status of health rpt 2017williamsburghealthfoundation.org/wp-content/uploads/whf... · 2018. 1....

The Status of Citizen Health in Greater Williamsburg

November 2017 YemiZewduYimer,CollegeofWilliam&Mary,B.S.Candidate,2018

PauletteParker,M.A.,SeniorProgramOfficer,WilliamsburgHealthFoundation

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TableofContentsExecutiveSummary.....................................................................................................................................5

Objective..................................................................................................................................................5

Scope........................................................................................................................................................5

Structure..................................................................................................................................................5

Findings....................................................................................................................................................5

Recommendations...................................................................................................................................6

Section1:DemographicProfile...................................................................................................................7

Section1.1:PopulationTrends................................................................................................................7

Section1.1A:PopulationGrowth........................................................................................................7

Figure1.1A:PopulationGrowthofGreaterWilliamsburgbyLocality(2000to2016)........................7

Table1.1ARateofGrowthinthePopulationofGreaterGreaterWilliamsburgandVirginiafrom2000to2016........................................................................................................................................8

Section1.1BPopulationProjections....................................................................................................8

Figure1.1B:PopulationProjectionsforGreaterWilliamsburg(2020,2030,and2040).....................8

Table1.1BPopulationProjectionsforGreaterWilliamsburgandVirginia(2020,2030,and2040)....9

Section1.1C:GrowthofSeniorPopulation.........................................................................................9

Figure1.1CSenior(60+)PopulationProjectionsforGreaterWilliamsburg(2020,2030,and2040)..9

Table1.1CSenior(60+)PopulationProjectionsforGreaterWilliamsburgandVirginia(2020,2030,and2040)...........................................................................................................................................10

Section1.2:AgeDistribution..................................................................................................................10

Figure1.2AgeDistributioninGreaterWilliamsburg(2015)..............................................................10

Section1.3:RaceandEthnicity..............................................................................................................11

Figure1.3A:RacePopulationinGreaterWilliamsburgbyLocality(2015)........................................11

Table1.3A:PopulationinGreaterWilliamsburgbyRaceandLocality(2015)...................................12

Table1.3B:PopulationGrowthoftheHipanicPopulation(April1,2010–July1,2016)..................12

Section2:HealthProfile............................................................................................................................13

Section2.1:HealthRisks........................................................................................................................13

Figure2.1:UnhealthyBehaviorsintheGreaterWilliamsburgLocalities(2017)...............................13

Section2.2:AccesstoCare....................................................................................................................14

Section2.3:ChronicIllnessandPoorHealth.........................................................................................14

Table2.3A:DiabetesPrevalencebyLocality(2017)..........................................................................14

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Table2.3C:LowBirthweightBirthsbyLocality..................................................................................15

Section2.4:BehavioralandMentalHealth...........................................................................................16

Table2.4:PercentofthePopulationwhoReportedFrequentPhysicalandMentalDistressbyLocality...............................................................................................................................................16

Section2.5:QualityofCare...................................................................................................................17

Section2.5A:HospitalReadmission...................................................................................................17

Table2.5A:ReadmissionRatesforRiversideandSentaraincomparisontotheVirginiaAverage(2015).................................................................................................................................................17

Section3:SocialDeterminantsofHealth..................................................................................................18

Section3.1Unemployment...................................................................................................................18

Figure3.1:AnnualUnemploymentRateforGreaterWilliamsburgbyLocality(2000-2015)............18

Section3.2:Poverty...............................................................................................................................19

Section3.2A:PovertyRate.................................................................................................................19

Figure3.2Ai:PercentofPopulationLivingBelow100%Poverty(2000-2015)..................................19

Figure3.2Aii:PercentofChildren(0-17Years)LivingBelow100%Poverty(2000-2015).................20

Section3.2B:SNAPEnrollment...........................................................................................................21

Figure3.2B:NumberofActiveSNAPClientsbySFY(2012-2016)......................................................21

Section3.2C:TANFEnrollment..........................................................................................................22

Figure3.2C:NumberofActiveTANFRecipientsbySFY(2012-2016)................................................22

Section3.3:HealthOpportunityIndex(HOI).....................................................................................23

Table3.3:HealthOpportunityIndex.................................................................................................23

Section3.4:TeenPregnancy..................................................................................................................24

Figure3.4A:TeenBirthRate(per1,000pop.)byYear(1998-2014)..................................................24

Figure3.4B:TeenBirthRate(per1,000pop.)byRaceandLocality(2014).......................................25

Section3.5:ChildreninSingleParentHouseholds................................................................................26

Figure3.5:ChildrenLivinginSingleParentHouseholdsvsChildrenLivinginMarriedCoupleHouseholdsbyLocality......................................................................................................................26

Section4:TheUninsuredandtheImpactofSafety-NetClinics................................................................27

Section4.1:MedicaidEnrollment..........................................................................................................27

Figure4.1:PercentofMedicaidClientsperLocalitybySFY(2012-2016)..........................................27

Section4.2:TheUninsured....................................................................................................................28

Figure4.2:UninsuredAdultsandChildrenbyLocality(2015)...........................................................28

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Section4.3:Safety-NetClinics...............................................................................................................29

Table4.3A:ImpactoftheGreaterWilliamsburgSafety-NetClinicswithintheWHFServiceArea(2017).................................................................................................................................................29

Table4.3B:ImpactoftheGreaterWilliamsburgSafetyNetClinicsfortheUninsuredPopulationwithintheWHFServiceArea(2017)..................................................................................................29

Conclusion.................................................................................................................................................30

Bibliography...............................................................................................................................................31

Appendix....................................................................................................................................................33

Table1:HIVPrevalenceRatebyLocalityper1,000...............................................................................33

Table2:NumberofMedicaidClientsasaPercentageofthePopulationfrom2012to2016...............33

Figure1:UninsuredChildrenbelow200%FPLandthepercentageofthetotaluninsuredpopulation34

Figure2:UninsuredAdults(18to64)withIncomesBelow138%FPLandthepercentageofthetotaluninsuredpopulation(%)......................................................................................................................35

Figure3:UninsuredPeople(underage65)withIncomesbetween138%and400%oftheFPLandthepercentageofthetotaluninsuredpopulation(%)................................................................................36

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ExecutiveSummaryObjective

Thisreportpresentskeyfindingsfromthemostrecentpublicallyavailablecommunity-levelhealthdatawiththegoaloftransformingthehardnumbersintoactionableknowledge.Thereportisintendedtofacilitatetargetedcommunitydialogue,informhealthandhumanserviceprovidersanddecisionmakers,andtoserveasacatalystforcollaborativeapproachestomeethealthandhumanserviceneeds,fillgapsforthevulnerable,andimprovethehealthofthecitizensofGreaterWilliamsburg.

Scope

TheareaofanalysisforthereportisGreaterWilliamsburg,whichiscomprisedofthreelocalities:JamesCityCounty,YorkCounty,andtheCityofWilliamsburg.Asof2016,GreaterWilliamsburgsupportedapopulationofapproximately158,000people.

Structure

Theremainderofthisdocumentisdividedintofoursections.

• ThefirstsectionpresentsandanalyzesdataonthedemographicprofileofGreaterWilliamsburgwithaparticularfocusondemographictrendsthatwillshapefuturedemandforhealthcareandhumanservicesinGreaterWilliamsburg.

