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How to Read the RHA

This assessment data is told in stories. Each county has a story and the Central Oregon Region has a story. In each region’s story below you can find relevant information and data from the Regional Health Assessment (RHA). This information has been extracted from the full report and accompanied with data visualizations that are updated automatically, so in the story you can find the most recent data.

 

If you want to know more about this data, click on the links that are inside the graphs. The red lines below show where these links are inside the graphs. These links take you to the specific data indicator page. On the data indicator page you can see a description of the data indicator and similar measurement from different regions and years.

 

If you want to return to the landing page or see other locations, in the last chapter of the story you can find links with buttons that you can use to navigate through the different stories.

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Process Overview

In 2015, per Senate Bill 648, the Central Oregon Health Council's responsibilities expanded to require creating and adopting a Regional Health Assessment and Regional Health Improvement Plan (RHIP) to serve as a strategic population health and health care system service plan for the region. The development of the RHA fulfills requirements for the hospital system, public health, behavioral health, early learning, Coordinated Care Organization (CCO), and other entities, allowing for a collaborative regional process that creates, adopts, and implements the RHA and RHIP.

People and organizations living in Central Oregon care a great deal about working together to improve the health of our communities. Information, sharing, and numbers data from a wide variety of people and organizations throughout the region contributed to the RHA.

The development of procedures, analysis of data, and integration efforts were guided by a commitment to promote health equity and prioritize efforts to address and lessen health inequities.

An evidence-based planning process called Mobilizing for Action through Planning and Partnership (MAPP) 2.0 guided the creation of the Regional Health Assessment (RHA).

This process used four types of assessments:

• Health Status Assessment: Quantitative health indicators describing the health status of communities in Central Oregon.

• Themes and Strengths Assessment: Community focus groups captured community members’ experiences with health in Central Oregon.

• Forces of Change Assessment: Community focus groups identified external threats and opportunities, including political and social issues affecting Central Oregon.

• Public Health System Assessment: Public Health Modernization Assessment Gaps Analysis.

We completed these assessments using various methods:

• An electronic and paper Community Health Survey

• Focus groups, walk-along interviews, panel discussions, and photo-voice projects

• Community Feedback Sessions

• Public Health Department feedback

• Quantitative data collection and review

All information and data underwent an in-depth analysis and integration to reach a holistic picture of the region’s health and well-being.

This information informed the development of this document. The 2025 Central Oregon Regional Health Improvement Plan will also use this information to develop and address priority health issues.

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About Data Sovereignty and Tribal Nations

Data sovereignty means that data is subject to the laws and governance structures of the jurisdiction from which it comes. It includes the rights and responsibilities that a nation or governing body has over the data generated within its borders.

Tribal governments, meaning the governing bodies of indigenous tribes or nations, also have concerns and interests regarding data sovereignty, particularly concerning data generated by tribal members or within tribal territories.

For tribal governments, data sovereignty is a critical issue due to historical and ongoing challenges related to data ownership, privacy, and control. Many indigenous communities have faced challenges such as exploitation of their data, lack of control over data collected within their territories, and insufficient representation in data governance processes.

There are several reasons why data sovereignty is significant for tribal governments:

• Cultural and Community Preservation: Indigenous communities often have unique cultural, linguistic, and traditional knowledge that they seek to protect and preserve. Data sovereignty allows them to control data collection, use, and distribution related to their culture, language, and traditions.

• Resource Management: Tribal governments may have jurisdiction over natural resources within their territories. Data sovereignty enables them to manage and make decisions based on land use, environmental conservation, and resource allocation data.

• Self-Determination and Governance: Data sovereignty links closely to the broader principles of self-determination and self-governance for indigenous peoples. It empowers tribal governments to assert control over their information and participate in decision-making processes that affect their communities.

• Legal and Jurisdictional Issues: Indigenous communities often operate under complex legal frameworks that intersect with national, state/provincial, and tribal laws. Data sovereignty helps clarify jurisdictional boundaries and ensures that tribal laws and regulations regarding data collection, storage, and sharing are respected.

We returned any tribal-related information or data received during the creation of this Regional Health Assessment to the tribal nation to which it belonged.

