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Community and Population Health Essay

Introduction

I currently reside in Denver County, Colorado. I have chosen to assess and analyze this community for this assignment. Denver, Colorado is located east of the Eastern Foothills of the Rocky Mountains. Denver County is centrally located within the city of Denver, Colorado and includes the Denver International Airport located north-east of the city. The elevation of this county is 5,277 feet and therefore is nicknamed the “Mile-High City”. Denver County contains 154.9 square miles of land with a large amount of parks and rivers, of which 1.4 miles is water. (City and County of Denver, 2011). Population Economic Status

According to the 2010 census, Denver County has a population of 600,158 people with a median age of 33.7 years old (U.S. Census Bureau, 2010a). Denver County’s population is approximately 50% male and 50% female (U.S. Census Bureau, 2010a). The ethnicity of Denver County is predominately White (52.2%), with Hispanic (31.8%) and Black (9.8%) ethnic groups comprising the next largest population groups (U.S. Census Bureau, 2010a).

The median household income in Denver County from 2008-2012 was is $49,091; compared to $58,244 for the entire state of Colorado (U.S. Census Bureau, 2010b). From2008-2012, 18.9% of households were at or below poverty; compared to an average of 12.9% for the entire state of Colorado (U.S. Census Bureau, 2010b). The average reported unemployment rate for persons ages 16 + in Denver County was 8.6% (with a +/- 0.4% margin of error) (U.S. Census Bureau, 2010a).

Denver County has a high percentage of educated workforce. In 2008-2012, 36.7% of the population age 25 + had obtained their Bachelor’s Degree, or a higher level of education; compared 28.5% for the entire US (U.S. Census Bureau, 2010b). Although Denver County has a large percentage of educated residents, it also has a high number of homeless residents. In a survey taken in January 2013, an estimated 11,167 people were homeless in Denver (including employed homeless) (Metro Denver Homeless Initiative, 2013). Of those individuals, 43% were women and 62% were adults with children (Metro Denver Homeless Initiative, 2013).

The birth rate in Denver County in 2012 was 9,236 (Colorado Department of Public Health and Environment, 2012). This was average compared to the previous two years – in 2011 there were 9,431 births compared to 2010 where there were 9,584 births (Colorado Department of Public Health and Environment, 2012). Denver County’s death rate in 2012 was 4,220 (Colorado Department of Public Health and Environment, 2012). This number was average compared to the previous two years as well – in 2011 there were 4,156 deaths and in 2010 there were 4,210 deaths. The number one cause of death in Denver County from 2010 – 2012 was cardiovascular disease (Colorado Department of Public Health and Environment, 2012). The majority of deaths related to population was individuals age 85+ (Colorado Department of Public Health and Environment, 2012).

Denver County offers two primary basic food assistance programs. These programs are called SNAP (Supplemental Nutrition Assistance Program) and WIC (Women, Infants, and Children). For the fiscal year of 2013, Colorado had an average of 47,636,090 persons from a total of 23,052,396 households were signed up for SNAP benefits (USDA, 2014a). This number had increased by approximately 1,027,016 persons from 2012 fiscal year (USDA, 2014a). For the fiscal year of 2013, Colorado had an average of 8,662,591 persons (including women, infants, and children) were receiving supplemental nutrition from the WIC program (USDA, 2014b). This number decreased by 245,249 persons from 2012 fiscal year (USDA, 2014b).

Cultural Assessment

The population size and sex of the cultural group I interviewed was of twenty white women. Out of the twenty women I interviewed, ten women were between the ages of 20-29 years old and ten women were between the ages of 30-49 years old. All twenty women are currently registered nurses on the internal medicine/oncology floor at the hospital I am currently employed at. The amount of nursing experience these individuals have ranges from two years to 29 years of experience. All twenty individuals interviewed have health insurance.

The attitudes toward age and aging of the twenty individuals surveyed varied with a similar goal of staying healthy to prevent the onset of diseases. The younger group interviewed felt it was important to eat healthy and exercise to promote internal health and longevity of life in general. The older group interviewed were more specific with their answers and felt it was important to maintain low stress lifestyles to promote good mental and physical health, to exercise to promote strong bones/balance, to perform mental exercises to help prevent the onset of dementia, and to regularly attend appointments. Both groups agreed that positive vs. negative attitudes directly affect physical health and one’s quality of life.

