Completed: 12/11/2014 Updated: 12/14/2014

Winona County

Community Health Improvement Plan

A plan for improving health, well being, and

quality of life in our community.

2014

TABLE OF CONTENTS

Completed: 12/11/2014 Updated: 12/14/2014

Table of Contents

Core Team Members 1

Demographics 2

Introduction 4

Community Prioritization Process 5

Community Health Priorities 13

Priority #1 13

Priority #2 14

Priority #3 15

Sustainability 17

Contact Information: 18

CORE TEAM MEMBERS

Page 1

Core Team Members

Core Team members serve as a resource and asset that will be utilized throughout Community Health Improvement Plan. These members will provide knowledge and expertise that will assist in the improvement of our community’s health.

Winona County Public Health Project FINE

Winona Health Minnesota Center for Health Statistics

Winona Area Chamber of Commerce Winona County United Way

Minnesota Department of Health Live Well Winona

Winona Community Foundation HIA Advisory Committee

Community Health Improvement Plan process included:

Engaging a broad group of partners and stakeholders that represent the community

and public health system in Winona County

Establishing a vision and mission

Developing workgroups

Gathering community input

Reviewing data to identify key strategic issues

Identifying priority health issues through a democratic process

Our Vision To provide a high quality of life, health, and well-being for all people in Winona County.

Our Mission

To empower the people of Winona County to achieve lifelong physical, mental and social

well-being through:

Equal access to high quality, affordable healthcare.

A coordinated system of care that is local, preventive, holistic, and patient centered.

An environment that supports healthy living for all.

DEMOGRAPHICS

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Demographics

Winona County encompasses 626 square miles and includes 19 townships. It is home to over 50,000 residents with the majority (65%) living in urban areas. Throughout the 19 townships lakes, rivers, and streams comprise approximately 15 square miles of the county.

Winona County has a population of 51,461. According to the U.S. Census Bureau, from 2000-2010, Winona County experienced a population increase of 1.02%. The population is spread through twelve cities including Altura, Dakota, Elba, Goodview, Lewiston, Minneiska, Minnesota City, Rollingstone, St. Charles, Stockton, Utica, and Winona. The largest town in Winona County is Winona, which has a population of approximately 27,592. The breakdown of population by incorporated areas is in the Population by City table below. Winona County has seen significant demographic growth in some of its townships, in particular those closest to its population centers of Winona and St. Charles. Some population growth in the county can be attributed to higher enrollments at Winona State University, Saint Mary’s University of Minnesota, and Minnesota College Southeast Technical. The expanding metropolitan areas of Rochester and La Crosse, in close proximity to Winona County’s borders, are also a factor.

Population by City

DEMOGRAPHICS

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WINONA COUNTY Southeast Region, Minnesota

DEMOGRAPHICS 2000 MOST RECENT DATA

Total population 49,985 51,232 (2013)

Percent of Color 4.90% 7.8% (2013)

Median age 32.8 33.8 (2013)

Veterans 2,989 (2009-2013)

AGING

Percent age 65+ 13.10% 16.1% (2015)

Median household income, 65+ head of household $34,382 $32,838 (2008-2012)

CHILDREN AND YOUTH

Percent of Population under 5 N/A 4.5% (2013)

Percent of Population under 18 N/A 18.3% (2013)

CIVIC ENGAGEMENT

Voter turnout 63.20% 38.3% (2014)

EARLY CHILDHOOD

Percent low birth weight among single births 3.00% 3.1% (2013)

Percent of children screened who were under age 5 N/A 82.1% (2013)

Number of children screened who were under age 5 N/A 343 (2013)

ECONOMY

Median household income $53,007 $49,753 (2012)

Percent of individuals below the poverty level 8.50% 14.4% (2013)

EDUCATION

Percent meeting or exceeding standards in 3rd grade reading N/A 63.1% (2014)

Percent meeting or exceeding standards in 8th grade math N/A 54.1% (2014)

Graduation rate (on time) N/A 81.6% (2013)

High School Graduate or higher (age 25+) N/A 89.9%(2009-2013)

Bachelor's Degree or higher (age 25+) 23.20% 26.8% (2009-2013)

HEALTH

Percent of adults (20+) with diagnosed diabetes N/A 7.1% (2011)

