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CentralNewHampshireHealthPartnership
CommunityHealthNeedsAssessment2017
CommunityInputonHealthIssuesandPriorities,
SelectedServiceAreaDemographicsandHealthStatusIndicators
Pleasedirectcommentsorquestionsto:
KateTarbox,MA,APRDirectorofMarketing&CommunityRelations
SpeareMemorialHospital16HospitalRoad,
Plymouth,NH03264603-238-6468
or
SaraDonahueCentralNewHampshireHealthPartnership
101BoulderPointDrive,Plymouth,NH03264
603-238-3510
CommunityHealthNeedsAssessmentPartners:CommunityActionProgramBelknap-MerrimackCounties*CommunitiesforAlcohol-andDrug-freeYouth(CADY)*GenesisBehavioralHealth*Mid-StateHealthCenter*NewfoundAreaNursingAssociation*Pemi-BakerCommunityHealth*SpeareMemorialHospitalwithadditionalassistanceoftheWholeVillageFamilyResourceCenter
andPlymouthRegionalSeniorCenter
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 1
CentralNewHampshireHealthPartnershipCommunityHealthNeedsAssessment
2017ExecutiveSummary
DuringtheperiodMaythroughSeptember2017,anassessmentofCommunityHealthNeedsAssessmentoftheCentralNewHampshireregionwascompletedbytheCentralNewHampshireHealthPartnership.Thepurposeoftheassessmentwastoidentifycommunityhealthconcerns,prioritiesandopportunitiesforcommunityhealthandhealthcaredeliverysystemsimprovement.Forthepurposeoftheassessment,thegeographicareaofinterestwas18municipalitiescomprisingtheCentralNewHampshirePublicHealthRegionwithatotalresidentpopulationof30,039,andservedbythememberagenciesoftheCentralNewHampshireHealthPartnership(www.cnhhp.org).Methodsemployedintheassessmentincludedsurveysofcommunityresidentsmadeavailableon-lineandpapersurveysplacedinnumerouslocationsthroughouttheregion;adirectemailsurveyofkeystakeholdersandcommunityleadersrepresentingmultiplecommunitysectors;asetofcommunitydiscussiongroups;compilationofresultsfromassessmentactivitiesfocusedspecificallyonbehavioralhealthneedsandgaps;andareviewofavailablepopulationdemographicsandhealthstatusindicators.Allinformationcollectionactivitiesandanalysessoughttofocusassessmentactivitiesonvulnerableanddisproportionatelyservedpopulationsintheregionincludingpopulationsthatcouldexperiencelimitedaccesstohealth-relatedservicesorresourcesduetoincome,age,disability,andsocialorphysicalisolation.Thetablebelowprovidesasummaryofcommunityhealthneedsandissuesidentifiedthroughthesemethods.
2 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
SUMMARYOFCOMMUNITYHEALTHNEEDSANDISSUESBYINFORMATIONSOURCECommunityHealth
Issue CommunitySurveys CommunityDiscussionGroups
CommunityHealthStatusIndicators
Alcoholanddruguseprevention,treatment
andrecovery
Preventionofsubstancemisuse,addictionandaccesstosubstancemisusetreatmentandrecoveryserviceswerethetopissuesidentifiedbybothcommunitysurveyrespondentsandkeystakeholders
Identifiedasahighandcontinuingpriorityforcommunityhealthimprovementbyallcommunitydiscussiongroups
Theoveralloverdosemortalityrateintheregionwas24.7per100,000people;amortalityratehigherthanmosttypesofcancerexceptlungcancer
Accesstoaffordablehealthcareservicesandinsurance
Availabilityofaffordablehealthinsurancewasthenexthighestpriorityaftersubstancemisuseidentifiedbycommunityandkeystakeholdersurveyrespondents
CommunitydiscussionsnotedimprovementsininsuranceaccessincludingMedicaid,butstillidentifiedcostandhealthcareserviceavailabilitybarriers
TheestimateduninsuranceratehasdeclinedsubstantiallyintheCNHHPservicearea(from14%toabout9%),),butstillexceedstheoveralluninsurancerateestimateforNH(6.4%)
SUMMARYOFCOMMUNITYHEALTHNEEDSANDISSUESBYINFORMATIONSOURCECommunityHealth
Issue CommunityHealthIssue CommunityHealthIssue CommunityHealthIssue
Accesstomentalhealthservices
Accesstomentalhealthcarewasthefourthhighestpriorityidentifiedbycommunityandkeystakeholdersurveyrespondentswith63%consideringita‘veryhighpriority’
Identifiedasahighandcontinuingpriorityforcommunityhealthimprovementbyallcommunitydiscussiongroupsincludingconcernsforinsufficientaccesstoinpatientpsychiatriccare
Medicaidmemberswithabehavioralhealthconditionresidingintheregionwereover4timesmorelikelytohavehadfourormorevisitstoanemergencydepartmentin2015andtwiceaslikelytohavehadanunplannedinpatientreadmissioncomparedtoMedicaidmemberswithoutarecentclaimshistoryindicatingabehavioralhealthcondition.
Domesticviolenceandchildhoodtrauma
Childabuseorneglectanddomesticviolencewereidentifiedasahighpriorityorveryhighprioritybyoverathreequartersofcommunitysurveyrespondents
Communitydiscussiongroupparticipantsreportedconcernsabouttheeffectsofparentalsubstanceuseonchildreninthecommunity;alsonotedalackofaffordablechildcareoptions
Theproportionofindividualslivingnearorbelowthepovertylevel,including38%ofchildren,ishigherintheregioncomparedtothestateoverall
Accesstohealthyfoodsandopportunitiesfor
activeliving
Opportunitiesforphysicalactivity,recreation,goodnutritionandaccesstohealthfoodscitedasahighorveryhighprioritybyabouttwothirdsofcommunityandkeystakeholdersurveyrespondents
Communitydiscussiongroupsidentifiedaneedforbettercommunicationaboutavailablehealth-relatedactivitiesandresources
55%ofadultsintheserviceareaareoverweightorobese;about23%ofadultsreportbeingphysicallyinactiveinthepast30days
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 3
Seniorservicesincludingassistedliving
orlongtermcareservices
Improvedresourcesforassistedlivingorlongtermcarewasthesixthhighestpriorityidentifiedbykeystakeholders
Localaccesstoaffordableseniorhousingandassistedlivingidentifiedbyparticipantsinthepublichealthcouncilandsenioradvisorycouncil
Theserviceareapopulationhasproportionallymoreseniors(17.7%are65+)comparedtoNHoverall(15.3%)
Accesstotransportation
Lackoftransportationwasidentifiedasthefourthmostsignificantbarrierkeepingpeoplefromaccessingservicesbykeystakeholders
AccesstotransportationIdentifiedbyallcommunitydiscussiongroupsasanunderlyingandchronicissueimpactingaccesstoservicesandsocialisolation,particularlyforyouthandfamilieswithlimitedincome
4.1%ofhouseholdsintheCNHHPregionreporthavingnovehicleavailable
4 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
CentralNewHampshireHealthPartnership
2017CommunityHealthNeedsAssessment
TableofContents
EXECUTIVESUMMARY 1
A. CommunityandKeyStakeholderSurveyResults 4
1.MostImportantHealthIssuesIdentifiedbyCommunitySurveyRespondents 7
2.MostImportantCommunityHealthIssuesIdentifiedbyKeyStakeholderSurveyRespondents 11
3.ComparisonofMostImportantCommunityHealthIssues;CommunityandKeyStakeholderRespondents 13
4.AccessBarrierstoServicesIdentifiedbyCommunitySurveyRespondents 15
5.BarrierstoServicesIdentifiedbyKeyStakeholderSurveyRespondents 19
6.BehavioralHealthNeedsSurveyFindings 22
B.CommunityHealthDiscussionGroups 28
1.CommunityDiscussionGroupThemes 29
2.HighPriorityIssuesfromCommunityDiscussionGroups 31
C.CommunityHealthStatusIndicators 37
1.DemographicsandSocialDeterminantsofHealth 37
2.AccesstoCare 42
3.HealthPromotionandDiseasePreventionPractices 48
4.SelectedHealthOutcomes 53
5.ComparisonofSelectedCommunityHealthIndicatorsbetween2014and2017 63
APPENDICES(seeseparatedocument):CommunityandKeyStakeholderSurveyResults,DiscussionGroupSummaries
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 5
A.COMMUNITYANDKEYSTAKEHOLDERSURVEYRESULTSWITHSELECTEDSERVICEAREADEMOGRAPHICSThetotalpopulationoftheprimaryserviceareaoftheCentralNewHampshireHealthPartnershipin2015was30,039accordingtotheUnitedStatesCensusBureau,whichisadecreaseof-1.9%orabout600peoplesincetheyear2010.TheFY2017CommunityHealthNeedsAssessmentSurveyconductedbytheCentralNHHealthPartnershipyielded409individualresponsesofwhich88%wereresidentsoftownswithintheprimaryserviceareaorapproximately1.5%ofthetotaladultpopulation.AsshownbyTable1,surveyrespondentsfromtheserviceareaarerepresentedinrelativelycloseproportionoveralltotheserviceareapopulationbytown.ItisalsoimportanttonotethatFY2017surveyrespondentsweremorelikelytobefemale(74.8%ofrespondents)andolder(29.5%age65yearsormore)comparedtotheoveralladultpopulationintheservicearea.
Table1:ServiceAreaPopulationbyTown;
ComparisontoProportionofFY2017CommunitySurveyRespondents
2015Population ZipCode* %ServiceAreaPopulation %ofRespondents
CNNHPServiceArea 30,039 Plymouth,Bridgewater 7382 03264 24.6% 22.4%Bristol,Alexandria,Bridgewater 5520 03222 18.4% 14.8%Campton,Ellsworth 3366 03223/19 11.2% 10.6%Holderness 2174 03245 7.2% 7.4%Rumney 1611 03266 5.4% 6.9%Thornton 2104 03285 7.0% 6.3%Ashland 2196 03217 7.3% 4.7%Hebron,Groton 1259 03241 4.2% 4.7%Lincoln,Livermore 1345 03251 4.5% 4.0%Woodstock 1054 03262 3.5% 1.8%Wentworth 941 03282 3.1% 1.8%Warren 873 03279/38 2.9% 1.9%WatervilleValley 214 3215 0.7% 0.8%Other/Unknown NewHampton(2.4%),Meredith(1.1%),Danbury(1.1%),Laconia
(1.1%)11.9%
*Surveyrespondentswereaskedtoindicatethezipcodeoftheircurrentlocalresidence.
6 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
Table2belowdisplaysadditionaldemographicandeconomicinformationforthetownsoftheCNHHPServiceArea.Onthistable,municipalitiesaredisplayedinorderofmedianhouseholdincomewithcomparisontothemedianhouseholdincomeintheregionandstateoverall.Asdisplayedbythetable,alltownsintheserviceareaexceptWatervilleValleyhavelowermedianhouseholdincomesthantheStateofNewHampshireoverall.Inaddition,allexcept3townshaveahigherproportionofindividualswithhouseholdincomesat200%ofthefederalpovertylevelorlesswhencomparedtothestateoverall.Figure1followingthistabledisplaysamapoftheserviceareawithshadingdepictingthemedianhouseholdincomebytownin5categoriesfromlowtohighmedianhouseholdincome.