• Thesecondsectionpresentsandanalyzesdataonthehealthofthecommunitywithaparticularfocusonhealthrisks,healthopportunities,andhealthoutcomes.

• Thethirdsectionpresentsandanalyzesdataonsocialandeconomicdeterminantsofhealthsuchasunemploymentandpoverty,alongwithindicatorsincludingtheutilizationofpublicassistanceprograms.

• Thefourthsectionpresentsandanalyzesdataonthosewithouthealthinsuranceandtheimpactofthesafety-netclinicsinGreaterWilliamsburg.

Findings

Onthesurface,itmayseemthatGreaterWilliamsburgisarelativelyaffluentandhealthyplacetolive.However,dataillustratethattherearemanychallengesandopportunitiesconcerninghealthandwell-being.Forinstance:

• DemographicgrowthandagingcontributetoagrowingdemandforhealthcareandhumanserviceswithinGreaterWilliamsburg.By2040,theU.S.CensusBureauestimatesthat32%ofthepopulationofGreaterWilliamsburgwillbeovertheageof60.Accordingtoreportspublishedin2015,estimatesshowthatover25%ofthepopulationisnowovertheageof60.

• ThousandsofGreaterWilliamsburgresidentsengageinunhealthybehaviors.• Almostone-quarteroftheadultpopulationisobese.• ThousandsofGreaterWilliamsburgresidentssufferfromchronicillness,poorhealth,andbehavioral

healthdisorders.Asanexampleoftheburdenthisplacesoncommunityhealthcareresources,

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peoplewithdiabeteshaveapproximately2.3timeshighermedicalexpensesthanthosewithoutthedisease.Anestimated10%ofthepopulationofGreaterWilliamsburghasdiabetes.

• SocialandeconomicdeterminantsofhealthindicatethatthevulnerablepopulationofGreaterWilliamsburgisespeciallyaffectedbyeconomictrends.Unemployment,poverty,andenrollmentinpublicassistanceprogramsareallhigherthantheywerein2007.

• Safety-netclinicsprovideaninvaluableservicetotheunderservedanduninsuredpopulationwithinGreaterWilliamsburg.IncollaborationwiththeWilliamsburgHealthFoundation,threesafety-netclinicsinthearea(OldeTowneMedicalandDentalCenter,AngelsofMercyFreeClinic,andLackeyClinic)managetotreatapproximately5,300uniqueuninsuredpatientseachyear,oraboutone-thirdoftheuninsuredpopulation.Yet,despitetheexceptionaleffortthattheseclinicsputintohelpingtomeetthehealthneedsofthevulnerable;approximatelytwointhreeuninsuredpeopleappearnottobereceivingregularhealthcare.Iforwhentheydoreceivecare,itmaybeatanemergencyroom,orotherproviders.

Recommendations

Weurgeourcommunitypartnerstopursueprogramstoimproveaccesstoaffordablecare,reducetheriskofchronicillnessandbehavioralhealthdisorders,andaddressdisparitiescausedbyrace,income,age,orhouseholdtype.Throughfocusedandcollaborativeefforts,webelievethatitispossibletoenhancethehealthandwell-beingofourcommunitybyraisingawarenessofthestatusofcommunityhealthandpromotinghealthylifestyles.

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Section1:DemographicProfileThissectionwillfocusontrendsinthedemographyofGreaterWilliamsburg.Thiswillhighlightpopulationgrowth,agedistribution,andracialandethnicprofilesoftheGreaterWilliamsburgpopulation.

Section1.1:PopulationTrends

Section1.1A:PopulationGrowthAccordingtopopulationestimatescompiledbytheWeldonCooperCenterforPublicServicefromtheAmericanCommunitySurvey(ACS)producedbytheU.S.CensusBureau,thepopulationofGreaterWilliamsburghasgrownatafasterratethanthepopulationofVirginiaasawhole.AsillustratedbyFigure1.1,between2000and2016,thepopulationofGreaterWilliamsburgincreasedfrom117,353personsto157,629persons–achangeofroughly34.3%,comparedtoonly18.4%forVirginia.However,thispopulationgrowthhasbeenunevenlydistributedamongthedifferentlocalitieswithinGreaterWilliamsburg.From2000to2016,thepopulationofJamesCityCountyincreasedby51.7%;thepopulationoftheCityofWilliamsburgincreasedby28.6%;andthepopulationofYorkCountyincreasedby20.7%.Asthisdramaticincreasecontinues,localhealthcareandhumanserviceprovidersmayfindthemselvesdealingwiththeaddedstrainofprovidingcaretoagrowingnumberofresidents.

Figure1.1A:PopulationGrowthofGreaterWilliamsburgbyLocality(2000to2016)

Source:WeldonCooperCenterforPublicService;DemographicsResearchGroup2016VirginiaPopulationEstimates

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Table1.1ARateofGrowthinthePopulationofGreaterGreaterWilliamsburgandVirginiafrom2000to2016 RateofGrowth RateofGrowthperYearJamesCityCounty 51.7% 3.2%YorkCounty 20.7% 1.3%CityofWilliamsburg 28.6% 1.8%GreaterWilliamsburg 34.3% 2.1%Virginia 18.4% 1.2%Source:WeldonCooperCenterforPublicService;DemographicsResearchGroup2016VirginiaPopulationEstimates

Section1.1BPopulationProjections

UsingdatafromtheU.S.CensusBureau,theWeldonCooperCenterforPublicServiceestimatesthatthepopulationofGreaterWilliamsburgwillcontinuetogrowfrom168,151personsin2020to217,214by2040–achangeof29.2%,orabout1.5%peryearonaverage.However,asillustratedbyFigure1.1B,muchofthisgrowthwillbefueledbyJamesCityCounty,wherethepopulationisexpectedtoincreaseby38.6%between2020and2040,oranaverageof1.9%peryear.Bycontrast,theCityofWilliamsburgandYorkCountyareexpectedtogrowatlowerrates.From2020to2040,thepopulationoftheCityofWilliamsburgisexpectedtogrowby21.1%,oranaverageof1.1%peryear,whilethepopulationofYorkCountyisexpectedtogrowby20.7%,oranaverageof1.0%peryear.

Figure1.1B:PopulationProjectionsforGreaterWilliamsburg(2020,2030,and2040)

Source:WeldonCooperCenterforPublicService;DemographicsResearchGroup2016VirginiaPopulationProjections

2020 2030 2040JamesCityCounty 79,404 95,549 110,044

YorkCounty 73,161 81,370 88,288

CityofWilliamsburg 15,586 17,372 18,882

GreaterWilliamsburg 168,151 194,291 217,214

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Table1.1BPopulationProjectionsforGreaterWilliamsburgandVirginia(2020,2030,and2040) RateofGrowth RateofGrowthperYearJamesCityCounty 38.6% 1.9%YorkCounty 20.7% 1.0%CityofWilliamsburg 21.1% 1.1%GreaterWilliamsburg 29.2% 1.5%Virginia 16.7% 0.8%Source:WeldonCooperCenterforPublicService;DemographicsResearchGroup2016VirginiaPopulationEstimates

Section1.1C:GrowthofSeniorPopulationAlargeportionofthepopulationgrowthwillcomefromincreasesinthepopulationoverage601.AsFigure1.1Cillustrates,by2040,thenumberofpersonsoverage60livinginGreaterWilliamsburgwillincreaseto68,509,orabout31.5%oftheoverallpopulation.However,theprocessofagingwillaffectcertainlocalitiesmorethanothers.Inparticular,thepercentofthepopulationoverage60isexpectedtoremainconstantintheCityofWilliamsburgatabout20%andinYorkCountyat24.5%between2016and2040.Ontheotherhand,thepercentofthepopulationoverage60isexpectedtoincreaseto43,199or39.3%inJamesCityCounty.Again,aswithpopulationgrowthmoregenerally,theprocessofagingmayplacealargerburdenonlocalhealthcareandhumanserviceprovidersastheyadapttoalargerandolderpopulation.

