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Northern

Health
Plan

A Note to the Community


March 2016

Weareproudtopresentthe2015CommunityHealthAssessmentReport,facilitatedbytheHealthDepartmentofNorthwest
MichiganwithfundingfromtheNorthernHealthPlan.Itisacomprehensivecollectionandanalysisofhealthstatusandneedsin
Alpena,Antrim,Charlevoix,Cheboygan,Emmet,Montmorency,OtsegoandPresqueIslecounties.Wevelearnedtoomanyof
ourresidents,especiallylowincomeresidents:

Areoverweightorobeseanddontspendadequatetimeengagedinphysicalactivity;
Lackaccesstohealthyfoodandrecreationalfacilitiesintheircommunities;
Experienceavarietyofbarrierstohealthcare,includingmentalhealthservicesandsubstanceusetreatment;and
Abusealcohol,tobaccoandotherdrugs.

Onestarkfactaboutthehealthofourcommunitiesisclear:eventhestrongestpartnershipamonghospitals,healthcare
providers,andhealthdepartmentscannotimpactcommunityhealthalone.Highschoolgraduationrates,communityplanning
anddesign,accesstohealthyfoodsandrecreationalactivities,andairandwaterqualityhaveasmuchorgreaterimpacton
healththanseeingadoctorornursewhenwearesick.
Gatheringawealthofinformation,analyzingdata,andsettingprioritieslaysthefoundationtoaCommunityHealth
ImprovementPlanthataddressthetopneedsintheregion.OnbehalfoftheCommunityHealthAssessment&Improvement
Initiative,weinviteyoutojoinusasweworktogethertoimprovehealthandqualityoflifeforallNorthernMichiganresidents.
Togetinvolved,pleasecontactJaneSundmacher,CommunityHealthPlanner,at2313475041or
jane.sundmacher@nwhealth.org.
Yoursingoodhealth,

LindaYaroch,HealthOfficer

HealthDepartmentofNorthwestMichigan

BradRider,HealthOfficer
DistrictHealthDepartment#4

America leads the world in medical research and medical care, and for all we spend on health care, we should be the
healthiest people on Earth. Yet, for some of the most important indicators, like how long we live, were not even in the
top 25, behind countries like Bosnia and Jordan. Its time for America to lead again on health and that means taking
three steps:
1. Ensure everyone can see a doctor when they are sick
2. Build preventive care into every health care plan and make it available to people who wont or cant go in for it
3. Stop thinking about health as something we get in the doctors office.
Health is something that starts in our families, our schools, and our workplaces, in our playgrounds and parks, and in the
air we breathe and the water we drink. The more you see the problem of health this way, the more opportunities you
have to improve it. Scientists have found that the conditions in which we live and work have an enormous impact on
our health, long before we ever see a doctor. Its time to expand the way we think about health to include how to keep it,
not just how to get it back.

A New Way to Talk About the Social Determinants of Health


The Robert Wood Johnson Foundation

NORTHERNMICHIGANCOMMUNITYHEALTHASSSESSMENT&IMPROVEMENTINITATIVE
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego and Presque Isle Counties
OVERVIEW

Community
Conversations
7highlystructuredfocus
groups
Sponsoredbythelocal
multipurpose
collaborativebody
126communityresidents
andleaders/experts
fromhealthcare,
education,business,
government,andfunding
sectors

Secondary
Data

Surveys
ProviderSurvey
designedwithMcLaren
andMunson;81
physicians,nurse
practitionersand
physiciansresponded
CommunitySurvey
designedwithDistrict
HealthDepartment#10,
McLarenandMunson;
disseminated
electronicallyandhard
copy(inhealth
departmentclinics)
N=1,220

120+communityhealth
indicators,collectedby
county;categories
includeaccesstocare,
leadingcausesofdeath,
dseaserates,healthrisk
behaviors,maternaland
childhealth,
demographicsandmore

DataReviewandPriorityRanking
Followingreviewofthedatacollectedinthecommunityhealthassessment,40stakeholdersrankedcommunityhealth
issuesutilizingaDecisionMatrixwiththefollowingcriteria:severity,magnitude,impact,availableresourcesand
potentialforsuccess
#1Accesstohealthcare,includingbehavioral,maternal/child,andoralhealthcare
#2Chronicdiseaseprevention
#3Substanceuse

CommunityHealthImprovementPlanfor20162018
AccesstoCare
Developedbyleadersandexperts
fromhealthdepartments,hospitals,
FQHCs,NorthernMichiganRegional
Entity,CMHagenciesandMSUSchool
ofHumanMedicine

ChronicDiseasePrevention
Developedbyleadersandexpertsfrom
healthdepartments,hospitals,FQHCs,
earlychildhoodprograms,MSU
Extension,MSUSchoolofMedicine
PolicySystems Community
Health
Environmental Linkages
Systems
Change
Change

SubstanceUse
Developedbyleadersandexperts
fromhealthdepartments,hospitals,
NorthernMichiganRegionalEntity,
CMHagencies,substanceuse
preventionagencies,substanceuse
treatmentfacilitiesandlaw
enforcement

EXECUTIVE SUMMARY

HowhealthyisNorthernMichigan?Howdowepreventdisease,savelives,andsavedollars?Howdoweworktogether
soallresidentscanmakehealthychoices?Thesequestionsdroveacomprehensive6monthexplorationutilizinga
collaborativeprocessinAlpena,Antrim,Charlevoix,Cheboygan,Emmet,Montmorency,OtsegoandPresqueIsle
counties.

TheNorthernMichiganCommunityHealthAssessment&ImprovementInitiativeisaremarkablecollaborationoftwo
healthdepartmentsandthreehospitalswithfundingfromtheNorthernHealthPlan.Leadersfromeachorganization
providedoversighttotheproject,ledbytheHealthDepartmentofNorthwestMichigan.

Bothprimarydata(CommunityThemes&StrengthsAssessment)andsecondarydata(CommunityHealthStatus
Assessment)werecollectedfortheCommunityHealthAssessment.

CommunityThemes&StrengthsAssessment
Nearly1,400residentsofthe8countyregionparticipatedintheCommunityThemes&StrengthsAssessment,
whichconsistedofCommunityConversations(atypeofstructuredfocusgroup),andtwotypesofsurveys(What
MatterstoYou?CommunitySurveyandHealthCareProviderSurvey).

o CommunityConversations
126residentsandstakeholdersparticipatedinsevenCommunityConversationsponsoredbythelocal
multipurposecollaborativebodyinSeptemberandOctober2015.Collectively,theirresponsetothe
question,Whatcanwedotomoveclosertoourvisionofahealthycommunity?is:

1. Assureandincreaseaccesstoprimarycare,behavioralhealth,andsubstanceuseservices
2. Increaseawareness,utilizationandprovisionofcommunityresources
3. Providehealthandwellnesseducationacrossthelifespan
4. Engageresidentsinthecommunity
5. Promotehealthylifestylesandincreaseaccesstohealthyeatingandphysicalactivity
6. Developeconomicopportunities
7. Offercommunityeventsforallagegroupsandabilities
8. Protecttheenvironment
9. Enhanceinfrastructureforinformationtechnology

WhatMattersToYou?CommunitySurvey
1,220communityresidentscompletedtheWhatMatterstoYou?Survey,whichwasdesignedbythe
NorthernMichiganHealthNetwork,hospitalsandhealthdepartments.Questionsandresponsestokey
itemsfromarebelow:

What are the most important factors for a healthy community?


1Accesstohealthcare
2Goodjobs/healthyeconomy
3Accesstoaffordablehealthyfood
4Goodschools/highvalueoneducation
5Affordablehousing
What are the most important community health problems in your county?
1Substanceuse
2Overweight/obesity
3Chronicdisease
4Mentalhealthissues
5Lackofaffordablehousing
3

HealthCareProviderSurvey
81physicians,nursepractitioners,andphysicianassistantscompletedthe2015HealthCareProvider
Survey.Questionsandresponsestokeyitemsfromthesurveyarebelow:

What are the most important factors for a healthy community?


1Accesstohealthcare
2Goodjobs/healthyeconomy
3Accesstoaffordablehealthyfood
4Goodschools/highvalueoneducation
5Affordablehousing

What are the most important community health problems in your county?
1Obesity/overweight
2Mentalhealthissues
3Lackofaccesstohealthcare
4Tobaccouse
5Substanceuse

CommunityHealthStatusAssessment
120+demographic,health,andsocial/economicindicatorswerecollectedbycountyforthe8countyregion.A
spreadsheet,withdescription,sourceandyearofdataandMichiganstatisticsforcomparisoncanbeviewedat
www.nwhealth.org.

Overall,theCommunityHealthStatusAssessmentrevealsamorehomogeneous,lesseducatedandpoorer
populationthantheStateasawhole.Residentsengageinhealthriskbehaviorsatgreaterratesthantheirpeers
elsewhereinMichigan,drivinghigherratesofchronicdisease.Therearemanybarrierstoaccessinghealthcare
intheruralregion,includinggeography,lackoftransportationoptions,andshortagesofprimarycareand
behavioralhealthproviders.

Priority Ranking

40stakeholdersfromacrosstheregionconvenedonDecember4,2015toreviewanddiscussprimaryandsecondary
datacollectedduringthe2015CommunityHealthAssessment.UtilizingaDecisionMatrix,theyrankedprioritiesforthe
8countyregionasfollows:

#1Accesstohealthcare,includingbehavioralhealth,maternalandchildhealth,andoralhealthcare
#2Chronicdiseaseprevention
#3Substanceuse
#4Mentalhealth
#5Healthdisparities

Community Health Improvement Plan

AregionalCommunityHealthImprovementPlanisavailableasacompaniondocumenttotheCommunityHealth
Assessment.Developedbyleadersandexpertsfortoprankedcommunityhealthpriorities,theCommunityHealth
ImprovementPlanincludesgoalsandobjectivesinalignmentwithHealthyPeople2020,evidencebasedstrategiesto
implement,andidentifiesleadcommunitypartnersforeachstrategy.

2015 Community Health Assessment


Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego and Presque Isle counties

TheNorthernMichiganCommunityHealthAssessment&ImprovementInitiative
adaptedtheMobilizingforActionthroughPlanning&Partnerships(MAPP)framework
forconductingthe2015CommunityHealthAssessment.Consideredthegold
standard,MAPPwasdevelopedbytheNationalAssociationforCounty&CityHealth
OfficialswiththeUSCentersforDiseaseControl&Prevention.Itisnotanagency
focusedassessmentinstrument;instead,itisacommunitydrivenplanningtoolthat
appliesstrategicthinkingtopriorityissuesandidentifiesresourcestoaddressthem.

ThreeofthefourMAPPassessments
wereutilizedforthe2015
CommunityHealthAssessment:

CommunityThemesand
StrengthsAssessment
CommunityHealthStatus
Assessment
ForcesofChangeAssessment

PHASE 1: Organizing for Success

ThefirstphaseofMAPPinvolvesorganizingtheprocessesforcollectingdataforthecommunityhealthassessment,
prioritizingissuesasindicatedintheassessment,anddevelopingacommunityhealthimprovementplantoaddresseach
ofthoseissues.Thepurposeofthisphaseistobuildcommitment,engagepartnersasactiveparticipants,anduse
partnerstimewell.Itresultsinaplanthatcanberealisticallyimplemented.Nooneindividualororganizationcan
improvecommunityhealthbythemselves.MAPPisbasedonthepremisethatjustabouteveryonehasastakeinhealth,
safetyandwellbeing.

TheExecutiveCommitteeoftheNorthernMichiganCommunityHealthAssessment&ImprovementInitiativeismadeup
ofleadersfromtwolocalhealthdepartments,threehospitals,andthecountyhealthplan.Earlyon,theydecidedona
combinationofprimaryandsecondarydatacollectionmethodsthatwouldnotonlyprovideanupdatedpictureof
healthandqualityoflifeintheeightcountyregion,butmeethospitalsCommunityBenefitrequirementsandhealth
departmentsPublicHealthAccreditationBoardrequirements.WithfundingfromtheNorthernHealthPlan(county
healthplanfortheeightcountyregion),theHealthDepartmentofNorthwestMichiganagreedtofacilitatetheproject.

NorthernMichiganCommunityHealthAssessment&ImprovementInitiative
ExecutiveCommittee

LindaYaroch,Chair
HealthOfficer
HealthDepartmentofNorthwestMichigan

JohnBruning
HealthOfficer
DistrictHealthDepartment#4

ThereseGreen
DirectorofWellnessServicesandCommunityRelations
McLarenNorthernMichigan

KathyJacobsen
DirectorofCommunityHealthEducation
MunsonHealthcareCharlevoixHospital

BruceMiller
ExecutiveDirector
NorthernHealthPlan

ChristiePerdue
DirectorofFoundationandMarketing
OtsegoMemorialHospital

PHASE 2: Visioning

Visioning,thesecondphaseofMAPP,providesfocus,purpose,anddirectiontotheMAPPprocesssothatparticipants
collectivelyachieveasharedvisionofthefuture.Itprovidesanoverarchinggoalforthecommunity:

Healthy people in healthy communities

PHASE 3: Conduct the assessments

ThreeMAPPassessmentswerefacilitatedintheeightcountyregion.Eachoneyieldsimportantinformationfor
improvingcommunityhealth,buttheirvalueismultipliedbyconsideringthefindingsasawhole.Together,the
assessmentsprovideacompleteviewofthecommunity.

CommunityThemes&StrengthsAssessment

What issues are the most important to health and quality of life in our community?
TheCommunityThemes&StrengthsAssessmentisavitalpartofthecommunityhealthimprovementprocess.During
thisphase,communitymembersthoughts,opinions,concerns,andsolutionsaregathered.Asaresult,theseindividuals
becomemorevestedintheprocess,withasenseofownershipandresponsibilityfortheoutcome.Avarietyofmethods
maybeused;theInitiativesExecutiveCommitteeselectedacombinationofsurveysandatypeoffocusgroupto
quantifycommunityinput.

CommunityConversations

SevenCommunityConversationswerefacilitatedusingtheTechnologyofParticipationsConsensusWorkshop
Method.Atypeofhighlystructuredfocusgroup,theConsensusWorkshopMethodutilizesacollective
integratedthinkingprocessandconsistsofindividualbrainstorming,smallgroupdiscussion,andfullgroup
discussion.Sponsoredbylocalmultipurposecollaborativebodies,CommunityConversationswereconvened
acrosstheregioninSeptemberandOctober2015.

SpecialthankstomultipurposecollaborativebodycoordinatorsforassistanceinsponsoringaCommunity
Conversation:

AlpenaCountyHumanServicesCoordinatingCouncil
BarbaraPorrett,CoordinatorofMarketing
AlconaHealthCenters

AntrimCountyCommunityCollaborative
KateKerr,CoordinatorofCommunityImpactandEngagement
UnitedWayofNorthwestMichigan

CharlevoixEmmetHumanServicesCoordinatingBody
MarciaCampbell,ProgramManagerofGreatStartReadinessProgram
CharlevoixEmmetIntermediateSchoolDistrict

CheboyganHumanServicesCoordinatingBody
TracyTorrence,ExecutiveDirector
CheboyganCountyUnitedWay

MontmorencyCountyFamilyCoordinatingCouncil
DonnaHardies,PreventionSpecialist
CatholicHumanServices

OtsegoHumanServicesNetwork
LaurieAndrews,RSVPVolunteerCoordinator
OtsegoCountyUnitedWay

PresqueIsleCountyHumanServicesCoordinatingCouncil
MarySchalk,4HYouthDevelopmentProgramAssociate
MichiganStateUniversityExtension

126residentsandstakeholdersparticipatedinsevenCommunityConversations.Theyincludedrepresentatives
fromhealthdepartments,hospitals,federallyqualifiedhealthcenters,homecareandhospiceagencies;
communitymentalhealthandbehavioralhealthproviders;socialserviceagencies,includingthosewhoserve
olderadultsanddisabledresidentsand/orprovidehousing,utility,ortransportationassistance;colleges,MSU
Extension,schools,andearlychildhoodeducationprograms;ChambersofCommerceandbusinesses;
government,courts,andlawenforcement,faithbasedorganizations;andUnitedWayandfoundations.

