How Healthy is Tampa Bay? by Timothy Gibbons

Established in 1996, the Tampa Bay Partnership Regional Research & Education Foundation conducts research on issues of regional economic significance and educates the public by serving as a source of data-driven information and conducting informational leadership programs, conferences and seminars. In 2006, the Foundation began an effort to develop a shared regional vision for the eight-county Tampa Bay region to answer the question: how can the overall region prosper from a position of strength, diversity, opportunity, and economic vitality over the long-term as we continue to grow? The regional visioning process, now known as ONE BAY, explores the issues that are most critical to the region’s future – not only the most urgent or pressing, but those issues that can only be successfully addressed with a long-term view and commitment in mind. For each ONE BAY initiative, the Foundation will: • Create a strong and diverse coalition within the region to achieve better coordination of services and resources and a higher appreciation and awareness among partners with less duplication of services. • Engage the community by implementing a participatory and highly-publicized process to increase awareness and knowledge. • Increase visibility so community residents may gain a better awareness of their own potential for improving their quality of life. • Create community ownership. Community-driven processes also lead to collective thinking, a sense of community ownership in initiatives, and ultimately, may produce more innovative, effective and sustainable solutions to complex problems. There are currently three active ONE BAY initiatives. Livable Communities. Started in 2007, the ONE BAY: Livable Communities initiative has drawn upon thousands of citizens to create a shared regional vision to plan for where future population and employment growth shall go through responsible land use, mobility, and environmental sustainability. This initiative is now in the implementation stages working collaboratively with the public and private sectors to support the Vision’s recommendations. Healthy Communities. Started in 2010, the ONE BAY: Healthy Communities initiative researched the overall health status of the region with the goal of one day achieving more positive health outcomes throughout our community. The next step will be to engage the public in the highly visible process to answer the question – How healthy do we want to be in 2050? Lifelong Learning. The Foundation recognizes that the quality of a region’s educational system is a critical factor in the site selection process for relocating and expanding companies; is a catalyst for research & commercialization; influences the skills of the region’s workforce and quantity of available knowledge workers; and can contribute to increasing the income of the region’s residents. In 2011, the Foundation will begin exploring how a long-term vision can engage the community towards an improved educational system for all its citizens. FULFILLING LIFE’S POSSIBILITIES

Tampa Bay Partnership Regional Research & Education Foundation Directors: Dan Mahurin, Chairman SunTrust Bank Lee Arnold Colliers Arnold David Fischer Community Foundation of Tampa Bay Stephen Mason BayCare Health System Stuart Rogel Tampa Bay Partnership

Visit www.myonebay.com for more information.

Table of Contents About The Tampa Bay Partnership Regional Research & Education Foundation

Welcome

Introduction

4-9

Next Steps

About the Tampa Bay Region

Economy/Demographics

12-13

Health Outcomes

14-19

Health-Related Behaviors

20-23

Health Systems

24-26

Health Access Environmental Health

28-31

Community Assessment

32-37

Goals & Methodology Health Indicators

38 39-44

Organizations

Steering Committee

References Acknowledgements

47-48 49

ONE BAY: Healthy Communities

As the nation begins a new era in health care, the country is also focusing on improving individual health. Americans are living longer, yet the number of healthy productive years is approximately 10% less than the average life expectancy. In addition, many individuals are unnecessarily dying too young. Investing in one’s health is a smart play for people who want to live healthier, longer, and happier lives. Communities investing in health will create a more attractive, safe, and opportunistic place for current and future generations. The Tampa Bay Partnership Regional Research & Education Foundation, through its regional visioning process known as ONE BAY, is committed to exploring the issues most critical to the region’s future which can only be successfully addressed with a long-term view and commitment. In 2010, the ONE BAY: Healthy Communities initiative convened a diverse group of stakeholders from the public, private and non-profit sectors and challenged them to find ways for us to become more pro-active, gain a better understanding of our unique health and community issues, and commit to working together to remove barriers and promote a healthy lifestyle for all residents.

Stephen R. Mason President & CEO, BayCare Health System

With Florida’s health rankings landing at the middle to bottom of national rankings, according to various surveys, our first goal was to establish baseline data to help our region understand how healthy the Tampa Bay region is compared to the state and nation. This assessment of the Tampa Bay region highlights areas where we excel, but also where we need improvement. While the state has various programs in place to address the challenges and opportunities Florida faces, we in the Tampa Bay region need to raise awareness of the issues and create compelling reasons why business and community leaders should commit to building cultures of health. • The Tampa Bay region, in some cases, mirrors the health of the nation (i.e., obesity); yet we have found that some Tampa Bay figures far exceed the U.S. rates and Healthy People 2010 targets (i.e., motor vehicle deaths). • Our most difficult challenges are in the areas of suicide, infant deaths, low birth weight babies, obesity, smoking, and motor vehicle deaths. • Although the entire nation is experiencing the aging of the baby boomer generation, a higher proportion of the Tampa Bay population is age 55 or older when compared to most other regions. We need to recognize the special needs and abilities of this rising demographic. We look forward to working closely with a variety of key stakeholders to improve the health of our current population and attract new residents and businesses to further our economic prosperity and competitiveness.

Sincerely,

Stephen R. Mason Chair, Steering Committee ONE BAY: Healthy Communities

FULFILLING LIFE’S POSSIBILITIES

Introduction

How healthy is the Tampa Bay community? How does it compare to Florida as a whole and to national

benchmarks? What community health improvement activities are occurring in the region? This report stems from a new long-term regional visioning initiative called ONE BAY: Healthy Communities, aimed at improving the health of the eight county region. The assessment on the following pages will give a basis for where we stand today, and help the region prioritize and collaborate toward common goals.

What is a Healthy Community? A healthy community encompasses the physical, psychological, economic, environmental and social well-being of its citizens. These health domains are interrelated, each impacting the other. An unsafe neighborhood inhibits outdoor physical activity; a poor economy increases unemployment and simultaneously decreases the likelihood of families being able to afford prescription medicines and preventive care; and health disparities have been correlated with race and socioeconomic status. In the broadest sense, a healthy community is one in which all sectors of the community (individuals, employers, governments, educators, faithbased organizations and health care providers), work together to remove barriers and promote a healthy lifestyle for all residents.

Living Longer Americans are living longer than we did 100 years ago. Living longer does not always mean living “healthy” longer. According to a recent study 4

U.S. Life Expectancy The number of “healthy” years that one can expect to live without illness or injury is 10% less than the average life expectancy.

Women

80 72

Total Years “Healthy” Years

Men

75 68

Total Years “Healthy” Years

by the Organisation for Economic Co-operation and Development (OECD), the number of years that one could expect to live healthy, that is, not limited by disease or injury, is 10% less than the average life expectancy. In the U.S., based upon an average life expectancy in 2006 of 80 years for women and 75 years for men, the “healthy” life expectancy is only 72 years for women and 68 years for men.1 Rather than dying at an early age from heart disease, stroke or cancer, we are more often living and coping with these and other chronic diseases, such as diabetes, arthritis, hypertension and respiratory diseases. Nearly 25% of those with chronic disease have one or more limitations in their daily activities.2 Not only is chronic disease shortening lives, the cost of treating chronic disease continues to increase. Roughly 75% of all health care dollars are spent treating chronic disease.3 Total health care spending in 2009 was nearly $2.5 trillion and is expected to reach $4.3 trillion in 2017, or 20% of the U.S. Gross Domestic Product.4,5 ONE BAY: Healthy Communities

A Social Awakening

Evaluating Community Health

Improved health, whether through disease prevention, increased access, elimination of disparities, or reduction of chronic disease, has become a greater part of the public dialogue in the last decade. The message being communicated, and increasingly heard, is that the majority of the American populace is not healthy.

In an effort to determine whether Tampa Bay is a healthy community, data for 60 indicators was collected in five areas: Economy/Demographics, Health Outcomes, Health-Related Behavior, Health Systems and Access, and Environmental Health for each of the eight counties in the Tampa Bay region. Analysis of health, economic and social indicators reveal that Tampa Bay, as far as health is concerned, is an average community. It is neither a shining example of health to be emulated by other communities, nor a region plagued by disease and unhealthy behavior to such a degree that it impacts economic growth of the region.

Highly popular network television reality shows like “The Biggest Loser” and “Jaime Oliver’s Food Revolution” have reinstated a national discussion. In addition, First Lady Michelle Obama has launched the “Let’s Move” initiative to combat childhood obesity and raise a healthier generation of children. Since the 1979 Surgeon General’s Healthy People report laid out a national public health agenda, research advances and proactive efforts of the public and private sector have made an impact. We have experienced: • Scientific and pharmaceutical advances on both the prevention and treatment of disease • Employers paying for preventive services and providing in-house health clinics for employees and families • Employers providing incentives for employees to take responsibility for their personal health and expenditures • An increase in the number of walking trails, marathons and triathlons • Places of employment and public places, including outdoor community venues (i.e., sports stadiums), becoming smoke-free zones • Comprehensive reforms through the Affordable Care Act of 2010 intended to lower health care costs, guarantee more choices, and enhance the quality care for all Americans • Requirements by the U.S. Department of Agriculture for school districts to have a wellness policy One of the most visible examples of societal change initiated by scientific findings, citizen action and legislative policy changes, is the transformation from a smoking culture to one where residents now expect a nearly smokefree community. FULFILLING LIFE’S POSSIBILITIES

Poor

Good

How healthy is Tampa Bay?

For many of the health indicators measured, Tampa Bay statistics are similar to state or national rates. However, state and national figures may not be the best benchmark, as they may also fall short of the national Healthy People 2010 goals as well as Healthy People 2020 targets. Of 16 indicators collected with corresponding Healthy People 2010 targets, only four met or exceeded the target in the Tampa Bay region with 12 trailing the 2010 benchmarks.

Spotlight: Healthy People 2010/2020 Healthy People 2010 was designed to be a guide for state and local governments, professional associations and other organizations to assist in setting local goals and taking action. The primary goals for Healthy People 2010 were:6 • Increase Quality and Years of Healthy Life • Eliminate Health Disparities The Healthy People objectives include over 450 measures that either affect health and well-being or demonstrate our progress, or lack thereof, in addressing a condition or illness. Measures of injury, violence, and environmental quality are also included as safe neighborhoods and clean air impact health. Healthy People 2020 was launched in December 2010 and includes a redesigned website, new topic areas and evidence-based interventions. www.healthypeople.gov

Introduction (cont.) Those meeting the goals include rates of colon cancer screenings and deaths caused by breast cancer, stroke and coronary heart disease. Of the targets where we are lagging, the more alarming statistics include suicide deaths, infant deaths, low birth weight babies, obesity, smoking, and motor vehicle deaths. We should note that some of these challenges are not just a Tampa Bay phenomenon. The percentage of adults in Tampa Bay who are overweight or obese mirrors that of the state and nation. With two-thirds of our adult population either overweight or obese, our nation is suffering the consequences in terms of increased costs, lower quality of life, and premature death. As the nation grapples with this challenge, Tampa Bay should be prepared to work in concert with state and national efforts so as to not fall behind. On the other hand, motor vehicle deaths in Tampa Bay (and Florida) far exceeded the Healthy People target while the U.S. numbers were below the target and trending downwards. In this area, we should work closely with state and local officials to increase the safety of our citizens. This report highlights notable indicators with more detailed information in subsequent sections.

Three out of four high school students in Tampa Bay graduate within four years of beginning high school, which is only marginally lower than state and national averages. Employers seeking a skilled and educated labor force may be concerned that only slightly over one in five Tampa Bay adults (age 25 and older) have a Bachelorâ&#x20AC;&#x2122;s degree or higher compared to nearly one in four nationally.

Health Outcomes When thinking about the health of a population, it is customary to consider the number of residents who die from a disease or condition, or who are living with a disabling condition.

Prevalence of smoking in U.S. declined from

42% in 1965 to

20% in 2007

A Growing and Diverse Region The Tampa Bay region is densely populated with over four million residents, of whom 60% are working age (18-64) and 20% are age 18-34, a desirable employment and consumer pool. The population is primarily white with African Americans comprising 11% of the total population. The Hispanic population is the fastest growing ethnic group with a 75% increase in the number of residents of Hispanic origin between 2000 and 2009. The regionâ&#x20AC;&#x2122;s median annual household income and annual per capita personal income lag behind national numbers. However, when other factors such as

cost of living and the absence of income tax are considered, the purchasing power of those lower regional incomes begins to align more closely with other communities. The percentage of families living below the poverty level in Tampa Bay approximates the rest of the nation at 13%. The regionâ&#x20AC;&#x2122;s unemployment rate was two percentage points higher than the nation in 2009, but historically, the Tampa Bay unemployment rate has trended less than national rates.7

Data on the health outcomes for thirteen diseases and conditions was collected for this report. The good news is that for the three conditions that cause the most deaths, coronary heart disease, stroke and cancer, there has been a downward trend in the number of deaths caused by these conditions. This is a national and state trend, as well as one seen in Tampa Bay. Of these three major causes of death, stroke and lung cancer stand out, but for opposite reasons. The Tampa Bay region has a substantially lower death rate from stroke, 34.6 deaths per 100,000 residents, compared to the national rate of 43.6 per 100,000 residents. The Healthy People 2010 target was 50, which Tampa Bay successfully met, even in 2002. Lung cancer deaths in Tampa Bay, unfortunately, exceed state and national figures. In 2006, there were 55.7 lung cancer deaths per every 100,000 residents in Tampa Bay compared to 51.2 in the state of Florida, and 51.5 nationally. Unlike other cancers, the correlation between lung cancer and smoking, is proven. Efforts to reduce the number of lung cancer deaths in Tampa Bay require successful behavioral intervention.

ONE BAY: Healthy Communities

Also trending down throughout the nation, state and region are deaths caused by pneumonia and influenza. These rates are generally reported together because pneumonia is often caused by influenza. In the U.S., pneumonia/influenza is the eighth leading cause of death with 17.8 deaths per 100,000 (2006). Deaths caused by pneumonia/influenza in Tampa Bay and in Florida are less than half of that, 8.8 and 8.9, respectively.

have declined over the last five years, the number of those immunized against pneumonia and influenza has increased, and those being screened for colon cancer have increased.

The condition with the most notable trend in the wrong direction is diabetes. According to the American Diabetes Association, 1.6 million new cases of diabetes are diagnosed in people age 20 and older each year, and the total costs for diagnosed diabetes in the U.S. in 2007 was $174 billion; $116 billion for direct medical costs and $58 billion for indirect costs (disability, work loss, premature mortality).8 In 2007, the ageadjusted percentage of adults who have ever been diagnosed with diabetes in the U.S. was 5.7%; in Tampa Bay it was 8.0%. Given the costs attributed to diabetes, both in terms of dollars and premature death, this is a condition demanding intervention.

The percentage of people throughout the region, state and nation, who are overweight, defined as having a body mass index (BMI) between 25.0 and 29.9, remained fairly stable between 2002 and 2007. Unfortunately, the rates of adult and childhood obesity (BMI greater than 30.0) have substantially increased. The percentage of adults in Tampa Bay who were obese in 2002 was 21.8. In 2007, it was 25.4%. Nearly 40% of Tampa Bay residents in 2007 reported that they did not regularly exercise and 26% reported being completely sedentary.

Another troubling statistic is the number of suicide deaths in Tampa Bay. In 2006, our region had 14.9 deaths per 100,000, a slight uptick from 14.7 in 2002. In Florida, there were 12.6 suicide deaths per 100,000 (2006) and 10.8 nationally. The Healthy People 2010 target was 4.8. The region’s infant mortality is slightly higher than state and national averages. Infant deaths are most often caused by birth defects, pre-term delivery, low birth weight, sudden infant death syndrome and maternal complications during pregnancy. Tampa Bay’s number of low birth weight babies is similar to state and national averages, which were all three to four percent above the Healthy People 2010 target of 5.0%. Tampa Bay’s birth rate to teenage girls less than 15 was 0.7 births per 1,000 which was only slightly higher than the state average of 0.6. However, the range throughout the region varies greatly.

FULFILLING LIFE’S POSSIBILITIES

Childhood immunizations have remained consistent over time yet there is room for improvement. In Tampa Bay, 77.4% of children age 2 had received their immunizations compared to the state rate of 83.2% and a Healthy People 2010 goal of 90%.

62% of Tampa Bay residents are overweight or obese Behaviors Affect Health Most Americans are able to choose whether to smoke, overeat, be active, binge on alcohol, prevent disease through immunizations or detect diseases early through screening tests. Others, unfortunately, have financial or psychological limitations that influence their ability to freely choose healthy behaviors. For those Tampa Bay residents with access and choice, they are generally making the same choices as residents throughout the country. Smoking rates

Good Access to Care Availability of health care services is generally good as the Tampa Bay region supports 50 acute care hospitals and physicians in all specialties. The region, as a whole, is not suffering from a physician shortage although some counties have fewer primary care providers than the average. The strength of a community’s outpatient care can be evaluated, to a certain extent, by examining the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators or PQIs. The PQIs are used in conjunction with hospital inpatient discharge data to identify quality of care for “ambulatory care-sensitive conditions.”9 Where the PQIs are low, the residents have access to primary care, chronic conditions like diabetes are managed using evidence-based guidelines, and care is coordinated. Consequently, hospital admission rates for these conditions are low.

Introduction (cont.) The Tampa Bay community is having some success assisting patients with their management of diabetes, as the PQIs for long-term complication for diabetes and lower-extremity amputation are below those for the state and nation. The PQIs for congestive heart failure and bacterial pneumonia are also much lower compared to state and national rates. For the other commonly measured PQIs, the regional numbers are generally in line with state and national figures. However, the pediatric urinary tract infection admission rate, both regionally and statewide, is more than 50% higher than the national rate.

average but residents generally have access to healthy foods.

