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Community Health Data Analysis for St. Clair CountyJune 2006A. Review of Health Status IndicatorsDemographic/Education/Socioeconomic IndicatorsAge Analysis:Age distribution, according to year 2000 demographics, for the under 5 to 44 year olds percentage rates for our county are lower than State. Our county rates for 45 year olds and older is higher than the State rates. St. Clair County has a population of 9,652. According to the “MCDC Demographic Profile 3 Trend Report 1990 – 2000 for St. Clair County, MO 29185”:
According to the “Cultural Diversity by Sex – 2000 Census Percentages for St. Clair County”:
Our citizens in St. Clair County are lower in percentage than State in these categories.
Our citizens are higher in percentage than State in this category. Race/Ethnicity Analysis:The majority of the county’s race is made up of 96% (9,268 of 9652) white non-Hispanic with a 4% (384 of 9652) minority population of people. No disparity in health status or barriers to accessing health care or preventative services have been experienced by race, ethnicity, immigrant, or refugee population groups. American Indian/Alaska Native population has increased in St. Clair County by 34 people in 1990 to 83 people in 2000. Hispanic population has increased in St. Clair County from 58 people in 1990 to 149 people in 2000. The overall percentage of the population that is represented by special population groups has increased:
Other Demographic Features:Low educational levels, family size and structure, and illiteracy contribute to increased health risks for some members of the community. Our county has shown improvement in education levels, thus decreasing illiteracy. Education levels have improved in St. Clair County for 25 year olds without a diploma:
Those with High School or GED went from:
More persons have also attending college:
The percentage of annual dropout of total enrollment from the schools in St. Clair County compared to the State are as follows:
All three county schools have a higher percent of increase in MSIP reading scores than State at the 3rd grade level, but a higher percent of lower MSIP reading scores in the 7th grade level for 2004.
MSIP Reading scores 2005
Graduation Rates:
Single mother households have increased in St. Clair County:
Single parent family households have increased in St. Clair County:
Divorced population has increased in St. Clair County:
The family structure is changing in our county, which will cause increased health risks. With single parent households it is harder to provide money, time, and attention. For example, a person getting ill in a single parent household may have more time to wait to get to a doctor due to the parent not being able to get off from work for fear of loosing their job. Economic Indicators:St. Clair County has a median household income of $25,321 in 1999 compared to $22,525 in 1990, but the State rate $37,934. We have 680 households bringing in less than $10,000 a year and 843 households bringing in $15,000 - $24,999 a year. Our average annual wage/salary has gone from $13,356 in 1997 to $15,420 in 2000. Our average wage/salary of $15,420 for 2000 compares to State at $32,525. We had 258 unemployed people out of 7,687 over the age of 16 in our county in 2000. No new jobs have become available, but our unemployment rate has gone from 7.3% in 1990 to 6.3% in 2000. Our workforce by industry is lead by other industries 1,950 people out of 3,860 (50.5%). Our health care and social assistance ranks at 16.6% with 642 people out of 3,860. Our workforce by occupation is management, professional and related occupations 1,027 persons 26.6% rate. Although we haven’t added new industry to our county, our economy has remained about the same for 2000 as it was for 1990. Our farming, fishing, and forestry workforce occupations are down significantly from 1990 with 480 employed persons at 15.1% dropping to 66 employed persons at 1.7% in. Missouri Work Flow Data shows the flow from St. Clair County to other counties as 1,663 workers. Remaining in St. Clair are 2,015 workers. The work flowing into St. Clair County from other counties is 494 workers. The rate of children in poverty in our County has gone down from 29.8% in 1990 to 25.3% in 2000, but we are higher in percentage rate than the State (15.3%). Transfer payments according to the Missouri State Census Data for unemployment insurance benefit payments and State employment insurance compensation is down. Government payments to individuals (retirement & disability insurance benefit, old age & retirement disability, and medical) and income maintenance benefit payments (Supplemental Security Income, family assistance, food stamps, and other income maintenance) are up. Free/reduced lunch program participation has increased at all three of our county schools:
