Professional Documents
Culture Documents
Health
Plan
Weareproudtopresentthe2015CommunityHealthAssessmentReport,facilitatedbytheHealthDepartmentofNorthwest
MichiganwithfundingfromtheNorthernHealthPlan.Itisacomprehensivecollectionandanalysisofhealthstatusandneedsin
Alpena,Antrim,Charlevoix,Cheboygan,Emmet,Montmorency,OtsegoandPresqueIslecounties.Wevelearnedtoomanyof
ourresidents,especiallylowincomeresidents:
Areoverweightorobeseanddontspendadequatetimeengagedinphysicalactivity;
Lackaccesstohealthyfoodandrecreationalfacilitiesintheircommunities;
Experienceavarietyofbarrierstohealthcare,includingmentalhealthservicesandsubstanceusetreatment;and
Abusealcohol,tobaccoandotherdrugs.
Onestarkfactaboutthehealthofourcommunitiesisclear:eventhestrongestpartnershipamonghospitals,healthcare
providers,andhealthdepartmentscannotimpactcommunityhealthalone.Highschoolgraduationrates,communityplanning
anddesign,accesstohealthyfoodsandrecreationalactivities,andairandwaterqualityhaveasmuchorgreaterimpacton
healththanseeingadoctorornursewhenwearesick.
Gatheringawealthofinformation,analyzingdata,andsettingprioritieslaysthefoundationtoaCommunityHealth
ImprovementPlanthataddressthetopneedsintheregion.OnbehalfoftheCommunityHealthAssessment&Improvement
Initiative,weinviteyoutojoinusasweworktogethertoimprovehealthandqualityoflifeforallNorthernMichiganresidents.
Togetinvolved,pleasecontactJaneSundmacher,CommunityHealthPlanner,at2313475041or
jane.sundmacher@nwhealth.org.
Yoursingoodhealth,
LindaYaroch,HealthOfficer
HealthDepartmentofNorthwestMichigan
BradRider,HealthOfficer
DistrictHealthDepartment#4
America leads the world in medical research and medical care, and for all we spend on health care, we should be the
healthiest people on Earth. Yet, for some of the most important indicators, like how long we live, were not even in the
top 25, behind countries like Bosnia and Jordan. Its time for America to lead again on health and that means taking
three steps:
1. Ensure everyone can see a doctor when they are sick
2. Build preventive care into every health care plan and make it available to people who wont or cant go in for it
3. Stop thinking about health as something we get in the doctors office.
Health is something that starts in our families, our schools, and our workplaces, in our playgrounds and parks, and in the
air we breathe and the water we drink. The more you see the problem of health this way, the more opportunities you
have to improve it. Scientists have found that the conditions in which we live and work have an enormous impact on
our health, long before we ever see a doctor. Its time to expand the way we think about health to include how to keep it,
not just how to get it back.
NORTHERNMICHIGANCOMMUNITYHEALTHASSSESSMENT&IMPROVEMENTINITATIVE
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego and Presque Isle Counties
OVERVIEW
Community
Conversations
7highlystructuredfocus
groups
Sponsoredbythelocal
multipurpose
collaborativebody
126communityresidents
andleaders/experts
fromhealthcare,
education,business,
government,andfunding
sectors
Secondary
Data
Surveys
ProviderSurvey
designedwithMcLaren
andMunson;81
physicians,nurse
practitionersand
physiciansresponded
CommunitySurvey
designedwithDistrict
HealthDepartment#10,
McLarenandMunson;
disseminated
electronicallyandhard
copy(inhealth
departmentclinics)
N=1,220
120+communityhealth
indicators,collectedby
county;categories
includeaccesstocare,
leadingcausesofdeath,
dseaserates,healthrisk
behaviors,maternaland
childhealth,
demographicsandmore
DataReviewandPriorityRanking
Followingreviewofthedatacollectedinthecommunityhealthassessment,40stakeholdersrankedcommunityhealth
issuesutilizingaDecisionMatrixwiththefollowingcriteria:severity,magnitude,impact,availableresourcesand
potentialforsuccess
#1Accesstohealthcare,includingbehavioral,maternal/child,andoralhealthcare
#2Chronicdiseaseprevention
#3Substanceuse
CommunityHealthImprovementPlanfor20162018
AccesstoCare
Developedbyleadersandexperts
fromhealthdepartments,hospitals,
FQHCs,NorthernMichiganRegional
Entity,CMHagenciesandMSUSchool
ofHumanMedicine
ChronicDiseasePrevention
Developedbyleadersandexpertsfrom
healthdepartments,hospitals,FQHCs,
earlychildhoodprograms,MSU
Extension,MSUSchoolofMedicine
PolicySystems Community
Health
Environmental Linkages
Systems
Change
Change
SubstanceUse
Developedbyleadersandexperts
fromhealthdepartments,hospitals,
NorthernMichiganRegionalEntity,
CMHagencies,substanceuse
preventionagencies,substanceuse
treatmentfacilitiesandlaw
enforcement
EXECUTIVE SUMMARY
HowhealthyisNorthernMichigan?Howdowepreventdisease,savelives,andsavedollars?Howdoweworktogether
soallresidentscanmakehealthychoices?Thesequestionsdroveacomprehensive6monthexplorationutilizinga
collaborativeprocessinAlpena,Antrim,Charlevoix,Cheboygan,Emmet,Montmorency,OtsegoandPresqueIsle
counties.
TheNorthernMichiganCommunityHealthAssessment&ImprovementInitiativeisaremarkablecollaborationoftwo
healthdepartmentsandthreehospitalswithfundingfromtheNorthernHealthPlan.Leadersfromeachorganization
providedoversighttotheproject,ledbytheHealthDepartmentofNorthwestMichigan.
Bothprimarydata(CommunityThemes&StrengthsAssessment)andsecondarydata(CommunityHealthStatus
Assessment)werecollectedfortheCommunityHealthAssessment.
CommunityThemes&StrengthsAssessment
Nearly1,400residentsofthe8countyregionparticipatedintheCommunityThemes&StrengthsAssessment,
whichconsistedofCommunityConversations(atypeofstructuredfocusgroup),andtwotypesofsurveys(What
MatterstoYou?CommunitySurveyandHealthCareProviderSurvey).
o CommunityConversations
126residentsandstakeholdersparticipatedinsevenCommunityConversationsponsoredbythelocal
multipurposecollaborativebodyinSeptemberandOctober2015.Collectively,theirresponsetothe
question,Whatcanwedotomoveclosertoourvisionofahealthycommunity?is:
1. Assureandincreaseaccesstoprimarycare,behavioralhealth,andsubstanceuseservices
2. Increaseawareness,utilizationandprovisionofcommunityresources
3. Providehealthandwellnesseducationacrossthelifespan
4. Engageresidentsinthecommunity
5. Promotehealthylifestylesandincreaseaccesstohealthyeatingandphysicalactivity
6. Developeconomicopportunities
7. Offercommunityeventsforallagegroupsandabilities
8. Protecttheenvironment
9. Enhanceinfrastructureforinformationtechnology
WhatMattersToYou?CommunitySurvey
1,220communityresidentscompletedtheWhatMatterstoYou?Survey,whichwasdesignedbythe
NorthernMichiganHealthNetwork,hospitalsandhealthdepartments.Questionsandresponsestokey
itemsfromarebelow:
HealthCareProviderSurvey
81physicians,nursepractitioners,andphysicianassistantscompletedthe2015HealthCareProvider
Survey.Questionsandresponsestokeyitemsfromthesurveyarebelow:
What are the most important community health problems in your county?
1Obesity/overweight
2Mentalhealthissues
3Lackofaccesstohealthcare
4Tobaccouse
5Substanceuse
CommunityHealthStatusAssessment
120+demographic,health,andsocial/economicindicatorswerecollectedbycountyforthe8countyregion.A
spreadsheet,withdescription,sourceandyearofdataandMichiganstatisticsforcomparisoncanbeviewedat
www.nwhealth.org.
Overall,theCommunityHealthStatusAssessmentrevealsamorehomogeneous,lesseducatedandpoorer
populationthantheStateasawhole.Residentsengageinhealthriskbehaviorsatgreaterratesthantheirpeers
elsewhereinMichigan,drivinghigherratesofchronicdisease.Therearemanybarrierstoaccessinghealthcare
intheruralregion,includinggeography,lackoftransportationoptions,andshortagesofprimarycareand
behavioralhealthproviders.
Priority Ranking
40stakeholdersfromacrosstheregionconvenedonDecember4,2015toreviewanddiscussprimaryandsecondary
datacollectedduringthe2015CommunityHealthAssessment.UtilizingaDecisionMatrix,theyrankedprioritiesforthe
8countyregionasfollows:
#1Accesstohealthcare,includingbehavioralhealth,maternalandchildhealth,andoralhealthcare
#2Chronicdiseaseprevention
#3Substanceuse
#4Mentalhealth
#5Healthdisparities
AregionalCommunityHealthImprovementPlanisavailableasacompaniondocumenttotheCommunityHealth
Assessment.Developedbyleadersandexpertsfortoprankedcommunityhealthpriorities,theCommunityHealth
ImprovementPlanincludesgoalsandobjectivesinalignmentwithHealthyPeople2020,evidencebasedstrategiesto
implement,andidentifiesleadcommunitypartnersforeachstrategy.
TheNorthernMichiganCommunityHealthAssessment&ImprovementInitiative
adaptedtheMobilizingforActionthroughPlanning&Partnerships(MAPP)framework
forconductingthe2015CommunityHealthAssessment.Consideredthegold
standard,MAPPwasdevelopedbytheNationalAssociationforCounty&CityHealth
OfficialswiththeUSCentersforDiseaseControl&Prevention.Itisnotanagency
focusedassessmentinstrument;instead,itisacommunitydrivenplanningtoolthat
appliesstrategicthinkingtopriorityissuesandidentifiesresourcestoaddressthem.
ThreeofthefourMAPPassessments
wereutilizedforthe2015
CommunityHealthAssessment:
CommunityThemesand
StrengthsAssessment
CommunityHealthStatus
Assessment
ForcesofChangeAssessment
ThefirstphaseofMAPPinvolvesorganizingtheprocessesforcollectingdataforthecommunityhealthassessment,
prioritizingissuesasindicatedintheassessment,anddevelopingacommunityhealthimprovementplantoaddresseach
ofthoseissues.Thepurposeofthisphaseistobuildcommitment,engagepartnersasactiveparticipants,anduse
partnerstimewell.Itresultsinaplanthatcanberealisticallyimplemented.Nooneindividualororganizationcan
improvecommunityhealthbythemselves.MAPPisbasedonthepremisethatjustabouteveryonehasastakeinhealth,
safetyandwellbeing.
TheExecutiveCommitteeoftheNorthernMichiganCommunityHealthAssessment&ImprovementInitiativeismadeup
ofleadersfromtwolocalhealthdepartments,threehospitals,andthecountyhealthplan.Earlyon,theydecidedona
combinationofprimaryandsecondarydatacollectionmethodsthatwouldnotonlyprovideanupdatedpictureof
healthandqualityoflifeintheeightcountyregion,butmeethospitalsCommunityBenefitrequirementsandhealth
departmentsPublicHealthAccreditationBoardrequirements.WithfundingfromtheNorthernHealthPlan(county
healthplanfortheeightcountyregion),theHealthDepartmentofNorthwestMichiganagreedtofacilitatetheproject.
NorthernMichiganCommunityHealthAssessment&ImprovementInitiative
ExecutiveCommittee
LindaYaroch,Chair
HealthOfficer
HealthDepartmentofNorthwestMichigan
JohnBruning
HealthOfficer
DistrictHealthDepartment#4
ThereseGreen
DirectorofWellnessServicesandCommunityRelations
McLarenNorthernMichigan
KathyJacobsen
DirectorofCommunityHealthEducation
MunsonHealthcareCharlevoixHospital
BruceMiller
ExecutiveDirector
NorthernHealthPlan
ChristiePerdue
DirectorofFoundationandMarketing
OtsegoMemorialHospital
PHASE 2: Visioning
Visioning,thesecondphaseofMAPP,providesfocus,purpose,anddirectiontotheMAPPprocesssothatparticipants
collectivelyachieveasharedvisionofthefuture.Itprovidesanoverarchinggoalforthecommunity:
ThreeMAPPassessmentswerefacilitatedintheeightcountyregion.Eachoneyieldsimportantinformationfor
improvingcommunityhealth,buttheirvalueismultipliedbyconsideringthefindingsasawhole.Together,the
assessmentsprovideacompleteviewofthecommunity.
CommunityThemes&StrengthsAssessment
What issues are the most important to health and quality of life in our community?
TheCommunityThemes&StrengthsAssessmentisavitalpartofthecommunityhealthimprovementprocess.During
thisphase,communitymembersthoughts,opinions,concerns,andsolutionsaregathered.Asaresult,theseindividuals
becomemorevestedintheprocess,withasenseofownershipandresponsibilityfortheoutcome.Avarietyofmethods
maybeused;theInitiativesExecutiveCommitteeselectedacombinationofsurveysandatypeoffocusgroupto
quantifycommunityinput.
CommunityConversations
SevenCommunityConversationswerefacilitatedusingtheTechnologyofParticipationsConsensusWorkshop
Method.Atypeofhighlystructuredfocusgroup,theConsensusWorkshopMethodutilizesacollective
integratedthinkingprocessandconsistsofindividualbrainstorming,smallgroupdiscussion,andfullgroup
discussion.Sponsoredbylocalmultipurposecollaborativebodies,CommunityConversationswereconvened
acrosstheregioninSeptemberandOctober2015.
SpecialthankstomultipurposecollaborativebodycoordinatorsforassistanceinsponsoringaCommunity
Conversation:
AlpenaCountyHumanServicesCoordinatingCouncil
BarbaraPorrett,CoordinatorofMarketing
AlconaHealthCenters
AntrimCountyCommunityCollaborative
KateKerr,CoordinatorofCommunityImpactandEngagement
UnitedWayofNorthwestMichigan
CharlevoixEmmetHumanServicesCoordinatingBody
MarciaCampbell,ProgramManagerofGreatStartReadinessProgram
CharlevoixEmmetIntermediateSchoolDistrict
CheboyganHumanServicesCoordinatingBody
TracyTorrence,ExecutiveDirector
CheboyganCountyUnitedWay
MontmorencyCountyFamilyCoordinatingCouncil
DonnaHardies,PreventionSpecialist
CatholicHumanServices
OtsegoHumanServicesNetwork
LaurieAndrews,RSVPVolunteerCoordinator
OtsegoCountyUnitedWay
PresqueIsleCountyHumanServicesCoordinatingCouncil
MarySchalk,4HYouthDevelopmentProgramAssociate
MichiganStateUniversityExtension
126residentsandstakeholdersparticipatedinsevenCommunityConversations.Theyincludedrepresentatives
fromhealthdepartments,hospitals,federallyqualifiedhealthcenters,homecareandhospiceagencies;
communitymentalhealthandbehavioralhealthproviders;socialserviceagencies,includingthosewhoserve
olderadultsanddisabledresidentsand/orprovidehousing,utility,ortransportationassistance;colleges,MSU
Extension,schools,andearlychildhoodeducationprograms;ChambersofCommerceandbusinesses;
government,courts,andlawenforcement,faithbasedorganizations;andUnitedWayandfoundations.
