Analysis of a geographical community

Community Analysis: Columbus, Ohio - Hilltop Area/Franklinton

Identification and History

The Franklinton/Hilltop area of Columbus, Ohio is located on the west side of the greater metropolitan area. Franklinton is in a river valley next to the Scioto River and the Hilltop area is just west of that on a rise. The Hilltop area is defined as the area between I-70 on the north, the B & O. railway to the east and south, and the I-270 outerbelt to the south and west (Greater Hilltop Area Commission, 2011). Its main street is West Broadstreet, otherwise known as U.S. route 40. There are welcome signs to the area near Mound Street and Hague Avenue. Franklinton is bordered by the Scioto River on the north and east, Hague Avenue on the east, Stimmel Road and Greenlawn Avenue on the South, and I-70 on the West. The main street in this area is also West Broadstreet. Although the areas are technically separated, there are still considered to be a single community by many locals because they share this same main street and are culturally similar. Both communities share resources and the residents do not consider themselves to be separate.

The history of Franklinton began in 1797 and was played out by Lucas Sullivant, a Virginia land surveyor. Franklinton 10 is the oldest community in Central Ohio (Franklinton Development Association, 2011). Franklinton began as a farming community, taking advantage of the rich fertile bottom lands of the river. It was originally separate from Columbus, but eventually became surrounded and enveloped by the city. It is located on a flood plain that is now protected from the Scioto River by a flood wall (Franklinton Development Association, 2011). Frequent floods in the area made it a poor choice for business development and it remains an impoverished and depressed area of the city.

Hilltop was originally known as Sullivant's Hill, and was slowly sold off in sections by the original Sullivant family. Lucas Sullivant was given the land for his service to the Federal government at the end of the 18th century (Greater Hilltop Area Commission, 2011). Franklinton and Hilltop were originally interconnected and it is their geography that allows them to remain culturally and socially interconnected today. Sullivant Avenue is a major secondary street in Hilltop.

The population of Franklinton is 11,529, with approximately 3,517 people per square mile (City-Data.com, 2011a). The Greater Hilltop Area is slightly larger than Franklinton, with a total population the 58,628 and a population density of 3605 people per square mile (City-Data.com, 2011b). These compare to Columbus that has a population density of 3,384 people per square mile (City-Data.com, 2011b). Franklinton and Hilltop share a common history of low income, impoverished citizens. Floods are the geography of the area has discouraged major corporate development in the area since their early beginnings.

Both areas are highly ethnic with a diverse number of ethnic backgrounds. The close proximity of these neighborhoods to major highways and the bus system with easy access to downtown allows seduces to work outside of the community. Major businesses are few in these neighborhoods and most opportunities for employment are outside the community. Both of these communities have been slated for redevelopment and are currently in the process of changes. For the purposes of this study the areas of Franklinton and Greater Hilltop will be referred to as "Franklinton/Hilltop."

Section II: Community Characteristics

Stanhope & Knollmueller (2001), outlined a technique for characterizing the health needs of the community. They divide the assessment into an assessment of the community which includes the place, the people, and the function of the community. The community health assessment includes the status of the health of the community, the structure that is available and the processes in place within the community to keep its citizens healthy.

Windshield Survey

The windshield survey of the Franklinton/Hilltop area begins with a trip down the main street through both areas. Driving down West Broadstreet tells the tale of an area that has been depressed for quite some time. Buildings in the Franklinton area are largely one story storefronts circa 1900. The Hilltop area has few businesses on Broadstreet and is mainly residential. The businesses along Franklinton's main street are in a significant state of dilapidation, with many of them boarded up in graffiti in plain sight. It was noted that older black men were seen standing on the street smoking or sitting by building reading newspapers. Franklinton is literally in the shadow of downtown Columbus.

If continuing down Broadstreet to the Hilltop area is a gradual progression into a more residential area. Hilltop appears to be built largely between the 1950s and 1960s, with numerous double housing units available. Many of them are small, one story or two story. It appears to be a family neighborhood with lots of kids riding bikes along the streets. It appears to be a mixed community with a high percentage of African-American. It appears to be a working class neighborhood. Driving down side streets tells the story of a mixed neighborhood. One house will be very nice and well kept, while the one right beside it will be in a state of disrepair with trash in the yard. In the Franklinton area, the side streets revealed a largely depressed community in a continued state of dilapidation. Housing units consisted of single family, doubles, and small six to a unit apartment buildings. Teens were hanging out on street corners smoking.