When I asked both groups of their opinions regarding what age adolescents are considered adults, I received drastically different answers. The younger group felt as if ages 18-19 years old are considered adults related to society’s description of an adult, the independency promoted with high school graduation, and the onset of college. The older group felt as if ages 22-23 years old are considered adults primarily related to maturity, life experiences, and the beginning of an entry level career after completion of a college degree. Both groups felt as if college education was an expectation. All of the individuals interviewed currently have their degree in nursing with an active nursing license.

Approximately one-third of those interviewed have their Bachelor’s Degree in Nursing and several of those interviewed possess recognizable specialty healthcare certifications. As an entirety, the group interviewed is healthy. Over half of those interviewed have no prior diagnoses regarding their state physical of health. The most obvious physical characteristic that both groups share is being overweight with eleven out of the twenty women interviewed currently being overweight according to their projected BMI.

The entire population interviewed shared the mental challenge of overcoming the stress presented at work regarding difficult/challenging patients and all women interviewed believed they have compromised their safety while caring for a patient at one time or another in their career. When I asked this group what the usual sources of stress are, work was number one for all twenty women interviewed. The younger population interviewed stated that children/family and educational goals are some of their secondary sources of stress.

The older population interviewed stated that aging/retirement and the health of other family members are their secondary sources of stress. Both groups primarily use the mountains/nature and outdoor activities, such as skiing and hiking, to cope with stress. Five of the individuals drive nearly sixty miles to work (one-way) daily, related to owning a home in the mountains to escape the “rush and chaos” of the city and helping to find a “balance in life”.

Out of all twenty individuals interviewed, over 3/4 of the woman are married and/or have a significant other. When asked what their number one priority in life was, family was consistently number one. Most all other interests and goals were related to benefiting or bettering the family. Some of the answers named were continuing educational goals, buying a new home, having a baby, planning retirement, and helping their parents with activities of daily life. Of the cultural group identified, all of them share a team attitude while still exhibiting individualist perspectives unique to personal preferences and opinions.

Neighborhood/Community Safety

Denver is divided into about 80 different official neighborhoods within Denver County (City and County of Denver, 2011). Those 80 different neighborhoods have been divided into seven police and fire districts; including Denver International Airport with has its own district (Denver Police Department, 2014; Denver Fire Department, 2014). The average response time for the Denver Police Department varied in 2013 from 14.9 minutes to respond to urgent, emergency calls (from the time a 911 call was received to the time an officer arrived on the scene) to 16.9 minutes for an officer to respond to a non-emergency call (Maass, 2013). According to Lt. Matt Murray from the Denver Police Department, these slow response times have been directly correlated with a lack of officers (Maass, 2013). According to Murray, the Denver Police Department can have as many as 1,426 officers and as of October 3, 2013, the Denver Police Department had only 1,350 officers (Maass, 2013). A new class of 70 recruits are currently in training in hopes to decrease the department’s response times in 2014 (Maass, 2013).

The Denver Fire Department maintains 34 different fire stations that are strategically split into seven districts (Denver Fire Department, 2014). Firefighter’s each work an average of three 24-hour shift with an average of 180 firefighter’s on-duty per shift (Denver Fire Department, 2014). The Denver Fire Department responds to a variety of calls including Fire Suppression, Rescue Operations, Hazardous Materials Response, Technical Rescue, Urban Search and Rescue, Water and Ice Rescue, High Angle Rope Rescue, Confined Space and Trench Rescue, Wildland Firefighting, and Emergency Medical Services.

They also perform thousands of building inspections annually, daily training and certifications, public and community education, school fire drills, and organize other special events (Denver Fire Department, 2014). According to the Denver Fire Department 2012 Annual Report, there were a total of 101,531 alarms/calls made in 2012 that required the response of the fire department team (Maass, 2013). Out of those 101,531 calls made to the fire department, 54,350 were for medical calls, 8,103 were for auto accidents, 2,248 were for fires, and approximately 37,000 calls required other services or rescues (Maass, 2013).

Denver County has a significant amount of violence, crime, and gang activity within the community. In January/February 2014 there were a total of 7,268 crimes captured by the National Incident-Based Reporting System (NIBRS) (Denver Police Department, 2014). According to this reporting system, the crimes are broken down into four categories; (1) crimes against persons, (2) crimes against property, (3) crimes against society, and (4) all other offenses (Denver Police Department, 2014). The top two offenses in Denver County per category included (1) simple assault and aggravated assault, (2) larceny and criminal mischief/damaged property, (3) drug/narcotic violations and prostitution, and (4) disorderly conduct/disturbing the peace and criminal trespassing (Denver Police Department, 2014). These figures are slightly elevated from a total of 6,822 crimes in January/February 2013 (Denver Police Department, 2014).

