Bolivar community
The Bolivar community includes Cedar, Dade, Polk, Hickory and St. Clair counties in Missouri.
PART 1: INTRODUCTION
Executive Summary
Since 2016, hospital systems, local public health agencies (LPHAs) and other health care partners in the greater Ozarks have worked together to release comprehensive Community Health Needs Assessments (CHNAs) every three years. This group, known as the Ozarks Health Commission (OHC), released community-level reports in 2016, 2019 and 2022. For the fourth iteration, the 2025 assessment has been compiled into community-level and regional snapshots, continuing the regional scope introduced in 2022.
Health care partners and LPHAs develop the results of these assessments into Community Health Improvement Plans (CHIPs). Organizations use CHIPs to target areas of health need and disparity in communities and create actionable plans to make them better over time.
The scope of the OHC region includes 33 counties across three states. These counties make up seven different communities, who each develop reports based on their community-level data. Information about data collection can be found in the OHC Regional Report.
The Bolivar Community includes Cedar, Dade, Polk, Hickory and St. Clair counties. Citizens Memorial Hospital serves all the counties. Cedar County Memorial Hospital also serves Cedar County, and Ellett Memorial Hospital serves St. Clair County. County health departments and other community stakeholders are an essential part of the CHNA process.
Methodology
Staff at Citizens Memorial Hospital (CMH) and the Polk County Health Center (PCHC) led the CHNA process for the Bolivar Community. They collected input from other community partners.
The process started with data collection led by the Ozarks Health Commission. These data set the framework for choosing health priorities. Data collection included a combination of qualitative and quantitative data. The primary data sources for this assessment include:
Community Partner Survey
This survey collected community partners’ views on priority health needs. The qualitative data helped determine the questions for the Community Survey. 79 contacts in the Bolivar Community received a survey invitation. 44 individuals completed it.
Community Survey
CMH, PCHC, Community Outreach Ministries, Bolivar Schools and other community partners shared the survey with the public. The goal was to understand residents’ health behaviors and needs. The Bolivar Community received 394 survey submissions. The qualitative data helped determine the greatest needs.
Public health data
Secondary data contain health factors and health outcomes. Comparisons to the entire OHC region, state and nation add perspective.
Missouri Hospital Association (MHA) data
These primary data have diagnoses from all clinic and hospital visits for residents of the five-county area.
Additional information about data collection can be found in the OHC Regional Report.
Service Area
The Bolivar Community includes five Missouri counties: Cedar, Dade, Polk, Hickory and St. Clair. Five local public health agencies (LPHAs) serve this community: Polk County Health Center, Dade County Health Department, Cedar County Health Department, Hickory County Health Department and St. Clair County Health Center. The community has three hospitals: CMH, Cedar County Memorial and Ellett Memorial. Additionally, Ozarks Community Health Center (OCHC), CoxHealth and Mercy run medical, dental and behavioral health clinics in these counties.
CMH is an 86-bed hospital in Bolivar, serving over 70,000 patients a year. CMH also manages 34 clinics, including 14 certified rural health clinics. The Citizens Memorial Health Care Foundation manages seven long-term care facilities, home health and other services. CMH serves eight counties: the five counties in the Bolivar Community and Dallas, Benton and northern Greene counties. CMH’s total service area is over 130,000 individuals.
Cedar County Memorial is a 25-bed critical access hospital in El Dorado Springs. It provides medical and surgical care for inpatients, outpatients and emergency room patients.
Ellett Memorial is a 12-bed critical access hospital in Appleton City. The hospital provides 24-hour emergency care. CMH has a management agreement with Ellett Memorial Hospital.
OCHC manages federally qualified health centers in Cedar, Dade, Dallas, Hickory and Polk counties. Federally qualified health centers are clinics that provide services regardless of a patient’s ability to pay. OCHC’s clinics provide medical, behavioral health and dental services with a sliding scale fee discount to self-pay patients.
The combined population of the Bolivar Community is 71,571. The largest town is Bolivar, with almost 11,000 residents. Bolivar is about 30 miles north of Springfield, Missouri and is the county seat of Polk County. The county is part of the Springfield Metropolitan Statistical Area and serves as a service and retail hub for counties to the north, east and west. The other county seats in the Bolivar Community include:
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Stockton, 1,932 residents, Cedar County
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Greenfield, 1,288 residents, Dade County
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Hermitage, 684 residents, Hickory County
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Osceola, 1,071 residents, St. Clair County
Residents of rural communities face unique challenges related to health care. This assessment highlights challenges to health and wellness in the Bolivar Community.
