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FAYETTE MEDICAL CENTER 2022 2024 COMMUNITY HEALTH NEEDS ASSESSMENT

TABLE OF CONTENTS INTRODUCTION 2 EXECUTIVE SUMMARY 2 METHODOLOGY 6 OBTAINING PUBLIC INPUT 8 2019 CHNA Review 8 Stakeholder Input 9 Relevant Health care Data 15 PRIORITIZED NEEDS AND ACTION PLANS TO ADDRESS 17 Access to Care Actions to Address 17 Mental Health Actions to Address 18 Risk Factors that Contribute to the Leading Causes of Death Actions to Address 18 OTHER RECOGNIZED HEALTH CARE NEEDS NOT PRIORITIZED 19 DOCUMENTING RESULTS PLANS TO MONITOR PROGRESS 19 EXISTING RESOURCES AVAILABLE TO MEET THE IDENTIFIED NEEDS 20 Licensed Health care Facilities Serving the Community 21 APPENDIX A County Health Profiles 22 42 State of Alabama Medical Statistic Maps 43 47 APPENDIX B County Health Rankings Roadmaps 48 APPENDIX C The Burden of Diabetes in Alabama 49 52

METHODOLOGY INTRODUCTION Fayette Medical Center is a 61 bed acute care rural hospital located in Fayette Alabama Since 1958 Fayette Medical Center has served the residents of Fayette County and the southern part of Lamar County with the highest quality of care meeting the ever growing health needs of citizens in West Alabama In 1984 the Fayette County Hospital Board made the decision to enter into a long term lease with the DCH Health System Because of the success of the partnership the lease was renewed in 1996 for 20 additional years However in 2007 the agreement was updated and extended for 20 years until September 2027 This has allowed for a stable health care environment in the area and local ownership of Fayette Medical Center Fayette Medical Center is accredited by the Joint Commission and provides services to include acute care primary care surgical care laboratory services pharmacy services diagnostic imaging intensive care and emergency services In addition specialty clinics in cardiology oncology urology orthopedics neurology ophthalmology nephrology and podiatry are provided For patients needing additional care in the hospital to improve outcomes and return to normal activities of daily life a swing bed rehabilitation program is provided based on each patient s individual needs and goals The Hospital also includes a 122 bed fully accredited intermediate and skilled nursing facility Fayette Medical Center is located just 45 miles north of the cities of Tuscaloosa and Northport Alabama It is one of the largest employers in the area and boasts a 5 star patient satisfaction rating attesting to the high quality compassionate care provided by the administrative clinical and support staff of the hospital According to data provided by the State Health Planning and Development Agency of the State of Alabama Fayette Medical Center had 826 admissions performed 2 433 inpatient and outpatient procedures and treated 10 738 patients who visited the emergency department in 2021 EXECUTIVE SUMMARY The Affordable Care Act Section 501 r requires notfor profit hospitals to conduct a Community Health Needs Assessment CHNA every three years to identify the health needs of the community prioritize health needs identified and to develop and implement action plans to address those needs This CHNA is a follow up to the CHNA conducted by Fayette Medical Center in 2019 As part of the process a stakeholder group was assembled to assist in identifying those needs and developing strategic goals 2 for the hospital to implement Prior CHNAs are reviewed and considered in the process as is pertinent health data obtained from local state and national sources This 2022 CHNA includes input from experts in public health local leaders in the community and representatives of the medically underserved minority and low income populations It also includes a review of the 2019 CHNA The report will also reflect data obtained from sources to include the Alabama Department of Public Health the Robert Wood Johnson

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Foundation the US Census Bureau the Centers for Disease Control and others The CHNA was facilitated by SBC Consulting LLC staff and members of the DCH Health System team After consideration of the patient population of the hospital the geographic area and the minority lowincome and medically underserved populations it was determined the community should be defined as Fayette County and southern Lamar County This is consistent with prior CHNAs conducted since 2013 Factors such as demographics socio economic status health behaviors and the environment were considered as each of these affects the overall health of the community Individual and small group meetings took place over several weeks 4 The Stakeholders input and the pertinent data provided identified several issues of health in the community including Transportation or lack thereof Access to basic primary care Access to specialty care especially as it relates to women Lack of inpatient mental health beds Obesity physical inactivity and poor food choices that contribute to diseases such as diabetes heart disease and stroke High rate of inflation No money to buy food

Increase in cancer many in the low income community did not seek preventive care during the COVID pandemic and as a result the incidence of cancer has risen available to the public on the DCH Health System website Progress of the needs and subsequent action plans will be updated as needed Lack of a resource guide and education materials This report will include the following Need for additional broadband coverage Need for additional telemedicine coverage 1 Methodology used to identify the health needs of the community Lack of available health care for the uninsured 2 2019 CHNA review Need for Medicaid expansion 3 Prioritized health needs and action plans to address the prioritized health needs Need for more physician coverage Need for additional ambulance coverage Comorbidities in the elderly community Additional data provided to the Stakeholders showed the leading causes of death in Fayette and Lamar County were heart disease cancer stroke and chronic lower respiratory disease Data provided from the County Health Rankings and Roadmaps in 2021 showed a high prevalence for diabetes and adult obesity as well as adult smoking all risk factors that contribute to the leading causes of death in the community 4 Existing resources available to address the identified health needs 5 Documentation and plans to monitor the CHNA 6 Supplemental data and appendices Other data showed additional health factors that contribute to poor health outcomes include perceived poor health days poor mental health days physical inactivity high rate of teen births and the lack of primary dental and mental health providers Data also showed the highest rate of infant deaths occurred in the African American community After reviewing the multiple issues of health identified through the Stakeholders input and the data provided by the facilitators the leadership of Fayette Medical Center determined the following three issues of health should be prioritized Access to Care Mental Health Factors that Contribute to the Leading Causes of Death Action plans to be implemented will be recommended and following approval of this CHNA by the DCH Health System Governing Board will be made widely 5

METHODOLOGY METHODOLOGY The leadership of the DCH Health System enlisted the assistance of SBC Consulting LLC to ensure steps taken to complete the CHNA were compliant with the requirements set forth in the Affordable Care Act Stephanie Craft and her team have worked with the DCH Health System and Fayette Medical Center since 2013 in facilitating three prior CHNAs Her knowledge of the community and input from the stakeholders provided a seamless and efficient process The leadership of the DCH Health System and Fayette Medical Center developed a comprehensive Stakeholder Committee consisting of a diverse group of individuals uniquely qualified to participate in the CHNA process The committee consisted of community and local government leaders experts in public health and those who represent the medically underserved and minority populations Each Stakeholder took ownership of the project and committed to work to improve the overall health of the community In addition to discussions which centered around the Stakeholders personal and work experiences supplemental public health data was provided that included demographics risk and behavioral factors socio economic and environmental factors and the leading causes of death in the community of Fayette and Lamar counties All of this supportive data helped to identify issues of health in the community Due to the COVID 19 protocols which were implemented early in the pandemic large group meetings were avoided Instead small focus group and individual meetings were held to ensure appropriate and required input was received The following individuals were enlisted as community Stakeholders Mike Freeman Probate Judge of Fayette County Rod Northam Mayor City of Fayette AL Charles Brandon Chair of the Fayette Medical Center Board of Directors 6 Bart Robertson Retired community member and Primary Officer of the Christian Center of Concern Redonia Keeton Director of the Christian Center of Concern Danny Whitehead Reverend of St Michael s Episcopal Church in Fayette AL Valerie Alford Program Director at North Harbor Pavilion Jennifer Singleton Community Education Manager at North Harbor Pavilion David Anderson Director of the DCH Diabetes and Nutrition Education Center Cindy Huggins Dietitian at the DCH Diabetes and Nutrition Education Center Marsha Fowler RN DCH Diabetes and Nutrition Education Center Cynthia Burton CEO of Community Service Programs David Gay CEO of Whatley Health Services Lynn Armour Executive Director of the Good Samaritan Clinic Billy Kirkpatrick PhD and CEO of Five Horizons Health Services Donald Jones Administrator of Fayette Medical Center Ashley Adcox Aging Services Director of the Area Agency on Aging of West Alabama Following approval of this CHNA the written report will be made widely available on the Fayette Medical Center homepage on the DCH Health System website

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OBTAINING PUBLIC INPUT According to Section 501 r 3 of the IRS regulations community input must be obtained from three primary sources including experts in public health representatives of the medically underserved minority and low income populations and written comments received from the most recently conducted CHNA Alzheimer s Disease Stroke Diabetes Motor vehicle accidents Obesity To date no comments have been received regarding the Fayette Medical Center 2019 CHNA Input was received from multiple experts in public health representatives of the medically underserved and minority populations as well as leaders in the community Additional public health data specific to Fayette and Lamar counties was also submitted for consideration to help identify the needs of the local community Stakeholders took into account their experiences with residents within the community as well as the supplemental data provided to determine health needs 1 2019 CHNA REVIEW In September of 2019 the DCH Health System Governing Board approved the 2019 CHNA Following that approval the CHNA was posted on the hospital s website and made widely available for public viewing The following information is provided as an update to the 2019 CHNA The Community for Fayette Medical Center was defined as Fayette County AL and the southern part of Lamar County AL The issues of health identified from all sources included the following Access to care Heart Disease Cancer Chronic Lower Respiratory Disease 8 Physical inactivity Lack of access to exercise opportunities Teen births Lack of dental care Mental health and the need for additional inpatient beds Poverty in children Opioid crisis Lack of services for the elderly Transportation Lack of obstetrical services Three needs were prioritized and the following actions plans were implemented 1 Access to Care Actions to Address Provide bi weekly and monthly specialty clinics through arrangements with the DCH Health System Expand the continuum of care in the elderly population with independent living assisted living and specialty care assisted living to complement the Fayette Medical Center longterm care facility Sustain the viability of the hospital by educating the public on services provided and marketing within the community

Continue collaboration with the DCH Foundation and the Fayette Medical Center Foundation to provide transportation prescription medications assistance with utilities and lodging for family members when needed Strengthen relationships with agencies and organizations serving residents in Fayette and Lamar counties including Community Service Programs of West Alabama the Good Samaritan Clinic and Whatley Health Services to ensure residents are aware of the services provided Advocate for the continuation of the half cent sales tax to benefit Fayette Medical Center Continue the Target Rural Scholars program in the local school system to identify students who may become clinicians and encourage them to return to the area to practice Continue the Explorer Post program with the Boy Scouts of America which is a hands on clinical teaching post for students aged 14 20 to encourage medical careers Investigate the use of telemedicine in other disciplines provided at Fayette Medical Center 2 Mental Health Actions to Address Implement the Qler telepsychiatry program in the emergency department of Fayette Medical Center Provide educational materials in the community regarding the telepsychiatry services at the hospital as well as services provided through other agencies and organizations who serve the community Work with the local EMS providers to allow public access to Narcon and other overdose kits Monitor the progress and implementation of any new action plans of the Governor s Opioid Overdose and Addiction Council 3 Risk Factors that Contribute to the Leading Causes of Death Actions to Address Work with the DCH Diabetes and Nutrition Education Center to increase referrals and ultimately improve diabetes management for patients Continue annual health fairs that provide free screenings including prostate diabetes vision cardiac colon and mammography screening Continue to participate and sponsor run walk events in the community to encourage exercise and increase physical activity Encourage local participation in the Alabama Department of Public Health s Scale Back Alabama program to decrease obesity in the area Expand the hospital cardiac rehabilitation program to include wellness and prevention Start regular exercise classes at the hospital While every effort has been made by Fayette Medical Center to implement the action plans established in the 2019 CHNA the COVID 19 pandemic prevented or halted progress due to the restrictions mandated by the State of Alabama Many of the action plans adopted through this process since 2013 are on going and have significantly contributed to the overall improvement of health and access to health care services for many in Fayette and southern Lamar counties At the time this report was submitted no public comments have been received 2 STAKEHOLDER INPUT Under Section 501 r 3 of the Patient Protection and Affordable Care Act not for profit entities must receive input from three primary sources 1 at least one state local tribal or regional governmental public health department 2 members of the medically underserved low income and minority populations and 3 written comments received on the hospital facility s most recently conducted CHNA 9

