Rockdale County Health Priorities: Demographics, Determinants, and Community Resources, Lecture notes of Public Health

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ROCKDALE COUNTY

Community Health Assessment

Community Health Improvement Plan

MOBILIZING FOR ACTION THROUGH

PLANNING AND PARTNERSHIPS

Table of Contents

Background

About the Rockdale Health Department

The Rockdale County Health Department continuously monitors the health status of the community to identify health problems, educate the public on ways to reduce health risks, and promote better health through individual contact and media interactions.

We regularly participate in and mobilize community groups to develop policies and action plans to improve the health of Rockdale community members. The health department enforces laws, regulations, and ordinances that protect health and ensure safety. Working together to provide these vitally important, essential public health services, we can improve the quality of life for everyone in the community and state.

Our Mission To protect and improve the health of our community by monitoring and preventing disease; promoting health and well-being; and preparing for disasters.

Our Vision A healthy, protected, and prepared community.

Our Values Availability: We will be available to our clients through emergency preparedness services, disease and outbreak investigations, expanded hours and readily available services. Affability: We will work to ensure our clients have a good experience at our clinics. We will treat clients, co-workers, partners and others in our community with respect. We will value our employees. Ability: We will work toward a high level of competency in all areas of service. Accountability: We will be good stewards of the funds and materials we receive. Adaptability: We will always look forward to meet the current and future needs of our community.

Purpose of This Report

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity -World Health Organization (WHO)^1

This report represents the information gathered through conducting a combined community health assessment (CHA) and community health improvement plan (CHIP) for Rockdale County, Georgia. By examining the county’s standing regarding key health indicators in tandem with community leader and member input, this combined CHA/CHIP will serve as a foundation for collaborative effort toward addressing the most important health needs of Rockdale County residents. This community-wide health assessment is intended to help shape coordinated community plans to improve health.

This report focuses not just on disease indicators like death rates and case counts, but also on the many factors that influence health, which include income, housing, demographics, education, and transportation. It also places an emphasis on community involvement as a means to truly understand the reality of health, well-being, and quality of life in the community. Because of this, both secondary quantitative data and primary qualitative data are included to provide a well- rounded perspective of health in Rockdale.

This report was done in collaboration with Rockdale Coalition for Children and Families, with tremendous support from Executive Director, Michael Hutcheson. Additional support was provided by University of Georgia Master of Public Health and Master of Social Work Candidate and GNR Health Intern, Haley Miranda.

(^1) World Health Organization http://www.who.int/about/definition/en/print.html

Table 1. The Six Phases of the MAPP Process

Six Phases of the MAPP Process

Phase One: Organize for Success

Community members and agencies form a partnership and learn about the MAPP process.

Phase Two: Visioning

Those who work, learn, live and play in the MAPP community create a common understanding of what it would look like to achieve a healthier community.

Phase Three: Four MAPP Assessments

Qualitative and quantitative data are gathered to provide a comprehensive picture of health in the community.

Phase Four: Identify Strategic Issues

The data are analyzed to uncover underlying themes that need to be addressed in order for the community to achieve its vision.

Phase Five: Formulate Goals and Strategies

The community identifies goals it wants to achieve and strategies it wants to implement related to strategic issues.

Phase Six: Action Cycle

The community implements and evaluates action plans to meet goals, address strategic issues, and achieve the community’s vision.

Four main assessments are included in Phase Three of the MAPP process, including the Community Health Status Assessment, Community Themes and Strengths Assessment, Local Public Health System Assessment, and Forces of Change Assessment.

The Community Health Status Assessment was utilized during focus groups we conducted with residents of Conyers Public Housing and high school students in August and November of 2018. The survey used was adapted from an assessment done by the San Antonio Metropolitan Health District in San Antonio, Texas.

The Community Themes and Strengths Assessment was addressed through interviews with community members. Throughout the months of March and April in 2018, the Community Health Coordinator at the Gwinnett, Newton, and Rockdale County Health Departments conducted Key Stakeholder Interviews with representatives from various community agencies to gather their insight on health, wellbeing, and quality of life in Rockdale County.

To conduct the Local Public Health System Assessment, we identified organizations and individuals to represent each of the 10 Essential Public Health Services. Each of these organizations and individuals was then invited to participate in a focus group to discuss these essential services in Rockdale County and complete the National Public Health Performance Standards Local Instrument.

In June of 2018, ten individuals from six community agencies met at the Rockdale Health Department to conduct the Forces of Change assessment. Agencies present included the

Gwinnett, Newton, and Rockdale County Health Departments, Clouds of Hope Substance Abuse Prevention Services, More than Conquerors, Rockdale Coalition for Children and Families, Prevent Child Abuse Rockdale, and the Conyers Housing Authority.