Please see the below resources for further exploration:

Native Land Information System

Indigenous Data Governance: Strategies from United States Native Nations

About the Tribal Nations of Central Oregon:

Confederated Tribes of Warm Springs

Cow Creek Band of Umpqua Tribe of Indians

The Klamath Tribes - Klamath, Modoc, Yahooskin

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Climate Health

Coming Soon

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Data Limitations

A data gap or limitation is a missing piece or flaw in the information gathered. It means there's something we don't know or fully understand, which may make it harder to draw accurate conclusions or make informed decisions. It's like having a puzzle with a missing piece – you can still see the picture, but a part is unclear or incomplete.

Data Gaps That Are Present

All data, including the information shared in this report, has gaps and limitations. Limitations happen for several reasons, including:

• Data Privacy Concerns: Due to increasing privacy concerns, certain sensitive information may be removed or withheld from datasets, leading to information gaps.

◯ For example, in our smaller communities, where fewer people report, we needed to hold back some data to maintain individual privacy.

• Temporal Gaps: Data might be collected at irregular intervals, leading to temporal gaps. For example, if economic data is collected annually, there may be gaps in understanding economic trends between each data point.

◯ For example, for the Point in Time Count of people living houseless during the COVID pandemic, the data collection did not occur.

• Incomplete Data: Sometimes, datasets are missing certain entries or fields, leading to incomplete information. This could be due to errors in data collection, data entry, or simply because certain information was not recorded.

◯ For example, we experienced transcription errors in some of the focus groups or survey responses, which made some information unusable.

• Geographical Gaps: Data may be collected unevenly across different geographical regions, leading to gaps in understanding regional variations. This could be due to logistical constraints or a need for more resources in certain areas.

◯ For example, lesser-resourced, smaller schools might not have been able to collect student self-reports on physical activity or nutrition.

• Technological Gaps: Advancements in technology may outpace data collection efforts, leading to gaps in understanding emerging trends or phenomena.

◯ For example, our health experts are seeing real-time local increases in syphilis rates, but the state or county electronic data collection lags.

• Underreporting or Non-Reporting: In some cases, events or incidents may go unreported or underreported, leading to gaps in data. This could be due to various reasons, such as social stigma, fear of repercussions, or lack of awareness.

◯ For example, low awareness and stigma of mental health needs among older adult men or people who speak English as a second language might have impacted reports of depression.

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Health Disparities and Data

What are health disparities?

Health disparities refer to variations in health outcomes or access to healthcare among different groups, often influenced by factors like race, ethnicity, socioeconomic status, geographic location, gender, or age. These differences can show up in various ways, such as varying rates of disease, different mortality rates, unequal access to healthcare services, and differences in health outcomes. (National Academies of Sciences et al., January 11, 2017)

Why are there health disparities?

Some of the reasons we experience health disparities include the following:

• Socioeconomic Factors: Socioeconomic factors strongly influence differences in health. People with lower incomes may face challenges accessing healthcare services due to issues like insurance coverage, transportation difficulties, and the inability to afford out-of-pocket expenses.

• Structural Racism and Discrimination: Systemic racism and discrimination can result in unequal access to quality healthcare, educational opportunities, employment, and housing, which in turn contribute to health disparities among underserved communities, particularly people of color.

• Environmental Factors: Environmental conditions such as pollution exposure, availability of healthy food options, and access to safe housing can significantly impact health outcomes. Marginalized communities are often disproportionately affected by environmental hazards.

• Healthcare Access and Quality: Disparities in accessing healthcare and its quality contribute to differences in health outcomes. Factors like proximity to healthcare facilities, the availability of culturally competent care, language barriers, and implicit biases among healthcare providers can all influence the quality of care received by different populations.

• Health Behaviors and Lifestyle Factors: Variations in health behaviors such as smoking, diet, physical activity, and adherence to medical recommendations can contribute to health disparities. Factors like education, culture, and resource access influence these behaviors.

How Data Helps Us Reduce Health Disparities

Communities can improve health disparities. Data serves as an essential tool to see and fix health disparities. We can see the disparities best when we can disaggregate the data.

Disaggregating data is when we take a big pile of information and break it into smaller, easier-to-understand pieces. Doing this lets us see what's in the mix more clearly and understand each type better. In data disaggregation, we sort data into categories based on factors like time, location, or demographics. This helps us see patterns and details that might need to be clarified when everything is lumped together.

