washington county Health Care Profile
Over 57% of Washington County respondents ranked money needed for prescriptions as a major concern, while 56.01% of individuals surveyed ranked money for ongoing medical care as a major concern. Over 55% of the county's respondents ranked money for emergency medical care as a major concern. While the escalating costs associated with the provision of medical care services are not unique to Washington County , other factors may have contributed to the respondents' perceptions of the high costs of medical care services. These factors include; the percentage of adults who do not have health insurance (16.5%), the overrepresentation of multicultural populations (in this survey) who disproportionately do not have health insurance, and the percentage of Washington County residents who meet the Federal criteria for poverty (12.7%), (Arkansas Department of Health, 2002). Sociodemographic factors such as gender, age, ethnicity, employment status, educational level, insurance status, and household, composition affected respondents' perceptions of the issues surrounding medical care costs. While salient demographic variables affected survey respondents perceptions of medical care costs, a multivariate analysis of all the sample's demographic variables was not conducted. This analysis may have provided a greater insight into the variability associated with survey participant's opinions, involving medical care costs.
Just over 40% of Washington County respondents ranked adequate and timely access to a physician as a major healthcare access concern. Thirty-eight and three quarters percent of those respondents ranked access to health care services as a major concern, while 36.65% ranked access to dental services as a major issue. Washington County has one of the highest ratios of primary care physicians per 10,000 population in the state (11.9 per 10,000) and is ranked 4 th out of 75 counties in Arkansas , (Arkansas Department of Health report 2002). However, not all of Washington County residents experience convenient access to physicians, or to uniformly affordable health care. According to the American Fact Finder (2000), slightly more than 30% of Washington County residents live in rural areas. It seems reasonable that a portion of the variability associated with accessing health care services may be related to the relative lack of physicians in the more rural areas of Washington County. Another possible contributing factor may be the overrepresentation of multicultural groups in this survey. In particular, the propensity of Marshall Islanders to identify access to a variety of health care services as a significant concern may have contributed to this finding.
In addition, as previously discussed, nearly 16.5% of Washington County residents have no health care insurance. The lack of health care insurance for 1 out of every 6 adults living in Washington County likely results in financial barriers to accessing basic health care and dental services. Further exploration of the variables affecting Washington County residents' ability to access basic health care services is needed in order to develop effective health care policy and accessible and affordable health care services.
Over 56% of Washington County respondents ranked cigarette smoking and/or second hand smoke as a major physical health care concern, while 54.57% of survey participants ranked cancer as a major concern. Just over 54% of the county's respondents ranked weight problems as a major concern.
Based on statistics provided by the Arkansas Department of Health (2002), approximately 1 out of every 4 adults in Washington County smokes (24.6%). While there is little question that this finding represents a significant health concern for the residents of Washington County, a partial explanation for concerns over cigarette smoke among Washington County respondents involves the smoke free referendum, which occurred in Fayetteville at the time the Northwest Arkansas Health Needs Assessment was conducted. This climate of concern may also partially explain why cancer was the second most frequently endorsed physical health concern by survey participants. While cancer is the second leading cause of death in Washington County (Arkansas Department of Health, 2002) behind heart disease, the age adjusted cancer rates for Washington County has actually declined between 1999 - 2000, (Washington County Hometown Health Improvement, 2001). It is reasonable to surmise that the high level of publicity and significant amount of information disseminated by the proponents of Smoke Free Fayetteville likely heightened the community's awareness of the health risks associated with cigarette smoking and/or exposure to second hand smoke. Survey respondents in Washington County also identified weight problems as a significant physical health care concern. This perception is congruent with existing health data, as 60.1% of Washington County residents are considered overweight, based upon their Body Mass Index (Arkansas Department of Health, 2002).
The gender, age, ethnicity, educational level, household composition, and insurance status of the survey respondents affected their perceptions of physical health care concerns. A multivariate analysis of these demographic variables and other factors not accessed in this health care survey is needed to further identify the sociocultural and demographic variables associated with the perceptions of Washington County respondents regarding physical health care issues.
Nearly 50% of Washington County respondents ranked substance abuse as a major mental health care concern for the region. Forty-one and a half percent of the county's respondents ranked alcoholism as a pressing mental health care issue, while 40.11% ranked depression as a major concern. Prevalence rates for these disorders are not available at the county level, due to the difficulty in gathering this kind of data and the stigma often associated with these conditions. While the increase of substance abuse disorders in Northwest Arkansas (primarily methamphetamines) has been well documented, there has been relatively less attention paid to the problems associated with alcohol and mental health disorders. This selective attention to problems associated with substance abuse is somewhat at odds with the significance of mental health disorders. For example, a recent World Health Organization report has indicated that depressive disorders are the leading cause of disability and lost productivity in the world today. The emphasis placed on substance abuse as the most pressing mental health concern by Washington County respondents most likely derives from the significance of this issue in Northwest Arkansas and the attention paid to this problem by the media. This statement is not meant to diminish the significance of substance abuse as a significant problem within Northwest Arkansas communities, nor is it meant to diminish the need for effective treatment facilities in order to treat this problem. It is simply meant to suggest that, on a population basis, many more people are affected by problems with alcohol and depression than they are with substance abuse. Support for this assertion is derived from data disseminated by the National Institute of Mental Health, which indicates that approximately 9.5% of adults age 18 and older experience a depressive disorder, and that an estimated 386,000 Arkansans engage in binge alcohol drinking per month (SAMHSA, 2002). In comparison, estimates for illicit drug usage among Arkansas adults, 18 years and older, are 118,000 per month (CDC, 2002).
Clearly there is a need for accessible, effective and affordable treatment facilities for substance abuse, alcohol and mental health disorders. The comparisons offered between the perceptions of survey respondents and data derived from the SAMHSA, CDC, and NIMH, is simply meant to suggest that there is somewhat of an incongruence between the public's perception of the relative pervasiveness of certain mental health conditions and nationally derived incidence rates of mental health, substance abuse, and alcohol related disorders.
Gender, age, ethnicity, employment status and educational level affected survey respondent's perceptions in terms of mental health care issues. More specifically, being female, middle aged, Caucasian, employed or having a college education, positively and significantly affected Washington County respondents' perceptions regarding the seriousness of a variety of mental health issues.
Nearly 52% of Washington County respondents ranked cultural and language barriers to accessing health care services as a major multicultural health care concern, while 46.3% of those respondents ranked access to affordable health care services as a major issue. Being female, middle aged, Marshallese, or having graduated from college or achieving a higher educational attainment level was significantly and positively related with identifying a variety of multicultural health concerns as a major issue.
The survey responses expressed by members of the Marshall Islander community were notable, due to their concerns over cost, accessibility, and language and cultural barriers, which hinder their ability to successfully access health care services. There have been anecdotal reports within Northwest Arkansas ' health care community concerning the difficulties that health care providers experience in successfully providing services to members of the Marshall Islander community. However, results obtained from the Northwest Arkansas Health Needs Assessment suggest that members of the Marshall Islander community are concerned about their health care status and successfully accessing affordable health care services. Cultural and/or language barriers, however, appear to often contribute to the difficulties that Marshall Islanders experience in obtaining needed health care services.