2010 
Health Needs Assessment 
Clay County, Florida 
2010 
Health Needs Assessment 
Clay County, Florida 

Clay County, 
FLORIDA 
Clay County, 
FLORIDA 
PREPARED BY THE 

Health Planning Council of Northeast Florida 

FUNDED BY 

Orange Park Medical Center 
Clay County Health Department 


www.hpcnef.org 

TABLE OF CONTENTS TABLE OF CONTENTS 
LETTER TO THE COMMUNITY . . . . . . . . . . . . . . . . . .5 
EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . .6 
COMMUNITY CALL TO ACTION . . . . . . . . . . . . . . . .7 
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 
Building on Past Success . . . . . . . . . . . . . . . . . .10 
2005 Recommendation 1 . . . . . . . . . . . . . . . . . .10 
2005 Recommendation 2 . . . . . . . . . . . . . . . . . .11 
2005 Recommendation 3 . . . . . . . . . . . . . . . . . .12 
2005 Recommendation 4 . . . . . . . . . . . . . . . . . .12 

METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . .13 

CLAY COUNTY PROFILE . . . . . . . . . . . . . . . . . . . . .16 
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . .16 
Geography and Governance . . . . . . . . . . . . . . .16 
POPULATION CHARACTERISTICS . . . . . . . . . .17 
Race and Ethnicity . . . . . . . . . . . . . . . . . . . . . . .17 
SOCIO-ECONOMIC PROFILE . . . . . . . . . . . . . .18 
Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 
Poverty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 
Public Assistance . . . . . . . . . . . . . . . . . . . . . . . .19 
Labor Force, Employment, and Industry . . . . . . 20 
Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 
Food Environment . . . . . . . . . . . . . . . . . . . . . . . .22 

COMMUNITY HEALTH STATUS . . . . . . . . . . . . . . . .23 
COUNTY HEALTH RANKING . . . . . . . . . . . . . . .25 
MORTALITY INDICATORS . . . . . . . . . . . . . . . . .26 
Leading Causes of Death . . . . . . . . . . . . . . . . . .27 
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 
Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 
Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . .30 
Prostate Cancer . . . . . . . . . . . . . . . . . . . . . . . . .31 
Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . .32 
Chronic Obstructive PulmonaryDisease (COPD) . . . . . . . . . . . . . . . . . . . . . . .33 
Unintentional Injuries . . . . . . . . . . . . . . . . . . . . .34 
Motor Vehicle Accidents . . . . . . . . . . . . . . . . . . .35 
Alcohol Related Motor Vehicle Accidents . . . . .36 
Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 
Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 
Alzheimer’s Disease . . . . . . . . . . . . . . . . . . . . . .40 
Liver Disease and Cirrhosis . . . . . . . . . . . . . . . .41 
Influenza and Pneumonia . . . . . . . . . . . . . . . . . .42 
COMMUNICABLE DISEASES . . . . . . . . . . . . . .43 

Enteric Diseases . . . . . . . . . . . . . . . . . . . . . . . . .43 
Vaccine Preventable Diseases . . . . . . . . . . . . . .43 
Sexually Transmitted Diseases . . . . . . . . . . . . . .43 
Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 
HIV and AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . .43 
MATERNAL AND CHILD HEALTH . . . . . . . . . . .44 
Female Population of Childbearing Age . . . . . .44 
Birth Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 
Infant Mortality . . . . . . . . . . . . . . . . . . . . . . . . . .45 
Poor Birth Outcomes . . . . . . . . . . . . . . . . . . . . .46 
Pre-Term Delivery . . . . . . . . . . . . . . . . . . . . . . . .46 
Low Birth Weight . . . . . . . . . . . . . . . . . . . . . . . .46 
Adolescent Births . . . . . . . . . . . . . . . . . . . . . . . .47 
SOCIAL AND MENTAL HEALTH . . . . . . . . . . . . .48 
Domestic Violence . . . . . . . . . . . . . . . . . . . . . . .48 
Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 
Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . .50 
BEHAVIORAL RISK FACTOR 
SURVEILLANCE SURVEY . . . . . . . . . . . . . . . .52 

ACCESS TO CARE . . . . . . . . . . . . . . . . . . . . . . . . . .53 
Health Insurance Coverage . . . . . . . . . . . . . . . .53 
Coverage for Children . . . . . . . . . . . . . . . . . . . .55 
Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 
Health Care Facilities . . . . . . . . . . . . . . . . . . . . .59 
Acute Care . . . . . . . . . . . . . . . . . . . . . . . . . . .59 
Emergency Room Care . . . . . . . . . . . . . . . . . .63 
Long-Term Care . . . . . . . . . . . . . . . . . . . . . . . . .65 
Mental and Substance Abuse . . . . . . . . . . . . . .67 

LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT . .68 

FORCES OF CHANGE ASSESSMENT . . . . . . . . . . .70 

COMMUNITY PARTICIPATION . . . . . . . . . . . . . . . . .75 

Community Survey . . . . . . . . . . . . . . . . . . . . . . .75 

Focus Groups . . . . . . . . . . . . . . . . . . . . . . . . . . .83 

KEY HEALTH ISSUES . . . . . . . . . . . . . . . . . . . . . . . .90 

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . .90 

KEY HEALTH ISSUES . . . . . . . . . . . . . . . . . . . . .90 

APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98 
Appendix A - Focus Group Questions . . . . . . . . . . .99 
Appendix B - Survey Questions . . . . . . . . . . . . . . .100 

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tables and figures tables and figures 
Image 1: The MAPP Model: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 
Image 2: Map of Florida Highlighting Clay County . . . . . . . . . . . . . . . . . . . . . . . . . . .16 
Table 1: General Population Trends, 2000-2030 . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 
Figure 1: Estimates of Population by Age Group, 2003 . . . . . . . . . . . . . . . . . . . . . . . .17 
Table 2: Clay County and Florida Population by Race, 2008 . . . . . . . . . . . . . . . . . . .17 
Table 3: Per Capita Income, Weekly Wage, and Median Household 

Income, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 
Figure 2: Household Income Levels, Clay County, 2008 . . . . . . . . . . . . . . . . . . . . . . .18 
Table 4: Estimates of Persons and Youth in Poverty, 2000 and 2008 . . . . . . . . . . . .19 
Figure 3: Individuals and Families receiving Public Assistance, 2004-2008 . . . . . . .19 
Figure 4: Unemployment, Clay County and Florida, 2004-2009 . . . . . . . . . . . . . . . . .20 
Table 5: Job Losses by Industry, Clay County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 
Table 6: High School Graduation and Drop-Out Rates, 2002-03 and 2007-08 . . . . .21 
Figure 5: Students Eligible to Receive Free and/or Reduced Price Meals . . . . . . . . .21 
Figure 6: Average Per-Capita Food Consumption, Northeast Florida Region, 2009 . .23 
Table 7: Clay County Health Factors Rankings, 2010 . . . . . . . . . . . . . . . . . . . . . . . .25 
Table 8: Top 10 Leading Causes of Death, Clay County, 2008 . . . . . . . . . . . . . . . . .27 
Figure 7: Cancer Mortality, All Types, 2003-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 
Figure 8: Cancer Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 
Figure 9: Lung Cancer Mortality, All Races, 2003-2008 . . . . . . . . . . . . . . . . . . . . . . .29 
Figure 10: Lung Cancer Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . . . . . . . . . .29 
Figure 11: Breast Cancer Mortality, 2003-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 
Figure 12: Breast Cancer Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . . . . . . . . .30 
Figure 13: Prostate Cancer Mortality, 2003-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 
Figure 14: Prostate Cancer Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . . . . . . .31 
Figure 15: Heart Disease Mortality, 2003-200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 
Figure 16: Heart Disease Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . . . . . . . . .32 
Figure 17: Chronic Obstructive Pulmonary Disease Mortality, All Races, 2003-2008 . .33 
Figure 18: Chronic Obstructive Pulmonary Disease Mortality, by Race, 2006-2008 . . .33 
Figure 19: Unintentional Injury Mortality, All Races, 2003-2008 . . . . . . . . . . . . . . . . . .34 
Figure 20: Unintentional Injuries Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . . .34 
Figure 21: Motor Vehicle Accident Mortality, All Races, 2003-2008 . . . . . . . . . . . . . . .35 
Figure 22: Motor Vehicle Accident Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . .35 
Figure 23: Alcohol Related Motor Vehicle Accidents, All Populations, 2006-2008 . . .36 
Figure 24: Stroke Mortality, All Races, 2003-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 
Figure 25: Stroke Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 
Figure 26: Diabetes Mortality, All Races, 2003-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . .38 
Figure 27: Diabetes Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . .38 
Figure 28: Rate of Resident Hospitalizations with a Primary Diagnosis of Diabetes, 

All Races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 
Figure 29: Alzheimer’s Mortality, All Races, 2003-2008 . . . . . . . . . . . . . . . . . . . . . . . . .40 
Figure 30: Alzheimer’s Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . . . . . . . . . . . .40 
Figure 31: Liver Disease And Cirrhosis Mortality, All Races, 2003-2008 . . . . . . . . . . .41 
Figure 32: Liver Disease And Cirrhosis Mortality, by Race, 2006-2008 . . . . . . . . . . . .41 
Figure 33: Influenza & Pneumonia Mortality, All Races, 2003-2008 . . . . . . . . . . . . . . .42 

2 


tables and figures tables and figures 
Figure 34: Influenza & Pneumonia Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . .42 
Table 8: Communicable Disease Mortality Rate(s), All Races, 2006-2008 . . . . . . . .43 
Figure 35: Female Population, Ages 15-44, by Race, 2004-2008 . . . . . . . . . . . . . . . . .44 
Figure 36: Live Birth Rate, by Race, 2004-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 
Figure 37: Infant Mortality Rates, All Races, 2003-2008 . . . . . . . . . . . . . . . . . . . . . . . .45 
Figure 38: Infant Mortality Rates, by Race, 2006-2008 . . . . . . . . . . . . . . . . . . . . . . . . .45 
Figure 39: Births to Mothers Ages 15-19yrs, All Races, 2003-2008 . . . . . . . . . . . . . . .47 
Figure 40: Births To Mothers Ages 15-19, by Race, 2006-2008 . . . . . . . . . . . . . . . . . .47 
Table 9: Domestic Violence Offenses, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 
Figure 41: Total Domestic Violence Offenses, All Races, 2003-2008 . . . . . . . . . . . . . .48 
Figure 42: Suicide Mortality, All Races, 2003-2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 
Figure 43: Suicide Mortality, by Race, 2006-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 
Figure 44: Total Involuntary Examinations for Clay County Residents, 2002-2007 . . . .50 
Table 10: Arrests by Offenses, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 
Table 11: Health Insurance Coverage, Clay County and Florida, 2009 . . . . . . . . . . . .54 
Figure 45: Median Monthly Medicaid Enrollment,Clay County and Florida, 

2004-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55 
Figure 46: KidCare Enrollment, Baker County and Florida, April 2008 . . . . . . . . . . . . .55 
Figure 47: Total Licensed Physicians, Clay County and Florida, 2006-2009 . . . . . . . .57 
Figure 48: Licensed Family Practice Physicians, Clay County and Florida, 

2006-2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57 
Figure 49: Licensed Internist Physicians, Clay County and Florida, 2006-2009 . . . . . .57 
Figure 50: Licensed Pediatricians, Clay County and Florida, 2006-2009 . . . . . . . . . . .58 
Figure 51: Licensed Obstetric/Gynecology Physicians, Clay County and Florida . . . .58 
Figure 52: Total Hospital Beds (All Facilities),clay County and Florida, 2006-2008 . . .59 
Figure 53: Acute Care Hospital Beds (All Facilities), Clay County and Florida, 

2006-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 
Figure 54: Specialty Hospital Beds (All Facilities), Clay County and Florida, 

2006-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60 
Table 12: Acute Care Hospital Inventory of Services, 2009 . . . . . . . . . . . . . . . . . . . . .60 
Figure 55: Hospital Admissions of Clay County residents, July-December 2009 . . . . .61 
Table 13: Top 12 Hospital Discharges, by DRG, Clay County Adults, 2009 . . . . . . . .62 
Table 14: Top 12 Hospital Discharges, by DRG, Clay County Pediatric 

Patients, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62 
Figure 56: Orange Park Medical Center Emergency Room Visits, 2000-2009 . . . . . ..63 
Figure 57: Orange Park Medical Center ER Visits Resulting in Inpatient Admissions, 

2000-2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 
Table 15: Top Emergency Room Diagnoses (regardless of admission status), 

Clay County Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 
Figure 58: Total Admissions, Kindred Hosptal – North Florida, 2000-2009 . . . . . . . . ..65 
Figure 59: Total Nursing Home Beds, Clay County and Florida, 2006-2008 . . . . . . . . .66 
Table 16: Free Standing Community Nursing Homes, 2009 . . . . . . . . . . . . . . . . . . . .66 
Figure 60: Adult Psychiatric Beds, Clay County and Florida, 2006-2008 . . . . . . . . . . .67 
Table 17: Local Public System Performance Assessment Summary, 2010 . . . . . . . . .69 

3 


4 4 

Thomas Pentz Thomas Pentz 
LETTER TO THE COMMUNITY 
C
C
aring for our community is a high priority at Orange Park Medical Center and the Clay 
County Health Department. It was our goal, along with the Health Planning Council of 
Northeast Florida to create a clear plan for the next several years to make Clay County a 
healthier place to live and grow. With that, we present to you the 2010 Clay County Health 
Assessment Report. At a time when our nation is facing critical health care issues, the people of 
Clay County are becoming increasingly aware of the impact of lifestyle, local 
physical and economic environments as well as affordable, accessible health care 
on the health of the community. These factors impact not only the individuals who 
live within the county, but the vitality and success of the county itself. This report is a 
call to action to encourage all health care providers, social service organizations, 
faith-based community and private citizens to join together and make Clay County a 
healthier and happier place to live and work. 

Over the last nine months, community leaders came together to assess the health 

status and priority health issues facing the county. Along with meeting on a monthly 

basis, focus groups were held with members of the community and surveys were 

conducted. In the end, we received feedback from over 1500 members of the Clay 

County community. Armed with this information, the task force of community leaders 

worked through all of the information to pinpoint the key health issues we are faced 

with as a community. The Clay County Health Assessment Task Force identified key 

health issues which included high rate of lung cancer mortality, diabetes, heart 

disease, infant mortality, limited access to dental services – among lower-income 

and uninsured adults, Alzheimer’s mortality, and substance abuse. 

Please take the time to review this report. This assessment is the product of a 
collective and collaborative effort from a variety of dedicated health and social service providers 
along with other invaluable community stakeholders from across all regions of Clay County. It is 
hoped that the findings from this community health assessment will serve to guide Clay County 
leaders in their program development efforts over the next 3-5 years. We encourage individuals 
who would like to work with the Lead Entities cited for the 2010 Goals and Activities to contact the 
Clay County Health Department to see how they can become involved to reach this goal. 

With best regards, 

CEO 
Nancy MillsAdministrator 
Orange Park Medical Center Clay County Health Department 


5 


EXECUTIVE SUMMARY EXECUTIVE SUMMARY 
T
T
he Orange park Medical Center, the Clay County Health Department and the Health Planning 
Council of Northeast Florida spearheaded an initiative to conduct a comprehensive, county-wide 
health needs assessment. 

The Clay County Health Assessment Task Force, comprised of community leaders from local medical and 
behavioral health providers, social service agencies, civic organizations and minority and faith-based 
groups came back together to: 1). Review the outcomes of the 2005 health needs assessment and 2). 
Launch the 2009-2010 county-wide assessment of the overall health status and priority health issues 
facing Clay County residents. 

Information collected during the needs assessment process was presented to the Clay County Health 
Assessment Task Force during monthly community meetings held at various locations in Clay County from 
October 2009-June2010. 

Components of Clay County’s health needs assessment included an analysis of demographics, health 
statistics, and access to health care indicators for county residents. This data included chronic disease 
death rates, infectious disease rates, and maternal and child health indictors, In addition, hospital 
utilization data of Clay County residents was presented as well as the availability of health resources and 
services in the county 

Input from Clay County residents was obtained from 4 focus group interviews from diverse populations. 

A community-wide survey that examined the community’s opinion on health care services and 
quality of life issues was also distributed to gain additional feedback from Clay County 
residents. Over 1,500 surveys were collected from Clay County residents. 
Key Issues and Recommendations 

The Clay County Health Assessment Task Force identified key health issues which included high 
rate of lung cancer mortality, diabetes, heart disease, infant mortality, limited access to dental services – among 
lower-income and uninsured adults, Alzheimer’s mortality, and substance abuse. Task Force members then 
collapsed these key health issues into broader health priorities and subsequently developed recommendations 
and actions steps. The Task Force believed these recommendations should be incorporated in the work of 
existing community groups and leaders and report on the progress of these recommendations through the Clay 
County Health Department Director on a quarterly basis. 

6 


2010 COMMUNITY 
CALL TO ACTION 
2010 COMMUNITY 
CALL TO ACTION 
GOAL 1: 

Improve the overall Health Literacy, along with awareness and understanding of healthy lifestyle 
recommendations, among Clay County residents through targeted health promotion campaigns/initiatives. 

HEALTH PRIORITIES: 

Overweight/Obesity, Diabetes, Cardiovascular Disease, Stroke 

ACTIVITY TIMEFRAME MEASURE OF SUCCESS LEAD ENTITY 
A. Coordinate with parish health programs/ 
health ministries to disseminate targeted 
health messages, education, and needed 
support services through local congregations. 
May 2014 # of health ministries 
and/or faith leaders 
actively participating 
in coordinated health 
education initiatives 
Mercy Network 
B. Partner with local businesses to create and 
deploy effective health messaging at consumer 
and employee “points of contact” (ie: messaging 
on consumer goods, worksite wellness 
programs, and training other service providers – 
such as barbers/beauticians - as health 
ambassadors, etc.) 
May 2014 # of business-based 
health promotion 
programs 
Clay Chamber of 
Commerce 
C. Work with school leaders to influence policy 
change that improves and integrates the 
provision of age-appropriate health education, 
prevention messaging, and physical activity for 
students within their core curriculum. 
May 2014 Resulting policies 
(Also, identify youth and 
adolescent S/A indicators 
available from providers 
for long term outcomes) 
Clay County 
School District 

GOAL 2: 

Increase/Improve access to goods and services needed to support a healthy lifestyle, especially among 
underserved populations, through improved interagency coordination and multi-sector partnerships. 

HEALTH PRIORITIES: 

Overweight/Obesity, Diabetes, Cardiovascular Disease, Stroke 

ACTIVITY TIMEFRAME MEASURE OF SUCCESS LEAD ENTITY 
A. Organize and co-host the first “Clay County 
Health Summit” with key community leaders to 
explore options to improve primary care access 
for lower income and uninsured residents. 
October 2010 • # of participants 
• Resulting 
plans/policies 
Health Planning 
Council of Northeast 
Florida (With sponsorship 
from the Blue Foundation) 
B. Strengthen existing collaborations with 
regional mobile health units to ensure access 
to needed primary and specialty care as well 
as appropriate screenings and education. 
May 2010 • # or % of low-income 
and uninsured 
persons served 
• Reduced hospital 
utilization among 
underserved pops 
St. Vincents Mobile 
Outreach and Clay 
County Health 
Department 

7 


COMMUNITY CALL TO ACTION 
CONTINUED 
COMMUNITY CALL TO ACTION 
CONTINUED 
GOAL 2: (continued) 

ACTIVITY TIMEFRAME MEASURE OF SUCCESS LEAD ENTITY 
C. Partner with existing organizations and 
resources that supply healthy foods (such as 
agricultural organizations to coordinate 
community gardens and supermarkets that 
sell fresh produce and meats) to improve 
access to healthy food for all residents, 
especially those in underserved 
areas/populations. 
May 2010 • Resulting policies 
related to the provision 
of/access to healthy 
produce and meats for 
underserved residents 
• Increase the 
proportion of the 
annual per capita 
food consumption 
that comes from fresh 
produce and meats 
Universithy of Florida 
Clay County 
Expansion Services 
and Clay County 
Health Department 

GOAL 3: 

Continue coordination with both the Clay Action Coalition and “Tobacco Free Clay” to improve the integration of 
appropriate substance use/misuse prevention messaging, screening, and assessment into routine medical care, 
especially for youth. 

HEALTH PRIORITIES: 

Substance Abuse/Misuse (Can include Alcohol, Tobacco, Illegal and Prescription Drugs) 

ACTIVITY TIMEFRAME MEASURE OF SUCCESS LEAD ENTITY 
A. Increase and improve the provision of 
substance use prevention messages within 
primary care and other routine healthcare 
settings.ess for lower income and uninsured 
residents. 
May 2010 Deferred to existing 
outcomes already being 
measured by providers/ 
coalitions 
Clay County Medical 
Society 
B. Integrate early risk assessment, screening, 
and education regarding substance 
use/misuse into the routine primary care of 
children and adolescents. 
May 2010 Deferred to existing 
outcomes already being 
measured by providers/ 
coalitions 
Clay County Medical 
Society 

8 


INTRODUCTION INTRODUCTION 
In the Fall of 2009, leaders from Orange Park 
Medical Center and the Clay County Health 
Department came together to launch a county-wide 
assessment of the overall health status and priority 
health issues facing Clay County residents. The 
Health Planning Council of Northeast Florida was 
subcontracted to guide and facilitate the process. 

More than 70 key healthcare and community 
stakeholders were invited to join the Clay County 
Health Assessment Task Force, and to participate in 
the assessment by representing the needs of their 
clients, constituents, and communities. Collectively, 
more than 40 community leaders contributed to the 
process by attending at least one Task Force 
meeting; with more than an additional 1,550 
residents contributing to the assessment through 
their participation in surveys and group 
discussions. 

