United Way Health Report

Community Needs 20 & Trends Assessment 11

health report United Way of Greater Kansas City

INTRODUCTION There is great value to good health for all Kansas City residents—healthier people are more productive, more engaged in their community, and more economically stable. Good health and economic stability lead to greater community prosperity.

Research has shown that one’s health is not just the result of a person’s individual behaviors, choices and genetics, but it is also significantly affected by powerful social factors such as education, income and quality of neighborhood and working environments. Health is tied to income or social class—in fact, income is the strongest predictor of health because the choices a person makes are shaped by the choices they have available to them. If they have no access to fresh affordable foods or safe places in which to be physically active, they will not eat healthy foods and exercise regularly. Chronic stress and discrimination also impose an additional burden on health. All these factors combine and interact to affect a person‘s overall health and mortality. As a result, to most effectively promote better health and reduce risk factors for poor health, both the person and their environment must be targeted for change.

Health insurance is also critical for ensuring good health. Children who have insurance are more likely to get preventive care, miss fewer days of school and are healthier than their counterparts. One’s health impacts employment and productivity, academic achievement and financial stability. Thus, it is critical to invest in the health of all people in a community so that they can lead healthy and productive lives and be active and effective community members.

How

to

Use This Report

United Way of Greater Kansas City works to ensure that people have all the building blocks for a good life: Education, Income and Health. For the Health area, this document is the 2011 assessment of the critical needs and trends that challenge this region’s ability to ensure that all residents and their neighborhoods are healthy, safe and thriving.

Needs data and best practice research were examined and compiled at the national, state and county levels, with a laser focus on issues directly relevant to the six-county, bi-state region—Cass, Clay, Jackson and Platte in Missouri; and Johnson and Wyandotte in Kansas. You will find data compiled on a range of indicators of good health - from health status and health care access to the unique challenges of specific subpopulations. In every case, specific challenges are highlighted for the communities of the region.

To achieve the common good, United Way seeks to be a catalyst for action in every community where needs are unmet. We invite you to share this information with others—using it as a tool to advocate for positive community change that results in healthy, thriving people and neighborhoods.

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2011 Community Needs & Trends Assessment

health status Health Related Survey Data Many residents living in the Greater Kansas City metropolitan statistical area (MSA), a 17-county region, experience challenges to being healthy. One source of data used to assess the health of communities is the Behavioral Risk Factor Surveillance System (BRFSS) which is a statebased system of health surveys that collects information on health risk behaviors, preventive health practices and health care access on a yearly basis.

More than 1 in 8 adults in the Greater Kansas City area reported poor or fair health.

In 2009, more than one out of eight adults reported that their overall health was poor or fair in the metropolitan area, with significant variability depending on where persons lived.

Behaviors and chronic conditions are also strongly related to overall health and well-being, such as current smoking habits, regular engagement in physical exercise, excessive alcohol consumption, consumption of a healthy diet such as adequate fruits and vegetables daily, preventive practices such as regular flu shots and the prevalence of hypertension and type 2 diabetes. In the Kansas City, MO-KS MSA in 2009:

• 20 percent of adults classified themselves as current smokers, with 75 percent of them smoking daily; • 23 percent of adults reported that they had engaged in no physical activities in the past 30 days; • 16 percent of adults reported consuming five or more drinks on one or more occasions in the past 30 days; • 19 percent or less than 1 in 5 adults reported consuming five or more servings of fruits and vegetables daily; • 30 percent reported not having had a flu shot in the past 12 months and being over the age of 65 years; • 27 percent of adults had been told that they had high blood pressure; • 8 percent of adults reported having type 2 diabetes.

Obesity

and

Related Conditions

Levels of obesity and overweight are climbing here as in other regions of the country, putting adults and youth at risk for current and future health challenges and chronic disease. Twenty-seven percent of adults in the metropolitan area are obese—or have body mass index ratios of 30 or greater.

Another 35 percent are overweight or have a BMI greater than 25 but less than 30. This is similar to the U.S. average. Having a BMI of 30 or greater is known to put persons at increased risk for coronary heart disease, type 2 diabetes, cancer, hypertension, stroke, osteoarthritis, and among women, a number of gynecological problems including infertility. In addition, obesity and associated health problems have a significant economic impact on the U.S. health care system. Medical spending attributable to obesity in the U.S. in 2008 was estimated at $147 billion.1

Health Report

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Obesity

and

Related Conditions (Continued)

More than 1 in 4 adults in the Kansas City area are obese, putting them at risk for multiple chronic diseases and increased mortality.2 Adults are not the only ones experiencing challenges to being healthy—many children are too. Levels of overweight and obesity among children across the U.S. are dramatically higher then they were 30-35 years ago. Obesity is defined differently among children as their bodies and their heights and weights are in constant development, so children who are at or above the 95th percentile of a sex-specific growth chart are categorized as obese. Results from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) indicate that an estimated 17 percent of children and adolescents between the ages of 2-19 years were obese in the U.S.

Trends in Obesity Among Children in the U.S., 1976-2007 1976-80 2007-08

19.6% 18.1%

10.4% 5% Ages 2-5

6.5% Ages 6-11

5% Ages 12-17

Source: National Health and Nutrition Examination Survey, Centers for Disease Control, 1976-2008

The prevalence of obesity among U.S. children was different at different age levels, genders, and racial and ethnic groups. Older children were much more likely to be obese than those who were between 2-5 years of age, with almost one in five 6-11 year olds being obese.3

Individuals who make under $35,000/year are more likely to suffer from chronic illnesses, use alcohol and exercise less than those who make $50,000/ year or more.

