Florida ranks 32nd in the US on the nine indicators the IWPR utilizes to assess women's health. The indicators are chron
Physical Health The detailed commentary and data are captured in separate sections for mental and physical health. If you wish to read both sections, proceed now with physical health. If you prefer, you can start with or only read the mental health section. According to the Institute of Women’s Policy Research (IWPR) “health is a critical component of women’s economic security and overall wellbeing. Multiple factors shape women’s health status, including genetics, behaviors and the environments where women work and play.” Florida ranks 32nd in the US on the nine indicators the IWPR utilizes to assess women’s health. The indicators are chronic disease, sexual health, mental health, physical health that includes behaviors, smoking, exercise and diet and prevention habits including mammograms, pap smears and other screenings. (Unless otherwise indicated, all national data noted in the following sections come from the IWPR report.) In addition to IWPR indicator references, there are some notations regarding Healthy People 2020 goals. “Healthy People is a set of goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the United States.” This Section Covers the Following Topics: •
Chronic Disease
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Reproductive and Maternal Health
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Behaviors
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Preventive Care
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Access to Care
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Priorities for Change
Chronic Disease Heart Disease National Heart disease is the leading cause of death for women of all ages in the United States. Nationally, between 2001-2011, women’s mortality rates from heart disease decreased by 36 percent (now at 136 per 100,000). Black women have the highest rate at 177.7 per 100,000.
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White women are next, followed by Native Americans. Hispanic and Asian/Pacific Islander women have the lowest rates at 98.8 and 74.9 respectively. Northeast Florida The rates in the five-county Northeast Florida area are about the same as the national rate. Over the 2009-2014 period, the rate ranged from 136.1 to 145.2 per 100,000 depending on the county. Cancers National Cancer is the second leading cause of death for all women in the United States. While the highest rate of incidence of all cancers is among white women, death rates are highest among black women. Lung cancer is the deadliest cancer for women; breast cancer is the most common. For the three most common cancers affecting women, the rates of incidence per 100,000 are breast (122.2), lung (52.1) and colorectal (34.1). Those three cancers also account for the highest rates of cancer death per 100,000: lung (36.4), breast (21.3) and colorectal (12.4). The rates of death from each of the three have decreased over the last decade. A decline in lung cancer is related to the increased public awareness of the hazards of smoking. White women have the highest rate of lung cancer, followed by black women. The decline in breast and colorectal cancers is related to early detection and advances in treatment. See the Preventive Care section below for a discussion of screening tests. Northeast Florida In Northeast Florida, 2014 breast cancer mortality rates range from a low of 16.0 per 100,000 in Clay County to a high of 22.8 in Duval County. Duval and Nassau county rates exceed the state rate, 20.2 (Note—due to small population, Baker County rates are considered “unstable” for comparison purposes.) Mortality rates among women for lung cancer in Baker (69.1), Clay (46.2) and Nassau (47.8) counties are significantly higher than the state rate (35.2 per 100,000). For colorectal cancer, the mortality rates among women in Clay (14.2) and Duval (14.0) exceed the state rate of 11.5, while the rate among Nassau County women is lower (8.1). For both lung and colorectal cancers, the mortality rates for women in Northeast Florida are lower than the rates for men. HIV and AIDS National The diagnosis of HIV has moved from a fatal disease to a chronic disease with the timely use of antiviral drugs. The rate of AIDS has declined nationally by 47 percent. Women of color are affected the most. Women ages 25-34 are the largest share of newly diagnosed cases. The incidence rate is 4.8 per 100,000 women nationally. The rate of being screened varies across ethnicity. Approximately 60 percent of black women report being screened compared to 32.5 percent of white women. The CDC reports that only 1 in 4 sexually active high school students
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has been tested for HIV. Florida ranked first among the 50 states in the number of HIV diagnoses in 2013 according to the CDC, with an estimated 5,364 adults and adolescents diagnosed. Northeast Florida Between 2005 and 2014 the number of adult women with HIV has declined from 6,923 to 6,147 in the five counties. The number of AIDS cases reported has declined from 1,426, to 804 for the state. However, there is concern that the rate is high among young people and LGBT women and men. Diabetes National Since 1980, the incidence of diabetes has quadrupled. Type 2 diabetes accounts for 90 – 95 percent of all diagnosed cases and is the fastest growing. (The remaining cases are mostly Type 1 and a small number of rarer kinds.) Diabetes increases the risk of heart disease, stroke, blindness, kidney disease and other adverse health conditions. In the U.S. overall, 10 percent of women aged 18 and older report having been told they have diabetes. Northeast Florida The incidence of diabetes is a bit below Florida’s rate (10.1 percent) in Nassau and St. Johns counties, but in Baker, Clay and Duval counties it is higher than the state. Rates of the disease vary by age. In Florida the age group with the highest rates is 45-65 followed by 6574 year olds.