Where We Can and Can’t See Health Disparities in Central Oregon

One of the reasons health disparities exist in Central Oregon is because we are a geographically large and diverse region. We have urban centers and rural areas. Historically, investments and policies have prioritized areas of greater population, resulting in an under-investment in services and support in rural areas.

You can see this in the data when comparing different counties. This underinvestment is evident when comparing health outcomes and social determinants of health between our more urban areas of Deschutes County and our more rural areas of Crook, Jefferson, and northern Klamath counties. More rural communities experience challenges accessing services, transportation, and well-paying jobs.

• 43% of Central Oregon Community Health Survey respondents reported that living wage jobs are the most important aspect to improve the quality of life in Crook County. This is compared to 21% of all Central Oregon Community Health Survey respondents across the whole Central Oregon region who reported that living wage jobs are the most important aspect to improve quality of life.

• Our rural counties have significantly fewer primary care providers than our urban centers. There are 32 primary care providers for every 100,000 people in Crook County and 56 primary care providers for every 100,000 people in Jefferson County, compared to 100 for every 100,000 people in Deschutes County.

• 68.5% of renters living in Sisters spend 30% or more of their household income on rent, compared to 50% of renters in Bend.

Additionally, Oregon and Central Oregon have a well-documented history of systemic racism. Racism’s impact on policies, investment, and decision-making results in white, English-speaking centric services, often limiting access and quality of services for our community members who have been underserved because of race, ethnicity, language spoken, ability, sexual orientation, gender, immigration status, and people who live at the intersection of these and other identities.

• Populations with more significant increases in being unhoused included people who are 18 and older, people who were previously sheltered, people who identify as female, and people who identify as Native American.

• Although only 10% of Community Health Survey respondents indicated that transportation was a barrier to accessing services, our focus group findings show that safe walking environments, transportation, and roads were a great concern to most of our subpopulations (Caregivers of children under five, high school and college students, Latino families, men working in manufacturing or construction, northern Klamath community residents, older adults, peer support specialists, people living unhoused, people with disabilities, rural migrant farmworkers, and traditional community health workers).

Unfortunately, health disparities exist even when we can’t see them in the data. This happens when there is limited or no data. A common place this is seen is when we try to learn more about subpopulations of age, race/ethnicity, or gender identity within a single county. County-level disaggregated data continues to be limited. This hole in quantitative data means studying and responding to qualitative data is all the more critical.

One reason data is not disaggregated beyond the county level is that the collection of demographic information continues to be an emerging practice for our organizations. Individuals' sharing of their personal demographics is emerging in our region. People are still learning about the important role of sharing their demographics and are concerned about reporting their personal information. In some of our counties, there are so few numbers of particular demographics that personal privacy would be at risk if data was disaggregated or reported publicly.

Please see the below resources for further exploration:

Racism and Health, Minority Health, Centers for Disease Control

‘Under the Skin’, PBS Newshour, 2022

Timeline of Oregon’s Racial and Educational History, PortlandOregon.gov

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How Data Gaps and Limitations Were Addressed

We recognized the presence and impact of data gaps on health disparities across our communities. When there were gaps in data or limited or no disaggregated data we:

• Conducted surveys, interviews, or focus groups with the community to gather primary data on health indicators and demographics.

• Utilized community health workers or volunteers to collect data through field visits and community engagement activities.

• Interviewed key stakeholders such as local healthcare providers, community leaders, and policymakers to gather insights and perspectives on health issues and priorities.

• Involved community members in the assessment process through participatory methods such as community forums, town hall meetings, or participatory research projects.

• Empowered community members to identify health priorities and solutions collaboratively.

• Triangulated data from multiple sources to validate findings and ensure data reliability and accuracy.

• Used regional or state data.

• Compared primary data with available secondary data to identify gaps and discrepancies.

Partners across our region continue to work to improve data collection, disaggregation, and sharing to improve health and well-being. We are responding to increasing encouragement and guidance at the state and local levels to improve and personalize care to specific populations' needs. We are also educating and encouraging people to share their demographics when requested by organizations that serve them.

Please see the below resources for further exploration:

Risks and Rewards of Demographic Data Collection: How Effective Data Privacy can Promote Health Equity, National Health Law Program, 2023.

