This is a community health assessment of a virtual city called Sentinel City. As the location of this city is unknown a direct comparison to other cities is impossible to perform. The city was subdivided into four districts that vary in population, income, and quality of living. There are countless community health concerns found throughout the city ranging from social in addition financial to environmental. There is a multitude of service available throughout the city but have not been utilized to their full potential.
B. Identification of Community: Assessment of Needs and Risks
- Demographics / Population Economic Status
The total population of Sentinel city in 2017 was 663,862 with 80.6% whites, 10.4% Black, 2% Native American, 3.7% Asian, 0.2% Hawaiian/Pacific Islander, 3.1% two or more races. Whichc is further broken down into 31.5% Hispanic or Latino and 52.7% non-Hispanic white. The median household income was $49,091, with 18.9% of the populous living below poverty level. The age breakdown is 7.4% under 5 years of age, 21.7% under age 18, 60.4% are over 18 and under 65 years old, 10.5% over age 65. (Sentinel City: Sentinel City, n.d.)
The Nightingale Square district has a population of 103, 974 which, primarily has a White population of (81.3%) followed by Hispanic (3.7%). The average household income was $269,550. The Acer Tech Center had a population of 168,390 majority of the population is white at (70.2%) and Latino (13.7%). The average household income was $166,300. The Casper Park District had the biggest population within the city at 352,643, which was largely white (63%) followed by Hispanic (24%). The median household income was $80,134. The Industrial Heights district had a population of 38,855. The governing culture was Hispanic (46%) and the secondary was Black (13.1%). The average household income was the lowest in the city at $24,672. (Sentinel City: Sentinel City, n.d.)
- Neighborhood/Community Safety Inventory
Nightingale Square appeared well kept and clean with only a few exceptions. There was garbage noted outside of Joe’s Grocery store with by a stray cat. The door to the Nightingale Square apartments was full of graffiti. At the edge of the district towards Acer Tech Center there was trash on the roadside.
Acer Tech Center was in the process of being refurbished but had some debris by the buildings. A train could be heard running on a track overhead. There were several policenoted through-out the streets of this area.
Caster Park District had an overgrown abandoned lot. The lot may have been a homeless camp site as there were burning barrels, and piles of crates and debris. A stray dog was wandering in the lot. There was trash accumulated in the corners of buildings. Containers were noted with flammable symbols at the construction site close to what appeared to be a sewage leak.
Industrial Heights had a fenced area with rusting barrels marked as hazardous material. A factory smokestack could be seen with smoke comeing from it . Debris was observed floating in the air.
Of the population 26% consme alcohol, 24% tobacco, 13% Marijuana, 8% Heroin, 6% cocaine, 6% CNS depressants, 3% club drugs and 1% methamphetamines. Furthermore, to these 12% of all prescriptions filled within Sentinel City in the last year was for hydrocodone. (Sentinel City: Sentinel City, n.d.)
Of the crimes committed within Sentinel City 23% of arrests were for cannabis, 17% battery, 16% controlled substance, 9% criminal trespassing, 6% reckless conduct, and 6% public intoxication. The response times of EMS are 7.46 minutes on average. (Sentinel City: Sentinel City, n.d.)
Observable gang violence within the Industrial Heights area was noteable. A car was set on fire and a store front with smashed windows was barricaded off with crime scene tape. Consitent with the data set within the last year there had been approximately 19 homicides, 35 simple assaults, 40 robberies and 95 aggravated assaults. (Sentinel City: Sentinel City, n.d.)
- Windshield Survey
The Nightingale Square area was clean and well maintained. The buildings are well constructed of brick and concrete. There were trees along the streets with several open green spaces noted. Several restauranst availale. There was a gym, pharmacy, dental office, health system, tattoo parlor, convenience stores as well as a large gas station. There was a large condominium. Joe’s Grocery store was a large market that appeared to have plentiful supply of goods. Billboards advertise recycling. There was a large recreational center with people playing on courts. People were excercising throughout the streets. Groups of people were gathering across from Joe’s watching street performers. There were cars parked on the road side and bus stops noted.
