Secondary Data

Review of Secondary Data

Copyright 2003 Community Health Alliance. All rights reserved. Unless otherwise indicated, all materials in this document are copyrighted by the Greenville Community Health Alliance. Materials may be used and distributed, but must be cited.
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The Research Tools

Qualitative Methods
Putting a Face on the Issues

Quantitative Methods
Measuring the Issues

Secondary Data

Expert Interviews

Health Indicators Data Scan

Community Focus Groups

Resident Telephone Survey

Underserved Resident Focus Groups

Business Insurance Survey

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Findings are based on reliable, comprehensive tools.

The Data

The Face
Expert Interviews
One on one and telephone interviews with community leaders and health care providers.

Secondary Data

Health Indicators Data Scan

Revisited issues explored in 1998 with more emphasis of changes over time. Deeper analysis including census tract level reporting. Benchmarks against other similar communities.

Resident Telephone Survey

1,507 completed telephone interviews with over-sampling of ZIP codes with higher levels poverty.
13 minute survey focusing on the uninsured with 90% response rate. Precision of +/-2.5% at 95% confidence interval.

Community Focus Groups

15 focus groups wrapped around health care issues. Participants included a wide representation of health care and community leaders.

Business Insurance Survey

Web-based survey sent to 1,700 Greater Greenville Chamber of Commerce members. Completed by 292 Chamber of Commerce members for a response rate of 17%. Focus on providing insurance to employees and the barriers to providing coverage.

Underserved Focus Groups

Two focus groups with uninsured and underserved residents. Participants recruited from telephone survey respondents.

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Quantitative Methods: Health Indicators

Key Components

Secondary Data

Demographic Data Scan

Compare changes in health status indicators since 1998 with emphasis on the issues of greatest need. Develop a more robust analysis of trends over time including since the 1998 study and in subsequent years Utilized to a greater extent data available from local agencies, hospitals, and stakeholders Provide benchmarks that are more meaningful than just national and South Carolina based. As outlined in 1998, South Carolina is not an aggressive benchmark.

Resident Telephone Survey

Business Insurance Survey

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The data scan addresses a variety of issues related to Greenville, going beyond just health care.

Secondary Data

General Demographics
Population and population growth Racial mix Age (with a focus on youth and seniors) Household income Educational attainment

Quality of Life Indicators

Crime and abuse The business environment and investment Healthcare spending Education

Health Behaviors and Disease

Death rates Disease rates Cancer rates Health behaviors Maternal indicators Youth health indicators

Components of Community Vitality and Health

Healthcare
Health insurance

Healthcare facilities and access

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The health of a community goes beyond just a description of the health care delivery system.

Secondary Data

Health is not measured just by the healthcare system, but also issues with the community and quality of life. The scan is extensive, looking at a variety of sources. Primary reason is to look at as much as possible to get a complete picture of Greenvilles health. However, not everything we found is shown just the most relevant.

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Since 1998, the demographic profile of Greenville has changed.

Then
(1998)

Now
(2002)

We are

Secondary Data

Growing Population

Population
Total population living in the county

353,845 10.5%
(1990-1998)

389,466 9.2%
(1998-2001)

Growing rapidly

Population Growth

and faster than SC

Income

$58,829

$62,900

Challenging Economy

Average household income

incomes are rising slightly

Unemployment
% Unemployed

2.0%

5.8%

Unemployment has more than doubled

DJIA
Dow Jones Industrial Average

9,500
11,500 in early 2000

8,000
9,500 today

More difficult economic environment

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Greenville remains the #1 most populous county in South Carolina.

Greenville Countys 2001 population is 387,000 and is expected to grow to over 405,000 by 2006.

Secondary Data

Greenvilles growth of 19% (60,000 people) between 1990 to 2000 is the 11th fastest out of 46 in the state. We have about 10% of the population of South Carolina. We are large and are growing faster than the rest of the state.

Source: Claritas, US Census Bureau

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growing slightly faster than South Carolina.

Population Changes
4,500,000
450,000

Secondary Data

384,631 4,000,000 4,053,648

400,000

3,500,000

350,000

3,000,000

300,000

2,500,000

209,776

250,000

2,000,000 2,382,594 1,500,000

200,000

150,000

1,000,000

Greenvilles growth of 19% (60,000 people) between 1990 to 2000 is the 11th fastest growth out of 46 counties in the state. We are large and are growing slightly faster than the rest of the state, having increased by 83% since 1960 (70% for SC).
1960 1970 1980 1990 2001

100,000

500,000

50,000

Source: South Carolina Office of Research and Statistics, U.S. Census Bureau, 2001 Supplemental Survey

Greenville Population
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SC Population

Greenvilles population has grown over 27% in 15 years.

Secondary Data

Source: Claritas

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The population is growing to the southeast. 75% of the countys population now live outside the traditional downtown geographies.