Collectively,theirresponsetothequestion,Whatcanwedotomoveclosertoourvisionofahealthy
community?is:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Assureandincreaseaccesstoprimarycare,behavioralhealth,andsubstanceuseservices
Increaseawareness,utilizationandprovisionofcommunityresources
Providehealthandwellnesseducationacrossthelifespan
Engageresidentsinthecommunity
Promotehealthylifestylesandincreaseaccesstohealthyeatingandphysicalactivity
Developeconomicopportunities
Offercommunityeventsforallagegroupsandabilities
Protecttheenvironment
Enhanceinfrastructureforinformationtechnology

ForcountyorbicountyCommunityConversationReports,pleaseseeAttachmentA.
7

WhatMatterstoYou?CommunitySurvey

TheWhatMatterstoYou?CommunitySurveywasdesignedforwidedistributionacrossNorthernMichiganin
partnershipwiththeNorthernMichiganHealthNetwork.Intheeighttipofthemittcounties,itwas
disseminatedthroughaSurveyMonkeylinktocommunitypartnersviaemail.Inaddition,hardcopieswitha
subsetofsurveyquestionsweredistributedtoclientsatlocalhealthdepartmentclinicstoassureinputfrom
thelowincomepopulation.Inall,1,220communityresidentscompletedthesurvey(SeeAttachmentB).
Respondentsfromacrossthetipofthemittregionidentifiedaccesstohealthcare,goodjobs/healthyeconomy,
accesstoaffordablehealthyfood,goodschools/highvalueoneducationandaffordablehousingasthemost
importantfactorsthatdefineahealthycommunity.Theyidentifiedsubstanceuse,obesity/overweight,chronic
disease,mentalhealthissuesandlackofaffordablehousingasthetopcommunityhealthproblemsintheir
county.

Whenaskedwhichdiseaseorconditionstheyhadbeendiagnosedwith,responseswere,inrankorder,
obesity/overweight,highbloodpressure,highcholesterol,asthma,anddentalproblems.
Topbarrierstoseekinghealthcarearehighdeductiblesandcopays(adults,olderadultsandchildren);limited
healthinsurancecoverage(adults,olderadultsandchildren);inabilitytoaffordofficevisits(adultsandolder
adults);difficulttosetappointments(adultsandchildren);andEmergencyRoomwaitingtime(olderadultsand
children).Inaddition,adultsalsoindicatedtheirinsurancedoesnotcoverdentalservicesandolderadults
indicatedtheirinsurancedoesnotcovermedications.Findingabehavioralhealthproviderisabarrierfor
children.
HealthCareProviderSurvey
SimilarlytotheWhatMatterstoYou?CommunitySurvey,theHealthCareProviderSurveywasdevelopedfor
widedistributioninpartnershipwithhospitals.Theydisseminatedthesurveyto81physicians,nurse
practitioners,andphysicianassistantsfromMcLarenNorthernMichigan,MunsonHealthcareCharlevoix
HospitalandOtsegoMemorialHospital.(PleaseseeAttachmentC).
Theyrankedthefollowingasthemostimportantfactorsforahealthycommunity:accesstohealthcare,good
jobs/healthyeconomy,accesstoaffordable,healthyfood,goodschools/highvalueoneducationandaffordable
housing.Theidentifiedobesity/overweight,mentalhealthissues,lackofaccesstohealthcare,andtobaccouse
andsubstanceuseasthetopcommunityhealthproblemsinthecommunities.

CommunityHealthStatusAssessment
Over120communityhealthindicatorswerecollected,organizedandanalyzedforeachoftheeightcountiesinthe
region,includingstatisticsalignedwiththeGovernorsHealth&WellnessDashboard.Inaddition,theCommunityHealth
StatusAssessmentincludessocialdeterminantsofhealthandotherstatisticsreportedannuallyintheCountyHealth
Rankings.TheCountyHealthRankingsmodelforpopulationhealthemphasizesinterrelatedfactorsthat,ifimproved,
canhelpmakecommunitieshealthierplacestolive,workandplay.

Thisdatabaseprovidesawealthofinformationthatcanbeaccessedeasilybytheentirecommunityforstrategic
planning,grantwriting,andotherdatadrivenactivities.Manyindicatorsaresummarizedbelow.Forfulldescriptionsof
indicators,aswellassource/yearofdata,comparisonstoStateratesandHealthyPeople2020Objectives(where
applicable),visitwww.nwhealth.orgorpartnerhospitalwebsites.

County Health Rankings Model

10

HealthOutcomes

Prematuredeath
TheCountyHealthRankingsquantifiesandcompareshealthstatusofcountypopulationsbymeasuring
theburdenofprematuredeaths,animportantmeasureofapopulation.Prematuredeathsaredeaths
thatoccurbeforeapersonreachestheageof75.Manyofthesedeathsareconsideredtobe
preventable.Byexaminingprematuremortalityratesacrosscommunitiesandinvestigatingthe
underlyingcausesofhighratesofprematuredeath,resourcescanbetargetedtowardstrategiesthat
willextendyearsoflife.
Asanation,morethan75%ofhealthcarespendingisonpeoplewithchronicconditions,suchasheart
disease,cancer,strokeanddiabetes.Thesepersistentconditionsthenationsleadingcausesofdeath
anddisabilityleaveintheirwakedeathsthatcouldbeprevented,lifelongdisability,compromised
qualityoflife,andburgeoninghealthcarecost

LeadingCausesofDeath,per100,00Residents(AgeAdjusted)
250
200
150
100
50
0

CoronaryHeartDiseaseDeaths

CancerDeaths

StrokeDeaths

MichiganDepartmentofHealthandHumanServices,201113
NationalCancerInstitute,20082013

11

HealthRelatedQualityoflife
Inadditiontomeasuringhowlongpeoplelive,itisalsoimportanttostudymeasuresofhowhealthy
peoplearewhiletheyarealive.Theirreportsofdayswhentheirphysicalhealthispoororfairisa
reliableestimateofhealth.

Days Physical Health Is


Poor or Fair

Source:CountyHealth
Rankings,2015

Mentalandemotionalwellbeingisalsoessentialtooverallhealth.Positivementalhealthallowspeople
torealizetheirfullpotential,copewiththestressesoflife,workproductively,andmakemeaningful
contributionstotheircommunities.Anxiety,moodandimpulsecontroldisordersareassociatedwitha
higherprobabilityofriskbehaviors(tobacco,alcoholandotherdruguse),intimatepartnerandfamily
violence,manyotherchronicandacuteconditions(obesity,diabetes,cardiovasculardisease,
HIV/sexuallytransmittedinfections)andprematuredeath.

12

Lowbirthweightinfants
Improvingthewellbeingofmothers,infants,andchildrenisanimportantgoalfortheU.S.Lowbirth
weight,whichiswhenaninfantweighslessthan2,500grams(approximately5lbs,8oz)atbirth,isa
criticalmeasurebecauseitrepresentsbothmaternalandinfanthealthfactors.Smoking,drugand
alcoholuse,lackofweightgainduringpregnancy,andanotherpregnancywithinsixmonthsarefactors
thatcontributetolowbirthweight.Infantsborntoteenagemothershaveahigherriskoflow
birthweightinfantsandmaybemoreatriskformanyhealthproblems.Somebabiesbecomesickinthe
firstsixdaysoflifeordevelopinfections.Otherbabiesmayevensufferfromlongertermproblems,such
asdelayedmotorandsocialdevelopmentorlearningdisabilities.

BabieswithLowBirthWeight

12

10

NA

NA

0
Antrim

Charlevoix

Emmet

Otsego

Alpena

Cheboygan Montmorency PresqueIsle

Statewide8.4%

MichiganDepartmentofHealthandHumanServices,2013

13

Health Factors

HealthBehaviors

Tobaccouse
Tobaccouseistheleadingcauseofdisease,disabilityanddeathintheUS.Livingtobaccofreereducesrisks
ofdevelopingheartdisease,variouscancers,chronicobstructivepulmonarydisease,periodontaldisease,
asthma,andotherdiseases.Tobaccofreelivingmeansavoidinguseofalltypesoftobacco,including
cigarettes,cigars,smokelesstobacco,pipes,andecigarettesandalsolivingfreefromsecondhandsmoke.

Adultsmokingratesinthe8countyregionexceedtheStaterateof20%,andthereisastrongcorrelation
betweentobaccouseandincome.Inaddition,maternalsmokingratesareveryhigh,rangingfrom26%in
EmmetCountyupto50%inAlpenaCountyandareevenhigheramonglowincomepregnantwomen.

PercentageofTobaccoUse
60
50
40
30
20
10
0

MothersWhoSmokedDuringPregnancy

AdultsWhoCurrentlySmoke

CountyHealthRankings,2015
MichiganDepartmentofHealthandHumanServices,2013

14

Obesity
Obesityisoftentheendresultofanoverallenergyimbalanceduetopoordietandlimitedphysicalactivity.
Itiscommonandserious,increasingtheriskforhealthconditionssuchascoronaryheartdisease,type2
diabetes,cancer,hypertension,dyslipidemia,stroke,liverandgallbladderdisease,sleepapneaand
respiratoryproblems,andosteoarthritis.Themedicalcostsofobesityarestaggering.

PercentageofAdultObesity(BMI>29)

40
35

30

25

20

15

10

Statewide32%

CountyHealthRankings,2015

15

Physicalactivity
Physicalactivityisoneofthemostimportantfactorsinimprovingoneshealth.Itstrengthensbonesand
muscles,reducesstressanddepression,andmakesiteasiertomaintainahealthybodyweight.Evenpeople
whodonotloseweightfromphysicalactivitygetsubstantivebenefitsfromregularphysicalactivity,
includinglowerincidenceofhighbloodpressure,diabetes,andcancer.Healthyphysicalactivityincludes
aerobicexercise,musclestrengtheningactivitiesandactivitiestoincreasebalanceandflexibility.As
describedbythePhysical Activity Guidelines for Americans,adultsshouldengageinatleast150minutesof
moderateintensityactivityeachweek,andchildrenandteenagersshouldengageinatleastonehourper
day.

PercentageofSedentaryAdults

30
25
20
15
10
5
0

Statewide23%

USCentersforDiseaseControlandPrevention,2011

Healthyeating
Thoughresearchonthefoodenvironmentisstillinitsearlystages,thereisstrongevidencethataccessto
fastfoodrestaurantsandresidinginfooddesertcorrelatewithahighprevalenceofoverweight,obesity,
andprematuredeath.Supermarketstraditionallyprovidehealthieroptionsthanconvenienceorsmaller
grocerystores.Nothavingaccesstofreshfruitsandvegetablesisanimportantbarriertoconsumptionand
isrelatedtoprematuremortality.

Food Deserts

USDepartmentof
Agriculture,2016

16

Accesstohealthyfoodcanhelpreducepeoplesriskforheartdisease,highbloodpressure,diabetes,
osteoporosis,andseveraltypesofcancer,aswellashelpthemmaintainahealthybodyweight.Asdescribed
inDietary Guidelines for Americans,eatinghealthymeansconsumingavarietyofnutritiousfoodsand
beverages,especiallyvegetables,fruits,lowandfatfreedairyproductsandwholegrains;limitingintakeof
saturatedfats,addedsugarsandsodium;keepingtransfatintakeaslowaspossible;andbalancingcaloric
intakewithcaloriesburnedtomanagebodyweight.

Drugandalcoholuse
Preventingdrugabuseandexcessivealcoholuseimprovesqualityoflife;academicperformance,workplace
productivityandmilitarypreparedness;reducescrimeandcriminaljusticeexpenses;reducesmotorvehicle
crashesandfatalities;andlowershealthcarecostsacuteandchronicconditions.Alcoholanddrugusecan
alsoimpedejudgmentandleadtoharmfulrisktakingbehavior.

Excessivealcoholuseincludesbingedrinking,underagedrinking,drinkingwhilepregnant,andalcohol
impaireddriving.Itisariskfactorforanumberofadversehealthoutcomes,suchasalcoholpoisoning,
hypertension,acutemyocardialinfarction,sexuallytransmittedinfections,unintendedpregnancy,fetal
alcoholsyndrome,suddeninfantdeathsyndrome,andinterpersonalviolence.

PercentageofAdultsWhoDrinkExcessively

30

25

20

15

10

NA
NA
0

Statewide18%

CountyHealthRankings,2015

17

TeenPregnancy
Teenpregnancyisassociatedwithpoorprenatalcareandpretermdelivery.Pregnantteensaremorelikely
thanolderwomentoreceivelateornoprenatalcare,havegestationalhypertensionandanemia,and
achievepoormaternalweightgain.Theyarealsomorelikelytohaveapretermdeliveryandlowbirth
weight,increasingtheriskofchilddevelopmentaldelays,illnessanddeath.Nearly80%ofteenagemothers
willaccessgovernmentsupportedprograms.Theirchildrenaremorelikelytobeincarcerated,dropofout
highschool,havemorechronichealthproblems,andbecometeenparentsthemselves.

TeenPregnancyRate
50
45
40
35
30
25
20
15
10
5
0

Statewide23per1,000femalesage1519

MichiganDepartmentofHealthandHumanServices,2013

ClinicalCare

Accesstohealthcare
Accesstohealthcaremeasuresaccessibilitytoneededprimarycare,healthcarespecialists,andemergency
treatment.Whilehavinghealthinsuranceisacrucialsteptowardaccessingthedifferentaspectsofthe
healthcaresystem,healthinsurancebyitselfdoesnotensureaccess.Itisalsonecessarytohave
comprehensivecoverage,providersthataccepttheindividualshealthinsurance,relativelycloseproximity
ofproviderstopatients,andprimarycareprovidersinthecommunity.

Thereareadditionalbarrierstoaccessinsomepopulationsduetolackoftransportationtodoctorsoffices,
lackofknowledgeofaboutpreventivecare,longwaitstogetanappointment,lowhealthliteracy,and
inabilitytopaythehighdeductibleofmanyinsuranceplansand/orcopaysforreceivingtreatment.

Lackofhealthinsurance
EmploymentbasedcoverageisthelargestsourceofhealthcoverageintheUS,andmanyunskilled,low
payingandparttimejobsdonotofferhealthcoveragebenefits.Ingeneral,employmentstatusisthemost
importantpredictorofhealthcarecoverageintheUS.Evidenceshowsthatuninsuredindividualsexperience
moreadverseoutcomesphysically,mentally,andfinanciallycomparedtoinsuredindividuals.The
uninsuredarelesslikelytoreceivepreventiveanddiagnostichealthcareservices,aremoreoftendiagnosed
atalaterdiseasestageand,onaverage,receivelesstreatmentfortheirconditioncomparedtothosewith
insurance.TheInstituteofMedicinereportsthattheuninsuredpopulationhasa25%highermortalityrate
thantheinsuredpopulation.
18


OveralltheproportionofuninsuredinNorthernMichiganishigherthantheStateasawhole.However,with
theenactmentoftheAffordableCareAct,andanintenseoutreach,educationandenrollmenteffortinthe
eightcountyregion,theproportionofuninsuredamongthelowincomepopulationhasdeclined
precipitously.

PercentageofResidentswithHealthInsurance
120
100
80
60
40
20
0

Adults

Children

CountyHealthRankings,2015
Healthcareprovidersupply

Havingaccesstocarerequiresnotonlyfinancialcoverage,butalsoaccesstoproviders.Sufficientavailability
ofprimarycarephysiciansisessentialsothatpeoplecangetpreventiveandprimarycareand,when
needed,referralstospecialtycare.

Ratio of Primary Care Poviders to


Population

Source:CountyHealth
Rankings,2015

19

Qualityofcare
Qualityofcarecanbeexplainedastheright care for the right person at the right time.TheInstituteof
Medicine(IOM)furtherdefinesthequalityofhealthcareasthedegreetowhichhealthservicesfor
individualsandpopulationsincreasethelikelihoodofdesiredhealthoutcomesandareconsistentwith
professionalknowledge.TheIOMlistssixcharacteristicsofqualityhealthcare:safe,timely,effective,
efficient,equitableandpatientcentered.

Therearehundredsofpotentialqualitymeasureswithnoconsensusyetonthebestsetofmeasures.
CountyHealthRankingsusesthreemeasuresofqualityhealthcare:preventablehospitalizations,screening
forbreastcancer,andscreeningfordiabetes.Theseindicatorswereselectedbecausetheyprovidethe
greatestbenefittopatientoutcomes,helptobridgegapsseenamongdifferentpopulations,andcanbe
implementedinasafe,efficientandcosteffectiveway.