Obesity In 2013 the American Medical Association classified obesity a disease, as did the American Heart Association. There has been debate in the public and medical press about the decision, with some expressing concern that it may “absolve” personal responsibility, as well as concern about the reliability of the Body Mass Index used to measure it. The current threshold for obesity is a BMI of greater than 30. While 35.7 percent of Americans now are categorized as obese, a target set by The Healthy People Initiative 2020 would reduce the rate for those 20 years and older to 30.5 percent.
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Obesity has important consequences for the nation’s health and economy. It is linked to chronic diseases such as heart disease, stroke, diabetes and some cancers. Costs in adults are estimated at $147 billion annually. Currently, Florida has the eighth lowest adult obesity rate in the nation, at 26.6 percent. Trending data from the last five years indicate it has leveled off. However, the picture deteriorates if numbers for overweight are combined with obesity. The five counties report rates from 48 percent in St Johns to 64.5 percent in Baker. The rates have trended upwards over the last 10 years. Aging and Chronic Health Conditions National As women age, they are more likely to have chronic health conditions and weakening immune systems, increasing their risk of contracting infectious diseases. They may experience decreased activity levels and often have no spouse, significant other or family to assist them. Six out of 10 women over the age of 65 are overweight or obese leading to health issues such as diabetes. They also report eating less than the recommended number of fruits and vegetables, are less likely to get 150 minutes of physical activity per week and report a higher average number of days with poor mental health per month. Overall, older women have lower socioeconomic status, tend to live longer than men, and have increased expenditures for health. Northeast Florida Northeast Florida population trends project continued, significant growth of the female population 65 and older. Currently, women 65 and older in St. Johns and Nassau counties exceed the national average for the percent of ALL adults 65 and older. The Jacksonville Community Council, Inc., 2015 report, “ReThink Aging,” pages 19-30, provides detail on a range of Northeast Florida health-related needs and priorities for the future.
Reproductive and Maternal Health Having the ability to decide whether and when to have children is important to women’s socio-economic wellbeing and overall health and is related to relationship stability and satisfaction. Unplanned pregnancy According to the Guttmacher Institute, over 50 percent of pregnancies are unplanned or mistimed. This number has not changed over time. The rate in Florida is 59 percent, according to the 2010 data reported by the National Campaign to Prevent Teen Pregnancy. Unintended pregnancies are highest among poor and low-income women, women aged 18-24, cohabitating women and minority women. The primary cause is inconsistent use of contraceptive measures.
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Teen Birth Rates and Teen Pregnancy Rates National/Florida In the U.S. from 1957 to 2012, the birth rate among teens 15 – 19 years old has declined by 67 percent. The circumstances of teen mothers have changed drastically in that time. In 1960, most teen mothers were married. Today, in that age group, 89 percent of births are to unmarried mothers. Teen pregnancy rates have fallen as well. Nationally, the rate peaked in 1990 and fell to 44 percent by 2012 data. The abortion rate among females ages 15-19 also has fallen over that time period. Florida is ranked 23rd in the nation in teen birth rates. The births to mothers ages 12-19 has declined over the last 20 years. The 2014 state birth rate was 15.6 per 1,000 in young women 12-19 years of age. Florida is ranked 32nd in the nation in teen pregnancy rates. As is the case with the teen birth rate, teen pregnancies have declined 55 percent since 1988; and 18 percent since 2008. Northeast Florida While the national and overall local rates of teen births have declined, several local realities show work is still needed to reduce teen pregnancy and improve access to adolescent health resources. Teen birth rates are below the state rates, except in Baker (28.0) and Duval (19.6). The 20-year trend Is down in all five counties. Northeast Florida Healthy Start analyzed the demographics and other characteristics of teens who gave birth in 2014: •
One third of teens who gave birth in 2014 live in the 11 local zip codes with the highest poverty rates.
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28 percent live in zip codes with the highest unemployment rates.
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46 percent had less than a high school diploma at the time of delivery.
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40 percent of teens who gave birth received late prenatal care.
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50 percent of teens who gave birth did not receive adequate or better prenatal care.
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80 percent of teens used Medicaid as a payment for delivery.