Environmental Health Risk IndicatorsAnalysis of indicators related to housing:The percentage of housing units in our county built before 1950 is 28.8% with 21.3% built before 1940. The average age of units is now 47.0. 579 units are less than 5 years old. 72 units lack complete plumbing facilities. 234 lack telephone service. 278 lack vehicle availability. Average household size is 2.34. 1,901 have moved in the last 5 years. Out of the 5,205 housing units in 2000, 100% are rural. 4,040 are occupied, 3,210 are owned, 830 are rented, and 1,165 units are vacant. Single family units 3,529, 2-4 units 204, 5-19 units 39, 20+ units 14, 1,371 mobile homes. No lead abatement or renovation projects have been undertaken in St. Clair County. Children with elevated blood lead levels in 1998 were 9.3 and in 2002 they were 4.9 compared to State levels of 12.3 in 1998 and 5 in 2002. According to MCDC Demographic Profile 3 Trend Report 1990-2000 the population for children under 5 years old for 2000 was 514. In 2004 lead levels were preformed on 206 children with 4 children in our county that were found to have elevated blood levels. These children with elevated blood lead levels are not living close to lead smelter/lead mine/ historic lead smelter. Analysis of indicators related to water supply:Most of our county water systems use ground water as their primary water source and 2 sites are using purchased surface water. We did have a report in November 2004 of e-coli. in the water at Lowry City – boil order was not issued. The water had been treated with chlorine. Public water supplies are not naturally fluoridated and fluoride is not added to the water supply. The last reports in Appleton City showing any Coliform was in September 2005, and in Osceola and Collins nothing since 2001. In 2003, EPA began cleaning up a hazardous waste site close to Osceola. Over 8,000 gallons of hazardous waste has been removed. Work has been completed. The site was not directly in contact with any bodies of water or public drinking water supplies. Many of the older rural homes in the area have failing septic systems. These generate valid complaints each year, which are dealt with before conditions result, which affect the health of members of the public. With Highway 13 and 52 we have hazardous materials carried on trucks daily. No spills have occurred as of this date. We also have agricultural operations that use materials that may contribute to environmental health risks. Public Safety/Domestic ViolenceAnalysis of indicators of public safety:Crime rates for homicide for St. Clair County for 1/1/04 to 12/8/04 were 1; assault were 5 2nd degree hand, 3 - 2nd degree other, 1 - 2nd degree vehicle, 6 – 3rd degree injury, 37 – 3rd degree assaults, 1 – law enforcement assault; juvenile crime were 1 missing, 8 runaway, and 2 child abuse, otherwise the report isn’t broken down into juvenile information; and violent crimes in our county were 1 attempted rape, 2 sexual assault, 1 stat. Rape, 9 unlawful use of weapon. Problem with illegal drug use or alcohol abuse: 33 possession illegal narcotics/drugs; 13 DWI for our county from 1/1/04 to 12/8/04. According to the sheriff’s department these are all increases from last year. Analysis of indicators related to abuse or neglect of vulnerable populations:Indicators of maltreatment and neglect of elderly in 2003 there were 29 cases reported, and in 2004 there were 20 cases reported to the hotline on St. Clair County residents. Indicators of maltreatment and neglect of children in 1998 was 37.4 in County compared to 22.4 in State (per 1000). In 2002 the rates were 50.8 in county compared to 44.3 in State (per 1000). DFS reported 14 reports on 27 children in October 2004, which is double what was reported last year. St. Clair County alternate care last November was 26. Currently only 3 foster families are registered in the County. More foster care is needed. Domestic violence reports 2 women in 1997-1999 in St. Clair County area. Unintended InjuryAnalysis of indicators related to injury:The major types of injuries in St. Clair County are unintended injuries due to motor vehicle accidents, traffic related, and falls – in/out-patient. The age and population groups mainly involved for traffic are the under 15 year olds (31 reported 1997 – 1999) and the 25-44 age groups (21 reported) of males. For falls the highest incidents are 65 and older females (206 in 1997-1999.) The rate of injury related hospitalization has increased from 712 in 1994-2000 to 931.3 in 1996-2002. Analysis of indicators related to traffic safety:The circumstances related to traffic safety use of seat belts and child safety seats unable to find statistical matter, but with 15 and under not driving and having a rate of 31 reported injuries in 1997-1999, this may be high due to not wearing seatbelts or not using child safety seats. Drug and alcohol use has 13 incidents in the county this year. The age group most likely to be involved in traffic accidents in St. Clair County is 25-44 years of age. Analysis of injuries at work:The incident of injury at work has decreased from 4 in 1994-2000 to 3.6 in 1996-2002. Maternal and Child Health IndicatorsAnalysis of maternal and child health indicators:Our county in 2002 had about the same prenatal care beginning in the first trimester as State (County 82.9% to State 87.8%). The birth to teen's rate for 2002 is slightly higher in the county than State (County 4.6 to State 4.1). Birth spacing (less than 18 months spacing) indicators show our county higher than State in 2002 (County 8.5 to State 6.1). Mothers smoking during pregnancy had a higher count in our county compared to State (County 33.3 and State 18.1). Births to women with less than a 12th grade education in 2002 in our county were elevated over