PreventableHospitalStayRate

60
50
40
30
20
10
0

Statewidehopsitalstaysforamnulatoryconditionsper1,000Medicareenrollees

CountyHealthRankings,2015

20

The Social Determinants of Health


The Social Determinants of Health are the circumstances in which people grow up, live, work, and age, and the
systems put in place to deal with illness. These circumstances are, in turn, shaped by a wider set of forces:
economic, social policies and politics.

Key Concepts in the Social Determinants of Health


WorldHealthOrganization

SocialandEconomicIndicators

Populationcharacteristics
AccordingtotheUSCensus,180,717liveinthe8countyregion.Thepopulationispredominantlywhite,
withNativeAmericansatabout2%,representingthelargestminoritygroup.

Race/Etnicity

Whitealone

AmericanIndianorAlaskaNativealone

Other
USCensusBureau,2014

21

Educationandincome
Therelationshipbetweenhighereducationandincomeandimprovedhealthoutcomesiswellknown,
withyearsofformaleducationcorrelatingstronglywithimprovedworkandeconomicopportunities,
reducedpsychosocialstress,andhealthierlifestyles.Theproportionofthepopulationwithatleasta
BachelorsdegreelagsbehindtheStateineverycountyintheregionwiththeexceptionofEmmet
County.

PercentageofEducationalAttainment

100
90
80
70
60
50
40
30
20
10
0

People25+withaBachelor'sDegreeorHigher

People25+withaHighSchoolDegreeorHigher
AmericanCommunitySurvey,20092013

Higherlevelsofeducationresultinhigherincomes,onaverage.Accesstohealthcareisaparticularly
importantresourcethatisoftenlinkedtojobsrequiringacertainlevelofeducationattainment.Even
whenincomeandhealthinsurancearecontrolled,themagnitudeofeducationseffectonhealth
outcomesremainssubstantiveandstatisticallysignificant.

Income
Withlowereducationallevelsacrosstheregion,itisnotsurprisingthatincomesfallbelowMichigans
medianincome($49,087)aswell,exceptinEmmetCounty,whereitreaches$51,113.Thesecounty
leveldatacannotaccuratelydescribethelargedisparitiesthatexistbetweenthelowestandhighest
incomesintheregion,particularlyintheNorthwestcounties.BydrillingdowntoCensusTract,stark
differencesbecomeevident.

22

MedianHouseholdIncome
60,000
50,000
40,000
30,000
20,000
10,000
0

Statewide$49,087

AmericanCommunitySurvey,20122014

TheproportionofsingleparenthouseholdsacrudepredictorforlowincomefallsaboveStaterate
of17.2%inallcountiesintheregion.Adultsandchildreninsingleparenthouseholdsareatriskfor
adversehealthoutcomessuchasmentalhealthandsubstanceuseproblems.

Childrensriskofpoorhealthandprematuremortalitymayalsobeincreasedduetopooreducational
attainmentsassociatedwithpoverty.Thechildreninpovertymeasureishighlycorrelatedwithoverall
povertyrates.

Single Parent Households

CountyHealth
Rankings,2015

23

Socialandemotionalsupport
TheCountyHealthRankingsmeasuresocialisolationbecausethelinkbetweensociallyisolated
individualsandpoorhealthhasbeenwellestablishedintheliterature.Sociallyisolatedindividuals
typicallyhavelimitedaccesstothetypesofsupportprovidedbypositiverelationships.Onestudyfound
themagnitudeofriskassociatedwithsocialisolationissimilartotheriskofcigarettesmokingfor
adversehealthoutcomes.
Understandingtheproportionofsociallyisolatedindividualsinacommunitymayprovideamore
completeperspectiveonacommunityscollectivehealthprofile.Thisisbecausesociallyisolated
individualsaremorelikelytobeconcentratedincommunitieswithpoorercommunitynetworks.
Poorfamilysupport,minimalcontactwithothers,andlimitedinvolvementincommunitylifeare
associatedwithincreasemorbidityandmortality.Furthermore,socialsupportnetworksarepowerful
predictorsofhealthbehaviors.
AlargeproportionofadultsinNorthernMichigandonothaveadequatesocialandemotionalsupport.
Aspovertyandpoorsocialconnectionsareamongriskfactorsforchildabuseandneglect,these
statisticsmayexplain,inpart,whychildabuseisgrotesquelyoverrepresentedintheeightcounty
region.

PercentageofChildAbuse
35
30
25
20
15
10
5
0

Statewide14.9%

KidsCountDataCenter,2013

Narrative adaped from Healthy People 2020 and National Prevention Strategy

24

PHASE 4: Strategic Directions


ThroughreviewandanalysisofthethreeMAPPassessments,sixStrategicDirectionsinthe8countyregionwere
identified.DatacollectedduringthecommunityhealthassessmentwassummarizedinaseriesofIssueBriefs(Please
seeAttachmentD).
OnDecember4,2015,40stakeholderswereconvenedtoreviewdatacollectedintheCommunityHealthAssessment.
ThemeetingwasfacilitatedutilizingaToPEnvironmentalScanningMethodcalledCooperativeReviewofQuantitative
Data.Insmallgroups,participantsreviewed,discussed,andpresentedanIssueBriefforoneStrategicDirection.As
presentationstothefullgroupwerecompleted,participantsconsideredtheseverity,magnitude,impact,resources
availableandpotentialforimprovement.ThesedatawereorganizedinaDecisionMatrix,rankingStrategicDirectionsas
follows:

PHASE 5: Formulate Goals and Strategies


ThenextstepofthecommunityhealthassessmentandimprovementcycleistodeveloparegionalCommunityHealth
ImprovementPlan.

Foreachofthethreetoprankedpriorities,ActionTeamsidentifiedgoalsandobjectivesinalignmentwith
Healthy People 2020. Forbaselines,evidencebase,andstrategiesandinterventions,pleaseseethe
CommunityHealthImprovementPlanfor20162018.

Priority#1: AccesstoCare,includingprimarycare,behavioralhealth,maternalandchildhealthandoral

healthcare

Developed by leaders/experts from health departments, hospitals, federally qualified health centers, community
mental health agencies and the county health plan for the region

Objective1: Increaseaccesstoprimarycare,behavioralhealth,maternalandchildhealthandoral

healthcare,includinguseofalternatedeliverymodels
Objective2: Increasetheproportionofpersonsunderage65withmedicalinsurance
Objective3: IncreasetheproportionofeligiblepersonsenrolledintheHealthyMichiganPlan

Objective4: Increasethenumberofpracticingprimarycareproviders

Priority#2:ChronicDisease

Developed by leaders/experts from health departments, hospitals, MSU-Extension

Goal: Promotehealthandreducechronicdiseasethroughtheconsumptionofhealthyfoodsand
achievementandmaintenanceofhealthybodyweight

Objective1:Increasevarietyandconsumptionofvegetablesinthedietsofthepopulationage2+

Objective2:Reduceconsumptionofsolidfatsandaddedsugarsinthedietsofthepopulationage2+
25


Goal: Improvehealth,fitnessandqualityoflifethroughdailyphysicalactivity

Objective1:Increasetheproportionofadultswhomeetcurrentfederalguidelinesforaerobicand
musclestrengtheningactivities

Objective2: Increasetheproportionofadolescentswhomeetcurrentfederalguidelinesforaerobic
andmusclestrengtheningactivities

Objective3:Increaselegislativepoliciesforthebuiltenvironmenttoenhanceaccesstooravailability
ofphysicalactivityopportunities

Goal: By2016,reduceillness,disabilityanddeathrelatedtobaccouseandsecondhandsmoke

Objective1:Reducetobaccoinitiationuseamongadolescents

Objective2:Increasesmokingcessationinpregnancy

Priority#3: SubstanceUse

Developed by leaders and experts from health departments, hospitals, substance use prevention agencies,
substance use treatment facilities, and law enforcement
Goal: Reducesubstanceabusetoprotectthehealth,safety,andqualityoflifeforall,especiallychildren

Objective1: Increasetheproportionofadolescentswhoperceivegreatormoderateriskassociated
withdrinkingalcoholregularly

Objective2: Increasetheproportionofpersonswhoarereferredforfollowupcareforalcohol

and/ordrugproblemsafterdiagnosisortreatment

Objective3: Reducenonmedicaluseofprescriptiondrugs

Objective4: Reducethenumberofdeathsattributabletoalcoholanddrugs

26


ATTACHMENT A
COMMUNITY CONVERSATION REPORTS

NORTHERNMICHIGANCOMMUNITYHEALTHANDIMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONONOCTOBER21,2015

What can we do here in Alpena County to move closer to our vision of a healthy community?
Enthusiastically
supportchildren
andyouth

Activelyprotect
ourenvironment

Broadlyincrease
ageappropriate
community
activities

Movefrom
problemfocusto
environmentfocus
forchildren
Moredaycare
providerswith
moreavailability

Educationon
sustainabilityto
protectnature
resources
$.10depositon
waterbottles

Increaseground
waterregulation
andenforcement

Encourage
recyclingeffortsin
thecommunity

Mandatory
recycling

Increase
understandingof
generationgaps

Schooling
assistanceGED
andoneonone
Increase
structured
physicalactivities
atschool
Increaseprograms
forsupportand
mentoring
Parentcoaching

Goodschools

Schoolbooksfor
eachchild

YMCA

Selfsufficient
supportsystems
foodplantingand
growing
Continueto
highlightnatural
resourcesclean
waterandair
Nofracking

Cleanupour
beaches

Freecommunity
educationforall
citizens
Makinghealthy
accessiblefood
andincreasing
knowledge
Moreactivities
gearedforseniors
andteens
Increase
affordable
community
activities
Communityaccess
toaffordable
recreational
equipment
Consistencyinour
messagehealthy
living

Greatlyincrease
accessto
comprehensive
healthcare
services
Accesstomore
healthcare
providers(physical
andbehavioral)
Accessto
behavioral/medical
healthcare
Physician
recruitmentand
retention

Efficiently
developeconomic
opportunities

Employment
opportunities

Enhanced
community
offeringsfor
increasedtourism
Highereducation
andtraining
opportunities

Increased
availabilitytomed
equipmentand
supportservices
Increasehome
careprovider
services

Programwhere
kidscanreach
theirhigh
potential
Diversityinjob
offerings

Morecentralized
resourceprograms

Increasingfunding

Enthusiastically
educatethe
community

Officiallydevelop
evidencebased
treatmentand
recoverservices

Opennessto
growthand
changeinthe
community
Createcommon
visionofahealthy
community

Changesin
culturethat
acceptssubstance
abuse
Addiction
recoveryservices

Publishstatistics:
goodandbad

Intentionally
evaluate
availability
affordabilityand
accessibilityof
infosystems
211textingfor
community
resources

Intentionally
addressways
povertyaffects
thecommunity

Affordablegap
services

Dependableand
affordable
internet,utilities

Increase
understandingof
poverty

Access to
substanceabuse
treatment

Connect
communityto
goodinformation

Aidpeopletoget
offState
assistance

Expand/grow
currentworking
efforts

Healthyandsafe
wateractivities

Texting
emergency
servicesforteens
andyoungadults

Community
involvement

Increase
volunteerism

Proactively
increasetrauma
informed
communities

Traumainformed
communities


NORTHERNMICHIGANCOMMUNITYHEALTHASSESSMENT&IMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONINANTRIMCOUNTYONOCTOBER16,2015
What can we do here in Antrim County to move closer to our vision of a healthy community?
Enthusiastic
allyprovide
trainingand
education
opportunities
across
lifespan

Intentionally
increase
accessto
affordable
childcare

Strategically
plan
affordable
housing

Thoughtfully
promote
youth
activities

Accessto
financeand
budget
counselingin
schools
More
educationon
lifeskillsin
schools

Accessto
vocational
education
opportunity

Accessto
affordable
childcare

Accessto
affordable
housing

Engage
youthin
activelife
Styles

Preschool
accessand
support
(cost)

Increasein
safe,
affordable
housing

Developing
saferec
activitiesfor
youth

Affordable
childcare(all
hours/nights
and
weekends)

Retirement
housingfor
seniors

Appropriate
teen
activities

Accessto
auto
insurance
anddrivers
education

Easieraccess
tooutlying
services

Bettercareer
planningata
youngage

Utilize
retiredto
teachyouth
lifeskills(ie,
cooking)
Better
educational
opportunities
within
county
Supportfor
small
businesses

Continually
provide
community

Intentionally
increase
accessto
behavioral
health
services

Building
Substance
stronger
abuse
familyvalues supportand
prevention

Actively
promote
health
insuranceto
increase
accessto
care
Increasein
residents
withhealth
insurance

Ongoing
healthyliving
educfreefor
families

Address
depression

Offeringsfor
faithbased
parenting
skills
programs

transportation

options

Increase
accessto
non
emergency
transport
Crosscounty
transportatio
nincluding
weekends

Clearly
increase
awareness
of
community
resources

Broaden
conversation
authentic
voices

Thoughtfully
consider
challengesof
mobility
impairments

Strategically
increase
enforcement
coveragein
highcrime
areas
Increaselaw
enforcement
inhighcrime
areas

Improve
physical
accessfor
mobility
impaired

Information
about
community
resources

Consistently
promote
healthy
eatingand
nutrition

Accessto
affordable
healthyfood

Maintain
accessto
fresh,
healthyfood
affordable
Supportfor
agriculture
DUFBfarmer
markets

Continually
offerevents
to
strengthen
families


NORTHERNMICHIGANCOMMUNITYHEALTHANDIMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONONOCTOBER28,2015

What can we do here in Charlevoix and Emmet counties to move closer to our vision of a healthy community?
Intentionally
integratebehavioral
andphysicalhealth
Healthinfoexchange
(notnecessarily
electronic)
Behavioralhealthin
schoolsPreKtohigh
school
Preventionand
treatmentoftobacco
andsubstanceuse
Affordableaccessible
mentalhealthacross
ages
Recognizecurrent
programsforhuman
serviceneeds
Expandaccessto
SUDservices,
especiallyintegrated
Incentivesfor
preventivehealth

Accessibilityand
availabilityofhealth
care
Expandandpromote
CHWsand
Navigators

Accesstobehavioral
health

Addressdiabetesand
prediabetes

Increase
immunizationrates
Increasemental
healthservices
Affordableaccessible
dentalcare
Freeclinicorhealth
accessinginsurance

Effectivelypromote
andcoordinate
communityservices
Collaborationamong
publicandprivate
providers
Involvinglocal
governmentaspart
ofthesolution
Educatecommunity
onavailable
programs
Effectivecommunity
outreachof
svcs/resources
Increaseawareness
ofservices
Mediacampaigns
sharedmessaging

Energetically
promotehealthy
living
Foodsystems
coordinatorforgood
food
Decreaseobesity,
increaseexercise,
healthyfoods
Accessibilityto
farmersmarketsand
healthyfood
Promotefree
recreational
opportunities
Freeandaccessible
physicalactivity
opportunities
Reducingscreen
timeforkidsandall

Strategically
developEconomic
Plan
Requirededucation
forassistance
programs
Taxbreaksfor
diversifiedbusiness
(new)
Accesstoquality
stablechildcareesp
infants
Developingcareers

Socialmediasharing
network

Easyaccessto
healthyfoods

Accesstotechnology

Diversestakeholder
groups

Saferoutesfor
walkingandbicycling

Cleanindustryjobs

Coordinated
outreach

Cleanhealthy
environment

Careerandjobfairs

Antistigma
campaign

Accesstoaffordable
andhealthyfoods

Bringbackactive
communitycenters

Accesstoaffordable
qualitychildcare
Livingwagejobs
yearround

Regularlyprovide
healthandwellness
education
Healthandsex
educationacrossthe
ages
Constructivespace
foryouth

Mindfullytransform
intoinclusive
community
Decreasestigma
engageatrisk
populations
Violencefree
communities

Educationvalued

Endingviolence
againstwomen

Promotereading
freemultiple
libraries
Educationongood
healthhabits

Supportivenetwork
forLGBTpopulation

Schoolattendance

Compassionand
understandingforall

Deliberatelyplanfor
public
transportation
Accessto
transportation

Continuouslycreate
affordablehousing
options
Affordablehousing

Public
transportationnon
emergencymedical
Improved
transportation
betweencounties
Publictransportation

Affordable
integratedhousing
Safeandaffordable
housing

Purposefully
prepareforaging
population
Eldercareand
healthyliving
options
Preparednessfor
agingboomer
population


NORTHERNMICHIGANCOMMUNITYHEALTHANDIMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONONSEPTEMBER28,2015INMONTMORENCYCOUNTY

What can we do here in Montmorency County to move closer to our vision of a healthy community?
Consistently
Strategically
educatethe
promote
community
economics

Healtheducation Healthysalaried
forchronicissues employees:

betterjobs,
insurance
Substanceabuse More
educationinthe
competitivepay
schools
jobs

Education
Affordable
training
housing

Healthyliving
accessforadults

Kidseatingand
growingown
salads

School
involvement:
FridayFolders
withtips
Newspaper/radio
adshealthy
reminders

Educateentire
community,kids
included

More
information
educationevents

Diabetes
education

Strategically
increaseto
physical
activities
Localaccessto
exercise

Improved
walking,hiking
bikingpaths
Walkable
community

Physicalactivity
forseniors

Thoroughly
involve
community
Collaboration

Reachoutto
businesseswith
specificwaysto
provideheld
Incentive
programto
reacheveryone
inthe
community
Community
gardens

Noincomeor
insurance
restrictionson
services
High
accountability
forprescription
rates

Youthactivities
tostayhealthy

Strategically
provide
preventive
education
Prenatalin
community

Boldlyincrease
awarenesson
substance
abuse
Rehabaccesson
Medicare

Freepreventive
medicalservices
forallyouth

Narconkits

Prediabetes
education

Carefullyplan
transportation
options
Accesstonon
busbased
transportation
Transportation
focusgroup

Intentionally
recruithealth
care
professionals
Recruitmentof
healthcare
professionals
Mentalhealth
supportand
followup

Expertly
develop
infrastructure
technology
Betterinternet
structure:cell
andinternet

Intentionally
monitorairfor
pollutants
Cleanair

Zealously
increase
awarenessof
abuse
Declineinchild,
spouseand
elderabuse


NORTHERNMICHIGANCOMMUNITYHEALTHANDIMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONONSEPTEMBER16,2015INOTSEGOCOUNTY

What can we do here in Otsego County to move closer to our vision of a healthy community?

