Community Health Simulation: Assessing Health Needs in Sentinel City

This report presents a community health simulation conducted in Sentinel City, a virtual environment designed to mirror a real United States city. The assessment covers various demographic aspects including age, gender, income, ethnicity, and insurance coverage across four distinct neighborhoods: Nightingale Square, Acer Tech Center, Casper Park District, and Industrial Heights. Key findings reveal significant disparities in median household income and insurance coverage among the neighborhoods, with Industrial Heights facing the most challenges. Safety assessments identified issues such as stray animals, trash accumulation, and high crime rates, particularly related to controlled substance use. The report also highlights available community resources, including parks and recreation, community health centers, elderly services, affordable housing, and social services provided by the city. Windshield surveys of each neighborhood provide detailed observations of the built environment, community activities, and potential health risks, informing recommendations for targeted interventions to improve the overall health and well-being of Sentinel City residents.

Running Head: COMMUNITY HEALTH SIMULATION 1
Community Health Simulation
[Name of Student]
[University/College]
[Instructor’s Name]
[Date of Submission]

COMMUNITY HEALTH SIMULATION 2
Community Health Simulation
Sentinel City is comprised of a diverse population with variations in age, gender, income and
ethnicity. The demographic assessment revealed the city has a population of 663,862 of which
29.1% are under the age of 18 and 70.9% who are over the age of 18. 52.7% of the population
are Caucasian (non-Hispanic or Latino), 31.5% are Hispanic or Latino, 10.4% are African
American, 3.7% are Asian, 3.1% are two or more races, 2.0% are American Indian and Alaska
Native, and 0.2% are Native Hawaiian. The city is made up of four neighborhoods: Nightingale
Square, Acer Tech Center, Casper Park District, and Industrial Heights. Casper Park District has
the highest neighborhood population of 352,643, followed by Acer Tech Center with a
population of 168,390, then Nightingale Square with 103,874 residents, and finally Industrial
Heights with the lowest population of 38,855.
Upon further assessment of city’s demographics, the median household income for the city is
$49,091. Each neighborhood’s median household income varies. Nightingale Square has the
highest median household income of $269,550, followed by Acer Square median income of
$166,300, then Casper Park District median income of $80,134, and finally Industrial Park with
the lowest median household income of $24,672. Of the total population 18.9% of the
population is living below poverty. The percentage of non-insured residents in the city is 62.4%.
37.5% of residents in Industrial Heights are not insured. Casper Park District has 22.7% of non-
insured residents, Acer Park has 1.5%, and Nightingale Square has the lowest non-insured
residents, 0.7%.
While performing the Neighborhood Safety Assessment, there were several safety hazards
identified. Throughout the city there were stray dogs and piles of trash on the street. Of all the
reported dog bites that resulted in hospitalization, 43% of them occurred in Industrial Heights.

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Industrial Heights has an industrial plant that produces black smoke coming from the exhaust
system at the top of the building and black liquid waste from the industrial plant, flowing from
pipes onto the street. Trash and rats were the greatest in Industrial Park, along with abandon
buildings, and broken store front glass. Industrial Heights had graffiti on various occupied and
abandon buildings and a burning car on the side of the street near the Soup Kitchen.
Based on the Neighborhood Safety Assessment, 16% of arrest are because of controlled
substance use and drugs. Marijuana, Cocaine, Heroin, Methamphetamines, and Club Drugs are
among the drugs used by residents of Sentinel City. Upon interviewing some of the citizens,
some admitted to using drugs when money was available through stealing or prostitution for
purchase of drugs. Other citizens stated they use marijuana recreationally. In the event of an
overdose or other emergency typical response times for Emergency Medical Services is 7.46
minutes.
The Neighborhood Safety Assessment revealed, Sentinel City’s Crime Rate of 3,605 per
100,000. Aggravated Assault was the most commonly reported crime in Sentinel City last year,
with a reported 1,231 incidents of assault. Other incidents of robbery, rape, and murder has
occurred within the city as well. According to Rodney Cooper, a police officer, Nightingale
Square is the safest area with low criminal activity and Industrial Heights and Casper Park
District are the highest areas of reported crime. Store owners have reported property damage and
shoplifting among residents of the city. There has been gang related aggravated assault in the
city. More than 100 incidents of gang related assaults occur each year. There are no visible or
active gang activity while touring the city or speaking with residents but abandon building
graffiti could be possibly associated with gang activity.