State (county 23.6 to State 19.2). Our county infant mortality was lower than State for 1993-2002 (County 5.4 to State 7.7). Trend lines show that problems are increasing. Poor birth outcomes can be linked to poverty or low education levels, but could also be linked to prenatal care (delivery is out of county and only one nurse midwife in the county for prenatal care, doctors are all out of county). No race or special populations are experiencing higher rates of infant mortality, low birth weight, or poor birth outcomes. Analyze indicators related to prenatal risks:Smoking during pregnancy is a high-risk 1st priority in our county (county rate is 33.3% compared to 18.1% for State). Improper weight gain of less than 15 pounds to term is a high-risk for our county ranking 2nd (County 11% and State 8.1%). Teen pregnancy rated a 3rd quintile with the county having a rate of 27.8% to State at 33.7%. Birth spacing rated 1st in quintile with our county having a rate of 14.9% to State at 10.8%. Late or no prenatal care ranked 2nd with county rate at 17.1% and State at 11.3%. Again these are not related to special populations. Analyze indicators of child well being:As of May 31, 2006 children age 2 that have completed their immunizations were at 51.37% which is up from year 2004, but still down from year 2000. As of October 7, 2004 children age 2 that had completed their immunizations were only 42.86% in our county. This was down from 2000 when we had only 65.7% immunized by the age of 2. If the child comes to the health department for immunizations they are also receiving the routine physical through our rural health clinic. The problem is that they aren’t coming in for the immunizations and therefore aren’t receiving the physical. Unintended injury and death rates among children in the community are showing unstable rate that cannot be rated with State at 7.2%. No leading causes are available and cannot be measured. Prevalence of Infectious DiseaseAnalysis of communicable disease rates:Race and special populations are not a factor. There was an outbreak or extraordinary incidence of Shigellosis in 2006. Analysis of vaccine preventable disease:No vaccine preventable disease cases were reported in 2004. There were 2 reports of Influenza A in 2005 and so far have been 8 reports for 2006. There were 9 reports from schools of Chickenpox in 2005 and so far this year (by May) we have had 12 reported 2006. No influenza deaths have been reported from January 2005 to May 2006. County childhood completed immunization rates for vaccine preventable disease for 2 year olds was 49.07% as of December14, 2004 and is now at 51.30% as of May 31, 2006. Prevalence of Chronic Disease Risk FactorsSt. Clair County’s rate for adult tobacco use is 32.9 % in 2003 compared to 26.4% at State. St. Clair County MCH Performance measures show that in 1999 our county baseline was 29.7% of women reported smoking during pregnancy, compared to 19.0% of State. Physical inactivity is lower at county with 20.7% compared to State at 24%. Obesity, BMI > +30, in adults 18 and older for the county in 2003 was rated 25% compared to State at 23.4%. The county rate for percent of adults with high cholesterol is 37.5% compared to 37.1% for State. Prevalence for asthma is at 11.2% for county compared to 10.8% for State. These all contribute to increasing the county’s heart disease, lung cancer and other smoking related diseases. There are no indicators available on obesity and inadequate diet by particular age groups, race, or special population for our county. The most prevalent causes of hospitalization in our county seem to be due to heart disease 264.6% compared to State at 164.6%, which is consistent with risk behaviors. A youth survey of 6th-8th graders was done at one of our schools in our county of 114 students. This survey had the following results: 42% of the students reported divorced and never married parents. 15.7% reported not being involved in extracurricular activities. 7% reported using tobacco beginning at the ages of 12-14. 23% reported using alcohol beginning at ages 10-13. 57% reported they could obtain drugs with 18% using drugs. 22% reported being sexually active and the highest level being at 6th grade. 23% reported the need to exercise regularly. 27% felt they weren’t in the normal range with most feeling overweight. 32% reported needing more dairy and 53% needing more fruits and vegetables. 44.7% reported the need to see a dentist, and 37.7% needed a physical. 31.5% reported not using safety restraints (seat belts). Our rates for women 50-64 with no mammogram or clinical breast exam in the last year are 57.3% for 2003 compared to State at 35.9%. Women 30-69 with no pap test in the last 3 years for 2003 in our county are 23.4% compared to State at 13.8%. Men and women >50 years who have never had a blood stool test is 63.9% in county compared to 57% in State, and who have never had a sigmoidoscopy or colonoscopy is 58.9% to States 49.2%. These services for mammogram, clinical breast exam, pap testing, blood stool testing and sigmoidoscopy or colonoscopy are available in our county at either the local clinics in Appleton City or Osceola or at one of the hospitals. Due to loss of supplies of contraception from the DHSS, the Health Center is planning to partner with a local Title