There did not appear to be significant community resources in the area of either Franklinton or the Hilltop. Both of these areas were within a short distance from main bus routes and residents have access to every part of the city from there. The most significant structure in the area was Mount Carmel Hospital and it's huge, sprawling campus. It is easily accessible from all areas of the communities by walking, taxi, or the bus system. This facility appears to be the leader in providing health care services to these communities.

Aside from Mount Carmel Health, there do not appear to be a significant number of private doctor or dentist offices in the area. Most services seem to operate in and around the big medical campus. It was noted that several free food pantries and service is relocated within the community with conspicuous advertising.

Both areas appear to have many needs in terms of providing access to community health. In terms of general appearances, Mount Carmel Health appears to be located in an area that has been renovated, but not too far away the remainder the community appears to be in a state of dilapidation. The community appears to have numerous resources available, but they also appear to have a great need for them. It does not appear that all of the citizens have access to the services that they need and there were many homeless in the area, more so in the Franklinton area, than in the Hilltop area.

If the community's greatest weakness appears to be that there needs if for services exceed their ability to provide them. They do not appear to be save sufficient employment in the area in many businesses have apparently been closed for many years. If it appears to be an area where there is no opportunity in the immediate area. The standard of living in the Hilltop area leads one to believe that the residents must be traveling elsewhere to work and then coming back to their homes. There are few places to work in the immediate area, yet the standard of living is better than that of the Franklinton area. The greatest weakness of these communities is a lack of resources available to meet the needs of the citizens.

The area does have several key strengths, but they are not apparent by conduct of the windshield survey. The first is that it has a major health facility located within easy access of the entire area. Although these two areas where the last to be funded in the Columbus area for community development projects, they have been slated for renovation and a facelift to lift them up.

Until recently, the frequency of flooding in the Franklinton area prevented it from being a target for revitalization. Many restrictions were in place due to flooding in the area. Now that the flood wall has been completed, the plan is in place to renovate and restore community pride and to attract businesses to the area (City of Columbus, 2003). The current plan includes an expansion of manufacturing and single family residential homes. This is an attempt to bring business and jobs to the area. This plan also includes a planned to construct a bike trail along the old abandoned railway and to provide more recreational opportunities and activities in the area (City of Columbus, 2003). The Greater Hilltop plan includes a major facelift in the parents of the area, particularly in the residential areas (City of Columbus, 2010). The current development plans and funding are the greatest assets in the possession of these two communities at the current time. They promise to bring a higher standard of living, attract residents with higher incomes, and lead to the establishment of more services for all of the residents.

Community Resources

An assessment of community resources for help and family's to achieve the optical level of wellness focus is on Mount Carmel Health System. Their won the largest hospitals in Central Ohio and there are few services, either general or specialty that cannot be found on the campus. Residents who have Health Insurance or who receive assistance by way of Medicare or Medicaid have easy access to the services at this facility and will not be the focus of the study. The study will address resources that are available for those who do not have access to Mount Carmel Health System due to a lack of insurance or other resources such as transportation or cost.

Citizens in both the Franklinton and Hilltop areas have access to numerous resources integrator Columbus area. The public transportation in Columbus gives them easy access to any other area of Columbus. Columbus has a wealth of resources available to promote the optimal level of wellness. The resources available in the greater Columbus area should also be considered in the assessment of resources available to the Franklinton and Hilltop communities. Columbus literally has thousands of not-for-profit, government and private resources available to meet every health need imaginable. In terms of resources, Mount caramel Health System is the biggest resource in the community.

Because the Westside of Columbus is a depressed area, it has become a priority for the provision of services by the Columbus Public Health Department. The Columbus Health Department main facility is located at 240 Persons Avenue (Columbus Public Health, 2011a). This facility is located near downtown, but on the opposite side of the Franklinton and Hilltop area. It is not within walking distance of either area. However, it is easily excess of the by the public transportation system.

The Columbus Public Health Department takes an active role in promoting public health in all areas of the city. They have main issue gives and programs designed to help improve health in the city as a whole, and in individual neighborhoods. They have regular services available on a year round basis, and special events such as wellness fairs, community events, and educational programs. Their programs include an infectious disease program to help track and educate the citizens about infectious disease and its prevention. They have an environmental health program that includes animal control, food production, lead control programs, and a number of other related services. They offer programs to help raise awareness of the importance of preparedness for a disaster and they provide information on help citizens can take control and responsibility of their own personal health, as well as that of their family.

