2004 BAKER COUNTY HEALTH NEEDS ASSESSMENT

Transcription

1 Taking the pulse of the community 2004 BAKER COUNTY HEALTH NEEDS ASSESSMENT Prepared by: Health Planning Council of Northeast Florida, Inc. 900 University Blvd North, Suite 110 Jacksonville, Florida 32211

2 TABLE OF CONTENTS LIST OF TABLES AND FIGURES... ii INTRODUCTION...1 BAKER COUNTY PROFILE...3 I. Introduction...3 II. Population Characteristics...3 III. Socio-Economic Profile...4 HEALTH STATUS...9 I. Mortality Indicators...9 II. Infectious Diseases...23 III. Maternal and Child Health...24 IV. Social and Mental Health...30 V. Behavioral Risk Factor Surveillance Survey...33 ACCESS TO CARE/HEALTH CARE RESOURCES...35 I. Introduction...35 II. Health Coverage...35 III. Primary Care...38 IV. Other Health Care Professionals...39 V. Health Care Facilities...40 VI. Licensed Health Care Services...45 COMMUNITY COMMENTS...47 I. Focus Groups...47 II. Key Informant Interviews...51 III. Community Surveys...52 KEY ISSUES AND RECOMMENDATIONS...63 I. Introduction...63 II. Action Plan...63 APPENDICES...65 Appendix A 2002 County Behavioral Risk Factor Surveillance Survey...65 Appendix B Focus Group Instrument...69 Appendix C-1 Survey Instrument...71 C-2 Other Survey Comments...75 i

3 LIST OF TABLES AND FIGURES TABLES Baker County Profile Table 1 Population Trends 2000, 2005, Table 2 Estimates of Population by Age Group, Table 3 Population by Race, Table 4 Per Capita and Median Household Income, Table 5 Estimates of Persons and Families in Poverty, Table 6 Families on Public Assistance, Table 7 Unemployment Rates, Table 8 High School Graduates, Table 9 Students Receiving Reduced Price or Free Lunch, Health Status Table 10 Population by Race, Table 11 Death Rates for Leading Causes of Death, Table 12 Reported AIDS and HIV Cases, Table 13 Sexually Transmitted Diseases, All Races, Table 14 Total Births and Birth Rates by Race, Table 15 Female Pop of Childbearing Women Age by Race, Table 16 Domestic Violence Offenses, Access to Care Table 17 Health Insurance Coverage, Table 18 Medicaid Enrollees, Table 19 KidCare Enrollment, Table 20 Medicare County Enrollment and Aged and Disabled Enrollment, Table 21 Acute Care Hospital Inventory of Services, Table 22 Adult Discharges, Baker County Residents, Table 23 Pediatric Discharges, Baker County Residents, Table 24 Free Standing Community Nursing Homes, FIGURES Baker County Profile Figure 1 Household Income Levels, Health Status Figure 2 Heart Disease Death Rates, All Races, , , Figure 3 Heart Disease Death Rates by Race, Figure 4 All Cancer Death Rates, All Races, , , Figure 5 All Cancer Death Rates by Race, Figure 6 Lung Cancer Death Rates, All Races, , , Figure 7 Lung Cancer Death Rates by Race, ii