There is a variety of different gang activity in Denver County. In 2003, Denver police estimated that there were 14,000 gang members in Denver who were affiliated with 220 different gangs (Gang activity in Denver, 2013). The Denver Police Department has since created gang prevention programs including education, a gang hotline, outreach programs for former gang members, crime stoppers anonymous tips hotline, and the Denver Police Department Gang Bureau (Denver Police Department, 2014). Even with gang prevention involvement in the community and with these prevention programs in place, from January-September 2013 there was a total of 143 total crimes that could be directly related to gang activity (Gurman, 2013). These crimes included homicides, sexual assault, robberies, and aggravated assault (Gurman, 2013).

Denver County is also populated with a high level of alcohol and drug abuse. The availability of marijuana with the recent legalization of recreational marijuana makes marijuana the most widely abused drug in Denver County (Mendelson, 2014). Alcohol, methamphetamines, heroin, cocaine, and prescription drugs are all found within the city limits of Denver as well (Mendelson, 2014). Denver County is centrally located between two interstates; I-25 and I-70. These interstates have many different entry and exit points to and from the city that provide easier access for drug trafficking and other illegal activities.

Denver County has many different programs protecting its air and water quality. The Environmental Quality Division (EQD) is responsible for a variety of measures including conducting compliance inspections of air emissions, monitoring pollutant levels, issuing permits, and constructing models of air pollutant levels in the Denver area (Department of Environmental Health, 2014a). In February 2014 Colorado became the first state to regulate methane emissions from hydraulic fracking (Kroh, 2014). This new regulation will directly increase water quality and decrease smog in the Denver area. The Department of Environmental Health (DEH) is responsible for monitoring the quality of water in Denver’s lakes and streams. The DEH collects an average of 13,000+ water samples and conducts more than 50,000 tests annually to ensure that Denver’s drinking water is clean and safe (Department of Environmental Health, 2014c). The goal is for the city of Denver to have fishable and swimmable waters in all the lakes and streams by 2020 (Department of Environmental Health, 2014c).

Denver’s Departments of Environmental Health, Public Works, and Parks and Recreation are all work together to ensure that the City meets this goal (Department of Environmental Health, 2014c). Denver’s current number one pollutant is trash and litter. Urban Drainage and Flood control district alone collects approximately 100 tons of trash from the streams and rivers in Denver annually (Department of Environmental Health, 2014b). There are several health risks living within Denver County. These risks include earthquakes, hazardous materials, winter storms, and severe thunderstorms with hail, lightening, tornados, and/or flooding (Office of Emergency Management, 2014b). Hit and run injuries have become an epidemic in Denver County with an increase in fatal crashes in Denver County.

Denver police reported 18,662 hit-and-run accidents, both sustaining injuries and sustaining no injuries, during 2011-2013 (Hubbard, 2014). At least one person in Denver metro area is injured every day by a hit-and-run driver and nearly three times a month a pedestrian is fatally injured by a motorist who flees the scene (Hubbard, 2014). Colorado legislators have recently increased the potential prison sentence for hit-and-run cases resulting in bodily injury and/or death. They have also formalized an alert program to inform the public on suspects, vehicles, and/or license plate numbers in an attempt to help in track down perpetrators (Hubbard, 2014).

Disaster Assessment and Planning

The state of Colorado and city of Denver has worked hard to organize a variety of disaster and emergency preparedness plans within the community. One source of information, READYColorado, offers a variety of data sources for the community. Their website, READYColorado.com, offers awareness and disaster preparedness for a variety of natural disasters, technological disasters, and human caused disasters. The website also contains statistics, facts, and a calendar list of current events and training exercises.

It offers links for volunteer opportunities regarding community involvement and educational classes and it also lists ways to stay informed of emergencies from such sources such as radio, television, text, live twitter feeds, and blogs. Three critical facilities in Denver County include three specific venues; Coors Field with 50K capacity, The Pepsi Center with 19K capacity, and Sports Authority at Mile High Stadium with 76K capacity (City and County of Denver, 2011). The most vulnerable populations to these disasters are the 22.3% of households with children less than 18 years of age, the approximately 23,000 individuals 65+ that live independently, and the residents in 51 long term care facilities within Denver County (City and County of Denver, 2011).

The primary disaster of concern for the Denver County is winter weather. Winter weather is an expectation living in Colorado. READYColorado contains information for home and vehicle preparation, emergency communications planning, proper dress for indoors and outdoors to protect the body from hypothermia, and hypothermia/frostbite warning signs. One can also find more information at Ready.gov, Colorado Department of Transportation, NOAA watch, and the American Red Cross regarding winter weather and the risks involved. Avalanches are of great threat to the mountainous regions of Colorado but do not pose a threat within Denver County.

