HEALTH INDICATORS AND CHARACTERISTICS

Assessing the health of a community involves examining mortality, morbidity, maternal and child health, social health, environmental health, and access to health care data. All of these aspects of health are interrelated and need to be looked at as part of a whole, with each contributing to the health of individuals and communities. In addition, the health of a community cannot be explored without examining the broader implications of race and socioeconomic status.

The political body responsible for the health of Durham County is the Durham County Board of Health. It is the policy-making, rule-making, and adjudicatory body for the Durham County Health Department. The members of the board are appointed by the Durham County Board of Commissioners (McClain & Johnson, November 5, 1999). The Board of Health has the responsibility to protect and promote the health of Durham County residents and to aid Durham County in reaching the Healthy Carolinians 2000 objectives.

Healthy Carolinians 2000 is a list of health objectives published in November 1992 by the Governor's Task Force on Health Objectives, in response to the Healthy People 2000 initiative of the United States Department of Health and Human Services. The overarching goals of Healthy Carolinians 2000 are to increase the span of healthy life, reduce health disparities among the disadvantaged, and emphasize preventive health services and healthy lifestyles (Healthy Carolinians 2000, 1999). Healthy Carolinians 2000 is used as a baseline for health improvement.

Mortality

Mortality rates are concrete indicators of a population's health status. Durham experienced a death rate of 859.8 deaths per 100,000 for 1997, a rate that is similar to the state, but higher than that of 545.4 per 100,000 observed in Wake County. The top two leading causes of death in Durham County, heart disease and cancer, accounted for 50% of the total lives lost. Table 7 illustrates the top ten causes of death for both Durham County and the state of North Carolina, 1997:

Table 7. Leading causes of deaths for Durham County and North Carolina, 1997*

*Source: North Carolina State Center for Health Statistics, NC Department of Health and Human Services [Online]. Available: http:// www.schs.state.nc.us/SCHS/healthstats/deaths/led/led_data.cfm [URL not working]
**per 100,000 persons

Heart disease strikes disproportionately at the county's sub-populations. Despite having a lower aggregate heart disease death rate than the state overall, nonwhites in Durham County have approximately a 63% higher rate of death for this condition than Whites (182.1/100,000 and 112.2/100,000 respectively). This is an indication of the large health disparities that exist within the county (State Center for Health Statistics, October 7, 1999).

Cancer Mortality

Cancer is the second leading cause of death in Durham County. The overall death rate from all cancers was 197.8 deaths per 100,000, a level slightly lower than the rate of the state (203.9 per 100,000). Death rates for trachea, bronchus, and lung cancer for Durham County are 55.1 deaths per 100,000 compared to the state rate of 62.4 per 100,000. Prostate cancer deaths occurred at a rate of 19.2 deaths per 100,000 in Durham County, a level that is also lower than that of the state (26.1 per 100,000). However, breast cancer deaths (32.6 per 100,000) were slightly higher than the state rate of 31.8 per 100,000 (SCHS, October 7, 1999).

Despite many of the similarities between the rates of cancer deaths for Durham County and the state of North Carolina, we again observe disparities among Whites and nonwhites at the county level. Table 8 highlights the differences in cancer mortality rates by sex and race:

Table 8. Cancer Mortality Rates in Durham County for the time period 1991 to 1995*

*Source: North Carolina State Center for Health Statistics, NC Department of Health and Human Services [Online]. Available: http:// www.schs.state.nc.us/SCHS/healthstats/deaths/led/led_data.cfm [URL not working]
**per 100,000 persons

Among all cancers, nonwhite county residents consistently experienced greater levels of mortality than White residents. Total cancer mortality among nonwhite males was approximately 37% higher than White males. Moreover, nonwhite males had a 5% higher mortality due to lung cancers and an alarming 138% increase in prostate cancers relative to white male residents. Similar findings existed between White and nonwhite females. Total cancer mortality was 28% higher among nonwhite females. Similarly, rates of breast cancer mortality were 48% higher among this cohort relative to White, female county residents. The only favorable comparison was observed for lung cancer mortality between White and nonwhite women, a rate that was approximately equal between both groups.

