Community Health Assesment 2024-2027

Independence Health & Animal Services

Community Health Assessment CHA

- 202 7

EXECUTIVE SUMMARY

The Community Health Assessment (CHA) is conducted every three years. The purpose of the CHA is to gain a better understanding of the health of our residents, collect key public health data on the contributing factors that lead to higher health risks or poorer health outcomes within the community, evaluate the services currently provided by the Independence Health & Animal Services Department (IHAS), and identify gaps in resources The 2024 CHA survey was sent out on May 31st, 2024 and the deadline for responses was July 1st, 2004. The initial findings from the CHA were presented to the Independence City Council on September 23rd, 2024.

The CHA is a collaborative process. Community partners reviewed and made recommendations on the questions that should be included on the CHA survey to ensure that health topics that their organizations rank as important would be represented. They provided additional feedback to ensure that questions were equitable. The organizations that contributed to this process included:

• Community Services League

• First Call KC

• Hope House

• M&H Consulting

• Independence School District

• Independence Advisory Board of Health

The 2024 CHA shows that just over 15% of Independence residents live below the federal poverty level and 49.2% of renter households are cost burdened. Suicide was found to be a public health issue that continues to plague the city with Independence having a higher rate of suicide than the surrounding areas and the state of Missouri as a whole. A quarter of respondents reported feeling that health care is not affordable in Independence and almost 16,000 residents are without health insurance.

The top 5 public health concerns identified from resident responses in the CHA survey were:

• Affordable housing

• Mental illness

• Houselessness

• Availability of affordable health care

• Firearm and gun violence

The 2024 CHA lays the foundation and guidance for the City of Independence to improve the health of residents. The health concerns and priorities identified in the 2024 CHA will be used to identify the priority areas IHAS will focus on for the Community Health Improvement Plan (CHIP). Priority areas will be ranked in the CHIP based on their ranking by survey respondents in the CHA survey, the quantitative data collected about each issue during the CHA, and input and rankings from our community partners.

KEY TERMS AND DEFINITIONS

ACRONYMS

IHAS: Independence Health & Animal Services Department

CDC: Centers for Disease Control and Prevention

CHA: Community Health Assessment

CHIP: Community Health Improvement Plan

CHR: County Health Rankings

MAPP: Mobilizing for Action through Planning and Partnerships

NACCHO: National Association of County and City Health Officials

NAMI: National Alliance on Mental Illness

NSLP: National School Lunch Program

SDOH: Social Determinants of Health

DEMOGRAPHIC TERMS

Ethnicity: The quality or fact of belonging to a population group or subgroup made up of people who share a common descent or cultural background 1

• Hispanic/Latino: Includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin.

Race: Each of the major groupings into which humankind is considered to be divided on the basis of physical characteristics or shared ancestry 1

• American Indian and Alaskan Native: Individuals with origins in any of the original peoples of North, Central, and South America, including, for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya.

• Asian: Individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia, including, for example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese.

• Black: A person having origins in any of the Black racial groups of Africa, including, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali.

• Native Hawaiian and Pacific Islander: Individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands, including, for example, Native Hawaiian, Samoan, Tongan, Fijian, and Marshallese.

• White: Individuals with origins in any of the original peoples of Europe, including, for example, English, German, Irish, Italian, Polish, and Scottish.

• Bi-racial: Individuals who report two or more racial groups

• Other Race: Individuals who did not have their race represented in the above choices.

Sexual Orientation: A person's identity in relation to the gender or genders to which they are sexually attracted; the fact of being heterosexual, homosexual, etc.2

• Bisexual: A person emotionally, romantically or sexually attracted to more than one gender, though not necessarily simultaneously, in the same way or to the same degree. Sometimes interchangeably with pansexual.

• Gay: A person who is emotionally, romantically, or sexually attracted to members of the same gender. Men, women and non-binary people may use this term to describe themselves.

• Lesbian: A woman who is emotionally, romantically or sexually attracted to other women. Women or non-binary people may use this term to describe themselves.

• Pansexual: Describes someone who has the potential for emotional, romantic or sexual attraction to people of any gender though not necessarily simultaneously, in the same way or to the same degree. Sometimes used interchangeably with bisexual.

• Straight: People who are attracted to a different gender. For example, women who are attracted to men or men who are attracted to women.3

DISABILITY TERM S

Ambulatory Difficulty: Having serious difficulty walking or climbing stairs

Cognitive Difficulty: A decline in cognitive function, which can affect memory, attention, language, perception, and problem-solving abilities

Independent Living Difficulty: Difficulty doing errands alone, such as visiting medical appointments or shopping

Hearing Difficulty: Diminished acuity to sounds which would otherwise be heard normally

Vision Difficulty: Impaired or reduced eyesight to the extent that it may not be corrected to a normal level

Self-care Difficulty: Unable to adequately perform the activities of daily living, including feeding, bathing, and hygiene practices4

ADDITIONAL TERMS

Census Tract: A small, relatively permanent statistical subdivision of a county. Each zip code will have multiple census tracts and have 4,000 people on average living in them. Each census track is named according to a numerical code.5

Childcare Desert: Any census tract where there more than 50 children under age 5 that contains either no childcare providers or so few options that there are more than three times as many children as there are licensed childcare slots.6

Data Suppression: Various methods or restrictions that are applied to census estimates to limit the disclosure of identifying information about respondents.7

Live Birth: The expulsion or extraction of a child from its mother where the child shows signs of life including heartbeat, breathing, voluntary muscle movements, and pulsation of the umbilical cord.8

Rates: A ratio that compares two different quantities which have different units

Health Disparities: Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.9

Health Equity: The attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, language, or other factors that affect access to care and health outcomes.9

Health Inequity: Differences in health status or in the distribution of health resources between different populations, arising from the conditions where people are born, grow, live, work, and age.10

Social Determinants of Health: The conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Social Determinants of Health (SDOH) are broken up into 5 domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Some examples of SDOH include polluted air and water, education, safe housing, and racism.11

C ITY DESCRIPTION

Independence is the fifth largest city in Missouri by population with 122,218 residents (U.S. Census Bureau, ACS) and is home to a variety of ethnic groups. The city is approximately 78 square miles, located in Jackson County, and is part of the Kansas City Metropolitan Area. This CHA covers Independence, which is comprised of the neighborhoods of Fairmont, McCoy, Maywood, Santa Fe, Bundschu, Bristol, and many more.

There are many different attractions in Independence, including the Harry S. Truman National Historic Site, as Independence is the hometown of President Truman and his wife, Bess. Residents can also enjoy trails, parks, museums, libraries, and various shopping areas.

Since 1940, the Santa-Cali-Gon Days Festival has taken place in Independence during Labor Day weekend to celebrate the city’s heritage as the starting point of the California, Santa Fe, and Oregon Trails. The 82-year-old event has become one of the nation’s leading festivals and now attracts more than 300,000 people annually, according to the Independence Chamber of Commerce.

What do residents have to say about Independence?

We bought our home in 1962, while it was still under construction and have enjoyed it for all these years. Neighborhood has felt safe for about 95% of the time!

I have two trails pretty close to my home, a welcoming library, Adventure Oasis is fantastic, there is free food or low cost offerings near me during the summer at the elementary schools

-Resident of 64056

– Resident of 64055

This town is so rich in history and has so much potential -Resident of 64056

FINDINGS

Survey respondents identified public health indicators and outcomes giving way to conclusions about the health of the community. This assessment will show how demographics, social environment, health behaviors, and healthcare access are interrelated. These factors have implications for community health and well-being. This report will be broken into sections covering several topics including educational attainment, economic stability, housing availability, access to health resources, violence and injury, mental and behavioral health, maternal child health and communicable disease. Each section will describe the issue and its context within public health using relevant data.

IDENTIFIED PUBLIC HEALTH CONCERNS

In addition to ranking their health, residents were asked what they perceived as the most important public health concerns for the city.

Top Five Public Health Concerns

Affordable housing (60.73%)

Mental health: including suicide and mental illness (55.25%)

Houselessness (50.58%)

Availability of affordable health care (48.0%)

Firearm and gun violence (44.21%)

Source: IHAS 2024 Community Health Survey

Affordable housing is a rising concern for Independence residents and moved from the second greatest public health concern in 2022 to the top spot in 2024. Median housing costs in Independence have increased every year since 2016, with a staggering rise from 2021 to 2022 of $20,000.12 Jackson County as a whole, Kansas City, Missouri, and the United States have all had the same trend of increasing median home values since 2016 with a proportionally large jump in value in 2022. While increasing home values is good for owners looking to sell their property, new prospective

homeowners struggle to enter the market when housing prices are too high. Out of renters, homeowners with a mortgage, and homeowners without a mortgage, renters in Independence experience the highest rate of being cost burdened

The second greatest area of concern for our community health assessment respondents this year was mental health. This issue was the fourth greatest concern in 2022. IHAS data shows that suicide is the second leading cause of death for those age groups that include those 1-44 years old, and 11% of survey respondents reported needing mental health services but not receiving treatment in the last year. Additionally, respondents in 64050, 64053, and 64056 had the highest self-reported rate of 6 or more poor mental health days.

The third concern for our community health assessment respondents in 2024 was houselessness. This issue is closely connected to affordable housing and mental health in our community. Houselessness has been a growing concerning across the nation and has seen increases over the past several years. In 2023, there were over 650,000 people experiencing houselessness in a single night nationwide.13 In Missouri, 11 people out of every 10,000 people are experiencing houselessness. Since 2007, Missouri has seen an 81% increase in the number of unsheltered individuals. The KC region had approximately 2,400 individuals experiencing houselessness in 2023, ~1,400 for the first time. 14 Houselessness has been connected to declines in physical and mental health. Individuals experience higher rates of mental illness, drug and alcohol use, tuberculosis, and other infections.

The fourth top public health concern this year was affordability of health care in our community. A quarter of our community health assessment respondents reported feeling that health care is not affordable in Independence, and almost 16,000 residents are without health insurance. The highest numbers of uninsured individuals are between the ages of 26-46 (23% of these residents are uninsured). In Independence, the rate of pregnant women, who do not receive prenatal care until the 2nd or 3rd trimester, is 23.2 per 100 live births. This is in comparison to a rate of 19.1 per 100 live births in Missouri overall.15

The fifth public health priority for respondents was firearms & gun violence. Gun violence and mental health are strongly linked, and, nationwide, gun deaths are more likely to be self-inflicted than homicides. In Independence, that rate is close to double. In 2020, Independence had a much higher rate of suicides with firearms (19.17 per 100,000 residents) than Jackson County (10.84 per 100,000 residents), Kansas City (9.92 per 100,000 residents), and Missouri as a whole (11.22 per 100,000 residents).16

DEMOGRAPHICS

15.8%

Of Independence residents have at least one disability12

18.4%

Of residents are over the age of 65 and face unique health challenges12

6.5%

Of residents speak a language other than English which can create barriers to health outcomes12

The health of a community is associated with numerous factors including the resources and services available (e.g., safe green space, access to healthy foods) as well as who lives in the community. Demographics help to describe the community and can influence the rates of health outcomes and behaviors of that area. While age, gender, race, and ethnicity are important characteristics that have an impact on an individual’s health, the distribution of these characteristics in a community may affect the number and type of services and resources available. Understanding the demographic makeup of a community is important for determining health disparities within populations and planning how best to serve the community. The section below provides an overview of the population of Independence.

POPULATION SIZE

Independence is the fifth-largest municipality in Missouri and includes 10 zip codes and 37 census tracts. Other municipalities bordering the city include Kansas City (Missouri’s largest city), Raytown, Lee’s Summit, Blue Springs, Buckner, and Sugar Creek, which vary in terms of size, growth patterns, wealth, and composition of residents. With a populati on of 122,218 residents according to the 2022 ACS population estimates, Independence comprises about 17% of Jackson County’s total population of 715,526.12

Source: U.S. Census Bureau; American Community Survey (ACS), 2017-2022

Between 2020 and 2021, the population of Independence grew around 4% (a growth of a little over 5,000 people). The majority of these residents moved from other areas in Jackson County to Independence while a few moved from out of state. The population size has remained relatively stable since 2021.

RACE AND ETHNICITY

Based on 2020 Census data, 70% of Independence residents identified themselves as White, 12% as Hispanic or Latino/a/x, and 8% as Black or African American. Seven (7) percent of residents identified

as having two or more races. The remaining 3% of residents identified themselves as Asian, American Indian or Alaskan Native, Native Hawaiian or other Pacific Islander, or some other race.

Source: Community Health Assessment Survey, 2024

AGE DISTRIBUTION

Table 1 shows the percentage of the population of Independence by age and sex. The proportion of males and females within Independence is nearly the same with females making up 51.3% of the population and males making up the other 48.7% 12

In Independence, 18.4% of the population is over the age of 65. People aged 65 and older have unique health concerns compared to the rest of the population including increased risk of falls, chronic diseases, and serious complications from infectious diseases.17 Additionally, 22.6% of the population is under 18 years of age. Like older adults, children and adolescents have different health concerns. The health needs of these special populations should be considered separately from other groups to properly address them.