The Task Force elected to utilize the “MAPP” 
community assessment model, as recommended 
by the Florida Department of Health as well as the 
National Association of City and County Health 
Officers (also known as “NACCHO”). MAPP 
is an 
acronym for “Mobilization for Action through Planning 
and Partnership;” and is a community-based 
participatory model that relies on the existing 
expertise of community representatives to identify, 
prioritize, and collectively address the county’s most 
prevalent health concerns. This type of county-wide 
health assessment was last completed in Clay 
during 2005; and it is recommended to re-occur 
every 3-5 years. 

The Clay County Health Assessment Task Force is 
comprised of representatives from local medical 
and behavioral health providers, social service 
agencies, civic organizations, minority and faith-
based groups, and other key community 
stakeholders. Information collected during the 
needs assessment process was presented to the 

Task Force members at community meetings that 
were held in various locations in Clay County 
including the City of Green Cove Springs City Hall, 
The Fleming Island Library, Life Care Center or 
Orange Park, and Holly Cove Apartment 
Community during November 2009 – July 2010. 

Components of Clay County’s health assessment 
included an analysis of available demographic 
data, health statistics, and access to health care 
indicators for county residents. Community input 
was obtained from five focus group discussions 
among known key population groups such as: the 
elderly, faith community, minority residents, parents, 
and business professionals. A county-wide survey 
that solicited the community’s opinions on health 
care services and quality of life issues was also 
distributed to gain additional feedback from Clay 
County residents. Detailed information summarizing 
each of these components is included in this report. 

During the final three community meetings, 
members of the Task Force made recommendations 
regarding the key health issues utilizing a summary 
of the data and information obtained through the 
four integrated assessments outlined in the MAPP 
model (a diagram of the model is included on page 
15 of this report). A summary of the Task Force 
members’ recommendations on the County’s priority 
health issues is included in the final section of this 
report, along with suggested goals and strategies to 
address them. 

This assessment is therefore the product of a 
collective and collaborative effort from a variety of 
dedicated health and social service providers along 
with other invaluable community stakeholders from 
across all regions of Clay County. It is hoped that 
the findings from this community health assessment 
will serve to guide health and social services 
providers in the county in their program 
development efforts over the next 3-5 years. 

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building on past SUCCESS building on past SUCCESS 
T
T
The previous Clay County Health Assessment Task Force developed a set of recommendations based on the 
findings that evolved from the 2005 assessment. Those recommendations and the suggested activity steps to 
achieve them were disseminated throughout the community through targeted discussions and presentations. The 
Task Force members then reconvened in both May of 2006 and December of 2007 to discuss progress toward each 
recommended goal. A final summary report of accomplishments related to these goals (through 2009) was also provided 
by the Clay County Health Department Administrator as a starting point to this assessment. Highlights from each of those 
reports are included below under each of the 2005 recommended goals. 

2005 Recommendation 1: 
Reduce teen drug and alcohol use 

1) Develop community awareness campaign in order to change community norms targeting both parents and teens. 

• Seek grant funding/ county assistance in the development of campaign. 
• Partner with the schools, law enforcement, churches, health professionals and community groups to 
disseminate awareness campaign. 
2) Encourage police to strongly enforce teen drinking violations. 

3) Develop teen/community center in Green Cove Springs (possibly partner with the YMCA). 

This recommendation was referred to the existing Clay Action Coalition, a group of community leaders working to 
address issues in Clay related substance abuse and behavioral health, especially among youth and adolescents. The 
Coalition and Clay County Behavioral Health Center applied for and were awarded a 5-year, $100,000 federal Drug Free 
Communities grant, along with an additional $75,000 for targeted substance abuse prevention. The Coalition also 
successfully bid for a $50,000 “Enforcing Underage Drinking Block Grant,” with Clay Behavioral Health Center as the 
fiscal agent for the 2-year funding period. 

The Clay Action Coalition continues to guide and encourage teen substance abuse prevention through ongoing 
compliance checks at convenience stores and restaurants to ensure that tobacco and alcohol retailers are properly 
checking identification. Individual member agencies have also implemented multiple programs to support substance 
abuse prevention. 

For example, the local Police Activities League (PAL) began transporting youth to Orange Park so that they could 
participate in structured activities; and the Elk’s Club and Clay School District provided drug prevention programs at an 
annual teen summit. Additionally, the Clay County Health Department and community partners implemented tobacco and 
substance use prevention campaigns and healthy lifestyle interventions through 

• Rick Bender presentations; 
• Establishing SWAT programs in Clay County schools; 
• “Tobacco Tales” Jungle Puppet Shows; 
• Breathe Easy Track Meet; 
• Founding of the Tobacco Free Clay partnership and associated newsletter; 
• Powering Up for Social Change event; 
• Teen Leadership Training (130 students); and 
• Movies on the Lawn (various sites) 
Additional partners in Green Cove Springs performed additional targeted activities under leadership of Chief Musco, including: 
• Operation Safe Streets; 
• Green Cove Springs Ministerial Alliance (supports community policing and neighborhood revitalization); and 
• Community Center at Augusta Savage complex - includes YMCA (operating swimming pool, youth sports, summer 
day camp). 
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2005 Recommendation 2: 
Reduce obesity and enhance chronic disease prevention 


1) 
Develop worksite wellness programs at businesses, schools and the hospital in conjunction with the 
“Healthy Clay” initiative. 

This activity was referred to the Clay County Chamber of Commerce and Orange Park Medical Center. The hospital 
implemented the Well Worksite Program, as recommended by the Wellness Council of America (more information 
about the program can be found at www.welcoa.org). Within six months, more than 6,400 employees from seven local 
employers had participated in the Well Worksite Program. Efforts were made to recruit an additional 13 employers to 
reach the initial goal. CCHD also established Employee wellness program and participation in First Coast Games; and 
the Chamber of Commerce continues to host an annual health fair. 

2) 
Provide safe recreational activities/parks for children in older, established neighborhoods. 

• Develop fact sheet of children’s recreational and sport activities available in the county. 
• Distribute fact sheet thru Healthy Clay businesses, schools and community groups. 
This activity was referred to the Clay County Health Department, Clay County Schools, and Clay County government. 
The health department in collaboration with the Clay County Parks Department and the Florida Department of Health 
facilitated the installation of a LifeTrain® system at Fox Meadow Park, one of the county’s nature/walking trails. The 
group also explored expanding the LifeTrain® system around baseball fields. The system is designed to accommodate 
the needs for persons of all types of physical abilities. 

3) 
Provide affordable fitness options as well as transportation to and from fitness centers. 

This activity was referred to the YMCA in Clay County. Leadership from the YMCA waw invited to attend subsequent 
Task Force and coalition meetings. The Health Department also compiled a list of county parks and recreation activities 
to share with the community. 

• Community Center at Augusta Savage complex includes the YMCA (operating a swimming pool, youth sports 
programs, and summer day camp); 
• With multiple partners, the Health Department hosts annual activities for Step Up Florida (Green Cove Springs 
events: 2008 with ~1200 participants, and 2009 with ~1600 participants; also Gold Head State Park events: 
2008 with ~35 and 2009 with ~80 participants.) 
• CCHD is part of a new 10 county RWJF funded multi-county learning collaborative project to reduce childhood 
obesity – Charles E. Bennett is the pilot school in Clay County (Power Panther Healthy Eating Contest) 
• CCHD and School District activities: Run/Walk club events (Hog Jog and Jingle Bell Run) 
• WIC food packages have been upgraded to include fresh produce and low/no fat items. 
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2005 Recommendation 3: 
Expand mental health services 

1) 
Form mental health task force to determine what services are available, the capacity of these programs, gaps 
in services and referral processes. 

2) 
Educate providers and community of resources available. 

This activity was referred to Clay Behavioral Health Services, Orange Park Medical Center, and NAS Hospital 
(Jacksonville). Clay Behavioral Health Services subsequently began training law enforcement officers to identify 
individuals with mental health issues in order to properly deal with incidents in the community. The mental health task 
force has not yet been developed. 

2005 Recommendation 4: 
Improve access to health services in west and south Clay County. 


1) 
Expand mobile health services to rural areas of Clay County either through a partnership with St. Vincent’s 
Mobile Health Ministry or the Clay County Health Dept. 

This activity was referred to St. Vincent’s Health Systems’ Mobile Health Ministries and the Clay County Health 
Department. Free services for the low income and uninsured are offered through dedicated We Care Clinics held at the 
Bear Run health department clinic in Orange Park (Saturday Clinic; The Way; and Clay County Smiles dental clinic). In 
addition, St. Vincent’s Mobile Health Outreach Ministries provides school/athletic physicals and screenings for students 
at Clay County schools; as well as primary care services three days per month in Clay County. The Clay County Health 
Department facilitated a partnership with the Baker County Health Department to provide dental services thru a mobile 
dental van to Clay Schools at least 2 weeks per month. St. Vincent’s is also looking into a mobile dental van. There is also 
a 5-county diabetes self-management program that includes Clay County, funded under the state’s Medicaid program 
through a Low Income Pool (LIP). This comprehensive diabetes management program provides enhanced services to 
low-income and uninsured diabetics with a goal to reduce inappropriate hospital and emergency room utilization and 
improve the quality of life for patients. 

2) 
Explore opportunity with Family Medical and Dental Centers to open a satellite location of the existing 
Federally Qualified Health Center (FQHC) in the target areas. 

This activity was referred to the Clay County Health Department. Health Department leaders subsequently met with 
Family Medical and Dental Centers (FMDC) administration about expanding services at a location in Clay Hill. It was 
discovered that Clay Hill does not meet the federal designation for a Health Professional Shortage Area (HPSA) and 
therefore does not qualify an FQHC site. FMDC then submitted expansion grants for pediatric dental services in 
Keystone Heights and adult dental services in Palatka. These proposals were not approved for funding, however the 
FQHC plans to resubmit when more funding opportunities are offered. Other expansions of services to the low-income 
and uninsured include: The Way Clinic and the LIP Comprehensive Diabetes Management Program (as mentioned in 
activity 1 above). 

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METHODOLOGY METHODOLOGY 
The Florida Department of Health recommends the implementation of evidence-based and effective assessment models 
such as the National Association of County and City Health Officials’ (NACCHO’s) Mobilizing for Action through 
Planning and Partnerships (MAPP) model for community health planning. This model was developed to provide a 
strategic approach to community health improvement by helping communities to identify and use existing resources 
wisely, consider unique local conditions and needs, and form effective partnerships for action.1 The model includes six 
distinct phases: 

1. Partnership development and organizing for success 
2. Visioning 
3. The Four MAPP assessments 
• Community Health Status Assessment 
• Community Strength and Themes Assessment 
• Local Public Health System Assessment 
• Forces of Change Assessment 
4. Identifying strategic issues 
5. Formulating goals and strategies 
6. Action (program planning, implementation, and evaluation) 
Clay County is fortunate to have long-standing proactive leadership within its healthcare network who strongly value 
solid and collaborative relationships with other health and support service providers throughout the community. Clay 
County Health Department maintains strong ongoing relationships with multiple health and social services providers 
locally; and compiled the initial Task Force invitation list from this network. More than 70 key stakeholders were invited 
to join the Task Force. 

At least fourteen Task Force members came together for the 2010 assessment kick-off meeting in November of 2009. 
Project staff provided an introduction to the project and highlighted the expected outcomes and benefits of the 
assessment. Emphasis was given that this is meant to be a community-driven process, meaning that the members of the 
Task Force would be charged with developing the county’s health priorities and proposing strategies to address them. 
Members were also provided with a complete overview of the MAPP assessment mode, a preliminary timeline of when 
each component should occur, and guidance on how they could most effectively contribute to the process. 

Participants also viewed a 25 minute segment from the acclaimed Unnatural Causes public television documentary, as 
graciously supplied by WJCT, the region’s local public broadcasting station. The full documentary is a four-hour miniseries 
that was broadcast nationally during 2009; and that served as a powerful tool to empower and mobilize entire 
communities into action. The segment shown during the Clay meeting exemplified how the environment and 
surroundings in which people live can impact their overall health. Members were then guided through an exercise to 
identify and discuss how various physical attributes in Clay County may have either positive or negative impacts on 
population health. The kick-off closed with a review of key findings and recommendations from the most recent 
assessment conducted in 2005; and the Clay County Health Department Administrator lead a discussion recognizing 
examples of health-related community accomplishments since that time. 

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The number of Task Force members doubled for the second assessment meeting held during January, 2010. The meeting 
was dedicated to presenting and discussing the data obtained through the recommended Health Status Assessment, 
the first of the four MAPP assessments. The discussion incorporated an analysis of population demographics and socioeconomic 
indicators, disease and death rates, healthcare utilization statistics, and access to healthcare indicators. The 
data was provided in two primary formats: (1) trend diagrams showing changes over time between 2003 and 2008 using 
3-year rolling averages; and (2) the most current available 3-year average rates with a comparison between white and 
non-white (racial and ethnic minority) populations. The members were also provided with relevant findings from the 
county’s most recent Behavioral Risk Factor Surveillance Survey (BRFSS), completed in 2007. Members subsequently 
discussed potential causes and other links between various conditions. Some members requested some specific 
additional data to help support and/or disprove speculations. 

Wider community input was sought during February-April 2010 through the Community Themes and Strengths 
Assessment that included a county-wide paper survey that solicited residents’ opinions on health and quality of life 
issues, as well as targeted focus group discussions across the county. The anonymous survey was administered by Task 
Force members at various locations throughout Clay County, including the annual county fair. In total. more than 1,500 
completed surveys were provided by residents, with proportional representation from all segments of the community. The 
survey results were compile and analyzed by Health Planning Council staff, then presented to the consortium members for 
further discussion. 

Utilizing guidance provided by the U.S. Centers for Disease Control and Prevention (CDC) under the National Public 
Health Performance Standards Program (NPHPSP), the Clay County Health Assessment Task Force members completed a 
Local Public Health System Performance Assessment in February, 2010. The members first reviewed the composition 
of the county’s public health safety-net to include all entities that serve the county’s most vulnerable residents. Health 
Planning Council staff then guided the Task Force members through a broad discussion of each of the 10 Essential Public 
Health Services, as outlined by the CDC; and the members discussed each until consensus was reached regarding the 
degree to which each service is present and effective throughout the county. Strengths and gaps in the county’s 
healthcare safety net and public health system were identified in this way, and were subsequently considered throughout 
the remainder of the planning process. 

• Trends are patterns over time, such as migration in and out of a community or a growing 
disillusionment with government. 
• Factors are discrete elements, such as a community’s large ethnic population, an urban 
setting, or a jurisdiction’s proximity to a major waterway. 
• Events are one-time occurrences, such as a hospital closure, a natural disaster, or the 
passage of new legislation. 
Additionally, the members were asked to consider trends, factors, and events related to a wide variety of perspectives including: 

• Social 
• Economic 
• Government/Political 
• Community 
• Environmental 
• Educational 
• Science/Technology 
• Ethical/Legal 
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Significant key issues and themes were recorded and updated throughout the process based on empirical evidence and 
community discussion. Key issues were then consolidated and prioritized based on the scope and severity of need, as 
well as the availability of resources to address them. The Taskforce members participated in detailed discussions related 
to the root causes of each key health issue, such as poor nutrition and inadequate physical activity. The partnership then 
worked to develop appropriate and realistic goals and strategies pertaining to each priority issue. In order to ensure 
alignment with state and national strategies, the Task Force members first reviewed the current U.S and Florida strategic 
plans for each of the three highest priority health issues. These included recommended community strategies and 
measurements to prevent obesity in the United States2, the Florida Diabetes Health System 2007-2013 Strategic Plan3, the 
CDC’s Public Health Action Plan to Prevent Heart Disease and Stroke4, the Florida Heart Disease and Stroke Prevention 
State Plan for 2009-20125, the National Drug Control Strategy (2010)6, and the Florida Drug Control Strategy (2009)7. This 
report presents a summary of the key health issues along with recommended goals and strategies developed through this 
process. The Clay County Health Assessment Task Force will continue to work in close partnership with Orange Park 
Medical Center, Clay County Health Department and other committed stakeholders, to ensure continued progress toward 
the goals listed in this report. 

Image 1: The MAPP Model: 


1National Association of City and County Health Officers, 2009 
2Morbidity and Mortality Weekly Report (MMWR), Volume 58/RR-7, July 24, 2009 
3Florida Department of Health, Diabetes Prevention and Control Program and the Florida Alliance for Diabetes Prevention and Care, 2010 
4U.S. Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, 2006 
5Florida Department of Health, Heart Disease and Stroke Prevention Program, 2009 
6U.S. Office of National Drug Control Policy, 2010 
7Florida Department of Children and Families, Office of Drug Control, 2009 

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CLAY COUNTY PROFILE CLAY COUNTY PROFILE 
Introduction 

The characteristics of a community, including the age, gender, ethnic background, and economic characteristics, 
influence the community’s health care needs and the design of delivery of services to meet those needs. This section 
provides an overview of the demographics and socio-economic characteristics of Clay County in comparison to the state. 

Geography and Governance 

Clay County encompasses 601 square miles of Northeast Florida, immediately southwest of the metropolitan city of 
Jacksonville and directly west of historic St. Augustine. The county’s entire eastern border is formed by the St. Johns 
River. The county contains 46 square miles of water among its many lakes and rivers; as well as many miles of 
undeveloped woodlands. 

The county was founded nearly 150 years ago and has evolved into a diverse culture of both suburban and rural areas. 
The 5 member, elected Board of County Commissioners is the law-making body of the county, operating under the Home 
Rule charter since 1991. Each elected member represents a specific district within the county for a designated four year 
term. Some specific government functions are performed by separately elected Constitutional Officers who are elected 
county-wide. These two groups together comprise the elected officials who are responsible to the voters of Clay County.1 

Image 2: Map of Florida Highlighting Clay County 


1All information obtained from the Clay County Government (website) 

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Population Characteristics 

Table 1 below shows Clay’s population trends and projections between 2000 and 2030. It is projected that Clay County 
will experience a 93% population growth during this time period, while Florida’s population as a whole is projected to 
increase by only 50%. 

Table 1: General Population Trends, 2000-2030 

Area Population 
2000 2005 2010 2015 2020 2025 2030 
Clay 140,814 169,623 186,947 206,450 229,204 251,182 271,775 

Florida 15,982,824 17,918,227 18,881,443 20,055,865 21,417,450 22,738,233 23,979,032 

Source: Florida Office of Economic and Demographic Research, 2010 

Figure 1 summarizes the age groups of Clay County residents with comparison to Florida. Clay is comprised of a 
younger population with respect to many other counties in the state. The highest proportion of its residents are in both 
the 45-64 and 25-44 age groups, accounting for 27% and 26% respectively, and more than half of the county’s 
population combined. Youth ages 14 and under make up 21%; and residents over the age of 65 make up 11% of the 
population. 

Figure 1: Estimates of Population by Age Group, 2003 


Source: Florida Office of Economic and Demographic Research, 2010 

Race and Ethnicity 

Table 2 shows the racial composition of Clay County with comparison to Florida. Only 10.4% of the population in Clay 
County is non-white. The “Other” race category includes American Indians, Asians, and Hawaiian/Pacific Islanders. 

Table 2: Clay County and Florida Population by Race, 2008 

Race Clay Florida 
Population Percentage Population Percentage 
White 165,200 87.2% 15,211,730 80.4% 
Black 17,260 9.1% 3,155,725 16.7% 
Other 7,018 3.7% 548,000 2.9% 
Total 189,667 100% 18,896,559 100% 
Source: Florida Office of Economic and Demographic Research, 2010 
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Socio-Economic Profile 

Income 

Clay County had a per capita income of $33,375 in 2009, which was slightly lower than Florida’s per capita income of 
$37,780. Respectively, the average weekly wage in Clay was $582 in 2009 compared to $760 across Florida as a whole 
(shown in Table 3 below). Clay County’s median household income, however, was $61,057 in 2008, which is higher than 
the state’s median household income of $44,857. The U.S. Census Bureau indicates that the average number of persons 
per household in Florida is 2.46, compared to 2.77 in Clay County. At least a portion of the difference in median 
household incomes between Clay and Florida may be attributed to there being (on average) more income earners living 
in each household in Clay County (i.e. that more persons in each household in Clay are working to support the 
household). 

Table 3: Per Capita Income, Weekly Wage, and Median Household Income, 2009 

Clay Florida 
Median Median 
Per Capita Avg. Weekly Household Per Capita Avg. Weekly Household 
Income Wage Income Income Wage Income 
$33,375 $582 $61,057 $37,780 $760 $44,857 

Source: Florida Research and Economic Database, Labor Mark Statistics, 2010 

With regard to household income levels, the largest percentage of Clay County households (24.1%) had incomes 
between $50,000 - $74,999 during 2008 ; while an additional 19.2% of households reported incomes between 
$75,000 - $99,999. The distribution of household incomes for Clay County are shown in Figure 2 below. 

Figure 2: Household Income Levels, Clay County, 2008 


Source: U.S. Census Bureau, 2010 

2U.S. Census Bureau, 2010 

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Poverty 

The estimated percentage of all persons living in poverty in Clay County was 8.0% in 2008, compared to an average 
of 12.1% across all of Florida. It is assumed that these percentages increased during 2009 as a result of increases in 
unemployment and the overall economic downturn that impacted the entire nation during that year, although updated 
figures were not yet available in time to be included in this planning process and report. 