Methods

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Method Summary

Creating the Regional Health Assessment requires drawing from various types of information called data. Each data type provides a different perspective on the health and experiences of people living in our Central Oregon Communities. Each type of information is critical to providing a holistic, more comprehensive picture of the health and well-being of our Central Oregon communities. The more complete the picture, the more equipped communities and organizations are to respond.

We gathered data in different ways.

Qualitative Data is first-hand sharing of experiences that dives into the intricacies of people's experiences, values, and perceptions. It brings the human element into the assessment, providing insights into the social determinants of health, community attitudes, and the barriers they experience. We gathered qualitative data through conversations with people in focus groups, panel discussions, walk-along interviews, and a community-focused survey.

Qualitative Data, collected as a primary data source, included:

• Social Determinants of Health - These things aren't medical but still affect people's health. Social determinants include things like how much money people have, if they can get help when needed, how good their education is, and even things like having enough food, a safe place to live, ways to get around, and feeling safe.

• Community Assets - These things in a community make life better for everyone. It could be people in the community who are good at doing things, places like schools or community centers, or even nice places to walk.

• Health Challenges - These are actual or perceived obstacles that make it challenging for people in their community to stay healthy. For example, substance or alcohol abuse makes it harder for everyone to be healthy.

Quantitative data is information or data that can be counted, measured, or given a numerical value. Quantitative data looks at “how many,” “how much,” or “how often. This data is pulled from a variety of sources that have done the counting on any given topic.

• Quantitative Data was derived from an array of secondary data sources, which included:

• Demographics - These include the characteristics of a population grouped by specific qualities like age, gender, and income.

• Health Disparities - This term refers to a particular type of health difference closely related to social, economic, environmental, or overall disadvantages.

• Health Indicators - These are measurable characteristics that provide insights into a population’s health. Examples include life expectancy, diabetes rates, and heart disease rates.

• Health Behaviors - These are individuals' actions, practices, or habits that impact health. Examples include tobacco use, regular physical activity, and nutrition.

After gathering data from numerous sources, we completed descriptive analyses.

• Descriptive Analysis - Descriptive analysis involves organizing, summarizing, and presenting data in a meaningful way to describe the basic features of the data groups. Descriptive statistics are often calculated at this stage to gain insights into the characteristics of the data.

After the data itself is better understood, we triangulate the data.

• Data triangulation - a method used to validate findings by cross-verifying data from different sources or using multiple data collection methods. It involves comparing and contrasting data obtained through various means to ensure the reliability and validity of the conclusions drawn from the research.

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Methods Details - Primary Data Collection and Initial Analysis Strategy

Primary data provides a well-rounded and comprehensive understanding of the region's health landscape. This assessment section focused on non-numerical information gathered through focus groups, panel discussions, and walk-along interviews. This data reveals people's experiences, values, and perceptions, providing insights into social determinants of health, community attitudes, and the barriers they experience. Primary data serves as a valuable complement to secondary data. While secondary data provides statistics and numerical trends, integrating primary and secondary data fosters a more holistic understanding of health outcomes. It gives a balanced narrative, allowing stakeholders to see beyond the numbers and understand the lived experiences and contextual factors that impact health in the region. This approach is invaluable for policy development, healthcare planning, and decision-making.

Primary data, explicitly using stories (qualitative data), is a vital component of the scientific method and essential for understanding the context behind secondary data. The social and health sciences firmly establish the validity of qualitative data. Researchers employ rigorous methodologies to collect and analyze qualitative data, ensuring it is reliable and trustworthy. When conducted professionally, qualitative research contributes to the body of evidence-based knowledge. It serves as a robust foundation for formulating healthcare interventions and strategies.

Community Health Survey

One method for gathering information first-hand from people living in the region was a Community Health Survey. It allows people to share their experiences affecting their and their communities’ health and well-being.

• The survey was:

• Voluntary

• Anonymous

• In electronic and paper formats

• In English and Spanish language formats

• Collected in person and virtually

Composed of 23 questions plus 15 questions about the respondent’s demographics

We made extensive efforts to reach and gather information that represented the demographics of our region. Efforts included partnering with population-specific and geographically-specific organizations. These partners shared and collected surveys in ways that were appropriate to their clients and community members. We offered incentives to people who completed the survey and organizations that assisted in outreach to specific populations.

