1. Obici Healthcare Foundation Community Health Assessment Community Health Solutions, Inc. May 23, 2007

2. Unofficial Discussion Draft Subject to Change 2 Table of Contents Executive Summary (Slide 3) 1.Health Demographic Indicators (Slide 13) 2.Community Survey Indicators (Slide 19) 3.Mortality Indicators (Slide 26) 4.Birth Indicators (Slide 31) 5.Adult Health Status Indicators (Slide 37) 6.Health Care Access Indicators (Slide 42) Appendix A: Gates County, NC Indicators (Slide 53) Appendix B: Table of Charts (Slide 68)

3. Unofficial Discussion Draft Subject to Change 3 Executive Summary Executive Summary Outline –Study Purpose, Scope, and Limitations –Study Methods –The Study Region –The Mission Statement as Organizing Principle –Demographics of the Study Region –Mission Focus 1: Addressing Unmet Needs of the Medically Indigent & Uninsured –Mission Focus 2: Preventing or Reducing Illness or Disease Additional Issues Organization of the Report

4. Unofficial Discussion Draft Subject to Change 4 Study Purpose, Scope, and Limitations Purpose –The purpose of the study is to provide information on community health status to the Obici Healthcare Foundation Scope –The study includes: Seven cities and counties in Virginia and North Carolina Six categories of health indicators from existing data Original survey data from Survey of Local Health Professionals and Community Leaders Limitations –The study was: Not designed or budgeted to identify or detail every conceivable health issue Designed to be a starting point to support Foundation planning rather than a comprehensive assessment of every issue

5. Unofficial Discussion Draft Subject to Change 5 Study Methods The study was conducted by Community Health Resource Center of Richmond, VA during December-May 2007 –Demographic data were obtained from SRC, Inc., a commercial data vendor –Death and Birth data were obtained from Virginia Department of Health and the North Carolina Department of Health –Hospital Discharge data were obtained from Virginia Health Information, Inc. –Adult health status data were obtained from the National Behavioral Risk Factor Surveillance Survey –Community Survey data were obtained from a sample of local health professionals and community leaders. The survey was limited to Virginia. –Gates County, NC data are presented separately (in Appendix A) because data were not available for some indicators, and other data were in different formats than Virginia data.

6. Unofficial Discussion Draft Subject to Change 6 The Study Region The Obici Healthcare Foundation Service Region includes most of seven cities and counties, including Gates County, NC. Gates Suffolk Isle of Wight Surry Sussex Southampton Franklin

7. Unofficial Discussion Draft Subject to Change 7 The Mission Statement as Organizing Principle The mission of the Obici Healthcare Foundation is to improve the health status of people living in the service area by: –1) addressing the unmet needs of the medically indigent and uninsured; and –2) supporting programs which have the primary purpose of preventing or reducing illness and disease. Study results are summarized in terms of the two mission focus areas.

8. Unofficial Discussion Draft Subject to Change 8 Demographics of the Service Area Major Findings from Virginia Service Region: –More than 156,000 people in the Virginia service region –Expected to reach 178,000+ by 2011 –Growing twice as fast as Virginia –Growth driven by Suffolk and Isle of Wight –42 percent African American compared to 19 percent for Virginia –22% of adults age 25+ without high school diploma compared to 14% for state –Poorer than state as a whole on most economic measures, including low-income children In addition, Gates County, NC has a population of 11,500+.and a roughly similar profile in terms of age, race, and income. See Appendix A for detail.

9. Unofficial Discussion Draft Subject to Change 9 Mission Focus 1: Addressing the Needs of the Medically Indigent & Uninsured Major Findings in the Virginia Service Region: –‘Access to quality health services’ identified as immediate & significant health concern by 39 of 63 respondents to Survey of Local Health Professionals and Community Leaders –In the Virginia Study Region for 2005: An estimated 22,500+ uninsured in the region, including 3,000-4000 children An estimated 12,700+ uninsured with income below 200 percent of poverty An estimated 17,000+ adults could not see a doctor due to cost An estimated 22,300+ adults had no dental visit in previous 2 years 3,584 hospital discharges for potentially preventable conditions Rates for all of the above were near or above the Virginia statewide rate In addition, Gates County, NC had an estimated 1,600+ uninsured in 2005. See Appendix A for detail.

10. Unofficial Discussion Draft Subject to Change 10 Mission Focus 2: Preventing or Reducing Illness and Disease Major Findings in the Virginia Service Region –Survey of Local Health Professionals and Community Leaders identified the following as leading community health concerns: Overweight, Obesity, & Nutrition Heart Disease & Stroke Diabetes Physical Activity & Fitness Cancer Substance abuse Oral health Mental health & mental disorders Sexually transmitted diseases Injury & violence Tobacco –Additional issues are noted in the report

11. Unofficial Discussion Draft Subject to Change 11 Mission Focus 2: Preventing or Reducing Illness and Disease Major Findings in the Virginia Service Region –By the numbers: Leading causes of death = heart disease, cancer, stroke, chronic lower respiratory disease, injury, and diabetes Among adults, an estimated: –73,000+ overweight or obese –30,000+ no exercise in past 30 days –91,000+ not consuming 5 or more fruits & vegetables per day –26,000+ smoke –15,900+ at risk for binge drinking –37,000+ with high blood pressure –35,700+ with high cholesterol –15,700+ with asthma –11,000+ with diabetes National rates of childhood overweight range from 10-16 percent, suggesting 3,700-6,000 children in the Virginia service region may be overweight. Rates in the Virginia Study Region were near or above Virginia statewide rates on most indicators. Rates in Gates County, NC are similar to the Virginia Service Region rates. See Appendix A for detail.

12. Unofficial Discussion Draft Subject to Change 12 Additional Issues Community Survey Responses –Community Survey Respondents were asked to identify local health concerns expected to emerge in the Virginia Service Region over next 1-3 years –Most frequently mentioned emerging local health issues: Medical Product Safety Public Health Infrastructure Occupational Safety & Health Vision & Hearing Food Safety

13. Unofficial Discussion Draft Subject to Change 13 Part 1. Health Demographic Indicators Purpose –Health status is highly influenced by a person’s age, sex, race, ethnicity, education, and income. Content –Chart 1.1-1.5 provide a demographic profile of the Virginia Service Region. Source –CHRC analysis of data from SRC Corporation, a commercial vendor of demographic data.