Table 4: Estimates of Persons and Youth in Poverty, 2000 and 2008 

Population Clay County 
2000 2008 
Florida 
2000 2008 
Individuals living in Poverty 6.8% 7.7% 12.5% 12.6% 
Youth <18 yrs living in Poverty 8.9% 10.4% 17.2% 17.6% 

Source: U.S. Census Bureau, American Community Survey, 2009 

Public Assistance 

Figure 3 on the following page illustrates the number of clients and families receiving public assistance from year 2000 
through 2008. There has been a slow but steady increase in the numbers of both individuals and families qualifying for 
assistance over the past 8 years. There was a marked increase of 23.8% in the number of individuals receiving 
assistance between 2008 and 2009. It is assumed by the Clay County Health Assessment Task Force members that this 
occurred as a direct result of increase unemployment in the area during the same time period. 

Figure 3: Individuals and Families receiving Public Assistance, 2004-2008 


Source: Economic Self-Sufficiency Services, Florida Department of Children and Families, 2010 

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Labor Force, Employment, and Industry 

According to the Florida Department of Labor and Employment Statistics, Clay County was home to a Civilian Labor 
Force of 96,322 as of June 2010. Of those, 10.3% were unemployed, compared to an average unemployment rate of 
11.6% for all of Florida. Clay County’s unemployment rate increased two and a half times (250%) between 2006 and 
2009. Florida experienced a 238% increase during this same time period; however Clay County’s unemployment rate is 
still below the state average. 

Figure 4: Unemployment, Clay County and Florida, 2004-2009 


Source: Florida Agency for Workforce Innovation, Labor Market Statistics, 2010 

Specific to industry type, manufacturing, management, construction, real estate, and retail sales suffered the most job 
losses during 2008-2009. Together these occupations accounted for a reported total of 2,430 lost jobs during the year in 
Clay; or nearly 8% of the county’s total jobs. Healthcare, social services, arts, recreation, transportation, and warehousing 
all saw job increases during the same time period. Job losses and gains are shown by industry in Table 5. 

Table 5: Job Losses by Industry, Clay County 

Industry 2007 2008 2009 Difference 2008-2009 % Change 2008-2009 
Manufacturing 1,753 1,811 1,253 558 30.81% 
Management 291 331 185 146 44.11% 
Healthcare/Social Svcs 5,986 6,308 6,483 (175) -2.77% 
Public Administration 2,355 2,403 2,333 70 2.91% 
Agriculture/Fishing 156 167 160 7 4.19% 
Construction 4,563 3,957 3,024 933 23.58% 
Arts & Recreation 488 1,042 1,175 (133) -12.76% 
Accommodations/Food Svcs 5,151 5,383 5,291 92 1.71% 
Utilities 460 456 4 0.87% 
Retail 9,231 8,933 8,366 567 6.35% 
Transportation/Warehouse 881 1,056 1,120 (64) -6.06% 
Real Estate/Rental 981 948 722 226 23.84% 

Source: Florida Agency for Workforce Innovation, Labor Market Statistics, 2010 

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Education 

There were a total of 35,998 students enrolled in Clay County Public Schools (Pre-Kindergarten through Grade 12) as of 
Fall 2009; which represents a 5.41% increase since the Fall of 2005. Clay County has been successful in improving the 
number and rate of high school students who graduate within 4 years of entering high school as well as reducing the rate 
of students who drop out before they graduate, over the past five school years. The most recent high school graduation 
drop-out rates are shown in Table 6 below, along with the figures from the 2002-03 school year. Clay County schools 
awarded 2,447 high school diplomas during 2008-2009 . 

Table 6: High School Graduation and Drop-Out Rates, 2002-03 and 2007-08 

Area 2002-03 School Year 2007-08 School Year 
Graduation Drop-Out Graduation Drop-Out 
Clay County 75.4% 2.2% 77.6% 2.0% 

Florida 69.0% 3.1% 75.4% 2.6% 

Figure 5 below illustrates the percentage of enrolled students who are eligible to receive free or reduced-price breakfast 
and lunch at school. Clay County has seen an 11.5% increase in this eligibility category during the ten year period 
between the 2000-01 and 2009-10 school years. The state of Florida as a whole experienced a slightly smaller 9.6% 
increase during the same time; yet remains higher than the average for Clay. 

Figure 5: Students Eligible to Receive Free and/or Reduced Price Meals 


Source: Florida Department of Education, Student Demographic Information Report, 2010. 
Note: Figures represent the total percentage of students in enrolled in public schools receiving free or reduced-price breakfast and lunch. Students 
whose family incomes are < 130% of the federal poverty guidelines are eligible for free breakfast/lunch; and students whose family incomes are 
between 131-185% are eligible for the reduced-price meal program. 


3Florida Department of Education, 2010. Refers to all diplomas issued throughout the school year. 

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Food Environment 

As mentioned earlier, the Task Force Members embarked on this assessment with a viewing of a specific episode of 
the acclaimed television series known as Unnatural Causes… is inequality making us sick? The series is a seven-part 
documentary produced by California Newsreel in 2008 that explores racial and socioeconomic inequalities in health. 
The full series was broadcast by Public Broadcasting Stations (PBS) nationwide at various times during 2008-2009; 
and served as a catalyst for thousands of organizations and communities to tackle the root causes of the nation’s 
alarming health disparities. The program aims to highlight and raise awareness about the impacts of the environment 
in which individuals live and work on their health. 

Evidence offered within the series suggests that more equitable social policies, secure living-wage jobs, affordable 
housing, racial justice, good schools, community empowerment, and family supports are health issues just as critical 
as diet, tobacco use, and exercise. Ultimately, Unnatural Causes works to answer the question: “How are the 
behavioral choices we make (such as diet and exercise) constrained by the choices we have?” 

The members viewed the segment called “Place Matters,” which examines three key themes: 

1. Built space and the social environment have a direct impact on residents’ health. 
2. Neighborhood conditions can have an indirect impact on health by making healthy choices easy, difficult, 
or impossible. 
3. Public policy choices and private investment decisions shape neighborhood conditions. 
The 29-minute episode illustrates a neighborhood that experiences higher rates of poverty, lower income rates, and 
lower rates of educational attainment than surrounding areas. Additionally, tobacco, liquor and fast food were easily 
found everywhere, but fresh produce was very difficult to find or buy. Quality affordable housing was also hard to find, 
and so were safe places to play and exercise. As a result, residents suffered from significantly higher rates of obesity 
and diabetes, along with other chronic health problems. 

In alignment with this theme, Health Planning Council staff compiled data related to the “food environment” within Clay 
County. Findings revealed that the county has 29 grocery stores with 3 additional “supercenters” or club-based stores. 
There are also 64 gas station/convenience stores in the county, along with 10 additional convenience stores that do not 
offer fuel. Among all stores, 25 are authorized to serve individuals under the state funded Women, Infants, and 
Children (WIC) program; and 61 stores are reported as “SNAP” authorized, meaning that they can accept food 
stamps. Data supplied by the U.S. Department of Agriculture (USDA) indicates that 1.83% of all Clay County residents 
must travel a distance greater than one mile to access a food store; compared to 11.43% of residents with incomes at 
or below the Federal Poverty Level (FPL) that must travel more than 1 mile to purchase food. 

Additional findings included that the cost of healthy food and beverages in the region are higher than less nutritional 
foods and soft drinks. For example, the cost of 1 gallon of low-fat milk averages at least 1.25 times higher than an 
equal amount of soda; and the cost of starchy vegetables (high in carbohydrates) is nearly one and a half times higher 
than an equal weight of green leafy vegetables. 

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The figure below lists the average individual consumption of various types of foods annually throughout Northeast 
Florida. Taskforce members noted that nearly half of all foods consumed in the region are pre-packaged/processed 
foods; and that natural, whole foods make-up only 35% of the average diet. 

Figure 6: Average Per-Capita Food Consumption, Northeast Florida Region, 2009 


Source: U.S. Department of Agriculture 

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COMMUNITY HEALTH STATUS COMMUNITY HEALTH STATUS 
The first of the four MAPP assessments completed during the planning process was the Community Health 
Status Assessment. The Florida MAPP Field Guide states that this assessment is intended to answer the 
questions: “How healthy are our residents?” and “What does the health status of our community look like?” 
This portion of the assessment includes the activities of collecting, analyzing, and reviewing available data 
that describes the population’s health; as well as comparing that data to other known time periods and/or 
geographies. 

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County Health Rankings 

In February 2010, the University of Wisconsin, under funding from the Robert Wood Johnson Foundation, released the 
2010 County Health Rankings, a collection of 50 reports that reflect the overall health of counties in every state across 
the country. For the first time, counties were able to get a snapshot of how healthy their residents are by comparing their 
overall health and the factors that influence their health, with other counties in their state. 

The rankings were compiled utilizing a 3 tier model of population health improvement. In this model, health outcomes are 
measures that describe the current health status of a county. These health outcomes are influenced by a set of health 
factors. These health factors and their subsequent outcomes may also be affected by community-based programs and 
policies designed to alter their distribution in the community. Counties can then improve health outcomes by addressing 
all health factors with effective, evidence-based programs and policies. For a more detailed explanation of the choice of 
measures, see www.countyhealthrankings.org. 

The report for Florida ranks the state’s counties according to their summary measures of health outcomes and health 
factors, as well as the components used to create each summary measure. Outcomes rankings are based on an equal 
weighting of mortality and morbidity measures. The summary health factors rankings are based on weighted scores of 
four types of factors: behavioral, clinical, social and economic, and environmental. The weights for the factors are based 
upon a review of the literature and expert input. 

Overall, Clay County ranked 7th among Florida’s 67 counties for health outcomes, and 13th for health factors. There were 
significant differences, however, when examining the individual rankings for each of the four topics considered for the 
health factors score. The table below lists the 4 topics, along with the type(s) of indicators included within each, and the 
corresponding rank for Clay County. 

Table 7: Clay County Health Factors Rankings, 2010 

HEALTH BEHAVIORS CLINICAL CARE SOCIO-ECONOMIC PHYSICAL ENVIRONMENT 
Tobacco Education 
Diet and Exercise 
Alcohol Use 
High-Risk Sex 
Access to Care 
Quality of Care 
Employment 
Income 
Family/Social Support 
Community Safety 
Air Quality 
Built Environment 
Access to healthy food 
Liquor Stores 
Clay Rank: 50th Clay Rank: 8th Clay Rank: 4th Clay Rank: 16th 

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Mortality Indicators 

Mortality rates can be key indicators of the state of health of a community. This section will examine various mortality 
rates among Clay County residents, with comparison to Florida as a whole. Mortality rates provided in this section 
reflect rolling 3-year averages of the rate of deaths per every 100,000 persons in the named area’s population. The 
rates are also proportionately age-adjusted to balance for variances in the age groups between different geographies. 
The majority of data for this section (unless otherwise noted) was obtained and compiled using the Florida Department 
of Health’s dedicated online data system known as the Florida Community Health Assessment Resource Tool Set, or 
“CHARTS”. Area-specific data queries and profiles can be obtained from: www.floridacharts.com 

It is important for effective community planning to acknowledge that the rate of deaths from specific diseases tend 
to vary among different racial/ethnic groups and geographies; and that both biological and cultural norms may 
contribute to these differences. The presented data on the following pages will therefore show two separate aspects 
of every disease or condition reported: 

1) 
Trends over time, presented as 3-year rolling averages of mortality rates for both the county and the state 
(for comparison); and 

2) 
A separate breakdown between white and non-white populations for the most current time period available 
(to identify racial disparities) 

All data included in this section represents the most current information available at the time that this report was 
compiled. Some figures have been updated for the report if new information became available after it was presented 
to the Task Force members during the planning meetings; in order to ensure that the final report includes the most 
current information available at the time of completion and publication to the community. Any significant differences 
from what was presented were shared with Task Force members prior to the development of the county’s health 
priorities and goals. 

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Leading Causes of Death 

The five leading causes of death in Clay County during the most recent period for which data is available (2006-2008) 
are shown below, along with their corresponding rank for both the state and the nation as a whole. The rankings show 
that Clay County has similar major health issues when considered in respect to both Florida and the U.S. 

Clay County Rank Disease/Condition Florida Rank U.S. Rank 
1 Cancer (total of all types) 1 2 
2 Heart Disease 2 1 
3 Respiratory Disease 4 4 
4 Accidental Injury 3 5 
5 Stroke 5 3 

Table 7 below lists the top ten leading causes of death in the county, with a 3-year average (age-adjusted) comparison to 
the state of Florida as a whole. 

Table 8:Top 10 Leading Causes of Death, Clay County, 2008 


Source: Florida CHARTS, 2010 

Each disease and condition listed above may impact specific population groups in Clay County more than others. The 
information presented in this section provides only a general snapshot of the impact of these diseases and conditions on 
the county as a whole; and does not account for the numerous and sometimes complex health issues faced by many 
residents. The Clay County Health Assessment Task Force members discussed each disease and condition in detail and 
provided invaluable insight into how each may have an amplified impact on some communities. The members were 
mindful to consider the figures shown in this section in combination with multiple other factors as discussed in the 
remaining three planning assessments that were completed as a part of the recommended model, prior to determining 
the county’s priority health concerns. 

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Cancer 

Cancer is a large group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the growth is 
left uncontrolled, it can result in death. Cancer ranks a close second only to heart disease as the leading cause of death 
in the United States.4 In Clay County, cancers are the leading cause of death, accounting for more than 1 of every 4 
deaths among residents in 2008. 

Figure 7: Cancer Mortality, All Types, 2003-2008 


Figure 8: Cancer Mortality, by Race, 2006-2008 


4U.S. Centers for Disease Control and Prevention (CDC),2010 

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Lung Cancer 

Lung Cancer is the most common type of cancer among Clay County residents, resulting in death rates that are virtually 
double than either breast or prostate cancer (the next two most common types). Lung Cancer tends to impact Clay 
County residents more frequently than in other areas of the state; and affects white populations at a higher rate than nonwhite 
populations in Clay. 

Figure 9: Lung Cancer Mortality, All Races, 2003-2008 


Figure 10: Lung Cancer Mortality, by Race, 2006-2008 


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Breast Cancer 

Except for skin cancer, breast cancer is the most common cancer among American women.5 Doctors recommend that 
women have regular clinical breast exams and mammograms to find breast cancer early. Treatment is more likely to work 
well when breast cancer is detected early. Before they have symptoms, women should get regular screening 
mammograms to detect breast cancer early6: 

• Women in their 40s and older should have mammograms every 1 or 2 years. 
• Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider 
whether to have mammograms and how often to have them. 
Clay County’s breast cancer mortality has fluctuated slightly over recent years, however has remained at or near the 
state’s overall average rate. 

Figure 11: Breast Cancer Mortality, 2003-2008 


Figure 12: Breast Cancer Mortality, by Race, 2006-2008 


5U.S. Centers for Disease Control and Prevention (CDC),2010 
6U.S. National Institutes of Health, National Cancer Institute, 2010 

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Prostate Cancer 

Prostate cancer is the most commonly diagnosed cancer in men, and second only to lung cancer in the number of 
cancer deaths in the United States. Currently, there is no scientific consensus on effective strategies to reduce the risk of 
prostate cancer. Additionally, there is no agreement on the effectiveness of screening or that the potential benefits 
outweigh the risks. Therefore, public health agencies face significant challenges in determining what actions to take to 
address prostate cancer.7 

Figure 13: Prostate Cancer Mortality, 2003-2008 


Figure 14: Prostate Cancer Mortality, by Race, 2006-2008 


7U.S. Centers for Disease Control and Prevention (CDC),2010 

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Heart Disease 

Heart disease remains the nation’s leading cause of death for both men and women, resulting in 26% or more than 1 in 
every 4 deaths in the U.S. during 2006. Half of deaths due to heart disease are women. The most common type of heart 
disease is coronary artery disease (CAD), which can lead to heart attack. Individuals can greatly reduce their risk for 
CAD through lifestyle changes and, in some cases, medication. People who have had a heart attack can also reduce the 
risk of future heart attacks or strokes by making lifestyle changes and taking medication.8 

Figure 15: Heart Disease Mortality, 2003-2008 


Figure 16: Heart Disease Mortality, by Race, 2006-2008 


8U.S. Centers for Disease Control and Prevention (CDC),2010 

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Chronic Obstructive Pulmonary Disease (COPD) 

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and 
breathing-related problems. It includes emphysema, chronic bronchitis, and in some cases, asthma. COPD is a leading 
cause of death, illness, and disability in the United States. Tobacco use is a key factor in the development and 
progression of COPD, but asthma, exposure to air pollutants in the home and workplace, genetic factors, and respiratory 
infections also play a role. COPD mortality has remained fairly stable in Clay County; and tends to impact white residents 
at rates more than twice that of non-white residents. 

Figure 17: Chronic Obstructive Pulmonary Disease Mortality, All Races, 2003-2008 


Figure 18: Chronic Obstructive Pulmonary Disease Mortality, by Race, 2006-2008 


8U.S. Centers for Disease Control and Prevention (CDC),2010 

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Unintentional Injuries 

Unintentional injuries include those that result from motor vehicle crashes, drowning, fire, falls, poisoning, and other 
home/recreational/workplace injuries. They are the 5th leading cause of death in the U.S.10 The rate of unintentional injury 
deaths has remained fairly stable in Clay over the past 5 years. The white population in Clay County is impacted by 
unintentional injuries more frequently than non-white populations in Clay. 

Figure 19: Unintentional Injury Mortality, All Races, 2003-2008 


Figure 20: Unintentional Injuries Mortality, by Race, 2006-2008 


10U.S. Centers for Disease Control and Prevention (CDC),2010 

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Motor Vehicle Accidents 

In the United States, motor vehicle–related injuries are the leading cause of death for people ages 1–34, and nearly 5 
million people sustain injuries that require an emergency department visit each year. National prevention strategies 
include a focus on improving seat belt use and reducing impaired driving; and target groups known to be at risk: child 
passengers, teen drivers, and older adult drivers. National strategies also include efforts to prevent pedestrian and 
bicycle injuries.11 The age-adjusted death rate from motor vehicle accidents in Clay County had shown a slight increase 
between 2003 and 2007, however decreased again during 2006-2008. 

Figure 21: Motor Vehicle Accident Mortality, All Races, 2003-2008 


Figure 22: Motor Vehicle Accident Mortality, by Race, 2006-2008 


11U.S. Centers for Disease Control and Prevention (CDC),2010 

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Alcohol Related Motor Vehicle Accidents 

Alcohol-impaired driving endangers the health and lives of drinking drivers, their passengers, and others on the road. 
Every day, 32 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver - this 
amounts to one death every 45 minutes. Alcohol-impaired driving takes an especially high toll on young people. One of 
every three drivers ages 21-24 who was killed in a motor vehicle crash in 2008 had a blood-alcohol concentration (BAC) 
of 0.08 (the legal limit) or above.12 

Figure 23: Alcohol Related Motor Vehicle Accidents, All Populations, 2006-2008 


Source: Florida Department of Highway Safety and Motor Vehicles, 2010 

12U.S. Centers for Disease Control and Prevention (CDC),2010 

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Stroke 

A stroke, sometimes called a brain attack, occurs when a clot blocks the blood supply to the brain or when a blood 
vessel in the brain bursts. Stroke is the third leading cause of death in the United States. Stroke can also cause 
significant disability, such as paralysis, speech difficulties, and emotional problems. Some new treatments can reduce 
stroke damage if patients get medical care soon after symptoms begin. When a stroke happens, it is important to 
recognize the symptoms, call 9-1-1 right away, and get to a hospital quickly. Individuals can greatly reduce their risk for 
stroke through lifestyle changes and, in some cases, medication.13 Clay County’s stroke mortality has seen a steady 
decline since 2003, especially among non-white populations. Successful strategies leading to this decline should be 
examined for possible replication among other disease states and conditions. 

Figure 24: Stroke Mortality, All Races, 2003-2008 


Figure 25: Stroke Mortality, by Race, 2006-2008 


13U.S. Centers for Disease Control and Prevention (CDC),2010 

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Diabetes 

Diabetes is a disease in which blood glucose levels are above normal. Diabetes is the sixth leading cause of death in the 
United States. Type 1 diabetes, which was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-
onset diabetes, may account for 5% to 10% of all diagnosed cases of diabetes. Type 2 diabetes, which was previously 
called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, may account for about 90% to 95% of 
all diagnosed cases. Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of 
gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.14 Research studies have found 
that moderate weight loss and exercise can prevent or delay type 2 diabetes among adults at high-risk of diabetes. The 
rate of deaths from diabetes had remained fairly stable in Clay County during the period from 1997–2003; but have 
shown a steady decline since 2004. Non-white populations are disproportionately impacted by diabetes, with mortality 
rates nearly twice those among white residents in Clay County. 

Figure 26: Diabetes Mortality, All Races, 2003-2008 


Figure 27: Diabetes Mortality, by Race, 2006-2008 


14U.S. Centers for Disease Control and Prevention (CDC),2010 

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Diabetes(continued) 

Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity 
amputations. People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from 
going too low or too high. 

Cardiovascular disease is the leading cause of early death among people with diabetes. Adults with diabetes are two to 
four times more likely than people without diabetes to have heart disease or experience a stroke. At least 65% of people 
with diabetes die from heart disease or stroke. About 70% of people with diabetes also have high blood pressure. 

A combination of high blood glucose and high blood pressure can also cause small blood vessels to swell and leak 
liquid into the retina of the eye; blurring the vision and sometimes leading to blindness. People with diabetes are also 
more likely to develop cataracts (a clouding of the eye’s lens), as well as glaucoma (optic nerve damage). 

Diabetes is the most common cause of kidney failure, accounting for nearly 44% of new cases annually in the U.S. In 
diabetic kidney disease (also called diabetic nephropathy), cells and blood vessels in the kidneys are damaged, 
affecting the organs’ ability to filter out waste. Waste builds up in the blood instead of being excreted. In some cases this 
can lead to kidney failure. 