X group to continue to be able to supply this much needed service. Leading Causes of MortalityAnalysis of leading causes of mortality:Mortality rates are higher in unintentional injuries and motor vehicle accidents. Total unintentional injuries for the county rate at 68.6% compared to State at 40.2%. Motor vehicle accidents rate at 45.7% compared to State at 20.1%. Both of these are ranking first in our county. Data does not show if this is related to lack of seatbelt use, or alcohol use as a contributing factor. All injuries and poisonings rate 94.5% in county with 64.1 % in State and it is also ranking first in our county. These are from 1999-2002 data. Rates of mortality that are higher than the state rate are not consistent with behavioral risk factors for diseases. The rate of mortality is also not consistent with rates of screening tests for early detection, or other risk factors like high blood pressure or high cholesterol. B. Community Health Improvement Capacity IndicatorsHealth Care System IndicatorsAnalysis of the Community’s Health Care System:Our healthcare provider rate in 2002 was 1:877 compared to States 1:407. We need more healthcare providers in our county. We have 8 full time doctors and 3 part time doctors. We do have 5 Nurse Practitioners and a Nurse midwife. We have a barrier of being a rural county and therefore transportation is a problem to get to a doctor. Adequate access to emergency services through Sac-Osage Hospital and Ellett Memorial Hospital is available. Acute care is available through Sac-Osage Hospital. Access to long-term care is available through Truman Lake (a skilled nursing facility), Appleton City Manor (an intermediate care facility), and Country Side Estates (a residential care facility. In 2003 16.6% of the county lacked health insurance coverage, compared to 12.31% of State. There doesn’t seem to be any particular segment of the population without health insurance. Only 2 dentists in the county give dental health care. Mental health has to be serviced from outside of the county. Miles for Smiles has been coming once a year to Lakeland and Osceola Schools. We have one pharmacy in Appleton City and a doctor's office that has a pharmacy that supplies for their clients. Otherwise, the people in St. Clair must go to Clinton or Bolivar. Medicaid participating dentists are available to our community. There are no populations that are not served due to language-specific or culturally knowledgeable service providers. Resources are available to provide transportation for health care access such as the OATS bus, PAR (Provide-a-Ride), and Medicaid transportation, but it is not adequate for the county population. Resources are available through On My Own, Inc. and DFS to accommodate those needing sight and hearing impaired services or other assisting technology. The health care resource gaps in our community are more doctors, more dentists, transportation, respite care, and pharmacy. Community Health Resource IndicatorsAnalysis of health resources that are available to address leading causes of mortality, especially premature deaths, and risk factors that contribute to leading health problems in the community: Presently we have available in our community: a physician for chemotherapy, recreation due to the lake, a swimming pool in Osceola, senior nutrition sites and one Senior Center, WIC, On My Own, Inc., First Steps, Pathways, Parents as Teachers, School nurses that are present daily, Cancer Society activities, Community Betterment Coalition, GED Classes, Medicaid Transportation, Oats bus, Doctors, Dentists, Nurse Practitioners, Certified Midwife, Health Coalition/CHART, and 2 Hospitals. The St. Clair County Health Center has two nurse practitioners that are part of the Rural Health Clinic. The Health Center assesses the community on a three-year basis and updates that assessment yearly. They provide guidance for a Maternal Child Health task force to work on reducing smoking in pregnancy and encourage first trimester prenatal care. The St. Clair County Health Center has provided a facilitator for the local C.H.A.R.T. and Regional C.H.A.R.T in 2004. Without this facilitator the local C.H.A.R.T. would have ceased functioning. The Health Center also provides Home Health in the county that would otherwise not be available. They provide immunizations through the Vaccine for Children Program through State to keep vaccine preventable diseases from occurring. We need an orthopedic doctor, drug/alcohol/tobacco treatment/classes, and summer feeding sites, respite care, and pharmacy. Community Health Assessment Summary of Findings for St. Clair CountyA) Review of community health status indicators, including primary and secondary data, reveals the following problems:
B) Review of Behavioral Risk Factor Surveillance System County Level Data reveals the following problems: Physical inactivity is lower than the State, Current smokers are higher than State, Overweight with BMI 25-29.9 is lower than State, and Obese (BMI > 30) is higher than State. C) The 3 most significant problems affecting the health status of the population within the jurisdiction of the local public health agency are (public health priorities):
D) Problems presented if a Pandemic Flu were to hit our county:
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