Onondaga County is the sixth most populated county in upstate New York, covering 780 square miles and having a population of 468,463. The county is mostly made up of forests and agricultural terrain, and it has a disproportionately small population.
A community's demographic and socioeconomic variables have a substantial impact on health behaviors, health care access, and health service utilization. As a result, these factors have an impact on the health outcomes and population makeup of a specific population. The county has a health discrepancy between towns, which is critical for the planning of community health systems. The median age of the county is 38.8 years which is older when compared to Syracuse’s median age of 29.9 years. However, the general population of the county is favorably young with a high proportion of residents comprising children under five years old while adults above 65 years being very few. Syracuse which is the county seat of Onondaga has a considerable high population of residents aged between 15 and 24 years mostly influenced by major colleges and universities in the County which are situated there.
Race and Ethnicity
96.7% of the county’s residents are being identified as no race. Which further divides into 80.4% of which are white and 11.1% identified as black. The majority of the black residents reside in the county seat. Self-identified Asians in the county account are only 4% while 0.7% of the population is Native Americans (Gupta, Schultz, & Lenkiewicz, 2017). 7.4% of the population is foreign born with a significant population migrating from Asia followed by Europe, Latin America, and Africa. Since the 21st century, more than 10,000 refugees have moved into the county with a majority of them coming from Myanmar, Thailand, Nepal, Somalia, and Iraq (Snow, 2014). English is the most spoken language in the county followed by Spanish which is the primary spoken language at home by 3.1% of the residents.
Poverty
Poor health is often as a result of poverty and other socio-economic related outcomes. The county has a high percentage of poverty among the black and Hispanic residents. 50% of the children in Syracuse under the age of 18 live in poverty, compared to 23% of the children countywide. The older population of people aged 65 years and above has the lowest margin with regards to poverty where only 8.2% of the citizens living in poverty.
Education
Education is an important social determinant of health. The county has 47.2% of children participating in preschool programs which help in creating a foundation for learning in young children. It also has 18 public school districts with an enrollment of approximately 70,000 students. There are apparent disparities in education between the city of Syracuse and other towns in the county. Syracuse City School District (SCSD) has a considerably low performance in the county and within the major part of the state of New York. Additionally, the high school dropout rate in Syracuse is high with 11% dropout experienced in 2015-16 school year compared to an average of 4% county wide (Gupta, Schultz, & Lenkiewicz, 2017).
Community Health and Safety Account
The health and safety resources within the county are considerably accounted for in different hospital services. The county has three recognized public hospitals, that is, Crouse Hospital, St. Joseph’s Hospital, and Upstate University Hospital all of which offer a diversified range of health care services. The health services present in the county range from primary care, behavioral health, dental, post-acute and community health providers. It is evident that the county has invested well towards the provision of healthcare services across a vast geographical region and offer different services to meet the needs of the community.
Onondaga County has an average of 3.4 beds per 100 people with all health institutions within the regions having a collective of 1592 beds (Snow, 2014). A full range of screening is conducted by clinics all around the county to improve the health services and meet the populations’ health demands. Types of screening available include; cancer screening, family planning, Immunization, HIV tests, Tuberculosis, and Lead Testing among other things.
Satisfaction rate in the county with regards to health and safety is very high, for example, St. Joseph’s has a 73% patient satisfaction rate which highlights just how safe the residents feel when faced with health concerns. Timely and efficient care in the hospital is also high with 98.5% efficiency. Outpatient primary care services are also well established in the region through three fundamental categories. The first category includes public and private subsidized clinics which offer services to uninsured and low-income residents. Secondly, the services are also offered through a group of hospital-owned clinics as part of large integrated delivery systems. Finally, the presence of private community hospitals that serve insured residents including those with Medicaid.
Disaster Assessment and Planning
Onondaga County’s Disaster Management Emergency Plan is based on core concepts which include; risk reduction (prevention and mitigation), response, and recovery. The principal hazards in the county have been identified as severe storms, severe winter, floods, ground failure, and earthquake. All these hazards have serious health implications if not well managed.
The risk assessment portion of the mitigation and planning process is a five-step plan which aims at establishing a mitigation plan as the final step with risk identification, profiling of hazards, inventory assets and estimated loss representing the steps as mentioned above in chronological order.
Interpretation
Access to health in the county is well above the New York State percentage with 91.3% of the county residents having health insurance compared to 87.6% in NYS. Despite the relatively high insurance rates, very few residents have a regular health care provider. Concerning preventable hospitalization, the county has a high percentage rate (111.6 per 10000) (St. Joseph's Hospital Health Center, 2016). Although this result ensures that the prevention agenda objective is met, there are disparities in rates based on race and ethnicity. For example, for each white non-Hispanic preventable hospitalization, there is 2.32 and 1.17 preventable hospitalization for black and Hispanics respectively.
22.9% of residents die prematurely with the rate being much higher among black and non-Hispanic community members. Geographic disparities in life expectancy are also evident among county residents and those living the city of Syracuse. County residents have a life expectancy of 80.5 years while that of Syracuse is 76.6 years which falls short of the national average. These differences are based upon sex with females having a longer life expectancy than males which is consistent with the national data.
Health Problems Facing the Community
Healthy People 2020 is a national objective aimed at improving all Americans health for the next 10years starting from 2010. Concerning Onondaga County, the following three issues were most pressing with regards to meeting the goals of the health people 2020 objectives. They include but are not limited to
Prevention of Chronic Disease such as obesity
The improvement of psychological health status and the prevention of substance abuse
Promotion of healthy women, infants, and children
To Improving the health and well-being of women, infant and children is a set object for the 2020 agenda to help determine the health of the next generation and prediction of future health implications on families, communities and healthcare facilities. Onondaga experiences many disparities regarding the weight of infants at birth with low birth weights being 8.1 percent which is higher than other counties in the state of New York. The rate of pre-term births in Syracuse is also alarming standing at 12% at the moment with the county averaging 10.4% as well. Additionally, the infant mortality rate for black infants is higher as compared to other ethnicities and race. Although race does not influence mortality, this gives researchers an opportunity to critically look at the social determinants that might lead to such a high rate among the black community.