The risk of earthquakes is low in Denver County. However if an earthquake was to occur, the city would be very susceptible to extensive damage. Residencies and some of the older buildings in Denver are not made to withstand earthquakes and would most likely suffer damage to their structures (Office of Emergency Management, 2014b).

Severe thunderstorms bringing hail, lightening, and tornados pose threats to the Denver County annually. Residents of the Colorado’s Front Range area are located in the heart of “Hail Alley” which begins mid-April and lasts through mid-August. The Front Range and Denver County receives a high frequency of large hail annually, averaging three to four hailstorms a year, and costing at least 25 million dollars in insured damage for each event (READYColorado and the State of Colorado, 2014b). Lightening poses the greatest threat to areas where the mountains and plains intersect (READYColorado and the State of Colorado, 2014b). Three deaths related to lightning strikes have known to occur in Denver since 2001 (National Weather Service, 2011). Tornados pose a threat to all areas of Colorado; however tornados to not typically get high intensity ratings within Denver County (City and County of Denver, 2011). Flying debris from high winds cause most injuries. NOAA weather radio, telephone alerts, and television sources provide alerts severe thunderstorms and the destructive events that they bring.

Denver County also has an outdoor warning siren system consisting of 76 electro-mechanical sirens that sound when there are tornado alerts and warnings (Office of Emergency Management, 2014a). Wildfire ignition by lightning is a bigger concern rural Colorado areas compared to the city. Respiratory problems can still result from the inhalation of smoke spread by wind. Wildfires burn thousands of acres and destroy hundreds of structures annually in Colorado. These fires are generally ignited by lightening or human causes and can easily be fueled by drought conditions, insect infestations, and heat. READYColorado offers information on risk assessment, home preparation, evacuation plans, and shelter information.

More information regarding wildfires can be found at Ready.gov, Ready, Set, Go!, Surviving Wildfire, The Red Cross, US Fire Administration – FEMA, and Colorado State Forest Service websites. Colorado Wildfire Risk Assessment Portal is also a useful tool in determining fire risks. Currently, Denver’s fire risk is between lowest intensity and moderate intensity risk (Colorado State Forest Service, 2014). Flooding has a big impact on Colorado and in 2013 challenged many residents in the Denver area. NOAA Weather Radio, commercial radio, television, and internet sources provide information on flood watches and warnings, including flash floods in Denver County. Flash flooding along streams such as Cherry Creek, Clear Creek, and Harvard Gulch pose the greatest threats within the Denver area.

The Corps of Engineers, Colorado Department of Public Health and Environment, and the Urban Drainage and Flood Control District websites provide 2013 flood information, current projects, and resources for flooding preparation and damage control in Colorado. Health risks involved from flooding include contamination from bacteria (ie. E.coli), parasites (ie. giaria), and viruses (ie. Hepatitis A), respiratory infections from mold and other irritants, and bodily injury from swiftly moving currents, electricity hazards, and hypothermia. It is very important for all Denver County residents to be up to date with Tetanus vaccinations.

Terrorism poses a rather unpredictable threat to Denver County. Denver County has a large metropolis population and houses both government buildings and military installations, contains large sports stadiums and an international airport. It is known that failure of the Cherry Creek Dam would cause catastrophic damage to both life and property within Denver County (City and County of Denver, 2011). There have been known international and domestic terrorist groups identified in Colorado during previous years (City and County of Denver, 2011). Education regarding the “eight signs of terrorism” can be found at multiple terrorism related websites including READYColorado.com. Denver also has specialized units including Denver Police Department Mounted Patrol, S.W.A.T.(Special Weapons And Tactics) who’s primary objective deals with hostage negotiation, drug busts and counterterrorism (City and County of Denver, 2011).

Hazardous material spill have an increase potential in Denver County related to the many different companies storing hazardous materials within city limits. There are approximately 400 facilities storing reportable quantities of hazardous materials on properties located throughout the county (Office of Emergency Management, 2014). Each company is regulated by law to hold emergency plans that would go into effect if an accidental release of substance was to occur. The interstates bring added risk to Denver County related to the traffic along I-25 and I-70. These two interstates pass through densely populated areas of Denver County Denver fire and police have Hazardous Materials Response teams in place that are trained to respond to such an event(s).