Over 3800 people across our region completed the survey during the eight months of active outreach from January to October 2024.

September 2023 Data Collection Update (1).pdf

We cleaned survey data and conducted descriptive statistics to analyze the information shared. Additionally, we performed comparative analyses to determine if there were differences in how community members prioritized health concerns based on their race, ethnicity, language, age, income, county, and health status. We developed five slide decks illustrating results through visualizations for the region and each county to be shared with community members during a series of Community Feedback Sessions.

Focus Groups

The second way we gathered first-hand information (primary data) was by hosting focus groups, panel discussions, and walk-along interviews throughout the region.

Along with seventeen community partners, we organized focus groups, panel discussions, and walk-along interviews to collect information about the strengths, gaps, and how the built environment affects health in our community. We created facilitation tools and a guide for the interviews. The study took four months, during which we recorded and transcribed 22 hours of audio, totaling 475 pages. We sent this data to the University of Wyoming's Wyoming Survey and Analysis Center (WYSAC) for coding and analysis. Using QDA Miner Lite software, we conducted an open-coding reflexive process and second-level axial coding to identify relationships between categories and subcategories. Our goal was to offer a comprehensive understanding of health issues in our region.

One hundred nineteen people participated in the 13 focus groups, 51 participated in the two-panel discussions, and 35 participated in the four walk-along interview groupings. We conducted seventeen of these data collection efforts in English, 21 in Spanish, and one in a mix of English and Spanish to suit the needs of the participants. It is unclear what language the walk-along interviews with the People Living Unhoused were conducted in. The Central Oregon Health Council did not collect demographic information about the participants. We collected data from six locations across Central Oregon: Bend, Madras, Metolius, Northern Klamath County, Prineville, and Redmond. Two of the focus groups were conducted with participants from Central Oregon in general. Additionally, two of the focus groups and one of the panels were conducted remotely via Zoom. The location for one of the walk-along interviews is unknown.

Community Feedback Sessions

After analyzing the data collected from the Community Health Survey and Focus Groups, we returned to our communities to share the findings. Sharing community data back to the community is critical for promoting transparency, accountability, collaboration, equity, and innovation and leads to stronger and more resilient communities.

We held six community feedback sessions throughout the region. The sessions were hosted by community organizations, publicized, and open to the public, and anyone was welcome to participate. Participants received a meal, mileage reimbursement, and gift card. Over 250 people participated. The findings from the survey were presented in a community-friendly format using a Community Data Walk methodology. Small groups of participants walked through data displays with a facilitator and engaged in conversation and sharing. After they looked through the data, participants answered questions about what they thought were their county’s strengths and challenges and if they saw themselves in the findings.

Please see the below resources for further exploration of the power of community data sharing:

Data Walks: An Innovative Way to Share Data with Communities, Urban Institute, 2015.

Beyond Inclusion. Equity in Public Engagement: A Guide for Practitioners. Simon Fraser University. Morris J. Wosk Centre for Dialogue.

Why Community Engagement Matters. PennState College of Agricultural Sciences.

Public Health Leadership Feedback

After obtaining feedback on community strengths and challenges during the Regional Health Assessment (RHA) Community Feedback Sessions, we approached Public Health Directors across our Central Oregon counties to provide input on what they also considered strengths and challenges in their counties. We shared this feedback with the Central Orgon Regional Epidemiologist, who provided updated data on these additional community strengths and challenges.

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Method Details - Secondary Data Collection and Initial Analysis

Secondary Data Collection

Through engaging Community Feedback Sessions and discussions with local public health leaders, we pinpointed the top three to four strengths and three to four challenges in community health and social determinants of health for each county, spanning Central Oregon and Deschutes, Crook, Jefferson, and Klamath Counties. We also identified secondary data on these key areas' strengths and challenges.

Our next step involved a secondary data assessment drawn from various sources to shape our finalized data indicator list. We curated this comprehensive list with input from resources such as the Oregon Health Authority (OHA) State Health Assessment, Wisconsin Health Rankings Framework, Central Oregon Health Data Website, and the 2019 Central Oregon Regional Health Assessment.

We compiled and analyzed a final list featuring 154 secondary data indicators. This included a diverse range of 'Health Domains' with 90 indicators (such as sexual health, emotional health, and communicable/chronic disease) and an assortment of factors under the umbrella of 'Social Determinants of Health' (SDOH) with 64 indicators (including education, employment, poverty/income, and housing status).

