# Presentation: 696131

## Implementing the CHIP model for Galveston’s Vulnerable Populations with HP 2010

- Daniel H. Freeman, Jr., Ph.D
- University of Texas Medical Branch
- www.utmb.edu/pmch/Services.htm

## Acknowledgements

- This report was prepared with the assistance of Christopher Langford, Faten El-Zeky, Ted Hanley, Michael Jackson, Barbara Crews, Chris Packard, Marilyn Brodwick, Chuck Chambers, the Galveston County Health District, the staff of UTMB and citizens of Galveston. The work was supported by a President’s Cabinet Award, the Department of Preventive Medicine and Community Health, the Office of Community Outreach and the Office University Advancement

- utmb.edu/pmch/Services.htm

**Notes:**
The project is an extension of the report card projects which are a collaborative effort initiated by the Galveston Partnership for Better Living and the Galveston County League of Women Voters.  Earlier report cards summarized the status of children (6) and the over 65 population.  The present report is funded in part by the UTMB President’s Cabinet.

## “Let not the needy, O Lord, be forgotten, 	nor the hope of the poor be taken away” BCP 1979

- utmb.edu/pmch/Services.htm

**Notes:**
The project began with a group of community advisors. Their task was to define vulnerability.  At its most basic level vulnerability stems from a loss of hope by individuals within a community.  This is nearly impossible to measure directly, but there are indicators.  The populations most at risk of vulnerability include children, the aged, the infirm, those with unstable housing, the poor and, ultimately, those who have been left behind.  This last group is the focus of this evening’s presentation. We will continue in later talks to address the other groups and some of the consequences of vulnerability as well as the community’s response.

## Community Health Improvement Process (CHIP Model)Durch Bailey and Stoto 1997

- utmb.edu/pmch/Services.htm

**Notes:**
Documented Needs
Extensive health care needs for children
Insurance for population
Public health and safety for Children
Indigent support programs
Food delivery programs.
Lack of consistent reporting of service delivery and mission statements

How do we address these needs?  A number  models for improving communities have been suggested.  One of the best known is the Community Improvement Process Model.

Community Improvement Process: Problem Identification and Prioritization Cycle
Community Coalitions – in Place
Community Profiles – in Place
Identify Critical Issues?
Health care needs
Insurance
Public Health and safety
Indigent Support
Food delivery to the disabled
Consistent Program Assessment at City Level

## Analysis and Implementation Cycle

- Analysis and Implementation Cycle

- Healthy People 2010

- utmb.edu/pmch/Services.htm

**Notes:**
Partial List of Non Governmental Agencies
AIDS Coalition of Coastal Texas
Alcohol and Drug Abuse Women's Center	
American Red Cross:	
Big Brothers & Big Sisters
Boy Scouts of America
Catholic Charities	
Family Service Center of Galveston
Galveston Brain Injury Association
Galveston County YMCA
Girl Scouts of American
Women's Resource and Crisis Center

## Indicators: Administrative Data

- Local
- Comparable
- Believable
- Useful

- City of Galveston

- County – State – Nation
- Neighborhoods

- Monitor process and outcomes

- Known strengths and weaknesses

- utmb.edu/pmch/Services.htm

**Notes:**
The criteria for including data are that they are:  local, comparable, believable and useful.  

The first criterion, local data, means that the indicators must be available, either in fact or in principle, at the local level.  No new data was gathered because of cost and time constraints.  

The second criterion, comparability, means that a comparison data set is required.  Three possibilities emerge.  The most desirable is time series data to establish the direction of the indicators:  are things getting better, getting worse, or stable. A second set of comparisons would be to the baselines reported by Healthy People 2010.  The list of reportable indicators will be reduced based on what is available. Another type of comparison is comparison to larger entities, especially the county, state, or nation.  Data are more readily available for these larger governmental units.  However, care must be taken to ensure the same indicators are being compared at the various levels. A third set of comparisons was across the neighborhoods of the City. 