HOUSEHOLD TYPES

There are 51,251 households in Independence based on 2022 ACS estimates. Out of those households, 39.6% of those households are married couples while 20.4% are single male households and 31.2% are single female households. In Independence, 60.5% of households are owned and 39.5% are rented 12

DISABILITY

The CDC defines a disability as “any condition of the body or mind that makes it more difficult for the person with the condition to do certain activities and interact with the world around them”.18 According to 2022 ACS data, 15.8% of Independence residents have at least one disability. The types of disabilities outlined by the U.S. Census Bureau are ambulatory (walking), cognitive, hearing, independent living, self-care, and vision difficulties.

Source: U.S. Census Bureau; American Community Survey (ACS), 2022.

Disability affects a higher portion of the population as age increases. For children under 5 years of age, 0.8% have a disability while 47.4% of adult 75 years old and older have a disability. Different racial and ethnic groups also experience disability at different rates in Independence. 18% of our White residents have a disability with Native Hawaiian and Other Pacific Islander and American Indian or Alaskan Native having higher rates at 20.7% and 29.6% respectively.12

Source: U.S. Census Bureau; American Community Survey (ACS), 2022.

DISABILITIES AND HEALTH

Disability can have negative impacts on health, with individuals with disabilities reporting poorer overall health, less access to care, and inactivity and smoking. People with disabilities are at a greater risk of having preventable health problems that are referred to as secondary conditions. Some of these secondary conditions include fatigue, decreased mental health and depression, and obesity.19 People with disabilities have less access to healthcare, have more depression and anxiety, engage in more risky health behaviors like smoking, and are less physically active 20

LANGUAGE

Approximately 93.5% of residents in Independence speak only English at home and 5% speak Spanish. Of the remaining 1.5% of residents (1734 residents), the majority speak an Asian or Pacific Island language. Around 551 residents speak some other Indo-European language, and around 108 residents speak some other language that was not represented in the previous categories.12

Language can be a barrier to health literacy. Language barriers and the inability to read or understand health information can pose serious health risks to individuals with limited English proficiency. Some words and ideas, especially ones specific to health, may be require a high degree of translation skill, which may not always be available. This can lead to misunderstandings and poor health outcomes.

SEXUAL ORIENTATION

Out of the respondents of the community health survey, 90% of respondents identified as straight/heterosexual, 3% identified as bisexual or pansexual, and 1% identified as each of the following: lesbian, gay, and other. While there is a lack of local and state level data to compare to, the U.S. Census Bureau added questions about sexual orientation to their 2021 Household Pulse Survey. From the Pulse survey, 88.3% of respondents identified as straight, 4.4% as bisexual, 3.3% as gay or lesbian, and 1.9% identified as something else.21

EDUCATION

This section looks at how education can affect public health. Education can be vital in helping individuals understand the importance of health, both physically and mentally. Studies have shown that people with continued education are more likely to learn about health risks, health behaviors, and how to manage their health.

A healthy community is one that offers quality educational opportunities and promotes lifelong learning and personal development -Resident of 64055

ENROLLMENT AND EDUCATIONAL ATTAINMENT

Education relates to employment rates and can affect the likelihood of being hired by employers. Data from 2019-20, show that higher levels of education correlates to higher employment rates, with the employment rate of individuals with bachelor’s degree or higher being 87%, while the same rate for individuals who haven’t completed high school the employment rate is 57%.22 According to the 2022 ACS, 19.2% of residents of Independence have a bachelor’s degree or higher.12

Students residing in Independence receive their education from one of four public school districts: Independence (ISD), Blue Springs (BSSD), Fort Osage (FOSD), and Raytown (RWQS). Higher Education institutions within Independence include Graceland University, Park University, Metropolitan Community College KC: Blue River Campus, and Faith Bible College. With 24.2% of the population having some college experience, Independence has a higher percentage than the Missouri and national percentage; with Missouri having 21.0% and the US having 19.1% of individuals having some college experience relating to their respective populations.12

Source: Community Health Assessment Survey, 2024

GRADUATION AND DROP - OUT RATES

Childhood education plays a vital role in learning healthy behaviors and the avoidance of unhealthy behaviors into adulthood.23 Looking at 2022-23 adjusted cohort graduation rates, the state of Missouri has a lower rate than 3 out of the 4 districts serving the population of Independence. The Missouri graduation rate remains at 89.98%, while Fort Osage R-I rate is 92.16%, Blue Spr ings R-IV is 96.06%, Independence is 90.29%, and Raytown is 76.06%.24 On the other hand, regarding high school (grades 9-12) 2022-23 drop-out rates, two out of four districts serving Independence have higher drop-out rates than the state of Missouri, whose rate is 1.70%. The drop-out rates of Blue Springs, Fort Osage, Independence, and Raytown are 0.20%, 1.00%, 1.90%, and 8.60%, respectively.25 Adults who have not graduated high school compared to adults who have, are more likely to develop poor health and die prematurely from diabetes, lung disease, cardiovascular disease, and other preventable conditions.26

FREE AND REDUCED LUNCH

The health program SNAP, Supplemental Nutrition Assistance Program, can reduce food insecurity, poverty, and is provided to 11.5% of households within Independence.12 Programs like SNAP and other health statuses can qualify a child into NSLP. NSLP is the National School Lunch Program and is a

USDA assisted meal program that provides everyday nutritious foods during lunch for free or at a reduced rate for children during the school day.27 In Missouri during the 2022-23 school year, 47.4% of students participated in the NSLP and obtained a free or reduced rate lunch. The National School Lunch Program can greatly reduce food insecurity and reduce the odds of poor educational outcomes, underdevelopment, and negative health effects.28 Within the public-school districts serving Independence, 26.9% of Blue Springs, 50.1% of Fort Osage, 69.1% of Independence, and 61.2% of Raytown students participated in the free or reduced rate lunch program during the 2022-23 school year.29 School lunches, such as provided by NSLP, can contain less fats, calories, and sugar than lunches that are brought from student’s homes. A healthier diet can lower the risk of conditions such as heart disease, cancer, diabetes, and promote good nutritional habits.30

CHILDCARE

Skills that are gained within high quality childcare settings include early educational concepts, emotional, and communication skills.31 Childcare provides an environment where a child has a safe space to learn and interact with other children, unfortunately there is a downside relating to cost. Research shows that families cannot maintain the cost of childcare expenses and are in grave need of federal assistance.32 As of 2022, 15.1% of the Independence population is below poverty level.12 Poverty levels can correlate with fewer options regarding childcare, and in turn can affect overall health. A U.S Census Bureau’s survey concluded that 21.8% of the population only had a relative for childcare and 61% of parents living with young children had no stable childcare arrangements.33 Positive impacts of stable childcare environments include encouraging healthy cognitive development, future educational strives, increased earnings, and positive health outcomes.34 While positive impacts of stable childcare arrangements are valued, there are also negative impacts of poor childcare. Poor quality childcare can lead to more behavior problems in children, and studies demonstrate higher quality childcare leads to better p erforming, happier children compared to poor quality childcare settings.35

Areas within Independence that demonstrate higher poverty levels tend to include childcare deserts. Childcare deserts are areas that either lack childcare centers or areas of high-cost childcare centers that have poor affordability based on the population that lives in the area.36 Currently within Independence, there are 39 childcare centers available to residents within the surrounding area.

A major issue relating to employment status and in-turn health, is the absence of childcare. An individual or family that lacks childcare, can have limited access to the work force or important medical appointments due to having no alternative caretakers for their children. Reported in 2021, 32% of the U.S workforce has an underage child in their care, and parents are needing to leave their jobs or reduce hours worked due to lack of childcare.37 Data shows that the pandemic had a major impact on childcare and employment loss, especially for women. In 2020 alone, studies showed 26% of women, due to lack of childcare, became unemployed.37 According to 2024 Community Health Survey responders, 5.63% sometimes avoid seeking medical care due to lack of childcare within Independence.

ECONOMIC STABILITY

15%

Of Independence residents live below the poverty level12

49.2%

Of renter households are cost burdened12 30%

Of survey respondents felt unsafe walking near their home or neighborhood

According to the CDC, “Economic stability includes key issues, such as poverty, employment, food security, and housing stability. These issues can affect how people prepare for and respond to an emergency.”38 Being able to afford food and medical services is just as important as being able to reach those resources. People living in poverty experience worse outcomes overall because their access to basic health services and healthy foods are restricted. Additionally, the more people spend on housing costs the less money they will have to spend on other resources.

INCOME AND POVERTY

Higher incomes make it easier to buy medical insurance and medical care, nutritious foods, better childcare, and to live in a safe neighborhood with good schools and recreational facilities. Unmet social needs, environmental factors, and barriers to accessing health care contribute to worse health outcomes for people with lower incomes. Over a lifetime, people who live in impoverished communities are at an increased risk for mental illness, chronic disease, higher mortality, and lower life expectancy.11

INCOME

According to the 2022 ACS, the median household income in Independence in 2022 was $57,415. This is about 15% lower than the median household income for Missouri which is $65,920. 42.9% of Independence households make less than $50,000, 33.7% have an income between $50,000 and $99,999, and 23.3% have a household income of over $100,000.12

In Independence, the relationship between health status and income was seen in the CHA responses. Survey respondents who made over $50,000 were more likely to report that they had Excellent or Very Good health, while respondents who made less than $50,000 were more likely to report that had Fair or Poor health.

Source: U.S. Census Bureau; American Community Survey (ACS), 2022; Community Health Assessment Survey, 2024

19.2% of respondents reported that, in the last year, they had been worried their household would run out of food before they were able to buy more and 23% reported that they had to choose between buying groceries and paying another bill in the last year.

POVERTY

The Centers for Disease Control and Prevention (CDC) defines poverty as a person or family with income below a certain limit.39 The Department of Health and Human Services (HHS) sets this limit based on the total income of the household and the amount of people living in the household. In 2022, a one-person household making less than $13,590 annually was considered impoverished while a four-person household making less than $27,750 held the same status.40 Residents living in poverty have less access to quality healthcare, healthy foods, stable housing, and safe neighborhoods.41 According to ACS data, just over 15% of Independence residents live below the federal poverty level in 2022, which is higher than the Missouri rate of 12.8% and the national rate of 12.5%.12 The overall poverty rate in Independence has been increasing since 2020.

Poverty rates by census tract in Independence vary, with certain tracts having a significantly higher rate of poverty than the city’s average rate.

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

Different racial groups in Independence experience poverty at different rates, with historically marginalized groups experiencing higher rates. Black or African American, American Indian or Alaskan Native, and residents that identified as some other race all had poverty rates more than twice that of White residents. Hispanic or Latino and residents that identified as two or more races also have rates of poverty significantly higher than Whites.12

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

CHILDHOOD POVERTY

Childhood poverty can have numerous negative consequences for a child's development. Children that live in low-income households have higher rates of cognitive problems, behavioral problems and health conditions such as asthma and pneumonia. Health problems stemming from inadequate nutrition are also more common in children living in low-income households.42

UNEMPLOYMENT

The rate of children living in poverty in Independence is significantly higher than the national rate. In 2022, 16.3% of U.S. children under the age of 18 were living in poverty.43 According to ACS data from the U.S. Census Bureau, 24.7% of children under the age of 18 in Independence were living in poverty. Additionally, 37% of all Independence residents living in poverty were under the age of 18.12

Unemployment can have negative consequences on mental health such as feelings of depression, anxiety, low self-esteem, and stress. Stress can lead to negative physical health by leading to various illnesses including stroke, high blood pressure, heart attack, heart disease, and arthritis.44

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

Independence’s unemployment rate was declining from 2017 to 2019, but started increasing again in 2020, coinciding with the Covid-19 pandemic. Independence had an unemployment rate of 4.9% in 2019, which has increased every year up to 2022 which had an unemployment rate of 6.2%.

Independence has had an unemployment rate that is higher than Missouri’s rate from 2017-2022, with the unemployment rate in Missouri being 4.3% in 2022.12

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

In Independence, most area codes, including 64050, 64051, 64052, 64053, 64054, 65055, 64056, 64057, and 64015 have at least one census tract with an unemployment rate over 6%. The tracts with the highest rates of unemployment were in area codes 64053, 64054, 64055, and 64057.

HOUSING

Homeownership is a hallmark of wealth in the United States and is an important way that Americans to build wealth. Homeowners have lower rates of chronic diseases than renters45, so it is important to evaluate the homeownership as a health measure. In Independence, there are currently disparities in homeownership between racial and ethnic groups that can be observed through the rates that certain groups own and rent property. White and Asian residents are more likely to own their homes than American Indian/Alaskan Native, Black, and Native Hawaiian/Pacific Islander residents. 64.5% of White residents and 64.8% of Asian residents own their homes compared to 56.1% of American Indian/Alaskan Native residents, 27.3% of Black residents, and 54.2% of Native Hawaiian/Pacific Islander residents.12

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

Median housing costs in Independence have increased every year since 2016, with a staggering rise from 2021 to 2022 of $20,000. Jackson County as a whole, Kansas City, Missouri, and the United States have all had the same trend of increasing median home values since 2016 with a proportionally large jump in value in 2022.12 While increasing home values is good for owners looking to sell their property, new prospective homeowners struggle to enter the market when housing prices are too high.