14. Unofficial Discussion Draft Subject to Change 14 Chart 1.1 Population Change 2000-2011 Indicator Desired DirectionFranklin Isle of Wight Southam ptonSuffolkSurrySussex Virginia Study RegionVirginia Population 2000 - 8,346 29,728 17,482 63,677 6,829 12,504 138,566 7,078,515 Population 2005-8,33933,17117,23379,2877,05711,639156,7267,538,791 Population 2011-8,64537,05917,07897,0637,17011,499178,5148,078,397 Population Growth 2000-2011-2997,331-40433,386341-1,00539,948999,882 Percent Growth 2000- 2011-4%25%-2%52%5%-8%29%14% The Virginia Service Region population is expected to grow by 29 percent from 2000 to 2011, with Suffolk and Isle of Wight driving the increase. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

15. Unofficial Discussion Draft Subject to Change 15 Chart 1.2 Population by Age 2005 Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Age 0-17 2005-2,0407,5753,53520,6681,5972,17537,5901,811,335 Percent Age 0-17 2005-24%23%21%26%23%19%24% Age 18-64 2005-4,80221,24011,11949,9474,4297,79799,3344,845,084 Percent Age 18-64 2005-58%64%65%63% 67%63%64% Age 65 Plus 2005-1,4974,3562,5798,6721,0311,66719,802882,375 Pct Age 65 Plus 2005-18%13%15%11%15%14%13%12% The Virginia Service Region includes more than 37,000 children and more than 19,800 seniors. The region is slightly older than Virginia as a whole. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

16. Unofficial Discussion Draft Subject to Change 16 Chart 1.3 Population by Race & Ethnicity 2005 IndicatorFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia American Indian or Alaska Native 2005 9 65 26 182 13 12307 16,819 Percent AIAN 20050% Asian Population 200565118356241015867345,897 Percent Asian 20051%0% 1%0% 1%5% Black or African American Pop. 20054,3558,9997,37734,4503,6347,21666,0311,462,507 Percent Black or African Am. 200552%27%43% 51%62%42%19% Hawaiian or Pacific Islander Pop. 200511012122373,776 Percent Hawaiian or Pacific Is. 20050% Multirace Population 2005773141011,03567871,681148,715 Percent Multirace 20051% 2% Other Race Population 200518104473172069575136,887 Percent Other Race 20050% 1%0%2% Percent White 200546%71%56%54%47%36%56%72% White Population 20053,81223,5469,64042,6213,3074,23687,1625,418,426 Hispanic Population 2005764181691,313731562,205435,843 Percent Hispanic 20051%3%1% 2%1% 3% The Virginia Service Region includes a significantly higher proportion of Black or African American residents than the state as a whole. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

17. Unofficial Discussion Draft Subject to Change 17 Chart 1.4 Adult Population by Education Status 2005 Indicator Desired DirectionFranklin Isle of Wight Southam ptonSuffolkSurrySussex Virginia Study RegionVirginia Population Age 25 Plus in 2005-5,48422,45111,91350,7564,7628,374103,7404,994,743 Age 25 Plus and Less than High School Education 2005Lower1,2734,2423,5179,3751,1302,85322,390694,230 Percent Age 25 Plus and Less than High School Education 2005Lower23%19%30%18%24%34%22%14% The Virginia Service Region has lower educational attainment (among adults) than Virginia as a whole. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

18. Unofficial Discussion Draft Subject to Change 18 Chart 1.5 Population by Income Status 2005 Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Per Capita Income 2006Higher$21,363$23,170$18,958$21,141$18,408$16,351$20,704$27,345 Average Household Income 2006Higher$49,295$59,560$47,254$56,088$47,442$42,826$53,812$69,571 Median Household Income 2006Higher$35,968$51,445$38,349$46,456$41,051$34,821$44,359$54,073 Child Poverty Rate 2004Lower24%12%18%15% 21%16%15% Est. Children in PovertyLower 490 909 636 3,100 240 457 5,831 271,700 Students Approved for Free/Reduced School Lunch 2005Lower80%34%40%39%52%74%na33% Est. Population Below 200 Percent Poverty 2005 Lower 3,169 7,961 5,515 24,579 2,329 3,492 47,044 1,809,310 Percent Population Below 200 Percent Poverty 2000 Lower 38%24%32%31%33%30% 24% The Virginia Service Region includes higher rates of poverty and near-poverty than Virginia as a whole. Rates are high for both children and adults. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

19. Unofficial Discussion Draft Subject to Change 19 Part 2. Community Survey Indicators Purpose –Community officials and professionals have valuable insight into community health concerns Content –Charts 2.1-2.6 summarize responses to the survey –Results are for Virginia Service Region only Source –The survey was sent to 180+ community officials and health professionals from a list provided by Obici Healthcare Foundation – 63 valid responses were received –Analysis is by CHRC

20. Unofficial Discussion Draft Subject to Change 20 Chart 2.1 Top Local Health Concerns from Community Survey Overweight, Obesity, & Nutrition was the most frequently named top local health concern in the Virginia Service Region Number of survey respondents (out of 63) identifying issue as among the ‘top five local health concerns.’

21. Unofficial Discussion Draft Subject to Change 21 Chart 2.2 Top Local Health Concerns from Community Survey Number of survey respondents (out of 63) identifying issue as among the ‘top five local health concerns.’ (continued)

22. Unofficial Discussion Draft Subject to Change 22 Chart 2.3 Immediate & Significant Local Health Concerns from Community Survey Number of survey respondents (out of 63) identifying issue as an ‘immediate significant local health concern.’ Overweight, Obesity, & Nutrition was the most frequently named ‘immediate significant local health concern’ in the Virginia Service Region.