The Columbus Public Health Department offers many other programs and services that address health issues on a citywide basis. However, the most relevant program to this study is the healthy neighborhoods program. This office reaches out to individual communities within the Columbus area. It targets local communities with many of the same programs that are targeted in the citywide health initiatives. They provide health and information and outreach to individual communities, as well as local community health events. They sponsor services through the Columbus Neighborhood Health Center, Inc., which is a federally qualified health center that operates five Health Centers in Columbus that provide primary Health Services to local residents (Columbus Public Health, 2011b).

Community Neighborhood Resource Centers provide not only offer Health Services themselves, they partner with other work local resources to provide what their local residents need. They concentrate on services for low income persons, who may not otherwise have access to community Health Resources. They offer services for many culturally diverse communities, such as those for the Asian-American community through Ohio State University Hospital. The closest free clinics in the Franklinton and Hilltop areas were located at 2300 West Broadstreet 1180 East Main Street, and 1934 North Fourth Street. None of these are located in the Franklinton or the Hilltop Area. The close this is at least a 35 to 40 minute bus ride. Some clinics only see a small number of patients or have very limited hours (Columbus Public Health Department, 2011c). They are not readily accessible to low income patients in the area.

The Franklinton and Hilltop areas have a wealth of resources just a short distance away. The problem is not the number of resources available to the highly visible low income population in the area makes it apparent that not all citizens are able to obtain the healthcare that they need. On the Columbus Public Health Department website it appears that in large number of resources are available to persons within individual communities. However, when one examines these resources more closely, a severe deficiency in the resources available to low income residents in the neighborhood is problematic. Special populations, or persons located in certain areas of town do not have resources available to them and the resources that they are that are available are inadequate. This is the case for the Franklinton area in particular.

The problem is twofold. The first part of the problem is that resources need to be available for low income persons, or special populations within the Franklinton and Hilltop areas. The second problem is making certain that all citizens have access to them. Transportation is the number one issue found in taking advantage of the city's low income Health Care Resources. The bus routes provide access to all areas of the city. Cab services are also available, but these may be cost prohibitive.

Free transportation services for the disabled, handicapped, elderly, and veterans are available, that offer their services free of charge for those who qualify. However, for those that do not fall into one of these categories, transportation may be prohibited in obtaining the services available. In addition, like the programs themselves, transportation services are limited and can only serve a fraction of those that need their services.

There are few services available outside of the Mount Carmel Health System in the area. In terms of school and occupational Health Services, mental health, pharmacies, dentists, private doctors, department's operated by the health department, safety and protective services, mental health, support groups, or shelters, none could be located within the limits of the neighborhood. During the windshield survey, several Neighborhood Watch signs were found in both areas, but it cannot be determined how active or effective these groups are in the community. Residents have access to services such as these largely through Ohio State University and the major healthcare systems throughout the city, if they have transportation and the funds necessary to access them.

Fire protection is provided by the Columbus division of fire. Police protection is provided by the Columbus police department. Services are considered adequate for the area and it is assumed that they are in compliance with the appropriate standards and guidelines, as dictated by the city of Columbus. Hilltop and Franklinton have a reputation for being high crime areas.

There is also a high level of drug addiction and homelessness in the area. All of the drug rehabilitation centers in Columbus, except for Maryhaven only accept patients who have insurance or the means to pay. Maryhaven has a long waiting list and it is difficult to actually get into the program. Maryhaven is a 501 (c)(3) program and operates through donations (Maryhaven, 2011). The program at Maryhaven does not appear to even come close to resolving the issues in the area. This single program is largely inadequate to serve the needs of the entire community. This is a significant area of need that was identified during the study.

Meals on wheels are provided by private contractors and by local churches in the area. Many of these services, such as Lifecare Alliance, have offices located in downtown Columbus, but they serve the Franklinton and Hilltop areas. Services for the elderly can be accessed by contacting the Franklin County office on aging (Franklin County Office on Aging, 2011). Senior Independence offers many of the same services as the office on aging, only they focus more on adult education, day centers, hospice, and Home Health Care. This agency also holds wellness clinics throughout city (Senior Independence, 2011). There are 29 agencies in the Columbus area that service all of the Columbus area of providing Home Healthcare Services for seniors (Yelloepages.com, 2011). It appears that seniors have a wealth of resources available to them throughout the city in that most of them only require a phone call. These are the most accessible services found throughout the course of this study. Seniors have access to services as long as they have access to a phone.