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

When housing costs take a significant portion of the of a household’s income, there are numerous negative health consequences. A household is considered cost burdened when over 30% of their income is spent on housing costs, including rent/mortgage and utilities. They are severely cost burdened when over 50% of their income is spent on these costs. These households are more likely to sacrifice other necessities like healthy foods and healthcare and are more likely to face unstable housing situations such as evictions or foreclosures.46

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

Out of renters, homeowners with a mortgage, and homeowners without a mortgage, renters in Independence experience the highest rate of being cost burdened. In 2022, renters were cost burdened at a rate of 492 per 1,000 households, while homeowners with a mortgage and homeowners without a mortgage had rates of 260 and 149 per 1,000 households respectively. While these rates have fluctuated for homeowners with a mortgage since 2017, the rate of cost burden households in this group is currently increase with the rate for renters and homeowners without a mortgage which have been increasing since 2020.12

Being housing cost burdened is tied closely to total household income. Households that made less than $20,000 a year were cost burdened at the highest rate for all groups and households that made more than $75,000 were cost burdened at the lowest rates 12

HOUSING CONDITIONS

Housing safety issues can lead to poor health outcomes for residents. The most reported issue was peeling or chipping paint, followed by mold or mildew and cracked or broken windows. In Independence, 11.8% of households have peeling or chipping paint and 10.7% have mold or mildew. 18 census tracts in Independence have a rate of 80% of homes built before 197912 and possibly have lead paint. Peeling or chipping paint can be a serious issue in older homes that may have used leadbased paint. The usage of lead-based paints in consumer products was banned by the federal government in 1978 but homes built before then could still have lead-based paint that has been painted over. Lead exposure is particularly dangerous for children because their bodies more readily absorb lead. Lead exposure can cause learning problems, slow growth, hearing problems, and anemia in children and cardiovascular, kidney, and reproductive issues in adults.47 Indoor mold also negatively affects health as they produce allergens that can irritate our skin, eyes, nose, mouth, and lungs whether we are allergic or not. Additionally, people who are allergic to molds can experience asthma attacks.48

Source: Community Health Assessment Survey, 2024

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

TRANSPORTATION

Adequate transportation plays a role in our access to healthy foods and where we can/how we get to work and school.49 Active transportation methods, such as walking and biking, can influence health by reducing the risks of obesity, heart disease, and diabetes.50

VEHICLE ACCESS

Vehicle access differs between Independence residents who own their property and residents that rent. Out of residents that own their property, 3.6% do not own a vehicle, while 12.6% of residents who rent did not own a vehicle.12 Households without a vehicle have less access to healthful foods and medical care.

PUBLIC TRANSPORTATION

A robust public transportation network can allow those without vehicles to reach necessary resources that are far from their homes. Independence utilizes one bus route, a paratransit service called RideKC Freedom, and a rideshare program called IRIS.

The bus route in Independence is the Independence 24 route which connects the Independence Transit Center in Independence to downtown Kansas City. This route runs from 5am-6pm MondayFriday, 5am-1pm on Saturday, and 5:45am-11pm on Sunday. There were previously six additional bus routes that made up the IndeBus system that provided transportation to various destinations in Independence, including CenterPoint Medical Center, Blue River Community College, Independence Transit Center, Blue Ridge Crossing, and s everal grocery and retail destinations. These bus lines were deprecated on December 31st, 2024, and replaced with the IRIS rideshare program.

IRIS is an on-demand rideshare program that Independence has implemented in partnerships with the Kansas City Area Transportation Authority, zTrip, and RideCo. The IRIS service area covers the entirety of Independence and operates 6am-6pm, Monday-Saturday. Instead of buses, IRIS makes use of 5 vehicles comprised of 4 sedans and one wheelchair accessible minivan. For $5 a ride, IRIS allows travel from one of the designated pick-up points to within ¼ of your destination as long as it is within the service area of Independence. Rides that start or end at the Independence Transit Center, Centerpoint Hospital, or the Blue Ridge transfer point do not cost a fare. Trips are booked using a mobile app, online, or by phone. It is unclear how the shift from bus routes to the IRIS service will affect access to healthcare, healthy foods, and retail in Independence.

Independence also has the RideKC Freedom program, a free door-to-door paratransit service for people with disabilities, older adults, and low-income residents in Independence, Kansas City, Johnson County Kansas, and Wyandotte County Kansas. Eligibility for the service must be determined ahead of time and all rides must be scheduled at least 24 hours in advance over the phone. RideKC Freedom On-Demand is a service with the same service area that is available for anyone to use. It offers same day booking by phone or using a mobile app and charges $5.00 a mile for the first 5 miles and $2 a mile after that.

The 2024 Community Health Survey before changes to the IndeBus service and the implementation of IRIS had occurred. Prior to these changes, Independence residents did not view the transportation system as a strength. 24% of survey respondents marked that public transportation was not a strength

in the community. The bus system in Independence connected to grocery, retail, and medical locations, but not every residential area had a bus stop.

WALKABILITY AND SAFETY

Perceived safety can impact an individual's willingness to walk, even when there is adequate access and infrastructure. 30% of survey respondents said that they feel sometimes unsafe or very unsafe walking near their home or neighborhood. Respondents that live in the 64053 and 64054 area codes were the most likely to say they felt unsafe or very unsafe. The most common reason given for why respondents felt very or sometimes unsafe was fear of violence.

ACCESS TO HEALTH RESOURCES

20.3%

Of residents have both low access to healthy foods and low income66

86.3%

Of survey respondents get an annual or yearly physical

23%

Of Independence residents aged 26-34 do not have health insurance12

The availability of healthcare resources can be based on the availability of primary care providers and hospitals, insurance coverage or ability of obtain insurance, and distance from and ability to travel to appointments. People often do not get regular check-ups or preventative treatment because they cannot reach services or cannot afford treatment. This causes increase cost and workload for physicians since patients are coming in later and are more likely to have develop serious conditions and increases the cost to patients who often pay more for healthcare services to treat preventable diseases and conditions.

HOSPITAL AND HEALTHCARE SERVICES

Independence has one hospital, Centerpoint Medical Center, but there are numerous hospitals in the surrounding area. Centerpoint offers a level II trauma center, an accredited chest pain center, cardiovascular services, orthopedic services, an accredited cancer program, neuroscience services, a level III neonatal intensive care unit, and outpatient services, including a surgery center. Other hospitals often used by Independence residents include University Health, Children’s Mercy, North Kansas City Hospital, and Saint Luke’s Hospital.

Low-cost health services, such as federally qualified health centers (FQHC), also exist in Independence, such as Swope Health Services, which has several locations throughout the metro area.

Making sure that health resources are accessible and affordable ensures those resources can be fully utilized by all groups in Independence. Access to social services and mental health services can provide opportunities for positive development among youth and healthy lifestyles for adults. Among survey respondents, 18.9% reported that social services where not a strength their community and 25.6% reported mental health services were not a strength. The affordability of healthcare also impacts how accessibl e it is, especially to low-income households. 25.3% of survey respondents reported that they did not feel affordable healthcare was a strength in their community.

HEALTH INSURANCE

Having health insurance provides greater access to healthcare services. People without health insurance are less likely to have a primary care provider and be able to afford health care services and medications.51 Almost 16,000 people in Independence (approximately 13% of Independence residents) are uninsured.12

Different age groups experience different rates of being uninsured. The age group with the most uninsured individuals is 26-34, with 23% of Independence residents in this group not having health insurance. Older adults and children are more insured by comparison. Most older adults in Independence have some kind of health insurance; only 1.4% of residents aged 65-74 are uninsured and less than 1% of people 75 and older are uninsured. Of children less than 6 years old in Independence, approximately 6% are uninsured while 7% of children aged 6-18 are uninsured.12

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

There are disparities in health insurance coverage between different racial and ethnic groups in Independence. 11.5% of White residents are uninsured. American Indian or Alaskan Native, Asian, Black, residents who identify as some other race, and residents that identify as two or more races have higher percentages of their populations that are uninsured at 31.9%, 15.3%, 14.3%, 30.9% and 17.7% respectively. 26.3% of residents who identify as Hispanic or Latino also lack adequate health insurance.12

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

Income levels share a proportional relationship with health insurance coverage in Independence. Since those who are uninsured are less likely to be able to afford medications and medical care, there is an increased need to improve the rate of insured individuals at low incomes.

Source: U.S. Census Bureau; American Community Survey (ACS), 2022

ACCESS TO CARE

Having access to healthcare improves one’s quality of life and reduces poor health outcomes. People who don’t have access to prescription medications, vaccines, or health information may not know how to or be able to take care of themselves when they become ill. Preventable diseases and illnesses can cause long term negative health outcomes if left untreated, which is more likely to happen when someone has poor healthcare access.52

Access to care can be impeded by the distance care is from someone or their ability to make it to a healthcare facility.51

ORAL HEALTH

Oral health affects our ability to speak, eat, and smile while also being connected to our overall health. Common oral health problems, such as tooth decay and cavities, and oral diseases can cause other health problems, especially in those who have certai n chronic conditions like diabetes. Having a yearly dental checkup, brushing twice a day, flossing daily and liming food and beverages that are high in sugar can prevent oral diseases and promote good oral health 53 70% of CHA survey respondents reported that they get a yearly/annual dental exam.

PRIMARY CARE VISITS

Primary care providers are a source of early disease detection and treatment as well as chronic disease management. Patients who visit a primary care physician regularly are more likely to receive preventative care such as flu shots, blood pressure screenings, and cancer screenings.54 It is important that residents have easy and equitable access to primary care providers in order to promote positive health outcomes and reduce disparities in health. 13.7% of our survey respondents reported that they did not get an annual or yearly physical exam.

Independence lacks the number of primary care physicians needed to support the population it serves. The rate of primary care physicians in Independence in 98.19 per 100,000 residents. Primary care physicians were verified using the NPI number on the NPPES NPI Registry. The HRSA developed a

scoring system called the Health Professional Shortage Area (HPSA) score that reflects the level of provider shortages in the area. Scores for primary care and mental health range from 1 to 25, with a higher score indicating a higher priority of need for physicians. These scores take into account the population to provider ratio, the percent of the population below the federal poverty threshold, and the travel time to the nearest provider outside of the HPSA designation area.55 Independence has a primary care HPSA score of 18 out of 25 which is high enough for Independence to be a designated HPSA area. and Jackson County as a whole has a mental health HPSA score of 17 out of 25.56

YEARLY VISION SCREENING

Regular eye exams are important for maintaining eye health and early detection of eye diseases. Children should receive at least 1 eye exam between the ages of 3 and 5 to detect symptoms of eye diseases in their early stages in order to prevent vision loss or blindness.57 Adults aged 18-64 should have an eye exam at least every two years. Adults 65 and older and at-risk adults of all ages should get an eye exam yearly. At risk individuals include those with a family history of eye disease, have occupations that strain the eyes or may be hazardous to eyes, have other health conditions that may affect eye health, and those who already have eye conditions or have had surgery on their eyes 58

ACCESS TO HEALTHY FOODS

Maintaining a diet with healthy foods, such as fruits, vegetables, and grains, reduce the risk of chronic diseases and overall health 59 Adults should eat around 1.5-2 cups of fruit and 2-3 cups of vegetables a day as part of a healthy diet.60 Access to stores and markets that sell fruits and vegetables is an important factor that influences the community’s health. The foods that we eat are influenced by the time it takes to travel to retailers, food prices, and the availability of healthy foods. People with lowincome face greater challenges to accessing healthy food that can negatively affect diet 61

When a household has restricted access to a grocery store, they get less of their food from large grocery stores and shop at convenience stores and other stores with limited access to healthy foods more than households that have sufficient access to grocery stores.62 Distance to grocery stores has been correlated with rates of obesity, diabetes, and hypertension with increased distance from the grocery store overlapping with increased rates.63 64 65 The price of grocery items affects healthy food consumption, especially in lower income households. Spending money on gas and transportation may further increase sensitivity to food prices for low-income households.

DISTANCE TO HEALTHY FOODS

The USDA created the Food Access Research Atlas to provide a data driven overview of food access for low-income census tracts. The Atlas uses population data from the 2010 census, 2019 urbanized area geographies, 2014-2018 American Community Surveys, and two 2019 nationwide list of supermarket stores. The goal of the Atlas is to identify census tracks that are in two categories: Low Access Census Tracts and Low Income and Low Access Census Tracts. The Atlas defines low access to healthy food as “being far from a supermarket, supercenter, or large grocery store”.66 The distance considered low access for urban areas is being more than half a mile from healthy food options, although the Atlas also provides data on people who live in urban areas and live more than 1 mile from healthy food options. By combining data from every census track in Independence, we can see that

70% of residents are low access by being over ½ a mile away from healthy food options and 19.6% are over 1 mile away.

