Health Disparities Survey Question Title * 1. How do you define ‘health’? State of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (WHO) The condition of being sound in body, mind or spirit. (Merriam Webster) The absence of any disease or impairment. (NIH) A state that allows the individual to adequately cope with all demands of daily life. (NIH) A state of balance, an equilibrium that an individual has established within himself and between himself and his social and physical environment. (NIH) Question Title * 2. Choose which of the following you see on a regular basis? Check all that apply. Family Doctor Eye Doctor Dentist WIC Specialist None Question Title * 3. The Covid pandemic has had the following impact on my life. Check all that apply. Feelings of isolation. Disagreement with family. Change in how I shop. Change how I get medical care. Caused me to put off preventative health services, (PAP, mammograms, colonoscopy, doctors visits) It did not change my life. Question Title * 4. I have the following: Health insurance. (Private, Medicare, Medicaid) No health insurance. Question Title * 5. Do you currently or have you driven out of the county to seek medical care due to unavailability? Yes No Question Title * 6. Check the top three (3) priorities that need addressed in Pettis Co: Accessible and affordable food options. Transportation Accessible and/or affordable services for mental health. Accessible and/or affordable childcare. Accessible and/or affordable elder care. Accessible and/or affordable housing. Accessible and/or affordable addiction support. Accessible and/or affordable shelters for abuse victims. Accessible and/or affordable health care and prescription medicine. Question Title * 7. Age: Under 18 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 8. Race: Asian or Pacific Islander Black or African American Hispanic or Latino Native American or Alaskan Native White or Caucasian Multiracial or Biracial Question Title * 9. Gender: Male Female Nonbinary Transgender Question Title * 10. Zip Code: 65301 65302 65334 65337 65350 65360 65336 65333 65351 65332 65347 65345 65335 65325 65348 65340 Done