Community Health Assessment of a Virtual City

Introduction

Sentinel City is a fictional city that has undergone a community health evaluation for the Community Health Assessment of a Virtual City. It is impossible to directly compare this city to other cities because its location is unknown. Four districts were created within the city, each with a different population, income, and standard of living. Many issues with community health may be found all around the city, from social to economic to environmental. Many services are available across the city, however, they are not being used to their fullest extent.

Identification of Community: Assessment of Needs and Risks

• Demographics / Population Economic Status

Neighborhood/Community Safety Inventory

With only a few exceptions, Nightingale Square appears to be properly maintained and neat. Outside of Joe’s Supermarket, a stray cat pointed out some trash. Graffiti covered the door to the Nightingale Square condominiums. There was rubbish by the roadside at the district’s perimeter, heading toward the Acer Tech Center.

The Acer Tech Center was being renovated, however, there was some debris by the buildings. On a track above, a train could be heard operating. The streets of this region were littered with police notes.

An abandoned lot in Caster Park District was overgrown. There were burning barrels, heaps of boxes, and other garbage, suggesting that the area may have been a camp for the homeless. The parking lot was home to a stray dog. The corners of buildings have rubbish piled there. In the vicinity of what looked to be a sewage leak, containers at the construction site were marked with combustible markings.

A walled area in Industrial Heights had rusted barrels labeled as dangerous materials. Smoke could be observed coming from a manufacturing smokestack. It was seen that debris was floating in the air.

Alcohol, cigarettes, marijuana, heroin, cocaine, CNS depressants, club drugs, and methamphetamine make up 26%, 24%, 13%, 8%, 6%, 6%, and 1% of the population, respectively. In addition, hydrocodone was prescribed 12% of the time in Sentinel City in the previous year. Sentinel City, n.d. (Sentinel City)

In Sentinel City, 23% of offenses lead to arrests for cannabis, 17% for battery, 16% for controlled substances, 9% for criminal trespassing, 6% for reckless behavior, and 6% for public intoxication. The average response time for EMS is 7.46 minutes. Sentinel City, n.d. (Sentinel City)

There was noticeable gang violence in the Industrial Heights neighborhood. A storefront with broken windows was blocked off with crime scene tape, and a car was set on fire. According to the data, there were about 19 homicides, 35 simple assaults, 40 robberies, and 95 aggravated assaults in the past year. Sentinel City, n.d. (Sentinel City)

Windshield Survey

The neighborhood around Nightingale Square was tidy and well-kept. There is no charge for this service……… There were trees along the streets, and there were also a number of open green places. Several restaurants are available. Together with a sizable gas station, there was a gym, pharmacy, dentist office, health system, tattoo shop, and convenience stores. There was a sizable condo. Joe’s Grocery was a sizable marketplace that seemed to have an abundance of things available. Billboards advertise recycling. There was a sizable recreation area with courts where people were playing. In the streets, people were moving about and exercising. People were congregating in front of Joe’s to see street entertainers. Bus stations were visible, and cars were parked along the side of the road.

Even still, there was some trash on the sides of the roads at Acer Tech Center. The structures are made of concrete and masonry. Individuals were seen walking and riding bikes for transit. An officer of the law was observed pacing the streets. There were numerous eateries, a coffee shop, a barbershop, the City Center Historical Hotel, and a sizable farmer’s market that offered the locals fresh fruits and vegetables. We saw dogs both leashed and unleashed. Outside of City Hall, some protesters were seen. On a track above, a train could be heard. People were riding bikes, walking, and driving cars. Around City Hall, there were green bushes and grass to be seen. Along the streets, there were trees to be seen.

The Casper Park District was worse. The brick-built structures were more dated. The corners of the buildings were filled with trash. Some of the roadways had trees lining them. There were indications that a commercial redevelopment project was about to begin. Together with a sushi restaurant, there were also various coffee shops, doughnut shops, bookstores, small grocery stores, and check-cashing businesses. A tiny produce stand was present. The Casper Senior Living Center and the ABC Childcare were located in this area of the city. There was a sizable overgrown yard with flaming barrels, piled-high containers, a stray dog, and graffiti. The area resembled a camp for the destitute. Dogs, cats, and a feral rabbit were among the many stray animals that wandered the neighborhood. Ads on billboards urge people to get flu shots, fight addiction, and refrain from texting and driving. There appeared to be a sewage leak and behind it enormous canisters with a combustible product within them. There was a motorcycle among the pedestrians. There were several construction workers in this neighborhood.

