Mission Statement. Introduction. County Overview. Population

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2 Mission Statement The mission of the Cumberland County Department of Public Health (CCDPH) is to improve and maintain the quality of health for all citizens in Cumberland County. Introduction Local Health Departments (LHDs) are required to write and submit a State-of-the County s Health (SOTCH) Report in the interim years between Community Health Assessments (CHAs). The SOTCH Report serves as a yearly update of the top five health concerns that were identified in the 2010 CHA and actions that were taken to address them. This report also includes a review of mortality, morbidity and other county data. This report will be distributed to the county board of health, county government officials, area libraries, and the local community will have web access. County Overview Cumberland County, located in the eastern part of the state, is 65 miles south of Raleigh in an area often referred to as the Sandhills. Fayetteville is Cumberland County s largest town and the county seat. Cumberland County has a total area of square miles, with square miles of land area. The county s average temperature in January is 40 F and 79 F in July. The average rainfall is 47 inches Population In 2011, the total population for Cumberland County was 324,885. A population percent change of 1.7% occurred from April 1, 2010 (population 319,431) to July 1, 2011 (population 324,885). The primary races were White (54.6%), Black/African-Americans (36.9%), and Hispanic/ Latino (9.9%). Females made up 51.4 % of the county population and males made up 48.6 %. 1 The county s median age was thirty-one (31) years % 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Percent White African-American Hispanic/Latino 1 select Cumberland County American Community Survey-Demographic and Housing Estimates 2

3 Socio-Economics (Poverty, Income, Workforce) The per capita money income in the past 12 months (2010 dollars) was $22,285. The median household income was $43,356 (2010). The overall poverty rate for the county was 18.0% and for children the poverty rate was 26% (2010). The elderly poverty rate was 10% ( ). Individuals living in poverty often have higher rates of chronic diseases, deaths, and undesired health outcomes. In 2011, Cumberland County had a total of 142,254 individuals in the labor force, 127,742 individuals were employed, and 14,512 individuals were unemployed. The unemployment rate was 10%. 3 Health Care Resources (2011 Active Health Professionals) Cumberland County reported 544 non-federal physicians, 203 federal physicians, 2,895 registered nurses, 136 dentists and 189 dental hygienists that were active in their profession. There were 16.6 physicians per 10,000 populations. 4 Physicians-Non- Physicians- Registered Dentists Dental Federal Federal Nurses Hygienists , Population without Insurance Uninsured estimates The percentage of county residents under age sixty-five (0-64 years) who did not have health insurance was 20.7% (58,000 residents). For ages 0-18 years, 10.7 % (10,000 residents) did not have health insurance and 25.3% (47,561) of county resident s ages years did not have health insurance. 5 Total Uninsured (ages 0-64) Children (ages 0-18) Adult (ages-19-64) Number Rate Number Rate Number Rate 58, % 10, % 48, % UNC Sheps Center for Health Services Research, NC Institute of Medicine, 3

4 Education The Cumberland County School District (fourth largest out of 115 in the state) consists of 85 schools with approximately 53,361 students and 6,807 employees. There are 53 elementary schools, 15 middle schools, 14 high schools, two special schools and one year round classical school. Source: Select facts and figures Cumberland County has several schools of higher education. See list below. Campbell University 143 Main St. Buies Creek, NC (910) Fayetteville State University (FSU) 1200 Murchison Rd. Fayetteville, NC (910) Fayetteville, Technical Community College (FTCC) 2201 Hull Rd. Fayetteville, NC (910) Methodist University 5400 Ramsey St. Fayetteville, NC (910) Miller-Motte College 3725 Ramsey St. Fayetteville, NC (910) Troy University 2620 Bragg Blvd. Fayetteville, NC (910) University of Phoenix 639 Executive Pl Fayetteville, NC (910)

