Health assessment pinpoints Kents needs

February 5, 2012
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Equal access to quality, affordable health care in Kent County is a laudable goal that’s still out of reach for too many of its residents, according to a recently released Kent County Community Health Needs Assessment. The level of a person’s education, their ethnicity and a dearth of medical providers who serve Medicaid patients are leading reasons for a chronic health care gap.

As a result of the study, which was conducted last year and required a coalition of service agencies, community hospitals, mental health providers, community aid foundations and the Kent County Health Department to work in tandem to craft a long-term systemic strategy, the CHNA has arrived at some lofty goals. They include tackling chronic diseases, promoting healthier lifestyles, reducing health disparities and getting a tighter rein on health care spending.

Input was culled from a racially and ethnically diverse group of individuals from throughout Kent County who possessed a broad range of life experiences and economic backgrounds. The study involved more than 80 partners and 12 focus groups with nearly 120 participants and 395 interviews, all of which transpired over several months last year.

Access to health care was residents’ most salient concern during focus groups and intercept interviews. The reasons for the dearth of health care include: an inability to afford preventive health care; primarily using emergency rooms to address deteriorating health; an inability to access dental and mental health providers; lack of availability of low-cost and free health providers; and lack of providers who serve patients who are insured through Medicaid.

Dr. Erin Inman, director of Spectrum Health Healthier Communities, said she does not believe the CHNA will languish on a shelf, as is sometimes the case with well-intentioned studies.

The next step will be to develop and implement new programs and services to meet residents’ needs, and to take another needs assessment in three years to determine if it has paved the way for improvements, Inman said.

“I’ve been in health care for 17 years and this feels different because of the number of individuals we have at the table who have the same goals, and because we have tangible data and because we have narrowed our priorities into pieces that we can tackle, that we can address,” said Inman. “I also believe, because this works hand in hand with other projects going on that will provide dollars to build a plan, that will also help address these same areas.”

The “other projects” Inman refers to includes a $1 million Community Transformation Implementation Plan grant awarded to Kent County by the Centers for Disease Control and Prevention. The grant is part of the U.S. Department of Health and Human Services' Community Transformation Grants to support public health efforts to reduce chronic diseases, promote healthier lifestyles, reduce health disparities and control health care spending. The three-year grant requires multiple organizations to work together to create a strategic approach to reduce three health measures by 5 percent: death and disability due to tobacco use; death and disability due to heart disease and stroke; and obesity rates.

The CHNA charted more than 40 health-related issues that residents indicated they wanted addressed. Of that number, the steering committee narrowed the list to five strategic priorities intended to build a stronger bridge between residents’ access to health care:

**Increase the proportion of community members, including the uninsured and working poor, who have access to affordable health care.

**Increase the number of providers available that accept Medicaid or offer low-cost/free services.

**Reduce disparities that block adequate prenatal care.

**Increase healthy eating by ensuring access to healthy foods.

**Reduce the disparity in health risk factors and protective factors between students.

One reason data was collected for the CHNA is because the Patient Protection and Affordable Care Act and Health Care Education Reconciliation Act of 2010 require tax-exempt hospitals to meet new requirements to maintain their tax-exempt status under IRC Section 501(c)(3). Tax-exempt hospitals and nonprofit organizations must conduct a community health needs assessment once every three years and adopt an implementation strategy to meet the community health needs identified in the assessment.

Although she wishes more time was devoted to culling data, Deanna Demory, Heart of West Michigan United Way’s director of community impact and health strategies, said the CHNA carries sufficient credibility to serve as a road map for revamping her nonprofit’s focus on its methods of funding, education and the health of those it serves.

“I call it the golden egg for United Way,” Demory said. “We are looking at revamping how we fund and what we focus on. What we will do with this information is take it and use it and figure out where we need to put our strategic energy. We divided that up into three areas: education, income and health and in order to do that, we need a community health needs assessment. It’s nice that we don’t have to do it by ourselves because the rest of community is involved.”

The CHNA coalition gathered data by forming two workgroups that collected population and community input data that spoke to community health access groups. Among the population data workgroup’s responsibilities was to review existing local, state and national secondary data sources to compile a comprehensive overview of the health status across populations within Kent County.

The community input workgroup gathered information from the community whose voice and health status may not be represented through local, state and national data sources. This involved setting up “community input walls” in large public venues so feedback from the public could be culled. Intercept interviews were conducted with vulnerable populations, and focus groups were used to gather feedback from diverse and hard-to-reach populations within Grand Rapids and Kent County.

Here is what these two workgroups discovered:

  • 13.6 percent of adults had no health care access during the past 12 months. However, the proportion increased for adults with less than a high school education (45.3 percent) and those lacking health insurance (54.9).

  • 10.7 percent of adults in Kent County report that they have no health care coverage. These numbers increased to 16.9 percent for African-Americans, 19.7 percent for adults with only a high school education and 23.6 percent for adults with less than a high school education.

  • Only 52.4 percent of youth who receive grades of D/F in school had received a check-up in the past 12 months.

  • 25.8 percent of adults in Kent County had not seen a dentist in the previous 12 months, and this proportion increased to 47.9 percent for adults lacking health insurance.

  • The current supply of dentists to serve low-income patients is about 55 percent of what is needed in Grand Rapids and only 29 percent of what is needed countywide.

Those who are white are more likely to receive adequate prenatal care in Kent County than if a person is Arab, black or Hispanic/Latino:

  • White: 78 percent said their prenatal care was adequate while 9.6 percent said it wasn’t.

  • Arab: 69.1 percent said their prenatal care was adequate while 17.5 percent said it wasn’t.

  • Black: 67.1 percent said their prenatal care was adequate while 19.8 percent said it wasn't.

  • Hispanic: 67.2 percent said their prenatal care was adequate while 17.9 percent said it wasn’t.

Moreover, the Kent County Fetal Infant Mortality Review found that African-American babies are significantly more likely to die before their first birthday than any other race. Further, African-American and Hispanic mothers were more likely to receive Medicaid, have had late entry into or no prenatal care, and experience distrust, fear or dissatisfaction with their health care.

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