and Level III G hospital (what does it stand for)… in legends, use what you need
  • Rural Health: Grays Harbor County

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

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