5 Mortality Infant Mortality (Infant death rates per 1000 Live births) Indicator Infant deaths Cumberland total cases Cumberland Rates NC total cases NC Rates Total , White , African-American , Hispanic (<1 year) Death rates per 1,000 Live Births, click on mortality-infants Infant death is death occurring within the first year of life. Contributing factors to infant deaths include: preterm birth, low birth weight, late access to prenatal care, teen pregnancy and tobacco and drug use. The infant death rate usually reflects the general health and well being of the community. A high infant death rate may indicate unmet health, nutrition, and medical needs as well as an unfavorable environment. The County s infant death rates (total, white and African-American) were slightly higher than the state. Leading Causes of Mortality Age-Adjusted Death Rate (Per 100,000 Population) Mortality or death rates are often used as measures of health status for a population. 6 Heart Disease, Cancer (all sites), Chronic Lower Respiratory Disease, Nephritis (Kidney disease), Stroke and diabetes were among the County s leading causes of death from Risk factors such as genetics, age, sex, and race can predispose certain individuals to chronic diseases such as heart disease, stroke, and cancer. However, lifestyle behaviors such as physical inactivity, poor dietary habits and being sedimentary are controllable factors that have a greater impact on mortality rates. When comparing years to , the county death rates continued to exceed the state death rates in all five leading causes of death. 7 Leading Cause of Death Cumberland NC Heart Disease Cancer-All Sites Chronic Lower Respiratory Disease Stroke Diabetes Mellitus Statistical Primer, State Center for Health Statistics, May Click on mortality 5

6 Morbidity Cumberland County s battle against sexually transmitted diseases continues to be on-going. Sexually transmitted diseases left untreated can contribute to complications in pregnancy, infertility and chronic disease. The cost of health care is also a concern for individuals who tested positive for HIV and for individuals who suffer from the complications of sexually transmitted infections. The county s rates for AIDS and gonorrhea exceeded the state rates. The county s gonorrhea rate was substantially higher than the state. People with HIV infection are living longer due to treatment with anti-retroviral drugs. During the years , the county s rate for syphilis was slightly higher than the state, cancer (all sites) and Tuberculosis were slightly lower than the state rate. Epidemiological studies provide strong evidence that infections with gonorrhea and/or syphilis can facilitate HIV transmission by two to five folds. Cancer is a significant burden to any community in terms of morbidity, years of life lost and economic cost. However, that burden can be prevented or reduced by developing and implementing culturally appropriate intervention strategies directed at specific populations. 8 Comparing years to , the county gonorrhea rate went down and syphilis rate went up. Communicable Disease Rates per 100,000 Populations INDICATOR CUMBERLAND NC AIDS * Gonorrhea Syphilis (1) Tuberculosis * Cancer (3) Communicable Disease Rates per 100,000 Populations INDICATOR CUMBERLAND NC AIDS * Gonorrhea Syphilis (1) Tuberculosis * Cancer (3) : Click on morbidity 1. Primary and Secondary Syphilis 2. *AID /TB -N.C. Health Statistics pocket guide per 100,000 population NC Central Cancer Registry, 1/2012 6

7 Pregnancy Rates per 1000 Population (Ages 15-19) Year 2011 The 2011 pregnancy rate for Cumberland County teens ages was 61.8 out of every 1,000 girls with a -9% change since Repeat pregnancies represented 27.6% (186) for the county compared to 26.0% for the State. Out of one hundred counties, Cumberland County ranked 17 th highest in the State for teen pregnancies for ages Pregnancy rates were higher among Hispanics (66.4%) and African-Americans (64.7%) than whites (54.5%). 9 Although the county s total pregnancy rate has decreased, overall county pregnancy rates continues to exceed the state s rates for years 2010 and (See charts below). The Cumberland County Department of Public Health offers comprehensive education, including information about abstinence, contraceptives and disease prevention. The agency recently initiated a Teen Pregnancy Task Force to address barriers such as transportation to clinic, accessing appointments, referral to family planning clinic classes and agency hours that might contribute to whether or not a teen receives needed services. The social and economic cost of teen pregnancy and birth often has a long-term impact on teen girls, their babies and the community. Reducing teen pregnancy will improve the health, education and social well-being of young ladies and benefit the social and economic costs for local communities Pregnancy Rates per 1,000 Populations for females ages Indicator Number of Pregnancies Rates Number of Repeat Pregnancies Repeat Pregnancy Rates County NC County NC County NC County NC Total* , , White 227 5, No data Black 332 5, No data Hispanic 76 2, No data 2010 Pregnancy Rates per 1,000 Populations for females ages Indicator Number of Pregnancies Rates Number of Repeat Pregnancies Repeat Pregnancy Rates County NC County NC County NC County NC Total* , , White 261 6, No data Black 411 6, No data Hispanic 72 2, No data 9 7

