Community Health Assessment and Diagnosis Essay

Community Diagnosis A Community Health Epidemiology Study with Community Diagnosis HGT Community Health Practicum/HAT1 Erika J. Schnell, R. N. 11/05/2012 Western Governor’s University Community Diagnosis Abstract The following is an assessment of an Eastern Washington Community known as Chelan/Douglas Counties which will lead to a community diagnosis.

This community diagnosis is based on publicly available statistical data gathered using the concepts of epidemiology of birth rates and leading causes of death and assessing the communities determinants of health from the websites of the Chelan/Douglas County Department of Health, the Washington State Department of Health, the World Health Organization, the Federal Centers for Disease Control and the Federal U. S. Census of 2010. Composed data will be assessed for the health status of the community and compiled into a genogram which will then be interpreted and the final outcome will be a diagnosis of a healthcare need for the community.

Community Description & Epidemiological Data What makes a Community? Communities are the composition of individuals and families, with specific and blended ethnic backgrounds and cultures; they share the fields of available employment, unemployment rates and its economic and social impacts. The overall average median income and educational status all affect communities. Communities share inherent health risks related to socioeconomic and environmental hazards and consequently they share common health problems.

The Eastern Washington community of Chelan/Douglas Counties includes the cities and towns of: Cashmere, Chelan, Dryden, East Wenatchee, Leavenworth, Lake Wenatchee, Malaga, Manson, Peshastin, Plain, Rock Island, Waterville, and Wenatchee. Community Diagnosis The two counties sit nestled against the eastern rim of the Cascade Mountain range and are separated by the Columbia River. They share a diverse geographic area from densely treed forest to high mountain desert territory. The area is fertile and has irrigated lands for vast production of multiple crops of fruits, vegetables and nuts.

The local economy is supported mostly through agriculture and tourism. That being said roughly one-third of Chelan/Douglas Counties employment is in agriculture which is seasonal, leaving many individuals and families without employment and health insurance for at least part of the year. The World Health Organization (WHO) uses Determinants of health to assess geographical regions around the World to best advocate for their health needs. These are listed below: Determinants of Health as put forth by the WHO. “• The health of individuals and communities are, to a large extent, affected by a combination of many factors. . Income and social status – Higher income and social status are linked to better health. 2. Education – Low education levels are linked with poor health, more stress and lower selfconfidence. 3. Physical Environment – Safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. 4. Employment and working conditions – People in employment are healthier, particularly those who have more control over their working conditions. 5. Social support networks – Greater support from families, friends and communities is linked to better health. . Culture – Customs and traditions, and the beliefs of the family and community all affect health. Community Diagnosis 7. Genetics – Inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illness. 8. Personal Behavior and coping skills – Balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health. 9. Health Services – Access and use of services that prevent and treat disease influence health. 10. Gender – Men and Women suffer from different types of diseases at different ages. (WHO, 2012) The Chelan/Douglas Counties population total is approximately 118,000 people per the 2010 Census with approximately 26% Hispanic ethnicity and 65% white. The Wenatchee Metropolitan Statistical (MSA) includes Chelan and Douglas Counties and it depends heavily on agriculture, retail, recreational activity and hospitality for employment of the bulk of their residents. The largest age group within the 118,000 population is the 35-64 year olds at 43,370 and followed by the 0-17 year olds at 28,318 and then the 18 – 34 year olds at 22,105 and finally 65+ at 17,056.

This puts the bulk of the work force at approximately 65,475 individuals of prime working ages. Unemployment rates are 12% for Chelan County and 15% for Douglas County. The number of residents who have an Associate Degree or Vocational Certificate is 10% and the number who have Bachelors or higher is 8% for both counties combined. The area’s population has grown annually by 40% since 2004, despite a 1% decrease in the annual birthrate, in Chelan County the infant mortality rate (IMR) was 4. 1 per 1,000 live births in 2010 which has increased 3% from 1998. In Douglas County the IMR was 0. per 1,000 live births, decreased 100% from 1998. Many individuals are relocating from California to retire, and recreational enthusiasts are Community Diagnosis moving here for the nature and recreational areas and many migrant workers are deciding to take up residence and stay in the area (Chelan/Douglas Trends, 2011). The average wage is measured by the average earned income through means of employment or self-employment. Chelan/Douglas Counties average wage was $32,378 in 2011, for a roughly 26% increase since 2002 when the average annual wage was $25,634.