Access to care for those without health insurance (private or public assistance) is limited to free clinics, community health centers and hospital emergency departments. In 2009, 28% of Tampa Bay’s residents ages 18-64 did not have health insurance which greatly exceeds the national rate of 22%.

Community Assessment Findings

The region’s not-for-profit hospitals, which provide the bulk of the charity care rendered to the un- and underinsured, have been feeling the effects of this large unfunded population for decades. Changes are looming with state legislation in addition to the expanded coverage provisions within the Patient Protection and Affordable Care Act.

Where We Live Affects How We Live The natural and built environment influence the health of a community. As communities understand and confront the impact of their growth and development patterns on residents’ health, the land use planning process offers a unique opportunity to bring together diverse partners and advance strategies to improve community health. Air pollution and unsafe drinking water lead to respiratory and gastrointestinal ailments. Fortunately, for Tampa Bay, the air and water quality are good.

The region’s crime rate of 688.9 violent crimes per 100,000 residents was much higher than the national rate of 454.5 and even higher than the state rate of 622.0. The presence of community violence influences where people live, work, shop, and learn. Violence jeopardizes health and safety by causing injuries, death, and emotional trauma. We need to broaden the understanding of the relationship between violence, chronic disease, and community vitality and highlight strategies to address the intersection.

The community assessment supplements the health indicator data and builds awareness about the many valuable programs and numerous organizations working to improve community health in the region. Of the nearly 100 organizations identified, the most prevalent programs include: • weight loss with an emphasis on nutrition, healthy eating, and exercise

Motor Vehicle and Pedestrian Deaths in Tampa Bay far exceed national average Commuting and vehicle miles travelled per day within the Tampa Bay region is on par with other locales, yet the transit ridership is low. However, deaths from motor vehicles in the region were unnecessarily high with 14.4 deaths per 100,000 in 2006 compared to 7.4 nationally and the Healthy People 2010 target of 8.0. The number of grocery stores per capita in Tampa Bay is slightly less than the national

• smoking cessation • diabetes management Significant programming is aimed at children, some of which is the result of federal and state legislation. School districts are creating healthier menu options, adjusting curriculum schedules to incorporate 150 minutes of physical education per week for K-5 students, and requiring physical activity as a component of after school programs. There are also programs aimed at teenagers and parents of teens to learn the signs of depression or despondence that lead to suicide. The region’s suicide rate is 35% higher than the national average. While this report did not encompass data subsets of gender, race and ethnicity, health disparities amongst different populations are clearly prevalent. Many of the programs

ONE BAY: Healthy Communities

identified in the region have developed programming geared towards lowincome or minority populations. Other trends identified in this report include:

Broad Public Outreach The region has classes for nutrition, cooking, exercise, smoking cessation, diabetes management, stroke prevention and prenatal care to name a few. In addition to classroom education, online education is now mainstream and becoming more personalized.

Word Cloud: ONE BAY: Healthy Communities Below is a “Wordle,” a computer generated “word cloud,” from text in the ONE BAY: Healthy Communities assessment report. The clouds give greater prominence to words that appear more frequently in the text. To create your own wordle, go to www.wordle.net.

Individual and Family Connections Although educational classes can reach a greater number of residents, many organizations – from the health departments and hospitals to the YMCAs and employers – are actively working to establish a relationship between the resident and an individual educator. They are devoting more resources to facilitate one-on-one interactions and develop trusting relationships. When appropriate, organizations are increasingly including the entire family in their educational and behavior modification efforts.

Increased Employer Involvement Employers are beginning to consider health as part of their corporate culture and 75% of employers surveyed believe they have a responsibility to foster improvement in their employees’ health. Emphasis on prevention, healthy lifestyles and disease management has increased as employers have seen their health care costs consume more and more of their budgets in the last decade. Recent developments include onsite physical fitness centers and the nearly universal prohibition of smoking on worksite property, including hospital campuses.

FULFILLING LIFE’S POSSIBILITIES

Next Steps

The Tampa Bay region’s public and private sector leaders are committed to developing

a long-term vision for healthy communities which is crucial to achieving regional prosperity. A regional effort focused on health opens doors for improved collaboration, synergizes resources and creates a powerful voice for a healthier Tampa Bay.

Next Steps With information available to us from a variety of sources, ONE BAY has taken the first step to collect and summarize the region’s health. In the coming year, we will utilize new tools and resources to keep this information updated, publicly available on the web, and begin connecting the community’s resources and convening stakeholders to further facilitate improvement. In partnership with Healthy Communities Institute (www.healthycommunitiesinstitute.com), we will: • Understand what is working and not working in the community • Efficiently participate in Best Practice sharing of successful community programs around the nation • Easily connect people to their local resources • Expand collaboration among organizations and key stakeholders • Engage the community as part of the solution to improve public health • Gather key stakeholders from the departments of public health, hospitals, economic development, public safety, transportation, education, and environmental services in order to drive multi-stakeholder collaboration to improve local public health • Educate local and state political leaders around the value of public health The next phase of this initiative will be to embark on a community input process. Together, we will prioritize the issues, set goals for the vision, and engage stakeholders towards leveraging resources for collective and targeted improvement. If we want a healthier Tampa Bay by 2050, what are we going to do now to get there? Please join us as we embark on this endeavor towards better health and longer, healthier, happier lives.

ONE BAY: Healthy Communities

About the Tampa Bay Region Geography The Tampa Bay region located in west-central Florida, consists of three contiguous metropolitan areas – TampaSt. Petersburg-Clearwater, BradentonSarasota-Venice and Lakeland-Winter Haven and the micropolitan area of Homosassa Springs. The eight counties making up a 6,515-square-mile area include Citrus, Hernando, Hillsborough, Manatee, Pasco, Pinellas, Polk and Sarasota.

Population The Tampa Bay region’s population is projected to increase from 4.1 million in 2009, to just below 4.5 million in 2014, which translates to nearly 400,000 new residents. Tampa Bay’s expanding population has grown more than 16% in the past eight years and is projected to grow an additional 10% by 2014.

Regional Assets While the recent economic recession has impacted the region, since 2001 Tampa Bay has seen both its labor force and employment grow. Between 2001 and 2009, the region has generated a net increase of 17,500 new jobs and added 100,000 workers to the labor force. Tampa Bay is home to the headquarters of more than 15 billion-dollar companies, eight of which are in the Fortune 1000. Opportunities for post-secondary education are numerous and widespread throughout the region. The region has 79 universities, colleges, community colleges, technical and trade schools and seminaries. The University of South Florida (USF) is the largest university in the region and is the third largest in the Southeast, serving more than 47,000 students across four campuses located in Tampa, St. Petersburg, SarasotaManatee and Lakeland. USF has a $1.8 billion annual budget and an annual economic impact of

FULFILLING LIFE’S POSSIBILITIES

$32.2 billion. USF is one of the nation’s top 63 public research universities and was awarded $394.1 million in research contracts and grants in FY 2009/2010. The communities of Tampa Bay enjoy an average annual temperature of 73 degrees and an annual average coastal water temperature of 75 degrees. The beaches and climate provide yearround swimming, sailing, water-skiing, jet skiing, windsurfing, parasailing, diving and shelling. It’s no secret anymore that along with our sunshine, our sciences and services have become a way of life in our region. Our science clusters include bioengineering, cancer research, neuroscience, and marine. Our service clusters include corporate shared services, financial, critical information processing and professional services. Notably, the region continues to develop the requisite talent and supply chain for successful growth.

Economy/Demographics

The average age of the U.S. population is increasing as the Baby Boomers move up the

age spectrum, while at the same time, the Hispanic population is growing rapidly. These population shifts are likely the two most influential demographic trends for the next thirty years. According to the

Brookings Institution’s new report, “State of Metropolitan America,” our nation faces “new realities” that are redefining who we are, where and with whom we live, and how we provide for our own welfare.10 These changing demographics will have an impact on how we grow and provide for ourselves in the future including how we tailor our health programs and community infrastructure to help all populations prosper.

Population Age Florida has long been known as the retiree state and the Tampa Bay region is no exception. Estimates for 2009 indicate that the percentage of Tampa Bay’s population 65 years and over is nearly 20% while the national average is nearly 13%.11 Our region’s experience with its senior population has generated some of the most comprehensive “Aging in Place” strategies in the country. This population accesses the health care system more frequently than other age groups and has created greater demand for health care services and end of life care.12 Tampa Bay residents under 18 years old comprise 21% of our population compared to 25% nationally. A little over 20% of our population are in the 18-34 age bracket, an important demographic among employers and retailers.13

Spotlight: SCOPE: Institute for the Ages SCOPE (Sarasota County Openly Plans for Excellence) has been working to create the Institute for the Ages. With nearly 30% of the population age 65 or older, Sarasota County is uniquely poised to be at the leading edge of creative thinking, policy changes and the emergence of new products and services that a community can draw upon in response to an aging population. www.scopexcel.org

Race and Ethnicity About 80% of the Tampa Bay region is white and about 11% are African American. The percentage of residents of Hispanic or Latino origin is increasing nationally. In 1970, those of Hispanic heritage comprised less than 5% of the U.S. population. In 2050, that number is projected to be over 30%.14 The percentage of Tampa Bay residents of Hispanic origin has increased from 9.4% of the population in 2000 to over 14% in 2009.

Economy Median Household Income Median household income in Tampa Bay dropped 1% from 2008 to 2007, and has consistently lagged behind state and national figures. Hillsborough County leads the region with median household income of $49,762 but is below the $52,209 U.S. average.

ONE BAY: Healthy Communities

Per Capita Personal Income Per capita personal income is the total of all income, including wages, proprietor income and transfer payments, such as Social Security, coming into a region divided by the region’s population.15 Per capita personal income in Tampa Bay has increased 15% since 2004, yet it still trails state and national figures. Sarasota County leads the region with a per capita personal income of $55,856.

Unemployment At the midpoint of the previous decade, when touted as the champion job-generating region, Tampa Bay enjoyed an unemployment rate of 4.5%, lower than the state and nation which recorded rates of 4.7% and 5.5% respectively. At the close of that decade however, Tampa Bay bore the brunt of the near shut-down in the housing market cluster (construction, retail sales, mortgage transaction processing), and regional unemployment rate of 11.2% soared beyond the rates of the state and nation, 10.5% and 9.3% respectively.

15%

growth in personal income between 2004-2008 in Tampa Bay

2009 regional unemployment rate was

11.2%

In 2008, the percentage of families living in the Tampa Bay region with incomes below the poverty rate stood at its highest rate in the last five years at 12.9%, yet below the state (13.3%) and national (13.2%) figures.

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High School Graduation Rates For the 2008-2009 school year in Tampa Bay, the percentage of students who graduated within four years of their first enrollment in 9th grade was 78.5%. In the last five years, regional and state graduation rates have gradually increased. It is difficult to compare to national averages as many states calculate graduation rates differently. The U.S. Department of Education has mandated that states implement a “uniform, comparable graduation rate” by the 2010-2011 school year.16 Individuals who do not finish high school may lack the basic skills required to function in an increasingly complicated job market and society.

College Graduates Attainment of a higher level of education is associated with higher income, better working conditions, and more opportunities for promotion. Specifically, those who have a Bachelor’s degree average almost twice the earnings of those with only a high school education.17

Families Living Below Poverty Level Federal poverty thresholds are set every year by the Census Bureau and vary by size of family and ages of family members. A high poverty rate is both a cause and a consequence of poor economic conditions. A high poverty rate indicates that local employment opportunities are not sufficient to provide for the local community.

Education

78.5% students graduate high school within four years in Tampa Bay

1/5

of Tampa Bay residents 25 years and older have a Bachelor’s degree

According to the Brookings Institution, more than one-third of U.S. adults had a post-secondary degree in 2008, up from one-quarter in 1990.18 But younger adults, especially in large metro areas, are not registering the same high levels of degree attainment as their predecessors. In Tampa Bay, 21.4% of the region’s population age 25 and above has a Bachelor’s degree. Among the counties, there is great variability in the percentage of residents who have completed a Bachelor’s degree or above, from a low of 13% to a high of 26%. Some communities have identified an education gap and developed training programs to meet the needs of both its residents and employers. (CareerEdge pg. 35)

Health Outcomes

Health outcome indicators reveal how medical conditions impact a community and are

useful in assessing community health when compared to benchmarks or outcomes in other regions. There are numerous health outcome indicators, yet there is not a uniformly accepted data set. Indicator selection may be influenced by areas of perceived concern, anecdotal evidence or an attempt by a community to determine the general health of the population. There are various ways to track health status and utilization of each depends on the specific information sought. The mortality rate depicts how many people per population die from the disease or condition in a given year. Prevalence is how many people at any one time have a disease and incidence is the number of new cases of a disease. Most of our health status indicators are reported as age-adjusted mortality rates but where that does not apply, it is noted. The most commonly accepted health outcome indicators include prevalence of chronic disease. In the U.S., 70% of deaths each year are related to chronic disease such as diabetes, cardiovascular and respiratory diseases and cancer.19 Other health status measures, although not among the primary causes of death in the U.S., often lead to chronic disease and are

70% of American deaths result from chronic disease also indicative of the health of the community. As is the case nationwide, chronic disease is the leading cause of death in the Tampa Bay region.

Chronic Disease Indicators The number of people dying from chronic disease in the last decade has fallen at the regional, state and national levels while the number of people living with chronic disease has increased. Chronic disease is widespread and impacts everyone, either directly or indirectly. A review of the data confirms that chronic disease is a primary cause of our overall decline in health status. The National Center

for Chronic Disease Prevention and Health Promotion (CDC) noted in its 2009 report, The Power of Prevention Chronic disease…the public health challenge of the 21st century, that: • In 2005, 133 million Americans – almost one out of every two adults had at least one chronic illness Approximately a quarter of those with chronic conditions have one or more limitations on their daily activity •

•

Health disparities in chronic disease incidence and mortality are widespread among members of racial and ethnic minority populations

•

Mental illnesses and chronic diseases are closely related

In addition to the vast number of Americans suffering from a chronic disease, the cost to society for treating these conditions is enormous and continues to grow. In 2009, the direct medical expenditures for cardiovascular disease and stroke alone reached $313.8 billion.20 •

ONE BAY: Healthy Communities

Cardiovascular Disease Cardiovascular disease kills more Americans each year than any other disease. Cardiovascular disease refers to a variety of heart and blood vessel diseases, including coronary heart disease, hypertension and stroke. Risk factors include high cholesterol, high blood pressure, tobacco use, physical inactivity, diabetes, excess weight and obesity. This indicator is measured by the death rate per 100,000 people due to coronary heart disease, one type of cardiovascular disease. The Healthy People 2010 target was 162 deaths per 100,000 people. The U.S. figure in 2006 was 144.3 deaths for every 100,000 people, 138.5 cardiovascular disease deaths per 100,000 people in Florida, and 147.3 per 100,000 people in Tampa Bay.

Stroke ranks

Coronary Heart Disease

Stroke

Deaths per 100,000 (age-adjusted)

180 170 160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0

180.0

177.3

180.7

162 Healthy People 2010

144.3

147.5 138.5

2002 2006

U.S. Florida Tampa Bay

180 170 160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0

2002 2006

50 Healthy People 2010

56.2 43.6 45.5

35.3

42.7 34.6

U.S. Florida Tampa Bay

3rd among the leading causes of death and disability in the U.S. Stroke Each year, approximately 795,000 people in the U.S. will suffer a new or recurrent stroke. Although people of all ages may have strokes, the risk more than doubles with each decade of life after age 55.21 This indicator is the death rate per 100,000 population due to stroke. The Healthy People 2010 national health target was to reduce the stroke death rate to 50 deaths per 100,000 population. In 2006, the U.S. rate was 43.6 deaths per 100,000 people, a reduction from 56.2 in 2002. Floridaâ&#x20AC;&#x2122;s stroke mortality rate of 35.3 was also lower than its 2002 rate of 45.5. The stroke mortality rate in Tampa Bay declined from 42.7 deaths per 100,000 in 2002, to 34.6 deaths in 2006, lower than both the U.S. and Florida rates for the same year.

FULFILLING LIFEâ&#x20AC;&#x2122;S POSSIBILITIES

Spotlight: American Heart Association: Go Red For Women Cardiovascular disease claims the lives of nearly 500,000 American women each year. To dispel the myths and raise awareness of heart disease as the number one killer of women, the American Heart Association created Go Red For Women, a passionate, emotional, social initiative designed to empower women to take charge of their heart health. It challenges them to know their risk for heart disease and take action to reduce their personal risk. It also gives them the tools they need to lead a hearthealthy life. In a 2008 survey, Lakeland/Polk County was the second LEAST heart-friendly city of its size in the nation. The AHA of Tampa Bay is determined to improve those numbers by changing behavior. Since July 2009, they have registered 3,600 women in their Go Red for Women campaign and documented that 86% have made at least one change in behavior since signing on. www.goredforwomen.org

Health Outcomes (cont.) Cancer Cancer Deaths Nationally, death rates from all cancers and from the four leading causes of cancer deaths (lung, colorectal, female breast, and prostate) declined. This indicator measures the death rate per 100,000 due to cancer. While less than the U.S. rate, 180.7 in 2006, and trending downward, the Tampa Bay mortality rate of 177.0 was higher than the state of Florida rate of 171.9.

Lung Cancer More people die from lung cancer than any other type of cancer. In 2002, lung cancer accounted for more deaths than breast cancer, prostate cancer and colon cancer combined. The Healthy People 2010 national health target was to reduce the lung cancer death rate to 43.3 deaths per 100,000 population. For the last year data is available, in 2006, the national rate was 51.5. Florida’s lung cancer mortality rate was 51.2 and Tampa Bay’s rate was 55.7 per 100,000 population.

