Aldermen, Board of

COMMUNITY HEALTH ASSESSMENT PRESENTATION NOVEMBER 9, 2011 A presentation was provided to the Board of Aldermen on Wednesday, November 9, 2011 at 6:45 p.m. in the Aldermanic Chamber. Members of the Board in Attendance: Alderman-at-Large Brian S. McCarthy Alderman-at-Large Ben Clemons Alderman-at-Large Mark S. Cookson Alderman-at-Large David W. Deane Alderman-at-Large Barbara Pressly Alderman-at-Large Lori Wilshire Alderman Kathryn D. Vitale Alderman Diane Sheehan Alderman Arthur T. Craffey, Jr. Alderman Michael J. Tabacsko Alderman Paul M. Chasse, Jr. Alderman Mary Ann Melizzi-Golja Alderman Jeffrey T. Cox Members not in Attendance: Also in Attendance: Mayor Donnalee Lozeau Kerran Vigroux, Div. Director, Public Health and Community Services Ashley Conley, Epidemiologist, Public Health and Community Serv. President McCarthy This evening we have a presentation on the Community Health Assessment. I just want to mention before that, Alderman Vitale called me to say that she would be here, but was hosting a constituent coffee and would be a little late. Mayor Lozeau Thank you Mr. President. Joining us tonight is our Director of Public Health and Community Service, Kerran Vigroux and our Epidemiologist, Ashley Conley. As you saw in the memo from both myself and Alderman Wilshire as Chairman of the Human Affairs Committee, and Alderman Melizzi-Golja as the Board of Health Liaison, this Community Health assessment is something that the staff has worked on for quite some time to be able to put together and present tonight. They have done a great job, and we are very pleased. Kerran Vigroux Thank you. Good evening. I’m Kerran Vigroux the Director of the Division of Public Health here in the City. First of all thank you Mayor for arranging for us to be able to present and thank you President McCarthy and the Aldermen. We’re very excited to be here and share these results with you. I believe that you will be pleased with the work that the division has accomplished. Ashley is actually going to do the actual presentation, but I just wanted to make you aware of a few things. We got to this point because when I first started with the City in the summer of 2008 one of the first things we did that fall is started having conversations with the Mayor about our need to conduct a strategic plan for the division, and the Mayor was very supportive and so I began looking for some funding in order to take us through a strategic planning process. We were actually able to get some funding from the Community Health Institute in Bow as well as our local Health Department who helped bring in a facilitator and work us through that process. Community Health Assessment Presentation 2 11/09/11 The number one outcome of that strategic plan was that we needed to conduct a comprehensive statistically significant community health assessment in order to inform where the division was going to go, what were the real health issues and concerns for the City of Nashua, and how should we conduct our future programming, and so we started on our process to conduct the community health assessment. It was a significant undertaking as the Mayor mentioned, but it wasn’t just our division that actually participated in this; there were many people throughout the city, departments that helped us including the Mayor who hosted and convened one of the key leader focus groups, Kathy Hersh, the Director of Community Development who facilitated one of the focus groups as well as served on our advisory board. We could not have completed the project without the help of Angelo Marino in Assessing. His work on the maps that you will see throughout the report as well as the maps he created for our volunteers to use when they went door to door throughout the city, fantastic job, wouldn’t have been able to do it without him, and you should know that. However, one person in particular shouldered the major responsibility of the oversight of this project, and that is Ashley Conley. She is the division Epidemiologist, and it is Ashley’s job to work on disease trends, outbreaks that happen. The work that she does and the data she analyzes informs the rest of the division in how we respond to disease cases and outbreaks throughout the city. She has done a fantastic job overseeing the project. She is always the first one to say how much work the entire division team did, but truly, as her supervisor, I can say we would not have been able to complete the project and it would not have been as statistically valid or comprehensive without her. She has done a great job, and you should know that as well. Two other things; just wanted you to be aware that this community health assessment is informing a lot of local decisions and actions that are happening through area agencies. The different local agencies are starting to use the results of the study to write grants, to help inform their decisions as they are looking at trying to prioritize their resources and targeting the health issues that are the highest priorities for the residents of Nashua. Also it has caught the recognition of the State Health Department that is using it as a best practice model for other regions throughout the state on how to conduct a community health assessment as well as the federal centers for disease control who has now asked Ashley to come down to Atlanta and serve as a subject matter expert to look at the way the tool that she used was used in order to conduct the community health assessment. Obviously we are very proud of the work that Ashley did, the work that the division has conducted, but it is a terrific reflection on the City. Thank you for having us here tonight. With that, I will have Ashley start her presentation. Ashley Conley Thank you very much for allowing us