Community Trends Jennifer Reese

I spoke with Cambree Johnson, a health educator for the Southwest Utah Public Health Department.

She identified five public health trends at her health department:

• high levels uninsured and underinsured populations
• low access to fresh food and fruits and vegetables
• low access to green space for exercise
• high incidence and prevalence of chronic disease, especially among Native Americans
• low rates of people accessing free public health programs 

High levels uninsured and underinsured populations: Cambree said that a large portion of community members do not have adequate insurance coverage, and most of those people are living at or below the poverty level. These people either barely missed the income-level cut off for medicaid or were not sure how to apply for medicaid. Because of this, people in her community do not go to preventive measures for disease, and they only see a physician when they are in critical condition (most going to the emergency department). This creates high premiums for those who are insured, raising the cost of medical care for the entire community. She said that physicians also do not want to work with uninsured populations because they are often difficult to deal with and the physician does not receive compensation. 

Low access to fresh food and fruits and vegetables: Cambree mentioned that rural parts of her community do not have great access to fresh food. This includes the Native Americans that live in this part of the state--many, if not all, Native Americans live in Indian reservations in rural settings, far away from fresh produce. These Native Americans also do not care to eat more fruits and vegetables because they are happy with their current unhealthy lifestyle. She stated that these populations were especially difficult to work with, and they also contributed to the high levels of obesity-related chronic disease in the community. The Native American populations are almost completely unresponsive to programs specifically directed towards them regarding fruit and vegetable consumption and availability. 

Low access to green space for exercise: Cambree talked about how poor areas in the community have low levels of exercise, mainly because of the lack of parks and recreational centers. These poor areas include populations of Native Americans, Hispanics, and some white people. The Native American population has more space for exercise when compared with Hispanics, yet the Native Americans do not value exercise so they do not use the space to exercise. The health department has tried to encourage behavior change regarding exercise within the Native American community and they have had little success. Among other populations, her department has developed successful home work-out programs and classes at the health department. 

High incidence and prevalence of chronic disease: Cambree stated that the main chronic diseases found in her community were asthma, diabetes, cancer, and heart disease. She thought that the high prevalence of asthma could be contributed to poor areas with lower levels of sanitation. She talked about cancer caused by smoking, such as lung cancer and oral cancer. The Native American population has much higher levels of tobacco use when compared with all other population in her community, causing high levels of cancer. The Native American population also has much higher rates of obesity when compared to all other populations, contributing to more cases of heart disease and diabetes. 

Low rates of people accessing free public health programs: Cambree's department currently runs over 130 different public health programs in the community. The programs include all types of issues such as reduced rates on car seats, teen tobacco cessation, exercise programs, and individual counseling. They provide many programs that are specifically targeted at the Native American population and the Hispanic population. She stated that even when they got local Native Americans to promote participate in activities, the community participation still remained stagnant. Their car seat program and WIC program has had good participation levels with the other populations in the community.