Children who are obese between the ages of 1013 have an 80 percent chance of becoming an obese adult.

Prevalence of obesity was also different across genders, with boys being more likely to be obese than girls.

Differences in prevalence are also evident across genders among different race and ethnicities. Among adolescent boys in 2007, those who are Hispanic and of Mexican descent were most likely to be obese (27 percent) while among adolescent girls, African American girls had the highest prevalence of obesity (29 percent).4 The increased prevalence of obesity among children is especially problematic because of the risk it carries for both current and future physical and emotional problems.

Obesity among children and youth can result in the development of chronic diseases like heart disease, high blood pressure and diabetes—chronic diseases generally seen in older sedentary adults. It is also associated with increased risk of emotional problems including lower selfesteem than normal weight children, such as depression, anxiety and obsessive compulsive disorders. And weight gain in childhood is strongly predictive of obesity in adulthood—studies show that a child who is obese between the ages of 10-13 has an 80 percent chance of becoming an obese adult.5

Health Disparities The overall health of Americans has improved in past decades but not all Americans have equally shared in this improvement. Health status in the U.S. is strongly related to a persons’ race and ethnicity, and their socioeconomic status.

Among non-elderly adults in the U.S., 17 percent of Hispanics and 16 percent of African Americans report they are in poor or fair health compared to 10 percent of non-Hispanic whites. Racial differences in life expectancy have persisted for over a hundred years, even as all have experienced gains in life expectancy. In 2009, non-Hispanic whites were expected to live 4.2 more years (78.6 years) than African Americans (74.3 years) in the U.S. The difference was even greater among men of both groups, with non-Hispanic white males expected to live to 76.2 years while African American males’ life expectancy is 70.9 years.6 These differences in life expectancy persist even when groups are matched for educational attainment.7

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2011 Community Needs & Trends Assessment

The relationship between income or socioeconomic status and health is complicated because of the interaction between the two—they both impact the other.8 Research shows a correlation between level of income and the likelihood for one or more health conditions or health related risk factors. Those who make less than $35,000 a year are more likely to report having diabetes, asthma, depression, heart disease, stroke, cancer, obesity, lack of access to health care, excessive alcohol use, and low levels of physical activity than those who make $50,000 a year or more. Additionally, those at the lower income level report poorer indoor and outdoor air quality, more dangerous occupations, and unsafe residential settings.9 Where someone lives has an impact on their health. Robert Wood Johnson’s Commission to Build a Healthier America (2009) made recommendations that reflected this broader understanding of the factors that affect health. Efforts to improve individual responsibility for ones’ health should also be accompanied by efforts to remove barriers to good health that can not always be overcome by an individual such as conditions in homes, schools, workplaces, and neighborhoods. Going beyond the focus on health care and individual behavior, the Commission made recommendations such as assuring high quality early developmental supports, full-service grocery stores in food deserts (areas that lack access to affordable fruits, vegetables, whole grains, low-fat milk, and other foods that make up the full range of a healthy diet), physical activity opportunities in schools daily, smoke-free communities, and integrating safety and wellness into a community’s culture.

Access to health care Uninsured Adults, 18-64 Years

In the Greater Kansas City six-county area, 13.5 percent of the total population was uninsured in 2009. This represented almost 245,000 persons.

In 2009, more than 1 in 8 of the Kansas City area population was uninsured.

The age group most likely to be uninsured was 18-64 year olds, 18.1 percent. Children and the elderly were much less likely to be uninsured due to greater access to public insurance coverage, with 7.7 percent of children and less than one percent of those over the age of 64 years being uninsured.

The recent recession has dramatically increased the number of uninsured, with an 18.2 percent increase in uninsured between 2008 and 2009 in the six-county area alone. This was largely driven by a decrease in the share of adults with employer-sponsored coverage.10

Percent of Uninsured Adults (age +18) 6-County Kansas City Area, 2009

32.3%

Ages 18-64 Ages 65+

22.1% 18.1% 14.6% 13.5%

13.2%

8.9% .2% Johnson

5.2% Wyandotte Health Report

0% Cass

.1%

Clay

.7% Jackson

0% Platte

United Way of Greater Kansas City

.8% 6-county area

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3 in 4 uninsured people live in working families.

Characteristics

of the

Adult Uninsured Population

in the

U.S.

In 2009, 50 million people in the U.S. under age 65 lacked health insurance. Nationally, about 19 percent of the non-elderly population was uninsured in 2009 and of those two-thirds had income below 200 percent of poverty.11 More than three-quarters of the uninsured in the U.S. are in working families—with 61 percent from families working full-time and 16 percent from families with part-time workers. While most workers who are offered employer-based health insurance enroll if eligible, many still struggle to afford coverage. Seventy-eight percent of the uninsured are families who make less than or equal to 250 percent of the Federal Poverty Level (FPL), which for a family of three in 2010 would be an income of less than $46,000 a year. Adults are overrepresented among the uninsured—while they make up 70 percent of the non-elderly population, they are more than 80 percent of the uninsured.

