Community Health Needs AssessmentWexford County, Michigan

June 2015

Northern Michigan Health Alliance

Assessing the Health of Our Community

Our OrganizationThe Northern Michigan Health Alliance is located in Wexford County, Michigan, and serves an estimated population of 32,886 residents (U.S. Census, 2014). This organization evaluates the population by many different health indicators, and compares them to Michigan’s statewide scores. By comparing the two populations side by side, the organization can see what the county is doing well and where there are areas of improvement. The purpose of the following assessment is to gain knowledge on areas of community health needs, and then implement programs and initiatives within the community based on the findings. The Northern Michigan Health Alliance also uses existing research to prioritize the health needs of those living in Wexford County and to improve existing programs in the community.

Our PopulationAs stated above, Wexford County has a population of around 33,000 people (U.S. Census, 2014). Of that population, the Northern Michigan Health Alliance directs its services to those people in the lowest socioeconomic brackets. We serve individuals and families throughout the community who exhibit the greatest need. In other words, we offer services to those that have an income below the poverty line, those that have a less than a high school education, and those who have little or no access to health services.

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Wexford County, MichiganPopulation: 32,886 people

The population we serve includes...- Individuals who have an income below the poverty line- Individuals who have less than a high school education- Individuals who have little to no access to health care and health care services

Northern Michigan Health Alliance

Demographic & Socioeconomic Wexford County is home to almost 33,000 people, and encompasses over 565 square miles in northwestern Michigan (U.S. Census, 2014). The population is predominantly non-Hispanic white (95.3 percent) with almost equal percentages of men and women (50.1 percent, 49.9 percent) (CDC, 2015). Over one half of the population is between the ages of 18 and 64 (59.8 percent), while less than one-quarter are under 18 (23.4 percent) and over 65 (16.8 percent) (CDC, 2015). Below are the population’s socioeconomic demographic information and population health indicators.

In Wexford County the majority of the population has at least a high school education (79 percent), as well as over half of the population having at least some college education (57.2 percent) (RWJF, 2015). Despite this however, 17 percent of the population is uninsured, 21 percent were not able to see a doctor due to cost, and 49 percent of school-aged children were eligible for free lunch (RWJF, 2015 & Feeding America, 2013). Median household income throughout the county is $39,566, which is significantly lower than the statewide median income average of $48,200 (RWJF, 2015). Wexford County also has a high rate of unemployment (12.1 percent) compared to the average of other peer counties throughout the nation (7.1 percent) (RWJF, 2015). Barriers to health in relation to socioeconomic status were also expressed as a source of concern for the citizens of Wexford County. 22.5 percent of residents were unable to see a medical practitioner due to cost (RWJF, 2015). Data collected for the county’s housing department also showed issues in housing availability throughout the county (MDCH, 2011). 33.7 percent of residents reported that high housing costs were yet another cost barrier for themselves and their families. 32.7 percent of residents also expressed that housing issues were a major stressor in their life and were affecting their overall general health (MDCH, 2011).

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Northern Michigan Health Alliance

Figure 1. Percentage of Uninsured in Wexford County, MI. County, State, and National trends of Uninsured individuals. Data from: http://www.countyhealthrankings.org/app/michigan/2015/rankings/wexford/county/outcomes/overall/snapshHealth IndicatorsIn Wexford County, 85 percent of the population has access to some sort of exercise opportunity (RWJF, 2015). Despite this, 24 percent of the population is physically inactive and 33 percent are considered to be obese (RWJF, 2015). In addition to the above statistics, 15 percent of the population is food insecure (RWJF, 2015). Eighty percent of the population below 200 percent of the poverty level is food insecure (Feeding America, 2013). Even though the majority of the population of Wexford County has access to exercise opportunities the population maintains a high rate of obesity. Relieving food insecurity could help resolve many issues that the community is facing.

Figure 2. Wexford County adult obesity rates in comparision to the top United states performs as well as the state of Michigan. Data taken from: http://www.countyhealthrankings.org/app/michigan/2015/rankings/wexford/county/outcomes/overall/snapshot

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Northern Michigan Health Alliance

Wexford County Top US Performers Michigan0%

5%

10%

15%

20%

25%

30%

35% 33%

25%

32%Adult Obesity Rates

Diabetes is a significant health issue for residents in Wexford County. Within the population, 13.5 percent have diabetes compared to the national average of 8.1 percent (CDC, 2015). Since there is a proven relationship between obesity and diabetes, reducing the obesity rate will also reduce the rate of diabetes as well. This is an area of concern that needs to be addressed. Another area of concern is the mortality rate associated with Alzheimer’s disease. Over 37 people per 100,000 die from Alzheimer’s disease in Wexford County, compared to the national rate of 27.3 people per 100,000 (CDC, 2015). As stated earlier, obesity is an issue as well. Within Region 7, which includes Wexford County, heart disease and cancer are the leading causes of death in the area. Region 7 of the state also has a slightly higher age adjusted death rate for stroke, unintentional injury, Alzheimer’s disease, and suicide than the rest of the state. The 2020 Health Target for cancer mortality is 160.6 deaths per 100,000 (MDCH, 2011). In the United States during the year of 2010, heart disease cost the healthcare system over $503 billion dollars. This figure is also projected to increase because of the aging population. Diabetes is the 7th leading cause of death in the region 7 area and the 6th leading cause of death in the whole state of Michigan (MDCH, 2011). Overall the risk for death among people with diabetes is double than that of those who do not have diabetes.