Cancer Morbidity

Table 9 illustrates the cancer incidence rates, rate of newly diagnosed cases during a specific year, in Durham County:

Table 9. Comparison of state and county cancer incidence rates per 100,000 persons, by year*

*Source: North Carolina State Center for Health Statistics, NC Department of Health and Human Services [Online]. Available: http://www.schs.state.nc.us/SCHS/healthstats/deaths/led/led_data.cfm [URL not working]

Both the state and county of Durham saw dramatic increases in the rates of cancer incidence between the years of 1995 and 1997, up slightly more than 13% during this time period. While rates of breast cancer incidence decreased in Durham County and the state, lung cancer incidence increased.

Communicable Diseases

Nowhere in North Carolina has the impact of HIV and AIDS been more pronounced than in Durham County. The 1997 HIV infection rate of 34 per 100,000 for Durham County is more than double that of the state's rate of 15 per 100,000 (SCHS, 1997). The County's African American population disproportionately feels the effect of elevated HIV infection rates. In March 1998, of the 470 cases of HIV infection in adults, 11% were White and 89% were African American. The male to female ratio of HIV infection also indicated a disparity between the sexes such that more males than females were infected with HIV (69%:31%). Because of the high incidence of HIV infection in the county, Durham leads the state in the rate of AIDS cases as well. Durham County's 1997 rate of AIDS cases of 2.7 per 100,000 is more than twice the rate for the state of North Carolina as a whole (Durham County Health Department, 1998).

Table 10 illustrates the rate of newly diagnosed cases for five sexually transmitted diseases in Durham County and in North Carolina for 1997:

Table 10. Communicable disease incidence rates per 10,000 persons for Durham County and peer comparisons, 1997*

Source: North Carolina State Center for Health Statistics, NC Department of Health and Human Services [Online]. Available: http://www.schs.state.nc.us/SCHS/healthstats/pocketguide/profile_2.cfm

The 1997 rates of Gonorrhea and Chlamydia in Durham County were 46.6 and 46.7 per 10,000 people respectively. Both rates exceeded the state rates by slightly more than 103%. While less dramatic differences between Durham County and the comparison groups exist for the other disease categories, Durham County generally experiences the highest levels of incidence among any of its peer comparisons.

Durham County faces the task of drastically reducing all communicable disease rates to meet the initiatives of Healthy Carolinians 2000. Addressing these health problems in the nonwhite population will be a significant challenge given the disproportionately high rates of disease in every communicable disease category for these populations.

Pregnancy

In 1998, there were 3,288 live births in Durham, 14% of whom were born low birth weight (2,499 grams or less). This percentage is higher than the state rate of 10.6 (SCHS, August 27, 1999). When this data is aggregated by race (Table 11), the disparity between whites and nonwhites in Durham County once again becomes evident. Low birth weight births occurred almost twice as often among nonwhites as whites in both Durham County and the state overall. These discrepancies may in part be attributable to the differential use of prenatal care among different races. In Durham County, 7.9% of nonwhite women compared to 1.5 % of white women who delivered babies received late or no prenatal care (SCHS, August 27, 1999).

Table 11. Live births, by race, 1998*

*Source : North Carolina State Center for Health Statistics, NC Department of Health and Human Services [Online]. Available: http://www.schs.state.nc.us/schs/healthstats/death/ims1998/1998rpt.html [URL not working]

Teen Pregnancy

Teenage pregnancy continues to be a major health and social concern for Durham County. Teenage mothers are more likely to be unmarried, poor, and lacking a high school education. A large gap exists between White and nonwhite teens in pregnancy rates. The 1996 pregnancy rate for white teens in Durham County (42 per 1,000) is lower than for white teenagers in North Carolina (72.4 per 1,000). The 1996 pregnancy rate for nonwhites in Durham County is 127.7 per 1,000. This rate is slightly lower than the North Carolina rate of 134.2 per 1,000 (North Carolina Child Advocacy Institute, 1996).