to come and talk to you this evening. This is just an overview of the process, and Kerran mentioned our strategic plan that we did back in the spring of 2009. Shortly after that, we had a slight pandemic that we had to respond to so it wasn’t until June of 2010 that we actually started the process of the community health assessment, and that took us until about this past September when we finally published and made available our community health assessment. The next piece of the process is our community health improvement plan, and this is exciting work because now we take what we learned in the assessment and we’re able to start putting into action ways to improve the health, and that is going to begin in December. We will talk a little bit more about that later. Then once you do your community health improvement plan then you start to implement projects and things in the community that can help out our health as a city. Community Health Assessment Presentation 3 11/09/11 Just a small overview on what is exactly a community health assessment. It is a process. It is not just a report. It is when you gather your stakeholders and the people that are involved in health in your community and you start to collect data. We will talk about the types of data that we collected, but once you gather all of the data you analyze it, you look at it, you see what is interesting, and then you are able to disseminate that information to others to be able to use it. At the end, you should have a report that highlights the strengths for health in the city and some of the areas that need improvement as well. That is just a brief definition of what an assessment is. There are lots of reasons we do health assessments. One is to engage community partners, and that was one thing that this health assessment definitely did; we had over 26 organizations from the area that came together to work on this. It provides information to community members. It sets the foundation for programs that we are going to try to implement or enhance existing programs. And it provides a baseline to monitor changes and trends. It is really hard to know if things are improving or getting worse if you don’t have a baseline. Being able to gather that and have that available is really important. Throughout the assessment, if you look at it, it is broken up by chapters and there are many different health topics included in here. This is actually the first community health assessment, comprehensive, in over a decade for the City so it has been a long time since we have been able to look at all of these health topics into one report and look at trends too. As you are going through you will see that we focus on infectious diseases, tobacco, chronic diseases, maternal and child health, and many more. We tried to get a good representation of all of those into our assessment. We had a fabulous advisory board. I mentioned that we had about 26 organizations from the area and it included social service organizations, medical partners, other city divisions, academic partners that all came together. The role of the advisory board was really to provide their expertise, to review documents, review surveys, recruit members for focus groups, and help us get the word out about the report once it was done. We relied on them to help us with that. They also attended meetings either every month or every other month, and some of our advisory board also participated on subcommittees, which was great so they not only wanted to be involved in the advisory board but they went the extra step and attended many more meetings and got more into the details of it, which was really great. When we talk about the next step, the improvement plan, many of these same organizations have decided to continue on and help us with that so they are dedicated and invested. The funding for our health assessment came from a few different places. Our Board of Health helped us with funding, we had some division funds. Then our two hospitals, Southern New Hampshire Medical Center and St. Joseph Hospital, also provided funds for our health assessment. Back in June we had a conference, prior to the release of the assessment, to gather feedback and input and to provide the preliminary results. That was in June at the Nashua Community College. That funding was provided by our State Health Department, the Department of Health and Human Services. At that conference, I will just mention, we had over 60 attendees come so it was very well attended and people learned a lot and they also provided feedback to us on the report so we could include that into the final report. I wanted to share with you one of the projects that we did with the community health assessment. This is with our photography students at both of our high schools. We had two photography classes, about 18 students, that participated in this, and what they did is they went out into the community and they took pictures of people or places or things, what they considered healthy or what they considered unhealthy in our community. I did put a few pictures up here so you could look at them. This is just a great way for us to get involvement and to make the community health assessment a little bit more personable. As you are looking through the report you are going to see lots of images of healthy or unhealthy things, and that was most likely from our Nashua High School students so they are given credit and Appendix V is dedicated to their pictures. Feel free to take a look at those as you go through. Community Health Assessment Presentation 4 11/09/11 The first important piece of this health assessment is who are we, who do we make up, who are our residents and who are we as a region as well. Chapter I of the report is all in demographics. I’m