Community Health Needs Assessment

Introduction and Overview

Berwood Yost

Franklin & Marshall College

Overview

• Data Sources

• Selected Highlights of CHNA Findings– Overview of Findings

• Health Indicators

• Social Context

– Defining Community Need– Community Transformation

• Summary

Data Sources

• Demographic Change– The data in this section of the report comes from data available through the U.S. Census

Bureau.• Behavioral Risk Factor Survey Indicators

– Most of the data presented in this section of the summary is based on a behavioral risk factor survey of 809 adult residents of Adams County and 1,004 adult residents of York County. The survey interviewing took place from September 26 through November 9, 2011. The survey sample was designed to be representative of the adult, non-institutionalized population of the two counties.

– The trend data is based on the Commonwealth of Pennsylvania’s behavioral risk factor surveillance system (BRFSS) survey and includes data gathered by the state from 2001 to 2010.

• Vital Statistics– Vital Statistics data were provided by the Bureau of Health Statistics and Research,

Pennsylvania Department of Health, through its Epidemiological Query and Mapping System (Epi-QMS). The Department specifically disclaims responsibility for any analyses, interpretations, or conclusions. All tables were created by the Center for Opinion Research, January 2012.

• Prevention Quality Indicators– The Prevention Quality Indicators are defined by the Agency for Healthcare Research and

Quality. The data presented in this summary were compiled from Pennsylvania Health Care Cost Containment Council data by Center for Opinion Research staff with assistance from the planning department at WellSpan Health.

• York County compares favorably to state rates on access indicators. Most notably, York County has higher rates of health insurance coverage and the trend on that indicator has improved over the past ten years.

• Access indicators are strongly associated with poverty and age.

• Residents above 55 years of age are more likely to have health care coverage and a personal physician. They are less likely to have not received health care due to cost or to have experienced one or more economic hardships during the past year. Those older than 55 are also less likely to have dental insurance.

• Poor and low-income respondents are much less likely to have health care coverage or a personal physician than higher income respondents. Poor respondents are most likely to have skipped health care due to costs and to have experienced one or more economic hardships in the past year. Low-income respondents are least likely to have dental insurance.

% State Rate

Ten-year Trend

Access Indicators Has health care coverage 91% Lower Increasing Has a personal physician 88% Same Stable Has dental insurance 67% Economic hardships (one or more) 39% Did not receive health care in past year because of cost 12% Same Stable Source: Healthy York Healthy Adams Behavioral Risk Factor Survey, November 2011 York County Respondents Only

0

20

40

60

80

100

2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010

Pennsylvania Adams, Franklin, Fulton York

Adults 18 – 64 with No Health Insurance 2001 – 2010, Adams County, York County and Pennsylvania

• York County compares favorably to state rates on behavioral indicators. The trend in York County on these indicators is mostly stable. The most striking statistic is the large number of overweight and obese individuals and the concomitantly low rates of exercise and vegetable consumption.

• Behavioral indicators are most strongly associated with age.

• Participation in strength training tends to decline with age as does the likelihood of being a daily smoker or a binge drinker. Body Mass Index tends to increase with age. Only one in four residents over the age of 55 falls in the normal weight range.

% State Rate

Ten-year Trend

Behavioral Indicators Participated in physical activities or exercise in past month 80% Same Stable Body Mass Index Category (overweight and obese) 66% Same Stable Strength training in past month 40% Smoking behavior (regular smoker) 22% Same Stable Exercised 30 minutes on five days in past week 21% Binge drinking behavior 15% Same Stable Consumed three servings of vegetables daily 3% Source: Healthy York Healthy Adams Behavioral Risk Factor Survey, November 2011 York County Respondents Only

0

10

20

30

40

50

60

70

80

90

100

2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010

Pennsylvania Adams, Franklin, Fulton York

Overweight and Obese Adults 2001 – 2010, Adams County, York County and Pennsylvania

• York County compares favorably to state rates on most prevention-related behaviors or conditions except for higher rates of poor mental health days. The trend in York County on these indicators is mostly stable although the trend for poor mental health days is increasing.

• Health prevention behaviors and conditions are most strongly associated with age and poverty.

• Respondents over 55 are more likely to visit the doctor for routine check ups and to get health screenings. They are also more likely to have limited health literacy. They are less likely to have poor mental health days or money worries.

• Poor respondents are more likely to have poor mental health days and days with depressive symptoms. Poor and low-income respondents are more likely to have money concerns and low health literacy and are less likely to have visited the dentist in the past year.

% State Rate

Ten-year Trend

Prevention Behaviors Ever had a PAP test (females only) 94% Gets needed social and emotional support 92% Same Stable Has ever had blood cholesterol checked 82% Visited dentist in past year 76% Visited doctor for routine check up in past year 69% Same Stable One or more days with depressive symptoms in past two weeks 61% Colonoscopy or sigmoidoscopy in past five years for those over 50 54% PSA test in past two years, males 40 and over 52% Mammogram in past two years (females only) 50% At least one day mental health was not good in past month 45% Lower Increasing At least one day physical health was not good in past month 39% Same Stable Poor health limited participation in normal activities in past month 36% Same Increasing Stressed about paying rent or mortgage 27% Blood stool test in past two years for those over 50 23% Stressed about paying for food 18% Limited health literacy 17% Source: Healthy York Healthy Adams Behavioral Risk Factor Survey, November 2011 York County Respondents Only

0102030405060708090

100

2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010

Pennsylvania Adams, Franklin, Fulton York

Poor Mental Health Days 2003 – 2010, Adams County, York County and Pennsylvania

• York County compares favorably to state rates on the presence of specific health conditions. The trend in York County on these indicators is mostly stable. The most striking statistics here are the high prevalence of high cholesterol and high blood pressure. That one in five residents has a depressive disorder also seems striking.

