Sparrow Ionia Hospital: Community Health Needs Assessment Sparrow/Sparow Ionia H… · Lansing and...

Prepared for Sparrow Health System

Sparrow Ionia Hospital:Community Health Needs Assessment

Prepared by Public Policy Associates, Incorporated February 2013

Public Policy Associates, Incorporated is a public policy research, development, and

evaluation firm headquartered in Lansing, Michigan. The firm serves clients nationally in the public, private, and nonprofit sectors by conducting research, analysis, and

evaluation that supports informed strategic decision making.

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Table of Contents Executive Summary ......................................................................................................................1

Sparrow Ionia Hospital Service Area .................................................................................... 1

Key Health Care Needs Within the Sparrow Ionia Hospital Service Area ..................... 1

Priority Health Issues to Be Addressed by Sparrow Ionia Hospital ................................ 2

Introduction ...................................................................................................................................3

Purpose of this Report ............................................................................................................. 3

Data Gathering ......................................................................................................................... 3

Report Content ......................................................................................................................... 4

Sparrow Ionia Hospital Area Profile ..........................................................................................5

Community Health Indicators ..................................................................................................11

Children in Poverty ............................................................................................................... 13

Single Parent Households ..................................................................................................... 14

Housing Costs ........................................................................................................................ 15

Education ................................................................................................................................ 16

Community Safety ................................................................................................................. 17

Environmental Quality .......................................................................................................... 18

Obesity Among Adults ......................................................................................................... 19

Obesity Among Young People ............................................................................................. 20

Tobacco Use Among Adults ................................................................................................. 21

Tobacco Use Among Youth .................................................................................................. 22

Alcohol Use Among Adults ................................................................................................. 23

Alcohol Use Among Adolescents ........................................................................................ 24

Access to Physicians .............................................................................................................. 25

Preventable Hospitalizations ............................................................................................... 26

Medicaid Enrollment ............................................................................................................. 27

Health Insurance Coverage .................................................................................................. 28

Disease Prevention: Immunization ..................................................................................... 29

Mental Health (Adults) ......................................................................................................... 30

Mental Health (Youth) .......................................................................................................... 31

Perceived Health Status ........................................................................................................ 32

Infant Mortality ...................................................................................................................... 33

Low‐Weight Births ................................................................................................................. 34

Premature Deaths................................................................................................................... 35

Cardiovascular Disease ......................................................................................................... 36

Accidental Deaths .................................................................................................................. 37

Community Health Assets .........................................................................................................39

Hospitals .................................................................................................................................. 39

Federally Qualified Health Clinics ...................................................................................... 39

Rural Health Clinics............................................................................................................... 39

Extended Care Facilities ........................................................................................................ 40

Physicians and Nurses .......................................................................................................... 40

Findings ........................................................................................................................................41

Socioeconomic Indicators ..................................................................................................... 41

Health Behaviors .................................................................................................................... 42

Access to Care ......................................................................................................................... 43

Children’s Health ................................................................................................................... 44

Health Outcomes.................................................................................................................... 45

Community Health Issues .........................................................................................................47

Methods ...................................................................................................................... Appendix A Interview and Focus Group Participants............................................................... Appendix B

Acknowledgements ____________________ This report was prepared with the assistance of Sparrow Ionia Hospital and residents throughout Ionia County who provided their time and insights in helping to identify the most important health needs, issues, and concerns throughout this region. Included among them are health care consumers, health care professionals, community leaders, government officials, working people, retirees, educators, community organization staff, and others. This assessment would not have been possible without their participation. We would also like to thank Lisa McCafferty, Director and Health Officer for the Ionia County Health Department, and Robert Lathers, CEO, Ionia County Community Mental Health, for their insights and advice for this health needs assessment. Their knowledge and experience as public health officials provided considerable insight regarding the health status and the health needs of the community served by Sparrow Ionia Hospital. Sincerely, William Roeser, CEO Dennis Swan, President and CEO Sparrow Ionia Hospital Sparrow Health System

Assessing community health needs and adopting a strategy to address those needs provides hospitals with a valuable opportunity to work together with community partners to identify strategies for improving health, quality of life, and the community’s vitality.1 Robert Wood Johnson Foundation, 2012

1 Robert Wood Johnson Foundation, “What’s new with community benefit?” Issue Brief (October 2012), 1. http://www.rwjf.org/healthpolicy.

Sparrow Ionia Hospital | Public Policy Associates, Inc. 1

Executive Summary

Sparrow Ionia Hospital Service Area Sparrow Ionia Hospital serves patients throughout Ionia County, Michigan. Patients requiring more advanced services than are available at Sparrow Ionia Hospital typically seek these services in Lansing or in Grand Rapids, Michigan. The following information regarding the most important health care needs and issues within Ionia County is based on insights provided by health care consumers, community leaders, health care professionals, and others in the Sparrow Ionia Hospital service area who were interviewed as part of this assessment. These findings are also based on social, economic, and health care data about Ionia County that were drawn from federal and state government agency reports. Much of the quantitative data presented in this assessment were extracted from these sources and provided to Sparrow Health System by the Ingham County Health Department.

Key Health Care Needs Within the Sparrow Ionia Hospital Service Area

Healthy Life Styles. The Ionia community is characterized by high rates of overweight and obese adults and youth. Interviewees generally recognize a need to reduce obesity in children and adults within the community in order to reduce the likelihood of diabetes and other chronic diseases in the future. This is closely associated with the need to promote healthy lifestyles through better eating patterns, greater amounts of physical activity, and the reduction of “screen time” for video games and television, especially among children, as indicated by individuals who were interviewed for this report.

Access to Primary Care Services. According to data provided by the Michigan Department of Community Health, Ionia County is underserved by primary care physicians and other primary care providers. One of seven community residents lacks a primary care physician. Data also show that residents of Ionia County are more likely to lack health insurance than residents elsewhere in the Sparrow Health

2 Sparrow Ionia Hospital | February 2013

System service area, and it is believed by some interviewees that lack of insurance contributes to area residents’ lack of a primary care physician.

Chronic Diseases. The impact of poor health behavior choices and the lower rate of health insurance among Ionia County households contribute towards relatively high rates of chronic diseases in the area, according to community leaders who participated in this assessment. It is widely accepted among health care professionals that high rates of obesity and depression or poor mental health are associated with chronic diseases, and these diseases (such as heart disease or diabetes) are typically reflected in relatively high levels of premature mortality (e.g., death before age 75). Lack of access to primary care services may also contribute to the lack of preventive care and ongoing monitoring that is needed to keep chronic diseases in check.

Priority Health Issues to Be Addressed by Sparrow Ionia Hospital Based on the needs identified in the Healthy! Capital Counties collaborative and supplemental research conducted by Sparrow Health System, Sparrow Ionia Hospital will address the following priority health issues in an Implementation Strategy:

Healthy lifestyles Access to primary care


Introduction ___________________________

Purpose of this Report As a community‐based hospital, the mission of Sparrow Ionia Hospital is “to improve the health of the people in our communities by providing quality, compassionate care to everyone, every time.”2 The purpose of this report is to assess the health status and health issue concerns within this community in order for Sparrow Ionia Hospital staff to identify and understand the community’s most pressing health care needs and to suggest activities and services to address these needs and concerns. The results of this assessment will provide the basis for developing a set of specific actions that Sparrow Ionia Hospital, in collaboration with other community partners, may undertake to resolve these issues and concerns and, ultimately, improve the health status of the community at large and the health of its individual residents. Although Ionia County is not part of the geographic area represented by the Healthy! Capital Counties (H!CC) Collaborative, this community health needs assessment (CHNA) was modeled on the assessment conducted by the Collaborative in the Greater Lansing area over the past eighteen months. H!CC is a consortium of hospitals and community health departments in the tri‐county Lansing area, comprising Clinton, Eaton, and Ingham Counties. Sparrow Health System is a leading participant in the H!CC Collaborative, and much of the information presented in the CHNA for the Greater Lansing area has been used to provide a relevant set of comparisons for the health indicators presented for Ionia County. This report is designed to be used by Sparrow Ionia Hospital along with public and private organizations throughout Ionia County, Michigan, as a benchmark for improving the health and well‐being of every resident of this area.

Data Gathering The information presented in this CHNA has been gathered from two principal sources.

2 Sparrow Health System. Accessed December 19, 2012. http://www.sparrow.org/missionvision/.


Statistical information about the population of the community served by Sparrow Ionia Hospital, the social and economic characteristics of the community, and the health care experiences and characteristics of the residents of the community are derived from a variety of standard sources of information including the Centers for Disease Control and Prevention (CDC), the Michigan Department of Community Health (MDCH), and the Bureau of the Census. Much of this statistical information was provided to Sparrow Health System by the Ingham County Health Department. This statistical information has been supplemented by interviews conducted with residents of the community served by Sparrow Ionia Hospital and interviews with public health officials in Ionia County. These interviews provide balance to the statistical information provided by incorporating the insights and perceptions of the community’s residents, including their perceptions of what they believe are the most important health care issues within the community and their suggestions as to what should be done about them. Although the identities of these contributors are confidential, a list of the types of people who participated is provided in Appendix B.

Report Content This assessment contains the following information:

A profile of the demographic, socioeconomic, and health status characteristics of the community served by Sparrow Ionia Hospital.

Twenty five one‐page community indicator reports that provide specific data for the six‐county region served by Sparrow Health System’s four community hospitals, including comparative data for the State of Michigan. These indicator pages also provide some additional details about the indicators, the sources of information, and comments about the issues that the indicator reflects that have been gleaned from interview and focus groups participants.

A brief list of health resources within the Sparrow Ionia Hospital service area.

Findings that identify the most important health care concerns and issues within the community based on the data presented.


