- For the low-income population of Cortland County, there is a shortage of dentists and primary care physicians (Table HS-2).
- There is one dentist per 9,000 low-income persons in Cortland (Table HS-2).
- There is one dentist per 3,000 in the overall population in Cortland (Table HS-2).
- There is only one dentist to serve the Medicaid population for cleanings and fillings.
- 9.6% of the public water in the county is fluoridated. In the United States that number is 62%.
- Approximately one-third of all births in Cortland County are financed by Medicaid. For Upstate NY, that number is 25% (Table HS-4).
- Despite the fact that poverty and high teen pregnancy rates usually go hand and hand, Cortland has been successful in reducing its rate of teen pregnancies and then maintaining a low teen pregnancy rate compared to Upstate NY, NYS, and the country (Table HS-5 and Graph HS-1).
- Cortland County does better than Upstate NY or NYS with a lower rate of low birth weight babies born here (Table HS-6).
- Cortland County has a high rate of chronic obstructive pulmonary disease (COPD), asthma, and lung cancer as well as a high rate of cigarette smokers. (Tables HS-8, HS-9, HS-10, & HS-14)
- County children age 0-4 have a higher rate of hospitalizations from asthma than Upstate NY children of the same age. (Table HS-10)
- STDs and AIDS both have low rates in the county. (Tables HS-11, HS-12)
- Cortland County compared to 12 peer counties is the third highest in percent of sedentary lifestyles. (Table HS-13)
- Violent crime is low in the county and property crime is high. (Table HS-16)
- Alcohol-related arrests for youth are high in the county. (Table HS-19)
- Cortland County has the highest or second highest rate in NYS of indicated reports of child abuse for the years we have data1993,1996, and 1998. (Table HS-23)
- The ZAP survey of county 8th graders shows a 56% drop in sexual intercourse reported between 1996 and 2000. (Table HS-25) Other risk behavior decreased as well but not as dramatically. The surveys indicate peer and parent support for these changes. (Table HS-26)
- The same survey also found a large number of 8th graders involved with physical violence in the year 2000, the first time that this information was requested. Four percent reported being threatened with a gun or knife. (Table HS-27)
- Community Health Status Reports and Indicators show that Cortland County should pay particular attention to the following: percentage of unmarried mothers, coronary heart disease, unintentional injuries and Hepatitis B. (Table HS-30)
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Community residents in focus groups, community visioning, and surveys indicated their "ideal" conditions for themselves, their families and their community. Residents want a safe community and generally regard Cortland as safe, probably due to the small size of its towns, villages and single city.
The ideal would be for a cleaner and greener environment. The repair of the infrastructure is essential. The proposed sports-complex with more skating and soccer facilities has captured the needs expressed by many. More recreational activities for youth and families would help people maintain healthy lifestyles. There is an even greater need in the more rural areas of the county. The proposed River Trail appears to meet numerous needs as well. The disabled need a paved trail to appreciate nature; bikers and skaters want the same.
The ideal is that everyone has health insurance and health education and that there is quality and accessible health and dental care. Teens should have fewer reasons to engage in high-risk behaviors. Fewer drugs, less alcohol abuse, and fewer bars are desired. Children and parents should be safe in their homes.
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The County Health Department prepares a Community Health Assessment every six years with biannual updates. It reports the health status of the entire community, not merely the services provided by the Health Department. The 2001 update highlights the community cooperation among major agencies and health care providers in addressing numerous issues including: dental health, mental health, welfare reform, asthma, teen pregnancy and smoking. It notes the leading role of the Health Department in successfully providing facilitated enrollment for Child Health Plus in 2000. It is available at local libraries or the Health Department.
The U. S. Department of Health and Human Services designates health care manpower shortage areas. It notes two shortage areas for this county primary care physicians and dentists. The lack of access to health and dental care of our low-income children has particular long-term ramifications. Between 1996 and 1998, there was a steady decline in the number of children (age 0-20) who accessed dental care through Medicaid, despite an increase in families dependent on Medicaid during that period. (See Table EW-12.)
Until recently there were no dentists who accepted Medicaid for preventive dental care -- cleaning teeth and filling cavities. Medicaid recipients had to travel to another county for service. There were long waits for appointments and there was no public transportation to the services. As of June 2001, Cortland County has a new dentist who will accept Medicaid for preventive services. Only 9.6% of the public water is fluoridated in the county. That number for the country as a whole is 62%.