Acer Tech Center was fairly clean with some debris seen on roadsides. The buildings are conctructed of brick and concrete. People were observed using bikes for transportation and walking. A police officers were seen walking the streets. There were several restaurants, a coffee shop, a barber’s shop, City Center Historical Hotel and a large farmer’s market providing fresh fruits and vegetables to the residents. Dogs were observed both on and off leash. A group of protestors were noted outside of City Hall. A train could be heard on an overhead track. People were using cars, bikes and walking. Green grass and shrubs were noted around the City Hall. Trees could be seen along the streets.
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Casper Park District was more rundown. The buildings were older and made of brick. Trash was seen in the corners of the buildings. Trees were seen lining some streets. There were signs for a business redevelopment project coming soon. A coffee shop, a doughnut shop, bookstore, several small grocery stores and multiple check cashing stores were noted along with a sushi shop. There was a small produce stand. This section of the city included the Casper Senior Living Center and the ABC Daycare. There was a large overgrown lot with graffiti, piled up crates, a stray dog and burning barrels. The lot had the feel of a homeless encampment. Several strays roamed the area including dogs, cats and a feral rabbit. Billboards advertise for flu vaccines, fighting addiction and not to text and drive. There appeared to be a sewage leak and behind it large containers with a flammable product within them. A motorcycle was noted among the pedestrians. Numerous construction workers were noted in this area.
The brick buildings of the Industrial Heights district appear run down. There was a factory smokestack billowing smoke, a fenced area with hazardous material in rusting barrels, burning trash cans and debris falling like snow. There was a large amount of graffiti. A building with smashed windows was blockaded behind a fence and had crime scene tape on the door. There was a busy soup kitchen behind the church. A school with a nice playground was filled with children. Trees were seen lining the street. A burning car was possibly the result on gang violence. There was check cashing stores and one convenience store. There was an obvious lack of retail services in this area and no fresh food seen. Billboards advertised to stop smoking and against teen pregnancy. There were multiple concrete barricades at the boarders of this area.
- Population Health Scavenger Hunt
Parks and Recreation: Offers Swimming lessons, Nutritional Courses, Gardening Courses, Kids summer programs, City sports leagues, Adult Fitness Courses and After School Programs. The budge for Parks and facilities has dropped significantly from year one but has increased in programs. The most common complaint was park location (40%) followed by crime (15%), drugs (15%) and stray animals (15%), then homeless population (10%) and lastly cleanliness (5%). The most common citations were for Trespassing after hours (31%), violent crimes (24%), Intoxication and drug use (16%), littering (11%), prostitution (9%). (Sentinel City: Sentinel City, n.d.)
Healthcare System-Elderly Services: Seniors used the following services in the last year Transportation (6.5%), service animals (2.5%), Meals on Wheels (1.3%), 0.95 elder abuse prevention advocates (0.95%), community centers (2.9%), government entitlement assistance (7.6%), medical care advocates (8.3%). Living options for seniors consist of Independent Senior Apartment units 1048, Senior Living Center Units 3472, Nursing Home Units 2874, Assisted Living Units 248, Skilled Nursing Care Beds 64, Long term care 36, Swing-Beds 24. (Sentinel City: Sentinel City, n.d.)
The incidents of services utilized were as follows. City Hall-Social Services: Adult and Child Protective Services provided Adoption assistance (425), Head start & early head start (110), Youth Independent Living services (90), Safe at home program (25), Child care provider accepting subsidized benefits (25). Healthcare Assistance provided Medicare over 100,000, ACA under 40,000, Medicaid under 20,000 and a small percentage of charitable healthcare. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC): 70 infant/children, 11 Breastfeeding, 10 pregnant, 9 postpartum. Supplemental Nutrition Assistance Program (SNAP): Recipients last year 24,359 Low income persons, 17,359 Disabled persons, 15,320 Persons in training programs, 9,953 Elderly, 60+ years. (Sentinel City: Sentinel City, n.d.)