23. Unofficial Discussion Draft Subject to Change 23 Chart 2.4 Immediate & Significant Local Health Concerns from Community Survey Number of survey respondents (out of 63) identifying issue as an ‘immediate significant local health concern.’ (continued)

24. Unofficial Discussion Draft Subject to Change 24 Chart 2.5 Emerging Local Health Concerns from Community Survey Medical Product Safety, Public Health Infrastructure, Occupational Safety & Health, Vision & Hearing, and Food Safety were the most frequently identified emerging local health issues in the Virginia Service Region. Number of survey respondents (out of 63) identifying issue as ‘not a significant concern now, but may be in 1-3 years.’

25. Unofficial Discussion Draft Subject to Change 25 Chart 2.6 Emerging Local Health Concerns from Community Survey (continued) Number of survey respondents (out of 63) identifying issue as ‘not a significant concern now, but may be in 1-3 years.’

26. Unofficial Discussion Draft Subject to Change 26 Part 3. Mortality Indicators Purpose –Leading causes of death provide important insights into the health and concerns of a population Content –Charts 3.1-3.4 show the leading causes of death in terms of counts, deaths per 100,000 population, and age-adjusted deaths per 100,000 population. Source –CHRC analysis of 2004 data from the Virginia Department of Health

27. Unofficial Discussion Draft Subject to Change 27 Chart 3.1 Leading Causes of Death Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Total Deaths 2004 Lower 113 323 184 670 47 125 1,462 56,312 Deaths per 100,000 Population Lower 1,334 985 1,046 875 674 1,049 947 755 Age-adjusted Deaths per 100,000 Population Lower939.21002.4961.71000.6606.9948.1na806.0 Diseases of the Heart Total Deaths 2004 Lower388849165142838213,850 Deaths per 100,000 Population Lower448.5268.4278.6215.4200.9235247.5185.7 Age-adjusted Deaths per 100,000 Population Lower294.6278.5246.9252.0180.3211.3na200.5 Malignant Neoplasms Total Deaths 2004 Lower237944149152533513,005 Deaths per 100,000 Population Lower271.5241250.2194.5215.2209.8217.1174.3 Age-adjusted Deaths per 100,000 Population Lower192.9229.5218.2219.8198.6186.0na182.4 Cerebrovascular Disease Total Deaths 2004 Lower213104825803,681 Deaths per 100,000 Population Lower23.639.756.962.728.74251.849.3 Age-adjusted Deaths per 100,000 Population Lower14.441.849.373.127.137.1na54.0 In 2004, multiple localities had age-adjusted death rates above the statewide rate for overall deaths, heart disease deaths, and cancer deaths. Suffolk had a higher rate for cerebrovascular disease deaths. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

28. Unofficial Discussion Draft Subject to Change 28 Chart 3.2 Leading Causes of Death Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Chronic Lower Respiratory Disease Total Deaths 2004 Lower61642416572,652 Deaths per 100,000 Population Lower70.848.822.731.314.350.436.935.5 Age-adjusted Deaths per 100,000 Population Lower48.948.620.236.710.044.7na38.8 Unintentional Injury Total Deaths 2004 Lower311183327742,458 Deaths per 100,000 Population Lower35.433.6102.443.128.758.848.032.9 Age-adjusted Deaths per 100,000 Population Lower23.533.399.845.423.658.3na33.7 Diabetes Mellitus Total Deaths 2004 Lower41153006561,555 Deaths per 100,000 Population Lower47.233.628.439.2050.436.320.8 Age-adjusted Deaths per 100,000 Population Lower34.831.025.645.10.044.4na22.0 Alzheimer's Disease Total Deaths 2004 Lower41342201441,452 Deaths per 100,000 Population Lower47.239.722.728.708.428.519.5 Age-adjusted Deaths per 100,000 Population Lower28.846.620.335.70.07.6na22.0 In 2004, multiple localities had age-adjusted death rates above the statewide rate for chronic lower respiratory disease, unintentional injury, diabetes, and Alzheimer’s. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

29. Unofficial Discussion Draft Subject to Change 29 Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Pneumonia and Influenza Total Deaths 2004 Lower7651226381,401 Deaths per 100,000 Population Lower82.618.328.415.728.750.424.618.8 Age-adjusted Deaths per 100,000 Population Lower58.617.525.918.423.645.9na20.8 Nephritis and Nephrosis Total Deaths 2004 Lower5161404301,232 Deaths per 100,000 Population Lower593.134.118.3033.619.416.5 Age-adjusted Deaths per 100,000 Population Lower46.92.730.420.90.029.7na17.9 Septicemia Total Deaths 2004 Lower1741402281,160 Deaths per 100,000 Population Lower11.821.422.718.3016.818.115.5 Age-adjusted Deaths per 100,000 Population Lower9.122.118.721.20.015.2na16.8 Suicide Total Deaths 2004 Lower06170216805 Deaths per 100,000 Population Lower018.35.79.1016.810.410.8 Age-adjusted Deaths per 100,000 Population Lower0.018.66.89.60.016.7na10.6 Chart 3.3 Leading Causes of Death In 2004, multiple localities had age-adjusted death rates above the statewide rate for Pneumonia & Influenza, Nephritis & Nephrosis, Septicemia, and Suicide. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

30. Unofficial Discussion Draft Subject to Change 30 Chart 3.4 Leading Causes of Death Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Pneumonitis due to Solids and Lquids Total Deaths 2004 Lower0.02.00.04.01.04.011.0525.0 Deaths per 100,000 Population Lower0.06.10.05.214.333.67.17.0 Age-adjusted Deaths per 100,000 Population Lower0.05.80.06.012.929.7na7.8 Chronic Liver Disease Total Deaths 2004 Lower2104119508 Deaths per 100,000 Population Lower23.63.105.214.38.45.86.8 Age-adjusted Deaths per 100,000 Population Lower20.53.50.05.810.07.5na6.7 Homicide and Legal Intervention Total Deaths 2004 Lower12330312412 Deaths per 100,000 Population Lower11.86.117.13.9025.27.85.5 Age-adjusted Deaths per 100,000 Population Lower11.46.018.33.80.026.1na5.5 In 2004, multiple localities had age-adjusted death rates above the statewide rate for pneumonitis, chronic liver disease, and homicide/legal intervention. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

