| Executive Summary
The
following is an Executive Summary of The
Health of Island County Report, a presentation by Tim McDonald, MPH, RS,
Health Services Director, Island County Health Department.
The presentation detailed the significant findings about the current health
of Island County residents, compiled by the Health Department’s Assessment &
Community Development section. Data sources for the report include the Island County and
Washington State Behavioral Risk Factor Surveillance Survey (BRFSS); U.S. Census; state
databases such as the cancer registry; local data sources and surveys such as the Child
Abuse Prevention Foundation, the Health Department’s Smile Survey, Whidbey General
Hospital, and the Island County Sheriff’s Office; the Washington State and Island
County Healthy Youth Surveys; and federal data sources and reports.
Each chapter of the report addresses many factors regarding its topic area. For example, the Chronic Disease chapter notes the
incidence of diseases (diabetes, adult and child asthma, cardiovascular disease, and
cancers (breast, cervical, skin, and colorectal)). It
also reports on mortality rates from chronic disease and rates of screening and preventive
health (mammogram, Pap test, prostate blood test, and blood cholesterol screening). Additionally, chapters may examine data on risk
factors such as physical inactivity, overweight, smoking, and sunscreen use in the Chronic
Disease chapter. Each chapter also contains
fast facts and issues for Island County, background (includes WA State data), local data
and findings, effective interventions, Healthy People 2000 & 2010 goals and
objectives, local resources and helpful Internet sites.
Island
County and Its People: Demographic and Economic Factors
Island County is growing but not as fast as in the past (18.9% from 1990-2000, compared to
36.7% from 1980-1990). There were 71,558 residents in the 2000 Census, almost 1/2 living
in rural areas (34,450). Due to its small landmass, IC is, however, the fifth most densely
populated county in WA.
About
14% of our residents are over age 65 and 25% under age 18.
Island County has a higher percentage of males ages 20-29 (due to the
presence of Naval Air Station-Whidbey). The
median age of residents is 37 (35.3 WA). We also have a larger proportion over age 65
compared to the state (14.3% vs. 11.2%). IC
has a higher percentage of married persons (compared to WA) but total percentage of family
households has decreased due to growth in other household structures. We are growing in racial/ethnic diversity; racial
minorities were 12.8% in 2000, compared to 6.8% in 1980 and 8.5% in 1990. Our largest racial minority group is Asian/Pacific
Islander (4.6%). Children are increasingly multiracial (7%) compared to 2% of adults.
We have more households (27,784) than the last census, but they are smaller size. Over one-third (35%) have children less than 18
years and 25% have an adult older than 65. Most
households are families but there has been an increase in other types of households
(single, non-family, other).
The median income in Island County in 1999 was $45,513, with a per capita income of
$21,472. Average annual wages are lower than
the State with IC wages being $24,731 compared to $37,458 in WA. 6.6% of IC persons are living below the Federal
Poverty Level (FPL) compared to 10.2% statewide, with 10.4% of all IC children living at
this level compared to 15.2% in WA state). Of concern are children age 5 and under whom
are the most affected by poverty with 1/3 of IC children under 200% of the FPL.
Of
note in Island County are our many residents who serve in the Armed Forces (11% in IC vs.
1% in WA). Most residents have a high school
education. Specific concerns include the 10.7% of our children less than 18 years old who
are not enrolled in school, and the 21.3% of our population ages 18-24 who have not
graduated from high school.
Quality
of Life & Social Context
Among the measures of quality-of life are having a home, food on your table, and people
who offer their support. Island County has a
large number of homeowners who have lived in their homes for many years. About 10% of homes are used seasonally, higher
than Washington State in general. The
majority of residents consider their neighborhoods to be safe, and most (77%) residents
feel there is enough safe and affordable housing. An
issue of concern is the rising number of persons seeking shelter (homeless). While most residents have someone to help them
with their emotional needs and/or social support, about 5% of residents were concerned
about having enough food. Being able to
communicate also impacts a person’s ability to socialize and make their needs known
(8% of IC residents do not speak English as their primary language).
General
Health Status
The
average life expectancy of Island County is 80.2 years.