It appears that seniors have sufficient access to services as long as they have a phone. Problem with access to the services is getting the information to the seniors about the services and programs that are available. This is the key barrier that lies in the way of providing senior citizens access to appropriate and proper care. These services provide community welfare that goes beyond that which is provided by the state. They provide services but did not provide additional funds similar to those provided by the state of Ohio. The main office for Franklin County is located in the downtown and is easily accessible by COTA bus (ODJFS, 2011). Other

than private organizations, few services were found offer beyond those of the state of Ohio.

Welfare services including emergency food, shelter, and clothing are provided by private organizations and civic organizations such as the YMCA. Faith Mission will provide those in need with a hot meal and warm bed if for the homeless (Faith Mission, 2011). There are four homeless shelters located downtown, but none in Franklinton/Hilltop area (Homeless Shelter Directory, 2011). Choice Women's Emergency Shelter operates as an emergency shelter for abused women. The main problem with these services in many of the other services offered in the area is that those who wish to use the services have to first know about them, next they have to have transportation to get to them, and many of these services in the City of Columbus are filled to capacity much of the time. Not only is the Franklinton/Hilltop area seriously in need of more services, the entire City of Columbus is in need of them too.

Recreation

Recreation and relaxation is an important part of a healthy lifestyle. Reducing stress and staying active is good for both the body and the mind. It is important have a number of recreational activities available in many areas of the city. The Center of Science and Industry (COSI) is located technically within the borders of Franklinton. It features a hands-on learning center for children of all ages. It is a feature attraction to the Columbus downtown area. It is accessible by bus and within a short walking distance of Franklinton. However, general admission is pricey. However, they give special discounts for persons with Medicare and Medicaid cards. They have one day a year where admission is free, which allows many who could not normally access the facility to do so.

Franklinton and hillside are close to many downtown Columbus events such as the Jazz Festival and the Arts Festival. From their homes, many can see the 4th of July fireworks display, or they can join in with only a short walk. Columbus has an active Recreation and Parks Dept. that maintains green spaces in runs programs throughout the area. The host the summer sports such as summer softball and soccer leagues. They also host golf outings and races. There are two outdoor pools in the Franklinton/Hilltop areas that are easily accessible and low-cost (Columbus Recreation and Parks, 2011). These areas do not lack in the variety of activities available in the area. This is one area in the health assessment where these this area of the city has a key strength. From appearances during the windshield survey, it appears that many people take advantage of the activities and facilities provided by the city of Columbus.

Biostatistics

The following data represents the key demographic data for the Franklinton/Hilltop area. Knowing this data will help planners determine what they need in the future. It might noted that not all information could be located. No information could be found that separated the Franklinton/Hilltop area from the rest of Columbus. Columbus and Franklin County data was combined in many sources, as Columbus takes up all of Franklin County. In all cases, the most recent data available was used for this demographic profile.

In using the demographic information contained in this chart, caution must be used due to the aggregate nature of the data. The areas of Franklinton and Hilltop are unique in their ethnic background and in their economic profiles due to the depressed nature of the area. When considering the statistics of Franklin County, it is suspected that the Franklinton/Hilltop areas represent the lower portions of the demographic data for Franklin County. The windshield survey told the story of an area with high unemployment, and a lower income than can be observed in a majority of the rest of the county. It is with these cautions that the following data must be considered.

City of Columbus/Franklin County

Ohio

US

Population Growth 2000-2010

+10-99%

+9.9%

9.7%

Dependency Ratio

Not Avail.

59.8

69.6%

Number of people in the area less than 18

16.9%

26.5%

24.3%

Number of people in the area over 65

10.2%

13.9%

12.9%

Median educational level

Persons with High School Diploma (25 or older)

84.6%

86.6%

84.6%

Persons with Bachelors Degree or higher (25 or older)

35..1%

23.6%

27.5%

Unemployment rate

8.2%

8.8%

9.2%

Per capita income

$27,002

$24,830

$27,041

Number of families living under the poverty level

18.4%

15.1%

14.3%

Ethnic characteristics

White

72.0%

82.7%

72.4%

African-American

19.4%

12.2%

12.6%

American Indian

0.3%

0.2%

0.9%

Asian//Pacific Islander

4.7%

1.7%

5.0%

Other Race Alone

1.2%

Not Avail.

Not Avail.

