Community Health Assessment
... Nashville are homicide, heart disease, unintentional injury, cancer, HIV, and stroke in that order. The numbers for suicide in North Nashville were too small to calculate YPLL in 1996. Figure 1: Bar Graph of Potential Years of Life Lost Community Health 9 North Nashville had the highest rate of homicide premature mortality in Davidson County. In Figure2 below, the graph shows the national average for potential years of life lost with homicides. The rate of homicide premature mortality in North Nashville was 1760 YPLL per 100,000 population. This nearly triples the county average of 611.0 (Health Department, 1996) and is almost five times the national average of 378 YPLL per 100,000 populations. The comparison to the United States is even more significant because the U.S. statistics are calculated by YPLL per 100,000 population under age 75 as opposed to age 65. Figure 2: Bar Graph of Homicides Community Health 10 The second leading cause of premature mortality in North Nashville was heart disease. North Nashville doubled the county average. In Figure 3 below, the graph shows the number of deaths related to heart disease. The YPLL per 100,000 population was 1,593 in North Nashville compared the county average of 784. North Nashville was slightly higher than the US average of 1,475. The difference between the North Nashville statistics is more significant because the U.S. statistics are based on YPLL per 100,000 population before age 75, instead of age 65 like the Nashville statistics. Figure 3: Bar Graph of Heart Disease Community Health 11 North Nashville ranked second worst of the fourteen districts for premature mortality due to unintentional injury trailing only the East Nashville Inglewood district. In Figure 4 below, the graph shows the number premature deaths. The YPLL in North Nashville was 1,278 compared to a 967 average in Davidson County. The North Nashville district rate was slightly higher than the average U.S. rate of 1,057, but again the U. S. statistics were based on YPLL before age 75 as opposed to 65 as with the Davidson County rates. Figure 4: Bar Graph of Premature Death Community Health 12 The fourth leading cause of premature mortality in North Nashville is cancer with 1,047 YPLL compared to the county average of 880. North Nashville ranks fourth worst in the county in this average. In Figure 5 below, the graph shows the number of deaths related to cancer. Figure 5: Bar Graph of Cancer Community Health 13 The fifth leading cause of premature mortality in North Nashville is HIV/AIDS with 915 YPLL. This ranks North Nashville as second worst in the County only behind Berry Hill/Woodbine district. The County average for this category is 517. In Figure 6 below, the graph show the number of death related HIV/AIDS cases. Figure 6: Bar Graph of HIV/AIDS Community Health 14 Stroke is the sixth leading cause of premature mortality in North Nashville. North Nashville had the most YPLL of the five districts in Davidson County with a rate high enough to calculate. North Nashville had a rate higher than the U.S. average and was more than double that of Davidson County. In Figure 7 below, the graph shows the number of stroke cases that result in death. Figure 7: Bar Graph of Cancer Related Deaths The most positive statistic expressed by North Nashville is the suicide mortality rate. Along with five other districts the North Nashville district had too few deaths to calculate. The County average was 367 YPLL compared to the U.S. average of YPLL. Community Health 15 North Nashville ranked the highest in three of seven categories for premature mortality and has the second highest in two out of the seven categories. The best ranking North Nashville had in mortality rate was the fourth highest and had one category in which there were too few deaths to calculate a YPLL rate. The birth rate for North Nashville ranked them sixth out of the fourteen areas with 60.6 births per 1000 females ages 15-44. The county average was 62.2 and the U. S. average was 65.7 births per 1000 females respectively. Although this statistic puts North Nashville lower than the averages, the adolescent birth rate ranked the area first with an average of 40.3 births per 1000 from ages 10 to 17. That leaves only 20.3 births per 1000 females for ages 17-44. Therefore, there were 20.3 births per 1000 for ages 10-14, one third of the entire rate for North Nashville. The Davidson County adolescent birth rate was 20.0 per 1000 females and for the U.S., that is 14.0 per 1000 females in this category. North Nashville ranked third in the county with 48.3 per 1000 females ages 10-19. The county average was 37.7. Comparisons of this data reveal that only 8.0 births per 1000 females occurred in females age 17-19 years. North Nashville had the second to last percentage of first trimester entry into care at only 82% compared to the Davidson County average of 89%. The adequate number of uncomplicated pregnancy visits for mother and fetus is expected to be ten or more. North Nashville had an average of 10.7 the County of 11.8 visits and the U. S. averaged 12.2 visits. Community Health 16 North Nashville had the highest percentage of low birth weight infants, which includes infants born weighing less than 5.5 pounds, with an average of 16.0%. The county average was only 8.6% and the U. S. average was 7.4% 1996. The very low birth rate includes infants weighing less than 3.5 pounds. This comparison ranks North Nashville third in the county at 3.2%, nearly two times the county average of 1.9%, and almost three times the National average of 1.4%. When looking at the average infant mortality rates from 1990-1996, North Nashville ranked second highest with an average of 12.6 per 1000 live births. The county average was 9.3. The National rate in this category was 7.2. Housing Data The community of North Nashville is primarily comprised of residential areas and more than a third of Davidson County’s public housing units. According to the Health Status of Davidson County 1990-1996, 21 % of these households receive public assistance, 75 % are single female households, and 14 % have no health insurance which ranks it the third highest in Middle Tennessee. Morbidity From the 1990-1996 report, North Nashville had the lowest percentage of residents