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New London - Obesity, inadequate access to health care, cancer, mental and behavioral health including drug and alcohol abuse, asthma, and sexual health including sexually transmitted diseases and teen pregnancy, are the six main health challenges facing residents of the 10-town region primarily served by Lawrence + Memorial Hospital.
That list was identified in the Community Health Needs Assessment, presented Wednesday by L+M and Ledge Light Health District, which serves five of the 10 towns, to an audience of about 30 community leaders.
The assessment, which hospitals are required to complete every three years under the federal Affordable Care Act, provides a baseline for creating programs that would systematically address the region's health needs. About 174,000 people live in the 10-town region, which includes East Lyme, Groton, Ledyard, Lyme, Montville, New London, North Stonington, Old Lyme, Stonington and Waterford.
"The next step will be to get stakeholder groups together to target each of the needs and develop a community health improvement plan," said Laurel Holmes, director of community health outreach and partnerships for L+M.
An action plan, she said, must be completed by August and submitted with the nonprofit hospital's 990 federal tax returns, she said. Ideally, she added, it would include names of groups that would be responsible for carrying out the various strategies in the plan, along with a timeline for reaching specific goals.
Work on the plan began in 2012. L+M operating funds paid for the project, Holmes said, including the services of Holleran Consulting to compile population and health data on the region and survey 26 of the region's health and human services professionals and community leaders.
The group identified nine key health issues in the region, and from there, the list was pared to six priorities the action plan will focus on, said Janeen Maxwell, health and human services consultant for Holleran.
These were among those Maxwell highlighted as some of the most significant findings of her research:
• Local diabetes rates have been steadily increasing since 2008, to about 34 cases per 1,000 people, more than four times higher than the federal Healthy People 2020 goal of 7.2 cases per 1,000. Healthy People 2020 is a 10-year initiative to improve the nation's health.
• 26 percent of New London adults are obese, while 59 percent of the city's fourth-grade girls and 45 percent of its fourth-grade boys are overweight or obese. Rates tend to be higher among the poor and among blacks and Latinos.
• Cancer incidence and mortality rates are higher in New London County compared to the state and the nation, about 520.4 cases per 100,000 people compared to 504.7 cases per 100,000 statewide and 465 per 100,000 nationally.
• Asthma rates are much higher for all age groups in the 10-town region than the federal Healthy People 2020 goals, about 234 cases per 100,000 for infants through 4-year-olds, and 188.8 cases among those ages 5 through 64.
• Key barriers to better health for the region's population include inadequate health insurance and finances; transportation and language problems, and shortages of primary care providers, especially those that accept Medicare and Medicaid.
Russell Melmed, epidemiologist for Ledge Light, presented another set of data from the L+M emergency department and other sources. Among his findings:
• The five leading causes of death in New London County are: cardiovascular disease, cancer, chronic lower respiratory diseases, injuries and accidents.
• The county's residents are dying of all five top causes at rates slightly higher than statewide rates.
• Heart disease deaths as a percentage of the population are highest in Stonington, North Stonington, Salem, Preston and Griswold. Communities with the highest numbers of heart disease deaths are: Stonington, Groton, New London, Waterford and Norwich.
• New London County residents seek care at hospital emergency departments more frequently than residents in the rest of the state but are admitted to the hospital less frequently. That indicates, Melmed said, that many patients are being treated and released for conditions that could have been treated by a primary care doctor.
• The main reason for emergency visits in New London County are: injury and poisoning, unspecific symptoms or conditions, respiratory diseases, musculoskeletal system and connective tissue diseases, and digestive diseases.
Melmed said preliminary data from the L+M emergency room show a disproportionate number of visits are due to diabetes- and asthma-related illnesses. His research also showed that a disproportionate number of these patients are coming from particular low-income neighborhoods in Groton and New London. He suggested programs be created to specifically target these communities.
"There is no reason you should be going to the ER for asthma or diabetes, certainly not at this frequency," he said. "You should be managing this at home. Maybe this is an 'access to care' issue."