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Monona County, Iowa


Farming was once the predominant way of life in Iowa’s Monona County, which is bordered on its western edge by the Missouri River and has just 13 people per square mile.

Although 76% of the county’s land area is devoted to farming, less than one-third of the workforce makes its living from farming. Manufacturing, transportation, and retail are other main sources of employment. Although agriculture remains important, the decline of farming, along with the aging of Iowa’s population as a whole, have led to a decrease in Monona County’s population from 11,692 in 1980 to 9,149 in 2014. Almost exclusively white, nearly 25% of the county’s population is aged 65 or older, compared with 13% for the state.

Today, Monona County residents of all ages face significant challenges to their health and well-being. A multisector community alliance and the Monona County public health department have identified key challenges, including alcohol abuse, child safety and well-being, and lack of physical activity, and have implemented targeted initiatives to address them. Their efforts have shown early signs of success, but more recent data to gauge sustained progress are unavailable. Left unanswered for now is how best to respond to Monona County’s alarming rates of heart disease and its contribution to premature death.

  • Overview

    Population and Demographics

    Population: 9,149

    U.S. Census Bureau; U.S. Department of Health and Human Services; photography courtesy Flickr user Jimmy Emerson, CC BY-NC-ND 2.0

  • Context and Actions

    Community Context and Challenges

    • The county ranks 82nd out of Iowa’s 99 counties for overall health outcomes and 92nd for key social and economic determinants of health, such as unemployment, children living in poverty, and children living in single-family homes.
    • Outdoor space and opportunities for physical activities are scarce, leading to high levels of physical inactivity in Monona County compared with the state (27% versus 24%), as well as a high obesity rate (29%).
    • Heart disease affects nearly one-third of the population and is the leading cause of death.
    • One in five adults (20%) report drinking excessively, significantly higher than the U.S. average (16%). Alcohol factors into 23% of driving deaths in Iowa, nearly twice the national rate of 14%.
    • Children are at high risk for abuse and neglect, and county residents have limited access to the supports that help prevent child maltreatment, e.g., health and mental health services, school social workers, food stamps, employment services, and quality housing.

    U.S. Census Bureau. (2014). 2010–2014 American Community Survey 5-year estimates.

    County Health Rankings & Roadmaps. (2015). Iowa. Monona County

    Taking Action

    Across Monona County, organizations and residents have been coming together across sectors to implement focused initiatives and outreach efforts.

    Since a 2010 community health improvement plan, the county health department and partners have targeted specific risk behaviors that influence residents’ health, such as alcohol abuse and physical inactivity. Input is currently being sought on the 2016 health assessment conducted by Monona County Public Health, from which the county aims to chart a five-year plan for action.

    These baseline reports, created in 2016, reflect our initial observations on select community programs and initiatives to gauge ongoing, as well as newer, efforts to improve community health. Future reports will provide more in-depth insights and analysis into this community's activities.

    Everyone Raising Awareness of Substance Abuse Education

    To identify interventions and goals to address underage drinking and adult binge drinking, the Monona County Community Alliance (MCCA) formed a group consisting of residents, business owners and health and social service agencies called ERASE (Everyone Raising Awareness of Substance Abuse Education). In 2011 the group received a 5-year grant from the Federal Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention that uses a framework emphasizing positive youth development, reducing risk behaviors, and building on assets to prevent problem behaviors.

    Monona County Community Alliance

    The Monona County Community Alliance (MCCA) brings together public, private, nonprofit and other organizations and residents to work together on a broad range of issues affecting the population. MCCA partners with Monona County Public Health on initiatives and outreach; for example, MCCA's website is hosted by the health department.

    Complete Streets and Trails

    Mapleton—Monona County’s most populated town with 1,217 people—has engaged in collaborative efforts to improve community walkability and enhance overall quality of life. The Complete Streets and Trails Projects in Mapleton began in the wake of a devastating tornado in 2011 which did not claim any lives but damaged or destroyed nearly half of the community. Mapleton convened an 18-member board to rebuild and recover Mapleton and to examine a plan for the community's long-term recovery.

    Learning for Life

    To support healthy child development, Monona County Public Health, in cooperation with Early Childhood Iowa—a collaboration of experts in early childhood development, health and education—offers Learning for Life. This evidence-based home visiting program to prevent childhood maltreatment is free for all expectant mothers and children ages zero to five in the county.

  • Going Forward

    Questions for Consideration

    Monona County’s population is contracting because of a long-term shift from its traditional farming economy to service-sector jobs and the aging of many lifelong residents. New residents are more likely to be born into single-parent households and to mothers with less than a high school education, compared to state levels. These factors present significant future challenges for the health and well-being of Monona County residents. Additional surveillance, data and information gathering, analysis, and reporting will examine how cross-sector partners can sustain or expand current initiatives and the impact of current programs on improved child, adolescent, and adult health outcomes.

    The following questions provide opportunities for further exploration:

    • Which priorities have residents and other stakeholders of Monona County identified as a result of the health department’s 2016 health assessment? How was their input sought?
    • Heart disease is the leading cause of death in Monona County, and its incidence exceeds state and national averages. Have Monona County health officials and local and regional health providers taken steps to address this disparity? What types of resources are needed to implement interventions?
    • To what extent has the collaboration between MCCA and ERASE resulted in reductions in alcohol abuse among young people? Have outcomes such as arrests for drunken driving or other indicators declined?
    • To what extent have the collaborative initiatives of Early Childhood Iowa and Monona County to promote early childhood learning had an impact on measures such as school success and other indicators of positive child development?
    • Have other communities in Monona County pursued the ambitious goals of Mapleton to promote walkability and enhance quality of life? What is their progress?
    • In what specific ways did the farm crisis of the 1980s alter Monona County’s demographics? To what extent do current health issues and initiatives reflect that legacy?
  • Downloads

    Community Snapshot Report

    Community Portrait Report

    Community Landscape Report