Percent of adults (20+) who are obese N/A 26.6% (2011)

Percent uninsured, under age 65 N/A 10.1% (2012)

Rate of psychiatric hospital admissions per 1,000 residents 5.7 7.3 (2012)

HOUSING

Share of all households paying 30% or more of income for monthly

housing costs 20.70% 31.3% (2009-2013)

Homeownership rate 70.80% 71.6% (2009-2013)

Median value of owner-occupied housing units N/A $158,000 (2009-2013)

Housing units N/A 20,834 (2013)

Persons per household N/A 2.48 (2009-2013)

IMMIGRATION

Percent foreign born 2.70% 3.6% (2009-2013)

NOTES: *Figures for percent in poverty and median household income were collected from the 2000 decennial census, which asked about

income during 1999. Elsewhere on the Compass site these are reported as 1999 data, but they are listed here in the 2000 column for comparison

purposes. Income data have been inflation-adjusted and are shown in most recent year dollars.

INTRODUCTION

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Introduction

The purpose of the Community Health Improvement Plan is to identify how to

strategically and collaboratively address community priority areas to improve the health

and well-being of the community. Community members used the assessment process to

formulate a community health improvement plan aimed at striving to provide effective,

quality health services and an environment that enables community members to reach

their full health potential through assessment, leadership and partnerships.

During 2013 and 2014, Winona Community partners organized a thoughtful and

strategic approach to facilitating a community health needs assessment that would

identify current and unmet needs in Winona County. The process examined community

demographics, socio-economic factors and health service utilization trends. This

assessment incorporates components of primary data collection and secondary data

analysis that focus on the health and social needs of Winona County using the zip code

55987.

The intent of the Community Health Needs Assessment process is to ensure that people

of Winona County are empowered to achieve lifelong physical, mental and social

wellbeing through 1) equal access to high quality affordable healthcare; 2) a coordinated

system of care that is local, preventative, holistic, and patient centered; and 3) and

environment that supports healthy living for all.

COMMUNITY PRIORITIZATION PROCESS

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Community Prioritization Process

In order to achieve the prioritization process; population data and community input was collected. Additional indicators of health were identified utilizing existing local, state, and national secondary data sources. A comprehensive overview of the health status across populations within Winona County was undertaken. At that point the Core Team members were polled to identify their primary health issues. Collectively, the group narrowed the scope of the long-term goals.

Goals were intended to be challenging, yet achievable over a 5-year term. With this in mind the core team identified several key steps.

Winona County Health Educator will continue to work with the Statewide Health Improvement Plan (SHIP) to improve the overall health of Winona County residents.

“I Can Prevent Diabetes” program will be implemented in cooperation with University of Minnesota Health Educator. This program will run over 16-weeks and is designed to work with at risk persons who are displaying pre-diabetes symptoms. This course will equip clients with long-term knowledge and tools to live out a healthier lifestyle.

Working collaboratively with Live Well Winona to educate citizens on healthy living actives in the community.

Continue work to with the Community Gardens group to enhance natural food options.

Winona County will work with the Farmers Market (in Winona and St. Charles) to maximize healthy food options for citizens at an affordable price.

Working with Project FINE to reach newcomer and immigrant populations in Winona County.

Working on Drug Free Communities and Winona County Alliance for Substance Abuse Prevention (ASAP) to reduce youth involvement in substance abuse.

Collaborate with local post-secondary institutions to establish and implement alcohol prevention policies and find ways to implement.

Work to enact a social host ordinance for Winona County; require alcohol retailer training; and re-establish alcohol compliance checks in an effort to reduce alcohol issues.

Partner with Winona Health, and other local mental health providers, to improve community access to mental health resources.

Work with Live Well Winona and Winona Health to create a user-friendly database that will allow residents to quickly identify resources.

