Identification of Community

Clark County is a county that is situated at the southwestern part of the state of Washington and is divided by the Columbia River (Clark Regional Emergency Services Agency, 2011). The county is in the evergreen region meaning that it experiences a favorable climate with wet weather during fall, mild winters in the spring and relatively warm months during summer (Clark Regional Emergency Services Agency, 2011). When it comes to the demographics of the county, the average age of the population is 37.1 years and is widely dominated by the white community who stand at 87% (TownCharts, 2016).

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Clark County being a region that is surrounded by rivers, mountainous areas, and the Pacific ocean, it is prone to some natural disasters that may occur in forms of storms, volcanic eruptions and most common flooding (Clark Regional Emergency Services Agency, 2011). The county is also at risk to humanmade disasters because of the high utilization of vehicles as the favored mode of transportation. Vehicles are known to cause air pollution through their emissions, a risk factor that exposes the residents of the county to many health complications that include asthma among other diseases relate to air pollution (Clark County Public Health Advisory Council and Clark County Public Health, 2012). Smoking has also been an issue in the county, though over the last couple of years the rate of smokers has declined due to the banning of tobacco use within 25 feet of public places (Clark County Public Health Advisory Council and Clark County Public Health, 2012).

The county is also a favorable region for commerce especially in the ocean transportation because of both the Colombian river and the Pacific Ocean, being that the former it is the only freshwater harbor in the whole of the western coast in the North American region (Clark Regional Emergency Services Agency, 2011). The ocean-going commerce creates a vast number of job opportunities in many of the sectors in other professionals that range from waste management that stands at 25.9 %, manufacturing at 14.1% and real estate at 10.1% as they are the highest employing sectors among many others (City-Data, 2016). Thought the county enjoys a vibrant commerce industry, 9.9% of the population are living below the federal poverty level (City-Data, 2016).

Assessment of Needs and Risks

Population Economic Status Assessment

The first tool that was used to assess the community to discover their social status by identifying the countys distribution of race, age, sex, and their economic status. The tool was essential in the identification of any inequities in the countys allocation of finances so as to assess the cost of health in the community. The population of the county stood at 459,495 as of July 2015 (USCB, 2015). The majority of the population was some other race who stood at 33.1%, two more races at 15.1%, while the white population stood at 12.5%, Native American and Alaskan Natives 6.9%, and the Asian community at 4.5% (USCB, 2015). The annual household income of the population was $59,551 (USCB, 2015). As stated earlier the percentage of the population that fell below the federal poverty level was 9.9%, and a further analysis conducted in 2013 revealed that the families that had children were most affected by poverty, and they stood at 15% (City-Data, 2016). However, earlier in the year 2010, a majority of those that were living below the federal poverty level were either individuals who were below 18 years or those who were 65 years or older at 7.5% (United Census Bureau, 2013). Also, the vast majority of those who were found to fall below the federal poverty level regarding race were the African American community at 35.7% (United Census Bureau, 2013). Of the total population that fell below the federal poverty level, females stood more at risk compared to men, in particular for households where there were no male figures in the family (Clark County Washington Department of Community Services, 2012).

Disaster Assessment and Planning Assessment

The tool was next in assessment of the communitys vulnerability to any natural or human-made threats, which communities were most likely to face threats in case of disasters, and if the county had any disaster preparedness plans that would aid them in the eventuality of any emergency situation. The county is not prone to frequent disasters; however, it still faces risk because of its geographical orientation regarding flooding because of the presence of water bodies. Also summer fires as a result of a high density of evergreen trees, volcanic activities due to surrounding mountainous regions as the major risk factors (Clark Regional Emergency Services Agency, 2011). The county is however well prepared when it comes to combating the disasters as it has several disaster preparedness groups and plans that can be readily available within 72 hours in case any emergency is reported (Clark Regional Emergency Services Agency, 2011).

The agency in charge of combating disasters in the county is the CRESA (Clark Regional Emergency Services Agency). They have partnered with other agencies in the regions such as the Red Cross Southwest chapter, local fire stations, public institutions, the police department, medical facilities among others (Clark Regional Emergency Services Agency, 2011). CRESA relays information in a prompt manner that enables the other agencies to be totally prepared in case of any emergency. While natural disasters may occur in the county, it is also at risk when it comes to public health through communicable diseases outbreaks and other environmental hazards (Clark Regional Emergency Services Agency, 2011). CRESA has responded to more than 33 disease outbreaks over the last 10years, of which 19 have been as a result of food-borne illnesses and the rest as respiratory diseases (Clark Regional Emergency Services Agency, 2011). A majority of the public health emergencies are more likely to occur in public areas or those areas that have a high population and because of the limited resources by CRESA to prepare and recover a majority of the vulnerable persons would most likely be at grave risk. Considering that 9.9% of the population falls under the federal poverty level (City-Data, 2016), disasters likely to occur as a result of public health outbreaks are a threat to the County.