Infant Mortality

Infant mortality is the death of a live born child before one year of age. The infant mortality rate is regarded as an indicator of the general health and well being of community. A high infant mortality rate may indicate unmet health, nutrition, and medical needs as well as unfavorable environmental and economic conditions within the population.

In order to attain an infant mortality rate of 7.4 infant deaths per year per 1,000 live births as specified under the Healthy Carolinians 2000 guidelines, the rate of infant mortality in Durham County (11.9) will need vast improvement. As with other disease and health conditions in the county, this differential can be attributed to the alarming disparities in the infant mortality rate between Whites and nonwhites. Although Durham's rate for Whites (7.1) is below the Healthy Carolinian 2000 goal, the rate for nonwhites (16.9) far exceeds this value. Table 12 shows the break down of infant deaths and infant mortality rates between Whites and nonwhites for 1998:

Table 12. Infant Deaths and Infant Mortality Rates for Durham County and state, 1998*

*Source : North Carolina State Center for Health Statistics, NC Department of Health and Human Services [Online]. Available: http://www.schs.state.nc.us/schs/healthstats/death/ims1998/1998rpt.html [URL not working]
**Per 1 year per 1,000 live births

Health Care Resources

Table 13 illustrates the provider to user ratios for 1997 according to the North Carolina State Center for Health Statistics:

Table 13. Population/ provider ratios, by county and state, 1997*

*Source: North Carolina State Center for Health Statistics, NC Department of Health and Human Services [Online]. Available: http:// www.schs.state.nc.us/schs/healthstats/pocketguide/profile_1.cfm
**Physician extenders are nurse practitioners and physician assistants, each weighted as .66 of a physician and added to the number of primary care physicians.

The population per primary care physician (PCP) ratio is 2,099 persons per PCP in Durham County. The same statistic from the Cecil G. Sheps Center for Health Services Research's (CGSC) NC Health Professions Data System's 1998 County Profiles is 453 persons per PCP (CGSC, August, 1999). This figure is closer to the PCP to population ratio alluded to in the Durham County Health Department's (DCHD) Community Diagnosis 1997-1998 which is 520 persons per PCP (DCHD, 1998). Our speculation is that the difference in the figures is due to the NC Health Profession Data System takes into account all PCPs licensed in the county and does not determine if they are still actively practicing or not. The statistics for PCP to population ratio for Wake County and all of North Carolina by the NC Health Professions Data System are similar to the North Carolina State Center for Health Statistics numbers.

According to the Durham County Health Department: Durham County has state of the art medical facilities and a broad range of research, teaching and clinical services with international reputations. Durham County boasts five hospitals, a federally qualified community health center, a health department and some sixteen health related services. Internationally known health industry and research centers such as Glaxo-Wellcome, ClinTrials, Quintiles, Cato Research, Ltd., Research Triangle Institute, and Family Health International in the Research Triangle Park are also located in Durham County (DCHD, 1998).

The main sources of health care delivery in Durham County are Duke University Health Systems, Lincoln Community Health Center, Durham County Health Department, and The Durham Center (see section on Social Health for more information on services provided by The Durham Center). In addition, there are five hospitals located in Durham County. These institutions are Duke University Medical Center which is a 1750 bed tertiary care hospital, Durham Regional Hospital which is a 460 general hospital that mainly serves the population of Durham County, Veteran's Administration Medical Center which serves veterans from all of North Carolina, North Carolina Eye and Ear Hospital which has 31 beds and provides both inpatient and outpatient surgical treatment, and Lenox Baker's Children's Hospital which provides outpatient medical treatment and rehabilitation to special needs children from the whole United States (DCHD, 1998).

