Linn County Oregon is located in the center of the Willamette Valley and covers
2,309 miles,19 of which are water (US Cesnus Bureau, 2015). It is the grass seed capitol of the world, and thus has a strong, rural culture. According to the US Census Bureau it has a population of 119, 356 people, and there are two hospitals available to serve this population. Because it is a large area with 37% of its residents living in a rural setting, transportation can be problematic. Unfortunately, over 20% of Linn County’s residents live at or below the poverty level and the large outlying area combined with this number can make access to health care a challenge (CityData.com, 2012). Population Economic Status Linn County Oregon consists of 119,356 people with an average household income of $45, 130 for two people. There is 20.5% of the population living below the poverty level and 19.7% of that total is under the age of 18. There is not a lot of cultural diversity in this area, as 93.4% of the population is White, followed by 8.4% Hispanic, and 1.3% Native American. Of that, 18.9% of the White population is living in poverty, 33.3% of the Hispanics, and 43.3% of the Native American’s also live at or below the poverty level (City-Data.com, 2012). Working in an Emergency Department, I see a large amount of the population that uses public assistance, as there tends to be the thought process that it is okay to use the ED for primary care. Twenty-five percent of the population is receiving public assistance. Thirty percent of the population is on Medicare and 2.6% of the population is on Welfare. There is an unemployment rate of 8.2% and has a teen pregnancy rate for ages 15 to 17 of 21.4% (City-Data.com, 2012).

Neighborhood/Community Safety Inventory For this assessment, the communities of Albany and Lebanon, which are the two largest communities in Linn County, were examined. There is very minimal air pollution in this area. Linn County has a ranking of 90 out of 100 in air pollution, which is very good. There are never any days rated as poor and 88% of the days are rated as good in terms of air pollution. The main sources of air pollution are carbon monoxide emissions and volatile organic emissions (Scorecard, n.d. ). Water pollution is minimal except during flooding, when this becomes a problem. Linn County has a lot of rain., and some level of flooding is common. The water rates as a 60 out of 100 for water pollution. There is scant natural radiation in the area and any other environmental pollutants are usually related to farming. Local weather conditions very rarely pose weather threats to the area. Flooding occurs more along the coastal regions of Oregon, but in 1964 there was a large storm that caused multiple deaths and again in 1996, and in 2012 a flood killed two people, when they drove through a parking lot and were swept away (Hazard Analysis, 2012) Snow and ice are rare, but when they occur, they also cause problems because we get it so rarely and we do not have the road equipment to handle it. There are lots of lakes and rivers in the area, so drowning is a hazard in this area. There are not a lot of stray animals in the area, so that is rarely a health risk. Wild animals could serve as a vector, but it is just about unheard of around here, even with all of the rural areas. With all of the farming, there is a lot of allergens in the air, so this can be a problem for asthmatics. There is also a lot of Poison Oak, so this is something that often brings people to the doctor. The buildings in Linn County vary greatly according to where you are at, both in the rural setting and the town setting. The roads are well maintained and building codes are strictly enforced. There is minimal lead exposure, the sanitation and recycling is well utilized, even in the country people recycle. There is a bottle recycling deposit and this adds monetary motivation for people to recycle. Litter patrol helps to keep the streets and highways clean. There are house fires about 4 to10 times a month, and rarely any injuries associated with them. The fire department response time is very low in the urban areas, but of course response time increases the further out that you are. Even in rural areas, it is still almost always below 12 minutes for a response time, as the fire stations are strategically placed throughout the county.
Cultural Assessment Tool There is not a lot of cultural diversity in Linn County. As previously stated it is primarily populated by Whites. There does not seem to be any prevalent racism though. The median age here is 39 (City-Data.com, 2012). Linn County has a greater percentage of its population over age 65 compared to the total population of Oregon. In Linn County, 15.9% of the population is over 65; the number of people over 65 in the state of Oregon is 13.5% . The percent of Linn County between the ages of 19-64 is 53.6%; this is lower than Oregon where 57.2% of the population is between 19-64 (City-Data.com, 2012). About 6.6% of the County is under age 5 and 22.8% of the population is between the ages of 5-18. Just over 50% of the population is also female (Linn County Department of Health, 2014). There are quite a few retirement homes and elder care homes in the county. Recently, Samaritan Health Services announced that they were going to move all of the 45 residents from a nice care facility and change it into a drug rehab center. The community was outraged and made such an outcry about leaving the elderly without a place to go, that SHS changed their minds and have decided to look at other locations. This is a good example to show that there is a lot of support and respect for our elders in the community.
