An Issue of Sentinel City Simulation

In 2012, Sentinel City has an overall estimated population of 634,265 and as a whole, the percentage of persons below the poverty level from 2008-2012 is 18.9% (Sentinel City, n.d.). In the city, there are four separate neighborhoods including Industrial Heights, Casper Park District, Acer Tech Center, and Nightingale Square. Looking at each neighborhood and starting with Industrial Heights, the median household income is $24,672 and the percentage of uninsured residents under age 65 is 37.5%. In Casper Park District, the median household income is $80,134 and the percentage of uninsured residents under 65 is 0.7%. In Acer Tech Center, the median household income is $166,300 and the percentage of uninsured residents under age 65 is 1.5%. Lastly, in Nightingale Square, the median household income is $269,550 and the percentage of uninsured residents under 65 is 0.7%. Furthermore, Industrial Heights has a population of 38,855, Casper Park has a population of 352,643, Acer Tech has a population of 168,390 and Nightingale Square has a population of 103,974. Looking at the age percentage breakdown of Sentinel City, 7.4% of the population are under 5 years, 21.7% under 18%, and 10.5% 65 years and older. Looking at the race percentage breakdown of Sentinel City, 80% of the population is white alone, 10.4% black or African American alone, 2.0% American Indian and Alaska Native alone, 3.7% Asian alone and 0.2% Pacific Islander alone (Sentinel City, n.d.).

When touring the city, apparent safety hazards include stray animals, buildings in disrepair and pollution among other things. It seemed as though the neighborhood of Industrial Heights had the most apparent safety hazards. There were several trash cans knocked over and spilling out garbage around the neighborhood as well as a few buildings emitting what looked like pollution from smoke. There was a stray dog across from the downtown store and graffiti on the walls of several buildings. While driving, there was also a motorcyclist who ran a red light and seemed to be driving recklessly. In terms of drug use in the city, 24% of the population is using tobacco, 26% using alcohol, 12% using marijuana, 5% using cocaine, 7% using heroin, 1% using methamphetamines, 2% using club drugs, and 5% using CNS depressants. Common arrest charges include public intoxication 6%, cannabis 23%, warrant for arrest 23%, battery 17%, controlled substance 16%, criminal trespassing 9%, reckless conduct 6% (Sentinel City, n.d.). However, on the trending data graphs, it looks as if crime is overall on the downward slope this year which is a good sign. EMS response time is less than that of two other comparison cities clocking in at around 7 minutes 30 seconds.

Stopping at the Department of Parks and Recreation, several programs are offered including swimming lessons, nutrition and gardening courses, kids summer programs, city sports leagues, adult fitness courses, and after school programs. Furthermore, there is a fairly large percentage of trespassing after hours (31%) as well as violent crimes (24%) and the most common park complaint last year was the homeless population. Stopping next at the Healthcare System, 6.8% of seniors use senior transportation and 7.6% of seniors use government entitlement assistance with the other services provided used to a lesser extent (Sentinel City, n.d.). The elderly are also offered living unit options in the form of independent apartments, long-term case, skilled nursing, and nursing homes. Driving next to City Hall, there are a number of adult and child protective services offered including adoption assistance, head/early head start and several others. There are around 200,000 citizens using Medicaid and just over 100,000 using Medicare (Sentinel City, n.d.). The Social Services Department also offers WIC to women and children as well as SNAP. The Better Health Clinic offers services to citizens such as contraception, pregnancy testing, STD services and cancer screening. Moreover, looking at the Teen Pregnancy graph, last year pregnancy in females ages 15-17 was on the rise at just under 500 (Sentinel City, n.d.). Next stopping at the Soup Kitchen located in Interfaith Church, homeless adults make up 64% of the clients served (Sentinel City, n.d.). Lastly, the Affordable Housing Project offers 1-and-2 bedroom units as well as studio units. Common tenant complaints vary from dogs barking and factory smoke to loitering and police activity.

Data/Needs Assessment Summary

Using the Windshield Survey along with the above three tools, Sentinel City and its four neighborhoods share several attributes that contribute to its citizens leading a healthy and safe lifestyle. However, some areas in the city also show signs of unsafe socioeconomic factors that limit the ability of its citizens to live these healthy lifestyles. There are 9 total determinants of health including income and social status, employment and working conditions, physical environments, health services, education, etc. Specifically in the neighborhood of Industrial Heights, low household income and a high percentage of uninsured residents show signs of these socioeconomic factors. This neighborhood also has the most apparent hazards out of the four. In addition, based on data collected, it seems as though there is a problem with the homeless population in the city. These all act as barriers for this community to lead healthy lifestyles. Sentinel city needs to begin to focus on eliminating these negative socioeconomic factors by, for example, economic development and more strict crime control which will ultimately impact the city’s health, living conditions and neighborhood surroundings and environment as a whole. If specific epidemiology data pertaining to mortality and birth rates were available, the city would be able to be analyzed further. However, we can look at an epidemiologic triangle and analyze the relationship between Sentinel City’s causal agents, susceptible persons, and environmental factors. Agents found in the city include infectious agents such as viruses, chemical agents such as toxic chemicals and pollution, and physical agents such as machinery. Hosts include characteristics such as age age, sex, diet, and exercise. Environment includes human population distribution, socioeconomic factors, and working conditions. In Sentinel City, it is clear that pollution is prevalent and crowding may be a problem based on the population of several of the neighborhoods. These and other elements, if changed can increase or decrease a citizen’s risk for disease. For instance, the elderly population [(10.5% of Sentinel City (Sentinel City, n.d.)] may be at higher risk to some of these elements than others, especially if, for example, pollution or viruses were on the uptrend. These are just a few examples of epidemiologic factors evident in Sentinel City.