Figure1.1CSenior(60+)PopulationProjectionsforGreaterWilliamsburg(2020,2030,and2040)

Source:WeldonCooperCenterforPublicService;DemographicsResearchGroup2016Virginia2020-2040PopulationProjections

1Thethresholdagefortheseniorpopulationvariesindifferentdatasetsateitherage60or65.Allthedatarelatingtoseniorsinthisreportincludenotationsindicatingthethresholdage.

2020 2030 2040JamesCityCounty 29,835 39,277 43,199

YorkCounty 17,028 21,347 21,591

CityofWilliamsburg 3,369 3,738 3,719

GreaterWilliamsburg 50,233 64,363 68,509

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Table1.1CSenior(60+)PopulationProjectionsforGreaterWilliamsburgandVirginia(2020,2030,and2040) RateofGrowth RateofGrowthperYearJamesCityCounty 39.3% 2.0%YorkCounty 24.5% 1.2%CityofWilliamsburg 20.0% 1.0%GreaterWilliamsburg 31.5% 1.6%Virginia 24.7% 1.2%Source:WeldonCooperCenterforPublicService;DemographicsResearchGroup2016VirginiaPopulationEstimates

Section1.2:AgeDistributionAccordingtotheU.S.CensusBureau’s2015CensusEstimates,andasillustratedbyFigure1.2:

• 4.9%ofthepopulationofGreaterWilliamsburgisunderage5.• 21.2%ofthepopulationofGreaterWilliamsburgisunderage18.• 59.7%ofthepopulationofGreaterWilliamsburgisbetweentheagesof18and64.• 19.1%ofthepopulationofGreaterWilliamsburgisoverage65.• 2.2%ofthepopulationorGreaterWilliamsburgisoverage85.

WhencomparedtoVirginia,thepopulationofGreaterWilliamsburgisrelativelyolder,consideringthat19.1%ofthepopulationofGreaterWilliamsburgisoverage65,andonly14.2%ofthepopulationofVirginiaisolderthanage65.

Figure1.2AgeDistributioninGreaterWilliamsburg(2015)


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However,despite their similaritiesandgeographicproximity theageprofileof JamesCityCounty, theCity of Williamsburg, and York County have some substantial differences. One reason for thesedifferences is thedisproportionateamountofyoungadultsandCollegeofWilliamandMarystudentsliving in theCityofWilliamsburg.Forexample,73.3%of thepopulationof theCityofWilliamsburg isbetweentheagesof18and64comparedto56.0%forJamesCityCountyand60.8%forYorkCounty.AsecondreasonforthesubstantialdifferencesisthedisproportionatenumberofseniorcitizenslivinginJamesCityCounty.Forexample:

• 23.6%oftheJamesCityCountypopulationisovertheageof65comparedto15.8%fortheCityofWilliamsburgand14.9%forYorkCounty.

• 2.9%ofthepopulationofJamesCityCountyisovertheageof85comparedto1.8%fortheCityofWilliamsburgand1.6%forYorkCounty.

Section1.3:RaceandEthnicityAccordingtotheU.S.CensusBureau’s2015CensusEstimates,andasillustratedbyFigure1.3andTable1.3,approximately78.2%ofthepopulationofGreaterWilliamsburgisWhite.TheAfricanAmericanpopulationisthesecondlargestgroup,accountingfor13.7%ofthepopulationofGreaterWilliamsburg.TheCityofWilliamsburghasthelargestminoritypresenceasapercentofthepopulationofeachofthelocalitieswithinGreaterWilliamsburg–animportantfactwhenconsideringhowhealthcareopportunities,risks,andoutcomesarelikelytodifferbyrace.

Figure1.3A:RacePopulationinGreaterWilliamsburgbyLocality(2015)


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Table1.3A:PopulationinGreaterWilliamsburgbyRaceandLocality(2015) White

AloneAfricanAmericanAlone

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TwoorMoreRaces

GreaterWilliamsburg 78.2% 13.7% 4.4% 0.6% 3.1%JamesCityCounty 80.5% 13.6% 2.7% 0.5% 2.8%YorkCounty 76.7% 13.5% 5.6% 0.7% 3.4%CityofWilliamsburg 74.1% 15.5% 6.7% 0.5% 3.2%Source:WeldonCooperCenterforPublicService;DemographicsResearchGroup2016VirginiaPopulationEstimates

PeoplethatidentifyasHispanicarenotincludedinthedatacollectionabovebecauseHispanicisanethnicity,notarace.Table1.3BhighlightsCensusdataonthetotalgrowthoftheHispanicpopulationineachofthelocalities,aswellastherateofgrowthbetweenApril1,2010andJuly1,2016.

Table1.3B:PopulationGrowthoftheHispanicPopulation(April1,2010–July1,2016) Total Hispanic Growth (% Increase) GreaterWilliamsburg 597 8.7% JamesCityCounty 237 7.8% YorkCounty 305 10.5% CityofWilliamsburg 55 5.8% Source:WeldonCooperCenterforPublicService;DemographicsResearchGroup2016VirginiaPopulationEstimates

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Section2:HealthProfileThefollowingsectioncontainsimportantpopulationhealthmeasuresthataidinillustratingthestateofhealth,aswellasthequalityofhealthcareinGreaterWilliamsburg.

Section2.1:HealthRisksAccordingtoestimatesfromthe2017CountyHealthRankingsforVirginia,asillustratedbyFigure2.1,itisestimatedthatthousandsofGreaterWilliamsburgresidentsengageinunhealthybehaviors.Reducingthesebehaviorswillhelp reduce theprevalenceofchronic illnessesand isessential for improving thehealth and overall well-being of our community. According of the 2017 County Health Rankings, ofadultsoverage18inGreaterWilliamsburg,anestimated:

• 17%ofthepopulationoftheCityofWilliamsburgreportedthattheysmoke,while13%ofthepopulationreportedsmokinginJamesCityCountyandYorkCounty.

• 23%ofthepopulationoftheCityofWilliamsburgreportedthattheydonotmeetthephysicalactivity recommendations, while 22% of the population reported physical inactivity in YorkCounty,and20%reportedphysicalinactivityinJamesCityCounty

• 19%ofthepopulationoftheCityofWilliamsburgreportedexcessivedrinking,while18%ofthepopulationofYorkCountyreportedexcessivedrinking,andJamesCityCountyReported17%.

Figure2.1:UnhealthyBehaviorsintheGreaterWilliamsburgLocalities(20172)

SOURCE:2017CountyHealthRankingsVirginiaData

2CountyHealthRankingsreleasesadatareporteveryyearinMarch.Sincethereportinvolvescollectingandcollatingnational-leveldata,thedataincludedineachyear’sreporthavetypicallybeencollectedtwotothreeyearsprior.Infigure2.1,dataonAdultSmokingwerecollectedin2015;dataonPhysicalInactivitywerecollectedin2013;dataonExcessiveDrinkingwerecollectedin2015.