In 1993 and 1996, Cortland had the dubious distinction of being first in the state with regard to the rate of indicated calls to the child abuse registry 49.9 calls /1000 families and 49.5/1000 respectively. A call is "indicated" when there is some credible evidence that a child has experienced abuse or neglect. In 1998, Chemung County led the state with 60 calls per 1000 families. Cortland was # 2 with 38/1000. Cortland County calls decreased between 1996 and 1998, unlike those for the rest of the state. (See Tables HS-23, HS-24.) The County District Attorneys office spearheaded a child abuse awareness campaign during these years. We do not know our status for 1994, 1995 or 1997 as the NYS Touchstones Kids Count Data Books of 1998 and 2000 provided data for only the 3 years mentioned above. We do know that the county had 874 total child abuse calls in 2000, 33% of which were founded.
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Healthy People 2010
Healthy People 2010 (HP 2010) presents a comprehensive, nationwide health promotion and disease prevention agenda. It is designed to serve as a roadmap for improving the health of all people in the United States during the first decade of the 21st century. There are two overarching goals for the decade:
- Increase quality and years of healthy life
- Eliminate health disparities
These goals are supported by 467 specific objectives in 28 focus areas. Each objective has a target to be achieved by the year 2010. These objectives may be accessed on the web site: www.health.gov/healthypeople/Publications
HP 2010 Focus Areas
1. Access to quality health services
2. Arthritis, osteoporosis, and chronic back conditions
4. Chronic kidney disease
6. Disability and secondary conditions
7. Educational and community based programs
8. Environmental health
9. Family planning
10. Food safety
11. Health communication
12. Health Disease and stroke
14. Immunization and Infectious Disease
15. Injury and Violence prevention
16. Maternal, Infant and child health
17. Medical product safety
18. Mental health and mental disorders
19. Nutrition and overweight
20. Occupational safety and health
21. Oral health
22. Physical activity and fitness
23. Public health infrastructure
24. Respiratory diseases
25. Sexually transmitted diseases
26. Substance abuse
27. Tobacco use
28. Vision and hearing
The leading health indicators determined by HP 2010 reflect the major public health concerns in the United States and were chosen based on their ability to motivate action, the availability of data to measure their progress, and their relevance as broad public health issues. They illuminate individual behaviors, physical and social environmental factors and important health system issues that greatly affect the health of individuals and communities.
HP 2010 Indicators
1. Physical activity
2. Overweight and obesity
3. Tobacco use
4. Substance abuse
5. Responsible sexual behavior
6. Mental health
7. Injury and violence
8. Environmental quality
10. Access to health care
HP 2010 suggests that the tracking of these indicators will provide a snapshot of the health of the nation. These leading health indicators serve as a link to the 467 objectives in Healthy People 2010 and can become the basic building blocks for community health initiatives.
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Further Significant Findings
Healthy People 2000 (HP 2000) and the NYS Department of Health have differing standards for childhood immunizations. NYS requires that Haemophilus Influenzae (HIB) and Hepatitis B be added to the federal requirements of Polio, DPT, and MMR. The HP 2000 goal is to have 90% of all 2 year olds immunized. Our County Health Department tracks its own immunization clinic and several pediatricians' offices. In 2000, Cortland County had a 72% rate of immunizations for the HP2000 goal and a 71% rate for the NYS requirements. It is an imperfect system, however, in that not all patients' immunizations are reported to the NYS Department of Health's central registry.
The National Risk Behavior Surveillance System indicates that 40% of Cortland citizens smoke cigarettes; the national average is 25%. The number of cases of lung cancer, chronic obstructive pulmonary disease and children's hospitalizations for asthma are considerably higher than the state average as well.
Heart disease is the number one killer in the U.S. with a half a million deaths per year. This is far more than the 23,000 deaths each year from alcohol related problems. Cigarette smoking contributes to heart disease and Cortland appears to have a high percent of cigarette smokers. Smoking cessation would prevent more disease than any other single behavior change according to the US Surgeon General. In Cortland County, heart disease causes more deaths than any other disease, but the rate of heart disease here is less than that in Upstate NY and NYS as a whole.
In May of 2001, a safety seat check done at Barry Elementary School by the Sheriff's Department and the County Health Department found that only 25% of the child seats inspected were properly installed and without defects; 42% were so old that they predated the federal safety standards, 13% had been involved in crashes and 21% were subject to a manufacturer's recall. This survey involved a total of 24 seats.
A NYS Office of Alcohol and Substance Abuse (OASAS) study shows Cortland County ranks higher than other similar rural and suburban counties for family problems and alcohol abuse. Youth alcohol and substance abuse consequences such as probation, alcohol treatment, accident involvement, and arrests are nearly double the state rate. (Cortland Standard 12/27/00). The study attributes this to a high rate of unemployment that can lead to alcoholism, divorce, separation and domestic violence, all of which may be interconnected.
The County Probation Department has experienced a 14% increase in caseload over the past two years. About 40-50% of all probationers violate their probation or are put on probation more than once. Half of the new cases in 2000 were due to DWI.
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