Breast Cancer Breast cancer is the most common type of cancer among women in the U.S. other than skin cancer. Based on rates from 2005-2007, one in eight female babies born today will be diagnosed with breast cancer at some time during their lifetime.22 This indicator shows the death rate per 100,000 females due to breast cancer. The Healthy People 2010 national health target was to reduce the breast cancer death rate to 22.3 deaths per 100,000 females. By 2006, the nation, the state and Tampa Bay had all met the Healthy People 2010 goal with 21.5 deaths per 100,000 females in the U.S. and Florida and 21.6 in Tampa Bay.

Lung Cancer 2002 2006 60 55.1 54.9 51.5 51.2

59.0 55.7

43.3 40 Healthy People 2010

30 20

Asthma is a condition where a person’s air passages become inflamed and the narrowing of the respiratory passages makes it difficult to breathe. Asthma is often brought on by exposure to inhaled allergens (like dust, pollen, cigarette smoke, pollution and animal dander) or by exertion and stress. There is no cure for asthma but, for most people, the symptoms can be managed through prevention strategies including minimizing exposure to allergens and other triggers, and a combination of quick-relief and long-term controller medications. In Tampa Bay in 2007, 7.6% of adults were told by a health care provider that they had asthma compared to 8.2% in the U.S. and 6.2% in Florida.

10 0

U.S. Florida Tampa Bay

Cancer is the 2nd leading cause of death in the U.S. Deaths per 100,000 (age-adjusted)

60 2002 2006

50 40 30 22.3

23.7

21.5

23.7

21.5

24.5

Spotlight: Tampa Bay Community Cancer Network The Tampa Bay Community Cancer Network is a collaborative network of academic and community-based organizations and is one of 25 Community Networks Programs across the country funded by the National Cancer Institute’s Center to Reduce Cancer Health Disparities.

Breast Cancer

21.6

20 Healthy People 2010

The network is made of local community-based health centers, nonprofit organizations, faithbased groups, adult education and literacy groups, and the Moffitt Cancer Center, as an NCI designated Cancer Center. Together, the goal is to create and implement sustainable and effective community-based interventions to impact cancer disparities in the Tampa Bay area. www.tbccn.org

Asthma Prevalence

Deaths per 100,000 (age-adjusted)

U.S. Florida Tampa Bay

ONE BAY: Healthy Communities

Diabetes Prevalence In 2007, the American Diabetes Association reported that 17.9 million Americans have been diagnosed with diabetes, 5.7 million Americans have diabetes but have not yet been diagnosed, and 57 million Americans are pre-diabetic, meaning their blood glucose levels are higher than normal and they are at increased risk for developing type 2 diabetes.23 Diabetes disproportionately affects minority populations and the elderly. Its incidence is likely to increase as minority populations grow and the U.S. population becomes older. This indicator shows the age-adjusted percentage of adults that have ever been diagnosed with diabetes. Even while adjusting for age, the Tampa Bay and Florida percentage, 8.0% and 7.9% respectively, was significantly higher than the national rate of 5.7%.

Diabetes Prevalence

Pneumonia/Influenza

2007 - % of adults ≥ 20 yrs old

Deaths per 100,000 (age-adjusted)

U.S. 5.7 5.7

U.S. FL

7.0

Tampa Bay

8.0

Citrus

8.4

Hernando

Hillsborough

8.4

Manatee

7.3

Pasco

8.4

Pinellas

million Americans are pre-diabetic Non-chronic Disease Indicators Pneumonia/Influenza In 2006, influenza and pneumonia ranked eighth among the leading causes of death in the United States. The two diseases are traditionally reported together, as pneumonia is frequently a complication of influenza. Influenza is a contagious disease caused by a virus. Pneumonia is a serious infection of the lungs that develops when the immune system is weakened. Persons most at risk include the elderly, the very young, and the immunocompromised. The death rate has decreased significantly since 2002 in the U.S., Florida and Tampa Bay. In 2006, Tampa Bay had 8.8 deaths per 100,000, well under the national average of 17.8.

FULFILLING LIFE’S POSSIBILITIES

7.2

Polk

U.S.

8.7

Sarasota

Florida Tampa Bay

6.6 0 0

2002 2003 2004 2005 2006

Spotlight: FAB Families Fit, Active, Black (FAB) Families is funded by the Department of Health and Human Services Community Partnership to Eliminate Health Disparities. FAB Families is a coalition of seven community partners that address disparities with diabetes and childhood/adolescent overweight/obesity among African Americans in St. Petersburg. One unique program, administered by the Midtown Health Council, is the Under the Tree Project. According to Gwendolyn Reese, part of the African-American culture is to “meet under the tree.” On the south side of St. Petersburg, a number of African-American men and women meet under trees in the area. In an effort to reach out to these individuals, some of who do not seek routine medical care, a health care professional regularly goes to these trees and checks their blood pressure, blood sugar and cholesterol. The health care volunteer (typically a nurse or pharmacist) seeing the individuals often leaves behind decks of cards and leaflet information containing health information about diabetes, stroke and other chronic illnesses. The health care team also visits other areas throughout the Mid-Town community such as restaurants, beauty and barber shops. www.stpetefabfamilies.com

Health Outcomes (cont.) Behavioral Health

Spotlight:

The National Alliance for Mental Illness (NAMI) recently released its 2009 report card of states and Florida received an overall “D” grade. According to the report, Floridians living with mental illness face uphill battles to get appropriate services due to a lack of funding and a shortage of mental health providers. The report’s authors noted concern with Florida’s insufficient efforts to address cultural competence and the inadequate supply of mental health professionals.24

American Foundation for Suicide Prevention

Suicide Deaths Suicide is a major, preventable public health problem. In 2006, suicide was the 11th leading cause of death in the United States.25 This indicator shows the age-adjusted death rate per 100,000 people due to suicide. In Tampa Bay, 14.9 deaths occur per 100,000 people compared to 12.6 in Florida and 10.9 in the U.S. The Healthy People 2010 national health target was to reduce the suicide rate to 4.8 deaths per 100,000 population. Between 2002 and 2006, the suicide rate increased in Tampa Bay while decreasing both nationally and in Florida. The rate of suicide in Tampa Bay in 2006 was more than three times greater than the Healthy People 2010 target. Although there are a number of inpatient and outpatient settings in the region for behavioral health issues such as depression, cognitive disorders, suicidal tendencies and substance abuse and addiction, the region’s high rate of suicide is alarming and deserves attention.

D Grade given to Florida for care of adults with mental illness Deaths per 100,000 (age-adjusted)

2002 2006 14.7 14.9 13.3 11.0

12.6

10.8

4.8 Healthy People 2010

Healthy People 2010

www.afsp.org

Spotlight: Operation PAR

Suicide Deaths 20

The Sarasota Chapter of the American Foundation for Suicide Prevention (AFSP) serves the following counties in Southwest Florida: Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough, Lee, Manatee, Pasco, Pinellas and Sarasota. AFSP is the leading national notfor-profit organization exclusively dedicated to understanding and preventing suicide through research, education and advocacy, and to reaching out to people with mental disorders and those impacted by suicide. Combining local and national efforts, this chapter promotes educating the community toward suicide prevention, intervention and postvention.

U.S. Florida Tampa Bay

Operation PAR cares for families and individuals impacted by substance abuse and mental illness and serves Pinellas, Pasco and Manatee counties. More than 13,000 individuals a year receive intervention and treatment services and another 40,000 participants are impacted annually by the agency’s messages of substance abuse awareness, education, prevention, research and information and referral. Despite this volume, the number of facilities/programs does not meet the need and many go without treatment. www.operationpar.org

ONE BAY: Healthy Communities

Maternal, Fetal and Infant Health Infant deaths The leading causes of death among infants are birth defects, pre-term delivery, low birth weight, Sudden Infant Death Syndrome (SIDS) and maternal complications during pregnancy. This indicator measures the mortality rate in deaths per 1,000 live births for infants within their first year of life. The Healthy People 2010 national health target was to reduce the infant mortality rate to 4.5 deaths per 1,000 live births. Tampa Bay and Florida had higher death rates with 7.5 and 7.2 deaths respectively.

8.5% of Tampa Bay newborns weighed less than 5 lbs. 8 oz. Low Birth Weight Low birth weight is most often associated with a baby being born too soon (prior to 37 weeks gestation) and/ or being too small for gestational age. Babies born with a low birth weight are more likely than babies of normal weight to have underdeveloped lungs and other organs that require specialized medical care. A common cause of low birth weight is poor nutritional status of mother prior to and during pregnancy.26 This indicator is the percentage of births in which the newborn weighed less than 2,500 grams (5 lbs., 8 oz.). The Healthy People 2010 national health target was to reduce the proportion of infants born with low birth weight to 5.0%. Between 2004 and 2008, Tampa Bay, Florida and the U.S. consistently ranged between 8.0 and 9.0%.

Births to Female Teens <15 yrs old Babies born to this population are more likely to be born prematurely, be of low birth weight and more likely to die in their first year of life than babies of women in their twenties and thirties.27 FULFILLING LIFE’S POSSIBILITIES

This indicator shows the number of births per 1,000 to female teens who were less than 15 years old when they delivered a baby. The state of Florida registered 0.6 births per 1,000 teen mothers and Tampa Bay at 0.7, though this rate varied widely within our region from 0-0.2 in Citrus, Hernando and Pasco; 0.5 in Pinellas and Sarasota; 0.8 in Hillsborough and Polk; and 1.3 in Manatee County.

Sexually Transmitted Diseases Despite the burdens, costs, complications, and preventable nature of STDs, they remain a significant public health problem. STDs can cause harmful, often irreversible, and costly clinical complications such as reproductive health problems, fetal and perinatal health problems, and cancer. This indicator is the reported number of cases for three sexually transmitted diseases, chlamydia, gonorrhea, syphilis (STDs). Florida and Tampa Bay are slightly lower than the U.S. at 514 cases per 100,000, yet the growth rate of the disease is greater in Tampa Bay than the national average. There is also a significant variation between counties from a low of 207 cases in Pasco County to a high of 717 cases in Hillsborough County.

Spotlight: Healthy Start Coalition Infant Mortality Campaign Florida law requires that every pregnant woman and every newborn is screened by a health professional to identify those at risk of poor birth, health and developmental outcomes. There are 30 Healthy Start Coalitions throughout the state. Each coalition receives funding from the state. Services can include prenatal counseling, perinatal counseling, education on birthing and breastfeeding classes, visiting home nurses, referrals for the Women, Infant and Children program, Medicaid applications, mental health services, and housing needs. The Pinellas County Healthy Start Coalition, as part of a statewide campaign, has studied fetal/infant mortality and determined that the main cause of death for Pinellas County babies is prematurity (babies born before 37 weeks). Prematurity has been linked to conditions related to the mother’s health such as: • Infections • Chronic Disease • Obesity • Smoking

Spotlight: Text4baby The Florida Department of Health and the National Healthy Mothers and Healthy Babies Coalition will soon launch “Text4baby”, an integrated mobile phone technology with timely health information for pregnant women and new moms. Women who sign up for the service will receive free text messages each week, timed to their due date or baby’s date of birth. The messages focus on a variety of topics critical to maternal and child health, including birth defects prevention, immunization, nutrition, seasonal flu, mental health, oral health and safe sleep. Text4baby messages also connect women to prenatal and infant care. 19

Health-Related Behaviors

An individualâ&#x20AC;&#x2122;s health-related behavior can impact the likelihood of developing chronic disease or suffering from other poor health outcomes. Although genetic composition plays a part

in the prevalence of some of these diseases, for the vast majority of cases behavior modification would greatly reduce the mortality rate for these conditions. Poor nutrition and diet, lack of physical activity, smoking, substance abuse, drug use and unsafe sex are all health-related behaviors that can be modified provided there is awareness, opportunity and motivation. In the last decade, public health practitioners have been moderately successful in increasing awareness of the consequences of unhealthy behaviors. For example, diets high in sodium can cause high blood pressure28 and high blood pressure increases the likelihood of having a stroke by four to six times.29 Likewise, cigarette smokers are two to four times more likely to develop cardiovascular heart disease than nonsmokers.30 Physical inactivity is responsible for 12.2% of the global burden of heart attacks after accounting for other cardiovascular risk factors.31 Someone attempting to reduce his or her risk of heart disease should stop smoking and exercise regularly. Despite increased sensitivities to the impact of risky or unhealthy habits, there has been limited success driving lasting behavior change. For the last 20 years, people have known that eating in excess and limited physical activity results in weight gain. Yet men

Cigarette smokers are

2-4

times more likely to develop cardiovascular heart disease than nonsmokers Nearly

40% of Tampa Bay residents do not exercise 150 minutes per week

in Florida have gained an average of 18.2 pounds, and women 10.6 pounds in this time period. If this rate continues, by 2018, the rate of obesity in Florida is forecasted to be 44%. Although behavior change is an individual effort, education about the need for the change can be a systemic or institutional driver of that change. Communities that come together to support individual behavior modification will likely be rewarded with improved population health.

A Heavier America Since 1960, the percentage of overweight Americans (age 20-74) has remained relatively steady at approximately one third of the population. However, the percent of Americans who are obese has increased from 13% to 34% and the percent who are extremely obese has increased from 1% to 6% of the population.32 In 2007, almost 63% of Americans, 62% of Floridians, and 62% of Tampa Bay residents were overweight or obese.

ONE BAY: Healthy Communities

150 minutes of physical education per

Overweight/Obesity The percentage of overweight and obese adults is an indicator of the overall health and lifestyle of a community. Obesity increases the risk of many diseases and health conditions including heart disease, type 2 diabetes, cancer, hypertension, stroke, liver and gallbladder disease, respiratory problems and osteoarthritis. The Healthy People 2010 national health target was to reduce the proportion of adults who are obese to 15%. In Tampa Bay in 2007, 36.8% of residents were overweight with a Body Mass Index (BMI) between 20 and 30. A BMI >=30 is considered obese while a BMI >=40 is categorized as extremely obese. Between 2002 and 2007, the percentage of adults who were obese in Tampa Bay increased from 21.8% to 25.4%.

Childhood Obesity Over the past three decades, obesity rates have doubled among children age 2-5 and tripled among 6-11 year-olds.33 Childhood obesity rates in Tampa Bay have declined slightly since 2006 when the percentage of first, third and sixth graders whose BMI was at or above the 95th percentile was 20.6%. In 2008, the percentage had dropped to 18.1, marginally better than the state percentage of 18.5.

Physical Activity In 2008, the U.S. Department of Health and Human Services issued the first-ever Physical Activity Guidelines which offer recommended amounts of exercise for people in different age groups. Adults • 2.5 hours/wk of moderate-intensity exercise or • 1.25 hours/wk of vigorous physical activity

FULFILLING LIFE’S POSSIBILITIES

week required for Florida K-5 students.

Percentage of Adults who are Obese (BMI >30) 2002 2007

30 26.3

24.1

25 21.9

20.4

• 1 hour/day of exercise • 3 hours/wk of vigorous intensity

25.4 21.8

20 15 Healthy People 10 2010

5 0

Children/Adolescents

U.S. Florida Tampa Bay

• 3 hours/wk of muscle-strengthening activity • 3 hours/wk of vigorous activity In that same year, 35% of American adults did not meet these recommendations.34 In Florida and in Tampa Bay in 2007, 39.4% of the population did not regularly engage in moderate or vigorous physical activity. Most adults have numerous options to participate in physical activity and learn about a healthy diet. County health departments offer resources for weight loss and the Healthy Start programs educate mothers about the importance of their own health and nutrition in addition to that of their infant.

Spotlight: Kidz Bite Back This campaign educates students about “Big Fat Industries” and “Couch Potato Companies” that promote excessive consumption and sedentary lifestyles. The students spread the word to other students and promote improved nutrition and increased physical activity. The campaign, developed by 180-Change, a Tampa Bay not-for-profit focused on youth health and safety, is active in selected Hillsborough and Pinellas County schools. www.kidzbiteback.com

Spotlight: The “Y” – YMCA The Tampa Bay region is home to over 40 YMCA branches. YMCA has exercise classes and sports leagues for children and is actively engaging entire families to exercise together. For example, the Sarasota YMCA developed Family TIME (Together It’s More Exciting), an initiative which emphasizes being more active, a healthier diet and spending time together. As part of this family focus, the Y recently launched Thank Goodness It’s Family Friday (TGIFF), where group exercise classes such as yoga, Zumba and kick-boxing have been designed for parents and children and are shortened to 40 minutes. The region’s YMCA branches also sponsor Healthy Kids Day in the Spring, a day of physical activities for kids and information for parents on family health. www.ymca.net 21

Health Behaviors (cont.) Tobacco and Alcohol Use Smoking Tobacco is the agent most directly responsible for avoidable illness and death in America today. Tobacco use brings premature death to almost half a million Americans each year, and it contributes to profound disability and pain in many others. Approximately one-third of all tobacco users in this country will die prematurely because of their dependence on tobacco. Areas with a high smoking prevalence will also have greater exposure to secondhand smoke for non-smokers, which can cause or exacerbate a wide range of adverse health effects including cancer, respiratory infections and asthma. The percentage of adults who have smoked more than 100 cigarettes in their lifetime and who currently smoke some days or everyday has declined at the regional, state and national level, but not sufficiently to meet the Healthy People 2010 target of 12%. In 2007 in Tampa Bay, 21.6% of the population smoked compared to 19.3% in the state and 19.8% in the U.S. For all three populations, there was a decrease in the number of smokers from 2002 but Tampa Bayâ&#x20AC;&#x2122;s decline was the most modest.

