There are different objectives to conducting a community health assessment; this depends on the county or community in question. In this case, the community is McKean County, Pennsylvania, and objectives for conducting health needs assessment were:
- To evaluate the community’s perception of its health status as well as their needs
- To come up with the county’s population health profile.
- To compare the county’s health status over the years by analyzing this assessment with the ones carried out in the past.
The results in this assessment give the baseline for planning for new services, improving existing services as well as establishing benchmarks that will be used for tracking changes in the community’s health over the years.
The community’s health profile was developed from data collected from various data sources, which include the U.S. Bureau of Census, the 2003 Pennsylvania Youth Report, and the Behavioral Risk Factor Survey. The data was classified in areas with health problems and health related behaviors; the data also provides measures of health determinants and health status, which include life expectancy at the age of 65 and at the birth, mortality ratios, and cause of death and incidence of diseases. During this assessment, the data collected in 1996 and that collected in 2004 was compared.
During the assessment, the perceptions of the community’s health needs were determined in the following ways:
- Data was collected on behavioral risk factor using the CDC- administered oversampling program; this was in 2004 assessment. In the 1996 assessment, a survey was done to a sample of residents from this county; the surveyors used questionnaires to analyze the issues relating to the health status of the county, behavioral risks, health care access, social support networks, social isolation and availability of health insurance.
- In both surveys carried out in 2004 and in 1996 assessments, the focus groups were interviewed. In the 2004 survey, the focus groups that were interviewed were human and health services providers, teenagers and the elderly, mental retardation and mental health providers. These groups were directed to discuss the main health problems facing residents of this county, factors contributing to these problems, possible ways to reduce or prevent the problems, ways in which the health system can be changed to improve health services to citizens of McKean County, and most needed social and health services in this county.
The overall social and Health Well-Being of the McKean County
Many residents of McKean County report that health status is very good or excellent, however, a big percentage of residents in this county report that their health as either poor or fair; this is as compared to the health status of the whole state of Pennsylvania. The death rate for this county is higher, when compared to the Pennsylvania state; this is according to the analysis done in 1996. McKean had 935.4 deaths while the state of Pennsylvania had 871 deaths per a population of 100,000 people.
According to the residents of this county, McKean is an excellent place to live and raise children. However, there were concerns which were raised by participants of the focus group in the 2004 and 1996 assessment. These concerns were about health care services accessibility, especially for residents who are elderly and those with special needs.
Major health problems in McKean County include;
- Cardiovascular disease
- Lung Cancer
- Oral health
- Child maltreatment
- Diabetes mellitus
- Chronic lower respiratory disease
- Tobacco, alcohol, as well as illicit drug use
- Stroke, chronic lower respiratory disease, lung cancer, diseases of the heart and cardiovascular disease are the major diseases that cause death in this county. The adjusted death rate of each of these diseases is high except for stroke. This county has high death rates of chronic lower respiratory disease, lung cancer and cardiovascular disease, when it a concern about is compared to Pennsylvania State; this creates the health status of McKean state.
- Cases of suicide have also risen in this county; this has become the major cause of death among people who are between the age of 25 to 44 years, this is according to the assessment carried out in 1996.
- The third leading disease causing death in this county is diabetes mellitus, the residents between 45 and 64 years are the most affected.
- Every focus group interviewed in the 2004 health assessment, perceive cancer incidence as a problem; however, the data collected do not support the perceptions of the focus groups. Therefore, the incidences should be investigated further to justify or dispute the perceptions and data, as well as address the citizen’s concerns. The incidence of Lung cancer in this county is higher when compared to the incidence rate in the whole state; this makes it a great concern in this county. There is also the lower respiratory disease in this state, which is mostly contributed by the use of cigarettes.
- The focus groups identified Asthma as a big concern; this is shown by asthma reports among children. There is a high rate of asthma in McKean County, especially in the area around Bradford School district. In Pennsylvanian State, this area has maintained a high rate of asthma for the last six years. This study will provide more information on the design and the strategies used for implementing methods for address the concerns of the residents.
- The 1996 assessment identified child maltreatment as a major issue in McKean County. The data presented in 1996 and 2004 assessment, show cases of child abuse that were reported; this includes all reports on investigations of suspected maltreatment. This reports also include cases that were unfounded and those that were substantiated. According to these assessments, child maltreatment reports in this county were two times that of Pennsylvanian State.