Population overview
The Bolivar Community has several important demographic and population trends. The total population decreased by 3% between 2010 and 2023. More than 21% of community residents are minors under the age of 18, while approximately 25% are over the age of 65. The population is, on average, older than both the state of Missouri and the nation. Also, about 54% of the community is aged 18-64. This group drives the workforce.
The Centers for Disease Control and Prevention (CDC)’s Social Vulnerability Index (SVI) rates the Bolivar Community at 0.62 on a 0 to 1 scale, with 1 being the most vulnerable. This score places the community at a medium to high level of vulnerability. Census data used to develop the SVI comes from four areas: Socioeconomic status, household characteristics, racial and ethnic minority status, and housing type and transportation.
The community’s vulnerable population includes the poor, disabled and elderly. These populations may have high chronic illness rates and poor overall health.
Population by county
Social vulnerability Index by County
Populations of interest
Two populations of interest emerged when Bolivar Community data were analyzed. These populations are more likely to have chronic health, mental health and health care access issues.
Individuals in poverty
Poverty and financial barriers harm health. In the Bolivar Community, over 17% live in poverty, compared to 13% in Missouri and the nation. Public health data show that 17% of residents 64 and younger in the Bolivar Community don’t have health insurance. This is higher than the state (13%) and nation (12%).
Individuals under 18
When looking at health factors for children under 18, many factors contribute to a lack of access to care. The Community Survey identified these factors for children:
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Financial barriers to insurance and health care
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Access to dental, vision and pediatric specialists
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Lack of affordable childcare
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Need for better health education
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Long wait times and insufficient local resources for therapy and mental health care
53% of those aged 0-18 live below 200% of the federal poverty level. That’s worse than the 48% in the region and 38% in the state. The uninsured rate is also higher — 7%, compared to 6% in the state and 5% in the nation. School enrollment rates for children ages 3-4 in the Bolivar Community (31%) are lower than in the region (37%) and state (44%).
PART 2: Community health priorities
Data overview
Representatives of CMH and PCHC met in December 2024 to analyze data. They cross-examined the top issues in each dataset to see which issues arose most often.
The top health factors across all datasets include:
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Poverty
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Access to care
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Access to health insurance
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Access to childcare
The top health outcomes identified in public health data include:
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Coronary heart disease*
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Stroke mortality*
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Adults with poor dental health
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Motor vehicle crash mortality
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Suicide
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Poor health 18+*
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Chronic diseases*
The top health outcomes identified in identified in MHA data include:
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Hypertension*
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Pain/back pain
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Diabetes*
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Rheumatoid arthritis and osteoarthritis*
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Chronic obstructive pulmonary disease*
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Hyperlipidemia*
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Ischemic heart disease*
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Obesity*
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Obsessive-compulsive disorder/anxiety disorders*
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Fibromyalgia, chronic pain and fatigue*
* Indicates a chronic condition.
Areas of focus
A group of community partners met in January 2025 to review the data summaries. Representatives of CMH, county health departments and local non-profits determined three priority areas:
Chronic disease
Mental health
Access to care
Chronic disease
Many of the top health outcomes identified by public health and MHA data are chronic conditions.
The Centers for Disease Control and Prevention (CDC) defines chronic diseases as “conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both.” ¹ Three chronic conditions are the top causes of death and disability in the U.S.:
Cancer
Diabetes
Heart disease
Heart disease
High blood pressure, high cholesterol and heart disease are in the top 10 diagnosed health conditions. Coronary heart disease is at the top of the list in public health data.
Diabetes
Diabetes is the third most common health issue in the Bolivar Community, according to MHA data.
Cancer
Most cancers occur at lower rates in the Bolivar Community than the OHC region and state. Only lung cancer has a higher rate, with a high rate of nicotine as a contributing factor. Cancer death rates are higher in the community but lower in Cedar and Polk counties. One reason for this could be having a cancer center in Polk County. Having closer access to cancer care likely increases the survival rate.
