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Community Health Practice Essay Community Description and Data Interpretation Pueblo, Colorado, also known as â€Å"The Home of the Heroes†, was given this proclamation in 1993 by the United States Congress, due to Pueblo having as many as four recipients of the â€Å"Medal of Honor† living here in the community. Pueblo dates back as far as 1842, and was known as â€Å"Fort Pueblo† (History of Pueblo). Over the years, Pueblo became the â€Å"backbone† of Southern Colorado due to the ore mines and is also the largest steel producing city in the United States, thus also being referred to as the â€Å"Steel City†. Pueblo has had a long and colorful history and has had five different countries and territories that â€Å"held dominion† over the area. These five areas are as follows: France, Mexico, Texas, Spain, and of course, the United States of America. (History of Pueblo) Pueblo County is 2,398 square mile area and is located approximately 112 miles south of the state capital of Denver, Colorado and approximately 100 miles north of the New Mexico border. Pueblo is geographically located at the intersection of the Arkansas River and Fountain Creek and is approximately 4600 feet above sea level. Although surrounded by lots of mountains such as the Wet Mountains, the Sangre de Cristo Mountains, Green Horn Mountains and Pikes Peak Mountain, Pueblo is very much desert land with annual precipitation being only approximately 12 inches. (Pueblo, Colorado, 2014). Pueblo County has a land area of 2389 square feet and 9.0 square miles of water. (City-Data Pueblo County, CO , 2012) Population/Economic Assesssment Pueblo’s population according to 2012’s census is 159,063 which is a growth rate of 3.56% since 2000, and which rank it 246th for the most populated city in the nation. Pueblo is comprised of a very diverse mix of people with the majority being white non-Hispanics at 56.2% and the Hispanics or â€Å"Latinos† comprising 39.2% of the population. The remaining population is comprised of African Americans 2.4%, Native Americans 2.9%, Asian 1% and the remaining 2.4% of the population are those that are of two or more races  (American Fact Finder). The average age of Pueblo’s population is approximately 39 years old. The total population percentages of those 18 years and younger is 24.5% and with those 65 years and older comprising 15.3%. (United Stated Census Bureau, 2010) `As mentioned before, Pueblo is one of the nation’s top leaders in steel production, but the huge â€Å"steel-market† crash of 1982 left Pueblo with a fairly weak economy sinc e that time. According to the 2010 census, the average annual household income in Pueblo is approximately $38,780, which has Pueblo County’s income ranking far below Colorado’s average income of $47,510. With such a difference in the average annual income, Pueblo has a high percentage of the population that is living below the Federal Poverty Level, making Pueblo’s overall poverty rate is the 2nd highest in the state of Colorado. The average household size is 2.47 people. According to statistics from the American Fact Finder, Pueblo County has 18.1% total population below the Federal Poverty Level. Of that population, there are 26.3% that are children 18 years and younger, those 18 years to 64 years old is 17% and those over the age of 65 are 9.6% below the Federal Poverty Level (America Fact Finder, 2012). With almost 20% of Pueblo County’s population being below the Federal Poverty Level, it would stand to reason the increase in the number of people in Pueblo that qualify for food stamps and other public assistance. According to the 2012 American Community Survey, there were an estimated total of 11,976 households in Pueblo County that received food stamps. Of the households that received food stamps 45.7% of them had children 18 years or younger and 23.4% had at least one person in the household that was 60 years or older. (United Stated Census Bureau, 2010) The unemployment rate in Pueblo County is 9.6% approximately 1% higher than the U.S. average; however, there has been a recent job growth of 1.38% in Pueblo. Even with the more than average unemployment rate and high population below the Federal Poverty Level, Pueblo County has a very low cost of living compared to the rest of the nation. The cost of living in Pueblo, CO is approximately 15.3% lower than the U.S. average with the median housing cost of $96,700. Even with the lower cost of living in Pueblo County, there are still about 175 individuals that are homeless that are living on the streets. With large international companies such as  Vestas pewag, and Rocla Concrete Tie choosing