Collectively,theirresponsetothequestion,Whatcanwedotomoveclosertoourvisionofahealthy
community?is:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Assureandincreaseaccesstoprimarycare,behavioralhealth,andsubstanceuseservices
Increaseawareness,utilizationandprovisionofcommunityresources
Providehealthandwellnesseducationacrossthelifespan
Engageresidentsinthecommunity
Promotehealthylifestylesandincreaseaccesstohealthyeatingandphysicalactivity
Developeconomicopportunities
Offercommunityeventsforallagegroupsandabilities
Protecttheenvironment
Enhanceinfrastructureforinformationtechnology
ForcountyorbicountyCommunityConversationReports,pleaseseeAttachmentA.
7
WhatMatterstoYou?CommunitySurvey
TheWhatMatterstoYou?CommunitySurveywasdesignedforwidedistributionacrossNorthernMichiganin
partnershipwiththeNorthernMichiganHealthNetwork.Intheeighttipofthemittcounties,itwas
disseminatedthroughaSurveyMonkeylinktocommunitypartnersviaemail.Inaddition,hardcopieswitha
subsetofsurveyquestionsweredistributedtoclientsatlocalhealthdepartmentclinicstoassureinputfrom
thelowincomepopulation.Inall,1,220communityresidentscompletedthesurvey(SeeAttachmentB).
Respondentsfromacrossthetipofthemittregionidentifiedaccesstohealthcare,goodjobs/healthyeconomy,
accesstoaffordablehealthyfood,goodschools/highvalueoneducationandaffordablehousingasthemost
importantfactorsthatdefineahealthycommunity.Theyidentifiedsubstanceuse,obesity/overweight,chronic
disease,mentalhealthissuesandlackofaffordablehousingasthetopcommunityhealthproblemsintheir
county.
Whenaskedwhichdiseaseorconditionstheyhadbeendiagnosedwith,responseswere,inrankorder,
obesity/overweight,highbloodpressure,highcholesterol,asthma,anddentalproblems.
Topbarrierstoseekinghealthcarearehighdeductiblesandcopays(adults,olderadultsandchildren);limited
healthinsurancecoverage(adults,olderadultsandchildren);inabilitytoaffordofficevisits(adultsandolder
adults);difficulttosetappointments(adultsandchildren);andEmergencyRoomwaitingtime(olderadultsand
children).Inaddition,adultsalsoindicatedtheirinsurancedoesnotcoverdentalservicesandolderadults
indicatedtheirinsurancedoesnotcovermedications.Findingabehavioralhealthproviderisabarrierfor
children.
HealthCareProviderSurvey
SimilarlytotheWhatMatterstoYou?CommunitySurvey,theHealthCareProviderSurveywasdevelopedfor
widedistributioninpartnershipwithhospitals.Theydisseminatedthesurveyto81physicians,nurse
practitioners,andphysicianassistantsfromMcLarenNorthernMichigan,MunsonHealthcareCharlevoix
HospitalandOtsegoMemorialHospital.(PleaseseeAttachmentC).
Theyrankedthefollowingasthemostimportantfactorsforahealthycommunity:accesstohealthcare,good
jobs/healthyeconomy,accesstoaffordable,healthyfood,goodschools/highvalueoneducationandaffordable
housing.Theidentifiedobesity/overweight,mentalhealthissues,lackofaccesstohealthcare,andtobaccouse
andsubstanceuseasthetopcommunityhealthproblemsinthecommunities.
CommunityHealthStatusAssessment
Over120communityhealthindicatorswerecollected,organizedandanalyzedforeachoftheeightcountiesinthe
region,includingstatisticsalignedwiththeGovernorsHealth&WellnessDashboard.Inaddition,theCommunityHealth
StatusAssessmentincludessocialdeterminantsofhealthandotherstatisticsreportedannuallyintheCountyHealth
Rankings.TheCountyHealthRankingsmodelforpopulationhealthemphasizesinterrelatedfactorsthat,ifimproved,
canhelpmakecommunitieshealthierplacestolive,workandplay.
Thisdatabaseprovidesawealthofinformationthatcanbeaccessedeasilybytheentirecommunityforstrategic
planning,grantwriting,andotherdatadrivenactivities.Manyindicatorsaresummarizedbelow.Forfulldescriptionsof
indicators,aswellassource/yearofdata,comparisonstoStateratesandHealthyPeople2020Objectives(where
applicable),visitwww.nwhealth.orgorpartnerhospitalwebsites.
10
HealthOutcomes
Prematuredeath
TheCountyHealthRankingsquantifiesandcompareshealthstatusofcountypopulationsbymeasuring
theburdenofprematuredeaths,animportantmeasureofapopulation.Prematuredeathsaredeaths
thatoccurbeforeapersonreachestheageof75.Manyofthesedeathsareconsideredtobe
preventable.Byexaminingprematuremortalityratesacrosscommunitiesandinvestigatingthe
underlyingcausesofhighratesofprematuredeath,resourcescanbetargetedtowardstrategiesthat
willextendyearsoflife.
Asanation,morethan75%ofhealthcarespendingisonpeoplewithchronicconditions,suchasheart
disease,cancer,strokeanddiabetes.Thesepersistentconditionsthenationsleadingcausesofdeath
anddisabilityleaveintheirwakedeathsthatcouldbeprevented,lifelongdisability,compromised
qualityoflife,andburgeoninghealthcarecost
LeadingCausesofDeath,per100,00Residents(AgeAdjusted)
250
200
150
100
50
0
CoronaryHeartDiseaseDeaths
CancerDeaths
StrokeDeaths
MichiganDepartmentofHealthandHumanServices,201113
NationalCancerInstitute,20082013
11
HealthRelatedQualityoflife
Inadditiontomeasuringhowlongpeoplelive,itisalsoimportanttostudymeasuresofhowhealthy
peoplearewhiletheyarealive.Theirreportsofdayswhentheirphysicalhealthispoororfairisa
reliableestimateofhealth.
Source:CountyHealth
Rankings,2015
Mentalandemotionalwellbeingisalsoessentialtooverallhealth.Positivementalhealthallowspeople
torealizetheirfullpotential,copewiththestressesoflife,workproductively,andmakemeaningful
contributionstotheircommunities.Anxiety,moodandimpulsecontroldisordersareassociatedwitha
higherprobabilityofriskbehaviors(tobacco,alcoholandotherdruguse),intimatepartnerandfamily
violence,manyotherchronicandacuteconditions(obesity,diabetes,cardiovasculardisease,
HIV/sexuallytransmittedinfections)andprematuredeath.
12
Lowbirthweightinfants
Improvingthewellbeingofmothers,infants,andchildrenisanimportantgoalfortheU.S.Lowbirth
weight,whichiswhenaninfantweighslessthan2,500grams(approximately5lbs,8oz)atbirth,isa
criticalmeasurebecauseitrepresentsbothmaternalandinfanthealthfactors.Smoking,drugand
alcoholuse,lackofweightgainduringpregnancy,andanotherpregnancywithinsixmonthsarefactors
thatcontributetolowbirthweight.Infantsborntoteenagemothershaveahigherriskoflow
birthweightinfantsandmaybemoreatriskformanyhealthproblems.Somebabiesbecomesickinthe
firstsixdaysoflifeordevelopinfections.Otherbabiesmayevensufferfromlongertermproblems,such
asdelayedmotorandsocialdevelopmentorlearningdisabilities.
BabieswithLowBirthWeight
12
10
NA
NA
0
Antrim
Charlevoix
Emmet
Otsego
Alpena
Statewide8.4%
MichiganDepartmentofHealthandHumanServices,2013
13
Health Factors
HealthBehaviors
Tobaccouse
Tobaccouseistheleadingcauseofdisease,disabilityanddeathintheUS.Livingtobaccofreereducesrisks
ofdevelopingheartdisease,variouscancers,chronicobstructivepulmonarydisease,periodontaldisease,
asthma,andotherdiseases.Tobaccofreelivingmeansavoidinguseofalltypesoftobacco,including
cigarettes,cigars,smokelesstobacco,pipes,andecigarettesandalsolivingfreefromsecondhandsmoke.
Adultsmokingratesinthe8countyregionexceedtheStaterateof20%,andthereisastrongcorrelation
betweentobaccouseandincome.Inaddition,maternalsmokingratesareveryhigh,rangingfrom26%in
EmmetCountyupto50%inAlpenaCountyandareevenhigheramonglowincomepregnantwomen.
PercentageofTobaccoUse
60
50
40
30
20
10
0
MothersWhoSmokedDuringPregnancy
AdultsWhoCurrentlySmoke
CountyHealthRankings,2015
MichiganDepartmentofHealthandHumanServices,2013
14
Obesity
Obesityisoftentheendresultofanoverallenergyimbalanceduetopoordietandlimitedphysicalactivity.
Itiscommonandserious,increasingtheriskforhealthconditionssuchascoronaryheartdisease,type2
diabetes,cancer,hypertension,dyslipidemia,stroke,liverandgallbladderdisease,sleepapneaand
respiratoryproblems,andosteoarthritis.Themedicalcostsofobesityarestaggering.
PercentageofAdultObesity(BMI>29)
40
35
30
25
20
15
10
Statewide32%
CountyHealthRankings,2015
15
Physicalactivity
Physicalactivityisoneofthemostimportantfactorsinimprovingoneshealth.Itstrengthensbonesand
muscles,reducesstressanddepression,andmakesiteasiertomaintainahealthybodyweight.Evenpeople
whodonotloseweightfromphysicalactivitygetsubstantivebenefitsfromregularphysicalactivity,
includinglowerincidenceofhighbloodpressure,diabetes,andcancer.Healthyphysicalactivityincludes
aerobicexercise,musclestrengtheningactivitiesandactivitiestoincreasebalanceandflexibility.As
describedbythePhysical Activity Guidelines for Americans,adultsshouldengageinatleast150minutesof
moderateintensityactivityeachweek,andchildrenandteenagersshouldengageinatleastonehourper
day.
PercentageofSedentaryAdults
30
25
20
15
10
5
0
Statewide23%
USCentersforDiseaseControlandPrevention,2011
Healthyeating
Thoughresearchonthefoodenvironmentisstillinitsearlystages,thereisstrongevidencethataccessto
fastfoodrestaurantsandresidinginfooddesertcorrelatewithahighprevalenceofoverweight,obesity,
andprematuredeath.Supermarketstraditionallyprovidehealthieroptionsthanconvenienceorsmaller
grocerystores.Nothavingaccesstofreshfruitsandvegetablesisanimportantbarriertoconsumptionand
isrelatedtoprematuremortality.
Food Deserts
USDepartmentof
Agriculture,2016
16
Accesstohealthyfoodcanhelpreducepeoplesriskforheartdisease,highbloodpressure,diabetes,
osteoporosis,andseveraltypesofcancer,aswellashelpthemmaintainahealthybodyweight.Asdescribed
inDietary Guidelines for Americans,eatinghealthymeansconsumingavarietyofnutritiousfoodsand
beverages,especiallyvegetables,fruits,lowandfatfreedairyproductsandwholegrains;limitingintakeof
saturatedfats,addedsugarsandsodium;keepingtransfatintakeaslowaspossible;andbalancingcaloric
intakewithcaloriesburnedtomanagebodyweight.
Drugandalcoholuse
Preventingdrugabuseandexcessivealcoholuseimprovesqualityoflife;academicperformance,workplace
productivityandmilitarypreparedness;reducescrimeandcriminaljusticeexpenses;reducesmotorvehicle
crashesandfatalities;andlowershealthcarecostsacuteandchronicconditions.Alcoholanddrugusecan
alsoimpedejudgmentandleadtoharmfulrisktakingbehavior.
Excessivealcoholuseincludesbingedrinking,underagedrinking,drinkingwhilepregnant,andalcohol
impaireddriving.Itisariskfactorforanumberofadversehealthoutcomes,suchasalcoholpoisoning,
hypertension,acutemyocardialinfarction,sexuallytransmittedinfections,unintendedpregnancy,fetal
alcoholsyndrome,suddeninfantdeathsyndrome,andinterpersonalviolence.
PercentageofAdultsWhoDrinkExcessively
30
25
20
15
10
NA
NA
0
Statewide18%
CountyHealthRankings,2015
17
TeenPregnancy
Teenpregnancyisassociatedwithpoorprenatalcareandpretermdelivery.Pregnantteensaremorelikely
thanolderwomentoreceivelateornoprenatalcare,havegestationalhypertensionandanemia,and
achievepoormaternalweightgain.Theyarealsomorelikelytohaveapretermdeliveryandlowbirth
weight,increasingtheriskofchilddevelopmentaldelays,illnessanddeath.Nearly80%ofteenagemothers
willaccessgovernmentsupportedprograms.Theirchildrenaremorelikelytobeincarcerated,dropofout
highschool,havemorechronichealthproblems,andbecometeenparentsthemselves.
TeenPregnancyRate
50
45
40
35
30
25
20
15
10
5
0
Statewide23per1,000femalesage1519
MichiganDepartmentofHealthandHumanServices,2013
ClinicalCare
Accesstohealthcare
Accesstohealthcaremeasuresaccessibilitytoneededprimarycare,healthcarespecialists,andemergency
treatment.Whilehavinghealthinsuranceisacrucialsteptowardaccessingthedifferentaspectsofthe
healthcaresystem,healthinsurancebyitselfdoesnotensureaccess.Itisalsonecessarytohave
comprehensivecoverage,providersthataccepttheindividualshealthinsurance,relativelycloseproximity
ofproviderstopatients,andprimarycareprovidersinthecommunity.
Thereareadditionalbarrierstoaccessinsomepopulationsduetolackoftransportationtodoctorsoffices,
lackofknowledgeofaboutpreventivecare,longwaitstogetanappointment,lowhealthliteracy,and
inabilitytopaythehighdeductibleofmanyinsuranceplansand/orcopaysforreceivingtreatment.