Having high blood glucose for many years can damage the blood vessels that bring oxygen to some nerves, as well as 
the nerve coverings. Damaged nerves may stop sending messages, or send messages too slowly or at the wrong times. 
Numbness, pain, and weakness in the hands, arms, feet, and legs may develop. Problems may also occur in various 
organs, including the digestive tract, heart, and sex organs. Diabetic neuropathy is the medical term for damage to the 
nervous system from diabetes. The most common type is peripheral neuropathy, which affects the arms and legs. Nerve 
damage, circulation problems, and infections can cause serious foot problems for people with diabetes. Poor circulation 
can sometimes lead to amputation of a toe, foot, or leg.15 

Figure 28: Rate of Resident Hospitalizations with a Primary Diagnosis of Diabetes, All Races 


15All information obtained from U.S. Centers for Disease Control and Prevention (CDC),2010 

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Alzheimer’s Disease 

Alzheimer’s disease has recently surpassed diabetes as the 6th leading cause of death among American adults. 
Notably, mortality rates for Alzheimer’s disease are on the rise, unlike heart disease and cancer death rates which are 
continuing to decline. The number of Americans with Alzheimer’s disease has doubled since 1980. Individuals with 
Alzheimer’s disease still make up less than 13 percent of the Medicare population; yet they account for 34 percent of 
Medicare spending.16 

Mortality from Alzheimer’s has shown a decline in Clay County since 2006; however remained at twice the state rate as of 
2006-2008. There is a slight disproportionate impact among non-white residents. 

Figure 29: Alzheimer’s Mortality, All Races, 2003-2008 


Figure 30: Alzheimer’s Mortality, by Race, 2006-2008 


16U.S. Centers for Disease Control and Prevention (CDC),2010 

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Liver Disease and Cirrhosis 

The liver is the 2nd largest and one of the most important organs in the human body. Almost all of the blood in the body 
passes through the liver. The liver performs hundreds of functions including storing nutrients, removing waste, and worn-
out cells from the blood, filtering, and processing chemicals from food, alcohol, and medications. Among the numerous 
diseases that affect the liver, cirrhosis accounts for most of the cases of liver disease and death associated with liver 
failure. Chronic alcoholism is the leading cause of cirrhosis in the United States. 

The rate of deaths associated with liver disease has increased slightly during recent years in Clay County, however 
remain at or near the state average. Liver disease impacts white population groups in Clay County at rates more than 
double those in non-white populations. 

Figure 31: Liver Disease And Cirrhosis Mortality, All Races, 2003-2008 


Figure 32: Liver Disease And Cirrhosis Mortality, by Race, 2006-2008 


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Influenza and Pneumonia 

Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. The flu can cause mild to severe illness, 
and at times can lead to death. Some people, such as older people, young children, and people with certain health 
conditions, are at high risk for serious flu complications. The best way to prevent the flu is by getting vaccinated each year. 

Pneumonia is an infection of the lungs that is usually caused by bacteria or viruses. Globally, pneumonia causes more 
deaths than any other infectious disease; however, it can often be prevented with vaccines and can usually be treated 
with antibiotics or antiviral drugs. 

Influenza and pneumonia together constitute the 8th leading cause of death in the United States. Deaths from flu and 
pneumonia have steadily decreased in Clay County since 2004; but remain at least twice as high among white 
populations when compared to non-white population groups in the county. 

Figure 33: Influenza & Pneumonia Mortality, All Races, 2003-2008 


Figure 34: Influenza & Pneumonia Mortality, by Race, 2006-2008 


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Communicable Diseases 

Enteric Diseases 

Bacterial and viral infections of the gastrointestinal tract can lead to diarrheal disease. Many of these pathogens are 
transmitted through contaminated food or water. In the United States, diarrhea is the second most common infectious 
illness, accounting for one out of every six of all infectious diseases.17 The overall incidence of enteric disease has 
steadily increased in both Clay and Florida since 2004. 

Vaccine Preventable Diseases 

Vaccine-preventable diseases, not long ago, disabled and killed thousands of Americans annually. Thanks to our 
country’s high childhood immunization coverage levels, these diseases are now very uncommon. Vaccine-preventable 
diseases include: Diptheria, Haemophilus Influenzae B (Hib), Hepatitis A and B, Measles, Mumps, Meningococcal, 
Pneumococcal, Polio, Pertussis (whooping cough), Rotavirus, Rubella, Tetanus, and Varicella (chickenpox). The rate of 
incidence of these diseases (combined) increased from 3.1 in Clay County during 2004-2006 to 4.5 by 2006-2008; while 
remaining virtually stable across Florida as a whole. 

Sexually Transmitted Diseases 

Sexually transmitted diseases (STDs), are among the most common infectious diseases in the United States today. More 
than 20 STDs have now been identified, and they affect more than 13 million men and women in this country each year. 
14 Clay County has seen a 33% increase in the incidence of STD’s since 2004, compared to a 21% increase statewide; 
but remains well below the state incidence rate. 

Hepatitis 

The word "hepatitis" means inflammation of the liver and also refers to a group of viral infections that affect the liver. The 
most common types are Hepatitis A, Hepatitis B, and Hepatitis C. Viral hepatitis is the leading cause of liver cancer and 
the most common reason for liver transplantation. 

HIV and AIDS 

The rate of HIV/AIDS deaths in Florida is equal to that of Homicides; and they share a rank as the eleventh leading cause 
of death among Floridians. Clay County has a significantly lower average rate of HIV and AIDS cases than Florida as a 
whole; ranking 26th among the state’s 67 counties in the number of HIV cases and 23rd in the number of AIDS cases 
reported. 

Table 8: Communicable Disease Mortality Rate(s), All Races, 2006-2008 

Communicable Diseases Clay Florida 
Enteric Disease Incidence Rate 84.2 51.1 
Vaccine Preventable Diseases (all) – Incidence Rate 4.5 3.3 
Gonorrhea, Chlamydia and Infectious Syphilis Incidence Rate 340.9 447.7 
Viral Hepatitis Mortality Rate 3.5 2.5 
HIV/AIDS Mortality Rate 3.1 8.4 

17National Institutes of Health, National Institute of Allergy and Infectious Diseases, 2010 

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Maternal and Child Health 

Female Population of Childbearing Age 

The Florida Department of Health defines childbearing age for women to be between 15 and 44 years. Overall, despite 
having a generally younger population than the state average, Clay County has a slightly lower proportion of the 
population that are women of child-bearing age. The greatest differences are among Hispanics (Clay County has a lower 
rate than Florida) and, to a lesser degree, black residents. 

Figure 35: Female Population, Ages 15-44, by Race, 2004-2008 (rate per 1,000 population) 


Birth Rate 

The rate of live births (per 1,000 population) in Clay are comparable to the average(s) for Florida, among all 
races/ethnicities. The figure below illustrates the rates of live births among all women, white only, black only, and 
Hispanic women in both Clay County and Florida. 

Figure 36: Live Birth Rate, by Race, 2004-2008 


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Infant Mortality 

The infant mortality rate refers to those babies who die before their 1st birthday (0-364 days). Infant mortality is one of the 
most important indicators of the health of a nation, as it is associated with a variety of factors such as maternal health, 
quality and access to medical care, socioeconomic conditions, and public health practices. The recent stagnation (since 
2000) in the U.S. infant mortality rate has generated concern among researchers and policy makers.18 Though great strides 
have been made in reducing the State’s infant mortality rate, Florida’s rate is still above most states and other industrialized 
countries. The nonwhite fetal and infant mortality rate is twice the white rate in Florida.19 Clay County has seen an overall 
decline in infant deaths between 2003 and 2007, although there was a slight increase again during 2006-2008. 

It is important to note that while the rate of infant mortality among non-white mothers in Clay County is significantly 
higher (2.9 times higher) than among white mothers; the actual number of infant deaths among minority populations was 
much lower than among whites. During 2006-2008, a total of 14 infants died in Clay County. Of those, 9 were white, 3 
were black, and 2 were Hispanic. 

Figure 37: Infant Mortality Rates, All Races, 2003-2008 


Figure 38: Infant Mortality Rates, by Race, 2006-2008 


18U.S. Centers for Disease Control and Prevention (CDC),2010 
19Florida Healthy Start Program, 2010 

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Poor Birth Outcomes 

Maternal behaviors known to be related to poor birth outcomes include tobacco use, alcohol use, and failure to consume 
adequate folic acid through multivitamins or diet. Evidence suggests that successful interventions targeting these 
behaviors prior to pregnancy are associated with improved health of the woman and her infant. For example, tobacco 
use during pregnancy is associated with preterm birth, small size for gestational age, and low birth weight. Tobacco use 
also contributes to the occurrence of spontaneous abortion, stillbirth, fetal death, and sudden infant death syndrome. 

National studies indicate that as many as one in 10 women have had a poor birth outcome, and are candidates for 
interventions to improve maternal health during the interconception period (the period of time between pregnancies). 
Certain subgroups of women (i.e., black women, women whose most recent pregnancy was unintended, and those who 
had Medicaid coverage before pregnancy or at delivery) displayed higher rates of previous low birth weight and preterm 
deliveries. This finding underscores the need for preconception clinical and public health services and programs 
targeted towards subpopulations of women who are identified to be at risk for poor birth outcomes. 

Pre-Term Delivery 

Preterm birth (births at less than 37 completed weeks of gestation) is a key risk factor for infant death. The percentage of 
preterm births has increased rapidly in the United States in recent years. 

Low Birth Weight 

The most important predictor for infant survival is birthweight. A baby’s chance for survival increases exponentially as 
birthweight increases to its optimal level. The incidence of low birth weight (LBW), defined as less than 2,500 g ( less 
than 5 lb, 8 oz), remains a major public health concern in the United States. Because two-thirds of all infants who die in 
the U.S. begin their lives with LBW; the 1990 health objectives for the nation state that “low birthweight babies should 
constitute no more than five percent of all live births”. Evidence clearly supports the negative effects of cigarette 
smoking during pregnancy on birth weight, and shows a dose-response relationship between number of cigarettes 
smoked during pregnancy and a corresponding decline in birth weight.20 

20All information obtained from the U.S. Centers for Disease Control and Prevention (CDC),2010 

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Adolescent Births 

Babies born to young mothers under the age of 18 are more likely to experience poor birth outcomes than those born to 
mothers between the ages of 18 and 45. Birth outcomes are also closely tied to the education, economic outlook, and 
family relationships of the mother. Births to teenage mothers in Clay County showed a steady decrease from 2005-2008 
(Figure 38). There was a higher rate of births to non-white teenage mothers than white mothers in Clay County as shown 
in Figure 39. 

Figure 39: Births to Mothers Ages 15-19yrs, All Races, 2003-2008 


Figure 40: Births To Mothers Ages 15-19, by Race, 2006-2008 


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Social and Mental Health 

Domestic Violence 

Domestic violence is a widespread social problem that affects families on all socio-economic and demographic levels. 
Clay County showed an increase in domestic violence from 2008- 2009, as shown in Table 14. 

Table 9: Domestic Violence Offenses, 2009 

Total Total Domestic % Change Rate Per 100,000 Rate Change 
Area Population Violence Offenses 2008-2009^ Population 2008-2009^ 
Baker 25,899 42 -41.7 162.2 -41.7 
Bradford 29,085 165 -17.5 567.3 -17.6 
Clay 185,208 1,267 5.0 684.1 4.9 
Duval 900,518 7,879 9.9 874.9 10.4 
Nassau 72,588 449 19.4 618.6 18.3 
Florida 18,750,483 116,547 3.0 621.6 3.3 

Note:^ Percent changes in the number and should be interpreted with caution, due the fact that in small counties, a small increase in crime can 
produce a large percent change. Source: FDLE. Crime in Florida, Florida Uniform Crime Report, Florida Statistical Analysis Center, 2009 

Figure 41: Total Domestic Violence Offenses, All Races, 2003-2008 


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Suicide 

Suicide occurs when a person ends their own life; and is the 11th leading cause of death among Americans. But suicide 
deaths are only part of the problem. More people survive suicide attempts than actually die. Those who attempt suicide 
and survive may have serious injuries like broken bones, brain damage, or organ failure. Also, people who survive often 
have depression and other mental health problems.21 Clay County has shown a slow but steady decrease in total suicides 
(by rate per 100,000 population) since 2003, while the rate across all of Florida has remained relatively stable. Suicide 
tends to occur more frequently among white populations than non-white groups. In Clay County, there were a total of 24 
suicides among white residents during 2008, compared to only 1 among all non-white population groups combined. 

Figure 42: Suicide Mortality, All Races, 2003-2008 


Figure 43: Suicide Mortality, by Race, 2006-2008 


21U.S. Centers for Disease Control and Prevention (CDC),2010 

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Baker Act Referrals/Examinations 

In 1971, the Florida Legislature enacted the Florida Mental Health Act, a comprehensive revision of the state’s mental 
health commitment laws. The law is widely referred to as the “Baker Act” in honor of Maxine Baker, the former state 
representative who sponsored the Act. The Baker Act allows for involuntary examination (also sometimes referred to as 
emergency or involuntary commitment). It can be initiated by judges, law enforcement officials, physicians or mental 
health professionals only when there is evidence that the person has a mental illness and is a harm to self, harm to 
others, or self neglectful (as defined in the Baker Act). Examinations may last up to 72 hours and can occur in any of over 
100 Florida Department of Children and Families-designated receiving facilities statewide.22 

It is important to note that some individuals for whom forms were received were never actually admitted to the receiving 
facility because an examination by a physician or psychologist performed prior to admission determined they did not 
meet criteria. The data also do not include information on what occurred after the initial examination. The data does not 
reveal how long individuals stayed at the facility and whether they remained on an involuntary or voluntary basis.23 

In Clay County, Orange Park Medical Center is the only reported receiving facility for clients referred under the Baker Act. 
The chart below illustrates the total number of reported Involuntary (i.e. Baker Act) referrals for Clay County residents, as 
well as the number and percent of those that were received at Orange Park Medical Center. It is important to note that 
there are at least 8 designated Baker Act receiving facilities in neighboring Duval County, and that those Clay Residents 
who were not received at OPMC were likely transported into Jacksonville (Duval). 

Figure 44: Total Involuntary Examinations for Clay County Residents, 2002-2007 


Substance Abuse 

Data reported from the Florida Department of Children and Families (DCF), who administrate mental health and 
substance abuse programs for the state, is available on a regional level and therefore may not identify specific issues 
and trends within single county. Clay County is included in DCF Region 4, along with neighboring Duval and also Nassau 
County. Regional data indicate that at least 17,288 adults received substance abuse treatment between July 1, 2008 and 
June 30, 2009. An additional 6,235 children received treatment during the same time period. Annual reports also show 
that at least 26,188 adults were served with mental health services, along with 12,635 children during 2008-2009. 

22Florida Department of Children and Families, 2010 
23The Florida Mental Health Act (The Baker Act) Report, 2007 (prepared by the University of South Florida) 


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The Department reports that approximately 33% of adults and 30% of children with needs related to substance misuse 
and abuse ever seek treatment. Of those, only 31% of adults and 56% of children actually receive the needed services. 
There was an average of 1,300 adults and 200 children (statewide) on monthly waiting lists during the 2008-2009 fiscal 
year in Florida. Despite Florida’s status as the 4th larges state in population, Florida’s per-capita funding for mental health 
and substance abuse services is ranked 49th and 37th respectively in the nation.24 

The Florida Department of Law Enforcement (FDLE) also publishes a report annually of “Drugs Identified in Deceased 
Persons by Florida Medical Examiners.” The 2009 report shows that the most common drugs identified in Region 4 in 
deceased persons included (excluding ethyl alcohol): Alprazolam (more commonly known by the namebrand Xanax) 
(n=127), Cocaine (n=125), Hydrocodone (n=115), and Oxycodone (n=94).25 

Teen-age drinking and drug use is a growing concern in many counties throughout Florida, as well as the nation. In 2004, 
20% of all arrests in Clay County from drug offenses were among juveniles with comparison to 9% statewide. In addition, 
Clay County had a higher percentage of youth liquor law violations than Florida, with 22% of total arrests from juveniles 
compared to only 4% in the state. Table 15 summarizes the total arrests from drug and alcohol related offenses in Clay 
County and Florida for juveniles and adults. 

Table 10: Arrests by Offenses, 2004 

Offenses 
Juvenile Arrests Adult Arrests 
Total Arrested Number Percent Number Percent 

Clay County Offenses 

Drug Arrests 577 113 20% 464 80% 
Driving Under Influence (DUI) 295 3 1% 292 99% 
Liquor Law Violations 65 14 22% 51 78% 

Florida Offenses 

Drug Arrests 150,334 14,134 9% 136,200 91% 
Driving Under Influence (DUI) 55,805 480 0.1% 55,325 99% 
Liquor Law Violations 35,692 1,419 4% 34,273 96% 

Source: Office of the Sheriff, Clay County, Annual Arrests Report, 2004 
Florida Department of Law Enforcement, Crime in Florida, 2004 Florida Uniform Crime Report 

The Florida Youth Substance Abuse Survey (FYSAS) is an annual, statewide school-based survey effort that measures 
the prevalence of alcohol, tobacco and other drug use and delinquent behaviors as well as the risk and protective 
factors related to these behaviors. The 2008 FYSAS was administered to 3,935 Clay County students in grades 6 – 12 in 
the spring of 2008. 

Key findings revealed that alcohol continues to be the most commonly used drug among Clay County students. After 
alcohol, students reported cigarettes and marijuana as the most commonly used drugs. Prevalence rates for other drugs 
are substantially lower. 

While some of the findings compare favorably to the national findings, Clay County youth are still reporting drug use and 
delinquent behavior that will negatively affect their lives and our society. The FYSAS data will enable Clay County’s 
planners to learn which risk and protective factors to target for their prevention, intervention and treatment programs. 
A full copy of Clay’s report can be found at: http://www.hpcnef.org/files/health-needs-assesments/ClayCounty.pdf 

24All information obtained from the Florida Department of Children and Families, 2010 
25Drugs Identified in Deceased Persons by Florida Medical Examiners, 2009 Report, FDLE, 2010 

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Behavioral Risk Factor Surveillance Survey 

The Centers for Disease Control and Prevention began the Behavior Risk Factor Surveillance System Survey (BRFSS) in 
the early 1980’s in a handful of states and today, all states participate in the survey. BRFSS data have been widely used 
to monitor health behavior and health status at the state and national levels, however, due to small sample sizes, 
statewide BRFSS results cannot provide accurate and reliable data at the county level for public health program planning 
and evaluation. Therefore, with support from county health departments and other health agencies, the Florida Bureau of 
Epidemiology designed and implemented the county-level BRFSS in 2002 to provide data on behavioral risk factors and 
chronic disease conditions for each of Florida’s 67 counties. 

The 2007 county-level BRFSS is the first since the initial county-level effort in 2002. Over 39,000 interviews were 
completed in the 2007 calendar year, with a target sample size of 500 completed surveys in each county. Five counties 
also requested additional questions, including Clay, Collier, Duval, Monroe, and Orange. In addition, 2007 county-level 
questionnaires included all of the questions asked on a state level, unlike 2002 in which an abbreviated questionnaire 
was administered. 

The 2007 BRFSS provides counties and the state with a rich data source to estimate the prevalence of personal health 
behaviors that contribute to morbidity and mortality among adults in Florida. This report presents the survey data on a 
variety of issues related to health status, health care access, lifestyle, chronic illnesses, and disease prevention practice. 
Findings can also be used to: (1) prioritize health issues and identify populations at highest risk for illness, disability, and 
death; (2) plan and evaluate prevention programs; (3) educate the community and policy makers about disease 
prevention; (4) support community policies that promote health and prevent disease. 

A total of 530 surveys were completed from Clay County during 2007. A summary of the county’s BRFSS Report can be found 
on the Bureau of Epidemiology’s website at: www.doh.state.fl.us/Disease_ctrl/epi/BRFSS_Reports/BRFSS_Index_2007.htm 
The report compares Clay County to statewide findings, as well as provides a comparison to the county-level findings 
obtained in 2002. 

Some of the key findings identified from the BRFSS report include that 68.8% of all adults surveyed self-reported that 
they are either overweight or obese; which was found to be significantly higher (statistically) than the state average of 
62.1% of adults reporting the same condition(s). Findings also revealed that 10.6% of Clay County residents reported 
having a diagnosis from a medical professional of Diabetes, compared to 8.7% of residents statewide. The rate of 
diabetes diagnoses in Clay decreased significantly as reported income increased, with 15.5% of residents making under 
$25,000 per year indicating a diabetes diagnosis compared to 12.8% of those making between $25,000 and $50,000; 
and an even smaller 9.2% of persons making more than $50,000 per year. 

The survey also revealed key findings related to smoking and tobacco use, binge drinking, consumption of fruits and 
vegetables, physical activity levels, and health insurance coverage status. The Task Force members reviewed all of the 
relevant findings from the survey; and key findings were highlighted again during the prioritization of health issues for 
the county. 

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ACCESS TO CARE ACCESS TO CARE 
The general term “Access to Care” is ambiguous in that it does not clearly define what type of treatment (i.e. care) is 
needed; nor does it specify how access is determined or measured. The U.S. Health Resources and Services 
Administration (HRSA) states that “access to health care is generally related to the ability of individuals in a population 
group to obtain appropriate services to diagnose and treat health problems and symptoms.” The Administration further 
adds that a variety of factors can influence access to health care for an individual or family, including: availability of 
health insurance or means of paying for needed services, sufficient numbers of appropriate health professionals to serve 
all those needing services, and availability of appropriate health care organizations within reasonable travel times.1 For 
the purposes of this assessment, the term’s applied definition may be best summarized by the U.S. Army’s Medical 
Department, which defines Access to Care (ATC) as: “encompassing all of the necessary activities that will ensure our 
beneficiaries get to the right provider, at the right time, at the right place.”2 This section will review some of the commonly 
examined indicators for access to care, as well as the available local data related to them. 