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Section2.2:AccesstoCareAccesstohealthcareisdefinedas“thetimelyuseofpersonalhealthservicestoachievethebestpossiblehealthoutcomes.”3Accesstoqualityhealthcareisimportantforpromotingandmaintaininghealthaswellasforpreventingandmanagingdisease.4Havingaccessmeansthatindividualsareabletogainentryintothehealthcaresystem.Themostinfluentialsinglevariableinwhetheranindividualisaccessinghealthservicesishealthinsurancecoverage.ThestatusandimpactofseveralsocialdeterminantsofhealthwhicharekeytoeconomicstatusandtheavailabilityofhealthinsurancewillbeexaminedintheSection3ofthisreport.

Section2.3:ChronicIllnessandPoorHealthChronicillnessisasignificantchallengeinhealthcareandisamajordrivingfactorforincreasesinhealthcarecosts.AccordingtotheCDC,morethan75%ofallhealthcarespendingintheUnitedStatesisforpeoplewith chronic conditions, and that share is growing.5 One influential factor contributing to theincreasingcostsassociatedwithtreatingchronicillnessisthecostofnewmedicationsbeingdevelopedto treat conditions such as high cholesterol. Yet, even with new andmore effective treatments andcures,“7outof10deathsamongAmericanseachyeararefromchronicdiseases.”6Sadly,itisestimatedthatthousandsofGreaterWilliamsburgresidentssufferfromchronicillnesses.

Table2.3AillustratesestimateddiabetesprevalenceinthethreelocalitiesofGreaterWilliamsburg.TheprevalenceofdiabetesinJamesCityCountyisimportanttonotebecauseitishigherthanintheotherlocalities, as well as in Virginia as a whole, as 10.5% of the population has diabetes. As Table 2.3Adisplays,9.5%ofthepopulationofYorkCountyhasdiabetes,and8.9%ofthepopulationoftheCityofWilliamsburg has diabetes. Overall, in the state of Virginia, 9.5% of the population has diabetes.Diabetes isanexpensivechronic illnessbecause it isoftenassociatedwithtwoor threeotherchronicdisease diagnoses. Peoplewith diabetes have approximately 2.3 times highermedical expenses thanthosewithoutthedisease.7Table2.3A:DiabetesPrevalencebyLocality(20178)Virginia 9.5%JamesCityCounty 10.5%YorkCounty 9.5%CityofWilliamsburg 8.9%SOURCE:2017CountyHealthRankingsVirginiaData

3InstituteofMedicine,CommitteeonMonitoringAccesstoPersonalHealthCareServices.AccesstoHealthCareinAmerica.Washington,DC:NationalAcademyPress;1993.4https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services5“ThePowerofPrevention,”NationalCenterforChronicDiseasePreventionandHealthPromotion,CentersforDiseaseControlandPrevention(2009).http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf6“ThePowerofPrevention,”NationalCenterforChronicDiseasePreventionandHealthPromotion,CentersforDiseaseControlandPrevention(2009).http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf7CDC(Ed.).(2016,December29).DiabetesatWork.,https://www.cdc.gov/diabetes/diabetesatwork/plan/costs.html8CountyHealthRankingsreleasesadatareporteveryMarch;howeveralotofthecompileddatawerecollectedinprioryears.DataonDiabetesPrevalencewerecollectedin2013.DataonHIVPrevalenceRatewerecollectedin2013.

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SeeAppendixTable1foranillustrationofHIVprevalencerateinthethreelocalitiesofGreaterWilliamsburgincomparisontoVirginiaoverall.DuetoadvancesinHIVtreatment,theinfectionisnowconsideredachronicillness.9PatientsareabletomanageHIVandhavelifeexpectanciesthataremeasuredindecadesratherthanyears.ThismakesHIVprevalenceaninterestingchronicillnesstotakenoteofintheGreaterWilliamsburgarea.

Table2.3Cshowsthepercentofbabiesbornatlowbirthweightoutofalllivebirthsbylocality.Lowbirthweightisapredictorofthehealthofapersonfortherestoftheirlives.Lowbirthweightisalsoanindicatorforthehealthofthemotherduetosocialdeterminantsofhealththatcancontributetomalnourishmentandillness.TheCityofWilliamsburgshowsthehighestlowbirthweightbirthrateat11%.JamesCityCountyhasthenexthighestlowbirthweightbirthrateat7%,andYorkCountyhas6%.

Table2.3C:LowBirthweightBirthsbyLocality #LiveBirths #LowBirthweight

Births%LowBirthweight

JamesCityCounty 4,831 332 7%YorkCounty 4,276 270 6%CityofWilliamsburg 762 86 11%SOURCE:2017CountyHealthRankingsVirginiaData10

9“TheEndofAIDS:HIVasaChronicDisease”USNationalLibraryofMedicineNationalInstitutesofHealth(2013).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058441/10CountyHealthRankingsreleasesadatareporteveryMarch;howeveralotofthecompileddatawerecollectedinprioryears.DataonLowBirthweightwerecollected2008-2014.

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Section2.4:BehavioralandMentalHealthMentalillnessesandbehavioraldisordersoccurathighratesinGreaterWilliamsburg.AlthoughapproximatelyoneinfiveAmericanssufferfromsomeformofmentalhealthdisordereachyearandonein20sufferfromaseriousmentalillness,11fewerthanhalfofthepopulationwhosufferfrommentaldisordersseektreatment.12Theproblemisexacerbatedbythefactthatpoormentalorbehavioralhealthoftencontributestootherchronicillnesses.

Table2.4showsthepercentageofthepopulationthathasreportedfrequentmentaldistressfromthe2017CountyHealthRankingsofVirginia. TheCityofWilliamsburgshowsthehighestpercentageofreportsoffrequentmentaldistressat11.13%.JamesCityCountyhasthenexthighestpercentageofat9.45%,andYorkCountyhas9.05%.Overall,inthestateofVirginiathepercentofthepopulationwhoreportedfrequentmentaldistressis10.47%,thusthereportsofmentaldistressintheCityofWilliamsburgisimportanttonotesinceitishigherthaninthestateofVirginiaoverall,aswellastherestofGreaterWilliamsburg.

Table2.4:PercentofthePopulationwhoreportedFrequentPhysicalandMentalDistressbyLocalityVirginia 10.47%JamesCityCounty 9.45%YorkCounty 9.05%CityofWilliamsburg 11.13%SOURCE:2017CountyHealthRankingsVirginiaData

11“MentalHealthConditions,”NationalAllianceonMentalIllness.AccessedAugust7,2015athttps://www.nami.org/Learn-More/Mental-Health-Conditions12“NearlyHalfofAmericansWithSevereMentalIllnessDoNotSeekTreatment,”CardiovascularNews.AccessedAugust7,2015athttp://circ.ahajournals.org/content/101/5/e66.full.pdf+html

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Section2.5:QualityofCareThissectionwillexplorehospitalreadmissionrates.Thisquantitativeevaluationgivesinsightintothequalityofcareinthethreelocalities.