Low income and low access is defined as meeting the requirements defined for low access previously, as well as meeting one of the following requirements: 1. Having income below the federal poverty limit, 2. Having a median family income less than or equal to 80% of the state- wide median family income, 3. Living in a metropolitan area and having a median family income less than or equal to 80% of the metropolitan area’s median family income. In Independence, 20.3% of residents are both low access by being over ½ a mile from healthy food options and low income while 4.6% were low access by being over 1 mile away from healthful food options and low income.67

Source: U.S. Department of Agriculture; Food Access Research Atlas, 2019

Most CHA survey respondents have taken their own vehicle to get groceries with 93% of respondents indicating that. 8% of respondents indicated that they have used online delivery services to get groceries. The 3% of respondents that marked that they get groceries some other way most frequently reported getting a ride from someone else to the grocery store. Only 3% of respondents walk to get groceries, which reflects how difficult and time consuming it is to walk to get groceries in Independence. This can pose problems for lower income households who may not be able to afford a vehicle or an online delivery service.

Source: Independence Permitted Establishments, 2024

Most Independence residents get their fruits and vegetables from grocery stores, with 95% of survey respondents indicating that they get some of their fruits and vegetables there. Farmers markets were the next most popular source of fruits and vegetables, with 28% of survey respondents getting some fruits and vegetables from them. 18% of respondents got some fruits and vegetables from their personal or family garden.

FOOD INSECURITY

There are 5882 households that receive SNAP/food stamps in Independence, which is 11.5% of total households. This is slightly higher than the 10% of households nationwide.12 However, there are still 3,961 households that are below the federal poverty threshold that are eligible to receive SNAP benefits. Participating in the SNAP program can promote positive health outcomes by providing a way to add nutritious and healthy foods to one's diet, decreasing the risk of chronic diseases like diabetes, obesity, and high blood pressure which can decreases healthcare costs for a household.68 69 Although data was not available for Independence specifically, there are 502 SNAP authorized stores in Jackson County.67

VIOLENCE AND INJURY

This section focuses on Independence crime data, unintentional injury, suicide, domestic violence and other forms of violence data. A key issue chosen by 2024 Community Health Assessment respondents is the issue of gun violence. Research demonstrates that per year, 18,000 Americans die from firearm homicide and 25,000 from firearm suicide.70 Per the 2024 Community Health Survey, firearm and gun violence was within the top five important public health concerns within Independence.

Another vital public health concern is unintentional injuries, and data supports that within ages of 1-44, a leading cause of death. As described in the 2024 Community Health Assessment, small actions make a difference towards the probability of injury. 1.5% of 2024 Independence Community Health Survey responders do not use a seatbelt, and 2% do not put a helmet on their child when riding a bike.

FIREARMS AND CRIME

Crime, including issues such as gun violence, homicide, assault, and more are linked to public health. Studies suggest that crime has an impact on social aspects of an individual’s life including relationships, parenting, work life, and overall functioning.71 Also suggested are health complications, such as limited physical activity, obesity, and chronic illnesses, that are linked to violent crime.72 Surveying national data, Missouri has a higher amount of violent crime per year than the national average; 2022 data shows Missouri with 488 reported violent crimes, compared to the U.S average of 380.7 73

A major threat to public health and safety overall is gun violence. Data recorded in 2021 suggests that Missouri has 1,351 gun violence deaths in an average year, and has 1.5 times the national average of firearm deaths.74 Gun violence can include a wide range of incidents including homicide and suicide. Per year, research shows that 18,000 Americans die of firearm homicide and 25,000 Americans by firearm suicide.70 In 2019 data shows that in Missouri, 537 homicide deaths and 681 suicide deaths, all by firearms were recorded.75 According to 2024 Community Health Survey, 55.3% of responders selected mental health, including suicide, as one of the five most important public health concerns for Independence.

Other incidents including domestic violence, intentional, and unintentional injuries are also impacted by gun violence. Nationally, half of the U.S adult population say a family member or themselves has been involved in a gun violence incident, as well as one in five adults say a family member has been killed with a gun.70 Gun violence not only affects health overall but can limit one’s lifespan and snuff out an individual’s potential. Looking at the link between gun violence and public health, it is important to identify factors, track community data, and look at prevention strategies to combat this epidemic of gun violence.76

DOMESTIC VIOLENCE

Domestic violence can be physical or emotional and be very harmful to an individual. It is defined as any actions, patterns, or threats of abusive behavior that is used by an individual to gain power or any advantage of a current or past partner.77 Data concludes that as of 2024, there have been 12,854 incidents of domestic violence reported within the state of Missouri, and 158 within the city limits of

Independence 78 With both males and females, the likelihood of being personally affected or impacted by domestic violence is most common within the range of 25-34 years of age.78 Domestic violence can gravely affect an individual’s health, including psychical, sexual, emotional, and mental impacts. More than 12 million people per year in the United States are impacted by partner violence, and per minute 24 people are impacted on average.79 The CHA survey asked respondents if they were impacted by various types of intimate partner violence. Around 12.8% of respondents reported that they have been insulted, called names by talked down to, or yell at by a family member or intimate/romantic partner.

Source: Community Health Assessment Survey, 2024

Studies show that intimate partner violence can result in health conditions such as chronic pain and cardiovascular, gastrointestinal, and neurological problems.80 Domestic violence also affects mental health, with survivors having an higher likelihood of experiencing PTSD (Post Traumatic Stress Disorder), depression, and suicide.81 Hope House is a key resource that can provide refuge and services for individuals experiencing domestic violence in the Kansas City, Missouri metro. Per the 2022-23 Hope House annual report, services including sheltering and hotel accommodation for survivors was provided to 6,304 women, 41 men, and 7,956 children.82

ACCIDENTS AND UNINTENTIONAL INJURY

Unintentional injuries are very common, and examples include falling, drowning, vehicle accidents, fires, opioid overdoses, and more. Research shows that for Americans ages 1-44, the leading cause of death is unintentional injuries. In the year 2022 alone, 89,000 U.S residents died as a result of unintentional injuries.83 From 2017-2021, 475 Independence residents died from accidents or unintentional injuries. The main contributors to these deaths were accidental poisonings, falls, and motor vehicle accidents.

Table 2: Cause of Death By Accident or Unintentional Injury Among Males and Females in Independence, 2017-2021

Source: MDHSS MOPHIMS Death MICA, 2017-2021

Unintentional injuries are a major public health issue because of the many impacts over a wide range of populations. According to the World Health Organization (WHO), for ages 5- 29 a leading cause of death is traffic injuries, for ages 5-14 drowning is the sixth leading cause of death, and over 684,000 deaths occur as a result of falling.84 Public health is impacted in a large way by these injuries because of trauma and the burden these incidents can bring. Childhood injury influence can include trauma that results in higher risk of suicide, mental illness, substance abuse, chronic illness, and introduction to crime.84 Socioeconomic factors such as poverty, housing, age, and living conditions can also impact unintentional injuries, and in turn impact public health.

Traffic crashes are a leading cause of death for children with 3% of all traffic fatalities in the United States being children under 14 years of age in 2022.85 The National Highway Traffic Safety Administration (NHTSA) estimates that proper car seat use can reduce the risk of fatality by 71% for infants and by 54% for children ages 1 to 4 years old in passenger cars.86 Understanding and following guidelines for proper car seat use can save lives.

According to the 2024 Community Health Survey, 1.5% of responders do not use a seatbelt when in a vehicle and 2% of responders do not put a helmet on their child when riding a bike. Since not all unintentional injuries are reported, public health officials can look at emergency room visits to understand the rate of injuries. Missouri data, as of 2005 to 2020, has identified 5,342,895 emergency room visits as a result of unintentional injuries, with 360,179 hospitalizations, and 38,229 deaths as a

result.87 Public health suggestions to stay safe form unintentional injuries include understanding ways that your everyday environment can be dangerous and prepare in order to remain safe. Safety measures to take may include accurate testers and alarms in your home, fire safety mechanisms, poison safety measures, child sleep safety, older adult fall preventions, and more. These safety precautions are demonstrated by the 2024 Community Health Survey as 84% of Independence responders reported having active, working smoke detectors in their homes.

MENTAL AND BEHAVIORAL HEALTH

This section examines lifestyle behaviors among Independence residents that support or hinder health. It examines several aspects of individuals’ personal health behaviors and risk factors (including physical activity, nutrition, sleep, alcohol, and substance use) that result in the leading causes of morbidity and mortality among area residents. This analysis tracks measures that are a part of the HP2030 Initiative, which is a 10-year agenda focused on improving the nation’s health. Where appropriate and available, this assessment compares Independence statistics to the state, as well as HP2030 targets. However, due to data constraints, some measures are available only for Jackson County, and, in some cases, only state-level data are available.

A healthy community has safe access to mental health/addiction services

-Resident of 64050

MENTAL HEALTH

A healthy community has good affordable food choices and safe environment for exercise.

-Resident of 64055

Mental health includes “our emotional, psychological, and social well-being. It affects how we think, feel, and act” 88 While good mental health can vary from person to person, it involves being able to cope with day-to-day stress, maintain relationships, and work productively. One’s mental health can fluctuate over time based on life events, stressors, and other factors 89

Mental health and mental illness are not the same. Mental illnesses, or mental health conditions, are conditions diagnosed by a health professional that negatively impact a person’s thinking, feelings, mood, and behavior, which can disrupt their daily life. Common mental health conditions include depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD). Risk factors for mental illnesses are complex. It can involve genetics, family history, trauma, and environmental factors including poverty and violence.88

An individual’s mental health determines how they handle stress, relate to others, and make healthy choices. It impacts all areas a person’s life. Mental health can have negative effects on a person’s physical health. For example, depression increases one’s risk for developing chronic conditions such as diabetes, heart disease, and stroke.88

MENTAL HEALTH IN INDEPENDENCE

Millions of people in the United States are affected by mental illness each year. According to the National Alliance on Mental Illness (NAMI), 1 in 5 adults and 1 in 6 youth in the United States

experience mental illness each year. Suicide is the 2nd leading cause of death among people aged 1014.90 The annual United States firearm suicide rate has increased 11% from 2019-2022, the highest documented level since 1968 91

Of the 22 public health concerns for Independence provided on the Community Health Assessment (CHA) Survey, mental health was chosen as the #2 issue. Residents wrote that they wanted “more community resources for health screenings/mental health” and “easy access to social services and mental health support”. Several wrote about a healthy community being one were everyone has access to mental health services. The CHA Survey also asked respondents to report the number of days they experienced feelings of anxiety, stress, or depression in the previous month. 62% of residents indicated experiencing at least 1 poor mental health day in the previous month. When the number of poor mental health days an individual experiences are high, this can lead to unemployment, substance use, houselessness, poor quality of life, and suicide.92

Source: Community Health Assessment Survey, 2024

MENTAL HEALTH - RELATED HOSPITAL VISITS

Several barriers exist that can explain why an individual may not seek help for their mental health. These include stigma, cost, logistics, and lack of awareness of available resources.93 The CHA Survey asked respondents to report if there was a time in the past twelve months when they needed treatment for a mental health problem but did not get it. 11% of respondents answered yes. Of these respondents, the top reason for why was cost. Due to challenges accessing quality, timely, and affordable, culturally competent care, some residents seek treatment and support for mental health conditions at hospital emergency rooms (ERs).

Residents in specific ZIP codes may be more likely to seek treatment for their mental health at an ER. Following these trends can provide insight to where mental health services are needed. From 20202022, individuals residing in the ZIP code 64050 were most likely to seek mental health care in the ER. In contrast, individuals residing the in the ZIP codes 64015 and 64016 were least likely to seek mental health care in the ER.

While mental illness is a risk factor that can increase the likelihood of a person experiencing suicidal ideation or suicide attempts, it is important to note that not all individuals with mental illness experience this. It is a myth that once an individual is suicidal they will always remain suicidal 94 Suicidal ideation is often short-term and situation-specific. Studies show that roughly 54% of individuals who have died by suicide did not have a diagnosable mental health disorder 94

Between 2018-2023, there were 2,659 suicide-related ER visits of Independence residents. Individuals residing in the ZIP codes 64050 and 64055 were most likely to experience a suicide-related ER visit. In contrast, individuals residing in the 64016 ZIP code were least likely to experience a suicide-related ER visit.95 Becoming more aware of which Independence locations need more resource can prevent future deaths and improve health outcomes 94

SUICIDE

Suicide is the

2nd

leading cause of death among 1–44-year-olds in Independence16

A public health issue that continues to plague individuals and families all over the world is suicide. Suicide is a leading cause of death in the United States and in 2022 alone, 1.6 million individuals attempted suicide.96 Suicide impacts more than just the individual who died but also families, friends, and the overall community that will have to live with the loss. There are many health related and trauma inducing incidents that can lead to suicidal thoughts or actions. Mental health struggles such as d epression and substance use, along with impactful events such as abuse, disasters, and loss can all lead to suicide.97 Higher than the national average, Missouri has a suicide rate of 18.7 per 100,000 people.98 Jackson County within 2020-2022 also has increasing suicide numbers as the years progress with reported numbers reaching 137, 161, and 163 respectively.99

Suicide was the second leading cause of death among ages 1 to 44 in Independence. At an age- adjusted rate of 29.8 suicides per 100,000 residents in 2021, Independence has a higher rate of suicide than the surrounding areas of Kansas City (17.65 per 100,000), Eastern Jackson County (21.81 per 100,000), and Missouri (18.66 per 100,000) as a whole. The suicide mortality rate in Independence has remained above 22 suicides per 100,000 residents since 2015 and increased in 2018, 2019, and 2021. Additionally, Independence has had a higher rate of suicide by discharge of a firearm than by other means every year from 2016-2021, with the 2021 rate for suicide mortality by discharge of a firearm being 17.93 per 100,000 residents, and the rate for suicides by other means at 11.86 per 100,000 residents. The proportion of suicide by firearm in Independence during these years (2016-2021) has ranged from 50% to 75% with 58% of suicides being completed by the discharge of a firearm in 2021 16

Financial difficulty, mental illness, and job problems are all risk factors for suicide.100 According to ACS data, just over 15% of Independence residents live below the federal poverty level in 2022, which is higher than the Missouri rate of 12.8% and the national rate of 12.5%.12 The overall poverty rate in

Independence has been increasing since 2020. Poverty has been linked to financial difficulty, an increased risk of mental illness, and can limit access to education and employment opportunities.41

Taking a closer look at risk factors, Independence has a higher age-adjusted prevalence of depression than Jackson County and the United States as a whole with the prevalence being 25.8%, 23.1%, and 21.1% respectively according to CDC PLACES.101 Access to care has also been designated as a risk factor for suicide. Independence has been designated as a primary care Health Professional Shortage Area (HPSA), and Jackson County has been designated as a mental health HPSA. This designation indicates that there are not enough physicians and mental health professionals to meet the need within our area.