Health Insurance Coverage 

Health insurance coverage, whether privately or publicly funded, is a primary factor in determining access to care for 
many people. Health insurance coverage may be obtained privately through an employer (the individual’s own or an 
immediate family member); or purchased independently. Many individuals also qualify for government subsidized or 
other publicly funded health coverage programs such as Medicare, Medicaid, Military and/or VA benefits, and others. 
These programs usually have specific eligibility requirements and are not available to everyone. Persons who are 
uninsured often include both full and part-time employees whose employers do not offer health insurance benefits, low-
income persons who do not qualify for Medicaid, early retirees, and numerous others who simply cannot afford the costly 
premiums of adequate coverage. Numerous studies have shown evidence that uninsured persons experience less 
positive medical outcomes than their insured counterparts; and are also less likely to have a regular source of primary 
care or seek preventive health services.3 

The 2004 Florida Health Insurance Study was funded by the State Planning Grant program of the U.S. Health Resources 
and Services Administration, with management at the state level from Florida’s Agency for Health Care Administration 
(AHCA). A research team at the University of Florida served as the prime contractor. Telephone interviews were 
conducted with 17,435 Florida households, collecting data for about 46,876 individuals, in the spring/summer of 2004. 
Unfortunately, funding has not been available for such an in-depth study since that time; and the data in the 2004 edition 
does not reflect new trends that have emerged as a result of the national economic downturn and associated job losses. 
For this reason, more current data was sought from additional sources. 

Responses from Clay County residents in the 2007 county-level BRFSS indicate that 88.7% of residents overall reported 
having some type of health insurance coverage at the time of the survey; compared to 81.4% statewide. This was 
considered to be a statistically significant difference from the state average. There were some specific differences in 
coverage noted among specific groups. For example, 91.2% of men reported having health insurance, compared to 
86.4% of women. Additionally, 91.5% of persons who had attended four or more years of college reported having 
coverage, compared to only 71.2% of persons with no formal education beyond high school. Similarly, 97.6% of persons 
making $50,000 or more per year had insurance, compared to only 70.8% among persons making less than $25,000. 

1U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), 2010 
2U.S. Army Medical Department, 2010 
3Cover the Uninsured, a National project of the Robert Wood Johnson Foundation, 2010 

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Data reported by the U.S. Census Bureau from the 2007 Small Area Health Insurance Estimates indicate that as many as 
22% of Clay County residents were uninsured at that time among all races, age groups, and genders. Additional data 
obtained and reported by the Florida Hospital Association (FHA) indicates that during 2006, at least 21.9% of Clay 
County residents between ages 18 and 64 were uninsured; with an additional 17.2% of minors under the age of 18 also 
being uninsured. Among seniors, the FHA reports at least 20.6% of Clay residents over the age of 65 were without health 
insurance during 2006. 

Florida’s Agency for Health Care Administration (AHCA) administers the Medicaid program for the state. The agency 
records and tracks various types of enrollment data, and many of these figures are available on their website at: 
http://ahca.myflorida.com/Medicaid/index.shtml. 

The table below shows the reported enrollments in Medicare, Medicare HMO, Medicaid, Medicaid HMO, and 
Commercial HMO insurance programs. Please note that significant numbers of insured residents are not reported 
because commercial insurance enrollment figures are not available and the number of employees covered by self 
insurance is unknown. 

Table 11: Health Insurance Coverage, Clay County and Florida, 2009 

Program Clay County Florida 
Medicare 25,332 (13.2%) 3,247,677 (17.1%) 
Medicare HMO 791 (0.4%) 750,336 (3.9%) 
Medicaid 19,740 (10.3%) 2,727,362 (14.3%) 
Medicaid HMO 3,314 (1.7%) 946,066 (5.0%) 
Commercial HMO 16,296 (8.5%) 1,573,347 (8.3%) 

Sources: Florida Medical Quality Assurance (FMQAI), AHCA, CMS, and ESRI population estimates, 2009 

As shown, Clay County has a lower percentage of residents enrolled in Medicare with comparison to the state, which is 
not surprising considering that persons over the age of 65 make up a smaller age group proportionally in the county 
when compared to the state as a whole. Clay County also has a lower Medicaid enrollment rate than the state overall. 
Commercial HMO enrollment typically reflects employer-sponsored coverage, and Clay County’s rate of coverage at 
8.5% is nearly equal the state’s overall rate of 8.3%. 

The median monthly Medicaid enrollment has increased in Clay County during recent years, while the rate across Florida 
as a whole has remained relatively stable. This trend is shown in figure 44 on the following page. 

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Figure 45: Median Monthly Medicaid Enrollment, Clay County and Florida, 2004-2008 

(Rate per 100,000 population)
Source: Florida Agency for Healthcare Administration (AHCA), 3/31/2010 

Coverage for Children 

Federal government provisions for children’s health coverage include Medicaid and Title XXI of the Social Security Act. 
In Florida, the KidCare Act of 1997 established eligibility requirements for coverage as well as created the Healthy Kids 
Program and the MediKids program for children ages 0-5. There are four general categories of children’s coverage in Florida: 

1. 
Medicaid covers children birth though 18 years, and eligibility is based on the age of child and household 
income. For example, children under age 1 are covered if the household income is below 200% of FPL; 
children aged 1-5 are covered if household income is less than 133% of FPL; and children aged 6 through 
18 are covered if household income is below 100% of FPL. 
2. 
MediKids covers children age 1 –5 whose income is between 133-200% of the federal poverty level. 
3. 
The Healthy Kids program provides medical coverage for children ages 5 up to 19 in households whose 
income is between 100 – 200% of the federal poverty level (FPL). 
4. 
Children’s Medical Services covers children from birth through 18 who have special behavioral or physical 
health needs or chronic medical conditions. 
The rate of KidCare enrollment per 100,000 children for each year between 2006 and 2008 are shown in the figure 
below, for both Clay County and Florida.4 

Figure 46: KidCare Enrollment (MediKids + Medicaid), Clay County and Florida, 2006-2008 

(Rate per 100,000 population) 
Source: Florida Agency for Healthcare Administration (AHCA), 3/31/10 

4Florida Agency for Healthcare Administration (AHCA), Florida KidCare program, 2010 

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Primary Care 

Primary Care Providers (PCP’s) give routine medical care for the prevention, diagnosis, and treatment of common 
medical conditions. Primary care is intended to be the entry point into the health care system for non-emergent 
services. PCP’s then refer patients requiring additional care to specialists for treatment. In this way, primary care 
providers often serve as “gatekeepers” for the health care system and play an important role in the coordination of care 
in today's managed care environment. The U.S. Health Resources and Services Administration (HRSA) considers 
general and family practitioners, internists, pediatricians, obstetricians and gynecologists, physician assistants, and 
nurse practitioners all as primary care providers. Additionally, public health nurses and school nurses provide primary 
care services to designated populations. 

Due to their central role in the health services system, a shortage of primary care providers can negatively impact the 
health of a community. For this reason, the Federal government has established specific criteria to determine whether 
an area has a shortage of providers; and also criteria to help determine whether a specific area is underserved. The 
HRSA Shortage Designation Branch is responsible for setting the criteria and ultimately deciding whether or not a 
geographic area, population group or facility is a Health Professional Shortage Area (HPSA) or a Medically 
Underserved Area or Population (MUA/MUP). Health Professional Shortage Areas (HPSA’s) may be designated as 
having a shortage of primary medical care, dental, or mental health providers. They may be urban or rural areas, 
population groups or specific medical or other public facilities. 

HRSA considers a primary care physician-to-population ratio of 1:3,500 persons adequate for most communities; 
except in areas where more than 20% of the population lives in poverty, where the ratio is increased to 3,000 persons 
per primary care physician. The primary care HPSA designation is also based on the availability of care in nearby 
areas, documented infant mortality rates, birth rates, and poverty level. The current Primary Care HPSA designations 
for Clay County include the town of Keystone Heights as well as low-income persons who live within the City of Green 
Cove Springs. 

Additionally, the federal administration defines Medically Underserved Areas (MUA’s) as a whole county or a group of 
contiguous counties in which residents have a shortage of personal health services; and Medically Underserved 
Populations (MUP’s) as groups of persons who face economic, cultural or linguistic barriers to health care. The current 
MUA/MUP designations for Clay County include only the Penney Farms Service Area (as defined by HRSA). 
Overall, Clay County has a significantly lower rate of licensed physicians when compared to the state as a whole 
(Figure 46). Among only Family Practice physicians there is a much smaller difference between the county and state 
rates (Figure 47); but when considering Internists only, Clay County has less than half the number of physicians per 
100,000 population than the state s a whole (Figure 48). 

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Figure 47: Total Licensed Physicians, Clay County and Florida, 2006-2009 

(Rate per 100,000 population)
Figure 48: Licensed Family Practice Physicians, Clay County and Florida, 2006-2009 

(Rate per 100,000 population)
Figure 49: Licensed Internist Physicians, Clay County and Florida, 2006-2009 

(Rate per 100,000 population) 
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The differences between the state and the county for the rates of OB/GYN physicians and Pediatricians are also shown in 
the figures below. 

It is important to note when looking at physician coverage rates in Clay County that the data reflects those physicians 
who list a Clay County address for their licensure, and does not account for many physicians who have a primary office 
location in neighboring metropolitan Jacksonville (with a corresponding Duval County address on file for their license) 
but who have satellite offices or otherwise provide services in Clay County. 

Figure 50: Licensed Pediatricians, Clay County and Florida, 2006-2009 

(Rate per 100,000 population)
Figure 51: Licensed Obstetric/Gynecology Physicians, Clay County and Florida, 2006-2009 

(Rate per 100,000 population) 
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Health Care Facilities 

Acute Care 

Acute care hospitals play a key role in the delivery of health care services, especially in more rural communities where 
primary and specialist outpatient care shortages may exist. In addition to providing traditional inpatient services, 
hospitals may also provide extensive diagnostic and treatment services on an outpatient basis. 

Overall, Clay County has a lower rate of available hospital beds when compared to Florida as a whole (Figure 51). This is 
especially true for acute care beds (Figure 52). The county does, however, have a higher rate of specialty hospital beds 
when compared to the rest of the state (Figure 53). 

Figure 52: Total Hospital Beds (All Facilities), Clay County and Florida, 2006-2008 

(Rate per 100,000 population)
Figure 53: Acute Care Hospital Beds (All Facilities), Clay County and Florida, 2006-2008 

(Rate per 100,000 population) 
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Figure 54: Specialty Hospital Beds (All Facilities), Clay County and Florida, 2006-2008 

(Rate per 100,000 population) 
Orange Park Medical Center is the primary hospital for Clay County, and provides a full range of medical, surgical, 
diagnostic, and emergency room services to residents. The hospital currently has 255 licensed beds including 224 acute 
care beds, 24 adult psychiatric beds, and 7 neonatal intensive care unit (NICU – Level 2) beds. The facility currently 
provides Level 1 adult cardiovascular services and hosts a primary stroke center. Construction is also underway for 
multiple planned expansions at the time of publication of this report, including a full cardiac surgery suite and additional 
Emergency Department rooms. More information about the hospital, available services, and planned expansions can be 
found on the company’s website at: www.OPMedical.com 

The table below provides a general inventory of available services within Orange Park Medical Center (OPMC) along 
with the hospitals in neighboring Baker and Duval Counties. 

Table 12: Acute Care Hospital Inventory of Services, 2009 


Note: *HBSNU = Hospital Based Skilled Nursing Unit 
Source: Health Planning Council of Northeast Florida, Inc. monthly hospital data report. 


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The figure below shows at which hospitals residents of Clay County sought care during the 2009 calendar year. The 
numbers were obtained from the reported zip code of residence when patients were admitted to each hospital; and are 
reflected as a percent of the total number of persons from Clay County who were admitted as inpatients (at any hospital) 
during the same time period. As shown, just over half of Clay Residents who entered a hospital utilized OPMC. An 
additional 20% of residents traveled to either St. Vincent’s Medical Center or Baptist Medical Center, both located in 
downtown Jacksonville. A total of 9% of Clay residents utilized hospitals outside of the immediate service area, which 
may occur while residents are traveling and/or working out of town. 

Figure 55: Hospital Admissions of Clay County residents, January-December 2009 

NORTH FLORIDA REGIONAL 
MEDICAL CENTER 
2% 
MAYO CLINIC 
2% 
BAPTIST MEDICAL 
CENTER SOUTH 
3% 
SHANDS HOSPITAL AT 
THE UNIV. OF FLORIDA 
3% 
SHANDS JACKSONVILLE 
MEDICAL CENTER 
4% 
MEMORIAL HOSPITAL 
JACKSONVILLE 
4% BAPTIST MEDICAL CENTER 
9% 
ALL OTHERS 
9% 
ORANGE PARK 
MEDICAL CENTER 
53% 
SAINT VINCENT’S 
MEDICAL CENTER 
11% 
Source: HPCNEF Patient Origin Study, 2009 

The purpose or reason for a hospital admission can often be determined by the primary diagnosis code documented at 
the time of the patient’s discharge from the hospital. Hospitals code within Diagnosis Related Groups (DRG’s) as a 
standard for documentation and billing purposes. 

The most frequent DRG recorded for Clay County Adults (at any hospital) was normal births/deliveries, accounting for 
nearly 20% of the top twelve DRG’s during 2009. Psychoses, which may represent a variety of unspecified mental health 
conditions, were the second most common reason for hospital admissions, accounting for 18% of the top twelve. Other 
leading causes for admission included joint replacements, Cesarean deliveries, digestive disorders, urinary system 
disorders, cardiovascular problems, infections, and pneumonia. The twelve most common DRG’s reported on discharge 
for Clay residents are listed in Table 13 on the following page. 

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Table 13: Top 12 Hospital Discharges, by DRG, Clay County Adults, 2009 

DRG Definition Discharges % of Top 12 
775 Vaginal delivery without complications 1,055 19.5% 
885 Psychoses 974 18.0% 
470 Major joint replacement or reattachment of lower extremity 521 9.6% 
766 Cesarean section without complications 480 8.9% 
392 Esophagitis, gastroenteritis & misc digest disorders 437 8.1% 
743 Uterine & adnexa procedure for non-malignancy 377 7.0% 
313 Chest pain 310 5.7% 
871 Septicemia (i.e. blood infections) 287 5.3% 
287 Circulatory disorders (except AMI), w cardiac catheterization 269 5.0% 
194 Simple pneumonia & pleurisy 239 4.4% 
690 Kidney & urinary tract infections 233 4.3% 
310 Cardiac arrhythmia & conduction disorders 220 4.1% 
Total Top 12 DRGs 5,402 100.0% 

Source: AHCA Hospital Discharge Data Files, 2009 

Among Clay’s youth (ages 0-17 years), birth is the leading cause for hospitalization, with most (60.6% of the top 12 
DRG’s) births being documented as normal newborns. Many newborn infants, however, are retained in the hospital with 
significant problems. Other reasons for admission among youth included phychoses and neuroses, bronchitis and 
asthma, and for chemotherapy. The 12 most frequent DRG’s reported for Clay’s youth are shown in the table below. 

Table 14: Top 12 Hospital Discharges, by DRG, Clay County Pediatric Patients, 2009 

DRG Definition Discharges % of Top 12 
795 Normal newborn 1,390 60.6% 
794 Neonate with other significant problems 384 16.7% 
792 Prematurity without major problems 101 4.4% 
793 Full term neonate with major problems 93 4.1% 
885 Psychoses 54 2.4% 
775 Vaginal delivery without complications 48 2.1% 
882 Neuroses, except depressive 44 1.9% 
791 Prematurity with major problems 42 1.8% 
789 Neonates, died or transferred to another acute care facility 38 1.7% 
847 Chemotherapy (without acute leukemia as secondary diagnosis) 36 1.6% 
790 Extreme immaturity or respiratory distress syndrome, neonate 35 1.5% 
203 Bronchitis & asthma 29 1.3% 
Total Top 12 DRGs 2,294 100.0% 
Source: AHCA Hospital Discharge Data Files, 2009 

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Emergency Room Care 

Local hospital Emergency Room (ER) utilization rates can be an indicator of the availability and accessibility of health 
care services within an area. Many ER visits are preventable, or involve conditions that may be more appropriately cared 
for in a primary care setting. Many ER visits are appropriate, however, and some of those do not necessarily result in 
hospital admissions. 

Figure 55 below illustrates the growing number of emergency room visits to Orange Park Medical Center during 20002009. 
The number of ER visits has increased by at least 75% during the past 9 years. 

Figure 56: Orange Park Medical Center Emergency Room Visits, 2000-2009 


Source: AHCA Discharge Hospital Data, 2009 

During 2000-2009, an average of 73% of Emergency Room visits at OPMC resulted in an inpatient admission. During 
only 2009, a total of 75% if persons treated in the ER were admitted. The figure below shows the total number of ER visits 
during each year, along with the corresponding number of inpatient admissions from the ER. 

Figure 57: Orange Park Medical Center ER Visits Resulting in Inpatient Admissions, 2000-2009 


Source: AHCA Discharge Hospital Data, Calendar Year 2009 

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Hospital data submitted to AHCA regarding the primary diagnosis at discharge from the ER (regardless of whether 
released or admitted as inpatient) provides the top ten reasons for emergency room visits among Clay County residents. 
The table below displays the top ten diagnoses among Clay adults by which hospital they visited, with the corresponding 
number of visits associated with each during July 2008-June 2009. 

Table 15: Top Emergency Room Diagnoses (regardless of admission status), Clay County Adults 

PRIMARY ORANGE PARK BAPTIST BAPTIST ST. VINCENT’S SHANDS ALL 
DIAGNOSIS DEFINITION PATIENTS MEDICAL MEDICAL MEDICAL MEDICAL AT OTHER 
CODE CENTER CENTER CENTER SOUTH CENTER STARKE HOPSITALS 
786.59 Other chest pain 1,072 750 79 94 40 21 88 
784.0 Headache 787 487 47 37 53 67 96 
599.0 Urinary tract infection 750 541 11 21 29 45 103 
847.0 Neck sprain 720 512 26 42 37 29 74 
789.09 Abdominal pain 681 489 21 75 20 15 61 
724.2 Lumbago 619 360 31 16 39 91 82 
786.50 Unspecified chest pain 603 328 47 9 45 62 112 
644.03 Threatened premature 
labor antepartum 538 507 31 
466.0 Acute bronchitis 525 410 12 10 18 33 42 
789.00 Abdominal pain 
-unspecified site 521 278 42 5 42 86 68 
646.83 Other specified antepartum 
complications 506 445 13 1 8 18 21 
682.6 Cellulitis and abscess 
of leg (except foot) 469 307 9 13 20 66 54 
TOP 25 TOTAL 7,791 5,414 338 323 20 533 832 

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Long-Term Care 

Long-term care is defined by HRSA as "those services designed to provide diagnostic, preventive, therapeutic, 
rehabilitative, supportive, and maintenance services for individuals who have chronic physical and/or mental 
impairments, in a variety of settings ranging from home to institutional settings, to ensure the quality of life." 

Kindred Hospital North Florida is a long term care hospital located in Green Cove Springs that offers a full range of 
services for catastrophically ill patients. As a regional referral center, the hospital specializes in managing medically 
complex, resource-intensive patients who require extended lengths of stay, Kindred Hospital delivers nearly all levels of 
care including intensive care. Specialized services offered include pulmonary services, critical care, renal dialysis, 
cardiac telemetry, blood bank, laboratory, pharmacy, EKG, radiology, nutritional support, surgery, would care, 
rehabilitative therapies, outpatient GI services, and comprehensive ultrasound. The facility houses 80 long term care 
beds. More information about Kindred Hospital North Florida can be found on their website: www.khnorthflorida.com 
The number of admissions to Kindred Hospital has increased steadily since 2000, as shown in Figure 57. 

Figure 58: Total Admissions, Kindred Hospital – North Florida, 2000-2009 


Long-term care also includes nursing home care. Medicaid is the primary funding source of nursing home care, paying 
for more than half (57.7%) of all nursing home days in Clay County. Medicaid typically pays for long-term care; while 
Medicare covers short-term care following hospital discharge. Many nursing homes limit the number of dedicated 
Medicaid beds in their facilities in order to control the number of low-reimbursing, long-term Medicaid patients admitted. 

There are nine free standing nursing homes in Clay County. The rate of available nursing home beds (per 100,000 
population) is higher than the state average, as shown in the figure below. 

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Figure 59: Total Nursing Home Beds, Clay County and Florida, 2006-2008 

The table below summarizes the number of nursing home beds, average occupancy rates, and percent of days covered 
by both Medicaid and Medicare for Clay County’s free standing nursing homes. 