Sparrow Ionia Hospital Area Profile______ Lansing area community residents and leaders interviewed for the Sparrow Health System Community Health Needs Assessment reported their perceptions of the health status of community residents in this region are mainly “Fair” to “Good.”

This response is in contrast to the perceptions of individuals’ own health status as reported in the 2010 Behavioral Risk Factor Survey for this area. In that study 57 percent of area residents indicated that their personal health status was excellent or very good; 16 percent reported their own health status as fair or poor. Despite these relatively healthy findings, there are considerable health care issues and health care needs evident throughout much of the Sparrow Hospital service area as revealed through the statistical profiles provided in the following pages and through the comments provided through interviews with community leaders.

3.75

3.33

3.86

3.8

3.66

0 1 2 3 4 5 6

Sparrow Specialty

Sparrow Lansing

Sparrow Ionia

Sparrow Clinton

Six‐County Area

Community Leadersʹ Perceived Area Health Status, 2012 (1 = Very Poor, 6 = Excellent)


Sparrow Ionia Hospital Profile Ionia County has a population of 63,905 residents, as reported in the 2010 Census of Population. Ionia County is the second smallest county in the six-county Sparrow Health System (SHS) service area. Although Ionia County is roughly half-way between the Lansing and Grand Rapids areas of influence, basic health care services are provided by Sparrow-Ionia Hospital while more advanced health care services are provided by hospitals in Lansing and Grand Rapids, respectively. Ionia County is characterized by a mixed economy consisting of manufacturing, agriculture, and government. The major Ionia County employer is the State of Michigan Department of Corrections.

Population Characteristics – Ionia County

91.7%

4.7% 0.4%

0.5% 1.3%1.4%

Ionia County Population by Race

White

African‐American

Asian

AmericanIndian/AlaskanNative

Other

Multi‐racial

• Population size: 63,905 • Age breakout:

0 – 4: 6.4% 5 – 14: 13.7% 15 – 44: 41.4% 45 – 64: 27.0% 65 – 74: 6.5% 75 and over: 4.9%

• Median age: 37.0 years • Racial composition:

White: 91.6% African American: 4.7% American Indian/Alaska Native: 0.5% Asian: 0.4% Multi-racial: 1.4% Other: 1.3% Native Hawaiian/Pac. Islander: None

• Ethnic composition: Hispanic: 4.5% Non-Hispanic: 95.5%

Source: Bureau of the Census, 2010 Census of Population


Social and Economic Indicators – Ionia County

Indicator Definition Percentage Relationship to

Michigan Income Children below 18 in poverty 21.0% Family Single parent households 10.8%

Education

Population age 25+ with a high school degree 86.7% Population age 25+ with a Bachelor’s degree or higher 13.1%

Safety Rate of violent crimes per 100,000 person 156.6

Affordable Housing Percentage of households that spend more than 30% of income on housing

34.5%

Environment Population density per square mile 111.9 people per mile2 Lower Density

More favorable than the statewide average About average Less favorable than the statewide average Source: Bureau of the Census, American Community Survey, 2006-2010; 2010 Census of Population; Michigan State Police, 2010. Ionia County is similar to the statewide average for several of the social and economic indicators identified above, including percentage of children living in poverty, single parent households, affordable housing (households that spend 30% or more of income on housing), and the percentage of the population that has a high school degree. Although 90% of adults age 25 or more are high school educated, only 13% of the adult population holds a bachelor’s degree; the latter percentage is considerably below the statewide average for college graduates. This figure also is impacted by the thousands of state correctional inmates housed in Ionia County, few of whom have more than a high school education. Although thousands of convicted criminals are housed in four correctional facilities in Ionia County, this is a relatively safe community with a rate of violent crimes well below the statewide average.


Health Indicators – Ionia County

Indicator Definition Results

Comparison With

Michigan

Child Health Rate of preventable asthma hospitalizations per 10,000 children 4.3 per 10,000

Quality of Life Perceived health status as “fair” or “poor” 11.5%

Adult Health Rate of preventable diabetes-related hospitalizations among adults

13.6 per 10,000

Premature Deaths Percentage of deaths prior to age 75 50.6% Maternal and Child Health

Low birth weight and very low birth weight babies

65.7 per 1,000 live births

Safety Policies/ Practices

Age-adjusted death rate due to accidental injury

62.2 per 10,000

More favorable than the statewide average About average Less favorable than the statewide average Source: Michigan Department of Community Health, 2012. Ionia County children exhibit substantially lower rates of preventable asthma hospitalizations—a common indicator of community health—when compared to both the state average and the six‐county service area. Similarly, Ionia County has a relatively low rate of underweight babies. The percentage of premature deaths is also lower than the state average. Only 11.5 percent of residents perceive their health status as “fair” or “poor.” Adults have similar rates of diabetes‐related hospitalizations as found throughout the state. However, the rate of accidental deaths in Ionia County exceeds the statewide average; and the rate of fatalities from automobile accidents in Ionia County in 2011 (approximately 1.2 per 10,000 residents) was higher than the expected rate across the state (approximately 0.9 fatalities per 10,000 residents). Source: Michigan Department of Transportation, 2011 Michigan Traffic Crash Facts. Lansing, MI; Michigan Office of Highway Safety Planning, 2012.


Behavior, Physical Condition, and Access to Care Indicators – Ionia County

Indicator Definition Percentage Comparison

With Michigan

Obesity Percentage of adults who are obese 30.7%

Percentage of adolescents who are obese 18.9%

Tobacco Use

Percentage of adults who currently smoke 15.4% Percentage of adolescents who smoked in the past month 13.9%

Alcohol Use

Percentage of adults who binge drank in past month 15.8% Percentage of adolescents who binge drank in past month 17.4%

Access to Care

Percentage of residents lacking a primary care physician 13.4% Percentage of population enrolled in Medicaid 10.7% Ratio of population per primary care physician

2670 per physician

Prevention Percentage of children 19 to 35 months old with recommended vaccinations 81.0%

Mental Health Percentage of adults who report their mental health is “not good” 14.0%

More favorable than the statewide average About average Less favorable than the statewide average Source: Michigan Department of Community Health, Michigan Behavioral Risk Factor Survey, 2008-2010; Health Resources and Services Administration, Area Resource File, 2010.

Source: Michigan Behavioral Risk Factor Survey, 2008-2010

33.9% 36.2% 32.3% 35.8% 30.1%47.6%

25.0% 22.0%49.5%

30.7%24.1%

29.3%

0%10%20%30%40%50%60%70%80%90%

Clinton Eaton Gratiot Ionia Ingham Shiawassee

Prevelence of Overweight and Obese Adults in the SHS Service Area as Indicated by Body‐Mass Index (BMI)

Obese Adults Overweight Adults


Community Health Indicators ___________

The indicators listed in Table 1, below, are presented in the following pages. They are grouped within the following categories:

Social, Economic, and Environmental Indicators: Children in Poverty; Single Parent Households; Education; Community Safety; Housing Costs; Nitrate Levels in Well Water (environmental quality)

Health Behavior Indicators: Adult Obesity; Youth Obesity; Adult Tobacco Usage; Youth Tobacco Usage; Adult Alcohol Consumption; Youth Alcohol Consumption

Clinical Care Indicators: Access to Physicians; Preventable Hospitalizations (Ambulatory‐Sensitive Admissions); Medicaid Enrollment; Health Insurance Coverage; Childhood Immunization

Mental Health Indicators: Adult Mental Health; Youth Mental Health

Morbidity and Mortality Indicators: Perceived Health Status; Infant Mortality; Low Birth‐weight Babies; Premature Deaths; Cardiovascular Disease; Accidental Deaths


Table 1: Indicator Data Sources

Indicator Data Source Year Children in Poverty Bureau of the Census, American Community Survey 2006-2010Single Parent Households Bureau of the Census, American Community Survey 2006-2010Housing Costs Bureau of the Census, American Community Survey 2006-2010Education Bureau of the Census, American Community Survey 2006-2010Community Safety Michigan State Police, Michigan Incident Crime Reporting 2010Environmental Quality Michigan Department of Environmental Quality 1988-2011

Obesity Among Adults Capital Area Behavioral Risk Factor Survey 2008-2010

Michigan Behavioral Risk Factor Survey 2008-2010Bureau of the Census, American Community Survey 2006-2010

Obesity Among Young People

Michigan Department of Education, Michigan Profile for Health Youth (MiPHY) 2012

Michigan Department of Community Health, Michigan Youth Risk Behavior Survey 2009

Tobacco Use Among Adults Capital Area Behavioral Risk Factor Survey 2008-2010Michigan Behavioral Risk Factor Survey 2008-2010

Tobacco Use Among Youth



Alcohol Use Among Adults Capital Area Behavioral Risk Factor Survey 2008-2010

Michigan Behavioral Risk Factor Survey 2010Bureau of the Census, American Community Survey 2006-2010

Alcohol Use Among Adolescents


Access to Physicians Health Resources and Services Administration, Area Resource File 2009-2010American Association of Medical Colleges 2011

Preventable Hospitalizations Michigan Department of Community Health, Michigan Resident Inpatient Files 2010

Medicaid Enrollment Michigan Department of Community Health 2012

Health Insurance Coverage Bureau of the Census, Small Area Health Insurance Estimates, American Community Survey 2009

Disease Prevention: Immunization

Michigan Department of Community Health, Michigan Care Improvement Registry 2012

Mental Health (Adults) Capital Area Behavioral Risk Factor Survey 2008-2010Michigan Behavioral Risk Factor Survey 2010

Mental Health (Youth)



Perceived Health Status Capital Area Behavioral Risk Factor Survey 2008-2010

Infant Mortality Michigan Department of Community Health, Michigan Infant Mortality Tables 2006-2010

Low-Weight Births Michigan Department of Community Health 2000-2010

Premature Deaths Michigan Department of Community Health, Michigan Resident Death File 2010

Cardiovascular Disease Michigan Department of Community Health, Michigan Resident Death File 2010

Accidental Deaths Michigan Department of Community Health, Michigan Resident Death File 2010


Children in Poverty

+-

19.0%

21.0%

23.0%

22.4%

12.1%

6.8%

16.7%

17.7%

19.8%

0.0% 10.0% 20.0% 30.0%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County

Tri‐County Lansing Area

Six‐County SHS ServiceArea

Michigan

Percentage of Children In Poverty, 2010

Source: American Community Survey, 2006‐2010

Measure. Children in poverty is the percentage of children living in households with incomes below the 2010 Federal Poverty Threshold as determined annually by the Census Bureau. For 2010, the poverty threshold ranged from $15,030 for a family with one adult below age 65 and one child to as much as $43,845 for a family with two adults and seven or more children. Data source & year. These data are from the Census Bureau’s American Community Survey for the period 2006 – 2010. Multi‐year estimates are used to estimate data for smaller areas such as cities and counties. Importance of this measure. The percentage of children in poverty has been shown to be closely associated with a variety of poor health behaviors, negative health effects, and negative outcomes including higher incidence of disease and premature death. The overall percentages of children in

poverty are lower for both the Lansing tri‐county area and the entire 6‐county SHS service area than for the entire state. The percentage of children in poverty exceeds the statewide average in Ingham, Gratiot, and Ionia counties. Of more than 12,000 children in poverty in Ingham County, 71% reside in the City of Lansing.

