Community Health AssessmentMPH 602

Cuyahoga County, OH, Community Health Needs Assessment: spring 2015

Prepared by: Steven Banjoff

Image source nationalatlas.gov

The Communities of Cuyahoga County

Map from Cuyahoga County Public Safety and Justice Services.

Cuyahoga County

• Location: Northeast quadrant of Ohio

• Population: 1,280,122 Male: 607,362 Female: 672,760 (U.S. Census, 2014)

• County Seat: Cleveland Pop. 396,815 (Cleveland City Planning Commission, 2014)

• Division: 23 Western, 35 Eastern Suburbs

Diversity

Cuyahoga County

Race White

African American

Hispanic

Asian

Native American

Other

2+ Mixed

Cleveland

Race White

African American

Hispanic

Asian

Native American

Other

2+ Mixed

Source: Charts compiled using data from Cleveland City Planning Commission 2014 neighborhood data report

Education Attainment Percentage

05

101520253035

Cuyahoga CountyClevelandOhio

(U.S. Census, 2014)

Economics

% of Population in Poverty % of Children in

Poverty % of Elderly 65+ in Poverty

05

101520253035404550

Cuyahoga CountyClevelandOhio

(U.S. Census, 2014)

Median Income

• Cuyahoga County: $43,804

• Cleveland: $27,349

• Ohio: $48,308 (U.S. Census, 2014)

Only one of the 34 neighborhoods that comprise Cleveland has a median income that is greater than the median income of Ohio and only two greater than the county median income.

(Cleveland City Planning Commission, 2014)

Population Density

Source: (Northern Ohio Data & Information Service, 2012)

Cuyahoga County• More than 2,500 people per square mile (NEOSCC, 2015)

• 8.2% loss of population between 2000-2010 (NEOSCC, 2015)

• 65th out of 88 counties in Health Outcomes (County Health Rankings, 2014)

• 50th in Health Factors (County Health Rankings, 2014)

• 78th in Social Economic Factors (County Health Rankings, 2014)

• 68th in Physical Environment (County Health Rankings, 2014)

High Degree of Segregation

Source: (Northern Ohio Data & Information Service, 2012)

The Aging of Cuyahoga Countyby Gender

% of Total Females in Population

0-4 years5-17 years18-24 years25-34 years35-44 years45-54 years55-64 years65+ years

% of Total Males in Population

0-4 years5-17 years18-24 years25-34 years35-44 years45-54 years55-64 years65+ years

Source: Data for charts compiled using Community Commons health indicators report generator

The Aging of Cuyahoga County by Race

Age Distribution: African American Population

0-4 years5-17 years18-24 years25-34 years35-44 years45-54 years55-64 years65+ years

Age Distribution: White Population

0-4 years5-17 years18-24 years25-34 years35-44 years45-54 years55-64 years65+ years

Source: Data for chart compiled using Community Commons health indicators report generator.

All Deaths per 100,000 1999-2013

< 1 years

1-4 years

5-14 years

15-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65-74 years

75-84 years

85+0

2000

4000

6000

8000

10000

12000

14000

16000

18000

Male BlackMale WhiteFemale BlackFemale White

Source: Data compiled using CDC Wonder online database National Center for Health Statistics

Cardiovascular Disease Related Deaths per 100,0001999-2013

15-24 years 25-34 35-44 45-54 55-640

100

200

300

400

500

600

700

800

900

Male Black2Male WhiteFemale BlackFemale White

Source: Data compiled using CDC Wonder online database National Center for Health Statistics

Cancer Related Death per 100,000 1999-2013

15-24yrs 25-34 35-44 45-54 55-640

100

200

300

400

500

600

700

Male BlackMale WhiteFemale BlackFemale White

Source: Data compiled using CDC Wonder online database National Center for Health Statistics

Cerebrovascular Related Death per 100,0001999-2013

<1 Year 1-4 yrs 4-15 yrs 15-24 25-34 35-44 45-54 55-640

20

40

60

80

100

120

Male BlackMale WhiteFemale BlackFemale White

Source: Data compiled using CDC Wonder online database National Center for Health Statistics