Table2:SelectedDemographicandEconomicInformation
Median
HouseholdIncome
%withincomeunder200%PovertyLevel
%familyhouseholdswithchildrenheadedbyasingleparent
%populationwithadisability
Ellsworth $37,000 23.2% 0.0% 14.3%Lincoln $37,095 49.6% 78.4% 20.7%Plymouth $40,745 42.9% 16.3% 9.9%Warren $40,769 47.7% 43.5% 19.0%Groton $43,846 36.2% 43.2% 17.2%Ashland $45,938 31.0% 32.8% 18.6%Woodstock $49,063 25.8% 44.8% 12.0%Bristol $50,080 29.1% 49.8% 13.8%CNNHPServiceArea $50,872 31.5% 30.1%
513.4%
Rumney $51,250 29.5% 39.4% 14.7%Wentworth $54,306 34.5% 9.6% 16.9%Alexandria $55,066 30.4% 12.6% 16.0%Bridgewater $55,500 16.8% 27.3% 17.4%Thornton $56,058 15.7% 12.8% 14.1%Campton $56,429 25.1% 29.0% 10.7%Hebron $57,222 38.7% 53.7% 13.1%Holderness $59,079 25.5% 24.0% 8.7%NewHampshire $66,779 22.3% 29.1% 12.1%WatervilleValley $87,500 7.0% 35.7% 6.5%
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 7
Figure1–MedianHouseholdIncomebyTown,CNHHPServiceArea
2009-2013AmericanCommunitySurvey;Mapsource:AmericanFactfinder
MedianHouseholdIncome($) Bridgewater
Bristol
Alexandria
LincolnLivermore
8 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
1.MostImportantCommunityHealthIssuesIdentifiedbyCommunitySurveyRespondents
Communityrespondentstothe2017CommunityHealthNeedsSurveywerepresentedwithalistof13health-relatedtopicsthathavebeenidentifiedasprioritiesinpreviouscommunityhealthassessmentsintheCentralNewHampshireregion.Foreachtopic,respondentswereaskedtoindicatetheextenttowhichtheythoughtitshouldremainapriorityforcommunityhealthimprovementworkrelativetootherpotentialpriorities.Asecondquestionpresentedrespondentswithalistof13moretopics,includingand“other’write-inoption,thatcouldbeconsideredprioritiesfortheCentralNewHampshireregion.Respondentswerethenaskedtoindicatetheextenttowhichtheythoughteachtopicshouldbecomeapriorityforcommunityhealthimprovementworkrelativetootherpotentialpriorities.
Table3onthenextpagedisplaysthetopprioritytopicsforhealthimprovementeffortsidentifiedbycommunityrespondents.Thetopicsdisplayedwithsolidcolorsaretopicsthathadbeenidentifiedinpreviousneedsassessment.Thosetopicsshownwithdottedcoloringaretopicsthatrosetoahighlevelpriorityfromthesecondsetofpotentialtopics.Thechartdisplaysthepercentageofrespondentsindicatingthetopicasahighpriorityorveryhighpriority(needsaremostlyunmet).Otherresponsechoicesweremoderatepriority,somewhatlowpriorityandlowpriority(needsaremostlymet).
Substancemisuseprevention,treatmentandrecovery,availabilityofaffordablehealthinsurance,andaccesstomentalhealthservicesareeachtopprioritiesfrompriorcommunityhealthneedsassessmentsthatremainamongthehighestpriorities.Childabuseorneglectanddomesticviolencearetwohighprioritiesnotspecificallyidentifiedinpriorneedsassessments,although‘fragilefamiliesandreductionoffamilystress’isarelatedtopicthatwaspreviouslyidentifiedasahighpriorityforcommunityhealthimprovementefforts.
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 9
Figure2:HighPriorityCommunityHealthIssues;CommunityRespondents
42%
37%
41%
40%
37%
27%
32%
31%
29%
30%
26%
33%
31%
34%
39%
53%
49%
52%
55%
55%
0% 20% 40% 60% 80% 100%
Opportunitiesforphysicalactivity,recreation
Healthcareforseniors
Accesstohealthyfoods,goodnutrition
Availabilityofprimarycareservices
Domesticviolence
Childabuseorneglect
Accesstomentalhealthcareservices
Availabilityofaffordablehealthinsurance
Accesstosubstancemisusetreatment/recoveryservices
Preventionofsubstancemisuseandaddiction
highpriority
veryhighpriority
LowPriority
SomewhatLowPriority
ModeratePriority
HighPriority
VeryHighPriority
NeedsareMostlyMet NeedsareMostlyUnmet
10 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
Thetablebelowdisplaysthetop5communityhealthimprovementprioritiesidentifiedbycommunitysurveyrespondentsbyagegroup.Thepercentagesshownarethetotalpercentageswithineachagegroupselectingthetopicasahighpriorityorveryhighpriority.Amongrespondentsage65yearsorolder,‘availabilityofprimarycareservices’and‘healthcareforseniors’werehigheronthelistcomparedtootheragegroups,while‘accesstosubstancemisusetreatmentandrecoveryservices’wasreportedasahigherpriority(relatively)byyoungeragegroups,aswas‘childabuseorneglect’.
Table3:COMMUNITYHEALTHIMPROVEMENTPRIORITIES
BYAGEGROUP;Communityrespondents
18-44years n=126 45-64years n=149 65+years n=115
Accesstosubstancemisusetreatmentandrecovery
services80.2% Preventionofsubstance
misuseandaddiction 87.7% Availabilityofaffordablehealthinsurance 90.8%
Preventionofsubstancemisuseandaddiction 77.6% Accesstomentalhealth
careservices 87.2% Availabilityofprimarycareservices 87.1%
Availabilityofaffordablehealthinsurance 75.4%
Accesstosubstancemisusetreatmentandrecoveryservices
87.1% Preventionofsubstancemisuseandaddiction 87.0%
Childabuseorneglect 74.4% Availabilityofaffordablehealthinsurance 84.5% Accesstomentalhealth
careservices 87.0%
Accesstohealthyfoods,goodnutrition 72.6% Childabuseorneglect 79.6% Healthcareforseniors 86.4%
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 11
Thetablebelowdisplaysthetop5communityhealthimprovementprioritiesidentifiedbycommunitysurveyrespondentsbyincomegroup.Aswiththeprevioustable,thepercentagesshownarethetotalpercentageswithineachagegroupselectingthetopicasahighpriorityorveryhighpriority.Amongrespondentswithhouseholdincomelessthan$25,000,‘availabilityofaffordablehealthinsurance’and‘availabilityofprimarycareservices’werehigheronthelist(relatively)comparedtootherincomegroups.Accesstomentalhealthcareandsubstanceusetreatmentserviceswereratedhigherbyrespondentsinthemiddleandupperincomegroups.
Table4:COMMUNITYHEALTHIMPROVEMENTPRIORITIES
BYINCOMECATEGORY;Communityrespondents
Lessthan$25,000 n=95 $25,000to$74,999 n=129 $75,000or more n=143
Availabilityofaffordablehealthinsurance 80.0% Accesstomentalhealth
careservices 90.3% Preventionofsubstancemisuseandaddiction 90.0%
Childabuseorneglect 77.6%Accesstosubstancemisusetreatmentandrecoveryservices
87.1%Accesstosubstancemisusetreatmentandrecoveryservices
89.3%
Availabilityofprimarycareservices 76.3% Availabilityofaffordable
healthinsurance 86.4% Accesstomentalhealthcareservices 86.6%
Preventionofsubstancemisuseandaddiction 75.8% Preventionofsubstance
misuseandaddiction 85.4% Accesstohealthyfoods,goodnutrition 80.9%
Domesticviolence 75.8% Childabuseorneglect 83.6% Availabilityofaffordablehealthinsurance 80.8%
12 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
2.MostImportantCommunityHealthIssuesIdentifiedbyKeyStakeholderSurveyRespondents
Inadditiontothesurveyofcommunityresidents,the2017CommunityHealthNeedsAssessmentincludedasimilarsurveysentbydirectemailtokeystakeholdersandcommunityleadersfromaroundtheregion.Atotalof51completedresponseswerereceived(56.7%responserate)representingthefollowingcommunitysectors.
Table5:KeyStakeholderSurveyRespondents
PercentofRespondents
CommunitySector
25.5%
19.6% Business(10)
17.6% PrimaryHealthCare(9)
15.7% Education/YouthServices(8)
13.7% Municipal/CountyGovernment
(7)
13.7% PublicHealth(7)
11.8% Faithorganization(6)
9.8% Fire/EmergencyMedical
Service(5)
9.8% PublicSafety/Law/Justice(5)
9.8% HumanService/Social
Communitymember/Volunteer(13respondents)19.6% Business(10)17.6% PrimaryHealthCare(9)15.7% Education/YouthServices(8)13.7% Municipal/CountyGovernment(7)11.8% PublicHealth(6)11.8% Faithorganization(6) 9.8% Fire/EmergencyMedicalService(5)9.8% PublicSafety/Law/Justice(5)9.8% HumanService/SocialService(5)5.9% MentalHealth/BehavioralHealth(3)3.9% HomeHealthCare(2)3.9% Civic/CulturalOrganization(2)2.0% MedicalSub-Specialty(1)
Respondentstothekeystakeholdersurveywerepresentedwiththesametwolistsofhealth-relatedtopics:thelistoftopicsidentifiedasprioritiesinpreviouscommunityhealthassessmentsintheCentralNewHampshireregion;andasecondlistoftopics(including‘other’)thatcouldbeconsideredprioritiesforhealthimprovementeffortsintheregion.Thechartonthenextpagedisplaystheresultsofthesequestionsfromkeystakeholderresponses.
Thetopfourissuesidentifiedbykeystakeholdersarethesameasthoseidentifiedbycommunityrespondents;withevenhigherpriorityratingsforsubstancemisuseprevention,treatmentandrecovery(approximately3ofevery4keystakeholderrespondents
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 13
identifiedtheseareasasveryhighpriority).Keystakeholdersweremorelikelytoidentifyassistedliving,longtermcareandhomehealthcareashighpriorities(relatively)comparedtocommunitysurveyrespondents.
Figure3:CommunityHealthImprovementPriorities KeyStakeholderSurveyRespondents
24%
33%
41%
50%
22%
37%
24%
30%
14%
26%
43%
33%
29%
22%
50%
37%
63%
58%
75%
72%
0% 20% 40% 60% 80% 100%
Reductionoffamilystress
Availabilityofprimarycareservices
Opportunitiesforphysicalactivity,recreation
Homehealthcareservices
Assistedlivingorlongtermcareservices
Childabuseorneglect
Accesstomentalhealthcareservices
Availabilityofaffordablehealthinsurance
Preventionofsubstancemisuseandaddiction
Accesstosubstancemisusetreatmentandrecoveryservices
highpriority
veryhighpriority
LowPriority
SomewhatLowPriority
ModeratePriority
HighPriority
VeryHighPriority
NeedsareMostlyMet NeedsareMostlyUnmet
14 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
3.ComparisonofMostImportantCommunityHealthIssues;CommunityandKeyStakeholderRespondents
Thechartbelowdisplaysacomparisonoftheresponsesbetweencommunityandkeystakeholdersurveysforthehighestprioritycommunityhealthissues.Bluebarsonthechartdisplaythepercentageofkeystakeholdersselectingthetopicashighpriorityorverypriorityandredbarsdisplaytheresultsfromcommunityrespondents(topicsarearrayedoverallhightolowaccordingtothecommunityrespondentpercentages;seecompletesurveyresultsintheAppendicesforremainingtopicsidentifiedaslowerpriorities).
Figure4:CommunityHealthImprovementPriorities ComparisonofCommunityandKeyStakeholderRespondents
0% 20% 40% 60% 80% 100%
Homehealthcareservices
Preventionandtreatmentofcancer
Assistedlivingorlongtermcareservices
Opportunitiesforphysicalactivity,recreation
Healthcareforseniors
Accesstohealthyfoods,goodnutrition
Availabilityofprimarycareservices
Domesticviolence
Childabuseorneglect
Accesstomentalhealthcareservices
Availabilityofaffordablehealthinsurance
Accesstosubstancemisusetreatment/recoveryservices
Preventionofsubstancemisuseandaddiction
Keystakeholders
Communityrespondents
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 15
Thechartbelowdisplaysthecombinedresultsfromthequestionsoncommunityhealthimprovementprioritiesfromtheperspectiveofcommunityandkeystakeholdersurveyrespondents.Theresponsepercentagesfromcommunityrespondentsweregivendoubleweightinthecomputationofcombinedresponses.Thetop10communityhealthprioritiesaredisplayed.Asinpreviouscharts,barsdepictedwithsolidcoloraretopicsthathadbeenidentifiedinpreviousneedsassessment.Thosetopicsshownwithdottedcoloring(childabuseorneglect,domesticviolence,assistedlivingorlongtermcareservices)aretopicsthatrosetoahighpriorityfromthesecondsetofpotentialtopics.