“Kids are the poorest population in the US. They have the least voice and the people who care for them are

paid the least.” Source: American Community Survey, 2006‐2010

Lansing71%

Balance of

County29%

Residence of Children At or Below the Poverty Level in Ingham County, 2010

(N = 12,418 children at or below poverty)


Single Parent Households

10.3%

10.8%

10.3%

9.4%

8.7%

7.7%

9.0%

9.4%

9.5%

0% 5% 10% 15%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County


Six‐County SHS ServiceArea

Michigan

Percentage of Single Parent Households

Measure. This measure reflects the percentage of households in which a single parent is raising at least one child. Data source & year. These data are from the Census Bureau’s American Community Survey for the period 2006 – 2010. Importance of this measure. Children in single‐parent households are at a higher risk for adverse health effects, such as emotional and behavioral problems, compared to their peers. Children in such households are more likely to develop depression, smoke, and abuse alcohol and other substances. Consequently, these children experience increased risk of morbidity and mortality of all causes. Similarly, single parents suffer from lower perceived health and higher risk of mortality.

Source: Health Matters in San Francisco. http://www.healthmattersinsf.org/

Both the Tri‐county area and the six‐county service area have slightly lower percentages of single parent households than the state as a whole. Locally, the rate is highest in Ionia County at 10.8 percent and lowest in Clinton County at 7.7 percent. Both Gratiot and Shiawassee counties also have percentages higher than the statewide average at 10.3 percent.

Source: American Community Survey, 2006‐2010.

25%

41%

8%

73%

34%

0% 20% 40% 60% 80%

White (non‐Hispanic)

Hispanic

Asian/Pacific Islander

African American

All

Perecentage of Michigan Children in Single Parent Households by Race, 2010

4.1%

6.2%5.2%

5.9% 5.8%6.6%

0.0%

2.0%

4.0%

6.0%

8.0%

Clin

ton

Eaton

Gratio

t

Ionia

Ingh

am

Shiawassee

Percentage of Children Living in Households Headed by a Grandparent

Source: American Community Survey, 2006‐2010.Source: Annie E. Casey Foundation, Kids Count data, 2012.


Housing Costs

32.6%

34.5%

30.8%

37.1%

29.4%

29.1%

34.0%

33.7%

34.8%

0% 10% 20% 30% 40%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County


Six‐County Region

Michigan

Percentage of Households with Housing Costs Greater than 30% of

Income, 2010

Measure. This measure is the percentage of households that spend more than 30 percent of their total household income on housing. Data source & year. U.S. Census Bureau, American Community Survey 2006‐2010. Importance of this measure. The percentage of income that a family spends on housing is directly related to the amount of income available for other expenses such as health insurance, transportation, heat, child care, and food items. high in sugars and fats.

Both the tri‐county region and the six‐county service areas have similar portions of households with high housing costs relative to income as compared with the statewide average. Clinton and Eaton counties have a lower percentage of households in this category which may be attributed to higher average incomes in these areas.

Source: U.S. Census Bureau, American Community Survey 2006‐2010, Table S2503.

“A lot of people have left their community to find jobs or

affordable housing due to these economic times.”

“The way the economy is right now you have to choose between your health and paying your

living expenses.”

“A lot of people lost their house because they can’t cover the expensive hospital bills.”


Education

14.9%

13.1%

13.5%

35.5%

24.3%

27.2%

31.2%

26.2%

25.0%

0.0% 10.0% 20.0% 30.0% 40.0%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County

Tri‐County LansingArea

Six‐County SHSService Area

Michigan

Percentage of Adults over 25 with a Bachelorʹs Degree or Higher

Measure. Educational attainment is measured by the percentage of adults who are 25 years or older who have a bachelor’s degree or a higher level of education Data source & year. These data are from the Census Bureau’s American Community Survey for the period 2006 – 2010. Importance of this measure. There is thought to be a strong correlation between positive health outcomes and higher levels of education. There is also a well‐known relationship between higher education levels and greater economic opportunities which typically relate to healthier lifestyles.

Both the tri‐county area and the six‐county service area have higher rates of adults with college degrees compared to the statewide average. The lowest rates of educational attainment are found in Gratiot, Ionia, and Shiawassee counties where about 14 percent of people over age 25 have a bachelor’s degree or higher. This is in sharp contrast to a much higher than average rate in Ingham County, where Michigan State University is located.

Source: American Community Survey, 2006‐2010.

12.0%

7.0% 7.6%

12.9%

9.3%

12.9%

10.1%

0.0%

5.0%

10.0%

15.0%

Michigan

Clin

ton

Eaton

Gratio

t

Ingh

am

Ionia

Shiawassee

Adults 25 and Older With Less Than a HS Diploma

“Making the kinds of decisions that abandon or undervalue education will kill you in the end. An uneducated

population dies quicker.” Source: American Community Survey, 2006‐2010.


Community Safety

204.3

156.6

91.5

438.7

159.5

60.9

313.2

270.6

489.9

0 100 200 300 400 500 600

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County


Six County SHS Service Area

Michigan

Violent Crime per 100,000 Persons, 2010

Measure. Community safety is represented by the rate of violent crimes per 100,000 residents per year. Violent crimes are annual incidents of murder and non‐negligent homicide, first‐degree rape, robbery, and aggravated assault, as reported by the Michigan State Police. These crimes are all crimes against people and, thus, represent the personal safety (or lack of safety) within each of the areas. Data source & year. These data are reported in the 2010 Michigan Incident Crime Reporting tabulations prepared by the Michigan State Police. Importance of this measure. In addition to reflecting the level of personal safety, crime generates stress among community residents, thus potentially undermining their psychological well‐being. High levels of crime may also deter community residents from outdoor activities and may add stress to participation in education and community activities.

Source: Michigan State Police. Michigan Incident Crime Reporting (MICR): 2010 All Offenses Reported by County/Agency.

While all of the counties examined show lower violent crime rates than was reported for the entire state of Michigan in 2010, Ingham County exhibited only a marginally lower rate at that time. Almost two‐thirds of the violent crimes in Ingham County occurred within Lansing. This indicates a higher potential level of stress that may be associated with health problems in the city.

Lansing, 2787

Balance of County, 1537

Average Number of Violent Crimes in Lansing and the Balance of Ingham County, 2008‐2010


Environmental Quality

1.1%

5.2%

3.1%

0.7%

1.4%

0.5%

0.9%

0% 1% 2% 3% 4% 5% 6%

Shiawassee

Ionia

Gratiot

Ingham

Eaton

Clinton


Michigan

Percentage of Well Samples with Nitrate Levels Above the Maximum

Containment Level*

N.A.

Measure. Water samples were tested for the level of nitrate in the water. This measure is the percentage of well water samples that exhibit nitrate levels in water that are above the Environmental Protection Agency standard of 10 milligrams per liter. Data Source & Year. Michigan Department of Environmental Quality, 1988 – 2011. This information is drawn from periodic tests of private water wells. Importance of this Measure. High nitrate levels in water may be related to the inappropriate or unsanitary disposal of human, animal, or industrial waste products. High nitrate levels in water can cause serious illnesses among infants below six months of age (methemoglobinemia). High nitrate levels may also be an indicator of other contaminants in the water. (See Michigan Department of Environmental Quality. Nitrate in Drinking Water: Information for private water well owners. (Brochure, 2003.) Source: http://www.michigan.gov/documents/deq/deq-wd-gws-ciu-nitratebrochure _270430_7.pdf

Source: Michigan Department of Environmental Quality. 1988-2011. * These data are meaningful only for localities and households that are not served by municipal water systems that are routinely tested for contaminants.

Although water quality is an important concern among environmentalists and community health specialists, environmental quality issues such as concerns about high levels of ground water contamination, air pollution, industrial pollution, or lead in house paint were also raised during the interviews and focus groups conducted for this project.

“I am worried about the health effects of pesticides and steroids in food products.”

“[I have concerns about] historical problems, such as abandoned

manufacturing plants that have led to significant groundwater issues.”