4 Figure 8 Breast Cancer Death Rates, All Races, , , Figure 9 Breast Cancer Death Rates by Race, Figure 10 Stroke Disease Death Rates, All Races, , , Figure 11 Stroke Disease Death Rates by Race, Figure 12 C.O.P.D. Death Rates, All Races, , , Figure 13 C.O.P.D. Death Rates by Race, Figure 14 Unintentional Injuries, All Races, , , Figure 15 Unintentional Injuries by Race, Figure 16 MVA Death Rates, All Races, , , Figure 17 MVA Death Rates by Race, Figure 18 Diabetes Death Rates, All Races, , , Figure 19 Diabetes Death Rates by Race, Figure 20 Influenza & Pneumonia Disease Death Rates, All Races, , , Figure 21 Influenza & Pneumonia Disease Death Rates by Races, Figure 22 Alzheimer s Disease Death Rates, All Races, , , Figure 23 Alzheimer s Disease Death Rates by Race, Figure 24 Liver Disease Death Rates, All Races, , , Figure 25 Liver Disease Death Rates by Race, Figure 26 Gonorrhea, Chlamydia, & Infectious Syphilis Rates, All Races, , , Figure 27 Infant Mortality Rates, All Races, , , Figure 28 Infant Mortality Rates by Race, Figure 29 Low Birthweights, All Races, , , Figure 30 Low Birthweights by Race, Figure 31 Births to Mothers Under 18, All Races, , , Figure 32 Births to Mothers Aged by Race, Figure 33 Percent of Pregnancies Receiving First Trimester Prenatal Care, All Races, , , Figure 34 Percent of Pregnancies Receiving First Trimester Prenatal Care by Race, Figure 35 Births to Mothers Who Smoked During Pregnancy, All Races, Figure 36 Suicide Death Rates for All Races, , , Figure 37 Suicide Death Rates by Race, Figure 38 Homicide Death Rates for, Races, , , Figure 39 Homicide Death Rates by Race, Access to Care Figure 40 Hospital Utilization by Baker County Residents, Figure 41 Ed Fraser Memorial Hospital ER Visits, Figure 42 Ed Fraser Memorial Inpatient Hospital Admissions, Figure 43 Total Rescue/Ambulance Patient Admissions, Figure 44 Leading ACS Condition Discharges in Baker County, iii

5 INTRODUCTION HISTORY The Baker County Health Improvement Advisory Council (BCHIAC) and the Health Planning Council of Northeast Florida (HPCNEF) collaborated in 2000 on a community health needs assessment titled Working Towards Wellness for a Healthier Tomorrow. Demographics and socio-economic indicators of Baker County residents were collected and analyzed for the 2000 needs assessment in addition to mortality rates, maternal and child health indicators, infectious disease rates, and health care utilization indicators. Results of the Five County Study on Heart Disease from the Behavioral Risk Factor Surveillance System Survey (BRFSS) were also analyzed. In addition, four focus groups were conducted during the 2000 community needs assessment to better understand the health beliefs of Baker County residents. Based on the health information collected during the 2000 community needs assessment, the following recommendations were made by the Baker County Health Improvement Advisory Council: Continue to pursue further grants and donations. Provide ongoing evaluation of health promotion and disease activities. Continue to develop community partners. Implement community-wide programs. Continue to work with the media to emphasize the health risks of Baker County and to increase awareness of community health promotion activities. Pursue additional health care providers into the area to expand health care services. ACCOMPLISHMENTS SINCE 2000 A number of accomplishments have occurred since Working Towards Wellness for a Healthier Tomorrow was completed. In 2001, the Baker County Health Department moved into its new location at Lowder Street. The present location includes a 20,000 square foot facility that has a greater capacity to meet the diverse health, social, and educational needs of Baker County s growing community. Also in 2001, the YMCA of Baker County opened and has served as a strong partner in the community. The YMCA anticipates breaking ground on a new pool by early Since the 2000 needs assessment, numerous health grants have been awarded in Baker County. A federal grant was awarded to the Baker County Health Department to connect chronically ill residents to health care, mental health, and substance abuse services. Highlights of this program include the development of a drug assistance program to help low-income residents receive prescription drugs at little or no cost. Other grants awarded to the Baker County Health Department include an abstinence education and intervention program for teenagers and parents, as well a Cardiovascular 1

6 Intervention Program (CIP) grant to offer cardiovascular and diabetes intervention programs to Baker County residents. In addition, a Closing the Gap Grant was awarded from the Florida Department of Health to help prevent the onset of diabetes among Baker County residents. HEALTHY BAKER INITIATIVE In the Spring of 2004, the Baker County Health Improvement Advisory Council, the Baker County Health Department, and the Health Planning Council of Northeast Florida decided to conduct an update to the 2000 health needs assessment. Healthy Baker was selected as the title of the new project, a title familiar with other health improvement initiatives at national and local levels. Components of the Healthy Baker needs assessment included an analysis of demographics, health statistics, and access to care indicators for Baker County residents. In addition, community input was obtained from focus group interviews, key informant interviews, and a community-wide written survey. Detailed information summarizing each of these components is included in this report. Four community presentations were held at the Baker County Health Department from August December, 2004 to summarize information collected during the Healthy Baker needs assessment. Members of the community who attended these presentations were given the opportunity to make recommendations of key health issues based on the information obtained from the comprehensive needs assessment. A summary of the community s key issues and recommendations is included in the final section of this report. 2