Diabetes Related Death per 100,000 1999-2013

35-44 yrs 45-54 55-64 65-740

20

40

60

80

100

120

140

160

Male BlackMale WhiteFemale BlackFemale White

Source: Data compiled using CDC Wonder online database National Center for Health Statistics

Chronic Lower Respiratory Related Death1999-2013

35-44yrs 45-54 55-64 65-740

20

40

60

80

100

120

140

160

Male BlackMale WhiteFemale BlackFemale White

Source: Data compiled using CDC Wonder online database National Center for Health Statistics

Accident (non-intentional) Related Death1999-2013

<1 yr 1-4 yrs 5-14yrs 15-24 25-34 35-44 45-54 55-64 65-74 75-840

20

40

60

80

100

120Male BlackMale WhiteFemale BlackFemale White

Source: Data compiled using CDC Wonder online database National Center for Health Statistics

Perceived Quality of HealthCuyahoga County

• 15% of the Population Considers themselves in poor to average health (County Health Rankings, 2014)

• 3.3 poor physical health days a month (County Health Rankings, 2014)

• 4.1 poor mental health days a month (County Health Rankings, 2014)

• 72nd of 88 counties in quality of life ranking (County Health Rankings, 2014)

Obesity

% of Population with BMI >30 in

2012

% of Female Population

with BMI > 30

% of Males with BMI > 30

% of Population with BMI >30 in

2004

0

5

10

15

20

25

30

35

Cuyahoga County

Ohio

United States

Source: Data for charts compiled using Community Commons health indicators report generator

Food Security

Source: Case Western Reserve Mandel School of Applied Science NEO-CANDO system, blue outline = City of Cleveland

% of Population Experiencing food insecurity

% of Population Food Insecure

% of Low Income Population with low

food access

% of Population with Low Food Access

0

5

10

15

20

25

30

Cuyahoga County

Ohio

United States

Source: Data for chart compiled using Community Commons health indicators report generator.

Food Environment

0

10

20

30

40

50

60

70

80

90

100

Cuyahoga County

Ohio

United States

Source: Data for chart compiled using Community Commons health indicators report generator.

Food Behavior

• Percent of Adults 18+ with inadequate fruit and vegetable consumption 76.6%

• Soda Expenditures as a % of Total Household ExpendituresRanked 82nd of 88 in Ohio

• % of food at home expenditures for Fruits and VegetablesRanked 32nd of 88 in Ohio

(Community Commons, 2015)

Physical Activity

0

5

10

15

20

25

30

Cuyahoga CountyOhioUnited States

Source: Data for chart compiled using Community Commons health indicators report generator

Access

Source: Obtained from Cleveland Plain Dealer online Northeast Ohio Media Group of map made by Smith Group JJR showing the eastside of Cuyahoga County and the existing park access problem there.

Access to Health Care

02

468

1012

141618

Cuyahoga CountyOhioUnited States

Source: Data for chart compiled using Community Commons health indicators report generator

Health Care Professionals

Primary Care Physicians per

100,000

Dentists per 100,000

0

20

40

60

80

100

120 Cuyahoga County

Ohio

United States

0

5

10

15

20

25 Cuyahoga County

Ohio

United States

Lead Levels in Children and Median Housing Value

Source: Cuyahoga County Board of Health

Cuyahoga County Crime Statistics

Region 1: Cleveland, Lakewood, Rocky River, Bay Village, Westlake, North Olmsted, Olmsted Township, Olmsted Falls, Fairview Park, Brook Park, Middleburg Heights, Berea, Strongsville.

Region 2: Cleveland, Brecksville, Broadview Heights, Brooklyn, Brooklyn Heights, Cuyahoga Heights, Garfield Heights, Independence, Maple Heights, Newburgh Heights, North Royalton, Parma, Parma Heights, Seven Hills, Valley View, Walton Hills

Source: Graphs obtained from Cuyahoga County Prosecutor benchmarks and data

Cuyahoga County Crime Statistics (cont’d)

Region 3: Cleveland, Bedford, Bedford Heights, Bentleyville, Chagrin Falls, Glenwillow, Highland Hills, Moreland Hills, North Randall, Oakwood, Orange, Solon, Warrensville Heights, Woodmere.