- The 1996 assessment identified issues on oral health; oral health issues are a challenge in this county, this is despite the progress in the accessibility of dental services by residents with low income. Reports show that a small number of adults in this county have gone for dental checkup for the past year; the percentage is 63%, it is small when it is compared to the statewide percentage of 72%. Only 44% of the adults without a permanent tooth extraction is recorded in McKean county, this is a small percentage compared to the Pennsylvanian state, which recorded 61%. According to the assessment report of 1996, residents of this county have no access to fluoridated water, and this water has been proven as a good prevention of dental carries.
- Tobacco, alcohol, as well as illicit drug use, according to the reports have influenced the health of residents of this county; the effects include lung diseases, cardiovascular disease, and asthma which are caused by the use of tobacco. Suicide, child maltreatment and accidents, which are caused by drug and alcohol use. The focus groups confirmed that these issues were challenges facing the county, and they were supported by the youth data as well as data from the behavioral risk factor.
The factors contributing to the health issues in McKean County include:
- The population of the elderly has increased in this county; this is according to the 1996 assessment report. The increase in the elderly population increases a burden on social and health services now as well as in the future. When this issue is combined with the loss of residents in the child bearing age and the loss of the young population, as well as the general population loss issue, they create challenges that are unique; these challenges are providing sufficient services that can address the increasing demand for health care.
- Education is a social issue that is crucial when addressing health issues, population with higher educational levels are always correlated with high levels of income, and therefore, they are assumed to have fewer health problems. The educational levels attained in McKean County have continued to increase; however, the county still remains behind when it is compared to the state levels. The McKean County has 34% of its residents with a post-high school education; this percentage is low when compared to that of Pennsylvanian population, which is 43%.
- Poverty is considered a major social factor influencing healthstatus among the residents of McKean County, particularly among children; this social factor is related to behavioral and other social problems in the county. Since the health assessment carried out in 2004, the income levels of people in McKean County has increased, however, when compared to the national and state level, this county still lags behind. According to the census report of 2001, 13.1% of the residents in this county languish in poverty; this includes 15.3% of families, which have children below 5 years. Also, 47% of the families consist of children under five years and a mother.
Behavioral Risk Factors
- Many focus groups identified that illicit drug use is a social problem which affects health in this county and according to the youth survey reports 24.1% of students in the12th grade used marijuana in the last 30 days.
- Another behavioral risk factor contributing to high death rates and illness in this county is alcohol; when alcohol is used in excess, it has a lot of effects which include cause of accidents among others. Approximately 21% of adults in McKean County are binge drinkers. Also, according to reports, 31.2% of students in the sixth grade had tried alcohol, and close to 51.3% of students in the 12th grade had consumed alcohol within the last 30 days.
- Physical inactivity and improper nutrition are other contributors to a health problem facing McKean County. These factors lead to an increase in diabetes mellitus, and an increased rate of cardiovascular disease. Most adults in McKean County do not report to leisure time physical activities, when compared to Pennsylvanian state, it is 29% vs. 23%. Also, the percentage of adults in this county who eat five fruits with vegetables per day is only 21%.
- Smoking has also been reported as a major risk factor causing several health conditions in McKean County. 28% of adults in this county are currently smokers, and according to the survey report carried out in 2003 by the Pennsylvanian Youth, 16% of the sixth grade students in McKean County have tried smoking cigarettes, and about 33.3%of 12th grade students have smoked cigarettes within the past 30 days.
- According to the elderly focus group, housing stock is an aspect of the physical environment affecting health in this county. They were impressed with the public housing for seniors; however, many live in private homes, which need to be refurbished because they are too old. Seniors depend on fixed incomes, and when it is coupled with rising heat costs, it becomes more difficult for them to maintain the homes.
- Participants in the focus groups had a perception that many of the health issues experienced in this county are related to the physical environment. According to them, issues of cancer and asthma were related to pollens and moulds, second-hand smoke, asbestos, industrial pollution and water contamination; however, it is not known how and how much they contribute to these health issues in the county.
Health Care: Availability of Resources, their Utilization and Access
- Health care coverage in McKean County is not enough, and this has created problems of accessing health care. Only 17% of residents who are between 18 and 64 years have no health insurance. There are other issues, which include lack of adequate public transport system high cost of drugs prescribed for use by health professionals, inconvenient times set for medical office; these issues were recognized as barriers to health care.