Two or more races

2.5%

2.1%

2.9%

Hispanic Latino (any)

2.7%

3.1%

16.3%

Data Sources: Tavares, Charleta 2009; Ohio Department of Development, 2011; Ohio Facts, 2011; U.S. Census Bureau, 2011

In general, Franklin County grew faster than the remainder of the state and the U.S. This means that the area is becoming ripe for development. This bodes well for the redevelopment projects that are scheduled for the Franklinton and Greater Hilltop areas. If developers can make the area attractive, then they can take advantage of this recent influx of people into the area. This is an important statistic in terms of the ability to raise the living standard for the people of Franklinton/Hilltop.

In terms of Health Care coverage, among adults 18 to 64, nearly 18.9% reported not having Health Insurance. Of the same population 22.4% reported that they did not have any form of prescription drug coverage. In terms of dental and vision care, the number of uncovered in Franklin County were 34.7% and 37.7% respectively. Seniors fared better than the working-age population due to Medicare benefits. However, nearly 57.8% reported that they do not have dental coverage. Seniors who did not have vision coverage were up 44.9% in the Franklin County area. One of the more important factors in these statistics is that of those that were uninsured, 43.3% had been uninsured for over three years. Even among employed adults, the statistics will held true because neither their employer nor unions offered Health Insurance as a benefit to their workers. This creates a significant gap in Health Care coverage, even among those who should be covered. This is a health risk that affects not only Franklin County in the area that is the topic of this study, a represents a serious healthcare problem for the nation as well.

The working population of Franklin County is 65.8%, with 24% below the age of 18 and 10.2% over the age of 65. One-third of the population must be supported by the remaining two-thirds. This reflects a significant problem in terms of the ability to care for young and elderly, as well is to provide for the needs of the rest of the population. The median educational level for Franklin County was at least a high school level, or some college.

Unemployment rates were measured as of June, 2011. Unemployment rates in Franklin County were slightly better than those in Ohio and in the U.S. However, the Franklinton/Hilltop area represents only a small segment of the Franklin County unemployment ratio. Employment opportunities in the area appear to be low in many of the residence who do work must go outside of the area to find employment. No data was available as to the unemployment ratio in the defined area of this research study. This may affect the ability to apply the statistics to the area that is the focus of this research study.

It might be noted that in the 2009 Columbus and Franklin County Consolidated Plan Franklinton/Hilltop were not listed as separate from downtown Columbus. According to the data in the plan, Franklinton has the second highest African-American population in the city. It is more than 50% African-American. By comparison, the Hilltop area is only 5 to 10% African-American. The population of African-Americans tends to increase as one gets closer to the downtown area. The Asian population was nearly nonexistent in the Franklinton area, but a small section of the hilltop area was between 5-10% Asian. Most of the Asian population in the Columbus area is located in the north west portion of the city. There is a small Hispanic population near the downtown area in the northern area of Franklinton. Hispanic population in that area ranges between 5-10%.

According to the Columbus Dispatch (2011), over the past 10 years, growth in the city has been uneven. The Franklinton/Hilltop area has seen an average increase of between 10-99%. Some areas of the city had significant losses, while the Franklinton/Hilltop areas grew. It is not known if the renovations planned for these communities played a significant role, or if it is the number of inexpensive properties that are available in the area.

According to the hot Ohio Department of Health (2008), heart disease is the highest cause of death in Franklin County residents. This study reported that 38.5% of phrasing county residents had been told by their physicians that they have high cholesterol, a common risk factor for the development of heart disease. If however, it is suspected that the statistics are even higher because of the high percentage of persons in the county who do not have health insurance.

In the Ohio Dept of health study, cancer rank as a second leading cause of death, third was lower respiratory diseases. These were followed by stroke, accident, and diabetes in that order. The statistics tell the story of a population that could take better care of themselves in terms of their health. According to the study, high percentages of the population either directly took actions that are a risk factor to their health such as smoking, lack of physical activity, and being overweight. The major causes of death and Franklin County are unnecessary if the population would learn to take better killer care of their health. This is a major public health issue that needs to be addressed. It is not just a problem in the defined area of the study, it is a problem that affects the nation as a whole. However, resolving the issue in the area under study will have an effect, even if that affected small, on the entire nation.

One of the most difficult factors in conducting a statistical analysis of the Franklinton/Hilltop area is that studies have not been conducted, other than those by developers and planners for the purpose of the improvement projects, it leads separate statistics in these areas from those of the greater Franklin County area. It is difficult to determine if statistics in this area are similar to those in other areas of Franklin County.