ZIP Code

% Growth 1990 to 2006

29681 29680 29652 29644 29635 29650 29651 29688 29615 29690 29697 29662 29669 29673 29636 29356 29687 29607 29627 29661 29617 29609 29611 29683 29605 29601

Simpsonville Simpsonville Greer Fountain Inn Cleveland Greer Greer Tigerville Greenville Travelers Rest Williamston Mauldin Pelzer Piedmont Conestee Landrum Taylors Greenville Belton Marietta Greenville Greenville Greenville Slater Greenville Greenville

99.8% 98.9% 84.6% 72.2% 49.3% 46.8% 41.6% 38.6% 37.9% 32.6% 32.2% 30.1% 27.5% 26.3% 26.0% 24.5% 22.3% 21.9% 19.5% 19.2% 14.9% 5.3% -2.5% -3.5% -4.9% -20.2%

Secondary Data

Population Growth 1990 to 2000

Source: Claritas and US Census Bureau

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The population is growing fastest in the Southeast.

Secondary Data

Source: Claritas and US Census Bureau

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Greenvillians are slightly more mobile than the rest of the state.

Secondary Data

Population Mobility
60%

163,000 people in Greenville County changed residences between 1995 and 2000. Of those moving to Greenville County from a different location, two out of three moved in from another state. Almost half of those with incomes less than $10,000 per year moved during the five-year period.

56% 52%

50%

40%
Greenville South Carolina

30%

26% 22% 21% 20% 14% 12%

20%

10%

7%

8% 3% 2%

0% Lived in same house in 1995 Different house Same County Different house Different County Stayed in South Carolina Moved out of South Carolina Moved elsewhere

Source: South Carolina Office of Research and Statistics, U.S. Census Bureau

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Greenvilles population is predominantly white, yet other groups are growing rapidly.

Racial Mix in Greenville

% Change in Population by Race

160%
145%

Secondary Data

Other 2% White 77%

Population Growth (1970-19970

140%

120%

Greenville South Carolina United States

Black 21%

100%

80%
68%

60%
48%

40%

Note: Race and ethnicity are related, yet not inclusive. Most Hispanics are considered white rather than black or other

Greenville is much whiter than 20% the state (77% compared to 68%).
0%

21% 14% 12% 6% 14% 16%

3,424 people in Greenville County reported their race as White in combination with another race.

White

African American

Asian

Source: U.S. Census, 2001

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Greenville County is highly segregated.

Secondary Data

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The foreign born population is becoming a more visible force with the last decade showing the largest growth in history.
South Carolina Foreign Born Population
3.5%

Secondary Data

3.0%

Greenvilles foreign born population in 2001 was 18,420, 5% of the total population. This is a growth of over 300% from the 6,000 residents in 1990. Greenville and South Carolina are still below the national average on the number of foreign born of 11%. South Carolina ranks 39th out of the 50 states. In 2000, more than three-fifths (62%) of the countys foreign born population had entered since 1990, and less than one-third (30%) of the foreign born residents had become naturalized citizens.
0.6% 1.5%

2.9%

2.5%

2.0%

1.5%

1.4%

1.0%

0.5%

0.4%

0.4%

0.4%

0.5% 0.3% 0.3% 0.3%

0.0% 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000

Source: South Carolina Office of Research and Statistics, U.S. Census Bureau, 2001 Supplemental Survey

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English is not the primary language in 7% of Greenvilles households.

Speaks Language Other Than English

Secondary Data

20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0%

Over 25,000 Greenvillians speak a language other than English in their homes.

18%

7% 5%

Greenville
Source: South Carolina Office of Research and Statistics, U.S. Census Bureau

South Carolina

United States

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The Hispanic population in 1990 was relatively non-existent.

Only one census tract had more than 2% of its population with Hispanic origin.

Secondary Data

1990 % Hispanic Population

Source: Claritas, 2001

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The Hispanic population in the county has grown over 400% in the last ten years.
Now, several census tracts have in excess of 15% Hispanic populations.

Secondary Data

Hispanics are at a double disadvantage with respect to health insurance because they are more likely than non-Hispanic counterparts to work in industries where insurance coverage is traditionally not offered and less likely to be offered insurance even when coverage is provided. Hispanics are the most uninsured ethnic group in America.
- Project HOPE Center for Health Affairs

Since 1990, the reported Hispanic population has grown from less than 3,000 to over 16,300.

1990 % Hispanic Population

Source: Claritas, 2001

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The Hispanic population is growing rapidly, now 4% of the population.

Secondary Data

I dont know what your estimates are for the Hispanic population, but I assure you, they are considerable underestimations.
- Focus Group Participant

Greenville County Hispanic Population

18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 1990
Source: Claritas, 2001

16,811

407% Growth

3,319

In the United States, the Hispanic population is 13%. In Greenville County it is 4%.