Uninsured Children Research indicates that childhood is the place to start to improve health outcomes, such as getting a healthy start which includes regular check ups, immunizations and access to health care when needed. While many low-income children are eligible for publicly financed health insurance, they are often not enrolled until they have an urgent medical need, which means they do not receive regular or preventive care. Getting a healthy start as a child improves their chances of becoming healthy adults and avoiding chronic conditions that can become limiting or disabling.

Almost eight percent of children in the six-county Kansas City area are uninsured, which is slightly less than the national figure of 10 percent. This represents 35,700 children without any insurance coverage. Between 2008 and 2009, the number of uninsured children increased 22 percent, or almost 6,500 additional children.

Percent of Uninsured Children (under 17 years of age), 6-County Kansas City Area, 2009 Johnson

Wyandotte Jackson

7.7%

7.6%

Platte

Health Insurance coverage for children 2009 (U.S.)

Medicaid / other public

10.8%

Cass Total

Clay

13.2%

4.8%

3.8%

One half of U.S. children are covered by insurance that is employer-sponsored. More than one in three depends on Medicaid or other public insurance sources to assure that they have access to health care services.

Employersponsored coverage

35%

51%

Uninsured

10% 4% Private non-group

79.3 Million children NOTES: Data may not total 100% due to rounding. Children includes all individuals under age 19.

SOURCE: Kaiser Commission on Medicaid and the Uninsured / Urban Institute analysis of 2010 ASEC Supplement to the CPS.

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1.6%

2011 Community Needs & Trends Assessment

1 in 3 Hispanics and 1 in 4 African Americans are uninsured compared to 1 in 7 non-Hispanic whites.

Race

and

Ethnicity

and

Access

to

Health Care

The likelihood of having insurance coverage varies across race and ethnicity in the U.S. racial and ethnic minorities are much more likely to be uninsured than non-Hispanic whites according to a Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis (KCMU/Urban Institute). Thirty-four percent of Hispanics and 23 percent of African Americans are uninsured compared to 14 percent of non-Hispanic whites. The majority of uninsured (81 percent) are native or naturalized citizens – although non-citizens (both legal and undocumented) are three times more likely to be uninsured than citizens.

Nationally, African Americans and Hispanics are almost twice as likely as non-Hispanic whites to rely on hospitals or clinics for their usual source of care than are non-Hispanic white Americans (16 and 13 percent, respectively vs. 8 percent).12

Barriers

to

Percent of U.S. Population without a Usual Source of Health Care

by Race and Ethnicity, 2009

Health Care

Across the United States, those who are uninsured are much more likely to report problems getting needed care compared to their insured counterparts, with the primary barriers being no source of usual care (56 percent), and anticipated high costs causing them to either postpone (32 percent) or go without care (26 percent) altogether. More than one out of four also reported not being able to afford the prescription drugs—a rate twice as high as those who were insured. This is compounded by the finding that most of the uninsured do not receive health services at free or reduced charge. Only one quarter of low-income uninsured adults (those making less than 200 percent of FPL) report that they have received care for free or reduced rates in the past year. Hospitals frequently charge uninsured patients two to four times what health insurers and public programs actually pay for hospital services.13

30% 20% 16%

African American

Hispanic

19.6%

Non-Hispanic White

Uninsured patients are often billed 2-4 times more than what health insurers pay for hospital services. barriers to health care among non-elderly adults, by insurance status, 2009 (U.S.) No usual source of care

55% 11% 11%

Uninsured

42% No preventive care

Went without needed care due to cost Could not afford prescription drugs

6% 6%

Medicaid / other public Employer / other private

26% 9% 4% 27% 13% 6%

Health Report

Non-elderly adults who had no health insurance were five times more likely to report that they did not have a medical home or usual source of care and seven times more likely to have had no preventive care in the past 12 months.14 Lack of insurance and a usual source of health care are prime reasons that persons use the emergency department at local hospitals for routine medical care.

In 2004, almost $41 billion of health care was uncompensated by the patient who received it or their source of health care coverage, with 58 percent of it paid for with federal dollars.15

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Maternal Health and Prenatal Care More than 4 in 5 women in the U.S. will deliver an infant in their lifetime.

A healthy pregnancy includes a woman whose body is optimally healthy and strong prior to pregnancy, appropriate prenatal care once she becomes pregnant so there is early prevention of complications, and a full term delivery of a healthy infant into a positive supportive environment that meets both the physical and emotional needs of both the woman and the infant. At any point in this timeline, health can be compromised for the mother and/or her child.

Women of childbearing age (18-44 years) who change behaviors such as quitting smoking and binge drinking before and during pregnancy can improve the outcomes for their infant. In 2009, 1 in 5 women of childbearing age in Kansas, and 1 in 4 in Missouri reported smoking, which contributes to prematurity and low birthweight.

That same year, 1 in 7 women of childbearing age in Kansas, and 1 in 5 in Missouri reported binge drinking, which is linked to birth defects and developmental delays.16 Complications most often seen in pregnancy include depression during the pregnancy and post partum, obesity, gestational diabetes mellitus, and pregnancy-related deaths. Approximately 1 in 10 women are depressed during any trimester of pregnancy, or any month one year after delivery. This not only affects a woman’s health, but it can interfere with the health of her relationship with her infant and the rest of her family.