31. Unofficial Discussion Draft Subject to Change 31 Part 4. Birth Indicators Purpose –Birth indicators provide insight into maternal and child health and health care access Content –Charts 4.1-4.5 show counts and rates for several common birth indicators. Source –CHRC analysis of 2004 data from the Virginia Department of Health

32. Unofficial Discussion Draft Subject to Change 32 Chart 4.1 Total Pregnancies Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Total Pregnancies - 210 455 209 1,636 91 159 2,760137,157 Induced Terminations of Pregnancy Lower476722355202753825,918 Natural Fetal Deaths Lower9331595791687,409 Total Live Births Higher 154 355 172 1,186 64 123 2,054 103,830 Birth Rate/1,000 Estimated Population-18.210.89.815.59.210.3 14.0713.9 In 2004, the region had 2,760 pregnancies resulting in 2,054 live births. Franklin, Suffolk, and the region as a whole had birth rates above the statewide rate. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

33. Unofficial Discussion Draft Subject to Change 33 Chart 4.2 Low Birth Weight and Late Prenatal Care Births Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Low Weight Births Low Weight Birth (<2,500 grams)Lower1726171214101958,674 Low Weight Birth Percent of Total BirthsLower117.39.910.26.38.1 9.58.4 Late/No Prenatal Care Births Began Care in First 13 WeeksHigher1263321501,06154105182888,054 Began Care After 13 WeeksLower 28 23 22 125 10 18 226 15,776 Percent Began Care After 13 WeeksLower 18.2 6.5 12.8 10.5 15.6 14.6 11.0 15.2 In 2004 there were 195 low weight births and 226 late or no prenatal care births. The low birth weight rate was higher than the statewide rate in three localities and the region as a whole. The late/no prenatal care rate was above the state rate in Franklin. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

34. Unofficial Discussion Draft Subject to Change 34 Chart 4.3 Non-marital Births Indicator Desired Direction Frankli n Isle of Wight Southam ptonSuffolkSurrySussex Virginia Study RegionVirginia Non-Marital BirthsLower8811371408286577332,190 Percent Non-Marital BirthsLower57.131.841.334.443.852.8 37.6331 In 2004 there were 773 non-marital births. The non-marital birth rate exceeded the statewide rate throughout the region. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

35. Unofficial Discussion Draft Subject to Change 35 Chart 4.4 Teen Pregnancies Indicator Desired Direction Frankli n Isle of Wight Southam ptonSuffolkSurrySussex Virginia Study RegionVirginia Total Teenage PregnanciesLower38472319272933613,343 Preg Rate/1,000 Pop Ages 10-19Lower60.121.621.134.313.545.7na26.5 Pregnancies Ages<15 yrsLower0016018293 Preg Rate/1,000 Pop Ages<15Lower001.82.103.1na1.2 Pregnancies Ages 15-17Lower1422571171203,906 Preg Rate/1,000 Ages 15-17Lower65.433.414.338.95.334na26 Pregnancies Ages 18-19Lower2425171156212089,144 Preg Rate/1,000 Ages 18-19Lower237.671100134.362.5198.1na92 In 2004 there were 336 teenage pregnancies, including 128 to teens under 18. Teen pregnancy rates were above the statewide rate in multiple localities. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

36. Unofficial Discussion Draft Subject to Change 36 Chart 4.5 Infant Deaths Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Total Infant Deaths 2004Lower344120124768 Five-Year Infant Death Rate/1,000 Live Births 2000-2004Lower11.85.88.39.68.513.3na7.4 In 2004 there were 24 infant deaths. Over the period 200-2004, the infant death rate was higher than the statewide rate in every locality except Isle of Wight. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

37. Unofficial Discussion Draft Subject to Change 37 Part 5. Adult Health Status Estimates Purpose –Adult health status estimates paint a picture of community health beyond death rates, birth rates, and hospitalization rates. Content –Charts 5.1-5.4 contain local estimates of adult health status. –The figures are ‘synthetic estimates’ based on application of statewide and national survey data to local demographics. They are for planning purposes only, and are not guaranteed for accuracy. Source –CHRC analysis of data from the National Behavioral Risk Factor Surveillance Survey and demographic data from SRC, Inc.

38. Unofficial Discussion Draft Subject to Change 38 Chart 5.1 Adult Health Limitation Estimates Indicator Desired DirectionFranklin Isle of Wight Southam ptonSuffolkSurrySussex Virginia Study RegionVirginia Fair or Poor Health Status 2005Lower1,2284,1472,3979,9651,0211,68520,443851,950 Percent Fair or Poor Health Status 2005Lower20%16%18%17%19%18%17% 15% Limitations Due to Health 2005 Lower 1,222 4,838 2,534 10,610 1,021 1,64721,872 1,018,935 Percent Limitations Due to Health 2005Lower19% 18%19%17%18% In 2005 there were an estimated 20,000+ adults in fair or poor health status. Estimated rates were above the statewide average. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

39. Unofficial Discussion Draft Subject to Change 39 Chart 5.2 Adult Overweight, Obesity, Exercise, and Nutrition Estimates Indicator Desired DirectionFranklin Isle of Wight Southam ptonSuffolkSurrySussex Virginia Study RegionVirginia Overweight or Obese 2005 Lower 3,874 15,383 8,452 35,992 3,374 6,01973,094 3,300,258 Percent Overweight or Obese 2005Lower62%60%62%61%62%64%61% 58% No Exercise in Past 30 Days 2005 Lower 1,757 6,169 3,520 15,124 1,474 2,52730,571 1,315,080 Percent No Exercise in Past 30 Days 2005 Lower 28%24%26% 27% 26% 23% Less Than Five Servings Per Day of Fruits and Vegetables 2005 Lower 4,768 19,658 10,561 45,195 4,150 7,31691,648 4,369,963 Percent Less than Five Servings per Day of Fruits & Vegetables 200576%77% 76%77% In 2005 there were an estimated 73,000+ adults who could be classified as overweight or obese. Overweight/obesity rates were estimated to be above the statewide average throughout the region. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