• Health conditions are most strongly associated with age and poverty.

• Respondents over 55 are more likely to be diabetic and to have been diagnosed with circulatory conditions and associated high rates of high blood pressure and high cholesterol. Respondents over 55 are also more likely to have been diagnosed with respiratory conditions and cancer. Those over 55 are less likely to report an anxiety or depressive disorder.

• Poor and low-income respondents are more likely to have circulatory disorders. Poor respondents are more likely to have asthma and anxiety or depressive disorders.

• Women are more likely than men to have a depressive disorder. Blacks are most likely among the racial/ethnic groups to have high blood pressure and Hispanics are most likely to have asthma.

% State Rate

Ten-year Trend

Conditions Has high cholesterol 39% Has high blood pressure 34% Has a depressive disorder 20% Has an anxiety disorder 18% Has asthma 11% Same Stable Respondent is diabetic 9% Same Stable Told has heart disease, heart attack, or stroke 9% Same Stable Has ever had cancer 9% Has COPD, emphysema, or chronic bronchitis 8% Source: Healthy York Healthy Adams Behavioral Risk Factor Survey, November 2011 York County Respondents Only

0102030405060708090

100

2004-2006 2005-2007 2006-2008 2007-2009 2008-2010

Pennsylvania Adams, Franklin,Fulton York

Adults with Hearth Disease, Heart Attack or Stroke 2004 – 2010, Adams County, York County and Pennsylvania

0.0

50.0

100.0

150.0

200.0

250.0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Pennsylvania Adams York

Age-Adjusted Cancer Death Rate per 100,000 1990 – 2009, Adams County, York County and Pennsylvania

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Pennsylvania Adams York

Lyme Disease Incidence Rate per 100,000 2000 – 2009, Adams County, York County and Pennsylvania

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Pennsylvania Adams York

Early Prenatal Care Rate 1990 – 2009, Adams County, York County and Pennsylvania

Demographic Estimates, Comparisons and Trends

Performance

(%, rate or value) State Average Year 10-year Trend

Defining Need

332,958

322,969

293,342

263,037

219,752

203,104

199,775

149,831

129,854

129,854

129,854

119,865

113,206

109,876

103,217

89,899

79,910

73,251

66,592

66,592

59,932

0 100,000 200,000 300,000

Total number of adult residents

Does not consume at least three servings of vegetables daily

Workers who drive alone to work

Has not excercised 30 minutes on five days in past week

Overweight and obese

One or more days with depressive symptoms.

No strength training in past month

At least one day mental health was not good in the past month

Had one or more economic hardships in the past year

Has high cholesterol

At least one day physical health was not good in the past month

Poor health limited participation in normal activities in the past month

Has high blood pressure

Does not have dental insurance

Has not visited a doctor for a routine check up in the past year

Stressed about paying rent or mortgage

Has not visited a dentist in the past year

Regular smoker

Has not participated in physical activities or exercise in the past month.

Has a depressive disorder

Has an anxiety disorder

Estimated Number of York County Residents

Factors that Contribute to Mortality

Risk Factors for Chronic Disease

Poverty Race/Eth Gender Age York Adams Hanover

Has health care coverageHas a personal physicianDid not receive health care in past year because of costHas dental insuranceEconomic hardships

Participated in physical activities or exercise in past monthExercised 30 minutes on five days in past weekStrength training in past monthSmoking behaviorBody Mass Index CategoryBinge drinking behaviorConsumed three servings of vegetables daily

Respondent is diabeticTold has heart disease, heart attack, or strokeHas COPD, emphysema, or chronic bronchitisHas high cholesterolHas high blood pressureHas asthmaHas ever had cancerHas an anxiety disorderHas a depressive disorder

At least one day physical health was not good in past monthAt least one day mental health was not good in past monthPoor health limited participation in normal activities in past monthVisited doctor for routine check up in past yearHealth Literacy ScoreVisited dentist in past yearHas ever had blood cholesterol checkedMammogram in past two yearsEver had a PAP testPSA test in past two years, males 40 and overBlood stool test in past two years for those over 50Colonoscopy or sigmoidoscopy in past five years for those over 50Gets needed social and emotional supportDays with depressive symptomsStressed about paying rent or mortgageStressed about paying for food

No significant difference p. > .05Significantly different, weak association p. < .05, sresid < 3Significantly different, moderate association p. < .05, sresid > 3Significantly different, strong association p. < .05, sresid > 4

Behavioral Indicators

Conditions

Prevention Behaviors

Results of Significance Testing for Selected VariablesHYCC - HAC Community Health Assessment Survey

Demographic Groups Regional Comparisons

Access Indicators

Health Disparities

A Community Approach to Health

Source: Centers for Disease Control and Prevention. Community Health Assessment aNd Group Evaluation (CHANGE) Action Guide: Building a Foundation of Knowledge to Prioritize Community Needs . Atlanta: U.S. Department of Health and Human Services, 2010.

Summary

• Health access and the health system are local strengths as is the regional economy.

• Health behaviors are comparatively positive, but negative health behaviors affect a large number of county residents.

• Mental health problems are increasing.• Health disparities related to poverty and age pose a

significant challenge.• The county’s physical environment may contribute to

adverse health outcomes.• Community-level interventions are required to drive

better health outcomes.