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Community health assessment – Task 1
Part A – Identification of community
The community assessed for this task was the Sacramento County located in California, United States.  Its county seat is Sacramento and it is bordered on the western side by the Sacramento River.  On the other three sides, it is surrounded by the San Joaquin River, Sierra Nevada Mountains, and the San Francisco Bay.  Most parts of this community are located either close to sea level or below sea level.  The largest population living here is the Whites, followed closely by the Hispanics, Latinos, African Americans, and Asians.
Part B – Summary of assessment tools
Population economic status
This assessment tool was used to find out the financial status of the people living in Sacramento County.  The annual average household income is $55,615 and 18.1% of households in the county lie below the poverty line.  The maximum percentage of people living in poverty includes African Americans, Hispanics, and Native Americans.  People belonging to the age group of less than 18 years are usually poorer than people belonging to the other age groups.  About 0.18% of the population is homeless (Zheng et al., 2014).
About 7.3% of the population of the county is unemployed. The total percentage of families receiving public economic assistance from the government is 33% and about 49% of the population enjoy health insurance benefits provided by their workplace.  The amount of money allocated for public health funding every year is $1,996,991,180 and the per capita public healthcare expenditure is $6,238.  The maximum coverage for healthcare expenditure is provided by private insurance, followed by Medicare and Medicaid (Zheng et al., 2014).
Disaster assessment and planning
The disasters most likely to affect people in Sacramento County include floods, drought, extreme climatic conditions and freezes.  Most disasters are a direct effect of extreme weather conditions and these include thunderstorms, heavy rainfall, lightning, hailstorms, strong winds, tornadoes, and hurricanes.  The industry most affected by these disasters is the agricultural industry which incurs heavy losses due to excessive heat, excessive rainfall, and wheat stripe rust.  Hence, there are a number of funding and assistance programs available for farmers and ranchers following these disasters (AMEC Earth and Environmental, Inc., 2004).
Damage to both public and private properties can be intense.  Roofs that are not well maintained can be blown off with strong winds or tornadoes.  Objects such as trash cans can be thrown about and hurt people.  Trees can be uprooted and windows can be broken.  Heavy fog can lead to multi-vehicle pileups due to extremely low visibility.  Floods can damage public property such as public transport, roadways and railways, and government buildings.  It can also shut down all business and affect the economy of the region.  Extreme weather conditions can lead to a breakdown in power lines and shut down electricity throughout the county.  Hailstorms and fogs can lead to serious accidents on the roads (AMEC Earth and Environmental, Inc., 2004).
Neighborhood/Community safety inventory
A review of potential health hazards in the Sacramento County found that superfund sites in the Sacramento County are important sources of land contamination.  There are about 30 to 40% of land releases that are proving harmful to the community.  The total number of sites causing this contamination is four.  At least three of these sites have led to the contamination of drinking water resources.  One of these sites is undergoing construction to make it less contaminated and less hazardous to the community (Scorecard, 2011).
There are at least two facilities in the county that release chemicals which are a part of the Toxics Release Inventory (TRI) to the land.  The total pounds of these chemicals that have been released to the land are 4,379.  An important example of these chemicals includes manganese compounds.  Apart from these, trichloroethylene has also been detected in considerable amounts at the superfund sites (Scorecard, 2011).
Cultural assessment
The population of Sacramento County is quite varied and comprises of Hispanics, African Americans, and Asian Pacific Islanders, making the county culturally and ethnically diverse.  These people contribute to about one thirds of the entire population of the county.  The primary language of the people is English, followed closely by Spanish.  Families belonging to this group face quite a lot of stresses and pressures, mostly related to a larger number of single-parent families, increasing poverty levels, problems with maternal and child health conditions, and domestic abuse(Dickinson, 1998).
The mental health plan of the Sacramento County is implemented by representative healthcare providers across all cultures.  This enables them to understand the needs of the patient, preferences of the families, and their willingness to proceed with treatment.  Each region has service centers for mental health patients which provides treatment and management of the conditions of patients in that particular region(Dickinson, 1998).
Windshield survey
There are a number of community centers in the county, both urban and rural, including the shopping area located in the center of the county.  Other urban communities located in and around the county include South Natomas, Del Paso Heights, North Highlands, Rancho Cordova, Arden-Arcade, Meadowview area, and South Sacramento.  Some of the rural community areas in the region include North Natomas, Antelope, Elverta, Rio Linda, Foothill Farms, Citrus Heights, and Elk Grove.  The eastern part of the region has been under continuous development and the county boasts a number of large shopping malls such as the Downtown Mall, the Florin Mall, the Arden Fair Mall, the Sunrise Mall, and an Outlet Mall having 60 stores.  The major routes of transportation include Interstate 80, Interstate 5, Highway 99, State Route 50, and Highway 160.  Public transport options include buses and light rails.  However, it is quite inconvenient and most people prefer using their own vehicles (Dickinson, 1998).
Scavenger Hunt
The following six organizations were chosen for the scavenger hunt.