Obesity Among Adults

47.6%

35.8%

32.3%

30.1%

36.2%

33.9%

32.1%

34.1%

35.1%

29.3%

30.7%

49.5%

24.1%

22.0%

25.0%

23.8%

26.7%

31.7%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County

Tri‐County Region

6‐County Region

Michigan

Adults Who are Overweight or Obese2008‐2010

Overweight Obese

Measure. Overweight adults are defined as having a body‐mass index (BMI) of 25.0 to 29.9. Obese adults have a BMI of 30.0 and above. BMI is a calculation which takes into account both height and weight. Data source & year. BMI was calculated from height and weight data submitted by sample participants in the Behavioral Risk Factor Surveillance System surveys conducted in Michigan between 2008 and 2010. Importance of this measure. The relationship of obesity to a number of serious chronic diseases among adults has been well documented. Foremost among obesity‐related maladies are diabetes, heart disease, high blood pressure, and liver disease.

Two‐thirds of adults age 18 and over in Michigan are either overweight or obese. Adults in the Tri‐County Lansing Area exhibit lower rates of overweight and obesity in most cases. Adults in Gratiot and Shiawassee counties exceed both regional and statewide levels.

Source: 2008-2020 Capital Area Behavioral Risk Factor Survey; 2008-2010 Michigan BRFSS; American Community Survey, 2006-2010.

“Obesity keeps increasing – if we can expand the communication and educational opportunities to make

people aware of the problem, perhaps we can control this problem.”

“In our obesity prevention efforts, people agree with us mentally but in practice [they] go back to offering candy

as rewards.”

Among interviewees, obesity was the most frequently listed top health issue in communities serviced by Sparrow

Health System.

41.6%28.7%

42.6%

0%

50%

Black non‐Hispanic White non‐Hispanic

Hispanic

Obese Adults by Race and Ethnicity in Michigan, 2009


Obesity Among Young People

17.3%

16.8%

17.4%

15.2%

15.2%

15.7%

15.6%

15.9%

14.2%

18.2%

16.5%

12.3%

14.0%

15.2%

10.0%

13.6%

14.4%

11.9%

Gratiot County

Ionia County

Shiawassee County

Ingham County

Eaton County

Clinton County

Tri‐County Region

6‐County Region

Michigan*

Youth Who Are Overweight or Obese2011‐2012

Overweight Obese

* 2009

Measure. Overweight youth are those who are at or above the 85th percentile and below the 95th percentile for body‐mass index (BMI) by age and sex. Obese youth are at or above the 95th percentile for BMI by age and sex. Data source & year. County data were drawn from the 2012 Michigan Profile for Healthy Youth (MiPHY) survey which is conducted among a sample of students in the 7th, 9th, and 11th grades in selected schools in selected districts in each county. Students in 31 of 72 school districts in the six‐county area participated, including those in 36 of 143 middle school buildings and 35 of 125 high school buildings. Statewide comparative data are from the 2009 Michigan Youth Risk Behavior Survey. Importance of this measure. Over‐weight and obese youth exhibit both current and future risk factors, including risk for heart disease, diabetes, stroke, and cancer. Over‐ weight youth are also are at a greater risk for being socially stigmatized and having poor self‐esteem.

Between 25% and 35% of youth in each of this region’s counties are overweight or obese, with some of the highest rates reported in the more rural areas. In all cases, these rates exceed the statewide levels recorded in 2009.

Source: Michigan Department of Education, 2012 Michigan Profile for Healthy Youth; Michigan Department of Community Health, 2009 Michigan Youth Risk Behavior Survey. Regional data calculated by PPA. * 2009 data.

“People try to fill their bellies and don’t worry about health necessarily. Families may eat better at the

beginning of the month than [at] the end due to financial limitations.”

“It’s a national disease frankly. I think

it’s going to get worse because kids don’t go out and get exercise. Schools are cutting back on gym and athletics.

It’s driven by revenue.”

Obese14%

Overweight16%

Not Overweight

70%

Overweight and Obese Youth in the Sparrow Service Area, 2011‐2012


Tobacco Use Among Adults

18.7%

15.4%

28.8%

21.4%

28.8%

16.4%

22.3%

21.6%

18.9%

0% 5% 10% 15% 20% 25% 30% 35%

Shiawassee County*

Ionia County*

Gratiot County*

Ingham County†

Eaton County†

Clinton County†


Six‐County SHS Service Area

Michigan

Perecentage of Current Adult SmokersMeasure. Tobacco use among adults is measured as the percentage of the adult population that reported smoking every day or most days and has smoked at least 100 cigarettes in their lifetime. Data source & year. Smoking data are from the 2008‐2010 Capital Area 2008‐2010 Michigan Behavioral Risk Factor Surveys. Importance of this measure. Despite years of publicity regarding the health dangers associated with tobacco use, about 20 to 25 percent of the adult population continues to smoke. Smoking has a variety of direct and indirect health consequences, including lung cancer, other pulmonary diseases, and heart disease. Indirect consequences include both low birth weight and the possibility of disease among those exposed to second hand smoke. As noted in the Healthy! Capital Counties CHNA Report, tobacco use may also indicate the need for smoking cessation programs or illustrate the effectiveness of existing programs.

Tobacco use in the six‐county Sparrow Health System service area is slightly higher than the state as a whole. Higher percentages of adults use tobacco in Eaton and Gratiot counties, while both Clinton and Ionia counties have much smaller percentages of users.

† Source: 2008‐2010 Capital Area Behavioral Risk Factor Survey * Source: 2008‐2010 Michigan Behavioral Risk Factor Survey

“There are programs out there to educate, but there are people who ignore it.”

“[It] was a high priority five to ten years ago, but [it] seems to have dropped off.”


Tobacco Use Among Youth

9.1%

9.4%

8.9%

5.4%

9.4%

4.0%

6.1%

6.7%14.0%

0% 2% 4% 6% 8% 10% 12% 14% 16%

Shiawassee

Ionia

Gratiot

Ingham

Eaton

Clinton


Six County Region

Michigan*

Percentage of Students Who Smoked Cigarettes in the Past 30 Days

* Michigan 2010 BRFS

Measure. Tobacco use among youth is measured as the percentage of young people who reported smoking cigarettes during the past 30 days. Data source & year. These data are drawn from the Michigan Department of Education, Michigan Profile for Healthy Youth (MiPHY), 2010 and the 2008‐2010 Capital Area Behavioral Risk Factor Survey. Importance of this measure. One of the successful outcomes of years of promoting the dangers of smoking and has been a decline in the prevalence of smoking among young people in recent years. Despite this, some young people continue to take up smoking each year. As is widely known, smoking has a variety of direct and indirect health consequences, including lung cancer, other pulmonary diseases, and heart disease. Indirect consequences include both low birth weight and the possibility of disease among those exposed to second hand smoke. As noted in the Healthy! Capital Counties CHNA Report, tobacco use may also indicate the need for smoking cessation programs or the effectiveness of existing programs.

Source: 2008-2010 Capital Area Behavioral Risk Factor Survey; 2008-2010 Michigan Behavioral Risk Factor Survey.

“I fear for smoking. I see way too many young people smoking.”

“We were doing more a few years

ago.”

Within the six‐county Sparrow Health System service area the percentage of youth that report having smoked a cigarette in the last 30 days is significantly lower than that for the state as a whole. The highest rates of tobacco use are found in the more rural counties within the SHS service area. The Lansing tri‐county region has a lower rate of youth tobacco use than the six‐county region overall with the highest rate found in Eaton County. This may be indicative of the scope and reach of current and past smoking cessation efforts.


Alcohol Use Among Adults

19.5%

15.8%

18.7%

16.7%

20.7%

17.9%

17.8%

17.8%

19.7%

0.0% 10.0% 20.0% 30.0%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County


Six‐County Region

Michigan*

Binge Drinking Among Adults, 2008‐2010

Measure. Binge drinking is defined as the percentage of adult males who had 5 or more and adult females who had 4 or more drinks of alcohol in a row within a short period of time during the past 30 days. Data source & year. These data are from the 2008‐2020 Capital Area Behavioral Risk Factor Survey; the 2008‐2010 Michigan Behavioral Risk Factor Survey; American Community Survey, 2006‐2010; and the Centers for Disease Control, Vital Signs, Binge Drinking. Importance of this measure. Adult binge drinking causes 80,000 deaths in the US each year and, in 2006 cost the economy $223.5 billion. This behavior can lead to increased incidents of violence, automobile accidents, suicide, unplanned pregnancies, spread of sexually transmitted diseases, and fetal alcohol syndrome. Community coalitions with a broad set of partners that includes educators, public safety, public health officials, and community leaders can help address this issue.

Source: 2008‐2020 Capital Area Behavioral Risk Factor Survey; 2008‐2011 Michigan BRFSS; American Community Survey, 2006‐2010.

“[We are] dealing with people who are addicted or drunk all the time. How do you motivate people to get out of where

they’re stuck?”

19.7% 20.4%

15.6%

20.5%21.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Michigan White Black Other Hispanic

Binge Drinking by Race and Ethnicity in Michigan, 2011


Alcohol Use Among Adolescents

10.7%

17.4%

13.8%

10.9%

16.1%

12.8%

12.3%

12.8%

23.2%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County


Six‐County Region

Michigan

Binge Drinking Among High School Students, 2011‐2012

Measure. Binge drinking is defined as the percentage of students who had 5 or more drinks of alcohol in a row, that is, within a couple of hours, during the past 30 days. Data source & year. County data were drawn from the 2012 Michigan Profile for Healthy Youth (MiPHY) survey which is conducted among students in the 7th, 9th, and 11th grades in selected schools in selected districts in each county. Regional data were calculated by the authors. Students in 31 of 72 school districts in the six‐county area participated, including those in 36 of 143 middle school buildings and 35 of 125 high school buildings. Statewide data are from the 2009 Michigan Youth Risk Behavior Survey. Importance of this measure. Alcohol consumption among adolescents may have a negative effect on brain development as well as negatively effecting liver and endocrine system development. Binge drinking can also lead to risk‐taking behaviors that might result in negative health outcomes such as sexually transmitted diseases, unplanned pregnancies, traffic‐related injuries, or alcohol poisoning.