Figure5:CommunityHealthImprovementPriorities
CommunityandKeyStakeholderResponsesCombined
16 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
4.BarrierstoServicesIdentifiedbyCommunitySurveyRespondents
RespondentstotheFY2017CommunityNeedsAssessmentSurveywereasked,“Inthepastyear,haveyouorsomeoneinyourhouseholdhaddifficultygettingthehealthcareorhumanservicesyouneeded?”Overall,30.4%ofsurveyrespondentsindicatedhavingsuchdifficulty.AsFigure6displays,thereisasignificantrelationshipbetweenreportedhouseholdincomecategoryandthelikelihoodthatrespondentsreportedhavingdifficultyaccessingservices.Figure7examinesresponsestothisquestionbysub-regionwithintheCNHHPservicearea.Ingeneral,theproportionofrespondentsindicatingdifficultyaccessingserviceswassimilaracrosstheregion.
Figure6:AccesstoServices Figure7:AccesstoServicesCommunitySurveyResponses bysub-region
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 17
30.4%
45.3%
31.0%
20.6%
0%
10%
20%
30%
40%
50%
AllRespondents Lessthan$25,000 $25,000to$74,999 $75,000ormore
AnnualHouseholdIncome
Inthepastyear,haveyouorsomeoneinyourhouseholdhaddifficultygettingthehealthcareorhumanservicesyouneeded?
Percentresponding"Yes"
18 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
Thesurveyalsoaskedpeopletoindicatetheareasinwhichtheyhaddifficultygettingservicesorassistance.AsdisplayedbyChart3,themostcommonservicetypesthatpeoplehaddifficultyaccessingwere:dentalcareforadults(32%ofthoserespondentsindicatingdifficultyaccessinganyservices);specialtyhealthcare(32%);primaryhealthcare(28%)andmentalhealthcare(28%).Notethatpercentagesonthischartareofthesubsetofrespondentswhoindicatedanydifficultyaccessingservices(30%ofallrespondents;n=120).
Figure8
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 19
Inaseparatequestion,43.9%ofsurveyrespondentsindicatedthat‘theyorsomeoneintheirhouseholdhadtotraveloutsideofthelocalareatogettheservicestheyneededinthepastyear’.Inanopen-endedfollow-upquestion,orthopediccare,cancertreatment,dentalcare,dermatologyandmentalhealthcarewerethemostcommonlycitedservicesforwhichpeopleweretravelingoutsideofthearea.(SeeAppendixAforcompletesurveyresponses.)
Respondentswhoreporteddifficultyaccessingservicesinthepastyearforthemselvesorafamilymemberwerealsoaskedtoindicatethereasonswhytheyhaddifficulty.AsshownonFigure9,thetopreasonscitedwere:‘serviceIneededwasnotavailableinmyarea’(43%);‘couldnotaffordtopay’fortheservice(41%);and‘hadnodentalinsurance’(34%).Percentagesareagaincalculatedfromthesubsetofrespondentswhoindicateddifficultyaccessingservices.
Figure9:AccessBarriersPerspectivesofCommunityRespondents
20 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
FurtheranalysisofthesetwoquestionsaddressingaccesstospecifictypesofservicesisshownbyTable6.Amongrespondentsindicatingdifficultyaccessingadultdentalcare,thetopreasonindicatedfordifficultyaccessingserviceswas‘hadnodentalinsurance‘(76%),followedbycouldnotaffordtopay’(73%).Similarly,amongrespondentsindicatingdifficultyaccessingprimarycareservices,thetopreasonscitedwerealsorelatedtoaffordabilityandlackofhealthinsurance.Amongrespondentsindicatingdifficultyaccessingspecialtyhealthcareandmentalhealthcare,thetopreasoncitedforaccessdifficultieswas‘serviceIneededwasnotavailableinmyarea(74%and53%respectively)and‘waitingtimetogetanappointment’wasalsofrequentlyassociatedwithrespondentsindicatingaccessdifficultiesinthesetwoareas.Thissuggeststhatavailableservicecapacityisamoresignificantaccessbarrierformentalhealthandspecialtymedicalservices(relatively)comparedtodentalcareandprimaryhealthcarewherethetopchallengesareassociatedwithinsuranceandaffordability.
TABLE6:TOPREASONSRESPONDENTSHADDIFFICULTYACCESSINGSERVICESBYTYPEOFSERVICE(Percentageofrespondentswhoreporteddifficultyaccessingaparticulartypeofservice)
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 21
5.BarrierstoServicesIdentifiedbyKeyStakeholderSurveyRespondents
Respondentstothekeystakeholdersurveywerealsoaskedtoidentifythemostsignificantbarriersthatpreventpeopleinthecommunityfromaccessingneededhealthcareservices.Thetopissuesidentifiedbythisgroupwerealsorelatedtoaffordabilityandinsurancecoverage.Othertopissuesincluded‘inabilitytonavigatethehealthcaresystem,lackoftransportation,andreluctancetoseekoutservices.
Figure10:MostSignificantBarrierstoAccessingServicesPerspectivesofKeyStakeholders
DentalCareforAdults(n=41,10.0%ofallrespondents)
SpecialtyHealth Care(n=38,9.3%ofallrespondents)
MentalHealthCare(n=34,8.3%ofallrespondents)
PrimaryHealthCare(n=33,8.1%ofallrespondents)
75.6%ofrespondentswhohaddifficultyreceivingadultdentalcarealsoreportedtheyHadnodentalinsurance
73.7%ofrespondentswhohaddifficultyreceivingspecialty healthcarealsoreportedtheService Ineededwasnotavailableinmyarea
52.9%ofrespondentswhohaddifficultyreceivingmentalhealthcarealsoreportedtheServiceIneededwasnotavailableinmyarea
45.5%ofrespondentswhohaddifficultyreceivingprimary healthcarealsoreportedtheCouldnotaffordtopay
73.2%Couldnotaffordtopay
42.1%Waiting timetogetanappointmentwastoolong
44.1%Couldnotaffordtopay
42.4%Hadnohealthinsurance
36.6%ServiceIneeded wasnotavailableinmyarea
28.9%Couldnotaffordtopay
41.2%Waitingtimetogetanappointmentwastoolong
36.4%OfficewasnotopenwhenIcouldgo
36.6%Hadnohealthinsurance
21.1%Hadnodentalinsurance
32.4%Insurancedeductiblewastooexpensive
30.3%Insurancedeductiblewastooexpensive
29.3%Wasnoteligible fortheservice
18.4%Insurance deductiblewastooexpensive
26.5%Didnotknowwheretogotogetservices
27.3%Waitingtimetogetanappointmentwastoolong
22 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 23
Keystakeholderswerealsoaskediftherearespecificpopulationsinthecommunitythatarenotbeingadequatelyservedbylocalhealthservices.About56%ofrespondentsindicatedthattherearespecificunderservedpopulations(6%responded“No”and38%were“Notsure”).Figure11displaysresultsfromkeystakeholderresponsesonspecificpopulationsthoughttobecurrentlyunderserved.‘PeopleinneedofMentalHealthCare’,‘Uninsured/Underinsured”,‘Peopleinneedofsubstanceabusetreatment’and‘LowIncome/Poor’werethemostfrequentlyindicatedpopulationsperceivedtobecurrentlyunderserved.
Figure11
24 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
TheFY2017CommunityHealthNeedsAssessmentSurveyaskedpeopletorespondtothequestion,“Ifyoucouldchangeonethingthatyoubelievewouldcontributetobetterhealthinyourcommunity,whatwouldyouchange?”Atotalof255surveyrespondents(62%)providedwrittenresponsestothisquestion.Table7providesasummaryofthemostcommonresponsesbytopictheme.AllcommentdetailcanbefoundinthereportAppendixA.
TABLE7
“Ifyoucouldchangeonethingthatyoubelievewouldcontributetobetterhealthinyourcommunity,whatwouldyouchange?”
Affordabilityofhealthcare/lowcostorsubsidizedservices;insurance;healthcarepaymentreform18.4%
ofallcomments
Healthcareprovideravailabilityincludingcertainspecialties;hoursandwaittime;healthcaredeliverysystemimprovements,qualityandoptions
17.3%
Accessibility/availabilityofsubstanceusetreatmentservices;substancemisuseprevention 10.6%
Accessibility/availabilityofmentalhealthservices 8.6%
Improvedresources,programsorenvironmentforphysicalactivity,activeliving;affordablerecreationandfitness 7.1%
Improvedresources,programsorenvironmentforhealthyeating/nutrition/foodaffordability; 5.5%
Programs/servicesforyouthandfamilies;healthylifestyleeducation 5.5%
Improvedjobopportunities;housing;childcare;economy 5.1%
Affordability/availabilityofdentalservices 4.7%
Caringcommunity/culture;communityconnectionsandsupports 4.3%
Improvedtransportationservices/publictransportation 3.9%
Seniorservices/assistedliving/concernsofaging 3.5%
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 25
6.BehavioralHealthNeedsSurveyFindings
Recognizingthecontinuedimportanceofmentalhealthandsubstancemisuseascommunityidentifiedprioritiesforimprovement,inthefallof2016,CNHHPmemberagenciespartneredwithotherhealthandhumanserviceprovidersinthebroaderLakesRegiontoconductanassessmentspecificallyfocusedonbehavioralhealthneeds.TheresultsofthisassessmentarebeingusedtoinformthedevelopmentofanIntegratedDeliveryNetworkforbehavioralhealthcareservicesintheregion,aswellasCNHHP’sspecificcommunityhealthimprovementefforts.OneaspectofthisassessmentwasaconsumersurveyofarearesidentstargetedtohighneedlocationsandpopulationswithaparticularemphasisonreachingpopulationscoveredbyMedicaid.Atotalof237consumersurveyswerecompleted;32%ofrespondentswereMedicaidmemberswithinthelast12months,42%hadusedmentalhealthservicesinthepast12months,and12%hadusedsubstanceuseservicesinthepast12months.Keyfindingsofthisbehavioralhealthneedsassessmentaredescribedhere.
Asdisplayedbychart9,about51%ofbehavioralhealthneedssurveyrespondentsindicatedthattheyhadeverbeentoldbyahealthprofessionalthattheymayhaveamentalhealthcondition,includingabout66%ofrespondentswhoalsoreportedhavingbeeneligibleforMedicaidinthepast12months.About15%ofrespondentsindicatedhavingbeentoldtheymayhavesubstanceuseproblemincludingabout28%ofMedicaidmembers.
Figure12
26 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
AsdisplayedbyChart10,about42%ofbehavioralhealthneedssurveyrespondentsindicatedthattheyhadreceivedsometypeofmentalhealthservicesinthepast12monthsincludingabout58%ofrespondentswhohadbeeneligibleforMedicaidinthepast12months.About12%ofrespondentsreportedreceivingservicesforsubstanceuseinthepast12monthsincludingabout24%ofMedicaidmembers.
About23%ofbehavioralhealthsurveyrespondentsindicatedhavingdifficultygettingthementalhealthservicestheyneededinthepast12months(Chart11),includingabout32%ofMedicaidmembers;while11%indicatedtheyhaddifficultygettingthesubstanceuseservicestheyneededincludingabout24%ofMedicaideligiblerespondents.
Figure14
Figure13
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 27
Furtheranalysisoftheseresultsshowsthatofthoserespondentswhodidreceivesometypeofmentalhealthservicesinthepast12months,about29%alsoindicatedhavingdifficultygettingthementalhealthservicestheyneeded.Amongrespondentswhoreceivednomentalhealthservicesinthepast12months,nearly1in5(about19%)indicatedaneedformentalhealthservicesthattheydidnotget.Thesefindingsmayreflectdifferentchallengestoreceivingservicessuchaswaitinglists(e.g.respondentsmayhavehaddifficultygettingservicesinitially,buteventuallydidso),gapsintheappropriatenessoracceptabilityofservices,financialobstaclestocareandrespondentreadinesstoseekservices.