The City of Independence has a mobile crisis response program called Alternative Response for Community Health (ARCH). ARCH responds to mental health, substance use, and quality of life 911 calls-alongside and sometimes in place of Police, Fire and Ambulance. ARCH connects people to resources and offers support in times of crisis.

Independence Health and Animal Services and local stakeholders formed the Independence Mental Health Task Force in 2021. The group became a registered Missouri coalition in 2023. Its mission is to lower the rate of teen suicide and improve the mental health of Independence youth. Local stakeholders meet monthly and combine efforts to achieve this mission. A major suicide prevention resource is 988 Suicide & Crisis Lifeline, this line can connect people 24/7 with licensed therapists and has a veterans crisis option.

HEALTH RISK BEHAVIORS

Health risk behaviors are adult behaviors that pose a risk to health, including binge drinking, lack of physical activity, and smoking 102 Lifestyle factors all affect health outcomes and can contribute to different the development of different chronic diseases. These lifestyle factors can include the foods one eats, the amount of physical activity one participates in regularly, as well as the amount of sleep one gets.

HEALTHY EATING

A healthy diet will provide health benefits over one’s lifetime and can greatly reduce the risk of noncommunicable diseases. While what can make up a balanced and healthy diet can vary for individuals based on culture, physical activity, age, gender, etc., the core basics of a healthy diet is universal. The World Health Organization recommends a diet that includes fruits, vegetables, lentils and beans, nuts, and whole grains.103

Limiting consumption of beverages with added sugar can also promote good health Sugar-sweetened beverages include non-sugar-free soda, fruit drinks, sports drinks, sweetened waters, and coffee and tea with added sugar. Frequently drinking

these beverages is associated with obesity, type 2 diabetes, kidney disease, non-alcoholic liver disease, tooth decay, cavities, and gout.104

PHYSICAL ACTIVITY

The positive effects of physical activity have long been reported, with numerous benefits towards prevention of non-communicable diseases such as cardiovascular diseases, cancer, and diabetes. It’s also been shown to assist with mental health as well.

Physical inactivity is one of the leading risk factors for non-communicable diseases. Inactive individuals have a 20-30% increased risk of death from non-communicable diseases compared to active individuals.

The World Health Organization recommends that in a given week for people to partake in 150–300 minutes of moderate-intensity aerobic physical activity or 75–150 minutes of vigorous-intensity aerobic physical activity 105 In 2024, 48% the Community Health Survey respondents reported they get more than 2 hours (120 minutes) of physical activity a week.

OBESITY

Obesity is when the body has high amounts of excess fat deposits and is one of the most pressing health crises in the world. Obesity increases risk for a variety of diseases, such as cancer, heart disease, and diabetes and affects large portions of quality of life, including mood, sleep, and moving around. Increasing the amount of physical activity one participates in, improving one’s diet to include healthier food options such as fruits and vegetables, and reducing sugar intake can help combat obesity.

Obesity has risen 10% in Independence adults in 3 years

BMI is a measure of body fat in one’s body based on the person’s height and weight.. Someone is considered overweight when their Body Mass Index (BMI) is greater than or equal to 25. A person is considered obes e when their BMI greater than or equal to 30.106

1 in 5 children are affected

by obesity107

It’s important to note that BMI does not directly measure body fat. BMI cannot distinguish between fat and muscle mass and cannot describe the distribution of fat in the body. BMI is used as a measure of health because it is moderately correlated with measures that do directly measure body fat and measuring is cheap, quick, and non-invasive.106

Based on results from the Community Health Survey, 42% of respondents reported to be obes e, an increase from the 38.1% reported in 2021, with 30% being overweight.

SLEEP

Sleep is a vital function of the body, and proper amounts of sleep is essential for health. It was recommended for grown adults to get no less than 7 hours of sleep a day. Proper sleep offers numerous health benefits including improved mental health and mood, improved attention and memory, more energy, reduced stress, and reduced risk of chronic conditions such as heart disease and high blood pressure.108

Based on results from the Community Health Survey, it was reported that the number of adults 18 years and older getting fewer than 7 hours of sleep was 49% of the population, which was an increase from the 37.8% reported in 2021.

SUBSTANCE USE

1 in 3 adults do not get enough sleep109

Substance use refers to the consumption of legal substances such as alcohol, tobacco, and cannabis as well as illicit substances, controlled prescriptions, and over-the-counter (OTC) medications. Substances impact the way users think, feel, and act. In the United States, the use and misuse of these substances affect the wellbeing and health of millions.110 Of the 22 public health concerns for Independence provided on the Community Health Assessment (CHA) Survey, alcohol and drug use is ranked the sixth top issue.

TOBACCO

Tobacco use remains the leading preventable cause of death in the United States and accounts for 480,000 deaths annually or approximately 1 in 5 deaths.111 Smoking tobacco negatively affects the health of smokers as well as those around them through second-hand smoke. There is no safe level of tobacco smoke; even brief exposure to tobacco smoke can cause serious health problems.112 Those that smoke tobacco are more likely than nonsmokers to develop heart disease, stroke, and lung cancer.111 Smokeless tobacco products such as chewing tobacco, nicotine pouches, and snuff can cause mouth cancers and gum disease 113

In 2021, smoking prevalence in Independence of adults was highest in ZIP codes 64053 and 64054. Increased smoking prevalence in these locations suggests there is an increased risk of secondhand smoke exposure. In contrast, ZIP codes 64057 and 64015 had the lowest smoking prevalence in Independence adults.

The CHA Survey asked respondents to report how often they smoked cigarettes in the past thirty days. 90% of respondents reported not at all while 7% reported they smoked cigarettes every day. Of those that answered that they do smoke cigarettes, 62% reported smoking 10 or less cigarettes and 32% reported smoking 10 or less cigarettes. The CHA Survey asked respondents to report how often they used an e-cigarette or vape product in the past thirty days. 3% of respondents reported every day while 95% reported not at all.

ALCOHOL AND BINGE DRINKING

Binge drinking is defined as consuming a large quantity of alcohol in a short period of time, typically within two hours, to reach a blood alcohol concentration (BAC) of 0.08% or more.114 In 2020-2021, excessive alcohol use was responsible for roughly 178,000 deaths or 488 per day.115 This was a 29% increase from 2016-2017. Excessive alcohol use can lead to injuries such as motor vehicle crashes, falling, burns, violence such as sexual violence, homicide, suicide, alcohol poisoning, drug overdose, unplanned pregnancies, and sexually transmitted infections (STIs). Alcohol increases the risk of several types of cancer, liver disease, stroke, and alcohol use disorder.116

In 2021, adult residents in the following ZIP codes in Independence reported binge-drinking behaviors at the highest frequency: 64015, 64016, and 64056. In contrast, adult residents in ZIP code 64054 reported binge-drinking the least.

The 2024 CHA Survey asked respondents to report how many days in the past month that they drank at least one alcoholic beverage such as beer, wine, a malt beverage, or liquor. 5% of respondents reported 10-19 days, 5% reported 6-9 days, 11% reported 3-5 days, 21% reported 1-2 days, and 52% reported 0 days. These respondents were then asked on average how many alcoholic beverages they have on the days they do drink. 6% reported drinking 3 alcoholic beverages, 16% reported drinking 2 alcoholic beverages, and 28% reported drinking 1 alcoholic beverage.

Source: Community Health Assessment Survey, 2024

Source: Community Health Assessment Survey, 2024

OPIOID USE

Drug overdoses, both fatal and nonfatal, have become an epidemic in Missouri over the past decade. Drug overdose is the leading cause of death among adults aged 18-44 in Missouri. In 2021, 1 out of 47 deaths was attributed to opioid overdose in Missouri. Over 70% of drug overdose deaths nationwide involve opioids 117 Opioids, sometimes called narcotics, are a class of medications prescribed by doctors to treat persistent or severe pain.118 Oxycodone (OxyContin), hydrocodone (Vicodin), codeine, heroin, morphine, and fentanyl are opioids.

Currently, there is a nationwide fentanyl crisis. Fentanyl is 50 times stronger than heroin and 100 times stronger than morphine. Due to its potency and the fact it is cheap to produce, it is often added to other drugs including heroin, methamphetamine, and cocaine. Fentanyl-laced drugs are made to resemble other opioids. Many may be unaware their drugs are laced with fentanyl and take their usual dose of the drug and subsequently overdose, which can be lethal.117

The rate of opioid overdose deaths in Independence increased by 90% from 2020 to 2021. The nonfatal overdose rate in increased from 360.38 per 100,000 to 375.14 per 100,000 from 2020 to 2021, however non-fatal overdoses from non-synthetic opioids increased by 69% in the same year.119 When CHA survey respondents were asked if anyone in their household had ever been prescribed opioids, 27% responded that they had.

An overdose can occur with any substance such as legal or illegal drugs, alcohol, and prescription or non-prescription medications.120 Overdoses can occur intentionally (i.e. people experiencing suicidal ideation) or unintentionally (i.e. children getting into medication). Opioid overdose can be lifethreatening and requires immediate emergency care (i.e. calling 911 immediately). Signs of an opioid overdose include if a person is extremely pale and/or clammy to the touch, has purple or blue fingernails or lips, cannot be awakened or is unable to speak, or if their breathing or heartbeat slows or stops.120 Naloxone (Narcan) is available for free to Independence residents at Independence Health and Animal Services inside Independence City Hall.

MATERNAL, CHILD AND INFANT HEALTH

A healthy community includes care for health of pregnant mother/baby and newborn

-Resident of 64055

A healthy community includes support for all with an emphasis on care for children

-Resident of 64057

This section of the report provides an overview of the health status of a mother and child during pregnancy, birth, and the postnatal period. The health of mothers and babies not only provides a general outlook for a population’s health, but directly impacts population growth. Pregnant women and newborns are susceptible to numerous diseases and conditions, so special attention must be paid to their health outcomes to ensure Independence has a growing and prosperous population.

PRENATAL CARE

Prenatal care is the medical care and support provided to mothers during pregnancy and is a crucial step in ensuring a healthy and safe pregnancy. Early, regular, and comprehensive prenatal care can help with early detection of health and developmental issues and prevent any complications This care can consist of regular check-ups, testing, prenatal vitamins, and immunizations.

Prenatal care is recommended to start in the first trimester by the American Congress of Obstetricians and Gynecologists. Most pregnant women with a low -risk pregnancy will have a checkup once a month during weeks 4 to 28 of pregnancy, once every 2 weeks during weeks 28 to 36 of pregnancy, and once a week during weeks 36 to 41 of pregnancy. Women who start prenatal care later in their pregnancy are considered as having received inadequate prenatal care. Prenatal inadequacy as a measure is defined as prenatal care starting in the 5th month of pregnancy or later or attendance of less than 50% of the appropriate number of prenatal visits.121

Source: Missouri DHSS, MICA, 2024

In 2021, Independence women receive inadequate prenatal care at a rate of 231 7 per 1,000 live births. This shows a drastic disparity through the state of Missouri, with a prenatal inadequacy rate of only 190 6 per 1,000 live births. Independence also has a disparity in prenatal care between white and black pregnant women, with black women experiencing prenatal inadequacy at a rate of 321 7 per 1,000 live births and white women at a rate of 197.6 per 1,000 live births.15

Source: MDHSS MOPHIMS Birth MICA, 2021.

One way to promote prenatal health is though vitamins. Folic acid is a B vitamin the CDC recommends that pregnant women take to help promote the development of the neural tube. The neural tube becomes the brain and spine, and folic acid can help prevent serious birth defects known neural tube defects. These defects occur in the first few weeks of pregnancy, so the CDC recommends women take folic acid if they can become or are trying to become pregnant.122

HEALTH RISKS DURING PREGNANCY

Certain health behaviors, such as smoking or unhealthy weight gain during pregnancy, pose risks to the mother’s and baby’s health during and after pregnancy.

