IPLAN

Purpose

The purpose of the Cumberland County community health plan is to promote and protect the health of all county residents.  This is to be accomplished through programs provided by the department in family case management, screenings, chronic disease management, prevention, environmental and education on relevant issues. With that in mind, let us set about developing a program outline which will increase healthy lives for all Cumberland County residents.  What is the plan, why it is necessary, and how to adapt it to meet the needs of Cumberland County residents is the focus of community sessions.  The process will include:

• Endorsement of the Board of Health
• Review of health department current status
• Establishing program outline
• Locating and confirming meeting sites
• Preparing news releases
• Sending invitations to specific representatives
  • County and township officials
  • Law enforcement
  • Senior programs
  • School officials
  • Health care providers
  • Mental health
  • Interagency members
  • Randomly selected township residents
• Carry out programs
• Summary of programs
• Prepare, review and submit IPLAN

This plan will be a roadmap to develop programs over the next five years to meet the needs identified.  All activities of the health department will be assessed according to the plan.  Evaluations of the programs will be ongoing and reported to the Board of Health.

Assessment

Assessment of the health needs in Cumberland County was a process of gathering relevant existing data, generating missing data, and interpreting the database.  Data collection began with the review of statistics found in the 1990 census of Housing and Development published by the U.S. Department of Commerce (appendix B), 1998 death statistics from the county clerk's office (appendix D), and the IPLAN data system (appendix A).

In review of the IPLAN Data System Report for 1993-1997 the following observations are made.

2.02 Leading Causes of Mortality - The top five causes of death are heart disease, malignant neoplasm, cerebrovascular disease, chronic obstructive pulmonary disease, and unintentional injury.

2.06 Potential Loss of Life (at age 65) - The numbers fluctuate to signify the top three as malignant neoplasm, unintentional injury and cardiovascular disease.

3.0 Maternal Child Health - Percentage of "Mothers who smoke" is higher than the state. There may be an upward trend for the number of teen pregnancies (plus 23 currently in WIC since beginning of 1998).

4.0 Chronic Disease - Cardiovascular disease (including cerebrovascular disease) has been significant since 1995 with an upward trend in the crude death rate percentage.  Lung cancer is the most significant of the malignant neoplasms with percentages high than the state and national averages.

5.0 Infectious Disease - No significant data.

6.0 Environmental/Occupational injury - There is a significant upward trend in the number of assaults since 1995.

7.0 Sentinel Events - It is notable that there is a high number of adults hospitalized for uncontrolled hypertension and children with asthma.

In reference to the IPLAN Data System indicators there are many factors that influence the approach to the overall community plan for meeting the health needs.  This part of the assessment is vital to the success of all programs.  The socioeconomic characteristics specific to Cumberland County include the high number of retired farming individuals (age 75+).  These residents have Social Security as the major source of income with many receiving less than $500 per month.  Their strong sense of pride helps to meet expenses on a very meager income.  The access to care is limited by transportation issues and low income.  There is no "Urgent Care" after clinic office hours so healthcare questions will be answered by an emergency trip to the hospital 30-40 miles away.  Maternal/Child healthcare is provided by family and friends, the health department, and visits to the local clinic.  WIC has a positive image in Cumberland County.  Chronic Disease management is supported by local professionals.  Many will believe what they hear from family members, right or wrong.  The approach to infectious disease is recognized as the "health department responsibility".  The immunization program reaches more individuals than any other does.  The environment concerns are related to quality water availability.  No large industries or factories exist in the area.  The focus of environmental programs relates to agriculture.  Sentinel events are directly related to education and access to healthcare.

In review of the Illinois County Behavioral Risk Assessment data the following observations can be made.

Cholesterol - The records indicate that screenings are being performed at the same rate as the state.  There is concern that 34.8% were elevated as compared to Illinois at 29%.

Colorectal Cancer Screening - Cumberland County is significantly lower than the State for both digital and proctoscopy exams.  (Digital CC-65.2%, IL 71.3%; Procto CC 28.2%, IL 34.9%)

Dental visits - 58.8% of the county residents have visited the dentist within the past year.  The chief reason for not visiting is that they "do not have a reason to go".

Exercise (sedentary lifestyle risk) - 37.3% describe their lifestyle as sedentary (IL 24.8%).  Those older than 65, especially (49%).