Teen Pregnancy/Births and Health Outcomes Teen birth is of concern for the health outcomes of both the mother and the child. Pregnancy and delivery can be harmful to teenagers’ health, as well as to social and educational
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development. Babies born to teen mothers are more likely to be born preterm and/or with low birth weight. Prenatal care Prenatal care can help mothers and babies remain healthy. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care. Health care providers can spot health problems early when they see mothers regularly. This allows health care providers to treat them early. Early treatment can cure many problems and prevent others. Additionally, prenatal visits offer a time for providers to talk to pregnant women about things they can do to give their unborn babies a healthy start to life. The higher the degree of education, the more likely prenatal care was initiated early in the pregnancy. The overall national trend is about 6 percent NOT seeking early care. In Florida five-year data shows about 6 percent of women have late or no prenatal care. In northeast Florida the rates of women who have late or no prenatal care are above the national rate in all counties. Preterm birth rate National Nationally, the preterm birth rate (less than 37 weeks) was 9.57 percent in 2014, down slightly from 2013 and down 8 percent from 2007. The preterm rate among singleton births has declined 10 percent since 2007. According to the CDC, preventing preterm birth remains a challenge because the causes of preterm births are numerous, complex and not always well understood. However, pregnant women can take important steps to help reduce their risk of preterm birth and improve their general health. These steps: •
Quit smoking.
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Avoid alcohol and illicit drugs.
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Get prenatal care early and throughout pregnancy.
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Seek medical attention for any warning signs or symptoms of preterm labor.
Preterm birth is the greatest contributor to infant death, with most preterm-related deaths occurring among babies who were born before 32 weeks. Preterm birth also is a leading cause of long-term neurological disabilities in children. A developing baby goes through important growth during the final weeks and months of pregnancy. Many organ systems, including the brain, lungs, and liver, need the final weeks of pregnancy to develop fully. The earlier the baby is born, the higher the risk of serious disability or death. Some problems that a baby born too early may face include breathing and feeding problems, cerebral palsy, developmental delays, vision and hearing problems. Preterm births also may cause emotional and economic burdens for families.
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Northeast Florida Northeast Florida preterm birth rates are higher than the national rate. Low Birth Weight The national 2014 rate for low birth weight (less than 2,500 grams) was 8 percent, essentially unchanged from 2013, but 3 percent lower than the 2006 high (8.26 percent). In Florida the low birth weight rate is 8.6. Low birth weight rates in Northeast Florida are higher except in St. Johns County. Baker County has the highest rate in the region. Infant Mortality National According to the Centers for Disease Control and Prevention, the death of a baby before his or her first birthday is called infant mortality. The infant mortality rate is an estimate of the number of infant deaths for every 1,000 live births. This rate is often used as an indicator of the health and well-being of a nation, because factors affecting the health of entire populations can also impact the mortality rate of infants. There are differences in infant mortality by age, race and ethnicity; for instance, the mortality rate for non-Hispanic black infants is more than twice that of nonHispanic white infants. According to the CDC, most newborns grow and thrive. However, for every 1,000 babies that are born, six die during their first year. Most of these babies die as a result of birth defects, preterm birth, low birth weight, sudden infant death, maternal complications of pregnancy and injuries. Florida/Northeast Florida The U.S. and Florida rates for infant mortality are nearly identical (6.0 and 6.1 per 1,000 live births). In Northeast Florida, Baker and Duval counties are above the national and state rates for a three-year period (2012-2014) with rates of 9.5 and 8.7 respectively. Clay and St. Johns Counties are below the state rate. The biggest issue is the disparity between the rates of infant mortality for black and white infants. In Duval county the rate for black infants is almost three times that of whites. In Nassau County it is almost twice that of whites.
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Sexually Transmitted Diseases (STDs) Bacterial STDs in women 15-34 have steadily increased in the last 20 years. Chlamydia is the most frequently reported bacterial sexually transmitted infection (STI) in the United States. Although symptoms are usually mild or absent, serious complications can occur before a woman recognizes a problem. Women ages 20-24 are at the highest risk, followed by ages 15-19. The rates for women in Baker and Duval counties exceed the national and state rates. Gonorrhea is a common infection, especially prevalent in the15-24 age group. It is transmitted by vaginal, oral and anal sex and can be transmitted from a pregnant woman to her baby. The rate in Duval County is 2.5 times higher than in the other Northeast Florida counties.
Behaviors Preventive behaviors can reduce the risk of developing diseases. Early detection through screening is the best practice for treatment and cure. Diet/Obesity/ Weight The American Medical Association and the American Heart Association determined that obesity should be considered a chronic disease. Detailed information about this data is found in the Chronic Disease section of this report. According to the National Institute for Health (NIH), about 60 percent of adults in the U.S. are overweight or obese. In black women the rate is almost 74 percent. Achieving a healthy weight can help control cholesterol, blood pressure and blood sugar. It may help prevent weightrelated diseases, such as heart disease, Type 2 diabetes, arthritis and some cancers. Eating too much and/or not being physically active enough lead to being overweight. National data suggests that only 20 percent of the population eats the recommended amount of fruits and vegetables. In Northeast Florida counties, women are consuming 14 to 25 percent of the recommended servings per day. Smoking Nationally 15.8 percent of women report having smoked or still smoke. This number has declined significantly since 2007 when 21.2 percent reported smoking. In Florida, 19.3 percent of women were smokers in 2007, declining to 14.4 percent in 2013. Clay reports the highest rate of women smokers, followed by Nassau, but all counties report declines in the last seven years. Exercise People who are physically active tend to live longer and have lower risk for heart disease, stroke, type 2 diabetes, depression and some cancers. Physical activity helps with weight control and may improve academic achievement in students.