Smoking during pregnancy increases the risk of abnormal bleeding during the pregnancy and during delivery for the mother. Babies of moms who smoke during pregnancy can receive damage to their brain and lungs, have a higher risk for birth defects, and are more likely to be born prematurely. Premature births are any births that occur 3 or more weeks before the due date and can cause issues with the baby’s weight, feeding, breathing, and brain development 123 In 2021, the rate of smoking during pregnancy in Independence was 128 1 per 1,000 live births.15

Source: MDHSS MOPHIMS Birth MICA, 2021.

Source: MDHSS MOPHIMS Birth MICA, 2021.

Unhealthy weight gain during pregnancy can contribute to poor health for the mother and child. The amount of weight the mother should gain during pregnancy is related to their height and weight before pregnancy. According to the CDC, a mother with a normal BMI (between 18.5-24.9) should gain between 25-35 pounds during their pregnancy. For the same BMI, this increases to 37-54 pounds if the mother is having twins. In the United States, 1 in 3 women gain the recommended amount of weight during pregnancy while 1 in 2 gained above the recommendation.124 In Independence, the rate

of excess weight gain during pregnancy is 244 9 per 1,000 live births (roughly 1 in 4) which is worse that the Missouri rate of 210.8 per 1,000 live births (roughly 1 in 5).15

BIRTH RATES

Birth rates are an important factor in population growth and impact health systems, education systems, and policy decisions in a jurisdiction.

Between 2017-2021, there were 7,269 live births in the City of Independence. The most common age for mothers in Independence was between 25 and 29 years old at a rate of 31.79 per 100 live births belonging to this age group. This is followed by a rate of 27.55 per 100 live births belonging to mothers aged 20 to 24.15

There are a multitude of factors that can contribute to complications during any pregnancy. This includes preterm birth, low birth weight, and miscarriage. Preterm, or premature, labor is categorized as birth before 37 weeks of pregnancy. In our community, White women had a preterm birth rate of 11.84 per 100 live births, which is in stark comparison to Black women at a preterm birth rate of 17.52 per 100 live births, and the Hispanic women at a rate of 12.15 per 100 live births . Looking at low birth weight, an infant born under 2500 grams (5.51 pounds), 11.62% of Independence babies are born underweight.15 Complications such as difficulty fighting infection, gastrointestinal problems, and a 20 times increase in the chance of a SIDS death within the first month of life can arise for the baby if born at a low weight.

INFANT MORTALITY

Infant mortality is used as a measure of overall health in a society and is measured as a count of infants who died before their first birthday.125 The Health People 2030 goal for the United States is for the rate of infant mortality to fall to 5 infant deaths per 1,000 live births. The infant mortality in Independence for 2021 was 11.92 infant deaths per 1,000 live births, although this rate is unreliable due to a low number of deaths. However, the surrounding areas of Kansas City and Eastern Jackson County have not met this goal yet, having rates of 7.92 and 7.19 infant deaths per 1,000 live births respectively. Missouri as a whole had a rate of 5.67 infant deaths per 1,000 live births,16 showing that more work can be done to reduce infant mortality.

The most common cause of infant death in Independence from 2017-2021 were conditions originating in the perinatal period. These conditions can originate before birth through the first 28 days after birth, even if the death occurs later. Examples of these conditions include disorders related to low birth weight, birth trauma, certain respiratory disorders, infections from the perinatal period, digestive system disorders, and disorders affecting temperature regulation in the newborn.126 Improved prenatal care through regular check ups and screenings during pregnancy and healthy diet and nutrition for the mother during pregnancy can help reduce the rate of these conditions.

SCHOOL AGE VACCINATIONS

Vaccines play a pivotal role in keeping the community and individuals safe from severe and sometime life-threatening diseases. Vaccines are made of a small amount of weakened or dead pathogens. This

allows one’s immune system a chance to learn about the pathogen while it’s not a threat. The immune system can build up a response to the pathogen so if it is ever encountered again the body has a defense already in place. While this can take a couple of weeks to develop, it can lead to lifelong protection against these diseases. Vaccinations can reduce the severity of a pathogen or even stop the pathogen before it ever makes you sick making it harder for the pathogen to spread person to person. When enough people in a population are vaccinated it creates a herd immunity.

COMMUNICABLE DISEASE

A healthy community has no disease, no sickness -Resident of 64057

Vaccines are given starting in childhood, this is important as it gets immunity to children before they come in contact with a pathogen. Missouri requires six immunizations to attend Missouri Public schools starting in Kindergarten. Five of these vaccines are required to attend early childhood classes prior to Kindergarten.

Communicable diseases are illnesses spread from person to person by multiple means. These diseases can spread through direct contact with infected people or animals, ingesting contaminated food or water, or being bitten by an insect. Independence Health and Animal Services values and works to preserve the health and safety of our community. Investigating communicable diseases enables us to establish and improve methods to prevent and control disease. Our Communicable Disease staff processed 1,214 reported disease cases, not including COVID-19, in 2023. Missouri law 19 CSR 20-20.020 requires reporting the identification of certain diseases and conditions to the health department and to the state. Communicable diseases can be prevented by taking certain measures. Vaccinations, regular handwashing, covering coughs with the inside of elbows or masks, and cleaning living areas to prevent homes for pests are all ways to prevent disease.

VACCINE PREVENTABLE DISEASES

Vaccines help our bodies fight better against specific diseases and many illnesses can be weakened or prevented with a vaccination. Approximately 50,000 adults in the United States die each year from diseases that vaccines are available for. There are many vaccines available in the US that can protect children and adults from diseases. These include COVID-19, Influenza, Varicella/Chickenpox, Pertussis, Hepatitis B, and more.127

RESPIRATORY ILLNESSES

Respiratory diseases are illnesses that can negatively affect our breathing. Some examples of respiratory illnesses include COVID-19, Influenza (flu), Respiratory Syncytial Virus (RSV), and the Common Cold. These illnesses are all caused by viruses and pose a high threat to vulnerable populations such as adults aged 65 and older, children under the age of 5, and pregnant women. They spread by breathing-in the air where an infected person has breathed, coughed, sneezed, talked, laughed, or sang and can be prevented by wearing masks, regular handwashing, and not touching infected surfaces. Independence reported 1,204 cases of the flu during the 2023-2024 season. IHAS saw a decline in COVID-19 cases in 2023.

TUBERCULOSIS

Tuberculosis (TB) is primarily a respiratory illness but can negatively affect other parts of the body as well. TB is caused by bacteria that can be spread by breathing-in the air where a person with TB has breathed, coughed, sneezed, talked, laughed, or sang. TB can be either active or latent. Active TB is when a person is infected with the bacteria and are symptomatic. People with active TB are able to spread the bacteria to others. Latent TB is when a person is infected with the bacteria, but it is inactive and not causing any symptoms. People with latent TB cannot spread it to others but should be treated to prevent the progression of the infection to active disease As many as 13 million people in the United States are estimated to have latent TB infections 128 129 In 2023, Independence Health and Animal Services investigated 37 cases of suspect, active, and latent TB.

GASTROINTESTINAL ILLNESSES

Table 3: Number of Reported Gastrointestinal Illness Cases in Independence, 2022-2023 (IHAS, 2024)

Gastrointestinal diseases are illnesses that can negatively affect our stomach or intestines. These include bacteria like Salmonella and Campylobacter or parasites such as Giardia, and more. These diseases are typically transmitted through contaminated food or water, contact with animals or their environment, or direct contact with an infected person. They can be prevented by regular handwashing, avoiding infected food and water, avoiding direct contact with an infected animal or person, not drinking unpasteurized milk, and disposing of food that has not been stored at the proper temperature. Certain groups of people are more likely to become seriously ill from these diseases including adults aged 65 and older, children younger than 5 years of age, and pregnant women. In the United States, 1 in 6 people get sick with a foodborne illness each year, although not all are reported.130 Foodborne illnesses are typically underreported because only a fraction of people seek care and are diagnosed. Independence Health and Animal Services investigated 69 cases of gastrointestinal diseases.

SEXUALLY TRANSMITTED INFECTIONS

Sexually Transmitted Infections (STIs) are infections that are spread primarily through sexual contact. Some examples of STIs include Chlamydia, Gonorrhea, and Syphilis. They can be prevented by wearing condoms during sex, receiving a Human Papillomavirus Infection (HPV) vaccine, and abstaining from sex with partners who have an STI. In 2022, 51,165 cases of STIs were reported in Missouri. These diseases can impact people of all ages; however, adolescents and young adults ages 15-24 see the highest burden of infection. This age group accounted for almost half of all new STIs that were reported in 2023.131

There were 286 reported cases of STIs in Independence. During this time period, Chlamydia was the most prevalent STI reported Gonorrhea and Chlamydia often present with no symptoms, which can lead to increased transmission to partners and under reporting of cases. These STIs can cause dangerous complications during pregnancy and can lead to fertility challenges and chronic reproductive issues when left untreated. Regular testing for anyone who is sexually active, even those without symptoms, is the most effective way to catch STIs early and prevent the spread. While IHAS does not provide STI treatment or testing, Jackson County Health Department offers confidential STI and Human Immunodeficiency Virus (HIV) testing. Treatment is available as needed, and high-risk reduction counseling is also available. Most services and treatments given are free of charge except prescriptions for medication.132

ZOONOTIC DISEASES

Zoonotic diseases are illnesses spread from infected animals to people. This can occur through direct contact with an infected animal or indirect contact with an infected animal’s environment. Zoonotic diseases can also be transferred through a vector such as an insect. An example of a zoonotic disease is Rabies. Rabies is caused by a virus and is typically spread through the bite of a rabies-infected animal. Rabies can be prevented by updating pets on their r abies vaccines, avoiding wild animals, calling animal control after sighting a stray animal, immediately washing animal bites and scratches with soap and water, and seeking medical attention soon after possible exposure. In the United States, more than 90% of reported cases of Rabies in animals occur in wildlife.133 134

VECTOR - BORNE DISEASES

Vector-borne diseases are illnesses spread through the bite of mosquitoes, ticks, and fleas. These include Rocky Mountain Spotted Fever, Lyme Disease, West Nile Virus, and more. They can be prevented by treating clothing and gear with 0.5% permethrin products and wearing Environmental Protection Agency-registered insect repellants in wooded or bushy areas. In the United States, cases of these diseases more than doubled between 2004-2018. The most reported vector-borne disease in the US is Lyme disease.135 Ehrlichiosis was the most common reported vector-borne disease in Independence in 2023.

LIFE EXPECTANCY

Heart disease was the leading cause of death among Independence residents from 2019-2021.16

Life expectancy in Independence is 1.5 years lower than Missouri and 1.1 years lower than the United States.137

Life expectancy is the average number of years a person can expect to live at a particular age based on age-specific death rates. Life expectancy at birth provides a reliable look into the general health and mortality of a population by estimating how long a person lives on average 136 Life expectancy is often different for certain groups, such as with men and women. Lower life expectancy is associated with worse health outcomes in a population.

Independence has lower life expectancy (75.9 years) at birth than Missouri (77.4 years) and the United States (77 years).137 This indicates that Independence residents are expected to have shorter lives than the average Missourian or American. When looking into the leading causes of death, we can see that the top five causes of death in Independence in 2021 were heart disease, cancer, accidents or unintentional injuries, chronic lower respiratory disease, and stroke. Additionally, suicide was the second leading cause of death among ages 1 to 44.16

YEARS OF POTENTIAL LIFE LOST

Years of potential life lost (YPLL) is a summary measure used to examine early deaths, or premature mortality, that occur in a community. Like life expectancy, YPLL is a good measure of the overall health of a community or group Research has shown that almost half of all premature deaths are due to preventable factors.138 Additionally, Black Americans and other racial groups experience significantly higher rates of YPLL compared to non-Hispanic White Americans.139 140 Looking at the YPLL helps health departments prioritize and plan public health programs and interventions.

YPLL utilizes a standard age, 75 in the United States, to estimate how many years a person could have lived if they had not died early. For example, when a teenager dies at the age of 15, they lost 60 years of potential life. To determine the total years of potential life lost within a community or due to a specific cause of death, all individual YPLL are added together. Independence saw a total of 14,887 years of potential life lost in 2021. When divided by the total population to get the rate, Independence had 13,245 YPLL per 100,000 residents.

LEADING CAUSES OF DEATH

There were 7,792 deaths in Independence between 2017 and 2021. Between 2017 and 2019 there was an average of 1,487 deaths per year. However, between 2020 and 2021 there was an average of 1,666 deaths per year. This is an approximately 12% increase in deaths among Independence residents. The mortality rate in Independence is higher than that of Missouri and the surrounding areas of Eastern Jackson County (EJC) and Kansas City.16 The top ten leading causes of death in Independence can be seen in the table below. Aside from COVID-19 and Alzheimer’s disease, Independence has higher mortality rates from these causes of death than the state of Missouri.

Table 4: Leading Causes of Death by Age-Adjusted Rate per 100,000, 2019-2021

Source: MDHSS MOPHIMS Death MICA, 2019-2021.

Source: MDHSS MOPHIMS Death MICA, 2009-2021.