Strategically
Promoteself
sufficiency

Aggressively
promoteschool
health
programs
Promo/accessto Includemore
allcommunity
subuse
resources
programsto
youthinschools
Mentoring/
Opportunities
supportsystems formentor
forindividuals
programs
andfamilies
Connect
TutoringforK
servicesto
12community
thoseinneed
involvement
withschoolsand
mentoring
Createpositive
Healthier
interactions
lifestylepromo
withlaw
inschools
enforcement
Responsible
Afterschool
citizenry
activitiesfor
children

Engaging
communityin
physicalactivity

Supportfor
homeless

Betterinsurance
outreachand
understanding

Promotelocal
farmersmarket
andencourage
EBTaccess
Morecomm
activitiesthat
promote
healthier
lifestyle
Freehandicap
accesstoall
beaches(Moby
Mats)
Recycleoffood
andother
products

Affordable
housing

Navigatingthe
healthcare
system

Lifeskills
development

Accessto
healthyrecipes

Public
awarenessof
homeless

Opportunities
forspiritual
growth
Supportversus
enabling

Encourage
community
volunteering
Accessto
budgeting
programs

Freerecreation
activitiesforall
children
Make
immunization
mandatory
Bringlocalfoods
intoschools

Consistently
promote
healthylifestyle

Economically
createhousing

Homeless
shelter

Transitional
housing
Community
involvement
withaffordable
housing

Clearlyinterpret
healthcare

Regularly
access
behavioral
health
Increasemental
healthaccess

Respectfully
supportyoung
families

Onevoice:
public,private,
charitable

Educational
opportunities
forpregnant
mothers
Update
guidelinesfor
daycare
assistance
Lifeskills:
groceryshop,
checking
account,rent
apartment,etc
Affordablegood
daycarewith
accesstolocal
resources

Increase
behavioral
healthproviders
andspecialists
Helpwith
Increase
prescriptionand behavioral
healthcosts
healthspecialist
(overinsurance) coverage

SupportUnited
Way

Encourageand
bringmore
doctorstothe
community
Encouragelocal
doctorstomake
housecallsto
shutins

Unifyinghuman
service
programs

Accessto
domestic
violence
counseling
Coordinate
betweensub
useprovider
andlegal
system

Advocacyand
awarenessof
benefits

Seniorhome
careadvocacy

Offerfree
healthylifestyle
classes

Offerhealthy

lifestylesin
schoolstoyouth

Intentionally
advocate
community

Continually
provide
transportation

Strategically
attractecon
growth

Affordable,
reliable
transportation

Opportunities
forfinancial
growth

Accessto
transportation,
awarenessof
options
24houraccess
tocommunity
transportation

Goodjobswith
livingwage

Regional
transportation

Financingadult
gapprograms,
ie,GED,drivers
license,gas
cards

NORTHERNMICHIGANCOMMUNITYHEALTHANDIMPROVEMENTINITIATIVE
COMMUNITYCONVERSATIONONSEPTEMBER22,2015INPRESQUEISLECOUNTY

What can we do here in Presque Isle to move closer to our vision of a healthy community?
Continuously
involve
community

Intentionally
initiate
collaboration

Creating
free/affordable
activitiesfor
families

Collaborationof
communityto
achievemore
withless

Need/indentify
community
champion

Schoolsmore
thaneducation
institution
community
center
Affordable
exerciseand
wellness
programs
Familyfriendly
events

Promote
community
activities

Beactiveinthe
community

Makeresources
readilyavailable

Collaboratewith
otheragencies

More
cooperation
betweenschool
systems;share
resources

Continually
providesupport
tolocalcitizens

Boldlyassure
accesstohealth
care

Enthusiastically
market
opportunities

Informal
support
peopleto
people

Physician
recruitment

Jobfairsand
healthfairs

Supportfor
family
caregivers
training,respite
andsupport
Affordable
assistedliving

Urgentcare

Liftingstigmafor
utilizing
resources(re
marketing)

Economic
Development
Committee,
partnershipsfor
business
Morecitizens
involvedin
decisionmaking
groups

Betteraccess to
mentalhealth
servicesin
schools

Healthcare
facilitiesmeet
andgreet

Supportfrom
localofficials
andlegislators

Educational
navigators
(volunteers)for
community
resources
Affordable
housingforlow
income

Officiallyseek
politicalvoice

Strategically
offertraining

Strategically
increaseaccess
tolocalfood

Childhood
educational
programsand
sessions

Utilizelocal
produce/farmers
forlocaleateries

Trauma
informed
training

Moretechnical
helpforlocal
farmersto
acceptBridge
Cards

Youthmental
healthfirstaid
training

Thoroughly
offerhealthand
wellness
optionsat
schools
TipoftheWeek
inFridayFolders

Healthyeating
programsin
schools

Considerably
enhance
transportation
options
Better
availabilityof
public
transportation
Affordable
transportation
outsidecity
limits

Enthusiastically
createhealthy
activities

Afterschool
activitiesfor
youngpeople
notinvolvedin
sports
Activitiesthat
involveparents
andmulti
generations

ATTACHMENT B
WHAT MATTERS TO YOU? COMMUNITY SURVEY REPORT

Q1 Please check the THREE most important factors needed for a healthy community.
Answered: 1,217

Skipped: 3

Access to
affordable healty
foods

Access to health
care

Affordable housing

Clean environment

Community
involvement

Good jobs and


healthy economy

Good schools/high
value on education

Healthy lifestyles

Low levels of child


abuse

Opportunities
for social/emotional
support

Parks and
recreation

Safe
neighborhoods

Strong family life

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Answer Choices

Access to affordable healthy foods

Access to health care, including primary care, specialty care, behavioral health services and dental care

Affordable housing

Clean environment

Community involvement

Goodjobsandhealthyeconomy

Goodschools/highvalueoneducation

Healthylifestyles

Lowlevelsofchildabuse

Opportunitiesforsocialand/oremotionalsupport

Parksandrecreation/accesstophysicalactivity

Safeneighborhoods

Strongfamilylife
TotalRespondents:1,217

Responses
33.61%

409

68.28%

831

27.03%

329

10.93%

133

5.01%

61

49.79%

606

28.18%

343

17.83%

217

6.98%

85

8.55%

104

10.27%

125

14.71%

179

21.04%

256

Q2 Please check the THREE most important community health problems in your county.
Answered: 1,215

Skipped: 5

Aging
problems

Chronic
diseases

Chronic pain

Homelessness

Infectious disease

Injury/trauma

Lack of access to
affordable heatlhy
food

Lack of access to
primary care

Lack of
affordable housing

Lack of physical
activity

Mental health issues

Overweight and obesity

Rape/sexual assault

Sexually
transmitted diseases

Substance
abuse

Suicide

Teenage pregnancy

Tobacco and ecigarette use

Unsafe home
environment

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Answer Choices

Responses

Aging problems (arthritis, hearing loss/vision loss)

14.57%

177

Chronic diseases (heart disease, cancer, diabetes, COPD, stroke)

33.09%

402

Chronic pain

4.77%

58

Homelessness

9.05%

110

Infectious disease

1.07%

13

Injury/trauma

1.56%

19

Lack of access to affordable, healthy food

15.97%

194

Lack of access to primary care, specialty care, behavioral health services or dental care

23.37%

284

Lack of affordable housing

24.44%

297

Lack of physical activity

15.06%

183

Mental health issues

26.42%

321

Overweight and obesity

41.07%

499

Rape/sexual assault

1.32%

16

Sexually transmitted diseases

1.15%

14

Substance abuse (alcohol, illegal drugs, prescription drugs)

48.15%

585

Suicide

2.72%

33

Teenage pregnancy

7.08%

86

Tobacco and e-cigarette use

13.17%

160

Unsafe home environment (child abuse and neglect and domestic violence)

11.85%

144

Total Respondents: 1,215


Q3 Please check all the problems adults, older adults, and children in your family are having in getting health care services.
Answered: 1,002

Skipped: 218

Cannot afford visits to doctor


or hospital

Cannot find doctor to take


me as a patient

Difficult to set apointments.

Do not know where to go

ER waiting time

Finding a behavioral
health provider

Finding a dentist

Finding a doctor

Getting pregnancy
care

Getting specialist
care

Health insurance
coverage is limited

Health insurance
does not cover
bevavioral health

Health insurance
does not cover
dental

Health insurance does


not cover medications

Health insurance has


high deductibles

Lack of health insurance

Physician dropped me as
a patient for missed
appointments

Too busy to get to doctor

Transportation issues

0%

10%

20%

30%

40%

Adults

Older adults

Children

50%

60%

70%

80%

90%

100%

Adults
Cannot afford visits to doctor,clinic, and/or hospital

Cannot find doctor to take me as a patient

Difficult to set appointments

Do not know where to go for health care

ER waiting time

Finding a behavioral health provider

Finding a dentist

Finding a doctor

Getting pregnancy care

Getting specialist care

Health insurance coverage is limited

Health insurance does not cover behavioral health services

Health insurance does not cover dental services

Health insurance does not cover medications

Health insurance has high deductibles and/or copays

Lack of health insurance

Physician dropped me as a patient for missing appointments

Too busy to get to doctor

Transportation issues

Older adults

Children

Total Respondents

81.84%

38.29%

26.04%

374

175

119

73.15%

44.36%

32.68%

188

114

84

83.14%

32.57%

37.71%

291

114

132

71.76%

47.65%

27.65%

122

81

47

86.74%

56.27%

60.93%

242

157

170

79.34%

42.07%

53.87%

215

114

146

73.08%

39.10%

37.18%

114

61

58

80.60%

42.29%

36.82%

162

85

74

89.04%

16.44%

15.07%

65

12

11

80.81%

46.86%

43.17%

219

127

117

85.12%

43.72%

38.14%

366

188

164

86.89%

53.88%

52.91%

179

111

109

81.82%

45.78%

36.36%

252

141

112

77.73%

61.33%

34.77%

199

157

89

91.31%

42.02%

36.17%

515

237

204

81.60%

39.20%

33.60%

204

98

84

83.75%

41.25%

27.50%

67

33

22

91.74%

23.91%

22.17%

211

55

51

63.79%

75.86%

39.08%

111

132

68

457

257

350

170

279

271

156

201

73

271

430

206

308

256

564

250

80

230

174


Q4 Have you or any member of your immediate family ever been told by a doctor or other health professional that you have
any of the following? Check all that apply.
Answered: 1,064

Skipped: 156

Alcoholism or
other addiction

Arthritis

Asthma

Cancer

Chronic pain

Dental health
problems

Diabetes/predia
betes

Hearing
problems

Heart
disease/hear...

High blood
pressure

High
cholesterol

Kidney disease

Lung
disease/COPD

Overweight/Obes e

Stroke

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

You

Member of your immediate family

You
Alcoholism or other addiction

Member of your immediate family

Total Respondents

9.47%

94.21%

190

Arthritis

56.52%

63.56%

483

Asthma

47.02%

63.10%

336

Cancer

20.83%

83.04%

336

Chronic pain

44.65%

71.56%

327

Dental health problems

45.96%

77.02%

322

Diabetes/prediabetes

28.80%

79.58%

382

Hearing problems

22.67%

82.67%

300

Heart disease/heart attack

11.88%

90.43%

303

High blood pressure

42.37%

76.73%

649

High cholesterol

44.26%

71.56%

531

Kidney disease

11.27%

88.73%

71

Lung disease/COPD

17.36%

88.19%

144

Overweight/Obese

69.75%

65.30%

562

Stroke

12.32%

88.41%

138


Q5 How long has it been since your most recent visit /care experience?
Answered: 945

Skipped: 275

Less than 1
month

At least 1 month
but less than 3
months

At least 3
months but less
than 6 months

At least 6
months but less
than 12 months

12 months or
more

0%
Answer Choices

30%

40%

50%

60%

70%

80%

90%

100%

Responses
27.72%

262

At least 1 month but less than 3 months

25.71%

243

At least 3 months but less than 6 months

15.56%

147

At least 6 months but less than 12 months

21.06%

199

12 months or more

9.95%

94

Total

20%

Less than 1 month

10%

945


Q6 Where was your most recent visit/care experience?
Answered: 903

Skipped: 317

General/Family
Physician

Specialist

Health
Department

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Answer Choices

Responses

General/Family Physician

78.07%

705

Specialist

23.81%

215

Health Department

1.11%

10

Total Respondents: 903


Q7 How many visits have you had with this provider?
Answered: 941

Skipped: 279

This was the


first visit

2-4 visits

5 or more
visits

0%
Answer Choices

20%

30%

40%

50%

60%

70%

80%

90%

100%

Responses

This was the first visit

12.54%

118

2-4 visits

31.35%

295

5 or more visits

56.11%

528

Total

10%

941


Q8 Do you have a primary care/family physician?
Answered: 945

Skipped: 275

Yes

No

Uncertain

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Answer Choices

Yes

91.75%

867

No

6.67%

63

Uncertain

1.59%

15

Total

Responses

945


Q9 Following is a series of characteristics which may describe your health care visit. Please indicate how important the characteristic
is to you.
Answered: 944

Skipped: 276

Health Care
Provider expresses
understanding of my values

Health Care
Provider shows respect for
my opinions

Health Care
Provider helps me
understand options

Health Care
Provider involves me in
decisions

Health Care
Provider spends enough
time with me

0.2

0.4

0.6

0.8

1.2

1.4

1.6

1.8

Very
important

Somewhat
important

Health Care Provider/Physician expresses

77.81%

18.68%

understanding of my personal values when

733

176

86.53%
816

Neither
Important nor
Unimportant

Somewhat
Unimportant

Very
Unimportant

2.65%

0.21%

0.64%

25

11.66%

1.17%

0.32%

0.32%

110

11

92.77%

6.27%

0.43%

0.21%

0.32%

873

59

91.19%

7.64%

0.64%

0.21%

0.32%

859

72

91.63%

7.52%

0.21%

0.21%

0.42%

865

71

Total

Weighted
Average

942

1.27

943

1.16

941

1.09

942

1.11

944

1.10

considering my care decisions


Health Care Provider/Physician shows respect for my
opinions
Health Care Provider/Physician helps me to
understand options available for treatment
Health Care Provider/Physician involves me in
decision-making about my care
Health Care Provider/Physician spends enough time
with me to discuss options and questions