- Utilization of drug and health services and mental health services was also report as one of the problems by the focus groups. According to these groups, there are no enough child psychiatric specialists as well as coverage of diagnosis treatment. There is a perception of gambling addiction in this county, and this is because of the presence of casinos in Salamanca. This is a concern that should be well investigated to improve the services in this region.
- There is a concern about the dental care utilization; this is seen mostly among citizens with low income and those living in outlying areas. Only 63% of adults in this county have gone to a dentist for a check-up in the past year, and this number is small when it is compared to 72% of the whole state.
- There is also inadequate supply of physicians for primary care; there are only 7.4 physicians for 10,000 residents of this county. When it is compared to the Pennsylvanian State which has 33.7% per 10,000 people the percentage is small. Also, 60% of physicians that are in practice are 50 years and above, and this makes it difficult to maintain an adequate supply of physicians. Again, physicians who provide special care are more limited in this county; there are no pulmonary disease specialists, allergists and cardiologists. Nurses who are registered in this county are few in this county; there are 60 nurses for every 10,000 residents, this number is small when it is compared to statewide number of 95 nurses per 10,000 residents.
- There is a decline in the number of beds in nursing homes; the number has gone as low as 592 beds from the year 1996 to 2002. To meet the demand of the increasing population in this county, especially for the old citizens, the number of beds needs to be increased.
- Hospital beds in this county are adequate for the citizens, and the emergency room utilization and occupancy rates are comparable to the average of the state.
The results of the assessment were presented during a community forum, and in the forum;
- Many people agreed that the health concerns presented were preventable; diabetes, respiratory diseases, Cancers and heart diseases are related to the community’s health behaviors, which include physical inactivity, poor diet and smoking, suicide, as well as injuries, are influenced by social isolation and drug and alcohol use. All these issues can be addressed by educating those affected and supporting them emotionally.
- It is important to deal with issues concerning health behavior, but these issues together other health concerns are caused majorly by the social and economic environment. Therefore, improving the living standards of residents in this county will help in dealing with the county’s health issues.
- During a health analysis, it is difficult to concentrate on problem areas; however, it should be realized that this county has resources which can be used to address health issues. According the health groups, McKean is a fine place and is worth living there; this is because of the presence of social service providers and agencies. There are agencies as well as entities which have shown commitment to helping the residents of this county to improve their health status, and these organizations include Pittsburgh University, the county’s collaborative board, the Center for Rural Health, the YMCA, the YWCA, the school systems, and hospitals, among others.
- McKean County has a diverse employment sector; this is in spite of the economic challenges experienced by residents of this county. The employment sector comprises of industries and businesses, and all of them are stakeholders of in the health of this community; businesses and industries improve the health status of this county through collaborative HealthWorks.
Now that we have the health challenges facing McKean County and available resources that would help to deal with the issue, we should come up with an appropriate procedure of finding a solution to the health problems.
- The first step is to distribute the report to the community, particularly to organizations and individuals who have authority and resources.
- Then, there will be identification of groups together with lead organizations for particular health concerns, and then identify appropriate funding resources and staff of volunteers for specific efforts. These activities will be done together with the identification of resources.
- The data in the report will be a justification for any guidance to additional resources that may be required to address the concerned identified in this county; this means that agencies should use this report to apply for funding.
McKean County is a rural community, and a social wellbeing of such communities depends on factors that influence the wellbeing of populations that live in urban areas, and these factors include health care, social services, education and good housing, among others. Also, the presence of a social capital, which include a social trust and a social cohesion together with a safe and clean natural environment are good for the creation and sustainability of a healthy community; this is regardless of whether the community is an urban community or a rural community. However, many of the health problems are amplified in communities living in rural areas. The challenges in rural areas, which include low-density patterns of settlement and sparse population, economies of scale, among others increases the costs of providing vital services to such communities. Rural communities are often faced with a decline in jobs and income, and this has lead to a decline in population. Also, the remoteness of rural areas and their distance from metropolitan areas complicate the process for the majority of people in rural areas to get benefits of urban centers proximity of economic activity. Lastly, changes in the usage of natural resources and availability of these resources in rural areas affect the living standards of citizens who are dependent on the resources, and for citizens who get recreational services together with other benefits.
There are a lot of barriers in rural areas when it comes to good health; however, there are aspects in rural areas which can be capitalized on, and these aspects are environment that supports healthy lifestyles and they include the community’s trust, strong social cohesion, personal relations between agency personnel and providers and organizational efficiencies of small organizations.