Table 16: Free Standing Community Nursing Homes, 2009 
Facility Name Total 2009 2005 Occupancy Medicaid % Medicare % 
Beds Total Total Rate 2009 2009 2009 
(Rate per 100,000 population) 
Consulate Health Care of Orange Park 120 38,211 40,044 87.2% 63.2% 17.7% 
Doctors Lake of Orange Park 120 39,759 37,719 90.8% 74.7% 9.3% 
Governor’s Creek Health and Rehabilitation 120 41,375 42,345 94.5% 80.5% 9.7% 
Heartland Health Care Center - Orange Park 120 39,108 36,780 89.3% 54.8% 18.2% 
Life Care Center at Wells Crossing 120 38,489 40,088 87.9% 38.6% 41.3% 
Life Care Center of Orange Park 180 61,589 63,122 93.7% 47.5% 33.0% 
The Pavilion For Health Care 40 12,482 13,081 85.5% 0.0% 0.0% 
Signature Healthcare of Orange Park 105 35,765 34,102 93.3% 72.0% 18.9% 
The Terrace at Fleming Island 108 38,697 25,645 98.2% 54.3% 17.8% 
Clay County Total 1,033 345,475 332,926 91.6% 57.7% 20.7% 

Source: HPCNEF Calendar Year Nursing Home Reports, 2009 

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Mental Health and Substance Abuse 

Clay County has a slightly lower rate of available adult psychiatric beds when compared to the state as a whole. 
Orange Park Medical Center has 24 licensed adult psychiatric beds within its facility, and is a receiving center for 
involuntary referrals initiated under the Florida Mental Health Act, more commonly referred to as the Baker Act. 

Figure 60: Adult Psychiatric Beds, Clay County and Florida, 2006-2008 

(Rate per 100,000 population) 
Clay Behavioral Health Center offers outpatient services for both adults and children dealing with mental health and/or 
substance misuse/abuse problems. The center is located in Middleburg and offers a full range of services including 
individual and group counseling, dual diagnosis services, case management, prevention services, intervention groups, 
emergency services and skills groups, family support, in-home and school-based counseling, a student assistance 
program (SAP), supported housing, a drop-in center, and referral services for detoxification as well as short and long 
term residential treatment. 

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LOCAL PUBLIC HEALTH 
SYSTEM ASSESSMENT 
LOCAL PUBLIC HEALTH 
SYSTEM ASSESSMENT 
The National Public Health Performance Standards Program (NPHPSP) was developed by the U.S. Department of Health 
and Human Services (DHHS) to provide measurable performance standards that public health systems can use to 
ensure the delivery of public health services. The DHHS defines the Local Public Health System to include all public, 
private, and voluntary entities, as well as individuals and informal associations that contribute to the delivery of public 
health services within a jurisdiction. 

The Local Public Health System Performance Assessment Instrument was principally developed by the National 
Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC). 
The 10 Essential Public Health Services provide the fundamental framework for the NPHPSP instruments, by describing 
the public health activities that should be undertaken in all communities. The Core Public Health Functions Steering 
Committee developed the framework for the Essential Services in 1994. The Local Assessment Instrument is divided into 
ten sections – one for each Essential Service. The 10 Essential Public Health Services are: 

1. Monitor health status to identify community health problems. 
2. Diagnose and investigate health problems and health hazards in the community. 
3. Inform, educate, and empower people about health issues. 
4. Mobilize community partnerships to identify and solve health problems. 
5. Develop policies and plans that support individual and community health efforts. 
6. Enforce laws and regulations that protect health and ensure safety. 
7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 
8. Assure a competent public and personal health care workforce. 
9. Evaluate effectiveness, accessibility and quality of personal and population-based health services. 
10. Research for new insights and innovative solutions to health problems. 
Local public health agencies (i.e. county health departments) are the natural leaders in the development of a cohesive 
local public health system. Local public health agencies have unique responsibilities to enable, assure, and enforce the 
provision of these essential services by entities within the local public health system. They assure an adequate statutory 
base for local public health activities, advocate with system partners for local policy changes to improve health, and 
assure that funding for public services meet the critical health needs of their populations. In addition, local public health 
agencies provide important leadership in maintaining and improving the performance and capacity of local public health 
systems to provide appropriate public health services.1 

The Clay County Health Assessment Task Force members reviewed and discussed each of the ten essential services 
and activities related to each occurring in Clay County. The members scored each service category by consensus, 
utilizing the recommended scoring levels provided by DHHS in the assessment instrument. The scoring methodology 
reflects a quartile scoring system in that activities that occur 0-25% of the time are considered with a “no” response; 
those that occur 26-50% of the time receive a “low partial” response; those that occur 51-75% of the time are considered 
as “high partial”; and those that occur 76-100% of the time are given a “yes” response. 

1U.S. Department of Health and Human Services, National Public Health Performance Standards Program 

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LOCAL PUBLIC HEALTH 
SYSTEM ASSESSMENT 
LOCAL PUBLIC HEALTH 
SYSTEM ASSESSMENT 
The table below provides the overall score for each of the ten essential services, as determined by the Taskforce 
members during a face-to-face meeting in February 2010. It is important to remember that these scores consider the 
county’s complete public health/safety-net services system and are not limited to only those activities performed directly 
by the county health department. 

Table 17: Local Public Health System Performance Assessment Summary, 2010 

Essential Public Health Service Community Response 
1. Monitor Community Health Status Yes 
2. Diagnose and Investigate Health Problems/Hazards Yes 
3. Inform, Educate, and Empower Communities Low Partial 
4. Mobilize Community Partnerships High Partial 
5. Develop Policies/Plans to Support Health Initiatives Low Partial 
6. Enforce Health Laws and Regulations Yes 
7. Link to Needed Health Services and Assure the Provision of 
Healthcare When Otherwise Unavailable No 
8. Assure a Competent Healthcare Workforce High Partial 
9. Evaluate Effectiveness, Accessibility, and Quality of Services High Partial 
10. Conduct Research / Identify Innovative Solutions High Partial 

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FORCES OF CHANGE 
ASSESSMENT 
FORCES OF CHANGE 
ASSESSMENT 
The Forces of Change assessment is intended to gain information and feedback from community representatives 
regarding current and anticipated trends, factors, and events that may impact the health of the community. The 
assessment generates responses to two primary questions: 

1. What is occurring or might occur that affects the health of our community or the local public health system? 
2. What specific threats or opportunities are generated by these occurrences? 
The Clay County Health Assessment Task Force members considered and discussed forces by three major types: 

• Trends are patterns over time such as disease/mortality rates, patient migration patterns, or cultural changes that 
influence consumers attitudes, behaviors, and beliefs related to health; 
• Factors are discrete elements of information such as population demographic data, geographic features within the 
community, existing policies, or capacity of available resources; and 
• Events are singe occurrences such as the opening or closure of a clinic site or hospital, a natural disaster, pandemic, 
or the passage of new legislation. 
The members were encouraged to consider a variety of perspectives when identifying potential forces. Specific types of 
forces discussed by the taskforce included: 

• Social forces such as population demographics, cultural norms, and violence/crime/safety 
• Economic forces such as changes in employment/income, program funding levels, and the stability of industry and 
trade within the region 
• Government/Political forces such as policy/legislation, budgeting, and advocacy 
• Community generated forces such as community initiatives and mobilization efforts 
• Environmental forces such as development, zoning and land use, transportation, and disaster planning 
• Educational forces occurring within public schools, colleges/universities, and adult education programs 
• Science/Technology forces such as healthcare advances, information technology, and communications 
• Ethical/Legal forces such as privacy and end of life issues 
The anticipated forces of change identified by the Task Force members, along with the potential impacts (both positive 
and negative) are included in the tables on the following pages. 

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ANTICIPATED FORCES OF CHANGETRENDS FACTORS EVENTS 
Social Increasing number of un-insured needing care Very limited services for homeless 
Florida Medicaid Reform - shifting populationsinto a managed care environmentIncreasing aged/elderly population 
Rural families may independently care foreldersin home, sometimes not recognizing escalatinghealth issues - and not accessing needed careIncreasing adult OP mental health needs -
related to increased stress 
Rural residents tend to be more self-reliantandpotentially less likely to access neededservices 
Increasing number of homeless - both new andmigrating from Duval due to increase violenceDecreasing number of migrant farm workersEconomic 
Increasing number of unemployed and low-
income 
Florida was one of the hardest hit states by theNational recession, and will likely take longerthan other states to recover 
Passage of the Federal "ARRA" stimulus act -
ultimately bringing HIT/HIE funds to Florida(among other programs) 
Decreasing funding and resources 
Florida still has among the highestunemploymentand foreclosure rates in the country 
Government/ 
Decreasing funding/resources 
Limited or no funding for prevention and/orhealth promotion programs 
Pending legislation regarding reorganizationof FL DOH and limitation to core servicesPolitical 
Increasing reporting/data requirements 
Low reimbursement to primary care providersamong federal programs (Medicare/Medicaid) 
Pending expansion of the FL Medicaid Reformpilot project and impacts on CHD CBR andservices.
Passage of US Healthcare Reform bill andunknownpotential impacts on residents and providersPotential changes in reimbursement tohospitalsand nursing homes / skilled nursing facilitiesPotential ending of FL Medicaid diseasemgmntservices contract and a change in thoseservices 
FORCES OF CHANGE ASSESSMENT 
CONTINUED 
ANTICIPATED FORCES OF CHANGETRENDS FACTORS EVENTS 
Social Increasing number of un-insured needing care Very limited services for homeless 
Florida Medicaid Reform - shifting populationsinto a managed care environmentIncreasing aged/elderly population 
Rural families may independently care foreldersin home, sometimes not recognizing escalatinghealth issues - and not accessing needed careIncreasing adult OP mental health needs -
related to increased stress 
Rural residents tend to be more self-reliantandpotentially less likely to access neededservices 
Increasing number of homeless - both new andmigrating from Duval due to increase violenceDecreasing number of migrant farm workersEconomic 
Increasing number of unemployed and low-
income 
Florida was one of the hardest hit states by theNational recession, and will likely take longerthan other states to recover 
Passage of the Federal "ARRA" stimulus act -
ultimately bringing HIT/HIE funds to Florida(among other programs) 
Decreasing funding and resources 
Florida still has among the highestunemploymentand foreclosure rates in the country 
Government/ 
Decreasing funding/resources 
Limited or no funding for prevention and/orhealth promotion programs 
Pending legislation regarding reorganizationof FL DOH and limitation to core servicesPolitical 
Increasing reporting/data requirements 
Low reimbursement to primary care providersamong federal programs (Medicare/Medicaid) 
Pending expansion of the FL Medicaid Reformpilot project and impacts on CHD CBR andservices.
Passage of US Healthcare Reform bill andunknownpotential impacts on residents and providersPotential changes in reimbursement tohospitalsand nursing homes / skilled nursing facilitiesPotential ending of FL Medicaid diseasemgmntservices contract and a change in thoseservices 
FORCES OF CHANGE ASSESSMENT 
CONTINUED 
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ANTICIPATED FORCES OF CHANGETRENDS FACTORS EVENTS 
Community Decreasing number of primary care providers Reduction of DCF offices and field staff 
Potential budget shortfall at both State andCountylevel forcing agencies to prioritize servicesIncreasing need for servicecoordination/linkage 
Strong desire/will among residents andagenciesto help and/or serve in the community 
Opening of new dental clinic in GCSIncreasing focus on crime and safety issues 
A relatively large number of communitycoalitions 
Noro-virus event at elementary schoolEnvironmental 
Increased focus on disaster/emergencyplanning 
County is large and cities/town are spread out New hospital in west Duval in next 2-5 yrsIncreasing number of empty structures - placeswhere various "bad" things occur (i.e.
drugs/sex) 
More rural counties, by nature, do not havethepopulation base to justify independentprograms 
Development of Brannan Field corridorIncreasing awareness among urban plannersrelating physical environment to healthoutcomes 
Large areas of green space, waterways andrichnatural resourcesLimited transportation options amongresidents 
Educational 
Increasing reliance among families on schoolmeals as a primary source of nutrition for kids 
School meals (low nutritional value) New national campaign to battle child obesityIncreasing emphasis on standardized testinganddecreased emphasis on physical education 
Limited time for physical activity for K-12 
Potential change in teacher pay structure torelyon standardized test scores 
Science/ 
Increasing efforts to exchange critical healthinfo. 
OPMC is working to increase HIE with nursinghomes and other facilities 
Open heart surgery suite opening 12/10Technology Increasing resources for resident to accessimportant health information (web, PHR's, etc.) 
2 new cardiac cath. Labs coming to OPMCOPMC applied for L2 Trauma Center andplans todouble size of ER during summer 2010Passage of ARRA bill and significant fundingtoFL to support HIT/HIE development statewideEthical/Legal 
Increasing aging population facing endof life issues 
County is well supported with nursing homes,
ALF's, and planned adult/retirementcommunities 
Potential coverage for end of life counseling infederal health reform packageIncreasing monitoring and identification offraud/abuse among payers of health services 
FORCES OF CHANGE ASSESSMENT 
CONTINUED 
ANTICIPATED FORCES OF CHANGETRENDS FACTORS EVENTS 
Community Decreasing number of primary care providers Reduction of DCF offices and field staff 
Potential budget shortfall at both State andCountylevel forcing agencies to prioritize servicesIncreasing need for servicecoordination/linkage 
Strong desire/will among residents andagenciesto help and/or serve in the community 
Opening of new dental clinic in GCSIncreasing focus on crime and safety issues 
A relatively large number of communitycoalitions 
Noro-virus event at elementary schoolEnvironmental 
Increased focus on disaster/emergencyplanning 
County is large and cities/town are spread out New hospital in west Duval in next 2-5 yrsIncreasing number of empty structures - placeswhere various "bad" things occur (i.e.
drugs/sex) 
More rural counties, by nature, do not havethepopulation base to justify independentprograms 
Development of Brannan Field corridorIncreasing awareness among urban plannersrelating physical environment to healthoutcomes 
Large areas of green space, waterways andrichnatural resourcesLimited transportation options amongresidents 
Educational 
Increasing reliance among families on schoolmeals as a primary source of nutrition for kids 
School meals (low nutritional value) New national campaign to battle child obesityIncreasing emphasis on standardized testinganddecreased emphasis on physical education 
Limited time for physical activity for K-12 
Potential change in teacher pay structure torelyon standardized test scores 
Science/ 
Increasing efforts to exchange critical healthinfo. 
OPMC is working to increase HIE with nursinghomes and other facilities 
Open heart surgery suite opening 12/10Technology Increasing resources for resident to accessimportant health information (web, PHR's, etc.) 
2 new cardiac cath. Labs coming to OPMCOPMC applied for L2 Trauma Center andplans todouble size of ER during summer 2010Passage of ARRA bill and significant fundingtoFL to support HIT/HIE development statewideEthical/Legal 
Increasing aging population facing endof life issues 
County is well supported with nursing homes,
ALF's, and planned adult/retirementcommunities 
Potential coverage for end of life counseling infederal health reform packageIncreasing monitoring and identification offraud/abuse among payers of health services 
FORCES OF CHANGE ASSESSMENT 
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 POTENTIAL IMPACTSFORCES 
THREATS OPPORTUNITIESTRENDSIncreasing numbers of unemployed / uninsured / low-
income 
Increased demand on an already strained safety-netIncreasing older/aged population Increase utilization/cost to the healthcare system Potential to better address end of life issues 
Increase strain on families to provide adequate careIncreasing adult mental health needs - related to stress Potential to exceed the capacity of existing servicesIncreasing numbers of homeless, both new and migrating Potential to exceed the capacity of existing servicesDecreasing number of migrant/seasonal farm workers More difficulty accessing this tight-knit population Potential to shift resources to other areas of need 
Decreasing funding and resources from all levels 
Decreased/eliminated ability to provide neededservices 
Emphasis on prioritization and collaborationIncreasing data collection/reporting and admin.
requirements 
Shifting resources from direct services to adminneeds 
Decreasing numbers of primary care providers Decreased resident access to medical homesIncreasing community focus on crime and safety issues Increased focus on safe environments to exerciseIncreased focus on disaster/emergency planning 
Increased opportunities to engage a wider scope ofstakeholders and community partnersIncreasing number of empty structures/buildings Hidden spaces suitable for drug and sex activitiesIncreasing awareness among urban planners relatingphysician environment to health outcomes 
Potential for increased coordination betweendevelopers and community healthIncreasing reliance among families on school mealsfor the majority of children’s' nutritionIncreasing emphasis on standardized testing in schools,
especially related to teacher pay 
Potential loss of good teachers in areas whereneeded 
Decreasing emphasis on physical education in schools Increased impact of child obesityIncreasing national/regional/local efforts to capture andexchange client-level health information and records 
High costs and potential for lack of coordination Potential for increased care coordination and qualityChanging reimbursement methodologies for hospitals andother healthcare facilities 
Reduced revenues resulting in reduces services Potential for higher quality services to prevent lossIncreasing monitoring and identification of healthcareprovider fraud and abuse 
Potential reduction in number(s) of providers Decreased costs 
FORCES OF CHANGE ASSESSMENT 
CONTINUED 
POTENTIAL IMPACTSFORCES 
THREATS OPPORTUNITIESTRENDSIncreasing numbers of unemployed / uninsured / low-
income 
Increased demand on an already strained safety-netIncreasing older/aged population Increase utilization/cost to the healthcare system Potential to better address end of life issues 
Increase strain on families to provide adequate careIncreasing adult mental health needs - related to stress Potential to exceed the capacity of existing servicesIncreasing numbers of homeless, both new and migrating Potential to exceed the capacity of existing servicesDecreasing number of migrant/seasonal farm workers More difficulty accessing this tight-knit population Potential to shift resources to other areas of need 
Decreasing funding and resources from all levels 
Decreased/eliminated ability to provide neededservices 
Emphasis on prioritization and collaborationIncreasing data collection/reporting and admin.
requirements 
Shifting resources from direct services to adminneeds 
Decreasing numbers of primary care providers Decreased resident access to medical homesIncreasing community focus on crime and safety issues Increased focus on safe environments to exerciseIncreased focus on disaster/emergency planning 
Increased opportunities to engage a wider scope ofstakeholders and community partnersIncreasing number of empty structures/buildings Hidden spaces suitable for drug and sex activitiesIncreasing awareness among urban planners relatingphysician environment to health outcomes 
Potential for increased coordination betweendevelopers and community healthIncreasing reliance among families on school mealsfor the majority of children’s' nutritionIncreasing emphasis on standardized testing in schools,
especially related to teacher pay 
Potential loss of good teachers in areas whereneeded 
Decreasing emphasis on physical education in schools Increased impact of child obesityIncreasing national/regional/local efforts to capture andexchange client-level health information and records 
High costs and potential for lack of coordination Potential for increased care coordination and qualityChanging reimbursement methodologies for hospitals andother healthcare facilities 
Reduced revenues resulting in reduces services Potential for higher quality services to prevent lossIncreasing monitoring and identification of healthcareprovider fraud and abuse 
Potential reduction in number(s) of providers Decreased costs 
FORCES OF CHANGE ASSESSMENT 
CONTINUED 
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POTENTIAL IMPACTSFORCES 
THREATS OPPORTUNITIESFACTORSRural populations tend to be more self-reliant and often donot access needed healthcare services for selves/family 
Potential for unidentified and untreated healthconditions that become severe before care is sought 
Potential target audience for structured healthpromotion, screening, and wellness educationFlorida particularly hard hit by economic recession Longer and slower recovery periodLimited/non-existent funding and resources focused onhealthy lifestyles and illness preventionLarge budget shortfalls and state and local level Reduced revenues for all services 
Increased need and willingness for collaboration,
coordination, and prioritization among agenciesLow reimbursement rates to primary care providers Decreased number of providersCounty is large and cities/towns are spread out Transportation hardships for residents More emphasis on localized community services 
Difficult to fund/implement individual communityprograms due to small population baseLarge green spaces, natural waterways, and rich resources Potential for development and revision of land-uses Large recreational areas for physical activity 
EVENTSFlorida Medicaid Reform pilot began in Clay in 2007 - andhas potential to expand to 19-27 addt'l counties during2010-11.
- Potential impact on health dept. reimbursement- Potential hardship on vulnerable clients shifting intomanaged care structures 
Decreased or eliminated ability among healthdepartments to care for uninsured clients and/orprovide needed wrap-around services in theircommunities 
Potential for public health to work more closely withmanaged care companies, and to advocate forincreased emphasis and services where needed.
Potential DOH reorganization bill 
Significant reduction in community health activitiesamong county health departments and DOH overall 
Increased need for community-based supportPassage of US Healthcare Reform legislation Increased demand for services for newly insured Improved access to health services for many 
Passage of US "ARRA" stimulus package - including $42.5Billion in funding to promote health IT and exchange 
Still limited financial resources to assist individualproviders, and EMR systems are VERY expensive 
Increased regional collaborative efforts to promoteEMR adoption, support, and information exchangeChanging FL Medicaid chronic disease managementcontract 
Potential for break in services for some beneficiaries DOH may shift chronic disease management to CHD'sOpening of new dental clinic in Green Cove Springs Sustainability Increased provision of needed services to adultsNew cardiac catheterization labs at OPMC Increased capacity to provide this service locallyNew open heart surgery suite at OPMC (coming) Increased capacity to provide this service locallyPotential upgrade to Level II Trauma center and increasedcapacity of OPMC Emergency Department (this summer) 
Significantly increased ability to provide critical careNew west Duval hospital opening in 2-5 yrsNational campaign against child obesity Increase awareness among communities 
FORCES OF CHANGE ASSESSMENT 
CONTINUED 
POTENTIAL IMPACTSFORCES 
THREATS OPPORTUNITIESFACTORSRural populations tend to be more self-reliant and often donot access needed healthcare services for selves/family 
Potential for unidentified and untreated healthconditions that become severe before care is sought 
Potential target audience for structured healthpromotion, screening, and wellness educationFlorida particularly hard hit by economic recession Longer and slower recovery periodLimited/non-existent funding and resources focused onhealthy lifestyles and illness preventionLarge budget shortfalls and state and local level Reduced revenues for all services 
Increased need and willingness for collaboration,
coordination, and prioritization among agenciesLow reimbursement rates to primary care providers Decreased number of providersCounty is large and cities/towns are spread out Transportation hardships for residents More emphasis on localized community services 
Difficult to fund/implement individual communityprograms due to small population baseLarge green spaces, natural waterways, and rich resources Potential for development and revision of land-uses Large recreational areas for physical activity 
EVENTSFlorida Medicaid Reform pilot began in Clay in 2007 - andhas potential to expand to 19-27 addt'l counties during2010-11.
- Potential impact on health dept. reimbursement- Potential hardship on vulnerable clients shifting intomanaged care structures 
Decreased or eliminated ability among healthdepartments to care for uninsured clients and/orprovide needed wrap-around services in theircommunities 
Potential for public health to work more closely withmanaged care companies, and to advocate forincreased emphasis and services where needed.
Potential DOH reorganization bill 
Significant reduction in community health activitiesamong county health departments and DOH overall 
Increased need for community-based supportPassage of US Healthcare Reform legislation Increased demand for services for newly insured Improved access to health services for many 
Passage of US "ARRA" stimulus package - including $42.5Billion in funding to promote health IT and exchange 
Still limited financial resources to assist individualproviders, and EMR systems are VERY expensive 
Increased regional collaborative efforts to promoteEMR adoption, support, and information exchangeChanging FL Medicaid chronic disease managementcontract 
Potential for break in services for some beneficiaries DOH may shift chronic disease management to CHD'sOpening of new dental clinic in Green Cove Springs Sustainability Increased provision of needed services to adultsNew cardiac catheterization labs at OPMC Increased capacity to provide this service locallyNew open heart surgery suite at OPMC (coming) Increased capacity to provide this service locallyPotential upgrade to Level II Trauma center and increasedcapacity of OPMC Emergency Department (this summer) 
Significantly increased ability to provide critical careNew west Duval hospital opening in 2-5 yrsNational campaign against child obesity Increase awareness among communities 
FORCES OF CHANGE ASSESSMENT 
CONTINUED 
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COMMUNITY 
PARTICIPATION 
COMMUNITY 
PARTICIPATION 
A second core element of the MAPP model is the Community Strengths and Themes Assessment. As noted in the 
Florida MAPP Field Guide, this portion of the planning process is intended to generate direct feedback from community 
residents regarding their perceptions of their own health, access to healthcare services, and the healthiness of their 
community overall. This assessment attempts to generate a better understanding of community health issues and 
concerns as well as residents’ quality of life. The themes and issues identified during this phase often offer insight into 
the information discovered through the other assessments. 