7 BAKER COUNTY PROFILE I. INTRODUCTION The characteristics of a community, including the age, gender, ethnic background, and economic characteristics, influence the community s health care needs and the design of delivery of services to meet those needs. This section provides an overview of the demographics and socioeconomic characteristics of Baker County in comparison to the state. Resting on the Florida-Georgia border, Baker County covers an area of 585 square miles. In 1861, Baker County became the 39 th county in Florida. The county was named for Honorable James McNait Baker, former Judge of the Fourth Judicial District of the State of Florida. The first county seat was located in Sanderson until February 1, 1886 when it was moved to Macclenny, which remains the current county seat. There are two incorporated municipalities in the county, Macclenny (5,000 population) and Glen St. Mary (500 population). Both have a mayor-council form of government. A five-member Board of County Commissioners governs the unincorporated areas. II. POPULATION CHARACTERISTICS According to the 2000 U.S. Census, Baker County s population was 22,259. Table 1 shows the population trend and the amount of population change between It is projected that Baker County will experience a 14.4% population growth during this ten year period, while Florida is projected to increase by 18%. Table 1 Population Trends 2000, 2005, 2010 Population Census Projection Projection Population Change % Population Area Change Baker 22,259 23,837 25,465 32, % Florida 15,982,378 17,436,441 18,866,703 2,884, % Source: Florida s Population Studies Bulletin #133 Population Projections by Age, Sex, and Race, Bureau of Economic and Business Research, UF, 2002 Age Baker County is comprised of a younger population, with respect to many other counties in the state. The highest percentage of residents in Baker County are in the age group, accounting for 30% of the county s population. The lowest percentage of residents were age 65 and older, making up only 10% of the county s population. Table 2 summarizes the age groups of Baker County residents with comparison to Florida. 3

8 Table 2 Estimates of Population by Age Group, 2003 Baker Florida Age Group Number Percentage Number Percentage ,901 21% 3,092,578 18% ,670 16% 2,216,802 13% ,153 30% 4,577,387 27% ,433 23% 4,262,479 25% 65+ 2,300 10% 3,075,699 18% Total 23, % 17,224, % Source: July 1 Population Estimates from Office of Governor, 2004 Race and Ethnicity Table 3 shows the racial composition of Baker County with comparison to Florida. Only 15% of the population in Baker County is non-white, which is just below Florida s total non-white population of 18%. The Other race category includes American Indians, Asians, and Hawaiian/Pacific Islanders. Table 3 Population by Race, 2003 Baker Florida Race Population Percentage Population Percentage White 19, % 14,012, % Black 3, % 2,690, % Other % 417, % Total 23, % 17,120, % Source: Population Estimates from the Executive Office of the Governor, 2004 III. SOCIO-ECONOMIC PROFILE Income Baker County had a per capita income of $15,631 in 2001, which fell below the state s per capita income of $20,199 (Table 4). At $35,692, Baker County also had a lower median household income than the state s average of $37,307. Table 4 Per Capita and Median Household Income, 2001 Baker Per Capita Median Household Per Capita Florida Median Household Income Income Income Income $15,631 $35,692 $20,199 $37,307 Source: ESRI Marketing Systems,

9 With regard to household income levels, nearly 36% of Baker County households had incomes in the $25,000 - $ 49,000 category and just over a quarter of the county had household incomes between $50,000 - $99,000 (Figure 1). Figure 1 Household Income Levels, 2001 Percent < $15K $15K -$24K $25K-$49K $50K-$99K $100K-$149K $150K Baker Florida Source: ESRI Marketing Systems, 2002 Poverty In 2003, the number of people in the United States below the official poverty threshold was 35.9 million in 2003, with a poverty rate of 12.5%. This figure was 1.3 million more than in As shown in Table 5, the estimated percentage of persons living in poverty in Baker County was 14.7%, compared to 12.5% in Florida. Table 5 Estimates of Persons and Families in Poverty, 2000 All Persons Children 0-17 Families Total County Population Number Percent Percent Percent Baker 20,168 2, Florida 15,605,367 1,952, Note: The 2000 US Census Poverty status refers to the 1999 poverty income level. Source: 2000 US Census Bureau Public Assistance National welfare reform and the initiation of Florida's WAGES program in 1996 dramatically reduced the number of families enrolled in the State Public Assistance Program. Table 6 summarizes the number of clients and families receiving public assistance from Baker County had an increase of nearly 30% in the number of clients receiving public assistance, whereas the state experienced a decrease of 31%. 5

