Monitoring The Human Condition Study — 2009

Monitoring The Human Condition Study - 2009 ** TRENDS ** Presented By: Warren Smith, Data Analyst Barnstable County Dept. of Human Services June 25, 2009 1

Background • Monitoring The Human Condition on Cape Cod Study: – – – – Health & Human Services Needs Assessment Annual Cape Cod Community Survey Findings Five Years of Data (2004 -2008) Latest US Census Statistics Findings Report in April Findings Presented at May HHSAC Meeting TRENDS Report in June 2

Today’s Presentation • Demographic Trends • Affordability Trends: – Trade-Offs – Central Issues • Trends in Eleven Key Areas: – Statistically-significant changes 3

Trends in Eleven Key Areas 1. Food/Nutrition 2. Housing 3. Leisure Time/Recreation 4. Medical/Dental 5. Mental Health 6. Overweight/Obesity 7. Childcare 8. Legal Assistance 9. Transportation 10. Discrimination 11. Work/Employment 4

Key Demographic Trends ** Changes in the Population ** 5

Population Changes • • Births Public School Enrollment Child Poverty Median Income Age Distributions Median Age Future Projections (Seniors/Elders) 6

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Notes: 14

Trends in Human Need on Cape Cod 15

Maslow's Hierarchy of Needs 16

2 nd and 1 st Levels of Need 2. Health and Well-Being 1. Air, Water, Food, Sleep, Clothing, Shelter 17

Affordability Key to Overcoming Unmet Health and Human Services Needs 18

Affordability Trends (2 nd and 1 st Level Items) • Healthcare Affordability: (2 nd level) – Health and Well-Being • Basic Needs Affordability: (1 st level) – Food – Clothing – Shelter 19

Notes: 20

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(“The” Central Issue!) 22

“The” Central Issue • “Paying insurance deductible/co-payment” – Strongly related to key affordability problems – Correlated with “Could not afford fees or costs for services” (combined with it? ) – 58% of Most Needy households report this as a barrier to accessing needed services – Statistical analysis (correlation) confirms strong links to affordability of nutritious food, dental care, and leisure time/recreation. 23

Trade-Offs ** Affordability ** 24

Historical Trade-Offs (Time Period: 2004 -2007) • Historically Inter-Related Affordability Cluster: – – – – “Not able to afford nutritious food” “Not always having enough money for food” “Not being able to afford recreational activities” “Not having enough money to pay for housing” “Paying for a mental health counselor” “Paying for or getting dental [insurance] care” “Could not afford fees or costs for services” “Paying insurance deductible/co-payments” 25

Today’s Trade-Offs (Latest 3 -Years: 2006 -2007 -2008) • Current Affordability Cluster: – – – “Not able to afford nutritious food” “Not being able to afford recreational activities” “Paying for or getting dental [insurance] care” “Could not afford fees or costs for services” “Paying insurance deductible/co-payments” 26

Trade-Offs Shown By Survey Cost of Living Responses (Most Needy Households in 2008) • To Afford Food: Trading Off – – – Telephone service Clothing store items (all) Rent or lease payments Car/truck insurance Transit services • To Afford Nutritious Food: Trading Off – Telephone service – Out-of-home fun activities – Clothing store items – In-home fun activities – Transit services 27

Trade-Offs (continued) • To Afford Housing: • To Afford Medical/Dental Care: Trading Off – Telephone service – Electric service – Clothing store items (school cloths) – Telephone service – Clothing store items (casual cloths) 28

Trade-Offs • To Afford Leisure Time and Recreation: Trading Off – Nutritious foods – Clothing store items (continued) • To Afford Mental Health Care: Trading Off – House or condo payments (casual and dress cloths) 29

Trends in Unmet Need Among Our Most Needy Households (2004 – 2007) 30

Definitions • Prevalence: – How widespread is the problem/barrier? • Proportion of households reporting a problem • Seriousness: – How detrimental is the problem/barrier? • Degree of seriousness on a “scale” (moderate, very serious, so serious did not get needed help) 31

Food/Nutrition (Changes 2004 – 2007) • Prevalence: – “Not always having enough money for food” [+41%] – “Not able to afford nutritious food” [+58%] • Seriousness: – “Not always having enough money for food” [+50%] – “Not able to afford nutritious food” [+73%] 32