It is evident that McKean County has an experience of many challenges discussed as well as community-level strengths. This report will analyze the challenges and strengths in details and incumbent citizens of this county, policy makers, social service and health care providers to partner in order to deal with the challenges through the development and implementation of a strategy that is socially inclusive and population based to achieve optimal health for McKean County residents. This report will form a basis on which partnerships and initiatives will be developed, it will also create a justification for accessing resources from both private and federal organizations as well as from the state.
In 1996, the community health assessment was carried out by School of Public Health of the University of Pittsburg, Bradford Regional Medical Center and the steering committee of Community Care together with educators, social service agencies, local health providers, and other community representatives. This community assessment was carried out with an aim of creating a health profile for McKean County residents, and evaluates the perceptions of the community’s health care needs and health status. The assessment was carried out through collecting data from organizations such as the Department of Health of Pennsylvania State and the U.S, Census Bureau, among others. This was accomplished through interviewing of focus groups in the community and qualitative surveys. In 2004, the assessment was initiated once more with support from the Center Rural Health of University of Pittsburgh Highmark Blue Cross Shield, and the Regional Medical Center of Bradford. The objective of this analysis is to give a survey of the behavioral and environmental characteristics, health, demographic and environmental status of McKean County; this analysis is based on the observations in 2004 and 1996 health assessments. Comparison will be done between the two assessments with an aim of identifying health problems that are persistence in McKean County, factors that lead to health problems and come up with initiatives that will address these issues, as well as provide a basis for the development of community level programs that will improve the County’s health status.
The data for the two assessments were obtained from;
- focus groups
- Surveillance Survey of Behavioral Risk Factor
- 2010 report on Healthy People
- Health Data Center of Pennsylvania State
- Bureau of the Census of U.S.
The data was then classified according to health problem areas, there was measuring of health determinants and health status. The 1996 data used census data of 1990 and the 2004 data used census data of 2000.
The 1996 assessment used two methods to determine the health needs and these methods include;
- A survey on county residents, which was carried using structured questions and the aim of this survey, was to determine the issues of availability of insurance, access to health care, behavioral health risks, health status and social issues.
- Interviews with focus groups such as rural women, teenagers, human and health service providers. In each group, the participants discussed issues such as a major health problems in McKean County, factors contributing to the health problems, the possible solutions to the problems, possible health system changes, and social and health services that are highly demanded.
The assessment carried out in 2004 obtained information through conducting interviews with focus groups, and the focus groups include;
- Mental retardation/ mental health providers
- Teens residents
- Elderly residents
- Partners of State Heath Improvement Plan
The results of the assessments are organized in economic, social, demographic and health status indicators. The health status indicators include health resources, social, mental, physical health and general health as well as a major risk factor (U.S. Bureau of the Census, 2001). There will be a direct comparison between the assessment carried out in 1966 and that carried out in 2004, however, because of the differences between, the 2000 and 1999 census; there can be no comparison between certain factors or data.
Demographic Trends and Data
McKean County has a scattered population, this is because a third of the county is inside Allegheny National Forest. The accessibility of these woodlands encourages hunting and makes both residents if this county and tourists to do outdoor recreation. These are good opportunities; however, the population of this county still declines, according to the census of 1990 the population was 47,131. For the previous two decades, approximately 10% of the population had been lost in this county, and young people of under the age of 65 years were the majority. This decline was also observed during the 2000 census, with the population estimation of 45,936; this records a population decline of 1,195 (U.S. Bureau of the Census, 2001). A great loss was observed among children and young adults; there was a decline of 13.35% in the age group between 20 and 24 years and 13.93% in the age group between 25 and 34 years. Children under 5 years and those between 15 and 19 years recorded a decline of 14.04% and 9.34% respectively. According census records, population of this county has continued to decline since 1960, except in 1995 when there was an increase.
Contrast to other age groups, the age group between 45-54 years recorded an increase, and the group of 85 years and above also recorded a 20.5% increase. The age group between 45 and 54 is likely to have fully grown children and probably moved away from the community. The issue in this county is an increase in people with 85 years and more, during the 1996 assessment, this group had the fastest growth rate, when it was compared to the census of 1980 and 1990.
The population of this county is expected to decrease further in the future; by 2020, a decrease of 0.6% is expected. The decrease is expected to be more in the child bearing age, and based on the previous records, the older segment of the population is expected to increase, especially those of 85 years and above, however, these are just projections.