In Washington State as a whole for 2011 the average annual wage measured approximately $50,264, for 55% more above Chelan/Douglas Counties. From 2002-2011, the state’s average annual wage increased by around 31%, which significantly above Chelan/Douglas County’s gains (Chelan/ Douglas Trends). The measure of median household income measures all sources of income such as employment wages, investments & property incomes, proprietors’ income, pensions, transfer payments and all financial sources for a household. The median household income represents the value in which 50% of households are less than and 50% are more than.

Households vary from the traditional family model in that they may be comprised of unrelated individuals cohabitating or individuals alone in a house. Median household income is valuable in ascertaining the success of a community’s economy. During the time period 1990-2011, Chelan/Douglas Counties nominal median household income has gone up from $26,794 to $45,714 for an increase of 71%. In Washington State, the nominal median household income began at $33,417, and then grew to $54,888 in 2010, a 64% increase. Nationally the nominal U. S. edian household income grew 67%, starting in 1990 at $29,943 and expanding to $50,046 in 2011 (Chelan Douglas Trends, 2011). Community Diagnosis When interviewed with open ended questions the (5) Hispanic residents of varying age and occupation expressed concern about there not being enough educational and employment opportunities for themselves and their children outside of the agriculture industry. They are aware of the limitations of seasonal employment and the consequences of lack of health insurance and work benefits and want more for themselves and their families.

Most of the adult Hispanics were born in Mexico and their children were born in the United States. The (3) White residents of varying age and occupation interviewed are concerned that the formerly migrant Hispanic population is staying put and moving out of the agriculture areas and into the employment sectors that were formerly held by white residents and not migrating thereby reducing the number of jobs available to whites and taking too much of the resources available through the Department of Health and Social Services.

The Violent Crime Rate constitutes the total of four different crimes perpetrated by adults, construed for this data as any person age 18 or older, within Chelan/Douglas Counties, noted in (descending) order by frequency of occurrence: aggravated assault, robbery, rape and murder. This total is expressed by incidence per 1,000 adult residents. “The overall violent crime rate in the Chelan-Douglas MSA has declined steadily for the reported period of 1995-2011. In 1995, the violent crime rate was 2. 6. By 2011, the rate had dropped to 1. , a 39% decrease over the period”, (Chelan/Douglas Trends, 2011). The negative outcomes of victims who have suffered violent crimes affect the community culture in regards to vies of person safety, trust and integrity within the community. Some of the negative personal outcomes for the victims of these types of crime include severe physical harm, reoccurring psychological trauma as with post- traumatic stress disorder, or even death. Community Diagnosis In 2011 in Chelan/Douglas County the frequency of property crimes perpetuated by adults per 1,000 adult residents was 26. , showing a decline of 47% from 1995 when rate was as high as 49. 6 per 1,000 adult residents. Washington State’s total rate was 35. 4 in 2011, for a decline of 38% compared to 1995. In review of national data taken from 2011, the data showed a total rate of 29. 0, also a decrease of 37% from 1995 nationally (Chelan/Douglas Trends, 2011). In Chelan/Douglas County in 2010, the arrest rate for violent crime per 1,000 youth was 1. 52, a decrease of 58% from the 1995 rate of 3. 6.

The youth property crime rate of arrests for 2010, per 1,000 youth was 17. 3, as with the other crimes noted this is a decrease of 71% from 1995, when the rate was 59. 3. Of note is that in recent years since 2005 youth arrest rates involving property crimes have elevated by 4% (Chelan/Douglas Trends, 2011). Tragically, the increased numbers of young people perpetrating is concerning to the community because the younger criminal activity begins the more likely it is to continue on to adulthood and could lead to more serious crimes.

Large numbers of juvenile crimes and subsequent arrests incur community and societal debts, like the need for more law enforcement officers, less ability of the EMS system to react to true emergencies, increased incarceration areas and special youth detention centers and probationary programs. Crime rates are reduced in areas of less unemployment and higher education within the community. Domestic violence is a crime defined by violence of any family members toward each other.

When families engage in disagreements which resort to physical harm or emotional and psychological injury, negative outcomes ensue most assuredly for any children involved. Domestic Violence charges can prevent individuals from employment in certain employment sectors, especially healthcare. These offenses also incur long-term community and societal costs, Community Diagnosis through counseling services, potential homelessness of the displaced family member(s), and remedial education for risk reduction of repeat behavior as well as burdening the law enforcement system.