Denver County has nearly a dozen different hospitals with a vast amount of public transportation options such as bicycle, RTD bus and light rail services, taxi cabs, car2go, and Lyft services. Denver County has excellent communications and response teams in the event of a disaster with a vast amount of online education; however this information is published mostly in the English language. With such a large population of homeless in Denver County and 18.9% of all households at or below poverty level (U.S. Census Bureau, 2010), the internet is not a good primary option for learning. Also, approximately 28% of all households speak a language other than English (City and County of Denver, 2011).

Community Diagnosis

Denver County is a very strong community regarding the number of educated workforce, median household income, number of hospitals, amount of public ground transportation, the protection of air and water quality, and the number of fire and police with specialty training teams and programs operating within the community. There is a very small percentage of residents 65+ who live independently and slightly over 1/5 of all households have children less than 18 years of age. The primary language is English and the community culture has a good overall team mentality. Denver County’s birth rate double the death rate with the leading cause of death cardiovascular disease in a primary death rate existing in the population 85+ (Colorado Department of Public Health, 2012).

Denver County has many open avenues regarding opportunities and readiness attitudes within community. The population of Denver County is approximately 50% male and 50% female with a median age of 33.7 years old (U.S. Census Bureau, 2010a). This provides the community with the opportunity to explore young ideas and diversity among sexes.

Denver County has a large number of homeless population with approximately 1/5 of the total population at or below poverty. These numbers exceed the national average. Denver County has two specific food programs being utilized greatly; SNAP and WIC benefits. There is a high number of crime, violence, and gangs within Denver County. There is a high level of alcohol and drug abuse within the community as well. Specialized police teams and community resources/programs assist with deterring these types of activities and assist in recovery efforts for those individuals. Colorado has recently legalized recreational marijuana which could be positive in terms of tax revenue for the state and future funding of programs and resources for the community. There could also be negative consequences regarding adolescent drug use and the increase of impaired drivers on the streets; however these statistics have not yet been measured and studied.

Denver County is contains a 100% urban population. This is both a strength and weakness to the city in terms of emergency evacuation. There are three critical facilities that exist in Denver County at specific venues with a capacity between 19K and 76K (City and County of Denver, 2011). Denver County is centrally located between I-25 and I-70 which can be an opportunity for evacuation or a barrier regarding avenues for drug trafficking and other illegal activities. There is a high ratio of hit-and-run injuries and fatalities within Denver County. Colorado legislators have recently increased potential prison sentences for hit-and-run cases resulting bodily injury and/or death. They have also formalized an alert program to inform and involve the public as an attempt to help track down perpetrators.

The formulation of a city-wide educational program focusing on the prevention of hit-and-run occurrences may be beneficial in reducing these numbers as well. It is important for the Denver Police Department to have quicker response times to both emergent and non-emergent calls. Hopefully with the addition of new recruits for the force who are currently in training, Denver County will see quicker response time to all calls made. This will also hopefully decrease the amount of gang-related crimes and deter community activity in general. It is evident that Denver County has a large trash and litter problem.

The initiation of more trash cans and recycle containers parallel with city-wide education would be beneficial in decreasing this problem. It would also be of benefit to the community and the court systems to enact a community service program that revolved around helping clean up the neighborhoods and streets. Denver County has good disaster and emergency preparedness plans within the community; however educational resources to the public need to be explored with a variety of different materials and other languages for maximum effectiveness. The primary educational method is by internet with most of the materials written in the English language only. Nearly 1/3 of all households in Denver County speak a language other than English.

References

City and County of Denver. (2011, Oct). Hazard Identification and Risk Assessment. Retrieved March 8, 2014,
fromhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source =web&cd=1&ved=0CCUQFjAA&url=http%3A%2F%2Fwww.denvergov.org%2FPortals%2F428%2Fdocuments%2FDenver%2520Hazard%2520Identification%2520and%2520Risk%2520Assessment.pdf&ei=AvEtU6etF8OJogSh5oDwDw&usg=AFQjCNEEQhg_2-JDt_OVeX3pIyYSKGcx9g&bvm=bv.62922401,d.cGU Colorado Department of Public Health and Environment. (n.d.). Health Statistics: 2012.

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in Colorado. Retrieved March 10, 2014, from http://www.coloradoan.com/article/201
40217/WINDSORBEACON01/302170069/Hit-run-fatal-crashes-rising-Colorado Kroh, Kiley. (2014, February 24). Climate Progress: Colorado Become The First State To
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(2013, January). The Gathering Place – Homelessness and Poverty Statistics. Retrieved
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