2001
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The Hispanic population is concentrated in small areas.

Hispanic Population 2002

Secondary Data

Source: Claritas, 2002

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Six census tracts account for a significant portion of Greenvilles Hispanic population.
Hispanic Population 2002

Secondary Data

16%

10% 18%

24%

14%

12%

Source: Claritas, 2002

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20% of Greenvilles Hispanic population live in a five mile wide circle.

Secondary Data

Northwest Crescent Child Development and Family Service Center

5.2%

2.2%

1.3%

5.5% 1.1%

2.4%

2.5%

Source: Claritas, 2001

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Births to Hispanic mothers in local hospitals has more the doubled since the 1998 studyfrom 4% of births to over 10%.
% Births to Hispanic Women in Greenville County to Local Residents

Secondary Data

15%

Of the 554 births to Hispanic13% mothers in local hospitals, less than 10% of 11% those mothers had health insurance.
9%

9.5% 7.6%

10.2%

7%

5.7%
5%

4.2% 3.4% 2.6% 1.8%

3%

1%

-1%
Greenville County Births Births to Hispanic Women % Births to Hispanic Women

1995 4,767 84 2%

1996 4,906 127 3%

1997 4,920 166 3%

1998 5,176 218 4%

1999 5,361 303 6%

2000 5,388 407 8%

2001 5,526 525 10%

2002 5,389 554 10%

Source: Greenville County Health Department II - 24

Greenvilles population is aging slowly.

By 2006, 24% of the population will be over age 55, up from 21% in 1990.

Secondary Data

Population by Age (2001-2006)

90,000
79,222 77,642

The baby boomlet is also apparent with the increase of those under age 24.

80,000

70,000

66,238 63,623 61 ,063

60,000

57,404 53,584 55,1 87 51 ,01 1 50,1 21 49,521

57,1 24

57,444

1990 2001 2006

46,21 3

50,000

48,201

40,000
35,202

36,084

30,000

27,842

27,263 25,751 23,01 2 1 8,1 74 1 7,31 0 1 1 ,861

20,000

10,000

6,649 5,632 3,1 03

0 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age

Source: Claritas

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A large group of residents are about to move into retirement, and become Medicare eligible.

Expected Population Change by Age (2001 to 2006)

30%

Secondary Data

28%
Between 1990 and 2000, the population ages 55 to 64 grew 28% and those aged 85 and older grew 18%. The greatest growth is with the 45 to 64 year olds. This is a group, also at great health risk. Around 110,000 Greenvillians will be moving into Medicare age in the next ten years; 11,000 per year.

25%

20%

18%

15% 11% 10% 7% 5% 2% 0% 2%

6%

5%

-5% -6% -10% 0-14 15-24 25-34 35-44 45-54

Age

55-64

65-74

75-84

85+

Source: Claritas

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There are about 100,000 children under age 18 living in Greenville County.

2006 Population under Age 17

Secondary Data

(% of Population)

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Income distribution is diverse and spread throughout the county.

Secondary Data

City View

Parkins Mill $138,000

Average HH Income

The median household income in the county is $50,332. This is higher than South Carolina at $44,227 and the U.S. at $50,046.

$33,159
Average HH Income

Source: US Census Bureau 2000, Claritas 2006 projections

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Some of the lowest income census tracts are directly adjacent to the highest income census tracts.

Secondary Data

Source: US Census Bureau 2000, Claritas 2006 projections

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Greenvilles poverty rate is lower than some other areas explored, yet 14% of our children live in poverty.
Population in Poverty
25%

Secondary Data

23%

20%

19% 18% 17% 16% 16%

Percent of Population in Poverty, 2001

15%

14%

11%
10%

% of Children Living in Poverty

Greenville County, 2000

South Carolina, 2000

United States, 2000

White children
5%

8% 29% 28%

10% 34% 29%

11% 33% 28%

Black children Hispanic children

0% Lexington Greenville Anderson Spartanburg Richland Charleston South Carolina United States

Source: U.S. Census, 2000 II - 30

We should continue to focus on areas of high poverty, taking services to the places of greatest need.

% HH making <$25,000

2002

Secondary Data

29601 Downtown 29611 Westside 29661 Marietta 29683 - Marietta 29617 Greer 29605 Augusta Road 29609 Laurens Road 29651 - Greer

41% 28% 22% 22% 20% 20% 20% 18%

14% of our children live in poverty.

Among subgroups, 28% of Hispanic children and 29% of African American children live in poverty.

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The Clinics are positioned in areas of the greatest financial and health care access need.

Secondary Data
Average Household Income

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Over half of all ZIP codes have a significant portion (90%+) of their populations with no college diploma.

Secondary Data
Source: US Census Bureau 2000, Claritas 2001 projections

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28% of Greenvillians do not have a high school diploma.

