Food insecurity and access to mental health services and health care are three areas that need immediate attention and investment in Central Florida, according to the 2019 Community Health Needs Assessment compiled by local nonprofit hospitals, health departments and community health centers.
Nearly 60% of more than 2,700 people who were surveyed for the assessment said they struggled with hopelessness and depression.
“That number just blew my mind,” said Daryl Tol, president and CEO of AdventHealth’s Central Florida Division, adding that his organization has plans to invest in mental health and find partners to help increase access to services.
Only 10% said that their community had sufficient mental health or substance abuse services.
The assessment, released this week, is conducted every three years and has been required by the Affordable Care Act since 2013. In its third iteration, the collaborative expanded its pool of partners, this time adding four local community health centers -- also known as federally quality health centers.
The partners also identified other health-care areas that needed improvement, including childhood immunization, chronic diseases, HIV/AIDS, substance abuse and infant mortality.
“Our health status indicators are very poor in the state of Florida, broadly. And it has to do with the legislative position on social spending and health care. It has to do with the massive growth of the state, the multicultural dynamic and the various needs that come with that and need to be recognized," Tol said.
The 711-page report is a collection of data from the partners, state and federal sources, a survey of residents and several focus groups.
Its goal is to identify health needs in Lake, Orange, Osceola and Seminole counties. The partners will next develop plans to addressed the issues. Hospitals will also use the data to guide their charitable giving.
The report shows that even though there are 32 hospitals and more than 20 emergency rooms -- not to mention many outpatient clinics -- in the four-county region, many Central Floridians still have problems finding a doctor or can’t afford care when they need it.
Almost one-third of survey respondents said they lacked access to high quality, affordable, healthy food.
It showed that diabetes and asthma hospitalizations decreased, as did the prevalence of colorectal cancer and lung cancer.
It confirmed that unemployment numbers have dropped, along with the homelessness rate, and that household income has slightly increased in recent years.
But despite the region’s economic growth, several areas in each county are still poor, with limited access to health care and other services that could benefit them.
“Struggles of the poor in our community just scream at you from the pages of the needs assessment,” said Tol.
Here’s what Central Florida looks like: It has almost equal number of men and women; about 67% of its population is white, followed by 31% Hispanic. More than 42% of the population is married; about 15% is 65 years and older, while 40% is between ages 35 and 64. The population of the four counties is about 2.6 million and is expected to increase by 8% in the next five years.
The report showed that like the rest of the nation, health disparities persist in Central Florida.
“There are serious concerns about infant mortality in minority populations, particularly among Black residents,” according to the report. “[While] the four-county region and state rates are near the Healthy People 2020 target, Black residents have infant mortality rates about 50 percent higher than White and Hispanic rates. In Lake County, the Hispanic infant mortality rate tripled between 2012 and 2017.”
When Andia and Keith Kolakowski are among thousands of parents who lose their babies in the first year of life. Several reasons lead to infant mortality, and no one effort can address the problem. But improving access to prenatal care, better nutrition and education have been shown to improve the outcomes for both mom and baby.
To the dismay of the health partners, there was a moderate reduction in preventive screening for women and the population aged 50 years and older. The percentage of women who receive pap tests has also been on a steady decline since 2002.
“That’s particularly hard to digest,” said Lainie Fox Ackerman, assistant vice president of external affairs and community benefit at Orlando Health. “It was disappointing to see us take a step back in that space.”
Survey respondents said that lack of transportation, lack of insurance, cost and health literacy could be among barriers to access preventive care. They also said that some residents may have difficulty trusting health providers.
In some areas of the region, there’s a serious shortage of mental health providers, the report showed.
While on average there is one mental health provider per every 809 residents in the four counties, in Lake County, there’s one mental health provider for every 1,285 individuals.
“That’s really untenable and it’s clear now that we have to either partner or build services that raise the number or providers available to help deal with this issue,” Tol said.
The county also had the highest teen suicide rate in 2017, with 15 cases per 100,000 population, almost three times the state average of 5.5. The rates in Orange, Osceola and Seminole counties were between 2.5 and 5 that year.
At 32 cases per 100,000, adult suicide rates in Lake county also were above the state average of 19.
The report showed that Osceola County had the highest rate of fentanyl-related deaths in 2017 at 11 per 100,000. The state average was eight that year and Orange County’s was nine.
For instance, at the Celebration campus, near the theme parks, the highest number of uninsured are northeast of the hospital, where between 9% to 40% of the population lives below the poverty line.
“There’s some data that’s showing that the areas around Disney are some of the happiest places in town and some of the saddest places in town,” said Tol. “It shows a divide."
The report also found:
Lake County had the highest rates of heart disease, adult obesity, high cholesterol and high blood pressure in the four-county area. It also had a higher rate of new lung cancer cases and diabetes hospitalization among children between ages 12 to 18.
Seminole County, which is the healthiest county in the region, had the lowest rate of licensed physicians, with 91 doctors per 100,000 residents. It also had a large drop in dentists, falling from 56 per 100,000 population in 2015-2016 to 17 in 2016/2017.
Osceola County had the highest rates of asthma, cancer, diabetes, childhood obesity and stroke in the four county area.
Orange County had the highest rate of licensed physicians, with 382 doctors per 100,000 people.
The leading causes of the death in the region are heart disease and cancer. The top causes of death from injury were poisoning, firearms, falls, car accidents and suffocation.
86% of the survey respondents said they had difficulty sleeping.