Many (61%) IC residents rate their health as excellent or very good with 10%
reporting their health as fair or poor. About
10-15% residents have a health problem or impairment that affects their functioning
(almost half are in pain). While limitations
and disabilities increase with age and family members offer the most help with care needs,
5% had no one to help.
Other
general health status indicators:
1. The
principle causes of death in IC for ages 1-64 are largely preventable (smoking, home
accident, suicide, pedestrian and motor vehicle).
2. Poor
sleeping is a problem for almost 10% of the population who report sleeping poorly for 3-30
days a month.
3. Poverty
is associated with poor health status. BRFSS respondents earning $20,000 or less had
higher levels of poor/fair health compared to those earning more than $20,000 (25% vs.
6%).
Health
Care: Access, Satisfaction & Coverage
Most persons had health coverage (94% vs. 90.2% in WA and 88.1% US) with a large number
(56.5%) reporting having their current coverage for more than 5 years. Lack of insurance was associated with low income,
mid-age (35-54), having children at home, and/or living on Camano Island. Most uninsured
(54%) could not afford premiums. Unique to
Island County is that most health insurance coverage is primarily government-based (44%
Medicare, Military, or Medicaid). Over one
quarter of residents had a second form of health insurance, particularly among those older
than 65. There was much regional variation in
health coverage, ranging from a low of 4.2% uninsured in North Whidbey to a high of 11.0%
uninsured on Camano. This again, is directly
related to a large proportion of our population having military coverage.
Overall,
IC residents are satisfied with the health care system (85% rate it excellent, very good
or good). Most residents (85%) had a
clinic/place they go with their health concerns. We
were pleased to see that many residents were getting preventive care. However, 8% of residents report having been unable
to fill a prescription due to cost.
Environmental
Health
The
impact of our environment on population health is an important area of public health
intervention. Through regulatory and
educational programs, ICPH and its partners work to protect food, water, and air. Increasingly, our work is aimed at minimizing
diseases such as West Nile Virus, Hantavirus, and Rabies, all of which humans acquire from
animal and insect vectors. Overall the
physical environment in Island County is very healthy, but there are several important
environmental factors for concern:
1. Almost
70% of residents are served by on-site sewage systems and ground water wells. An upcoming concern is that 15-20% of IC wells may
not meet the new EPA arsenic standards for large water systems.
2. The
Health Department responds to and investigates 10-20 foodborne outbreaks a year —
Island County had disease outbreaks in 2000 (Salmonella, Shigella and Giardiasis) and 2002
(Norwalk-like).
3. Zoonotic
and vector-borne diseases occur in Island County. Island
County had the first horse in Washington State diagnosed with West Nile Virus in 2002, and
2 bats tested positive for rabies in 2003. Maintaining
animal inoculations is important for livestock and pet owners.
4. Deer
mice, known carriers of Hantavirus are common in Island County.
5. Also,
six percent of Island County residents report being chemically sensitive.
Unintentional
Injury
In
order to reach the goal of a healthy community for all, the burden of death, illness and
injury must be minimized. Prevention of
disease and injury is a mainstay of public health efforts.
Unintentional injury is the leading cause of death for person’s ages
1-64. Motor vehicle accidents are the leading
cause of unintentional injury death to persons less than 65 years. Seatbelts do help save lives, but almost 13% of
residents do not always wear their seatbelt. Island
County has a high number of households with firearms.
Almost forty percent (38%) of adults surveyed had firearms in the house. 47% of those were unlocked and 21% were loaded
(about 50% of these were also unlocked).
Due to our geography of being surrounded by water, Island County often loses several
residents to drowning each year. Many adults
(37%) had been in a small boat (< 20 ft.) in the past year, and 21.6% of them never
wear a lifejacket. Island County had 3
drownings in 2001. It would be a Health
Department goal to have all residents wearing life jackets in small boats.
Several
other areas of unintentional injury are worth mentioning.
Falls constitute the highest number (65%) of non-fatal hospitalizations for
unintentional injury. Homes, especially of
older residents, should be inspected by family members/neighbors to make then as safe as
possible. Another precautionary preventive
measure is the wearing of bike helmets. Of
concern are the 16.7% of children who use bicycle helmets only sometimes (6.3%), seldom
(3.1%) or never (7.3%), according to their parents.