8 2010 Community Health Assessment Five Priority Areas The Community Health Assessment process identified nine health indicators that stood out for Cumberland County. These were health indicators that exceeded the State rates and/or were cited as perceived health problems in the community via of the community health opinion survey. The perceived health problems cited from the community survey were supported by secondary data. Five community health priorities were selected from a list of nine health indicators. Advisory committee members, work group members and community members scored each of the nine health indicators. Average scores were calculated and each health indicator was selected based on the rank in descending order. Health priorities selected to be addressed in the action plan were: (1) Heart Disease (2) Obesity (3) Teenage Pregnancy Prevention (4) Cancer (5) Diabetes Results from a health opinion survey and secondary state data were used to identify priority areas. The partners (Department of Public Health and local agencies) completed a community action plan to address health issues identified as priority through the assessment process. 8

9 Health Priorities 1. Heart Disease: Objective- By 2015, to reduce by 5% the heart disease death rate among men and women ages years. 2. Obesity: Objective- By 2015, to increase by 60% the percentage of adults getting the recommended amount of physical activity. Progress Made In the Last Year on Priorities July 2011 June 30, 2012 Progress- Interventions to address Health Priorities Eat Smart Move More Weigh Less (ESMMWL) is a 19-week weight management program that uses the Theory of Planned Behavior, informing, empowering and motivating participants to live mindfully as they make choices about eating and physical activity. ESMMWL was implemented at Department of Social Services (DSS), FSU, Indian Association and Tokay recreation center. As a result of the ESMMWL program, participants reported that they were better educated regarding healthy eating and physical activity and were able to apply what was learned to develop a healthier lifestyle. Also, participants reported that they increased their physical activity regimen and ate smaller portion sizes. Nutrition programs (healthy eating) were conducted at FTCC, reaching 180 adults, fitness centers reaching thirty adults and local community agencies reaching 284 residents. Health promotion Coordinator participated in nine health fairs reaching 460 people. Eat Smart Move More Weigh Less (ESMMWL) was implemented at four local sites. An evaluation survey completed by the participants showed that most participants either maintained or lost weight. Most participants at Tokay Senior Center and DSS lost between 5-20 pounds. Several participants reported that they increased their physical activity regime, ate smaller portion sizes and watched calorie consumption. Physical Activity programs were conducted at three (3) recreation centers reaching 525 people. Six recreation centers developed and implemented physical activity and/or healthy eating policies. 3. Teenage pregnancy: Objective- By 2015, to reduce by 5% the rate of unintended pregnancies among female s ages years. Public Health provided about 24 family planning classes reaching 72 teen girls ages Public Health and Cumberland Co. Schools sponsored a tee shirt contest for Teen Pregnancy Prevention month. The theme was centered on abstinence. Three high schools participated. Public Health and Cumberland Co. Schools and Foxy 99 radio station partnered to participate on a radio-talk show focusing on teen pregnancy prevention. Teens from three high schools developed PSAs* to air on the radio, reaching approximately 68,000 teens. Public Health conducted contraception classes in four high schools and one middle school reaching 874 students. Promotion of and how to access the family planning clinic was also provided to the students. Public Health conducted dorm-based contraception classes at Fayetteville State University reaching 404 students. 9