Fruit and Vegetable consumption - 10% of 18-24 yr-old adults do not eat the recommended 5 servings per day (IL 14.2%); and 56% of those 24-44 yrs. consume less than 3 per day (IL 47.7%)Hypertension - 73% of the respondents have had their blood pressure checked within the past year (IL 72%); 25.4% of those were told that they had high blood pressure (IL 23.6%); there did not appear to be any age or gender significance.

Smoking - It is significant that the percentage of 25-44 year old adults who smoke is 32.8% (IL 27.1%); of the 45-64 category 31.6% smoke >1 pack per day (IL 27.1%) (sample size 33); Very significant is the number of respondents who have tried to quit in the past year in each age category.

	Cumberland County	Illinois
(18-24)	80.4%	62.6%
(25-44)	44.2%	47.2%
(45-64)	37.2%	33.6%
(>65)	63.0%	31.8%

Acute Drinking Risk (Binge: > 5 drinks at one time within a month) - Alarmingly high percentage noted in the 18-24 age group (49.6%, IL 23.9%) with higher than state averages for all other age groups.  It is noted that the sample size was small.

In the data collected in the "I Sing the Body Electric" survey of high school students in the county other risk factors were identified that affect health and wellbeing of residents.  These percentages were based on raw data collected at the smaller of the two high schools in the county and no comparisons have been assessed with any larger body asked the same questions.  The primary areas of concern from that data include:

Seat-belt use - 29% rarely, if ever, wears a seat belt.

Smoking - 21% of those who smoke started at the age of 13-14 and 13.9% did not show any ID to purchase cigarettes.

Binge drinking - 34.7% had more than 5 drinks at one time within the past month.

Health concerns - Drinking was identified by the teens as the most important concern.

Relevant existing data from the IPLAN data system and 1998 death statistics (county report) reveal the following broad categories:

Through the Nominal Group process, missing data of the health needs of the community was collected.  The group was encouraged to brainstorm and formulate a needs list.  The leading topic at the open sessions related to issues with children, chiefly behavioral problem and dental care access.  The second area was the problem with access to help in the home for chronically ill and their families.  At the beginning of each session the representatives also completed a written survey.  Healthcare access and community health in the home again had a strong lead.

Two follow-up sessions divided the topics into age and environmental categories.  Interpretation of all the data allowed grouping the needs into seven categories.  These were then ready for prioritization.

Some background information about the residents of Cumberland County needs to be also considered in the review of this statistical data.  Chief areas for information sharing are at school sporting events, church, and club meetings.

Family ties and traditional lifestyles play an important role in ranking the perceived importance of health problems or needs.  Heritage of the majority of families is part of the assessment of body structure, size, shape, gait and personalities so that it identifies the county population, even to the extent of location of the resident township.

Most of the population is located in remote rural homes.  There is an abundance of homegrown beef, pork, eggs, seasonal garden produce and fruit orchards.  All tend to "look after" their neighbors, sharing what they have.  This extends to the equally important time of sickness, disaster, and death.  This is the main source of health information, right or wrong.  They will tend to recognize the expert as someone from the county over an "outsider".  Therefore, based on this data, we need to target activities that include cardiovascular, respiratory related diseases, cancer and assaults.

Traditions run strong.  Most homes have great cooks and local family members for sharing, preparing, and serving food.  Many use real whipped cream for special dishes and serve desserts such as rich fudge or peanut brittle.  Breads, meat and potatoes are on the menus for all meals.  "Christmas is not Christmas without........"

During the late 70's and through the 80's the cancer rates in Cumberland County were recorded in depth.  Specific patterns were identified with high rates and types of cancer in certain areas of the county.  Few knew (or didn't want to believe) that large amounts of unknown chemicals were discharged into road ditches in Greenup.  Every household in that area had one or more deaths related to cancer at that time.  When inspected, it was found to be a number one hazardous materials dumpsite in the state and ranked number 16 in the nation.  Due to the intense efforts of the Health Department the area was cleaned up, but many wonder if traces remain.  Cancer screening has moved from the highest priority to a concern since that time.

All of this data and information were compiled to identify the health needs of the county for the next five years.  The county residents have indicated a desire to assist with the program development, selecting individual areas of interest.  They appear to have accepted ownership of the problems and are ready to participate in programs to preserve and protect the heritage of Cumberland County.