Areas with the Greatest Level of No High School Diploma, 2001

Secondary Data

Percent with Less than High School Diploma

29682 Slater 29636 Conestee 29601 Downtown 29661 Marietta 29611 Westside 29615 Eastside 29650 Greer 29662 - Mauldin

36% 33% 33% 31% 31% 7% 10% 10%

Source: US Census Bureau 2000, Claritas 2001 projections

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Greenville level of people without high school diplomas is higher than some other areas.

Population without a High School Diploma

35%

Secondary Data

Percent of Population without a High School Diploma

30%

28%
25%

28%

29%

24% 22% 21%

24%

25%

25%

26%

26%

20%

18% 15%

15%

10%

5%

0%

Among those 25+ of age. Source: Greenville Chamber of Commerce Vitality Index, 2000

C Ch ar lo tte ,N Co C lu m bi a, SC At la nt a, G G re A en sb or o, NC Na sh vi lle ,T Ch N ar le st on ,S Un C ite d St at es As he vil le ,N Bi rm C in gh am Ch ,A at L ta no og a, TN G re en vi lle ,S C Au gu st a, G A

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Ra l

ei gh ,N

The percent of the population receiving food stamps is lower than South Carolina, yet higher than the U.S.

Food Stamp Recipients

7%

Secondary Data

6.6% 6.4% 6.1%

6%
Percent of Population Receiving Food Stamps, 1997

5.5%

5.4% 5.1% 4.9% 4.6%

5%

4%

3%

2%

1%

0% South Carolina
Source: Greenville Chamber of Commerce Vitality Index, 2000, South Carolina Department of Social Services

Georgia

Tennessee

North Carolina

Charleston MSA

Greenville County

United States

Columbia MSA

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Greenvilles population is slightly more married than other areas.

Marital Status

Secondary Data

60%

57%

54% 54%

The delaying of marriage since 1970 by both men and women has led to a substantial in the percentage of young, never-married adults. The rate of divorce in Greenville has grown from 8% in 1990 to 9.4% in 2000.

50%

40%

30%

20%
Greenville South Carolina United States

10%

9% 3% 3% 2%

9%

10% 7% 7% 7%

0% Married Separated Divorced Widowed

Source: South Carolina Office of Research and Statistics, U.S. Census Bureau

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28% of children lives in a single parent household.

Composition of Families with Children

90%

Secondary Data

80%
Percent of Children Living under Each Situation, 1995

77% 72%

Fathers are becoming increasingly absent in the home. The percent of children living in single parent families has gone from 12% in 1970 to 28% in 2001.

70%

60%

1995
50%

2001

40%

30%

23%
20%

19%

10%

4%
0%

5%

Married couple
Source: Claritas, 2002

Single female

Single male

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One in four children lives in a single parent household.

Poverty by Family Composition

45,000

Secondary Data

40,000

Children Living under Each Situation, 1995

35,000

Families above Poverty Families in Poverty

30,000

25,000 37,707 40,081

20,000

49% of families living in poverty are single mothers with children.

15,000

10,000 8,455 5,000 5,816 0 1,489 1,080 2,445 582 2,277 225 3,786 546

Married with children

Married without children

Male with children

Male without children

Female with children

Female without children

Source: Claritas, 2002 II - 39

Family dynamics are changing

Secondary Data

28% of children live in a single parent households, up from 12% in 1970. Half of households living in poverty are single mother households with children under age 18. While only 4% of children living in two parent households live in poverty, 31% of children living in single mother households live in poverty. In 1960, a little over one in three moms with children under age six worked. Now, over 65% of Greenville mothers work, putting additional pressures on the household.

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Births to single mothers is especially high among minority households.

Births to Single Mothers (Excludes Paternity Acknowledged Cases)

70%

Secondary Data

African Am erican and Other White

60%

Total

Percent of Births to Single Mothers

50%

40%

30%

20%

10%

0%

1960
Source: Greenville County Kids Count, 2002

1970

1988

1998

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More mothers are working outside the house than ever before.

Mothers of Children Under Six Who Work Outside the Home

80%

Secondary Data

Percent of Mothers of Children under Six who Currently Work

70%

65%
60%

67%

50%

78% of mothers with children ages 6 to 17 worked.

40%

37% 32%

30%

20%

10%

In 1960, a little over one in three moms worked. Now over two out of three work, most likely increasing the pressures on our children.

Greenville South Carolina

0%

1960

1990
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The level of children born to children has remained flat in the county.

Births to Mothers Under 18

Secondary Data

8 7

Percent of Births to Mothers under 18

7 6

5 5

4 4

Greenville County South Carolina USA

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
Source: Greenville County Kids Count, 2002 II - 43

The level of children born to less educated mothers is decreasing in Greenville.

