Aug. 18--Pima County's biggest health problem is a lack of access to medical care, a new report says.

The "Pima County Community Health Needs Assessment," released Friday, was completed by officials from Tucson's nonprofit hospitals as part of a requirement under the new federal health law.

As a next step, each health system will create a plan to address the health gaps that Friday's report identifies.

Among those gaps is that 20 percent of Pima County adults and nearly 12 percent of county children have no health insurance.

State cuts to Medicaid, which is for extremely indigent people, left more people without health coverage, says the report, published jointly by the Carondelet Health Network, Tucson Medical Center and the University of Arizona Medical Center. The authors also say limited coverage for behavioral health and a lack of access to medications are hindering local residents from getting the care they need.

Other county residents are not getting appropriate health care because of a shortage of primary-care providers, the 121-page document says.

The report identifies the most medically underserved areas in Pima County as Ajo, and the Pascua Yaqui and Tohono O'odham reservations.

Obesity, diabetes and substance abuse were identified as the county's top medical problems.

Also noted was an increase in deaths from firearms between 2005 and 2010, the most recent data available. The 2010 rate was 16.9 deaths from firearms per 100,000 people. That was up from 14.1 deaths per 100,000.

Suicides, diabetes and drug-induced deaths also increased between 2005 and 2010. Arizona has the highest suicide rate in the U.S. for people over 60.

Public health problems highlighted in the report were particularly prevalent on the two American Indian reservations in Pima County, where unemployment is more than 25 percent.

The Tohono O'odham Nation southwest of Tucson has an infant mortality rate of 16 deaths for every 1,000 live births, which is more than double both the national and Pima County rates.

Tribal Chairman Ned Norris said the primary responsibility for health care on the reservation falls to the federal government's Indian Health Services.

"Funding in this area has continued to decline, forcing tribes to often fund these programs on their own," he said Friday.

While great needs remain, the Tohono O'odham Nation has made "significant strides" in addressing health issues in recent years and some of the information in the report may not reflect those improvements, he added.

The report will help county government officials focus on issues related to access of care, and will also help in applying for grants, said Honey Pivirotto, assistant Pima County administrator for health policy.

Pima County was one of the stakeholders that provided input in the project. Pivirotto said rather than competing with one another, the local health entities collaborated to address health problems together.

Pivirotto said she was surprised by the report's results on health care for the elderly, which showed they need a better continuum of care between providers.

"With this whole initiative we can try to get greater awareness to address the disjointed continuum, and maybe fill in the gaps as a community," she said.

Top 10 causes of death in Pima County

1. Cardiovascular disease

2. Cancer -- lung, colorectal and melanoma are the most common

3. Accident -- motor vehicle crashes

4. Chronic lower respiratory diseases

5. Stroke

6. Drugs

7. Diabetes

8. Alzheimer's disease

9. Suicide

10. Firearms

Source: Pima County Community Health Needs Assessment

Contact reporter Stephanie Innes at sinnes@azstarnet.com or 573-4134.

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