Community Health Center: Services provided include Contraceptive services, Pregnancy testing and counseling, Achieving pregnancy, basic infertility services, sexually transmitted disease services, Breast cancer screening, cervical cancer screening, other preventative health services. The rate of teen pregnancy had dropped from well over 800 in year 3 to just over 400 last year. There is no statistical data indicating the number of new cases of STDs diagnosed in the last year. The data set indicated the percentage of new cases of STDs between the individuals age 15 to 25 and over 25. The overall new cases seem to be largely in the over 25 population especially Hepatitis B and HIV. The most prevalent STDs in ages 15-25 was Gonorrhea and Chlamydia. (Sentinel City: Sentinel City, n.d.)
Soup Kitchen: The Soup kitchen served between 40,000 to 50,000 meals per month. The recipients included Homeless Adults (64%), Disabled Adults (7%), Elderly (6%), Healthy Adults (6%), Homeless children (3%), healthy children (2%). (Sentinel City: Sentinel City, n.d.)
Affordable Housing Project: The average renters’ income by unit had dropped each of the last five years. Last year average renter’s income occupying the 2 bedroom units was just over $30,000, 1 bedroom unit was under $30,000 and studio unit was under $20,000. The majority of the occupied units are 2 bedrooms with only a small number of vacancies. The studios were about three-fourths occupied, while only about half of the 1 bedroom units were full. Crime in the city had gone down in recent years dropping from 3900 incidents three years ago to 2100 incidents, but remains higher in this area. Of the 2100 reported crimes city-wide 420 were in the area of the low-income apartments and 14 were on property. The most common tenant complaints were factory smoke (21%) followed by dogs barking (18%), Noise (17%), loitering (13%), high rent (10%) and police activity (6%). (Sentinel City: Sentinel City, n.d.)
B1. Analysis of Collected Data
As 18.9% of the populous living below poverty level, there was a myriad of problems stemming from this. A significant portion of the population in the Industrial Heights and Casper Park District were health uninsured, at 37.5% and 22.7% respectively. Of students in higher education 67% have no student health services, 24% have limited student health services and only 9% have comprehensive student health services. Although there were no data sets indicating obesity levels, health problems that obesity can contribute to are prevalent within Sentinel city. Heart disease may be a problem as Sentinel City EMS had to treat ventricular fibrillation at a significantly higher rate to the comparison cities at over 140. The pharmacy also prescribed a significant percent of lisinopril, amlodipine, hydrochlorothiazide to treat high blood pressure. There are 6 cardiology practice within the city. The second most common medication filled at the pharmacies is simvastatin, which indicates that high cholesterol is prevalent in the population. Insulin and metformin were also in the top eleven prescribed medications, showing a prevalence of diabetes in the cities inhabitants. (Sentinel City: Sentinel City, n.d.)
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In addition to the residents living near or below the poverty line there is an unknown number of homeless individuals living within Sentinel City. The soup kitchen statistics indicated that 70% of the meals were administered to the homeless. Thirty-five percent of the complaints about the city parks were in regards to the homeless population which had increased from only ten percent five years ago. (Sentinel City: Sentinel City, n.d.)
According to the data set, 27% of children receive free or reduced lunches. The source of calories consumed by children age two through nineteen was 7% from school, 14% from fast food, 5% from restaurants, 67% from home and 7% other. Adults consume 68% at home, 13% fast food, 10% restaurants and 9% other.
There has been an increase in childhood vaccinations, 50% of all students having received vaccinations up from approximately 20% five years ago. (Sentinel City: Sentinel City, n.d.) Although this was significant progress it falls well below the national average and the goal of 90% by Healthy People 2020. (“Healthy People: Immunization and Infectious Diseases,” 2017)
On the windshield survey pollution was observed but air and water quality reports on Sentinel City were unavailable. The most common complaint for residents of the low-income housing was factory smoke. The most common medical issue among collage age students was respiratory complaints which may be result from the poor air quality.