Similarfindingswereobservedforrespondentsindicatingdifficultyaccessingsubstanceuseserviceswherenearlyhalfofrespondents(46%)whodidreceivesubstanceuseservicesintheprior12monthsalsoindicateddifficultyingettingservicestheyneeded.Amongthoserespondentswhodidnotaccesssubstanceuseservicesintheprior12months,about6%reportedaneedforservicesthattheydidnotget.
Figure15
28 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
Chart13displaysthetopreasonsreportedfornotgettingneededmentalhealthservices.Theseare“IthoughtIcouldhandletheproblemwithouttreatment”and“Ididnothavetime(duetojob,childcare,orothercommitments”,followedby“TherewerenoopeningsorIcouldnotgetanappointment”and“Healthinsurancedidnotcovertheserviceorenoughofthecosts”.Thetopmentalhealthservicesthatpeoplereportedhavingdifficultyaccessing(Chart14)areindividualtherapyorcounseling(79%)andservicesforco-occurringmentalandsubstanceuseconditions.Takentogether,thesefindingssuggestissuesoflimitedworkforcecapacitywithrespecttocounselors/therapistsaswellastheneedforintegrationofmentalhealthandSUDservices.
Figure16 Figure17
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 29
Reportedreasonsforsubstanceuseserviceaccessdifficultiesaresimilarwiththetopreasonsbeing“Iwasnotreadytostopusingalcoholordrugs”,“IthoughtIcouldhandletheproblemwithouttreatment”,and“TherewerenoopeningsorIcouldnotgetanappointment”.However,somedifferencesareobservedforthetypeofservicesrespondentshaddifficultygetting(Chart16).While‘individualtherapyorcounseling’wasagainthetopservicementioned,itwasmentionedbyasmallerproportionofrespondentsandamorediversearrayofserviceswerementionedathigherfrequencyincludingco-occurringmentalhealthandsubstanceuseservices,peerandrecoverysupportservices,intensiveoutpatienttreatmentandopioidtreatment.
Figure18 Figure19
30 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
Thefocusedassessmentofbehavioralhealthneedsalsoincludedasurveyofareahealthandhumanserviceproviders(n=147).AsdisplayedbyChart17,respondentstotheprovidersurveyalsoreflecttheobservationthatworkforcecapacityisanimportantconcernwith‘waitinglists/lackofappointmentavailability’citedasatopbarriertoaccessingbehavioralhealthservicesintheregion.Transportationchallenges,healthinsurancecoveragelimitationsandcompetingdemandsontimewerealsonotedassubstantialbarrierstoaccessingneededbehavioralhealthservices.
Figure20
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 31
B.COMMUNITYHEALTHDISCUSSIONGROUPS
Asetofthreediscussiongroupswereconvenedinthesummerof2017aspartofaneffortbytheCentralNHHealthPartnershiptounderstandthehealth-relatedneedsofthecommunityandtoplanprogramsandservicesthataddressthoseneeds.Thepurposeofthediscussiongroupswastogetinputonhealthissuesthatmattertothecommunityandthoughtsandperceptionsaboutthehealthofthecommunity.Discussiongroupswereconvenedrepresentingavarietyofimportantcommunitysectorsandperspectives,specificallythefollowing:
• Inter-AgencyCouncilhostedbyWholeVillage(17participants)
• CentralNHPublicHealthAdvisoryCouncil(13participants)
• ParentGrouphostedbyWholeVillage(13participants)• PlymouthandBristolareaSeniorAdvisoryCouncils(10
participants)
32 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
1. CommunityDiscussionGroupThemes
Thefollowingparagraphssummarizethefindingsfromthecommunitydiscussiongroups.SeeAppendixAformoredetailednotesfromthesegroupsorganizedbytopic.
1. Discussiongroupparticipantscomprehendedanddescribedacomprehensive,holisticperspectiveonhealthandwell-being.Thecontributionsofhealthbehaviors,thephysicalenvironment,programsandservices,andunderlyingdeterminantsofhealthsuchashousing,incomeandeducationwerealldiscussedwithrespecttoindividualandcommunityhealthoutcomes.
2. Participantshadmixedfeelingsabouttheoverallhealthofthecommunity.Positivefactorscitedincludetheperceptionofincreasedparticipationinphysicalactivityandanumberofspecificcommunityresourcesthatpromotehealthandwellness.However,therewasalsodiscussionofadivideinhealthoutcomesbetweenindividualsandfamilieswithmoreresources,particularlyincomeandhousing,comparedtothosewithlimitedresources.Anumberofcommentsalsospecificallycitedsubstancemisuseasanincreasingproblem,aswellconcernsaboutmulti-generationalhealthbehaviorsthatcontributetopoorhealthoutcomes.
3. ParticipantsidentifiedawidevarietyofcommunitystrengthsandresourcesthatpromotehealthincludingSpeareMemorialHospital,GenesisBehavioralHealth,MidstateHealthCenter,‘BoulderPoint’,Pemi-BakerAquatic&Fitness,activeAAandAlAnonprograms,thePlymouthandBristolSeniorCenters,theTapply-ThompsonCommunityCenter,CADY,theALLWellCenter,theGotLunchprogram,HeadStart,WholeVillageFamilyResourceCenter,thephysicalenvironmentandoutdoorrecreationalactivities,andfarmers’markets.
4. Participantsidentifiedarangeofbarrierstopromotinggoodhealthinthecommunityincludingtheneedformoreawarenessofavailableresources(...asingleplacetogothatlinkedyouintothedifferentresourcesfordifferentissues...thatwouldbe
"Whenwe’retalkingaboutpoverty,we’renottalkingaboutthepersonwhoisstrugglingtofindfoodorshelterortransportation.Wearetalkingaboutthecommunity;thatthispersonisn’tinpoverty,weareinpoverty."InteragencyCouncilParticipant
"I’dsaythisisahealthandwellnessconsciouscommunity....ThecommunityandtheuniversityaretiedtogetherinwellnessactivitiesthroughtheALLWellCenter.Theyhaveanopentrackthatinvitespeoplein.Therearepeoplefromherethatgodownthereandwalklapsatlunchorafterlunch.Justgeneralaccesstooutdooractivitieshereisawesome."SeniorAdvisoryCouncilParticipant
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 33
reallyhelpful.”),accesstomedicalspecialists,affordabilityofhealthcareservices(“Insuranceisexpensive,butthenonceyougo,it’sjustthatmuchmore.Soyoujusttrytostayoutasmuchasyoucan.”),theneedforimprovedaccesstotransportation,andaddressingintergenerationalpoverty,substancemisuseandmentalhealth.
5. Withrespecttowhatorganizationscouldbedoingbettertosupportorimprovecommunityhealth,participantsidentifiedneedsforimprovedcoordinationbetweenlocalorganizationsandhospitals,bettercommunication,socialmediapresenceandmarketingofhealth-relatedopportunities,increasedsupportandeducationaddressingsubstancemisuse,andmoreleadershipforaddressinglongtermcommunityhealthissuesincludingstrongerconnectionswiththeuniversity.
"Idon’tthinkweworktogetherasacommunity.AndIdon’tknowwhatthat’sallabout...Ithinkit’sjustkindofthewayit’salwaysbeen.Itjustneedstochange,andwejustneedtochangeit....It’sahardareabecausewe’vegotsomanydifferentcommunitiescomingtogether...peoplethathavelivedinthesameneighborhoodformanygenerations.Andthenwe’vegotallthenewpeople,thecollegiateprofessors...we’vegotalldifferentlevels.Ithinkallgettingonthesamebustogether;wecouldbeareallystrongcommunity.Whatthattakes,Idon’tknow."ParentGroupParticipant
34 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
2. HighPriorityIssuesfromCommunityDiscussionGroups
Ineachofthecommunitydiscussiongroupsconvenedin2017,thediscussiongroupfacilitatorreadtoppriorityareasidentifiedinthe2014CommunityHealthNeedsAssessmentandthecurrentCNHHPCommunityHealthImprovementPlan.Theseprioritieswere:
1. Accesstoaffordablehealthcareservicesandinsurance2. Alcohol,anddruguseprevention,treatmentandrecovery3. Accesstomentalhealthservices4. HealthyEating,ActiveLiving,obesityprevention5. Assistancewithcarecoordinationandhealthsystemnavigation6. SupportofFragileFamilies&ReductionofFamilyStress
Participantswerethenaskediftheywere:a)awareofanyprogramsoractivitiesthathavefocusedonanyoftheseareas;b)iftheyhadnoticedanyimprovementsintheseareas;andc)iftheythoughtthesearestillthemostimportantissuesforthecommunitytoaddressforimprovinghealthoriftherearenew,differentpriorities.Discussionparticipantsidentifiedanumberofprogramsandservicesintendedtoaddress:a)addresshealthcareaffordabilityandaccessincludingtheAffordableCareActandMedicaidExpansion;b)substancemisuseandmentalhealthcapacityincludingeffortstoimprovebehavioralservicesprovidedthroughhomehealthservices;andc)physicalactivity,particularlyprogramsforpeoplewithchronicdiseasethroughGenesisandMid-State.
Withsomeadditions(seenextpage),mostparticipantsineachgroupexpressedtheoverallopinionthattheprioritiesidentifiedin2014werestillthemostimportantissuestofocusattentiononforcommunityhealthimprovement.However,someparticipantsalsosuggestedfocusingononeoracoupleareasthatarecross-cutting,withtransportationmentionedinseveralgroupsasanexampleofanissuethathasbeenalongtermchallengeandtouchesonmanyissuesassociatedwithaccesstoservicesandqualityoflife.
“Ingeneralforalltheprioritiesmentioned,therehasbeenmoredone,butthewavecomingatusissomuchbiggerthatitsortofswampstheincreasedefforts.It’snotthattherehaven’tbeenincreasedeffortsintheseareas,justnotenoughtokeepupwiththedemand.InteragencyCouncilParticipant
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 35
Thetablebelowdisplaysthetopoverallprioritiesidentifiedbyeachsetofdiscussiongroups.Asnotedonthepreviouspage,thecommunitydiscussiongroupsconvenedin2017generallyendorsedthesamesetofprioritiesasidentifiedin2014.Someadditionalthemesemergedinthesediscussionsandarenotedinthistableaswell.
TABLE8–COMMUNITYDISCUSSIONGROUPS;MAJORTHEMES&PRIORITIES
Inter-AgencyCouncil PublicHealthAdvisoryCouncil ParentGroup SeniorAdvisoryCouncil
MentalHealthandSubstanceUse
OftheclientsIseeintheWelfaredepartmentprobably75%atleasthavesomeconnectiontoeitherMHorSUorboth.Alotoftimesboth.
Ithinkthatourcommunityputsonaveryhealthyfront,butsortofbehindthescenes,notsomuch..it’sthepoverty,it’sthesubstanceabuse,it’sthementalillness,it’sthefamilydysfunction,allofthat. We’vegotpeopleinourERswaitingweekstryingtogetservices.
Professionalrecoveryresourcesiswhatwedon’thave.Like,IOPs. SomeoneIknowisinthehospitalfor(aseriousmentalhealthissue),andtheycouldn’tfind(theperson)abedintimesotheystuckherinaroomforthreedaysandjustleft(thepersonthere.
Ithinkmoreneedstobesaidtoteenagersmaybeaboutthedrugs.Theyneedmoreinformation.Theyneedtoknowthathappens.
SocialDeterminants;Socialconnectedness
It’saglobalissue.Wellbeingdependsonallofthosesupportsandfeelinglikeyouarepartofthecommunityandnotfeelinglikeyouareshamedbecauseyouareaccessingthosesupports.Povertyandaccessarethebigones.