Pueblo, Colorado as new sites for their companies, unemployment rates will lower and this can only boost the economy and increase the population. (Community Health Status Report, 2011) Before the inception of the current Affordable Care Act, Pueblo County had approximately 30,312 individuals that were on Medicaid. This number has drastically increased since January 1, 2014 since Colorado was a state that chose â€Å"Medicaid Expansion† to assist with aiding the health care costs and compliance of the Affordable Health Care Act. According to Colorado Health Institute, Pueblo County has done an amazing job getting the â€Å"uninsured† children in public insurance programs. Pueblo County recorded that 95.7% of children eligible for Medicaid/CHP+ is enrolled. Access to health care is largely affected by available and affordable health insurance. Pueblo County was noted to have a total of 13.6% of the population in 2010 that were uninsured. The amount of money that Pueblo County spent per capita on public health funding took a significant drop in 3 years from 2009 to 2011 of over $2.00 per person. Pueblo County also has a large percentage (18.8%) of individuals that not only are on Medicaid but are dually covered by Medicare. Dual coverage is based on income, health and disability; these individuals are usually in very poor health with chronic, complicated health problems and/or mental issues. Even with the public health funding, Pueblo County still has 17% of the population that have unmet health needs because of financial limitations. Hopefully with the new law of the Affordable Care Act the percentage of â€Å"unmet† health needs will completely diminish or at least significantly decrease. Cultural Assessment Pueblo, Colorado is a multi-cultural community with the majority of the population of Hispanics, Italians and Slovenians that have occupied Pueblo for generations. The Hispanic culture is the most prominent in Pueblo, which can be seen in the architecture, art, festivals and museums which pays great tribute to their Hispanic heritage. One of the largest pieces of the Hispanic culture that is enjoyed by all in Pueblo is the food. Pueblo holds annual festivals and celebrations that display the unique cuisines of the Hispanic culture, the most prominent cuisine being the â€Å"Pueblo Green Chili†. Food of the Hispanic culture and the health risks may contribute to the high number of adults that are overweight or obese. According to findings in the Pueblo Community Health Status Report of 2011, 23% adults over the age of 18 are overweight. With such a large Hispanic population comes a high percentage of the population that have genetic disposition for Diabetes Mellitus Type 2. (County Health Rankings and Road Maps, 2013) A large family unit which includes generations of â€Å"extended† family is a huge part of the Hispanic culture in Pueblo. The Hispanic population in Pueblo really holds the matriarchs and/or patriarchs to a high respect. Although not nearly as prominent in Pueblo, the Italian culture is a large part of Pueblo’s culture as well. Italian culture is seen predominantly in the culinary influences that paved the way for the unique â€Å"Pueboloan† dishes, such as the Italian Sausage sandwich that you can find at one of Pueblo’s oldest tra ditions, Pass Key Restaurant. (Pueblo, Colorado, 2013). The Slovenian culture is another influential part of Pueblo’s culture. The Slovenians migrated to Pueblo and settled here working in the steel industry. They introduced cultural and culinary traditions that are still very highly practiced and part of Pueblo’s culture even today. For example, Potica is one of the most popular culinary treats that is extremely popular around the holiday season, but can be found and enjoyed all year around. The Slovenian folk music and theatre can also be seen throughout Pueblo. (History of Pueblo) Catholicism is the predominant religion in Pueblo and is a huge part of the culture. Approximately 68% of Pueblo proclaims they are Catholic. In Pueblo’s culture, women are the largest majority of this population, although â€Å"Holy Orders† are the role of the men. (Pueblo, Colorado, 2014) Genogram Interpretation From my observation of data, statistics and information gathered for Pueblo County’s Community assessment, I have found that Pueblo County overall is a fairly healthy community. The community is predominately white, non-Hispanic population with an increase of the Hispanic population in the past two years. The Median household income is $38,780 and 16.9% household at or below poverty level. The unemployment rate at 9.6% which is 1% higher that the U.S. average. With such financial difficulties there were