The data indicate that the six counties that Sparrow Health System serves all perform much better than the state as a whole on this indicator. While the rates are higher in Eaton and Ingham counties, these areas are still below the statewide average.

Source: American Community Survey, 2006-2010

“I see a lot of alcohol being served in the area, including high school graduation parties,

weddings, and party stores.”

“There is still a lot of drinking and driving going on in this county. People think because you’re on a country road it’s okay.”


Access to Physicians

2530

2670

1323

762

1907

2494

1017

1114

1034

0 1000 2000 3000

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County


Six‐County Region

Michigan

Population per Primary Care Physician, 2009‐2010

Measure. The measure on the top right is the number of total residents per primary care physician (including general medicine, family practice, internal medicine, pediatrics, or gynecology). Below is the percentage of the resident population that does not have a primary care physician for routine health care needs. Data source & year. Data are from the U.S. Department of Health & Human Services, Health Resources and Services Administration (HRSA), Area Resource File, 2009‐2010, the American Association of Medical Colleges (AAMC), and the Behavioral Risk Factor Survey, 2008‐2010. Importance of this measure. Primary care serves as the gateway to health through the provision of preventive care services, treatment for basic health needs, and referrals to specialized care when needed. Lack of access to primary care may delay treatment for minor problems that, with time, may become serious concerns with life‐threatening consequences.

While the Lansing area and the entire six‐county Sparrow Service Area have an average number of physicians available for the population served, the Lansing area and Ingham County, in particular, report more than 1 in 4 residents does not have a primary care physician.

Source: Health Resources and Services Administration, Area Resource File, 2009-2010; American Association of Medical Colleges, 2011.

“Many people are reluctant to drive into Lansing, so if the required resources are not available many people go without”

“Ingham County is not underserved as far as number of physicians to population

ratio.”

“The emergency room becomes their primary care vehicle since primary care is not really available without insurance.”

Source: American Community Survey, 2006‐2010

12.5%

25.4%

14.8%21.6%

29.1%

13.4% 14.0%

0%

10%

20%

30%

40%

Michigan

Lan

sing

Area

Clin

ton

Cou

nty

Eaton

Cou

nty

Ingh

amCou

nty

Gratio

tCou

nty

Ionia

Cou

nty

Shiawassee

Cou

nty

Percentage Lacking Access to a Primary Care Physician, 2008‐2010

NA


Preventable Hospitalizations

209.6

325.8

184.2

218.3

181.1

212.1

268.4

0 50 100 150 200 250 300 350

Shiawassee

Gratiot

Ionia

Ingham

Clinton

Eaton

Michigan

Preventable Hospitalizations per 10,000 Population, 2010

Measure. Preventable hospitalizations are those which typically do not require inpatient services for treatment. Common preventable hospitalizations diagnoses are diabetes for adults and asthma for children. Data source & year. These data are from the Michigan Department of Community Health, 2010 Michigan Resident Inpatient Files. Importance of this measure “High rates of Ambulatory Care Sensitive hospitalizations in a community may be an indicator of a lack of or failure of prevention efforts, a primary care resource shortage, poor performance of primary health care delivery systems, or other factors that create barriers to obtaining timely and effective care.” Michigan Department of Community Health. http://www.mdch.state.mi.us/pha/osr/CHI/HOSP/INSTRUC2.htm

Source: Michigan Department of Community Health, 2010 Michigan Resident Inpatient Files.

25.6

18.1

12.4

21.4

14.3

0 10 20 30

Ingham County

Eaton County

Clinton County

Tri‐County LansingArea

Michigan

Example: Preventable Hospitalizations Due to Asthma per 10,000 Children Below Age 18

“Routine physical exams. Yes if you have insurance. If you don’t, that’s the last thing that you’re going to do. Of all the issues, that’s probably the biggest gap. If we can catch some of this stuff earlier, it would be better/save money.”

The tri‐county area has a much higher rate of preventable hospitalizations due to asthma per 10,000 children younger than 18 than does the state as a whole. Ingham County performs much worse on this measure than does Clinton or Eaton counties. (See chart at left.)


Medicaid Enrollment

12.2%

10.7%

12.0%

11.9%

8.3%

6.2%

10.2%

10.6%

12.3%

0% 2% 4% 6% 8% 10% 12% 14%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County



Michigan

Percentage of Residents Enrolled in Medicaid

Measure. This measure reflects the percentage of residents enrolled in any Medicaid Health Plan. Data source & year. These data are August 2012 enrollment figures from the Michigan Department of Community Health. Importance of this measure. Because accurate measurements of uninsured individuals are not standardized, accurately measuring the percentage of Medicaid enrollees can help provide firmer estimates for health insurance coverage in the region. (http://www.chis.ucla.edu/dataquality6.html). This indicator is also helpful in determining an area’s demand for services and providers that accept Medicaid patients.

Both the tri‐county area and the six‐county service area have a lower percentage of residents enrolled in a Medicaid Health Plan than that state as a whole. Clinton County enrollment is the lowest, with only 6.2% of residents enrolled in a Medicaid Health Plan.

Source: Michigan Department of Community Health, 2012

“We’re not a physician shortage area, but we’re low on specialists in this area. Specialists don’t see uninsured or Medicaid, so we need more access

to that.”

“Dental and some of the specialty care is largely restricted if you’re on Medicaid. In our area, there is one dentist . . . who will see Medicaid [patients]. If [a] kid is in hospital, they [physicians] will see them, but

not in office.”


Health Insurance Coverage

10.3%

11.3%

14.2%

12.9%

16.4%

14.9%

13.6%

13.4%

13.9%

0.0% 5.0% 10.0% 15.0% 20.0%

Clinton County

Eaton County

Ingham County

3‐county region

Gratiot County

Ionia County

Shiawassee County

6‐county region

Michigan

Percentage of the Population Without Health Insurance, 2009

Measure. This is the percentage of the entire non‐institutionalized population that reported not having any form of health insurance, including commercial insurance, Medicare, Medicaid, military services health care, or other health insurance. Data source & year. These data are from the Bureau of the Census, 2009 Small Area Health Insurance Estimates. Regional estimates were calculated by the authors. Importance of this measure. The lack of health care insurance provides an estimate of the potential level of unmet health care needs in the community as well as the potential level of uncompensated care when uninsured individuals may need care provided by the emergency department of a local hospital.

Source: Bureau for the Census, Small Area Health Insurance Estimates, 2009.

4.4%

12.4%

16.1%

24.6%

0.0% 10.0% 20.0% 30.0%

Massachusetts

Michigan

U.S.

Texas

Percent Uninsured, Selected States, 2009‐2011 Average

Source: U.S. Census Bureau, Current Population Survey, 2009 to 2012 Annual Social and Economic Supplements.

Compared to the total percentage of uninsured people across the United States, Michigan has a relatively low proportion of residents without any form of health insurance. Only 13 states have a smaller proportion of their population that is uninsured. The rates presented above for Clinton, Eaton, and Ingham counties, in particular, compare very favorably with most of the rest of the nation.

“People who don’t have health insurance put off getting care, and lot of small businesses don’t provide

insurance.”

“I see the real gaps where people don’t have insurance. Seems to me people who have insurance can get care.

Physicians won’t take Medicaid because the reimbursement is so poor.”


Disease Prevention: Immunization

75%77%

79% 81%76%

81%78%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Michigan

Clin

ton Co.

Eaton Co.

Gratio

t Co.

Ingh

am Co.

Ionia Co.

Shiawassee Co.

Percentage of Children Ages 19 to 35 Months with Recommended

Immunizations, 2012

Measure. This reflects the percentage of children 19 to 35 months of age who have received the recommended 4:3:1:3:3:1 series of immunizations (including immunization for polio, hepatitis B, measles, mumps, diphtheria, and several others). Data source & year. These data are from the Michigan Department of Community Health, Michigan Care Improvement Registry, June 2012. (http://www.mcir.org/index.html) Importance of this measure. Vaccinations received early in life provide lifelong immunity from several deadly childhood diseases (Healthy! Capital Counties, 2012). Protection against childhood diseases reduces deaths and improves long‐term health for individuals, and protects the community at large. Source: MDCH, “Michigan Immunization Timely Tips.” April 2011.

68.3%

78.5%

72.1%

64.1%

0% 50% 100%

Michigan

Hispanic

White

AfricanAmerican

Childhood Immunization by Race and Ethnicity, 2011

Source: Michigan Department of Community Health, Michigan Care Improvement Registry, June 2012.

While these figures do not represent the immunization rates for the Greater Lansing area, the general pattern of disparity in the percentage of children immunized by race and ethnicity are likely to be found in this six‐county region.

“I worry about the parents who don’t follow up with immunizations. I am surprised that schools don’t do a better

job.”

“There is a lack of outreach and education when it comes to

immunizations”


Mental Health (Adults)

13.4%

14.0%

6.4%

12.1%

14.5%

6.9%

11.8%

11.9%

10.7%

0% 5% 10% 15% 20%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County


Six‐County Region

Michigan

Adults Reporting Poor Mental Health 2008‐2010

Measure. This is the percentage of individuals age 18 and older reporting 14 or more days of poor mental health in the past 30 days. Data source & year. Data are from the 2008‐2010 Capital Area BRF & SC Survey; 2010 Michigan BRFSS; American Community Survey, 2006‐2010. Importance of this measure. The relationship between mental health and physical health is important to overall well‐being. As a determinant of quality of life, mental well‐being is positively correlated to physical well‐being. There are multiple facets to mental health included in this measure such as stress, emotional problems, and depression.

While both the six‐county and the tri‐county regions register a somewhat higher percentage of adults reporting poor mental health compared to the state as a whole, Clinton and Gratiot counties perform noticeably better on this measure.

Source: 2008-2010 Capital Area BRF & SC Survey; 2010 Michigan BRFSS; American Community Survey, 2006-2010.