We began by searching the Central Oregon Health Data Website to pinpoint regional information on individual indicators in Crook, Deschutes, Jefferson, and parts of Northern Klamath (zip codes=97731; 97733; 97737) counties. If data wasn't available there, we extended our search to various web pages and dashboards within the Oregon Health Authority online portal, the Oregon Student Health Survey website, Centers for Disease Control and Prevention (CDC), and the Census Bureau. The Oregon Public Health Assessment Tool (OPHAT), a web-based analytical tool, provided adjusted and unadjusted prevalence rates (including 95% confidence intervals) for selected factors across time for individual Oregon counties. Additionally, the Oregon Public Health Epidemiologists’ User System (ORPHEUS) also helped us gather updated counts and population rates for selected communicable or infectious diseases.

We collected and compiled information into a comprehensive spreadsheet, including website links and years of available data.

Secondary Data Analyses

In our initial analyses, we crafted graphics showing selected indicators and concise descriptions. This involved comparing the indicators across Central Oregon counties and, when possible, against state and national counts/rates. We created short digital slide presentations that compiled this information across various health domains, such as emotional health, chronic disease, and sexually transmitted diseases. These presentations were then shared with regional public health partners, serving as both a valuable resource for decision-making and a platform for gathering feedback on challenges and strengths across the region.

Integration of Data and Final Analysis

Following the analysis and triangulation of results from the Community Health Survey, focus groups, and community feedback sessions, we compiled secondary data and organized the findings into two accessible formats. Both formats present the findings for each county and the Central Oregon region as a whole through the lens of strengths and challenges in the categories of health indicators and social determinants of health.

First, we crafted community-friendly infographic reports. These reports, totaling 48 pages, feature a variety of graphic elements, including line graphs, donut charts, bar graphs, person graphs, narrative callouts, and quotes sourced from 39 data references.

Additionally, we developed an electronic report that is available on the Central Oregon Health Data Website. This electronic report seamlessly links to the data referenced in the community-friendly infographics, ensuring real-time updates as information becomes available.

Additional Information

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Guiding Timeline

From the Summer of 2022 to the Spring of 2024, health partners in Central Oregon worked collaboratively to create the Central Oregon Regional Health Assessment. The Central Oregon Health Council provided convening, facilitation, and project management. The stages of development of the Regional Health Assessment were entirely transparent and public in all processes and outcomes.

 

 

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The Steering Committee and the Core Development Team

The 2024 Regional Health Assessment Steering Committee and the Core Development Team ensured that efforts aligned collaboratively throughout the Central Oregon region. This united approach assessed all community members' needs with additional consideration given to marginalized and underserved communities.

The purpose of the 2024 Regional Health Assessment (RHA) Steering Committee was to advise the Core Development Team to create a regional health assessment that is community-driven, comprehensive, equity-focused, approachable, easy-to-use, and meets statutory requirements outlined for local Governmental Public Health Departments, Coordinated Care Organization, and Hospital System.

The Steering Committee was composed of numerous topical experts and data analysts from organizations across Central Oregon:

• Community members

• Community-based organizations

• Local Governmental Public Health Authorities

• Local Governmental Mental Health Authorities

• Federally Qualified Health Centers

• Local Hospital System

• Traditional Health Workers

• Primary Care Providers

• Child and adolescent health services

• Education Community Advisory Committee members of the Central Oregon Health Council

• Local Coordinated Care Organization

• Tribal Nations

Responsibilities of the Steering Committee included:

• Making Informed decisions based on their expertise and the organization they represent.

• Advising on, promoting, and assisting in information collection efforts to increase community participation, especially community members who are marginalized, underserved, or both.

• Identifying priority populations for information collection efforts.

• Connecting the Regional Health Assessment Core Development Team to existing community leaders and priority populations to prioritize marginalized and underserved communities. Advising on the content of the final 2024 Regional Health Assessment.

• Participating in a Community Partner Assessment facilitated during one of the scheduled Steering Committee meetings.

• Serving as champions in the region by communicating 2024 Regional Health Assessment efforts.

The Purpose of the Core Development Team was to create a collaborative group of community partners with decision-making capabilities to lead, design, and implement the strategies, actions, and tools needed for collecting, analyzing, and publishing the Regional Health Assessment.