Although the Fayette Medical Center CHNA was made widely available for public viewing and comment on the DCH Health System website at the time this CHNA was completed no comments had been received Facilitator Stephanie Craft and DCH Health System staff member Sammy Watson conducted interviews with various leaders in the community those representing the medically underserved minority and low income populations The following is a summary of the interviews conducted throughout the development of the CHNA The Honorable K Michael Freeman Probate Judge of Fayette County Alabama As Probate Judge Mr Freeman has many judicial and administrative duties in Fayette County including hearing cases involving administration of estates adoptions legitimations guardianships conservatorships eminent domain change of name and involuntary mental commitments His office also maintains records and issues licenses He is the Chief Election Officer of the county and serves as Chairman of the Fayette County Commission Through his experience as Probate Judge Mr Freeman identified mental health as a major issue of health in West Alabama He stated that there is a tremendous need for additional inpatient psychiatric beds as there are a limited number of beds available in West Alabama Many individuals who have been committed to a mental health facility through the court system are on a wait list for an available bed He also suggested there is a need for additional mental health services for adolescents He attributed this need in part to the COVID 19 pandemic and the restrictions placed on schools and students during the height of the pandemic Mr Freeman also expressed the need for greater access to care for individuals in the service area of Fayette Medical Center He said that telepsychiatry is currently used in the emergency department of the hospital but he would like to see telemedicine expanded for primary care and possibly other 10 specialty services that are currently limited in the area Additionally he expressed the need for greater broadband access in the area Mr Freeman expressed great appreciation for the relationship between Fayette Medical Center and the DCH Health System Rod Northam Mayor of Fayette Alabama Charles Brandon Chairman of the Fayette Medical Center local Board of Directors As mayor of Fayette Alabama Mr Northam is responsible for the operations of several departments in the city including Fire and Rescue the Police Department Household Trash and Limb Removal Parks and Recreation the Water Board the Gas Board the Municipal Court Beautification Sanitation and the City Engineer Mr Brandon Chairman of the Fayette Medical Center local Board of Directors works closely with the administration of the hospital and city officials to ensure Fayette Medical Center remains viable and continues to provide critical services to residents in the service area According to Mr Northam and Mr Brandon recruitment of physicians to Fayette is a critical health need for the community in order to provide local health care services but finding housing in Fayette is close to impossible impeding the ability to recruit physicians to the area While there are plans to expand the roadways in the area there is a great need to annex additional land into the city in order to expand opportunities to build additional housing Both gentlemen also expressed the need for greater access to specialists especially for women s care Also as it relates to access to care Mr Northam and Mr Brandon cited transportation as an issue as the lack of transportation prevents many low income residents from getting to their doctor appointments to the grocery store to purchase food and to jobs In the near future a local manufacturing plant will be expanding adding 150 additional jobs Both men agreed there is a need for workforce development in the area Finally both Mr Northam and Mr Brandon expressed the need for additional mental health services in West Alabama

Rev Whitehead and Mr Robertson all agreed that issues of health they see include the uninsured access to food and basic preventive care mental illness lack of resources and the need for Medicaid expansion in Alabama Mr Bart Robertson Primary Officer of the Christian Center of Concern Ms Redonia Keeton Director of the Christian Center of Concern Reverend Danny Whitehead Rector of St Michael s Episcopal Church in Fayette AL Mr Robertson Ms Keeton and Rev Whitehead participated in a focus group meeting with facilitators Stephanie Craft and Sammy Watson These individuals provide vital services to low income minority populations and the medically underserved in the community served by Fayette Medical Center The Christian Center of Concern is a non profit organization that operates entirely with volunteers and donations from churches individuals businesses food drives civic groups and the USPS The Center ministry began in 1990 and has served the community by providing food to anyone in need and to those who receive limited food stamps The service supplements individual and family needs and helps ensure survival The Christian Center of Concern is also a ministry supported by St Michael s Episcopal Church In addition Rev Whitehead has several outreach ministries that also provide for the community St Michael s Beans and Rice Ministry serves 30 families a month with a high protein meal and the Harvesting Hope Community Garden provides free nutrient dense produce and education on healthy eating for those in need in the community Rev Whitehead stated that while they provide healthy seeds and plants and will educate residents on how to grow fresh vegetables many will not come and refuse to eat healthy As a result many low income residents resort to fast food and other poor eating options and are overweight or have diabetes Ms Keeton stated that many residents in the area have food insecurity as well as great needs for personal hygiene products such as toilet paper dish detergent and soap She also stated that many in the low income and minority populations are still fearful of contracting the COVID 19 virus and as such will not seek the help they need including medical care Ms Keeton Valerie Alford Program Director at North Harbor Pavilion Jennifer Singleton Community Education Manager at North Harbor Pavilion North Harbor Pavilion which is located on the campus of Northport Medical Center is an inpatient psychiatric treatment facility for adult and geriatric patients This facility serves patients throughout West Alabama The interdisciplinary treatment plan includes nursing care group therapy mental health education and a discharge plan specifically designed to improve the quality of life of the patient Ms Alford and Ms Singleton agreed that there is a great need for additional inpatient psychiatric beds to serve adolescent patients It is their hope that the leadership of the DCH Health System will consider the process of adding adolescent psychiatric beds to North Harbor Pavilion to address the need throughout West Alabama They noted the increase in anxiety depression and suicide in children due to the COVID 19 pandemic and the restrictions placed on schools The onset of the pandemic shut down previous action plans that were designed to address the mental health crisis in the area The Talks Saves Lives program which is designed to prevent suicide in children was halted due to COVID Ms Singleton is fully trained in this program and it is anticipated that the program will begin in the near future as restrictions have been lifted and schools have returned to in person learning Ms Singleton and Ms Alford also noted the great need for mental health medication administration in the homeless population They also plan to start a shot clinic at North Harbor Pavilion to allow patients to receive much needed maintenance medications to mitigate the effects of some mental health disorders The intent is to minimize crisis situations that result in admission to the emergency department and arrests Both ladies also expressed concern in the shortage 11

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of mental health staff While in the past there was a need for another psychiatrist that need has been fulfilled however other clinical staff is still needed North Harbor Pavilion now has a pharmacist on staff as well North Harbor Pavilion staff has also been trained and plans to implement the Screening Brief Intervention and Referral to Treatment program SBIRT which is a comprehensive integrated public health approach for early identification and intervention with patients whose patterns of alcohol and or drug use put their health at risk This program will address and allow for early intervention and prevent multiple admissions to the facility David Anderson Director of the DCH Diabetes and Nutrition Education Center Cindy Huggins Dietician at the DCH Diabetes and Nutrition Education Center Marsha Fowler RN DCH Diabetes and Nutrition Education Center The team of the DCH Diabetes and Nutrition Education Center met with facilitators Stephanie Craft and Sammy Watson to discuss the burden of diabetes in West Alabama The Alabama Department of Public Health Data provided in this report shows that diabetes is one of the leading causes of death in Fayette and Lamar counties This is consistent with most of the counties in Alabama National data states Alabama has the third fastest projected increase in diabetes and it is projected that Alabama s diabetes rate will increase by 38 percent over the next 10 years through 2030 Studies also show that this increase will most likely occur in rural areas low income areas and areas with high obesity rates Mr Anderson Ms Huggins and Ms Fowler all agreed that there is a need for more education to the public regarding this disease The DCH Diabetes and Nutrition Education Center is a stand alone facility that provides education and training in self management skills for individuals with diabetes and nutritional needs with the goal of delaying the onset of diabetes or preventing complications associated with the disease COVID 19 prevented the normal class schedule and size of the class but it is the hope of the team that regular classes will resume immediately It is also their desire to participate in health fairs and market to physicians throughout the service area to ensure that individuals and families are aware of the services the DCH Diabetes and Nutrition Education Center provides The US Department of Health and Human Services Healthy People 2030 continues to list as one its goals to reduce the burden of diabetes and to improve the quality of life for people who have or are at risk for developing diabetes The program initiatives of the DCH Diabetes and Nutrition Education Center mirror the objectives set forth in the federal government s program Cynthia Burton CEO of Community Service Program Chairman of Whatley Health Services Board of Directors David Gay CEO of Whatley Health Services DCH Health System Board of Directors member Pastor of Beulah Baptist Church former Director of Bryce Hospital and Taylor Hardin Mental Health Facility To ensure compliance with the Affordable Care Act several representatives of the medically underserved low income and minority populations were interviewed for this CHNA project The organizations represented by Ms Burton and Mr Gay provide a comprehensive array of services to the underserved uninsured and minority populations throughout West Alabama including the counties of Fayette and Lamar Community Service Programs of West Alabama is a private nonprofit community action agency that provides education housing and support services that includes assistance for the elderly meal delivery utility assistance and case management It is the goal of the agency to create self sufficiency for those served resulting in a better quality of life Whatley Health Services is a private nonprofit community health center that provides primary health care and dental care in multiple locations throughout West Alabama 13

Services include internal medicine family pediatric and adolescent care mental health care the WIC program for women and children chiropractic care HIV AIDS care pre natal care dental care ENT services pharmacy services and laboratory services Mr Gay and Ms Burton addressed many health needs identified in the individuals and families they serve Issues identified included Lack of community resources Transportation COVID 19 and associated consequences Access to basic primary and preventive care Increase in the suicide rate in children Long wait times in the emergency room Domestic violence Lack of affordable housing nurses counselors and others who provide primary health and dental care to more than 350 uninsured and underinsured adults aged 19 64 While the Good Samaritan Clinic does not provide services to Lamar County it does to residents with income at or below 200 percent of the poverty level in Fayette County It is the only free clinic in the area Ms Armour met with facilitators and explained that many of the residents in the service area are unaware of their services She also stated that many could not come to their clinic because they did not have transportation and many did not seek care at all because of the stigma associated with poverty and receiving free care It is the hope of Ms Armour that Fayette Medical Center will provide information on the clinic s services to increase access to vital health services in the rural area of Fayette County Homelessness Language barriers among the increased Hispanic population High rate of inflation Food insecurity High cost of childcare Ms Burton and Mr Gay both agreed that the DCH Health System and its hospitals including Fayette Medical Center have been steadfast in attempting to address these needs however the health needs remain prevalent in the community They both agreed it is incumbent upon all these organizations to continue the relationships and work together to educate the public on the services provided by the organizations It was suggested that when appropriate patients need to be educated on these services upon discharge from the emergency department or the hospital Lynn Armour Executive Director of the Good Samaritan Clinic in Northport Alabama The Good Samaritan Clinic is a nonprofit free clinic staffed by volunteer physicians pharmacists dentists 14 Billy Kirkpatrick PhD CEO of Five Horizons Health Services The CHNA facilitators met with Dr Kirkpatrick and several members of his staff in a focus group to discuss the health needs of the clients served by Five Horizons Health Services Five Horizons is a nonprofit organization formerly known as West Alabama AIDS Outreach The former agency grew beyond providing just HIV related outreach and prevention services to now include general and more specialized health services The organization serves 10 counties in West Alabama including Fayette and Lamar counties and provides HIV case management and counseling housing assistance HIV AIDS prevention education and free HIV testing Dr Kirkpatrick and his staff identified transportation as a major issue of health as the lack of transportation prevents those in the rural areas from seeking testing and preventive treatment Access is a barrier to care for those in the rural area that Dr Kirkpatrick and his staff want to eliminate He also stated that many individuals in rural areas are unaware of the services

provided He suggested more robust education to patients who may present at the emergency room or may be admitted to Fayette Medical Center Dr Kirkpatrick is considering a mobile clinic to reach those located in the rural areas of West Alabama Donald Jones RN Administrator of Fayette Medical Center A meeting was held between facilitators and Mr Donald Jones RN and Administrator of Fayette Medical Center to discuss issues of health and prior issues of health and action plans that have been implemented to address those issues Mr Jones agreed that mental health and access to specialty psychiatric services remains a major issue of health in the area and additional resources are needed to adequately address those needs He confirmed that the use of telepsychiatry in the Fayette Medical Center emergency department has helped to provide greater access to mental health services and he hopes to expand the use of telemedicine to address other access issues in the area Mr Jones reported that efforts to recruit physicians and nursing staff is also of great importance in addressing the access to care need in the area He also noted that there is a significant increase in the elderly population in the area and those individuals need additional services such as independent living assisted living and specialty care assisted living services which are currently not available in the area Mr Jones confirmed that poor health factors that contribute to the leading causes of death in the area are still prevalent in Fayette and Lamar counties While the prior CHNA suggested free health screenings to educate residents in the area on better care and proper treatment to manage common health problems including diabetes hypertension and obesity the COVID 19 pandemic significantly reduced the ability of his staff to conduct these health fairs He hopes to continue this program and other events and sponsorships such as run walk events and the Alabama Department of Public Health s Scale Back Alabama program to decrease the incidence of obesity in the area Ashley Adcox Aging Services Director of the Area Agency on Aging of West Alabama Ms Adcox met with the facilitators to discuss the various health needs of the clients served by her agency The Area Agency on Aging of West Alabama provides services to elderly persons and their families as well as those who are disabled The agency serves more than 830 clients in a sevencounty area including Fayette and Lamar counties The resources provided by the agency assist older adults in maintaining independence in their homes in a safe and effective manner for as long as possible Adults who qualify for the program can receive legal counseling home delivered meals assistance with chores in their homes discounts on prescription medications part time job placement health promotion classes long term care services housing and advice on health insurance plans to best suit the need of each individual or family The agency does not provide dental and vision insurance coverage and this is indeed an issue of health for the elderly according to Ms Adcox She also suggested transportation is a major barrier creating a lack of access for many in the elderly population All efforts were made by Fayette Medical Center the staff of DCH Health System and the facilitator team to gain input from all appropriate and required sources for this CHNA exercise 3 RELEVANT HEALTH CARE DATA Additional pertinent data obtained from local state and national data is provided in Appendixes A B and C 15