“We have facilities now that we did not have 10‐15 years ago, but affordability continues to be an

issue.”

“There is a gap in mental health services; we don’t have adequate resources in terms of practitioners

or facilities.”

“Mental health services are no longer represented in the

community, especially for the uninsured.”

10.4%11.6%

10.4%

14.7%

0.0%

5.0%

10.0%

15.0%

20.0%

White Black Other Hispanic

Adults Reporting Poor Mental Health, by Race and Ethnicity, 2010


Mental Health (Youth)

26.9%

29.2%

29.4%

26.7%

27.7%

24.5%

26.7%

27.1%

26.0%

Shiawassee

Ionia

Gratiot

Ingham

Eaton

Clinton


Six‐County Region

Michigan

0% 5% 10% 15% 20% 25% 30% 35%

Adolescents With Symptoms* of Depression, 2011

Measure. This measure is the percentage of students (grades 7, 9, 11, and 12 in some cases) who report feeling sadness or hopelessness almost every day for at least 2 weeks in a row that results in not doing usual activities. This reflects feelings of stress, depression, and other emotional problems. Data source & year. These data are from the Michigan Profile for Healthy Youth Survey (MiPHY), 2012; Michigan Youth Risk Factor Survey, 2011. Importance of this measure. Mental health is an important component of overall health. Depression among youth not only may be manifest in feelings of sadness, defeat or hopelessness, but may interfere with school activities and may affect physical health as well.

*Self-reported feelings of sadness or hopelessness for 2 weeks or more. Source: Michigan Department of Education; Michigan Department of Community Health. Michigan Profile for Healthy Youth, 2012 County Reports; CDC, National Center for Health Statistics, Michigan Youth Risk Behavior Survey, 2011. /mdoe.state.mi.us/MIPHYADMIN/reports/ CountyReport.aspx

28.8%

34.5%

24.3%

Black Hispanic White0%

10%

20%

30%

40%

Adolescents With Symptons of Depression by Race and

Ethnicity, 2011

“[We are] seeing more kids with mental health problems, but it is very difficult to find treatment for

them.”

Indicators of youth depression are slightly above the statewide average in mostly rural Gratiot and Ionia counties. Hispanic and African‐American youth report higher overall rates of depression than white youth in Michigan.


Perceived Health Status

3.75

3.33

3.86

3.8

3.66

0 1 2 3 4 5 6

Sparrow Specialty

Sparrow Lansing

Sparrow Ionia

Sparrow Clinton

Six‐County Area

Community Leaders ́Perceived Area Health Status, 2012 (1 = Very Poor, 6 =

Excellent)

14.0%

11.5%

16.1%

16.0%

16.0%

17.0%

16.2%

15.5%

14.2%

0% 5% 10% 15% 20%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County



Michigan

Percentage of Adults with a ʺFair/Poorʺ Perceived General Health Status

Measure. Health status is the percentage of adults who self‐reported their health as “fair” or “poor” when asked “Would you say that in general your health is excellent, very good, good, fair, or poor?.” Data source & year. Capital Area Behavioral Risk Factor Survey 2008 – 2010; Ingham County Health Department. Importance of this measure. Perceived health status is indicative of quality of life, or those physical, emotional, and social items that contribute to one’s well‐being. Self‐ perceived health status can also be an important indicator for determining health care and health‐related service demands for a community.

http://publichealth.lacounty.gov/ha/reports/angelenos/chapter4/angel4phs.pdf

Between 14 and 16 percent of the population throughout Michigan, the six‐county SHS service area, and the Greater Lansing Area perceive their own health status as “fair” or “poor.” Ionia County is an exception as only 11 percent report relatively poor health status.

Interviews conducted for Sparrow Health System asked community and health care leaders to provide their perceptions of the general health status of the Greater Lansing area. They indicated that the health of area residents is good, but not excellent.

Source: Capital Area Behavioral Risk Factor Survey, 2008‐2010; Ingham County Health Department.


Infant Mortality

4.9

3.9

8.7

6.3

5.4

3.9

6.1

5.9

7.5

0 2 4 6 8 10

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County


Six‐County Regioan

Michigan

Average Annual Infant Deaths per 1,000 Live Births, 2006‐2010

Measure. This is the average annual number of infant deaths for every 1,000 live births between 2006 and 2010. Data source & year. Data were obtained from the Michigan Department of Community Health, Michigan Infant Mortality Tables.; Center for Disease Control (CDC), Birth Outcomes; Center for Disease Control, Office of Minority Health and Health Disparities. Importance of this measure. According to the CDC, infant mortality is associated with maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices. This indicator reflects factors associated with the health of the mother before and during pregnancy and also problems of infants including congenital abnormalities, pre‐term/low birth weight, Sudden Infant Death Syndrome (SIDS), and respiratory distress syndrome. Racial disparities also exist with infant mortality among African Americans occurring at nearly twice the national average, and according to the Indian Health Service, SIDS deaths among American Indian and Alaska Natives are 2.3 times the rate for non‐Hispanic white mothers. Centers for Disease Control. http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/InfantMortality.htm

Source: Michigan Department of Community Health, Michigan Infant Mortality tables. http://www.mdch.state.mi.us/pha/osr/index.asp?Id=3

“We could do a better job getting people who don’t have insurance hooked up earlier. We need more resources,

especially at the ICHD level. A lot of it is awareness. Many of them have multiple other issues. If you have insurance or money, you get great

prenatal care.”

With the exception of Gratiot County, all of the counties in the SHS service area perform better on this indicator than the state as a whole. In Ingham County, the greatest percentage of infant deaths is reported in the city of Lansing.

Lansing81%

Balance of Ingham County19%

Average Annual Infant Deaths, Lansing & Balance of Ingham County,

2006‐2010


Low‐Weight Births

74.8

65.7

71.8

81.3

70

69.1

77.2

75.3

82.8

0 20 40 60 80 100

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County

Tri‐County Region

6‐County Region

Michigan

Low Weight Babies, Average per 1,000 Live Births

Measure. Babies that weigh less than 2,500 grams (5 pounds, 8 ounces) at the time of birth are considered low birth weight babies. About one in 12 babies born in the U.S. (83.3 per 1,000 live births) weigh less than 2,500 grams. Data source & year. These data are calculated from county birth data compiled by the Michigan Department of Community Health for the year 2000 through 2010. Michigan birth data may be found at http://www.mdch.state.mi.us/pha/osr/index.asp?Id=2 Importance of this measure. Low birth weight may be an indicator of the health status of mothers in a community. There are several factors responsible for low birth weight, including chronic health problems among the mothers and poor pre‐natal care. There are also several implications for low birth weight babies early in life, including breathing problems, vision problems, learning problems, hearing loss, and cerebral palsy. Low birth weight risk can be reduced through improved pre‐natal care, better nutrition, smoking cessation, and other health improvements.

The incidence of low birth weight babies in this region over the past 10 years compares favorably with statewide and national figures. Low birth weight babies in both the Lansing area as well as the entire 6‐county Sparrow Health System service area are about 10 percent below the statewide rate. The highest area rates are found in mainly urban Ingham County and mainly rural Shiawassee County.

Source: Michigan Department of Community Health, Michigan Natality

“If you have insurance or money you get great prenatal care. There are just gaps for people who don’t have insurance or money.”

“When you look at some of the statistics I would say the overall health status is fair to poor. Particularly looking at low birth weight babies.”


Premature Deaths

44%

51%

42%

44%

43%

39%

42%

56%

0% 10% 20% 30% 40% 50% 60%

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County

Tri‐County Lansing Area*

Michigan

Percentage of Deaths Before Age 75 (Premature Death), 2010

Measure. Death prior to age 75 is considered premature death. Data source & year. These data are drawn from the Michigan Department of Community Health, Michigan Resident Death File, 2010; Importance of this measure. The percentage of an area’s population that dies before the age of 75 is indicative of deaths that might have been prevented. Examining the underlying reasons for “premature” deaths are likely to reveal community health issues that can be addressed and, if resolved, may lead to longer life among community residents.

Across Michigan, 56 percent of the population dies before the age of 75. Within the six‐county SHS service area Ionia has the highest mark at 51 percent with a low of 39 percent for Clinton County. Using premature death as a singular surrogate for overall community health, each of the counties in the SHS service area exhibits a healthier status than generally found throughout the entire State of Michigan.

Source: Michigan Department of Community Health, Michigan Resident Death File, 2010; Ingham County Health Department.

“Factors such as the percentages of adult smokers and adults with a college education are associated with premature mortality among U.S. counties. Population health policies aimed at reducing mortality disparities require an understanding of the socioeconomic context within which modifiable variables exist.” Cheng, Erika R., and David A. Kindig. "Disparities in Premature Mortality Between High- and Low-Income US Counties." http://www.cdc.gov/pcd/issues/2012/11_0120.htm.

* 2012 Community Health Profile and Health Needs Assessment. Healthy! Capital Counties.


Cardiovascular Disease

209

182

249

195

158

171

181

207

0 100 200 300

Shiawassee County

Ionia County

Gratiot County

Ingham County

Eaton County

Clinton County

Tri‐County LansingArea*

Michigan

Deaths Due to Cardiovascular Disease per 10,000 Residents, 2010

Measure. Deaths due to cardiovascular disease per 10,000 residents are used to represent the impact of chronic disease in the community. Data source & year. Data are from the Michigan Department of Community Health, Michigan Resident Death File, 2010; Importance of this measure. There is a strong correlation between cardiovascular disease and chronic morbidity (illness) and mortality (death). Cardiovascular disease includes coronary artery disease, stroke, cardiomyopathy, and heart failure.