10 The Florida Department of Children and Families speculated that a majority of former assistance recipients have moved into minimum wage jobs that offer few, if any, employment benefits. Because Medicaid coverage is phased out within a year of employment, many are eventually left without health insurance. Table 6 Families on Public Assistance Persons Receiving Cash Assistance % Area Familie s Clients Familie s Clients Familie s Clients Familie s Clients Familie s Clients Chang e Baker % Florid a 75, , , , , , , , , , % Note: June TANF enrollment figures provided Source: Economic Self-Sufficiency Services, Florida Department of Children and Families, Labor Force, Employment, and Industry The Baker County Chamber of Commerce estimated the workforce in Baker County at 9,147 employed workers. Over half of the workforce in Baker County commute outside of the county but many of them would prefer to work in the county. The Baker Chamber of Commerce reported the average annual salary at $22,035. According to the Florida Department of Labor and Employment Statistics in 2003, there was an average of 10,284 persons employed monthly in all industries in Baker County. The largest percentage of Baker County s workforce are employed in retail trade, health care and social assistance positions, however, agriculture has always played a predominant role in the history of Baker County. Forestry is the backbone of the agricultural community, followed closely by the ornamental horticulture industry. Baker County has two main industrial parks. Enterprise East, located east of Macclenny, offers water and water treatment facilities. Wal-Mart s Food Distribution Center, employing approximately 600 employees, is also located in Enterprise East. Enterprise West, located in Sanderson, offers rail from CSX Transportation. Wiremil, Inc., a manufacturer of pre-stressed steel cable for road and bridge construction and Sanderson Pipe Corporation, a PVC pipe manufacturer are located in Enterprise West. Unemployment Between , Baker County s unemployment rate showed an increase of 33.3% (Table 7). Florida experienced an increase of 30.8% in the unemployment rate during this same time period due to the downturn in the economy in the last three years. 6

11 Table 7 Unemployment Rates, Unemployment % Area % Change Baker % Florida % Source: Florida Agency for Workforce Innovation, Labor Market Statistics, Local Area Unemployment Statistics Program, 2004 Education There are three elementary schools (K-5), one middle school (6-8) and one high school (9-12) with a total enrollment of 4,741 students. The high school graduation rate in Baker County for was 67.3% (Table 8). Table 8 High School Graduates, Number ^Graduation enrolled in Area 12 th Rate grade Drop Out Rate *Percent Planning to Enter College * Percent Planning to Enter Technical School Baker % 3.7% 60.0% 3.2% Florida 134, % 3.1% 63.3% 4.5% ^Graduation rate is defined as % of students who graduate from high school within 4 years after entering 9 th grade for the first time. *Figures may not reflect complete data Source: Bureau of Education information and Accountability Services. Florida Dept of Education, Florida School Indicator Report; Profiles of School Districts, Table 9 summarizes the number of students receiving free or reduced lunch. The percentage of students receiving free or reduced lunches in Baker County was less than the state. Table 9 Students Receiving Reduced Price or Free Lunch, 2003 Number of Students by Racial/Ethnic Category, Fall 2003 White, Non- Hispanic Black, Non- Hispanic Asian Pacific Islander Other* Total Total Students in Public Schools Students Enrolled in Free or Reduced Lunch^ Area Hispanic Baker 1, ,831 4, % Florida 338, , ,217 16,885 30,564 1,163,553 2,476, % *Other includes American Indian/Alaskan Native and Multiple Races. ^ Total percentage of students in enrolled in public schools receiving free or reduced lunches. Students whose family incomes are < 130% of the federal poverty guidelines are eligible for free lunch and students whose family incomes are between % are eligible for the reduced price lunch program. Source: Florida Dept of Education, Student Database, Survey 2 data, October 13-17,

