HEALTH

SUMMARY MEASURES OF HEALTH IN STRAFFORD COUNTY:
Source: Health Resources and Services Administration, July 2000

• Average Life Expectancy (1990): 76.9 years .
Median for all U.S. Counties: 75.4 years

• All Causes of Death (1993-1997): 844.4 deaths/100,000 population
Median for all U.S. Counties: 923.2 deaths/100,000 population

• Self-Rated Health Status: 12.1% adults report fair or poor health
Median for all U.S. Counties: 14.7% adults report fair or poor health

• Average Number of Unhealthy Days in Past Month: 5.7 days
Median for all U.S. Counties: 5.1 days

County Percent	Birth Measures	U.S. Percent (1997)
5.6	Low Birth Weight (<2500g)	7.5
1.2	Very Low Birth Weight (<1500g)	1.4
7.8	Premature Births (<37 weeks)	11.4
3.1	Teen Mothers, <18	12.7
1.2	Older Mothers, 40+	2.1
27	Unmarried Mothers	32.4
11.5	No Care in First Trimester	17

County Rate	Infant Mortality	U.S. Rate (1997)
6.1	Infant Mortality	7.2
4.3	Neonatal Infant Mortality	4.8
1.8	Post-neonatal Infant Mortality	2.5

County Rate	Death Measures	U.S. Rate (1997)
28.2	Breast Cancer	28.6
23.2	Colon Cancer	21.6
216.1	Coronary Heart Disease	216
68.4	Lung Cancer	58.1
10.9	Motor Vehicle Injuries	15.8
62.7	Stroke	62
8.6	Suicide	11.4
15.5	Unintentional Injury	33.3

• Immunization education

• Smoking cessation

• Education/Resources

• Primary Care Access

• Transportation for health care

EXCERPTS FROM FRISBIE MEMORIAL HOSPITAL COMMUNITY NEEDS ASSESSMENT RESULTS
JUNE 22, 2000

• Lack of ability to pay a pervasive issue.

• Individuals with little or no insurance
coverage are postponing primary care.

• Lack of transportation a common theme.

• Serious availability of care issues, i.e.
no availability dental professionals.

• Need to strengthen first time and
follow up rates for mammograms.

• Rate of smoking much higher
than in other areas of the state.

• Domestic violence a significant issue.

• A growing adolescent drug abuse problem.

There has been a 22% decrease in the number or low birth weight infants (less than 2500 grams) born to mothers in the 18-24 age group. (1994-97)

The data indicate that there has been a 21% increase in the incidence of breast cancer in the 45-64 age group. Not-with-standing any causal factors which may exist, this is a positive sign that more cases may be being discovered at an early stage. (1994-97)

The rate of heart disease mortality decreased for all age groups. (1994-97)

Lung cancer mortality statistics became worse by 15% for the 75+ age group. (1994-97)

The percent of children and the percent of adults on Medicaid are 61.5% and 9.5% higher respectively in the service area than at the state level. (1997-1998)

The percent of births to mothers age 18-24 and mothers age 25+ with less than 12 years of education is 11.7% and 43.9% higher respectively in the Rochester HSA than at the state level. (1993-1997)

Due to the smoking habits of mothers age 25-44, the rate of maternal smoking was 28.4% higher in the Rochester service area than in the state as a whole.

The death rate for individuals with diabetes age 65-74 and age 75+ are 39.4% and 30% higher respectively in the service area than at the state level.

EXCERPTS FROM NEW HAMPSHIRE REGIONAL HEALTH PROFILES
STATE OF NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SERVICES
JULY, 2001

The Dover Health Service Area comprises Dover, Durham, Lee, Madbury, and Rollinsford.

The Rochester Health Service Area comprises Barrington, Farmington, Middleton, Milton, New Durham, Rochester, Somersworth and Strafford

Source: NHDHHS - OCPH, Primary Care Access Data Report: Assessing New Hampshire's Communities,1993-1997

Statistically, disparities in oral health and access are related to socioeconomic factors, including income, education, and health insurance coverage. Income and insurance status have the greatest influence on access. In 1999, 48% of uninsured adults reported not seeing a dentist in the past year as compared to 18% of adults with employer-sponsored dental insurance. Lack of dental insurance varies by geographic location, ranging from a low of 18% in the Derry area to a high of 55% in the Colebrook area.

In 1997, a New Hampshire Legislative Committee determined that of New Hampshire's practicing dentists, only 57% participated in Medicaid, and that 75% of those dentists treated 100 or fewer Medicaid patients. Since then, NH has increased provider reimbursement on 12 preventive and restorative services and funded school and community-based programs throughout the state. Currently, 15 state-funded programs provide services ranging from inschool screening, cleaning and weekly fluoride rinses to a full complement of restorative care in a dental office. Recent DHHS data shows improvement in the percentage of Medicaid children who receive a dental visit. However, only 58% of dentists enrolled in Medicaid actually billed for any services, and 42% of Medicaid children and 52% of Medicaid adults did not receive the recommended number of dental visits in 1999. It is not clear from the data what types of services Medicaid visits entailed, or if needed restorative care was actually performed.

Between 1985 and 1995 the dentist-to-population ratio in the United Stated declined by 23%, with fewer than two dentists replacing every three that retired. NH is anticipating a similar workforce issue - approximately 50% of the state's practicing dentists are over the age of 50 and 20% are over the age of 60. Recruiting new dentists to NH may be compromised by the fact that there is no dental school or residency program in the state. A recent statewide survey of dentists reveals another workforce issue: 48% of dentists report there is an inadequate number of dental hygienists to meet the needs of their practice. There is only one dental hygienist training program in NH.

The uneven geographic distribution of dentists creates barriers to care especially m more rural and inner-city areas. Since 1999, 65 towns and some census tracts in Manchester (representing 20% of the state's population) have received federal designation as Dental Health Professional Shortage Areas (DHPSAs). These designations are based in part on an inadequate dentist-topopulation ratio, long waiting times to get an appointment, high rates of poverty, and/or a lack of dentists willing to care for the low-income uninsured and Medicaid population. NH and its underserved communities are attempting to overcome existing and anticipated workforce and geographic shortages. Strategies include creating new training opportunities for dental school and dental hygienist students, establishing loan repayment incentives for dentists practicing in designated areas, and promoting the oral health field as a career option for New Hampshire students.

New Hampshire is among those states with the lowest percentage of the population (43%) benefiting from public fluoridated water systems. The Healthy People 2010 goal for public water fluoridation is 75%. One strategy for improving oral health in communities without public or naturally fluoridated water is to introduce the routine use of fluoride supplements. This effort can include prescribing children's vitamins with fluoride, applying fluoride varnishes, fluoride rinse programs, and the use of fluoride toothpaste.

The U.S. Centers for Disease Control and Prevention (CDC) recommends that the state of New Hampshire spend between $10.9 million and $24.8 million a year to have an effective, comprehensive tobacco prevention program. A 2004 report from the Campaign for Tobacco-Free Kids shows that New Hampshire currently spends no money on tobacco prevention, which ranks New Hampshire last among the states in the funding of tobacco prevention programs. New Hampshire is spending no money on tobacco prevention despite the $135.4 million in tobacco-generated revenue the state collects each year. The report also estimated tobacco companies spend $100.9 million annually to market their products in New Hampshire.