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Rates of activity vary across states and regions and by gender. People living in the South are less likely to be physically active that those in the West, Northeast and Midwest. Women are less likely than men to meet physical activity guidelines. In general, most Americans need more physical activity.
Preventive Care For breast cancer, regular screening leads to early detection and better cure rates. But controversy continues about the age at which women should begin to have regular mammograms. The United States Preventive Services Task Force recommends they begin at age 50 and be done every other year, while the American Congress of Obstetricians and Gynecologists recommends annual screenings beginning at age 40 and the American Cancer Society recommends annual screenings beginning at age 45. Nationally 80 percent of the population reports getting regular mammograms over the age of 50. All Northeast Florida counties are below the national levels of screening, ranging from 47.8 percent in Baker County to 66.2 percent in St. Johns County. Cervical cancer forms in tissues of the cervix (the organ that connects the uterus and vagina) and is slow-growing. According to American Cancer Society, 1 out of 147 women in the United States will be diagnosed in her lifetime. Early cervical cancer can be cured by removing or destroying the pre-cancerous or cancerous tissue. Thus, early detection is very important and the Centers for Disease Control and Prevention highly recommend screenings with regular Pap tests. Cervical cancer is almost always caused by the human papillomavirus (HPV), which is transmitted through sexual contact. The FDA has approved vaccines against HPV, which prevent infection by HPV and thus prevent cervical cancer if taken before sexual activity begins. These vaccines prevent infection by HPV 16 and 18, which cause 70 percent of cervical cancers, but do not prevent all HPVs. So routine Pap tests remain necessary. The Healthy People 2020 national health target is to reduce the uterine cervical cancer incidence rate to 7.1 cases per 100,000 women. New cervical cancer screening guidelines released separately in March 2015 by the United States Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) recommend against routine yearly testing. Instead, the guidelines recommend testing every three years for women ages 21-65; routine cervical cancer screening for women under 21 and over 65 is no longer recommended. The two groups also introduced the option of a lengthened, five-year screening interval for women ages 30-65 when screened with a combination of Pap testing and human papillomavirus (HPV) testing. Nationally 80 percent of women report getting Pap smears at least every three years. In Northeast Florida, rates are 60 percent or lower. The cervical cancer rate is 7.4 percent in Clay and St. Johns ranging up to 17.2 percent in Nassau. For colorectal cancer, the recommendation is for regular screening to begin at age 50. The Centers for Disease Control and Prevention reports that about one-third of adults aged 50 and older – the age group at greatest risk of developing colorectal cancer – have not been screened as recommended.
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Access to Care In 2013 in the United States, 81.5 percent of non-elderly women (aged 18-64) reported having health insurance coverage. In Florida 23.1 percent of women reported not being able to see a physician in the past year due to cost. The problem was highest in Baker County at 28.6 percent. Clay and Duval counties reported rates of about 21.5 percent. Nassau and St. Johns fared much better. Locally access to care varies by county. Here is information about the number of physicians available.
Priorities for Change Expand Girls’ Access to Reproductive Health Care Sexually transmitted diseases, unplanned pregnancy and teen pregnancy can all be reduced by providing access to reproductive health care, including contraception. The Northeast Florida Teen Pregnancy Task Force’s “Plan for Community Action” outlines an action plan for doing just that. It includes an array of initiatives directed to young women, young men, parents, the faithbased community and schools. Among the specific priorities are providing evidence-based comprehensive sex education in multiple settings (schools, churches and other programming); incorporating teen pregnancy prevention and foster parent engagement into foster care programs, and public sector advocacy initiatives. The task force has explored effective models of school-based health clinics. There is evidence that providing students with accurate reproductive health education and contraception information at a school- based clinic is more likely to result in the use of contraception consistently and correctly. Among the proven models of school-based clinics are those in Denver and Oakland. Additional references that describe successful efforts to improve health outcomes on many fronts, including reproductive health are: •
Educating Girls: Creating a foundation for positive sexual and reproductive health behaviors
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Family Planning
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Voices of Hope Mental Health
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