40. Unofficial Discussion Draft Subject to Change 40 Chart 5.3 Adult Smoking and Alcohol Consumption Estimates Indicator Desired DirectionFranklin Isle of Wight Southam ptonSuffolkSurrySussex Virginia Study RegionVirginia Smoke 2005 Lower 1,291 5,682 3,027 12,955 1,174 2,14826,278 1,285,441 Percent Smoke 2005 Lower 21%22% 23%22% 23% Risk for Binge Drinking 2005 Lower 699 3,558 1,877 7,796 655 1,32515,910 877,214 Percent Risk for Binge Drinking 2005 Lower 11%14% 13%12%14%13% 15% In 2005 there were an estimated 26,000+ adult smokers and an estimated 15,900+ adults at risk for binge drinking. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

41. Unofficial Discussion Draft Subject to Change 41 Chart 5.4 Adult Chronic Disease Estimates Indicator Desired DirectionFranklin Isle of Wight Southam ptonSuffolkSurrySussex Virginia Study RegionVirginia Diabetes (Told by Doctor) 2005 Lower7122,3291,3705,62759595611,589 445,774 Percent Diabetes (Told by Doctor) 2005 Lower 11%9%10% 11%10% 8% High Blood Pressure (Told by Doctor) 2005 Lower2,2427,7304,39718,0551,8623,04737,333 1,525,070 Percent High Blood Pressure (Told by Doctor) 2005 Lower 36%30%32%31%34%32%31% 27% High Cholesterol (Told by Doctor) 2005 Lower1,9907,8844,15017,2931,6822,72635,724 1,646,714 Percent High Cholesterol (Told by Doctor) 2005 Lower 32%31%30% 31%29%30% 29% Asthma (Told by Doctor) 2005 Lower 806 3,251 1,753 7,562 693 1,22115,286 731,758 Percent Asthma (Told by Doctor) 2005 Lower 13% Arthritis (Told by Doctor) 2005 Lower 2,047 7,602 4,041 16,706 1,676 2,58434,656 1,538,622 Percent Arthritis (Told by Doctor) 2005 Lower 33%30% 29%31%27%29% 27% In 2005 there were an estimated 11,500+ adults with diabetes, 37,000+ adults with high blood pressure, 35,700+ with high cholesterol, 15,200+ with asthma, and 34,600+ with arthritis. These estimates assume a diagnosis of the specified disease, and do not include those not yet diagnosed. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

42. Unofficial Discussion Draft Subject to Change 42 Part 6. Health Care Access Indicators Purpose –Access to health care is a fundamental prerequisite for community health. Content –Charts 6.1-6.9 provide various measures of health care access in the Virginia Service Region. Source –Uninsured estimates and adult health care access estimates were produced by CHRC using ‘synthetic estimation techniques’ in which national and state-level survey data are applied to local demographic profiles. –Underserved area designations were obtained from the U.S. Health Resources and Services Administration. –Ambulatory Care Sensitive Condition indicators were produced by CHRC using discharge data from Virginia Health Information, Inc. and population data from SRC, Inc.

43. Unofficial Discussion Draft Subject to Change 43 Chart 6.1 Uninsured Estimates Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Est. Population Below 200 Percent Poverty 2005 Lower 3,169 7,961 5,515 24,579 2,329 3,492 47,044 1,809,310 Est. Uninsured Below 200 Percent Poverty 2005 Lower 856 2,149 1,489 6,636 629 943 12,702 488,514 Est. Uninsured Above 200 Percent Poverty 2005 Lower 465 2,269 1,055 4,924 426 733 9,871 515,653 Est. Uninsured Rate 2005Lower16%13%15% 14% 13% Est. Uninsured Total 2005 Lower 1,321 4,418 2,544 11,560 1,054 1,676 22,573 1,004,167 Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Among the uninsured are an estimated 3,000-5,000 children under 18, and17,500-19,500 adults.

44. Unofficial Discussion Draft Subject to Change 44 Chart 6.2 Adult Health Care Access Estimates Indicator Desired DirectionFranklin Isle of Wight Southam ptonSuffolkSurrySussex Virginia Study RegionVirginia Est. Could Not See Doctor Due to Cost 2005 Lower 901 3,404 1,918 8,558 797 1,43917,017 765,200 Est. Percent Could Not See Doctor Due to Cost 2005 Lower 14%13%14%15% 14% 13% Est. No Dental Visit Past 2 Years 2005 Lower 1,247 4,532 2,676 10,918 1,033 1,90122,307 997,589 Percent No dental visit 2 years 2005Lower20%18%20%19% 20%19% 18% Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

45. Unofficial Discussion Draft Subject to Change 45 Chart 6.3 Underserved Area Designations Access to health care is closely tied to availability of health care providers. Every locality in the region except for Southampton and Franklin have been designated as health professional shortage areas (HPSAs), meaning they may have a shortage of health professionals to meet population need. In addition, Surry County, Sussex County, Gates County are designated as ‘medically underserved areas’ (MUA), indicating they have additional risk factors related to poverty, infant mortality, or both. Designations are made by the Federal Bureau of Primary Health Care in coordination with the Virginia Department of Health. MUA/ HPSA HPSA MUA/ HPSA

46. Unofficial Discussion Draft Subject to Change 46 Charts 6.4-6.9 Ambulatory Care Sensitive Condition Discharges Ambulatory Care Sensitive Conditions are health conditions for which inpatient hospitalization may be avoided with proper ambulatory care. A region with high rates of ACSC discharges may have barriers to ambulatory care utilization. Technical Note: –Virginia Health Information, Inc. requires the following notice to accompany any use of its data: –“VHI has provided non-confidential patient level information used in this report which it has compiled in accordance with Virginia law, but which it has no authority to independently verify. By using this report, the user agrees to assume all risks that may be associated with or arise from the use of inaccurate data. VHI cannot and does not represent that the use of VHI’s data was appropriate for this report, or endorse or support any conclusions of inferences that may be drawn from the use of VHI’s data.”

