State of the Health and Well-being of the People of the Southeastern Region of North CarolinaKathleen A. Ennen, PhD, RN and Carol Heinrich, PhD, APN,

RN, School of Nursing

Graduate Students: Cristina Norman, Simona Chitescu, and Kat Bodrie

Definitions

What is health?• Health is more than the absence of illness• Health is a process of continuous adjustment to

changing demands of life What is well-being?

• Standard of living, income, access to good and services

• Also freedom, happiness, art, environmental health

The Southeastern Region of North Carolina

Picture courtesy of City-Data.com

Community Health Assessment: Uninsured• Over 1.4 million people in NC without health

insurance• “Cluster” of high rates (22.0%-28.3%) in the

SE region including Onslow, Jones, Duplin, Sampson, and Pender counties

• 20.3% - 22.0% in Bladen & Columbus counties

Community Health Assessment: Health Disparities

NIH: "Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”

Infant mortality Cancer (prostate, breast, lung, and colorectal) Diabetes Cardiovascular diseases Stroke Asthma Homicide Sexually transmitted diseases (HIV/AIDS, syphilis, gonorrhea,

chlamydia)

Web of poverty, race, and poor health

Community Health

Assessment: Access to Health Services Region has accessibility to

quality healthcare• Hospitals• Clinics• Healthcare providers

Midwives and Licensed Practical Nurses (1,2)

County

Registered Nurses

Certified Nurse

Midwive

s

Nurse Practitioners

Licensed Practi

cal Nurse

s

State Total 79,835 198 2,440 16,960

Bladen 148 0 4 85

Brunswick 427 0 14 209

Columbus 444 0 15 145

Duplin 261 2 15 91

New Hanover 2562 4 91 516

Onslow 758 2 34 245

Pender 153 0 9 80

Sampson 331 0 10 146

1. Nurse practitioners and certified nurse midwives are included in counts of registered nurses.

2. Includes those who are licensed and active within the profession as well as those with unknown

activity status; inactives are excluded.

Source: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, with data derived from the North Carolina Board of Nursing, 2006.

North Carolina Health Professions Data System

2005 Health Professionals per 10,000 Population

CountyPopulation

(1)Physicians

(2,3)

PrimaryCare

Physicians(2, 3, 4)

Dentist(2)

Pharmacists (2)

Registered Nurses (2)

Nurse Practitioners

(2)

Certified Nurse

Midwives (2, 5)

Physician Assistants

(2)

STATE TOTAL8,663,67

4 20.7 8.8 4.4 8.4 92.1 2.82 0.23 3.09

Bladen 33,204 7.2 6 1.5 4.5 44.6 1.20 0.00 2.41

Brunswick 87,715 9.2 4.3 3 7.5 48.7 1.60 0.00 3.19

Columbus 54,643 10.2 5.7 2 8.8 81.3 2.75 0.00 3.48

Duplin 52,141 6.5 5.4 2.3 4.8 50.1 2.88 0.38 1.15

New Hanover 177,692 33.3 12.7 6.9 10.2 144.2 5.12 0.23 6.30

Onslow 161,958 7.3 3.8 3.4 3.9 46.8 2.10 0.12 1.67

Pender 46,142 3.7 2.4 2.2 5.4 33.2 1.95 0.00 0.65

Sampson 63,375 7.6 4.7 1.6 5.2 52.2 1.58 0.00 1.89

                   

1. Source: Log Into North Carolina (LINC) Database, Office of State Planning, NC Office of the Governor.

2. Includes those who are licensed and active within the profession as well as those with unknown activity status; inactives are excluded.

3. Physicians include doctors of medicine and doctors of osteopathy who are non-federal, non resident-in-training.

4. Primary care physicians include those physicians who report a primary specialty of family practice, general practice, internal medicine, obstetrics/gynecology, or pediatrics.

5. Certified Nurse Midwives are calculated per 10,000 females aged 15-44 (child-bearing population). Population Source: LINC (1).

Morbidity and Mortality “Top 10” in NC

• Heart disease• Cancer• Stroke• Unintentional injury• Chronic lower respiratory disease• Diabetes mellitus• Alzheimer’s disease• Influenza and pneumonia• Nephritis• Septicemia

Others include vehicle injuries, suicide, and homicide

Morbidity and Mortality:

Chronic Disease Heart disease, stroke, cancer, and diabetes

are among most prevalent Tobacco use, lack of physical activity, poor

nutrition, obesity are major contributors to heart disease and cancer

Heart disease deaths in SE (per 100,000):• Bladen, Columbus, Sampson -- 601-692 • Duplin, Pender -- 566-599• Brunswick, Onslow -- 528-564• New Hanover -- 504-52

Morbidity and Mortality: Preventative Measures Education

• Signs and symptoms of heart attack and stroke• Importance of calling 911 quickly• Parents regulating childhood nutrition

Risky Behavior Reduction• Binge drinking in grades 11-12 • Marijuana use by those in grades 9 -10

Mental Health

Depression Physical inactivity Chronic Pain Suicide

Dental Health

32% children 6-17 years untreated dental caries

Elder Services

Projected growth of population age 65 and older from 2000 to 2030:

Brunswick county > 200%

New Hanover, Pender, Onslow counties 100-199%

Columbus, Bladen, Sampson, & Duplin counties 43 to 99%

Places of residence: long-term care facilities, independent apartment complexes, assistive living facilities, nonmedical in-home care

Summation Uninsured

• Policymakers can focus efforts on areas with low insurance coverage rates• Local healthcare providers can better demonstrate the extent of their need

for government and philanthropic support using estimates of local uninsured populations

↑ # of RNs• Address needs of rural medically underserved areas• Disease prevention and education to lower risks and burdens of chronic

illness• ↑ access to basic health care services

Decreasing risks for chronic disease • ↑ Blood pressure checks• ↑ Blood Cholesterol checks• ↑ Flu shots & Pneumonia vaccines for those > 65 years• ↑ # of women who receive mammograms• ↓ Tobacco use in high school students• ↑ Use of new cholesterol-lowering medications• ↑ # of children receiving basic dental care • ↓ sun overexposure

References

WISQARS™ http://webappa.cdc.gov/cgi-bin/broker.exe Ricketts, T. C., & Holmes, G. M. “Running the numbers.” NC

Medical Journal, May/June 2006, Volume 67, Number 3, pp.235-236.

CDC (2003). http://ww.cdc.gov/nccdphp/publications/factsheets/ChronicDisease/north_carolina.htm

National Institutes of health (NIH). Addressing Health Disparities: The NIH Program of Action. “What are health disparities.” http://healthdisparities.nih.gov/whatare.html.

AMA (2001). Area Resource File 2004.