Lackofhealthinsurance
EmploymentbasedcoverageisthelargestsourceofhealthcoverageintheUS,andmanyunskilled,low
payingandparttimejobsdonotofferhealthcoveragebenefits.Ingeneral,employmentstatusisthemost
importantpredictorofhealthcarecoverageintheUS.Evidenceshowsthatuninsuredindividualsexperience
moreadverseoutcomesphysically,mentally,andfinanciallycomparedtoinsuredindividuals.The
uninsuredarelesslikelytoreceivepreventiveanddiagnostichealthcareservices,aremoreoftendiagnosed
atalaterdiseasestageand,onaverage,receivelesstreatmentfortheirconditioncomparedtothosewith
insurance.TheInstituteofMedicinereportsthattheuninsuredpopulationhasa25%highermortalityrate
thantheinsuredpopulation.
18
OveralltheproportionofuninsuredinNorthernMichiganishigherthantheStateasawhole.However,with
theenactmentoftheAffordableCareAct,andanintenseoutreach,educationandenrollmenteffortinthe
eightcountyregion,theproportionofuninsuredamongthelowincomepopulationhasdeclined
precipitously.
PercentageofResidentswithHealthInsurance
120
100
80
60
40
20
0
Adults
Children
CountyHealthRankings,2015
Healthcareprovidersupply
Havingaccesstocarerequiresnotonlyfinancialcoverage,butalsoaccesstoproviders.Sufficientavailability
ofprimarycarephysiciansisessentialsothatpeoplecangetpreventiveandprimarycareand,when
needed,referralstospecialtycare.
Source:CountyHealth
Rankings,2015
19
Qualityofcare
Qualityofcarecanbeexplainedastheright care for the right person at the right time.TheInstituteof
Medicine(IOM)furtherdefinesthequalityofhealthcareasthedegreetowhichhealthservicesfor
individualsandpopulationsincreasethelikelihoodofdesiredhealthoutcomesandareconsistentwith
professionalknowledge.TheIOMlistssixcharacteristicsofqualityhealthcare:safe,timely,effective,
efficient,equitableandpatientcentered.
Therearehundredsofpotentialqualitymeasureswithnoconsensusyetonthebestsetofmeasures.
CountyHealthRankingsusesthreemeasuresofqualityhealthcare:preventablehospitalizations,screening
forbreastcancer,andscreeningfordiabetes.Theseindicatorswereselectedbecausetheyprovidethe
greatestbenefittopatientoutcomes,helptobridgegapsseenamongdifferentpopulations,andcanbe
implementedinasafe,efficientandcosteffectiveway.
PreventableHospitalStayRate
60
50
40
30
20
10
0
Statewidehopsitalstaysforamnulatoryconditionsper1,000Medicareenrollees
CountyHealthRankings,2015
20
SocialandEconomicIndicators
Populationcharacteristics
AccordingtotheUSCensus,180,717liveinthe8countyregion.Thepopulationispredominantlywhite,
withNativeAmericansatabout2%,representingthelargestminoritygroup.
Race/Etnicity
Whitealone
AmericanIndianorAlaskaNativealone
Other
USCensusBureau,2014
21
Educationandincome
Therelationshipbetweenhighereducationandincomeandimprovedhealthoutcomesiswellknown,
withyearsofformaleducationcorrelatingstronglywithimprovedworkandeconomicopportunities,
reducedpsychosocialstress,andhealthierlifestyles.Theproportionofthepopulationwithatleasta
BachelorsdegreelagsbehindtheStateineverycountyintheregionwiththeexceptionofEmmet
County.
PercentageofEducationalAttainment
100
90
80
70
60
50
40
30
20
10
0
People25+withaBachelor'sDegreeorHigher
People25+withaHighSchoolDegreeorHigher
AmericanCommunitySurvey,20092013
Higherlevelsofeducationresultinhigherincomes,onaverage.Accesstohealthcareisaparticularly
importantresourcethatisoftenlinkedtojobsrequiringacertainlevelofeducationattainment.Even
whenincomeandhealthinsurancearecontrolled,themagnitudeofeducationseffectonhealth
outcomesremainssubstantiveandstatisticallysignificant.
Income
Withlowereducationallevelsacrosstheregion,itisnotsurprisingthatincomesfallbelowMichigans
medianincome($49,087)aswell,exceptinEmmetCounty,whereitreaches$51,113.Thesecounty
leveldatacannotaccuratelydescribethelargedisparitiesthatexistbetweenthelowestandhighest
incomesintheregion,particularlyintheNorthwestcounties.BydrillingdowntoCensusTract,stark
differencesbecomeevident.
22
MedianHouseholdIncome
60,000
50,000
40,000
30,000
20,000
10,000
0
Statewide$49,087
AmericanCommunitySurvey,20122014
TheproportionofsingleparenthouseholdsacrudepredictorforlowincomefallsaboveStaterate
of17.2%inallcountiesintheregion.Adultsandchildreninsingleparenthouseholdsareatriskfor
adversehealthoutcomessuchasmentalhealthandsubstanceuseproblems.
Childrensriskofpoorhealthandprematuremortalitymayalsobeincreasedduetopooreducational
attainmentsassociatedwithpoverty.Thechildreninpovertymeasureishighlycorrelatedwithoverall
povertyrates.
CountyHealth
Rankings,2015
23
Socialandemotionalsupport
TheCountyHealthRankingsmeasuresocialisolationbecausethelinkbetweensociallyisolated
individualsandpoorhealthhasbeenwellestablishedintheliterature.Sociallyisolatedindividuals
typicallyhavelimitedaccesstothetypesofsupportprovidedbypositiverelationships.Onestudyfound
themagnitudeofriskassociatedwithsocialisolationissimilartotheriskofcigarettesmokingfor
adversehealthoutcomes.
Understandingtheproportionofsociallyisolatedindividualsinacommunitymayprovideamore
completeperspectiveonacommunityscollectivehealthprofile.Thisisbecausesociallyisolated
individualsaremorelikelytobeconcentratedincommunitieswithpoorercommunitynetworks.
Poorfamilysupport,minimalcontactwithothers,andlimitedinvolvementincommunitylifeare
associatedwithincreasemorbidityandmortality.Furthermore,socialsupportnetworksarepowerful
predictorsofhealthbehaviors.
AlargeproportionofadultsinNorthernMichigandonothaveadequatesocialandemotionalsupport.
Aspovertyandpoorsocialconnectionsareamongriskfactorsforchildabuseandneglect,these
statisticsmayexplain,inpart,whychildabuseisgrotesquelyoverrepresentedintheeightcounty
region.
PercentageofChildAbuse
35
30
25
20
15
10
5
0
Statewide14.9%
KidsCountDataCenter,2013
Narrative adaped from Healthy People 2020 and National Prevention Strategy
24
Foreachofthethreetoprankedpriorities,ActionTeamsidentifiedgoalsandobjectivesinalignmentwith
Healthy People 2020. Forbaselines,evidencebase,andstrategiesandinterventions,pleaseseethe
CommunityHealthImprovementPlanfor20162018.
Priority#1: AccesstoCare,includingprimarycare,behavioralhealth,maternalandchildhealthandoral
healthcare
Developed by leaders/experts from health departments, hospitals, federally qualified health centers, community
mental health agencies and the county health plan for the region
Objective1: Increaseaccesstoprimarycare,behavioralhealth,maternalandchildhealthandoral
healthcare,includinguseofalternatedeliverymodels
Objective2: Increasetheproportionofpersonsunderage65withmedicalinsurance
Objective3: IncreasetheproportionofeligiblepersonsenrolledintheHealthyMichiganPlan
Objective4: Increasethenumberofpracticingprimarycareproviders
Priority#2:ChronicDisease
Goal: Promotehealthandreducechronicdiseasethroughtheconsumptionofhealthyfoodsand
achievementandmaintenanceofhealthybodyweight
Objective1:Increasevarietyandconsumptionofvegetablesinthedietsofthepopulationage2+
Objective2:Reduceconsumptionofsolidfatsandaddedsugarsinthedietsofthepopulationage2+
25
Goal: Improvehealth,fitnessandqualityoflifethroughdailyphysicalactivity
Objective1:Increasetheproportionofadultswhomeetcurrentfederalguidelinesforaerobicand
musclestrengtheningactivities
Objective2: Increasetheproportionofadolescentswhomeetcurrentfederalguidelinesforaerobic
andmusclestrengtheningactivities
Objective3:Increaselegislativepoliciesforthebuiltenvironmenttoenhanceaccesstooravailability
ofphysicalactivityopportunities
Goal: By2016,reduceillness,disabilityanddeathrelatedtobaccouseandsecondhandsmoke
Objective1:Reducetobaccoinitiationuseamongadolescents
Objective2:Increasesmokingcessationinpregnancy
Priority#3: SubstanceUse
Developed by leaders and experts from health departments, hospitals, substance use prevention agencies,
substance use treatment facilities, and law enforcement
Goal: Reducesubstanceabusetoprotectthehealth,safety,andqualityoflifeforall,especiallychildren
Objective1: Increasetheproportionofadolescentswhoperceivegreatormoderateriskassociated
withdrinkingalcoholregularly
Objective2: Increasetheproportionofpersonswhoarereferredforfollowupcareforalcohol
and/ordrugproblemsafterdiagnosisortreatment
Objective3: Reducenonmedicaluseofprescriptiondrugs
Objective4: Reducethenumberofdeathsattributabletoalcoholanddrugs
26
ATTACHMENT A
COMMUNITY CONVERSATION REPORTS
NORTHERNMICHIGANCOMMUNITYHEALTHANDIMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONONOCTOBER21,2015
What can we do here in Alpena County to move closer to our vision of a healthy community?
Enthusiastically
supportchildren
andyouth
Activelyprotect
ourenvironment
Broadlyincrease
ageappropriate
community
activities
Movefrom
problemfocusto
environmentfocus
forchildren
Moredaycare
providerswith
moreavailability
Educationon
sustainabilityto
protectnature
resources
$.10depositon
waterbottles
Increaseground
waterregulation
andenforcement
Encourage
recyclingeffortsin
thecommunity
Mandatory
recycling
Increase
understandingof
generationgaps
Schooling
assistanceGED
andoneonone
Increase
structured
physicalactivities
atschool
Increaseprograms
forsupportand
mentoring
Parentcoaching
Goodschools
Schoolbooksfor
eachchild
YMCA
Selfsufficient
supportsystems
foodplantingand
growing
Continueto
highlightnatural
resourcesclean
waterandair
Nofracking
Cleanupour
beaches
Freecommunity
educationforall
citizens
Makinghealthy
accessiblefood
andincreasing
knowledge
Moreactivities
gearedforseniors
andteens
Increase
affordable
community
activities
Communityaccess
toaffordable
recreational
equipment
Consistencyinour
messagehealthy
living
Greatlyincrease
accessto
comprehensive
healthcare
services
Accesstomore
healthcare
providers(physical
andbehavioral)
Accessto
behavioral/medical
healthcare
Physician
recruitmentand
retention
Efficiently
developeconomic
opportunities
Employment
opportunities
Enhanced
community
offeringsfor
increasedtourism
Highereducation
andtraining
opportunities
Increased
availabilitytomed
equipmentand
supportservices
Increasehome
careprovider
services
Programwhere
kidscanreach
theirhigh
potential
Diversityinjob
offerings
Morecentralized
resourceprograms
Increasingfunding
Enthusiastically
educatethe
community
Officiallydevelop
evidencebased
treatmentand
recoverservices
Opennessto
growthand
changeinthe
community
Createcommon
visionofahealthy
community
Changesin
culturethat
acceptssubstance
abuse
Addiction
recoveryservices
Publishstatistics:
goodandbad
Intentionally
evaluate
availability
affordabilityand
accessibilityof
infosystems
211textingfor
community
resources
Intentionally
addressways
povertyaffects
thecommunity
Affordablegap
services
Dependableand
affordable
internet,utilities
Increase
understandingof
poverty
Access to
substanceabuse
treatment
Connect
communityto
goodinformation
Aidpeopletoget
offState
assistance
Expand/grow
currentworking
efforts
Healthyandsafe
wateractivities
Texting
emergency
servicesforteens
andyoungadults
Community
involvement
Increase
volunteerism
Proactively
increasetrauma
informed
communities
Traumainformed
communities
NORTHERNMICHIGANCOMMUNITYHEALTHASSESSMENT&IMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONINANTRIMCOUNTYONOCTOBER16,2015
What can we do here in Antrim County to move closer to our vision of a healthy community?
Enthusiastic
allyprovide
trainingand
education
opportunities
across
lifespan
Intentionally
increase
accessto
affordable
childcare
Strategically
plan
affordable
housing
Thoughtfully
promote
youth
activities
Accessto
financeand
budget
counselingin
schools
More
educationon
lifeskillsin
schools
Accessto
vocational
education
opportunity
Accessto
affordable
childcare
Accessto
affordable
housing
Engage
youthin
activelife
Styles
Preschool
accessand
support
(cost)
Increasein
safe,
affordable
housing
Developing
saferec
activitiesfor
youth
Affordable
childcare(all
hours/nights
and
weekends)
Retirement
housingfor
seniors
Appropriate
teen
activities
Accessto
auto
insurance
anddrivers
education
Easieraccess
tooutlying
services
Bettercareer
planningata
youngage
Utilize
retiredto
teachyouth
lifeskills(ie,
cooking)
Better
educational
opportunities
within
county
Supportfor
small
businesses
Continually
provide
community
Intentionally
increase
accessto
behavioral
health
services
Building
Substance
stronger
abuse
familyvalues supportand
prevention
Actively
promote
health
insuranceto
increase
accessto
care
Increasein
residents
withhealth
insurance
Ongoing
healthyliving
educfreefor
families
Address
depression
Offeringsfor
faithbased
parenting
skills
programs
transportation
options
Increase
accessto
non
emergency
transport
Crosscounty
transportatio
nincluding
weekends
Clearly
increase
awareness
of
community
resources
Broaden
conversation
authentic
voices
Thoughtfully
consider
challengesof
mobility
impairments
Strategically
increase
enforcement
coveragein
highcrime
areas
Increaselaw
enforcement
inhighcrime
areas
Improve
physical
accessfor
mobility
impaired
Information
about
community
resources
Consistently
promote
healthy
eatingand
nutrition
Accessto
affordable
healthyfood
Maintain
accessto
fresh,
healthyfood
affordable
Supportfor
agriculture
DUFBfarmer
markets
Continually
offerevents
to
strengthen
families
NORTHERNMICHIGANCOMMUNITYHEALTHANDIMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONONOCTOBER28,2015
What can we do here in Charlevoix and Emmet counties to move closer to our vision of a healthy community?