reporting that their health was good. Approximately 38% of the residents reported no exercise in the last thirty days, ranking it the second highest. North Nashville reported that 39% had high Community Health 17 blood pressure, 30% had high cholesterol, 54% always wear seat belts, 31% are smokers, and 40% drank alcohol in the last thirty days. There were 1,210 new cases per 100,000 persons reported in 1996, the highest in Davidson County. There were 212 cases of syphilis reported in North Nashville, making it four times higher than the county rate. There were 1,387 new cases of gonorrhea cases reported making it the second highest in Davidson County. They have 50% new gastrointestinal infections. In the health risk factor category, North Nashville scored near the last of ranking in all categories but two. Knowledge About the Environment Land use The North Nashville land use is predominately residential. The area is located directly north of the downtown Nashville and contains only 1.5% of the Davidson County’s land area. This is the fourth smallest of the fourteen districts and with an approximate population of 24,377. Within this area, there is a university, a medical school and distribution park. (Planning Districts Profiles, 2002). Low income, newly built housing is now available for families with funding from the government grants. There is also a small shopping center within the north Nashville area. A very small portion of the land use is industries, park or recreation and retail stores. Police and Fire Protection The West Patrol Bureau is comprised of several sectors, which includes the north Nashville sector. Their responsibility includes serving and protecting the community. The north Community Health 18 sector now has a new location on Clarksville Highway. This sector is responsible for several districts but field operations are primarily in the north Nashville area. However just like many professions manpower is problem. Metro budgeting has been a prevailing concern for inadequate staffing within the department. Also salary has accounted for inadequate manpower. There overall goal is to provide quality services thereby decreasing the amount of crime and incidences within the area (Planning Districts, 2002). The police department provides several services and programs in the community. Some of the programs include Drug Abuse Resistance Education or DARE, Police Explorers, Boy Scouts Crime Prevention Merit Badges for school-age children. These programs allow children who are high risk for committing crimes or displaying destructive behavior to explore other constructive options for dealing with life challenges. The total number of fatal and nonfatal crimes and incidences in the north Nashville district ranks the second among all fourteen districts. In helping to provide quality services the police department works closely with the Nashville fire department. The Nashville fire department comprises of several bureaus that service the Nashville area at large. The organizational chart includes the Fire/EMS Bureau, Paramedic/EMS Bureau and Community Services Bureau. The Fire/EMS Bureau is the largest bureau in the department. There are a total of seven districts that service the Metropolitan population, which include the north sector. The Fire/EMS responds to all fire and medical incidents. Other areas within the department to help provide quality protective services are the Special Hazards/Water Rescue division and a Health and Safety Division. Community Health 19 Transportation The most widely used form of transportation in the north Nashville is the MTA (Metropolitan Transit Authority). The MTA offers a variety of services to the community from the school-age child to the disabled. In this district the MTA is easily accessible and provides frequent scheduling and routing. Many of the routes in the area are very close to General Hospital and public housing. Some of the services that are provided include Quest Youth Bus Service, which provides low fare transportation to children who need transportation to school. One of the major services is reduced fare and disability accessible vans/buses for senior citizens and individuals with disabilities. General fare for transportation is $1.75 and 10 cents for transfers to another routing. Quest Youth Fare is 90 cents and the fare for the disabled and senior citizens is 35 cents. The goal of the MTA is to provide safe and reliable transportation to those that utilize the system. Special Hazards The Engineering Services is responsible for conducting, promoting and protecting public health and the environment. Services provided range from soil interpretation, subsurface sewage disposal systems, and land use development, pollution and public sanitary sewers. Under the same department they also enforce the health and sanitation codes in the entire Metropolitan and Davidson County. The overall sanitation, garbage disposal, and sanitary sewers in the north Nashville are have improved over the past three years. In working with landowners and developers and other agencies by enforcing rules and regulations have minimized public health hazards within the community. Community Health 20 Channels of Communications Service Organizations There are many channels of communication in the north Nashville area. These services are provided to the community at no charge. Family Life Center offers clothes to women and children. Focus provides bus tickets, passes, and gas. Religious Organizations The religious organization service has the largest source of communication. There are a wide variety of churches in this area. There are approximately 40 different churches throughout the north Nashville area. Many of these organizations provide numerous services the community at large. The largest denomination in the area is Baptist. Lutheran Family Services of Tennessee is part of the Second Harvest Food Bank that provides food assistance. Voluntary Health Organizations Samaritan Ministries is also available to provide clothes, medical, dental, food bank, and referrals. Community Actions Groups The community also has access to the Metro Action Commission. They are a non-profit organization and help to fight poverty by facilitating self-sufficiency of the residents. The eligibility for their services is