District 8-1: Valdosta Addressing Community Health DisparitiesBY MERYL ABRAMS, DAVID BERNDT, MOLLY CINDERELLA, ASHLEY DAVIS, TRACE DEIGHAN, JADA FAMBROUGH, STEPHEN HAMMETT, SARAH JANSEN, NEIL PATEL, TAYLOR PHELPS, JOHN SHAPIRO, PAT SIMMONS, BENJAMIN SOOKHOO, AND ALLESYN YOUNG

Counties of District 8-1County Ranking

Echols (EC) 60

Lowndes (LW) 72

Berrien (BI) 76

Brooks (BO) 82

Tift (TI) 89

Lanier (LN) 100

Cook (CO) 108

Irwin (IR) 132

Ben Hill (BH) 147

Turner (TU) 153

EC

LW

TI

BO

BI

LN

CO

IR BH TU

Health District Popu-lation by County

Criteria for Ranking

Two components

• Health Outcomes

• Morbidity

• Mortality

• Health Factors

• Behaviors

• Clinical Care

• Social and Economic

• Physical Environment

• Changing health factors can shape health outomes

Health Behaviors• Diet and exercise• Sexual activity and teen

birth rates

Clinical Care• Access to care

• Golden Hour• Quality of care

Social Factors• Education• Employment• Income

Areas of Concern for District 8-1

Health Behaviors: Diet and Exercise

Problems

• Obesity

• Lack of physical activity

Potential Solutions

•Physically active classrooms

•Social support in community settings

• Buddy system walking groups

EC TU IR LN BO CO BH BI TI LW10%

15%

20%

25%

30%

35%

24%

33%31%

29%26%

29%31%30%29%

27%

Physical Inactivity

Georgia Avg. 24%

EC TU IR LN BO CO BH BI TI LW10%

15%

20%

25%

30%

35%

40%

29%

34%31% 31% 33%33%31%

30%34%

Adult Obesity

Georgia Avg. 28%

Health Behaviors: Sexual Activity

Problems• Teen Birth Rate

Potential Solutions

• Condom availability program

• Mass media campaigns

• Sexual education addressing pregnancy

and STDs

EC TU IR LN BO CO BH BI TI LW1.00%

3.00%

5.00%

7.00%

9.00%

11.00%

6.70%

10.10%

8.30%

5.70%

9.30%

7.80%

9.30%

6.30%

6.80%5.00%

Teen Birth Rate

Georgia Avg. 5.0%

Clinical Care: Access to and Quality of Care

Problems• Uninsured

• Primary care physicians

• Doctor: Patient ratio

• Golden Hour

Potential Solutions

EC TU IR LN BO CO BH BI TI LW18%

23%

28%

33%

38% 36%

25%25%26%26%

24%24%25%

22%

Uninsured

Georgia Avg. 22%

EC TU IR LN BO CO BH BI TI LW800

18002800380048005800680078008800

1604

64435296

1917

8000

3205

33701925

10102238

Pop. per primary care physician

Georgia Avg. 1611

Clinical Care: Access to and Quality of Care

Problems• Uninsured

• Primary care physicians

• Doctor: Patient ratio

• Golden Hour

Potential Solutions• Telemedicine

• Extended privileges of nurse practitioners

• Expand rural training tracts

1 2 3 4 5 6 7 8 9 1018%20%22%24%26%28%30%32%34%36%38%36%

25%25%26%26%

24%24%25%

22%

Uninsured

EC TU IR LN BO CO BH BI TI LW18%

23%

28%

33%

38% 36%

25%25%26%26%

24%24%25%

22%

Uninsured

Georgia Avg. 22%

EC TU IR LN BO CO BH BI TI LW800

18002800380048005800680078008800

1604

64435296

1917

8000

3205

33701925

10102238

Pop. per primary care physician

Georgia Avg. 1611

Social Behaviors: Education, Income EmploymentProblems• High unemployment

• Low median household income

Potential Solutions• Summer work experience

programs

• Career pathway and bridge programs for adults

• Drop-out prevention programs

• Early Head Start

EC TU IR LN BO CO BH BI TI LW5.00%

7.00%

9.00%

11.00%

13.00%

15.00%

7.3%

11.6%

13.2%

8.5%

9.4%

12.7%13.8%

12.0%

11.5%

9.3%

Unemployment

Georgia Avg. 9.8%

EC TU IR LN BO CO BH BI TI LW15000

20000

25000

30000

35000

40000

45000

50000Georgia: $45,886

Median Income

Health Disparities Amongst the Counties Counties differ by

Demographics

Geography

Access to care

Education

Economics

Disparities were identified based on African-American constitution

Hypothesized explanations

Disparity in health education

Community ties

Program efficacy

50 60 70 80 90 100 110 120 130 140 150 1600%

10%

20%

30%

40%

50%

County Health Ranking by African American Pop.%

5% 6% 7% 8% 9% 10% 11%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

County Teen Birth Rate by African American Pop. %

Disparities in Morbidity and Mortality Rural districts are more

prone to specific health outcomes

Urban settings provide: Better access to health

facilities

Improved capacity for health education of population

Broader range of programs tailored to community

Greater opportunities for social support

0

50

100

150

200

250

Disparities in Mortality by County Size

Lung Cancer Stroke Heart Disease

**Lines represent Georgia Avgs**

Risk Factors

Modifiable

1) Self risk behaviors

2) Access to primary care

3) Health education curriculum

Limited Modifiability

4) Number of facilities and hospitals

5) Homicide/MVA rate

6) Income/Economics of counties

Criteria for recommendations:• Fiscally feasible

• Geographically accessible

• Relevant to the community

• Culturally appropriate

How can we, as physicians, help?