Another issue in pregnancy can be obesity which is associated with complications for both mother and child. Currently 1 in 5 women are obese at the beginning of their pregnancy, putting them at increased risk for gestational hypertension, preeclampsia, gestational diabetes, and the potential for a cesarean birth. Infants of obese mothers are at increased risk for death, birth defects, obesity, and developing type 2 diabetes later in life.

In 2009, 26 percent of women ages 18-44 years in the metropolitan area were obese—or more than 1 in 4 women of childbearing age.17 Gestational diabetes mellitus, or diabetes that develops at the onset of pregnancy, affects 2-10 percent of pregnancies and can be a risk factor for both the mother and infant. Given that 15-50 percent of those who develop gestational diabetes will also develop type II diabetes in later years, its development in pregnancy can be an important time of intervention to prevent complications during the infant’s development and later chronic health issues for the mother.

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2011 Community Needs & Trends Assessment

Teenage mothers are more likely to drop out of school and live in poverty.

Teen Pregnancy Overall, the number of pregnancies among women under the age of 20 was relatively stable between 2005 and 2009 in the six-county area, with some counties experiencing drops and others small increases. However, while the trend is not increasing, over 3,000 pregnancies occur among teenage girls each year, which puts them and their children at risk for negative consequences.

Research comparing outcomes for women who give birth in their teenage years versus giving birth later finds that teenage mothers are more likely to drop out of school and live in poverty; their children are more likely to be of low birth weight; grow up in poverty; experience abuse and neglect, and enter the welfare system. Teenage pregnancy is also expensive— especially if 17 or younger. Teen pregnancy and child-bearing have significant costs to the mother, her children, and the taxpayers who cover much of the costs for health care, lost income tax revenue, and child welfare. As a result, reducing teen pregnancies can benefit national, state, and local economies, and improve the educational, health and income prospects for this population.18

Teenage Pregnancies by County (age 10-19), 2005-2009

2009

537

1,572

2008

449 589

1,764

2007

1,784

2006

1,787

2005

Wyandotte

560 601

510 497

553

Johnson

128 78

530

562

1,665

Jackson

314

Clay

Cass

353

137 83

345

142 91

295 286

152 89

152 92

Platte

Source: KS Dept. of Health & Environment, Mo. Dept. of Health & Senior Services

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family conflict and violence 1 in 4 women and 1 in 9 of men will be victims of domestic violence at some point in their lives.

Domestic

and

Family Violence

Domestic violence, also known as intimate partner violence, is violence that occurs between two persons who are currently in or have been in a close relationship, such as marriage or dating. This kind of violence can be manifested as physical violence, sexual violence, emotional abuse, or threats of physical or sexual violence.

Regardless of whether it happens once or is ongoing, such behavior is classified as domestic violence.

Domestic violence affects the victims’ health in many ways – and not always visibly. Emotional harm is common, with many victims experiencing trauma symptoms such as flashbacks, panic attacks, difficulty trusting others, and struggling to deal with the anger and distress. This emotional harm may lead to depression or even consideration of suicide. Victims may attempt to cope with their trauma by engaging in harmful health behaviors such as smoking, drinking alcohol, taking drugs, or having risky sex.

In the United States, 1 in 4 women and 1 in 9 men are victims of domestic violence at some point in their lives.19 Each year, women experience about 4.8 million intimate partner related physical assaults and rapes. Men are the victims of about 2.9 million intimate partner related physical assaults.20 Domestic violence shelters serving Wyandotte and Johnson Counties in Kansas and Jackson, Clay and Platte Counties in Missouri form the Metropolitan Family Violence Coalition (MFVC) and use a common data base to track crisis calls. In 2009, the MFVC shelters answered almost 24,000 calls, three out of four of which were from victims of violence calling on their own behalf. Callers reported all forms of abuse including physical abuse, verbal/psychological abuse, threats and actual assaults with weapons, rape, confinement, destruction of pets and property, and stalking. Women represented 97 percent of victims.21 The six domestic violence shelters had capacity of 375 emergency shelter beds in 2009. Due to a shortage of available bed space, 4,814 persons were turned away that year. In 2008, the most recent year in which combined data is available at the state level, 7,672 incidents of domestic violence were reported in the counties served by the MFVC.

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2011 Community Needs & Trends Assessment

Family

and Intimate

Partner Murders

One out of seven, or 14 percent, of all homicides in the U.S. in 2007 were a result of domestic violence, accounting for 2,340 deaths.22 Of these deaths, 70 percent were women and 30 percent were men. Among women who were murdered by men, the precipitating factor in 45 percent of the murders was the women’s attempt to leave.23 Domestic violence sometimes co-occurs with child maltreatment. Among families referred for child welfare investigations for child maltreatment, the lifetime prevalence of domestic violence is 45 percent, past year prevalence is 29 percent, and caregiver depression is associated with increased prevalence.24

1 in 5 children in the U.S. are estimated to experience some form of child abuse.

Child Maltreatment An estimated 1 in 5 U.S. children experience some form of child maltreatment.25 Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (e.g., clergy, coach, teacher). There are four common types of abuse, including physical abuse, sexual abuse, emotional abuse, and neglect.