going to just do a brief overview of that. I want to mention that when we did the data for the report, it is local data here for Nashua, it is regional data for the greater Nashua region, and it is also State data. What we tried to do is we tried to compare ourselves; how is the city doing in relation to the region, how is the region doing in relation to the State, and then sometimes we have in there the United States measures as well so we can just kind of gauge and let us know how we are doing in the grand scheme of things. Within the City of Nashua we have over 86,000 residents. That is according to the 2010 U.S. Census that just came out. We have about 86% are Caucasian and 14% minority, about 8% are Hispanic or Latino population, and 80% of our residents speak English only at home so that is 20% of our residents that speak a different language when they are at home with their families. Within the Nashua School District there are 49 languages that are spoken at home. That is just showing some of the diversity that we have in our city within our population. If we look at education, about 9% have less than a 9th grade education and no diploma and the other 90% have above that. This is a map that Angelo helped us put together of the city, and I’m just pointing it out for later in our presentation. This is broken out by census tract. The U.S. Census Bureau has regions or towns broken up by census tract and if you look at the red lines those are all of the census tracts we have here in the city. There is also on there, you can see City Hall is right by 107/108, right in the middle on the right hand side of the map. That is right about where we are right now. This is going to come into play when we talk about some of the other maps that are displayed in the report and then also when we did our survey. As a public health region, who are we? If you are not familiar, there are 15 public health regions in the State of New Hampshire, and the Greater Nashua Public Health Region is one of them. It makes up 13 towns and the population is about 205,000. Of these 15 regions, the greater Nashua region has the largest population. About 92-100% of the residents are Caucasian. That is excluding Nashua, and it ranges between about 88% and 97% that speak English only at home. If you remember with Nashua about 80% of residents spoke English only at home so we’re just trying to show a little of the diversity that we have here. This is a map of our public health region so you can see we go all the way over to Wilton and then all the way over to Pelham, and these are our 13 towns that are included in the report. Whenever you see Greater Nashua Public Health Region, these are the towns that are included in that. In the report, in the very beginning, we have our Executive Summary, and the Executive Summary goes over some of the highlights; what are the things that are going really well as far as health in the city and some of those are prenatal care, a great proportion of our women are getting early and adequate prenatal care and they are accessing it in the first trimester so that is great news. The weight of newborns; they categorize them as low birth weight, very low birth weight, or normal birth weight, and we are doing really well. We don’t have a lot of newborns that are at the very low birth rate or low birth weight so that is a great thing. We also have a great number of adults that are getting their cholesterol screened on a regular basis. Those are just some areas that we really are doing great for health. The three top health concerns that came out of the health assessment were; obesity, nutrition, and physical activity, access to healthcare, and mental health. I will touch briefly on obesity right now, but I have a few slides later on where we will look a little bit more at the data. But obesity and nutrition were identified by both of our focus groups as the top issue of concern within the city and within the region. When we look at the stats we will see why we’re thinking of it as an issue. When we did our survey of residents they ranked it as the 3rd health concern amongst residents as well. When we look at access to healthcare, access is a very broad term and includes a lot of different facets; it includes transportation to appointments, insurance coverage, ability to make appointments so when we look Community Health Assessment Presentation 5 11/09/11 at that it is not just one thing that stands out for access to healthcare. But some of the things that were brought up were our medical partners in our focus groups said that there needs to be more coordination among different sectors of healthcare so instead of just focusing on primary health we should also focus on oral health and mental health; how can we look at the individual in the family with all of those components instead of soloing them out into different groups. That was one thing that was mentioned. Our key leaders in our focus group mentioned assistance with healthcare for low income and our population with no insurance. That was one thing that our key leaders brought up. It was also the number one thing that our residents brought up during our survey. For mental health one of the big things was access to services. Both focus groups identified it as an issue on how do we increase those services to people and make them available. I’m going to go through a few components of our health assessment and the amount of work that went in from our organizations, our advisory board, the staff in the division was just many hours were put into it so we are really proud of the work that was done with these different aspects. The first is our health survey. You may have seen whether it was in the newspaper, the flyers we posted, we tried to do our best to get