Immunizations â&#x20AC;&#x201C; Prevention

% of Adult Smokers Deaths per 100,000 (age-adjusted)

Childhood Immunizations

2002 2007 24.0

23.2 22.2 19.9

21.6

19.3

Immunization rates for 2-year-olds have remained steady in our region for the last five years at 77.4% and were comparable to national figures but trailed the state rate of 83.2%. Both lagged the Healthy People 2010 goal of 90%.

15 12 Healthy 10 People 2010

Influenza Immunizations

U.S. Florida Tampa Bay

1/3 of all tobacco users will die prematurely

Consumption of Alcohol Male binge drinking is defined as five or more drinks on one occasion, and female binge drinking is four or more drinks on one occasion. Among adults who engage in heavy or binge drinking, the Tampa Bay region is equivalent to the national average of 15.8% (2007) and represents a marginal decrease from 2002. This indicator measures the percentage of adults who reported binge drinking at least once during the 30 days prior to the survey. The prevalence of binge drinking among men is twice that of women. In addition, it was found that binge drinkers are 14 times more likely to report alcohol-impaired driving than non-binge drinkers.35 22

Immunizations protect children from contracting and spreading communicable diseases such as measles, mumps, and whooping cough. These diseases can result in extended school absences, hospitalizations, and death.

Influenza is a contagious disease caused by viruses. It can lead to pneumonia and can be dangerous for people with heart or breathing conditions. Infection with influenza can cause high fever, diarrhea and seizures in children. The seasonal influenza vaccine, recommended annually by the CDC, can prevent serious illness and death. This indicator measures the percentage of adults over 65 who have had a flu vaccine within the last year. The immunization rate is going up in the Tampa Bay region, state and nation but at 64%, we trailed the Healthy People 2010 objective of 90%.

Spotlight: Tobacco Free Florida Unveiled in 2008 under the direction of the Florida Department of Health, the Tobacco Free Florida campaign seeks to decrease the number of tobacco users in the state of Florida through efforts aimed at both preventing nonusers from starting to use tobacco and encouraging current users to quit. These efforts are funded by money derived from court settlements against major tobacco companies, and include initiatives in the realm of advertising, public relations, interactive, guerilla media, event media, sponsored promotions and more. It is our hope that one day every Floridian might be free of the hazards of tobacco and that we all may eventually live in the paradise that our name implies - a truly Tobacco Free Florida. www.tobaccofreeflorida.com

ONE BAY: Healthy Communities

Pneumonia Immunizations Pneumococcal pneumonia is a serious condition characterized by high fever, cough and shortness of breath. It is the leading cause of vaccine-preventable death and illness in the United States. Pneumococcal pneumonia kills about one out of every 20 people who come down with the disease. It is a contagious disease and can be spread by respiratory secretions from coughing or sneezing. The pneumococcal vaccine is very effective at preventing severe disease, hospitalization and death. This indicator measures the percentage of adults over 65 who have ever received the pneumonia immunization. In the Tampa Bay region, the rate was 65.8% which slightly exceeded our rate for influenza vaccines. This rate is comparable to the state and national rates but again trailed the Healthy People 2010 benchmark of 90%.

Health Screenings Breast Cancer Screening Breast cancer is the second leading cause of cancer death for women36 and early detection through mammograms has proven effective in reducing the death rate. In 2007, 65% of women age 40 and over in Tampa Bay and in the state of Florida have received a mammogram in the past year. Although this approaches the Healthy People 2010 target of 70%, this number has not increased in the last five years.

Cervical Cancer Screening The Pap test checks for changes in the cells of the cervix that can be early signs of cervical cancer. Cervical cancer is a common cancer that has a very high cure rate when caught early. In 2003, the American College of Obstetricians and Gynecologists altered their recommendation for Pap tests from every year to every three years if no abnormal tests had occurred. Women under 30 should have a Pap test every two years. This indicator measures women, age 18 FULFILLING LIFEâ&#x20AC;&#x2122;S POSSIBILITIES

% of Immunizations 2007

Healthy People U.S. Florida Tampa Bay

100

90% Healthy People 2010

83.4 77.4

Colon Cancer Screening

76.1

72.0

67.3 63.0 65.8 64.6 64.1

and older, who have received a Pap test in the last year. Both the region and state values have decreased between 2002 and 2007 which may be a result of a change in the guidelines. In Florida, the percentage of women, in 2007, who had received a Pap test in the last year was 64.8%.

Childhood Influenza Pneumonia

In 2007

63.1% of Tampa Bay women had a Pap test

Colorectal cancer is second only to lung cancer in the number of deaths it causes annually in the U.S. If adults age 50 or older had regular screening tests, as many as 60% of deaths from colorectal cancer could be prevented. Sigmoidoscopy and colonoscopy are both effective screening methods for detecting colon cancer before symptoms develop. If detected early, treatment for colon cancer is more successful. The indicator is the percentage of adults 50 years old and older who received a sigmoidoscopy or colonoscopy in the past five years. The Healthy People 2010 national health target was to increase the proportion of adults aged 50 years and older who received a colorectal cancer screening exam to 50%. Between 2002 and 2007, screening rates increased in the Tampa Bay region from 44.2% to 54.9% and in the state from 44.6% to 53.7%.

Spotlight: National Breast & Cervical Cancer Early Detection Program The Centers for Disease Control administers and funds states for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The Florida program is available statewide through the lead of 16 county health departments including four in Tampa Bay: Hillsborough, Manatee, Pasco and Pinellas. Females between 50 and 64 years of age, have household income at or below 200% of the Federal Poverty Level, and are uninsured or have no insurance that covers screenings are eligible. As of the end of 2009, over 1,500 women screened through this program have been diagnosed with breast cancer, over 50 with invasive cervical cancer and 470 with pre-cancerous lesions or conditions.

Health Systems

Hospitals in the United States provide the setting for some of lifeâ&#x20AC;&#x2122;s most pivotal

eventsâ&#x20AC;&#x201D;the birth of a child, major surgery and treatment for otherwise fatal illnesses. These hospitals house the most sophisticated medical technology in the world and provide state-of-the-art diagnostic and therapeutic services. But access to these services comes with certain costs. In 2008, nearly 37% of personal health care expenditures in the United States were for hospital care.37 Policymakers, employers, and consumers have made the quality of care in U.S. hospitals a top priority and have voiced the need to assess, monitor, track and improve the quality of inpatient care. The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving the quality, safety, efficiency and effectiveness of health care for all Americans. As one of 12 agencies within the Department of Health and Human Services, AHRQ supports health services research that will improve the quality of health care and promote evidence-based decision-making. AHRQ has developed measures for assessing health care quality.

Prevention Quality Indicators Prevention Quality Indicators (PQIs) are a set of measures that can be used with hospital inpatient discharge data to identify quality of care. Even though these indicators are based on hospital inpatient data, they provide insight into the community health care system or services outside the hospital setting. These are conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent

complications or more severe disease. The PQIs represent hospital admission rates for ambulatory care-sensitive conditions. (Note that the national data presented here is for 2007 while the state and regional data is for 2009.)

37% of personal health care expenditures in the United States go toward hospital care

Hypertension Hypertension is the term used to describe high blood pressure. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of complications, although drug treatment may prove necessary in patients for whom lifestyle changes prove ineffective or insufficient.38 This indicator is the annual ageadjusted hospitalization rate due to hypertension per 100,000 residents, age 18 years and older. In Tampa Bay, the hospitalization rate rose from 55.3 in 2008 to 64.7 in 2009 per 100,000. Florida rates were much higher at 74.1 and 84.7 in 2008 and 2009, respectively.

ONE BAY: Healthy Communities

Congestive Heart Failure Congestive heart failure is a condition in which the heart can’t pump enough blood to the body’s other organs. This can result from coronary artery disease, diabetes, past heart attack, hypertension, heart infections, diseases of the heart valves or muscle, and congenital heart defects. In heart failure, symptoms are usually related to reduced blood flow and accumulation of fluids in body tissues. This indicator is the average annual age-adjusted hospitalization rate due to non-hypertensive congestive heart failure, including rheumatic heart failure, per 100,000 people age 18 and older. While nationally the rate was 415.5 per 100,000, Florida and Tampa Bay were substantially lower at 333.2 and 274.3 respectively in 2009.

Chronic Obstructive Pulmonary Disease Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. According to the American Lung Association, COPD includes chronic bronchitis, emphysema and bronchiectasis. COPD is often related to tobacco use but can also be caused by air pollutants in the home and workplace, genetic factors and respiratory infections. This indicator is the average annual age-adjusted hospitalization rate due to COPD per 100,000 people age 18 and older. Nationally, the rate was 193 while Florida and Tampa Bay rates were slightly higher at 214.4 and 207.9 respectively.

Uncontrolled Diabetes Uncontrolled diabetes indicates that the patient’s blood sugar level is not kept within acceptable levels by his or her current treatment routine. Diabetes risk factors such as obesity and physical inactivity have played a major role in this dramatic increase. This indicator is the average annual age-adjusted hospitalization rate due to uncontrolled diabetes per 100,000 FULFILLING LIFE’S POSSIBILITIES

Diabetes Hospitalization Rates (per 100,000) Uncontrolled Diabetes Short-term Complications Long-term Complications Lower Extremity Amputations

125

123.8 116.2 106.2

100

75 59.9

55.7

54.8

50 33.6 31.0

21.1

U.S.

30.2 24.7

Florida

diabetes per 100,000 people ages 18 and older. Nationally, the rate per 100,000 was 59.9. In Florida, the rate was 54.8 and in Tampa Bay, 55.7.

Diabetes Long-term Complication Long-term complications of diabetes may include heart disease, stroke, blindness, amputations, kidney disease and nerve damage. This indicator was the average annual ageadjusted hospitalization rate due to long-term complications of diabetes per 100,000 people age 18 and older. Nationally, the rate per 100,000 was 123.8. In Florida, the rate was 116.2 and in Tampa Bay, 106.2.

Lower-extremity Amputation in Patients with Diabetes 26.6

Tampa Bay

Complications from diabetes include: heart disease stroke blindness amputation kidney disease nerve damage people ages 18 and older. Nationally, the rate was 21.1. In Florida the rate was 31.0 and in Tampa Bay, 24.7.

Diabetes Short-term Complication Short-term complications of diabetes can include hyper- or hypoglycemia, diabetic ketoacidosis and hyperosmolar nonketotic coma. This indicator was the average annual age-adjusted hospitalization rate due to short-term complications of

This indicator measures the average annual age-adjusted hospitalization rate for lower-extremity amputation among patients with diabetes per 100,000, age 18 and older. Nationally, the rate was 33.6. In Florida the rate was 30.2 and in Tampa Bay, 26.6. Diabetes is a major risk factor for lower-extremity amputation, which can be caused by infection, neuropathy, and microvascular disease. Proper and continued treatment and glucose control may reduce the incidence of lowerextremity amputation.

Bacterial Pneumonia Pneumonia is an inflammation of the lungs that’s usually caused by infection with bacteria, viruses, fungi or other organisms. Pneumonia is a particular concern for older adults and people with chronic illnesses or impaired immune systems but it can also strike young, healthy people. Some forms of bacterial pneumonia are treatable with antibiotics but antibiotic-resistant strains are a growing problem. This indicator is the average annual age-adjusted hospitalization rate due to bacterial pneumonia per 100,000 people ages 18 and older. In the U.S. approximately 374.8 per 100,000 people were hospitalized compared to 234.1 in Florida and 205.2 in Tampa Bay. 25

Health Systems (cont.) Asthma

Diabetes Short-term Complication

Asthma is a condition in which a personâ&#x20AC;&#x2122;s air passages become inflamed, and the narrowing of the respiratory passages makes it difficult to breathe. There is no cure for asthma but, for most people, the symptoms can be managed through a combination of long-term medication prevention strategies and short-term quick relievers. In some cases, however, asthma symptoms are severe enough to warrant hospitalization and can result in death.

The CDC reports that diabetes is ranked as one of the leading chronic illnesses for younger children and teens.40 Over 186,000 youths 20 years of age and younger have the disease.41 This indicator is the average annual age-adjusted hospitalization rate due to short-term complications of diabetes per 100,000 children ages 6 years to 17 years. While the U.S. average was 29.7, Tampa Bay rates were 25.3 and Florida 24.8.

This indicator is the average annual age-adjusted hospitalization rate due to asthma per 100,000 people ages 18 and older. Again, Florida and Tampa Bay ranked higher than the national rate of 117.9 with Florida in at 136.7 and Tampa Bay at 133.3 per 100,000.

Pediatric Asthma Nearly five million asthma sufferers are under age 18. Among children ages 5 to 17, asthma is the leading cause of school absences from a chronic illness. It accounts for an annual loss of more than 14 million school days per year and more hospitalizations than any other childhood disease.

Urinary Tract Infection Urinary tract infections (UTI) are a serious health problem affecting millions of people each year. According to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), infections of the urinary tract are the second most common type of infection in the body, accounting for about 8.3 million doctor visits each year. This indicator is the average annual age-adjusted hospitalization rate due to urinary tract infections per 100,000 people age 18 and older. Tampa Bay rates (182.1) were consistent with Florida (185.3) and U.S. rates (185.4).

Perforated Appendix Perforated appendix results from delay in surgery, potentially reflecting problems in access to ambulatory care or misdiagnosis. Timely diagnosis and treatment may reduce the incidence of perforated appendix. This indicator measures admissions for perforated appendix per 1,000 adults age 18 and older. The U.S. benchmark is approximately 280.2 while Tampa Bay admissions were slightly lower at 273.1 and Florida even lower at 253.6. 26

Diabetes is ranked as one of the leading chronic illnesses for young children and teens Pediatric Quality Indicators: The Pediatric Quality Indicators (PDIs) are a set of measures that focus on childrenâ&#x20AC;&#x2122;s health care quality using routinely collected hospital discharge data as the basis for indicator specification. In 2000, children accounted for 18% or 6.3 million of the hospitalizations in the U.S. The vast majority of these stays were for newborn infants, with children and adolescents (1 to 17 years old) accounting for 1.8 million of the hospital stays (5%).39

This indicator is the average annual age-adjusted hospitalization rate due to asthma per 100,000 children ages 2-17 years. The U.S. rate averages 134.8. From 2008 to 2009, the rate in Florida rose from 120.3 to 137.9 and in Tampa Bay from 122.7 to 140.6.

Pediatric Urinary Tract Infection Urinary tract infections (UTIs) occur in about 3% of children every year. The risk throughout childhood of having a UTI is 8% for girls and 2% for boys. Treatment is oral antibiotics or, in extreme cases, intravenous antibiotics.42 This indicator is the average annual age-adjusted hospitalization rate due to UTIs per 100,000 people age 18 and older and in children 3 months to 17 years. While the U.S. average was 41.7, Florida and Tampa Bay ranked higher with 63.9 and 64.1, respectively, increasing since 2008.

ONE BAY: Healthy Communities

Health Access

Access refers to actual proximity of health care as well as the ability to afford it. In order for a

community to be healthy, the citizens need to be able to access high-quality care at all levels of the health care delivery system. Our eight-county region has 50 acute care hospitals, two children’s hospitals and a world-renowned cancer center. Given this depth of service capacity, residents generally do not have to travel unreasonable distances to access quality health services.

Uninsured Population The ranks of the uninsured keep growing. Nationally, for those between ages 18 and 64, 22.3% were uninsured in 2009 and in the state of Florida, nearly 30% were uninsured.43 America’s Health Rankings in 2009 placed Florida 48 out of 50 states because of the high percentage of residents who lack insurance coverage. In Tampa Bay in 2008, 24.6% of the population between ages 18-64 was uninsured and it is estimated that 28% of Tampa Bay residents were uninsured in 2009.44 For those residents who are uninsured, their financial hardship has been well documented by the media and was one of the driving forces behind passage of the Patient Protection and Affordable Care Act. For those in our region who are uninsured or underinsured, the region’s community health centers provide primary care services to these populations on a sliding fee scale basis. Access to primary care for those who are uninsured and FULFILLING LIFE’S POSSIBILITIES

28% of Tampa Bay population between ages 18-64 were uninsured in 2009

60-80 primary care physicians per 100,000 recommended

ineligible for Medicaid or Medicare varies from county to county with each county making every effort to serve this population despite enduring budget reductions in recent years. Hillsborough and Polk Counties offer the most comprehensive services, as their funding comes from ¼ and ½ cent sales tax surcharges, respectively, yet they still are challenged to meet the health care needs of their residents.

Access to Primary Care Providers The Department of Health and Human Services’ Council on Graduate Medical Education recommends 60 to 80 primary care physicians per 100,000 people. As a region, we slightly exceed this range but individual counties vary widely. Hillsborough, Pinellas and Sarasota counties all had more than 90 primary care providers per 100,000 population in 2008 but Citrus, Pasco and Polk counties were at or below the minimum recommendation of 60. Hernando and Manatee counties were just above 60. 27

Environmental Health

The air we breathe, the water we drink, crossing the street, driving our car and the food we eat are all examples of how our built and natural environments can

influence our health, reduce risk factors and encourage people to make healthy choices that promote healthy lifestyles and prevent disease and injury. Research shows a connection between our environment and our health, but we have a long way to go to in understanding what links the two.

Natural Environment

Water Quality

Air Quality Index

34.3

The Environmental Protection Agency (EPA) estimates that reducing air pollution to levels required by the 1990 Clean Air Act Amendments will prevent more than 1.7 million asthma attacks.45

Established by the EPA, the Air Quality Index (AQI) is an index for reporting daily air quality. AQI describes how clean or polluted the air is and what associated health effects may be of concern. The EPA calculates the AQI for five major air pollutants regulated by the Clean Air Act.46 Measurements for air pollutants are converted into AQI values using standard formulas developed by the EPA. AQI is measured on the spectrum 0-500 with less than 50 being good and over three hundred as hazardous.47 The higher the AQI value, the greater the level of air pollution and the greater the health concern. In Tampa Bay, the median AQI value of 34.3 in 2008 represents good air quality with little potential to affect public health.