The Industrial Heights neighborhood’s brick buildings appear dilapidated. A manufacturing smokestack was spewing smoke, there was a fenced-off area with rusty barrels of hazardous substance within, trash cans were burning, and debris was falling like snow. Graffiti covered much of the area. A building with damaged windows was blockaded behind a fence and had crime scene tape on the door. Behind the cathedral, a bustling soup kitchen operated. The playground of a nearby school was crowded with kids. The street was lined with trees. Gang violence may have resulted in a burning automobile. There was one convenience shop and check cashing locations. There were no fresh foods visible, and there was a glaring lack of shop services. There were billboards warning people not to smoke and against teen pregnancy. The boundaries of this area were marked by a number of concrete obstacles.

Population Health Scavenger Hunt

Parks and Recreation: Provides after-school programs, nutrition classes, gardening classes, summer camps for kids, city sports leagues, and swimming instruction. While programming has risen, the budget for parks and amenities has decreased dramatically from year one. The location of the park had the most complaints (40%) followed by crime (15%), drug use (15%), stray animals (15%), homeless people (10%), and sanitation (5%). The most frequently-issued tickets were for prostitution (9%), drunkenness and drug use (16%), violent offenses (24%), and trespassing after hours (31%). Sentinel City, n.d. (Sentinel City)

Aged Services in the Healthcare System: Seniors used the following services in the previous year Transportation (6.5%), Meals on Wheels (1.3%), 0.95 advocates for preventing elder abuse, community centers (2.9%), government entitlement support (7.6%), and 8.3% advocates for medical care. There are 1048 independent senior apartment units, 3472 senior living center units, 2874 nursing home units, 248 assisted living units, 64 skilled nursing care beds, 36 long-term care beds, and 24 swing-beds available for senior citizens. Sentinel City, n.d. (Sentinel City)

These were the incidents where services were used. Adoption help (425); Head Start & Early Head Start (110); Youth Independent Living Services (90); Safe at Home Program (25); Child Care Provider Accepting Subsidized Benefits; City Hall-Social Services (25). Medicare provided over 100,000 services, ACA under 40,000, Medicaid under 20,000, and a minor portion of charitable healthcare was given by Healthcare Help. Women, Infants, and Children (WIC): 70 infants/children, 11 breastfeeding mothers, 10 expectant mothers, and 9 new mothers. Supplemental Nutrition Assistance Program (SNAP) recipients last year included 9,953 seniors 60 and older, 17,359 disabled people, 24,359 low-income people, and 15,320 people enrolled in training programs. Sentinel City, n.d. (Sentinel City)

Community Health Center: Services offered include contraception, pregnancy testing and counseling, conceiving a child, basic infertility care, STD treatment, breast and cervical cancer screenings, and other preventative health treatments. Teen pregnancy rates decreased from well over 800 in year 3 to slightly over 400 in the previous year. The number of new STD cases diagnosed in the previous year is not known statistically. The data set showed the proportion of new STD cases among those aged 15 to 25 and over 25. The population over 25 appears to account for the majority of new cases, particularly of Hepatitis B and HIV. In people aged 15 to 25, gonorrhea and chlamydia were the most common STDs. Sentinel City, n.d. (Sentinel City)

Soup Kitchen: Every month, the soup kitchen served 40,000–50,000 meals. Homeless adults (64%) and disabled adults (7%), elderly people (6%), healthy adults (6%), homeless children (3%), and healthy children (2%), were among the recipients. Sentinel City, n.d. (Sentinel City)

Affordable Housing Project: Over the previous five years, the average household income of renters has decreased. The average renter’s income for two-bedroom apartments last year was just over $30,000, for one-bedroom apartments it was under $30,000, and for studio apartments it was under $20,000. With only a few vacancies, most occupied units have two bedrooms. Over three-fourths of the studio apartments were occupied, compared to only approximately half of the one-bedroom apartments. The city’s crime rate has decreased in recent years, from 3900 events three years ago to 2100 incidents today, but it is still greater in this region. Of 2100 recorded crimes, city-wide 420 were in the neighborhood of the low-income apartments and 14 were on the property. Factory smoke (21%) and dogs barking (18%) were the most frequent tenant complaints, followed by noise (17%), loitering (13%), excessive rent (10%), and police activity (6%). Sentinel City, n.d. (Sentinel City)

Analysis of Collected Data

Many issues were brought on by the fact that 18.9% of the population was living in poverty. 37.5% and 22.7%, respectively, of the population in the Industrial Heights and Casper Park District lack health insurance. In higher education, 67% of students lack access to student health services, 24% have only limited access, and only 9% have full access. Despite the absence of data sets suggesting obesity levels, Sentinel city has a high prevalence of health issues that obesity can exacerbate. Given that Sentinel City EMS had to treat ventricular fibrillation at a rate almost 140 times higher than the comparable cities, heart disease may be an issue. To manage high blood pressure, the pharmacist additionally recommended a sizable percentage of lisinopril, amlodipine, and hydrochlorothiazide. Within the city, there are 6 cardiology practices. Simvastatin is the second most frequently prescribed drug at pharmacies, which suggests that high cholesterol is a common condition. The top eleven prescribed drugs also included insulin and metformin, indicating that diabetes is a common condition among the city’s residents. Sentinel City, n.d. (Sentinel City)