12 HEALTH STATUS I. MORTALITY INDICATORS Mortality rates can be key indicators of the state of health of a community. This section will compare mortality rates for Baker County with state mortality rates, as well as small surrounding counties that share Baker County s borders, including Bradford, Clay, Nassau, and Union Counties. Mortality rates for the leading causes of death provided in this section include heart disease, stroke, pneumonia and influenza, diabetes, liver disease, chronic obstructive pulmonary disease (C.O.P.D.), cancer, Alzheimer s disease, suicide, unintentional injuries, and motor vehicle accidents. Table 10 summarizes the population of Baker County with its smaller surrounding counties. Baker County s percentage of its white and non-white population were very close to the state. Clay and Nassau Counties have a lower percentage of black residents than Baker County, while Bradford and Union Counties exceeded Baker s minority population. Table 10 Population by Race, 2003 Area Race Population Race as % of Population Baker Total 23, % White 19, % Black 3, % Other % Bradford Total 27, % White 21, % Black 5, % Other % Clay Total 156, % White 140, % Black 11, % Other 4, % Nassau Total 63, % White 58, % Black 4, % Other % Union Total 13, % White 10, % Black 3, % Other % Florida Total 17,134, % White 14,012, % Black 2,690, % Other 432, % Source: July 1 Population Estimates from the Office of the Governor, 2004 A significant number of Baker County deaths are premature and preventable. Behavior modification and risk reduction can reduce the mortality rates of many of the leading causes of death, especially those attributed to heart disease, lung cancer, and motor vehicle accidents. Individuals may improve both the length and quality of their lives by simply following a healthy 9

13 lifestyle and receiving regular medical care. Table11 summarizes the age-adjusted death rates for several of the leading causes of deaths for all races. Baker County rates doubled the state s death rates for stroke, pneumonia/influenza, diabetes, and COPD. Baker County rates were also higher than other counties in the area with the exception of Union County. Table 11 Death Rates for Leading Causes of Death, Age-Adjusted Death Rates Per 100,00 Population Heart Cancer Stroke COPD Diabetes Pneumonia/ Area Disease Influenza Liver Disease Baker Bradford Clay Nassau Union Florida Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Heart Disease Heart disease remains the nation s leading cause of death. Many scientific studies show that certain characteristics, or risk factors, increase the likelihood of heart disease. The major modifiable risk factors of the disease are high blood pressure, high blood cholesterol, cigarette smoking, obesity, and physical inactivity. Advancing age, gender, and genetic predisposition to heart disease are risk factors that cannot be changed. Figure 2 Heart Disease Death Rates for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Figure 2 shows age adjusted heart disease death rates for the period of time between Three-year averages were used for the comparison due to the small number of deaths per year for 10

14 the county. Baker County has shown a decline in heart disease deaths over this time period, however still remains significantly higher than Florida s rates. Figure 3 summarizes age-adjusted death rates for heart disease by race for the three-year period of time from Baker County s heart disease death rates in the non-white population fell below death rates in the white population, unlike the state s rates, where non-white deaths exceeded white deaths for heart disease. Figure 3 Heart Disease Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Cancer Cancer is a large group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the growth is left uncontrolled, it can result in death. Cancer ranks second only to heart disease as the leading cause of death in the United States. Many types of cancer exist but only a handful together account for more than half of all cancerrelated illness and deaths. In Florida, it is estimated that one out of every four deaths is from cancer. Cancers of the lung and breast are responsible for the majority of cancer deaths in Northeast Florida and the nation. Cancer develops gradually as a result of a complex mix of factors related to environment, lifestyle, and heredity. Scientists have identified many risk factors that increase the chance of getting cancer. Nearly two-thirds of cancer deaths can be linked these modifiable risk factors including poor diet, obesity, and lack of physical activity. In addition, many skin cancers could be prevented by use of sunscreens and other protective measures. 11

15 A slight decrease in deaths attributable to cancer occurred in Baker County, as shown in Figure 4. The cancer death rate across the different racial groups in Baker County are similar, with the white population s age-adjusted death rate at deaths per 100,000 and the non-white population s age-adjusted death rate at deaths per 100,000 (Figure 5). Figure 4 All Cancer Death Rates for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Figure 5 All Cancer Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis,