approximately 13,760 individuals that receive food assistance, Pueblo is a multi-Cultural community consisting of Hispanic, Italian Slovinian. All cultures brought together with food served at festivals and at restaurants. Pueblo is predominately Catholic religion at 68% with women playing a large part in Catholic Hispanic Culture. Large Hispanic population diagnosed with diabetes type II and obesity. The crime rate is higher than the national average. In 2006, Pueblo County had approximately 2.4 liquor stores per 10,000 people. Underage rates of drinking increased with age. Methamphetamine use in youth (less than 10 percent), but showed signs of increase between 2005 and 2007. The health factors and morbidity and mortality rates of Pueblo County are higher than the national benchmarks. Pueblo has 95% of days with good air quality and drinking water safety at 1%. Pueblo County has a disaster/ emergency management preparedness plan as well as a chemical stockpile emergency preparedness program for the Pueblo Chemical Depot. Pueblo operates in an all-hazards disaster plan with Pueblo Health Department being the lead in the Emergency support function of Public Health. Pueblo County, Colorado is overall a healthy community. Nevertheless, the areas where improvements need to be made are determining a way to attend to each individual’s reaction to negative life events. These events are causing a rise in binge drinking and the use of methamphetamine abuse. Creating and implementing a plan to decrease the poverty level and being able to inform and address access and functional needs. Neighborhood/Community Safety Assessment As sad as it is to say, violence in Pueblo County is a huge â€Å"health† problem. Pueblo’s overall crime index as reported in 2006 was 6945 crimes which was higher than the national average and encompasses â€Å"violent† and â€Å"property† crimes. Violent crimes consist of murder, rape and aggravated assaults. Property crimes include burglary, larceny, theft , motor vehicle theft , arson, and vandalism. In 2006, Pueblo had a reported total of 628 violent crimes with breakdown as follows: Murders – 6; Rapes 49; Robberies – 170; Aggravated assaults – 403. Pueblo’s reported â€Å"property crimes are as  follows: Burglary – 6317; Larceny/Thefts – 4409; Motor Vehicle Thefts – 455 and Arsen – 55. (Pueblo Colorado Crime statistics and Data Resources, 2014) . Along with the high crime rates that fill Pueblo’s neighborhoods that have an effect on the safety and health of the county are the large nu mber of liquor stores that fill them. In 2006, Pueblo County had approximately 2.4 liquor stores per 10,000 people. (Community Health Status Report, 2011) With such a high density of liquor stores and access to alcohol, it can also contribute or be a large relation to the economic and social crumbling of the community and overall rate of crime. There are studies that report that the â€Å"over-concentration of liquor stores increases the perceived lack of safety and limits walkability in the community†. (Community Health Status Report, 2011). The excessive consumption of alcohol also leads to major health problems, such as, cirrhosis of the liver, cardiovascular disease, cancer, anemia as well as the effects due to injuries sustained in car accidents secondary to driving under the influence. Substance abuse, including alcohol, is another public health concern in the Pueblo community. One of the biggest concerns of alcohol abuse is that of â€Å"binge† drinking among individuals. Binge drinking is a major indicator of substance abuse and is defined as â€Å"Consuming five or more alcoholic drinks in one occasion in the pa st month†. From 2007-2009, there were 14.5% of adults in Pueblo that reported binge drinking, a rate that was well below the Healthy People 2020 objective. (Community Health Status Report, 2011). According to the website, Teen Drug Abuse, 90% of alcohol consumption by those that are underage is in the form of â€Å"binge† drinking. (Teens and Addiction, 2014). In Pueblo County, underage rates of drinking increased with age, indicating that teenagers are more likely to experiment or try alcohol around the ages of 16 or 17. (Community Health Status Report, 2011). In Pueblo County, methamphetamine use in youth ages 15-18 years was low (less than 10 percent), but showed signs of increase between 2005 and 2007 for the â€Å"15 or younger† category. Following national trends, results from 2009 indicate decreasing methamphetamine usage across the board for all age groups. This may be in part to successful prevention interventions, education campaigns about methamphetamine use, or inconsistent self-reporting (Community Health