The processes and findings related to each of these four assessments is further detailed in the CHA/CHIP.

To supplement information gathered from the community, data from the U.S. Census Bureau, Georgia Department of Public Health’s Online Analytical Statistical Information System (OASIS), and County Health Rankings were included regarding demographics, poverty, transportation, and morbidity and mortality.

Rockdale County Health Priorities

Community partners identified eight health priorities for Rockdale County. The priorities are listed in order of

1. Obesity and Diabetes a. Need for education and awareness on the causes of obesity and diabetes b. Lack of wellness culture and environment
2. Mental Health and Substance Abuse a. Need for education and awareness of mental health issues at all ages b. Need to connect the individuals and support systems to the free and low-cost mental health resources c. Lack of knowledge about effective coping methods and when to act d. Need for education about substance abuse definitions, prescriber contribution, and proper disposal.
3. Access to Care – Transportation a. Need for transportation to providers and grocery stores is an issue for all population groups, especially young, poor, or Senior citizens
4. Access to Care – Providers and Prevention a. Lack of knowledge about the importance of preventative care, especially beyond the age group of pediatrics b. Shortage of providers who accept multiple types of government insurance c. Need to connect the community to free and low-cost services
5. Sexually Transmitted Infections a. need for education surrounding STI prevention i. Need to educate multiple populations and age groups b. Need to educate the public on misconceptions
6. Tobacco a. Need for education about e-cigarettes, vapes, and other devices. b. Need to decrease the barriers and fears surrounding cessation
7. Adolescent Lifestyle a. Need to decrease advertising and targeting for e-cigarette products directed towards adolescents b. Need to increase and advertise support systems and activities for adolescents c. Need for early and accurate information for teens concerning sexual education and the use of contraceptives. d. Need to raise awareness around social media and cyber bullying
8. Breast Cancer a. Need for education surrounding early detection, including the importance of self- breast exams and mammograms b. Need for marketing and education of free and low-cost screening and treatment c. Lack of knowledge of the ability for lifestyle change to decrease risk

Section 1: Determinants of Health

The social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics. -WHO

Demographics and Diversity

To understand and improve health- and health determinants- in Rockdale County, we must first consider the county and its residents.

Rockdale County is located in the Atlanta metropolitan area’s eastern suburbs about 25 miles from downtown Atlanta. Over the past 4 decades, the county has grown dramatically, increasing nearly 50% from 1994 to 2017 (Figure 1). The fastest rate of population growth took place from 1970 to 1980 when the population more than doubled from 18,152 to 36,747, but the population still grew by over 10% from 2007 to 2017. The city of Conyers (population 16,015)^5 is the only incorporated area in the county.

Figure 1. Population Trends of Rockdale County, 1994 to 2017

It is important to note that annual population estimates suggest that the rapid population growth apparent in Figure has slowed by 2008, likely due to the economic recession. From 2006 to 2007, the county added an estimated 2,235 residents, but from 2011 to 2012, the estimated

(^5) Google Public Data

https://www.google.com/publicdata/explore?ds=kf7tgg1uo9ude_&met_y=population&hl=en&dl=en#!ctype=l&strai l=false&bcs=d&nselm=h&met_y=population&scale_y=lin&ind_y=false&rdim=country&idim=place:1319336&ifdi m=country&hl=en_US&dl=en&ind=false

Figure 2. Age Distribution of Rockdale County, 2017

As stated previously, the number of adults who are aging has increased significantly since 2000. Figure 3 shows the trends in the percent of the population over the age of 60, a group that now makes up over 20% of Rockdale’s population.

Infancy 1%

1-4 Years 5%

5 - 12 Years 11%

13 - 19 Years 10%

20 - 29 Years 13%

30 - 44 Years 18%

45 - 59 Years 22%

60 - 74 Years 15%

Years 5%

Figure 3. Percent of Population 60 Years of Age and Older, Rockdale County, 1994 to 2017

Birth Rate

The number and rate of births declined steadily from 2008 to 2012 and had a small uptick from 2012 to 2015 before decreasing again in 2016 and 2017 (Figure 4). In 2017, 68.8% of births in Rockdale were repeat births.

Figure 4. Number of Births, Rockdale County, 1994 to 2017

In 1994, multiracial residents made up 0.0% of the population, but in 2017, 2.1% of the population was multiracial. The percent of Rockdale’s population that is Asian has decreased from 2.0% in 2000 to 1.8% in 2017. While the American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander groups have increased slightly since 1994, they still make up a very small part of Rockdale’s population (0.6% and 0.1% respectively).

