SOCIAL HEALTH AND INDICATORS

Social health encompasses various health characteristics that can enhance or create barriers to one's overall heath status. Components of social health include behavioral health, crime, and domestic violence. Both individuals and society have historically underestimated the influence of social health on life functionality. It is important to recognize that social and cultural norms often disfavor family or public discussion of many social health issues making the access to treatment difficult. As a result, pinpointing true incidence and prevalence of social health indicators is a difficult task. This next section presents available secondary data on social health and quality of life characteristics in Durham County.

Due to its large societal implications, control of substance use is an integral part of improving social health. Drug and alcohol use have been associated with increased levels of mortality, traffic fatalities, crime, sexually transmitted diseases, and with incidence of mental illness. According to the Alcohol/Drug Council of North Carolina, an estimated 19,435 persons, nearly ten percent of Durham County residents, were addicted to alcohol or drugs in 1997 (Alcohol/Drug Council of North Carolina, 1997).

Substance use is also reflected in related arrests. For the estimated 202,000 residents in Durham County in 1998, rates for Driving While under the Influence (DWI) and drug arrests were 749 and 624 per 100,000 residents respectively (Alcohol/Drug Council of North Carolina, 1999). These findings are high in comparison to neighboring Wake County for the same year (675 DWI arrests per 100,000 residents and 597 drug arrests per 100,00 residents), particularly given that Wake County has a population that is twice as large as the population of Durham County (574,828 residents).

Admissions data from the Area North Carolina Division of Mental Health shows that alcohol abuse (16.2%), substance abuse (18.5%), and anxiety or depression (16.8%) treatment were the most provided services for the North Central Region of North Carolina, an area that includes Durham County and 10 neighboring counties (Developmental Disabilities and Substance Abuse Services, November 1998a). The Area NC Division of Mental Health provides services that include: psychiatric hospitals, mental retardation centers, alcohol and drug abuse treatment centers, schools for emotionally disturbed, and special care centers. The only local facility under this division in Durham County is the Durham Center.

Despite an increasing need for alcohol and substance abuse treatment services as reported by the Division of Mental Health (1998), the Butner Area Drug Abuse and Treatment Center (ADATC), which served the North Central Region, was closed in 1996. Currently, only two remaining state facilities are open which has placed a strain on available services and resulted in an overall declining admission rate. Moreover, these closings may be partially attributable to the low treatment rate observed in the North Central Region in 1998 (31.7 persons per 100,000), the second lowest rate of the four state areas. Only the South Central Region serving 10.8 persons per 100,000 was lower. In contrast, the Western Region served at a rate of 52.5 persons per 100,000 and the Eastern Region served 70.6 persons per 100,000 (North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services November 1998a).

Table 14 shows the regional distribution of Area Program admission rates for 1997-1998 aggregated by age:

*Source: North Carolina Area Programs Admission Characteristics, FY 1998.
** Totals do not always equal 100% due to rounding.

The largest age group admitted to Area Programs was between 25-54 years of age with a slightly smaller proportion in their pre-teen and teenage years. This is substantiated by recent data from the Durham County Health Department (1998) and the Area North Carolina Division of Mental Health (1998) which shows that the largest rate of admission for services at the John Umstead Psychiatric Hospital and other Area Programs in Durham is the 15-44 year age bracket. This indicates that because of the broad age distribution in need of mental health services, age specialized programming as well as a closer examination of mental health issues at the county level may be necessary.

We must note that as the elderly population of Durham County increases, so do their needs for specialized mental health care, a suggestion highlighted in the 1997-1998 Durham County Community Diagnosis (DCHD, 1998). The Durham Center has made strides in developing and increasing the availability of assessment, individual therapy, case management, and adult care services (Atkinson, Salmon, Ash, and Morse, 1997). However, services that address family/caregiver support, geriatric mental health advocacy, or consultation with public agencies are lacking. Moreover, the most recent Durham County Community Diagnosis update states that Durham County MH/DD/SA has only one staff member with special interest or training in geriatrics in contrast to many other county mental health programs have several staff members specializing in geriatric mental health needs.

Table 15 illustrates the racial and gender breakdown of Area Program admissions for 1997-1998:

*Source: North Carolina Area Programs Admission Characteristics, FY 1998, Area North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services, November 1998c
** Totals do not always equal 100% due to rounding.

The majority of North Central residents receiving services at Area Programs were Whites followed by African Americans and Hispanics. Although the percentage of Hispanics that were admitted for services in FY 1997-1998 is very small, it is increasingly evident that continual surveillance is crucial as the Hispanic population in Durham continues to grow.

With regard to gender, it is interesting to note that fewer females were admitted for services than males, a finding that is consistent across all racial and ethnic categories. Without more detailed statistics, however, it is difficult to determine if this difference is due to increased stress for males, fewer social supports for females, or some other unknown deterrent. Interviews with service providers suggest that referrals to programs while incarcerated allow a high proportion of men to access these services.

During fiscal year (FY) 1997-1998, 7,978 Durham County residents receiving treatment for mental health, developmental disabilities, or substance abuse (MH/DD/SA) were primarily served at the Durham Center (Area North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services, November 1998d). The Durham Center is the only Area Program in Durham County. This facility provides numerous child, adult and family services ranging from crisis intervention, residential treatment, and outpatient services (DCG, 1999). Of the 7,978 persons served, 5,107 received mental illness treatment (2,858 adults and 2,249 children), 388 received a service related to developmental disabilities (225 adults and 163 children), and 2,483 were provided with substance abuse treatment (2,414 adults and 69 children) (Area North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services, November 1998d).