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PRIORITIZED NEEDS AND ACTION PLANS TO ADDRESS After comprehensive review of the Stakeholder s input additional pertinent data and prior CHNA priorities the leadership of Fayette Medical Center and the DCH Health System determined three issues of health to be considered priorities for Fayette Medical Center to address Financial feasibility effectiveness and available resources were considered Multiple issues of health identified in this CHNA were consistent with issues of health identified in previous CHNAs and as such many strategies are currently in place and are considered effective to address these needs Fayette Medical Center maintains its desire to focus on strategic plans designed to improve the overall health of residents in the community and to ensure access to health care for everyone in the community regardless of their ability to pay For that reason the following three needs are established as priorities and the action plans to address those needs are included 1 Access to Care Actions to Address Continue the arrangement with DCH Health System to provide specialty clinics in Fayette Alabama on a bi weekly and monthly basis Those clinics will include orthopedics neurology cardiac care nephrology podiatry urology optometry and a Veteran s Administration clinic for veterans Explore expanding services for the elderly to provide a more appropriate continuum of care to include independent living assisted living and a specialty care assisted living facility to complement Fayette Medical Center s existing nursing care facility Continue to promote and market the rural health clinics in the area and the new Fayette Medical Center primary care clinic through social media and through more traditional display advertising Fayette Medical Center plans to work with the DCH Health System Vice President of Marketing and Communications to assist in this endeavor Expand the use of telemedicine in the area Fayette Medical Center currently uses the Qler program in the emergency department to provide consultations to patients needing mental health evaluations This program allows a boardcertified licensed psychiatrist provided by the Qler network to work with the emergency room physicians to recommend a treatment plan for the patient including appropriate medications and follow up care Due to the success of this program the hospital has expanded use in the inpatient and nursing home settings Fayette Medical Center leadership is evaluating costs and effectiveness of using telemedicine in cardiac and neurology cases to make certain patients are getting access to the most appropriate care Continue collaborative efforts with the DCH Health System Foundation and the Fayette Medical Center Foundation to provide transportation prescription medications lodging for family members when specialty services are needed outside of Fayette and financial assistance with utilities for residents in Fayette and Lamar counties Continue working with the City of Fayette elected officials to extend the half cent sales tax which provides funding for the hospital to operate City officials voted in July of 2021 to renew the sales tax for three additional years through 2024 Maintain relationships with other organizations in the area such as Community Service Programs of West Alabama the Good Samaritan Clinic Whatley Health Services and the Area Agency on Aging of West Alabama to improve access to health care in West Alabama Continue to work with the local school programs and the University of Alabama to identify students who are interested in the medical field and encourage their return to Fayette to practice 17

Continue efforts to recruit physicians and nursing staff to Fayette Alabama Work with the governmental leaders in the city of Fayette and the county of Fayette to develop land to increase housing opportunities for the increase in population expected in the area 2 Mental Health Actions to Address Expand the use of telemedicine in other settings besides the emergency department As stated earlier Fayette Medical Center is currently using the Qler program to assist emergency room physicians in developing treatment plans and medication management for patients needing mental health evaluations The hospital has expanded this program to the inpatient setting of the hospital and the long term care facility at Fayette Medical Center Continue to distribute educational materials throughout the community on the telepsychiatry services provided at Fayette Medical Center as well as mental health services provided by other organizations serving the area including Indian Rivers Behavioral Health West Alabama Mental Health Center Five Horizons Health Services and Whatley Health Services Continue relationship with the Fayette County EMS providers to increase access to Narcon overdose kits 18 Work with the DCH Health System and North Harbor Pavilion to increase inpatient mental health beds for adolescents Work with the staff at North Harbor Pavilion to provide education materials to students in the local school system on suicide prevention 3 Risk Factors that Contribute to the Leading Causes of Death Actions to Address Continue to coordinate efforts with the DCH Diabetes and Nutrition Education Center to market to local physicians to increase referrals and better manage the obesity and diabetes epidemic in the area Continue annual health fairs that provide free screenings including prostate diabetes vision cardiac colon and mammography screening Provide sponsorships and encourage employee participation in local community events that encourage exercise and increased physical activity Encourage Fayette Medical Center s employees continued participation in the DCH employee wellness program Market and educate residents in the area on the newly expanded Fayette Medical Center cardiac rehabilitation program which includes wellness and prevention

METHODOLOGY OTHER RECOGNIZED HEALTH CARE NEEDS NOT PRIORITIZED While multiple issues of health were identified throughout the CHNA process Fayette Medical Center leadership determined it was impossible to address each of the health issues identified by the Stakeholders and the data provided As such it was decided that the most effective and financially feasible path forward was to continue action plans for issues of health considered priorities in past CHNAs Stakeholder meetings suggested the issues of health remain constant in the community and efforts to address those issues have been successful and should remain in place Issues of health that were identified but not considered as priorities can be addressed by other agencies and organizations in the area that provide services to residents in Fayette and Lamar Counties DOCUMENTING RESULTS PLANS TO MONITOR PROGRESS Following approval of this report by the Fayette Medical Center s Governing Board the hospital will make this report available to the public for viewing and comments on the hospital website It is the intention of Fayette Medical Center to continue the action plans currently established through prior CHNA projects to ensure all residents in Fayette County as well as those served by the hospital in southern Lamar County are provided with the highest quality of health care services in an accessible and affordable manner The goal of this plan is to provide services that improve the quality of life for all residents in the community including the medically underserved the low income and the minority populations 19

EXISTING RESOURCES AVAILABLE TO MEET THE IDENTIFIED HEALTH NEEDS The following is a list of available resources specific to Fayette County and southern Lamar County in West Alabama United Way of West Alabama Fayette County Child Welfare The Alabama Department of Public Health Fayette County Parks and Recreation Department The Alabama Department of Mental Health The Alabama Department of Senior Services Health InfoNet of Alabama consumer health information The Alabama Department of Human Resources Hospice of West Alabama The Alabama Cooperative Extension Services Northwest Alabama Mental Health Center Alabama Medicaid Agency Whatley Health Center comprehensive health services for the medically underserved low income and minority populations All Kids health care coverage program for children under 19 Alabama Autism Society The Arc of Fayette Lamar and Marengo Counties services for intellectual and or developmental disabilities American Red Cross disaster relief military services CPR first aid safety classes The Salvation Army Start Program substance abuse assistance The Sickle Cell Disease Association of America West Alabama Chapter United Cerebral Palsy of West Alabama Alabama Rural Health Association Five Horizons Health Services HIV Aids treatment prevention and education Area Agency on Aging Fayette County Senior Centers Good Samaritan Clinic free primary and dental health care for the indigent and uninsured Bevill State Community College West Alabama Mental Health Alliance mental health service support and outreach Boys and Girls Club of West Alabama education recreation and leadership programs for children and youth Community Service Programs of West Alabama support programs educational programs housing assistance Easter Seals of West Alabama assistance to children and adults with physical handicaps Fayette Senior Activity Center hot meals educational programs transportation to the center activities and services some health services 20 Fayette Chamber of Commerce

LICENSED HEALTH CARE FACILITIES SERVING THE COMMUNITY Licensed Facilities in Fayette County Alabama Type of Facility Facility Assisted Living Facility Morningview Estates End Stage Renal Disease Treatment Center Fayette Dialysis Home Health Agency Fayette Medical Center HomeCare Hospital Fayette Medical Center Independent Clinical Laboratory Fayette Medical Center Laboratory Nursing Home Fayette Medical Center Long Term Care Unit Rural Health Clinic Fayette Medical Center Licensed Facilities in Lamar County Alabama Type of Facility Facility Community Mental Health Center Northwest Alabama Mental Health Center Home Health Agencies Lamar County Home Care Encompass Health Home Health Nursing Home Generations of Vernon LLC Rural Health Clinics Millport Family Practice Clinic Sulligent Medical Clinic Fayette Medical Clinic Millport 21

APPENDIX A SU M M ARY Total Population 209 355 Births 2 630 Deaths 1 739 Median Age 33 8 Life Expectancy at Birth 77 0 Total Fertility Rate per 1 000 Females Aged 10 49 1 540 0 Number Marriages Issued TUSCALOOSA 2019 HEALTH PROFILE 1 226 Rate Number Divorces Granted 699 Rate Rates per 1 000 population P RE GN AN C Y N ATAL I T Y Females Aged 15 44 Females Aged 10 19 Number Rate Number Rate Estimated Pregnancies 3 836 77 7 289 19 8 Births 2 630 12 6 185 12 6 Induced Terminations of Pregnancy 618 12 5 61 4 2 Estimated Total Fetal Losses 588 43 Birth rates per 1 000 population Estimated pregnancy and induced termination of pregnancy rates are per 1 000 females in specified age group BIRTH S B Y AGE GR O U P O F M O T HE R Total 10 14 15 17 18 19 20 2 630 1 39 145 2 445 Rate 12 6 0 2 7 4 41 3 52 0 White 1 395 0 16 70 1 309 Rate 10 4 0 0 4 8 31 3 46 7 All Births Black and Other Rate 1 235 1 23 75 1 136 16 5 0 4 12 0 58 7 59 9 Rates are per 1 000 females in specified age group Births with unknown age of mother are included in the age group 20 L I V E B I RT HS Females Aged 15 44 Births to Unmarried Women Low Weight Births Multiple Births Medicaid Births Number Percent Number Percent 1 337 50 9 160 86 5 288 11 0 20 10 8 96 3 7 6 3 2 1 199 45 6 136 73 5 Percentages are of all births with known status for females in specified age group 22 Females Aged 10 19