Women, Infants, and Children Office (WIC)–This center is located in five areas of the Sacramento County including South Sacramento, Del Paso Heights, Oak Park, Rancho Cordova, and Elk Grove.  This program especially targets pregnant ladies, new mothers, and children below the age of five.  It provides advice on the right nutritional considerations for the ladies and children, referrals to various community services, and information about breastfeeding.  It works on self-referrals and welcomes anyone who fulfills their eligibility requirements.  It is active on social media sites such as Facebook and Pinterest where it posts educational information for the general population.
Sacramento County Public Health – It is available for all people of the county and its main objective is to promote health and safety among the people.  It publishes health status reports which focus on different aspects and determinants of health in different communities.  It has also recently launched a health data website which provides free information about health-related topics to the people.
Planned Parenthood – This organization has four centers in Sacramento including North Highlands, B Street, Capitol Plaza, and Fruitridge.  They provide services such as abortions, birth control, men’s sexuality issues, emergency contraception, sexual orientation, pregnancy, sexually transmitted diseases (STD), and women’s health.  They also provide online services such as birth control advice, treatment for urinary tract infections, and online testing for STDs.
Senior and Adult Services (SAS) Division – This program is meant mainly for older people living with disabilities.  It aims to protect these people against abuse and neglect, and to try and give them an independent life to the extent possible.  Its programs include adult protective services, in-home supportive services, and senior volunteer services.  It has a number of resources such as hotlines, handbooks, and factsheets providing relevant information about the organization and their services.
Weave, Inc.  – This organization primarily takes care of victims of domestic abuse and sexual harassment in Sacramento County.  It has a support helpline and an option for volunteering.  It also provides a number of educational resources and seminars to strive towards making a community that is free of all forms of violence.  It also has a store where recycled fashion can be donated and bought, and this money is used to help victims get back on their feet.
Next Move – This organization is a shelter for homeless people which provides a place to live for 30 days to people with children, single parents, boys over the age of 14, and two-parent families.  It is constantly improving its services by building facilities such as playgrounds for homeless children.  Its major programs include emergency shelter, transitional housing, Francis house center, and permanent supportive and rapid re-housing programs.
Part B1 – Interpretation of collected data/other epidemiological data
An assessment of the epidemiological data collected for the Sacramento County has put a number of facts in perspective.  Males are more likely to die at a younger age than women due to health conditions such as cardiovascular disease and heart injury.  The average life expectancy of the people of this county is 79.7 years.  Diabetes contributes to the seventh largest cause of death, the other causes being heart disease, stroke, and end-stage renal disease (Zheng et al., 2013).
Chronic lower respiratory diseases are quite common in the population of the county.  Asthma affects 15.5% of the population, which is higher than the asthma prevalence rates for California.  A mortality rate due to lower respiratory diseases is quite high in people above the age of 65, with about 95,000 deaths each year.  The rate of diabetes in the people of Sacramento County is 5.8%, which is lower than the rate observed in neighboring cities and states.  Out of these, the rate of diabetes among women was found to be more than the rate among men.  People aged 65 and above were most likely to get diagnosed with diabetes, followed closely by the age group of 50 to 64 years.  Diabetes and asthma are both found to be highest in American Indians and Alaskan Natives (Zheng et al., 2013).
About 16.7% of teenagers were found to be overweight compared to 12.7% of overweight children, and 5.7% are considered obese.  About 31.9% of adults were found to be overweight and 26.5% of adults were found to be obese.  Males were more likely to have higher body weights than females.  About 6.4% of the people have been diagnosed with cardiovascular disease and it is the largest cause of death in the population.  This rate is also found to be higher than that of California.  People aged 65 and above were most likely to get diagnosed with heart disease.  About 30% of adults and 60% of older adults have been diagnosed with hypertension, the control of which can lead to a reduction in the rates of heart disease.  Hypertension stands to be the 9th leading cause of death.  It can also lead to stroke, which is the 4th leading cause of death in Sacramento County (Zheng et al., 2013).
In conclusion, the health conditions widely prevalent among the people in Sacramento include cardiovascular disease, stroke, hypertension, diabetes, obesity, and asthma.  A good control over lifestyle factors and control of body weight and blood pressure can lower the prevalence of these conditions and lead to most people, including older people, lead healthier lives (Zheng et al., 2013).
Part C1 –Identification of top 3 problems in the selected community
Following the assessment of data obtained, it is quite apparent that the top 3 health problems prevalent in the Sacramento County are cardiovascular disease, stroke, and diabetes.
Part C1a – Comparing the top 3 problems in relation to Healthy People 2020 objectives
Cardiovascular disease
Cardiovascular disease is the largest cause of death in the United States, including the Sacramento County.  The most important risk factors include hypertension, high cholesterol levels, diabetes, smoking, poor lifestyle, and obesity.  Effective control of these factors can lead to a considerable decline in the rate of cardiovascular disease.  It is currently estimated that about 1 in 3 adults in the United States are diagnosed with heart disease.  It leads to a decreased quality of life, disability, and significant expenditure in its management.  The Healthy People 2020 objectives are designed so as to improve cardiovascular health of the population, reduce deaths due to coronary heart disease, promote frequent monitoring of blood pressure and blood cholesterol, promote healthier lifestyles, increase the use of aspirin among adults who are at risk for developing cardiovascular disease, and promote awareness about the symptoms and prevention of heart attacks(Healthy People 2020, 2016).