It is not possible to compile similar numbers from the six-county Kansas City area as the states of Kansas and Missouri collect and report their incidents of child abuse and neglect in different ways. However Child Trends, using the National Child Abuse and Neglect Data System, recently reported that from 2000-2009, levels of substantiated child maltreatment decreased 14 percent, with the state of Kansas’ rates dropping 25 percent or more and Missouri’s rates dropping between 10-25 percent in the same time frame.

However, during the time period between 2000 and 2009 both states modified their definitions of substantiated maltreatment and abuse, which may have influenced the trend line.

U.S., state and local child protective services received 3.3 million reports of children being abused or neglected in 2008. Of those, 71 percent of the children were classified as victims of child neglect, 16 percent as victims of physical abuse, 9 percent as victims of sexual abuse, and 7 percent were victims of emotional abuse. In 2008, an estimated 1,740 children in the U.S. ages 0-17 years died from abuse and neglect (2.3 per 100,000 children). Eighty percent of deaths were among children younger than age 4.26 In 2009, the four Missouri counties of Jackson, Cass, Clay and Platte reported 926 cases of substantiated abuse or neglect in children.27

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SENIOR ADULTS Almost 40 million U.S. citizens were 65 years of age or older in 2010, with 13 percent of the total population being a senior.

Similarly, about 12 percent or 1 in 8 of the general population in the six-county Kansas City area was 65 years of age or older, or 209,000 seniors. Fifty-eight percent of local seniors were female, reflecting the greater life span for women than men.

In 2010, 29 percent of Kansas City Area seniors lived alone.

National data suggests that older persons who live alone are almost three times more likely to live below 100 percent of poverty than those who live with family members.

Almost one out of 14 seniors in the metropolitan area, or 7.3 percent, lived below the poverty level. While this was a lower rate than the general population, disparities in rates based on race and gender among the elderly were significant. National data suggests that older women are 62 percent more likely to be poor than older men (10.7 percent vs. 6.6 percent) and that the highest poverty rates are among older Hispanic women (45 percent) and older African American women (33 percent) who live alone.

In 2009, 40 percent of Kansas City area seniors 65 years or older reported that they had some kind of disability (i.e., difficulty in hearing, vision, cognition, ambulation, self-care, or independent living). While the severity of these disabilities varies, many are severe enough to interfere with daily living and may require that people seek assistance. National data suggests that the proportion of seniors who reported having a disability increases with age. While almost 37 percent of all seniors in the U.S. report that they had a severe disability in 2005, 56 percent over the age of 80 reported a severe disability and among them, 29 percent reported needing assistance as a result.

Older adults who live alone are 3 times more likely to live below poverty than those who live with family members.

Characteristics of Seniors (age 65+) GREATER Kansas City REGION, 2009

40% 28% Income below 200% Federal Poverty Level

Seniors with self-reported disability

78%

29%

Living alone

Living in house vs. apartment

As a greater number of Americans become seniors, their needs for health care and related supportive services will increase. Many will want to continue to live in their homes with some assistance in activities in daily living.

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2011 Community Needs & Trends Assessment

persons with disabilities 1 in 10 adults under the age of 64 have a disability.

Nationally, 36 million Americans self-report that they have a disability that interferes with daily living. This was 12 percent of the 5 years of age and older, civilian non-institutionalized population in the U.S. in 2009. In the six-county Kansas City area, the distribution of who has a disability by age is very similar to national data both overall and across age ranges, although the range varies across counties. The proportion of those with disabilities varies across different age groups, with a greater proportion of those who are older experiencing challenges. Locally, among children under 18 years of age, 4.2 percent have disabilities. Almost 10 percent of those ages 18 to 64 years have disabilities, and 39.5 percent of adults 65 years or older have disabilities. This closely mirrors national levels.

Percent of Residents Self-reporting a Disability, 2009

Johnson Wyandotte % under 18 with disability.......................3.1% 4.5% % 18-64 with disability............................6.2% 14.3% % 65 and over with disability..................33.5% 45.5%

% of total population with a disability.......8.2% 14.7%

Cass 5.5% 8.7% 39.9%

Clay 5.2% 10.4% 41.3%

Jackson 4.3% 11.7% 41.8%

Platte 4.9% 9.3% 38.9%

11.5%

12.5%

13.5%

11.4%

A variety of disabilities of differing severity differentially impact a person’s mobility, communication, and reasoning.

The word “disability� is often associated with a physical impairment, but other disabilities that can significantly impair day-to-day life are more difficult to assess. More than 13.5 million Americans 5 years or older suffer from attention and cognition disabilities that affect concentration, memory, or decision-making abilities.

Percent of Persons with Disabilities by Age, 6-County Kansas City Area, 2009 17 years or less 18-64 years Hearing difficulty...................................0.7% 2.2% Vision difficulty.....................................0.6% 1.6% Cognitive difficulty................................4.2% 4.1% Ambulatory difficulty.............................0.8% 4.9% Self-care difficulty..................................0.7% 1.7% Independent living difficulty............................................3.4%

Total.....................................................4.2% 9.8%

65 year or more 16.7% 7.3% 9.6% 25.5% 8.5% 17.1% 39.5%

Having a disability puts a person at greater risk for poverty than those without a disability. While almost 10 percent of the metropolitan area population age 16 or over lived below the federal poverty line in 2009, over 17 percent with a disability lived below the poverty level. Given that 72 percent of people age 16 or older with a disability in the metropolitan area are not in the workforce, access to social security disability benefits is a crucial source of support for meeting their basic needs. The median income for residents age 16 or older in the metropolitan area in 2009 was $30,640; while the median earnings for those with a disability in the same region was $19,944. Seniors make up a disproportionate share of persons with disabilities, but they are less likely to be poor than those with disabilities under the age of 65 years.