COMMUNITY PRIORITIZATION PROCESS

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Two surveys were conducted and are identified as Survey A and Survey B:

Survey A: Six thousand surveys were mailed to the general population residing in zip code 55987. Respondents returned their completed survey in a postage-paid envelope to an independent tabulation site located in Minneapolis, MN. Nearly 2000 surveys were returned and the response rate was 28%. Key finding were:

21.9% said they have been told by their doctor they have/had depression

27.7% said they have been told by their doctor they have/had high cholesterol

14.1% said they have been told by their doctor they have/had obesity; however, 61.1% are classified as overweight or obese according to their BMI

56% thought their general health was good to excellent

50.9% said they are trying to lose weight

32.7% said in the past 12 months there was a time when they thought they needed to seek medical but did not get it or delayed getting it

12.9% said in the past 12 months there was a time when they wanted to talk with or seek help from a health professional about emotional problems such as stress, depression, excess worrying, troubling thoughts or emotional problems, but did not or delayed talking to someone

34.4% said in the past 12 months there was a time when they delayed getting dental work done

9.7% said they have been binge drinking in the past 30 days

Survey B: Two hundred surveys were distributed to the immigrant population

through a variety of methods including distribution to targeted households, hosting focus groups at central locations and one-on one surveying. The surveys were either completed privately or by assistance from representatives and/ or translators of Project FINE. 30% of the immigrant population completed the survey. Key finding were:

46.1% thought their general health was good

22.2% said they have been told by their doctor they are or were overweight while only 8.9% were told they are or were obese

43.3% are currently trying to lose weight; however, 69.4% are classified as overweight or obese according to their BMI

COMMUNITY PRIORITIZATION PROCESS

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22.8% said they have been told by their doctor they have/had depression

12.8% said they have been told by their doctor they have/had anxiety

16.7% said they have been told by their doctor they have/had high blood pressure

29.4% said in the past 12 months there was a time when they thought they needed to seek medical but did not get it or delayed getting it

15.6% said in the past 12 months there was a time when they thought they wanted to talk with or seek help from a health professional about emotional problems such as stress, depression, excess worrying, troubling thoughts or emotional problems, but did not or delayed talking with someone

32.7% said in the past 12 months there was a time when they delayed getting dental work done

The top three needs identified from Survey A were:

Overweight/Obesity

Mental Health Access

Binge Drinking

The top four needs identified from Survey B were:

Overweight/Obesity

Access to Healthcare due to lack of Transportation

Healthcare costing too much or lack of Health Insurance

Running out of food before had money to buy more

Additional needs identified through the focus group process were:

Need for preventative care and education of access and benefits of preventative care

Lack of adequate dental care for the underprivileged population

After review of the survey findings, six different issues were initially identified as major priorities through a careful review of the survey data and rankings. Using a prioritization process three strategic priorities were chosen. These will be addressed throughout this Community Health Improvement Plan and shared with our partners.

COMMUNITY PRIORITIZATION PROCESS

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The prioritization process began with a review of the community health assessment key findings. Core Team members reviewed a master list of health indicators (based on County Health Rankings Health Factors).

Figure 1: County Health Rankings Model

Health Outcomes and Health Factors are affected by underlying causes. Figure 2 below from “The Wisconsin Guidebook on Improving the Health of Local Communities” identifies potential underlying causes related to Health Outcomes and Health Factors. Health disparities are the differences between groups in their health status. Examples of health disparities are race/ethnicity, gender, income groups and age.

COMMUNITY PRIORITIZATION PROCESS

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Figure 2: Wisconsin Guidebook on Improving the Health of Local Communities What Makes a Community Healthy

COMMUNITY PRIORITIZATION PROCESS

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Community Health Needs

By far, the issue of greatest concern to the interview participants was access to medical,

mental and dental health services due to lack of available services, low-cost services, or

transportation.

• A number of people commented on trends in health care that people with or

without insurance are experiencing. These include:

o Many people go out of the area for specialty care which is very difficult

for patients without resources.

o It has become difficult to find dentists who take Medicaid or self pay

who are greatly in need of dental services.

o Lack of transportation to and from appointments is a problem as well

as finding funds for people that have no resources.

Trends in Community Health Status:

The most frequently reported trend was the increase in childhood and adult obesity which

was identified as a major problem in all focus groups. Other negative trends in community

health status included increases in:

• People without health insurance

• Fewer people accessing preventive care or screenings due to lack of insurance,

higher deductibles, or lack of income

• Lack of mental health access

• Stress and depression

• Alcohol use and drug abuse

Some positive trends in community health status include:

• People are eating healthier and exercising more, becoming more health

conscious and aware, and making more thoughtful lifestyle choices

• Healthy lifestyle options in the Winona region

COMMUNITY PRIORITIZATION PROCESS

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Problems or Barriers to Obtaining Health Care

The most frequent problem related to obtaining health care is lack of health

insurance or ability to pay for care and/or medications.