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While completing the scavenger hunt, I discovered an array of community resources available to
the residents of Sentinel City. Sentinel City’s Department of Parks and Recreation, located in
Nightingale Square provides swimming lessons, nutrition and gardening courses, summer
programs for youth, city sport leagues, adult fitness classes, and after school programs. While
visiting the park, there were several residents engaging in outdoor sports. Most residents are
aware of the services the Park and Recreational Department offer, but 40% of residents have
complained about the location of the park. The park has seen budget cuts compared to four years
ago of almost of half of its available funds. The city has decided to increase the budget of its
classes, offering more classes to residents. For residents who like to enhance their parenting
skills, computer skills, language proficiency, and become sober, the Community Health Center
offers classes and support groups. Along with daycare during classes, many parents can attend
classes or support groups without having to arrange child care. Classes are offered monthly for
parenting and more frequently for computer skills. The English Language Learners class offered
here has the highest participation among residents of Casper Park District.
For the elderly population, Sentinel City’s Health Care System’s Elderly Service, located in Acer
Tech Center, offers transportation, service animals, Meals on Wheels, elder abuse prevention,
community centers, Government Entitlement Assistance, and Medical Care Advocates. In
addition to services, the Health Care System has living options ranging from independent living,
nursing homes, skilled nursing facilities, and senior living units. Residents who are not elderly
but may still need housing options, due to limited income, the Sentinel Affordable Housing
Project, located in Casper Park District, may be able to assist with their housing needs. Only
50% of the housing project is occupied by residents. There are several floorplans available from

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studio apartments to two-bedroom apartments. For those looking to obtain residential occupancy,
their chances of securing housing is greater in the event all requirements are met.
Sentinel City’s City Hall seems to be the heart of the services used by residents. The City Hall
Social Services Department provides adoption assistance, head start for children, youth
independent living, stay at home program for child care, and subsidy benefits. The City Hall also
provides healthcare assistance, Women Infant Child Benefits, and Supplemental Nutrition
Assistance Program for low income residents. More than 65,000 residents were recipients of the
program last year. For residents who do not meet requirements for the Supplemental Nutrition
Assistance Program and in need of food, the Soup Kitchen, located in Industrial Heights, near the
Interfaith Church, provides meals to people in the community. Majority of the population served
here are homeless adults. The Soup Kitchen serves on average about 40,000 meals a month.
Food is provided to the church to serve the community through government funding and other
assistive food programs.
The Windshield Survey of the Industrial Heights Neighborhood revealed several abandon
buildings covered with graffiti. Most of the living areas are apartment and condo style. The
buildings were older and connected. There were many people walking, as the median income
level is low, it is apparent that many people probably can’t afford cars. The homeless population
is increased in this area and is reflected by accounts of business owner, Raja Kakkam, who stated
shoplifting and theft are among his biggest concern, along with safety. Industrial Heights is one
of the more diverse neighborhoods, with the highest crime rates. Rats were among the trash as
black liquid flowed out of pipes near the factory. There was a car on fire near the Soup Kitchen,
no one seemed to be concerned as the fire continued to burn. The school district is located within
this neighborhood, not far from the pollution being produced by the factory. There is minimal

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plant life in the area. There are no signs about politics, smoking, addiction support, or health
promotion.
The Bodega Supermarket in this area reports low sales for the neighborhood in produce
and high sales in canned foods which are more affordable in some cases. When entering the
store, there were no visible fresh fruit or vegetables for purchase. Since many people are unable
to afford cars or public transportation fast food, The Soup Kitchen, and canned foods may be the
only food source available since the store doesn’t offer a wide variety of fresh foods. Although
there is a lot of reported crime in this area, crossing guards and other adults are outside the
school yard assisting children crossing the street to and from school. The Better Health Clinic is
in Industrial Heights. Patients among this clinic have high rates of STDs. Interviewing some
residents reveals there are some acts of prostitution in the area, which can become a health
concern if individuals aren’t treated properly. The Mayor and District Reprehensive are in the
planning phase to help this community by renovating the abandon buildings for homeless people
and making the neighborhood accommodable for the residents.
The Windshield Survey of the Casper Park District revealed more people walking around the
neighborhood, a bigger presence of police, clean buildings, and minimal graffiti. Stray dogs and
rats were noted in some areas of the neighborhood. There are signs posted about avoiding texting
and driving, addiction support, flu vaccination, and a radio ad located in the park. The buildings
are well maintained, various cars are parked along the streets, and people are riding bikes
throughout the neighborhood. Apartment building signs are visible along with various stores and
exhibits like the art gallery. There is a park which is in the process of being cleaned by inmates
of a cleaning crew. The park looks to be once abandoned but in the process of being revitalized,