Q10 How would you rate your most recent visit/care experience with regard to each characteristic?
Answered: 939

Skipped: 281

Health Care
Provider expresses
understanding of my values

Health Care
Provider shows respect for
my opinions

Health Care
Provider helps me
understand option

Health Care
Provider involves me in
decision-making

Health Care
Provider spends enough
time with me

0.2

0.4

0.6

0.8

1.2

1.4

1.6

1.8

Excellent

Health Care Provider/Physician expresses understanding of my personal


values when considering my care decisions
Health Care Provider/Physician shows respect for my opinions

Health Care Provider/Physician helps me to understand options available for


treatment
Health Care Provider/Physician involves me in decision-making about my
care
Health Care Provider/Physician spends enough time with me to discuss
options and questions

Above
Average

Average

Below
Average

Poor

60.66%

24.41%

12.69%

1.60%

0.64%

569

229

119

15

63.79%

23.22%

9.69%

2.56%

0.75%

599

218

91

24

62.47%

24.73%

10.13%

1.92%

0.75%

586

232

95

18

64.74%

22.76%

9.83%

1.92%

0.75%

606

213

92

18

63.82%

20.38%

11.95%

2.24%

1.60%

598

191

112

21

15

Total

Weighted
Average

938

1.57

939

1.53

938

1.54

936

1.51

937

1.57


Q11 Please consider your most recent health care visit/experience. Then, for each of the following statements, rate your level of
agreement with how each statement reflects that most recent experience with the Health Care Provider/Physician.
Answered: 936

Skipped: 284

Health Care
Provider demonstrated
knowledge

Health Care
Provider expressed
understanding

Health Care
Provider asked questions
about my preferences

Health Care
Provider listened carefully

Health Care
Provider explained things so I
could understand

0.2

0.4

0.6

0.8

1.2

1.4

1.6

1.8

Health Care Provider/Physician demonstrated


knowledge of my medical history
Health Care Provider/Physician expressed
understanding of my personal situation when

Strongly
Agree

Somewhat
Agree

63.14%

25.53%

591

239

65.92%
617

Neither
Agree nor
Disagree

Somewhat
Disagree

Strongly
Disagree

N/A

6.84%

2.56%

1.50%

0.43%

64

24

14

22.22%

7.91%

2.14%

1.18%

0.64%

208

74

20

11

65.67%

21.28%

7.70%

3.64%

1.50%

0.21%

614

199

72

34

14

69.55%

20.62%

6.30%

1.60%

1.71%

0.21%

651

193

59

15

16

76.55%

18.31%

3.64%

1.18%

0.32%

0.00%

715

171

34

11

Total

Weighted
Average

936

1.53

936

1.49

935

1.54

936

1.45

934

1.30

considering my care decisions


Health Care Provider/Physician asked questions of me
regarding my preferences
Health Care Provider/Physician listened to me carefully

Health Care Provider/Physician explained things in a


way that was easy to understand


Q12 Again, please consider your most recent health care visit/experience. Then, for each of the following statements, rate your level
of agreement with how each statement reflects that most recent experience with the Staff/Care Team.
Answered: 936

Skipped: 284

Staff treated me with


courtesy and respect

Staff explained things


in a way easy to
understand

Staff kept me informed


of delays

Staff followed up with


me in a timely manner

Staff are accessible


during lunch hour

The care team


demonstrated shared
information

10

Somewhat
Disagree

Strongly
Disagree

N/A

Strongly
Agree

Somewhat
Agree

71.90%

19.87%

4.38%

2.46%

1.18%

0.21%

673

186

41

23

11

69.12%

20.09%

6.41%

1.28%

0.96%

2.14%

647

188

60

12

20

45.55%

16.61%

14.04%

6.22%

3.75%

13.83%

425

155

131

58

35

129

Staff followed up with me in a timely manner when I

46.36%

18.95%

9.21%

6.75%

3.53%

15.20%

contacted the provider's office with questions and/or

433

177

86

63

33

142

27.07%

15.04%

20.62%

6.55%

10.63%

20.09%

252

140

192

61

99

187

38.84%

20.49%

23.61%

3.97%

2.79%

10.30%

362

191

220

37

26

96

Staff at the provider's office treated me with courtesy


and respect
Staff explained things in a way that was easy to
understand
Staff kept me informed of any delays to my scheduled
appointment.

Neither
Agree nor
Disagree

Total

Weighted
Average

936

1.41

936

1.41

933

1.91

934

1.85

931

2.48

932

2.01

concerns
Staff are accessible during the standard lunch hour
(12pm-1pm)
The care team (Physician, Nurse, Physician's
Assistant) demonstrated that my health information
was shared among members of the team


Q13 Please indicate how much you feel each of the following is a barrier to getting the health care that you need, or makes it more
difficult.
Answered: 1,165

Skipped: 55

Availability of information
health care resources

Availability of information
cost of health care

Coordination of resources

Access to affordable
health care

Access to holistic options

Availability of
transportation

Availability of child care

Ability to contact (no


phone)

Ability to take time off


work fo appointments

10

Major Barrier
Availability of information on area health care resources

Availability of information on cost of health care services

Coordination of resources among services and providers

Access to affordable health care

Access to holistic treatment options

Availability of transportation

Availability of child care

Ability to contact (no telephone)

Ability to take time off work for appointment/care

Minor Barrier

Not a Barrier

NA

Total

8.65%

30.51%

53.97%

6.87%

97

342

605

77

25.49%

38.10%

30.73%

5.68%

287

429

346

64

17.08%

37.21%

38.55%

7.16%

191

416

431

80

26.95%

30.23%

37.23%

5.59%

304

341

420

63

19.64%

23.14%

34.35%

22.87%

219

258

383

255

8.36%

9.98%

62.86%

18.79%

93

111

699

209

9.07%

10.23%

40.31%

40.39%

101

114

449

450

2.71%

7.85%

61.73%

27.71%

30

87

684

18.80%

31.60%

39.36%

213

358

446

307

Weighted Average

1,121

2.59

1,126

2.17

1,118

2.36

1,128

2.21

1,115

2.60

1,112

2.92

1,114

3.12

1,108

3.14

1,133

2.41

10.24%
116


Q14 Where do you get health information?
Answered: 1,208

Skipped: 12

Doctor or
health clinic

Family or
friends

Health
Department

Internet

Newspapers or
magazines

Radio

Television

0%

Yes

10%

20%

Sometimes

30%

No

40%

50%

60%

70%

80%

90%

100%

Yes
Doctor or health clinic

Family or friends

Health Department

Internet

Newspapers or magazines

Radio

Television

Sometimes

No

Total

79.15%

19.77%

1.09%

945

236

13

29.14%

51.73%

19.13%

329

584

216

20.64%

28.60%

50.76%

231

320

568

45.37%

45.71%

8.92%

524

528

103

14.68%

42.11%

43.21%

161

462

474

8.99%

28.07%

62.94%

98

306

686

11.11%

36.43%

52.46%

122

400

576

1,194

1,129

1,119

1,155

1,097

1,090

1,098

Q15 Please tell us about yourself. This anonymous personal health information helps us to plan programs and services where
they are needed. In which of the following counties do you live?
Answered: 1,220

Skipped: 0

Answer Choices

Alcona

Alpena

Antrim

Benzie

Charlevoix

Cheboygan

Crawford

Emmet

Montmorency

Newaygo

Oceana

Ogemaw

Oscoda

Otsego

PresqueIsle

Responses
0.00%
10.98%
5.41%
0.00%

0
134
66
0

17.62%

215

14.67%

179

0.00%

28.20%

344

1.80%

22

0.00%

0.00%

0.00%

0.00%

17.79%

217

3.52%

43

Q16 What is your age?


Answered: 1,199

Skipped: 21

18-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Answer Choices

Responses

18-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

6064

6569

7074

75+
Total

91

9.01%

108

9.84%

118

9.42%

113

9.76%

117

10.26%

123

15.18%

182

14.76%

177

10.26%

123

2.67%

32

0.83%

10

0.42%

1,199

7.59%

Q17 What is your highest level of education?


Answered: 1,216

Skipped: 4

8th grade or less

Some high school

High school
graduate/vocational

Some college

College graduate

Post
college/secondary

Refused
(VOLUNTEERED)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Answer Choices

8th grade or less

0.16%

Some high school

2.47%

30

High school graduate/vocational-technical/GED

13.90%

169

Some college

24.34%

296

College graduate

42.11%

512

Post college/secondary school

17.02%

207

Refused (VOLUNTEERED)

0.00%

Total

Responses

0
1,216

Q18 What is your annual household income?


Answered: 1,166

Skipped: 54

Less than
$15,000

$15,000 $34,999

$35,000 $74,999

$75,000 $99,999

$100,000 or
more

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Answer Choices

Responses

Less than $15,000

8.32%

97

$15,000 - $34,999

21.27%

248

$35,000 - $74,999

37.31%

435

$75,000 - $99,999

16.64%

194

$100,000 or more

16.47%

192

Total

1,166

Q19 Do you have health insurance?


Answered: 1,208

Skipped: 12

Yes

No

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Answer Choices

Yes

95.20%

No

4.80%

Total

Responses
1,150
58
1,208

Q20 What is your race/ethnicity?


Answered: 1,208

Skipped: 12

White

Black or
African America

American
Indian or Alaska
Native

Asian

Native
Hawaiian or
Pacific Islander

Hispanic or
Latino

Two or more races

0%

10%

20%

30%

40%

50%

60%

70%

Answer Choices

90%

100%

Responses

White

97.35%

Black or African American

0.17%

American Indian or Alaska Native

1.74%

21

Asian

0.17%

Native Hawaiian or Pacific Islander

0.08%

Hispanic or Latino

0.66%

Two or more races

1.49%

18

Total Respondents: 1,208

80%

1,176

Q21 Gender
Answered: 1,213

Skipped: 7

Male

Female

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Answer Choices

Male

12.94%

157

Female

87.06%

1,056

Total

Responses

1,213

ATTACHMENT C
HEALTH CARE PROVIDER SURVEY REPORT
Q1 Check the three most important factors needed for a "healthy community."
Answered: 81

Skipped: 0

Access to
affordable healthy
foods

Access to health
care

Affordable
housing

Clean
environment

Community
involvement

Good jobs and


healthy economy

Good
schools/high
value on
education
Healthy lifestyles

Low levels of
child abuse

Opportunities for
social/emotional
support

Parks and
recreation

Safe
neighborhoods

Strong family life

0%

10%

20%

30%

40%

50%

Answer Choices

Access to affordable healthy foods

Access to health care, including primary care, specialty care, behavioral health services and dental care

Affordable housing

Clean environment

Community involvement

Goodjobsandhealthyeconomy

Goodschools/highvalueoneducation

Healthylifestyles

Lowlevelsofchildabuse

Opportunitiesforsocialand/oremotionalsupport

Parksandrecreation/accesstophysicalactivity

Safeneighborhoods

Strongfamilylife
TotalRespondents:81

60%

70%

80%

90%

100%
Responses
20.99%

17

67.90%

55

12.35%

10

11.11%

7.41%

48.15%

39

40.74%

33

39.51%

32

2.47%

11.11%

8.64%

9.88%

17.28%

14

Q2 Check the three most important community health problems in the county you live in.
Answered: 81

Skipped: 0

Aging problems

Chronic disease

Chronic pain

Homelessness

Infectious
Disease

Injury/trauma

Lack of access to
affordable healthy
food

Lack of access to
primary care

Lack of
affordable housing

Lack of physical activity

Mental health issues

Overweight and obesity

Rape/sexual assault

Sexually
transmitted disease

Substance abuse

Suicide

Teenage
pregnancy

Tobacco use

Unsafe home
environments

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Answer Choices

Responses

Aging problems

13.58%

11

Chronic disease

24.69%

20

Chronic pain

8.64%

Homelessness

0.00%

Infectious Disease

0.00%

Injury/trauma

2.47%

Lack of access to affordable healthy food

7.41%

Lack of access to primary care, specialty care, behavioral health services or dental care

40.74%

33

Lack of affordable housing

8.64%

Lack of physical activity

18.52%

15

Mental health issues

45.68%

37

Overweight and obesity

56.79%

46

Rape/sexual assault

0.00%

Sexually transmitted diseases

0.00%

Substance abuse

27.16%

22

Suicide

1.23%

Teenage pregnancy

0.00%

Tobacco use

39.51%

32

Unsafe home environments (child abuse and neglect/domestic violence)

2.47%

Total Respondents: 81

Q3 Which hospital are you primarily affiliated with?


Answered: 81

Skipped: 0

Alpena
Regional Hospital

Charlevoix
Area Hospital

Gerber
Memorial Health

Kalkaska
Memorial Health

McLaren
Northern Michigan

Mecosta County
Medical Center

Memorial
Medical Center

Mercy Health
Partners

Munson
Healthcare Cadillac

Munson
Healthcare Grayling

Munson Medical
Center

Otsego
Memorial Hospital

Paul Oliver
Memorial Hospital

St. Joseph
Health System

West Branch
Regional Medical

West Shore
Medical Center

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Alpena Regional Medical Center

0.00%

Charlevoix Area Hospital

19.75%

16

Gerber Memorial Health Services

0.00%

Kalkaska Memorial Health Center

0.00%

McLaren Northern Michigan

60.49%

49

Mecosta County Medical Center

0.00%

Memorial Medical Center of West Michigan

0.00%

Mercy Health Partners, Lakeshore Campus

0.00%

Munson Healthcare Cadillac Hospital

0.00%

Munson Healthcare Grayling Hospital

0.00%

Munson Medical Center

0.00%

Otsego Memorial Hospital

19.75%

16

Paul Oliver Memorial Hospital

0.00%

St. Joseph Health System

0.00%

West Branch Regional Medical Center

0.00%

West Shore Medical Center

0.00%

Total

81

Q4 Where do you live?


Answered: 80

Alcona County

Alpena County

Antrim County

Benzie County

Charlevoix
County

Cheboygan
County

Crawford County

Emmet County

Grand Traverse
County

Iosco County

Kalkaska County

Lake County

Leelanau County

Manistee County

Mason County

Mecosta County

Missaukee
County

Montmorency
County

Newaygo County

Skipped: 0

Oceana County

Ogemaw County

Oscoda County

Otsego County

Presque Isle
County

Roscommon
County

Wexford County

0%

Answer Choices

Alcona County

Alpena County

Antrim County

Benzie County

Charlevoix County

Cheboygan County

Crawford County

Emmet County

Grand Traverse County

Iosco County

Kalkaska County

Lake County

30%

40%

50%

60%

70%

80%

90%

100%

Responses
0.00%

1.25%

2.50%

0.00%

26.25%

21

6.25%

1.25%

52.50%

42

0.00%

0.00%

0.00%

0.00%

0.00%

0
0

Mason County

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

Manistee County

Mecosta County

Missaukee County

Montmorency County

Newaygo County

OceanaCounty

OgemawCounty

OscodaCounty

OtsegoCounty

PresqueIsleCounty

RoscommonCounty

WexfordCounty

20%

0.00%

Leelanau County

Total

10%

10.00%

0.00%

0.00%

0.00%

80

Q5 Do you practice primary or specialty care?


Answered: 79

Skipped: 2

Primary Care

Specialty Care

0%

Answer Choices

20%

30%

40%

50%

60%

70%

80%

90%

100%

Responses

Primary Care

39.24%

31

Specialty Care

60.76%

48

Total

10%

79

ATTACHMENT D
ISSUE BRIEFS

HEALTHDISPARITIESANDDETERMINENTSOFHEALTH
Americabenefitswheneveryonehastheopportunitytolivealong,healthyandproductivelife,yethealthdisparities
persist.Ahealthdisparityisadifferenceinhealthoutcomesacrosssubgroupsofthepopulation.Healthdisparitiesare
oftentodeterminantsofhealthsocial,economic,orenvironmentaldisadvantages,suchaslessaccesstogoodjobs,
unsafeneighborhoods,orlackofaffordabletransportationoptions.Healthdisparitiesadverselyaffectgroupsofpeople
whohavesystematicallyexperiencedgreaterobstaclestohealthonthebasisoftheirracialorethnicgroup;religion;
socioeconomicstatus;gender;age,mentalhealth;cognitive,sensory,orphysicaldisability;sexualorientationorgender
identity;geographiclocation,orothercharacteristicshistoricallylinkedtodiscriminationorexclusion.Manyhealth
concerns,suchasheartdisease,asthma,obesity,diabetes,HIV/AIDS,viralhepatitisBandC,infantmortality,and
violence,disproportionatelyaffectcertainpopulation.Reducingdisparitiesinhealthwillgiveeveryoneachancetolivea
healthylifeandimprovethequalityoflifeforallAmericans.