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Northern Michigan Health Alliance

Figure 3. Percentage of adults in Wexford county licing with diagnosed diabetes. Data taken directly

from http://wwwn.cdc.gov/CommunityHealth/profile/currentprofile/MI/Wexford/125

When assessing quality of life in Wexford County, 19 percent report having poor or fair health, and 3.9 percent report having one or more poor physical or mental health days (RWJF, 2015). In Michigan, 14 percent of the population reported having poor or fair health, which is 5% less than those living in Wexford County (RWJF, 2015). Michigan’s entire population also has fewer poor physical and mental health days. Wexford County residents also have limited access to healthy foods (4 percent) (RWJF, 2015).

Wexford County has a moderately large amount of individuals that uninsured (13 percent) (RWJF, 2015). Despite this however, the county does have several primary care physicians, dentists, and mental health providers. The county also has been very successful in monitoring diabetics and in conducting mammograms.

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Northern Michigan Health Alliance

Wexford County Top US Performers Michigan84%

85%

86%

87%

88%

89%

90%

91%

Percentage of Diabetic Monitor-ing

Figure 4. Diabetic Monitoring in Wexford county in comparison to other top US performers and Michigan. Data from http://www.countyhealthrankings.org/app/michigan/2015/rankings/wexford/county/outcomes/overall/snapshot

Existing Health ResourcesWexford County has 1,017 people per primary care physician, 1,718 people per dentist, and 616 people per mental health provider (RWJF, 2015). The county lacks mental health providers compared to the top performers in the United States and the state of Michigan. As for dentists and primary care physicians, Wexford County is about par with U.S. top performers and the state of Michigan but all are still lacking primary care physicians. Nearly one in five americans lack proper medical care because of medical professional shortages being experienced all across the United States today (MDCH, 2011).

Figure 5. Number of primary care phsyicians per citizen in Wexford County. In comparision to

other Top US Performers and Michigan. Data from

http://www.countyhealthrankings.org/app/michigan/2015/rankings/wexford/county/outcomes/overall/snapshot

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Northern Michigan Health Alliance

Wexford County Top US Performers Michigan0

200

400

600

800

1000

1200

1400

PCPs per Citizen

GapsThrough rigorous analysis of countywide data and statistics, some gaps have been identified. When looking at teen pregnancy trends, teen births, and percentage of births to teens, in general the rates in Wexford County are higher than those in neighboring Missaukee County, and both counties are higher than the statewide rates. Teen pregnancies include births, miscarriages, and abortions (MDCH, 2011). Sex education curriculum in schools is also another area that needs improvement according to the Wexford County Health Needs Assessment. According to the Behavior Risk Factor Survey, those who report they have ever been told that have diabetes in Wexford County is 9.6 percent, which is slightly higher than Michigan’s percentage of 9.3 percent. In Missaukee County, the percentage is 19.3 (MDCH, 2011). The BRFSS correlates well with Missaukee County for diabetes as a cause of underlying death. The County Health Rankings also reported high rates of diabetes screening in all counties. Nutritional education for diabetic individuals could be seen as area of improvement by the Wexford County Health Needs Assessment.

Figure 6. Teen births per 1000 Femal Population in Wexford County compared to top US performers and the State of Michgian. Data from http://www.countyhealthrankings.org/app/michigan/2015/rankings/wexford/county/outcomes/overall/snapshot

Prioritization of NeedsAfter considering socioeconomic data, health indicators, health resources within the county, and gaps in those resources, the Northern Michigan Health Alliance has prioritized the following needs as the most important health issues throughout the county:

Obesity/Overweight Access to Primary Care Diabetes Alzheimer’s Disease (mortality)

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Northern Michigan Health Alliance

Wexford County Top US Performers Michigan05

101520253035404550

Number of Births per 1000 Females Aged 15-19

These needs are justified in the tables and graph throughout this report, and most importantly, the graph below.

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References

County Profile. (n.d.). Retrieved June 16, 2015, from http://wwwn.cdc.gov/CommunityHealth/profile/countyprofile/MI/Wexford/outcomes/overall/snapshot

Feeding America (2013) Retrieved June 16, 2015 http://www.feedingamerica.org/hunger-in-america/our-research/map-the-meal-gap/2013/MI_AllCounties_CDs_MMG_2013.pdf

Michigan Department of Community Health(MDCH), (2011). Health Profile Chart Book Region 7. State of Michigan. Retrieved from assets.thehcn.net/.../munsonhealthcare/Region_7_Chartbook___final.pdf

Robert Wood Johnson Foundation County Health Rankings (RWJF). (n.d.). Retrieved June 16, 2015, from http://www.countyhealthrankings.org/app/michigan/2015/rankings/wexford/county

U.S. Census (2014). Retrieved from http://quickfacts.census.gov/qfd/states/26/26165.html

Wexford County, MI. (n.d.). Retrieved June 16, 2015, from http://wwwn.cdc.gov/CommunityHealth/profile/currentprofile/MI/Wexford/

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