Infectious
Disease
A historical role for county health departments is the prevention of infectious disease. Many of the great achievements of public health and
gains in population health during the last century are due to better infectious disease
prevention and control through immunizations, sanitation and medical advances. The
emergence of antibiotic resistant diseases and the reemergence of past diseases make it
necessary for ICPH to continue to focus work in this area.
Island
County has a number of infectious disease concerns. We
had outbreaks of pertussis (whooping cough) in 1999 and 2000. Cases were almost exclusively among unvaccinated
children. The spread of Hepatitis A, B, and
C is a concern — Island County had 10 cases of Hepatitis C in 2001 and 25 cases in
2002. Island County rates of STDs are higher
than the State average… and have been rising each of the past 3 years. Chlamydia is by far the most common STD (80% of
the cases occurring among those ages 15-24), and rates doubled between 2001-2002.
Pneumonia
and influenza deaths together constitute the 6th leading cause of death in the United
States. In 2000-2001, 67% of Island County
adults older than 65 years received shots for the flu and 71% for pneumonia. Tetanus is also a vaccine-preventable disease and
almost one quarter (23%) of adults were not or did not know if they were up-to-date on
their tetanus shot.
Chronic
Disease & Physical Activity
Heart Disease
Diseases
of the heart are the leading cause of death in Island County. Data shows increases in
reported incidence of heart attack (4 to 5.1%), angina (3 to 5%) and stroke (2 to 2.6%)
since 1996. High blood pressure
(hypertension) affects 28.5% of IC adults, and this has increased from 1996 (22.8%).
County levels are above WA (22.1%) and US (23.9%) levels, and significantly higher than HP
2010 goals (16%). We were pleased to see that
more county adults are having their cholesterol checked. However, 18% of adults have never
had a cholesterol screening.
Physical Activity & Overweight
Being
overweight significantly impacts physical health. Similar
to the nation and state, our rate of overweight residents is increasing. One third (34%) of the adult population in Island
County is overweight, and this has significantly increased since 1996 (26%). It is also
significantly higher than HP 2000 and 2010 goals (20 and 15%). Obesity affects 5% of the adult population and
this, too, has increased since 1996 (from 4.1%).
Physical
activity is key to maintaining a healthy body. Seventy
three percent (73%) of Island County adults are at risk for health problems related to
lack of exercise. Many conditions have been identified as caused or worsened by
inactivity, including heart disease, high blood pressure, depression, obesity and some
cancers. Diabetes affects 5% of IC adults, and exercise is an important component in
controlling diabetes.
Asthma in Island County
Almost
eleven percent (10.9) of adults report that they have been diagnosed with asthma (WA
11.9%, US 10.5%). Asthma is often considered to be an environmental disease and there are
well known "triggers" that exacerbate symptoms (tobacco smoke, dust mites,
etc.). Asthma is the most common
disease of childhood, the leading cause of absence from school, and 4th leading cause of
disability in children. In the Island County
BRFSS, 14% of adults said that they have at least one child that has been diagnosed with
asthma. In the Island County Healthy
Youth Survey, __% of youth
reported they had asthma and __ % had used medication for their asthma or suffered an
asthma attack in the past year.
Maternal-Child
Health
Public
health began to focus on the health of mothers and children over a century ago when
complications of pregnancy and infant and early childhood deaths were much higher than
they are today. While not directly impacting
our mortality rates, several key findings emerged from examining maternal and child health
data. There is a lack of Early Childhood
Education/Parent Support programs and/or resources available to new parents and/or
children in overburdened families (“at risk”), and there is an increase in child
abuse reports in the past two years.
Other
findings of concern regarding childcare in Island County:
- Many more children are being cared for by relatives (16.2% . . .
considerably higher than the state average).
- Many
families (45.1%) reported having none, one, or few choices for childcare.
- 6%
of adults reported they felt their child’s provider was doing a poor/very poor job
responding to child’s emotional needs (1.7% WA).
- Many
also gave their child’s care setting a poor/very poor rating for safety (6% vs.