APPENDIX A TUSCALOOSA 2019 HEALTH PROFILE Cont INFA NT RE LATE D MORTAL I T Y B Y RAC E AN D M O T HE R S AGE GR O U P All Ages Ages 10 19 All Races White Black and Other All Races White Black and Other 29 12 17 0 0 0 11 0 8 6 13 8 0 0 0 0 0 0 Infant Deaths Rate per 1 000 Births Postneonatal Deaths Rate per 1 000 Births Neonatal Deaths Rate per 1 000 Births 9 3 6 0 0 0 3 4 2 2 4 9 0 0 0 0 0 0 20 9 11 0 0 0 7 6 6 5 8 9 0 0 0 0 0 0 Infant deaths are by race of child births are by race of mother 2 0 1 9 E STIMATE D POP U L AT I O N S B Y AGE GRO U P R AC E AN D SE X All Races Age Group White Black and Other Total Male Female Total Male Female Total Male Female 209 355 100 780 108 575 134 441 66 468 67 973 74 914 34 312 40 602 0 4 12 532 6 427 6 105 7 143 3 681 3 462 5 389 2 746 2 643 5 9 12 364 6 250 6 114 7 049 3 568 3 481 5 315 2 682 2 633 10 14 11 951 6 098 5 853 6 843 3 465 3 378 5 108 2 633 2 475 15 44 96 501 47 141 49 360 60 256 30 527 29 729 36 245 16 614 19 631 45 64 47 218 22 429 24 789 31 623 15 717 15 906 15 595 6 712 8 883 65 84 25 611 11 447 14 164 19 054 8 715 10 339 6 557 2 732 3 825 3 178 988 2 190 2 473 795 1 678 705 193 512 Total 85 M O RTAL I T Y All Races Deaths Rate per 1 000 Population White Black and Other Total Male Female Total Male Female Total Male Female 1 739 884 855 1 233 622 611 506 262 244 8 3 8 8 7 9 9 2 9 4 9 0 6 8 7 6 6 0 SE LE C T E D C AU SE S O F D E AT H Total Male Female White Number Rate Number Rate Number Rate Heart Disease 453 216 4 226 224 3 227 Cancer 316 150 9 171 169 7 145 Stroke 95 45 4 52 51 6 Accidents 90 43 0 65 CLRD 95 45 4 53 Diabetes 20 9 6 11 10 9 Influenza and Pneumonia 39 18 6 17 16 9 Alzheimer s Disease 88 42 0 29 28 8 Suicide 27 12 9 23 Homicide 19 9 1 16 0 0 0 0 HIV Disease Black and Other Number Rate Number Rate 209 1 314 233 6 139 185 5 133 5 204 151 7 112 149 5 43 39 6 66 49 1 29 38 7 64 5 25 23 0 69 51 3 21 28 0 52 6 42 38 7 77 57 3 18 24 0 9 8 3 14 10 4 6 8 0 22 20 3 26 19 3 13 17 4 59 54 3 72 53 6 16 21 4 22 8 4 3 7 22 16 4 5 6 7 15 9 3 2 8 1 0 7 18 24 0 0 0 0 0 0 0 0 0 0 0 0 Rates are per 100 000 population in specified categories CLRD is known as Chronic Lower Respiratory Disease 23

APPENDIX A TUSCALOOSA 2019 HEALTH PROFILE Cont A CCIDE NTA L DE ATH S All Ages Number D E AT HS B Y AGE GR O U P Ages 19 and Under Rate Number Rate Total Age Group All Accidents 90 43 0 4 7 4 Total Motor Vehicle 32 15 3 3 5 6 0 14 Suffocation Poisoning Smoke Fire and Flames Falls Rate 1 739 8 3 40 1 1 2 1 0 0 0 0 15 44 127 1 3 26 12 4 0 0 0 45 64 356 7 5 1 0 5 0 0 0 65 84 792 30 9 85 424 133 4 11 5 3 0 0 0 Drowning 4 1 9 0 0 0 Firearms 2 1 0 1 1 9 12 0 Other Accidents Number Rates are per 1 000 population in specified age group Rates are per 100 000 population in specified categories SE LE C T E D C AN C E R SI T E D E AT HS Total All Cancers Male Female Number Rate Number Rate Number Rate 316 150 9 171 169 7 145 133 5 Trachea Bronchus Lung Pleura 87 41 6 57 56 6 30 27 6 Colorectal 26 12 4 11 10 9 15 13 8 Breast female 19 9 1 19 17 5 Prostate male 13 6 2 13 12 9 Pancreas 24 11 5 10 9 9 14 12 9 Leukemias 9 4 3 4 4 0 5 4 6 Non Hodgkin s Lymphomas 9 4 3 5 5 0 4 3 7 Ovary female 4 1 9 4 3 7 Brain and Other Nervous System 4 1 9 2 2 0 2 1 8 Stomach Uterus and Cervix female Esophagus Melanoma of Skin Other 8 3 8 5 5 0 3 2 8 10 4 8 10 9 2 7 3 3 5 5 0 2 1 8 3 1 4 2 2 0 1 0 9 93 57 36 Rates are per 100 000 population in specified categories Measurements are based on small denominators should be used with caution Rates and ratios based on a denominator of less than 50 births or 1 000 population are shaded Estimated pregnancies are the sum of births induced terminations of pregnancy abortions and estimated total fetal losses Estimated total fetal losses are equal to the sum of 20 percent of births and 10 percent of induced terminations of pregnancy The total fertility rate is the sum of age specific birth rates multiplied by the width of the intervals i e five years A total fertility rate of 2 100 births per 1 000 females ages 10 49 years would maintain the current population Estimated populations are from the U S Census Bureau See Appendix B for other definitions and formulas 24

APPENDIX A SU M M ARY Total Population 19 930 Births 187 Deaths 291 Median Age 42 2 Life Expectancy at Birth 74 3 Total Fertility Rate per 1 000 Females Aged 10 49 1 601 5 Number Marriages Issued PICKENS 2019 HEALTH PROFILE Divorces Granted 101 Rate Number 58 Rate Rates per 1 000 population PRE GN AN C Y N ATAL I T Y Females Aged 15 44 Females Aged 10 19 Number Rate Number Rate Estimated Pregnancies 272 77 7 20 19 1 Births 187 9 4 15 14 2 Induced Terminations of Pregnancy 43 12 3 2 1 9 Estimated Total Fetal Losses 42 3 Birth rates per 1 000 population Estimated pregnancy and induced termination of pregnancy rates are per 1 000 females in specified age group BIRTH S B Y AGE GR O U P O F M O T HE R Total 10 14 15 17 18 19 20 All Births 187 0 6 9 172 Rate 9 4 0 0 18 5 41 7 47 3 White 94 0 1 4 89 Rate 8 1 0 0 5 9 35 3 45 6 Black and Other Rate 93 0 5 5 83 11 1 0 0 32 4 48 6 49 3 Rates are per 1 000 females in specified age group Births with unknown age of mother are included in the age group 20 L I V E B I RT HS Females Aged 15 44 Births to Unmarried Women Low Weight Births Multiple Births Medicaid Births Females Aged 10 19 Number Percent Number Percent 118 63 1 13 86 7 21 11 2 0 0 0 4 2 1 0 0 0 104 55 6 11 73 3 Percentages are of all births with known status for females in specified age group 25

APPENDIX A PICKENS 2019 HEALTH PROFILE Cont INFA NT RE LATE D MORTAL I T Y B Y RAC E AN D M O T HE R S AGE GR O U P All Ages Ages 10 19 All Races White Black and Other All Races White Black and Other 2 2 0 0 0 0 10 7 21 3 0 0 0 0 0 0 0 0 Infant Deaths Rate per 1 000 Births Postneonatal Deaths 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0 10 7 21 3 0 0 0 0 0 0 0 0 Rate per 1 000 Births Neonatal Deaths Rate per 1 000 Births Infant deaths are by race of child births are by race of mother 2 0 1 9 E STIMATE D POP U L AT I O N S B Y AGE GR O U P RAC E AN D SE X All Races Age Group Total White Black and Other Total Male Female Total Male Female Total Male Female 19 930 10 014 9 916 11 568 5 985 5 583 8 362 4 029 4 333 0 4 1 026 542 484 497 253 244 529 289 240 5 9 1 038 552 486 536 296 240 502 256 246 10 14 1 083 567 516 559 289 270 524 278 246 15 44 7 417 3 922 3 495 4 088 2 246 1 842 3 329 1 676 1 653 45 64 5 480 2 660 2 820 3 348 1 701 1 647 2 132 959 1 173 65 84 3 456 1 609 1 847 2 270 1 090 1 180 1 186 519 667 430 162 268 270 110 160 160 52 108 85 M O RTAL I T Y All Races Deaths Rate per 1 000 Population White Black and Other Total Male Female Total Male Female Total Male Female 291 158 133 195 108 87 96 50 46 14 6 15 8 13 4 16 9 18 0 15 6 11 5 12 4 10 6 SE LE C T E D C AU SE S O F D E AT H Total Male Female White Number Rate Number Rate Number Rate Number Rate Number Rate Heart Disease 81 406 4 42 419 4 39 393 3 57 492 7 24 287 0 Cancer 57 286 0 36 359 5 21 211 8 33 285 3 24 287 0 Stroke 16 80 3 9 89 9 7 70 6 11 95 1 5 59 8 Accidents 14 70 2 11 109 8 3 30 3 8 69 2 6 71 8 CLRD 26 130 5 11 109 8 15 151 3 18 155 6 8 95 7 Diabetes 4 20 1 3 30 0 1 10 1 2 17 3 2 23 9 Influenza and Pneumonia 9 45 2 6 59 9 3 30 3 8 69 2 1 12 0 Alzheimer s Disease 11 55 2 4 39 9 7 70 6 10 86 4 1 12 0 Suicide 1 5 0 1 10 0 0 0 0 1 8 6 0 0 0 Homicide 2 10 0 2 20 0 0 0 0 1 8 6 1 12 0 HIV Disease 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rates are per 100 000 population in specified categories CLRD is known as Chronic Lower Respiratory Disease 26 Black and Other

PICKENS 2019 HEALTH PROFILE Cont APPENDIX A A CCIDE NTA L DE ATH S All Ages D E AT HS B Y AGE GROU P Ages 19 and Under Total Number Rate Number Rate 14 70 2 0 0 0 Total Motor Vehicle 7 35 1 0 0 0 0 14 Suffocation 1 5 0 0 0 0 15 44 All Accidents Age Group Number Rate 291 14 6 3 1 0 11 1 5 Poisoning 1 5 0 0 0 0 45 64 59 10 8 Smoke Fire and Flames 0 0 0 0 0 0 65 84 144 41 7 85 74 172 1 Falls 2 10 0 0 0 0 Drowning 0 0 0 0 0 0 Firearms 0 0 0 0 0 0 Other Accidents 3 0 Rates are per 1 000 population in specified age group Rates are per 100 000 population in specified categories SE LE C T E D C AN C E R SI T E D E AT HS Total Male Female Number Rate Number Rate Number Rate All Cancers 57 286 0 36 359 5 21 211 8 Trachea Bronchus Lung Pleura 14 70 2 10 99 9 4 40 3 Colorectal 5 25 1 4 39 9 1 10 1 Breast female 5 25 1 5 50 4 Prostate male 2 10 0 2 20 0 Pancreas 5 25 1 3 30 0 2 20 2 Leukemias 2 10 0 1 10 0 1 10 1 Non Hodgkin s Lymphomas 2 10 0 2 20 0 0 0 0 Ovary female 3 15 1 3 30 3 Brain and Other Nervous System 0 0 0 0 0 0 0 0 0 Stomach 0 0 0 0 0 0 0 0 0 Uterus and Cervix female 1 5 0 1 10 1 Esophagus 3 15 1 3 30 0 0 0 0 0 0 0 0 0 0 0 0 0 15 11 4 Melanoma of Skin Other Rates are per 100 000 population in specified categories Measurements are based on small denominators should be used with caution Rates and ratios based on a denominator of less than 50 births or 1 000 population are shaded Estimated pregnancies are the sum of births induced terminations of pregnancy abortions and estimated total fetal losses Estimated total fetal losses are equal to the sum of 20 percent of births and 10 percent of induced terminations of pregnancy The total fertility rate is the sum of age specific birth rates multiplied by the width of the intervals i e five years A total fertility rate of 2 100 births per 1 000 females ages 10 49 years would maintain the current population Estimated populations are from the U S Census Bureau See Appendix B for other definitions and formulas 27

APPENDIX A SU M M ARY Total Population 13 805 Births 122 Deaths 196 Median Age 44 6 Life Expectancy at Birth 75 1 Total Fertility Rate per 1 000 Females Aged 10 49 1 643 5 Number Marriages Issued LAMAR 2019 HEALTH PROFILE 81 Rate Number Divorces Granted 104 Rate Rates per 1 000 population P RE GN AN C Y N ATAL I T Y Females Aged 15 44 Females Aged 10 19 Number Rate Number Rate Estimated Pregnancies 155 67 9 14 17 9 Births 122 8 8 10 12 6 8 3 5 2 2 5 25 2 Induced Terminations of Pregnancy Estimated Total Fetal Losses Birth rates per 1 000 population Estimated pregnancy and induced termination of pregnancy rates are per 1 000 females in specified age group BIRTH S B Y AGE GR O U P O F M O T HE R All Births Total 10 14 15 17 18 19 20 122 0 0 10 112 Rate 8 8 0 0 0 0 66 5 47 5 White 110 0 0 10 100 Rate 9 1 0 0 0 0 77 6 48 8 12 0 0 0 12 7 0 0 0 0 0 0 0 38 6 Black and Other Rate Rates are per 1 000 females in specified age group Births with unknown age of mother are included in the age group 20 L I V E B I RT HS Females Aged 15 44 Percent Number Percent 54 44 3 8 80 0 Low Weight Births 7 5 7 1 10 0 Multiple Births 0 0 0 0 0 0 60 49 2 9 90 0 Births to Unmarried Women Medicaid Births Percentages are of all births with known status for females in specified age group 28 Females Aged 10 19 Number