Young adults often cannot afford health insurance so they go without.

People do not get preventive care or they wait to obtain health care until their

problems are very serious. This sometimes results in needing emergency care

There is a lack of information and communication about available, free/low-

cost services

Transportation to medical services was also identified as a barrier by several

participants.

Barriers for seniors include transportation issues and also the difficulty in

accessing care due to cost and lack of assistance for coordinating care and

helping to manage medications.

Cuts in funding and services were also identified as barriers, including:

Huge cuts in county mental health services

Overall funding for nonprofit organizations is stagnant or decreased

It was noted that some people do not know where to go when they need help. However,

the most frequently identified places where people go include:

The Emergency Room

o The ER is often the place people go for mental health crises.

o The ED is getting more dangerous for staff, more difficult patients.

Urgent Care Clinic

Personal doctor (for those with insurance)

Services that are Lacking to Meet Community Need

A mobile medical unit with nurses and physician assistants that can provide exams and

can write prescriptions when needed.

Mental health. Every focus group mentioned this need.

Dental care.

Vision care

Provide lab work for patients for free and medications for free in conjunction

with a local pharmacy

Demonstrate healthy cooking and healthy snacks for youth

Provide screenings for youth

COMMUNITY PRIORITIZATION PROCESS

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Recommendations for Improving Health Care Access and Community Health Status

Institute 24-hour “Ask a Doctor/Nurse” line to help determine who needs ER

services

Embark on a healthy lifestyles, healthy living, self-care program

Educate kids in the schools so they learn about health issues while they are

young

Educate adults about chronic disease prevention (all languages needed)

Promote vaccines. Educate people on how they protect the public’s health and

that they are safe

Provide community outreach and services in the community (e.g., immunization

clinics, medical screenings, preventive services)

Develop an information/education campaign to help people find services that

are relevant for their needs.

COMMUNITY HEALTH PRIORITIES

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Community Health Priorities

The following top three community health priorities will be the focus for Winona County over the next three years:

Priority #1: Mental Health Services

Priority Rationale: Our community needs ongoing education regarding mental health issues and how those issues can impact an individual’s day-to-day functioning. There is a need for mental health evaluation and service access. This priority is intended to assist individuals who have not sought mental health support and/or lack natural support.

Objective 1: by Aug. 2017 - Responsible parties: Winona County Community Services and Winona Mental Health Services. Develop collaborative approach with area organizations to focus attention and resources on behavioral health issues in Winona County.

Objective 2: by April 2016 - Responsible parties: Winona County Community Services and Winona Mental Health Services. Identify strategies to eliminate fragmentation of behavioral health services to Winona County residents.

Objective 3: by Dec. 2015 - Responsible parties: Winona County Community Services, Winona Mental Health Services, and Live Well Winona. Increase mental health awareness and education by sponsoring at least three (3) educational forums by December 2015.

Alignments:

Healthy People 2020: Improve mental health through prevention and by ensuring

access to appropriate, quality mental health services (Mental Health and Mental

Disorders, Goal). Increase the proportion of primary care facilities that provide mental

health treatment onsite or by paid referral (MHMD-5), Increase the proportion of

persons with co-occurring substance abuse and mental disorders who receive treatment

for both disorders (MHMD-10), and Increase depression screening by primary care

providers (MHMD-11).

Healthy Minnesota 2020:

Capitalize on the opportunity to influence health in early childhood.

Assure that the opportunity to be healthy is available everywhere and for everyone.

Strengthen communities to create their own healthy futures.

COMMUNITY HEALTH PRIORITIES

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Priority #2: Preventive Care Services

Priority Rationale: Community lacks education on available preventative care services and how to efficiently access them in our community. This priority is aimed at assisting individuals who are in need of provider reference and service access.

Objective 1: Dec. 2017 - Responsible parties: Winona County Community Services, Winona Health, and Live Well Winona. Reduce the disparity of preventive screenings in the minority or disadvantaged populations, supporting cultural factors and promoting healthy living for all county residents.