The population racial diversity has increased slightly considering the population records between 1990 and 2000; this is evident in the record of African-American population, which is showing a 1.9 increase, the population increased from 520 to 860. However, the majority are Caucasians who are 96% of the population in McKean County.
Economic Trends and Data
The income level of rural individuals tends to lag behind when compared to that of individuals from urban (Gamm et al, 2010). In rural areas, there are fewer professional jobs; more of the jobs are industrial such as manufacturing. This means that this county is not an exception. According to table 3, the county lost real income jobs and the loss was more compared to that of Pennsylvanian State and overall United States. 1n 1980, the county’s median household income was 12% lower that of the state, and in 1990, the difference went up to 21%. In addition, the income per capita was observed to be 13% lower than that of the state, in 1980, and went even lower by 23% in 1990.
According to the Census income data in 2000, the family and household income rose above 43%, and income per capita increased to above 55%. There was also an observed decrease in poverty level, however, the county is still low in terms of income per capita, family and household income; this is when it is compared to that of Pennsylvanian and the whole of United States (U.S. Bureau of the Census, 2001). In terms of income distribution, the 2000 Census recorded 20.1% of households with an income of $15,000. Approximately 32.9% of citizens have an income of $ 15,000-$34,999, and an income of 100,000 or more is earned by 4.1 of households.
Poverty has been recorded as a major risk influencing poor health in this county; this fact is magnified in rural areas, and McKean is not an exception. According to the assessment carried out in 1996, this county had a poverty level that was33% higher than the average poverty of the state at that time (Pennsylvania Department of Community and Economic Development, 2005). In this county, children under 18 years were poorer; the population living in poverty was recorded as 27.53%, this is higher compared to 15.38%. Families in this county are more vulnerable to the poverty effects, particularly the single-parent families. Also, families headed by single female households showed a high probability of being poor; this is seen nationwide, statewide and countywide. The poverty level in this county has declined, however, according to table 5, the poverty figures exceed that of the overall state. These findings contradict the fact that a big percentage of both parents in this county are in the work force; it 69.2% which is high 60.2% of the state. This is because more parents are in the workforce, but what they are earning is less compared to individual’s overall earning. The issue of concern is the high numbers of poor single female-headed households; the numbers are higher than that of the state.
According to the 1996 assessment, this county has a decline oil and timber; these two industries are the major source of livelihood in this county. The decline in timber has made the legislative to limit the cutting of trees; also, the decline in oil is because of the decline in crude oil deposits. The 1996 assessment also found out that the manufacturing industry was a major employer in this county, but the number of job had decreased from 40% to 31%. However, the assessment observed an increase in professional services together with their related services.
This is a social issue that is important to the community health; this is because higher education leads to higher income and higher income means less health problems. This county has increased its educational attainment over the last decades, with 58% in 1970 and 75% in 1990; this was impressive, but education changes with times. Therefore, adults who gained education during that time cannot get gainful employment with the same education level.
The assessment carried out in 2004 shows that education attainment level in increasing. The number of adults who have attained high school level education rose to 82.2%, and those with post high school education rose to 34.3; this includes bachelor, associate of professional degree as well as college (Pennsylvania Department of Education, 1998). However, this state still lags behind when it is compared to the state; the state has 43.8% residents with at least college education. When considering the rate of dropouts, statistics shows that the state has reduced the rate of dropout while McKean County has increased the rate. The 2004 assessment shows that the dropout rate has remained constant.
Health status indicators
According to 1996 assessment the death rate for all causes was similar to the state. Table 10 shows the comparative data of the 2004 assessment; these comparisons are between the causes of death in the county and state.
Behavioral risk factor
These risk factors were assessed by the Health Department of Pennsylvanian state through the BRFSS; this system entails telephone interviews using randomly generated numbers to find a household to be interviewed. During the interview, each participant is asked questions to gather information on health.
Communities within Pennsylvanian Commonwealth were among the participants, and they contributed a third of the cost in order for additional interviews to be conducted. According to the findings, 20% of adults in this county had fair or poor health; this number is high when compared to Pennsylvanian State, which recorded a 15%. The adults were also reported of not having leisure time physical activity; the number was again higher than 23% recorded in among state adults. Another area of concern was the health insurance, where 17% of adults between 18 years and 64 years did not have health insurance; this is high when compared to 13% for the state. These individuals are sometimes affected by severe illness; sometimes they are removed from the workforce and even have long-term effects to these individuals together with their families.
