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

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

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

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

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

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

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14 Notes:

15 Trends in Human Need on Cape Cod

16 Maslow's Hierarchy of Needs

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

18 Affordability Key to Overcoming Unmet Health and Human Services Needs

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

20 Notes:

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22 (“The” Central Issue!)

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

24 Trade-Offs ** Affordability **

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

45 Notes:

46 The “Most Needy”

47 Who Are “Most Needy” Compared to Overall Cape Cod Sample: –Problems and Service Barriers: 2.5x to 3x Times More Households Report Problems/Barriers also, 2.5x to 3x Times More Seriousness Reported

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

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

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

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