500

34.3 median AQI value in Tampa Bay

99.6% compliance of Tampa Bay community water systems

These measures are based on violations reported by states to the EPA Safe Drinking Water Information System. All federal agencies must set performance standards for community water systems, which are public water systems that supply water to the same population year-round. By 2011, the EPAâ&#x20AC;&#x2122;s target is for community water systems to provide drinking water that meets all applicable health-based drinking water standards 96% of the time. The measure tracks the duration of a populationâ&#x20AC;&#x2122;s exposure to violations. For example, some systems may receive a violation for an incident that lasts only one day (e.g. turbidity increase due to storm event). The measure is intended to give a more accurate picture of exposure of the population to contamination. In 2009, community water systems in the Tampa Bay area were in compliance 99.6% of the time compared to 96.3% in the U.S. and 98.9% in Florida.

ONE BAY: Healthy Communities

Transportation Today, the U.S. transportation system is designed to move people and goods efficiently, however, there is a growing awareness across communities that transportation systems impact quality of life and health. Expanding the availability of, safety for, and access to a variety of transportation options and integrating health-enhancing choices into transportation policy has the potential to save lives by preventing chronic diseases, reducing and preventing deaths, and improving environmental health.48

Daily Vehicle Miles Traveled Per Capita Vehicle miles traveled (VMT) indicates the demand on county roads and freeways. Areas with higher numbers of vehicle miles traveled tend to have higher rates of motor vehicle and pedestrian accidents, injuries and fatalities. Vehicle miles traveled lead to increased air pollution and greenhouse gas emission which contribute to cardiovascular mortality rates and respiratory disease. On average, Americans spend 443 hours in a car each year. Increased numbers of VMT have been tied to obesity and impact general well-being.49 This indicator shows the average weekday daily VMT per capita as measured by total number of vehicle miles divided by the county’s population. In 2008, the weekday daily VMT per capita for the U.S. was 26.8, for Florida it was 29.6 and for Tampa Bay it was 27.8.

Motor Vehicles Deaths Motor vehicle-related injuries kill more children and young adults than any other single cause in the United States. More than 33,000 people in the United States died in motor vehicle crashes in 2009, the lowest number of deaths since 1950.50 Crash injuries result in about 500,000 hospitalizations and four million emergency department visits annually.51 Increased use of safety belts and reductions in driving while

FULFILLING LIFE’S POSSIBILITIES

Motor Vehicle Fatalities Deaths per 100,000 (age-adjusted)

2002 2006

13.3 13.6

10 9.2%

Healthy People 2010

8.2

14.7 14.4

7.4

impaired are two of the most effective means to reduce the risk of death and serious injury of occupants in motor vehicle crashes.52 This indicator shows the age-adjusted death rate per 100,000 people due to motor vehicle crashes. In 2006, Florida and Tampa Bay far exceeded the number of deaths at 13.6 and 14.4 deaths per 100,000 compared to 7.4 in the U.S. The Healthy People 2010 target was 8.0.

Pedestrian Fatalities

U.S. Florida Tampa Bay

27.8 average weekday daily vehicle miles travelled per capita in Tampa Bay in 2008

In 2009, 4,092 pedestrians were killed in traffic crashes in the United States. With 2.51 deaths per 100,000 people, Florida had the highest pedestrian fatality rate of all 50 states in 2009. California, the most populated state, ranked 15th.53 This indicator shows the number of pedestrians killed in traffic collisions per 100,000 population. The Healthy People 2010 national health target was to reduce the pedestrian death rate on public roads to 1.0 death per 100,000 population. In Tampa Bay, the pedestrian fatality rate declined from 3.2 persons per 100,000 in 2006 compared to 4.1 in 2003.

Spotlight: Charlotte Area Transit System Research shows a correlation between weight loss and ridership on the Charlotte Rail Line. The Journal of Preventative Medicine recently published a study on Charlotte’s Lynx Light Rail. Their research found riding the blue line led to an average weight loss of around 6.5 pounds and that Light Rail users are 81% less likely to be obese over time. Researchers say that’s because walking to and from your stop is part of a more physically active lifestyle. The built environment can constrain or facilitate physical activity. While the results are impressive, most studies of the health consequences of the built environment face problems of selection bias associated with confounding effects of residential choice and transportation decisions. Nonetheless, the authors of this study state that the findings suggest that improving neighborhood environments and increasing the public’s use of light rail transit systems could provide improvements in health outcomes for millions of individuals.54

Environmental (cont.) Travel to work Lengthy commutes cut into workers’ free time and can contribute to health problems such as headache, anxiety, and increased blood pressure. More time spent in transit also translates to increased consumption of fossil fuels used for transportation, which is costly for workers as well as for the environment.

Tampa Bay commuters spent

25.1 minutes traveling to work in 2008

Spotlight: Safe Routes to School The Safe Routes to School Program (SRTS) was authorized in August 2005 by Section 1404 of the federal transportation act, SAFETEA-LU (the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users). This program provided a total of $612 million in Federal-aid highway funds to State Departments of Transportation (DOTs) over five Federal fiscal years (FY2005-2009), to make it safer, easier and more fun for children in grades K through 8, to walk or bicycle to and from school. The Florida Department of Transportation received approximately $29.1 million for use on SRTS projects through Federal Fiscal year 2009. The purposes of the Safe Routes to School Program are: • To enable and encourage children, including those with disabilities, to walk and bicycle to school • To make bicycling and walking to school a safer and more appealing transportation alternative, thereby encouraging a healthy and active lifestyle from an early age • To facilitate the planning, development, and implementation of projects and activities that will improve safety and reduce traffic, fuel consumption and air pollution in the vicinity of schools The Alliance for Bicycling and Walking in its 2010 Benchmarking report measured the potential impact of bicycling and walking levels on public health. They found a correlation between obesity and overweight levels, physical activity levels, high blood pressure and diabetes. States with higher levels of bicycling and walking • average lower obesity levels • have higher levels of physical activity • have lower rates of diabetes • average lower levels of high blood pressure

This indicator shows the average daily commuting travel time to work in minutes for workers 16 years of age and older. In 2008, Tampa Bay commuters spent an average of 25.1 minutes traveling to work, whereas commuters in Pasco and Hernando spent the most time in their cars at about 30.1 minutes.

Transit Ridership Public transportation offers mobility for U.S. residents, particularly people without cars. Transit can help bridge the spatial divide between people and jobs, services, and training opportunities. Public transportation is also beneficial because it reduces fuel consumption, minimizes air pollution, and relieves traffic congestion. This indicator is the daily average number of unlinked transit trips as a percentage of population. In the past five years, transit ridership as a percent of the population has been steadily increasing in Tampa Bay from 1.86% to 2.27% but in 2008, still lagged the Healthy People 2010 target of 3.6%.

Built Environment Population Density Persons per square mile is the average number of inhabitants per square mile of land area. Population density is one indicator of how land is used in a given area. Higher population density signifies more urban areas. According to the Brookings Institution, our nation’s large metro areas remain at the cutting edge of the nation’s continued growth. Growth of primary city populations of the nation’s 100 metropolitan areas accelerated from 2006 to 2008, at the same time that suburban population growth slowed. Some of this resurgence of big cities is due to inherent strengths, such as broad economic diversity. But much is attributable to a “windfall” of residents attracted to and retained in cities who might – in the absence of the housing crisis and deepening recession – have moved to the suburbs.55

ONE BAY: Healthy Communities

Between 2004 and 2008, the population of the Tampa Bay region grew at an average of 6.9% with the outlying areas in Pasco and Hernando counties growing at a much faster rate of 15.2% and 16.4% respectively compared to Pinellas County which had a negative growth rate of 1.5%.

alcohol that is available for immediate consumption than do taverns and restaurants serving alcohol. This indicator measures liquor stores per 100,000 residents. In Tampa Bay, there are an average of 6.9 establishments per 100,000 people compared to 10.1 in the U.S. It should be noted that Florida law permits the sale of alcohol in establishments other than liquor stores, such as grocery and convenience stores. If those vendors were included in the density calculation, the region and state rates would likely be closer to the national average.

Access to Healthy Foods Studies have linked the food environment to consumption of healthy food and overall health outcomes. Grocery stores include establishments generally known as supermarkets, smaller grocery stores and delicatessen-type establishments primarily engaged in retailing a general line of food, such as canned and frozen foods, fresh fruits and vegetables, and fresh and prepared meats, fish and poultry. (Convenience stores, large general merchandise stores that also retail food, such as supercenters and warehouse club stores are excluded.) This indicator measures grocery stores per 100,000 residents. In Tampa Bay, there were 19.2 establishments per 100,000 people compared to 21.3 in the U.S. A “food desert” is an area without a grocery store within a reasonable walking distance or near public transportation.56 Residents in a food desert do not have access to healthy foods. Tampa Bay is not a food desert as communities within the region have made strides in increasing the availability of healthy foods; from the addition of grocery stores in neighborhoods which previously lacked one, to the expansion in the number of farmer’s markets selling locally grown fresh produce.57

Liquor Store Density Researchers have documented a variety of problems associated with the physical availability of alcohol including assaultive violence, motor vehicle accidents, drinking and driving, riding with a drinking driver, high mortality rates due to liver cirrhosis, and binge drinking. Furthermore, liquor stores sell larger quantities of

FULFILLING LIFE’S POSSIBILITIES

Public Safety Violent Crime Rate

19.2 grocery establishments per 100,000 people in Tampa Bay

A violent crime is a crime in which the offender uses or threatens to use violent force upon the victim. In the FBI’s Uniform Crime Reporting Program, violent crime is composed of four offenses: murder and nonnegligent manslaughter, forcible rape, robbery and aggravated assault. Over 1.3 million violent crimes occurred nationwide in 2009, showing a decrease of 6.1% from the 2008 estimate.58 This indicator is the rate per 100,000 population of total violent crimes. There were an estimated 454.5 violent crimes per 100,000 inhabitants in 2008 in the U.S. compared to 688.9 in Florida and 622.0 in Tampa Bay.

Spotlight: Women Infant and Children (WIC) WIC is a food program for women, infants and children funded by the U.S. Department of Agriculture and administered through the county health departments. The program provides vouchers for the purchase of WIC foods to supplement the nutritional needs of a pregnant woman, a breastfeeding mother, a new mother, an infant or a child up to 5 years old. www.doh.state.fl.us/family/wic

Community Assessment

The community assessment

that follows was an opportunity for ONE BAY: Healthy Communities to supplement the health indicator data and learn about the many valuable programs and organizations working to affect community health in the Tampa Bay region. As we move through this visioning process, it will become very important to gain the feedback and participation of these organizations towards a common vision and goal setting for the region. As a starting point, a comprehensive, though not conclusive, list of public, private, and non-profit organizations from the eight-county region was compiled based on their involvement with any one aspect of creating a healthy community. While not every single organization that has an impact could be identified, a broad effort was made to find programs targeting specific conditions for populations at risk for disparities, low-income residents and larger employee populations. Direct health care providers (physicians, clinics, nursing homes, hospices) were excluded because their contribution to community health generally occurs at the individual level. Hospitals were included not for their direct patient care activities, but for their admirable community outreach programs. In an effort to reach our community of employers, an online survey of employers was conducted through the Maddux Business Wire and Tampa Bay Partnership from August 19 - September 10, 2010. The survey focused on employee benefits at nearly

Over

100 organizations in Tampa Bay region focused on improving community health 150 organizations, of all sizes, responded. Employers, as the primary funders of health insurance benefits for working age adults, serve an important role for employee access to health care, disease prevention and health and wellness programs. Our independent research and outreach regarding community health programming identified a list of nearly 140

organizations. Three-fourths of these 140 organizations were contacted for additional information and most were interviewed. This process provided substantial insight into the numerous community health activities being conducted in the region. Throughout this report, you will find examples of unique programs and organizations spotlighted. While there was not sufficient time to interview every entity, we continue to encourage organizations to submit additional information about their efforts to this process. In total, the community assessment process got information from nearly 280 organizations in the Tampa Bay region (including the 150 employer responses). The organizations have been grouped into the following sectors: • Governmental agencies • Hospitals • Not-for-profit organizations • Alliances/partnerships • Employers

ONE BAY: Healthy Communities

Governmental Agencies Federal Programs The U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), the Health Resources Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMSHA), the U.S. Department of Agriculture (USDA), and the U.S. Department of Transportation (USDT) are the primary Federal funding agencies for health improvement programs and typically provide the funds to state or local agencies for administration of programs such as Women, Infants and Children (WIC, pg. 31), Healthy Start/Head Start (pg. 19), and National Breast & Cervical Cancer Early Detection Program (pg. 23). For many programs, like Safe Routes to School (pg. 30), federal funding must be supplemented by state, local and often private funds in order to meet the community needs. Other programs are fully-funded federal grants, such as the nearly $5 million grant awarded to the Pinellas County Health Department to implement policy changes in all sectors of the community to combat obesity. The grant is from the Prevention and Public Health Fund, a component of the Affordable Care Act/Health and Human Services Communities Putting Prevention to Work Program. The CDC administers this prevention and wellness initiative.

State of Florida Florida Department of Health The largest state agency focused on improving public health is the Florida Department of Health. The Florida Department of Health funds and oversees the 67 county health departments in the state and is charged to “promote, protect and improve” the health of the “public” or residents. Despite their moniker of county health departments, they are not within the county government structure but are divisions of the state health department. The physical and behavioral services provided or coordinated by county health departments varies slightly, depending on the demographics and FULFILLING LIFE’S POSSIBILITIES

8 state county health departments

4 regional health councils

2 children’s services councils needs of the county, yet all provide the following services or direct residents to another resource for care or education: • Immunizations/vaccinations • Smoking cessation • Weight loss/nutrition education • Diabetes management • Illicit and prescription medication and alcohol addiction • Suicide prevention • Sexually transmitted disease testing and treatment

• Pregnancy prevention • Pre-natal care aimed at reducing low birth weight and infant mortality Health departments also oversee vital statistics, environmental health and preparedness, and programs addressing the health needs of the community.

Regional Health Councils The Florida legislature has established a network of agencies called Health Councils with 11 districts throughout the state. The Health Councils are mandated by state law to conduct regional health planning and implementation. The Councils collect and analyze health care data, describe community health status, identify health care needs and resources, and work with community partners to design strategies to improve access to affordable and quality of health care services at the local level. The Tampa Bay region has four Health Councils that encompass counties beyond our region.

Region 3 WellFlorida Council Region 5 Suncoast Health Council Region 6 Health Council of West Central Florida

Region 8 Health Planning Council of Southwest Florida

Spotlight: Suncoast Health Council: MedNet Prescription Assistance The Suncoast Health Council in Pinellas County started the MedNet Prescription Assistance Program in 1999 in response to a finding that access to prescription medications was identified as the top health issue in the county. The program expands access to prescription medicines for low-income uninsured and underinsured adults with chronic health conditions. The program expanded to 19 sites in five counties and in 2009 obtained $5.2 million in free prescription medications, returning $9.93 for every dollar spent to provide the services. Funding is provided by private foundations and public entities. www.healthcouncils.org 33

Community (cont.) Children’s Services Councils Eleven counties within Florida have children’s services councils which focus on serving the needs of all children within the county. Eight of these counties have passed referendums authorizing an ad valorem tax for the sole purpose of funding programs and services for children. In the Tampa Bay region, Pinellas and Hillsborough counties each have a children’s services council.

Juvenile Welfare Board of Pinellas County The Juvenile Welfare Board (JWB) funds programs in three priority areas: Ending Child Maltreatment, School Readiness and Ensuring School Success. The fourth area for funding is a conglomeration of programs that do not directly fall within these priorities but have been deemed necessary, such as residential programs, behavioral health counseling and coordinated child care.

Children’s Board of Hillsborough County The Children’s Board of Hillsborough County funds numerous programs throughout Hillsborough County with an emphasis on: Promoting Healthy Births, Improving School Readiness, Advancing School Achievement and Helping Families Succeed.

County Government Funding for community health programs at the county level is dependent on prioritization of needs and budget dollars available. Most of the region’s counties have an established health and human or social services agency that is completely separate from the county health department. The county health or social service agency is typically charged with addressing medical and social service needs of the county and often assists residents in need with access to health care. County governments also have departments whose functions are complementary to the foundations

67 Hospitals in Tampa Bay region

for a healthy community. For example, county sheriff’s departments and local police departments work to keep our region safe. Public works, transportation, economic development, education, and parks and recreation departments are all collaborating to improve the quality and “livability” of our communities.

Hospitals The Tampa Bay region is home to 67 hospitals including acute care, long-term care, rehabilitation, cancer, psychiatric, addiction and children’s hospitals. Of the 50 acute care hospitals, 23 are tax-exempt not-for-profit and 27 are for-profit. All of the region’s hospitals offer community health programming for local residents but the not-for-profit hospitals tend to provide greater financial contribution to the community.

In exchange for tax-exempt status, not-for-profit hospitals are obligated to provide benefit to the community. These hospitals fulfill this obligation by providing charity care, financial assistance to low-income patients, subsidized health care, research, health professions education and sponsoring community education and health-related activities.59 According to an IRS study of hospitals completed in February 2009, uncompensated care was the largest category of community benefit expenditures at 56% followed by medical education and training (23%), research (15%) and community programs (6%).60 Charitable activities of hospitals in the Tampa Bay region, particularly those with tax-exempt status, mirror those of the IRS study with the largest community benefit provided in the form of charity care. Our regional hospitals provide programs to local residents, generally at no cost including disease management programs, heart risk assessments, cholesterol, glucose, breast and cervical screenings, health fairs, and educational workshops on numerous health topics. In addition to these programs provided directly by the hospitals, many hospitals also financially support community activities such as walks, runs and triathlons.