Status Report, 2011) Housing, water quality, and air quality are factors that can be classified as the environmental quality/safety of Pueblo,  County. â€Å"Homes† represent to most a place of safety, security and shelter and because these factors are so important they have the potential to help or harm the h ealth of the community. The United Way Pueblo County evaluation in 2009 reported that Pueblo County had a large shortage of â€Å"low income† rental housing. The estimated rental housing in Pueblo County reported in 2009 was 32% and home ownership was reported at 68%. (America Fact Finder, 2012). Sewage is another factor that can potentially be a huge source of water contamination. Waste water treatment plants in higher populated areas of Pueblo County are used to treat sewage before being released back into the environment; however, not all areas of Pueblo County are served by a treatment plant. Pueblo County has approximately 16,000 homes that have septic systems and are not serviced by a waste water treatment plant. Water wells can become contaminated due to improper septic system treatment. In Pueblo County, the majority of its population the drinking water comes from surface water. In some cases, the drinking water may come from shallow surface sources or underground wells. (Community Health Sta tus Report, 2011). The air quality in Pueblo is for the very good with the particle matter (PM2.5) being very low. Particle matter is defined by the EPA as the tiny particles directly emitted into the air and particles formed in the air by chemical transformation of gaseous pollutants. (United Stated Census Bureau, 2010). According to the Pueblo City-County Health Department’s Environmental Health Division, there were over 830 complaints in 2010 with the majority of complaints which were 41% of the total complaints were about the housing. (City-Data Pueblo County, CO , 2012). All in all the environmental Quality of Pueblo County is above average. The health factors and morbidity and mortality rates of Pueblo County are in lot of cases higher than the national benchmarks. Premature infant deaths in Pueblo County in 2009 were 8,767. Malignant neoplasms rank first in Pueblo County for the leading casue of death with heart disease being second leading cause of death in Pueblo County. (Community Health Status Report, 2011) Morbidity reporting of poor or fair health was 17% Health factors in Pueblo County such as smoking was 23% compared to the National benchmark of 13%, teen birth rate was 63% compared to National benchmark of 21%, sexually transmitted diseases reported in Pueblo County was approximately 352 with the national benchmark of 92. (County Health Rankings and Road  Maps, 2013). Disaster Assessment Pueblo has a Disaster Management Program which includes several support functions based on the emergency which includes the following: transportation, fires, wildfires, victim care, search and rescue, long-term recovery, hazmat, damage assessment, floods, mass fatality, terrorism, tornadoes and winter storms. The program’s goal is to prevent or decrease the impact of natural or human caused disasters. There are also additional support systems such as behavioral health response and an animal health response plan. The department staff and fire fighters are specially trained and ready to respond to any major disasters that may occur. The command staff members assist in the coordination of the disaster and emergency management training exercises in the local region. There are monthly meetings with the members and the Pueblo County Emergency Response Team (PERT) and with other local emergency reponse and support agencies. (Pueblo, Colorado, 2014). Pueblo also operates and â€Å"All Hazards† disaster plan that is designed to address the needs of the Pueblo Fire Department and the people of Pueblo in and efficient and effective manner if a disaster occurs. It is also serves as a supplement to the Pueblo County Emergency Operations Plan. (Pueblo, Colorado, 2014). The Pueblo Chemical Depot, a chemical weapons storage site is located in Pueblo County. Mustard agents HD and HT are stored at the Pueblo Chemical Depot. The chemical stockpile emergency preparedness program is the federally funded program administered by the Department of Defense and the Federal Emergency Management Agency (FEMA). The program was placed to prepare the local authorities for a possible chemical weapons incident. If such an incident occurs, Pueblo Chemical Depot will notify the Pueblo County Sheriff’s Communication Center in accordance between the agreement between Pueblo County and Pueblo Chemical Depot. (Emergency Services Bureau, 2013) Due to the hot dry