In 1998, Duke University created a new health entity named the Duke University Health Systems (DUHS). Its goal is "to create a premier integrated health system that uses Duke's academic and research strengths to improve clinical care" (Duke University Medical Center [DUMC], December 21, 1998). The new health system owns Duke University Hospital, and Duke University Affiliated Physicians, which includes several primary care practices in Durham County. The Private Diagnostic Clinic, a medical practice maintained by Duke University Medical Center faculty, has a contract with DUHS (DUMC, December 21, 1998). The DUHS is the main health care provider to the population of Durham County that has adequate health insurance coverage.

Durham Regional Hospital facilities are leased by DUHS. Durham Regional Hospital's employees are DUHS employees but the hospital continues to have a county appointed Board of Directors. Currently, the hospital reports a $4.3 million budget shortfall for the first quarter of the 1999 fiscal year. This budget shortfall has heightened fears in the Durham community that the DUHS will take financial actions at the hospital without the Board of Director's permission. Such a move is allowable by the contract between the Board of Directors and DUHS if Durham Regional Hospital's financial situation worsens (Chorpening, J., November 20, 1999). On the hospital's campus is Durham County's only inpatient substance abuse treatment program, Oakleigh Chemical Dependency Treatment Center. DUHS closed its inpatient substance abuse treatment service earlier this year to concentrate on improving their outpatient substance abuse clinic, Duke Addictions Program. DUHS now sends its patients in need of inpatient treatment to the Oakleigh facility (DUMC, May 17, 1999).

Since 1970, the Lincoln Community Health Center has served the residents of Durham County and especially reaches out to the under-served populations of the community. The Health Center provides prenatal and family planning services in conjunction with the Durham County Health Department. Other services offered on the premises are comprehensive, including general adult medicine, pediatrics, adolescent, dental, social work/mental health, and ophthalmology.

The Lincoln Community Health Center goes a long way to reach its customers. Examples include the provision of transportation services to increase access to its services and a school based wellness clinic located on the campus of Hillside High School. Moreover, the Lincoln Community Health Center has expanded its clinic hours into the evening and Saturday mornings to meet the needs of the community. The Community Health Center has added urgent care hours in collaboration with Duke University Health System (DUHS); this activity is the called the Lincoln-Duke Urgent Care. DUHS decided there was a need for an urgent care center in southern Durham County. The urgent care staff members are employees of the Lincoln Center but the medical providers are Duke employees who rotate between Lincoln-Duke Urgent Care and another DUHS affiliated urgent care center in the northern part of the County. This collaboration began on November 30, 1998 (Lincoln Community Health Center, Inc. [LCHC], 1999).

According to the Lincoln Community Health Center, it "continues to serve an increasing number of Hispanic/Latino patients. Of the 26,354 patients seen in 1998, 3,573 (13.6%) were Hispanic. This number compares to 9.7 percent in 1997…and 2.7 % in 1994" (LCHC, 1999). Unfortunately, these are some of the only concrete figures regarding the rapidly growing Hispanic community and its effect on health resources in the county.

Another major source of health care is the Durham County Health Department. The Health Department provides preventive and medical treatment services including care for patients with chronic illnesses such as diabetes, comprehensive care for patients with communicable diseases, immunizations, dental care, and nutrition services. As previously mentioned, the Health Department operates a maternity clinic in collaboration with the Lincoln Community Health Center. The Health Department also provides public health services such as surveillance of environmental health, food sanitation and private water supplies, health education, and manages vital statistics (birth and death records) for the entire county.

Several reports from Durham County health care institutions mention the challenges of dealing with the current managed health care climate (LCHC, 1999; DUMC, December 21, 1998; and DCHD, 1998). However, this was not expressed in the primary data collection phase of this community diagnosis.

Demographic, Educational, and Economic Characteristics

Back to TOC

Socail Health and Indicators