Change in the Percent of Children born to Mothers with Less than a High School Education
15%
Change in Percent of Kids born to Mothers without a High School Diploma, 1987 to 1997

Secondary Data

10%

10%

5%

0%

Greenville
-5%

South Carolina

United States

-10%

-15%

-20%

-20%
-25%

-21%

Source: Greenville Vitality Index II - 44

Half of the households in Greenville that live in poverty are headed by single mothers with children under the age of 18.
Composition of Families with Children
90%

Secondary Data

80%
Percent of Children Living under Each Situation, 1995

77% 72%

70%

60%

1995
50%

2001

40%

30%

23%
20%

19%

10%

4%
0%

5%

Married couple
Source: Claritas, 2002

Single female

Single male

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There are significant differences in employment in families by race and ethnicity.

Household Composition by Employment

60%

Secondary Data

50%

48%

Whites: 78% in traditional dual income, or father income households Blacks: 54% in single mother households Hispanics: Lower dual income, yet high father only employment
40%

Percent of Households with Children

40%

White Black Hispanic

30%

29%
27%

30%

29%

20%

14%
10%

14%

9%
7% 3%

10% 7% 3% 4%
5%

7% 1%
2%

4% 2% 2%

2%
0%

1%

Two parents, both work

Source: Greenville County Kids Count, 2002

Two Two parents, parents, father only mother only works works

Two parents, neither works

Mother only Mother only Father only Father only works doesn't works doesn't work work

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Quality of Life Indicators

Secondary Data

General Demographics
Population and population growth Racial mix Age (with a focus on youth and seniors) Household income Educational attainment Families

Quality of Life Indicators

Crime and abuse The business environment and investment Healthcare spending

Health Behaviors and Disease

Death rates Disease rates Cancer rates Health behaviors

Components of Community Vitality and Health

Education

Maternal indicators
Youth health indicators

Healthcare
Health insurance Healthcare facilities and access

II - 47

Greenvilles crime rate increased by 7% between 1987 and 1997.

Total Crime Rate

900

Secondary Data

800

700

Crime Rate per 10,000 Population

600

500

400

300
Anderson County Greenville County

200
Crimes include murder, rape, robbery, aggravated assault, breaking and entering, larceny and motor vehicle theft Source: Greenville Chamber of Commerce Vitality Index, 2000. Crime in South Carolina, Uniform Crime Reports Department, State Law Enforcement Division

Pickens County Richland County South Carolina

100

Spartanburg County

0 1987

1988

1989

1990

1991

1993

1994

1995

1996

1997
II - 48

Crime in Greenville has decreased since 1999.

Source:South Carolina Office of Research and Statistics, 2003

Secondary Data

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Cases of neglect and mental injury are higher in Greenville than in South Carolina.

Secondary Data

Nationally, one in three victims of physical abuse is a baby--less than a year old. In 1990, more one-year-olds were maltreated than in any previous year for which we have data. Almost 90 percent of children who died of abuse and neglect in 1990 were under the age of five, 53 percent were less than a year old. The leading cause of death among children aged one to four is unintentional injury.

Types of Abuse in Greenville County

40% 35%
Percent of Abuse Cases, 1997

34%

30% 25% 25% 20% 20% 15% 10% 5% 0% 5% 5% 14% 13% 24%

Physical abuse
Source: Starting Points: Meeting the Needs of Our Youngest Children, The Carnegie Foundation, 1999

Sexual abuse

Neglect

Mental injury

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Greenvilles domestic violence victimization rate is lower than the states.

Domestic Violence Victimization Rate

160

Secondary Data

140

120

Crime Rate per 10,000 Population

100

80

60

40
Greenville County South Carolina

20

Source: South Carolina Incident Based Reporting System (SLED)

0 1996

1997

1998

1999

2000
II - 51

Health Behaviors and Disease

Secondary Data

General Demographics
Population and population growth Racial mix Age (with a focus on youth and seniors) Household income Educational attainment

Quality of Life Indicators

Crime and abuse The business environment and investment Healthcare spending

Health Behaviors and Disease

Death rates Disease rates Cancer rates Health behaviors

Components of Community Vitality and Health

Education

Maternal indicators
Youth health indicators

Healthcare
Health insurance Healthcare facilities and access

II - 52

Death rates have changed dramatically over the last few years.
Healthy People 2010 Target 166 160 45 48 60 NA 22 NA NA

Standard Death Rates per 100,000

Then
1998

Now
2001

Secondary Data

Heart Disease Cancer Lung Cancer Stroke Chronic Obstructive Pulmonary Disease Diabetes Breast Cancer (female) Prostate Cancer Colorectal Cancer

165 188 52 55 50 24 29 23 20

202 190 55 59 44 25 24 19 22

All death statistics are age adjusted and standardized to the 2000 population. Source: Impact of Chronic Conditions, Greenvile County, 2001 II - 53

Greenvilles standard cancer death rate is 198 compared to the states 212.