Intentionally
integratebehavioral
andphysicalhealth
Healthinfoexchange
(notnecessarily
electronic)
Behavioralhealthin
schoolsPreKtohigh
school
Preventionand
treatmentoftobacco
andsubstanceuse
Affordableaccessible
mentalhealthacross
ages
Recognizecurrent
programsforhuman
serviceneeds
Expandaccessto
SUDservices,
especiallyintegrated
Incentivesfor
preventivehealth
Accessibilityand
availabilityofhealth
care
Expandandpromote
CHWsand
Navigators
Accesstobehavioral
health
Addressdiabetesand
prediabetes
Increase
immunizationrates
Increasemental
healthservices
Affordableaccessible
dentalcare
Freeclinicorhealth
accessinginsurance
Effectivelypromote
andcoordinate
communityservices
Collaborationamong
publicandprivate
providers
Involvinglocal
governmentaspart
ofthesolution
Educatecommunity
onavailable
programs
Effectivecommunity
outreachof
svcs/resources
Increaseawareness
ofservices
Mediacampaigns
sharedmessaging
Energetically
promotehealthy
living
Foodsystems
coordinatorforgood
food
Decreaseobesity,
increaseexercise,
healthyfoods
Accessibilityto
farmersmarketsand
healthyfood
Promotefree
recreational
opportunities
Freeandaccessible
physicalactivity
opportunities
Reducingscreen
timeforkidsandall
Strategically
developEconomic
Plan
Requirededucation
forassistance
programs
Taxbreaksfor
diversifiedbusiness
(new)
Accesstoquality
stablechildcareesp
infants
Developingcareers
Socialmediasharing
network
Easyaccessto
healthyfoods
Accesstotechnology
Diversestakeholder
groups
Saferoutesfor
walkingandbicycling
Cleanindustryjobs
Coordinated
outreach
Cleanhealthy
environment
Careerandjobfairs
Antistigma
campaign
Accesstoaffordable
andhealthyfoods
Bringbackactive
communitycenters
Accesstoaffordable
qualitychildcare
Livingwagejobs
yearround
Regularlyprovide
healthandwellness
education
Healthandsex
educationacrossthe
ages
Constructivespace
foryouth
Mindfullytransform
intoinclusive
community
Decreasestigma
engageatrisk
populations
Violencefree
communities
Educationvalued
Endingviolence
againstwomen
Promotereading
freemultiple
libraries
Educationongood
healthhabits
Supportivenetwork
forLGBTpopulation
Schoolattendance
Compassionand
understandingforall
Deliberatelyplanfor
public
transportation
Accessto
transportation
Continuouslycreate
affordablehousing
options
Affordablehousing
Public
transportationnon
emergencymedical
Improved
transportation
betweencounties
Publictransportation
Affordable
integratedhousing
Safeandaffordable
housing
Purposefully
prepareforaging
population
Eldercareand
healthyliving
options
Preparednessfor
agingboomer
population
NORTHERNMICHIGANCOMMUNITYHEALTHANDIMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONONSEPTEMBER28,2015INMONTMORENCYCOUNTY
What can we do here in Montmorency County to move closer to our vision of a healthy community?
Consistently
Strategically
educatethe
promote
community
economics
Healtheducation Healthysalaried
forchronicissues employees:
betterjobs,
insurance
Substanceabuse More
educationinthe
competitivepay
schools
jobs
Education
Affordable
training
housing
Healthyliving
accessforadults
Kidseatingand
growingown
salads
School
involvement:
FridayFolders
withtips
Newspaper/radio
adshealthy
reminders
Educateentire
community,kids
included
More
information
educationevents
Diabetes
education
Strategically
increaseto
physical
activities
Localaccessto
exercise
Improved
walking,hiking
bikingpaths
Walkable
community
Physicalactivity
forseniors
Thoroughly
involve
community
Collaboration
Reachoutto
businesseswith
specificwaysto
provideheld
Incentive
programto
reacheveryone
inthe
community
Community
gardens
Noincomeor
insurance
restrictionson
services
High
accountability
forprescription
rates
Youthactivities
tostayhealthy
Strategically
provide
preventive
education
Prenatalin
community
Boldlyincrease
awarenesson
substance
abuse
Rehabaccesson
Medicare
Freepreventive
medicalservices
forallyouth
Narconkits
Prediabetes
education
Carefullyplan
transportation
options
Accesstonon
busbased
transportation
Transportation
focusgroup
Intentionally
recruithealth
care
professionals
Recruitmentof
healthcare
professionals
Mentalhealth
supportand
followup
Expertly
develop
infrastructure
technology
Betterinternet
structure:cell
andinternet
Intentionally
monitorairfor
pollutants
Cleanair
Zealously
increase
awarenessof
abuse
Declineinchild,
spouseand
elderabuse
NORTHERNMICHIGANCOMMUNITYHEALTHANDIMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONONSEPTEMBER16,2015INOTSEGOCOUNTY
What can we do here in Otsego County to move closer to our vision of a healthy community?
Strategically
Promoteself
sufficiency
Aggressively
promoteschool
health
programs
Promo/accessto Includemore
allcommunity
subuse
resources
programsto
youthinschools
Mentoring/
Opportunities
supportsystems formentor
forindividuals
programs
andfamilies
Connect
TutoringforK
servicesto
12community
thoseinneed
involvement
withschoolsand
mentoring
Createpositive
Healthier
interactions
lifestylepromo
withlaw
inschools
enforcement
Responsible
Afterschool
citizenry
activitiesfor
children
Engaging
communityin
physicalactivity
Supportfor
homeless
Betterinsurance
outreachand
understanding
Promotelocal
farmersmarket
andencourage
EBTaccess
Morecomm
activitiesthat
promote
healthier
lifestyle
Freehandicap
accesstoall
beaches(Moby
Mats)
Recycleoffood
andother
products
Affordable
housing
Navigatingthe
healthcare
system
Lifeskills
development
Accessto
healthyrecipes
Public
awarenessof
homeless
Opportunities
forspiritual
growth
Supportversus
enabling
Encourage
community
volunteering
Accessto
budgeting
programs
Freerecreation
activitiesforall
children
Make
immunization
mandatory
Bringlocalfoods
intoschools
Consistently
promote
healthylifestyle
Economically
createhousing
Homeless
shelter
Transitional
housing
Community
involvement
withaffordable
housing
Clearlyinterpret
healthcare
Regularly
access
behavioral
health
Increasemental
healthaccess
Respectfully
supportyoung
families
Onevoice:
public,private,
charitable
Educational
opportunities
forpregnant
mothers
Update
guidelinesfor
daycare
assistance
Lifeskills:
groceryshop,
checking
account,rent
apartment,etc
Affordablegood
daycarewith
accesstolocal
resources
Increase
behavioral
healthproviders
andspecialists
Helpwith
Increase
prescriptionand behavioral
healthcosts
healthspecialist
(overinsurance) coverage
SupportUnited
Way
Encourageand
bringmore
doctorstothe
community
Encouragelocal
doctorstomake
housecallsto
shutins
Unifyinghuman
service
programs
Accessto
domestic
violence
counseling
Coordinate
betweensub
useprovider
andlegal
system
Advocacyand
awarenessof
benefits
Seniorhome
careadvocacy
Offerfree
healthylifestyle
classes
Offerhealthy
lifestylesin
schoolstoyouth
Intentionally
advocate
community
Continually
provide
transportation
Strategically
attractecon
growth
Affordable,
reliable
transportation
Opportunities
forfinancial
growth
Accessto
transportation,
awarenessof
options
24houraccess
tocommunity
transportation
Goodjobswith
livingwage
Regional
transportation
Financingadult
gapprograms,
ie,GED,drivers
license,gas
cards
NORTHERNMICHIGANCOMMUNITYHEALTHANDIMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONONSEPTEMBER22,2015INPRESQUEISLECOUNTY
What can we do here in Presque Isle to move closer to our vision of a healthy community?
Continuously
involve
community
Intentionally
initiate
collaboration
Creating
free/affordable
activitiesfor
families
Collaborationof
communityto
achievemore
withless
Need/indentify
community
champion
Schoolsmore
thaneducation
institution
community
center
Affordable
exerciseand
wellness
programs
Familyfriendly
events
Promote
community
activities
Beactiveinthe
community
Makeresources
readilyavailable
Collaboratewith
otheragencies
More
cooperation
betweenschool
systems;share
resources
Continually
providesupport
tolocalcitizens
Boldlyassure
accesstohealth
care
Enthusiastically
market
opportunities
Informal
support
peopleto
people
Physician
recruitment
Jobfairsand
healthfairs
Supportfor
family
caregivers
training,respite
andsupport
Affordable
assistedliving
Urgentcare
Liftingstigmafor
utilizing
resources(re
marketing)
Economic
Development
Committee,
partnershipsfor
business
Morecitizens
involvedin
decisionmaking
groups
Betteraccess to
mentalhealth
servicesin
schools
Healthcare
facilitiesmeet
andgreet
Supportfrom
localofficials
andlegislators
Educational
navigators
(volunteers)for
community
resources
Affordable
housingforlow
income
Officiallyseek
politicalvoice
Strategically
offertraining
Strategically
increaseaccess
tolocalfood
Childhood
educational
programsand
sessions
Utilizelocal
produce/farmers
forlocaleateries
Trauma
informed
training
Moretechnical
helpforlocal
farmersto
acceptBridge
Cards
Youthmental
healthfirstaid
training
Thoroughly
offerhealthand
wellness
optionsat
schools
TipoftheWeek
inFridayFolders
Healthyeating
programsin
schools
Considerably
enhance
transportation
options
Better
availabilityof
public
transportation
Affordable
transportation
outsidecity
limits
Enthusiastically
createhealthy
activities
Afterschool
activitiesfor
youngpeople
notinvolvedin
sports
Activitiesthat
involveparents
andmulti
generations
ATTACHMENT B
WHAT MATTERS TO YOU? COMMUNITY SURVEY REPORT
Q1 Please check the THREE most important factors needed for a healthy community.
Answered: 1,217
Skipped: 3
Access to
affordable healty
foods
Access to health
care
Affordable housing
Clean environment
Community
involvement
Good schools/high
value on education
Healthy lifestyles
Opportunities
for social/emotional
support
Parks and
recreation
Safe
neighborhoods
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Answer Choices
Access to health care, including primary care, specialty care, behavioral health services and dental care
Affordable housing
Clean environment
Community involvement
Goodjobsandhealthyeconomy
Goodschools/highvalueoneducation
Healthylifestyles
Lowlevelsofchildabuse
Opportunitiesforsocialand/oremotionalsupport
Parksandrecreation/accesstophysicalactivity
Safeneighborhoods
Strongfamilylife
TotalRespondents:1,217
Responses
33.61%
409
68.28%
831
27.03%
329
10.93%
133
5.01%
61
49.79%
606
28.18%
343
17.83%
217
6.98%
85
8.55%
104
10.27%
125
14.71%
179
21.04%
256
Q2 Please check the THREE most important community health problems in your county.
Answered: 1,215
Skipped: 5
Aging
problems
Chronic
diseases
Chronic pain
Homelessness
Infectious disease
Injury/trauma
Lack of access to
affordable heatlhy
food
Lack of access to
primary care
Lack of
affordable housing
Lack of physical
activity
Rape/sexual assault
Sexually
transmitted diseases
Substance
abuse
Suicide
Teenage pregnancy
Unsafe home
environment
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Answer Choices
Responses
14.57%
177
33.09%
402
Chronic pain
4.77%
58
Homelessness
9.05%
110
Infectious disease
1.07%
13
Injury/trauma
1.56%
19
15.97%
194
Lack of access to primary care, specialty care, behavioral health services or dental care
23.37%
284
24.44%
297
15.06%
183
26.42%
321
41.07%
499
Rape/sexual assault
1.32%
16
1.15%
14
48.15%
585
Suicide
2.72%
33
Teenage pregnancy
7.08%
86
13.17%
160
Unsafe home environment (child abuse and neglect and domestic violence)
11.85%
144
Q3 Please check all the problems adults, older adults, and children in your family are having in getting health care services.
Answered: 1,002
Skipped: 218
ER waiting time
Finding a behavioral
health provider
Finding a dentist
Finding a doctor
Getting pregnancy
care
Getting specialist
care
Health insurance
coverage is limited
Health insurance
does not cover
bevavioral health
Health insurance
does not cover
dental
Physician dropped me as
a patient for missed
appointments
Transportation issues
0%
10%
20%
30%
40%
Adults
Older adults
Children
50%
60%
70%
80%
90%
100%
Adults
Cannot afford visits to doctor,clinic, and/or hospital
ER waiting time
Finding a dentist
Finding a doctor
Transportation issues
Older adults
Children
Total Respondents
81.84%
38.29%
26.04%
374
175
119
73.15%
44.36%
32.68%
188
114
84
83.14%
32.57%
37.71%
291
114
132
71.76%
47.65%
27.65%
122
81
47
86.74%
56.27%
60.93%
242
157
170
79.34%
42.07%
53.87%
215
114
146
73.08%
39.10%
37.18%
114
61
58
80.60%
42.29%
36.82%
162
85
74
89.04%
16.44%
15.07%
65
12
11
80.81%
46.86%
43.17%
219
127
117
85.12%
43.72%
38.14%
366
188
164
86.89%
53.88%
52.91%
179
111
109
81.82%
45.78%
36.36%
252
141
112
77.73%
61.33%
34.77%
199
157
89
91.31%
42.02%
36.17%
515
237
204
81.60%
39.20%
33.60%
204
98
84
83.75%
41.25%
27.50%
67
33
22
91.74%
23.91%
22.17%
211
55
51
63.79%
75.86%
39.08%
111
132
68
457
257
350
170
279
271
156
201
73
271
430
206
308
256
564
250
80
230
174
Q4 Have you or any member of your immediate family ever been told by a doctor or other health professional that you have
any of the following? Check all that apply.
Answered: 1,064
Skipped: 156
Alcoholism or
other addiction
Arthritis
Asthma
Cancer
Chronic pain
Dental health
problems
Diabetes/predia
betes
Hearing
problems
Heart
disease/hear...