Community Survey 

Community feedback was solicited through a paper survey of residents through a wide variety of venues across the 
county during the months of February – April of 2010. The Clay County Health Department and the members of Clay 
County Health Assessment Task Force first reviewed the survey instrument that had been utilized for the previous health 
needs assessment in 2005; then members made recommendations to update the survey tool for the 2010 assessment. 
The members were cautious, however, not to change specific questions so that results could be compared over time 
from the previous 2005 survey response data. The Task Force did decide, however, to add a question about stress and 
the economy given the recent economic downturn nationally, statewide and at the local level. A copy of the full survey 
questionnaire is included as Appendix B to this document. 

The Clay County Health Department staff, as well as several community-based health and social service providers, 
distributed surveys to residents at the Clay County Fair, Clay County Health Department clinics and WIC, Orange Park 
Medical Center, St. Vincent’s mobile unit, The Way clinic, Clay Behavioral Health Center, Clay Council on Aging, Life Care 
Center of Orange Park, Amedisys Home Health, and Clay County Schools (faculty and staff only). In total, 1,518 surveys 
were completed by residents. 

Demographics of Survey Respondents 

Overall, the survey responses include representation from all areas of the county (determined through self-reported zip 
code of residence). 


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A large majority (79%) of the survey respondents were female. There was a significant under-representation of men 
among the survey respondents. However, the 2010 survey efforts did see a slight increase in the number of men 
completing the survey compared to the 2005 survey. The largest age group of respondents were persons between 
40-54 years old, comprising a total of 32% of responses. This age group makes up 15% of the county’s total population. 
Approximately 13% of survey respondents were over the age of 65, which is slightly over (10%) Clay County’s elderly 
population. 80% of survey respondents were white and 20% were non-white, which closely matched Clay County’s 
population demographics of race (83% white, 17% non-white). With regard to ethnicity, 5.8% of survey respondents were 
Hispanic, which closely matched the county’s Hispanic population of 6.8%. Geographically, there was a wide range of 
participants living throughout Clay County, including good representation from Orange Park, Middleburg, Green Cove 
Springs and Keystone Heights. Approximately 39% of participants were employed full-time (67%, 2005) and 18% 
(4.4%, 2005) reported being unemployed, which is more than twice the county’s unemployment rate of 6.9% in 2008. 
40% (34%, 2005) of the survey respondents reported having a high school diploma or GED as their highest level of 
education completed and 17% (23%, 2005) reported having a 4 year college. Compared to the 2005 report, Clay 
County survey respondents experienced a huge increase in reported household incomes under $20,000. 37% of survey 
respondents reported household incomes under $20,000 compared to 19% in 2005. Compared to the 2005 report, Clay 
County survey respondents reported a 9% drop in reported household incomes between $50,000 - $99,000. A detailed 
summary of information obtained from the demographic section of the survey is included in this report. 

Survey Analysis 

A total of 1,518 (1,116 surveys, 2005) surveys were entered manually into an online database using SurveyMonkey; 
then the organized data was exported into an Excel workbook for mathematical analysis. Primarily descriptive statistics 
were used to interpret the data and present the findings to committee members. Cross tabulations were applied in cases 
where community reports indicated that specific health disparities exist. The following section summarizes the results of 
the 2010 survey responses compared to the 2005 survey responses 

How do you rate your overall health? 


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Check up to 5 selections you feel are the most important features of a healthy community 


Check up to 5 of the health problems that you feel are the most important in Clay County: 


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COMMUNITY PA R TICIPATION 
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Check up to 3 behaviors you are most concerned about in Clay County: 


What health care services are difficult to obtain in your community? 


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How do you rate the quality of health services in Clay County? 


What do feel are barriers for you in getting healthcare? 


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COMMUNITY PA R TICIPATION 
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When you need to use prescription medications for an illness, do you 


How is your health care covered? 


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Where would you go if you are sick? 


Where would you go if your children/dependents are sick? 


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Have you had added stress related to the economy in the last year that negatively impacted your health? 
NEW QUESTION FOR 2010 SURVEY 


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Focus Groups 

Introduction 

In the Spring of 2010, the Health Planning Council of Northeast Florida conducted six focus groups for the Clay County 
health needs assessment. The purpose of these focus groups was to better understand the views and opinions of Clay 
County residents about the quality of life in their community. This report will outline the focus group methodology and 
summary of key themes identified in the focus group discussions. 

Focus Group Methodology 

A set of questions was developed for the focus groups to explore how residents felt about the quality of life in Clay 
County. The focus group instrument was used in similar health needs assessments in surrounding counties. A copy of 
the focus group questions that were used are included as Appendix C-1. 

Focus groups were scheduled by staff at the Clay County Health Department and Health Planning Council through the 
assistance of members from the Clay County Community Health Assessment Task Force. Efforts were made to target 
existing groups that were already meeting throughout the county. 

Six focus groups were conducted. The size of the focus groups ranged from 6 – 26 participants, with a total of 60 
participants. A list of the focus group locations is summarized below: 

Penny Farms: Located in Penny Farms 
Orange Park Senior Center: Located in Orange Park 
Soul Winning Temple: Located in Green Cove Springs 
Rotary Club: Keystone Heights 
Life Care Center of Orange Park: Orange Park 
Amedisys Home Health Care: Orange Park 

Focus groups were moderated by a Health Planning Council staff member or consultant and handwritten notes were 
taken during each of the groups to ensure that no comments were missed. Notes were carefully reviewed to explore 
participants’ comments and discover whether similar concerns and opinions were voiced by Clay County residents. 
A summary of common themes each of the focus groups discussions is included in this section. 

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1. In general, are you satisfied 
with the quality of life in your 
community? 
(open to interpretation of 
community – neighborhood, 
town, or county) 
a. Is this a good place to 
raise children? 
b. Is this community a good 
place to grow old? 
c. Do you feel there is 
economic opportunity in 
the community? 
General quality of life 

Clay County has good fresh air and is a great place to live and raise a family. In 
general the community is safe and there are plenty of places to shop. This is also a 
community where you have to make some tradeoffs; commuting to work in Duval 
County, growth that threatens the environment (clean air), and not much economic 
opportunity. 

School and youths 

• Many of the schools have excellent teachers and principals. Students begin 
having problems in middle and high school, but the elementary schools are fine. 
• Some schools have more resources than others. The nice schools have all the 
latest equipment, while the urban schools look like prisons creating a poor 
learning environment. [Note: It is not clear what constitutes an urban school in 
Clay County.] 
• Teens do not have many options to keep them busy unless they get involved in 
school activities or their parents provide (pay for) activities for them. Likewise, 
once young people graduate from high school there is nothing for them in Clay. 
• Clay County has not focused on the high drop out rate. 
• Students come to school, but are not ready to learn. This is a family issue. 
• Students start the school day too early in the morning. Many are still asleep. 
• There is a lot of new infrastructure going on especially in areas like Middleburg. 
• We need more schools. 
• There are not a lot of after hours daycare options for working parents who have 
odd shifts. 
• There is not a lot of recreation for kids other than the Slough that opened, and 
hanging out at the mall which can be dangerous. 
• Good place. Lots of Churches, good schools, 
• Kids must make up their own entertainment (some residents liked that idea, 
others did not). 
• Lots of recreational opportunities, especially for the poor who want to 
participate. 
Affordable child care 

The County needs more affordable day care and after-school programs to 
accommodate working parents. The community has many options for day care, but 
the costs are very high. It is the same with children’s activities, the options are many, 
but not affordable. 

Elderly 

Clay County is a good place for older people especially when the community is 
compared to other areas of Florida. Many live in communities with other older people 
and know their neighbors. The Clay County Area Office on Aging also provides 
many services for seniors. [Note: Two of the groups took place in senior settings.] 
While the community is elderly friendly, there is a need for more affordable assisted 
living. Clay County also has a lot of hidden senior poverty and many seniors do not 
know how to access the services they need. 

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• There is no elder housing other than Skilled Nursing Facilities (SNF’s). 
• Transportation is not good as compared to Duval County public transportation. 
• Churches are plentiful except of Jewish faith. 
• Adult day care is very lacking. 
• Social service support is not readily accessible or available. 
• Mental health support is available. 
• Is there a food pantry for low income families like in Duval County? 
• If you can’t drive, it’s not [a good place to grow old]. 
• Not [a good place to grow old] if you need medical care close by. 
• Limited assisted living options. 
• They closed the Health Dept. in Keystone Heights! (discussion) 
• “Now, Penny Farms…down the road is a good place to live if you’re elderly!” 
• Churches support seniors. 
• Senior Center has activities, meals & transportation to Gainesville & O.P. 
Housing 

Clay County is known for having very affordable housing as compared to the rest of 
the region, however renting a home or apartment can be very expensive. The rents 
are comparable to Duval County. 

Transportation 

• Commuting to Jacksonville can be very long, for some up to an hour to work and 
back on a daily basis, which takes away personal and family time. Many hope 
the new beltway, under construction, will eliminate some of the commute time. 
• Transportation for the elderly is very good; the service provides seniors with the 
means to get around for minimal cost. Still, many of the community’s elders do 
not know how to access the transportation services that are available. 
• Most of the participants agreed that Clay County does not have a real public 
transportation system. Clay Transit and JTA do not provide viable options for 
residents. 
Economic development 

• Clay County does not have many jobs. This is due in part to the current 
economic crisis, but there have never been many jobs here. The jobs are lower 
paying. Most people go somewhere else, like Jacksonville, for their job. Young 
people move away because there are few opportunities for work and the SJRCC 
is the only higher educational institution. 
• Clay County is situated like the boroughs around Manhattan or the counties 
around Atlanta – Duval is the center and the other counties revolve around it. 
Just like people drive into Manhattan for work, people drive into Jacksonville 
for work. 
• Many local businesses have closed; not much growth is happening right now. 
It is a good thing that growth has slowed. The time has come for proper 
community planning in Penny Farms (not another “Orange Park”). 
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2. Do you feel your community 
is a safe place to live? 
(Consider perceptions of) 

a. Safety in the home 
b. Workplace 
c. Schools and playgrounds 
d. Parks 
e. Do the neighbors know 
each other and look out 
for one another?… 
• There is increased retail growth in Middleburg. However, they are building new 
‘malls’ without totally filling up the others first. 
• County in “pretty bad shape”: lack of jobs, underemployed, people can’t 
support a family while making $8 to $12 an hour (all that’s offered in KH). 
• Educational opportunities to learn new trade, some in KH, most in Gainesville. 
• More affordable housing every day (especially with bad economy). 
• One participant had read that Clay & Seminole County have highest migration 
out of community for employment. 
Food and nutrition 

• Food is expensive in Clay County. Not much food is locally grown and there is 
little fresh produce. 
Safety 

Participants felt safe in their community, but expressed concerns about other areas. 
The “overwhelming” number of pedophiles came up in all focus groups; likely as a 
result of the heavy media attention and focus on the recent Somer Thompson case. 

• Penny Farms is a safe community. 
• The Sheriff’s office does a good job of policing the community. 
• The people who live in the community look out for each other: “(We) try to 
protect each other from hard times and desperate people.” 
• Some expressed concerns that the parks are beautiful, but seem unsafe and 
might be used by pedophiles. The number of pedophiles in Middleburg and 
Green Cove Springs was of particular concern. 
• There was also the perception that Green Cove was a high poverty and high 
crime community. 
• Green Cove Springs is a safe community for children and adults. 
• Green Cove Springs and all of Clay County are very spiritual communities. 
• Compared to other communities, Clay County is very safe. 
• One participant stated he “moved here from Daytona where people will take 
from you and not even think about it. In Clay you can leave your doors 
unlocked.” 
• The view of the police and Sherriff’s Office were less positive than Penny Farms, 
“The police presence can be overwhelming, it’s like they are waiting for us to do 
something wrong.” 
• Clay County is safer than Duval County, but there are too many child molesters. 
[Note: The group used Sommer Thompson as an example]. Participants felt 
safe in their homes, but were not sure about the safety of schools and other 
areas. 
• For the most part the sheriffs’ office is visible and readily available. 
• The mall is a scary place and not very safe in the evenings. “Being a woman, I 
do not go out alone after dark.” 
• More established neighborhoods look after each other. For instance, they really 
came together after Somer disappeared. 
• People don’t want to get involved. 
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FOCUS GROUP QUESTIONS 
• Relatively safe- hardly any violent crime; only property crime. 
• Convenience stores are not safe. 
• “2 drug store hold ups last year-whole area shut down to go see what 
happened” 
• Lady was assaulted on scooter on walking trail… Assailant just wanted her 
prescription drugs. 
• Schools, businesses & playgrounds safe here. 
• Neighbors look out for each other. 
SUMMARY RESPONSES 
3. Do you believe there is a • Most people rely of their church, family, or friends when they have personal or 
network of support for financial problems. Otherwise Clay County does not have a lot of agencies to 
individuals and families help people. Many of the agencies are small and when they run out of money 
during times of stress and they have to stop helping people. Mental health and substance abuse services 
need? are available in some areas of the county, but services are very limited. 
a. Medical crisis • Service providers include Catholic Charities, the Salvation Army, and United 
b. Mental health and 
substance abuse 
Way’s 2-1-1. Clay Behavioral Health provides mental health services and SHINE 
(Serving Health Insurance Needs of Elders) offers 2-1-1 assistance through 2-11. 
[Note: Could not verify SHINE’s 211 service] 
c. Pregnancy 
• Men and women released from Clay County Jail and the homeless are sent out 
d. Financial the county because those in charge think it would make the county look bad to 
e. Death have these people out on the streets. 
f. services for children • Illegal drug use does not seem to be a problem; there may be more prescribed 
with special needs medication abuse. 
4. Are you satisfied with the The quality of health care is generally perceived to be of good quality, the 
health care system in your community has good physicians, and pharmacies are easy to find; however care is 
community? costly, many people lack insurance, the elderly find it difficult to find doctors who 
(Consider) accept Medicare, and the poor find it difficult to find doctors who accept Medicaid. 
Other issues are as follows: 
a. Cost 
• There is “illness” care; but not “real” healthcare or preventative care. 
b. Quality 
• Physicians are over-prescribing medicines instead of offering holistic medical 
c. Options advice. 
d. Prescription drugs • Orange Park Medical Center is viewed as a good hospital, but satisfaction with 
hospital services is mixed. More than one participant agreed that the hospital’s 
goal is to make money by conducting needless tests and admitting elderly 
patients unnecessarily. 
• It is particularly difficult to find specialists that accept government sponsored 
health plans – Medicare & Medicaid. 
• Because Medicare does not cover dentist visits, the elderly have to find private 
insurance or cover cost out of pocket, which may be expensive. 
The transportation service provided by the Clay Transit Authority is an appreciated 
service that allows the elderly to make doctors appointments in Clay County and 
Duval County for a small fee. 

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5. Are there health services 
you need that are not 
available to you? 
FOCUS GROUP QUESTIONS 
Clay County has an abundance of health care services, but there are challenges: 
• Green Cove Springs does not have a hospital and there are no urgent care 
centers. 
• The community’s health care providers do not have a holistic, preventative-
approach to care. 
• Clay County is full of doctors, but not enough accept Medicare or Medicaid. 
• The insurance companies make access to care very difficult, which causes 
frustration for many. A participant stated, “Most services are available, but the 
insurance companies run everything.” 
SUMMARY RESPONSES 
6. Are you aware of the public 
health services that are 
available in Clay County? 
(i.e. Clay County Health 
Department) 
Most participants were not well informed about the public health services offered in 
Clay County. The Green Cove Springs group did know that some health services are 
provided by the Clay County Health Department via the mobile unit at Harvey’s 
grocery store on SR 17 and children could get free shots. 
There is some uncertainty, depending on the speaker, about the location of the 
health department. A participant stated that there was a Beau Hill location, but no 
medical services were offered there. In another group participants stated that the 
Green Cove location had been closed and there was only an Orange Park location. 
This was important because the group began discussing the lack of public 
transportation and not having access to a personal vehicle being an obstacle to 
receiving services at the health department. There was some disagreement from 
group to group on whether or not the Clay County Health Department offered dental 
services. 
7. What do you see as the 
school’s role in health? 
Participants were aware that schools currently screen children for vision and hearing 
problem, and obesity. “Teachers may be over-burdened and lack the time to teach 
this subject, but health education could be incorporated into a standard curriculum.” 
Home economics would be another way to introduce healthy living within the 
schools. 
Nutrition and exercise could be improved in the schools. 
• School lunches are very expensive, but the quality of the food is poor. 
• Students need more access to physical education. 
• Schools should rethink what they serve in the cafeterias and what is sold in the 
vending machines. 
• High school students who need free or reduced lunch have to go to the school 
board to get the proper paperwork, which could be an obstacle to applying. 
• One young woman (a high school student) stated that she does not eat during 
the school day. She buys a big breakfast at McDonald’s and that sustains her 
during school. She does this because it is cheaper. 
One participant was adamant that the schools should not have a role in health, 
stating that, “It is better when the government does not get involved.” 

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8. If you could create any 
type(s) of “health program(s)” 
for Clay County residents 
what would it/they be? 
Each focus group mentioned the need for more wellness and prevention programs 
with the idea that health education is an overlooked preventative. However, even the 
best programs are not guarantee of a healthier community. As one participant 
offered, “you can’t force people to take care of themselves.” 

Healthy communities also make a place for all of its residents. Clay County would 
benefit from creating solutions for those residents who are isolated and need 
assistance. This includes the elderly, school-age kids, college students, etc. Efforts 
to bridge the generation gap through intergeneration programs and opportunities 
(beyond the church) were also mentioned. 


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KEY HEALTH ISSUES KEY HEALTH ISSUES 
Introduction 

The Clay County Health Assessment Task Force meetings were held from October 2009-June 2010 as part of the Clay 
County health needs assessment. Information provided in the previous chapters of this report was presented to members 
of the Clay County Health Assessment Task Force, including chronic disease death rates, infectious disease rates, and 
maternal and child health indicators. In addition, hospital utilization data of Clay County residents was presented as well 
as the availability of health resources and services in the county. Community input from Clay County residents was 
obtained through focus groups and surveys. 

Key Health Issues and Recommencation 

The Clay County Health Assessment Task Force identified key health issues which included high rate of lung cancer 
mortality, diabetes, heart disease, infant mortality, limited access to dental services – among lower-income and uninsured 
adults, Alzheimer’s mortality, and substance abuse. Task Force members then collapsed these key health issues into 
broader health priorities and subsequently developed recommendations and actions steps. The Task Force believed 
these recommendations should be incorporated in the work of existing community groups and leaders and report on the 
progress of these recommendations through the Clay County Health Department Administrator on a quarterly basis. 