KeyFacts:
Avarietyofhealthrelatedhazardsare
RuralAmericansareapopulationgroupthatexperiencessignificant
disproportionatelyfoundinlowincome
healthdisparities,suchashigherincidenceofdiseaseanddisability,
housing,includingmold,allergens,poor
increasedmortalityratesandlowerlifeexpectancy,andhigherrates
indoorairquality,structuraldeficiencies
ofpainandsuffering.Socialdeterminantsofhealthinruralareas
andleadcontamination
includegeographicisolation,lowersocioeconomicstatus,higher
Workrelatedfactors,including
ratesofhealthriskbehaviors,andlimitedjobopportunities.Rural
occupationalexposurestochemicals,
residentsaremorelikelytohaveanumberofchronicconditionsand
physicaloverexertion,excessiveheator
arelesslikelytoreceiverecommendedpreventiveservices,inpart
cold,noiseandstressorjobstraincan
duetolackofaccesstophysiciansandhealthcaredeliverysites
createorworsenavarietyofhealth
and/oradequatetransportationoptions.
problems,includingcancer,COPD,

asthma,andheartdisease.
Apersonsdecisionsareinfluencedby
Education,employment,andhealthareinextricablylinked.Without
howchoicesarepresented.Forexample,
agoodeducation,prospectsforastableandrewardingjobwith
presentingfruitinamoreattractiveway
goodearningsdecrease.Educationisassociatedwithlivinglonger,
toschoolchildrencanmorethandouble
experiencingbetterhealth,practicinghealthpromotingbehaviors
theamountoffruittheypurchase.
suchasexercisingregularly,refrainingfromsmoking,andobtaining
Onaverage,adultswithseriousmental
timelyhealthcheckupsandscreenings
illnessdie25earlierthantheirpeers,
largelyduetopreventablehealth
conditions
Morethan80millionintheUSdonot
Theburdenofchronicdiseaseisdisproportionatelydistributed
haveaccesstofluoridatedwater.
acrossthepopulation.Therearesignificantdisparitiesbasedon
Fluoridatedwaterreducestoothdecayby
gender,age,race/ethnicity,geographicareaandsocioeconomic
25%inchildrenandadults.Forevery$1
spentonfluoridationsavesmorethan$40 status.Diseasedoesnotoccurinisolation,andchronicdiseaseinno
exception.Chronicdiseaseissignificantlyinfluencedbythephysical,
indentaltreatmentcosts
socialandpoliticalenvironment,includingmaternalandchildhealth,
Lesbian,gay,bisexualandtransgender
accesstoeducationalopportunities,availabilityofhealthyfoods,
individualsmaybeatincreasedriskfor
physicaleducationandextracurricularactivitiesinschools,accessto
healthriskbehaviors.However,onlya
healthyfoods,qualityofworkingconditionsandworksitehealth,
limitednumberofreportsinclude
availableofcommunitysupportandresourcesandaccessto
informationonsexualorientation
affordable,qualityhealthcare.

Rurality

Education and Income

Home, School and the Workplace

Narrativeadaptedfrom Healthy People 2020 and the National Prevention Strategy

HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties

TipoftheMittData
Rurality: TheUSCensusBureaudesignatesall8tipofthemittcountiesasrural.Overall,thereare23.6personsper
squaremilelivingintheregion;statewide,thereare174.8personspersquaremile.
Ethnicity/Race: Population(183,997)ispredominantlywhite;largestminoritygroupsareNativeAmericansand
Hispanic/Latino

Age: 36,314residentsofthe8countyregionareage017(20%)and147,683are18+.With20%ofthepopulationage
65+inNorthwestcountiesand24%inNortheastcounties,ageskewsolder,whencomparedtotheState(15%)andthe
segmentisgrowingfaster
Education: Graduationratesinthe8countiesexceedState(79%)exceptinAlpena(73%)andrangeupto92%inPresque
IsleCounty.TheproportionofthepopulationwhohasearnedatleastaBachelordegreerangesfrom10%in
MontmorencyCountyto32%inEmmetCounty.Montmorency(10%),Alpena(16%),Cheboygan(16%),PresqueIsle
(16%),Otsego(20%)andAntrim(24%)arebelowState(26%).
Housing: Theproportionofrenterswhospend30%ormoreofhouseholdincomeonrentrangesfrom40%inPresqueIsle
Countyto69%inMontmorencyCounty.RatesforAntrim(58%)andMontmorency(69%)areaboveStaterate(55%).
Income: Medianhouseholdincomerangesfrom$42,632inMontmorencyCountyto$61,664inEmmetCounty,hoveringat
orexceedingState($48,411)inallbutMontmorency($42,632)andCheboygan($46,010)andPresqueIsle($46,601)
Poverty: TheproportionoffamilieswholivebelowtheFederalPovertyLevelrangesfrom7%inEmmetCountyto13%in
AlpenaandCheboygancounties,whichslightlyexceedStaterate(12%).

CommunityConversations
117communitymembersandrepresentativesfromlocalhealthdepartments,hospitalsandotherhealthcareproviders,
socialserviceagencies,schools,business,andgovernmentparticipatedinaCommunityConversation.Theiranswerstothe
questionWhatcanwedohereinthiscountytomoveclosertoourvisionofahealthycommunity?,includedmanyissues
relatedtodeterminantsofhealth,suchasattractingeconomicgrowthandincreasingoptionsforaffordablehousing,
transportation,andchildcare,increasinglawenforcementinhighcrimeareas.
Alpena
Antrim
Charlevoix
Cheboygan
Emmet
Montmorency
Otsego
PresqueIsle
X
X
X
X
X
X
X
X

WhatMatterstoYou?SurveyN=1,220
Themostimportantfactorsneededforahealthycommunityaccordingtocommunitysurveyrespondentsare,inrankorder:
1)accesstohealthcare;2)goodjobsandhealthyeconomy;3)accesstoaffordablehealthyfoods;4)goodschools/highvalue
oneducation;and5)affordablehousing.Themostimportantcommunityhealthproblemsintheircountywere:1)substance
use;2)overweightandobesity;3)chronicdisease;4)mentalhealthissues;5)lackofaffordablehousing.Manysurvey
respondentsnotedtheycannotaffordhealthcareservices(81%)andtransportationisabarriertogettingtoappointments
(63%).

HealthCareProviderSurveyN=126
Physicians,nursepractitionersandphysicianassistantsrankedaccesstohealthcare,goodjobs/healthyeconomy,healthy
lifestyles,goodschools/highvalueoneducation,andaccesstoaffordablehealthyfoodsasthetopfactorsneededfora
healthycommunity.Thetopcommunityhealthproblemsintheircountieswere:obesityandoverweight,mentalhealth
issues,lackofaccesstocare,andtobaccouse.

Northern
Health
Plan

ISSUEBRIEF:ACCESSTOHEALTHCARE
Accesstohealthservicesisimportantateveryage.Havingbothaprimarycareproviderandmedicalinsurancecan
preventillnessbyimprovingaccesstoarangeofrecommendedpreventiveservicesacrossthelifespan,fromchildhood
vaccinationstoscreeningtestsforcancerandchronicdiseases,suchasdiabetesandheartdisease.Havingaprimary
careproviderandmedicalinsurancealsoplaysavitalroleinfindinghealthproblemsintheirearliest,mosttreatable
stages,andmanagingapersonthroughthecourseofthedisease.Lackingaccesstohealthservicesevenforjusta
shortperiodcanleadtopoorhealthoutcomesovertime.

KeyFacts:
Almost1in4Americansdonothavea
regularprimarycareproviderorhealth
centerwheretheycanreceiveroutine
medicalservices
Lessthanhalfofolderadultsareupto
dateonacoresetofclinicalpreventive
services,includingcancerscreeningsand
immunizations
LessthanhalfofAmericanswith
hypertensionhaveadequatelycontrolled
bloodpressureandonlyonethirdwith
highcholesterolhaveitadequately
controlled.Improvingcontrolisoneofthe
mosteffectivewaystopreventheart
diseaseandstroke
Colorectalcanceristhesecondleading
causeofdeathintheU.S.Someestimates
suggestthatifscreeningimplementedat
recommendedlevels,morethan18,000
livescouldbesavedeachyear
Eachyear,asthmacoststheU.Sabout
$3.30perpersoninmedicalexpenses,
missedschool/workdaysandearlydeaths
Communityprogramsthatteachpeople
howtomanagetheirdiabetescanhelp
preventshortandlongtermhealth
conditions,enhancequalityoflife,and
containhealthcarecosts
Morethan80millionpeopleintheUSdo
nothavefluoridatedwater,whichreduces
toothdecayby25%inchildrenandadults.
Everydollarspentonfluoridationsaves
morethan$40indentaltreatmentcosts
Nationally,only44.5%(ageadjusted)of
peopleage2andolderhadadentalvisit
inthepast12months,aratethathas
remainedunchangedforthepastdecade

Health Insurance
Peoplewithoutmedicalinsurancearemorelikelytolackausual
sourceofmedicalcare,andaremorelikelytoskiproutinemedical
careduetocost,increasingtheirriskforseriousanddisablinghealth
conditions.Whenthedoaccesshealthservices,theyareoften
burdenedwithlargemedicalbillsandoutofpocketexpenses.

Regular Source of Medical Care


Accesstohealthservicesaffectsapersonshealthandwellbeing.
Regularandreliableaccesstohealthservicescanpreventdisease
anddisability,detectandtreatillnessesorotherhealthconditions,
increasequalityoflife,reducethelikelihoodofprematuredeathand
increaselifeexpectancy.Primarycareprovidersplayanimportant
roleinprotectingthehealthandsafetyofthecommunitiesthey
serve.Theycandevelopmeaningfulandsustainedrelationshipswith
patientsandprovideintegratedserviceswhilepracticinginthe
contextoffamilyandcommunity.Havingausualprimarycare
providerisassociatedwithgreaterpatienttrustintheprovider,good
patientprovidercommunicationandincreasedlikelihoodthat
patientswillreceiveappropriatecare.

Clinical/Community Preventive Services


Clinicalpreventiveservices,suchasroutinediseasescreeningand
scheduledimmunizations,arekeytoreducingdeathanddisability
andimprovingtheNationshealth.Theseservicesbothpreventand
detectillnessesanddiseasesfromflutocancerintheirearlier,
moretreatablestages,significantlyreducingtheriskofillness,
disability,earlydeath,andmedicalcarecosts.Theycanbesupported
andreinforcedbycommunitybasedprevention,policies,and
programs.Communityprogramscanalsoplayaroleinpromoting
theuseofclinicalpreventiveservicesandassessingclientsin
overcomingbarrierstotransportation,childcareandnavigating
resources.

Social Determinants of Health

Oneofthebarrierstoaccessingtohealthcareisthehighcostof
medicalinsurance,deductiblesandcopays.Alackofmedical
servicesinsomecommunities,coupledwithashortageofprimarycareproviders,alsonegativelyaffectspeoplesability
toaccesshealthservices.Livinginaruralareaitselfisadeterminanthealth.Geographicisolation,fewertransportation
optionsandlimitedresourcescompoundaccessbarriers.

Adapted from Healthy People 2020 and the National Prevention Strategy

HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties

TipoftheMittData
Health Professions Shortage Areas: ThereareHealthProfessionsShortageAreasdesignatedinAlpena,Antrim,
Charlevoix,Cheboygan,Emmet,Montmorency,OtsegoandPresqueIslecountiesforprimarycare,behavioralhealth,
and/ordentalcare
Primary Care Provider Rate: FivecountieshaveprovidertopopulationratiosconsiderablybelowStaterate(80per
100,000):PresqueIsle(15);Antrim(34);Cheboygan(62)Montmorency(63);andOtsego(67).Unsurprisingly,counties
wherehospitalsarelocated,andmedicalpracticesareconcentrated,havehigherrates:86per100,000inAlpena
County,96per100,000inCharlevoixCounty,and134per100,000inEmmetCounty.
Health Insurance: Mostrecentdata(2013)forratesofinsuredfortheoveralladultpopulationrangefrom80%in
MontmorencyCountyto84%inOtsegoCounty.However,withtheimplementationoftheAffordableCareAct,the
federalHealthInsuranceMarketplaceopenedlatein2012andwassoonfollowedbytheStatesHealthyMichiganPlan.
AsofApril2015,virtually100%ofeligibleadultsfromthe8countyregionwereenrolledinoneoftheseprograms.The
proportionofchildrencoveredbyanyinsurancerangeshoversat9495%inalleightcounties,slightlybelowStaterate
of96%.

CommunityConversations

MajorForcesofChange

117communitymembersandrepresentativesfromlocal
healthdepartments,hospitalsandotherhealthcare
providers,socialserviceagencies,schools,business,and
governmentparticipatedinaCommunityConversationto
answerthequestion,Whatcanwedohereinthiscounty
tomoveclosertoourvisionofahealthycommunity?
Improvingaccesstohealthcareincludingprimarycare,
behavioralhealth,and/ororalhealthcare,wasidentifiedas
anactioninthefollowingcounties:
ALP ANT
CHXEM
CHB MON OTS
PI

Affordable Care Act (ACA)


Implementedin2013,theACArepresentsthelargest
overhauloftheU.S.healthcaresystemsincethe
enactmentofMedicareandMedicarein1965.It
introducedmechanismslikemandates,subsidiesand
insuranceexchanges.Thelawrequiresinsurance
companiestocoverallapplicantswithinnewminimum
standardsandofferthesameratesregardlessofpre
existingconditionsorsex.
Enroll Northern Michigan
EnrollNorthernMichiganisaverysuccessfulcollaborative
X
X
X
X
X
X
X
WhatMatterstoYou?SurveyN=1,220 initiativeofhealthdepartments,hospitals,federally
qualifiedhealthcenters,communitymentalhealth
Accesstohealthcarewasthe#1factorneededfora
agenciesandothercommunitypartnersfromacrossthe
healthycommunityintheCommunitySurvey,with69%
tipofthemittregion.LedbytheHealthDepartmentof
identifyingaccesstoprimarycare,specialtycare,
NorthwestMichiganwithfundingfromtheNorthern
behavioralhealthanddentalcareasatopfactor.They
HealthPlantoenrolleligibleadultsintheACA:Healthy
rankedaccesstocare6thasaneedintheircounty,after
MichiganPlanortheHealthInsuranceMarketplace.
substanceuse,overweightandobesity,chronicdisease
Mi-Connect
mentalhealthissues,andaffordablehousing.
MiConnectisledbyAlconaHealthCenters,asystemof
federallyqualifiedhealthcenters.Theinitiativeis
HealthCareProviderSurveyN=126
designedtoincreaseintegrationofprimarycareand
Similarly,69%ofphysicians,nursepractitionersand
behavioralhealthandincreaseaccesstooralhealthcare
physicianassistantsidentifiedaccesstohealthcareasatop acrossan11countyregion.
factor,rankingit#1intheHealthCareProviderSurvey.
Regardinglocalcommunityhealthproblems,theyranked
accesstohealthcarethird,followingoverweight/obesity
andmentalhealthissues.

Northern
Health
Plan

ISSUEBRIEF:CHRONICDISEASE
Chronicdiseaseresultsinseriousillnessanddisability,decreasedqualityoflife,andhundredsofbillionsofdollarsin
economiclosseveryyear.Heartdisease,stroke,cancer,diabetes,obesityandarthritis,areamongthemostcommon
andpreventableofallhealthproblems.Sevenofthetop10causesofdeathintheUSarechronicdiseaseandtwo
heartdiseaseandcancertogetheraccountfornearly48%ofalldeaths.TheriskofAmericansdevelopinganddying
fromchronicdiseasewouldbesubstantiallyreducedifmajorimprovementsweremadeintheUSpopulationindietand
physicalactivity,controlofhighbloodpressureandcholesterol,andsmokingcessation.