47. Unofficial Discussion Draft Subject to Change 47 Chart 6.4 Ambulatory Care Sensitive Condition Discharges Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Total Ambulatory Care Sensitive Condition Discharges w/o Psychosis 2005Lower5515894361,5471253363,584 150,932 Ambulatory Care Sensitive Condition Discharges (w/o Psychosis) per 100,000 Population 2005Lower6,6081,7762,5301,9511,7712,8872,287 2,002 In 2005, residents of the Virginia Service Region had 3,548 ACSC discharges from Virginia hospitals. The rate of hospitalization was above the statewide rate in Franklin, Southampton, Sussex, and the region as a whole. Charts 6.5-6.8 show detailed breakouts of ACSC discharges by condition. Chart 6.9 shows separate data on discharges for psychosis, which some researchers also identify as an ambulatory care sensitive condition.

48. Unofficial Discussion Draft Subject to Change 48 Chart 6.5 Ambulatory Care Sensitive Condition Discharges Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Dehydration Discharges 2005Lower151127992922889786 34,555 Dehydration Discharges per 100,000 Pop.Lower1,811383574368397765502458 Congestive Heart Failure Discharges 2005Lower1131331013562061784 24,513 CHF Discharges per 100,000 Pop.Lower1,355401586449283524500325 Bacterial Pneumonia Discharges 2005Lower6780622081950486 23,440 Bact Pneum Discharges per 100,000 Pop.Lower803241360262269430310311 Chronic Obstructive Pulmonary Disease Discharges 2005Lower354629114931264 14,097 COPD Discharges per 100,000 Pop.Lower420139168144128266168187 Asthma Discharges 2005Lower323832107817234 10,233 Asthma Discharges per 100,000 Pop.Lower384115186135113146149136 Yellow shading=rates above statewide rate. Use caution in interpreting rates for conditions with less than 30 discharges.

49. Unofficial Discussion Draft Subject to Change 49 Chart 6.6 Ambulatory Care Sensitive Condition Discharges Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Kidney Discharges 2005Lower55314190418239 10,194 Kidney Discharges per 100,000 Pop.Lower6609323811457155152135 Cellulitis Discharges 2005Lower213130103923217 9,646 Cellulitis Discharges per 100,000 Pop.Lower25293174130128198138128 Diabetes Discharges 2005Lower3448151331014254 8,498 Diabetes Discharges per 100,000 Pop.Lower40814587168142120162113 Convulsions Discharges 2005Lower1214104841199 4,122 Convulsions Discharges per 100,000 Pop.Lower14442586157956355 Gastroenteritis Discharges 2005Lower6122202648 2,861 Gastro Discharges per 100,000 Pop.Lower7236122528523138 Yellow shading=rates above statewide rate. Use caution in interpreting rates for conditions with less than 30 discharges.

50. Unofficial Discussion Draft Subject to Change 50 Chart 6.7 Ambulatory Care Sensitive Condition Discharges Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Hypertension Discharges 2005Lower431234439 2,133 Hypertension Discharges per 100,000 Pop.Lower48962957342528 Angina Discharges 2005Lower476100330 2,105 Angina Discharges per 100,0000 Pop.Lower482135130261928 Epilepsy Discharges 2005Lower612101020 1,204 Epilepsy Discharges per 100,000 Pop.Lower72312131401316 Iron Deficiency Anemia Discharges 2005Lower31072215 753 Iron Deficiency Anemia Discharges per 100,000 Pop.Lower36309281710 Severe ENT Infection Discharges 2005Lower26282323 959 Severe ENT Discharges per 100,000 Pop.Lower2418121028261513 Yellow shading=rates above statewide rate. Use caution in interpreting rates for conditions with less than 30 discharges.

51. Unofficial Discussion Draft Subject to Change 51 Chart 6.8 Ambulatory Care Sensitive Condition Discharges Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Pelvic Inflammatory Disease Discharges 2005Lower461132430 941 PID Discharges per 100,000 Pop.Lower481861628341912 Dental Condition Discharges 2005Lower1223008 374 Dental Discharges per 100,000 Pop.Lower126 40055 Tuberculosis Discharges 2005Lower1311107 179 Tuberculosis Discharges per 100,000 Pop.Lower1296114042 Hypoglycemia Discharges 2005Lower0001001 125 Hypoglycemia Discharges per 100,000 Pop.Lower00010012 Yellow shading=rates above statewide rate. Use caution in interpreting rates for conditions with less than 30 discharges.

52. Unofficial Discussion Draft Subject to Change 52 Chart 6.9 Ambulatory Care Sensitive Condition Discharges: Psychosis Indicator Desired DirectionFranklin Isle of Wight Southa mptonSuffolkSurrySussex Virginia Study RegionVirginia Psychosis Discharges 2005Lower641095232059122726 40,694 Psychosis Discharges per 100,000 Population 2005Lower7673293024048361,048463 540 Yellow shading=rates above statewide rate. Use caution in interpreting rates for conditions with less than 30 discharges. Note: Psychosis is treated separately in this study because some but not all researchers identify psychosis as an ambulatory care sensitive condition.

53. Unofficial Discussion Draft Subject to Change 53 Appendix A. Gates County, NC Indicators Gates County, NC is treated separately in this report for two reasons: –1) Data for some indicators were not available in the same format or for the same year as the Virginia Study Region –2) the Survey of Local Health Professionals and Community Leaders was limited to the Virginia Study Region.

54. Unofficial Discussion Draft Subject to Change 54 Chart A.1 Gates County Population Profile IndicatorValue Population 2000 10,516 Population 2005 11,060 Population 2011 11,519 Population Growth 2000-2011 1,003 Percent Growth 2000-201110% Source: CHRC analysis of data from SRC Corp.

