Purpose of the Study
With the rapid changes occurring in health care technology, increasing health care costs, and changing social needs, the nation is faced with the challenges of developing a health care system that is responsive to local needs and that places greater responsibility on local decision-making. The public health departments throughout the State of Missouri, in cooperation with the Missouri Department of Health, are presently engaged in the process of developing plans that will guide the local decision-making process on strategic actions to improve the status of community health. The Barry County Health Department has taken the lead in initiating and guiding the health planning process for Barry County. This report represents the outcome of efforts undertaken by the Barry County Health Department to assess the health needs of the Barry County community. To assist the Health Department in this task, the Center for Resource Planning and Management, Missouri State University, was engaged to carry out the health assessment for Barry County.
The health assessment for Barry County has involved several activities. Data on demographic and socio-economic characteristics of the population that are relevant to health were compiled and evaluated to better understand the health care needs of the current population as well as anticipated needs of the future population. Health statistics have also been examined to provide an overview of the current health status of the population and changes or trends in health status. In order to encourage public participation in the needs assessment process and to better respond to community needs, a community health survey was conducted during January 1997. This survey was mailed to 2,000 households in the county; 635 households, or approximately 1 in 17 households in Barry County, completed and returned the survey. In addition, the survey was translated into Spanish and distributed to the Hispanic population. The 42 respondents to the Spanish survey have their results tabulated separately in order to get definitive input about the needs of the immigrant population. Figure 2-2 Barry County Communities The Barry County Health Assessment presents a descriptive analysis of these various data compiled and an identification of priority health issues for Barry County based on both public perceptions and current health conditions. It is intended that this health assessment provide a foundation for the Barry County Health Department, other public and private sector health care providers, and community stakeholders to move forward in the process of developing effective strategies and decision-making for improving the health status of the Barry County community.
A companion report entitled, Barry County Health Resources Directory, provides a more detailed inventory of health care facilities, service providers, and programs currently available to the residents of Barry County. This report is designed as an information guide, suitable for reference use by health care providers and the public.
Demographic and Socio-economic Conditions
Barry County has had significant population growth since 1990. The most recent estimate of population (1996) is 32,325. Other characteristics of the population such as age and gender are similar to those of the state of Missouri. What is unique about the Barry County population is the recent influx of immigrants from Mexico. The number of immigrants in the county has been difficult to determine. Since there is no reliable information concerning this population, the actual county growth may be even higher than the population estimates. Barry County’s income levels are lower than those of the state, region, and neighboring counties. Educational attainment is not as high as other parts of southwest Missouri. Barry County residents typically have a high school education (or less) and work in the manufacturing sector of the economy. Unemployment rates in the county roughly mirror those of the state as a whole.
The rates for out-of-wedlock births and abortions are relatively low in Barry County. Nevertheless, rates of teenage pregnancy remain significantly high. Reported child abuse is low in the county, while a high number of Barry County residents participate in the WIC program. Heart disease is the leading cause of hospitalization and death in the county. Cancer is the second leading cause of death and fourth leading cause of hospitalization. Accidental death rates are relatively high in the county, mainly due to automobile accidents.
Barry County benefits from both its location near regional medical centers and its own local health resources. Barry County residents can easily access major medical services in Springfield, Joplin, and Northwest Arkansas. The county also has local hospitals in Monett, Cassville, and Aurora. The county has a significant number of nursing home beds in the county, mainly in Monett and Cassville. The county is served by four ambulance districts, and has more than a dozen primary care physicians.
Community Health Survey
A random, mail out survey was answered by 635 Barry County residents. The respondents came from all parts of the county and many income levels. The older age groups were far better represented in the survey responses than the younger age groups. All ethnic groups and genders were represented in the survey, except the Hispanic population appears to have been severely under-represented. The Spanish survey compensates for this. The survey respondents ranked Cancer as the county’s leading health problem. Several substance abuse issues also ranked quite high, just behind cancer. Overall, the average rankings for almost all of health issues in the random survey can be classified as "moderately serious". Respondents ranked very few issues as "slight" or "not at all" a problem. A comparison of some major health issues in the survey is compared with data from the Missouri Department of Health in Table 1.
Table 1: Summary of Major Perceived Issues vs. Health Data
Barry County residents between 25 and 34 both knew the services of the Barry County Health Department best and used them the most. Older residents knew health department services better than other groups, but used them less. Younger residents knew health department services less, but used them more than most other age groups. Nearly half of the respondents go to the doctor 2-5 times a year. About 7% do not normally go to the doctor. Eleven percent go more than 10 times a year. Out of the responding households, 85% had a regular family doctor. Reputation, costs, and clinic/hospital affiliation were the three top factors that respondents used in selecting a health care professional. Two-thirds of the survey respondents had total health insurance coverage in their households. About 62% of the respondents had private health insurance, and 39% had Medicare. Eight percent of households reported having no health insurance. Barry County residents used the Springfield hospitals most often for medical care. Out-patient and emergency services were used more often in Monett, Cassville, and Aurora. Other hospital services were used in Joplin and Northwest Arkansas. Overall, about 80% of the regular survey respondents felt that their health needs were being met.
The community health survey was translated into Spanish and distributed to at a local Hispanic meeting. The Spanish survey respondents were generally younger and had lower incomes than the regular survey respondents. The Spanish Survey respondents ranked economic issues far higher than the priority issues in the regular survey. The Spanish survey respondents also weighted the health issues with less severity than the regular survey respondents. A comparison of the top five issues for both the surveys is found in Table 2.
Table 2: A Comparison of Top issues in the regular and Spanish surveys
Spanish survey respondents had greater concerns about insurance and the cost of medical care than regular survey respondents. The Spanish survey group also had more problems with transportation than the general population. They were less likely to use the Barry County Health Department or to have a family doctor. Only 17% felt that their healthcare needs were being met.