Talkingabouttheisolationissue,it’snotjustseniors.Therearealotofyoungfamiliesthatareveryisolatedandtheydon’thavecommunityconnections,connectionswithfriends,withneighbors.
Idon’tknowhowopenweareaboutcommunication...intermsofwhat’sgoingon,orwedon’tdiscussalotofthingsthatmaybeshouldbediscussedinanopenforumforourcommunity.AndIfeellikethat’shurtingalotofpeople,health-wise.
IthinkBristoltakescareofpeople,butyouhavetoask...andalotofpeoplethatneedservices,they’resortofafraidtoask.Wouldtheyknowwhotoask? Youimprovethequalityoflifeandthentheotherthingswillfallintoplace.
36 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
Inter-AgencyCouncil PublicHealthAdvisoryCouncil ParentGroup SeniorAdvisoryCouncil
Provideravailability;capacity;workforceshortages
Therearestaffingshortagesinallthoseareas.Innursing,insocialwork,inmentalhealth.There’salineoutofeverydoor.That’sthefrustration.It’snotthatwedon’thavepeoplewhowanttohelp.
Ithinkoneofthegoodthingsfromthecommunityperspectiveispeopleknowwheretogointhiscommunity.It’seasilyidentifiablewhotheprovidersare...
Ihad(several)counselors,justdifferentonesbecausetheyeitherquit,orwereletgo,orbecausetheempathyisnotthere.So,tobuildrapportwithsomeonewho’ssupposedtohelpyouiskindofdifficultwhenyouhavejustsuchalotofturnover. Inoticemy(spouse),everycoupleyears(myspouse)gotanotherdoctorbecausethey’vefulfilledtheirthreeyears.Itseemshardtokeepphysiciansinthearea.
AlmosteverythingIneedisrighthere.I’vebeenverypleasedwiththeavailabilityandqualityofthehealthcareservicethatI’vegottenatSpeare. OneofthethingsthatI’venoticed,whereIcamefromtherewasanurgentcarecenterprobablyeverysixblocks.Andthere’snotalotinthiswholeentireareagoingfromBristoltoLincoln...Arethereany?
Carecoordination;Navigation;Accesstoinformation
Alotofpeoplestillalsohaveafearof“thesystem”.Fearthattheyaregoingtogetjudged;theyknowtheyneedhelp,ortheywanthelpormaybetheydon’tknowtheyneedhelp,butit’sthefearofthesystem.
TheinsurancenavigationthingthatcamewiththeACA,basically,ACAfundedfolkstohelppatientsnavigatehowtogetinsurance.AndIthinkitwasprettysuccessful.Butthat’sallunwinding—
WholeVillagegivesyoutherightresources,whereyouneedthem.Especiallydownatthehomelessshelter.They’reprettygoodabouthelpingpeopleout...Theatmospherehere,aswellas—thehelpisgenuinewhenthey’reassistingyouwithanything.
Peoplekepttellingme,“Thereareservicesavailable.Youjusthavetoask.”AndIkeptsaying,“WhodoIask?”
Evenaconsolidatedonlinesource...Iftherewasasingleplacetogothatlinkedyouintothedifferentresourcesfordifferentissues,thenIthinkthatwouldbereallyhelpful.
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 37
Inter-AgencyCouncil PublicHealthAdvisoryCouncil ParentGroup SeniorAdvisoryCouncil
Transportation Thedifficultchallengeinbeingaruralcommunityisthetransportationpiece...asgreatofaconnectionaswefeelandthatsenseofonenessinourcommunity,it’sdifficultbecauseweareruralandbecausethingsaresospreadout...
Transportationplaysasignificantroleinourruralcommunity...especiallyinthewintermonthsthetransportationpieceisahugebarrierintermsofcommunityhealthandconnection.
I’velikedtheideaoftacklingtransportation.Itcomesupyearafteryear...
Beingstuckinsubsidizedhousingwithouttransportation,especiallythatdistancedownRoute25,andtobetryingtoarrestyourownaddictionortakecareofyourmentalhealthissues,itfeelsalmosthopelessinthemsituations.It’shardtogetout,hardtofollowthrough.
Transportationgoestoallthoseissuesthatyouhadfromfouryearsago,don’tyouthink?Putsthemalltogether.
Ithinkoneofthebiggestproblemsaltogetheristransportation.Evenifthere’ssomethingrighthereintown,ifyoudon’thaveacar,it’snoteasytogetto.AndIusejustabouteveryresourcethatthereis.Ifinallybrokedownandboughtmyselfacartosavemyownsanity.
Accesstohealthcare;healthcareinsurance
AccesstohealthcarehasimprovedasaresultofMedicaidExpansion.ThisisHUGEandhasradicallyimprovedaccesstohealthcare.
We’vemadeadentinaccesstohealthinsurance.Idon’tknowifthedentwillremain.
I’vegotfriendsthatcannowaffordinsurancewithObamacare.Buttheydon’tknowwhetheritwillbeavailablenextyear.That’stheuncertainty.Thepaperworkistremendous.
Insuranceisexpensive,butthenonceyougo,it’sjustthatmuchmore.Soyoujusttrytostayoutasmuchasyoucan...It’dhavetobesomethingreallymajorformetogo.
38 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
Inter-AgencyCouncil PublicHealthAdvisoryCouncil ParentGroup SeniorAdvisoryCouncil
Healthcareforseniors
Addcareforfraileldersasapriority.Therearealotfraileldersinourcommunity;kindofaspecialpopulation.
Alotofpeoplearedrawnherethatareretiringorareofretirementage.Andalotofyoungpeoplearedrawntoleave.Andsoourdemographicischanging.
Isolationisahugeriskfactoronmanylevelsforhealth...ourelderlypopulationstruggleparticularlyinthewintertime;andlackfamilysupportsorplansiftheyaresick.Wespendalotoftimedoingsocialservicetohelpthem
Mytopissuewouldbehandicapaccessibility.Notjustforpeoplewithobvioushandicaps.It’selderlypeople,period...Yougointosomanyandtherearestepsandnowayforthemtogetintoarestaurantorwhatever,anditmakesitdifficult.
AssistedLiving;Longtermcare
Oneofthethingsthatwearelackingisthattherearenoassistedlivingfacilities,nonursinghomesinthearea.Wedefinitelyarenotmeetingtheneedsofthosewhoaremiddleincomeorlowincomewhocouldn’taffordit,eveniftheywantedto.
Iwastryingtofigureoutwhere(arelative)couldlive.(Myrelative)didn’twanttobeaburden.AndIaskedaround.Ididn’treallyfindalotofhelp.IendedupgoingallthewaydowntoFranklintofindaplacefor(myrelative)tolive..Iwasfrustratedthattherewasn’tsomethingcloser.
Therearenoresidentiallivingplacesthatareaffordabletosomebodyonafixedincome.
HealthyEating,ActiveLiving
Ifwecouldfocusonanupstreammodelandgetintheirearlier,thenthatwillhelpuswithourchildren,whetherit’sobesity,ortheexercise,andgetfamiliesinvolved.
Ithinkitwouldbehelpfulifwehadwalkablecommunities,likewehadsidewalks,wehadbikepaths,thatparentsfeltcomfortablethattheirchildcouldbikeovertotheirfriend’shouse.
Iseeanawfullotofpeoplefrom5inthemorninguntildarkwalking,biking,pushingstrollers.There’salotofpeopleoutgettingphysicalactivityonaregularbasis.
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 39
Inter-AgencyCouncil PublicHealthAdvisoryCouncil ParentGroup SeniorAdvisoryCouncil
AvailabilityofDentalCare
Westillhaveanadultaccessissueregardingoral
Dentalisavery,verybigissue.Idon’tthinkitisasmuchforchildren,butadults.It’sbad.
There’snoplaceherethathastheslidingscalefee.Youcan’tgetinsurancethroughMedicaid...youloseitwhenyou’re21.So,alotofpeopledon’thavedentalinsurance.Andit’sexpensive.
YouseealotofpeoplegoingintheERbecausetheygetinfectedteethconstantly.Theyjustsendyouhome,prettymuch.
Therearealotofdentistshereintown,butifyoulistentotheconversationaboutthem,it’slike“Well,don’tgothere,don’tgothere.”AndbythetimeIgotdoneIsaid,“Whodoyougoseethen?”
Injuryprevention Ijustthinkit’sasafetyissue(learningtoswim).There’snaturalwaterinallofourcommunitiesandwedon’thaveaneasywaytoaddressthat.It’snoteasy,it’snotaffordable...personally,Ithinkthat’sabighealthissue.
It’sreallynicetohaveallthesepoolsintownandnotbeabletogetin...therearesomanypeoplethathaven’tlearnedhowtoswimbecauseit’snoteasyto.
My(spouse)hasahardtimegettingintosomeplacesbecause(ofaphysicaldisability).Ithinkthatitwouldn’tbeabadideatohavealittlemoreemphasisonthattypeofthing...orevenmyself,I’vehadahardtime—youcouldtripreallyeasy.
TheonlythingIcanthinkthatwouldhelpmeisrailings...it’saverylittlething—evenapost,ifit’sonlyonestep,wouldhelp.
CommunityCenter I’vealwaysdreamedabouthavingarealreccenterwheretherewasachildcarefacility....Haveusallworktogetherasacommunityinthisnicelittlereccenter
Andteachkidshowtoswim,right?Ourkidsneedtoknowhowtoswim.
40 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
C.COMMUNITYHEALTHSTATUSINDICATORS
Thissectionofthe2017CommunityHealthNeedsAssessmentreportprovidesinformationonkeyindicatorsandmeasuresofcommunityhealthstatus.Somemeasuresassociatedwithhealthstatushavebeenincludedearlierinthisreport,suchasmeasuresofincomeandpoverty.Wherepossible,statisticsarepresentedspecifictothe18townserviceareaidentifiedbytheCentralNewHampshireHealthPartnership.Insomeinstances,dataareonlyavailableatthecountylevel.Intheseinstances,informationispresentedforGraftonCounty,becausetheCNHHPserviceareaisentirelywithinGraftonCountyandcomprisesabout34%ofthetotalcountypopulation.
1. DemographicsandSocialDeterminantsofHealth
Apopulation’sdemographicandsocialcharacteristics,includingsuchfactorsasprosperity,education,andhousinginfluenceitshealthstatus.Similarly,factorssuchasage,disability,languageandtransportationcaninfluencethetypesofhealthandsocialservicesneededbycommunities.
a. GeneralPopulationCharacteristics
Accordingtothe2015AmericanCommunitySurvey,thepopulationoftheCNHHPServiceAreaisolderonaveragethaninNewHampshireoverall.Theserviceareamaponthenextpagedisplaysthepercentofthepopulation65yearsofageandolderbytown.Between2010and2015,thepopulationoftheCNHHPServiceAreadeclinedbyalmost2%.
Indicators CNHHPServiceArea NewHampshirePopulationOverview TotalPopulation 30,039 1,319,171
Overageof65 17.7% 15.3%Underageof18 16.2% 20.5%
Changeinpopulation(2010to2015) -1.9% +0.6%
DataSource:U.S.CensusBureau,2011-2015AmericanCommunitySurvey5-YearEstimatesand2010USCensus.
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 41
PercentofPopulation65yearsofageandolder
CNHHPServiceAreaTowns
b.Poverty
Thecorrelationbetweeneconomicprosperityandgoodhealthstatusiswellestablished.Inversely,thelackofeconomicprosperity,orpoverty,canbeassociatedwithbarrierstoaccessinghealthservices,healthyfood,andhealthyphysicalenvironmentsthatcontributetogoodhealth.Informationdescribinghouseholdincomeandpovertystatuswasincludedinthefirstsectionofthisreport.Thetablebelowpresentstheproportionofchildrenunderage18livingbelowthe100%and200%oftheFederalPovertyLevelintheCNHHPServiceAreacomparedwithratesforNewHampshireoverall.