the message out, but in October of 2010 we went out and did a survey of our residents in the community. It was a door-to-door survey to talk with people about health. We utilized a protocol called the Community Assessment for Public Health Emergency Response also known as CASPER and that was developed by the CDC or the Center for Disease Control in Atlanta. We were the first in New Hampshire to use this protocol. We were probably the first in New England although I haven’t checked in with the other states to see if they have used it, but the thing about this protocol is it is used usually following a disaster to identify health needs of the community, but it can also be used for things like a community health assessment. Then it gives you a dual purpose; you are training volunteers and you are getting the protocol set in place for use after a disaster, but then you are also gathering great health data for your health assessment in a non-disaster setting. It really helped us prepare to be able to do this. We went to 30 different neighborhoods and we did 7 interviews per neighborhood. The big thing is it was randomized so we didn’t personally pick out which neighborhoods we liked better, we randomized it so that we weren’t biased towards certain areas of the city over others. That is really important to know. We had teams of two that went into the neighborhoods on October 23rd and November 6th, and it consisted of 34 questions. Most of the questions covered chronic diseases, emergency preparedness, some demographic information, and then some community preparedness type questions. That is what our survey entailed. We did work with Angelo from Assessing to print out maps, and it was a huge help for us to identify where we needed to go in those 30 neighborhoods. Since then we have gone to two national conferences to present our results and our work. The first was the Council for State and Territorial Epidemiologists Conference where I was able to provide an oral presentation on this and then last week our Medical Director, Dr. Daniels, was able to go to the American Public Health Association conference to present on a poster. Good things have happened since we have done this health survey. I did pick two questions out of the survey to look at with you. The first one is how would you rate the health of our community. This was one of the very first questions we asked our residents, and as you can see over 80% said that we’re healthy or somewhat healthy and an additional 7% said we were very healthy so this is just getting at their perspective. We don’t have any measures for this, but when asking somebody what do they think this is how they would rate the health of our community. When we asked what one health issue would you fix to make Nashua a healthier place to live, the number one that came up was access to health care, and that included again lots of different components. It wasn’t just one thing that was identified within healthcare. The second health topic was environmental health. This encompassed many things from concern over air pollution to concerns over sanitation and things of that nature so environmental health. And the third one was physical exercise, nutrition, and weight management. Those are the big things that are on our resident minds out in our community. Community Health Assessment Presentation 6 11/09/11 These are just some pictures of our surveyors. We had over 60 volunteers that went out door-to-door. We went out on two days and most came back the second time so that means they had a lot of fun going out to talk to our residents. It was a very positive experience. People were happy we were asking them and getting their feedback and input. There are a lot of people to thank within the health survey, especially our residents, the people that actually completed the survey. It took about 10-15 minutes for them to complete it and it was a brisk day so they had to spend some time with us so it was great, and we also need to thank our volunteers that helped and both of our hospitals and Lamprey Healthcare as well. We briefly mentioned the focus groups. There were two focus groups. One was with key leaders and one was with medical providers. Our key leader focus group was on March 3rd and Southern New Hampshire Medical Center allowed us to use their board room and we had 16 attendees including our Mayor who helped facilitate and this key leader focus group and the next one is the medical provider focus group, the main goal was to ask what is the top health issue from your perspective, what resources do we have available to address this health issue, what are we currently doing to address this health issue, and what do we want to do moving forward. The whole goal was to pick one health issue that we wanted to look at and then go deeper into conversation about it. The medical provider focus group was held on March 7th at St. Joseph Hospital and we had 18 physicians and nurse practitioners come to it from all of our medical partners, and their backgrounds were from OBGYN, pediatrics, family medicine, and internal medicine. Those are the medical providers that see our population for a lot of routine physicals and regular maintenance of health. They were the people that we wanted to have on this to talk about what was our top health issue. Like I said the big thing was looking at one health issue and then going deeper into it. The questions that we gave to each group varied slightly. For instance, for the key leaders we talked about what in your day to day job do you see as a big health issue, what have you learned, and why is it an important health issue. Then with the medical providers we talked specifically about their office; within your practice, what do you see most often in your