55. Unofficial Discussion Draft Subject to Change 55 Chart A.2 Gates County Race & Ethnicity Profile IndicatorValue American Indian or Alaska Native 38 Percent AIAN 0% Asian Population 2005 36 Percent Asian 2005 0% Black or African American Population 2005 4249 Percent Black or African American 2005 38% Hawaiian or Pacific Islander Population 2005 3 Percent Hawaiian or Pacific Islander 2005 0% Multirace Population 2005 97 Percent Multirace 2005 1% Other Race Population 2005 11 Percent Other Race 2005 0% White Population 2005 6626 Percent White 2005 60% Hispanic Population 2005 92 Percent Hispanic 2005 0% Source: CHRC analysis of data from SRC Corp.

56. Unofficial Discussion Draft Subject to Change 56 Chart A.3 Gates County Age Profile IndicatorValue Age 0-17 2005 2583 Percent Age 0-17 2005 23% Age 18-64 2005 6832 Percent Age 18-64 2005 62% Age 65 Plus 2005 1645 Pct Age 65 Plus 2005 15% Source: CHRC analysis of data from SRC Corp.

57. Unofficial Discussion Draft Subject to Change 57 Chart A.4 Gates County Educational Attainment & Economic Profile IndicatorValue Education Population Age 25 Plus in 2005 7,370 Age 25 Plus and Less than High School Education 2005 1810 Percent Age 25 Plus and Less than High School Education 2005 25% Economic Status Per Capita Income 2006 $ 18,290 Average Household Income 2006 $ 47,623 Median Household Income 2006$39,802 Child Poverty Rate 2004 18% Est. Children in Poverty 462 Est. Population Below 200 Percent Poverty 2005 3,871 Percent Population Below 200 Percent Poverty 2000 35% Source: CHRC analysis of data from SRC Corp.

58. Unofficial Discussion Draft Subject to Change 58 Chart A.5 Gates County Health Care Access Profile IndicatorValue Medically underserved as of 2006 Yes Uninsured Estimates Est. Population Below 200 Percent Poverty 2005 3,871 Est. Uninsured Below 200 Percent Poverty 2005 1,045 Est. Uninsured Above 200 Percent Poverty 2005 647 Est. Uninsured Rate 2005 15% Est. Uninsured Total 2005 1,692 Adult Access Estimates Est. Could Not See Doctor Due to Cost 2005 1,102 Est. Percent Could Not See Doctor Due to Cost 2005 13% Est. No Dental Visit Past 2 Years 2005 1,865 Percent No dental visit 2 years 2005 22% Source: CHRC synthetic estimates using National Behavioral Risk Factor Surveillance Survey data applied to local demographic data from SRC Corp.

59. Unofficial Discussion Draft Subject to Change 59 Chart A.6 Gates County Mortality Profile IndicatorValue Deaths from All Causes Total Deaths 2005 118 Deaths per 100,000 Population 204 Age-adjusted Deaths per 100,000 Population 226.8 Diseases of the Heart Total Deaths 2005 23 Deaths per 100,000 Population 205 Age-adjusted Deaths per 100,000 Population 233.9 Malignant Neoplasms Total Deaths 2005 31 Deaths per 100,000 Population 276.3 Age-adjusted Deaths per 100,000 Population 209.1 Cerebrovascular Disease Total Deaths 2005 11 Deaths per 100,000 Population 98 Age-adjusted Deaths per 100,000 Population 62.9 Chronic Lower Respiratory Disease Total Deaths 2005 5 Deaths per 100,000 Population 44.6 Age-adjusted Deaths per 100,000 Population 46 Source: CHRC analysis of data from NC Department of Health

60. Unofficial Discussion Draft Subject to Change 60 Chart A.7 Gates County Mortality Profile (continued) IndicatorValue Unintentional Injury Total Deaths 2005 2 Deaths per 100,000 Population 17.8 Age-adjusted Deaths per 100,000 Population NA Diabetes Mellitus Total Deaths 2005 7 Deaths per 100,000 Population 62.4 Age-adjusted Deaths per 100,000 Population 53.7 Alzheimer's Disease Total Deaths 2005 1 Deaths per 100,000 Population 8.9 Age-adjusted Deaths per 100,000 Population 17.5 Pneumonia and Influenza Total Deaths 2005 2 Deaths per 100,000 Population 17.8 Age-adjusted Deaths per 100,000 Population 9.8 Nephritis and Nephrosis Total Deaths 2005 2 Deaths per 100,000 Population 17.8 Age-adjusted Deaths per 100,000 Population 11 Source: CHRC analysis of data from NC Department of Health

61. Unofficial Discussion Draft Subject to Change 61 Chart A.8 Gates County Mortality Profile (continued) IndicatorValue Septicemia Total Deaths 2005 3 Deaths per 100,000 Population 26.7 Age-adjusted Deaths per 100,000 Population 24.6 Suicide Total Deaths 2005 2 Deaths per 100,000 Population 17.8 Age-adjusted Deaths per 100,000 Population 5.4 Chronic Liver Disease Total Deaths 2005 0 Deaths per 100,000 Population 0 Age-adjusted Deaths per 100,000 Population 6.7 Homicide and Legal Intervention Total Deaths 2005 2 Deaths per 100,000 Population 17.8 Age-adjusted Deaths per 100,000 Population 15.2 Source: CHRC analysis of data from NC Department of Health

62. Unofficial Discussion Draft Subject to Change 62 Chart A.9 Gates County Birth Profile IndicatorValue Pregnancies Total Pregnancies 172 Induced Terminations of Pregnancy 44 Natural Fetal Deaths 1 Total Live Births 127 Birth Rate/1,000 Estimated Population 11.5 Source: CHRC analysis of data from NC Department of Health

63. Unofficial Discussion Draft Subject to Change 63 Chart A.10 Gates County Birth Profile (continued) IndicatorValue Non-Marital Births 64 Percent Non-Marital Births 50% Low Weight Births Low Weight Birth (<2,500 grams) 19 Low Weight Birth Percent of Total Births 15% Late/No Prenatal Care Births Began Care in First 13 Weeks 111 Began Care After 13 Weeks 16 Percent Began Care After 13 Weeks 13% Source: CHRC analysis of data from NC Department of Health