Section2.5A:HospitalReadmissionHospitalreadmissionisdefinedaswhenapatienthasbeenadmittedtothesamehospitalwiththesameproblemwithinthirtydaysofdischarge.Readmissionratesareusednationallyasoneindicatorofthequalityofcareandefficiencyofahospital.

Table2.5AdisplaysreadmissionratesforRiversideDoctors’Hospital(RDH)ofWilliamsburgandSentaraWilliamsburgRegionalMedicalCenter(SWRMC)incomparisontotheVirginiaaverageforheartfailure,pneumonia,andhip/kneerelatedinjuries.RDHandSWRMCarethetwohospitalsinGreaterWilliamsburg.Table2.5AshowsthatforthemostpartbothhospitalshavelowerreadmissionratesthantheVirginiaaverageinthemajorityoftheconditionshighlightedinthistable.

Table2.5A:ReadmissionRatesforRiversideandSentaraincomparisontotheVirginiaAverage(2015) RiversideDoctors’

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HeartFailure 20.30% 18.70% 21.93%Pneumonia 14.90% 15.80% 17.44%Hip/Knee 4.40% 5.30% 4.85%SOURCE:VHHAQualityandPatientSafetyScorecard(2012-2015)

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Section3:SocialDeterminantsofHealthSocialDeterminantsofHealth(SDH)arefactorsthatincludesocialandeconomicaspectsthatarepartofeverydaylifethataffectawiderangeofhealthoutcomes.Thesefactorsplayalargepartindisparitiesinhealthamongandbetweendifferentracial,ethnicandeconomicgroups.ThissectionpresentsthelatestdatafromtheVirginiaDepartmentofSocialServices,theU.S.DepartmentofLaborStatistics,theVirginiaDepartmentofHealth,andthe2017SmallAreaHealthInsuranceEstimates(SAHIE).Thissectionbeginswithdataontwoofthemostinfluentialdeterminants:unemploymentandpoverty.Unemploymentandunder-employmentaswellashouseholdpovertyhaveadocumentednegativeimpactonhealthstatus.Thesesectionsarefollowedbymetricsonothersocio-economicDeterminantsofHealth,suchastheVirginiaHealthDepartment’sHeathOpportunityIndex(HOI),therateofteenpregnancy,andtherateofchildrenlivinginsingleparenthouseholds.

Section3.1UnemploymentDefinedasthepercentofthelaborforcethathasnojobbutisactivelysearchingforwork,theunemploymentratehasbeenshowntobebothacauseandconsequenceofpoorhealth.

13Asillustrated

byFigure3.1,theunemploymentratefortheCityofWilliamsburgsurpassesJamesCityCounty,YorkCounty,andstatewidelevels.ThesourceincludesdatafromPoquosonbecauseitsharesaDepartmentofSocialServiceswithYorkCounty.IntheCityofWilliamsburg,theunemploymentrateincreasedfrom5.6%in2007to10.2%in2010beforedecliningto6.3%by2015.Yet,despitetherecentdecreaseinunemployment,GreaterWilliamsburghasyettoreturntopre-recessionlevels.

Figure3.1:AnnualUnemploymentRateforGreaterWilliamsburgbyLocality(2000-2015)

SOURCE:VDSSLocalDepartmentofSocialServicesProfileReport,SFY201614

13Schmitz,Hendrik.“WhyAreTheUnemployedinWorseHealth?TheCausalEffectofUnemploymentonHealth.”LaborEconomics18(2011):71-78.14StateFiscalYear(SFY)referstothe12-monthtimeperiodthatthestateusesforaccountingandfinancialpurposes.Thisperioddoesnotalignwiththecalendaryear.TheSFYstartsonJuly1andendsonJune30.

0%

2%

4%

6%

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18%

2000

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tofthe

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Virginia

19

Section3.2:PovertyThissectiondisplaysdataonindicatorsofpoverty.Thisincludespovertyrates,SupplementalNutritionAssistanceProgram(SNAP)enrollment,andTemporaryAssistanceforNeedyFamilies(TANF)enrollment.Enrollmentingovernmentassistanceprogramsisincludedbecausedefinedlevelsofpoverty,asmeasuredbyhouseholdincome,arerequiredforenrollment.

Section3.2A:PovertyRateAsillustratedbyFigure3.2Ai,thepovertyrateforGreaterWilliamsburghasincreasedgradually,risingfrom5.7%in2000to7.0%in2015.However,liketheunemploymentrate,thepovertyrateintheCityofWilliamsburghasbeenconsistentlyhigherthanthepovertyrateforVirginia,JamesCityCounty,orYorkCounty.Forinstance,asof2015,thepovertyrateintheCityofWilliamsburgwas22.0%comparedto11.2%forVirginia,7.1%forJamesCityCounty,and5.3%forYorkCounty.ThehighlevelofpovertyintheCityofWilliamsburgistroublesome,asmanystudieshavedemonstratedastrongassociationbetweenpovertyandpoorhealthoutcomes,suchaschronicdiseases,disability,andmentalorbehavioralhealth.15,16,17Thechildpovertyrateisconsistentlyamoreaccuratedescriptionofpovertythantheoverallpovertyrateofallagesbecausethelatterdoesnotaccountforyoungadultsorstudentswhodonothaveasteadyincomeoftheirown,butwhodonotexperiencetheadverseeffectsofpoverty.SeeFigure3.2Aiiforthechildpovertyrate.Figure3.2Ai:PercentofPopulationLivingBelow100%Poverty(2000-2015)


15Plantinga,LauraC.,KirstenL.Johansen,DeanSchillinger,andNeilR.Powe.“LowerSocioeconomicStatusandDisabilityamongUSAdultswithChronicKidneyDisease,1999-2008.”PreventingChronicDisease9(2012):1-11.16Sabanayagam,CharumathiandAnoopShankar.“IncomeIsaStrongerPredictorofMortalitythanEducationinaNationalSampleofUSAdults.”JournalofHealth,Population,andNutrition1(2012):82-86.17Yoshikawa,Hirokazu,J.LawrenceAber,andWilliamR.Beardslee.“TheEffectsofPovertyontheMental,Emotional,andBehavioralHealthofChildrenandYouth.”AmericanPsychologist67,no.4(2012):272-284.

0%

5%

10%

15%

20%

25%

30%

Percen

tofP

opulation

Year

JamesCityCounty

YorkCounty/Poquoson

CityofWilliamsburg

Virginia

20

AsillustratedbyFigure3.2Aii,despitebeinglowerthanthechildpovertyrateforVirginia,thechildpovertyrateforGreaterWilliamsburghasalsoincreasedgradually,risingfrom7.1%in2000to9.7%in2015.However,asabove,thechildpovertyrateintheCityofWilliamsburghasbeenconsistentlyhigherthanthechildpovertyrateforVirginia,JamesCityCounty,orYorkCounty.Forinstance,asof2015,thechildpovertyrateintheCityofWilliamsburgwas25.1%comparedto15.0%forVirginia,10.2%forJamesCityCounty,and6.7%forYorkCounty.

Figure3.2Aii:PercentofChildren(0-17Years)LivingBelow100%Poverty(2000-2015)


0%

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Virginia

21

Section3.2B:SupplementalNutritionAssistanceProgram(SNAP)EnrollmentAsillustratedbyFigure3.2B,thenumberofSNAPclientslivinginGreaterWilliamsburghasincreasedasaportionoftheoverallpopulationovertimebeforelevelingoffanddecliningstartingin2013.From2013to2016,theofSNAPclientpopulationinGreaterWilliamsburghasdeclinedslightlyto13,876persons,witharateofdeclineof8.9%.