Additionally, CDC identified four risk behaviors that cause many preventable chronic diseases:
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Smoking
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Poor nutrition
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Physical inactivity
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Excessive alcohol use
Qualitative survey data links these issues to chronic conditions: Poverty, access to care, insurance barriers and personal circumstances.
Populations of interest
Population living in poverty
The Bolivar Community must manage chronic diseases. Reducing stroke and heart disease deaths among the poor will improve the community’s health and wellness. Financial barriers often block access to a healthy lifestyle and care for chronic conditions.
Individuals under age 18
The 18 and younger population is less likely to have chronic health conditions than older groups. Yet, their habits as kids and teens can lead to chronic conditions in adulthood. Education is a contributing factor. In the Bolivar Community, only 31% of children ages 3-4 enroll in school. This rate is lower than 37% in the OHC region and 44% in Missouri. Only 17% of the population has a bachelor’s degree or higher. The lowest rate of 10% is in Hickory County, and the highest rate of 20% is in Polk County. The rate is 24% in the OHC region and 31% in the state. Education can boost health. It helps people learn to make healthy choices.
Mental health
The Mental Health Foundation says a direct correlation exists between mental health and physical health problems. ² Either problem can cause the other.
Assessment data show that poor mental health is a concern at all ages in the Bolivar Community. Quantitative data show high rates of poor mental health in ages 18+. Data are not available for people under 18. However, the Community Survey shows youth mental health as a concern. Respondents reported long wait times and few local youth mental health resources.
In the Bolivar Community, behavioral and anxiety disorders are higher than the OHC region, but lower than the state. This could be due to having fewer mental health providers in less populated rural areas. For example, Polk County reports the highest rate of behavioral health disorder. It also has the highest rate of mental health providers in the community. Lack of access to mental health also can affect the data. Data for counties with fewer mental health providers likely experience underreporting.
Other identified factors leading to poor mental health include:
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Quality of life: Poor general and physical health.
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Rate of mental health providers: Issues with scheduling, insurance and fear of diagnosis.
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Poverty: Financial barriers to receiving mental health care.
Populations of interest
Population living in poverty
Those in poverty often can’t afford mental health care. If they do have health insurance, it may not cover mental health services. Yet mental health care is crucial for this population. The World Health Organization says poverty raises the risk of mental illness. ³
Individuals under age 18
Community Survey responses noted unmet child mental health needs. There was a high demand for affordable, accessible mental health services. These included counseling, autism therapy and school-based support. Many faced long waits and a lack of local resources. CMH, OCHC and other mental health providers offer school-based counseling. This service gives easier access for children to receive mental health care. Yet, access continues to be an issue for the Community’s children and youth.
The pandemic heightened awareness of mental health issues. As a result, more attention is being given to youth mental health. The Office of the U.S. Surgeon General issued an advisory titled “Youth Mental Health” in December 2021. It states, “Mental health is an essential part of overall health,” and “Focusing on youth mental health now is critical.” The advisory also states, “Mental health challenges are the leading cause of disability and poor life outcomes in young people.” ⁴
Addressing youth mental health will provide kids with a stronger foundation for mental and physical wellness into adulthood.
Access to care
Access to care is a weakness in all datasets. The Community Partner Survey found issues with access to health insurance and childcare.
The Community Survey identified four specific areas of barriers to care:
Financial barriers
Health insurance barriers
Access to medical providers
Time, motivation, mental health and personal circumstances
Public health data further document these barriers as shown in the table below.
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Financial barriers
Survey results include the high cost of health care, insurance and healthy foods as barriers. Many cited the high costs of medical care and living as major barriers to better health.
Poverty has a direct connection to negative health outcomes. The Bolivar Community is a rural area. It has a lower income and median household income than the OHC region and state. The lower incomes place a higher percentage of the population in or close to poverty.
Health insurance barriers
Access to health insurance also limits access to care. Both surveys identified it as a barrier. The Bolivar Community uninsured rate is marginally higher than the OHC region. Yet, health insurance barriers involve more than just having health insurance. Those with insurance cited coverage limits as a barrier. They had poor coverage and limited access to treatments and medications.