LAMAR 2019 HEALTH PROFILE Cont APPENDIX A INFA NT RE LATE D M ORTA L I T Y B Y R AC E AN D M O T HE R S AGE GRO U P All Ages Ages 10 19 All Races White Black and Other All Races White Black and Other 1 0 1 0 0 0 8 2 0 0 83 3 0 0 0 0 Infant Deaths Rate per 1 000 Births Postneonatal Deaths Rate per 1 000 Births Neonatal Deaths Rate per 1 000 Births 1 0 1 0 0 0 8 2 0 0 83 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Infant deaths are by race of child births are by race of mother 2 0 1 9 E STIMATE D POP U L AT I O N S B Y AGE GRO U P R AC E AN D SE X All Races Age Group Total White Black and Other Total Male Female Total Male Female Total Male Female 13 805 6 760 7 045 12 083 5 940 6 143 1 722 820 902 0 4 784 401 383 651 337 314 133 64 69 5 9 754 378 376 641 316 325 113 62 51 10 14 874 457 417 765 402 363 109 55 54 15 44 4 561 2 276 2 285 3 951 1 972 1 979 610 304 306 45 64 3 772 1 877 1 895 3 303 1 669 1 634 469 208 261 65 84 2 701 1 258 1 443 2 447 1 138 1 309 254 120 134 359 113 246 325 106 219 34 7 27 85 M O RTAL I T Y All Races Deaths Rate per 1 000 Population White Black and Other Total Male Female Total Male Female Total Male Female 196 92 104 182 86 96 14 6 8 14 2 13 6 14 8 15 1 14 5 15 6 8 1 7 3 8 9 SE LE C T E D C AU SE S O F D E AT H Total Male Female White Black and Other Number Rate Number Rate Number Rate Number Rate Number Rate Heart Disease 48 347 7 25 369 8 23 326 5 47 389 0 1 58 1 Cancer 42 304 2 20 295 9 22 312 3 39 322 8 3 174 2 Stroke 11 79 7 3 44 4 8 113 6 10 82 8 1 58 1 Accidents 12 86 9 7 103 6 5 71 0 11 91 0 1 58 1 CLRD 17 123 1 10 147 9 7 99 4 16 132 4 1 58 1 Diabetes 7 50 7 3 44 4 4 56 8 7 57 9 0 0 0 Influenza and Pneumonia 7 50 7 4 59 2 3 42 6 7 57 9 0 0 0 Alzheimer s Disease 6 43 5 1 14 8 5 71 0 5 41 4 1 58 1 Suicide 2 14 5 2 29 6 0 0 0 2 16 6 0 0 0 Homicide 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 HIV Disease 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rates are per 100 000 population in specified categories CLRD is known as Chronic Lower Respiratory Disease 29

APPENDIX A LAMAR 2019 HEALTH PROFILE Cont A CCIDE NTA L DE ATH S All Ages D E AT HS B Y AGE GROU P Ages 19 and Under Total Number Rate Number Rate Age Group 12 86 9 1 31 0 Total All Accidents Number Rate 196 14 2 Motor Vehicle 6 43 5 0 0 0 0 14 2 0 8 Suffocation 1 7 2 0 0 0 15 44 9 2 0 Poisoning 0 0 0 0 0 0 45 64 34 9 0 100 37 0 51 142 1 Smoke Fire and Flames 0 0 0 0 0 0 65 84 Falls 3 21 7 0 0 0 85 Drowning 0 0 0 0 0 0 Firearms 0 0 0 0 0 0 Other Accidents 2 1 Rates are per 1 000 population in specified age group Rates are per 100 000 population in specified categories SE LE CT E D C AN C E R SI T E D E AT HS Total Male Female Number Rate Number Rate Number Rate 42 304 2 20 295 9 22 312 3 Trachea Bronchus Lung Pleura 8 58 0 3 44 4 5 71 0 Colorectal 5 36 2 4 59 2 1 14 2 Breast female 3 21 7 3 42 6 Prostate male 2 14 5 2 29 6 Pancreas 3 21 7 1 14 8 2 28 4 Leukemias 0 0 0 0 0 0 0 0 0 Non Hodgkin s Lymphomas 2 14 5 1 14 8 1 14 2 Ovary female 0 0 0 0 0 0 Brain and Other Nervous System 0 0 0 0 0 0 0 0 0 Stomach 0 0 0 0 0 0 0 0 0 Uterus and Cervix female 1 7 2 1 14 2 Esophagus 0 0 0 0 0 0 0 0 0 Melanoma of Skin 1 7 2 1 14 8 0 0 0 17 8 9 All Cancers Other Rates are per 100 000 population in specified categories Measurements are based on small denominators should be used with caution Rates and ratios based on a denominator of less than 50 births or 1 000 population are shaded Estimated pregnancies are the sum of births induced terminations of pregnancy abortions and estimated total fetal losses Estimated total fetal losses are equal to the sum of 20 percent of births and 10 percent of induced terminations of pregnancy The total fertility rate is the sum of age specific birth rates multiplied by the width of the intervals i e five years A total fertility rate of 2 100 births per 1 000 females ages 10 49 years would maintain the current population Estimated populations are from the U S Census Bureau See Appendix B for other definitions and formulas 30

APPENDIX A SU M M ARY Total Population 14 651 Births 193 Deaths 219 Median Age 40 8 Life Expectancy at Birth 71 1 Total Fertility Rate per 1 000 Females Aged 10 49 2 098 5 Marriages Issued HALE 2019 HEALTH PROFILE Divorces Granted Number 50 Rate Number 46 Rate Rates per 1 000 population PRE GN AN C Y N ATAL I T Y Females Aged 15 44 Females Aged 10 19 Number Rate Number Rate Estimated Pregnancies 275 101 8 21 23 7 Births 193 13 2 11 12 5 Induced Terminations of Pregnancy 39 14 5 7 7 9 Estimated Total Fetal Losses 43 3 Birth rates per 1 000 population Estimated pregnancy and induced termination of pregnancy rates are per 1 000 females in specified age group BIRTH S B Y AGE GRO U P O F M O T HE R Total 10 14 15 17 18 19 20 All Births 193 0 4 7 182 Rate 13 2 0 0 15 5 40 6 68 0 White 68 0 1 2 65 Rate 11 4 0 0 11 3 34 0 67 7 Black and Other Rate 125 0 3 5 117 14 4 0 0 17 6 44 0 68 1 Rates are per 1 000 females in specified age group Births with unknown age of mother are included in the age group 20 L I V E B I RT HS Females Aged 15 44 Births to Unmarried Women Low Weight Births Multiple Births Medicaid Births Females Aged 10 19 Number Percent Number Percent 127 65 8 10 90 9 14 7 3 0 0 0 4 2 1 0 0 0 119 61 7 9 81 8 Percentages are of all births with known status for females in specified age group 31

APPENDIX A HALE 2019 HEALTH PROFILE Cont INFA NT RE LATE D M ORTA L I T Y B Y R AC E AN D M O T HE R S AGE GRO U P All Ages Ages 10 19 All Races White Black and Other All Races White Black and Other 4 0 4 1 0 1 20 7 0 0 32 0 90 9 0 0 125 0 Infant Deaths Rate per 1 000 Births Postneonatal Deaths Rate per 1 000 Births Neonatal Deaths Rate per 1 000 Births 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 4 1 0 1 20 7 0 0 32 0 90 9 0 0 125 0 Infant deaths are by race of child births are by race of mother 2 0 1 9 E STIMATE D POP U L AT I O N S B Y AGE GRO U P R AC E AN D SE X All Races Age Group White Black and Other Total Male Female Total Male Female Total Male Female 14 651 6 950 7 701 5 963 2 956 3 007 8 688 3 994 4 694 0 4 990 525 465 331 179 152 659 346 313 5 9 906 462 444 357 189 168 549 273 276 Total 10 14 947 495 452 348 170 178 599 325 274 15 44 5 138 2 441 2 697 1 883 938 945 3 255 1 503 1 752 45 64 3 785 1 757 2 208 1 599 812 787 2 186 945 1 241 65 84 2 523 1 166 1 357 1 268 605 663 1 255 561 694 362 104 258 177 63 114 185 41 144 85 M O RTAL I T Y All Races Total Deaths Rate per 1 000 Population Male White Female Black and Other Total Male Female Total Male Female 219 111 108 89 41 48 130 70 60 14 9 16 0 14 0 14 9 13 9 16 0 15 0 17 5 12 8 SE LE C T E D C AU SE S O F D E AT H Total Male Female White Number Rate Number Rate Number Rate Number Rate Number Rate Heart Disease 65 443 7 38 546 8 27 350 6 27 452 8 38 437 4 Cancer 26 177 5 13 187 1 13 168 8 12 201 2 14 161 1 Stroke 20 136 5 11 158 3 9 116 9 4 67 1 16 184 2 Accidents 8 54 6 6 86 3 2 26 0 3 50 3 5 57 6 CLRD 9 61 4 3 43 2 6 77 9 5 83 9 4 46 0 Diabetes 3 20 5 3 43 2 0 0 0 0 0 0 3 34 5 Influenza and Pneumonia 5 34 1 4 57 6 1 13 0 1 16 8 4 46 0 Alzheimer s Disease 8 54 6 4 57 6 4 51 9 6 100 6 2 23 0 Suicide 2 13 7 0 0 0 2 26 0 2 33 5 0 0 0 Homicide 1 6 8 0 0 0 1 13 0 0 0 0 1 11 5 HIV Disease 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rates are per 100 000 population in specified categories CLRD is known as Chronic Lower Respiratory Disease 32 Black and Other

HALE 2019 HEALTH PROFILE Cont APPENDIX A A CCIDE NTA L DE ATH S All Ages D E AT HS B Y AGE GROU P Ages 19 and Under Total Number Rate Number Rate Age Group 8 54 6 2 53 8 Total All Accidents Number Rate 219 14 9 Motor Vehicle 3 20 5 0 0 0 0 14 6 2 1 Suffocation 1 6 8 0 0 0 15 44 15 2 9 Poisoning 0 0 0 0 0 0 45 64 55 14 5 Smoke Fire and Flames 2 13 7 1 26 9 65 84 90 35 7 Falls 1 6 8 0 0 0 85 53 146 4 Drowning 1 6 8 1 26 9 Firearms 0 0 0 0 0 0 Other Accidents 0 0 Rates are per 1 000 population in specified age group Rates are per 100 000 population in specified categories SE LE CT E D C AN C E R SI T E D E AT HS Total Male Female Number Rate Number Rate Number Rate 26 177 5 13 187 1 13 168 8 Trachea Bronchus Lung Pleura 8 54 6 6 86 3 2 26 0 Colorectal 1 6 8 1 14 4 0 0 0 Breast female 2 13 7 2 26 0 Prostate male 1 6 8 1 14 4 Pancreas 2 13 7 1 14 4 1 13 0 Leukemias 0 0 0 0 0 0 0 0 Non Hodgkin s Lymphomas 0 0 0 0 0 0 0 0 0 Ovary female 1 6 8 1 13 0 Brain and Other Nervous System 0 0 0 0 0 0 0 0 0 Stomach 0 0 0 0 0 0 0 0 0 Uterus and Cervix female 2 13 7 2 26 0 Esophagus 1 6 8 0 0 0 1 13 0 Melanoma of Skin 0 0 0 0 0 0 0 0 0 Other 8 4 4 All Cancers Rates are per 100 000 population in specified categories Measurements are based on small denominators should be used with caution Rates and ratios based on a denominator of less than 50 births or 1 000 population are shaded Estimated pregnancies are the sum of births induced terminations of pregnancy abortions and estimated total fetal losses Estimated total fetal losses are equal to the sum of 20 percent of births and 10 percent of induced terminations of pregnancy The total fertility rate is the sum of age specific birth rates multiplied by the width of the intervals i e five years A total fertility rate of 2 100 births per 1 000 females ages 10 49 years would maintain the current population Estimated populations are from the U S Census Bureau See Appendix B for other definitions and formulas 33