Figure3.2B:NumberofActiveSNAPClientsbySFY(2012-2016)


-

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22

Section3.2C:TemporaryAssistanceforNeedyFamilies(TANF)EnrollmentObservingTANFenrollmentwillhelptohighlighttherateofpovertyintheGreaterWilliamsburgarea.ThenumberofTANFrecipientslivinginGreaterWilliamsburghasfluctuatedandincreasedmodestlyovertime.AsillustratedbyFigure3.2C,thenumberofTANFrecipientslivinginGreaterWilliamsburghasdecreasedfrom1,831personsin2012,to1,461personsby2016.Ofthose1,461enrollees,725livedinJamesCityCounty,589livedinYorkCounty,and147livedintheCityofWilliamsburg.

Figure3.2C:NumberofActiveTANFRecipientsbySFY(2012-2016)


0

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23

Section3.3:HealthOpportunityIndex(HOI)TheHealthOpportunityIndex(HOI)isarankingthatfacilitatestheobservationofanumberoffactorsthataffecthealth.TheVirginiaHOImethodologyincorporatesthirteenindicatorsthatareorganizedintofourcategories:economicopportunity18,consumeropportunity19,communityenvironment20,andwellnessdisparity21.Thisrankingisdesignedtohelpdecisionmakersfocusonfactorsincommunitiesthataffecthealth.Therankinglevelsrangefromoneto134,usingacomparativerankingofthe134localitiesinthestate.

Table2.5CdisplaystheVirginiaHOIranksandtheindicatorranksofthethreelocalitiesofGreaterWilliamsburgincomparisontothestateasawhole,asofDecember2015.TheoverallVirginia“rankings”areactuallynotactualrankings,butratherthemedianscoresofalllocalitiesinVirginia.AllthreelocalitiesofGreaterWilliamsburgrankhigherthanthemedianmeasurementof67foralllocalitiesinVirginia.YorkCountyisconsideredtohavea“veryhigh”opportunitylevelwhichitleadstoitsHOIrankat16thinthestate.Thisrankingisimpactedby“veryhigh”consumeropportunityandeconomicopportunitylevels.YorkCountyisfollowedbytheCityofWilliamsburg,whichisconsideredtohavea“high”opportunitylevelat34thinthestate.Thisrankingisimpactedbya“veryhigh”communityenvironmentrankinganda“verylow”wellnessdisparityranking.Next,JamesCityCountyhasa“high”opportunitylevelat43rdinthestate.Thisrankingisimpactedbya“verylow”rankinginwellnessdisparitybutoffsetby“high”rankingsinconsumeropportunity.

Table3.3:HealthOpportunityIndex HOIRank Economic

OpportunityConsumerOpportunity

CommunityEnvironment

WellnessDisparity

Virginia 67 67 68 68 67JamesCityCounty 43 59 25 53 122YorkCounty 16 21 11 49 48CityofWilliamsburg 34 123 22 9 112SOURCE:VDHVirginiaHOI(2015)

18EconomicOpportunity:Includesanemploymentaccessibilityindicatorbasedondistanceofpossibleemploymentfromresidentialareas;anincomeinequalityindicatorwhichmeasuresincomedistribution;andajobparticipationindicator,whichmeasuresthepercentofthoseaged16-64yearsthatareinthelaborforce.19ConsumerOpportunity:Measuresaccesstobasicconsumerresources.Includesanaffordabilityindicatorwhichmeasurestheproportionofincomethatisspentonhousingandtransportation;aneducationindicatorwhichmeasurestheaverageyearsofschoolthatmembersofthecommunityparticipatein;afoodaccessibilityindicatorwhichmeasurestheaccessibilityofvulnerablepopulationstofood;andamaterialdeprivationindicator,whichmeasuresovercrowding,unemployment,percentageofpeoplewithnovehicle,andthepercentageofpersonswhorentinsteadofbuyhomes.20CommunityEnvironment:MeasurementsthatincludeanAirQualityIndicatorthatconsidersEPAmeasuresofairpollution;apopulationchurningindicatorthatmeasurespopulationturnover;apopulationdensityindicator;andawalkabilityindicatorbasedonresidentialdensity,employmentdensity,landusediversity,andaccessibility.21WellnessDisparity:Measuresinequalitiesthrough:anaccesstocareindicatorthatconsidersaccesstoprimarycare,andmeanstopayforcare;andasegregationindicator,whichmeasurescommunitydiversityanddistancebetweenareaswithdifferentracialandethnicprofiles.

24

Section3.4:TeenPregnancyAsillustratedbyFigure3.4A,therateofteenbirthsperyearfelldramaticallyinGreaterWilliamsburgfrom1998to2014.Theteenbirthrate(thenumberofteenbirthsper1,000womenbetweentheagesof10and19)fellfrom22.0in1998to9.4in2014.Furthermore,thenumberofteenbirthsperyeardecreasedfrom99in1998to50in2014despitetheincreasedpopulation.TheteenbirthratevarieswithintheGreaterWilliamsburgarea.Asof2014,theteenbirthratewas5.8inJamesCityCounty,2.6intheCityofWilliamsburg,and3.7per1,000teenwomeninYorkCounty.

Figure3.4A:TeenBirthRate(per1,000pop.)byYear(1998-2014)


0.0

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CityofWilliamsburg

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25

AsillustratedbyFigure3.4B,theteenbirthratealsovariesbyrace.Inparticular,theteenbirthrateforthenon-WhitepopulationishigherthanfortheWhitepopulation.Asof2014,theteenbirthratefortheWhitepopulationinGreaterWilliamsburgwas3.2birthsper1,000womenbetweentheagesof10and19comparedto6.6fortheAfricanAmericanpopulationand12.3forthosebelongingtoaraceotherthanWhiteorBlack.RacialdisparitiesinteenbirthsaremostprevalentinJamesCityCounty,wheretheteenbirthratefortheWhitepopulationis2.9comparedto10.6fortheBlackpopulationand37.0forthosebelongingtoaraceotherthanBlackorWhite.

Figure3.4B:TeenBirthRate(per1,000pop.)byRaceandLocality(2014)


Therecentdeclineinteenbirthratesissignificantfromahealthpolicyperspectivebecauseteenmotherstendtohavelowerhouseholdincomes,aremorelikelytobeeligibleforpublicassistance,demonstratelowereducationalattainment,arelesslikelytobemarried,andhavechildrenthatlaginstandardsofearlydevelopment.Inturn,thechildrenofteenmothersareathigherriskofexperiencingworseeducational,behavioral,andhealthoutcomesoverthecourseoftheirlives22.

22Pinzon,JorgeL.;Jones,VeronnieF.;COMMITTEEONADOLESCENCE,COMMITTEEONEARLYCHILDHOOD,“CareofAdolescentParentsandTheirChildren,”PediatricsDecember2012,VOLUME130/ISSUE6FromtheAmericanAcademyofPediatricsClinicalReport

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26

Section3.5:ChildreninSingleParentHouseholdsInGreaterWilliamsburg,anestimated25,406childrenliveinamarriedcouplehouseholdcomparedto6,851wholiveinasingleparenthousehold.Ofthose6,851childrenwholiveinasingleparenthousehold,3,317liveinJamesCityCounty,3,057liveinYorkCounty,and477liveintheCityofWilliamsburg.Furthermore,1,460childrenliveinfatheronlyhouseholdswhile5,391liveinmotheronlyhouseholds.