Housing (Changes 2004 – 2007) • Prevalence: – “Not having enough money to pay for housing” [+52%] • Seriousness: – “Not having enough money to pay for housing” [+66%] – Overcrowding: “Not enough room in your house for all of the people who live there” [+43%] 33

Leisure Time/Recreation (Changes 2004 – 2007) • Prevalence: – “Not being able to afford recreational activities” [+29%] • Seriousness: – “Not being able to afford recreational activities” [+40%] 34

Medical/Dental (Changes 2004 – 2007) • Prevalence: – Do any of the household insurances “provide for dental care? ” [+39%] – “Is any adult (age 18+) in Fair-to-Poor health” [+64%] • Seriousness: – “Paying for or getting dental (insurance) care” [-10%] – “Not having enough money to pay the doctor, dentist, or to buy prescription medications” [+21%] 35

Mental Health (Changes 2004 – 2007) • Prevalence: – “Paying for a mental health counselor” [+49%] • Seriousness: – “Paying for a mental health counselor” [+56%] – “Having a lot of anxiety or stress in the household” [+19%] 36

Overweight/Obesity (Changes 2004 – 2007) • Prevalence: – “Seriously overweight person(s) in household” [+1, 749%] • Seriousness: – “Seriously overweight person(s) in household” [+3, 600%] 37

Childcare (Changes 2004 – 2007) • Prevalence: – Average number of “children (age 17 or younger) living in your household? ” [-22%] • Seriousness: – “Not being able to find or afford afterschool child care” [+39%] 38

Legal Assistance (Changes 2004 – 2007) • Prevalence: – “Not being able to afford legal help” [+27%] • Seriousness: – “Not being able to afford legal help” [+37%] – “Immigration or Visa dispute” [+37%] 39

Transportation (Changes 2004 – 2007) • Prevalence: – “Lack of transportation” [+76%] • Seriousness: – “Lack of transportation” [+79%] 40

Discrimination (Changes 2004 – 2007) • Prevalence: – “Feelings of discrimination” [+47%] • Seriousness: – “Feelings of discrimination” [+69%] – “Discrimination (due to race, age, language, sexual identity/orientation, etc. )” [+142%] 41

Work/Employment (Changes 2004 – 2007) • Prevalence: – “All adults (age 18+) in your household are employed” [-31%] • Seriousness: – “Unable to take time away from work to go to services” [+17%] 42

Comment on 2008 Most Needy • Due to a much broader-based demographic profile of the 2008 Most Needy households: – Household incomes are higher than usual: • Fewer affordability issues – Education levels are higher – Fewer children and child-related issues: • Fewer problems getting after-school child care – Fewer housing issues and less overcrowding – Fewer employed household members: • Fewer work-related access issues • Fewer leisure time/recreation issues • Fewer job training/skills upgrade issues • More retiree households – More households have a working vehicle: • Fewer transportation issues – Fewer feelings of discrimination – Fewer system capacity complaints ("not accepting new clients”) 43

Q & A • • What surprised you? What made you happy? What made you sad? What is most positive? What is most negative? What additional info do you need? What should be next? . . . 44

Notes: 45

The “Most Needy” 46

Who Are “Most Needy” • Compared to Overall Cape Cod Sample: – Problems and Service Barriers: • 2. 5 x to 3 x Times More Households Report Problems/Barriers also, • 2. 5 x to 3 x Times More Seriousness Reported 47

Historically “Most Needy” Cape Cod Households (Four Well-Defined Population “Groups”) 48

Group #5: ALL Retired THEN Group #4: NOT All Retired 80% Working, Middle-Class Families/Individuals— ”Doing OK, in General” Group #3: Undefined Most Years “Most Needy” Group #2 20% “Most Needy” Group #1 49

What Happened? Where Were These New Arrivals Last Year? 50

NOW Group #5: ALL Retired Group #4: NOT All Retired Working, Middle-Class Families/Individuals— “Many Not Doing So Well These Days” 74% Some New Retirees “Most Needy” Group #3 “Most Needy” Group #2 26% “Most Needy” Group #1 51