LEADING CAUSE OF DEATH BY SEX

In 2019, The life expectancy at birth in Independence was 73.1 for males and 78.5 for females. During the same year, the life expectancy at birth in Missouri for males was 74.8 years and 80.0 for females (MDHSS), while for the United States it was 73.2 years for males and 79.1 for females.141 The leading cause of death for males and females in Independence is heart disease. Compared to females, however, rates of heart disease are 1.6 times higher in males. The second leading cause of death in males and females is cancer with the rates being 1.4 times higher in males compared to females. The third and fourth leading causes of death for males are accidents and chronic lower respiratory diseases, respectively. In contrast, the causes are flipped for females with chronic lower respiratory disease coming in as the third leading cause of death and accidents the fourth. The rates for both causes are, again, higher for males than females. The fifth leading causes of death in males is suicide while the fifth leading cause of death in females is stroke.16

Source: MDHSS MOPHIMS Death MICA, 2017-2021.

Looking closer into heart disease, the main contributors to heart disease death among males and females are other forms of chronic ischemic heart disease, heart failure, and other forms of heart disease. For cancer, cancers of the trachea, bronchus and lungs; cancers of the colon, rectum and anus; and unspecified neoplasms are among the main contributors to cancer deaths for males and females. Additionally, females have breast cancer and pancreatic cancer among the top contributors and males have prostate cancer and cancer of the liver and bile ducts.

LEADING CAUSE OF DEATH BY AGE

Children under 1 year of age are most likely to die from conditions that originated during the perinatal period, congenital anomalies, and accidents or unintentional injuries. The leading causes of death for children ages 1 to 17 are accidents or unintentional injury, suicide, and homicide. The death rates in this age group are lower when compared to the other ages. Accidents and suicide are the top two leading causes of death for people ages 18 to 24 and 25 to 44. While suicide occurs at a similar rate for both ages, the rate of accidents or unintentional injuries is higher among those 25 to 44. Cancer and heart disease are among the leading causes of death for people ages 25 and older, with the rate being highest in people 65 and older.16

Leading Causes of Death by Age in Independence, 2017-2021

CHRONIC ILLNESS AND DISEASE

Chronic diseases are one of the leading causes of death and disability. Six out of ten Americans currently live with at least one chronic disease.142 In Missouri, approximately seven in every ten deaths are attributed to a chronic disease. These diseases are often caused by poor health behaviors including tobacco use, poor nutrition, lack of physical activity, and excessive alcohol use.141

HEART DISEASE

Heart disease accounts for one in every five deaths and is the leading cause of death for both men and women in the United States. Moreover, heart disease is the leading cause of death for most racial and ethnic groups in the United States, including African American, American Indian, Alaska Native, Hispanic, and white men.143 Missouri data showed that in 2021 the total Missouri age-adjusted rate by 2000 standard population was 202 deaths per 100,000 state residents, and the Independence total rate was 209 per 100,000.16 The mortality rate from heart disease has fluctuated from 2012-2020, with the 2020 mortality rate being slightly higher than the 2012 rate in Missouri. The mortality rate for Independence sharply increased after 2012, since then it has fluctuated slightly but remained high.16

Source: MDHSS MOPHIMS Death MICA, 2009-2021.

STROKE

In 2022, 1 in 6 deaths from cardiovascular disease was due to stroke. First-time stroke occurs nearly twice as much in those who are black or African American as for those that are white. In addition to being a leading cause of death, strokes are also a leading cause of long-term disability in the United States.144 Risk of stroke increases with age, but strokes can occur at any age. In 2014, 38% of people hospitalized for stroke were less than 65 years old.145 Missouri Information for Community Assessment (MICA) data shows that the death rate from stroke has increased slightly from 38 deaths per 100,000 state residents in 2018 to 40 deaths per 100,000. Independence saw a sharp increase with 38 deaths per 100,000 residents in 2018 to 45 deaths per 100,000 in 2020 and then saw a decrease back to 38 deaths per 100,000 residents 16 The mortality rate for stroke in Independence fluctuates greatly but is currently lower than the state’s mortality rate.

Source: MDHSS MOPHIMS Death MICA, 2009-2021.

CHRONIC LOWER RESPIRATORY DISEASE

Chronic Lower Respiratory Disease (CLRD), which includes Chronic Obstructive Pulmonary Disease (COPD), causes airflow blockage and breathing-related problems. It includes emphysema, chronic bronchitis, and, in some cases, asthma. In 2018, CLRD was the fourth leading cause of death, with 15.7 million people reported being diagnosed. Nationally, the prevalence of CLRD remained stable from 2011 to 2022 and was significantly higher in women than in men.146 In 2022, between 7% and 8% of Missouri residents had CLRD.145 The rates for CLRD for Independence were higher than for the state. Independence CLRD rates increased from 2016 to 2020 and then decreased in 2021 16

Source: MDHSS MOPHIMS Death MICA, 2009-2021.

DIABETES

There are three main types of diabetes: type 1, type 2, and gestational. Type 1 diabetes is typically diagnosed in children and young adults and is believed to be caused by an autoimmune reaction. Type 1 is currently not preventable but can be managed effectively. Type 2 diabetes is usually diagnosed in adults but has been increasing among children and young adults in recent years. Type 2 is preventable with diet and lifestyle changes. Gestational diabetes is diabetes that develops in a pregnant woman and will typically go away after the baby is born.147 Diabetes is the 8th leading cause of death nationally, with around 38 million adults having diabetes. In Missouri, it was estimated that almost 600,000 adults are living with diagnosed diabetes in 2023.148 Independence has seen an increase in deaths from diabetes from 2019 to 2021 and experiences this at a higher rate than the surrounding areas of Eastern Jackson County and Kansas City.

Source: MDHSS MOPHIMS Death MICA, 2009-2021.

A LOOK AT THE DEPARTMENT

The Independence Health and Animal Services Department works to protect the health and wellbeing of the residents of Independence across a variety of fields. The department is divided into 5 divisions: Animal Services, Communicable Disease and Immunization, Disease Prevention and Emergency Preparedness, Health Inspections, and The Alternative Response for Community Health (ARCH) Animal Services operates out of the Independence Animal Shelter on 78 Highway. Communicable Disease, Disease Prevention and Emergency Preparedness, and Health Inspection operations occur from Independence City Hall. ARCH is a joint endeavor between the Independence Health and Animal Services Department and Fire Department. The next section will provide a brief description of each division’s roles and activities.

ANIMAL SERVICES

The mission of the Animal Services Division is to protect the safety and welfare of people and animals in our community by promoting an environment of responsible pet ownership. Staff strives to take a leadership role in promoting humane care for animals in the community, promote spay and neuter initiatives to reduce pet overpopulation, make every effort to reunite pets with their families, and promote efforts to increase pet retention.

Table 6: Intake and Outcome of the Independence Animal Shelter, 2019-2023

The Independence-run animal shelter operates with the goal of reuniting lost animals with their families and finding new homes for animals in need. The shelter has a vet clinic to provide services, including spay/neuter and microchipping procedures for the animals that are taken in. For pet owners struggling with feeding their animals the shelter offers a pet food pantry. Those in need can call and schedule a pickup time to receive a monthly allotment of food. The pet food pantry provided 726.5 pounds of cat food and 3,297 pounds of dog food to families in need in 2023.

The shelter also offers a Trap-Neuter-Return (TNR) program for community cats in Independence and unincorporated Jackson County. TNR helps to prevent unwanted litters of kittens in the community. Community cats are humanely trapped, spayed/neutered, vaccinated, treated for parasites, eartipped, and returned to their outdoor home. The TNR clinic captured and returned 125 cats in 2020, 207 in 2021, 349 in 2022, and 357 in 2023

In addition to the above services, the Independence Animal Services officers are based out of the shelter. Independence Animal Services officers are the first responders for issues and emergencies concerning animals. Animal Services Officers are responsible for enforcing city codes regarding the keeping and caring of animals in Independence to promote health, safety, and welfare for both people and animals. In 2023, Animal Services received almost 5,000 calls, including reports of animal abuse/neglect, unrestrained animals, rabies exposure, injured animals, and aggressive/dangerous animals.

Table 7:Animal Services Call Activity, 2023

COMMUNICABLE DISEASE AND IMMUNIZATION

The Communicable Disease and Immunization staff is dedicated to a variety of activities and programs that affect the health, safety, and well-being of the community.

They have the responsibility for the following:

• Tracking disease trends in the community.

• Conducting investigations on reported cases of reportable communicable diseases and outbreaks.

• Vaccination clinics

• Providing communicable disease and immunization education to childcare facilities, schools, and parents.

• Ensuring children in childcare facilities are properly immunized by completing immunization audits.

• Comparing and interpreting data to detect possible changes in the health status of the population.

• Maintaining partnerships with the healthcare community.

DISEASE PREVENTION AND EMERGENCY PREPAREDNESS

The Disease Prevention staff of IHAS informs, motivates, and helps individuals and groups to assume responsibility for improving the health of themselves, their families, and their community. The staff promotes health practices and lifestyles that will lead to the highest level of individual and community health and advocates social and environmental changes as needed to facilitate these goals. Public health emergency preparedness planning and education are provided in collaboration with City, regional, and state emergency officials.

YOUTH MENTAL HEALTH

The disease prevention team is working to improve the current state of mental health in Independence. The Independence Suicide and Mental Health Task Force was formed in 2021 with a

mission to lower the rate of teen suicide and improve the mental health of Independence youth. Here, local stakeholders meet monthly and discuss efforts being performed to reach this goal. Current members include IHAS, Children’s Mercy, Comprehensive Mental Health, the Independence School District, local religious leaders, etc.

Mental Health First Aid (MHFA) is a skills-based training course offered by the department. It teaches participants how to recognize and respond to signs of mental health challenges and substance use issues in adults and children. Teachers, coaches, employers, parents, and hospital and school staff should know MHFA. There are three MHFA programs: adult, youth, and teen. IHAS has taught 12 Youth Mental Health First Aid classes to city staff and community members.

IHAS staff regularly attend events hosted by the City to hand out health promotional and educational materials to the public. IHAS collaborates with the communications department of the City to post mental health messages and resources on social media using a series called Mental Health Mondays. This series is to raise awareness of various issues and provide education to the public. Mental Health Monday messages have included Children’s Mental Health Week, National Suicide Awareness Month, National Bullying Prevention Month, National Impaired Driving Month, etc.

EARLY CHILDHOOD EDUCATION CLASSES

IHAS works with many local childcare providers to improve the health status of children in childcare. To accomplish this, the department provides free health promotion classes approved by the State to preschool-aged children attending childcare centers located in Independence. Classes include handwashing, nutrition, oral hygiene, physical activity, bullying prevention, fire safety, poison prevention, and sun and water safety.

REDUCING HEALTH DISPARITIES

IHAS administers a grant that aims to reduce health disparities and decrease cases of COVID-19 by providing Independence residents with subscriptions to grocery delivery services and providing computers to areas of town/community centers in Independence.

Providing both high-risk and underserved populations in Independence as well as families that have at least one COVID-19-positive member with a subscription to grocery delivery service would reduce their risk of outside exposures and contracting COVID-19. It also allows families to effectively quarantine or isolate as needed. Providing computers for areas of town/community centers in Independence that meet the criteria for being high-risk and underserved, increases the accessibility of healthful foods and the ability for these populations to access telehealth services. Both would lead to improved health outcomes in the targeted populations.

Populations being served will include racial and ethnic minority groups residing in Independence as well as those under the age of 65 with a disability, living in poverty, and/or having no computer access.

EMERGENCY PREPAREDNESS

Any number of public health emergencies could occur in Independence and the surrounding areas ranging from natural disease outbreaks to deliberate acts of terrorism involving the use of biological agents. The Emergency Preparedness team works to educate the public on ways to prepare and develop plans to use during emergencies.

Public health has a significant role to play in emergency response. Public health’s main functions are to provide the community with a plan to maintain good health, prevent its citizens from getting ill, and control the spread of disease. Once a public health threat is suspected or identified, the responsibility of public health is to coordinate the overall response. This requires conducting an epidemiological investigation to determine the source, informing medical providers of the status of the situation, providing prophylactic antibiotics or vaccines as appropriate, and informing the public how to respond to protect themselves.

HEALTH INSPECTIONS

Permitted Establishments regulate, educate, and license through routine inspections, complaint investigations, and continuous training in all food/drink establishments, retail grocery, child day care facilities, lodging, massage therapy, tattoo parlors, and commercial swimming pools/spas Consistent monitoring of these facilities in accordance with the City’s laws ensures that people remain happy and healthy when interacting with services in Independence.

ALTERNATIVE RESPONSE FOR COMMUNITY HEALTH

The Alternative Response for Community Health (ARCH) program is a community response program composed of Licensed Clinical Social Workers (LCSW) for the Independence Health and Animal Services Department and Community Paramedics from the Independence Fire Department that began operation in July 2022. ARCH responds to 911 events alongside or in place of traditional first responders. They advocate for the needs of individuals, seeking incident resolution that both minimizes first responder responsibility for low-acuity emergency events and reducing barriers to appropriate assistance for individuals within the 911 system. ARCH has two goals: 1. Connect individuals within the 911 system with the most appropriate resources and 2. Keep emergency responders available within the community by diverting them from low-acuity emergency response.