APPENDIX A SU M M ARY Total Population 8 111 Births 86 Deaths 92 Median Age 43 9 Life Expectancy at Birth 76 4 Total Fertility Rate per 1 000 Females Aged 10 49 1 878 5 Marriages Issued GREENE 2019 HEALTH PROFILE Number 46 Rate Number Divorces Granted 9 Rate Rates per 1 000 population PR E GN AN C Y N ATAL I T Y Females Aged 15 44 Number Estimated Pregnancies Females Aged 10 19 Rate Number Rate 127 93 5 20 39 8 Births 86 10 6 13 25 8 Induced Terminations of Pregnancy 22 16 1 4 8 0 Estimated Total Fetal Losses 19 3 Birth rates per 1 000 population Estimated pregnancy and induced termination of pregnancy rates are per 1 000 females in specified age group BIRTH S B Y AGE GR O U P O F M O T HE R Total 10 14 15 17 18 19 20 86 1 5 7 73 10 6 3 8 34 9 73 2 54 5 All Births Rate White 7 0 1 1 5 Rate 4 7 0 0 92 6 138 9 27 0 Black and Other Rate 79 1 4 6 68 11 9 4 3 30 2 67 9 58 9 Rates are per 1 000 females in specified age group Births with unknown age of mother are included in the age group 20 L I V E B I RT HS Females Aged 15 44 Number Percent Number Percent Births to Unmarried Women 66 76 7 10 76 9 Low Weight Births 19 22 1 2 15 4 4 4 7 0 0 0 64 74 4 13 100 0 Multiple Births Medicaid Births Percentages are of all births with known status for females in specified age group 34 Females Aged 10 19

GREENE 2019 HEALTH PROFILE Cont APPENDIX A INFA NT RE LATE D M ORTA L I T Y B Y R AC E AN D M O T HE R S AGE GRO U P All Ages Ages 10 19 All Races White Black and Other All Races White Black and Other 2 0 2 0 0 0 23 3 0 0 25 3 0 0 0 0 0 0 Infant Deaths Rate per 1 000 Births Postneonatal Deaths Rate per 1 000 Births 1 0 1 0 0 0 11 6 0 0 12 7 0 0 0 0 0 0 1 0 1 0 0 0 11 6 0 0 12 7 0 0 0 0 0 0 Neonatal Deaths Rate per 1 000 Births Infant deaths are by race of child births are by race of mother 2 0 1 9 E STIMATE D POP U L AT I O N S B Y AGE GRO U P R AC E AN D SE X All Races Age Group Total White Black and Other Total Male Female Total Male Female Total Male Female 8 111 3 829 4 282 1 500 735 765 6 611 3 094 3 517 0 4 466 247 219 66 27 39 400 220 180 5 9 480 250 230 64 29 35 416 221 195 10 14 509 245 264 64 35 29 445 210 235 15 44 2 691 1 328 1 363 341 179 162 2 350 1 149 1 201 45 64 2 075 941 1 134 475 244 232 1 599 697 902 65 84 1 646 740 906 429 200 229 1 217 540 677 244 78 166 60 21 39 184 57 127 85 M O RTAL I T Y All Races Black and Other Total Male Female Total Male Female Total Male Female 92 61 31 22 13 9 70 48 22 11 3 15 9 7 2 14 7 17 7 11 8 10 6 15 5 6 3 Deaths Rate per 1 000 Population White SE LE C T E D C AU SE S O F D E AT H Total Male Female White Black and Other Number Rate Number Rate Number Rate Number Rate Number Rate Heart Disease 25 308 2 17 444 0 8 186 8 4 266 7 21 317 7 Cancer 16 197 3 10 261 2 6 140 1 4 266 7 12 181 5 Stroke 7 86 3 4 104 5 3 70 1 2 133 3 5 75 6 Accidents 7 86 3 5 130 6 2 46 7 1 66 7 6 90 8 CLRD 6 74 0 3 78 3 3 70 1 3 200 0 3 45 4 Diabetes 4 49 3 2 52 2 2 46 7 1 66 7 3 45 4 Influenza and Pneumonia 2 24 7 1 26 1 1 23 4 1 66 7 1 15 1 Alzheimer s Disease 2 24 7 2 52 2 0 0 0 1 66 7 1 15 1 Suicide 2 24 7 2 52 2 0 0 0 2 133 3 0 0 0 Homicide 1 12 3 1 26 1 0 0 0 0 0 0 1 15 1 HIV Disease 1 12 3 1 26 1 0 0 0 0 0 0 1 15 1 Rates are per 100 000 population in specified categories CLRD is known as Chronic Lower Respiratory Disease 35

GREENE 2019 HEALTH PROFILE Cont APPENDIX A A CCIDE NTA L DE ATH S All Ages D E AT HS B Y AGE GRO UP Ages 19 and Under Total Number Rate Number Rate Age Group 7 86 3 1 51 9 Total All Accidents Number Rate 92 11 3 Motor Vehicle 5 61 6 0 0 0 0 14 2 1 4 Suffocation 0 0 0 0 0 0 15 44 10 3 7 Poisoning 0 0 0 0 0 0 45 64 22 10 6 Smoke Fire and Flames 0 0 0 0 0 0 65 84 40 24 3 Falls 0 0 0 0 0 0 85 18 73 8 Drowning 1 12 3 1 51 9 Firearms 0 0 0 0 0 0 Other Accidents 1 0 Rates are per 1 000 population in specified age group Rates are per 100 000 population in specified categories SE LE CT E D C AN C E R SI T E D E AT HS Total Male Female Number Rate Number Rate Number Rate 16 197 3 10 261 2 6 140 1 Trachea Bronchus Lung Pleura 5 61 6 3 78 3 2 46 7 Colorectal 1 12 3 1 26 1 0 0 0 Breast female 1 12 3 1 23 4 Prostate male 3 37 0 3 78 3 Pancreas 1 12 3 0 0 0 1 23 4 Leukemias 0 0 0 0 0 0 0 0 0 Non Hodgkin s Lymphomas 0 0 0 0 0 0 0 0 0 Ovary female 1 12 3 1 23 4 Brain and Other Nervous System 0 0 0 0 0 0 0 0 0 Stomach 1 12 3 1 26 1 0 0 0 Uterus and Cervix female 0 0 0 0 0 0 Esophagus 0 0 0 0 0 0 0 0 0 Melanoma of Skin 0 0 0 0 0 0 0 0 0 Other 3 2 1 All Cancers Rates are per 100 000 population in specified categories Measurements are based on small denominators should be used with caution Rates and ratios based on a denominator of less than 50 births or 1 000 population are shaded Estimated pregnancies are the sum of births induced terminations of pregnancy abortions and estimated total fetal losses Estimated total fetal losses are equal to the sum of 20 percent of births and 10 percent of induced terminations of pregnancy The total fertility rate is the sum of age specific birth rates multiplied by the width of the intervals i e five years A total fertility rate of 2 100 births per 1 000 females ages 10 49 years would maintain the current population Estimated populations are from the U S Census Bureau See Appendix B for other definitions and formulas 36

APPENDIX A SU M M ARY Total Population 16 302 Births 197 Deaths 217 Median Age 43 9 Life Expectancy at Birth 74 0 Total Fertility Rate per 1 000 Females Aged 10 49 2 153 5 Number Marriages Issued FAYETTE 2019 HEALTH PROFILE Divorces Granted 101 Rate Number 37 Rate Rates per 1 000 population PRE GN AN C Y N ATAL I T Y Females Aged 15 44 Females Aged 10 19 Number Rate Number Rate Estimated Pregnancies 254 93 5 24 26 1 Births 197 12 1 19 20 8 Induced Terminations of Pregnancy 16 5 9 1 1 1 Estimated Total Fetal Losses 41 4 Birth rates per 1 000 population Estimated pregnancy and induced termination of pregnancy rates are per 1 000 females in specified age group BIRTH S B Y AGE GRO U P O F M O T HE R Total 10 14 15 17 18 19 20 All Births 197 0 4 15 178 Rate 12 1 0 0 15 0 84 5 63 3 White 178 0 3 14 161 Rate 12 7 0 0 13 2 92 1 66 0 Black and Other Rate 19 0 1 1 17 8 2 0 0 26 0 39 1 45 5 Rates are per 1 000 females in specified age group Births with unknown age of mother are included in the age group 20 L I V E B I RT HS Females Aged 15 44 Females Aged 10 19 Number Percent Number Percent Births to Unmarried Women 87 44 2 11 57 9 Low Weight Births 23 11 7 3 15 8 Multiple Births 12 6 1 0 0 0 Medicaid Births 97 49 5 14 73 7 Percentages are of all births with known status for females in specified age group 37

APPENDIX A FAYETTE 2019 HEALTH PROFILE Cont INFA NT RE LATE D MORTAL I T Y B Y RAC E AN D M O T HE R S AGE GR O U P All Ages Ages 10 19 All Races White Black and Other All Races White Black and Other 2 2 0 0 0 0 10 2 11 2 0 0 0 0 0 0 0 0 Infant Deaths Rate per 1 000 Births Postneonatal Deaths Rate per 1 000 Births Neonatal Deaths Rate per 1 000 Births 1 1 0 0 0 0 5 1 5 6 0 0 0 0 0 0 0 0 1 1 0 0 0 0 5 1 5 6 0 0 0 0 0 0 0 0 Infant deaths are by race of child births are by race of mother 2 0 1 9 E STIMATE D POP U L AT I O N S B Y AGE GRO U P R AC E AN D SE X All Races Age Group Total White Black and Other Total Male Female Total Male Female Total Male Female 16 302 7 937 8 365 13 980 6 817 7 163 2 322 1 120 1 202 0 4 902 447 455 698 364 334 204 83 121 5 9 956 475 481 759 384 375 197 91 106 10 14 997 526 471 857 441 416 140 85 55 15 44 5 496 2 779 2 717 4 716 2 379 2 337 780 400 380 45 64 4 406 2 158 2 248 3 828 1 873 1 955 578 285 293 65 84 3 220 1 440 1 780 2 847 1 278 1 569 373 162 211 325 112 213 275 98 177 50 14 36 85 M O RTAL I T Y All Races Deaths Rate per 1 000 Population White Black and Other Total Male Female Total Male Female Total Male Female 217 126 91 185 111 74 32 15 17 13 3 15 9 10 9 13 2 16 3 10 3 13 8 13 4 14 1 SE LEC T E D C AU SE S O F D E AT H Total Male Female White Number Rate Number Rate Number Rate Number Rate Number Rate Heart Disease 51 312 8 35 441 0 16 191 3 43 307 6 8 344 5 Cancer 33 202 4 20 252 0 13 155 4 28 200 3 5 215 3 Stroke 8 49 1 4 50 4 4 47 8 8 57 2 0 0 0 Accidents 15 92 0 11 138 6 4 47 8 13 93 0 2 86 1 CLRD 28 171 8 17 214 2 11 131 5 23 164 5 5 215 3 Diabetes 6 36 8 4 50 4 2 23 9 5 35 8 1 43 1 Influenza and Pneumonia 5 30 7 3 37 8 2 23 9 3 21 5 2 86 1 Alzheimer s Disease 9 55 2 2 25 2 7 83 7 8 57 2 1 43 1 Suicide 5 30 7 3 37 8 2 23 9 5 35 8 0 0 0 Homicide 2 12 3 2 25 2 0 0 0 2 14 3 0 0 0 HIV Disease 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rates are per 100 000 population in specified categories CLRD is known as Chronic Lower Respiratory Disease 38 Black and Other