High blood
pressure
High
cholesterol
Kidney disease
Lung
disease/COPD
Overweight/Obes e
Stroke
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
You
You
Alcoholism or other addiction
Total Respondents
9.47%
94.21%
190
Arthritis
56.52%
63.56%
483
Asthma
47.02%
63.10%
336
Cancer
20.83%
83.04%
336
Chronic pain
44.65%
71.56%
327
45.96%
77.02%
322
Diabetes/prediabetes
28.80%
79.58%
382
Hearing problems
22.67%
82.67%
300
11.88%
90.43%
303
42.37%
76.73%
649
High cholesterol
44.26%
71.56%
531
Kidney disease
11.27%
88.73%
71
Lung disease/COPD
17.36%
88.19%
144
Overweight/Obese
69.75%
65.30%
562
Stroke
12.32%
88.41%
138
Q5 How long has it been since your most recent visit /care experience?
Answered: 945
Skipped: 275
Less than 1
month
At least 1 month
but less than 3
months
At least 3
months but less
than 6 months
At least 6
months but less
than 12 months
12 months or
more
0%
Answer Choices
30%
40%
50%
60%
70%
80%
90%
100%
Responses
27.72%
262
25.71%
243
15.56%
147
21.06%
199
12 months or more
9.95%
94
Total
20%
10%
945
Q6 Where was your most recent visit/care experience?
Answered: 903
Skipped: 317
General/Family
Physician
Specialist
Health
Department
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Answer Choices
Responses
General/Family Physician
78.07%
705
Specialist
23.81%
215
Health Department
1.11%
10
Q7 How many visits have you had with this provider?
Answered: 941
Skipped: 279
2-4 visits
5 or more
visits
0%
Answer Choices
20%
30%
40%
50%
60%
70%
80%
90%
100%
Responses
12.54%
118
2-4 visits
31.35%
295
5 or more visits
56.11%
528
Total
10%
941
Q8 Do you have a primary care/family physician?
Answered: 945
Skipped: 275
Yes
No
Uncertain
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Answer Choices
Yes
91.75%
867
No
6.67%
63
Uncertain
1.59%
15
Total
Responses
945
Q9 Following is a series of characteristics which may describe your health care visit. Please indicate how important the characteristic
is to you.
Answered: 944
Skipped: 276
Health Care
Provider expresses
understanding of my values
Health Care
Provider shows respect for
my opinions
Health Care
Provider helps me
understand options
Health Care
Provider involves me in
decisions
Health Care
Provider spends enough
time with me
0.2
0.4
0.6
0.8
1.2
1.4
1.6
1.8
Very
important
Somewhat
important
77.81%
18.68%
733
176
86.53%
816
Neither
Important nor
Unimportant
Somewhat
Unimportant
Very
Unimportant
2.65%
0.21%
0.64%
25
11.66%
1.17%
0.32%
0.32%
110
11
92.77%
6.27%
0.43%
0.21%
0.32%
873
59
91.19%
7.64%
0.64%
0.21%
0.32%
859
72
91.63%
7.52%
0.21%
0.21%
0.42%
865
71
Total
Weighted
Average
942
1.27
943
1.16
941
1.09
942
1.11
944
1.10
Q10 How would you rate your most recent visit/care experience with regard to each characteristic?
Answered: 939
Skipped: 281
Health Care
Provider expresses
understanding of my values
Health Care
Provider shows respect for
my opinions
Health Care
Provider helps me
understand option
Health Care
Provider involves me in
decision-making
Health Care
Provider spends enough
time with me
0.2
0.4
0.6
0.8
1.2
1.4
1.6
1.8
Excellent
Above
Average
Average
Below
Average
Poor
60.66%
24.41%
12.69%
1.60%
0.64%
569
229
119
15
63.79%
23.22%
9.69%
2.56%
0.75%
599
218
91
24
62.47%
24.73%
10.13%
1.92%
0.75%
586
232
95
18
64.74%
22.76%
9.83%
1.92%
0.75%
606
213
92
18
63.82%
20.38%
11.95%
2.24%
1.60%
598
191
112
21
15
Total
Weighted
Average
938
1.57
939
1.53
938
1.54
936
1.51
937
1.57
Q11 Please consider your most recent health care visit/experience. Then, for each of the following statements, rate your level of
agreement with how each statement reflects that most recent experience with the Health Care Provider/Physician.
Answered: 936
Skipped: 284
Health Care
Provider demonstrated
knowledge
Health Care
Provider expressed
understanding
Health Care
Provider asked questions
about my preferences
Health Care
Provider listened carefully
Health Care
Provider explained things so I
could understand
0.2
0.4
0.6
0.8
1.2
1.4
1.6
1.8
Strongly
Agree
Somewhat
Agree
63.14%
25.53%
591
239
65.92%
617
Neither
Agree nor
Disagree
Somewhat
Disagree
Strongly
Disagree
N/A
6.84%
2.56%
1.50%
0.43%
64
24
14
22.22%
7.91%
2.14%
1.18%
0.64%
208
74
20
11
65.67%
21.28%
7.70%
3.64%
1.50%
0.21%
614
199
72
34
14
69.55%
20.62%
6.30%
1.60%
1.71%
0.21%
651
193
59
15
16
76.55%
18.31%
3.64%
1.18%
0.32%
0.00%
715
171
34
11
Total
Weighted
Average
936
1.53
936
1.49
935
1.54
936
1.45
934
1.30
Q12 Again, please consider your most recent health care visit/experience. Then, for each of the following statements, rate your level
of agreement with how each statement reflects that most recent experience with the Staff/Care Team.
Answered: 936
Skipped: 284
10
Somewhat
Disagree
Strongly
Disagree
N/A
Strongly
Agree
Somewhat
Agree
71.90%
19.87%
4.38%
2.46%
1.18%
0.21%
673
186
41
23
11
69.12%
20.09%
6.41%
1.28%
0.96%
2.14%
647
188
60
12
20
45.55%
16.61%
14.04%
6.22%
3.75%
13.83%
425
155
131
58
35
129
46.36%
18.95%
9.21%
6.75%
3.53%
15.20%
433
177
86
63
33
142
27.07%
15.04%
20.62%
6.55%
10.63%
20.09%
252
140
192
61
99
187
38.84%
20.49%
23.61%
3.97%
2.79%
10.30%
362
191
220
37
26
96
Neither
Agree nor
Disagree
Total
Weighted
Average
936
1.41
936
1.41
933
1.91
934
1.85
931
2.48
932
2.01
concerns
Staff are accessible during the standard lunch hour
(12pm-1pm)
The care team (Physician, Nurse, Physician's
Assistant) demonstrated that my health information
was shared among members of the team
Q13 Please indicate how much you feel each of the following is a barrier to getting the health care that you need, or makes it more
difficult.
Answered: 1,165
Skipped: 55
Availability of information
health care resources
Availability of information
cost of health care
Coordination of resources
Access to affordable
health care
Availability of
transportation
10
Major Barrier
Availability of information on area health care resources
Availability of transportation
Minor Barrier
Not a Barrier
NA
Total
8.65%
30.51%
53.97%
6.87%
97
342
605
77
25.49%
38.10%
30.73%
5.68%
287
429
346
64
17.08%
37.21%
38.55%
7.16%
191
416
431
80
26.95%
30.23%
37.23%
5.59%
304
341
420
63
19.64%
23.14%
34.35%
22.87%
219
258
383
255
8.36%
9.98%
62.86%
18.79%
93
111
699
209
9.07%
10.23%
40.31%
40.39%
101
114
449
450
2.71%
7.85%
61.73%
27.71%
30
87
684
18.80%
31.60%
39.36%
213
358
446
307
Weighted Average
1,121
2.59
1,126
2.17
1,118
2.36
1,128
2.21
1,115
2.60
1,112
2.92
1,114
3.12
1,108
3.14
1,133
2.41
10.24%
116
Q14 Where do you get health information?
Answered: 1,208
Skipped: 12
Doctor or
health clinic
Family or
friends
Health
Department
Internet
Newspapers or
magazines
Radio
Television
0%
Yes
10%
20%
Sometimes
30%
No
40%
50%
60%
70%
80%
90%
100%
Yes
Doctor or health clinic
Family or friends
Health Department
Internet
Newspapers or magazines
Radio
Television
Sometimes
No
Total
79.15%
19.77%
1.09%
945
236
13
29.14%
51.73%
19.13%
329
584
216
20.64%
28.60%
50.76%
231
320
568
45.37%
45.71%
8.92%
524
528
103
14.68%
42.11%
43.21%
161
462
474
8.99%
28.07%
62.94%
98
306
686
11.11%
36.43%
52.46%
122
400
576
1,194
1,129
1,119
1,155
1,097
1,090
1,098
Q15 Please tell us about yourself. This anonymous personal health information helps us to plan programs and services where
they are needed. In which of the following counties do you live?
Answered: 1,220
Skipped: 0
Answer Choices
Alcona
Alpena
Antrim
Benzie
Charlevoix
Cheboygan
Crawford
Emmet
Montmorency
Newaygo
Oceana
Ogemaw
Oscoda
Otsego
PresqueIsle
Responses
0.00%
10.98%
5.41%
0.00%
0
134
66
0
17.62%
215
14.67%
179
0.00%
28.20%
344
1.80%
22
0.00%
0.00%
0.00%
0.00%
17.79%
217
3.52%
43
Skipped: 21
18-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Answer Choices
Responses
18-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
6064
6569
7074
75+
Total
91
9.01%
108
9.84%
118
9.42%
113
9.76%
117
10.26%
123
15.18%
182
14.76%
177
10.26%
123
2.67%
32
0.83%
10
0.42%
1,199
7.59%
Skipped: 4
High school
graduate/vocational
Some college
College graduate
Post
college/secondary
Refused
(VOLUNTEERED)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Answer Choices
0.16%
2.47%
30
13.90%
169
Some college
24.34%
296
College graduate
42.11%
512
17.02%
207
Refused (VOLUNTEERED)
0.00%
Total
Responses
0
1,216
Skipped: 54
Less than
$15,000
$15,000 $34,999
$35,000 $74,999
$75,000 $99,999
$100,000 or
more
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Answer Choices
Responses
8.32%
97
$15,000 - $34,999
21.27%
248
$35,000 - $74,999
37.31%
435
$75,000 - $99,999
16.64%
194
$100,000 or more
16.47%
192
Total
1,166
Skipped: 12
Yes
No
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Answer Choices
Yes
95.20%
No
4.80%
Total
Responses
1,150
58
1,208
Skipped: 12
White
Black or
African America
American
Indian or Alaska
Native
Asian
Native
Hawaiian or
Pacific Islander
Hispanic or
Latino
0%
10%
20%
30%
40%
50%
60%
70%
Answer Choices
90%
100%
Responses
White
97.35%
0.17%
1.74%
21
Asian
0.17%
0.08%
Hispanic or Latino
0.66%
1.49%
18
80%
1,176
Q21 Gender
Answered: 1,213
Skipped: 7
Male
Female
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Answer Choices
Male
12.94%
157
Female
87.06%
1,056
Total
Responses
1,213
ATTACHMENT C
HEALTH CARE PROVIDER SURVEY REPORT
Q1 Check the three most important factors needed for a "healthy community."
Answered: 81
Skipped: 0
Access to
affordable healthy
foods
Access to health
care
Affordable
housing
Clean
environment
Community
involvement
Good
schools/high
value on
education
Healthy lifestyles
Low levels of
child abuse
Opportunities for
social/emotional
support
Parks and
recreation
Safe
neighborhoods
0%
10%
20%
30%
40%
50%
Answer Choices
Access to health care, including primary care, specialty care, behavioral health services and dental care
Affordable housing
Clean environment
Community involvement
Goodjobsandhealthyeconomy
Goodschools/highvalueoneducation
Healthylifestyles
Lowlevelsofchildabuse
Opportunitiesforsocialand/oremotionalsupport
Parksandrecreation/accesstophysicalactivity
Safeneighborhoods
Strongfamilylife
TotalRespondents:81
60%
70%
80%
90%
100%
Responses
20.99%
17
67.90%
55
12.35%
10
11.11%
7.41%
48.15%
39
40.74%
33
39.51%
32
2.47%
11.11%
8.64%
9.88%
17.28%
14
Q2 Check the three most important community health problems in the county you live in.
Answered: 81
Skipped: 0
Aging problems
Chronic disease
Chronic pain
Homelessness
Infectious
Disease
Injury/trauma
Lack of access to
affordable healthy
food
Lack of access to
primary care
Lack of
affordable housing
Rape/sexual assault
Sexually
transmitted disease
Substance abuse
Suicide
Teenage
pregnancy
Tobacco use
Unsafe home
environments
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Answer Choices
Responses
Aging problems
13.58%
11
Chronic disease
24.69%
20
Chronic pain
8.64%
Homelessness
0.00%
Infectious Disease
0.00%
Injury/trauma
2.47%
7.41%
Lack of access to primary care, specialty care, behavioral health services or dental care
40.74%
33
8.64%
18.52%
15
45.68%
37
56.79%
46
Rape/sexual assault
0.00%
0.00%
Substance abuse
27.16%
22
Suicide
1.23%
Teenage pregnancy
0.00%
Tobacco use
39.51%
32
2.47%
Total Respondents: 81
Skipped: 0
Alpena
Regional Hospital
Charlevoix
Area Hospital
Gerber
Memorial Health
Kalkaska
Memorial Health
McLaren
Northern Michigan
Mecosta County
Medical Center
Memorial
Medical Center
Mercy Health
Partners
Munson
Healthcare Cadillac
Munson
Healthcare Grayling
Munson Medical
Center
Otsego
Memorial Hospital
Paul Oliver
Memorial Hospital
St. Joseph
Health System
West Branch
Regional Medical
West Shore
Medical Center
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0.00%
19.75%
16
0.00%
0.00%
60.49%
49
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
19.75%
16
0.00%
0.00%
0.00%
0.00%
Total
81
Alcona County
Alpena County
Antrim County
Benzie County
Charlevoix
County
Cheboygan
County
Crawford County
Emmet County
Grand Traverse
County
Iosco County
Kalkaska County
Lake County
Leelanau County
Manistee County
Mason County
Mecosta County
Missaukee
County
Montmorency
County
Newaygo County
Skipped: 0
Oceana County
Ogemaw County
Oscoda County
Otsego County
Presque Isle
County
Roscommon
County
Wexford County
0%
Answer Choices
Alcona County
Alpena County
Antrim County
Benzie County
Charlevoix County
Cheboygan County
Crawford County
Emmet County
Iosco County
Kalkaska County
Lake County
30%
40%
50%
60%
70%
80%
90%
100%
Responses
0.00%
1.25%
2.50%
0.00%
26.25%
21
6.25%
1.25%
52.50%
42
0.00%
0.00%
0.00%
0.00%
0.00%
0
0
Mason County
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Manistee County
Mecosta County
Missaukee County
Montmorency County
Newaygo County
OceanaCounty
OgemawCounty
OscodaCounty
OtsegoCounty
PresqueIsleCounty
RoscommonCounty
WexfordCounty
20%
0.00%
Leelanau County
Total
10%
10.00%
0.00%
0.00%
0.00%
80
Skipped: 2
Primary Care
Specialty Care
0%
Answer Choices
20%
30%
40%
50%
60%
70%
80%
90%
100%
Responses
Primary Care
39.24%
31
Specialty Care
60.76%
48
Total
10%
79
ATTACHMENT D
ISSUE BRIEFS
HEALTHDISPARITIESANDDETERMINENTSOFHEALTH
Americabenefitswheneveryonehastheopportunitytolivealong,healthyandproductivelife,yethealthdisparities
persist.Ahealthdisparityisadifferenceinhealthoutcomesacrosssubgroupsofthepopulation.Healthdisparitiesare
oftentodeterminantsofhealthsocial,economic,orenvironmentaldisadvantages,suchaslessaccesstogoodjobs,
unsafeneighborhoods,orlackofaffordabletransportationoptions.Healthdisparitiesadverselyaffectgroupsofpeople
whohavesystematicallyexperiencedgreaterobstaclestohealthonthebasisoftheirracialorethnicgroup;religion;
socioeconomicstatus;gender;age,mentalhealth;cognitive,sensory,orphysicaldisability;sexualorientationorgender
identity;geographiclocation,orothercharacteristicshistoricallylinkedtodiscriminationorexclusion.Manyhealth
concerns,suchasheartdisease,asthma,obesity,diabetes,HIV/AIDS,viralhepatitisBandC,infantmortality,and
violence,disproportionatelyaffectcertainpopulation.Reducingdisparitiesinhealthwillgiveeveryoneachancetolivea
healthylifeandimprovethequalityoflifeforallAmericans.