295.6

149.1 124.7 151.9

235.9

0

100

200

300

Black AmericanIndian/Alaska

Native

Asian/PacificIslander

Hispanic White, Non‐Hispanic

Deaths per 100,000 Residents from Heart Disease, Males, by Race and Ethnicity:

U.S., 2008

Source: Michigan Department of Community Health, Michigan Resident Death File, 2010.

“Across Michigan, Black Men have the highest rates of cardiovascular disease deaths, followed by Black Women. White Males have a higher rate of mortality from cardiovascular disease than White Women.” Healthy! Capital Counties 2012 Community Health Profile & Health Needs Assessment, 47.

* 2012 Community Health Profile and Health Needs Assessment. Healthy! Capital Counties.

The highest rate of cardiovascular disease in the six‐county SHS service area is in Gratiot County. Shiawassee County is the second highest in the region with a rate close to the statewide average. All of the remaining counties in the region have rates lower than the statewide average with the lowest rate found in Eaton County.

National Center for Health Statistics. Health, United States 2011: With Special Feature on Socioeconomic Status and Health. Hyattsville, MD. 2012 Table 30.


Accidental Deaths

45.5

62.1

42.4

28.1

28.7

28.3

29.3

35.3

35.4

0 10 20 30 40 50 60 70

Shiawassee County

Ionia County

Gratiot County*

Ingham County

Eaton County

Clinton County

Tri‐County Region

6‐County Region

Michigan

Age‐Adjusted Death Rate Due to Accidental Injury per 100,000 Persons, 2010

Measure. Deaths due to accidental injury per 10,000 persons include unintentional injuries such as traffic‐related fatalities, falls, suffocation, drowning, and poisoning. The measure excludes deaths attributed to homicide or suicide. Data source & year. The data are reported on the Michigan Department of Community Health, Michigan Resident Death File, 2010. Importance of this measure. Accidental death due to poisoning and drowning are among the leading causes of death for children and young adults. Accidental death resulting from a fall is one of the leading causes of death among people 65 and over. According to the Healthy! Capital Counties Collaborative, poor socioeconomic environments can lead to an increase in deaths due to accidental injuries.

The rate of death due to accidental injury is higher in Ionia and Shiawassee counties compared to both the statewide and the tri‐county areas.

Source: Michigan Department of Community Health, Michigan Resident Death File, 2010; County Health Profiles. www.mdch.state.mi.us/pha/osr/chi/profiles/frame.html

13.3

37.6

5

16.1

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Large Metro

Central

Large Metro Fring

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Med

ium M

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Small M

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Town/City

(Micropo

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)

Rural

Age‐Adjusted Motor Vehicle Death Rates per 100,000, 2007‐2009

Male Female

The graph on the right is a comparison of the rates of death due to accidental injury from traffic related incidents in the U.S. between urban and rural localities. The trends found in the six county service area are similar to this national trend data. Source: CDC, Morbidity and Mortality Weekly Report. March 23, 2012 (volume 61, number 11; page 197. Source data may be found within the National Vital Statistics System. County‐level mortality file. http://www.cdc.gov/nchs/deaths.htm and http://wonder.cdc.gov/mortsql.html


Community Health Assets ______________

Hospitals

Sparrow Ionia Hospital. Ionia, Michigan General medical and surgical hospital Critical access hospital3 25 beds 524 admissions 51,303 outpatient visits 232 personnel

Federally Qualified Health Clinics Both are located in Belding.

Belding Health Center Belding Migrant Health Center

Rural Health Clinics

Charles R. Barker, Jr. DO Family Practice, PC (Belding)

Family Health Center Portland (Portland)

Ionia Family Practice (Ionia)

Tony Balice Clinic (Ionia)

3 Critical Access Hospitals are typically located in rural areas, at least 35 miles from the nearest hospital, and furnish 24-hour emergency care services 7 days a week. Critical Access Hospitals are limited to no more than 25 inpatient beds. Centers for Medicare & Medicaid Services (CMS). http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/CAHs.html


Extended Care Facilities

Two for‐profit nursing homes, 248 total beds

Physicians and Nurses

Table 2: Health Care Professionals in the Sparrow Health System Service Area, 2008

County

Total, Active, Non-Federal

Medical Doctors'

Active Nurse

AnesthetistsActive Nurse Practitioners

Active Certified

Nurse Midwives

Total Advanced Practice Nurses

Clinton County 41 3 26 1 30 Eaton County 65 7 28 0 35 Ingham County 836 9 97 10 116 Ionia County 21 6 10 4 20 Gratiot County 48 4 10 1 15 Shiawassee County 45 9 13 2 24 Area Total 1056 38 184 18 240 Source: U.S. Department of Health & Human Resources, Health Resources and Services Administration, Area Resource File, 2010.


Findings ______________________________

Socioeconomic Indicators The area served by Sparrow Ionia Hospital is not a prosperous community. Indicators associated with poverty are higher in this area than for the entire six‐county Sparrow Health System service area as well as for the entire state. Households that spend more than 30 percent of their income on housing costs are about average, but the area’s educational level—as indicated by the percentage of area residents with bachelor’s degree—is considerably lower than for the region or the state. Each of these indicators may relate to stress which can have negative impacts on health among area residents. Alternatively, the area is characterized by a very low violent crime rate which may reduce one potential source of stress that may be found more commonly in other locations. Indicator Location Measure Comparison

Children in poverty Michigan 19.0% 6‐County Region 17.7% Ionia County 21.0%

Single parent families Michigan 9.5% 6‐County Region 9.4%

Ionia County 10.8%

Housing costs more than 30% of household income

Michigan 34.8% 6‐County Region 33.7%

Ionia County 34.5%

Violent crimes per 1,000 persons Michigan 489.9 6‐County Region 270.6 Ionia County 156.6

Adults with at least a Bachelor’s degree

Michigan 25.0% 6‐County Region 25.2% Ionia County 13.1%

More favorable than the statewide average About average Less favorable than the statewide average


Health Behaviors Indicators of healthy behaviors in the Sparrow Ionia Hospital service area are somewhat favorable in comparison to nearby areas and to the entire state. Smoking and drinking percentages among Ionia County residents are more favorable than average or about average. Data regarding obesity among young people, however, clearly reflects the observations of some community leaders who indicated that obesity is a major problem within this community. Indicator Location Measure Comparison

Adults who are obese Michigan 31.7% 6‐County Region 26.7% Ionia County 30.7%

Children who are obese Michigan 11.9% 6‐County Region 14.4%

Ionia County 16.5%

Adults who smoke Michigan 18.9% 6‐County Region 21.6%

Ionia County 15.4%

Students who smoked in the past 30 days


Binge drinking among adults Michigan 19.7% 6‐County Region 17.8%

Ionia County 15.8%

Binge drinking among high school students


More favorable than the statewide average About average Less favorable than statewide average


Access to Care An important health care need in the Sparrow Ionia Hospital service area is access to primary care services. The percentage of persons lacking access to a primary care physician in the area is slightly greater than the percentage across the entire state, but as noted below, the population per primary care physician in the area is about 2.5 times the ratio for the six‐county region or the state. This implies long waits for primary care, at best, or serious difficulty getting primary care services at all for some area residents. Indicator Location Measure Comparison

Persons per primary care physician Michigan 1,034 6‐County Region 1,114

Ionia County 2,670

Persons lacking access to a primary care physician

Michigan 12.5% 6‐County Region N.A. Ionia County 13.4%

Medicaid enrollment Michigan 12.3% 6‐County Region 10.6%

Ionia County 10.8%

Adults reporting poor or fair health Michigan 14.2% 6‐County Region 16.2% Ionia County 17.4%

Adults reporting poor mental health Michigan 10.7%

6‐County Region 11.9%

Ionia County 14.0% More favorable than the statewide average About average Less favorable than the statewide average


Children’s Health Despite the issues related to accessing primary care services in Ionia County, early childhood indicators are very favorable. Both infant mortality and the incidence of low birth weight babies are lower than found elsewhere in the region or the state. In addition, although not illustrated below, 81 percent of children ages 19 to 35 months have received their recommended immunizations. This is the highest rate among the six counties served by Sparrow Health System, and is higher than the 75 percent rate for Michigan overall. Indicator Location Measure Comparison

Infant deaths per 1,000 live births Michigan 7.5 6‐County Region 5.9

Ionia County 3.9

Low birth weight babies per 1,000 live births

Michigan 82.8 6‐County Region 75.3

Ionia County 65.7 More favorable than the statewide average About average Less favorable than the statewide average

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Community Health Issues _______________ Based on the data reported in this report and the comments collected from key interviewees within the Ionia County community, the following are the most important health issues that are facing the community at this time:

Healthy Life Styles. Obesity among adults and youth and the implications of these reflections of life style choices were among the most commonly identified community health problems. These issues are widely seen as part of a larger concern with healthy life style issues including poor eating habits, lack of exercise, alcohol consumption, tobacco use, and high levels of accidental deaths that may be associated with risky behavior, including drinking and driving.

Access to Primary Care Services. While this issue is reported by interviewees to be somewhat alleviated by the Sparrow Ionia Hospital Emergency Department, the Federally Qualified Health Clinic (FQHC) in Belding, and several rural health clinics within the county, these clinics do not meet all of the primary health care needs of the entire community, according to feedback from interviewees. There is a clear need for more primary care providers to bring the ratio of residents to primary care physicians closer to statewide and regional levels, thus assuring more adequate urgent care and preventive health services.

Chronic Diseases. Although the mortality rate from cardiac disease in this community is about average for the six‐county region and even lower than the statewide rate, several other indicators point towards the likelihood that chronic disease is an important concern in this community. Chief among them is the rate of premature deaths (e.g., deaths prior to age 75), preventable hospital admission due to diabetes, and relatively high rates of childhood and adult obesity. In addition, as one observer interviewed for this assessment stated, despite the availability of a few primary care clinics in this community, “there are a lot of people being attended to, but there are a lot of people that have illnesses that are not being treated.” Another interviewee claims that people with chronic illnesses are “getting pushed under the rug” or, at best, are referred elsewhere.