16 Figure 6 summarizes age-adjusted lung cancer death rates from Baker County exceeded Florida s death rate during this time period, however began to show a decrease from Figure 6 Lung Cancer Death Rates for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Figure 7 shows age-adjusted death rates from lung cancer by race. Lung disease appears to disproportionately affect the white population in Baker County, with death rates over twice as high than the nonwhite population. Figure 7 Lung Cancer Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis,

17 Breast cancer death rates showed little change in Baker County from (Figure 8). Baker County s death rates for breast cancer exceed death rates in its surrounding counties as well as the state as a whole. Fewer nonwhite deaths occurred in Baker County than white deaths, as shown in Figure 9. Figure 8 Breast Cancer Death Rates for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Figure 9 Breast Cancer Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Stroke Stroke is a cardiovascular disease that affects the blood vessels supplying blood to the brain. For people over the age of 55 years, the incidence of stroke more than doubles in each successive decade. High blood pressure and cigarette smoking are the leading modifiable risk factors for stroke. Stroke is the third leading cause of death in the United States. 14

18 As shown in Figure 10, Baker County s rate of deaths from strokes has decreased during the time period from , however, still remains double that of Florida s death rate. Figure 10 Stroke Disease Death Rates for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Figure 11 depicts stroke death rates by race from Baker County had a much higher rate of deaths in the nonwhite population (106.3 per 100,000) than the white population (65.1 per 100,000). Figure 11 Stroke Deaths Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis,

19 Chronic Obstructive Pulmonary Disease Millions of Americans suffer from Chronic Obstructive Pulmonary Disease (COPD), making it the fourth leading cause of death in the United States. COPD is characterized by permanent airflow obstruction in the lungs. Chronic bronchitis, emphysema, and asthma fall within this category of disease. With the exception of asthma, COPD is linked primarily to cigarette smoking and is preventable in many cases. Other known causes of COPD are frequent lung infections and exposure to certain industrial pollutants. There has been little change in the COPD age-adjusted death rates in Baker County from Baker County had double the rate of COPD deaths with comparison to the state (Figure 12). Figure 12 C.O.P.D. Death Rates for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: C.O.P.D. includes asthma. Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Figure 13 C.O.P.D. Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: C.O.P.D. includes asthma. Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis,

20 C.O.P.D. appears to disproportionately affect the white population in Baker County, with death rates approximately three times as high than the non-white population (Figure 13). This may be attributable to the higher smoking rates among the white population. Unintentional Injuries Unintentional injuries are the fifth leading cause of death in the United States. These injuries include motor vehicle crashes, drowning, fires, falls, and other home and recreation injuries. Unintentional injuries have shown an increase in Baker County from (Figure 14). Figure 14 Unintentional Injuries for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Figure 15 Unintentional Injuries by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis,

21 The white population in Baker County had double the number of deaths from unintentional injuries (60.2 deaths per 100,000) in comparison to the non-white population (30.2 deaths per 100,000) as shown in Figure 15. Motor Vehicle Accidents Half of all unintentional injury deaths are due to motor vehicle crashes and motor vehicle accidents (MVA) are the leading cause of injury death in Florida. Age-adjusted death rates of MVA in Baker County steadily increased from (Figure 16). The majority of deaths from Baker County were in the white population (43.6 per 100,000), with very few deaths in the non-white population (7.3 per 100,000) as shown in Figure 17. Figure 16 Motor Vehicle Accident Death Rates for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation, and Data Analysis, 2004 Figure 17 Motor Vehicle Accident Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation, and Data Analysis,

22 Diabetes Diabetes is a chronic metabolic disease that affects millions of Americans and is the sixth leading cause of death in the United States. While heredity is a major determinant of the disease, lifestyle factors such as obesity can also cause diabetes. Baker County s death rate from diabetes is approximately twice as high as Florida s death rate (Figure 18). Diabetes appears to affect a proportionate number of whites and non-whites, with little difference among death rates by race in Baker County (Figure 19). Figure 18 Diabetes Disease Death Rates for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis Figure 19 Diabetes Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted, Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis,

23 Influenza/Pneumonia Influenza and pneumonia deaths together constitute the seventh leading cause of death in the United States. Influenza causes an average of 114,000 hospitalizations and 36,000 deaths annually and pneumococcal disease causes an average of 175,000 hospitalizations and 6,000 deaths annually. The combined use of effective vaccines and early medical treatment hold down the death rates associated with these highly communicable diseases. Figure 20 illustrates age-adjusted death rates from influenza and pneumonia for all races from Baker County was over twice as high as the state s rate during this period of time. Figure 20 Influenza and Pneumonia Disease Death Rates for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis Figure 21 Influenza and Pneumonia Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis,

