Running head: COUNTY HEALTH PROFILE 1

COUNTY HEALTH PROFILE 3

Madison County Health ProfileMaranda G. CavinderState College of Florida, Manatee-Sarasota

AbstractMadison County is a rural county in which there are many health related pitfalls when compared to the state of Florida. One of the biggest issues I noted while examining the available data was the large proportion of heart disease among residents of Madison County. As a matter of fact, Madison County has one of the highest rates of heart disease related deaths within Florida. In order to fully assess this indicator I dug deeper by investigating the incidence of hypertension, high cholesterol, obesity, nutritional status, and activity level. The interventions I proposed for this county include education of the community residents, providing health screenings to residents, increasing the activity level within the county, increasing the intake of fruits and vegetables by all residents, and lastly increasing the number of citizens who have insurance and access to medical care.

Madison County Health ProfileAssessmentCounty DescriptionMadison County Florida was created in 1827 and was named after the fourth U.S. President, James Madison (Madison County Florida, 2011). Madison County is located in northern Florida, near the Florida-Georgia border (Madison County Florida, 2011). According to the 2010 census data the county has a total area of about 695.95 square miles (U.S. Census Bureau, 2014). It is said that Madison was once Floridas largest county, but it has surrendered Taylor, Lafayette, and Dixie (Madison County Florida, 2011). Madison County has 2 towns called Greenville and Lee and one city called Madison City (Hometown Locator, 2014). There are approximately 15 neighborhoods, subdivisions or settlements within Madison (Hometown Locator, 2014). Madison County is bordered by 3 rivers, including the Aucilla River, the Withlacoochee River, and the Suwannee (Madison County Florida, 2011). Madison County is considered about 80% rural and only 20% urban (County Health Rankings, 2014). Unfortunately, Madison County is raked number 56 out of 67 on overall rankings in health outcomes and number 61 out of 67 if ranked on overall ranking in health factors (County Health Rankings, 2014).Education can be obtained through one of Madison Counties 5 public schools, and 3 private schools serving pre-kindergarten to twelfth grade. Madison County is also the home of North Florida Community College (Florida Department of Health, 2006). St Leo university also provides Bachelors Degrees on the campus of North Florida Community College.The most recent estimates state that Madison County is home to over a little more than 19,000 residents. Between the years 2000-2010 it is estimated that Madison County has experienced a 2.6% population growth. The largest industry sectors within Madison County are as follows: education and health services (16.4%), trade, transportation, and utilities (15.4%) and public administration (11.2%) (Florida Department of Transportation, 2013). Recent job growth in Madison County includes the following industries: educational services with 493 new jobs, retail trade with 61 new jobs, administration support, waste management, and remediation services with 19 new jobs, construction with 11 new jobs, and manufacturing with 10 new jobs (Florida Department of Transportation, 2013). Despite this recent job creating many Madison County residents commute outside of the county for employment opportunities (Florida Department of Health, 2006). The top employers in Madison County are the Madison County Correctional Facility, Nestle Waters, Johnson & Johnson Petroleum, Madison County Memorial Hospital, and Life Park of Madison Nursing Home, (Florida Department of Transportation, 2013). Other top employers include the Madison County School District and the Madison County Government (Florida TaxWatch Briefing, 2012). Because Madison County is a smaller, rural area they have less access to health care within their own county. Within Madison County there are a total of about eight licensed physicians, and five family practice physicians (Florida Department of Health, 2014). Madison County also has five total licensed dentists (Florida Department of Health, 2014). The Madison County Health Department is another resource for those seeking medical care within the county. The health department provides a general clinic offering immunizations and physical exams, family planning and OB services, podiatry services, STD treatment, nutrition services, and much more (Madison County Health Department, 2013). The Madison County Health Department also provides a dental clinic for which fees are based on documented family size and income (Madison County Health Department, 2013). Madison County has one hospital. The Madison County Memorial Hospital is a 42-bed hospital that has been serving the needs of Madison County since 1937 (Florida Department of Healthy, 2014). Madison County also has two nursing homes, the Lake Park of Madison with 120 beds, and the Madison Nursing Center with 60 beds (UCompareHealthCare, 2014). Madison County also has one dialysis center called Four Freedoms Dialysis and at least 4 pharmacies (UCompareHealthCare, 2014). Madison County residents also have access to the North Florida Medical Centers Tri-County Family Health Care center which sees patient on a sliding scale program (North Florida Medical Centers, 2014).County Demographic and Socioeconomic IndicatorsUnless otherwise cited, the source of all demographic, economic and health indicator data included in this report is the Florida Community Health Assessment Resource Tool Set (CHARTS) website (Florida Department of Healthy [FDOH], 2014). Based on 2012 estimates, a total of 19,374 people live in Madison County. The age distribution in Madison County is similar to that of the state, with the highest percent of the population (27.9%) in the 45 to 64 years of age group. The median age in Madison County is 40.2 years compared to the state median of 40.3. The distribution of population by race is somewhat different than that of the state; 59.1% of the county population is White, 38.9% are Black and 2.0% are Other. In the state of Florida, 78.4% of the population is White, and 16.5% are Black. The proportion of the county population of Hispanic ethnicity is 5.0%, which is significantly lower than the proportion of the state population (23.2%)Madison County Residents fall in the fourth (least desirable) quartile when compared to other counties within Florida when ranked on measures of economic stability. Between the years of 2006-2010, 21.0% of Madison County residents lived at or below the Federal Poverty Level (FPL), compared to 13.8% of residents statewide. The median household income in Madison County (between 2006 and 2010) is about $37, 459 which is less than the states average of $47,661. More than one-third of Madison County children below the age of 18 years (39.5%) lived in families at or below the poverty level. Unemployment rates for Madison County adults averaged 8.8% between the years of 2006-2010, compared to 8.9% among Florida adults. Reported measures of educational achievement among the residents of Madison County are also less than the state average, with 25.2% of county residents over the age of 25 years having less than a high school diploma (compared to 14.7% statewide). However, less than 3% of Madison County residents over the age of 5 speak English less than very well, compared to 11.8 % statewide. Communicable Disease IndicatorsMadison County residents fall in the fourth quartile when compared to other Florida Counties when ranked on the total Gonorrhea, Chlamydia and Infectious Syphilis. Between the years of 2010-2012 708.1 residents out of a total of 100,000 were infected with one of the above STDs, compared to 513.7 individuals statewide. Madison County raked in the first quartile with no residents infected with Syphilis, compared to 6.7 out of 100,000 residents statewide. Madison County fell short on the number of reported gonorrhea cases, falling into the fourth quartile. The number of residents with Gonorrhea in Madison County between the years of 2010-2012 was 172.7 per 100,000 compared to 104.6 per 100,000 residents in the state of Florida. Madison County again fell short on the reported number of cases of Chlamydia, again falling into the fourth quartile. Between the years of 2010-2012 535.4 per 100,000 residents within Madison County reported having Chlamydia compared to only 402.4 per 100,000 residents statewide. Madison County residents fall in the first quartile when compared to other Florida Counties on measures of acute hepatitis b cases. In 2010-2012 0 residents per 100,000 were newly infected with hepatitis B compared to 3.7 per 100,000 residents statewide. Madison County residents fell into the fourth quartile when compared to other Florida Counties on measures of tuberculosis cases. Between the years of 2010-2012 5.2 out of 100,000 residents within Madison County were diagnosed with tuberculosis compared with only 2.9 per 100,00 residents within the state of Florida. Lastly, I would like to examine the rate of HIV and AIDS cases within Madison County. Unless otherwise stated the figures provided below are based on 3 year rolling rates for the years 2010-2012. All of these rates are established per 100,000 individuals. In Madison County the rate of HIV cases for all races is 12.1 which is more than 50% less than the state rate of 27.2. This counties rate has consistently remained less than the states rate of HIV cases. In Madison County during the above given years all cases occurred in Black, Non-Hispanic individuals, there were no cases in White or Hispanic individuals. In Madison County the rate of AIDS cases for all races is 5.2 which is more than three times less than the states rate of 16.3. With one exception Madison Countys rates have remained less than the state rate dating back to 1991. In the period from 2006-2008 the rate of AIDS cases in Madison was 26.0 contrasting to the states rate of 23.7. As with the HIV cases in Madison County there were no AIDS cases reported during 2010-2012 by White or Hispanic individuals. All cases were reported by Non-Hispanic Black residents. Chronic Disease IndicatorsUnless otherwise stated the death rates presented in this paper are three year age adjusted death rates for the years of 2010-2012. During the three year period between 2010- 2012 there were a total of 634 deaths in Madison County. For Madison County the age adjusted death rate (AADR) per 100,000 for the years of 2010-2012 was 886.3 compared to the rate of 682.0 for the state. The 3 year AADR per 100,000 by race for all causes of death in Madison County are as follows: White (841.0), Black (968.2) and Hispanic (549.0), compared to the state with White (674.5), Black (765.8), and Hispanic (520.8). Heart disease appeared to be the leading cause of death in Madison County with the 3 year AADR per 100,000 for all races being 267.0, compared to a rate of 155.5 for the state. Using the same parameters the 3 year AADR by race in Madison County are is as follows White (232.1), Black (351.6), and Hispanic (129.2), compared to the state with White (153.5), Black, (176.9), and Hispanic (127.8). As demonstrated by the data, it is clear that deaths from heart disease seem to be more prevalent in Black residents, both county and statewide. White residents of Madison County also seem to have an increased rate of heart disease when compared to White residents of the state. The second leading cause of death is cancer. Cancer deaths within Madison County accounted for a 3 year AADR of 143.6, compared to an AADR of 160.4 for the state of Florida. As you can see, the rate of cancer deaths among Madison County residents is slightly lower than that of the states residents. The 3-year AADR for cancer deaths by race in Madison County is as follows: White (155.6), Black (117.6) and Hispanic (52.8), compared to the states totals of White (161.1), Black (166.5), and Hispanic (116.1). Cancer seems to have been most prevalent in White residents within Madison County. Hispanic residents of Madison County had less prevalence of cancer than the state average. The third leading cause of death is chronic lower respiratory disease (CLRD), with the 3-year AADR for all races being 43.5 for Madison County and 39.0 for the state of Florida. As you can see, Madison County has a significantly higher proportion of individuals affected by chronic lower respiratory diseases when compared to number of affected state residents. When using the same parameters but displaying the data by race we see that the AADRs for CLRD in Madison County are as follows: White (53.9) Black (15.9), and (0.0) for Hispanic. This pattern is similar to that of all Florida residents, with the AADRs as follows: White (40.9), Black (23.2), and Hispanic (23.4). As you can see from the above data white residents have a higher rate of chronic lower respiratory disease than Black and Hispanic races. Lastly, I would like to talk about the sixth leading cause of death, drawing your attention towards the racial differences. The sixth leading cause of death is diabetes. In the state of Florida the 3-year AADR for diabetes was 19.6, compared to the AADR within Madison County being 25.0. Already you can see that diabetes related deaths are prominent within Madison County. Within Madison County the AADR for White residents with diabetes was (14.3), with Black residents having a higher rate of (47.7) diabetes related deaths. This racial distribution also rings true for state residents, with similar age adjusted death rates. According to the Florida Charts Data Dictionary the difference between age-adjusted death rates and crude death rates are as follows: Age-adjusted death rates control for differences between populations due to age. Age adjusted rates are calculated using the Year 2000 Standard Population Proportion. Population estimates are provided by the Florida Legislature, Office of Economic and Demographic Research. Crude death rates are usually expressed per 1,000 or per 100,000. Crude death rates are calculated by dividing the number of deaths by the estimated mid-year population, then multiplying by 1,000 (or by 100,000) (Florida CHARTS, 2013).Maternal and Child Health IndicatorsIn Florida, between the years of 2010-2012 there were a total of 640,710 births. In Madison County there were a total of 637 births between the same years, leaving us with an average of about 212.3 births per year. Between the years of 2010-2012 the rate of births to Florida mothers ages 15-19 (per 1,000 births) was (29.6) in comparison to the population of Madison County rate of (39.9). As illustrated by these figures it is obvious that Madison County has a higher rate of births to mothers age 15-19 than that of the state. Within Madison County the majority of these births were by Blacks with a three year rate of (43.3), compared to Whites (37.1) and Hispanics (23.8). Using the same parameters for the state of Florida, the rates are: Black (45.3), Whites (25.5) and Hispanic (30.2).The infant mortality (Deaths from birth to 364 days) rate per 1,000 individuals for the state of Florida between the years of 2010-2012 was 6.3. This equals about 4,057 total infant deaths in Florida for the given years. Using the same parameters for Madison County the rate for all races is 14.1 with a total of 9 infant deaths for the given years. Given this data it is evident that there is a higher rate of infant mortality within Madison County when compared to the state. Given the same parameters the racial breakdown in Madison County is as follows: White (2.9), Black (28.8), and Hispanic (33.3), in comparison to the states racial breakdown: White (4.7), Black (11.5), and Hispanic (5.1). Given the above data it is evident that the rate of infant deaths in Black and Hispanic residents is higher in Madison County than the states average. The total number of live births under 2500 grams (between the years of 2010-2012) within the state of Florida was 55,568 births, in contrast to Madison County with a total of only 75 births. The total percent of low birth weight babies (