The third criterion was for the indicators to be based on believable data, that is, from reputable sources.  This means that we will rely upon data that are in the public domain and have been subjected to some form of public review and assessment.  Most of the data that met this criterion can be obtained from government agencies, either in traditional printed reports or from the Internet with well-documented and maintained websites.  Unfortunately, we found that most agencies either did not have current data systems or were unwilling to release data because of confidentiality concerns.  We report on the available data and compare it to other indicators where possible.

The fourth criterion is that the indicators be useful.  This means that the indicators must be readily understandable to policymakers.  In addition inferences drawn from a change or difference in an indicator should be reasonably unambiguous.  Ideally, a low rating on an indicator would suggest a program of action for remediation.

## Tool for Assessing Programs

- Demographics:
- Population and Change
- Neighborhoods ~4000 persons
- Indicators:
- Economic
- Health and Disability
- Behavior and Social
- [Education]

- utmb.edu/pmch/Services.htm

**Notes:**
Tonight we focus on the economic status and education of Galveston’s population.  On the next Monday we will talk more about the consequences of vulnerability.  We will also discuss some of responses of our city to need.

## Galveston’s Population 2000: 57,247

- utmb.edu/pmch/Services.htm

**Notes:**
Census 2000 reported 57,614 residents in the City of Galveston.  Of these 25% are black, 26% are Hispanic, 44% are white and 5% are Asian and others or combinations.  Children represent about 23% of the population and 14% are over 65 and 6% are over 75.  Note that while the population under 18 is roughly equally distributed among blacks, Hispanics and whites, after age 65, whites represent nearly two thirds of the population.

## Map 2. Galveston’s Ethnic Structure Persons in 2000

- utmb.edu/pmch/Services.htm

**Notes:**
When we look at our neighborhoods, we see while in a strict sense they are diverse, in fact there are sharp differences.  
North of Broadway is disproportionately black
West of 61st street is disproportionately white
The Hispanic population is concentrated across the center of the island

## Galveston Island’s Population: 1970 to 2000

- Galveston Island’s Population: 1970 to 2000

- Total Population
-      62,396		       62,146 	      60,789 	   57,247

- utmb.edu/pmch/Services.htm

**Notes:**
Galveston’s total population has been relatively stable for several decades. Considering the whole island including Jamaica Beach, In 1970 it was 62,396 and by 2000 it had declined by 5.7%.   The island has experiences net out migration of whites and blacks, accompanied by a net increase of Hispanics, Asians and others.  To understand the fine structure, we must both drill down to the neighborhoods and look out across the county.

## Map 3. Galveston’s Population Change Since 1990

- utmb.edu/pmch/Services.htm

**Notes:**
And as with population counts, the changes have differed by neighborhood.  
The traditionally black neighborhoods have experienced significant losses of the black population.  In some cases their has been an influx of Hispanics, and in the case of the CBD of whites.
The center of the island has seen a marked loss of whites and an corresponding increase in Hispanics.
The growth of the West End has been fueled by modest in migration of all groups.

## Socio-Economic Indicators

- Poverty
- Public Assistance

- utmb.edu/pmch/Services.htm

## Percentage of Children Living in Poverty by City, County, Texas, US: 1999

- http://www.census.gov/

- utmb.edu/pmch/Services.htm

**Notes:**
Poverty strikes disproportionately at children. According to the Texas Education Agency, while nearly 50% of Texas children are economically disadvantaged, 63% of Galveston’s children are economically disadvantaged.  

According to Census 2000, during 1999, Galveston had 32.3% children classified as living in poverty according to Census 2000. This percentage is markedly higher than the poverty rates for League City (4.9%), Texas City (20.6%), Texas (20.3%), and the United States (16.1%).

## Map 4. Percentage in Poverty by Age

- utmb.edu/pmch/Services.htm

**Notes:**
On the island, poverty depends on your neighborhood and on your age.  It is concentrated north of Broadway and among the youngest.  But it affects all ages and all neighborhoods.

## Map 5. Percentage in Poverty by Race Ethnicity

- utmb.edu/pmch/Services.htm

**Notes:**
Poverty is also disproportionately distributed by race.  Note the expensive poverty among Asians and blacks in Carver Park and Bayou Shore.