KeyFacts:
Avarietyofhealthrelatedhazardsare
RuralAmericansareapopulationgroupthatexperiencessignificant
disproportionatelyfoundinlowincome
healthdisparities,suchashigherincidenceofdiseaseanddisability,
housing,includingmold,allergens,poor
increasedmortalityratesandlowerlifeexpectancy,andhigherrates
indoorairquality,structuraldeficiencies
ofpainandsuffering.Socialdeterminantsofhealthinruralareas
andleadcontamination
includegeographicisolation,lowersocioeconomicstatus,higher
Workrelatedfactors,including
ratesofhealthriskbehaviors,andlimitedjobopportunities.Rural
occupationalexposurestochemicals,
residentsaremorelikelytohaveanumberofchronicconditionsand
physicaloverexertion,excessiveheator
arelesslikelytoreceiverecommendedpreventiveservices,inpart
cold,noiseandstressorjobstraincan
duetolackofaccesstophysiciansandhealthcaredeliverysites
createorworsenavarietyofhealth
and/oradequatetransportationoptions.
problems,includingcancer,COPD,
asthma,andheartdisease.
Apersonsdecisionsareinfluencedby
Education,employment,andhealthareinextricablylinked.Without
howchoicesarepresented.Forexample,
agoodeducation,prospectsforastableandrewardingjobwith
presentingfruitinamoreattractiveway
goodearningsdecrease.Educationisassociatedwithlivinglonger,
toschoolchildrencanmorethandouble
experiencingbetterhealth,practicinghealthpromotingbehaviors
theamountoffruittheypurchase.
suchasexercisingregularly,refrainingfromsmoking,andobtaining
Onaverage,adultswithseriousmental
timelyhealthcheckupsandscreenings
illnessdie25earlierthantheirpeers,
largelyduetopreventablehealth
conditions
Morethan80millionintheUSdonot
Theburdenofchronicdiseaseisdisproportionatelydistributed
haveaccesstofluoridatedwater.
acrossthepopulation.Therearesignificantdisparitiesbasedon
Fluoridatedwaterreducestoothdecayby
gender,age,race/ethnicity,geographicareaandsocioeconomic
25%inchildrenandadults.Forevery$1
spentonfluoridationsavesmorethan$40 status.Diseasedoesnotoccurinisolation,andchronicdiseaseinno
exception.Chronicdiseaseissignificantlyinfluencedbythephysical,
indentaltreatmentcosts
socialandpoliticalenvironment,includingmaternalandchildhealth,
Lesbian,gay,bisexualandtransgender
accesstoeducationalopportunities,availabilityofhealthyfoods,
individualsmaybeatincreasedriskfor
physicaleducationandextracurricularactivitiesinschools,accessto
healthriskbehaviors.However,onlya
healthyfoods,qualityofworkingconditionsandworksitehealth,
limitednumberofreportsinclude
availableofcommunitysupportandresourcesandaccessto
informationonsexualorientation
affordable,qualityhealthcare.
Rurality
HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties
TipoftheMittData
Rurality: TheUSCensusBureaudesignatesall8tipofthemittcountiesasrural.Overall,thereare23.6personsper
squaremilelivingintheregion;statewide,thereare174.8personspersquaremile.
Ethnicity/Race: Population(183,997)ispredominantlywhite;largestminoritygroupsareNativeAmericansand
Hispanic/Latino
Age: 36,314residentsofthe8countyregionareage017(20%)and147,683are18+.With20%ofthepopulationage
65+inNorthwestcountiesand24%inNortheastcounties,ageskewsolder,whencomparedtotheState(15%)andthe
segmentisgrowingfaster
Education: Graduationratesinthe8countiesexceedState(79%)exceptinAlpena(73%)andrangeupto92%inPresque
IsleCounty.TheproportionofthepopulationwhohasearnedatleastaBachelordegreerangesfrom10%in
MontmorencyCountyto32%inEmmetCounty.Montmorency(10%),Alpena(16%),Cheboygan(16%),PresqueIsle
(16%),Otsego(20%)andAntrim(24%)arebelowState(26%).
Housing: Theproportionofrenterswhospend30%ormoreofhouseholdincomeonrentrangesfrom40%inPresqueIsle
Countyto69%inMontmorencyCounty.RatesforAntrim(58%)andMontmorency(69%)areaboveStaterate(55%).
Income: Medianhouseholdincomerangesfrom$42,632inMontmorencyCountyto$61,664inEmmetCounty,hoveringat
orexceedingState($48,411)inallbutMontmorency($42,632)andCheboygan($46,010)andPresqueIsle($46,601)
Poverty: TheproportionoffamilieswholivebelowtheFederalPovertyLevelrangesfrom7%inEmmetCountyto13%in
AlpenaandCheboygancounties,whichslightlyexceedStaterate(12%).
CommunityConversations
117communitymembersandrepresentativesfromlocalhealthdepartments,hospitalsandotherhealthcareproviders,
socialserviceagencies,schools,business,andgovernmentparticipatedinaCommunityConversation.Theiranswerstothe
questionWhatcanwedohereinthiscountytomoveclosertoourvisionofahealthycommunity?,includedmanyissues
relatedtodeterminantsofhealth,suchasattractingeconomicgrowthandincreasingoptionsforaffordablehousing,
transportation,andchildcare,increasinglawenforcementinhighcrimeareas.
Alpena
Antrim
Charlevoix
Cheboygan
Emmet
Montmorency
Otsego
PresqueIsle
X
X
X
X
X
X
X
X
WhatMatterstoYou?SurveyN=1,220
Themostimportantfactorsneededforahealthycommunityaccordingtocommunitysurveyrespondentsare,inrankorder:
1)accesstohealthcare;2)goodjobsandhealthyeconomy;3)accesstoaffordablehealthyfoods;4)goodschools/highvalue
oneducation;and5)affordablehousing.Themostimportantcommunityhealthproblemsintheircountywere:1)substance
use;2)overweightandobesity;3)chronicdisease;4)mentalhealthissues;5)lackofaffordablehousing.Manysurvey
respondentsnotedtheycannotaffordhealthcareservices(81%)andtransportationisabarriertogettingtoappointments
(63%).
HealthCareProviderSurveyN=126
Physicians,nursepractitionersandphysicianassistantsrankedaccesstohealthcare,goodjobs/healthyeconomy,healthy
lifestyles,goodschools/highvalueoneducation,andaccesstoaffordablehealthyfoodsasthetopfactorsneededfora
healthycommunity.Thetopcommunityhealthproblemsintheircountieswere:obesityandoverweight,mentalhealth
issues,lackofaccesstocare,andtobaccouse.
Northern
Health
Plan
ISSUEBRIEF:ACCESSTOHEALTHCARE
Accesstohealthservicesisimportantateveryage.Havingbothaprimarycareproviderandmedicalinsurancecan
preventillnessbyimprovingaccesstoarangeofrecommendedpreventiveservicesacrossthelifespan,fromchildhood
vaccinationstoscreeningtestsforcancerandchronicdiseases,suchasdiabetesandheartdisease.Havingaprimary
careproviderandmedicalinsurancealsoplaysavitalroleinfindinghealthproblemsintheirearliest,mosttreatable
stages,andmanagingapersonthroughthecourseofthedisease.Lackingaccesstohealthservicesevenforjusta
shortperiodcanleadtopoorhealthoutcomesovertime.
KeyFacts:
Almost1in4Americansdonothavea
regularprimarycareproviderorhealth
centerwheretheycanreceiveroutine
medicalservices
Lessthanhalfofolderadultsareupto
dateonacoresetofclinicalpreventive
services,includingcancerscreeningsand
immunizations
LessthanhalfofAmericanswith
hypertensionhaveadequatelycontrolled
bloodpressureandonlyonethirdwith
highcholesterolhaveitadequately
controlled.Improvingcontrolisoneofthe
mosteffectivewaystopreventheart
diseaseandstroke
Colorectalcanceristhesecondleading
causeofdeathintheU.S.Someestimates
suggestthatifscreeningimplementedat
recommendedlevels,morethan18,000
livescouldbesavedeachyear
Eachyear,asthmacoststheU.Sabout
$3.30perpersoninmedicalexpenses,
missedschool/workdaysandearlydeaths
Communityprogramsthatteachpeople
howtomanagetheirdiabetescanhelp
preventshortandlongtermhealth
conditions,enhancequalityoflife,and
containhealthcarecosts
Morethan80millionpeopleintheUSdo
nothavefluoridatedwater,whichreduces
toothdecayby25%inchildrenandadults.
Everydollarspentonfluoridationsaves
morethan$40indentaltreatmentcosts
Nationally,only44.5%(ageadjusted)of
peopleage2andolderhadadentalvisit
inthepast12months,aratethathas
remainedunchangedforthepastdecade
Health Insurance
Peoplewithoutmedicalinsurancearemorelikelytolackausual
sourceofmedicalcare,andaremorelikelytoskiproutinemedical
careduetocost,increasingtheirriskforseriousanddisablinghealth
conditions.Whenthedoaccesshealthservices,theyareoften
burdenedwithlargemedicalbillsandoutofpocketexpenses.
Oneofthebarrierstoaccessingtohealthcareisthehighcostof
medicalinsurance,deductiblesandcopays.Alackofmedical
servicesinsomecommunities,coupledwithashortageofprimarycareproviders,alsonegativelyaffectspeoplesability
toaccesshealthservices.Livinginaruralareaitselfisadeterminanthealth.Geographicisolation,fewertransportation
optionsandlimitedresourcescompoundaccessbarriers.
Adapted from Healthy People 2020 and the National Prevention Strategy
HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties
TipoftheMittData
Health Professions Shortage Areas: ThereareHealthProfessionsShortageAreasdesignatedinAlpena,Antrim,
Charlevoix,Cheboygan,Emmet,Montmorency,OtsegoandPresqueIslecountiesforprimarycare,behavioralhealth,
and/ordentalcare
Primary Care Provider Rate: FivecountieshaveprovidertopopulationratiosconsiderablybelowStaterate(80per
100,000):PresqueIsle(15);Antrim(34);Cheboygan(62)Montmorency(63);andOtsego(67).Unsurprisingly,counties
wherehospitalsarelocated,andmedicalpracticesareconcentrated,havehigherrates:86per100,000inAlpena
County,96per100,000inCharlevoixCounty,and134per100,000inEmmetCounty.
Health Insurance: Mostrecentdata(2013)forratesofinsuredfortheoveralladultpopulationrangefrom80%in
MontmorencyCountyto84%inOtsegoCounty.However,withtheimplementationoftheAffordableCareAct,the
federalHealthInsuranceMarketplaceopenedlatein2012andwassoonfollowedbytheStatesHealthyMichiganPlan.
AsofApril2015,virtually100%ofeligibleadultsfromthe8countyregionwereenrolledinoneoftheseprograms.The
proportionofchildrencoveredbyanyinsurancerangeshoversat9495%inalleightcounties,slightlybelowStaterate
of96%.
CommunityConversations
MajorForcesofChange
117communitymembersandrepresentativesfromlocal
healthdepartments,hospitalsandotherhealthcare
providers,socialserviceagencies,schools,business,and
governmentparticipatedinaCommunityConversationto
answerthequestion,Whatcanwedohereinthiscounty
tomoveclosertoourvisionofahealthycommunity?
Improvingaccesstohealthcareincludingprimarycare,
behavioralhealth,and/ororalhealthcare,wasidentifiedas
anactioninthefollowingcounties:
ALP ANT
CHXEM
CHB MON OTS
PI
Northern
Health
Plan
ISSUEBRIEF:CHRONICDISEASE
Chronicdiseaseresultsinseriousillnessanddisability,decreasedqualityoflife,andhundredsofbillionsofdollarsin
economiclosseveryyear.Heartdisease,stroke,cancer,diabetes,obesityandarthritis,areamongthemostcommon
andpreventableofallhealthproblems.Sevenofthetop10causesofdeathintheUSarechronicdiseaseandtwo
heartdiseaseandcancertogetheraccountfornearly48%ofalldeaths.TheriskofAmericansdevelopinganddying
fromchronicdiseasewouldbesubstantiallyreducedifmajorimprovementsweremadeintheUSpopulationindietand
physicalactivity,controlofhighbloodpressureandcholesterol,andsmokingcessation.