Secondary Data
Source: DHEC, 2000
II - 54

Greenvilles standard diabetes rate has grown slightly more than the states.

Secondary Data
Source: DHEC, 2000
II - 55

There are opportunities for Greenville to improve preventable deaths.

Secondary Data

Greenville Deaths
% of population 18-29 that died during the 1990s

South Carolina

County Rank
(1=best, 46=worst)

.9% 79%

1.1% 75%

8 32

Preventable Deaths
% of deaths of persons 18-29 during the 1990s that were PREVENTABLE

ER Visits
Visits of 18-29 year olds to the ER due to unintentional injuries

25% 2.94

26% 3.11

19 18

ER Homicide Visits
Visits of 18-29 years olds to the ER due to assault, homicide, or attempted homicide

Source: South Carolina Kids Count Project

II - 56

Most of the deaths of young people are avoidable.

Secondary Data

Young adults often endanger their natural healthiness through inappropriate lifestyles, risk-taking, and inadequate primary healthcare.
SC Young Adults Report
Major Causes of Death among Young Adults 1990-1998
Total Ages 15-24 15-17 18-19 20-24 25-29 30-34

Motor and Traffic Accidents Suicide All Other Homicide and Legal Intervention HIV/AIDS Other Accidents Cancer Heart Disease Total % Preventable

27% 12% 15% 9% 11% 6% 7% 13% 100% 74%

42% 15% 14% 9% 2% 3% 6% 9% 100% 82%

52% 9% 14% 8% 0% 3% 10% 4% 100% 83%

52% 13% 11% 4% 0% 4% 2% 14% 100% 80%

35% 19% 15% 11% 3% 2% 5% 10% 100% 83%

23% 12% 17% 9% 14% 5% 6% 14% 100% 75%

13% 9% 14% 9% 19% 10% 10% 17% 100% 64%

Source: SC Young Adults Report

II - 57

All cancers, prostate cancer, and cervical cancer have higher rates of hospitalization in Greenville than in South Carolina.

Data Secondary Disease Rates

Printed in the Greenville News, July 2002

Standard Rate of Hospitalization, 2001

Source: DHEC, 2000

II - 58

Heart disease has the highest cost of hospitalization in Greenville County.

Secondary Data

Total Cost of Hospitalization, 2000

Greenville South Carolina

Heart Disease All Cancers Stroke COPD Diabetes Hypertension Colorectal Cancer Lung Cancer Breast Cancer Prostate Cancer Cervical Cancer

$ $ $ $ $ $ $ $ $ $ $

70,612,900 46,953,600 18,926,700 12,074,400 8,230,000 5,940,200 5,531,200 4,865,000 1,895,800 1,461,733 233,600

$ $ $ $ $ $ $ $ $ $ $

713,999,000 453,970,000 222,825,500 142,372,000 99,171,500 64,884,500 58,972,400 53,277,000 16,500,600 16,448,228 3,119,300

Source: DHEC, 2001

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AIDS is still growing in Greenville, yet HIV has dropped off slightly.

AIDS

HIV
50
Greenville Spartanburg

Secondary Data

50 45 40 35
Rate per 100,000
Rate per 100,000

45 40 35 30 25 20 15 10 5 0

Greenville Spartanburg Charleston

Charleston

30 25 20 15 10 5 0

1995

1996

1997

1998

1999

1995

1996

1997

1998

1999
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Source: DHEC, 2001

Other STDs have dropped slightly in the County.

Other Sexually Transmitted Disease

Secondary Data

903 803 703 603

Rate per 100,000

503 403 303 203 103 3

Greenville Spartanburg Charleston

1995
Source: DHEC, 2001

1996

1997

1998

1999
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Access to Care
Primary Care Physicians per 100,000, 1998
140 120 100
117 97 121

Secondary Data

Rate per 100,000

Area Hospitals/Clinics, 1998

81 80
80

80 60 40 20 0
55

70 60

69 64

Rate per 100,000

50 40

32
30 20 10 0

lle

nd er so n

bi a

C ha rle st on

pa r ta nb ur g

or k

G re en vi

C ol

um

19 7

Dentists per 100,000, 1998

80

nb ur g

so n

bi a

/S pa r ta

60
Rate per 100,000

50 40 30 20 10 0
34

46 33 29

48

G re en vi

lle

70

67

Source: www.communityhealthstatus.com

lle

so n

bi a

Sp ar ta nb ur g

Ch ar le st on

G re en vi

Yo rk

An de r

um

Ch ar le st on

Ch ar lo tte

An de r

Co l

um

Co l

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Health behaviors are still a concern, especially obesity.