Access to medical providers
Rural areas in the Bolivar Community have a large shortage of providers, including nurse practitioners and providers for primary, mental and dental care. Health care provider shortages are common in rural areas. The National Rural Health Association reports that rural areas have only 40 primary care physicians per 100,000 people.⁵ In urban areas, the rate is 53 physicians per 100,000.
Public health data show no addiction/substance use providers in the community. However, CMH has an outpatient Addiction Recovery Program. It uses medication assisted treatment, one of a few programs in the rural U.S. to use this evidence-based treatment. Based in Bolivar, providers also see patients in other counties.
Another strength is the Bolivar Community’s rate of federally qualified health centers (FQHCs). Though it is lower than the OHC region, it is higher than the rates for the state and nation. Ozarks Community Health Center operates FQHCs in the Community.
Time, motivation, mental health and other personal circumstances
Respondents cited work schedules, low energy and health issues for not living healthily. Over 50% of survey respondents said they lack the time or interest for good nutrition. Over 40% lack the time or interest for exercise. Some cited mental health as a reason for a lack of healthy pursuits.
Populations of interest
Population living in poverty
The National Health Council states, “The availability and quality of health care resources are heavily dependent on a patient’s financial situation.” ⁶ Poverty creates barriers to accessing care, such as unreliable transportation, homelessness and hunger.
Individuals under age 18
The Community Survey identified unmet needs related to the lack of certain pediatric health care providers in their community. New partnerships between nearby Springfield health systems and children’s hospitals should increase access to pediatric specialists.
Other issues included:
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Limited dental and vision care due to long wait times or unavailability. OCHC runs the Miles for Smiles Mobile Unit that treats children ages 1-18 at local schools.
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Long wait times and not enough local resources for therapy and mental health care for children.
PART 3: Closing Remarks
Conclusion
While this overview of health in the Bolivar Community is not comprehensive, it gives an important glimpse into priority health issues reflected in both data and community feedback. The 2025 assessment will be used to inform public health and health care initiatives. These initiatives will be outlined in a forthcoming Community Health Improvement Plan.
Dissemination
The OHC regional report and all community-level reports are available to the public through various channels
Websites
Ozarks Health Commission
Citizens Memorial Hospital
Polk County Health Center
Printed copies
Printed copies will be available by request through health care partners and LPHAs. Please refer to organization websites or contact an organization directly
Social media
Polk County Health Center
facebook.com/polkcountyhealthcenter
Cedar County Health Department
facebook.com/profile.php?id=100087247838874
Dade County Health Department
Hickory County Health Department
Facebook.com/HickoryCountyHealthDepartment
Citizens Memorial Hospital
Health services available
Polk County Health Center
Cedar County Health Department
cedarcountymo.gov/health-department
Dade County Health Department
Ellett Memorial Hospital
Hickory County Health Department
Cedar County Memorial Hospital
Citizens Memorial Hospital
Ozarks Community Health Center
St. Clair Health Center
Ackowledgements
Thank you to Bolivar Community partners and residents for contributing to this assessment through your feedback. Your contributions provide rich context to the vast health care data compiled for this report.
Thank you to the OHC Steering Committee for your collaboration and resource sharing during every step of the CHNA process.
Thank you to the Bolivar Community representatives in the OHC steering committee for your contributions toward data collection and creation of the report.
Citations
¹ “About Chronic Diseases.” Centers for Disease Control and Prevention. Last modified October 4, 2024. https://www.cdc.gov/chronic-disease/about/index.html.
² “Physical health and mental health.” Mental Health Foundation. Last modified February 18, 2022. https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/physical-health-and-mental-health.
³ “Mental Health.” World Health Organization. Last modified June 7, 2022. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response.
⁴ Murthy, Vivek H. “Youth Mental Health.” Office of the Surgeon General. Last modified February 4, 2025. https://www.hhs.gov/surgeongeneral/reports-and-publications/youth-mental-health/index.html.
⁵ “About Rural Health Care.” National Rural Health Association. Last modified, 2025. https://www.ruralhealth.us/about-us/about-rural-health-care.
⁶ Witting, Lillian. “Limited Access: Poverty and Barriers to Accessible Health Care.” National Health Council. Last modified January 20, 2023. https://nationalhealthcouncil.org/blog/limited-access-poverty-and-barriers-to-accessible-health-care/.