summers, a fire or wildfire frequently occurs and there is an emergency support system that is in place. The following agencies included are the Pueblo County Sheriff’s Office Emergency Services Bureau, Public Works, the Colorado State Patrol, the Colorado State Forest Service, US Forest Service, Colorado State Parks, American Medical Response, both local hospitals –  Parkview Medical Center and St Mary Corwin Hospital. The Emergency Support Function and Wildland Fire Incident Annex is there to guarantee a correct response from the numerous agencies involved for containing and extinguishing fires. This is an effective system that was established to manage the various resources and agencies involved to fight structural and wild land fires in Pueblo County. (Emergency Services Bureau, 2013). The Pueblo Activation Sequence establishes procedures for the activation and operation of the Pueblo County Emergency Operations Center (EOC). The EOC is activated to an anticipated or actual response that involves more than one area or jurisdiction and/or multiple response agencies. This includes agencies that respond to HazMat accidents, severe weather, flooding, earthquakes, civil disturbances or terrorism. (Emergency Services Bureau, 2013) The Pueblo County Health Department leads the emergency support functions for Public Health and Medical Services. Their supporting agencies are as follows: Local Hospitals, EMS, Behavioral Health Services, Emergency Service Bureau, Coroner, Agriculture, Education, Human Services, Law Enforcement Agencies, Military and Veteran Affairs, Public Safety, Regulatory Agencies, Transportation, Pueblo Community Health Center, American Red Cross, Salvation Army and COVOAD. This program provides a response and recovery action related to the lifesaving tra nsport, evacuation, treatment of the injured, controlling of the spread contamination, prevention of contamination of water and food supplies and the disposition of any dead. (Emergency Services Bureau, 2013) As you can see, Pueblo County is very well prepared with any type of natural, chemical, or human caused disaster. Summary From my observation of data, statistics and information gathered for Pueblo County’s Community assessment, I have found that Pueblo County overall is a fairly healthy community. The community is predominately white, non-Hispanic population with an increase of the Hispanic population in the past two years. The air pollution in Pueblo County is below the national average with 95% of days with good air quality and only 5% with moderate air quality. An area that could use improvement would be to find a way to attend to the individuals that make negative responses to traumatic or  negative life events. These responses and events may play a huge factor in the rise of homicides that are taking place in Pueblo County. The education of the public community about the emergency and disaster preparedness programs through community outreach will help to inform and develop functional needs for Pueblo. Works Cited (2013). Retrieved February 07, 2014, from Pueblo, Colorado: http://pueblo.org/history America Fact Finder. (2012). Retrieved 02 08, 2014, from U.S. Census Bureau: http://quickfacts.census.gov/qfd/states/08/0862000.html City-Data Pueblo County, CO . (2012). Retrieved February 5, 2014, from http://www.city.data.com/county/Pueblo_County-CO.html Community Health Status Report. (2011). Retrieved February 2, 2014, from Pueblo.org: http://county.pueblo.org/sites/default/files/documents/Status%20Report%202011%20Final.pdf County Health Rankings and Road Maps. (2013). Retrieved February 8, 2014, from http://www.countyhealthrankings.org/aIntpp/#/colorado/2013/pueblo/county/outcomes/overall/additional/by-rank Emergency Services Bureau. (2013). Retrieved February 9, 2014, from Pueblo County Sheriffs Office: http://www.sheriff.co.pueblo.co.us/esb/oem.html History of Pueblo. (n.d.). Retrieved 02 08, 2014, from Pueblo, CO Official Website : http://www.pueblo.us/index.aspx?nid=119 Particle Matter. ( 2013, March 18). Retrieved February 5, 2014, from EPA United Stated Environment Protection Agency: http://www.epa.gov/pm/ Pueblo Colorado Crime statistics and Data Resources. (2014). Retrieved February 2, 2014, from Area Connect: http://pueblo.areaconnect.com/crime1.htm Pueblo, Colorado. (2014, January 31). Retrieved February 08, 2014, from Wikipedia: http://en.wikipedia.org/wiki/Pueblo,_Colorado Teens and Addiction. (2014, February). Retrieved February 9, 2014, from Teen Driug Abuse: http://www.teen-drug-abuse.org/ United Stated Census Bureau. (2010). Retrieved February 2, 2014, from Current Population Survey: http://www.census.gov/hhes/www/cpstables.htm