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Mental and Behavioral Health In 2008, 1 in 7 or 14 percent of adults in the U.S. received treatment for a mental health problem.

The Substance Abuse and Mental Health Services Administration (SAMHSA) examines mental health treatment each year through the National Survey on Drug Use and Health (NSDUH). This includes all adults who received care in inpatient or outpatient settings and/or used prescription medication for mental or emotional problems. However, the burden of illness is particularly concentrated among those who experience disability due to serious mental illness (SMI), in which the disorder results in serious functional impairment and interferes with major life activities. The NSDUH found that just over half (58 percent) of adults with a serious mental illness received treatment for a mental health problem.

Childhood Emotional

and

Only 3 in 5 of adults with a serious mental illness received treatment for the problem in 2008.

Behavioral Issues

Early childhood experiences with parents and caregivers can affect a child’s later risk for mental health and behavioral issues. Early childhood research clearly links the mental health of the parents and living environment to the behavioral, mental health and cognitive development of young children. This in part is related to evidence of how early relationships and experience influence the actual architecture of the developing brain – and subsequently the child’s development.28 In years past it was thought that children did not experience mood disorders like depression. Better studies of how the brain develops differentially in youth diagnosed with mental disorders and research about first symptoms and early signs with adults with mental illness has changed that belief. Research now suggests that vulnerability to mental illness – and resilience- are shaped by genes and environment interacting together, through childhood and adolescence.29 Mental health, which includes emotional and behavioral areas of health, is a critical component of child well-being.

Appropriate treatment and intervention for children with emotional or behavioral difficulties has been shown to lessen the impact of mental health problem on school achievement, relationships with family members and peers, and risk for substance abuse.30 In a national study conducted in 2005-2006, 14.5 percent of children aged 4-17 had parents who spoke with a health care provider or school staff about their child’s emotional or behavioral difficulties. The gender of the child affected the likelihood of whether their parents sought assistance - 18 percent of boys and 11 percent of girls had parents who spoke with someone about difficulties with both the parents of younger and older children seeking assistance with equal frequency. Of those 8.3 million children, 2.9 million children were prescribed medication for emotional and/or behavioral difficulties.31

Substance Abuse

The use and abuse of substances, especially alcohol and tobacco, has a long history in U.S. culture. In 2009, more than half of Americans aged 12 years or older reported that they were current alcohol drinkers and 28 percent reported currently using tobacco. Additionally, 1 in 11 Americans aged 12 or older reported current illicit drug use, with the use of marijuana as the most commonly used illicit drug. In 2009, an estimated 22.5 million persons (8.9 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Two-thirds of these were classified as dependent on or abusing alcohol but not illicit drugs. Based on the most recent census of the Kansas City six-county area, this percent of the population would estimate that over 310,000 local residents aged 12 or older had substance dependence or abuse in the past year.

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2011 Community Needs & Trends Assessment

Alcohol is the most abused substance in the U.S. In 2009, 24 percent of Americans 12 years or older reported binge drinking, or consuming five or 1 in 11 Americans aged 12 more drinks on an occasion one or more times in the past 30 days. Much and over reported current of this statistic is driven by the binge drinking behavior of young adults.

Among 18 to 25 year olds, the rate of binge drinking was 42 percent or illicit drug use in 2009. more than 2 in 5 reporting the behavior at least once in the past 30 days.

The rate of current alcohol use among 12-17 year olds was 15 percent, or more than 1 in 7 in 2009, even though they were not old enough to legally consume alcohol.

Alcohol consumption is a major risk factor for traffic fatalities and claims the lives of both adults and children. In the U.S. in 2009, there were 10,839 traffic fatalities in alcohol-impaired driving crashes which accounted for 32 percent of the total motor vehicle fatalities in the United States. In the same year, one out of seven fatalities among children ages 14 and younger in the U.S. occurred in alcohol-impaired-driving crashes.

In the metropolitan area, as in the rest of the U.S., the majority of adults report consuming at least one drink in the past 30 days (53 percent). In the 2009 BRFSS, about 1 in 6 adults in the metropolitan area reported binge drinking in the past 30 days. One in 20 reported heavy drinking, which for men is more than two drinks a day and for women more than one drink a day each day of the past 30 days.

Smoking causes cancer, heart disease stroke and multiple lung diseases including emphysema, bronchitis and chronic airway obstruction. While tobacco use in the sixcounty Kansas City area is down from years past, as it is across most of the U.S., tobacco still accounts for 1 in 5 deaths in the U.S. annually—1 in 9 of these is the result of secondhand smoke.32 Locally, nearly 1 in 5 adults reported being a current smoker in 2009, with approximately 75 percent smoking daily and the other 25 percent smoking several days a week.

1 in 5 adults in the Kansas City area reported being a current smoker in 2009.

