Rural Areas of America have traditionally been challenged to adequately support the health care needs of their residents. Assessment, Assurance and Policy Development are the core functions of Public Health and, with that in mind, access to care and provision of direct services to underinsure and uninsured, when otherwise not available, rest with Public Health. With the goal of making the best use of limited existing and future resources (both human and fiscal) and facilitating cooperation among adjacent rural communities, the West Central Public Health Partnership
(WCPHP) was formed in 2006, through a grant from The Colorado Trust, for the purpose of providing more efficient and more effective public health services in Planning and Management Region 10. The WCPHP comprises public health and environment personnel from Delta, Gunnison, Hinsdale, Montrose, Ouray and San Miguel counties in west central Colorado.
A regional health assessment was completed by the WCPHP in 2007 as one of the four initial goals of the WCPHP. It was the intention to update the regional health assessment in 2010-2011. With the passage of the Colorado Public Health Reorganization Act (the Act), effective July 1, 2008, state and local public health agencies are charged with establishing state and local public health plans that set priorities for the public health system in Colorado. A health assessment must be done and stakeholders engaged in order to then create a public health plan. As a result of the Act and a prevention grant obtained by the Director of the Colorado Department of
Public Health and Environment (CDPHE) Office of Planning and Partnership (OPP), the WCPHP was chosen as a regional pilot site for the development of the proposed Colorado Health Assessment and Planning System (CHAPS). The WCPHP became the core planning team with additional stakeholders identified in each county, a regional planner hired, and a regional health assessment process started.
The specific objectives of the regional health assessment are to:
Provide baseline measures on key indicators describing health trends in the region;
Provide a tool for public officials to develop informed decisions regarding policies that maintain or improve the health of people in the region;
Provide the public with information about health care resources and information for informed decision making and advocacy; and to
Inform the CHAPS process for CDPHE.
The Regional Health Assessment 2011 is linked to indicators and goals contained in the Healthy People 2010 and 2020 reports issued by the US Department of Health and Human Services. The Regional Health Assessment 2011 is based primarily on data available from various state agencies. It is also based on primary data provided by key informants within the WCPHP and by stakeholders in the counties of the WCPHP.
County level data were obtained whenever possible. When county level data was not available, regional data was used. Indicators were selected, in part, based on the consistency of available data across county lines.
The counties of Delta, Gunnison, Hinsdale, Montrose, Ouray and San Miguel are contiguous and located in the center of Colorado’s Western Slope of the Rocky Mountains and are designated as rural/frontier counties. The city of Montrose is the most populous and the trade center for the region. Montrose/Delta are more agricultural and have most of the region’s population and elderly. Gunnison, Hinsdale, Ouray and San Miguel are more rural tourist/mountain communities and the home to the world renowned ski areas of Crested Butte and Telluride and world class fishing. Western State College is located in Gunnison and the Black Canyon of the Gunnison National Park in Montrose County. Ouray is known as “Little Switzerland” and Hinsdale County is the least populated county in the state. According to the 2009 Region 10 Health
Profile, the 2008 regional population is 101,485, half of which is 20-64 years. Our region is more white/non-Hispanic than the state as a whole (84.6 region vs. 71.9 state) and we have a lower percentage of Hispanic population than the state (12.8 vs. 18.9). The resort areas are a haven for second homeowners, resulting in a high cost of living and significantly inflated home values. Less than three-quarters of our adults have health insurance and fewer adults are getting preventive testing and vaccines than the state as a whole.
A primary objective of the health assessment is to identify priority areas deserving attention in the future development of health services and infrastructure. Priorities were identified through two sources: stakeholders or key informants in each of the counties and an analysis of local data (key indicators).
Priorities Identified by Indicators, Stakeholders and Key Informants
As part of the assessment and planning process, a health status data report was prepared in the fall of 2010 and stakeholder groups were identified in each of the six counties. A summary of key findings from the indicators was presented to stakeholders in meetings held in each of the six counties in May 2011. Table A (below) shows the key findings from the indicators in the Health Data Report 2010 and as prioritized by the core planning team (WCPHP). The priority Healthy Lifestyles promotion and education included: (tobacco, obesity, healthy eating, and exercise).
In the first stakeholder meetings in each of the counties, the stakeholders selected their top focus areas based on the key indicators presented. The focus areas were then compiled into a table format for further prioritization of regional priorities by the core planning team (WCPHP). Table B (below) shows the focus areas as prioritized by the stakeholders.
The core planning team then picked regional priorities based in part by the prioritization of the data and the stakeholders. Additionally, criteria used by the core planning team for regional priorities were:
“Winnable Battles” as per the Colorado list
Four priorities at the most
At least one priority in the Environmental Health area
Keep it simple
A “quick win” on at least one priority area
Priorities that lend themselves to regional strategies
The following regional priorities were chosen based on the above criteria by the core planning team. These priorities will be the basis for strategies and an action plan as part of the regional public health improvement plan (PHIP).
Improve well water quality
Mental Health/Substance abuse
At the second stakeholder meetings held in each of the counties, stakeholders were presented the regional priorities chosen, county specific priorities were discussed as well as best practices. Stakeholders were given the opportunity to give further input on best practices for the priority areas chosen and in at least half of the counties, the stakeholders self-organized for addressing some county priorities that were not chosen as regional priorities. For example: Gunnison County stakeholders considered low birth weight and infant mortality as well as home births a priority that deserved special attention in their county. Montrose County formed a subcommittee to work on a county wide falls prevention program, Delta County formed a subcommittee to address injury prevention coordination, and Ouray County chose to address the capacity issue of providing essential public health services long term.