High rate of Lung Cancer Mortality 

Community Health Status Assessment 

• Cancers (all cancers combined) are the Top leading cause of death among Clay residents. 
• Lung Cancer has the highest mortality rate among all reported cancers. 
• The rate (per 100,000 population) of Lung CA deaths among Clay residents was 60 during 2006-2008, compared 
to a statewide rate in Florida of 48. 
• BRFSS indicates that 22% of Clay residents smoke, compared to 19% across FL. 
• BRFSS also shows that 19% of Clay residents are exposed to 2nd hand smoke, compared to 15% across Florida 
as a whole. 
• Similarly, Chronic Lower Respiratory Disease (CLRD) is the 3rd leading cause of death in Clay County – with a 
rate of 57 deaths per 100,000 during 2006-2008, compared to a statewide rate of 36 in FL. CLRD is most 
common among white residents, at a rate nearly twice that of non-white residents. 
• Conversely, Clay County residents are hospitalized for CLRD at a rate of 278 per 100,000; while across FL this 
rate is 321. 
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Community Strengths and Themes Assessment 

• Cancers (all cancers combined) are the 2nd leading health concern among Clay residents. 
• Smoking/Tobacco use is the 6th leading health concern among residents surveyed. 
• Tobacco use (of any kind) is also the 6th leading behavioral concern. 
• Residents report difficulties accessing specialty care due to lack of providers (including pulmonologists and 
oncologists), especially providers who will accept government sponsored health insurance plans such as Medicaid 
and Medicare. 
• Residents report that the system of care in Clay does not emphasize preventative care or healthy lifestyles. 
Forces of Change Assessment 

• There is little or no funding available to support preventive services or health promotion. 
• Many employers and public places are adopting a “smoke free” policy at their sites. 
Local Public Health System Assessment 

• The Area Health Education Centers (AHEC’s) in Florida have a large grant to provide smoking cessation and tobacco 
prevention services. 
• Medicaid (the primary source of health coverage among lower income populations) covers only a limited number 
and type of services for tobacco cessation/prevention. 
• While services are available, the system could do more to make the community aware of the services as well as 
promoting healthy lifestyles. 
Diabetes 

Community Health Status Assessment 

• Diabetes is the 6th leading cause of death in Clay County: 
• Rate (per 100,000 pop) in Clay is 25.3 compared to 20.6 across FL as a whole. 
• There has, however, been a slow but steady decrease in diabetes-related deaths in the county over the past 5-6 
years, bringing the rate closer to the statewide average. 
• The rate of hospitalizations in Clay related to diabetes has increased over 5 years. 
• There is a significant disparity among non-white populations: 
• Rate among white: 24.1 compared to rate for non-white: 46.9 
• BRFSS – Adults with a diabetes diagnosis in Clay: 10.6% compared to FL: 8.7% 
• Percent of diabetes diagnoses decreases as income increases: 
• <$25K: 15.5% | $25K-$50K: 12.8% | $50K+: 9.2% 
• More common among men (12.1%) than women (9.3%) 
• BRFSS – Percent of Clay diabetics who had at least 2 HbA1c tests in the past year: 53.5% (FL: 71.2%) 
• Percent of Clay diabetics with DSME: 44.8% compared to FL: 51.4% 
• Percent of Clay residents classified as overweight/obese: 68.8% compared to FL: 62.1% 
¦ 


Overweight percent decreases as education increases 

¦ 


Overweight increases as income increases 

¦ 


Overweight is higher among married couples (45% vs. 31% in single persons) 

¦ 


Obesity percentage decrease among older populations 

• Clay County has a low rate of Internist physicians (per 100,000 pop) compared to FL as a whole 
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Community Strengths and Themes Assessment 

• Diabetes is the 4th leading health concern among Clay residents surveyed 
• 34% of residents marked this choice – compared to 26% of respondents in 2005 
• Obesity is the top health concern among residents - 47% of persons surveyed 
• Poor eating/nutrition was the 5th leading behavioral concern among residents surveyed 
• Being overweight was the 3rd leading behavioral concern 
• Cost was reported as the largest barrier to obtaining healthcare services – including medications 
• Limited or no access to primary care was reported among residents – especially low-income 
• Residents report that healthy food is expensive – request more locally grown and healthy food 
• Residents report concern over poor nutrition in school meals 
Forces of Change Assessment 

• There is little or no funding available to support preventive services or health promotion. 
• There is an increasing number of unemployed/low-income/uninsured residents 
• Decreasing number/rate of primary care physicians nationwide and across FL, including Clay 
• Access to DCF/Medicaid services – and worsening as a result of budget cuts across the state 
• Clay has many natural lands for recreation and good agriculture 
Local Public Health System Assessment 

• Clay has strength in mobilizing community partnerships 
• System could do better in informing residents of available services and health promotion 
• System could do more for policy change and planning. 
Heart Disease 

Community Health Status Assessment 

• Heart Disease is the 2nd leading cause of death in Clay County: 
• Rate (per 100,000 pop) in Clay is 158 compared to 162 across FL as a whole. 
• There has, however, been a slow but steady decrease in the county over the past 5-6 years, bringing the rate closer 
to the statewide average. 
• “Other chest pain” is the leading cause of Emergency Room visits among Clay adults 
• “Unspecified chest pain is #7 
• 7th leading DRG among adults discharged from a hospital stay 
• 3rd leading outpatient surgical procedure is cardiac catheterization among adults 
• Clay County has a low rate of Internist physicians (per 100,000 pop) compared to FL as a whole 
• BRFSS – Percent of adults with CVD diagnosis 8.8% compared to FL: 9.3% 
• CVD incidence decreases as income increases: <$25K: 17.2% $25K-$50K: 11.6% $50K+: 3.5% 
• Slightly higher than the state average have had cholesterol checks in the past year 
• Slightly higher than state average have been diagnosed with HTN 
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Community Strengths and Themes Assessment 

• Heart disease/Stroke was the 6th leading health concern among Clay residents surveyed 
• 34% of residents marked this choice – compared to 32% of respondents in 2005 
• Obesity is the top health concern among residents - 47% of persons surveyed 
• Being overweight was the 3rd leading behavioral concern 
• Poor eating/nutrition was the 5th leading behavioral concern 
• Lack of exercise was the 7th leading behavioral concern 
• Cost was reported as the largest barrier to obtaining healthcare services – including medications 
• Limited or no access to primary care was reported among residents – especially low-income 
• Specialty care (including cardiology) was the 4th most difficult service to obtain in Clay (22%) 
• 72% of residents report being impacted by stress related to the economy – especially low income 
• Residents report that healthy food is expensive – request more locally grown and healthy food 
Forces of Change Assessment 

• There is little or no funding available to support preventive services or health promotion. 
• There is an increasing number of unemployed/low-income/uninsured residents 
• Decreasing number/rate of primary care physicians nationwide and across FL, including Clay 
• Access to DCF/Medicaid services – and worsening as a result of budget cuts across the state 
• Clay has many natural lands for recreation and good agriculture 
Local Public Health System Assessment 

• Clay has strength in mobilizing community partnerships 
• System could do better in informing residents of available services and health promotion 
• System could do more for policy change and planning. 
Infant Mortality 

Community Health Status Assessment 

• Overall, rate is lower than the state average: Clay 5.7 (per 100,000) vs. FL 7.2 
• There is, however, a disproportionate impact among non-white populations: 
• 
White rate (per 100,000 pop): 4.6 vs. Non-White rate: 13.3 
• 
It is important to note that this reflects a total of 9 non-white infant deaths during 2008, compared to a total 
of 11 infant deaths among whites. 
• The rate of OB/GYN’s in Clay is half the state rate: Clay 5.4 (per 100,000 pop) vs. FL 10.5 
• Few of the OB/GYN’s in Clay will accept Medicaid 
• The rate of births to teenage moms (ages 15-19) is higher among non-white (50.8) than white (33.6) 
• BRFSS – 18% of Clay women self-reported as current smokers (39.2% among incomes <$25K) 
• BRFSS – 15% of Clay women reported skipping a medical visit due to cost (33.5% among <$25K) 
• 88% of Clay women reported having some type of health insurance coverage 
• 85.6% among ages 18-44 
• 70% among incomes <$25K 
• 88% of Clay women reported having a primary care provider 
• 79% among incomes <$25K 
• 75% among women ages 18-44yrs 
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Community Strengths and Themes Assessment 

• Survey results show increasing numbers of persons in Clay relying on Medicaid/Medicare; and decreasing 
numbers/rate of persons with private health insurance. 
• A self-report of “fair” or “poor” health status was most common among low-income and uninsured 
• Low-income and uninsured report difficulty accessing primary care and preventative services 
• OB/GYN services was reported as the 17th most difficult service to obtain in Clay (approximately 10% of female 
respondents marked this choice) 
• Teen pregnancy was the 13th highest health concern among residents surveyed 
• Infant Mortality was the 22nd most common health concern 
• Drugs and alcohol was the top behavioral concern among residents 
Forces of Change Assessment 

• Limited and decreasing funding for preventative programs and health promotion 
• Increased rate of unemployed, low-income, and uninsured 
• Migration out of Duval and other urban areas into more rural areas of Clay – contributing to challenges with 
transportation and access to services 
• Limited and decreasing access to vital DCF services 
• Limited options for affordable housing – creating competing priorities for many families 
• Family members cohabitating to reduce costs (may be a benefit for young families) 
Local Public Health System Assessment 

• Significant reduction in access to DCF and other vital social services as a result of budget cuts 
• Significant cuts to the county’s Healthy Families programming 
• Strong coalition building in the county and opportunities for partnership 
Limited Access to Dental Services – Among Lower-Income and Uninsured Adults 

Community Health Status Assessment 

• Clay has a slightly lower rate of dental providers than FL as a whole: Clay 48.4 vs. FL 60.9 
• Access to dental services among low-income groups showed a slight but steady increase between 2002 and 2006 
(most recent data available) 
• BRFSS – 19% of Clay residents reported not accessing dental services in the past year due to cost 
• Among men only: 16% | Among women only: 22% 
• Lack of dental access decreases and education and income increases 
Community Strengths and Themes Assessment 

• Dental care was rated the #1 most difficult service to obtain in Clay County among those surveyed: 
• 35% of survey respondents reported this compared to 27% in 2005 
• Dental problems was the 9th leading health concern among residents surveyed 
• 20% of respondents compared to 15% in 2005 
• Persons with incomes of less than $20K/yr – approx. 55% reported difficulty accessing dental 
• Top reported barriers among low-income and uninsured were inability to afford care, not knowing how/where to 
access services, and limited or no transportation. 
• Focus group participants asking for more healthy food options, such as locally grown 
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Forces of Change Assessment 

• Increased rate of unemployed, low-income, and uninsured 
• Poor reimbursement for dental services by the state’s Medicaid program – causing a decrease in the number of 
providers to will accept it. 
• New dental clinic in Green Cove! 
Local Public Health System Assessment 

• Excellent partnership among CHD and others in the county to establish new clinic 
• Strong volunteer base among providers – to provide limited services 
• Client difficulty in accessing DCF and other needed support services 
• Strong WeCare program – and improving 
Alzheimer’s Mortality 

Community Health Status Assessment 

• Clay’s rate (per 100,000): 32.8 compared to Florida’s rate: 16.5 
• Clay has a lower 65+ population when compared to the rest of Florida (possibly skewing rates) 
• Alzheimer’s (related) is reported as the 7th leading cause of death among Clay residents 
• Data shows a lower per-capita income in Clay County, however a higher Median Household Income when compared 
to the rest of Florida – indicating a potentially higher rate of extended families residing in the same household – 
including elders residing with adult children for care/support. 
• Clay County has a higher rate of nursing home beds available compared to the rest of Florida, however has a lower 
rate of adult psychiatric beds available than the average across the state. 
Community Strengths and Themes Assessment 

• End of life issues were ranked 18th of 24 possible choices for health concerns 
• (11% of persons surveyed) 
• Mental health issues were ranked 10th – by 20% of persons surveyed 
• Older survey respondents were less likely to be impacted by stress from the economy 
• Older respondents reported more consistent access to primary care services 
• The most common barriers to health services reported by respondents aged 75+ were: 
• Transportation 
• Wait times for and inconvenient hours of services 
• Not knowing about services and/or how to access them 
Forces of Change Assessment 

• Increasing elder population – “Baby Boomers” coming of age 
• Declining availability of primary care providers and decreasing funding for preventative care and health promotion 
activities 
• Anecdotal feedback that an increasing number of elders are moving in with adult children as their support needs increase. 
• “Tricky Marketing” by Medicare supplement/replacement insurance plans. 
• OPMC working to improve electronic information sharing among nursing homes in Clay – to improve 
quality/continuity of care for elders. 
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KEY HEALTH ISSUES 
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Local Public Health System Assessment 

• Improvement needed for linkage and referral services among entities 
• Clay Council on Aging provides good transportation and other needed services 
• Potential to improve on informing/engaging the public on available resources and services 
Substance Abuse 

Community Health Status Assessment 

• [Need local data] 
• Clay BRFSS – 18% of adults surveyed self-reported engaging in binge drinking (4-5+ drinks during a single 
occasion) during the past year. Among men only: 22.2% vs. among women only: 14.2% 
• DCF State/Regional (Northeast region) Data: 
• 17,288 adults served with substance abuse treatment during 2008-2009 
• 6,235 children served with substance abuse treatment during same time period 
• 26,188 adults served with mental health treatment/counseling 
• 12,635 children served with mental health treatment/counseling 
• DCF reports that approximately 33% of adults and 30% of children with needs related to substance abuse seek 
treatment services. Of those, approximately 31% of adults and 56% of children actually receive the needed services. 
• There was an average of 1,300 adults and 200 children on waiting lists for treatment services – MONTHLY 
(statewide) – during 2008-2009. 
• SAMHSA and DCF estimate that 5.4% of Florida’s adult population, and 7.9% of youth suffer from serious mental 
illness and/or serious emotional disturbance. In clay county, this would equate to an estimated 7,644 adults and 
3,570 youth (under 18) suffering from significant mental illness. (Calculated estimates based on 2009 census 
population estimates) 
• “Despite Florida’s status as the 4th largest state in population, Florida’s per-capita funding for mental health and 
substance abuse services is ranked 49th and 37th respectively in the nation. 
• DCF reported “Drug Use and Perception Trends”: 
• In recent year, FL has see a marked upsurge in prescription drug misuse/abuse… which has created an added 
demand for medication-assisted treatment and more acute services. 
• 
Alcohol accounts for the highest percentage of adult treatment admissions (35%), followed by marijuana 
(23.5%) and cocaine/crack (19.9%). 
• Marijuana accounts for the highest percentage of adolescent admissions (77.9%), followed by alcohol (14%). 
• Most drug-related deaths in FL involve the use of 2 or more substances. 
Community Strengths and Themes Assessment 

• Alcohol/Drug addiction was the 3rd leading health concern among residents surveyed. 
• Mental health problems were ranked as the 10th leading health concern among residents. 
• Both were cross-cutting among gender, race, and income levels. 
• Drug abuse was the TOP leading behavioral concern reported among residents. (Increased from 37% of 
respondents in 2005 to 58% of respondents in 2010) 
• Alcohol abuse was the 2nd leading behavioral concern reported. (Increased from 40% of respondents in 2005 to 
44% in 2010) 
• Mental health services were reported as the 5th most difficult service to obtain among residents. 
• Substance abuse services (drug and alcohol) were reported as the 6th most difficult service to get. 
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KEY HEALTH ISSUES 
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• The highest rate of difficulty in obtaining both services (mental health and substance abuse) was among persons 
with incomes between $31,000 - $50,000. 
• 72% of residents report being impacted by stress related to the economy – especially low income. 
• Focus group comment: “Illegal drug use does not seem to be a problem; there may be more prescribed medication 
abuse.” 
Forces of Change Assessment 

• Increasing numbers/rate of low-income and uninsured requiring services. 
• Increasing adult outpatient mental health needs related to increased stress. 
• Business closings and foreclosures as a result of the poor economy create an increased number of vacant structures 
= an increasing number of available spaces to foster homeless and also a variety of deviant activities including drug 
use. 
• Migration of homeless populations out of Duval into Clay. 
Local Public Health System Assessment 

• Strength in coalition building and support – such as the Clay Action Coalition. 
• Weaknesses identified in community education and health promotion activities. 
• Limited and decreasing access to DCF and other needed support services. 
• Decreasing funding and resources. 
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APPENDICIES 


#

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Focus Group Questions 
APPENDIX A 
Focus Group Questions 
APPENDIX A 
1. In general, are you satisfied with the quality of life in your community for yourself? 
A. Is this a good place to raise children? 
a. School quality 
b. Day care 
c. After school care 
d. Recreation 
e. Environment 
B. Is this community a good place to grow old? 
a. Elder friendly housing 
b. Transportation 
c. Churches 
d. Shopping 
e. Elder day care 
f. Social support organizations and agencies 
g. Services and activities 
C. Do you feel there is economic opportunity in the community? 
a. Locally owned and operated businesses 
b. Jobs with career growth and job training 
c. Higher education opportunities 
d. Affordable housing options 
e. Reasonable commute 
2. Do you feel your community is a safe place to live? 
a. Safety in the home 
b. Workplace 
c. Schools and playgrounds 
d. Parks 
e. Do the neighbors know each other and look out for one another… 
3. Do you believe there is a network of support for individuals and families during times of stress and need? 
a. Medical crisis 
b. Mental health and substance abuse 
c. Pregnancy 
d. Financial 
e. Death 
f. Services for children with special needs 
4. Are you satisfied with the health care system in your community? 
a. Cost 
b. Quality 
c. Options 
d. Prescription drugs 
5. Are there health services you need that are not available to you? 
6. Are you aware of the public health services that are available in Clay County? 
(i.e. Clay County Health Department) 
7. What do you see as the school’s role in health? 
8. If you could create any type(s) of “health program(s)” for Clay County residents what would it/they be? 
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SURVEY QUESTIONS 
APPENDIX B 
SURVEY QUESTIONS 
APPENDIX B 
The Clay County Health Assessment TaskForce needs your help to better understand the health of our community. 
Please fill out this survey to share your opinions about healthcare services and the quality of life in Clay County. A report 
of the survey results will be presented to the community, and made available to the public. The responses that you give 
in this survey will help to make Clay County a healthier and better place to live! 

1. How do you rate your overall health? (check one selection) 
 Excellent  Good  Fair  Poor  I don’t know 

2. Choose up to 5 of the items below that you feel are the most important features of a healthy community: 
 Access to churches or other places of worship 
 Access to healthcare 
 Access to parks and recreation 
 Access to public transportation 
 Affordable and/or available housing options 
 Available arts and cultural events 
 Clean and healthy environment 
 Absence of discrimination 
 Adequate handicapped parking/accommodations 
 Good place to raise kids 
 Good jobs, healthy economy 
 Good education 
 Low crime rates/safe neighborhoods 
 Preventative health care (annual check-ups) 
 Quality child care 
 Access to social services 
 Good place to grow old 
 Other: ___________________________________ 
3. Choose up to 5 of the health problems below that you feel are the most important in Clay County: 
 Asthma  Addiction – alcohol or drug 
 Respiratory/ lung disease (COPD, emphysema)  Mental health problems 


 Cancers  Child abuse/neglect 
 Contagious diseases (i.e. flu, pneumonia)  Teenage pregnancy 
 Diabetes  Firearm-related injuries 
 Heart disease & stroke  Domestic violence 
 HIV/ AIDS/Sexually Transmitted Diseases  Infant death/ premature birth 
 Obesity  End of life care (nursing homes, hospice) 
 High blood pressure  Environmental health, sewers, septic tanks 
 Smoking/tobacco use  Motor vehicle crash injuries 
 Dental problems  Suicide 
 Rape/sexual assault  Other: __________________________________ 

4. Choose up to 3 unhealthy behaviors you are most concerned about in Clay County: 
 Alcohol abuse  Being overweight  Not using birth control 
 Drug abuse  Poor eating habits and nutrition  Teen sexual activity 
 Tobacco use (any kind)  Not getting enough exercise  Unsafe sex (any) 
 Dropping out of school  Not getting “shots” to prevent disease  Other: ________________ 
 Discrimination  Unlicensed and/or unsafe drivers 

5. What health care services are difficult to obtain in your community? (check all that apply): 
 Alternative therapy (herbals, acupuncture)  Physical therapy, rehab therapy 
 Ambulance services  Prescriptions/medications/medical supplies 
 Chiropractic care  Preventive care (ex. annual check-ups) 
 Dental/oral care  Primary care (family doctor or walk-in clinic) 
 Emergency room care  Specialty M. D. care (ex. heart doctor) 
 Family planning/birth control  Substance abuse services-drug and alcohol 
 Inpatient hospital  Vision care 
 Lab work  X-rays/mammograms 
 Mental health/counseling  Other: _________________________________ 
 OB/pregnancy care 

6. How do you rate the quality of health services in Clay County? 
 Excellent  Good  Fair  Poor  I don’t know 

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THANK YOU FOR COMPLETING THIS SUREVEY 
SURVEY QUESTIONS 
APPENDIX B 
101 THANK YOU FOR COMPLETING THIS SUREVEY 
SURVEY QUESTIONS 
APPENDIX B 
101 

The CodeRED Emergency Notification System is an ultra, high-speed telephone communication service used for 
emergency notifications and the distribution of information considered to be important. This system allows the 
citizens of Clay County to be notified via telephone in case of an emergency situation that requires immediate action, 
such as an evacuation, contaminated water event, hazardous chemical spill, etc. CodeRed is capable of dialing the 
entire County within minutes. When calling, it delivers a pre-recorded message describing the situation to a live 
person, answering machine or voicemail in the affected area, possibly including instructions regarding immediate 
action on the part of the recipient. 

This system is a free service provided through Clay County Public Safety. Numbers registered on the system are 
confidential and are not shared with another entity. 

If you reside or own property in Clay County and would like to receive CodeRED emergency messages, you may 
sign-up by clicking on the CodeRED link found on the County’s website at www.claycountygov.com or by calling 
Clay County Emergency Management at 1-877-252-9362. 

YOUR HEALTH AND SAFETY DEPENDS ON 
KNOWING WHAT’S HAPPENING IN AN EMERGENCY! 
STAY INFORMED – SUBSCRIBE TO CODE RED, 
A FREE SERVICE PROVIDED BY CLAY COUNTY 
EMERGENCY MANAGEMENT.