FAYETTE 2019 HEALTH PROFILE Cont APPENDIX A A CCIDE NTA L DE ATH S All Ages D E AT HS B Y AGE GRO UP Ages 19 and Under Total Number Rate Number Rate Age Group 15 92 0 1 26 5 Total Motor Vehicle 3 18 4 1 26 5 0 14 Suffocation 1 6 1 0 0 0 15 44 Poisoning 5 30 7 0 0 0 Smoke Fire and Flames 1 6 1 0 0 0 Falls 2 12 3 0 0 0 85 Drowning 1 6 1 0 0 0 Firearms 0 0 0 0 0 0 Other Accidents 2 0 All Accidents Number Rate 217 13 3 2 0 7 15 2 7 45 64 51 11 6 65 84 104 32 3 45 138 5 Rates are per 100 000 population in specified categories SE LE CT E D C AN C E R SI T E D E AT HS Total Male Female Number Rate Number Rate Number Rate 33 202 4 20 252 0 13 155 4 Trachea Bronchus Lung Pleura 7 42 9 4 50 4 3 35 9 Colorectal 6 36 8 3 37 8 3 35 9 Breast female 2 12 3 2 23 9 Prostate male 4 24 5 4 50 4 Pancreas 2 12 3 0 0 0 2 23 9 Leukemias 1 6 1 0 0 0 1 12 0 Non Hodgkin s Lymphomas 0 0 0 0 0 0 0 0 0 Ovary female 0 0 0 0 0 0 Brain and Other Nervous System 1 6 1 1 12 6 0 0 0 Stomach 0 0 0 0 0 0 0 0 0 Uterus and Cervix female 0 0 0 0 0 0 Esophagus 1 6 1 1 12 6 0 0 0 Melanoma of Skin 0 0 0 0 0 0 0 0 0 Other 9 7 2 All Cancers Rates are per 100 000 population in specified categories Measurements are based on small denominators should be used with caution Rates and ratios based on a denominator of less than 50 births or 1 000 population are shaded Estimated pregnancies are the sum of births induced terminations of pregnancy abortions and estimated total fetal losses Estimated total fetal losses are equal to the sum of 20 percent of births and 10 percent of induced terminations of pregnancy The total fertility rate is the sum of age specific birth rates multiplied by the width of the intervals i e five years A total fertility rate of 2 100 births per 1 000 females ages 10 49 years would maintain the current population Estimated populations are from the U S Census Bureau See Appendix B for other definitions and formulas 39

APPENDIX A SU M M ARY Total Population 22 394 Births 246 Deaths 264 Median Age 40 0 Life Expectancy at Birth 73 6 Total Fertility Rate per 1 000 Females Aged 10 49 1 956 0 Number Marriages Issued BIBB 2019 HEALTH PROFILE 126 Rate Number Divorces Granted 0 Rate Rates per 1 000 population P R E GN AN C Y N ATAL I T Y Females Aged 15 44 Females Aged 10 19 Number Rate Number Rate Estimated Pregnancies 305 81 5 19 16 2 Births 246 11 0 15 12 7 9 2 4 1 0 8 50 3 Induced Terminations of Pregnancy Estimated Total Fetal Losses Birth rates per 1 000 population Estimated pregnancy and induced termination of pregnancy rates are per 1 000 females in specified age group BIRTH S B Y AGE GR O U P O F M O T HE R Total 10 14 15 17 18 19 20 All Births 246 0 2 13 231 Rate 11 0 0 0 5 8 56 1 59 6 White 195 0 2 7 186 Rate 11 3 0 0 7 2 37 6 60 1 Black and Other Rate 51 0 0 6 45 9 8 0 0 0 0 132 7 57 4 Rates are per 1 000 females in specified age group Births with unknown age of mother are included in the age group 20 L I V E B I RT HS Females Aged 15 44 Births to Unmarried Women Low Weight Births Multiple Births Medicaid Births Number Percent Number Percent 112 45 5 12 80 0 27 11 0 0 0 0 6 2 4 0 0 0 121 49 2 9 60 0 Percentages are of all births with known status for females in specified age group 40 Females Aged 10 19

APPENDIX A BIBB 2019 HEALTH PROFILE Cont INFA NT RE LATE D M ORTA L I T Y B Y R AC E AN D M O T HE R S AGE GRO U P All Ages Ages 10 19 All Races White Black and Other All Races White Black and Other 5 4 1 0 0 0 20 3 20 5 19 6 0 0 0 0 0 0 Infant Deaths Rate per 1 000 Births Postneonatal Deaths Rate per 1 000 Births 3 3 0 0 0 0 12 2 15 4 0 0 0 0 0 0 0 0 2 1 1 0 0 0 8 1 5 1 19 6 0 0 0 0 0 0 Neonatal Deaths Rate per 1 000 Births Infant deaths are by race of child births are by race of mother 2 0 1 9 E STIM ATE D POPU L AT I O N S B Y AGE GRO U P R AC E AN D SE X All Races Age Group Total White Black and Other Total Male Female Total Male Female Total Male Female 22 394 11 929 10 465 17 191 8 766 8 425 5 203 3 163 2 040 0 4 1 246 622 624 964 482 482 282 140 142 5 9 1 198 631 567 919 482 437 279 149 130 10 14 1 269 667 602 976 529 447 293 138 155 15 44 8 890 5 145 3 745 6 332 3 347 2 985 2 558 1 798 760 45 64 6 058 3 197 2 861 4 801 2 484 2 317 1 257 713 544 65 84 3 344 1 544 1 800 2 880 1 339 1 541 464 205 259 389 123 266 319 103 216 70 20 50 85 M O RTAL I T Y All Races Deaths Rate per 1 000 Population White Black and Other Total Male Female Total Male Female Total Male Female 264 135 129 219 108 111 45 27 18 11 8 11 3 12 3 12 7 12 3 13 2 8 6 8 5 8 8 SE LE C T E D C AU SE S O F D E AT H Total Male Female White Black and Other Number Rate Number Rate Number Rate Number Rate Number Rate Heart Disease 74 330 4 38 318 6 36 344 0 57 331 6 17 326 7 Cancer 50 223 3 28 234 7 22 210 2 45 261 8 5 96 1 Stroke 19 84 8 11 92 2 8 76 4 16 93 1 3 57 7 Accidents 15 67 0 10 83 8 5 47 8 14 81 4 1 19 2 CLRD 15 67 0 7 58 7 8 76 4 15 87 3 0 0 0 Diabetes 6 26 8 2 16 8 4 38 2 5 29 1 1 19 2 Influenza and Pneumonia 4 17 9 1 8 4 3 28 7 2 11 6 2 38 4 Alzheimer s Disease 10 44 7 4 33 5 6 57 3 7 40 7 3 57 7 Suicide 3 13 4 2 16 8 1 9 6 3 17 5 0 0 0 Homicide 4 17 9 3 25 1 1 9 6 0 0 0 4 76 9 HIV Disease 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rates are per 100 000 population in specified categories CLRD is known as Chronic Lower Respiratory Disease 41

BIBB 2019 HEALTH PROFILE Cont APPENDIX A A CCIDE NTA L DE ATH S All Ages Number All Accidents Motor Vehicle D E AT HS B Y AGE GROU P Ages 19 and Under Rate Number Total Rate Age Group 15 67 0 2 40 1 Total 6 26 8 1 20 0 0 14 Number Rate 264 11 8 5 1 3 Suffocation 3 13 4 1 20 0 15 44 19 2 1 Poisoning 3 13 4 0 0 0 45 64 61 10 1 Smoke Fire and Flames 1 4 5 0 0 0 65 84 136 40 7 85 43 110 5 Falls 1 4 5 0 0 0 Drowning 0 0 0 0 0 0 Firearms 0 0 0 0 0 0 Other Accidents 1 0 Rates are per 1 000 population in specified age group Rates are per 100 000 population in specified categories SE LE CT E D C AN C E R SI T E D E AT HS Total Male Female Number Rate Number Rate Number Rate All Cancers 50 223 3 28 234 7 22 210 2 Trachea Bronchus Lung Pleura 14 62 5 9 75 4 5 47 8 Colorectal 0 0 0 0 0 0 0 0 0 Breast female 1 4 5 1 9 6 Prostate male 0 0 0 0 0 0 Pancreas 3 13 4 2 16 8 1 9 6 Leukemias 2 8 9 1 8 4 1 9 6 Non Hodgkin s Lymphomas 6 26 8 3 25 1 3 28 7 Ovary female 3 13 4 3 28 7 Brain and Other Nervous System 1 4 5 1 8 4 0 0 0 Stomach 0 0 0 0 0 0 0 0 0 Uterus and Cervix female 0 0 0 0 0 0 Esophagus 1 4 5 1 8 4 0 0 0 0 0 0 0 0 0 0 0 0 14 11 8 Melanoma of Skin Other Rates are per 100 000 population in specified categories Measurements are based on small denominators should be used with caution Rates and ratios based on a denominator of less than 50 births or 1 000 population are shaded Estimated pregnancies are the sum of births induced terminations of pregnancy abortions and estimated total fetal losses Estimated total fetal losses are equal to the sum of 20 percent of births and 10 percent of induced terminations of pregnancy The total fertility rate is the sum of age specific birth rates multiplied by the width of the intervals i e five years A total fertility rate of 2 100 births per 1 000 females ages 10 49 years would maintain the current population Estimated populations are from the U S Census Bureau See Appendix B for other definitions and formulas 42

STATE OF ALABAMA MEDICAL STATISTIC MAPS APPENDIX A Percent of Obesity by Public Health Districts Alabama 2019 Lauderdale Limestone Jackson Madison Colbert Lawrence Franklin 34 7 Morgan Dekalb Marshall Northern Marion Cherokee Cullman Winston Blount 35 1 Fayette 41 1 Cleburne Talladega Jefferson Tuscaloosa Calhoun St Clair Jefferson Pickens 34 4 Northeastern Walker Lamar Etowah Clay Shelby West Central Bibb Greene Coosa Tallapoosa Chambers 34 7 Chilton Hale Randolph East Central Perry Autauga Sumter Elmore Lee Macon Dallas Marengo Choctaw Russell Montgomery Lowndes 38 2 Southwestern Wilcox Butler Crenshaw Monroe 38 8 Southeastern Henry Conecuh Coffee Covington Escambia 37 3 Barbour Pike Clarke Washington Bullock Geneva Dale Houston Mobile Mobile Baldwin Source 2019 Alabama Behavioral Risk Factor Surveillance system BRFSS 43

STATE OF ALABAMA MEDICAL STATISTIC MAPS Cont APPENDIX A Medically Underserved Areas Populations MUA Ps Lauderdale Limestone Jackson Madison Colbert Lawrence Franklin Marion Morgan Winston Dekalb Marshall Cherokee Cullman Etowah Blount Walker Lamar Calhoun St Clair Fayette Jefferson Cleburne Talladega Pickens Tuscaloosa Bibb Greene Coosa Tallapoosa Chilton Hale Perry Autauga Sumter Randolph Clay Shelby Chambers Lee Elmore Macon Dallas Marengo Russell Montgomery Lowndes Choctaw Bullock Wilcox Barbour Clarke Crenshaw Monroe Washington Pike Butler Conecuh Dale Coffee Covington Escambia Geneva Henry Houston Mobile Baldwin 44 Legend Not Designated Medically Underserved Area Medically Underserved Population Medically Underserved Area and Population

STATE OF ALABAMA MEDICAL STATISTIC MAPS Cont APPENDIX A Dental Health Professional Shortage Areas October 2017 Lauderdale 17 Limestone 10 Colbert 17 Lawrence Franklin Marion 12 Winston 17 17 14 Morgan 12 19 Jackson Madison Dekalb Marshall 19 14 Cherokee Cullman 19 16 17 Blount Lamar 15 Walker Fayette 19 19 19 Calhoun St Clair 19 13 Jefferson 13 Pickens Talladega 14 15 Coosa 15 21 17 Perry 17 Dallas Macon 19 17 Lowndes Choctaw 19 Lee Montgomery 21 19 19 21 Washington Barbour 19 Pike Butler 19 Monroe 19 19 21 Clarke Russell Bullock 19 Wilcox 15 19 17 Autauga 19 Marengo Chambers 19 Elmore 21 Sumter 16 Tallapoosa 14 Chilton Hale Randolph 16 Bibb 21 Clay Shelby Greene 19 Cleburne Tuscaloosa 19 19 Etowah 19 19 Crenshaw Conecuh Coffee 19 19 Covington Escambia 19 17 17 Geneva Henry Dale 19 14 14 Houston 14 Mobile 17 Baldwin 17 HPSA Designation Type Low income Non designated Numerals indicate HPSA Scores Range 1 26 Niko Phillips 334 206 3807 or Niko Phillips adph state al us 45