ARCH provides transports to Independence residents to Alternative Treatment Facilities, meets with residents, family members, and friends to facilitate support and growth post-crisis, and conducts follow-up visits to maintain engagement. Since they began operation in 2022, ARCH has responded to over 1,636 emergency response calls and conducted over 1,439 follow-up visits. They work to engage with residents and assist them in connected with and engaging in resources that assist with mental health, substance use, chronic medical care, and other quality-of-life events. In 2024, ARCH partnered with the Heartland Center for behavioral change to engage substance use specialists on emergency incidents.

PROCESS AND METHODS

The assessment process included synthesizing existing (secondary) data on social, economic, and health indicators in the region. Primary quantitative information from a survey to community members from across the 10 zip codes was also used to create a health profile for Independence. The quantitative and qualitative data collection sought to elicit the perspectives and opinions of a range of representative samples from different audiences. To identify priorities and opportunities for action, surveys elicited key information from residents.

The methods section details how quantitative data for the CHA focuses the lens of public health in a direction with both breadth and depth. Specifically, the CHA defines health in the broadest sense and recognizes that multiple mechanisms determine health from lifestyle behaviors (e.g., healthy eating and active living), to medical services (e.g., access to care), to social and economic factors (e.g., household income) to the physical environment (e.g., property maintenance and animal services). The beginning discussion of this section describes the larger social determinants of the health framework that helped to guide this process.

SOCIAL DETERMINANTS OF HEALTH FRAMEWORK

It is important to recognize that multiple factors affect health, and there is a dynamic relationship between people and their environments. Where and how people live, work, play, and learn are interconnected factors that are critical to consider when assessing a community’s health. Not only do genetics and lifestyle behaviors affect one’s health, but also upstream factors such as employment status and quality of housing may influence health more than previously thought. The social determinants of health framework address the distribution of wellness and illness among a population its patterns, origins, and implications. While the data to which we have access is often a snapshot of a population in time, the people represented by that data have lived their lives in ways that are enabled and constrained by economic circumstances, social context, and government policies. Building on this framework, this assessment utilizes data to discuss which populations are healthiest and least healthy in the community, as well as to examine the larger social and economic factors associated with good and poor health.

The following diagram provides a visual representation detailing the upstream factors influencing individual lifestyle factors.

Source: Dahlgreen and Whitehead (1991)

PRIMARY DATA COLLECTION

The 2024 CHA Survey for Independence was developed by IHAS staff in consultation with community partners. Community partners reviewed and made recommendations on the questions that should be included on the CHA survey to ensure that health topics that their organizations rank as important would be represented. They provided additional feedback to ensure that questions were equitable. The survey was available in both English and Spanish. The organizations that contributed to this process included:

• Community Services League

• First Call KC

• Hope House

• M&H Consulting

• Independence School District

• Independence Advisory Board of Health

The six-page was sent out to 20,000 randomly selected households. The use of Geographic Information Systems (GIS) allowed the sample to be statistically significant for each zip code within Independence city limits. Residents could complete the survey online using Microsoft Forms or mail the completed paper survey to the department. Surveys received through the mail were hand-entered by IHAS staff into Microsoft Forms. Out of the 20,000 households that received a survey, 2,262

completed surveys were received. One survey was excluded from the results as the zip code was marked as a zip code outside of Independence giving us a total sample size of 2,261 households. The 2024 CHA had an 11% response rate. This response rate was a 1% increase from the 2022 CHA Survey.

SECONDARY DATA COLLECTION

To provide a salient community health profile for Independence, the Community Health Assessment required harvesting secondary quantitative data drawn from national, state, and local sources. This allowed the development of a portrait of these areas that discusses health, social, and economic characteristics. Data sources included but were not limited to U.S. Census, CDC, MICA, IHAS, and County Health Rankings. Types of data included self- reporting of health behaviors from large, population-based surveys such as the Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Survey (YRBS), as well as public health disease surveillance data and vital statistics based on birth and death records. A full list of sources is provided in the References section.

ANALYS I S

Primary and secondary data were analyzed with R Studio Software, ArcGIS Online, and Microsoft Excel. Types of analyses included the calculation of rates to compare outcomes between different sized populations and the calculation of descriptive statistics such as count, percentage, and mean.

LIMITATIONS

As with all research efforts, there are several limitations related to the assessment’s research methods. For the secondary data analyses, several sources did not provide current data stratified by race/ethnicity, gender, or age thus, for the total population these data were not subject to analysis. It is also important to note that there were geographic limitations to the BRFSS data, which are only available at the county level as a whole, and YRBSS data, which are only available at the state level. In several instances, data from MICA is also limited to Jackson County. Across all sources, some data were suppressed and not available because population counts were too small to report. Likewise, data based on self-reports (i.e., BRFSS, YRBSS, Community Health Survey) should be interpreted with particular caution. In some instances, respondents may over- or under-report behaviors and illnesses based on fear of social stigma or misunderstanding of the question’s intention. In addition, respondents may be prone to recall bias that is, they may attempt to answer accurately but remember incorrectly. In some surveys, reporting and recall bias may differ according to a risk factor or health outcome of interest.

All Independence households that returned the survey, including incomplete surveys, were included in the analysis. Responses that were unclear on the paper survey responses, such as checking more boxes than asked for, or were not answered were treated as “missing”. Households that returned surveys were eligible to participate in a raffle of four iPads or a Roku TV, which may have influenced the demographic of the respondents. The surveys had a low representation of low-income homes. Additionally, as an addr ess was required to receive a survey, individuals who are houseless were not reached. Additional survey completion options are needed in the future to reach underrepresented

groups. This includes providing postage stamps, participating in health fairs, and in-person options at different locations such as WIC offices/food stamp offices, libraries, community centers, etc.

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110. Substance Abuse and Mental Health Services Administration. (2024). Learn About Substances. Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/substance-use/learn

111. Centers for Disease Control and Prevention. (2024). Cigarette Smoking. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/tobacco/about/index.html

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113. American Cancer Society. (2024). Health Risks of Smokeless Tobacco. American Cancer Society. Retrieved from https://www.cancer.org/cancer/riskprevention/tobacco/smokeless-tobacco.html

114. National Institute on Alcohol Abuse and Alcoholism. (2024). Understanding Binge Drinking. National Institute of Health. Retrieved from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/binge-drinking

115. Centers for Disease Control and Prevention. (n.d.). Excessive Alcohol Deaths. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/alcohol/features/excessive-alcohol-deaths.html

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117. Missouri Department of Health and Senior Services. (n.d.). Drug Overdose Dashboard – Fatal Overdoses. Missouri Department of Health and Senior Services. Retrieved from https://health.mo.gov/data/opioids/

118. U.S. Department of Health and Human Services. (2022). What Are Opioids?. U.S. Department of Health and Human Services. Retrieved from https://www.hhs.gov/opioids/prevention/index.html

119. Missouri Department of Health and Human Services, Division of Vital Statistics. (2024). Deaths, Hospitalizations, 2017-2021. Data Request.

120. Substance Abuse and Mental Health Services Administration. (2024). What is Opioid Overdose? Treatments and Preventions. Retrieved from https://www.samhsa.gov/substanceuse/treatment/overdose-prevention

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APPENDIX A: 2024 CO MMUNITY HEALTH ASSESSMENT (CHA) SURVEY

SECTION I: MY COMMUNITY

1. In your opinion, what are the FIVE most important public health concerns for Independence in the next 5 years? Please choose FIVE

2. In your opinion, what are the tops strengths of your community and neighbors POSSIBLE

3. Do you use city parks, sports fields or trails?

a. If yes, how do you use the park or trail? Please check all that apply.

b. If no, why not? Please check all that apply.

4. How safe do you currently feel walking near your home or in your neighborhood?

a. If you chose very unsafe or sometimes unsafe about, what makes you feel unsafe walking near your home or your neighborhood?

SECTION II: HEALTH STATUS

5. How would you rate your general overall health:

6. In the past month, how often have you experienced feelings of anxiety, stress, or depression?

7. How difficult have these feelings made if for you to do your work, take care of things at home, or get along with people?

8. How often does anyone, including a family member or intimate/romantic partner:

a. Threaten to hurt you?

b. Insult you, call you names, talk down to you, or yell at you?

c. Physically hurt you?

d. Restrict your access to a vehicle?

e. Restrict your access to a shared bank account or the money you have earned?

f. Restrict your access to friends and family?

SECTION III: ACCESS TO CARE

9. Do you currently have any kind of health insurance coverage, including private health insurance or government plans such as Medicare or Medicaid?

10. Not including yourself, do the people in your household currently have health insurance coverage?

11. Do you get an annual/yearly physical exam?

12. Do you get an annual/yearly eye exam or vision screening?

13. In the past 12 months, have you ever avoided seeking medical care for yourself or a family member due to…

a. Concern about the cost of the visit or the co-pay?

b. Lack of health insurance?

c. Not knowing where to go?

d. Lack of reliable transportation?

e. Not being able to get off of work or school?

f. Lack of childcare?

g. Not feeling comfortable or welcome at the clinic?

h. Lack of interpretation services?

i. Distrust in the healthcare system?

14. In the past 12 months, have you ever avoided filling or refilling a prescription due to concerns about the cost of medication?

15. Was there a time in the past 12 months when you needed treatment for a mental health problem, but you did not get it?

a. If you answered yes, what kept you from getting treatment?

Responses varied

16. Do you get an annual/yearly dental exam?

17. How long has it been since you last visited the dentist or dental clinic for any reason?

18. Did you get a flu shot in the last year?

a. If no, what kept you from getting a flu shot? Please check all that apply.

19. Did you get a COVID-19 vaccine in the last year?

a. If no, what kept you from getting a COVID-19 vaccine? Please check all that apply.

20. Are the children in your household current on their recommended immunizations (shots)?

a. If no, why not? Please check all that apply.

21. Where do you get your health information (information on local health care resources, educational information, etc.)? Please check all that apply.

SECTION III: LIFESTYLE

22. How many hours of physical activity do you get in a typical week?

23. How many servings of fruits do you usually eat in a day? (1 serving = 1 cup)

24. How many servings of vegetables? Please check all that apply.

25. Where do you get your fruits and vegetables? Please check all that apply.

26. On average, how many sugar-sweetened drinks (including fruits juices and soda) do you have in a day?

27. On average, how many house of sleep do you get in a 24-hour period?

28. How often do you use seatbelts when you drive or ride in a car?

29. If you have child in your household, how often do they wear a helmet when they ride a bike/scooter/skateboard?

30. Please indicate which of the following you have done at your home to prepare for a disaster or emergency.

together a kit for the car, with things like food, flashlight, blankets, and tire chains

multiple ways to be alerted to weather emergencies

SECTION IV: HOUSING AND FOOD SECURITY

31. In the past 12 months, have you ever…

a. Been worried that you or your household would run out of food before you were able to buy more?

b. Had to choose between buying groceries and paying another bill such as utilities, medical bills, or gas/transportation?

32. When I shop for groceries, I … RESPONSES

33. Between 2020 and today, have you or your household been evicted or forced to move out of a residence? Please choose all that apply.

34. Do you have problems with any of the following in your home? Please choose all that apply.

SECTION V: SUBSTANCE USE

35. In the past 30 days, how often have you smoke cigarettes?

a. If you answered every day or some days, how many cigarettes do you smoke on a normal day?

Average: 11.93

36. In the past 30 days, how often have you used an e-cigarette or vape product?

37. Do you currently use any of the following nicotine products? Please check all that apply.

38. During the past 30 days, on how many different days did you have at least one drink of an alcoholic beverage such as beer, wine, a malt beverage, or liquor?

39. On average, on the days when you drink alcohol, about how many drinks do you have?

40. Have you or anyone in your household used any of the following drugs in the past 30 days?

Please check all that apply.

41. Has anyone in your household ever been prescribed opioids?

SECTION VI: ENVIRONMENTAL HEALTH

42. How important do you feel routine inspections of…

a. Restaurants (and other sites where food is handled/prepared) are in making sure that food is safe to eat?

b. Childcare facilities are?

c. Lodging (hotels, motels, bed and breakfasts, etc.) are?

43. If you believed you or someone in your family had food poisoning, how likely would you be to report it? This could be from any food source such as a restaurant, cafeteria, an event, take out, grocery store, street vendor, etc?

SECTION VII: ANIMAL SERVICES

44. How many pets do you have at your residence?

a. If you have pets, are your pets up to date on their rabies vaccination?

b. If you have pets, are they spayed or neutered?

45. Do you feed or provide care to stray cats in your area?

a. If yes, are they spayed or neutered?

46. From the list below, please select the THREE most important issues:

SECTION VIII: ABOUT YOU

47. What is your zip code?

49. What is your height? Used with weight to calculate BMI

50. What is your weight? Used with height to calculate BMI

51. How do you currently identify your gender?

52. Which of the following best represents how you think of yourself?

53. How do you describe yourself? Please check all that apply.

54. What is the main language spoken in your household?

55.

56. What is the total number of children under 18 years of age in your household?

57. What is your employment status? Please check all that apply.

58. During the past 12 months, what was the total combined income of all members of your household before taxes?

59. Which of the following best describe your home?

60. What is the highest grade or level of school you have completed or the highest degree you have received?

61. What does a healthy community look like to you?