KeyFacts:
AboutofadultsintheUS117million
Healthyeatingcanhelpreducepeoplesriskforheartdisease,high
peoplehave1+chronicconditions.1in4
bloodpressure,diabetes,osteoporosisandseveraltypesofcancer,
adultshave2+chronicconditions
aswellashelpmaintainahealthybodyweight.Asdescribedinthe
LeadingcausesofdeathintheUSare
Dietary Guidelines for Americans,eatinghealthymeansconsuminga
heartdisease,cancerandstroke
varietyofnutritiousfoodsandbeverages,especiallyvegetables,
Highbloodpressureaffects1in3adults
fruits,fatfreedairyproductsandwholegrains;limitingintakeof
andmorethanofAmericanswithhigh
saturatedfats,addedsugars,andsodium;keepingtransfatintakeas
bloodpressuredonothaveitunder
lowaspossibleandbalancingcaloricintakewithcaloriesburnedto
control.
managebodyweight.Safeeatingmeansensuringthatfoodisfree
Arthritisisthemostcommoncauseof
fromharmfulcontaminants,suchasbacteriaandviruses
disability.Ofthe53millionadultswitha
diagnosisofarthritis,22millionsaythey
havetroublewiththeirusualactivities
Engaginginregularphysicalactivityisoneofthemostimportant
becauseofthedisease
thingspeopleofallagescandotoimprovetheirhealth.Physical
Diabetesistheleadingcauseofkidney
activitystrengthensbonesandmuscles,reducesstressand
failure,lowerlimbamputationsother
depression,andmakesiteasiertomaintainahealthybodyweightor
thanthosecausedbyinjury,andnew
reduceweightifoverweightorobese.Evenpeoplewhodonotlose
casesofblindnessinadults.
weightgainsubstantialbenefitsfromregularphysicalactivity,
Obesityisaseriousconcern.Morethan
includinglowerratesofhighbloodpressure,diabetes,andcancer.
1/3ofadultsareobese(BMI30kg/m2).
Healthyphysicalactivityincludesaerobicactivity,muscle
Nearly1in5youthage219areobese
th
strengtheningactivitiesandactivitiestoincreasebalanceand
(BMI95 percentile)
flexibility.AsdescribedbythePhysical Activity Guidelines for
Fewerthan15%ofadultsand10%of
Americans,adultsshouldengageinatleast150minutesof
adolescentseatrecommendedamounts
moderateintensityactivityeachweek,andchildrenandteenagers
offruitsandvegetableseachday
shouldengageinatleastonehourofactivityperday.
MostAmericansconsumemorethan2x
therecommendedaveragedailysodium
level.Nearly80%ofsodiumisconsumed
frompackaged,processed,andrestaurant Theburdenofchronicdiseaseisdisproportionatelydistributed
food.
acrossthepopulation.Therearesignificantdisparitiesbasedon
Atleast40%ofadultsand80%of
gender,age,race/ethnicity,geographicareaandsocioeconomic
adolescentsdonotmeetthePhysical
status.Diseasedoesnotoccurinisolation,andchronicdiseaseinno
ActivityGuidelinesforAmericans
exception.Chronicdiseaseissignificantlyinfluencedbythephysical,
Only13%ofchildrenwalkorbiketo
socialandpoliticalenvironment,includingmaternalandchildhealth,
school,comparedto44%agenerationago accesstoeducationalopportunities,availabilityofhealthyfoods,
Theaverage8to18yearoldisexposed
physicaleducationandextracurricularactivitiesinschools,accessto
tonearly7.5hoursofpassivescreentime
healthyfoods,qualityofworkingconditionsandworksitehealth,
(TVs,smartphones,computers,video
availableofcommunitysupportandresourcesandaccessto
games,etc)everyday
affordable,qualityhealthcare.
Healthy Eating
Physical Activity
Narrative adapted from Healthy People 2020 and the National Prevention Strategy
HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties
TipoftheMittData
Obesity--adults: Adultobesityratesrangefrom27%inCharlevoixCountyto35%inAlpenaCountyinthe8countyregion.
OnlyCharlevoix(27%)andEmmet(28%)arebelowStaterateof32%.
Obesityteens: Teenobesityratesrangefrom10%inPresqueIsleCountyto19%inCheboyganCounty;2countiesarebelow
Staterate(13%):PresqueIsle(10%),Antrim(11%).
Lack of physical activityadults: Statewide,23%ofadultsdonotengageinanyphysicalactivityotherthantheirregularjob.
Inthe8countyregion,theproportionrangesfrom18%inEmmetCountyto26%inPresqueIsle.Montmorency(24%),Otsego
(25%)andPresqueIsle(26%)countiesexceedStaterate.
Lack of physical activityteens: Theproportionofhighschoolstudentswhodidnotengagein60minutesofphysical
activityin5ofthelast7daysrangesfrom31%inPresqueIsleCountyto53%inOtsegoCounty.Forcomparison,Staterateis
50%.
CommunityConversations
MajorForcesofChange
117communitymembersandrepresentativesfromlocal
healthdepartments,hospitalsandotherhealthcare
providers,socialserviceagencies,schools,business,and
governmentparticipatedinaCommunityConversationto
answerthequestion,Whatcanwedohereinthiscountyto
moveclosertoourvisionofahealthycommunity?,issues
relatedtoreducingchronicdiseaseand/orobesitywas
identifiedasanactioninthefollowingcounties:
ALP ANT
CHXEM
CHB MON OTS
PI
WhatMatterstoYou?SurveyN=1,220
HealthCareProviderSurveyN=126
32%ofcommunityresidentsidentifiedaccesstoaffordable
healthyfoodasanimportantfactorneededforahealthy
community,rankingit3rdafteraccesstohealthcareandgood
jobs/healthyeconomy.Theyidentifiedthefollowingastop
communityhealthproblemsintheircounty:substanceuse,
obesity/overweight,andchronicdiseaseRespondentsmost
oftennotedtheyhadbeendiagnosedwith
overweight/obesity(70%),arthritis(57%),asthma(48%),high
cholesterol(46%),dentalhealthproblems(45%),highblood
pressure(44%)andchronicpain(43%)
Physicians,nursepractitionersandphysicianassistants
rankedhealthylifestylesasthe3rdmostimportantfactor
forahealthycommunity,followingaccesstohealthcareand
goodjobs/healthyeconomy.Theyidentifiedobesityand
overweightasthetopcommunityhealthproblem,followed
bymentalhealthissues,lackofaccesstohealthcare,
substanceuseandtobaccouse.
Northern
Health
Plan
ISSUEBRIEF:MATERNAL,INFANTANDCHILDHEALTH
Thewellbeingofmothers,infants,andchildrendeterminesthehealthofthenextgenerationandhelpspredictfuturepublic
healthchallengesforfamilies,communities,andthemedicalcaresystem.Moreover,healthybirthoutcomesandearly
identificationandtreatmentofhealthconditionsamonginfantscanpreventdeathordisabilityandenablechildrentoreach
theirfullpotential.Despitemajoradvancesinmedicalcare,criticalthreatstomaternal,infant,andchildhealthstillexist.Amongthe
Nationsmostpressingchallengesarereducingtherateofpretermbirthsandtheinfantdeathrate.
KeyFacts:
Nearlyhalfofallpregnanciesare
Healthyreproductiveandsexualpracticescanplayacriticalroleinenabling
unintended.Associatedrisksincludelow
peopletoremainhealthyandactivelycontributetotheircommunity.
birthweight,postpartumdepression,and
Planningandhavingahealthypregnancyisvitaltothehealthofwomen,
familystress
infants,andfamiliesandisespeciallyimportantinpreventingteenpregnancy
31%ofwomenwhodeliveraninfant
andchildbearing,whichwillhelpraiseeducationalattainment,increase
sufferpregnancycomplications,ranging
employmentopportunities,andenhancefinancialstability. Accesstoquality
fromdepressiontotheneedfora
healthservicesandsupportforsafepracticescanimprovephysicaland
cesareandelivery
emotionalwellbeingandreduceteenandunintendedpregnancies,
Althoughrare,theriskofdeathduring
HIV/AIDS,viralhepatitis,andothersexuallytransmittedinfections.
pregnancyhasdeclinedlittleoverthelast
20years
Infantmortalityratesarehigheramong
Vaccinesareamongthemostcosteffectiveclinicalpreventiveservicesand
womenofcolor,adolescents,unmarried
areacorecomponentofanypreventiveservicespackage.Childhood
mothers,peoplewhosmoke,thosewith
lowereducationlevels,andthosewhodid immunizationprogramsprovideaveryhighreturnoninvestment.For
example,foreachbirthcohortvaccinatedwiththeroutineimmunization
notobtainadequateprenatalcare
schedule(thisincludesDTap,Td,Hib,Polio,MMR,HepB,andvaricella
Thepretermbirthratehasrisenmore
vaccines),societysaves33,000lives;prevents14millioncasesofdisease;
than20%inthepast20years.Preterm
reducesdirecthealthcarecostsby$9.9billionandsaves$33.4billionin
infantsaremorelikelytosuffer
indirectcosts.Despiteprogress,about300childrenintheU.S.dieeachyear
complicationsatbirth,diewithinthefirst
fromvaccinepreventablediseases.Communitieswithpocketsof
yearoflife,andhavelifelonghealth
unvaccinatedandundervaccinatedpopulationsareatincreasedriskfor
challengessuchascerebralpalsyor
outbreaksofvaccinepreventablediseases.
learningdisabilities
Onaverage,42,000deathsperyearare
preventedamongchildrenwhoreceive
recommendedvaccines
Adverseexperiencesinchildhood,includingviolenceandmaltreatment,are
Thereareapproximately19millionnew
associatedwithhealthriskbehaviorssuchassmoking,alcoholanddruguse,
casesofsexuallytransmittedinfections
andriskysexualbehavior,aswellashealthproblemssuchasobesity,
eachyearalmosthalfofthesearein
diabetes,ischemicheartdisease,sexuallytransmittedinfection,and
youngpeopleage15to24.
attemptedsuicide.
Bingedrinkingandillicitdruguseare
associatedwithintimatepartnerviolence
andriskysexualbehaviors,including
Arangeofbiological,social,environmental,andphysicalfactorshavebeen
unprotectedsexandmultiplesex
linkedtomaternal,infant,andchildhealthoutcomes.Theseincluderaceand
partners.Theseactivitiesincreasetherisk
ethnicity,age,andsocioeconomicfactors,suchasincomelevel,educational
ofunintendedpregnanciesandincrease
theriskofacquiringHIVandothersexually attainment,medicalinsurancecoverage,accesstomedicalcare,
prepregnancyhealth,andgeneralhealthstatus.Forexample,childrenreared
transmittedinfections
insafeandnurturingfamiliesandneighborhoods,freefrommaltreatment
andothersocialproblems,aremorelikelytohavebetteroutcomesasadults.
Childhood Immunizations
Adapted from Healthy People 2020 and the National Prevention Strategy
HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties
RegionalStatistics
Infant mortality rate: Fiveyearinfantmortalityrates(200913)rangefrom4.8per1,000livebirthsinCharlevoixCountyto
15.2per1,000livebirthsinPresqueIsleCounty;forcomparison,Michiganinfantmortalityrateforthesameperiodwas6.0.
Early prenatal care: Thepercentageofbirthstowomenwhoreceivedprenatalcarewithinthefirstthreemonthsoftheir
pregnancyrangesfrom59.9%inCharlevoixCountyto86.3%inAlpenaCounty.OnlyAlpenaCountyexceedstheStaterateof
77.9%.
Low birthweight: Theproportionofinfantswhowerebornweighinglessthan2,500gramsrangesfrom4.2%inCharlevoix
Countyto9.6%inAntrimCounty.LowbirthweightrateswerehigherthanState(7.8%)injust2counties:AntrimandOtsego.
Maternal smoking: Maternalsmokingratesarehighacrossthetipofthemitt,exceedingStaterate(19.7%)ineverycounty.
Ratesrangefrom26.3%inEmmetCountyto49.8%inAlpenaCounty.
Childhood immunization: Theproportionofchildrenage1935monthswhohavereceivedrecommendedimmunizations(4
Dtap,3Polio,1MMR,3Hib,1Varicella,4PCV,and2HepA)rangesfrom65.4%inPresqueIsleCountyto79.4inEmmet
County.OnlyCharlevoixandEmmetcountiesexceedStaterate.
Child abuse and neglect: Ratesforconfirmedchildabuseandneglectarehigherinallofthetipofthemittcountiesthanthe
Stateasawhole(14.9per1,000children<19).Theyrangefrom16.3per1,000inEmmetto29.9per1,000inAntrimCounty.
CommunityConversations
117communitymembersandrepresentativesfromlocalhealthdepartments,hospitalsandotherhealthcareproviders,
socialserviceagencies,schools,business,andgovernmentparticipatedinaCommunityConversationtoanswerthequestion,
Whatcanwedohereinthiscountytomoveclosertoourvisionofahealthycommunity?Actionsrelatedtomaternal,
infantand/orchildhealthwereidentifiedinthefollowingcounties:
ALPENA
ANTRIM
CHARLEVOIXEMMET
CHEBOYGAN MONTMORENCY
OTSEGO
PRESQUEIS
MajorForcesofChange
Perinatal Initiative of Northern Lower Michigan: ThePerinatalInitiativewasorganizedin2012bytheNorthCentralCouncil
oftheMichiganHealthandHospitalAssociation.Itsmembersincludethe12hospitalsand7localhealthdepartmentsthat
servea21countyregionaswellasmanystateandlocalpartners.
Michigan Home Visiting Initiative: HealthDepartmentofNorthwestMichiganisimplementingHealthyFamiliesAmericain
thecountieswithhighestneedina21countyregion.With$1.6Minannualfunding,itprovides voluntary, family support
services in the homes of at-risk pregnant women and families with children aged 0-5.
Northern
Health
Plan
ISSUEBRIEF:MENTALHEALTH
Mentalhealthisessentialtoapersonswellbeing,healthyfamilyandinterpersonalrelationships,andtheabilitytolive
afullandproductivelife.Peoplewithuntreatedmentalhealthdisordersareathighriskformanyunhealthyandunsafe
behaviors,includingsubstanceuse,violentorselfdestructivebehavior,andsuicide.Mentalhealthdisorderscanhave
harmfulandlonglastingeffectsincludinghighpsychosocialandeconomiccostsnotonlyforpeoplelivingwiththe
disorder,butalsofortheirfamilies,schools,workplaces,andcommunities.Fortunately,anumberofmentalhealth
disorderscanbetreatedeffectively,andpreventionofmentalhealthdisordersisagrowingareaofresearchand
practice.Earlydiagnosisandtreatmentcandecreasethediseaseburdenofmentalhealthdisordersaswellasassociated
chronicdiseases.AssessingandaddressingmentalhealthremainsimportanttoensurethatallAmericansleadlonger,
healthierlives.