STATE OF ALABAMA MEDICAL STATISTIC MAPS Cont APPENDIX A Mental Health Professional Shortage Areas August 2018 Lauderdale 11 Limestone 12 Colbert 11 Lawrence Franklin Marion 12 Winston 19 15 Morgan 12 11 Jackson Madison Dekalb Marshall 17 15 Cherokee Cullman 19 16 17 Blount Lamar 18 Walker Fayette 19 19 19 Talladega Bibb Coosa 18 11 Perry 16 Dallas 19 Macon 17 16 Lowndes Choctaw 18 Lee Montgomery 20 18 Monroe 18 Washington Barbour 17 Pike Butler 18 17 17 20 Clarke Russell Bullock 16 Wilcox 17 17 16 Autauga 18 Marengo Chambers 17 Elmore 20 Sumter 18 Tallapoosa 18 Chilton Hale Randolph 18 11 Greene 18 Clay Shelby 18 10 Cleburne 18 Tuscaloosa 18 10 18 18 18 Calhoun St Clair Jefferson Pickens 17 Etowah 18 17 Crenshaw Conecuh Coffee 18 19 Covington Escambia 18 18 18 Geneva Henry Dale 17 17 17 Houston 17 Mobile 19 Baldwin 5 HPSA Designation Type Geographic Low income Non designated Numerals indicate HPSA Scores Range 1 25 Niko Phillips 334 206 3807 or Niko Phillips adph state al us 46

STATE OF ALABAMA MEDICAL STATISTIC MAPS Cont APPENDIX A Primary Care Health Professional Shortage Areas January 2019 Lauderdale 14 Limestone 15 Colbert 14 Lawrence Franklin Marion 11 Winston 15 9 Morgan 15 10 Jackson Madison Dekalb Marshall 14 10 Cherokee Cullman 15 13 15 Blount Lamar 15 Walker Fayette 15 16 15 15 Talladega Coosa 16 16 Perry 19 Sumter 12 18 20 Elmore 18 15 Monroe 18 Washington 20 Barbour 20 Pike Butler 18 Russell 21 18 Clarke Lee 16 Bullock 22 Wilcox 18 21 18 16 Lowndes Choctaw 14 Chambers Macon Montgomery 15 17 20 16 Dallas Marengo 16 Autauga 17 Tallapoosa 14 Chilton Hale Randolph 12 Bibb 20 Clay Shelby Greene 18 Cleburne 13 Tuscaloosa 23 13 9 15 13 Calhoun St Clair Jefferson Pickens 15 Etowah 15 11 Crenshaw Coffee 15 14 Henry Dale Conecuh 11 15 Covington Escambia 11 16 Geneva 14 Houston Mobile 13 Baldwin 15 HPSA Designation Type Geographic Low income Non designated Numerals indicate HPSA Scores Range 1 25 Niko Phillips 334 206 3807 or Niko Phillips adph state al us 47

APPENDIX B C O UNT Y H E ALTH RA NKIN G S ROA DMA PS C O MPAR E COU NTIES 2021 RA NKIN G S Alabama Fayette Lamar Bibb Greene Hale Tuscaloosa Pickens Health Outcomes Length of Life 9 800 10 500 11 200 12 200 12 900 13 700 8 500 8 800 21 24 25 24 34 29 21 27 4 4 5 1 5 2 4 9 6 0 5 3 4 4 5 2 4 9 5 5 5 8 5 3 5 8 5 6 5 0 5 3 10 11 9 10 16 12 11 13 Premature Death Quality of Life Poor or Fair Health Poor Physical Health Days Poor Mental Health Days Low Birthweight Health Factors Health Behaviors Adult Smoking 20 24 24 23 27 24 20 24 Adult Obesity 36 38 34 37 38 45 36 39 5 5 7 1 7 1 7 6 3 8 6 3 7 3 6 8 Food Environment Index Physical Inactivity 29 30 31 33 24 32 28 26 Access to Exercise Opportunities 61 34 10 16 6 30 76 6 Excessive Drinking 15 15 15 15 10 12 15 13 Alcohol impaired Driving Deaths 27 22 23 30 32 32 34 15 Sexually Transmitted Infections 583 4 461 5 258 1 613 2 1 200 5 1 505 5 890 7 594 8 Teen Births 29 37 39 38 49 35 21 33 Clinical Care 12 12 12 11 12 11 10 12 Primary Care Physicians Uninsured 1 530 1 970 1 1 870 1 2 060 1 4 910 1 1 390 1 2 490 1 Dentists 2 000 1 3 260 1 4 600 1 4 480 1 8 110 1 7 330 1 2 010 1 4 980 1 Mental Health Providers 920 1 8 150 1 6 900 1 3 730 1 8 110 1 7 330 1 680 1 4 980 1 Preventable Hospital Stays 5 466 4 667 5 917 6 690 6 410 6 585 5 624 5 829 Mammography Screening 40 38 38 33 29 31 44 44 Flu Vaccinations 43 47 43 40 32 34 46 46 Social Economic Factors High School Completion Some College Unemployment Children in Poverty Income Inequality 86 83 82 79 79 84 88 82 61 51 48 40 52 46 64 54 3 0 3 1 3 1 3 1 5 6 3 9 2 7 3 5 22 23 22 26 46 31 20 34 5 2 5 2 5 2 5 0 5 7 6 2 5 2 5 8 Children in Single parent Households 32 28 24 31 72 51 35 40 Social Associations 12 3 8 5 7 2 8 5 8 5 6 8 10 7 10 0 480 162 89 669 209 402 166 Injury Deaths 84 102 92 106 84 90 64 83 Physical Environment Violent Crime 9 2 9 2 8 8 10 0 9 1 9 4 7 4 9 1 Drinking Water Violations Air Pollution Particulate Matter Yes No No No No No No Severe Housing Problems 14 12 10 9 19 15 16 13 Driving Alone to Work 86 86 90 87 73 89 86 82 Long Commute Driving Alone 35 44 44 52 42 53 26 54 Compare across states with caution Note Blank values reflect unreliable or missing data 48

METHODOLOGY THE BURDEN OF DIABETES IN ALABAMA Diabetes is an epidemic in the United States According to the Centers for Disease Control and Prevention CDC over 34 million Americans have diabetes and face its devastating consequences What s true nationwide is also true in Alabama ALABAMA S DIABETES EPIDEMIC Approximately 553 000 people in Alabama or 14 6 of the adult population have diagnosed diabetes An additional 119 000 people in Alabama have diabetes but don t know it greatly increasing their health risk There are 1 316 000 people in Alabama 34 6 of the adult population who have prediabetes with blood glucose levels higher than are higher than normal but not yet high enough to be diagnosed as diabetes Every year an estimated 41 000 adults in Alabama are diagnosed with diabetes DIABETES IS EXPENSIVE People with diabetes have medical expenses approximately 2 3 times higher than those who do not have diabetes Total direct medical expenses for diagnosed diabetes in Alabama were estimated at 4 2 billion in 2017 In addition another 1 7 billion was spent on indirect costs from lost productivity due to diabetes APPENDIX C Diagnosed diabetes costs an estimated 5 9 billion in Alabama each year The serious complications include heart disease stroke amputation end stage kidney disease blindness and death IMPROVING LIVES PREVENTING DIABETES AND FINDING A CURE In 2019 the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health invested 30 465 029 in diabetesrelated research projects in Alabama The Division of Diabetes Translation at the CDC provided 1 821 128 in diabetes prevention and educational grants in Alabama in 2018 Sources include Diabetes Prevalence 2016 state diagnosed diabetes prevalence cdc gov diabetes data 2017 state undiagnosed diabetes prevalence Dall et al The Economic Burden of Elevated Blood Glucose Levels in 2017 Diabetes Care December 2019 vol 42 Diabetes Incidence 2016 state diabetes incidence rates cdc gov diabetes data Cost America Diabetes Association Economic Costs of Diabetes in the U S in 2017 Diabetes Care May 2018 Research expenditures 2019 NIDDK funding Projectreporter nih gov 2018 CDC diabetes funding www cdc gov fundingprofiles Learn more at diabetes org 1 800 DIABETES 800 342 2383 49

THE BURDEN OF DIABETES IN ALABAMA Cont APPENDIX C Counties with the Highest Rates of Diabetes and Ratios of Citizens to Primary Care Providers in Alabama Lauderdale Limestone Madison Jackson Colbert Lawrence Franklin Morgan Marion Winston Dekalb Marshall Cherokee Cullman Etowah Blount Lamar Fayette Walker Calhoun St Clair Cleburne Jefferson Talladega Pickens Tuscaloosa Bibb Coosa Greene Tallapoosa Chilton Hale Randolph Clay Shelby Perry Chambers Lee Elmore Autauga Sumter Macon Marengo Dallas Russell Montgomery Choctaw Bullock Lowndes Wilcox Barbour Pike Butler Clarke Monroe Crenshaw Coffee Conecuh Washington Dale Henry Covington Houston Escambia Geneva Mobile Baldwin Alabama counties with 5 or fewer providers and diabetes prevalence above 10 6 Alabama counties with 6 10 providers and diabetes prevalence above 10 6 Ratio of citizens to primary care providers higher than 6 000 1 Data Source 2017 County Health Rankings www countyhealthrankings org and BRFSS 2015 50

THE BURDEN OF DIABETES IN ALABAMA Cont APPENDIX C Alabama Poverty Vision Loss and Diabetes Prevalence by County Lauderdale 18 7 Limestone 13 6 Lawrence 16 6 Franklin 23 1 Marion 20 2 Morgan 15 0 Winston 20 1 Jackson 22 0 Madison 14 2 Colbert 16 7 Cullman 17 2 Fayette 20 6 Walker 23 5 Cherokee 18 6 Etowah 22 0 Blount 17 5 Lamar 20 6 Dekalb 24 0 Marshall 22 0 Calhoun 20 5 St Clair 14 3 Cleburne 17 0 Jefferson 19 5 Talladega 22 5 Pickens 25 0 Tuscaloosa 18 0 Bibb 18 1 Greene 33 2 Hale 28 1 Dallas 35 2 Marengo 25 6 Tallapoosa Chambers 21 3 21 3 Lee 25 2 Elmore 14 4 Autauga 13 1 Sumter 38 1 Choctaw 25 0 Coosa 18 8 Chilton 18 1 Perry 46 9 Randolph 20 4 Clay 19 5 Shelby 9 6 Macon 32 1 Montgomery 22 5 Lowndes 31 4 Bullock 35 1 Wilcox 33 7 Clarke 24 9 Crenshaw 21 2 Conecuh 30 6 Washington 18 5 Barbour 25 4 Pike 26 4 Butler 25 0 Monroe 25 3 Escambia 25 1 Russell 20 9 Covington 20 8 Dale 22 4 Coffee 16 8 Geneva 23 9 Henry 17 3 Houston 20 1 Mobile 19 6 Baldwin 13 0 Under 12 in poverty 12 15 4 in poverty 15 5 19 in poverty 19 1 24 9 in poverty 25 and above in poverty Source Alabama Possible American Community Survey ACS0 5 Year Activity Table B 10103 and BRFSS 2015 3 73 or more of county residents report vision loss Diabetes prevalence at or above 12 2 among Medicare Medicaid and BCBS beneficiaries15 5 19 in poverty 3 73 or more of county residents report vision loss AND Diabetes prevalence at or above 12 2 among Medicare medicaid and BCBS beneficiaries 51

APPENDIX C THE BURDEN OF DIABETES IN ALABAMA Cont APPENDIX C Diagnosed Diabetes Total Adults with Diabetes Age adjusted Percentage Alabama 14 12 10 8 6 4 2 Vertical dotted line indicates major changes to the survey methods in 2011 http www cdc gov SurveillancePractice reports brfss brfss html Horizontal dotted line indicates No Data Suppressed Data or both Diagnosed Diabetes Total Adults with Diabetes Age adjusted Percentage Alabama Total Year Percentage LL 2004 7 9 7 0 8 8 2005 9 3 8 3 10 4 2006 9 5 8 5 10 6 2007 9 7 9 0 10 6 2008 10 6 9 7 11 5 2009 10 9 10 0 11 9 2010 11 3 10 4 12 3 2011 10 9 10 1 11 7 2012 11 1 10 3 11 9 2013 12 6 11 7 13 7 2014 11 8 11 0 12 6 2015 12 0 11 2 12 9 2016 13 2 12 2 14 2 Major changes to the survey methods in 2011 http www cdc gov SurveillancePractice reports brfss brfss html Indicates No Data Indicates Suppressed Data LL Lower Limit UL Upper Limit 52 UL 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 0