Within these racial categories, 10.5% of individuals identify at Hispanic or Latino. In the 2010 census, the Hispanic or Latino population of Rockdale county (9.5% at that time) was majority Mexican (7.2% of the total population) and the remaining Hispanic or Latino population identified as Puerto Rican (0.7%), Cuban (0.2%), or other Hispanic or Latino (1.3%). Among the 1.8% of the population that reported being Asian in 2010, 0.6% were Asian Indian, 0.4% were Vietnamese, 0.2% were Filipino, 0.2% were Korean, 0.1% were Chinese, and 0.3% were other Asian.

According to the U.S. Census Bureau’s five-year estimates for 2012 to 2016, 9.6% of Rockdale County Residents were foreign born. Among these estimated 8,670 foreign born residents, 43% were born in Mexico, 24% were born in Latin America, 16% were born in Asia, 6% were born in Europe, and 11% were born in other foreign nations. 8

Because an estimated 32% of the foreign-born population over the age of 5 in Rockdale speak English less than well, linguistic isolation is a point of concern. In addition, 11.2% of Rockdale’s residents over the age of 5 speak a language other than English at home. 9

Families and Households

According to the U.S. Census Bureau’s five-year estimates for 2012 to 2016, there were 29, households in Rockdale County with an average of 2.9 people per household, compared to an estimated 30,027 households with an average of 2.8 people per household in 2010. Families – defined as a householder with at least one related person – made up 88% of households; over half (57%) were married couple families and 31% were families without a married couple. 12% were non-family households.^10

Rockdale County’s population has been quite mobile. According to 2012 to 2016 estimates, 15.6% of residents moved or changed residence in the previous year.^11

(^8) Grantmakers Concerned with Immigrants and Refugees http://maps.gcir.org (^9) United States Census Bureau Quick Facts

https://www.census.gov/quickfacts/fact/table/US,GA,rockdalecountygeorgia/IPE120216 10 Census Reporter, 2017 https://censusreporter.org/profiles/06000US1324790774-conyers-ccd-rockdale-county-ga/ (^11) United States Census Bureau Quick Facts

Economy and Basic Needs

Few people would deny that there are many advantages of having more income or wealth. Nevertheless, apart from the well-known link between economic resources and being able to afford health insurance and medical care, their influence on health has received relatively little attention from the general public or policy-makers, despite a large body of evidence from studies documenting strong and pervasive relationships between income, wealth and health. -Robert Wood Johnson Foundation (RWJF), Report on Income, Wealth, and Health^12

As described by the Robert Wood Johnson Foundation above, there are strong links between incomes, wealth, and healthy, which is why any health assessment must include an examination of these factors. To give just one example of the connection between income and health, life expectancy at age 25 is closely correlated with income as a percentage of the federal poverty level (FPL). Life expectancy at age 25 was more than 6 years longer for people earning more than 4 times the FPL compared with those earning less than or equal to the FPL (Figure 7).

Figure 7. Life Expectancy after Age 25 based on Family Income

We will examine income indicators for Rockdale County first and then markers of poverty within the county.

(^12) Robert Wood Johnson Foundation http://rwjf.org/content/dam/farm/reorts/issue_briefs/2011/rwjf

Figure 8. Poverty by Age and Gender in Rockdale County.

In 2015 to 2016, 71% of students were eligible to receive free or reduced-price school meals which was higher than the same measure in 2013 (66%) and 2000 (25%). This measure is also higher than the percent of students who were eligible during 2015 to 2016 to receive free or reduced-price school meals in all of Georgia (62%).^19

Demographic data suggest that some of the poverty in the county is clustered along the west- central portion of the county along interstate 20, including part of the city of Conyers (Figure 8, 2011, from 2010 Census).

(^19) County Health Rankings, 2018

http://www.countyhealthrankings.org/app/georgia/2018/rankings/rockdale/county/outcomes/overall/snapshot

Figure 9. Demographic Clusters based on Income

Detailed descriptions of demographic cluster groups are available at https://oasis.state.ga.us/gis/demographiccluster/documents/DemoClusters2011Description.pdf Blue colors represent higher income areas; yellow and red colors represent lower income areas.

Employment and Income

Among workers who commute in their care alone, 46% commute more than 30 minutes.^20 From 2012 to 2016 in Rockdale County, the mean travel time to work for workers age 16 years or older was 30.8 minutes.^21

From 2012 to 2016, an estimated 62% of the county’s population age 16 years and older was employed. This is a 6% decrease from the time period of 2008 to 2012.

Since 2007, unemployment has become a major problem for Rockdale County, as it has for much of the nation. According to the Robert Wood Johnson Foundation, job loss and unemployment are linked to a number of health problems, including stress-related conditions like

(^20) County Health Rankings, 2018 (^21) U.S. Census Bureau, Quick Facts