Food safety was a problem in the city both in the grocery store and restaurants. An alarming 90 cases of food-borne illness was reported from seafood and almost 60 from poultry at Joe’s Grocery in the last year. Restaurant food safety violations included cleaning and washing (6), food storage (5), heating/cooling food (3), and bugs/rodents (2). Each of these violations were up one incident from the prior year. (Sentinel City: Sentinel City, n.d.)
There is a lack of pet responsibility. Approximately 60% of owned pets are unregistered. A mere ten percent of the animals entering shelters have been spayed or neutered. Of the animals entering the shelter, 32% of the animals were reunited with their owners and 26% were adopted out. The result was 2,040 animals being euthanized last year. (Sentinel City: Sentinel City, n.d.) According to the ASPCA, of the 542,000 dogs and 100,000 cats that are brought in each year only about 26% of dogs and 5% of cats are returned to their owners. Which indicates a higher than average pet return rate inspite of the lack of pet registration. (Shelter Intake and Surrender, n.d.)
C1. Community Diagnosis by: Identification of Top Three Problems in Sentinel City Comparing the Top 3 Problems in Relation to Problems to Healthy People 2020
Sentinel City is faced with multiple challenges but a large cluster of problems fall under the Healthy People 2020 topics and objectives category of nutrition and weight status. This topic covers both obesity and malnutrition as well as heart disease, hypertension, dyslipidemia and other weight effected medical problems. This overlaps with the second objective topic of Heart disease and stroke. In addition to this problem Environmental Health concerning air and water quality was a significant problem in this city. (“2020 Topics and Objectives,” n.d.)
C2. Selected #1 Health Problem and Availability of Community Resources
Nutrition and weight status is the number one concern with in Sentinel City. As 18.9% of cities inhabitance living below there is high likely hood of food insecurity. “Food Security is defined as the assured access at all times to enough food for an active, healthy life, as well as enough food that is safe, nutritious, and acquired in socially acceptable ways.” (Edelstein, 2011, p. 71) If this problem was properly addressed a number related problems could be controlled. Poor nutrition is linked to obesity, hypertension, high cholesterol, heart disease, diabetes, stroke, gout and cancer. (Ajmera, 2015) It is assumed that this is a problem in the city as evidence by the large number of blood pressure medication prescribed as well as medications for high cholesterol and diabetes. In addition, the high incidence of ventricular fibrillation treated by EMS, indicate a higher than average occurrence of heart disease. The Casper Park District had a lack of access to fresh foods as well as a low-income level. The city has a large famers’ market in the Industrial Heights area, if a Farmers’ Market Nutrition Program (FMNP) could be established with in the Casper Park District it would allow access to healthy, local, fresh foods to a large at-risk population. The City Hall Social Service could apply to the state for a grant for the FMNP to provided coupons to WIC participants and seniors. The coupons allow the participant to buy foods from famers and farmers’ markets that have been authorized by the state. (“Farmers’ Market Nutrition Program (FMNP),” n.d.) The Project for Public Spaces (PPS) suggests that the interactions at a farmers’ market is a social experience that enhances a sense of community among the participants. (“PPS,” n.d.) The Parks and Recreation department already provides nutritional and fitness courses. These programs need to be targeted to the at-risk population and marketed aggressively. The nutritional programs should encourage the my plate method as an easy guideline for choosing the appropriate proportions of each food type. (“Choose My Plate,” n.d.) Further education on the DASH Diet would benefit those with or at risk of obesity, hypertension and diabetes. The DASH Diet teaches healthy eating of foods in their natural and unprocessed forms. It has been proven to lower blood pressure and help participants lose weight. (“Dash for Health,” n.d.) A weight loss as small as 5% will decrease obesity related risk factors such as heart disease. (Sample, 2016)
C3. Identification of Primary Prevention Topic
The primary prevention concern identified was Obesity/Nutrition. In the top eleven medications prescribed with in the last year, eight of them can be related to obesity and nutrition. Simvastatin for high cholesterol (>10%), Lisinopril for hypertension (10%), Levothyroxine for hypothyroid may be exacerbated by obesity (>8%), Amlodipine for hypertension (just under 8%) Omeprazole for acid reflux is also exacerbated by obesity (just under 8%), Metformin for diabetes (approximately 5%), hydrochlorothiazide for hypertension (approximately 5%), and insulin for diabetes 4%). The EMS responded to over 140 ventricular fibrillations within the last year. The closest comparison city was less than 120. The city supports the need for 6 cardiology practices and performs approximately 25,000 cardiac surgical procedures annually. The average hours a day high school students participated in sport, exercise and recreation was an alarming 0%. (Sentinel City: Sentinel City, n.d.)
