District 8 1 Valdosta Addressing Community Health Disparities

District 8 -1: Valdosta Addressing Community Health Disparities BY MERYL ABRAMS, DAVID BERNDT, MOLLY CINDERELLA, ASHLEY DAVIS, TRACE DEIGHAN, JADA FAMBROUGH, STEPHEN HAMMETT, SARAH JANSEN, NEIL PATEL, TAYLOR PHELPS, JOHN SHAPIRO, PAT SIMMONS, BENJAMIN SOOKHOO, AND ALLESYN YOUNG

Counties of District 8 -1 County Ranking Echols (EC) 60 Lowndes (LW) 72 Berrien (BI) 76 Brooks (BO) 82 Tift (TI) 89 Lanier (LN) 100 Cook (CO) 108 Irwin (IR) 132 Ben Hill (BH) 147 Turner (TU) 153 Health District Population by County IR BH TU CO EC LW LN BI BO TI

Criteria for Ranking Two components • • • Health Outcomes • Morbidity • Mortality Health Factors • Behaviors • Clinical Care • Social and Economic • Physical Environment Changing health factors can shape health outomes

Areas of Concern for District 8 -1 Health Behaviors • Diet and exercise • Sexual activity and teen birth rates Clinical Care • Access to care • Golden Hour • Quality of care Social Factors • Education • Employment • Income

Health Behaviors: Diet and Exercise Problems • Obesity • Lack of physical activity Potential Solutions • • • Physically active classrooms Adult Obesity 40% 34% 35% 30% 31% 29% 25% 33% 31% 34% 30% Georgia Avg. 28% 20% 15% 10% EC TU IR LN BO CO BH BI TI LW Physical Inactivity 33% 35% Social support in community settings 30% Buddy system walking groups 20% 25% 24% 31% 29% 31% 30% 26% 29% 27% Georgia Avg. 24% 15% 10% EC TU IR LN BO CO BH BI TI LW

Health Behaviors: Sexual Activity Problems • Teen Birth Rate 11, 00% Teen Birth Rate 10, 10% • Condom availability program • Mass media campaigns • Sexual education addressing pregnancy and STDs 6, 80% 7, 00% 6, 70% 5, 00% 9, 30% 8, 30% 9, 00% Potential Solutions 9, 30% 5, 70% 6, 30% 5, 00% Georgia Avg. 5. 0% 3, 00% 1, 00% EC TU IR LN BO CO BH BI TI LW

Clinical Care: Access to and Quality of Care Problems • Uninsured • Primary care physicians • • Uninsured 38% 36% 33% 25% 26% 24% 25% 22% 23% Georgia Avg. 22% 18% EC TU IR Doctor: Patient ratio LN BO CO BH BI TI LW Pop. per primary care physician Golden Hour Potential Solutions 25% 28% 8800 6800 8000 6443 5296 4800 2800 3370 1604 1917 3205 2238 1925 1010 Georgia Avg. 1611 EC TU IR LN BO CO BH BI TI LW

Clinical Care: Access to and Quality of Care Problems • Uninsured • Primary care physicians • • Doctor: Patient ratio Uninsured 38%36% 38% 33% 23% BI 8 TI 9 LW 10 Pop. per primary care physician Golden Hour 8800 • Telemedicine 6800 • Extended privileges of nurse practitioners 4800 Expand rural training tracts 22% Georgia Avg. 22% 18% EC TU IR LN BO CO BH 1 2 3 4 5 6 7 Potential Solutions • 25% 26% 26%26% 25% 25% 24%24% 28% 2800 8000 6443 5296 3370 1604 1917 3205 2238 1925 1010 Georgia Avg. 1611 EC TU IR LN BO CO BH BI TI LW

Social Behaviors: Education, Income Employment Problems • High unemployment • Low median household income Unemployment 15, 00% 13, 00% Summer work experience programs 11. 6% 11, 00% 7. 3% 8. 5% 11. 5% 12. 0% 9. 4% 9, 00% 9. 3% Georgia Avg. 9. 8% 5, 00% EC TU IR LN BO CO BH BI Potential Solutions • 13. 8% 12. 7% 13. 2% TI LW Median Income 45000 • Career pathway and bridge programs for adults • Drop-out prevention programs 25000 • Early Head Start 15000 Georgia: $45, 886 35000 EC TU IR LN BO CO BH BI TI LW

