Findings
VIII. Health and Safety
Priority Areas of Concern
Community members identified the following 5 issues as priority areas of concern. Opinions were obtained through focus groups, surveys and at the Blue Ribbon Community Assessment Team Meeting held every December:
1. Health Care Accessibility
Cortland County is designated as a Primary Care Health Professional Shortage Area (HPSA) for the Low Income Population, by the U.S. Department of Health and Human Services. The County is also designated as a Dental HPSA for the low-income population. The county is being assessed to determine if it qualifies as a Mental HPSA.
2. Dental Services
In both 2002 and 2005 “access to dental and medical care” was ranked as the 3rd highest of 20 priority issues by the public voting at the Business Showcases. Nearly 1800 citizens voted and their voices were heard. There is now preventive dental care available in Cortland County through Family Health Network.
An October 2003 dental survey and assessment of 162 third grade children in five school districts found that 62% had experienced dental caries and 37.5% had untreated caries. Seventy percent of these children had seen a dentist in the past 12 months; 71% used fluoride supplements and 83% had dental insurance. There was no significant difference in the percent of carries across socio-economic status, however, low-income children were more likely to have untreated carries and less likely to have insurance or to use fluoride supplements.
More than 67% of the nation has fluoridated public water supplies while in Cortland County less than 4.5% of the public has water that is fluoridated. The Village of Homer voted in 2005 to eliminate fluoridation despite a very vocal drive against fluoride over the years. A door-to-door survey of the residents on the east side of the City of Cortland revealed that the majority (51.8%) wanted fluoride. Only 21.5% said no and 26.7% were undecided. (Appendix 2)
Good oral health is an essential component of overall health. Efforts to educate the community about the importance of proper oral hygiene took a huge stride forward with the creation of two life-size cartoon characters, “Mighty Molar” and “Murray the Toothbrush”, who took their place with McGruff, the Crime-fighting Dog in county schools and parades. The Seven Valleys Health Coalition leads the Dental Steering Committee and along with Mighty Molar, they have created a life-size board game “Tooth or Dare” for elementary school children’s edification.
3. Mental Health Services
The stigma attached to seeking mental health services and the need for behavioral health services for children is an on-going problem, not just in Cortland, but nation wide. These concerns are echoed in the largest-ever mental health survey, published in the Achieves of General Psychiatry in June 2005. The article stated that while mental illness is by far more a disease of youth, youth sufferers are especially overlooked. Half of those who will eventually be diagnosed show signs of the disease by age 14.
The study focused on 4 categories: impulse control, anxiety, mood disorders and substance abuse. Conducted by the National Institute of Mental Health (NIMH), the study noted that the US leads the world with the highest rate of mental illness and that:
- One-half of all Americans meet the criteria at some point in their life of having experienced at least one of the 4 categories studied.
- One quarter of all Americans in the past year met the definitions of having a mental illness.
- One quarter of those, were so affected that their ability to function was seriously impaired.
- Less than half of those in need actually seek treatment and it is often after a decade of symptoms.
- Treatment is usually inadequate according to the study.
The Cortland Mental Health Task Force is working to increase access to behavioral health services, primarily by attempting to integrate mental health screening and evaluations into primary care settings. At the same time, a New York Statewide Task Force led by the New York State Association for Rural Health is attempting to get Medicaid reimbursement for tele-psychiatry consults and treatment delivered by video teleconferencing to selected rural communities.
4. Health Care Services
The new President and CEO of Cortland Memorial Hospital, Brian Mitteer, oversaw two major construction projects at Brattleboro Memorial Hospital (BMH) in Vermont. BMH was considered one of the most efficiently run hospitals in Vermont. Cortland Memorial Hospital, with its 181 beds and 80-bed residential care facility, is unique in its independence from major corporate ownership. Its two recent renovations allow for the continued improvement of care for patients. An expanded out patient center offers diagnostic imaging – Magnetic Resonance Imaging (MRI), CT scans, bone density screening, ultrasound and X-ray, as well as rehabilitation services. The emergency services department has been modernized with expanded space and services. Evening Care, Weekends Too provides walk in service for non-emergent care. Cortland Memorial Hospital has joined with St. Joseph’s Hospital in Syracuse to provide a site for kidney dialysis in the county.
Cayuga Medical Center operates an urgent care center just outside the city of Cortland and is able to provide imaging and diagnostic services from the site as well.
5. Health Insurance Coverage
In 1994, 35 million people in America did not have health insurance; in 2005 that number reached 45 million. The percent of the U.S. Population without private health insurance has increased from 23% in 1984, to 28% in 2001 and 30% in 2002. US Census statistics indicate that 94% of private coverage is obtained through the workplace. However, employers have seen double-digit increases in health insurance premiums for the fourth consecutive year. These rising costs have led to fewer employers offering health insurance, higher out of pocket costs for employees that are offered insurance and have even been cited as a factor in the decrease in job creation.