Community Diagnoses

Based on Healthy People 20/20, Sentinel City’s first problem is substance abuse. The goal that pertains to this is “to reduce substance abuse to protect the health, safety, and quality of life for all, especially children” (Substance Abuse, 2017). Sentinel City has a problem with a percentage of the population using illicit drugs, such as alcohol and hard drugs like cocaine and heroin. Tobacco and alcohol use are the most common, with marijuana following closely behind. These percentages can be decreased by working on preventing substance abuse from first occurring and by putting a halt on substance abuse that is already occurring. Substance abuse can have a major impact on the community. It can lead to social, physical, mental, and public health problems including violence, abuse, teenage pregnancy, auto accidents, crime and even homicide or suicide. Interventions can include drug screening, behavioral counseling, sobriety checkpoint programs, mentoring programs to prevent drug and alcohol abuse from occurring in the first place, and mass media campaigns (Substance Abuse - Interventions & Resources, 2017).

The second problem that Sentinel City has is injury and violence, with a Healthy People 20/20 goal of “prevent(ing) unintentional injuries and violence, and reduce(ing) their consequences” (Injury and Violence Prevention – Overview, 2017). Sentinel City has records of battery, criminal trespassing, reckless conduct, and several others. Specifically, gang-related crime ranges from simple assault to homicide. Men make up more of the victims who committed crimes in Sentinel City than women. According to Healthy People 20/20, “both unintentional injuries and those caused by acts of violence are among the top 15 killers for Americans of all ages” (Injury and Violence Prevention – Overview, 2017). Prevention of injury and violence can have a significant impact on citizens of Sentinel City by decreasing the consequences of premature death, poor mental health, high medical costs, and lost productivity. Furthermore, not only can death and serious injury occur, but the cost of crime and violence related injuries can be extraordinary. “The total estimated lifetime medical and work loss costs associated with fatal and non-fatal injuries in the United States was $671 billion in 2013” according to Morbidity and Mortality Weekly Reports (Cost of Injury Data, 2017). Influencing the risk for injury and violence, social environment factors such as education, social norms, relationships, community environment, and attitudes stand tall. By modifying the environment, mandating stricter legislation and enforcement, and working to change behaviors these factors can begin to be addressed. Additionally, a community might focus on changing social norms, fostering safe relationships and environments, and altering policies in order to prevent violence and injury.

Lastly, Sentinel City has a problem with sexually transmitted diseases. Healthy People 20/20 associates this topic with a goal to “promote healthy sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases (STDs) and their complications” (Sexually Transmitted Diseases, 2017). Sentinel City had a total of 7 diagnosed STDS last year, with the majority of them occurring over age 25. STDs can cause socioeconomic burdens, costs, and complications such as infertility, fetal health problems, increased risk for HIV, and cancer. Socioeconomic factors that affect the spreading of STDs include racial disparities, poverty, access to health care, and substance abuse (Sexually Transmitted Diseases, 2017). Several of these factors are apparent in Sentinel City and may be contributing to the STDs occurring. For the third year in a row, STD rates increased as of 2016, specifically chlamydia, gonorrhea and syphilis. The CDC places importance on talking, testing and treating (The State of STDs – Infographic, 2017). With these steps, the goal is to interrupt the climb of STD rates and to promote healthy sexual behaviors to prevent complications from STDs. Community resources available in Sentinel City to address the problem of STDs include STD screening and other unnamed services, basic infertility services, and mental health services such as a free standing psychiatric hospital and case management services that citizens can use if mental and/or emotional help is needed (Sentinel City, 2017). The services directly related to STD screening are found in the Better Health Clinic in Industrial Heights, which is a great resource available to citizens of Sentinel City. Looking at this problem, prevention of sexually transmitted infections is the primary prevention topic of choice for Sentinel City.

Community Assessment Strategies

After developing assessment strategies to use in Sentinel City, I can easily apply some of the same strategies in my own community. Through these strategies, I can better identify community needs, strengths and resources, and problems. I would begin by gathering existing data, such as demographics. This can include age, gender, socioeconomic characteristics, racial distributions, mortality/morbidity data, and community institutions. This data can be found by conducting surveys, viewing published reports, or by contacting the local public health department. I would also conduct a windshield survey by driving around the entire community and taking notes on observations. I would examine housing, transportation, social service centers, commons, street people and animals, race and ethnicity, health indicators, media, and business and industry. From this point, I would work toward identifying a problem for the community, just as done for Sentinel City, and proceed to establish goals and objectives and to identify intervention activities. I would then work toward implementing the work and activities necessary in order to achieve the outlined goals and objectives.