10 Health Priorities 4. Cancer: Objective- By 2015, to reduce the overall cancer death rate per 100,000 populations by 3%. 5. Diabetes: Objective- By 2015, to reduce the diabetes death rate by 7%. Progress Public Health partnered with local breast cancer prevention foundation (Sherri Arnold Graham) Fitness Center (Curves-three sites), Cape Fear Diagnostic Center and local churches to provide breast cancer prevention education and mammograms. Eight (8) breast cancer prevention out-reach programs were conducted in the local community reaching 170 women. Nutrition education programs (Healthy eating) were conducted at thirteen communitysetting reaching 494 residents. The Cumberland County Department of Public Health offers a Diabetes Self-Management Education Program (DSME) to help diabetic patients take control of their health by improving lifestyle habits and reducing the risk of complications caused by the disease. The DSME program begins with an initial assessment appointment with a registered nurse, followed by two group sessions covering diabetes education and nutrition. Follow-up visits will be scheduled at three months and one year after the sessions. The program offers helpful incentives; educational material on how to live well with diabetes; and examples of nutritious foods and ways to build your own healthy eating plan. Approximately fifty-seven (57) clients have participated in the program. Better Health of Cumberland County offers the following services: Diabetes monitoring clinics with education session Take Charge of Diabetes 7-week self-management class Glucometer training Exercise classes for diabetics Diabetes and blood pressure screening Diabetes supplies (limited) Foot care clinics Vision screening for eye disease Medication review *PSA (Public Service Announcement) 10

11 Changes in Data That Guided Selection of These Priorities The partners (Cumberland County Department of Public Health, CHA Advisory group and community) developed health priorities by using secondary state data, reviewing previous health trends, and the community health opinion survey. Currently, no significant changes have been reported to require reprioritization. Other Changes That Affect Health Concerns: The economy has made a tremendous impact on public health. State budget restraints have caused some gaps in the public health workforce, which is a major component of the public health infrastructure. If the State continues to face an economic down turn, it can impact Public Health s ability to provide preventive healthcare. Preventive healthcare is important in controlling health cost and encouraging healthy lifestyles. Physical activity and healthy eating are two major prevention strategies that can impact healthy outcomes, but continued economic challenges will make it difficult to fund prevention programs. Also, persistent health disparities and accessing health care services continues to have a major impact on the vulnerable residents of Cumberland County. Cumberland County continues to have a challenge with transportation, especially in rural areas of the county and medication needs for the uninsured and/or underinsured residents of the county. New and Emerging Issues That Affect Health: In an effort to increase access to care for working people, the Cumberland County Department of Public Health offers an evening clinic on Tuesdays from 5 to 7 p.m. Currently, the evening clinics provides required childhood and adult immunizations, as well as testing for HIV/AIDS or syphilis. Other clinics and/or programs will be added in the near future. Patients are seen on a walk-in basis. Work-place Wellness: All in the name of reducing health care costs and having healthy, productive employees the Department of Public Health manages the county employee wellness program. The program includes an employee express care clinic, employee pharmacy and a wellness program. The employee wellness program is designed to improve the health of the employees and to reduce the cost paid out-of-pocket by employees and by county in terms of cost for medical office visits and pharmacy bills. 11

12 Ways Community Members Can Get Involved Community members can get involved by participating in community coalitions and alliances to empower communities to create supportative healthy environments. Conclusion Although budgetary constraints and depleting resources offers some challenges for the county, through collaborative efforts with partners and local agencies the county continues to provide a quality service to the community. The basis to addressing the challenges and opportunities ahead is to understand problems of the past, to anticipate emerging issues and to respond effectively through preparation, communication, prevention and public health policy. Note: To obtain more information or to make a comment please contact Cumberland County Department of Public Health at (910) or (910)