In Chelan/Douglas Counties the domestic violence rate has decreased 38% from the 19982010 period, from 7. 4 to 4. 6 incidents per 1,000 residents of any age. The Washington State rate has been consistently higher than the Chelan/ Doulas County’s. In 2010, the rate was 5. 6 incidents per 1,000 residents a decline by 26% over the time period of 1998 to 2010 (Chelan/Douglas Trends 2011). The Chelan County Regional Justice Center correctional facility for adults in Chelan and Douglas Counties has 383-beds and is downtown in the heart of the city of Wenatchee.

It serves the 118,000 people population and covers a geographical area of over 5,000 square miles. On site satellite buildings house the 42-bed minimum security facility as well as the 66-bed direct supervision minimum security facility which holds Work Release Inmate Workers and Volunteer Inmate Workers. Eligibility for Electronic Home Monitoring, Satellite Monitoring, and Work Release Programs is court-approved for specific low risk sentenced offenders. While incarcerated the County provides its inmates basic medical treatment, mental health counseling and necessary nutrition.

In addition, the Chelan County Regional Justice Center offers several programs to benefit the spiritual, emotional, psychological and physical well-being of perpetrators incarcerated within the facility including: Religious Services and Counseling, AA and NA meetings, Educational services, Anger Management program, ESL classes, Fit2BFathers program, Getting It Right program, as well as release planning. The community partners participating in these programs are The Literacy Council, WSU Extension, Washington State Department of Corrections, and Catholic Family Services.

Community Diagnosis The predominate religion of the area is Catholicism followed closely by Mormons and Seventh Day Adventists various Baptist Churches, and United Free Methodists among others and there is at least one church in every small town in the county. The churches are very active within the community and do many fund raisers, canned food drives and free dinners to feed and support the areas under privileged residents. This community has ample healthcare services available with a large local health department serving counties, three hospitals, one in Leavenworth, one in Chelan, and one in Wenatchee.

It also has four clinics, one in Leavenworth, one in Chelan, and two in Wenatchee. This community is a rural community. Rural communities are variable related to their different characteristics such as seasonal temperatures, environmental factors, population concentration, local economy, cultural, religious and political diversity, specific healthcare concerns and their access and adequacy of available social services and healthcare resources. There is not a lot of preventative cancer screening occurring in the under insured populations.

Unfortunately this area has one of the highest rates of Breast and Lung Cancers in the state of Washington and Nationally. The Hispanic community is reluctant to utilize the medical services without first trying to cure their loved ones on their own. They employ herbal remedies used in Mexico, for example using heat and hot foods to treat colds and flu, unfortunately then they are quick to use the emergency departments when home remedies fail. The white community is more likely to seek attention at the walk in clinics at first sign of illness than are their Hispanic counterparts.

Both groups when interviewed have a social stigma related to mental illness and believe that the individuals who are homeless due to mental illness should be institutionalized. The area has County Mental Health Professionals to assess crises however the only inpatient treatment facility Community Diagnosis is located at Eastern State Mental Facility in Medical Lake, over 200 miles away. There are mental health services available at 2 out of the four clinics, both in Wenatchee.

For Social services there is a local Department of Health and Social Services, the Department of Health, Catholic Family Services, the Salvation Army, the Good Will, the United Way of Chelan/Douglas Counties, Family Planning Services and many low income housing units available to low income individuals and families and those with debilitating mental illnesses including but not limited to the Christopher House for women children and developmentally delayed, the Hospitality House for homeless men, The Community Foundation of NCW and The Partnership for Children and families.

There are also three Drug and Alcohol treatment centers. In addition the community has an Army National Guard Armory station in Wenatchee, full time Fire Departments for East Wenatchee, Wenatchee, and Lake Chelan and volunteer fire departments in every small town within the counties. This allows for speedy responses to Natural disasters, manmade hazards and emergency medical services.

Disaster plans are coordinated locally and regionally with Federal Emergency Management Agency (FEMA) in Seattle, WA and include biohazard; natural disasters and acts of terrorism and bioterrorism, these plans are available at FEMAs and Washington State’s websites (Washington Military Department, Emergency Management Division, 2012). The three leading causes of death in Chelan/Douglas Counties are Cancer, Heart Disease and Stroke. Of these three leading causes of death Lung Cancers in the area are above State and National levels.