Area PercentofChildreninPovertyIncome<100%FPL
PercentofChildreninornearPovertyIncome<200%FPL
CNHHPServiceArea 11.0% 38.1%
NewHampshire 11.9% 27.6%
DataSource:U.S.CensusBureau,2011–2015AmericanCommunitySurvey5-YearEstimates.
Bridgewater
BristolAlexandria
LincolnLivermore
42 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
c. Education
Educationalattainmentisalsoconsideredakeydriverofhealthstatuswithlowerlevelsofeducationlinkedtobothpovertyandpoorhealth.AsimilarproportionofthepopulationoftheCNHHPServiceAreahaveearnedatleastahighschooldiplomaorequivalentcomparedtoNewHampshireoverall.Thetablebelowpresentsdataonthepercentageofthepopulationaged25andolderwithoutahighschooldiploma(orequivalent).
Area PercentofPopulationAged25+withNoHighSchoolDiploma
CNHHPServiceArea 7.5%
NewHampshire 7.7%
DataSource:U.S.CensusBureau,2011–2015AmericanCommunitySurvey5-YearEstimates.
d. Language
AninabilitytospeakEnglishwellcancreatebarrierstoaccessingservices,communicationwithserviceproviders,andabilitytounderstandandapplyhealthinformation(healthliteracy).Thetablebelowreportsthepercentageofthepopulationaged5andolderwhospeakalanguageotherthanEnglishathomeandspeakEnglishlessthan"verywell".
Area PercentofPopulationAged5+WhoSpeakEnglishLessThan“VeryWell”
CNHHPServiceArea 0.4%
NewHampshire 0.9%
DataSource:U.S.CensusBureau,2009–2013AmericanCommunitySurvey5-YearEstimates.
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 43
e. Housing
Housingcharacteristics,includinghousingqualityandcostburdenasaproportionofincome,caninfluencethehealthoffamiliesandcommunities.Thetablebelowpresentsdataonthepercentageofhousingunitsthatareconsideredsubstandardhousingandhousingcostburden.
“Substandard”housingunitsarehousingunitsthathaveatleastoneofthefollowingcharacteristics1)lackingcompleteplumbingfacilities,2)lackingcompletekitchenfacilities,3)anaverageofmorethanoneoccupantperroom,4)selectedmonthlyownercostsasapercentageofhouseholdincomegreaterthan30percent,and5)grossrentasapercentageofhouseholdincomegreaterthan30percent.
Acomponentofthesubstandardhousingindexistheproportionofincomethatisspentonhousingcosts.AccordingtoresearchbytheU.S.DepartmentofHousingandUrbandevelopment,householdsthatspendmorethan30percentofincomeonhousingcostsarelesslikelytohaveadequateresourcesforfood,clothing,medicalcare,orotherneeds.Thetablebelowshowstheproportionofhouseholdsintheregionforwhichthemortgageorrentalcostsexceed30%ofhouseholdincome.
AreaPercentofHousingUnitsCategorizedAs“Substandard”
PercentofHouseholdswithHousingCosts>30%ofHouseholdIncome
CNHHPServiceArea 33.6% 32.8%
NewHampshire 34.5% 35.1%
DataSource:2011–2015AmericanCommunitySurvey5-YearEstimates;Sub-standardHousingandHousingCostBurdendataaccessedfromCommunityCommons.
44 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
f. Transportation
Individualswithlimitedtransportationoptionsalsohavelimitedemploymentoptions,greaterdifficultyaccessingservices,andmorechallengestoleadingindependent,healthylives.Thenexttablepresentsdataonthepercentofhouseholdsthathavenovehicleavailable.
Area PercentofHouseholdswithNoVehicleAvailable
CNHHPServiceArea 4.1%
NewHampshire 5.1%
DataSource:U.S.CensusBureau,2011–2015AmericanCommunitySurvey5-YearEstimates.
g. DisabilityStatus
Disabilityisdefinedastheproductofinteractionsamongindividuals’bodies;theirphysical,emotional,andmentalhealth;andthephysicalandsocialenvironmentinwhichtheylive,work,orplay.Disabilityexistswherethisinteractionresultsinlimitationsofactivitiesandrestrictionstofullparticipationatschool,atwork,athome,orinthecommunity.TheUSCensusBureau(AmericanCommunitySurvey)identifiespeoplereportingseriousdifficultywithfourbasicareasoffunctioning–hearing,vision,cognition,andambulation.Accordingtothe2015AmericanCommunitySurvey,13.4%ofCNHHPServiceArearesidentsreporthavingatleastonedisability,aratethatisslightlyhigherthantheoverallNewHampshirerateandmostlikelyareflectionoftheproportionallyolderpopulation.
AreaPercentofPopulationReportingSerious
DifficultyWithHearing,Vision,Cognitionand/orAmbulation
CNHHPServiceArea 13.4%
NewHampshire 12.1%
DataSource:U.S.CensusBureau,2011–2015AmericanCommunitySurvey5-YearEstimates.
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 45
2.AccesstoCare
Accesstocarereferstotheeasewithwhichanindividualcanobtainneededservices.Accessisinfluencedbyavarietyoffactorsincludingaffordabilityofservicesandinsurancecoverage,providercapacityinrelationshiptopopulationneedanddemandforservices,andrelatedconceptsofavailability,proximityandappropriatenessofservices.
a.InsuranceCoverage
Table9onthenextpagedisplaysestimatesoftheproportionofresidentswhodonothaveanyformofhealthinsurancecoveragebymunicipality,aswellastheproportionofresidentscoveredbyMedicareorMedicaid.Itisimportanttonotethatthedatasourceforthesemunicipallevelestimatesisa5yearspanoftheAmericanCommunitySurvey.Acombinationoffiveyearsofdataisrequiredtoproducereasonablystableestimatesontheseandothermeasuresfromthesurveysamples.However,thisparticulartimeperiodspansaperiodofsignificantchangeinthehealthinsurancemarketwiththeimplementationofthefederalAffordableCareActandthebeginningofMedicaidexpansioninNewHampshire.Figures21and22followingthetabledisplay1yearestimatesofuninsuranceandMedicaidcoverage.ThisanalysisappliesgroupingsofzipcodetabulationareastoderiveestimatesattheregionalandstatelevelfromtheAmericanCommunitySurvey.Theseestimatesarelessprecise,butareincludedtoillustrateimportanttrendsininsurancecoverage
AsdisplayedbyFigures21and22,theoveralluninsuranceratehasdeclinedsubstantiallyintheCNHHPservicearea(fromalmost14%toabout9%),butstillexceedstheoveralluninsurancerateestimateforNH(6.4%).AsignificantcontributortothischangeappearstobeincreasesinMedicaidcoverage,whereestimatesofMedicaidcoverageincreasedfromabout13%ofthetotalpopulationin2013toabout17%in2015.
46 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
TABLE9
Area PercentoftheTotalPopulationwithNoHealthInsuranceCoverage
PercentwithMedicareCoverage
PercentwithMedicaidCoverage
Ellsworth 36.6% 44.6% 10.7%Groton 31.4% 22.2% 14.3%Ashland 21.0% 22.1% 13.9%Alexandria 20.0% 20.5% 16.3%Lincoln 20.0% 23.4% 19.3%Warren 19.6% 23.5% 20.5%Woodstock 18.6% 18.0% 8.6%Wentworth 18.4% 25.6% 12.1%Holderness 16.9% 18.7% 8.5%Rumney 16.4% 18.8% 15.2%Hebron 15.8% 29.9% 10.3%Thornton 14.9% 23.4% 10.7%Bristol 13.7% 22.2% 14.8%Campton 11.9% 24.2% 6.2%Bridgewater 9.6% 28.0% 14.0%Plymouth 9.4% 11.4% 8.8%WatervilleValley 2.4% 23.4% 0.0%
DataSource:U.S.CensusBureau,2011–2015AmericanCommunitySurvey5-YearEstimates
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 47
Figure21
Figure22
2013 2014 2015CNHHP 13.7% 12.4% 9.2%NH 10.8% 9.3% 6.4%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
PercentofPopulationwithNoHealthInsurance2013-2015
CNHHP
NH
2013 2014 2015CNHHP 13.1% 16.5% 17.3%NH 11.3% 11.1% 12.9%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
PercentofPopulationwithMedicaidCoverage2013-2015
CNHHP
NH
48 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
b.AdultswithaPersonalHealthCareProvider
Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportthattheyhaveatleastonepersonwhotheythinkofasapersonaldoctororhealthcareprovider.Alowerpercentageonthisindicatormayhighlightinsufficientaccessoravailabilityofmedicalproviders,alackofawarenessorhealthknowledgeorotherbarrierspreventingformationofarelationshipwithaparticularmedicalcareprovider.
Area Percentofadultswhoreporthavingapersonaldoctororhealthcareprovider
CNHHPServiceArea 80.6%
NewHampshire 86.8%
DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015.RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.
c.PreventableHospitalStays
PreventableHospitalStaysisthehospitaldischargeratefordiagnosespotentiallytreatableinoutpatientsetting,alsoknownasambulatorycaresensitiveconditions,suchasdiabetes,hypertension,asthmaandchronicobstructivepulmonarydisease.ThismeasureisreportedforMedicareenrollees.Ahighrateofinpatientstaysforambulatorycaresensitiveconditionsmayindicatelimitedaccess,availabilityorqualityofprimaryandoutpatientspecialtycareinacommunity.TherateofpreventablehospitalstaysinBelknapCountyissimilartotheoverallstaterate.
Area Numberofhospitalstaysforambulatorycaresensitiveconditionsper1,000Medicareenrollees
GraftonCounty 40.1
NewHampshire 44.8
DataSource:DartmouthAtlasofHealthCare,2014;accessedthroughCountyHealthRankingsRegionalrateisnotsignificantlydifferentthantheoverallNHrate
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 49
d.BehavioralHealthCare-EmergencyDepartmentUtilizationandHospitalRe-admissionforBehavioralHealthConditions
Overutilizationordependenceonemergencydepartmentsforcareofindividualswithbehavioralhealthconditionscanbeanindicationoflimitedaccesstoorcapacityofoutpatientmentalhealthservices.Similarly,unplannedhospitalre-admissionscanindicategapsinavailablecommunityandsocialsupportsystems.
AspartoftheregionalplanningworktodevelopanIntegratedDeliveryNetworkforbehavioralhealth,analyseswereconductedwithMedicaidclaimsdatatocompareemergencydepartmentutilizationandhospitalre-admissionsforMedicaidmemberswithevidenceofabehavioralhealthconditionbasedonclaimshistory.Figure23displaysthefindingthatMedicaidmembersresidingintheLakesRegionofNH(includingtheCNHHPservicearea)withabehavioralhealthconditionwereover4timesmorelikelytohavehadfourormorevisitstoanemergencydepartmentin2015(8.6%ofmemberswithevidenceofabehavioralhealthconditioncomparedto1.9%ofmemberswithout).Similarly,the30dayhospitalinpatientreadmissionrateforbehavioralhealthindicatedmembers(13.4%)wasmorethandoubletheratefornon-behavioralhealthindicatedmembers(5.9%).
Figure23 Figure24
DataSource:NHMedicaid,2015claimsdata
8.6%
1.9%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
BHIndicated NotBHIndicated
FrequentEDUsers(4+visits,anyhospital)PercentofallMedicaidMembers,2015
BehaivoralHealthIndicatedorNotIndicicated
50 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
e.DentalCareUtilization(Adult)
Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportthattheyhavenotvisitedadentist,dentalhygienistordentalclinicwithinthepastfiveyears.AhigherproportionofadultsintheCNHHPserviceareareportnothavingseenadentistcomparedtothestate.
Area Percent of adults who have not visited a dentist or dental clinic
in the past 5 years
CNHHPServiceArea 17.7%
NewHampshire 11.4%
DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014.RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically
f.PoorDentalHealth
Thisindicatorreportsthepercentageofadultsage18andolderwhoself-reportthatsixormoreoftheirpermanentteethhavebeenremovedduetotoothdecay,gumdisease,orinfection.Inadditiontohighlightingneededimprovementsinpreventiveoralhealthcare,thisindicatorcanalsohighlightalackofaccesstocare,alackofhealthknowledge,orsocialandeconomicbarrierspreventingutilizationofservices.