Then
1998

Now
2001

South Carolina

Secondary Data

Current Smoking Sedentary lifestyle Overweight* High Cholesterol

25% 65% 53% 29%

22% 40% 58% 31%

25% 62% 53% 24%

SC Obesity by BMI - 1900 to 2002

30%
26%

25%
% of Respondents

20% 15%
14%

Poor nutritional habits not only make otherwise healthy young adults vulnerable to heart disease, cancer and other chronic conditions in subsequent decades of life, but also impair the development of babies and children in the care of young adults.
- SC Young Adults Count, 2001

10% 5%
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

South Carolina Behavioral Risk Factor Surveillance System, 1998, 1999, 2001

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Untraditional household births are common in Greenville, and are higher than the state and country.

Secondary Data

In 2001, 2,670 women had children in Greenville County.

Among those, 37%, or almost 1,000 births, were among unmarried women. The United States rate is 29% and for South Carolina the rate is 35%. In 1998, 46% of births with African Americans were to single mothers; 10% of white births.

Source: U.S. Census 2001

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Unintended births are prevalent.

Secondary Data

Statewide, 50% of all live births and almost all abortions of young adult women are the result of unintended pregnancy; so approximately threefifths of all pregnancies are unintended. Two-thirds of these women were not using any means of birth control prior to or during the time they became pregnant.

Source: South Carolina Young Adults Count 2002

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38% of African American mothers to be do not initiate prenatal care until after the first trimester.

Secondary Data

Initiation of Prenatal Care by Mothers Ages 18 to 29 in Greenville County, 1990-1999

1 81% 1 1 61% 1
Rate per 100,000

76%

1 0 0 0 0 0 18% 15% 4% 3% 7% 1% 1% 3% 28%

Total White African American and Other

1st Trimester
Source: Young Adults Count 2002

2nd Trimester

3rd Trimester

No Prenatal Care
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For every dollar spend on prenatal care, the community saves almost five dollars.

Secondary Data

A study was conducted analyzing the delivery records of 970 undocumented immigrants in California in 2000. Those with no prenatal care:
Were four times more likely to be delivered of low birth weight infants Cost $2,341 more initially and $3,247 more when incremental long-term morbidity cost was added
Cost of Care

$12,000

$11,183
Prenatal care, $0

$10,000

Maternity care, $2,414

$8,000

$6,816
$6,000 Prenatal care, $702

Postnatal care, $3,930

Maternity care, $2,933 $4,000

For every dollar cut from prenatal care an increase of $3.33 in postnatal care and $4.63 in incremental long-term cost is expected.

$2,000

Postnatal care, $1,589

Long-term care, $4,839

Long-term care, $1,592 $0

Prenatal Care

No Prenatal Care

Source: Michael C. Lu, et. Al, Elimination of public funding of prenatal care of undocumented immigrants in California: A cost/benefit analysis American Journal of Obstetric Gynecology, January 2000

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The infant mortality is better than South Carolina and the United States.

Secondary Data

In the United States, nine out of every thousand infants die before age one--a mortality rate higher than that of 19 other nations. In Greenville, the infant mortality rate is 6.8 per 1,000 compared to 9.8 for South Carolina, and 7.2 for the United States. The mortality rate is higher for infants born in minority families. African American babies are twice as likely to die within the first year of life as white babies.

Infant Mortality
14.0

12.0

11.8 10.4

11.2 9.2 9.8

10.0
Rate per 1,000

8.0

7.5 6.8

6.0
1996

4.0

1997 1998 1999

2.0

Source: Starting Points: Meeting the Needs of Our Youngest Children, The Carnegie Foundation, 1999 and SCDHEC, 2000

0.0
Greenville Spartanburg Anderson York Columbia Charleston South Carolina

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Secondary Data

Created to measure the health of Americans by the CDC. Conducted annually, collected monthly.

Core survey, with special issues conducted on a state level. Some of the CHA 1998 survey modeled after the core survey.
In 2001, 212,510 surveys conducted. 3,201 conducted among South Carolinians, and 312 among Greenvillians.

We have downloaded the data files and are able to develop analyses for Greenville for the past several years. Cannot, however, dig into the ZIP code or neighborhood level.
The data file will be given to the United Way and Health Department if needed.

Source: BFRSS, 2001

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An Example of Personal Health Data from BRFSS Survey

Secondary Data

Greenville Physical health not good Mental health including depression and stress Poor health kept from usual activities 65%

South Carolina 67%

United States 66%

35%

33%

34%

39%

40%

38%

Source: BFRSS, 2001

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Based on the BRFSS, Greenvillians in 2001 believed they were healthier than South Carolinians and Americans.

Secondary Data

Perceived General Health

35%
31% 32% 29% 33% 29% 29%

30%

25%

23%

24% 22%

20%
Greenville

15%

South Carolina United States 12% 11% 12%

10%
5% 5% 5%

5%

0%
Excellent Very Good Good Fair Poor

Source: BRFSS, 2001

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CTS Household Survey

Greenville was selected as one of twelve communities to be studied throughout the country. Since 1998, the Center has conducted site visits and surveys specifically about Greenville and how it relates to other communities. A new report is expected in May 2003. Preliminary copies will be mailed if available.