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Neighborhood/Community Safety Inventory

The tool was subsequently used in the assessment of safety hazards that exist in the County that could pose serious health complications to the countys population regarding potential climatic and landscape threats or hazardous materials. As had been described earlier the geographical orientation of the county puts it at risk from natural disasters, and the fact that the most preferred means of transport is by vehicles, gas emissions are relatively high (Clark Regional Emergency Services Agency, 2011). Clark County has however ensured that they curb the high rate of emissions by requiring all vehicles to pass an emissions test when one is transferring vehicles through sale or 365 days before the expiry of license plates (Washington State Department of Ecology, 2016).

The fact that the county is in an evergreen state with a high population of timber, it is highly at risk from wildfires and smoke especially during the summer season when the temperatures are at their highest. As a result, the county has instituted some bans in the form of vegetative burning bans and use of wood burning devices and stoves (Washington State Department of Ecology, 2016). Another safety concern for the county has been lead exposure especially for children under 72 months (Washington State Department of Ecology, 2016). Drinking water and paint chippings from houses older than 1980 are the leading causes of lead exposure in the county (Washington State Department of Ecology, 2016). Over the years, the center for disease control has tested children below 72 months for lead exposure (Centers for Disease Control and Prevention, 2016). Although the numbers are not as high, the department of health in the county developed the Lead Action plan and the testing guidelines for children in 2015 so as to educate parents how to reduce lead exposure (Centers for Disease Control and Prevention, 2016). Tobacco usage has also been found to be a threat in the County especially among pregnant women who on average stood at 14.6% higher than the Washington States average of 10.3% in 2006 (Clark County Washington Public Health, 2007).

Furthermore, drug-related hospitalizations have been found to increase over the years with the recent statistics in 2013 indicating that there were 357.3 cases per 100,000 drug-related hospitalizations (Clark County, Washington Public Health, 2008). Injury related accidents are also common in the county because of the heavy presence of motor vehicles in the county (Clark County, Washington Public Health, 2008). Other injury related accidents occur as a result of falls whereby the county has shown a high number of deaths at 3.3 deaths per 100,000 which is greater than the expected Healthy People goal (Clark County, Washington Public Health, 2008). Youth suicides as other injury-related deaths have also increased in Clark County from the year 2003 to 2013 where there have been a reported 91 deaths majorly from the age groups between 10 to 24 years (Clark County, Washington Public Health, 2008).

Cultural Assessment

The tool was used in a further evaluation of the community of Clark County where issues to do with religiosity, ethnicity, race and age distribution were considered. The last census conducted in the year 2010 reveals that Clark County has a predominant community of white people who represent 85% of the residents or a population of 375,289 (United Census Bureau, 2015). Falling second are the Hispanics representing 8% or 37,171 individuals, then the Asian population at 4% or 18,171 individuals, fourthly are two or more races who make up 4% or 18,585 people and lastly the African American race who make up 1% of the population or 10,319 individuals (United Census Bureau, 2015). The American Indian or Alaskan natives and the Pacific Islanders also made up 1% of the population or 3,847 and 2,945 individuals respectively (United Census Bureau, 2015). The total population stood at 438,272 individuals and of this 14.7 % comprised of those who were between 5 to 14 years, secondly those between 15 to 17 years represented 4.5% of the population, thirdly those between 18 to 24 years represented 8.3% of the population (United Census Bureau, 2015). Lastly, those that were more than 60 years of age represented 18.7% of the total population (United Census Bureau, 2015).

Like many other counties around the state of Washington, Clark County is highly a non-religious community as 71.6% of the individuals in the population are not affiliated to any religious belief (City-Data, 2016). However, 13.7% or 35,008 persons in the population are made up of Evangelical Protestants while 6.3% profess to the Catholic faith, 3% to mainline Protestants, 0.1% to Black Protestants and other religious groups not mentioned comprising of 5.3% (City-Data, 2016).