64. Unofficial Discussion Draft Subject to Change 64 Chart A.11 Gates County Birth Profile (continued) IndicatorValue Teen Pregnancy Total Teenage Pregnancies 30 Preg Rate/1,000 Pop Ages 10-19 52.3 Pregnancies Ages<15 yrs 0 Preg Rate/1,000 Pop Ages<15 na Pregnancies Ages 15-17 12 Preg Rate/1,000 Ages 15-17 na Pregnancies Ages 18-19 18 Preg Rate/1,000 Ages 18-19 na Source: CHRC analysis of data from NC Department of Health

65. Unofficial Discussion Draft Subject to Change 65 Chart A.12 Gates County Adult Health Status Indicators IndicatorValue Adult Population 2005 8,477 Fair or Poor Health Status 2005 1,335 Percent Fair or Poor Health Status 2005 16% Limitations Due to Health 2005 1,526 Percent Limitations Due to Health 200518% Source: CHRC synthetic estimates using National Behavioral Risk Factor Surveillance Survey data applied to local demographic data from SRC Corp.

66. Unofficial Discussion Draft Subject to Change 66 Chart A.13 Gates County Adult Health Status Indicators (continued) IndicatorValue Overweight or Obese 2005 5,256 Percent Overweight or Obese 200562% No Exercise in Past 30 Days 2005 2,204 Percent No Exercise in Past 30 Days 2005 26% Less Than Five Servings Per Day of Fruits and Vegetables 2005 6,358 Percent Less Than Five Servings Per Day of Fruits and Vegetables 2005 75% Smoke 2005 1,950 Percent Smoke 2005 23% Risk for Binge Drinking 2005 1,102 Percent Risk for Binge Drinking 2005 13% Source: CHRC synthetic estimates using National Behavioral Risk Factor Surveillance Survey data applied to local demographic data from SRC Corp.

67. Unofficial Discussion Draft Subject to Change 67 Chart A.14 Gates County Adult Health Status Indicators (continued) IndicatorValue Diabetes (Told by Doctor) 2005 839 Percent Diabetes (Told by Doctor) 2005 10% High Blood Pressure (Told by Doctor) 2005 2,560 Percent High Blood Pressure (Told by Doctor) 2005 30% High Cholesterol (Told by Doctor) 2005 2,357 Percent High Cholesterol (Told by Doctor) 2005 28% Asthma (Told by Doctor) 2005 1,119 Percent Asthma (Told by Doctor) 2005 13% Arthritis (Told by Doctor) 2005 2,543 Percent Arthritis (Told by Doctor) 2005 30% Source: CHRC synthetic estimates using National Behavioral Risk Factor Surveillance Survey data applied to local demographic data from SRC Corp.

68. Unofficial Discussion Draft Subject to Change 68 Appendix B. Table of Charts Part 1 Health Demographic Indictors Chart 1.1 Population Change 2000-2011 (Slide 14) Chart 1.2 Population by Age 2005 (Slide 15) Chart 1.3 Population by Race & Ethnicity 2005 (Slide 16) Chart 1.4 Adult Population by Education Status 2005 (Slide 17) Chart 1.5 Population by Income Status 2005 (Slide 18) Part 2 Community Survey Chart 2.1 Top Local Health Concerns from Community Survey (Slide 20) Chart 2.2 Top Local Health Concerns from Community Survey Cont. (Slide 21) Cart 2.3 Immediate & Significant Local Health Concerns from Community Survey (Slide 22) Chart 2.4 Immediate & Significant Local Health Concerns from Community Survey Cont. (Slide 23) Chart 2.5 Emerging Local Concerns from Community Survey (Slide 24) Chart 2.6 Emerging Local Concerns from Community Survey Cont. (Slide 25) Part 3 Mortality Indicators Chart 3.1 Leading Causes of Death (Slide 27) Chart 3.2 Leading Causes of Death Cont. (Slide 28) Chart 3.3 Leading Causes of Death Cont. (Slide 29) Chart 3.4 Leading Causes of Death Cont. (Slide 30) Part 4 Birth Indicators Chart 4.1 Total Pregnancies (Slide 32) Chart 4.2 Low Birth Weight and Late Prenatal Care Births (Slide 33) Chart 4.3 Non-marital Births (Slide 34) Chart 4.4 Teen Pregnancies (Slide 35) Part 5 Adult Health Status Estimates Chart 5.1 Adult Health Limitation Estimates (Slide 38) Chart 5.2 Adult Overweight, Obesity, and Nutrition Estimates (Slide 39) Chart 5.3 Adult Smoking and Alcohol Consumption Estimates (Slide 40) Chart 5.4 Adult Chronic Disease Estimates (Slide 41) Part 6 Health Care Access Indicators Chart 6.1 Uninsured Estimates (Slide 43) Chart 6.2 Adult Health Care Access Estimates (Slide 44) Chart 6.3 Uninsured Area Designations (Slide 45) Chart 6.4 Ambulatory Care Sensitive Condition Discharges (Slide 46) Chart 6.5 through Chart 6.8 Ambulatory Care Sensitive Condition Discharges (Slides 47-51) Chart 6.9 Ambulatory Care Sensitive Condition Discharges: Psychosis (Slide 52) Appendix A: Gates County, NC Indicators Chart A.1 Gates County Population Profile (Slide 54) Chart A.2 Gates County Race & Ethnicity Profile (Slide 55) Chart A.3 Gates County Age Profile (Slide 56) Chart A.4 Gates County Educational Attainment & Economic Profile (Slide 57) Chart A.5 Gates County Health Care Access Profile (Slide 58) Chart A.6 Gates County Mortality Profile (Slide 59) Chart A.7 – Chart A.8 Gates County Mortality Profile (Slides 60-61) Charts A.9-Chart A.11 Gates County Birth Profile (Slides 62- 64) Chart A.12 –Chart A.14Gates County Adult Health Status Indicators (Slides 65-67)