Not-for-Profit Organizations A not-for-profit organization (NPO) is mission-driven, exempt from federal corporate income taxes and classified

Spotlight: BayCare Health System: Faith Community Nursing The Faith Community Nursing Program, available through BayCare Health System, trains nurses who establish health ministries within their home faith-based congregation. Over 200 nurse volunteers work in underserved communities and homeless shelters. Their mission is health promotion and disease prevention. Nurses arrange for health screenings or presentations by community health centers. In 2009, there were 14,000 hours served with 36,000 direct and indirect contacts. www.stanthonys.com

ONE BAY: Healthy Communities

according to the U.S. Internal Revenue Code. NPOs include professional associations, charities, foundations, religious organizations, social clubs, fraternal organizations, private schools, and colleges and museums and cultural organizations. The Tampa Bay region is home to hundreds of NPOs, a small portion of which is focused on health-related issues. Many of the NPOs with a health mission or emphasis are affiliates of national organizations such as: • American Heart Association • American Cancer Society • American Lung Association • American Diabetes Association • Susan G. Komen for the Cure • Alzheimer’s Association • American Association of Retired Persons

Funding Organizations Other national NPOs are primarily funding organizations. These organizations raise money from the community and re-distribute it in the form of grants to fund programs designed by the local NPOs. The programs must be aligned with the strategic objectives of the funding organization in order to receive grant funding. In 2009, the United Way began a process to identify the most promising evidence-based community strategies to improve health, education and financial stability. The United Way has a strong presence in Tampa Bay with an affiliate in each of our eight counties. Our region also has several community foundations that raise money from the community for the community. Residents participate in prioritysetting processes and award grants based on these priorities. Our region’s community foundations include: • Community Foundation of Tampa Bay • Pinellas County Community Foundation • Sarasota/Manatee Community Foundation • Gulf Coast Community Foundation FULFILLING LIFE’S POSSIBILITIES

Allegany Franciscan Ministries is a Catholic organization with three regions in Florida, including Tampa Bay. Local grants include Healthy Start, the Tampa Bay Healthcare Collaborative, Kidz Bite Back, James B. Sanderlin Family Center, the Sulphur Springs Resource Center and Faith Community Nursing.

Alliances

Corporate Philanthropy

• Polk County Health Alliance

Many publicly owned companies have formed separate foundations that give back to their communities. Large corporations such as Blue Cross/Blue Shield, Publix, AT&T, Bank of America and UnitedHealthcare all have foundations that have supported regional programs.

• Health and Human Services Coordinating Council of Pinellas County

Our region supports other private foundations that are not focused on health but are currently funding programs for children, the homeless and the disabled in addition to funding for the arts and humanities. Combined, all of these efforts serve to improve the quality of life for our Tampa Bay region.

Recognizing the overlapping needs of certain populations, health alliances or collaborations have formed in each of the eight counties. All of the county coalitions include the health department but diverge from there. The focus of the alliances varies slightly but all are working together to improve the health of the residents. Alliances identified include:

• Hernando County Health Care Advisory Board • Citrus Partnerships in Health • Shared Services Alliance of Citrus County • Community Alliance of Sarasota County • Manatee County Substance Abuse Coalition • Health Equity Coalition of Hillsborough County • HillsboroughHATS (Health and Transition Services) • Manatee Healthcare Alliance

Spotlight: Non-profit Programs Gulf Coast Community Foundation of Venice: CareerEdge (www. gulfcoastcf.org) is a collaborative program aimed at transitioning low-wage earners into higher-paying positions in an effort to provide trained employees for the Manatee-Sarasota businesses focusing on the health care industry first. Healthy Together: Prime Time Sister Circles (www.healthy-together. org), developed by the Gaston & Porter Health Improvement Center, is designed for 40-70-year-old African American women. According to their research, African American women are dying prematurely at a rate higher than any other population in America. Using esteembuilding support groups, the program motivates participants to make changes in their lifestyle and create lifelong wellness plans. Healthy Together enrolled 60 women with more than 50% of the participants reducing their blood pressure, BMI and abdominal circumference. Sarasota County’s Community Health Improvement Partnership (CHIP) (www.chip4health.org): Housed within the Department of Health, CHIP hosted a Community Health Interactive, which convened and engaged a diverse group of citizens in changing the status quo, prioritizing health challenges and generating solutions and action steps.

Community (cont.) Employers An online survey was conducted through the Maddux Business Wire and Tampa Bay Partnership from August 19 - September 10, 2010, in which nearly 150 organizations responded. The purpose of the survey was to assess an employer’s cost in providing health care, their view on their role in affecting employee health, and their direct involvement with employee health and wellness initiatives and in the community. The survey is not representative of the entire labor force in the region, but supports that Tampa Bay employers, as a whole, are in line with national benefits trends. Of the survey respondents, over 60% of companies have less than 100 employees. According to the 2008 County Business Patterns, 98% of Tampa Bay establishments had fewer than 100 employees. As a result, it should be noted that a higher percentage of large employers responded to the employer survey than is represented in the business community.

The Cost of Medical Care The cost of medical care continues to rise and both employers and employees are paying more. As has been the case nationally, medical expenses for Tampa Bay employers have increased at a rate outpacing inflation. Survey results demonstrate that between 2008 and 2009 health care expenses for half of the region’s employers increased between 1-15%. For 16% of the employers, costs increased 16-30%. For employees, personal medical expenditures have increased either because they have moved into a high deductible consumer-directed health plan or their share of the premium contribution expected by the employer has increased. According to our employer survey, between 20082009, 42% of employees saw their medical expenses increase between 1-15%. Another 10% of employees saw increases of 16-30%. 36

Nearly

75% of employers surveyed believe they have a responsibility to play an active role in their employee’s health

Employer Expense Employee Expense 41.5

• Health education seminars

• Weight loss programs • Healthy meal options in building/ on campus • Preventive counseling/ support groups • Wellness clinic

• Workplace violence awareness programs

16.3 9.8

10 0

An overwhelming majority of our local employers are committed to their employees’ health. Nearly 75% of survey respondents believe that they have a responsibility to take an active role in improving the health status of their employees. For the employers that benefit from economies of scale because of their large employee base, their offerings include one or more of the following: • Free or discounted health club memberships/on-site fitness center

2008-09 Increase in Medical Expenses 49.1

The Employer’s Role in Employee Health

1-15% Increase

16-30% Increase

Behaviors/Diseases Targeted by Employer Programs Smoking Cessation Weight Loss High Blood Pressure

Of the 100 organizations that answered the question asking what behaviors or diseases they were hoping to impact with their employee health programs, 48% were addressing smoking and 46% were addressing weight loss. High blood pressure, diabetes, high cholesterol, coronary heart disease, substance abuse, depression and stroke prevention were also risk factors that employers are monitoring and hope to impact. The larger employers also tend to cover cancer screenings for their employees at no charge. Over 55% of employers responding to the survey indicated that they offer an Employee Assistance Program (EAP). EAPs provide counseling and other resources for employees and family members with behavioral health concerns such as substance abuse and depression.

Diabetes High Cholesterol Coronary Heart Disease Substance Abuse Depression Stroke Prevention Healthy Lifestyle Asthma 0% 10% 20% 30% 40% 50%

For smaller employers who do not have the resources to track specific behaviors or risk factors or offer EAPs, they have begun emphasizing prevention and general health and ONE BAY: Healthy Communities

wellness in an effort to get employees more engaged in an active lifestyle.

Spotlight: USF Health

Regardless of whether a healthy lifestyle program was offered or not, 41% of employers indicated that in the last two years, their company has spent either more staff time, more budget dollars, or both, in an effort to improve employee health.

USF Health’s mission is to enhance life by improving health through research, education and healthcare to improve the full spectrum of health, from the environment, to the community, to the individual. Together, through talent and innovation, USF Health is developing real-world solutions to reach our shared value – making life better.

In terms of outcomes for these wellness programs, there is not much objective evidence of their success. For the few largest employers who are self-insured and have trend data, they have documented that prevention activities such as wellness visits and health screenings have increased. Benefits managers report that if the CEO and senior management embrace the wellness and healthy living initiatives, and it is part of the corporate culture, then employees seem more engaged with their personal wellness. These companies are leveraging their healthy culture into an effective employee recruitment tool.

Community Support Tampa Bay employers are actively engaged in supporting health activities for our entire community. Seventy-four percent of respondents financially sponsor walks, marathons, triathlons, children’s athletics and health fairs while 44% financially sponsor infrastructure improvements such as walking trails, bike paths, parks, playground equipment and athletic complexes/community recreation centers. Of those who financially sponsor community health improvement activities or infrastructure improvements, 75% of that sponsorship was $10,000 or less.

PaperFree Florida is helping doctors across the state convert to electronic medical records as a national model for bringing health care into the digital age.

75% of employers spent up to

$10,000 on community health sponsorships

USF Health’s Center for Advanced Medical Learning and Simulation, a $30 million project in downtown Tampa, will use leading USF faculty surgeons to train surgeons from around the world on how to perform robotic, computerassisted, and image-guided surgeries. In the simulation center’s Virtual Hospital, doctors, nurses and other healthcare providers will train side-by-side, perfecting the teamwork and communication skills vital to topquality medicine. www.health.usf.edu

Leadership in the Community

Spotlight: Hernando County Worksite Wellness Toolkit

The survey asked respondents whom they perceive to be taking a leadership role in improving community health. Hospitals and hospital systems received the most responses, followed by national nonprofit organizations with local presence like the American Cancer Society, American Heart Association and the United Way.

Hernando County has very few large employers and many small employers. To assist the county employers who cannot afford to offer wellness programs, the Hernando County Health Department, supported by a grant from The United Way of Hernando County, developed a free Worksite Wellness Toolkit that is designed to be a quick and flexible resource for promoting positive lifestyle choices among employees. The toolkit includes health facts, tips posters, newsletter and paycheck inserts on topics such as physical activity, nutrition, smoking cessation, stress management and habit formation.

FULFILLING LIFE’S POSSIBILITIES

Goals & Methodology ONE BAY: Healthy Communities has measured the health of the region using a two-fold approach: • Using a core set of indicators in the areas of Economy/Demographics; Health Outcomes; Health Related Behaviors; Health Systems/Access; and Environmental Health • Initiating an inventory of existing community health improvement programs within the region as a start for community support and collaboration.

Methodology Indicator Selection The Healthy Communities Data Committee, comprised of public health researchers, providers and insurance organization leaders developed the following criteria for the selection of the indicators: • Must reflect the care delivered in the community • Must be established measures • Must be an area of concern to public health or reflect the Tampa Bay region’s unique qualities • Must be publicly available data with measurement reported at the national, state and county level, where possible The indicators selected provide a comprehensive view of community health, wellness and disease. They include measures of mortality, disease prevalence, hospitalization rates, health-related behaviors, and environmental factors. Sources Public data sources include the Center for Disease Control and Prevention, Florida Department of Health, U.S. Census Bureau, Florida Bureau of Immunization, Federal Bureau of Investigations, Environmental Protection Agency, Kaiser Family Foundation, U.S. Bureau of Economic Analysis, and U.S. Health Resources and Services Administration.

Regionalization

Age Adjustments

County-level measures for the Citrus, Hernando, Pasco, Pinellas, Hillsborough, Polk, Manatee and Sarasota counties were aggregated into a Tampa Bay region score. This composite score allows for comparisons with the Tampa Bay region (county vs. region, region vs. state, etc.). To create Tampa Bay region-level scores, population ratios calculated from appropriate county-level weighing factors were used. Regional figures were compared to state and national figures and to Healthy People 2010 when available.

Measures were adjusted to account for the differences related to age, where applicable. For example, Florida has an older population than the rest of the United States, on average. Therefore, the health-related measures were statistically adjusted to reveal differences in community health not related to aging.

Trends Whenever possible, five year trend data were collected to provide perspective on the relative direction of the community health indicators. Some measures, such as the Florida Department of Health Behavioral Risk Factor Surveillance System (BRFSS), are conducted every two years. A compilation of the county, regional, and state data is included in the Appendices. Detailed Operational Definition of Measures and Data Sources are available at the following website: www.myonebay.com

Data Limitations Many measures were collected using surveys conducted from randomly selected individuals, such as the state and federal Behavioral Risk Factor Surveillance System (BRFSS). As such, the numbers listed for each measure represent a point estimate within a range of possible numbers, called the confidence intervals (not reported). This means that the scores may give the impression of exactness, but may actually contain various levels of imprecision depending on the sample size. In these instances, direct comparisons between national, state, and county measures should be performed with caution. Some of the data collected for measures may not be from the same source at all levels. For example, national surveys on immunizations for two year olds conducted by the CDC were performed on 19 to 35 month olds during a six month period. On the other hand, Florida countylevel immunization surveys conducted by the Florida Department of Health were completed for children that were two in the first week in January. These slightly different approaches result in indicators that are not directly comparable. ONE BAY: Healthy Communities

Health Indicators Population U.S.

Florida

TB Region

Citrus

Hernando

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

4,159,158

140,357

171,233

1,195,317

318,361

471,709

909,013

583,403

369,765

100%

3.4%

4.1%

28.7%

7.6%

11.3%

21.9%

14.0%

8.9%

Hernando

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

$39,552

$49,762

$46,573

$42,407

2009 Census Population Source: U.S. Census Bureau

307,006,550 18,537,969 % of Region

Economy/Demographics U.S.

Florida

TB Region

Citrus

2008 Median Household Annual Income Source: U.S. Census Small Area Income and Poverty Estimates

$52,029 $47,802

$46,199

$38,476

$45,899 $44,350

$49,001

$43,064 $32,572

$55,856

2008 Annual Per Capita Personal Income Source: Bureau of Economic Analysis Regional Economic Accounts - Personal income, population, per capita personal income (Table CA1-3 3.0)

$40,166 $39,064

$38,427

$30,170

$29,148

$37,778

$40,353

$29,113

10.7%

11.5%

11.9%

10.8%

11.4%

11.2%

13.9%

12.2%

13.2%

10.9%

15.3%

9.9%

78.7%

73.7%

67.3%

70.6%

83.5%

2009 Unemployment Source: Bureau of Labor Statistics, CPS (National), LAUS (Regional and Local)

9.3%

10.5%

11.2%

12.3%

13.2%

2008 Families Living Below Poverty Level (%) Source: U.S. Census Small Area Income and Poverty Estimates Data

13.2%

13.3%

12.9%

15.8%

12.4%

2007 High School Graduation Rates (Within 4 Years of 9th Grade Enrollment) Source: Florida Department of Education, FSIR

73.9%

75.4%

78.5%

76.1%

75.1%

79.1%

2009 College Graduates (% Age 25+ with Bachelorâ&#x20AC;&#x2122;s Degree or higher) Source: Nielsen Claritas, 2009

24.6%

22.57%

21.37%

13.42%

12.66%

25.98%

22.38%

14.68%

23.16%

15.04%

26.51%

Citrus

Hernando

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

175.4

148.6

149.9

137.4

169.0

109.1

41.7

29.1

32.7

34.9

41.2

28.6

188.2

162.1

187.5

174.4

177.8

153.6

Health Outcomes U.S.

Florida

TB Region

2006 Coronary Heart Disease (Age-Adjusted Deaths per 100,000) Source: CDC Wonder Compressed Mortality, 1999-2006 Request

144.3

138.5

147.3

158.2

153.8

2006 Stroke (Age-Adjusted Deaths per 100,000) Source: CDC Wonder Compressed Mortality, 1999-2006 Request

43.6

35.3

34.6

31.0

30.5

2006 Cancer (Age-Adjusted Deaths per 100,000) Source: CDC Wonder Compressed Mortality, 1999-2006 Request

180.7

171.9

177.0

FULFILLING LIFEâ&#x20AC;&#x2122;S POSSIBILITIES

212.3

204.0

Health Indicators (cont.) Health Outcomes (cont.) U.S.

Florida

TB Region

Citrus

Hernando

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

54.7

49.3

61.5

57.9

55.6

46.3

18.0

24.4

19.7

26.7

18.8

7.9

2006 Lung Cancer (Age-Adjusted Deaths per 100,000) Source: CDC Wonder Compressed Mortality, 1999-2006 Request

51.5

51.2

55.7

68.7

63.9

2006 Female Breast Cancer (Age-Adjusted Deaths per 100,000) Source: CDC Wonder Compressed Mortality, 1999-2006 Request

17.8

21.5

22.4

23.2

26.4

21.7

2007 Asthma (Percentage of adults (18+) who currently have asthma) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

10.8

6.2

7.6

11.8

7.3

6.9

7.1

7.2

8.8

2007 Diabetes (Percentage of adults â&#x2030;Ľ 20 years old diagnosed with type 1 or type 2 diabetes) Source: CDC Diabetes Data and Trends - County Level Estimates of Diagnosed Diabetes

5.7

7.9

8.0

8.4

7.3

8.4

7.2

8.7

6.6

7.8

7.2

4.4

9.1

15.4

9.5

15.0

16.1

18.8

16.1

10.9

13.5

6.0

9.3

7.5

4.6

8.0

8.2

8.9

8.1

7.3

1.3

0.2

0.5

0.8

0.5

2006 Pneumonia/Influenza (Age-Adjusted Deaths per 100,000) Source: CDC Wonder Compressed Mortality, 1999-2006 Request

5.7

8.9

8.8

7.3

9.8

2006 Suicide Deaths (Age-Adjusted Deaths per 100,000) Source: CDC Wonder Compressed Mortality, 1999-2006 Request

10.8

12.6

14.9

18.7

10.7

2008 Infant Deaths (Infant Deaths (under 1 year) per 1,000 live births all causes) Source: Florida Vital Statistics (CHARTS)

6.7 (2006)

7.2

7.5

5.4

5.7

8.0

2008 Low Birth Weight (Low Birth Weight (<2500 grams) per 100 live births) Source: Florida Vital Statistics

8.2

8.8

8.5

7.2

7.7

9.3

2008 Birth to Female Teens (Births per 1,000 to females aged 10-14) Source: Florida Vital Statistics/CDC

0.6

0.0

0.8

2008 Sexually Transmitted Diseases (Reported Cases of STDs (Chlamydia/gonorrhea/syphilis per 100,000) Source: Florida Department of Health Trends & Statistics / CDC Sexually Transmitted Diseases Surveillance

528.2

514.3

514.2

222.4

209.9

717.0

487.0

207.8

584.5

532.7

331.7

Hernando

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

32.6

41.9

Health-Related Behaviors U.S.