Secondary Data

Typical Questions Was there any time during the past 12 months when you put off or postponed getting medical care you thought you needed? Is there a place that you usually go to when you are sick or need advice about your health? All things considered, have you been satisfied or dissatisfied with the health care you have received during the last 12 months? How long did you have to wait between the time you made the appointment and the day you actually saw the doctor?

Have conducted three waves of surveys with consumers, physicians, and employers. In the last wave, 59,000 individuals were interviewed.
The 1999 survey talked with over 2,500 residents of the Greenville MSA. We have secured this data, and are applying for the ability for deeper analysis.

Source: Center for Studying Health System Change

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The Community Impact Study measured the state of Greenvilles neighborhoods

Secondary Data

Using the United Way of Americas COMPASS research software, surveyed Greenvillians.
As part of the effort, a telephone survey was conducted with 864 residents during the last quarter of 2002. This effort is helpful to validate the efforts being conducted here.

Source: Community Impact Study, 2003

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Neighborhood Issues
Major Neighborhood Issues (% saying a "Major" issue)
Poor road and/or traffic conditions Quality of education Lack of affordable medical care 19% 18% 17% 17% 16% 14% 14% 13% 12% 11% 11% 11% 10% 9% 9% 9% 9% 8% 7% 7% 7% 6% 6% 6% 6% 6% 5% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%
II - 74

Secondary Data

Inadequate public transportation Shortage of recreational facilities Unemployment or underemployment Crime Lack of jobs Alcohol and/or drug abuse Lack of affordable care for children Lack of cultural activities School drop out Poverty Noise or other pollution Unsafe school environment Teen pregnancy Shortage of affordable housing Water or air pollution Family violence, abuse of children or adults Racial or ethnic discrimination Illiteracy Gangs Substandard housing HIV/AIDS Sexually transmitted diseases Mental illness or emotional issues Overcrowded housing

Top Five Poor road and/or traffic conditions Quality of education Lack of affordable medical care Inadequate public transportation

Shortage of recreational facilities

Source: Community Impact Study, 2003

Residents say affordable healthcare is the biggest issue in Downtown and Fountain Inn

Secondary Data

% saying Lack of affordable medical care is a major issue

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Household Challenges
Top Five Finding it difficult to budget money

Having a lot of anxiety, stress, or depression

Not having enough money for doctor, prescription medications, or insurance Children receiving quality education Not being able to find work

Major Neighborhood Issues (% saying a "Major" issue)

Finding it difficult to budget money Having a lot of anxiety, stress, or depression Not having enough money for doctor, prescription medications, or insurance Children receiving quality education

23% 20% 20% 15% 13% 13% 13%

Living in housing that needs major repairs Children or teenagers experiencing behavior or emotional issues Children being unsafe at school

7% 7% 7% 7% 6% 6% 6% 6% 6% 5% 4% 4% 3% 3% 1% 0% 5% 10% 15% 20% 25%

Secondary Data

Feeling unsafe in your neighborhood Not know ing w here to go to receive medical care. Not being able to get transportation for a person w ith a disability or an elder Experiencing an alcohol and/or drug issue

Not being able to find w ork Having no place to go for recreational activity Experiencing noise or other pollution

Not being able to afford legal help Not being able to get care for a person w ith a disability, serious illness, or an elder Not being able to afford recreational activities Experiencing air or w ater pollution Not being able to afford entertainment activities Not having any place to go w here you can receive medical care. Not having enough money to buy needed clothing and shoes Not having enough money for food Not having enough money to pay for housing

11% 11% 10% 10% 10% 9% 9% 8% 7% 5% 10% 15% 20% 25%

Not having enough room in your house for all the people w ho live there Not being able to find or afford care for children Not being able to get transportation for yourself Experiencing racial, gender, or ethnic discrimination Experiencing household crime

Difficulty in reading w ell enough to get along Experiencing physical conflict in the household Experiencing household threats from gangs

Source: Community Impact Study, 2003

0%

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Satisfaction with Health Care

35%

Secondary Data

Families not satisfied with the health care they received during the last 12 months Physicians not agreeing that it is possible to provide high quality care to all of their patients

30%

25%

20%

15%

10%

5%

0%
G re en vi lle Li ttl e R oc k In di an ap ol is Cl ev el an d La ns in g i 20 0, 00 0 Ne wa rk Bo st on Co un ty ix Sy ra cu se Se at tl Ph oe n M St at es e ia m

O ra ng e

ov er Po pu l at io ns

Source: Household and

Physicians Surveys, Center for Studying Health System Change, 1997

Un i

te d

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