## Map 6. Poverty and Public Assistance

- utmb.edu/pmch/Services.htm

**Notes:**
The response to poverty through public assistance again depends on your neighborhood.  The gap is smallest where there is the least poverty, Lake Madeline.  It is worst in areas that are often overlooked: East End, Lindale, and Offats Bayou

## Health Indicators

- Natality
- Immunizations
- Sexually transmitted diseases
- Preventable Hospitalizations

- utmb.edu/pmch/Services.htm

**Notes:**
Measuring the health of the population is critical to understanding the general well being of the community.  Many indicators are available from the Galveston County Health District and the Texas Health Care Data Council.  We report those which were identified by the Agencies, Affiliates and focus groups.  Natality concerns the conditions surrounding births and new born. Immunization refers primarily to children but is also of concern to our older population.  Sexually transmitted disease have a known cause and can be specifically targeted for eradication. Finally, disability afflicts all ages and all groups.  It is particular important to consider for our city, which includes a major medical center.

## Births with Timely Prenatal Care1998 through 2002

*To increase to 90% the proportion of pregnant women who receive early and adequate prenatal care.*

- utmb.edu/pmch/Services.htm

## Children Adequately Immunized at Age 2 Years

- Table 19

- utmb.edu/pmch/Services.htm

## Incidence Rates for GonorrheaAmong Children Age15 through 19 Years

| To reduce gonorrhea among adolescents to 19 new cases per 100,000 |
| --- |

- Table 25

- utmb.edu/pmch/Services.htm

## Pediatric Asthma Hospitalization Race & Ethnicity, Under Age 18 years,1999-2001

- Pediatric Asthma Hospitalization Race & Ethnicity, Under Age 18 years,1999-2001

*Under 5 cases*

- *

- *

*HP 2010 Objective 1.9a:  17.3 per 10,000 persons*

- March 3, 2004

- Frank Lemus, PMCH & SCOA, UTMB

- utmb.edu/pmch/Services.htm

## Uncontrolled Diabetes Hospitalization Race & Ethnicity, Aged 18 – 64 years,1999-2001

- Uncontrolled Diabetes Hospitalization Race & Ethnicity, Aged 18 – 64 years,1999-2001

*HP 2010 Objective 1.9b:  5.4 per 10,000*

- *

** Under 5 cases*

- March 3, 2004

- Frank Lemus, PMCH & SCOA, UTMB

- utmb.edu/pmch/Services.htm

## Pneumonia and Influenza Hospitalization Race & Ethnicity, Age 65+ Years, 1999-2001

- Pneumonia and Influenza Hospitalization Race & Ethnicity, Age 65+ Years, 1999-2001

- *

- *

- *

- **

**** Under 5 cases*

- *

- *

- *

- *

- *

- *

*HP 2010 Objective 1-9c:  8 per 10,000*

- March 3, 2004

- Frank Lemus, PMCH & SCOA, UTMB

- utmb.edu/pmch/Services.htm

## Behavior and Social Indicators

- Smoking
- Alcohol
- Violence

- utmb.edu/pmch/Services.htm

**Notes:**
Focus groups identified smoking, substance abuse and violence as key concerns.  Smoking represents a major health risk that can be limited by effective legal enforcement. Similarly alcohol is illegal for most teens and can be controlled.  Similarly gangs and the threat of personal injury from fights and weapons are a major concern.

## Cigarette Use and Source for High School Students

- utmb.edu/pmch/Services.htm

## High School Students’ Alcohol Use

- Table 37

- utmb.edu/pmch/Services.htm

## High School Students' Risky Driving

- Table 29 and 36

- utmb.edu/pmch/Services.htm

## High school students who carried a weapon, engaged in, or witnessed violent behavior on school property

- utmb.edu/pmch/Services.htm

## Implications of CHIP and HP 2010

- Schools
- $70 Million bond issue passed, first since 1993
- Police removed from schools
- Health
- Immunization campaigns reorganized
- Serious attack on STD’s through Teen Health Clinics
- Sale of cigarettes seriously restricted
- Community Investment Model for United Way

- utmb.edu/pmch/Services.htm

## 20 Percent of Today100 Percent of Tomorrow

- utmb.edu/pmch/Services.htm

## Questions?www.utmb.edu/pmch/Services.htm

- utmb.edu/pmch/Services.htm