As an alternative to the Area Programs, The Lincoln Community Health Center is a mental health resource that serves the needs of the under-served communities in the city of Durham (Lincoln Community Health Center, Inc; 1999). In 1998, Lincoln saw 256 patients for drug dependence and 485 for depressive disorders. It should be noted that drug dependence and depressive treatment, not ranked in Lincoln's 1997 top 30 health problems, have more recently become the 17th and 23rd most treated problems in their facilities. Consequently, Lincoln has re-implemented R.E.T.O.H- Resume End the Old Habit- to address the rise in the number of reported cases of primary and secondary alcohol abuse.

Continuing on the theme that the interview data suggests, the increased awareness of the impact of emotional health on health in general may be reflective of the increased mental health and substance abuse services at the Lincoln Community Health Center. Also, the closing of the North Central region ADATC has possibly resulted in a carry-over effect as individuals in need of services have been forced to look elsewhere.

Domestic violence includes physical and emotional abuse towards women, children, and men. The impacts of domestic violence are profound and long lasting. Victims can be physically injured, get sexually transmitted diseases, or start experiencing other symptoms such as substance abuse, depression, anxiety, and suicide. Due to underreporting of assaults against women, gender specific crime statistics are difficult to obtain. During the 1998-1999 fiscal year the Orange/Durham Coalition for Battered Women Inc. reported receiving 1499 calls to their crisis line. Calls to the crisis line appear to be from whites and African Americans at approximately the same rate, 40.43% and 47.20% respectively (Orange/Durham Coalition for Battered Women, Inc., 1999).

As the last state to change its laws in 1993 to include marital rape as a crime, North Carolina is taking steps toward changing reporting methods, laws and attitudes (Hunt, 1999). The Governor's Task Force Committee reviewed existing domestic violence laws and made recommendations to increase victim safety and accountability of offenders, increase services to all counties, implement training for police officers and other government employees, and develop a conscious-raising campaign.

Reported crime in Durham County appears to be decreasing. Overall, the 1998 Crime Index by jurisdiction for Durham County reports a total of 9,571 crimes per 100,000 county residents, a level that is considerably higher than both Wake County (3,432crimes/100,000) and Orange County 2,481 crimes/100,000). However, the rate in Durham County does represent a substantial decrease from 1997 (North Carolina State Bureau of Investigation, 1999). Violent crimes, including murder, robbery, and aggravated assault all decreased from 2,342 to 1,991 cases. However, a slight increase in the number of forcible rapes occurred during this same period, up from 94 to 102 rapes (North Carolina State Bureau of Investigation, 1999). Similarly, property crimes such as breaking and entering, larceny, and motor vehicle theft all decreased in 1998 from 17,998 cases to 6,800 cases in 1997, yet arson increased from 52 to 58 cases. It, therefore, appears that efforts to control the elevated levels of crime in Durham County are attaining relatively successful results.

Health is not only affected by disease transmission and individual behaviors, but also by environmental exposures. Drinking water quality, exposure to toxins such as lead and radon, and air quality can all have negative consequences on the health and well-being of county residents. Table 16 lists the top sources of toxic emissions in Durham County for 1997:

*Source: Environmental Defense Fund Scorecard page. (1999). [Online]. Available: http://www.scorecard.org/community/index.tcl

Total hazardous waste generated by Durham County has been declining, from 1369 tons in 1993 to 1278 tons in 1995 (EPA, 1995), despite continued economic growth in the county. This indicates that efforts are being made to reduce the exposure of county residents to toxic emissions and pollutants.

Air quality is also an important environmental health issue. The air quality in Durham county is measured by pollutant concentrations which include carbon monoxide, ozone, nitrogen dioxide, sulfur dioxide, particulate matter and lead. The Environmental Protection Agency's Pollutant Standards Index indicates that Durham County has favorable air quality measures, with a median PSI level in 1998 of 42 out of a scale of 0-200 (200 being unhealthful). These measures are relatively consistent from year to year, as there were no days with unhealthful air quality in 1996 or 1997 (Environmental Defense Fund, 1999). However, 63% of cancer risk resulting from air pollution in Durham County is attributed to carbon monoxide emissions from automobiles. Given the increasing growth and resultant traffic congestion in the area, this risk is likely to increase (EDF, 1999).

Another important environmental health issue is lead exposure. Lead exposure is a difficult environmental hazard to regulate as the problem occurs in the home environment and reduction of lead exposure is dependent upon personal awareness and initiative (North Carolina Department of Health and Human Services, October 21, 1999). Even low levels of lead exposure in children may cause problems such as delayed cognitive development and higher levels can result in irreversible mental retardation and even death (North Carolina Department of Health and Human Services, October 21, 1999).

The main source of lead exposure is paint in homes and buildings built before 1978. Lead poisoning often occurs from children eating paint chips or inhaling dust from flaking paint. Also, paint dust in soil outside homes can cause harm from children's play, even in soil around homes that have been renovated inside. The building conditions that facilitate lead poisoning are most often present in lower income neighborhoods (US Department of Health and Human Services, September 1999).

The state or federal government does not mandate screening for lead, though it is highly recommended that children be screened at least once between the ages of six months and six years. In Durham County, lead screening is free and is performed at the Lincoln Community Health Center, Duke University Medical Center, and the Durham County Health Department.

The overall picture of Durham County's health status is one of a county with improving health indicators in some areas, yet others that still require concerted effort attention. Of great concern are the large disparities in health status among Whites and nonwhites in the county. It is expected that such gaps will only increase as the number of Hispanics migrating into the county rises in the coming years. In order to reduce these disparities and approach the Healthy Carolinians 2000 objectives, these issues will need to be addressed. Poor and average performance is not acceptable in the "City of Medicine". Durham County must work to achieve improvements in all areas of health for each and every one of its residents.

Health Indicators and Characteristics

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Chapter 1: Economics and Job Training