In the U.S alone 18.1% of adults aged 18 and above suffer from any mental illness in a given year while 4.2% suffer from severe mental related diseases. The relation between mental health and substance abuse cannot be ignored, and the 2020 goals touch on both these issues. With regards to mental health, depression is the second most reported significant chronic condition for the Medicaid beneficiaries in the county. This is followed by other mental health diagnoses such as chronic stress and anxiety, schizophrenia, attention deficit disorder and chronic mental health diagnosis. Furthermore, of the top ten causes of emergency visits by the Medicaid patients 28% account for mental related diagnosis.
More than 22 million Americans have substance abuse problems relating to drug use and alcohol. 95% of the said population does not even know they have substance abuse problems which set the standards for prevention initiatives (Healthy People 2020, 2017). In Onondaga County, newly born drug-related diagnoses are the second leading causes of hospitalization. The rate is reported to be 257 per 10,000 discharges. Additionally, opium and heroin-related death cases have been on the rise in the county since 2010 thus reflecting the need to achieve 2020 vision.
Prevention of Obesity
Apart from leading to obesity, unhealthful dieting can lead to type 2 diabetes, cancer, heart diseases, and high blood pressure. Healthy people 2020 promote health and reduce chronic diseases such as the ones mentioned through instilling a culture of healthy dieting across the great American nation. The 3rd leading cause of hospitalization in the county points to diabetes with hypertension counting as the number one reason in Medicaid patients.
Community Resources Applied to Minimize Chronic Diseases
Interventions and resources required for the prevention and minimization of chronic diseases ought to be evidence-based resources and institutions that are accredited to mitigate such intervention through best practice principles. In Onondaga County, some of the resources include hospitals, diagnostic and treatment centers, hospital-based clinics, health home partners, behavioral health providers, community-based organizations, and school-based health centers.
Community-based resources such as The Salvation Army, Enable, Arise Inc, and Aurora of Central New York often collaborate with behavioral health centers including Hillside Children’s Center and Liberty Resources to provide specific health needs of the residents. In total, the county has a total of 36 Health Professional Shortage Area (HPSA) facilities for primary care and 10 Medically Underserved Area/Population facilities to offer medical services across the wider region of the county. (St. Joseph's Hospital Health Center, 2016)
Primary Prevention of Obesity
The main prevention of obesity should be rooted in children as a foundation and progress upwards to adults. Children are the basis of any given society and regular assessments for eating habits to start at birth and to occur during immunizations and regular clinical visits. Evidence-based research suggests that there are three ways to which obesity as a chronic disease could be mitigated and minimized across a wide demographical range. These include:
Nutrition and Eating Habits
Healthy eating is associated with a healthy weight; thus information regarding best eating, feeding, and nutrition practices should be recommended within all healthcare institutions and facilities. The information also ought to be shared throughout the growth and development as well as regular assessments of patient and children. A good example is the use of brochures and supportive dietary assessments and information sharing by qualified healthcare providers and dietitians. Demographic appropriate questionnaires are also an effective way towards building a culture of understanding the eating habits and needs of individuals across a wide demography. Understanding the eating habits and diets of different ethnicities, age, and occupation help dietitians compile sufficient recommendation plans that help mitigate obesity.
Physical Activity and Secondary Behavior
Physical activities impact weight of individuals and should be effectively assessed while implementing primary prevention interventions. Recommending such activities is essential based on the understanding of the patients or people suffering from obesity. With regards to factors such as age and daily routines, healthcare givers can adopt an appropriate intervention plan that incorporates physical exercises of particular intensity throughout the day (Registered Nurses Association of Ontario, 2014). This may include muscle and bone strengthening activities, development of movement skills, appropriate workplace activities among other things. Throughout the implementation of these activities, it is important to note that anthropometric measures although necessary should be applied cautiously. Most obese or overweight patients are wary of their situations and to reduce psychosocial impacts such as low self-esteem, labeling, and body image shame, health care providers ought to take measures and be mindful of these unintended consequences.
References
Gupta, I., Schultz, R., & Lenkiewicz, B. (2017). Onondaga County Community Health Assessment and Improvement Plan 2016-2018. Onondaga, NY: Onondaga County Health Department. Retrieved from http://www.ongov.net/health/documents/OnondagaCountyCHA-CHIP.pdf
Healthy People 2020,. (2017). Nutrition and Weight Status | Healthy People 2020. Healthypeople.gov. Retrieved 30 March 2017, from https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status
Registered Nurses Association of Ontario,. (2014). Primary Prevention of Childhood Obesity (2nd ed.). Toronto, Ontario: Registered Nurses’ Association of Ontario. Retrieved from http://rnao.ca/sites/rnao-ca/files/Childhood_obesity_FINAL_19.12.2014.pdf
Snow, J. (2014). Central New York Care Collaborative Community Health Assessment. Boston, MA: JSI Research and Training Institute. Retrieved from https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_applications/docs/central_ny_dsrip_pps/3.8_cny_cna.pdf
St. Joseph's Hospital Health Center,. (2016). Community Health Needs Assessment. New York, NY: St. Joseph's Hospital. Retrieved from https://www.sjhsyr.org/upload/docs/SJ_CommunityHealthNeedsAssessment_FINAL_E-version.pdf