The Core Development Team included representation from:

• County Health Departments

• Regional Hospital System

• Coordinated Care Organization

• Regional Health Council

The Core Development Team's responsibilities included:

• Defining the values, preparing and implementing the actions needed to collect the information.

• Reviewing, updating, and defining the secondary-level indicators needed for the RHA.

• Reviewing and approving the appropriate collection methods needed to collect primary information.

• Advocating for their communities’ representation in collecting information and final reports.

• Making decisions about conflicting information, supplying complementary reports needed to complete the study, or both.

• Supporting all the activities needed to inform their communities about the preliminary results.

• Defining what is presented to the Steering Committee for feedback and make themselves available to present and disseminate results or make suggestions to collect information needed for the report.

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Definitions and Citations

Definitions

Central Oregon includes Crook, Deschutes, Jefferson and Klamath counties, unless otherwise indicated. BRFSS data are aggregated from 2018-2021 unless otherwise indicated.

Binge alcohol use is defined as drinking four (for females) to five (for males) or more drinks on the same occasion.

Heavy drinking is defined as consuming 8 (for females) to 15 (for males) or more drinks per week.

Food Insecurity is the lack of access, at times, to enough food for an active, healthy life or with uncertain availability of nutritionally adequate foods. “People” refers to someone aged 12 or older, “youth” refers to someone aged 12 to 18, and “adult” refers to someone aged 18 or older.

Exercise Opportunities is having access to places for physical activity (i.e., recreation facilities and parks). County-level BRFSS data are age-adjusted; regional-level BRFSS data are unadjusted. Being obese is defined as having a body mass index (BMI) of 30-99.8.

Adequate prenatal care is defined as receiving care beginning in the first or second trimester and having at least 5 prenatal visits.

Independent living difficulty is defined as having challenges performing instrumental activities of daily living (IADLs) due to a physical, mental, or emotional condition.

Sheltered is defined as living in emergency shelter, transitional housing, or a hotel/motel paid for with a voucher/by an agency.

The food environment index combines two measures of food access: the percentage of the population that is low-income and has low access to a grocery store, and the percentage of the population that did not have access to a reliable source of food during the past year (food insecurity). The index ranges from 0 (worst) to 10 (best) and equally weights the two measures.

Illicit drug use includes the misuse of prescription psychotherapeutics or the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine.

Misuse of prescription psychotherapeutics is defined as use in any way not directed by a doctor, including use without a prescription of one's own; use in greater amounts, more often, or longer than told; or use in any other way not directed by a doctor.

Prescription psychotherapeutics do not include over-the-counter drugs. Regional designations in the regional report are defined by the National Survey on Drug Use and Health and include: Multnomah (Multnomah County), Clackamas and Washington (Clackamas and Washington Counties), Northwest (Clatsop, Columbia, Tillamook, Yamhill, Polk, Marion, Lincoln, Benton, Linn, and Lane Counties); Southwest (Douglas, Coos, Curry, Josephine, Jackson, and Klamath Counties), Central (Jefferson, Crook, and Deschutes Counties), and Eastern (Lake, Harney, Malheur, Grant, Baker, Wheeler, Wallowa, Union, Umatilla, Morrow, Gilliam, Sherman, Wasco, and Hood River Counties

Definitions related to tobacco and e-cigarettes.

A variety of substitutes for cigarettes exist globally, falling into three main categories: alternative smoking products, smokeless options, and nicotine products not derived from tobacco (O’Connor, 2012). Non-cigarette tobacco and nicotine alternatives encompass a broad spectrum of items, including cigars, smokeless tobacco products like snus, chews, dip, and snuff, dissolvable tobacco products, oral nicotine pouches, hookah, and electronic nicotine delivery systems (ENDS) (O’Connor, 2012).Electronic nicotine delivery systems, known by various names such as vapes, vaporizers, vape pens, hookah pens, electronic cigarettes (e-cigarettes or e-cigs), e-cigars, and e-pipes, utilize an "e-liquid" consisting of nicotine derived from tobacco, flavorings, propylene glycol, vegetable glycerin, and other substances (FDA, January 29, 2024). Resembling regular cigarettes, cigars, or pens, e-cigarettes operate on a battery and contain a mixture of nicotine, flavorings, and additional chemicals (National Cancer Institute., n.d.). Despite lacking tobacco, they produce vapor when used, which users inhale, with various options offering different nicotine concentrations (National Cancer Institute., n.d.).