Disaster Assessment and Planning Guide
More than half of Linn County’s population is between the ages of 19-64. Only 16% are over 65 and 22% are of the ages between five and 18. Since 9/11 there has been a large push towards disaster planning. There are plans set in place for major disasters. The greatest threat to this area is the Cascadia earthquake. This looms on the horizon as something that is going to occur, as it is overdue, and is usually around a 9.0 in magnitude. We do not have very many earthquakes, so this has the potential to be a huge disaster. The last one occurred in 1700 and caused a huge tsunami in Japan. These earthquakes normally occur every 240 years, and we are well past that mark now (Hazard Analysis, 2015). In 2012 there was a state wide disaster drill to help prepare for this. The two hospitals located in Linn County also have annual disaster drills. The City of Albany in Linn County did a Hazard Analysis in 2015 and it ranks the top expected disaster in Linn County as snow. There are not any snow plows in the area, so snow is can be potentially disastrous. There is a lot of chronic disease in this area, so this is a problem when people need their prescriptions, or doctor appointments, etc. Seventy percent of the injuries associated with heavy snow fall occur from car accidents (Hazard Analysis, 2015). To help alleviate this problem, there are several local 4X4 clubs that volunteer to transport people to appointments. They will also drive nurses and doctors to work.

Windshield Survey There is a large variation of homes, appearances, and economic status throughout Linn County. I live 16 miles outside of town, so just in the drive into a town, things vary. It is agricultural, with lots of country roads, green grass, fields, cows, sheep, and horses. The homes vary immensely from manufactured homes with big barns, to 1940’s to 2000’s. On the drive in, there is much more open space than there are homes. In town, there is also a big variation. The town of Lebanon, that is the closest town has a lower economic standing than the neighboring town of Albany. Most buildings are made of wood or a composite siding. In downtown Albany, almost all of the homes are historic and built in the 1800’s. In Lebanon, most are 1940’s or more recent. Homes are not built on top of each other like in the bigger cities. Most people have a big backyard and are not sitting in a tiny lot.
There are people out walking. Prior to town, the walker or joggers look to be exercising, but once you move into town, there are more people who look like they are going to the store or possibly up to no good. Being on the I-5 corridor, there is a serious methamphetamine problem in this area. There has also been a recent influx of heroin. Unfortunately, it is hard to drive through either town without seeing the prevalence of these drugs. Although the streets are clean, there are clearly people walking down the streets who are either homeless, on drugs, or mentally ill. There are is one mall in Albany, and that is a major hang out for people of all ages. The greater than sixty-five like to walk there so they can stay dry, the middle aged like to shop, and the younger than 18 like to hang out. There are also a lot of coffee shops around that people meet and hang out at. There are lots of public parks, and lots of young mothers with their children playing at these. People are fairly inviting and open to others. Public transportation is very limited. There is one bus that runs through Albany and out to the local community college. There is a dial-a-bus in Lebanon that transports the elderly. There is currently not even a cab company in Lebanon, although last week when I did my windshield survey, it was still active. There is also a train station in Albany, and this is still utilized by quite a few people, especially for quick trips to Seattle. There are lots of gas stations, banks, grocery stores, and fast food restaurants. Downtown Albany has a different vibe, with the historic and it is limited to high end dining, boutiques, and coffee shops. The other areas of both Lebanon and Albany are filled to the brim with fast food joints, gas stations, Wal-Mart, banks, Costco, and grocery stores. Most parking lots are fairly full. There is a lot of commerce