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with the help of the inmates and community. More plant life can be observed throughout the bus
tour in this area.
There is a Sushi restaurant, coffee shop, donut shop, and a vendor selling vegetables and
fruit within the Business Development Project courtyard. People are engaged with each other,
conversing, walking, and eating. Outdoor chairs and tables for eating are accessible throughout
the neighborhood. Street signs are posted to caution drivers of rough roadways. The clothing the
people are wearing are more colorful. There is more than one primary ethnic group walking
through the neighborhood. The community is vibrant as individuals chose to wear clothes that
express themselves, like the lady wearing the head covering walking through the neighborhood.
The nearest hospital is in Acer Tech Center but depending on the reason of medical attention
there is a closer clinic, the Better Health Clinic that can possibly serve the patient’s needs.
The Windshield Survey of the Acer Tech Center Neighborhood revealed a very active urban
lifestyle. People are gathered in front of City Hall peacefully protesting about taxes. The police
are present among the community as Acer Tech comes in second place with being a safe area
with low criminal activity. The Mayor of Sentinel City along with a District Representative are
among citizens discussing upcoming plans about the city. There are numerous billboards
throughout the city with messages about smoking, avoiding texting and driving, and some
political signs. There are several restaurants like Lily’s Restaurant and Italian Restaurants to
choose from, along with a coffee and donut shop. There is a large market with fruits and
vegetables available for purchase outside of the Acer Tech Business Center. There are more
business signs in the area and the neighborhood seems to be concerned about a healthy
environment, as one apartment complex has turned to ‘living green’ which is visible on the sign

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outside the complex. The Sentinel City Healthcare System, Community Center, and BUZZ
Radio Station are located within the Acer Tech Center Community.
There are no official signs in the neighborhood to tell you where an area begins or ends, but there
are signs on the buildings that include the name of the neighborhood, like the Acer Apartment
Building and the Acer Living Green Condominiums. The buildings are well maintained with
small amounts of graffiti and minimal trash. There are many open spaces here, as many of the
buildings are businesses, the area has a high traffic of citizens walking, riding bikes, and cars
parked along the street. There is no sense of territory from the citizens, since there are many
spaces available with chairs and tables throughout the neighborhoods near shops and restaurants.
Public transportation bus waiting areas are present with maps available to view the routes.
People in this area seem to use the bus for transportation and some were observed waiting for the
next available bus. A railroad track bridge can be seen at the Acer Tech Center and Casper Park
District intersection, near Pine Street. Many of the residents observed throughout the
neighborhood were Caucasian.
The Windshield Survey of the Nightingale Square Neighborhood revealed a family-oriented
neighborhood. Families are across the street of Joe’s Grocery store, watching street performers
with their children. Although upbeat and entertaining, the areas still suffers from trash piles in
the corner of buildings. Dogs and rats were observed running near the trash. Trash is also
observed near Joe’s Grocery Store which has had issues with increased amounts of food borne
illnesses. Waste Management is visible picking up trash in receptors but seems to omit the large
amounts of trash and wooden boxes near the grocery store and in other areas in the community.
The area is diverse with people of different ethnicities shopping and conversing in Joe’s Grocery
Store. Addiction signs sponsored by Sentinel Rehabilitation System are visible along with signs

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about recycling, and vaccinations. The only free-standing gym is in Nightingale Square beside a
gas station. Some of the buildings are new with central heating and air, but there is a brown older
building across the street that uses window units for heating and air. The Palace Condos offers
energy efficient living, conserving energy and reducing waste.
Sentinel City Department of Parks and Recreation, Senior Living Center, Public Health
Department, and a local pharmacy are in the Nightingale Square Community. Several citizens
with disabilities were observed near the Sentinel City’s Health Department. None of the
buildings observed had handicap accessible environments available for use. Like the Acer Tech
Center, there are no actual posted signs to know when you’ve entered the community, many of
the buildings like Nightingale Square Apartments has the community’s name attached to the
complex. No bike commuters were observed in the community. There were not many people out
walking since this area has the highest median household income, most people are probably able
to afford cars and avoid using public transportation.
After collecting epidemiological data for Sentinel City through the Windshield Survey, many
environmental factors can contribute to heart disease among the citizens. Trash pilled near
abandon buildings, the factory which produces black smoke and liquid waste onto the street and
the air, the landfill which has an increased amount of non-recyclable waste, and concerns about
the city’s water reservoir that is being contaminated by the homeless population are all factors
that increase health risk within the community. The top two causes of death in Sentinel City is
Cardiovascular Disease and Heart Disease killing 2,154 people a year. Medical studies show that
air pollution can trigger heart attacks, strokes, and irregular heart rhythms, especially in people
who are already at risk for these conditions. Also, for people with heart failure, air pollution can
further reduce the ability of the heart to pump blood the way that it should. Very small particles