Stroke is the third leading cause of death in the United States and the fourth leading cause of death in the Sacramento County.  The most important risk factors include high blood pressure and cholesterol levels, diabetes, tobacco smoking, poor lifestyle habits, and overweight or obesity. Effective control of these factors can lead to a considerable decline in the rate of strokes.  Overall, cerebrovascular disease leads to a decreased quality of life, disability, and significant expenditure in its management.  The Healthy People 2020 objectives are designed so as to improve cerebrovascular health of the population, promote frequent monitoring of blood pressure and blood cholesterol, promote healthier lifestyles, and promote awareness about the symptoms and prevention of strokes (Healthy People 2020, 2016).
Diabetes is estimated to be the seventh leading cause of death in the United States and about 23.6 million people are affected by this condition.  It can lead to other serious complications such as heart attacks, strokes, blindness, and kidney failure.  The Healthy People 2020 objectives regarding diabetes recommend reducing the number of new diagnoses of diabetes per year, reduce mortality related to diabetes, improve glycemic control among diabetics, and promote healthy lifestyle habits through awareness and education programs for high-risk group people (Healthy People 2020, 2016).
Parts C2/C2a/C3 – Primary prevention topic and community resources
The number of people getting diagnosed with diabetes is constantly increasing every year and it is widely prevalent among the African American population of Sacramento County.  Interviews with these people have also led to most of them complaining about generations suffering from diabetes in their families.  They are also found to have good knowledge about a healthy diet and the importance of physical activity.  The most important barriers for these people in not maintaining a healthy lifestyle include neighborhoods unsafe for exercise, lack of transportation, lack of motivation, miscommunication with their healthcare providers, and need for more educational resources (Ziegahn, 2013).
According to statistics from the Sacramento Office of the American Diabetes Association, one out of every three children born in the United States will be affected by diabetes. An important indication for developing diabetes is the wide prevalence of overweight and obesity (American Diabetes Association, 2016).  Hence, in Sacramento County, an important area that needs immediate attention is the prevention of overweight and obesity through healthy nutrition and physical activity.  The government of Sacramento has been widely involved in the prevention of obesity, especially among children, and the following community resources are available to help the population of the county.
The Community Health Status Report published in 2014 in Sacramento County indicates that the prevalence of diabetes is increasing and obesity is the most important risk factor for this condition (Zheng et al., 2014).  The Public Health Department of the Sacramento County is actively involved in helping children and adults overcome obesity before it leads to serious illnesses (Public Health, 2016).  A childhood obesity prevention coalition in the county has effectively analyzed the reasons for childhood obesity, mainly less physical activity due to social change and difficulty in maintaining a healthy and balanced diet. It includes members from various institutions such as schools, hospitals, health insurance organizations, non-profit organizations, health departments, nutrition programs, health educators, and advocacy organizations.  They are all involved in promoting interventions aimed to reduce childhood obesity and these include promoting breastfeeding, healthy eating practices in schools, regular monitoring of weight in hospitals, construction of outdoor recreation centers for children, reducing the time children spend on technology like television and video games, and provision of nutritious foods in local grocery stores (Childhood Obesity Prevention Coalition).
AMEC Earth and Environmental, Inc.  (2004).  Sacramento County – Multi-hazard mitigation plan.  Retrieved from http://hazardmitigation.calema.ca.gov/docs/lhmp/Sacramento_County_LHMP.pdf
Dickinson, R., Collin, I., Johnson, M.  P., Cox, D., and Nottoli, C.  (1998).  Phase II consolidation of Medi-Cal Specialty Mental Health Services – Cultural Competence Plan.  Retrieved from http://www.dhhs.saccounty.net/BHS/Documents/Reports–Workplans/Phase-II-Consolidation-of-Medi-Cal-Specialty-Mental-Health-Services.pdf
Healthy People 2020.  (2016).  2020 Topics and Objectives.  Retrieved from https://www.healthypeople.gov/2020/topics-objectives
Scorecard.  (2011).  Goodguide.  Retrieved from http://scorecard.goodguide.com/env-releases/land/county.tcl?fips_county_code=06067
Zheng, H., Pry, J., and Chung, H.  (2013).  The chronic disease experience of Sacramento County residents.  Retrieved from https://www.sierrahealth.org/assets/HSC_Sacramento_County_Report_May_2013.pdf
Zheng, H., Pry, J., Chung, H., Lockett, C., and Olivia, C.  K.  (2014).  Community Health Status Report.  Retrieved from http://www.dhhs.saccounty.net/PUB/Documents/Disease-Control-Epidemiology/RT-HealthStatusReport2014Final.pdf
Ziegahn, L., Styne, D., Askia, J., Roberts, T., Lewis, E.  T., and Edwards, W.  (2013).  Strategies to prevent and reduce diabetes and obesity in Sacramento, California: The African American leadership coalition and University of California, Davis.  Preventing Chronic Disease, 10, 130074.

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