Area Percentofadultswhoreporthavingsixormoreoftheirpermanentteethremoved
CNHHPServiceArea 15.5%
NewHampshire 15.5%
DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014.RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 51
3.HealthPromotionandDiseasePreventionPractices
Adoptinghealthylifestylepracticesandbehaviors,suchasnotsmokingandlimitingalcoholintake,canpreventorcontroltheeffectsofdiseaseandinjury.Forexample,regularphysicalactivitynotonlybuildsfitness,buthelpstomaintainbalance,promotesrelaxation,andreducestheriskofdisease.Similarly,eatingahealthydietrichinfruits,vegetablesandwholegrainscanreduceriskfordiseaseslikeheartdisease,certaincancers,diabetes,andosteoporosis.Thissectionincludesindicatorsofindividualbehaviorsinfluencingpersonalhealthandwellness.Someindicatorsofclinicalpreventionpractices,suchasscreeningforcancerandheartdisease,areincludedinalatersectionthatalsodescribespopulationhealthoutcomesinthoseareas.
a.FruitandVegetableConsumption(Adults)
Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportconsuminglessthan5servingsoffruitsandvegetableseachday.Unhealthyeatinghabitscontributetosignificanthealthissuessuchasobesityanddiabetes.
AreaPercentofAdultsConsumingFewFruits
orVegetables
GraftonCounty 69.0%
NewHampshire 71.5%
DataSource:CentersforDiseaseControlandPrevention,BehavioralRiskFactorSurveillanceSystem,2005-2009(mostrecentavailable).AreaestimatesfromCommunityCommons;Differenceisnotstatisticallysignificant
b.PhysicalInactivity(Adults)
Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportleisuretimephysicalactivity,basedonthequestion:"Duringthepastmonth,otherthanyourregularjob,didyouparticipateinanyphysicalactivitiesorexercisessuchasrunning,calisthenics,golf,gardening,orwalkingforexercise?".Lackofphysicalactivitycanleadtosignificanthealthissuessuch
52 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
asobesityandpoorcardiovascularhealth.About1in5adultsintheregioncanbeconsideredphysicallyinactiveonaregularbasis–aratesimilartotherestofNewHampshire.
Area Physicallyinactiveinthepast30days,%ofadults
CNHHPServiceArea 22.7%
NewHampshire 20.8%
DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015.RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.
c.PneumoniaandInfluenzaVaccinations(Adults)
Thisindicatorreportsthepercentageofadultswhoself-reportthattheyhaveeverreceivedapneumoniavaccineorreceivedinfluenzavaccineinthepastyear.Inadditiontomeasuringthepopulationproportionreceivingpreventivevaccines,thisindicatorcanalsohighlightalackofaccesstopreventivecare,opportunitiesforhealtheducation,orotherbarrierspreventingutilizationofservices.
Area
Adultswhohavereceivedaflushotinpast12monthsandthosewhohaveeverreceivedapneumococcalvaccination
InfluenzaVaccination18yearsofageorolder
PneumococcalVaccination65yearofageorolder
CNHHPServiceArea 49.0% 80.8%
NewHampshire 43.7% 76.1%
DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015.RegionalratesarenotsignificantlydifferentthantheoverallNHratestatistically.
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 53
d.SubstanceMisuse
Substancemisuse,involvingalcohol,illicitdrugs,misuseofprescriptiondrugs,orcombinationsofallofthesebehaviors,isassociatedwithacomplexrangeofnegativeconsequencesforhealthandwellbeingofindividuals,familiesandcommunities.Inadditiontocontributingtobothacuteandchronicdiseaseandinjury,substancemisuseisassociatedwithdestructivesocialconditions,includingfamilydysfunction,lowerprosperity,domesticviolenceandcrime.
Excessivedrinking:Excessivealcoholuse,eitherintheformofheavydrinking(drinkingmorethantwodrinksperdayonaverageformenormorethanonedrinkperdayonaverageforwomen),orbingedrinking(drinking5ormoredrinksonanoccasionformenor4ormoredrinksonanoccasionforwomen),canleadtoincreasedriskofhealthproblemssuchasliverdiseaseorunintentionalinjuries.
AreaEngagedinBingeDrinkinginPast30days,PercentofAdults
Male Female Total
CNHHPServiceArea 18.5% 12.5% 14.7%
NewHampshire 21.7% 12.3% 16.8%DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015.RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.
AreaHeavyAlcoholUse,PercentofAdults
Male Female Total
CNHHPServiceArea NA NA 9.8%
GraftonCounty 6.0% 9.8% 7.9%
NewHampshire 6.0% 6.9% 6.5%DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2015.
RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.
54 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
Althoughunderagedrinkingisillegal,alcoholisthemostcommonlyusedandmisuseddrugamongyouth.Onaverage,underagedrinkersalsoconsumemoredrinksperdrinkingoccasionthanadultdrinkers.IntheCentralNHregion,therateofbingedrinkingamonghighschoolagedyouthissimilartotheoverallstaterate.
AreaEngagedinBingeDrinkinginPast30days,
PercentofHighSchoolYouthMale Female Total
CNHHPServiceArea 17.3% 16.0% 16.6%
NewHampshire 17.2% 16.1% 16.8%DataSource:NHYouthRiskBehaviorSurvey,2015
RegionalrateisnotsignificantlydifferentthantheoverallNHrate
Themisuseofprescriptiondrugs,particularlyprescriptionpainrelievers,posessignificantrisktoindividualhealthandcanbeacontributingfactorleadingtomisuseofotherdrugsandacauseofunintentionaloverdoseandmortality.About17%ofhighschoolyouthintheCentralNHregionreporthavingeverusedaprescriptiondrugthatwasnotprescribedtothem.
AreaEverusedprescriptiondrugs‘notprescribedtoyou’,
PercentofHighSchoolYouthMale Female Total
CNHHPServiceArea 16.3% 17.6% 16.9%
NewHampshire 14.0% 12.5% 13.4%DataSource:NHYouthRiskBehaviorSurvey,2015
RegionalrateisnotsignificantlydifferentthantheoverallNHrate
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 55
e.CigaretteSmoking
Tobaccouseisaprimarycontributortoleadingcausesofdeathsuchaslungcancer,respiratorydiseaseandcardiovasculardisease.Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportcurrentlysmokingcigarettessomedaysoreveryday.Nearly1in4adults(24%)inthecommunitiesoftheCentralNHPublicHealthRegionareestimatedtobecurrentsmokers.Theestimateofthepercentofadultsstatewidewhoarecurrentsmokersis17%.
Area PercentofAdultswhoareCurrentSmokers
CNHHPServiceArea 24.2%
NewHampshire 17.0%
DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically
f.TeenBirthRate
Teenpregnancyiscloselylinkedtoeconomicprosperity,educationalattainment,andoverallinfantandchildwell-being.TheteenbirthrateintheCentralNHPublicHealthregionissignificantlylowerthantherateinNewHampshireoverall.
Area Teen Birth Rate per 1,000 Women Age 15-19
CNHHPServiceArea 8.9*
New Hampshire 12.0
Datasource:NHDivisionofVitalRecordsAdministrationbirthcertificatedata;2011-2015.*RateisstatisticallydifferentandlowerthantheoverallNHrate
56 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
4. SelectedHealthOutcomes
Traditionalmeasuresofpopulationhealthstatusfocusonratesofillnessordisease(morbidity)anddeath(mortality)fromspecificcauses.Advancesinpublichealthandmedicinethroughthe20thCenturyhavereducedinfectiousdiseaseandcomplicationsofchildbirthasmajorcontributorstoorcausesofdeathanddisease.Chronicdiseases,suchasheartdisease,cancer,respiratorydiseaseanddiabetes,alongwithinjuryandviolence,arenowtheprimaryburdensonthehealthandwellbeingofindividuals,familiesandcommunities.Inadditiontoconsideringtheabsolutemagnitudeofspecificdiseaseburdensinapopulation,examinationofdisparitiesindiseaseratescanhelptoidentifyareasofneedandopportunitiesforintervention.
a.OverweightandObesity
Beingoverweightorobesecanindicateanunhealthylifestylethatputsindividualsatriskforavarietyofsignificanthealthissuesincludinghypertension,heartdiseaseanddiabetes.Theindicatorsbelowreportthepercentageofadultsaged18andolderwhoself-reportthattheyhaveaBodyMassIndex(BMI)greaterthan30.0(obese)orgreaterthan25.0(overweightorobese).ThechartonthenextpagedisplaysthetrendinGraftonCountysince2004towardincreasingprevalenceofobesityintheadultpopulation,althoughaplateauintheproportionofadultswhoareobeseappearstohavebeenachievedinmorerecentyears.
Area PercentObesePercentOverweightor
Obese
CNHHPServiceArea 19.8%* 55.2%
NewHampshire 27.0% 63.6%
DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015*RateisstatisticallydifferentandlowerthantheoverallNHrate
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 57
DataSource:CentersforDiseaseControlandPrevention,NationalDiabetesSurveillanceSystem
b.HeartDisease
HeartdiseaseisthesecondleadingcauseofdeathinNewHampshireandintheCentralNHRegionafterallformsofCancer.Heartdiseaseiscloselyrelatedtounhealthyweight,highbloodpressure,highcholesterol,andsubstanceabuseincludingtobaccouse.In2015,DiseasesoftheHeartwasthecauseof50deathsintheCentralNHPublicHealthRegion.
HeartDiseasePrevalence:Thisindicatorreportsthepercentageofadultsaged18andolderwhohaveeverbeentoldbyadoctorthattheyhavecoronaryheartdiseaseorangina.
Area PercentofAdultswithHeartDisease(self-reported)
CNHHPServiceArea 4.0%
NewHampshire 4.0%
DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2014-2015RateisnotstatisticallydifferentthantheoverallNHrate
20.5 21.4 22.2 22.7 22.9 23.725.3 26.5 26.3 24.9
0
5
10
15
20
25
30
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013Pe
rcen
tofA
dults;A
geAdjusted
Year
ProportionofAdultsWhoAreObeseGraftonCounty;2004- 2013
58 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
CholesterolScreening:Highlevelsoftotalcholesterolandlowdensitylipoprotein-cholesterol(LDL-C)andlowlevelsofhighdensitylipoprotein-cholesterol(HDL-C)areimportantriskfactorsforcoronaryheartdisease.Periodiccholesterolscreeningforadults,particularlythosewithotherriskfactors,isabeneficialprocedureforearlyidentificationofheartdiseasethatcanbetreatedwithpreventivetherapy.Thetablebelowdisplaystheproportionofadultswhoreportthattheyhavehadtheircholesterollevelscheckedatsomepointwithinthepast5years.
AreaPercentofadultswhohavehadtheir
cholesterollevelscheckedwithinthepast5years
CNHHPServiceArea 85.3%
NewHampshire 83.0%
DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2015.RateisnotstatisticallydifferentthantheoverallNHrate
HeartDiseaseandStrokeMortality:CoronaryHeartDisease,anarrowingofthesmallbloodvesselsthatsupplybloodandoxygentotheheart,isthelargestcomponentofheartdiseasemortality.TherateofdeathduetocoronaryheartdiseaseamongLakesRegionresidentswassignificantlyhigherthantheoverallrateforNewHampshireinthe2011to2015timeperiod.Cerebrovasculardisease(stroke),whichhappenswhenbloodflowtoapartofthebrainstops,isthefifthleadingcauseofdeathinNewHampshireandintheLakesRegion.
AreaCoronaryHeartDiseaseMortality(per100,000people,age-adjusted)
CerebrovascularDiseaseMortality(per100,000people,age-adjusted)
CNHHPServiceArea 90.9 27.9
NewHampshire 95.9 28.7
DataSource:NHDivisionofVitalRecordsdeathcertificatedata,2011-2015RatesarenotstatisticallydifferentthantheoverallNHrate
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 59
c.Diabetes
Diabetesisanincreasinglyprevalentchronichealthconditionthatputsindividualsatriskforfurtherhealthcomplications,butisalsoamenabletocontrolthroughdietandadequateclinicalcare.