References

FDA. (2024, January 29). E-cigarettes, vapes, and other ends. U.S. Food and Drug Administration.

National Cancer Institute. (n.d.). NCI Dictionary of Cancer Terms

O’Connor, R. J. (2012). Non-cigarette tobacco products: What have we learnt and where are we headed? Tobacco Control, 21(2), 181–190. 

Citations

You can read the list of citations here.

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Approvals and Endorsements

Approval and Endorsement of the 2024 Regional Health Assessment

 

Partners across Central Oregon are making important strides to improve the health and well-being of all people living in our region. This progress will continue to be supported by partnerships among healthcare providers, local governments, educators, community-based and non-profit organizations, businesses, community groups, individuals, and other entities. To further our vision of a healthier Central Oregon, we have collaborated to compile the 2024 Central Oregon Regional Health Assessment.

As partners in improving the health and well-being of Central Oregon residents, we endorse and affirm the contents of this public document, the 2025 Central Oregon Regional Health Assessment, as accurate, valuable, and significant.

We acknowledge the significance of this document, indicating our commitment to:

• Measure progress, process, and outcomes through a shared lens. We use the Regional Health Assessment (RHA) to develop the Regional Health Improvement Plan and other health and well-being improvement efforts.

• Collaborate to solve complex issues by inviting diverse perspectives from throughout the Central Oregon region. This deepens our shared understanding of complex issues and propels us toward better progress and outcomes.

• Coordinate collective efforts, recognizing that we are made up of diverse partner organizations and individuals with unique strengths, skills, and resources. We coordinate our efforts and use our unique strengths and skills.

• Partner with priority populations so the individuals living in our diverse Central Oregon communities remain the center of our work. We make every effort to include people from every part of the region in our workgroups, discussions, processes, and decisions.

We commend our communities for their efforts in producing such comprehensive and insightful work.

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Acknowledgments

The creation of this report is the collective and collaborative work of over 4000 individuals living throughout Central Oregon who shared their personal experiences, nearly 30 community organizations serving our region’s people, and multiple contractors who assisted with data analysis and creation of infographics.

We thank everyone who contributed their experiences, insight, specialty knowledge, skills, and time to create this report. Your name may not be here, but this report holds the unique impressions left by your involvement. We are grateful to you.  

Here are a few of the people and groups involved in the creation of the 2024 Central Oregon Regional Health Assessment.

 

509J School District

Advantage Dental from DentaQuest

Age+

The B.E.A.M.

Bend Senior High School Students

Bend-La Pine School District

BestCare Treatment

Central Oregon Disability Support Network

Central Oregon Community College Students

Central Oregon Community College

Comagine Health

Community Advisory Council, PacificSource Community Solutions

Confederated Tribes of Warm Springs

Council on Aging of Central Oregon

Crook County Public Health

Deschutes County Behavioral Health Services

Deschutes County Public Health

Early Learning Hub, Better Together

Ellipse Theatre Company

Family Access Network 

Family Connects Central Oregon

The Father's Group

First Light Peer Support

High Desert Education Service District,  Migrant Education

Homeless Outreach Services

Horses on the Ranch

Ignatius Bau Consulting

Jefferson County Public Health

Jéssica Sánchez-Millar, Interpreting Service

Justice, Equity, Diversity and Inclusion Committee, Central Oregon Health Council

Klamath County Health Department

Klamath County Public Health

La Pine Community Health Center

Latino Community Association

Lines for Life: Youthline and Native Youthline

Mosaic Community Health

NAMI Central Oregon

NatureConnects Central Oregon

Northern Klamath County Residents

PacificSource Community Solutions

Planned Parenthood Columbia Willamette

Professional Interpreters, Inc.

Provider Engagement Panel, PacificSource Community Solutions

Quon Design and Communication, Inc.

St.Charles Health System

Traditional Community Health Workers, Mosaic Community Health

Translations y Traducciones

Volunteers in Medicine

Walker Range Patrol Association

Wyoming Survey & Analysis Center University of Wyoming

Youth Compass Connect