Health Disparities Amongst the Counties differ by County Health Ranking by African American Pop. % 50% 40% 30% Demographics 20% Geography 10% Access to care Education Economics Disparities were identified based on African-American constitution Hypothesized explanations Ø Disparity in health education Ø Community ties Ø Program efficacy 0% 50 60 70 80 90 100 110 120 130 140 150 160 County Teen Birth Rate by African American Pop. % 45% 40% 35% 30% 25% 20% 15% 10% 5% 6% 7% 8% 9% 10% 11%

Disparities in Morbidity and Mortality Disparities in Mortality by County Size 250 Rural districts are more prone to specific health outcomes 200 Urban settings provide: Better access to health facilities 150 100 Improved capacity for health 50 education of population Broader range of programs tailored to community Greater opportunities for social support Lung Cancer 0 0 Stroke 50 000 Heart Disease 100 000 **Lines represent Georgia Avgs**

Risk Factors Criteria for recommendations: • Fiscally feasible • Geographically accessible • Relevant to the community • Culturally appropriate Modifiable 1) Self risk behaviors 2) Access to primary care 3) Health education curriculum Limited Modifiability 1) Number of facilities and hospitals 2) Homicide/MVA rate 3) Income/Economics of counties

How can we, as physicians, help? • Assist in modification of risky behaviors • Facilitate access to primary care • Enlist help of teachers and counselors • Identify and communicate health disparities

Special thanks to… Dr. William Grow, Health District Director; South District Patrina Bowles, Health District Administrator Assistant Erin Mundy, Director of Community Based Training Programs Anne Hinton; Information Technology Support and Services

Bibliography • Alford S. Science and success, 3 rd edition: Sex education and other programs that work to prevent teen pregnancy, HIV and sexually transmitted infections. Washington, DC: Advocates for Youth; 2012. • Barr-Anderson DJ, Au. Young M, Whitt-Glover MC, Glenn BA, Yancey AK. Integration of short bouts of physical activity into organizational routine: A systematic review of the literature. American Journal of Preventive Medicine. 2011; 40(1): 76 -93. • Bartfeld J, Kim M, Ryu JH, Ahn H-M. The School Breakfast Program: Participation and impacts. Madison: University of Wisconsin-Madison; 2009. • Bashshur RL, Shannon GW. National telemedicine initiatives: Essential to healthcare reform. Telemedicine Journal and e. Health. 2009; 15(6): 600 -10 • Blake SM, Ledsky R, Goodenow C, et al. Condom availability programs in Massachusetts high schools: Relationships with condom use and sexual behavior. American Journal of Public Health. 2003; 93(6): 955 -62. • Christenson SL, Thurlow ML. School dropouts: Prevention considerations, interventions, and challenges. Current Directions in Psychological Science. 2004; 13(1): 36 -9. • Daniels ZM, Vanleit BJ, Skipper BJ, Sanders ML, Rhyne RL. Factors in recruiting and retaining health professionals for rural practice. Journal of Rural Health. 2007; 23(1): 62– 71 • Georgia Department of Health. Online Analytical Statistical Information System. Available at http: //oasis. state. ga. us/oasis/. Accessed on October 27, 2013. • Georgia Department of Public Health. South Health District Programs and Services. Available at http: //www. southhealthdistrict. com/default. asp. Access on October 27, 2013 • Havnes T, Mogstad M. No child left behind: Subsidized child care and children’s long-run outcomes. American Economic Journal. 2011; 3(2): 97 -129.

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Group member roles: Meryl Abrams – County Researcher, Power. Point Contributor David Berndt – County Researcher Molly Cinderella – Communications Officer Ashley Davis – County Researcher Trace Deighan – County Researcher Jada Fambrough – County Researcher Stephen Hammett – Podcast Producer Sarah Jansen – County Researcher, Power. Point Contributor, Podcast Voice Neil Patel – Podcast Producer Taylor Phelps – County Researcher John Shapiro – Data Analyzer, Power. Point Contributor, Podcast Voice Pat Simmons – Data Analyzer, Power. Point Contributor Benjamin Sookhoo – County Researcher, Meeting Coordinator Allesyn Young – County Researcher