in these towns. There are a lot of trees planted along sidewalks and green grass, flowers, and shrubs planted both in residential and commercial areas. There are parks spread throughout the area. There are lots of city parks throughout Albany and Lebanon and there are county parks and a state park throughout the county. The Willamette Valley has a lot of rain, and so everything is usually lush and green. When you are driving out of town, there are occasional joggers and bicyclists, but once you get in the town of Albany it is more varied. There are mothers pushing strollers, homeless people, and business people walking down the streets. In the center of Albany, there is a homeless shelter that offers beds and food to 100 people, so a lot of the homeless population is centered around this place. It also has several businesses throughout the town to offer these people some work. There are 6 high schools located throughout the county and a lot of elementary schools. The state of neighborhoods varies depending on what part of town you are in. There are well kept yards and some dilapidated homes and yards. It is incredibly variable, as it is in most places. On the whole, there is very minimal litter, yards are mostly maintained, and people are respectful of property. You do not see graffiti or other destructive vandalism. As the majority of the population is Caucasian, there are only signs in English. There are quite a few churches in the area mostly Protestant and Catholic. There are cars parked in the parking lot of some of the larger churches seven days a week. There are a lot of obese people, wheelchair bound people, and smokers out and about most days. There are also people who have mental health problems and those that are on an illicit substance. There are a lot of clinics, doctor’s offices, chiropractor offices, dentists, accupunturists, and massage therapists around the county. Health care is readily available, although there is a shortage of a primary care providers. Even though it is election time, there is not a lot of propaganda around the area. We are in a farming area, so there is a strong Republican contingency, although Oregon is well known for being liberal. A lot of people subscribe to the local paper, Democrat Herald, and there is also the Oregonian and Statesman Journal that people read. Most coffee shops and fast food restaurants also offer free wi-fi.
Population Health Scavenger Hunt Since Linn County covers such a large outlying area, the fire department has to have substations strategically located throughout. The Lebanon Fire District serves 28,000 people and cover an area of 456 square miles. To meet these needs, there are 21 full time employees, three battalion chiefs plus a lot of volunteers. They still have a response time of less than 12 minutes for virtually any area. They respond to thousands of medical calls per year and the fire calls are variable. Albany fire department may have 4 structure fires a week and Lebanon may only do one to four a month. Besides responding to fires, the fire department also goes to car accidents, public assists, medical emergencies, and patient transfers. They all work 24 hour shifts, which can be exhausting on a busy shift with little down time. The medical personnel are always well turned out and professional in appearance. Albany Helping Hands is a homeless shelter in Albany, the largest town in Linn County. It offers food, bedding, and clothing for the homeless community. What sets this shelter apart is that it requires its occupants to work in exchange for their stay. They operate a thrift store, have a wood cutting business, and operate a farm where they sell fresh produce and farm raised chickens. Although there are 100 beds available, this is not enough to meet the county’s needs. Also, it does not allow drinking or drugs, which unfortunately turns a lot of people away. They also expect you to work, although they do make allowances for those that are not physically able. The Boys and Girls Club has facilities both in Lebanon and Albany. They offer after school care for school aged children and for a minimal fee offer childcare during the summer as well. They also have sports such as basketball, volleyball, indoor and outdoor soccer, baseball, and softball.