The Franklinton/Hilltop area has a reputation as a high crime, depressed area. It is suspected that it also has high rates of teen pregnancy and other community health related maladies. This reputation is supported by the windshield survey and observations of the area. However, without reliable statistical analyses that separate out these areas, it is not known if the impact that these factors have on the area. In terms of community health, if a nurse must make their best guess based on observation about how closely the reputation of the area reflects reality of life in this section of the city.

Section III: Analysis and Assets

The Franklinton/Hilltop areas not unlike other depressed areas of the country in shares many of the same afflictions. To further aid in the analysis of the problem, informal interviews were conducted with 10 people in the area. These included business owners, nurses at the community hospital, and people on the streets. The sample population included people from all walks of life from the on to the elderly. Demographic information was not taken, other than that which could be observed.

Interview Results

The Franklinton/Hilltop area has a reputation as a depressed area of the city. An assessment of the history of the area demonstrated that the geographic proximity to the Scioto River and flooding problems were key reasons for its inability to rise up from poverty. However, only limited data could be found that separates this area from the rest of Columbus and from Franklin County. It is not known if the numbers reflect the observations of the area. To further clarify the position of the area in terms of its reputation and the realities of living in it these interviews revealed the expected results.

The results of the interviews revealed that the area does suffer from an impoverished lifestyle. People only community have little hope to rise up. If nurses in the area identified many common problems that were expected such as a high level of substance abuse, low education levels, and a high number of people with inadequate or no housing at all. People in this trees did not feel that there was ample opportunity in the area to improve one's own situation through employment. As expected, many people in the area when outside to work. Business owners found it difficult to make ends meet because either the people could not afford what was being sold, problems with theft and loss, and a lack of people coming into the area to shop. They reported the most their business was local and that it was scarce. People in the area did not feel safe and felt that it was a high crime area. From the responses of the interviews, it appears that the reputation of the area matches the perceptions of the people who live there, and of health professionals who work there.

Problem/Asset Identification and Community Diagnosis

The geographic location of the area in a floodplain was found to be a major contributor to the inability of the area, called the "Bottoms" to be unable to attract businesses and dries up from poverty. It is believed that this issue has been resolved by the completion of a flood wall to eliminate the problem. This was the first step to resolving the issues that plagued the area. After this was completed, the city launched a plan to renovate the area so that businesses would be attracted to it, offering economic development and opportunities for employment. This plan by the city is a key asset that will help the area to grow and improve in the long run.

The question is whether this facelift will result in solutions to other problems in the area. For instance, if the area continues to remain a high crime area, or if the problems associated with drugs in the area are not resolved, then the ability of the area to improve will be limited. The existence of these problems in the area will be a hindrance in the effectiveness of the city's plans. These issues must be resolved are to produce a complete makeover that is more than surface results. Many respondents in the interview express the same sentiments. When asked about the effectiveness of the city's new renovation plans, the general consensus was that just painting the buildings and sprucing up would not have an effect on the underlying issues in the area. They fell this fit either make the results of the plan short lived, or that it would limit the effectiveness of the plan.

The diagnosis of this area is based on the results of all of the elements of this study. The history of the area, the windshield survey, demographic data, and an assessment of the resources available and the community pain of picture of an area that cannot provide for the basic needs of a large portion of its citizens. The Hilltop area fares better in this respect than Franklinton. The focus of the proposed plan will be in the Franklinton area, because the problems are much more challenging in this area. Health issues such as obesity, smoking, preventing cancer, and taking measures to have a healthy lifestyle cannot be addressed until the basic needs of the community have been met. The focus of the diagnosis and solutions to these problems will focus on improving the ability of the community to beat the basic needs of its citizens.

The elements of the research study confirmed that a problem exists and the severity of the problem. An effort by the nursing community to resolve the underlying social issues in the community will play a vital role in the success of the city's plan to upgrade the area. The most significant insufficiency in the area was a lack of services for those who are in need of them. The same could be said for the rest of the Columbia area, but the Franklinton area was almost void of any resources at all. If it was found the citizens in need had to travel to other areas is cities to access services. Some of these required long bus rides or cabs, which may be cost for fit prohibitive. There many other reasons why people in the area could not access services, one of them is that they may not be aware of the services that are available that to them, even if they did have transportation to get there.

The following table summarizes the five most important community problems and presents solutions to them. Provision of basic needs and services takes a priority over many other health issues, because the ability to solve these other health issues is dependent a pawn a person first being able to meet their primary needs.