Objective 2: July 2016 - Responsible parties: Winona County Community Services Winona Health, and Live Well Winona. Work with Winona providers to create a universal preventative screening tool.

Objective 3: Dec. 2015 - Responsible parties: Winona County Community Services Winona Health, and Live Well Winona. Increase educational efforts on the value of preventive care.

Objective 4: June 2016 - Responsible parties: Winona County Community Services, Winona Health, Live Well Winona, and City of Winona Transportation. Investigate transportation solutions to enhance care to underserved populations.

Objective 5: Aug. 2017 - Responsible parties: Winona County Community Services and Winona County Dental Group. Explore opportunities to provide preventive dental care to the underserved population.

Alignments:

Healthy People 2020: Improve access to comprehensive, quality health care

services.(Access to Health Services, Goal). Increase the proportion of persons with

medical insurance (AHS-1), Increase the proportion of persons with a usual primary

care provider (AHS-3), and Reduce the proportion of persons who are unable to obtain

or delay in obtaining necessary medical care, dental care, or prescription medicines

(AHS-6).

Healthy Minnesota 2020:

Capitalize on the opportunity to influence health in early childhood.

Assure that the opportunity to be healthy is available everywhere and for everyone.

Strengthen communities to create their own healthy futures.

COMMUNITY HEALTH PRIORITIES

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Priority #3: Obesity/Overweight:

Priority Rationale: Educate our community on the risk and negative impact of obesity. Ensure any social determinants surrounding obesity are addressed. This priority is aimed at assisting individuals with unhealthy eating habits and have other health concerns related to obesity.

Objective 1: Nov. 2015 - Responsible parties: Winona County Community Services, Winona County School Districts, and Live Well Winona. Identify opportunities to promote healthy lifestyles, recreational opportunities, healthy eating and wellness behaviors by partnering with area organizations, schools, businesses and Live Well Winona.

Objective 2: June 2016 - Responsible parties: Winona County Community Services and Live Well Winona. Educate community on ‘what is obesity’, the impact of overweight on health and well-being, understanding important ‘health numbers’, and offering viable solutions through at least three (3) educational forums by June 2016.

Objective 3: Dec. 2018 - Responsible parties: Winona County Community Services, Project FINE, Community Gardens, and Farmers Market. Ensure that all income levels have access to healthy foods which then will reduce the risk for obesity in our community.

Outcomes: Increased attendance at Winona County Farmer’s Markets and participants in I Can Prevent Diabetes will decrease their body mass index.

Alignments:

Healthy People 2020: Promote health and reduce chronic disease risk through the

consumption of healthful diets and achievement and maintenance of healthy body

weights. (Nutrition and Weight Status, Goal). Increase the proportion of physician

office visits that include counseling or education related to nutrition or weight (NWS-

6), Increase the proportion of adults who are at a healthy weight (NWS-8), Reduce the

proportion of adults who are obese (NWS-9), Reduce the proportion of children and

adolescents who are considered obese (NWS-10), and Prevent inappropriate weight

gain in youth and adults (NWS-11).

Healthy Minnesota 2020:

Capitalize on the opportunity to influence health in early childhood.

Assure that the opportunity to be healthy is available everywhere and for everyone.

Strengthen communities to create their own healthy futures.

COMMUNITY HEALTH PRIORITIES

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Figure 3: Behavior Change Framework

What influences behavior changes?

6 components necessary for behavior to occur

Behavior = Environment/Person

Engage community stakeholders with a shared interest in improving community health needs. Need to engage a neutral partner to facilitate the group process. Participants in this group need to represent the private and public health system in Winona County. Develop workgroups based on the health priorities, gather community input/data collection, and review data to identify key strategic issues. Establish a work plan through a democratic process. Individual organizations may need to revise existing policies and procedures to address practice changes. Community engagement and collaborative participation are vital to the community health improvement process.

SUSTAINABILITY

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Sustainability

The Winona County Community Health Improvement Plan was created by a core team of community members to broaden and build upon successful local initiatives. This health improvement plan identifies specific evidence-based components based on community health needs.

CONTACT INFORMATION

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Contact Information:

Beth Wilms, Director

Community Services

202 West Third Street

Winona, MN 55987

Tel: 507-457-6205

Fax: 507-454-9381

www.co.winona.mn.us