patients. The questions varied slightly, but the most important thing was to identify that health issue and the resources around it. With the results, the top health issue from both groups was obesity and weight management or unhealthy behaviors. These were both done separately, nobody told one group over the other that the top issue from this group was health for weight management so you guys should say that too. They were completely independent of each other. When we talked about resources and what is going on in the community, the answers were pretty similar. Both groups felt that this issue is important because if you start to address this issue you start to address many other health issues; health disease and asthma management and diabetes are all effected by weight and weight management so if you start to effect this then you are also going to affect those diseases as well. Both focus groups mentioned that there are a lot of agencies that work on this; our hospitals work on this, our medical partners, but it is often done in silos so there isn’t a coordinated effort amongst this one health issue so the resources are probably there, but how can we utilize them better and utilize them together to make a larger impact was really what both groups were talking about. Kathy Hersh from Community Development and then Debbie Daniels our Medical Director were facilitators for both of those groups, and we would really like to thank the people that participated in our focus groups. They spent about two hours with us and they even completed a survey ahead of time for it. It was great to have all of their feedback and input. Community Health Assessment Presentation 7 11/09/11 One thing I do want to mention is all of the data that is collected in this report isn’t just from databases located at the Department of Health & Human Services, it is also from our local agencies so there were a number of organizations within our city and within our region that provided data for us. It was a great show of collaboration amongst them to be able to share that information and to put it together all into one report. I just wanted to mention the organizations that were involved in that. One of the realty neat aspects of the community health assessment are our use of mapping in GIS, and that was with the help of Angelo Marino again in Assessing. I wanted to highlight just a couple of the maps that we were able to put together. This one again, if you remember I showed the map by census tracts so you could see in the previous map it was red highlights to break it out, this map again is broken out by census tract, and it looks at the percent of Nashua residents that are below the poverty level by census tract. This gives us an idea of where our low income residents are residing. As you will see from the next one that can often help us look at health outcomes or health issues as well. If we look at this map, the dark dark blue, which is in that middle upper right corner, are the areas with the greatest amount of poverty by census tract and the light light greenish colors is the lowest number of residents below the poverty level. If we look at this next map, this is Nashua’s pre-1950 housing and elevated blood lead levels. If you are not familiar with this, pre 1950 housing they used lead paint to paint the housing, and now the lead paint is starting to decay. Children can easily ingest the paint chips from window sills and the walls. What happens is they have elevated blood lead levels. That can have a huge consequence to the child when it comes to cognitive development and education. Here it is broken up by census tract again and if you look at the dark blue, very very dark blue census tracts, that is where we have the greatest amount of pre 1950 housing with lead based paint. The red dots are the cases of elevated blood lead levels for the past ten years from 2000 to 2010 so if you look at where all of our cases of lead poisoning are it is also in the areas with the greatest pre 1950s housing, which is also the areas that have the greatest amount of poverty in our residents. This is how we were able to use mapping to start to look at these different health issues. There was also a program through Community Development to start to abate the houses or to remove the lead hazards or to address them, and when you look at the numbers, the houses that they helped address were also in these areas that are concentrated by kids with lead poisoning and the pre 1950 housing. A big thank you to Angelo for his help on all of those maps. And then we have a CDC Public Health Associate, Victoria Alabi who was with us for two years, and she spent a lot of time working with Angelo on putting those maps together as well. The Secondary Data, secondary data is what we call information that we get from databases so a good example is at the Department of Health & Human Services, they have the Behavioral Risk Factor Surveillance System and that is a survey that is sent out to adults 18 years and over and they ask questions on heart conditions, asthma, disabilities, a whole gamut of things and they are able to collect that information and analyze it. They are also able to analyze it for the City of Nashua. That is an example of secondary data where we asked the State we would really like this information and they are able to analyze it, put it together, and send it to us. We were also able to use the Department of Environmental Services when we looked at air pollution and the Department of Education and the Youth Risk Behavioral Health System. That is a survey that is given primarily to teenagers in high schools that looks at different health conditions. We also looked at the Northern New England Poison Control Center to see poisonings in children and