Windshield Survey

The other tool that was used in the assessment of the community was the windshield survey that was important to understanding the issues surrounding housing, infrastructure, employment and the overall characteristics of the population in Clark County. To achieve a maximum result through the use of the tool, driving was considered as the best option that was undertaken by driving through the County to gain a first experience through observation of how unique the community was. A trip through the eastern side of the county reveals many new residential developments which have been constructed through a mixed use of both wooden and concrete materials. In the downtown area, the majority of the buildings small one-story houses that have a Victorian architecture to them while those on the upper parts are mainly two-story houses resembling more of traditional houses.

Industrial areas in the county are located on the riverfront of the Columbia River largely centralized in the west side of the county. The central train station in the County is also located in the industrial area and serves the northern, southern, and eastern parts of the state as well Intercontinental in the transportation of both bulk and light goods. As earlier stated, the population mostly relies on a car or public bus transportation and thus gas stations are frequent in the county spread at about every 5 to 10 miles. There are also two major freeways that connect the County to the neighboring state of Oregon as people travel to various employment establishments. As a result, there is heavy traffic during the morning hours and evenings as people go to and from work.

There are also many community and state parks that are located throughout the county and re free to access without any charges. In the summer season many people visit these parks whereas, during winter, coffee shops, shopping centers and gyms are more traditional establishments where people visit. There are also fast food restaurants spread evenly in the county, and as a result of many public schools, these restaurants are a common gathering place after school. There are also many service offices that are not limited to legal, realty, salons and medical offices. Furthermore, there are two major hospitals and other urgent care centers readily within reach for the residents. Lastly, communication is a huge part of the community, and there are a vast amount of cell phone towers as well as the Columbian daily newspaper to serve such needs.

Scavenger Hunt

The scavenger hunt was the last tool that was used to assess the kind of services that the people of Clark County received, and to ensure the maximum result of this, both local and government organizations were visited.

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Clark County Public Health

The department is located in a three-story building. After walking into the office, the writer talked to the receptionist who explained that the agency is responsible for providing attention to people at risk and the vulnerable in the community. It serves people from all backgrounds and ages through teaching, public mentorship, and research. The public health department is also responsible for providing birth and death certificate services, outreach services especially to the disabled and vulnerable, free vaccinations to prevent disease widespread among others.

Women, Infants, and Children office (WIC)

The offices are located in the same building as those of the County public health department. Upon arrival, the receptionist greeted the writer and explained that the organization is responsible for facilitation of the pregnant women, infants, and children under the age of 5. Further, the receptionist explained that they offer services that include breastfeeding education and support, education regarding dietary needs and farmers market cash in the months of June through October.

The American Red Cross: The Southwest Chapter

The writer drove to the local American Red Cross building that is located off Fourth Plain that is a main road in the center of the city. The offices serve the residents of Clark, Cowlitz, Klickitat, Pacific, Skamania, and Wahkiakum counties. Upon arrival at the offices, a volunteer was on hand to help the writer, and he explained that the main aim of Red Cross is to relieve and alleviate suffering. He explained that they are responsible for putting up shelters and proving food during natural disasters to affected communities. The southwest chapter was further responsible for providing onsite first aid services at the local community events and also educating the population on disaster preparedness.

Interpretation of Data

Clark County is a vast County with a huge population that requires particular attention in the analysis of data that was gathered from various sources. The primary data that was being collected and analyzed was the epidemiological evidence that points to the transmission and control of diseases. The major data points included the mortality, life expectancy rates and how people perceived their health in the county. The mortality rate in the County stood at 6.9 per 1000 whereas the birth rate reflected 13 per 1000 of the total population (City-Data, 2016). The mortality rate from the year 1998 to 2008 was found to have decreased to 742 per 100,000 cases (City-Data, 2016). When mortality rates between races were compared, the black race suffered a higher number of deaths compared to their white Caucasian counterparts where there were 1,047 deaths for the former compared to 742 deaths in the later (Clark County, Washington Public Health, 2010). The significant difference would have been caused by the fact that there are huge income disparities between the two races as well as higher genetic dispositions for the African Americans. Males were also found to be at greater risk of death as a result of unhealthy lifestyle choices, motor vehicle accidents as well as stress induced causes that reflected 905 deaths per 100,000 compared to 668 deaths per 100,000 for their female counterparts (Clark County, Washington Public Health, 2010). Age also played a significant factor when it came to mortality rates as those who were 65 years and above attributed to 4,595 deaths per 100,000 (Clark County, Washington Public Health, 2010).