In addition to those who live in Sentinel City at or below the poverty line, there are also an undetermined number of homeless people. According to the figures from the soup kitchens, 70% of the meals were served to the homeless. 35 percent of the concerns regarding city parks were concerning the growing number of homeless people, which was just 10% five years ago. Sentinel City, n.d. (Sentinel City)

The data set indicates that 27% of kids get free or reduced-price lunches. The source of calories ingested by children aged two through nineteen was 7% from school, 14% from fast food, 5% from restaurants, 67% from home, and 7% else. Adult consumption is divided among restaurants, fast food (13%), home (68%), and others (9%).

Childhood immunization rates have increased, with 50% of all students getting

 

immunizations, compared to 20% five years earlier.

Sentinel City, n.d. (Sentinel City) Although this was a remarkable improvement, it is still far behind the target of 90% by Healthy People 2020 and the national average. The 2017 publication “Healthy People: Immunization and Infectious Diseases”

Pollution was seen on the windshield survey, but Sentinel City air and water quality assessments were not accessible. Smoke from factories was the most frequent issue raised by low-income housing occupants. Respiratory issues, which may be caused by poor air quality, were the most prevalent medical problem among college-age students.

In the city, there were issues with food safety in both restaurants and grocery stores. At Joe’s Supermarket, an astounding 90 cases of foodborne illness were reported from seafood and nearly 60 from chicken in the previous year. There were six cleaning and washing violations, five food storage violations, three violations for heating/cooling food, and one for bugs/rodents in restaurants (2). These offenses all represented an increase of one incidence over the previous year. Sentinel City, n.d. (Sentinel City)

Pet owners are not being responsible enough. About 60% of pets that are owned are unregistered. Only 10% of animals that are brought into shelters have been spayed or neutered. 32% of animals brought into the shelter were returned to their owners, and 26% were adopted. 2,040 animals were euthanized as a result last year. Sentinel City, n.d. (Sentinel City) Just around 26% of the 542,000 dogs and 100,000 cats that are brought in each year are returned to their owners, according to the ASPCA. Which, despite the absence of pet registration, suggests a higher-than-normal pet return rate. Intake and Surrender at a Shelter, n.d.

Community Diagnosis by:  Identification of Top Three Problems in Sentinel City Comparing the Top 3 Problems in Relation to Problems to Healthy People 2020

Sentinel City faces several difficulties, but a significant number of them come under the nutrition and weight status issue area of the Healthy People 2020 topics and objectives. This topic includes information about obesity, malnutrition, heart disease, high blood pressure, dyslipidemia, and other health issues related to weight. Heart disease and stroke, the second target topic, are also covered by this. Environmental Health, specifically the quality of the air and water, was a major issue in this city in addition to this one. n.d., “2020 Themes and Goals”

Selected #1 Health Problem and Availability of Community Resources

The main issue in Sentinel City is with nutrition and weight status. Food insecurity is highly likely given that 18.9% of people live below the poverty line in cities. The definition of food security is “the secured access to enough food at all times for an active, healthy life, as well as enough food that is sufficient, safe, and acquired in socially acceptable methods.” (2011) Edelstein, p. 71 A number of problems that are linked to this one may be controlled if it was adequately addressed. Obesity, hypertension, high cholesterol, heart disease, diabetes, stroke, gout, and cancer are all associated with poor nutrition. 2015’s Ajmera Given the high number of prescriptions for blood pressure medications, as well as drugs for high cholesterol and diabetes, it is assumed that this is an issue in the city. Also, the high rate of ventricular fibrillation treated by EMS suggests that heart illness occurs more frequently than usual. The Casper Park District had a low-income level and limited access to fresh goods. A big at-risk population would have access to healthy, fresh foods if a Farmers’ Market Nutrition Program (FMNP) could be implemented in the Casper Park District. The city maintains a sizable farmers’ market in the Industrial Heights district. The City Hall Social Service might ask the state for funding so that the FMNP could give WIC recipients and older citizens discounts. The participant can purchase food at state-approved farmers’ markets and local farms using the coupons. (FMNP) Farmers’ Market Nutrition Program, n.d.) According to the Partnership for Public Spaces (PPS), interactions at a farmers market are a social activity that strengthens a sense of community among the attendees. (“PPS,” n.d.) Fitness and nutrition classes are already offered by the Parks and Recreation department. These services need to be aggressively promoted and targeted at the group that is in danger. My plate method should be promoted by nutritional programs as a simple way to choose the right amounts of each food type. n.d., “Pick My Plate” Anyone who has or is at risk for obesity, hypertension, or diabetes would benefit from further information about the DASH diet. The DASH Diet promotes wholesome eating by emphasizing whole, unprocessed foods. It has been demonstrated to reduce blood pressure and aid in weight loss for individuals. n.d., “Dash for Health” Even a 5% weight loss will reduce obesity-related risk factors including heart disease.