KeyFacts:
AboutofadultsintheUS117million
Healthyeatingcanhelpreducepeoplesriskforheartdisease,high
peoplehave1+chronicconditions.1in4
bloodpressure,diabetes,osteoporosisandseveraltypesofcancer,
adultshave2+chronicconditions
aswellashelpmaintainahealthybodyweight.Asdescribedinthe
LeadingcausesofdeathintheUSare
Dietary Guidelines for Americans,eatinghealthymeansconsuminga
heartdisease,cancerandstroke
varietyofnutritiousfoodsandbeverages,especiallyvegetables,
Highbloodpressureaffects1in3adults
fruits,fatfreedairyproductsandwholegrains;limitingintakeof
andmorethanofAmericanswithhigh
saturatedfats,addedsugars,andsodium;keepingtransfatintakeas
bloodpressuredonothaveitunder
lowaspossibleandbalancingcaloricintakewithcaloriesburnedto
control.
managebodyweight.Safeeatingmeansensuringthatfoodisfree
Arthritisisthemostcommoncauseof
fromharmfulcontaminants,suchasbacteriaandviruses
disability.Ofthe53millionadultswitha

diagnosisofarthritis,22millionsaythey
havetroublewiththeirusualactivities
Engaginginregularphysicalactivityisoneofthemostimportant
becauseofthedisease
thingspeopleofallagescandotoimprovetheirhealth.Physical
Diabetesistheleadingcauseofkidney
activitystrengthensbonesandmuscles,reducesstressand
failure,lowerlimbamputationsother
depression,andmakesiteasiertomaintainahealthybodyweightor
thanthosecausedbyinjury,andnew
reduceweightifoverweightorobese.Evenpeoplewhodonotlose
casesofblindnessinadults.
weightgainsubstantialbenefitsfromregularphysicalactivity,
Obesityisaseriousconcern.Morethan
includinglowerratesofhighbloodpressure,diabetes,andcancer.
1/3ofadultsareobese(BMI30kg/m2).
Healthyphysicalactivityincludesaerobicactivity,muscle
Nearly1in5youthage219areobese
th
strengtheningactivitiesandactivitiestoincreasebalanceand
(BMI95 percentile)
flexibility.AsdescribedbythePhysical Activity Guidelines for
Fewerthan15%ofadultsand10%of
Americans,adultsshouldengageinatleast150minutesof
adolescentseatrecommendedamounts
moderateintensityactivityeachweek,andchildrenandteenagers
offruitsandvegetableseachday
shouldengageinatleastonehourofactivityperday.
MostAmericansconsumemorethan2x

therecommendedaveragedailysodium
level.Nearly80%ofsodiumisconsumed
frompackaged,processed,andrestaurant Theburdenofchronicdiseaseisdisproportionatelydistributed
food.
acrossthepopulation.Therearesignificantdisparitiesbasedon
Atleast40%ofadultsand80%of
gender,age,race/ethnicity,geographicareaandsocioeconomic
adolescentsdonotmeetthePhysical
status.Diseasedoesnotoccurinisolation,andchronicdiseaseinno
ActivityGuidelinesforAmericans
exception.Chronicdiseaseissignificantlyinfluencedbythephysical,
Only13%ofchildrenwalkorbiketo
socialandpoliticalenvironment,includingmaternalandchildhealth,
school,comparedto44%agenerationago accesstoeducationalopportunities,availabilityofhealthyfoods,
Theaverage8to18yearoldisexposed
physicaleducationandextracurricularactivitiesinschools,accessto
tonearly7.5hoursofpassivescreentime
healthyfoods,qualityofworkingconditionsandworksitehealth,
(TVs,smartphones,computers,video
availableofcommunitysupportandresourcesandaccessto
games,etc)everyday
affordable,qualityhealthcare.

Healthy Eating

Physical Activity

Social Determinants of Health

Narrative adapted from Healthy People 2020 and the National Prevention Strategy

HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties

TipoftheMittData
Obesity--adults: Adultobesityratesrangefrom27%inCharlevoixCountyto35%inAlpenaCountyinthe8countyregion.
OnlyCharlevoix(27%)andEmmet(28%)arebelowStaterateof32%.
Obesityteens: Teenobesityratesrangefrom10%inPresqueIsleCountyto19%inCheboyganCounty;2countiesarebelow
Staterate(13%):PresqueIsle(10%),Antrim(11%).
Lack of physical activityadults: Statewide,23%ofadultsdonotengageinanyphysicalactivityotherthantheirregularjob.
Inthe8countyregion,theproportionrangesfrom18%inEmmetCountyto26%inPresqueIsle.Montmorency(24%),Otsego
(25%)andPresqueIsle(26%)countiesexceedStaterate.
Lack of physical activityteens: Theproportionofhighschoolstudentswhodidnotengagein60minutesofphysical
activityin5ofthelast7daysrangesfrom31%inPresqueIsleCountyto53%inOtsegoCounty.Forcomparison,Staterateis
50%.

CommunityConversations

MajorForcesofChange

117communitymembersandrepresentativesfromlocal
healthdepartments,hospitalsandotherhealthcare
providers,socialserviceagencies,schools,business,and
governmentparticipatedinaCommunityConversationto
answerthequestion,Whatcanwedohereinthiscountyto
moveclosertoourvisionofahealthycommunity?,issues
relatedtoreducingchronicdiseaseand/orobesitywas
identifiedasanactioninthefollowingcounties:

ALP ANT
CHXEM
CHB MON OTS
PI

Chronic Disease Coordinating Network: TheNorthern


HealthPlanisfundingHealthDepartmentofNorthwest
(Northwest)Michigantoimplementacomprehensive
approachtochronicdiseasepreventionandtreatment
guidedbyacrosssectorcoalitionwithrepresentativesfrom
acrossthe8countytipofthemittregion
Healthy Food Service Guidelines: 6localhealth
departments,includingDistrictHealthDepartment#4and
Northwest,havereceivedfundingfromMDHHStoincrease
thenumberofworksitescomplyingwithHealthyFood
ServiceGuidelines

WhatMatterstoYou?SurveyN=1,220

HealthCareProviderSurveyN=126

32%ofcommunityresidentsidentifiedaccesstoaffordable
healthyfoodasanimportantfactorneededforahealthy
community,rankingit3rdafteraccesstohealthcareandgood
jobs/healthyeconomy.Theyidentifiedthefollowingastop
communityhealthproblemsintheircounty:substanceuse,
obesity/overweight,andchronicdiseaseRespondentsmost
oftennotedtheyhadbeendiagnosedwith
overweight/obesity(70%),arthritis(57%),asthma(48%),high
cholesterol(46%),dentalhealthproblems(45%),highblood
pressure(44%)andchronicpain(43%)

Physicians,nursepractitionersandphysicianassistants
rankedhealthylifestylesasthe3rdmostimportantfactor
forahealthycommunity,followingaccesstohealthcareand
goodjobs/healthyeconomy.Theyidentifiedobesityand
overweightasthetopcommunityhealthproblem,followed
bymentalhealthissues,lackofaccesstohealthcare,
substanceuseandtobaccouse.

Northern
Health
Plan

ISSUEBRIEF:MATERNAL,INFANTANDCHILDHEALTH
Thewellbeingofmothers,infants,andchildrendeterminesthehealthofthenextgenerationandhelpspredictfuturepublic
healthchallengesforfamilies,communities,andthemedicalcaresystem.Moreover,healthybirthoutcomesandearly
identificationandtreatmentofhealthconditionsamonginfantscanpreventdeathordisabilityandenablechildrentoreach
theirfullpotential.Despitemajoradvancesinmedicalcare,criticalthreatstomaternal,infant,andchildhealthstillexist.Amongthe
Nationsmostpressingchallengesarereducingtherateofpretermbirthsandtheinfantdeathrate.

KeyFacts:
Nearlyhalfofallpregnanciesare
Healthyreproductiveandsexualpracticescanplayacriticalroleinenabling
unintended.Associatedrisksincludelow
peopletoremainhealthyandactivelycontributetotheircommunity.
birthweight,postpartumdepression,and
Planningandhavingahealthypregnancyisvitaltothehealthofwomen,
familystress
infants,andfamiliesandisespeciallyimportantinpreventingteenpregnancy
31%ofwomenwhodeliveraninfant
andchildbearing,whichwillhelpraiseeducationalattainment,increase
sufferpregnancycomplications,ranging
employmentopportunities,andenhancefinancialstability. Accesstoquality
fromdepressiontotheneedfora
healthservicesandsupportforsafepracticescanimprovephysicaland
cesareandelivery
emotionalwellbeingandreduceteenandunintendedpregnancies,
Althoughrare,theriskofdeathduring
HIV/AIDS,viralhepatitis,andothersexuallytransmittedinfections.
pregnancyhasdeclinedlittleoverthelast

20years
Infantmortalityratesarehigheramong
Vaccinesareamongthemostcosteffectiveclinicalpreventiveservicesand
womenofcolor,adolescents,unmarried
areacorecomponentofanypreventiveservicespackage.Childhood
mothers,peoplewhosmoke,thosewith
lowereducationlevels,andthosewhodid immunizationprogramsprovideaveryhighreturnoninvestment.For
example,foreachbirthcohortvaccinatedwiththeroutineimmunization
notobtainadequateprenatalcare
schedule(thisincludesDTap,Td,Hib,Polio,MMR,HepB,andvaricella
Thepretermbirthratehasrisenmore
vaccines),societysaves33,000lives;prevents14millioncasesofdisease;
than20%inthepast20years.Preterm
reducesdirecthealthcarecostsby$9.9billionandsaves$33.4billionin
infantsaremorelikelytosuffer
indirectcosts.Despiteprogress,about300childrenintheU.S.dieeachyear
complicationsatbirth,diewithinthefirst
fromvaccinepreventablediseases.Communitieswithpocketsof
yearoflife,andhavelifelonghealth
unvaccinatedandundervaccinatedpopulationsareatincreasedriskfor
challengessuchascerebralpalsyor
outbreaksofvaccinepreventablediseases.
learningdisabilities

Onaverage,42,000deathsperyearare
preventedamongchildrenwhoreceive
recommendedvaccines
Adverseexperiencesinchildhood,includingviolenceandmaltreatment,are
Thereareapproximately19millionnew
associatedwithhealthriskbehaviorssuchassmoking,alcoholanddruguse,
casesofsexuallytransmittedinfections
andriskysexualbehavior,aswellashealthproblemssuchasobesity,
eachyearalmosthalfofthesearein
diabetes,ischemicheartdisease,sexuallytransmittedinfection,and
youngpeopleage15to24.
attemptedsuicide.
Bingedrinkingandillicitdruguseare

associatedwithintimatepartnerviolence
andriskysexualbehaviors,including
Arangeofbiological,social,environmental,andphysicalfactorshavebeen
unprotectedsexandmultiplesex
linkedtomaternal,infant,andchildhealthoutcomes.Theseincluderaceand
partners.Theseactivitiesincreasetherisk
ethnicity,age,andsocioeconomicfactors,suchasincomelevel,educational
ofunintendedpregnanciesandincrease
theriskofacquiringHIVandothersexually attainment,medicalinsurancecoverage,accesstomedicalcare,
prepregnancyhealth,andgeneralhealthstatus.Forexample,childrenreared
transmittedinfections
insafeandnurturingfamiliesandneighborhoods,freefrommaltreatment
andothersocialproblems,aremorelikelytohavebetteroutcomesasadults.

Reproductive and Sexual Health

Childhood Immunizations

Child Abuse and Neglect

Social Determinants of Health

Adapted from Healthy People 2020 and the National Prevention Strategy

HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties

RegionalStatistics
Infant mortality rate: Fiveyearinfantmortalityrates(200913)rangefrom4.8per1,000livebirthsinCharlevoixCountyto
15.2per1,000livebirthsinPresqueIsleCounty;forcomparison,Michiganinfantmortalityrateforthesameperiodwas6.0.
Early prenatal care: Thepercentageofbirthstowomenwhoreceivedprenatalcarewithinthefirstthreemonthsoftheir
pregnancyrangesfrom59.9%inCharlevoixCountyto86.3%inAlpenaCounty.OnlyAlpenaCountyexceedstheStaterateof
77.9%.
Low birthweight: Theproportionofinfantswhowerebornweighinglessthan2,500gramsrangesfrom4.2%inCharlevoix
Countyto9.6%inAntrimCounty.LowbirthweightrateswerehigherthanState(7.8%)injust2counties:AntrimandOtsego.
Maternal smoking: Maternalsmokingratesarehighacrossthetipofthemitt,exceedingStaterate(19.7%)ineverycounty.
Ratesrangefrom26.3%inEmmetCountyto49.8%inAlpenaCounty.
Childhood immunization: Theproportionofchildrenage1935monthswhohavereceivedrecommendedimmunizations(4
Dtap,3Polio,1MMR,3Hib,1Varicella,4PCV,and2HepA)rangesfrom65.4%inPresqueIsleCountyto79.4inEmmet
County.OnlyCharlevoixandEmmetcountiesexceedStaterate.
Child abuse and neglect: Ratesforconfirmedchildabuseandneglectarehigherinallofthetipofthemittcountiesthanthe
Stateasawhole(14.9per1,000children<19).Theyrangefrom16.3per1,000inEmmetto29.9per1,000inAntrimCounty.

CommunityConversations
117communitymembersandrepresentativesfromlocalhealthdepartments,hospitalsandotherhealthcareproviders,
socialserviceagencies,schools,business,andgovernmentparticipatedinaCommunityConversationtoanswerthequestion,
Whatcanwedohereinthiscountytomoveclosertoourvisionofahealthycommunity?Actionsrelatedtomaternal,
infantand/orchildhealthwereidentifiedinthefollowingcounties:
ALPENA
ANTRIM
CHARLEVOIXEMMET
CHEBOYGAN MONTMORENCY
OTSEGO
PRESQUEIS

MajorForcesofChange
Perinatal Initiative of Northern Lower Michigan: ThePerinatalInitiativewasorganizedin2012bytheNorthCentralCouncil
oftheMichiganHealthandHospitalAssociation.Itsmembersincludethe12hospitalsand7localhealthdepartmentsthat
servea21countyregionaswellasmanystateandlocalpartners.
Michigan Home Visiting Initiative: HealthDepartmentofNorthwestMichiganisimplementingHealthyFamiliesAmericain
thecountieswithhighestneedina21countyregion.With$1.6Minannualfunding,itprovides voluntary, family support
services in the homes of at-risk pregnant women and families with children aged 0-5.

Sustaining Community-Based Immunization Project: DistrictHealthDepartment#10wasawarded$492,000onbehalfofthe


6localhealthdepartmentpartnersintheNorthernMichiganPublicHealthAlliance(NMPHA).Itisdesignedtoincrease
immunizationratesamongchildrenandolderadultsinMCIRRegion5ina2timeperiod(20152018)
Health Systems Change for Tobacco Dependence Treatment: HealthDepartmentofNorthwestMichiganwasawardedthis
$125,000,1yeargrantonbehalfoftheNMPHA.ThepurposeoftheprojectistoimplementtheCDCsTobaccoDependence
TreatmentGuidelinesconsistentlyinhealthdepartmentsFamilyPlanningClinicsina25countyregion.

Northern
Health
Plan

ISSUEBRIEF:MENTALHEALTH
Mentalhealthisessentialtoapersonswellbeing,healthyfamilyandinterpersonalrelationships,andtheabilitytolive
afullandproductivelife.Peoplewithuntreatedmentalhealthdisordersareathighriskformanyunhealthyandunsafe
behaviors,includingsubstanceuse,violentorselfdestructivebehavior,andsuicide.Mentalhealthdisorderscanhave
harmfulandlonglastingeffectsincludinghighpsychosocialandeconomiccostsnotonlyforpeoplelivingwiththe
disorder,butalsofortheirfamilies,schools,workplaces,andcommunities.Fortunately,anumberofmentalhealth
disorderscanbetreatedeffectively,andpreventionofmentalhealthdisordersisagrowingareaofresearchand
practice.Earlydiagnosisandtreatmentcandecreasethediseaseburdenofmentalhealthdisordersaswellasassociated
chronicdiseases.AssessingandaddressingmentalhealthremainsimportanttoensurethatallAmericansleadlonger,
healthierlives.