24 As shown in Figure 21, influenza and pneumonia death rates were twice as high in the white population in Baker County than in the non-white population. Alzheimer s Disease An estimated 4.5 million Americans have Alzheimer s disease. This number has more than doubled since Alzheimer s disease is the nation s eighth leading cause of death. The death rates for this disease remained relatively stable in Baker County from (Figure 22). There were no deaths from Alzheimer s disease reported in the non-white population in Baker County from (Figure 23). Baker County s neighboring counties also showed very low death rates for the non-white population as well. Figure 22 Alzheimer s Disease Death Rates, for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Figure 23 Alzheimer s Disease Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis,

25 Liver Disease Among the numerous diseases that affect the liver, cirrhosis accounts for most of the cases of liver disease and death associated with liver failure. Cirrhosis is largely attributed to heavy alcohol consumption and to a great extent, is preventable. As shown in Figure 24, death rates from liver disease has shown a steady increase in Baker County from Liver disease appears to disproportionately affect the white population in Baker County, with 26.4 white deaths per 100,000 compared to 8.5 non-white deaths per 100,000 population (Figure 25). Figure 24 Liver Disease Death Rates for All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004 Figure 25 Liver Disease Death Rates by Race, Rate per 100,000 population Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average, Age Adjusted Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis,

26 II. INFECTIOUS DISEASES Infectious diseases are effectively controlled in the United States through prevention (immunizations) and treatment (antibiotics). However, certain diseases, such as HIV/AIDS, sexually transmitted diseases, tuberculosis, and enteric diseases, resist our best efforts and continue to pose major health and welfare problems for Americans. HIV/AIDS HIV/AIDS is the nation's leading cause of death due to infectious disease and represents the eleventh leading cause of death among Floridians. The HIV virus that causes AIDS is primarily spread through unprotected sexual activity and the sharing of intravenous needles, high-risk behaviors that can expose individuals to the virus-laden body fluids of infected persons. Recent improvements in medical treatment, especially the introduction of protease inhibitors, have dramatically slowed the development of full-blown AIDS among HIV-infected persons. Baker County had a lower average rate of HIV and AIDS cases from than Florida (Table 12). The number of HIV and AIDS cases by race is not available in counties where the total number of cases are less than three, due to confidentiality issues. Table 12 Reported AIDS and HIV Cases, HIV Cases AIDS Cases Area Average # Rate per Average # Rate per of Cases 100,000 of Cases 100,000 Baker Bradford Clay Nassau Union Florida 6, , Note: Three-Year average Source: Florida Department of Health, Bureau of HIV/AIDS, 2004 Sexually Transmitted Diseases Gonorrhea, chlamydia, syphilis, herpes, and genital warts are the most common sexually transmitted diseases in the United States. The composition of the resident population and the vigilance of testing and reporting of STDs by local health care providers affect the number of reported cases of STDs and the calculated rate of their occurrence. Despite their common occurrence, the reporting of herpes and genital warts cases is not legally required due to the difficulty and expense of their diagnosis. There is no known cure for either herpes or genital warts. 23

27 The STD rate in Baker County peaked from the period between , but then showed a decrease from (Figure 26). There were no cases of syphilis reported in Baker County from Figure 26 Total Gonorrhea, Chlamydia, & Infectious Syphilis Rates, All Races, , , Rate per 100,000 population Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages Source: Florida Department of Health, Office of Planning, Evaluation, and Data Analysis, 2004 Table 13 Sexually Transmitted Diseases, All Races, Gonorrhea Chlamydia Syphilis Area Ave # of Rate per Ave # of Rate per Ave # of Rate per Cases 100,000 Cases 100,000 Cases 100,000 Baker Bradford Clay Nassau Union Florida 20, , Note: Three-Year average Source: Florida Department of Health, Office of Planning, Evaluation, and Data Analysis, 2004 Baker County had a lower gonorrhea rate than the state, however, had a much higher rate of chlamydia than the state, with cases per 100,000 compared to the state s rate at per 100,000 (Table 13). III. MATERNAL AND CHILD HEALTH Birth Rate Population growth in a community is a combination of natural increase (more births than deaths) and migration (more people moving into the area than leaving). The birth rate for Baker County was 15.4 births per 1,000 for all races, higher than the state s rate of 12.5 births per 1,000 (Table 14). 24