obviously the Census is where we got a lot of our demographic data. The example of secondary data that I wanted to show to all of you was talking specifically about obesity because that was the one overwhelming issue that our focus group members wanted to talk about, that our residents talked about, so here is a map of the United States and it is looking at it by county, but it is adults over 20 years of age, and the dark brown areas, especially you can see it in the southern states, that dark Community Health Assessment Presentation 8 11/09/11 brown, means that over 30% of the population in those counties are considered obese. If you look at the very light, white pale, only about 19% of the adults there are considered obese. If you look at New Hampshire, we kind of have a wide range from about 19% to about 30% of residents in the state that are considered obese. If we look specifically at Nashua and the State, we have about 26% of our residents are considered obese and about 33% are considered overweight. That is one thing that came to people’s minds when we were talking about what are some of our health issues, and our medical providers again were saying we can start to address this and we can address a lot of health issues that we have, and people’s health will increase and get better because of it. If we look at childhood obesity, we don’t have a lot of data when it comes to city level data, but we do have it for the county. This is looking at Hillsborough County and about 16% of the children in Hillsborough County are considered obese and another 14.5% are considered overweight. So when we look at what do we need to do to help our kids maintain a healthy weight that is something that we are going to look at in our improvement plan, which comes up in our next step of our process. Moving forward, I already mentioned our Community Health Improvement Plan (CHIP). This is a very exciting time because now we take what we learned from the assessment and we say okay what do we want to do to make change. It is a long-term process. It is not something that is done quickly in 6 months or a year. It will take about a year to put that plan together and it will take another two years to start to implement those measures into the community. I can update this slide because it is about 24 organizations now have signed up to be a part of our CHIP Advisory Board. We even have a few physicians in the city that are interested in working with us on this CHIP, which is great because we are going to need their help if we are going to try and make a difference. That is all I have for the presentation to provide a brief overview of the assessment and moving forward. If there are any questions we have about five minutes for questions if anybody has any. Alderman Wilshire I don’t have a question, just a comment. I think this is a fabulous report and the energy and the enthusiasm that went into it is fabulous. Thank you so much for all of your work and thanks Kerran for all of your work. This is great. Ashley Conley Thank you. Alderman Pressly Thank you. It is a very fine report. It is nice of you to have done this. I have a question. I received a notice some time ago that because of lack of State funding that you had to eliminate the HIV screening. Where have you been able to send these people and what has been the reaction to eliminating that service? Mayor Lozeau That might be a better question for the Director. Kerran Vigroux Alderman Pressly you are correct, we did receive notice from the State Department of Health that was our funder for our STD program not our HIV program. They were two separate programs. That was the sole support mainly for the STD services so that was counseling, testing. It was across the State that funding Community Health Assessment Presentation 9 11/09/11 was eliminated so any programs across the State that had STD programs also closed. Manchester Health Department, our local Area Health Center was affected as well. Where people are going or can go is limited because that was the program that was providing the service. If they do have a primary care provider, they would go there. However, a lot of people would still have chosen to come to the local health department because of the anonymity that we provided that they wouldn’t have access to it probably with their provider. They may have for other reasons not wanted to go there. But that is an option, and then the emergency room. Alderman Pressly At the hospitals? Kerran Vigroux Yes. Some of these infections rise to the level of discomfort and disease that they have to seek immediate care. But it is a program that I think the City definitely needs to provide, it is something that we’re looking at, but there will be no funding from the State for it as far as we have been told. Alderman Vitale When you say that it is something that the City should provide, and I agree that there is a need, do we know what it would cost the City to provide that program? Has it been broken down that way? Kerran Vigroux We have started looking at that. The funding from the State was about $150,000 a year. It served almost 1,000 client units. Sometimes it could be the same client, but it was unit services about 1,000 as well as the testing. The testing services are what are costly, and we can’t contain those costs. We have spoken to the hospitals about using their laboratories. The State laboratory actually was more cost effective than what they could provide for us. So there are ongoing conversations, we’re trying to get our arms wrapped around the true costs. Alderman Vitale And the cost that we know that might be to the community if those people that would have gone for testing, the cost on the flip side if they don’t go and the long-term costs of not seeking