AsillustratedinFigure3.5,anestimated79%ofchildreninGreaterWilliamsburgliveinmarriedcouplehouseholds.AhigherpercentofchildreninGreaterWilliamsburgliveinmarriedcouplehouseholdscomparedtoVirginia.However,childrenlivingintheCityofWilliamsburgwere20percentagepointsmorelikelytoliveinasingle-parenthouseholdthanthoselivinginYorkCounty,and12percentagepointsmorelikelythanthoselivinginJamesCityCounty.Alongsidethedataonunemployment,poverty,andutilizationofpublicassistance,thisfindingsupportstheideathatthehealthandhumanservicesneedsoftheCityofWilliamsburgaregreaterthananddistinctfromtheneedsofGreaterWilliamsburgasawhole.

Figure3.5:ChildrenLivinginSingleParentHouseholdsvsChildrenLivinginMarriedCoupleHouseholdsbyLocality


1,460647

702

111

5,391 2,6702,355

366

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GreaterWilliamsburg JamesCityCounty YorkCounty/Poquoson CityofWilliamsburg

%ofC

hildren

Locality

ChildrenUnder18LivinginMarried-CoupleHH ChildrenUnder18LivinginFatherOnlyHH

ChildrenUnder18LivinginMotherOnlyHH

27

Section4:TheUninsuredandtheImpactofSafety-NetClinics

Section4.1:MedicaidEnrollmentAsillustratedbyFigure4.1,thepercentoftheGreaterWilliamsburgpopulationenrolledinMedicaidhasincreasedsubstantially.From2012to2016,thenumberofMedicaidenrolleesinGreaterWilliamsburgincreasedby38.3%from11,526personsin2012,to15,945personsby2016.Ofthose15,945enrollees,8,018liveinJamesCityCounty,6,193liveinYorkCounty,and1,734liveintheCityofWilliamsburg.IntheCityofWilliamsburg,11.7%ofthepopulationwasenrolledinMedicaidin2015,comparedto10.9%forJamesCityCounty,8.9%forYorkCounty.Overall,theGreaterWilliamsburglocalitieshaverelativelylowerratesofenrollmentthanVirginiaasawhole,howevertherateofincreaseinMedicaidenrollmentinGreaterWilliamsburgbetween2009and2015hasoutpacedtheenrollmentincreaseinVirginiaasawhole:43.6%inGreaterWilliamsburgcomparedto35%inVirginia.Basedonthesetrendlines,Medicaidenrollmentcanbeexpectedtocontinuetoincreasewithorwithoutanexpansionoftheprogram.

Figure4.1:PercentofMedicaidClientsperLocalitybySFY(2012-2016)

SOURCE:VDSSLocalDepartmentofSocialServicesProfileReport,SFY2016;SeealsoAppendix:Table2

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2012 2013 2014 2015 2016

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Virginia

28

Section4.2:TheUninsuredFigure3.6illustratesthepercentageofuninsuredindividualsinthepopulationperlocality,highlightinguninsuredadultsanduninsuredchildren.Acrossallthreelocalities,thereisalowerproportionofuninsuredchildrenthanthereisofuninsuredadults.ThiscanbeattributedtotheChildren’sHealthInsuranceProgram(CHIP)thatprovidescoverageforamajorityofchildrenthroughMedicaidandotherprograms.23TherateofuninsuredindividualsisimportanttonoteintheCityofWilliamsburg,withthehighestpercentageofuninsuredadultsat14.98%,anduninsuredchildrenat6.90%.NextisJamesCityCountyat11.98%foruninsuredadultsand6.20%foruninsuredchildren,andYorkCountywith10.57%uninsuredadultsand5.39%uninsuredchildren.

Figure4.2:UninsuredAdultsandChildrenbyLocality(2015)

SOURCE:2017SmallAreaHealthInsuranceEstimates(SAHIE);SeeAlsoAppendix:Figure1,Figure2,andFigure3.

23Medicaid.gov.Children'sHealthInsuranceProgram(CHIP).https://www.medicaid.gov/chip/index.html

JamesCityCounty YorkCounty CityofWilliamsburg Virginia

ages18-64 10.30% 9.30% 14.60% 12.40%

18andunder 4.80% 4.90% 6.40% 5.00%

0%

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%Uninsured

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29

Section4.3:Safety-NetClinicsThreesafety-netclinicsoperateinGreaterWilliamsburgandprovideaninvaluableservicetotheunderservedanduninsuredpopulation:OldeTowneMedicalandDentalCenter,AngelsofMercyFreeClinic,andLackeyClinic.Table4.3Adisplaysdataonthenumberofpatientsineachofthesafety-netclinicscollectedfromthefinalprogressreportsofeachclinic,coveringtheyearJuly1,2016toJune30,2017.Thesedatashowthatthethreeclinicsprovidedover26,000patientvisitswithover18,800ofthoseservingpatientsfromtheWHFservicearea.24Table4.3A:ImpactoftheGreaterWilliamsburgSafety-NetClinicswithintheWHFServiceArea(2017)

TotalsVisits

VisitsfromWHFServiceArea(%of

TotalVisits)

TotalPatients

PatientsfromWHFServiceArea(%ofTotalPatients)

AngelsofMercyClinic

1,614 1,602(99.3%) 352 349(99.1%)

LackeyClinic 10,242 3,638(35.5%) 1,681 607(36.1%)OldeTowneMedicalandDentalCenter

14,500 13,630(94.0%) 4,646 4,367(94.0%)

Totals 26,356 18,870(71.6%) 6,679 5,323(79.7%)SOURCE:FinalProgressReport,submittedtotheWilliamsburgHealthFoundationfortheyearJuly1,2016throughJune30,2017

Table4.3BshowstheimpactofthethreeGreaterWilliamsburgsafety-netclinicsfortheuninsuredpopulationoftheWHFservicearea.Together,theclinicsseeover4,300uniqueuninsuredpatientsfromtheWHFservicearea.Thisindicatesthattheclinicsserveanestimated39%oftheuninsuredpopulationintheWHFservicearea.25(The2017SmallAreaHealthInsuranceEstimatesindicatethat11,166non-elderlyindividualsinGreaterWilliamsburgareuninsured.)26Table4.3B:ImpactoftheGreaterWilliamsburgSafetyNetClinicsfortheUninsuredPopulationwithintheWHFServiceArea(2017)

TotalUninsuredPatientVisits

UninsuredPatientVisitsfromWHFServiceArea(%of

TotalVisits)

TotalUninsuredPatients

UninsuredPatientsfromWHFServiceArea(%ofTotalPatients)

AngelsofMercyClinic

1,614 1,602(99.3%) 352 349(99.1%)

LackeyClinic 10,242 3,638(35.5%) 1,681 607(36.1%)OldeTowneMedicalandDentalCenter27

11,310 10,631(94.0%) 3,623 3,406(94.0%)

Totals 23,166 15,871(68.5%) 5,656 4,362(77.1%)SOURCE:FinalProgressReport,submittedtotheWilliamsburgHealthFoundationfortheyearJuly1,2016throughJune30,2017

24AlldatainthesetwotablesweresubmittedtotheWilliamsburgHealthFoundationintheFinalProgressReportsoftheclinics,receivedinJanuaryandJuly2017.25Calculation:4,362UninsuredpatientsfromWHFserviceareadividedby11,166totaluninsuredpatientsinGreaterWilliamsburgequals39%.26SmallAreaHealthInsuranceEstimates(SAHIE)calculatedusingdatafromtheAmericanCommunitySurvey(ACS)oftheCensusBureau.Onlynon-elderly,orpeopleundertheageof65,areincludedinuninsurednumbersbecauseoftheavailabilityofMedicare.27OldeTowneMedicalandDentalCenterreportsthat78%ofitspatientsareuninsured.