Florida

TB Region

Citrus

2007 Overweight Adults (% of adults with BMI between 25.0-29.9) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

36.6

38.0

36.8

38.2

36.8

39.4

33.2

35.9

35.5

ONE BAY: Healthy Communities

Health-Related Behaviors (cont.) U.S.

Florida

TB Region

Citrus

Hernando

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

33.2

17.2

65.9

59.1

2007 Obesity (% of adults with BMI between 30.0-99.9) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

26.3

24.1

25.4

25.0

25.1

24.8

21.5

21.8

27.7

2007 Overweight and Obese Adults (% of adults with BMI between >25.0) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

63.0

62.1

62.2

65.9

61.9

64.2

54.7

57.6

63.2

2008-2009 Childhood Obesity (% of 1st, 3rd, 6th graders whose body mass index (BMI) at or above the 95th percentile) Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.

N/A

18.5

18.1

17.6

18.4

14.4

25.9

18.5

18.3

20.3

18.9

25.9

19.3

52.8

66.6

2007 Physical Activity (% of individuals who engage in no leisure-time physical activity) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

22.6

25.4

23.9

28.7

25.9

25.3

24.4

22.3

22.1

Percentage of Adults Who Are Physically Active Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

64.5

60.6

53.6

59.6

62.3

62.4

62.3

63.3

2007 Smoking (% of adults who have smoked >100 cigarettes in lifetime and who smoke on some days or everyday) Source: Florida CHARTS: Florida Department of Health, BR FSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

19.8

19.3

21.6

26.8

27.0

22.1

14.9

30.4

22.6

2007 Consumption of Alcohol (% of adult males having five or more drinks, or adult females having four or more drinks on one occasion, one or more times in the past 30 days) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

15.5

16.2

15.8

14.8

13.9

19.6

13.9

15.7

12.8

16.3

13.4

83.5

81.9

82.1

89.4

69.8

2008 Childhood Immunizations (Immunization levels among 2-yr.-olds) Source: The Florida Bureau of Immunization

76.1

83.4

77.4

N/A

87.2

2007 Influenza Immunizations (% of adults over 65 years old who received influenza immunizations in the last year) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

72.0

64.6

64.1

65.5

65.4

56.6

74.0

62.5

68.5

62.1

72.2

2007 Pneumonia Immunizations (% of adults over 65 years old who have ever received the pneumonia immunization) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

67.3

63.0

65.8

68.6

73.3

57.4

77.6

69.5

67.2

64.9

71.6

63.3

69.3

62.3

63.9

2007 Breast Cancer Screening (Women age 40 and over who received mammogram in past year) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

N/A

64.9

65.0

62.8

66.2

66.0

67.0

63.9

63.0

2007 Cervical Cancer Screening (Women age 18 and older who received a Pap test in the past year) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

N/A

64.8

63.1

FULFILLING LIFEâ&#x20AC;&#x2122;S POSSIBILITIES

52.5

55.6

64.4

63.0

66.2

63.2

Health Indicators (cont.) Health-Related Behaviors (cont.) U.S.

Florida

TB Region

Citrus

Hernando

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

2007 Colon Cancer Screening (Adults 50-years-old and older who received a sigmoidoscopy or colonoscopy in the past five years) Source: Florida CHARTS: Florida Department of Health, BRFSS County Questionnaire (2002 & 2007) / CDC BRFSS Nationwide (States and DC) Prevalence and Trend Data

N/A

53.7

54.9

51.5

54.3

50.1

60.1

53.7

57.7

61.7

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

33.0

55.1

57.7

137.8

18.5

266.2

229.1

461.0

168.4

Health Systems/Access *(U.S. Data is for 2007) U.S. *

Florida

TB Region

Citrus

Hernando

2009 Hypertension - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

61.7

84.7

64.7

54.2

62.5

75.6

2009 Congestive Heart Failure - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

415.5

333.2

274.3

277.6

276.4

321.0

228.6

2009 Chronic obstructive Pulmonary disease - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

193.0

214.4

207.9

213.1

209.9

216.9

170.3

188.7

208.4

339.9

106.6

21.6

17.9

50.7

8.0

47.9

80.8

38.0

98.2

150.2

47.2

2009 Uncontrolled Diabetes - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

21.1

31.0

24.7

11.0

15.9

35.4

9.8

2009 Diabetes Short-term complication - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

59.9

54.8

55.7

57.5

45.6

62.8

32.5

55.9

2009 Diabetes Long-term complication - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

123.8

116.2

106.2

75.9

108.6

138.4

65.8

112.6

2009 Low-extremity amputation among patients with Diabetes - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

33.6

30.2

26.6

34.2

24.4

28.8

22.0

31.2

25.0

30.0

19.2

130.6

162.8

215.2

298.4

104.1

81.0

126.1

119.2

214.7

62.4

248.1

251.4

278.4

272.5

329.1

2009 Bacterial pneumonia - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

374.8

234.1

205.2

156.5

197.9

278.5

2009 Adult asthma - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

117.9

136.7

133.3

122.2

156.7

154.8

2009 Perforated Appendix - Age-Adjusted hospitalization rate per 1,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

280.2

253.6

273.1

284.9

171.3

282.0

ONE BAY: Healthy Communities

Health Systems/Access (cont.) *(U.S. Data is for 2007) U.S. *

Florida

TB Region

Citrus

Hernando

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

2009 Pediatric Diabetes Short-term Complications Admission Rate - PDI 15 - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

29.7

24.8

25.3

10.9

24.8

30.9

31.2

18.6

15.3

36.3

15.2

2009 Pediatric Asthma Admission Rate - PDI 14 - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

134.8

137.9

140.6

91.4

160.6

144.2

114.4

98.6

142.3

192.6

99.7

153.6

194.5

288.3

79.4

2009 Urinary tract infection - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

185.4

185.3

182.1

129.9

176.0

224.4

135.0

2009 Pediatric Urinary Tract Infection Admission Rate - PDI 18 - Age-Adjusted hospitalization rate per 100,000 Source: BayCare Health System analysis of FL Agency for Health Care Administration with AHRQ PQI software

41.7

63.9

64.1

74.9

113.1

75.4

71.6

62.0

37.6

73.6

31.3

23.2%

27.5%

28.3%

24.0%

23.4%

26.2%

2008 Rates of Uninsured Source: U.S. Census American Community Survey, Health Insurance Coverage

19.7%

24.8%

24.6%

27.3%

2008 Access to Primary Care Provider (Primary Care Physicians per 100,000) Source: FL CHARTS: Health Resources Availability: Physicians

89.6

96.9

83.1

56.9

68.0

92.7

65.5

61.7

103.5

60.7

96.5

Citrus

Hernando

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

N/A

40.0

36.0

35.0

10.0

8.7

N/A

9.6

9.5

8.9

Environmental Health U.S.

Florida

TB Region

2008 Clean Air (Median Air Quality Index) Source: Environmental Protection Agency

N/A

00.0

34.3

N/A

2006 Air Pollution (Average Particulate Concentrations) Source: FL Department of Health

N/A

0.0

8.8

9.27

N/A

2009 Drinking Water (% of population served by community water systems failing to meet standards for 96% of person months) Source: Environmental Protection Agency

3.7

1.0

0.4

5.2

0.0

0.1

0.0

0.1

0.6

0.0

29.0

29.5

28.9

23.1

25.5

28.8

30.7

14.9

12.1

13.9

18.6

10.7

23.1

9.2

2008 Daily Vehicle Miles Travelled per Capita Source: FL Department of Transportation

26.8

29.6

27.8

29.2

2006 Motor Vehicle Deaths Source: CDC Wonder Compressed Mortality, 1999-2006 Request

7.4

13.6

14.4

FULFILLING LIFEâ&#x20AC;&#x2122;S POSSIBILITIES

20.5

Health Indicators (cont.) Environmental Health (cont.) U.S.

Florida

TB Region

Citrus

Hernando

Hillsborough

Manatee

Pasco

Pinellas

Polk

Sarasota

0.6

3.3

1.6

4.9

2.9

4.5

1.4

30.2

25.6

23.0

30.1

23.1

25.6

21.4

3.2

1.3

0.6

3.9

1.1

1.9

1,123.6

426.1

632.4

3,251.9

309.8

651.0

22.5

20.1

13.9

21.9

16.4

18.1

5.6

10.2

2006 Pedestrian Fatalities Source: CDC Wonder Compressed Mortality, 1999-2006 Request

2.1

3.3

3.2

4.4

2008 Time Travel to Work Source: U.S. Census American Community Survey 1-Yr Estimates

25.3

25.9

25.1

2008 Daily Transit Ridership (Daily trips as a % of population) Source: National Transit Database

2.97

1.09

2.3

N/A

0.31

2008 Population Density (Avg # persons per sq. mile) Source: U.S. Census Annual Population Estimates

339.9

1,218.9

242.2

358.9

2007 Grocery Stores in county per 100,000 people Source: U.S. Census North American Industry Classification System County Business Patterns

21.3

20.2

19.2

13.6

13.0

2007 Liquor Store Density (does not include non-liquor stores such as grocery and gas stations) Source: U.S. Census North American Industry Classification System County Business Patterns

10.1

6.9

4.3

7.1

6.4

8.3

6.3

7.1

2008 Violent Crime Rate (violent crimes per 100,000 residents) Source: FBI Uniform Crime Reports

454.5

688.9

622.0

(not available by county)

ONE BAY: Healthy Communities

Organizations These organizations were identified as having a potential role in impacting community health. Organizations noted with an * were researched and most subsequently interviewed. AARP Florida* All Children’s Hospital* Allegany Franciscan Ministries* American Cancer Society - Florida Division American Heart Association* Amerigroup* Bartow Regional Medical Center* BayCare Health System* Bayfront Medical Center* Blake Medical Center* BlueCross/BlueShield of Florida* Blue Foundation for a Healthier Florida Bon Secours St Petersburg Brandon Regional Hospital* Brooksville Regional Hospital* Children’s Advocacy Center - St. Joe’s Children’s Hospital* Children’s Board of Hillsborough County* Citrus County Health Department/FL Dept of Health Citrus Memorial Health System Coca-Cola Enterprises* Community Foundation of Sarasota Community Foundation of Tampa Bay (includes divisions for Hernando, Pasco, Greater St. Pete and Sun City Center) Community Hospital Conn Foundation* Doctors Hospital of Sarasota Early Learning Coalition of Pasco and Hernando Counties Edward White Hospital Englewood Community Hospital FAB Families* Fit4AllKids* Florida Hospital Zephyrhills Good Samaritan Health Clinic Gulf Coast Community Foundation of Venice* H. Lee Moffit Cancer Center and Research Institute* Health and Human Services Coordinating Council for Pinellas County* Health Council of W. Central Florida* Health Equity Coalition of Hillsborough County* Health Planning Council of Southwest Florida HealthSouth Rehab Hospital of Sarasota HealthSouth Rehabilitation Hospital of Spring Hill HealthSouth RidgeLake Hospital Healthy Start Coalition of Pinellas County* Healthy Together* Heart of Florida Regional Medical Center Helen Ellis Memorial Hospital Hernando County Department of Health* Hernando County School District Hernando Youth Initiative* Hillsborough County Department of Health* Hillsborough County School District Hillsborough Education Foundation Hillsborough Health Department/FL Dept of Health* James A Haley VA Medical Center Juvenile Welfare Board of Pinellas County* K Force* Kidz Bite Back* Kindred Hospital Tampa Kindred Hospital Bay Area - St Petersburg Kindred Hospital Central Tampa Lake Wales Medical Center Lakeland Regional Medical Center* Lakewood Ranch Medical Center Largo Medical Center* Manatee Chamber of Commerce Healthcare Committee* Manatee County Community Services Dept* Manatee County Health Department/FL Dept of Health* Manatee County Family YMCA* Manatee County School District Manatee Glens Hospital

FULFILLING LIFE’S POSSIBILITIES

Manatee Memorial Hospital Manatee Palms Youth Services Mease Countryside Hospital* Mease Dunedin Hospital* Memorial Hospital Tampa Midtown Health Council* MORE HEALTH - Tampa General/All Childrens/Hills. & Pinn. School Dist.* Morton Plant Hospital* Morton Plant North Bay Hospital* National Council on Alcoholism and Drug Dependence Tampa Bay Northside Hospital and Heart Institute Oak Hill Hospital* Operation PAR Palms of Pasadena* Pasco County Health Department/FL Dept of Health Pasco Regional Medical Center* Pinellas Community Foundation Pinellas County Health Department/FL Dept of Health* Pinellas County Health and Human Services* Pinellas County Planning Department* Pinellas County School District* Pinellas Education Foundation Polk County Health Department/FL Dept of Health* Polk County School District Polk Vision Regional Medical Center Bayonet Point* Sarasota Chapter of the American Foundation for Suicide Prevention Sarasota County Community Health Improvement Partnership* Sarasota County Health Department/FL Dept of Health* Sarasota County School District (SRQKids4Health)* Sarasota Family YMCA* Sarasota Memorial Hospital* Seven Rivers Regional Medical Center Shriners Hospital for Children South Bay Hospital South County Family YMCA South Florida Baptist Hospital Spring Hill Regional Hospital* Springbrook Hospital St. Anthony’s Hospital* St. Joseph’s Children’s Hospital * St. Joseph’s Hospital* St. Joseph’s Hospital North* St. Joseph’s Women’s Hospital* St. Petersburg General Hospital* Sun Coast Hospital Suncoast Center* Suncoast Health Council* Syniverse Technologies* Tampa Bay Healthcare Collaborative* Tampa General Hospital* Tampa Metropolitan Area YMCA* TechData* TECO Energy* Town and Country* UnitedHealthcare of Florida United Way of Central Florida* United Way of Central Florida* United Way of Hernando County* United Way of Manatee County* United Way of Pasco County* United Way of Sarasota County* United Way of Tampa Bay* University Community Hospital - Medical Center* University Community Hospital Carrollwood* USF School of Public Health* Venice Regional Medical Center* WellFlorida Council Windmoor Healthcare of Clearwater YMCA of Greater St Petersburg* YMCA of the Suncoast* YMCA of West Central Florida*

Steering Committee The following members of our community serve on the ONE BAY: Healthy Communities Steering Committee: Steve Mason* Chair, Healthy Communities Steering Committee President & CEO, BayCare Health System

Jean Mayer Senior Vice President, Strategic Services Tampa General Hospital

Diana Baker CEO-President, United Way of Tampa Bay

William (Bill) McHugh CEO, Florida Region, AMERIGROUP Community Care

George Banks, MD Medical Director, Manatee County Health Department

Suzy O’Malley VP of Metro Tampa Bay, American Heart Association

Jennifer Bencie, M.D., M.S.A. Administrator, Manatee County Health Department

Tom Pankey Managing Director/Advisory Services, KPMG LLP

Alan Bomstein President, Creative Contractors, Inc.