Interpretation
Epidemiology is the study of disease in a community and the further evaluation of why this disease of condition occurred. Linn County ranks 29th out of Oregon’s 33 counties in morbidity. Morbidity is an attempt to measure the quality of life or health experienced by a specific population (Linn County Health Assessment 2014). The three main causes of death are heart disease, cancer, and COPD. Unfortunately, 18% of its residents report being in poor to fair health, 17% report having inadequate social support, and 8% report on major depressive episode in the past thirty days (Linn County Department of Health Services, 2014). The lack of mental health resources in our area is a big problem. In the Emergency Department in one community we will have three to five mental health patients at a time (in a 12 bed ED) and will end up holding one to two of them for days because there is nowhere for them to go and they are a danger to themselves or others. With nearly 10% of the population feeling despondent in the last 30 days, the lack of resources for mental health is a big concern. Some of the other community concerns are the tobacco rates, lack of childhood immunization, increased chronic diseases, obesity, and decreased rates of preventative screening. There are so many problems in this community, but working in an ED gives a different perspective. Access to healthcare is a huge issue. There are not enough primary care providers. When going to establish care with a provider, the appointment is scheduled for three to six months out. This is fine if you are scheduling ahead and do not actually need anything, but when you have recently been seen in the Emergency Department or were just released from the hospital and have a chronic or new diagnosis that needs to be followed up with, this is a huge obstacle. There is also the problem of a lack of public transportation and people not being able to afford gas or transportation to see a doctor. Healthy People 2020 provides science based national objectives for improving the health of Americans over the next ten years. They also recognize that access to health care is a nationwide problem. Healthy People 2020 states that “access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone.” There are three parts that need to be met for access to healthcare to have the best outcomes. First of all, there needs to be access to the health care system. This is having a Primary Care Provider or Medical Home. Next, there needs to be access to a location where the needed services are provided. Third, the patient must find a PCP that they feel they can trust and communicate with. Not having access to health care impacts an individual’s overall physical and mental health, wellness, quality of life, and potentially may decrease life expectancy (Health People 2020). Another problem is the lack of access to mental health care. There is a huge contingency of mental health in this area and there is not enough case workers or care for people suffering from an acute crisis. People who are undergoing an acute exacerbation do not have a lot of options. They often come in or are brought in for help, but there are not enough beds in the state, and none in Linn County to place these people to help them get through this crisis. Healthy People 2020 also has a lot to say about access to mental health care. Their goal is to improve mental health through prevention and also by making sure that people in need have access to the mental health services that are needed. Mental health disorders are the leading cause of disability in the United States. And in any given year, 13 million American adults have a debilitating mental illness. This has a huge impact on people’s lives and the workforce. A third major problem is the high rate of tobacco use. In Linn County, it is rare to have people say they have never been a smoker, whereas in the neighboring county, it is rare for people to have ever smoked. There are a lot of teenage pregnancies in the county which also translates into a lot of smoking during pregnancy. According to Healthy People 2020, “tobacco use is the single most preventable cause of death and disease in the United States.” Preventing tobacco use is the number one priority using campaigning and education. Next, is to provide the tobacco user with the tools and encouragement necessary to quit smoking (Healthy People 2020). Access to health care is a huge dilemma in Linn County. People have a tendency to use the Emergency Department as their primary care since there are not enough PCP’s in this area. There is a bus operating in Albany, but that does not help anyone in the outlying areas, and it is fairly limited in its route and hours of operation. There is also dial a bus for seniors, but once again it is limited in its hours, and is specific in the population it serves. The elderly that are in assisted living are fairly well set as most of the places of offer transportation to their patrons doctor appointments. Samaritan Health Services, that employs the majority of Linn County’s healthcare workers, has established one medical home and is in the process of establishing more. These homes are a one stop shop for patients to help meet all of their healthcare needs at one location. They offer nutritionists, diagnostic services, primary care doctors, diabetic counseling, and wound care. This does make it easier for people to be able to reach their appointments and to not have to travel to multiple locations when money and time is often an issue. Samaritan is also working hard to recruit more primary care physicians to the area. Because the area has such a large outlying area, even if there were enough PCPs available, there is the issue of actually getting patients to their appointments. Samaritan’s Medical Home does help with this problem in some respects, but there is still the concern of getting to that location. There are medical transports available, but these are only covered by Medicaid, not private insurance or Medicare. Providing more access to health care through increasing the number or Primary Care Physicians available and providing affordable transportation to doctor’s appointments are two forms of primary prevention for the lack of access to health care. Samaritan’s establishment of the Medical Home is another solid step towards increasing access for the community. Linn County is a beautiful part of the world and member’s of its community are working hard to improve the quality of life for its residents.

References
City-Data.com. (2012). http://www.city-data.com/county/Linn_County-OR.html
Hazard Analysis City of Albany. (2015). http://www.cityofalbany.net/images/stories/fire/em/mitigation/2015_city_of_albany_hazard_analysis.pdf
Healthy People 2020. (n.d.). www.healthypeople.gov
Linn County Department of Health Services. (2013). http://public.health.oregon.gov/ProviderPartnerResources/LocalHealthDepartmentResources/Documents/Linn_County_Annual_Plan_2013.pdf
Scorecard by Good Guide. (n.d.) www.Scorecard.goodguide.com
United States Census Bureau. (2015). http://www.census.gov/quickfacts/table/PST045215/41043