Percentage of Alcohol Impaired Driving Fatalities to Total Driving Fatalities 6-County Kansas City Area, 2009

41%

39% 30%

2006

2005

29%

2008

44% 2009

2007

In the six-county Kansas City area, the total number of alcohol impaired fatalities was 147 in 2009, down from 188 in 2005. However, the portion of driving fatalities in which at least one of the drivers had a blood alcohol concentration of .08 grams per deciliter or greater, making them legally intoxicated, actually increased 46 percent across this same time, from 30 percent in 2005 to 44 percent in 2009.

Health Report

United Way of Greater Kansas City

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Implications for Community Leaders and Policymakers A comprehensive approach to health is necessary to help people begin their lives healthy and sustain that health throughout their lifespan. In order to do so, the public sector, private sector and individuals must bring about change in the systems that impact individuals’ health.

Leadership from the community could work together to use the strengths and resources of the Greater Kansas City area to develop and implement policy and practices that support residents’ overall health, including policies that ensure: 1. Homes are free from physical hazards and communities are supportive of individual health, safety and development.

2. Healthy beginnings to life including prenatal, well-baby and pediatric care for children up to 6 years old to assure a healthy pregnancy and birth; age-appropriate, culturally competent, primary and preventive care that supports early development; and healthy home environments that support infants and children.

3. Affordable opportunities for a nutritious diet and regular physical activity as both are essential to good health.

4. Access to healthy choices and strong interpersonal relationships because such relationships increase the odds that people will preserve, regain or increase their health and wellness.

5. Individuals have access to necessary health care services, including those for preventive, mental, dental, pharmaceutical, vision or others as needed, and that they are provided in a coordinated way to produce the best health results.

HEALTH: UNITED WAY’S RESPONSE What We Do United Way of Greater Kansas City leverages community engagement and investment to advance the building blocks of a good life: Education, Income and Health. In the health area, our efforts are targeted to ensuring that people and their neighborhoods are safe, healthy and thriving. Through a commitment to collaborative, accountable results and innovation, we advance systemic community change strategies, invest in human service programs at partner agencies and work in partnership on community initiatives.

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2011 Community Needs & Trends Assessment

We Invest in Programs that Achieve Human Service Goals •

•

•

•

People achieve better health by adopting healthy lifestyles and by accessing equitable, quality, and affordable health care for physical, dental and mental health needs.

United Way invests in programs that remove barriers to access for the medically uninsured and underinsured.

Programs funded include those that provide physical and oral health care, support services for individuals with specific health conditions, provide care coordination services, address connection between physical and mental health and help to enroll individuals in Children’s Health Insurance Program (CHIP) or Medicaid.

People are engaged in helping their neighborhoods be safe and thrive, and those who have experienced family violence or other crime overcome barriers to regaining healthy productive lives.

United Way invests in programs that help victims of family violence and sexual assault to receive services that provides shelter and support, crisis intervention, counseling, case management and legal advocacy.

People of all ages avoid or overcome substance abuse and addiction to lead safe, healthy lives.

United Way supports two types of programs: 1) Prevention and education programming designed to raise the awareness of the impact of substance use and abuse and that teach skills and strategies for avoidance, and 2) Counseling services that offer inpatient or outpatient treatment for those coping with a substance abuse issue.

Seniors and people with disabilities (mental, physical and developmental) overcome barriers to live as independently as possible.

United Way invests in programs that include home and community based programs that provide support to allow individuals to maintain or increase their independence, that support caregivers of older adults or the disabled, or that fosters community engagement.

We advance efforts that create systemic community change Healthy Connections

Promotes access to regular health care for children, their families and pregnant women. Without health insurance many individuals do not seek care for health conditions until a situation is very serious or life threatening. In 2010, United Way partnered with nine nonprofit organizations to locate and enroll approximately 700 children and 450 adults in CHIP or Medicaid. In 2011, efforts continue to connect children and their families to health insurance through partnering with six area nonprofit organizations.

For more information, contact: Karen Gettinger, 816-559-4710, karengettinger@uwgkc.org

We partner in Community Initiatives Heart of America Community AIDS Partnership

In partnership with Hallmark Corporate Foundation, Greater Kansas City Community Foundation and the AIDS Council, this partnership was founded in 1990 to pool resources to address the HIV/AIDS epidemic. More than 25 local and national private funders have pooled their resources with United Way to provide more than $4 million in grants to aggressively respond to HIV/AIDS in our region.

For more information, contact: Alinda Dennis, 816-559-4677, alindadennis@uwgkc.org

Neighborhood Self Help Fund

This project seeks to improve low to moderate income neighborhoods by providing funding at a grass-roots level. Small grants ranging from $200–$3,000 are awarded to neighborhood associations for projects such as crime prevention, mowing abandoned properties, assisting elderly or disabled homeowners with property maintenance as well as creating community gardens and neighborhood clean-up events. Funding is provided by various banks and foundations and United Way provides in-kind administrative support.

For more information, contact: Karen Gettinger, 816-559-4710, karengettinger@uwgkc.org

United Way 2-1-1 health care advocate United Way 2-1-1 is an information and referral service connecting people to community resources and volunteer opportunities in 16 counties in Missouri and seven counties in Kansas. Callers reach a trained, caring professional seven days a week, 24 hours a day, 365 days a year through this easy-to-remember 3-digit telephone number. It’s fast, free and confidential.