Donna Petersen, Sc.D.* Dean, USF College of Public Health

Eileen Coogan Boyle President & CEO, Allegany Franciscan Ministries

Celeste Philip, MD, MPH Senior Physician, Polk County Health Department

Maureen “Moe” Freaney Bureau Director, Health & Human Services, Pinellas County Leslene Gordon, PhD, RD, LD/N Community Health Director, Hillsborough County Health Department G. Scott Goyer Executive Director, YMCA of the Suncoast Daniel Haight, MD Director, Polk County Health Department Ron Hytoff President & CEO, Tampa General Hospital William Johnson Director of Shared Services Coca-Cola Enterprises Bottling Companies Richard Karl, M.D. Surgeon, USF Health Stephen Klasko, M.D. Vice President, Health Sciences; Dean, College of Medicine, USF Health Sciences Center Jack Kolosky EVP, Chief Operating Officer H. Lee Moffitt Cancer Center & Research Institute Barbara Langland Orban, Ph.D. Associate Professor and Chair, Department of Health Policy and Management, USF College of Public Health Rick Lentz, LEED AP Florida Regional Vice President, Cutler Associates, Inc. T. David Lewis CEO, UnitedHealthcare of Florida, Inc. Gwen MacKenzie President and CEO, Sarasota Memorial Hospital Dan Mahurin* Chair, TBP Regional Research & Education Foundation Chairman, President & CEO, SunTrust Bank, Tampa Bay Ernest Marquart Managing Partner, Shumaker, Loop & Kendrick, LLP 46

David Pizzo* Market President, BlueCross BlueShield of Florida Michelle Robinson* President - Southeast Region, Verizon Stuart Rogel* President & CEO, Tampa Bay Partnership Jayme S. Rothberg, MS, RT Dean, Health Occupations, Pasco-Hernando Community College The Honorable Karen Seel Vice-Chair, Commissioner - District 5, Pinellas County Mickey Smith CEO, Oak Hill Hospital Jim Vett General Manager/VP, Vanguard Advanced Pharmacy Systems * denotes Executive Committee

Data Committee Denise Remus, Ph.D., R.N. Chair, Data Committee Chief Quality Officer, BayCare Health System Bob Costello Director of Strategic Planning, BayCare Health System Linda Leon, R.N., MBA/HCM Director Clinical Outcomes, BayCare Health System Barbara Langland Orban, Ph.D. Associate Professor and Chair, Department of Health Policy and Management, USF College of Public Health Michael Manocchia, Ph.D. Sr. Research Scientist, Medical Informatics, BlueCross BlueShield of Florida Michael Newman Vice President, Medical Informatics, BlueCross BlueShield of Florida Etienne Pracht, Ph.D. Associate Professor, Department of Health Policy and Management, USF College of Public Health ONE BAY: Healthy Communities

References Introduction (pages 4-9) Organisation for Economic Co-Operation and Development, Women and Men in OECD Countries, 27, accessed Oct. 13, 2010, http://www. oecd.org/dataoecd/44/52/37962502.pdf 1

National Center for Chronic Disease Prevention and Health Promotion, The Power of Prevention, Chronic disease…the public health challenge of the 21st century (2009), 1, last modified Jan. 11, 2010, http://www.cdc. gov/chronicdisease/overview/pop.htm 2

National Center for Chronic Disease Prevention and Health Promotion The Power of Prevention, Chronic disease…the public health challenge of the 21st century (2009), 1, last modified Jan. 11, 2010, http://www.cdc. gov/chronicdisease/overview/pop.htm 3

Anne Martin, David Lassman, Lekha Whittle, Aaron Catlin, and the National Health Expenditure Accounts Team, “Annual Spending Update: Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades”, Health Affairs, Jan. 2011 30:111-22, doi:10.1377/hlthaff.2010.1032. 4

Sean Keehan, Andrea Sisko, Christopher Truffer, Sheila Smith, Cathy Cowan, John Poisal, M. Kent Clemens the National Health Expenditure Accounts Projections Team, “Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare”, Health Affairs, 27, no. 2 (2008): w145-w155 (Published online ), doi:10.1377/ hlthaff.27.2.w145. 5

U.S. Department of Health and Human Services, “Healthy People 2010: Understanding and Improving Health, (second edition)” A Systematic Approach to Health Improvement, last modified Jan. 20, 2001, http:// www.healthypeople.gov/2010/Document/html/uih/uih_2.htm 6

U.S. Department of Labor, Bureau of Labor Statistics, “Overview of BLS Statistics on Unemployment”, last modified June 4, 2010, http://www. bls.gov/bls/unemployment.htm 7

American Diabetes Association, Diabetes Basics, Diabetes Statistics, “Data from the 2007 National Diabetes Fact Sheet”, http://www. diabetes.org/diabetes-basics/diabetes-statistics/ 8

Agency for Healthcare Research and Quality, “Prevention Quality Indicators Overview”, AHRQ Quality Indicators, July 2004, Rockville, MD. http://www.qualityindicators.ahrq.gov/pqi_overview.htm 9

Economy/Demographics (pages 12-13) Brookings Institution, The State of Metropolitan America, On the Front Lines of Demographic Transformation, Executive Summary, 1, 2010, http://www.brookings.edu/~/media/Files/Programs/Metro/state_of_ metro_america/metro_america_execsum2.pdf 10

U.S. Census Bureau, “ACS Demographic and Housing Estimates: 2009. Data Set: 2009 American Community Survey 1-Year Estimates Survey: American Community Survey”, American FactFinder http:// factfinder.census.gov 11

The percentage of Medicare expenditures for post-acute settings such as nursing homes, hospice and home health has increased substantially in the last decade. National Center for Health Statistics. Health, United States, 2009: With Special Feature on Medical Technology, Hyattsville, MD, 2010, Table 142, http://www.cdc.gov/nchs/data/hus/hus09. pdf#listtables 12

U.S. Census Bureau, Population Division, Table 5, “Percent Distribution of the Projected Population by Net International Migration Series, Race, and Hispanic Origin for the United States: 2010 to 2050” (NP2009-T5), Release Date: December 16, 2009. The federal government treats Hispanic origin and race as separate and distinct concepts. In surveys and censuses, separate questions are asked on Hispanic origin and race. The question on Hispanic origin asks respondents if they are Spanish, Hispanic or Latino. Starting with Census 2000, the question on race asked respondents to report the race or races they consider 14

FULFILLING LIFE’S POSSIBILITIES

themselves to be. Thus, Hispanics may be of any race. U.S. Census Bureau, Population Division, Social & Demographic Statistics, U.S. Census Bureau Guidance on the Presentation and Comparison of Race and Hispanic Origin Data, 2003, http://www.census.gov/population/ www/socdemo/compraceho.html U.S. Census Bureau, State and County QuickFacts, “Household Income and Persons Below Poverty”, http://quickfacts.census.gov/qfd/ meta/long_IPE010204.htm 15

Florida Department of Education, Office of Education Information and Accountability Services, Data Report, Florida Public High School Graduation Rates, 2008-09, Series 2010-09D, Nov. 2009. 16

National Education Association, Office of Higher Education, Update, “Higher Education: Who Benefits?”, Vol 9, Number 3, May 2003, http:// www.nea.org/assets/docs/HE/vol9no3.pdf 17

Brookings Institution, The State of Metropolitan America, On the Front Lines of Demographic Transformation, Executive Summary, 1, 2010, http://www.brookings.edu/~/media/Files/Programs/Metro/state_of_ metro_america/metro_america_execsum2.pdf 18

Health Outcomes (pages 14-19) Centers for Disease Control and Prevention, A-Z Index, Chronic Disease Prevention and Health Promotion, last modified Jan. 5, 2011, http://www.cdc.gov/chronicdisease/; Council of State Governments Trends Alert, “Using Sound Science to Prevent Chronic Disease: State Policy Implications”, 2, www.healthystates.csg.org 19

American Heart Association, “Risk Factors and Coronary Heart Disease and Stroke”, last modified Jan. 20, 2008, http://www.americanheart.org/ presenter.jhtml?identifier=539 21

Altekruse SF, Kosary CL, Krapcho M, Neyman N, Aminou R, Waldron W, Ruhl J, Howlader N, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Cronin K, Chen HS, Feuer EJ, Stinchcomb DG, Edwards BK (eds). “SEER Cancer Statistics Review, 1975-2007”, (National Cancer Institute. Bethesda, MD, 2010) http://seer.cancer.gov/csr/1975_2007/ 22

American Diabetes Association, Diabetes Statistics, “Data from the 2007 National Diabetes Fact Sheet”, http://www.diabetes.org/ diabetes-basics/diabetes-statistics/?utm_source=WWW&utm_ medium=DropDownDB&utm_content=Statistics&utm_campaign=CON 23

National Alliance for Mental Illness, “Grading the States 2009 Report Card: Florida”, http://www.nami.org/gtsTemplate09. cfm?Section=Florida_Grades09&template=/contentmanagement/ contentdisplay.cfm&contentID=74682 24

Centers for Disease Control and Prevention, A-Z Index, “Injury Prevention & Control: Data Statistics (WISQARSTM)”, last modified Mar. 4, 2010, http://www.cdc.gov/injury/wisqars/index.html 25

UNICEF, Child info, “Monitoring the Situation of Children and Women, Statistics by Area/Child Nutrition”, last modified Nov. 2009, http://www. childinfo.org/low_birthweight.html 26

March of Dimes, Professionals, Medical Resources, last modified Nov. 2009, http://www.marchofdimes.com/Professionals/medicalresources_ teenpregnancy.html 27

Health-Related Behaviors (pages 23-24) American Heart Association, “Understand Your Risk for High Blood Pressure”, last modified July 30, 2010, http:// www.heart.org/HEARTORG/Conditions/HighBloodPressure/ UnderstandYourRiskforHighBloodPressure/Understand-Your-Risk-forHigh-Blood-Pressure_UCM_002052_Article.jsp 28

WedMD, “Hypertension/High Blood Pressure Guide”, http://www. webmd.com/hypertension-high-blood-pressure/guide/hypertensionhigh-blood-pressure-stroke 29

References (cont.) Health-Related Behaviors (pages 23-24)

Environmental Health (pages 28-31)

Centers for Disease Control and Prevention, A-Z Index, “Smoking and Tobacco Use”, last modified Sept. 15, 2010, http://www.cdc.gov/ tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/

Prof Salim Yusuf DPhil a, Steven Hawken MSc a, Stephanie Ôunpuu PhD a, Tony Dans MD a, Alvaro Avezum MD a, Fernando Lanas MD a, Matthew McQueen FRCP a, Andrzej Budaj MD a, Prem Pais MD a, John Varigos BSc a, Liu Lisheng MD a, on behalf of the INTERHEART Study Investigators, Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study, The Lancet, Volume 364, Issue 943B, 937-52, Published online Sept. 3, 2004 http://image.thelancet.com/ extras/04art8001web.pdf 31

Centers for Disease Control and Prevention, A-Z Index, Publications and Information Products, NCHS Health E-Stat, “Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1976-1980 Through 2008-2008”, June 2010, http://www.cdc. gov/nchs/products/hestats.htm 32

Centers for Disease Control and Prevention, A-Z Index, “Childhood Overweight and Obesity”, last modified Mar. 31, 2010, http://www.cdc. gov/obesity/childhood/index.html 33

Pleis JR, Lucas JW, Ward BW. Summary health statistics for U.S. adults: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Stat 10(242), 2009. 34

Centers for Disease Control and Prevention, A-Z Index, “Alcohol and Public Health Fact Sheets”, last modified Dec. 17, 2010, http://www.cdc. gov/alcohol/fact-sheets/binge-drinking.htm 35

Centers for Disease Control and Prevention, A-Z Index, “Breast Cancer: Rates of New Cases and Deaths”, last modified Oct. 20, 2010, http://www.cdc.gov/Features/dsBreastCancerTrends/ 36

Environmental Protection Agency, “New Report Shows Benefits of 1990 Clear Air Act Amendments Outweigh Costs by Four-to-One Margin”, last modified Sept. 10, 2009, http://www.epa.gov/history/ topics/caa90/10.htm U.S. Environmental Protection Agency, Air Quality Index - A Guide to Air Quality and Your Health, Aug. 2009, http://www.epa.gov/airnow/ aqi_brochure_08-09.pdf 46

U.S. Environmental Protection Agency, Air Quality Index - A Guide to Air Quality and Your Health, Aug. 2009, http://www.epa.gov/airnow/ aqi_brochure_08-09.pdf 47

Centers for Disease Control and Prevention, “CDC Recommendations for Improving Health through Transportation Policy”, Apr. 28, 2010, http://www.cdc.gov/transportation/docs/FINAL%20CDC%20 Transportation%20Recommendations-4-28-2010.pdf 48

The Sierra Club, “Clearing the Air with Transit Spending”, Nov. 2001, http://www.sierraclub.org/sprawl/report01/SierraClub_ SprawlReport2001_low-res.pdf 49

U.S. Department of Transportation, National Highway Traffic Safety Administration, Traffic Safety Facts, “Highlights of 2009 Motor Vehicle Crashes”, Aug. 2010, http://www-nrd.nhtsa.dot.gov/Pubs/811363.pdf 50

Website: Miami-Dade Matters: Better health through community, “Age-Adjusted Death Rate due to Motor Vehicle Collisions”, 2008, http:// www.miamidadematters.org/modules.php?op=modload&name=NSIndicator&file=indicator&iid=48 51

National Highway Traffic Safety Administration, “2009 Ranking of STATE Pedestrian Fatality Rates – State: USA”, http://www-fars.nhtsa. dot.gov/States/StatesPedestrians.aspx 53

Health Systems (pages 24-27) U.S. Centers for Medicare and Medicaid Services, Office of the Actuary, “Personal Health Care Expenditures by Object and Source of Payment: 2008”, Internet release date: Dec. 15, 2010, http://www.hhsstat.net/scripts/orgurl.cfm?orgabb=CMS-OA 37

Nelson, Mark. “Drug treatment of elevated blood pressure”, Australian Prescriber (33): 108–112, August, 2010, http://www.australianprescriber. com/magazine/33/4/108/12 38

Agency for Healthcare Research and Quality, Care of Children and Adolescents in U.S. Hospitals. HCUP Fact Book No. 4. AHRQ Publication No. 04-0004, (AHRQ: Rockville, MD, 2003). http://www.ahrq. gov/data/hcup/factbk4/ 39

Centers for Disease Control and Prevention, A-Z Index, Diabetes Public Health Resource, “Children and Diabetes SEARCH for Diabetes in Youth”, last modified Oct. 20, 2010, http://www.cdc.gov/diabetes/ projects/diab_children.htm 40

John M. MacDonald, PhD, Robert J. Stokes, PhD, Deborah A. Cohen, MD, MPH, Aaron Kofner, MS, Greg K. Ridgeway, PhD, “The Effect of Light Rail Transit on Body Mass Index and Physical Activity”, Am J Prev Med 2010; 39(2):105-112, http://download.journals.elsevierhealth.com/ pdfs/journals/0749-3797/PIIS0749379710002977.pdf 54

Centers for Disease Control and Prevention, CDC Features, “Food Deserts”, last modified July 5, 2010, www.cdc.gov/Features/FoodDeserts 56

U.S. Department of Agriculture, Food Environment Atlas, http://maps. ers.usda.gov/FoodAtlas/foodenv5.aspx 57

Centers for Disease Control and Prevention, A-Z Index, Diabetes Public Health Resource, “2007 National Diabetes Fact Sheet”, last modified Mar. 12, 2010, http://www.cdc.gov/diabetes/pubs/estimates07.htm#3

U.S. Department of Justice, Federal Bureau of Investigation, “Crime in the United States, 2009, National Data”, Table 1 and 1A, released Sept. 2010, http://www2.fbi.gov/ucr/cius2009/offenses/standard_links/ national_estimates.html

National Kidney and Urologic Diseases Information Clearinghouse, “Urinary Tract Infections in Children”, NIH Publication No. 07-4246, Dec. 2005, http://kidney.niddk.nih.gov/kudiseases/pubs/utichildren/

Community Assessment (pages 32-37)

State Health Access Data Assistance Center, “Health Insurance Coverage Estimates, CPS, All Ages, All Poverty Levels, United States: Calendar Year 2009”, http://www.shadac.org/datacenter/tables/tables/ id/e7162673-6f5d-4cf3-851e-628cffb34054 43

American Hospital Association,” AHA Guidance on Reporting of Community Benefit”, Nov. 27, 2006. 59

Internal Revenue Service, “IRS Exempt Organizations Hospital Compliance Project”, Executive Summary, Feb. 2009, http://www.irs. gov/pub/irs-tege/execsum_hospprojrept.pdf 60

Estimation based on 3.5% increase in Florida rates of uninsured. State Health Access Data Assistance Center, “Health Insurance Coverage Estimates Tables”, last modified Sept 20, 2010, http://www.shadac.org/ datacenter/tables/filters/id/f4906958-164b-4875-a562-0bf1fc2030d1 44

ONE BAY: Healthy Communities

Acknowledgements The Tampa Bay Partnership Regional Research & Education Foundation thanks the following organizations and individuals whose efforts, insights, and support were critical to the completion of this report. First and foremost, we thank BayCare Health System, Blue Cross Blue Shield of Florida, United Way of Tampa Bay, and the Allegheny Franciscan Foundation for their generous financial and intellectual support of this project. BayCare and Blue Cross Blue Shield have provided long-standing support to the Tampa Bay Partnership for many years, and we welcome the participation of our community partners from the United Way and Allegheny Franciscan Foundation who provide valuable insights and expertise from our community. The Steering Committee greatly informed the overall approach to the Initiative, the methodology and scope of this report. The Data Committee spent countless hours developing criteria, reviewing data, and co-authoring the Health Outcomes, Health Behaviors, Infrastructure, and Health Access chapters of this report. Special recognition goes to Denise Remus, PhD, RN, who not only chaired the Data Committee, but also provided wise counsel and insight into the numerous report drafts. Lynda Leedy, J.D., provided day-to-day management of the initiative including conducting a comprehensive community survey assessment, research assistance, and convening leadership and committees to guide the overall scope of this project. Zac Pruitt, Data Intern, Doctoral Student, at the University of South Florida for compiling the data sources for the indicators reflected in this report. Mr. Pruitt provided much needed, timely assistance to the Foundation in navigating and analyzing data from the various data sources. The project would not have been possible without his tireless effort. Healthy Communities Institute gave permission for us to utilize the descriptor language they have developed for their Healthy Communities Network system for our indicators in this report. Amy Lovett Dunn, BayCare, Laurel St. Clair, BayCare, Erica Rogers Maxwell, American Heart Association and Michael Manocchia, PhD, Blue Cross Blue Shield of Florida, gave generously of their time to critique, proof and edit drafts of this report. Stuart Rogel, President & CEO of the Tampa Bay Partnership, provided invaluable guidance and vision for this project. Other Tampa Bay Partnership staff members also contributed to data analysis, co-authoring, editing and design for this report including Elisa DeGregorio, Dave Sobush, Chris Steinocher, Betty Carlin and Kasey Smith. Laurie Beyer Weinberg, Beyer Design, provided the layout and design for the report.

Funding Partners Initial funding for the ONE BAY: Healthy Communities initiative to fund the research and development of this report comes from:

FULFILLING LIFEâ&#x20AC;&#x2122;S POSSIBILITIES

an initiative of

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