WA’s 0.9%) and for cleanliness (6.8% vs. WA’s 0.9%).
Oral
Health Findings
Dental
care emerged as an issue for both adults and children. Over 10% of families with children
wanted dental care for their child in the two years previous to the BRFSS but were unable
to get it. Since that time, the Island
County Health Department has started the Access to Baby and Child Dentistry (ABCD)
Program. Almost one in five (18%)
of adults had not seen a dentist in year prior to the BRFSS survey. Of those, 22% did not see a dentist because of
cost. Only 65% of adult respondents have some
form of dental insurance.
Mental
Health
A
number of issues arose concerning mental health. They
included:
1. Scarce
resources for mental health prevention services; our county has very few education or
outreach resources or support groups focused on mental health. There is a higher demand than resources can
provide for mental health services, and ineffectiveness of the state structure diverts
some resources to administration rather than to direct services.
2. Of
county adults
with health impairments, the most frequently reported condition was
depression/anxiety/emotional problems (25.8%).
3. We
lost 43 residents to suicide in 1996-2001 and our Healthy Youth Survey showed that a
number of youths contemplate suicide.
4. Island
County has had scarce resources
for child/adolescent mental health. Until
very recently, it was difficult to find child/adolescent mental health professionals in
Island County who would accept private insurance — this is improving).
5. With
few mental health professionals able to see persons on a sliding fee scale, there also is
a resource “gap” for working poor and/or uninsured adults, and individuals are
often unable to pay for services out-of-pocket.
6. Many
insurance programs limit their provision of mental health services.
Substance
Abuse
Tobacco
Smoking
is the leading preventable cause of death in the US.
Almost on in five (19%) of adults are at risk for smoking
related illnesses. We are pleased to note
that the percent of all adults that smoke in IC (19%) is lower than WA state (24%) or US
(23%), but those that smoke in IC smoke more packs of cigarettes per day. There has also been a downward trend in youth
smoking. From 1998 to 2002, IC data shows a
10% drop in smoking among 12th graders (30%-20%)… lower than the US rates
across grades.
Alcohol
Alcohol
use continues to be a primary health concern. The
percent of IC adults that consumed 60 or more drinks in the last 30-day period is higher
than that of WA State (5% vs. 3%). Adult
binge drinking has also increased since 1996 (13.3 to 15% of adults), is higher than WA
state (14%), lower than the US (16.6%), and significantly higher than the HP 2010 goal
(6%). Binge drinking is especially prevalent
in the 18-24 age group and in North Whidbey. Our
youth’s alcohol usage rates are lower than WA state and US rates; still, 17% of 8th
graders, 34% of 10th graders and 39% of 12th graders report using alcohol in last 30 days.
On
a positive note, data show youth are finding drugs less available, are showing less
positive attitudes toward drug use themselves and among their friends, and feel that there
are more risks in using drugs. Despite this,
however, a number of youths report they intend to use illicit drugs at some time.
Crime
& Violence
Child
abuse is a county-wide concern. The number of children (and percent of all children) ages
birth to 17 referred as victims of maltreatment and judged to merit an investigation, has
increased in Island County from 394 in 1998 to 441 in 2000.
The Island County Sheriff’s Office also is seeing an increase in such
cases. In 2000-2001 there were 2 incidents
of child homicide. Again, we refer to the
lack of programs and/or resources available to new parents and/or parents in families that
are "at risk". The Health
Department and their community-based health advisory board both believe that early
intervention/prevention programs for young children and their families (e.g. the Healthy
Families project) are a demonstrated way to prevent violence in society.
Research also shows that youth who drop out of school and who do not complete an
educational program are more at risk for lives of crime and violence. Our Healthy Youth Survey data that show that youth
at risk for academic failure and those with a low commitment to school are issues of
concern for Island County residents. Data
also show that youths perceive handguns to be readily available. These issues must be addressed by a number of
agencies, parents and community members as a whole.
Regional
Variations
The
Health Department divides the county into four planning regions: North, Central and South Whidbey Island and Camano
Island. Half (51%) of the population lives in
North Whidbey, 30% in other parts of Whidbey and 19% on Camano. North Whidbey is the slowest growing, while Camano
has grown 53.6% and South and Central Whidbey have grown by more than one-third. North Whidbey has the youngest population while
Central Whidbey has the oldest. North Whidbey
is most racially/ethnically diverse. North
Whidbey has the lowest incomes while Camano has the highest incomes.