KeyFacts:
Manymentalhealthdisordersare
Mentalhealthandphysicalhealthareinextricablylinked.Evidence
preventableandtreatable.Early
hasshownthatmentalhealthdisordersmostoftendepression
identificationandtreatmentcanprevent
arestronglyassociatedwiththerisk,occurrence,management,
theonsetofdisease,decreaseratesof
progression,andoutcomeofseriouschronicdiseasesandhealth
chronicdisease,andhelppeoplelive
conditions,includingdiabetes,hypertension,stroke,heartdisease,
longer,healthierlives
andcancer.Thisassociationappearstobecausedbymentalhealth
Approximately1in4adultsintheUShave
disordersthatprecedechronicdisease;chronicdiseasecanintensify
hadamentalhealthdisorderinthepast
thesymptomsofmentalhealthdisorders,ineffectcreatingacycleof
yearmostcommonlyanxietyor
poorhealth.Thiscycledecreasesapersonsabilitytoparticipatein
depressionand1in17hadaserious
thetreatmentofandrecoveryfrommentalhealthdisordersand
mentalillness
chronicdisease.Therefore,whileeffortsareunderwaytoreducethe
1in5childrenintheUnitedStateshave
burdenofdeathanddisabilitycausedbychronicdiseaseintheUS,
hadamentalhealthdisorder,most
simultaneouslyimprovingmentalhealthnationwideiscriticalto
commonlyAD/HD
improvingthehealthofallAmericans.
Achildexperiencingmentalhealthissues

ismorelikelytohaveproblemsatschool
andisatgreaterriskofenteringthe
Newmentalhealthissueshaveemergedamongsomespecial
criminaljusticesystem
Inagivenyear,lessthanhalfofthepeople populations,suchasveteranswhohaveexperiencedphysicaland
mentaltrauma;peopleincommunitieswithlargescalepsychological
diagnosedwithamentalillnessreceive
traumacausedbynaturaldisasters;olderadults,asthe
treatment.Theunmetneedisgreatest
understandingandtreatmentofdementiaandmooddisorders
amongunderservedgroups,suchasolder
continuestoimprove.AstheFederalGovernmentimplements
adults,minorities,thosewithouthealth
healthreformlegislation,itwillgiveattentiontoprovidingservices
insurance,andresidentsofruralareas
forindividualswithmentalillnessandsubstanceusedisorders,
Morethan34,000Americansdieasa
includingnewopportunitiesforaccesstoandcoveragefortreatment
resultofsuicideeveryyear
approximately1suicideevery15minutes. andpreventionservices.
SuicideratesarehighestamongAmerican
Indian/AlaskaNativeyouth.
Riskfactorsforsuicideincludesubstance
Severalfactorshavebeenlinkedtomentalhealth,includingraceand
use,isolation,extremeemotionalstress,a ethnicity,gender,age,incomelevel,educationlevel,sexual
historyofchildmaltreatmentandmental
orientation,andgeographiclocation.Othersocialconditionssuch
healthconditionssuchasdepression
asinterpersonal,family,andcommunitydynamics,housingquality,
Racialdiscriminationisassociatedwith
socialsupport,employmentopportunities,andworkandschool
chronicstressandcanleadtonegative
conditionscanalsoinfluencementalhealthriskandoutcomes,
healthoutcomessuchashypertension
bothpositivelyandnegatively.Forexample,safesharedplacesfor
peopletointeract,suchasparksandchurches,cansupportmental
health.

Impact on Physical Health

Emerging Issues in Mental Health

Social Determinants of Health

Adapted from Healthy People 2020 and the National Prevention Strategy

HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties

TipoftheMittData
Suicide:AgeadjustedsuicideratesarehigherthanState(10.2per100,000)forthe6countiesreported(unabletocalculate
forMontmorencyandPresque).Ratesrangefrom12.5per100,000inEmmetCountyto20.5inAntrimCounty
Depression among older adults: TheproportionofadultsenrolledinMedicarerangesfrom13%inCharlevoixCountyto18%
inOtsegoCounty.RatesarehigherthanState(17%)inAlpenaandOtsego(18%)only.
Inadequate social support: Ofthe7countiesreporting(unabletocalculatePresqueIsle),theproportionofadultswhoreport
theyhaveinadequatesocialsupportrangesfrom12%inCharlevoixCountyto20%inAlpena,Cheboygan,andOtsego
counties.Forcomparison,Staterateis20%.
Poor mental health days: Ofthe7countiesreporting(unabletocalculateMontmorency),theaveragenumberofdaysper
monthadultsexperienceapoormentalhealthdayrangesfrom2.5inCheboyganCountyto5.4inAntrimCounty.Emmet(3.9
days),Otsego(4.1days),andAntrim(5.4days)exceedStaterateof3.7dayspermonth

CommunityConversations

MajorForcesofChange

117communitymembersandrepresentativesfromlocal
healthdepartments,hospitalsandotherhealthcare
providers,socialserviceagencies,schools,business,and
governmentparticipatedinaCommunityConversationto
answerthequestion,Whatcanwedohereinthiscountyto
moveclosertoourvisionofahealthycommunity?
Addressingprevention,treatmentand/oraccesstomental
healthserviceswasidentifiedasanactioninthefollowing
counties:
ALP ANT
CHXEM
CHB MON OTS
PI

Mi-Connect: MiConnectisledbyAlconaHealthCenters,a
systemoffederallyqualifiedhealthcenterswithfederal
funding.Akeygoalistoincreaseintegrationofprimarycare
andbehavioralhealthacrossan11countyregion.
Child and Adolescent Health Centers (CAHC): Thereare6
schoollinkedorschoolbasedhealthcentersinthe8county
region.Eachoneoffersmentalhealthservicestostudents
andfamiliesatnocharge.Primarycareandmentalhealth
servicesarefullyintegratedatCAHCsinAntrimandEmmet
counties
Northeast Michigan Childrens Behavioral Health
X
X
X

X
X
Itisnoteworthythatthe#1actionidentifiedintheCharlevoix Initiative: TheWKKelloggFoundationfundedtheInitiative
EmmetConversationwastointentionally integrate accessible toprovidefamiliesandchildrenage012witheducationand
servicesincollaborationwithseveralcommunitypartners
behavioral and physical health services

WhatMatterstoYou?SurveyN=1,220
Whenaskedwhatarethe3mostimportantfactorsfora
healthycommunity,topresponseswere:accesstohealthcare
(69%);goodjobs/healthyeconomy(50%);accessto
affordablehealthyfood(33%);affordablehousing(27%);and
goodschools/highvalueoneducation(28%).Community
membersidentifiedtheseproblemsmostoften:substance
abuse(48%);overweight/obesity(42%);chronicdisease
(33%),mentalhealthissues(27%)andlackofaffordable
housing(26%).Whenaskedwhatbarrierstocarethey
experience,87%saidtheirhealthinsurancepolicydoesnot
coverbehavioralhealth;80%indicatedtheyhaveproblems
findingabehavioralhealthproviderand78%saidtheirhealth
insurancepolicydoesnotcovermedications.63%of
respondentsindicatedtransportationissuespresenta
problemingettinghealthcareservices.

Primary care-behavioral health integration at FQHCs:


Severalfederallyqualifiedhealthcentersacrosstheregion
nowcolocateprimarycareandmentalhealthservices,often
inpartnershipwiththeregionalcommunitymentalhealth
agency.

HealthCareProviderSurveyN=126
Whenaskedwhatarethe3mostimportantfactorsfora
healthycommunity,topresponseswere:accesstohealth
care(69%);goodjobs/healthyeconomy(51%);healthy
lifestyles(39%);goodschools/highvalueoneducation(32%);
andaccesstohealthyfoods(23%).Physicians,nurse
practitionersandphysiciansassistantidentifiedthese
communityhealthproblemsmostoften:overweightobesity
(58%)mentalhealthissues(43%),lackofaccesstohealth
care(38%),substance/tobaccouse(35%)

Northern
Health
Plan

ISSUEBRIEF:SUBSTANCEUSE
Preventingdrugabuseandexcessivealcoholuseincreasespeopleschancesoflivinglong,healthyandproductivelives.
Excessivealcoholuseincludesbingedrinking,underagedrinking,drinkingwhilepregnant,andalcoholimpaireddriving.Drug
abuseincludesanyinappropriateuseofpharmaceuticals(bothprescriptionandoverthecounterdrugs)andanyuseofillicit
drugs.Alcoholandotherdrugusecanimpedejudgmentandleadtoharmfulrisktakingbehavior.Preventingdruguseand
alcoholabuseimprovesqualityoflife,academicperformance,workplaceproductivityandmilitarypreparedness;reducescrime
andcriminaljusticeexpenses;reducesvehiclecrashesandfatalities;andlowershealthcarecostsforacute/chronicconditions.

KEYFACTS
Excessivealcoholuseisaleadingcauseof
Substanceabuseinvolvingdrugs,alcohol,orbothisassociatedwitha
preventabledeathintheU.S.amongall
rangeofdestructivesocialconditions,includingfamilydisruptions,financial
agegroups.
problems,lostproductivity,failureinschool,domesticviolence,childabuse,
Overhalfofthealcoholconsumedby
andcrime.Inaddition,substanceabusecontributestoanumberofnegative
adultsand90%ofthealcoholconsumed
healthoutcomesandpublichealthproblems,includingcardiovascular
byyouthoccurswhilebingedrinking.
conditions,pregnancycomplications,HIV/AIDS,sexuallytransmitted
Prescriptiondruguseisthenations
infections,domesticviolence,childabuseandneglect,motorvehiclecrashes,
fastestgrowingdrugproblem.ERvisits
homicideandsuicide.Improvedevaluationofcommunitylevelprevention
involvingthemisuseorabuseof
hasenhancedresearchersunderstandingofenvironmentalandsocial
pharmaceuticaldrugshavedoubledover
factorsthatcontributetotheinitiationandabuseofalcoholandillicitdrugs,
thepast5years.
leadingtoamoresophisticatedunderstandingofhowtoimplement
Chronicdruguse,crime,andincarceration evidencebasedstrategiesinspecificsocialandculturalsettings.Estimatesof
areinextricablyconnected.Atleasthalfof thetotaloverallcostsofsubstanceabuseintheUnitedStates,includinglost
stateandFederalinmatesintheU.S.were productivityandhealthandcrimerelatedcosts,exceed$600billion
activedrugusersatthetimeofarrest.
annually.
9%ofchildrenlivewithatleast1parent
whoabusesalcoholorotherdrugs.They
aremorelikelytoexperiencephysical,
Tobaccouseisthesinglemostpreventablecauseofdisease,disability,and
sexualoremotionalabuseorneglectand
deathintheUS,yetmoredeathsarecausedeachyearbytobaccousethan
morelikelytobeplacedinfostercare.
byalldeathsfromHIV,illegaldruguse,alcoholuse,motorvehicleinjuries,
Ratesofmarijuanausebyyouthand
suicides,andmurderscombined.Asaresultofwidespreadtobaccouse,
youngadultsareontheriseandfewer
approximately443,000Americansdiefromtobaccorelatedillnesses,suchas
youthperceivegreatriskfromsmokingit
cancerandheartdisease,eachyear.Anestimated49,000ofthesedeaths
After40yearsofsteadilydeclining
aretheresultofsecondhandsmokeexposure.Tobaccouseposesaheavy
smokingrates,thedeclineinadults
burdenontheU.S.economyandmedicalcaresystem.Eachyear,cigarette
smokingratesintheU.S.hasstalled
smokingcostsmorethan$193billioninmedicalcarecosts,while
Smokingduringpregnancyposesrisksto
secondhandsmokecostsanadditional$10million.
themotherandfetus.Ababyborntoa

Alcohol and Drug Use

Tobacco Use

motherwhosmokedduringpregnancyis
morelikelytohavelessdevelopedlungs
andlowbirthweight,andismorelikelyto
bebornprematurely.
MorethanoftheU.S.population(88
millionpeople)andmorethanhalfofall
childrenintheU.Sareexposedto
secondhandsmokeonaregularbasis.

Social Determinants of Health


Severalbiological,social,environmental,psychological,andgeneticfactors
areassociatedwithalcohol,tobaccoandotherdruguse.Thesefactorscan
includegender,raceandethnicity,age,incomelevel,educational
attainment,andsexualorientation.Substanceabuseisalsostrongly
influencedbyinterpersonal,household,andcommunitydynamics.Family,
socialnetworks,andpeerpressurearekeyinfluencersofsubstanceabuse
amongadolescents.

AdaptedfromHealthy People 2020 and National Prevention Strategy

HIGHLIGHTSFROMTHE2015COMMUNITYHEALTHASSSESSMENT
Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Montmorency, Otsego, and Presque Isle counties

TipoftheMittData
Heavy and binge drinkingadults: Moreadultsintheregiondrinkheavilyand/orbingedrinkinthepast30daysthaninthe
Stateasawhole(18%).Ratesrangefrom19%inEmmetCountyto27%inAntrimCounty(unabletocalculateratesin
MontmorencyandPresqueIslecounties).Similarly,
Binge drinkingteens: MoreyouthbingedrankcomparedtotheState(6%).Theproportionof9thand11thgrade

studentsreportingtheyhad5+drinkswithinashortperiodoftimeinthepast30daysrangesfrom10%in
CharlevoixCountyto22%inPresqueIsleCounty
Marijuana use--teens: Theproportionofhighschoolstudentswhoreportusingmarijuana1ormoretimesinthe
past30daysrangesfrom9%inPresqueIsleCountyto22%inOtsegoCounty.Otsego(22%),Antrim(21%),Emmet
(15%)andCheboygan(13%)countiesexceedStaterate(9%).
Deaths due to drug poisoning: DeathsduetodrugpoisoningexceedStaterate(13per100,000population)in
PresqueIsle(19),Otsego(17),Antrim(16),Antrim(15)andCheboygan(15)counties.
Tobacco useadults: AmuchhigherproportionofadultssmokecigarettesinNorthernMichiganthantheStateasawhole
(12%).Smokingratesintheregionrangefrom16%inPresqueIsleCountyto31%inMontmorencyCounty.
Tobacco useteens:Theproportionof9thand11thgradestudentsreportingtheysmokedatleastonceinthepast30days
hoversatorexceedsState(10%),rangingfrom11%inEmmetCountyto23%inOtsegoCounty.

CommunityConversations

MajorForcesofChange

117communitymembersandrepresentativesfromlocal
healthdepartments,hospitalsandotherhealthcare
providers,socialserviceagencies,schools,business,and
governmentparticipatedinaCommunityConversationto
answerthequestion,Whatcanwedohereinthiscountyto
moveclosertoourvisionofahealthycommunity?
DuringtheCommunityConversations,addressingprevention
andtreatmentforalcohol,tobaccoandotherdrugusewas
identifiedasanactioninthefollowing
AL
AN
CHXEM
CHB MON OTS
PI
X
X
X
X
X
X

Affordable Care Act (ACA):TheACAincludessubstanceuse


treatmentasanessentialservicetobeofferedwithallhealth
insurancepolicies,substantiallyincreasingaccess
Michigan Medical Marijuana Program (MMMP): The
MMMPgivesmanyyouthandsomeparentstheimpression
thatmarijuanaisnotadangerousdrug.
Prescription Drug Use Task Force: NMREleadsthis
coalitionwithrepresentativesfromphysiciansandhealth
careorganizations,substanceusepreventionand
treatmentagencies,lawenforcement,andothercommunity
partners

HealthCareProviderSurveyN=122
Whenaskedwhatthe3topcommunityhealthproblemsareintheircounty,physicians,nursepractitioners,andphysicians
assistantsindicatedoverweight/obesity(58%),mentalhealthissues(43%),lackofaccesstohealthcare(38%),substanceuse
(35%),tobaccouse(35%),chronicdisease(28%),lackofphysicalactivity(19%),agingproblems(11%).

WhatMatterstoYouCommunitySurveyN=1,140
Thetoprankedfactorsneededforahealthycommunitywere:accesstohealthcare(69%),goodjobs/healthyeconomy(50%),
accesstoaffordablehealthyfoods(33%),goodschools(28%),andaffordablehousing(27%).Substanceusewasrankedthe#1
needintheircounties(48%),followedbyoverweight/obesity(42%),chronicdisease(33%),mentalhealthissues(28%),and
affordablehousing(26%).11%ofrespondentsnotedtheyhadbeendiagnosedwithalcoholismorotheraddictionand93%
hadafamilymemberwhohadbeendiagnosedwithalcoholismorotheraddiction.

Northern
Health
Plan

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