KeyFacts:
Manymentalhealthdisordersare
Mentalhealthandphysicalhealthareinextricablylinked.Evidence
preventableandtreatable.Early
hasshownthatmentalhealthdisordersmostoftendepression
identificationandtreatmentcanprevent
arestronglyassociatedwiththerisk,occurrence,management,
theonsetofdisease,decreaseratesof
progression,andoutcomeofseriouschronicdiseasesandhealth
chronicdisease,andhelppeoplelive
conditions,includingdiabetes,hypertension,stroke,heartdisease,
longer,healthierlives
andcancer.Thisassociationappearstobecausedbymentalhealth
Approximately1in4adultsintheUShave
disordersthatprecedechronicdisease;chronicdiseasecanintensify
hadamentalhealthdisorderinthepast
thesymptomsofmentalhealthdisorders,ineffectcreatingacycleof
yearmostcommonlyanxietyor
poorhealth.Thiscycledecreasesapersonsabilitytoparticipatein
depressionand1in17hadaserious
thetreatmentofandrecoveryfrommentalhealthdisordersand
mentalillness
chronicdisease.Therefore,whileeffortsareunderwaytoreducethe
1in5childrenintheUnitedStateshave
burdenofdeathanddisabilitycausedbychronicdiseaseintheUS,
hadamentalhealthdisorder,most
simultaneouslyimprovingmentalhealthnationwideiscriticalto
commonlyAD/HD
improvingthehealthofallAmericans.
Achildexperiencingmentalhealthissues
ismorelikelytohaveproblemsatschool
andisatgreaterriskofenteringthe
Newmentalhealthissueshaveemergedamongsomespecial
criminaljusticesystem
Inagivenyear,lessthanhalfofthepeople populations,suchasveteranswhohaveexperiencedphysicaland
mentaltrauma;peopleincommunitieswithlargescalepsychological
diagnosedwithamentalillnessreceive
traumacausedbynaturaldisasters;olderadults,asthe
treatment.Theunmetneedisgreatest
understandingandtreatmentofdementiaandmooddisorders
amongunderservedgroups,suchasolder
continuestoimprove.AstheFederalGovernmentimplements
adults,minorities,thosewithouthealth
healthreformlegislation,itwillgiveattentiontoprovidingservices
insurance,andresidentsofruralareas
forindividualswithmentalillnessandsubstanceusedisorders,
Morethan34,000Americansdieasa
includingnewopportunitiesforaccesstoandcoveragefortreatment
resultofsuicideeveryyear
approximately1suicideevery15minutes. andpreventionservices.
SuicideratesarehighestamongAmerican
Indian/AlaskaNativeyouth.
Riskfactorsforsuicideincludesubstance
Severalfactorshavebeenlinkedtomentalhealth,includingraceand
use,isolation,extremeemotionalstress,a ethnicity,gender,age,incomelevel,educationlevel,sexual
historyofchildmaltreatmentandmental
orientation,andgeographiclocation.Othersocialconditionssuch
healthconditionssuchasdepression
asinterpersonal,family,andcommunitydynamics,housingquality,
Racialdiscriminationisassociatedwith
socialsupport,employmentopportunities,andworkandschool
chronicstressandcanleadtonegative
conditionscanalsoinfluencementalhealthriskandoutcomes,
healthoutcomessuchashypertension
bothpositivelyandnegatively.Forexample,safesharedplacesfor
peopletointeract,suchasparksandchurches,cansupportmental
health.
Adapted from Healthy People 2020 and the National Prevention Strategy
HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties
TipoftheMittData
Suicide:AgeadjustedsuicideratesarehigherthanState(10.2per100,000)forthe6countiesreported(unabletocalculate
forMontmorencyandPresque).Ratesrangefrom12.5per100,000inEmmetCountyto20.5inAntrimCounty
Depression among older adults: TheproportionofadultsenrolledinMedicarerangesfrom13%inCharlevoixCountyto18%
inOtsegoCounty.RatesarehigherthanState(17%)inAlpenaandOtsego(18%)only.
Inadequate social support: Ofthe7countiesreporting(unabletocalculatePresqueIsle),theproportionofadultswhoreport
theyhaveinadequatesocialsupportrangesfrom12%inCharlevoixCountyto20%inAlpena,Cheboygan,andOtsego
counties.Forcomparison,Staterateis20%.
Poor mental health days: Ofthe7countiesreporting(unabletocalculateMontmorency),theaveragenumberofdaysper
monthadultsexperienceapoormentalhealthdayrangesfrom2.5inCheboyganCountyto5.4inAntrimCounty.Emmet(3.9
days),Otsego(4.1days),andAntrim(5.4days)exceedStaterateof3.7dayspermonth
CommunityConversations
MajorForcesofChange
117communitymembersandrepresentativesfromlocal
healthdepartments,hospitalsandotherhealthcare
providers,socialserviceagencies,schools,business,and
governmentparticipatedinaCommunityConversationto
answerthequestion,Whatcanwedohereinthiscountyto
moveclosertoourvisionofahealthycommunity?
Addressingprevention,treatmentand/oraccesstomental
healthserviceswasidentifiedasanactioninthefollowing
counties:
ALP ANT
CHXEM
CHB MON OTS
PI
Mi-Connect: MiConnectisledbyAlconaHealthCenters,a
systemoffederallyqualifiedhealthcenterswithfederal
funding.Akeygoalistoincreaseintegrationofprimarycare
andbehavioralhealthacrossan11countyregion.
Child and Adolescent Health Centers (CAHC): Thereare6
schoollinkedorschoolbasedhealthcentersinthe8county
region.Eachoneoffersmentalhealthservicestostudents
andfamiliesatnocharge.Primarycareandmentalhealth
servicesarefullyintegratedatCAHCsinAntrimandEmmet
counties
Northeast Michigan Childrens Behavioral Health
X
X
X
X
X
Itisnoteworthythatthe#1actionidentifiedintheCharlevoix Initiative: TheWKKelloggFoundationfundedtheInitiative
EmmetConversationwastointentionally integrate accessible toprovidefamiliesandchildrenage012witheducationand
servicesincollaborationwithseveralcommunitypartners
behavioral and physical health services
WhatMatterstoYou?SurveyN=1,220
Whenaskedwhatarethe3mostimportantfactorsfora
healthycommunity,topresponseswere:accesstohealthcare
(69%);goodjobs/healthyeconomy(50%);accessto
affordablehealthyfood(33%);affordablehousing(27%);and
goodschools/highvalueoneducation(28%).Community
membersidentifiedtheseproblemsmostoften:substance
abuse(48%);overweight/obesity(42%);chronicdisease
(33%),mentalhealthissues(27%)andlackofaffordable
housing(26%).Whenaskedwhatbarrierstocarethey
experience,87%saidtheirhealthinsurancepolicydoesnot
coverbehavioralhealth;80%indicatedtheyhaveproblems
findingabehavioralhealthproviderand78%saidtheirhealth
insurancepolicydoesnotcovermedications.63%of
respondentsindicatedtransportationissuespresenta
problemingettinghealthcareservices.
HealthCareProviderSurveyN=126
Whenaskedwhatarethe3mostimportantfactorsfora
healthycommunity,topresponseswere:accesstohealth
care(69%);goodjobs/healthyeconomy(51%);healthy
lifestyles(39%);goodschools/highvalueoneducation(32%);
andaccesstohealthyfoods(23%).Physicians,nurse
practitionersandphysiciansassistantidentifiedthese
communityhealthproblemsmostoften:overweightobesity
(58%)mentalhealthissues(43%),lackofaccesstohealth
care(38%),substance/tobaccouse(35%)
Northern
Health
Plan
ISSUEBRIEF:SUBSTANCEUSE
Preventingdrugabuseandexcessivealcoholuseincreasespeopleschancesoflivinglong,healthyandproductivelives.
Excessivealcoholuseincludesbingedrinking,underagedrinking,drinkingwhilepregnant,andalcoholimpaireddriving.Drug
abuseincludesanyinappropriateuseofpharmaceuticals(bothprescriptionandoverthecounterdrugs)andanyuseofillicit
drugs.Alcoholandotherdrugusecanimpedejudgmentandleadtoharmfulrisktakingbehavior.Preventingdruguseand
alcoholabuseimprovesqualityoflife,academicperformance,workplaceproductivityandmilitarypreparedness;reducescrime
andcriminaljusticeexpenses;reducesvehiclecrashesandfatalities;andlowershealthcarecostsforacute/chronicconditions.
KEYFACTS
Excessivealcoholuseisaleadingcauseof
Substanceabuseinvolvingdrugs,alcohol,orbothisassociatedwitha
preventabledeathintheU.S.amongall
rangeofdestructivesocialconditions,includingfamilydisruptions,financial
agegroups.
problems,lostproductivity,failureinschool,domesticviolence,childabuse,
Overhalfofthealcoholconsumedby
andcrime.Inaddition,substanceabusecontributestoanumberofnegative
adultsand90%ofthealcoholconsumed
healthoutcomesandpublichealthproblems,includingcardiovascular
byyouthoccurswhilebingedrinking.
conditions,pregnancycomplications,HIV/AIDS,sexuallytransmitted
Prescriptiondruguseisthenations
infections,domesticviolence,childabuseandneglect,motorvehiclecrashes,
fastestgrowingdrugproblem.ERvisits
homicideandsuicide.Improvedevaluationofcommunitylevelprevention
involvingthemisuseorabuseof
hasenhancedresearchersunderstandingofenvironmentalandsocial
pharmaceuticaldrugshavedoubledover
factorsthatcontributetotheinitiationandabuseofalcoholandillicitdrugs,
thepast5years.
leadingtoamoresophisticatedunderstandingofhowtoimplement
Chronicdruguse,crime,andincarceration evidencebasedstrategiesinspecificsocialandculturalsettings.Estimatesof
areinextricablyconnected.Atleasthalfof thetotaloverallcostsofsubstanceabuseintheUnitedStates,includinglost
stateandFederalinmatesintheU.S.were productivityandhealthandcrimerelatedcosts,exceed$600billion
activedrugusersatthetimeofarrest.
annually.
9%ofchildrenlivewithatleast1parent
whoabusesalcoholorotherdrugs.They
aremorelikelytoexperiencephysical,
Tobaccouseisthesinglemostpreventablecauseofdisease,disability,and
sexualoremotionalabuseorneglectand
deathintheUS,yetmoredeathsarecausedeachyearbytobaccousethan
morelikelytobeplacedinfostercare.
byalldeathsfromHIV,illegaldruguse,alcoholuse,motorvehicleinjuries,
Ratesofmarijuanausebyyouthand
suicides,andmurderscombined.Asaresultofwidespreadtobaccouse,
youngadultsareontheriseandfewer
approximately443,000Americansdiefromtobaccorelatedillnesses,suchas
youthperceivegreatriskfromsmokingit
cancerandheartdisease,eachyear.Anestimated49,000ofthesedeaths
After40yearsofsteadilydeclining
aretheresultofsecondhandsmokeexposure.Tobaccouseposesaheavy
smokingrates,thedeclineinadults
burdenontheU.S.economyandmedicalcaresystem.Eachyear,cigarette
smokingratesintheU.S.hasstalled
smokingcostsmorethan$193billioninmedicalcarecosts,while
Smokingduringpregnancyposesrisksto
secondhandsmokecostsanadditional$10million.
themotherandfetus.Ababyborntoa
Tobacco Use
motherwhosmokedduringpregnancyis
morelikelytohavelessdevelopedlungs
andlowbirthweight,andismorelikelyto
bebornprematurely.
MorethanoftheU.S.population(88
millionpeople)andmorethanhalfofall
childrenintheU.Sareexposedto
secondhandsmokeonaregularbasis.
HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties
TipoftheMittData
Heavy and binge drinkingadults: Moreadultsintheregiondrinkheavilyand/orbingedrinkinthepast30daysthaninthe
Stateasawhole(18%).Ratesrangefrom19%inEmmetCountyto27%inAntrimCounty(unabletocalculateratesin
MontmorencyandPresqueIslecounties).Similarly,
Binge drinkingteens: MoreyouthbingedrankcomparedtotheState(6%).Theproportionof9thand11thgrade
studentsreportingtheyhad5+drinkswithinashortperiodoftimeinthepast30daysrangesfrom10%in
CharlevoixCountyto22%inPresqueIsleCounty
Marijuana use--teens: Theproportionofhighschoolstudentswhoreportusingmarijuana1ormoretimesinthe
past30daysrangesfrom9%inPresqueIsleCountyto22%inOtsegoCounty.Otsego(22%),Antrim(21%),Emmet
(15%)andCheboygan(13%)countiesexceedStaterate(9%).
Deaths due to drug poisoning: DeathsduetodrugpoisoningexceedStaterate(13per100,000population)in
PresqueIsle(19),Otsego(17),Antrim(16),Antrim(15)andCheboygan(15)counties.
Tobacco useadults: AmuchhigherproportionofadultssmokecigarettesinNorthernMichiganthantheStateasawhole
(12%).Smokingratesintheregionrangefrom16%inPresqueIsleCountyto31%inMontmorencyCounty.
Tobacco useteens:Theproportionof9thand11thgradestudentsreportingtheysmokedatleastonceinthepast30days
hoversatorexceedsState(10%),rangingfrom11%inEmmetCountyto23%inOtsegoCounty.
CommunityConversations
MajorForcesofChange
117communitymembersandrepresentativesfromlocal
healthdepartments,hospitalsandotherhealthcare
providers,socialserviceagencies,schools,business,and
governmentparticipatedinaCommunityConversationto
answerthequestion,Whatcanwedohereinthiscountyto
moveclosertoourvisionofahealthycommunity?
DuringtheCommunityConversations,addressingprevention
andtreatmentforalcohol,tobaccoandotherdrugusewas
identifiedasanactioninthefollowing
AL
AN
CHXEM
CHB MON OTS
PI
X
X
X
X
X
X
HealthCareProviderSurveyN=122
Whenaskedwhatthe3topcommunityhealthproblemsareintheircounty,physicians,nursepractitioners,andphysicians
assistantsindicatedoverweight/obesity(58%),mentalhealthissues(43%),lackofaccesstohealthcare(38%),substanceuse
(35%),tobaccouse(35%),chronicdisease(28%),lackofphysicalactivity(19%),agingproblems(11%).
WhatMatterstoYouCommunitySurveyN=1,140
Thetoprankedfactorsneededforahealthycommunitywere:accesstohealthcare(69%),goodjobs/healthyeconomy(50%),
accesstoaffordablehealthyfoods(33%),goodschools(28%),andaffordablehousing(27%).Substanceusewasrankedthe#1
needintheircounties(48%),followedbyoverweight/obesity(42%),chronicdisease(33%),mentalhealthissues(28%),and
affordablehousing(26%).11%ofrespondentsnotedtheyhadbeendiagnosedwithalcoholismorotheraddictionand93%
hadafamilymemberwhohadbeendiagnosedwithalcoholismorotheraddiction.
Northern
Health
Plan