Region 4: Cleveland, Beachwood, Gates Mills, Highland Heights, Hunting Valley, Mayfield, Mayfield Heights, Pepper Pike, Richmond Heights, Shaker Heights, South Euclid, University Heights

Source: Graphs obtained from Cuyahoga County Prosecutor benchmarks and data

Crime Statistics (cont’d)

Region 5: Cleveland, Bratenahl, Cleveland Heights, East Cleveland, Euclid

Source: graphs obtained from Cuyahoga County Prosecutor benchmarks and data, chart mislabeled as Region 3

Map obtained from Cleveland.com

Source: Case Western Reserve Mandel School of Applied Social Science

Opportunity

The following health topics have been identified by this Community Health Assessment that are in need of improvement through intervention, policy change, and raising awareness. The Community Health Assessment further indicates The City of Cleveland and the inner ring suburbs are areas of greatest critical need and the health of the county as a whole may be best served by having initial focus on these communities.

PovertyCardiovascular disease

Cerebrovascular diseaseCancer

DiabetesRespiratory disease

Accidental death/disabilityObesity

Food environment/behavior/securityPhysical environment/behavior

CrimeAccess to healthcare

GeriatricsMental Health

Substance abuse

Prioritization

The prioritization process for these health issues should be established

by a predetermined member work group that is comprised of the participating

stakeholders. To make sure the process is as democratic as possible, use of the

National Association of County & City Health Officials guidelines for Nominal Group

Technique should be employed (NACCHO, 2011). This method is particular useful

in the early phases of prioritization that helps to determine group structure,

generate ideas, and allows all to have equal say in the process (NACCHO, 2011).

Step by step guidelines for this process can be found here

http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-S

ummaries-and-Examples.pdf

to facilitate the proper use of this process.

Available Resources

• Cuyahoga County Board of Health• Cleveland Department of Health• Cleveland City Planning Commission• Cuyahoga County Prosecutors Office• Ohio Department of Health• Northeast Ohio Sewer District• Ohio Department of Treasury• Cleveland Clinic Foundation care network• University Hospitals care network• Case Western Reserve Mandel School of Applied

Social Science• Cleveland State University Maxine Goodman Levin

College of Urban Affairs• Cleveland State University Howard A. Mims African

American Cultural Center• Cleveland Restoration Society• Cuyahoga County Children and Family Services• The American Heart Association greater Cleveland

chapter• American Cancer Society greater Cleveland chapter• National Alliance for the Mentally Ill, greater

Cleveland chapter• Cleveland Food Bank• Northeast Ohio Sustainable Communities Consortium • Cuyahoga County Land Reutilization Corporation

• The Urban Agriculture working group• The National Organization of Homebuilders Cuyahoga

County chapter• The Environmental Protection Agency Cuyahoga

County Office• Cleveland City Mission• Salvation Army• Regional Transit Authority• Cleveland Professional sport teams, Brown’s, Indians,

Cavaliers charity foundations• Cleveland Metropark System• Northeast Ohio Areawide Coordination Agency• Green energy Ohio• Cleveland Museum of Natural History• Central Community Food Co-op• Gund Foundation• Cleveland Public Art• Cleveland Industrial Retention Initiative• State of Ohio• Center for Disease Control and Prevention• Various non-profit Religious and other Charitable

Organizations in the area not mentioned directly

Strengths and Weaknesses

• Some of the areas’ greatest strengths are also some of the areas’ greatest weaknesses. The World class medical facilities help to ensure adequate numbers of primary care officials in the area and world class treatment, they can also foster a feeling of over-reliance on medical professionals to manage health issues. The diverse population provides a large pool of far ranging experiences and cultural information in which to draw, but also sets the stage for segregation and isolation to occur as each group views differing community members as “the Other”. The large population supplies better opportunity for revenue streams, larger pool of people to try and recruit from, and more advocacy groups, but the potential for dissent on how to prioritize, implement, and fund initiatives and issues is also larger. The multiple number of advocacy groups provide numerous pathways to greater awareness, collaboration opportunities, and more programs and initiatives to be implemented, but they also may lead to information overload and volunteerism burnout or redundancy to occur wasting dollars that could be better spent elsewhere. The good news is there are strong movements forward across the area, initiatives like the Heritage Home Program that help homeowners with home improvement and maintenance for homes over 50 years old, Cleveland Lakefront Development, Northeast Ohio Sustainable Communities Initiative, Bikeway Master Plan, and others (Cleveland City Planning Commission, 2015) reveals there is a strong commitment to improving the environment and health of the community. By further encouraging and identifying areas of collaboration and community empowerment between Cuyahoga County and the City of Cleveland, commitment and community awareness will continue to grow, and its citizens will have greater opportunity to take greater ownership and control of their health.