28 The rate of non-white births for Baker County was 13.9 births per 1,000 population, which fell below the state s non-white birth rate of 18.2 births per 1,000 population. Table 14 Total Births and Birth Rates by Race, All Races White Nonwhite Area Number Rate Number Rate Number Rate Baker Bradford Clay 1, , Nassau Union Florida 205, , , Note: Rate per 1,000 total population Source: Florida Department of Health, Office of Planning, Evaluation, and Data Analysis, 2004 Female Population of Childbearing Age by Race The percentage of women of childbearing age (15-44years) in Baker County represented approximately 20% of the total population (Table 15). The majority of women of childbearing age in Baker County were white (86.7%), exceeding Florida s percentage of 77.8%. Table 15 Female Population of Childbearing Women Age by Race, Area Total Childbearing Population White Black Other Number Percentage Number Percentage Number Percentage Number Percentage Baker 4, , Bradford 4, , Clay 31, , , , Nassau 11, , Union 2, , Florida 3,264, ,540, , , Note: Three-Year Average Source: Florida Department of Health, Office of Planning, Evaluation and Data Analysis, 2004 Infant Mortality Infant mortality includes the deaths of babies from birth to 364 days. The leading causes of infant deaths in Florida were perinatal conditions, congenital anomalies, low birth weight, and sudden infant death syndrome. Although the majority of infant deaths are due to prenatal genetic and environmental conditions, early prenatal and sustained postnatal care through the first year can considerably improve infant survival rates. Infant mortality rates from are provided in Figure 27. Baker County experienced a sharp decline in infant deaths after Infant mortality rates in Baker County in were 5.7 deaths per 1,000 births, which fell below the state s rate of 7.3 deaths per 1,000 births. 25

29 Figure 27 Infant Mortality Rates for All Races, , , Rate per 1,000 live births Baker Bradford Clay Nassau Union Florida Note: Three-Year Averages of death rates per 1,000 live births Source: Florida Department of Health, Office of Planning, Evaluation, and Data Analysis, 2004 As shown in Figure 28, Baker County had a higher non-white infant mortality rate (6.9 deaths per 1,000 births), with comparison to the white population (5.5 deaths per 1,000 births). Figure 28 Infant Mortality Rates by Race, Rate per 1,000 live births Baker Bradford Clay Nassau Union Florida All Races White Non-White Note: Three-Year Average of deaths and death rates per 1,000 live births Source: Florida Department of Health, Office of Planning, Evaluation, and Data Analysis, 2004 Low Birth Weight Babies born less than five and a half pounds, or 2500 grams, in weight are termed "low birth weight" births. The highest rates of these births occur to teen and minority mothers. These vulnerable babies have an increased risk of morbidity and mortality and consume a disproportionate share of health care resources during the first year of life and early childhood years. 26

30 Baker County s low birth rate showed an increase from (Figure 29). Baker s low birthweight rate was lower than the state s rate. However, the low birthweight rate of non-white mothers in Baker County was over twice as high as white mothers (Figure 30). Figure 29 Low Birthweights for All Races, , , Rate per 1,000 live births Baker Bradford Clay Nassau Union Florida Note: Birthweight less than 2500 grams Source: Florida Department of Health, Office of Planning, Evaluation, and Data Analysis, 2004 Figure 30 Low Birthweights by Race, Rate per 1,000 live births Baker Bradford Clay Nassau Union Florida All Races White Non-White Source: Florida Department of Health, Office of Planning, Evaluation, and Data Analysis, 2004 Note: Birthweight less than 2500 grams Adolescent Births Babies born to young mothers (women under the age of 18) are more likely to experience poor birth outcomes than those born to older mothers. Birth outcomes are also closely tied to the education, economic outlook, and family relationships of the mother. A cyclical pattern of young, single parenthood, poverty, and low levels of educational achievement too often results in generation after generation of what is termed "babies having babies." 27