that treatment. Kerran Vigroux Correct the socioeconomic costs of someone not being treated and then transmitting it to others and the continued infection and how that affects your community is much higher than the cost of prevention. Alderman Pressly Just a comment, is that the only place it’s under your name? Is that the way people can access the report? Ashley Conley The report is available on the City website. If you go to the Division of Public Health & Community Services, we have the full report and we also broke it out by chapter in case you don’t want to download the whole Community Health Assessment Presentation 10 11/09/11 thing. We also have on there the slides from our conference that we held in June available. That is the best place to go. Alderman Pressly Thank you. Alderman Sheehan Thank you. I echo what the others have said about thank you and a lot of great work. The pictures are really good. The high school students have some talent in here. The things that you’ve been have been being cut I see are trending up including teenage pregnancy has nearly doubled. Are we catching this again at a certain interval to see what trend and where that is going, and you could talk a little about that? Ashley Conley Every three years we will be doing a community health assessment. In two years we will start planning for that again and we will look at this assessment and we will pick out the areas that we want to see what has changed and we will do something similar to this as well. We will be able to keep trending the data over time. Alderman Sheehan Thank you. President McCarthy Are there any further questions? Thank you very much. Ashley Conley Thank you very much. The presentation concluded at 7:30 p.m.  City of Nashua Community Health Assessment A S H L E Y C O N L E Y, M S , C P H EPIDEMIOLOGIST D I V I S I O N O F P U B L I C H E A LT H AND COMMUNITY SERVICES N O V E M B E R 9 , 2 0 11 BOARD OF ALDERMEN  Process 2 Community Apply for grants Community Strategic Health Implement Projects Health Program Develop. Planning Improvement Assessment Education Plan Completed Identified as Spring a need from 2009 by the Strategic Division Plan 10/25/2011 What is a Community Health Assessment? 3  A process by which community members gain an understanding of the health, concerns, and health care systems of the community by identifying, collecting, analyzing, and disseminating information on community assets, strengths, resources, and needs. 10/25/2011  Why did we do one? 4  Engages community partners to identify and evaluate health issues  Provide information to community members  Sets the foundation for future programs and grants; helps plan effective interventions  Provides a baseline to monitor changes and trends  Build partnerships and coalitions  Identify emerging issues 10/25/2011  Health Topics 5  Infectious Diseases  Tobacco  Chronic Diseases  Maternal and Child  Environmental Health (e.g. teen Health (e.g. lead, birth , low birth radon, air quality) weight)  Injury (e.g. assault,  Risk Factors falls)  Screenings  Mental Health  More… 10/25/2011  CHA Advisory Board 6  Adult Learning Center  Home, Health, Hospice  Big Brothers Big Sisters of  Nashua Area Health Center Greater Nashua  Nashua Community College  Boys & Girls Club of Greater  Nashua Pastoral Care Center Nashua  Nashua Police Athletic League  City of Nashua, Community Development  Nashua School District  City of Nashua, Parks & Rec  Nashua Senior Activity Center  Colby-Sawyer College  Nashua Soup Kitchen  Community Health Institute  Rivier College  Dartmouth-Hitchcock  Southern NH HIV/AIDS Task  Gateways Force  Greater Nashua Dental  Southern NH Medical Center Connections  Southern NH Services  Greater Nashua Mental Health  St. Joseph Hospital Center  United Way of Greater Nashua  Harbor Care Clinic  YMCA 10/25/2011  Funding 7  Community Health Assessment  City of Nashua Board of Health  City of Nashua Division of Public Health & Community Services  Southern NH Medical Center  St. Joseph Hospital  Conference  NH DHHS and US DHHS/CDC 10/25/2011 Nashua High School Photography Project 8 Nashua High North and South photography students were asked to go into the community and take pictures of people, places and things that they think are “healthy” and “unhealthy”.  Nashua High North: Erin Knoetig, photo 1  Nashua High South: Angela Walsh, photo 2  18 students participated  Submitted 1-10 photos per student 10/25/2011 Nashua High School Photography Project 9 10/25/2011 Nashua High School Photography Project 10 10/25/2011 Who Are We as a City and a Region? 11 10/25/2011  City of Nashua 12  Population: 86,494 (2010 US Census)  85.7% White; 14.3% Minority  7.8% Hispanic or Latino  80% of residents speak English only at home  There are 49 languages spoken at home for students in the Nashua School District  9.3% have less than 9th grade education or no diploma 10/25/2011  Ciity of Nas ua Ce sus Tracts I Leg,end !!!l CI HALL FIRE STA 10 S .. SC COL 10/25/2011 13 Greater Nashua Public Health Region 14  15 Public Health Regions in NH  13 towns in the Greater Nashua Region  Population: 205,765 (2010 US Census)  92% to 100% of residents are White (excluding Nashua)  88.5% to 97.5% speak only English at home (excluding Nashua)  3% to 9.1% have less than a 9th grade education or no diploma (excluding Nashua) 10/25/2011 Greater Nashua Public Health Region 15 Mason Holliis Nashua P.elham 10/25/2011  Executive Summary 16 TOP 3 HEALTH CONCERNS: 1. OBESITY 2. ACCESS TO HEALTHCARE 3. MENTAL HEALTH 10/25/2011 Components of the CHA 17 •HEALTH SURVEY •FOCUS GROUPS •LOCAL DATA •GIS •SECONDARY DATA 10/25/2011  Health Survey 18  Utilized a rapid needs assessment protocol from the Centers for Disease Control and Prevention  First in NH to use this protocol  Door-to-door survey of 207 residents in the City of Nashua  Went to 30 different neighborhoods and did 7 interviews per neighborhood (Randomized)  Teams of 2 went into the neighborhoods on Oct. 23rd and Nov. 6th  34 questions that covered a wide variety of topics 10/25/2011  How would you rate the health of our community? 