Sparrow Ionia Hospital | Public Policy Associates, Inc. A‐1

Appendix A: Methods __________________ In order to meet the needs of the community served by this hospital and to meet the requirements that are required by law, Sparrow Health System engaged in a two‐phase CHNA process beginning in 2011 and continuing through 2012. This process consisted of (1) participating as a supporting partner of the Healthy! Capital Counties’ (H!CC) region‐wide community health needs assessment, and (2) by supplementing the H!CC community health needs assessment and prioritization efforts with additional data collection, analysis, and identification of critical health care needs in the areas served by each of Sparrow Health System’s hospitals. Healthy! Capital Counties. H!CC is a collaborative effort of four acute care community hospital organizations and three area health departments that serve the Greater Lansing area, as defined by Clinton, Eaton, and Ingham counties, Michigan. The four hospital organizations are:

Sparrow Health System, consisting of four community hospitals, three of which are located in the three‐county Greater Lansing region:

Sparrow Hospital, Lansing, Michigan Sparrow Specialty Hospital, Lansing, Michigan Sparrow Clinton Hospital, St. Johns, Michigan Sparrow Ionia Hospital, Ionia, Michigan

McLaren Greater Lansing Hayes Green Beach Memorial Hospital Eaton Rapids Medical Center

The three health departments collaborating in this effort are:

Ingham County Health Department, serving Ingham County, Michigan Barry‐Eaton District Health Department, serving Eaton County, Michigan Mid‐Michigan District Health Department, serving Clinton County, Michigan

Additional support was provided by Physician’s Health Plan of Mid‐Michigan, McLaren Health Plan, Ingham Health Plan Corporation, and the National Association of County and City Health Officials.

A‐2 Sparrow Ionia Hospital | February 2013

As a partner of the Healthy! Capital Counties collaborative, Sparrow Health System participated as a member of the Steering Team that was directly responsible for overseeing the CHNA conducted within the three‐county region as well as for community dialogues conducted by H!CC to identify the greatest health care needs in the region, prioritize these needs, and incorporate them into a region‐wide (e.g., Clinton, Eaton, and Ingham counties) Community Health Improvement Plan (CHIP). Under the direct supervision of the health officers within each of the three community health departments, the H!CC CHNA was compiled from publicly‐available data resources obtained from the U.S. Bureau of the Census (American Community Survey), Michigan Department of Community Health (vital records and registries), Michigan State Police (crime statistics), Centers for Disease Control and Prevention (Behavioral Risk Factor Surveillance Survey), and the Michigan Department of Education (Michigan Profile for Healthy Youth), among others. These data were supplemented by nine focus groups conducted with Lansing area residents (including one conducted in Spanish) who may be considered medically underserved or, at a minimum, may have greater than average health care needs. These individuals consisted of adults without health insurance, those enrolled in Medicaid, unemployed residents, handicapped residents, and low‐wage workers. Data collected through these efforts were compiled in a region‐wide report that was used as the basis for a series of public community dialogues in which the findings were discussed and participants were asked to assist the professional staff in identifying the area’s most important health care needs. These needs were prioritized at a subsequent community meeting. The Collaborative’s region‐wide health improvement plan will be based on these determinations and the interests of each partner—hospitals, health departments, and others, alike—to work towards ameliorating the high priority issues. Sparrow Health System. As Sparrow Health System serves all or parts of six counties, including the three‐county Greater Lansing area, it was determined by its Executive Leadership that their participation in the Healthy! Capital Counties collaborative would need to be supplemented with additional data collection efforts in order to include these additional areas—such as the community served by Sparrow Ionia Hospital—in their assessment, and because there were some additional service area populations and issues which were not directly addressed in the H!CC assessment process. In response to this need for additional information, Sparrow Health System hired Public Policy Associates, Inc., to work with the H!CC team on their foundational community health needs assessment and to collect additional data to meet the health system’s additional information needs.


Through these efforts, the following tasks were accomplished. 1. Professional Community Health Expertise. By participating collaboratively with H!CC,

the foundation for the Sparrow Health System Community Health Needs Assessments was based on the professional expertise and direction of the Health Officers and technical staff of each of the participating health departments:

Renee Branch Canady, Ph.D., Health Officer, Ingham County Health Department, Lansing, Michigan

Colette Scrimger, Health Officer, Barry‐Eaton District Health Department, Hastings, Michigan

Marcus Cheatham, Health Officer, Mid‐Michigan District Health Department, Stanton, Michigan

In addition, Lisa McCafferty, the Health Officer for the Ionia County Health Department, and Robert Lathers, the Chief Executive Officer of Ionia County Community Mental Health Services, were consulted for the Ionia County assessment.

2. Quantitative Data Collection. Much of the quantitative information contained in this

report are drawn from the same resources found in the H!CC CHNA report, and most of these data were supplied by the Ingham County Health Department to Sparrow Health System through Sparrow’s participation in this collaborative. In a few cases, data were updated to reflect the availability of more recent data. In addition, Sparrow Health System’s consultants compiled some additional data elements for this assessment. Additional data elements include the following:

Single parent households. Bureau of the Census, American Community Survey, 2006‐2010;

Medicaid enrollment. Michigan Department of Community Health, 2012; Health insurance coverage (population without health insurance). Bureau of the Census, Small Area Health Insurance Estimates, 2009.

Low birth weight babies. Michigan Department of Community Health, 2000‐2010.

3. Qualitative Data Collection. In order to reach a broad cross‐section of the hospitals’

service areas and in order to investigate the heath care needs and concerns of identifiable sub‐groups within the region’s population, Sparrow Health System

A‐4 Sparrow Ionia Hospital | February 2013

sponsored 39 one‐on‐one interviews and six focus groups as part of this assessment. Interviews were conducted in person or by telephone and typically took 45 to 60 minutes. Focus groups were scheduled for 90 minutes each; some exceeded that length of time. Interviews and focus groups were conducted between June 2012 and November 2012.

Interviewees and focus group participants were mainly health care consumers who have health care insurance and who serve in their respective communities as health care leaders, elected officials, health care providers, social service workers, educators, retirees, and others, as noted below. All interviews were conducted by Public Policy Associates, Inc. staff. Interviewees included residents of each county in which a Sparrow Health System hospital is located, including Ionia County. Please note that approximately 15 percent of all interviewees were located within Ionia County, and none of the Ionia County interviewees were members of the minority groups listed below due to the relatively low proportion of minorities in this county (with the exception of prison inmates whose health care needs are overwhelmingly provided within the prison system or elsewhere). Approximately twenty‐five percent of all participants who participated in these data collection efforts are members of racial or ethnic minority groups. Racial, ethnic, and religious minority interests represented include the following:

Muslim Community focus group African American focus group Medical director of an Hispanic Community organization Representatives of the East Indian Community International students from China, Taiwan, and Egypt

Other community participants include the following:

Community health leaders, including health care administrators and hospital board members

Health care providers, including physicians, other service providers, and long‐term care providers

Educators, including one health care educator Social service providers Refugee service providers


State and local elected officials Students Retirees

All interviewees and focus group participants were explicitly asked to identify the most pressing community health needs as well as their suggestions for addressing these issues. Identification of the most frequently mentioned community health needs for each hospital’s service area were combined with the findings illustrated through analysis of community health indicators to compile the findings in this report.

4. Follow‐Up/Community Health Priorities. A key follow‐up effort has been to identify

how the high priority community health needs that have been identified independently through each process relate to each other, and how they collectively represent the basis upon which the most important health needs in the Sparrow Health System service area and the H!CC three‐county region will be addressed. At the time this report was completed, an illustration of the commonalities between the two sets of priorities was prepared and circulated to all of the hospitals and health departments participating in this collaborative effort for their planning activities.

Sparrow Ionia Hospital | Public Policy Associates, Inc. B‐1

Appendix B: Interview and Focus Group Participants ____________________________ As a supplement to the Healthy! Capital Counties (H!CC) Community Health Needs Assessment (CHNA), interviewees and focus group participants were solicited from a wide variety of community residents within the six main counties served by Sparrow Health System hospitals. Among those solicited were community leaders and health care leaders; state and local elected officials; physicians and other health care providers or workers; leaders and members of racial, ethnic, and religious minorities; educators; students; retirees; social service providers; and others. Minority group members with whom these issues were discussed include African Americans, members of the Muslim community from several different ethnic backgrounds, international students, and members of the East Indian community. Health care issues within the Hispanic community were addressed by a physician that serves the Hispanic community. International students were from China and the Middle East. The occupations or special expertise of these participants not only include expected participants such as city managers, health care administrators, and social service providers, but they also include a fitness coach, two dentists, a farmer, a former drug addict, a firefighter, a high school principal, a veterinarian, and a librarian. Almost 70 individuals participated either as interviewees or focus group participants for this project. The categories in which these individuals are classified are found in Table B‐1, below. Note that some individuals are classified in more than one category. Also note that only a subset of these individuals were interviewed with specific reference to Sparrow Ionia Hospital and the Ionia County service area.

Table B-1: Interviewees and Focus Group Members, 2012 Category Number Community Leader 15 Educator 6 Government Official 8 Health Care Administrator 7 Health Care Consumer (not otherwise categorized) 6 Health Care Provider/Health Care Worker 10 Hospital Board Member 11 Long-Term Care Provider 4 Minority Community Leader 5

B‐2 Sparrow Ionia Hospital | February 2013

Table B-1: Interviewees and Focus Group Members, 2012 Category Number Minority Community Member 15 Physician 4 Refugee Services 2 Religious Leader 1 Religious Minority Member 8 Retiree 4 Social Services Provider 9 Student 3 Total* 118 * Some individuals are in more than one category.

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