DiabetesPrevalence:Thisindicatorreportsthepercentageofadultsaged20andolderwhohaveeverbeentoldbyadoctorthattheyhavediabetes.About8.0%ofCentralNHadultsand9.0%ofNewHampshireadultsoverallreporthavingbeentoldbyahealthprofessionalthattheyhavediabetes.
DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2014-2015.RegionalrateisnotstatisticallydifferentthantheoverallNHrate
DiabetesManagement:ThisindicatorreportsthepercentageofMedicarebeneficiarieswithdiabetesawhohavehadahemoglobinA1c(HbA1c)test,abloodtestwhichmeasuresbloodglucoselevels,administeredbyahealthcareprofessionalinthepastyear.RegularHbA1Ctestingisimportantfordiabetesmanagementandpreventionofdiabetes-relatedhealthcomplications.
DataSource:DartmouthAtlasofHealthCare,2014;accessedthroughCommunityCommonsRegionalrateisnotsignificantlydifferentthantheoverallNHrate
Area PercentofAdultswithDiabetes,ageadjusted
CNHHPServiceArea 7.7%
NewHampshire 8.6%
Area PercentofMedicareBeneficiarieswithDiabeteswithAnnualHemoglobinA1cTest
GraftonCounty 90.1%
NewHampshire 90.3%
60 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
Diabetes-relatedMortality:TherateofdeathduetoDiabetesMellitusamongLakesRegionresidentsissimilartotheoverallrateforNewHampshireandistheseventhleadingcauseofdeathintheregion.
DataSource:NHDHHSHospitalDischargeDataCollectionSystem,2014-2015RatesarenotsignificantlydifferentthanoverallNHrate
d.Cancer
CanceristheleadingcauseofdeathinNewHampshire.Althoughnotallcancerscanbeprevented,riskfactorsforsomecancerscanbereduced.Itisestimatedthatnearlytwo-thirdsofcancerdiagnosesanddeathsintheUScanbelinkedtobehaviors,includingtobaccouse,poornutrition,obesity,andlackofexercise.
CancerScreening:Thetableonthenextpagedisplaysscreeningratesforcolorectalcancer,breastcancerandcervicalcancer.TheUnitedStatesPreventiveServicesTaskForce(USPSTF)recommendsscreeningforcolorectalcancerusingfecaloccultbloodtesting,sigmoidoscopy,orcolonoscopy,inadults,beginningatage50yearsandcontinuinguntilage75years.Theproportionofadultsage50to75whoareincompliancewiththeUSPSTFrecommendations(self-report)inCNNHPregion(77.8%)issimilartotheoverallNHrate(74.9%).TheproportionofwomenwhoreportbeingincompliancewithbreastandcervicalcancerscreeningrecommendationsarealsosimilartotheoverallNHrate.
Area DeathsduetoDiabetesMellitus(per100,000people,ageadjusted)
CNHHPServiceArea 16.5
NewHampshire 18.1
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 61
CancerScreeningType CNHHPServiceArea NewHampshire
Percentofadultswhoareaged50+thatmetUSPSTFcolorectalcancerscreeningrecommendations*
77.9% 74.9%
Percentoffemalesaged50+whohavehadamammograminthepasttwoyears**
80.2 80.8%
Percentoffemalesaged18+whohavehadapaptestinthepast3years***
71.2% 78.6%
*DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2015.**DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2014.
***DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2012and2014.RegionalratesarenotstatisticallydifferentthantheoverallNHrate
CancerIncidenceandCancerMortality:Thetablebelowshowscancerincidenceratesbysitegroupforthecancertypesthataccountforthemajoritynewcancercases(incidence).
CancerIncidenceper100,000people,ageadjusted
CNHHPServiceArea NewHampshire
Overallcancerincidence(AllInvasiveCancers) 489.8 498.8
CancerIncidencebyType Breast(female) 136.9 141.8Prostate(male) 129.7 128.7
Lungandbronchus 59.8 67.7Colorectal 45.2 38.2Bladder 31.9 28.7
MelanomaofSkin 29.7 28.6DataSource:NHStateCancerRegistry,2010-2014
RatesarenotsignificantlydifferentthanoverallNHrate
62 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
CancerMortality:Thetablebelowshowstheoverallcancermortalityrateandforthecancertypesthataccountforthemajoritycancerdeaths.Theoverallcancermortalityrateandmortalityratefromspecificcancertypesaresimilartothestateoverall.Asdisplayedbythechartatthebottomofthepage,theoverallcancermortalityrateintheregionhasbeendecliningatalinearrateofabout-4%peryearsincetheyear2000.
CancerMortalityper100,000people,ageadjusted
CNHHPServiceArea NewHampshireOverallcancermortality(AllInvasiveCancers) 164.5 165.1
CancerMortalitybyType Lungandbronchus 41.1 45.8Breast(female) 15.5 19.6Prostate(male) 28.2 20.4
Colorectal 16.6 13.1Pancreas 10.8 11.1
DataSource:NHStateCancerRegistry,2011-2015RegionalratesarenotsignificantlydifferentthanoverallNHrate
259.4
228.8
181.7183.2
189.3
180.7191.7
160.8
188.6187.7
151.7
167.6166.1
185.2152.5
151.2
y=-4.4285x+220.53
0
50
100
150
200
250
300age-ad
justed
rateper100
,000
peo
ple
OverallCancerMortalityRateAllcancers;Allagesandgenders
2000-2015CentralNHPublicHealthRegion
|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 63
e.Asthma
Asthmaisachroniclungdiseasethatinflamesandnarrowstheairways.Asthmacausesrecurringperiodsofwheezing,chesttightness,shortnessofbreath,andcoughing.Asthmaisanincreasinglyprevalentconditionthatcanbeexacerbatedbypoorenvironmentalconditions.
AsthmaPrevalence:Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportthattheyhaveeverbeentoldbyadoctor,nurse,orotherhealthprofessionalthattheyhadasthma;alsodisplayedisthepercentageofchildrenwithcurrentasthmaasreportedbyaparentorguardian.Thereportedasthmarateintheregionforchildrenislowerthanthestateoverall,althoughtheobserveddifferenceisnotstatisticallysignificant.
AreaPercentofChildren(ages0to17)
withCurrentAsthma*PercentofAdults(18+)with
CurrentAsthma**
CNHHPServiceArea 3.8% 11.2%
NewHampshire 7.2% 10.1%*DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2015
**NHDHHS,BehavioralRiskFactorSurveillanceSystem,2014-2015RegionalratesarenotstatisticallydifferentthantheoverallNHrate
64 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
f.IntentionalandUnintentionalInjury:
Accidentsandinjuryarethethirdleadingcauseofdeathintheregionandinthestate.Ofparticularnoteinrecentyears,NewHampshirehasbeenamongthehardesthitstatesbytheepidemicofopioidmisuse,rankingsecondbehindWestVirginia,inthenumberofopioid-relateddeathspercapitaandhighestfordeathspercapitafromsyntheticopioidslikefentanyl.
DrugOverdoseMortality:Asdisplayedbythecharttotheright,theoveralloverdosemortalityrateintheregionislowerthanthestateoverall,althoughtheobserveddifferenceisnotstatisticallysignificant.
Area
AlldrugoverdosedeathsCentralNHPublicHealthRegion,2015
(prescription,illicit,other&unspecifieddrugs)Age-adjustedrateper100,000population
CNHHPServiceArea 24.7
NewHampshire 32.6
DataSource:NHDivisionofVitalRecordsdeathcertificatedata,2015RateisnotstatisticallydifferentthantheoverallNHrate
Suicide:Thisindicatorreportstherateofdeathduetointentionalself-harm(suicide)per100,000people.Suicideratescanbeanindicatorofaccesstomentalhealthcare.Duringtheperiod2011and2015,thesuiciderateintheCentralNHregionwassimilartotheoverallNHrateofsuicidedeaths.
Area SuicideDeathsper100,000people;anycauseormechanism
CNHHPServiceArea 12.9
NewHampshire 14.6
DataSource:NHDivisionofVitalRecordsdeathcertificatedata,2011-2015RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.
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g.PrematureMortality
Anoverallmeasureoftheburdenofpreventableinjuryanddiseaseisprematuremortality.Theindicatorbelowexpressesprematuremortalityasthetotalyearsofpotentiallifelostbeforeage75(YPLL-75).Everydeathoccurringbeforetheageof75contributestothetotalnumberofyearsofpotentiallifelost.Duringtheperiod2012to2014,940deathsinGraftonCountyoccurredbeforetheageof75andtheaverageannualtotalofYPLL-75was5,100yearsofpotentiallifelostper100,000population.
Area Yearsofpotentiallifelostbeforeage75per100,000population(age-adjusted)
GraftonCounty 5,100
NewHampshire 5,500
Datasource:NationalCenterforHealthStatistics,NationalVitalStatisticsSystemaccessedviaCountyHealthRankings,2012-2014.
RateisnotstatisticallydifferentthantheoverallNHrate
66 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment
5.ComparisonofSelectedCommunityHealthIndicatorsbetween2017and2014
Thetablebelowdisplayscomparisonsofestimatedratesforkeycommunityhealthstatusindicatorsbetweenthecurrentcommunityhealthassessment(2017)andthepreviousassessmentconductedin2014,aswellasthemostrecentstatewidestatisticforeachindicator.Thiscomparisonisprovidedforinformationalpurposesanditisimportanttonotethedifferencesbetweenthe2014and2017estimatesfortheregionandthestatecomparisonestimatearenotsignificantlydifferentata95%confidencelevelformostindicators.Ininstanceswheretherearestatisticallysignificantdifferencesbetweenrecentestimates,theindicatorsarehighlightedinboldfont.
Table10:ComparisonofSelectedCommunityHealthIndicatorsbetween2017and2014withNHStateComparison
CommunityHealthIndicator GeographicArea2014CommunityHealthAssessment
2017CommunityHealthAssessment
NHStateComparison
Accesstocare Percentageofadultpopulation(age18+)
withouthealthinsurancecoverageCNHHPServiceArea 13.5% 9.2% 6.4%
Donothavingapersonaldoctororhealthcareprovider,percentofadults
CNHHPServiceArea14.1% 19.4% 13.2%
Havenotvisitedadentistordentalclinicinthepast5years,percentofadults
CNHHPServiceArea14.3% 17.7% 11.4%
HealthPromotionandDiseasePrevention
Currentsmoking,percentofadults CNHHPServiceArea 21.2% 24.2% 17.0%
Physicallyinactiveinthepast30days,%ofadults
CNHHPServiceArea 21.0% 22.7% 19.0%
Bingedrinking,percentofadults CNHHPServiceArea 20.7% 16.6% 16.8%
TeenBirthRate,per1,000WomenAge15-19 CNHHPServiceArea 10.6 8.9 12.0
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CommunityHealthIndicator GeographicArea2014CommunityHealthAssessment
2017CommunityHealthAssessment
NHStateComparison
HealthOutcomes
Obese,percentofadults CNHHPServiceArea 25.1% 19.8% 27.0%
Evertoldhaddiabetes,percentofadults CNHHPServiceArea 9.2% 7.7% 8.6%
Currentasthma,percentofadults CNHHPServiceArea 18.3% 11.2% 10.1
CoronaryHeartDiseaseMortality,per100,000people,age-adjusted
CNHHPServiceArea 151.8 90.9 95.9
CancerIncidence,Allsites,per100,000people,age-adjusted
CNHHPServiceArea 509.6 489.8 498.8
CancerDeaths,AllSites,per100,000people,age-adjusted
CNHHPServiceArea 171.9 164.5 165.1
Yearsofpotentiallifelostbeforeage75per100,000population,age-adjusted
GraftonCounty 4,956 5,100 5,500