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are the pollutants of greatest concern for triggering these effects (Heart Disease, Stroke, and
Outdoor Air Pollution, 2010). To reduce these adverse effects on the community, city officials,
leaders, and factory workers should ensure smokestacks are vented and properly fitted, cleaned,
and maintained regularly to ensure proper function to reduce air pollutants in the environment
(US EPA, 2018).
For the residential trash, more signs promoting recycling, educating the citizens about health
effects, and educating about biodegradable products can greatly reduce the amount of waste. The
CDC recommends, storing trash and food waste inside the home, in rodent-proof containers, and
frequently cleaning the containers with soap and water. Dispose of trash and garbage on a
frequent and regular basis and pick up or eliminate clutter. Exterminating and decreasing
accessibility of trash, the source of food for rodents, decreases the number of rodents in the area.
The use of drugs, alcohol, and cigarettes are high among citizens who were interviewed. Social
histories of citizens interviewed revealed many do not exercise and prefer to eat meals at home.
There is only one free standing gym available in Nightingale Square. The recreational center
provides classes but almost half of those surveyed said the gym’s location was too far to travel.
Drug, alcohol, cigarette smoking, and lack of exercise are all factors that increases the risk of
heart attacks and strokes. The Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, and Office on Smoking and Health, provides
information on locating and applying for current program funding opportunities and grants
related to smoking and tobacco use prevention for cities and states.
The first problem noted was the trash throughout the city, air pollution from the factory, and
rodents. As observed during the Windshield Survey, trash is a significant issue within the entire
city. According to Healthy People 2020, the goal is to reduce air toxic emissions to decrease the

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risk of adverse health effects caused by mobile, area, and major sources of airborne toxics. The
second problem noted was the substance abuse among citizens. According to Healthy People
2020, the goal is to reduce substance abuse to protect the health, safety, and quality of life for all,
especially children. The third and final problem noted was the use of tobacco. According to
Healthy People 2020, the goal is to reduce illness, disability, and death related to tobacco use and
secondhand smoke exposure. Further with the reduction of smoking, it can help preserve the
environmental air quality.
To address and resolve the waste within the city, Sentinel City Waste Management can
start by composting, recycling, and combusting more trash rather than placing the trash in
landfills, since the landfill has almost reached capacity. Taking a collaborative approach in
providing multiple bins for recycled products in the city, allows citizens to also take some
responsibility for a cleaner environment. Another community resource would be the government
officials of the city. Since officials are actively planning to start a recycling program, community
input, communication, and participation is vital in the success of resolving waste in the city.
My primary prevention topic is environmental health. Upon assessment, trash was
disbursed throughout the city. As previously mentioned, environmental factors can contribute to
negative health consequences like heart attacks. According to Health People 2020, the goal is to
promote health for all through a healthy environment. Since humans interact in the environment,
these interactions affect quality of life, years of healthy life lived, and health disparities. The
World Health Organization, defines environment, as it relates to health, as all the physical,
chemical, and biological factors external to a person, and all the related behaviors. If this
community can improve their environmental health, it can provide not only a cleaner
environment free of trash and rodents, but also reduce the risk of pollutant related heart disease.

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Through assessing the simulated Sentinel City, I have learned how to systematically
discover problems in the area and how problems are connected to more than just on area of the
community or the city. Implementing the Demographic Assessment, Neighborhood and
Community Assessment, and Windshield Survey, will help provide a system assessment while
individually assessing each community. Being able to interview residents and ask specific
questions related to their environment is essential to getting an exact concept of the area.
Moreover, the assessment of the community and the answers from resident’s interviews will not
only help discover a problem, but assist in identifying, what can be done as a collaborative effort
to fix systems that may be broken or not effective. To apply these assessment skills, it is
important for me, the assessor to prioritize health concerns, have an objective point of view in
order to convey the correct assessment findings, and remain organized when collecting data to
ensure the assessment is accurate and meets the needs of the community.