Identification of Primary Prevention Topic

Obesity and nutrition were the main areas of concern for prevention. Eight of the top eleven drugs administered in the past year have a connection to nutrition and obesity. Levothyroxine for hypothyroidism that may be made worse by obesity (>8%), Simvastatin for high cholesterol (>10%), Lisinopril for hypertension (>10%), and Amlodipine for hypertension (just under 8%) Obesity (just under 8%), Metformin (about 5%), hydrochlorothiazide (about 5%), and insulin (about 4%) are other conditions that make omeprazole for acid reflux worse. Around 140 ventricular fibrillations were attended to by the EMS in the previous year. Less than 120 people lived in the closest comparable city. The city provides financial support for 6 cardiology practices and conducts over 25,000 heart surgeries annually. High school students engaged in sports, exercise, and recreation on average for 0 hours every day. Sentinel City, n.d. (Sentinel City)

The citizens of this city must adopt a healthier way of living. Physical activity needs to be increased, and eating habits need to be changed. They must include minimally processed foods, fresh fruits and vegetables, and fresh produce in their diet. If at all possible, restrict your intake of fast food and prepared items that are heavy in sodium, lipids, and carbohydrates. The kids’ access to nutritious, well-balanced meals should be ensured by the schools and daycare centers. This will provide kids energy to learn, play, and grow as well as help them establish a healthy lifestyle. In addition to providing sustenance, the Soup Kitchen and other community resources must promote good eating habits. Regrettably, it is quicker and less expensive to make processed and prepackaged foods than fresh foods, but they provide fewer nutrients and are packed with dangerous preservatives. Exercise and a healthy diet should be emphasized in classes at school and in the neighborhood. The community’s general health will increase if these adjustments can be accomplished.

Application of Learning from Simulation to Future Community Assessment Strategies

I’ve had the opportunity to practice the abilities I’ll need to conduct a community health assessment in my own town thanks to the Sentinel City simulation. It offered a secure setting where I could experiment with each stage and then quickly go back to follow up with places where I required more details. This will help me efficiently get the data I need when I ride out in my local community because I will have a better grasp of what information to look for.

References

• 2020 Topics and Objectives. (n.d.). Retrieved 6/1/2017, from http://healthypeople.gov/topics-objectives
• Ajmera, R. (2015). The Effects of Poor Nutrition on Your Health. Retrieved from www.livingstrong.com/article/31172-effects-poor-nutrition-health
• Choose My Plate. (n.d.). Retrieved 6/1/2017, from http://www.choosemyplate.gov
• Edelstein, S. (2011). Nutrition in Public Health (3rd Edition ed.). Retrieved from https://wgu.vitalsource.com/#/books/978128407946/cfi/0!/4/2/2@0:087.5
• Farmers’ Market Nutrition Program (FMNP). (n.d.). Retrieved 6/1/2017, from http://fns.usda.gov/fmnp/overview
• Farmers Markets as a Strategy to Improve Access to Healthy Food for Low-Income Families and Communities. (n.d.). Retrieved from http://pps.org/wp-content/uploads/2013/02/RWJF-Report.pdf
• Immunization and Infectious Diseases: National Snapshot. (2017). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topics/immunization-and-infectious-diseases/national-snapshot
• Sample, I. (2016). Small Weight Loss Brings Big Health Benefits for Obese Patients. Retrieved from http://theguardian.com/science/2016/feb/22/small-weight-loss-brings-big-health-benefits-for-obese-patients
• Sentinel City:  Sentinel City. (n.d.). Retrieved May 27, 2017, from http://citl.americansentinel.edu/twine/SC2.3_Healthcare System – Storyline output/story.html
• Shelter Intake and Surrender. (2016). Retrieved from http://www.aspca.org/animal-homelessness/shelter-intake-and-surrender/pet-statistics
• The Dash Diet Eating Plan. (n.d.). Retrieved 6/1/2017, from http://dashforhealth.com/about-dash-diet/dash-diet-menu-plan/.