Within the counties combines lung cancer was responsible for the highest number of deaths at a rate of 57. 7 deaths per 100,000 individuals of all ages in 2010. Lung cancer has been on the rise at an increase of 10% since 1997and of alarming finding in 2010, was Community Diagnosis the increase in the death rate for prostate cancer at 47 deaths per 100,000 people, reflecting an increase of 279% from 1997-2010. The breast cancer rate in 2010 was totaled to be 18. 0 deaths per 100,000 people, which is decreased 32% from 1997, at the time the rate totaled 26. 6.

The State has also listed lung cancer as the most prevalent type of cancer deaths with around 48 deaths per 100,000 residents (Chelan/Douglas Trends, 2011). There is much to be said about environmental exposure to agricultural by-products in this community. Exposure to toxins which may cause cellular mutations and cancers. This community has several lakes and rivers the largest lake being Lake Chelan and the largest river being the Columbia River. Many Apple and Pear orchards are nestled along the rivers and streams, allowing pesticide and fertilizer runoff to contaminate the waters.

The air is polluted by inversions caused from agricultural slash pile burning and pesticide sprays blown on the trees multiple times per year. Many workers are exposed to the pesticides and fertilizers by working in the fields and orchards and by picking, sorting, handling and packaging the products. This community is also within 200 miles of Hanford Nuclear Reservation, which is known to leak, and most recently has been on the local news for possible new storage tank failures. Many local residents eat fish out of the Columbia River and its tributaries which have swam up river past the nuclear reservation to get to our rivers.

Lakes in surrounding counties such as Lake Roosevelt for example have had their fish deemed contaminated and unfit to eat. Community Genogram *See attachment for Genogram Genogram Interpretation Community Diagnosis The Genogram is a visual interpretation of the culmination of epidemiological data from which the community diagnosis is derived. The Genogram I have constructed is composed of four distinct areas: Population by Age and Ethnicity Chelan/Douglas Counties, Environment ; Health Hazards, Access to Healthcare ; Community Safety, and Socio-Economic Issues.

Specific data taken from the data collected is utilized to portray points of interest to the author and readers. Through the summation of the data depicted within the Genogram, one can easily deduce the logic of the community diagnosis for the need for increased education and prevention of the leading causes of cancer for the area, especially for those who are without health insurance. The background of the Genogram uses visual icons to support the written information in the Genogram and in the body of this paper showing environmental toxicity and agriculture as linked as they are.

Community Diagnosis Multiple environmental agricultural hazards exist within the Chelan/Douglas County and surrounding Regions. With three high mortality rate cancers in Chelan/Douglas Counties female breast cancer, lung cancer and prostate cancer and each with increases, except breast cancer, since 2005 it calls to question the preventative measures, education, screening and the true accessibility of appropriate treatments within the community and region.

This is especially true for people who are without insurance coverage for themselves and their families, these people and families find themselves vulnerable to health and financial calamity. Though adults ages 65 plus can receive Medicare and low-income families with children can receive state assistance through Medicaid individuals in the middle are often without health insurance coverage. In Community Diagnosis Chelan/Douglas Counties in 2009-2010 up to 29% of the population were uninsured, in the state 18% were uninsured 2009 through 2010 (Chelan/Douglas Trends, 2011).

The populations of uninsured residents are more likely to have compromised health when compared with the insured. This is due to decreased or lack of preventative care and screenings so when problems are found with health status they tend to be at more advanced stages and are more likely to receive less therapeutic care and have increased mortality rates. It is estimated that in Washington State approximately just under one in eight residents are uninsured and also reports decreasing shares of residents getting employer sponsored health insurance, as the number of residents receiving Medicaid has increased.

Health care professionals should use trends and statistics to lobby patients to act preventatively undergo screening and early detection programs, as well as being informed of the signs of lung cancer and other prevalent cancers to improve early detection and better treatment outcomes for insured and the uninsured. The uninsured population is at considerable risk for increased mortality with disease rate due to the lack of preventative care and screenings as well as treatments available to their insured counterparts. Community Diagnosis Data Sources Chelan Douglas Health District (2011).

Chelan Douglas Trends. Retrieved from http://www. chelandouglastrends. ewu. edu/ Washington Military Department, Emergency Management Division (2012). Washington State Enhanced Hazard Mitigation Plan. Retrieved from http://www. emd. wa. gov/plans/washington_state_hazard_ mitigation_plan. shtml The World Health Organization (WHO). (2012). The Determinants of Health. Retrieved from http://www. who. int/hia/evidence/doh/en/ United States Census Bureau (2010). State ; County QuickFacts. Retrieved from http://quickfacts. census. gov/qfd/states/53000. html