To advance positive health outcomes, a full-time health care advocate is available who is able to provide additional time and expertise to assist those callers who have more complex medical situations. The health care advocate helps them navigate the health care system to aid them in getting the care that they need.

For more information, contact: Marcie Watts, 2-1-1 or 816-474-5112, marciewatts@uwgkc.org

Health Report

United Way of Greater Kansas City

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End Notes Acknowledgements Primary research and data analysis for this report was provided by United Community Services of Johnson County, Kan. 1.

Finkelstein, EA, Trogdon, JG, Cohen, JW, and Dietz, W. Annual medical spending attributable to obesity: Payer- and service-specific estimates.

Health Affairs 2009, 28(5): w822-w83.

2.

SMART BRFSS 2009, Centers for Disease Control and Prevention.

3.

Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA 2010, 303(3):242–9.

4.

Ogden et al, 2010.

5.

American Academy of Child and Adolescent Psychiatry, Facts for Families: Obesity in Children and Teens, May 2008.

6.

National Vital Statistics Reports Vol 59, No. 4 p. 29 –www.ctc.gov/nchs/data/nvsr/nvsr59/nvsr59_04.pdf

7.

Braveman et al 2010. Socioeconomic Disparities in Health in the United States: What Can We Learn from the Patterns? American Journal of Public Health 100:S186-S196.

8.

Singh, G.K. and Siahpush, M. 2006 Widening socioeconomic inequalities in US life expectancy, 1980-2000, International Journal of Epidemiology, August 2006. 35 (4): 969-979.

9.

BRFSS, 2007, Centers for Disease Control and Prevention.

10. American Community Survey, U.S. Census Bureau, 2008, 2009.

11. Kaiser Commission on Medicaid and the Uninsured, www.kff.org/uninsured/upload/7451-06.pdf.

12. Agency for Health Care Research and Quality – Addressing Racial and Ethnic Disparities in Health Care Fact Sheet www.ahrq.gov/research/ disparit.htm.

13. Kaiser Commission on Medicaid and the Uninsured. 2010. The Uninsured, A Primer: Key facts about Americans without health insurance, The Henry Kaiser Family Foundation, Menlo Park, CA. 14. Kaiser Commission on Medicaid and the Uninsured. 2010. The Uninsured, A Primer: Key facts about Americans without health insurance, The Henry Kaiser Family Foundation, Menlo Park, CA. 15. Kaiser Commission on Medicaid and the Uninsured, Urban Institute, 2004.

16. Perinatal Data Snapshots: Missouri and Kansas, March of Dimes, March 2011 accessed at www.marchofdimes.com/peristats.

17. BRFSS 2009, Centers for Disease Control and Prevention.

18. National Campaign to Prevent Teen Pregnancy; www.teenpregnancy.org.

19. CDC BRFSS 2005.

20. CDC Fact Sheet: Understanding Intimate Partner Violence, 2011.

21. Shapiro, M.D. 1999-2011. Alice (Version 6.85) [computer software]. Kansas City, MO: In Focus.

22. Department of Justice, Bureau of Justice Statistics. Intimate Partner Violence [online]. http://bjs.ojp.usdoj.gov/index. cfm?ty=tp&tid=971#summary.

23. Block, C.R. 2003. How can practitioners help an abused woman lower her risk of death in Intimate Partner Homicide? NIJ Journal, 250, 4-7.

Washington D.C.: National Institute of Justice, U.S. Dept of Justice.

24. Kelleher et al 2006 www.ncjrs.gov/pdffiles1/nij/grants/213503.pdf.

25. Finkelhor D, Turner H, Ormond R, Hamby SL. Violence, abuse and crime exposure in a national sample of children and youth. Pediatrics 2009; 124:1411-1423.

26. U.S. Dept of Health and Human Services, Administration on Children, Youth and Families. Child Maltreatment 2008 [Washington, DC: U.S. Government Printing Office, 2010] available at: www.acf.hhs.gov.

27. Missouri Department of Social Services: Children’s Division Annual Report Fiscal Year 2009, accessed at www.dss.mo.gov/re/pdf/cs/csfy09.pdf.

28. National Research Council and Institute of Medicine. 2000. From Neurons to Neighborhoods: The Science of Early Childhood Development.

Committee on Integrating the Science of Early Childhood Development. Jack P. Shonkoff and Deborah A. Phillips, eds. Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press.

29. NIMH Children’s Mental Health Awareness- Brain Development During Childhood and Adolescence Fact Sheet www.nimh.nih.gov.

30. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: Substance Abuse and Mental Health Services Administration, National Institutes of Health: National Institute of Mental Health. 1999. AND New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. Final Report. July 2003.

31. Simpson GA, Cohen, RA, Pastor, PN, Reuben CA. Use of mental health services on the past 12 months by children aged 4-17 years: United States, 2005-2006. NCHS data brief, no. 8. Hyattsville, MD: National Center for Health Statistics. 2008.

32. Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report 2008; 57(45):1226–8 [accessed 2011 Mar 11].

Source for graphs, unless otherwise noted: U.S. Census Bureau, American Community Survey.

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2011 Community Needs & Trends Assessment

United Way of Greater Kansas City 1080 Washington Street Kansas City, MO 64105 (816) 472-4289 9/19/11

www.unitedwaygkc.org