19 45% 42% 40% 40% 35% 30% 25% 20% 15% 10% 7% 7% 5% 4% 0% Very Healthy Healthy Somewhat Very Unhealthy Don't Know Healthy 10/25/2011  What one health issue would you fix to make Nashua a healthier place to live? 20 Child Health 7% Substance Abuse 7% Physical Exercise/Nutrition/Weight 15% Environmental Health 16% Don't Know 17% Healthcare (Access, Insurance, Other) 18% Other 20% 10/25/2011  ~l 10/25/2011 21 10/25/2011 22  Acknowledgements 23  CHA Health Survey Subcommittee  Victoria Alabi  Mike Amichetti  Theresa Calope  Ashley Conley  Amy Cullum  Debbie Daniels  Corinn Dembkoski  Mariellen Durso  Meredith Lyons  Ray Peterson  Health Survey Volunteers  Southern NH Medical Center, St. Joseph Hospital, Nashua Area Health Center  City of Nashua, Assessing Department  Residents that completed the survey  Adapx and Anoto 10/25/2011  Focus Groups 24 KEY LEADERS MEDICAL PROVIDERS 10/25/2011  Key Leaders Focus Group 25  March 3, 2011 @ SNHMC  16 Attendees  Mayor Lozeau  Greater Nashua Dental Connections  City of Nashua Board of Health  Courville Communities  Nashua Area Health  Nashua Community Center College  Gateways  Rockingham Ambulance  St. Joseph Hospital  Dartmouth-Hitchcock  Nashua School District  Southern NH Medical Center  United Way of Greater Nashua  Greater Nashua Mental Health Center 10/25/2011  Medical Providers Focus Group 26  March 7, 2011 @ SJH  18 Attendees  Dartmouth-Hitchcock  Harbor Care Clinic  Nashua Area Health Center  Nashua Board of Health  Southern NH Medical Center  St. Joseph Hospital  From various backgrounds – OBGYN, pediatrics, family medicine, internal medicine 10/25/2011  Questions 27  Varied between the 2 groups but focused on identifying the most important health issue in the community, identifying resources and community action 10/25/2011  Results 28  Top health issue from both groups:  Obesity and weight management (unhealthy behaviors)  Both mentioned different agencies working on this issue but in silos  Both think the resources are there but they are not coordinated  Both mentioned current and previous activities surrounding this issue 10/25/2011  Acknowledgements 29  Facilitators: Kathy Hersh, Debbie Daniels  CHA Focus Group Subcommittee  Victoria Alabi  Mike Amichetti  Melissa Bugeau  Ashley Conley  Kathy Hersh  Debbie Daniels  Focus group trial run participants  Southern NH Medical Center & St. Joseph Hospital  Provided meeting space and coffee   Focus Group Attendees 10/25/2011  Local Data 30 N A S H U A A R E A H E A LT H C E N T E R G R E AT E R N A S H U A M E N TA L H E A LT H C E N T E R HARBOR CARE CLINIC KEYSTONE HALL N A S H U A F I R E D E PA R T M E N T NASHUA SCHOOL DISTRICT N A S H U A P O L I C E D E PA R T M E N T S O U T H E R N N H H I V / A I D S TA S K F O R C E SOUTHERN NH SERVICES NH 2-1-1 OFFICE OF MEDICAID BUSINESS & POLICY N H H E A LT H Y K I D S 10/25/2011 GIS Applications 31 10/25/2011  Percent of Nashua Residents below the Poverty Level by Census Tract Nashua CensusTracts Poverty (people) 0 1.5-2.1 % 02.2-3.6% 3.7 - 10.4 % _10.5-17.2% _ 17.3-31.7% 10/25/2011 Source: American Community Survey, 2005-2009 32  Nashua's pre-1950 Housing Units by Census Tracts and Elevated Blood Lead levels ". E.. v • ..., elOOd L..oll ·· ,, ."21, "O~~l'" :r00040' .0· , _C_I,_ _ l_-'-'N 0"·2.1' _u.u ... • u.,u'" _ U.'.S2,f'" _S21.llJ1L ••• 10/25/2011 • 33  Acknowledgements 34  City of Nashua, Assessing Department  Angelo Marino, GIS Manager  City of Nashua, DPHCS  Victoria Alabi, Public Health Associate 10/25/2011  Secondary Data 35 N H D E PA R T M E N T O F H E A LT H & H U M A N S E R V I C E S NH Behavioral Risk Factor Surveillance System NH Cancer Registry N H D E PA R T M E N T O F E N V I R O N M E N TA L S E R V I C E S N H D E PA R T M E N T O F E D U C AT I O N NH Youth Risk Behavioral Health System NORTHERN NEW ENGLAND POISON CONTROL CENTER US CENSUS 10/25/2011 County-level Estimates of Obesity among Adults aged ≥ 20 years: United States, 2008 36 Age-Adjusted percent 10/25/2011 Adult Body Mass Index, 2008-2009 37 45 40 35 Percent 30 25 20 Neither overweight or obese Overweight Obese •Nashua •NH minus Nashua 10/25/2011  Childhood Obesity 38 Region Specific Prevalence* Estimates and 95% CI of Overweight and Obesity, 2008-2009 Belknap Carroll Cheshire Coos** Hillsborough Rockingham Strafford Variable Merrimack Grafton Sullivan (n=220) (n=1,021) (n=405) (n=347) (n=389) (n=402) (n=298) 17.7 18.7 23.9 16.2 18.1 13.6 Obese (12.7- (13.7- 22.2 (19.2-28.6) (13-22.3) (13.9-22.3) (8-19.3) 22.7) 23.6) 16.9 Over- 17.8 13.6 14.5 15.3 13.6 (12.6- 19.3 weight (13.9-21.6) (9.9-17.3) (12.1-17) (12.8-17.9) (10-17.2) 21.2) 64.2 66.5 69.7 Normal 57.1 67.4 64.7 (59.4- (60.9- 55.9 (62.7- Weight (53.6-60.6) (63.9-71) (60.7-68.6) 68.9) 72.2) 76.7) Under- 1.2 1.2 1.2 1.8 1.9 3.1 2.6 weight (0-2.5) (0-2.8) (0-2.8) (0.6-3.6) (0.2-3.5) (0.8-5.4) * Only children 7-10 years (3,082) included ** Coos County estimated based on a census Source: NH DHHS 10/25/2011  Moving Forward 39  Conduct a Community Health Improvement Plan (CHIP)  A long term, systematic effort to address health problems based on the results of the assessment  So far 22 organizations have signed up to be on the CHIP Advisory Board  3 physicians have expressed interest in working on a workgroup with the Medical Director 10/25/2011  Thank you! 40 ASHLEY CONLEY EPIDEMIOLOGIST CITY OF NASHUA, DPHCS 1 8 M U L B E R RY S T, N A S H U A , N H C O N L E YA @ N A S H U A N H . G O V 603-589-4552 10/25/2011