A report released this month has identified the top five health concerns facing a four-county region in central Missouri.
The 2015 Community Health Needs Assessment of Cole, Miller, Moniteau and Osage counties outlines heart disease, mental health, health literacy, substance abuse and adult oral health as the most troublesome health woes of the examined area. The Central Missouri Community Health Assessment Partnership led the effort, joining together Capital Region Medical Center, SSM St. Mary's Hospital, Jefferson City Medical Group (JCMG), Community Health Center of Central Missouri, the United Way of Central Missouri and county health departments.
The assessment is a result of the Affordable Care Act, which requires nonprofit hospitals to complete a study once every three years. The hospitals must then implement a plan to address the concerns within the calendar year, said Tiffany Rutledge, Capital Region corporate and community health supervisor. From January to June, the partnership conducted the study, using analytic data and feedback from area residents, community leaders and physicians to narrow down the region's health priorities.
Discussion groups, individual surveys and a poll of health care providers and physician groups provided the partnership with its feedback, which Tracy O'Rourke, SSM regional vice president of strategy and business development, said was essential in the process.
"I think it was a great opportunity for us to hear from the public and stakeholders dealing with these issues," O'Rourke said. "The data tells part of the story, but the ability to talk to individuals who face this day in and day out was valuable."
Rutledge said the assessment is not perfect because certain data is several years old, but community feedback pinpointed reoccurring themes.
Community signals mental health, substance abuse as troubling trends
Mental and behavioral health was one of those reoccurring themes, according to the assessment. Participants in all seven community forums discussed the need for greater mental health services and better access to it.
"They were really calling out for help," Rutledge said, referencing the forums.
Rutledge said mental health was not on the partnership's radar in 2012 when it completed its last assessment. The top five topics then were: access to quality care, heart disease and obesity prevention, cancer screenings and treatment, diabetes prevention and management, and overall health status of Miller County.
Data from 2012 ranked mental disorders third in causes for in-patient hospitalization within the region.
The call for better mental health stretched across age groups.
A participant in the Cole County Community Leaders' second session commented, "We have children in dire need of help and nowhere to turn."
In the Moniteau Community Community forum, someone said, "(Division of Family Services) resources have been taken away like counselors going into the home. There are less case workers now. The kids are drowning in the chaotic environment."
When mental health issues aren't addressed, Rutledge said law enforcement is on the front line of response.
A participant in the first Cole County session commented, "A lot of people are struggling with mental health issues that end up committing crimes, and then the police are left to handle the situation."
Rutledge said educators also often face the challenge of assisting those with mental health issues. Both police and educators, she said, are sometimes not trained well enough to properly handle these situations, and that's when they look to the medical community for support. Capital Region will specifically target mental health in its implementation plan, Rutledge said.
"We're pulling anyone who provides mental health service in the community, see what limits access and what specific pieces Capital Region can impact," she said.
Focus groups also overwhelmingly sounded problems with substance abuse, particularly with youth and how a greater amount of drugs are available to them. The assessment lists the substance abuse challenges the community faces as:
• Underage drinking;
• Retailers targeting/selling to minors;
• Rock methamphetamine;
• Exposure to younger children;
• E-cigarettes and smoking;
• K2, marijuana and triple C;
• Skittles parties (sharing of prescription medications); and
• No access to substance abuse treatment, detox or recovery programs.
One of the 22 participants in the Miller County focus group said, "A family here in our community has a child with a drug problem, and there are no resources to get him the care he needs. This is a family that works hard, cares for their child and has insurance, yet their hands are tied. They are left to try and sort this out on their own."
Heart disease kills most in region
Heart disease made the list both in 2012 and 2015. Risk factors for the disease are rampant in the region, the assessment shows. According to the National Heart, Lung and Blood Institute, smoking, high amounts of fat and cholesterol, high blood pressure, high sugar levels, diabetes and blood vessel inflammation contribute to heart disease.
Obesity, smoking and no exercise are three of the top five health risk factors for the area. Heart and circulation problems are the No. 1 cause of in-patient hospitalizations, and congestive heart failure is the fifth preventable condition that landed people in the hospital.
Heart disease ranks No. 1 for the four counties in chronic diseases utilizing the emergency room, chronic diseases requiring in-patient hospitalization and cause of death.
Physician groups at Capital Region and St. Mary's listed obesity as a top concern.
"The rate of obesity is continuing to climb, contributing to many health problems, most notably heart disease, which is the most prevalent disease/condition and the leading cause of death in Missouri including three of the four counties in our region," the assessment states. "A prominent health need is increased public education regarding healthy weight and risk factors for heart disease, along with greater access to screenings and follow-up care."
In each county, higher percentages of the adult population are overweight (recording a body mass index, or BMI, between 25-29) rather than obese (recording a BMI greater than or equal to 30).
• Cole County: 37.8 percent overweight and 25.8 percent obese.
• Miller County: 37.8 percent overweight and 33.5 percent obese.
• Moniteau County: 36.8 percent overweight and 32.9 percent obese.
• Osage County: 39.4 percent overweight and 27.2 percent obese.
Adult oral health, health literacy round out priority list
Though dental care did not score high in data rankings, the topic was re-addressed through community input. Of the 527 individuals surveyed, 40 percent felt dental health is a challenge for the community. Assessment feedback stated people lack dental insurance. Medicaid isn't an option as it doesn't cover oral health. According to the assessment, research links gum disease with another type of chronic disease, and evidence suggests dental health is connected to poorly controlled diabetes and heart disease.
Cole is the only county with a better population-to-dentist ratio than the state average with 1,871 individuals for every dentist. The disparity of dentists is the highest in Osage County with 4,563 individuals per dentist.
Lastly on the list, Rutledge said despite health information being easily accessible through the Internet, many don't comprehend what they read. Health literacy will change that, she added.
"There's a ton of information available, but they don't know how to interpret it," Rutledge said.
Medical community looks to the future
O'Rourke said St. Mary's Hospital will develop its own implementation plan over the next couple of months. Emily Mantle, JCMG community relations coordinator, said the for-profit group was not required to participate in the assessment but did so to be a player in meeting the community's health needs.
Rutledge said the assessment comes in handy on a daily basis for Capital Region as the medical center applies for grants and allocates resources for community betterment. A copy of the Community Health Needs Assessment is available on Capital Region's website, crmc.org, under the "About Us" tab.