Works Cited• Center for Disease Control and Prevention. (2015). CDC WONDER. Retrieved from Center for Disease Control and Prevention,

National Center For Health Statistics, Underlying Cause of Death1999-2013, CDC Wonder online database, Data from the cause of death files: http://wonder.cdc.gov/

• Cleveland City Planning. (2014). 2014 Neighborhood Fact Sheets. Retrieved from Cleveland City Planning Commission: http://planning.city.cleveland.oh.us/2010census/factsheets.php

• Cleveland City Planning Commission. (2015). Current Activities. Retrieved from Cleveland City Planning Commission: http://planning.city.cleveland.oh.us/cpc.html

• Community Commons. (2015). Community Health Needs Assessment Full Health Indicators Report. Retrieved from Community Commons, date accessed 4/3/15: http://assessment.communitycommons.org/CHNA/report.aspx?page=1&id=710

• County Health Rankings. (2014). County Health Rankings and Roadmaps, Cuyahoga. Retrieved from County Health Rankings and Roadmaps, Building a Culture of Health County by County: http://www.countyhealthrankings.org/app/ohio/2014/rankings/cuyahoga/county/outcomes/overall/additional

• Cuyahoga County Board of Health. (2014). Child and Family Health Services (CFHS) Community Health Indicators Project. Retrieved from Cuyahoga County Board of Health: http://www.ccbh.net/storage/child-and-family-health/CFHS%20Indicators%20Report_2014%20Update_FINAL.pdf

• Cuyahoga County Prosecutor. (2014). Regional Crime Statistics. Retrieved from Cuyahoga County Office of the Prosecutor: http://prosecutor.cuyahogacounty.us/en-US/benchmarks-data.aspx

• Health Improvement Partnership. (2013, March 21). Community Health Status Assessment of Cuyahoga County, Ohio. Retrieved from Health Improvement Partnership: http://www.naccho.org/topics/infrastructure/accreditation/upload/full-chachipcombined-3-20-13.pdf

Works Cited

Mandel School of Applied Social Science. (2009, September 22). NEO-CANDO updates: Social and Economic Data. Retrieved from Case Western Reserve University, Mandel School News and Events: http://blog.case.edu/msass/2009/09/22/neo_cando_updates_social_and_economic_data.html

NACCHO. (2011, October 18). First Things First: Prioritizing Health Problems. Retrieved from National Association of County and City Health Officials: http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-Summaries-and-Examples.pdf

NEOSCC. (2015). Population Decline, Northeast Ohio's population is spreading out. Retrieved from Northeast Ohio sustainable Communities Consortium: Northeast Ohio sustainable Communities Consortium

Northern Ohio Data & Information Service. (2012, August). Maxine Goodman Levin College of Urban Affairs. Retrieved from Cleveland State University: http://urban.csuohio.edu/nodis/gis_CBMaps.html

Ohio Dept. of Health. (2015). Public Health Assessment and Wellness. Retrieved from Ohio Department of Health: http://ship.oh.networkofcare.org/ph/indicator.aspx?id=25&c=5

Robert Woods Foundation. (2014, May 12). County Health Rankings and Roadmaps. Retrieved from Robert Woods Foundation Web site, July 27 2014: http://www.countyhealthrankings.org/app/ohio/2014/overview

U.S. Census Bureau. (2010). American Fact Finder. Retrieved from U.S. Department of Commerce United States Census Bureau: http://factfinder.census.gov/rest/dnldController/deliver?_ts=445011178441

U.S. Census Bureau. (2014). American Fact Finder. Retrieved from U.S. Department of Commerce United States Census Bureau: http://factfinder.census.gov/rest/dnldController/deliver?_ts=445011178441