Specific health indicators
The number of death caused by cancer in the county increased since 1993, but that of the state declined during the same period
Prenatal Care and Teen Pregnancy
Considering prenatal care, 12.6% of women in this county ignore treatment during the first trimester; this rate is higher when compared to that of the state, which is 14.8%. The number also presents the percentage of women who do not receive proper care when pregnant and 9.4% of the children were born without their mothers seeking prenatal care. Prenatal care helps in early identification of problems in pregnancy, which helps to cut down on premature deliveries, disabilities and mortality. Results on teen pregnancy are presented in table 15.
Stroke and heart disease
This community is at risk of fatalities and injuries because of accidents caused by crashing of motor vehicles and presence of firearms. Table 17 gives the data collected:
This county has had incidences in suicide and the table below shows how it has been fluctuating. Between 1996 and 2004, suicide claimed many lives in this county, and a study has to be carried out why people commit suicide; however, here is a likelihood that social isolation and economic factors play a big role in the cases of suicide.
Available resources and access
There are enough hospital beds in this county to meet the requirements of the residents; the rate of occupancy is the same as the state average. There is no hospital with cardiac catheterization, an Alzheimer’s disease Clinic, child psychiatric services or outpatient services, neonatal intensive care and angioplasty (U.S. Bureau of the Census, 2001). Nursing home beds have declined in number up to 592 beds, this decline was recorded between 1996 and 2002, on the other hand, the available facilities mainly offer skilled care, and they have few beds used for assisted living, immediate care. These services are on demand in the old population.
Care physicians are limited in this county; the number is 7.4 per ten thousand residents, and that of state are 33.7 per ten thousand residents. 60% of these physicians are 50 years and above. This county has no pulmonary disease specialists, allergists and cardiologists; this is despite the increase in the aging population as well as incidences of cardiovascular disease (Centers for Disease Control, 2003). McKean also has a shortage of registered nurses, and the number of dentists is not consistent yearly. Children immunization level has increased; however, there is no public program to offer pneumonia and influenza vaccine to old population. These diseases are ranked fifth in causing death in the population of 65 years and above.
Low income families recorded a higher rate of poor mental health; this has been attributed to poverty, and most cases are difficult to handle. Mental health providers recommend for more staffs and programs to handle alcohol and drug abuse.
Health care coverage are high in this county, however 17% of the population between 18 years and 64 years do not have health insurance. Additionally, medical assistance coverage is perceived as inadequate this is because some health providers discriminate MA patients. There are high rates of death in Medical Assistance and Medicare patients. There are also issues of public transport in some areas, which hinders access to medical care. Limit of office hours is another barrier to health care in this county.
Major concerns identified are:
- Cardiovascular disease, lung cancer, stroke, chronic lower respiratory disease and heart diseases; they are the leading in causing high death rate in this county.
- Suicide has risen so high that it has been classified among the leading cause of death, the age group that is most affected is 25-44 years
- Diabetes Mellitus is ranked as the third leading in causing death in this county, and residents between 45 and 64 years are the most victims.
- Cancer incidence is identified as a problem in each and every focus group in the 2004 assessment
- Asthma is identified as an issue in children, with the highest being in school-going children; this is according to the report from school.
- Child maltreatment was identified in 1996 assessment as a major concern.
- Oral Health is an issue, especially among adults in this county; they rarely visit the dentist.
- Drug use, tobacco and alcohol have influenced health in this county through their effects such as lung diseases, cardiovascular disease, asthma, suicide , child maltreatment and accidents
To address these health issues funding is required and these report will show evidence for the need to fund health in this county. To address the issues in a better way several things are recommended:
- Poverty eradication through offering employment opportunities
- Education should be enhanced and encouraged so that residents in this county can secure employment in the professional sector
- Residents in this county should be made aware of the importance of healthy practices for instance, importance of dental check-ups.
- Transport system should be streamlined to improve access to health care
- Rehabilitation centers should be established to deal with those who take drugs and addicts of alcohol and tobacco, and others.
Centers for Disease Control. (2003). CDC Wonder. Web.
Pennsylvania Department of Community and Economic Development. (2005). McKean County Profile. Web.
Pennsylvania Department of Education. (1998). K-12 Schools Statistics 1997-98. Web.
U.S. Bureau of the Census. (2001). 2000 Census of Population and Housing STF3. Web.
U.S. Bureau of the Census. (2001). State and County QuickFacts: McKean County, Pennsylvania. Web.