EXECUTIVE SUMMARY

This report contains the results of a baseline community health assessment of Marion County which supports development of a unified leadership model that will continuously assess and improve the health status of the population of Marion County. This effort envisions an Indianapolis where health institutions work collaboratively to attain measurable improvements, where individuals take responsibility for their health, where the emphasis is on prevention, and where cost effective, high quality health care is accessible to all.

The community health assessment has been a cooperative effort of the Marion County Health Department and the following Marion County hospitals: Community Hospitals Indianapolis, Indiana University Hospitals, Methodist Hospital of Indiana, St. Francis Hospital and Health Centers, St. Vincent Hospitals and Health Services, Westview Hospital, Winona Hospital, and Wishard Health Services. A Steering Committee, comprised of representatives from the participating hospitals and the Marion County Health Department, designed the community health assessment process with the understanding that there are many stakeholders responsible, in a broad sense, for the community’s health. These health system stakeholders include a complete array of purchasers, payors, providers, and consumers. A Community Advisory Committee, composed of representatives of community organizations, promoted community involvement in the assessment and identified community health issues.

Two governing principles have driven the design and development of this project: (1) the most effective way to improve the overall health status of the community is through enhanced neighborhood-based services organized around a primary care model; and (2) a comprehensive community health needs assessment that provides baseline data is prerequisite to the development of a long term community effort to improve the health status of persons living in Marion County. The term “health” is defined in its broadest sense--one which includes biologic, environmental and lifestyle factors, as well as those related to the health care system.

The Indiana University Bowen Research Center (located on the IUPUI campus) was responsible for survey design and execution, data collection and analysis, and report preparation. The data collection tasks of this project have been closely coordinated with the Community Service Council's SAVI (Social Assets/Vulnerability Indicators-a comprehensive database of community indicators) update. Bowen Research Center staff, with significant assistance and input from the Steering Committee and Marion County Health Department staff, collected, organized, and analyzed the health assessment data from three major sources:

• Baseline statistical data from a wide range of sources, including vital statistics, hospital discharge data, SAVI, Census, and others;
• Data from a random sample of 2,895 telephone interviews and 701 follow-up in-home interviews; and
• Information gathered from 13 focus groups.

Major Findings By Source

Statistical Data Sources

Heart disease, cancer and stroke are the leading causes of death in Marion County, as they are nationally. Cardiovascular diseases, including coronary heart diseases and stroke, account for over 40 percent of all deaths in Marion County. Cancer, lung cancer and chronic lung disease rates in Marion County exceed those at the state and national levels. The three most common avoidable causes of hospitalization (asthma, pneumonia and congestive heart failure) account for more than 4,100 hospitalizations annually in Marion County.

Reducing rates of these diseases requires changes in individual behaviors, such as smoking, alcohol consumption and physical fitness. For example, eighty percent of all lung cancer is attributed to cigarette smoking--and smoking rates in Marion County exceed state and national rates.

Data from Interviews

The importance of the relationship between the quality of the neighborhood and perception of overall health was demonstrated by the number of times the issue was raised in the interviews--a factor identified in other healthy cities projects.

1. Dirty Neighborhoods and Pollution
2. Cancer
3. AIDS
4. Problems Associated with Aging
5. Heart Disease
6. No Problems Identified
7. Colds/Flu
8. Lack of Money
9. Drug Abuse
10. Transportation/Access
11. Lack of Insurance
12. Smoking

The reader will note that the interview respondents’ perception of the major health issues facing Marion County differ from those supported by the statistical data. There may be several reasons for this seeming conflict--the important point is that where perception and reality do not match provides important information as to where public awareness and education efforts about important health issues would be most effective.

Focus Group Findings

The community leaders who participated in the thirteen focus groups identified specific areas of needs related to specific populations and health issues. In addition, a number of common themes to all the focus groups emerged:

• Community needs involving such issues as accessibility and coordination of services, the need to meet basic needs first, provide one-stop services, address illegal drugs, and others;
• Needs of community organizations, including technical assistance in planning and priority-setting, leadership support in forming collaborations, assistance in grant-writing, resources for staff development; and
• Specific recommendations for improving the effectiveness of health care service systems, such as involving the community and consumers in decision making, publicizing successful programs, promoting better communication among agencies, establishing measurable outcomes for all programs, and several others.

Findings By Health Issue

The data collected by the community health assessment were organized by “key health issues” and analyzed. The issues identified by that analysis--including consideration of the Healthy People 2000 objectives--led to the recommendations for intervention. The health issues which provide significant opportunities for improving the health status of the citizens of our community are chronic disease prevention and control, substance abuse, mental health, violence and abusive behavior, unintentional injuries, neighborhood health issues, environmental health, maternal and child health, HIV/AIDS, sexually transmitted disease, immunization and oral health.

During the assessment, community service organizations confirmed the need to develop a system to provide timely and useful demographic, environmental, socio-economic, and health status information to a group of diverse users-providers, neighborhood groups, service organizations, and others. Access to such a system would directly impact effectiveness and efficiency of community health improvement efforts.

Recommendations

The data gathered by the community health assessment raised nearly 150 health-related issues. The Steering Committee narrowed that list to eighteen focus areas by measuring each against the project’s guiding principles and by considering the needs of the community stakeholders. The recommendations are categorized into four major groupings to highlight the level at which efforts should be primarily focused. They are presented in no particular order.

1. Focus on Neighborhoods Enhance existing neighborhood-based interventions which bear directly on the concerns identified in the interviews.

• Improve the “livability” of our neighborhoods by focusing on safety, personal relationships, and appearance--as well as the quality of the services and resources available to them.
• Improve the environmental quality, appearance and cleanliness of our neighborhoods.
• Reduce unintentional injuries, particularly injuries due to motor vehicle accidents and falls among older adults.

2. Focus on Access and Appropriate Utilization of Health Care Services Interventions that increase access to community oriented primary care will reduce hospitalizations and the cost associated with extensive medical care.

• Improve access to primary health care services.
• Integrate screening and management of clinical depression into medical care.
• Increase access to substance abuse prevention and treatment services.
• Improve the health status of the homeless in Marion County.
• Reduce the incidence of adverse birth outcomes, including infant mortality.
• Improve access to screening, detection, proper treatment, and follow-up services for breast, cervical, colorectal, and prostate cancer.
• Reduce hospitalizations due to asthma and pneumonia.
• Improve the oral health status of Marion County residents.

3. Focus on Personal Responsibility Interventions which support and reinforce individuals taking personal responsibility for their own health and for their own behavioral choices.

• Reduce the prevalence of smoking among the adults and reduce the initiation of smoking among young adolescents.
• Reduce the prevalence of risk factors associated with cardiovascular disease.
• Reduce the prevalence of alcohol abuse.
• Reduce the incidence of adolescent pregnancy.
• Reduce the transmission of HIV and sexually transmitted diseases.

4. Improving Support Systems Enhanced support for the community’s health service directly impact effectiveness and efficiency of community health improvement envisioned by this effort.

• Develop an integrated health information network.
• Pool and coordinate resources to provide support services to health care providers and health-related programs.

Volume 1 -- Community Health Assessment