• Assist in modification of risky behaviors

• Facilitate access to primary care

• Enlist help of teachers and counselors

• Identify and communicate health

disparities

Special thanks to…

Dr. William Grow, Health District Director; South District

Patrina Bowles, Health District Administrator Assistant

Erin Mundy, Director of Community Based Training Programs

Anne Hinton; Information Technology Support and Services

Bibliography• Alford S. Science and success, 3rd edition: Sex education and other programs that work to prevent teen

pregnancy, HIV and sexually transmitted infections. Washington, DC: Advocates for Youth; 2012.

• Barr-Anderson DJ, AuYoung M, Whitt-Glover MC, Glenn BA, Yancey AK. Integration of short bouts of physical activity into organizational routine: A systematic review of the literature. American Journal of Preventive Medicine. 2011;40(1):76-93. 

• Bartfeld J, Kim M, Ryu JH, Ahn H-M. The School Breakfast Program: Participation and impacts. Madison: University of Wisconsin-Madison; 2009.

• Bashshur RL, Shannon GW. National telemedicine initiatives: Essential to healthcare reform. Telemedicine Journal and e-Health. 2009;15(6):600-10

• Blake SM, Ledsky R, Goodenow C, et al. Condom availability programs in Massachusetts high schools: Relationships with condom use and sexual behavior. American Journal of Public Health. 2003;93(6):955-62. 

• Christenson SL, Thurlow ML. School dropouts: Prevention considerations, interventions, and challenges. Current Directions in Psychological Science. 2004;13(1):36-9.

• Daniels ZM, Vanleit BJ, Skipper BJ, Sanders ML, Rhyne RL. Factors in recruiting and retaining health professionals for rural practice. Journal of Rural Health. 2007;23(1):62–71

• Georgia Department of Health. Online Analytical Statistical Information System. Available at http://oasis.state.ga.us/oasis/. Accessed on October 27, 2013.

• Georgia Department of Public Health. South Health District Programs and Services. Available at http://www.southhealthdistrict.com/default.asp. Access on October 27, 2013

• Havnes T, Mogstad M. No child left behind: Subsidized child care and children’s long-run outcomes. American Economic Journal. 2011;3(2):97-129.

Bibliography cont.• Keller SN, Brown JD. Media interventions to promote responsible sexual behavior. Journal of Sex Research.

2002;39(1):67-72.

• Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: An evidence-based review. Obesity. 2008;16(5):1009-18.

• Laurant M, Reeves D, Hermens R, et al. Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Review. 2004;(4):CD001271.

• McCombs JS, Augustine CH, Schwartz HL, et al. Making summer count: How summer programs can boost children's learning. Santa Monica: RAND Corporation; 2011: Monograph Report 1120.

• National Center for Health Statistics. Vital Statistical Data: 1996-2005. Available at http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm. Accessed on October 27, 2013 Smith E, Green A. How workplace experiences while at school affect career pathways. Adelaide: National Centre for Vocational Education Research (NCVER); 2005.

• Social Security Administration. National Average Wage Index. Available at http://www.ssa.gov/oact/cola/AWI.html. Accessed on October 27, 2013.

• Sum A, McLaughlin J. Out with the young and in with the old: US labor markets 2000-2008 and the case for an immediate jobs creation program for teens and young adults. Boston: Center for Labor Market Studies Publications, Northeastern University; 2008.

• Tucker, Cherri, Colette Caldwell, Carla Graves, Kelly McNamara, and Allen Dever. "Fact Sheet on Georgia's Trauma Physicians." Gpbw.georgia.gov. Georgia Board for Physician Workforce, Apr. 2011. Web. 27 Oct. 2013.

• United Health Foundation. America’s Health Rankings, 2013 ed. Available at http://www.americashealthrankings.org/GA/2012-2012. Accessed on October 27, 2013.

Group member roles: Meryl Abrams – County Researcher, PowerPoint Contributor

David Berndt – County Researcher

Molly Cinderella – Communications Officer

Ashley Davis – County Researcher

Trace Deighan – County Researcher

Jada Fambrough – County Researcher

Stephen Hammett – Podcast Producer

Sarah Jansen – County Researcher, PowerPoint Contributor, Podcast Voice

Neil Patel – Podcast Producer

Taylor Phelps – County Researcher

John Shapiro – Data Analyzer, PowerPoint Contributor, Podcast Voice

Pat Simmons – Data Analyzer, PowerPoint Contributor

Benjamin Sookhoo – County Researcher, Meeting Coordinator

Allesyn Young – County Researcher