The inhabitant of this city need to establish a healthier life style. There needs to be an increase in physical activity and an improvement in dietary habits. They need add fresh fruits, fresh vegetables and minimally processed foods to their diet. Fast foods and prepackaged foods that are high in sodium, fats and carbohydrates need to severally limited or avoided all together if possible. The schools and aftercare facilities should ensure that the children are provided with a healthy balanced diet. This will help to establish healthy lifestyle, give them energy to learn, play and grow. The Soup Kitchen and other community resources that provide nutrition must also facilitate healthy eating practices. Unfortunately, processed and prepackaged foods tend to be cheaper and quicker to prepare that fresh foods, but they offer less nutrient and are laden with unhealthy preservatives. Classes within the school and the community should emphasize exercise and healthy nutritional choices. If these changes can be made the overall health of the community will improve.
D. Application of Learning from Simulation to Future Community Assessment Strategies
The Sentinel City simulation has allowed me to practice the skills I will need to perform a community health assessment in my own community. It provided a safe environment to test out each step and easily return to follow up and areas I needed more information on. This will ensure I have a better understanding of the information I will be looking for when I ride out in my own community and efficiently collect that data I require.
- 2020 Topics and Objectives. (n.d.). Retrieved 6/1/2017, from http://healthypeople.gov/topics-objectives
- Ajmera, R. (2015). The Effects of Poor Nutrition on Your Health. Retrieved from www.livingstrong.com/article/31172-effects-poor-nutrition-health
- Choose My Plate. (n.d.). Retrieved 6/1/2017, from http://www.choosemyplate.gov
- Edelstein, S. (2011). Nutrition in Public Health (3rd Edition ed.). Retrieved from https://wgu.vitalsource.com/#/books/978128407946/cfi/0!/4/2/2@0:087.5
- Farmers’ Market Nutrition Program (FMNP). (n.d.). Retrieved 6/1/2017, from http://fns.usda.gov/fmnp/overview
- Farmers Markets as a Strategy to Improve Access to Healthy Food for Low-Income Families and Communities. (n.d.). Retrieved from http://pps.org/wp-content/uploads/2013/02/RWJF-Report.pdf
- Immunization and Infectious Diseases: National Snapshot. (2017). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topics/immunization-and-infectious-diseases/national-snapshot
- Sample, I. (2016). Small Weight Loss Brings Big Health Benifits for Obese Patients. Retrieved from http://theguardian.com/science/2016/feb/22/small-weight-loss-brings-big-health-benefits-for-obese-patients
- Sentinel City: Sentinel City. (n.d.). Retrieved May 27, 2017 from http://citl.americansentinel.edu/twine/SC2.3_Healthcare System – Storyline output/story.html
- Shelter Intake and Surrender. (2016). Retrieved from http://www.aspca.org/animal-homelessness/shelter-intake-and-surrender/pet-statistics
- The Dash Diet Eating Plan. (n.d.). Retrieved 6/1/2017, from http://dashforhealth.com/about-dash-diet/dash-diet-menu-plan/.
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