There are also differences in health care satisfaction, coverage and access. They include:
Camano Island had the highest rate of uninsured (11%) (IC average is 6%). (Employment-based insurance in Island County is
67.1%.) North Whidbey had the highest rate of health insurance (95.8%), with 42.4% having
military coverage. Dental concerns were more
prevalent in South Whidbey and Camano.
Regions
varied substantially in their use of preventive measures and behaviors. North Whidbey has the highest rates of seatbelt
and bike helmet use, while Central and South Whidbey has lower rates of lifejacket use.
North Whidbey residents are more likely to smoke, and they drink more on the occasions
when they do drink (27.3% had 3+ drinks at one time and 11.9% of those had 5+
drinks). Of particular concern are the 7.5%
of respondents who had drank 5+ drinks five or more times in the previous month, and the
total of 12.1% who had drank 5+ drinks, 3 or more times in the past month. This behavior was very definitely correlated to
the 18-24 year olds. South Whidbey had a
higher percentage of residents who drank more frequently, with almost 17% drinking on more
than 16 days in the past month. Other examples of regional variations included more
environmental concerns in South Whidbey and lower asthma rates in Central & South
Whidbey.
In
summary, while there are a number of health concerns prevalent throughout the entire
county, the four regions of Island County do vary significantly. The Health Department
suggests that support efforts may be targeted at either the entire county or regionally. Regional partnerships or agencies serving
particular areas are encouraged to dialogue with each other, explore effective community
interventions, and to plan for health interventions aimed at areas of concern.
Health
Care Priorities of Island County Boards
Island
County Health Department has a number of community-based advisory boards. There are specific advantages of community
involvement in decision-making and priority setting based on data. These advantages include a better public
understanding of relationship between regulation and the prevention of disease, increased
public support for health programs, increased access to local non-governmental resources,
and broader community partnerships to address priority issues. The expectations and objectives for the boards are
to implement community-based health assessments, measure a wide range of health
indicators, develop policy recommendations based upon data & community input, and
develop new relationships with the public by facilitating new community partnerships and
educating staff and community about health issues impacting Island County.
Several of the boards have developed priority
areas. The Board of Health appoints the
Island County Community Health Advisory Board (CHAB), composed of 21 community members and
8 student members, selected to represent various regions, systems, agencies, and
population subgroups. Their priority health
issues are:
1. Early Childhood
Education & Support,
2. Mental Health,
3. Chronic Disease &
Preventive Health,
4. Physical Activity
Another community-based advisory group is
the Island County Environmental Assessment Team (EHAT). The EHAT is following the
nationally recognized PACE-EH model (Protocol for Assessing Community Excellence in
Environmental Health). Island County received a 3-year capacity-building grant from the
Centers for Disease Control and Prevention to model the PACE-EH process and to develop
environmental health priorities and action plans for Island County. They are comprised of
25 citizen volunteers who were appointed by the Board of Health, and who have have diverse
experiences, backgrounds, interests and viewpoints that represent Island County. Their top
4 environmental health issues are:
1. Vector-borne disease (West Nile Virus)
2. Arsenic in drinking water
3. Dumping (littering) in Island County
4. Walkable Island County (exercise/walking/physical
fitness)
Other
Health Department Community Advisory Boards include the IC Mental Health Advisory Board,
the IC Alcoholism/Substance Abuse Advisory Board, the IC Developmental Disabilities
Advisory Board, and the Water Resources Advisory Committee.
Staff
members of the Island County Health Department are currently monitoring a number of
emerging health issues including the growing rate of STDs, low rates of childhood
immunizations, vector-borne diseases (West Nile Virus, Rabies, Hantavirus), and
infectious diseases (TB, Hepatitis, Meningitis, etc.). The
department is also working
closely with community agencies addressing Homeland Security issues and the threat of
evolving world-wide health concerns (Bioterrorism, SARS).
Full Report (pdf files)
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