based on income. Metro Action Commission provides emergency services, Head Start, WIC, family development, employment/employment training, income management, transportation, housing, health care, and economic development. Community Health 21 They offer a program called Summer Food Services for children that provides a nutritionally balanced meal for low-income children that participate in lunch programs during regular school year. This program is available though age 18 and for the disabled until age 25. Emergency Assistance Program meets some basic needs for low-income families for a short term during an emergency of crisis. Some other services that are offered include medical supplies, utility assistance, bus tickets, rent or mortgage assistance, car repair, eye exams, temporary shelters, fan and air conditioners for the elderly and disabled, and home repairs. Newspapers, Radio, Television The newspaper, radio and television provide easy accessible communication. The Tennessean is a daily metropolitan paper. Another major source of information is the Tennessee Tribune, which is Nashville’s leading black newspaper. The office is located on Jefferson Street, in the North Nashville district. For many individuals television serves has a major source of communications through a variety of cable stations and local channels. Some major sources of informal communication are markets, barber shops, and hair salons. Data About Health and Health Related Facilities Geographically Accessible North Nashville has one major hospital and several dental and medical clinics. This community also has a wide range of resources to offer these residents. These facilities are in close proximity to many of its residents. Community Health 22 Inter-relationships between Neighborhood Health Clinics, Health Department, and Satellite Clinics Matthew Walker Comprehensive Health Center is a community health center. Mathew Walker offers many services such as adult care, pediatric care, prenatal, obstetrical and gynecological, immunizations, lab, pharmacy, radiology, podiatry, nephrology, dental, and mental health services. They support several community health programs such as family planning, health education, social services, and transportation. Matthew Walker is a provider that is associated with the Tennessee Primary Care Association, or TPCA. TPCA are not-for-profit, consumer directed healthcare corporations that work to provide cost-effective, high quality care to underserved and uninsured people. They work to strengthen community-based primary health care systems in Tennessee. They help to identify needs that are unmet and assist to develop care systems, advocate primary care resources, and promote awareness of migrant and community health centers and the services that are provided. Matthew Walker helps to bridge the widening gap that exists between community needs and the decision-makers at all levels of the government. TPCA members are health care consultants, primary health clinics, schools for health professions, and those that are interested in improving the community. These centers are federally funded. Providers meet the rigorous federal standards for quality health care and services. They also qualify to receive reimbursement from Medicaid and Medicare. Community Health 23 Hospital Facilities/Long Term Care Facilities/Home Health Care Agencies/Hospices Nashville General Hospital offers a wide range of services to the community including oncology, ophthalmology, cardiac catherization, surgery, emergency department services, mobile crisis unit, neonatal intensive care, physical and occupational therapy, social services, and dental services. The hospital has a language interpretation program that speaks Spanish, Kurdish, and American Sign Language. Nashville General Hospital also offers different community programs. One of these is the Super Sixty Plus program that is free and open to the public. This program helps to promote good health for seniors through free blood pressure checks, lunch, games for fun and learning, while listening to speakers on topics like hypertension, memory loss, elder abuse, and diabetes. They also participate in various screenings and health fairs offering blood pressure screening and health information and services. Insurance is not required and payments are arranged on individual needs. They are committed to providing equal quality care that is accessible to everyone. Meharry Clinic is a medical and dental clinic. The clinic offers adult services, pharmacy, social services, dental services, and eye care. The Meharry Medical Services Foundation through the college manages this clinic. They allow for clinical training for medical residents. The clinic also provides care to a diverse group of patients with emphasis on those who are uninsured or underinsured. They provide community-based health care services. Research is performed while placing an emphasis on the underserved communities, health conditions, and diseases that affect ethnic minority populations. Community Health 24 There are many pharmacy resources for the indigent and seniors. Some of the local pharmacies include Genesis, Metro Public Health Department, and United Neighborhood Health Services. There are also pharmaceutical companies that offer services for low-income families such as Bayer Corporation, Bristol-Myers Squibb Company, Eli Lilly and Company, Hoechst Marion Roussel, Novo-Nordisk Pharmaceuticals, Phizer Inc., Merck, Abbott Labs, and Adventis. There are currently no long term facilities, home health care agencies, or hospices located in the community of North Nashville Emergency Clinics There are no emergency clinics located in this community. However, Nashville General Hospital does offer emergency services for North Nashville. Health-related Support Groups Nashville General Hospital as well as Meharry Clinic offers several support groups. They include groups for diabetes, cancer, and HIV/AIDS. Prioritization of Health Problems By working on three major community issues, North Nashville can improve on several health related issues. The three health problems that have the greatest priority placed on them are education, teen birth rate, and homicide. The community health nursing care plan for North Nashville is as follows: By improving the lev...