30

ConclusionAlthoughseizingtheopportunitiestoimprovecitizenhealthandwell-beingandovercomingthehealthchallengesfacedbythevulnerablemayseemdaunting,theWilliamsburgHealthFoundationhasdesignedthisreporttohelpguidethecommunityconversation.Throughthecreationoftargetedcommunitydialogueandcollaboration,webelievethatthisreportwillactasaspringboardfordialogue,change,andinnovation.

31

Bibliography

“2017CountyHealthRankingsandNationalData”CountyHealthRankingsandRoadmapshttp://www.countyhealthrankings.org/rankings/data

CDC(2016,December29).DiabetesatWork.,

https://www.cdc.gov/diabetes/diabetesatwork/plan/costs.html“TheEndofAIDS:HIVasaChronicDisease”USNationalLibraryofMedicineNationalInstitutesofHealth

(2013).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058441/FinalProgressReport,submittedtotheWilliamsburgHealthFoundationfortheyearJuly1,2016

throughJune30,2017byAngelsofMercyFreeClinic(2017)FinalProgressReport,submittedtotheWilliamsburgHealthFoundationfortheyearJuly1,2016

throughJune30,2017byOldeTownMedical&DentalCenter(2017)FinalProgressReport,submittedtotheWilliamsburgHealthFoundationfortheyearJuly1,2016

throughJune30,2017byLackeyClinic(2017)Knox,Richard.“$1,000PillforHepatitisCSpursDebateOverDrugPrices,”NationalPublicRadio,

December30,2013.http://www.npr.org/sections/health-shots/2013/12/30/256885858/-1-000-pill-for-hepatitis-c-spurs-debate-over-drug-prices

Mangen,Dan,“Cholesteroldrugcostworrieslingerevenafterspendingreport,”CNBC,August6,2015.

http://www.cnbc.com/2015/08/06/cholesterol-drug-cost-worries-linger-even-after-spending-report.html

Medicaid.gov.Children'sHealthInsuranceProgram(CHIP).https://www.medicaid.gov/chip/index.html“MentalHealthConditions,”NationalAllianceonMentalIllness.AccessedAugust7,2015at

https://www.nami.org/Learn-More/Mental-Health-Conditions“NearlyHalfofAmericanswithSevereMentalIllnessDoNotSeekTreatment,”CardiovascularNews. AccessedAugust7,2015athttp://circ.ahajournals.org/content/101/5/e66.full.pdf+htmlPinzon,JorgeL.;Jones,VeronnieF.;COMMITTEEONADOLESCENCE,COMMITTEEONEARLY

CHILDHOOD,“CareofAdolescentParentsandTheirChildren,”PediatricsDecember2012,VOLUME130/ISSUE6fromtheAmericanAcademyofPediatricsClinicalReport

32

Plantinga,LauraC.,KirstenL.Johansen,DeanSchillinger,andNeilR.Powe.“LowerSocioeconomicStatusandDisabilityamongUSAdultswithChronicKidneyDisease,1999-2008.”PreventingChronicDisease9(2012):1-11.

“ThePowerofPrevention,”NationalCenterforChronicDiseasePreventionandHealthPromotion,

CentersforDiseaseControlandPrevention(2009).http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf

Sabanayagam,CharumathiandAnoopShankar.“IncomeIsaStrongerPredictorofMortalitythan

EducationinaNationalSampleofUSAdults.”JournalofHealth,Population,andNutrition1(2012):82-86.

Schmitz,Hendrik.“WhyAreTheUnemployedinWorseHealth?TheCausalEffectofUnemploymenton Health.”LaborEconomics18(2011):71-78.Staff,I.(2015,June12).FiscalYear-FY.http://www.investopedia.com/terms/f/fiscalyear.aspU.S.DepartmentofHealthandHumanServices.HPSAFind.

https://datawarehouse.hrsa.gov/tools/analyzers/HpsaFindResults.aspxVirginiaHospitalandHealthcareAssociation(Ed.).(n.d.).Scorecard.RetrievedJune29,2017,from

http://www.vhha.com/quality-patient-safety/scorecard/VirginiaDepartmentofSocialServices.“LocalDepartmentsofSocialServicesProfile,SFY2016.”

http://www.dss.virginia.gov/geninfo/reports/agency_wide/ldss_profile.cgiWeldonCooperCenterforPublicService,PopulationEstimatesforAge&SES,Race&Hispanic,and

Townshttp://demographics.coopercenter.org/population-estimates-age-sex-race-hispanic-towns/

WeldonCooperCenterforPublicService,VirginiaPopulationProjections,“LocalityTotalPopulation”

http://www.coopercenter.org/demographics/virginia-population-projectionsWeldonCooperCenterforPublicService,VirginiaPopulationProjections.“PopulationProjectionsby

AgeandSexforVirginiaanditsLocalities.”http://www.coopercenter.org/demographics/virginia-population-projections

Yoshikawa,Hirokazu,J.LawrenceAber,andWilliamR.Beardslee.“TheEffectsofPovertyontheMental,

Emotional,andBehavioralHealthofChildrenandYouth.”AmericanPsychologist67,no.4(2012):272-284.

33

Appendix

Table1:HIVPrevalenceRatebyLocalityper1,000

SOURCE:2017CountyHealthRankingsVirginiaData

Table2:NumberofMedicaidClientsasaPercentageofthePopulationfrom2012to2016


Virginia 0.315JamesCityCounty 0.078YorkCounty 0.094CityofWilliamsburg 0.355

JamesCityCounty YorkCounty/Poquoson

CityofWilliamsburg Virginia

2012 8.32% 5.72% 8.57% 14.20%

2013 9.86% 6.98% 10.81% 14.63%

2014 9.99% 7.16% 11.15% 14.94%

2015 10.32% 7.44% 12.00% 15.71%

2016 10.89% 7.66% 11.24% 15.84%

34

Figure1:UninsuredChildrenbelow200%FPLandthepercentageofthetotaluninsuredpopulation

SOURCE:2017SmallAreaHealthInsuranceEstimates(SAHIE)

369(3.5%)383(3.7%)

68(0.7%)

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35

Figure2:UninsuredAdults(18to64)withIncomesBelow138%FPLandthepercentageofthetotaluninsuredpopulation(%)


1443(13.8%)

1111(10.6%)

468(4.5%)

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36

Figure3:UninsuredPeople(underage65)withIncomesbetween138%and400%oftheFPLandthepercentageofthetotaluninsuredpopulation(%)


2345(22.5%) 2334(22.4%)

465(4.5%)

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status of health rpt 2017williamsburghealthfoundation.org/wp-content/uploads/whf... · 2018. 1....

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