The leading cause of death from communicable diseases in the county was found to be cancer (City-Data 2016). Of the cancers, lung cancer was most prevalent as evidenced by the fact that over the period between 2003 to 2012 most of the county residents representing 46.3% had smoked 100 or more cigarettes in their lifetime (City-Data 2016). Furthermore, smoking and obesity both contribute to the high prevalence of asthma in the county which has been found to be one of the highest in the nation as 10% of the residents reported to have asthma in the county (City-Data 2016). Lastly, injury-related deaths have been increasing in the county over the years, a worrying statistic since it was found out that 76% of the residents in Clark County commute daily to and from a location (Clark Regional Emergency Services Agency, 2011). Further, in 2005 there was a rate of 12.1 deaths per 100,000 individuals that were attributed to motor vehicle accidents (Clark County Washington Public Health, 2010). The statistics are worrying since they show the risk the residents present themselves on the roads on a daily basis.

Top Three Problems in Relation to Healthy People 2020 Goals

At number one is issues of obesity as the leading cause of morbidity and mortality in Clark County. The obesity rates in the county are higher compared to those of the State of Washington at 26% compared to 22% of the state (Clark County, Washington Public Health, 2008). The rate is, however, lower compared to that of the Healthy People 2020 goals of 30.5% but nonetheless points to a problem since most of the adolescents and children in Clark County are considered overweight (U.S. Department of Health and Human Services, 2016; Community Assessment, 2013). To show the seriousness of the problem, the obesity rate tripled since 1980 for children aged between 6 to 11 years at 19.6% (Community Assessment. (2013). The rate of adolescents in the tenth grade that was obese standing at 25% was also higher when compared to the revised rate of Healthy People 2020 goals which stood at 14.5% (U.S. Department of Health and Human Services, 2016).

Smoking is also another problem in the county as revealed in 2005 with 19% of the adult population found to be smoking and an additional 21% of teens in the twelfth grade who smoke (Clark County, Washington Public Health, 2007). The rates do not meet the requirements of the Healthy People 2020 goals of less than 12% (U.S. Department of Health and Human Services, 2016; Clark County, Washington Public Health, 2007). Additionally the rate of pregnant women that smoke exceeded the 2020 objective of abstinence from smoking which was placed at 98.6% during pregnancy (Clark County, Washington Public Health, 2007). The rate of pregnant women who smoked in Clark County was 12% with an abstinence rate of 88% (Clark County, Washington Public Health, 2007)

Lastly, issues too with healthcare access were found to be of concern in Clark County. The most prevalent issue was that of pregnant women accessing prenatal care in their first trimester which was found to be lower than the 2020 target rate of 77.6% (Clark County, Washington Public Health, 2010). The rate in Clark County was found to be 76% (Clark County, Washington Public Health, 2010). When it came to the number of adult community members who were assigned a primary care provider, the county ranked lower that the intended recommendation of the Healthy People 2020 goal of 83.9% falling ant 74% for the county (Clark County, Washington Public Health, 2010). Furthermore, the County also ranked lower when it came to healthcare coverage where the rate was 87% compared to a target goal of 100% by Healthy People 2020 (U.S. Department of Health and Human Services, 2016).

Availability of Community Resources for Selected Problem

Clark County is not endowed with a lot of resources when it comes to addressing health issues. Those that are available are not enough to cater for the entire population although they can be found through the WIC (Women, Infants, and Children) office, the Vancouver Farmers Market, and the YMCA. The agencies are in an attempt to get the community to adopt healthier lifestyles to improve their health. Through the WIC, pregnant women, and children below the age of five are receiving services geared towards improving their dietary needs through mainly breastfeeding education following the World Health Organization guidelines. Eventually, they are combating obesity in the early stages of life. Secondly, the Vancouver Farmers Market is promoting healthier eating habits, providing a boost to the local economy and establishing a community gathering site that encourages community members to socialize and go outdoors (Vancouver Farmers Market, 2016). Finally, the YMCA is geared towards establishing a healthier body and mind. Its a Christian based agency, and through its many programs it helps develop the physical, mental, and emotional wellbeing of both adults and children (YMCA of Columbia-Willamette, 2016).

Primary Prevention Topic

Obesity is a nationwide problem and is causing catastrophic health issues. Clark County is no stranger to the fact that it is adversely contributing to the morbidity and mortality rates in the county. Of more concern is the fact that many children and adolescents are being affected and eventually it is causing an increase in other communicable diseases such as diabetes-related ailments. Diabetes related problems have risen to 83 cases per 100,000 individuals (Healthy Columbia Willamette, 2013), thus demanding it to be addressed through primary prevention efforts. Therefore, using the assessment tools mentioned above, the community health of Clark County has been put into perspective and it shows a lot more needs to be done to improve the health of the residents in the County.

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